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1.
Female Pelvic Medicine and Reconstructive Surgery ; 28(6):S144, 2022.
Article in English | EMBASE | ID: covidwho-2008696

ABSTRACT

Introduction: Elevated blood pressure (BP) is the leading modifiable risk factor for cardiovascular disease (CVD), the leading cause of death in women. Timely referral to primary care from subspecialty care occurs infrequently. BP Connect, a staff protocol for specialty clinics, almost doubled timely primary care follow-up for rheumatology patients with elevated BP (AOR 1.9, 1.4 - 2.5;from 29% to 42%). Objective: To evaluate the feasibility and impact of implementing BP Connect in urogynecology and gynecology clinics. Methods: In two academic urogynecology and gynecology clinics, the BP Connect intervention trained medical assistants and nurses to Check (re-measure) BPs above 140/90, Advise patients of links between BP and CVD, and Connect patients with confirmed high BP for timely primary care follow-up. Implementation included (1) tailored staff engagement focus groups;(2) staff education defining elevated BP (above 140/90) and CVD risk;(3) electronic health record (EHR) alerts prompting staff to re-measure elevated BPs and order timely (within 4 weeks) follow-up for confirmed high BP;(4) staff feedback (monthly audits);and (5) patient education and tools (brochure and BP log). Clinic staff were surveyed pre- and post-implementation about confidence and comfort with BP discussion and referral. Descriptive analyses compared rates of BP re-measurement, offers for and fulfillment of timely primary care follow-up in the 6 months before (08/2020-02/2021) and after (02/2021-08/2021) BP Connect implementation. Multivariable logistic regression, controlling for age, insurance, hypertension, and CVD, evaluated impacts on timely primary care follow-up. Results: BP was elevated in 676 pre-implementation and 708 post-implementation visits. Table 1 describes demographic and relevant medical history for these patient visits. The only statistically significant difference between the pre- and post-implementation visits was a higher proportion insured by Medicaid during pre-implementation (16% vs. 10%). The rate of BP re-measurement increased from 19% pre- to 75% post-implementation (p less than .0001). During postimplementation, among visits where patients had confirmed high BP, staff provided patient education in 83% and offered referral for primary care follow-up in 60% of instances. Overall, the rate of timely primary care follow-up for high BP increased from 28% before to 48% after implementation (p less than .0001) despite implementation during the COVID pandemic. BP Connect implementation resulted in a 12-fold increase in BP re-measurement among patients with high BP and a 2-fold increase in timely follow-up with primary care (Table 2). Staff confidence to do something about high BP increased from 27 to 67%;comfort discussing high BP with patients increased from 27 to 83%, and comfort coordinating referral to primary care for high BP increased from 9 to 42% (all p less than .05). Conclusions: BP Connect implementation was feasible in academic urogynecology and gynecology clinics and doubled the likelihood of patients with high BP having timely primary care follow-up without creating undue burden on subspecialty clinics. The impact of BP Connect in urogynecology and gynecology clinics on timely primary care follow-up was almost identical to that seen in the rheumatology clinics where the intervention was initially developed and tested. Future work will examine adaptation and expansion of BP Connect to other specialties and health systems (Table Presented).

2.
Soc Sci Med ; 311:115319, 2022.
Article in English | PMC | ID: covidwho-2008124

ABSTRACT

One of the most consistent and worrying features of the COVID-19 pandemic globally has been the disproportionate burden of the epidemic in the most deprived areas. Most of the literature so far though has focused on estimating the extent of these inequalities. There has been much less attention paid to exploring the main pathways underpinning them. In this study, we employ the syndemic pandemic theoretical framework and apply novel decomposition methods to investigate the proportion of the COVID-19 mortality gap by area-level deprivation in England during the first wave of the pandemic (January to July 2020) was accounted for by pre-existing inequalities in the compositional and contextual characteristics of place. We use a decomposition approach to explicitly quantify the independent contribution of four inequalities pathways (vulnerability, susceptibility, exposure and transmission) in explaining the more severe COVID-19 outcomes in the most deprived local authorities compared to the rest. We find that inequalities in transmission (73%) and in vulnerability (49%) factors explained the highest proportion of mortality by deprivation. Our results suggest that public health agencies need to develop short- and long-term strategies to alleviate these underlying inequalities in order to alleviate the more severe impacts on the most vulnerable communities.

3.
European Stroke Journal ; 7(1 SUPPL):572, 2022.
Article in English | EMBASE | ID: covidwho-1928145

ABSTRACT

Background and aims: Hyperglycaemia in acute ischaemic stroke (AIS) is common, reduces the efficacy of stroke thrombolysis and thrombectomy, with worse clinical outcomes. Insulin therapies are difficult to implement and maintain, and may cause symptomatic hypoglycaemia. An alternative treatment is Exenatide, a GLP-1 agonist that lowers blood glucose with a very low risk of hypoglycaemia. Methods: The Trial of Exenatide in Acute Ischaemic Stroke (TEXAIS) enrolled adult patients with AIS ≤9 hours of stroke onset to receive treatment with short-acting Exenatide (5μg bid subcutaneous injection) or Standard care for 5 days, or until hospital discharge (whichever sooner).Primary outcome: proportion of patients with ≥8 point improvement in NIHSS score (or NIHSS 0-1) at 7 days. Results: 350 patients randomised, median age 71 years (IQR 62, 79), and median NIHSS 4 (IQR 2, 8). Planned recruitment (n=528) stopped early due to Covid and time constraints. On Admission the median blood glucose was 6.7 (IQR 5.70, 8.50), and 42% patients had hyperglycaemia (>7.0 mmol/L). Primary outcome occurred in 97/171 (56.7%) in Standard care group vs 104/170 (61.2%) in Exenatide group [aOR: 1.22 (CI 0.79, 1.88) p=0.38]. Mean daily per-patient frequency of hyperglycaemia was significantly less in the Exenatide group (p=0.002). No episodes of hypoglycaemia reported over the treatment period. Nausea/vomiting occurred in 7/174 (4.0%) patients on Exenatide. Conclusions: In this Phase 2 trial Exenatide did not significantly reduce neurological disability at 7 days. Exenatide significantly reduced frequency of hyperglycaemic events, and was safe to use. These results warrant further investigation with larger Phase 3 trials.

4.
Journal of Urology ; 207(SUPPL 5):e655, 2022.
Article in English | EMBASE | ID: covidwho-1886522

ABSTRACT

INTRODUCTION AND OBJECTIVE: Inpatient consultations are sometimes initiated in order to establish care without any acute need for specialist services. This creates additional expense for the health system while potentially delaying patient care and/or discharge. Urinary retention is often straightforward, requiring only bladder rest and medical optimization prior to trial of void in the outpatient setting for resolution. We sought to evaluate whether or not a simple decision tree could assist medical hospitalists in appropriately selecting patients requiring inpatient urologic management from those who can be safely directed to outpatient care. METHODS: Consults for urinary retention were identified based on billing data from July 2019 through June 2021. Male and female retention guideline policies were implemented to assist primary teams in determining if a patient's retention could be managed via simple algorithm, or were deemed complex and requiring of inpatient urologic evaluation. Consults were considered complex if associated with gross hematuria with clots, recent pelvic trauma, neurologic deficits/injury, new or worsening hydronephrosis, or acute kidney injury. Patients were grouped into a pre-intervention 8-month period of July 2019 through February 2020, which was compared to a post intervention 10-month period of September 2020 through June 2021. March to August 2020 were excluded due to COVID-19 hospital volume changes. Chi square analysis was performed. RESULTS: A total of 163 retention consults were placed over the 18 study months. In the pre-intervention period, urology consultation was only truly required in 27/80 (33.8%). After implementation of the pathway, this significantly increased to 47/83 (56.6%, p=0.003). Furthermore while the percentage of monthly consults requiring inpatient consultation increased in the post-intervention period, the overall total number of consults decreased from 10.0/month to 8.3/ month. CONCLUSIONS: Implementation of this urinary retention pathway increased the number of relevant inpatient consults while decreasing the number of simple retention consults. The net effect was a decrease in overall consults. This simple pathway may have identified more complex patients while reducing overutilization of specialist care.

5.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-329443

ABSTRACT

The nose is the portal for SARS-CoV-2 infection, suggesting the nose as a target for topical antiviral therapies. Because detergents are virucidal, Johnson and Johnson's Baby Shampoo (J&J) was tested as a topical virucidal agent in SARS-CoV-2 infected subjects. Twice daily irrigation of J&J in hypertonic saline, hypertonic saline alone, or no intervention were compared (n = 24/group). Despite demonstrated safety and robust efficacy in in vitro virucidal assays, J&J irrigations had no impact on viral titers or symptom scores in treated subjects relative to controls. Similar findings were observed administering J&J to infected cultured human airway epithelia using protocols mimicking the clinical trial regimen. Additional studies of cultured human nasal epithelia demonstrated that lack of efficacy reflected pharmacokinetic failure, with the most virucidal J&J detergent components rapidly absorbed from nasal surfaces. This study emphasizes the need to assess the pharmacokinetic characteristics of virucidal agents on airway surfaces to guide clinical trials.

6.
Physiotherapy (United Kingdom) ; 114:e22, 2022.
Article in English | EMBASE | ID: covidwho-1706384

ABSTRACT

Keywords: Patient preferences, Virtual consultations, Musculoskeletal Purpose: Videoconferencing (VC) has been cited as being able to reduce the number of face-to-face (F2F) outpatient appointments over the next 10 years. VC has been shown to be acceptable, however, face to face care is still seen as the ‘gold standard’. The COVID-19 pandemic has highlighted the potential for VC. The subject of this paper continues our previous research into patient preferences for VC in an orthopaedic rehabilitation setting. It is assumed that a patient will choose the option that they prefer (as iy provides the most utility). A Discrete Choice Experiment (DCE) was designed to investigate the factors influencing preference for VC among patients attending orthopaedic rehabilitation. Qualitative interviews were conducted with a small sample of participants to support theorisation into why the identified factors were important. The purpose of this research was to identify factors that influence patient preferences for video consultations in an orthopaedic rehabilitation setting. To explain why these factors influence preference. Methods: Previous research from the CONNECT Project informed DCE development. The design of the DCE took into account best practice guidance (ISPOR good practice for conjoint analysis) during its development. An efficient fractional factorial design with 16 choice scenarios was created that identified all main effects and partial two-way interactions. To reduce the impact of cognitive fatigue the design was blocked into two ‘blocks’ of eight scenarios each. Three pilots were undertaken to refine the questionnaire, to ensure comprehension. Quantitative analysis uses a binary logit regression models. A small number of participants strongly in favour of F2F and VC were sampled for qualitative interview using content analysis to provide additional insight into the results. Results: Two hundred and nineteen and 61 participants completed the ‘Block 1’ and ‘Block 2’ questionnaire, respectively. The study was terminated early due to COVID-19;as paired questionnaires from ‘Block 1’ and ‘Block 2’ were required for analysis, only 61 questionnaires (122 patients) were used. Duration of appointment, time of day, patient qualifications, access to equipment, difficulty with activities, multiple health issues, travel costs significant predictors to preference, were significant predictors of preference. A simplified conceptual model has been developed to explain how these factors interact to inform preference;these include contextual, structural and relationship factors. Eight participants who strongly preferred F2F and five participants who strongly preferred VC were interviewed. These interviews provided underlying rationale for choices. Conclusion(s): We have successfully designed and conducted a discrete choice experiment that investigated the trade-offs between pathway factors for patients attending orthopaedic rehabilitation appointments. A conceptual model was designed to focus attention towards the factors that influences preferences. Impact: An understanding of factors, such as those identified from this study, will enable clinicians to identify patients who prefer virtual consultations. The model developed from this study can inform the development of future technologies, trials and qualitative work to further explore the mechanisms that influence preference. Funding acknowledgements: Anthony Gilbert is funded by a Health Education England (HEE) and National Institute for Health Research (NIHR), Clinical Doctoral Research Fellowship for this research project (ICA-CDRF-2017-03-025).

7.
Journal of Spinal Cord Medicine ; 44(SUPPL 1):S293-S294, 2021.
Article in English | EMBASE | ID: covidwho-1569420

ABSTRACT

Objectives: There are four constituents of well-being that people can be trained in: awareness, connection, insight, and purpose. Well-being is a skill. Research is shown that interventions to strengthen these components are linked with potentially health-promoting changes inside the brain. Emotional well-being is recognized as one of the six indicators by Spinal cord Injury Implementation and Evaluation Quality Care Consortium. Benefits of mindfulness include reduced stress, less anxiety, a great sense of calm and increased focus and attention. The objective of this program is to cultivate the practice of mindfulness meditation as a skill to address emotional well-being following a spinal cord injury. Methods: A mindfulness meditation program is offered for inpatient spinal cord injury (SCI)/disease at Providence Care Hospital in Kingston, Ontario. This program started in January 2019, however the program interrupted for a few months due to COVID 19 pandemic. This program is guided by three rehabilitation team members including spiritual care provider, social worker and behavioral technologist. The session is held once weekly for four consecutive weeks and each session lasts 60 minutes. The sessions are not dependent on each other. The goal of the program is to learn about mindfulness and stress tolerance skills and to begin developing a personal practice. The participants fill out a feedback questionnaire at the end of fourth session. Results: The feedback from patients was positive. Patients rated the program is helpful (8-10/10). The participants found the most helpful part of the program;being in the moment with yourself, connecting with people being present, connection, finding peace in your mind and take time to regenerate energy. Conclusion: In the rehabilitation setting a holistic approach is the key to success and emotional well-being is underestimated. The patient's health outcome can be maximized not only through physical activity but also through strengthening of their mind by practicing mindfulness. The notion that our mind and mental processes are influenced by the health of our bodies requires further exploration in the SCI population.

8.
Pharmacoepidemiology and Drug Safety ; 30:106-106, 2021.
Article in English | Web of Science | ID: covidwho-1381605
9.
Forests Trees and Livelihoods ; 2021.
Article in English | Scopus | ID: covidwho-1349719

ABSTRACT

Forming 16 percent of the global population and growing, the large numbers of youth particularly in the developing world presents both a challenge and an opportunity. Although better educated than their parents, young men and women are chronically unemployed or in vulnerable work positions. While the majority of young people live in rural areas, these issues have sometimes resulted in large scale migration from rural to urban areas. In forested areas, those who remain are often highly dependent on forests for goods and services for their livelihood. Community forestry has been shown to be an effective strategy for sustainable forest management and livelihoods. Unfortunately, youth have often been marginalized in benefiting from or participating in decision-making about community forests. This is frequently attributed to local, cultural, and traditional norms that give priority to older generations in decision-making. Given their stake in sustainable forest management in a post-pandemic world, as well as their large numbers, it is important to utilize new approaches to bring young men and women together with older generations to address challenges and foster opportunities. This will then capitalize on the knowledge, energy, enthusiasm, innovative ideas, leadership ability, technological literacy, and resilience that youth can contribute to community forest management and rural communities. © 2021 Taylor & Francis Group, LLC.

10.
Value in Health ; 24:S9-S10, 2021.
Article in English | Web of Science | ID: covidwho-1306146
11.
Value in Health ; 24:S9-S10, 2021.
Article in English | ScienceDirect | ID: covidwho-1253300
12.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-8848

ABSTRACT

The nose is the portal for SARS-CoV-2 infection, suggesting the nose as a target for topical antiviral therapies. Because detergents are virucidal, Johnson and Johnson's Baby Shampoo (J&J) was tested as a topical virucidal agent in SARS-CoV-2 infected subjects. Twice daily irrigation of J&J in hypertonic saline, hypertonic saline alone, or no intervention were compared (n = 24/group). Despite demonstrated safety and robust efficacy in in vitro virucidal assays, J&J irrigations had no impact on viral titers or symptom scores in treated subjects relative to controls. Similar findings were observed administering J&J to infected cultured human airway epithelia using protocols mimicking the clinical trial regimen. Additional studies of cultured human nasal epithelia demonstrated that lack of efficacy reflected pharmacokinetic failure, with the most virucidal J&J detergent components rapidly absorbed from nasal surfaces. This study emphasizes the need to assess the pharmacokinetic characteristics of virucidal agents on airway surfaces to guide clinical trials.

13.
Global Advances in Health and Medicine ; 10:22-23, 2021.
Article in English | EMBASE | ID: covidwho-1234511

ABSTRACT

Objective: Integrative medicine is a key framework for the treatment of chronic medical conditions, particularly chronic pain. In-person visits pose notable barriers for individuals with pain or limited mobility, particularly in rural or underserved areas. However, many barriers are pertinent to the expansion of telehealth use in integrative medicine settings, such as concerns about maintaining patient-clinician rapport in the delivery of holistic, relationship-based care. The COVID-19 pandemic served as impetus for an immediate and complete transition to telehealth services in this interdisciplinary outpatient integrative medicine clinic. This poster will present rich qualitative perspectives from multiple stakeholder levels on the experience of virtual visits to examine whether telehealth represents an acceptable, accessible, and high-quality option for providing integrative healthcare. Methods: Patients (N=180), providers (N=19), and administrative staff (N=7) in our outpatient integrative health clinic were surveyed about their experience of providing or receiving care via telehealth. Specifically, participants were asked to describe what telehealth visits were like in comparison to in-person visits. Free-text responses were analyzed for major and minor emergent themes. Results: Major themes identified from the data included acceptability, ease/convenience, comfort, interpersonal connection, technology difficulties, application of telehealth to group/movement classes, and equity/access. Overwhelmingly, participants described telehealth as an acceptable and adequate, at times equal or superior, alternative to in-person visits. Importantly, telehealth improved comfort for patients who could hold visits at home where they were most comfortable. Challenges were also welldescribed including technological issues and loss of interpersonal connection. Conclusion: Telehealth visits represent an acceptable, at times preferable, way to deliver care in an outpatient integrative medicine setting. Telehealth represents a particularly promising care modality for patients experiencing chronic pain or limited mobility, or those residing in rural and underserved communities. Detailed qualitative results provide rich perspective to inform future implementation and health policy regarding telehealth use.

14.
Global Advances in Health and Medicine ; 10:21-22, 2021.
Article in English | EMBASE | ID: covidwho-1234506

ABSTRACT

Objective: Interdisciplinary integrative medicine is key to treatment of chronic pain conditions. In-person visits can burden this population, particularly in rural and underserved areas with limited transportation options. Telehealth visits, were historically unsupported by payment models, delivery platforms, health and technological literacy, and clinician buy-in. The COVID-19 pandemic initiated a rapid transition to telehealth at our interdisciplinary outpatient integrative medicine center. This poster will describe the quantitative experience of telehealth integrative medicine services among stakeholders. Methods: Patients (n=472), clinicians (n=25), and staff (n=12) ranked telehealth vs in-person visits by survey with custom scale quality judgments and discrete choice after transitioning to telehealth and three months later. Results: Patient quality judgements significantly favored telehealth at baseline, B=.77 [0.29-1.25], SE=.25, t(712)= 3.15, p=.002, and increased in preference for telehealth at three months, B=.27 [-0.03-0.57], SE=.15, t(712)= 1.76, p=.079. Quality of technology, residing outside the county, and experiencing multiple disciplines predicted patient telehealth favorability. Clinicians did not favor one modality over the other, B=-1.00 [-1.56--0.44], SE=.29, t(799)=-3.48, p<.001. Patient discrete choice split at baseline and favored telehealth at three months. Overall, discrete choice favored telehealth at follow-up across clinicians and patients. Administrative staff's overall impression of telehealth was most favorable of all groups. Conclusion: Telehealth is a promising care modality for patients experiencing chronic pain. Far from a temporary preference, after three months, the majority of patients indicated they would choose telehealth visits over inperson visits, if they were equally safe. Policy that does not support telehealth for outpatient integrative medicine cannot do so under the name of patient preference, perceptions of quality, patient choice, or access.

15.
Open Forum Infectious Diseases ; 7(SUPPL 1):S593, 2020.
Article in English | EMBASE | ID: covidwho-1185945

ABSTRACT

Background. Convalescent plasma (CP) may be obtained from patients who have recovered from the novel coronavirus disease, COVID-19, caused by the virus SARS-CoV-2. Although not FDA approved, preliminary data suggests patients who receive convalescent plasma from recovered donors may have shortened recovery time and symptom reduction. The purpose of the study is to detail learner recruitment of convalescent plasma donation (CPD) for treating hospitalized COVID-19 patients. Methods. Prisma Health Midlands formed a multidisciplinary CP donation team, consisting of seven COVID-19-certified pharmacy learner volunteers, two pharmacists, and two providers. Primary eligibility criteria were SARS-CoV-2 polymerase chain reaction (PCR) positivity at least 28 days prior to donation and asymptomatic for a minimum of 14 days. Donors were excluded based on FDA guidelines for CPD, limiting ineligible contact. Team learners were trained on call techniques and subsequently contacted, educated, and requested candidates donate through this program. Willing donors were then linked to The Blood Connection to circulate CP back into the Prisma Health System, creating a self-sustaining and closed-loop donation cycle. Results. In total, 253 recovered adult patients with positive SARS-CoV-2 PCR test results were evaluated. 195 patients met baseline inclusion criteria for contact. This pre-screen reduced call and travel time for ineligible candidates. 108 patients were successfully reached. Of the 108, n=79 (73.14%) accepted referral to The Blood Connection, and n=29 (26.85%) were no longer candidates primarily due to patient communicated new exclusionary factors, such as active COVID-19 symptoms. The program allowed for rapid, internal access to CP for patients hospitalized with COVID-19 at Prisma Health Midlands. Conclusion. Interest and awareness in COVID-19 CPD was successfully increased upon direct communication from the team and was felt to represent a personnel intense but successful model for recruiting potential CP donors. This program educated and utilized learners during this pandemic to enhance Prisma Health's ability to obtain CP for hospitalized patients using a closed system.

16.
Journal of the Royal Anthropological Institute ; 2020.
Article in English | Scopus | ID: covidwho-991114

ABSTRACT

The Ebola outbreak in West Africa involved the introduction of new forms of social and physical separation that aimed to curtail the spread of the disease. People changed the ways they lived to avoid contact with those who might be sick. A suite of governmental instruments was introduced, ranging from by-laws and public health campaigns to the use of specialist treatment centres and military force. These events transformed social connections and affected possibilities for trust in intimate, governmental, and therapeutic relations. Drawing upon fieldwork in Sierra Leone, Liberia, and Guinea, this article explores these forms of separation and social distance ethnographically, with a focus on material objects, touch, and spaces of separation. In doing so, we contribute to discussions on the constitution of trust and distance within social relations, and the ways in which separation can enable certain kinds of closeness. Our analysis offers insights for those seeking to understand the impact of the ongoing COVID-19 pandemic on the ways that people relate to, and care for, others. © 2020 The Authors. Journal of the Royal Anthropological Institute published by John Wiley & Sons Ltd on behalf of Royal Anthropological Institute

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