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1.
Department of Veterans Affairs ; 11:11, 2021.
Article in English | MEDLINE | ID: covidwho-2102797

ABSTRACT

As both the largest integrated health system and largest provider of telehealth in the country, the Veterans Health Administration (VHA) has a particular interest in understanding how best to implement and utilize virtual care. VHA has long embraced virtual care as part of its mission to "serve all who have served" regardless of their socioeconomic and geographic circumstances. Having begun conducting "virtual care" in the 1960s when doctors first communicated with patient's via TV screens,1 VHA has since provided over 2.6 million episodes of care to more than 900,000 Veterans in 20192 and has distributed over 50,000 data- and video-enabled iPads for Veterans throughout the country.3 Virtual care within VHA includes services such as MyHealtheVet secure messaging, the Home Telehealth program that combines case management principles with remote monitoring to improve access and coordinate care, and the VA Video Connect (VVC) video platform for synchronous visits within both specialty and primary care.4 Increasing Veteran access to care via virtual care has been an integral part of VHA's strategy for improving chronic disease management for a population that is on average older and sicker than their civilian counterparts.5,6 Given the importance that virtual care has for Veteran care even beyond the COVID-19 pandemic, understanding the strengths and limitations associated with synchronous virtual care will be critical in shaping how VHA utilizes virtual care going forward.

2.
16th IFIP WG 11.12 International Symposium on Human Aspects of Information Security and Assurance, HAISA 2022 ; 658 IFIP:228-239, 2022.
Article in English | Scopus | ID: covidwho-1971580

ABSTRACT

The challenge of meeting security requirements (of a nation-state) and the privacy needs of citizens is perhaps a political goal, but it is enabled by technology. Attacks on citizens tend to move the balance towards security, whilst civil liberties groups often act as a counter to not over-correct security, so as to guarantee privacy. This paper explores Australian attitudes towards privacy and surveillance during the pandemic. We consider a fundamental question: Has the pandemic changed the perception of Australian citizens with regard to their fundamental right to privacy? We surveyed Australian attitudes to privacy in the light of the COVID-19 pandemic and report on some interesting results. © 2022, IFIP International Federation for Information Processing.

3.
Irish Medical Journal ; 114(10), 2021.
Article in English | Scopus | ID: covidwho-1710718

ABSTRACT

Aim COVID-19 presents challenges in ensuring gold standard patient care in hospital settings. This study aimed to assess the effectiveness of telephone consultations as a modality for delivery of orthopaedic outpatient clinics, as measured by levels of patient satisfaction. Methods N = 100 orthopaedic trauma patients who received a teleconsultation were retrospectively surveyed. The survey included specific questions related to patient satisfaction scored with a Likert scale, as well as free-form questions facilitating expansion of patient opinion. The responses were quantitatively and qualitatively assessed. Results In 98% (n=95) of cases respondents were either satisfied or very satisfied with telephone consultations irrespective of age group, condition or length of time since commencement of symptoms. Nearly half of all respondents (47%, n=45) would choose teleconsultation again. The provision of clear information and the convenience of teleconsultation were noted as drivers of satisfaction. Discussion Teleconsultation was associated with a high satisfaction rate and may prove an effective tool in delivering remote patient care particularly in less complex cases not requiring physical examination or updated imaging. Further work addressing patient beliefs and expectations regarding telemedicine will be beneficial. © 2021, Irish Medical Association. All rights reserved.

4.
Thrombosis Update ; : 100086, 2021.
Article in English | ScienceDirect | ID: covidwho-1510378

ABSTRACT

Since the beginning of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) virus pandemic, several highly effective and safe vaccines have been produced at remarkable speed. Following global implementation of vaccination programmes, cases of thrombosis with thrombocytopenia following administration of adenoviral vector-based vaccines started being reported. In this review we discuss the known pathogenesis and epidemiology of so-called vaccine induced thrombocytopenia and thrombosis (VITT). We consider the available guidelines, diagnostic laboratory tests and management options for these patients. Finally, we discuss important unanswered questions and areas for future research in this novel pathoclinical entity.

5.
Research and Practice in Thrombosis and Haemostasis ; 5(SUPPL 2), 2021.
Article in English | EMBASE | ID: covidwho-1509178

ABSTRACT

Background: While the use of vitamin K antagonists (VKAs) has markedly reduced since the introduction of direct oral anticoagulants (DOACs), they are still the anticoagulant of choice for certain patients. The COVID-19 pandemic has resulted in anticoagulation clinics having to adapt services to ensure that anticoagulation is safely monitored, while minimising viral transmission to patients and staff. Contingency planning for staff absences also needed to be considered. Aims: To review the success of the strategies adapted for outpatient management of VKAs during the Covid-19 pandemic. Methods: Patients attending the anticoagulation clinic were managed as per the algorithm in Figure 1. Performance of the clinic was monitored using time in therapeutic range (TTR) and extreme INR values <1.5 and >4.5 during this time period using DAWN® anticoagulation software. Results: 504 patients required INR monitoring during the pandemic (See Figure 2). A total of 8588 INR tests were carried out with an overall TTR of 74% and 6% of extreme INR values. The percentage time in range of the Covid-19 pathway patients was 39% (15/39) of which 17% (7/39) had extreme INR values. There were a total of 314 days of Covid-19 leave due to contact isolation and vulnerable staff in the department. Conclusions: Under normal circumstances, patients on VKAs require regular monitoring to ensure safe and efficacious anticoagulation. Covid-19 patients require more frequent monitoring when ill due to changes in their oral intake and commencement of interacting medications. The global Covid-19 pandemic has made regular monitoring of these patients more difficult due to the potential for spread of the virus between patients and staff. However, following a global review of the service, proper monitoring and patient care has been safely achieved by the careful triage of patients, the use of personal protective equipment and the use of virtual consultations.

7.
Occup Med (Lond) ; 71(6-7): 250-254, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1376325

ABSTRACT

BACKGROUND: The first COVID-19-positive patient was identified in Ireland on 29 February 2020 (Department of Health, Government of Ireland; https://www.gov.ie/en/pressrelease/2f75fd-statement-from-the-national-public-healthemergency-team-sat-29-feb/). Healthcare worker (HCW) quarantining became a core intervention for those identified as 'close contacts' to reduce onward transmission within the workplace to patients and colleagues. Whether a quarantining strategy could be justified at a time when there was an increased demand for the services of HCWs remained unknown. AIMS: To establish whether quarantining staff away from a healthcare setting during a pandemic is justified. METHODS: This retrospective study examined close contacts of COVID-19-positive index cases (both residents and HCWs) in a community hospital over a 4-week period from 1 to 28 April 2020. Close contacts were identified in accordance with national guidelines. Zones of the hospital were examined to determine the number of COVID-positive index cases and their close contacts. A cumulative result for the hospital was recorded. RESULTS: While outcomes varied over time, per zone and per HCW category, the overall conversion rate from close contact to an index case was 30%. CONCLUSIONS: This study vindicates the policy of quarantining close contact HCWs from their workplaces as they pose a significant threat to both their patients and fellow workers.


Subject(s)
COVID-19 , Quarantine , Delivery of Health Care , Health Personnel , Humans , Retrospective Studies , SARS-CoV-2
8.
Irish Journal of Medical Science ; 190(SUPPL 1):S14-S14, 2021.
Article in English | Web of Science | ID: covidwho-1063754
9.
IFIP Advances in Information and Communication Technology ; 593 IFIPAICT:3-15, 2020.
Article in English | Scopus | ID: covidwho-1001972

ABSTRACT

There has always been tension between security needs (as expressed by a nation-state) and privacy needs (as expressed by the citizens of said nation-state). Achieving this balance is perhaps one of the goals of statecraft. Terrorist attacks tend to shift the balance towards security, whilst proponents of civil liberties tend to want to move the balance in the other direction. We examine Australian attitudes to privacy in the light of the COVID-19 pandemic and consider whether the effect of the pandemic is likely to change Australian’s perception of their fundamental right to privacy, as determined by law, enabled by technology and shaped by human concerns. © 2020, IFIP International Federation for Information Processing.

10.
Irish Medical Journal ; 113(8):1-4, 2020.
Article in English | Scopus | ID: covidwho-824887

ABSTRACT

Aims There is increasing concern amongst clinicians of a possible increase in venous thromboembolism (VTE) events in patients with COVID-19. There remains limited data defining the incidence of VTE in this population and thus also a paucity of research examining the impact of targeted treatment in patients with thrombotic complications. Methods We examined the number of symptomatic VTE events amongst proven COVID-19 patients admitted to a tertiary level academic hospital, over a one-month period. Patient characteristics, admission and discharge inflammatory and coagulation markers were included in the analysis. Results Sixty-one patients were identified. Twelve patients (19.6%) admitted with COVID-19 were treated for a suspected PE. Of these patients, 3 patients were discharged on anticoagulation, 3 died and 6 remain inpatients at the end of the study period. Discussion COVID-19 patients are at increased risk of VTE. This risk may extend beyond the period of admission. Further research examining the role of extending the duration of thromboprophylaxis in COVID-19 patients beyond hospital discharge is warranted. © 2020, Irish Medical Association. All rights reserved.

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