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1.
Diabetes Research and Clinical Practice ; 186, 2022.
Article in English | EMBASE | ID: covidwho-1894928

ABSTRACT

Background: There were reports on lower rates of hospitalization for acute coronary syndrome during COVID-19 pandemic due to fear to attend to hospitals, resulting in delayed diagnosis and treatment. In addition to fragmented care, hospital capacity strain affects access to care continuity for patients with acute coronary syndrome. Aim: To examine the impact of multicomponent integrated care on hard clinical outcomes in patients with acute coronary syndrome. Method: A literature search was conducted on PubMed, EMBASE, Ovid and Cochrane library databases for randomized controlled trials published in English language between January 1980 and November 2020. Trials were eligible if there was intervention with multicomponent integrated care, defined as 2 or more quality improvement strategies targeting different domains (the healthcare system, health-care providers and patients), for 1 month or more among patients with acute coronary syndrome. The outcomes of interest were mortality, hospital re-admission and emergency department visits, stratified by all-cause and cardiovascular-related. We pooled the risk ratio (RR) with 95% confidence interval (CI) for the association between multicomponent integrated care and clinical outcomes using the Mantel-Haenszel test. Results: We identified a total of 74 eligible trials with 92,625 patients with acute coronary syndrome. The most common quality improvement strategies implemented were team change (83.8%), patient education (62.2%) and facilitated patient-provider relay (54.1%). In random-effect models, compared with usual care, multicomponent integrated care was associated with reduced risk for all-cause mortality (RR 0.84, 95% CI 0.78-0.90;p<0.001;I2=0%), cardiovascular mortality (RR 0.81, 95% CI 0.69-0.95;p=0.009;I2=0%), all-cause hospitalization (RR 0.88, 95% CI, 0.78-0.99;p=0.040;I2=58%) and cardiovascular-related hospitalization (RR 0.89, 95% CI 0.77-1.03;p=0.110;I2=79%). The associations of multicomponent integrated care with emergency department visits (RR 0.98, 95% CI 0.81-1.19;p=0.860;I2=66%) and unplanned outpatient visits (RR 1.03, 95% CI 0.90-1.18;p=0.650;I2=40%) were not statistically significant. Discussion: Multicomponent integrated care can improve patients’ outcomes after acute coronary syndrome. Patients with acute coronary syndrome need to understand their condition, adhere to treatment and perform self-management to prevent recurrence with worse prognosis. Our findings highlight that multicomponent integrated care can reduce risk for mortality and hospitalization in these high-risk patients.

2.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-333892

ABSTRACT

Background: Third COVID-19 vaccine doses are broadly recommended, but immunogenicity data remain limited, particularly in older adults. Methods: We measured circulating antibodies against the SARS-CoV-2 spike protein receptor-binding domain, ACE2 displacement, and virus neutralization against ancestral and Omicron (BA.1) strains from pre-vaccine up to one month following the third dose, in 151 adults aged 24-98 years who received COVID-19 mRNA vaccines. Results: Following two vaccine doses, humoral immunity was weaker, less functional and less durable in older adults, where a higher number of chronic health conditions was a key correlate of weaker responses and poorer durability. Third doses boosted antibody binding and function to higher levels than second-doses, and induced responses in older adults that were comparable in magnitude to those in younger adults. Humoral responses against Omicron were universally weaker than against the ancestral strain after both second and third doses;nevertheless, after three doses, anti-Omicron responses in older adults reached equivalence to those in younger adults. After three vaccine doses, the number of chronic health conditions, but not age per se, was the strongest consistent correlate of weaker humoral responses. Conclusion: Results underscore the immune benefits of third COVID-19 vaccine doses, particularly in older adults.

4.
Clinical and Experimental Ophthalmology ; 49(8):964-964, 2022.
Article in English | Web of Science | ID: covidwho-1548563
5.
Palliative Medicine ; 35(1 SUPPL):193, 2021.
Article in English | EMBASE | ID: covidwho-1477122

ABSTRACT

Poor communication skills can compromise patient care in palliative medicine. As accreditation bodies have only called for mandatory communication skills trainings (CSTs) in recent years, CSTs are new to most hospital departments. This systematic scoping review aims to gather data on existing CSTs to identify key factors in teaching and assessing communication skills in the palliative care setting so that effective evidence- based CSTs applicable to the post-COVID-19 era can be designed. Independent searches across 7 bibliographic databases were carried out. A 'split approach' comprising thematic analysis, directed content analysis and tabulated summaries of included articles was employed. 25,809 abstracts were identified, and 109 articles were included and analysed. Themes revealed include problems with existing CSTs;guiding principles for curriculum design;teaching methods;curriculum content;assessment methods and outcomes measured;integration of curriculum;and resources, facilitators and barriers to effective training. A major flaw in existing CSTs is the lack of curriculum structure, focus and standardisation. The planning and execution of a CST curriculum needs to be stepwise and competency based. Holistic assessment by faculty, simulated patients and peers on the learner's performance plays a key role in consolidating knowledge. The educational institute must clearly define the objectives of the programme, allocate sufficient administrative and financial resources, and ensure the wellbeing of its stakeholders. Beyond medical education, a spiral curriculum with longitudinal assessments will equip learners in palliative care with the necessary skills and confidence to face complex communication scenarios in our healthcare landscape. Good communication skills can improve patient satisfaction, treatment compliance, and reduce physician burnout and the frequency of malpractice claims. This strengthens the overall doctor-patient relationship in palliative care. (Table Presented) .

6.
2020 Ieee 12th International Conference on Humanoid, Nanotechnology, Information Technology, Communication and Control, Environment, and Management ; 2020.
Article in English | Web of Science | ID: covidwho-1361861

ABSTRACT

Open-source ventilators (OSVs) are considered as an immediate response for the shortages of ventilator equipment in hospitals due to the ongoing global pandemic caused by the Coronavirus disease 2019 (COVID-19). One of the designs explored for OSVs utilizes a bag-valve-mask as a source for mechanical ventilation. Despite its availability for use and being medically accepted, proper calibration must be observed in measuring ventilator scalars such as inspiratory pressure, inspiratory flow, and tidal volume to promote the safe use of the OSV and prevent OSV users to do more harm to the patient. This study discusses different calibration techniques to properly acquire ventilator scalar measurements using an integrated ventilator scalar measurement module. All in all, different calibration setups and bag-valve-mask-based mechanisms were tested and documented to determine an effective means to acquire accurate and precise ventilator scalar measurements.

7.
IEEE Int. Conf. Humanoid, Nanotechnol., Inf. Technol., Commun. Control, Environ., Manag., HNICEM ; 2020.
Article in English | Scopus | ID: covidwho-1220147

ABSTRACT

Automation is considered as the driving force of Fourth Industrial Revolution (Industry 4.0) to develop smart and automated devices for existing manufacturing processes. However, the global medical outbreak perpetrated by the Coronavirus Disease 2019 (COVID-19) challenged researchers to explore new concepts and innovate existing technologies whilst resolving the ongoing health crisis. Thus, the demand for utilizing the automation concept in biomedical devices is reasonably high. For this study, the researchers have successfully implemented an industrial-grade programmable logic controller that will control the mechanical ventilation process of a bag-valve-mask-based emergency ventilator. Various mechanisms were observed, and the results have been documented. © 2020 IEEE.

8.
IEEE Int. Conf. Humanoid, Nanotechnol., Inf. Technol., Commun. Control, Environ., Manag., HNICEM ; 2020.
Article in English | Scopus | ID: covidwho-1219038

ABSTRACT

In response to COVID-19 pandemic, universities and related institutions around the world came up with various mechanical ventilator designs to help cope with the expected shortages of ventilators as the pandemic rages. Many of these designs are based on automating the manual operation of the Bag Valve Mask (BVM), a ubiquitous resuscitator device used for emergency ventilation or resuscitation of patients with breathing problems. In this paper, the mechanical design and development process for a BVM-based emergency ventilator is discussed. In particular, the evolution of the design from a simple, low-cost device to a more sophisticated system acceptable to pulmonologists and related medical practitioners is documented. © 2020 IEEE.

9.
Rev Neurol (Paris) ; 177(3): 275-282, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1078105

ABSTRACT

BACKGROUND: Neurological disorders associated with SARS-CoV-2 infection represent a clinical challenge because they encompass a broad neurological spectrum and may occur before the diagnosis of COVID-19. METHODS: In this monocentric retrospective case series, medical records from patients with acute neurological disorders associated with SARS-CoV-2 infection from medicine departments of an academic center in Paris area were collected between March 15th and May 15th 2020. Diagnosis of SARS-CoV-2 was ascertained through specific RT-PCR in nasopharyngeal swabs or based on circulating serum IgG antibodies. RESULTS: Twenty-six patients diagnosed with SARS-CoV-2 infection presented with neurological disorders: encephalitis (N=8), encephalopathy (N=6), cerebrovascular events (ischemic strokes N=4 and vein thromboses N=2), other central nervous system (CNS) disorders (N=4), and Guillain-Barré syndrome (N=2). The diagnosis of SARS-CoV-2 was delayed on average 1.6 days after the onset of neurological disorder, especially in case of encephalitis 3.9 days, encephalopathy 1.0 day, and cerebrovascular event 2.7 days. CONCLUSIONS: Our study confirms that COVID-19 can yield a broad spectrum of neurological disorders. Because neurological presentations of COVID-19 often occur a few days before the diagnosis of SARS-COV-2 infection, clinicians should take preventive measures such as patient isolation and masks for any new admission to avoid nosocomial infections. Anti-SARS-CoV2 antibody detection in RT-PCR SARS CoV-2 negative suspected cases is useful to confirm a posteriori the diagnosis of atypical COVID-19 presentations.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/psychology , Female , Humans , Male , Middle Aged , Nervous System Diseases/virology , Paris/epidemiology , Retrospective Studies , SARS-CoV-2/physiology , Young Adult
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