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1.
Eur Arch Otorhinolaryngol ; 2022.
Article in English | PubMed | ID: covidwho-2027485

ABSTRACT

PURPOSE: To compare outcomes of telephone and face-to-face consultations for new otology referrals and discuss the wider use of telemedicine in otology. METHODS: Retrospective cohort study including new adult otology referrals to our unit, sampled consecutively between March 2021 and May 2021, seen in either a face-to-face or telephone clinic. Primary outcome measure was the proportion of patients with a definitive management outcome (discharged or added to waiting list for treatment) versus the proportion of patients requiring follow-up for further assessment or review. RESULTS: 150 new patients referred for a routine otology consultation (75 telephone, 75 face-to-face) were included. 53/75 patients (71%) undergoing a face-to-face consultation received a definitive outcome following initial review, versus 22/75 (29%) telephone patients (χ(2) < 0.001, OR 5.8). 52/75 (69%) telephone patients were followed up face-to-face for examination. The mean (SD) number of appointments required to reach a definitive outcome was 1.22 (0.58) and 1.75 (0.73) in the face-to-face and telephone cohorts, respectively (p < 0.001). CONCLUSIONS: Telephone clinics in otology have played an important role as part of the COVID19 response. However, they are currently limited by a lack of clinical examination and audiometry. Remote assessment pathways in otology that incorporate asynchronous review of recorded examinations alongside audiometry, either conventional or boothless, may mitigate this problem;however, further research is required.

2.
Frontiers in psychiatry Frontiers Research Foundation ; 13:964949, 2022.
Article in English | MEDLINE | ID: covidwho-2022916

ABSTRACT

Background: The world witnessed a highly contagious and deadly disease, COVID-19, toward the end of 2019. India is one of the worst affected countries. We aimed to assess anxiety and depression levels among adult tobacco users and people who recently quit tobacco during COVID-19 lockdown in India. Materials and methods: The study was conducted across two Indian cities, Delhi and Chennai (July-August, 2020) among adult tobacco users (n = 801). Telephonic interviews were conducted using validated mental health tools (Patient Health Questionnaire-PHQ-9 and Generalized Anxiety Disorder-GAD-7) to assess the anxiety and depression levels of the participants. Descriptive analysis and multiple logistic regression were used to study the prevalence and correlates of depression and anxiety. Results: We found that 20.6% of tobacco users had depression symptoms (3.9% moderate to severe);20.7% had anxiety symptoms (3.8% moderate to severe). Risk factors associated with depression and anxiety included food, housing, and financial insecurity. Conclusion: During COVID-19 lockdown, mental health of tobacco users (primarily women) was associated with food, housing and financial insecurity. The Indian Government rightly initiated several health, social and economic measures to shield the most vulnerable from COVID-19, including a ban on the sale of tobacco products. It is also necessary to prioritize universal health coverage, expanded social security net, tobacco cessation and mental health services to such vulnerable populations during pandemic situations.

3.
Frontiers in Medicine ; 9:924979, 2022.
Article in English | MEDLINE | ID: covidwho-2022768

ABSTRACT

Interpretation of medical images with a computer-aided diagnosis (CAD) system is arduous because of the complex structure of cancerous lesions in different imaging modalities, high degree of resemblance between inter-classes, presence of dissimilar characteristics in intra-classes, scarcity of medical data, and presence of artifacts and noises. In this study, these challenges are addressed by developing a shallow convolutional neural network (CNN) model with optimal configuration performing ablation study by altering layer structure and hyper-parameters and utilizing a suitable augmentation technique. Eight medical datasets with different modalities are investigated where the proposed model, named MNet-10, with low computational complexity is able to yield optimal performance across all datasets. The impact of photometric and geometric augmentation techniques on different datasets is also evaluated. We selected the mammogram dataset to proceed with the ablation study for being one of the most challenging imaging modalities. Before generating the model, the dataset is augmented using the two approaches. A base CNN model is constructed first and applied to both the augmented and non-augmented mammogram datasets where the highest accuracy is obtained with the photometric dataset. Therefore, the architecture and hyper-parameters of the model are determined by performing an ablation study on the base model using the mammogram photometric dataset. Afterward, the robustness of the network and the impact of different augmentation techniques are assessed by training the model with the rest of the seven datasets. We obtain a test accuracy of 97.34% on the mammogram, 98.43% on the skin cancer, 99.54% on the brain tumor magnetic resonance imaging (MRI), 97.29% on the COVID chest X-ray, 96.31% on the tympanic membrane, 99.82% on the chest computed tomography (CT) scan, and 98.75% on the breast cancer ultrasound datasets by photometric augmentation and 96.76% on the breast cancer microscopic biopsy dataset by geometric augmentation. Moreover, some elastic deformation augmentation methods are explored with the proposed model using all the datasets to evaluate their effectiveness. Finally, VGG16, InceptionV3, and ResNet50 were trained on the best-performing augmented datasets, and their performance consistency was compared with that of the MNet-10 model. The findings may aid future researchers in medical data analysis involving ablation studies and augmentation techniques.

4.
PLoS One ; 17(9):e0273919, 2022.
Article in English | PubMed | ID: covidwho-2021947

ABSTRACT

Physical activity is associated lower risk for a broad range of non-communicable diseases and early mortality, and even small changes in daily activity levels could have a profound effect on public health at the population level. The COVID-19 pandemic reshaped daily life for United States (US) adults resulting in reductions in physical activity early in the pandemic, but its longer-term effects on daily activities are unknown. To examine the longer-term impact of the pandemic on daily activity levels, we conducted a nationwide longitudinal study of 1,635 adults (20-75 years) in AmeriSpeak. Previous-day recalls of time-use, sedentary time, and physical activity were completed on randomly selected days in Fall 2019 (pre-pandemic) and Fall 2020. Overall, US adults reported less time in transportation (-0.47 hrs/d), more total discretionary time (0.40 hrs/d), but no changes in total sedentary time (0.10 hrs/d) or leisure-time physical activity (-0.06 hrs/d). Women reported significantly less total activity (-0.36 hrs/d) and participants with children < 13 yrs reported more sedentary time (0.60 to 0.82 hrs/d) and less moderate-to-vigorous intensity activity (-0.84 to -0.72 hrs/d). Adults without children reported no changes in sedentary time (0.02 hrs/d) or moderate-vigorous intensity activity (-0.06 hrs/d). Adults who started working from home reported no changes in physical activity, but they were among the most sedentary and least active population groups at both timepoints. Our findings describe the complex inter-play between competing behaviors as time-use demands have changed in response to the pandemic, particularly for adults with younger children. Many US adults are likely to continue working from home;therefore, implementation of evidence-based approaches to increase physical activity and reduce sedentary time in this growing population subgroup appears warranted.

5.
3rd International Conference on Intelligent Engineering and Management, ICIEM 2022 ; : 274-278, 2022.
Article in English | Scopus | ID: covidwho-2018839

ABSTRACT

Still in many countries COVID19 virus is changing its structure and creating damages in terms of economy and education. In India during the period of January 2022 third wave is on its high peak. Many colleges and schools are still forced to teach online. This paper describes how cyber security actionable or practical fundamental were taught by school or college teachers. Various cyber security tools are used to explain the actionable insight of the subject. Main Topics or concepts covered are MITM (Man In the Middle Attack) using ethercap tool in Kali Linux, spoofing methods like ARP (Address Resolution Protocol) spoofing and DNS (Domain Name System) spoofing, network intrusion detection using snort , finding information about packets using wireshark tool and other tools like nmap and netcat for finding the vulnerability. Even brief details were given about how to crack password using wireshark. © 2022 IEEE.

6.
Nursing Education Perspectives ; 43(5):328-330, 2022.
Article in English | Web of Science | ID: covidwho-2018183

ABSTRACT

Clinical experiences are critical for undergraduate nursing students to apply didactic learning experiences and meet the core competencies established for licensure. However, the coronavirus (COVID-19) pandemic severely limited access to clinical experiences for undergraduate nursing students. The VA Home Telehealth program provided unique clinical experiences for veteran undergraduate nursing students, increased the use of technology, and limited the adverse effects of the pandemic in a rural, vulnerable population. This collaboration was crucial in helping students progress with their nursing education during a time of crisis.

7.
British Journal of Anaesthesia ; 01:01, 2022.
Article in English | MEDLINE | ID: covidwho-2014950

ABSTRACT

The response to the COVID-19 pandemic and the approach to patient safety share three important concepts: the challenges of preventing rare events, use of rules, and tolerance for uncertainty. We discuss how each of these ideas can be utilised in perioperative safety to create a high-reliability system.

8.
Journal of Neurology Neurosurgery and Psychiatry ; 93(9), 2022.
Article in English | Web of Science | ID: covidwho-2005418
9.
JACCP Journal of the American College of Clinical Pharmacy ; 5(7):760, 2022.
Article in English | EMBASE | ID: covidwho-2003609

ABSTRACT

Introduction: The Food and Drug Administration authorized baricitinib and tocilizumab for emergency use for the treatment of suspected or confirmed COVID-19 in high-risk hospitalized patients. To balance the scarcity of drug with broad emergency use authorization criteria, our facility imposed more stringent criteria. While both drugs have been shown to reduce 28-day mortality in COVID-19, it is unclear if one drug has a place in therapy different from the other. Research Question or Hypothesis: Is there a significant difference in 28-day mortality between patients treated with baricitinib compared to tocilizumab? Study Design: Single-center, retrospective cohort Methods: The electronic medical record was queried for all consecutive patients who received either baricitinib or tocilizumab in a 6-month period. The primary outcome was 28-day mortality in COVID-19 patients who received either drug. Patients had to receive concomitant corticosteroids and supplemental oxygenation not more than 24 hours before therapy initiation. Secondary outcomes included in-hospital mortality, incidence of secondary bacterial infections (SBI), and other relevant comparisons. Fisher's Exact Test was used to compare categorical data;independent samples t-test and Wilcoxon Rank Sum were used to compare normally and non-normally distributed continuous data, respectively. Results: Fifty patients were included: 8 (16%) received baricitinib and 42 (84%) received tocilizumab. Baseline characteristics were similar between groups including APACHE-II score (21.02±16.54). 28-day mortality was higher for tocilizumab (50% vs. 12.5%, p=0.064) but did not reach significance. In-hospital mortality was significantly higher for tocilizumab (57.1% vs. 12.5%, p=0.049). There was no significant difference in the incidence of SBI or vasopressor requirements between the groups. Conclusion: Although tocilizumab resulted in significantly higher inhospital mortality, these patients could have been unable to take oral agents, like baricitinib, and have had further progression of COVID- 19. Until larger studies are conducted, the choice of one agent over another will likely be based on situation-specific factors.

11.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003344

ABSTRACT

Introduction: During the pediatric trials for Coronavirus disease 2019 (COVID-19) vaccine the patient population was limited, likely leading to an inappreciable amount of adverse events. As more of the healthy adolescent male population began receiving the COVID-19 vaccination, cases of myocarditis shortly after became more frequently seen. Case Description: A previously well 15-year-old obese male presented to a pediatric ER with 3 days of left arm pain and 1 day of acute left-sided chest pain three days after receiving his second Pfizer-BioNTech COVID-19 vaccine in his left anterior deltoid area. The patient felt unwell afterwards with myalgias, headache, numbness, tingling, emesis, and 1-day history of fever of 38.8°C. He denied feelings of dizziness, syncope, palpitations, change in pain with position or deep breaths. Motrin and Tums did not seem to provide any relief. He had no history of recent viral illness and no known COVID-19 exposure. Initial evaluation included a normal chest Xray and normal sinus rhythm on EKG. Laboratory work revealed elevated troponin-I at 3.18 ng/mL, elevated Total CK at 399 units/L, CK-MB at 19 ng/mL, and BNP <10 pg/mL. Cardiology was consulted and following a normal echocardiogram, the patient was sent for a stat cardiac MRI. The imaging revealed acute myopericarditis with a small pericardial effusion. Mild patchy delayed subepicardial enhancement was also noted in the mid cavity and basal posterolateral wall (suggestive of postinflammatory scarring related to localized myocarditis.) During this time, CK-MB and Troponin-I continued to trend upwards. The patient was then started on standard treatment with Ibuprofen 800 mg Q6H and pantoprazole for gastric protection. His CK-MB peaked at 174 and Troponin-I at 26 which both subsequently trended downwards and normalized prior to discharge. Discussion: Patients who present with chest pain require a broad differential to encompass other possible etiologies including Coxsackie virus, Echovirus, Mycoplasma, EBV, and even Syphilis. Infectious diseases also followed along with the patient throughout his hospital course. All work-up for other potential causes remained negative. 1 week after presentation, his cardiac markers returned to baseline normal values. Conclusion: The study included close to 3,000 adolescents with only 754 ranging in the 16-17 age group further emphasizing the limited power of the study. Myocarditis and pericarditis are known, however rare, side effect of vaccinations and is seen more commonly in males. As the time period between receiving the COVID-19 vaccination and presenting with cardiac symptoms is short it is crucial to provide rapid care and adequate treatment.

12.
Journal of General Internal Medicine ; 37:S196, 2022.
Article in English | EMBASE | ID: covidwho-1995598

ABSTRACT

BACKGROUND: Underuse of interpretation services for Limited English Proficiency (LEP) patients has been both widely reported in popularmedia and is increasingly documented in the literature. The COVID-19 pandemic has affected every aspect of healthcare and has directly impacted the use of interpreters with barriers such as strict visitation policies, limited patient interactions with healthcare workers, and withdrawal of in-person interpreters from the hospital setting. In this study we assess the use of interpreter services by healthcare professionals (HCPs) for LEP patients at an academic teaching hospital during the pandemic. METHODS: A combination of quantitative and qualitative data was obtained, and a total of 107 HCPs responded to the survey between August and October 2021. The majority of respondents were physicians (50.4%) and the largest specialties represented were Internal Medicine, Hospital Medicine, and medical subspecialties (36.4%). RESULTS: Study participants reported a preference for digital interpreters. Despite affirming the importance of interpretation services for LEP patients and endorsing the use of telephone and tablet digital methods, many HCPs cite hassle and time constraints as limiting factors for the use of interpreter services. HCPs reported wide variation in use of interpretation services based on type of encounter. Of HCPs who assessed themselves as non-fluent in Spanish, 71% reported patient encounters without interpretation services, with some reporting they “know enough Spanish to get through”. When asked to rank their likely use of interpretation services in different clinical settings, 88% stated they use interpretation in “Goals of Care Meetings”, 87%use them when “Consenting Patients”, and 80% use them for the initial encounters. However, only 47% and 51% stated that they used interpreters for follow-up encounters and consult visits, respectively. Only 25% reported using interpreters for other visits. CONCLUSIONS: The COVID-19 Pandemic has hastened a shift to digital platforms in many arenas, and healthcare interpretation services have been equally affected. However, despite hopes that digital or telephonic means of interpretation would improve interpretation use by HCPs, our study shows that HCPs continue to use these services at inadequate rates. Time constraints, hassle, and encounter type were common explanations for underuse before the pandemic and continue to be widely cited during COVID-19. The legal imperative to use adequate interpretation services at every encounter should be better communicated to HCPs, and health systems should work to decrease barriers to interpreter services use. If third party interpretation presents the same barriers to use, healthcare systems should consider a strategic change to increase the bilingual work force and certify language skills so that patients can receive language-concordant care more consistently.

13.
Journal of General Internal Medicine ; 37:S594, 2022.
Article in English | EMBASE | ID: covidwho-1995776

ABSTRACT

STATEMENT OF PROBLEM/QUESTION: Despite accounting for only 34% of the population in Austin, Latinx individuals made up 50% of those who tested positive for coronavirus, 54% of COVID-related hospitalizations, and 51% of COVID-related deaths between March and June 2020. Of hospitalized patients, 40% had never seen a primary care physician (PCP), had high rates of previously undiagnosed health conditions and significant health-related social needs (HRSNs). DESCRIPTION OF PROGRAM/INTERVENTION: We implemented an interdisciplinary pilot program at a local academic teaching hospital to improve community outcomes and address HRSNs. The intervention is led by a bilingual community health worker (CHW), and includes discharge follow-up with patients hospitalized with COVID-19. As the pandemic ebbed and flowed across multiple surges, we expanded the intervention to Latinx patients with other complex health conditions. The full sample was included in the analysis. MEASURES OF SUCCESS: This is a mixed-method evaluation, which includes quantitative patient data (n=96), as well as qualitative data from hospital-based, healthcare professionals (n=26) that collaborated with the CHW. Quantitative data includes patient demographics (age, gender, race, education & insurance), HRSNs, community referrals and primary care followup. Qualitative data was collected via focus groups with case managers, hospitalists, residents and palliative care team members. Focus groups were approximately 60 minutes long, and we used content analysis to identify themes. FINDINGS TO DATE: The majority of patients were hospitalized for COVID-19 (n= 67, 70%) while the rest were diagnosed with other acute conditions. Average length of stay (LOS) was 13.8 days and the median LOS was 8 days. Mean age was 50.6 years, 66% of patients were male and 79% spoke Spanish. Half of the patients had less than a high school education, while 20% had more than a high school education. One-third of patients were employed while the rest were either seeking employment (16%) or nonworking (50%). The majority of patients were either uninsured (42%) or had county-based health coverage for the uninsured (30%). The top HRSNs included food (47%), rental assistance (36%) and utility assistance (36%). Almost half of patients attended a follow up with a PCP. Initial qualitative themes fall into three categories: 1) the role of a CHW, 2) the benefits of a CHW in the hospital and 3) growth opportunities. KEY LESSONS FOR DISSEMINATION: This pilot program demonstrated the capacity for CHWs to raise the hospital scope of care, particularly within the context of COVID-19. CHWs are experts in assessing and addressing HRSNs and can provide complementary services to inpatient care teams. CHWs provide culturally appropriate, transitional care to patients with chronic illnesses, which directly addresses the socioeconomic barriers to receiving continuity of care. Additional and diverse funding mechanism are needed to expand the presence of CHWs in hospital settings and increase the capacity to serve more patients.

14.
Journal of General Internal Medicine ; 37:S593-S594, 2022.
Article in English | EMBASE | ID: covidwho-1995775

ABSTRACT

STATEMENT OF PROBLEM/QUESTION: The COVID-19 pandemic highlights the disproportionate burden of disease on communities made vulnerable by structural inequities. The pandemic has increased economic hardship, including housing instability, food insecurity and ability to pay bills. Hospitalization for COVID-19 is an opportunity to address unmet healthrelated social needs (HRSNs) and connect patients with community resources. DESCRIPTION OF PROGRAM/INTERVENTION: Community health workers (CHWs) play a critical role in response to public health crises. To address the inequitable burden of COVID-19 on Austin's Latinx population, we implemented a pilot program at an academic hospital where a CHW helps patients navigate care transitions and address unmet HRSNs. The care team referred patients with COVID-19 to the CHW, who met with patients to establish rapport, provide language-concordant communication between the care team and patient/family, deliver health promotion education, and assess HRSNs. MEASURES OF SUCCESS: This includes three typical cases describing key components of the CHW pilot program. CHWs connected patients and families to community resources and facilitated discharge planning and connection with primary care providers. The CHWs continued to follow patients for at least 45 days after discharge to assist with care coordination. We provide qualitative data from patients and healthcare professionals. FINDINGS TO DATE: Patient 1 is a 38-year-old day laborer with hypertension hospitalized with COVID-19 pneumonia. His family of four is undocumented and faced economic insecurity due to loss of work from the pandemic. The CHW assisted with utilities, bills, food and rent through coordination with local organizations to provide direct financial assistance to the family. Patient 2 is a 45-year-old woman with diabetes hospitalized with COVID-19 pneumonia. She is a mother of three children, two with disabilities. In addition to financial insecurity, she identified transportation as a primary HRSN. The CHW arranged financial resources to fix their car, which allowed the family to access school and clinic resources. Patient 3 is a 36-year-old man hospitalized with COVID-19 pneumonia. The CHW connected the family, including three children, with their school social worker, enabling access to financial support for utilities, food and clothes. The CHW arranged free food delivery to their home for four months. The CHW also secured county-based indigent care coverage for the patient, enabling hospital follow-up with a primary care provider. The patient's wife noted, because of the CHW, “We never felt alone” and now feel “capable of navigating a health system that we never felt we had access to.” KEY LESSONS FOR DISSEMINATION: CHWs, as patient advocates and skilled care navigators, build trust, establish longitudinal relationships with patients and address unmet HRSNs that can enable successful care transitions. CHWs can alleviate the disproportionate burden of COVID-19 on individuals with unmet HRSNs. Supporting the work of CHWs within hospital care teams can improve care transitions.

15.
Journal of General Internal Medicine ; 37:S199, 2022.
Article in English | EMBASE | ID: covidwho-1995774

ABSTRACT

BACKGROUND: COVID-19 has uniquely impacted the United States due to an under-resourced and over-burdened public health system. As the pandemic has ebbed and flowed across multiple surges, it has profoundly affected healthcare infrastructure. Multiple reports have noted a marked increase in burnout and compassion fatigue among healthcare professionals (HCPs) during COVID-19, which can adversely impact clinical care. However, the majority of studies have focused only on physicians or nurses in international settings;there is very little research on the experiences of HCPs in the U.S. This study explores the impact of a two-year pandemic on HCPs in terms of compassion, burnout and secondary trauma. METHODS: This is a mixed-method assessment of hospital HCPs (n=26) during COVID-19 including case managers, hospitalists, residents and palliative care team members. Quantitative data include HCP demographics (age, gender, race & education) as well as compassion, burnout and secondary trauma as measured by the Professional Quality of Life (ProQOL) Scale. Qualitative data was collected via 60-minute focus groups with HCPs, and content analysis was used to identify themes. RESULTS: Mean age was 35.2 years and 73% identified as female. The majority of HCPs identified as white (n=21) and 20% as Latinx, while one person identified as Black and four as Asian. About one-third of HCPs spoke Spanish. The majority were physicians (n=15, 58%), while three were social workers, three were registered nurses, one was an advanced practice nurse practitioner and one was a chaplain. HCPs had worked in healthcare for amean of 6.8 years (median=3) with a max of 38 years. Compassion, burnout and secondary trauma survey scores fell within the average range across HCPs. However, qualitative interviews identified burnout as a major theme amongst HCPs. Multiple factors associated with burnout were identified, including the unpredictability of COVID-19, high death rates, understaffing, unfilled positions, long working hours, social isolation and the politicization of COVID-19. CONCLUSIONS: Traditional compassion, fatigue and burnout surveys such as the ProQOL may not fully capture the complexities of how COVID-19 has affected healthcare professionals. Our qualitative data provides rich descriptions of compassion fatigue and burnout that were not captured by the survey data. Due to the unpredictable nature of the pandemic, as well as the large swings in hospitalization numbers, it is possible that the survey data did not reflect the level of burnout or compassion fatigue since data was collected at the end of the delta surge. It is also possible that HCPs most affected by secondary trauma or burnout have left the healthcare field, as supported by current literature. Larger scale assessments of healthcare professionals in the U.S. are warranted to further understand the impact of the COVID-19 pandemic on healthcare professionals, organizational factors leading to compassion fatigue or burnout, and potential policy solutions.

16.
International Journal of Current Pharmaceutical Research ; 14(4):95-96, 2022.
Article in English | EMBASE | ID: covidwho-1969957

ABSTRACT

Objective: To study SARS-CoV-2 viral load in maternal and neonatal bodily fluids, Passage of anti-SARS-CoV-2 antibody through placenta and breastmilk, and incidence of fetoplacental infection. Methods: The data were gathered from five databases and included a review of research articles published between 2020 and 2021. PubMed Google Scholar The following terms were used in the search: 1. Clinical symptoms of the mother, 2. The ratio of negative to positive RT-PCR test results in infants, 3. Ratios of normal to aberrant IgG and IgM, 4. Antibody Placental Transfer, 5. Time period for maternal immunization to produce effective antibodies, 6. Neonatal Immune Response, 7. Antibodies are transferred through breast milk after moms have been immunised. Results: Several prospective and retrospective studies conducted in Wuhan, Philadelphia, Florida and Massachusetts consisted of seropositive as well as seronegative pregnant women. SARS-CoV-2 antibodies were detected in the sera of the mother and correlated with the antibodies detected in the neonatal blood. Significant transfer of IgG SARS-CoV-2 antibodies through placenta and breast milk was observed;that is, positive correlation was found between SARS-CoV-2 IgG concentrations in cord and maternal sera (= 0.886;< .001). Not only passively, but mothers infected during the peripartum period protect the newborn by actively stimulating and training the neonate system via breastmilk immune complexes. Conclusion: We here highlight novel insights arising from recent research endeavours on the transmission of SARS-CoV-2 antibodies from a mother to an infant.

17.
BMJ Leader ; 5:A28, 2021.
Article in English | EMBASE | ID: covidwho-1968367

ABSTRACT

Aim NICE COVID-19 guidelines NG191 recognise that frailer patients, including those with a higher Rockwood Clinical Frailty Scale1 (CFS), are seldom improved by hospital admission. The project used a collaborative approach to undertake frailty reviews, aiming to reduce inappropriate hospital admissions. The reviews included discussing residents' preferred place of care and options in the event of deterioration, a Treatment Escalation Plan (TEP). Method A collaborative was formed between care home managers, pharmacists and geriatricians to review frailty factors in residents over 65 years, excluding those with Learning Disabilities. Care homes with high risk of COVID-19 were prioritised. A Standard Operational Procedure was approved within one month. Using existing resources only, the project was delivered over 3 months. Communication was sent to GP practices, care homes and residents/families and consent was obtained. Templates were developed and education delivered. Results Review outcomes were recorded electronically onto the GP clinical system. Care homes kept a copy and informed residents/ families of the outcome. 595 residents were reviewed in 21 care homes. Preliminary analysis for 71 residents reviewed May 2020 to April 2021 show: • 42 survivors, 33 with severe frailty (CFS 7-9), 9 not severely frail (CFS<7). Out of total 28 residents with TEP indicating avoidance of hospital admission, 23 were not admitted and 5 had single hospital admission. 14 residents TEP included hospital management of whom 7 were admitted. • 26 of the 29 deceased residents were severely frail. 96% died in their preferred place of death. Conclusion Clinical leadership demonstrated courage and capacity to challenge the status quo, improve organisational processes and innovate practice. This helped staff morale at a difficult time of immense pressure and positively enhanced care homes' profile and residents' experience.

18.
JOURNAL OF GENERAL INTERNAL MEDICINE ; 37(SUPPL 2):199-199, 2022.
Article in English | Web of Science | ID: covidwho-1935278
20.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927721

ABSTRACT

Introduction: First synthesized in 1869, Hydroxyurea is known for its efficacy in treating myeloproliferative disorders, cervical cancer, and sickle cell disease. Usually well-tolerated, Hydroxyurea has numerous documented adverse effects, including bone marrow suppression, fevers, gastrointestinal upset, anorexia, and maculopapular rash. In addition, one rare side effect is interstitial pneumonitis, a potentially devastating complication if overlooked. We present one such case of Hydroxyurea-induced interstitial pneumonitis. Case Description: A 65-year-old man with a six-month diagnosis of Chronic Granulocytic Leukemia (CGL) on Hydroxyurea developed acute hypoxemic respiratory failure saturating 80% on room air with HR 102, RR 24, and increasing oxygen requirements (10 Lpm) after being admitted with complaints of worsening dyspnea, fatigue, and productive cough with yellow/green sputum. Physical examination was notable for cachexia, ill appearance, generalized weakness, hoarse voice, tachycardia, tachypnea, diffusely diminished breath sounds, and scattered rales on auscultation of lung fields. Initial imaging was notable for bilateral airspace disease and pulmonary opacities on chest radiography and bilateral pneumonia (concerning for COVID-19 pneumonia), mediastinal adenopathy, and splenomegaly on chest computed tomography. Initial laboratory results were notable for leukocytosis 62.5 th/uL, lactic acidosis 2.5 mmol/L, procalcitonin level 4.95 ng/mL, and negative COVID-19 PCR test. Prompt initiation of Vancomycin/Cefepime therapy ensued upon collection of blood cultures in light of possible sepsis. Flagyl, Valacyclovir, and Posaconazole were added to antimicrobial coverage, along with steroid therapy, due to minimal clinical improvement. Tachycardia with significant oxygen requirements alternating between BiPAP and heated high flow nasal cannula with FiO2 ranging from 70-85% persisted. Daily imaging also showed worsening airspace disease. Negative viral, bacterial, and fungal cultures led to subsequent discontinuation of Hydroxyurea therapy due to suspicion of medicationinduced pneumonitis. Three days after cessation of Hydroxyurea, the patient's oxygen requirements began to decrease and imaging revealed interval resolution of pneumonitic changes in the absence of antimicrobial therapy. The patient was later transitioned to Ruxolitinib for his underlying CGL prior to his discharge home without the need for home oxygen therapy. Discussion: Thought to be caused by hypersensitivity pneumonitis, pulmonary toxicity from Hydroxyurea can easily be misdiagnosed. Unfortunately, while much is known about the pancytopenic, gastrointestinal, and cutaneous side effects of Hydroxyurea, few cases in the literature highlight the potentially fatal interstitial pneumopathy caused by Hydroxyurea, first reported in 1999. Thus, this case serves as an additional contribution to the minutiae of literature detailing Hydroxyurea's adverse pulmonary side effect profile. (Figure Presented).

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