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1.
Am J Gastroenterol ; 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1780299

ABSTRACT

ABSTRACT: Telemedicine generally refers to the use of technology to communicate with patients and provide healthcare from a distance. Advances in technology, specifically computers, cellphones, and other mobile devices, have facilitated healthcare providers' growing ability to virtually monitor and mentor patients. There has been a progressive expansion in the use of telemedicine in the field of gastroenterology, which has been accelerated by the COVID-19 pandemic. In this review, we discuss telemedicine - its history, various forms, and limitations - and its current applications in gastroenterology. Specifically, we focus on telemedicine in gastroenterology practice in general as well as specific applications, including the management of inflammatory bowel disease, celiac disease, and colorectal cancer surveillance and its use as an aid in endoscopic procedures.

2.
BMJ Open ; 12(1): e052495, 2022 01 07.
Article in English | MEDLINE | ID: covidwho-1613003

ABSTRACT

OBJECTIVES: To examine the prevalence of mental health symptoms during the first surge of COVID-19 in the USA, and their associations with COVID-19-related emotional distress, health self-management and healthcare utilisation. DESIGN: Cross-sectional analysis of wave 3 (1-22 May 2020) survey data from the ongoing Chicago COVID-19 Comorbidities (C3) study. SETTING: Seven academic and community health centres in Chicago, Illinois. PARTICIPANTS: 565 adults aged 23-88 with one or more chronic conditions completing at least one prior C3 study wave. PRIMARY AND SECONDARY OUTCOME MEASURES: Clinically relevant anxiety and depressive symptoms as measured using Patient-Reported Outcomes Measurement Information System short forms. Self-reported emotional and health-related responses to COVID-19 were measured through a combination of single-item questions and validated measures. RESULTS: Rates of anxiety and depressive symptoms were 14% (81/563) and 15% (84/563), respectively. Anxiety and depressive symptoms were then each separately associated with greater worry about contracting COVID-19 (relative risk (RR) 2.32, 95% CI 1.52 to 3.53; RR 1.67, 95% CI 1.10 to 2.54), greater stress (RR 4.93, 95% CI 3.20 to 7.59; RR 3.01, 95% CI 1.96 to 4.61) and loneliness (RR 3.82, 95% CI 2.21 to 6.60; RR 5.37, 95% CI 3.21 to 8.98), greater avoidance of the doctor (RR 1.62, 95% CI 1.06 to 2.49; RR 1.54, 95% CI 1.00 to 2.36) and difficulty managing health (least square means (LS Means) 6.09, 95% CI 5.25 to 6.92 vs 4.23, 95% CI 3.70 to 4.75; LS Means 5.85, 95% CI 5.04 to 6.65 vs 4.22, 95% CI 3.70 to 4.75) and medications (LS Means 3.71, 95% CI 2.98 to 4.43 vs 2.47, 95% CI 2.02 to 2.92) due to the pandemic. CONCLUSIONS: Identifying and addressing mental health concerns may be an important factor to consider in COVID-19 prevention and management among high-risk medical populations.


Subject(s)
COVID-19 , Self-Management , Adult , Anxiety/epidemiology , Chicago/epidemiology , Chronic Disease , Cross-Sectional Studies , Depression/epidemiology , Humans , Pandemics , Prevalence , SARS-CoV-2
3.
Hepatol Commun ; 6(5): 1236-1247, 2022 May.
Article in English | MEDLINE | ID: covidwho-1597604

ABSTRACT

The corona virus disease 2019 (COVID-19) pandemic has had a wide-ranging impact on the clinical practice of medicine and emotional well-being of providers. Our aim was to determine the impact of the COVID-19 pandemic on practice and burnout among hepatology providers. From February to March 2021, we conducted an electronic survey of American Association for the Study of Liver Diseases (AASLD) members who were hepatologists, gastroenterologists, and advanced practice providers (APPs). The survey included 26 questions on clinical practice and emotional well-being derived from validated instruments. A total of 230 eligible members completed the survey as follows: 107 (47%) were adult transplant hepatologists, 43 (19%) were adult general hepatologists, 14 (6%) were adult gastroenterologists, 11 (5%) were pediatric hepatologists, 45 (19%) were APPs, and 9 (4%) were other providers. We found that 69 (30%) experienced a reduction in compensation, 92 (40%) experienced a reduction in staff, and 9 (4%) closed their practice; 100 (43%) respondents reported experiencing burnout. In univariate analysis, burnout was more frequently reported in those ≤55 years old (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.2-4.2), women (OR, 2.2; 95% CI, 1.3-3.7), nontransplant hepatology (OR, 2.0; 95% CI, 1.1-3.3), APPs (OR, 2.7; 95% CI, 1.4-5.1), and those less than 10 years in practice (OR, 1.9; 95% CI, 1.1-3.3). In multivariable analysis, only age ≤55 years was associated with burnout (OR, 2.3; 95% CI, 1.1-4.8). The most common ways the respondents suggested the AASLD could help was through virtual platforms for networking, mentoring, and coping with the changes in practice due to the COVID-19 pandemic. Conclusion: The COVID-19 pandemic has had a substantial impact on the clinical practice of hepatology as well as burnout and emotional well-being. Women, APPs, and early and mid-career clinicians more frequently reported burnout. Identified strategies to cope with burnout include virtual platforms to facilitate networking and mentoring.


Subject(s)
Burnout, Professional , COVID-19 , Gastroenterology , Adult , Burnout, Professional/epidemiology , Burnout, Psychological , COVID-19/epidemiology , Child , Female , Humans , Middle Aged , Pandemics , United States/epidemiology
4.
Transplant Infectious Disease ; n/a(n/a), 2021.
Article in English | Wiley | ID: covidwho-1411012

ABSTRACT

Abstract Background Solid organ transplant recipients (SOTRs) are at increased risk for adverse outcomes with COVID-19. Early data shows a lower SARS-CoV-2 spike antibody immune response among SOTRs leading to patient concerns about vaccine efficacy. Public health messaging has largely left out immunocompromised individuals leading to a higher risk of vaccine misinformation. The American Society of Transplantation recommends COVID-19 vaccination for all SOTRs, however, patient concerns and beliefs about vaccination are largely unknown. Methods We conducted a transplant-center-based, pragmatic pilot trial to encourage COVID-19 vaccination among 103 unvaccinated SOTRs. We assessed vaccine concerns, barriers to vaccination, answered questions about efficacy, side effects, and clinical recommendations. Results A total of 24% (n = 25) of SOTRs reported that they will schedule COVID-19 vaccination after the study call, 46% reported that they will consider vaccination in the future, and 30% said they will not consider vaccination. Older age and White race were associated with lower willingness to schedule the vaccine, whereas Black race and longer time from transplant were associated with higher willingness. Common vaccine concerns included lack of long-term data, inconsistent messaging from providers, scheduling inconvenience, and insufficient resources. Follow-up approximately one month after the initial outreach found 52% (n = 13) of liver transplant recipients (LTRs) and 10% (n = 3) of kidney transplant recipients (KTRs) subsequently received COVID-19 vaccines for a vaccination rate of 29% among respondents. Conclusion Transplant center-based vaccine outreach efforts can decrease misinformation and increase vaccination uptake;however, vaccine-related mistrust remains high. This article is protected by copyright. All rights reserved

6.
Am J Gastroenterol ; 116(6): 1345-1349, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1194822

ABSTRACT

INTRODUCTION: To assess beliefs about safety, effectiveness, and delivery of the coronavirus disease 2019 (COVID-19) vaccine among chronic Gastroenterology and Hepatology patients at an academic health system. METHODS: We asked about vaccine beliefs, vaccine concerns, and preferred location to receive the COVID-19 vaccine. RESULTS: A total of 1,215 patients responded (response rate: 37%). Most patients believed that vaccines are safe, effective, and that they would take the COVID-19 vaccine at a medical office or pharmacy. However, we identified important sociodemographic factors associated with vaccine hesitancy. DISCUSSION: Patients have high level of trust in the COVID-19 vaccine and are likely to follow their specialist physician recommendations.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Health Knowledge, Attitudes, Practice , Vaccination/psychology , Adult , Aged , COVID-19/epidemiology , COVID-19/immunology , COVID-19/virology , COVID-19 Vaccines/adverse effects , Chronic Disease , Female , Gastroenterology/statistics & numerical data , Humans , Male , Middle Aged , SARS-CoV-2/immunology , Socioeconomic Factors , Surveys and Questionnaires/statistics & numerical data , Vaccination/adverse effects , Vaccination/statistics & numerical data
10.
Hepatology ; 72(2): 723-728, 2020 08.
Article in English | MEDLINE | ID: covidwho-754841

ABSTRACT

Evidence strongly supports that access to specialty gastroenterology or hepatology care in cirrhosis is associated with higher adherence to guideline-recommended care and improves clinical outcomes. Presently, only about one half of acute care hospitalizations for cirrhosis-related complications result in inpatient specialty care, and the current hepatology workforce cannot meet the demand of patients with liver disease nationwide, particularly in less densely populated areas and in community-based practices not affiliated with academic centers. Telemedicine, defined as the delivery of health care services at a distance using electronic means for diagnosis and treatment, holds tremendous promise to increase access to broadly specialty care. The technology is cheap and easy to use, although it is presently limited in scale by interstate licensing restrictions and reimbursement barriers. The outbreak of severe acute respiratory syndrome coronavirus 2 and coronavirus disease 2019 has, in the short term, accelerated the growth of telemedicine delivery as a public health and social distancing measure. Herein, we examine whether this public health crisis can accelerate the national conversation about broader adoption of telemedicine for routine medical care in non-crisis situations, using a case series from our telehepatology program as a pragmatic example.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Liver Diseases/therapy , Pneumonia, Viral/epidemiology , Telemedicine , Adult , Aged , COVID-19 , Emergencies , Female , Humans , Male , Middle Aged , Pandemics , Patient Acceptance of Health Care , Pilot Projects , SARS-CoV-2
11.
J Gen Intern Med ; 35(11): 3285-3292, 2020 11.
Article in English | MEDLINE | ID: covidwho-739674

ABSTRACT

BACKGROUND: The US outbreak of coronavirus disease 2019 (COVID-19) accelerated rapidly over a short time to become a public health crisis. OBJECTIVE: To assess how high-risk adults' COVID-19 knowledge, beliefs, behaviors, and sense of preparedness changed from the onset of the US outbreak (March 13-20, 2020) to the acceleration phase (March 27-April 7, 2020). DESIGN: Longitudinal, two-wave telephone survey. PARTICIPANTS: 588 predominately older adults with ≥ 1 chronic condition recruited from 4 active, federally funded studies in Chicago. MAIN MEASURES: Self-reported knowledge of COVID-19 symptoms and prevention, related beliefs, behaviors, and sense of preparedness. KEY RESULTS: From the onset to the acceleration phase, participants increasingly perceived COVID-19 to be a serious public health threat, reported more changes to their daily routine and plans, and reported greater preparedness. The proportion of respondents who believed they were "not at all likely" to get the virus decreased slightly (24.9 to 22.4%; p = 0.04), but there was no significant change in the proportion of those who were unable to accurately identify ways to prevent infection (29.2 to 25.7%; p 0.14). In multivariable analyses, black adults and those with lower health literacy were more likely to report less perceived susceptibility to COVID-19 (black adults: relative risk (RR) 1.62, 95% confidence interval (CI) 1.07-2.44, p = 0.02; marginal health literacy: RR 1.96, 95% CI 1.26-3.07, p < 0.01). Individuals with low health literacy remained more likely to feel unprepared for the outbreak (RR 1.80, 95% CI 1.11-2.92, p = 0.02) and to express confidence in the federal government response (RR 2.11, 95% CI 1.49-3.00, p < 0.001) CONCLUSIONS: Adults at higher risk for COVID-19 continue to lack critical knowledge about prevention. While participants reported greater changes to daily routines and plans, disparities continued to exist in perceived susceptibility to COVID-19 and in preparedness. Public health messaging to date may not be effectively reaching vulnerable communities.


Subject(s)
COVID-19/psychology , Health Knowledge, Attitudes, Practice , Aged , COVID-19/prevention & control , Chicago , Female , Health Literacy/statistics & numerical data , Humans , Longitudinal Studies , Male , Middle Aged , SARS-CoV-2 , Self Report
12.
Hepatology ; 72(5): 1819-1837, 2020 11.
Article in English | MEDLINE | ID: covidwho-691225

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 pandemic has drastically altered all facets of clinical care and research. Clinical research in hepatology has had a rich tradition in several domains, including the discovery and therapeutic development for diseases such as hepatitis B and C and studying the natural history of many forms of chronic liver disease. National Institutes of Health, foundation, and industry funding have provided important opportunities to advance the academic careers of young investigators while they strived to make contributions to the field. Instantaneously, however, all nonessential research activities were halted when the pandemic started, forcing those involved in clinical research to rethink their research strategy, including a shift to coronavirus disease 2019 research while endeavoring to maintain their preexisting agenda. Strategies to maintain the integrity of ongoing studies, including patient follow-up, safety assessments, and continuation of investigational products, have included a shift to telemedicine, remote safety laboratory monitoring, and shipping of investigational products to study subjects. As a revamp of research is being planned, unique issues that face the research community include maintenance of infrastructure, funding, completion of studies in the predetermined time frame, and the need to reprogram career path timelines. Real-world databases, biomarker and long-term follow up studies, and research involving special groups (children, the homeless, and other marginalized populations) are likely to face unique challenges. The implementation of telemedicine has been dramatically accelerated and will serve as a backbone for the future of clinical research. As we move forward, innovation in clinical trial design will be essential for conducting optimized clinical research.


Subject(s)
Biomedical Research/organization & administration , Coronavirus Infections/prevention & control , Gastroenterology/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Telemedicine/organization & administration , COVID-19 , Coronavirus Infections/epidemiology , Delivery of Health Care , Female , Forecasting , Humans , Male , Needs Assessment , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Program Development , Program Evaluation , Research Design , United States
15.
Clin Liver Dis (Hoboken) ; 15(5): 187-190, 2020 May.
Article in English | MEDLINE | ID: covidwho-327214
17.
Ann Intern Med ; 173(2): 100-109, 2020 07 21.
Article in English | MEDLINE | ID: covidwho-45929

ABSTRACT

BACKGROUND: The evolving outbreak of coronavirus disease 2019 (COVID-19) is requiring social distancing and other measures to protect public health. However, messaging has been inconsistent and unclear. OBJECTIVE: To determine COVID-19 awareness, knowledge, attitudes, and related behaviors among U.S. adults who are more vulnerable to complications of infection because of age and comorbid conditions. DESIGN: Cross-sectional survey linked to 3 active clinical trials and 1 cohort study. SETTING: 5 academic internal medicine practices and 2 federally qualified health centers. PATIENTS: 630 adults aged 23 to 88 years living with 1 or more chronic conditions. MEASUREMENTS: Self-reported knowledge, attitudes, and behaviors related to COVID-19. RESULTS: A fourth (24.6%) of participants were "very worried" about getting the coronavirus. Nearly a third could not correctly identify symptoms (28.3%) or ways to prevent infection (30.2%). One in 4 adults (24.6%) believed that they were "not at all likely" to get the virus, and 21.9% reported that COVID-19 had little or no effect on their daily routine. One in 10 respondents was very confident that the federal government could prevent a nationwide outbreak. In multivariable analyses, participants who were black, were living below the poverty level, and had low health literacy were more likely to be less worried about COVID-19, to not believe that they would become infected, and to feel less prepared for an outbreak. Those with low health literacy had greater confidence in the federal government response. LIMITATION: Cross-sectional study of adults with underlying health conditions in 1 city during the initial week of the COVID-19 U.S. outbreak. CONCLUSION: Many adults with comorbid conditions lacked critical knowledge about COVID-19 and, despite concern, were not changing routines or plans. Noted disparities suggest that greater public health efforts may be needed to mobilize the most vulnerable communities. PRIMARY FUNDING SOURCE: National Institutes of Health.


Subject(s)
Chronic Disease/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Health Knowledge, Attitudes, Practice , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Vulnerable Populations , Adult , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2 , Self Report , Surveys and Questionnaires , United States/epidemiology
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