Did virtual consultations during Covid-19 improve diabetes transition clinic attendance compared to face to face clinic attendance

We have an established transition clinic for the patients with diabetes aged 16 to 19. Our Transition clinic covers a vast area including deprived areas such as Ellesmereport. We do have 3 monthly follow up in addition to the home visits by paedatric diabetes specialist nurses. The team involves paediatric consultants, pdsn and dietcician from adult and paedatrics departments. Virtual consultation were the main mode of consultations during covid. We used Accu Rx, Attendanywhere and telephone consultations. We compared the clinic attendance pre and post covid. We compared clinic attendance for 9 months from March 2019 to December 2019 which were pre Covid to March 2020 to December 2020 during Covid. We had 150 appointments in 2019 and 112 appointments in 2020. The DNAs were 21 during covid with virtual consultations and 28 pre Covid with face to face appointments. The DNA rates were 18.6% in 2019 as face to face review and 18.75% during covid as virtual consultations. Surprisingly, the DNA rates did not improve when the clinics were virtual as we expected. In Conclusion, the virtual consultations did not improve the attendance in this vulnerable age group. Due to vulnerability of this age group, we felt that the face to face consultations were more appropriate. All of our appointments for the diabetes transition clinics are face to face in person due to above findings.

Home-based care programme (HBCP) for patients with COVID-19: Boon or burden during pandemic management?

Introduction and Aim: India experienced the peak of the second wave of COVID-19 during April to June 2021. Massive surge of cases resulting in shortage of beds and oxygen, home care was recommended as a strategy for management of asymptomatic/mild COVID-19 cases. The present study was undertaken to perform home visits and monitor COVID 19 patients who are a part of home-based care programme (HBCP) in Puttur taluk of Dakshina Kannada district, identification and immediate referral of patients with red flag signs/ symptoms and to identify barriers/challenges faced by health care staff in implementing the programme. Methodology: The present study was a cross-sectional study with universal sampling. It was carried out as part of a district programme for management of home isolation COVID-19 patients. The team visited the houses of COVID-19 patients and evaluated them. Result(s): A total of 112 COVID-19 patients were in home isolation during the study period in Puttur Taluk. Hypertension (29.5%) was the most common co-morbidity and nearly two-fifths (41.1%) of the study participants had one or more comorbidities. Almost two-third (63%) of the patients with comorbidities were symptomatic compared to only 29.4% of patients without any comorbidities. Of the six patients who had saturation of less than 95% five were more than 60 years of age, only one had received vaccination against COVID-19 and all had comorbidities. The HBCP had to face several challenges as the team members could not be in full PPE because of long distances between the houses and hard to reach areas. Conclusion(s): Overall, it is a helpful initiative for patients as the health services were provided at the doorstep during the time of restriction of movement. This can be an important tool in managing not only COVID pandemic but also future outbreaks that may follow.Copyright © 2023, Indian Association of Biomedical Scientists. All rights reserved.

The Use of a Single-Time Sit-To-Stand Test in Ambulatory Individuals With Spinal Cord Injury by Primary Health Care Providers.

Background: The uncertain health care situations, such as that created by the COVID-19 pandemic, has limited hospital access and facilitated a paradigm shift in health care toward an increased demand for standard home visits and community-based rehabilitation services, including by ambulatory individuals with spinal cord injury (SCI). Objectives: This 6-month prospective study explored the validity and reliability of a single-time sit-to-stand (STSTS) test when used by primary health care (PHC) providers, including a village health volunteer, caregiver, individual with SCI, and health professional. Methods: Eighty-two participants were assessed for the STSTS using four arm placement conditions (arms on a walking device, arms on knees, arms free by the sides, and arms crossed over the chest) and standard measures, with prospective fall data follow-up over 6 months. Thirty participants involved in the reliability study were also assessed and reassessed for the ability to complete the STSTS conditions by PHC providers. Results: Outcomes of the STSTS test, except the condition with arms on a walking device, could significantly discriminate lower extremity muscle strength (LEMS) and mobility of the participants (rpb = -0.58 to 0.69) with moderate concurrent validity. Outcomes of the tests without using the arms also showed moderate to almost-perfect reliability (kappa = 0.754-1.000) when assessed by PHC raters. Conclusion: The findings suggest the use of an STSTS with arms free by the sides as a standard practical measure by PHC providers to reflect LEMS and mobility of ambulatory individuals with SCI in various clinical, community, and home-based settings.

Re-Emergence of Measles

In 2018-19, even before the pandemic, the world experienced major outbreaks of measles with 140,000 reported deaths mostly in low income countries where children suffer from malnutrition and overcrowding. In areas recovering from natural disasters and conflict areas and most children remain unvaccinated, outbreaks occur. The Philippines suffered similarly, with a devastating outcome and deaths of more than 800 children, even adults, in more than 40,000 hospitalized cases reported in 2019 over a 2 month period. A massive loss of vaccine confidence in 2018, brought about by the controversial introduction of a dengue vaccine reduced childhood vaccination coverage at an all-time low of 40-50%. Previous rates were in the 80-90% and measles was almost on the verge of elimination with no deaths and no cases between 2005-2009. The basic elements of complacency, convenience and confidence plus frequent occurrence of natural disasters over the years contributed much to these measles outbreaks. As a strategy, the government went into a massive supplementary immunization program with measles campaign including home visits to prevent another outbreak in the next 2 years after the pandemic begun. It has been implemented but targets are still wanting. The lessons learned from Measles resurgence are echoing all throughout the world and as the global response to the COVID19 continues, the measles as well as polio and other vaccine- preventable diseases need to be addressed with strategies that each country would find appropriate for them. Without sustained attention, the gains that have been achieved previously could easily get lost.Copyright © 2023

Exploration of patients' preference for modalities of care among peritoneal dialysis patients in Singapore: a single-center experience.

INTRODUCTION: Peritoneal dialysis (PD) is home-based dialysis therapy and therefore a suitable modality for kidney failure patients, particularly, during the COVID-19 pandemic. The present study examined patients' preferences for different PD-related services. METHODS: This was a cross-sectional survey study. Anonymized data from PD patients followed up at a single center in Singapore were collected using an online platform. The study focused on telehealth services, home visits, and monitoring of quality-of-life (QoL). RESULTS: A total of 78 PD patients responded to the survey. The majority of participants were Chinese (76%), married (73%), and between 45 and 65 years old (45%). The in-person visit was preferred over teleconsultation for consultation with nephrologists (68% versus 32%), counseling for kidney disease and dialysis by renal coordinators (59%), whereas the telehealth service was favored over in-person visit for dietary counseling (60%) and medication counseling (64%). Most participants (81%) preferred medication delivery over self-collection, and the acceptable turnaround time was 1 week. Sixty percent would like to have a regular home visit, but 23% refused such visits. The preferred frequency of home visits was one-to-three visits within the first 6 months (74%) and then 6 monthly for subsequent visits (40%). The majority of participants (87%) agreed with QoL monitoring, and the preferred frequency of monitoring varied between 6 monthly (45%) and yearly (40%). Participants also indicated three key areas in research to improve QoL, such as the development of artificial kidneys, portable PD devices, and simplification of PD procedure. Participants also would like to see improvement in two main areas of PD services, such as delivery service for PD solutions and social (instrumental, informational, and emotional) support. CONCLUSIONS: Most PD patients preferred in-person visits with nephrologists or renal coordinators; however, they favored telehealth services with dieticians and pharmacists. PD patients also welcomed home visit service and QoL monitoring. Future studies should confirm these findings.

An Rct of Home-Based Care to Reduce Posthospital Mortality in South Africa: Homelink

Background: In sub-Saharan Africa 23% of people living with HIV (PLWH) die 6 months after discharge from a hospital. Failure to engage in care posthospitalization is associated with mortality. We evaluated whether a series of structured post-hospitalization home visits would reduce mortality among recently discharged PLHIV in South Africa. Method(s): We designed a home visit package with up to 6 home visits starting 1-week post-hospitalization and every 2 weeks as required thereafter. The home visit team consisted of a professional nurse and a counsellor;they used a structured assessment algorithm to evaluate participants' social and medical needs, obtained direction from a doctor for further guidance, collected specimens for laboratory testing, or referred the participant for further evaluation. We compared this intervention to care as usual in a pilot randomized trial conducted at a single hospital in South Africa. The primary goals of the study were to determine feasibility and acceptability and identify opportunities to improve the home visit intervention. We report effectiveness for PLWH based on the primary outcome of all-cause mortality 6 months after discharge from hospital. Result(s): We enrolled 125 PLWH who were randomized 1:1 to home visit intervention or care as usual;14 were late exclusions because they died prior to discharge (n=13) or had a prolonged hospital stay (n=1). In the 111 PLHIV included in the analysis, the median (interquartile range [IQR]) age was 39 (33, 48) years, 69% were women, the median duration of the index hospitalization was 7 (3, 12) days, and primary reasons for the index hospitalization included TB (31%), heart and/or lung related diseases (22%), non-TB/COVID infections (25%), and anemia (15%). Most [96% (n=53/55)] intervention arm participants received >=1 home visits. By six months 14 (13%) participants died: 4 (7%) in home visit intervention arm and 10 (18%) in the care as usual arm (p=0.09). A similar proportion of readmissions occurred by arm: 20 (36%) in the home visit arm and 22 (39%) in care as usual. Conclusion(s): Home visits done after discharge from hospital provided care services to an extremely vulnerable group of PLWH at very high mortality risk . We demonstrated both feasibility and preliminary efficacy of delivering post-hospital visits. Structured home visits appear to be a promising approach that would benefit PLWH. Larger studies in diverse populations with cost effectiveness components are required.

Telerehabilitation in the 'real-world': Implementation of remotely delivered pulmonary rehabilitation

Introduction: Pulmonary rehabilitation (PR) is an effective treatment for people with chronic respiratory disease but is delivered to <5% of eligible individuals. Home-based telerehabilitation achieves similar clinical outcomes to centre-based PR in clinical trials. We aimed to evaluate the clinical implementation of telerehabilitation. Method(s): Suitable individuals with respiratory disease referred for PR at Alfred Health have been offered the option of an 8-week home-based telerehabilitation program (one home visit followed by twice-weekly exercise training sessions, with real time supervision, for 8-weeks). Equipment was provided to patients, as necessary. Standard PR assessments were conducted pre and post program. Program completion was defined as undertaking >=70% of prescribed sessions. Real-world implementation was evaluated against the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Result(s): Reach: Across 2-years (Sept 2020-22), 269 people were referred with 55 (21%) undertaking telerehabilitation (25 female, mean (SD) age 61 (11) years, 6-min walk distance (6MWD) 430 (120) metres, Chronic Respiratory Questionnaire Dyspnoea (CRQD) domain 16 (6)). Participant diagnoses included COPD (n = 11), ILD (n = 15), bronchiectasis (n = 5), asthma (n = 2), post COVID-19 (n = 9), and pulmonary hypertension (n = 4). Forty participants (73%) completed >=70% of prescribed sessions. Effectiveness: Significant and clinically meaningful improvements were demonstrated (CRQD MD 4 (95% CI 1, 6);6MWD MD 24 m (95% CI 8, 41)). Adoption: Training to deliver telerehabilitation and perform home visits was completed by PR clinicians (n = 7 and n = 4 respectively). Implementation: All participants independently supplied Wi-Fi, and 40% used their own exercise equipment or internet-enabled device. Most participants had an in-person home visit (n = 45), and undertook cycle-based training (n = 46). Fifteen participants required additional support for iPad or videoconferencing navigation. There were no serious adverse advents. Maintenance will be evaluated following this pilot period. Conclusion(s): 'Real-world' telerehabilitation achieves clinically meaningful outcomes for patients and provided access to an effective model of PR particularly when centre-based programs were unavailable due to COVID-19 restrictions.

Short Time: Postnatal Hospital Care during Covid-19 Pandemic. The Results of a Psychological Wellbeing Screening in the Immediate Postpartum

Introduction: During the Covid-19 pandemic, isolation, fear of contagion, changes in care circumstances, and suspended or restricted visitor access impacted the psychological wellbeing of puerperae. As shown in literature [1,2], Covid-19 pandemic increased depressive and post-traumatic stress related symptoms in mothers in the postnatal period. Moreover, it could determine serious psychological challenges for pregnant and postpartum women, with potential "short" and "long" term consequences for the health of mothers and their children [2]. Healthcare providers should guarantee easy access to mental health services, as a primary strategy to support the health of both mothers and children [2]. After the worldwide spread of Covid-19 the organization of every hospital ward changed, including the obstetric and neonatal units. Compared to the pre-pandemic period, a reduction of the average length of stay in hospital for the new mothers was instituted [3]. This was the result of a reduction of the hospital beds, mostly because of the need to allocate mothers tested positive for Covid-19 in a separate area and to lower the risk of Covid-19 transmission in hospitals. The Obstetric Psychological Service of the Spedali Civili hospital in Brescia started a screening program for the wellbeing of the perinatal period in 2018, with a gradual development and improvement of the organization of this activity [4]. Screening was suspended during the first wave of Covid-19 pandemic from 6th of March to 4th of May 2020. Nevertheless, it was necessary to cope with the Covid-19 pandemic changing demands and methods in order to continue with the screening of women admitted in obstetrics ward. Method(s): A screening of psychological perinatal wellbeing was performed in puerperae admitted to the Second Department of Obstetrics at Spedali Civili hospital in Brescia. Screening consisted in a psychological consult, during which the psychologist illustrated the Obstetric Psychological Service to the woman and identified her psychological need, without using tests. This was eventually followed by an assessment consultation, specialist care and referral to the out-of-hospital psychological services, if required by the woman or considered necessary by the psychologist. It was made a comparison between data collected from October 2019 to January 2020 and from May 2020 to December 2021. Result(s): Compared to the pre-pandemic period, average length of stay in the Second Division of Obstetrics was reduced. In particular, starting from March 2020, the expected discharge of the puerpera was about 24 hours after vaginal birth and 48 hours after cesarean delivery, if no complications occurred for both mother and newborn. Previously, discharge was expected after about 48 hours and 72 hours, respectively. Discharge that occurs 24 hours after vaginal birth is named "Early discharge" and requires the activation of the out-of-hospital services, with home visits by an obstetrician. From October 2019 to January 2020, 470 admitted women were screened, of which 23 (4,9%) demanded a further psychological consultation[4]. Between May 2020 and December 2021, 5145 screening were performed. Among them 550 (10.7%) demanded a further psychological consultation. From those data we can affirm that there was an increase in psychological consultations (from 4.9% to 10.7%), after exhibiting a psychological need during the postnatal screening. Conclusion(s): Covid-19 pandemic changed the care conditions of the woman during the pregnancy and the immediate post-partum. The reduction of the average length of hospital stay of the women in the postpartum did not stop the Psychological Service prevention program. The Obstetric Psychological Service of the Spedali Civili hospital in Brescia implemented his activity increasing the pace of work, to be able to screen as many admitted women as possible. It was noticed that, after the Covid-19 first outbreak, the demand for psychological consultation after the screening consult was more than doubled in comparison to the pre-pandemic perio . This emphasized the benefit of an early interception of the psychological need of the women in the immediate post-partum period, especially during the Covid-19 pandemic.

Telehealth development of virtual environmental home visits to facilitate stroke patients discharges from Hospital

Introduction: The Covid-19 pandemic has progressed the use of digital technology in the NHS to enable remote working and reduce the risk of infection transmission in NHS settings (Hutchings 2020) Telehealth is the use of electronic information and telecommunications technologies to enable and support clinical health care, patient and professionals to provide care virtually (Clipper 2020). A research study published by BJOT (2020) identified that remote home visits were feasible depending on visitor abilities, training and visit standardisation (BJOT 2020). Environmental Home visits (EHV) are fundamental to the discharge process to enable identification of appropriate equipment for the safe and timely discharge of stroke survivors. According to the National Clinical Guidelines for Stroke, stroke survivors should be offered assessment and provision of equipment and adaptations (National Clinical Guidelines for Stroke, 2016). In response to the Covid-19 pandemic to ensure safe discharge and reduced direct face-to-face contact virtual environmental home visits (VEHV) on a stroke ward was developed. Method(s): Microsoft Teams was the technology platform used to facilitate VEHV. Visits were arranged with families and caregivers who had access to the technology and were able to understand the technology. Therapists directed the patient's home environment and asked the individuals completing the VEHV for appropriate dimensions and measurements and an environmental home visit document was completed. Result(s): VEHV were completed by both qualified occupational therapists and therapy assistants were then trained to be able to implement VEHV. The use of Microsoft Teams was found to be a suitable technology platform with families and care givers who were technology competent. However where patients families and care givers did not have access to the appropriate technology or were not sufficiently computer literate VEHV's were not appropriate. Conclusion(s): The VEHV were found to be time efficient, improved patient flow, enabled a number of VEHV to be completed in a day and reduced direct face-to-face contact during Covid-19 while still maintaining communication with patient families and care givers.

Functional recovery of hospitalised patients with covid-19: a prospective cohort study

Aim and Objectives: To characterize the functional recovery of hospitalized patients diagnosed with COVID-19 at 3-, 6-, 9- and 12-months post-discharge. Method(s): We are conducting a multi-regional prospective cohort study in hospitalized COVID-19 patients 18 years and older in Canada. Patients are assessed upon admission and at 3-, 6-, 9-, and 12-months follow-up. Data collection is completed via telephone interviews in addition to home visits. Outcomes include the Activity Measure for Post-Acute Care Mobility and Cognition scales and lung function. Result(s): Preliminary data from 242 hospitalized COVID-19 patients (60.1 +/- 13.0 yrs) indicate that the most common self-reported symptoms are fatigue (47%) and shortness of breath (35%) at 12-months follow-up. Our lung function data suggests that 39-46% of post-acute patients with COVID-19 have impaired FEV1 (<80% predicted), and 38- 49% have impaired FVC (<80% predicted) at 3-,6-, 9- and 12-month follow-up. At 12-months, 38-45% of patients continue to have clinically important deficits in cognition and mobility below premorbid levels, respectively, and 55.4% of patients report that COVID-19 continues to impact their daily life activities (Figure 1). Conclusion(s): There is a high prevalence of functional limitations in COVID-19 survivors over 12 months of followup. Our data support the need for multi-disciplinary rehabilitation for patients post-hospitalisation for COVID-19.

Impact of natural disasters and pandemics on blood supply: A systematic review

Background: Natural disasters and pandemics can be highly challenging to blood supply chains. This review aimed to assess the impacts of pandemics and natural disasters on blood donation globally, appraise any similarities and differences, and provide an overview of the mitigation strategies and optimizations applied as well as risks modelling undertaken. Method(s): Full text, peer-reviewed articles that studied the impact of any pandemic and natural disaster on blood donation, blood supply management, and modelling searchable in PubMed, Scopus, Web of Science, and Cochrane Library between Jan 1980 and Jan 2023, inclusive were included. We performed quality assessments and summarised potential lessons learned. Result(s): Overall, 98 studies were identified and assessed in this review, of which 58 were related to pandemics and 17 related to natural disasters. 97% of the studies on pandemics and blood donation were on COVID-19, while 88% of studies on natural disasters were on earthquakes. We confirmed that during the COVID-19 pandemic, blood donation numbers decreased compared to the pre-pandemic period, while just after an earthquake, blood donation numbers tended to increase, which in both cases put the blood supply chain under pressure (creating shortage or wastage). The increase of first-time donors was higher after a sudden destructive earthquake than after the COVID-19 pandemic. Public awareness campaigns, donors transportation, home visits, measures to minimize wastage of blood components, activation of contingency plans, and altering donor eligibility criteria were implemented to help the blood supply chain to respond to the demand and reduce wastage. However, no pandemic plans, per se were identified highlighting the lack of an emergency plan in collaboration with health authorities. Several optimization models were developed to help the blood supply chain reduce costs and identify faster transportation in times of earthquake, however, optimization models targeting a pandemic were lacking, as were risk modelling analyses for both events. Conclusion(s): Optimization models, risk modelling, serosurveillance and haemovigilance should be combined with infectious diseases case surveillance to better prepare the whole supply chain logistics to safely attend the demand. Findings on blood donor demographics were inconclusive during or after major events, which highlight the need for further investigations.Copyright © 2023 The Authors

Home medical care for patients with covid-19 / Atención médica a domicilio en pacientes con covid-19

La atención de salud en domicilio es un servicio que brindan los profesionales sanitarios en los hogares de los pacientes en tiempos de pandemia por Covid-19; este servicio sufrió alteraciones en su proceso desde la planificación hasta la atención. Objetivo: Describir el proceso de atención medica a domicilio en pacientes con covid-19. Materiales y Método: Con el objetivo de describir el proceso de atención médica en domicilio a pacientes con Covid-19, se realiza el presente artículo elaborado como una revisión bibliográfica; de un nivel de investigación tipo descriptivo en donde se realizó un análisis sistemático de los documentos encontrados en la web. Resultados: Se encontraron estudios relacionados, donde indican que las visitas domiciliarias a personas con Covid-19 y se priorizó la identificación temprana de los signos de peligro. Conclusión: A pesar del riesgo de contagio de los profesionales de salud, continuaron realizando las visitas domiciliarias brindando una atención médica adecuada(AU)

Home health care is a service provided by health professionals in patients' homes in times of the Covid-19 pandemic; This service suffered changes in its process from planning to care. Objective: To describe the process of home health care in patients with covid-19Materials and Method: With the aim of describing the process of medical care at home for patients with Covid-19, this article is prepared as a bibliographic review; of a descriptive type research level where a systematic analysis of the documents found on the web was carried out. Results: Related studies were found, indicating that home visits to people with Covid-19 and early identification of danger signs were prioritized. Conclusion: Despite the risk of infection of health professionals, they continued to make home visits providing adequate medical care(AU)

Community Non-Invasive Ventilation practitioner service utilisation for Motor Neurone Disease patients following the Covid-19 pandemic

Introduction: The community non-invasive ventilation (NIV) practitioner service is supported by two physiotherapists who provide out-reach domiciliary support to patients with Motor Neurone Disease (MND). The aim of this study was to look at service utilisation, including NIV set-ups and palliative care referrals for this cohort of patients following the Covid-19 pandemic. Method(s): During the UK national lockdowns and the periods of shielding for vulnerable patients, the service was run remotely via telephone support with home visits only undertaken if clinically indicated. We retrospectively studied all patients in the service with MND from January 2019 to December 2021, looking at number of new referrals to the service, NIV set-ups and referrals to palliative care. Result(s): 105 patients were identified with MND, 52% male, mean age 67 (SD 10). Between 2020 and 2021, new referrals increased by 35%, NIV set-ups by 56% and palliative care referrals also increased by 22%. A similar trend was observed for the data comparing 2019 and 2021 (see figure 1). Conclusion(s): This study identified an increase in community MND NIV practitioner service utilisation and palliative care referrals following the Covid-19 pandemic. Further work is needed to understand how the impact of the pandemic on access to healthcare and the shielding of MND patients may have contributed to these findings.

Does the remote consultation mobile unit or phygitale medical unit, a new way of managing unscheduled care in general medicine, make it possible to reduce the use of emergency rooms?

Introduction: In partnership with SAUVlife volunteers and SAMU 50, a remote consultation mobile unit (UMT) was deployed in the Manche department of France, targeting elderly and dependent patients where access to care is difficult due to the lack of a general practitioner and the decrease of home visits. This new vector could be an alternative to the use of emergency rooms. Method(s): We performed a monocentric retrospective observational study of the activity of the UMT from January 1 to June 30, 2021 within the SAMU 50 at the Saint-Lo Hospital. After initial medical regulation, the patients without a vital emergency could benefit from an intervention of the UMT. Result(s): The UMT intervened 681 times. At the end of the intervention, 65.6% of the patients could be left on site. The phygital unit performed 621 teleconsultations allowing 414 patients (66.7%) to remain at home and 199 patients (32%) to be transported to an emergency room. Those transported were significantly older with an average age of 71.26 years (P < 0.001). The interventions lasted an average of 1 hour and 27 minutes. Discussion(s): This experiment is new in the emergency context. This tool seems to respond to the lack of ambulatory care in the department. Its use in the context of the COVID-19 pandemic is convincing and allows for the limitation of viral transmissions through home care. However, the interventions are long and the use of the UMT can be optimized both in terms of intervention time and the number of interventions performed per day. Conclusion(s): The mobile telemedicine unit is a real contribution in the absence of general practitioners, to carry out unscheduled home visits. Even more in an epidemic context where it limits the use of emergency rooms and ultimately the transmission of infectious agents. Copyright © 2022 Elsevier Masson SAS

Collective Knowledge and Experience for Resource-Focused Business Continuity Plans Foundation: Survey on How Home-Visit Nursing Operators in Japan Coped with the COVID-19 Pandemic

This paper presents a nationwide survey about how Japanese home-visit nursing stations prepared and coped with the coronavirus disease 2019 COVID-19 pandemic. This study also aimed to provide a practical foundation and guide to develop business continuity plans (BCPs) for home-visit nursing stations and nursing care facilities to cope with pandemics. We applied a resource-focused BCP framework to efficiently collect and summarize knowledge and experiences from many facilities about the responses and countermeasures based on the three fundamental purposes to keep resources: prevent loss, promote increase, and utilize limited resources. We conducted a survey during Japan's third wave of the COVID-19 pandemic and analyzed the responses using a qualitative and inductive content analysis method. We could develop categories to summarize various responses and countermeasures in a consistent and comprehensive manner. Based on the analysis results, we proposed six fundamental sub-plans to reorganize resource-focused BCP. The categorization and sub-plans are not special or innovative;however, since they focus only on resources and explain what we need to consider in BCPs in terms of action plans for resources, we expect that it is easier for BCP non-experts to understand the concept and utilize it for developing practical responses and countermeasures. © Fuji Technology Press Ltd.

How Decentralized Clinical Trials Made a Global Alzheimer's Trial Possible during the Pandemic

Background/Objective: The COVID-19 pandemic threatened the future of many clinical trials, including a global Phase III clinical trial focused on preclinical Alzheimer's disease. To retain participants in this fragile patient population, despite the restrictions of the pandemic, decentralized clinical trial (DCT) methods were adopted, including the participation of mobile research nurses to execute home visits Design: The trial required one-hour intravenous (IV) infusions every month for 4.5 years during the double-blind treatment period, with the option for an additional four years during the open-label treatment period. Investigational product (IP) was shipped to participants and reconstituted by mobile research nurses. Project management teams coordinated IP delivery and ancillary infusion supplies, separating logistics from clinical responsibilities. The same nurses were assigned to participants to create familiarity and comfort. Result(s): To date, more than 900 home visits have been conducted and 889 infusions completed. Patients were accepting of receiving infusions at home at a rate higher than the sponsor had anticipated at the outset of the pandemic. Visits began within seven weeks from the time of project kickoff. Conclusion(s): Patient interest and comfort with having nurses infuse them at home kept them on regimen and compliant to a demanding protocol, despite the challenges of the pandemic. Demand for DCTs has continued to increase, even after COVID-19 fears have subsided somewhat.

Effect of an Intensive Nurse Home Visiting Program on Adverse Birth Outcomes in a Medicaid-Eligible Population: A Randomized Clinical Trial

Mortality, morbidity, and childhood developmental challenges can all result fromadverse birth outcomes. In regard to these outcomes, the United States exhibits significant racial and socioeconomic inequities, and effective interventions targeting lowincome pregnant people are necessary. A recommendation for expanding home visiting programs has been provided with the hope of improving newborn andmaternal outcomes, and substantial federal funding is granted to these programs via theMaternal, Infant, and Early Childhood Home Visiting program. The Nurse-Family Partnership program is a nurse home visiting service targeting nulliparous low-income families during pregnancy and early childhood. The state of South Carolina's preterm birth rate in 2016 was the sixth highest in the United States, which motivated the state to offer program services to Medicaid-eligible nulliparous women through aMedicaid waiver. This study's objective was to determine effects of intensive nurse home visiting programs on the composite outcome of small for gestational age, low birth weight, preterm birth, and perinatal mortality. This randomized clinical trial assigned participants in a 2:1 ratio to either a control group or an intervention group, which was offered access to the program. The control group was offered a list of community-based resources available to them, and all participants received usual care for South Carolina. Inclusion criteria were nulliparous pregnancy of less than 28 weeks' gestation, income-eligible for Medicaid during pregnancy, and residence in a program-served county. Self-referral, or referral through schools, clinicians, and Medicaid led patients to 1 of 9 program-implementing sites. The intervention, which consisted of a prenatal and early childhood home visiting program, was carried out by nurses conducting home visits with participants from pregnancy through the first 2 years of the child's life. The nurses used activities tailored to the clients' strengths, preferences, and risks via educational tools, motivational interviews, goal setting related to prenatal health, health assessments, maternal life course, and child health and development. Utilization of health care was encouraged when needed, coupled with referrals to health and social services. Ideal visits ranged from weekly 60- to 90-minute sessions for 4 weeks following enrollment and then every other week leading up to delivery. Nurse training encouraged flexible support of clients for more or fewer visits as necessary, with services provided in both Spanish and English, with other translation options. Enrollment for the study began on April 1, 2016, but concerns for the COVID-19 pandemic led to a recruitment halt on March 17, 2020. However, 95% of the target recruitment goal had already occurred, and the remaining home visits were conducted via telehealth. A total of 3319 patients were eligible and opted for enrollment. Upon time of enrollment, 18% of participants were younger than 19 years, with 54.8% of them between 19 and 24 years old. Self-reported race and ethnicity statistics were reported as 55.2% non-Hispanic Black, and 22.4% had not completed high school. Body mass index of greater than 30 kg/m2 was present in 34.5%, and smoking 3 months before pregnancy was reported in 25.8% of participants. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Bringing health care closer to patients - Two years of the home care ALS programme in Slovenia

Ljubljana ALS Center takes care of the majority of patients with ALS in Slovenia. Due to limited access to health care during COVID-19 pandemic, we have started a home care ALS programme to improve care of patients with ALS. We developed eligibility criteria to decide which patients could benefit from home visits. The criteria included problematic transport due to patient immobility, mechanical ventilation use, gastrostomy-related problems and need for advanced directives discussion. During March 2020 and March 2022, we performed 190 home visits in 67 patients. This represents 20% of all ALS out-patient visits and 30% of the patients treated at our center during this period. The patients were visited on average every 3.3 months (range between visits 3 days -15 months). Only 4% of the visits were done due to a sudden unexpected clinical deterioration. The neurologist that performed home visits was usually accompanied by one or two members of our multidisciplinary team (mostly by respiratory therapist and sometimes by nurse, social worker or team coordinator). 58% of the patients visited were using gastrostomy, 72% were using noninvasive ventilation (NIV) and 9% were using invasive ventilation (IV). The main procedures/tasks performed at home visits were: arterial blood gasses analysis (in 72% of all visits), assessment of NIV (in 60%), adjustment of symptomatic therapy (in 41%), advance directive regarding mechanical ventilation (in 28%), prescription of existing therapy (in 13%), discussion on possible gastrostomy (in 13%), gastrostomy assessment (in 10%), gastrostomy care (in 10%), replacement of gastric tube (in 5%), assessment of IV (in 5%), botulinum toxin application (in 5%), decision to withhold treatment (in 4%), introduction of NIV (in 2%), introduction of cough assist (in 2%), discussion on treatment withdrawal (in 1%). The home care ALS programme provides an improved health care for patients with ALS, especially for those in advance stages of the disease. Many of these patients would probably not be able to attend regular out-patient visits at the hospital. The multidisciplinary programme integrates different aspects of ALS care, the most important being home ventilation and palliative care. Based on our experience, it can be cost and time effective with appropriate planning. The programme has recently received long-term funding by the Health Insurance Institute of Slovenia as a part of mobile palliative teams initiative.