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Postoperative respiratory failure is a significant cause of morbidity and mortality. Early identification of patients at moderate to high risk of postoperative respiratory failure is critical to effective prevention strategies. A multi-disciplinary team developed a robust process for the early identification of at-risk patients and the prevention of respiratory failure in the perioperative setting.
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BackgroundMost of the morbidity and mortality in nCovid19 is due to pneumonia which can be reduced by early diagnosis and treatment. Chest CT scan plays an important role in the early diagnosis and management of respiratory complications due to nCovid19. Clinicians should be aware about the indications for the CT scan of the thorax, timing of investigation, and limitations of CT.Main body of abstractChest CT scan is indicated in patients with moderate to severe respiratory symptoms and pretest probability of nCovid19 infection, when RT-PCR test results are negative, and in patients for whom an RT-PCR test is not performed or not readily available. When a rapid antigen test is negative and an RT-PCR test report takes time, CT can be used in seriously ill patients to decide whether it is COVID or not. For patients who are dependent on oxygen even after 2 weeks, CT may help to show the extent of lung involvement and predict long-term prognosis. CT may be done to exclude nCovid19 pneumonia. For patients with high risk for nCovid19 who require an immediate diagnosis to rule out lung involvement, CT can be done. A normal CT excludes nCovid19 pneumonia. CT scan is required in confirmed cases of nCovid19 pneumonia when complications are suspected clinically. These include pulmonary thromboembolism, pneumothorax, mediastinal/surgical emphysema, bacterial pneumonia, and unexplained deterioration with new shadows in chest X-ray. CT pulmonary angiogram is indicated when pulmonary embolism is suspected, and in other cases, plain CT should be done. In pre-operative cases where emergency surgery is required, nCovid19 disease is suspected clinically, and RT-PCR report awaited or not available, CT thorax can be done.ConclusionCT scan is useful for early diagnosis of lung involvement, detection complications, triaging of cases, risk stratification, and preoperative evaluation in select cases. CT scan should be done only when there is a definite indication so to reduce radiation hazards and to reduce health care expenditure. Normal CT excludes nCovid19 lung involvement, but the patient may have upper respiratory involvement which may progress later to involve lungs.
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Reabilitarea respiratorie este o metodă eficientă în reducerea simptomelor respiratorii şi incidenţei complicaţiilor, scăderea anxietăţii, depresiei, creşterea tolerantei la efort, îmbunătăţirea calităţii vieţii şi activităţilor zilnice în contextul Lungului Covid, incluzând utilizarea tehnologiei la domiciliul pacientului prin optimizarea intervenţiei la distanţă sub atenta observaţie a unui fizioterapeut (telereabilitarea). În urma studierii a 400 articole publicate în PubMed, Elsevier, Research Gates, Sci-Hub, British Medical Journal şi a ghidurilor de specialitate COVID-19 elaborate în ţări precum: SUA, China, Italia, Marea Britanie, propunem câteva protocoale de reabilitare. În timpul pandemiei, în pofida subvariantelor şi a persistenţei îndelungate a Lungului Covid, specialiştii în reabilitare respiratorie au ajuns la consensul privind importanţa practicării exerciţiului fizic timpuriu pentru antrenarea musculaturii respiratorii (AMR), cu /fără aparate de reeducare respiratorie. Adjuvant se folosesc cu succes poziţiile de drenaj bronşic, clapping-ul toracic, educarea tusei şi a vorbitului, exerciţii de: echilibru, mers, stretching şi Core.Alternate abstract:Respiratory rehabilitation is an effective method in reducing respiratory symptoms and the incidence of complications, decreasing anxiety, depression, increasing exercise tolerance, improving the quality of life and daily activities in the context of Long Covid, including the use of technology at the patient's home by optimizing remote intervention under the careful observation of a physiotherapist (telerehabilitation). Following the study of 400 articles published in PubMed, Elsevier, Research Gates, Sci-Hub, British Medical Journal and the specialist COVID-19 guidelines developed in countries such as: USA, China, Italy, Great Britain, we suggest some rehabilitation protocols. During the pandemic, despite the subvariants of COVID-19 and persistence of Long Covid, respiratory rehabilitation specialists have reached a consensus on the importance of practicing early physical exercise for training the respiratory muscles (AMR), with/without respiratory re-education devices. Bronchial drainage positions, chest clapping, cough and speaking training, exercises of: balance, walking, stretching and Core are also used successfully.
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The world witnessed and went through the COVID-19 pandemic for a major part of two years, the after effects of which still reverberate loudly worldwide. The psychological and emotional turmoil was felt by everyone but was accentuated many fold, especially for the COVID-19 survivors. Years of research have already established gratitude and hope to be the predictors of psychological well-being. The present research study made an attempt to explore gratitude and hope as the correlates of psychological well-being amongst COVID-19 survivors. The sample of this research study consisted of 76 survivors (N=76) from the state of Haryana, India. Gratitude Questionnaire-6 by McCullough et al. (2002);the Adult State Hope Scale by Snyder et al. (1996);and Ryffs Psychological Well-being Scale (RPWBS-18;Ryff et al., 2010) were used for the assessment of the variables. Descriptive statistics and Pearson's Product Moment Correlation was applied to explore the relationship among the variables. The findings of the study establish a significant positive correlation between both, gratitude and psychological well-being & hope and psychological well-being.
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Oncology Nursing Practice COVID-19 recovery presented nursing leadership with opportunities to document productivity measures for oncology nursing services rendered and potentially impact revenue. A nurse billing and charge capture committee composed of network nursing and revenue department team members was convened to establish billable and productivity related nursing tasks. The purpose was to identify ambulatory oncology nursing practice that would generate billable revenue, identify non-billable tasks that could generate statistical codes to measure productivity, and create an educational plan to implement changes in nursing practice to support billing. Committee leads identified key stakeholders from each of the health system network sites to participate. The committee assessed and categorized nursing practice into actions such as central line maintenance and phlebotomy to support nursing revenue (billable) versus distinct productivity measures that were documented by nursing time (non-billable). Both groups included the nursing professional development specialists who engaged nursing informatics and the IT department. Their collaboration led to standardized nursing documentation using EPIC smart phrases, charge capture codes, and stat codes for productivity. The revenue integrity team ensured charges and statistical codes were compliant with regulatory standards. EPIC analysts optimized nursing documentation by creating smart phrases to support billing and track nursing time. Departmental reports used the smart phrases to identify patients to support nursing documentation compliance. For non-billable items, the smart phrases and documented time interval were used to capture productivity. The reports were monitored for nursing documentation and charge capture compliance. In the first two fiscal quarters, 1,421 nurse billing items were documented as well as 1,648 non-billable items that totaled over 440 hours of nursing time. Results were discussed at leadership and staff meetings. The revenue group identified and prioritized a list of oncology nursing functions that were associated with chargeable specific Current Procedure Terminology (CPT) codes. Initially, two nursing tasks, central line maintenance and therapeutic phlebotomy, were implemented. Other chargeable tasks that followed included in person chemotherapy and pre-operative/post-operative teaching visits, port assessment, chemotherapy pump and peripheral line assessment follow up, dressing changes and skin assessment. The productivity group defined and prioritized a list of productivity measures which included telephone encounters, authorization and registration, form completion (FMLA, disability, prior authorization, and oral medications), chemotherapy and preoperative/postoperative teaching which occurred in tandem with provider visits or by video or telephone.
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Background: Postacute sequelae of SARS-CoV-2 (PASC) include fatigue, dyspnea, anxiety, and cognitive impairment. Few studies have explored the prevalence or presentation of PASC among nursing home (NH) residents. Method: A case–control study was conducted at 1 NH in Michigan in December 2021. Cases were defined as residents with SARS-CoV-2 infection between November 2, 2020, and October 8, 2021. Controls lived at the same NH during this interval and never tested positive for SARS CoV-2. Patient characteristics were compared between cases and controls using the Fisher exact test and Wilcoxon rank-sum test. Primary outcomes were functional decline, cognition, and adverse health outcomes. Outcomes were assessed by comparing measures on last observation to observations before COVID-19 diagnosis (cases) or to earliest observation (controls). Multivariable logistic regression assessed correlation between COVID-19 diagnosis and outcomes. Results: In total, 152 residents were identified for inclusion (147 included in final analyses, 76 cases, 71 controls);5 were excluded due to insufficient data. We collected the following resident characteristics: 66% were aged ≥80 years;73% were female;95% were non-Hispanic white;82% were long-stay residents;median of 3 comorbidities (IQR, 2–4). The mean number of follow-up observations was 2.60 (SD, 1.25). No significant differences in population characteristics were detected between cases and controls. Moreover, 106 patients (46 cases and 60 controls) had at least 1 follow-up visit and were thus included in the analyses to evaluate long-term outcomes. Among them, cases experienced significant declines in completing transfers (OR 5.65, p Conclusions: Nursing home residents with COVID-19 are more likely to enter hospice and have a higher mortality rate in the year following infection. Survivors experience significant functional decline in basic activities of daily living, specifically in the ability to transfer and dress. Larger studies are needed to further characterize our findings and to design interventions that can help overcome these long-term sequelae from COVID-19.Funding: NoneDisclosures: None
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ObjectivesEnhanced recovery after surgery (ERAS) is an evidence-based surgical quality improvement program that has been shown to improve patient outcomes, while reducing overall resource costs. The aim of this study was to evaluate the impact of implementation of ERAS for gynecologic oncology patients undergoing laparotomy during the COVID-19 pandemic.MethodsWe conducted a pre-post study that included women admitted for gynecological oncology abdominal surgery. Outcomes of interest included post-operative LOS, readmission, and return to ED within 30 days of discharge. Outcomes were compared for the pre (June 2019-June 2020) and post (July 2020-June 2021) intervention periods, using Chi-square for categorical variables and t-test for continuous variables.ResultsA total of 364 patients were included, among whom 217 were admitted in the pre and 147 were admitted in post intervention period. It was observed that patients had higher BMI (p<0.01), higher ASA category (p=0.71), and higher Charlson comorbidity index (p=0.07) in the post compared with pre intervention period. There was a trend towards decreasing mean post-operative LOS from 104.1 to 91.4 hours (p=0.12). However, there was a slight non-significant increase in hospital readmission from 6.0% to 8.2% (p=0.42), with no notable differences in ED visits (13.8% to 12.9%, p=0.81).ConclusionsDespite the challenges associated with the COVID-19 pandemic, including delays in surgical care access and associated increase in patient morbidity, we were able to successfully implement ERAS as routine medical care for gynecologic oncology patients. Future directions include auditing compliance and in-depth cost analysis.
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Purpose>The COVID-19 outbreak has undoubtedly affected overall mental health. Thus, researching resilience is important, as it has been previously discussed as a means to protect people from mental health problems. This study aims to clarify whether survivors of a traumatic event (i.e. cancer survivors) are more resilient to living through another traumatic experience, such as COVID-19, compared to those who have never had such an experience. The study also examines the role of emotional creativity in this process.Design/methodology/approach>A quantitative research design was adopted. The data collection was performed through a survey (N = 338), which was conducted among two separate groups of participants. The first group (N = 152) included the survivors of a traumatic event (i.e. cancer survivors), and the second group (N = 186) included those who did not have such an experience.Findings>The results demonstrate that living through a traumatic experience results in a higher level of resilience during another traumatic experience (i.e. COVID-19), which is the result of higher post-traumatic growth. Moreover, emotional creativity is discussed as an explanatory variable that explains a significantly higher level of post-traumatic growth among survivors of a traumatic event.Originality/value>This research offers a better understanding of the effect of living through a traumatic event on post-traumatic growth and resilience in living through another traumatic experience. Moreover, post-traumatic growth is explained through emotional creativity improvement, which happens after experiencing a traumatic life event.
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P226 Figure 1ConclusionPatients recovering from severe Covid-19 have worse insulin sensitivity compared to controls, but similar metabolic flexibility. Physical inactivity and liver adiposity may play a role in these observations.FundingNIHR Nottingham BRC (NoRCoRP), PHOSP UKRI, Nottingham Hospitals Charity, University of Nottingham alumni donation.
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The restrictions imposed by coronavirus meant limits on the chance to exercise outdoors. But being active remains important before, during and after cancer treatment, and international experts have called for ‘exercise prescriptions’ to cope with side effects of treatment and lower the risk of some cancers returning.
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BackgroundThis worldwide new COVID-19 pandemic has a great impact on our gastrointestinal oncology clinical practice, many restrictions for elective and emergency management, especially on GI cancer already been applied in every referred hospital. Current guidelines suggest postponing elective surgery for those cases. But in some instances, we must perform surgery for some reasons, including untreatable pain or impending obstruction. Enhanced recovery after surgery might have an important role in increasing the favorable outcome for these patients.MethodsThis prospective study was done for the last 4 months from March 2020. All resectable GI cancer patients have been included in this study, ERAS protocols have been applicated for perioperative management. The main outcome was the length of stay, readmission rate, post-operative complications and in hospital mortality. Prior neoadjuvant chemotherapy will be excluded from this study.ResultsDuring the last 4 months, we reported 45 cases of resectable GI cancer, 28 cases needed emergency surgery and the others had an elective resection. ERAS protocols have been applied during this pandemic. Right colectomy, Anterior resection and Low Anterior resection with primary anastomosis were the most common surgeries performed. The other procedures were retroperitoneal tumor resection. The main length of stay was 4.5 days, and no leak anastomosis was reported. 1 patient has not survived the prolonged sepsis condition from the closed-loop obstruction of rectal cancer.ConclusionsERAS protocol for GI cancer during the COVID-19 pandemic was safe, and feasible, and it would reduce the length of stay and be applicable for this prolonged pandemic.
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ObjectiveTo test if patients recovering from COVID-19 are at increased risk of mental morbidities and to what extent such risk is exacerbated by illness severity.DesignPopulation-based cross-sectional study.SettingIceland.ParticipantsA total of 22 861 individuals were recruited through invitations to existing nationwide cohorts and a social media campaign from 24 April to 22 July 2020, of which 373 were patients recovering from COVID-19.Main outcome measuresSymptoms of depression (Patient Health Questionnaire), anxiety (General Anxiety Disorder Scale) and posttraumatic stress disorder (PTSD;modified Primary Care PTSD Screen for DSM-5) above screening thresholds. Adjusting for multiple covariates and comorbidities, multivariable Poisson regression was used to assess the association between COVID-19 severity and mental morbidities.ResultsCompared with individuals without a diagnosis of COVID-19, patients recovering from COVID-19 had increased risk of depression (22.1% vs 16.2%;adjusted relative risk (aRR) 1.48, 95% CI 1.20 to 1.82) and PTSD (19.5% vs 15.6%;aRR 1.38, 95% CI 1.09 to 1.75) but not anxiety (13.1% vs 11.3%;aRR 1.24, 95% CI 0.93 to 1.64). Elevated relative risks were limited to patients recovering from COVID-19 that were 40 years or older and were particularly high among individuals with university education. Among patients recovering from COVID-19, symptoms of depression were particularly common among those in the highest, compared with the lowest tertile of influenza-like symptom burden (47.1% vs 5.8%;aRR 6.42, 95% CI 2.77 to 14.87), among patients confined to bed for 7 days or longer compared with those never confined to bed (33.3% vs 10.9%;aRR 3.67, 95% CI 1.97 to 6.86) and among patients hospitalised for COVID-19 compared with those never admitted to hospital (48.1% vs 19.9%;aRR 2.72, 95% CI 1.67 to 4.44).ConclusionsSevere disease course is associated with increased risk of depression and PTSD among patients recovering from COVID-19.
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Three times a week, Salli Pilcher drives from her home in a northern corner of the Lake District, pulls on a wetsuit and takes the plunge in one of the deepest – and coldest – lakes in England.
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Psychosocial stress, tension, and depression are quite common in many parts of the developed world. Integrative medicine techniques which may potentially increase spiritual and emotional well-being may be useful in combating chronic psychosocial stress, as well as challenges with depression and excessive tension. The present observational study examines the effect of singing-bowl sound healing on emotional and spiritual well-being and particularly examines interrelationships between changes in spiritual well-being with changes in tension and depressed mood post-sound healing. Participants experienced a sound healing environment of vibrational musical instruments such as singing bowls (bell-like instruments), gongs, and other vibrational instruments. Sixty-two participants were examined in an observational study using singing-bowl sound healing. Emotional and spiritual well-being were examined by utilizing standardized questionnaires. Results revealed significant correlations between improvements in scores of spiritual well-being and reductions in scores of tension and depression post-sound healing. Moreover, effects varied by age of the study participants. Specifically, the association between spiritual well-being improvement and depression improvement was strongest for ages 31–40, while spiritual well-being improvement and tension improvement associations were strongest for ages 51–60. Implications for applying sound healing meditations as a potential low-cost, low-technology therapeutic technique are discussed for emotional and spiritual well-being.
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El presente artículo expone un breve análisis de los efectos económicos y en el comercio exterior que han tenido las regulaciones y políticas implementadas a nivel mundial para enfrentar y contener la pandemia de la covid-19, incluyendo: i) restricciones sobre las exportaciones de insumos médicos y de protección personal y facilitación de las importaciones, ii) limitaciones a la movilidad y cierres de fronteras y iii) los efectos de la incertidumbre generada por la emergencia sanitaria en la inversión extranjera directa. Adicionalmente, se propone que una de las consecuencias a largo plazo que dejará la covid-19 será el aumento generalizado de medidas proteccionistas a través de mecanismos de defensa comercial y barreras arancelarias y no arancelarias. Lo anterior en respuesta a las políticas de recuperación económica que implementen los países. Particularmente, China cuenta con un plan de reactivación de exportaciones tan agresivo que tiene el potencial de desencadenar una ola de medidas de defensa comercial en el mundo para contener su expansión en los mercados internacionales. La historia del desarrollo del comercio exterior muestra cómo el aumento en las medidas de defensa comercial ha sido una respuesta normal del mundo ante las graves crisis financieras que se han presentado. En el presente caso, ya se muestran algunos indicios de aumento del proteccionismo en algunos países, especialmente en la industria siderúrgica. Por ende, es probable que, en un contexto de recuperación de la economía mundial por la covid-19, los países continúen adoptando medidas para proteger la sostenibilidad de sus industrias nacionales.Alternate :The following article presents a brief analysis of the effects on the economy and international trade of the rules and policies implemented in the world to face and contain the covid-19 pandemic, including: i) export restrictions on medical supplies and personal protective equipment, as well as import facilitation measures;ii) travel limitations and border closures;and iii) the effects of the uncertainty generated by the sanitary emergency on foreign direct investment. In addition, the paper proposes that one of the long-term consequences of covid-19 will be a generalized increase in protectionist policies through trade remedies and tariff and non-tariff barriers, in response to the economic recovery measures implemented in each country. Particularly, China has such an aggressive exports recovery plan, that it will potentially trigger a wave of trade remedies across the globe, to contain its expansion on foreign markets. The history of international trade development demonstrates that an increase in trade remedies, has been a usual response in the world, after deep financial crisis. In this case, early signs of the increase in protectionism are already appearing in some countries, especially in the steel industry. Thus, it is probable that, in the context of a global economic recovery, countries continue to adopt measures to protect the sustainability of their national industries.