ABSTRACT
INTRODUCTION AND OBJECTIVE: Robotic assisted radical prostatectomy (RARP) is an invaluable whole gland treatment for intermediate, high-risk prostate cancer (PCa). However, a non-negligible proportion of these patients still harbour urinary incontinence and erectile disfunction after surgery. To assess the efficacy of our rehabilitation program in these patients. METHOD(S): A two arm, retrospective study on patients who underwent a RARP at a single institution in two pre-specified time intervals, namely March-July 2019 (study group) and March-July 2020 (control group), was conducted. Patients in the study group underwent a specific rehabilitation program, consisting of counseling with a prostate case-manager, an urologist and a physiotherapist, therefore starting pelvic floor muscle training (PFMT) at least 1-month before RARP. Due to the Covid-19 pandemic restrictions, this structured program was not delivered to the control group. The primary endpoint was the assessment functional outcomes at 30 days, 3 and 6 months after surgery. Continence recovery was defined as no use of pad, while erectile function (EF) recovery was defined as erection sufficient for an intercourse. Secondary endpoints included the following: surgical waiting time (SWT;period from prostate biopsy to surgery), biochemical recurrence (BCR) and/or imaging evidence of progression. RESULT(S): We included 249 patients, 136 (54.6%) in the study group and 113 (45.4%) in the control group. At 30 days after RARP, 49 (36.0%) patients in the study group were completely continent, and 6 (4.4%) had preserved EF as compared to 8 (7.1%) and 0 (0%) in the control group (p<0.001 and p=0.072 respectively). At 3 months, 131 (96.3%) were continent and 30 (22.1%) patients had recovery of EF in the study group, compared with 77 (68.14%) and 9 (8.0%) in the control group (p<0.001). Finally, at 6 months, 134 (98.5%) were continent and 50 (36.8%) had erection sufficient for intercourse in the study group, as compared with 96 (85.0%) and 19 (16.8%) in the control group (p<0.001). Median SWT was 2.9 (2.5-3.1) in 2019 and 5.8 (5.0-7.0) in 2020, (p<0.001). Median follow-up was 42 months (43-44) in the study group vs 32 (31-32) in the control group. No significant differences were observed in the proportion of patients experiencing BCR or imaging disease progression (8.1% vs 2.7%, p>=0.05). CONCLUSION(S): Our rehabilitation program is an valuable tool to enhance functional outcomes in patients undergoing RARP. Further prospective studies are still needed to confirm our results.
ABSTRACT
Background: Inflammatory bowel diseases (IBDs) are a group of conditions characterized by a chronic inflammation of the digestive tract. IBDs can lead to extraintestinal manifestations that concern articulations, skin, liver, kidneys and eyes. Given the complexity of the diseases, patient affected by IBD are monitored by a multi-disciplinary team whose IBD nurse becomes one of the main figure. In 2018, the University of Udine fostered the post-graduate IBD nurse education programme called "IBD nurse case manager", with the aims to a) promote high standards of clinical practice and research initiatives;and b) educate active members of the multi-disciplinary professional network both at national and international level. Method(s): A retrospective observational study has been conducted in 2022. All patients who attended the IBD clinic for administration of biological therapy, gastroenterological visits, training for subcutaneous therapy administration, follow-up for clinical studies (also via calls and/or emails) were included. Descriptive statistic has been used to describe the activity of the IBD clinic from 2018 to 2021 Results: From the 1st of January 2018 to the 31st of December 2021, a total of 1,114 patients (47% females;average age of 45 years) were admitted to the IBD clinic. Outpatient visits were 701 in 2018 and 679 in 2019, while 639 during the COVID-19 pandemic in 2020 and 708 in 2021;from 2020 to 2021 there was an increase of 11% of activities. The number of drug administrations increased by 35% from 2018 (n=353) to 2019 (n=475);also, these endovenous therapies were not modified in 2020 (n=487, +3%) and in 2021 (n=476, -3%). The number of education sessions for subcutaneous therapy decreased by 15% from 2018 (n=30) to 2019 (n=26);then, the number increased by 34% from 2019 to 2020 (n=35) and by 135% from 2020 to 2021 (n=83). Follow-up appointments for clinical studies decreased by 60% from 2018 (n=26) to 2019 (n=11), then, the number increased by 100% from 2019 to 2020 (n=22) and decreased by 20% during 2021 (n=17). In 2020, virtual visits were implemented, with an increase of 458% of phone calls in 2021 (n=1,329) compared to 2020 (n=290). Conclusion(s): Data show that qualified nurses may improve IBD pathways and increase the IBD clinic activities with high quality standards of care. In addition, motivation, satisfaction and willingness to continue education training were perceived among nurses. The collaboration between the University of Udine and the Hospital of Udine showed encouraging results that can be replicated in similar contexts.
ABSTRACT
Introduction & Objectives: Robotic assisted radical prostatectomy (RARP) is an invaluable whole gland treatment for intermediate, high-risk prostate cancer (PCa). However, a non-negligible proportion of these patients still harbour urinary incontinence and erectile disfunction after surgery. To assess the efficacy of our rehabilitation program among patient with intermediate, high-risk PCa underwent RARP. Material(s) and Method(s): A two arm, retrospective study on patients who underwent a RARP at a single institution in two time intervals, namely March-July 2019 (study group) and March-July 2020 (control group), was conducted. Patients in the study group underwent a specific rehabilitation program, consisting of counseling with a prostate case-manager, an urologist and a physiotherapist, therefore starting pelvic floor muscle training (PFMT) at least 1-month before RARP. Due to the Covid-19 pandemic restrictions, this structured program was not delivered to the control group. The primary endpoint was the assessment functional outcomes at 30 days, 3 and 6 months after surgery. Continence recovery was defined as no use of pad, while erectile function (EF) recovery was defined as erection sufficient for an intercourse. Secondary endpoints included the following: surgical waiting time (SWT), defined as period from prostate biopsy to surgery and oncological outcomes, defined as biochemical recurrence (BCR) and/or imaging evidence of progression. Result(s): We included 249 patients, 136 (54.6%) in the study group and 113 (45.4%) in the control group. No significant differences in baseline characteristics, clinical and pathological features were observed between the two groups. At 30 days after RARP, 49 (36.0%) patients in the study group were completely continent, and 6 (4.4%) had preserved EF as compared to 8 (7.1%) and 0 (0%) in the control group (p <0.001 and p=0.072 respectively). At 3 months, 131 (96.3%) were fully continent and 30 (22.1%) patients had full recovery of EF in the study group, compared with 77 (68.14%) and 9 (8.0%) in the control group (p <0.001). Finally, at 6 months, 134 (98.5%) were continent and 50 (36.8%) had erection sufficient for intercourse in the study group, as compared with 96 (85.0%) and 19 (16.8%) in the control group (p <0.001). Median SWT was 2.9 (2.5-3.1) in 2019 and 5.8 (5.0-7.0) in 2020, (p<0.001). Median follow-up was 42 months (43-44) in the study group vs 32 (31-32) in the control group. No significant differences were observed in the proportion of patients experiencing BCR or disease progression between the two groups (8.1% vs 2.7%, p>=0.05). Conclusion(s): Our rehabilitation program appears to be a valuable tool to enhance functional outcomes in patients undergoing RARP. Further prospective studies on larger populations are still needed to confirm our results.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.
ABSTRACT
Background: Sarcomas are rare cancers with complex diagnoses, requiring multimodal management in referral Centers with a dedicated Disease Multidisciplinary Team (DMT). COVID-19 pandemic imposed a sudden revolution in care management leading to activation of digital health tools such as virtual DMT meetings. We investigated how transition from face-to-face (FTF) to virtual meetings (VM) impacted clinical practice in a Sarcoma referral Center in Italy. Method(s): An online survey was administered to the participants of the Sarcoma DMT meetings held between 2020 and 2022 at Regina Elena National Cancer Institute of Rome. The survey consisted of 40 questions inquiring the experience of professionals in DMT meetings, opinions about FTF/VM, future perspectives. Moreover, we retrospectively analyzed the registries of DMT meetings held from March 9th 2019 to March 8th 2022 and we defined three 12-months periods by using the date of National lockdown beginning in Italy (March 9th 2020) as cutoff: a pre-covid, a covid, a post-covid phase. Result(s): A total of 22 healthcare professionals answered the survey: 18 medical doctors, 1 psychologist and 3 data/case managers. The most important changes in VM were better quality of clinical approach and research (22%), technological innovation (50%), and better logistical setting (95%). Between participants, 90% were highly/moderately satisfied with the depth of discussion, 100% declared that attendance was similar (68%) or increased (32%) compared to FTF, 86% thought that decision-making process was not affected, and 95% were still able to interact adequately and access relevant patients' data. 91% thought that VM could be approved hereafter and 100% that would facilitate DMT expansion globally. The median participation rate in Institutional Sarcoma DMT meetings was 58% (95% confidence interval (CI) 55%-60%), 62% (95% CI 48%-71%), and 64% (95% CI 61%-68%) respectively in the pre-covid, covid, and post-covid periods (p 0.0159). Compared to the re-discussed cases, the new ones rose from 30.1% in the pre-covid to 37.9% in the covid and 42.3% in the post-covid period (p<0.0001). Conclusion(s): VM guarantees a great standard of effectiveness in health assistance and should be a suitable or additional tool for the management of patients in clinical practice. Legal entity responsible for the study: IRCCS Regina Elena National Cancer Institute (IRE). Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.Copyright © 2023 European Society for Medical Oncology
ABSTRACT
Objectives: Analyzing the factors associated with improving the work ability index and quality of life in patients with disabilities participating in a return-to-work (RTW) program utilizing a case management system. Method(s): A total of 154 patients, who are disabled workers administered in the Centre of Return To Work in Indonesia, participated in this study during the outbreaks of COVID 19. Utilizing descriptive statistics, the profile of RTW participants has been outlined. Utilizing specific sociodemographic and occupational factors, the association between RTW outcomes was examined. In this study, quality of life has been measured by a validated questionnaire of WHOQoL-BREF and Work Ability Index by WAI questionnaire from The Finnish Institute of Occupational Health. Meanwhile, correlation and logistic regression have been used to study the association between identified factors of quality of life and work ability index. Result(s): The findings indicate that scores of physical health and social domain for quality of life among patients reach higher than other domains in this study which remain 72.93 and 76.14, respectively. However, patients' work ability index is generally considered moderate to excellent with a mean score of 39.3(S.D 4.4). The level of education and all quality of life domains have proven statistically correlated with Work Ability Index (WAI). The level of education and physical health as the domain of quality of life significantly can explain factors associated with the work ability index of patients (p<0.05) who have been involved in the framework of case management. Conclusion(s): Endeavors to strengthen the workability index and quality of life among disabled patient throughout the RTW program might start by ensuring that the case manager made every effort to meet the worker's and employer's commitments to the RTW program outcomes. The factors that may contribute to the association of the work ability index are physical health and level of education. Copyright © 2022
ABSTRACT
Background: The COVID-19 pandemic has impacted our community in many ways, with negative downstream effects on the mental health system. Greater limitations on community resources have resulted in increased emergency room visits for acute mental health treatment. The increase in patients, along with limited resources, has led to patients boarding for hours to days in emergency rooms and medical floors. Method(s): Given the need for acute psychiatric treatment in the ED and medical floor, a rapid psychiatric stabilization (RPS) team was created. This team consists of 2 complex case BH managers, ED BH case managers, advanced practice clinicians, and psychiatrists;they meet virtually each morning to deploy resources where needed. The goal is to start active psychiatric treatment at time of presentation. Result(s): Examples of cases treated by the RPS team: Example #1: J.R. is a 10 yr. old who presented to the ED for increasing aggressive behaviors. Initial recommendation was for inpatient psychiatric admission;however, no bed was able to be secured. A psychiatrist met with J.R. daily and started medication for his aggression. After 4 days in the ED, J.R was stable for discharge, with an aftercare plan arranged by the complex BH case manager. Additionally, the team collaborated with his pediatrician to obtain prior authorization for psychotropic medication until an outpatient psychiatric appointment was secured. Example #2: H.B. is a 28 yr. old who presented to the ED with SI, however, was medically admitted due to being COVID positive. She was treated psychiatrically on the medical floor. As a result, she was discharged prior to her 10-day quarantine was completed, due to her positive response to treatment, and with psychiatric follow up arranged by the complex BH case manager. Prior to establishing the RPS team, discharges from the medical floor would have been difficult due to the inability to set up aftercare. Discussion(s): The American Academy of Child and Adolescent Psychiatry and Children's Hospital Association have declared a national emergency in children's mental health (1). Data from Mental Health America showed that any mental illness has increased 5% nationally, with a 7.6% increase in Pennsylvania (2). Additionally, adults with serious thoughts of suicide have increased 6% nationally and 16% in Pennsylvania. At LVHN-Lehigh Valley, psychiatric emergency room presentations have increased 1,401 (20%) compared to last year and are projected at 8,398. Clearly, demand for psychiatric treatment has grown, creating strain on the limited recourses available. Conclusion(s): The increased need for psychiatric treatment, coupled with the reduction of community resources, will cause psychiatric providers to rethink and redesign care in the post-pandemic world. The deployment of a RPS team to actively treat patients in non-traditional psychiatric settings is just one attempt at dealing with the psychiatric crises. Copyright © 2022
ABSTRACT
Introduction: Pediatric colonoscopy is a routine procedure used to diagnose and treat gastrointestinal conditions. Effective delivery of bowel preparation (BP) instructions is important to achieve optimal cleanout results and can occur in a variety of methods including in-person, written pamphlet, or video. Inadequate preparation has been shown to increase the duration of colonoscopy, potentially increasing the procedural risk and the inability to complete the procedure, which leads to the need for repeat procedures associated with increased costs, risks, and psychological hardships. Thus, several studies have looked at optimal medication regimens for adequate BP and different delivery methods of BP instructions for adult colonoscopies, finding that more BP education results in greater patient comprehension, thereby improving BP scores. Objective(s): However, there is limited information on which delivery method of BP instruction yields optimal cleanouts, specifically for pediatric patients undergoing colonoscopy. The aim of this quality improvement study was to determine if the quality of BP is affected by the method of instruction delivery. Method(s): Our centre's delivery method of BP instructions had historically been in-person by a physician or nurse case manager (NCM), but in 2019 we developed an online video for families to watch instead. From 2019 to 2021, patients aged 0-18 years and their families received either in-person or video instructions (both along with a written pamphlet to take home) on BP prior to colonoscopy. In 2020, due to the COVID-19 pandemic, patients began receiving instructions over the phone, recorded as 'in-person' along with a mailed-out pamphlet. In March 2020, due to staff shortages, some families were only receiving the written pamphlet, so this third modality of instructions were also included in the study. We excluded inpatient BPs, flexible sigmoidoscopies and repeat colonoscopies. Outpatient BP consisted of pico-salax with dosing based on the patient's weight, the day before the procedure. The Ottawa Bowel Preparation Quality Scale was used to score the BP, with a cut-off score <7 as adequate cleanout at the time of colonoscopy. Patient age, indication for scope, method of delivery and time to procedure were captured. Video and pamphlet only groups were combined into one alternative instruction group due to small numbers for statistical analysis. Primary outcome was the differences in BP scores between the in-person and alternative instruction groups. Result(s): Of the 136 patients (mean age 11.51y (SD 4.53)), 81 (60%) received in-person BP instructions (46 from a physician (62.2%) and 28 from a NCM (37.8%) n=74), 25 (18%) received video instructions, and 30 (22%) received pamphlet only. The median time from BP instruction to the scope procedure was 30 days (IQR 14, 49;range 1-116 days), but only captured prior to onset of COVID pandemic. BP adequacy was achieved in 81.2% of patients (Table 1). There were no significant differences in BP adequacy (76.8% vs. 83.6%, p=0.333) or mean (SD) total BP score between in-person and other (video/pamphlet) methods (5.33 (3.0) vs. 5.33 (2.89), p=0.997), respectively. Age was not a significant predictor for BP scores (p>0.094), but indication for scope did predict total BP score, albeit irrespective of delivery method. Patients who underwent colonoscopy for an indication of IBD had higher total BP scores than those without (M=6.81, SD=2.66 vs. M=5.06, 2.93, p=0.005) and patients who had polyp had lower BP scores than those without (M=2.58, SD=2.07 vs (M=5.59, SD=2.89, p=0.001). Conclusion(s): In conclusion, method of BP instruction delivery for pediatric patients undergoing colonoscopy does not impact quality of BP. Further studies are required to explore the role of parental factors such as education, socioeconomic status, or primary language on BP quality as well as the role of waiting times for endoscopy on the retention of information.
ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Societal and cultural barriers that prevent ethnic minorities from achieving health equity include lack of access and misinformation. COVID-19 vaccine hesitancy among ethnic minorities has limited vaccination rates thus hindering the establishment of herd immunity. Vaccination rates in college students aged 18-24 in New York state (NYS) is high (80%). However, in minority populations, college students are much less likely to be vaccinated with rates of 15% in African Americans (AA) and 21% in Latinx individuals. Access to health care also limits young minority populations from sexual health screenings, contributing to a significantly higher rate of sexually transmitted infections (STI) and HIV infection. One in five people in the United States (US) have a STI, and almost half of new STIs occur in teens aged 15-24, with a disproportionately high percentage occurring in AA. Sexual health education and screenings should therefore be focused on this at risk population. Health inequity is often grounded by multiple historical and personal factors, but access to medical professionals is an important element for intervention. DESCRIPTION OF PROGRAM/INTERVENTION: The Ally Care Center at Westchester Medical Center partnered with a local college in New Rochelle, New York to provide a multi-pronged community event. On July 22, 2021 we conducted a virtual session to address questions for the college community. We subsequently brought our multidisciplinary team of medical providers, case managers and psychologists to the college on five occasions to provide COVID-19 vaccinations and sexual health screenings. MEASURES OF SUCCESS: Vaccination rates and STI screening rates FINDINGS TO DATE: Over a total of five visits, 109 members of a predominantly minority college population received the first dose of the COVID vaccine and 98 received the second dose indicating an 89.9% rate of full vaccination. This is about 10% higher compared to NYS COVID vaccination rates in the age group 18-24 years which is 80.9% as of November 2021. Vaccination rates with atleast one dose in minority group adults older than 15 years of age are 15% for AA, 14.6% for Asians, and 21% for Latinx. Fourteen students opted for sexual health screenings, of whom two were found to be positive for chlamydia and treated. KEY LESSONS FOR DISSEMINATION: Health disparities may in part be driven by medical misinformation and lack of access to healthcare providers. Community level outreach events can ensure that routine preventative health strategies are made available to minority populations. These can be most effective when tackling multiple health care needs. These events also provide an opportunity to address misniformation and cultivate trust in medical professionals.
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.
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.
ABSTRACT
Background and Aims: In Spain, HIV, HBV, and HCV prevalence are lower in females. A 2017–2018 Ministry of Health serosurvey in 7, 675 primary care patients found 0.35% and 0.08% chronic HCV infection in men and women. A previous opportunistic, population-based screening program in 11, 449 primary care patients seen in our health department found 0.18% and 0.06% HIV infection prevalence, 1.11% and 0.56% chronic HBV infection prevalence, and 0.73% and 0.25% chronic HCV infection prevalence in men and women from February to December 2019. We aimed to assess HIV, HBV, and HCV prevalence among women seeking care in our health department’s 5 Sexual and Reproductive Health Units (SRHU), in the Human Reproduction Unit (HRU), and the Obstetrics and Gynecology Service (OGS). Method: We implemented opportunistic HIV, HBV, and HCV screening from March to October 2021, despite challenges related to a fifth wave of the SARS-CoV-2 pandemic. We used existing infrastructure and staff, aided by electronic health record system modifications, to identify screening eligibility and request serologies. Patients were eligible for testing upon verbal consent if they were between 18 and 80, and had no record of testing in the previous year, and required blood tests in their current health care visit. Follow-up or discharge was given, regardless of test results. A case manager contacted positive patients to ensure and monitor linkage to specialist medical care. Herein we analyze data from patients aged 18 to 45 — the maximum age of patients seen in the HRU. Results: We screened 934 women, of whom 48.1% (449) in SRHUs, 26.0% (243) in the HRU, and 25.9% (242) in the OGS (26%). Regarding age and nationality,14.6.% (136)were aged 18 to 25, 45.5% (425)were 26 to 35, 39.9% (373) were 36 to 45, and 20.6% (192) were foreigners. We found 1 (0.1%) HIV antibody positive patient (a 45-year-old from the Dominican Republic), 1 (0.1%) HBV surface antigen positive patient (a 36-year-old from China), 1 (0.1%) HCV antibody positive patient, and no HCV RNA positive patients. Conclusion: HIV prevalence among Valencian women in reproductive and sexual health serviceswas similar to the general population in primary health care in the area. In contrast, chronic HBV infection prevalence was low, and chronic HCV infection was not found. Our data suggest that opportunistic HBV and HCV screening of women aged 18 to 45 out of populations at increased risk is an inefficient public health strategy in our area
ABSTRACT
Background: Our study evaluates the efficacy of an outpatient personalized multidisciplinary intervention model guided by comprehensive geriatric assessment (CGA), for pre-frail and frail elderly. Methods: A single-arm self-controlled study was conducted at the outpatient departments (OPD) of a medical center in Taiwan. Subjects received personalized multidisciplinary intervention, including physical therapy, psychotherapy, a nutritional consultation, precise medicine, and social resource linkage, as determined by the results of their CGAs. After 3 months of interventions, change in the proportions of the frail status (frail, pre-frail and robust), functional scores, depressive status, cognition, nutritional status, percentage of inappropriate medication used and social resource usage were analyzed. A logistic regression model was applied to determine the predictive factors associated with an improvement in frail severity. Results: A significant improvement in frail status was found (proportion of frail: 44.5% versus 23.1%, p < 0.001). Physical function, depressive and nutritional status were also significantly improved. 18.5% of participants used inappropriate medications, with benzodiazepine hypnotics the most common (40.9%). 24.2% of subjects were successfully linked to social resources. The presence of the frail phenotypes exhaustion was significantly associated with an improvement in frail severity (odds ratio (OR) = 2.77, 95% confidence interval (CI) = 1.15–6.66, p = 0.023). There was a significant dose response relationship between the improvement of frail status and physical training times (proportion of improved frail status: 23.7%, 40.5% and 47.9% for 0, 1–3, and 4–6 times of physical training, p = 0.03). Conclusion: The reported CGA-based, personalized multidisciplinary intervention model was effective at improving frail severity among pre-frail and frail elderly in OPDs.
ABSTRACT
Awareness practices are mind-body medicine techniques that help quiet the chatter of worry, fear, or the “to-do list” in the mind and allows the individual to experience calm and focus. Neuro-Oncology families undergo a variety of stressors that increase the “mind chatter” once their child is diagnosed with a brain tumor. These families not only have to manage the day-to-day tasks of family life, but they are thrust into a world of uncertainty which often can breed anxiety. To help mitigate the stress and anxiety that Neuro-Oncology families undergo, sessions focusing on awareness practices were offered to parent caregivers once a week for 15-20 minutes via the Zoom platform. The goal of these sessions was to offer respite from mental and emotional challenges brought on by the cancer diagnosis and the COVID 19 pandemic. Separate sessions were also offered to Oncology nurse case managers to help decrease compassion fatigue as these nurses also walk alongside oncology families through the cancer journey providing advocacy and patient/family support. Breath awareness, imagery, and meditation practices were used during the sessions to activate the body's relaxation response to allow for rest and restoration.
ABSTRACT
Rationale: Patients with chronic obstructive pulmonary disease (COPD) suffer heightened morbidity, mortality, and readmission rates. COPD is co-prevalent with obstructive sleep apnea (OSA) in 20-60% of patients, and patients with COPD/OSA overlap are at higher risk for hospital readmission and mortality compared to COPD alone. Current COPD readmission reduction programs are focused on decreasing COPD readmissions;however, few explore impactful comorbid conditions. No study has identified peri-discharge barriers in the acute care setting from the perspective of patients with COPD/OSA or healthcare workers to identify areas of improvement. Methods: Semi-structured interviews, conducted via telephone (recorded) of hospitalized patients with COPD/OSA and acute care healthcare workers were conducted at an urban academic medical center (11/2020-1/2021) among a convenience sample of recruited participants. All recordings were transcribed and uploaded to NVivo, which facilitated thematic analysis, using an a priori codebook. Coding was conducted in rounds, and meetings were used to resolve differences and update the codebook as needed. This iterative process continued until all transcripts were analyzed. Results: Thirty-five participants were interviewed, 27 healthcare workers (HCW), 4 nurses, 6 respiratory therapists, 5 physicians, 3 case managers, 4 social workers, and 5 pharmacists, and 8 patients. The HCWs interviewed served an average of 7.5 years, were <50 years old (81.5%), and most were female (74.1%), white (81.5%), and non-Hispanic (100%). HCW respondents identified barriers that mapped to four main levels: patient, team, hospital, and the healthcare system. Select barriers HCWs identified included health literacy, patient cognitive impairments, peri-discharge time management, lack of resources for patients post-discharge, cost, and insurance. All patient interviewees were <50 years old, most were male (62.5%), white (62.5%), and non-Hispanic (87.5%). Select barriers patients identified included current SES status, care team discussions, disease burden (visits to ED/hospital), follow-up care (including transportation), and perceptions of healthcare due to COVID-19. Conclusion: Healthcare workers and COPD/OSA patients report multilevel hospital discharge barriers. To improve barriers to care for these complex patients, multilevel interventions addressing noted barriers are needed.
ABSTRACT
Introduction: Acute eosinophilic pneumonia (AEP) is an uncommon lung disease. Its incidence and epidemiology remain understudied till date. The hypothesized etiology of AEP is an acute hypersensitivity reaction to an inhaled antigen such as tobacco smoke and other peculiar environmental factors. Vaccines as triggers of AEP, albeit very rare, have been reported in the literature. Case presentation: A 64-year-old male with history of hyperlipidemia on atorvastatin presented to the emergency room with complaints of cough productive of pink tinged sputum, exertional shortness of breath, chills and fever with maximum recorded temperature of 101 °F. His symptoms started within a few hours of receiving tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine two days ago. He denied any recent travel. He was a lifelong non-smoker and was employed as hospital case manager. His vitals were significant for tachycardia 116/min, tachypnea 30 breaths/min and SaO2 of 93 % on 10L. On physical examination, he was noted to have coarse and diminished breath sounds in both lung fields. Initial lab work showed elevated leukocyte count of 20.4 k/uL with absolute eosinophil count of 1.6 k/uL. Other labs were unremarkable. Diffuse bilateral reticulonodular and alveolar opacities were visualized on chest X-ray. Computed tomography (CT) of the chest showed profuse pulmonary nodules, scattered ground glass opacities and septal thickening concerning for bilateral multifocal pneumonia (figure 1). Blood cultures and sputum cultures were obtained and he was empirically treated with ceftriaxone and azithromycin. Sputum eosinophil smear was positive raising concerns for fungal and parasitic infections. Cultures remained negative and his hypoxia worsened. Thus, infectious diseases and pulmonology were consulted. Extensive infective disease work-up for bacterial, fungal, parasitic and viral pathogens came back negative. CT guided biopsy of a lung nodule demonstrated interalveolar eosinophil and fibrin deposition consistent with eosinophilic pneumonia (figure 2). Patient was started on glucocorticoids with dramatic improvement in his symptoms, imaging and oxygen needs. With his symptom onset following Tdap vaccine and negative infective work-up, AEP was suspected to be triggered by the vaccine. Discussion: AEP provoked by vaccination is rare. Cases have been reported with influenza, pneumococcal and also COVID-19 vaccines. To the best of our knowledge, this is the first report of AEP following Tdap vaccine in adults. Only up to 30% of patients with AEP will have peripheral eosinophilia. Diagnosis is usually confirmed on lung biopsy and patients respond very well to glucocorticoids.
ABSTRACT
The proceedings contain 307 papers. The topics discussed include: participation of elderly, cognitively impaired cancer patients in end-of-life decision-making: a qualitative study using non-participant observation;a qualitative study of experience of patients living with chronic obstructive pulmonary disease in the primary care setting in Cape Town;national multicenter cross-sectional study to identify medical, social and ethical problems of the elderly population in Georgia;facilitated online video interviewing with older people with advancing frailty: a novel approach to co-production;what contributes to or hampers living at home until the end-of-life with advanced dementia? an interview study among family caregivers, general practitioners and case managers;participation of cognitively impaired cancer patients in end-of-life decision-making ? barriers and facilitators;needs and problems of people with dementia living at home: a mixed methods study;and patterns of deaths in people with dementia and Alzheimer's during the COVID-19 pandemic in England: lessons for palliative care before the next pandemic.
ABSTRACT
Background: The American Case Manager Association defines Case Management, in Lifestyle Medicine perspective, a collaborative practice between all the actors involved in the care process. The goal of this review was to evaluate the Nurse Case Manager role in Type 2 Diabetes patients, analyzing the quali/quan-titative data related to Nurse Case Management programs in Lifestyle Medicine view. Study design and Methods: Three independent operators were involved in two distinct phases, applying the Prisma method, specifics PICOS and research strategies from PubMed and Cinahl. The first part integrated a Cochrane systematic review on the Specialist Nurses in Diabetes Mellitus, while the second part evaluated the Nurse Case Manager interventions in Lifestyle Medicine view. Results: The first part includes 13 studies and the second 6. The glycemic control was improved in the Nurse Case Manager groups in Lifestyle Medicine perspective. Good results were appreciated in secondary outcomes: lipid profile, Body Mass Index, quality of life and stress management. The results for the management of self-care and adherence to Lifestyle Medicine programs are encouraging. Conclusions: It emerged unequivocally that, taking care and supporting the diabetic subject, leads to significant benefits in the general health and to reduction of possible complications. After the Covid-19 Pandemic, the Nurse Case Manager Lifestyle Medicine could represent a valid alternative of health management for the improvement of care in Type 2 Diabetic patients.
Subject(s)
COVID-19 , Case Managers , Diabetes Mellitus, Type 2 , Diabetes Mellitus, Type 2/therapy , Humans , Life Style , Pandemics , Quality of LifeABSTRACT
Background: Gynecological cancers of the uterus and cervix are common malignancies in women. The correct management of these tumors involves many figures. Material and methods: Therefore, to respond to these multidisciplinary needs in June 2019 in Azienda Ospedialiero-Universitaria of Modena was born a Diagnostic and Therapeutic Care Pathways (DTCP) with gynaecologists, radiotherapists, medical oncologists, radiologists, nuclear medical doctors, pathologists, anaesthesiologists, a nurse Case Manager and a patients' association representative. A molecular biologist, endocrinologists and nutritionists have already enriched the team after the first year of activity. The group performs weekly collegial discussions of clinical cases and cohort visits, continued in the COVID era. Results: The new diagnoses in the first year of activity were 53 endometrial cancers (EC) and 24 cervical ones (CC). The median age at diagnosis was 51 years between EC patients and 70 years in CC. 87% of EC were endometrioid subtypes, while 65% CC were squamous cell ones. 70% EC patients (pts) were stage (st) I (52% IA and 48% IB), 5,5% st II, 9,4% st III and 11,3% st IV. Immunohistochemical analysis for estrogen and progesterone receptor, p53 and mismatch repair (MMR) proteins were performed on 20 EC. All tumours tested are p53 negative. We found 3 pts who had MMR deficiency, none of them diagnosed with Lynch syndrome at the subsequent genetic counselling. After surgery, 66% pts in st I underwent observation and 34% made radiotherapy (RT). Among st II pts, 1 patient performed RT, one other platinum- based chemotherapy (pCT) and the third did not perform any adjuvant treatment for ECOG. All except one st III pts (67%) underwent pCT with RT. Among st IV one received surgery, pCT and palliative RT, the others (83%) made pCT. Most CC were diagnosed in early st. 9 pts underwent upfront surgery, followed in 2 cases with RT and in 3 with RT and pCT. One patient received neoadjuvant chemo-RT. Radical RT with weekly cisplatin was performed in 9 pts, other 4 pts made RT alone due to advanced age and/or ECOG. One patient started observation for age, ECOG and absence of symptoms. Conclusions: In our experience, DTCP allows the optimization of the diagnostic and therapeutic strategy in EC and CC pts, especially in most complex cases.