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Introduction: It is well documented that survivors of ICU admissions struggle to return to pre-admission level of function because of both physical and psychological burden. Current guidance therefore recommends a follow-up service to review patients 2-3 months post discharge [NICE 2009]. Prior to 2020 University Hospitals Bristol and Weston had no such service. With the increase in patient numbers seen during the COVID-19 pandemic, funding was received to provide a follow-up clinic to COVID-19 survivors. Objective(s): To provide a service that supports and empowers patients with their recovery from critical illness. Improving quality of life, speed of recovery and reducing longer term health care needs. Method(s): Referral criteria for the clinic included COVID-19 patients who received advanced respiratory support within intensive care and the high dependence unit. 8 weeks post discharge patients had a telephone appointment where ongoing symptoms could be identified. Advice around recovery, signposting to resources and onward referrals to appropriate specialities were provided. At 10 weeks post discharge patients had lung function tests and a chest X-ray which were reviewed by respiratory consultants. Based on the combination of these assessments, patients would be discharged or referred into the multidisciplinary team (MDT) follow-up clinic. The face to face clinic consisted of appointments with an intensivist, clinical psychologist, physiotherapist, and occupational therapist. Where needed patients would also be seen by a speech and language therapist or dietitian. Patients were seen only once in follow up clinic but again would be referred onto appropriate services within trust or the community, including but not exclusively community therapy services, secondary care services, SALT, dietetic or psychology clinics. Result(s): One of the key outcomes was the need for 147 onward referrals (an average of 1.13 referrals per patient). This included, 31 referrals to musculoskeletal physiotherapy outpatients for problems originating or made worse by their admission. 20 referrals to secondary care, including cardiology and ENT. 16 referrals to community occupational therapy, for provision of equipment, home adaptations and support in accessing the community. Subjectively, patient feedback was excellent. When asked what they felt was the most valuable thing they had taken from the clinic they reported: "Reassurance";"To know I'm not alone, others feel like this";"They listened to me and gave advice";"The ability to ask anything I wanted and the obvious kindness and support from all the clinicians I saw". Conclusion(s): Onward referral rates made by the follow-up clinic highlight the many issues faced by patients following discharge from ICU and hospital. With timely recognition and management, we can prevent a majority of these symptoms manifesting into chronic problems. This has the potential to lower the long-term burden on health care and improve quality of life for patients in both the short and long term. Without the follow-up clinic, these issues may have been missed or delayed. This reinforces the importance of the follow-up clinic and the need for ongoing investment.
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Objectives: To assess the knowledge, attitude and practices of preventive measures against COVID-19 infection among pregnant women. It is our understanding that assessing healthcare needs and healthcare education form the pillars for better healthcare thereby this study was conducted. Methodology: An observational cross-sectional study was conducted in which 150 antenatal women were included. Face-to-face interview was conducted by using a self-developed internally validated semi-structured questionnaire based on 3 major domains, Knowledge (10), Attitude (10) and Practice (4), with close ended questions. Each response-correct was allotted score 1 & incorrect allotted score of 0. The responses were described as frequencies and percentages. Scoring system-Poor score<60%, Fair score 60-75%, Good score > 75% of total score in each domain. Result(s): 103(68.7%) had good knowledge and 121(80.7%) had poor attitude, regarding COVID affecting their pregnancy, antenatal visits and unborn baby. 113(75.3%) were practicing preventive habits. Conclusion(s): Our study showed the anxiety and fear related to Covid-19 affected mental health of women and their adherence to antenatal care which needs to be addressed in providing antenatal care services.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
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The stormy clouds of the coronavirus disease 2019 outbreak caused a rapidly spreading epidemic still hanging over the sphere. Any steps to transition toward a new normal should be guided by health authorities, together with economic and societal considerations. There are various items mainly falling into three classifications, including patient worry, clinical demand, and economic recession. Social distancing, lay-offs, and decreased number of patients with health insurance may lead to a prolonged period to retrieve normalcy. To return to a new normal, an individualized management model should be developed for each laboratory based on staff, instruments, services, crowding, physical space, hospital base unit, or outpatient clinic. Continuous training of different occupational staffs is among the key parameters in maintaining this readiness. The proposed response model should have internal and systemic integrity as well as coherence among the included items in two intra- and inter-unit management categories, namely thinking globally and acting locally.Copyright © 2021 mums.ac.ir All rights reserved.
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Intro: This study aimed at evaluating healthcare-related sepses caused by three multi-drug resistant Gram-negative bacteria (Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa) in a tertiary hospital in 2018-2020, particularly concerning therapy, antibiotic-resistance and outcomes, by also comparing the pre-COVID (2018-2019) and COVID (2020) periods. Method(s): An observational, retrospective-cohort analysis was based on data related to patients admitted to the "SS. Antonio e Biagio e Cesare Arrigo" Hospital in Alessandria (Italy) between 2018 and 2020, with septic episodes from bacteria of the examined species, whose antibiogram proved resistance to >= 2 antimicrobial classes indicated by the European Centre for Disease Prevention and Control. Data were retrieved from patients' medical records and the hospital's computer-based application. Statistics involved Fisher-test comparisons and cumulative incidence analyses. Finding(s): Inclusion criteria led to enrolment of 174 patients. Comparison between 2020 and 2018-2019 showed a relative increase in A. baumannii cases, at the expense of the other species (p<0.0001), and an increasing resistance trend for K. pneumoniae, with a higher proportion of cases resistant to 3-4 classes of antimicrobials (p<0.0001). Overall, most patients were treated with carbapenems (72.4%), although the COVID period saw a significant rise in the use of polymyxins, particularly colistin (62.5% vs 36%, p=0.0005). In both periods, more than half patients recovered (53-57%) and around one third died (27-34%), but with different outcomes according to the infecting bacterium, generally better for P. aeruginosa (70% recovered at 60 days) and worse for A. baumannii (55% recovered). Discussion(s): The study confirmed the importance of the burden connected to healthcare-related sepses. Moreover, since the COVID outbreak, a trend could be spotted towards higher relative incidence of complex cases, caused by antimicrobial-resistant bacteria and thus requiring second-line therapy. Conclusion(s): These findings underline the importance of appropriate antimicrobial stewardship and infection control in view of the evolving healthcare needs.Copyright © 2023
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Background: We performed a search in the PubMed databases, Web of Science, LILACS, MEDLINE, SciELO, and Cochrane Library using the keywords COVID-19, Novel coronavirus, corona, 2019-nCoV, SARS-CoV-2, ENT, nose, anosmia, hyposmia, smell, olfactory, ORL, different ENT related symptoms. We reviewed published and peer-reviewed studies that reported the ENT manifestations in COVID-19 laboratory-confirmed positive patients. Main text: Within the included 2549 COVID-19 laboratory-confirmed positive patients, smell affection was reported in 1453 patients (57%). The other reported ENT manifestations were taste disorder (49.2%), headache (42.8%), nasal blockage (26.3%), sore throat (25.7%), runny nose or rhinorrhea (21.3%), upper respiratory tract infection (URTI) (7.9%), and frequent sneezing (3.6%). Conclusion(s): Smell affection in COVID-19 is common and could be one of the red flag signs in COVID-19 infection. With a sensitivity of utilized questionnaire in smell identification, a homogenous universal well-defined COVID-19 questionnaire is needed to make the COVID-19 data collection more sensible.Copyright © 2021, The Author(s).
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Intro: SARS-CoV-2 infection primarily affects the respiratory system. However, other organ systems may also be involved, leading to acute and chronic sequelae. Among other post-acute sequelae, incident diabetes is also being assessed but population-based evidence is still sparse. We evaluated the association between COVID-19 infection including severity of infection and diabetes incidence using population-based registries and datasets. Method(s): We conducted a population-based matched retrospective cohort study using data from the BC COVID-19 Cohort. The exposure was SARS-CoV-2 infection, and the primary outcome was incident diabetes identified >30 days after the specimen collection-date for COVID-19 test. We performed multivariable Cox proportional hazard modeling to assess the effect of COVID-19 infection and disease severity on diabetes. Stratified analyses were performed to evaluate the effect modification of SARS-CoV-2 infection on diabetes risk. Finally, we computed, the confounder-adjusted population attributable fraction from the Cox models Findings: During the median follow-up of 257 days, 608 (0.5%) events were observed among exposed and 1,864 (0.4%) among unexposed. Incident-diabetes rate/100,000 person-years was significantly higher among the exposed group vs. unexposed group (672.2 vs 508.7 respectively). The risk of incident diabetes was higher among those with COVID-19 infection (HR=1.16, 95% CI:1.06-1.28), and among males (aHR=1.22, 95%CI:1.06-1.40). The risk of diabetes was much higher among people with more severe disease (HRICU=3.32, 95%CI:1.99 - 5.54;HRhospitalized=1.97, 95%CI:1.33 - 2.93). Conclusion(s): SARS-CoV-2 infection is associated with higher risk of diabetes overall and among males. Severe SARS-CoV-2 infection is associated with higher risk of diabetes among both males and females. Furthermore, infection with SARS-CoV-2 could contribute to 3-5% increase in burden of diabetes, which will result in substantial number of diabetes cases with impact on healthcare needs for management of diabetes and its complications in addition to health of affected population.Copyright © 2023
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Introduction: Psychological requirements are extremely important in the formation of a person's personality and conduct. During the COVID-19 epidemic in Jouf, Kingdom of Saudi Arabia, the goal of the current study was to determine the psychological and medical requirements of Saudi children. Method(s): The research received responses from 205 mothers in total, 90 of whom were the mothers of male children and 105 of whom were the mothers of female children. The investigation was carried out during the global COVID-19 epidemic that also afflicted the Kingdom of Saudi Arabia. The study made use of a 42-item measure measuring psychosocial and health needs across four categories. Result(s): Whether the study's findings were based on the children's overall score or their academic, psychological, or health requirements, it was discovered that these needs were modest. From the perspective of their moms, neither gender nor class significantly affected the children's health or psychological requirements. Conclusion(s): This study suggests giving the kids family programs to take advantage of and manage their downtime and boost their levels of outdoor exercise.Copyright © 2022, Universidade de Sao Paulo. Museu de Zoologia. All rights reserved.
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Introduction: This article describes the challenges and opportunities that the COVID-19 pandemic presented for providing and coordinating care for children and youth with special health care needs (CYSHCN) who rely on a diverse array of systems to promote their health, education, and well-being. Method(s): Peer-reviewed published literature and reports from the national government and nonprofit organizations that advocate for CYSHCN were examined, particularly concerning systems that impacted CYSHCN during COVID-19. Result(s): Pre-COVID-19, CYSHCN and their families faced challenges accessing and coordinating care across diverse systems. COVID-19 exacerbated these challenges because of disruptions in care and services that negatively impacted CYSHCN. COVID-19 also highlighted opportunities for positive change and care innovations. Discussion(s): Understanding the systems of care that CYSHCN rely on and the effects of COVID-19 on these systems can enhance access to and quality of care. Recommendations are made for practice, leadership, research, and policy.Copyright © 2022 National Association of Pediatric Nurse Practitioners
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Introduction: In the UK between the March 23, 2020 and May 10, 2020, the government enforced a lockdown. This, combined with COVID, caused OMFS hospitals across London to experience a change in staffing, resources and patient presentations. This study examines these changes, how patient care was adapted during this period and what can be learnt for the future. Method(s): Data was collected from OMFS units attached to all 4 level 1 trauma centers in London. Prospective data was collected from March 23, 2020-May 10, 2020 (1st period). Retrospective data was collected from hospital coding records for 23rd of March - May 10, 2019 (2nd period). Data was collected on all referrals to the OMFS team including diagnosis, patient demographics and treatment received. Result(s): There was an 84% reduction in patients presenting with mandible fracture. 2 units with dental emergency services experienced no change in dental abscess presentations whilst the other 2 units saw a decrease of 70-75%. There was a trend towards reducing admission and general anaesthetic treatments. Most mandible fractures were treated in the outpatient setting with 1 unit discharging 100% of mandible fractures that presented to A&E. Only 13 of 72 paediatric lacerations were treated with general anaesthetic. Conclusion(s): The COVID lockdown period, like war time, posed great challenges to healthcare provision. This paper presents the changes experienced and how patients were managed. Aiming to allow reflection and learning to guide changes in management to be adopted for the future.Copyright © 2022
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Purpose: The United States has seen a rise in sexually transmitted infections (STIs);the need to increase access for screening is essential to reverse this trend, especially for vulnerable populations such as LGBT+ individuals, people of color, or those at a low socioeconomic status. This study's primary objective is to assess preferences for mail-in STI screening among participants assigned female at birth already established with a primary care clinic. The study aims to provide insight into the need for clinicians to adopt mail-in testing for patients to improve screening access. Methods: Participants were recruited for this cross-sectional study from a clinical database of established patients with a focus on USPSTF recommendations for STI screening such as assigned female at birth (AFAB) and aged 18–24 years. Recruitment was done through a mailer from September to October 2021, inviting participants to complete an online survey. Statistical analyses were conducted using SAS software (SAS Institute Inc., Cary NC), version 9.4. Results: Overall, there was as a higher preference for home testing (61/88 = 0.69, 95% CI 0.59-0.79) among respondents. LGBT+ identity, age, recent clinical encounter, relationship status, living situation, or race and/or ethnicity, were not statistically significant associated with preference for home testing. However, there were lower odds for preferring home collection among participants with less education (OR 0.25, 95% CI 0.08-0.77, p<0.05), who lacked insurance (OR 0.19, 95% CI 0.06-0.67, p<0.05), or were unemployed (OR 0.28, 95% CI 0.08-0.95;p<0.05). Conclusions: Results from this survey indicate the desire for home testing among individuals from all demographics, influenced by social determinants of health such as education level and employment and insurance status. with overall acceptability for self-collection STI screening through mail-in methods (61/88=0.69;95% CI 0.59-0.79). The rising rates of STIs among young adults and delays in routine STI services secondary due to the ongoing COVID-19 pandemic and budget cuts emphasize the importance of new approaches to STI screening. Primary care clinics can expand needed screening by integrating such methods into workflows for established patients. These findings indicate a need for innovative outreach efforts to curb rising rates of STIs in the United States with additional consideration for research specific to LGBT+ health care needs, updated USPSTF recommendations for screening, and inclusive public health messaging. Sources of Support: Dr. Tana Chongsuwat was supported by the University of Wisconsin Primary Care Research Fellowship, funded by grant T32HP10010 from the Health Resources and Services Administration. The study was funded by a small grant by the University of Wisconsin Department of Pediatrics.
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From the analysis of the national and international literature and considering the socio-demographic changes, it is necessary to rethink the organizational models capable of giving concrete answers to the new health and welfare needs of the population. The progressive increase of the elderly population and of people with at least one chronic disease and the SARS-CoV-2 pandemic have highlighted the need for a health and social system close to the population, which increases the territorial assistance, in particular at the patient's home. Home care must become an elective place for prevention and health promotion activities. PNRR funds for proximity networks, telemedicine and innovation in the health field will enable assistance to be directed towards a new organizational and operational perspective, where the family and community nurse will play a key role. In the care of patients on home dialysis the evidence described in the literature reports the benefits of home hemodialysis treatment, in which the nurse of the family and community through his care skills, technical and psychological counselling, tele assistance and e-health can be integrated into the home care path, assisting the patient and the family unit and supporting them in the different health needs, especially in the quality of life outcome. Copyright © 2022 The Authors.
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Background: In light of the COVID-19 pandemic, gastroenterologists in Alberta moved to virtual care for many clinic visits. As the public health situation evolves, it is important to evaluate provider satisfaction with virtual care during these unprecedented times. Aims: To assess healthcare provider (HCP) satisfaction with virtual care during the COVID-19 pandemic. Methods: We administered a 20-item satisfaction survey that assessed the usefulness, ease of use, interface qualities, reliability, and overall satisfaction with virtual care tools for the delivery of care to patients with gastrointestinal diseases. One hundred and twenty-five gastroenterologists in Alberta were invited to participate via email. We used a modified Telehealth Usability Questionnaire (TUQ) which was open for response from June 19-August 30, 2020. Results: The overall response rate was 19% (24/125) with 46% female respondents. Most respondents worked in an academic facility (63%) and had been in practice for a mean duration of 12.3 years. Respondents were from seven facilities within the South, Calgary, Central and Edmonton health zones. Virtual care reported was a hybrid model consisting of telephone and in-person (54%) or telephone and video consults (42%). Although 90% indicated that virtual care tools improved access to healthcare, provided location flexibility and were appropriate to meet healthcare needs, only 42% agreed that it saved time. Inconclusive virtual consultations due to the absence of physical examination and missing lab values was reported by 75% and 33% of HCPs, respectively. Ninety-five percent of HCPs who used video conferencing found it simple, easy to learn and were able to become productive quickly with it. Over 60% of HCPs reported that virtual care (irrespective of the platform used) was not the same as in-person visits. The mean overall satisfaction for HCPs who rarely or never had virtual care prior to the pandemic, was 0.57 points higher than those who often provided virtual care (4.36 vs 3.79;95% CI: 0.26-0.88, p=0.001). Overall, 88% of providers were satisfied with virtual care and all respondents were willing to use it again (Figure 1). Identified areas of concern included patient safety, patient education on best practices, adequate remuneration, additional administrative duties, and challenges with providing care for new patients on virtual platforms. Conclusions: This survey of GI providers in Alberta showed high satisfaction and acceptance with virtual care. However, the majority reported it to be less reliable than in-person visits. Access to Alberta Netcare to view investigations was deemed valuable. Areas of concern that needs to be addressed include patient education on virtual care best practices and provider resources to assist with new consultations on virtual platforms.
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Background: There are increasing numbers of immigrant children held in government custody at the US-Mexico border and across the US. Further, anti-immigrant policies and the US COVID-19 pandemic response exacerbated detention conditions under the Trump administration. Thus, there is a greater need to identify the health concerns and challenges clinicians face when caring for these children. Methods: A national cross-sectional 66- question online survey was distributed from October 2020 to January 2021 through national pediatric and migrant health listservs including the Academy of Pediatrics (AAP). The reported total number of listserv members was 6200, but the degree of redundancy among these groups was not able to be assessed. Clinicians were asked about care delays, health problems encountered, and resources needed while caring for children under government custody. “Children in government custody” was defined as children (0-17 years) who currently or previously (in the past 5 years) were under the custody of the US Immigration Customs Enforcement, Customs Border Protection and/or the Office of Refugee and Resettlement. Results: Eightytwo clinicians responded and cared for children clinically. Thirty four cared for children who were in government custody. About 1/3 of this subset of respondents noted care delays while in custody and delays in establishing primary care after custody release. The two main health issues seen were a lack of routine health maintenance and traumatic exposures. Most commonly, children were behind on vaccinations and needed mental health screening. Exposure to violence was the most common traumatic exposure. Furthermore, 47% of clinicians felt that their current resources were inadequate and requested legal assistance and mental health support. Importantly, 58% of respondents were not aware of or were unsure of the Centers for Disease Control and Prevention domestic refugee health guidelines for the care of migrant children and adults. Conclusion: Children who experience detention have significant healthcare needs, many of which clinicians do not feel equipped to address. The reported health complications emphasize the need for policy measures, such as those recommended by the AAP, namely, the provision of evidence-based medical evaluations, trauma-informed care, and family-centered medical homes with comprehensive primary care and embedded mental health and legal support systems. Child detention should end. If present, children should be released to ORR shelters with pediatric clinicians providing healthcare and oversite until children can be safely released to vetted legal guardians and established in medical homes. This process should be swift with improved integration of detainment and post-detainment healthcare. Clinicians can be supported with training on immigrant screening guidelines. Of note, the low response rate and inability to distinguish between ICE, CBP, and ORR on the survey limits these results. Nonetheless, these findings support further research and recommendations for policy changes to improve the health and well-being of newly-arrived immigrant children.
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The COVID-19 pandemic limited health care access for individuals with multiple chronic medical conditions. Our aim was to evaluate the impact of COVID-19 on mental health and quality of health care in patients with chronic comorbidities such as DM, HTN and CKD. An online survey was sent to patients over the age of 18 years who have been seen at Joslin during the last 24 months. Surveys were sent to participants by Redcap or conducted through telephone. The survey consisted of 92 items that included COVID diagnosis, General Health, Home self-care, Vaccines, Exposure to COVID, Health- care access and delivery, Perceptions of healthcare quality during the COVID-19 Pandemic, Pregnancy, Mental well-being, Diet and lifestyle, and demographics. Anxiety and depression symptoms were assessed using the Patient Health Questionnaire-4 (PHQ-4). As of November 1, 2021, 1189 had completed the survey. The mean age of participants was 54.2 ± 17.3 years. Half were women, and 89.2% were White. One hundred-six reported to have had COVID-19 infection;94% had diabetes, 36% had HTN, and 8% had CKD. An income of < $50,000 was reported in 9% and 39% were college graduates. While half of the CKD participants felt COVID-19 made their quality of healthcare “worse or a lot worse”, 81% of the participants with CKD felt that their doctors were available to meet their healthcare needs. In addition, the majority of the CKD participants reported to have access to all of their medications during the pandemic. About 48% reported COVID-19 outbreak has negatively affected their mental health with 21% and 11% screened positive for anxiety and depression respectively. Results were similar in patients with CKD. Individuals with depression and anxiety were, more likely to be women and obese. Fifteen percent of the participants with depression and 10.6% with anxiety responded that COVID-19 made the quality of healthcare a lot worse compared to 3.6% in individuals with no depression and 3.3% with no anxiety respectively (p<0.001). The COVID-19 pandemic has made an impact on mental health and quality of healthcare in individuals with CKD.
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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.