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Background: The overarching aim of the study was to (1) investigate how working with COVID-19 patients has impacted work environment, and (2) to identify how factors in the work environment impact adverse health outcomes among hospital personnel (HP), throughout the four waves of the pandemic. Material(s) and Method(s): In a web-based survey altogether 2472 HP participated from four large university hospitals in Norway, whereof N = 680 in April-June 2020 (T1), N = 1073 in December-January 2020/2021 (T2), N = 818 in April-May 2021 (T3), and N = 972 in December 2021-February 2022 (T4). At each time point participants reported on pandemic related work tasks, work environment and adverse health outcomes. Somatic symptoms, psychological distress, posttraumatic stress symptoms and burnout served as outcomes of multivariable linear regression models. The percentage of responders involved in ICU treatment of COVID-19 patients varied between 21% and 40% from T1-T4. Result(s): Reported stressors altered in strength during the 4 waves. Preliminary results indicate that exposure to patients with COVID-19 was associated with more frequent experience of work environmental factors. Compared to colleagues not working with patients with COVID-19 HP reported challenges related to professional competency and training, predictability in teams and work environment, manageable workload, adequate help and support for work stress management, user-friendliness of Personal Protection Equipment and infection protection safety. Furthermore, these environmental factors were associated with symptoms of psychological unhealth on at least one timepoint. Conclusion(s): The results may help guide organizational efforts to maintain professional competency and to reduce stress more efficiently among hospital personnel at different stages in response to long-term crises.
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Aims: The COVID-19 pandemic presented new difficulties for integrated healthcare worldwide. Our study aims to highlight developing needs for cooperation while describing structures and practices of consultation liaison (CL) services established during pandemic across Europe. Method(s): The cross-sectional survey used an ONLINE self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies cooperating in EAPM, and heads of CL services from June to October 2021 Results: 259 hospital CL services took part in the study (28.0% response rate). 222 (85.7%) of these services reported providing COVID-19-related mental health care (COVIDpsyCare). Among them, 192 services (86.5%) reported the development of specialized COVID-psyCare co-operation arrangements. 135 services (50.8%) provided specific COVID-psyCare for patients, 85 (38.2%) for relatives, and 171 (77.0%) for staff, with 56.3%, 14.6%, and 23.7% of time resources invested for these groups, respectively. Interventions for hospital staff, commonly related to the liaison function of CL services, were rated as being the most helpful. Regarding newly emerging demands, 129 (58.1%) CL services stated a need for communication and support among themselves concerning COVID-psyCare, and 142 (64.0%) suggested certain adjustments or enhancements that they thought were crucial for the future. Conclusion(s): Specific structure to provide COVID mental health care for patients, their relatives, or staff were implemented in over 80% of the participating CL services. Resources were primarily allocated for patient care, and staff assistance was mostly achieved through the implementation of specialized interventions. COVID psyCare's development calls for further intra- and interinstitutional cooperation.Copyright © 2023
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Background and Objectives: The effects of COVID-19 on surgical practice are extensive and include modifications to perioperative practice and ways of working, workforce and staffing difficulties, procedural prioritization, intraoperative viral transmission risk, and surgical training and education. There is a lack of information about the way this pandemic has impacted medical professionals because of surgical practice. Aims and Objectives: The current study's goal was to determine the dispersion of COVID 19 through patients to healthcare professionals utilising PPE during emergency surgeries. Material(s) and Method(s): The study was conducted as a hospital based retro prospective observational study at the Department of General Surgery, Government Medical College and hospital of central India. After receiving institutional ethical committee permission and the informed written consent, 36 patients receiving emergency surgeries during COVID-19 Era and 109 health care professionals involved in patient care were evaluated for the onset of any COVID 19 symptom for 5 days postoperatively. All the data collected were analyzed using SPSS statistical software version 26. Result(s): Among these 36 emergency surgeries patients, 86.1% (n=31) had COVID positive report during admission, mostly had complain of respiratory symptoms. Out of 16 COVID positive health workers, 81.25% (n=13) suffered from respiratory symptoms, 43.75% (n=7) had G.I symptoms and 12.50% (n=2) were asymptomatic. Analysis showed a positive relation between COVID positive status and depression in health care professionals (p=0.028). Out of 93 COVID negative health care workers involved in emergency surgeries, 90.32 % (n=84) were asymptomatic. Only 9.67% (n=9) health care workers had respiratory symptoms and 2.1% (n=2) had gastrointestinal symptoms. Conclusion(s): The current study may aid in the development of mitigation measures to enhance mental well-being, as well as the identification of factors of poor mental state and therapies to treat people suffering from a mental condition. Postoperative assessments in a digital environment on an individual basis allow team members to voice their worries and comments to the system as a mitigating technique. Evidence-based training and education for HCWs on pandemic preparation has been shown to be critical for improving hospital staff expertise, abilities, and mental well-being during a pandemic.Copyright © 2023, Dr. Yashwant Research Labs Pvt. Ltd.. All rights reserved.
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Objectives: The objective of this project was to improve healthcare deserts in Sub-Saharan Africa through sustainable knowledge transfer and capacity-building leveraging an advanced cloud-based telemedicine platform. Method(s): In 2022, WTI and its network of partners delivered 2 telehealth devices as part of the effort to create a sustainable platform to address a known health desert in a previously abandoned clinic in the village of Opoji, in the state of Edo, Nigeria. Providers were trained in two cohorts. Global Experts for this project were organized with Providence Health and their Global and Domestic Engagement (GDE) department and trained in telementoring and teleconsulting. Local Specialists were first trained on the platform and then telementored by Global Experts. To better understand the health value outcomes of these interventions, observational research was employed to measure the improvement of patient-to-provider ratios. These ratios were baselined for average patient loads. Result(s): As a result of the pilot, provider-to-patient ratios were improved. Prior to the WTI program, interventions were only available 5% of the time (9 hrs/wk vs 168 hrs/wk), with very basic expertise. After the Opoji Comprehensive Medical Center was reopened and the supporting physicians were scheduled, patients could be seen with a high level of global medical expertise 100% of the time (24 hours per day). Conclusion(s): Telemedicine technology can improve capacity-building in Sub-Saharan Africa with relatively minimal resource allocation in a replicable and scalable manner. Data collection for the pilot did have limitations. The opportunity to collect patient-reported outcomes, including patient satisfaction with telemedicine visits, exists but COVID and other barriers prevented researchers from fully implementing. By mentoring the local specialty hospital staff to deliver care by cloud-based devices, the program has developed an "Africans helping Africans" approach to achieve sustainable capacity building which can be built upon and further researched.Copyright © 2023
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BACKGROUND: The COVID-19 pandemic has exhausted the employees of hospital center and had a negative impact on medical students. AIM: The aims are to show the efforts of Occupational Medicine to provide support for healthcare workers and to increase student's interest in O.M. MATERIALS AND METHODS: Out of the total number of employees of the Clinical Hospital Center Rijeka, which is 3500, 275 of them claim for recognition of COVID-19 occupational diseases in 2022. The 6th-year medical students of the Rijeka Faculty of Medicine, 130 in total and 22 sanitary engineers were surveyed by the quality service regarding their satisfaction with the Occupational Medicine classes. Statsoft Statistica 10 was used to calculate the results. RESULT(S): All HCW are recognized as having COVID-19 as a professional disease. Older age correlated with greater absenteeism. Hospital employees are dissatisfied, tired, they demand work benefits, contraindications for shift work, night work, work in COVID centers, and requesting maternity leave. Many also quit their jobs the hospital management is looking for and hiring new employees, who quickly leave due to difficult working conditions and low incomes. Occupational medicine also has a problem with students. During the pandemic, classes were held online. Interest in classes declined, a small number of students joined the lectures, but all responded to the survey. The answers showed a lack of interest in the Occupational Medicine course. With subsiding of the pandemic, it would be obligatory to continue "live" classes, take students on a tour of industrial facilities, and cancel the failed evaluation of teachers. CONCLUSION(S): Easing of working conditions for HCW and changes in teaching is necessary.Copyright © 2023, Scientific Foundation SPIROSKI. All rights reserved.
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Intro: Uptake of SARS-CoV-2 rapid antigen tests (RATs) for self-testing has been high following authorisation by the Australian Therapeutic Goods Administration (TGA). However, there are no published Australian data assessing feasibility and compliance with home-based rapid antigen testing. The aim of this study was to determine the acceptability of daily rapid antigen self-testing. Method(s): We prospectively recruited a cohort of hospital employees and students from primary and secondary school to perform daily self-testing using RATs in the home over 14 consecutive days. Participants consenting to the study were supplied with 15 Roche SARS-CoV-2 Antigen Nasal Self Tests, 3 saliva swabs for self-collection for RT-PCR and were asked to record results and answer a daily survey using a smartphone application. Finding(s): 38% (26/68) of the cohort were compliant to 14 consecutive days of testing;this was significantly higher in students (71%) than hospital employees (28%). The median number of tests performed over 14 consecutive days was 11 and time to first missed test was a median 5.5 days. The most common reasons for missing days were "I forgot" (37.5%) and "too busy" (8.9%). Ease of self- nasal swabbing, self-nasal testing. performing the test and using the app were rated as comfortable/very comfortable in over 80% of the cohort. Discussion(s): Most study participants in this Australian cohort were compliant with frequent home-based RATs. By study end most participants (93.8%) found the testing process acceptable/very acceptable. There is need for further work on the cost-effectiveness and impact of self-tested RATs under a range of specific uses and conditions. Conclusion(s): This study provided valuable information on acceptability and feasibility of regular home-based testing which could be applied to other diseases. Ongoing community engagement with clear information on RATs including accuracy and use cases is important for decision-making and addressing concerns, particularly for linguistically diverse peoples.Copyright © 2023
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While providing medical care to patients with a new coronavirus infection, medical workers are at risk of developing COVID-19 significantly more often than the general population. In addition to morbidity risks, an important question is the duration of the immune response to COVID-19. The aim of our study is to assess the incidence of COVID-19 and the duration of the persistence of anti-SARS-CoV-2 antibodies among hospital medical staff. Material and methods. We conducted a retrospective non-randomized single-center study, based on the analysis of the laboratory database of the Municipal Clinical Hospital No. 52 (Moscow). The results of the 2160 employees were included into analysis. The inclusion criteria were as follows: at least one result of antibody determination to SARS-CoV-2 in period from June 2020 to January 2021;the date of the last antibody determination to SARS-CoV-2 no earlier than November 1, 2020. Additionally, a group of 100 employees were selected for further investigation of the persistence of immunoglobulin G (IgG) antibodies to SARS-CoV-2. Additionally, a group of 100 employees was selected, who had a confirmed fact of seroconversion for IgG and the presence of at least three results of IgG to SARS-CoV-2 determination with an interval of at least 4 weeks. Results. According to IgG determination results, by January 2021, 66.6% of all hospital employees have already been ill with COVID-19. The medical staff who worked with patients with COVID-19 been ill with COVID-19 in 78.2% of cases. The share of sick medical personnel who did not work with this group of patients was 55.3%. The first termination of antibodies persistence to SARS-CoV-2 from employees was marked from 3-4 months of observation. After 7-9 months, 23% of the observed group became seronegative. Odds ratio for the risk of COVID-19 for medical staff, who worked with COVID-19 patients was 2.89 (95% CI 2.34-3.56) to other medical staff and 3.6 (95% CI 2.82-4.59) to non-medical staff. Conclusion. The incidence of COVID-19 and the risk of infection among medical workers is significantly higher than among the general population, which dictates the need of further improvement of COVID-19 prevention measures among medical workers.Copyright © 2022 by the authors.
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The epidemic of coronavirus disease 2019 (COVID-19) has seriously affected people's normal work, life, and medical treatment. Since Mar. 2022, there has been a pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variant in Shanghai. In order to meet the needs of hospitalization for patients, and at the same time for better control of epidemic and nosocomial infections, a large hospital in Shanghai innovatively set up a centralized transition ward in the hospital, and established scientific rules of medical work, regulations for prevention of nosocomial infections and efficient norms for patient admission. During the operation of the ward, a total of 211 patients were treated and one of the patients was confirmed of COVID-19 recurrence. All work was carried out methodically, and neither hospitalized patients nor medical staff had nosocomial infection of COVID-19. The preparation, operation and management of the central transition ward in our hospital are summarized here to provide guidance and reference for general hospitals to carry out similar work under the epidemic.
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Introduction: Patient satisfaction with services is generally considered the main component of quality of care and can be described as the subjective perception of service quality resulting from the matching of expectations about services with actual experience and results. Therefore, the purpose of this study is to investigate the level of satisfaction of hospitalized patients with a definite or suspected diagnosis of covid-19 from the care staff of covid-19 wards. Methods: In this cross-sectional descriptive study, 172 patients with covid-19 who were admitted to Peymaniyeh Hospital in Jahrom city in 2019 with the diagnosis of corona virus disease were examined. The data collection tool in this study included two questionnaires for demographic information (age, sex, underlying disease, duration of hospitalization, etc.) and a satisfaction questionnaire for the medical staff. Data analysis was done using spss software version 21 and descriptive and inferential statistical tests. Results: The most frequent age was 31-40 years old (22.1%). The satisfaction level of the majority of hospitalized patients from the treatment staff was high, 133 patients (77.3%), the satisfaction level of 37 patients (21.5%) was average, and the satisfaction level of only 2 patients (1.2%) was low. Conclusion: Based on the results of the present study, the level of satisfaction of the majority of patients was reported at a high level. However, the demographic variables (age, sex, marriage, education, occupation, economic status, etc.) of the patients did not have a statistically significant relationship with the level of satisfaction of hospitalized patients with a definite or suspected diagnosis of Covid-19 from the medical staff. Therefore, by implementing continuous training programs and investigating cases of dissatisfaction, we can try to improve the satisfaction of patients as much as possible.
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Purpose of study The COVID-19 pandemic led to an unprecedented rapid transmission of healthcare information. This information was critical to enact frequently changing patient care protocols and to inform staff about redistribution of hospital resources at New York University Langone Hospital- Long Island. In this investigation, we analyze our hospital clinicians' methods of mass communication to front-line health care workers, with particular interest in assessing how communication was informed by real-time clinical findings. At the height of the pandemic (March 25th- April 15th), a mass broadcast email disseminated daily from the Director of Pulmonary and Critical Care was effective in informing treatment protocols that were clinically observed to improve patient outcomes. We analyzed over thirty broadcast emails and identified three major categories of information that were routinely addressed and/or updated: (i) reallocation of resources, (ii) clinical protocol changes, (iii) recommended lab tests for monitoring patient clinical course. We also interviewed key hospital clinicians and administrators on their experience working during the height of the pandemic. We found treatment protocols in these emails included information regarding the use of steroids and monoclonal antibody therapy, ventilators, and patient repositioning. In addition, the hospital's first autopsy results on COVID related deaths gave further insight into the disease process and manner of death for many patients (diffuse alveolar damage and evidence of hypercoagulability). So, too, did clinical findings around this time support what was seen grossly on autopsy-patients with more severe disease often presented with serial d-dimer levels >6x the normal limit. The information through these different conduits was synthesized and subsequently communicated in the aforementioned mass emails as an anticoagulation treatment protocol. Through continuous input of data, this protocol was updated and adjusted over the course of three weeks. We found that real-time communication amongst hospital staff regarding patient treatment protocols was a dynamic process that required synthesis of lab values, autopsy findings, and observed response to treatments. Successful treatment of patients depended on continuous review and communication of this information. Methods used The COVID-19 pandemic led to an unprecedented rapid transmission of healthcare information. This information was critical to enact frequently changing patient care protocols and to inform staff about redistribution of hospital resources at New York University Langone Hospital-- Long Island. In this investigation, we analyze our hospital clinicians' methods of mass communication to front-line health care workers, with particular interest in assessing how communication was informed by real-time clinical findings. At the height of the pandemic (March 25th- April 15th), a mass broadcast email disseminated daily from the Director of Pulmonary and Critical Care was effective in informing treatment protocols that were clinically observed to improve patient outcomes. Summary of results We analyzed over thirty broadcast emails and identified three major categories of information that were routinely addressed and/or updated: (i) reallocation of resources, (ii) clinical protocol changes, (iii) recommended lab tests for monitoring patient clinical course. We also interviewed key hospital clinicians and administrators on their experience working during the height of the pandemic. We found treatment protocols in these emails included information regarding the use of steroids and monoclonal antibody therapy, ventilators, and patient repositioning. In addition, the hospital's first autopsy results on COVID related deaths gave further insight into the disease process and manner of death for many patients (diffuse alveolar damage and evidence of hypercoagulability). So, too, did clinical findings around this time support what was seen grossly on autopsy- patients with more severe disease often presented with seri l d-dimer levels >6x the normal limit. The information through these different conduits was synthesized and subsequently communicated in the aforementioned mass emails as an anticoagulation treatment protocol. Through continuous input of data, this protocol was updated and adjusted over the course of three weeks. Conclusions We found that real-time communication amongst hospital staff regarding patient treatment protocols was a dynamic process that required synthesis of lab values, autopsy findings, and observed response to treatments. Successful treatment of patients depended on continuous review and communication of this information.
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Background: The novel coronavirus SARS-CoV- 2 has caused far-reaching consequences world-wide. Lack of immunity in human, severe airway disease based on a high virulence and its airborne transmission pointed to a significant role of the airways. To investigate immune responses and antibody seroconversion in nasal lining fluid and in serum we examined a cohort of health professionals at the university hospital Klinikum rechts der Isar in Munich. By long-term follow-up of infected and non-infected participants, we were able to investigate the development of local and systemic immunity against SARS-CoV- 2. Method(s): To learn about nasal antibody production we reached out for hospital staff with estimated high risk of a possible Covid19 infection due to their working conditions and staff members suffering from symptoms like fever, cough, loss of smell and taste or sore throat. To detect current infections, we performed SARS-CoV- 2 PCR testing at visit one (V1) and asked our participants to rate possible Covid19 symptoms by filling a questionnaire before every sampling. We eventually included participants, who had been tested positive for SARS-CoV- 2 before (n = 22), as well as people without detected infection, including high-risk contact persons of Covid19 patients and individuals with no Covid-19 infection so far (n = 85). The cohort included 107 hospital staff members, who were sampled six times overall between March and September 2020. Each of the six visits V1 -V6 contained the sampling of serum and nasal fluid to measure IgG, IgM, and IgA rates using immunoassay technique. Result(s): We were able to show the increase of IgA and IgG in the nasal mucosa after recent Covid19 infection. In infected individuals the levels of SARS-CoV- 2 specific nasal IgA increased until V2 with a mean of 4,81 +/- 1,92 mug/l compared to a mean of 0,13 mug/l in non-infected participants, followed by a plateau until V4 and decreased again until V6. Nasal IgG showed a similar trend, apart from a steeper decline after reaching a peak on V2 with a mean of 7,39 +/- 1,63 mug/l, which correlated to the antibody responses in serum. Non-infected individuals showed a mean level of 0,03 mug/l nasal IgG on V2. Serum IgA declined from V1 onwards and hereby showed a quicker drop of systemic antibody levels compared to the nasal lining fluid. Nasal antibody rates reached peaks of 40,00 mug/l (nasal IgA) and 25,74 mug/l (nasal IgG). However, these counts will need further confirmation by a vaccinated control group. Conclusion(s): Nasal measurement of SARS-CoV- 2 specific antibodies provides deeper understanding of mucosal processes while facing inflammation, which may pave the way to less invasive diagnostic possibilities in the future. Furthermore, nasal antibodies built-up after an infection with Covid19 may be protective features concerning a possible re-infection with the virus.
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BNT162b2, an mRNA-based SARS-CoV-2 vaccine (Pfizer- BioNTech), is one of the most effective COVID-19 vaccines and has been approved by more than 130 countries worldwide. However, several studies have reported that the COVID-19 vaccine shows high interpersonal variability in terms of humoral and cellular responses, such as those with respect to SARS-CoV-2 spike protein immunoglobulin (Ig)G, IgA, IgM, neutralizing antibodies, and CD4+ & CD8+ T cells. The objective of this study is to investigate the kinetic changes in anti-SARS-CoV-2 spike IgG (IgG-S) profiles and adverse reactions and their associations with HLA profiles among 100 hospital workers from the Center Hospital of the National Center for Global Health and Medicine (NCGM), Tokyo, Japan. DQA1*03:03:01 (p = 0.017;OR 2.80, 95% CI 1.05-7.25) was significantly associated with higher IgG-S production after two doses of BNT162b2 while DQB1*06:01:01:01 (p = 0.028, OR 0.27, 95% CI 0.05-0.94) was significantly associated with IgG-S declines after two doses of BNT162b2. No HLA alleles were significantly associated with either local symptoms or fever. However, C*12:02:02 (p = 0.058;OR 0.42, 95% CI 0.15-1.16), B*52:01:01 (p = 0.031;OR 0.38, 95% CI 0.14-1.03), DQA1*03:02:01 (p = 0.028;OR 0.39, 95% CI 0.15-1.00) and DPB1*02:01:02 (p = 0.024;OR 0.45, 95% CI 0.21-0.97) appeared significantly associated with protection against systemic symptoms after two doses of BNT162b2 vaccination. Further studies with larger sample sizes are clearly warranted to determine HLA allele associations with the production and long-term sustainability of IgG-S after COVID-19 vaccination.
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Background: SARS-CoV-2 infection poses tremendous challenge to the healthcare system of nations across the globe. Healthcare workers (HCWs) are crucial to the ongoing response to the SARS-CoV-2 pandemic. During the course of their work, they are exposed to hazards that place them at the risk of infection. Serological testing for SARS-CoV2 among healthcare workers, which form a high risk group helps in identifying the burden of hidden infection in an institutional setting. The present study aims to investigate the seroprevalence of IgG antibodies against SARS-CoV-2 among HCWs during 1st and 2nd wave. Material & Methods: A prospective study was conducted at Viral Research and Diagnostic Laboratory, Government Medical College, Amritsar during June July 2020 (1st wave)and April May 2021(2nd wave). During this period, 184 blood samples were collected from healthcare workers from Government Medical College and Hospital, Amritsar. Serum was separated and used for detection of Anti-SARS-CoV-2 IgG antibodies by ELISA technique. Results: Out of the 184 samples, 79 (42.9%) were found to be seropositive. Higher seropositivity was seen i.e 60.8% during the 2nd wave (April-May 2021) as compared to 25% during 1st wave. The increase in seroprevalence was observed in almost all categories of HCWs, Doctors 44.4% vz 13.04%, nurses 54.8% vz 34.7%, lab technicians 72% vz 30.4% and housekeeping staff 72.2% vz 21.7%. Also the unvaccinated HCWs showed higher seroprevalence during the second wave and 87.5% of vaccinated HCWs had demonstrable IgG antibodies. Conclusions: High seropositivity was observed among healthcare workers due to their nature of work. Rise of seropositivity among unvaccinated HCWs during 2nd wave concludes that increase in seroprevalence was attributable to natural infection. The vaccine's immunological response was also highlighted in the study.
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Outcomes: 1. Compare characteristics and clinical outcomes of inpatients with COVID receiving palliative care consultation (PCC) versus those who did not. 2. Elucidate evolution of PCC interventions over trajectory of successive COVID surges. Background/objectives: Palliative care (PC) teams have played an integral role in the care of critically ill patients hospitalized with COVID-19. This study describes how an inpatient, hands-on palliative care team adapted as the viral characteristics of the disease evolved. Method(s): Retrospective chart review of 2,879 patients, hospitalized with a primary diagnosis of COVID-19, at a large, urban academic hospital in Washington, DC from March 2020 through March 2022. Data was collected on baseline demographics, clinical characteristics, hospital course, and palliative care consultations (PCCs). Results were compared between patients receiving PCCs and those who did not. Trends in results were studied across the region's three surge periods, "Initial" (March 2020 to June 2020), "Delta" (November 2020 to April 2021), and "Omicron" (December 2021 to January 2022). Result(s): In-hospital mortality declined over the Initial, Delta, and Omicron surges with mortality rates of 17.5% (n=137), 13.6% (n=121), and 11.2% (n=62), respectively. ICU admission rates declined, with 21.6% (n=169), 21.3% (n=189) and 17.0% (n=94) for each of the surges. 393 (13.7%) patients received a PCC, with consult rates of 12.7%, 12.1%, and 14.3% for each surge, respectively. In-hospital mortality for PCC patients was 47.8% (41.1%, 51.2%, 40.9% by surge) vs. 9.3% for non-PCC (14.2%, 7.3%, 5.6%). Majority of PCC patients had COPD in Initial (87.4%, n=83) and Delta (93.7%, n=119) surges (14.8%, n=13 for Omicron). As hospital staff became acclimated to the pandemic and the sense of urgency declined, the days to PCC increased (7.1, 8.8, 10.1 days, respectively). During the Initial surge, the primary PCC interventions were for symptom management (28.5%, n=290), psychosocial support (18.9%, n=193), and goals of care (14.9%, n=152). Psychosocial support (13.5%, n=172) and goals-of-care (6.3%, n=80) interventions declined during the less acute Omicron surge (13.5%, n=172), while symptom management increased (38.2%, n=488). Conclusion(s): The demographic profile and viral characteristics of COVID-19 patients changed over the course of the pandemic, impacting both patient outcomes and palliative care's interdisciplinary response to the needs of patients and families.Copyright © 2023
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Aim of the study was to assess the current state of implementating key aspects of infection prevention and control (IPC) in Armenian hospitals, defined by the main WHO components, using the survey tool IPCAF (Infection Prevention and Control Assessment Framework). Materials and methods. 113 hospitals were involved in the study. All participants filled out the IPCAF questionnaire, consisting of 8 sections (each rated up to 100 points) devoted to various IPC aspects. Depending on the total final score, IPC programs were divided into the following categories: advanced (601-800 points), intermediate (401-600 points), basic (201-400 points) and inadequate (0-200 points). The study conducted a descriptive analysis of the overall IPCAF score as well as score evaluation of the relevant core components and some selected questions of particular interest. Results. The 2021 total average score for all IPCAF components for all hospitals in Armenia is 578.0+/-7.9 points, which is currently regarded as an "intermediate" level. At the same time, 47 (41.6%) hospitals were assigned to the advanced category, 63 (55.7%) - to the average category and 3 (2.7%) - to the basic category. Analysis of the main IPC components (CC, Core component) revealed that the maximum average scores were obtained for the components CC2 (IPC Guidelines) - 80.8 points, CC8 (Creating a safe environment in medical premises, as well as materials and equipment for IPC) - 75.5 points and CC7 (Workload, staffing and number of beds) - 75.2 points. The lowest average scores were obtained for the key components: CC4 (Surveillance for healthcare-associated infections) with 54.7 points and CC3 (IPC education and training) with 59.5 points. Conclusion. Legislative and practical changes implemented in the real world during the novel coronavirus infection (COVID-19) pandemic have significantly contributed to improved scores for many key components of IPC programs. The study found that the IPCAF is a useful tool for assessing IPC standards and identifying gaps, regardless of a country economic development level. In our opinion, the re-use of IPCAF in all medical institutions should be encouraged, which is important for monitoring changes and trends in IPC, as well as proposing individual strategies in the development and improvement of IPC.Copyright © 2022 Saint Petersburg Pasteur Institute. All rights reserved.
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Introduction: Atrial fibrillation (AF) causes about one-fifth of ischaemic strokes, with a high risk of early recurrence. Oral anticoagulation is highly effective for reducing the long-term risk of recurrent ischaemic stroke in patients with AF. However, its benefit in the acute phase is unclear. OPTIMAS is an RCT aiming to establish the safety and efficacy of early anticoagulation with a direct oral anticoagulant (DOAC). Available evidence and guidelines emphasise the lack of evidence to guide clinicians and support continued randomisation into trials including OPTIMAS. Method(s): OPTIMAS will enrol 3,478 participants with ischaemic stroke and AF from 100+ stroke services in the UK. Participants are randomised 1:1 to early (within 4 days) or standard (day 7 to 14 after stroke) initiation of anticoagulation. Follow-up is at 90 days, blinded to treatment allocation. The primary outcome is the incidence of stroke of any cause, and systemic arterial embolism. Result(s): OPTIMAS opened in June 2019 and is recruiting from 95 sites. 2,053 participants have been randomised as of 29th June 2022. Recruitment and site-set up were reduced during the COVID-19 pandemic, due to national lockdowns and hospital staff being reallocated to COVID-related trials. This did temporarily slow recruitment, but we rapidly developed a successful contingency plan to face these challenges, implementing strategies including: collecting the 90-day follow-ups centrally;obtaining consents by phone;and encouraging sites to sign up to the NIHR Associate PI Scheme to help with trial-related activities. For the last 10 months the trial has consistently been recruiting at least 80 participants per month. Conclusion(s): OPTIMAS will determine the efficacy and safety of early anticoagulation in patients with ischaemic strokes and AF. The trial recruited successfully during the most challenging period of the COVID- 19 pandemic and continues to do so.
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Background Despite lower rates of illness, morbidity and mortality associated with SARS-CoV-2 infection in children during the pandemic, their health and wellbeing has been significantly impacted. Emerging evidence indicates that this includes experiences of hospital-based care for them and their families. As part of a series of multi-site research studies to undertake a rapid appraisal of healthcare workers' perceptions of working during the pandemic, our study focussed on clinical and non-clinical staff perceptions of the impact of COVID-19 on aspects of care delivery, preparedness and staffing which were specific to a specialist children's hospital. Methods This was a qualitative study. Hospital staff were invited to take part in a single telephone interview. Researchers used a qualitative rapid appraisal design. This included a semi-structured interview guide, RREAL Rapid Assessment Procedure (RAP) sheet to share data, audio recording and transcription of interviews, with a framework approach to analysis. Results Thirty-six staff participated representing a wide range of roles within the hospital: 19 (53%) nurses, seven (19%) medical staff, 10 (28%) other staff groups (including radiographers, managers, play staff, schoolteachers, domestic and portering staff, social workers). Three themes related to the impact on children and families were identified: Same Hospital but Different for Everyone, Families Paid the Price and The Digital World. Conclusion Providing care and treatment for children and families changed profoundly during the pandemic, particularly during lockdowns periods. Adaptations to deliver clinical care, play, schooling, and other therapies online were rapidly put into action, however benefits were not universal or always inclusive. The disruption to a central principle of children's hospital care-the presence and involvement of families-was of critical concern to staff. We present perceptions of staff on how changes to the organisation of care delivery within Great Ormond Street Hospital impacted upon children and families.
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While teledermatology has been a feature of some dermatology services for some time, the COVID-19 pandemic has led to both a deterioration in waiting lists for routine patients, and the use of distance consultation as a means of providing and improving access for such patients. The majority of teledermatology platforms rely on general practitioner (GP)-submitted information and images, and most data suggest that these systems result in around 50% of patients avoiding hospital attendance through the implementation of management plans suggested by hospital-based consultants (Mehrtens SH, Shall L, Halpern SM. A 14 year review of a UK teledermatology service: experience of over 40,000 teleconsultations. Clin Exp Dermatol 2019;44: 874-81). We now report the use of an online platform (Virtual LucyTM) using patient-provided information via a structured questionnaire, and patient images uploaded following clear online guidance, reinforced by call centre interaction. The data are derived from funded National Health Service (NHS) work: there was no specific funding for its generation. In total, 3500 patients from two hospital trusts with routine waiting list pressures were invited to use the system as an alternative to eventual hospital attendance. After secure registration, they completed dermatology and general health questionnaires based on conventional medical history taking, as well as a Dermatology Life Quality Index and then uploaded one or more images as appropriate. The patient data were reviewed by a consultant and a self-populated report provided to the patient, GP and trust within 72 h. Forty-eight per cent of patients were discharged to their GP with reassurance or a management plan. Patients requiring hospital attendance were signposted to appropriate clinics (e.g. isotretinoin, phototherapy, patch testing) or to surgical clinics for biopsy or excision. Hospital trust-based consultants were able to access the platform to view images prior to any surgery. Of patients directed to hospital clinics, 32% were reclassified as being urgent - waiting list duration was the main determinant of the need for reclassification. Of all images, 0.5% were unsatisfactory, and those patients were contacted through the platform to ask for a replacement image with specific advice. One per cent of patients were contacted by clinical staff by telephone or video to clarify or expand on the information given, and approximately 1% of patients used the platform to ask for additional treatment details. There were no patient complaints, and GP and hospital staff issues related to logistics were increasingly uncommon as iterative development of the system and support processes occurred. Teledermatology using patient-derived information and images gives similar outcomes to those seen in published conventional teledermatology, puts fewer demands on clinical staff, is popular with patients and has a significant benefit to the NHS.
ABSTRACT
Background In March 2020 and January 2021 Great Ormond Street Hospital (GOSH) staff were redeployed to hospitals in North Central London, to support the care of adult Covid positive in-patients and paediatric services. In addition to providing care for children usually referred to GOSH, the hospital prepared for children who required hospital care who would usually have been admitted to other Paediatric Intensive Care Units across London - units repurposed to provide adult intensive care;and children who would normally receive their care in local hospital paediatric services, many of which were closed as staff were treating adults. Clinical skills training was offered to up-skill non-ward-based staff and provide an update on current techniques utilised in the care of general paediatric patients. Methods Within a wider study to understand healthcare workers' perceptions of care delivery in the context of the COVID-19 pandemic, GOSH staff were invited to take part in a single semi-structured interview by telephone. In our sampling strategy, we purposively recruited staff with experience of redeployment. We employed qualitative rapid appraisal design, RREAL Rapid Assessment Procedures (RAP) for early sharing, interpretation and analysis of data, audio recording and transcription of interviews and framework analysis. Results Recruitment and interviews took place between March and November 2021. Thirty-six GOSH staff were recruited, 18 (50%) participants had been redeployed outside the hospital and 4 (11%) within the hospital. We identified six themes which illustrated staff experiences of redeployment. These included (i) drivers and agency;(ii) preparation for redeployment;(iii) working reality;(iv) impact on family life;(v) professional disruption and (vi) personal challenges. Conclusion Redeployment was reported as both challenging and rewarding. More timely confirmation and bespoke training recognising individual skill sets was recommended. Support structures were available with the majority preferring those developed with close colleagues.