Functional Impact of Telehealth Physical Therapy Services on Patients Post Hematopoietic Stem Cell Transplant

BACKGROUND AND PURPOSE: Stem cell transplantation (SCT) in patients with hematological cancers results in longstanding physical changes. Commonly reported symptoms include chronic fatigue, global weakness, interference with activities of daily living (ADLs) and aerobic deconditioning. Aside from the sequela of symptoms experienced post SCT, these patients remain in an immunosuppressed state for several months following discharge from the hospital. Patients are often advised by their medical team to isolate themselves unless to attend follow-up outpatient clinic appointments. With the COVID-19 pandemic, this functional gap in the continuum of care worsened. As a result, SCT patients are both hesitant and discouraged to pursue outpatient or home health physical therapy even when these services are warranted. Thus, there is great need for options to safely optimize function for people post-SCT that are suitable in today's ever-changing environment. The purpose of this case series is to describe the functional impact of incorporating telehealth into the continuum of care for post SCT patients. CASE DESCRIPTION: 9 patients post inpatient admission for SCT were triaged to telehealth PT based on their scores on the Short Physical Performance Battery (SPPB) and the Activity Measure for Post Acute Care (AM-PAC) at the time of discharge from inpatient care. Scores on the SPPB ranged from 5-11, and AMPAC scores ranged from 21-24, demonstrating physical impairment. Patients were scheduled to receive telehealth twice a week. Sessions consisted of therapeutic exercises monitored via secure video software. Lab values were monitored via electronic medical record to assess appropriateness for therapy prior to each session. Rating of perceived exertion (RPE) scale and patientowned pulse oximeter were used to monitor patient fatigue levels. Patients' progress was assessed via Lower Extremity Functional Scale (LEFS), Brief Fatigue Inventory (BFI) and 5-times sit to stand (5xSTS) scores. OUTCOME(S): One year post telehealth implementation, patients reported improved independence and achievement of selfselected goals. Notable patient quotes include, "I feel less fearful in climbing up and down the stairs, and I feel more independent with laundry and cooking.which was very important for me." Additionally, patients reported a decrease in LEFS and BFI scores. Initial LEFS scores averaged 40% and dropped to 20% by discharge. Similarly, BFI scores dropped by 2 points at discharge, reflecting improved self-reported functional performance and a return to pre transplant fatigue levels. 5xSTS scores decreased by greater than 3 seconds in 6 of 9 patients, with one patient performing where previously unable. DISCUSSION: Telehealth services provide an additional method of care delivery to those unable to seek it in the traditional sense. For the severely immunocompromised, physical therapy via telehealth provides direct connection to providers trained in oncology rehabilitation serving as a feasible bridge between inpatient and outpatient care for amelioration of side effects associated with SCT.

Falsified medicines at the times of COVID-19 pandemic: some AIFA cases and experiences

Gathering and analysing the signals from the field is a key practice in counteracting pharmaceutical crime: the connection between the units dealing with pharmacrime and enforcement/customs offices is quite obvious, but also the networks set up for pharmacovigilance, quality defects, distribution, e-market, GXP should be properly considered, since suspicious signals may be found in reports that are usually not considered in terms of possible criminal behaviours, as it happened in 2014 with the Volcano Operation led by AIFA, that was triggered by a quality report, allowing to discovered an impressive scheme for falsification, theft and laundering of medicines at European level. The usual reports that the AIFA competent office submit to in-depth analysis relate to: * medicines without Marketing/Import Authorization in Italy, found at customs following passengers or in courier shipments;* medicines in transit at Italian customs offices, coming/going from/to third countries;* medicines from third countries, lacking any authorization in Italy, intended for local communities in Italy;* medicines without AIC in Italy, found in points of sale not authorized for the marketing of medicines or illegally held, in large quantities, by unauthorized private parties;* pharmacologically active medicines/active substances, the subject of suspicious commercial transactions between third countries;* falsified medicines, found in Europe and in non-EU countries;* medicines bearing falsified machine-readable stickers;* stolen medicines;and * illegal websites. In this framework, the increase in the use of e-commerce (due to lockdown and pandemic), increasing demand for 'miracle medicines' against COVID-19 and other diseases: illegal framework (and strategies) are changing, as it is reflected in the most recent recurring cases that were investigated, that is, * Traditional Chinese Medicines without authorization in Italy (customs and local shops);* Non authorized medicines marketed as cosmetics (local shops);* Medicines against relevant diseases, e.g. psoriasis, sold as cosmetics (online market);* Counterfeit OTC products from unauthorized channels (online market);and * 'Miracle medicines' for the prevention of COVID-19 (online market and local distribution). The increase in the use of e-commerce (due to lockdown and pandemic) is changing the channels for offering: social network had a major role in creating the demand for 'miracle medicines' against COVID-19, mirroring the one we already know for other diseases. This change in the offer also triggered a change in the communication strategy: the need for a reaction to the so-called 'infodemic', that is, the outbreak of fake news, mainly circulating through social network, forced AIFA to find proper models for showing the whole framework behind many apparently nonrelated issues, underlining the danger related to the new channels/products, more than their illegality.

A review of infection prevention and control guidelines for dental offices during the COVID-19 pandemic in mid-2020

Background: The COVID-19 pandemic was a challenge for all dental professionals who had to rapidly update infection prevention and control (IPAC) guidelines and protocols due to increased risk of SARS-CoV-2 transmission during common aerosol-generating procedures (AGPs), and a lack of consensus on how best to mitigate the risk of transmission in a dental office. Thus, the purpose of this descriptive study was to compare the variance in IPAC guidelines for dental offices that emerged, and to assess practice consistency from early to mid-2020. Methods: A comprehensive literature search was conducted from May 26 to July 8, 2020 for IPAC documentation specific to the dental office during the COVID-19 pandemic. Documents that met the inclusion criteria were independently reviewed. Data was extracted using a framework based on the following IPAC domains: pre-appointment, waiting room, personal protective equipment (PPE) selection, treatment room, and post-dismissal. Results: A total of 67 IPAC documents specific to dental offices were reviewed in this study. Included documents originated from 22 dental associations, 17 peer-reviewed articles, 13 dental regulators, 11 government bodies, two public health units, and two dental corporations. There was a great degree of variance with IPAC guidelines from the pre-appointment stage, during treatment, and post-treatment. Recommendations that emerged with some level of consistency involved pre-screening patients for COVID-19 symptoms (97%), staggering appointments (84%), social distancing, minimizing occupants in the waiting room, wearing a face shield over protective eyewear for AGPs (92%), and preprocedural rinses (84%). There was less consistency with recommendations for consolidating multiple appointments (36%), waiting room ventilation (46%), N95 masks (47%) versus FFP2/FFP3 masks (30%) use for AGPs, fit-testing respirators (37%), enclosing open operatories for AGPs (28%), prioritizing minimally invasive procedures (30%), and using third-party laundry companies (32%). Conclusions: The risk of SARS-CoV-2 transmission, lack of consensus on mode of spread, and need for rapid action resulted in a significant variation in most downstream IPAC interventions in the hierarchy of controls, including choice of PPE, treatment room, and post-dismissal domains. Upstream interventions, including pre-appointment and waiting room domains, were relatively consistent in practices in early to mid-2020.

Effect of Pregelatinized Starch on the Properties of Poly (Vinyl Alcohol) Film for the Water-Soluble Laundry Bag

The goal of this study was to develop pregelatinized starch (P-St) and polyvinyl alcohol (PVOH) films as water-soluble laundry plastic bags to avoid having contact with COVID-19 infected clothes by extrusion method. The effects of pregelatinized starch (P-St) content on the properties of polyvinyl alcohol (PVOH) films were examined. PVOH and P-St blend were compounded by twin-screw extruder with various P-St content of 0, 10, 20, 30, and 40% by weight with fixed glycerol content of 20 phr. The blend films were produced by blown film extrusion. The chemical structure, thermal properties, water-solubility, mechanical properties, and the cross-sections morphological properties of PVOH/G/P-St were characterized. As a result, the formation of intermolecular interactions between PVOH, glycerol and P-St was confirmed by FTIR. Moreover, the addition of P-St on PVOH could reduce the thermal stability due to the content of P-St with amylose, a substance of amorphous structure, affecting the chains flexibility of PVOH/G/P-St. From the differential scanning calorimeter result, the glass transition temperature was increased with the increment of P-St content because the chains entanglement between PVOH and P-St had affected the reduction in crystallinity and led to the decrement of the melting temperature. Furthermore, the water solubility would strongly be dependent on the percentage of the gelatinized starch (%GS). The solubility decreased as the percentage of the GS increased. In addition, PVOH with 20% of P-St film possessed the highest value in tensile strength and modulus, and the particles of P-St have a good distribution in PVOH/G indicating to stronger interaction of P-St and PVOH/G. © 2022, Chiang Mai University. All rights reserved.

Only half of global healthcare facilities have basic hygiene services, says WHO

Half of the world’s healthcare facilities lack basic hygiene services, a new report by the World Health Organization and Unicef has found.1 An estimated 3.85 billion people would be at risk of contracting an infection if they visited their local healthcare facility, from not being able to wash or sanitise their hands at points of care and near toilets. A lack of basic hygiene can be deadly, particularly for vulnerable people, as pathogens spread easily from contaminated hands in healthcare facilities, said Kelly Ann Naylor, Unicef’s director of WASH and climate, environment, energy, and disaster risk reduction (CEED). “Healthcare workers need water for all kinds of purposes: for hand hygiene, cleaning laundry, for decontamination of medical devices.”

Occupational skin dermatoses as a result of Covid-19 prevention practices

Introduction: Occupational skin diseases (OSD) account for a significant proportion of occupational disease. High risk occupations for OSD include workers in the healthcare, food service, metal-working, hairdressing and construction industries. The prevention of the COVID-19 virus has increased the use of personal protective equipment (PPE), handwashing and cleaning practices globally. Methods: We will cover the first hand experiences gained during the pandemic, by reviewing the presentations of OSD at a dermatology clinic as result of COVID-19 practices. Results: During the pandemic, the use of PPE created occlusive and humid environments particularly exacerbating underlying skin conditions. This phenomenon was not exclusive to high risk OSD occupations. Atopic individuals at risk of OSD had an increased susceptibility to irritant contact dermatitis (ICD) as a consequence of using hand sanitizers and additional hand washing. Furthermore more exacting cleaning practices provided exposures to additional irritants and allergens, such as laundry rinses containing benzalkonium chloride (BAK) and fragrances in personal care products. Patch testing proved useful in diagnosing and treating patients, which allowed workers to return to work. Conclusions: Personal protective practices adopted during the pandemic adversely affected workers, especially those with underlying skin conditions. This included the use of PPE, increased hand washing and sanitizing practices as well as increased cleaning practices. Treatment of underlying skin disorders as well as education on skin protection has been pertinent during this time.

Health care worker knowledge and attitudes towards uniform laundering during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic raised concerns towards domestic laundering of healthcare worker (HCW) uniforms; this is common practice in countries such as the United Kingdom (UK) and United States. Previous research suggested 4-32% of nurses did not adhere to laundry policies, which could be an infection control risk. This study aimed to investigate the knowledge and attitudes of UK healthcare workers towards domestic laundering of uniforms during the COVID-19 pandemic. METHODS: Online and paper questionnaires were distributed to HCWs and nursing students who regularly wear uniforms. Differences in knowledge between HCWs were analyzed by Chi-squared tests and attitudes were examined using exploratory factor analysis. RESULTS: About 86% of participants (n = 1099 of 1277) laundered their uniforms domestically. Respondents were confident in laundering their uniforms appropriately (71%), however 17% failed to launder at the recommended temperature (60°C). Most participants (68%) would prefer their employer launder their uniforms, with mixed negative emotions towards domestic laundering. Limited provision of uniforms and changing and/or storage facilities were a barrier to following guidelines. CONCLUSION: Most HCWs domestically launder their uniforms, despite a preference for professional laundering. One-fifth of HCWs deviated from the UK National Health Service uniform guidelines; onsite changing facilities were the most significant barrier towards adherence.

Granular Parakeratosis secondary to benzalkonium chloride exposure from laundry rinse aids

Introduction: Granular parakeratosis (GP) is a dermatosis characterised by a rash at intertriginous sites. The pathogenesis is uncertain although it is proposed to be an irritant contact reaction with cases related to benzalkonium chloride (BAC) reported. This study aims to review the clinical presentation and histopathological features of GP. Methods: This study is a retrospective case series of adult and paediatric patients seen at private and public dermatology clinics in Auckland, New Zealand between 2015 and 2020. Information is collected on patient demographics, presentation, investigation and management. Results: Twelve cases (seven adults, five children) are included. The typical presentation of GP was erythematous or brown, scaly papules and plaques with desquamation in a predominantly flexural distribution. The rash was also observed in the anterior neck, natal cleft and helices of the ears. All patients reported recent exposure to BAC in laundry rinse solution and creams commonly found on the consumer market. Ten biopsies were taken from four patients. Psoriasiform and eczematous findings were common on histopathology. The mainstay of treatment was cessation of BAC exposure. Conclusion: GP has a distinct clinical pattern although histopathological findings are varied. Our experience is that patients often have delayed diagnosis. Clinical diagnosis is usually possible and resolution of GP typically follows avoidance of BAC. Clinicians should have a high index of suspicion for GP in patients presenting with erythematous flexural eruptions and seek a history of exposure to BAC, especially in context of the COVID-19 pandemic and increased antiseptic use.

Patient perspectives regarding a 7-day therapy model during the onset of COVID-19

Background: COVID-19 presented unique challenges for patient wellbeing in tertiary SCI rehabilitation settings. Patients had long evening and weekend stretches to occupy themselves while isolated from their family and support network without access to volunteers, peer mentors, recreational outings or weekend passes. Objective: To describe the outcomes of a 7-day therapy model implemented during COVID-19 (Apr-Aug2020) from a patient perspective. Method: The pandemic provided an opportunity to redeploy outpatient staff to the inpatient program, and provide therapy services 7-days/week for 12 hours/day (vs. 5 days/week for 8 hrs) to: 1) enhance physical distancing ;2) intensify inpatient therapy;3) create opportunity to practice skills prior to discharge;4) facilitate daily e-visits (visitor restrictions);5) increase recreation/leisure offerings;and, 6) increase supportive care on units. In total 6 PT's, 4 OT's, 2 Assistive Technology Staff (ATS) were redeployed. Enhanced recreation therapy evening programs (bocce, movies, relaxation, adapted sport, etc.) and extended gym hours were provided. Supports for feeding, laundry, activities of daily living (ADL), 2, and e-visits were established. Leadership team worked extended hours and weekends. Seating clinic staff supported wheelchair prescription and ADP processes. Patient surveys were designed and piloted by the Toronto IES team to evaluate the effectiveness and impact of the enhanced therapy schedule. Data were analyzed by postdoctoral fellows (GJ and RA) using appropriate descriptive statistics or qualitative methods. Participants: Patients & tertiary academic staff. supported wheelchair prescription and ADP processes. Patient surveys were designed and piloted by the Toronto IES team to evaluate the effectiveness and impact of the enhanced therapy schedule. Data were analyzed by postdoctoral fellows (GJ and RA) using appropriate descriptive statistics or qualitative methods. Participants: Patients & tertiary academic staff. Findings: Thirty inpatients, 77% male, 6 paraplegics and 24 tetraplegics, majority of non-traumatic etiology, with a median 57-80 day LOS indicated their preference for a 6-day (vs 7-day) therapy model.Weekend recreational programs had the best attendance, while recreational programming attendance was a predictor of greater program satisfaction. A majority of inpatients indicated their preference for 6-day per week programming indicating they would appreciate a day of relaxation (which could still be therapeutic, just less physical and more recreational perhaps). Conclusion: Temporary redeployment of staff resulted in increased inpatient support services and therapy availability. Study results underscore the importance of role clarity and goal setting, therapeutic recreation services, especially on weekends;the potential value of a 6-day therapy model;and, our reliance on volunteer and family caregiver services, therapeutic and weekend passes as essential components of care.

Yet Another Potential Age-Old Nonpharmaceutical Intervention

Social conventions of the day kept Morisot from pursuing the same subject matter as her male counterparts, such as Monet and Renoir, who often painted popular sites of leisure around Paris. Because Morisot liked to paint outdoors―and frequenting such sites without a chaperone would have invited scandal―she instead depicted domestic scenes, landscapes, and portraits, stating, “It is important to express oneself, provided the feelings are real and are taken from your own experience.” According to exhibition notes from the Barnes Foundation, “Working women are a recurring subject in Morisot’s painting. October 19, 2021 The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Volume 27, Number 11—November 2021 About the Cover Yet Another Potential Age-Old Nonpharmaceutical Intervention Downloads Article ------------ RIS [TXT - 2 KB] Article Metrics Metric Details Related Articles Coronavirus Vaccine Breakthrough Infections ------------ Postvaccination MIS-A with No Prior Infection ------------ SARS-CoV-2 Associated with Large Public Gatherings ------------ More articles on Vaccine, Immunization Kathleen Gensheimer and Byron BreedloveComments to Author Author affiliations:

Quantifying pathogen infection risks from household laundry practices.

AIMS: Contaminated laundry can spread infections. However, current directives for safe laundering are limited to healthcare settings and not reflective of domestic conditions. We aimed to use quantitative microbial risk assessment to evaluate household laundering practices (e.g., detergent selection, washing and drying temperatures, and sanitizer use) relative to log10 reductions in pathogens and infection risks during the clothes sorting, washer/dryer loading, folding and storing steps. METHODS AND RESULTS: Using published data, we characterized laundry infection risks for respiratory and enteric pathogens relative to a single user contact scenario and a 1.0 × 10-6 acceptable risk threshold. For respiratory pathogens, risks following cold water wash temperatures (e.g. median 14.4℃) and standard detergents ranged from 2.2 × 10-5 to 2.2 × 10-7 . Use of advanced, enzymatic detergents reduced risks to 8.6 × 10-8 and 2.2 × 10-11 respectively. For enteric pathogens, however, hot water, advanced detergents, sanitizing agents and drying are needed to reach risk targets. SIGNIFICANCE AND IMPACT OF THE STUDY: Conclusions provide guidance for household laundry practices to achieve targeted risk reductions, given a single user contact scenario. A key finding was that hand hygiene implemented at critical control points in the laundering process was the most significant driver of infection prevention, additionally reducing infection risks by up to 6 log10 .

The Stability of Model Human Coronaviruses on Textiles in the Environment and during Health Care Laundering.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) persists on stainless steel and plastic for up to 7 days, suggesting that coronavirus disease 2019 (COVID-19) could be spread by fomite transmission. There is limited research on the stability of SARS-CoV-2 on textiles, with the risk of textiles acting as fomites not being well understood. To date, there does not appear to be any published research on the stability of coronaviruses during laundering, which is required to determine the efficacy of current laundering policies in the decontamination of health care textiles. The aim of this study was to investigate the environmental stability of human coronaviruses HCoV-OC43 and HCoV-229E on different textile fiber types and the persistence of HCoV-OC43 on textiles during domestic and industrial laundering. This study demonstrated that human coronaviruses (5 log10 50% tissue culture infective doses [TCID50]) remain infectious on polyester for ≥72 h, cotton for ≥24 h, and polycotton for ≥6 h; HCoV-OC43 was also able to transfer from polyester to PVC or polyester after 72 h. Under clean conditions, HCoV-OC43 was not detectable on cotton swatches laundered with industrial and domestic wash cycles without temperature and detergent (≥4.57-log10-TCID50 reduction), suggesting that the dilution and agitation of wash cycles are sufficient to remove human coronaviruses from textiles. In the presence of interfering substances (artificial saliva), ≤1.78 log10 TCID50 HCoV-OC43 was detected after washing domestically without temperature and detergent, unlike industrial laundering, where the virus was completely removed. However, no infectious HCoV-OC43 was detected when washed domestically with detergent.IMPORTANCE Synthetic textiles such as polyester could potentially act as fomites of human coronaviruses, indicating the importance of infection control procedures during handling of contaminated textiles prior to laundering. This study provides novel evidence that human coronaviruses can persist on textiles for up to 3 days and are readily transferred from polyester textile to other surfaces after 72 h of incubation. This is of particular importance for the domestic laundering of contaminated textiles such as health care uniforms in the United Kingdom and United States, where there may be a risk of cross-contaminating the domestic environment. It was demonstrated that human coronaviruses are removed from contaminated textiles by typical domestic and commercial wash cycles, even at low temperatures without detergent, indicating that current health care laundering policies are likely sufficient in the decontamination of SARS-CoV-2 from textiles.

The role of textiles as fomites in the healthcare environment: a review of the infection control risk.

BACKGROUND: Infectious diseases are a significant threat in both healthcare and community settings. Healthcare associated infections (HCAIs) in particular are a leading cause of complications during hospitalisation. Contamination of the healthcare environment is recognised as a source of infectious disease yet the significance of porous surfaces including healthcare textiles as fomites is not well understood. It is currently assumed there is little infection risk from textiles due to a lack of direct epidemiological evidence. Decontamination of healthcare textiles is achieved with heat and/or detergents by commercial or in-house laundering with the exception of healthcare worker uniforms which are laundered domestically in some countries. The emergence of the COVID-19 pandemic has increased the need for rigorous infection control including effective decontamination of potential fomites in the healthcare environment. This article aims to review the evidence for the role of textiles in the transmission of infection, outline current procedures for laundering healthcare textiles and review studies evaluating the decontamination efficacy of domestic and industrial laundering. METHODOLOGY: Pubmed, Google Scholar and Web of Science were searched for publications pertaining to the survival and transmission of microorganisms on textiles with a particular focus on the healthcare environment. RESULTS: A number of studies indicate that microorganisms survive on textiles for extended periods of time and can transfer on to skin and other surfaces suggesting it is biologically plausible that HCAIs and other infectious diseases can be transmitted directly through contact with contaminated textiles. Accordingly, there are a number of case studies that link small outbreaks with inadequate laundering or infection control processes surrounding healthcare laundry. Studies have also demonstrated the survival of potential pathogens during laundering of healthcare textiles, which may increase the risk of infection supporting the data published on specific outbreak case studies. CONCLUSIONS: There are no large-scale epidemiological studies demonstrating a direct link between HCAIs and contaminated textiles yet evidence of outbreaks from published case studies should not be disregarded. Adequate microbial decontamination of linen and infection control procedures during laundering are required to minimise the risk of infection from healthcare textiles. Domestic laundering of healthcare worker uniforms is a particular concern due to the lack of control and monitoring of decontamination, offering a route for potential pathogens to enter the clinical environment. Industrial laundering of healthcare worker uniforms provides greater assurances of adequate decontamination compared to domestic laundering, due to the ability to monitor laundering parameters; this is of particular importance during the COVID-19 pandemic to minimise any risk of SARS-CoV-2 transmission.