Asthma in the elderly and COVID-19: results of the 90-day post-hospital follow-up.

Background. After the first wave of the new SARS-CoV-2 coronavirus infection, the researchers focused on identifying potential short-and long-term complications of COVID-19, especially in high-risk patients, after prolonged hospitalization and intensive care. Objective. To study the outcomes, adverse effects of severe COVID-19 and their predictors 90 days after hospital discharge in elderly patients with asthma. Material and methods. The study included elderly patients (101 subjects, 42 males and 59 females;median age 74 (67;79) years) with asthma, discharged from the hospital after treatment of severe COVID-19. They were followed up for 90 days after discharge. In the hospital, COVID-19 was confirmed by laboratory tests (polymerase chain reaction method) and/or clinically and radiologically. All patients had a documented history of asthma according to GINA 2020 criteria. Results and discussion. During the 90-day post-hospital follow-up, 86 (85%) patients survived, and 15 (15%) died after discharge. Deaths were reported within 1 to 4 weeks after discharge: 6 subjects died during re-hospitalization, 6 at home, and 3 in a rehabilitation center. The multivariate regression analysis model, adjusted for all statistically significant indicators, and the ROC analysis showed the most significant predictors of 90-day post-hospital mortality and their threshold values. They include the Charlson comorbidity index >=4 points, lung damage according to computed tomography >=30%, the absolute number of eosinophils <=100 cells/muL, and concomitant diabetes mellitus. The analysis showed that 90-day post-hospital mortality depends on combinations of identified risk factors;a combination of two, three, and especially four risk factors statistically significantly is associated with patients' lower average survival time. Conclusion. The key risk factors for 90-day post-hospital mortality in elderly patients with asthma after severe COVID-19 include the Charlson comorbidity index, lung damage >=30% according to computed tomography, the absolute number of eosinophils <=100 cells/muL, and concomitant diabetes mellitus. The 90-day post-hospital survival rate is correlated with the number of risk factors identified in patients. The effect of asthma severity on 90-day post-hospital mortality in elderly patients was not observed.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

Disease Flare-Ups after Sars-Cov-2 Vaccination among Patients with Rheumatic and Musculoskeletal Diseases in a Rheumatology Specialized Care Center: Sri Lanka

Background/Aims In the recent past, there has been growing research interest in COVID- 19 vaccines and their impact on the disease dynamics of rheumatic and musculoskeletal diseases (RMDs). The intersection of COVID-19 and autoimmunity has led to the theoretical possibility of flare-ups of autoimmune diseases with COVID vaccines. This study was conducted to evaluate the occurrence and the nature of flare-ups following the COVID vaccination on patients with RMDs. Methods This cross-sectional analytical study was conducted at Ragama Rheumatology and Rehabilitation Hospital, Sri Lanka involving 248 clinic patients using a structured questionnaire. Results The mean age of the study population was 52.69 and 75.4% were females. 12 patients (4.7%) reported flare symptoms following 1st dose of vaccination. Of them, 67% were females and 41.7% were within the 40-45 years age group. 75% of patients have experienced the onset of the flare symptoms following 1 week of the vaccination and 41.7% of symptoms have lasted more than 8 weeks. 66.7% who had this flare have received Sinopharm, while 25% received Covishield. In this flare 58.3% got polyarthritis,16.7% monoarthritis, 8.3% oligoarthritis and 16.7% generalized rash. By contrast, 42 (16.9%) patients who received the 2nd dose of the vaccine had flare symptoms. 90.5% of this population were females and 38.1% were within the 50-59 years age group. 42% got flare following 1st week of the vaccination and 57% of symptoms have lasted more than 8 weeks. 5 patients who had flare symptoms following the first dose reported having flare after the 2nd dose too. None of the flare symptoms following 1st or 2nd dose of the vaccinations needed hospitalization. Interestingly gender (p=0.012), use of methotrexate (p=0.043), and the presence of flare to the first dose (p=0.02) were found to be significantly correlated with the occurrence of flare symptoms following 2nd dose of vaccination. Conclusion This study reveals a considerable incidence of non-severe RMD flareups following COVID vaccination, mainly with the 2nd dose. Further studying on the effects of repeated and periodic COVID vaccination among patients with RMDs is timely to reassure and to improve vaccine acceptance in this group of patients.

A free-standing children's hospital helps a post-partum woman needing VV-ECMO during COVID-19 Pandemic when ECMO resources were limited

Our case is a 21 y/o pregnant female, 26weeks gestation who presented to OB triage with COVID-19. She was admitted to OB/GYN unit in acute hypoxic respiratory failure and started on steroids and remdesivir. On hospital day 6, she underwent an emergent c-section for fetal distress due to increasing hypoxia and severe ARDS. As her arterial blood gas being ph 7.17/81/40/29.6/-0.4, lactate 6.8nmol/L with escalating vasoactive medication and ventilator settings;ECMO was decided. However, all adult ECMO resources were limited, even within other adult facilities in Central Florida. Through multidisciplinary discussions amongst OB/GYN, adult ICU, and our pediatric ECMO activation team, it was decided to transfer the patient to our free-standing pediatric hospital. The patient was successfully transferred and cannulated for VV-ECMO. Total ECMO run was 413 hours. On ECMO day #12 patient underwent a tracheostomy. On ECMO day # 17, patient developed headaches and seizure activity in which CT revealed a subdural hemorrhage. She was taken off ECMO and underwent an emergent decompressive craniectomy with hematoma evacuation by our pediatric neurosurgical team. Once stable enough, she was discharged post ECMO day #15 (PICU day #32) to rehabilitation center. Two weeks later she had her bone flap replaced, trach removed, and she walked out of our unit home. This case exudes two key points for discussion. The first point of understanding ECMO physiology allows a team to treat many different patient populations. Although this patient was unusual to our pediatric bedside providers being post-partum, our team knew we could help. The second key point is excellent multidisciplinary teamwork and that communication is essential. At Orlando Health Arnold Palmer Hospital, our ECMO activation team consists of surgeons, pediatric intensivists, CT surgeons, perfusionists, nursing, and administration. We meet virtually to discuss how to execute initiation and daily ECMO treatment plans. There were some on the virtual call that were hesitant in accepting care of this adult due to variety of reasons, saying no would have been the easier answer, but not the right thing to do. What we learned from this case may seem so obvious and simple but very difficult to execute;multidisciplinary teamwork, humility, and open communication gave this patient the ability to walk out of the hospital with her baby. Other pediatric ECMO teams can learn from this case is they too can help in extraordinary times such as during a pandemic when adult recourses are limited.

Psychosomatic state and laboratory parameters of COVID-19 convalescent patients.

Objective. To evaluate some parameters of the psychosomatic state, cytokine levels (IL-6, IL-8, IL-17A), and free radical status (levels of nitrates and nitrites, antioxidant plasma activity) in convalescent patients after severe COVID-19. Patients and methods. We examined 64 patients who had severe COVID-19 and underwent either a 30-35-day course of inpatient rehabilitation after their discharge from a hospital for infectious diseases or a 60-65-day course of outpatient rehabilitation at the Ambulatory Center of Nalchik, Clinical Hospital No 1. Results. We surveyed patients after severe COVID-19 and found that they required a long rehabilitation. Many of them reported asthenic syndrome, psycho-emotional disorders, and other complaints upon discharge from the hospital. Serum levels of proinflammatory cytokines remained high in patients after severe COVID-19 even 30-35 days following their discharge (p < 0.05). Serum levels of IL-6, IL-8, nitrites, and nitrates remained elevated on days 60-65 following discharge (p < 0.05), despite comprehensive therapy in a rehabilitation department. Plasma antioxidant activity was reduced, whereas IL-17A level normalized by this time. Conclusion. Our findings suggest that currently used rehabilitation measures for COVID-19 are insufficient. Adequate rehabilitation of convalescent COVID-19 patients requires proper monitoring of their immune system condition, as well as new effective methods for immune correction and restoration of their psychoemotional status after the acute phase of the disease.Copyright © 2022, Dynasty Publishing House. All rights reserved.

Asthma in the elderly and COVID-19: results of the 90-day post-hospital follow-up.

Background. After the first wave of the new SARS-CoV-2 coronavirus infection, the researchers focused on identifying potential short-and long-term complications of COVID-19, especially in high-risk patients, after prolonged hospitalization and intensive care. Objective. To study the outcomes, adverse effects of severe COVID-19 and their predictors 90 days after hospital discharge in elderly patients with asthma. Material and methods. The study included elderly patients (101 subjects, 42 males and 59 females;median age 74 (67;79) years) with asthma, discharged from the hospital after treatment of severe COVID-19. They were followed up for 90 days after discharge. In the hospital, COVID-19 was confirmed by laboratory tests (polymerase chain reaction method) and/or clinically and radiologically. All patients had a documented history of asthma according to GINA 2020 criteria. Results and discussion. During the 90-day post-hospital follow-up, 86 (85%) patients survived, and 15 (15%) died after discharge. Deaths were reported within 1 to 4 weeks after discharge: 6 subjects died during re-hospitalization, 6 at home, and 3 in a rehabilitation center. The multivariate regression analysis model, adjusted for all statistically significant indicators, and the ROC analysis showed the most significant predictors of 90-day post-hospital mortality and their threshold values. They include the Charlson comorbidity index >=4 points, lung damage according to computed tomography >=30%, the absolute number of eosinophils <=100 cells/muL, and concomitant diabetes mellitus. The analysis showed that 90-day post-hospital mortality depends on combinations of identified risk factors;a combination of two, three, and especially four risk factors statistically significantly is associated with patients' lower average survival time. Conclusion. The key risk factors for 90-day post-hospital mortality in elderly patients with asthma after severe COVID-19 include the Charlson comorbidity index, lung damage >=30% according to computed tomography, the absolute number of eosinophils <=100 cells/muL, and concomitant diabetes mellitus. The 90-day post-hospital survival rate is correlated with the number of risk factors identified in patients. The effect of asthma severity on 90-day post-hospital mortality in elderly patients was not observed.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

Proceedings of the 6th National Patient Reported Outcome Measures (PROMs) Annual Conference

The proceedings contain 47 papers. The topics discussed include: long COVID rehabilitation services, Cardiff and Vale and Cwm Taf Morgannwg University health boards: social return on investment;the clinical meaning of family reported outcome measure (FROM-16) scores: translational research to support holistic clinical practice;patient-centered outcome measure design: the perspectives and preferences of children and young people with life-limiting or life-threatening conditions;co-creation of a patient reported outcome measure for older people with frailty and acute care needs (PROM-OPAC);PROMs: coming of age in lymphoedema services in Wales;ForMi-person-centered planning and outcomes recording app;true colors online mood monitoring in the bipolar disorder research network (BDRN) research program: challenges, benefits and importance of personalization;patient reported outcome measures for rheumatoid arthritis disease activity: using Rasch measurement theory to achieve more meaningful measurement;developing a roadmap towards national collection of electronic patient-reported outcomes for people with chronic kidney disease in the UK;and measuring bereavement support needs in people bereaved during Covid-19;the adaptation and development of a bereavement support needs scale.

Epidemiological study of major amputations of upper and lower limbs in France

Major amputation procedures are referenced in medical databases. Despite the existence of these data, no epidemiological follow-up for this condition exists. Amputation is the cause of permanent disability. Measuring its evolution and incidence rates could help improve care and outcomes. The objective of this study was to update epidemiological data by determining the evolution and incidence rates of major upper and lower limb amputations from 2011 to 2020, as well as to analyze the average length of stay for hospitalization according to procedures and regions from 2015 to 2019. This work is a retrospective study. It focuses on the analysis of the "Scansante.fr" database. The data were processed by descriptive analysis and statistical analysis. From 2011 to 2020, 1,616 acts of major amputations of the upper limb and 116,866 acts of major amputations of the lower limb were identified. Trans-humeral amputation and trans-tibial amputation were the most common amputations found for the upper limb and lower limb, respectively. New Aquitaine is the region with the highest average number of major amputations of the lower limb. The highest average rate of major amputations of the lower limb was found in the French Overseas Departments. The analysis of major amputations shows a general regressive trend for both the upper and lower limbs. Two main limitations guide the regression trend: the drop in the number of major amputation procedures between 2019 and 2020 corresponds to the health context of the Covid-19 pandemic, and some procedures are potentially underestimated because of the confidentiality criterion. The study of the incidence of amputation procedures is essential to understand and manage prevention and rehabilitation services in the French population. Level of Evidence: 5.Copyright © 2022 Elsevier Masson SAS

Strategy for Services Anticipation at the Rehabilitation Center of BNN Based on Moving Average and Exponential Smoothing Forecasting Method

One of the Indonesian government's responses to the COVID-19 pandemic is making policies related to restrictions on public services which affects the organizational resilience of the Rehabilitation Center of the National Narcotics Board (BNN). This research aimed to determine the historical pattern of the influence of public service policies during the COVID-19 pandemic on the client population, to forecast the client population for 3 (three) months ahead, and to analyze strategies for anticipating rehabilitation services at the Rehabilitation Center of BNN. This research method is quantitative by using a moving average (MA) and exponential smoothing forecasting model. Based on the validity test, MA is the best forecasting model, which indicates a possibility of a spike in male clients with the same amount in the pre-pandemic period, as many as 310 people, and the average female client is 7 people. Meanwhile, adolescent clients show inaccurate prediction results with MAPE 149.825. Strategies that can be implemented to anticipate a spike in the number of clients if it reaches the highest forecasting point are: increasing the budget, modifying the rehabilitation program for female and adolescent clients, a balanced staff composition, and the availability of facilities and infrastructure. [ FROM AUTHOR] Copyright of Technium Social Sciences Journal is the property of Technium Press Constanta and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Analysis of Estonian Ecmo Registry Data of Covid Outbrake 2020 to 2022

We launched Estonian nationwide ECMO registry in 2021 including data of all patients supported with ECLS in both ECMO centres - Tartu University Hospital and North Estonia Medical Centre. For the completeness of Registry all retrospective data were added back from 2009. Dataset includes patient demographics, diagnoses, ICU-, hospital- and 12 month survival, ECLS details and complications. To date, the registry contains data of 301 patients. Since January 2020, 65 confirmed Covid-19 patients have received ECLS support: VV-ECMO was used 55, ECCO2R 7, VA support 1 and eCPR in 2 instances. The primary outcome in our analysis was in-hospital death. Secondary outcome was to compare in-hospital mortality and length of stay of Covid-confirmed patients to the 54 non-Covid ARDS patients treated with VV-ECMO. Finding(s): Data for 55 adult patients with Covid-19 who received VV-ECMO support were available and included to this study. Of these 19(34.5%) were discharged home or to rehabilitation centre, 6(10.9%) were still in hospital at a time of analysis and 22(40.0%) died. One patient was bridged to successful lung transplantation. We also supported two pregnant patients with good maternal and neonatal outcomes. Comparing hospital mortality of Covid-confirmed cases to 54 non-Covid adult ARDS patients, hospital mortality was similar between the groups - 44.9% (22/49) and 46.2% (34/52) respectively. For those who were discharged alive, hospital LOS was longer for Covid-confirmed cases compared to non-Covid patients (mean 59 vs 50 days, respectively). Interpretation(s): In patients with Covid-19 who received ECMO, observed outcome supports existing recommendations to consider use of ECMO in refractory Covid-19 related respiratory failure when performed in experienced centres. Registry can also be used to coordinate ECMO beds, equipment and personnel as resources become constrained. We constantly monitored availability of ECMO beds and agreed on common indications for VV ECMO in covid patients. Further analysis will concentrate on 12 month survival and functional outcome.Copyright © 2022

Effect of Telerehabilitation Versus In-Clinic Rehabilitation Delivery on Self-Efficacy in Breast Cancer-Related Lymphedema

Background: Individuals with breast cancer-related lymphedema (BCRL) require self-management strategies to reduce risk of infection, exacerbation, and/or progression of lymphedema. The coronavirus pandemic thrust the medical field into the world of telehealth;both patients and providers were forced to reduce in-person treatments and engage in this new platform of rehabilitation delivery. The role of telehealth in promotion of self-management for BCRL is unknown. Purpose(s): This study examines self-efficacy during cancer rehabilitation for in-clinic versus telehealth visits among individuals with BCRL during the pandemic quarantine April to November 2020. Method(s): Forty women who recently completed oncology rehabilitation for BCRL were asked to complete demographics and 2 Likert surveys, including the Exercise Self-Efficacy Scale (ESES) and the Self-Care Self-Efficacy Scale (SCSE), to compare the efficacy of telehealth versus in-person treatment modalities. Result(s): Thirty-two participants completed the survey and indicated that the percentage of telehealth visits was less than face-to-face visits. Despite this, the participants indicated numerous positive moderately strong correlations between self-care self-efficacy and exercise self-efficacy for both types of visits (P <.05). Limitation(s): Self-report surveys by a convenience sample, multifactorial characteristics of rehabilitation treatment across modes, and varying severity of lymphedema may limit study findings. Conclusion(s): Telehealth provided safe and effective care to participants and bolstered confidence in self-care and self-management of BCRL. Data support that telehealth visits can be considered an essential part of comprehensive cancer rehabilitation care. Future research is needed to establish and optimize practice guidelines in both health delivery systems.Copyright © 2023 Lippincott Williams and Wilkins. All rights reserved.

Care trajectories of COVID-19 patients: from preventive measures to rehabilitation

This study aims to analyze the care trajectories of patients diagnosed with COVID-19 who were hospitalized and are currently undergoing rehabilitation regarding their use of and access to the healthcare network (HN). An evaluative, qualitative study was carried out based on interviews with patients in the city of Niteroi, Rio de Janeiro State, Brazil. The care trajectories were reconstructed at three different occasions that express their experiences with the healthcare and support network during the pandemic: prevention, support and diagnosis measures;hospitalization;post-COVID-19 care, rehabilitation and support. The results indicate that the main source of information about COVID-19 was TV newscasts. Preventive hygiene measures were the most widely adopted. The family was the main support network. There was no waiting time for admission to the municipal referral hospital. Hospitalization was very well evaluated in terms of user embracement, multidisciplinary care, virtual visits and daily contact between doctor and family members. A post-discharge "care vacuum" was identified, with no follow-up by primary health care (PHC) and other public services. Low-cost health insurance plans and private specialized post-COVID-19 services were frequently and spontaneously sought until the implementation of the rehabilitation service. In summary, solitary and discontinuous care trajectories of individuals and families shed light on several challenges to the health system, including guaranteed access to coordinated PHC and expanded offer of specialized public services and rehabilitation, aligned with the principles of humanized care, in addition to the maintenance of social support measures.Copyright © 2023 Fundacao Oswaldo Cruz. All rights reserved.

A pilot study implementing mood intervention in inpatient stroke rehabilitation with people with aphasia

Introduction: Psychological distress is common in people with aphasia, it causes avoidable suffering and impacts on healthcare outcomes and length of hospital stays. This pilot aimed to implement and evaluate a stepped psychological care approach for people with post-stroke aphasia in inpatient stroke rehabilitation. Method(s): A pathway was created to trial;[1] assessing mood using the Distress Thermometer [2] establishing goals to either improve or maintain mood, [3] creating an intervention plan in line with levels 1-2 of the stepped psychological care approach including mindfulness, behavioural activation, education, peer-group experience, and opportunities for mood discussion. Between June-September 2021, data was collected for all patients with aphasia admitted to the rehabilitation unit including Signs of Depression Screening Scale (SDSS) scores, and therapy assistant/researcher reflections. Result(s): Data was collected for nine patients;due to missing data five complete data sets were included. The pre-intervention median SDSS=3, and post-intervention SDSS=1. Reflection notes indicated positive feedback from two patients, increased rapport, greater role satisfaction, short term mood improvements within sessions. Several interventions were declined;mindfulness (3 patients), group/peer sessions (2 ), behavioural activation (2) and any mood intervention (3). Mood interventions had to be deprioritised at times due to workload. The COVID-19 pandemic also meant some activities were unavailable. Conclusion(s): This pilot showed that not all patients wanted to engage with specific or all mood interventions at this early rehabilitation stage. Further research is needed to establish which patients benefit from which intervention and at what stage it should be offered.

A collaborative project aimed at improving the acute rehabilitation unit environment in order to increase patient's social interaction and better support their sense of well-being

Introduction: Research shows patients having in-patient rehabilitation spend most of their day inactive with few opportunities for social interaction. Evidence suggests the physical environment impacts on well-being during rehabilitation. On the acute stroke unit, at St Georges Hospital, social spaces available for patients were repurposed for clinical use during the COVID pandemic. This project aimed to collaborate with patients, families and staff to enhance the ward environment. Method(s): CREATE, a co-designed, collaborative project model aiming to increase patient activity on stroke units, was adopted. Questionnaires were distributed to patients, families and staff on their views of the current use of the ward spaces with suggestions for change. Charitable funds were contacted to gain advice around provision of resources and funding. Result(s): Results indicated a lack of communal spaces for socialising and a need for more organised activities. Two strands of focus were agreed: 1. Revitalisation of communal spaces;2. Establishing a permanent activities coordinator. The project is now in the implementation phase. Conclusion(s): This quality improvement project sought to understand the views of patients, families and staff on how the physical ward environment was utilised and the interplay with their rehabilitation experience. Findings suggested the need to reclaim and revitalise social spaces on the ward and to establish a permanent activities coordinator role. The creation of a less institutional and more welcoming environment will better support patients' sense of well-being during rehabilitation. Success will lead to an increase in participation in social interaction for patients outside of therapy time.

Nocturnal hypoventilation and respiratory muscle/cough weakness in COVID-19 ICU survivors

Background: The impact of severe COVID-19 in nocturnal hypoventilation and respiratory muscles/cough strength is unknown. Aim(s): Characterize respiratory function in post-ICU COVID-19 patients and correlate these findings with COVID-19 associated outcomes. Method(s): Retrospective study with 55 post-ICU COVID-19 patients admitted to a rehabilitation center (RC). Clinical data were collected and patients performed arterial blood gas analysis, nocturnal oxy-capnography, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and peak cough flow (PCF) at admission. Result(s): Mean age was 64.4+/-10.2 years, 39 (70.9%) were male. Co-morbidities were present in 50 (90.9%): 39 (70.9%) hypertension;20 (36.4%) diabetes;3 (5.5%) OSA;1 (1.8%) COPD. None had neuromuscular disorders. Median of ICU length was 25.5 (min 5;max 190) days. Fifty-three (96.4%) needed mechanical and invasive ventilation, 6 (10.9%) ECMO and 22 (40%) tracheostomy (all decannulated before admission to our RC). Eighteen (32.7%) had criteria of nocturnal hypoventilation, 17 (30.9%) inspiratory, 16 (29.1%) expiratory and 17 (30.9%) cough weakness. Sepsis correlated with increased length of ICU stay (p=0.007) and with lower PCF values (p=0.048). Neurologic disfunction was associated with lower minimum SpO2 and more time of SpO2<88% (p=0.032;p=0.035). Renal disfunction was associated with higher values of mean and maximum TcCO2 (p=0.003;p=0.011). Patients with previously diagnosed OSA had higher values of MIP and PCF (p=0.006;p<0.001) at evaluation. Conclusion(s): In COVID-19 ICU survivors, nocturnal hypoventilation, inspiratory/expiratory muscle and cough weakness are common and may have an impact in rehabilitation outcomes.

Multidimensional Assessment of Dyspnea in Postcovid Patients Referred to Pulmonary Rehabilitation

MULTIDIMENSIONAL ASSESSMENT OF DYSPNEA IN POSTCOVID PATIENTS REFERRED TO PULMONARY REHABILITATION In patients who suffer sequels after severe acute respiratory syndrome caused by Coronavirus 2 (SARS-CoV2), dyspnea is the most prevalent respiratory symptom. We aimed to analyze a subgroup of patients under follow-up in the pulmonology rehabilitation units after hospitalization for moderate-severe SARS-CoV2 pneumonia. We prospectively studied 455 patients until November 2021. We analyzed: dyspnea by mMRC scale, grade of fatigue by FACIT-F (0 without fatigue-4 intense fatigue), spirometry and DLCO, 6-minute walk test (Osses'equations), isometric strength of dominant quadriceps (weakness threshold <70%), maximal sniff nasal inspiratory pressure test (weakness thresholds <70 cmH2O for men and <60 cmH2O for women), body composition and physical activity IPAQ-7. We grouped our sample according to the severity of the mMRC dyspnea (>= 2 vs < 2) and results were compared for the global sample and separately for men and women. Table 1 shows the baseline characteristics. 41.5% of women and 19.5% of men showed inspiratory muscle weakness. 52.7% of the patients reported dyspnea mMRC >= 2 and studied variables were significantly worse (Table 2). In the women group, only the 6-minute walk distance, the level of physical activity and the fatigue grade were significantly worse in patients with greater dyspnea (Table 2). Conclusion(s): In our sample, multifactorial moderate-intense dyspnea becomes a good marker of functional capacity, muscle function, grade of fatigue and physical activity in patients who have suffered from moderate-severe Covid-19 pneumonia.

Poor nutritional status and dynapenia are highly prevalent in post-acute COVID-19

Malnutrition estimates range between 5 and 69% in acute Coronavirus disease 2019 (COVID-19) patients. With respect to body composition (BC) and muscle function, low values of phase angle (PhA) and handgrip strength (HGS) have been related to poor disease outcomes. Little evidence is available in post-acute patients. We aimed to combine the evaluation of nutritional status, BC, and muscle strength in a real-life cross-sectional cohort of post-acute COVID-19 patients referred to a rehabilitation center after hospital discharge. The study population included 144 patients (M=95;mean age 64.8yrs), of which 37% bedridden (M=60%). Nutritional status was evaluated with the Mini-Nutritional Assessment (MNA) and Controlling Nutritional status (CONUT) scores. Fat-free mass (FFM), skeletal muscle (SM), and raw variables, i.e. PhA, were estimated with bioelectrical impedance analysis. HGS was measured with a digital handle dynamometer for both dominant and non-dominant body sides. Dynapenia was identified according to the 2019 EWGSOP criteria. According to MNA, 18% of patients were malnourished and 62% at risk of malnutrition. As for CONUT, 21% of patients had moderate-severe malnutrition, while 58%light malnutrition. Overall, malnutrition was highly prevalent in older patients with more comorbidities. Marked abnormalities of PhAand HGSwere more frequent in bedridden or malnourished patients, and when FFM or SM were low. Dynapenic patients were 65% males and 47% females. Malnutrition, BC alterations, and low HGS occur in post-acute COVID-19 patients. Future studies will help to tailor screening algorithms for full nutritional status assessment to appropriate care processes and rehabilitation strategies.

Clinical and functional characteristics of patients recovering from severe COVID-19 attending an inpatient pulmonary rehabilitation program

Background and Aims: A proportion of patients with coronavirus disease 2019 (COVID-19) need hospitalization due to severe respiratory symptoms. This study describes the characteristics of survivors of severe COVID-19 subsequently admitted to inpatient pulmonary rehabilitation (PR) and identifies their rehabilitation needs. Subjects and methods: From the COVID-19 Registry of the Fondazione Don Gnocchi we extracted 203 patients admitted for inpatient PR after severe COVID-19 from April 2020 till September 2021. Specific information on the acute-hospital stay, clinical and functional characteristics on admission to the rehabilitation units were collected. Result(s): During the acute phase of the disease 80% of patients needed ICU admission, receiving mechanical ventilation (MV) for 26 days. On admission to the rehabilitation units, 10% of patients were still on MV, 28% had tracheostomy, 70% were on O2 therapy, 24% were diagnosed critical illness neuropathy. Eighty % showed a modified Barthel Index <75 and only 25% were able to perform a six-minute walk test. Montreal Cognitive Assessment and Hospital Anxiety and Depression Scale were also performed, indicating a variable presence of neurocognitive impairment and symptoms of anxiety and/or depression. Moreover, 32% scored >=2 at the Malnutrition Universal Screening Tool and 47% showed dysphagia needing logopedic treatment Conclusion(s): Our analysis shows that patients admitted for inpatient PR after severe COVID-19 represent a multifaceted and clinically complex patient population who need customized, comprehensive rehabilitation programs, carried out by teams with different professional skills.

Immunotherapy-responsive recurrent extensive white matter disease without neuronal or glial surface antibodies: A case report

Background: Acute disseminated encephalomyelitis (ADEM) is classically considered as a monophasic immune-mediated demyelinating disorder. A relapse can occur in children but extremely rare in adults. Case-report: A 57-year-old man presented with fulminant ADEM-like episode without proceeding viral illness. Neurological deficits rapidly developed associated with extensive demyelinating brain lesions with vasogenic edema. After the initiation of aggressive immunotherapy, his symptoms resolved, but he relapsed twice during 26-month observation period;one was a mild episode characterized by rapidly evolving MRI lesions without development of symptoms, and the other was a fulminant ADEM-like episode similar to the first one. The second fulminant episode occurred only 2 days after getting a flu shot despite no clinical or radiological relapse when he received COVID-19 vaccinations. The patient's symptoms and extensive brain MRI lesions improved after the initiation of aggressive immunotherapy at the early stage. No autoantibodies against neuronal surface (such as GABA A receptor) or glial surface antigens (aquaporin 4, or myelin oligodendrocyte glycoprotein) were identified in either serum or CSF. Conclusion(s): Extensive white matter lesions can occur without neuronal or glial surface antibodies, recurrent fulminant ADEM-like episode can develop even in an adult patient, and flu shot may provoke fulminant ADEM-like episode.Copyright © 2022

Stroke Service Redesign to Facilitate Hospital Flow during the Covid-19 Pandemic

Introduction: During the Covid-19 pandemic it was recognised by MTW, a reconfiguration of the acute hospital would be required to create extra bed capacity and protect vulnerable patient groups. Alongside the pandemic the Kent and Medway stroke reconfiguration occurred (Winidbank, 2015). Since July 2020, MTW Stroke Unit admission data shows an average rise of 107% in activity. In December 2020, 'The Hilton Stroke Pathway' (HSP) was developed as a 6 month rehabilitation pilot to increase the MTW bed-base away from the acute site . The pathway consisted of an innovative virtual and homecare rehabilitation service in collaboration with Hilton Nursing Partners. Method(s): The pilots were evaluated using 5 key criteria: financial performance, clinical service delivery, quality of care, patient experience and stakeholder feedback. The pathway is overseen by MTW therapists, discharge liaison services and Hilton care. The aim of the pathway: Enable safe discharge home for stroke patients requiring specialist rehabilitation as soon as they were medically fit. Ensure patients rehabilitation was delivered safely and effectively. Provide a flexible service supporting patients with a range of therapy need. Provide nursing and care support as required. There are 3 levels of support: recovery, moderate and intensive. The MDT discussed which level was most appropriate for the patient. This was then reviewed as patients improved. Initially the therapy was overseen virtually by the OT, PT and SALT team. However, due to complexity of some of the patients' rehabilitation needs, therapy staff shifted to face-to-face therapy sessions. Due to the success of the pilot phase MTW decided to transition the pathway to business as usual. As part of this the pathway was reviewed in collaboration with KCFHT and therapy outcome measures were collected. Monthly monitoring meetings continue with Hilton, to ensure ongoing quality of care and effectiveness of the pathway Results: Since the beginning of the pilot the pathway has achieved positive results in SSNAP. Between January and June 2021 92.2% required OT, 84.4% required PT and 63.3% required SALT. The results in chart 1-2 are from Jan - April 2022. Chart 1 shows patient outcomes for destination on discharge. Chart 2 shows the difference in Therapy Outcome Measure (TOMs) admission and discharge scores. There has been a significant difference in the TOMS in three domains (significant difference=0.5)(Enderby and John, 2019), impairments, activity and participation. The biggest improvements has been seen in activity and participation meaning the HSP are enabling patients to integrate back into society and their occupational roles in life. The pilot evidenced using multi-organisational working has enabled earlier and safer discharges home. The new pathway has allowed for flexible acute bed capacity following the closure of stroke services at Medway hospital and during the challenges that accompanied the Covid-19 pandemic. The HSP has shown significant improvement with functional outcomes and integration back into occupational roles. In 2022 52% of the patients did not require further social care at the end of the pathway. SSNAP data shows a higher intensity of therapy was provided with an average of 34 minutes of OT, 37 minute of PT and 14 mins of SALT per day, whilst on the pathway. Therefore, MTW and Hilton Nursing Partners are keen for continuation of this pathway into future stroke development. Additionally, collaboration with KCHFT community neurorehabiliation team enabled the West Kent stroke rehabilitation pathways to be defined seen in Chart 3. The integration of Hilton Nursing Partners and the MTW MDT enabled safe and effective facilitation for stroke patients into their homes, whilst achieving high levels of independence. Conclusion(s): The stroke service demonstrated what can be achieved in a short timeframe and in challenging circumstances. The implementation was robust and a positive use of NHS resources to proactively enable changes in stroke service provision required across West Kent The pathway was well received by patients and staff, providing a direction of travel towards community-based stroke rehabilitation services which reflect the national guidelines for stroke services (RCP, 2016;NICE, 2013).

Post-COVID pulmonary rehabilitation at primary hospital in Nepal: Preliminary experience from LMIC

Introduction: Nepal is low and middle income country (LMIC) in South Asia with over 11 million SARS-CoV-2 infections reported till February 2022. Decline in lung function with poor functional status have been observed in substantial proportion among post-COVID patients in Nepal. Aims and objectives: The aim of this study was to assess benefits of pulmonary rehabilitation in post-COVID patients at Methinkot hospital, a primary level hospital in Nepal where specialized health services and rehabilitation facilities are not available. Method(s): A cross-sectional study was conducted in December 2021 at Methinkot hospital. Post-COVID patients with persistent symptoms were included. A structured pulmonary rehabilitation program comprising of breathing exercise, airway clearance technique, flexibility and endurance exercise was designed and was delivered by a visiting pulmonary rehabilitation specialist from tertiary hospital. Patients were instructed for thrice weekly home based rehabilitation for four weeks and were assessed at the end of four weeks. Result(s): Forty-two patients were included. Mean age of patients was 38.33+/-10.7 years. There were 17 (40.5 %) male. Shortness of breath on exertion (71.4%), fatigue (52.4%) and chest discomfort (35.7%) were the most common reported symptoms. Upon completion of four-week pulmonary rehabilitation, 34(81%) patients reported symptomatic improvement while 30(71.4%) reported rehabilitation measure to be beneficial. Conclusion(s): Early pulmonary rehabilitation service could be highly beneficial in reducing post-COVID morbidities. Establishment and continuation of sustainable and affordable rehabilitation service is challenging in resource limited setting.