Long-term support of COVID-19 patients with veno-venous extracorporeal membrane oxygenation: Complications, predictors of mortality and long-term outcome

Objectives: Treatment of severe respiratory distress syndrome (ARDS) due to COVID-19 by veno-venous extracorporeal membrane oxygenation (VV-ECMO) had a mortality of up to 70% in Germany. Many patients with COVID-19 need VV-ECMO support longer than 28 days (long-term VV-ECMO). Evidence on mortality, complications during intensive care, functional status after discharge and mortality-predictors for patients supported with long-term VV-ECMO is lacking. Method(s): Retrospective study of 137 consecutive patients treated with VV-ECMO for ARDS due to COVID-19 at University Hospital Regensburg from March 2020 to March 2022. Result(s): 38% (n=52;87% male) of patients needed longterm VV-ECMO support. In these, SOFA score (median [IQR]) at ECMO initiation was 9 [8-11], age 58.2 [50.6- 62.5] years, PaO2/FiO2-ratio 67 [52-88] mmHg, pCO262 [52-74] mmHg, Murray-Score 3.3 [3.0-3.6] and PEEP 15 [13 - 16] cmH2O. Duration of long-term support was 45 [35-65] days. 26 (50%) patients were discharged from the ICU. Only one patient died after hospital discharge. At VVECMO initiation, baseline characteristics did not differ between deceased and survivors. Complications were frequent (acute kidney injury: 31/52, renal replacement therapy: 14/52, pulmonary embolism: 21/52, intracranial hemorrhage 8/52, major bleeding 34/52 and secondary sclerosing cholangitis: 5/52) and more frequent in the deceased. Karnofsky index (normal 100) after rehabilitation was 70 [57.5-82.5]. Twelve of the 18 patients discharged from rehabilitation had a satisfactory quality of life according to their own subjective assessment. Four patients required nursing support. Mortality-predictors within the first 30 days on VV-ECMO only observed in those who deceased later, were: Bilirubin >5mg/dl for > 7 days, pulmonary compliance <10ml/mbar for >14 days, and repeated serum concentrations of interleukin 8 >150ng/L. Conclusion(s): Long-term extracorporeal lung support in patients with COVID-19 resulted in 50 % survival and subsequently lead to a satisfactory quality of life and functionality in the majority of patients. It should preferably be performed in experienced centers because of a high incidence of complications. Several findings during the early course were associated with late mortality but need validation in large prospective studies.

Improving Neuropsychological Rehabilitation for COVID-19 Patients Guideline-Based Advances

Cognitive sequelae after recovery from an initial COVID-19 disease are present in a subset of affected individuals, coalescing around several important issues such as effects of age, COVID-19 disease severity, comorbidities, and other factors. Some neuropsychological symptoms appear more common among certain patient populations. Comorbidities may complicate neuropsychological assessment as well. Hence, we need a guideline-based evaluation to guide neuropsychological rehabilitation. Drawing from the recent revision of the German National Guideline for the Long- and Post-COVID Syndrome and current advances in international guidance on neuropsychological assessment, this article provides practical and scientifically informed recommendations for the neuropsychological assessment of individuals recovering from coronavirus-related diseases.

Effect of an Internet-based Intervention on Motor Behavior in Patients after Percutaneous Coronary Intervention

Background During the containment of COVID-19，the traditional face-to-face interventions conducted at the rehabilitation center were plagued by many limitations，while internet-based interventions can overcome the limitations of geographic location，working hours and transportation，with less medical costs. Objective To examine the effects of internet-based interventions on knowledge，attitude/belief and practice（KAP） toward rehabilitation exercises，physical activity（PA）level，and exercise compliance inpatients after PCI. Methods The subjects were 76 patients who received their first PCI in Department of Cardiology，Tangshan Gongren Hospital from November 2021 to June 2022. They were randomly and equally divided into two groups to receive either internet-based intervention with routine nursing（experimental group） or routine nursing （control group）. Before and three months after the intervention，the Rehabilitation Exercise Knowledge-Belief-Practice Scale for Patients with Coronary Heart Disease（REKBPCHD），the International Physical Activity Questionnaire-Short Form （IPAQ-SF），and Patients' Exercise Log were used to assess the KAP level，PA level，and exercise adherence，respectively. The impact of network intervention on exercise adherence in patients after PCI by univariate Logistic regression analysis. Results After 3 months of intervention，a significant increase was found in the average total score of REKBPCHD，and the average scores of the knowledge dimension，attitude dimension and practice dimension of the scale in the experimental group（P<0.05），and the increase was more notable than that in the control group（P<0.05）. Moreover，both post-intervention low PA level and total PA level in the experimental group were higher than those in the control group（P<0.05）. Both post-intervention low PA level and total PA level were higher than the baseline levels in the experimental group（P<0.05）. The post-intervention exercise compliance of experimental group were higher than that in the control group（P=0.003）. Univariate Logistic regression analysis showed that the risk of non-adherence to exercise in the experimental group was relatively lower than that in the control group 〔OR=0.143，95%CI（0.034，0.594），P=0.007〕. Conclusion Theinternet-based intervention can effectively improve the KAP level toward rehabilitation，PA level，and exercise adherence in patients after PCI. © 2023 Chinese General Practice. All rights reserved.

Patient Outcomes in CMV and SARS-CoV-2 Coinfection

This study examines clinical outcomes in patients with cytomegalovirus (CMV) and SARS-CoV-2 coinfection. Between June and November 2020, previously immunocompetent patients with SARS-CoV-2 and CMV coinfection were identified at Houston Methodist Hospital as part of routine clinical correlation by a molecular pathologist. SARS-CoV-2 nasopharyngeal specimens were analyzed by real time reverse-transcriptase polymerase chain reaction (RT-PCR). All CMV tests were performed on plasma or bronchoalveolar lavage (BAL) specimens and analyzed by competitive polymerase chain reaction. 65 previously immunocompetent patients with CMV and SARS-CoV-2 coinfection were identified. Patient demographics include 41 male patients (63%) and 24 female patients (37%) ranging in age from 34 to 86 years (mean: 66.04, median 68). Documented pre-existing conditions include 27 patients with hypertension 41.5%), 19 patients with diabetes mellitus (29.2%), 9 patients with coronary artery disease (13.8%), and 3 patients with asthma (4.6%). Eight patients (12.3%) had no documented pre-existing conditions. The plasma CMV viral load ranged from <300 to 21,566 IU/mL. The CMV PCR results from bronchoalveolar lavage and bronchial wash specimens ranged from <300 to 59,127 IU/mL. CMV PCR was initially negative in 10 patients then positive on serial testing. 60 patients were critically ill requiring ventilator support (92.3%). 47 patients (72.3%) expired, 7 patients (10.8%) were transferred to a long term acute care facility, 3 patients (4.6%) were discharged to a rehabilitation facility, 3 patients (4.6%) were discharged home, and 1 patient (1.5%) remained in-patient at the time of analysis. The prevalence of CMV seropositivity and medical comorbidities increases with age. Reactivation of latent CMV is a known occurrence in critically ill patients that is associated with poor outcomes. The majority of the patients in our cohort were 50 years old, and all were severely to critically ill with a mortality rate of 72.3% These findings suggest CMV portends a worse prognosis in patients with COVID-19. These findings also demonstrate the importance of clinical correlation in molecular testing.

Recent Trends in Remote Healthcare Applications and Futuristic Approach

Remote healthcare is a well-accepted telemedicine service that renders efficient and reliable healthcare to patients suffering from chronic diseases, neurological disorders, diabetes, osteoporosis, sensory organs, and other ailments. Artificial intelligence, wireless communication, sensors, organic polymers, and wearables enable affordable, non-invasive healthcare to patients in all age groups. Telehealth services and telemedicine are beneficial to people residing in remote locations or patients with limited mobility, rehabilitation treatment, and post-operative recovery. Remote healthcare applications and services proved to be significant during the COVID-19 pandemic for both patients and doctors. This study presents a detailed study of the use of artificial intelligence and the internet of things in applications of remote healthcare in many domains of health, along with recent patents. This research also presents network diagrams of documents from the Scopus database using the tool VOSViewer. The paper highlights gap which can be undertaken by future researchers. © 2023 IEEE.

Post-exertional malaise may persist in Long COVID despite learning STOP-REST-PACE

Background Objective Methods Results Conclusions Physical activity used in rehabilitation can trigger post-exertional malaise (PEM) in people with Long COVID. Concerns remain if the STOP-REST-PACE approach promoted by patient communities and professional organizations can be safely administered and contributes to return to usual activities.(1) To observe PEM over 12 weeks of telerehabilitation based on the STOP-REST-PACE approach. (2) To describe the changes in health-related quality of life (HRQoL), respiratory symptoms, fatigue and return to work.This was an observational prospective cohort of participants with Long COVID referred to a telerehabilitation service. Participants received up to 14 h of physiotherapy and occupational therapy over 12 weeks based on the STOP-REST-PACE approach. Frequency was personalized, up to two sessions weekly. An independent coordinator assessed PEM, HRQoL, respiratory symptoms, fatigue and return to work.Thirty-four participants were included and 30 completed the 12 weeks of telerehabilitation. Participants had an average of eight impairments. We found PEM in all participants at baseline. After 12 weeks, PEM remained present for 19 out of 30 participants. Respiratory symptoms significantly improved (COPD Assessment Test: 19.2 ± 7.3 vs 13.8 ± 7.7, p < .001). Fatigue and HRQoL did not significantly improve (p = 0.32 and p = 0.20, respectively). Only four participants were able to work full time.PEM persisted for close to two-third of participants despite learning the STOP-REST-PACE approach through physical and occupational therapy sessions over 12 weeks. Respiratory symptoms improved, but we did not observe a difference in fatigue and HRQoL. Return to work was out of reach for most participants. [ FROM AUTHOR] Copyright of Fatigue: Biomedicine, Health & Behavior is the property of Taylor & Francis Ltd 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.)

Evidence on post-ICU syndrome prevention and rehabilitation strategies in adults: An umbrella review

Introduction: Post-ICU syndrome (PICS) is a syndrome that is becoming increasingly important due to the growing number of patients surviving critical illness, a phenomenon that has been accentuated especially after the COVID-19 pandemic. The focus of the medical practice that cares for these patients should be oriented toward the best available interventions to prevent and rehabilitate the sequelae of PICS. Objective: To synthesize the evidence on the efficacy and effectiveness of strategies for preventing and rehabilitating PICS in adult patients. Methods: Umbrella review (CRD42022321610). PubMed, Scopus, Ovid (Cochrane), and LILACS were searched for systematic reviews evaluating any intervention to prevent or rehabilitate PICS and its effect on any of the PICS domain(s) (i.e., mental, cognitive, or physical outcomes). Results: 20 studies were included, and 10 were classified as of low or very-low methodological quality, so they were not included in the summary of results. Therapies at the mental and cognitive levels seem to have a beneficial effect but with limited evidence. The interventions analyzed in the physical sphere are very heterogeneous and have contradictory results, with little quality of evidence. Conclusions: Considering the systematic reviews included in this work, this research allows us to conclude that there is low-quality and contradictory information on the efficacy of interventions for the prevention or rehabilitation of PICS. Future practice should focus on developing high- quality studies. © 2023 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

Glucosaminylmuramyl dipeptide efficacy in post-COVID-19 patient rehabilitation treatment.

The COVID-19 pandemic has altered people's lifestyles around the world. Prevention of recurrent episodes of the disease and mitigation of its consequences are especially associated with effective post-COVID-19 rehabilitation in patients. The aim of the study was to evaluate the effects of the drug Likopid (glucosaminylmuramyl dipeptide, GMDP) for post-COVID-19 rehabilitation in patients. Material and methods. Patients who recovered from mild to moderate COVID-19 (n=60, mean age 54+/- 11.7 years) were randomized into the observation group (n=30, 15 men and 15 women) who received 2 courses of Licopid (1 mg twice a day) and the comparison group (n=30, 15 men and 15 women). Analysis of the phenotypic and functional characteristics of the innate immune cellular factors was carried out before the start of immunomodulatory therapy, immediately after the end of the course, and also after 6 months observations. In order to assess the quality of life of all patients, we used the SF-36 Health Status Survey and the Hospital Anxiety and Depression Scale questionnaires. Results. During assessing the effect of immunomodulatory therapy on the parameters of innate immunity of patients at the stage of rehabilitation after COVID-19, an increase in the protective cytolytic activity of CD16+ and CD8+Gr+ cells, as well as a persistent increase in TLR2, TLR4 and TLR9 expression was found, which indicates the antigen recognition recovery and presentation at the level of the monocytic link of the immune system. The use of GMDP as an immunomodulatory agent resulted in an 8-fold reduction in the frequency and severity of respiratory infections due to an increase in the total monocyte count. As a result of assessing patients' quality of life against the background of the therapy, a positive dynamic in role functioning was revealed in patients. In the general assessment of their health status, an increase in physical and mental well-being was noted during 6 months of observation. The comparison group showed no improvement in the psychoemotional state. Discussion. The study demonstrated the effectiveness of GMDP immunomodulatory therapy in correcting immunological parameters for post-COVID-19 rehabilitation in patients. The data obtained are consistent with the previously discovered ability of GMDP to restore impaired functions of phagocytic cells and induce the expression of their surface activation markers, which in turn contributes to an adequate response to pathogens. Conclusion. The study revealed that the correction of immunological parameters with the use of GMDP in COVID-19 convalescents contributed not only to a decrease in the frequency and severity of respiratory infections, but also to an improvement in the psycho-emotional state of patients, and a decrease in anxiety and depression.Copyright © Eco-Vector, 2023. All rights reserved.

Clinician-initiated written communication for families of patients at a long-term acute care hospital

Objective To assess the experience of families and clinicians at a long term acute care hospital (LTACH) after implementing a written communication intervention. Methods Written communication templates were developed for six clinical disciplines. LTACH clinicians used templates to describe the condition of 30 mechanically ventilated patients at up to three time points. Completed templates were the basis for written summaries that there were sent to families. Impressions of the intervention among families (n = 21) and clinicians (n = 17) were assessed using a descriptive correlational design. Interviews were analyzed using thematic content analysis. Results We identified four themes during interviews with families: Written summaries 1) facilitated communication with LTACH staff, 2) reduced stress related to COVID-19 visitor restrictions, 3) facilitated understanding of the patient condition, prognosis, and goals and 4) facilitated communication among family members. Although clinicians understood why families would appreciate written material, they did not feel that the intervention addressed their main challenge – overly optimistic expectations for patient recovery among families. Conclusion Written communication positively affected the experience of families of LTACH patients, but was less useful for clincians. Innovation Use of written patient care updates helps LTACH clinicians initiate communication with families.

The impact of COVID-19 on extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA): A single centre study

Objectives: The COVID-19 pandemic has been affecting everything including ECMO service. At the moment we have to equip PPE before ECPR and we thought it may influence on time to establish venoarterial ECMO and patient outcomes. Method(s): We compared OHCA-patients who underwent ECPR in our hospital before (January 2015 - March 2020) and after (April 2020 - December 2022) the Government of Japan declared a state of emergency in relation to COVID-19. Result(s): There were 32 and 9 patients in the pre- and post-COVID-19 pandemic sample. Of these, 9 (28.1%) vs. 5 (55.6%) survived extracorporeal life support (ECLS), p=0.23, and 4 (12.5%) vs. 2 (22.2%) had good neurologic outcomes (cerebral performance category 1- 2) after ECLS. Seven (21.9%) vs. 1 (12.5%) were discharged or transferred alive from the hospital (one patient of the post-COVID-19 cohort has been still hospitalised for rehabilitation), p>0.99. Mean values of low-flow time were respectively 67.3 minutes (SD 18.3) and 55.6 minutes (SD 17.1), p=0.091, and median values of time to establish ECMO from admission were respectively 32.5 minutes (IQR 15.8) and 26.0 minutes (IQR 4.0), p=0.23. Conclusion(s): There were no differences in time-toECMO or outcomes in patients who underwent ECPR for refractory OHCA before and after the COVID-19 pandemic.

Covid-19 Pandemisinin Otizm Spektrum Bozukluğu Olan Bireylerin Fiziksel Aktiviteye Katılımı Üzerindeki Etkileri: Yaşanmış Ebeveyn Deneyimleri

Türkiye'de olduǧu gibi, virüsün dünya çapında yayılmasını engellemek amacıyla neredeyse her ülkede katı acil durum önlemleri ve kısıtlamalar uygulanmıştır. Karahan ve diǧerleri (2021) ise OSB olan bireylerin ebeveynleri ile gerçekleştirilen görüşmeler doǧrultusunda, pandemi sürecinde 'problem davranışları ve baş etme deneyimleri' ile ilgili evde kalınan sürecin ebeveynler için zorlayıcı olduǧunu, OSB olan çocukların kendine zarar verme, agresif davranma ve kontrolsüz davranışlar sergiledikleri sonucuna ulaşmıştır. Amerikan Psikiyatri Derneǧi'nin (American Psychiatric Association, 2013) OSB tanımında;bu bireylerin ilgi alanlarının oldukça dar olduǧu, tekrarlayan davranışlarının bulunduǧu ve beklenmedik bir deǧişime ayak uydurmada oldukça zorlandıkları belirtilmektedir. Türkiye de kısıtlamaların devam ettiǧi süreçte, nüfusun önemli bir bölümünü oluşturan özel gereksinimli bireylerin ' durum belirtir belge' bulundurmaları şartıyla yanlarında refakatçi bir kişi ile birlikte sokaǧa belirli sürelerle çıkmalarına izin vermiştir.Alternate :Introduction: The COVID-19 pandemic rapidly spread throughout the whole world and negatively affected individuals' participation in physical activity. In this context, the purpose of the research is to investigate the effects of the COVID-19 pandemic on the participation in physical activity of individuals with Autism Spectrum Disorder (ASD) from the perspective of their parents. Method: Ten parents (6 mothers and 4 fathers) with children diagnosed with ASD constituted the sample group for the research designed by the phenomenological qualitative research method. A semi-structured interview form and a personal information form were used as data collection tools. The data analysis was performed using the content analysis method. Findings: In the direction of the findings obtained from the research, four inclusive themes were determined. These are a) the effects of the pandemic on life;b) the difficulties encountered during the period of the pandemic;c) the necessity of physical activity;and d) the changing events. Under these themes, there are 12 sub-themes in total. Discussion: The parents expressed that the practices performed for the sake of decreasing the propagation rate of the virus had negatively affected especially the education, parent relationships, and active lifestyles of children with ASD. According to the parents, the physical activity habits of children with ASD significantly changed, and usually, home-based events were performed during the restrictions. The parents specified that they had understood how extremely important the participation in physical activity of children with ASD was during the period of the pandemic.

Feedback on post COVID-19 rehabilitation.

The outbreak of Coronavirus Disease 19 (COVID-19) following the Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) viral infection has placed particular pressure on occidental health systems, especially in terms of acute care resources and critical care skills. A number of affected patients subsequently required a rehabilitation process, due to multiple functional limitations, either as a result of an extended stay in intensive care or the consequences of the infection itself. The aim of this article is to report on the Geneva experience in post COVID19 rehabilitation, through 2 clinical vignettes, illustrating the heterogeneity of symptoms and deficits that may be encountered following this disease.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.

Serving a sentence in Italy: Old and new challenges

The Italian system of the enforcement of the sentences has been shaped, since the enter into force of the Italian Constitution in 1948, on the rehabilitation principle but the path towards a real implementation of this pivotal goal is still ongoing. Moreover, conditions like the ones strictly linked to permanent prison overcrowding and reduced economical resources for the implementation of prison and probation staff stand as elements that slow down the achievement of the expected outcomes. In this complicated framework, people that committed a crime can count on a well structured system of alternative measures that have been improved and reinforced during the last twenty years. Despite the ongoing efforts for a better application of such measures, there are still specific issues linked, above all, to the most vulnerable people (foreigners and persons at the margins of the society) that are in the position to experiment substantial discrimination in regard to their lack of the fundamental elements asked by the law for the application of an alternative sanctions. To overcome the many problems still unresolved, the Italian prison and probation system is attaching great importance to the role of restorative justice, as a useful tool for achieving constitutional objectives. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.

Influence of massage on respiratory and circulatory parameters in a post- COVID-19 patient: a case study

Monitoring the SaO2 levels and other respiratory function parameters after recovering from COVID-19 can have essential meaning in the assessment of the efficacy of using physiotherapy methods, including classical massage. Purpose of the research was to assess the influence of an individual classical back massage session as well as the effects of an entire 8-session back massage therapy on SaO2, HR and spirometry parameters in a patient after recovering from COVID-19, with constant monitoring of massage areas' temperature changes. Data and methods. The study comprised a case study of a patient who recovered from COVID-19. The patient was subjected to a classical back and spine massage therapy utilising all the basic techniques. The design was based on the results of the following tests: lung x-ray, SaO2, HR, spirometry parameters, and the 6-minute walking distance test. The degree of the influence of the classical massage techniques was monitored using the infrared thermography. Results. Continuous oxygen saturation monitoring during the massage sessions enabled to observe a decrease in the level of this parameter during utilisation of rubbing and tapotement on muscles of both the right and the left side of the back. During the usage of the intense massage techniques SaO2 dropped maximally to 92-93%. Such decrease was noted after massaging the right as well as the left side of the back, during every massage session. I addition it was found that in the case of the patient who recovered from COVID-19 changing the body position from sitting down to lying down after the massage session the level of tissues saturation decreased. The observed changes in the VA/Q ratio that occurred in response to the 8-session massage therapy lasting for 3 weeks might indicate that better conditions for ventilation and oxygen perfusion at the alveolar surface were reached. This translated in the patient who recovered from COVID-19 into 2% increase in oxygen saturation level after completing the massage therapy. Conclusion. Utilising the intense rubbing and tapotement techniques has to be carefully considered due to their significant influence on decrease in the level of saturation.

MASK UP! Supporting Mask Wearing of Children With Extensive Support Needs

Since the reopening of schools after COVID-19, students and staff have been required to wear face masks. Some students, including those with extensive support needs (ESN), may have difficulty in wearing these novel protective garments. Fortunately, researchers have demonstrated the effectiveness of several procedures for supporting the wearing of similar equipment (e.g., glasses, hearing aids). In this paper, we draw upon the available research to propose a protocol for teaching students with ESN to put on and maintain the use of face masks.

THE CURRENT SITUATION OF MUSCULOSKELETAL ULTRASOUND EDUCATION - A SYSTEMATIC LITERATURE REVIEW

BackgroundThe use of musculoskeletal ultrasound improves patient care by increasing diagnostic and therapeutic safety. With its growing application and increasing evidence of its value, the demand for standardized training in musculoskeletal ultrasonography (MSUS) rises rapidly.ObjectivesIn this systematic literature review, we aim to provide a general overview of the various aspects of musculoskeletal ultrasound education worldwide, including target groups, teaching staff, didactic methods, and course formats, as well as to reflect on existing problems and future opportunities. No restrictions were made regarding the educational level of the course recipients nor the specialization of the course instructors.MethodsIn our methodological approach, we followed the PRISMA statement for reporting systematic reviews and meta-analyses of studies[1]. In January 2022, the databases Embase, PubMed, and Google Scholar were considered with all publications to date and were filtered for relevant publications using previously defined keywords. Title and were then screened independently by two authors for inclusion using relevant study characteristics determined in advance according to the PICO scheme[1]. Finally relevant information was filtered from the full text version of the sixty-seven included publications.ResultsThe range of training programs has increased greatly in recent years, primarily aiming at residents in rheumatology, radiology and physical medicine and rehabilitation. However, MSUS is also receiving more attention as a training tool for medical students. Due to the COVID pandemic, didactic approaches using distance learning via simulators and handheld devices have gained additional importance. Given the existing lack of sufficient equipment and trained teaching staff, those approaches should continue to be explored post-pandemic. Another still existing problem is the low international comparability of MSUS training and competency assessment. Therefore, several international institutions, including the European League Against Rheumatism (EULAR) and the Pan-American League of Associations for Rheumatology (PANLAR) have proposed guidelines for training curricula to promote standardized ultrasound training.ConclusionThere is a broad consensus that the development of standardized curricula improves training and facilitates the implementation of new training centers. The development of alternative teaching methods incorporating e-learning, peer teaching, and distance learning on mobile ultrasound devices and the determination of international guidelines could facilitate overcoming the remaining major obstacles still to be passed.Reference[1]Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700. doi:10.1136/bmj.b2700Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Implementing the Yorkshire Cancer Research funded Prehabilitation Radiotherapy Exercise smoking Habit cessation And Balanced diet Study (PREHABS): a therapeutic radiographer's perspective

Introduction: Lung cancer patients often have a number of comorbidities which impacts patient mortality and morbidity rates. Lifestyle changes for this group of patients have the potential to positively impact both quality of life and longevity. The Yorkshire Cancer Research funded Prehabilitation Radiotherapy Exercise smoking Habit cessation And Balanced diet Study (PREHABS) was designed to determine if it is feasible to embed interventions promoting a healthier lifestyle into the radical lung radiotherapy pathway. Method(s): The PREHABS study was led by therapeutic radiographers trained in smoking cessation provision, motivational interviewing, informed consent and good clinical practice and a dietitian. Radiographers screened and consented study participants, delivered the exercise intervention and up to 12-weeks of smoking cessation support, whilst dietary advice was provided by the dietitian. Patients diagnosed with chronic obstructive pulmonary disease (COPD), were referred to a community based pulmonary rehabilitation service rather than the PREHABS exercise intervention. Ethical and regulatory approvals were secured in September 2021. Result(s): 61 patients were recruited between September 2021 and October 2022. The majority were female (n=42), mean age 73.1 years (SD 9.36 years). Discussion(s): In addition to the training requirements detailed above and the challenges of COVID-19, the radiographers had to become adept in a number of study-specific aspects including writing the study standard operating procedures (SOPs), creating a study organisational workflow and patient recruitment. The PREHABS study has broadened the radiographer's perspective beyond the radiotherapy department, by further understanding the complex comorbidities that lung cancer patients present with, how to motivate patients to positively change their lifestyle, and how the side effects caused by cancer treatment can affect a patient's ability to change their lifestyle. Conclusion(s): Therapeutic radiographers, after appropriate training, are capable of delivering lifestyle intervention support within a radical lung cancer radiotherapy pathway. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

Persistent Dyspnea after Recovery from COVID-19: Two Case Reports from Bangladesh

Globally, millions of documented SARS-CoV-2 infections with hundreds of thousands of deaths already reported. The majority of the fatal events have been reported in adults older than 70 years and those who have multiple co-morbidities. Despite the misery fatality of the virus, a significant number of peoples recovered from critical conditions also. Mild cases improved significantly with symptomatic management with strict maintenance of isolation. Therefore, many people believed that COVID-19 is a short-term illness, mild cases recovered completely within 2 weeks and severe or critical illness may require 3-6 weeks for complete recovery. However, the latest issue coming forward is delayed recovery in the surviving patients from severe or moderate COVID presenting with multisystem complications. We reported two cases of post COVID complications, newly named as "long COVID syndrome”. We described the common symptoms two patients experienced following recovery from acute phase of COVID-19 and how they were managed. We also discussed on the pathogenesis and management plan of common symptoms persisting after recovery of COVID-19.

Isometric thumb extension exercise as part of a multimodal intervention for de Quervain's syndrome: A randomised feasibility trial

Introduction: de Quervain's syndrome is a painful condition commonly presented to hand therapists. Exercise is utilised as an intervention, but isometric exercise has not been investigated. We aimed to assess the feasibility and safety of isometric thumb extension exercise for de Quervain's syndrome and to explore differences between high-load and low-load isometric exercise. Method(s): This parallel-group randomised clinical feasibility trial included individuals with de Quervain's syndrome. All participants underwent a 2 week washout period where they received an orthosis, education, and range of motion exercises. Eligible participants were then randomised to receive high or low-load isometric thumb extension exercises, performed daily for 4 weeks. Feasibility and safety were assessed by recruitment and drop-out rates, adherence, adverse events, and participant feedback via semi-structured interviews. Secondary outcomes included patient-reported outcomes for pain and function, and blinded assessment of range of motion and strength. Result(s): Twenty-eight participants were randomised. There were no drop-outs after randomisation, and no serious adverse events. Adherence to exercise was 86.7%, with 84% of participants stating they would choose to participate again. There were clinically and statistically significant improvements in pain and function over time (p < 0.001) but not in range of motion or strength. There were no statistically significant between-group differences. Conclusion(s): Isometric thumb extension exercise within a multimodal approach appears a safe and feasible intervention for people with de Quervain's syndrome. A large multi-centre trial would be required to compare high- and low-load isometric exercises. Further research investigating exercise and multimodal interventions in this population is warranted.Copyright © The Author(s) 2023.