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Many of the coaching clients are high achievers and in most of the prepandemic sessions presented as confident, in control and professional. Their reasons for coaching were often focused on their desire to move to the next level, which called for them to identify their strengths and perceived weaknesses and take action to address the identified gaps in their skills and knowledge through the coaching or through further training. This chapter offers a 'good enough' experience for clients and so, during the pandemic, moved reluctantly to working via online platforms or telephone sessions, depending on the client's preference. During the pandemic it is encouraged to build in the time to take walks before and after online sessions and, when it became possible to do so, to start taking that coffee time again rather than going straight from an online psychotherapy session to online business. The client with a pure obsessive compulsive disorder (POCD) diagnosis also saw benefits to their being-in-the-world from the pandemic. POCD often manifests as intrusive, inappropriate and shameful thoughts on which the person will ruminate. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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Objectives: This study aimed to estimate the direct medical costs of patients with post COVID-19 condition in a Colombian insurance company with more than 2.5 million affiliates. Method(s): We conducted a bottom-up cost-of-illness study of adults with persistent symptoms after at least three months of hospital discharge due to COVID-19. We surveyed patients that were hospitalized between March 2020 and August 2021. We asked about healthcare resource utilization (HCRU), which included laboratories and images, medications, consults, rehospitalizations, and others, associated with post COVID-19 condition. The answers were verified using the company's outpatient and inpatient service authorization records. Costs were estimated from the third payer perspective and expressed in American dollars using an exchange rate of 1USD$=3,743COP. Result(s): We included 202 participants, 51.5% were male, mean age of 55.6 years old, 49% had a comorbidity (41.9% hypertension), and 46 patients (22.8%) required an intensive care unit. A total of 159 (78.7%) patients reported at least one symptom after discharge. Of these, 132 (65.3%) persisted with at least one symptom during the telephone survey. Seventy-five (47.2%) of the 159 patients with persistent symptoms reported HCRU. Of these, 93.3% consulted a physician (mean consultations: 2.1 SD 1.1;mean consultations with specialists: 2.4 SD 2.0), and 9.3% were re-hospitalized. The average direct medical costs of post COVID-19 condition were US$824 (95%CI 195-1,454). Costs in outpatient were US$373 (95%CI 158-588), and in inpatient, US$3,285 (95%CI -167-6,738). Conclusion(s): It is crucial to follow up and identify patients discharged from the hospital who persist with symptoms after three months since we observed a greater HCRU, including prolonged recovery therapiesCopyright © 2023
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Introduction: Cancer patients have a high risk of severe COVID-19 and complications from it. Although the COVID-19 pandemic has led to an increase in the conduction of clinical trials (CTs), there is a scarcity of data on CT participation among cancer patients. We aimed to describe the level of participation in a COVID-19 CT, willingness to participate, as well as trust in sources of information for CTs among persons with and without a previous cancer diagnosis in Puerto Rico. Method(s): Data collected from November 2021 to March 2022 from two cross-sectional studies were merged and used for analysis. Informed consent, telephone, face-to-face, and online interviews were conducted among participants >=18 years old living in Puerto Rico (n=987). Descriptive statistics and bivariate analysis (Fisher's exact text and chi-squared test) was done to describe the outcomes of interest, overall and by cancer status. Result(s): Mean age of participants was 41+/-15.5 years. Most participants were women (71.3%), with an educational level greater than high school (89.5%) and with an annual family income below $20,000 (75.1%). Overall, 4.4% of participants (n=43) reported history of cancer diagnosis. Only 1.8% of the population reported to have participated in a COVID-19 CT to receive either a treatment or vaccine;stratifying by cancer, none of the cancer patients had participated in a COVID-19 CT, and only 1.9% of non-cancer patients participated. While 37.0% of the participants indicated being very willing to sign up for a CT assessing COVID-19 treatment, willingness was higher in cancer patients (55.8%) than among participants without cancer (36.1%). Regarding trust in sources of information for CTs, the level of trust ("a great deal/a fair amount") was higher for their physicians (87.6%), researchers (87.0%), the National Institute of Health (86.7%), their local clinics (82.9%), and a university hospital (82.7%), while it was lower for a pharmaceutical company (64.0%), and for friend, relative, or community leader (37.6%);no differences were observed by cancer status. Conclusion(s): While participation in COVID-19 CTs was extremely low in the study population, the willingness to participate was higher among cancer patients. Education on CTs and their availability are necessary to increase participation in this understudied group. Such efforts will enhance the representation of Hispanic and vulnerable populations, such as cancer patients, on COVID-19 CTs, and thus proper generalizability of study findings in the future.
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This study focuses on measuring the relationship between organizational learning culture (OLC) and turnover intentions of telecommuting call center agents. Although many studies involve the call center industry from different perspectives, the literature is scant in studies that have assessed the relationship between OLC and turnover intent in telecommuting call center agents. Call centers exist in almost every organization worldwide. Organizations have centralized their customer service process through computerbased technologies allowing call center agents to work from home. In addition, in the post-COVID-19 era, telecommuting has become a permanent option for many call center employees. Indeed, in the call center industry, telecommuting has become an essential part of the business strategy that seeks to attract new and maintain current employees. In the call center industry, learning is a factor that influences job satisfaction and turnover intentions. Specifically, OLC increases job satisfaction and performance in telecommuting call center agents, influencing employees' turnover intentions. The study 's findings indicate that OLC is a needed factor that helps lower turnover intentions of telecommuting call center agents in the United States.
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Background: The Early Youth Engagement (EYE) project co-developed the first engagement-focussed intervention derived from the perspectives of young people and their families in Early Intervention in Psychosis services. Patient and Public Involvement (PPI) in the EYE-2 study aimed to ensure that the voices of people experiencing first episode psychosis, and carers, were embedded in the refinement, delivery and evaluation of the Early Youth Engagement (EYE-2) approach across the UK. Method(s): The EYE-2 project used a multi-level PPI approach: Each of five sites had a PPI lead, trained and supported by senior PPI researchers. PPI leads convened local Lived Experience Advisory Panels (LEAPs), and co-delivered staff and researcher training. Practical challenges were identified and resolved. Results and Impacts: Tangible PPI impacts included: the co-produced revised booklets and EYE-2 website https://www.likemind.nhs.uk following workshops of over 40 people;the delivery of on average 52 peer-led intervention social groups at each site, allowing people to connect with peers with lived experience and build a sense of optimism, shared identity, interpersonal skills and problem-solving in a social environment, with activities driven by service users. Written outcomes included a PPI-led booklet on running peer-led social groups, a person-centred telephone interview for the HoNOS questionnaire for use during the Covid-19 pandemic, peer reviewed papers, blogs and video logs. Conclusion(s): PPI was integral to the delivery of the EYE-2 study;the multi-level approach facilitated a diversity of voices across different aspects of the study and ensured that people with lived experience shaped the intervention, research design and implementation.
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The COVID-19 pandemic had a critical impact on the Thai criminal justice system. The goal of this study is to explore policies and practices of Thailand's Department of Probation as it responded to the COVID-19 pandemic. This study surveyed probation officers in Thailand (N = 534) from March to April 2021, focusing on probation practices and case management issues prior- and post- COVID-19. Data reveals that, overall, the frequency of officer-offender contacts remained steady even though the type of contact changed after COVID-19. In-person contact was replaced by remote contact strategies, specifically telephone calls, which increased significantly following the onset of the pandemic.
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AimsTo study feasibility and impact of telephone and video communication on perceptions of loneliness and social isolation in community-dwelling older adults.MethodsPurposive flyer distribution to communities, area agencies on aging, meals on wheels, and snowball sampling. Sixteen people met inclusion criteria. Pre- and post-intervention data were collected: UCLA-3, UCLA20, FRAIL Scale, and Social Frailty Scale. Participants were allocated to either telephone or video communication groups, completing 8 weeks of one time per week 45-60-minute conversations.ResultsUCLA-20 demonstrated statistical significance (p = .017) for the full cohort with large effect size (Hedges' g = 1.273). UCLA-3, SFS-8, and FRAIL Scale did not demonstrate statistically significant pre-post differences. No statistically significant differences (p > .05) were identified between the telephone and video communication groups.ConclusionRemote communication may have a positive impact on perceptions of loneliness that appear to be independent of the communication modality utilized. Randomized controlled trials are required to determine if either modality is more effective.
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This paper examines how telework frequency has affected the usage of major communication media, and subsequently knowledge sharing, among a large sample of full-time Japanese employees with no prior telework experience during the country's fourth COVID-19 state of emergency. Results suggest that mandatory telework resulted in lower use of face-to-face meetings and phone calls;in higher use of instant messaging and virtual meetings, and that it had no effect on e-mail use. Moreover, phone call, instant messaging, and virtual meeting frequencies were found to mediate the relationship between telework frequency and knowledge sharing. These findings highlight the importance of both existing and newer communication media in offsetting the loss of face-to-face meeting opportunities. Government-mandated telework may have accelerated the adoption of new communication tools such as instant messaging and virtual meeting, which had not yet gained full acceptance before the pandemic.
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Introduction: In 2019/20 a total of 171,900 people were admitted to adult general intensive care units (ICU) across England, Wales and Northern Ireland, with a survival rate of 79.6% at hospital discharge.1 Patients who survive critical illness and admission to ICU often experience ICU-related long-term physical and non-physical impairments and disability following hospital discharge.2 National guidance advocates multidisciplinary team (MDT) follow up to identify and manage the unmet health needs of this patient population.3-4 The UK has seen an increase in the number of follow up services available in the last 7 years.2 The Covid-19 pandemic further highlighted the need to provide this service, locally resulting in the establishment of the Belfast Health and Social Care Trust (BHSCT) ICU follow up clinic in July 2020. The follow up clinic is offered to patients aged = 18 years, an ICU length of stay of = 4 days, who have been discharged from an inpatient setting within the last 12 weeks and do not receive follow up from any other established care pathway. The clinic consists of an ICU Nurse, Doctor, Clinical Psychologist and Physiotherapist. Patients are offered either a virtual, face-to-face or telephone appointment. Objective(s): To identify unmet rehabilitation needs and onward referral requirements of patients presenting at an ICU follow-up clinic in Northern Ireland. Method(s): Data was gathered retrospectively using an excel database detailing patient demographics, appointment details and onward referrals generated from the clinic. Data was analysed for a set time period between the 01/12/2021 - 09/02/2022. The type of referral and the profession responsible were captured. Result(s): During the time period eight post ICU follow up clinics were completed. A total of 36 patient's attended (14 male and 22 female). Six appointments were attended virtually via MS Teams, 12 via telephone and 18 face-to-face. Twenty-three (64%) of the patients required at least one onward health referral. A total of 61 onward health referrals were generated from this population. Table 1 details the number of onwards referrals by speciality. Conclusion(s): Approximately 64% of patients who attended the post ICU follow up clinic, during a 10 week period, demonstrated unmet rehabilitation needs resulting in onward health referrals. This data supports the need for a post ICU follow up clinic at BHSCT to identify ongoing need, ensure transition of care to relevant services and optimise patient's physical and psychological outcomes. One limitation of this study is that not all recommended allied health professionals are commissioned for the clinic which may impact on the health needs identified. Future work should consider the impact of this and discussions regarding the need for a commissioned post ICU follow up clinic which is truly MDT for this patient population should be considered.
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While the substantial majority of clinical trials still take place in countries classified by the World Bank as high income, a review of clinical trial registrations on the World Health Organization (WHO) International Clinical Trials Registry Platform and clinicaltrials.gov shows that a significant and growing number are being conducted in LMICs, with major centers in Eastern Europe, the Middle East, Brazil, China, India, and South Africa. COVID-19 will likely have a longlasting effect on global supply chains.11 The U.S. and more than 50 other countries are restricting or considering restrictions on exports of supplies that are needed to mitigate the effects of COVID-19 locally.12 Internationally, the World Trade Organization and the World Customs Organization issued a joint statement noting the disruptive impact of the virus on global supply chains and pledged to cooperate to facilitate trade in essential goods.13 LMICs are struggling to obtain limited hospital supplies in the global market in competition with the U.S., the European Union, Japan, and similar high-income buyers, as recent reporting about the COVID-19 outbreak in Nigeria shows.14 Clinical trial sites in LMICs that cannot obtain needed supplies in-country could obtain them from a study sponsor, assuming the products can be legally imported and shipments to that country are not cost-prohibitive in light of global freight and logistic disruptions. [...]informed consent forms and study institutional review board (IRB) and independent ethics committee (IEC) approvals may need to be revisited in light of local conditions. Clint D. Hermes is an attorney at Bass, Berry & Sims References 1. https://main.icmr.nic.in/sites/default/files/guidelines/EC_Guidance_ COVID19_06_05_2020.pdf 2. http://www.sahpra.org.za/wp-content/uploads/2020/03/SAHPRACommunication_COVID_19-Final-25032020.pdf 3. https://pharmacyboardkenya.org/files/?file=Clinical_Trials_During_ COVID-19_Pandemic.pdf 4. http://portal.anvisa.gov.br/documents/219201/4340788/SEI_ ANVISA+-+0989653+-+Nota+Técnica14.pdf/6b48273f-550f-47618ba1-4e731a87b526 5. https://www.gob.mx/cofepris/articulos/medidas-extraordinarias-enrelacion-a-estudios-clinicos-ante-la-pandemia-de-covid-19 6. https://ensayosclinicos-repec.ins.gob.pe/images/Nueva_actualización_12.12.19/Actualización_2020/Comunicado_N_002-2020.pdf 7. https://www.imf.org/en/Topics/imf-and-covid19/Policy-Responsesto-COVID-19 8. https://www.bsg.ox.ac.uk/research/research-projects/coronavirusgovernment-response-tracker 9. https://covidtracker.bsg.ox.ac.uk/stringency-map 10.https://www.who.int/news-room/commentaries/detail/immunitypassports-in-the-context-of-covid-19 11. https://www.weforum.org/agenda/2020/04/supply-chains-leadership-business-economics-trade-coronavirus-covid19/ 12. https://www.weforum.org/agenda/2020/03/covid-19-coronaviruslessons-past-supply-chain-disruptions/ 13.http://www.wcoomd.org/en/media/newsroom/2020/april/wco-wtojoint-statement-on-covid-19-related-trade-measures.aspx 14.https://www.nytimes.com/2020/05/17/world/africa/coronaviruskano-nigeria-hotspot.html 15. https://mp.weixin.qq.com/s/amB7fBxLw8KSR9DcUsbTWg
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Introduction: Families of patients admitted to the Intensive Care Unit (ICU) experience significant emotional distress.1 Visiting restrictions mandated during the COVID-19 pandemic presented new barriers to family communication, including a shift from regular bedside nursing updates and in-person family meetings to scheduled, clinician-led telephone calls and video calls.2 This resulted in loss of non-verbal clues and feedback during family discussions, difficulties establishing rapport with families and risked inconsistent messages and moral injury to staff.3 Objectives: We aimed to design a system where all ICU family discussions were documented in one place in a standardised format, thereby clarifying information given to families to date and helping staff give families a consistent message. In addition, we aimed to provide practical advice for the staff making family update telephone calls and strategies for managing difficult telephone conversations. Method(s): We designed and implemented an ICU family communication booklet: this was colour-coded blue;separate to other ICU documentation within the patient notes;and included communication aids and schematics to help staff optimise and structure a telephone update. Using Quality Improvement methodology, we completed four Plan-Do-Study-Act (PDSA) cycles and gathered qualitative and quantitative feedback: this occurred prior to the project and at one,12,18 and 21 months post introduction. We implemented suggested changes at each stage. We designed staff surveys with questions in a 5-point Likert scale format plus opportunity for free comments. Twenty-one months post implementation, we designed and delivered an MDT awareness campaign using the 'tea-trolley training' method,4 departmental induction sessions for new ICU doctors and nurses and a 'Message of the Week' initiative. An updated version of the booklet was introduced in February 2022 (Figure 1). Result(s): Staff survey results are shown in Table 1. Forty-six staff participated in tea trolley training, feedback form return rate 100%. Following feedback, the family communication booklet was updated to include the following: a prompt to set up a password;a new communication checklist at the front, including documentation of next of kin contact details, a prompt to confirm details for video calls, confirm primary contact and whether the next of kin would like updates during the night;consent (if the patient is awake) for video calls while sedated;information regarding patient property;prompt to give families our designated ICU email address to allow relatives to send in photographs to display next to patients' beds;prompts to encourage MDT documentation and patient diary entry. Conclusion(s): During unprecedented visiting restrictions in the COVID-19 pandemic, we implemented an ICU family communication booklet which has been so successful that we plan to use it indefinitely. We plan to further develop this tool by encouraging MDT involvement, seek further staff feedback in six months' time, incorporate this structure into our electronic patient information system when introduced and collect feedback from patients and their next of kin at our ICU follow up clinic. This communication booklet would potentially be reproducible and transferable to other ICUs and could be used as part of a national ICU family communication initiative.
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The COVID-19 pandemic and the lockdown of the spring 2020 led psychotherapists and psychoanalysts working with children and adolescents to experiment, whether they liked it or not, with new ways of meeting, by telephone or video-conferencing, and new practices were generated. In this context, new questions about the treatment format lead to a discussion of the precise place and function of telephone sessions with the adolescent as compared to the child. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (French) La pandemie de Covid-19 et le confinement du printemps 2020 ont conduit les psychotherapeutes et psychanalystes d'enfants et d'adolescents a l'experimentation, a marche forcee, de nouveaux modes de rencontres, par telephone ou visio, generateurs de pratiques inedites. Dans ce contexte de nouvelles interrogations concernant ce dispositif conduisent a preciser la place et la fonction des seances au telephone chez l'adolescent comparativement a l'enfant. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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The Covid-19 pandemic obliged many healthcare providers to transition rapidly to a remote-only model of care. Concerns have been expressed about patient access to remote services, their appropriateness for sensitive consultations and physical examinations. Pre-pandemic research into telemedicine showed evidence of its effectiveness, but patient, staff and service user perspectives on remote care approaches remain unclear. This study explored the experiences and perceptions of care among patients, practitioners and managers in a single United Kingdom chronic pain organisation whose services were delivered remotely (telephone and online) during the pandemic. Nineteen participants (seven patients, seven practitioners, five managers) took part in in-depth qualitative interviews, conducted via telephone or online. Transcripts were analysed thematically. Five service provider and four service user themes were generated. Service provider themes comprised "The change process," "Accessibility and efficiency," "Effective when remote: Contact, support and education," "Concerns about communication, connection and disembodied work," and "Supporting and sustaining the team." Patients' themes comprised "Preferences, expectations and acceptance of remote care," "Convenience and accessibility," "Sense of support" and "Delivery modality matters." The study provides evidence from the qualitative evaluation of a single remote only service of its benefits and limitations as perceived by stakeholders. Findings suggest that service providers could address limitations, and progress to a blended care package, based on for patient need and choice. Further attention could be paid to services delivered by telephone, and to staff communication skills, resources, time management and wellbeing needs.Copyright © Nova Science Publishers, Inc.
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Introduction: The COVID-19 pandemic necessitated multiple changes to the format of myeloma clinics to minimise the risk of infection among patients and staff. These included changing in-person clinic appointments to telephone appointments when there was no medical need for face-to- face review and instituting a courier service for delivery of oral or self-administered medications. As COVID-19 restrictions relaxed, we sought to investigate the acceptability of these changes to our patients and to determine which, if any, of the new arrangements should continue. Method(s): Patients who attended the Myeloma Clinic at The Royal Marsden Hospital, both in-person and by telephone, on four separate dates in August and September 2022 were asked to complete a questionnaire to provide their opinions using a combination of multiple-choice, Likert scale and free-text questions. These covered the main domains of change outlined above along with questions about blood test location and attendance with family and friends. Result(s): Questionnaires were returned by 59 patients, 11 relating to in-person appointments and 48 to telephone appointments. 86.0% of patients were in favour of continuing the option of telephone appointments, with many highlighting their convenience and the avoidance of long travel and waiting times, with some also mentioning their COVID-19 security. However, a number of patients expressed concerns including communication difficulties, the inability to effectively assess physical health with an examination and a lack of reassurance. Furthermore, those who attended in-person appointments felt they were very COVID-secure, assigning them a mean of score of 4.5, where 1 was very insecure and 5 very secure. Several suggested that the optimum schedule would include regular telephone appointments with occasional in-person meetings. Interestingly, only 25.5% of patients wanted a video calling option. Patients were also very positive about receiving medications by courier, with 94.1% of patients receiving their medications within two working days of their clinic appointment. 81.8% of patients expressed a wish for this option to continue, highlighting the increased convenience and reduction in waiting times. Conclusion(s): These results suggest that changes made to the Myeloma Clinic in response to the COVID-19 pandemic have improved the patient experience. A mixture of telephone and in-person appointments may be preferable for this cohort of patients, many of whom require regular appointments for chemotherapy approval but are medically stable, and whose frailty makes long travel and waiting times challenging. These findings have implications for the planning of myeloma clinics across the UK.
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Objective: Since the last decade, the notion of minimally invasive cardiac surgery (MICS) has gained worldwide rapid popularity. Bangladesh is not far from mastering this technique due to the increasing interest of both patients and surgeons. Meanwhile, during this COVID-19 era could it help patients, remains the main question. In this context, we have operated on a total of 523 patients from October 2020 to November 2021 including, 89 patients who were MICS and among them, 17 were coronary artery bypass grafting. Method(s): We have included all patients who underwent minimally invasive coronary artery surgery in our hospital from October 2020 to November 2021 irrespective of single (MIDCAB) / multi-vessel disease (MICAS) or combined valve replacement with coronary revascularization. Data were collected from the hospital database, telephone conversations, and direct clinic visits. All data were analyzed statistically and expressed in the form of tables. Result(s): In the last 14 months of pandemics we have operated on a total of 89 MICS patients, among them 10 were Minimally Invasive Direct Coronary Artery Bypass (MIDCAB), 6 were double or triple vessels coronary artery surgery (MICAS), 1 patient underwent upper-mini aortic valve replacement along with coronary revascularization. One of our patients needed re-exploration for chest wall bleeding on the same day. Mean ICU and hospital stay in our series were less than conventional revascularization. There was no in-hospital or 30 days' mortality in our series. Conclusion(s): Cardiac surgery these days is headed toward less invasive approaches with the aid of technology, advanced instruments, and pioneer's lead. But from our in-hospital results we conclude that by avoiding median sternotomy, these minimal invasive revascularization techniques can provide hope to the patients by alleviating symptoms with restored vascularity, reduced morbidity, preventing sudden cardiac death. Health costs reduction with shorter hospital and ICU stay are the added benefits.
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Chronic pain is a health problem that disproportionately affects older adults and negatively impacts quality of life. Gratitude interventions have emerged as a promising approach to ameliorate the negative impact of pain and enhance well-being. Despite the high prevalence of older adults with chronic pain, there are no gratitude interventions among older adults with chronic pain. The current study utilized a two-week gratitude daily diary intervention in a sample of 38 older adults (M = 67.53 years) with chronic knee or hip pain to evaluate the effects of gratitude on well-being (Aim 1) and the effects of the intervention on changes in well-being (Aim 2) across the study. Participants were randomly assigned to either the gratitude group (n = 21) or the attention-matched control group (n = 17). Participants in the gratitude group wrote three things they were grateful for each day, while the attention-matched control did not journal. All participants completed pre- and post-intervention interviews and received 14 nightly phone calls, which allowed for "global" analyses using pre-and post-intervention data and "daily" analyses using nightly phone call data. The results of Aim 1 revealed that trait and state gratitude were significantly related to physical and mental well-being, controlling for age and income level. In Aim 2, no significant effects emerged for treatment group on global or daily changes in well-being in Aim 2. However, significant main effects emerged for time on global and daily well-being outcomes, indicating improvements in well-being across time, regardless of treatment condition. The impact of small sample size, COVID-19, and methodological limitations are discussed, and clinical implications and future directions for gratitude interventions focused on improving the well-being of older adults with chronic pain are provided. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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Since the pandemic, remote medical consultations have become a routine part of healthcare provision. But the concept of remote consultations mediated via communication technology is not as new as we might expect, and was in fact predicted a century ago.Copyright © 2023 Wiley Interface Ltd.
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Introduction: It is well documented that survivors of ICU admissions struggle to return to pre-admission level of function because of both physical and psychological burden. Current guidance therefore recommends a follow-up service to review patients 2-3 months post discharge [NICE 2009]. Prior to 2020 University Hospitals Bristol and Weston had no such service. With the increase in patient numbers seen during the COVID-19 pandemic, funding was received to provide a follow-up clinic to COVID-19 survivors. Objective(s): To provide a service that supports and empowers patients with their recovery from critical illness. Improving quality of life, speed of recovery and reducing longer term health care needs. Method(s): Referral criteria for the clinic included COVID-19 patients who received advanced respiratory support within intensive care and the high dependence unit. 8 weeks post discharge patients had a telephone appointment where ongoing symptoms could be identified. Advice around recovery, signposting to resources and onward referrals to appropriate specialities were provided. At 10 weeks post discharge patients had lung function tests and a chest X-ray which were reviewed by respiratory consultants. Based on the combination of these assessments, patients would be discharged or referred into the multidisciplinary team (MDT) follow-up clinic. The face to face clinic consisted of appointments with an intensivist, clinical psychologist, physiotherapist, and occupational therapist. Where needed patients would also be seen by a speech and language therapist or dietitian. Patients were seen only once in follow up clinic but again would be referred onto appropriate services within trust or the community, including but not exclusively community therapy services, secondary care services, SALT, dietetic or psychology clinics. Result(s): One of the key outcomes was the need for 147 onward referrals (an average of 1.13 referrals per patient). This included, 31 referrals to musculoskeletal physiotherapy outpatients for problems originating or made worse by their admission. 20 referrals to secondary care, including cardiology and ENT. 16 referrals to community occupational therapy, for provision of equipment, home adaptations and support in accessing the community. Subjectively, patient feedback was excellent. When asked what they felt was the most valuable thing they had taken from the clinic they reported: "Reassurance";"To know I'm not alone, others feel like this";"They listened to me and gave advice";"The ability to ask anything I wanted and the obvious kindness and support from all the clinicians I saw". Conclusion(s): Onward referral rates made by the follow-up clinic highlight the many issues faced by patients following discharge from ICU and hospital. With timely recognition and management, we can prevent a majority of these symptoms manifesting into chronic problems. This has the potential to lower the long-term burden on health care and improve quality of life for patients in both the short and long term. Without the follow-up clinic, these issues may have been missed or delayed. This reinforces the importance of the follow-up clinic and the need for ongoing investment.
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The problem of prevention of coronavirus disease 2019 (COVID-19) in patients with immune-mediated inflammatory rheumatic diseases (IMRD) remains highly relevant. The presence of IRD is associated with a high risk of disease and severe course of COVID-19 during immunosuppressive treatment, primarily anti-B cell therapy with rituximab (RTX), and a low level of post-vaccination response in such patients. A new strategy for the prevention and treatment of COVID-19 are virus-neutralizing monoclonal antibodies to coronavirus;currently, combined long-acting monoclonal antibodies tixagevimab and cilgavimab (Evusheld) are registered for prevention in the world and the Russian Federation. . Tixagevimab and cilgavimab (TC) show neutralizing activity against SARS-CoV-2, including the Omicron strain, primarily its variants BA.4, BA.5, BA.2.75 ("Centaur"). Objective - to evaluate the efficacy and safety of TC for pre-exposure prophylaxis of COVID-19 in rheumatic patients receiving RTX, based on a prospective observational study. Materials and methods. The main group included 86 patients with various IMRD receiving RTX: 50 of them had ANCA-associated systemic vasculitis (AAV), 15 - rheumatoid arthritis, 9 - Sjogren's syndrome (SS), 4 - IgG4-related disease, 3 - systemic lupus erythematosus (SLE), 3 - dermatomyositis (DM), 2 - systemic scleroderma (SSD). Median age was 59 (19-82) years;male: female ratio - 1:1,8. From March 26 to August 30 2022, patients received a single intramuscular injection of TC in a total dose of 300 mg, mainly after RTX (in 52% of cases, in 28% on the next day after RTX). The control group included 42 patients with AAV (median age - 45 (35-71) years;male: female ratio - 1:1), also treated with RTX, who did not receive pre-exposure prophylaxis of TC. The duration of observation was 7 months, until November 1 2022. At this time, 98% of confirmed cases of coronavirus in the Russian Federation were Omicron. A telephone and/or online survey of patient has been conducted to detect cases of COVID-19 and adverse reactions. Results. In the TC group, confirmed coronavirus infection have been detected in 17 (20%) patients (AAV - 10, SS - 3, SSD - 2, SLE - 1, DM - 1), with fever in 7 (8%), only in one case hospitalization was required (lung damage was not detected in computed tomography), in two cases, according to CT mild lung damage (CT 1-2), there were no deaths. Good TC's tolerability was noted, signs not associated with COVID-19 or progression of IMRD after administration of TC were observed in 8 (9%) patients (GPA - 3 MPA - 1, RA - 2, SLE - 1, IgG4-related disease - 1), adverse reactions definitely associated with the use of TC were not found. The most serious event not associated with coronavirus infection was the progression of polyneuropathy in a patient with RA. In the control group, 3 (7%) patients were diagnosed with COVID-19, one with severe lung injury (CT 3, pulmonary embolism) and death. Conclusions. The data of clinical studies and our own clinical experience evidence the effectiveness of the use of a combination of long-acting monoclonal antibodies TC (Evusheld), registered for indications for pre-exposure prophylaxis and treatment of COVID-19. Patients with IMRD treated with RTX have a favorable safety profile of TC. The introduction of virus-neutralizing monoclonal antibodies, a new drug class for the prevention and treatment of infectious diseases, opens significant prospects for improving the prognosis of patients with IRD.Copyright © 2023 Ima-Press Publishing House. All rights reserved.