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1.
Journal of Urology ; 207(SUPPL 5):e160, 2022.
Article in English | EMBASE | ID: covidwho-1886482

ABSTRACT

INTRODUCTION AND OBJECTIVE: Spina Bifida (SB) is a congenital spinal defect with multiple urologic manifestations requiring life-long urologic care. Transition to adult health care can be particularly difficult for patients with complex medical issues, especially during COVID-19. Our team created an online educational series for patients with SB to help provide education and community building. Herein, we describe our experience with a virtual SB Education Series and the results of survey-based patient experience through a virtual platform. METHODS: Patients with SB ages 16-24 and their caregivers were identified at a single tertiary academic medical center and were invited to the zoom education day series. Pre and post session surveys were collected, and data analyzed. RESULTS: There were a total of 68 registrations for 4 conferences held between 5/3/20-12/9/20. 24, 24, 21, 36 invitations were sent out before each session and 18,18, 11, 21 patients attended each education session, respectively. A total of 46% (31/68) participants completed the pre-survey and 19% (13/68) completed the post-survey. The survey results can be found in Table 1. Participants were comfortable using telehealth for medical visits (4.87), found them easy (4.69) and would use telehealth for future appointments (4.7). This did not increase significantly after the educational sessions. However, there was a significant increase in patients' comfort of navigating non-emergent medical problems during the COVID-19 pandemic between pre and post-survey results (4.07 vs 5.17, p <0.01). Importantly, participants did not feel that they lost the ability to connect with other individuals during the pandemic (4.45) and were strongly in favor of attending future conferences. CONCLUSIONS: This program aimed to reach patients with SB who were transitioning from pediatric to adult urology. Attendance increased with higher volume of direct outreach of patients in the adult and pediatric SB clinics. Importantly, by engaging in online educational series, participants became more comfortable managing non-emergent urologic issues. Transitional urology patients with SB can benefit from online educational sessions and this platform was well received. Future directions will be to increase participants and determine the effectiveness of video educational session on participants' access to care.

2.
Journal of Urology ; 207(SUPPL 5):e108, 2022.
Article in English | EMBASE | ID: covidwho-1886481

ABSTRACT

INTRODUCTION AND OBJECTIVE: To our knowledge no study has implemented virtual support groups in conjunction with the standard of care as a potential additional supportive measure for patients with interstitial cystitis (IC). The aim of this study was to assess feasibility and the patient experience of virtual support group sessions in this population. METHODS: Adult IC patients seen at our institution within the past 6 months were identified by ICD-10 diagnosis code N30.10. Eligible patients were offered to attend two predetermined virtual support groups. Three, hour-long sessions were held over Zoom for each group, with each session separated by two weeks. After the concluding session, participants completed a survey assessing their experience with the virtual support group. A free text response was also prompted regarding patient's overall experience. RESULTS: 12 patients formed two support groups (5 females in one, 5 females and 2 males in the other). 10 attended all three virtual sessions, with 2 missing the last session. All 12 completed the survey. 9 patients (75%) agreed that a virtual setting was more convenient compared to inperson meetings (3 were neutral) and 8 patients (67%) stated they would be more likely to attend virtually even without health risks related to COVID-19 (3 were neutral, 1 preferred in-person). Logistically, 10 patients (83%) were able to successfully navigate the technology involved (2 were neutral). As an overall experience, 9 patients (75%) reported benefit from attending (2 neutral and 1 disagreed). Only 4 patients (33%) indicated they felt more comfortable managing their IC as a result of participation in the group (3 were neutral, 4 disagreed). Feedback in free text comments expressed appreciation for hearing others' journey with IC. Other comments included discomfort with a mixed sex group, a wish for more than 3 sessions to allow for better connection in a virtual setting, and a wish for patient education by the session moderator. CONCLUSIONS: Offering interstitial cystitis support groups in a virtual setting is a viable alternative to in-person meetings. IC patients who otherwise would not attend an in-person support group may be inclined to participate virtually. Future support groups may benefit from being as longitudinal as possible to facilitate comfort among participants in a virtual setting. (Table Presented) .

3.
International Journal of Low-Carbon Technologies ; 17:678-685, 2022.
Article in English | Web of Science | ID: covidwho-1886438

ABSTRACT

Windows are the communication medium between indoor and outdoor, but their influence and the corresponding landscape outside the window are often ignored due to the outdoor frequent activities of people. The coronavirus disease 2019 (COVID-19) has been a better choice to show the window performance, especially for the anxiety level alleviation of people isolated at home. A national survey was conducted on the anxiety of self-separation people and the window influence. The results showed that the average anxiety level was 1.54, between a little anxious and anxious, due to the COVID-19. The best satisfaction with the landscape outside the window was waterscape (2.98), followed by green plants (2.33) and buildings (0.83). During the COVID-19, the average number of overlook times increased by 1.49 times/day, which is higher 0.42 ties/day than the normal condition. The landscape types had the certain influence on the overlook frequency, the window opening times and even the anxiety level. The average anxiety levels are 1.36 and 1.68 with natural landscapes and human landscapes, respectively. Optimizing the landscapes outside the window plays an important role in alleviating the anxiety of residents and improving their mental health.

4.
Gastrointestinal Endoscopy ; 95(6):AB65, 2022.
Article in English | EMBASE | ID: covidwho-1885778

ABSTRACT

DDW 2022 Author Disclosures: Louise Krott: NO financial relationship with a commercial interest ;Lynn Debels: NO financial relationship with a commercial interest ;Christophe Schoonjans: NO financial relationship with a commercial interest ;John Anderson: NO financial relationship with a commercial interest ;Roland Valori: NO financial relationship with a commercial interest ;Lobke Desomer: NO financial relationship with a commercial interest ;David Tate: NO financial relationship with a commercial interest Introduction: Colonoscopy is a complex practical skill, which is highly operator dependent. The consistent attainment of key performance indicators (KPIs) by a colonoscopist depends primarily upon training. Local factors, outside of a trainee’s control, may mean their training is unstructured and contingent upon the observed practice of a small number of trainers. This is particularly true given current travel restrictions imposed by the worldwide COVID-19 pandemic. We sought to demonstrate the feasibility and impact of a one-day virtual-live colonoscopy-training course with remote, experienced trainers. Aims and methods: 6 endoscopy trainees [Belgium] underwent a one-day course (the intervention) involving training by consciously competent colonoscopists who were physically remote [United Kingdom]. The intervention comprised 5 interactive sessions on colonoscopy theory combined with 6 live sessions, where trainees performed colonoscopy in their local endoscopy unit, receiving real-time instruction and performance enhancing feedback via a tele-conference monitor situated next to the endoscopic image. Trainers and the five trainees not doing the colonoscopy could follow the procedure in real-time including room view, view of the magnetic colonoscope imager and the endoscopic image. Colonoscopy KPIs were assessed on trainee-performed colonoscopies [unsedated or midazolam/fentanyl sedation] for 3 weeks prior and 4 weeks after the training. Qualitative trainee and trainer feedback regarding the course was obtained. Results: 6 experienced colonoscopy trainees (median 26 months prior-training) underwent the intervention. Trainees performed 60 colonoscopies, (33 pre-, and 27 post-training). Favorable trends in cecal intubation rate (CIR) and adenoma detection rate (ADR) were observed, (91% vs 96% (P=0.386), and 39% vs 63% (P=0.069) respectively). A trend to improved endoscopist-reported comfort scores ([Gloucester Comfort Score (GCS)>3] 18% vs 11% (P=0.375)) and nurse-reported comfort scores (GCS>3 22% vs 8% (P=0.189)) was observed (Table 1). Course participants and trainers alike reported globally favourable qualitative experiences with the expert trainers finding the format feasible and specifically mentioning they could focus on the training without distraction due to reduced cognitive load. Conclusions: Standardization of colonoscopy training is critical to the consistent attainment of KPIs by practicing colonoscopists and improving patient experience. This is the first demonstration of delivering live colonoscopy training remotely: an approach acceptable to trainees and trainers that has a positive impact on KPIs. Pending larger studies focused on efficacy, this approach has the potential to create a standardized curriculum for colonoscopy training, removing the barriers of travel, and allowing expanded exposure to consciously-competent expert trainers. [Formula presented]

5.
Pediatric Blood and Cancer ; 69(SUPPL 2):S115-S116, 2022.
Article in English | EMBASE | ID: covidwho-1885437

ABSTRACT

Background: Many children with cancer, survivors of childhood cancer, and patients with sickle cell disease experience pain, yet receive inadequate pain management due to health care provider lack of knowledge and comfort. Pain management using opioids is a required competency for pediatric hematology/oncology (PHO) fellows, yet knowledge gaps persist. Objectives: Pediatric Opioid Analgesia Self-Instruction System (PedOASIS) is an interactive, case-based education tool for independent learning by post-graduate medical trainees which has undergone pilot testing and validity and reliability testing. The goal of this study was to evaluate its efficacy in increasing PHO fellows' knowledge and comfort with using opioids to manage pain. Design/Method: PHO fellows were recruited from 74 ACGMEaccredited US programs during the 2019-2020 academic year. Participants were randomized to receive access to PedOASIS (intervention) or usual PHO training (control). Participants completed surveys at enrollment, immediately after distribution of the tool, and 6 months later. Surveys assessed subjective comfort with prescribing opioids and objective knowledge, using a version of the questions from the tool. Results: At baseline, mean scores on the 10-question knowledge assessment did not significantly differ by level of training (first year: 5.05, second year 5.74, third/fourth year: 5.58;p = 0.410) or between groups (intervention: 5.38, control: 5.5;p = 0.795). Following intervention, mean score was significantly higher in the intervention group (8.91) vs. controls (5.38;p < .0001). Six months later, scores in both groups decreased but remained significantly higher in the intervention group (6.91) compared to baseline (p = 0.0002) and compared to controls (4.91, p < .0001). Fellows indicated comfort with selecting opioid and starting dose for an opioid-naive patient at baseline but less with rotating opioids. Intervention group reported significant increases in comfort dosing opioids after exposure to the tool (p = 0.022) and in rotating opioids (p = 0.054) following the intervention. Conclusion: Use of PedOASIS was associated with improvement in scores on validated knowledge questions and in comfort using opioids for pain management in PHO fellows exposed to the tool compared to fellows without the tool. These findings suggest that this is a valid, reliable, and effective curricular tool. The use of self-directed learning has been associated with increased knowledge gains when compared to traditional didactic methods. The asynchronous learning structure is useful in the setting of the ongoing SARS-CoV19 pandemic, which has necessitated significant alterations in medical education. Based on these results, we suggest that PedOASIS is an effective and relevant addition to the PHO fellowship curriculum.

6.
European Journal of Molecular and Clinical Medicine ; 9(3):6133-6144, 2022.
Article in English | EMBASE | ID: covidwho-1885105

ABSTRACT

Background: Frontline healthcare workers play a critical role in the containment of the coronavirus disease-2019 (COVID-19) pandemic, and as they are wearing personal protective equipment to minimize cross-transmission and acquire confidence in fighting the pandemic (PPE) they face health problems and discomfort as well because of long duty hours. Objectives: To explore the health issues associated with use of PPE among healthcare front liners and to find out the possible solutions for the identified problems. Methodology: A cross sectional observational study involving a group of medical staff was done using a pre tested semi structured questionnaire using google forms at a tertiary care teaching hospital. Results: Maximum people said that Goggles and gowns are the most uncomfortable part of the PPE and the problems/health conditions faced most frequently was fog in goggles/shield and feeling hot and suffocating. Females, Intern Doctors and those with indefinite/not fixed duty were mostly unsatisfied with the PPE that was given. Conclusion: To alleviate healthcare workers’ burnout and job pressures, effective strategies for increasing comfort at workplace is required. More training regarding donning /doffing and comfortable and adequate supply of PPE is needed in order to get uninterrupted and quality service from the healthcare workers.

7.
Architectural Science Review ; : 13, 2022.
Article in English | English Web of Science | ID: covidwho-1882843

ABSTRACT

Due to the increasing amount of time that people are spending indoors, the need to ensure adequate ventilation has become a priority. The confirmed airborne transmission of COVID-19 highlights the necessity to consider the effect of ventilation on the reduction of the infection risk. In naturally ventilated buildings, the ventilation rate is not easy to determine, and it is difficult to estimate the risk to implement preventive measures. This paper presents a method to estimate the infection probability from CO2 concentration monitoring, which was applied to university classrooms. The effects of people's activity, classroom characteristics, occupancy and protective masks were also investigated. From the method, it is possible to calculate the infection probability using CO2 dataloggers that can be adopted as 'alarm' systems to keep the infection probability below a critical value. The method will enhance healthy conditions indoors and reduce the risk of infectious diseases in the future.

8.
4th International Conference on Reliability, Safety and Security of Railway Systems, RSSRail 2022 ; 13294 LNCS:95-111, 2022.
Article in English | Scopus | ID: covidwho-1877757

ABSTRACT

Passenger comfort systems such as Heating, Ventilation, and Air-Conditioning units (HVACs) usually lack the data monitoring quality enjoyed by mission-critical systems in trains. But climate change, in addition to the high ventilation standards enforced by authorities due to the COVID pandemic, have increased the importance of HVACs worldwide. We propose a machine learning (ML) approach to the challenge of failure detection from incomplete data, consisting of two steps: 1. human-annotation bootstrapping, on a fraction of temperature data, to detect ongoing functional loss and build an artificial ground truth (AGT);2. failure prediction from digital-data, using the AGT to train an ML model based on failure diagnose codes to foretell functional loss. We exercise our approach in trains of Dutch Railways, showing its implementation, ML-predictive capabilities (the ML model for the AGT can detect HVAC malfunctions online), limitations (we could not foretell failures from our digital data), and discussing its application to other assets. © 2022, Springer Nature Switzerland AG.

9.
Pakistan Journal of Medical and Health Sciences ; 16(4):694-696, 2022.
Article in English | EMBASE | ID: covidwho-1870365

ABSTRACT

Introduction: The COVID-19 could be a dangerous widespread that has influenced each angle of life including education. The educational institutes have been closed to avoid the spread of the infection, and they have changed over their system into distance education. Completing the semester there's a have to be address the risky issues within the modern framework to create it for future usage Objectives: 1-To explore the effects of Covid-19 on life style 2- To know the perceptions and suggestions regarding online education in pandemic Material and Methods Study design: Qualitative Settings: Rawalpindi Medical University Duration: Six months i.e. 1st January 2021 to 30th June 2021 Data Collection procedure: It was focus group discussion conducted via Zoom link. There were 15 medical students were selected from all five classes of MBBS randomly after taking informed consent. A variety of issues that were obtained from the discussion were identified. Results: The findings have uncovered that most of the members were influenced by the widespread period contrarily Anxiety, hope less, and fatigue. It is clear from the findings that education process has had its shortcomings instead of its advantages such as need of interaction, and communication which lead the students to segregation, issues about exams, conventional instructive habits, the load of assignments, and time administration. On the other side the advantages regarding flexibility of place and time to learn and comfort in assessment Conclusion: It is evident that the COVID-19 widespread process has influenced the students' lives adversely. These negative sentiments have not been overcome by the instruction they uncovered all through the period. While, in conventional campus life they would be at the side their companions and teachers and they would overcome the issues together through socializing. Distance education system tried to facilitating teaching. The COVID-19 widespread period ought to be regarded as an opportunity for teachers to consider how to push the distance education framework forward. Within the light of the findings, it would be awesome to create the current distance education practices which we may well are beyond any doubt that long-term executions get a solid premise.

10.
Journal of Investigative Medicine ; 70(4):1151, 2022.
Article in English | EMBASE | ID: covidwho-1868762

ABSTRACT

Purpose of Study Research has shown that low levels of physical activity in U.S. adolescents contributes to childhood obesity. Some studies have shown benefits from Doctor's office and school-based interventions for underserved adolescents with less access to affordable healthcare. Few studies have examined the Emergency Department (ED) as a setting to reach this population. The purpose of this study is to determine the receptivity of underserved adolescents with receiving an ED intervention to increase their physical activity. Methods Used This pilot study consists of a cross-sectional survey. The study population included were underserved adolescents between the ages of 12 to 18 who qualified for public insurance and presented to the ED. Children with private insurance or those presenting with COVID-19 or COVID-19 symptoms were excluded. Data points collected included age, race/ethnicity, comfort levels for discussing physical activity in the ED on a 1:10 scale, likelihood to change their opinions about physical activity in ED on a 1-10 scale, preferred setting to receive an intervention on physical activity, and setting most likely to change their opinions about physical activity. Summary of Results Out of the 47 patients that were enrolled to date, 51% were male, the mean age was 15 years (SD 2 yrs.). Patients identified as Hispanic/Latino (34.0%), White/ Caucasian (29.8%), African American (27.7%), Biracial (6.4%), and Asian (2.1%). For comfort level discussing physical activity in the ED, the mean was 6.5 (SD 2.4), 53.2% picked high comfort (7-10), 36.2% picked medium comfort (4-6), and 10.6% picked low comfort (0-3). For likelihood to change their opinions about physical activity in the ED, the mean was 6.6 (SD 2.5), 57.4% picked high likelihood (7-10), 29.8% picked medium likelihood (4-6), and 12.8% picked low likelihood (0-3). Most preferred physical activity intervention settings were: School (56.8%), Doctor's office (31.8%), and ED (6.8%). Settings most likely to change an adolescent's physical activity opinions were: Doctor's office (44.2%), ED (30.2%), and School (20.9%). Comfort level and likelihood levels were similar across gender and race/ethnicity groups when tested with a Kruskal-Wallis test. Conclusions Underserved adolescents report being comfortable and likely to change their physical activity opinions if approached in the ED setting. This reported receptivity suggests the ED may be a good venue to institute an intervention. The most preferred intervention setting for underserved adolescents was school, and the venue most likely to impact change was the Doctor's office followed by the ED. (Table Presented).

11.
Rheumatology (United Kingdom) ; 61(SUPPL 1):i110, 2022.
Article in English | EMBASE | ID: covidwho-1868414

ABSTRACT

Background/Aims Over the last 12 months (September 2020-21), we have been conducting a clinical trial with two biologic agents comparing pain outcomes in rheumatoid arthritis (RA) (n=26). Within the trial, we investigated how participants with RA taking immunosuppressive medication felt about their care and responded to the COVID-19 pandemic. Such information is important to guide healthcare providers. Methods Semi-structured interviews were conducted either face-to-face or virtually with participants who had recently been recruited to the Biologics for Rheumatoid Arthritis Pain (BIORA-PAIN) study and attended a South West London hospital. Participants had a DAS-28- CRP score of above 5.1 and were just starting on biological treatment. Seven interviews were conducted between April-September 2021, lasting between 23-60 minutes during which participants were asked how they managed their RA during the pandemic. All the responding participants were female, aged between 27-74 (mean 50.3 years), with a mixture of employment status and some living alone or with others. Interviews were recorded then transcribed verbatim and an interim thematic analysis was conducted. Results Four main themes were identified: the effect of lockdown;care of self;medical care;and support. Participants reported weight gain during lockdown due to being more sedentary and feeling less able to exercise, which increased stiffness. Despite reporting no official advice from doctors regarding shielding, most participants felt more vulnerable due to awareness of immunosuppression, but protective measures and vaccine uptake alleviated fears. Many sought advice from online resources, such as Versus Arthritis, and support groups which, as well as comfort, provided information enabling some participants to ask doctors specific questions about their care and medications. Most participants were wary of misinformation and chose to use trusted websites such as NHS and gov.uk or sources advised by doctors. There were varied reports of participants' experiences of their care: most participants felt that their care was largely unaffected by the pandemic, with all participants feeling able to obtain current medication. However, some felt the COVID-19 restrictions slowed the progress of their care and felt unsupported whilst suffering worsening symptoms. Face-to-face appointments were preferred over telephone appointments, as participants felt doctors were unable to assess their pain and joints via phone call. Participants who lived alone suffered more mentally. Conclusion Participants in this study were wary of coronavirus in relation to their disease and many chose to shield whilst reporting no shielding guidance. Many participants looked for reliable sources to research their care and treatment, which have been increased by feeling less able to contact clinicians during the pandemic. Participants felt that routine treatment was possible via telephone but changes in their condition required face-to-face appointments.

12.
International Journal of Thermal Sciences ; 179:107686, 2022.
Article in English | ScienceDirect | ID: covidwho-1867264

ABSTRACT

Worship places represent a unique type of buildings due to their functionality, dense occupancy, intermittent use, roof geometry, large inner space, and consumed energy of cooling/heating systems. In addition, thermal comfort and indoor air quality are decisive keys that affect the psychological and physiological conditions of occupants as well as their activity level and working efficiency. Though, a scarce number of studies focused on investigating the indoor conditions of worship places. Thus, a mosque located in Bahrain was selected to examine the influence of the occupancy level and period on thermal comfort sensation and indoor air quality. The readings of air temperature, humidity, air velocity, and CO2 concentration were recorded during real several occupancy levels and periods during the summer season. The measured findings of PMV and PPD metrics indicated that the social distancing between worshippers, during the SARS-CoV-2 pandemic, causes a feeling of coolness under the existing cooling system. Meanwhile, the 2-h occupancy period produced a 75% increment of CO2 concentration, 55% during 1-h occupancy, and 20% during half an hour occupancy. Therefore, the air-conditioning systems of worship places should be reconsidered in terms of ventilation rates and partial operating to provide comfortable conditions that accommodate different occupancy levels and periods.

13.
Building and Environment ; 219:109227, 2022.
Article in English | ScienceDirect | ID: covidwho-1866930

ABSTRACT

The building energy performance has been highly studied in the last decades considering the indoor environmental quality, and sustainability indicators to examine energy-efficient cost-optimal, and nZEB building levels for different building typologies. However, since the start of the COVID-19 pandemic in 2020, the usage and operation of public spaces and buildings have evolved according to COVID-19 measures produced by the authorities. Social distancing measures and HVAC system measures affecting energy performance and indoor environmental quality of the public buildings are consequently necessary for building energy performance studies. Thereby, it is aimed at re-considering an energy-efficient cost-optimal retrofitting approach for a primary school building case, under the COVID-19 measures to recast an energy-efficient cost-optimal level and apply a cost-efficiency criterion to search for the measures adapted nZEB scenarios. COVID-19 measures affecting building energy performance, such as social distancing and IEQ requirements, were analysed. Then, probable ventilation rates were controlled by the infection probability method to satisfy the limit number for infection. Thus, pre-COVID-19 and post-COVID-19 variables regarding occupancy density and HVAC operation were determined for the calculation process. Besides, retrofit scenarios were shaped to improve optic and thermophysical properties of the façade, lighting, and HVAC systems performance. Then, energy, LCC, thermal comfort and IEQ performance of retrofit scenarios were calculated with a calibrated model. Results were evaluated by applying the cost-efficiency criterion to find out nZEB scenarios. It can be stated that distinct LCC and energy use increments occurred in the cost-optimal range and nZEB level.

14.
Evidence-Based Practice in Child and Adolescent Mental Health ; 2022.
Article in English | EMBASE | ID: covidwho-1860773

ABSTRACT

The purpose of this qualitative study was to capture the perspectives of individuals representing an urban, predominantly Latinx community who are underresourced by mental health services about the use of telehealth to deliver mental health treatment. The COVID-19 pandemic required hospital- and community-based mental health programs to pivot to telehealth with alarming speed and very little opportunity to assess the feasibility, acceptability, and disparate impact on unique populations of patients. This study aimed to assess perceived strengths and limitations of telehealth mental health service delivery via qualitative focus group methods. Three focus groups were conducted with 13 youth (aged 8–17) who were being treated at an urban, academic children’s hospital serving a predominantly Latinx community mental health population;two focus groups were conducted with 19 parents of said children;and one focus group was conducted with four mental health providers providing services to this population. A coding schema was designed to capture themes relevant to the following: (1) privacy and confidentiality;(2) perceived limitations of telehealth;(3) comfort with telehealth;(4) therapeutic relationship;(5) perceived strengths of telehealth;(6) perceived safety of telehealth;and (7) advice for providers engaging in telehealth. Findings were illustrative of both perceived strengths and limitations across these domains that can inform optimized telehealth mental health services moving forward.

15.
Sustainability ; 14(9):22, 2022.
Article in English | Web of Science | ID: covidwho-1855766

ABSTRACT

Evidence shows that people have a major impact on building performance. Occupants' impact is especially important in social housing, where their occupants may present greater vulnerabilities, and their needs are not always considered. This study aims to analyse the socio-demographic influence in social rental housing concerning hygrothermal comfort and energy consumption in a case study located in Vitoria, Spain during the first 4-month period of 2020 and 2021 (during and after COVID-19 lockdown). An innovative data management system is included, where the users and administration can see in real-time the temperature and consumption in the dwellings. A 2-phase method has been applied;phase 1 is associated with outdoor climate conditions, building properties and social profile. Phase 2 determined the results in energy consumption, indoor hygrothermal comfort and occupant energy-use pattern. The results show that the comfort levels and energy consumption vary according to the analysed social profiles, as well as the heating activation periods and domestic hot water system usage. In conclusion, socio-demographic characteristics of social housing households influence the hygrothermal comfort of their dwellings, occupants' behaviour and heating and domestic hot water energy consumption.

16.
Epidemiology ; 70(SUPPL 1):S229-S230, 2022.
Article in English | EMBASE | ID: covidwho-1854003

ABSTRACT

Introduction: Cognitive decline in the elderly is a diagnostic challenge - one that must consider numerous differential diagnoses, including dementia. Given the profound impact of one's cognition on functional status and quality of life, early recognition of reversible and treatable causes of cognitive decline, especially when it occurs at a rate faster than expected, is critical. Case Presentation: An 86-year-old female was admitted from long-term care for a 2-week history of cognitive decline, hypoxia, and vomiting that began after receiving the second dose of the COVID vaccine. Her past medical history was significant for dementia, right middle cerebral artery stroke, benign left parietal neoplasm under surveillance, and pulmonary emboli. Investigations for her hypoxia were unremarkable;thus, it was thought to be due to aspiration from emesis. Initially, the patient's cognitive decline was presumed to be secondary to her dementia, which has been progressive for the past 5 years, leading to her eventual admission to long-term care. However, it was highlighted that the patient's cognition rapidly declined in a period of weeks. Despite her dementia, at baseline, the patient could engage in full conversations. However, over the past few weeks, the patient could only communicate with a few words and became newly dependent with ADLs. The patient was not delirious, given the non-fluctuating cognitive decline with normal attention and level of consciousness. Laboratory studies, including TSH and vitamin B12, were normal. CT Brain was completed given patient's history of parietal neoplasm, demonstrating a new left occipital lobe lesion with vasogenic edema. The patient was started on dexamethasone given the size of the lesion and edema. With this, her cognition significantly improved over days, allowing the patient to be involved in the decision-making of her care. Unfortunately, the patient had an aspiration event during her admission. As per her wishes, she was discharged to long-term care with symptom-focused, comfort care. Discussion: In this case, we discuss our approach to cognitive decline and highlight the importance of maintaining a broad differential, even in the face of known dementia. Finding reversible causes of cognitive decline can not only improve quality of life, but as seen in our patient, it can allow individuals to participate in meaningful decisions regarding their goals of care.

17.
Epidemiology ; 70(SUPPL 1):S240, 2022.
Article in English | EMBASE | ID: covidwho-1853987

ABSTRACT

Background: In America there are currently many older adults living alone in hopes of maintaining their independence. COVID-19 emphasized the pre-existing issue of social isolation among older adults, especially with society's ever-increasing dependence on technology. In response to the pandemic, the HealthWise program was created to teach older adults about technology, using Zoom©, to increase comfortability and confidence when using technology. Methods: To participate in HealthWise, participants needed to be 55 or better, have WIFI connection and the ability to participate in sessions for the duration of the program. All participants were assigned to trained coaches, who were students at Eastern Virginia Medical School. During the first session each participant signed a consent form and completed a 14-question survey. Questions included multiple choice and Likert scales pertaining to age, race, educational level, frequency of technology use, and their level of comfort using technology. One-hour sessions were conducted twice a week for three months. The goal was for participants to gain proficiency in the following skills: WIFI, Zoom ©, email and the Birdsong App, an internet- based software for older adults. Results: There were 66 participants total. 56% of all participants lived alone, while 24% lived with their spouse. 24% completed some college but have no degree, 20% had a bachelor's degree, 18% had a master's degree, 15% had a high school degree (or equivalent) and 12% had an associate degree. 88% of participants use technology more than five plus times per week, while only 12% use technology less than five times. Of those using technology consistently, only 40% are comfortable with their abilities. Participants with an associate degree or higher reported to be more comfortable using technology compared to participants with a high school education or lower (p-value, 0.025). Conclusion: The pre-survey data demonstrates there is a need within the older adult population to receive technological training. In addition, the data shows an interest among older adults to receive training despite education level and current levels of comfort using technology. Additional research will be conducted to gather data on retention of skills and comfortability using technology.

18.
Epidemiology ; 70(SUPPL 1):S295, 2022.
Article in English | EMBASE | ID: covidwho-1853980

ABSTRACT

Background: Explosive growth in the use of telemedicine occurred during the coronavirus disease 2019 (COVID-19) pandemic. To benefit from telemedicine, patients must have the capacity to engage with technology, for which inexperience and access may pose barriers particularly in older adults. Telemedicine also has the potential to lessen healthcare burden in this population due to frequent appointments, physical and cognitive disabilities, and reliance on caretakers. This study aimed to better understand the perspectives of older women with non-metastatic breast cancer on telemedicine, in regards to visit convenience, completeness, and interpersonal satisfaction. Methods: In this qualitative study, semi-structured interviews were conducted in a convenience sample of women age 65+, postprimary treatment for Stage I-III breast cancer, who received in-person outpatient care at NCCH (NC Cancer Hospital) before transitioning to telemedicine after March 2020. Patients were interviewed about their perceptions of telemedicine (telephone, video) as compared to in-person visits. Audio files of interviews were transcribed and reviewed to identify themes established a priori in the interview protocol. Results: 15 patients (telephone=5, video=10) were consented and interviewed (July-October 2021), mean age=74. 87% (13/15 participants) reported that they preferred a hybrid care model that included telemedicine care over in-person care alone. COVID-19, physical disability, and transportation burden were associated with telemedicine preference. Comfort with familiar patient-provider interaction and lack of physical exam were associated with in-person appointment preference. In-person appointment was favored early in the postprimary treatment phase;telemedicine was more acceptable when relationships were well-established, and patients had lower illness anxiety. All participants who had appointments via video preferred it over telephone, whereas some participants who had telephone visits wanted to use video but faced technological challenges in its use. Conclusions: Patient-clinician conversations and clinic protocols guiding decisions about the use of telemedicine should take into account newness of diagnosis, patient comfort and familiarity with the care team, travel burden, disability, and an explanation as to whether the physical exam is or is not essential.

19.
Epidemiology ; 70(SUPPL 1):S270, 2022.
Article in English | EMBASE | ID: covidwho-1853979

ABSTRACT

Background: This case describes the circumstances of an older woman and her daughter faced with the dilemma of whether or not to receive the COVID-19 vaccine at the end of life. Methods: Ms. V was a 90-year-old woman with past medical history of major neurocognitive disorder, asthma, and hypertension on home hospice after experiencing a rapid decline beginning in November 2020. By January 2021, she had significantly deteriorated with a prognosis of weeks. At this time, the COVID-19 vaccine had become available to high-risk individuals and their household members. Because Ms. V lacked capacity to make her medical decisions, her daughter and healthcare power of attorney, Ms. B, had to determine her wishes. Ms. V's goals were comfort care and to avoid hospitalization. Although she had worked as a nurse, she had declined her annual influenza vaccine in the past. However, Ms. B felt that her mother would have wanted to help her children and caretakers get the vaccine, which would only be possible if she got the vaccine first. Results: Extensive conversations with Ms. V's children, hospice team, and geriatrician were held utilizing the 4-box approach to ethical decision making.1 Ms. B decided that her mother would have wanted to receive the vaccine for the main purpose of also vaccinating her children, who both had advanced heart failure and were at high risk for complications from COVID-19. She received one dose of the Pfizer COVID-19 vaccine and died ten days later. Her children and live-in caregiver all received the Pfizer Covid-19. Conclusion: Although Ms. V had previously refused annual influenza vaccinations, her daughter felt that her mother would have gotten the vaccine to provide protection for her children and caregiver. While it was acknowledged that Ms. V would probably gather little immunity benefit from the vaccine due to her poor prognosis, her daughter felt that the benefits of the entire household receiving the vaccine outweighed any potential risks. Her family called this final act of protection her dying wish.

20.
Journal of Pain ; 23(5):33-34, 2022.
Article in English | EMBASE | ID: covidwho-1851621

ABSTRACT

Transcutaneous electrical nerve stimulation (TENS), a non-pharmacological treatment, is safe and effective for movement-evoked pain in individuals with Fibromyalgia (FM). The purpose of our NIH-funded pragmatic clinical trial, Fibromyalgia TENS in PT Study (FM-TIPS), assesses feasibility and effectiveness of adding TENS to usual physical therapy (PT) treatment in individuals with FM. We partnered with 33 sites in 6 healthcare systems, training 150+ Midwest clinicians. Outpatient PT clinic sites are cluster randomized to a TENS or a No-TENS intervention, stratified by system and clinic size. We will recruit ∼600 patients with a primary or secondary diagnosis of FM. We developed comprehensive communication and training procedures to ensure study fidelity and adapted over the course of the study to enhance learning. We will provide an overview and the impact of the pandemic on these procedures. Representatives for each healthcare system, each clinic and the study team were identified for communication and training. Training included initial study introduction, human subjects protection, and study procedures. We used a hybrid approach with written, video, onsite, and virtual instruction. All materials and procedures, for clinician and patient-facing materials, website, videos, equipment use (iPad for screening, TENS units), and clinician procedures for PT visits 1-3, were piloted and reviewed by clinicians from each healthcare system. Additional communication and feedback include weekly enrollment reports, monthly newsletters, relationship building with clinicians, enrollment incentives, and continuing education webinars. The pandemic required creative and evolving solutions to maintain study involvement and recruitment. Barriers for enrollment are screening PT Visit 1, comfort level of clinicians for PT Visits 2 and 3, delays/alterations in training and planning, clinician demands, clinicians/patient illness, and staff shortages in the clinics. Current enrollment, study training and implementation has been affected by COVID-19 and we developed creative methods for training and implementation for FM-TIPS. Grant support from Research supported in this USASP was supported by National Institutes of Health Heal Initiative Grant UG3/UH3 AR076387-01 and UL1TR002537.

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