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1.
Gastroenterology ; 162(7):S-786, 2022.
Article in English | EMBASE | ID: covidwho-1967371

ABSTRACT

Background Patients with immune-mediated inflammatory diseases (IMID) are at higher risk for infectious diseases. Despite this increased risk and the available guidelines1, we reported a suboptimal vaccination rate of 33.8% of IMID patients in 2018. In the meantime, a vaccination module was introduced in the electronic patient health record of our hospital to accurately document and monitor vaccination status of patients. The impact of this new module on vaccination coverage was re-evaluated in the same IMID patients in 2021. Methods Between Aug and Oct 2021, the vaccination status of 1448 (out of the original 1488) IMID patients (44.8% male, median age 53.6 years) was collected (798 patients with IBD, 612 with rheumatological, and 38 with dermatological inflammatory conditions) and compared to that of 2018. The vaccination status was obtained mainly through the patients' electronic medical records. Missing data were added after contacting patients or their general practitioner. Results From 2018 to 2021, the overall vaccination coverage of all IMID patients significantly increased from 33.8% to 51.1% (p<0.001, Figure 1). The vaccination coverage in IBD patients increased significantly from 75.9% to 86.3% for influenza (p<0.001), from 72.9% to 88.7% for pneumococci (p<0.001), from 66.0% to 80.2% for hepatitis B (p<0.001), from 79.9% to 85.7% for tetanus (p=0.041) and from 42.2% to 60.4% overall (p<0.001) (Figure 1 and Table 1). Similarly, the vaccination coverage significantly increased for rheumatology patients, namely from 69.3% to 78.3% for influenza (p<0.001), from 34.5% to 85.0% for pneumococci (p<0.001) and from 32.8% to 36.5% for hepatitis B (p<0.001) (Table 1). For patients with dermatological inflammatory conditions, vaccination coverage significantly increased from 60.5% to 81.6% for pneumococci (p=0.031) and from 47.1% to 55.3% for hepatitis B (p=0.002) (Table 1). Conclusion The suboptimal vaccination rate measured in 2018 and the COVID-19 pandemic stressed the importance of vaccination recommendations to patients and healthcare professionals. We here show that the implementation of a vaccination tool integrated in the electronic medical record of patients is correlated with a significant increase in specific vaccination rates and also in the total amount of IMID patients that were fully vaccinated according to guidelines. 1. Rahier JF, Magro F, Abreu C, et al. Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis. 2014;8:443–468.(Figure Presented)(Table Presented)

2.
Gastroenterology ; 162(7):S-287, 2022.
Article in English | EMBASE | ID: covidwho-1967276

ABSTRACT

Background: The Familial Mediterranean Fever (FMF) Program at the University of California, Los Angeles is the only dedicated FMF diagnostic and treatment clinic in the United States, receiving global referrals. FMF is a rare autosomal recessive genetic disorder characterized by recurrent febrile polyserositis. Serious complications from untreated FMF are easily preventable with early diagnosis and treatment. The COVID-19 pandemic constrained educational and interdisciplinary in-person visits and prompted exploration of innovative telehealth solutions. Objective: This study aimed to explore the feasibility and clinical process outcomes associated with a multidisciplinary telemedicine model to deliver consultative and continuing care to FMF patients. Our secondary objectives included assessing provider, patient, and trainee satisfaction. Study design: We implemented a multidisciplinary telemedicine clinic with gastroenterologists, a medical geneticist, and trainees. All patients with suspected FMF referred to our clinic during the pandemic were included. Patients were sent a HIPAAcompliant Zoom link for their clinic appointment. We mirrored our in-person academic teaching model, first with the trainee interviewing the patient virtually and then later presenting to the team, along with family members, who joined for the case presentation and consensus on diagnostic impressions and management recommendations. Patient characteristics and clinical process outcomes were assessed during the visit and from the electronic medical record (EMR). Post-visit surveys of patients, physicians and trainees were then taken to assess effectiveness and desirability of the approach. Results: 86 patients were enrolled in the multidisciplinary telemedicine model from March 2020 to March 2021. In comparison, 87 pre-pandemic visits occurred between March 2019 to March 2020. No significant difference was found in patient volume seen with telehealth and surveys showed increased provider, patient, and trainee satisfaction. The telehealth model enabled health care delivery to a variety of locations that lacked expert experience with this rare disease. Patients could also avoid costly travel to UCLA and risk exposure to COVID-19. Surveys showed increased satisfaction with Zoom than the integrated video functionality in our in-house EMR by allowing for inclusion of multiple specialists and interested family members. Sample collection for indicated laboratory tests could still be ordered at a local phlebotomy center. Conclusion: A multidisciplinary telemedicine model for outpatient management of FMF patients resulted in rates of ambulatory management similar to those seen pre-pandemic and resulted in improved patient and physician satisfaction. FMF is especially amendable to this approach, as patients are asymptomatic between attacks, making hands-on physical exam less pertinent.

3.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S52, 2022.
Article in English | EMBASE | ID: covidwho-1966667

ABSTRACT

Introduction: Kratom (mitragynine speciosa) is a tree native to Southeast Asia that has both opioid, stimulant, and other unknown properties. It is currently legal in the United States and used for therapeutic and recreational purposes. There is a dearth of literature on kratom’s effects on the body. At least half of reported kratom exposures resulted in a serious medical outcome, including death (1). In contrast, there are no controlled clinical trials on safety and efficacy of kratom as a treatment (2). Case: A 32-year-old Caucasian, currently unemployed, unmarried, mother of two children presented intubated to the MICU from an outside hospital with acute fulminant hepatic failure in the setting of significant kratom use. The patient also presented febrile with intracranial hemorrhage, cerebral edema, GI bleeding, acute renal failure, and diffuse intravascular coagulation. Psychiatry was consulted for potential liver transplant candidacy. Her previous history included six years of opioid use and transition to kratom 1-2 years prior to admission, with recent ingestion up to twenty-five times the patient’s usual amount (up to 125mg). Pertinent positive labs included elevated troponin (0.4), transaminitis ( >11,000), elevated PT/PTT (99/52), D-dimer ( >20), hematuria, pyuria, serum ferritin, prolonged QTc (514), and hypoglycemia. Pertinent negatives included unrevealing serum ethanol, phosphatidylethanol, viral hepatitis, HIV, COVID-19, EBV, CMV, other viral panels, acetaminophen level, toxicology screen, and EEG. Imaging revealed interstitial pulmonary edema and diffuse cerebral edema. Given lack of published information on kratom, the team emergently listed the patient for liver transplant despite significant concern for kratom use disorder. Over the course of three days, the patient’s mental status and labs continued to worsen, ultimately resulting in death. Interventions pursued included dialysis, mechanical ventilation, intracranial pressure monitoring with pressure optimization, anticonvulsant therapy, antibiotic therapy, N-acetylcysteine, and other routine MICU care. Due to relatively unremarkable health before ingestion, lack of other significant events, and severe rapid decline, multidisciplinary team consensus cause of death was due to kratom ingestion causing “acute liver failure with hepatic coma”. Discussion: This case report will go into further detail on kratom by analyzing kratom’s mechanism of action, therapeutic use, known side effects including addictive potential, effects on the liver including acute fulminant injury, and current laws and regulations surrounding kratom in the United States with relevance to public health. This is relevant to psychiatrists in the general consult, transplant, and addictions services. References: 1. Post S, Spiller HA, Chounthirath T, Smith GA. Kratom exposures reported to United States poison control centers: 2011–2017. Clinical Toxicology. 2019 57:10,847-854. DOI:10.1080/15563650.2019.1569236 2. Prozialeck W. Update on the Pharmacology and Legal Status of Kratom. J of the AOA. 2016, 116, 802-809. DOI: https://doi.org/10.7556/jaoa.2016.156

4.
Revista Cubana de Salud Publica ; 48(2), 2022.
Article in Spanish | EMBASE | ID: covidwho-1965341

ABSTRACT

Introduction: Although there is ample scientific evidence on the pandemic, the impact of COVID-19 on health services from the perspective of healthcare personnel has been little explored. Objective: To explore the experiences in health services of epidemiologists in training during the COVID-19 pandemic. Methods: Exploratory, qualitative-descriptive study, with ethnographic research tools for data collection such as observation, field diary and group interview;as well as grounded theory for the construction of categories that allowed to understand the studied phenomenon. For the formation of the focus group, seven epidemiologists in training from a Colombian university participated, with prior informed consent. The topic was introduced, with the subsequent application of the focus group guide tools, consensus posters, response sheets and an observation guide. Results: Hospital collapse and emerging restructuring of health services were generated, promoting other care strategies such as telemedicine. Study participants experienced fear attending patients on stressful days, with shortages of supplies and medicines;they were stigmatized, which generated "anxiety and work stress." However, they learned "to better classify cases" and with the increase in patients they were able to perceive inequities that represented a professional and human challenge. Conclusions: The COVID-19 pandemic has been valid as a learning process with new training perspectives to be able to act in the face of health events of global interest, with the necessary application and management of protocols, which can change the focus of health care and allow epidemiology to move towards education, promotion and prevention.

5.
The American Journal of International Law ; 116(3):579-585, 2022.
Article in English | ProQuest Central | ID: covidwho-1960135

ABSTRACT

For the Court, this conclusion was bolstered by the observations that vaccination was not administered against the will of the applicants;that there is no consensus between member states over a single model to achieve the highest level of vaccination;that the introduction of a legal duty to vaccinate children raises sensitive moral or ethical issues;and that the case concerns matters of healthcare policy (paras. 276–79). [...]the Court considered that the measure satisfied the proportionality test. Furthermore, the Court underlined the temporal nature of the exclusion, as all children—also when not vaccinated—can still be enrolled in primary school (para. 307). [...]the Court concluded that the Czech Republic had not overstepped its margin of appreciation and consequently that there was no violation of the right to private life (paras. 310–11). [...]the Court held, also by sixteen votes to one, that it was unnecessary to examine separately the complaints of the five child applicants under Article 2, Protocol No. 1 in light of the previous findings under Article 8 (para. 345).

6.
Br J Sports Med ; 2022 Jul 21.
Article in English | MEDLINE | ID: covidwho-1962132

ABSTRACT

Acute illnesses affecting the respiratory tract are common and form a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. Acute respiratory illness (ARill) can broadly be classified as non-infective ARill and acute respiratory infections (ARinf). The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to ARinf in athletes. The International Olympic Committee (IOC) Medical and Scientific Commission appointed an international consensus group to review ARill (non-infective ARill and ARinf) in athletes. Six subgroups of the IOC Consensus group were initially established to review the following key areas of ARill in athletes: (1) epidemiology/risk factors for ARill, (2) ARinf, (3) non-infective ARill including ARill due to environmental exposure, (4) acute asthma and related conditions, (5) effects of ARill on exercise/sports performance, medical complications/return-to-sport and (6) acute nasal/vocal cord dysfunction presenting as ARill. Several systematic and narrative reviews were conducted by IOC consensus subgroups, and these then formed the basis of sections in the consensus documents. Drafting and internal review of sections were allocated to 'core' members of the consensus group, and an advanced draft of the consensus document was discussed during a meeting of the main consensus core group in Lausanne, Switzerland on 11 to 12 October 2021. Final edits were completed after the meeting. This consensus document (part 1) focusses on ARinf, which accounts for the majority of ARill in athletes. The first section of this consensus proposes a set of definitions and classifications of ARinf in athletes to standardise future data collection and reporting. The remainder of the consensus paper examines a wide range of clinical considerations related to ARinf in athletes: epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations, risks of infection during exercise, effects of infection on exercise/sports performance and return-to-sport guidelines.

7.
Neuro-Oncology ; 24:i145, 2022.
Article in English | EMBASE | ID: covidwho-1956576

ABSTRACT

INTRODUCTION: Surgery in patients diagnosed with COVID-19 is associated with increased risk of morbidity and mortality, especially within 6 weeks of SARSCoV- 2 infection. Furthermore, most studies have focused on adults, and little is known about perioperative outcomes in children with COVID-19. METHODS: We reviewed the operative census of the Division of Neurosurgery of Philippine General Hospital from March 2020 until December 2021. We identified all pediatric patients with brain tumors and confirmed COVID-19 infection within two weeks of their neuro-oncologic surgery. Their clinical course and outcomes are described herein. RESULTS: Four patients were included in this case series: three had tumors in the cerebellum, one in the pineal region. All of them were boys, with ages ranging from 4 months to 13 years. All tumors were malignant, and two were confirmed to be medulloblastoma after tumor resection. COVID-19 infection was diagnosed by the presence of SARS-CoV-2 RNA through a nasopharyngeal swab. Three patients acquired the virus post-operatively, likely from nosocomial transmission. In the remaining patient, it was community-acquired. All the patients had chest radiographs consistent with pneumonia but none had marked elevation of serum inflammatory markers. No patient received remdesivir or tocilizumab. At the time of their presentation, either the COVID-19 vaccine was not yet available in the country, or the patient was not yet eligible for vaccination. One patient died because of brain herniation from tumor progression, two were discharged and eventually underwent adjuvant therapy, and one remained in-hospital as of this writing. DISCUSSION: COVID-19 infection resulted in delays in the management of patients with pediatric CNS tumors. Given the high risk of these patients for potential complications, consensus guidelines must be established to achieve good outcomes and prolong survival.

8.
Journal of Pediatric Infectious Diseases ; 2022.
Article in English | EMBASE | ID: covidwho-1956444

ABSTRACT

Objective The research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mainly consists of adult patients, leaving its impact on children understudied. This study aims to investigate the correlations between viral load, clinical course, age, and Alpha variant (B.1.1.7) in children. Methods The study was conducted on children under the age of 18 years, who were admitted to Amasya University Sabuncuoglu Serefeddin Research and Training Hospital in Turkey between February and April 2021. ΔCt values, which were obtained by real-time polymerase chain reaction (PCR), were analyzed to estimate the viral loads of the patients. Alpha variant (B.1.1.7) positivity was determined by real-time PCR. Results There was no difference between estimated viral loads of different clinical courses (p > 0.05), or between asymptomatic and symptomatic patients (p > 0.05). Viral loads were found to decrease with increasing age (p = 0.002). Also, a higher rate of symptomatic disease was found in children under the age of 4 years (p < 0.05). Alpha variant (B.1.1.7) was not found to be associated with severe disease in children (p > 0.05). Conclusion Our results demonstrate higher viral loads and symptomatic disease in children under the age of 4 years. Alpha variant (B.1.1.7) was not found to be related to disease severity. There has not been a consensus on the vaccination of the pediatric population worldwide. More studies are needed to understand the viral kinetics of SARS-CoV-2 and its severity on children to build effective vaccination strategies in children as public health restrictions are eased.

9.
J Healthc Leadersh ; 14: 63-70, 2022.
Article in English | MEDLINE | ID: covidwho-1951786

ABSTRACT

The RAND/UCLA modified Delphi panel method is a formal group consensus process that systematically and quantitatively combines expert opinion and evidence by asking panelists to rate, discuss, then re-rate items. The method has been used to develop medical society guidelines, other clinical practice guidelines, disease classification systems, research agendas, and quality improvement interventions. Traditionally, a group of experts meet in person to discuss results of a first-round survey. After the meeting, experts complete a second-round survey used to develop areas of consensus. During the COVID-19 pandemic, this aspect of the method was not possible. As such, we have adapted the method to conduct virtual RAND/UCLA modified Delphi panels. In this study, we present a targeted literature review to describe and summarize the existing evidence on the RAND/UCLA modified Delphi panel method and outline our adaptation for conducting these panels virtually. Transitioning from in-person to virtual meetings was not without challenges, but there have also been unexpected advantages. The method we describe here can be a cost-effective and efficient alternative for researchers and clinicians.

10.
Journal of Adolescent Health ; 70(4):S30, 2022.
Article in English | EMBASE | ID: covidwho-1936666

ABSTRACT

Purpose: Compared to cisgender peers, gender diverse youth (GDY) face significant mental health disparities. Parent affirmation reduces these disparities, but there are few evidence-based support programs for parents of GDY and none centered on 1:1 parent peer support, which has shown promise in other pediatric settings. This study aimed to evaluate a 1:1 peer mentor program for parents of GDY, the Parent Outreach Program (POP). Methods: We created anonymous online surveys consisting of open-ended questions about the POP distributed via email to program mentors (parents providing support) and mentees (parents receiving support). Participants were asked why they became involved, benefits and challenges, and how this program compared to others they had participated in. Open-ended responses were coded by two authors using two iteratively developed codebooks (one each for mentors and mentees);codes were adjudicated to consensus and key themes were identified for both participant types. Results: In total, 20 participants (6 mentors, 14 mentees) completed parallel surveys. Themes identified for mentors included feeling giving back was important, their mentoring experience, challenges, and personal growth resulting from being a mentor. Mentors wanted to help other families, “[POP was] rewarding in knowing that by helping the parents you can ultimately help the kids”. They shared logistical challenges like “coordinating schedules” as well as the potential for conversations to be triggering;“Sometimes it brings up a memory of my own family that evokes an emotion”. Mentors also noted their participation was a positive experience: “[POP] offers us the opportunity to grow in our knowledge and feelings in regard to our own child”. Themes identified for mentees included the importance of finding community through the POP, receiving education, relating to their mentors, practical considerations, and qualities of a good mentor. Parent mentees shared relief in finding a “sense of community”;as one mentee said, “It was a lifeline to some sanity”. They also noted that the POP gave them specialized information and that they connected with mentors based on shared experiences: “We craved parents with a true understanding of the many feelings, changes, activities…”. They addressed practical considerations like the intimacy of 1:1 support and that recommendations from a provider mattered to them: “This [program] is more intimate and focused on our stories;” “When the social worker offered it, I had no doubt.” Mentees stressed that mentors “being non-judgmental, willing to listen” was critical. All mentees noted that they would recommend POP to other parents. Conclusions: Both parent mentors and mentees shared that 1:1 peer support was valuable and allowed mentors to give back and experience personal growth, while providing community and resources to mentees who were struggling to understand and support their GDY’s journey. The POP also provides an alternative to large support groups given the ongoing COVID-19 pandemic. This program and others offering 1:1 parent peer support may fill an important gap in supporting parents of GDY, ultimately improving mental health outcomes for their young people. Sources of Support: Dr. Kidd was supported by the National Center for Advancing Translational Science of the NIH, Award Number TL1TR001858.

11.
Journal of Adolescent Health ; 70(4):S24-S25, 2022.
Article in English | EMBASE | ID: covidwho-1936663

ABSTRACT

Purpose: The COVID-19 pandemic has challenged the health care and education systems on all fronts: safely providing care for patients, restructuring how care is delivered, and rapidly innovating to deliver stimulating medical education via tele-technology. The pandemic also highlighted multiple health disparities, resulting in an urgent call to action to promote health equity. In response to these challenges, the New York State (NYS) Clinical Education Initiative (CEI) Sexual Health Center of Excellence developed a video-based educational curriculum entitled, “Building Blocks for Trans & Gender Diverse Care.” The curriculum aims to guide clinical providers to create a practice space for delivering care that is gender affirming and inclusive. Methods: The curriculum provides a quick, easy to access, graduated learning experience that engages learners at multiple levels. Content includes foundational concepts and terminology, creating inclusive healthcare spaces and non-stigmatizing encounters. It also offers clinical guidance and pearls related to the gender transition process. The curriculum was unveiled at the 7th Annual NYS Sexual Health Conference, and then shared on the CEI YouTube channel where it is presented as 3 episodes, broken into 12 parts, each 5 to 18 minutes long. The YouTube link has been shared on multiple clinician listservs, with an international subscriber base. The link is also available on the employee learning and performance platform used by a major academic medical center. By disseminating through multiple access points, we aim to build awareness and competence to a broader audience. Utilization of YouTube enables our team to assess curriculum usage by tracking numbers of views and learner comments. Beginning in October 2021, the curriculum will also be accessible on the open source CEI website for free Continuing Education (CE) credits, both medical and nursing. As with all curricula on the CEI website, demographic information regarding viewers and evaluation feedback are collected. Results: Preliminary results reveal that between 6/29/21 and 9/9/21, the videos have been viewed 871 times through the CEI YouTube channel. The consensus feedback received (verbal comments, responses to listserv posts) has been overwhelmingly positive. Access to CE accredited videos will open on Oct 1, 2021. Information regarding number of views, completion of the entire 3 part series, demographics of viewers (profession, age/race/ethnicity practice specialty, practice location) will be reported along with quantitative and qualitative evaluation results. Conclusions: An accessible, short educational video curriculum has been well-received and easily disseminated via the Internet during an initial marketing rollout. It has the potential to build competence broadly among clinicians to provide an affirming and inclusive healthcare experience for transgender and gender diverse patients. The video format is particularly appropriate during a pandemic, when in-person engagement has been challenging in both patient care and continuing education activities. Sources of Support: New York State AIDS Institute, Clinical Education Initiative.

12.
Journal of Adolescent Health ; 70(4):S23, 2022.
Article in English | EMBASE | ID: covidwho-1936662

ABSTRACT

Purpose: Pediatric gender centers have seen a notable increase in demand for gender-affirming care services during the COVID-19 pandemic. This increased need has contributed to delays in youth accessing this time-sensitive care and amplified the importance of primary care providers (PCPs) playing an active role supporting gender diverse youth in the post-pandemic world. To guide interventions to support PCPs in gender-affirming care, we sought to understand how often PCP’s see gender diverse youth in primary care and assess PCP comfort facilitating conversations about gender identity in this setting. The objectives of this study were to (1) understand whether PCPs are routinely discussing pronouns and gender identity with adolescents and (2) explore barriers to and the impact of having such discussions in primary care. Methods: This project integrated data from a needs assessment survey and from semi-structured, qualitative interviews with pediatric PCPs. The 15-item survey was administered to PCPs in a large, hospital-affiliated, pediatric primary care network in the northeastern US to better understand PCPs experiences providing adolescent healthcare. Hour long, semi-structured interviews were conducted with pediatric PCPs in the pacific northwest using an interview guide developed in partnership with two PCP stakeholders. Survey responses were analyzed descriptively. Interviews were transcribed and analyzed by two authors in Dedoose qualitative analysis software via inductive thematic analysis using an iteratively designed codebook that was adjudicated to consensus. Results: Of the pediatric PCPs surveyed (n=85), the majority were pediatricians (67%) and most had been in practice for more than 5 years (75%). Almost all (92%) PCPs reported caring for at least one gender diverse youth in their practice in the last year. However, PCPs reported discussing pronouns (15%) and gender identity (29%) during annual well visits with adolescent patients much less frequently than discussing mood (98%), motor vehicle safety (77%) and sexuality (61%). Relatedly, gender-affirming care (60%) was the topic most frequently selected by PCPs for additional education. In separate PCP interviews, participants (n=15) indicated that while they felt discussions about pronouns and gender identity were important, they experienced specific structural and interpersonal barriers that prevented these conversations from occurring. These barriers included poor health system infrastructure (like forms and electronic health records), staff concerns, uncertainty around language, lack of awareness and fear. PCPs also discussed that when they asked about pronouns and gender identity, it normalized conversations about gender, helped facilitate family support, created welcoming environments in the health system and allowed for earlier identification of youth in need of support. Conclusions: Pediatric PCPs recognize the critical role they play in supporting gender-diverse youth and their families, particularly around normalizing conversations about gender identity. However, multiple individual and clinic-level barriers to asking about pronouns and gender identity remain. These results highlight the continued need to provide resources, education and support to PCPs in discussing these topics in the primary care setting to facilitate access to time-sensitive gender-affirming care. Sources of Support: This project was supported by the Seattle Children's Research Institute Career Development and AHRQ K12HS026393-03 (PI: Sequeira).

13.
Journal of Adolescent Health ; 70(4):S20-S21, 2022.
Article in English | EMBASE | ID: covidwho-1936660

ABSTRACT

Purpose: Despite greatly reduced roadway travel during the COVID-19 shelter-in-place orders, alcohol and drug use among seriously and fatally injured roadway users in the U.S. increased in 2020. Motor vehicle crashes are the leading cause of death for U.S. youth. As travel resumes to pre-pandemic levels, it remains essential to identify novel strategies to prevent driving while impaired (DWI) and riding with an impaired driver (RWI). This qualitative study explored how youth avoid DWI and RWI during and after high school to inform prevention efforts. Methods: In 2020, virtual in-depth individual interviews were conducted with a geographically diverse sample of 105 young adults. Participants were purposively sampled from the NEXT Generation Health Study, a nationally representative longitudinal cohort study, and had varying levels of experience with DWI/RWI during and after high school (mean age 26.36±0.52 y/o, 47.7% ♀). A semi-structured interview guide explored pre-pandemic experiences with DWI/RWI. Using directed content analysis approaches, guided by ecodevelopment theory, a six-member multidisciplinary team systematically applied inductive and deductive codes to each transcript;agreement was achieved by team consensus. Themes were derived using data immersion (with coded data and transcripts), investigator reflexivity and team dialogue. We present themes derived from the codes “Chose not to DWI”, “Chose not to RWI”, and “Missed Opportunities for Prevention”. Results: Participants avoided DWI by trusting their self-assessment of impairment, defined as poor physical ability to drive, “I knew I could barely stand up and coherently walk through the sand …. [it’s] probably not the best idea for me to get behind the wheel.” Some relied on trusted, close friends to intervene: “My perspective is like ‘I'm good to drive but I'm swirling’. [My friends] will make those decisions for me to prevent what could happen”. Perceived police presence on the roadways also prevented potential DWI, “You always consider that there’s gonna be more cops on the road or not”. Additional factors included party pre-planning, past experiences with law enforcement, and easy access to alternative transportation or post-party housing. Participants described avoiding RWI by observing severe driver intoxication: “They were falling down trying to get in the truck — that was a telltale sign”. They also described the need for “better options”, which more often included rides from sober friends than rides from family or ride-share. Bystander interventions were a common technique to avoid RWI (and prevent DWI) during high school. For example, when asked how they avoided RWI, one participant reported “I've stopped several of my friends that have been drinking and I told them they weren't going nowhere”. Conclusions: As youth return to pre-pandemic levels of social activity, DWI/RWI prevention initiatives should bolster protective and prevention strategies that youth are already using, such as peer-to-peer bystander interventions and proactive planning for multiple transportation or housing options among peers. Youth may benefit from prevention and education efforts that enhance awareness of the cognitive impacts of alcohol and drug use on driving. Future research should identify optimal strategies for DWI/RWI prevention intervention delivery, both during and after high school. Sources of Support: R01AA026313.

14.
Supportive Care in Cancer ; 30:S177, 2022.
Article in English | EMBASE | ID: covidwho-1935800

ABSTRACT

Introduction In response to COVID-19, a rapid shift was made to deliver behavioural swallowing therapy in the PRO-ACTIVE trial via a TeleHealth (TH) approach. Patient experiences with TH were explored. Methods A theory-guided qualitative approach explored the perspective of consenting participants who received at least one TH swallowing therapy session. Patients participated in a one-time semi-structured interview. Interview transcripts were analyzed for content and theme using a multi-step consensus process to build a coding framework and key messages. Results Eleven participants recounted their TH experiences and reported feeling satisfied, comfortable and confident with the session(s). Facilitating factors included: previous experience with teleconferencing, access to optimal equipment, clinician skill, and caregiver assistance. TH was considered beneficial to reduce commuting time, potential exposure to COVID19, energy expenditure and also allow caregiver participation. Limitations were also identified, including lack or poor previous experience with technology, and less opportunity for personalization. Participants indicated that use of audio alone was less preferred than an audio/video platform. Conclusions Patients reported overall that TH sessions did not compromise their clinical learning experience when compared to in-person sessions. Patient feedback about TH provides an important perspective to inform best practices for care delivery.

15.
Monatsschr Kinderheilkd ; 170(6): 539-547, 2022.
Article in German | MEDLINE | ID: covidwho-1935750

ABSTRACT

This current consensus paper for long COVID complements the existing AWMF S1 guidelines for long COVID with a detailed overview on the various clinical aspects of long COVID in children and adolescents. Members of 19 different pediatric societies of the DGKJ convent and collaborating societies together provide expert-based recommendations for the clinical management of long COVID based on the currently available but limited academic evidence for long COVID in children and adolescents. It contains screening questions for long COVID and suggestions for a structured, standardized pediatric medical history and diagnostic evaluation for patients with suspected long COVID. A time and resource-saving questionnaire, which takes the clinical complexity of long COVID into account, is offered via the DGKJ and DGPI websites as well as additional questionnaires suggested for an advanced screening of specific neurocognitive and/or psychiatric symptoms including post-exertional malaise (PEM) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). According to the individual medical history as well as clinical signs and symptoms a step by step diagnostic procedure and a multidisciplinary therapeutic approach are recommended.

16.
CLINICAL DIABETOLOGY ; 11(2):119-126, 2022.
Article in English | Web of Science | ID: covidwho-1939335

ABSTRACT

Background: Frailty is associated with increased risk of hospitalization in diabetic patients. Both SARS-CoV-2 pandemic and type 2 diabetes mellitus contribute to the frailty. In this study we aimed to observe clinical and laboratory indices of the diabetic subjects during COVID-19 pandemic who were either frail or not according to Edmonton frail score. Material and methods: During the pandemic era, 100 consecutive patients with type 2 diabetes mellitus divided into two groups either as frail or non-frail according to the Edmonton Frail Scale scores. Laboratory and clinical features of the frail and non-frail subjects were compared. Results: Frail patients were older than the non-frail diabetics. Blood urea, serum creatinine, eGFR, plasma albumin, total cholesterol, triglyceride, HbA1c, mean platelet volume (MPV), and monocyte lymphocyte ratio (MLR) levels of the frail and non-frail groups were significantly different. Moreover, Edmonton frail score was significantly and positively correlated with blood urea, serum creatinine, MLR, MPV, HbA1c and inversely correlated with eGFR and plasma albumin levels. Conclusions: We think that HbA1c, MPV and MLR could be surrogate markers of frailty in diabetic elderly during COVID-19 outbreak. Strategies to keep them in normal range do not only improve diabetes control but also reduce the risk of frailty in this population.

17.
Chinese Journal of Neurology ; 55(4):289-299, 2022.
Article in Chinese | EMBASE | ID: covidwho-1939082

ABSTRACT

Coronavirus disease 2019 (COVID‑19) caused by 2019 novel coronavirus (2019‑nCoV), has constituted a major worldwide public health event. At present, vaccination against COVID‑19 is being actively promoted in order to establish a population immune barrier. Here consensus guidance is given on the safety and efficacy of COVID‑19 vaccination in patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). Overall, the risk of 2019‑nCoV infection in MS or NMOSD patients is not increased than that in the general population. The existing vaccines against COVID‑19 do not cause vaccine‑derived infection in patients receiving any immune interventions, although the effectiveness of vaccine may be reduced in some cases (such as the use of sphingosine‑1‑phosphate receptor modulator or B‑cell depletion agent). There is no sufficient evidence that vaccination will aggravate MS or NMOSD, or directly lead to disease recurrence. Therefore, after fully informed consent and pre‑assessment of vaccination‑related risk, it should be recommended that MS and NMOSD patients with stable disease control be vaccinated against COVID‑19.

18.
Global Spine Journal ; 12(3):169S, 2022.
Article in English | EMBASE | ID: covidwho-1938246

ABSTRACT

Introduction: Blended learning, which combines in-person learning and e-learning, has grown rapidly in education. Advantages of this modality include control over content, learning sequence, and pace of learning, allowing participants to tailor their experiences to meet their personal learning objectives. Blended learning enables adaptive and collaborative learning and transforms the teacher's role from transmitting knowledge (instructing) to facilitating learning. Objectives: Our study aimed to assess the efficacy of blended learning in a pediatric scoliosis training program through the largest Surgical Training Institution in Sub-Saharan Africa, The College of Surgeons of East, Central and Southern Africa (COSECSA). Material and Methods: The course comprised of three parts;1-the online portion, which allowed participants to review lectures, papers, and audiovisual materials over a 3-week period;2-the in-person session, where participants spent a full day with an international expert, reviewing cases in a team-based approach and coming to a consensus on treatment strategy;and 3-a one week, in-person experience where participants were exposed to pre-surgical planning conferences, clinic, casting, and scrubbing into surgeries with international experts. All participants completed a Needs Assessment (NA) and quiz prior to the course. The NA contained 6 various topics, with 3 questions for each topic scored by a 10-point scale in pediatric spine deformity. The quiz included 15 surgical and clinical questions related to the pediatric spine deformity topics. The NA and quiz were taken before the course, after the online session, and after the in-person session. A final survey was conducted at the end of the in-person surgical week. Results: Thirty-six orthopedic surgeons and neurosurgeons enrolled in the course primarily from Tanzania, Kenya, and Malawi. The NA assessment scores improved significantly over the course of the three surveys from 67.3 prior to the course, to 90.9 mid-course, and 94.0 after the course (p = 0.0007). The clinical quiz scores improved over the 3 time points from 9.91 to 11.9, and 12.3, respectively. At the end of the in-person surgical week, 100% of respondents stated that they had improvement in knowledge and 92% considered the knowledge sufficient to change their clinical practice. In surveying the persistent obstacles to translating knowledge gained through blended learning to clinical practice, the top responses were constraints in personnel and cost of implants at their home institution. Conclusion: The blended learning approach in a pediatric spine deformity program is effective, feasible, and shows a statistically significant change in participants' confidence and knowledgebase in these complex pathologies. Our results are limited due to the small sample size. Future studies will evaluate larger number of participants in the post-COVID era and translation to other areas of spine surgery, such as minimally-invasive surgery.

19.
Chinese Journal of Digestive Surgery ; 19(7):703-713, 2020.
Article in Chinese | Scopus | ID: covidwho-1934281
20.
Front Pediatr ; 10: 834673, 2022.
Article in English | MEDLINE | ID: covidwho-1933735

ABSTRACT

Background: Even after the publication of the 2017 update of Italian guidelines on treatment of fever in pediatrics, some fundamental questions are still open and new ones emerged during the COVID-19 pandemic. Objective: To assess the level of consensus among Italian pediatricians on different topics related to treatment of fever in children by using the Delphi technique. Methods: A Delphi study was undertaken between June and September 2021, when two questionnaires were consecutively sent to a panel of experts to be answered anonymously. An invitation to participate was sent to 500 pediatricians distributed over the whole national territory and 80 (16%) of them accepted to participate on a voluntary basis. The questionnaires were structured into three specific topics: "therapeutic appropriateness and management of the febrile child," "management of the febrile child in the presence of other diseases," and "future perspectives in remote management." Each topic had six statements. Results: A first-round questionnaire was sent to 80 accepting pediatricians from different Italian regions. Of the 72 respondents (23% working in hospitals and 72% outside), 33% were from northern, 12% central, and 55% southern Italy or islands. A second-round questionnaire was sent to the same 80 pediatricians and 69 of them responded, without significant differences for workplaces or geographical distribution as compared with the first questionnaire. Overall, 75 participants answered at least one of the two questionnaires. All the statements on the topics of "therapeutic appropriateness and management of the febrile child" and "future perspectives in remote management" reached the predefined cut off for consensus (75% or more). Only one statement on "management of the febrile child in the presence of other diseases" did not achieve the consensus even after the second round. Conclusions: Italian pediatricians agree on several aspects of treatment of febrile children and their expert opinions could support everyday decision process complementary to recommendations by regulatory agencies and guidelines.

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