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1.
Journal of Pediatric Nursing ; 69:10-17, 2023.
Article in English | ScienceDirect | ID: covidwho-2165757

ABSTRACT

Background The increase in telehealth usage has sustained since the beginning of the COVID-19 pandemic. While Remote Patient Monitoring (RPM) programs are abundantly used in the management of adults, pediatric RPM programs remain rare. Methods An RPM department was developed to serve several, multi-specialty pediatric programs. This department uses a centralized nursing team that manages all patients enrolled in RPM programs. Each program is unique and created in partnership with the centralized nurses and the ambulatory care teams. The various programs allow for transmission of patient- and caregiver-generated health data and consistent communication between the patient or caregiver and the managing providers, allowing for real-time plan adaptation. Findings Over 1200 patients have been managed through the 18 various RPM programs. Approximately 300 patients are monitored each month by the centralized nursing team. Patient and caregiver experience has been high due to resources offered including on-demand video visits and text messaging with the nursing team. Discussion Multi-specialty RPM departments help to expand the reach of an institution and provide care to more patients. Quality improvement must be ongoing to ensure equity of participation and perceived benefit of the programs for both providers and patients and caregivers. Application to practice Pediatric RPM programs can improve patient care delivery by decreasing days away from home while improving access to care. Ensuring equitable opportunity for patient participation is imperative in achieving success for an RPM department.

2.
Perioperative Care and Operating Room Management ; : 100305, 2022.
Article in English | ScienceDirect | ID: covidwho-2165751

ABSTRACT

The compounding effect of infectious outbreaks and climate change has put a strain on surgical care. Adverse weather conditions derail preoperative planning, postoperative recovery, supply chains and equipment. The COVID-19 pandemic has restricted elective surgical care for the past two years. It is expected that novel SARS-CoV-2 strains and the emergence of Monkeypox can also put barriers to surgical care. Consecutively, mounting surgical morbidity and strenuous efforts to adhere to infection control further increase the ecological footprint of surgical care fueling a vicious circle of clinical and environmental challenges. Multilevel action from the side of surgeons and surgical societies is required. This includes creating contingency plans for sustainable surgical practice amidst public health emergencies, informing stakeholders and the public about the cumulative ramifications of the syndemic on surgery and promoting social participation among surgeons.

3.
HardwareX ; 13:e00383, 2023.
Article in English | ScienceDirect | ID: covidwho-2165740

ABSTRACT

We introduce an autonomous oxygen concentrator that was designed in Peru to fight the oxygen shortage produced worldwide as a consequence of the COVID-19 pandemic. Oxygen concentrators represent a suitable and favorable option for administering this gas at the patient's bedside in developing countries, especially when cylinders and tubed systems are unavailable or when access to them is restricted by lack of accessories, inadequate power supply, or shortage of qualified personnel. Our system uses a pressure swing adsorption technique to provide oxygen to patients at a flow rate of up to 15 l/min ± 1,5 l/min and a concentration of 93 % ± 3 %, offering robustness, safety and functionality. The quality measurements obtained from the validation process demonstrate repeatability and accuracy. The complete design files are provided in the source file repository to facilitate oxygen concentrator production in low and middle income countries, where access to oxygen is still a major problem even after the pandemic. Oxygen is part of the World Health Organization Model List of Essential Medicines and is perhaps the only medicine that has no substitute. This device can provide a reliable supply of oxygen for critically ill patients and improve their chances of survival.

4.
Multiple Sclerosis and Related Disorders ; : 104507, 2023.
Article in English | ScienceDirect | ID: covidwho-2165727

ABSTRACT

Introduction Multiple sclerosis is associated with decrease in health-promoting behaviors (HPBs) and require appropriate nursing interventions. Telenursing can play an important role in education of patients during the COVID-19 pandemic in which face-to-face education is limited. This study aimed to investigate the effect of self-care education with telenursing approach on HPBs in patients with MS. Materials and methods In this clinical trial, 68 patients with MS were selected using simple random sampling from Jahrom MS Society and randomly assigned to the intervention (n = 34) and control (n = 34) groups. In the intervention group, educational sessions were held three days a week for six weeks. Data were collected using demographic information and Walker's Health-Promoting Lifestyle questionnaires before and immediately after the intervention. Data were analyzed by Mann-Whitney and Wilcoxon tests using SPSS software (Ver. 21). Results Based on the findings, immediately after the intervention, the mean score of HPBs was significantly higher (p = 0.005) in the intervention group (145.38 ± 26.66) than the control group (129.18 ± 22.35). The means of nutrition, exercise, health responsibility, and stress management were significantly different between the intervention and control groups immediately after the intervention (p < 0.05). Conclusion results this study indicated that self-care education with telenursing approach was effective on HPBs in patients with MS. It can be beneficial to employ as an educative-supportive approach in MS patients.

5.
Medicina Clínica (English Edition) ; 2022.
Article in English | ScienceDirect | ID: covidwho-2165694

ABSTRACT

Objective Herpes simplex virus type 1 (HSV-1) reactivation have been described in patients with invasive mechanical ventilation and recently in patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 with higher rates of reactivation than were detected previously in critical care, and although the diagnosis of HSV-1 pneumonia is not easy, its presence is associate with an increase in morbidity and mortality. The objective of this study is to determinate if the identification of HSV-1 in lower airway of patients with ARDS secondary to COVID-19 have influence in clinical outcome and mortality. Method Two hundred twenty-four admitted patients in intensive care unit (ICU) of Complejo Hospitalario Universitario de Toledo diagnosed of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were reviewed and were selected those with mechanical ventilation who had undergone (BAL). It was registered all results of HSV-1 PCR (negative and positive). Results During the study period (November 28, 2020 to April 13, 2021) was admitted 224 patients in ICU diagnosed of SARS-CoV-2 pneumonia. Eighty-three patients of them had undergone BAL, with HSV-1 PCR positive result in 47 (56%), and negative result in 36 (43.4%). We performed pathological anatomy study in BAL samples on 26 of the total BAL realized. Typical cytopathic characteristics of HSV-1 were found in 13 samples (50%) and 11 of them (84.6%) have had HSV-1 PCR positive result. Thirty days mortality was significantly higher in the group of patients with HSV-1 PCR positive result (33.5% vs. 57.4%, P = .015). This difference was stronger in the group of patients with HSV-1 findings in the pathological anatomy study (30.8% vs. 69.2%, P = .047). Conclusion Our results suggest that ARDS secondary to SARS-CoV-2 pneumonia is highly associated to HSV-1 reactivation and that the finding of HSV-1 in lower airway is associated with a worst prognostic and with significantly mortality increase. It is necessary to carry out more extensive studies to determinate if treatment with acyclovir can improve the prognosis of these patients. Resumen Objetivo Las reactivaciones del virus herpes simple (VHS) están descritas en los pacientes en ventilación mecánica invasiva y recientemente en el síndrome de distrés respiratorio agudo (SDRA) por COVID-19, con tasas más altas que las descritas previamente en pacientes críticos, y aunque el diagnóstico de neumonía por VHS es difícil, su presencia se asocia con aumento de la morbimortalidad. El objetivo de este estudio es determinar si la identificación de VHS en el tracto respiratorio inferior en pacientes en ventilación mecánica con SDRA por COVID-19 influye sobre la evolución clínica y la mortalidad. Método Se revisaron 224 pacientes ingresados en el servicio de medicina intensiva del Complejo Hospitalario de Toledo con el diagnóstico de neumonía por SARS-CoV-2 y se seleccionaron los pacientes en ventilación mecánica a los que se les había realizado lavado broncoalveolar (LBA). Se registraron todos los resultados de la PCR, tanto si fue positiva como si fue negativa para VHS. Resultados Durante el periodo de estudio (del 28 de noviembre de 2020 hasta el 13 de abril de 2021) ingresaron 224 pacientes en la UCI con el diagnóstico de neumonía por SARS-CoV-2. De ellos, en 83 se realizó lavado broncoalveolar (LBA), siendo la PCR para VHS-1 positiva en 47 y negativa en 36 (56,6%). Realizamos estudio anatomopatológico en muestras de LBA a 26 pacientes del total de la muestra. Se encontraron características citopáticas típicas de infección por herpes en 13 (50%), de los cuales 11 (84,6%) tenían PCR positiva. La mortalidad a los 30 días fue significativamente mayor en el grupo de pacientes con PCR positiva (33,5% vs 57,4%, p = 0,015). Esta diferencia fue aún más marcada en el grupo con hallazgos anatomopatológicos compatibles con neumonía por VHS (30,8% versus 69,2%, p = 0,047). Conclusión Nuestros resultados sugieren que el SDRA secundario a neumonía por SARS-CoV-2 se asocia a una alta reactivación del VHS y que su hallazgo en el tracto respiratorio inferior se asocia con un peor pronóstico y un aumento significativo de la mortalidad. Son necesarios estudios más amplios para determinar si el tratamiento con aciclovir puede mejorar el pronóstico de estos pacientes.

6.
Reddy, Dereddi Raja, Cuenca, John A.; Botdorf, Joshua, Muthu, Mayoora, Hanmandlu, Ankit, Wegner, Robert, Crommett, John, Gutierrez, Cristina, Rathi, Nisha, Sajith, Bilja, Knafl, Mark, Abbas, Hussein A.; Woodman, Scott E.; Nates, Joseph L.; Aaroe, Ashley, Aloia, Thomas A.; Andrews, Lee, Badami, Kiran K.; Baganz, Janna A.; Bajwa, Pratibha, Baker, Lori R.; Barbosa, Gregory R.; Beird, Hannah C.; Bourgeois, Matt, Brock, Kristy, Burton, Elizabeth M.; Cata, Juan, Chung, Caroline, Cutherell, Michael, Cuenca, John A.; Cyr, Pierre B.; Dabaja, Bouthaina, Dagher, Hiba, Daniels, Kevin M.; Domask, Mary, Draetta, Giulio, Fisher, Sarah, French, Katy Elizabeth, Futreal, Andrew, Gaeta, Maria, Gibbons, Christopher, Godoy, Myrna, Goldstein, Drew, Gunther, Jillian, Hernandez, Cristhiam, Hutcheson, Kate, Jaffray, David, Jin, Jeff, John, Teny Matthew, Kell, Trey, Knafl, Mark, Kothari, Anai, Kwan, Rayson C.; Lee, J. Jack, Liao, Yue, Litton, Jennifer, Liu, Alex, McEnery, Kevin W.; McGuire, Mary, Musunuru, Tego, Muthu, Mayoora, Nates, Joseph L.; Owen, Craig S.; Padmakumar, Priyadharshini, Page, Melody, Palaskas, Nicholas, Patel, Jay J.; Bajwa, Pratibha, Ravi, Vinod, Russell, Ludivine, Sajith, Bilja, Scheet, Paul A.; Schmidt, Stephanie, Shaw, Kenna R.; Shete, Sanjay, Shoenthal, Daniel P.; Stoltenberg, Lessley J.; Subbiah, Ishwaria, Suitor, Chuck, Tawbi, Hussein, Thompson, Phillip, Turin, Anastasia, Unni, Samir, Vicknamparampil, Benju, Weber, Max C.; Weinstein, John, Williams, Zoe, Woodman, Scott E.; Wozny, Mark C.; Wu, Carol, Wu, Jia, Yao, James C.; Young, Chingyi, Yu, Emily, Zatorski, Steven.
Mayo Clinic Proceedings ; 2022.
Article in English | ScienceDirect | ID: covidwho-2165689

ABSTRACT

There is scant information on the clinical progression, end-of-life decisions, and cause of death of cancer patients diagnosed with COVID-19. Therefore, we conducted a case series of patients admitted to a comprehensive cancer center who did not survive their hospitalization. To determine the cause of death of death three board-certified intensivists reviewed the electronic medical records. Concordance regarding cause of death was calculated. Discrepancies were resolved through a joint case-by-case review and discussion between the three reviewers. During the study period, 551 patients with cancer and COVID-19 were admitted to a dedicated specialty unit;among them, 61 (11.6%) were non-survivors. Among non-survivors, thirty-one (51%) patients had hematological, and 29 (48%) had undergone cancer-directed chemotherapy within 3 months before admission. The median time to death was 15 days (95% CI, 11.8-18.2). There were no differences in time to death by cancer category or cancer treatment intent. The majority of decedents (84%) had full code status at admission;however, 53 (87%) had a Do-Not-Resuscitate order at the time of death. Most deaths were deemed to be COVID-19-related (88.5%). The concordance between the reviewers for the cause of death was 78.7%. In contrast to the belief that COVID-19 decedents perish due to their comorbidities, in our study only one of every ten patients died of cancer–related causes. Full-scale interventions were offered to all patients irrespective of oncologic treatment intent. However, most decedents in this population preferred care with non-resuscitative measures rather than full support at the end of life.

7.
Journal of Pain and Symptom Management ; 2022.
Article in English | ScienceDirect | ID: covidwho-2165616

ABSTRACT

Context The Latinx population faced higher rates of infection and severe illness during the COVID-19 pandemic, resulting in an increased need for palliative care services. Objectives We describe the creation and impact of a formal palliative care initiative developed for seriously ill, Spanish-speaking patients during the COVID-19 pandemic at a tertiary care academic medical center. Methods Patients were enrolled in the Spanish Palliative Care Initiative during a 2-month period starting in April 2020. Selected patients were longitudinally followed by a rotating team of Spanish-speaking palliative care clinicians. Following the intervention, a retrospective chart review was conducted to evaluate the impact of the program. Results We enrolled 22 patients. The most frequent palliative care task completed during the initial visit was information giving (77%) and during follow-up visits were goals of care discussion (59%) and coping support (59%). Fifteen patients (68%) had a change in code status and 4 patients (18%) were discharged to hospice. Conclusion The creation of a focused clinical program targeting a historically marginalized population offered opportunity for early palliative care intervention in clinical care for Spanish-speaking patients. This underscores the need for Spanish-language concordant palliative care to improve serious illness care, and end-of-life care, by providing continuity of care, spiritual care, and ICU team support.

8.
Journal of Infection and Public Health ; 16(2):196-205, 2023.
Article in English | ScienceDirect | ID: covidwho-2165585

ABSTRACT

Introduction Global Health Security borders on prevention, detection and response to public health threats like the novel coronavirus disease 2019 (COVID-19). Global Health Security Index (GHSI) of 2019 and 2021 revealed the world remains ill-prepared to deal with future pandemics, evident in the historic impact of COVID-19 on countries. As at 7th December 2022, COVID-19 has infected over 600 million people and claimed over six million lives, mostly in countries with higher GHSI scores. Objective Determine whether the GHSI scores of countries have a correlation with COVID-19 cases, deaths and vaccination coverage, while adjusting for country level dynamics. Methods This paper utilizes GHSI database of 195 countries. Data consists of 171 questions grouped into 37 indicators across six overarching categories on health security and COVID-19. Multivariate multiple regression analysis with robust standard errors was conducted to test the hypothesis that high GHSI ratings do not guarantee better COVID-19 outcomes like cases, deaths and vaccination coverage. Also, avplots STATA command was used to check outliers with potential negative effect on outcome and predictor variables. Results Global average GHSI score for all 195 countries was 38.9. United States of America recorded the highest GHSI score of 75.9 but also recorded one of the highest COVID-19 cases and deaths;Somalia recorded the worst GHSI score of 16.0 and one of the lowest COVID-19 cases and deaths. High GHSI scores did not associate positively with reduction in COVID-19 cases (Coef=157133.4, p-value=0.009, [95%CI 39728.64 274538.15]) and deaths (Coef=1405.804, p-value=0.047, [95%CI 18.1 2793.508]). However, high GHSI ratings associated with increases in persons fully vaccinated per 100 population (Coef=0.572, p-value=0.000, [95%CI.272.873]). Conclusion It appears the world might still not be adequately prepared for the next major pandemic, if the narrative remains unchanged. Countries that recorded higher GHSI scores, counter-intuitively, recorded higher COVID-19 cases and deaths. Countries need to invest more in interventions towards attaining Universal Health Coverage (UHC) including integrated health systems and formidable primary health care to enhance preparedness and response to pandemics.

9.
Cillóniz, Catia, Motos, Anna, Castañeda, Tatiana, Gabarrús, Albert, Barbé, Ferran, Torres, Antoni, Gumucio-Sanguino, Víctor D.; Mañez, Rafael, Solé-Violan, Jordi, de Castro, Felipe Rodríguez, Suarez-Sipmann, Fernando, García, Ruth Noemí Jorge, Aznar, María Mora, Torres, Mateu, Martinez, María, Alegre, Cynthia, Riera, Jordi, Contreras, Sofía, Pericas, Juan Manuel, Ferrer, Ricard, Riera, Jordi, Caballero, Jesús, Trujillano, Javier, Vallverdú, Montse, León, Miguel, Badía, Mariona, Balsera, Begoña, Servià, Lluís, Vilanova, Judit, Rodríguez, Silvia, Montserrat, Neus, Iglesias, Silvia, Prados, Javier, Carvalho, Sula, Miralbés, Mar, Monclou, Josman, Jiménez, Gabriel, Codina, Jordi, Val, Estela, Pagliarani, Pablo, Rubio, Jorge, Morales, Dulce, Pujol, Andrés, Furro, Àngels, García, Beatriz, Torres, Gerard, Vengoechea, Javier, Calvo, David de Gozalo, González, Jessica, Gomez, Silvia, Gómez, José M.; Franco, Nieves, Barberán, José, Albaiceta, Guillermo M.; Espina, Lorena Forcelledo, Prieto, Emilio García, Vicente, Paula Martín, del Busto Martínez, Cecilia, Vidal-Cortés, Pablo, Garmendia, José Luis García, Cabello, María Aguilar, Fernández, Carmen Eulalia Martínez, Carbonell, Nieves, Cortés, María Luisa Blasco, Lázaro, Ainhoa Serrano, Díaz, Mar Juan, Ortiz, Aaron Blandino, Menendez, Rosario, Valdivia, Luis Jorge, Boado, María Victoria, Chinesta, Susana Sancho, del Carmen de la Torre, Maria, Varela, Ignacio Martínez, Vieiro, María Teresa Bouza, Arijón, Inés Esmorís, Hermoso, David Campi, Salinas, Rafaela Nogueras, Monjo, Teresa Farre, Bou, Ramon Nogue, Naya, Gregorio Marco, Barberà, Carme, Coll, Núria Ramon, Catalán-González, Mercedes, Montejo-González, Juan Carlos, Sanchez-Giron, Gloria Renedo, Bustamante-Munguira, Juan, Bustamante-Munguira, Elena, Avila, Ramon Cicuendez, Herrera, Nuria Mamolar, Almansa, Raquel, Ortega, Alicia, Bermejo-Martin, Jesús, Sagredo, Víctor, Añon, Jose, Agrifoglio, Alexander, Cachafeiro, Lucia, Maseda, Emilio, Socias, Lorenzo, Novo, Mariana Andrea, Figueras, Albert, Janer, Maria Teresa, Soliva, Laura, Ocón, Marta, Clar, Luisa, Ayestarán, J. Ignacio, Peñasco, Yhivian, Fernández, Sandra Campos, Serra-Fortuny, Mireia, Forcadell-Ferreres, Eva, Salvador-Adell, Immaculada, Bofill, Neus, Adell-Serrano, Berta, Díaz, Josep Pedregosa, Casacuberta-Barberà, Núria, Urrelo-Cerrón, Luis, Piñol-Tena, Àngels, Roche-Campo, Ferran, de la Gándara, Amalia Martínez, Murúa, Pablo Ryan, Ruíz, Covadonga Rodríguez, García, Laura Carrión, Álvarez, Juan I. Lazo, Lorente, José Ángel, Loza-Vázquez, Ana, Guerrero, Desire Macias, Huerta, Arturo, Tognetti, Daniel, Redruello, Carlos García, Rodríguez, David Mosquera, Fernández, Eva María Menor, Adrio, Sabela Vara, Casal, Vanesa Gómez, Pensado, Marta Segura, Vilas, María Digna Rivas, Sagastume, Amaia García, de Pablo Sánchez, Raul, Laguna, David Pestaña, Bardi, Tommaso, Villar, Rosario Amaya, Gonzalez, Carmen Gómez, Castillo, Maria Luisa Gascón, Garnacho-Montero, José, Cantón-Bulnes, María Luisa, Marin-Corral, Judith, Pérez, Cristina Carbajales, Masclans, Joan Ramon, Degracia, Ana Salazar, Bigas, Judit, Muñoz-Bermúdez, Rosana, Vilà-Vilardel, Clara, Parrilla, Francisco, Dot, Irene, Zapatero, Ana, Díaz, Yolanda, Gracia, María Pilar, Pérez, Purificación, Castellví, Andrea, Climent, Cristina, Serra, Lidia, Barbena, Laura, Cano, Iosune, Ricart, Pilar, Herraiz, Alba, Marcos, Pilar, Rodríguez, Laura, Sariñena, Maria Teresa, Sánchez, Ana, Úbeda, Alejandro, Delgado, María Cruz Martin, Gallego, Elena, Jimenez, Juan Fernando Masa, Gomà, Gemma, Díaz, Emi, Ibarz, Mercedes, De Mendoza, Diego, Barbeta, Enric, Alcaraz-Serrano, Victoria, Badia, Joan Ramon, Castella, Manuel, Bueno, Leticia, Ceccato, Adrian, Palomeque, Andrea, Barat, Laia Fernandez, Cillóniz, Catia, Conde, Pamela, Fernández, Javier, Gabarrus, Albert, Kiarostami, Karsa, López-Gavín, Alexandre, Mantellini, Cecilia L.; Speziale, Carla, Vázquez, Nil, Yang, Hua, Yang, Minlan, Ferrando, Carlos, Castro, Pedro, Arrieta, Marta, Nicolas, Jose Maria, Andrea, Rut, Barroso, Marta, Pérez, Raquel, Álvarez, Sergio, Garcia-Gasulla, Dario, Tormos, Adrián, Lomas, Luis Tamayo, Aldecoa, Cesar, Herrán-Monge, Rubén, García, José Ángel Berezo, Giraudo, Pedro Enríquez, Fernández, Pablo Cardinal, López, Alberto Rubio, Pravia, Orville Báez, Messa, Juan López, Bastida, Leire Pérez, Ruiz, Antonjo Alvarez, Trenado, José, Pous, Anna Parera, Galbán, Cristóbal, Lago, Ana López, Paz, Eva Saborido, Segade, Patricia Barral, Mariño, Ana Balan, Mendez, Manuel Valledor, de Frutos, Raúl, Aguilera, Luciano, Pérez-García, Felipe, López-Ramos, Esther, Ruiz-García, Ángela Leonor, Beteré, Belén, Blancas, Rafael, Dólera, Cristina, Planelles, Gloria Perez, Peis, Enrique Marmol, Juan, Maria Dolores Martinez, Miralles, Miriam Ruiz, Rubio, Eva Perez, Martin-Montalvo, Maria Van der Hofstadt, Sánchez-Miralles, Ángel, Warrington, Tatiana Villada, Pozo-Laderas, Juan Carlos, Estrella, Angel, Cano, Sara Guadalupe Moreno, Gordo, Federico, Palacios, Basilisa Martinez, Nieto, Maite, Nieto, Maria Teresa, Ossa, Sergio, Ortega, Ana, Sanchez, Miguel, Santacoloma, Bitor.
Journal of Infection ; 2022.
Article in English | ScienceDirect | ID: covidwho-2165580
10.
Journal of Immunological Methods ; 513:113410, 2023.
Article in English | ScienceDirect | ID: covidwho-2165568

ABSTRACT

Background Breakthrough cases of SARS-CoV-2 infection correlate with decreased antibody immunity following mRNA vaccination. Measuring kinetics of vaccine efficacy using traditional laboratory approaches is more expensive and can be impractical. In this study, we evaluated the diagnostic performance of a validated COVID-19 point-of-care lateral flow assay (LFA) kit in detecting post-vaccination antibody response. Methods We conducted a prospective cohort study of whole blood and plasma samples to evaluate the performance of a LFA in detecting SARS-CoV-2-specific antibodies following mRNA vaccination compared to enzyme-linked immunosorbent assays (ELISAs). Health care workers at 2 tertiary centers who completed an initial BNT162b2 (n = 103) or mRNA-1273 (n = 35) vaccine series were enrolled between June and August of 2021. We performed an exploratory analysis to correlate band strength and antibody concentration of LFAs and ELISAs respectively. Results When compared to the ELISA, LFA results showed similar test positivity for plasma samples (P = 0.55), but not for whole blood samples (P < 0.001). For whole blood samples on the LFA, antibody detection differed between BNT162b2 (68.9%, 95% CI: 59.1%–77.7%) and mRNA-1273 (100%, 95% CI: 90.0%–100%, P < 0.001) vaccines. Higher plasma antibody concentrations correlated with greater LFA sensitivity. Samples with thick LFA bands had higher antibody concentrations compared to samples having faint LFA bands (81.8 arbitrary unit [AU]/mL vs. 57.1 AU/mL, P < 0.01). Conclusions The performance of a LFA in detecting SARS-CoV-2 antibodies was significantly better when plasma samples were used. The strength of label bands on the LFA may correlate with antibody concentration and could be a useful point-of-care monitoring tool for post-vaccine antibody status.

11.
Journal of Infection and Chemotherapy ; 2023.
Article in English | ScienceDirect | ID: covidwho-2165564

ABSTRACT

Introduction Quantitative thorax Computed Tomography (CT) is used to determine the severity of COVID-19 pneumonia. With a new approach, quantitative thoracic CT is to contribute to the triage of patients with severe COVID-19 pneumonia in the ICU and to evaluate its relation with mortality by taking into account the vaccination status. Methods Fifty-six patients who had a diagnosis of COVID-19 pneumonia confirmed in the adult ICU were evaluated retrospectively. To evaluate the degree of parenchymal involvement, the quantitative CT "craniocaudal diameter of the thorax/craniocaudal largest lesion diameter (CCDT/CCDL)” ratio and semi-quantitative total CT severity scores (TCTSS) (0:0%;1:1–25%;2:26–50%;3:51–75% and 4:76–100%) were calculated. Both methods were analyzed with comparative ROC curves for predicting mortality. The effects of vaccines on thorax CT findings and laboratory parameters were also investigated. Results The sensitivities and specificities were found to be 72.5%, 75.61%, and 80%, 73.33% when CCDT/CCDL and TCTSS cutoff value was taken <1.4, and >9, respectively, to predict mortality in COVID-19 pneumonia (Area Under the Curve = AUC = 0.797 and 0.752). Both methods predicted mortality well and no statistical differences were detected between them (p = 0.3618). In vaccinated patients, CRP was higher (p = 0.045), and LDH and ferritin were lower (p = 0.049, p = 0.004). The number of lobes involved was lower in the vaccinated group (p = 0.001). Conclusions The quantitative CT score (CCDT/CCDL) may play as important a role as TCTSS in diagnosing COVID-19 pneumonia, determining the severity of the disease, and predicting the related mortality. COVID-19 vaccines may affect laboratory parameters and cause less pneumonia on thoracic CT than in unvaccinated individuals.

12.
Journal Européen des Urgences et de Réanimation ; 2023.
Article in French | ScienceDirect | ID: covidwho-2165536

ABSTRACT

Résumé Introduction En partenariat avec l'Association SAUVlife (unité mobile de télémédecine) « phygital » et le SAMU 50, l'UMT où une unité phygitale a été déployée dans la Manche destinée à des patients âgés et/ou dépendants pour lesquels l'accès aux soins est rendu difficile par la carence de médecin traitant et de la diminution des visites à domicile. Ce nouveau vecteur pourrait être une alternative au recours aux urgences hospitalières. Méthode Nous avons réalisé une étude observationnelle rétrospective monocentrique de l'activité de l'UMT du 1er janvier au 30 juin 2021 au sein du service du SAMU 50 au CH Saint-Lô. Après régulation médicale, les patients ne relevant pas d'une urgence vitale pouvaient bénéficier d'une intervention de l'UMT. Résultats L'UMT est intervenue 681 fois. Au décours, 65,6 % de patients ont pu être laissés sur place. Cette unité phygitale a réalisé 621 téléconsultations permettant à 414 patients (66,7 %) de rester chez eux et 199 patients (32 %) d'être transportés vers un SAU. Ceux transportés étaient significativement plus âgés avec un âge moyen de 71,26 ans (p<0,001). Les interventions ont duré 1h27 en moyenne. Discussion Cette expérimentation est inédite dans le cadre de l'urgence. Cet outil semble répondre à la carence d'offre de soins du département. Son utilisation dans le cadre de la pandémie de COVID-19 est probante et permet par ses prises en charge à domicile une limitation des transmissions virales. Toutefois, les interventions sont longues et l'utilisation de l'UMT peut être optimisée tant sur le temps d'intervention que sur le nombre réalisé par jour. Conclusion L'unité mobile de télémédecine est un vrai apport en l'absence de médecins généralistes pour réaliser des visites à domicile de soins non programmés d'autant plus dans un contexte épidémique où elle limite le recours aux urgences et in fine la transmission des agents infectieux. Summary Introduction In partnership with SAUVlife volunteers and SAMU 50, a remote consultation mobile unit (UMT) was deployed in the Manche department of France, targeting elderly and dependent patients where access to care is difficult due to the lack of a general practitioner and the decrease of home visits. This new vector could be an alternative to the use of emergency rooms. Method We performed a monocentric retrospective observational study of the activity of the UMT from January 1 to June 30, 2021 within the SAMU 50 at the Saint-Lô Hospital. After initial medical regulation, the patients without a vital emergency could benefit from an intervention of the UMT. Results The UMT intervened 681 times. At the end of the intervention, 65.6% of the patients could be left on site. The phygital unit performed 621 teleconsultations allowing 414 patients (66.7%) to remain at home and 199 patients (32%) to be transported to an emergency room. Those transported were significantly older with an average age of 71.26years (P<0.001). The interventions lasted an average of 1hour and 27minutes. Discussion This experiment is new in the emergency context. This tool seems to respond to the lack of ambulatory care in the department. Its use in the context of the COVID-19 pandemic is convincing and allows for the limitation of viral transmissions through home care. However, the interventions are long and the use of the UMT can be optimized both in terms of intervention time and the number of interventions performed per day. Conclusion The mobile telemedicine unit is a real contribution in the absence of general practitioners, to carry out unscheduled home visits. Even more in an epidemic context where it limits the use of emergency rooms and ultimately the transmission of infectious agents.

14.
Journal of the American Medical Directors Association ; 2022.
Article in English | ScienceDirect | ID: covidwho-2165482

ABSTRACT

Objective To evaluate changes in mental health and well-being (eg, quality of work life, health, intention to leave) among nursing home managers from a February 2020 prepandemic baseline to December 2021 in Alberta, Canada. Design Repeated cross-sectional survey. Setting and Participants A random sample of nursing homes (n = 35) in urban areas of Alberta was selected on 3 strata (region, size, ownership). Care managers were invited to participate if they (1) managed a unit, (2) worked there for at least 3 months, and (3) worked at least 6 shifts per month. Methods We measured various mental health and well-being outcomes, including job satisfaction (Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale), burnout (Maslach Burnout Inventory—exhaustion, cynicism, efficacy), organizational citizenship behaviors (constructive efforts by individuals to implement changes to improve performance), mental and physical health (Short Form–8 Health Survey), burden of worry, and intention to leave. We use mixed effects regression to examine changes at the survey time points, controlling for staffing and resident acuity. Results The final sample included 181 care managers (87 in the pre-COVID survey;94 in the COVID survey). Response rates were 66.9% and 82.5% for the pre-COVID and COVID surveys, respectively. In the regression analysis, we found statistically significant negative changes in job satisfaction (mean difference −0.26, 95% CI –0.47 to −0.06;P = .011), cynicism (mean difference 0.43, 95% CI 0.02-0.84;P = .041), exhaustion (mean difference 0.84, 95% CI 0.41-1.27;P < .001), and SF-8 mental health (mean difference −6.49, 95% CI –9.60 to −3.39;P < .001). Conclusions and Implications Mental health and well-being of nursing home managers worsened during the pandemic, potentially placing them at risk for leaving their jobs and in need of improved support. These findings should be a major concern for policy makers, particularly given serious prepandemic workforce shortages. Ongoing assessment and support of this understudied group are needed.

15.
The American Journal of Geriatric Psychiatry ; 2022.
Article in English | ScienceDirect | ID: covidwho-2165476

ABSTRACT

Objective Older adults are disproportionally impacted by the COVID-19 pandemic, causing a mental health crisis in late life, due to physical restrictions (e.g., quarantine), limited access to services, and lower literacy and access to technology. Despite established benefits, systematic screening of mental health needs of older adults in community and routine care settings is limited and presents multiple challenges. Cross-disciplinary collaborations are essential for identification and evaluation of mental health needs and service delivery. Methods Using a research-practice partnership (RPP) model, we developed and implemented a routine mental health needs identification and tracking tool at a community-based social services organization. Repeated screenings were conducted remotely over five months and included depression, anxiety, perceived loneliness, social support, and related domains such as sleep quality, resilience, and trauma symptoms linked to COVID-19. We examined symptomatic distress levels and associations between different domains of functioning. Results Our project describes the process of establishing a research-practice partnership during the COVID-19 pandemic. We collected 292 screenings from 124 individuals;clients were mildly to moderately depressed and anxious, reporting large amounts of time alone and moderate levels of loneliness. Those reporting higher depressive symptoms reported higher anxiety symptoms, poorer sleep quality, lower quality of life, lower capacity to adapt to challenging situations, and greater trauma symptoms due to COVID-19. Conclusions Our routine screening tool can serve as a blueprint for case management agencies and senior centers nationwide, beyond the pressing mental health crisis due to COVID-19, to continue identifying needs as they emerge in the community.

16.
International Journal of Disaster Risk Reduction ; : 103516, 2022.
Article in English | ScienceDirect | ID: covidwho-2165369

ABSTRACT

Social service providers work to alleviate social disadvantages, which may particularly loom during crises. These organisations have a close understanding of the needs of their clients. However, this knowledge is rarely taken into account in tailoring crisis measures, which may lead to increased vulnerability and create additional suffering. In this paper, we take a novel look at the role of care organisations as intermediaries between their clients and the authorities in representing the needs and capabilities of vulnerable people and explore the factors hindering or facilitating this representation. We focused on care organisations in Europe and collected data from 32 interviews, followed by 5 workshops and an international colloquium with 6 language-based discussion groups with participants from organisations offering care services to socially marginalised individuals. The results demonstrate the role these organisations had in advocating their clients' needs to the authorities to adapt the crisis measures accordingly ("bottom-up approach”), and communicating official information about the risks and government rules to their clients ("top-down approach”). We found effective mediation to stem from long-term, trusting client relationship to be able to reflect on clients' needs, while the lack of collaboration protocol and tradition can be seen as the main barrier to inclusive crisis management. Networking with social care services to bring their expertise into crisis management systems is essential to promote the resilience of the diverse society.

17.
Heliyon ; 9(1):e12704, 2023.
Article in English | ScienceDirect | ID: covidwho-2165332

ABSTRACT

Critically ill patients infected with SARS-CoV-2 display adaptive immunity, but it is unknown if they develop cross-reactivity to variants of concern (VOCs). We profiled cross-immunity against SARS-CoV-2 VOCs in naturally infected, non-vaccinated, critically ill COVID-19 patients. Wave-1 patients (wild-type infection) were similar in demographics to Wave-3 patients (wild-type/alpha infection), but Wave-3 patients had higher illness severity. Wave-1 patients developed increasing neutralizing antibodies to all variants, as did patients during Wave-3. Wave-3 patients, when compared to Wave-1, developed more robust antibody responses, particularly for wild-type, alpha, beta and delta variants. Within Wave-3, neutralizing antibodies were significantly less to beta and gamma VOCs, as compared to wild-type, alpha and delta. Patients previously diagnosed with cancer or chronic obstructive pulmonary disease had significantly fewer neutralizing antibodies. Naturally infected ICU patients developed adaptive responses to all VOCs, with greater responses in those patients more likely to be infected with the alpha variant, versus wild-type.

18.
Health Policy ; 2022.
Article in English | ScienceDirect | ID: covidwho-2165322

ABSTRACT

Introduction . Although childbirth services were accessible after Covid-19 outbreak, the measures taken by the Italian Government for contagion containment required some restrictions on the presence of trusted persons for mothers, forcing them to isolation during hospitalization. To preserve companionship, the Regional Health Authority of Tuscany issued a resolution providing partners with the possibility to be present during labour and childbirth for non-asymptomatic women. Objectives . In this study, we: 1) analyse the impact of pandemic on companionship in terms of significant reduction of the possibility for women to be accompanied by a trusted person during labour and childbirth;and 2) ascertain if the regional resolution issued was effective in containing the reduction of companionship. Methods . We performed an interrupted time series analysis to measure the variation of the possibility for women to be accompanied by a trusted person during labour and childbirth, in response to formalization of lock-down due to Covid-19 outbreak and the introduction of the regional resolution aimed at contrasting negative effects on companionship. Results and conclusions . The ITS analysis showed that there was a significant decrease in the women-reported experience of companionship in the month of the formalization of lock-down, namely March 2020, followed by a slight increase in the upcoming months. A trend reversal was observed after May 2020, when the regional resolution was fully operational.

19.
Farmacia Hospitalaria ; 2022.
Article in English | ScienceDirect | ID: covidwho-2165297

ABSTRACT

Objective: To describe the marginal cost and survival of patients treated with tocilizumab in a university hospital under real-life conditions and to evaluate factors that could influence costs and health outcomes will be evaluated. Methods: Observational, single-center, retrospective study of a cohort of adult patients infected with SARS-COV2 treated with tocilizumab. The 1 year restricted mean survival time was analyzed in life-years gained (LYG). The influence of sex, age and severity on patient survival was evaluated. The marginal cost/LYG and marginal cost/survivor ratios were calculated. Results: 508 patients (66 ± 13 years;32% women) were included. Seventeen percent were admitted to the ICU. Overall survival was 77%. Age older than 71.5 years (HR = 1.08;95%CI 1.07–1.10;p < 0.001) and ICU admission at initiation of treatment (HR = 2.01;95%CI 1.30–3.09;p = 0.002) were identified as risk factors. The total budgetary impact of tocilizumab in the period analyzed was 206,466 euros. The patients with the highest cost per unit of health outcome were those admitted to the ICU and those over 71.5 years, with a marginal cost/LYG of €966 and a marginal cost/survivor of €1136. Conclusion: The efficiency of treatment with tocilizumab is associated with the age and severity of the patients. The figures are lower in all subgroups than the thresholds usually used in cost-effectiveness evaluations. The results of the present study suggest that early first dose of tocilizumab is an efficient strategy. RESUMEN Objetivo: Describir el coste marginal y la supervivencia de los pacientes tratados con tocilizumab en un hospital universitario en condiciones de vida real. Y evaluar los factores que podrían influir los costes y los resultados en salud. Metodología: Estudio observacional, retrospectivo y unicéntrico de una cohorte de pacientes adultos infectados con SARS-COV2 tratados con tocilizumab. Se analizó, en años de vida ganados (AVG), la media de supervivencia restringida a 1 año. Se evaluó la influencia del sexo, la edad y la gravedad en la supervivencia de los pacientes. Se calcularon el ratio coste marginal/AVG y coste marginal/superviviente. Resultados: Se incluyeron 508 pacientes (66 ± 13 años;32% mujeres). Un 17% ingresó en UCI. La supervivencia global fue del 77%. Se identificaron como factores de riesgo la edad mayor de 71,5 años (HR = 1,08;IC95% 1,07–1,10;p < 0,001), y el ingreso en UCI al iniciar el tratamiento (HR = 2,01;IC95% 1,30–3,09;p = 0,002). El impacto presupuestario total de tocilizumab en el periodo analizado ascendió a 206.466€. Los pacientes con mayor coste por unidad de resultado en salud son los pacientes ingresados en UCI y mayores de 71,5 años, que presentan un coste marginal/AVG de 966 € y un coste marginal/superviviente de 1.136€. Conclusión: La eficiencia del tratamiento con tocilizumab se asocia a la edad y a la gravedad de los pacientes. Las cifras son inferiores en todos los subgrupos a los umbrales habitualmente utilizados en las evaluaciones coste-efectividad. Los resultados del presente estudio sugieren que el inicio precoz de tocilizumab es una estrategia eficiente.

20.
Endocrine Practice ; 2022.
Article in English | ScienceDirect | ID: covidwho-2165284

ABSTRACT

Objectives Diabetes management presents a substantial burden to individuals living with the condition and their families, healthcare professionals, and healthcare systems. Although an increasing number of digital tools are available to assist with tasks such as blood glucose monitoring and insulin dose calculation, multiple persistent barriers continue to prevent their optimal use. Methods As a guide to creating an equitable connected digital diabetes ecosystem, we propose a roadmap with key milestones that need to be achieved along the way. Results During the Coronavirus 2019 pandemic, there was an increased use of digital tools to support diabetes care, but at the same time, the pandemic also highlighted problems of inequities in access to and use of these same technologies. Based on these observations, a connected diabetes ecosystem should incorporate and optimize the use of existing treatments and technologies, integrate tasks such as glucose monitoring, data analysis, and insulin dose calculations, and lead to improved and equitable health outcomes. Conclusions Development of this ecosystem will require overcoming multiple obstacles, including interoperability and data security concerns. However, an integrated system would optimize existing devices, technologies and treatments to improve help to improve outcomes.

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