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1.
BMJ Open ; 13(1), 2023.
Article in English | ProQuest Central | ID: covidwho-2193757

ABSTRACT

ObjectivesThe Computer-Aided Risk Score for Mortality (CARM) estimates the risk of in-hospital mortality following acute admission to the hospital by automatically amalgamating physiological measures, blood tests, gender, age and COVID-19 status. Our aims were to implement the score with a small group of practitioners and understand their first-hand experience of interacting with the score in situ.DesignPilot implementation evaluation study involving qualitative interviews.SettingThis study was conducted in one of the two National Health Service hospital trusts in the North of England in which the score was developed.ParticipantsMedical, older person and ICU/anaesthetic consultants and specialist grade registrars (n=116) and critical outreach nurses (n=7) were given access to CARM. Nine interviews were conducted in total, with eight doctors and one critical care outreach nurse.InterventionsParticipants were given access to the CARM score, visible after login to the patients' electronic record, along with information about the development and intended use of the score.ResultsFour themes and 14 subthemes emerged from reflexive thematic analysis: (1) current use (including support or challenge clinical judgement and decision making, communicating risk of mortality and professional curiosity);(2) barriers and facilitators to use (including litigation, resource needs, perception of the evidence base, strengths and limitations), (3) implementation support needs (including roll-out and integration, access, training and education);and (4) recommendations for development (including presentation and functionality and potential additional data). Barriers and facilitators to use, and recommendations for development featured highly across most interviews.ConclusionOur in situ evaluation of the pilot implementation of CARM demonstrated its scope in supporting clinical decision making and communicating risk of mortality between clinical colleagues and with service users. It suggested to us barriers to implementation of the score. Our findings may support those seeking to develop, implement or improve the adoption of risk scores.

3.
1st IEEE International Workshop on Metrology for Extended Reality, Artificial Intelligence and Neural Engineering, MetroXRAINE 2022 ; : 335-339, 2022.
Article in English | Scopus | ID: covidwho-2192014

ABSTRACT

The growing research trends in the field of artificial intelligence have largely impacted the healthcare sector. Thanks to the high predictive power of machine learning approaches, new tools to support the clinical decision-making can be designed. However, since the demand for healthcare services is complex and highly changing, as it is affected by external unpredictable factors such as the CoViD-19, the reliability and robustness of such predictive tools is highly dependent on their capability of varying and adapting the forecasting in accordance with variations in environmental factors and health needs. In this work, we propose a combined simulation and machine learning approach to study the robustness and adaptability of predictive tools for healthcare management. Discrete event simulation is employed to simulate a generic healthcare service. The patients' length of stay (LOS) is monitored as a performance indicator of the care process. Three machine learning algorithms have been tested to predict the LOS in different simulated scenarios obtained by varying the level of demand for the healthcare service. The predictability of the tested algorithms has been studied in terms of mean errors. Preliminary results suggest that abrupt changes in the healthcare demand have a negative impact on the performance of the machine learning algorithms, which are not prone to adapt decisions to the surrounding environment. The design of novel intelligent health system, which aim to integrate artificial intelligence tools in the clinical decision-making process, should take into account these limitations. In this sense the use of simulation can be beneficial in the assessment of the new generation of decision support systems in healthcare. © 2022 IEEE.

4.
Critical Care Medicine ; 51(1 Supplement):448, 2023.
Article in English | EMBASE | ID: covidwho-2190631

ABSTRACT

INTRODUCTION: Venovenous (VV) extracorporeal membrane oxygenation (ECMO) has been used successfully to treat COVID-19 patients in severe respiratory failure. The objective of our multi-center study is to evaluate mortality, time of ECMO initiation, and demographics in COVID-19 patients treated with VV-ECMO. METHOD(S): Electronic medical records from March 2020 to October 2021 were studied in 49 sites across the United States. Patients treated with ECMO who tested positive for COVID-19 were included in this retrospective data analysis (N=363, age interquartile range: 37-55 years). Odds of inhospital mortality were compared using logistic regression models. At thresholds 1-7 days, patients classified as 'early ECMO' were matched to 'delayed ECMO' patients using coarsened exact matching, resulting in 7 independent analyses for early/delayed ECMO cannulation relative to the number of days of pre-ECMO mechanical ventilation (MV). RESULT(S): There were no significant differences in mortality in patients who received early or delayed ECMO. There were also no significant differences in mortality between races, body mass index (BMI), smoking status, hypertension, chronic kidney disease, coronary artery disease, steroid use, or diabetes pre-cannulation. Lastly, pre-cannulation factors associated with mortality in COVID-19 patients treated with ECMO include the use of vasopressors, which was associated with an 87% increase in mortality (p=0.017, confidence interval [CI] 1.12, 3.15);proning, which was associated with a 85% increase in mortality (p=0.015, CI 1.13, 3.06);and the use of baricitinib, which was associated with a four-fold increase in mortality (p=0.041, CI 1.11, 17.6). CONCLUSION(S): We found no evidence that particular demographic characteristics (including race, BMI, or smoking status) contribute to mortality, nor did we find evidence that the length of time on MV prior to ECMO influences mortality. The analysis of large datasets in the ECMO population may better inform clinical decision making.

5.
Critical Care Medicine ; 51(1 Supplement):86, 2023.
Article in English | EMBASE | ID: covidwho-2190485

ABSTRACT

INTRODUCTION: Bivalirudin remains a viable strategy during extracorporeal membrane oxygenation (ECMO). The accuracy of activated partial thromboplastin time (aPTT) for bivalirudin intensity in ECMO may be imperfect resulting in suboptimal dosing, which may increase the risk of bleeding or thrombotic complications. The purpose of this study was to evaluate the correlation between PTT and thromboelastography (TEG) reaction (R) time in adult ECMO patients anticoagulated with bivalirudin. METHOD(S): This was a multicenter, retrospective study conducted over a 22-month period (January 2020 to October 2021. Adult ICU patients requiring ECMO and bivalirudin therapy with >=1 corresponding TEG and aPTT samples drawn <=4 hours of each other were included. The primary endpoint was to determine the correlation coefficient between the TEG R time and bivalirudin aPTT serum concentrations. Pearson's correlation coefficient was used to evaluate the correlation using a kappa measure of agreement between TEG results and bivalirudin aPTT serum concentrations. RESULT(S): A total of 104 patients consisting of 848 concurrent laboratory assessments of R time and aPTT were included. COVID-19 positive tests were confirmed in 48.1% (n=50) of included patients. A moderate correlation between TEG R time and aPTT was demonstrated in the study population (r=0.41;p< 0.001). A similar relationship between TEG R time and aPTT was observed in both COVID-19 positive (r=0.44;p< 0.0001) and negative (r=0.45;p< 0.0001). Overall, 59.2% of all concurrent TEG R time and aPTT values showed agreement on the study institution's therapeutic category (sub-, supra-, and therapeutic) of bivalirudin. 78.3% (n=277) of aPTT values were categorized as therapeutic among all discordant assessment (n=346) between TEG R time and aPTT. The discordant TEG R times with a therapeutic PTT were almost equally distributed between subtherapeutic and supratherapeutic categories. CONCLUSION(S): Moderate correlation was found between TEG R time and aPTT associated with bivalirudin during ECMO in critically ill adults. Further research is warranted to address the optimal test to guide clinical decision-making for anticoagulation dosing in ECMO patients with discordant results.

6.
Open Forum Infectious Diseases ; 9(Supplement 2):S877, 2022.
Article in English | EMBASE | ID: covidwho-2190019

ABSTRACT

Background. Learning the burden and seasonality of respiratory viral infections in children in resource-limited settings is critical for hospital infection care and prevention and national public health programs. We built a prospective surveillance program of severe acute respiratory illness (SARI) in hospitalized children at Hopital Saint Damien - Nos Petits Freres et Soeurs to gather local evidence and support informed clinical and policy decision-making. The COVID-19 pandemic erupted as we were launching our project, requiring the use of available point-of-care diagnostics. Methods. Children < 18 years of age with cough, history of fever >= 38 Cdegree, of < 10 days evolution, and requiring hospitalization were included in the study. We obtained a nasopharyngeal swab and collected demographic and clinical data for eligible patients. Samples were tested using antigen test on-site for influenza A (Flu A) and B (Flu B), respiratory syncytial virus (RSV), and SARS-CoV-2. Afterwards, all specimens (both negative and positive) were stored and shipped for molecular studies. Results. We obtained and tested 167 samples from patients since April 30, 2021, through January 31, 2022. Single isolates were detected in 88 samples (53%), multiple isolates in 20 samples (12%), and no isolates in 59 samples (35%). Positive cases for RSV, Flu A, and Flu B peaked between November and January. Rhinovirus 1A (RhV) was detected throughout the study period, with peaks around August-September and was the most often detected viral isolate (49, 38%), followed by RSV (37, 29%). Co-infections were seen with RSV, Flu A, RhV, and SARS-CoV-2. Molecular studies detected 7 isolates of Flu A not detected by rapid test, 1 isolate of Flu B, and 1 isolate of SARS-CoV-2. However, it failed to detect 2 isolates of Flu A detected by rapid test, 1 isolate of Flu B, and 1 isolate of SARS-CoV-2. Conclusion. Our study captured circulating respiratory viruses in children with SARI in Haiti during the COVID-19 pandemic. Preliminary data suggest an increase in respiratory viruses between August and January. Improving point-of-care diagnostics can better inform providers of the local epidemiology of respiratory viruses and support clinical decision-making, such as good use of antibiotics. However, we confirmed the sensitivity of molecular testing. (Figure Presented).

7.
Open Forum Infectious Diseases ; 9(Supplement 2):S223, 2022.
Article in English | EMBASE | ID: covidwho-2189637

ABSTRACT

Background. Distinguishing COVID-19 Associated Pulmonary Aspergillosis (CAPA) and invasive mold infections (IMIs) from other causes of secondary pneumonia in COVID-19 can be challenging. 1,3-beta-D-Glucan and galactomannan are commonly utilized biomarkers for the workup of IMIs but are limited by a lack of specificity and sensitivity respectively. Cell-free plasma next-generation sequencing (cfNGS) is a promising non-invasive approach that can provide direct detection of pathogens in patient's serum. This study explored its potential role in the evaluation of secondary pneumonia in patients with COVID-19. Methods. We performed a retrospective single-center observational study from March 2020 to December 2021 at Virginia Commonwealth University Medical Center, a 811-bed tertiary care center, to evaluate patients with laboratory confirmed SARS-CoV-2 virus infection who underwent cfNGS for the evaluation of CAPA. CfNGS (Karius, Inc., Redwood City, CA) was performed at the discretion of the clinical provider and we evaluated the test indication, patient history, clinical impact, correlation with serum biomarkers, and 30 day all-cause mortality. Results. Thirteen patients were evaluated and none had Aspergillus species detected. One patient had Pneumocystis jirovecii on cfNGS. There was a 76.9% (10/13) concordance rate with patients' serum fungal biomarkers. CfNGS also detected concomitant organisms in 53.8% (7/13) of our cohort. These data assisted in changes of clinical management for 84.6% (11/13) of patients and lead to the change in antifungal usage in 69.2% (9/13). Conclusion. In this study, both negative and positive cfNGS test results assisted in important clinical decision making. cfNGS may have a role in the evaluation of CAPA or other IMIs in patients with COVID-19.

8.
Open Forum Infectious Diseases ; 9(Supplement 2):S184-S185, 2022.
Article in English | EMBASE | ID: covidwho-2189591

ABSTRACT

Background. Procalcitonin (PCT) is often measured in patients with signs of bacterial infection. PCT is often elevated in bacterial pneumonia and septic shock and usually low in viral infections. Recent studies have found a correlation between PCT and disease severity in COVID-19, and most patients receive antibiotics despite bacterial co-infection being rare. We sought to characterize PCT trends in COVID-19, assess its relation to bacterial pneumonia, and assess its relation to clinical decision making around antimicrobial use. Methods. We included patients >=18 hospitalized at Michigan Medicine (3/1/20- 10/31/21), positive for COVID-19, with >= 1 PCT measurement. Structured query was used to retrospectively extract data. Patients started on an antibiotic underwent retrospective chart review by 2 reviewers for presence of bacterial pneumonia (bPNA), and were classified as having proven, probable, possible, or no bPNA (Figure 1). Multivariable models controlling for time from start of the pandemic, demographics, and comorbidities were used to determine associations of PCT and bPNA with antimicrobial use. Figure 1: Flow diagram of patients included in analyses Results. 793 patients met inclusion criteria, with 224 (28.2%) initiated on antibiotics. Of these 224, 33 (14.7%) had proven/probable bPNA, 125 (55.8%) had possible bPNA, and 66 (29.5%) had no bPNA. On average, patients had 2.6 +/-3.7 (mean +/-SD) PCT measurements, with 4.1 +/-5.2 if on antibiotics vs. 2.0 +/-2.6 if not. Initial PCT was higher in those on antibiotics and highest in those with proven/probable bPNA (Table 1). After adjustment for confounders, initial PCT was associated with antibiotic initiation (OR 1.68, 95% CI 1.47-1.91, p < 0.0001) (Table 2). Initial PCT (RR 1.11, 95% CI 1.03-1.20, p=0.008), change in PCT over time (RR 1.03, 95% CI 1.01-1.05, p=0.007), and bPNA category (RR 1.51, 95% CI 1.23-1.84, p < 0.0001) were associated with antibiotic duration (Table 3). Conclusion. PCT was elevated in patients with COVID-19, but more pronounced with bPNA. Antibiotics were started in > 25% of patients, regardless of bPNA. PCT trends associate with the decision to initiate antibiotics and treatment duration, independent of bPNA and comorbidities. Future prospective studies should determine if PCT can be used to safely make decisions around antibiotic treatment for bacterial infection during COVID-19.

9.
Open Forum Infectious Diseases ; 9(Supplement 2):S32-S33, 2022.
Article in English | EMBASE | ID: covidwho-2189509

ABSTRACT

Background. COVID-19 vaccines reduce the incidence of severe clinical outcomes, however, some patients remain at risk of severe disease. The primary aim of this large, nationwide retrospective cohort was to identify risk factors for severe disease despite vaccination. Methods. Nationwide cohort study of US Veteran patients with laboratoryconfirmed SARS-CoV-2 infection after vaccination. The primary outcome was development of severe COVID-19 disease, defined as a hospitalization within 14 days of a positive SARS-CoV-2 diagnostic test and either SpO2 <= 94%, receipt of supplemental oxygen, mechanical ventilation, or death within 28 days. Exposure variables included demographic and clinical risk factors, receipt of an additional vaccine dose, and calendar months since initial vaccination series. Data were analyzed using logistic regression, and adjusted odds ratios (aORs) are presented. Results. Among 111,151 breakthrough infections, 110,760 had disease severity assessments and were included. 14,690/110,790 (13.3%) were hospitalized with severe COVID-19 or died. Risk factors for severe disease are presented in Figure 1. The strongest risk factor for severe disease despite vaccination was age. Immunocompromising conditions, including immunosuppressive medications (Cytokine-blocking, aOR, 1.73, CI, 1.37-2.18;receipt of glucocorticoids, aOR, 2.41, CI, 2.25, 2.58;leukocyte inhibitory, aOR 2.44, CI, 1.98-2.99;lymphocyte-depleting, aOR, 2.12, 1.61-2.79), cytotoxic chemotherapy within 6 months (aOR, 2.69;CI, 2.25, 3.21), and leukemias/lymphomas were also associated with increased risk (aOR, 1.84, CI, 1.59-2.14), as were chronic conditions associated with end-organ disease. Receipt of an additional (booster) dose of vaccine was associated with reduced odds of severe disease, with risk reduction from vaccination and boosting strongest during the months immediately following vaccine doses. Variables with aOR <1 are associated with reduced odds of severe breakthrough infections and variables with aOR >1 are associated with increased odds of severe breakthrough infections. Referent groups for multicategory variables are listed in bold. Presented with a logarithmic scale. Conclusion. In this nationwide cohort, we identified risk factors for severe disease despite vaccination. Findings can be used to inform outreach efforts for booster vaccinations and to inform clinical decision making about risk and to identify patients who would benefit from interventions in addition to vaccination, such as preexposure prophylaxis and antiviral therapy. (Table Presented).

10.
Journal of Biomedical Informatics ; : 104283, 2023.
Article in English | ScienceDirect | ID: covidwho-2180119

ABSTRACT

Purpose Recent developments in the field of artificial intelligence and acoustics have made it possible to objectively monitor cough in clinical and ambulatory settings. We hypothesized that time patterns of objectively measured cough in COVID-19 patients could predict clinical prognosis and help rapidly identify patients at high risk of intubation or death. Methods One hundred and twenty-three patients hospitalized with COVID-19 were enrolled at University of Florida Health Shands and the Centre Hospitalier de l'Université de Montréal. Patients' cough was continuously monitored digitally along with clinical severity of disease until hospital discharge, intubation, or death. The natural history of cough in hospitalized COVID-19 disease was described and logistic models fitted on cough time patterns were used to predict clinical outcomes. Results In both cohorts, higher early coughing rates were associated with more favorable clinical outcomes. The transitional cough rate, or maximum cough per hour rate predicting unfavorable outcomes, was 3·40 and the AUC for cough frequency as a predictor of unfavorable outcomes was 0·761. The initial 6h (0·792) and 24h (0·719) post-enrolment observation periods confirmed this association and showed similar predictive value. Interpretation: Digital cough monitoring could be used as a prognosis biomarker to predict unfavorable clinical outcomes in COVID-19 disease. With early sampling periods showing good predictive value, this digital biomarker could be combined with clinical and paraclinical evaluation and is well adapted for triaging patients in overwhelmed or resources-limited health programs.

11.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63(Supplement 2):S207, 2022.
Article in English | EMBASE | ID: covidwho-2179926

ABSTRACT

Background: Transplant psychiatry and organ selection committees have a past littered with inequalities. With the growing medical advances in transplantation and the increasing number of transplants, it is the perfect time for transplant psychiatrists to adopt anti-racist practices and promote equity in marginalized communities. Method(s): Search query on PubMed: "Transplant Racism" Last 10 years Results: 42 articles, 25 after exclusion of articles not focused on transplant racism Reviewed the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT), Psychosocial Assessment of Candidates for Transplant (PACT), and the Transplant Evaluation Rating Scale (TERS). Result(s): Our literature review showed many barriers that would serve to limit or diminish the candidacy for transplantation among minority groups. Specific examples include lack of healthcare, lack of cultural and linguistic aides, and racism serving as a barrier to medical care (Purnell, 2021). All three rating scales have domains referencing substance use, social support systems, and transplant literacy. (Maldonado, 2008;Olbrisch, et al. 1988;Twillman, et al., 1993). Discussion(s): Our results are consistent that there is inherent inequity in the current transplantation evaluation process. This marginalization is a result of ongoing systemic barriers and differing rates of health literacy, cohesion of social supports, and cultural differences towards nicotine and marijuana. Conclusion(s): We recommend using a holistic and flexible approach in transplant evaluations, with a focus on equity, by advocating for patients in the following ways: 1. Education of primary care and specialist providers that practice mostly within marginalized communities 2. Advocating for increased health literacy and outreach in marginalized communities 3. Adopting a more nuanced approach in applying the social support system, substance use, health literacy, and lifestyle factors of the transplant rating scales. 4. Less stringent application to absolute and relative contraindications in transplant rating scales, especially concerning drug use, social supports, housing, and health literacy 5. Advocate for abolishing eGFR race corrections 6. Promoting services to help process the effects of racism and promote increased treatment alliance References: 1. Purnell TS, Simpson DC, Callender CO, Boulware LE. Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation. Am J Transplant. 2021;21:2327-2332. 2. Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) Stanford University Medical Center. Maldonado et al, 2008;Maldonado et al, Psychosomatics 2012 3. Olbrisch, M. E., Levenson, J. L., & Hamer, R. (1989). The PACT: A rating scale for the study of clinical decision-making in psychosocial screening of organ transplant candidates. Clinical Transplantation, 3, 164-169. 4. Twillman, R. K., Manetto, C., Wellisch, D. K., & Wolcott, D. L. (1993). The Transplant Evaluation Rating Scale: A revision of the Psychosocial Levels System for evaluating organ transplant candidates. Psychosomatics: Journal of Consultation and Liaison Psychiatry, 34(2), 144-153. Copyright © 2022

12.
Alzheimer's and Dementia ; 18(S8) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2172407

ABSTRACT

Background: Receiving a diagnosis of dementia can affect all aspects of an individual's life, including their sense of identity. As a consequence, some people with dementia may socially withdraw due to stigma, embarrassment or fear of what might happen if other people were to find out about the diagnosis. The "Who to tell, how and when" intervention, a group-based face-to-face intervention, has been developed for people affected by dementia who are fearful of disclosing the diagnosis to others. This study aims to adapt the existing intervention for online delivery, in light of the ongoing COVID-19 pandemic. Method(s): A co-created, user-centred design in three phases is applied. In phase 1, focus groups conducted with people with dementia and informal caregivers will inform the platform, features and adaptation of pre-existing material. Phase 2 consists of the development of the digital prototype. In phase 3, the feasibility and usability are tested with end users to inform prototype v. 2.0. Result(s): Research has indicated that peer support in the disclosure decision-making process is especially important for participants. Results from phase 1 and 2, including findings from the discussions with the focus groups and options appraisals for the peer support elements of the digital intervention will be discussed. We will discuss general principles of adaptation from paper manual to digital intervention. Conclusion(s): Online access to this intervention may be especially valuable for people who wish to maintain anonymity and privacy, for example people from cultural or ethnic groups where the stigma of dementia is high. Online versions of face-to-face interventions improve overall accessibility by providing choice. Copyright © 2022 the Alzheimer's Association.

13.
NeuroQuantology ; 20(17):1-12, 2022.
Article in English | EMBASE | ID: covidwho-2206881

ABSTRACT

Since the beginning of the year in January 2020, the world witnessed a terrifying unpredictable health emergency of human life which resulted in an outbreak of a disease known as a novel coronavirus (SARS CoV-2 / COVID-19-acute respiratory disease) which was declared a pandemic by the World Health Organization (WHO). With an abrupt increase in the number of cases, a nationwide lockdown was imposed where Pharmacists served as a lifeline by supplying medicines to people across the world and their operation has made a big difference amid the global pandemic. In such difficult times, Pharmacists have helped vulnerable patients stay well and ensured their safety amidst the pandemic. Although pharmacies and drug stores play an important part in the healing process, many people have the perception that they provide a commercial or business-like service. The doctor prescribes the right medicine with the right instructions, and the pharmacist fills the prescription for a fee. In a nutshell, it's a straightforward business. With the advancement of the healthcare system, the role of the Pharmacist has become crucial in today's era which is defined by insights and discoveries that elevate the greater well-being of humans. Due to the rapid expansion, the urban concentration of health services remains a challenge in a country like India. Hence there has to be strict monitoring governance over the healthcare framework. Copyright © 2022, Anka Publishers. All rights reserved.

14.
Journal of Pharmaceutical Negative Results ; 13:2108-2115, 2022.
Article in English | EMBASE | ID: covidwho-2206726

ABSTRACT

Indian Medical care has a distinguished history & goes back over 5000 years while Ayurveda is being utilized & embraced for every one of the infirmities. The effect of Corona virus - 19 Pandemic & the current development of second wave undermined the actual presence of medical care area. This pandemic has led to many escape clauses, downsides and inadequate overall set of laws to the floor. In this article it has been examined about the Corona virus - 19 Pandemic and the current circumstance of second wave and the normal third wave and the preparation of the State run administrations in handling medical care issues both in private and public and the progressions that are required right away. Furthermore the present overall set of laws winning in the nation and its response to the Pandemic are additionally examined. However there are regulations, for example, Pestilence Regulations, Irresistible Sicknesses Regulations, Shopper Freedoms, Catastrophe The board, Right to somewhere safe and secure and Wellbeing given by the Indian Constitution. The utilization of such regulations in this emergency circumstance, further tightening of the regulations for requirement is additionally talked about. Also, the High Court of India has taken up sumoto the instance of immunization and Pandemic circumstance of Corona virus - 19 have referenced a few perceptions, and headings to be upheld quickly by the State, Focal and Association Domains to battle the plague and to save the existences of individuals are examined frayed. Furthermore the ecological changes remembering foundation for the medical care offices are additionally talked about. A few ideas are made to reinforce the medical services framework both the private and government are made. Nonetheless, the examination in the article is unfinished on the grounds what is going on is another danger to the existence of individuals, not in presence any time. Thus, this medical care area needs to gain some useful knowledge from the pit falls and experience. Likewise it is important to think off third wave which will hamper wellbeing of youngsters (Children) according to the researchers ahead of time with the goal that the errors committed till currently are not rehashed. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

16.
Journal of Clinical Outcomes Management ; 29(1):11-15, 2022.
Article in English | EMBASE | ID: covidwho-1881368

ABSTRACT

Equitable Standards for All Patients in a Crisis

17.
Journal of Nursing Education ; 61(12):693-699, 2022.
Article in English | ProQuest Central | ID: covidwho-2155458

ABSTRACT

Background: Evidence suggests competency in clinical judgment may be lacking in new graduate nurses. Graduates from accelerated baccalaureate nursing (ABSN) programs have even less time to develop clinical judgment competency. Various simulation modalities, including high-fidelity manikin and virtual reality, have been used to develop clinical judgment in prelicensure students. However, the outcomes of these simulation modalities on clinical judgment in ABSN students is not well understood. Method: An integrative literature review was conducted using five databases with primary research that examined the effect of manikin or virtual simulation on clinical judgment in BSN students. Results: Fourteen studies were included in this review. The findings were organized using Tanner's Clinical Judgment Model. Conclusion: Findings from this review were mixed, with a lack of evidence comparing the two modalities. Future research should include comparison studies aimed at examining the effects of these modalities with ABSN students. [J Nurs Educ. 2022;61(12):693–699.]

18.
Front Vet Sci ; 9: 911026, 2022.
Article in English | MEDLINE | ID: covidwho-2148130

ABSTRACT

To provide students of veterinary medicine with the necessary day 1 competences, e-learning offerings are increasingly used in addition to classical teaching formats such as lectures. For example, virtual patients offer the possibility of case-based, computer-assisted learning. A concept to teach and test clinical decision-making is the key feature (KF) approach. KF questions consist of three to five critical points that are crucial for the case resolution. In the current study usage, learning success, usability and acceptance of KF cases as neurological virtual patients should be determined in comparison to the long cases format. Elective courses were offered in winter term 2019/20 and summer term 2020 and a total of 38 virtual patients with neurological diseases were presented in the KF format. Eight cases were provided with a new clinical decision-making application (Clinical Reasoning Tool) and contrasted with eight other cases without the tool. In addition to the evaluation of the learning analytics (e.g., processing times, success rates), an evaluation took place after course completion. After 229 course participations (168 individual students and additional 61 with repeated participation), 199 evaluation sheets were completed. The average processing time of a long case was 53 min, while that of a KF case 17 min. 78% of the long cases and 73% of KF cases were successfully completed. The average processing time of cases with Clinical Reasoning Tool was 19 min. The success rate was 58.3 vs. 60.3% for cases without the tool. In the survey, the long cases received a ranking (1 = very good, 6 = poor) of 2.4, while KF cases received a grade of 1.6, 134 of the respondents confirmed that the casework made them feel better prepared to secure a diagnosis in a real patient. Flexibility in learning (n = 93) and practical relevance (n = 65) were the most frequently listed positive aspects. Since KF cases are short and highlight only the most important features of a patient, 30% (n = 70) of respondents expressed the desire for more specialist information. KF cases are suitable for presenting a wide range of diseases and for training students' clinical decision-making skills. The Clinical Reasoning Tool can be used for better structuring and visualizing the reasoning process.

19.
Integrated Healthcare Journal ; 4(1), 2022.
Article in English | ProQuest Central | ID: covidwho-2137884

ABSTRACT

ObjectivesGlobal spread of COVID-19 at an unprecedented speed has heavily strained healthcare systems worldwide, and reliable alternatives to analogue healthcare are urgently needed.MethodsDuring the first COVID-19 wave in the Netherlands, we launched six regional online networks and analysed the activity and content in a qualitative mixed-methods manner.ResultsWe observed continued activity and collaboration on the platform between healthcare professionals at the different levels of care.ConclusionThe networks described here were launched successfully and have the potential to optimise the COVID-19 response.

20.
JAMIA Open ; 5(3) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2135374

ABSTRACT

Objectives: Although the World Health Organization (WHO) Clinical Progression Scale for COVID-19 is useful in prospective clinical trials, it cannot be effectively used with retrospective Electronic Health Record (EHR) datasets. Modifying the existing WHO Clinical Progression Scale, we developed an ordinal severity scale (OS) and assessed its usefulness in the analyses of COVID-19 patient outcomes using retrospective EHR data. Material(s) and Method(s): An OS was developed to assign COVID-19 disease severity using the Observational Medical Outcomes Partnership common data model within the National COVID Cohort Collaborative (N3C) data enclave. We then evaluated usefulness of the developed OS using heterogenous EHR data from January 2020 to October 2021 submitted to N3C by 63 healthcare organizations across the United States. Principal component analysis (PCA) was employed to characterize changes in disease severity among patients during the 28-day period following COVID-19 diagnosis. Result(s): The data set used in this analysis consists of 2 880 456 patients. PCA of the day-to-day variation in OS levels over the totality of the 28-day period revealed contrasting patterns of variation in disease severity within the first and second 14 days and illustrated the importance of evaluation over the full 28-day period. Discussion(s): An OS with well-defined, robust features, based on discrete EHR data elements, is useful for assessments of COVID-19 patient outcomes, providing insights on the progression of COVID-19 disease severity over time. Conclusion(s): The OS provides a framework that can facilitate better understanding of the course of acute COVID-19, informing clinical decision-making and resource allocation. Copyright © 2022 The Author(s).

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