Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 504
Filter
Add filters

Year range
1.
Pediatr Clin North Am ; 69(5): 847-864, 2022 10.
Article in English | MEDLINE | ID: covidwho-2105693

ABSTRACT

Adolescent Medicine addresses the health care of adolescents, young adults, and their families. Adolescent psychology constitutes an important part. The COVID-19 pandemic has given insight into adolescent needs, bringing the focus on prevention rather than mere correction. One needs to factor in the unique aspects of adolescence, their need to impress peers and gain acceptance, and their unique information processing, not calculating trade-offs between risk and reward the way adults might, in a linear, rational, logical, and verbal manner. The article focuses on the need for collaborative training among the various stakeholders in Child and Adolescent Mental Health.


Subject(s)
Adolescent Medicine , COVID-19 , Adolescent , COVID-19/epidemiology , Child , Humans , Internationality , Pandemics , Psychology, Adolescent , Young Adult
2.
Dissertation Abstracts International Section A: Humanities and Social Sciences ; 84(2-A):No Pagination Specified, 2023.
Article in English | APA PsycInfo | ID: covidwho-2102016

ABSTRACT

Social and emotional learning has been recognized for positively impacting students' social, emotional, behavioral, and academic outcomes (Durlak et al., 2011;Dusenbury & Weissberg, 2017;Taylor et al., 2017). State departments of education have taken this research and implemented statewide social and emotional learning standards for educators to incorporate into their curriculum (Collaborative for Academic, Social, and Emotional Learning [CASEL], 2019;Ecklund et al., 2018;Yoder et al., 2020). However, there is a dearth of research on the experiences of educators who plan, prepare, deliver, and evaluate the SEL standards. Additionally, the 2020-2021 school year was profoundly impacted by the COVID-19 health pandemic that created additional challenges for educators trying to meet academic and SEL standards (Darling-Hammond & Hyler, 2020). The purpose of this study was to explore the lived experiences of elementary educators who were implementing the state SEL standards during the COVID-19 health pandemic. Semi-structured interviews were conducted with 15 elementary educators licensed as either general education classroom teachers, principals, or school counselors and worked for at least two years. Participants were from a midwestern state that had kindergarten through twelfth grade SEL state standards. Moustakas' (1994) phenomenological reduction process was utilized to describe the essence of the participants' experience that included: a need to prioritize SEL, a focus on relationship building while navigating barriers to connection, awareness of adult SEL needs, and educational inequities highlighted by COVID-19. Implications for elementary educators, educational training programs, and educational policy makers are discussed in addition to recommendations for future research. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

3.
Galen Medical Journal ; 11, 2022.
Article in English | Web of Science | ID: covidwho-2072452

ABSTRACT

Background: Sexual function in patients with cardiovascular disease (CVDs) is often associated with anxiety and irrational beliefs. Moreover, 60-78% of patients with CVDs report sexual problems. Some studies suggest that sexual counseling is necessary for these patients but is not usually provided for them. Online or telephone counseling may be helpful during the covid-19 pandemic, but studies on its application to sexual function appear to be limited. This study aimed to investigate the effectiveness of online vs. telephone counseling of rational-emotional-behavioral therapy (REBT) on the sexual function of women undergoing cardiac rehabilitation. Materials and Methods: In this randomized clinical trial study, 46 women diagnosed with CVDs under rehabilitation were assigned into online and telephone groups. Overall, eight 60-min intervention sessions were held (once a week). The Female's Sexual Function Index (FSFI) questionnaire was completed by the women at baseline, week 8th, and follow-up week 12th (main outcome). Results: FSFI scores between the two groups at baseline (online: 13.28 +/- 2, telephone: 12.68 +/- 1.52, P=0.254) compared to week 12th (online 28.86 +/- 2.44, telephone, 26.6 +/- 2.10, P=0.002) were significantly different. As for within-group comparison in baseline compared to week 12th statistically significant difference was observed in all subscales of FSFI (P < 0.05). Conclusion: Online and telephone REBT counseling can improve the sexual function of women undergoing cardiac rehabilitation, but online counseling appears to be more effective. Thus, this method is recommended to improve the sexual function of these women during the covid-19 pandemic.

4.
Psikhologicheskaya Nauka I Obrazovanie-Psychological Science and Education ; 27(4):77-87, 2022.
Article in English | Web of Science | ID: covidwho-2072294

ABSTRACT

Optimization of the models for the provision of professional psychological assis-tance to students is one of the priority tasks of the Concept for the development of psychological services in the education system of the Russian Federation. The aim of this study was to identify the barriers and facilitators in seeking psycho-logical help among Russian secondary school students from the perspective of experts who provide such assistance. Two series of semi-structured interviews (before the COVID-19 pandemic and during it) with 10 experts from seven regions of the Russian Federation responsible for organizing psychological work in the re-gion were carried out. The barriers and facilitators of help-seeking identified as a result of the thematic analysis were compared with the AAAQ model (availability, accessibility, acceptability, quality of help) (WHO, 2017). Among the barriers, a special place is held by factors associated with acceptability and the perceived quality of provided assistance. Among the facilitators, experts especially highlight the factors related to the availability and the acceptability of psychological help (knowledge of the possibilities of obtaining it, its credibility, the use of new com-munication technologies of with a psychologist). Associated with the pandemic waving up in psychological difficulties and the expansion of remote communica-tion have become powerful factors in the increase of availability and acceptability of psychological services.

5.
Healthcare (Basel) ; 10(10)2022 Oct 13.
Article in English | MEDLINE | ID: covidwho-2071362

ABSTRACT

The German Consortium Hereditary Breast and Ovarian Cancer (GC-HBOC) consists of 23 academic centers striving to provide high-quality regional care for affected individuals and healthy at-risk family members. According to the standard operating procedures defined by the GC-HBOC, a Familial Breast and Ovarian Cancer Center was implemented at the University Medicine Greifswald over a four-year period from 2018 to 2021, despite the COVID-19 pandemic. Genetic analyses were performed in a total of 658 individuals, including 41 males, which paved the way to local annual risk-adapted breast cancer surveillance for 91 women and prophylactic surgery for 34 women in 2021. Our experience in the North Eastern part of Germany demonstrates that it is possible to establish a high-risk breast and ovarian cancer service even in a sparsely populated region. Major facilitators are the interdisciplinary collaboration of dedicated local experts, the support of the GC-HBOC, fruitful clinical and scientific cooperations and the use of technical improvements. As a blueprint, our project report may help to further expand the network of specialized and knowledge-generating care for HBOC families.

6.
Journal of Microbiology, Immunology and Infection ; 2022.
Article in English | ScienceDirect | ID: covidwho-2069363

ABSTRACT

Background To contain the coronavirus disease 2019 (Covid-19) pandemic, non-pharmacologic interventions, including lockdown and social distancing, may have adverse impact on access to HIV testing and care. This study investigated the impact of Covid-19 on HIV testing and care at a major hospital in Taiwan in 2020-2021. Methods The numbers of clients seeking anonymous HIV voluntary counseling and testing were compared 2 years before (2018-2019) and 2 years after Covid-19 outbreak (2020-2021). People living with HIV (PLWH) who sought care at the hospital during 2018-2021 were included to examine the status of HIV care delivery and disposition. Results The annual number of HIV screening tests performed had significantly decreased from 2,507 and 2,794 in 2018 and 2019, respectively, to 2,161 and 1,737 in 2020 and 2021, respectively. The rate of discontinuation of HIV care among PLWH was 3.7% in 2019, which remained unchanged in 2020 (3.7%) and 2021 (3.8%). The respective percentage of annual plasma HIV RNA testing <2 times increased from 8.4% and 7.8% in 2018 and 2019 to 7.0% and 10.7% in 2020 and 2021, so was that of annual syphilis testing <2 times (10.1% and 8.8% to 7.9% and 12.0%). The rates of plasma HIV RNA <200 copies/ml ranged from 97.0% to 98.1% in 2018-2021. Conclusions During the Covid-19 pandemic, access to HIV counseling and testing was significantly limited. While the number of HIV-related testing decreased, the impact of Covid-19 on the continuity of antiretroviral therapy and viral suppression among PLWH appeared to be minimal in Taiwan.

7.
Przegl Epidemiol ; 76(2): 255-266, 2022.
Article in English | MEDLINE | ID: covidwho-2067624

ABSTRACT

INTRODUCTION: At the beginning of COVID-19 pandemic, due to lockdown, limited mobility, as well as changes in the activity profile of some laboratories, the restriction also applied to access to various screening tests, including HIV screening tests. AIM: The aim of the study was to assess HIV testing trend during COVID-19 pandemic in laboratories in Poland and its comparison to the preceding years, with special focus on testing in the network of Voluntary Testing and Counselling (VCT) sites serving population with higher behavior risk, which increase the possibility of HIV infection. MATERIAL AND METHODS: Analysis of the changes in HIV tests number was based on the results of the annual survey of HIV tests conducted among the laboratories throughout the country. The questionnaire included data on screening and positive tests by testing site type, age group and gender. In addition, we extracted data collected in comprehensive National AIDS Centre database, based on epidemiological and behavior data collected by VCT on people who come for testing. RESULTS: There are approximately 400,000 HIV tests annually run in general population in last years. COVID-19 pandemic, which occurred in beginning of 2020 did not have a huge impact on HIV test number among these population, because there was observed 1% decreased. Pandemic COVID-19, due to few lockdown reduced the HIV tests number among VCT clients - population with higher HIV risk infection. Tests number decreased by 44% compare to previous year, due to temporal closed of these centres. Data analysis shows that due to the pandemic, the structure of the surveyed people changed, especially in terms of age and gender, and the place where the study was performed. CONCLUSION: We confirmed low HIV testing rates in general population and low positivity rate over the studied period. The positivity rate was higher in the testing site network targeting individuals engaging in high risk behaviors. Changes observed in HIV testing trends in recent years have been affected by the COVID-19 pandemic.


Subject(s)
COVID-19 , HIV Infections , COVID-19/epidemiology , Communicable Disease Control , HIV Infections/diagnosis , HIV Infections/epidemiology , HIV Testing , Humans , Pandemics , Poland/epidemiology
8.
Clinical and Experimental Rheumatology ; 40(10):79, 2022.
Article in English | EMBASE | ID: covidwho-2067781

ABSTRACT

Background. Hearing dysfunction, caused by the involvement of the vestibulocochlear nerve or by direct damage on inner ear structures has been described in patients with Sjogren's Syndrome (SS). Previous studies evaluating the prevalence and incidence of hearing dysfunction in SS showed conflicting results, therefore, to date, the exact prevalence has not been extensively evaluated. Objectives. The aim of this study is to evaluate the prevalence of hearing involvement in patients with primary SS (pSS). Materials and methods. Patients with pSS (AECC criteria) with >=18 years of age attending a dedicated Sjogren's syndrome clinic were consecutively enrolled Auditory function was investigated by pure tone audiometry (PTA), It-Matrix test (Speech Reception Threshold in noise leading to 50% correct sentences-SRT) and the Hearing Handicap Inventory (HHI) during a baseline visit and at a follow up visit. A questionnaire of auto-evaluation of hearing loss impact on life was also administered to the patients. Results. Twenty-five patients with pSS (24 females) were enrolled in the study. The median age was 56.2 years (IQR 49-64) The mean disease duration was 3.7 years, 8 were treated with hydroxychloroquine (HCQ) and 1 with methotrexate. At baseline evaluation PTA revealed hearing loss in 17 patients (68%) with severity ranging from mild to severe. Fifteen patients (60%) presented mild hearing loss, 1(4%) moderate e 1 (4%) severe. The It-Matrix score ranged from -9.9 to 0.9 (median - 3.50). Median HHI score was 12.17 (min 0, max 68, SD 177.9). For Covid restrictions, a follow-up evaluation was available for 10 patients only. In these patients, a worsening of PTA and HHI was observed. Interestingly, the it-Matrix scores of patients with a stable disease showed an improvement. Conclusions. These preliminary findings suggest that hearing involvement is common in patients with SS and that it progresses over time. If confirmed on larger cohorts, these data will be useful for physicians in counseling patients about their disease and, in case of suspicious symptoms, an early evaluation by an otolaryngologist may prevent delay in diagnosis and allow an appropriate diagnostic evaluation and therapeutic intervention.

9.
Pharmaceutical Journal ; 308(7958), 2022.
Article in English | EMBASE | ID: covidwho-2065021
10.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P20-P21, 2022.
Article in English | EMBASE | ID: covidwho-2064482

ABSTRACT

Introduction: While there is anecdotal evidence that a SARSCoV- 2 (COVID-19) reverse transcription polymerase chain reaction screening nasopharyngeal swab confers an elevated risk of epistaxis, no studies substantiate this. We aim to assess the association between epistaxis and exposure to a provideradministered COVID-19 swab. Method(s): A paired-exposure crossover cohort design was used among all patients who received a single COVID-19 swab between April 2020 and March 2021. Occurrence of epistaxis was compared during the hazard period, the 7 days following the index COVID-19 swab, to the control period, the 7 days preceding the index COVID-19 swab. McNemar test was used to compare rates of control- and hazard-period epistaxis. Conditional logistic regression was used to evaluate sociodemographic and clinical risk factors for epistaxis. Result(s): A total of 827,987 participants were included, with 1047 epistaxis encounters. The prevalence of epistaxis during the hazard and control periods were 0.08% and 0.04%, respectively. Swab exposure was associated with 1.92-fold odds of epistaxis in the hazard period (95% CI, 1.73, 2.12];P<.01). Older age (odds ratio [OR] 1.07;95% CI, 1.02, 1.75), Asian ancestry (OR 1.68;95% CI, 1.40, 2.02), men (OR 1.33;95% CI, 1.16, 1.54), anticoagulation/antiplatelet use (OR 2.88;95% CI, 2.11, 3.92), hypertension (OR 2.31;95% CI, 1.92, 2.78), and prior facial trauma (OR 1.63;95% CI, 1.21, 2.19) were associated with significantly increased odds of epistaxis during the hazard period (P<.01). Conclusion(s): COVID-19 nasal swabs are associated with increased risk of epistaxis. Physicians should provide additional counseling to patients, particularly those at highest risk, including those on anticoagulants/antiplatelets or with hypertension, prior to undergoing a COVID-19 nasal swab.

11.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P170, 2022.
Article in English | EMBASE | ID: covidwho-2064425

ABSTRACT

Introduction: Keloids of the head and neck can result in significant disfigurement and psychological stress. Here we report a novel case of keloid formation at a well-healed postauricular incision presenting after a year of daily ear loop mask use and discuss unique considerations for management. Method(s): This is a retrospective case review of a 35-year-old African American man with Klinefelter syndrome, type 2 diabetes mellitus, and a history of hypertrophic scar formation who presented to otology clinic in 2015 with chronic left otitis media and cholesteatoma. He underwent left tympanoplasty and mastoidectomy in 2016 through a postauricular incision 1 cm posterior to retroauricular sulcus in a standard fashion. In 2018, the patient was noted to have a hypertrophic scar without extension beyond the borders of the incision that was stable until 2021. Result(s): In 2021, the patient was noted to develop a 12A 7-cm postauricular keloid in the setting of mechanical irritation from his mask worn throughout the COVID-19 pandemic. Given the disfiguring cosmesis and resulting challenges securing an ear loop mask, he elected to undergo complete excision of the postauricular keloid with tension-free primary closure of the wound, intralesional corticosteroid injection (triamcinolone acetonide 40 mg/mL), and pressure dressing. The patient was counseled on options for mask wearing to avoid contact with the postauricular incision. Conclusion(s): When designing postauricular incisions in patients prone to hypertrophic scar or keloid formation, the point of postauricular contact of ear loop masks is a novel consideration to minimize risk of future pressure-related injury. Counseling on alternative face masks that tie behind the head or anchoring ear loops to buttons sewn onto a hat or headband are other preventative pressures.

12.
Journal of Neurology, Neurosurgery and Psychiatry ; 93(Supplement 1):A69, 2022.
Article in English | EMBASE | ID: covidwho-2064254

ABSTRACT

Video consultations have become a viable alternative for face-to-face consultations during Covid19 pandemic and are expected to be used increasingly in the future. To date, there is little evidence to support the acceptability of these services or to document the benefits and challenges when offering online clinics to HD patients. Method We report on an EHDN WG Genetic Counselling and Testing project of 41 healthcare professionals from 15 European countries. Participants filled in a purposely-designed survey to assess the acceptability, benefits and challenges of telemedicine with HD affected and at risk individuals. The survey was active from March 2020 until March 2021. Results Respondents were geneticists (34%), neurologists (34%), genetic counsellors (15%), and others (psychologists, psychiatrists and research practitioners) (17%). Before the Covid-19 pandemic, professionals saw 4.5 HD patients per week and most (85%) never used telemedicine. During the pandemic, professionals saw 2.4 patients per week in face-toface consultations and 3.4 patients in online consultations. 85% of professionals felt that HD clinics can be done safely and effectively online. Most respondents agreed several aspects of consultations can be done safely online: follow-up counselling (78%), genetic counselling for predictive testing (54%), psychological assessment (49%), psychiatric and behavioural assessment (44%). The main benefits of telemedicine perceived were and challenges were also listed and discussed at length. Conclusions and discussion Our data are encouraging in relation to the potential for virtual and hybrid consultations in HD care. We draw on both quantitative and qualitative data to discuss professionals' views on telemedicine as well as potential implications for future practice.

13.
Archives of Disease in Childhood ; 107(Supplement 2):A21, 2022.
Article in English | EMBASE | ID: covidwho-2064011

ABSTRACT

Aims A recent RCPCH publication shared the struggles across Paediatric Emergency Departments (PEDs) with meeting the 'Facing the Future' standards for children and young people (CYP) with mental health (MH) concerns, with few units studied being able to adequately meet the needs of CYP in MH crisis (1). We work in a central London teaching hospital and major trauma centre: our aim was to understand the experience of CYP aged 13-17 presenting to the PED with MH concerns, as compared with those presenting with physical complaints. Methods Collection of quantitative data surrounding CYP in the ED with MH presentations (n=271), including time to be seen, time to see Child and Adolescent Mental Health Services (CAMHS), time to admission or discharge, and total time spent in ED (all as compared with physical health presentations n=7551). Use of independent samples t-tests to analyse differences between groups across outcomes. Two time periods (1 July-30 Oct 2019 and 1 July-30 Oct 2021, n= 3913 and 3909 respectively) were examined to encapsulate pre and post COVID. Qualitative inquiry with 22 CYP presenting to the ED to co-produce experience maps to visualise their healthcare journeys and identify opportunities to improve their care. Results CYP with MH presentations spent a mean time of 747.6 minutes in the ED, compared with physical health patients who spent 195.76 minutes (p=<0.001). Mean time to be seen by CAMHS was 225.0 minutes, whereas patients with physical health complaints who are referred to specialties waited 196.52 minutes to be seen (a difference that was not significant). More CYP with MH presentations than those with physical health presentations spent >4 hours but <12 hours in the ED (76.4% vs 18.4%, p<0.001) and almost 1/3 spent more than 12 hours in the ED (32.8% vs 1.0%, p<0.001). Experience mapping captured that CYP and families acknowledged the wait but would benefit from signposting of the physical environment (e.g. 'you are here' maps), the presence of age-appropriate entertainment, and the input of volunteers or staff to support basic needs (e.g. food, water, pillows): we are implementing each. Conclusion CYP with MH presentations have a worse experience of the ED than their counterparts with physical health complaints, spending longer in the department, being more likely to surpass 4 or 12 hours in the ED. CYP have indicated to us some simple changes to their environment and the management of their stay which could improve their experience. It is widely acknowledged that most areas need to grow our provision of CAMHS to meet the need, but we also need to further utilise other MH services available beyond hospital walls (e.g. crisis lines, wellbeing practitioners, school counselling, youth support services). (1) John Criddle, Virginia Davies, RCPCH Website https:// www.rcpch.ac.uk/news-events/news/time-raise-standard-childrenpresenting- emergency-departments-mental-health-crisis.

14.
American Journal of Transplantation ; 22(Supplement 3):776, 2022.
Article in English | EMBASE | ID: covidwho-2063545

ABSTRACT

Purpose: COVID-19 infection in kidney transplant (KT) recipients is characterized by an unpredictable course and can be life-threatening. Prompt adjustment of immunosuppression and hospitalization when decompensated are potential strategies to increase survival. Our objective is to determine if advanced practice nurse (APN)-driven COVID-19 monitoring would result in better health outcomes for KT recipients. Method(s): We performed a retrospective study on KT patients diagnosed with COVID-19 between 4/1/2020 and 11/30/2021. The patients were stratified into two groups: (1) a control group who initially presented to the emergency department (ED) with COVID-19 symptoms, (2) an intervention group where patients were diagnosed with COVID-19 outside of the ED and followed by the APN team. The APNs monitored this group daily via telephone and/or video call for symptom assessment, immunosuppression adjustment, health counseling, and emotional support. If the patients were distressed, the APNs arranged admission to the nearest hospital or transplant center. Data were analyzed using Pearson Chi-squared for comparisons and linear or logistic regression modeling with adjustment for age, ethnicity, diabetes, and obesity Results: In our cohort, there were 102 KT patients that were infected with the SARS-CoV-2 virus. The majority were Hispanic ethnicity and male gender who presented with fever and flu like symptoms. Fourty-four patients required oxygen therapy. Immunosuppression was adjusted earlier in the intervention group . When the APNs recommended hospitalization, those patients experienced less acute kidney injury (AKI), shorter duration of illness, lower readmission rates, and greater survival than the control group. Conclusion(s): In this single transplant center study, KT recipients diagnosed with COVID-19 had better clinical outcomes when intervention occurred in a timely manner by the APN team. Possible explanations include earlier withdrawal of antimetabolites, prompt triage for hospitalization, and enforcing of nursing practices (dietary educations, blood pressure/glucose management, emotional support). Interpretation and generalization of these findings should be cautious due to a small sample size. As more treatment options for COVID-19 emerge, earlier interventions and close monitoring as demonstrated in our APN-driven model has the potential to achieve better health outcomes.

15.
American Journal of Transplantation ; 22(Supplement 3):877, 2022.
Article in English | EMBASE | ID: covidwho-2063474

ABSTRACT

Purpose: SARS-CoV-2 infection in kidney transplant recipients is associated with an increased risk of severe disease and mortality relative to other patient populations, with mortality reported to be as high as 30% early in the pandemic. It has been demonstrated that vaccination against SARS-CoV-2 after transplantation is less effective as when administered prior to immunosuppression administration. To reduce the risk of poorer outcomes associated with immunosuppression, it is advisable that transplant candidates complete a SARS-CoV-2 vaccine series prior to transplantation. SARS-CoV-2 vaccine hesitancy contributes to under-vaccination in the transplant candidate population. We describe candidate perspectives associated with vaccine hesitancy in kidney transplant candidates. Method(s): Vaccination status of actively listed kidney transplant candidates at our center was reviewed in January 2022. The infectious disease nurse practitioner performed counseling telephone visits with all available candidates not vaccinated against SARS-CoV-2 to uncover their perspectives around vaccination and determine reasons for vaccine refusal/hesitancy. Result(s): Of the 233 candidates actively listed for kidney transplant, 23 (9.8%) were found to be unvaccinated against SARS-CoV-2. Of the 23 patients, 20 (87%) were successfully contacted for telephone interview. Thirteen (65%) candidates described safety concerns as their primary reason for vaccine hesitancy. The most common concerns shared by unvaccinated candidates were a lack of trust in the development of SARS-CoV-2 vaccines, speed of development and general lack of safety data. Five (38%) of the 13 candidates expressed additional concern about the effect of vaccines could have on their native kidney function. One candidate expressed fear that vaccine will increase HLA sensitization, making it more difficult for organ matching. Three candidates stated they did not need the vaccine, citing isolation, healthy diet and prior infection as protective factors. Three candidates cited medical reasons. These included recent monoclonal antibody treatment for SARS-CoV-2 infection (2) and lymphadenopathy (1). Conclusion(s): For patients awaiting kidney transplant, the primary reason contributing to vaccine hesitancy is concern regarding vaccine safety. For some, concerns are specific to diagnosis and status as a transplant candidate. Transplant centers should continue to address vaccine hesitancy in order to provide accurate information and targeted patient education around vaccine safety and benefit to aid patients in making decisions based on available scientific data.

16.
Chest ; 162(4):A2281, 2022.
Article in English | EMBASE | ID: covidwho-2060930

ABSTRACT

SESSION TITLE: Impact of Health Disparities and Differences SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: To address rural healthcare disparities by providing access to home based pulmonary rehabilitation (HBPR) program for eligible veterans at the Salem Veterans Affairs Medical Center (VAMC) who reside in remote areas or those with barriers of long travel time and transportation hardship. METHODS: The Pulmonary Section at the Salem VAMC received a grant from the Office of Rural Health to establish HBPR program for eligible veterans. Its goal was to improve quality of life and potentially reduce COPD hospitalizations and exacerbations (AECOPD). Under the direction of pulmonologists, the program was run by an exercise physiologist (EP). Referrals were received from inpatient and outpatient providers. After an initial in-person evaluation, weekly telehealth meetings (telephone, video) occurred over 12 weeks. Veterans were provided with the equipment, and an individualized targeted exercise program along with education and counseling on tobacco cessation, nutrition, oxygen compliance, stress management, medication adherence. Follow up appointments were scheduled at 3, 6 and 12 months post completion. RESULTS: Between September 2020 and January 2022, 312 consults were received, 206 consults were scheduled and 175 veterans enrolled. To date, 100 have completed the program with 24 ongoing. 30% declined service, citing: comorbidities, physical debility, difficulty remembering scheduled appointments, lack of motivation, social reasons, worsening health status. Mean age was 71, male predominance (95%). Referral diagnoses included: COPD (86%), chronic hypoxic respiratory failure (55%), COVID-19 (11%), Interstital Lung Diseases (10%). Mean FEV1 was 57% predicted, mean MMRC Dyspnea Scale 2.5, mean BODE score 5. 20% of enrolled veterans were active smokers, 72% were former smokers. 6 minute walk test increased from 156 meters on enrollment to 216 meters on completion. 45 veterans required hospitalization for pulmonary issues during their participation in the program. EP identified on weekly appointments 20 AECOPD that were treated as outpatient, 1 spontaneous pneumothorax that led to hospitalization, and facilitated the refill of inhalers or adjustment of medical regimen. Patient satisfaction score, including perception of benefit post completion was 29.4/30. CONCLUSIONS: HBPR at the Salem VAMC provided access to eligible veterans, overcoming barriers of rurality, transportation hardship and lack of nearby conventional programs. It also offered off business hours PR to veterans who continue to work. It allowed decrease in community care referrals thus establishing useful and cost effective service. CLINICAL IMPLICATIONS: Pulmonary Rehabilitation has been shown to reduce morbidity, improve functional status and have mortality benefit. Healthcare discrepancies and disparities have been a major obstacle for enrollment. HBPR would address these issues and contribute to decreased health service utilization and costs. DISCLOSURES: No relevant relationships by Nathalie Abi Hatem No relevant relationships by Brittany Frost No relevant relationships by Mitchell Horowitz No relevant relationships by Deepa Lala

17.
Chest ; 162(4):A1458, 2022.
Article in English | EMBASE | ID: covidwho-2060819

ABSTRACT

SESSION TITLE: Quality Improvement SESSION TYPE: Original Investigations PRESENTED ON: 10/17/22 1:30 pm - 2:30 pm PURPOSE: Organ transplant is the ultimate necessity in managing many end-stage organ pathologies. As per the health resource and service administration, 17 people die every day while waiting for an organ transplant. In the year 2020, 169 million Americans registered as organ donors, but due to the limitations of organ donation such as cause of death and condition of the organ at the time of death, only about 3 in 1000 people die in such a way that their organs are in an optimum condition for transplantation 1. The role of nurses in organ donation is critical in both acute and critical care settings 2. Educating nurses on certain aspects of organ donation, such as approaching the families and counseling regarding moral and legal considerations, will acclererate the process of organs retrieval from the interested donors. We hypothesized that in addition to Best Practice Alert (BPA) on Electronic Medical Record (EMR), educating nurses can optimize organ donation by timely referring the organs for transplantation. METHODS: ICU-wide nursing education sessions were conducted elucidating that when a ventilated patient qualifies for Life Gift notification and a BPA does not pop up in EMR, Nurses should immediately call the Houston Methodist organ donation service, Life Gift within one hour of the following two triggers: 1) Loss of one or more brainstem reflex(es), 2) Glasgow Coma Scale (GCS) ≤ 5. Nurses were also educated to start a timely discussion with the family proposing Life Gift prior to discussing the withdrawal of life-sustaining treatments, popularly known as terminal extubation. The data for timely organ referral from the preceding six months (January 2021 to June 2021) was compared to the four months (July 2021 to October 2021) following the nursing education sessions. RESULTS: The total number of timely referrals in the pre- and post-education period were n=23/33 Vs. n=29/31. The overall timely referral of the organ for transplantation increased from 69.2% to 95%. Out of four months post-education, two months record the compliance of 100%. Our chi-square statistic was 5.969 with a p-value of 0.01456. We performed Yates continuity correction due to small sample size and to compensate for deviations from the theoretical (smooth) probability distribution. Our chi-square statistic with Yates correction was 4.506, and the p-value was 0.034 (Significant at p < 0.05). Our study was limited by the small sample size, high nursing turnover due to the COVID-19 pandemic, and logistic restrictions due to the pandemic. CONCLUSIONS: The overall referring time for organs improved after nursing education sessions, including targeted triggers. CLINICAL IMPLICATIONS: Nursing education plays a crucial role in organ donation programs. Further studies are needed to better understand the issues that nurses face and develop new strategies that can be implemented to improve the organ and tissue referrals for organ donation. DISCLOSURES: No relevant relationships by Muhammad Mohsin Abid No relevant relationships by Sana Jogezai No relevant relationships by Iqbal Ratnani No relevant relationships by Salim Surani No relevant relationships by Muhammad Hassan Virk

18.
Chest ; 162(4):A1289-A1290, 2022.
Article in English | EMBASE | ID: covidwho-2060797

ABSTRACT

SESSION TITLE: COVID-19 Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Much has been learned about the immune dysregulation and release of pro-inflammatory cytokines since the emergence of the COVID-19 pandemic.1 Patients with interstitial lung disease are often on immunosuppressive agents, such as rituximab, which is a B-cell depleting agent. There has been a large retrospective cohort study showing that rituximab therapy was the only immunosuppressive medication with a trend towards in-hospital death.2 We present a case of COVID-19 in a patient on rituximab with ANCA vasculitis. CASE PRESENTATION: A 51-year-old male, never smoker, with ANCA positive vasculitis (positive MPO and PR3) and interstitial lung disease (on 4-5L of oxygen) presented to the hospital with nausea and fever for 2 days and was found to have a positive SARS-CoV-2 PCR. At the time of presentation, he was on rituximab 1000 mg x 2 doses every 6 months with last infusion one month prior to presentation, azathioprine 150 mg daily, prednisone 15 mg daily, nintedanib 100 mg BID, and IVIG monthly. Spirometry showed FVC of 1.60L/37% predicted and an FEV1 1.28L/39% predicted. Patient had 2 COVID vaccinations and one booster (all Pfizer mRNA), the latter 3 months prior to presentation. On admission, he was saturating at 55% on 4L and placed on 15L non-rebreather;he was afebrile, normotensive, and with a pulse of 110 BPM. Exam was notable for a cough, wheezing, and tachypnea. Lab work was notable for positive SARS-COV-2 PCR, a total white blood cell count of 5.3x103 uL, and a normal hemoglobin and platelet count. He had a CO2 of 34, normal creatinine, and no transaminitis. Lactate dehydrogenase (LDH) was elevated at 318 U/L, and lactate was elevated at 3.5 mmol/L. His chest x-ray on admission demonstrated patchy filling opacities and low lung volumes. He received dexamethasone, remdesivir, and the monoclonal antibodies casirivimab and imdevimab (REGEN-COV) on the first day of admission. Patient also received his monthly IVIG dose inpatient. After a week, he was weaned back to his home oxygen and symptomatically back to baseline. Most recent PFTs on the same outpatient immunosuppressive regimen as prior to admission are unchanged. Patient received two doses of preventative monoclonal antibodies (EVUSHELD) 3 months after admission. DISCUSSION: Here we discuss a case of a patient with severe COVID-19 pneumonia requiring inpatient hospitalization despite three COVID mRNA vaccinations, likely secondary to difficulty in mounting an immune response to the vaccinations given his use of immunosuppressive medications. This is also an example of the early use of monoclonal antibodies in an inpatient with long term preservation of his underlying lung function.3 CONCLUSIONS: We recommend counseling and close observation of patients on rituximab due to risk of severe COVID-19 infection as well the use of preventative monoclonal antibodies (EVUSHELD). Reference #1: Jamal M, Bangash HI, Habiba M, Lei Y, Xie T, Sun J, Wei Z, Hong Z, Shao L, Zhang Q. Immune dysregulation and system pathology in COVID-19. Virulence. 2021 Dec;12(1):918-936. doi: 10.1080/21505594.2021.1898790. PMID: 33757410;PMCID: PMC7993139. Reference #2: Andersen, K. M., Bates, B. A., Rashidi, E. S., Olex, A. L., Mannon, R. B., Patel, R. C., Singh, J., Sun, J., Auwaerter, P. G., Ng, D. K., Segal, J. B., Garibaldi, B. T., Mehta, H. B., Alexander, G. C., Haendel, M. A., & Chute, C. G. (2022). Long-term use of immunosuppressive medicines and in-hospital COVID-19 outcomes: A retrospective cohort study using data from the National COVID Cohort Collaborative. The Lancet Rheumatology, 4(1), e33–e41. https://doi.org/10.1016/S2665-9913(21)00325-8 Reference #3: Weinreich, D. M., Sivapalasingam, S., Norton, T., Ali, S., Gao, H., Bhore, R., Xiao, J., Hooper, A. T., Hamilton, J. D., Musser, B. J., Rofail, D., Hussein, M., Im, J., Atmodjo, D. Y., Perry, C., Pan, C., Mahmood, A., Hosain, R., Davis, J. D., Yancopoulos, G. D. (2021). Regen-cov antibody combination and outcomes in outpatients with covid-19. New England Journal of Medicine, 385(23), e81. https://doi.org/10.1056/NEJMoa2108163 DISCLOSURES: Advisory Committee Member relationship with Genentech Please note: 2019-2022 Added 06/06/2022 by Ayodeji Adegunsoye, value=Consulting fee Advisory Committee Member relationship with Boehringer Ingelheim Please note: 2018-2022 Added 06/06/2022 by Ayodeji Adegunsoye, value=Consulting fee Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: 2018-2022 Added 06/06/2022 by Ayodeji Adegunsoye, value=Honoraria Consultant relationship with Genentech Please note: 2018-2020 by Ayodeji Adegunsoye, value=Consulting fee Removed 06/06/2022 by Ayodeji Adegunsoye No relevant relationships by Cathryn Lee No relevant relationships by Kavitha Selvan PI relationship with Boehringer-Ingelheim Please note: >$100000 by Mary Strek, value=Grant/Research Support PI relationship with Galapagos Please note: $70,000-100,00 by Mary Strek, value=Grant/Research Support Endpoint Adjudication Committee Member relationship with Fibrogen Please note: $1-$1000 by Mary Strek, value=Honoraria No relevant relationships by Rachel Strykowski

19.
Chest ; 162(4):A366, 2022.
Article in English | EMBASE | ID: covidwho-2060576

ABSTRACT

SESSION TITLE: Advances in the Management of Respiratory Infections SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: The factors influencing vaccine uptake are varied and understanding of patient and provider barriers to adult vaccination is limited. Given the importance of provider recommendations for improving uptake, we sought to understand knowledge, attitudes, and behaviors among primary care providers and pulmonologists concerning influenza, pneumococcal, and COVID-19 vaccination regarding their adult patients. METHODS: We conducted a survey using the REDCaps platform of 454 Mayo Clinic physicians and advanced practice providers practicing in community internal medicine, family medicine, geriatrics, and pulmonology practicing in Rochester and southeastern Minnesota. We made 3 contacts over 3 months in Fall 2021. Our survey used questions adapted from a variety of sources. Experts evaluated the survey and made revisions, iteratively changing it before IRB approval. It was tested to ensure the survey was usable and able to be understood by the intended population. Results are described combining percentages of those that “sometimes” or “often” used strategies and barriers described are as “some” or “a lot”. RESULTS: 127/454 (28%) providers responded. Most respondents reported that they specifically counseled their high-risk adults to receive the influenza vaccine (92%), the pneumococcal vaccine (87%), and the COVID-19 vaccine (100%). 64% utilize a state or regional immunization information system (IIS) to assess and record immunization data and many use a written or electronic alert when an adult patient hasn’t received their influenza (79%) or pneumococcal (73%) vaccine. Vaccine reminder-recalls are only sent a third of the time. Common misperceptions among patients reported by health care providers were that the flu vaccine would make them sick (87%), get influenza (66%) or that it was not severe enough to warrant vaccination (74%). Barriers to discussions on influenza were lack of time (47%) and other health issues taking precedence (44%). Providers were asked what strategies they used to encourage influenza vaccination. They often discussed morbidity and mortality (88%), their personal experiences (73%), effectiveness of the vaccine (91%), protection of others close to the patient (94%) and provided a statement they felt it was safer to vaccinate than to not (92%). When asked how effective these strategies were, they produced somewhat effective responses. CONCLUSIONS: Providers reported they are counseling patients on vaccines due most of the time. They readily identify numerous patient-reported concerns. They are not frequently using patient-reminder-recall systems but most use immunization information systems and provider point-of-care prompts. CLINICAL IMPLICATIONS: Despite barriers to extensive discussions of immunizations, providers still frequently discussed vaccinations with patients, utilizing written or electronic alerts, although patient reminders were rarely sent. DISCLOSURES: No relevant relationships by Jamie Felzer No relevant relationships by Robert Jacobson No relevant relationships by Young Juhn No relevant relationships by Cassie Kennedy No relevant relationships by Lila Rutten No relevant relationships by Chung-Il Wi

20.
Chest ; 162(4):A346, 2022.
Article in English | EMBASE | ID: covidwho-2060570

ABSTRACT

SESSION TITLE: Long COVID: It Can Take Your Breath Away SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: Post-acute sequelae of COVID-19 (PASC) infection is an area of active research, and much remains unknown about the trajectory of respiratory system recovery. While chronic dyspnea is a commonly reported PASC symptom, it is unclear how objective lung function metrics change over time. In this study, we sought to in lung function in PASC by comparing serial pulmonary function tests (PFTs) after COVID-19 infection. METHODS: Patients with prior COVID-19 infection and at least two PFTs after acute infection were identified retrospectively from our COVID-19 recovery clinic at a tertiary care center in Chicago, Illinois. PFT data and other clinical information were ed from the electronic medical record. Using a matched paired t-test, the differences between forced expiratory volume at one second (FEV1), forced vital capacity (FVC), total lung capacity (TLC), and diffusion capacity of carbon monoxide (DLCO) were compared over time. RESULTS: There were 32 patients who underwent pulmonary function testing twice after COVID-19 illness from 2020-2022, with a mean age of 56 years. The majority of the cohort were female (59%) and white (56%). 16 patients (50%) had required hospitalization for their acute COVID-19 illness, and 7 (22%) had required ICU level of care. The mean time from illness onset to first PFT was 207 days, and the mean time between the first and second PFT was 204 days. There was a statistically significant increase in FVC (2.2%, p=0.01), TLC (2.2%, p=0.01), and DLCO (2.43 mL/min/mmHg), but not in FEV1. Rate of change was calculated for each patient by dividing the difference for each parameter by the time (in years) between PFTs. TLC improved most rapidly (median 10.9% per year, IQR 0-24), followed by DLCO (median 6.6% per year, IQR -1 – 19.4). FEV1 increased by 3.9% per year (IQR -12.5 – 22), and FVC increased by 5.1% per year (IQR -4.5 – 22.7). Rate of change was calculated for each patient by dividing the difference for each parameter by the time (in years) between PFTs. TLC improved most rapidly (median 10.9% per year, IQR 0-24), followed by DLCO (median 6.6% per year, IQR -1 – 19.4). FEV1 increased by 3.9% per year (IQR -12.5 – 22), and FVC increased by 5.1% per year (IQR -4.5 – 22.7). CONCLUSIONS: There was an improvement in lung function metrics in our PASC cohort. This data describes the rate of improvement for each parameter, which may be helpful in prognostication and counselling patients about expected recovery times. CLINICAL IMPLICATIONS: A large number of patients with PASC experience chronic dyspnea and have persistent radiographic changes and/or abnormal pulmonary function testing. Our data suggests that for patients with abnormal PFTs, there is gradual improvement over time. With the burden of COVID-19 illness worldwide, it is crucial that we can accurately risk stratify those at high risk for persistent symptoms as well as understand the trajectory of recovery. DISCLOSURES: no disclosure submitted for Joseph Bailey;No relevant relationships by Amy Ludwig No relevant relationships by Marc Sala

SELECTION OF CITATIONS
SEARCH DETAIL