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1.
Infection and Drug Resistance ; 15:1995-2013, 2022.
Article in English | EMBASE | ID: covidwho-1822314

ABSTRACT

Background & Aims: Coronavirus disease 2019 (COVID-19) is a global health problem, presenting with symptoms ranging from mild nonspecific symptoms to serious pneumonia. Early screening techniques are essential in the diagnosis and assessment of disease progression. This consensus was designed to clarify the role of lung ultrasonography versus other imaging modalities in the COVID-19 pandemic. Methods: A multidisciplinary team consisting of experts from different specialties (ie, pulmonary diseases, infectious diseases, intensive care unit and emergency medicine, radiology, and public health) who deal with patients with COVID-19 from different geographical areas was classified into task groups to review the literatures from different databases and generate 10 statements. The final consensus statements were based on expert physically panelists’ discussion held in Cairo July 2021 followed by electric voting for each statement. Results: The statements were electronically voted to be either “agree,” “not agree,” or “neutral.” For a statement to be accepted to the consensus, it should have 80% agreement. Conclusion: Lung ultrasonography is a rapid and useful tool, which can be performed at bedside and overcomes computed tomography limitations, for screening and monitoring patients with COVID-19 with an accepted accuracy rate.

3.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816886

ABSTRACT

Introduction: To ensure safe delivery of oncologic care in the COVID-19 pandemic, telemedicine has been rapidly adopted. We assessed accessibility and time to treatment initiation for thoracic oncology patients seen via telemedicine or in-person during the initial phase of the COVID-19 pandemic. Methods: We conducted a retrospective cohort study of patients with thoracic malignancies seen within a multidisciplinary team at the University of Pennsylvania Health System (UPHS) during the first surge of COVID-19 cases in Philadelphia (March 1 to June 30, 2020). Patients with an index visit for a new phase of care, defined as a new diagnosis, local recurrence, or newly discovered metastatic disease were included. Patients who did not receive subsequent oncologic care within the UPHS were excluded. Dates of referral, index visit, and treatment initiation were ed from the electronic medical record (EMR). Patients were divided into groups based on index visit type (in-person vs. telemedicine). Comparisons of time to care between groups were evaluated using the Wilcoxon rank-sum test. Results: Between March 1 and June 30, 2020, 241 distinct thoracic oncology patients were seen for a new phase of care and managed with surgery (n=78, 32.4%), radiation (including concurrent chemoradiation) (n=59, 24.5%), or systemic therapy (n=73, 30.3%). The majority of visits were for a diagnosis of a new thoracic cancer (87.1%). 133 patients (55.2%) were seen in-person and 108 (44.8%) were seen via telemedicine. Baseline characteristics of patients seen via telemedicine vs in-person were well balanced. As expected, the proportion of telemedicine to in-person visit types changed with the local phase of the pandemic with an initial increase of telemedicine during the lockdown period and a decrease during the re-opening phase. A higher proportion of visits were conducted via telemedicine when receiving systemic therapy or radiation as compared to surgery. Among patients with new diagnoses (n=210), the median time from referral to initial visit was significantly shorter amongst the patients seen via telemedicine vs. in-person (4.5 vs. 6.0 days, p=0.006), though only 67.1% had referral dates reported in the EMR. Time-to-treatment stratified by treatment modality received did not differ by type of initial visit (median values in-person vs. telemedicine: surgery 16 vs. 22 days, p= 0.48;radiation 26.5 vs. 28 days, p=0.90;systemic therapy 13.5 vs. 14 days, p=0.49). A sensitivity analysis limited to new diagnoses only (210/241) confirmed the same results. Conclusions: Rapid adoption of telemedicine sustained timely delivery of oncologic care during the initial surge of the COVID19 pandemic across a thoracic oncology multi-disciplinary clinic. While the full impact of telemedicine on long term clinical outcomes remains to be determined, faster times from referral to initial visit in the telemedicine group provide preliminary evidence that telemedicine could sustain or improve accessibility to oncologic care, especially during current and future pandemics.

4.
Age and Ageing ; 51(SUPPL 1):i9, 2022.
Article in English | EMBASE | ID: covidwho-1815975

ABSTRACT

Background: A dedicated Communication Sheet was introduced on an Acute Frailty ward at the Royal Surrey County Hospital (by a Nurse-in-Charge and foundation doctors under the supervision of a Consultant Geriatrician) to improve communication between the Multidisciplinary team(MDT) and patients' NoK/families. Introduction: Communication with patients' NoK is an essential part of providing holistic care & has become important given the COVID-19 visiting restrictions. Multidisciplinary Team (MDT) members were facing difficulties in knowing the following while updating NoK: 1. The correct contact details of the Next of Kin and other significant persons involved in care. 2. When the last NoK update was done and what was discussed. 3. If the patient has consented to NoK updates. This led to dissatisfaction and complaints from families regarding the frequency and consistency of updates. To make this easier for staff, a communication sheet was introduced. Methods: A Plan-Do-Study-Act Method: was used. Following discussion at a ward governance meet, a survey was conducted to assess the difficulty faced by MDT members in NoK updates. A Communication Sheet designed by a Nurse-in-Charge and Foundation Doctors was trialled for 1 month. The sheet was updated following feedback. A repeat Survey was conducted to assess if NoK updates were easier after the intervention. Results: After the Introduction: of the Communication Sheets, the number of staff facing 'significant difficulty' in the above-mentioned parameters reduced and those facing 'no difficulty' increased. Feedback from MDT members suggested that they found the intervention useful. Conclusion: Dedicated communication sheets made updating families/NoK easier. This ensures consistent updates especially when visiting is restricted. This fosters a better patientclinician relationship. Given its success, we plan to share this with other frailty wards to scale up this intervention.

5.
Age and Ageing ; 51(SUPPL 1):i16, 2022.
Article in English | EMBASE | ID: covidwho-1815971

ABSTRACT

Background: Advance care planning (ACP) is an ongoing conversation where healthcare professionals explore patients' and families' wishes in order to act within their best interests. The COVID19 pandemic continues to highlight the importance of timely ACP, namely while our patients have capacity. We noted that despite advancing age, accumulating co-morbidities and high clinical frailty scores (CFS);ACP discussions were not taking place within our elderly department. We aimed to increase ACP conversations and ensure documentation on ReSPECT forms to allow continuity within primary care. Methods: 10 patients per ward were randomly selected. 69 patients met inclusion criteria (over 65 with CFS ≥5 or any patient with dementia). We reviewed electronic and paper records and defined evidence of ACP as ReSPECT form including preferred place of death (PPoD), or discussion with patient or relative in medical notes. We randomly selected a pilot ward and applied interventions over 4 weeks: • Small group teaching to junior doctors • Visiting ward MDTs to identify appropriate patients for ACP • Presenting baseline data to geriatricians • Visual aids from the palliative care team and prompt sheets for doctors. Results: Prior to our interventions, 22% of our sample had evidence of advance care planning, 33% of discussions documented on ReSPECT form. Following our intervention period we reviewed medical notes on our pilot ward. 58% patients now had evidence of ACP, with 66% documented on a ReSPECT form. Conclusion: We achieved a significant increase in advance care planning within our elderly medicine department, and are therefore better equipped to provide personalised care alongside our patients' wishes and values. Next steps: • Expanding teaching across the multi-disciplinary team • ACP 'champions' to highlight appropriate patients • Expansion of initial interventions across the departmentWe hope to embed and maintain this change through education, training and inspiring others.

6.
Malta Medical Journal ; 34(1):35-42, 2022.
Article in English | EMBASE | ID: covidwho-1812692

ABSTRACT

BACKGROUND COVID-19 was a global shock, causing challenges to many countries’ healthcare services. This paper provides a summary of Malta’s healthcare system journey during the COVID-19 pandemic with its initial preparedness for COVID-19 pandemic and the impact of COVID-19 on the service during the first 12 months of the pandemic. METHODS A literature search was conducted using Google and reviewing Maltese online newspapers. A comprehensive summary of internal operations conducted at Mater Dei Hospital, the country’s only acute general hospital, was provided by the Chief Operating Officer. RESULTS Several infrastructural changes including the increase in bed capacity and ITU areas were instituted in preparation for the pandemic. The health system showed resilience during the first wave. However, the situation was more precarious during the second wave. The end of December 2020 saw the start of the Covid-19 vaccination rollout, with over 30 health system hubs offering this service across the islands. Simultaneously health professional’s burnout is on the rise as resources and workforce are overstretched. CONCLUSION The collaborative effort between the guidance provided by the Public Health Authorities and the hospital’s multi-disciplinary team have been pinnacle during the pandemic. However, the future of the healthcare system is heavily dependent on the population’s behaviour, timely measures, the vaccination rollout and the type of immunity acquired through vaccination or infection.

7.
Clinical Nurse Specialist ; 36(2):84-91, 2022.
Article in English | Web of Science | ID: covidwho-1794981

ABSTRACT

Purpose/Aims Healthcare workers internationally continue to look for innovative ways to improve patient outcomes and optimize resource utilization during the coronavirus disease 2019 (COVID-19) pandemic. Proning awake, nonintubated patients has been suggested as a potential intervention in critical care. The aim of this study is to provide a multidisciplinary approach to safely perform awake self-prone positioning in the acute care setting. Design This is a prospective, descriptive study. Method Patients with COVID-19 were screened and enrolled within 48 hours of a positive test. After approval from the primary team, patients were provided education materials by a multidisciplinary team on the self-prone intervention. Visual cues were placed in the room. Patients were requested to maintain a diary of hours of prone positioning. Patients' baseline characteristics, admission vitals, daily oxygen requirements, and level of care were collected. Results Of 203 patients screened, 31 were enrolled. No pressure-related injury or catheter (intravenous or urinary) displacement was identified. Eighty-one percent of patients spent less than 8 hours a day in prone positioning. Among patients enrolled, none required invasive ventilation or died. Conclusions Awake self-proning can be performed safely in patients given a diagnosis of COVID-19 in the acute care setting with a multidisciplinary team.

8.
Am J Health Syst Pharm ; 2022 Apr 07.
Article in English | MEDLINE | ID: covidwho-1778883

ABSTRACT

DISCLAIMER: In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: To evaluate and compare antimicrobial stewardship program (ASP) guideline adherence (primary outcome) as well as length of stay, 30-day all-cause mortality, clinical cure, antimicrobial consumption, and incidence of multidrug-resistant (MDR) pathogens (secondary outcomes) between an infectious diseases (ID) pharmacist-led intervention group and a standard ASP group. METHODS: A quasi-experimental study was performed at Thammasat University Hospital between August 2019 and April 2020. Data including baseline characteristics and primary and secondary outcomes were collected from the electronic medical record by the ID pharmacist. RESULTS: The ASP guideline adherence in the ID pharmacist-led intervention group was significantly higher than in the standard ASP group (79% vs 56.6%; P < 0.001), especially with regard to appropriate indication (P < 0.001), dosage regimen (P = 0.005), and duration (P = 0.001). The acceptance rate of ID pharmacist recommendations was 81.8% (44/54). The most common key barriers to following recommendations were physician resistance (11/20; 55%) and high severity of disease in the patient (6/20; 30%). Compared to the standard ASP group, there was a trend toward clinical cure in the ID pharmacist-led intervention group (63.6% vs 56.1%; P = 0.127), while 30-day all-cause mortality (15.9% vs 1.5%; P = 0.344) and median length of stay (20 vs 18 days; P = 0.085) were similar in the 2 groups. Carbapenem (P = 0.042) and fosfomycin (P = 0.014) consumption declined in the ID pharmacist-led intervention group. A marginally significant decrease in the overall incidence of MDR pathogens was also observed in the ID pharmacist-led intervention group (coefficient, -5.93; P = 0.049). CONCLUSION: Our study demonstrates that an ID pharmacist-led intervention can improve ASP guideline adherence and may reduce carbapenem consumption.

9.
Front Public Health ; 9: 735754, 2021.
Article in English | MEDLINE | ID: covidwho-1775877

ABSTRACT

Background and Objective: Improving quality of care is one of the primary goals in current Chinese hospital reforms. Teamwork can play an essential role. Characteristics of teamwork and interventions for improving teamwork in hospitals have been widely studied. However, most of these studies are from a Western context; evidence from China is scarce. Because of the contextual differences between China and Western countries, empirical evidence on teamwork from Western hospitals may have limited validity in China. This systematic review aims to advance the evidence base and understanding of teamwork in Chinese hospitals. Methods: Both English (i.e., Embase, Medline, and Web of Science) and Chinese databases (i.e., CNKI, CQVIP, and Wanfang) were searched for relevant articles until February 6, 2020. We included the studies that empirically researched teamwork in Chinese hospitals. Studies were excluded if they (1) were not conducted in hospitals in Mainland China, (2) did not research teamwork on team interventions, (3) were not empirical, (4) were not written in English or Chinese, (5) were not published in peer-reviewed journals, and (6) were not conducted in teams that provide direct patient care. Both deductive and inductive approaches were used to analyze data. The Mixed Methods Appraisal Tool (MMAT) was used to assess their methodological quality. Results: A total of 70 articles (i.e., 39 English articles and 31 Chinese articles) were included. The results are presented in two main categories: Teamwork components and Team interventions. The evidence regarding the relationships among inputs, processes, and outcomes is scarce and mostly inconclusive. The only conclusive evidence shows that females perceive better team processes than males. Similar types of training and tools were introduced as can be found in Western literature, all showing positive effects. In line with the Chinese health reforms, many of the intervention studies regard the introduction of multidisciplinary teams (MDTs). The evidence on the implementation of MDTs reveals that they have led to lower complication rates, shorter hospital stays, higher diagnosis accuracy, efficiency improvement, and a variety of better disease-specific clinical outcomes. Evidence on the effect on patient survival is inconclusive. Conclusion: The Chinese studies on teamwork components mainly focus on the input-process relationship. The evidence provided on this relationship is, however, mostly inconclusive. The intervention studies in Chinese hospitals predominantly focus on patient outcomes rather than organizational and employee outcomes. The introduction of training, tools, and MDTs generally shows promising results. The evidence from primary hospitals and rural areas, which are prioritized in the health reforms, is especially scarce. Advancing the evidence base on teamwork, especially in primary hospitals and rural areas, is needed and can inform policy and management to promote the health reform implementation. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020175069, identifier CRD42020175069.


Subject(s)
Health Care Reform , China , Female , Hospitals , Humans , Male , Patient Care Team
10.
British Journal of Surgery ; 109(SUPPL 1):i47, 2022.
Article in English | EMBASE | ID: covidwho-1769152

ABSTRACT

Aim: The COVID-19 pandemic continues to present unprecedented challenges for healthcare systems. This has resulted in the pragmatic shift in practice of plastic surgery units worldwide. Many units reported a significant fall in urgent melanoma referrals, leading to patients presenting with advanced disease. Our objective was to evaluate our unit's experience with both non-invasive and invasive melanoma during the COVID-19 pandemic and compare it to the UK, mainland Europe and North America. Method: A Retrospective chart review was performed on all patients diagnosed with invasive and non-invasive cutaneous melanoma between March to December of 2019 (control) compared to 2020 (COVID-19 pandemic) in a single plastic surgery unit in Ireland. Results: A total of 589 patients were included in the study. Of these, 314 (53%) with invasive melanoma, compared to 275 (47%) with noninvasive disease. Overall, more patients were diagnosed with both invasive and non-invasive melanoma in 2020 than 2019 (p<0.05). However, significantly longer waiting times in 2020 (64 days) compared to 2019 (28 days) (p<0.05) with the majority of referral being from GP in 2019 (83%) compared to 61% in 2020. Positive sentinel lymph node was higher in 2019 at 56% (n=28) compared to 24% (n=22) in 2020. There was no statistically significant difference in the tutor characteristics or metastasis status. Conclusions: Our study highlights that with prompt efficient restructuring of services, including governmental agreement to utilise private sector to continue urgent elective surgery, virtual triaging and follow-up and most importantly virtual complex skin multidisciplinary team meeting, we could reserve successful management of skin cancer even in the most devastating times.

11.
Journal of the American College of Cardiology ; 79(9):2514, 2022.
Article in English | EMBASE | ID: covidwho-1768644

ABSTRACT

Background: Louis-Dietz syndrome (LDS) Type 3 is a rare disorder caused by an autosomal-dominant mutation in SMAD-3, altering the TGF-β pathway. LDS Type 3 typically manifests as aortic aneurysms and early-onset osteoarthritis, however other dermatologic, cardiovascular, and skeletal abnormalities have been reported. Case: A 51-year-old woman was referred to the cardiology clinic for episodes of palpitations, syncope, chest pain, and shortness of breath during the COVID-19 pandemic. She had a history of congestive heart failure, cardiomyopathy, patent foramen ovale, atrial septal aneurysm, pre-COVID myocarditis, mitral valve prolapse, mitral regurgitation, and pericarditis. She also has a pertinent medical history of hypermobile Ehlers-Danlos syndrome (hEDS) and systemic lupus erythematosus (SLE). Her family and social history were remarkable for a daughter with SLE. Cardiopulmonary and general physical exams were remarkable for hypermobility. Evaluation with an ECG and Holter monitor showed normal sinus rhythm with unifocal premature ventricular contractions (PVCs) that correlated with her symptoms. Decision-making: The patient was initially managed un-successfully with beta and calcium channel blockers. Cardiac ablation was subsequently performed on a left ventricular septal focus with remote magnetic navigation using the Niobe system from Stereotaxis inc. (due to its low risk for cardiac perforation). At 6 months follow up, the patient exhibited an increase in left ventricular ejection fraction from 40-50% to 55-60%, fewer symptoms, and fewer PVCs. She was later diagnosed with a right internal carotid artery aneurysm that prompted genetic testing that was positive for LDS Type 3. Conclusion: This patient’s unique combination of illnesses required a multidisciplinary team for management. The Stereotaxis robotic system safely and successfully treated the patient’s PVCs and resulted in improvement of left ventricular function. Due to previous reports of arrhythmias associated with these connective tissue disorders, additional studies are necessary to understand the role of the SMAD-3 mutation, EDS, and SLE in contributing to arrhythmogenicity.

12.
Genetics in Medicine ; 24(3):S174, 2022.
Article in English | EMBASE | ID: covidwho-1768093

ABSTRACT

Introduction: Phenylketonuria (PKU) is an inherited autosomal recessive disorder caused by variants in the PAH gene which encodes for phenylalanine hydroxylase (PAH). PAH deficiency leads to phenylalanine (Phe) accumulation, which untreated can cause intellectual disability, microcephaly, delayed speech, seizures, psychiatric symptoms, and behavioral abnormalities. Early detection of elevated Phe through newborn screening allows for rapid initiation of a Phe-restricted diet to prevent severe neurological outcomes;however, suboptimal Phe control throughout the lifespan is associated with increased rates of psychiatric illness and deficits in executive function even in early treated patients. Lifelong management of PKU is challenging, and it is well documented that many adult patients become lost to follow-up, despite the American College of Medical Genetics recommendation for lifelong management. Here we describe and evaluate efforts to improve follow-up care for patients with PKU of all ages at one center through formalization of clinic guidelines and creation of an overdue outreach program. Methods: The PKU clinic team is a multidisciplinary team consisting of an APN Director, physician, dieticians, diet tech, genetic counselor, registered nurse, and social worker. Regular meetings were scheduled with all clinic staff members to review PKU treatment guidelines, recommended lab monitoring, and visit frequency. After establishing formal guidelines, algorithms were created to determine thresholds for initiating patient outreach based on both age and type of PKU treatment. EMR-based data collection is used to track adherence to both clinic visits and consistent submission of Phe levels. Data was collected and analyzed for Lurie Children’s PKU program, which consists of roughly 250 patients. Baseline levels for adherence to clinic visits and filter card submission were collected at time of implementation. Data was then collected and analyzed initially after 18 months, and has been further analyzed for a second 18 months (which correlates with the start of the COVID-19 pandemic). Results: Overall baseline adherence across the PKU patient population for annual clinic visits was 72% (144/200). Clinic visit adherence increased to 88% at 18 months, and then was essentially unchanged at 86% through COVID-19 pandemic. In the pediatric patient population, annual clinic follow-up adherence was 92% (79/86) at baseline, which increased to 98% with implementation and maintained 98% during the pandemic. In the adult patient population, 54% (57/106) were adherent at baseline with clinic follow-up. With implementation compliance increased to 80% initially and was then reported to be 74% during the pandemic. Baseline for all PKU patients showed 81% (161/200) filter card submission within the last 12 months. Submission increased to 91% after 18 months of overdue outreach, and as of October 2021, 85% of all patients had submitted a filter card within the last calendar year. Adult patients specifically showed an increase, with 53% at baseline to 69% after implementation. Hyperphenylalaninemia (hyperphe) patients over the age of 2 showed an 18% (5/28) submission at baseline. With the overdue outreach program, this increased to 31% of patients initially and has further increased to 39%. Clinic visits for patients greater than 7 years old rose from 13% (3/24) initially to 57% and has further increased to 67%. Conclusion: Implementation of a coordinated overdue outreach program is successful in re-engaging patients with the PKU clinic and improving adherence to treatment recommendations. We have seen increased patient adherence across all domains, and have maintained this improved adherence despite the global COVID-19 pandemic. We believe that integrating overdue outreach guidelines into clinical practice is a replicable model for PKU clinics.

13.
Endocrine Practice ; 27(12 SUPPL):S14, 2021.
Article in English | EMBASE | ID: covidwho-1768064

ABSTRACT

Background: The coronavirus disease (COVID-19) pandemic created a new challenge for people with diabetes seeking face-toface consultations. We developed virtual care for people with type 1 diabetes (T1DM) by providing structured education on glycemic control and weight management. The objective of this study was to evaluate the effectiveness of this virtual support. Material(s) and Method(s): A total of 170 T1DM people treated with multiple daily injections (MDI) were offered virtual care through multi-disciplinary team. The outcome measures were changes in HbA1c, weight, hypoglycemic, and diabetic ketoacidosis (DKA) episodes, monitored at baseline and throughout the virtual support period. Result(s): During the virtual support HbA1C reduction was significant in people who showed continuity (n= 130;-8.05 mmol/mol, p< 0.0001) and 79 people were overweight/obesity had reduced their weight significantly (-2.96 kg, p= 0.003). CGM user for glucose monitoring had further reduction (n=79;-8.12 mmol/mol, p<0.001). The daily hypoglycemia episode also decreased (n= 5, pre 2.82 vs post 1.64, p= 0.003). No episodes of severe hypoglycemia, DKA, or hospitalization occurred during this period. Conclusion(s): Virtual care has a significant role in diabetes care in a pandemic situation and can be integrated into future consultation.

14.
Open Forum Infectious Diseases ; 8(SUPPL 1):S132-S133, 2021.
Article in English | EMBASE | ID: covidwho-1746752

ABSTRACT

Background. Seasonal influenza vaccination decreases individual and population-level morbidity and mortality, mitigates risk of acquiring influenza-like illness, and prevents healthcare system overburdening. Vaccination is important for people living with HIV (PLWH) who have increased risk for severe disease, hospitalization, and poor outcomes. Moreover, influenza vaccination has been associated with decreased COVID-19 mortality in older patients. Historical annual adult influenza vaccinations rates at the study site were 65%, exceeding local and national benchmarks. Amidst COVID-19, we recognized a need to increase influenza vaccination rates. Methods. A multifaceted, bundled quality improvement (QI) initiative aimed to achieve ≥ 80% influenza vaccination coverage for the 2020-21 season in PLWH ≥18 years of age at our Wilmington site (N=750). Stakeholders were identified, and a voluntary multidisciplinary team formed to lead the initiative (Fig. 1). Fishbone diagram outlined clear, rapidly implementable, and reproducible levers for change (Fig. 2). Physical and virtual space changes included: diverse clinical displays (visuals, patient materials), phone messaging, and virtual platform use. Staff education and updates were consistently provided by the team. Institutional Review Board exemption was received, and electronic medical record and CareWare data were extracted from 1 Oct 2020 through 31 March 2021. All external vaccinations were confirmed. Overall and eligible in-clinic vaccination rates were updated and displayed weekly. Results. 86% vaccination coverage was achieved (Fig. 3) with a median weekly in-clinic vaccination rate of 67% (Fig. 4). Conclusion. A QI project to improve 2020-21 influenza vaccination rates exceeded our goal in adult PLWH at an urban mid-Atlantic HIV clinic during the COVID-19 pandemic. A multidisciplinary approach that engaged stakeholders was vital to success. Rapid roll-out of changes was challenging, requiring flexibility and clear communication. Data collection was consistent, albeit imperfect, and needs enhancement. Elucidating the effects of each change and the COVID-19 pandemic on vaccination rates is not yet known. Lessons learned may be applicable to other ambulatory settings and will inform future vaccination efforts.

15.
Open Forum Infectious Diseases ; 8(SUPPL 1):S173-S174, 2021.
Article in English | EMBASE | ID: covidwho-1746737

ABSTRACT

Background. Communication among health care professionals during antimicrobial prescribing is critical to ensure appropriate use. This is of concern in Guatemala where physicians seldom consider guidance from other professionals during antimicrobial prescribing activities. Methods. We carried out a cross sectional questionnaire and open ended interviews with physicians from five hospitals in Guatemala to describe perceptions of communication between health care providers, and acceptance of antimicrobial guidance during prescribing. Results. From January to April 2021 an electronic questionnaire was sent to enrolled physicians of which 74% completed participation (n=107/145). Fifty-five percent participated in open ended interviews (n=79/145). Respondents perceived high levels of communication between physicians and ID specialists (94% of respondents);52%, and 54% perceived high levels of physician-pharmacist, and physician-nurse communication respectively. Significant differences in the perception of physician-pharmacist communication were detected when comparing responses between hospitals, and between respondent sex (chi2, p< 0.05). Barriers to communication between professionals included lack of local guidelines or protocols, patient overload, COVID-19 pandemic, lack of mentorship, and little room to discuss antimicrobial therapy with higher-ranking physicians. Eighty percent and 45% of physicians were open to receiving antibiotic optimization recommendations from other physicians, and pharmacists respectively. Notable barriers to accepting recommendations from pharmacists included lack of regular communication, lack of clinical experience, and concern about evidence based recommendations. Conclusion. Effective communication is perceived between physicians during antimicrobial prescribing activities. Marginal levels of communication and acceptance of prescribing recommendations have been detected between physicians and pharmacists. In this milieu, there is an opportunity to strengthen multidisciplinary teams to optimize antimicrobial use.

16.
Colorectal Disease ; 24(SUPPL 1):86-87, 2022.
Article in English | EMBASE | ID: covidwho-1745952

ABSTRACT

Purpose/Background: To investigate the effectiveness of a one-stop colorectal cancer (CRC) staging pathway using faecal immunochemical test (FIT) as stratification tool. Methods/Interventions: The OSCARS pathway, which uses FIT as a triage tool to identify 'high risk' patients, was formally introduced in March 2020 in our Hospital Trust. A major driving force for this was to deal with the increased pressures on diagnostic services resulting from the COVID-19 pandemic. 2 week wait colorectal cancer referrals deemed appropriate to proceed to diagnostic testing prior to a clinic review ('straight to test') who had a FIT > 100 μg Hb/g faeces were allocated to the OSCARS pathway. This involved a single hospital visit during which they would have an endoscopy, a staging CT or completion CT colonography if needed, and be assessed and counseled by a colorectal cancer surgeon. Notes of all patents referred with suspected colorectal cancer between 01/01/2020 and 16/03/2021 (prior to the introduction of the pathway) and 16/03/2021 and 31/07/2021 (post introduction of the pathway) were reviewed to evaluate outcomes of the pathway. Time from referral to investigations, histological diagnosis and discussion at multidisciplinary team (MDT) meeting was compared before and after the introduction of the OSCARS pathway. Results/Outcomes: There were a total of 748 patients referred with suspected colorectal cancer in the pre-OSCARS group and 1194 in the OSCARS group. of those who were referred with an increased FIT, 43 (8.0%) and 86 (7.9%) were diagnosed with colorectal cancer (CRC) respectively. CRC diagnoses established on a 'straight to test' pathway increased from 69.8% in pre-OSCARS to 86.0% in the OSCARS groups, likely due to better stratification to a 'straight to test' pathway through the use of FIT. Despite the COVID-19 pandemic coinciding with the introduction of the OSCARS pathway, time for 'referral to first investigation' and 'referral to endoscopy' were similar between the groups (13 vs 12 days, p = 0.511 and 13 vs 13, p = 0.988). All patients diagnosed with cancer in the OSCARS group had staging CT scan on the same day (as opposed to 4 days pre-OSCARS, p = 0.002) but the difference in time for 'endoscopy to MRI' (8 vs 5 days, p0.271) or 'endoscopy to histopathology (4 vs 5 days, p = 0.236) did not change significantly. Time for 'endoscopy to MDT' was significantly reduced from 14.5 to 9 days (p = 0.019). Conclusion/Discussion: Time from referral to diagnostic test on 'straight to test' pathway remained unchanged in our Trust despite COVID-19 pandemic as a result of stringent stratification using FIT. Time from 'endoscopy to MDT' was significantly reduced with introduction of the OSCARS pathway due to same day access to CT scanner. It is likely that this section of the 2ww pathway would further be reduced with improved access to MRI and histopathology reporting services. Although OSCARS pathway reduces the number of hospital visits, its effect on patients' experience needs to be formally assessed.

17.
Colorectal Disease ; 24(SUPPL 1):113, 2022.
Article in English | EMBASE | ID: covidwho-1745943

ABSTRACT

Purpose/Background: Pelvic exenteration (PE), or “beyond-TME” surgery has become an established treatment for locally-advanced, or recurrent colorectal cancer, with the aim of achieving a complete (R0) resection and improve survival. We have established a regional centre for the management of advanced colorectal cancer and pelvic sarcoma. Methods/Interventions: This was a retrospective, observational study using electronic health records (EHR). Patients were identified from a prospectively managed database and from multi-disciplinary team minutes. Data was gathered for 47 patients operated on by our Advanced Cancer service between November 2016 and March 2021 by four surgeons. EHR were searched for tumour and operation characteristics, complications, survival, oncological and recurrence data. During the COVID-19 pandemic, some patients had their operations at a separate, private hospital. Eligible patients were those that had pelvic exenteration (defined as removal of colon/rectum with additional organs such as bladder, prostate, vagina, sacrum, kidney), or large pelvic dissection for sarcoma. Results/Outcomes: 47 patients (23 male, 24 female) underwent operation, with a median age of 64 and ASA II. 33 (70%) patients presented with a primary tumour and 14 with a recurrent tumour. 37 (79%) had a locally advanced rectal or sigmoid cancer, 2 (4%) anal cancers, 2 gastro-intestinal stromal tumours and 6 (13%) pelvic sarcomas. One patient with recurrent rectal cancer had inoperable disease found at time of surgery so proceeded with only a palliative resection. Resection type is presented in Table 1. 43 patients had recorded status for margins, of which 33 (77%) had R0 resection and 10 (23%) R1. Mean operating time was 499 minutes (range 130-1020). Median time in critical care post-op was 2.5 days (IQR 1-6) and length of stay 13 days (IQR 13-20.5). 30-day Clavien-Dindo complications were: none (15, 32%), Grade I/II (17, 36%), Grade III (6, 13%), Grade IV (8, 17%). One patient operated on in the independent sector could not have inpatient records assessed. 10 patients had a return to theatre, the majority (5) for wound washout, 1 for each of the following indications: replacement of ureteric stent, ureteric reimplantation, revision of ischaemic colostomy, revision of flap, planned return for removal of haemostatic packs. There was no 90 day mortality. At a median of 25.6 months follow-up, 32 (68%) patients remain alive. In the 15 patients who have died, the mean time to death from procedure was 16.7 months. Recurrence was seen in 11 (23%) patients, of which 6 (13%) were distant, 3 (6%) local and 2 (4%) both. Conclusion/Discussion: This data shows that it is possible to set up a new advanced cancer unit and achieve outcomes, in terms of mortality, margin status and recurrence that are comparable with those previously published by other centres during their set-up phase. (Table Presented).

18.
Journal of the Hong Kong College of Cardiology ; 28(2):91, 2020.
Article in English | EMBASE | ID: covidwho-1743905

ABSTRACT

Objectives: Cardiovascular disease (CVD) is the leading noncommunicable cause of mortality and morbidity globally. In-person education and awareness programs conducted as part of the CVD prevention efforts have either come to a standstill or have been replaced by web-based programs in the COVID-19 era. This study describes the design and execution of web-based programs to improve awareness and educate cardiac patients during the pandemic. Methods: All web-based education/awareness sessions conducted since the start of the government-enforced lockdown in India till date (23 March-10 September 2020) were included. A multidisciplinary team consisting of Physician, Physiotherapist and Dietician worked completely online to maintain continuity of service to previously enrolled patients and to develop comprehensive web-based programs for newly enrolling patients. Patient education sessions were incorporated into the homebased CVD prevention/rehabilitation programs, which also consisted of supervised exercise sessions. Web-based awareness programs about CVD prevention strategies during the pandemic were provided to corporate employees, paying special attention to the psychosocial challenges of working from home, and to the general public. Google Meet or Zoom was used for the audiovisual presentation followed by discussion. Results: Our team provided 28 web-based education sessions and 6 awareness webinars for a total of 185 individuals during this period. The topics covered are provided in the Table. The enrolees and their family members actively participated in the sessions and interacted during the discussion. The feedback was that the communication was clear and that the online sessions were effective. The only barrier was the occasional technical snag or connectivity issue, which hindered the continuity of the session briefly. Conclusion: There has been a huge sea change in the way healthcare has been delivered during the COVID-19 pandemic and CVD prevention services are no exception. Web-based programs with online sessions replacing inperson sessions are proving to be effective in patient education and awareness creation and might be the way forward even after the pandemic in resourcelimited settings like India.

19.
Journal of the Hong Kong College of Cardiology ; 28(2):90, 2020.
Article in English | EMBASE | ID: covidwho-1743904

ABSTRACT

Objectives: Home-based cardiac rehabilitation (HBCR) and prevention programs (HBPP) which occupied a small proportion of the overall Preventive Cardiology work in the past have become mainstream during the COVID-19 pandemic. This study aims to analyse the design and delivery of HBCR/HBPP pre and during the pandemic to address evolving patient needs. Methods: All patients who had undergone HBCR/HBPP at our Preventive Cardiology centre in Chennai, India till 22 March 2020 (pre-pandemic enrolees) and from 23 March-10 September 2020 (during-pandemic enrolees) were included. Hybrid programs had some in-person and some online/phone sessions;completely home-based programs had only online/phone sessions. Intake evaluation consisted of physician consultation, review of medical records, health-related lifestyle questionnaire, quality of life questionnaire, 24-hour diet recall and body mass index and functional capacity (FC) assessment. The sixminute walk test (6MWT) or the 2-minute step test (2MST) was used for FC assessment. A multidisciplinary team consisting of Physician, Physiotherapist and Dietician provided 1-2 sessions per week for 3-6 months. HBCR was offered to low/medium risk patients. Results: Of the 29 subjects (57±13 years, 69% male), 16 (55%) were prepandemic enrolees and 13 (45%) during-pandemic enrolees. Completely homebased programs were provided to 4 (25%) of the pre-pandemic enrolees and to 13 (100%) of the during-pandemic enrolees (p=0.0002). Almost all pre-pandemic enrolees resided outside Chennai and travelled by air/train/road for in-person sessions in the hybrid program;an elderly woman residing in Chennai preferred the hybrid program, as she needed a caregiver to accompany her. Majority of pre-pandemic home-based sessions were phone calls whereas majority of during-pandemic sessions were online video sessions with supervised exercise and/or audiovisual presentation. FC was assessed using 6MWT in 17 (59%) and 2MST in 9 (31%) subjects;FC was not assessed in 3 pre-pandemic enrolees. No adverse events were reported. Conclusion: Multidisciplinary HBCR/HBPP is an effective and safer alternative to traditional programs. There is potential to expand these services post-pandemic to all patients irrespective of place of residence and risk profile.

20.
Irish Journal of Occupational Therapy ; 2022.
Article in English | Scopus | ID: covidwho-1741094

ABSTRACT

Purpose: There is a high prevalence of trauma among mental health clients, with risk of re-traumatisation when admitted to a Department of Psychiatry (DoP) (Kimberg and Wheeler, 2019). The COVID-19 pandemic poses challenges to therapy service operations in DoPs, with infection control measures impacting opportunities for therapeutic and social engagement. A trauma-informed care (TIC) lens was used when adapting services in Tallaght University Hospital DoP in response to COVID-19. Design/methodology/approach: An interdisciplinary approach was taken to adapt therapy services during early stages of the pandemic. Changes were informed by TIC principles to minimise re-traumatisation while maintaining high-quality services. Changes included expansion of the therapeutic activity programme, changes to groups, addition of COVID-19-specific groups and increased awareness of communication support needs. Findings: The early response to the pandemic, combined with the focus on TIC, resulted in continued, effective therapy services and positive client feedback. With clients’ involvement in their care enhanced, Individual Care Planning goals were achieved through group interventions. Originality/value: The COVID-19 pandemic brought unprecedented changes to mental health services. This paper highlights a response to unique challenges brought by COVID-19 on a DoP. © 2022, Laura Carroll, Hannah Casey, Rory Adams, Stephanie O’Connor and Áine O’Reilly.

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