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1.
SARS-CoV-2 en una clínica privada de hematología y medicina interna. ; 64(5):464-470, 2022.
Article in English | Academic Search Complete | ID: covidwho-2026163

ABSTRACT

Objective. Determine the proportion of vaccinated patients in a private hematology and internal medicine outpatient clinic and potential factors in adherence in at-risk patients (due to onco-hematological diseases). Materials and methods. This is a cross-sectional study of outpatients from a private clinic. We applied a non-validated instrument to all patients attending the outpatient clinic from May to October 2021. According to the primary diagnosis, we classified patients into onco-hematological and non-onco-hematological patients. Since national authorities exclusively executed and planned the rollout of vaccines, the order and eligibility defined by authorities of vaccination was considered when conducting the analysis and patients were classified according to the their corresponding group. Results. 397 participants were accrued, 269 (68%) had an onco-hematological condition. In the whole group, 73 (18.3%) had a history of infection. Vaccination history was present in 286 persons (72%);82% had two doses. In the subset of 269 persons with an oncohematological condition, 191 (71%) were vaccinated, whereas 95 participants with non-hematological conditions (73%) had received the vaccine. Vaccination status was associated with age (OR 1.07, 95%CI: 1.03,1.10, p<0.0001) and body mass index (OR 1.11, 95%CI: 1.04,1.17, p<0.0001). Conclusions. According to our study, vaccination adherence at our center is significantly different from the nationwide proportion of vaccines. (English) [ FROM AUTHOR] Objetivo. Determinar la proporción de pacientes vacunados en una clínica de hematología y medicina interna y los factores potenciales involucrados en la adherencia. Material y métodos. Estudio transversal en pacientes ambulatorios de una clínica privada. Se aplicó un instrumento no validado a todos los pacientes que acudieron a consulta externa de la clínica de mayo a octubre de 2021. De acuerdo con el diagnóstico primario, los pacientes se clasificaron como onco-hematológicos y no onco-hematológicos. Debido a que las autoridades nacionales ejecutaron y planearon exclusivamente la designación de vacunas, el orden y la selección de las mismas fue considerado al momento del análisis y clasificación de los pacientes de acuerdo con su grupo correspondiente. Resultados. Se reclutaron 397 participantes, 269 (68%) tenían una enfermedad oncohematológica y 73 (18.3%) tenían antecedente de infección. El antecedente de vacunación estuvo presente en 286 personas (72%), de ellas, 82% recibió dos dosis. En el grupo de pacientes con enfermedad oncohematológica, 191 (71%) habían sido vacunados, mientras que 95 participantes con otras afecciones (73%) habían recibido la vacuna. La vacunación se asoció con la edad (OR 1.07, IC95%: 1.03,1.10, p<0.0001) y el índice de masa corporal (OR 1.11, IC95%: 1.04,1.17, p<0.0001). Conclusiones. La adherencia a la vacuna en nuestro centro es significativamente diferente a la proporción de vacunación reportada por fuentes públicas. (Spanish) [ FROM AUTHOR] Copyright of Salud Pública de México is the property of Instituto Nacional de Salud Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

2.
Missouri Medicine ; 119(1):26-27, 2022.
Article in English | MEDLINE | ID: covidwho-2012376
3.
Klinik Psikiyatri Dergisi: The Journal of Clinical Psychiatry ; 25(2):202-208, 2022.
Article in Turkish | APA PsycInfo | ID: covidwho-2011429

ABSTRACT

Objective: The aim of this study is to determine the sociodemographic characteristics and psychiatric diagnoses of children and adolescents who refered to the psychiatry outpatient clinic during the COVID-19 pandemic. Method: This study enrolled the patients who were presented to the Child and Adolescent Psychiatry outpatient clinic between September 2019 and March 2020 and between September 2020 and March 2021. The patients were scanned retrospectively with the Nucleus outpatient clinic system. The data were analyzed with SSPS 21.0. Age, gender and psychiatric diagnosis of patients Results: were examined. This study enrolled 1157 patients with 10.8 mean age and 61.5% male participants. 53% (n = 622) of patients was diagnosed before pandemia and 46.2% (n = 535) of patients was diagnosed during pandemia. Before pandemia: patients were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) 40%, Anxiety Disorder (AD) 16.1%, Autism Spectrum Disorder (ASD) 5.1%. During pandemia: patients were diagnosed with ADHD 27.3%, AD 19.3%, ASD 5.6%. During the pandemia the number of female patients increased (p = 0.017), mean age of patients decreased (p = 0.035), the diagnosed ADHD rates decreased (p < 0.001) and the diagnosed AD (p = 0.024), Major Depressive Disorder (MDD) (p=0.001) rates increased. Conclusion: In our study the diagnosis of AD and MDD during pandemia increased and the diagnosis of ADHD decreased. Because of the online education during pandemia, number of ADHD patients decreased and increasing in diagnosis of AD and MDD might caused by phsycial and social limitations. In this period it is important to follow and treat the patients that already have psychiatric disorder like ADHD. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Turkish) Amac: Cin'de baslayan ve tum dunyayi etkileyen COVID-19 salgini global bir saglik krizine donusmustur. Bu calismanin amaci, COVID-19 pandemisi sirasinda psikiyatri poliklinigine basvuran cocuk ve ergenlerin sosyodemografik ozelliklerini ve psikiyatrik tanilarini belirlemektir. Yontem: AFSU cocuk psikiyatri poliklinigine Eylul 2019-Mart 2020 ve Eylul 2020-Mart 2021 tarihleri arasinda basvuran hastalar calismaya dahil edilmistir. Hastalar retrospektif olarak Nucleus poliklinik sistemi ile taranmistir. Veriler SSPS 21.0 ile analiz edilmistir. Vakalarin yas, cinsiyet ve psikiyatrik tanilari incelenmistir. Bulgular: Calismaya 1157 hasta dahil edilmistir. Hastalarin yas ortalamasi 10,8 yil ve %61,5'i erkek cinsiyetteydi. Hastalarin %53,8'i (n = 622) pandemi oncesinde, %46,2'si (n = 535) pandemi sonrasinda basvuru yapmistir. Pandemi sonrasi donemde, pandemi oncesi doneme gore basvurular kiz cinsiyet yonunde artmistir (p = 0,017) ve basvuranlarin yas ortalamasi azalmistir (p = 0,035). Pandemi oncesinde basvuranlarin %40,0'i Dikkat Eksikligi ve Hiperaktivite Bozuklugu (DEHB), %16,1'i Anksiyete Bozuklugu (AB), %5,1'i Otizm Spektrum Bozuklugu (OSB) ana tanisi alirken, pandemi sonrasi basvuranlarin %27,3'u DEHB, %19,3'u AB, %5,6'si OSB ana tanisi almistir. Pandemi sonrasinda pandemi oncesine gore DEHB tanisi alma sikligi azalmistir (p < 0,001), AB (p = 0,024) ve Major Depresif Bozukluk (MDB) (p = 0,001) tanilarinda artis gorulmustur. Sonuc: Calismamizda pandemi sonrasi AB ve MDB tanilarinin artis gosterdigi, DEHB tanisinin ise azaldigi gorulmustur. Pandemi sirasinda uzaktan egitim surecine gecilmesi, DEHB belirtileri nedeniyle yapilan basvurulari azaltirken ortaya cikan fiziksel ve sosyal kisitliliklar AB ve MDB tanilarini arttirmis olabilir. Bu donemde DEHB gibi mevcut psikiyatrik bozuklugu olan hastalarin takiplerinin ve tedavilerinin aksatilmamasi uzun donemde gidisat icin onem arz etmektedir. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

4.
Clinical Microbiology and Infection ; 2022.
Article in English | ScienceDirect | ID: covidwho-1996084

ABSTRACT

Objectives The potential benefit of convalescent plasma (CP) therapy for COVID-19 is highest when given early after symptom onset. Our objective was to determine the effectiveness of CP in improving the disease course of COVID-19 in high-risk outpatients. Methods A multicentre double blind randomized trial was conducted comparing 300mL of CP with non-CP. Patients were 50 years or older, symptomatic for <8 days, had PCR or antigen-test confirmed COVID-19 and at least 1 risk factor for severe COVID-19. The primary endpoint was the highest score on a 5-point ordinal scale ranging from fully recovered (score=1) or not (2) on day 7, over hospital admission (3), ICU admission (4) and death (5) in the 28 days following randomization. Secondary endpoints were hospital admission, symptom duration and viral RNA excretion. Results After enrolment of 421 patients and the transfusion of 416, recruitment was discontinued when the countrywide vaccination uptake in those aged >50 years was 80%. Patients had a median age of 60, symptoms for 5 days and 207 of 416 received CP. During the 28 days of follow-up, 28 patients were hospitalized and 2 died. The odds ratio (OR) for an improved disease severity score with CP was 0.86 (95%credible interval 0.59-1.22). The OR was 0.58 (95%confidence interval 0.33–1.02) for patients with ≤5 days of symptoms. The hazard ratio for hospital admission was 0.61 (95%confidence interval 0.28-1.34). No difference was found in viral RNA excretion nor in the duration of symptoms. Conclusions In patients with early COVID-19, CP did not improve the 5-point disease severity score. Clinical registry number NCT04589949.

5.
Journal of Imab ; 28(3):4461-4464, 2022.
Article in English | Web of Science | ID: covidwho-1979550

ABSTRACT

Purpose: to analyze the epidemiological and clinical parameters of asthmatic patients with COVID-19 infection. Materials and methods: a retrospective study was performed including data from an outpatient pulmonary practice in Pleven, Bulgaria, for the period 01.04. 2020 - 31.12. 2021. Sixty-five asthmatics were included and divided into two groups, referred to hospital due to COVID-19 infection (A) and outpatients (B), and their epidemiological and clinical data were compared. Results: 65 patients were analyzed, 46 (71%) women and 19 (29%) men. Forty-four patients were confirmed with PCR and/or antigen test, and in 21, the diagnosis was based on clinical and X-ray data. Group A included 18 patients. It was found that patients over 65 years were significantly more in group A (44.4% vs 18.8%, p<0.05). There were significant differences between the groups concerning ischemic heart disease (9%/ 3%, p=0.001), arterial hypertension (10.6%/7.6%, p=0.007), heart failure (3%/0%, p=0.01), diabetes, but not in allergic rhinitis. We did not find a distinction regarding sex, adherence to inhalation therapy and usage of systemic corticosteroids (p>0.05). None of the patients had an exacerbation during the treatment in the hospital and within a month after the hospital discharge. Conclusion: According to the analyses of the study, COVID-19 infection is not a risk factor for asthma exacerbations. The leading causes for the severity of the coronavirus infection in asthmatics are the age and some concomitant diseases.

6.
PeerJ ; 10: e13762, 2022.
Article in English | MEDLINE | ID: covidwho-1975335

ABSTRACT

Background: Clinical characteristics, including laboratory parameters, of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant have been limited. Methods: This retrospective case-control study was conducted in a single hospital. Patients with coronavirus disease 2019 (COVID-19) who visited the Asahikawa City Hospital outpatient department as new patients and underwent blood tests were included in this study. We analyzed the data from January 2022 to April 2022 during the Omicron phase and from April 2021 to October 2021 during the Delta phase. Patients who were treated at other hospitals after visiting our hospital were excluded. All blood tests were performed before treatment for COVID-19 was initiated. Demographic information, laboratory data, and clinical courses were extracted from electronic medical records. We matched the two groups by age and comorbidities and compared their characteristics. We also analyzed factors associated with pneumonia in the Omicron phase. Results: A total of 151 Omicron patients and 167 delta patients were analyzed in this study. The mean age, rate of comorbidities, and vaccination were significantly higher in the Omicron group. The number of patients with pneumonia or those requiring oxygen, admissions, or both was significantly lower in the Omicron group. Lactate dehydrogenase (LDH), C-reactive protein (CRP), ferritin, aspartate aminotransferase (AST), and neutrophil-to-lymphocyte ratio (NLR) levels were significantly lower in the Omicron group. Compared with the mild symptom and pneumonia groups in the Omicron group, older age, higher body mass index (BMI), higher non-vaccination, higher LDH, and higher CRP levels were associated with the pneumonia group. Conclusion: The Omicron variant is associated with a reduction in hospitalization and the risk of pneumonia compared to the delta variant in a real-life clinical setting. In the Omicron variant, the risk of pneumonia is related to high-risk factors, laboratory data such as LDH and CRP levels, and no vaccination.

7.
J Am Board Fam Med ; 35(4): 686-694, 2022.
Article in English | MEDLINE | ID: covidwho-1963336

ABSTRACT

INTRODUCTION: The COVID-19 global pandemic has affected all ethnic and minority groups although not equally. The goals of the present study are twofold: describe the diverse COVID-19-related care needs Hispanic patients presenting to a primary care facility and the symptom clusters and socioeconomic factors that may impact their wellbeing. METHODS: This is a retrospective cohort of Hispanic patients in an outpatient clinic serving an urban lower socioeconomic demographic, between May 9 and July 31, 2020. COVID-19 infection was confirmed by polymerase chain reaction or rapid antibody test. Student's t-test was used for means and the chi2 was used for comparisons of proportions. RESULTS: A total of 6616 patients visited Alivio, 409 were triaged to a containment area, and 378 were tested for COVID-19; 230 with, 148 without symptoms. Of those tested, 161(42.6%) were positive, representing 2.4% of total patients seen. Age, temperature, and pulse rate were all significantly higher in patients with symptoms compared with those without. Symptoms were grouped into 5 clusters: constitutional, n = 143(62%), respiratory, n = 136 (59%), and somatic, n = 97(42%) were most common. No single cluster was particularly diagnostic of COVID-19, although those with symptoms in multiple clusters were more likely to test positive, P < .001. The majority worked in essential jobs, were uninsured, and had more than half had prolonged symptoms. CONCLUSIONS: Hispanic patients have diverse reasons for seeking health care and for testing in a pandemic. COVID-19 is a syndromic disease as evidenced from the clustering of symptoms. Essential workers and uninsured health status may lead to more prolonged disease course.


Subject(s)
COVID-19 , COVID-19/epidemiology , Hispanic or Latino , Humans , Pandemics , Primary Health Care , Retrospective Studies , SARS-CoV-2
8.
Front Immunol ; 13: 902140, 2022.
Article in English | MEDLINE | ID: covidwho-1963475

ABSTRACT

Background: Information on the clinical characteristics and pathophysiological mechanisms underlying post-COVID-19 fatigue are scarce. The main objective of this study was to evaluate sex-specific humoral and T-cell responses associated with post-COVID-19 fatigue in a sample of individuals treated as outpatients. Methods: At a median time of 279 (179;325) days after the acute infection, a total of 281 individuals (45.9% men) aged 18-87 years old were included in the analysis. The participants were examined at the University Hospital of Augsburg, Southern Germany. Fatigue was assessed using the Fatigue Assessment Scale (FAS). Levels of anti-SARS-CoV2-spike IgG antibodies were measured by an enzyme-linked immunosorbent assay (ELISA), and for exploration of the SARS-CoV2-specific T-cell response, ex vivo ELISpot/FLUOROspot assays were conducted using an interferon-γ (IFN-γ) and interleukin-2 (IL-2) SARS-CoV-iSpot kit. Results: Women more significantly suffered from post-COVID-19 fatigue in comparison to men (47.4% versus 25.6%, p=0.0002). Females but not males with fatigue showed a significantly lower number of T-cells producing IFN-γ, IL-2 or both IL-2 and IFNγ in comparison with females without fatigue. In both sexes, serum levels of anti-SARS-CoV2-spike IgG antibodies did not differ significantly between participants with or without fatigue. Conclusions: Development of fatigue after acute COVID-19 disease might be associated with SARS-CoV-2-specific T-cell responses in women, but not men after a mild infection course treated outpatient.


Subject(s)
COVID-19 , SARS-CoV-2 , Adolescent , Adult , Aged , Aged, 80 and over , Antibodies, Viral , Fatigue/etiology , Female , Humans , Immunoglobulin G , Interleukin-2 , Male , Middle Aged , Outpatients , RNA, Viral , T-Lymphocytes , Young Adult
9.
BMC Prim Care ; 23(1): 151, 2022 06 13.
Article in English | MEDLINE | ID: covidwho-1951066

ABSTRACT

BACKGROUND: Our goals are to quantify the impact on acute care utilization of a specialized COVID-19 clinic with an integrated remote patient monitoring program in an academic medical center and further examine these data with stakeholder perceptions of clinic effectiveness and acceptability. METHODS: A retrospective cohort was drawn from enrolled and unenrolled ambulatory patients who tested positive in May through September 2020 matched on age, presence of comorbidities and other factors. Qualitative semi-structured interviews with patients, frontline clinician, and administrators were analyzed in an inductive-deductive approach to identify key themes. RESULTS: Enrolled patients were more likely to be hospitalized than unenrolled patients (N = 11/137 in enrolled vs 2/126 unenrolled, p = .02), reflecting a higher admittance rate following emergency department (ED) events among the enrolled vs unenrolled, though this was not a significant difference (46% vs 25%, respectively, p = .32). Thirty-eight qualitative interviews conducted June to October 2020 revealed broad stakeholder belief in the clinic's support of appropriate care escalation. Contrary to beliefs the clinic reduced inappropriate care utilization, no difference was seen between enrolled and unenrolled patients who presented to the ED and were not admitted (N = 10/137 in enrolled vs 8/126 unenrolled, p = .76). Administrators and providers described the clinic's integral role in allowing health services to resume in other areas of the health system following an initial lockdown. CONCLUSIONS: Acute care utilization and multi-stakeholder interviews suggest heightened outpatient observation through a specialized COVID-19 clinic and remote patient monitoring program may have contributed to an increase in appropriate acute care utilization. The clinic's role securing safe reopening of health services systemwide was endorsed as a primary, if unmeasured, benefit.


Subject(s)
COVID-19 , Ambulatory Care Facilities , COVID-19/epidemiology , Communicable Disease Control , Humans , Monitoring, Physiologic/methods , Retrospective Studies
10.
Palliat Support Care ; : 1-8, 2022 Jul 12.
Article in English | MEDLINE | ID: covidwho-1931278

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has widened the funded use of telehealth in Australia to support telehealth delivery to all patients in any setting. Increasing the use and experience of telehealth brings to light unique insights into the advantages and challenges of this new model of healthcare delivery This study aimed to qualitatively explore the experiences of both palliative care physicians and patients setting, including their views on its future role in healthcare. METHODS: This qualitative study was conducted across three metropolitan tertiary palliative care centers in Victoria, Australia between November 2020 and March 2021. Purposive sampling identified 23 participants (12 physicians and 11 patients). Semi-structured interviews focused on the last telehealth consultation, thoughts and impressions of telehealth, and the possibility of telehealth remaining in palliative care. A thematic approach was adopted to code and analyze the data. RESULTS: Telehealth transformed the ways physicians and patients in this study perceived and engaged with outpatient palliative care across the entire continuum of care. Four key themes were identified: (1) access to care; (2) delivery of care; (3) engagement with care; and (4) the future. SIGNIFICANCE OF RESULTS: This study provides novel data bringing together the perspective of patients and physicians, which confirms the utility of telehealth in palliative care. Its convenience enables more frequent review, enables reviews to occur in response to lower levels of concern, and adds toward enhancing the continuity of care across and between settings. Moving forward, support seemed strongest for a hybrid model of telehealth and face-to-face consultations guided by key parameters relating to the level of anticipated complexity.

11.
Br J Clin Pharmacol ; 2022 Jul 13.
Article in English | MEDLINE | ID: covidwho-1927560
12.
Anadolu Psikiyatri Dergisi ; 22(4):185-193, 2021.
Article in English | APA PsycInfo | ID: covidwho-1919039

ABSTRACT

[Correction Notice: An Erratum for this article was reported in Vol 23(1) of Anadolu Psikiyatri Dergisi (see record 2022-72055-007). In the original article, the second affiliation lacks information;therefore the information of ''Islamic Science University of Malaysia (USIM)'' has been added in parenthesis. The article has been updated in the journal's archive. You may access the updated article via the link below.] Objective: Long-term social distancing, isolation, and economic fallout may be significant psychological triggers during pandemic, such as COVID-19, especially for those with underlying psychiatric illness. This study was conducted to address the psychological impact of COVID-19 pandemic among patients with depression based at a teaching hospital in Malaysia. Methods: This is a cross-sectional online study among patients with depression from University Malaya Medical Centre, using Generalized Anxiety Disorder-7 (GAD-7), Montgomery-Asberg Depression Rating Scale-Self Assessment (MADRS-S), Insomnia Severity Index (ISI), Multidimensional Scale of Perceived Social Support (MSPSS), Knowledge, Attitudes, and Practices (KAP), and Social Media Addiction during COVID-19 Pandemic (SMACOP). Results: One hundred seventy-eight patients participated in this study. The mean total of the KAP score is 12.65 (SD = 2.65), with knowledge section (mean = 7.34 [SD = 2.13]), attitudes section (mean = 2.63 [SD = 0.58]), and practices section (mean = 2.69 [SD = 1.00]). They scored moderately on the MADRS-S (mean = 21.03 [SD = 4.62]) and ISI (mean = 20.25 [SD = 4.62]) but had high GAD-7 scores (mean = 16.8 (SD = 6.27]). From the multiple logistic regression analyses, depressive symptoms of greater severity (MADRS-S 18-34) are significantly associated with more severe insomnia (P < .001, adjusted OR = 9.101, 95% CI: 3.613-22.924). Furthermore, the high anxiety level is associated with the younger age group (P = .029, Adjusted OR = 2.274, 95% CI: 1.090-4.746), greater severity of insomnia (P < .001, Adjusted OR = 22.9, 95% CI: 6.145-85.343), and higher risk of COVID-19 related social media addiction (P = .011, adjusted OR = 2.637, 95% CI: 1.253-5.550). Conclusion: This study demonstrates the high levels of sleep disturbances and anxiety symptoms experienced by outpatients with depression during the COVID-19 pandemic. These are closely linked to the younger age group and at-risk social media addiction related to COVID-19. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

13.
Ann R Coll Surg Engl ; 103(8): 599-603, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1910438

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has demanded radical changes in service delivery. Our centre adopted the use of outpatient telemedicine to reduce close-contact interactions between patients and staff. We hypothesised that incidental gains may be associated with this. We evaluated financial, practical and environmental implications of substituting virtual clinics (VCs) for in-person urology outpatient appointments. METHODS: VCs were studied over a 3-month period. Based on patient-reported 'usual mode of transport' to the hospital, travel distance, time, petrol and parking costs, and the carbon emissions avoided by virtue of remote consultations were calculated. The underlying symptom/diagnosis and the 'effectiveness' of the VC were evaluated. RESULTS: Of 1,016 scheduled consultations, 736 (72.44%) were conducted by VCs over the study period. VCs resulted in an agreed treatment plan in 98.4% of a representative patient sample. The use of VCs was associated with an overall travel distance saving for patients of 31,038 miles (49,951km) over 3 months, with an average round-trip journey of 93.8 miles (151km) avoided for each rural-dwelling patient and an average financial saving of £25.91 (€28.70) per rural-dwelling car traveller. An estimated 1,257.8 hours of patient time were saved by avoidance of travel and clinic waiting times. Based on car-travelling patients alone, a 6.07-tonne reduction in carbon emissions was achieved with the use of VCs. CONCLUSIONS: In appropriate clinical circumstances, VCs appear to provide efficiency across a number of domains. Future healthcare may involve offering outpatients the option of telemedicine as an alternative to physical attendance.


Subject(s)
Cost Savings , Remote Consultation , Travel , Vehicle Emissions , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , Female , Humans , Male , Middle Aged , United Kingdom , Urology , Young Adult
14.
J Telemed Telecare ; : 1357633X221103828, 2022 Jun 23.
Article in English | MEDLINE | ID: covidwho-1909969

ABSTRACT

INTRODUCTION: As a result of the coronavirus pandemic, outpatient consultations in National Health Service Lanarkshire were conducted using various forms of teleconsultation. A qualitative study was undertaken to ascertain how senior medical students valued the experience of outpatient teleconsultations in comparison to face-to-face consultations during the pandemic. METHODS: Anonymised, voluntary surveys were emailed to all medical students who attended clinical placements in specialties utilising teleconsultations. Participants were asked to compare their experience of and perceived value of virtual consultants to face-to-face consultations. Thematic and statistical analysis was performed on the collected data. RESULTS: Participants unanimously agreed face-to-face consultations enabled learning, with 71.4% (n = 7) having similar experiences in video consultations if a senior was physically present beside them. Video consultation, when the senior clinician was also present virtually, was deemed useful to a lesser extent (66.7%, n = 6). Only half (57.1%, n = 14) valued the learning from telephone consultations. Qualitative analysis revealed that although face to face was the preferred consultation style, there was useful learning gained in all modalities. Students appreciated discussion with senior clinicians to facilitate learning and valued involvement in the consultation through history taking, especially in teleconsultations. DISCUSSION: Teleconsultation was an effective learning tool for medical students during the coronavirus pandemic, which preserved student exposure to patients during lockdown. This study is optimistic that widespread incorporation of teleconsultation, in all modality, has the ability to support students' clinical exposure and learning, which is becoming increasingly limited as medical student numbers continue to rise and with the ongoing effects of the pandemic.

15.
BMJ Open Qual ; 11(2)2022 06.
Article in English | MEDLINE | ID: covidwho-1902025

ABSTRACT

BACKGROUND: Distancing measures enforced by the COVID-19 pandemic impose a restriction on the number of patients simultaneously present in hospital waiting areas. OBJECTIVE: Evaluate waiting area occupancy of an intervention that designs clinic blueprint schedules, in which all appointments of the pre-COVID-19 case mix are scheduled either digitally or in person under COVID-19 distancing measures, whereby the number of in-person appointments is maximised. METHODS: Preintervention analysis and prospective assessment of intervention outcomes were used to evaluate the outcomes on waiting area occupancy and number of in-person consultations (postintervention only) using descriptive statistics, for two settings in the Rheumatology Clinic of Sint Maartenskliniek (SMK) and Medical Oncology & Haematology Outpatient Clinic of University Medical Center Utrecht (UMCU). Retrospective data from October 2019 to February 2020 were used to evaluate the pre-COVID-19 blueprint schedules. An iterative optimisation and simulation approach was followed, based on integer linear programming and Monte Carlo simulation, which iteratively optimised and evaluated blueprint schedules until the 95% CI of the number of patients in the waiting area did not exceed available capacity. RESULTS: Under pre-COVID-19 blueprint schedules, waiting areas would be overcrowded by up to 22 (SMK) and 11 (UMCU) patients, given the COVID-19 distancing measures. The postintervention blueprint scheduled all appointments without overcrowding the waiting areas, of which 88% and 87% were in person and 12% and 13% were digitally (SMK and UMCU, respectively). CONCLUSIONS: The intervention was effective in two case studies with different waiting area characteristics and a varying number of interdependent patient trajectory stages. The intervention is generically applicable to a wide range of healthcare services that schedule a (series of) appointment(s) for their patients. Care providers can use the intervention to evaluate overcrowding of waiting area(s) and design optimal blueprint schedules to continue a maximum number of in-person appointments under pandemic distancing measures.


Subject(s)
COVID-19 , Ambulatory Care Facilities , COVID-19/prevention & control , Humans , Pandemics/prevention & control , Prospective Studies , Retrospective Studies
16.
Age and Ageing ; 51, 2022.
Article in English | ProQuest Central | ID: covidwho-1901102

ABSTRACT

Introduction Hand grip strength is a useful measure of muscle function. Many hand dynamometers that are less costly than the gold standard Jamar dynamometer are available but their use in clinical outpatient setting has yet to be validated. This study aimed to determine the inter-instrument reliability between Camry electronic and Jamar hydraulic dynamometers. Method A cross-sectional study was conducted on patients aged ≥65 years during their post COVID-19 follow up clinic visit. Hand grip strength was assessed using both Jamar and Camry dynamometers following standard protocol while information on participants’ demographics, health and COVID-19 hospitalizations were collected from hospital electronic medical records. Reliability between both devices was determined using intraclass correlation coefficient (ICC) and devices were compared based on subcategories of participants’ demographics and clinical characteristics. Results Ninety-three participants (mean age: 73 ± 6 years, 52.7% males) were recruited in this study. Average grip strength recorded with Jamar dynamometer (18.1 ± 7.4 kg) was higher than Camry dynamometer (19.5 ± 6.6 kg). Sub categorical comparison depicted no significant discrepancy between the devices discovered among male participants (p = 0.262), Malay participants (p = 0.243) and participants aged >70 years (p = 0.090). According to the diagnostic cut-off recommended by Asian Working Group for Sarcopenia (AWGS) 2019, similar number of participants had low grip strength using Jamar (n = 69, 74.2%) and Camry (n = 68, 73.2%) dynamometers. The odds of Camry detecting low grip strength was 0.946 times (95% CI: 0.493–1.817) as compared to Jamar dynamometer. Readings measured using both dynamometers were highly correlated to each other (r = 0.88) with ICC of 0.92, indicating an excellent inter-instrument reliability. Conclusion Comparable measures between Jamar and Camry hand dynamometers support the interchangeable use of the devices among older population. Hence, the alternative use of Camry dynamometer is appropriate for the outpatient setting.

17.
Eur J Clin Microbiol Infect Dis ; 41(7): 1065-1076, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1899202

ABSTRACT

This study aimed to compare the clinical progression of COVID-19 in high-risk outpatients treated with the monoclonal antibodies (mAb) bamlanivimab, bamlanivimab-etesevimab and casirivimab-imdevimab. This is an observational, multi-centre, prospective study conducted from 18 March to 15 July 2021 in eight Italian tertiary-care hospitals including mild-to-moderate COVID-19 outpatients receiving bamlanivimab (700 mg), bamlanivimab-etesevimab (700-1400 mg) or casirivimab-imdevimab (1200-1200 mg). All patients were at high risk of COVID-19 progression according to Italian Medicines Agency definitions. In a patient subgroup, SARS-CoV-2 variant and anti-SARS-CoV-2 serology were analysed at baseline. Factors associated with 28-day all-cause hospitalisation were identified using multivariable multilevel logistic regression (MMLR) and summarised with adjusted odds ratio (aOR) and 95% confidence interval (CI). A total of 635 outpatients received mAb: 161 (25.4%) bamlanivimab, 396 (62.4%) bamlanivimab-etesevimab and 78 (12.2%) casirivimab-imdevimab. Ninety-five (15%) patients received full or partial SARS-CoV-2 vaccination. The B.1.1.7 (Alpha) variant was detected in 99% of patients. Baseline serology showed no significant differences among the three mAb regimen groups. Twenty-eight-day all-cause hospitalisation was 11.3%, with a significantly higher proportion (p 0.001) in the bamlanivimab group (18.6%), compared to the bamlanivimab-etesevimab (10.1%) and casirivimab-imdevimab (2.6%) groups. On MMLR, aORs for 28-day all-cause hospitalisation were significantly lower in patients receiving bamlanivimab-etesevimab (aOR 0.51, 95% CI 0.30-0.88 p 0.015) and casirivimab-imdevimab (aOR 0.14, 95% CI 0.03-0.61, p 0.009) compared to those receiving bamlanivimab. No patients with a history of vaccination were hospitalised. The study suggests differences in clinical outcomes among the first available mAb regimens for treating high-risk COVID-19 outpatients. Randomised trials are needed to compare efficacy of mAb combination regimens in high-risk populations and according to circulating variants.


Subject(s)
COVID-19 , SARS-CoV-2 , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , Antibodies, Neutralizing , COVID-19/drug therapy , COVID-19 Vaccines , Disease Progression , Humans , Prospective Studies , Treatment Outcome
18.
Actas Dermosifiliogr ; 113(5): 467-480, 2022 May.
Article in English, Spanish | MEDLINE | ID: covidwho-1889150

ABSTRACT

BACKGROUND AND OBJECTIVE: No recent data on health care resources and medical and surgical activity in Spanish dermatology departments are available in the literature. The aim of this study was to compile this information for 2019. MATERIAL AND METHODS: Cross-sectional study based on an online survey sent to the heads of dermatology departments at public hospitals in Spain. RESULTS: Of the 162 department heads contacted, 59 answered the survey (participation rate, 36.4%). General findings included a shortage of staff, especially dermatologists, in hospitals of low and medium complexity. The main reason given for the shortage of dermatologists was a lack of interested applicants. Large hospital complexes had more infrastructure and equipment. Over 50% of the departments surveyed used a combination of in-person and virtual visits. Psoriasis units were the most common specialized care units. Approximately 75% of the hospitals had operating rooms with an anesthetist. More complex procedures such as sentinel lymph node biopsy and Mohs micrographic surgery were performed more often in large hospital complexes. Hospitalization and the presence of dermatology residents working call shifts were also more common in these hospitals. Teaching and research activity differed according to hospital complexity. CONCLUSIONS: We have mapped health care resource availability and medical and surgical activity in Spanish dermatology departments prior to the COVID-19 pandemic. Our findings could be useful for improving clinical management and defining future actions and areas for improvement.


Subject(s)
COVID-19 , Dermatology , COVID-19/epidemiology , Cross-Sectional Studies , Delivery of Health Care , Hospitals, Public , Humans , Pandemics
19.
Dissertation Abstracts International: Section B: The Sciences and Engineering ; 83(6-B):No Pagination Specified, 2022.
Article in English | APA PsycInfo | ID: covidwho-1887659

ABSTRACT

The purpose of this study was to examine job burnout of medical providers in outpatient clinics. Job burnout is a psychological syndrome resulting from job interpersonal stressors;it is measured using three dimensions: (1) emotional exhaustion-feelings of being emotionally overextended and exhausted by one's work, (2) depersonalization-a unfeeling and impersonal response toward patients, and (3) personal accomplishment-feelings of competence and achievement in one's work (Maslach & Jackson, 2020). Using a convenience sample, healthcare providers in Southern Nevada were asked to participate. The study was approved by the University of Nevada, Las Vegas, Internal Review Board (IRB). After an initial Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS (MP)) was administered virtually (due to COVID-19), healthcare providers were presented with a job burnout educational in-service regarding how to identify and define job burnout, a summary of research and findings regarding employee stress, information of when to seek help, and a discussion of how job burnout affects patient care. After a 60-day period, the MBI-HSS (MP) was re-administered, voluntarily, to the same employees. This project's aim was to improve job burnout subscale scores in a 60-day period using a job burnout educational intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

20.
Enferm Infecc Microbiol Clin (Engl Ed) ; 40(6): 289-295, 2022.
Article in English | MEDLINE | ID: covidwho-1881951

ABSTRACT

OBJECTIVES: To assess the efficacy and safety of hydroxychloroquine (HCQ) compared with no treatment in healthcare workers with mild SARS-CoV-2 infection. METHODS: Prospective, non-randomized study. All health professionals with confirmed COVID-19 between April 7 and May 6, 2020, non-requiring initial hospitalization were asked to participate. Patients who accepted treatment were given HCQ for five days (loading dose of 400mg q12h the first day followed by200mg q12h). Control group included patients with contraindications for HCQ or who rejected treatment. Study outcomes were negative conversion and viral dynamics of SARS-CoV-2, symptoms duration and disease progression. RESULT: Overall, 142 patients were enrolled: 87 in treatment group and 55 in control group. The median age was 37 years and 75% were female, with few comorbidities. There were no significant differences in time to negative conversion of PCR between both groups. The only significant difference in the probability of negative conversion of PCR was observed at day 21 (18.7%, 95%CI 2.0-35.4). The decrease of SARS-CoV-2 viral load during follow-up was similar in both groups. A non significant reduction in duration of some symptoms in HCQ group was observed. Two patients with HCQ and 4 without treatment developed pneumonia. No patients required admission to the Intensive Care Unit or died. About 50% of patients presented mild side effects of HCQ, mainly diarrhea. CONCLUSIONS: Our study failed to show a substantial benefit of HCQ in viral dynamics and in resolution of clinical symptoms in health care workers with mild COVID-19.


Subject(s)
COVID-19 , Hydroxychloroquine , Adult , COVID-19/drug therapy , Delivery of Health Care , Female , Health Personnel , Humans , Hydroxychloroquine/adverse effects , Male , Prospective Studies , SARS-CoV-2
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