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1.
Journal of Clinical Periodontology ; 49:296, 2022.
Article in English | EMBASE | ID: covidwho-1956769

ABSTRACT

Background: Nifedipine is a calcium channel-blocking drug, common antihypertensive medication. Gingival tissue enlargement is a frequent periodontal side effect, associated to the presence of dental plaque. Description of the procedure: In January 2018, a male 62-year-old patient was evaluated at the Dentistry Department of Coimbra University Hospital. His main complaint was gingival “swelling” and masticatory difficulty. Anamnesis revealed hypertension medicated with Nifedipine for 8 years. Besides partial edentulism and tooth migration, oral observation highlighted severe bimaxillary gingival enlargement, not restricted to the papillae, pronounced inflammation and periodontal attachment loss. Periodontal screening revealed 10 mm probing depth (PD) at several interdental sites, maximum clinical attachment loss (CAL) of 5 mm, bleeding on probing (BOP) of 61% and plaque index (PI) of 100%. The patient was diagnosed Nifedipine Gingival Enlargement with a Generalized Stage IV, Grade B Periodontitis. Non-surgical periodontal treatment was initiated with oral hygiene instructions, supra and subgingival instrumentation. Simultaneously, his assistant physician replaced nifedipine with enalapril. The patient attended regular periodontal appointments for 12 months. A decrease in gingival enlargement was noted in the subsequent months. Due to COVID-19 restrictions, patient was only reevaluated in May 2021. Outcomes: Three years after replacement of nifedipine and nonsurgical periodontal treatment, gingival enlargement was resolved. Periodontitis was stabilized, as periodontogram revealed a mean reduction PD of 6 mm at the deepest sites, grade II furcation involvements, BOP of 10% and PI of 34%. Step 3 periodontal therapy could be initiated. Due to economic restrictions, oral rehabilitation could not be fulfilled. Conclusions: Severe gingival tissue enlargement related to nifedipine in a periodontitis IVB patient was resolved by non-surgical periodontal treatment. Meticulous plaque control is mandatory. Communication with the Physician is important to alter the medication and restore patient's quality of life.

2.
Journal of Clinical Periodontology ; 49:79-80, 2022.
Article in English | EMBASE | ID: covidwho-1956755

ABSTRACT

Background & Aim: 'Aerosol generating procedures' (AGPs) can risk spread COVID-19 and other diseases. Suspension of routine dentistry due to COVID-19 pandemic led to increased use of antibiotics and dental extraction, reduced access to dental care, and compromised dental businesses' financial sustainability. The recommended additional personal protective equipment (PPE) for AGPs increases treatment cost, clinical waste and poses a risk to the environment. The transmission of COVID- 19 and other air-borne infections will be a risk for foreseeable future. We have developed a novel patient shield (NoPaS) to help prevent spread of COVID-19 and other air-borne viruses and bacteria during AGPs. NoPaS is a device with a hood, a suction and air curtains that prevents aerosol spread. Methods: We carried out extensive research to ensure acceptability and efficacy of NoPaS. This included: market research, computational simulations. in-vitro smoke visualization and particle image velocimetry (PIV). NoPaS was then tested using dental simulation units (DSUs) with artificial salivary enzyme. Dentists carried out three AGPs (examination using air spray;ultrasonic scaling;class I cavity repair) and a non-AGP (hand-scaling) with and without NoPaS. Dentists were randomized to perform procedures with or without NoPaS first. Aerosol generation and spread were measured by counting clearance zones on starch agar plates at three distances from the dentist's working field. Results: The data obtained from lab-based studies and market research informed the final product design. Over 90% of patients and dental practitioners felt safer when using NoPaS. The mean percentage of clearance zone for AGPs with and without NoPaS were 0.9% and 75%. The patent was filed following successful test results. Conclusions: NoPaS is an effective, low-cost, and environmentallyfriendly solution for performing AGPs with no risk of virus transmission. With modifications, it can be used for medical procedures on head and neck. Further work is currently underway to take NoPaS into mass production.

3.
British Journal of Dermatology ; 186(6):e245, 2022.
Article in English | EMBASE | ID: covidwho-1956713

ABSTRACT

A 73-year-old man presented with left shin ulceration two weeks after receiving his first dose of the Oxford-AstraZeneca vaccine. Within 24 h of vaccination, the patient became generally unwell with fever and headache. On the third day after vaccination, he developed left shin erythema and blistering, which rapidly ulcerated. This formed two superficial ulcers with a necrotic base and a violaceous edge on the lateral aspect of his left shin, measuring approximately 2 cm × 3 cm. He had a background of atrial fibrillation and ischemic cardiomyopathy, and had been on several longstanding medications including apixaban. Blood tests revealed normal clotting, full blood count, liver and renal function. The differential diagnosis included pyoderma gangrenosum, vasculitic ulceration, and a cutaneous adverse drug reaction to vaccination. A punch biopsy was obtained from the edge of an ulcer, which revealed microthrombi within blood vessels, an ischemic epidermis, and fat necrosis of subcutaneous tissue. The patient experienced slow healing of ulceration with topical clobetasol propionate 0.05%, neomycin sulphate and nystatin ointment, and compression bandaging treatment. To our knowledge, this is the first reported case of cutaneous thrombosis associated with skin necrosis following Oxford/AstraZeneca vaccination. Recently there have been concerns related to reports of thrombotic events at atypical sites (including cerebral and splanchnic vascular beds) associated with thrombocytopenia following Oxford/ AstraZeneca vaccination (Greinacher A, Thiele T, Warkentin TE et al. Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. N Engl J Med 2021;384: 2092-101). These findings extend the range of atypically located thromboses associated with COVID-19 vaccination and reinforce the necessity for physicians to be vigilant for signs and symptoms related to thromboses at atypical sites in recently vaccinated patients.

4.
Neuro-Oncology ; 24:i149-i150, 2022.
Article in English | EMBASE | ID: covidwho-1956578

ABSTRACT

BACKGROUND: The SARS-COV2 pandemic had huge impact on how clinical research is conducted when clinical research coordinators (CRC) transitioned to working remotely. An urgent transition of paper documentation into electronic formats had to occur without compromising participant safety or data integrity. Adverse event (AE) reporting had previously been captured in various paper formats with wet signature. AEs, attribution, severity, and clinical significance had to be changed into being electronically captured and incorporated into the medical record that captures the events in real time. METHOD: We assessed the satisfaction of the new method of AE recording amongst pediatric hematology oncology physicians and staff in a large academic institution during the COVID pandemic through a REDCap survey. The survey assessed the time, effort, perceived efficacy and overall acceptability of the paper-based and electronic methods of AE documentation. RESULTS: Seventy-one staff members were surveyed. Fifty (65%) responded, including 6 participants who were not involved in the AE reporting process and did not complete the survey. Of the remaining 44 participants, 43 (98%) preferred an electronic documentation method. Secondary results and further analysis will be presented at the meeting. CONCLUSIONS: The COVID pandemic has changed how CRC report AEs and electronic documentation seems to be the preferred method of documentation.

5.
Neuro-Oncology ; 24:i74-i75, 2022.
Article in English | EMBASE | ID: covidwho-1956572

ABSTRACT

INTRODUCTION: High-grade gliomas account for <5% of all pediatric brain tumors with a 20% 5-year overall survival even with maximal safe resection followed by concurrent radiotherapy and chemotherapy. Patients in low-and middle-income countries already face delays and barriers to the treatment they require. The current COVID pandemic has added unique challenges to the delivery of complex, multidisciplinary health services to these patients. METHODOLOGY AND RESULTS: We retrospectively reviewed the records of four patients, ages 2-18 years old, with histologically confirmed high-grade glioma managed in a tertiary government institution from 2020-2021. Three of the patients had a supratentorial tumor and one patient had multiple tumors located in both supra-and infratentorial compartments. Neurosurgical procedures performed were: gross total excision (1), subtotal excision (2), and biopsy (1). The tissue diagnoses obtained were glioblastoma (3) and high-grade astrocytoma (1). Two patients survived and are currently undergoing adjuvant radiotherapy and chemotherapy. The remaining two patients expired: one from hospital-acquired pneumonia and the other from COVID-19 infection. DISCUSSION: Decreased mobility due to lockdowns, the burden of requiring negative COVID-19 results before admission for surgery, reduced hospital capacity to comply with physical distancing measures, the postponement of elective surgery to minimize COVID-19 transmission, physician and nursing shortages due to infection or mandatory isolation of staff, cancellation of face-to-face outpatient clinics, and hesitation among patients and their families to go to the hospital for fear of exposure were found to be common causes of delays in treatment. Also, the redirection of health resources and other government and hospital policies to handle the COVID-19 pandemic resulted in an overall delay in the delivery of health services. In particular, the management of pediatric patients with cancers, especially high-grade gliomas, was significantly disrupted.

6.
Journal of Investigative Dermatology ; 142(8):S66, 2022.
Article in English | EMBASE | ID: covidwho-1956221

ABSTRACT

The impact of the COVID-19 pandemic caused dermatology providers to use telemedicine to safely arrange clinic appointments during lockdowns. This study aimed to evaluate the impact of telehealth on antibiotic prescription length. Specifically, we sought to compare antibiotic length prescription for virtual vs. in-person visits before, during, and after COVID-19 shutdowns. A retrospective cohort study was performed using all documented pharmaceutical prescriptions of tetracycline in 2019-2021 prescribed by dermatology providers at a large academic tertiary referral center. Results show an increase in telemedicine visits from 0.75% (2019) to 18.51% (2020), with a decrease to 3.98% in 2021 (p<0.0001). Analysis demonstrates that a tetracycline prescription of over 91 days was given in 37.90% vs. 28.83% of visits for virtual vs. in-person visits respectively (p<0.0001). Interestingly, 52.64% of antibiotic prescriptions written by staff physician dermatologists exceeded 91 days vs. 18.18% for dermatology fellows, 25.74% for resident physicians, and 21.35% for physician-assistants (p<0.001). The demonstrated increase in duration of tetracycline prescription during virtual visits is perhaps indicative of less data available for clinical decision-making, longer wait times between provider appointments during this era of lockdowns, and providers desire to make the visit worthwhile. Future studies should explore factors related to provider decision-making in virtual compared to in-person visits. This research is important in laying a foundation for how virtual visits may play a greater role in dermatologic care as we move towards a post-COVID world.

7.
European Journal of Clinical Pharmacology ; 78:S130, 2022.
Article in English | EMBASE | ID: covidwho-1955961

ABSTRACT

Introduction: Zolpidem and zopiclone are widely used for sleep disorders, yet their abuse and dependence potential has been underestimated. The electronic prescription of zolpidem/zopiclone became mandatory on 17.07.2019 in Greece. Objectives: To investigate descriptive characteristics of zolpidem/ zopiclone prescriptions and the impact of the mandatory electronic prescription mandate. Methods: Anonymized prescriptions of zopiclone (ATC: N05CF01) and/or zolpidem (ATC: NC05CF02) that were executed in pharmacies between 01.10.2018 and 01.10.2021 were obtained from the Greek nationwide prescription database. The database covers almost the entire Greek population and it is administrated by IDIKA of the Greek Ministry of Health. We investigated descriptive characteristics of prescriptions, and calculated themonthly number of prescriptions taking into consideration dates with potential impact, i.e., the date of the mandatory electronic prescription mandate (on 17.07.2019) and the date of the first case of COVID-19 in Greece (on 26.02.2020). Results and Conclusion: During the investigated period of three years, there were 1229842 executed prescriptions of zolpidem (89.4%), zopiclone (10.4%) or both (0.3%), considering 156554 unique patients. The patients weremainly elderly (73.1%were ≥ 65 years old) andwomen (64.5%). The majority of the prescription physicians (69.9%) were general practitioners or internists, followed by 17% psychiatrists or neurologists, 5.3% cardiologists, 4.5% physicians in specialty training, 1% nephrologists and 2.4% of physicians with another specialty. After the mandatory electronic prescription mandate and before COVID- 19 in Greece, i.e., between 08.2019 to 03.2020, there was a notable increase of prescriptions in comparison to the previous period from 10.2018 to 07.2019 (median 37267 vs median 34106;Mann-Whitney U=9, p-value=0.009). After COVID-19, the median monthly number of prescriptions was 36363, yet there were variations ranging from 16963 to 39956. In conclusion, the mandatory electronic prescription system could increase the surveillance of drugs with abuse potential such as zolpidem and zopiclone. Nevertheless, the large number of prescriptions in elderly patients and prescribed by primary care physicians is worrisome and warrants further investigation.

8.
European Journal of Clinical Pharmacology ; 78:S79, 2022.
Article in English | EMBASE | ID: covidwho-1955957

ABSTRACT

Introduction: Drug-drug interactions (DDI) are generally a significant cause of morbidity and mortality, as well as increased costs and length of hospital stay. In Sweden today, electronic health records with integrated DDI warnings have been implemented in virtually all hospitals, with the exception of the intensive care units, where the medications charts are either still on paper or, if electronic, still not connected to DDI warning systems. However, in the ICU, it may well be that the clinical relevance of interaction warnings differ from ordinary care, due to the type of medications used, as well as the close monitoring of the patients. Objectives: This study aimed to determine the frequency of potential DDIs and clinically relevant DDIs during the hospitalization of patients in three different Swedish ICUs at the same university hospital. Methods: This observational pilot study was conducted at a mixed ICU, a cardiothoracic ICU and a neurosurgical ICU over the course of a total of 5 months during the covid-19 pandemic year 2021. The investigator visited the ward once weekly and checked all prescribed medications on that day for each patient against the DDI database SFINX/Janusmed Interactions. The result was communicated to the physician in charge. Results: The sample size included 172 patients. A total of 53 patients (31%) were found to have at least one potential DDI (pDDI). The most common pDDIs in all three ICUs were drugs with risk of QT prolongation and drugs with increased risk of serotonergic toxicity. 29-41% of the pDDIs in the different ICUs were drugs with risk of QTprolongation, the most frequent drugs being amiodarone, antibiotics (erythromycin, moxifloxacin and ciprofloxacin) and ondansetrone. 7-24% of the pDDIs in the different ICUs were drugs with increased risk of serotonergic toxicity, the most frequent drugs being selective serotonin reuptake inhibitors (SSRI), fentanyl, remifentanil, pethidine and metoclopramide. Neurosurgical intensive care patients were exposed to higher frequency of pDDI with serotonergic toxicity compared with the other intensive care unit-patients. Observed pDDIs led to dose-adjustment in 6 cases and exchange of drugs in 4 cases. No adverse drug reactions (ADRs) were observed. Conclusion: Potential DDIs are common in ICU patients, but far from all are clinically relevant.We need to learn more about the clinical relevance of the pDDIs in this patient setting, as a basis for customized either manual or computerized decision support algorithms to decrease the risk of unfavorable outcomes due to DDIs.

9.
European Journal of Clinical Pharmacology ; 78:S30-S31, 2022.
Article in English | EMBASE | ID: covidwho-1955953

ABSTRACT

Introduction: Antibiotic resistances are among themost threatening public health issues worldwide, being highly associated with inadequate antibiotic use. To tackle this challenge, it is crucial to educate health professionals to appropriately prescribe and dispense antibiotics. Thus, out team developed eHealthResp, an educational intervention composed by two online courses and a clinical decision support system in the form of a mobile app directed to primary care physicians and community pharmacists, aiming to improve antibiotic prescribing and dispensing in respiratory tract infections. Objectives: The main goal of this pilot study is to validate the eHealthResp online courses and the clinical decision support system (mobile app), involving a small group of health professionals. Methods: Aproximately 15 physicians and 15 pharmacists will be recruited to participate in the study. Participants will have complete autonomy to explore and evaluate the eHealthResp mobile app and online courses, composed by six modules on respiratory tract infections for physicians (i) acute otitis media, ii) acute rhinosinusitis, iii) acute pharyngotonsilitis, iv) acute tracheobronchitis, v) community-acquired pneumonia, and vi) COVID-19), and three modules for pharmacists (i) common cold and flu, ii) acute rhinosinusitis, acute pharyngotonsilitis, and acute tracheobronchitis, and iii) acting protocol). Each online course is also composed by four clinical cases and the most recommended pharmacological therapy. Additionally, for the the global validation of the online course and the mobile app, participants will be invited to complete a questionnaire including three sections of questions. The first part, consisting of five brief questions, will allow the collection of sociodemographic data. The second part contains four groups of closed questions, and the third part consists of four open-answer questions, both aiming to evaluate the online course and mobile app elements. Results: After the assessment made by the physicians and pharmacists who agreed to participate in the pilot study, the data obtained will be duly analyzed and integrated by the research team. The appropriate changes will be incorporated into the e-Health platforms to improve the quality of both the online courses and the eHealthResp mobile app. Conclusions: The findings of this pilot study will provide important information for the next stage of the project, ensuring the feasibility of the educational interventions in a group of primary care physicians and community pharmacists from the Centre region of Portugal, using a randomized controlled trial designed by clusters.

10.
Heroin Addiction and Related Clinical Problems ; 24(3):41-45, 2022.
Article in English | EMBASE | ID: covidwho-1955735

ABSTRACT

The SARS-CoV-2 pandemic poses new challenges and requires new solutions for problems previously not faced by our generation. This particularly applies to the field of opioid dependence therapy due to the physical and psychological vulnerability of patients and the treatment model that often requires daily attendance. An overview is given of the responses of the physicians and the recommendations of medical societies in Germany during the year 2020 with a special focus on the lockdown periods and the challenges and guidelines for the patients, patient organizations and physicians, both outpatient and in prison. Reduced travel and empty inner cities led to reduced patient income combined with closed patient organizations during lockdown, leading to a temporary increase of patients in opioid dependence therapy. New hygiene procedures had to be implemented. A temporary change in the German Narcotics Prescription Ordinance, including longer periods for take-home prescriptions, allowed for ongoing supply with improved social distancing. Depot buprenorphine significantly reduces the risk of infection by avoiding the daily commute and presence at the practice with many other patients. This is even more favourable in prison settings by greatly reducing the movement of prisoners and diversion of drugs.

11.
American Journal of Cardiovascular Disease ; 12(3):149-152, 2022.
Article in English | EMBASE | ID: covidwho-1955690

ABSTRACT

The COVID-19, actual pandemic due to SARS COV 2 is associated with numerous thromboembolic compli-cations. Although venous thrombosis including pulmonary embolisms have been widely described, arterial localiza-tion seems rarely reported. Acute limb ischemia and myocardial infarction are two major consequences of arterial thrombosis and their concomitant occurrence among COVID-19 patients is extremely rare. It is an evident aspect of hypercoagulability and a real challenge to physicians. We herein describe the management of a 77 years old COVID-19 patient presenting an acute lower limb ischemia with concomitant myocardial infarction. He underwent coronary angiography with subsequent stent placement then was transferred to the operating room where a throm-bectomy was performed. The outcome was poor as the cardiogenic shock persisted in addition to a reperfusion syndrome with multiorgan failure.

12.
Healthcare (Basel) ; 10(8)2022 Jul 26.
Article in English | MEDLINE | ID: covidwho-1957274

ABSTRACT

The COVID-19 pandemic has affected not only the quality of care and patient safety but also physician engagement. The aim of this study was to investigate physician engagement before and during the COVID-19 pandemic and to identify the areas to improve regarding physician engagement. An online survey was conducted from April 2019 to September 2020 among the physicians of 44 hospitals under the Bangkok Dusit Medical Services Public Company Limited (BDMS) before and during the COVID-19 pandemic. The results were analyzed using an independent T-test and one-way ANOVA to compare the continuous variables across groups. Multiple linear regression was used to identify and adjust the variables to determine the areas for improvement. Among the 10,746 respondents, physician engagement during the COVID-19 pandemic was significantly higher than in the pre-COVID-19 period (4.12 vs. 4.06, p-value < 0.001). The top three recommendations to promote physician engagement during the COVID-19 situation comprised (1) marketing (70%), (2) intra-and inter-organizational communication (69%), and (3) the competency of clinical staff (67%). During the COVID-19 pandemic, the positive outcomes toward physician engagement focused on infra-organizational development. These results can be considered in a strategy to optimize physician engagement, which affects the quality of care and patient safety.

13.
Int J Psychiatry Clin Pract ; : 1-10, 2022 Jul 23.
Article in English | MEDLINE | ID: covidwho-1956513

ABSTRACT

BACKGROUND: Healthcare workers are leading the way in treating patients with coronavirus disease 2019 (COVID-19). Due to the high levels of psychological stress, this group is more likely to experience psychological issues. These psychological problems in healthcare providers include depression, anxiety, insomnia, stress and post-traumatic stress disorder (PTSD). The goal of this systematic review and meta-analysis was to find out how common these problems were in the face of COVID-19. METHODS: On 20 February 2022, systematic searches were conducted in the PubMed, Cochrane Library, Scopus, EMBASE, Science Direct, Web of Science and ProQuest databases. Two authors selected articles based on search keywords. As a last step, articles about the prevalence of psychological problems among healthcare workers in the face of COVID-19 were looked at and analysed for five different outcomes. RESULTS: The initial search yielded 18,609 articles. After reviewing the titles, abstracts and full texts of the articles, 44 were chosen for the final analysis and 29 were subjected to a meta-analysis. Insomnia, anxiety, depression, PTSD and stress are among the psychological issues faced by healthcare workers. Furthermore, the highest pooled prevalence of depression, anxiety, insomnia, PTSD and stress was 36% (95% confidence interval (CI) 24-50%), 47% (95% CI 22-74%), 49% (95% CI 28-70%), 37% (95% CI 19-59%) and 27% (95% CI 6-69%). CONCLUSIONS: In this meta-analysis, insomnia was found to be the most common mental health problem, followed by anxiety, PTSD, depression and stress in healthcare workers in the face of the COVID-19 pandemic. Generally, the pooled prevalence of these mental health problems was higher among physicians, nurses and older staff in the subgroup analysis. As a result, health policymakers and managers of the health care system should think about effective interventions to promote mental health, paying particular attention to these two groups.Key pointsStudies conducted in China reported more mental problems than in other countries.Health policymakers and health system managers should hold training programs to promote healthcare workers' mental health with a particular focus on more vulnerable groups.The prevalence of PTSD, stress, anxiety, depression and insomnia were higher among physicians, nurses and older staff.Health systems at both national and local levels have to take older physicians, nurses and healthcare providers into consideration while designing interventions.

14.
Psychiatry Res ; 316: 114739, 2022 Jul 26.
Article in English | MEDLINE | ID: covidwho-1956301

ABSTRACT

Physician wellness was greatly impacted during the COVID-19 pandemic. Busy clinical services, personal safety concerns, changing guidelines, and compassion fatigue weighed on physicians. Although studies have examined physician wellness, few have studied how it changed over time. A survey about wellness was distributed to 299 physicians at Ascension St. Vincent Hospital-Indianapolis March 2020, July 2020, November 2020, and March 2021. Physicians also free-texted about their well-being during the pandemic. Participation rates over the four time periods averaged 22.23%. Responses were compared among the time periods using Pearson Chi-Square and Fisher's Exact Tests. Six wellness factors (anxiety, worry about becoming ill, worry about infecting family, worry about caring for children, concern about personal finances) were reported as worse after the pandemic began, but statistically significantly improved over the course of the study. In contrast, seven wellness measures (increased issues with depression, frustration, hopelessness, fatigue, dread going to work, worry about missing work, worry about caring for family), that also worsened after the pandemic began, did not statistically improve over time. Physician wellness was impacted by the pandemic; however, not all measures followed the same course over time. Longitudinal assessments of wellness can help inform programs to best support physicians.

15.
Glob Health Med ; 4(2): 116-121, 2022 Apr 30.
Article in English | MEDLINE | ID: covidwho-1955544

ABSTRACT

Emergency physicians perform endotracheal intubations for patients with COVID-19. However, the trends in the intubation for COVID-19 patients in terms of success rate, complications, personal protective equipment (PPE) information, barrier enclosure use, and its transition have not been established. We conducted a retrospective study of COVID-19 cases that required tracheal intubation at four hospitals in the Tokyo metropolitan area between January 2020 and August 2021. The overall intubation success rate, operator experience, and infection control methods were investigated. We then compared the early and late phases of the pandemic for a period of 8 months each. A total of 211 cases met the inclusion criteria, and 133 were eligible for analysis. The intubation success rate increased from 85% to 94% from early to late phase, although the percentage of intubations performed by emergency medicine residents increased significantly in the late phase (p = 0.03). The percentage of light PPE use significantly increased from 65% to 91% from early to late phase (p < 0.01), whereas the percentage of barrier enclosure use significantly decreased from 26% to 0% (p < 0.01). Furthermore, the infection prevention methods during intubation became more simplified from early to late phase.

16.
Eur J Med Res ; 27(1): 84, 2022 Jun 03.
Article in English | MEDLINE | ID: covidwho-1951357

ABSTRACT

BACKGROUND: During the last 2 years, in the Kurdistan Region, Northern Iraq, there were thousands of COVID-19 cases that have not been reported officially, but diagnosed and confirmed by private laboratories and private hospitals, or clinicians based on typical clinical signs, as well as few people using home self-test after appearing of some flu-like clinical symptoms. Thus, this study aims to assess the misdiagnosis and mismanagement of cases before COVID-19 confirmation. METHODS: This study enrolled 100 consecutive patients who visited an outpatient clinic of Shar Hospital that had symptoms highly suspicious of COVID-19 infection while misdiagnosed previously to have other types of disease. Detailed questionnaires were filled for all studied patients, including age, gender, main presenting symptoms, and duration of these symptoms with the following questions: who made the false diagnosis, depending on which diagnostic test the false diagnosis was made, which medication was used for the false diagnosis, who prescribed those medications, and how long those medications were used. They were investigated by RT-PCR on their nasopharyngeal swab for confirmation. RESULTS: Most of the false diagnoses were typhoid (63%), influenza (14%), pneumonia (9%), gastroenteritis (5%), common cold (4%), brucellosis (4%), and meningitis (1%). Regarding the false diagnosis of cases, 92% were made by non-physician healthcare workers, and only 8% were made by physicians. All false diagnoses with typhoid, gastroenteritis, and common cold were made by non-physician healthcare workers, together with about half of the diagnosis of pneumonia and brucellosis, with statistically significant results (P < 0.001). CONCLUSIONS: We realized that some patients had been misdiagnosed before the COVID-19 infection confirmation. Their health conditions improved drastically after correct diagnosis and treatment, and this research is considered the first research to be conducted in Iraq in this regard.


Subject(s)
Brucellosis , COVID-19 , Common Cold , Gastroenteritis , Typhoid Fever , COVID-19/diagnosis , Diagnostic Errors , Humans , Iraq/epidemiology , SARS-CoV-2/genetics
17.
Online Information Review ; 2022.
Article in English | Scopus | ID: covidwho-1948706

ABSTRACT

Purpose: The purpose of this study is to explore the information-seeking behavior of Egyptian physicians serving in COVID-19 isolation hospitals. Design/methodology/approach: A sample of 91 physicians serving in Egyptian isolation hospitals answered the study questionnaire. Findings: Demographically, more than half of respondents were males. Over one-third of them are holding Doctor of Medicine (M.D), followed by one-third holding Master of Medicine (MMed). Respondents' age ranged from 30 to 60 years. Internal medicine is the most common specialty, accounting for nearly half of all physicians, followed by chest medicine and intensive care medicine. The information-seeking behavior of these three groups in their regular work is believed to be different, but since all of the participants are working in COVID-19 isolation hospitals, they should have the same information resources, Internet access and the same needs relevant to COVID-19 in order to make accurate clinical decisions. The physicians used traditional and electronic information sources to fulfill their information needs, the most important of which were to make a specific research, find an answer to a specific case, and deliver a medical lecture. Colleagues, coworkers, nurses and pharmacists were the most important channels pursued by Egyptian physicians to obtain information. Originality/value: This study is the first study that focuses on investigating the information-seeking behavior of Egyptian physicians serving in isolation hospitals. Any findings resulted from this study may serve as a noteworthy reference that may be useful to the Egyptian health sector, experts, researchers, as well as policymakers in establishing strategic decisions for making the understating much better. Peer review: The peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-08-2020-0350 © 2022, Emerald Publishing Limited.

18.
Supportive Care in Cancer ; 30:S24, 2022.
Article in English | EMBASE | ID: covidwho-1935802

ABSTRACT

Introduction Early in the pandemic, Cancer Australia developed a conceptual framework which provided guidance on approaches to optimal cancer care in the face of significant health system challenges and risk of exposure to and harm from COVID-19. Emerging evidence during the pandemic indicated that cancer patients experienced considerable psychosocial impacts, including increased distress, depression and anxiety, and unmet information needs. Methods Evidence on the impact of the COVID-19 pandemic on cancer patients, cancer care across the care continuum, and health system capacity was reviewed, to June 2021. The conceptual framework was updated based on international and national published evidence, guidance, recommendations, and position statements. Results Supportive care strategies for cancer patients during a pandemic include extra vigilance by practitioners of screening for distress;improved communication with patients and their carers of changes to cancer care plans;provision of timely information and guidance to inform shared decision making;attention to the impact of infection control measures;, and adoption of innovative models of supportive care. Conclusions Cancer Australia's updated conceptual framework, underpinned by principles defining optimal cancer care, informs optimal supportive care across the continuum during a pandemic. It provides a planning resource for cancer care clinicians and policymakers for the current and future pandemics when supportive care needs are more paramount than ever.

19.
Supportive Care in Cancer ; 30:S144, 2022.
Article in English | EMBASE | ID: covidwho-1935796

ABSTRACT

Introduction Clinician burnout and distress are pervasive and exacerbated by the COVID-19 pandemic, but the drivers may vary by provider discipline and care setting. We surveyed the wellbeing of nurses and physicians in oncology and cardiovascular programs at a Canadian hospital network. Methods Nurses (n=261) and physicians (n=167) completed measures of the WellBeing Index to assess distress levels and rated perceived workplace fairness, staffing levels, professional satisfaction and impact of COVID-19 on work and personal life. Associations between high distress and outcomes of interest were explored using chi-squared tests and in multivariable models. Results Of 428 participating clinicians, 82% of nurses and 62% of physicians reported high distress with no significant differences between programs. High distress in nurses was linked to impact of COVID-19 on personal life [OR=4.4 (1.8-10.6), p=0.001], and in physicians, insufficient staffing [OR=3.7 (1.6-8.7), p=0.003], professional dissatisfaction [OR=5.4 (1.4- 21.8), p=0.017], and impact of COVID-19 on work [OR=3.9 (1.5-10.3), p=0.006]. High distress in oncology and cardiovascular nurses was linked to unfair treatment [OR=4.9 (1.1-23.0), p=0.042], and impact of COVID19 on work [OR=4.0 (1.1-14.2, p=0.035], respectively. Conclusions High distress is common in nurses and physicians in oncology and cardiovascular programs but drivers vary by clinician discipline and care setting. Multifaceted approaches to mitigate burnout and distress may improve clinician wellbeing.

20.
Supportive Care in Cancer ; 30:S49, 2022.
Article in English | EMBASE | ID: covidwho-1935780

ABSTRACT

Introduction Caring for older adults with cancer is more demanding than ever. A key challenge during the COVID-19 pandemic has been the transition of care provision to telehealth. Methods Surveys were developed and distributed in April 2020 and summer 2021 by the Cancer and Aging Research Group Advocacy Committee and Association of Community Cancer Centers. Data on telehealth and demographics presented will be analyzed using descriptive statistics and chisquares. Results Most of the respondents in both cohorts were physicians, APPs, and social workers, and predominately US-based. More than 80% used telehealth during COVID compared to only 28.4% before COVID. In 2020 and 2021, respectively, the top barriers to telehealth were patient technology challenges (90.5%, 95.7%), patient access to technology (91.2%, 95.7%), patient perception (44.2%, 87.8%), treatment inappropriate for telehealth (31.4%, 81.3%), and patient impairments (e.g., auditory acuity, which was not included in 2020) to technology use (96.5%). In 2021, benefits noted included: lower need for transportation (81.9%), decreased patient exposure (78.5%%), caregiver availability (68.1%%), healthcare worker safety (66.7%%), and ease of scheduling (45.6%). Conclusions A year into the COVID crisis, cancer care providers face consistent barriers to providing telehealth to older adults with cancer. Further studies are needed to evaluate telehealth's long-term impact and determine if patients' perceptions are congruent with their healthcare providers.

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