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1.
Pain Physician ; 25(3): 223-238, 2022 05.
Article in English | MEDLINE | ID: covidwho-1871335

ABSTRACT

BACKGROUND: Multiple publications have shown the significant impact of the COVID-19 pandemic on US healthcare and increasing costs over the recent years in managing low back and neck pain as well as other musculoskeletal disorders. The COVID-19 pandemic has affected many modalities of treatments, including those related to chronic pain management, including both interventional techniques and opioids. While there have not been assessments of utilization of interventional techniques specific to the ongoing COVID-19 pandemic, previous analysis published with data from 2000 to 2018 demonstrated a decline in utilization of interventional techniques from 2009 to 2018 of 6.7%, with an annual decline of 0.8% per 100,000 fee-for-service (FFS) in the Medicare population. During that same time, the Medicare population has grown by 3% annually. OBJECTIVES: The objectives of this analysis include an evaluation of the impact of the COVID-19 pandemic, as well as an updated assessment of the utilization of interventional techniques in managing chronic pain in the Medicare population from 2010 to 2019, 2010 to 2020, and 2019 to 2020 in the FFS Medicare population of the United States. STUDY DESIGN: Utilization patterns and variables of interventional techniques with the impact of the COVID-19 pandemic in managing chronic pain were assessed from 2000 to 2020 in the FFS Medicare population of the United States. METHODS: The data for the analysis was obtained from the master database from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary from 2000 to 2020. RESULTS: The results of the present investigation revealed an 18.7% decrease in utilization of all interventional techniques per 100,000 Medicare beneficiaries from 2019 to 2020, with a 19% decrease for epidural and adhesiolysis procedures, a 17.5% decrease for facet joint interventions and sacroiliac joint blocks, and a 25.4% decrease for disc procedures and other types of nerve blocks. The results differed from 2000 to 2010 with an annualized increase of 10.2% per 100,000 Medicare population compared to an annualized decrease of 0.4% from 2010 to 2019, and a 2.5% decrease from 2010 to 2020 for all interventional techniques. For epidural and adhesiolysis procedures decreases were more significant and annualized at 3.1% from 2010 to 2019, increasing the decline to 4.8% from 2010 to 2020. For facet joint interventions and sacroiliac joint blocks, the reversal of growth patterns was observed but maintained at an annualized rate increase of 2.1% from 2010 to 2019, which changed to a decrease of 0.01% from 2010 to 2020. Disc procedures and other types of nerve blocks showed similar patterns as epidurals with an 0.8% annualized reduction from 2010 to 2019, which was further reduced to 3.6% from 2010 to 2020 due to COVID-19. LIMITATIONS: Data for the COVID-19 pandemic impact were available only for 2019 and 2020 and only the FFS Medicare population was utilized; utilization patterns in Medicare Advantage Plans, which constitutes almost 40% of the Medicare enrollment in 2020 were not available. Moreover, this analysis shares the limitations present in all retrospective reviews of claims based datasets. CONCLUSION: The decline driven by the COVID-19 pandemic was 18.7% from 2019 to 2020. Overall decline in utilization in interventional techniques from 2010 to 2020 was 22.0% per 100,000 Medicare population, with an annual diminution of 2.5%, despite an increase in the population rate of 3.3% annualized (38.9% overall) and Medicare enrollees of 33.4% and 2.9% annually.


Subject(s)
COVID-19 , Chronic Pain , Aged , Chronic Pain/epidemiology , Humans , Medicare , Pain Management/methods , Pandemics , Retrospective Studies , United States
2.
Romanian Journal of Neurology/ Revista Romana de Neurologie ; 21(1):75-77, 2022.
Article in English | EMBASE | ID: covidwho-1870331

ABSTRACT

Background. COVID-19 emerged in Wuhan, China and spread rapidly, becoming a global health pandemic. The condition, apart from its typical respiratory presentation, may also cause neurological complications. Case presentation. A 35-year-old, ex-smoker presented with bilateral lower limb weakness associated with urinary incontinence and constipation following the resolution of a suspected COVID-19 infection. His MRI-Spine showed areas of abnormal densities confirming the diagnosis of transverse myelitis. On the presence of positive SARS-CoV-2 antibodies, COVID-19 was concluded as the pathological trigger for the condition. He was treated using Methylprednisolone and Plasmapheresis with supportive limb physiotherapy which led to a partial recovery of the patient’s disability. Conclusion. This is the first case of TM associated with COVID-19 in Pakistan and considering the current scenario of a global pandemic, COVID-19 needs to be considered as an important differential for not only TM but other neurological manifestations like encephalitis, neuritis etc.

3.
Journal of Oncology Pharmacy Practice ; 28(2 SUPPL):4-5, 2022.
Article in English | EMBASE | ID: covidwho-1868951

ABSTRACT

Background: Bone loss is a well-recognised complication of myeloma, affecting up to 90% of patients. It is associated with fractures, spinal cord compression and hypercalcaemia. 1,2 Myeloma patients are routinely prescribed zoledronic acid, which has been shown to prevent skeletal-related events, preserve bone density and prolong progression-free survival.3 At NBT, zoledronic acid is prescribed on a paper prescription chart, which is not routinely reviewed by a pharmacist This process is not in accordance with other therapy, which is prescribed on ChemoCare and clinically verified by a pharmacist prior to administration. Objectives • To assess the adherence of zoledronic acid prescribing at NBT against the South West Clinical Network (SWCN) protocol. • To identify areas for improvement in the prescribing of zoledronic acid for prevention of skeletal events. Standards: 100% of patients receiving zoledronic treatment should meet the following go-ahead criteria:4 • Acceptable bloods within seven days of treatment (creatinine, calcium, phosphate, magnesium) • Comprehensive dental examination. • Dose modification based on creatinine clearance. • Treatment deferred if hypocalcaemia or hypophosphataemia. Methodology: The audit was conducted over a one month period between 1/11/2020 and 30/11/2020. A total number of 58 prescriptions were included in the audit. The data collection sheet for the audit included;patient details, date of treatment and zoledronic acid dose. This information was extracted from the drug charts. The information system ICE was used to verify the blood results and validity period. Creatinine clearance was calculated using the Cockcroft and Gault equation. The medical notes were reviewed for evidence of dental checks. Data was recorded on Excel for further analysis by the pharmacist. Results: An overview of all four audit standards is shown in Figure 1. Two of the four audit standards were fully met (standards 2 and 4). 2% of patients (n= 1/58) did not receive an appropriate zoledronic acid dose adjustment based on renal function (standard 3). 36% (n=21/58) of patients did not have bloods within seven days of treatment (standard 1), however all of these patients had bloods within a month of treatment, in line with the Summary of Product Characteristic recommendations.5 Discussion and conclusion: The audit demonstrated that adherence to zoledronic acid prescribing guidelines is generally satisfactory;however several areas for improvement were identified. Feedback was provided to the haematology team and the following recommendations made: • Critical bloods must be done within one week of treatment. • Evidence of a dental examination must be clearly documented. • An approved app must be used for calculating creatinine clearance. • Introduction of a pharmacist clinical verification. • Zoledronic acid should be prescribed on ChemoCare, to assist with the above recommendations. Limitations: This audit was only carried out over a month which will only provide a snapshot of prescribing and results may have been impacted by the COVID-19 pandemic. It was difficult to find documentation for dental checks and treatment delays due to bloods and in some cases, information had to be verified by the prescriber.

4.
Rheumatology (United Kingdom) ; 61(SUPPL 1):i47, 2022.
Article in English | EMBASE | ID: covidwho-1868369

ABSTRACT

Background/Aims Heterotopic ossification (HO) is the abnormal formation and deposition of mature lamellar bone within soft tissue, associated with trauma, surgery, neurologic injury and prolonged immobilisation. Several recent case reports have demonstrated this condition in COVID-19 patients requiring mechanical ventilation. Methods We present a case of heterotopic ossification in the shoulder after a long stay in intensive care unit (ICU) due to COVID-19 infection. Results A 55-year-old man with stable psoriatic arthritis on sulfasalazine was admitted to ICU for mechanical ventilation after contracting COVID-19 infection. After discharge from ICU, he began noticing increasing right shoulder pain with restricted movements of abduction, internal and external rotation. His serum alkaline phosphatase was moderately elevated. Despite physiotherapy and NSAIDs, there was slow improvement. Shoulder x-ray showed significant bony overgrowth around proximal humerus which was initially thought to be part of his psoriatic arthritis. It was confirmed at Rheumatology/Radiology MDT to be heterotopic ossification. A computed tomography of the right shoulder was requested to evaluate the extent of the condition and orthopaedic advice was sought. Conclusion There are many factors contributing to the development of heterotopic ossification including trauma, spinal cord injury, brain injury, hypoxia, prolonged immobilisation with limitation of joint movement and prolonged bed rest which cause alterations in calcium homeostasis, male sex and over 60 years of age. New onset joint pain and stiffness in patients who have recovered from COVID-19 especially those who had long ICU stay should be further investigated for this condition. Treatment includes analgesia and physiotherapy with potential surgical intervention.

5.
Medicina Dello Sport ; 75(1):69-83, 2022.
Article in English | Web of Science | ID: covidwho-1856575

ABSTRACT

BACKGROUND: the prevention protocols of COVID-19 impact several restrictions in the sports world, the influence of this scenario in the athletes with impairment increased associated a multifactorial condition like environment, etiology. or psychological perception. The aim of this study was to identify the influences of impairments and sports on characteristics of load training during the COVID-19 Pandemic, life satisfaction and the expectation about the influence of pandemic on the performance in the Tokyo 2020 Paralympic Games. METHODS: One hundred eighty Brazilian para-athletes, in a cross-sectional study, answered a survey about their training load before and during the Pandemic, satisfaction with life and expectation about their performance. Athletes were divided into three groups according to their sport practiced: individual sports (Ind-1);Individual sports with opposition (Ind-2) and team sports (Team). The data were analyzed by impairments and sports roups. RESULTS: Hours of training, number of sessions and rating of perceived exertion reduced during the pandemic. Limb impairment and spinal cord injurygroups reduced training hours during pandemic. Team group showed lower training sessions per week than the Ind-1 group. No difference was found in life satisfaction among the groups. Most athletes believe that the pandemic will damage their performance in the Tokyo Paralympic Games. CONCLUSIONS: Influences of COVID-19 Pandemic on training loads were identified to all groups, however there were no differences between disabilities or sports in the life satisfaction and expectation about the influence of pandemic on the performance in the Tokyo 2020 Paralympic Games.

6.
Technology and Innovation ; 22(2):157-164, 2022.
Article in English | Web of Science | ID: covidwho-1856501

ABSTRACT

The COVID-19 pandemic has dramatically impacted delivery of outpatient care. Many people with spina bifida (SB) in the U.S. receive outpatient healthcare in a multidisciplinary setting. In accordance with state healthcare mandates, outpatient multidisciplinary clinic visits were deferred, postponed, or canceled, while telemedicine systems were implemented. A survey was created and distributed to all known SB clinics in the U.S. We explored the impact of the COVID-19 pandemic on the delivery of outpatient care for the SB population and the use of telemedicine in response. Novel uses of telehealth, benefits of use, suggestions for overcoming barriers, and future opportunities are identified and discussed.

7.
J Orthop Sci ; 2022 May 15.
Article in English | MEDLINE | ID: covidwho-1851617

ABSTRACT

BACKGROUND: Surgical smoke is a vaporous by-product generated during tissue incision and cauterization with an electric scalpel. This smoke contains tissue- and blood/vascular-derived substances, bacteria, viruses, and chemical substances. Among them, it contains many fine particles called particulate matter (PM) 2.5, which are harmful and hazardous to the human body. We aimed to investigate the occurrence of PM2.5 in surgical smoke produced during spinal surgery and to evaluate the efficacy of an electric scalpel with a smoke evacuation pencil. METHODS: In this retrospective observational study, 89 patients who underwent spinal surgery between June 2019 and May 2021 were included. A dust monitor was installed in the operating room to measure the PM2.5 air concentration during the surgery. During each surgery, the total amount of PM2.5, the maximum PM2.5 air concentration, the exposure time to PM2.5, and the average value of PM2.5 air concentration from the start to the end of the surgery were calculated. RESULTS: We found that in 29 of the 89 cases (32.6%), the air concentration of PM2.5 increased to a level that could cause health damage during the surgery. Twelve cases (13.4%) reached the level that could cause serious health damage, and 8 cases (9%) reached an emergency warning level. The total amount and the maximum and average levels of PM2.5 were significantly suppressed in the surgery with a smoke evacuation pencil group than in the surgery without a smoke evacuation pencil group. CONCLUSION: We detected hazardous levels of PM2.5 in the air during spinal surgery, highlighting the importance of considering smoke control or reduction during spinal surgery. We recommend using an electric scalpel with a smoke evacuation pencil for regulating PM2.5 levels in the operating room.

8.
Clin Case Rep ; 10(5): e05876, 2022 May.
Article in English | MEDLINE | ID: covidwho-1850030

ABSTRACT

Transverse myelitis can be a complication of SARS-CoV-2 infection. We report the case of a transverse myelitis related to SARS-CoV-2 infection. Beyond the disease itself, neurological involvement affects functionality. In this situation, physical and rehabilitation medicine plays a crucial role in managing patient rehabilitation.

9.
Bone Jt Open ; 2(12): 1096-1101, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1846902

ABSTRACT

AIMS: With resumption of elective spine surgery services in the UK following the first wave of the COVID-19 pandemic, we conducted a multicentre British Association of Spine Surgeons (BASS) collaborative study to examine the complications and deaths due to COVID-19 at the recovery phase of the pandemic. The aim was to analyze the safety of elective spinal surgery during the pandemic. METHODS: A prospective observational study was conducted from eight spinal centres for the first month of operating following restoration of elective spine surgery in each individual unit. Primary outcome measure was the 30-day postoperative COVID-19 infection rate. Secondary outcomes analyzed were the 30-day mortality rate, surgical adverse events, medical complications, and length of inpatient stay. RESULTS: In all, 257 patients (128 males) with a median age of 54 years (2 to 88) formed the study cohort. The mean number of procedures performed from each unit was 32 (16 to 101), with 118 procedures (46%) done as category three prioritization level. The majority of patients (87%) were low-medium "risk stratification" category and the mean length of hospital stay was 5.2 days. None of the patients were diagnosed with COVID-19 infection, nor was there any mortality related to COVID-19 during the 30-day follow-up period, with 25 patients (10%) having been tested for symptoms. Overall, 32 patients (12%) developed a total of 34 complications, with the majority (19/34) being grade 1 to 2 Clavien-Dindo classification of surgical complications. No patient required postoperative care in an intensive care setting for any unexpected complication. CONCLUSION: This study shows that safe and effective planned spinal surgical services can be restored avoiding viral transmission, with diligent adherence to national guidelines and COVID-19-secure pathways tailored according to the resources of the individual spinal units. Cite this article: Bone Jt Open 2021;2(12):1096-1101.

10.
Int J Infect Dis ; 118: 264-269, 2022 May.
Article in English | MEDLINE | ID: covidwho-1838867

ABSTRACT

OBJECTIVES: The study aimed to explore the efficacy and safety of linezolid-based chemotherapeutic regimens for patients with postoperative multidrug-resistant spinal tuberculosis. METHODS: The randomized controlled study included 50 Mycobacterium tuberculosis culture or pathological-confirmed multidrug resistant tuberculosis patients who received spinal surgery from January 2018 to February 2020. Twenty-five patients were assigned to the control group and the study group, respectively. Random number method was used for patient allocation and they were treated with levofloxacin, pyrazinamide, thioisonicotinamide enteric-coated tablet, amikacin sulfate injection, and sodium p-amino salicylate injection, accompanied by linezolid or not. RESULTS: The overall effective rate of the study group was higher than that of the control group (88.00% vs 64.00%, P<0.05). The severity of pain at 3 and 6 months postoperatively was lower in the study group than that in the control group (P<0.05). Postoperatively, the study group had higher bone graft fusion rate, shorter mean bone graft fusion time, and higher paraspinal cyst absorption rate than the control group (P<0.05). Postoperatively, the study group had lower levels of PCT, ESR, and CRP than the control group (P <0.05). All patients had normal hepatic and renal function, and no statistical difference of adverse effects between 2 groups were found. CONCLUSIONS: Linezolid-based chemotherapeutic regimens can effectively treat patients with postoperative multidrug-resistant spinal tuberculosis but have higher rates of adverse reactions.


Subject(s)
Linezolid , Tuberculosis, Multidrug-Resistant , Tuberculosis, Spinal , Humans , Linezolid/adverse effects , Mycobacterium tuberculosis/drug effects , Treatment Outcome , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/surgery , Tuberculosis, Spinal/drug therapy , Tuberculosis, Spinal/surgery
11.
Front Neurol ; 12: 739354, 2021.
Article in English | MEDLINE | ID: covidwho-1834471

ABSTRACT

AIM: The aim of this research is to focus on gaining an insight into the knowledge, attitudes, behavioural practises (KAP), and psychological impact relating to COVID-19 among the people living with spinal cord injury receiving in-patient rehabilitation. METHODS: A prospective, cross-sectional survey of people with SCI (N = 207), who were in active in-patient rehabilitation from two tertiary SCI Rehabilitation Centres in Bangladesh. Data were collected via face-to-face interviews, after voluntary consent, using a pretested, language validated questionnaire on Knowledge, Attitude and Behavioural practises (KAP) and the Depression, Anxiety, Stress Scale (DASS-21). Ethical approval and trial registration were obtained prospectively. RESULTS: A total of 207 people with SCI responded, among which 87% were men and 13% were women, with a mean age of 34.18 ± 12.9 years. Within the sample group, people living with tetraplegia comprised 33.8%, and people living with paraplegia comprised 66.2%. Overall, 63.8% of the participants were diagnosed with an SCI categorised as ASIA-A. Overall, the "knowledge score" was 8.59 ± 2.3 out of 12, "depression" was 11.18 ± 8, "anxiety" was 7.72 ± 5.1, and "stress" was 9.32 ± 6.7 from a total of 21 scores each category. The strong correlation was between knowledge, DASS scores, and age (p < 0.05). In addition, there was a strong correlation between knowledge, gender (p < 0.05) and education (p < 0.01). Binary logistic regression found a stronger association of knowledge and DASS scores with gender, young age, illiteracy (p < 0.01), and rural residence (p < 0.05). A positive relationship was found between depression and anxiety scores (p < 0.01) and a moderate positive relationship was found between depression and stress scores (p < 0.01). A positive attitude was reported by the majority of participants (p < 0.05). In terms of behavioural practises, participants reported both self and caregiver had followed health advice with regard to consulting health professionals (65.7%), implementing isolation (63.8%), taking droplet precaution care (87.4%), and hygiene care (90.3%). CONCLUSION: Participants in this study reported high levels of knowledge, adoption of positive attitudes, and the practise of positive health advisory behaviours related to COVID-19 prevention procedures. However, high levels of depression, anxiety, and stress were also reported. Overall, women and younger participants were more likely to have high KAP, whereas those living in rural areas and with literacy challenges were less likely to report high knowledge scores.

12.
Muscle Nerve ; 65(5): 498-507, 2022 05.
Article in English | MEDLINE | ID: covidwho-1813581

ABSTRACT

Spinal muscular atrophy (SMA) is a group of neurodegenerative disorders resulting from the loss of spinal motor neurons. 95% of patients share a pathogenic mechanism of loss of survival motor neuron (SMN) 1 protein expression due to homozygous deletions or other mutations of the SMN1 gene, with the different phenotypes influenced by variable copy numbers of the SMN2 gene. Advances in supportive care, disease modifying treatment and novel gene therapies have led to an increase in the prevalence of SMA, with a third of SMA patients now represented by adults. Despite the growing number of adult patients, consensus on the management of SMA has focused primarily on the pediatric population. As the disease burden is vastly different in adult SMA, an approach to treatment must be tailored to their unique needs. This review will focus on the management of the adult SMA patient as they age and will discuss proper transition of care from a pediatric to adult center, including the need for continued monitoring for osteoporosis, scoliosis, malnutrition, and declining mobility and functioning. As in the pediatric population, multidisciplinary care remains the best approach to the management of adult SMA. Novel and emerging therapies such as nusinersen and risdiplam provide hope for these patients, though these medications are of uncertain efficacy in this population and require additional study.


Subject(s)
Muscular Atrophy, Spinal , Adult , Genetic Therapy , Homozygote , Humans , Motor Neurons/pathology , Muscular Atrophy, Spinal/diagnosis , Muscular Atrophy, Spinal/genetics , Muscular Atrophy, Spinal/therapy , Phenotype , Survival of Motor Neuron 1 Protein/genetics
13.
Pain Physician ; 24(S1):S209-S232, 2021.
Article in English | ProQuest Central | ID: covidwho-1813052

ABSTRACT

BACKGROUND: Transforaminal epidural injections have been used since the late 1990s to treat lumbar radicular pain. They have been the subject of considerable attention, with varying conclusions from systematic reviews as to their efficacy. Transforaminal injections have been associated with rare but major complications. Further, the use of transforaminal injections has increased since the passage of the Affordable Care Act. Finally, with the SARS-CoV-2 pandemic, there has been heightened concern regarding the risk associated with steroid injections. OBJECTIVES: To evaluate and update the effectiveness of transforaminal injections for 4 indications: radicular pain;from spinal stenosis;from failed back surgery syndrome;and for axial low back pain;and to evaluate the safety of the procedure. STUDY DESIGN: A systematic review and meta-analysis of the efficacy of transforaminal injections. METHODS: The available literature on transforaminal injections was reviewed and the quality assessed. The level of evidence was classified on a 5-point scale based on the quality of evidence developed by the US Preventive Services Task Force (USPSTF) and modified by the American Society of Interventional Pain Physicians (ASIPP). Data sources included relevant literature from 1966 to April 2020, and manual searches of the bibliographies of known primary and review articles. Pain relief and functional improvement were the primary outcome measures. A minimum of 6 months pain relief follow-up was required. RESULTS: For this systematic review, 66 studies were identified. Eighteen randomized controlled trials met the inclusion criteria. No observational studies were included. Eleven randomized controlled trials dealt with various aspects of transforaminal injections for radicular pain owing to disc herniation. Based on these studies, there is Level 1 evidence supporting the use of transforaminal injections for radicular pain owing to disc herniation. A meta-analysis showed that at both 3 and 6 months, there was highly statistically significant improvement in both pain and function with both particulate and nonparticulate steroids. For radicular pain from central stenosis there is one moderate quality study, with Level IV evidence. For radicular pain caused by failed back surgery syndrome there is one moderate quality study, with Level IV evidence. For radicular pain from foraminal stenosis and for axial pain there is Level V evidence, opinion-based/consensus, supporting the use of transforaminal injections. Transforaminal injections are generally safe. However, they have been associated with major neurologic complications related to cord infarct. Causes other than intraluminal injection of particulates appear to be at play. The use of an infraneural approach and of blunt needles appear to offer the greatest patient safety. Because of concern over the role of particulate steroids, multiple other injectates have been evaluated, including nonparticulate steroids, tumor necrosis factor alpha (TNF-a) inhibitors, and local anesthetics without steroids. No injectate has been proven superior. If there is concern about immunosuppression because of risk of COVID-19 infection, either the lowest possible dose of steroid or no steroid should be used. LIMITATIONS: The study was limited by the paucity of literature for some indications. CONCLUSIONS: There is Level I evidence for the use of transforaminal injections for radicular pain from disc herniations.

14.
Int J Environ Res Public Health ; 19(8)2022 04 11.
Article in English | MEDLINE | ID: covidwho-1809859

ABSTRACT

BACKGROUND: One of the greatest challenges faced by people following a spinal cord injury is reintegrating into the community. Peer mentors are people who have had shared experiences of disadvantage and distress and have successfully navigated their way through the associated challenges to lead meaningful lives. Historically, peer mentoring services have been predominantly delivered via face-to-face interactions. Little is known about the experience of people with spinal cord injury engaging in online peer support services, and what the challenges and benefits are of this mode of delivery. METHODS: An anonymous online survey consisting of closed and open response questions was used to collect data. Quantitative data were analysed descriptively and qualitative data were analysed using inductive content analysis. RESULTS: Positive benefits of engaging in peer support via videoconferencing included convenience and social connectedness. The main barriers were problems with Wi-Fi and internet connections, inconsistencies between platforms and having to learn new platforms. Even though responses were mixed when comparing videoconferencing to face-to-face peer support, most participants felt socially connected. CONCLUSIONS: Addressing barriers through the provision of appropriate technology, and targeted and individualised assistance, is important to facilitate uptake of online peer support for people with spinal cord injury.


Subject(s)
Mentoring , Spinal Cord Injuries , Humans , Mentors , Peer Group , Spinal Cord Injuries/therapy , Videoconferencing
15.
Child Care Health Dev ; 2022 Apr 20.
Article in English | MEDLINE | ID: covidwho-1807035

ABSTRACT

AIMS: Parents of children with spinal muscular atrophy (SMA) often struggle with the all-consuming nature of the demands of caring for a child with substantial physical needs. Our aim was to explore experiences, challenges and needs of parents of a child with SMA in a COVID-19 pandemic situation. METHOD: Nineteen parents of 21 children (15 months to 13 years of age) with SMA types 1-3 participated in semi-structured interviews in June to July 2020. The interviews were analysed using inductive thematic analysis. RESULTS: Parents mentioned the protection of the health and well-being of the child as the central perspective and driving force during the COVID-19 pandemic. Three subthemes were identified: (1) responsibility, (2) balancing vulnerability and resilience and (3) (in)security. Some parents focused on the positive aspects during the lockdown, such as continuation of nusinersen treatment and family life. Some parents described helpful and positive cognitions to cope with the situation. In general, parents described a need for information with regard to COVID-19 and their child with SMA and a need for discussing their dilemmas and insecurities with a healthcare professional. INTERPRETATION: Parents put the health and well-being of their children first during the pandemic. From this study, we learned that parents of children with SMA need information and value direct contact with a healthcare professional to share their dilemmas and insecurities. The dialogue can help to empower parents in the conflicts and decisions they have to make during a pandemic.

16.
Journal of Sexual Medicine ; 19(4):S60, 2022.
Article in English | EMBASE | ID: covidwho-1796416

ABSTRACT

Introduction: The COVID-19 pandemic has changed the lives of many in the past year. As of writing this article, the virus has claimed over half a million American lives and has infected millions more. It has affected many people regardless of age, gender, race, religion, or medical history. We have noticed a unique sequence of events in urology patients with a prior history of inflatable penis prothesis implantation who have gotten critically ill from the SARS-CoV-2 virus. Objective: We report our experience with patients with an inflatable penile prothesis who suffered respiratory failure due to the SARS-CoV-2 virus and findings that would help limit the risk of implant infection and/or erosion if prolonged urethral catherization is needed. Methods: We have encountered 3 patients with a very similar history in the past year. They were all men aged 57-72 years old who had a functioning inflatable penile prothesis (IPP) for many years (3-13) and were intubated for a prolonged period of time (2-4 weeks) after suffering respiratory distress from the SARS-CoV-2 virus. During this time, they all had a prolonged urethral Foley catherization for urinary drainage while in the ICU. They were all subsequently found to have urethral erosion of a penile implant cylinder which was not present prior to hospitalization. Their charts were reviewed. Results: Two patients underwent explantation of their IPP during their hospital stay and one presented to our outpatient office 2 months after discharge with the complaint of urethral cylinder erosion and underwent subsequent explantation. Conclusions: Urethral catheterization is commonly used in the intensive care unit and spinal cord injury patients due to their convenience and efficacy. The friction and inflammation created by prolonged transurethral catheterization can be disastrous for IPPs by increasing the likelihood of infection and/or device erosion. In fact, Steidle and Mulcahy found that five out of their nine patients (55%) with IPPs who had an indwelling or intermittent transurethral catheterization were eventually found to have erosion of their IPP. In addition, indwelling transurethral catheters also confer a higher risk of urinary tract infection. Han et al. found that suprapubic tube placement conferred a statistically significantly lower risk of urinary tract infection when compared to indwelling transurethral catheterization for over five days at an odds ratio of 0.142 (95% CI 0.073-0.0276). Another alternative to bladder drainage in the intubated IPP patient is clean intermittent catherization (CIC), however this poses a unique challenge in the intubated COVID positive patient as it repeatedly exposes healthcare staff the virus-carrying patient. When compared to indwelling transurethral catherization, suprapubic tube placement has been shown to confer a lower risk of urinary tract infection and IPP infection/erosion. This can primarily be explained by its ability to drain the bladder without creating inflammation and friction in the urethra. Therefore, we propose that any team caring for a patient with an IPP and a planned, prolonged indwelling transurethral catheterization consult urology services to have a suprapubic tube temporarily placed. This will ensure that the risk of urinary tract infection and/or IPP erosion is kept as low as possible. Disclosure: Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific, Neotract

17.
Turk Noroloji Dergisi ; 28(1):51-54, 2022.
Article in English | EMBASE | ID: covidwho-1792131

ABSTRACT

Since the first case has emerged, different neurological complications associated with Coronavirus disease-2019 (COVID-19) have been reported all over the world. The association between coronavirus and Guillain-Barré syndrome (GBS) has also been reported before. Unfortunately, there is no certain mechanism about this association yet. Molecular mimicry is one of the first hypotheses to express the undesirable autoimmunity in GBS. According to this;the antibodies produced against virus may target peripheral nerves or spinal nerve roots. The entity of direct viral neurotoxicity has also been discussed. Here, we presented four variants of GBS associated with coronavirus that we followed up in our clinic between September-December 2020. While the first patient had demyelinating sensorimotor neuropathy concurrent with COVID-19, the other ones were postinfectious. The second patient had motor axonal neuropathy and the third one had sensorimotor axonal neuropathy. There was Miller-Fisher syndrome and GBS overlap in the fourth patient.

18.
Arch. Neurosci. ; 9(1):5, 2022.
Article in English | Web of Science | ID: covidwho-1791961

ABSTRACT

Background: One of the chronic diseases with various challenges for patients and caregivers is spinal cord injury (SCI). The spread and prevalence of coronavirus disease 2019 (COVID-19) have been an influential risk factor for abuse. Objectives: The aim of this study was to assess the rate of abuse in patients with SCI during the COVID-19 pandemic. Methods: This cross-sectional descriptive study population was all SCI cases in Ilam, Iran. Researcher-made forms and questionnaires with confirmed validity and reliability, including the demographic characteristics, form and perceived abuse researcher-made questionnaire for people with SCI, were used. The perceived abuse questionnaire for patients with SCI was a researcher-made questionnaire designed based on library studies, interviews with patients, and determination of abuse instances. This instrument consists of 20 questions answered as yes (score 1) or no (score 0). After data collection, statistical analyzes were performed using the SPSS software version 16. Results: According to our results, the mean +/- SD of the perceived abuse score by caregivers and patients was 8.48 +/- 2.31 and 42.45% during the COVID-19 pandemic, respectively. Moreover, the mean +/- SD of the age of patients was 62.86 +/- 19.15 years, and the patient abuse increased with elevation in age (P = 0, F = 27.42). The possible abuse score was 0 - 20 divided into three categories of low (20, 20.4%), moderate (76, 76.5%), and high (2, 2%). The perceived abuse score was significantly higher among women and patients with a history of more than 10 years of SCI. Abuse prevalence did not have a significant relationship with income and marital status. Regarding age and abuse, our results showed a rise in perceived abuse scores with an increase in age. Conclusions: The present study showed that it is necessary to take measures to prevent abuse in patients with SCI. Moreover, the prevalence of abuse related to COVID-19 in patients with SCI was high. Therefore, preventive actions need to be proposed in this field.

19.
Top Spinal Cord Inj Rehabil ; 28(2): 185-195, 2022.
Article in English | MEDLINE | ID: covidwho-1786626

ABSTRACT

Background: Emerging evidence suggests that the COVID-19 pandemic has been accompanied by increased rates of depression and social isolation. However, we do not yet understand how the COVID-19 pandemic has affected the psychosocial health of people with spinal cord injury (PwSCI), a population that is already at risk of experiencing mental health conditions. Objectives: The aims of the study were to (1) examine the impact of the pandemic on the psychosocial health of PwSCI and (2) investigate the experiences of PwSCI and resources they reported needing during the peak of the pandemic. Methods: A cross-sectional survey with closed- and open-ended questions was administered to 51 PwSCI. Participants were included if they had an SCI, were 18 years or older, lived in St. Louis, Missouri, and surrounding areas, and understood English. Results: Canonical correlation showed a significant association between financial security, food insecurity, and personal assistance service use and adverse psychosocial health outcomes (p < .001). Participants reported interest in resources related to COVID-19 precautions for wheelchair users as well as home exercise programming and financial assistance with utilities. Finally, qualitative analysis revealed four major themes: (1) mental health during the pandemic, (2) financial concerns and reduced access to personal assistance services, (3) feelings of social isolation prior to the pandemic, and (4) local and national authorities' handling of the pandemic. Conclusion: PwSCI are impacted by the COVID-19 pandemic and reported a variety of resource needs. These findings may inform service providers, support systems, and organizations to better support PwSCI during times of crisis.


Subject(s)
COVID-19 , Spinal Cord Injuries , Cross-Sectional Studies , Humans , Pandemics , SARS-CoV-2 , Spinal Cord Injuries/complications , Spinal Cord Injuries/epidemiology
20.
Journal of Clinical Oncology ; 40(6 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779703

ABSTRACT

Background: Caregiver burden has been intensified by the COVID-19 pandemic. The Carer Well-being Index is a global research study commissioned by Embracing Carers, a partnered initiative with nine global caregiving organizations. The study sought to explore and delineate the impact of the pandemic on the health and well-being of caregivers across the globe, including those caring for persons with cancer. Methods: The survey was conducted via online and phone methodologies in September and October 2020, with over 9,000 unpaid carers across 12 countries, including the United States and Canada. Unpaid carers were defined as those who care for someone with a long-term illness (e.g., cancer), physical disability (e.g., spinal cord injury), or cognitive/mental condition (e.g., Alzheimer's). The base sample size for cancer caregivers from the global surveyed population was n=1035. Statistically significant differences between cancer carers and non-cancer carers were evaluated using the Chi-square test with p ≤ 0.05. Results: 63% of all caregivers were women, with a 60/40 female to male split in the cancer carer group. While the average age of started caregiving was 37.2 years, and 39.0 in cancer carers, caregivers caring for someone with cancer were more likely than the average caregiver to be in the 60+ age group. Compared to non-cancer caregivers surveyed, a higher percentage of cancer caregivers became carers in the last year (26 vs 13% of non-cancer caregivers). Providing emotional support, managing doctor appointments, preparing meals, home maintenance and housekeeping, transportation, and giving/managing medications were more likely to be among cancer caregivers' primary responsibilities, compared to non-cancer caregivers. Cancer carers were significantly more likely than non-cancer carers to have reported negative impacts because of COVID on their emotional/mental, physical, and financial health, and paid work responsibilities. Overall, cancer caregivers were significantly more likely to report that COVID has made caregiving harder than non-cancer caregivers (71 vs 63%), and were more likely to report never receiving support from a variety of organizations, such as insurance organizations (71 vs. 66% non-cancer caregivers) and local/state government (73 vs. 66%). Of note, cancer carers were more likely to report a positive impact on the relationship with the person being cared for (61 vs. 56%). Conclusions: These results highlight the burdens that have been intensified for cancer carers. Actions are needed to help with health and well-being such as offering and promoting mental health services, respite care;providing financial support to take leaves from paid work, access to equipment and services such as housecleaning. By working together with health care providers, organizations, and government on these types of initiatives, the burden upon cancer caregivers can be lessened.

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