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1.
Medicine - Programa de Formación Médica Continuada Acreditado ; 13(63):3737-3740, 2022.
Article in English | ScienceDirect | ID: covidwho-2031557

ABSTRACT

Resumen La espirometría y la medición de la capacidad de difusión del monóxido de carbono son dos pruebas básicas en el algoritmo diagnóstico de la mayoría de las enfermedades pulmonares, debido a su amplia disponibilidad, sencillez y bajo coste. Son importantes también en la valoración prequirúrgica y la valoración de la discapacidad, así como en el ámbito de la medicina legal y del trabajo. Son pruebas fundamentales para establecer el pronóstico de determinadas enfermedades, como en el caso de las enfermedades pulmonares intersticiales. Requieren de personal de enfermería entrenado para su realización y deben realizarse en laboratorios de función pulmonar que cumplan una serie de requisitos técnicos. La actual pandemia por el virus SARS-COV-2ha obligado a crear documentos y protocolos específicos por parte de las sociedades científicas para poder realizar estas pruebas con seguridad. Spirometry and the measurement of carbon monoxide diffusion capacity are two basic tests in the diagnostic algorithm of most lung diseases given their widespread availability, simplicity, and low cost. They are also important in presurgical evaluations and the evaluation of disability, as well as in the fields of legal and occupational medicine. They are fundamental tests for establishing the prognosis of certain illnesses, such as interstitial lung diseases. They require trained nursing department staff to conduct them and they must be performed in lung function laboratories that meet a series of technical requirements. The current SARS-CoV-2 pandemic has made it necessary for scientific societies to create specific documents and protocols in order to safely conduct these tests.

2.
J Clin Med ; 11(3)2022 Feb 06.
Article in English | MEDLINE | ID: covidwho-2010134

ABSTRACT

BACKGROUND: In patients with Duchenne Muscular Dystrophy (DMD), the respiratory system determines the quality and length of life; therefore, the search for easy and safe everyday monitoring of the pulmonary function is currently extremely important, particularly in the COVID-19 pandemic. The aim of the study was to evaluate the influence of a three-month home electronic spirometry (e-spirometry) monitoring of the pulmonary function and strength of respiratory muscles as well as the patients' benefits from this telemetric program. METHODS: Twenty-one boys with DMD (aged 7-22; non-ambulatory-11) received a remote electronic spirometer for home use with a special application dedicated for patients and connected with a doctor platform. Control of the hospital spirometry (forced vital capacity-FVC, forced expiratory volume in 1 second-FEV1, peak expiratory flow-PEF) and respiratory muscle strength (maximal inspiratory-MIP and expiratory pressures-MEP) before and after the three-month monitoring were performed as well telemonitoring benefit survey. RESULTS: A total of 1403 measurements were performed; 15 of the participants were able to achieve correct attempts. There were no differences between the hospital and the home spirometry results as well as between respiratory muscle strength during v1 vs. v2 visits for the whole study group (all parameters p > 0.05); the six participants achieved increased value of FVC during the study period. There was a positive correlation between ΔFVC and the number of assessments during the home spirometry (r = 0.7, p < 0.001). Differences between FVC and MIPcmH2O (r = 0.58; p = 0.01), MEPcmH2O (r = 0.75; p < 0.001) was revealed. The mean general satisfaction rating of the telemonitoring was 4.46/5 (SD 0.66) after one month and 4.91/5 (SD 0.28) after three months. The most reported benefit of the home monitoring was the improvement in breathing (38% of participants after one month, 52% after three months of telemonitoring). Forgetting about the procedures was the most common reason for irregular measurements; the participants reported also increased motivation but less time to perform tests. CONCLUSIONS: The study indicates high compliance of the home telemonitoring results with the examination in the hospital. Benefits from home spirometry were visible for all participants; the most important benefit was breathing improvement. The remote home spirometry is usable for everyday monitoring of the pulmonary function in DMD patients as well can be also treated as respiratory muscle training.

3.
Indian Journal of Critical Care Medicine ; 26:S114-S115, 2022.
Article in English | EMBASE | ID: covidwho-2006403

ABSTRACT

The second wave of the pandemic exposed many hospitals to their unpreparedness to handle sudden surge patients due to lack of infrastructure to handle the relentless inflow of pts whilst also running short of beds, o2, ventilators, trained HCW's, PPE, medications, and other essentials. The aim of the study was to use judiciously the available resources, fine-tune the patient care, reduce the workload and burden of HCW s, optimize pts care, and improve the outcomes. This observation was done at a tertiary care hospital. The following fine-tuning was done: 1. Oxygen: Robust O2 systems that would support the pandemic, would take time to put in place, so conducting training programmers in a short period for HCW regarding optimal usage and avoid misusing or wastage of O2 was done in a relatively short time. We selected an HCW as O2 provider, the only job to check o2 delivery and SPO2 around the clock. 2. Foleys Catheters and Diapers: Patients on high O2 requirements when mobilized, O2 delivery to patients were discontinued along with disruption of prone positions and derecruitment of lungs and had severe hypoxia. So we started catheterizing the pts on high O2 need. 3. Family Visit: Family visits made pts comfortable, more compliant to the care. And it also reduced the significant burden of HCW's who had to otherwise communicate multiple times with their relatives via audio or video phone calls. This also brought transparency of the care. 4. Simple Protocols: We simplified the charts with only two sheets, one for the doctor one for the staff. These simple changes made work easy and more efficient and also help in collecting data. 5. DRUG Boy: Drugs indenting and on-time delivery were challenging. We selected a person only for drug delivery and later with drugs becoming precious and anticipating problems, drug boy used to deliver medications to the patient in presence of family. 6. Continuous Monitoring by a Leader: COVID is a dynamic process and requires continuous monitoring, timely interventions. Leaders have to take complete charge continuously from admission to discharge. Fragmented care by multiple people worsens the situations. 7. DVT Stockings: COVID is a prothrombotic state for the prevention of clots all moderate to severe pts were applied DVT stockings, along with chemoprophylaxis which prevented DVT significantly. 8. Anxiolytics, Restricted Mobilization, and Spirometry: Mild anxiolytics reduced the stress, work of breathing, and good compliance to the NIV. Strict restriction in mobilizing and adequate spirometry was supervised in moderate to severe COVID patients in the early stages to help in early recovery from COVID-19. 9. Prone Position in COVID: In moderate and severe ARDS in patients on O2 with face mask, O2 by BIPAP support and in invasively ventilated patients were subjected to prone positioning for 16-18 hours/day, which helped in improving lung recruitment oxygenation of patients and better outcomes while reducing the oxygen requirements. Conclusion: COVID pandemic is very challenging. Conservative management and fine-tuning of the resources available will have multiple benefits and also improve outcomes. With these innovations, quality will improved was costeffective and easily replicable in any hospital.

4.
Indian Journal of Critical Care Medicine ; 26:S100-S101, 2022.
Article in English | EMBASE | ID: covidwho-2006390

ABSTRACT

COVID pandemic has made the health care system difficult to prepare for demanding situations. Second wave of the pandemic made many hospitals unable to handle the relentless inflow of patients whilst also running short of beds, oxygen cylinders, health care workers, and other essentials, with limited resources, we had two challenges to secure better supplies and judiciously use the resources. The aim of the study was to use judiciously the resources, fine tune the patient care, reduce the work load/burden of HCW and improve the outcomes and to see whether these fine tuning will sustain better care and improve the outcomes This observation is done at tertiary care centre. The innovation or fine-tuning were done as follows, 1. Oxygen Boy: The O2 is lifesaving in COVID-19 and its a long game. The neglect of O2 systems have been partly market failure, partly lack of knowledge and anticipation, and misuse Robust O2 systems that would support the pandemic take time to put in place, so conducting training programmes in short period for HCW regarding using or misusing O2 can be done in the relatively short times if there is good planning and management. We selected an HCW as O2 boy;his job was only checking O2 delivery and monitoring SPO2. He was given SPO2 targets to maintain. He would adjust the O2 depending on the targets, we found care was better, reduced O2 misuse, and less burden on HCW including hospital authorities. He also used to monitor continuous prone positions. 2. Foleys Catheters and Diapers: Due to the shortage of ICU/HDU beds during the peak of pandemic, moderate to severe patients were managed in wards with close monitoring. In the initial stages, we faced problems in patients on high o2 when they were mobilized to restrooms. Continuous o2 awake prone was disturbed and derecruited and had severe hypoxia with symptoms and few near codes. So we started catheterizing the patients on high o2 requirements/ elderly, and diapers used if very hypoxic. After these changes the surprises were less, compliance for care was more, and complaints from the patients were very less. 3. Family Visit: Allowing family person visit with precautions was very useful. Family visits made patients comfortable, more compliant with the care, families were happy and reduced the significant burden of HCW's and brought transparency of the care. Complaints of misusing of the drugs were less. 4. Simple Protocols: Due to scarcity of HCW and over working, we analyzed the work flow and found more time was taken for documenting and following the reports than actual patient care. So we simplified the charts with only two sheets, one for the doctor one for the staff. These simple changes made work easy and more efficient and also help in collecting data. 5. 'Drug' Boy: Drugs indenting and on-time delivery was challenging with limited staff and a high workload. We selected a person only for drug delivery and later with drugs becoming precious and anticipating problems, drug boy used to deliver in family presence. This reduced the further burden of HCW's. 6. Continuous Monitoring by a Leader: COVID is a dynamic process and requires continuous monitoring, timely interventions. Leaders have to take complete charge continuously from admission to discharge. Fragmented care by multiple people worsens the situation. 7. Support from the Other Specialities: With above mentioned fine tuning, we found rounds by any specialists doctors was comfortable, less time-consuming, and could manage many patients. This reduces the burden of intensivists and physicians. 8. Monitored Hydration: Most patients were hydrated in view of reduced appetite, druginduced, third spacing, and on NIV. This simple regime significantly reduced acute kidney injuries. 9. DVT Stockings: COVID is a prothrombotic state for the prevention of clots all moderate to severe patients were applied DVT stockings, this prevented DVT significantly. 10. Anxiolytics, Restricted Mobilization, and Spirometry: Mild anxiolytics reduce the stress, work of breathing, and good compliance to the NIV. Stric restriction in mobilizing and no spirometry in moderate to severe COVID in early stages. Conclusion: COVID pandemic is very challenging, till data no proper pharmacological treatment available. So fine tuning of the resources available will have multiple benefits and also improve outcomes. With these innovations, quality improves, cost-effective, and can easily be replicable in any centre.

5.
Clinical Nutrition ESPEN ; 48:496-497, 2022.
Article in English | EMBASE | ID: covidwho-2003951

ABSTRACT

Malnutrition, both severe and acute in covid 19 patients are particularly serious problems, may depress the immune system further indicating a poor outcome in terms of morbidity, quality of life and mortality1. Thus, dietary intake may play a major role in determining nutritional status of patients with pneumonia due to COVID 19. Aim was to screen and evaluate the intake of macro-nutrients in subjects who could tolerate oral intake with mild to moderate pneumonia due to Covid 19 assessed for nutritional status, fat free mass index (FFMI) and basic lung function. A cross sectional study was carried out on 71 patients admitted to an ICU in an urban multispecialty hospital from August 2020 to January 2021. Nutritional status, lung function, body composition was assessed using Patient generated Subjective global assessment (PGSGA), Spirometry and Fat Free Mass Index (FFMI) respectively. Dietary intakes were assessed using Food record charts (FRCs). The results show that higher proportion of subjects were unable to meet the RDI for energy (56%), protein (90%) and fat (66%);carbohydrate intake was above RDI (41%) despite of providing oral nutritional supplements in an attempt to meet the required dietary allowance and nutritional needs in these subjects. 24 (73%) subjects out of 33 under stage B & C reported lack of appetite with early satiety. Mean age of the patients was 62± 8.8 yrs. and mean BMI on admission was 21.1± 4.2 kg/m2. [Formula presented] In conclusion subjects included in this study with better nutritional status and nutrient intakes had better lung function. Hence, early identification of malnutrition by screening, assessment with timely nutrition intervention in COVID 19 subjects by fueling of deficits in nutrient intake may preserve lean body mass, improve nutritional status, avoid deterioration of lung function due to malnutrition thus leading to a probable positive prognosis of the disease. References 1. Damayanthi HDWT, Prabani KIP. Nutritional determinants and COVID-19 outcomes of older patients with COVID-19: A systematic review. Arch Gerontol Geriatr. 2021 Jul-Aug;95:104411.

6.
Lung Cancer ; 165:S21-S22, 2022.
Article in English | EMBASE | ID: covidwho-1996669

ABSTRACT

Introduction: The NHS England Targeted Lung Health Check (TLHC) programme is now live in 23 sites. Expansion to 20 further projects planned in early 2022 will enable every Cancer Alliance the opportunity to participate and scope requirements for a potential national programme. Combined, these cover a population of ~1.35m of an estimated 6.25m ever-smokers aged 55 to 75 nationally (ONS 2019). We present our preliminary findings. Methods: Data returns are collected from sites by the NHS Strategy Unit and collated by Ipsos MORI for independent evaluation. Data management summaries are available to the national team on a quarterly basis to review where improvements might be necessary. A ‘Shiny app’ dashboard summarises site level data returns on a monthly basis. Diagnosis data typically lag behind invitation, LHC and low dose CT (LDCT) completion data due to time taken to confirm diagnosis. Onboarded site data includes retrospective historical activity since inception. Results: 172,684 participants have been invited for TLHC (at 30th September 2021), with 57,409 TLHCs completed approximately equally split across 23 original and ‘onboarded’ sites (phase 2). 33,593 LDCT scans have been undertaken (22,986 baseline). 402 lung cancers are presently reported (1.75% of participants referred for LDCT), but can under-estimate most recent/earliest onboarded cancer diagnoses and require continuous quality assurance. Early data suggests ~80% of cancers found are stage 1 or 2. 95% of responders to the TLHC attendee survey rated their experience as ‘very good’ or ‘good’. The COVID-19 protocol addendum including virtual LHCs and pause on spirometry allowed the programme to continue to grow throughout the pandemic. Conclusions: TLHC teams have made impressive progress in engaging participants with their programmes despite a respiratory pandemic. Preliminary results are as expected and encouraging. Careful adherence to quality assurance and mitigation of potential barriers, particularly workforce is crucial to optimise further expansion

7.
Anaesthesia, Pain and Intensive Care ; 26(3):368-381, 2022.
Article in English | EMBASE | ID: covidwho-1998179

ABSTRACT

Background & Objective: Every operating room has been associated with a variety of occupational hazards, but not many studies have been conducted to assess and address these hazards. We used a qualitative approach to explore operating room personnel's experiences of workplace hazards and how these hazards threaten their occupational safety and health (OSH). Methodology: This qualitative study was conducted in five teaching hospitals in the south-west of Iran from February 2019 to March 2021. The sample was 24 operating room personnel who were selected under convenient sampling technique. Data were collected using semi-structured, individual interviews, document review and non-participant observation. The collected data were analyzed according to the qualitative content analysis method using MAXQDA v. 2020. Results: After prolonged analysis of the data, the researchers extracted 644 codes, 13 subcategories, 4 categories, and 1 main theme. The main theme of the study was working in a context of occupational hazards. Conclusions: Operating rooms are full of potential dangers, which, when combined with the personnel's negligence and management inefficiencies, increase the risk of occupational health and safety. Therefore, making working conditions safe by providing adequate personal protective equipment (PPE), in-service training, and identifying and managing the causes of personnel negligence are recommended. Moreover, strategies should be introduced to manage stress and conflicts among the healthcare personnel, thus controlling psychological hazards.

8.
Journal of Cystic Fibrosis ; 21:S124-S125, 2022.
Article in English | EMBASE | ID: covidwho-1996788

ABSTRACT

Objectives: The aim of this ongoing longitudinal study is to examine the effects of elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) on aspects of physical fitness (PF, strength endurance, explosive power, coordination under time pressure, coordination for the precision aspect, trunk flexibility, peak workload, habitual physical activity (HPA, steps/day, intensity), and zscores of FEV1 and BMI in children with cystic fibrosis (CF)). All children have been receiving ELX/TEZ/IVA for 19.2 ± 10.4 (11–33) months. Methods: Six children with CF agreed to participate (3f/3 m) mean age 13 ± 4yrs (9–17 yrs), FEV1 z-score − 1.017 ± 1.817 (-3.2–0.8). PFwas assessed using 5 test items at baseline and 4.51 ± 0.98 years later;strength endurance (PU push-ups, SU sit-ups), explosive power (SLJ standing long jump), coordination under time pressure (JSS jumping side to side), coordination for the precision aspect (BB balancing backward on beams), and trunk flexibility (FB, forward bend). Cycle-ergometry (Godfrey-protocol) was used to determine Wpeak. Lung function was measured by spirometry. Results: Significant improvements were seen in test items representing strength endurance (PU, SU) and coordination under time pressure (JSS) (p < .05). Although HPA expressed as steps/day remained the same, thetime of moderate to vigorous intensity of HPA decreases significantly (p < .05). A slight, not significant, improvement of BMI Z-score was observed (p > .05). No or small changes could be observed for the parameter FEV1 z-score, Wpeak, PF, SLJ, BB and FB (p > 0.05). Conclusion: ELX/TEZ/IVA therapy seems to be a facilitator to increase some aspects of PF. The decrease in intensity of HPA is possibly an effect of the COVID-19 Pandemic that has already been described in healthy and asthmatic children. In this ongoing study, we assume that clearer effects will be shown with a greater number of children included. However, ELX/ TEZ/IVA enhanced muscle strength endurance in children with CF.

9.
Journal of Cystic Fibrosis ; 21:S124, 2022.
Article in English | EMBASE | ID: covidwho-1996787

ABSTRACT

Background: Due to disease progression, people with cystic fibrosis (PwCF) were expected to lose 1–2% of the FEV1% predicted per year along with decreased exercise tolerance, malabsorption and weight loss. Research into the development of CFTR modulators has dominated PwCF research, and in 2020, NHSE agreed to a deal which made approximately 80% of PwCF eligible for Triple Modulator Therapy (Kaftrio®). The combination of the elexacaftor/tezacaftor/ivacaftor has shown improvements in the structure and function of the NaCl channels. PwCF reported improvements in: energy, strength, breathing, sputum production, diabetes control, BMI and lung function (Edgeworth 2017).Wewere therefore interested to observe the effects of Kaftrio® on our patient group at Nottingham University Hospitals Trust (NUH) Objectives: To observe the physiological effects of Kaftrio® in regard to weight, FEV1, grip strength and 6MWT in adult PwCF at NUH Methods: A retrospective observation of 99 eligible patients who attended the NUH (Sept 20-March 21) was undertaken on initiation of on-license Kaftrio®. Patients were seen on initiation and after 3 months. Data was collected as part of their routine MDTAnnual Assessment process (Weight, FEV1, grip strength and 6MWT). Results: Of the 99 patients (aged 18–50) we observed, weight +4.14% (n = 55), FEV1 +22.5% (n = 42), grip strength − 0.48% (n = 41) and 6MWT +1.14% (n = 36). Limitations: Patient dissent to assessments, interrater reliability, variability in spirometry device, COVID-19 pandemic restrictions and side effects resulting in termination of Kaftrio®. Conclusions: Overall improvement occurred in all areas except for grip strength. It is encouraging to see a general improvement within our cohort of patients which reflects changes aligned with international research. However, the reduction in chest symptom burden does pose the question of the nature of thephysiotherapy involvement in cystic fibrosis for thefuture.

10.
Journal of Cystic Fibrosis ; 21:S93, 2022.
Article in English | EMBASE | ID: covidwho-1996782

ABSTRACT

Background: Respiratory management of cystic fibrosis (CF) relies on accurate monitoring of trends in lung function. The COVID-19 pandemic accelerated uptake of home spirometers at our paediatric & adult CF centres. Objectives: To establish the reliability and consistency of home-measured spirometry compared to clinic spirometry in children with CF. Methods: A single centre retrospective study. A timeline was constructed for each individual consisting of 3 pre-pandemic hospital clinic sessions and 3 subsequent virtual sessions. The acceptable period between sessions was 3–12weeks. Remote deviceswere Nuvoair® Next or Spirobank® Smart. Control data from CF adults with concurrent clinic and home Nuvoair® data in 2019. Accepted FVC & FEV1session values were used to calculate coefficient of variance (CoV). Sessions graded as ‘F’ (ATS guidelines) were noted but excluded. GLI percent predicted values were used, with height values interpolated from growth charts if necessary. Results: Sequential spirometry data and baseline demographics are shown in table 1 (n = 139). The proportion of acceptable and unacceptable spirometry (ATS) did not differ between Nuvoair® and hospital measurements. There were more A grades and fewer F grades with hospital spirometry. (Table Presented) Conclusions: Routine home spirometry had acceptable variability and quality compared to hospital measures. The step-up in home spirometry measurements for children using Nuvoair® was not seen in pre-pandemic adult data. The differences between home and hospital measures in children suggest an influence of isolation above that of equipment differences.

11.
Journal of Cystic Fibrosis ; 21:S82, 2022.
Article in English | EMBASE | ID: covidwho-1996774

ABSTRACT

Objectives: To analyse characteristics of people with cystic fibrosis (PwCF) who were using home spirometry devices (HS) during 2020–2021 Methods: During the COVID-19 pandemic, the CF Foundation (CFF) partnered with a technology vendor, ZephyRx, to distribute MIR HS devices to eligible PwCF. During 04/2020–12/2021, 20,157 spirometers were shipped to PwCF. PwCF enrolled in the CFF patient Registry (CFFPR) provided an additional consent to have their HS values linked to their CFFPR data. An application programming interface (API) was built to allow transfers of HS data (FEV1, FVC, FEF25–75, sex, date of birth, height) from each device. Each record contained a CFFPR ID to enable its linkage to the CFFPR. This analysis uses CFFPR data to describe the HS cohort and the data obtained through API to characterise HS utilisation trends. Demographic and clinical characteristics between the HS cohort and the 2019–2020 CFFPR population ages 7 and older were also compared. Results: 272 (94.4%) CF programs participated in the HS program. Records of 1,537 patients, who had activated their device by January 10, 2021, or earlier were linked to CFFPR. The cohort was 69.8% adult, 89.5% Caucasian, 57.8% female, and had a mean age of 27.8, and mean FEV1 of 79.9% predicted. When compared to the CFFPR population, the HS cohort was older, contained more Caucasians and females, and had lower lung function. The median number of acceptable FEV1 measurements supplied per PwCF was 4 (IQR 2–8). 1065 (69%) PwCF in the HS cohort continued to use their device 6 months from activation. Conclusions: HS data has the potential to augment care and research databases like the CFFPR. Little is known about PwCF’s long-term usage of HS devices in a real-world setting. While the HS cohort is small and may be biased compared to the CFFPR population, we have established a reliable channel for collecting HS data and that PwCF’s usage patterns suggests that most are using the devices on a regular basis.

12.
Journal of Cystic Fibrosis ; 21:S70-S71, 2022.
Article in English | EMBASE | ID: covidwho-1996772

ABSTRACT

Objectives: Elexacaftor/tezacaftor/ivacaftor (ETI) combination therapy - Kaftrio® was approved for use in the UK in August 2020 for those aged >12 years. Our study aimed to study the effects of ETI therapy on lung function and exercise performance. Methods: Two-centre retrospective analysis of clinical data obtained during patients’ annual review assessments. Patients had undergone spirometry and static lung volume measurements followed by an incremental maximal ramp cardiopulmonary exercise testing (CPET) performed on a cycle ergometer. Data were analysed using a paired sample t-test. Results: Lung function improvement did not reach statistical significance. Of note, four patients had a baseline (pre-ETI) FEV1 belowthe lower limit of normal (LLN <-1.64 Z scores), and one improved their FEV1 from 41% predicted to 87% with Kaftrio®. Five had a VO2peak% predicted below the LLN (< 85% predicted) prior to treatment and 8 post treatment. Therewas a significant fall in VO2peak % predicted, p = 0.03. However, this was not seen in the VO2peak relative to bodyweight, p = 0.07. There was also a significant fall in VO2 at anaerobic threshold (AT) as a % of predicted VO2peak, p = 0.01. Table 1. (Table Presented) (Table Presented) Conclusions: This real-world study suggests Kaftrio® does not improve exercise capacity in the majority of CF patients. It is hypothesised that the lack of improvement may be due to a reduced physical activity over the study period as a result of feeling better on Kaftrio® and also the SARSCoV2 pandemic. The decrease in VO2 at AT would support the hypothesis of physical deconditioning. The reasons for not seeing statistical differences in lung function are likely to represent the relatively high baseline FEV1 alongside small study numbers. In summary, whilst having the potential to be a performance-enhancing drug, performance gains on Kaftrio® can only occur if matched by training, and studies to investigate the training potential of Kaftrio® are required.

13.
Journal of Cystic Fibrosis ; 21:S48, 2022.
Article in English | EMBASE | ID: covidwho-1996759

ABSTRACT

Objective: The COVID-19 pandemic triggered a worldwide need for telehealth services. Previously providing services in remote communities, virtual consultations were implemented to accommodate the needs of people with CF (pwCF) who were shielding and unable to attend faceto- face consultations. Method: This group has compiled a CF Physiotherapist’s toolkit of essential elements necessary to enable delivery and promotion of safe, equitable virtual sessions, specific to pwCF. Through international collaboration and shared experience, the toolkitwas developed to support physiotherapists working across paediatric and adults with CF. Results: Centres implementing telehealth into routine care need rigorous methods to evaluate safety and effectiveness ensuring optimal care. Using telehealth for joint sessions with shared care centres, or during transitional periods, should be considered ensuring equitable access and specialised care for all. The health benefits of telehealth, the coincident enhanced control of cross infection and resource savings, to the hospital and the person/family with CF in time and travel costs, are invaluable. A blend of virtual and faceto- face consultations could be the mainstay of future CF care. CFTR modulator therapy, improved specialised care, and improving life expectancy is compelling clinicians to review current services, improve efficiencies and continually optimise care and health outcomes. Telehealth, may provide an option for alternative models of care which may not be suitable for all but should be considered as an option in future CF services. Conclusions: Using this toolkit, the CF Physiotherapist is provided with relevant guidance and support for delivery of online/virtual respiratory review, spirometry assessment, evaluation of inhalation therapy, airway clearance and exercise opportunities. The toolkit promotes an equitable translation from face-to-face care to virtual care and includes strategies for risk mitigation in the virtual setting.

14.
Journal of Cystic Fibrosis ; 21:S46, 2022.
Article in English | EMBASE | ID: covidwho-1996756

ABSTRACT

Objectives: The use of digital technology for remote monitoring has increased within CF care in recent years, including the use of remote spirometry. The challenges posed by the COVID-19 pandemic have also meant that delivery of CF care virtually has been required. The NuvoAir platform allows for remote lung function monitoring and is validated for spirometry, however there is no real-world data comparing results to hospital spirometry within an adult CF cohort. FEV1 is an established marker of disease progression within CF. Accurate spirometry results are therefore key in guiding appropriate decision-making. Repeatability of FEV1 and FVC is defined as results being within 150 mls of each other. Methods: FEV1 (L) completed by CF patients at St Bartholomew’s Hospital, on the same day on the NuvoAir Air Next spirometer and SentrySuite Vyaire Medical software, were recorded. Spirometry was completed at either an outpatient review, MDT clinic or during admission. Results were collected between August 2020 and December 2021. Results: A total of 46 sets of results were recorded. The mean difference between FEV1 (L) on the 2 devices was 0.035L (1.6%). The correlation between the FEV1 (L) on the NuvoAir Air Next and SentrySuite was statistically significant (p = 0, r = 0.97). The number of FEV1 results that varied by more than 150mls between devices was 22/46 (47.8%). Conclusion: FEV1 results from the 2 devices showed a statistically significant correlation and a small mean difference. However, as almost half of the sets of results varied by more than is acceptable for determining repeatability, the 2 devices cannot consistently be perceived to be comparable in clinic practice. Further data collection is needed to review the sensitivity to change on the NuvoAir Air Next device compared with hospital spirometry software within a CF cohort.

15.
Journal of Cystic Fibrosis ; 21:S43, 2022.
Article in English | EMBASE | ID: covidwho-1996748

ABSTRACT

Objectives: Children with cystic fibrosis (CF) in Sweden are routinely monitored at the hospital more often than the recommended CF guidelines. The COVID-19 pandemic has challenged the healthcare system and the use of digital tools and virtual visits has rapidly increased. The aim of this study was to investigate how children experienced home spirometry (HS) and virtual visits. Methods: A prospective multicentre study including children aged 5–17 years from all 4 Swedish CF centres were conducted between May 2020 to November 2021. All participants received a home spirometer AirNext (NuvoAir,Stockholm, Sweden). Physical visits could be converted to virtual visits during the study and the children were instructed to perform HS prior to both virtual and a physical visits. An anonymous survey was conducted at the end of the study. Results: A total of 60 children with CF were included in the study. During the mean (range) study period of 6.8 (3.1–11.5) months, they completed on average 2.3 (1–4) virtual visits and 3.0 (2–4) physical visits. The survey was completed by 55 (92%) participating children with a mean age of 11.5 (5– 17) years. The virtual visitswere rated just as high as the physical meetings. No child felt more stressed with the opportunity to perform HS;on the contrary, some children (22%) felt less stressed with this possibility. After the introduction of HS, almost all children (98%) responded that they felt calmer or as before the introduction of HS. Half of the children responded that they nowunderstand their CF-disease better than before. Virtual visits reduced the burden of travel time to the hospital and shortened the mean time away from school up to 3.0 (1.3–4.0) days over a year. Conclusion: Home spirometry increased the understanding of the CF lung disease and did not cause more stress in children with CF. Virtual visits were very appreciated and provide a possibility to decrease school absenteeism due to fewer physical visits at the hospital.

16.
Journal of Cystic Fibrosis ; 21:S13-S14, 2022.
Article in English | EMBASE | ID: covidwho-1996741

ABSTRACT

From September 2020 until January 2022, children with CF in the UK aged 6–12 years homozygous for F508del had a choice of CFTR modulators: Lumacaftor/ivacaftor(LUM/IVA) or tezacaftor/ivacaftor (TEZ/IVA)+ ivacaftor (IVA). Although benefit of the individual agents has been demonstrated in clinical trials, there is no direct comparison between treatments.1 Objectives: Review of Forced Expiratory Volume in 1 second (FEV1) and nutritional clinical benefits of switching from LUM/IVA to TEZ/IVA + IVA. Method: A retrospective review of 18 paediatric patients (pts) swapped from LUM/IVA to TEZ/IVA + IVA. Data collected of length of time on each CFTR modulator, body mass index (BMI) centile, FEV1 (% predicted and zscore). FEV1 data analysed using ANOVA test. Results: 12 female;6 male pts (Mean age 9 yrs 6mths (range 8–12 years)). Two pts swapped from LUM/IVA due to tolerability issues. The other families chose to swap. Mean length of time was 13 mths (±1.3) on LUM/IVA and 9mths ± 1.2 on TEZ/IVA + IVA. Spirometry;table 1 (Table Presented) Conclusion: Swapping CFTR modulators for most pts offered no clear improvement in FEV1 or BMI, the surrogate markers of lung and nutritional health. However, pts did not experience the usual decline in FEV1 seen in CF. There are many potential confounding factors that need to be considered, including that data was collected during the COVID pandemic. As new modulators are developed, further research will be required to better understand their mechanism of action in individual pts to guide optimal personalised prescribing. 1 Walker S., et al., A phase 3 study of tezacaftor in combination with ivacaftor in children aged 6 through 11years with cystic fibrosis, J CYST FIBROS;June 2019;18(708–713).

17.
Journal of General Internal Medicine ; 37:S492, 2022.
Article in English | EMBASE | ID: covidwho-1995691

ABSTRACT

CASE: 45-year-old African American female with history of hypertension, hypothyroidism and prior tobacco abuse was admitted to hospital with shortness of breath and hypoxia. She was diagnosed with COVID-19 pneumonia due to her respiratory symptoms, CT scan findings of bilateral pulmonary infiltrate and positive COVID IgG antibodies although a PCR test was negative. The patient was discharged and later seen in pulmonary clinic where on further questioning she complained of fatigue, bilateral wrist and knee pain, and exertional dyspnea. On auscultation, bilateral rales were noted in the lower lung fields. She was noted to desaturate upon ambulation. PFTs (pulmonary function tests) revealed severe restrictive spirometry and severe gas transfer defect. A HRCT revealed bilateral infiltrates suggestive of organizing pneumonia. CPK was elevated at 449. Serologies were positive for ANA and antijo1 and negative for other connective tissue diseases. The patient was diagnosed with anti-synthetase syndrome (ASS). She was treated with oxygen, steroids and tacrolimus with reported improvement in her symptoms. IMPACT/DISCUSSION: ASS is a rare chronic systemic autoimmune disorder that predominantly affects females with a median age of 50. It is characterized by autoantibodies against aminoacyl-tRNA synthetase enzyme. The role of these autoantibodies in the development of ASS is not fully understood. Several autoantibodies have been identified including anti-Jo1, anti-EJ, antiOJ, anti-PL7, anti-PL12, anti-SC, anti-KS, anti-JS, anti-HA, anti-YRS. Among them, anti-Jo1 is the most common. The ASS is characterized by myositis, interstitial lung disease( ILD), arthritis, fever, Raynaud's phenomenon, mechanic's hand plus positive serologic testing of the Anti- aminoacyl-tRNA synthetase enzyme. The majority of the patients with Anti- Jo-1 antibodies develop ILD. An organizing pneumonia pattern can be seen in the settings of connective tissue disease and is commonly found in those with the ASS. ILD may be the first manifestation of the disease. CONCLUSION: We present a case of a 45 year old female mistakenly diagnosed with COVID pneumonia who on further evaluation was found to have ILD secondary to Antisynthetase Syndrome, a form of inflammatory myositis. An organizing pneumonia pattern on HRCT can be found in many settings other than COVID pneumonia. Careful attention to the history, physical examination, lab findings and COVID test results remain important in identifying etiologies other than COVID 19 for a patient's respiratory symptoms during the pandemic. Delays in diagnosis can be quite harmful to patients.

18.
Rassegna di Patologia dell'Apparato Respiratorio ; 37(2):81-85, 2022.
Article in Italian | EMBASE | ID: covidwho-1989036

ABSTRACT

Summary In June 2020, indications were developed for the resumption of pulmonary function testing in the course of a SARS-CoV-2 pandemic, in support of national, regional and company direc-tives, as well as for pulmonologists dedicated to pulmonary function laboratories. The present document represents an update of the previous one in the light of new knowledge and the current SARS-CoV-2 epidemiological situation.

19.
European Journal of Molecular and Clinical Medicine ; 9(2):438-458, 2022.
Article in English | EMBASE | ID: covidwho-1981086

ABSTRACT

Introduction: Pulmonary Function Tests (PFTs), especially spirometry is an established mode of assessing chronic lung diseases especially Asthma. Spirometric reference values are essential in assessing pulmonary function. Normative values of these tests differ from population to population and with difference in methods and apparatus used. The normal standards for pulmonary function measurements among the hilly areas of Himachal Pradesh is not reported yet. Aim: To measure the normative values of spirometry (FEV1, FVC, FEV1/FVC, PEFR) in children of 5- 18 years age range living in and around Solan district of Himachal Pradesh, India. Material and Methods: This cross-sectional study was carried out at M.M Medical College and Hospital, Kumarhatti, Solan, HP, India and comprised school-going children and nearby community aged 5-18 years. After noting their gender, age, height and weight, the pulmonary function test measures, Forced vital capacity (FVC), Forced expiratory volume in 1 second (FEV1), FEV1/FVC%, FEF 25-75% and peak expiratory flow rate were taken. Simple and multiple regression models were used for the prediction of pulmonary function test values. SPSS 20 was used for statistical analysis Results: Of the 200 participants, 110(55%) were boys and 90 (45%) were girls. The mean age was 12.47±3.27 years. The means height, weight, forced expiratory volume in 1 second, force vital capacity, peak expiratory flow rate FEV1/FVC% and FEF 25-75% were 147.39±16.07cm, 41.30±12.38kg, 2.54±0.70, 2.90±0.8, 5.42±1.30, 87.41±3.85% and 2.90±0.84 respectively. All the three variables - Age, Height and Weight-had significant linear relationship and positive correlation with the pulmonary function test values (p0.7). Among these three variables maximum correlation was found with height (r=>0.8). Conclusion: Age, height and weight had statistically significant and positive correlation with the PFT values, both for boys and girls. Height was found to be most strongly and positively correlated with the PFT values. Overall significant difference was seen in FEV1/FVC and FEF 25-75 among boys and girls except FEV1, FVC and PEFR of the same age group. The fitted regression equations would help to predict the PFT values for the Indian children living in hilly areas at given age, height and weight. This study should be seen as a pilot study and will require data from a large population to establish normal values for our population.

20.
Medicni Perspektivi ; 27(2):51-57, 2022.
Article in Russian | Web of Science | ID: covidwho-1979912

ABSTRACT

The aim of our study was to assess the ventilation function of the lungs in persons who had pneumonia after COVID-19 in the Pridneprovie region in January-April 2021, and to determine the types of ventilation disorders and their severity. We examined 41 people who had pneumonia after COVID-19 not earlier than 4 weeks after the onset of clinical symptoms (the median is 48 (40;68) days). All of them made up the main group (average age - 55.8 +/- 5.6 years, men - 21 (51.2%), women - 20 (48.8%)). Patients were divided into two subgroups depending on the severity of the coronavirus disease in the acute period: subgroup 1 included 26 people (average age - 56.1 +/- 4.2 years;men - 12 (42.2%), women - 14 (53.8%)) who had a mild course of the acute period of the disease;subgroup 2 - 15 people (average age - 55.2 +/- 5.3 years, men - 9 (60.0%), women - 6 (40.0%)), who had a severe course of the acute period of COVID-19. Clinical examination, assessment of dyspnea (The Modified Medical Research Council Dyspnea scale), level of the cough and sputum (by the Savchenko scale), oxygen saturation, spirometry with a bronchodilation test were conducted. Almost half of the patients with pneumonia after COVID-19 had various disorders of the ventilation function of the lungs. In cases with a mild course of the acute period of COVID-19, obstructive changes were significantly more frequent (p=0.035), and in patients with a severe course of the acute period of COVID-19 - restrictive disorders (p=0.002) prevailed. Bronchoobstructive changes in the post-COVID period are most often caused not by decrease in the forced expiratory volume per second but by the ratio of (FEV1)/forced vital capacity (below 0.7) and/or by the presence of visualized changes in the "flow-volume" curve.

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