Subject(s)
Aftercare/methods , COVID-19/rehabilitation , Patient Navigation , Survivors , Telemedicine/methods , Aftercare/organization & administration , Cognitive Dysfunction/diagnosis , Depression/diagnosis , Health Literacy , Health Services Accessibility , Humans , Mass Screening , Motivational Interviewing , SARS-CoV-2 , Sepsis/rehabilitation , Telemedicine/organization & administrationSubject(s)
Aftercare/organization & administration , COVID-19 , Nervous System Diseases/therapy , Neurology/organization & administration , Patient Satisfaction , Telemedicine/organization & administration , Adult , Aftercare/standards , Aged , Female , Hospitals, Teaching , Humans , Male , Mexico , Middle Aged , Neurology/standards , Program Development , Telemedicine/instrumentation , Telemedicine/standardsSubject(s)
COVID-19/psychology , Mental Disorders/therapy , Mental Health , Primary Health Care/organization & administration , Aftercare/organization & administration , COVID-19/epidemiology , Counseling/organization & administration , Humans , Mental Disorders/epidemiology , Mental Disorders/psychology , Prevalence , United Kingdom/epidemiologyABSTRACT
BACKGROUND: The symptoms, radiography, biochemistry and healthcare utilisation of patients with COVID-19 following discharge from hospital have not been well described. METHODS: Retrospective analysis of 401 adult patients attending a clinic following an index hospital admission or emergency department attendance with COVID-19. Regression models were used to assess the association between characteristics and persistent abnormal chest radiographs or breathlessness. RESULTS: 75.1% of patients were symptomatic at a median of 53 days post discharge and 72 days after symptom onset and chest radiographs were abnormal in 47.4%. Symptoms and radiographic abnormalities were similar in PCR-positive and PCR-negative patients. Severity of COVID-19 was significantly associated with persistent radiographic abnormalities and breathlessness. 18.5% of patients had unscheduled healthcare visits in the 30 days post discharge. CONCLUSIONS: Patients with COVID-19 experience persistent symptoms and abnormal blood biomarkers with a gradual resolution of radiological abnormalities over time. These findings can inform patients and clinicians about expected recovery times and plan services for follow-up of patients with COVID-19.
Subject(s)
Aftercare , Biomarkers/analysis , COVID-19 , Patient Discharge/standards , Radiography, Thoracic , Symptom Assessment , Aftercare/methods , Aftercare/organization & administration , COVID-19/blood , COVID-19/diagnostic imaging , COVID-19/epidemiology , COVID-19/physiopathology , Female , Humans , Male , Middle Aged , Patient Acceptance of Health Care/statistics & numerical data , Radiography, Thoracic/methods , Radiography, Thoracic/statistics & numerical data , Recovery of Function , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Symptom Assessment/methods , Symptom Assessment/statistics & numerical data , Time Factors , United Kingdom/epidemiologyABSTRACT
Survivors of COVID-19 are a vulnerable population, with complex needs because of lingering symptoms and complications across multiple organ systems. Those who required hospitalization or intensive care are also at risk for post-hospital syndrome and post-ICU syndromes, with attendant cognitive, psychological, and physical impairments, and high levels of health care utilization. Effective ambulatory care for COVID-19 survivors requires coordination across multiple subspecialties, which can be burdensome if not well coordinated. With growing recognition of these needs, post-COVID-19 clinics are being created across the country. We describe the design and implementation of multidisciplinary post-COVID-19 clinics at two academic health systems, Johns Hopkins and the University of California-San Francisco. We highlight components of the model which should be replicated across sites, while acknowledging opportunities to tailor offerings to the local institutional context. Our goal is to provide a replicable framework for others to create these much-needed care delivery models for survivors of COVID-19.
Subject(s)
Aftercare/organization & administration , COVID-19 , Outpatient Clinics, Hospital/organization & administration , Survivors , COVID-19/therapy , Hospital Design and Construction , Humans , Time FactorsABSTRACT
Background: The coronavirus disease 2019 pandemic caused by the severe acute respiratory syndrome coronavirus 2 has challenged obstetrical care providers. Universal testing on labor and delivery units has been implemented by many hospitals to ensure patient and staff safety. Asymptomatic carrier rates are expected to vary based on geographic differences in disease prevalence, although differences within the same city have not been reported previously. In addition, clinical follow-up of women who had a negative result for severe acute respiratory syndrome coronavirus 2 during obstetrical hospitalization has not been included in any previous reports. Objective: This study aimed to describe the prevalence of positive severe acute respiratory syndrome coronavirus 2 test results among asymptomatic pregnant women at 2 Philadelphia obstetrical hospitals, characterize the clinical course of those who had a positive result, and report symptom development among all women tested in the 2 weeks after hospitalization. Study Design: This is an observational study of asymptomatic pregnant women who underwent severe acute respiratory syndrome coronavirus 2 testing at 2 academic health centers (Hospital of the University of Pennsylvania and Pennsylvania Hospital) in Philadelphia, Pennsylvania, between April 13, 2020, and April 26, 2020. All women tested were contacted via telephone for symptom follow-up at 1 and 2 weeks after discharge. Asymptomatic positive test rates are reported for the overall population and by hospital. The hospital and 2-week posthospital course are described for women who had a positive result for severe acute respiratory syndrome coronavirus 2. Posthospital symptom development among women who had a negative result for severe acute respiratory syndrome coronavirus 2 is also described. Results: A total of 318 asymptomatic women underwent severe acute respiratory syndrome coronavirus 2 testing during this 2-week period; 8 women had a positive result. The overall asymptomatic test positive rate was 2.5%. The rate at Hospital of the University of Pennsylvania was 3.8% compared with 1.3% at Pennsylvania Hospital (P=.283). Of note, 3 women (37.5%) who were initially asymptomatic developed mild symptoms in the 2 weeks after a positive test result. Repeat severe acute respiratory syndrome coronavirus 2 testing was performed in 14 of the 310 women (4.5%) who initially had a negative result; 2 women (0.6%) had a positive result on repeat testing. Moreover, 242 (78.1%) and 213 (68.7%) of the 310 women who had a negative result for severe acute respiratory syndrome coronavirus 2 at the time of the initial hospitalization were followed up via telephone at 1 and 2 weeks after admission, respectively. Viral symptoms, including fevers, chills, shortness of breath, or cough, were self-reported in 4.5% and 4.2% of these women at 1 and 2 weeks after discharge, respectively. Conclusion: The asymptomatic positive severe acute respiratory syndrome coronavirus 2 test rate among an obstetrical population in Philadelphia differed between 2 hospitals and was lower than that described in other geographic regions. This supports the importance of institution-specific testing protocols. The development of symptomatic severe acute respiratory syndrome coronavirus 2 infection after hospitalization among women with initial negative test results is uncommon.
Subject(s)
COVID-19 , Carrier State , Hospitalization/statistics & numerical data , Pregnancy Complications, Infectious , SARS-CoV-2/isolation & purification , Adult , Aftercare/methods , Aftercare/organization & administration , Aftercare/statistics & numerical data , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19 Testing/methods , Carrier State/diagnosis , Carrier State/epidemiology , Female , Humans , Philadelphia/epidemiology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/physiopathology , Prevalence , Symptom Assessment/statistics & numerical dataSubject(s)
Aftercare , COVID-19 , Convalescence , Mobile Applications , Monitoring, Ambulatory , Stress, Psychological , Aftercare/methods , Aftercare/organization & administration , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19/psychology , COVID-19/therapy , Cell Phone , China , Female , Humans , Male , Middle Aged , Monitoring, Ambulatory/instrumentation , Monitoring, Ambulatory/methods , Patient Discharge , Prognosis , Recovery of Function , SARS-CoV-2 , Severity of Illness Index , Stress, Psychological/diagnosis , Stress, Psychological/physiopathology , Stress, Psychological/prevention & control , Telemedicine/methodsABSTRACT
We describe the utility of telephonic aftercare services (including liaising with primary healthcare providers) rendered to persons with psychiatric disorders (n = 1049) during the lockdown period of COVID 19 pandemic in India. Such consultations can be continued even after the COVID 19 period for suitable patients.
Subject(s)
Aftercare/organization & administration , COVID-19 , Continuity of Patient Care/organization & administration , Mental Disorders/therapy , Mental Health Services/organization & administration , Patient Acceptance of Health Care , Patient Satisfaction , Telemedicine/organization & administration , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/prevention & control , Female , Humans , India , Male , Middle Aged , Telephone , Young AdultSubject(s)
Aftercare , COVID-19 , Hand Injuries , Infection Control , Plastic Surgery Procedures , Adult , Aftercare/methods , Aftercare/organization & administration , COVID-19/epidemiology , COVID-19/prevention & control , Female , Hand Injuries/classification , Hand Injuries/epidemiology , Hand Injuries/etiology , Hand Injuries/surgery , Humans , Infection Control/methods , Infection Control/organization & administration , London/epidemiology , Male , Organizational Innovation , Outcome and Process Assessment, Health Care , Plastic Surgery Procedures/methods , Plastic Surgery Procedures/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Telemedicine , Time-to-Treatment/statistics & numerical data , Trauma Centers/organization & administration , Trauma Centers/statistics & numerical data , Trauma Centers/trendsSubject(s)
Coronavirus Infections , Hospital Units , Infection Control/methods , Inflammatory Bowel Diseases , Mass Screening/methods , Pandemics , Pneumonia, Viral , Telemedicine , Aftercare/methods , Aftercare/organization & administration , Betacoronavirus , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Hospital Units/organization & administration , Hospital Units/statistics & numerical data , Hospital Units/trends , Hospitalization/statistics & numerical data , Humans , Inflammatory Bowel Diseases/diagnosis , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/therapy , Italy/epidemiology , Organizational Innovation , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Remote Consultation/methods , SARS-CoV-2 , Surveys and Questionnaires , Telemedicine/methods , Telemedicine/organization & administrationABSTRACT
COVID-19 has had profound management implications for orthopaedic management due to balancing patient outcomes with clinical safety and limited resources. The BOAST guidelines on outpatient orthopaedic fracture management took a pragmatic approach. At Great Western Hospital, Swindon, a closed loop audit was performed looking at a selection of these guidelines, to assess if our initial changes were sufficient and what could be improved. METHOD: An audit was designed around fracture immobilisation, type of initial fracture clinic assessment, default virtual follow up clinic and late imaging. Interventions were implemented and re-audited. RESULTS: Initially 223 patients were identified over 4 weeks. Of these, 100% had removable casts and 99% did not have late imaging. 96% of patients were initially assessed virtually or had initial orthopaedic approval to be seen in face to face clinic. 97% had virtual follow up or had documented reasons why not. The 26 patients who were initially seen face to face were put through a simulated virtual fracture clinic. 22 appointments and 13 Xray attendances could have been avoided. We implemented a change of requiring all patients to be assessed at consultant level before having a face to face appointment. The re-audit showed over 99% achievement in all areas. CONCLUSION: Virtual fracture clinics, both triaging new patients and follow-up clinics have dramatically changed our outpatient management, helping the most appropriate patients to be seen face to face. Despite their limitations, they have been well tolerated by patients and improved patient safety and treatment.
Subject(s)
COVID-19/prevention & control , Fractures, Bone/therapy , Orthopedics/organization & administration , Outpatient Clinics, Hospital/organization & administration , Telemedicine/organization & administration , Aftercare/organization & administration , Aftercare/standards , Aftercare/statistics & numerical data , COVID-19/epidemiology , Communicable Disease Control/standards , England , Fracture Fixation , Fractures, Bone/diagnosis , Guideline Adherence/statistics & numerical data , Health Plan Implementation , Humans , Medical Audit/statistics & numerical data , Office Visits/statistics & numerical data , Orthopedics/standards , Orthopedics/statistics & numerical data , Outpatient Clinics, Hospital/standards , Outpatient Clinics, Hospital/statistics & numerical data , Pandemics/prevention & control , Patient Safety , Practice Guidelines as Topic , Program Evaluation , Societies, Medical/standards , Telemedicine/standards , Telemedicine/statistics & numerical data , Treatment OutcomeSubject(s)
Communicable Disease Control , Coronavirus Infections , Inflammatory Bowel Diseases , Pandemics , Patient Care Management , Pneumonia, Viral , Adult , Aftercare/methods , Aftercare/organization & administration , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Cohort Studies , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Disease Transmission, Infectious/prevention & control , Female , Humans , Inflammatory Bowel Diseases/diagnosis , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/therapy , Male , Mortality , New York City/epidemiology , Organizational Innovation , Outcome and Process Assessment, Health Care , Patient Care Management/methods , Patient Care Management/organization & administration , Patient Care Management/trends , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission , SARS-CoV-2 , Telemedicine/methods , COVID-19 Drug TreatmentSubject(s)
Aftercare , Communicable Disease Control , Coronavirus Infections , Hospital Units/organization & administration , Inflammatory Bowel Diseases , Pandemics , Patient Care Management , Pneumonia, Viral , Adult , Aftercare/methods , Aftercare/organization & administration , Betacoronavirus , COVID-19 , Communicable Disease Control/methods , Communicable Disease Control/standards , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Egypt/epidemiology , Female , Humans , Immunologic Factors/therapeutic use , Incidence , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/therapy , Male , Organizational Innovation , Pandemics/prevention & control , Patient Care Management/methods , Patient Care Management/trends , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , SARS-CoV-2 , Severity of Illness IndexABSTRACT
Background: Telemedicine is seen as a savior during the COVID-19 pandemic. Materials & methods: This study is a descriptive cross-sectional study conducted with cancer patients who were interviewed via telemedicine from a tertiary care comprehensive oncology center. Results: A total of 421 patients were included in the study and 118 of them (28.0%) were >65 years old. Communication was provided most frequently by voice call (n = 213; 50.5%). The majority of the patients contacted by telemedicine had breast cancer (n = 270; 64.1%). For 135 patients (32.1%) no further examination or intervention was required and the previously planned follow-up visit was postponed by the clinician. Conclusion: This study showed that telemedicine could open a new era for medical oncology specialists.
Subject(s)
Breast Neoplasms/drug therapy , Cancer Survivors , Coronavirus Infections/prevention & control , Medical Oncology/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Telemedicine/organization & administration , Administration, Oral , Adult , Aftercare/methods , Aftercare/organization & administration , Aftercare/standards , Aftercare/trends , Aged , Aged, 80 and over , Antineoplastic Agents/therapeutic use , Betacoronavirus/pathogenicity , Breast Neoplasms/diagnosis , Breast Neoplasms/mortality , Breast Neoplasms, Male , COVID-19 , Cancer Care Facilities/organization & administration , Cancer Care Facilities/standards , Cancer Care Facilities/trends , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/drug therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Cross-Sectional Studies , Female , Genital Neoplasms, Female/diagnosis , Genital Neoplasms, Female/drug therapy , Humans , Infection Control/organization & administration , Infection Control/standards , Lung Neoplasms/diagnosis , Lung Neoplasms/drug therapy , Male , Medical Oncology/methods , Medical Oncology/standards , Medical Oncology/trends , Medication Therapy Management/organization & administration , Medication Therapy Management/standards , Medication Therapy Management/trends , Middle Aged , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/drug therapy , SARS-CoV-2 , Telemedicine/standards , Telemedicine/trendsSubject(s)
Aftercare , Coronavirus Infections/rehabilitation , Critical Care , Critical Illness/rehabilitation , Health Services Accessibility , Health Status Disparities , Healthcare Disparities , Mental Disorders/etiology , Pneumonia, Viral/rehabilitation , Aftercare/organization & administration , Aftercare/standards , COVID-19 , Health Services Accessibility/organization & administration , Health Services Accessibility/standards , Humans , Mental Disorders/rehabilitation , Minority Groups , Pandemics , Survivors , Vulnerable PopulationsABSTRACT
The Italian College of Breast Radiologists by the Italian Society of Medical Radiology (SIRM) provides recommendations for breast care provision and procedural prioritization during COVID-19 pandemic, being aware that medical decisions must be currently taken balancing patient's individual and community safety: (1) patients having a scheduled or to-be-scheduled appointment for in-depth diagnostic breast imaging or needle biopsy should confirm the appointment or obtain a new one; (2) patients who have suspicious symptoms of breast cancer (in particular: new onset palpable nodule; skin or nipple retraction; orange peel skin; unilateral secretion from the nipple) should request non-deferrable tests at radiology services; (3) asymptomatic women performing annual mammographic follow-up after breast cancer treatment should preferably schedule the appointment within 1 year and 3 months from the previous check, compatibly with the local organizational conditions; (4) asymptomatic women who have not responded to the invitation for screening mammography after the onset of the pandemic or have been informed of the suspension of the screening activity should schedule the check preferably within 3 months from the date of the not performed check, compatibly with local organizational conditions. The Italian College of Breast Radiologists by SIRM recommends precautions to protect both patients and healthcare workers (radiologists, radiographers, nurses, and reception staff) from infection or disease spread on the occasion of breast imaging procedures, particularly mammography, breast ultrasound, breast magnetic resonance imaging, and breast intervention procedures.
Subject(s)
Appointments and Schedules , Betacoronavirus , Breast Neoplasms/diagnostic imaging , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Radiology , Societies, Medical , Aftercare/organization & administration , Asymptomatic Diseases , Breast Neoplasms/psychology , Breast Neoplasms/therapy , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Early Detection of Cancer/standards , Female , Humans , Italy , Occupational Diseases/prevention & control , Personal Protective Equipment , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , SARS-CoV-2 , Symptom Assessment/methods , Symptom Assessment/standardsABSTRACT
Traditional Chinese medicine (TCM), an ancient system of alternative medicine, played an active role in the prevention and control of COVID-19 in China. It improved the clinical symptoms of patients, reduced the mortality rate, improved the recovery rate, and effectively relieved the operating pressure on the national medical system during critical conditions. In light of the current global pandemic, TCM-related measures might open up a new channel in the control of COVID-19 in other countries and regions. Here, we summarize the TCM-related measures that were widely used in China, including TCM guidelines, the Wuchang pattern, mobile cabin hospitals, integrated treatment of TCM and modern medicine for critical patients, and non-medicine therapy for convalescent patients, and describe how TCM effectively treated patients afflicted with the COVID-19. Effective TCM therapies could, therefore, be recommended and practiced based on the existing medical evidence from increased scientific studies.
Subject(s)
Betacoronavirus/physiology , Communicable Disease Control/methods , Coronavirus Infections , Drugs, Chinese Herbal , Medicine, Chinese Traditional/methods , Pandemics , Pneumonia, Viral , Preventive Medicine/methods , Aftercare/methods , Aftercare/organization & administration , COVID-19 , China/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Drugs, Chinese Herbal/classification , Drugs, Chinese Herbal/pharmacology , Humans , Mobile Health Units/organization & administration , Pandemics/prevention & control , Patient Care/methods , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , SARS-CoV-2 , COVID-19 Drug TreatmentSubject(s)
Adolescent Psychiatry/organization & administration , Aftercare/organization & administration , COVID-19/prevention & control , Hospitals, University/organization & administration , Mental Disorders/therapy , Psychiatric Department, Hospital/organization & administration , Telemedicine/organization & administration , Adolescent , Child , Child Psychiatry/organization & administration , Female , Humans , Length of Stay , Male , Patient Discharge , Risk Assessment , TurkeySubject(s)
Aftercare/organization & administration , Ambulatory Care/organization & administration , Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , Betacoronavirus/isolation & purification , COVID-19 , Chronic Disease , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/pathology , Diagnostic Techniques, Respiratory System , Disease Management , Epithelium/pathology , Epithelium/virology , Exudates and Transudates , Fibrosis , Follow-Up Studies , Humans , Lung/pathology , Lung/virology , Mobile Applications , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/pathology , Respiration Disorders/complications , Respiration Disorders/therapy , SARS-CoV-2 , Smartphone , Telemedicine/methods , Telemedicine/organization & administrationABSTRACT
The Covid 19 epidemic has modified the way that plastic surgeons can treat their patients. At our hospital all elective surgery was canceled and only the more severe cases were admitted. The outpatient department activity has been reduced also. We present the number and diagnoses of patients, treated as in- and out-patients, during seven weeks from the onset of the epidemic, comparing our activity from the lockdown of elective surgery with the numbers and diagnoses observed during the same weeks of last year. Finally we underline the importance of using telemedicine and web-based tools to transmit images of lesions that need the surgeon's evaluation, and can be used by the patient to keep in touch with a doctor during the distressing time of delay of the expected procedure.