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2.
BMJ ; 374: n2209, 2021 09 30.
Article in English | MEDLINE | ID: covidwho-1448003

ABSTRACT

OBJECTIVE: To determine if virtual care with remote automated monitoring (RAM) technology versus standard care increases days alive at home among adults discharged after non-elective surgery during the covid-19 pandemic. DESIGN: Multicentre randomised controlled trial. SETTING: 8 acute care hospitals in Canada. PARTICIPANTS: 905 adults (≥40 years) who resided in areas with mobile phone coverage and were to be discharged from hospital after non-elective surgery were randomised either to virtual care and RAM (n=451) or to standard care (n=454). 903 participants (99.8%) completed the 31 day follow-up. INTERVENTION: Participants in the experimental group received a tablet computer and RAM technology that measured blood pressure, heart rate, respiratory rate, oxygen saturation, temperature, and body weight. For 30 days the participants took daily biophysical measurements and photographs of their wound and interacted with nurses virtually. Participants in the standard care group received post-hospital discharge management according to the centre's usual care. Patients, healthcare providers, and data collectors were aware of patients' group allocations. Outcome adjudicators were blinded to group allocation. MAIN OUTCOME MEASURES: The primary outcome was days alive at home during 31 days of follow-up. The 12 secondary outcomes included acute hospital care, detection and correction of drug errors, and pain at 7, 15, and 30 days after randomisation. RESULTS: All 905 participants (mean age 63.1 years) were analysed in the groups to which they were randomised. Days alive at home during 31 days of follow-up were 29.7 in the virtual care group and 29.5 in the standard care group: relative risk 1.01 (95% confidence interval 0.99 to 1.02); absolute difference 0.2% (95% confidence interval -0.5% to 0.9%). 99 participants (22.0%) in the virtual care group and 124 (27.3%) in the standard care group required acute hospital care: relative risk 0.80 (0.64 to 1.01); absolute difference 5.3% (-0.3% to 10.9%). More participants in the virtual care group than standard care group had a drug error detected (134 (29.7%) v 25 (5.5%); absolute difference 24.2%, 19.5% to 28.9%) and a drug error corrected (absolute difference 24.4%, 19.9% to 28.9%). Fewer participants in the virtual care group than standard care group reported pain at 7, 15, and 30 days after randomisation: absolute differences 13.9% (7.4% to 20.4%), 11.9% (5.1% to 18.7%), and 9.6% (2.9% to 16.3%), respectively. Beneficial effects proved substantially larger in centres with a higher rate of care escalation. CONCLUSION: Virtual care with RAM shows promise in improving outcomes important to patients and to optimal health system function. TRIAL REGISTRATION: ClinicalTrials.gov NCT04344665.


Subject(s)
Aftercare/methods , Monitoring, Ambulatory/methods , Surgical Procedures, Operative/nursing , Telemedicine/methods , Aged , COVID-19/epidemiology , Canada/epidemiology , Female , Humans , Male , Medication Errors/statistics & numerical data , Middle Aged , Pain, Postoperative/epidemiology , Pandemics , Patient Discharge , Postoperative Period , Surgical Procedures, Operative/mortality
5.
Rev Mal Respir ; 37(6): 505-510, 2020 Jun.
Article in French | MEDLINE | ID: covidwho-1386577

ABSTRACT

The French-language Respiratory Medicine Society (SPLF) proposes a guide for the follow-up of patients who have presented with SARS-CoV-2 pneumonia. The proposals are based on known data from previous epidemics, on acute lesions observed in SARS-CoV-2 patients and on expert opinion. This guide proposes a follow-up based on three categories of patients: (1) patients managed outside hospital for possible or proven SARS-CoV-2 infection, referred by their physician for persistent dyspnoea; (2) patients hospitalized for SARS-CoV-2 pneumonia in a medical unit; (3) patients hospitalized for SARS-CoV-2 pneumonia in an intensive care unit. The subsequent follow-up will have to be adapted to the initial assessment. This guide emphasises the possibility of others causes of dyspnoea (cardiac, thromboembolic, hyperventilation syndrome…). These proposals may evolve over time as more knowledge becomes available.


Subject(s)
Aftercare/methods , Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Aftercare/standards , Ambulatory Care/methods , Ambulatory Care/standards , COVID-19 , Cardiovascular Diseases/prevention & control , Coronavirus Infections/complications , Coronavirus Infections/rehabilitation , Critical Care/methods , Critical Care/standards , Diagnostic Techniques, Respiratory System/standards , Disease Management , Emergency Medical Services/methods , Emergency Medical Services/standards , Health Priorities , Hospitalization , Humans , Inpatients , Outpatients , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/rehabilitation , Respiratory Therapy/methods , Respiratory Therapy/standards , Symptom Assessment/methods , Symptom Assessment/standards , Thromboembolism/prevention & control , Thrombophilia/drug therapy , Thrombophilia/etiology
6.
J Laryngol Otol ; 135(9): 815-819, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1333849

ABSTRACT

OBJECTIVE: To review patient satisfaction with the change in practice towards telephone consultations during and after the coronavirus disease 2019 pandemic for head and neck cancer follow up. METHOD: A retrospective analysis was conducted of head and neck cancer telephone appointments during a six-month period in a tertiary referral centre. RESULTS: Patients found the telephone consultations beneficial (98 per cent), with 30 per cent stating they were relieved to not have to attend hospital. Patients who travelled further, those with lower stage disease and patients with a greater interval from initial treatment were most satisfied with the telephone consultations. Sixty-eight per cent of patients stated they would be happy to have telephone consultations as part of their regular follow up after the pandemic. CONCLUSION: Patients found the telephone consultations beneficial and 30 per cent considered them preferable to face-to-face appointments. This study demonstrates that telephone consultations can be used as an adjunct to face-to-face appointments in an effort to reduce hospital attendances whilst maintaining close follow up.


Subject(s)
Aftercare , Head and Neck Neoplasms/therapy , Patient Satisfaction , Referral and Consultation , Adult , Aftercare/methods , Aftercare/psychology , Aftercare/standards , Aged , Aged, 80 and over , Humans , Middle Aged , Patient Satisfaction/statistics & numerical data , Retrospective Studies , Telephone , Tertiary Care Centers
7.
BMC Fam Pract ; 22(1): 160, 2021 07 24.
Article in English | MEDLINE | ID: covidwho-1322924

ABSTRACT

Many survivors of critical illness suffer from long-lasting physical, cognitive, and mental health sequelae. The number of affected patients is expected to markedly increase due to the COVID-19 pandemic. Many ICU survivors receive long-term care from a primary care physician. Hence, awareness and appropriate management of these sequelae is crucial. An interdisciplinary authorship team participated in a narrative literature review to identify key issues in managing COVID-19 ICU-survivors in primary care. The aim of this perspective paper is to synthesize important literature to understand and manage sequelae of critical illness due to COVID-19 in the primary care setting.


Subject(s)
Aftercare , COVID-19/therapy , Primary Health Care , Aftercare/methods , COVID-19/complications , COVID-19/psychology , Critical Illness , Family Health , Humans , Intensive Care Units , Mental Health , Survivors
8.
Pediatrics ; 148(2)2021 08.
Article in English | MEDLINE | ID: covidwho-1315900

ABSTRACT

BACKGROUND: In spring 2020, a novel hyperinflammatory process associated with severe acute respiratory syndrome coronavirus 2 multisystem inflammatory syndrome in children (MIS-C) was described. The long-term impact remains unknown. We report longitudinal outcomes from a New York interdisciplinary follow-up program. METHODS: All children <21 years of age, admitted to NewYork-Presbyterian with MIS-C in 2020, were included. Children were followed at 1 to 4 weeks, 1 to 4 months, and 4 to 9 months postdischarge. RESULTS: In total, 45 children were admitted with MIS-C. The median time to last follow-up was 5.8 months (interquartile range 1.3-6.7). Of those admitted, 76% required intensive care and 64% required vasopressors and/or inotropes. On admission, patients exhibited significant nonspecific inflammation, generalized lymphopenia, and thrombocytopenia. Soluble interleukin (IL) IL-2R, IL-6, IL-10, IL-17, IL-18, and C-X-C Motif Chemokine Ligand 9 were elevated. A total of 80% (n = 36) had at least mild and 44% (n = 20) had moderate-severe echocardiographic abnormalities including coronary abnormalities (9% had a z score of 2-2.5; 7% had a z score > 2.5). Whereas most inflammatory markers normalized by 1 to 4 weeks, 32% (n = 11 of 34) exhibited persistent lymphocytosis, with increased double-negative T cells in 96% of assessed patients (n = 23 of 24). By 1 to 4 weeks, only 18% (n = 7 of 39) had mild echocardiographic findings; all had normal coronaries. At 1 to 4 months, the proportion of double-negative T cells remained elevated in 92% (median 9%). At 4 to 9 months, only 1 child had persistent mild dysfunction. One had mild mitral and/or tricuspid regurgitation. CONCLUSIONS: Although the majority of children with MIS-C present critically ill, most inflammatory and cardiac manifestations in our cohort resolved rapidly.


Subject(s)
Aftercare/methods , COVID-19/epidemiology , Critical Care/statistics & numerical data , Pandemics , Systemic Inflammatory Response Syndrome/epidemiology , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Male , New York/epidemiology , Patient Discharge/trends , Retrospective Studies
9.
Rheumatol Int ; 41(11): 1957-1962, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1309034

ABSTRACT

Multi-system inflammatory syndrome in children (MIS-C) associated with COVID-19 is a recently recognised potentially life-threatening entity. There is limited data on post-MIS-C sequelae. 21 children fulfilling the WHO criteria for MIS-C were included in our study. Data were collected at baseline and at 12-16 weeks post-discharge to look for any persistent sequelae mainly relating to the lungs or heart including coronary arteries. Fever was the most common presentation, found in 18 (85.7%) patients. All had a marked hyper-inflammatory state. Low ejection fraction (EF) was found in 10 (47.6%), but none had any coronary artery abnormality. All received corticosteroids, while 7 (33.3%) children required additional treatment with intravenous Immunoglobulins. 20 children improved while 1 left against medical advice. At discharge, 3 children had impaired left ventricular function. At median 15 weeks' follow-up, no persistent complications were found. EF had returned to normal and no coronary artery abnormalities were found during repeat echocardiography. Chest radiographs showed no fibrosis and all biochemical parameters had normalized. The children with MIS-C are extremely sick during the acute stage. Timely and adequate management led to full recovery without any sequelae at a median follow-up of 15 weeks.


Subject(s)
Aftercare/methods , COVID-19/complications , Systemic Inflammatory Response Syndrome/complications , Adolescent , COVID-19/physiopathology , COVID-19/therapy , Child , Child, Preschool , Female , Follow-Up Studies , Humans , India , Male , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/physiopathology , Systemic Inflammatory Response Syndrome/therapy
10.
Chest ; 160(1): 187-198, 2021 07.
Article in English | MEDLINE | ID: covidwho-1290546

ABSTRACT

BACKGROUND: More than 20% of hospitalized patients with COVID-19 demonstrate ARDS requiring ICU admission. The long-term respiratory sequelae in such patients remain unclear. RESEARCH QUESTION: What are the major long-term pulmonary sequelae in critical patients who survive COVID-19? STUDY DESIGN AND METHODS: Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated 3 months after hospitalization discharge. The follow-up comprised symptom and quality of life, anxiety and depression questionnaires, pulmonary function tests, exercise test (6-min walking test [6MWT]), and chest CT imaging. RESULTS: One hundred twenty-five patients admitted to the ICU with ARDS secondary to COVID-19 were recruited between March and June 2020. At the 3-month follow-up, 62 patients were available for pulmonary evaluation. The most frequent symptoms were dyspnea (46.7%) and cough (34.4%). Eighty-two percent of patients showed a lung diffusing capacity of less than 80%. The median distance in the 6MWT was 400 m (interquartile range, 362-440 m). CT scans showed abnormal results in 70.2% of patients, demonstrating reticular lesions in 49.1% and fibrotic patterns in 21.1%. Patients with more severe alterations on chest CT scan showed worse pulmonary function and presented more degrees of desaturation in the 6MWT. Factors associated with the severity of lung damage on chest CT scan were age and length of invasive mechanical ventilation during the ICU stay. INTERPRETATION: Three months after hospital discharge, pulmonary structural abnormalities and functional impairment are highly prevalent in patients with ARDS secondary to COVID-19 who required an ICU stay. Pulmonary evaluation should be considered for all critical COVID-19 survivors 3 months after discharge.


Subject(s)
COVID-19 , Long Term Adverse Effects , Lung/diagnostic imaging , Quality of Life , Respiratory Function Tests/methods , Survivors , Tomography, X-Ray Computed/methods , Aftercare/methods , Aftercare/statistics & numerical data , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , Female , Humans , Intensive Care Units/statistics & numerical data , Long Term Adverse Effects/diagnosis , Long Term Adverse Effects/epidemiology , Long Term Adverse Effects/etiology , Long Term Adverse Effects/psychology , Lung/physiopathology , Male , Middle Aged , Outcome Assessment, Health Care , Patient Discharge/statistics & numerical data , Prevalence , SARS-CoV-2 , Spain/epidemiology , Survivors/psychology , Survivors/statistics & numerical data , Walk Test/methods , Walk Test/statistics & numerical data
11.
Ann R Coll Surg Engl ; 103(7): 520-523, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1288675

ABSTRACT

INTRODUCTION: In light of the COVID-19 recommendations from the Association of Coloproctology of Great Britain and Ireland, we aimed to study patient and clinician satisfaction with a newly established telephone (TP) colorectal clinic service in lieu of traditional face-to-face (FTF) appointments. Comparative outcomes included patient versus clinician satisfaction; patient versus clinician desire to continue TP clinics postpandemic; and views of Specialty Trainee 3+ (ST3+)/Specialty Associate Specialist (SAS) doctors versus consultants on TP compared with FTF appointments. METHODS: We conducted a prospective service evaluation of patient and clinician satisfaction with colorectal surgery TP clinics between 1 June 2020 and 30 June 2020 in a British District General Hospital. RESULTS: Patients had higher satisfaction than clinicians with TP clinics: 91.5% versus 66.6% reported above-average experience [odds ratio (OR) = 5.35, 95% confidence interval (CI) 1.53 to 18.75, p = 0.01]. Clinicians had lower demand to continue TP clinics post-COVID-19 versus patients, with a trend towards significance (60% versus 82.9%, OR = 0.31, 95% CI 0.10 to 0.97, p = 0.08). ST3+/SAS doctors were more likely than consultants to find TP clinics inferior to FTF consultation for patient assessment (48.3% versus 23.7%, OR = 3.00, 95% CI 1.17 to 7.71, p = 0.03). CONCLUSIONS: While clinicians may be concerned that patient assessment suffers, patient satisfaction with TP clinics is high. There should be a place for TP clinics post-COVID-19 but there must be a robust process for patient selection as well as adequate training for current and future generations of clinicians.


Subject(s)
COVID-19/prevention & control , Colorectal Neoplasms/diagnosis , Medical Oncology/methods , Remote Consultation/methods , Telephone , Aftercare/methods , Aftercare/standards , Aftercare/statistics & numerical data , COVID-19/epidemiology , COVID-19/transmission , Colorectal Neoplasms/therapy , Humans , Infection Control/standards , Job Satisfaction , Medical Oncology/standards , Medical Oncology/statistics & numerical data , Patient Satisfaction/statistics & numerical data , Prospective Studies , Remote Consultation/standards , Remote Consultation/statistics & numerical data , Surgeons/psychology , Surgeons/statistics & numerical data , Surveys and Questionnaires/statistics & numerical data , United Kingdom/epidemiology
12.
J Am Geriatr Soc ; 69(10): 2722-2731, 2021 10.
Article in English | MEDLINE | ID: covidwho-1268124

ABSTRACT

OBJECTIVE: To assess the association between SARS-CoV-2 infection and decreased hand grip strength (HGS). DESIGN: Longitudinal population-based study. SETTING: Community-dwelling older adults (aged ≥60 years) living in a rural Ecuadorian village struck by the SARS-CoV-2 pandemic. PARTICIPANTS: Of 282 enrolled individuals, 254 (90%) finished the study. MEASUREMENTS: HGS was measured 3 months before (January 2020) and 9 months after the introduction of the virus into the population (January 2021). SARS-CoV-2 antibody testing was performed in two rounds: in May-June (early) and September-November (late), 2020. An independent association between SARS-CoV-2 infection and HGS decline was assessed by fitting linear mixed models for longitudinal data. Changes in HGS scores in SARS-CoV-2 seropositive subjects, according to the time elapsed since seroconversion, were compared with those who remained seronegative. RESULTS: Overall, 149 (59%) individuals became seropositive for SARS-CoV-2. The mean HGS (in kg) was 25.3 ± 8.3 at baseline and 23.7 ± 8.1 at follow-up (p = 0.028), with 140 individuals having >5% HGS decline between both measurements. The follow-up HGS measurement decreased by 1.72 kg in seropositive individuals, and by 0.57 kg in their seronegative counterparts (p < 0.001). SARS-CoV-2 seropositive individuals were 2.27 times more likely (95% CI: 1.33-3.87) to have a lower HGS measurement at the time of follow-up than those who remained seronegative. When compared with seronegative subjects, seropositive patients with early seroconversion were 3.41 times (95% CI: 1.73-6.74) more likely to have >5% HGS decline at the time of the follow-up than those with later, i.e., more recent, infections. CONCLUSIONS: This study shows an independent deleterious impact of SARS-CoV-2 on HGS that is more marked among individuals with infections that occurred more than 8 months before follow-up HGS. Results suggest the possibility of chronic damage to skeletal muscles by SARS-CoV-2.


Subject(s)
COVID-19/complications , Geriatric Assessment , Hand Strength , SARS-CoV-2/isolation & purification , Aftercare/methods , Aftercare/statistics & numerical data , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19 Serological Testing/methods , Ecuador/epidemiology , Female , Geriatric Assessment/methods , Geriatric Assessment/statistics & numerical data , Health Services for the Aged/statistics & numerical data , Humans , Independent Living/statistics & numerical data , Longitudinal Studies , Male , Rural Population
13.
J Am Geriatr Soc ; 69(10): 2745-2751, 2021 10.
Article in English | MEDLINE | ID: covidwho-1268122

ABSTRACT

BACKGROUND/OBJECTIVES: Transitional care management (TCM) visits delivered following hospitalization have been associated with reductions in mortality, readmissions, and total costs; however, uptake remains low. We sought to describe trends in TCM visit delivery during the COVID-19 pandemic. DESIGN: Cross-sectional study of ambulatory electronic health records from December 30, 2019 and January 3, 2021. SETTING: United States. PARTICIPANTS: Forty four thousand six hundred and eighty-one patients receiving transitional care management services. MEASUREMENTS: Weekly rates of in-person and telehealth TCM visits before COVID-19 was declared a national emergency (December 30, 2019 to March 15, 2020), during the initial pandemic period (March 16, 2020 to April 12, 2020) and later period (April 12, 2020 to January 3, 2021). Characteristics of patients receiving in-person and telehealth TCM visits were compared. RESULTS: A total of 44,681 TCM visits occurred during the study period with the majority of patients receiving TCM visits age 65 years and older (68.0%) and female (55.0%) Prior to the COVID-19 pandemic, nearly all TCM visits were conducted in-person. In the initial pandemic, there was an immediate decline in overall TCM visits and a rise in telehealth TCM visits, accounting for 15.4% of TCM visits during this period. In the later pandemic, the average weekly number of TCM visits was 841 and 14.0% were telehealth. During the initial and later pandemic periods, 73.3% and 33.6% of COVID-19-related TCM visits were conducted by telehealth, respectively. Across periods, patterns of telehealth use for TCM visits were similar for younger and older adults. CONCLUSION: The study findings highlight a novel and sustained shift to providing TCM services via telehealth during the COVID-19 pandemic, which may reduce barriers to accessing a high-value service for older adults during a vulnerable transition period. Further investigations comparing outcomes of in-person and telehealth TCM visits are needed to inform innovation in ambulatory post-discharge care.


Subject(s)
Aftercare , Ambulatory Care/statistics & numerical data , COVID-19 , Telemedicine , Transitional Care , Aftercare/methods , Aftercare/trends , Aged , COVID-19/mortality , COVID-19/prevention & control , COVID-19/therapy , Costs and Cost Analysis , Cross-Sectional Studies , Electronic Health Records/statistics & numerical data , Female , Humans , Male , Massachusetts/epidemiology , Mortality , Patient Discharge , Patient Readmission/statistics & numerical data , SARS-CoV-2 , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , Telemedicine/trends , Transitional Care/organization & administration , Transitional Care/trends
15.
Ann Am Thorac Soc ; 18(5): 799-806, 2021 05.
Article in English | MEDLINE | ID: covidwho-1219727

ABSTRACT

Rationale: The natural history of recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unknown. Because fibrosis with persistent physiological deficit is a previously described feature of patients recovering from similar coronaviruses, treatment represents an early opportunity to modify the disease course, potentially preventing irreversible impairment.Objectives: Determine the incidence of and describe the progression of persistent inflammatory interstitial lung disease (ILD) following SARS-CoV-2 when treated with prednisolone.Methods: A structured assessment protocol screened for sequelae of SARS-CoV-2 pneumonitis. Eight hundred thirty-seven patients were assessed by telephone 4 weeks after discharge. Those with ongoing symptoms had outpatient assessment at 6 weeks. Thirty patients diagnosed with persistent interstitial lung changes at a multidisciplinary team meeting were reviewed in the interstitial lung disease service and offered treatment. These patients had persistent, nonimproving symptoms.Results: At 4 weeks after discharge, 39% of patients reported ongoing symptoms (325/837) and were assessed. Interstitial lung disease, predominantly organizing pneumonia, with significant functional deficit was observed in 35/837 survivors (4.8%). Thirty of these patients received steroid treatment, resulting in a mean relative increase in transfer factor following treatment of 31.6% (standard deviation [SD] ± 27.6, P < 0.001), and forced vital capacity of 9.6% (SD ± 13.0, P = 0.014), with significant symptomatic and radiological improvement.Conclusions: Following SARS-CoV-2 pneumonitis, a cohort of patients are left with both radiological inflammatory lung disease and persistent physiological and functional deficit. Early treatment with corticosteroids was well tolerated and associated with rapid and significant improvement. These preliminary data should inform further study into the natural history and potential treatment for patients with persistent inflammatory ILD following SARS-CoV-2 infection.


Subject(s)
Aftercare/methods , COVID-19/complications , Glucocorticoids/therapeutic use , Lung Diseases, Interstitial , Lung , Respiratory Function Tests/methods , COVID-19/mortality , COVID-19/therapy , Female , Hospitalization/statistics & numerical data , Humans , Lung/diagnostic imaging , Lung/physiopathology , Lung/virology , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/etiology , Lung Diseases, Interstitial/physiopathology , Lung Diseases, Interstitial/therapy , Male , Middle Aged , Patient Discharge/statistics & numerical data , SARS-CoV-2/isolation & purification , Survivors/statistics & numerical data , Symptom Assessment/methods , Symptom Assessment/statistics & numerical data , Tomography, X-Ray Computed/methods , Treatment Outcome , United Kingdom/epidemiology
16.
Plast Surg Nurs ; 41(1): 36-39, 2021.
Article in English | MEDLINE | ID: covidwho-1218019

ABSTRACT

On March 11, 2020, the World Health Organization declared COVID-19 to be a pandemic, challenging health care systems all over the world. National health care systems have reorganized to cope with the disease. Surgical services departments around the world have been affected and elective surgical procedures have been postponed to conserve medical resources. When a patient with COVID-19 requires an urgent microsurgical free flap due to trauma or a tumor, personnel from the health care facility must have a protocol in place to follow for the patient's care and follow-up. In this article, we present our protocol for patients with COVID-19 requiring reconstructive microsurgery.


Subject(s)
COVID-19/prevention & control , Free Tissue Flaps/transplantation , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Microsurgery/methods , Perioperative Care/methods , Reconstructive Surgical Procedures/methods , Aftercare/methods , Aftercare/standards , COVID-19/complications , COVID-19/transmission , Clinical Protocols , Hospitals, University , Humans , Infection Control/standards , Microsurgery/standards , Perioperative Care/standards , Reconstructive Surgical Procedures/standards , Spain
17.
Contraception ; 104(3): 289-295, 2021 09.
Article in English | MEDLINE | ID: covidwho-1216311

ABSTRACT

OBJECTIVE: To explore US provider perspectives about self-sourced medication abortion and how their attitudes and clinic practices changed in the context of the COVID-19 pandemic. STUDY DESIGN: We conducted a multi-method study of survey and interview data. We performed 40 baseline interviews and surveys in spring 2019 and 36 follow-up surveys and ten interviews one year later. We compared pre- and post-Likert scale responses of provider views on the importance of different aspects of standard medication abortion assessment and evaluation (e.g., related to ultrasounds and blood-typing). We performed content analysis of the follow-up interviews using deductive-inductive analysis. RESULTS: Survey results revealed that clinics substantially changed their medication abortion protocols in response to COVID-19, with more than half increasing their gestational age limits and introducing telemedicine for follow-up of a medication abortion. Interview analysis suggested that physicians were more supportive of self-sourced medication abortion in response to changing clinic protocols that decreased in-clinic assessment and evaluation for medication abortion, and as a result of physicians' altered assessments of risk in the context of COVID-19. Having evidence already in place that supported these practice changes made the implementation of new protocols more efficient, while working in a state with restrictive abortion policies thwarted the flexibility of clinics to adapt to changes in standards of care. CONCLUSION: This exploratory study reveals that the COVID-19 pandemic has altered clinical assessment of risk and has shifted practice towards a less medicalized model. Further work to facilitate person-centered abortion information and care can build on initial modifications in response to the pandemic. IMPLICATIONS: COVID-19 has shifted clinician perception of risk and has catalyzed a change in clinical protocols for medication abortion. However, state laws and policies that regulate medication abortion limit physician ability to respond to changes in risk assessment.


Subject(s)
Abortifacient Agents/therapeutic use , Abortion, Induced/methods , Abortion, Induced/trends , Attitude of Health Personnel , COVID-19/prevention & control , Physicians/psychology , Practice Patterns, Physicians'/trends , Adult , Aftercare/methods , Aftercare/trends , Clinical Protocols , Female , Health Policy , Humans , Interviews as Topic , Male , Middle Aged , Risk Assessment , Self Administration , Surveys and Questionnaires , United States
18.
Semin Perinatol ; 45(5): 151430, 2021 08.
Article in English | MEDLINE | ID: covidwho-1203278

ABSTRACT

Little empirical data support the use of telemedicine to provide medical and developmental follow-up care to preterm and high-risk infants after hospital discharge. Nevertheless, the COVID-19 pandemic temporarily rendered telemedicine the only means by which to provide essential follow-up care to this population. In this article we discuss our institution's experience with rapid implementation of telemedicine in a multi-site neonatal follow-up program as well as benefits and limitations of the use of telemedicine in this context. Finally, we discuss the current problems that must be solved in order to optimize telemedicine as a tool for providing comprehensive, multidisciplinary medical and developmental care to high risk infants and their families.


Subject(s)
Aftercare , COVID-19 , Infant Care , Patient Care Team/organization & administration , Telemedicine , Aftercare/methods , Aftercare/trends , COVID-19/epidemiology , COVID-19/prevention & control , Child Development , Family Health , Humans , Infant Care/methods , Infant Care/organization & administration , Infant, Newborn , Infant, Newborn, Diseases/epidemiology , Infant, Newborn, Diseases/therapy , Infant, Premature/growth & development , Program Evaluation , Risk Assessment/methods , SARS-CoV-2 , Telemedicine/methods , Telemedicine/organization & administration , United States/epidemiology
19.
Contraception ; 104(1): 77-81, 2021 07.
Article in English | MEDLINE | ID: covidwho-1198678

ABSTRACT

OBJECTIVES: To document medication abortion clinical practice changes adopted by providers in response to the COVID-19 pandemic. STUDY DESIGN: Longitudinal descriptive study, comprised of three online surveys conducted between April to December, 2020. We recruited sites from email lists of national abortion and family planning organizations. RESULTS: Seventy-four sites opted to participate. We analyzed 55/74 sites (74%) that provided medication abortion and completed all three surveys. The total number of abortion encounters reported by the sites remained consistent throughout the study period, though medication abortion encounters increased while first-trimester aspiration abortion encounters decreased. In response to the COVID-19 pandemic, sites reduced the number of in-person visits associated with medication abortion and confirmation of successful termination. In February 2020, considered prepandemic, 39/55 sites (71%) required 2 or more patient visits for a medication abortion. By April 2020, 19/55 sites (35%) reported reducing the total number of in-person visits associated with a medication abortion. As of October 2020, 37 sites indicated newly adopting a practice of offering medication abortion follow-up with no in-person visits. CONCLUSIONS: Sites quickly adopted protocols incorporating practices that are well-supported in the literature, including forgoing Rh-testing and pre-abortion ultrasound in some circumstances and relying on patient report of symptoms or home pregnancy tests to confirm successful completion of medication abortion. Importantly, these practices reduce face-to-face interactions and the opportunity for virus transmission. Sustaining these changes even after the public health crisis is over may increase patient access to abortion, and these impacts should be evaluated in future research. IMPLICATIONS STATEMENT: Medication abortion serves a critical function in maintaining access to abortion when there are limitations to in-person clinic visits. Sites throughout the country successfully and quickly adopted protocols that reduced visits associated with the abortion, reducing in-person screenings, relying on telehealth, and implementing remote follow-up.


Subject(s)
Abortifacient Agents , Abortion, Induced/methods , Abortion, Induced/trends , COVID-19/prevention & control , Pandemics/prevention & control , Practice Patterns, Physicians'/trends , Telemedicine/trends , Aftercare/methods , Aftercare/trends , COVID-19/epidemiology , Female , Health Care Surveys , Humans , Longitudinal Studies , Pregnancy , Telemedicine/methods , United States/epidemiology
20.
Rev Esp Cir Ortop Traumatol (Engl Ed) ; 65(3): 167-171, 2021.
Article in English | MEDLINE | ID: covidwho-1188971

ABSTRACT

Background and aim: The current COVID-19 pandemic scenario has driven surgical departments to a transformation.The worldwide spread of the disease has led to a public health quarantine where health care professionals are at high risk of infection. In this context, telemedicine has been promoted and scaled up to reduce the risk of transmission. This study aims to demonstrate that a combined framework based on telematics and in-person clinical encounter not only ensures medical care but the safety of healthcare professionals and patients. Material and method: Descriptive observational study on the follow-up of patients during the COVID19 Pandemic, combining telephone and traditional. Results: A total of 5031 telephone calls were made, differentiating between medical referrals, specialised primary care visits, and outpatient consultation.They were classified as successful, required an in-person visit, or no successful telephone contact. Furthermore, we divided them into 2 groups: resolved and unresolved.53% of all telematic visits were successful. Conclusions: Telematic medical systems are a feasible option in a orthopedics department and an interesting resource to preserve once the pandemic is resolved. Future lines of research should be opened to improve system success, analyze its cost-effectiveness ratio, and correct any legal conflicts that may exist.


Subject(s)
Aftercare/methods , COVID-19/prevention & control , Infection Control/methods , Orthopedics/methods , Postoperative Care/methods , Remote Consultation/methods , Telephone , Aftercare/statistics & numerical data , COVID-19/epidemiology , Feasibility Studies , Health Policy , Health Services Accessibility , Humans , Orthopedics/statistics & numerical data , Outcome and Process Assessment, Health Care , Pandemics , Physical Distancing , Postoperative Care/statistics & numerical data , Remote Consultation/statistics & numerical data , Spain/epidemiology
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