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1.
Cardiovasc Ultrasound ; 20(1): 2, 2022 Jan 19.
Article in English | MEDLINE | ID: covidwho-1633049

ABSTRACT

BACKGROUND: This study aimed to investigate the relationship between echocardiography results and lung ultrasound score (LUS) in coronavirus disease 2019 (COVID-19) pneumonia patients and evaluate the impact of the combined application of these techniques in the evaluation of COVID-19 pneumonia. METHODS: Hospitalized COVID-19 pneumonia patients who underwent daily lung ultrasound and echocardiography were included in this study. Patients with tricuspid regurgitation within three days of admission were enrolled. Moreover, the correlation and differences between their pulmonary artery pressure (PAP) and LUS on days 3, 8, and 13 were analyzed. The inner diameter of the pulmonary artery root as well as the size of the atria and ventricles were also considered. RESULTS: The PAP on days 3, 8, and 13 of hospitalization was positively correlated with the LUS (r = 0.448, p = 0.003; r = 0.738, p < 0.001; r = 0.325, p = 0.036, respectively). On day 8, the values of both PAP and LUS were higher than on days 3 and 13 (p < 0.01). Similarly, PAP and LUS were significantly increased in 92.9% (39/42) and 90.5% (38/42) of patients, respectively, and at least one of these two values was positive in 97.6% (41/42) of cases. The inner diameters of the right atrium, right ventricle, and pulmonary artery also differed significantly from their corresponding values on days 3 and 13 (p < 0.05). CONCLUSIONS: PAP is positively correlated with LUS in COVID-19 pneumonia. The two values could be combined for a more precise assessment of disease progression and recovery status.


Subject(s)
COVID-19 , Pneumonia , Echocardiography , Humans , Lung/diagnostic imaging , Pilot Projects , Pneumonia/diagnostic imaging , SARS-CoV-2 , Ultrasonography
2.
Acta Biomed ; 92(S2): e2021330, 2021 12 22.
Article in English | MEDLINE | ID: covidwho-1625871

ABSTRACT

BACKGROUND AND AIM OF THE WORK: In a society that tries so hard to forget and make people forget that death exists, death has never been so close to man in his daily life as during this pandemic. Health care professionals have therefore all too often had to  deal with the death of the people they care for and with related issues such as, for example, the dignity of death, the humanization of death and care for the dying. The aim of the study is to highlight the perceptions of physicians, nurses and health and social workers in the difficult moment of the end of life, also analyzing which coping strategies were implemented by them. METHODS: All Italian healthcare workers were enrolled in this survey. The questionnaire was administered in an online version. Physicians, nurses and support staff (social and health workers) were contacted through social networks. RESULTS: A total of 512 healthcare workers were enrolled in this survey. No statistical significant differences were recorded among the COPE-NVI- 25 sub dimensions according to sex, profession and to different wards. Additionally, by considering the COPE-NVI-25 sub dimensions according to years of work experience, a statistical significant difference was reported in the Transcendent Orientation sub dimension (p=.047), as healthcare workers with 11-20 years of work experience recorded higher levels than the other two groups. By considering differences in the COPE-NVI-25 sub dimensions according to religion, significant differences were recorded in the transcendent orientation (p=.032), in the positive attitude (p=.030), in the social support (p=.035). CONCLUSIONS: From the evidence in the literature, the quality of end-of-life care performance has a positive correlation with awareness of a good death and attitudes towards end-of-life care.


Subject(s)
COVID-19 , Pandemics , Adaptation, Psychological , Death , Health Personnel , Humans , Male , Pilot Projects , SARS-CoV-2
3.
PLoS One ; 16(12): e0261818, 2021.
Article in English | MEDLINE | ID: covidwho-1623662

ABSTRACT

OBJECTIVE: Our project aims to provide: an overview of the impact of the COVID-19 pandemic on the field of mental health professionals in 23 countries;a model of recommendations for good practice and proposals for methods and digital tools to improve the well-being at work of mental health professionals and the quality of services offered during crisis and post-crisis periods;an in-depth ethics review of the assessment of the use of numerical tools for psychiatry professionals and patient support, including teleconsulting. METHODS: This is a large international survey conducted among 2,000 mental health professionals in 23 countries over a 12-month period. This survey will be based on 30 individual interviews and 20 focus group sessions, and a digital questionnaire will be sent online to 2,000 professionals based on the criteria of gender, age, professional experience, psychiatric specialty, context of work in psychiatry, and geographical location. Regarding the development of telepsychiatry during the COVID-19 pandemic, a pilot study on the use of digital tools will be carried out on 100 clients of psychiatry professionals in France and Belgium. DISCUSSION-CONCLUSION: This study will contribute to the co-construction of an international organization and monitoring system that takes into account psychiatric health professionals as major resources to fight against the COVID-19 pandemic and to develop efficient processes for preparing and anticipating crises by reducing psychosocial risks as much as possible. This project also aims to design tools for remote medicine and to develop the use of numerical tools for monitoring and supporting professionals and helping professionals to build the conditions for satisfactory operational work during crises and post-crisis situations, using adapted organizational methods. Our ongoing research should support professionals in the search for existing concrete solutions to cope with emergency work situations while maintaining an optimal quality of life.


Subject(s)
COVID-19/epidemiology , COVID-19/psychology , Mental Health Services/organization & administration , Mental Health , Pandemics , Professional Practice , Psychotherapists/psychology , SARS-CoV-2 , Belgium/epidemiology , COVID-19/virology , Female , France/epidemiology , Humans , Male , Pilot Projects , Quality of Life/psychology , Surveys and Questionnaires , Telemedicine/methods
4.
Nutrients ; 13(12)2021 Dec 15.
Article in English | MEDLINE | ID: covidwho-1622630

ABSTRACT

Culinary medicine is an evidence-based approach that blends the art of cooking with the science of medicine to inculcate a healthy dietary pattern. Food prescription programs are gaining popularity in the Unites States, as a means to improve access to healthy foods among patient populations. The purpose of this paper is to describe the implementation and preliminary impact of A Prescription for Healthy Living (APHL) culinary medicine curriculum on biometric and diet-related behavioral and psychosocial outcomes among patients with diabetes participating in a clinic-led food prescription (food Rx) program. We used a quasi-experimental design to assess APHL program impact on patient biometric outcome data obtained from electronic health records, including glycosylated hemoglobin (HbA1c), body mass index (BMI), and blood pressure (n = 33 patients in the APHL group, n = 75 patients in the food Rx-only group). Pre-post surveys were administered among those in the APHL group to monitor program impact on psychosocial and behavioral outcomes. Results of the outcome analysis showed significant pre-to-post reduction in HbA1c levels among participants within the APHL group (estimated mean difference = -0.96% (-1.82, -0.10), p = 0.028). Between-group changes showed a greater decrease in HbA1c among those participating in APHL as compared to food Rx-only, albeit these differences were not statistically significant. Participation in APHL demonstrated significant increases in the consumption of fruits and vegetables, fewer participants reported that cooking healthy food is difficult, increased frequency of cooking from scratch, and increased self-efficacy in meal planning and cooking (p < 0.01). In conclusion, the results of our pilot study suggest the potential positive impact of a virtually-implemented culinary medicine approach in improving health outcomes among low-income patients with type 2 diabetes, albeit studies with a larger sample size and a rigorous study design are needed.


Subject(s)
Curriculum , Diabetes Mellitus, Type 2/diet therapy , Feeding Behavior , Nutritional Sciences , Biometry , COVID-19 , Cooking/methods , Diet Therapy , Diet, Healthy , Health Education , Humans , Pilot Projects , Psychiatric Rehabilitation , SARS-CoV-2
5.
J Neurosci Nurs ; 54(1): 30-34, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1621702

ABSTRACT

ABSTRACT: BACKGROUND: The Bispectral (BIS) monitor is a validated, noninvasive monitor placed over the forehead to titrate sedation in patients under general anesthesia in the operating room. In the neurocritical care unit, there is limited room on the forehead because of incisions, injuries, and other monitoring devices. This is a pilot study to determine whether a BIS nasal montage correlates to the standard frontal-temporal data in this patient population. METHODS: This prospective nonandomized pilot study enrolled 10 critically ill, intubated, and sedated adult patients admitted to the neurocritical care unit. Each patient had a BIS monitor placed over the standard frontal-temporal location and over the alternative nasal dorsum with simultaneous data collected for 24 hours. RESULTS: In the frontal-temporal location, the mean (SD) BIS score was 50.9 (15.0), average minimum BIS score was 47.0 (15.0), and average maximum BIS score was 58.4 (16.7). In the nasal dorsum location, the mean BIS score was 54.8 (21.6), average minimum BIS score was 52.8 (20.9), and average maximum BIS score was 58.0 (22.2). Baseline nonparametric tests showed nonsignificant P values for all variables except for Signal Quality Index. Generalized linear model analysis demonstrated significant differences between the 2 monitor locations (P < .0001). CONCLUSION: The results of this pilot study do not support using a BIS nasal montage as an alternative for patients in the neurocritical care unit.


Subject(s)
Consciousness Monitors , Electroencephalography , Adult , Conscious Sedation , Humans , Hypnotics and Sedatives , Intensive Care Units , Pilot Projects , Prospective Studies
6.
PLoS One ; 16(12): e0261704, 2021.
Article in English | MEDLINE | ID: covidwho-1613355

ABSTRACT

This pilot project investigated environmental SARS-CoV-2 presence in seven Midwestern meatpacking plants from May 2020 to January 2021. This study investigated social distancing and infection control practices and incorporated environmental sampling of surfaces and air in employee common areas. All plants increased their social distancing efforts, increased the frequency of cleaning and disinfecting worker areas, and screened for symptomatic people to prevent entry into the workplace. 575 samples from common areas were collected and evaluated with RT-qPCR for the presence of SARS-CoV-2. 42/367 surface samples were positive, while no virus was detected in air samples. Case positive data from the counties surrounding each plant showed peak positive SARS-CoV-2 cases from 12-55 days before the virus was detected in the plant, indicating that environmental sampling is likely a lagging indicator of community and plant infection.


Subject(s)
COVID-19/epidemiology , Environmental Monitoring/statistics & numerical data , Meat-Packing Industry/statistics & numerical data , Disinfection/statistics & numerical data , Humans , Midwestern United States/epidemiology , Physical Distancing , Pilot Projects
7.
Front Public Health ; 9: 789402, 2021.
Article in English | MEDLINE | ID: covidwho-1607927

ABSTRACT

Repeated testing of a population is critical for limiting the spread of the SARS-CoV-2 virus and for the safe reopening of educational institutions such as kindergarten-grade 12 (K-12) schools and colleges. Many screening efforts utilize the CDC RT-PCR based assay which targets two regions of the novel Coronavirus nucleocapsid gene. The standard approach of testing each person individually, however, poses a financial burden to these institutions and is therefore a barrier to using testing for re-opening. Pooling samples from multiple individuals into a single test is an attractive alternate approach that promises significant cost savings-however the specificity and sensitivity of such approaches needs to be assessed prior to deployment. To this end, we conducted a pilot study to evaluate the feasibility of analyzing samples in pools of eight by the established RT-PCR assay. Participants (1,576) were recruited from amongst the Tufts University community undergoing regular screening. Each volunteer provided two swabs, one analyzed separately and the other in a pool of eight. Because the positivity rate was very low, we spiked approximately half of the pools with laboratory-generated swabs produced from known positive cases outside the Tufts testing program. The results of pooled tests had 100% correspondence with those of their respective individual tests. We conclude that pooling eight samples does not negatively impact the specificity or sensitivity of the RT-PCR assay and suggest that this approach can be utilized by institutions seeking to reduce surveillance costs.


Subject(s)
COVID-19 , RNA, Viral , Humans , Pilot Projects , SARS-CoV-2 , Schools , Specimen Handling
8.
Crit Care ; 26(1): 1, 2022 01 03.
Article in English | MEDLINE | ID: covidwho-1607666

ABSTRACT

BACKGROUND: SARS-CoV-2 seems to affect the regulation of pulmonary perfusion. Hypoperfusion in areas of well-aerated lung parenchyma results in a ventilation-perfusion mismatch that can be characterized using subtraction computed tomography angiography (sCTA). This study aims to evaluate the efficacy of oral sildenafil in treating COVID-19 inpatients showing perfusion abnormalities in sCTA. METHODS: Triple-blinded, randomized, placebo-controlled trial was conducted in Chile in a tertiary-care hospital able to provide on-site sCTA scans and ventilatory support when needed between August 2020 and March 2021. In total, 82 eligible adults were admitted to the ED with RT-PCR-confirmed or highly probable SARS-COV-2 infection and sCTA performed within 24 h of admission showing perfusion abnormalities in areas of well-aerated lung parenchyma; 42 were excluded and 40 participants were enrolled and randomized (1:1 ratio) once hospitalized. The active intervention group received sildenafil (25 mg orally three times a day for seven days), and the control group received identical placebo capsules in the same way. Primary outcomes were differences in oxygenation parameters measured daily during follow-up (PaO2/FiO2 ratio and A-a gradient). Secondary outcomes included admission to the ICU, requirement of non-invasive ventilation, invasive mechanical ventilation (IMV), and mortality rates. Analysis was performed on an intention-to-treat basis. RESULTS: Totally, 40 participants were enrolled (20 in the placebo group and 20 in the sildenafil group); 33 [82.5%] were male; and median age was 57 [IQR 41-68] years. No significant differences in mean PaO2/FiO2 ratios and A-a gradients were found between groups (repeated-measures ANOVA p = 0.67 and p = 0.69). IMV was required in 4 patients who received placebo and none in the sildenafil arm (logrank p = 0.04). Patients in the sildenafil arm showed a significantly shorter median length of hospital stay than the placebo group (9 IQR 7-12 days vs. 12 IQR 9-21 days, p = 0.04). CONCLUSIONS: No statistically significant differences were found in the oxygenation parameters. Sildenafil treatment could have a potential therapeutic role regarding the need for IMV in COVID-19 patients with specific perfusion patterns in sCTA. A large-scale study is needed to confirm these results. TRIAL REGISTRATION: Sildenafil for treating patients with COVID-19 and perfusion mismatch: a pilot randomized trial, NCT04489446, Registered 28 July 2020, https://clinicaltrials.gov/ct2/show/NCT04489446 .


Subject(s)
COVID-19 , Sildenafil Citrate , Vasodilator Agents , Administration, Oral , Adult , Aged , COVID-19/drug therapy , COVID-19/physiopathology , Female , Humans , Male , Middle Aged , Pilot Projects , Sildenafil Citrate/administration & dosage , Treatment Outcome , Vasodilator Agents/administration & dosage , Ventilation-Perfusion Ratio
9.
Crit Care ; 26(1): 9, 2022 01 04.
Article in English | MEDLINE | ID: covidwho-1606943

ABSTRACT

ClinicalTrials.gov identifier (NCT number): NCT03852537 , Registered February 25, 2019.


Subject(s)
COVID-19 , Steroids , Biomarkers , COVID-19/drug therapy , Humans , Pilot Projects , Steroids/administration & dosage , Treatment Outcome
10.
J Korean Med Sci ; 36(50): e338, 2021 Dec 27.
Article in English | MEDLINE | ID: covidwho-1596045

ABSTRACT

Generating a testable working hypothesis is the first step towards conducting original research. Such research may prove or disprove the proposed hypothesis. Case reports, case series, online surveys and other observational studies, clinical trials, and narrative reviews help to generate hypotheses. Observational and interventional studies help to test hypotheses. A good hypothesis is usually based on previous evidence-based reports. Hypotheses without evidence-based justification and a priori ideas are not received favourably by the scientific community. Original research to test a hypothesis should be carefully planned to ensure appropriate methodology and adequate statistical power. While hypotheses can challenge conventional thinking and may be controversial, they should not be destructive. A hypothesis should be tested by ethically sound experiments with meaningful ethical and clinical implications. The coronavirus disease 2019 pandemic has brought into sharp focus numerous hypotheses, some of which were proven (e.g. effectiveness of corticosteroids in those with hypoxia) while others were disproven (e.g. ineffectiveness of hydroxychloroquine and ivermectin).


Subject(s)
COVID-19/drug therapy , Research Design , SARS-CoV-2 , COVID-19/epidemiology , Ethics, Research , Humans , Peer Review , Pilot Projects , Publishing
11.
PLoS One ; 16(12): e0261832, 2021.
Article in English | MEDLINE | ID: covidwho-1595434

ABSTRACT

The objective of this study was to evaluate the relationships of food safety knowledge, attitude and eating behavior of consumers during national lockdowns in the advent of the COVID-19 pandemic. A total of 157 respondents completed the online survey using a structured questionnaire worldwide. Overall, the respondents exhibited good attitude and good knowledge towards public health including food safety especially on the importance of social distancing, mask wearing, well-balanced diet, physical exercise and personal hygiene, such as hand washing during the pandemic lockdowns. A Structural Equation Modeling (SEM) was used to test the relationships among food safety knowledge, attitude and behavior under the pandemic conditions. Results showed that attitude towards food safety under the coronavirus pandemic and lockdowns positively affected the eating behavior of the respondents, which exhibited a high ß (0.686) among the variables tested (p<0.05). Food safety knowledge was apparently not affected by the food safety behavior of the respondents.


Subject(s)
COVID-19/epidemiology , Feeding Behavior/psychology , Food Safety , Health Knowledge, Attitudes, Practice , Pandemics , Adolescent , Adult , Aged , Female , Global Health , Hand Disinfection , Health Behavior , Humans , Male , Middle Aged , Pilot Projects , Public Health , Surveys and Questionnaires , Young Adult
12.
PLoS One ; 16(12): e0261006, 2021.
Article in English | MEDLINE | ID: covidwho-1593120

ABSTRACT

BACKGROUND: Adherence to antiretroviral therapy (ART) remains problematic. Regular monitoring of its barriers is clinically recommended, however, patient-provider communication around adherence is often inadequate. Our team thus decided to develop a new electronically administered patient-reported outcome measure (PROM) of barriers to ART adherence (the I-Score) to systematically capture this data for physician consideration in routine HIV care. To prepare for a controlled definitive trial to test the I-Score intervention, a pilot study was designed. Its primary objectives are to evaluate patient and physician perceptions of the I-Score intervention and its implementation strategy. METHODS: This one-arm, 6-month study will adopt a mixed method type 3 implementation-effectiveness hybrid design and be conducted at the Chronic Viral Illness Service of the McGill University Health Centre (Montreal, Canada). Four HIV physicians and 32 of their HIV patients with known or suspected adherence problems will participate. The intervention will involve having patients complete the I-Score through a smartphone application (Opal), before meeting with their physician. Both patients and physicians will have access to the I-Score results, for consideration during the clinic visits at Times 1, 2 (3 months), and 3 (6 months). The implementation strategy will focus on stakeholder involvement, education, and training; promoting the intervention's adaptability; and hiring an Application Manager to facilitate implementation. Implementation, patient, and service outcomes will be collected (Times 1-2-3). The primary outcome is the intervention's acceptability to patients and physicians. Qualitative data obtained, in part, through physician focus groups (Times 2-3) and patient interviews (Times 2-3) will help evaluate the implementation strategy and inform any methodological adaptations. DISCUSSION: This study will help plan a definitive trial to test the efficacy of the I-Score intervention. It will generate needed data on electronic PROM interventions in routine HIV care that will help improve understanding of conditions for their successful implementation. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04702412; https://clinicaltrials.gov/.


Subject(s)
Anti-Retroviral Agents/therapeutic use , Electronic Health Records , Health Services , Medication Adherence , Patient Portals , Patient Reported Outcome Measures , Canada , Humans , Pilot Projects
13.
Sensors (Basel) ; 21(24)2021 Dec 16.
Article in English | MEDLINE | ID: covidwho-1580511

ABSTRACT

This work introduces a new socially assistive robot termed MARIA T21 (meaning "Mobile Autonomous Robot for Interaction with Autistics", with the addition of the acronym T21, meaning "Trisomy 21", which is used to designate individuals with Down syndrome). This new robot is used in psychomotor therapies for children with Down syndrome (contributing to improve their proprioception, postural balance, and gait) as well as in psychosocial and cognitive therapies for children with autism spectrum disorder. The robot uses, as a novelty, an embedded mini-video projector able to project Serious Games on the floor or tables to make already-established therapies funnier to these children, thus creating a motivating and facilitating effect for both children and therapists. The Serious Games were developed in Python through the library Pygame, considering theoretical bases of behavioral psychology for these children, which are integrated into the robot through the robot operating system (ROS). Encouraging results from the child-robot interaction are shown, according to outcomes obtained from the application of the Goal Attainment Scale. Regarding the Serious Games, they were considered suitable based on both the "Guidelines for Game Design of Serious Games for Children" and the "Evaluation of the Psychological Bases" used during the games' development. Thus, this pilot study seeks to demonstrate that the use of a robot as a therapeutic tool together with the concept of Serious Games is an innovative and promising tool to help health professionals in conducting therapies with children with autistic spectrum disorder and Down syndrome. Due to health issues imposed by the COVID-19 pandemic, the sample of children was limited to eight children (one child with typical development, one with Trisomy 21, both female, and six children with ASD, one girl and five boys), from 4 to 9 years of age. For the non-typically developing children, the inclusion criterion was the existence of a conclusive diagnosis and fulfillment of at least 1 year of therapy. The protocol was carried out in an infant psychotherapy room with three video cameras, supervised by a group of researchers and a therapist. The experiments were separated into four steps: The first stage was composed of a robot introduction followed by an approximation between robot and child to establish eye contact and assess proxemics and interaction between child/robot. In the second stage, the robot projected Serious Games on the floor, and emitted verbal commands, seeking to evaluate the child's susceptibility to perform the proposed tasks. In the third stage, the games were performed for a certain time, with the robot sending messages of positive reinforcement to encourage the child to accomplish the game. Finally, in the fourth stage, the robot finished the games and said goodbye to the child, using messages aiming to build a closer relationship with the child.


Subject(s)
Autism Spectrum Disorder , COVID-19 , Down Syndrome , Robotics , Autism Spectrum Disorder/therapy , Down Syndrome/therapy , Female , Humans , Male , Pandemics , Pilot Projects , SARS-CoV-2
14.
Atherosclerosis ; 341: 43-49, 2022 01.
Article in English | MEDLINE | ID: covidwho-1588250

ABSTRACT

BACKGROUND AND AIMS: Thrombosis is a major driver of adverse outcome and mortality in patients with Coronavirus disease 2019 (COVID-19). Hypercoagulability may be related to the cytokine storm associated with COVID-19, which is mainly driven by interleukin (IL)-6. Plasma lipoprotein(a) [Lp(a)] levels increase following IL-6 upregulation and Lp(a) has anti-fibrinolytic properties. This study investigated whether Lp(a) elevation may contribute to the pro-thrombotic state hallmarking COVID-19 patients. METHODS: Lp(a), IL-6 and C-reactive protein (CRP) levels were measured in 219 hospitalized patients with COVID-19 and analyzed with linear mixed effects model. The baseline biomarkers and increases during admission were related to venous thromboembolism (VTE) incidence and clinical outcomes in a Kaplan-Meier and logistic regression analysis. RESULTS: Lp(a) levels increased significantly by a mean of 16.9 mg/dl in patients with COVID-19 during the first 21 days after admission. Serial Lp(a) measurements were available in 146 patients. In the top tertile of Lp(a) increase, 56.2% of COVID-19 patients experienced a VTE event compared to 18.4% in the lowest tertile (RR 3.06, 95% CI 1.61-5.81; p < 0.001). This association remained significant after adjusting for age, sex, IL-6 and CRP increase and number of measurements. Increases in IL-6 and CRP were not associated with VTE. Increase in Lp(a) was strongly correlated with increase in IL-6 (r = 0.44, 95% CI 0.30-0.56, p < 0.001). CONCLUSIONS: Increases in Lp(a) levels during the acute phase of COVID-19 were strongly associated with VTE incidence. The acute increase in anti-fibrinolytic Lp(a) may tilt the balance to VTE in patients hospitalized for COVID-19.


Subject(s)
COVID-19 , Venous Thromboembolism , Humans , Lipoprotein(a) , Pilot Projects , Risk Factors , SARS-CoV-2 , Venous Thromboembolism/diagnosis , Venous Thromboembolism/epidemiology
15.
BMC Surg ; 21(1): 422, 2021 Dec 16.
Article in English | MEDLINE | ID: covidwho-1582080

ABSTRACT

BACKGROUND: The SARS-CoV2 virus has been identified in abdominal cavity of the COVID-19 patients. Therefore, the potential viral transmission from any surgical created smoke in these patients is of concern especially in laparoscopic surgery. This study aimed to compare the amount of surgical smoke and surgical field contamination between laparoscopic and open surgery in fresh cadavers. METHODS: Cholecystectomy in 12 cadavers was performed and they were divided into 4 groups: laparoscopic approach with or without smoke evacuator, and open approach with or without smoke evacuator. The increased particle counts in surgical smoke of each group were analyzed. In the model of appendectomy, surgical field contamination under ultraviolet light and visual contamination scale between laparoscopic and open approach were compared. RESULTS: Open cholecystectomy significantly produced a greater amount of overall particle sizes, particle sizes < 5 µm and particle sizes ≥ 5 µm than laparoscopic cholecystectomy (10,307 × 103 vs 3738 × 103, 10,226 × 103 vs 3685 × 103 and 81 × 103 vs 53 × 103 count/m3, respectively at p < 0.05). The use of smoke evacuator led to decrease in the amount of overall particle sizes of 58% and 32.4% in the open and laparoscopic chelecystectomy respectively. Median (interquatile range) visual contamination scale of surgical field in open appendectomy [3.50 (2.33, 4.67)] was significantly greater than laparoscopic appendectomy [1.50 (0.67, 2.33)] at p < 0.001. CONCLUSIONS: Laparoscopic cholecystectomy yielded less smoke-related particles than open cholecystectomy. The use of smoke evacuator, abeit non-significantly, reduced the particles in both open and laparoscopic cholecystectomy. Laparoscopic appendectomy had a lower degree of surgical field contamination than the open approach.


Subject(s)
COVID-19 , Laparoscopy , Cadaver , Humans , Pandemics , Pilot Projects , RNA, Viral , SARS-CoV-2
16.
BMC Res Notes ; 14(1): 466, 2021 Dec 23.
Article in English | MEDLINE | ID: covidwho-1582018

ABSTRACT

OBJECTIVES: SARS-CoV-2, severe respiratory syndrome coronavirus-2, is an RNA virus that emerged from China sweeping the globe in the form of a pandemic that became an international public health concern. This pilot study aimed to describe the genetic variation and molecular epidemiology of SARS-CoV-2 in Palestine in fall 2020. RESULTS: To achieve these aims, whole genome sequencing of SARS-CoV-2, phylogenetic analysis, haplotype networking and genetic diversity analysis were performed. These analyses revealed a unique spike mutation H245N that has never been reported before. The phylogenetic analysis depicted that three clusters existed in Palestinian SARS-CoV-2 genome sequences, in which cluster-I comprised the majority of clusters by 90%. Congruently, the haplotype network analysis depicted the same three clusters with a total of 39 haplotypes. The genetic diversity analysis showed that Cluster-I is highly diverse as confirmed by statistically significant mutation rate indices, Tajima's D and Fu-Li's-F tests (- 2.11 and 2.74, respectively), highest number of mutations (Eta = 120), highest number of haplotypes (h = 17), and highest average number of nucleotide differences between any two sequences (S = 118). The study confirmed the high genetic diversity among the Palestinian of SARS-CoV-2 which possessed high number of mutations including one which was reported for the first time.


Subject(s)
Genome, Viral , SARS-CoV-2 , Spike Glycoprotein, Coronavirus/genetics , Arabs , COVID-19/virology , Humans , Middle East , Mutation , Phylogeny , Pilot Projects , SARS-CoV-2/genetics , Whole Genome Sequencing
17.
Med Educ Online ; 26(1): 1892017, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1575053

ABSTRACT

Introduction: Telesimulation may allow simulationists to continue with essential simulation-based training programs during the COVID-19 pandemic. Hence, we investigated the feasibility of telesimulation for neonatal resuscitation training, assessed participants' attitudes towards telesimulation as well as its effect on neonatal resuscitation knowledge, and compared results between medical students and neonatal nurses. Methods: For this prospective observational pilot study, medical students and neonatal nursing staff were recruited on a voluntary basis. Pre- and post-training knowledge was assessed using a 20-question questionnaire. Following the educational intervention, participants further answered a six-item questionnaire on their perception of telesimulation. For the telesimulation session, participants received a simulation package including a low-fidelity mannequin and medical equipment. The one-hour telesimulation session was delivered by an experienced instructor and broadcasted via Cisco Webex for groups of 2-3 participants, covering all elements of the neonatal resuscitation algorithm and including deliberate technical skills practice. Results: Nine medical students and nine neonatal nurses participated in a total of seven telesimulation sessions. In general, participants enjoyed the telesimulation session, acknowledged a positive learning effect and found telesimulation suitable for neonatal resuscitation training, but were critical of potential technical issues, training logistics, and the quality of supervision and feedback. Neonatal resuscitation knowledge scores increased significantly after the educational intervention both for medical students and nurses. Conclusions: Telesimulation is feasible for neonatal resuscitation training and associated with significant improvements in knowledge of current resuscitation guidelines, without differences between medical students and neonatal nurses.


Subject(s)
COVID-19/epidemiology , Resuscitation/education , Simulation Training/methods , Students, Medical/psychology , Students, Nursing/psychology , Telemedicine/methods , Adult , Attitude of Health Personnel , Clinical Competence , Female , Humans , Infant, Newborn , Learning , Male , Pandemics , Pilot Projects , Prospective Studies , SARS-CoV-2 , Surveys and Questionnaires
18.
J Med Internet Res ; 23(2): e22790, 2021 02 19.
Article in English | MEDLINE | ID: covidwho-1574794

ABSTRACT

BACKGROUND: Intimate partner violence (IPV) is one of the leading causes of pregnancy-related death. Prenatal health care providers can offer critical screening and support to pregnant people who experience IPV. During the COVID-19 shelter-in-place order, mobile apps may offer such people the opportunity to continue receiving screening and support services. OBJECTIVE: We aimed to examine cases of IPV that were reported on a prenatal care app before and during the implementation of COVID-19 shelter-in-place mandates. METHODS: The number of patients who underwent voluntary IPV screening and the incidence rate of IPV were determined by using a prenatal care app that was disseminated to patients from a single, large health care system. We compared the IPV screening frequencies and IPV incidence rates of patients who started using the app before the COVID-19 shelter-in-place order, to those of patients who started using the app during the shelter-in-place order. RESULTS: We found 552 patients who started using the app within 60 days prior to the enforcement of the shelter-in-place order, and 407 patients who used the app at the start of shelter-in-place enforcement until the order was lifted. The incidence rates of voluntary IPV screening for new app users during the two time periods were similar (before sheltering in place: 252/552, 46%; during sheltering in place: 163/407, 40%). The overall use of the IPV screening tool increased during the shelter-in-place order. A slight, nonsignificant increase in the incidence of physical, sexual, and psychological violence during the shelter-in-place order was found across all app users (P=.56). Notably, none of the patients who screened positively for IPV had mentions of IPV in their medical charts. CONCLUSIONS: App-based screening for IPV is feasible during times when in-person access to health care providers is limited. Our results suggest that the incidence of IPV slightly increased during the shelter-in-place order. App-based screening may also address the needs of those who are unwilling or unable to share their IPV experiences with their health care provider.


Subject(s)
COVID-19/psychology , Emergency Shelter/methods , Intimate Partner Violence/psychology , Quality Improvement/standards , Remote Consultation/methods , Telemedicine/methods , Adult , Female , Humans , Male , Pilot Projects , Pregnancy , SARS-CoV-2
19.
PLoS One ; 16(3): e0247686, 2021.
Article in English | MEDLINE | ID: covidwho-1574773

ABSTRACT

OBJECTIVES: The aim of this study was to investigate possible patterns of demand for chest imaging during the first wave of the SARS-CoV-2 pandemic and derive a decision aid for the allocation of resources in future pandemic challenges. MATERIALS AND METHODS: Time data of requests for patients with suspected or confirmed coronavirus disease 2019 (COVID-19) lung disease were analyzed between February 27th and May 27th 2020. A multinomial logistic regression model was used to evaluate differences in the number of requests between 3 time intervals (I1: 6am - 2pm, I2: 2pm - 10pm, I3: 10pm - 6am). A cosinor model was applied to investigate the demand per hour. Requests per day were compared to the number of regional COVID-19 cases. RESULTS: 551 COVID-19 related chest imagings (32.8% outpatients, 67.2% in-patients) of 243 patients were conducted (33.3% female, 66.7% male, mean age 60 ± 17 years). Most exams for outpatients were required during I2 (I1 vs. I2: odds ratio (OR) = 0.73, 95% confidence interval (CI) 0.62-0.86, p = 0.01; I2 vs. I3: OR = 1.24, 95% CI 1.04-1.48, p = 0.03) with an acrophase at 7:29 pm. Requests for in-patients decreased from I1 to I3 (I1 vs. I2: OR = 1.24, 95% CI 1.09-1.41, p = 0.01; I2 vs. I3: OR = 1.16, 95% CI 1.05-1.28, p = 0.01) with an acrophase at 12:51 pm. The number of requests per day for outpatients developed similarly to regional cases while demand for in-patients increased later and persisted longer. CONCLUSIONS: The demand for COVID-19 related chest imaging displayed distinct distribution patterns depending on the sector of patient care and point of time during the SARS-CoV-2 pandemic. These patterns should be considered in the allocation of resources in future pandemic challenges with similar disease characteristics.


Subject(s)
COVID-19/diagnostic imaging , Diagnostic Imaging/trends , Thorax/diagnostic imaging , Adult , Aged , COVID-19/epidemiology , Diagnostic Tests, Routine/trends , Female , Humans , Male , Middle Aged , Models, Theoretical , Pandemics , Pilot Projects , SARS-CoV-2/pathogenicity , Thorax/virology
20.
Med Educ Online ; 26(1): 1911019, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1574085

ABSTRACT

During the height of the COVID-19 pandemic, telemedicine visits surged to increase access and maintain continuity of care, while reducing transmission of disease. However, few curricula exist for training residents on how to care for patients via telemedicine, especially in pediatrics. We aimed to create and evaluate an interactive, competency-based pilot curriculum, to meet the urgent need to train residents in telemedicine. The curriculum was developed in 2020 and includes a didactic, cased-based discussions, and direct observation exercise. A model for precepting residents, adhering to new ACGME guidelines, was also created to further engage residents in telemedicine in the outpatient general pediatrics settings. To evaluate the curriculum, we assessed feasibility of a direct observation to provide feedback and we conducted pre and post surveys to assess for changes in residents' self-reported skills in performing telemedicine visits following implementation of the curriculum. 16 residents participated in the curriculum and 15 completed both the pre and post surveys (93%). Residents' self-reported efficacy in performing key components of telemedicine visits, including completion of telemedicine visit (p = 0.023), initiation of visits (p = 0.01), and documentation (p = 0.001) all improved significantly following implementation. Residents' perception of patient satisfaction with telemedicine and personal perception of ease of use of the telemedicine system increased, though neither were statistically significant. Uptake of the direct observation exercise was nearly universal, with all but one resident having a direct observation completed during their ambulatory month. This novel, interactive telemedicine pilot curriculum for residents addresses ACGME competencies and provides residents with a toolkit for engaging in telemedicine.


Subject(s)
Curriculum , Pediatrics , Telemedicine , COVID-19 , Child , Female , Humans , Internship and Residency , Pandemics , Pilot Projects , SARS-CoV-2 , Surveys and Questionnaires , User-Computer Interface
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