The Evaluation of Telehealth Services during the Covid-19 Pandemic on Levels of Psychological Growth

Objective: The COVID-19 pandemic is considered a traumatic event. The aim of this study was to examine the effects of telehealth services offered at the Istanbul University, Istanbul Faculty of Medicine to health workers with presumed COVID-19 or close contact with a suspected/confirmed COVID-19 patient on pandemic management, vaccination, and psychological growth at one year after diagnosis.Material and Methods: The cohort study included 237 employees with COVID-19/risky contact who were monitored remotely via a telehealth service provided between April 6 and July 31, 2020. First, they were followed up for 21 days with the telehealth service. Second, they were invited by phone to complete an online questionnaire and 94 (39.7%) of them participated. The questionnaire included questions about pandemic-related difficulties experienced during the last year and the Posttraumatic Growth Inventory (PTGI).Results: Of the 234 employees, 172 (73.5%) and 164 (70.1%) had the first and second doses of the COVID-19 vaccine, re spectively. Employees who did not need psychological support had significantly lower PTGI change in self-perception and total scores than those who did not/could not receive psychological support (p=0.007 and p=0.016, respectively). Employees who used personal protective equipment (PPE) more carefully had a significantly higher PTGI self-perception score (p=0.005), life philosophy (p=0.014), interpersonal relationships (p=0.011), and total score (p=0.004) than employees who reported that they did not change how they use PPE and were sometimes careless.Conclusion: The results of our study suggest that health workers are showing evidence of posttraumatic growth by seeing the positives as well as the negatives caused by the pandemic.

Evaluation of the frequency, follow-up, and treatment of patients with multisystem inflammatory syndrome related to COVID-19

Aim: Aim of this study is evaluate the clinical features, laboratory values, treatment and follow-up of in children with COVID-19-associated multisystem inflammatory syndrome (MIS-C) disease. Materials and Methods: In this study, patients aged between 2 months and 17 years, who applied to the Inonu University Faculty of Medicine, Department of Pediatrics between March 2020, and February 2021 due to MIS-C related to COVID-19 disease, were reviewed retrospectively. Demographic data, clinical features, laboratory values, treatment and follow-up data of the patients were evaluated. Results: Forty-nine patients diagnosed with MIS-C between March 2020 and February 2021 were included in the study. Thirty-one (72.7%) patients were male and 18 (27.3%) were female. The most common indications for admission were fever (100%), abdominal pain (51.6%), vomiting (42.9%), cough (38.8%), diarrhea (28.8%), shortness of breath, rash, conjunctivitis, and convulsion. Levels of CRP (93.9%), D-dimer (85.7%), fibrinogen (73.4%), interleukin 6 (IL6) (73.4%), procalcitonin (71.4%), NT-proBNP (63.2%) remained at high levels in respective number of patients. The (32.6%) patients were followed up in the intensive care unit. These patients had cardiogenic shock (26.5%), severe pneumonia (18.3%), and acute gastroenteritis (14.3%). It was determined that the mean age of the patients followed up for cardiogenic shock was 12.5 years and relatively higher (p < 0.05). One patient died during follow-up. Conclusion: Although the manifestations of MIS- C due to COVID -19 are seen relatively rarely in children, it constitutes a serious problem and they mostly require hospitalization in intensive care unit, simultaneously involves many organ systems, and leads a serious course with higher risk of mortality. Another problem in these patients is higher rates of cardiac involvement. For this reason, it is important to take necessary precautions to protect children against COVID 19 and its associated MIS-C, and to include them in vaccination programs.

An Integrated Care Model Based on Hospital and Home during the Covid-19 Pandemic: Telehealth

Objective: In this study, we aimed to present the details of a successfully implemented telehealth model in a university hospital during the COVID-19 pandemic. Materials and Methods: Istanbul Faculty of Medicine is a uni-versity hospital where the first confirmed case of COVID-19 in Turkey was detected. In IFM, patients who were diagnosed with COVID-19 and received outpatient or inpatient treatment were followed up by telehealth for 21-28 days after leaving the hospital. The distinguishing features of this service are the provision of remote outpatient clinical monitoring personally by physicians and the use of web-based IP information technologies. Results: Between March 15 and July 1, 2020, 1,042 individuals were followed up at least once, 860 patients for 21 days or more by the 26 physicians providing the telehealth service. A total of 11,736 calls were made by the physicians and 7,342 of those calls were answered and a total of 1,086 calls were made by patients. The median number of calls per patient was 4 (1-23). The median duration of the completed calls was 2.8 min (<1-50 min). During these follow-ups patients were informed about the importance of isolation. Most of the patients expressed their satisfaction with these follow-ups by thanking the calling physician. Conclusion: In a pandemic such as COVID-19, telehealth services may increase adherence to treatment and isolation pre-cautions among patients with diseases that require follow-up without hospitalization after diagnosis. Telehealth will facilitate early recognition of symptoms that may require hospitalization, ensuring these patients receive the care they need. Therefore, this approach should be widely adopted.

Congenital Heart Disease and COVID-19: A Single-Center Experience

Background: Coronavirus disease 2019 (COVID-19) has been infecting children since December 2019 and has caused a severe epi-demic and millions of deaths worldwide. COVID-19 has severe clinical effects and is more complicated to manage in patients with underlying diseases, such as congenital heart disease (CHD), past surgical operations, arrhythmia, and end-organ damage. Objectives: This study aimed to evaluate the clinical course, follow-up, and treatment process of patients with CHD and COVID-19 in Inonu University Faculty of Medicine, Department of Pediatrics, Turkey during March 2020-February 2021. Methods: This retrospective study was performed on patients with CHD and COVID-19 in the Department of Pediatrics at Inonu University Faculty of Medicine during March 2020-February 2021, selected by making full count sampling. Admission complaints, clinical findings, biochemical parameters, echocardiography results, hospitalization times, treatments, and clinical follow-up findings were retrieved from patients’ files. Results: 11 patients with underlying CHD and COVID-19 were evaluated retrospectively during the study. Ten patients were hospitalized and treated due to COVID-19. Treatment of seven of these patients continued in the intensive care unit (ICU), and five were followed up under a mechanical ventilator. Two patients died during follow-up in the ICU. Conclusions: The clinical course of COVID-19 is severe, and the mortality rate is high in patients with serious diseases, such as underlying CHD. Therefore, COVID-19 in patients with CHD requires more serious and careful follow-up.

AN INTEGRATED CARE MODEL BASED ON HOSPITAL AND HOME DURING THE COVID-19 PANDEMIC: TELEHEALTH

Objective: In this study, we aimed to present the details of a successfully implemented telehealth model in a university hospital during the COVID-19 pandemic. Materials and Methods: Istanbul Faculty of Medicine is a university hospital where the first confirmed case of COVID-19 in Turkey was detected. In IFM, patients who were diagnosed with COVID-19 and received outpatient or inpatient treatment were followed up by telehealth for 21-28 days after leaving the hospital. The distinguishing features of this service are the provision of remote outpatient clinical monitoring personally by physicians and the use of web-based IP information technologies. Results: Between March 15 and July 1, 2020, 1,042 individuals were followed up at least once, 860 patients for 21 days or more by the 26 physicians providing the telehealth service. A total of 11,736 calls were made by the physicians and 7,342 of those calls were answered and a total of 1,086 calls were made by patients. The median number of calls per patient was 4 (1-23). The median duration of the completed calls was 2.8 min (<1–50 min). During these follow-ups patients were informed about the importance of isolation. Most of the patients expressed their satisfaction with these follow-ups by thanking the calling physician. Conclusion: In a pandemic such as COVID-19, telehealth services may increase adherence to treatment and isolation precautions among patients with diseases that require follow-up without hospitalization after diagnosis. Telehealth will facilitate early recognition of symptoms that may require hospitalization, ensuring these patients receive the care they need. Therefore, this approach should be widely adopted. © 2022 Istanbul University Press. All Rights Reserved.

AN INTEGRATED CARE MODEL BASED ON HOSPITAL AND HOME DURING THE COVID-19 PANDEMIC: TELEHEALTH

Objective: In this study, we aimed to present the details of a suc-cessfully implemented telehealth model in a university hospital during the COVID-19 pandemic. Materials and Methods: Istanbul Faculty of Medicine (IFM) is a university hospital where the first confirmed case of COVID-19 in Turkey was detected. In IFM, patients who were diagnosed with COVID-19 and received outpatient or inpatient treatment were followed up by telehealth for 21-28 days after leaving the hospi-tal. The distinguishing features of this service are the provision of remote outpatient clinical monitoring personally by physicians and the use of web-based IP information technologies. Results: Between March 15 and July 1, 2020, 1,042 individuals were followed up at least once, 860 patients for 21 days or more by the 26 physicians providing the telehealth service. A total of 11,736 calls were made by the physicians and 7,342 of those calls were answered and a total of 1,086 calls were made by patients. The median number of calls per patient was 4 (1-23). The median duration of the completed calls was 2.8 min (<1-50 min). During these follow-ups patients were informed about the importance of isolation. Most of the patients expressed their satisfaction with these follow-ups by thanking the calling physician. Conclusion: In a pandemic such as COVID-19, telehealth ser-vices may increase adherence to treatment and isolation pre-cautions among patients with diseases that require follow-up without hospitalization after diagnosis. Telehealth will facilitate early recognition of symptoms that may require hospitalization, ensuring these patients receive the care they need. Therefore, this approach should be widely adopted.

Erratum to: Older Adults Hospitalized with COVID-19: Clinical Characteristics and Early Outcomes from a Single Center in Istanbul, Turkey (The journal of nutrition, health & aging, (2020), 24, 9, (928-937), 10.1007/s12603-020-1499-9)

Two unrelated tables have interfered with our article. There are two Table 1 and Table 2 in the original publication. We request readers to disregard “Table 1. General characteristics of the subjects by sex” and age and “Table 2. Parameters of the ROC analysis for the diagnostic performance of SPPB in identifying high risk for frailty phenotype and geriatric syndromes for community-dwelling older adults by sex”. The correct Table 1 and Table 2 is found in the manuscript as “Table 1. Baseline demographic and clinical characteristics of the hospitalized Covid-19 patients stratified by age” and “Table 2. Laboratory and radiological findings of the hospitalized Covid-19 patients at hospital admission stratified by age. We apologize to the readers for this error on proof stage ”

Older adults hospitalized with COVID-19: clinical characteristics and early outcomes from a single center in Istanbul, Turkey

Objective: Older adults have been continuously reported to be at higher risk for adverse outcomes of Covid-19. We aimed to describe clinical characteristics and early outcomes of the older Covid-19 patients hospitalized in our center comparatively with the younger patients, and also to analyze the triage factors that were related to the in-hospital mortality of older adults. Design: Retrospective;observational study. Setting: Istanbul Faculty of Medicine hospital, Turkey. Participants: 362 hospitalized patients with laboratory-confirmed Covid-19 from March 11 to May 11, 2020. Measurements: The demographic information;associated comorbidities;presenting clinical, laboratory, radiological characteristics on admission and outcomes from the electronic medical records were analyzed comparatively between the younger (<65 years) and older (65 years) adults. Factors associated with in-hospital mortality of the older adults were analyzed by multivariate regression analyses.

Older Adults Hospitalized with Covid-19: Clinical Characteristics and Early Outcomes from a Single Center in Istanbul, Turkey.

OBJECTIVE: Older adults have been continuously reported to be at higher risk for adverse outcomes of Covid-19. We aimed to describe clinical characteristics and early outcomes of the older Covid-19 patients hospitalized in our center comparatively with the younger patients, and also to analyze the triage factors that were related to the in-hospital mortality of older adults. DESIGN: Retrospective; observational study. SETTING: Istanbul Faculty of Medicine hospital, Turkey. PARTICIPANTS: 362 hospitalized patients with laboratory-confirmed Covid-19 from March 11 to May 11, 2020. MEASUREMENTS: The demographic information; associated comorbidities; presenting clinical, laboratory, radiological characteristics on admission and outcomes from the electronic medical records were analyzed comparatively between the younger (<65 years) and older (≥65 years) adults. Factors associated with in-hospital mortality of the older adults were analyzed by multivariate regression analyses. RESULTS: The median age was 56 years (interquartile range [IQR], 46-67), and 224 (61.9%) were male. There were 104 (28.7%) patients ≥65 years of age. More than half of the patients (58%) had one or more chronic comorbidity. The three most common presenting symptoms in the older patients were fatigue/myalgia (89.4%), dry cough (72.1%), and fever (63.5%). Cough and fever were significantly less prevalent in older adults compared to younger patients (p=0.001 and 0.008, respectively). Clinically severe pneumonia was present in 31.5% of the study population being more common in older adults (49% vs. 24.4%) (p<0.001). The laboratory parameters that were significantly different between the older and younger adults were as follows: the older patients had significantly higher CRP, D-dimer, TnT, pro-BNP, procalcitonin levels, higher prevalence of lymphopenia, neutrophilia, increased creatinine, and lower hemoglobin, ALT, albumin level (p<0.05). In the radiological evaluation, more than half of the patients (54.6%) had moderate-severe pneumonia, which was more prevalent in older patients (66% vs. 50%) (p=0.006). The adverse outcomes were significantly more prevalent in older adults compared to the younger patients (ICU admission, 28.8% vs. 8.9%; mortality, 23.1% vs. 4.3%, p<0.001). Among the triage evaluation parameters, the only factor associated with higher mortality was the presence of clinically severe pneumonia on admission (Odds Ratio=12.3, 95% confidence interval=2.7-55.5, p=0.001). CONCLUSION: Older patients presented with more prevalent chronic comorbidities, less prevalent symptomatology but more severe respiratory signs and laboratory abnormalities than the younger patients. Among the triage assessment factors, the clinical evaluation of pulmonary involvement came in front to help clinicians to stratify the patients for mortality risk.