ABSTRACT
BACKGROUND: Long COVID is a serious public health concern due to its high prevalence and potentially debilitating symptoms. Symptoms may include fatigue, dyspnea, cognitive problems, insomnia, anxiety, and depression. There is currently no cure for long COVID, and the average length of recovery and proportion of patients who fully recover are still unknown. Subsequently, there is a critical need to improve function. Research in other chronic conditions suggests that psychosocial self-management interventions reduce symptom severity and interference with functioning. We describe the design of our study to examine the feasibility, acceptability, appropriateness, and preliminary efficacy of an intervention designed to improve symptom management and coping in adults with long COVID. METHODS: This pilot trial (N = 50) uses a pragmatic, randomized two-group parallel design set within the University of Washington Post-COVID Rehabilitation and Recovery Clinic. The self-management intervention is a 6-week, group-based telemedicine intervention that teaches evidence-based strategies to manage common symptoms and improve stress management as well as communication and self-advocacy. The comparator is a wait-list control. Participants complete self-report measures of the primary and secondary outcomes at baseline and post-treatment/wait-list. Primary outcomes include intervention feasibility, acceptability, and appropriateness. Secondary outcomes include Patient-Reported Outcomes Measurement Information System measures of fatigue, sleep disturbance, cognitive difficulties, self-efficacy, pain interference, depression and anxiety symptoms, and a measure of long COVID symptoms and impression of change. At post-intervention, intervention participants also complete a qualitative interview to inform intervention refinement. Quantitative data will be examined using descriptive and statistical analysis including t-tests and chi-square tests to compare the intervention and wait-list groups on secondary outcomes. Qualitative data will be analyzed using the rigorous and accelerated data reduction technique (RADaR). DISCUSSION: Results of this pilot randomized controlled trial will characterize the feasibility, acceptability, and appropriateness of the self-management intervention and inform intervention refinement necessary prior to further testing. Long COVID is a public health concern, and rehabilitation approaches that equip patients to manage symptoms may improve patient function and quality of life and reduce burden on the health care system. TRIAL REGISTRATION: NCT05658536. December 16, 2022.
ABSTRACT
Healthcare-associated infections due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has increased since the discovery of the Omicron variant. We describe a SARS-CoV-2 outbreak in the medicine-surgery unit of a rural community hospital at the time of high community transmission of Omicron variant in our county. The outbreak occurred in the medicine-surgery unit of an 89-bed rural community hospital in northern Maine. The characteristics of the patients and healthcare workers (HCWs) affected by the outbreak are described. Patient and HCW data collected as part of the outbreak investigation were used in this report. The outbreak control measures implemented are also described. A total of 24 people tested positive for SARS-CoV-2 including 11 patients and 13 HCWs. A total of 12 of the 24 (50%) persons were symptomatic, and rhinorrhea was the most common symptom noted (8/12, 67%). None of the symptomatic persons had gastrointestinal symptoms or symptoms of a loss of sense of smell or taste. All HCWs were vaccinated and 8 of the 11 patients were vaccinated. Outbreak control measures in the affected unit included implementation of full PPE (N95 respirators, eye protection, gowns and gloves) during all patient care, serial testing of employees and patients in the affected unit, cohorting positive patients, closing visitation and thorough environmental cleaning including use of ultraviolet (UV) light disinfection. This outbreak exemplifies the high transmissibility of the Omicron variant of SARS-CoV-2. The outbreak occurred despite a well-established infection control program. We noted that serial testing, use of N95 respirators during all patient care and UV disinfection were some of the measures that could be successful in outbreak control.
ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic revealed the importance of improving the accessibility of quality public health messaging especially among underserved communities. By establishing a robust communication infrastructure, communities may begin to address the disparities exacerbated by misinformation. In this article, we describe the work done by Worth a Shot, a community-led organization that partnered with trusted, informed county residents; the county residents served as "public health ambassadors" who provided accurate, timely information to their communities in a culturally sensitive approach. This youth-led work may serve as a model for other communities that seek to improve outreach to underserved communities.
ABSTRACT
Clostridial myonecrosis is a medical and surgical emergency which requires early and aggressive intervention to reduce mortality. We report a rare case of Clostridium septicum myonecrosis that disseminated hematogenously from a gastric perforation. The patient was afebrile and hemodynamically stable upon admission. He rapidly developed spontaneous clostridial myonecrosis and succumbed to septic shock 36 hours after presentation. In our extensive literature review this is the only case with blood cultures confirming Clostridium septicum bacteremia with a surgically confirmed gastric perforation source in the setting of spontaneous clostridial myonecrosis.
Subject(s)
Clostridium Infections/diagnosis , Clostridium Infections/etiology , Clostridium septicum , Gas Gangrene/diagnosis , Gas Gangrene/etiology , Aged , Biomarkers , Disease Management , Disease Susceptibility , Emergency Medical Services , Fatal Outcome , Humans , Male , Peptic Ulcer Perforation/complications , Peptic Ulcer Perforation/diagnosis , Peptic Ulcer Perforation/surgery , Postoperative Complications , Radiography, Thoracic , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The aim of this survey was to assess the attitudes of physicians toward antibiotic prescribing and explore their knowledge about antimicrobial resistance (AMR) in ambulatory care settings. METHODS: We conducted a cross-sectional survey that was administered to physicians who work primarily in ambulatory care settings in the United States. The survey was self-administered, voluntary, and anonymous, and was delivered through electronic mail and online forums using a 35-item questionnaire. RESULTS: The survey was completed by 323 physicians. Ninety-nine percent of respondents agreed that AMR is a national problem, but only 63% agreed that AMR is a local problem within their own facilities. Ninety-four percent of the respondents reported that each antibiotic prescription can impact AMR; however, 23% still believed that aggressive prescribing is necessary to avoid clinical failures. Factor perceived to have a low to moderate impact on the physicians' choice of antibiotic was the presence of prescription guidelines (54%). Top measures reported to be effective in reducing the emergence of AMR were institution specific guidelines (94%), institution specific antibiogram (92%), educating health care providers (87%), and regular audits and feedback on antibiotic prescribing (86%). CONCLUSIONS: AMR awareness campaigns and antibiotic stewardships incorporating interactive education and feedback, along with input of local experts, are critically needed to address the problem of AMR in both inpatient and ambulatory settings.