Home-based initiatives for acute management of COVID-19 patients needing oxygen: differences across The Netherlands.

OBJECTIVE: During the COVID-19 pandemic new collaborative-care initiatives were developed for treating and monitoring COVID-19 patients with oxygen at home. Aim was to provide a structured overview focused on differences and similarities of initiatives of acute home-based management in the Netherlands. METHODS: Initiatives were eligible for evaluation if (i) COVID-19 patients received oxygen treatment at home; (ii) patients received structured remote monitoring; (iii) it was not an 'early hospital discharge' program; (iv) at least one patient was included. Protocols were screened, and additional information was obtained from involved physicians. Design choices were categorised into: eligible patient group, organization medical care, remote monitoring, nursing care, and devices used. RESULTS: Nine initiatives were screened for eligibility; five were included. Three initiatives included low-risk patients and two were designed specifically for frail patients. Emergency department (ED) visit for an initial diagnostic work-up and evaluation was mandatory in three initiatives before starting home management. Medical responsibility was either assigned to the general practitioner or hospital specialist, most often pulmonologist or internist. Pulse-oximetry was used in all initiatives, with additional monitoring of heart rate and respiratory rate in three initiatives. Remote monitoring staff's qualification and authority varied, and organization and logistics were covered by persons with various backgrounds. All initiatives offered remote monitoring via an application, two also offered a paper diary option. CONCLUSIONS: We observed differences in the organization of interprofessional collaboration for acute home management of hypoxemic COVID-19 patients. All initiatives used pulse-oximetry and an app for remote monitoring. Our overview may be of help to healthcare providers and organizations to set up and implement similar acute home management initiatives for critical episodes of COVID-19 (or other acute disorders) that would otherwise require hospital care.

[The Alice in Wonderland syndrome]. / Het 'Alice in Wonderland'-syndroom.

BACKGROUND: Alice in Wonderland syndrome (AIWS) is characterised by abnormal perception, such as metamorphopsia, macropsia, micropsia, teleopsia and pelopsia. Although brief and transient, these episodes of visual distortion may lead to great anxiety, especially in children. AIWS seems to be associated with specific viral infections, epilepsy, migraine, and brain tumours. CASE DESCRIPTION: An 8-year-old boy had episodes of seeing persons further away than they actually were (teleopsia). These perceptual distortions occurred when he was about to go to sleep. The episodes never exceeded 10 minutes. He was referred to a paediatrician and an ophthalmologist, who found no abnormalities. Serological tests showed a positive IgG for both Epstein-Barr and varicella zoster virus. CONCLUSION: The cause of AIWS is unclear. When occurring in the young patient, parents often become worried. In most cases no serious pathological cause is found. Usually, reassurance is sufficient. Therefore, general practitioners should be able to recognise the symptoms.