ABSTRACT
Introduction: The purpose of this case report is to describe the 7-year functional outcomes and health-related quality of life (HRQOL) of the first successful pediatric bilateral hand transplantation. The report focuses on activity and participation. The authors suggest assessment methods that can be applied to future cases. Method(s): The child underwent quadrimembral amputation at age two years and received bilateral hand allografts at age eight. Rehabilitation included biomechanical, neurorehabilitation, and occupational approaches in acute and outpatient settings. Therapist observed outcomes assessments, patientreported and parent-reported outcome questionnaires were repeated over a 7-year period. Result(s): At 7-years post transplantation, the adolescent and his mother reported a high level of satisfaction with the outcomes. Therapist observed assessments showed the adolescent achieved functional gross motor dexterity with each upper extremity. Although left gross and fine dexterity was superior to the right at all timepoints observed, the adolescent used his right upper extremity as dominant and incorporated both extremities as appropriate for bimanual tasks. The adolescent achieved modified independence to full independence with self-care activities. The adolescent participated in diverse activities with a high level of enjoyment. Participation was more diverse, social, and communitybased prior to and after the initial COVID-19 pandemic restrictions. At 7-years post transplantation when the adolescent was 15-years of age, the parent rated more instrumental activities of daily living as somewhat difficult. Discussion and Conclusion(s): Therapist observed outcomes assessments, patient-reported and parent-reported outcome questionnaires, showed the child had incorporated his hands into various activities, was completing daily activities independently, and HRQOL outcomes in social, emotional, cognitive, and physical domains were favorable. Most results were stable over time. The decrease in right hand dexterity scores might reflect small kinesiological changes in the right hand. Difficulty with some instrumental activities of daily living were likely due to new activities typical of child development for this now 15-year-old patient.
ABSTRACT
Aim: To determine the long-term impact of telemedicine in child neurology care during the COVID-19 pandemic and with the reopening of outpatient clinics. Method(s): We performed an observational cohort study of 34 837 in-person visits and 14 820 telemedicine outpatient visits across 26 399 individuals. We assessed differences in care across visit types, time-period observed, time between follow-ups, patient portal activation rates, and demographic factors. Result(s): We observed a higher proportion of telemedicine for epilepsy (International Classification of Diseases, 10th Revision G40: odds ratio [OR] 1.4, 95% confidence interval [CI] 1.3-1.5) and a lower proportion for movement disorders (G25: OR 0.7, 95% CI 0.6-0.8;R25: OR 0.7, 95% CI 0.6-0.9) relative to in-person visits. Infants were more likely to be seen in-person after reopening clinics than by telemedicine (OR 1.6, 95% CI 1.5-1.8) as were individuals with neuromuscular disorders (OR 1.6, 95% CI 1.5-1.7). Self-reported racial and ethnic minority populations and those with highest social vulnerability had lower telemedicine participation rates (OR 0.8, 95% CI 0.8-0.8;OR 0.7, 95% CI 0.7-0.8). Interpretation(s): Telemedicine continued to be utilized even once in-person clinics were available. Pediatric epilepsy care can often be performed using telemedicine while young patients with neuromuscular disorders often require in-person assessment. Prominent barriers for socially vulnerable families and racial and ethnic minorities persist.Copyright © 2022 Mac Keith Press.
ABSTRACT
This descriptive research uses multiple methods to understand consumers' interactions with hand sanitizer packaging at the point of purchase during the coronavirus pandemic. An analysis of common visual codes within the product category defines a typical hand sanitizer package at the time of the study. Eye-tracking biometrics systematically describe consumers' attention to hand sanitizer products while shopping. Finally, quantitative and qualitative survey data capture participants' perceived typicality of hand sanitizer packaging, package element preferences and their attitude towards the product. A multiple regression analysis found that visual appeal, brand confidence and packaging have a significant positive relationship to participants' perceived typicality. Packages perceived as typical were best described as transparent with non-pigmented products and few graphical elements included on the principal display panel (PDP). Form, dispensing method and active ingredient were the most important considerations in hand sanitizer purchases. Participants indicated that brand was not an important factor when shopping for hand sanitizer, but biometrics suggested that it was more important than most other text. Findings contribute to the growing research around package design typicality with a novel product category and offer a baseline understanding of expectations for hand sanitizer packaging. Attention towards 11 hand sanitizer packaging stimuli and survey responses of 61 human subjects located in the southeast United States during the coronavirus pandemic were collected and analysed. Further research is needed to understand consumer interaction with hand sanitizer packaging outside this context.
ABSTRACT
Background: COVID-19 outbreaks with high mortality rates have been reported from long-term care facilities (LTCFs) worldwide despite infection control and prevention (ICP) measures. However, no systematic data exist on COVID-19 burden and its risk factors in Swiss-LTCFs. Aims: to assess (i) COVID-19 incidence and-related mortality for the year 2020 and their influencing factors, (ii) vaccination rates of residents and health care workers (HCW). Methods: LTCFs from cantons of St Gallen (SG) and Vaud (VD) (Eastern and Western Switzerland) were invited to participate in this cohort study. In May 2021, we collected COVID-19 cases and-related deaths 2020 and their potential risk factors at institutional level (e.g. size, number of single beds, staffing, ICP measures, aggregated resident characteristics) as well as vaccination rates of residents and HCW. Risk factor analysis and prospective surveillance of COVID-19 is ongoing. Results: We enrolled a total of 59 institutions (33 from SG, 26 from VD), with a median of 46 (IQR 33.69) occupied beds. In 2020, median COVID-19 incidence was 38.6 per 100 occupied beds, with higher rates in VD than in SG (48% vs. 29.4%, p = 0.028) (Fig. 1). Rates varied widely among LTCFs, with some institutions reporting no COVID-19 cases. On average (median), one-fifth (20%) of COVID-19 cases died and COVID-19 related deaths accounted for 21.6% of total deaths. Regarding ICP measures, 54/59 institutions (91.5%) recommended using gowns in contact with COVID-19 patients, whilst use of other PPE (i.e. FFP2 masks, glows and googles) was more heterogeneous. Only a few LTCFs reported having ever used regular testing of asymptomatic residents (6/59, 10.2%) or HCW (14/59, 23.7%) as a prevention strategy. Nearly half of them (27/59, 45.8%) never banned visits or only in outbreak situations. Of 2786 residents, a median of 72.2% per facility received ≥1 dose of COVID-19 vaccine. COVID-19 vaccine uptake among HCW was low (28.6%) (Fig. 1). Conclusion: COVID-19 burden was highly heterogeneous in Swiss LTCFs. Further analyses will reveal factors, which could potentially explain these differences. Of note, we found a relatively high COVID-19 vaccine uptake among care home residents, whilst vaccine coverage of HCW is low.