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Objectives: To present an unusual complication related to prolonged ECMO support in a patient with COVID19 induced acute respiratory syndrome (ARDS). Method(s): Clinical chart review of the care process after obtaining the informed consent from the patient. Result(s): A 48-year-old female with COVID-19 infection during second wave of pandemic in August 2021 progressed to severe ARDS. She was put on VV-ECMO support after failing conventional therapy for refractory hypoxemia. Her cannulation configuration included a 25 F venous drainage cannula in the right femoral vein and a 21 F venous return cannula in the right Internal Jugular (IJ) vein. Cannulations were performed using the ;Seldinger technique;under USG guidance, and no difficulties or complications were reported. Her hospital course was notable for delirium, and intermittent bleeding from the cannula sites. After 80 days of support, she showed adequate respiratory improvement which allowed ECMO decannulation. She continued to show improvement, and was eventually discharged after 102 days of total hospital stay. During her 6 weeks follow-up clinic visit a palpable thrill was noted at the jugular ECMO cannula site. A CT angiogram of the neck demonstrated a large venous varix connecting the right IJ and the left common carotid artery with filling from the left common carotid artery. ECMO cannulation site complications such as aneurysm, clots, infections and stenosis are well known. What was unusual in this case is the nature of the aneurysm given that there were no arterial procedures performed on the left side of the neck. She was managed by an ;Amplatzer plug;to the carotid artery at the level of the connection to the varix without any complications. Conclusion(s): Longer duration of ECMO support needs careful follow-up for timely recognition and management of vascular complications. (Figure Presented).
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BACKGROUND: Considering the prolongation of the COVID-19 pandemic, the lack of studies on burnout, particularly in healthcare workers, needs to be addressed. This report aimed to identify the risk factors of burnout by comparing the level of burnout between nurses in general wards and those in COVID-19-dedicated wards in a national university hospital. METHODS: A survey based on the Korean version of Burnout Assessment Tool (BAT-K) was conducted on nurses between 10 January and 31 January 2022. The BAT-K consists of exhaustion, mental distance, cognitive impairment, emotional impairment and secondary symptoms. RESULTS: A total of 165 nurses, including 81 nurses from the COVID-19-dedicated ward, completed the questionnaire. The percentage of general-ward nurses with an emotional impairment score above the clinical cutoff was higher than that of COVID-19 ward nurses. General ward compared to the COVID-19 ward increased the risk of presenting with total-core symptoms. Two factors increased the risk regarding mental distance: short career length and underlying disease. CONCLUSIONS: In contrast to previous studies, the risk of burnout in the COVID-19-ward nurses was lower than that of the general ward nurses. The risk regarding mental distance was correlated with short career length and presence of an underlying disease.
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BACKGROUND: Transition to adulthood is a stressful time for caregivers of children and youth with Autism Spectrum Disorder (ASD). Anecdotally, we know that cultural perspectives can directly influence decisions made around ASD diagnosis, treatment, and transition to adulthood. However, there is a paucity of research into these cultural perspectives and how they may affect illness trajectories. OBJECTIVE(S): 1.Through open-ended responses, identify cultural values that play a role in decision making around health care and life course planning during transition to adulthood in ASD. 2.Identify criteria for success in adulthood from parents of children and youth with ASD in a culturally diverse population. 3.Identify systemic barriers that prevent families from accessing culturally sensitive care 4.Educate health care workers on any unique cultural perspective that may impact transition planning. DESIGN/METHODS: In-depth interviews (IDIs) were conducted with caregivers (i.e., parents/guardians) of children and youth with autism. Interviews were recorded, transcribed, and coded using deductive and inductive coding methods by two independent coders, with inter-rater reliability confirmed by Cohen's kappa coefficient. RESULT(S): A total of 12 IDIs were conducted. The main themes that were discussed included caregivers' understanding of adulthood for their child with ASD, barriers to accessing services, the importance of culture and religion/spirituality to their child's future, recommendations to improve current services and programming and the impact of the COVID-19 pandemic on decision-making. Caregivers expressed their desire for their child to be independent as they transition to adulthood. They also described how cultural or religious/spiritual practices are integrated into their child's life and the importance of maintaining their cultural identity. Caregivers emphasized the lack of culturally tailored resources as their child transitions to adulthood to maintain that sense of community. CONCLUSION(S): Caregivers' cultural perspectives are an integral part of their identity and an important aspect of their environment that should be taken into consideration as children and youth with ASD transition to adulthood.
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Background: The effects of isolation and loneliness have been exacerbated by the COVID-19 pandemic. While assistive technology offers potential benefits for long-term care residents, there is limited evidence on technology adoption in complex care environments in LTC. The voices of older persons, family members and staff perspectives are not adequately included in implementation science literature. The poster report the adoption of Tochie, a smart audio device that allows family members to remotely record and schedule messages, such as daily reminders or comforting audio recordings, to send to their loved ones in LTC care homes during the time of COVID lockdown. Method(s): We applied qualitative descriptive design with interview and focus group methods. A total of 25 people in LTC participated in the study, including residents, family members, and care staff from two long-term care homes in British Columbia, Canada. Each resident was given a device to use with their family member for a four-week intervention period. The research team checked in with family members and staff weekly via telephone and email to provide support and gather feedback. Pre- and post-intervention focus groups and interviews were held via Zoom and phone correspondence to learn about participants' experiences using Tochie. Thematic analysis was performed to identify themes. Result(s): Four common themes were identified to describe the experience of using Tochie in LTC: (a) fostering emotional connection (b) connecting in creative and personalized ways (c) considering contextual considerations in LTC (d) lessons learned for future developments. Conclusion(s): The COVID-19 pandemic has provided us an opportunity to redefine and reconstruct what it means to "keep in touch" with loved ones in care settings. In our study, residents, families and staff highlighted the ways in which Tochie has enabled and expanded possibilities for family connection. Our findings offer pragmatic insights into challenges and possibilities for future product development and implementation. Copyright © 2022 the Alzheimer's Association.
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Background: COVID-19's physical distancing mandates have increased the likelihood of experiencing social isolation and loneliness for residents in long-term care (LTC), especially those living with dementia. Social isolation correlates with health risks, including depression and cognitive decline. Telepresence robots can be remotely driven and facilitate social interactions through videoconferencing. Researchers have begun to explore opportunities of using these robots in the healthcare field;however, there is a research gap on examining factors influencing their implementation in LTC from the perspectives of key stakeholders. This qualitative descriptive study focuses on exploring LTC staff and leadership teams' perspectives on facilitators and barriers to implementing telepresence robots. Method(s): We employed purposive and snowballing methods to recruit 22 participants from two LTC homes in British Columbia, Canada: operational and unit leaders, and interdisciplinary staff including nursing staff, care aides and allied health practitioners. Consolidated Framework for Implementation Research (CFIR) guided our data collection and analysis. Semi-structured interviews were conducted by virtual meetings. Thematic analysis was performed to identify themes. Result(s): Analysis of the data produced three themes: (a) perceived needs and values for family-resident connections, (b) engagement through conversation and partnership, and (c) confidence with training and timely support. Based on the findings and CFIR guidance, we offer a preliminary conceptual tool "START": Share benefits and successes;Tailor policies and plans with staff partners;Acknowledge and address staff concerns;Repeated training and demonstrations;and Timely technical support. Conclusion(s): This study offers pragmatic insights into staff and leadership teams' perceptions of facilitators and barriers of implementing telepresence robots in LTC. The complexity of technology implementation will require executive and leadership teams to consider additional factors beyond the Plan-Do-Study-Act (PDSA) cycle. Copyright © 2022 the Alzheimer's Association.
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BACKGROUND: The COVID-19 pandemic has disproportionately impacted older adults living with dementia in Long-Term Care (LTC). Social isolation and loss of connections with families among residents have been detrimental and severely impacted quality of life.
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Background: Smart phone mobile application (Breathe Easy app) with data dashboard (https://www.zephyrx.com/) receive and display results of remote FVC accelerated in use during COVID-19 pandemic. Objective(s): We assessed the reliability of FVC as reported with in-clinic Conventional (Viaire and Vyasis, USA) and inclinic portable and at-home portable (MIR Spirobank Smart, Italy) spirometers that calculated FVC as percentage of predicted values based on GLI (Global Lung Index)-2012 reference standard. Method(s): In this retrospective study, twenty-two ALS patients were analyzed from a total of 95 ALS patients seen in clinic between July 2020 and June 2021. Independent analysis of FVC % predicted values acquired with portable spirometer was performed using GLI-2012 online calculator equations based on age, height, gender and ethnicity. To confirm that the same reference standard GLI-2012 was displayed by the software application, a web-based tool was used to calculate % predicted FVC to confirm that spirometric values were standardized according to GLI-2012 (glicalculator. ersnet.org). Result(s): A third of dashboard-reported measurements were found to be 1% less than calculated measurements (29 out of 87 portable spirometry measurements) and appeared to be a fairly consistent difference in the first 1/3 of FVC followed longitudinally. Query was brought to the attention of the ZephyRx software development team. Dashboard algorithm was assessed to investigate for possible systematic error to account for the difference. The automated dashboard reporting of age using exact birth date to one decimal place on the day of testing as opposed to birth year used with manual calculations was confirmed to result in the 1% predicted difference in manually calculated FVC. Discussion(s): Reported difference in spirometric values can be due to systematic difference in spirometric reference standards or a true difference in pulmonary function (1). ALS-specific digital health technology require vetting by independent ALS neuromuscular and pulmonary researchers and quality testing needs to occur within the clinical realm (2).
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Background: COVID-19 pandemic presents new opportunities to augment respiratory monitoring complementary to remote telehealth services. Stratification of vital capacity may allow for characterization of FVC and disease trajectory clusters (1). Objective(s): In this implementation science study, we assessed the feasibility of measuring FVC in seated upright and supine positions obtained with in-clinic-conventional (Viaire and Vyasis, USA), in-clinic-portable and at-home-portable (MIR Spirobank Smart, Italy) spirometers with respiratory therapist coaching. Method(s): Electronic health records of 22/95 ALS clinic patients (23%) from single-center in Central New York that launched AHT between July 2020 and June 2021 was reviewed in this IRB-approved retrospective study. Mean age of patients was 65 years old and 9 were males. Patients were stratified according to baseline seated FVC % predicted by conventional method: Group A, FVC >80%, Group B, 60-80%, Group C <60% predicted. Patients unable to come to clinic received spirometers by mail followed with remote training with respiratory therapists without conventional spirometry. Result(s): Pearson correlation coefficient was used to evaluate the correlation between FVC measurement using conventional and portable spirometry by position. Bland-Altman analysis was performed to evaluate the mean difference (conventional - portable) with 95% limits of agreement. Measurement of seated FVC acquired during the same clinic visit (N=13) were highly correlated in liters (R2=0.95, p<0.0001) and % predicted (R2=0.952, p<0.0001). Bland- Altman analysis showed good agreement with a mean difference of 0.147L, 0.345 to 0.639L);4.154% predicted, (8.004 to 16.311%). In-clinic supine FVC (N=4) were highly correlated in liters (R2=0.987, p=0.007) and % predicted (R2=0.987, p=0.007) with a mean difference of =0.33L, (0.101 to 0.761L);8.5% predicted, (0.043-17.043%). Supine vital capacity measurements were more frequently obtained with AHT 35/52 (67.31%) vs. 9/21(42.86%) with Conventional spirometry. Safety concerns associated with patient transfers were the most frequently encountered barrier in performing supine testing in clinic. Reason for drop out for 2/22 patients with no remote AHT was attributed to perceived aggravation of anxiety from readily viewing FVC results on smartphone and low baseline FVC (<50% predicted). AHT led to prompt initiation of NIV in 5/22 patients, of which 3 were homebound, had low FVC at initial AHT (12-48% predicted), low ALS FRSR (14-28 out of 48) and received remote AHT training without conventional spirometry. An ongoing slow vital capacity (NCT05106569) prospective clinical study in ALS will determine if frequent respiratory surveillance from home using AHT leads to better outcomes in relation to use of NIV.
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Even before the COVID-19 pandemic, careers in medicine were challenging, and the academic journey could be a lonely one. The pandemic presented both challenges and opportunities in mentoring such as utilizing technology to transform formal mentorship programs into those that are beneficial for women and minorities because these programs can offer critical engagement, opportunities to hear and express multiple perspectives, expand our capacity to understand and talk about complex social issues, and meaning-making frameworks. Medical schools can utilize innovative and creative mentoring programs to support medical students as they enter the medical profession. © Common Ground Research Networks, Joseph Muñoz et al., All Rights Reserved.
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This document reports the numbers of prostheses recorded and reported to the NJR between 1 January and 31 December 2020. The tables show volumes of components as they have been entered into the registry, regardless of construct. The procedure counts in this document are presented without adjustment and may vary from counts found in the corresponding main NJR Annual Report analysis. If a procedure has been submitted with missing implant information this will also cause numbers to differ. Procedure counts below four have been suppressed. Components are listed and described according to the current classifications used in the registry. It must be noted that due to COVID-19, the ratio of revision to primary procedures increased in 2020 and this may affect the relative changes in the types and brands of implants used in comparison to previous years. As this document was not published for 2019 Annual Report data, comparison has been made with the 2018 Annual Report data.
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Beyond the optical and analytical performance of the sensor itself, the development of an optical detection tool in response to a pressing research or diagnostic need requires consideration of a host of additional factors. This talk will provide an overview of two photonic sensor systems developed for profiling the human immune response to COVID-19 infection and/or vaccination. One, focused on the design goal of high multiplexing (many targets per sensor), was built on the Arrayed Imaging Reflectometry (AIR) platform. AIR is a free-space optics technique that relies on the creation and target molecule binding-induced disruption of an antireflective coating on the surface of a silicon chip. The second method, focused on low cost and high speed, uses a small (1 x 4 mm) ring resonator photonic chip embedded in a plastic card able to provide passive transport of human samples. This “disposable photonics” platform is able to detect and quantify anti-COVID antibodies in a human sample in a minute, making it attractive for high-throughput testing applications. © 2022 SPIE
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Background. Clostridioides difficile infection (CDI) continues to be a major global public health concern, particularly during the ongoing SARS-CoV-2 coronavirus disease 2019 (COVID-19) pandemic. Despite new social distancing guidelines and enhanced infection control procedures (e.g., masking, hand hygiene) being implemented since the beginning of COVID-19, little evidence indicates whether these changes have influenced the prevalence of CDI hospitalizations. This study aims to measure CDI prevalence before and during the COVID-19 pandemic in a local cohort of U.S. Veterans. Methods. This was a cross-sectional study of all Veterans presenting to the South Texas Veterans Health Care System in San Antonio, Texas from Jan 1, 2019 to Apr 30, 2021. Monthly laboratory confirmed CDI events were collected overall and categorized as the following: hospital-onset, healthcare facility-associated (HO-HCFACDI), community-onset, healthcare facility-associated CDI (CO-HCFA-CDI), and community-associated CDI (CA-CDI). Monthly confirmed COVID-19 cases were also collected. CDI prevalence was calculated as CDI events per 10,000 bed days of care (BDOC) and was compared between pre-pandemic (Jan 2019-Feb 2020) and pandemic (Mar 2020-Apr 2021) periods. Results. A total of 285 CDI events, 920 COVID-19 cases, and 104,220 BDOC were included in this study. The overall CDI rate increased from 20.33 per 10,000 BDOC pre-pandemic to 34.51 per 10,000 during the pandemic (p< 0.0001). This was driven primarily by a rise in CO-HCFA-CDI rates (0.95 vs 2.52 per 10,000 BDOC;p< 0.0001) during the pandemic, followed by increases in CA-CDI (15.58 vs. 18.61 per 10,000 BDOC;p< 0.0001) and HO-HCFA-CDI (2.66 vs. 5.43 per 10,000 BDOC;p< 0.0001). Lastly, CDI rates have tripled since the start of the pandemic (March-Apr 2020) compared to the current year (March-Apr 2021) (14.69 vs. 43.76 per 10,000 BDOC). Conclusion. Overall, CDI prevalence increased during the COVID-19 pandemic, driven mostly by an increase in CO-HCFA-CDI. As COVID-19 rates increased, CDI rates also increased, likely due to greater healthcare exposures and antibiotic use. Continued surveillance of COVID-19 and CDI is warranted to further decrease infection rates.
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The Scottish Children’s Hearings System makes life-changing decisions regarding the care and protection of children up to 18 years of age referred due to a need for support – because of offending behaviour or a risk to their physical or emotional safety. In March 2020, due to the Covid-19 crisis, Hearings underwent one of the most significant changes since their inception: proceedings shifted to an online conferencing platform (“virtual hearings”), and some procedural modifications were introduced. In June 2020, we used an online survey to gather more than 270 responses from professionals, volunteers, young people, and families who had experience of virtual hearings. These responses highlight that while there are reasonable justifications for the use of virtual hearings, including the duty to ensure orders are appropriately reviewed and renewed, concerns related to children and young people’s right to participation, privacy and representation bring into question the extent to which children’s rights are realised in virtual Children’s Hearings. © Robert B. Porter et al., 2021.