FEASIBILITY of LINKING UNIVERSAL WELL-CHILD HEALTHCARE and FINANCIAL COUNSELLING: FINDINGS from the AUSTRALIAN HEALTHIER WEALTHIER FAMILIES (HWF) PILOT RANDOMISED CONTROLLED TRIAL

Background: We pilot-tested the feasibility and short-term impacts of "Healthier Wealthier Families" (HWF), which seeks to reduce financial hardship by developing a referral pathway between universal child and family health (CFH) services and financial counselling. Method(s): Setting: CFH services in five sites (Victoria, New South Wales), coinciding with the COVID-19 pandemic. Participant(s): Caregivers of children aged 0-5 years. Eligible clients disclosed financial hardship using a study-designed screening tool. Design(s): Pilot randomised controlled trial (RCT). With mixed progress in Sites 1-3, we conducted an implementation evaluation and adapted the protocol to a simplified RCT (Site 4) and direct referral with pre-post evaluation (Site 5). Intervention(s): Financial counselling. The comparator was usual care. Measures: Feasibility was assessed via proportions of clients screened, enrolled, followed-up, and who accessed financial counselling. Impacts (quantitative surveys, qualitative interviews) included finances to 6 months post-enrolment. Result(s): 72%-100% of clients across sites answered the financial screen. In RCT sites (1-4), less than one-quarter enrolled. In Site 5, n = 44/64 (64%) clients were eligible and engaged with financial counselling. Common challenges facing these clients were utility debts (73%), obtaining government entitlements (43%) and material aid/emergency relief (27%). On average, their household income increased $250 per fortnight ($6504 annually), and families received average single payments of $784. Caregivers identified benefits including reduced stress, practical help, increased knowledge and empowerment. Conclusion(s): Financial hardship screening via CFH, and direct referral, were acceptable to caregivers. Individual randomisation was infeasible. Matching between populations and CFH practice is necessary to incorporate a HWF model of care.

[Telemedicine and social Media in the management of ECMOs in the era of COVID-19: The Tunisian experience]. / La télémédecine et les réseaux sociaux dans la gestion des ECMO à l'ère de COVID-19 : l'expérience Tunisienne.

INTRODUCTION: In Tunisia, as elsewhere in the world, severe forms of acute respiratory distress syndrome (ARDS) related to SARS-Covid19 have been observed. When the usual means of resuscitation were no longer sufficient, the implementation of the Extracorporeal membrane oxygenation or ECMO was needed. AIM: The whole problem of the management of these patients in this pandemic period has been to manage the operation of the ECMO machine, usually reserved for expert and specialized centers in the field. METHODS: The cardio-vascular surgery department of La Rabta teaching hospital of Tunis has tried the experience of management of ECMO implanted in the different reanimations of Tunis, remotely, using telemedicine and social networks. Thus, a Facebook-Messenger discussion group was created and enabled the management of patients under ECMO via video conferencing in real time involving all stakeholders. RESULTS: A call was made whenever the physician needed it. The video provided an opportunity to discuss with surgeons and perfusionists in real time the complications or problems of these patients. Their clinical status was continuously shared on the focus group. Following the instructions of the expert surgeons and the exchanges made on the group, the reanimator could then intervene on this or that parameter. CONCLUSION: Social media have invaded everyone's daily lives and health professionals are not exception to this trend. The Covid-19 pandemic has only strengthened this digital alternative with the goal of efficiency and patient interest. While their use in a professional setting offers many advantages, it must nevertheless be done in compliance with the rules of ethics and bring real added value.