Acute or chronic? Failing left ventricle in a 34 year old

Submission content Introduction: An unusual case of a very young patient without previously known cardiac disease presenting with severe left ventricular failure, detected by a point of care echocardiogram. Main Body: A 34 year old previously well man was brought to hospital after seeing his general practitioner with one month of progressive shortness of breath on exertion. This began around the time the patient received his second covid-19 vaccination. He was sleeping in a chair as he was unable to lie flat. Abnormal observations led the GP to call an ambulance. In the emergency department, the patient required oxygen 5L/min to maintain SpO2 >94%, but he was not in respiratory distress at rest. Blood pressure was 92/53mmHg, mean 67mmHg. Point of care testing for COVID-19 was negative. He was alert, with warm peripheries. Lactate was 1.0mmol/L and he was producing more than 0.5ml/kg/hr of urine. There was no ankle swelling. ECG showed sinus tachycardia. He underwent CT pulmonary angiography which demonstrated no pulmonary embolus, but there was bilateral pulmonary edema. Troponin was 17ng/l, BNP was 2700pg/ml. Furosemide 40mg was given intravenously by the general medical team. Critical care outreach asked for an urgent intensivist review given the highly unusual diagnosis of pulmonary edema in a man of this age. An immediate FUSIC Heart scan identified a dilated left ventricle with end diastolic diameter 7cm and severe global systolic impairment. The right ventricle was not severely impaired, with TAPSE 18mm. There was no significant pericardial effusion. Multiple B lines and trace pulmonary effusions were identified at the lung bases. The patient was urgently discussed with the regional cardiac unit in case of further deterioration, basic images were shared via a cloud system. A potential diagnosis of vaccination-associated myocarditis was considered,1 but in view of the low troponin, the presentation was felt most likely to represent decompensated chronic dilated cardiomyopathy. The patient disclosed a family history of early cardiac death in males. Aggressive diuresis was commenced. The patient was admitted to a monitored bed given the potential risk of arrhythmia or further haemodynamic deterioration. Advice was given that in the event of worsening hypotension, fluids should not be administered but the cardiac centre should be contacted immediately. Formal echocardiography confirmed the POCUS findings, with ejection fraction <35%. He was initiated on ACE inhibitors and beta adrenergic blockade. His symptoms improved and he was able to return home and to work, and is currently undergoing further investigations to establish the etiology of his condition. Conclusion(s): Early echocardiography provided early evidence of a cardiac cause for the patient's presentation and highlighted the severity of the underlying pathology. This directed early aggressive diuresis and safety-netting by virtue of discussion with a tertiary cardiac centre whilst it was established whether this was an acute or decompensated chronic pathology. Ultrasound findings: PLAX, PSAX and A4Ch views demonstrating a severely dilated (7cm end diastolic diameter) left ventricle with global severe systolic impairment.

Patient Survey in Medical Practices on their Visit during the SARS-CoV-2 Pandemic.

Background: Since the beginning of the SARS-CoV2 pandemic medical practices have implemented diverse protective measures to contain the pandemic, practice organization and structures were adapted. In order to get information about patients' perception of their doctors' visit during the pandemic, we conducted a patient survey in medical practices. Method(s): Cross-sectional study of 58 patients, who were interviewed in four medical practices (family physicians and specialists) in the South West of Munich from 02.04.-17.04.2020 on the following topics: "personal risk assessment", "sense of security and perception of protection measures in the practice setting", "importance of the doctor's visit" and "change of medication, nicotine consumption". By means of a questionnaire with 24 items, data were collected anonymously. Results are presented descriptively and via ANOVA as well as via linear regression. Result(s): The personal risk assessments for COVID-19-disease and for a severe course of COVID-19 were rated low moderate, independent of sex or age. Around 8% of the surveyed patients discussed their personal risk with their doctors. The sense of security in the practice setting was rated high. The rating of the protection equipment was good as well, and closely met expectations. The personal importance of the visit varied. Only 6% had considered cancelling their visit beforehand. A change of medication due to SARS-CoV-2 pandemic was not observed. Conclusion(s): The patient survey provides a snapshot of the outpatient setting from the patient's perspective in a hyperdynamic pandemic situation. Yet, due to the small study population, the results have to be interpreted with caution.Copyright © 2021, Deutscher Arzteverlag.

Public Health Impact of UK COVID-19 Booster Vaccination during Omicron Predominance

Objectives: To estimate the public health impact of COVID-19 booster vaccination in the UK during Omicron predominance, and to explore the impact in counterfactual scenarios with different booster eligibility or uptake. Method(s): A dynamic transmission model was developed to compare public health outcomes for actual and hypothetical UK Spring and Autumn 2022 booster programs. Outcomes were projected over an extended time horizon from April 2022-April 2023, assuming continued Omicron predominance as in Jan-Mar 2022. Health outcomes included averted cases, hospitalizations, long COVID cases, and deaths. NHS resource use outcomes were averted general ward and intensive care unit bed days and general practitioner visits. Patient productivity loss outcomes considered productive days lost for those in and outside the paid work force. Analyses used publicly available data. Result(s): Model output suggested that actual Spring and Autumn 2022 programs, which offered boosters to older adults and vulnerable populations, would avert approximately 716,000 hospitalizations, 1.9M long COVID cases and 125,000 deaths compared to not offering boosters in Spring and Autumn 2022. In a scenario that broadened eligibility to individuals aged >=5 years, an estimated 1.6M hospitalizations, 8.3M long COVID cases, and 222,000 deaths were averted. A scenario assuming broadened eligibility and increased uptake produced the greatest benefit among scenarios analyzed: 1.6M hospitalizations, 9.2M long COVID cases, and 228,000 deaths averted;and 953M productive days saved. Scenarios offering boosters only to high-risk individuals (aged >=5 years) were also estimated to improve benefit relative to actual programs. High-risk-only programs assuming increased uptake provided about half to two-thirds of the benefit estimated for programs assuming broadened eligibility and increased uptake. Conclusion(s): UK booster vaccination programs were estimated to provide substantial benefit to public health during Omicron predominance. Public health benefits could be maximized by broadening booster eligibility to younger age groups and increasing uptake.Copyright © 2023

Features of the mental state of doctors of various specialties during the COVID-19 pandemic.

In the context of the COVID-19 pandemic, the burden on healthcare professionals at all levels has increased significantly, especially those who are at the forefront of the fight for patients' lives. Physicians directly caring for COVID-19 patients are exposed to excessive stress and significant biological and psychosocial risk. Objective. To identify the features of the mental state of doctors of various specialties during the COVID-19 pandemic. Material and methods. The study included 85 doctors of the Arkhangelsk region: 41 anesthesiologists/intensive care physicians (mean age 32.4+/-5.0 years) and 44 general practitioners (mean age 38.9+/-4.2 years). The study was conducted during the third wave of the COVID-19 pandemic (from May to June 2021). We used the following study methods: questionnaire, psychological testing (K. Maslach and S. Jackson Burnout Inventory (MBI), Beck's Depression Inventory, Perceived Stress Scale, World Health Organisation-Five Well-Being Index), mathematical and statistical processing of empirical data. Results and discussion. Analysis of the results showed that about half of the surveyed general practitioners and only 3 (7.3%) of the anesthesiologists/intensive care physicians had a history of COVID-19, having contracted it while performing professional duties. Manifestations of maladaptation, such as low professional competence, lack of soft skills, aggressiveness, introversion, risktaking, recklessness, and family problems, are more pronounced in anesthesiologists/intensive care physicians. They were more likely to have negative emotions and feelings, were less satisfied with themselves and life in general, and had a lower well-being index than general practitioners. General practitioners overestimated their professional burnout severity and more often complained about their state of health. Correlation analysis of the examination results for anesthesiologists/intensive care physicians allowed us to identify direct relationships between the level of perceived stress, overstrain and depression, low mood, difficulties in relationships with relatives and colleagues, dissatisfaction with various aspects of life, inverse relationships between the level of perceived stress and the well-being index. In general practitioners, direct relationships were established between perceived stress and overexertion, and inverse relationships were established between the level of perceived stress, the well-being index, and the reduction of personal achievements. Conclusion. The COVID-19 pandemic negatively impacts anesthesiologists/intensive care physicians more than general practitioners, causing negative emotions and maladaptation. In primary care physicians, the pandemic increases mobilization processes to address emerging professional challenges. Therefore, special attention should be paid to psychological support for anesthesiologists/intensive care physicians.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

Disseminated Mucormycosis in a patient on long term immunosuppression: Severe fungal infections as multi-system disorders

Introduction: Mucormycosis is a rare, severe fungal infection with an incidence of 0.005 to 0.17 per million.1 but incidence has risen recently, particularly in the Asian subcontinent, due to use of immunosuppression for Covid19.2 Presentations can vary and are classified into: rhino-orbito-cerebral, pulmonary, cutaneous, disseminated, renal and gastrointestinal. Risk factors include diabetes, immunosuppression, iron overload, malnutrition, and prematurity.1,3 Although mucormycosis has an extremely high mortality rate and disseminated infection is usually fatal, treatment options exist if diagnosed early and surgical debridement may be curative. Objective(s): We present a case of mucormycois in a female patient in her 40s who was immunosuppressed with methotrexate for rheumatoid disease. This case is discussed to increase awareness of critical illness caused by opportunistic invasive fungal infections in immunosuppressed patients and promote timely identification and management. Method(s): We detail the clinical context and management of a patient with mucormycosis and discuss relevant literature. Result(s): A female patient in her 40s who had been experiencing upper respiratory tract symptoms for several weeks, including cough and brown sputum, was admitted with a presumptive diagnosis of methotrexate toxicity after a full blood count performed by the general practitioner demonstrated pancytopenia. Initially, National Early Warning System 2 score (NEWS2) was 2 but became intensely hypertensive during blood transfusion and then profoundly shocked with an escalating NEWS2. Broad-spectrum antibiotics and fluconazole were commenced for neutropenic sepsis and the patient was referred to critical care in multiple organ failure. Computerised tomography (CT) scan of the chest, abdomen and pelvis showed "left upper lobe consolidation, which with neutropenia might represent an angioinvasive aspergillosis". She had multiple areas of skin discolouration and desquamation. Haematology and Infectious Diseases opinions were sought, and a bone marrow biopsy was performed which showed severe toxic effects consistent with sepsis/life threatening infection. Progressive proptosis was noted, and CT scan of her head was requested. Sadly, she was never stable enough for CT transfer. Beta D Glucan and aspergillus antigen serology was negative. Broncho-alveolar lavage demonstrated Candida albicans and then, later, Rhizopus arrhizus was isolated and anti-fungal treatment changed to voriconazole and then amphotericin B. Upon reviewing the notes in light of the positive culture for Rhizopus, the patient had likely been exhibiting symptomatic Mucormycosis sinus infection for some time prior to this admission with disseminated infection. The patient's condition continued to deteriorate and she sadly died. Conclusion(s): * The Early Warning Score significantly underestimated how unwell the patient was upon arrival in ED, a systems-based assessment would have demonstrated that the patient had multiple system dysfunction and significant potential to deteriorate suddenly despite having stable observations * The methotrexate level has no clinical value in diagnosing or refuting a diagnosis of methotrexate toxicity * A full examination of the immunosuppressed patient including ENT is a necessity when searching for a source of infection * Invasive fungal infections can cause multi-system symptoms and atypical presentations * As a greater proportion of patients have received systemic immunosuppression for Covid-19, vigilance for more unusual pathogens, including Mucormycosis by clinicians is advised.

Determinants of COVID-19 vaccine acceptance amongst doctors practising in Cross River State, Nigeria

Background: COVID-19 vaccine is one of the most effective public health intervention approaches for prevention of COVID-19. Despite its well-known efficacy and safety, significant proportion of frontline COVID-19 healthcare workers remain hesitant about accepting the vaccine for whatever reasons. This study aimed to determine acceptance rate and determinants of vaccine refusal among doctors in Cross River State, Nigeria. Methodology: This was a cross-sectional survey of doctors using structured online questionnaire administered via the WhatsApp platform of the medical doctors' association, in order to assess their rate of acceptance of COVID-19 vaccines, and reasons for vaccine refusal. The predictors of vaccine acceptance were analysed by univariate and multivariate logistic regression analyses. Result(s): Of the 443 medical doctors targeted on the WhatsApp platform, 164 responded to the questionnaire survey, giving a response rate of 37.0% (164/443). The mean age of the respondents is 38 +/-6.28 years, 91 (55.5%) are 38 years old and above, 97 (59.1%) are males and 67 (40.9%) are females, giving a male-to-female ratio of 1.4:1. The greater proportion of the respondents are physicians (70/148, 47.3%) and about three-quarter of the participants (127/164, 77.4%) had received COVID-19 vaccine. The proportion of physicians who had received COVID-19 vaccine (57/70, 81.4%) was more than the proportion of general practitioners (31/42, 73.8%) and surgeons (24/35, 68.6%). Low perceived benefit of vaccination was the main reason given for COVID-19 vaccine refusal (45.9%, 17/37). No significant association was found between vaccine refusal and suspected predictors (p>0.05). Conclusion(s): Our study revealed high rate of COVID-19 vaccine acceptance among medical doctors especially among the physicians, with the surgeons showing lowest acceptance rate. A significant proportion would not take vaccine because they perceived it lacks much benefits. To raise vaccine acceptance among doctors, more efforts on vaccine literacy that would target doctors from all sub-specialties especially surgeons and incorporate vaccine benefits should be made.Copyright 2023 AJCEM Open Access. This article is licensed and distributed under the terms of the Creative Commons Attrition 4.0 International License <a rel="license" href="http://creativecommons.org/licenses/by/4.0/", which permits unrestricted use, distribution and reproduction in any medium, provided credit is given to the original author(s) and the source. Editor-in-Chief: Prof. S. S. Taiwo.

New Zealanders with low back pain seeking health care: a retrospective descriptive analysis of Accident Compensation Corporation-funded low back pain healthcare service usage

Introduction. Most New Zealanders experience low back pain (LBP) at least once throughout their lifetime and many seek help from the large range of health providers in primary care. Accident Compensation Corporation (ACC) funds a significant proportion of those claims, but which services are they funding and what are the costs? Method. This was a retrospective audit and descriptive analysis of ACC-funded, non-public hospital healthcare service use by people with LBP in New Zealand (NZ). Outcome measures were the healthcare services accessed by people with ACC-funded LBP,the claims (all occurrences for a service that has generated a payment/ year), single contact (with a service), and costs (NZ$) for services between 2009 and 2020. Results. The number of claims for services were 129 000 for physiotherapy, 105 000 for general practitioner and 59 000 for radiology services. Per single contact, elective surgery and radiology services were the most expensive. During 2009-2020, there were 3.3 million ACC claims for LBP with a total cost of NZ$4 billion. Over this time, there was an increase in claims, costs and single contacts. Costs decreased slightly during 2010 due to changes in healthcare funding and in 2020 due to the COVID-19 pandemic. Discussion. Consumers have considerable choice in where they access health care for ACC-funded LBP services. This study shows the services they use most frequently and the cost to NZ for those services. These data can inform service planning for ACC-funded LBP health care in NZ.

Retrospective review of vaccination status in patients with newly diagnosed chronic lymphocytic leukaemia

Introduction: Patients with chronic lymphocytic leukaemia (CLL) are at increased risk of infection. CLL is associated with a secondary immunodeficiency and impaired response to vaccination. Recent British Society of Haematology guidelines recommend that patients with CLL should receive vaccination against pneumococcal infection at diagnosis, an annual influenza vaccine and COVID-19 vaccination. Patients aged 70-79 years should also receive the Shingrix vaccine. Patients with CLL should not receive live vaccines. In response to this guideline, a letter detailing vaccination requirements was created for patients to give to their general practitioner (GP). The local process for vaccination referral has since changed. Previously, vaccination requirements were communicated to the GP via letter. There is now a dedicated Vaccination Hub to which clinicians can directly refer patients for appropriate vaccinations. Aim(s): The aim of this project was to assess vaccination referral and vaccination status in patients with newly diagnosed CLL. Method(s): All new diagnoses of CLL from 2021 to 2022 were identified by review of the Haematology Multi-Disciplinary Team meeting electronic registration forms. Electronic patient records were reviewed to determine vaccination referral completion and vaccination status. Result(s): A total of 29 patients were identified as new diagnoses of CLL. Seventeen patients were diagnosed in 2021 and 12 in 2022. Sixty-nine percent of the patients were male and the average age was 70.9 years. Vaccination was discussed with 11 patients (38%) and 10 patients (34%) were referred for vaccination. Eleven patients (38%) had never received a pneumococcal vaccine. Nine patients (31%) had previously received the vaccine but not within the past 5 years. Five patients (17%) patients had received one dose of Pneumovax 23 following referral. No patients had received the initial Prevenar 13 vaccine. Twelve patients (41%) had not received an influenza vaccine. Of those who had received the vaccine, the majority (70%) had received this routinely. Similarly, 71% of patients had received the COVID-19 vaccine routinely as opposed to three patients who received this postreferral. Of those who were eligible, 50% had received the Shingrix vaccine. Conclusion/Discussion: Local rates of vaccination in patients with CLL are low. Numbers were too small to allow for comparison between the methods of referral. Of those referred, not all received the appropriate vaccinations. Further work is therefore required to improve both the number and completion of the referrals. Future steps will include local teaching on vaccinations in CLL and the referral pathway.

Persons Diagnosed with COVID-19 in Linked Clinical Practice Research Datalink (CPRD) - Hospital Episode Statistics (HES) Data: A Cohort Description

Objectives: Clinical Practice Research Datalink (CPRD) Aurum captures primary care electronic healthcare records for ~28% of the population in England. From August 2020-;March 2022, all SARS-CoV-2 polymerase chain reaction (PCR) tests performed were reported back to the patient's general practitioner (GP), making the CPRD a closed system uniquely positioned to answer COVID research questions. Method(s): We defined persons with COVID as those recorded in primary care with a positive PCR test from August 1, 2020-March 31, 2021. We required continuous registration with their GP practice for >=365 days prior to diagnosis to establish comorbid conditions, and eligibility for linkage to Hospital Episode Statistics (HES) Admitted Patient Care data. Hospitalizations for COVID were defined as persons admitted with a primary diagnosis of COVID (ICD-10-CM U07.1) within 12 weeks of the initial primary care diagnosis record. Result(s): Our cohort included 535,453 persons diagnosed in primary care with COVID, with 2% later hospitalized. The hospitalized group was 57% male, 42% current/former smokers, 35% obese46% with a Charlson Comorbidity Index >1 and 98% had never received any COVID vaccine. Hospitalizations increased with age;<0.1% of patients aged 1-17, 1% aged 18-49, 4% aged 50-64, 9% aged 65-74, 13% aged 74-84, and 11% of COVID cases aged >=85 were hospitalized. Persons living in socially disadvantaged areas were overrepresented in the hospitalized cohort (25% in the Index of Multiple Deprivation's most deprived quintile). Conclusion(s): Consistent with other studies, hospitalized COVID patients were disproportionately those with male sex, smoking history, high body mass index, comorbidity and unvaccinated status. Hospitalizations were more common with age, and for individuals living in socially and economically deprived communities. Understanding the demographic and clinical characteristics of this cohort can help contextualize future work describing healthcare resource utilization and costs, as well as the impact of vaccines, associated with COVID in England.Copyright © 2023

Health Disparities and Comparison of Psychiatric Medication Use before and after the COVID-19 Pandemic Lockdown among General Practitioner Practices in the North East of England.

BACKGROUND: Psychiatric medications play a vital role in the management of mental health disorders. However, the COVID-19 pandemic and subsequent lockdown limited access to primary care services, leading to an increase in remote assessment and treatment options to maintain social distancing. This study aimed to investigate the impact of the COVID-19 pandemic lockdown on the use of psychiatric medication in primary care settings. METHODS: We conducted a retrospective claims-based analysis of anonymized monthly aggregate practice-level data on anxiolytics and hypnotics use from 322 general practitioner (GP) practices in the North East of England, where health disparities are known to be higher. Participants were all residents who took anxiolytics and hypnotics from primary care facilities for two financial years, from 2019/20 to 2020/21. The primary outcome was the volume of Anxiolytics and Hypnotics used as the standardized, average daily quantities (ADQs) per 1000 patients. Based on the OpenPrescribing database, a random-effect model was applied to quantify the change in the level and trend of anxiolytics and hypnotics use after the UK national lockdown in March 2020. Practice characteristics extracted from the Fingertips data were assessed for their association with a reduction in medication use following the lockdown. RESULTS: This study in the North East of England found that GP practices in higher health disparate regions had a lower workload than those in less health disparate areas, potentially due to disparities in healthcare utilization and socioeconomic status. Patients in the region reported higher levels of satisfaction with healthcare services compared to the England average, but there were differences between patients living in higher versus less health disparate areas. The study highlights the need for targeted interventions to address health disparities, particularly in higher health disparate areas. The study also found that psychiatric medication use was significantly more common in residents living in higher health disparate areas. Daily anxiolytics and hypnotics use decreased by 14 items per 1000 patients between the financial years 2019/20 and 2020/21. A further nine items per 1000 decreased for higher health disparate areas during the UK national lockdown. CONCLUSIONS: People during the COVID-19 lockdown were associated with an increased risk of unmet psychiatric medication demand, especially for higher health disparate areas that had low-socioeconomic status.

Gender differences in GPs' strategies for coping with the stress of the COVID-19 pandemic in Catalonia: A cross-sectional study.

BACKGROUND: The Covid-19 pandemic has increased stress levels in GPs, who have resorted to different coping strategies to deal with this crisis. Gender differences in coping styles may be contributing factors in the development of psychological distress. OBJECTIVES: To identify differences by gender and by stress level in coping strategies of GPs during the Covid-19 pandemic. METHODS: A cross-sectional, web-based survey conducted with GPs in Catalonia (Spain), in June-July 2021. via the institution's email distribution list, all GPs members of the Catalan Society of Family and Community Medicine were invited to complete a survey assessing sociodemographic, health and work-related characteristics, experienced stress (Stress scale of the Depression, Anxiety and Stress Scales-DASS 21) and the frequency of use of a range of coping strategies (Brief-COPE) classified as problem-focused, emotion-focused and avoidant strategies, some of which are adaptive and others maladaptive. We compared the scores of each strategy by gender and stress level using Student's t-test. RESULTS: Of 4739 members, 522 GPs participated in the study (response rate 11%; 79.1% women; mean age = 46.9 years, SD = 10.5). Of these, 41.9% reported moderate-severe stress levels. The most common coping strategies were acceptance, active coping, planning, positive reframing and venting. More frequently than men, women resorted to emotional and instrumental support, venting, distraction and self-blame, whereas men used acceptance and humour more commonly than women. Moderate-severe stress levels were associated with non-adaptive coping, with increased use of avoidance strategies, self-blame, religion and venting, and decreased use of positive reframing and acceptance. CONCLUSION: The most common coping strategies were adaptive and differed by gender. However, highly stressful situations caused maladaptive strategies to emerge.

Autoimmune pulmonary alveolar proteinosis in an adolescent girl with rapidly progressive dyspnea

Autoimmune pulmonary alveolar proteinosis (PAP) is a rare disease, especially in pediatrics, but important to consider, as it may avoid unnecessary and/or invasive investigations and delayed diagnosis. This case report highlights an adolescent girl with rapid onset dyspnea but an unremarkable physical exam and initial testing. However, due to a high index of suspicion, a chest computed tomography (CT) scan was done, revealing a "crazy paving" pattern, which then prompted expedited assessment. This finding, however, is not as specific as often discussed and has a broad differential diagnosis, which will be reviewed in detail as part of this case. Furthermore, this report demonstrates a diagnostic approach for PAP that avoids lung biopsy, previously considered to be required for diagnosis of PAP, but is increasingly becoming unnecessary with more advanced blood tests and understanding of their sensitivity and specificity. Additionally, management strategies for PAP will be briefly discussed.Copyright © 2022 Canadian Thoracic Society.

Cooperate with community health centers to eliminate HCV in low prevalence region of South China

Background: Shenzhen, a city of immigrants in South China, has a low HCV incidence rate of 19.47 per 100,000. To eliminate HCV in this low prevalence region, it may be efficiency to collaborate with the communities to screen HCV in high risk population. There are 849 Community Health Centers up to now in Shenzhen. The study aimed to evaluate the model of HCV elimination in high-risk population with Community Health Centers. Method(s): The Shenzhen Medical Association assigned hepatologists to educate Primary Care Physicians (PCPs) of 13 Community Health Centers in Bao'an District from 2021.6-2022.6. The PCPs need to take HCV knowledge tests before and after the training. Only when all the questions are answered correctly can the test be passed. Then they recommend the high risk population, e.g., PWID, pricking wound, iatrogenic exposure, to do the HCV antibody test and transfer the patients with HCV-Ab (+) to the hepatologist of Shenzhen Bao'an People's Hospital. Result(s): 151 PCPs participated in HCV knowledge education, the pass rate improved from 15.2% to 53.8% after the training. The high risk population screening number in Community Health Centers improved from 192 (a year before) to 300, even affected by the lockdown of COVID-19. The HCV antibody positive rate in high risk population is 4% (12/300), higher than the hospital population (0.8%, Shenzhen Bao'an People's Hospital), the blood donor (0.3%, Shenzhen Blood Center). The HCV-Ab positive patients in communities transferred to Shenzhen Bao'an People's Hospital, where the rate of DAA treatment is improved from 36.6% (a year before) to 64.1%. Conclusion(s): It is an efficient way to achieve HCV elimination earlier to screening in high risk population through PCPs in low prevalence region. Expanding this model to other Community Health Centers in Shenzhen may accelerate HCV elimination. (Figure Presented).

Multisystem inflammatory syndrome associated with COVID-19 in adult: the case report

The multisystem inflammatory syndrome associated with COVID-19 coronavirus infection was first described in April-May 2020, mainly among children who had an acute infectious disease. Soon there were reports of the development of MIS in adults (MIS-A). More than 200 cases of MVS in adults have been described and systematized in the world, while in Russia there is no separate registration of MVS, a single description of MVS is given in the literature. Material and methods. We presented Case report of MIS-A in a 21-year-old woman, accompanied by persistent fever, multiple organ failure syndrome, is presented. The stages of diagnosis and treatment of MIS-A. Result and discussion. A positive effect was achieved during therapy with corticosteroids and intravenous immunoglobulin. MIS-A is a rare life-threatening complication of a COVID-19 that requires emergency therapy with the inclusion of corticosteroids and intravenous immunoglobulin in an adequate dose. The given example will be interesting for general practitioners, infectious disease specialists and therapists.Copyright © 2023 The authors.

Comprehensive medication management services provided via telehealth or hybrid models: A scoping review

Comprehensive medication management (CMM) is increasingly provided by health care teams through telehealth or hybrid modalities. The purpose of this scoping literature review was to assess the published literature and examine the economic, clinical, and humanistic outcomes of CMM services provided by pharmacists via telehealth or hybrid modalities. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Randomized controlled trials (RCTs) and observational studies were included if they: reported on economic, clinical, or humanistic outcomes;were conducted via telehealth or hybrid modalities;included a pharmacist on their interprofessional team;and evaluated CMM services. The search was conducted between January 1, 2000, and September 28, 2021. The search strategy was adapted for use in Medline (PubMed);Embase;Cochrane;Cumulative Index to Nursing and Allied Health Literature;PsychINFO;International Pharmaceutical s;Scopus;and grey literature. Four reviewers extracted data using a screening tool developed for this study and reviewed for risk of bias. Authors screened 3500 articles, from which 11 studies met the inclusion criteria (9 observational studies, 2 RCTs). In seven studies, clinical outcomes improved with telehealth CMM interventions compared to either usual care, face-to-face CMM, or educational controls, as shown by the statistically significant changes in chronic disease clinical outcomes. Two studies evaluated and found increased patient and provider satisfaction. One study described a source of revenue for a telehealth CMM service. Overall, study results indicate that telehealth CMM services, in select cases, may be associated with improved clinical outcomes, but the methods of the included studies were not homogenous enough to conclude that telehealth or hybrid modalities were superior to in-person CMM. To understand the full impact on the Quadruple Aim, additional research is needed to investigate the financial outcomes of CMM conducted using telehealth or hybrid technologies.Copyright © 2022 Pharmacotherapy Publications, Inc.

Primary Care Physicians' Knowledge, Attitude and Practice towards Bariatric Operations in the Kingdom of Bahrain

Background: Obesity is an epidemic treatable disease. In Bahrain, the prevalence of obesity was 36.2%. Bariatric surgery should be considered for patients with BMI >= 40, or >= 30 with obesity-related comorbidities. Family physicians have a key role in identifying and counseling patients who may qualify for bariatric surgery. The most common reason for physicians' refusal of referral for bariatric surgeries is fear of complications followed by concern of ineffective weight loss following the surgery. Doctors are not comfortable providing post bariatric operation care. Aim(s): To study the PCPs' knowledge, attitude and practice towards bariatric surgeries in the kingdom of Bahrain. Method(s): this is a cross-sectional study of a convenient sample of physicians working in the Kingdom of Bahrain health centers, using an electronic and manual questionnaire to test the knowledge, attitude and practice towards bariatric surgery. Result(s): The sample included a total of 222 participants. 56.1% agreed that the BMI >= 40 without weight related comorbidities is an indication for bariatric surgery and 92.3% of them referred patients for bariatric surgery, with BMI (88.6%) as the most influential factor followed by presence of comorbidities (87.8%). On the other hand, lack of resources was the main cause for not referring patient for bariatric surgery (29.4%) followed by concerns with follow up (23.5%). 80.6% are comfortable to initiate conversations with their patients about bariatric surgery, while 36.1% feel comfortable explaining the procedural options to a patient. 83.8% agreed that additional medical education in bariatric surgical care would be useful. Conclusion(s): Primary care physicians showed well knowledge about the referral criteria to bariatric surgeries and that's reflected by the high referral rate (92.3%). But there is a gap in the knowledge mean score across different age groups and experience. Less than half of the physicians are not comfortable dealing with patients. Continuous medical education is essential to address the gap and to establish comprehensive obesity management guidelines for primary care physicians.Copyright © 2023, Bahrain Medical Bulletin. All rights reserved.

The COVID-19 Pandemic Influence on Doctor's Service Performance Using Workload as a Mediation Variable

BACKGROUND: The COVID-19 pandemic greatly affected doctors' increasing workload, especially in Primary Health Care Facilities. If this is not addressed immediately, it will affect the performance or quality of a doctor's service. AIM: This research objective is to identify the role of Primary Healthcare Facility doctors' workload in moderating the impact of the COVID-19 Pandemic on their performance. METHOD(S): The explanatory-descriptive research was conducted using a quantitative approach. The research respondents were 103 general practitioners who worked at a Primary Healthcare Facility in Malang City (35.0% male and 65.0% female, the most extensive age range was 26-35 years (74.8%), with a working period of 1-5 years. 57 (55.3%) The research instrument was a questionnaire declared valid and reliable, distributed online, and analyzed using Partial Least Square. RESULT(S): The findings demonstrated that the COVID-19 pandemic significantly positively affected the performance of Primary Healthcare Facility doctors (beta = 0.455, t stat = 11.390). The pandemic also significantly impacted workload (beta = 0.283, t stat = 4.347). Workload impacted performance significantly and positively (beta = 0.224, t stat 4.157). Workload mediates the COVID-19 Pandemic influence on doctors' performance (beta = 0.063, t stat = 3.005). CONCLUSION(S): Doctors at Primary Health Care have not all experienced a decline in performance despite the increased workload due to the COVID-19 Pandemic. It forces doctors to juggle between completing their tasks, fighting against disease, and improving their performance.Copyright © 2023.