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1.
Alzheimer's and Dementia ; 18(S8) (no pagination), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2172392

RESUMO

Background: With COVID-19, online opportunities to support families living with dementia are becoming increasingly important. However, academic institutions are typically not prepared to develop and test online platforms. We present a case study to describe steps for creating an infrastructure to test an online platform, WeCareAdvisor (WCA). WCA provides caregivers disease education and tailored strategies to manage dementia-related behavioral symptoms using the DICE Approach. WCA was previously tested in a small, randomized trial demonstrating positive caregiver outcomes. To advance its evidence-base, WCA is being tested in a NIA-funded Stage III efficacy trial with a national sample of 326 caregivers. Method(s): To test WCA, an infrastructure in the academic institution had to be created to address HIPAA compliance, privacy considerations, integrate user and developer input, and support rigorous trial methodologies. Through key informant interviews and literature reviews, we established a six-step process: 1) Identifying and engaging key stakeholders (legal, Information Technology offices, research team, software company);2) Creating software development agreement with stakeholder input;3) Detailing scope of work and an oversight structure of software company, 4) Developing formal agreements with the software company, 5) Conducting security assessments with university IT offices;and 6) Establishing formal vendor status of the software company. This also necessitated new roles and responsibilities of research team members. Result(s): The six-step process was labor intensive, transpired over 12 months, and involved over 15 iterative meetings with investigators, project staff, and stakeholders. Careful coordination of stakeholders to provide practical and iterative guidance at each of the six steps was essential. Deliberations resulted in app store access, URLs and domains, and compliance and privacy statements reviewed and approved by various university offices, and then launching WCA on app stores for access by study participants. Conclusion(s): Researchers and academic institutions have varying levels of understanding and readiness to engage in infrastructure development to rigorously test online platforms. Our approach resulted in an effective infrastructure for testing WCA which can be used by other researchers. Development of an infrastructure requires new skills for investigators, engaging multiple stakeholders, appropriately budgeting for this activity, and allocating sufficient start-up time. Copyright © 2022 the Alzheimer's Association.

2.
Medical Journal of Malaysia ; 77(Supplement 1):5-9, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2058532

RESUMO

Introduction: Coronavirus disease (COVID-19) must be controlled by involving all stakeholders, including the community. Community protocol compliance with COVID-19 health guidelines is essential. This study assessed the social determinants of health on community protocol compliance with COVID-19 health guidelines among adults in Yogyakarta, Indonesia. Material(s) and Method(s): This study was a mixed-method study of 461 adults from February through May 2021 in Yogyakarta Province. We collected data through an online survey, focus group discussions, and in-depth interviews. Logistic regression was used to analyze the results. Result(s): Most respondents (86%) always wore masks, followed social distancing (51.8%), and washed their hands regularly (99%). Subjects older than 45 years, women, and community leaders demonstrated greater compliance with COVID-19 health protocols compared to other people. On the other hand, the occupation has become a healthy lifestyle practice indicator. Conclusion(s): Gender, age, educational level, economics, and social status were determinants of health protocol adherence among adults in Yogyakarta. Therefore, health providers need to consider social determinants for health promotion approaches and COVID-19 prevention and control strategies. Copyright © 2022, Malaysian Medical Association. All rights reserved.

3.
Journal of the Intensive Care Society ; 23(1):96-97, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2043058

RESUMO

Introduction: 42% of patients in the intensive care unit (ICU) will suffer ocular damage during their stay.1 Multiple mechanisms that usually protect the eye are inhibited, whilst interventions such as positive airway pressure and muscle relaxants further expose the eye to harm.2 This became increasingly evident during the COVID-19 pandemic, where non-invasive ventilation and proning of patients exposed patients to risk of injury.3 Redeployment of Ophthalmologists to ICU during the first wave of the COVID-19 pandemic highlighted the need for a robust and sustainable intervention to reduce the frequency of eye complications in our unit. Objectives: Our objective was to reduce harm to eyes in all patients within the Royal Infirmary of Edinburgh (RIE) to zero ICU within nine months. Methods: Our QI project involved initial staff and patient data collection regarding current eye care practices. A fish-bone diagram facilitated group discussions with ICU clinical teams regarding prior eye care practices. A pareto chart identified categories to focus on, with a driver diagram identifying change ideas. Our primary intervention was the design and introduction of a bespoke eye care guideline. Specific outcomes, processes, and balancing measures were set out, and multiple PDSA cycles helped to prompt interventions to ensure consistent and standardised care was delivered. Run charts were regularly reviewed and a variety of interventions were introduced throughout the data collection period as tests of change. These included: 1. posters highlighting guideline enrolment 2. formal teaching at handovers and on the unit 3. educational emails to staff members 4. prompts on daily reviews to highlight eye care assessments. Between 28 Sept 2020 -28 June 21, twenty patients in RIE ICU were randomly selected by the data collection team weekly. Patient outcome -eyes were examined and noted if they had developed any ocular complications during their stay. Patients who had evidence of ocular damage on admission were excluded unless they developed further complications. A single episode was not counted twice. Process outcomes -Eye care guideline adherence was recorded, and non-compliance was rectified following data collection. The data was recorded on run charts, accessible via MS teams, allowing all project team members to review the data remotely. Results: During our data collection period, the introduction of our guideline and educational interventions reduced the median number of patients who suffered eye complications in ICU by 50% within nine months (Figure 1). Chemosis and evidence of dry eyes were the most common complications. Since initiation of the guideline, our educational interventions have maintained median guideline compliance at 80%. Conclusion: This is a comprehensive, patient-centred, QI project, utilizing a systematic methodology to introduce a new guideline within ICU. This project has resulted in a sustained improvement of eye care standards, and reduction of eye complications within RIE ICU. This project was ongoing during the second wave of the COVID-19 pandemic, where constant rotation of medical staff, unfamiliar with ICU, required education to ensure guideline compliance was achieved. Our eye care guideline is now part of a multicentre project to standardise care across NHS healthboards.

4.
British Journal of Surgery ; 109:vi62, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2042561

RESUMO

Aim: The Enhanced Recovery After Surgery (ERAS) protocol for total laryngectomies was first implemented in our tertiary head and neck centre from November 2019. It includes pre-operative carbohydrate loading and an early swallow test which facilitates recommencement of oral intake to improve outcomes. Protocol adherence rate and patient outcomes were measured to determine the effectiveness and benefits of ERAS in laryngectomy patients. Method: 22 total laryngectomy patients from November 2019 to September 2021 were enrolled onto the ERAS protocol, 18 primary and 3 salvage cases. An analysis of the respective patient cohorts was performed to determine adherence to the ERAS protocol and outcomes such as complications and length of inpatient stay were measured. Results: 19 patients (86%) received pre-operative carbohydrate loading successfully, while 3 patients were contraindicated due to background of diabetes. Early swallow test was performed in 59% of patients. Potential reasons for delay were stoma dehiscence or clinical suspicion of neo-pharyngeal leak. 59% of primary cases were deemed medically fit for discharge within the target timeframe of 12-14 days whereas no target was set for salvage cases due to expected poor healing. Main complication in primary cases was neo-pharyngeal leak followed by stoma dehiscence with 28% and 11% respectively. Conclusion: Limitations of our study include small sample size due to the COVID-19 pandemic. Despite its infancy, the ERAS protocol has achieved good outcomes in early recommencement of oral intake post-laryngectomy and encouraging early safe discharge from hospital. Future plans include establishment of Prehab Clinic and application of ERAS to neck dissection patients.

5.
Anaesthesia ; 77:17, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2032351

RESUMO

The COVID-19 pandemic has led to unprecedented challenges to surgical services in the UK. Government guidance on the usage of personal protective equipment (PPE) during theatre proceedings [1] has been adapted into local protocols by NHS Trusts across the UK, which is paramount to minimise the potential risk of exposure to staff and patients. We audited the adherence of members of staff working in operating theatres at a district general hospital to local COVID-19 PPE protocols. Methods This was a single-centre audit performed over a 2-month period between June and July 2021. Data were collected by direct observation of staff in the operating theatre environment. Eight staff roles representing members of the anaesthetic, surgical and nursing teams were observed in five different operating lists. The PPE items worn by staff in the presence of aerosol-generating procedures (AGPs) and during direct patient contact were recorded and compared to the local hospital protocols. Results We observed 365 members of staff during 46 patient encounters across the five theatre lists. During AGPs, overall staff adherence for PPE items was 59.1% for FFP3 masks, 25.1% for eye protection, 49.3% for gowns, 62.9% for gloves. For direct patient contact, adherence was 98.4% for surgical masks, 10.7% for eye protection, 37.8% for gowns, 0% for aprons and 80.8% for gloves. Adherence was lowest during emergency lists for patients with an unknown or positive COVID-19 status, with 51.1% of staff wearing FFP3 masks during AGPs here. The staff group with the worst adherence was the surgical team, with 0% of the correct PPE items being worn during AGPs. Discussion Poor adherence to local PPE protocols was demonstrated across all list types and staff member groups, which was worse in higher risk scenarios. This was likely due to suboptimal awareness of guidelines and mixed personal attitudes towards PPE. Recommendations were made for increased dissemination of protocols, introduction of visual prompts in theatre departments and inclusion of protocol signposting in theatre team briefings. Re-auditing is in progress to assess for sustained change following these interventions. Poor adherence to protocols could be contributing to ongoing COVID-19 transmission in hospitals if the results here are reflected nationally, so we recommend that this study is replicated in other hospital Trusts as part of quality-assurance initiatives to reduce COVID-19 transmission in hospitals.

6.
Annals of the Rheumatic Diseases ; 81:1093-1094, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2008816

RESUMO

Background: Physical activity (PA) is an important component in the management of people with rheumatoid arthritis (RA) (1). Interventions incorporating Behaviour Change (BC) theory are needed to target physically inactive people with RA. The study Physiotherapist-led Intervention to Promote Physical Activity in Rheumatoid Arthritis (PIPPRA) was designed using the Behaviour Change Wheel (BCW) and a pilot study of feasibility undertaken (ClinicalTrials.gov Identifer: NCT03644160). Objectives: To obtain reliable estimates regarding recruitment rates;participant retention;protocol adherence and possible adverse events, and to producing estimates of the potential effect sizes of the BC intervention on changes in outcomes of physical activity;fatigue;disability and quality of life. Methods: Participants were recruited at University Hospital (UH) rheumatology clinics and randomly assigned to control group (physical activity information leafilet) or intervention group (four BC physiotherapy sessions in eight weeks). Inclusion criteria were diagnosis of RA (ACR/EULAR 2010 classifcation criteria), aged 18+ years and classifed as insufficiently physically active. Ethical approval was obtained from the UH research ethics committee. Participants were assessed at baseline (T0), 8-weeks (T1), and 24-weeks (T2). Descriptive statistics and t-tests were used to analyse the data with SPSS v22. Results: 320 participants were identifed through chart review with direct contact then with people meeting the inclusion criteria at rheumatology clinics. Of the clinic attendees n=183 (57%) were eligible to participate and n=58 (55%) of those consented to participate. The recruitment rate was 6.4 per month and refusal rate was 59%. Due to impact of COVID-19 on the study n=25 (43%) participants completed the study (n=11 (44%) in intervention and n=14 (56%) in control). Of the 25, n= 23 (92%) were female, mean age was 60 years (sd 11.5). Intervention group participants completed 100% of BC sessions 1 & 2, 88% session 3 and 81% session 4. No serious adverse events were reported. Secondary outcome measures data is Table 1. Conclusion: The PIPPRA study designed using the BCW to improve promote physical activity was feasible and safe. This pilot study provides a framework for larger intervention studies and based on these fndings a fully powered trial is recommended.

7.
Indian Journal of Critical Care Medicine ; 26:S98-S99, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2006388

RESUMO

Introduction: Nutrition plays an important role in ICU patients, more so in hypercatabolic COVID-19 illness. Among other lifethreatening problems, nutrition seemed to have taken a backseat in many hospitals due to logistics, reduction of manpower, isolation practices, etc. Objectives: To study the pattern and use of nutrition in our tertiary care COVID ICU in comparison to the non-COVID ICU. Materials and methods: An observational study was performed of 941 consecutive patients from March 2020 to June 2021 by collecting data from the iNUTRIMON software.1 In view of the various challenges faced in the delivery of appropriate nutrition and the hypermetabolic nature of the disease a COVID-specific nutrition protocol was formulated at the start of the pandemic.2 It involved the use of enteral scientific feeding formula for all COVID patients tolerating an oral diet. The protocol can be accessed at https://www.opensciencepublications.com/fulltextarticles/IJN- 2395-2326-7-216.html. The energy was prescribed using simple predictive equations (i.e., 25 kcal/kg). In case of mechanically ventilated patients, indirect calorimetry-derived measures were used. All patients were prescribed 1.8 g/kg proteins. The protocol for nutrition patients remained the same with the exception that in non-COVID patients oral supplements were added only if 50% of the kitchen diet was not taken within 3 days. The use of TPN for both groups remained as per the protocol. The software iNutrimon calculated the scientific feeding formulae (product) based on the prescription of energy, proteins, and volumes, taking into account the viscosity and precise water requirement per scoop of formula feed. Results: The mean length of ICU stay of COVID patients was 9.31 days as compared to 6.8 days in non-COVID patients. 8.8% of the patients required TPN as compared to 1.4% of the non-COVID population. Only 0.6% of the total enteral feeding in the COVID ICU was with kitchen diet alone compared to 7.8% in the non-COVID ICU. The incidence of use of supplemental nutrition was 97% per patient as compared to 57.6% per non-COVID patient. Among the scientific feeding formulae, the use of peptamen (85%) was highest in COVID patients as compared to 25% in non-COVID patients. The per-day cost of nutrition for COVID patients admitted to the ICU was found to be comparable to non-COVID patients when a cost analysis was done. Conclusion: There was a 168% increase in the use of scientific feeding formula and a 60% increase in the use of TPN in COVID patients as compared to non-COVID patients. This is also reflected as an increase in the cost of feeding. The use of TPN seems to suggest the increased intolerance to enteral nutrition. The increased use of scientific feeding formulae may indicate the adherence to protocol and also seems to suggest that COVID patients needed to be supplemented as kitchen feeds were unable to meet the requirements.

8.
Clinical Nutrition ESPEN ; 48:499, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2003954

RESUMO

Early enteral feeding is important in maintaining the integrity of the gastrointestinal tract mucosal barrier and associated with less bacterial translocation and decreased stimulation of the systemic inflammatory response and subsequent improved outcomes in intensive care (ICU) patients. Enteral feeding by nasogastric (NG) tubes is the preferred route of nutritional support for most ICU patients. However, ICU patients with delayed gastric emptying and poor intestinal motility may not tolerate gastric feeding and may therefore benefit from post-pyloric feeding via nasojejunal (NJ) tubes1. We reviewed the effectiveness of 35 NJ tube placement in 24 patients on ICU between January and March 2021. The M:F ratio was 4:1, median age 69 years (30–80 years) and 54% of patients were non-White British. 10 patients (42%) had diabetes and 54% had COVID-19 as part of their admitting diagnoses. The median BMI was 25 (range 20 – 32.3) and none of the patients were identified as high risk for refeeding syndrome at the time of NJ tube insertion. Nutritional information was unavailable on 5 patients. Of the remaining 19 patients, 26% of patients (n=5) were commenced on parenteral nutrition (PN) within 48 hours of NJ insertion. Only 1 patient was able to meet their nutritional requirements enterally via NJ tube at 5 days;a further 2 patients had their nutritional requirements met with supplemental PN. In 8 of 22 referrals the indication for NJ tube insertion was because an NG tube could not be passed. The evaluation revealed discrepancies in adherence to protocols for high gastric residual volumes and prokinetic use. Documentation surrounding decision making, requesting and inserting an NJ tube was poor and probably reflects the complexity of the patients, involvement of multiple clinical teams, and various documentation modalities (i.e., verbal, written and different electronic systems). There was clinical dispute regarding the indication for NJ tube insertion in 23% of cases (documented in 3 of 13 referrals for NJ tube insertion). Where documentation was available 43% of patients (n=10) had an NJ tube placed on the day of request;the median time from request to insertion was 1 day (range 0-10). 5 patients had more than one NJ tube inserted (median 3;range 2–5). There was variation in experience and expertise of the endoscopists placing the NJ tubes. NJ tube feeding is considered to be less expensive and have less complications than PN2. However, our evaluation has revealed a range of issues relating to both the insertion and use of NJ tubes in an ICU setting. The true resource ‘cost’ of NJ tube insertion is probably underestimated in the literature and the complications of PN probably overestimated in the context of modern ICU and nutrition support team clinical practices. We suspect that our clinical experience is not unique and that more research is needed in this area. We are using this work to educate clinical teams, standardise documentation, provide better support and supervision for endoscopists, and raise awareness of the benefit and need for supplemental PN where nutritional requirements are not consistently reached enterally. 1 Schröder S, Hülst S V, Claussen M et al. Postpyloric feeding tubes for surgical intensive care patients. Anaesthetist 2011;60 (3): 214-20. 2 Lochs H, Dejong C, Hammarqvist F et al. ESPEN Guidelines on enteral nutrition: Gastroenterology. Clin Nutr 2006;25(20: 260-74.

9.
Pediatrics ; 149, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2003418

RESUMO

Purpose/Objectives: Effective management of childhood obesity is critical to prevent long-term medical and psychosocial sequelae. In 2015, the AAP issued guidelines on monitoring body mass index (BMI) and providing comprehensive obesity care based on risk factors. However, literature demonstrates that physician adherence to these guidelines is often poor. Electronic health record (EHR) clinical decision support tools can be effective in standardizing weight management. Utilizing EPIC SmartSets to improve physician adherence to AAP obesity management guidelines, we aimed to increase by 30% in 6 months the following: formal diagnosis of elevated BMI, frequency of weight follow-up visits, adherence to recommended lab screening, and subspecialty referrals. Design/Methods: Pre- and post-intervention surveys were distributed to residents/faculty at an academic primary care clinic to identify variability in practice and barriers to guideline adherence, which informed intervention designs. Cycle 1: SmartSets were implemented in July 2020 with diagnosis codes, note templates, readiness to change surveys, recommended lab and referral orders, patient handouts/questionnaires, and follow-up visit suggestions. Education was completed for providers. Cycle 2: Based on end-user input, SmartSets were integrated into preexisting well-visit templates rather than requiring separate workflow. Analysis metrics included the percentage of: well-visits with an appropriate diagnosis of elevated BMI, acute visits designated as weight follow-ups, and weight or well-visits in which labs were ordered or subspecialty referrals placed. All patients with BMI 85-94.9%ile (overweight) and BMI ≥95%ile (obese) ages 2-17.9 years old seen from 7/1/2019 to 3/31/2021 were included. Data was plotted on run/control charts to assess trends after implementation and revision. Results: A total of 748 overweight patients and 669 patients with obesity were seen during this timeframe. There was a sustained increase in appropriate diagnosis of elevated BMI from an average of 49% pre-intervention to 71% postintervention (Fig. 1), surpassing our aim. There were no significant trends in the percentage of weight visits, labs, or referrals. Appropriate utilization of the implemented EHR tools for well-visits improved after second cycle revisions (39% to 88%). Provider-perceived barriers to AAP guideline adherence included lack of family willingness to participate in management, lack of visit time, and socioeconomic factors out of the provider's control (Fig. 2). Conclusion/Discussion: The first step to instigate practice changes is through problem identification. By utilizing end-user feedback and preserving clinical workflows, the incorporation of AAP guidelines into EPIC SmartSets improved the diagnosis of elevated BMI during well-visits. However, due to COVID-19, it is unclear whether lab orders, referrals, or weight follow-ups improved. Additional EPIC modifications, such as auto-populated lab results, could minimize the need to chart review and thus improve these behaviors. While we demonstrated improved physician recognition, more studies are warranted to address the complex challenges primary care providers and families face regarding weight management. - Control Chart for BMI Diagnoses Made at Applicable Well Child Checks (WCC) by Month Percent of patients with elevated BMI seen at a well-visit from July 2019 through March 2021 who were formally given the diagnosis of elevated BMI. Goal to increase appropriate diagnoses by 30%. -Pareto Chart of Perceived Barriers to Adherence to AAP Guidelines for Weight Management Based upon surveys of residents and faculty at the academic pediatrics clinic studied.

10.
Psychosomatic Medicine ; 84(5):A137, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2003188

RESUMO

Elevated pro-inflammatory cytokines such as interleukin-6 (IL-6) have been observed in patients with COVID-19 and are associated with adverse clinical outcomes. Systemic immune response is co-regulated via the vagally-mediated cholinergic anti-inflammatory reflex. Specifically, a reduced release of pro-inflammatory cytokines such as IL-6 from acetylcholine-synthesizing T-cells in response to Vagus nerve stimulation has been demonstrated in animal and human studies. A known non-invasive and cost-effective way to stimulate efferent vagal activity is slow-paced breathing. The primary aim of this RCT was to determine if high-dose breath-assisted reflex stimulation results in a reduction of systemic inflammatory levels in COVID-19 patients. 48 hospitalized COVID-19 patients with moderate to severe symptoms from two isolation wards were randomized to intervention (3x20min app-assisted slow-paced breathing @6BPM) or TAU control group at the University Medical Center Ulm (Germany) during March & May 2021 (BEAT-COVID-study;DRKS00023971). Morning samples of IL-6, protocol adherence and self-reported total practice time (TPT) were collected bi-daily. Mixed effect linear regression models were used to explore groupXtime differences as well as dose-response analysis. Models were adjusted for age, ward, and TAU protocols. A total of 40 patients (age 55±14;67% male) were included to the final analysis. Feasibility of the applied breathing protocol was good, oxygenation was stable and no adverse events occurred. Adherence was closely monitored and sufficient in 17 out of 25 IG patients. Primary reason for non-adherence was worsening of symptoms with transfer to ICU. Reduction rate in inflammatory markers were not statistically different between IG and CG. Investigating the effect of categorized TPT on next morning IL-6 levels in 25 IG patients from 112 intervention days revealed significant lower IL-6 values when TPT exceeded 40min (b= -0.898ln[pg/ml];p=0.043). This is equivalent to a ratio of 59.3% reduction in circulating IL-6 compared to days with TPT <10min. This is the first clinical RCT to study immediate anti-inflammatory effects of a slow-paced breathing protocol in hospitalized COVID-19 patients. Although no between group differences were found in the reduction rate of systemic inflammatory markers, promising dose-response effects were observed.

11.
Hong Kong Journal of Paediatrics ; 27(1):47, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2003053

RESUMO

Background: Nowadays, noninvasive ventilation is the mainstay of the ventilation strategy in the neonatal intensive care units (NICUs) and most of infants, especially preterm infants, having respiratory problems, are provided noninvasive ventilation (NIV) upon their demands. Nevertheless, complication of NIV device-related pressure injury was common, the incidence of nasal injury ranged from 20% to 60%. Limited studies were found evaluating the nursing care of preterm infants receiving NIV. Aims: This study aimed to develop an evidence-based clinical practice guideline for preterm infants receiving NIV, implement the guideline in a NICU of a regional hospital, and evaluate infant outcomes including comfort, incidence of NIV device-related pressure injury. Besides, improvement on nurse's knowledge and practice for caring infants under NIV were assessed. Study Design and Methods: The Iowa Model-Revised was adopted as the theoretical framework to guide the study process. A multidisciplinary workgroup consists of eight stakeholders in NICU was formed for the process and acted as the champions for the new practice. A before and after study design was adopted and included the preimplementation and post-implementation phases. An integrative review was conducted to identify relevant studies from eight electronic databases before the study. All eligible studies were appraised using the Johns Hopkins University's evidence appraisal tool. Neonatal Pain, Agitation and Sedation Scale (N-PASS) for pain assessment and two self-developed NIV care bundle knowledge test and audit tool were used for the study. Results: Due to the COVID-19 pandemic in 2020, the study was extended for a month and ended in January 2021. A total of 74 infants in Pre-implementation phase (before group) and 67 infants in Post-implementation phase (after group) were recruited. Logistic regression model was used to compare the incidence of pressure injury between groups after adjusted for all substantial covariates in the study. Infants in after group had an 84% decreased odds of acquiring pressure injury (adjusted OR=0.149, 95% CI 0.045-0.495, p=0.002). Infant's comfort level whilst receiving NIV was not determined in the study as the after group having a significantly lesser mean time (p<0.001) in calm state but lower N-PASS score. Regarding nurse participants, 71 nurses received the training programme on NIV care bundle, and overall nurses' knowledge level improved immediately (adjusted p<0.001) and at 12 weeks after the programme. Three audits were conducted to evaluate nurses' practice, nurses' compliance rate to the care bundle significantly improved at 12 (p<0.001) and 24 weeks (p<0.001) in comparison with baseline compliance rate in the pre-implementation phase. However, nurses' knowledge retention at 12-week and compliance rate at 24-week after the training programme declined. Conclusion: The evidence-based clinical practice guideline aims to promote comfort and prevent injury in infants receiving NIV, and outcomes of the infants depend on vigilant nursing care and compliance to this clinical practice guideline. Declining of nurse's knowledge level and practice compliance found in the study indicates the needs of continuous education and audit on the practice to sustain the service quality and patient's safety.

12.
Journal of General Internal Medicine ; 37:S138-S139, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1995597

RESUMO

BACKGROUND: Adherence to guideline-concordant management of incidentally detected pulmonary nodules (PNs) is frequently poor. We designed and implemented a division-level intervention to improve Fleischner society guideline adherence at our institution. METHODS: Our intervention included: (1) radiology report templates for documentation of PNs, (2) generation of daily reports of incidentally identified PNs, (3) a population health coordinator who documented PN identification in the electronic health record (EHR) and managed patient outreach, and (4) EHR templates for clinician documentation of disclosure to patients and clinical care plan. Outcomes were rates of PN disclosure and completion of recommended surveillance chest computed tomography (CT) or sub specialist evaluation. Outcomes were assessed in patients with a PN identified before (01/02/ 2018-03/31/2019) and after (04/01/2019-09/30/2020) implementation of the intervention in 4 primary care practices. RESULTS: Pre-and post-implementation cohorts included 395 and 432 patients, respectively. Mean age was 65.1±10.8 vs 65.0±11.8 (p=0.881) and 59.5% vs 60.2% were female (p=0.895). Race was White in 52.4% vs 43.3%, Black in 39.5% vs 45.1%, and other 8.1%vs 11.6%(p=0.166). Recommended management was surveillance chest CT (72.4% vs 73.6%), subspecialist referral (21.0% vs 13.7%), or no further imaging (6.6% vs 12.7%;p=0.001). Disclosure of PNs increased from 78.5% to 94.9%, an improvement of 16.4% (95% CI 11.9-21.0%). Surveillance CT ordering increased from 66.4% [n=190/286] to 88.7% [n=282/318], an improvement of 22.3% (95% CI 15.8-28.7%) and CT completion increased from 67.1% [n=192/286] to 85.5% [n=272/318], an improvement of 18.4% (95% CI 11.7-25.1%). When CT was completed >30 days after the recommended time interval, median delay was reduced by 66.5 days (163.5 [n=72] vs 97.0 [n=97], p=0.004), despite post-intervention overlapping with the COVID-19 pandemic (Figure 1). The rate of completed sub specialist evaluation was similar (94.0% [n=78/83] vs 93.9% [n=46/49], p=1). CONCLUSIONS: A multicomponent division-level intervention improved rates of PN disclosure and surveillance CT ordering and completion. Our findings support expansion of system-level approaches that standardize and automate processes to improve guideline adherence.

13.
Pharmaceutical Technology ; 45(11):14-15, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1955749
14.
Sleep ; 45(SUPPL 1):A90-A91, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1927392

RESUMO

Introduction: The COVID-19 pandemic has challenged researchers to use remote data collection. Our project includes determining DLMO phase, requiring a family-friendly without face-to-face interaction. We describe here our protocol, experiences, lessons learned, and findings from the first 15 participants. Methods: Fifteen urban-dwelling children with moderate to severe persistent asthma [7 girls, ages 7 (n=1) to 10 years;and 8 boys, 8 or 9 years] and caregiver (CG) participated. CG tracked bedtimes and risetimes in daily diaries for 10-14 days;average bedtimes from 5 nights preceding saliva collection were used to determine timing for 10 half-hourly samples. CG and child were oriented and then watched a demo video. A spit-kit was delivered to the home the afternoon of the study. Kits included a small cooler bag with bottle of water, 10 numbered and 5 spare Salivette tubes (Starstedt, Germany), plastic bag, dark wraparound glasses with securing strap, and log sheet. Data collection began with a zoom call with staff, CG, and child to reiterate the instructions, answer questions, and observe the first sample. Thereafter, a staff member telephoned the caregiver every 30 minutes to prompt the next sample and query whether glasses had been kept on. CG placed kit outside the home for morning pick up. Samples were centrifuged and frozen (-20°) until sending to the assay lab (SolidPhase, Portland, ME) for melatonin radioimmunoassay (Alpco, Windham, NH). Results: DLMO phase was determined with a 4pg/ml threshold for 11 children. DLMO phases (mtime=21:46±68 min) and average bedtimes (mtime=20:40±88min) were positively correlated (r=.87). Challenges identified for missed DLMOs included: one child supervised by a teenaged sibling (not CG);one child/CG identified as potentially uncooperative. The other two misses likely arose from low saliva quantity, inconsistencies with staff training, and inadequate description of requirements for wearing glasses. Procedure modifications included strategies tailored to families' needs, experiences, and home environment that can challenge adherence to protocol, greater emphasis on wearing glasses, and cartoon reminder card and scales added to kit. Subsequent samples were successful. Conclusion: Our approach was effective for determining DLMO phase in children using a remote approach with careful application of methods.

15.
Neurology ; 98(18 SUPPL), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1925251

RESUMO

Objective: The objective of this study was to investigate the COVID-19 lockdown's impact on the rates of non-compliance in NINDS/NIH because of its potential to negatively impact patient safety and data integrity. Background: COVID-19 has caused 226.2 million confirmed cases and 4.6 million deaths globally. Without treatments or vaccines, distancing and lockdowns were recommended. Despite the benefits, little is known about the effects on patient safety and non-compliance in clinical research during current lockdown guidelines. Design/Methods: Non-compliance events from July 2019 to August 2021 were stratified by the date of non-compliance (pre- or post-lockdown enforced March 11th, 2020). Then, events were described by size, location, and category of protocols and type, primary category, sub-category, and cause of events. Additionally, non-compliance caused by COVID-19 was analyzed to determine common characteristics. Results: Three hundred and ninety-five non-compliance events occurred across 47 protocols with 14,453 total enrolled patients at risk. The overall rate of non-compliance increased significantly from 0.0164 events per patient to 0.0342 events per patient after the lockdown. The number of non-compliance events increased significantly from 79 events to 293 events for onsite protocols. Seventy-six non-compliance events occurred before the lockdown for small-sized protocols, while 152 occurred after. For events caused by COVID-19, 99% were minor deviations, 99% were related to procedural compliance, 65% involved the patient's study visit not being completed, and 28% involved the patient's study visit being completed out of timeframe. Conclusions: It is important to understand this pandemic's implications for the conduct of clinical research. Protocols should be developed with, and actively amended to include, maximum flexibility to capture all safety data, such as enabling broad study visit windows and blood draws in the community, without compromising scientific quality. This recommendation should be considered when changes occur to existing protocols that are outside of the principal investigator's control.

16.
BJPsych Open ; 7(5), 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1883558

RESUMO

Background Cognitive-behavioural therapy (CBT) is recommended for all patients with psychosis, but is offered to only a minority. This is attributable, in part, to the resource-intensive nature of CBT for psychosis. Responses have included the development of CBT for psychosis in brief and targeted formats, and its delivery by briefly trained therapists. This study explored a combination of these responses by investigating a brief, CBT-informed intervention targeted at distressing voices (the GiVE intervention) administered by a briefly trained workforce of assistant psychologists. Aims To explore the feasibility of conducting a randomised controlled trial to evaluate the clinical and cost-effectiveness of the GiVE intervention when delivered by assistant psychologists to patients with psychosis. Method This was a three-arm, feasibility, randomised controlled trial comparing the GiVE intervention, a supportive counselling intervention and treatment as usual, recruiting across two sites, with 1:1:1 allocation and blind post-treatment and follow-up assessments. Results Feasibility outcomes were favourable with regard to the recruitment and retention of participants and the adherence of assistant psychologists to therapy and supervision protocols. For the candidate primary outcomes, estimated effects were in favour of GiVE compared with supportive counselling and treatment as usual at post-treatment. At follow-up, estimated effects were in favour of supportive counselling compared with GiVE and treatment as usual, and GiVE compared with treatment as usual. Conclusions A definitive trial of the GiVE intervention, delivered by assistant psychologists, is feasible. Adaptations to the GiVE intervention and the design of any future trials may be necessary.

17.
Epidemiology ; 70(SUPPL 1):S298, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1854010

RESUMO

Background: The Government of Pakistan implemented an age-specific policy to protect the aging adults from COVID-19, in addition to lockdown in the year 2020. This policy disallowed people above 50 years of age from going to mosques to offer prayer during the holy Islamic month of Ramadan. In this paper, we study policy compliance among aging adults. Methods: We conducted a telephonic, population-based repeated crosssectional study with a panel component in 24 districts of Pakistan via a preformed questionnaire between April and July 2020. The primary objective was to assess compliance with the age-specific COVID-19 policy among people above 60 years of age, using difference-indifferences design (comparison group: 50 years or below). We further conducted a descriptive analysis to estimate the proportion of our study population who regularly followed the three main coronavirus preventive measures, i.e. regular hand washing, wearing masks and physical distancing. Results: In about 62.1% of our observations, people above 60 years of age went out daily during the lockdown as opposed to the spirit of lockdown. The difference-in-differences regression analysis revealed that individuals above the age of 60 years did not significantly reduce going to the mosque for prayer after the onset of Ramadan as compared to those aged 50 years or younger (p>0.05). Apart from that, our analysis also showed no significant difference between people above 60 years and younger study participants (aged 60 years or less) in terms of going out daily during the lockdown (p>0.05). Furthermore, about 54% of people above 60 years of age washed hands regularly, while about 66.4% of the aging adults practiced physical distancing and 55.9% reported that they wore a mask while going out. The regression analysis revealed no significant difference among the three age groups in terms of regularly following the three main COVID-19 preventive measures (p>0.05). Conclusion: These findings indicate that policy compliance among aging adults remained limited in our setting. Moreover, aging adults in our study population did not behave more cautiously during the pandemic, despite being at a higher risk of developing a severe COVID-19 illness.

18.
Journal of Contemporary Clinical Practice ; 7(2):65-76, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1818892

RESUMO

Introduction This study aimed to explore the factors contributing to COVID-19 vaccine hesitancy (VH) among healthcare workers (HCWs) who missed the first dose of the COVID-19 vaccine in Nigeria. Methods We conducted a qualitative study of the factors contributing to COVID-19 VH among HCWs at the University College Hospital, Ibadan using purposive sampling technique. Each interview session was held through telephone conversation. Qualitative data were analyzed using Colaizzi's phenomenological method. Results The mean age of the 15 HCWs was 34.33±3.77 years;10 (66.7%) were females;6 (40.0%) were physiotherapists. Three themes were identified. The first theme, “Factors contributing to COVID-19 VH among healthcare workers” had five clusters: i) Lack of adequate information regarding the COVID-19 vaccine;ii) Challenges with immunization schedule;iii) Fear of side effects of the COVID-19 vaccine;iv) Lack of trust in the government;and v) Concerns about the safety of the COVID-19 vaccine. The second theme, “Healthcare workers' perception on the solution to COVID-19” had three clusters: i) Adherence to non-pharmaceutical measures;ii) Vaccine production: key to submerging the COVID-19 pandemic;and iii) Healthcare workers' perception of their roles in patient education on the COVID-19 vaccine. The third theme;“Recommendations to encourage COVID-19 vaccine acceptance among healthcare workers” had three clusters: i) Disclosure of extensive information on COVID-19 vaccine components;ii) Decentralization of COVID-19 vaccine collection points;and iii) Procurement of other brands of the COVID-19 vaccine. Conclusions Public health authorities should promote information on the safety and efficacy of the COVID-19 vaccine.

19.
International Journal of Public Health Science ; 11(2):713-723, 2022.
Artigo em Inglês | Scopus | ID: covidwho-1776662

RESUMO

The elderly is the most vulnerable population group during coronavirus disease 2019 (COVID-19) pandemic. Unfortunately, the vaccination uptake against COVID-19 among the seniors was considered low. This research aimed to point out the most significant factor as the recommendation for government to develop strategy in increasing COVID-19 participation among elderly. The variables are the health belief model, trust in health authorities and media, the experience regarding COVID-19, the general vaccination behaviour, and the novel contribution is the addition of the health protocol compliance as the determining factors of COVID-19 vaccination uptake action among the elderly in Indonesia. The online survey using a structured questionnaire obtained 213 respondents aged ≥55 years old. Structured equation modelling was employed to test the model. The result showed that the health belief model (β=0.296), trust in media and authorities (β=0.524), and general vaccination behaviour (β=0.319) significantly affect health protocol compliance. The health belief model (β=0.699), trust in media authorities (β=0.933), and health protocol compliance (β=0.406) significantly affected the COVID-19 vaccination uptake behaviour. This result gives the implication that the government should focus on improving the trust in media and authorities among the elderly. This action would improve the knowledge of COVID-19 and increase the vaccination coverage among the elderly. © 2022, Intelektual Pustaka Media Utama. All rights reserved.

20.
Journal of the American College of Cardiology ; 79(9):624, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1768623

RESUMO

Background: Measurement of our performance with National Cardiovascular Data Registry (NCDR®) Percutaneous Coronary Intervention (PCI) Registry® reflected below national average in STEMI mortality. Targeting cardiogenic shock (CS) was key to improved care. AIM was to improve CS processes of care and STEMI mortality. Methods: Novant Health (NH) utilized a system thinking multidisciplinary approach driven by an evolving Plan-Do-Study-Act Cycle (PDSA) Model for Improvement* in combination with the Cath PCI Registry® dashboard performance measures, process and outcome metrics. Data analysis supported change recommendations to advocate for an advanced care program and future CS team. Initial review included a 9-month baseline group from Oct 01,2017 - June 30,2018 versus 7-month comparison from July 01,2018 - Jan 31,2019. Implementation of recommendations from GAP analysis Q1 2019 tracking of specific projects and initiatives Q2-Q3 2019. Outcome utilized for measuring success was Cath PCI Registry ACS STEMI mortality Metric #18 from Q3 2019 - Q1 2021. Results: NHPMC data results rolling four quarter STEMI risk adjusted mortality Metric #18 baseline percentage rate 8.28 Q3 2019 - Q1 2021 decreased to 6.34. This represented a positive Impact of our initiatives. The US Registry benchmark 50th - 75th percentile for this metric trended upward during this timeframe possibly due to the high acuity of patients impacted by the COVID pandemic. Conclusion: NH emphasis on protocol adherence, team engagement, consistency in care processes resulted in organizational learning and continued aspiration towards excellence. In review of our single-center project we improved care to our CS population and decreased STEMI ACS risk adjusted mortality. Teams continue to be engaged in strategies for effective, efficient and equitable patient centered care. Integration of CS best practices in annual nursing education with sharing of knowledge across NH footprint. In process of developing synergistic care of high-risk transferred ACS patients with CS and developing care pathways. Initiation of ECMO program in June 2021 with continued efforts to establish a structured shock team.

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