'I'm still here, I'm alive and breathing': The experience of Black Americans with long COVID.

AIMS AND OBJECTIVES: In this study, we aimed to characterize the impact of long COVID on quality of life and approaches to symptom management among Black American adults. BACKGROUND: As a novel condition, qualitative evidence concerning long COVID symptoms and their impact on quality of life can inform the refinement of diagnostic criteria and care plans. However, the underrepresentation of Black Americans in long COVID research is a barrier to achieving equitable care for all long COVID patients. DESIGN: We employed an interpretive description study design. METHODS: We recruited a convenience sample of 15 Black American adults with long COVID. We analysed the anonymized transcripts from race-concordant, semi-structured interviews using an inductive, thematic analysis approach. We followed the SRQR reporting guidelines. RESULTS: We identified four themes: (1) The impact of long COVID symptoms on personal identity and pre-existing conditions; (2) Self-management strategies for long COVID symptoms; (3) Social determinants of health and symptom management; and (4) Effects on interpersonal relationships. CONCLUSION: Findings demonstrate the comprehensive ramifications of long COVID on the lives of Black American adults. Results also articulate how pre-existing conditions, social risk factors, distrust due to systemic racism, and the nature of interpersonal relationships can complicate symptom management. RELEVANCE TO CLINICAL PRACTICE: Care approaches that support access to and implementation of integrative therapies may be best suited to meet the needs of long COVID patients. Clinicians should also prioritize eliminating patient exposure to discrimination, implicit bias, and microaggressions. This is of particular concern for long COVID patients who have symptoms that are difficult to objectively quantify, such as pain and fatigue. NO PATIENT OR PUBLIC CONTRIBUTION: While patient perspectives and experiences were the focus of this study, patients were not involved with the design or conduct of the study, data analysis or interpretation, or writing the manuscript.

'H-type' duplex gallbladder resected laparoscopically with transcystic choledochoscopy and stone retrieval.

A duplex gallbladder is an extremely rare congenital anomaly that while may remain asymptomatic, may also develop into biliary colic, cholecystitis, cholangitis or pancreatitis. In these circumstances, it is advisable to surgically remove both gallbladders. Typically, a cholecystectomy is performed laparoscopically as this aids patient recovery and complication risk; however, when congenital abnormalities are present, some may choose to revert to an open operation. Through this case, we demonstrate that even when presented with a duplex gallbladder during surgery, it is safe to remove it laparoscopically as well as performing transcystic choledochoscopy and basket retrieval without complications.

Effect of exogenous melatonin on the cellular response of Holstein heifer calves during vaccination.

Despite rigorous vaccination protocols, calf morbidity is the primary contributor to economic loss in the calf sector of the dairy industry. Melatonin has modulated immune response in other mature animal species. We hypothesized that exogenous melatonin may improve the cellular response to vaccination in dairy calves. Our objective was to evaluate the effect of exogenous melatonin on polymorphonuclear leukocyte (PMN) function in Holstein heifer calves during immunization. Sixty neonatal Holstein heifers were enrolled by birth cohort (block) and randomized to one of four treatments: control (CON), vaccination of 0.5 mg ovalbumin on days 0 and 21 (VAC), implantation of 24 mg melatonin on day 0 (MEL), or both melatonin and vaccine treatments (MVAC). Jugular blood was collected on days 0, 21, 42, and 63 to measure circulating melatonin, anti-ovalbumin immunoglobulin-G, and PMN function. Calves implanted with melatonin had greater circulating melatonin than non-implanted on day 21 (P < 0.01). Anti-ovalbumin IgG was greater for vaccinated than non-vaccinated calves (P < 0.01). Anti-ovalbumin IgG was greater for MVAC than VAC calves on day 63. Percent of cells and mean florescence intensity of cells performing oxidative burst decreased from day 0 to day 63 (P < 0.01) but were not affected by treatment (P ≥ 0.26). There was a tendency (P = 0.10) for an interaction of melatonin, vaccination, and day for the mean florescence intensity of cells performing phagocytosis where MVAC was greater than all other treatments on d 42. Exogenous melatonin may alter PMN function of calves during vaccination. Further research is needed to define the effect of melatonin on development of antigen-specific IgG during programmed vaccination protocols.

Opportunities to Improve Long COVID Care: Implications from Semi-structured Interviews with Black Patients.

BACKGROUND: Long coronavirus disease (COVID) is an emerging condition that could considerably burden healthcare systems. Prior qualitative studies characterize the experience of having long COVID, which is valuable for informing care strategies. However, evidence comes from predominantly White samples. This is a concern because underrepresentation of Black patients in research and intervention development contribute to racial inequities. OBJECTIVE: To facilitate racial equity in long COVID care, the purpose of this qualitative study was to inform the development of care strategies that are responsive to the experiences and perspectives of Black patients with long COVID in the United States of America. METHODS: Using convenience sampling, we conducted race-concordant, semi-structured, and open-ended interviews with Black adults (80% female, mean age = 39) who had long COVID. We transcribed and anonymized the recorded interviews. We analyzed the transcripts using inductive, thematic analysis. Theme development focused on who can help or hinder strategies for reducing health inequities, what should be done to change care policies or treatment strategies, and when are the critical timepoints for intervention. RESULTS: We developed four main themes. Participants reported challenges before and after COVID testing. Many participants contacted primary care physicians as a first step for long COVID treatment. However, not all respondents had positive experiences and at times felt dismissed. Without a qualifying diagnosis, participants could not obtain disability benefits, which negatively influenced their employment and increased financial hardship. CONCLUSIONS: There are possible targets for improving long COVID care, from COVID testing through to long-term treatment plans. There is a need to increase long COVID awareness among physicians. Diagnosis and a standardized treatment plan could help patients avoid unnecessary healthcare utilization and obtain comprehensive support.

Hand hygiene compliance by health care workers at a teaching hospital, Kingston, Jamaica.

INTRODUCTION: Consistent practice of hand hygiene (HH) has been shown to reduce the incidence and spread of hospital acquired infections. The objectives of this study were to determine the level of compliance and possible factors affecting compliance with HH practices among HCWs at a teaching hospital in Kingston, Jamaica. METHODOLOGY: A prospective observational study was undertaken at the University Hospital of the West Indies (UHWI) over a two weeks period. Trained, validated observers identified opportunities for hand hygiene as defined by the WHO "Five Hand Hygiene Moments" and recorded whether appropriate hand hygiene actions were taken or missed. Observations were covert to prevent the observer's presence influencing the behaviour of the healthcare workers (HCWs) and targeted areas included the intensive care units (ICUs), surgical wards and surgical outpatient departments. A ward infrastructure survey was also done. Data were entered and analysed using SPSS version 16 for Windows. Chi-square analysis using Pearson's formula was used to test associations between 'exposure' factors and the outcome 'compliance'. RESULTS: A total of 270 hand hygiene opportunities were observed and the overall compliance rate was 38.9%. No differences were observed between the various types of HCWs or seniority. HCWs were more likely to perform hand hygiene if the indication was 'after' rather than 'before' patient contact (p = 0.001). CONCLUSION: This study underscores the need for improvement in HH practices among HCWs in a teaching hospital. Health education with particular attention to the need for HH prior to physical contact with patients is indicated.

Leadership in surgery for public sector hospitals in Jamaica: strategies for the operating room.

The barriers to health care delivery in developing nations are many: underfunding, limited support services, scarce resources, suboptimal health care worker attitudes, and deficient health care policies are some of the challenges. The literature contains little information about health care leadership in developing nations. This discursive paper examines the impact of leadership on the delivery of operating room (OR) services in public sector hospitals in Jamaica.Delivery of OR services in Jamaica is hindered by many unique cultural, financial, political, and environmental barriers. We identify six leadership goals adapted to this environment to achieve change. Effective leadership must adapt to the environment. Delivery of OR services in Jamaica may be improved by addressing leadership training, workplace safety, interpersonal communication, and work environment and by revising existing policies. Additionally, there should be regular practice audits and quality control surveys.

Revisiting current strategies for primary prevention of motorcycle collisions in Jamaica.

Motorcycle Road Traffic Collisions place a heavy burden on emergency medical services in Jamaica. We explore the existing strategies and legislative policies that may prevent or reduce the severity of these injuries in Jamaica. This is an important aspect of health care as it may minimize the impact of these preventable injuries on the limited resources of the health services.

Colonic perforation: a lethal consequence of cannabis body packing.

Body packing is one method of smuggling cannabis across international borders. The practice is prevalent in Jamaica. There has been one reported death from this practice in medical literature. We report a second fatal case of cannabis body packing, reinforcing the dangerous nature of this practice.

Arteriovenous fistulas as vascular access for hemodialysis: The preliminary experience at the University Hospital of the West Indies, Jamaica.

BACKGROUND: The demand for vascular hemodialysis access creation is steadily increasing. To satisfy the demand, a vascular access team was established at the University Hospital of the West Indies, Jamaica. The outcomes of this practice are reported. METHODS: A retrospective study of all patients who had permanent vascular dialysis access established at the University Hospital of the West Indies between January 1, 2002, and December 31, 2006, was performed. Data were analyzed using SPSS version 12.0 (SPSS Inc, USA). A direct anastomosis between an autogenous artery and vein was considered an arteriovenous fistula (AVF). When prosthetic material was used, the access was considered to be an arteriovenous graft. Accesses that were nonfunctional after six weeks of maturation were considered to be primary failures, while those that failed after previous successful dialysis were considered to be secondary failures. Primary patency was defined as the interval between access placement and the first intervention for failure. Secondary patency was the interval between access placement and abandonment. Cumulative patency was defined as the number of accesses that remained patent over a given time period, regardless of the number of interventions performed. RESULTS: Of 41 patients, nine were excluded due to incomplete data. Final analyses were performed on 32 patients with a mean (± SD) age of 42.3±15.3 years (range 18 to 66 years, median 43 years). The access type was an AVF in 100% of cases, which included distal radiocephalic fistulas in 27 patients, brachial-cephalic fistulas in three patients and proximal radiocephalic fistulas in two patients. Operations were performed in four (12.5%) incident and 28 (87.5%) prevalent dialysis patients. The mean delay between initiation of dialysis and AVF creation was 21.2±26.1 months (range one to 94 months, median 10 months). There were eight (25%) primary failures. Of the remaining 24 patients, there were seven (29.2%) secondary failures from thrombosis. There was primary patency for a mean of 723.9±422.1 days (range 199 to 1314 days, median 678 days). Only one (4.2%) patient had thrombectomy to prolong AVF function, resulting in secondary patency for 439 days. Cumulative patency was 62.5%, 33.3%, 25% and 4.2% for one, two, three and four years, respectively. CONCLUSIONS: The rate of AVF creation for end-stage renal disease patients in this setting far exceeds the target goals set forward by the National Kidney Foundation published updated Dialysis Outcomes Quality Initiative (NKF/DOQI) Guidelines and the Centers for Medicaid & Medicare Services Fistula First initiative. This is being achieved with acceptable rates of morbidity and patency. There is room for improvement in postoperative surveillance to increase early detection of failing accesses and allow for increased utility of interventions for assisted patency.