Integrating healthcare for follow-up of adult COVID-19 patients in an outpatient clinic: A matter of cooperation.

RATIONALE AIMS AND OBJECTIVES: A large number of patients infected with SARS-CoV-2 (COVID-19) need outpatient follow-up after hospitalization. As these patients may experience a broad range of symptoms, as do patients infected with the related SARS-CoV-1 virus, we set up a multidisciplinary outpatient clinic involving pulmonologists, internists, and geriatricians. Patients were allocated to a specialist based on symptoms reported on a self-developed questionnaire of expected symptoms of COVID-19. This study aimed to evaluate the effectiveness of this outpatient clinic. METHODS: In this retrospective study, the medical records of patients who presented to the outpatient clinic for follow-up after hospitalization for COVID-19 up to 31 August 2020, were reviewed. RESULTS: In total, 266 patients were seen at the outpatient clinic at least once. Overall, 100 patients were seen by a pulmonologist, 97 by an internist, and 65 by a geriatrician. A referral between these 3 medical specialists was needed for only 14 patients (5.3%). Fifty patients were seen by a psychologist, mostly those with a HADS score >10. Only 5 (2.2%) of the 221 patients who were not directly referred to a psychologist based on triage needed psychological support. Forty-eight patients (18%) were also seen by a physiatrist. CONCLUSION: Identifying which medical specialist (pulmonologist, internist, and/or geriatrician) should see patients attending a post-COVID outpatient clinic based on patient-reported symptoms proved an effective approach to managing the flow of post-COVID patients.

Reasons to prescribe antipsychotics for the behavioral symptoms of dementia: a survey in Dutch nursing homes among physicians, nurses, and family caregivers.

OBJECTIVES: Despite serious safety concerns, prescription rates of antipsychotics for the treatment of the behavioral and psychological symptoms of dementia remain high, especially in nursing homes. This high prevalence of antipsychotic use cannot be explained by the modest success rate reported in the literature. In this study, we aim at clarifying the reasons for prescribing an antipsychotic drug in behavioral and psychological symptoms of dementia and look at the role of nurses and family caregivers in the decision-making process that precedes the prescription of an antipsychotic drug. DESIGN: Questionnaire used in a one-on-one interview with elderly care physicians, nurses, and family caregivers. SETTING: We conducted a survey in 23 nursing homes in the Netherlands. METHOD: On each dementia ward, the physician selected 1 or 2 patients who started antipsychotics most recently. An interviewer then held a structured questionnaire with the physician, the nurse, and the first relative of the patient. The first part of the interview consisted of questions about the general ideas of the physicians and the second part consisted of case-related questions to physicians, nurses, and family caregivers. RESULTS: Physicians, nurses, and family caregivers generally consider the possible benefits of antipsychotics to outweigh the risk of side effects. The main reasons to start therapy are agitation and aggression. Physicians felt pressured by nurses to prescribe in 17% of cases. Physicians felt supported by the guideline of the Dutch Association of Elderly Care Physicians. The estimated average success rate in the discussed cases (the patient is expected to improve on the target behavior) among physicians was 50%, nurses reported 53%, and relatives 55%. The most frequently expected adverse reactions were increased fall risk, sedation, and parkinsonism. Nurses expected cognitive decline. The family felt insufficiently informed about the side effects in 44% of the cases. CONCLUSION: The interviewed nursing home physicians and nurses expect almost half of their patients with dementia and behavioral disturbances to benefit from antipsychotic therapy. Serious side effects were expected to occur only sporadically. These expectations may contribute to the high rate of antipsychotic use among these patients.

Quality of life of children with spina bifida in Kenya is not related to the degree of the spinal defects.

OBJECTIVES: To assess the relationship between the degree of symptoms and defects caused by spina bifida and the quality of life (QoL) of children with spina bifida in Kenya. METHODS: Children with spina bifida at BethanyKids at Kijabe Hospital, at mobile clinics throughout Kenya and a control group of healthy children were interviewed regarding their QoL. The SEIQoL-DW was used as an instrument to measure the QoL. This instrument can transfer well across cultures by using open questions clustered in six domains chosen based on the study group responses. Symptoms and impairment caused by spina bifida were obtained from the medical files. RESULTS: Sixty-nine per cent of 102 patients with spina bifida had a myelomeningocele, 59% had hydrocephalus, and of 49 incontinent children older than 2.5 years, 67% used clean intermittent catheterization. Quality of life of children was 65.1 on a scale from 0 to 100, compared to 78.0 in the healthy control group. Not one single determinant made a significant difference in the overall QoL. The most important domains were 'development' and 'self-actualization'. The lowest scores were found in the domain 'health and disease'. CONCLUSION: This study showed no significant influence of the degree of defects of spina bifida on the QoL, but identified domains that can be targeted for improvement in children with spina bifida.