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Documents  COVID-19 | enregistrements trouvés : 106

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The anti-inflammatory effects of a Mediterranean diet: a review | Novembre 2022 H

Article (Nutrition clinique)

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Purpose of review: Chronic noncommunicable diseases remain the leading cause of morbidity and mortality worldwide and the majority are preventable with a healthy diet and lifestyle, but controversy remains as to the best approach. Greater adherence to a traditional Mediterranean diet has consistently been associated with lower morbidity and mortality from cardiovascular disease, diabetes and many cancers, and lower all-cause mortality. Despite the well known benefits on chronic disease risk there remains some scepticism as to the effects of this dietary pattern across populations outside the Mediterranean and the mechanisms of action of this traditional plant-based dietary pattern.

This narrative review aims to summarize the latest evidence on the health protective effects of a traditional Mediterranean diet on chronic noncommunicable diseases, specifically focussing on the anti-inflammatory effects of this highly published dietary pattern.

Recent findings: Recent high-quality evidence now supports a Mediterranean diet in secondary prevention of cardiovascular disease with impacts on atherosclerosis progression, likely through reduction of systemic inflammation and irrespective of changes in cholesterol or weight. The Mediterranean diet has a low Dietary Inflammatory Index illustrating its anti-inflammatory potential. This dietary pattern beneficially modulates the gut microbiota and immune system, including emerging evidence for efficacy against severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019). Emerging evidence shows clinicians are not routinely recommending a Mediterranean diet despite well known evidence due to barriers such as lack of training, patient materials and concerns about potential patient adherence.

Summary: The physiological mechanisms of action of this healthy diet pattern are becoming better understood to be multisystem and involving the gut. Larger controlled trials investigating mechanistic effects in broader non-Mediterranean populations are warranted. Although reflected in therapeutic guidelines for chronic disease management worldwide there are individual, clinical practice and health system barriers to its implementation that need a multisectoral approach to address.
Purpose of review: Chronic noncommunicable diseases remain the leading cause of morbidity and mortality worldwide and the majority are preventable with a healthy diet and lifestyle, but controversy remains as to the best approach. Greater adherence to a traditional Mediterranean diet has consistently been associated with lower morbidity and mortality from cardiovascular disease, diabetes and many cancers, and lower all-cause mortality. Despite ...

COVID-19 ; Coronavirus ; Inflammation (Pathologie) - Diétothérapie ; Alimentation - Méditerranée, Région de la

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Background
Gastrointestinal and sensory manifestations (GSMs) of coronavirus disease 2019 (COVID-19) may affect food intake, resulting in malnutrition and poor outcomes. We characterized the impact of GSMs and oral nutrition supplementation on energy-protein intake (EPI) and hospital discharge in adult patients with COVID-19.

Methods
Patients from two hospitals were enrolled (n = 357). We recorded the presence and type of GSM at admission, estimated energy requirements (EER) and the EPI based on regular food intake (plate diagram sheets) during hospital stays. Patients not achieving 60% of their EER from food over 2 consecutive days received oral nutrition supplementation (ONS) with a high-energy-protein oral drink.

Results
Most patients (63.6%) presented with GSMs at admission. Anorexia was the most common manifestation (44%). Patients with anorexia or more than one GSMs were more likely to not achieve 60% EER on the first day of follow-up and to require the ONS intervention (P ≤ 0.050). Prevalence of at least one GSM was higher in patients who did not achieve hospital discharge than in patients who achieved it (74.2% vs 54.6%, P = 0.038). The patients requiring ONS (26.9%) demonstrated good adherence to the intervention (79.3%), achieved their EER during 95.7% of the supplementation time, and presented with hospital discharge rates similar to patients not requiring ONS (92.2% vs 91.9%, respectively; P = 1.000).

Conclusions
GSM were prevalent in COVID-19 and it impaired EER attendance and patient recovery. ONS was well-tolerated, aided EER attendance, and potentially facilitated hospital discharge.
Background
Gastrointestinal and sensory manifestations (GSMs) of coronavirus disease 2019 (COVID-19) may affect food intake, resulting in malnutrition and poor outcomes. We characterized the impact of GSMs and oral nutrition supplementation on energy-protein intake (EPI) and hospital discharge in adult patients with COVID-19.

Methods
Patients from two hospitals were enrolled (n = 357). We recorded the presence and type of GSM at admission, ...

Hospitalisation ; COVID-19 ; Nutrition

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Phase angle, obtained by bioelectrical impedance, is an indicator of cellular integrity and has been proposed as a prognostic parameter in patients who are critically ill. This systematic review aimed to evaluate the association between phase angle and adverse clinical outcomes in hospitalized patients with coronavirus disease–2019 (COVID-19). An extensive literature search was performed in the MEDLINE/PubMed, Embase, and Web of Science databases, with interest in observational studies evaluating the association between phase angle and adverse clinical outcomes in individuals aged ≥18 years hospitalized with COVID-19. Studies were independently selected by two reviewers, according to eligibility criteria. Subsequently, data were extracted and presented in a qualitative synthesis. The evaluation of the quality of the studies was performed according to the Newcastle-Ottawa scale. The full methodology was published in PROSPERO (ID CRD42022306177). A total of 392 articles were identified, resulting in seven selected studies, of which six were prospective cohorts and one was retrospective. In the quality assessment, six studies obtained scores equal to or greater than seven, indicating a low risk of bias. A total of 750 participants composed the samples of the selected studies. Five studies reported an independent association between phase angle and adverse clinical outcomes during hospitalization for COVID-19, with emphasis on prolonged hospitalization and mechanical ventilation and higher mortality in patients with a lower phase angle. Thus, phase angle measurement can be useful in the early identification of risks in patients hospitalized with COVID-19, for the purpose of adequacy of clinical management.
Phase angle, obtained by bioelectrical impedance, is an indicator of cellular integrity and has been proposed as a prognostic parameter in patients who are critically ill. This systematic review aimed to evaluate the association between phase angle and adverse clinical outcomes in hospitalized patients with coronavirus disease–2019 (COVID-19). An extensive literature search was performed in the MEDLINE/PubMed, Embase, and Web of Science ...

Hospitalisation ; COVID-19 ; Coronavirus

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Objectives: The incidence of feeding and eating problems and disorders (FEPD) in children increased during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to assess the impact of the COVID-19 pandemic on young children with FEPD and their parents.

Methods: Cross-sectional survey: parents of children with FEPD (0-11 years) in the Netherlands completed an online questionnaire (January-April 2021). This questionnaire included 4 demographic questions (including criteria of pediatric feeding disorder [PFD] and/or avoidant/restrictive food intake disorder [ARFID]) and 11 questions related to experienced impact of the COVID-19 pandemic. Parental responses regarding children with FEPD (including PFD and ARFID) were compared with those of healthy controls (HCs).

Results: In total, 240 children (median age, 5.5 years; interquartile range [IQR], 3.5-7.9 years; 53.3% female) were included; 129 children with FEPD and 111 HC. Most children with FEPD fulfilled criteria for PFD (n = 119; 92.2%) and/or ARFID (n = 117; 90.7%). Parents of children with FEPD reported more stress (of their child [P = 0.014] and parental stress [P = 0.014]), worse eating by the child (P < 0.001), more negative relations within the family (P = 0.006), and less support from the environment (P = 0.001) compared with parents of HC during the COVID-19 pandemic than before.

Conclusions: It seems that the COVID-19 pandemic had great impact on young children with FEPD and their parents because parents of children with FEPD reported significantly more perceived stress within both the child and parents, more difficult eating behavior of the child, more negative behavior between family members, and less support from the environment as compared with HC.
Objectives: The incidence of feeding and eating problems and disorders (FEPD) in children increased during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to assess the impact of the COVID-19 pandemic on young children with FEPD and their parents.

Methods: Cross-sectional survey: parents of children with FEPD (0-11 years) in the Netherlands completed an online questionnaire (January-April 2021). This questionnaire ...

COVID-19 ; Alimentation ; Enfants - Alimentation ; Troubles du comportement alimentaire

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Abstract: Data are equivocal on the consequences of COVID-19 pandemic on pain and well-being for individuals with chronic pain. Furthermore, little is known regarding its impact on the health of young adults with chronic pain. We conducted a longitudinal study to compare pain, psychological functioning, and substance use before and during the pandemic of 196 young adults with chronic pain. Participants aged 18 to 24 years (M = 21.1 years; 79.6% females) reported on pain, anxiety, depression, and substance use before (October 2018-August 2019) and during the pandemic (October 2020-November 2020), in addition to the assessment of COVID-19 exposure and its impact. Before the pandemic, young adults experienced mild-to-moderate pain intensity (M = 3.75, SD = 2.33) and pain interference (M = 3.44, SD = 2.69). Findings were that pain intensity, pain interference, and depression symptoms remained stable during the pandemic. In contrast, anxiety symptoms increased significantly (M = 8.21, SD = 5.84 vs M = 8.89, SD = 5.95, P = 0.04). Tobacco, alcohol, and cannabis use were unchanged. Mixed linear models revealed that COVID-19 exposure and impact were not associated with changes in pain intensity or interference, with female sex associated with increased pain intensity ([beta] = 0.86, P = 0.02) and pain interference ([beta] = 0.87, P = 0.02). Our findings indicated relative stability of pain symptoms experienced by young adults with chronic pain. However, the increases in anxiety highlight the need to facilitate treatment access for mental health services to mitigate downstream impact.
Abstract: Data are equivocal on the consequences of COVID-19 pandemic on pain and well-being for individuals with chronic pain. Furthermore, little is known regarding its impact on the health of young adults with chronic pain. We conducted a longitudinal study to compare pain, psychological functioning, and substance use before and during the pandemic of 196 young adults with chronic pain. Participants aged 18 to 24 years (M = 21.1 years; 79.6% ...

Douleur chronique ; Jeunes adultes ; COVID-19 ; Anxiété ; Dépression

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Objectives: During the coronavirus-19 pandemic, experts recommended delaying routine cancer screening and modifying treatment strategies. We sought to understand the sequalae of these recommendations.

Materials and Methods: We performed a retrospective single-center analysis of screening, diagnosis, and treatment of lung, colorectal, and breast cancer. Data was collected from our institutional cancer registry. Prepandemic (2016-2019) was compared with pandemic (2020) data.

Results: Three thousand three sixty one screening chest computed tomography scans (CTs), 35,917 colonoscopies, and 48,093 screening mammograms were performed. There was no difference in CTs [81.0 (SEM10.0) vs. 65.6 (SEM3.29), P=0.067] or mammograms [1017.0 (SEM171.8) vs. 809.4 (SEM56.41), P=0.177] in 2020 versus prepandemic. There were fewer colonoscopies in 2020 [651.4 (SEM103.5) vs. 758.91 (SEM11.79), P=0.043]. There was a decrease in cancer diagnoses per month in 2020 of lung [22.70 (SEM1.469) vs. 28.75 (SEM0.8216), P=0.003] and breast [38.56 (SEM6.133) vs. 51.82 (SEM1.257), P=0.001], but not colorectal [13.11 (SEM1.467) vs. 15.88 (SEM0.585), P=0.074] cancer. There was no change in stage at presentation for lung (P=0.717), breast (P=0.115), or colorectal cancer (P=0.180). Lung had a shorter time-to-treatment in 2020 [38.92 days (SEM 2.48) vs. 66 (SEM1.46), P=0.002].

Conclusions: In 2020, there was no difference in screening studies for lung and breast cancer but there was a decrease in new diagnoses. Although there were fewer colonoscopies performed in 2020, there was no change in new colorectal cancer diagnoses. Despite changes in guidelines during the pandemic, the time-to-treatment for lung cancer was shorter and was unchanged for colorectal and breast cancer. These findings highlight the importance of continuing care for a vulnerable patient population despite a pandemic.
Objectives: During the coronavirus-19 pandemic, experts recommended delaying routine cancer screening and modifying treatment strategies. We sought to understand the sequalae of these recommendations.

Materials and Methods: We performed a retrospective single-center analysis of screening, diagnosis, and treatment of lung, colorectal, and breast cancer. Data was collected from our institutional cancer registry. Prepandemic (2016-2019) was ...

COVID-19 ; Pandémies ; Poumons - Cancer ; Côlon - Cancer ; Cancer colorectal ; Sein - Cancer ; Cancer - Traitement

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Purpose of review: To summarize the current literature on the psychological impact of COVID-19 on patients with cancer, both in terms of the impact of the virus itself and of changes in the healthcare system; and to describe current recommendations for supporting patients with cancer during the pandemic.

Recent findings: Multiple studies have shown that patients with cancer experience high levels of psychological distress during COVID-19. Factors of greater vulnerability have been described as: being young, being female, low socioeconomic status, lower educational level, having low levels of hope or optimism, lower social support, and having cancer with curative intent. The severe acute respiratory syndrome-coronavirus-2pandemic has accelerated the healthcare digitization process. All departments involved in the diagnosis and treatment of cancer have made contingency plans to minimize the impact on patients.

Summary: Psychological distress is one of the most frequently occurring symptoms in patients with cancer during the pandemic. The COVID-19 pandemic has led to a restructuring of the healthcare system. The paradigm shift may pose a challenge for both healthcare professionals and patients.
Purpose of review: To summarize the current literature on the psychological impact of COVID-19 on patients with cancer, both in terms of the impact of the virus itself and of changes in the healthcare system; and to describe current recommendations for supporting patients with cancer during the pandemic.

Recent findings: Multiple studies have shown that patients with cancer experience high levels of psychological distress during COVID-19. ...

Cancer ; COVID-19 ; PSYCHOLOGIE ; Détresse ; Télémédecine

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Purpose of review: Supportive and palliative care services have been an important component of the overall COVID-19 pandemic response. However, significant changes in the provision and models of care were needed in order to optimize the care delivered to vulnerable cancer patients. This review discusses the evolution of palliative and supportive care service in response to the pandemic, and highlights remaining challenges.

Recent findings: Direct competition for resources, as well as widespread implementation of safety measures resulted in major shifts in the mode of assessment and communication with cancer patients by supportive care teams. Telemedicine/virtual consultation and follow-up visits became an integral strategy, with high uptake and satisfaction amongst patients, families and providers. However, inequities in access to the required technologies were sometimes exposed. Hospice/palliative care unit (PCU) bed occupancy declined markedly because of restrictive visitation policies. Collection of patient-reported outcome (PRO) data was suspended in many cancer centers, with resulting under-recognition of anxiety and depression in ambulatory patients. As in many other areas, disparities in delivery of supportive and palliative care were magnified by the pandemic.

Summary: Virtual care platforms have been widely adopted and will continue to be used to include a wider circle of family/friends and care providers in the provision of palliative and supportive care. To facilitate equitable delivery of supportive care within a pandemic, further research and resources are needed to train and support generalists and palliative care providers. Strategies to successfully collect PROs from all patients in a virtual manner must be developed and implemented.
Purpose of review: Supportive and palliative care services have been an important component of the overall COVID-19 pandemic response. However, significant changes in the provision and models of care were needed in order to optimize the care delivered to vulnerable cancer patients. This review discusses the evolution of palliative and supportive care service in response to the pandemic, and highlights remaining challenges.

Recent findings: ...

COVID-19 ; Coronavirus ; Soins palliatifs ; Oncologie

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Impact of COVID-19 on cancer screening: a global perspective | Septembre 2022 H

Article (Oncologie)

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Purpose of review: Cancer screening disruption due to COVID-19 may have a significant impact on patients, healthcare practitioners, and healthcare systems. In this present review, we aim to offer a comprehensive view of the effect of the COVID-19 pandemic on cancer screening programs worldwide.

Recent findings: The present review comprised 33 publications. During the COVID-19 pandemic, the rates of cancer screening investigations were drastically reduced worldwide. Screening rates plummeted for all types of cancer, all ages, and racial/ethnic groups. Reductions in screening percentages were higher in several underserved racial groups. Cancer screening was suspended for at least 30 days in 13 countries.

Summary: Screenings for all types of cancer fell sharply. In the chain of cancer management, delays in any step are liable to change the outcome of the next step. Further long-term research will be needed to fully comprehend the impact of the pandemic on cancer services and patient outcomes.
Purpose of review: Cancer screening disruption due to COVID-19 may have a significant impact on patients, healthcare practitioners, and healthcare systems. In this present review, we aim to offer a comprehensive view of the effect of the COVID-19 pandemic on cancer screening programs worldwide.

Recent findings: The present review comprised 33 publications. During the COVID-19 pandemic, the rates of cancer screening investigations were ...

Cancer ; Coronavirus ; COVID-19

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Objective: It was aimed to reveal the continuing perfusion defect rates in patients with a diagnosis of pulmonary embolism (PE) due to COVID-19 who have completed the third month of anticoagulant therapy but whose symptoms or laboratory elevations continue.

Methods: Patients with COVID-19 who were diagnosed with PE by Q-SPECT-CT between 1 September 2020 and 1 November 2021, who underwent control Q-SPECT/CT were included in the study. Demographic characteristics, laboratory findings, and first and second Q-SPECT/CT evaluation results of the patients were recorded.

Results: It was observed that the pulmonary defect continued in Q-SPECT/CT in the third month of anticoagulant treatment in 58.3% of the patients diagnosed with PE due to COVID-19, and new defects developed in 6.3%. The persistence rate of segment defects was higher than that of subsegment defects. It was observed that the defects persisted more frequently in patients with a history of hospitalization due to COVID-19.

Conclusion: Perfusion defects may still be present in patients diagnosed with PE due to COVID-19 in the presence of persistent dyspnea/chest pain/D-dimer elevation after 3 months of treatment. Perfusion defect persistence rates are higher in defects more proximal to the subsegment level and in people with severe COVID-19, and extended treatment should be considered in these patients.
Objective: It was aimed to reveal the continuing perfusion defect rates in patients with a diagnosis of pulmonary embolism (PE) due to COVID-19 who have completed the third month of anticoagulant therapy but whose symptoms or laboratory elevations continue.

Methods: Patients with COVID-19 who were diagnosed with PE by Q-SPECT-CT between 1 September 2020 and 1 November 2021, who underwent control Q-SPECT/CT were included in the study. D...

COVID-19 ; Pandémies ; Embolie pulmonaire ; Imagerie médicale

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Purpose of review: The purpose of this review is to outline the impact of the COVID-19 pandemic on movement disorder holistic care, particularly in the care of people with Parkinson disease (PWP).

Recent findings: As the pandemic unfolds, a flurry of literature was published regarding the impact of COVID-19 on people with Parkinson disease including the direct impact of infection, availability of ambulatory care, loss of community-based team care, and acceptability of telemedicine.

Summary: COVID-19 has impacted the care of PWP in numerous ways. Recognizing infection in PWP poses challenges. Specific long-term complications, including emerging reports of long COVID syndrome is a growing concern. Caregivers and PWP have also been impacted by COVID-19 social isolation restrictions, with radical changes to the structure of social networks and support systems globally. In a matter of weeks, the global community saw an incredible uptake in telemedicine, which brought benefits and pitfalls. As PWP adapted to virtual platforms and the changing architecture of care delivery, the pandemic amplified many preexisting inequities amongst populations and countries, exposing a new 'digital divide'.
Purpose of review: The purpose of this review is to outline the impact of the COVID-19 pandemic on movement disorder holistic care, particularly in the care of people with Parkinson disease (PWP).

Recent findings: As the pandemic unfolds, a flurry of literature was published regarding the impact of COVID-19 on people with Parkinson disease including the direct impact of infection, availability of ambulatory care, loss of community-based team ...

COVID-19 ; Parkinsoniens - Soins ; Maladie de Parkinson ; Télémédecine

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Objectives: This study aimed to describe changes in pediatric emergency department (ED) mental and behavioral health (MBH) visits before and during the early COVID-19 pandemic.

Methods: We retrospectively reviewed medical records of patients aged from 5 to 17 years presenting to the pediatric ED of a major tertiary care hospital with MBH-related concerns from March 2017 to September 2020. We evaluated trends in MBH ED visits over the study period, specifically comparing patient demographics, diagnosis categories, and ED disposition between the pre-COVID (2019) and COVID (2020) periods using pairwise Pearson [chi]2 analyses with reported odds ratios (ORs) in SAS statistical software version 9.4 (SAS Institute Inc, Cary, NC).

Results: Of 8093 MBH-related visits, 58.5% were females, 85.4% were adolescents, and 62.7% self-identified as non-Hispanic. The proportion of MBH-related ED visits increased from 3.8% to 7.5% over the study period (P < 0.0001). Although total MBH visits decreased by 17.3% from 2019 to 2020, there was a proportionate increase in MBH-to-total-ED visits, representing a 42.8% increase through 2019. Compared with 2019, there was a proportionate increase in MBH-related ED visits by females (10.6%, P < 0.0001), older adolescents (18.2%, P < 0.0001), and non-Hispanic patients (6.1%, P = 0.017) in 2020. The MBH visits in 2020 were more likely related to suicidality/self-harm (OR, 1.2; confidence interval [CI], 1.1-1.4) or substance use (OR, 1.4; CI, 1.1-1.9). Compared with 2019, there were significantly higher odds of admission (OR, 1.6; CI, 1.3-2.1) or transfer for inpatient psychiatric care (OR, 1.8; CI, 1.6-2.1) in 2020.

Conclusions: Our data suggest that the early COVID-19 pandemic had a significant impact on MBH-related ED visits. Compared with 2019, we observed a significant increase in the proportion of MBH-to-total-ED visits primarily affecting older adolescent, non-Hispanic girls with suicidality/self-harm and substance-related disorders in 2020, despite an overall decrease in the number of MBH visits during this period. There was also an increase in the proportion of visits resulting in admission or transfer for inpatient psychiatric care in 2020.
Objectives: This study aimed to describe changes in pediatric emergency department (ED) mental and behavioral health (MBH) visits before and during the early COVID-19 pandemic.

Methods: We retrospectively reviewed medical records of patients aged from 5 to 17 years presenting to the pediatric ED of a major tertiary care hospital with MBH-related concerns from March 2017 to September 2020. We evaluated trends in MBH ED visits over the study ...

COVID-19 ; Médecine d'urgence ; Hôpitaux - Services des urgences ; Enfants - Santé mentale

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OBJECTIVES: To describe 3-6-month neurologic outcomes of survivors of COVID-19-associated acute respiratory distress syndrome, invasively ventilated in the ICU.

DESIGN: A bicentric prospective study during the two first waves of the pandemic (March to May and September to December, 2020).

SETTING: Two academic hospital ICUs, Paris, France.

PATIENTS: Adult COVID-19-associated acute respiratory distress syndrome survivors, invasively ventilated in the ICU, were eligible for a neurologic consultation between 3 and 6 months post ICU discharge.

INTERVENTIONS: Follow-up by face-to-face neurologic consultation.

MEASURES AND MAIN RESULTS: The primary endpoint was favorable functional outcome defined by a modified Rankin scale score less than 2, indicating survival with no significant disability. Secondary endpoints included mild cognitive impairment (Montreal Cognitive Assessment score < 26), ICU-acquired weakness (Medical Research Council score < 48), anxiety and depression (Hospital Anxiety and Depression score > 7), and posttraumatic stress disorder (posttraumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders 5 score > 30). Of 54 eligible survivors, four non-French-speaking patients were excluded, eight patients were lost-to-follow-up, and one died during follow-up. Forty-one patients were included. Time between ICU discharge and neurologic consultation was 3.8 months (3.6-5.9 mo). A favorable functional outcome was observed in 16 patients (39%) and mild cognitive impairment in 17 of 33 patients tested (52%). ICU-acquired weakness, depression or anxiety, and posttraumatic stress disorder were reported in six of 37 cases (16%), eight of 31 cases (26%), and two of 27 cases (7%), respectively. Twenty-nine patients (74%) required rehabilitation (motor, cognitive, or psychologic). ICU and hospital lengths of stay, tracheostomy, and corticosteroids were negatively associated with favorable outcome. By contrast, use of alpha-2 agonists during ICU stay was associated with favorable outcome.

CONCLUSIONS: COVID-19-associated acute respiratory distress syndrome requiring intubation led to slight-to-severe functional disability in about 60% of survivors 4 months after ICU discharge. Cognitive impairment, muscle weakness, and psychologic symptoms were frequent. A large multicenter study is warranted to allow identification of modifiable factors for improving long-term outcome.
OBJECTIVES: To describe 3-6-month neurologic outcomes of survivors of COVID-19-associated acute respiratory distress syndrome, invasively ventilated in the ICU.

DESIGN: A bicentric prospective study during the two first waves of the pandemic (March to May and September to December, 2020).

SETTING: Two academic hospital ICUs, Paris, France.

PATIENTS: Adult COVID-19-associated acute respiratory distress syndrome survivors, invasively ventilated ...

Appareil respiratoire - Maladies ; COVID-19 ; Cognition

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Older adults are a vulnerable group with a high need for coronavirus disease 2019 (COVID-19) vaccines, but these individuals are also more prone to the development of vaccine-related adverse events.

Older adults with frailty, disability, dementia or living in long-term care facilities need special attention in COVID-19 vaccination programs because supporting evidence for the safety and efficacy of COVID-19 vaccines in these individuals is limited.

The active involvement of geriatricians in vaccine development and related public-policy development is important for the success of adult vaccination strategies against COVID-19 and other communicable and noncommunicable diseases.

The completion of a primary series of COVID-19 vaccines with a heterologous booster dose remains the best strategy to reduce the impact of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections and transmission.
Older adults are a vulnerable group with a high need for coronavirus disease 2019 (COVID-19) vaccines, but these individuals are also more prone to the development of vaccine-related adverse events.

Older adults with frailty, disability, dementia or living in long-term care facilities need special attention in COVID-19 vaccination programs because supporting evidence for the safety and efficacy of COVID-19 vaccines in these individuals is ...

COVID-19 ; Coronavirus ; Vaccination ; Personnes âgées

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Influencing Discharge Efficiency: Addressing Interdisciplinary Communication, Transportation, and COVID-19 as Barriers | Juillet / Août 2022 H

Article (Gestion, administration et droit de la santé)

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Purpose: At one tertiary, academic medical center, two general medicine units averaged 94% and 97% occupancy causing strain on patient throughput. This project was implemented at these two comparable general medicine units, totaling 64 beds. On each of these units, Pareto analyses on causal factors related to discharge order to exit time (DOTE) were performed. DOTE was defined as the period in minutes from when a provider orders a discharge to when the patient actually exits a room. Prime DOTE reduction opportunities were elicited that highlighted the need to address coordination of hospital discharge transportation; that is, arriving family members averaged 120 and 129 min for the two units, and medicars and ambulances averaged 122 and 156 min, which fell above the established 90-min overall strategic DOTE goal. Coordinating efficient discharges decreases the likelihood of hospital bottlenecking and improves patient satisfaction.

Case Management Setting: The health care team is composed of physician and provider services, nursing, and case management, as well as the patient and family. Team-focused interventions aimed at reducing DOTE included leveraging interdisciplinary communication technology and messaging for efficiency and accuracy within the health care team and proactive scheduling of hospital discharge transportation arrival. Process objectives measured included percentage of the health care team educated and utilization of the discharge suite. Outcome objectives measured included median DOTE times, patient satisfaction, and emergency department boarding volume and times. Significantly, admissions for coronavirus disease-2019 (COVID-19) cases were also rapidly increasing early on during program implementation resulting in one of the two general medicine units to be designated for COVID-19 overflow.

Research Methodology: Using Lean methodology, the project design was formed based on the Institute for Healthcare Improvement's work on improving hospital-wide patient flow and the Agency for Healthcare Research and Quality's (AHRQ) IDEAL patient discharge framework to better achieve the well-known, triple aim. In response to COVID-19 demands, the Plan-Do-Study-Act process was warranted to be able to manage acute changes, using iterative processing.

Results and Implications: This program evaluation study assessed whether a communication training program that taught an interdisciplinary team of case managers, nurses, physicians, and related staff how to reduce DOTE was useful. The program had a material impact on the DOTE metric knowing that the hospital's ultimate strategic goal is to reduce DOTE to 90 min or less. A reduction in discharge time was documented when using weekly data from the hospital's discharge dashboard powered by the Maestro database. More specifically, nurses fully trained in the interdisciplinary communications program aimed to reduce DOTE had significantly lower DOTE outcomes on their discharges compared with untrained staff (i.e., average untrained = 127 min, average trained = 93 min). In addition, the fully trained nurses had 14% more of their discharges fall at or below the 90-min goal compared with untrained staff (i.e., untrained = 40%, trained = 54%). Supplemental research also suggested that the content of the communication training program was very relevant (e.g., empowering families to pick up the patients and using scheduling vs. will-call transportation strategies with patients lowered the DOTE metric). Corollary analyses showed that readmissions were also lowered, and patient satisfaction ratings increased. In addition, the interdisciplinary communications training program can benefit from being updated to include content on how COVID-19 issues adversely impact discharge times since significant relationships between various COVID-19 measures and higher discharge exit times were documented.
Purpose: At one tertiary, academic medical center, two general medicine units averaged 94% and 97% occupancy causing strain on patient throughput. This project was implemented at these two comparable general medicine units, totaling 64 beds. On each of these units, Pareto analyses on causal factors related to discharge order to exit time (DOTE) were performed. DOTE was defined as the period in minutes from when a provider orders a discharge to ...

COVID-19 ; Communication ; Transport des malades et des blessés

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Some COVID-19 patients experience dyspnea without objective impairment of pulmonary or cardiac function.

COVID-19 ; Pneumologie ; Dyspnée

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Caring for older adults during the COVID-19 pandemic | Juin 2022 H

Article (Gériatrie - gérontologie)

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Background
Elderly patients represent a high-risk group with increased risk of death from COVID-19. Despite the number of published studies, several unmet needs in care for older adults exist.
Objectives
To discuss unmet needs of COVID-19 in this special population.
Sources
A literature review for studies on COVID-19 in elderly patients published between December 2019 and November 2021 was performed. Clinical questions were formulated to guide the literature search. The search was conducted in the MEDLINE database, combining specific search terms. Two reviewers independently conducted the search and selected the studies according to the prespecified clinical questions.
Content
Elderly patients with COVID-19 have peculiar characteristics. They may have atypical clinical presentation, with no fever and with delirium or neurological manifestations as the most common signs, with potential delayed diagnosis and increased risk of death. The reported fatality rates among elderly patients with COVID-19 are extremely high. Several factors, including comorbidities, atypical presentation, and exclusion from intensive care unit care, contribute to this excess of mortality. Age alone is frequently used as a key factor to exclude the elderly from intensive care, but there is evidence that frailty rather than age better predicts the risk of poor outcome in this category. Durability of vaccine efficacy in the elderly remains debated, and the need for a third booster dose is becoming increasingly evident. Finally, efforts to care for elderly patients who have survived after acute COVID-19 should be implemented, considering the high rates of long COVID sequelae and the risk of longitudinal functional and cognitive decline.
Implications
We highlight peculiar aspects of COVID-19 in elderly patients and factors contributing to high risk of poor outcome in this category. We also illuminated gaps in current evidence, suggesting future research directions and underlining the need for further studies on the optimal management of elderly patients with COVID-19.
Background
Elderly patients represent a high-risk group with increased risk of death from COVID-19. Despite the number of published studies, several unmet needs in care for older adults exist.
Objectives
To discuss unmet needs of COVID-19 in this special population.
Sources
A literature review for studies on COVID-19 in elderly patients published between December 2019 and November 2021 was performed. Clinical questions were formulated to guide ...

COVID-19 ; Coronavirus ; Personnes âgées

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The aim of this study was to investigate if and how disordered gaming, loneliness, and family relations have changed throughout the COVID-19 pandemic (from 2019 to 2021), and whether there were any changes in the association between these variables across three samples of gamers (for each respective year). Samples from 2019, 2020, and 2021 were matched by using propensity score matching across socio-demographic characteristics. The total effective sample comprised 897 gamers (N = 299 per year). These samples were compared in terms of disordered gaming – separately as Gaming Disorder (GD; WHO framework) and Internet Gaming Disorder (IGD; APA framework), loneliness, and family harmony scores with analyses of covariance (ANCOVAs), with age and gender as covariates. Steiger tests were used for correlation differences testing. ANCOVAs showed that while GD and IGD scores have increased significantly during the pandemic years, loneliness and family harmony did not change significantly. Furthermore, the correlation differences tests indicated that the correlations between both IGD and GD with loneliness as well as poorer family harmony have increased during the pandemic years. This study provides empirical evidence that the well-being of gamers might have been negatively affected during the COVID-19 pandemic. While loneliness and family harmony did not increase, the stronger correlations between Gaming Disorder and other variables might suggest that gaming may have been used to cope with loneliness and poorer family harmony.
The aim of this study was to investigate if and how disordered gaming, loneliness, and family relations have changed throughout the COVID-19 pandemic (from 2019 to 2021), and whether there were any changes in the association between these variables across three samples of gamers (for each respective year). Samples from 2019, 2020, and 2021 were matched by using propensity score matching across socio-demographic characteristics. The total ...

Pandémies ; Joueurs de jeux vidéo ; Solitude ; Familles - Aspect social ; COVID-19 ; Dépendance (Psychologie)

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Objective: This study investigated the relationship between intimate partner violence (IPV) experienced
both before and during the COVID-19 pandemic and increased economic insecurity in food, phone/internet
services, health care, and housing. We also assessed sociodemographic differences associated with
increased economic insecurity among women and transgender/nonbinary adults since the start of the
COVID-19 pandemic. Method: An online, cross-sectional survey was administered to a general population
sample of women and transgender individuals in one Midwestern state (N = 1,169). Results: IPV
victimization during stay-at-home orders was associated with approximately three times higher odds of
housing insecurity (adjusted odds ratio [AOR] = 3.06, p < .001) and increased health care insecurity
(AOR = 2.95, p < .001) than those without victimization during stay-at-home orders, even after adjusting
for IPV immediately prior to the pandemic. Multiracial, pregnant, and sexual minority (defined as lesbian,
gay, bisexual, queer, or other sexual orientation [LGBQ+]) women and transgender/nonbinary individuals
were at elevated risk for specific forms of increased insecurity. Conclusions: Findings highlight the need for
continued COVID-19 legislation that enhances housing and rental support for populations most in need of
safe and stable housing, particularly survivors of IPV. Reduced access to health care limits IPV
opportunities for intervention and treatment. Expanding accessible and affordable health care options
during the COVID-19 pandemic can enhance the safety and well-being of survivors and increase
opportunities for providers to screen for IPV.
Objective: This study investigated the relationship between intimate partner violence (IPV) experienced
both before and during the COVID-19 pandemic and increased economic insecurity in food, phone/internet
services, health care, and housing. We also assessed sociodemographic differences associated with
increased economic insecurity among women and transgender/nonbinary adults since the start of the
COVID-19 pandemic. Method: An online, ...

COVID-19 ; Violence entre conjoints ; Insécurité ; Finances personnelles ; Identité de genre

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Descripteurs

COVID-19 [106]

Coronavirus [54]

Pandémies [13]

Physiothérapie [11]

Personnes âgées [10]

Pneumologie [10]

Rehabilitation [8]

Vaccination [8]

Appareil respiratoire - Maladies [6]

Cancer [5]

Télémédecine [5]

Dépendance (Psychologie) [4]

Anxiété [3]

Enfants - Santé mentale [3]

Épuisement professionnel [3]

Infection [3]

Soins de santé primaires [3]

Stress [3]

Anticorps [2]

Appareil respiratoire - Infections [2]

Dyspnée [2]

Gériatrie [2]

Gestion de crise [2]

Hospitalisation [2]

Isolation [2]

Nutrition [2]

Oncologie [2]

Pneumonie [2]

Santé mentale [2]

Santé publique [2]

Sciences [2]

SCIENCES DE LA SANTÉ [2]

Service social [2]

Services de santé - Accessibilité [2]

SOINS INFIRMIERS [2]

Toxicomanie [2]

Travail social [2]

Violence entre conjoints [2]

Accidents vasculaires cérébraux [1]

Adolescents - Santé mentale [1]

Aérosols - Transmission [1]

Alimentation [1]

Alimentation - Méditerranée, Région de la [1]

Angoisse [1]

Anticoagulants [1]

Asthme [1]

Autochtones - Santé mentale [1]

BANDES DESSINÉES [1]

Bien - Aspect psychologique [1]

Biotechnologie [1]

Cancer - Prévention [1]

Cancer - Traitement [1]

Cancer colorectal [1]

Cerveau - Lésions et blessures [1]

Chirurgie [1]

Cognition [1]

Côlon - Cancer [1]

Communication [1]

Comportement sédentaire [1]

Confinement (Politique sanitaire) - Aspect psychologique [1]

Démence [1]

Dépression [1]

Détresse [1]

Douleur chronique [1]

Dysphasie [1]

Éducation sanitaire [1]

Embolie pulmonaire [1]

Enfants - Alimentation [1]

Éthique [1]

Familles - Aspect social [1]

Femmes enceintes [1]

Finances personnelles [1]

Fractures [1]

Grossesse [1]

Hanche [1]

Hôpitaux - Services des urgences [1]

Hyperphagie [1]

Identité de genre [1]

Imagerie médicale [1]

Immunologie [1]

Infection - Prévention [1]

Infirmières - Rôle professionnel [1]

Inflammation (Pathologie) - Diétothérapie [1]

Influenza [1]

Insécurité [1]

Interdisciplinarité [1]

Internet [1]

Jeunes adultes [1]

Jeux vidéo - Aspect psychologique [1]

Joueurs de jeux vidéo [1]

Maladie de Parkinson [1]

Maladies infectieuses [1]

Médecine d'urgence [1]

Médecins - Responsabilité professionnelle [1]

Médicaments [1]

Médicaments - Usage [1]

Motivation en éducation [1]

Opioïdes [1]

PARENTS [1]

Parents d'enfants autistes [1]

Parents et enfants [1]

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