Experiences of Healthcare Workers of Hospitalised Individuals with covid-19 in Kano, Nigeria: A Qualitative Study

Background: Management of patients with covid-19 needing hospitalisation is challenging worldwide. However, little or no information has been gathered regarding the experiences of healthcare workers (hcw s) involved in the care of patients with covid-19 in poorly resourced settings. This study explored the experiences of hcw s managing hospitalised patients with covid-19 in a treatment centre in Kano, Nigeria. Methods: hcw s directly or indirectly involved in managing patients with covid-19 in one of the two treatment centres in Kano, Nigeria, were sampled based on being information-rich cases. The study participants were interviewed individually via telephone using a semi-structured interview guide. Data collection was stopped when content saturation was attained. Data was analysed using thematic synthesis. Results: Eleven hcw s, comprising two medical doctors, five nurses, a laboratory staff member, a community health extension worker, an environmental health officer and a cleaner, participated in this study. Four major themes were generated: (i) the profile and readiness of hcw s prior to being engaged to work in a covid-19 treatment centre, (ii) the experience of hcw s while working in the covid-19 treatment wards, (iii) challenges with working in covid-19 treatment wards, and (iv) post-treatment support for covid-19 patients. The participants had variable prior experience in managing patients with infectious diseases. Interventions offered were mainly antiviral therapy, nursing care, counselling, nutritional interventions and toilet hygiene. Challenges encountered included insufficient cooperation from patients, poor personnel welfare, lack of human resources/equipment and issues interfering with wellbeing (stigma). Conclusion: The studied population exhibited professional competence and success in managing hospitalised patients with covid-19 during hospitalisation, despite existing challenges.

Supporting adolescents living with HIV within boarding schools in Kenya

Adolescents and youth living with HIV (AYLHIV) are a uniquely vulnerable population facing challenges around adherence, disclosure of HIV status and stigma. Providing school-based support for AYLHIV offers an opportunity to optimize their health and wellbeing. The purpose of this study was to evaluate the feasibility of school-based supportive interventions for AYLHIV in Kenya. From 2016–2019, with funding from ViiV Healthcare, the Elizabeth Glaser Pediatric AIDS Foundation implemented the innovative Red Carpet Program (RCP) for AYLHIV in participating public healthcare facilities and boarding schools in Homa Bay and Turkana Counties in Kenya. In this analysis, we report the implementation of the school-based interventions for AYLHIV in schools, which included: a) capacity building for overall in-school HIV, stigma and sexual and reproductive health education; b) HIV care and treatment support; c) bi-directional linkages with healthcare facilities; and d) psychosocial support (PSS). Overall, 561 school staff and 476 school adolescent health advocates received training to facilitate supportive environments for AYLHIV and school-wide education on HIV, stigma, and sexual and reproductive health. All 87 boarding schools inter-linked to 66 regional healthcare facilities to support care and treatment of AYLHIV. Across all RCP schools, 546 AYLHIV had their HIV status disclosed to school staff and received supportive care within schools, including treatment literacy and adherence counselling, confidential storage and access to HIV medications. School-based interventions to optimize care and treatment support for AYLHIV are feasible and contribute to advancing sexual and reproductive health within schools.

Virtual embolization for treatment support of intracranial AVMs using an interactive desktop and VR application

Purpose The treatment of intracranial arteriovenous malformations (AVM) is challenging due to their complex anatomy. For this vessel pathology, arteries are directly linked to veins without a capillary bed in between. For endovascular treatment, embolization is carried out, where the arteries that supply the AVM are consecutively blocked. A virtual embolization could support the medical expert in treatment planning. Method We designed and implemented an immersive VR application that allows the visualization of the simulated blood flow by displaying millions of particles. Furthermore, the user can interactively block or unblock arteries that supply the AVM and analyze the altered blood flow based on pre-computed simulations. Results In a pilot study, the application was successfully adapted to three patient-specific cases. We performed a qualitative evaluation with two experienced neuroradiologist who regularly conduct AVM embolizations. The feature of virtually blocking or unblocking feeders was rated highly beneficial, and a desire for the inclusion of quantitative information was formulated. Conclusion The presented application allows for virtual embolization and interactive blood flow visualization in an immersive virtual reality environment. It could serve as useful addition for treatment planning and education in clinical practice, supporting the understanding of AVM topology as well as understanding the influence of the AVM’s feeding arteries.

Trajectories of stroke recovery of impairment, function, and quality of life in response to 12-month mobility and fitness intervention

BACKGROUND: Gait deficits and functional disability are persistent problems for many stroke survivors, even after standard neurorehabilitation. There is little quantified information regarding the trajectories of response to a long-dose, 12-month intervention. OBJECTIVE: We quantified treatment response to an intensive neurorehabilitation mobility and fitness program. METHODS: The 12-month neurorehabilitation program targeted impairments in balance, limb coordination, gait coordination, and functional mobility, for five chronic stroke survivors. We obtained measures of those variables every two months. RESULTS: We found statistically and clinically significant group improvement in measures of impairment and function. There was high variation across individuals in terms of the timing and the gains exhibited. CONCLUSIONS: Long-duration neurorehabilitation (12 months) for mobility/fitness produced clinically and/or statistically significant gains in impairment and function. There was unique pattern of change for each individual. Gains exhibited late in the treatment support a 12-month intervention. Some measures for some subjects did not reach a plateau at 12 months, justifying further investigation of a longer program (>12 months) of rehabilitation and/or maintenance care for stroke survivors.

From Biomarkers to Novel Therapeutic Approaches in Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a heterogeneous and complex disorder. In this review, we provided a comprehensive overview of biomarkers involved in COPD, and potential novel biological therapies that may provide additional therapeutic options for COPD. The complex characteristics of COPD have made the recommendation of a generalized therapy challenging, suggesting that a tailored, personalized strategy may lead to better outcomes. Existing and unmet needs for COPD treatment support the continued development of biological therapies, including additional investigations into the potential clinical applications of this approach.

COVID-19 and Multiorgan Dysfunction Syndrome

Severe acute respiratory syndrome (SARS) is the leading cause of death in COVID-19 infection, however, multi-organ dysfunction due to COVID-19 and/or because of co-morbidities is a usual accompaniment causing unfavorable outcome. Early detection of organ failure and giving appropriate organ support may improve the chances of survival. Arterial Blood Gas (ABG) analysis; electrolytes coupled with clinical picture and with organ related laboratory investigations may help in diagnosis of MODS and sepsis in COVID-19 SEVERE SYNDROME. Acute kidney injury (AKI), myocarditis, thromboembolism, acute liver de-compensation, hospital acquired infections, cardiac arrest, glycemic variability, thyroid dysfunction and other organ failure may lead to MODS.As patients having multiple organ syndrome requires ICU admission and interventions like intubation, hemodialysis and other extracorporeal treatment support knowing holistically about “COVID-19 MODS” is important for treating physicians.

Blockchain Technology Projects to Provide Telemedical Services: Systematic Review

Background One of the most promising health care development areas is introducing telemedicine services and creating solutions based on blockchain technology. The study of systems combining both these domains indicates the ongoing expansion of digital technologies in this market segment. Objective This paper aims to review the feasibility of blockchain technology for telemedicine. Methods The authors identified relevant studies via systematic searches of databases including PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar. The suitability of each for inclusion in this review was assessed independently. Owing to the lack of publications, available blockchain-based tokens were discovered via conventional web search engines (Google, Yahoo, and Yandex). Results Of the 40 discovered projects, only 18 met the selection criteria. The 5 most prevalent features of the available solutions (N=18) were medical data access (14/18, 78%), medical service processing (14/18, 78%), diagnostic support (10/18, 56%), payment transactions (10/18, 56%), and fundraising for telemedical instrument development (5/18, 28%). Conclusions These different features (eg, medical data access, medical service processing, epidemiology reporting, diagnostic support, and treatment support) allow us to discuss the possibilities for integration of blockchain technology into telemedicine and health care on different levels. In this area, a wide range of tasks can be identified that could be accomplished based on digital technologies using blockchains.

Factors Affecting the Family Burden of the Palliative Family

The process of palliative patient care indirectly causes a burden on the family. This study aims to determine the description of the family burden in caring for palliative patients. This study is a qualitative research with a phenomenological study design. Participant criteria are families who care for patients for at least 6 months. The number of respondents in this study were 4 respondents as care givers of palliative patients. The research method using the analysis method used includes categorizing themes, compiling sub-categorization of themes and the last is the coding process. The results of the study showed that there was a description of the family burden of palliative patients and a description of the factors that influenced palliative patients including economic status, patient complaints, family support, family perception, availability of treatment support tools, and the ability of families to manage family burdens. The burden on the family can be reduced by training the family to manage the existing factors.

Invasive Multimodal Neuromonitoring in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review

Background and Purpose: Aneurysmal subarachnoid hemorrhage is a devastating disease leaving surviving patients often severely disabled. Delayed cerebral ischemia (DCI) has been identified as one of the main contributors to poor clinical outcome after subarachnoid hemorrhage. The objective of this review is to summarize existing clinical evidence assessing the diagnostic value of invasive neuromonitoring (INM) in detecting DCI and provide an update of evidence since the 2014 consensus statement on multimodality monitoring in neurocritical care. Methods: Three invasive monitoring techniques were targeted in the data collection process: brain tissue oxygen tension (p ti O 2 ), cerebral microdialysis, and electrocorticography. Prospective and retrospective studies as well as case series (≥10 patients) were included as long as monitoring was used to detect DCI or guide DCI treatment. Results: Forty-seven studies reporting INM in the context of DCI were included (p ti O 2 : N=21; cerebral microdialysis: N=22; electrocorticography: N=4). Changes in brain oxygen tension are associated with angiographic vasospasm or reduction in regional cerebral blood flow. Metabolic monitoring with trend analysis of the lactate to pyruvate ratio using cerebral microdialysis, identifies patients at risk for DCI. Clusters of cortical spreading depolarizations are associated with clinical neurological worsening and cerebral infarction in selected patients receiving electrocorticography monitoring. Conclusions: Data supports the use of INM for the detection of DCI in selected patients. Generalizability to all subarachnoid hemorrhage patients is limited by design bias of available studies and lack of randomized trials. Continuous data recording with trend analysis and the combination of INM modalities can provide tailored treatment support in patients at high risk for DCI. Future trials should test interventions triggered by INM in relation to cerebral infarctions.