scholarly journals 1611 Significant Epistaxis Secondary To COVID-19 Nasopharyngeal Swab

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Laycock ◽  
O Ahmed ◽  
J Wasson
Keyword(s):  
Healthcare Professionals ◽  
Rare Complication ◽  
Formal Training ◽  
Nasopharyngeal Swab ◽  
Procedural Skill ◽  
Shortness Of Breath ◽  
Healthcare Staff ◽  
Respiratory Compromise ◽  
New Techniques ◽  
Nasal Pathology

Abstract Aim This case highlights the need for appropriate training when adopting new techniques, even for relatively simple procedures. Method we report a rare complication of the innovative COVID-19 nasopharyngeal swab which is a new skill for many healthcare professionals and frequently performed with little or no training. Results We describe a case of iatrogenic epistaxis after a diagnostic nasopharyngeal swab was taken during the COVID-19 pandemic. The epistaxis was significant, causing haemodynamic and respiratory compromise. In a frail patient who is susceptible to epistaxis, the potenial for further harm is significant. After initially presenting with shortness of breath, this patient (who had no previous nasal pathology) underwent routine naso- and oro- pharyngeal swabbing to test for COVID-19. He felt immediate discomfort in his nasopharynx and epistaxis ensued. The bleeding persisted for several hours; bilateral anterior and posterior nasal packing was required to eventually cease the bleed. He was compromised with a falling haemoglobin, and aspiration of blood compounded his shortness of breath. Conclusions Epistaxis is a potentially serious side effect of nasopharyngeal swabbing; a procedural skill dramatically increasing in prevalence during the COVID-19 pandemic. We advocate for formal training of this procedure for all healthcare staff required to undertake it. Presenting such a case report can help us in understanding the complications of this procedure, and better thus inform the patient consenting process.

scholarly journals 782 A Rare Complication in A Post-Operative Bariatric Patient: COVID-19 Induced Mesenteric Venous Thrombosis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Winstanley ◽  
M Goodfellow
Keyword(s):  
Gastric Bypass ◽  
Abdominal Pain ◽  
Ct Scan ◽  
Acute Abdominal Pain ◽  
Myeloproliferative Neoplasms ◽  
Rare Complication ◽  
Nasopharyngeal Swab ◽  
Thrombotic Complications ◽  
Tract Infections ◽  
Mesenteric Thrombosis

Abstract Introduction The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has provided enormous challenges in the delivery of surgical care. In addition to respiratory tract infections, coronavirus disease 2019 (COVID-19) is associated with both arterial and venous thrombotic complications. Case Details: We present a case of acute superior mesenteric venous (SMV) thrombosis in a 36-year-old female patient who underwent Roux-en-Y gastric bypass three years previously. Her presentation with acute abdominal pain occurred 6 days after a positive nasopharyngeal swab. An admission CT scan demonstrated an abrupt cut off in the proximal SMV with resultant small bowel oedema. Subsequent thrombophilia screening and mutation testing for myeloproliferative neoplasms were all negative. She had also previously carried three pregnancies to term without any thrombotic complications. Hence, the high suspicion of acute COVID-19 induced mesenteric thrombosis. Conclusions In patients who have previously undergone Rouy-en-Y gastric bypass and lost significant weight, acute abdominal pain normally raises a high suspicion of internal hernia. However, as the pandemic progresses surgeons need to be mindful of COVID-19 induced mesenteric thrombosis as a differential diagnosis during the workup of acute abdominal pain. This was well demonstrated on a CT scan with intravenous contrast.

scholarly journals A rare case of paradoxical pulmonary embolism in spontaneous aortocaval fistula

2021 ◽  
pp. 20200183
Author(s):  
Valentina Vespro ◽  
Stefano Fusco ◽  
Anna Maria Ierardi ◽  
Viviana Grassi ◽  
Ilenia D’Alessio ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Inferior Vena ◽  
Rare Complication ◽  
Vena Cava ◽  
Paradoxical Embolism ◽  
Aortocaval Fistula ◽  
Shortness Of Breath ◽  
Right Heart ◽  
Abdominal Ct ◽  
Abdominal Aortic

Aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA), occurring in less than 1% of all AAAs. Paradoxical embolism can rarely be associated with ACF, pulmonary embolism may originate from dislodgment of thrombotic material from the AAA in the inferior vena cava (IVC) through the ACF. We report a case of a patient admitted to the emergency department with abdominal pain and shortness of breath who immediately underwent thoraco-abdominal CT. Imaging allowed a prompt pre-operative diagnosis of an ACF between an AAA and the IVC, also identifying CT signs of right heart overload and the presence of a paradoxical pulmonary embolism.

scholarly journals Low Risk of COVID-19 Infection in an Ambulatory Gastrointestinal Endoscopy Center in Argentina

2021 ◽  
Vol 51 (2) ◽  
Author(s):  
José Tawil ◽  
Josie Libertucci ◽  
Ana Adet Caldelari ◽  
Irene Banchero ◽  
Sandra Canseco ◽  
...  
Keyword(s):  
General Population ◽  
Gastrointestinal Endoscopy ◽  
Healthcare Professionals ◽  
Hospital Setting ◽  
Low Risk ◽  
Risk Of Infection ◽  
Healthcare Staff ◽  
Future Health ◽  
Endoscopic Procedures ◽  
Staff Members

Background and Objectives. Since the onset of the COVID-19 pandemic, concerns have been raised regarding the risk of infection to both healthcare staff and patients during gastrointestinal endoscopy procedures. Given the importance of performing routine endoscopic procedures to an individual’s future health, we sought to estimate the risk of COVID-19 infection for healthcare staff and patients undergoing endoscopic studies at an ambulatory endoscopy center during the pandemic. Material and Methods. This is a prospective(and) analytical cohort study conducted in an ambulatory gastroenterology center located in the Autonomous City of Buenos Aires, Argentina. Patients undergoing different endoscopic procedures were evaluated for COVID-19 between April 14 and August 31, 2020. COVID-19 was also evaluated in all healthcare and associated staff during the same time period. The risk (cumulative incidence) of acquiring COVID-19 in all patients and staff was calculated. Results. Between April 14 and August 31, 2020, procedures were performed in 3,745 patients with a mean age of 51.12 years; 2,102 (56.18%) were male and 1,643 (43.82%) were female. Follow-up was completed in 3,492 patients, 18 of whom tested positive for COVID-19 standing for an incidence of 0.52% (95%CI 0.31 – 0.81%). Six (5.45%) out of 110 staff members were infected with COVID-19 (1 endoscopist, 4 endoscopy assistants and 1 administrative staff member). In this group, the incidence of positive tests for COVID-19 was 5.45% (95%CI: 2.03 – 11.50%). The increased rates of positive cases among our patients and healthcare professionals were respectively 7.9 and 23.6 times lower than in general population. Conclusion. During the study period, the proportion of COVID-19 infections in our ambulatory specialized in gastrointestinal endoscopy was low and much lower than that in the general population for both patients and healthcare professionals. Endoscopic procedures undertaken at this center were low risk, likely due to strict compliance with established pandemic protocols. Future studies should compare the risk of infection in the hospital setting.

Pericarditis and Cardiac Tamponade in Juvenile Rheumatoid Arthritis

PEDIATRICS ◽  
1981 ◽  
Vol 68 (3) ◽  
pp. 369-373 ◽  
Author(s):  
Carolyn L. Yancey ◽  
Robert A. Doughty ◽  
Barbara A. Cohlan ◽  
Balu H. Athreya
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiac Tamponade ◽  
Juvenile Rheumatoid Arthritis ◽  
Sinus Tachycardia ◽  
Rare Complication ◽  
Shortness Of Breath ◽  
Significant Morbidity ◽  
T Wave ◽  
Inflammatory Drugs

Cardiac tamponade is a rare complication of juvenile rheumatoid arthritis. Three cases seen in the last two years at the Children's Hospital of Philadelphia are reported and compared to four previously reported cases. All three children had systemic-type juvenile rheumatoid arthritis with tachypnea, shortness of breath, and chest pain. Cardiac signs in these children included decreased heart sounds, pericardial friction rub, jugular venous distention, and pulsus paradoxus greater than 12 mm Hg. Roentgenograms of the chest showed cardiomegaly with bilateral pleural effusions. Electrocardiograms showed sinus tachycardia and nonspecific ST-T wave changes. Echocardiograms demonstrated pericardial effusions in all subjects and poor ventricular movements in one child. All three children were treated with short-acting anti-inflammatory drugs and/or prednisone. Pericardiocentesis was performed in two cases. There was no significant morbidity after a mean follow-up of two years.

scholarly journals Fourteen years of quality improvement education in healthcare: a utilisation-focused evaluation using concept mapping

2019 ◽  
Vol 8 (4) ◽  
pp. e000795 ◽  
Author(s):  
Frida Smith ◽  
Patrik Alexandersson ◽  
Bo Bergman ◽  
Lisa Vaughn ◽  
Andreas Hellström
Keyword(s):  
Quality Improvement ◽  
Concept Mapping ◽  
Mixed Method ◽  
Healthcare Professionals ◽  
Organisational Performance ◽  
Healthcare Staff ◽  
Long Term Outcomes ◽  
Analysis Process ◽  
Kirkpatrick Model

BackgroundThe need for training in quality improvement for healthcare staff is well acknowledged, but long-term outcomes of such training are hard to evaluate. Behaviour change, improved organisational performance and results are sought for, but these variables are complex, multifactorial and difficult to assess.AimThe purpose of this article is to explore the personal and organisational outcomes identified by participants over 14 years of university-led QI courses for healthcare professionals.MethodInspired by the Kirkpatrick model for evaluation, we used concept mapping, a structured mixed method that allows for richness of data to be captured and visualised by inviting stakeholders throughout the process. In total, 331 previous course participants were included in the study by responding to two prompts, and 19 stakeholders taking part in the analysis process by doing the sorting.ResultTwo maps, one for personal outcomes and one for organisational outcomes, show clusters of the responses from previous course participants and how the outcomes relate to each other in meta-clusters. Both maps show possible long-term outcomes described by the previous course participants.ConclusionThe results of this study indicate that it is possible that training in quality improvement with a strong experiential pedagogical approach fosters a long-term improvement capability for the course participants and, even more important, a long-term improvement capability (and increased improvement skill) in their respective organisations.

scholarly journals The effect of living a ‘yogic lifestyle’ on stress response and self-image in healthcare professionals: a pilot study

2020 ◽  
Vol 6 (6) ◽  
pp. FSO473 ◽  
Author(s):  
Kavita Beri ◽  
Vidya Menon ◽  
Edgardo Guzman ◽  
Claudia Chapa ◽  
Raxa Patel ◽  
...  
Keyword(s):  
Pilot Study ◽  
Life Stress ◽  
Healthcare Professionals ◽  
Personal Life ◽  
Healthcare Staff ◽  
Self Compassion ◽  
Self Image ◽  
Work Pressure ◽  
Tantra Yoga ◽  
The Impact

Background: Healthcare staff in modern metropolitan settings face higher rates of burnout characterized by emotional stress and difficulty coping with not only building work pressure but also balancing personal life stress. The aim of this pilot study was to see the impact of a yogic lifestyle, incorporating diet, exercise and mindfulness activities based on tantra yoga. Materials & methods: Fifteen participants were recruited and completed three or more of the interventions. Results: The 4-week pilot study showed increased self-compassion and decreased stress among the participants.

scholarly journals The simulation coaching concept - A step towards expertise

2020 ◽  
Vol 10 (4) ◽  
pp. 83
Author(s):  
Mari Salminen-Tuomaala ◽  
Jaakko Hallila ◽  
Asta Niinimäki ◽  
Paula Paussu
Keyword(s):  
Healthcare Professionals ◽  
Professional Competence ◽  
Development Project ◽  
Educational Institutions ◽  
Learning Needs ◽  
Healthcare Staff ◽  
Learning Skills ◽  
Ongoing Research ◽  
Coaching Intervention ◽  
Simulation Based

Background and objective: This paper presents a sub-study of an ongoing research and development project (August 1, 2017-December 31, 2019), whose aim has been to use simulation-based coaching to meet social and healthcare staff’s self-reported learning needs in 20 small and medium-sized enterprises in Finland. Two regional educational institutions are responsible for the management of the project. The study aim was to examine the development of self-rated professional competence and expertise of social and healthcare staff, following a simulation coaching project.Methods: An electronic questionnaire was used to collect information about participants’ self-rated expertise, first in November 2017 and again in May 2019 following the simulation-based coaching intervention. IBM SPSS for Windows 25 was used to analyse the data.Results: The respondents appreciated simulation coaching as an effective way of developing expertise and the continuous learning skills of professionals. In this project, coaching was considered to be especially suitable for theoretical and practical management of acute situations; for keeping up with change in society; for anticipating development needs, and for promoting the attractiveness and competitiveness of the company where they worked.Conclusions: The simulation coaching concept, which involves action-based and concrete ways of developing theoretical and practical competence, is well suited for social and healthcare professionals undertaking continuing education. Using the companies’ own facilities facilitates participation and application of new knowledge and skills.

scholarly journals Attitudes and Approaches to Use of Meal Replacement Products among Healthcare Professionals in Management of Excess Weight

2020 ◽  
Vol 10 (9) ◽  
pp. 136
Author(s):  
Gabrielle Maston ◽  
Janet Franklin ◽  
Alice A. Gibson ◽  
Elisa Manson ◽  
Samantha Hocking ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Management ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Overweight And Obesity ◽  
Prescribing Patterns ◽  
Formal Training ◽  
Meal Replacement ◽  
Potential Barriers ◽  
Safety Concerns

Meal replacement product-based diets are an effective weight loss intervention used in the management of obesity. Historically, these diets have been underutilised by HealthCare Professionals (HCPs). An online survey of mixed methods design was distributed to HCPs to capture current perceptions and prescribing patterns of meal replacement products (MRPs) in the management of overweight and obesity. A total of 303 HCPs working in weight management across Australia began the survey and 197 (65%) completed it. While over 70% of HCPs have prescribed MRP currently or in the past, MRPs are only prescribed to a median 7% of patients seeking weight management treatment. Qualitative analysis identified potential barriers to MRP prescription, which include experience with patient non-compliance, perceived poor long-term weight loss durability and safety concerns regarding the product and its use as a total meal replacement program. Safety concerns are centred on the perceived risk of weight cycling and its potential negative psychological impact. MRP prescription is 66% more likely to occur if HCPs had formal training in the use of MRPs relative to those who did not, with a relative risk (RR) of 1.7 (95% CI 1.4, 2.0). This study highlights the potential barriers to the prescription of MRPs, which are centred around safety concerns. This also indicates that formal training may enhance the likelihood of prescribing MRPs, suggesting that once HCPs have a comprehensive understanding of the products and the evidence behind their use, their prescription is likely to be increased.

scholarly journals Pseudomyxoma peritonei (PMP) - a rare entity

2011 ◽  
Vol 15 (3) ◽  
pp. 79-81 ◽  
Author(s):  
Zaeem Ismail Ebrahim ◽  
Zarina Ismail Lockhat ◽  
Farzanah Ismail
Keyword(s):  
Pseudomyxoma Peritonei ◽  
Rare Complication ◽  
Morbidity And Mortality ◽  
Rare Entity ◽  
Loss Of Function ◽  
New Techniques ◽  
Visceral Organs ◽  
Mucinous Tumours

Pseudomyxoma peritonei (PMP) is a rare complication of mucinous tumours of appendiceal or ovarian origin that results in peritoneal and omental implants. Clinical morbidity and mortality arise from the fact that copious amounts of extracellular and peritoneal mucin result in distortion and loss of function of visceral organs. Therapeutic paracentesis is not possible because of the nature of the mucin. Currently, new techniques are being used to attempt to debulk the mucin volume; none, however, has lead to superior outcome.

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