scholarly journals 955. Trends in Top COVID-19 Questions Among a National Audience of Primary Care Clinicians

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S570-S570
Author(s):  
Aylin Madore ◽  
Margaret Oliverio ◽  
Steven Nock
Keyword(s):  
Infectious Disease ◽  
Primary Care ◽  
Clinical Decision Making ◽  
Critical Role ◽  
Specific Treatment ◽  
Clinical Decision ◽  
Trends Over Time ◽  
Primary Care Clinicians ◽  
Over Time

Abstract Background As COVID-19 took the world by storm, primary care clinicians (PCCs) played a critical role in identification and management of this disease. Yet, knowledge around COVID-19 is constantly evolving, leaving clinicians with many unanswered questions. We sought to examine what questions PCCs had about COVID-19 and whether there were any trends over time. Methods We sought to examine what questions PCCs had about COVID-19 and whether there were any trends over time. We collected questions from PCCs during 4 live virtual 60-minute continuing medical education (CME) panel discussions on COVID-19 led by infectious disease experts from November 2020 to February 2021. Questions were independently sorted and analyzed by 2 MDs using constant-comparison and tie-break methodology. Results A total of 600 questions pertaining to COVID-19 were collected across 4 sessions. Top questions asked by PCCs ranked in descending order related to the following topics, with most common themes listed in parentheses: 1. Vaccines (efficacy, safety in pregnancy, indications/contraindications, timing of administration, side effects/adverse events) 2. Medication-Specific Treatment (monoclonal antibodies, ivermectin, steroids, convalescent plasma, supplements [vitamin D, zinc, vitamin c]) 3. Testing (false positive/false negatives, use in travel, quarantine, and gatherings) 4. Other Management (role of anticoagulation, use of chronic medications, guidelines) 5. Personal Protective Equipment (masks, eye protection, post-vaccination, use in travel). [Table 1] The percentage of questions around vaccination increased from 5% of total questions in October 2020 to 67% in February 2021. Questions related to Treatment declined from 20% to 6%, Testing declined from 21% to 3%, Other Management declined from 6% to 1% and PPE increased from 3% to 8% during this period. Table 1. Top 5 topics of questions listed in descending order of frequency across all 4 COVID-19 panel sessions. Table 2. Percentage of questions in the top 5 topics for each of the 4 COVID-19 panel sessions, with associated trendline. Conclusion PCCs nationally have gaps in knowledge around COVID-19 which can impact clinical decision-making. Based on our analysis of questions submitted by PCCs to infectious disease experts in a CME setting, the greatest gaps in knowledge were around vaccination, treatment, and testing with vaccination showing the greatest shift in interest over time. Disclosures All Authors: No reported disclosures

scholarly journals In-depth blood proteome profiling analysis revealed distinct functional characteristics of plasma proteins between severe and non-severe COVID-19 patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Joonho Park ◽  
Hyeyoon Kim ◽  
So Yeon Kim ◽  
Yeonjae Kim ◽  
Jee-Soo Lee ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Good Prognosis ◽  
Severe Illness ◽  
Proteome Profiling ◽  
T Cell Suppression ◽  
Cell Suppression ◽  
Profiling Analysis ◽  
Necrosis Factor

AbstractThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over forty million patients worldwide. Although most coronavirus disease 2019 (COVID-19) patients have a good prognosis, some develop severe illness. Markers that define disease severity or predict clinical outcome need to be urgently developed as the mortality rate in critical cases is approximately 61.5%. In the present study, we performed in-depth proteome profiling of undepleted plasma from eight COVID-19 patients. Quantitative proteomic analysis using the BoxCar method revealed that 91 out of 1222 quantified proteins were differentially expressed depending on the severity of COVID-19. Importantly, we found 76 proteins, previously not reported, which could be novel prognostic biomarker candidates. Our plasma proteome signatures captured the host response to SARS-CoV-2 infection, thereby highlighting the role of neutrophil activation, complement activation, platelet function, and T cell suppression as well as proinflammatory factors upstream and downstream of interleukin-6, interleukin-1B, and tumor necrosis factor. Consequently, this study supports the development of blood biomarkers and potential therapeutic targets to aid clinical decision-making and subsequently improve prognosis of COVID-19.

scholarly journals Clinical decision making and research in hepatocellular carcinoma: Pivotal role of imaging techniques

Hepatology ◽  
2011 ◽  
Vol 54 (6) ◽  
pp. 2238-2244 ◽  
Author(s):  
Jordi Bruix ◽  
Maria Reig ◽  
Jordi Rimola ◽  
Alejandro Forner ◽  
Marta Burrel ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Imaging Techniques ◽  
Clinical Decision ◽  
Pivotal Role

Practice Guidelines for the Diagnosis of COVID-19-Associated Pulmonary Aspergillosis in an Intensive Care Setting

2021 ◽  
pp. 088506662110471
Author(s):  
Zia Hashim ◽  
Zafar Neyaz ◽  
Rungmei S.K. Marak ◽  
Alok Nath ◽  
Soniya Nityanand ◽  
...  
Keyword(s):  
Intensive Care ◽  
Practice Guidelines ◽  
Clinical Management ◽  
Care Setting ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Third Wave ◽  
Intensive Care Setting ◽  
Pulmonary Aspergillosis

Coronavirus disease-2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a new disease characterized by secondary Aspergillus mold infection in patients with COVID-19. It primarily affects patients with COVID-19 in critical state with acute respiratory distress syndrome, requiring intensive care and mechanical ventilation. CAPA has a higher mortality rate than COVID-19, posing a serious threat to affected individuals. COVID-19 is a potential risk factor for CAPA and has already claimed a massive death toll worldwide since its outbreak in December 2019. Its second wave is currently progressing towards a peak, while the third wave of this devastating pandemic is expected to follow. Therefore, an early and accurate diagnosis of CAPA is of utmost importance for effective clinical management of this highly fatal disease. However, there are no uniform criteria for diagnosing CAPA in an intensive care setting. Therefore, based on a review of existing information and our own experience, we have proposed new criteria in the form of practice guidelines for diagnosing CAPA, focusing on the points relevant for intensivists and pulmonary and critical care physicians. The main highlights of these guidelines include the role of CAPA-appropriate test specimens, clinical risk factors, computed tomography of the thorax, and non-culture-based indirect and direct mycological evidence for diagnosing CAPA in the intensive care unit. These guidelines classify the diagnosis of CAPA into suspected, possible, and probable categories to facilitate clinical decision-making. We hope that these practice guidelines will adequately address the diagnostic challenges of CAPA, providing an easy-to-use and practical algorithm to clinicians for rapid diagnosis and clinical management of the disease.

The value of a consultant physiotherapist within a primary care musculoskeletal interface service: part of the spinal multidisciplinary team

2021 ◽  
Vol 28 (1) ◽  
pp. 1-10
Author(s):  
Michelle L Angus ◽  
Victoria Dickens ◽  
Naveed Yasin ◽  
James Greenwood ◽  
Irfan Siddique
Keyword(s):  
Primary Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Tertiary Referral Centre ◽  
Allied Health Professionals ◽  
Convenience Sample ◽  
Surgical Services ◽  
Pain Pathway ◽  
The Uk ◽  
Case Based

Background/aims The national low back pain pathway in the UK suggests practitioners managing patients with spinal pathology should be specifically trained to do so and have the ability to link with tertiary spinal services when required. The aim of this study was to ensure referrals through to a tertiary spinal surgical centre are appropriate and patients get the correct advice early in their management pathway. Methods A retrospective review of 700 cases were discussed at a spinal case-based discussion meeting in a primary care interface service, compared to services without this model. A convenience sample of cases were analysed with the consultant physiotherapist and those referred from other allied health professionals into the tertiary spinal surgical centre. Case-based team discussion took place before every referral into the tertiary spinal service, with spinal surgical discussion where required. Results Patients referred from other interface services were more likely to require further work-up such as investigations, or be discharged from clinic on their first attendance than those who had been through the case-based discussion. Conclusions A consultant physiotherapist working as part of the spinal team of a tertiary referral centre can help advanced practitioners with their clinical decision making to help prevent unnecessary referrals to spinal surgical services.

Measurement and Prediction of Sound Exposure Levels by University Wind Bands

2010 ◽  
Vol 25 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Kris Chesky
Keyword(s):  
Linear Regression Analysis ◽  
Critical Role ◽  
Significant Proportion ◽  
Sound Exposure ◽  
Sound Levels ◽  
Wind Bands ◽  
Exposure Levels ◽  
The Mean ◽  
Over Time

The purpose of this study was to determine sound exposure levels generated in two college wind bands. Dosimeter data from a large sample of ensemble-based instructional activities (n = 43) was collected over time and processed to assess associations with predictor variables that may be relevant to this context, including indicators of time spend at various intensity levels, maximum and peak sound levels, degree of variability of sound levels over time, and the percentage of time playing music. The mean dose per event for the entire sample was 109.5% and ranged from 53.8% to 166.9%. Results of linear regression analysis revealed that regressors accounted for a significant proportion of the variance in dose (F = 128.42, p < 0.000) and a statistically significant and very large (96% variance accounted for) contribution to the prediction of dose. Findings implicate the critical role of the instructor and teaching pedagogy.

The Role of Primary Care in Population and Community Health: Pragmatic Approaches to Integration

2019 ◽  
pp. 101-108
Author(s):  
Julie Wood ◽  
Kevin Grumbach
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Population Health ◽  
Health Management ◽  
Parks And Recreation ◽  
Centered Care ◽  
Care Models ◽  
Primary Care Clinicians ◽  
Family Centered

This chapter looks at the role of primary health care in community health. Primary care, it argues, has built on its historical roots of holistic family-centered care to embrace the broader concept of population health. The chapter looks at the evolution of care models from patient/family-centered to panel management (the sum of patients being cared for by a primary care practice), to community health management. This broader concept of health necessitates collaboration with partners outside the clinical practice, including public health professionals, policymakers, schools, housing, parks and recreation, law enforcement, transportation, and food systems. The chapter describes the population and community framework and its historical role in the development of primary care, and then turns to the proposal of pragmatic approaches that busy primary care clinicians and care teams can use to integrate population health approaches into their practices.

Keys to Effective Communication in All Circumstances

2019 ◽  
pp. 27-42
Author(s):  
Kirsten J. Broadfoot ◽  
Todd A. Guth
Keyword(s):  
Cognitive Processing ◽  
Clinical Decision Making ◽  
Situational Awareness ◽  
Clinical Decision ◽  
Patient Needs ◽  
High Stakes ◽  
Communication Practices ◽  
High Degree ◽  
Patient Stories ◽  
Over Time

Emergency departments (EDs), with their high degree of interruption, evolving and often incoherent patient stories, and multiple patient needs, strain practitioner cognitive processing over time, forcing a reliance on default communication approaches and pattern recognition. This shift to scripted, routinized, and default approaches to interaction in the ED reduces situational awareness, impacting providers’ ability to respond appropriately to the person and story in front of them and their clinical decision making. However, being able to rapidly and effectively adapt to circumstances is essential for high-functioning providers in emergency department settings. Although solid, learned fundamental communication checklists can suffice in straightforward, low-stakes, or routine individual and team encounters, complicated, high-stakes, or unusual circumstances or situations require effective communicators to move beyond habituated communication practices to those that enable providers to appropriately interpret and adapt to circumstances while respecting self, others, and context.

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