Shifting to the ambulatory patient-centered tuberculosis care model in Romania – preliminary results of the pilot project conducted in Marius Nasta Institute of Pneumology dispensaries, January–December 2020

Reversing the concept of the Romanian medical system in terms of approaching patients with tuberculosis (TB) and removing them from a hospital-centred system into a more friendly outpatient system, closer to their needs, is one of its challenges. Preliminary data of this project show that through minimal and consistent investments the diagnosis, treatment and monitorisation can be made exclusively in the outpatient department for these patients.

COVID-19’s natural course among ambulatory monitored outpatients

Research objective was to detail COVID-19’s natural trajectory in relation to the Czech population’s viral load. Our prospective detailed daily questionnaire-based telemonitoring study evaluated COVID-19’s impact among 105 outpatients. In accordance with government quarantine requirements, outpatients were divided into a cohort with two negative tests at the end of the disease (40 patients) and a cohort with a new algorithm (65 patients) following a 14-day quarantine. Median follow-up differed significantly between the 2 groups (23 days vs. 16 days). Only 6% of patients were asymptomatic during the entire telemonitoring period. Another 13% of patients were diagnosed asymptomatic, as suspected contacts, yet later developed symptoms, while the remaining 81% were diagnosed as symptomatic on average 6 days following symptom onset. Telemonitoring enabled precise symptom status chronicling. The most frequently reported complaints were fevers, respiratory issues, and anosmia. Six patients were eventually hospitalized for complications detected early after routine telemonitoring. During the extended follow-up (median 181 days), anosmia persisted in 26% of patients. 79% of patients in the new quarantine algorithm cohort reported no symptoms on day 11 compared to just 56% of patients in the two negative test cohort upon first testing negative (median–19 days). The highest viral load occurred within 0–2 days of initial symptom onset. Both the PCR viral load and two consecutive PCR negative sample realizations indicated high interindividual variability with a surprisingly fluctuating pattern among 43% of patients. No definitive COVID-19 symptoms or set of symptoms excepting anosmia (59%) and/or ageusia (47%) were identified. No preexisting medical conditions specifically foreshadowed disease trajectory in a given patient. Without a PCR negativity requirement for quarantine cessation, patients could exhibit fewer symptoms. Our study therefore highlights the urgent need for routine ambulatory patient telemedicine monitoring, early complication detection, intensive mass education connecting disease demeanor with subsequent swift diagnostics, and, notably, the need to reevaluate and modify quarantine regulations for better control of SARS-CoV-2 proliferation.

Has Covid-19 reduced the management of end-stage kidney disease in 2020?

The SARS-CoV-2 pandemic has been associated with a drop in diagnoses of several diseases in 2020, including cancers. In this letter addressed to the editor, the Groupement des Néphrologues Francophones de Belgique (GNFB), assessed whether there was a similar effect concerning end-stage renal disease (ESRD). Data of patients with ESRD form 25 of the 26 centers constituting the GNFB register were collected. In conclusion, the year 2020 was marked by an 8% drop in the incidence of overall treatments for ESRD. A particularly marked decline in outpatient dialysis initiation programs (PD and HDD). In addition, the interruption of transplant programs in academic centers as well as the closure of ambulatory patient clinics in a majority of hospitals was associated with a delay in nephrological management.

COVID-19’s Natural Course Among Ambulatory Monitored Outpatients

Background: Research objective was to detail COVID-19’s natural trajectory in relation to the Czech population’s viral load.Methods: Our prospective detailed daily questionnaire-based telemonitoring study evaluated COVID-19’s impact among 105 outpatients. In accordance with government quarantine requirements, outpatients were divided into a cohort with two negative tests at the end of the disease (40 patients) and a cohort with a new algorithm (65 patients) following a fourteen-day quarantine.Results: Median follow-up differed significantly between the 2 groups (23 days vs. 16 days). Only 6% of patients were asymptomatic during the entire telemonitoring period. 13% of patients were diagnosed asymptomatic, as suspected contacts, yet later developed symptoms, while the remaining 81% were diagnosed on average 6 days following symptom onset. Telemonitoring enabled precise symptom status chronicling. The most frequently reported complaints were fevers, respiratory issues, and anosmia. Six patients were eventually hospitalized for complications detected early after routine telemonitoring. During the extended follow-up (median 181 days), anosmia persisted in 26% of patients. 79% of patients in the new quarantine algorithm cohort reported no symptoms on day 11 compared to just 56% of patients in the two negative test cohort upon first testing negative (median–19 days). The highest viral load occurred within 0-2 days of initial symptom onset. Both the PCR viral load and two consecutive PCR negative sample realizations indicated high interindividual variability with a surprisingly fluctuating pattern among 43% of patients.Conclusions: No definitive COVID-19 symptoms or set of symptoms excepting anosmia (59%) and/or ageusia (47%) were identified. No preexisting medical conditions specifically foreshadowed disease trajectory in a given patient. Without a PCR negativity requirement for quarantine cessation, patients could exhibit fewer symptoms. Our study therefore highlights the urgent need for routine ambulatory patient telemedicine monitoring, early complication detection, intensive mass education connecting disease demeanor with subsequent swift diagnostics, and, notably, the need to reevaluate and modify quarantine regulations for better control of SARS-CoV-2 proliferation.

Leveraging an Ambulatory Patient and Family Advisory Council to Improve Patient Experience Scores

Reports have shown that ambulatory primary care practices that include patients and families in their quality improvement efforts have many benefits including better relationships and interactions with patients. In this paper, we describe our experience of involving our patients, family, and staff who are members of or Patient and Family Advisory Council (PFAC) in our quality improvement efforts related to patient experience. For a year, members of the PFAC suggested creative implementations to our office policies and workflow to improve satisfaction scores on the Clinician and Group Consumer Assessment of Health care Providers and Systems survey in key areas: information about delays, wait times in clinic, and convenience of appointments.

Synchronous Bilateral Local Medial Sural Artery Perforator Flaps for “Hooker Knees”

Pressure sores restricted to the knee region in an ambulatory patient are extremely unusual. However, this can be an occupational hazard for the prostitute who is not given the courtesy of adequate breaks to prevent simultaneous bilateral knee tissue ischemia. The existence of this condition to date has been poorly discussed in the reconstructive literature. Yet treatment varies little from the basic principles for pressure sore management. Once that is completed, the medial sural artery perforator flap donor site usually remains uninvolved by any etiological mechanisms and provides a local flap with a long pedicle that potentially can permit the necessary synchronous coverage of the bilateral “hooker knee.”