COVID-19 Care Research Articles

Medical Board Discipline of Physicians for Spreading Medical Misinformation.

False medical information disseminated dangerously during the COVID-19 pandemic, with certain physicians playing a surprisingly prominent role. Medical boards engendered widespread criticism for not imposing forceful sanctions, but considerable uncertainty remains about how the professional licensure system regulates physician-spread misinformation. To compare the level of professional discipline of physicians for spreading medical misinformation relative to discipline for other offenses. This cross-sectional study analyzed and coded publicly reported medical board disciplinary actions in the 5 most populous US states. The analysis included data from January 1, 2020, through May 30, 2023, for California, Florida, New York, and Pennsylvania and from January 1, 2020, through March 30, 2022, for Texas. Medical board disciplinary proceedings that resulted in some form of sanction were analyzed. Codes were assigned for the different types of offenses relied on by medical boards for imposing physician discipline. Among 3128 medical board disciplinary proceedings in the 5 most populous states, spreading misinformation to the community was the least common reason for medical board discipline of physicians (6 [0.1%] of all identified offenses). Two reasons tied for third least common: patient-directed misinformation (21 [0.3%]) and inappropriate advertising or patient solicitation (21 [0.3%]). The frequency of misinformation conduct was exponentially lower than more common reasons for discipline, such as physician negligence (1911 [28.7%]), problematic record-keeping (990 [14.9%]), and inappropriate prescribing (901 [13.5%]). Patient-directed misinformation provided a basis for discipline 3 times as often as spreading misinformation to the community. The frequency of disciplinary actions for any reasons related to COVID-19 care, even if not about misinformation, was also quite low (10 [0.2%]). Sanctions in misinformation actions tended to be relatively light. The frequency of discipline for physician-spread misinformation observed in this cross-sectional study was quite low despite increased salience and medical board warnings since the start of the COVID-19 pandemic about the dangers of physicians spreading falsehoods. These findings suggest that there is a serious disconnect between regulatory guidance and enforcement and that medical boards relied on spreading misinformation to patients as a reason for discipline 3 times more frequently than disseminating falsehoods to the public. These results shed light on important policy concerns about professional licensure, including why, under current patient-centered frameworks, this form of regulation may be particularly ill-suited to address medical misinformation.

Supporting Long Covid Care: a webtool to facilitate help-seeking among people with Long Covid

Abstract Background Long Covid (also known as Post-COVID19 Condition or Post-COVID Syndrome) is characterised by persistent symptoms following SARSCoV2 infection not explained by other pathology. Some evidence suggests that people from marginalised communities are more likely to experience Long Covid but are less likely to be represented in post-covid care in England. Objectives Findings from the STIMULATE-ICP case finding and HI-COVE studies show that some people living with Long Covid struggle to get adequate healthcare and social support. Barriers to obtaining support include a lack of awareness of Long Covid and supports available, uncertainty around the cause and complexity of symptoms, as well as experiences and expectations of stigma. The new Supporting Long Covid Care (SLCC) webtool was developed based on these findings and aimed to both facilitate help-seeking for people with probable Long Covid who are not receiving care and raise awareness among professionals. Extensive engagement with people with lived experience and professionals shaped the webtool. SLCC content was then beta-tested with stakeholders. Results SLCC (long-covid-care.org.uk) was launched in March 2024. One of its features is the acknowledgement that Long Covid can be a stigmatising condition. SLCC includes real-life quotes to connect emotionally with users, highlights the shared experiences of people living with Long Covid and illustrates the difficulties faced when seeking recognition and support. It encourages conversations with professionals, friends, family and others who may be relied on for support and offers resources to facilitate those conversations and inform next steps. SLCC is also an informative tool for healthcare professionals around Long Covid stigma. Conclusions SLCC is open to use by members of the public. Real-world evaluation and translation to other languages are now needed to explore if this webtool is beneficial and contributes towards addressing health inequalities. Key messages • SLCC encourages people with probable Long Covid to seek help and support. • SLCC raises awareness among healthcare professionals about the barriers and stigma people, particularly those from disadvantaged backgrounds, may face when considering reaching out for support.

Overlapping conditions in Long COVID at a multisite academic center.

Many patients experience persistent symptoms after COVID-19, a syndrome referred to as Long COVID (LC). The goal of this study was to identify novel new or worsening comorbidities self-reported in patients with LC. Patients diagnosed with LC (n = 732) at the Mayo Long COVID Care Clinic in Rochester, Minnesota and Jacksonville, Florida were sent questionnaires to assess the development of new or worsening comorbidities following COVID-19 compared to patients with SARS-CoV-2 that did not develop LC (controls). Both groups were also asked questions screening for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), generalized joint hypermobility (GJH) and orthostatic intolerance. 247 people with LC (33.7%) and 40 controls (50%) responded to the surveys. In this study LC patients averaged 53 years of age and were predominantly White (95%) women (75%). The greatest prevalence of new or worsening comorbidities following SARS-CoV-2 infection in patients with LC vs. controls reported in this study were pain (94.4% vs. 0%, p < 0.001), neurological (92.4% vs. 15.4%, p < 0.001), sleep (82.8% vs. 5.3%, p < 0.001), skin (69.8% vs. 0%, p < 0.001), and genitourinary (60.6% vs. 25.0%, p = 0.029) issues. 58% of LC patients screened positive for ME/CFS vs. 0% of controls (p < 0.001), 27% positive for GJH compared to 10% of controls (p = 0.026), and a positive average score of 4.0 on orthostatic intolerance vs. 0 (p < 0.001). The majority of LC patients with ME/CFS were women (77%). We found that comorbidities across 12 surveyed categories were increased in patients following SARS-CoV-2 infection. Our data also support the overlap of LC with ME/CFS, GJH, and orthostatic intolerance. We discuss the pathophysiologic, research, and clinical implications of identifying these conditions with LC.

Experience of caring for patients with COVID-19 and educational achievement among Japanese resident physicians: a nationwide survey with general medicine in-training examination

BackgroundAs healthcare professional trainees, resident physicians are expected to help with COVID-19 care in various ways. Many resident physicians worldwide have cared for COVID-19 patients despite the increased risk of burnout. However, few studies have examined the experience with COVID-19 care among resident physicians and its effects on competency achievement regarding clinical basics and COVID-19 patient care.MethodThis nationwide, cross-sectional Japanese study used a clinical training environment questionnaire for resident physicians (PGY-1 and − 2) in 593 teaching hospitals during the General Medicine In-Training Examination in January 2021. The General Medicine In-Training Examination questions comprised four categories (medical interviews and professionalism; symptomatology and clinical reasoning; physical examination and clinical procedures; and disease knowledge) and a COVID-19-related question. We examined the COVID-19 care experience and its relationship with the General Medicine In-Training Examination score, adjusting for resident and hospital variables.ResultsOf the 6,049 resident physicians, 2,841 (47.0%) had no experience caring for patients with COVID-19 during 2020. Total and categorical General Medicine In-Training Examination scores were not different irrespective of the experience with COVID-19 patient care. For the COVID-19-related question, residents with experience in COVID-19 care showed a significant increase in correct response by 2.6% (95% confidence interval, 0.3–4.9%; p = 0.028).ConclusionsThe resident physicians’ COVID-19 care experience was associated with better achievement of COVID-19-related competency without reducing clinical basics. However, approximately half of the residents missed the critical experience of caring for patients during this unparalleled pandemic in Japan.

Function and activity capacity at 1 year after the admission to intensive care unit for COVID-19

Objective To describe hand grip strength, walking speed, functional mobility, and postural control at one year following intensive care unit admission for COVID-19, and to find any predictors that are associated with impaired hand grip strength, walking speed, functional mobility, or postural control at the 1-year follow-up. Design Retrospective cross-sectional and longitudinal observational study. Setting Intensive care unit and outpatient research clinic at Sahlgrenska University Hospital. Participants Of the 105 individuals in “The Gothenburg Recovery and Rehabilitation after COVID-19 and Intensive Care Unit” cohort, 78 participated in this study. Main measures Descriptive statistics for hand grip strength, walking speed, functional mobility, and postural control were presented and binary logistic regressions were performed to find their significant predictors. Results At 1-year following intensive care unit admission for COVID-19, impaired hand grip strength was found in 24.4% for the right hand and 23.1% for the left hand. Walking speed, functional mobility, and postural control were found to be impaired in 29.5%, 21.8%, and 5.1%, respectively. For impaired walking speed, longer length of stay at intensive care unit and presence of diabetes mellitus were risk factors. Diabetes mellitus was found to be the risk factor for impaired functional mobility. Conclusion In this study, 45% of the participants showed impairment in function, activity capacity or both. These results suggest that individuals who recovered after intensive care unit admission for COVID-19 would benefit from receiving long-term follow-up to enable identification of those with need of physical health assistance and rehabilitation.

Perspectives and lived experiences of survivors and caregivers of COVID-19 patients in a teaching hospital in a tribal district of Chhattisgarh, India

ABSTRACT Background: The rural–urban healthcare disparity in India was exacerbated during the COVID-19 pandemic, with the second wave hitting rural areas particularly hard due to weak infrastructure. A study in Chhattisgarh aims to explore the experiences of severely ill COVID-19 survivors and caregivers to inform patient-centric care delivery in primary settings. Methods: In this qualitative study, we conducted in-depth interviews with seven patients and seven caregivers during home visits or telephonically to understand lived experiences of receiving care for COVID-19 in an ICU in the public health system. Socioecological model was used to guide the qualitative inquiry. Results: COVID-19 patients faced stigma due to their diagnosis. The survivors felt lonely due to isolation, uncertainty about their illness, and fear of death. Poor mental health during ICU stay affected their physical health. Patients with caregivers felt supported despite visitor restrictions. Transparent communication with health providers reduced distress. Conclusion: The study in Chhattisgarh, India, highlights ICU survivors’ and caregivers’ experiences, revealing fear and loneliness among patients. Effective communication and caregiver presence improve outcomes, emphasizing holistic support. There’s an urgent need for palliative care integration, caregiver inclusion, and comprehensive post-discharge follow-up by primary-level practitioners in rural settings. Lack of state-level palliative care policy emphasizes the need for comprehensive initiatives to enhance healthcare outcomes.

Risk factors for infection after carbapenem-resistant Acinetobacter baumannii colonization

PurposePredicting infection risk in carbapenem-resistant Acinetobacter baumannii (CRAB) colonized patients may help in improving timely appropriate antibiotic therapy. This study aims to explore risk factors for developing infections in hospitalized patients with previous CRAB colonization.MethodsWe performed an observational retrospective cohort study at ASST Sette Laghi-Varese Hospital between January 2020 and December 2022. All consecutive adult (> 18 years old) hospitalized patients with documented colonization by CRAB at any anatomical site or with CRAB infections preceded by CRAB colonization were included. Univariate and multivariate analyses were performed to investigate infection risk factors.ResultsOverall, 144 patients were included in the study: 104 colonized only and 40 infected patients. Colonization and infection rates significantly changed over the years (2020–2022, p < 0.001). The incidence of infections in CRAB carriers was 27.8% (40/144). Median time from colonization to infection was 4 days (IQR 1-8.5). Overall, inhospital mortality was 32.7% and 55.0% in colonized only and infected patients, respectively. At the multivariable logistic regression cardiovascular disease (OR 5.83, 95% CI 1.12–30.43, p = 0.037), COVID-19 (OR 3.72, 95% CI 1.16–11.91, p = 0.027) and intensive care unit (ICU) admission (OR 8.83, 95% CI 2.94–26.51, p < 0.001) were risk factors independently associated with cardiovascular disease CRAB infection after colonization.ConclusionsWe observed an increased infection risk in patients colonized with CRAB with cardiovascular disease, COVID-19 and admitted in ICU setting. Additional evidence is needed to identify predictors of infection in colonized patients.

COVID-19 and Cancer Care: A Review and Practical Guide to Caring for Cancer Patients in the Era of COVID-19.

COVID-19, a novel infectious disease caused by the emergence of the SARS-CoV-2 virus in 2020, has had a profound impact on healthcare, both at the individual and population level. The impact at the population level was felt most acutely during the emergency phase of the pandemic, with hospital capacity issues leading to widespread disruptions and delays in the delivery of healthcare services such as screening programs and elective surgeries. While hospitals are no longer being acutely overwhelmed by COVID-19 patients, the impact of the virus on vulnerable patient populations such as cancer patients continues to be of ongoing consequence. Cancer patients remain at high risk of hospitalization, ICU admission, and death due to COVID-19, even in the era of vaccination. Infection prevention and risk mitigation strategies such air quality control, masking, testing, vaccination, and treatment should therefore be integrated into the usual care and counseling of cancer patients moving forward to avoid preventable morbidity and mortality from this infection and ensure the safety of this vulnerable cohort as they navigate their cancer diagnosis and treatment in the era of COVID-19.

The Relationship Between Nurses’ Moral Distress, Their Spiritual Well-Being, and Moral Intelligence

Background: Intensive Care Unit (ICU) and Emergency Department (ED) nurses have faced several moral challenges during the COVID-19 pandemic. The factors associated with nurses’ moral distress (MD) can vary depending on the cultural context. Objectives: This study aimed to determine the relationship between MD, spiritual well-being (SWB), and moral intelligence (MQ) of nurses in ICUs and EDs during the COVID-19 pandemic. Methods: This descriptive cross-sectional study was conducted in 2020. The data were collected using self-report questionnaires, including those for personal and professional profiles, Corley’s Moral Distress Scale-Revised, Paloutzian &amp; Ellison’s Spiritual Well-being, and Lennick &amp; Kiel’s Moral Intelligence. Of the 543 nurses working in the ICUs and EDs of hospitals in Zanjan Province (Iran), 370 participants were selected by census sampling. Results: The study results indicated that 90.8% of nurses experienced high MD. The results of the partial correlation test showed no statistically significant relationship between nurses' MD and their SWB or MQ (P &gt; 0.001). Nurses with an associate's degree (P = 0.019) and those working in the EDs (P = 0.001) and the COVID-19 care center hospital (P = 0.001) had higher levels of MD. Religious well-being and the educational level of nurses could predict only 2.5% of the variations in nurses’ MD. Conclusions: This study showed that SWB and MQ of nurses are not related to nurses’ MD, unlike environmental factors. It is recommended that managers provide more support to reduce nurses’ MD in critical situations, such as during the COVID-19 pandemic.

A Quasi Experimental Study to Assess the Effectiveness of Jacobson’s Progressive Muscle Relaxation Therapy on Anxiety and Quality of Sleep Among Covid-19 Patients at Selected Covid Care Centre, Coimbatore

Global prevalence of anxiety and depression increased to 25% during the first year of pandemic. Pandemic is not just a medical phenomenon; it affected individuals, society and caused emotional disruptions, anxiety, stress, stigma and sleep problems. Aim: The present study was undertaken with the aim to assess the effectiveness of Jacobson’s Progressive Muscle Relaxation Therapy on anxiety and quality of sleep among COVID-19 patients. Methodology: A quantitative approach with Quasi-Experimental, one group pretest-posttest design was adopted. A purposive sampling technique was used to recruit the study participants, and the sample size was 60. Pretest level of anxiety and quality of sleep were assessed using Hamilton Anxiety Rating Scale and Modified Pittsburgh Sleep Quality Index. Jacobson’s progressive muscle relaxation therapy (JPMR) was administered in individual session for 20 minutes, one session per day for 6 consecutive days. Posttest was conducted by using same questionnaires on the 7th day, after the intervention. Results: ‘z’ test was used to compare the level of anxiety before and after the intervention, the calculated value z=4.85 was greater than the tabulated value 3.29 at 0.001 level of significance. With regard to the quality of sleep before and after intervention, the calculated value z=5.87 was greater than the tabulated value 3.29 at 0.001 level of significance. Conclusion: The study concluded that Jacobson's Progressive Muscle Relaxation Therapy was effective in reducing the anxiety and improving the sleep quality among COVID-19 patients.

Unbiased care, unequal outcomes: a nursing telehealth intervention reveals systematic inequities in COVID-19 care delivery

BackgroundThe Covid Connected Care Center (C4), a low-barrier telephone nurse hotline, was developed at an academic medical center to increase access to healthcare information and services across the state of Oregon, including to those without a usual source of care. Other studies have demonstrated that telephone triage services can positively influence health behaviors, but it is not known how this effect is maintained across racial/ethnic groups. The objective of this study was to show that the C4 reached throughout the state of Oregon, was valuable to callers, and that recommendations given affected callers’ subsequent health-related behaviors.MethodsThis mixed-methods study, informed by the RE-AIM (Reach, Effectiveness, Addoption, Implementation and Maintenance) framework, assessed caller demographics and clinical care from March 30 2020 until September 8, 2021. Descriptive statistics, multivariable risk models and Zou’s modified Poisson modeling were applied to electronic health record and call system data; An inductive approach was used for patient and staff experience surveys and semi-structured interviews. Approval was obtained from the OHSU Institutional Review Board (Study 00021413).Results145,537 telephone calls and 92,100 text-based contacts (61% and 39%, respectively) were included. Callers tended to not have a usual source of primary care and utilized recommended services. Emergency department utilization was minimal (1.5%). Racial or ethnic disparities were not detected in the recommendations, but Black (RR 0.92, CI 0.86–0.98) and Multiracial (RR 0.90 CI 0.81–0.99) callers were less likely than non-Hispanic white callers to receive a COVID-19 test. Participants in the post-call survey (n = 50) would recommend this service to friends or family. Interviews with callers (n = 9) revealed this was because they valued assistance translating general recommendations into a personalized care plan. C4 staff interviewed (n = 9) valued the opportunity to serve the public. The C4 was a trusted resource to the public and reached the intended audiences. However, disparities in access to COVID-19 testing persisted.ConclusionsNursing triage hotlines can guide caller behavior and be an effective part of a robust public health information infrastructure.

Long COVID Illness: Disparities in Understanding and Receipt of Care in Emergency Department Populations

BackgroundMost Long COVID studies rely on traditional surveillance methods that miss underserved populations who use emergency departments (EDs) as their primary health care source. ObjectivesIn medically-underserved ED populations, we sought to determine 1) whether there are gaps in awareness and self-declared understanding about Long COVID illness, and 2) the prevalence, impact, and receipt of care for Long COVID symptoms. Design, Setting and ParticipantsCross-sectional, convenience sample survey study of adult patients at 11 geographically representative US EDs from 12/2022-10/2023. MeasurementsAwareness and self-declared understanding about Long COVID illness; prevalence, impact, and receipt of care for Long COVID symptoms. ResultsOf 1618 eligible patients,1455 (89.9%) agreed to participate: 33.4% African American, 30.9% Latino/a, and 17.1% lacked primary care; 33.2% had persistent COVID symptoms lasting > 1-month, 20.3% had symptoms > 3-months; 49.8% with Long COVID symptoms missed work/school because of symptoms; 30.3% of all participants and 33.5% of participants who had Long COVID symptoms had prior awareness and self-declared understanding of Long COVID. Characteristics associated with poor understanding of Long COVID were: African American race (adjusted odds ratio [aOR] 3.68, 95% confidence interval [CI] 2.66-5.09) and Latino/a ethnicity (aOR 3.16, 95% CI 2.15-4.64). Participants lacking primary care were less likely to have received Long COVID care (24.6% vs 51.2%; difference 26.6%; 95% CI 13.7-36.9%). Conclusions/RelevanceDespite high prevalence and impact of Long COVID symptoms, most of this ED population had limited awareness and self-declared understanding of Long COVID and many had not received care. EDs should consider development of protocols for diagnosis, education, and treatment of Long COVID illness.

Recent Scenario of the Indian Healthcare System Post COVID-19 Emergence and in Severely ill Patients

Abstract: The coronavirus disease 2019 pandemic has brought fundamental changes to our priorities and problems, especially those related to the healthcare sector. The COVID-19 pandemic put even the world's most advanced healthcare systems to the test and India's healthcare system has been rattled as well. In this accordance, the Indian government has introduced many new policies and schemes like free vaccination drive, Atmanirbhar Bharat, and free COVID care under Ayushman Bharat. With the continuation of COVID-19, problems like Self-medication and hoarding of medicines among the common population keep on rising and this was due to flu-like symptoms of COVID-19, miss information on social media, or due to less or no interaction between patients and doctors as the population is now shifting to telemedicine which offers the benefit of consultation at their own home. These situations served as a boon to the Pharma sector as stocks of many pharma companies and industries have been reported to have increased in the past 2 years of the pandemic due to an increase in demand and manufacturing and consumption of pharmaceutical goods and also reportedly being increased by alot in coming years. However, this rapid growth of the pharmaceutical sector is beneficial for pharmacists, businessmen, and others who are directly or indirectly associated with the healthcare fraternity but in our opinion, it will negatively impact the Indian economy or can be viewed as a problem which can lead to the downfall of the qualitative aspect of the pharma sector in the long term.

Monitoring of myocardial injury by serial measurements of QRS area and T area: The MaastrICCht cohort.

Manually derived electrocardiographic (ECG) parameters were not associated with mortality in mechanically ventilated COVID-19 patients in earlier studies, while increased high-sensitivity cardiac troponin-T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were. To provide evidence for vectorcardiography (VCG) measures as potential cardiac monitoring tool, we investigated VCG trajectories during critical illness. All mechanically ventilated COVID-19 patients were included in the Maastricht Intensive Care Covid Cohort between March 2020 and October 2021. Serum hs-cTnT and NT-proBNP concentrations were measured daily. Conversion of daily 12-lead ECGs to VCGs by a MATLAB-based script provided QRS area, T area, maximal QRS amplitude, and QRS duration. Linear mixed-effect models investigated trajectories in serum and VCG markers over time between non-survivors and survivors, adjusted for confounders. In 322 patients, 5461 hs-cTnT, 5435 NT-proBNP concentrations and 3280 ECGs and VCGs were analyzed. Non-survivors had higher hs-cTnT concentrations at intubation and both hs-cTnT and NT-proBNP significantly increased compared with survivors. In non-survivors, the following VCG parameters decreased more when compared to survivors: QRS area (-0.27 (95% CI) (-0.37 to -0.16, p < .01) μVs per day), T area (-0.39 (-0.62 to -0.16, p < .01) μVs per day), and maximal QRS amplitude (-0.01 (-0.01 to -0.01, p < .01) mV per day). QRS duration did not differ. VCG-derived QRS area and T area decreased in non-survivors compared with survivors, suggesting that an increase in myocardial damage and tissue loss play a role in the course of critical illness and may drive mortality. These VCG markers may be used to monitor critically ill patients.

Translation and cultural adaptation of the COVID-19 Yorkshire Rehabilitation Scale into German.

Experts estimate that in up to 10% of the infected, SARS-CoV-2 would cause persistent symptoms, activity limitations and reduced quality of life. Referred to as long COVID, these conditions might, in the future, specifically impact German-speaking countries due to their higher rates of unvaccinated people compared to other Western countries. Accurate measurement of symptom burden and its consequences is needed to manage conditions such as long COVID, and several tools have been developed to do so. However, no patient-reported instrument existed in the German language at the time of writing. This study, therefore, aimed to develop a German version of the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS). We conducted a translation and qualitative evaluation, including cultural adaptation, of the C19-YRS and assessed its face validity. After creating a preliminary version, 26 individuals (14 women [53%]) participated in cognitive interviews (January 2022 to March 2022). Using cognitive debriefing interviews, we ensured the content's comprehensibility. The matrix-framework method guided the qualitative data analysis. Compared to the original English version, adaptations were necessary, resulting in changes to the introductory text, while the items for recording persistent symptoms were hardly changed. The German version of the C19-YRS is expected to support standardized long COVID care.

Challenges in Receiving Care for Long COVID: A Qualitative Interview Study Among Primary Care Patients About Expectations and Experiences.

For many patients with post-COVID-19 condition (long COVID), primary care is the first point of interaction with the health care system. In principle, primary care is well situated to manage long COVID. Beyond expressions of disempowerment, however, the patient's perspective regarding the quality of long COVID care is lacking. Therefore, this study aimed to analyze the expectations and experiences of primary care patients seeking treatment for long COVID. A phenomenological approach guided this analysis. Using purposive sampling, we conducted semistructured interviews with English-speaking, adult primary care patients describing symptoms of long COVID. We deidentified and transcribed the recorded interviews. Transcripts were analyzed using inductive qualitative content analysis. This article reports results from 19 interviews (53% female, mean age = 54 years). Patients expected their primary care practitioners (PCPs) to be knowledgeable about long COVID, attentive to their individual condition, and to engage in collaborative processes for treatment. Patients described 2 areas of experiences. First, interactions with clinicians were perceived as positive when clinicians were honest and validating, and negative when patients felt dismissed or discouraged. Second, patients described challenges navigating the fragmented US health care system when coordinating care, treatment and testing, and payment. Primary care patients' experiences seeking care for long COVID are incongruent with their expectations. Patients must overcome barriers at each level of the health care system and are frustrated by the constant challenges. PCPs and other health care professionals might increase congruence with expectations and experiences through listening, validating, and advocating for patients with long COVID.Annals Early Access article.

Returning to work and health status at 12 months among patients with COVID-19 cared for in intensive care—A prospective, longitudinal study

ObjectiveIntensive care unit (ICU) stay for a serious illness has a long-term impact on patients’ physical and psychological well-being, affecting their ability to return to their everyday life. We aimed to investigate whether there are differences in health status between those who return to work and those who do not, and how demographic characteristics and illness severity impact patients’ ability to return to work 12 months after intensive care for COVID-19. Research methodologyThis was a prospective longitudinal cohort study. The participants were patients who had been in intensive care for COVID-19 and had worked before contracting COVID-19. Data on return to previous occupational status, demographic data, comorbidities, intensive care characteristics, and health status were collected at a 12-month follow-up visit. SettingGeneral ICU at the Uppsala University Hospital in Sweden. ResultsSeventy-three participants were included in the study. Twelve months after discharge from the ICU, 77 % (n = 56) had returned to work. The participants who were unable to return to work reported more severe health symptoms. The (odds ratio [OR] for not returning to work was high for critical illness OR, 12.05; 95 % confidence interval [CI], 2.07–70.29, p = 0.006) and length of ICU stay (OR, 1.06; 95 % CI, 1.01–1.11, p = 0.01) ConclusionTwo-thirds of the participants were able to return to work within 1 year after discharge from the ICU. The primary factors contributing to the failure to work were duration of the acute disease and presence of severe and persistent long-term symptoms. Implications for clinical practicePatients’ health status must be comprehensively assessed and their ability to return to work should be addressed in the rehabilitation process. Therefore, any complications faced by the patients must be identified and treated early to increase the possibility of their successful return to work.

Rapid Establishment of a Tertiary Level Makeshift COVID-19 Care Hospital in New Delhi during Second Wave of the COVID-19 Pandemic

Rapid Establishment of a Tertiary Level Makeshift COVID-19 Care Hospital in New Delhi during Second Wave of the COVID-19 Pandemic

Knowledge Management in the COVID-19 Era

The pandemic has been a watershed in the knowledge management that is carried out in Higher Education Institutions (HEIs). Studies on vulnerability and resilience risks highlight material, financial and human resources as the central axis of the knowledge network, although research on stigma indicates that mistrust prevails between decision makers and those who carry them out. Therefore, the objective of this work was to contrast the hypotheses related to knowledge management as a regulatory process of trust relationships between the parties involved. A cross-sectional, exploratory, and correlational study was carried out with a sample of 10 professional practitioners and social workers involved in COVID-19 care. The results show that a structure of nodes prevails that begins with innovation, continues with competitiveness and ends with efficiency as central, unifying and structural axes of information translation and knowledge transfer. The results are not extensive to the university community, although they are innovative because they highlight trust as the guiding principle of knowledge management.

Navigating Uncertainty with Compassion: Healthcare Assistants' Reflections on Balancing COVID-19 and Routine Care through Adversity.

The coronavirus disease 2019 pandemic created unprecedented challenges for healthcare systems around the world. Healthcare assistants played a vital role in the provision of frontline patient care during this crisis. Despite their important contribution, there exists limited research that specifically examines the healthcare assistant's experiences and perspectives of care provision during the COVID-19 pandemic. This study explored healthcare assistants' caring experiences and perspectives on resilience and self-efficacy during the COVID-19 pandemic in Hong Kong. A qualitative descriptive study with semi-structured interviews was conducted with 25 healthcare assistants from public hospitals. Interview recordings were analyzed using thematic analysis. Five main themes emerged from the data: frontline reinforcement: supporting HCAs through resourcing and education amidst the COVID-19 crisis, confronting uncertainty: building personal fortitude in the face of the COVID-19 pandemic, fostering collective resilience through shared support, self-efficacy as a catalyst for adaptive growth, and paving the way for transformation. These findings advocate for the resilience and self-efficacy of healthcare assistants; this may potentially strengthen healthcare system preparedness for navigating unpredictable challenges in the future.