Management of post-acute covid-19 in primary care

BMJ, Journal Year: 2020, Volume and Issue: unknown, P. m3026 - m3026

Published: Aug. 11, 2020

What you need to know• Management of covid-19 after the first three weeks is currently based on limited evidence • Approximately 10% people experience prolonged illness Many such patients recover spontaneously (if slowly) with holistic support, rest, symptomatic treatment, and gradual increase in activity Home pulse oximetry can be helpful monitoring breathlessness Indications for specialist assessment include clinical concern along respiratory, cardiac, or neurological symptoms that are new, persistent, progressive

Language: Английский

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Post-COVID-19 acute sarcopenia: physiopathology and management

Aging Clinical and Experimental Research, Journal Year: 2021, Volume and Issue: 33(10), P. 2887 - 2898

Published: July 30, 2021

Abstract In this review, we discuss the pathophysiologic and management aspects of acute sarcopenia in relation to SARS-CoV-2 infection. COVID-19 is as a multi-organ infectious disease characterized by severe inflammatory highly catabolic status, influencing deep changes body build, especially amount, structure, function skeletal muscles which would amount acutely developed sarcopenia. Acute may largely impact patients’ in-hospital prognosis well vulnerability post-COVID-19 functional physical deterioration. The individual outcome degree muscle mass loss be influenced multiple factors, including patient’s general pre-infection medical condition, older adults. This paper gathers information about how hyper-inflammatory involvement exacerbates immunosenescence process, enhances endothelial damage, due mitochondrial dysfunction autophagy, induces myofibrillar breakdown degradation. aftermath these complex immunological SARS-CoV-2-related phenomena, augmented anosmia, ageusia altered microbiota lead decreased food intake exacerbated catabolism. Moreover, imposed inactivity, lock-down, quarantine or hospitalization with bedrest intensify process. All deleterious mechanisms must swiftly put check multidisciplinary approach nutritional support, early cardio-pulmonary rehabilitation, psychological support cognitive training. proposed holistic patients appears essential minimize disastrous outcomes allow avoiding long syndrome.

Language: Английский

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Early rehabilitation in post-acute COVID-19 patients: data from an Italian COVID-19 Rehabilitation Unit and proposal of a treatment protocol

European Journal of Physical and Rehabilitation Medicine, Journal Year: 2020, Volume and Issue: 56(5)

Published: Nov. 1, 2020

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic is quickly spreading, putting under heavy stress health systems worldwide and especially Intensive Care Units (ICU). Rehabilitation have a crucial role in reducing disability order to reintroduce patients the community.AIM: The aim of this study characterize pulmonary function status propose an early rehabilitation protocol cohort post-acute COVID-19 admitted Italian Unit.DESIGN: Cross-sectional observational study.SETTING: Inpatients Unit.POPULATION: Post-acute patients.METHODS: Demographic, anamnestic clinical characteristics, laboratory exams medical imaging findings were collected for entire cohort. Outcome measures evaluated at admission Unit were: type respiratory supports needed, fraction inspired oxygen (FiO2), partial pressure (PaO2), FiO2/PaO2, Barthel Index (BI), modified Medical Research Council (mMRC) Dyspnoea Scale, 6-Minute Walking Test (6-MWT). Furthermore, we proposed based on baseline FiO2.RESULTS: We included 32 (22 male 10 female), mean aged 72.6±10.9 years. BI was 45.2±27.6, with need higher FiO2 (≥40%) showing lower values: 39.6±25.7 vs. 53.3±29.3. All had grade 4 or 5 mMRC Dyspnea Scale. Only 14 able walk (43.7%). 6-MWT feasible 6 (18.8%) distance 45.0±100.6 meters.CONCLUSIONS: Taken together, our suggest that suffered from dyspnea shortness breath even minimal activities, resulting severe disability, only few them perform poor results. An according conditions patients.CLINICAL REHABILITATION IMPACT: This could provide accurate description sub-acute along proposal treatment help physicians tailor best possible rehabilitative treatment.

Language: Английский

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Tackling challenges in care of Alzheimer's disease and other dementias amid the COVID‐19 pandemic, now and in the future

Alzheimer s & Dementia, Journal Year: 2020, Volume and Issue: 16(11), P. 1571 - 1581

Published: Aug. 12, 2020

We have provided an overview on the profound impact of COVID-19 upon older people with Alzheimer's disease and other dementias challenges encountered in our management dementia different health-care settings, including hospital, out-patient, care homes, community during pandemic. also proposed a conceptual framework practical suggestions for providers tackling these challenges, which can apply to general, or without neurological diseases, such as stroke parkinsonism. believe this review will provide strategic directions set standards leaders dementia, governmental bodies around world coordinating emergency response plans protecting caring amid COIVD-19 outbreak, is likely continue at varying severity regions medium term.

Language: Английский

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Beneficial effects of multi-disciplinary rehabilitation in postacute COVID-19: an observational cohort study

European Journal of Physical and Rehabilitation Medicine, Journal Year: 2021, Volume and Issue: 57(2)

Published: May 1, 2021

The Coronavirus Disease 2019 (COVID-19) pandemic increases the demand for postacute care in patients after a severe disease course. Various long-term sequelae are expected and rehabilitation medicine is challenged to support physical cognitive recovery.We aimed explore dysfunctions outcome of COVID-19 survivors early rehabilitation.Observational cohort study.This study evaluated hospitalized SARS-CoV-2 infection analyzed rehabilitative outcomes subgroup included prospective observational multicenter CovILD study.A total 23 subjects discharged critical underwent an individualized, multiprofessional rehabilitation. At start rehabilitation, impairment pulmonary function (87%), symptoms related postintensive syndrome, neuropsychological dysfunction (85%) were frequently found, whereas cardiac appeared be largely unaffected. Of interest, multi-disciplinary resulted significant improvement lung function, as reflected by increase forced vital capacity (P=0.007) expiratory volume one second (P=0.014), (P=0.003), diffusion carbon monoxide (P=0.002). Accordingly, performance status significantly improved mean six-minute walking distance 176 (SD±137) meters. Contrarily, considerable proportion still had limited (83%) or neurological including peripheral neuropathy at end rehabilitation.Individuals course present with persisting hospital discharge. Those benefit from inpatient rehabilitation.Our data demonstrated highly promising effects COVID-19. This findings urge further evaluations may impact future treatment strategies.

Language: Английский

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COVID-19 pandemic: health impact of staying at home, social distancing and ‘lockdown’ measures—a systematic review of systematic reviews

Journal of Public Health, Journal Year: 2021, Volume and Issue: 43(3), P. e462 - e481

Published: March 23, 2021

Abstract Background To systematically review the evidence published in systematic reviews (SR) on health impact of staying at home, social distancing and lockdown measures. We followed a approach, line with PRISMA guidelines. Methods In October 2020, we searched databases Cochrane Database Systematic Reviews, Ovid Medline, Embase Web Science, using pre-defined search strategy. Results The literature yielded an initial list 2172 records. After screening titles abstracts, by full-text screening, 51 articles were retained included analysis. All them referred to first wave coronavirus disease 2019 pandemic. direct that was covered greatest number (25) SR related mental health, 13 healthcare delivery 12 infection control. predominant areas indirect impacts studies relate economic impacts. Only three mentioned negative education. Conclusions focus so far has been uneven, receiving most attention. measures contain spread virus can be indirect, having both intended unintended consequences. Highlights

Language: Английский

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Effectiveness of Telerehabilitation in Physical Therapist Practice: An Umbrella and Mapping Review With Meta–Meta-Analysis

Physical Therapy, Journal Year: 2021, Volume and Issue: 101(5)

Published: Feb. 19, 2021

Telerehabilitation is an option that should be adapted as soon possible to face the crisis caused by coronavirus disease 2019. An umbrella and mapping review with meta-meta-analysis (MMA) of available scientific evidence was performed determine whether telerehabilitation could effective alternative conventional rehabilitation in physical therapist practice.A systematic reviews a synthesis findings all published date visual map were performed. A search realized Cochrane Database Systematic Reviews, MEDLINE (PubMed), Google Scholar. Two independent reviewers data analysis assessed quality included reviews, assessing risk bias using ROBIS.Twenty-nine articles met inclusion criteria selected divided according type patient targeted for (patients cardiorespiratory, musculoskeletal, neurological conditions). The MMA regarding function between usual care did not reveal statistically significant difference patients cardiorespiratory musculoskeletal conditions. For conditions, revealed but negligible effect size 6 favor (standardized mean = 0.18; 95% CI 0.03-0.34).The results present showed offers positive clinical results, even comparable face-to-face approaches.The advantages lower cost less interference processes patients' daily life justify implementing settings 2019 era.

Language: Английский

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Long COVID and Health Inequities: The Role of Primary Care

Milbank Quarterly, Journal Year: 2021, Volume and Issue: 99(2), P. 519 - 541

Published: March 30, 2021

Policy Points An estimated 700,000 people in the United States have "long COVID," that is, symptoms of COVID-19 persisting beyond three weeks. and its long-term sequelae are strongly influenced by social determinants such as poverty structural inequalities racism discrimination. Primary care providers a unique position to provide coordinate for vulnerable patients with long COVID. measures should include strengthening primary care, optimizing data quality, addressing multiple nested domains inequity.

Language: Английский

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Pulmonary Rehabilitation in a Post-COVID-19 World: Telerehabilitation as a New Standard in Patients with COPD

International Journal of COPD, Journal Year: 2021, Volume and Issue: Volume 16, P. 379 - 391

Published: Feb. 1, 2021

Abstract: Pulmonary rehabilitation (PR) is effective in reducing symptoms and improving health status, exercise tolerance of patients with chronic obstructive pulmonary disease (COPD). The coronavirus 19 (COVID-19) pandemic has greatly impacted PR programs their delivery to patients. Owing fears viral transmission resultant outbreaks COVID-19, institution-based have been forced significantly reduce enrolment or some cases completely shut down during the pandemic. As a majority COPD are elderly multiple co-morbidities including cardiovascular diabetes, they notably susceptible severe complications COVID-19. such, advised stay at home avoid social contact maximum extent possible. This increased patients' vulnerability physical deconditioning, depression, isolation. To address this major gap care, traditional hospital clinic-centered converted all learning contents home-based telerehabilitation There are, however, significant barriers approach that impeded its implementation community. These include variable access use technology (by patients), lack standardization methods tools for evaluation program, inadequate training resources professionals optimally delivering pressing need high-quality studies on these modalities enable successful via teleconferencing technologies. Here, we highlight importance post-COVID world discuss various strategies clinical implementation. Keywords: rehabilitation, telerehabilitation,

Language: Английский

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Rehabilitation and COVID-19: the Cochrane Rehabilitation 2020 rapid living systematic review

European Journal of Physical and Rehabilitation Medicine, Journal Year: 2020, Volume and Issue: 56(5)

Published: Nov. 1, 2020

INTRODUCTION: This paper improves the methodology of first edition rapid living systematic review started in April 2020, with aim to gather and present current evidence informing rehabilitation patients COVID-19 and/or describing consequences due disease its treatment.EVIDENCE ACQUISITION: The Cochrane for a was applied. Primary research papers, published from 1 January 30 June reporting patients' data, no limits study design were included. Studies categorized design, question, phase, limitations functioning (disability) interest type service involved. Methodological quality assessment based on Risk Bias tools, level table (OCEBM 2011) all other studies.EVIDENCE SYNTHESIS: Thirty-six, out 3703 One 2 (RCT), 7 3 (2 cohort studies, cross-sectional studies case-control studies), 28 papers 4 (descriptive studies); 61% reported epidemiological data clinical presentations, 5 investigated natural history/determining factors, searched prevalence, intervention efficacy (though not harms), looked at health organization.CONCLUSIONS: Main issues emerging review: it is advised test people neurological disorders presenting symptom changes; dysphagia frequent complication after oro-tracheal intubation admitted ICU; discharge, survivors may report persistent restrictive ventilatory deficits regardless severity; there only sparse low concerning any promote functional recovery; substantial increase resource (staff equipment) needed rehabilitation.

Language: Английский

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