Effect of patient COVID-19 vaccine hesitancy on hospital care team perceptions

BACKGROUNDThe coronavirus disease 2019 (COVID-19) pandemic posed new challenges in patient care worldwide. Vaccinations, which have proven efficacious in lowering the COVID-19 hospital burden, are still avoided by large populations. We, therefore, hypothesized that hospital care teams would have worse perceptions regarding the characteristics and care of patients with vaccine hesitancy.AIMTo evaluate whether patient vaccine hesitancy affected the hospital care team (HCT) perceptions.METHODSWe performed a prospective clinical study using structured questionnaires. We approached physicians and nurses with previous experience caring for COVID-19 patients from 11 medical centers across Israel during the fourth COVID-19 surge (September and October 2021). The participants completed a questionnaire with the following parts: (1) Sociodemographic characteristics; (2) Assessment of anger (STAXI instrument) and chronic workplace stress (Shirom-Melamed burnout measure); and (3) Three tools to assess the effect of patient vaccine hesitancy on the HCT perceptions (the difficult doctor-patient relation questionnaire, the medical staff perception of patient’s responsibility questionnaire and the characterological derogation questionnaire). Results were evaluated according to each part of the questionnaire and the questionnaire as a whole. Associations between HCT perceptions and their baseline characteristics, anger or chronic workplace stress were assessed.RESULTSThe HCT experienced their relationship with unvaccinated patients as more difficult (P < 0.001, Cohen’s d = 0.85), perceived unvaccinated patients as responsible for their medical condition (P < 0.001, d = 1.39) and perceived vaccinated patients as having a higher character value (P < 0.001, d = 1.03). Unvaccinated patients were considered selfish (P < 0.001), less mature (P < 0.001) and less satisfying to care for (P < 0.001). The relationship with unvaccinated patients was more difficult among HCT with higher burnout (r = 0.37, n = 66, P = 0.002). No correlations with baseline characteristics were found. All three study tools showed high internal consistency (α between 0.72 and 0.845).CONCLUSIONOur results should raise awareness of the possible effects of vaccine hesitancy on HCT perceptions regarding unvaccinated patients. In order to minimize the potential negative impact on patient care, designated departments should promote specific patient-centered preparations. Further investigations should assess whether vaccine hesitancy directly affects patient quality of care.     

Safety,usability, and performance of a wireless left atrial pressure monitoring system in patients with heart failure: the VECTOR-HF trial

Aims

In heart failure (HF), implantable haemodynamic monitoring devices have been shown to optimize therapy, anticipating clinical decompensation and preventing hospitalization. Direct left-sided haemodynamic sensors offer theoretical benefits beyond pulmonary artery pressure monitoring systems. We evaluated the safety, usability, and performance of a novel left atrial pressure (LAP) monitoring system in HF patients.

Methods and results

The VECTOR-HF study (NCT03775161) was a first-in-human, prospective, multicentre, single-arm, clinical trial enrolling 30 patients with HF. The device consisted of an interatrial positioned leadless sensor, able to transmit LAP data wirelessly. After 3 months, a right heart catheterization was performed to correlate mean pulmonary capillary wedge pressure (PCWP) with simultaneous mean LAP obtained from the device. Remote LAP measurements were then used to guide patient management. The miniaturized device was successfully implanted in all 30 patients, without acute major adverse cardiac and neurological events (MACNE). At 3 months, freedom from short-term MACNE was 97%. Agreement between sensor-calculated LAP and PCWP was consistent, with a mean difference of −0.22 ± 4.92 mmHg, the correlation coefficient and the Lin's concordance correlation coefficient values were equal to 0.79 (p < 0.0001) and 0.776 (95% confidence interval 0.582–0.886), respectively. Preliminary experience with V-LAP-based HF management was associated with significant improvements in New York Heart Association (NYHA) functional class (32% of patients reached NYHA class II at 6 months, p < 0.005; 60% of patients at 12 months, p < 0.005) and 6-min walk test distance (from 244.59 ± 119.59 m at baseline to 311.78 ± 129.88 m after 6 months, p < 0.05, and 343.95 ± 146.15 m after 12 months, p < 0.05).

Conclusion

The V-LAP™ monitoring system proved to be generally safe and provided a good correlation with invasive PCWP. Initial evidence also suggests possible improvement in HF clinical symptoms.     

Persistence and perceived consequences of cannabis use and dependence among young adults: implications for policy

AIMS: To document patterns of cannabis use and dependence from late-adolescence through to the mid-twenties; to describe perceived consequences of cannabis use among young people; and to consider policy implications of these findings. METHODS: This was a longitudinal study of the Dunedin Multidisciplinary Health and Development Study birth cohort with repeated measures of cannabis use at ages 18, 21 and 26 years. RESULTS: Twelve month prevalence rates of cannabis use (just over 50%) and dependence (just under 10%) remained stable between age 21 and 26 years, contrary to an expected decline. Cannabis dependence, as distinct from occasional use, was associated with high rates of harder drug use, selling of drugs and drug conviction. Cumulatively, almost 3/4 of our cohort had tried cannabis by age 26. Young people thought the risk of getting caught using cannabis was trivial, and that using cannabis had few negative social consequences. CONCLUSIONS: The persistent high rates of cannabis use and dependence among young New Zealand adults raises important issues for policy makers. Current laws are not particularly effective in deterring use. Whereas occasional use does not appear to present a serious problem, cannabis dependence among users is a serious public health issue that warrants immediate action.     

Comparison of the pharmacokinetics of fosinoprilat with enalaprilat and lisinopril in patients with congestive heart failure and chronic renal insufficiency

AIMS: To compare the serum pharmacokinetics of fosinoprilat with enalaprilat and lisinopril after 1 and 10 days of dosing with fosinopril, enalapril and lisinopril. METHODS: Patients with congestive heart failure (CHF, NYHA Class II-IV) and chronic renal insufficiency (creatinine clearance 相似文献   

Treatment of avulsed clavicle and recurrent subluxations of the ipsilateral shoulder by dynamic fixation

A new operative approach is presented for treatment of fractured distal end of clavicle associated with recurrent anterior shoulder subluxations. One case is presented in which open reduction of the fractured clavicle and stabilizing the anterior shoulder joint were accomplished by transfer of the coracoid process with its attached muscles under the subcapularis muscle onto the clavicle. The operation was followed by complete reduction of the fracture and a stable shoulder joint.     

Lateral distribution of ovarian dermoid cyst

STUDY OBJECTIVE: To determine the distribution of ovarian dermoid cysts in a large series of women. DESIGN: Observational study (Canadian Task Force classification II-3). SETTING: University teaching hospitals. PATIENTS: Three hundred thirty-six women. INTERVENTION: Evaluation of operative reports. MEASUREMENTS AND MAIN RESULTS: Dermoid cysts had a mean diameter of 5.6 cm. They were present in the right ovary (48.8 %), left ovary (37.8%), and bilaterally (13.4%). Unilateral cysts were more frequent in the right ovary (56.4%) than in the left (p = 0.002, odds ratio 1.7, confidence interval 1.2-2.3). This was significantly different from the expected 50% (4.45, chi2). A similar predisposition was found when we included women with bilateral cysts (p < 0.01, OR 1.5, CI 1.1-1.9). Patient age and size of cyst did not differ between those with left and right lesions. CONCLUSION: In this large cohort of women, ovarian dermoid cysts had a predisposition to a right lateral location.