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Background and purpose

Countries, facing the challenge of COVID-19, need to provide services that can adapt to fluctuations in demand and changing circumstances. In 2020, the Australian Government established 140 COVID-19 testing and screening ‘respiratory disease clinics’ across Australia. Our clinic, the first to open in Victoria, established a safe, effective and adaptive model of care employing a casual workforce of health assistants from multiple training backgrounds. This paper describes a model of care that can adjust to continue to screen patients for COVID-19, whilst simultaneously rolling out vaccinations aimed at preventing infection.

Methods

The respiratory clinic operates across two sessions, with three clinicians providing clinical services and Covid-19 testing. The patient transits through three phases of care after making an appointment:

-Telephone registration and nurse-triage, from offices located above the clinic

-In clinic assessment and testing, via drive-through or in-room consultation, determined clinically

-Post-consultation notification of results to the patient and their regular GP, and data reporting.

Health assistants book appointments, guide patients, assist with infection control, remotely transcribe consultations (using video-consultation from the clinic) and complete post-visit notifications. New staff are trained using a buddy system.

Results

The adaptive model entails appointments for sessional vaccination clinics are made only when a nurse is satisfied that patients have enough information to provide informed consent. Patients attend for nurse-led vaccinations in cohorts, guided and supported by health assistants. Vaccination details and notifications are gathered and transcribed remotely by video.

Conclusions

This ‘Pandemic-flexible’ model of care, where clinicians are supported by health assistants, can be further adapted to accommodate different clinical scenarios.

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Male reproductive health and SARS-COV-2: what General Practitioners should know and do (part of a study)

Background and purpose:

After 1 year of COVID-19 crisis increasing number of scientific publications are reporting warrying facts about the impact of SARS-COV-2 on male reproductive health. Despite the successes in the diagnostics, we still do not have reliable methods for early detection of various organ damages and effective treatment of this disease.

Methods:The authors present part of a PhD study on male reproductive health in General Practice (bibliographic review) during COVID-19 crisis and questionnaires for GPs and patients with some targeted questions.

Results: Scientific publications search and analysis have proven men are more affected by SARS-COV-2 than women because of the role of ACE2 and TMPRSS2 in the testis and male reproductive system. Some very important for the general practice questions are outlined in this PhD study: (1) To what extent GPs are aware of the mechanisms of the impact of SARS-COV-2 on male reproductive system (especially impaired spermatogenesis), different clinical representations, signs and symptoms of COVID-19 and eventual development of orchitis or tumors caused by SARS-CoV-2. (2) To what extent and how patients are informed about possible future reproductive problems related to SARS-COV-2 and COVID-19. (3) Communication difficulties when talking with patients about these sensitive problems. (4) Suggestions about prophylaxis and preservation of male reproductive health in general practice. Authors also propose short educational course for GPs on this important issue.

ConclusionsS

SpecialGeneral Practice targeted measures should be undertaken to prevent, detect and treat male reproductive health problems related to SARS-COV-2 and COVID-19.

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Background and purpose

Covid infection is associated with an unpredictable, rapid, fall in oxygen levels for some patients, which can be overlooked as silent hypoxia. Detecting this fall can help improve survival by providing earlier treatments, such as steroids and high flow oxygen. Home oximetry was a management option that emerged early in the Covid pandemic, but is still not yet widely applied. Oxygen saturation monitors are readily purchased by individuals and their use is now supported, as a priority, by Public Health England and, internationally, by the World Health Organisation (WHO).

Methods

We provide case reports, description of service development, and analysis to outline the development of one of the first UK supported home oxygen saturation self-monitoring services and its impact within one English Clinical Commissioning Group (CCG), covering 550,000 people.

Results

We present the case report that triggered the provision of oximeters to patients in March 2020 and led to the development of a full service in West Hampshire CCG. The outcomes, including policy adoption in the UK and WHO, and the development of analysis by university partners will be presented. Cut off oxygen levels for admission and treatment will be outlined. Early patient feedback indicates increased feelings of support and that older patients prefer telephone support to digital solutions.

Conclusions

Oxygen saturation self-monitoring for Covid is achievable and a good example of integrated care and system working. It empowers patients and, has potential to reduce admissions, morbidity and mortality. As a relatively low cost intervention it can be instigated by patients independently or in conjunction with healthcare providers.

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1.Background and purpose:
From the beginning of the global pandemic in Serbia, Primary care center “ Vozdovac „ has established a special COVID19 department. During the period of ten months, 37285 were admitted for examination. Given the high number of SARS-Cov2 positive patients in the country, hospitals capacities were limited and many patients were assigned home treatment through primary care physicians. In response of facing large number of patients seeking medical help, we introduced telemedical communications.

2. Method: retrospective case series study

3. Results: This study includes 8344 patients who tested positive for SARS Cov2 . Goal of the study was to demonstrate how early identification of symptoms for home-treated patients is important to evaluate their condition and the need for hospitalization. After initial examination and testing, patients were sent home for isolation and stayed in communication with their doctors, sharing information about their health and symptoms. We used modified MEWS score to evaluate patient current status, and schedule an additional testing and appointments. Points assignment included systolic BP, heart and respiratory rate, temperature and AVPU score. Assessment also included interpretation of blood tests and oxygen saturation levels. 77.1% of patient had score below 4 with no or mild risk of ICU admission, and they were contacted every 2-3 days, 1621 patients had score from 5-6, that demanded caution and daily monitoring. Score 7 and above had 288 patients who were immediately hospitalized.

4. Conclusion: Continuous outpatient monitoring using telemedicine and additional follow-ups played an important role in identification of early signs of deterioration and necessity for hospital treatment.

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INTRODUCTION:

The COVID-19 disease, the global health threat, is frequently associated with neurological complications, including strokes. The bibliography describing the pathophysiological pathways of those clinical manifestations is increasingly abundant.

BRIEF CLINICAL HISTORY:

A 50-year-old male with a history of arterial hypertension and type 2 diabetes mellitus, without any toxic habits, consulted the E.R., after being hospitalized for COVID-related pneumonia for 8 days, because of hemiparesis of the right upper limb and mixed dysphasia of 8 hours of evolution. The urgent CT-scan was performed, and multiple ischaemic infarcts of early, subacute evolution were found in the left frontal-parietal lobar surface with premotor frontal involvement and in the anterior cortical vascular border territory, described as secondary to COVID-19 infection. Due to the time of evolution and location of the occlusion, the acute-phase treatment was discharged, and the patient was admitted to the Internal Medicine Ward for a conservative treatment.

FINAL DIAGNOSIS:

COVID-19 related ischaemic stroke

DISCUSSION:

Cerebrovascular events, especially ischaemic strokes are frequently related to COVID-19 infection. The hypercoagulability, similar to the one described in septic shock, can be the origin. On the other hand, the COVID-19 binds to ACE-2 (angiotensin-converting enzyme 2) in brain endothelium and cellular membranes, leaving many organs, including the brain itself exposed to the harmful effect of ACE-1. Although, there are some other studies that point out that the ischaemic events cannot be considered as a major complication of COVID-19 infection.

The goal of this review, inspired by the quoted case report, is to exam the clinical, neurological manifestations and pathophysiological pathways.