The Evidence Speaks Series is a recurring feature highlighting the latest in CHÉOS research. This series features summaries of select publications as well as in-depth features on the latest work from our investigators. The Series is designed to keep media and the research community up-to-date with CHÉOS’ current research results in the health outcomes field.
White CA, Kappel JE, Levin A, Moran SM, Pandeya S, Thanabalasingam SJ, On behalf of the CSN COVID-19 Rapid Response Team. Management of Advanced Chronic Kidney Disease During the COVID-19 Pandemic: Suggestions From the Canadian Society of Nephrology COVID-19 Rapid Response Team. Can J Kidney Health Dis. 2020 Jul 19 epub ahead of print.
Patients with kidney disease are more likely to suffer complications from COVID-19 and from changes in their usual level of health care support. CHÉOS Scientist Dr. Adeera Levin joined the Canadian Society of Nephrology (CSN) COVID-19 Rapid Response Team to help address challenges in the care of patients with advanced chronic kidney disease (CKD) during the ongoing pandemic. Through reviewing a number of COVID-19 and CKD documents and programs, the CSN have developed guidance on how to provide the best possible care to patients with advanced CKD who typically receive multidisciplinary care using a model that takes into account the resources that are currently available. Their guidance covers a breadth of topics, including: adherence to clinic visit schedules; the use of telehealth; how multidisciplinary care be provided; advice for patients on bloodwork; education to be provided to patients; how patients can monitor aspects of their health at home; when to refer to multidisciplinary care; advice on kidney replacement therapy; how medications be provided and monitored; the availability of PPE; and discussions with patients about COVID-19 risk in CKD. The suggestions put forward in this manuscript have been determined with the primary goal of protecting patients and health care workers from COVID-19. The guidance will enable the best care possible be provided during the pandemic.
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Hawke LD, Barbic SP, Voineskos A, Szatmari P, Cleverley K, Hayes E, Relihan J, Daley M, Courtney D, Cheung A, Darnay K, Henderson JL. Impacts of COVID-19 on Youth Mental Health, Substance Use, and Well-being: A Rapid Survey of Clinical and Community Samples: Répercussions de la COVID-19 sur la santé mentale, l’utilisation de substances et le bien-être des adolescents : un sondage rapide d’échantillons cliniques et communautaires. Can J Psychiatry. 2020 Jul 14 epub ahead of print.
There have been multiple publications regarding the psychological and mental health impacts of the COVID-19 pandemic, and interventions to address them. However, there has been little research on mental health and substance use (MHSU) among youth during pandemics, limiting the ability to meet this population’s needs. CHÉOS Scientist Dr. Skye Barbic collaborated with a team from Toronto to conduct a cross-sectional survey to rapidly understand how COVID-19 is affecting youth MHSU, well-being, coping, and unmet needs. The ultimate aim is to enhance knowledge surrounding the impacts of public health crises on youth MHSU and well-being. The results of the survey show that many youth are concerned about their mental health; they perceive their mental health to have deteriorated since before the pandemic and report that there have been substantial disruptions to mental health services. The survey also shows that, while substance use seems to have declined as a whole, a subset of youth report using substances to cope. Some participants report positive impacts and are using various coping strategies to manage their wellness. The participants also shared some ideas of strategies that could help support youth during the pandemic. As a whole, this study encourages service planners to use these findings to increase support for young people during these trying times. They should think outside the box and offer accessible MHSU services remotely or in-person (respecting physical distancing requirements), where necessary. Service providers should also ensure that reliable information is readily available for youth and that positive coping strategies are emphasized.
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Lauck S, Forman J, Borregaard B, Sathananthan J, Achtem L, McCalmont G, Muir D, Hawkey MC, Smith A, Kirk BH, Wood DA, Webb JG. Facilitating transcatheter aortic valve implantation in the era of COVID-19: Recommendations for programmes. Eur J Cardiovasc Nurs. 2020 Jun 4 epub ahead of print.
People living with severe aortic stenosis are often elderly and suffer from comorbidities and frailty. Transcatheter aortic valve implantation (TAVI) is a minimally invasive treatment that can help improve patients’ lives. During COVID-19, there have been challenges with providing treatments to older people and, in cases of severe aortic stenosis, this can result in emergency hospital admissions and worsening of symptoms. In this paper, CHÉOS Scientist Dr. Sandra Lauck and team outline several recommendations to optimize access to TAVI during the COVID-19 pandemic. The authors emphasize the importance of the TAVI programme nurse, and suggest a review of the in-person assessment pathway to ensure physical distancing and avoid delays in treatment decisions. For patients preparing for admission, it is recommended that the separate pre-procedure appointment and consultation with the anaesthesiologist be used more discriminately to mitigate the risks of COVID-19. Furthermore, because wait time for TAVI is associated with adverse events and worse outcomes, the authors suggest that TAVI programs adopt processes to enable active monitoring of patients on the wait list and appropriate queuing of procedures. A minimalist approach to TAVI is also recommended; this refers to fully optimized activities aimed at achieving the best outcome without compromising patient safety. Finally, the priorities of care in the post-procedure phase should include close monitoring, early mobilization and accelerated reconditioning, and discharge planning. While critical care contingency plans must be in place, most TAVI patients can be transferred to a cardiac monitoring ward, reducing the impact of TAVI on ICUs. These recommendations could help TAVI programs facilitate access to care without compromising safety and enable hospitals to manage competing demands created by COVID-19.
