Background
Advancements in medical technology and increased life expectancy have been described as contributing to the evolution of endocarditis. We sought to determine whether there has been a change in the incidence, demographics, microbiology, complications, and outcomes of infective endocarditis over a ten-year time span.
Methods
We screened 28,420 transthoracic and transesophageal echocardiogram reports performed at our center for the following indications: fever, masses, emboli (including stroke), sepsis, bacteremia, and endocarditis in two time periods: 1999 through 2000 and 2009 through 2010. Data were collected from diagnosed endocarditis cases.
Results
Overall, 143 cases of infective endocarditis were analyzed (48 in 1999-2000 and 95 in 2009-2010). The endocarditis incidence per number of admissions remained nearly constant at 0.113% for 1999-2000 and 0.148% for 2009-2010 (p = 0.153). However, tricuspid valve involvement increased markedly from 6% to 36% (p < 0.001). Also, reported history of intravenous drug use increased from 15% to 40% (p = 0.002). Valvular complications doubled from 17% to 35% (p = 0.031). Septic pulmonary emboli increased from 10% to 25% (p = 0.047). Despite these noted differences, inpatient mortality remained unchanged at 25% and 28% (p = 0.696) for the two time periods, respectively.
Conclusions
The incidence of endocarditis at our center has not changed and mortality remains high, but the “face of endocarditis” in Kentucky has evolved with an increased incidence of tricuspid valve involvement, valvular complications, and embolic events.
Background
The COVID-19 lockdown imposed a sudden change in lifestyle with self-isolation and a rapid shift to the use of technology to maintain clinical care and social connections.
Objective
In this mixed methods study, we explored the impact of isolation during the lockdown on the use of technology in older adults with type 1 diabetes (T1D).
Methods
Older adults (aged ≥65 years) with T1D using continuous glucose monitoring (CGM) participated in semistructured interviews during the COVID-19 lockdown. A multidisciplinary team coded the interviews. In addition, CGM metrics from a subgroup of participants were collected before and during the lockdown.
Results
We evaluated 34 participants (mean age 71, SD 5 years). Three themes related to technology use emerged from the thematic analysis regarding the impact of isolation on (1) insulin pump and CGM use to manage diabetes, including timely access to supplies, and changing Medicare eligibility regulations; (2) technology use for social interaction; and (3) telehealth use to maintain medical care. The CGM data from a subgroup (19/34, 56%; mean age 74, SD 5 years) showed an increase in time in range (mean 57%, SD 17% vs mean 63%, SD 15%; P=.001), a decrease in hyperglycemia (>180 mg/dL; mean 41%, SD 19% vs mean 35%, SD 17%; P<.001), and no change in hypoglycemia (<70 mg/dL; median 0.7%, IQR 0%-2% vs median 1.1%, IQR 0%-4%; P=.40) during the lockdown compared to before the lockdown.
Conclusions
These findings show that our cohort of older adults successfully used technology during isolation. Participants provided the positive and negative perceptions of technology use. Clinicians can benefit from our findings by identifying barriers to technology use during times of isolation and developing strategies to overcome these barriers.
BACKGROUND
Background: The COVID-19 lockdown imposed a sudden change in lifestyle with self-isolation and a rapid shift to the use of technology to maintain clinical care and social connections.
OBJECTIVE
Objective: In this mixed-methods study, we explored the impact of isolation during the lockdown on the use of technology in older adults with Type 1 Diabetes (T1D)
METHODS
Methods: Older adults (age ≥65 years) with T1D using continuous glucose monitoring (CGM) participated in semi-structured interviews during the COVID-19 lockdown. A multidisciplinary team coded the interviews. In addition, CGM metrics from a subgroup of participants were collected before and during the lockdown.
RESULTS
Results: We evaluated 34 participants (age 71±5 years). Three themes related to technology use emerged from the thematic analysis regarding the impact of isolation on: 1) insulin pump and CGM use to manage diabetes including timely access to supplies, and changing Medicare eligibility regulations; 2) technology use for social interaction, and 3) telehealth use to maintain medical care. The CGM data from a subgroup (n=19; age 74±5 years) showed an increase in time in range (57±17 vs 63±15%; p= 0.001), a decrease in hyperglycemia (>180 mg/dL) (41±19 vs 35±17; p< 0.001), and no change in hypoglycemia (<70 mg/dL) (0.7% vs 1.1%) during the lockdown, compared to before.
CONCLUSIONS
Conclusion: These findings show our cohort of older adults successfully used technology during isolation. Participants provided positive and negative perceptions of technology use. Clinicians can benefit from our findings by identifying barriers to technology use during times of isolation and developing strategies to overcome these barriers.
CLINICALTRIAL
Clinicaltrials.gov NCT03078491
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