Safe at Last? Late Effects of a Mass Immunization Campaign on Households' Economic Insecurity

We study the effects of receiving immunization from COVID-19 on households' economic insecurity. To provide causal estimates we use a fuzzy regression discontinuity design which takes advantage of the UK's immunization plan. The plan was primarily based on age, granting differential eligibility to proximate cohorts. Our estimated local average treatment effect indicates that the share of households who declared being economically insecure dropped by 41 percentage points among those who received the vaccine due to the eligibility criteria. Using a difference-in-discontinuity design we next document that immunization was more salient for women as well as for large households and those with children. Our results suggest that the mass immunization campaign against COVID-19 had relevant short-run economic effects, well beyond its expected impact on people's health.

A Quality Improvement Project Impacts Resident Satisfaction with the Depart Process

Purpose of Study The current depart process resulted in slow work-flow and patient safety and equity concerns. The QI project aimed to improve resident satisfaction with the hospital discharge process. Methods Used The QI project was designed using the Model for Improvement. Starting April 2020, Plan-Do-Study-Act cycles included: hiring clinical team coordinators;creating standard depart instructions for diabetic ketoacidosis, pyelonephritis, seizures, croup and dehydration;uploading instructions to Powerchart;and clinician reminders to use instructions with families. Measures examined monthly, included resident satisfaction and patient readmissions. Summary of Results Resident satisfaction improved from 4.8 (February 2020) to 7.8 (August 2020) for the overall discharge process;from 5.3 to 7.9 for family education on all key points;from 6.0 to 7.7 for smooth transition of care;from 3.0 to 7.4 for no language barriers;and from 3.0 to 6.7 for no unnecessary delays, on a scale of 0/strongly disagree/ terrible to 10/strongly agree/excellent. Readmissions also trended downward. Conclusions During this QI project to address the depart process, resident satisfaction improved and readmissions declined. These results are encouraging, but should be interpreted in the context of decreased patient census due to COVID-19 and non-respiratory season, which may have decreased workload and increased education time and interpreter access. Next steps include PDSAs related to health literacy and Spanish translation.

A Sensitive and Practical Evaluation to Detect Lower-Limb Strength Changes in Geriatrics: The Isometric Knee Extension Test

This study aimed to examine the sensitivity of the isometric knee extension (IKE) test to detect changes in the lower-limb strength of institutionalized older adults after exercise and inactivity periods. Thirty-four and fifteen institutionalized older adults completed the training and inactive periods, respectively. At each time point, the participants completed two testing sessions. In the first session, they performed the IKE test. As a complement to this evaluation, the second testing session was used to assess their functional capacity and handgrip strength. The sensitivity of the IKE test was examined by comparing the changes generated in this test against the repeatability of the protocol. A 4-week multicomponent Vivifrail program was implemented. After that, a subsample of the participants was re-evaluated after a 14-week inactivity period. Significant changes (p < 0.01;ES ≥ 0.27) in the IKE strength for both the dominant (+0.27 N/kg) and non-dominant legs (+0.25 N/kg) were produced after the training intervention. Likewise, significant decrements (p < 0.01;ES ≥ 0.31) were detected after the inactive period for the dominant (−0.29 N/kg) and non-dominant legs (−0.32 N/kg). All mean changes were found to be superior to the variability threshold of the IKE test for both legs, with superior sensitivity for the non-dominant leg (≥73%). Thus, the IKE test is a sensitive and practical tool for detecting changes in the lower-limb strength of institutionalized older adults after exercise and inactivity periods. Because of its applicability, it seems pertinent to implement the IKE test in a geriatric context. © 2023 by the authors.

Incidental Appendiceal Tumors During Appendectomy: A 19-year Retrospective Review at a Municipal Hospital

Introduction: Appendectomy is the most common emergency surgical procedure. While non-operative management (NOMA) has gained popularity, particularly during the COVID pandemic, there is concern that NOMA might miss appendiceal tumors, including malignant ones. We sought to investigate the incidence and distribution of appendiceal tumors among appendectomy patients to determine its impact on the decision to pursue NOMA. Methods: We conducted a retrospective review of 1694 appendectomies for acute appendicitis at our institution between January 2001 and December 2019, to identify pathology-confirmed neoplasms in appendiceal specimens. Results: We identified 24 tumors among 1694 cases, with an incidence of 1.43% and average age of 48.7 years. This included 9 Low Grade Appendiceal Mucinous Neoplasms (LAMNs), 6 neuroendocrine tumors (NETs), 6 Mucoceles without adenoma, and one each of adenocarcinoma, endometrioma, and neurofibroma. The incidence in our sample had a bimodal distribution, with peaks in the 2nd and 5th decades of life. Twenty cases were managed by appendectomy alone, with only 4 requiring colectomy. 4 of 24 cases with tumors (16.66%) also had appendicoliths while 343 of 1670 (20%) without neoplasms had appendicoliths. Conclusion: Appendiceal tumors were rare in our series, and most were cured with appendectomy alone. LAMNs and NETs were the most common tumors identified. All patients under 40 had relatively benign disease, and overall tumor incidence had a bimodal distribution, similar to other series. Incidence of appendicoliths was unaffected by the presence of tumor. We conclude that NOMA is a safe alternative to surgery in patients under 40.

Risk perception and the impact of the sars-cov-2 (Corona virus) pandemic on rheumatic diseases in Mexico

Objectives: To describe risk perception and its relationship with sources of information consulted, actions, and the impact of the pandemic on the physical and mental health as well as social aspects of a group of patients from the rheumatology consultation. Methods: A survey was conducted from August 10 to November 29, 2020 in rheumatic diseases (RD) patients who returned to an outpatient clinic in Mexico following the Stay at home program implemented from March 23 to July 31. An online questionnaire was administered on mobile devices. Measurements: Assessment of the patient's health status by rheumatologist (visual analog scale ranging 0-10) and some sections of the UNIV-COVID-19 questionnaire. A descriptive analysis was performed. Measures of central tendency and dispersion for continuous variables and frequency measures for categorical variables. Normality was checked with the Shapiro-Wilk test. Inferential statistical tests were performed to determine differences between the COVID-19 + vs -groups with Chi-square and Student's t test for nominal and continuous sociodemographic variables, respectively. Logistic regressions were performed. Results: A total of 471 patients with RD were included, 84.5% women, aged 46.9 (SD 14.5) years old;rheumatoid arthritis (RA) was the most prevalent diagnosis 42.4%. 4.8%had SARS-CoV-2 infection, 21.74% required hospitalization. Treatment modification was reported in 36.1% (66.6% discontinued);health condition worsened in 39.1% of the patients. 52.1% of the patients who made modifications in their treatment had COVID-19 and 39.1% of those who had COVID-19 reported that their health condition worsened. The perception of risk was 85.9% (very serious/serious). The preventive action carried out was home isolation 44.3%. Television was consulted 88.7%and alert 74.5%the most prevalent feeling, while 7% said they felt discriminated. The logistic regression analysis revealed that having SpA, taking leflunomide, feeling discriminated, and greater perception of risk were associated with having COVID-19. The bimodal results for each variable are presented to indicate the change on action taken per group. Conclusion: The risk perception in RD patients was very high. 5% had COVID-19. The impact on disease activity, physical/mental health was greater in patients with COVID-19. Discrimination of RD and COVID-19 patients is an important phenomenon.