Imaging recommendations and algorithms for pediatric tuberculosis: part 1-thoracic tuberculosis.

Tuberculosis (TB) remains a global health problem and is the second leading cause of death from a single infectious agent, behind the novel coronavirus disease of 2019. Children are amongst the most vulnerable groups affected by TB, and imaging manifestations are different in children when compared to adults. TB primarily involves the lungs and mediastinal lymph nodes. Clinical history, physical examination, laboratory examinations and various medical imaging tools are combined to establish the diagnosis. Even though chest radiography is the accepted initial radiological imaging modality for the evaluation of children with TB, this paper, the first of two parts, aims to discuss the advantages and limitations of the various medical imaging modalities and to provide recommendations on which is most appropriate for the initial diagnosis and assessment of possible complications of pulmonary TB in children. Practical, evidence-based imaging algorithms are also presented.

Pandemic coping and COVID-19 preventive behaviors among cancer survivors

Background Cancer survivors are at greater risk for COVID-19 complications, emphasizing the importance of adherence to COVID-19 prevention. Active coping mechanisms can help manage pandemic stress but disengaged coping practices can have adverse effects. Objectives 1) Identify differences in COVID-19 coping styles and COVID-19 preventive behaviors among cancer survivors in active treatment, survivors not in treatment, and a comparison group without a cancer history 2) Exploring variables that may predict adherence to COVID-19 preventative behaviors. Patient Involvement & Methods This study used an online survey among two categories of cancer survivors – one group in active treatment and one group no longer in treatment – and one group without a cancer history (N=897 total). Results and Discussion Cancer survivors in treatment were more likely to utilize both active and disengaged coping (p<.001). This could indicate that the additional COVID-19 strain is making survivors more likely to engage in coping in any way possible. Cancer survivors not in treatment were less likely to report intent to carry out COVID- 19 preventative behaviors compared to the comparison group (p=.009). Providers should understand how survivors may use both coping mechanism types because these coping strategies predict both depression and adherence to COVID-19 preventive behaviors.

Pandemic coping and COVID-19 preventive behaviors among cancer survivors.

BACKGROUND: Cancer survivors are at greater risk for COVID-19 complications, emphasizing the importance of adherence to COVID-19 prevention. Active coping mechanisms can help manage pandemic stress but disengaged coping practices can have adverse effects. OBJECTIVES: 1) Identify differences in COVID-19 coping styles and COVID-19 preventive behaviors among cancer survivors in active treatment, survivors not in treatment, and a comparison group without a cancer history. 2) Exploring variables that may predict adherence to COVID-19 preventative behaviors. PATIENT INVOLVEMENT & METHODS: This study used an online survey among two categories of cancer survivors - one group in active treatment and one group no longer in treatment - and one group without a cancer history (N = 897 total). RESULTS AND DISCUSSION: Cancer survivors in treatment were more likely to utilize both active and disengaged coping (p < .001). This could indicate that the additional COVID-19 strain is making survivors more likely to engage in coping in any way possible. Cancer survivors not in treatment were less likely to report intent to carry out COVID- 19 preventative behaviors compared to the comparison group (p = .009). Providers should understand how survivors may use both coping mechanism types because these coping strategies predict both depression and adherence to COVID-19 preventive behaviors.

Improving Medical Student Mentorship in Orthopaedic Surgery.

Introduction: Owing to limited clinical clerkships and travel restrictions related to COVID-19, recent medical student mentorship in orthopaedic surgery has been impacted negatively. The purpose of this quality improvement (QI) project was to determine if medical student awareness of orthopaedics as a possible career field may be improved through a mentoring program designed and delivered by orthopaedic residents. Methods: A five-resident QI team developed four educational sessions aimed at a medical student audience. Forum topics included: (1) orthopaedics as a career, (2) fracture conference, (3) splinting workshop, and (4) residency application process. Pre- and post-forum surveys were administered to student participants to assess changes in their perceptions regarding orthopaedic surgery. Data derived from the questionnaires were analyzed with nonparametric statistical tests. Results: Of 18 forum participants, 14 were men and 4 were women. A total of 40 survey pairs were collected, averaging 10 per session. In the all-participant encounter analysis, there were statistically significant improvements in all outcome measures including interest in, exposure to, and knowledge of orthopaedics; exposure to our training program; and ability to interact with our residents. Those undecided regarding their specialty demonstrated larger increases in post-forum responses, suggesting that the learning experience was more impactful for that subgroup. Conclusions: This QI initiative was a successful demonstration of orthopaedic resident mentorship of medical students, wherein perceptions of orthopaedics were influenced favorably by the educational experience. For some students with limited access to orthopaedic clerkships or formal one-on-one mentoring, forums like these may be an acceptable alternative.

Between Healthcare Practitioners and Clergy: Evangelicals and COVID-19 Vaccine Hesitancy.

Evangelical Christians are among the most hesitant to get the COVID-19 vaccine. This study examined the extent to which COVID-19 vaccination uptake among Evangelicals is explained by demographic characteristics, Health Belief Model constructs, and faith-based support factors. Survey research firm Qualtrics recruited 531 U.S. adults and conducted a survey to explore predictors of COVID-19 vaccine uptake among people who self-identified as Evangelicals in September 2021. A logistic regression showed that those reporting high perceived benefits of the COVID-19 vaccine were more likely to be vaccinated, while those reporting high perceived barriers were less likely to be vaccinated. Those whose healthcare provider asked them about the vaccine were more likely to be vaccinated than those whose healthcare provider did not ask. Finally, while those who reported information seeking from religious leaders were less likely to be vaccinated, those who reported more faith-based support for vaccination were more likely to be vaccinated. In addition to beliefs about benefits and barriers to vaccination, the role of healthcare providers and clergy were important factors influencing vaccination status. Intervention efforts that capitalize on partnerships between health providers and clergy in supportive congregations may be able to reach undecided Evangelicals.

Endorsement of COVID-19 related misinformation among cancer survivors.

OBJECTIVES: To determine whether cancer survivors currently in treatment are more or less likely to endorse COVID-19 related misinformation compared to their counterparts no longer in treatment and those without a cancer history. METHODS: We conducted a Qualtrics survey among 897 adults to determine differences in endorsement of COVID-19 misinformation among cancer survivors in active treatment, cancer survivors no longer in treatment, and a control group with no cancer history. RESULTS: Cancer survivors currently undergoing treatment were more likely to believe misinformation related to COVID-19 than those without a cancer history. Least likely to endorse COVID-19 misinformation were cancer survivor no longer in treatment. CONCLUSION: These results alert healthcare professionals to overall high levels of endorsement of COVID-19 misinformation among cancer survivors on active treatment. Oncologists and other providers working with patients undergoing treatment for cancer should be particularly mindful of the potential elevated beliefs in misinformation among this group. PRACTICAL IMPLICATIONS: Since patients undergoing cancer treatment seem to be particularly vulnerable to COVID-19 misinformation, oncologists and other healthcare providers working with this patient population should help address patients' concerns about the pandemic and how it relates to their course of treatment.

How Academic Medical Centers Can Navigate the Pandemic and Its Aftermath: Solutions for 3 Major Issues.

The COVID-19 crisis has seriously affected academic medical centers (AMCs) on multiple levels. Combined with many trends that were already under way pre pandemic, the current situation has generated significant disruption and underscored the need for change within and across AMCs. In this article, the authors explore some of the major issues and propose actionable solutions in 3 areas of concentration. First, the impact on medical students is considered, particularly the trade-offs associated with online learning and the need to place greater pedagogical emphasis on virtual care delivery and other skills that will be increasingly in demand. Solutions described include greater utilization of technology, building more public health knowledge into the curriculum, and partnering with a wide range of academic disciplines. Second, leadership recruiting, vital to long-term success for AMCs, has been complicated by the crisis. Pressures discussed include adapting to the dynamics of competitive physician labor markets as well as attracting candidates with the skill sets to meet the requirements of a shifting AMC leadership landscape. Solutions proposed in this domain include making search processes more focused and streamlined, prioritizing creativity and flexibility as core management capabilities to be sought, and enhancing efforts with assistance from outside advisors. Finally, attention is devoted to the severe financial impact wrought by the pandemic, creating challenges whose resolution is central to planning future AMC directions. Specific challenges include recovery of lost clinical revenue and cash flow, determining how to deal with research funding, and the precarious economic balancing act engendered by the need to continue distance education. A full embrace of telehealth, collaborative policy-making among the many AMC constituencies, and committing fully to being in the vanguard of the transition to value-based care form the solution set offered.

U.S. public support for COVID-19 vaccine donation to low- and middle-income countries during the COVID-19 pandemic.

As COVID-19 vaccines become available to the public, there will be a massive worldwide distribution effort. Vaccine distribution has historically been unequal primarily due to the inability of nations with developing economies to purchase enough vaccine to fully vaccinate their populations. Inequitable access to COVID-19 vaccines will not just cause humanitarian suffering, it will likely also be associated with increased economic suffering worldwide. This study focuses on the U.S. population and its beliefs about future COVID-19 vaccine donation by the U.S. to low- and middle-income countries. This study carried out a survey among 788 U.S. adults. Variables include demographics, COVID-19 vaccine priority status, COVID-19 vaccine donation beliefs, and Social Dominance Orientation. Analyses showed that older respondents were both less likely to endorse higher levels of COVID-19 vaccine donations and were more likely to want to wait until all in the U.S. who want the vaccine have received it; those who identified as Democrats were more likely to endorse higher levels of future COVID-19 vaccine donation than Republicans; and those scoring higher on SDO were both less likely to endorse higher levels of COVID-19 vaccine donations as well as more likely to want to wait until all in the U.S. who want the vaccine have received it. Policymakers, as well as healthcare providers and public health communication professionals, should give consideration to those messages most likely to engender support for global prevention efforts with each audience segment.

Willingness to get the COVID-19 vaccine with and without emergency use authorization.

BACKGROUND: This study assessed psychosocial predictors of U.S. adults' willingness to get a future COVID-19 vaccine and whether these predictors differ under an emergency use authorization (EUA) release of the vaccine. METHODS: A survey of 788 U.S. adults was conducted to explore the relationships between demographics and psychosocial predictors of intent to get a future COVID-19 vaccine as well as willingness to get such a vaccine under EUA. RESULTS: Significant predictors of COVID-19 vaccine uptake intentions were education, having insurance, scoring high on subjective norms, a positive attitude toward the vaccine, as well as high perceived susceptibility to COVID-19, high perceived benefits of the vaccine, scoring low on barriers to the vaccine, and scoring high on self-efficacy. Predictors of willingness to take a COVID-19 vaccine under EUA were age, race/ethnicity, positive subjective norms, high perceived behavioral control, positive attitudes toward the vaccine, as well as high perceived susceptibility to COVID-19, high perceived benefits of the vaccine, low barriers to the vaccine, and scoring high on self-efficacy for getting the vaccine. Concerns about rushed vaccine development appear to reduce vaccine uptake intent, as well as willingness to get the vaccine under EUA. CONCLUSIONS: COVID-19 vaccine-related messages should both address concerns about the vaccine and its development and reinforce benefits of the vaccine (both factors significant in both models). Vaccine efforts may need to go beyond just communications campaigns correcting misinformation about a COVID-19 vaccine to also focus on re-establishing public trust in government agencies.

COVID-19-Related Misinformation among Parents of Patients with Pediatric Cancer.

We conducted a survey among 735 parents to determine differences in endorsement of misinformation related to the coronavirus disease pandemic between parents of children in cancer treatment and those with children who had no cancer history. Parents of children with cancer were more likely to believe misinformation than parents of children without cancer.

Cross-sectional Imaging Manifestations of Extrapulmonary Involvement in COVID-19 Disease.

ABSTRACT: Coronavirus disease 2019 (COVID-19) disease has spread worldwide since it was first discovered in China's Hubei province in December 2019. Respiratory illness is the primary manifestation of COVID-19 disease, and its pathophysiology as well as the clinical and cross-sectional imaging manifestations has been adequately reported. However, there is emerging evidence of its multisystemic nature, with associated extrapulmonary manifestations including gastrointestinal, cardiovascular, renal, and neurological findings. There is still limited understanding with regard to the extrapulmonary involvement in this disease. This review aims to put together the prevalence, proposed pathophysiology, and the spectrum of clinical and cross-sectional imaging manifestations of associated extrapulmonary findings in COVID-19 disease.

AMBUCOV : description d’un système de dépistage hospitalier en ambulatoire en réponse à l’épidémie de CoViD-19

Introduction Suite à la déclaration d’épidémie de pneumopathies au nouveau coronavirus CoViD-19 en Chine en décembre 2019, 11 patients ont été confirmés infectés en France du 20/01 au 10/02/2020 dont 5 en Île-de-France. Devant l’afflux de personnes nécessitant un dépistage et le manque de place en unité d’isolement dans les établissements de soins référent (ESR), un système dégradé d’accueil pour le dépistage des cas suspects de CoViD-19 a été élaboré. En concertation avec les autorités sanitaires françaises et la direction de l’hôpital, le département des maladies infectieuses a développé le projet AmbuCoV pour pouvoir accueillir au mieux et sans délais toutes les personnes qui lui étaient adressées. Matériels et méthodes Mise en place d’une unité dédiée pour la prise en charge des personnes nécessitant un dépistage pour le CoViD-19 et ne justifiant pas d’une hospitalisation. L’unité AmbuCoV, ouverte 24h/24 et 7j/7, a fonctionné avec le personnel minimum et respecté un parcours patient développé par l’équipe pluridisciplinaire du service pour le dépistage et l’isolement au sein de l’établissement. Le laboratoire de virologie procédait à deux séries de PCR par jour, avec un rendu des résultats vers 13h pour les prélèvements envoyés avant 8h, et 19h pour ceux envoyés avant 14h. Une évaluation interne a été menée afin d’évaluer quantitativement et qualitativement ce dispositif. Résultats AmbuCoV a été ouvert le 31 janvier 2020 et comprenait 22 lits répartis en 16 chambres. Une infirmière effectuait le prélèvement nasopharyngé et la prise des constantes dans le box dédié en pression négative de l’unite d’isolement. Les personnes sans ATCD et paucisymptomatiques (constantes normales, t<38°C, absence de dyspnée et de toux) étaient accompagnées pour être isolées dans l’unité AmbuCoV jusqu’à réception des résultats. Ces patients ne nécessitant pas de soins infirmiers, une aide-soignante présente dans l’unité en permanence répondait à leurs besoins et assurait le lien avec les infirmières et médecins du service. En cas d’infection CoViD-19 confirmée les patients devaient être hospitalisés dans l’unité d’isolement. Les deux premières semaines, 15 personnes de 10 à 48 ans ont été admises dans AmbuCov soit 20 % des personnes admises pour dépistage du CoViD-19 dans notre ESR. Nous présentons en photos et à l’aide de figures la procédure et le parcours des personnes prises en charge. Aucune personne suspecte d’infection à CoViD-19 ne s’est vue refusée l’admission pour dépistage dans notre ESR. Les usagers et le personnel soignant se sont montrés satisfaits de ce programme. La principale limitation à l’utilisation de l’unité AmbuCoV était l’absence de pression négative dans les chambres qui contre-indiquait la prise en charge des personnes présentant une toux ou des signes broncho-pulmonaires. Un système de recyclage de l’air par appareil mobile (Plasmair) est à l’essai. Conclusion Nous avons mis en place une stratégie de dépistage ambulatoire d’une infection virale émergente pour faire face à l’augmentation de patients et de cas suspects en contexte épidémique. Cette unité baptisée AmbuCoV nous a permis de faire face rapidement et efficacement à l’afflux de personnes et pourra être réutilisée à l’avenir en cas de nouvelle épidémie. Nous souhaitons partager notre expérience, ainsi que son évaluation en termes de points forts et difficultés rencontrées, afin qu’elle puisse servir à d’autres personnels de santé.