Evaluation of Quality-of-Care Indicators Among Patients With Crohn's Disease and Ulcerative Colitis in the United States: 2019-2020

Introduction: Crohn's disease (CD) and ulcerative colitis (UC) can be difficult to manage and, due to a lack of meaningful quality measures, patient (pt) care may vary by provider. To understand where gaps in care may exist for these pts, this study assessed specific healthcare resource utilization (HRU) and medication metrics that may be potential quality of care (QOC) indicators. Method(s): Using a large commercial US claims database (2019-2020), pts with CD or UC were identified. Potential QOC indicators were selected based on clinical guidelines and recommendations from measures of quality organizations and included CD or UC prevalence;gastroenterologist (GE) and IBD-related non-GE outpatient visits;IBD-related emergency department visits or hospitalizations;excessive steroid use (prednisone equivalent >=10 mg/day for >=60 consecutive days or a single prescription of >=600 mg prednisone);excessive steroid users on corticosteroid (CS)-sparing therapy;excessive steroid users with central dual-energy X-ray absorptiometry (DEXA) or osteoporosis pharmacologic treatment;use of targeted immunomodulators (TIMs) and oral mesalamine (CD only);imaging assessments;and assessment of inflammatory biomarkers. National percentages of pts achieving each metric are reported. Result(s): In total, 41,555 CD and 52,507 UC pts were identified in 2019, resulting in a 0.3% and 0.4% prevalence, respectively (Table). Over a third of CD pts (39.8%) and almost half of UC pts (45.5%) did not visit a GE in 2019. Around 10% CD pts, and up to 6.4% of UC pts, had IBD-related ED visits or hospitalizations. 17.1% CD and 14.5% UC pts were excessive steroid users, yet < 9% CD and UC pts, received DEXA scans and/or bone treatments. A third of excessive steroid users with CD (34.5%), and over half (53.0%) of those with UC, did not receive CS-sparing therapy. The rate of TIM use was over two times higher in CD vs UC pts (CD: 44.3%;UC: 18.9%). Despite evidence that mesalamine is ineffective in CD, 18.7% of pts with CD were prescribed it. Inflammatory biomarker level testing rates were < 50% in both CD and UC. Similar outcomes were reported in 2020, with lower HRU, possibly due to COVID-19. Conclusion(s): This analysis of QOC indicators highlights various areas for improvement that may provide better treatment outcomes and reduce HRU for pts with CD and UC. Future research is needed to assess outcomes in pts that are not being routinely monitored. (Table Presented).

The Feasibility of a Pediatric Distance Learning Curriculum for Emergency Nurses During the COVID-19 Pandemic: An Improving Pediatric Acute Care Through Simulation Collaboration

Introduction: To develop and evaluate the feasibility and effectiveness of a longitudinal pediatric distance learning curriculum for general emergency nurses, facilitated by nurse educators, with central support through the Improving Acute Care Through Simulation collaborative. Methods: Kern's 6-step curriculum development framework was used with pediatric status epilepticus aimed at maintaining physical distancing, resulting in a 12-week curriculum bookended by 1-hour telesimulations, with weekly 30-minute online asynchronous distance learning. Recruited nurse educators recruited a minimum of 2 local nurses. Nurse educators facilitated the intervention, completed implementation surveys, and engaged with other educators with the Improving Pediatric Acute Care through Simulation project coordinator. Feasibility data included nurse educator project engagement and curriculum engagement by nurses with each activity. Efficacy data were collected through satisfaction surveys, pre-post knowledge surveys, and pre-post telesimulation performance checklists. Results: Thirteen of 17 pediatric nurse educators recruited staff to complete both telesimulations, and 38 of 110 enrolled nurses completed pre-post knowledge surveys. Knowledge scores improved from a median of 70 of 100 (interquartile range: 66-78) to 88 (interquartile range: 79-94) (P =.018), and telesimulation performance improved from a median of 60 of 100 (interquartile range: 45-60) to 100 (interquartile range: 85-100) (P =.016). Feedback included a shortened intervention and including physician participants. Discussion: A longitudinal pediatric distance learning curriculum for emergency nurses collaboratively developed and implemented by nurse educators and Improving Pediatric Acute Care through Simulation was feasible for nurse educators to implement, led to modest engagement in all activities by nurses, and resulted in improvement in nurses’ knowledge and skills. Future directions include shortening intervention time and broadening interprofessional scope. © 2022 Emergency Nurses Association

A CENTRIFUGAL MICROFLUIDIC METHOD FOR ENRICHMENT AND ENZYMATIC EXTRACTION OF SARS-COV-2 RNA FROM CLINICAL SAMPLES

The requirement for diversification of methods for sample preparation of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is increasingly important to circumvent analysis bottlenecks and continue widespread surveillance testing. We report a centrifugally-driven microfluidic platform for automated affinity nanoparticle enrichment and enzymatic RNA extraction of SARS-CoV-2. The microfluidic disc (μCD) and accompanying mechatronic system(s) are capable of sample preparation from up to six patient samples simultaneously and under 20 minutes. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.

ULTRA-RAPID REAL-TIME MICROFLUIDIC POLYMERASE CHAIN REACTION INSTRUMENT FOR CLINICAL AND FORENSIC APPLICATIONS

The SARS-CoV-2 pandemic has elevated the development of novel diagnostic solutions, including rapid nucleic acid amplification tests (NAATs), to a global priority to meet the high demand for accurate, timely viral detection and diagnosis. However, ubiquitously implemented NAATs, such as polymerase chain reaction (PCR), consume hours of testing. We report a field-forward instrument capable of ultra-fast real-time PCR for amplification-based nucleic acid detection in a custom-designed microfluidic chip. Prudent selection and unconventional positioning of thermal cyclers relative to the microfluidic chip and a fluorescent detector permit ultra-fast simultaneous amplification and detection, with 40 cycles complete in under 10 minutes. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.

Using payments data to nowcast macroeconomic variables during the onset of Covid-19

The Covid-19 pandemic and its resulting public health mitigation measures have caused large-scale economic disruption globally. At this time, there is an increased need to predict the macroeconomy's short-term dynamics to ensure the effective implementation of fiscal and monetary policy. However, economic prediction during a crisis is challenging because of the unprecedented economic impact of such an event, which increases the unreliability of traditionally used linear models that employ lagged data. We help to address these challenges by using timely retail payments system data in linear and nonlinear machine learning models. We find that, compared with a benchmark, our model has a roughly 15-45% reduction in root mean square error when used for macroeconomic nowcasting during the global financial crisis. For nowcasting during the Covid-19 shock, our model predictions are much closer to the official estimates.

Assessing the impact on pharmacists' time byintroducing a technician screening process forclinical trial prescriptions

Introduction: Various national guidance from the LordCarter 2016 report to the NHS Long term plan haveemphasised the need to transform traditional hospitalpharmacy and make work streams more efficient.[1] A clinical trials pharmacist has historically validated clinical trialmedicines. Whilst this is good practice for non-chemotherapyprescriptions, it is not a requirement of the Clinical TrialRegulations.[2] Interruption to validate trial prescriptionscan have a negative impact on pharmacists' duty and consequently patient outcomes. With limited data available, thisissue has been highlighted by anecdotal evidence. Due to theoften complex requirements associated with trials, the research team are responsible for assessing the suitability oftreatment. This includes checking interactions with concomitant medication, reviewing blood results and patient counselling. The clinical aspect of the pharmacist validation istherefore removed, allowing technicians to be involved in thescreening of suitable prescriptions. Much is written on technicians extending their roles in the clinical setting, but thisservice improvement focuses on enhancing their role withinthe pharmacy clinical trials department.Aim: To evaluate the amount of pharmacists' time savedby the introduction of technician screening of clinical trialprescriptions.Method: A risk-based proforma was created and usedby a pharmacist to assess clinical trial prescriptions for thesuitability of screening by a Band 7 technician. Only prescriptions with pre-printed doses, no aseptic preparationor additional medicines, were approved for technicianscreening. The process of screening therefore only involvesthe checking of patient and prescriber details, allergy statusand possibly a medication randomisation. The techniciansunder-went an in-house training including the screening ofprescriptions under pharmacist supervision. A quantitativedata collection tool was used to review the screening/validation of all nonchemotherapy clinical trial prescriptionsreceived at two sites over a two-week period in September2020. The data collection tool was piloted and all data wasanalysed using Microsoft Excel. Results: A total of 89 prescriptions were received. 56(63%) were eligible for technician screening, of which a suitable technician validated 50%.Across both sites a total time of 360 minutes were spentvalidating/screening prescriptions including solving prescription related issues. Combining the time taken by a pharmacistto return from a clinical area and screening time consequentlysaved a total of 227 minutes of pharmacists' time.Conclusion: Distributing the workload amongst trainedstaff saves pharmacist's time, which can be utilised on clinical and complex tasks. This does not eliminate the requirement of a pharmacist to validate prescriptions however;itreduces the frequency and streamlines the service. Furtherdata collection is required to analyse the direct impact onpatients' and any changes in the number of reported errors.A limitation to the study is the lack of data prior to implementation as a comparator. Additionally, during data collection there were no suitable technicians available at onesite due to the Covid-19 pandemic, resulting in only 50%of eligible prescriptions being screened by a technician.Ultimately, this does not change the outcome;enhancingtechnician's roles allows pharmacists' time to be used moreefficiently.

Pandemic Response and Crisis Informatics: An Imperative for Public Health Messaging

The focus of this research is to examine the usage patterns exhibited by users of online search engines in the midst of COVID-19. We aim to understand how the queries are structured and their timing on the various platforms that citizens are using to check the availability of Personal Protective Equipment (PPE) since the outbreak of the COVID-19 public health crisis. Understanding and analyzing peak volume for information platforms is critical, especially for public health policy, with a mind toward crisis informatics. In this study, we collect all the data of users querying data from Face Mask Map (FMM), a real-time application which displays the inventory status for all stores selling PPE. This data is from the point at which the public health crisis became widely known to the time at which PPE availability saturated the market. As COVID-19 continues to proliferate and affect people around the globe, official organizations such as Department of Health and World Health Organization (WHO) utilize Web or Social Media (Facebook or Twitter) to announce up-to-date news, e.g. daily confirmed cases or in order to update policy regarding resource management. We then correlate the significant announcements from public health officials, specifically published by Ministry of Health and Welfare (MoHW) in Taiwan, that are concerning usage and distribution of PPE. We find that the temporal dynamics of aggregated users behavior are consistent with the events. For the practitioner of disaster management, it is critical to be able to identify when the public will consistently react to public health announcements for the purpose of ensuring proper supply distribution and avoid misallocation. It is our hope that the study can help to build an effective online disaster preparedness information system, in the consideration of computing and public psychology, to better respond to disaster with a greater corpus of data. © 2020 IEEE.

Skills teaching in COVID lockdown in the UK: Lessons learnt

Introduction. Social distancing is one of the community mitigation measures that has been recommended during the COVID 19 pandemic. Social distancing can reduce virus transmission by increasing physical distance or reducing frequency of meeting in socially dense community settings, such as Universities or workplaces. In response to this, Birmingham City University School of Nursing and Midwifery rapidly developed and transferred much of their student learning online. However, for healthcare students this is not always practicable and is particularly notable in respect to developing clinical skills which cannot be learnt online nor should be attempted for the first time in practice. Birmingham City University has recently actively sought to address such training needs. In April, it opened its campus as a Skills Training Hub to help upskill hundreds of students taking on extended work placement in a bid to bolster frontline NHS workforce numbers to aid in the fight against COVID 19. When opening Birmingham City University Skills Hub, the primary focus of the planning phase was towards promoting staff and student safety. Conclusions. The plans that were put in to place meant that clinical skills teaching had to be organised differently from how it was before lockdown and in a way that was safe and sustainable for future needs. © 2020 Stephen Wanless et al., published by Sciendo 2020.