ABSTRACT
The deadliness associated with the COVID-19 disease caused by the SARS-CoV-2 virus plunged the entire global community into the worst times of this century. It was globally realized that a timely diagnosis, effective treatment, and prevention were the key factors in its management. Responding to the emergent scenario, sequencing of the genome of this virus was performed and shared with the scientific community in the nick of time. Thereafter, diverse sets of test kits to detect the SARS-CoV-2 and to detect the antibodies in the patients of the COVID-19 were developed at the war scale. It was indeed a war but with a microscopic spiky package of 50–200 nanometres in diameter having a genome of about 29.9 kb encoding deadly tools in its arsenal. For the reason, patients of the COVID-19 exhibit diverse symptoms from mild influenza-like to potentially fatal ones that overlap with other respiratory diseases, only efficient testing was essential during the early stages of infection to identify COVID-19 patients among others. The diverse test kits designed exclusively for rapid and accurate outcomes proved instrumental in identifying individuals among asymptomatics, presymptomatics, and symptomatics. The test kits have also been playing an appreciable role in identifying communities with hot spots to facilitate proper management. To meet the demand of higher throughput and simplification of the testing process, novel ways were devised that did not otherwise allow the testing spree to get hit with pandemic supply bottlenecks. Mechanistic models have played an essential role in shaping public health policy. The regulatory agencies, both at the world health and the regional public health levels, shared the knowledge and experience on the test kits that helped in the development and improvement in the testing capability and efficiency of the testing infrastructure. The information about the emergence of variants of the SARS-CoV-2 happening due to intrinsic behavior of the viral genomes drew attention of the test kit developers, regulatory agencies, and end-users to be vigilant over the test outcomes. Offering a mechanistic approach, in this chapter, testing strategies for the detection of SARS-CoV-2 virus and COVID-19 disease are delineated. © The Author(s), under exclusive licence to Springer Nature Singapore Pte Ltd. 2021.
ABSTRACT
Objectives: To collate and review published evidence to assess patient impact and economic burden of cataract surgery wait times in Canada. Methods: A targeted literature search was conducted using PubMed from January 1, 2007–December 10, 2021, and supplemented by grey literature search. Included studies were those reporting Canada-specific data. Results: Overall, six publications were included. All 6 reported patient impact related to waiting for cataract surgery in Canada, including decline in visual acuity(n=4);greater risk of falls(n=4), motor vehicle accidents(n=3), and depression(n=3);reduced quality life(n=3);interference with treating other eye diseases such as glaucoma, diabetic retinopathy, and AMD(n=1);permanent disability(n=1);and even increased risk of death(n=1). Eye Physicians and Surgeons of Ontario (2018) also highlighted challenges recent ophthalmology graduates face to secure operating room time. This can potentially lead to a lack of surgical competency resulting in more complications, greater incidence of unsuccessful surgeries, decline in ophthalmologists able to perform cataract surgery, and ultimately longer wait times. Canadian Council of the Blind reported an estimated 143,000 necessary eye surgeries missed or delayed in 2020 due to COVID-19, resulting in increased risk of vision loss (vision loss costing $27,251/person/year). It’s also projected from 2021 to 2023, costs of vision loss due to additional wait times of ophthalmic surgeries (most specifically cataract surgery) will be $520.2 million annually in Canada;owing 85% of these costs to loss of well-being ($442.2 million/year) and the remainder to direct healthcare system costs ($78 million/year). Further, average costs incurred by someone with vision loss until they receive surgery is $54/day. Conclusions: Increased cataract surgery wait times in Canada has negative implications, including worse patient outcomes and increased patient and healthcare system costs. There remains an urgent need to reduce wait times to ensure timely treatment access for individuals undergoing cataract surgery in Canada.
ABSTRACT
Objectives: Pan-Canadian benchmark for cataract surgery wait times is 16 weeks, with aim for 90% of patients to meet this target timeframe. A targeted literature review was conducted to assess recent trends of Canada’s cataract surgery wait times, including impact of COVID-19. Methods: PubMed was searched January 1, 2017–December 10, 2021, and supplemented by grey literature search. Search terms included cataract surgery, wait times, epidemiology, Canada, and COVID-19. Inclusion criteria comprised of literature reporting national and provincial (Ontario, Quebec, British Columbia, Alberta) data with outcomes of interest: percentage of patients treated within 16-week benchmark, 90th percentile wait time (10% waited >x weeks), and 50th percentile/median wait time (half waited >x weeks). Results: Published data from 8 unique sources were included (n=3 white papers, n=5 government data). Canadian Institute for Health Information (CIHI) reported percentage of patients treated within 16 weeks nationally (2017=71%, 2018=70%, 2019=71%, 2020=45%) and by province (Ontario: 2017=69%, 2020=40%;Quebec: 2017=85%, 2020=53%;British Columbia: 2017=63%, 2020=53%;Alberta: 2017=56%, 2020=34%). Five sources reported 90th percentile: CIHI national data showed 10% waited >30.0-31.0 weeks from 2017–2019, and >44.0 weeks in 2020;for Ontario in 2018, 10% waited >28.9 weeks, according to the Eye Physicians and Surgeons of Ontario;provincial government data showed similar results for Alberta (2017–2018=>38.6, 2020–2021=>41.0-63.0) and British Columbia (2021=>27.9). Median wait times (weeks) were reported by 5 sources, with similar national results by CIHI and OECD (2017–2019=9.3-9.6, 2020=18.9);Fraser Institute also reported 2020 national (20.6 [12.0-64.0]) and provincial (Ontario=17.0, Quebec=12.0, British Columbia=28.0, Alberta=24.0) data. Conclusions: Approximately 30% of patients experienced a wait longer than the 16-week pan-Canadian benchmark from 2017–2019, growing to 55% in 2020 amidst COVID-19. To mitigate the impact of COVID-19 and bring wait times to the recommended threshold, collaboration among provincial health authorities and clinicians may be necessary with prioritization of stable funding and reimbursement for cataract surgery.
ABSTRACT
Objectives: The ongoing complex humanitarian crisis in Venezuelahas disproportionately affected access to sexual and reproductive health (SRH) services. Restrictive abortion laws lead to unsafe abortions and increased maternal mortality/morbidity. We sought to understand whether a digital tool that safely facilitates self-managed abortion and contraception access would be acceptable and feasible for Venezuelan women and their community. Our study aimed to: Understand how Venezuelan women access SRH information and services;Understand their preferences for design of a digital tool that will safely facilitate self-managed abortions and contraception access;Co-design a user-centered digital tool, Aya, that includes their preferences and experiences. Methods: This is a mixed-methods implementation research study with a focus on co-design with Venezuelan women, grassroots community-based organizations, healthcare providers, SRH advocates and program experts: Results: 30% of surveyed Venezuelan women had an abortion, half used unsafe methods. 83% own a smartphone, 77% have internet access. Qualitative interviews highlighted the impact of the humanitarian crisis and COVID-19 on access to SRH services, safe abortion, and contraceptive methods. Venezuelan women were supportive of a digital tool that would safely facilitate self-managed abortion and contraception access. Aya is being co-designed and will be ready for pilot testing in Spring 2021. Conclusions: We conducted user-centered research to understand the complexities around safe abortion care and contraception access in a humanitarian setting. We are co-designing Aya to ensure successful implementation, sustainability, and scalability within Venezuela.