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We study the effect of the COVID-19 pandemic on chronic disease drug adherence. Focusing on asthma, we use a database that tracks the vast majority of prescription drug claims in the U.S. from 2018 to 2020. Using a difference-in-differences empirical specification, we compare monthly drug adherence in 2019 and 2020 for the set of chronic patients taking asthma medication before the onset of the pandemic. We find that the pandemic increased adherence for asthmatic adults by 10 percent. However, we find a sustained decrease in pediatric drug adherence that is most severe for the youngest children. By the end of 2020, drug adherence fell by 30 percent for children aged 0 to 5, by 12 percent for children aged 6 to 12, and 5 percent for children aged 13 to 18. These negative effects are persistent regardless of changes in medical need, socioeconomic factors, insurance coverage and access to health services. We provide suggestive evidence that the observed pediatric changes are likely driven by parental inattention.
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In immediate response to the COVID-19 health emergency, the Materials Science and Engineering (MatSE) department at The Pennsylvania State University (Penn State)—similar to most educational institutions around the world—followed health experts’ advice to quickly pivot from in-person instruction to remote instruction in an effort to prevent the spread of the virus. This means all learning activities that have conventionally taken place in classrooms, such as lectures, seminars, and laboratory practices, were adjusted accordingly during the academic years of 2019–2020 and 2020–2021;the modification of teaching methods started in March 2020.
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Objective: Severe Maternal Morbidity (SMM) can be considered a marker of both maternity care and maternal mortality. The aim of this study was to review SMM in 2021 within the National Maternity Hospital (NMH), a tertiary level unit in Dublin, Ireland, with more than 9,000 births per year. Design: The study was a retrospective cohort study of women who experienced SMM in the NMH, Dublin in 2021. Methods: SMM was defined using the criteria established by the National Perinatal Epidemiology Centre (NPEC) in University College Cork. There are 17 reportable morbidities including Major Obstetric Haemorrhage (MOH), Eclampsia, Peripartum Hysterectomy, Anaesthetic complications etc. Data was prospectively recorded from a variety of sources including HDU, Pathology, Placenta Accreta Team, Maternal Medicine Team, Microbiology, Haematology, Anaesthesiology, Labour Ward. Data was included from Jan 1st 2021 to December 31st of the same year. Results: Using the NPEC criteria, 41 women experience at least one SMM during this time, of which four had more than one SMM. As with previous audits and in parallel with National and International data, the most common SMM was MOH with 18 cases. Five women underwent a Peripartum Hysterectomy. Seven women had Renal/Liver Dysfunction, mostly as a result of Pre-eclampsia. Of note, given the context of the COVID pandemic, there were no patients with septic shock due to a COVID infection. There was one late maternal death due to metastatic carcinoma diagnosed during pregnancy. Conclusion: This study highlights the importance of ongoing training for new and established staff members in obstetric emergencies, such as MOH. It also demonstrates importance of audit in the clinical setting, where ongoing reviews highlight issues of importance.
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Background: Good communication with patients and families is important for older adults admitted to acute stroke or geriatric medicine wards, particularly with COVID19-related restricted visiting. These patients often have communication difficulties including aphasia, delirium, cognitive or hearing impairment, limiting their own communication with relatives. Using the Plan, Do, Study, Act (PDSA) approach we undertook a quality improvement project to optimise communication with families of patients on above wards in a large tertiary hospital. Methods: PDSA cycle 1: Staff were surveyed to identify satisfaction level with communication and ways to optimise communication. Inpatients on study wards were identified, we recorded demographic and clinical details and prevalence of communication difficulties. We created a designated folder with individual 'communication sheets' in conjunction with ward doctors and the nurse manager. PDSA cycle 2: We performed a rapid interval audit of the communication folder use. 'Outlier' patients were excluded as their teams did not receive education about folder use. Results: PDSA cycle 1: A total of 90 inpatients on three wards were included, mean age 78y (SD ±14.4y), 47% were male. Three-quarters (73%) had a communication difficulty noted, reported by nursing staff. Two patients were intubated and six had stroke-related aphasia. Half of surveyed staff reported communication with families was suboptimal. Most (86%) suggested a centrally-located communication logbook would be helpful. PDSA cycle 2: Over two weeks, communication sheets were reviewed for all included patients. Median frequency of calls to families was 4 days (range 0- 14). Most (79%) had the name of the primary contact clearly documented. Many (52%) included no contact number. Only 9% had secondary contact information documented. Conclusion: Communication with families of patients on acute stroke and geriatric medicine wards was suboptimal. Over a short interval this improved with regular phone calls using specific centrally-located communication folders. Further optimisation of their use is needed.
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A Discrete Event Simulation (DES) model was developed by Powertrain Operations Manufacturing Engineering (PTME) in support of the Ventilator Challenge production line at a Ford Motor Company facility. The facility needed to be installed and commissioned both quickly and efficiently, with DES being one of the key tools utilised to achieve this. A flexible, dynamic input model with Excel-based data input and results dashboard enabled rapid changes to the model, enabling a clear understanding of the impact of evolving factors such as operator efficiency, labour requirements and part quality throughout the project's duration. By adopting different simulation concepts the model was applied across the entire product lifecycle, from conceptualisation to decommissioning. Through the development and implementation of this model, the characteristics of the production facility were better understood, allowing targeted engineering actions to improve productivity. This project also highlighted some key learnings for applying DES within rapidly changing manufacturing environments. © 2021 SW 2021. All rights reserved.
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OBJECTIVE: To provide a framework for a virtual curriculum during the COVID-19 pandemic for medical student educators that introduces and teaches clinical concepts important in urology and surgical specialties in general. METHODS: We created a 1-week virtual urology course utilizing interactive lectures, case-based exercises, and faculty-proctored surgical video reviews. Students were assigned self-study modules and participated in case-based discussions and presentations on a topic of their choice. Students' perceptions of urology as a specialty and the utility of the course was evaluated through pre- and postcourse surveys. Understanding of urologic content was evaluated with a multiple-choice exam. RESULTS: A total of nine students were enrolled in the course. All students reported increased understanding of the common urologic diagnoses and of urology as a specialty by an average of 2.5 points on a 10-point Likert scale (Cohen's measure of effect size: 3.2). Additionally, 56% of students reported increased interest, 22% reported no change and 22% reported a decreased interest in pursuing urology as a specialty following the course. Students self-reported increased knowledge of a variety of urologic topics on a 10-point Likert scale. The average exam score on the multiple-choice exam improved from 50% before the course to 89% after the course. CONCLUSIONS: Various teaching techniques can be employed through a virtual platform to introduce medical students to the specialty of urology and increase clinical knowledge surrounding common urologic conditions. As the longevity of the COVID-19 pandemic becomes increasingly apparent and virtual teaching is normalized, these techniques can have far-reaching utility within the traditional medical student surgical curriculum.
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OBJECTIVE: The aim of this study is to test the psychometric properties of the Spanish validation of the Fear of COVID-19 Scale (FCV-19S) in a Paraguayan population. METHODS: Participants were recruited through an Internet-based survey. All participants whose scores in the Hospital Anxiety and Depression Scale (HADS) and The Fear Questionnaire (FQ) were greater than zero were included. 1245 subjects responded voluntarily: 1077 subjects, scoring >0, were considered. RESULTS: To establish construct validity of the FCV-19S, an exploratory factor analysis was performed using the KMO test, which was adequate, and the Bartlett sphericity test, which was significant (p <.0001). The CFI, NFI, GFI, TLI and RMSEA indices were used to evaluate the model and showed good adjustment. Cronbach's α showed valid internal consistency (α = 0.86). This validation was supported by significant correlation (p <.001) with the HADS scale for anxiety and depression and with the FQ scale for specific phobia. CONCLUSIONS: The Spanish version of the FCV-19S is a 7-item scale with two dimensions, psychological symptoms and physiological symptoms, which demonstrated robust psychometric properties in a Paraguayan population.
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COVID-19 , Fear , Humans , Psychometrics , Reproducibility of Results , SARS-CoV-2ABSTRACT
On Thursday 14 May 2020 Maynooth University Library hosted a seminar via Zoom, entitled ‘Irish Libraries and COVID-19: First Reflections’. The seminar explored the response of the library sector to the global pandemic that has impacted every aspect of life. This article presents the case studies from the seminar. © 2020 Ubiquity Press. All rights reserved.