Impact of COVID-19 Pandemic on Urological Service: Experience at a Taiwanese Tertiary Center

Purpose: The Taiwan Central Epidemic Command Center raised the coronavirus disease 2019 (COVID-19) pandemic alert to level 3 throughout the nation since May 19, 2021, and asked hospitals to reduce patient intake. Surgical departments were the worst affected. The aim of this study is to share experiences of urological practice adjustment in a tertiary medical center during the pandemic and to evaluate the impact of the COVID-19 pandemic on the urological service in Taiwan under a level 3 epidemic alert. Materials and Methods: This observational study was conducted from June 1, 2021, to June 31, 2021, when a level 3 pandemic alert was declared. Data of patients visiting the urology department at the Taipei Veterans General Hospital were recorded and compared with data 1 year before the COVID-19 outbreak in Taiwan (June 1, 2020, to June 31, 2020). Data included outpatient visits, elective surgeries, emergent surgeries, functional urological examinations, and diagnostic procedures in outpatient settings. Results: There was no significant decrease in all types of uro-oncological surgeries, except bladder urothelial carcinoma (UCB)-related procedures. The total number of UCB-related procedures showed 66.67% reduction. Stone-related surgeries were reduced by 45.7%. Only 12% of all transurethral prostate resections were performed in the pandemic. There was a significant decrease in all types of functional urology and andrology procedures. More than 30% reduction was noted in the number of patients visiting the urology department in June 2021 compared to that in June 2020. Conclusion: Our data provide a reference of how the urological service was affected during the level 3 pandemic alert in Taiwan. We postponed most elective surgeries and outpatient visits or diagnostic outpatient examinations procedures according to prioritization guidelines. Uro-oncology-related service was less affected because oncology patients have a stronger motivation for treatment. Benign urological condition-related procedures were significantly influenced. After the epidemic slowdown, the backlog should be gradually managed based on priority.

New Onset and Exacerbations of Psoriasis Following COVID-19 Vaccines: A Systematic Review.

BACKGROUND: Vaccination has been promoted to control viral transmission in response to the coronavirus disease 2019 (COVID-19) pandemic. Cases of new-onset or exacerbation of psoriasis, an immune-mediated inflammatory disease, were reported following COVID-19 vaccination. However, a comprehensive review examining the association between COVID-19 vaccination and the occurrence or exacerbation of psoriasis has yet to be performed. OBJECTIVE: The aim of this systematic review is to investigate the demographics, clinical variables, and outcomes associated with psoriasis following COVID-19 vaccination. METHODS: A systematic literature search was conducted using the PubMed, Embase, Web of Science, and Cochrane databases from database inception to April 25, 2022. The review included studies with relevant terms, including 'psoriasis,' 'psoriasis vulgaris,' 'guttate psoriasis,' 'pustular psoriasis,' 'palmoplantar pustulosis,' 'psoriatic erythroderma,' 'psoriatic arthritis,' 'COVID-19,' and 'vaccine.' We included all studies reporting at least one patient who developed new-onset psoriasis or experienced a psoriasis flare following at least one dose of any COVID-19 vaccine. A flare was defined as the worsening of disease conditions after vaccination according to the study by Gregoire et al. The appraisal tool described by Murad et al. was used to assess the quality of case reports and series, whereas the National Institute of Health quality assessment tool was used to assess observational studies. RESULTS: The initial search yielded 367 results, including 7 studies reporting new-onset psoriasis, 32 studies reporting psoriasis flares, and 4 studies reporting both. The most commonly observed psoriasis subtype was plaque-type psoriasis. mRNA vaccines, including those produced by Moderna and BioNTech/Pfizer, were frequently associated with subsequent psoriasis episodes. First, second, and third vaccine doses were associated with psoriasis incidents, with the second dose most frequently associated with psoriasis flares. Delayed onset was observed, ranging from 2 to 21 days in the new-onset group and from 1 to 90 days in the flare group. Most patients experienced favorable outcomes, with improvement or resolution occurring within 3 days to 4 months. CONCLUSIONS: Both new-onset psoriasis and psoriasis flares were reported as cutaneous adverse events following COVID-19 vaccination. Psoriatic patients may require regular follow-up before and after COVID-19 vaccination. TRIAL REGISTRATION: Review registration number PROSPERO database: CRD42022304157.

INTERPROFESSIONAL COLLABORATIVE PRACTICE IN PRIMARY CARE DURING COVID-19: MEDICAL AND PHARMACY STUDENT TEAMS PROVIDING TELEHEALTH OUTREACH TO HIGHRISK PATIENTS

SETTING AND PARTICIPANTS: Many schools offer classroom and simulation interprofessional education but fewer offer interprofessional collaborative practice (ICP) opportunities. ICP in telehealth settings provides unique learning opportunities and addresses clinical and educational challenges during the pandemic. In this rotation, medical and pharmacy students practice interprofessional collaboration (IPC) while providing telehealth outreach to highrisk primary care patients. DESCRIPTION: Each student completed four 3-hour virtual sessions in 2-4 weeks. After orientation and didactics, students collaboratively contacted highrisk primary care patients using Doximity and Zoom. They triaged symptoms, assessed medication adherence, administered screenings and counseled about COVID-19. Students then presented to medicine and pharmacy preceptors, practiced communication skills and discussed team experiences. In the pilot rotation, students completed a post-rotation survey and interview to assess achievement of learning objectives. In subsequent rotations, students completed pre- and post-rotation surveys to assess changes in attitudes towards IPC. EVALUATION: In the pilot rotation, 2 medical and 3 pharmacy students (100% response rate) completed the post- rotation survey and interview. All students agreed or strongly agreed that the rotation increased their confidence in IPC. Qualitative themes included appreciation of professional differences in clinical approach and recognition of collaborative contributions to patient outcomes (e.g., connecting patients to care). In subsequent rotations, 1 medical and 5 pharmacy students (100% response rate) completed pre- and postrotation surveys. The 10-item SPICE-R2 instrument assessed attitudes towards IPC on a 5 point Likert scale from 1 (strongly disagree) to 5 (strongly agree) (Zorek et al., 2016, see online resource). Post-rotation, average student agreement scores increased for all 10 items. All students strongly agreed that students from different disciplines should be educated to establish collaborative relationships with one another (item 7). The item related to understanding training requirements of other health professions remained the lowest agreement score (item 5). DISCUSSION / REFLECTION / LESSONS LEARNED: The rotation increased student confidence in IPC. Students' perception of the value of IPC also increased. Limitations included changes in the interprofessional team in subsequent rotations. Due to scheduling differences, some rotations included pharmacy students working with medicine and pharmacy preceptors without medical students. In these rotations, all pharmacy students reported that the rotation was very or extremely effective in improving their ability to engage in IPC. This suggests that changes in the interprofessional team may not significantly impact rotation effectiveness. Future rotations will include professional training overviews to address the knowledge deficits shown by the lowest SPICE-R2 score.

Development and Validation of a Model for Estimation of the Effects of Ritual Design on Audiences’ Satisfaction with Fashion Show

The modern economic era is experience-oriented, with pleasure generated through perceptual experiences to create an enjoyable process and more sales. Under the influence of the coronavirus-19 (COVID-19) pandemic, people have begun to pursue a sense of ritual and to focus on their emotion, which has enhanced the connection between brands and consumers. The new emphasis on enhancing consumer experiences illustrates how incorporation of ritual and cultural imagery have become a means through which fashion brands can distinguish themselves from global competitors. Although international fashion weeks are now being hosted through virtual catwalks, these shows lack face-to-face interactions and a sense of on-site ritual. Therefore, many have proposed that the COVID-19 era fashion industry should be redesigned to ensure shows maintain a strong sense of ritual that enables audiences to transform their perceptions through a cultivated atmosphere to experience pleasure and satisfaction. In the present study, we explored the incorporation of cultural experiences into fashion curation to identify modern design focuses for fashion curation. We also analyzed the shows of different brands participating in the fashion weeks and discussed whether incorporation of ritual in the design of the shows affected their experiential value and audience satisfaction. Our conclusions were as follows: 1. use of ritual in designing fashion shows was effective, 2. ritual in the design of fashion shows increased participants’ satisfaction with the show and its experiential value. Future studies should integrate design practice into our proposed research framework to provide a reference for fashion curation and instruction to develop curators that meet the needs of the fashion industry. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The association of admission random blood glucose concentration and body-mass index with mortality in COVID-19 patients.

OBJECTIVE: This study aimed to investigate the association between hyperglycemia and body mass index (BMI), along with other associated comorbidities in hospitalized COVID-19 patients among the Indonesian population. PATIENTS AND METHODS: This was a retrospective study conducted at Hasan Sadikin Hospital, Bandung between March 1, 2020, and August 30, 2020. Data were analyzed using the chi-square test for categorical data and unpaired t-test and Mann-Whitney alternative test for numerical data using SPSS version 24.0 (IBM SPSS Statistics for Windows, Version 24.0. IBM, Armonk, NY, USA) and GraphPad Prism version 7.0 for Windows. RESULTS: A total of 142 hospitalized COVID-19 patients were documented between March and August 2020 at the Hasan Sadikin Hospital. Among the 142 patients, 116 (81.7%) survived, while 26 (18.3%) died. Sex, age, BMI, number of comorbidities, heart rate, respiratory rate, peripheral oxygen saturation, platelet count, random blood glucose (RBG), and length of stay (LOS) were significantly associated with mortality. Multivariate analyses demonstrated that admission RBG levels > 140 mg/dl were independently associated with an increased risk of mortality in COVID-19 patients (OR 4.3, 95% CI 1.1-17.5, p = 0.043), while BMI > 25 kg/m2 was significantly associated with reduced mortality (OR, 0.22; 95% CI 0.05-0.88, p = 0.033). CONCLUSIONS: Admission hyperglycemia, indicated by an increase in RBG levels >140 mg/dL, is independently associated with an increased risk of mortality in hospitalized COVID-19 patients, while obesity (BMI >25 kg/m2) might have protective properties against the risk of death.

Viruscape: A microscopic adventure game to guide conceptual learning of SARS-CoV-2 mechanisms

This paper presents the pilot version of Viruscape, a novel adventure PC and console game designed to facilitate the conceptual learning of Coronavirus mechanisms and expand the civic science education toolkit. Medical illustration using 3D modeling and motion graphics software has long been a niche practice to help advance education, research, and practice in healthcare-related fields. In Viruscape, we leverage the unexploited potential of such software to create interactive virtual worlds and gameplay experience to promote a more systematic learning of human health concepts and advance medical literacy for the general public. Viruscape immerses players in a microscopic world through the "eyes"of viruses whose goal is to defeat the human immune system. We translate the relevant immunology mechanisms into game play mechanisms that players learn to master, while providing a unique and interactive gaming experience. Future development of the game could focus on involving diverse users and health experts in co-design or consultation sessions and customizing the game world to represent players' real-world health condition. The concept of Viruscape can be used to further develop parallel episodes of the game that feature other human health mechanisms such as other types of infection, heart disease or cancer. © 2021 Owner/Author.

Nurses' experiences of emergency department triage during the COVID-19 pandemic in Indonesia.

PURPOSE: To explore the experiences of nurses working in emergency departments in selecting and triaging patients during the COVID-19 pandemic. DESIGN: Descriptive phenomenology was applied in this study. METHODS: Data were collected from nurses working at hospitals in Indonesia using snowball sampling and telephone interviews. A total of 10 emergency nurses participated, and Colaizzi's method of data analysis was applied. FINDINGS: Six themes and 10 subthemes emerged. The main themes were "extreme challenges in triage," "feeling of responsibility under uncontrolled spread and infection," "physical and psychological exhaustion," "discovering strategies under difficult circumstances," "looking for positive reinforcement," and "optimism in togetherness." Nurses had to deal with the challenge of COVID-19 in the ED triage, interestingly so, the nurses they have shown the development of professional responsibility. Nurses are also experienced in finding patient selection and triage strategies and the sense of optimism that may influence strategy and practice during the COVID-19 pandemic. CONCLUSIONS: This findings identify nurses' experiences in dealing with the extreme challenges of emergency department triage as well as their associated strategies and optimism. CLINICAL RELEVANCE: Providing support to emergency nurses, improving emergency department triage, and community empowerment are suggested as strategies to improve nursing care during the COVID-19 pandemic.

Impact on aerosol generation of a mouthpiece designed to reduce droplet spread of covid-19 during upper gastrointestinal endoscopy, a single center randomized controlled trial

Introduction: In the continuous battle against the COVID-19 pandemic, searches to reduce the transmission during aerosol formatting procedures became key in health care. For upper gastrointestinal (GI) endoscopy, several typologies of face masks have been examined with various outcomes. Aims & Methods: We aimed to compare a commercially available droplet reduction mouthpiece B1 (Fujifilm Corporation, Tokyo, Japan) with a conventional one, in terms of aerosol formation both during and after upper GI endoscopy. Between March and April 2020 eighty COVID-19 negative patients referred for diagnostic upper GI endoscopy procedures, of which 7 also comprised through-the-scope balloon dilation, were included in the study and randomized in a 1:1 ratio between a conventional mouthpiece and the mouthpiece B1. Aerosol generation (0.3;0.5;1.0;3.0;5.0 and 10.0 micron particles) was measured using a Lasair® II Particle Counter (Particle Measuring Systems, Inc., United States) at different standardized time points (before endoscopy, 1-3-5 minutes during endoscopy, at the end and 1-3-5-10-15 minutes after endoscopy). Statistical analysis was performed using an unpaired student t-test to compare both groups, two-way ANOVA was used to test for differences over time and considered significant for a p<0.05. Ethical approval was obtained for this study (KU Leuven trial S65197) and every patient provided informed consent. Study was registered on clinicaltrials.gov (registration number NCT04864015). Results: There were no differences in baseline characteristics, type of sedation, insufflation rate or procedural duration between both groups. Comparison of aerosol formation at the different time-points showed no statistically significant difference for the 0.3;0.5;1.0;3.0;5.0 or 10.0 micron particles. Also the cumulative total number of particles over time were was not significantly different, see table 1. Conclusion: Compared to conventional mouthpieces, the commercially available mouthpiece B1 did not result in a statistically significant reduction in aerosol formation during routine upper GI endoscopy in this single center randomized trial.

Transforming challenges into opportunities: conducting health preference research during the COVID-19 pandemic and beyond.

The disruptions to health research during the COVID-19 pandemic are being recognized globally, and there is a growing need for understanding the pandemic's impact on the health and health preferences of patients, caregivers, and the general public. Ongoing and planned health preference research (HPR) has been affected due to problems associated with recruitment, data collection, and data interpretation. While there are no "one size fits all" solutions, this commentary summarizes the key challenges in HPR within the context of the pandemic and offers pragmatic solutions and directions for future research. We recommend recruitment of a diverse, typically under-represented population in HPR using online, quota-based crowdsourcing platforms, and community partnerships. We foresee emerging evidence on remote, and telephone-based HPR modes of administration, with further studies on the shifts in preferences related to health and healthcare services as a result of the pandemic. We believe that the recalibration of HPR, due to what one would hope is an impermanent change, will permanently change how we conduct HPR in the future.

Correlates of testing positive for SARS-CoV-2 in patients with rheumatic ad musculoskeletal diseases

Background: Many studies on COVID-19 outcomes in patients with RMD have either restricted to COVID positive RMD patients or compared them to the general clinic population as a comparator. Given heterogeneity in behaviors and risks, clinical characteristics associated with a positive diagnosis among patients with RMD seeking testing for Sars-CoV-2 remain less well studied. Objectives: Among patients with RMD receiving a Sars-CoV-2 PCR test, we aimed to identify RMD-related factors associated with a positive test result. Methods: Among patients seen at least once in the University of Washington (UW) rheumatology clinics between March 2018 to March 2020, we reviewed electronic medical records to identify patients undergoing Sars-CoV-2 PCR testing from March 1 through October 31, 2020. Patients with RMD were categorized into two groups: those who tested positive for Sars-CoV-2 and those who tested negative. We randomly selected patients from the negative group in a 2:1 ratio for further data abstraction. Student's t-test and Chi-squared tests were used to compare continuous and categorical variables, respectively, between the groups. To determine the correlates of testing positive for Sars-CoV-2, specifically RMD medication use and disease activity, we constructed different multivariable logistic regression models adjusted for age, sex, race/ethnicity, presence of comorbidities, body mass index, and smoking. Results: A total of 2768 RMD patients underwent SARS-CoV-2 PCR testing within the UW system, of whom 43 (1.5%) were positive at least once. Three patients with incomplete information were excluded. Patients who tested positive had higher prevalence of end stage renal disease (ESRD)/chronic kidney disease (CKD) (24% versus 11%), had higher rates of active disease (24% versus 20%), were older (>55 years) (mean age 57.3 versus 54.8 years), male (63% versus 55%), non-white race/ethnicity (32% versus 26%), and higher prevalence of multiple comorbidities (42% versus 31%) (Table 1). In the multivariable models, neither RMD medication use (versus no use, Table 1) nor high disease activity (vs low disease activity/remission) were statistically significantly associated with COVID-19 positivity. Among the 41 COVID-19 positive patients, a majority recovered without specific treatments, although approximately one third of the positive patients were hospitalized and three deaths were observed. Conclusion: In this study, patients who tested positive did not differ in many ways from those who tested negative. (Figure Presented).

The effect of an air purifier on aerosol generation measurements during clinical motility testing.

BACKGROUND: Aerosol spread is key to interpret the risk of viral contamination during clinical procedures such as esophageal high-resolution manometry (HRM). Installing an air purifier seems a legitimate strategy, but this has recently been questioned. METHODS: Patients undergoing an HRM procedure at the Leuven University Hospital were included in this clinical study. All subjects had to wear a surgical mask which was only lowered beneath the nose during the placement and removal of the nasogastric catheter. The number of aerosol particles was measured by a Lasair® II Particle Counter to obtain data about different particles sizes: 0.3; 0.5; 1.0; 3.0; 5.0; and 10.0 µm. Measurements were done immediately before the placement and the removal of the HRM catheter, and one and 5 min after. A portable air purifier with high-efficiency particle air filters was installed in the hospital room. KEY RESULTS: Thirteen patients underwent a manometry examination. The amount of 0.3 µm-sized particles was unaffected during the whole procedure. The larger particle sizes (1.0; 3.0; 5.0; and 10.0 µm) decreased when the catheter was positioned, but not 0.5 µm. During the HRM measurements itself, these numbers decreased further. Yet, 1 min after catheter removal a significant elevation of particles was seen, which did not recover within 5 min. CONCLUSIONS & INTERFERENCES: Based on this study, there is no evidence that filtration systems reduce aerosol particles properly during a clinical investigation.

The Impact of COVID-19 on Gastrointestinal Motility Testing in Asia and Europe.

BACKGROUND: The new coronavirus disease (COVID-19) has high infection and mortality rates, and has become a pandemic. The infection and mortality rates are lower in Asian countries than in European countries. This study aimed to conduct a survey on the effects of COVID-19 on the capacity to perform gastrointestinal motility tests in Asian countries compared with European countries. METHODS: We used the questionnaire previously established by our team for researchers in European countries. The correlation between the decreased rate of gastrointestinal motility and function tests, and the infection/mortality rates of COVID-19 and stringency of a government's interventions in each country was analysed and protective measures were assessed. RESULTS: In total, 58 gastroenterologists/motility experts in Asian countries responded to this survey. The infection/mortality rates of COVID-19 and Stringency Index had a significant impact on the testing capacity of oesophageal manometry and catheter-based pH monitoring. In European countries, most facilities used filtering facepiece 2/3 (FFP2/3) masks during oesophageal motility studies. Meanwhile, in Asian countries, most facilities used surgical masks. CONCLUSION: The total infection and mortality rates of COVID-19 can affect the rate of gastrointestinal motility testing and the type of protective equipment that must be used.

Effect of chronic obstructive pulmonary disease and smoking on the outcome of COVID-19.

OBJECTIVE: To investigate the association between chronic obstructive pulmonary disease (COPD) and smoking with outcome in patients with COVID-19.METHODS: A systematic literature search was performed using PubMed, EuropePMC, SCOPUS and the Cochrane Central Database. A composite of poor outcome, mortality, severe COVID-19, the need for treatment in an intensive care unit (ICU) and disease progression were the outcomes of interest.RESULTS: Data on 4603 patients were pooled from 21 studies. COPD was associated with an increased risk for composite poor outcome (OR 5.01, 95%CI 3.06-8.22; P < 0.001; I² 0%), mortality (OR 4.36, 95%CI 1.45-13.10; P = 0.009; I² 0%), severe COVID-19 (OR 4.62, 95%CI 2.49-8.56; P < 0.001; I² 0%), ICU care (OR 8.33, 95%CI 1.27-54.56; P = 0.03; I² 0%), and disease progression (OR 8.42, 95%CI 1.60-44.27; P = 0.01; I² 0%). Smoking was found to increase the risk of composite poor outcome (OR 1.52, 95%CI 1.16-2.00; P = 0.005; I² 12%), and subgroup analysis showed that smoking was significant for increased risk of severe COVID-19 (OR 1.65, 95%CI 1.17-2.34; P = 0.004; I² 11%). Current smokers were at higher risk of composite poor outcomes (OR 1.58, 95%CI 1.10-2.27; P = 0.01; I² 0%) than former/non-smokers.CONCLUSION: Our systematic review and meta-analysis revealed that COPD and smoking were associated with poor outcomes in patients with COVID-19.

A survey on the impact of the COVID-19 pandemic on motility and functional investigations in Europe and considerations for recommencing activities in the early recovery phase.

BACKGROUND: The COVID-19 pandemic, declared by WHO on March 13, 2020, had a major global impact on the healthcare system and services. In the acute phase, the presence of the SARS-CoV-2 virus in the aerodigestive tract limited activities in the gastroenterology clinic and procedures to emergencies only. Motility and function testing was interrupted and as we enter the recovery phase, restarting these procedures requires a safety-focused approach with adequate infection prevention for patients and healthcare professionals. METHODS: We summarized knowledge on the presence of the SARS-CoV-2 virus in the aerodigestive tract and the risk of spread with motility and functional testing. We surveyed 39 European centers documenting how the pandemic affected activities and which measures they are considering for restarting these measurements. We propose recommendations based on current knowledge as applied in our center. RESULTS: Positioning of catheters for gastrointestinal motility tests carries a concern for aerosol-borne infection of healthcare workers. The risk is low with breath tests. The surveyed centers stopped almost all motility and function tests from the second half of March. The speed of restarting and the safety measures taken varied highly. CONCLUSIONS AND INFERENCES: Based on these findings, we provided recommendations and practical relevant information for motility and function test procedures in the COVID-19 pandemic era, to guarantee a high-quality patient care with adequate infection prevention.