Public health emergencies: Case studies, competencies, and essential services of public health

Public Health Emergencies provides a current overview of public health emergency preparedness and response principles with case studies highlighting lessons learned from recent natural and man-made disasters and emergencies. Designed for graduate and advanced undergraduate public health students, this book utilizes the 10 essential services of public health as performance standards and foundational competencies from the Council on Education for Public Health to assess public health systems. It emphasizes the roles and responsibilities of public health careers in state and local health departments as well as other institutions and clarifies their importance during health-related emergencies in the community. Written by prominent experts, including health professionals and leaders on the frontlines, this textbook provides the framework and lessons for understanding the public health implications of disasters, emergencies, and other catastrophic events, stressing applied understanding for students interested in pursuing public health preparedness roles. Practical in its approach, Part One begins with an introduction to the fundamentals of public health emergency preparedness with chapters on community readiness, all-hazards preparedness design, disaster risk assessments, and emergency operation plans. Part Two covers a range of public health emergency events, including hurricanes, tornadoes, earthquakes, disease outbreaks and pandemics, accidents and chemical contamination, nuclear and radiological hazards, extreme heat events, and water supply hazards. The final part addresses special considerations, such as how the law serves as a foundation to public health actions;preparedness considerations for persons with disabilities, access, and functional needs;children and disasters;and a chapter evaluating emerging and evolving threats. Throughout, chapters convey the roles of front-line, supervisory, and leadership personnel of the many stakeholders involved in preparedness, response, and recovery efforts to demonstrate decision-making in action. © 2022 Springer Publishing Company, LLC.

EXAMINING THE 1-YEAR IMPACT OF COVID-19 ON UROLOGY RESIDENT SURGICAL EXPERIENCE: AN ANALYSIS OF NATIONAL SURGICAL CASE LOGS

INTRODUCTION AND OBJECTIVE: The emergence of the COVID-19 pandemic resulted in elective surgical closures beginning in March 2020. In the immediate 6-months after COVID-19 began, there was a significant reduction in national resident operative experience. Our objective is to evaluate the impact of COVID-19 on urology resident surgical experience the year before and after COVID-19 using a national surgical case log registry. METHODS: Canadian national urology resident case log data (T-Res) was analyzed for the 2-year time period from March 15, 2019 - March 14, 2021 with respect to the 14 most commonly performed urological procedures. The 12-month time period prior to COVID-19 was compared to the 12-month time period after COVID-19. Data was analyzed from 11 residency programs with regular active users generating case logs over this time period. Total and specific case volumes per program and per resident user of the time period were analyzed. A paired Wilcoxon signed-rank test was used for comparison of mean cases pre- and post-COVID-19 with an alpha of 0.05 defined as significant. RESULTS: A total of 26,715 procedures were recorded over the 24-month period among 150 unique resident users in 11 training programs. In the 12-months prior to COVID-19, 11,906 procedures were logged while 14,809 procedures were logged in the 12-months after. Nationally, mean total case numbers per program (1082.4 vs. 1346.3;p=0.27) and per resident were not significantly reduced in the 12-months after COVID-19 when compared to 12-months prior (144.5 vs. 135.9;p=0.53). For specific surgeries by program, mean volumes per resident before and after COVID-19 were not significantly different including TURBT (18.5 vs. 19.4;p=0.66), TURP (11.3 vs. 11.7;p=0.72), PCNL (4.1 vs. 3.3;p=0.80), circumcision (6.9 vs. 5.9;p=0.25), hypospadias repair (0.9 vs. 0.6;p=0.39), hydrocelectomy (3.9 vs. 2.6;p=0.37), orchidopexy (4.2 vs. 4.1;p=0.99), ureteroscopy (18.6 vs. 21.3;p=0.53), stent insertion (17.7 vs. 16.7;p=0.77), radical prostatectomy (4.9 vs. 4.8;p=0.89), radical nephrectomy (3.6 vs. 4.0;p=0.75), partial nephrectomy (2.4 vs. 3.0;p=0.29), radical cystectomy (2.8 vs. 3.2;p=0.51), and cystolitholapaxy (3.1 vs. 2.5;p=0.48). While nationally overall case volumes were stable, 3/11 (27.3%) of programs continue to report a significant reduction in surgical volumes 1 year after COVID-19 even when adjusted for number of resident users. CONCLUSIONS: Based on this national case log sample resident operative experience has rebounded one year after COVID-19. However, 27.3% of programs still report significantly reduced case volumes per resident after COVID-19 and this may warrant further examination to ensure focal deficiencies in training don't arise.

The impact of COVID-19 on urology resident surgical experience: An analysis of national case logs

INTRODUCTION AND OBJECTIVE: To analyze the impact of elective surgical closures across Canadian Urology residency programs using a national case log surgical registry. METHODS: Urology resident case log data in T-Res was analyzed for 11 different residency programs for the time period of Sept 15, 2019 - Sept 14, 2020 for 20 common urological procedures. The 6- month time period (Sept 15, 2019-March 14, 2020) prior to COVID-19 was compared to the 6-month time period after COVID-19 (March 20, 2020-Sept 14, 2020). Total number of cases per program for the 20 most common surgeries as well as specific surgery volumes were analyzed. A paired sample t-test was used for comparison of mean cases pre- and post-COVID-19 with an alpha of 0.05 defined as significant. RESULTS: A total of 12,831 procedures were recorded in TRes over the 12-month period among 122 resident users in 11 training programs. In the 6-months prior to COVID-19, 7211 procedures were logged while 5620 procedures were logged in the 6-months after. 9/ 11 (81.8%) programs reported a reduction in surgical volumes. Mean total case numbers were significantly reduced in the 6-months after COVID-19 when compared to 6-months prior (510.9 procedures per program vs. 655.5;p=0.05). Mean program volumes after COVID-19 for TURBT (62.1 vs. 75.4;p=0.26), PCNL (33.5 vs. 48.5;p=0.27), hypospadias repair (1.5 vs. 3.5;p=0.08), ureteroscopy (69.5 vs. 76.1;p=0.66), stent insertion (63.7 vs. 76.5;p=0.24), radical prostatectomy (17.4 vs. 21.5;p=0.37), radical nephrectomy (14.2 vs. 20.9;p=0.20), and partial nephrectomy (9.9 vs. 10.6;p=0.67) were not significantly reduced. However, mean surgical volumes after COVID-19 for TURP (33.5 vs. 48.5;p=0.02), circumcision (12.7 vs. 26.6;p=0.02), hydrocelectomy (7.0 vs. 13.2;p=0.01), orchidopexy (10.7 vs. 20.3;p=0.03), radical cystectomy (5.7 vs. 13.1;p=0.006), and cystolithopaxy (7.9 vs. 13.7;p=0.04) were reduced in the 6- months following COVID-19. CONCLUSIONS: Based on this national case log sample there appears to be an overall decline in urology resident surgical experience in the 6 months after COVID-19. This decline appears most pronounced in TURP, circumcision, hydrocelectomy, orchidopexy, radical cystectomy and cystolithopaxy.

Uncertainty about the future: Insights from older patients with acute myeloid leukaemia (aml) on different treatment paths

Background: AML is a haematologic cancer primarily affecting older people (median age 68 at diagnosis). Prognosis is poor, with median survival ranging from 2 to 10 months from diagnosis, depending on patient health, age, and treatment path. Some patients described struggling with uncertainty about the future, but it is unclear how this differs across patients and treatment paths. Aims: This study explored the experiences of AML patients (≥65 years old, not receiving intensive chemotherapy), their close relatives, and independent clinicians. Specifically, patient expectations for the future and how these varied by treatment path and by time since diagnosis were investigated. Methods: A total of 28 AML patients (aged 65-83;median 74), 25 relatives, and 10 clinicians from the US, UK, and Canada each took part in a 60-minute, semi-structured telephone interview. Open-ended questions were used to elicit spontaneous content, followed by focused questions when needed. Results: Patients had diverse treatment histories: 13 no treatment, 14 with experience of non-intensive chemotherapy (NIC) including 3 who discontinued treatment, and 1 on best supportive care (BSC). At time of interview the mean time since diagnosis was 5 (range 2 to 9) months for patients with no treatment experience, and 8 (range 2 to 19) months for those with treatment experience. The BSC patient was diagnosed 9 months prior to interview. Patients discussed positive and negative expectations for the future related to: physical functioning;treatment;life expectancy;ability to do hobbies, spend time with family, and go on vacation. In the no treatment group, there was evidence that expectations about the future became more negative over time. Few patients (n=4/13) recalled having negative expectations about the future at diagnosis, while most (n=10/13) did at time of interview. In contrast, patients with treatment experience appeared to have increasingly positive expectations. Most of these patients (n=11/14) recalled negative expectations when diagnosed, whereas at interview most (n=9/14) felt hopeful about future events. Further, of patients with treatment experience, almost all those diagnosed ≥6 months prior to interview had positive expectations about their future (n=6/7), while under half of those diagnosed <6 months prior (n=3/7) did. Clinicians (n=7/10) further highlighted that patient expectations changed over time depending on treatment success. Additionally, patients (n=15/28) and relatives (n=15/25) discussed feeling uncertain throughout the AML journey, reporting unknowns around life expectancy, what they would be able to accomplish, and future plans. Uncertainty was a consistent experience regardless of treatment history, with similar proportions of patients not on treatment (n=7/13) and those with NIC experience (n=7/14) reporting the sentiment. Additionally, recently interviewed patients (n=7/13) and relatives (n=7/10) noted that the ongoing COVID-19 pandemic contributed to experiences of uncertainty and difficulties planning for the future. Summary/Conclusion: There were key differences between patients not on treatment and those with experience of NIC, as patients with treatment experience demonstrated more hope for the future. Regardless, uncertainty is a key element of the AML journey. For some patients, this was exacerbated by the COVID-19 pandemic. These findings highlight the importance of ensuring all patients are provided with emotional and spiritual support to help them process their diagnosis and plan for the future, both during this pandemic and beyond.

Distress in a pandemic: The association of the coronavirus disease-2019 (COVID-19) pandemic with distress and quality of life in hematopoietic stem cell transplantation (HSCT)

Background: The global COVID-19 pandemic has drastically disrupted cancer care, potentially exacerbating patients' distress levels. Patients with hematologic malignancies undergoing HSCT may be especially vulnerable to this pandemic stress given their well-documented heightened psychological distress and impaired quality of life (QOL). However, the association of the COVID-19 pandemic with distress and QOL is not well understood. Methods: We conducted a cross-sectional analysis of data from 205 patients with hematologic malignancies undergoing HSCT who were enrolled in a multisite, randomized supportive care trial. We compared baseline pre-HSCT distress (depression, anxiety, and posttraumatic stress disorder [PTSD] symptoms) and QOL between participants enrolled pre-COVID-19 (i.e., 03/2019-01/2020) and during the COVID-19 pandemic (i.e., 03/2020-01/2021). We used the Hospital Anxiety & Depression Scale, PTSD Checklist, and Functional Assessment of Cancer Therapy-Bone Marrow Transplant to assess symptoms of depression, anxiety, and PTSD, as well as QOL respectively. We used regression models adjusting for age, gender, race, relationship status, and cancer diagnosis to examine the relationship between the period of enrollment and patient-reported distress and QOL. Results: Prior to COVID-19, 124 participants enrolled, and 81 participants enrolled during the COVID-19 pandemic. The two cohorts had similar baseline demographic and disease risk factors. Most participants were non-Hispanic (n = 185;90.2%), White (n = 138;86.3%), and female (n = 131;64.5%) with a mean (SD) age of 54.9 (11.7) years. In multivariate regression models, enrollment during COVID-19 was not associated with pre-HSCT depression (B = 0.004;95% CI, -0.02 to 0.03;p = 0.73), anxiety (B = 0.008;95% CI, -0.01 to 0.03;p = 0.44), PTSD (B = 0.004;95% CI, -0.004 to 0.01;p = 0.35) symptoms or QOL (B = -0.003;95% CI, -0.02 to 0.01;p = 0.68). Conclusions: Contrary to the widespread notion that the COVID-19 pandemic has worsened distress in patients with cancer, we found no differences in pre-HSCT distress or QOL in patients with hematologic malignancies undergoing HSCT prior to or during the COVID19 pandemic. Our findings highlight the need to comprehensively explore the multifactorial causes (e.g., illness experience, treatment burden) of distress and QOL deficits in HSCT recipients irrespective of the COVID-19 pandemic.