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BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has influenced hospital infection control practices. AIM: To evaluate the impact of the COVID-19 pandemic on healthcare-associated infections (HAIs) in intensive care units (ICUs). METHODS: A retrospective analysis using data from the Korean National Healthcare-Associated Infections Surveillance System was conducted. Comparisons between incidence rates and micro-organism distributions of bloodstream infection (BSI), central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) before and during the COVID-19 pandemic were performed according to hospital size. FINDINGS: The incidence rate of BSI significantly decreased during the COVID-19 pandemic compared to the pre-COVID-19 period (1.38 vs 1.23 per 10,000 patient-days, relative change -11.5%; P < 0.001). The incidence rate of VAP (1.03 vs 0.81 per 1000 device-days, relative change -21.4%; P < 0.001) significantly decreased during the COVID-19 pandemic compared to the pre-COVID-19 period, whereas rates of CLABSI (2.30 vs 2.23 per 1000 device-days; P = 0.19) and CAUTI (1.26 vs 1.26 per 1000 device-days; P = 0.99) were similar between the two periods. The rates of BSI and CLABSI significantly increased during the COVID-19 pandemic compared to the pre-COVID-19 period in large-sized hospitals, whereas these rates significantly decreased in small-to-medium-sized hospitals. The rates of CAUTI and VAP significantly decreased in small-sized hospitals. There were no significant changing trends in the rates of multidrug-resistant pathogens isolated from patients with HAI between the two periods. CONCLUSION: The incidence rates of BSI and VAP in ICUs decreased during the COVID-19 pandemic compared to the pre-COVID-19 period. This decrease was mainly seen in small-to-medium-sized hospitals.
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The rapid spread of COVID-19 not only created a global public health crisis, but also affected almost every aspect of our lives. After investigating the fundamental impact of the COVID-19 outbreak on housing needs, this study envisions what multifamily housing will look like in a post-pandemic world. Through the lessons learned during the COVID-19 pandemic, the design of residential architecture should incorporate preventive and mitigating measures to cope with any future epidemics. After factoring this new reality, this study aims to develop architectural planning strategies for multifamily housing, particularly mid to high-rise apartment housing as a predominant housing typology in Korea. An in-depth multi-disciplinary literature review was carried out to examine previous outbreaks and their impacts, assess the transmission of viruses in built environments, and observe the emerging lifestyles that resulted in the new approach of living, working, and interacting. Comparative analyses of existing guidelines for multifamily housing in response to COVID-19 were also conducted to develop a conceptual framework of architectural planning more suitable for multifamily housing in Korea. As a result of this study, a set of architectural strategies that accommodated new lifestyles while promoting quality of life through an occupant's health and well-being were established. This strategy set is intended to provide a foundation for further research to generate more detailed design considerations for future residential developments. © 2022 Architectural Institute of Korea.
ABSTRACT
The rapid spread of COVID-19 not only created a global public health crisis, but also affected almost every aspect of our lives. After investigating the fundamental impact of the COVID-19 outbreak on housing needs, this study envisions what multifamily housing will look like in a post-pandemic world. Through the lessons learned during the COVID-19 pandemic, the design of residential architecture should incorporate preventive and mitigating measures to cope with any future epidemics. After factoring this new reality, this study aims to develop architectural planning strategies for multifamily housing, particularly mid to high-rise apartment housing as a predominant housing typology in Korea. An in-depth multi-disciplinary literature review was carried out to examine previous outbreaks and their impacts, assess the transmission of viruses in built environments, and observe the emerging lifestyles that resulted in the new approach of living, working, and interacting. Comparative analyses of existing guidelines for multifamily housing in response to COVID-19 were also conducted to develop a conceptual framework of architectural planning more suitable for multifamily housing in Korea. As a result of this study, a set of architectural strategies that accommodated new lifestyles while promoting quality of life through an occupant's health and well-being were established. This strategy set is intended to provide a foundation for further research to generate more detailed design considerations for future residential developments. © 2022 Architectural Institute of Korea.
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We document and quantify a new implicit transfer mechanism in the SBA 7(a) loan program that redistributes funds between US states. We use SBA 7(a) loan data in conjunction with Dealscan private corporate loan data to show that SBA 7(a) loan interest rates are much less responsive to predicted local loan default risk compared to private corporate loans. This redistributes funds from states with low default risk to states with high default risk. These transfers are positively correlated with the severity of local economic shocks during the Great Recession and the COVID-19 Recession. Therefore, even though it was unintended, the interest rates on SBA 7(a) loans acted as an automatic stabilizer mitigating regional economic shocks.
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Introduction: During the COVID-19 pandemic, measures taken to prevent the spread of the coronavirus have led to significant changes in the lifestyle and habits of young people. The pandemic led to poor dietary patterns, reduced physical activities, and increased mental stress, which are all risk factors for weight gain. The goal of this study was to investigate the pattern of weight gain among young adults between age 18-50 years during the pandemic, and to identify factors associated with significant weight gain of 20 pounds of more. Method(s): We included young adults between ages 18 to 50 years with at least one documented weight in their electronic health records before the start of the COVID-19 pandemic shelter-in-place orders (3/19/2019 to 3/19/2020) and at least one documented weight after COVID-19 vaccines became available (12/14/2020 to 12/14/2021). Multivariable logistic regression analysis was used to identify factors associated with greater than 20 pounds of weight gain. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Result(s): The study cohort included 133,750 young adults aged 18-50 years (median age 43 years. 39.7% men). The cohort is racially and ethnically diverse, with 22.6% self-identified as White, 7.2% Black, 48.1% Hispanic, and 17.3% Asian. During the pandemic, 53866 (40.3%) lost weight or had no weight gain, 50662 (37.9%) gained 0-9 pounds (lbs), 19422 (14.5%) gained 10-19 lbs, and 9800 (7.3%) gained 20 lbs or more. Individuals who gained 20 lbs or more were younger and more likely to reside in low-income neighborhoods. Multivariable logistic regression demonstrated the following factors to be associated with significant weight gain: male sex (OR 1.10, 95% CI 1.05-1.15), Black race (OR 1.14, 95% CI 1.05-1.23), low income (OR 1.16, 95% CI 1.16-1.35), and history of depression (OR 1.64, 95% CI 1.56-1.73). Conclusion(s): In this cohort of young adults, 59.7% experienced weight gain during the pandemic, with 7.5% gaining 20 lbs or more. Factors associated with significant weight gain included male sex, black race, low income, and a history of depression. Intervention strategies to promote healthy lifestyle may be particularly important for patients with depression, and young adults from lowincome neighborhoods.
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Background. Coronavirus Disease 2019 (COVID-19) pandemic has influenced hospital infection control practices. We evaluated the impact of the COVID-19 pandemic on healthcare-associated infections (HAIs) in the intensive care unit. Methods. We conducted a retrospective analysis using data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS). KONIS has conducted nationwide prospective surveillance of HAIs in intensive care units. Comparisons of incidence rates of bloodstream infection (BSI), central lineassociated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) before (Jan 2018-Dec 2019) and during the COVID-19 pandemic (Jan 2020-Jun 2021) were performed according to hospital size. The microorganism distributions in BSI, urinary tract infection, and pneumonia were compared between the period before and during the COVID-19 pandemic. Results. The incidence rate of BSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period (1.38 vs. 1.19 per 10,000 patient-days;P < 0.001) [Table 1]. Incidence rates of CLABSI (2.30 vs. 2.17 per 1,000 device-days;P = 0.03) and VAP (1.03 vs. 0.81 per 1,000 device-days;P < 0.001) decreased significantly during the COVID-19 pandemic than in the pre-COVID-19 period, whereas that rate of CAUTI was similar between the two periods. The annual trends of incidence rate of CLABSI and VAP also has decreased (Figure 1). According to the hospital size, the incidence rate per 1,000 device-days of CLABSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period in small to medium-sized hospitals (300-699 beds). The incidence rate per 1,000 device-days of VAP significantly decreased only in small-sized hospitals (200-449 beds). The microorganism distributions in HAIs did not change significantly. Conclusion. The incidence rates of CLABSI and VAP decreased during the COVID-19 pandemic than in the pre-COVID-19 period, which was attributable to the changes in small to medium-sized hospitals. (Figure Presented).
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BACKGROUND: Since the onset of the COVID-19 pandemic, healthcare systems have faced significant barriers to providing quality primary care, particularly as practices shifted to telemedicine modalities without established technical and educational frameworks for patients, teams, and clinicians. We created an iterative quality improvement project with Unannounced Standardized Patients (USPs) to explore variation in telehealth practices across three public ambulatory care clinics. METHODS: Clinical leadership designed two USP cases reflective of local patient populations and their common clinical needs. USPs portrayed either;(1) a 40-45-year-old Black male with hypertension, or (2) a 40-45-year-old Latina with an asthma exacerbation and hypertension. Both were vaccine hesitant. USPs evaluated visit workflow and clinician's communication skills across core domains (Table 1). After each visit, the USPs completed a behaviorally anchored checklist. Domain summary scores were calculated as mean percent marked “well done.” A t-test was used to compare scores across phases and cases. RESULTS: 60 visits (48 video, 12 audio-only) were conducted in two phases (May-August 2021;September-December 2021). Of the 24 USPs (18 calls, 9 texts) contacted prior to their visit, only 4 spoke directly to a care team member. 74% of USPs recommended the clinic. There were no significant differences in domain scores between phases or cases (Table 1). Most clinicians (82% in both phases) introduced the topic of the COVID-19 vaccine appropriately. Regarding screening, most providers asked about smoking (79%) and alcohol use (72%), but few screened for vaping (22%) or depression (4%). 70% of clinicians or care teams replied to a MyChart portal message that was sent by the USP to the care team after the visit. CONCLUSIONS: Findings highlight opportunities for system-based change to optimize telehealth care (particularly the integration of team members in previsit planning, standardized screenings, and patient follow-up). Data across phases indicate sustained need for quality improvement efforts;reviewing comparative data with clinic leadership will inform further evaluation of health systems and educational methods.
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SETTING AND PARTICIPANTS: Clinician trainees across our health system, including: 1) 107 internal medicine faculty and residents who participated in workplace-based learning at public, private, and federal (Veterans Affairs) ambulatory practices, 2) 16 clinicians at our student health center, and 3) upwards of 250 medical students, residents, and newly-hired general internal medicine (GIM) faculty members from medicine, neurology, and pediatrics departments in our simulation center. DESCRIPTION: While core communication skills have always been at the forefront of medical trainee assessment, information on transference of those skills and integration of the in-person clinical workflow to the virtual care environment was limited prior to COVID-19. NYU Grossman School of Medicine (NYUSOM) implemented a telehealth improvement program across medical students, residents and faculty. In order to assess and improve our systems' ongoing telehealth practices, we employed three distinct educational methodologies across our health systems since March 2020: objective structured clinical exams (OSCEs) and announced (ASPs) and unannounced standardized patient (USPs). Cases were designed to target common, site-specific issues (i.e., hearing loss, COVID-19 vaccine hesitancy, social determinants of health, and sexual and mental health concerns). In line with previous work, all SPs were trained to use a standard behaviorally-anchored checklist to assess communication and telemedicine-specific skills over video visit ( Zoom or WebEx). USPs, professional actors who conduct visits unbeknownst to the clinician, were also trained to collect data on clinic functioning. EVALUATION: Summary reports on performance were provided to both clinical and education leadership and learners to identify future training needs. Data on telemedicine skills across all projects demonstrates room for improvement (mean % marked 'well done' across learners: 46% in the OSCE, 68% at the SHC, and 48% in the public clinics, respectively). Common telemedicine challenges included prompting the SP to adjust their video frame or remove distracting background noise. Most health systems conducted fewer screenings virtually than they did inperson (e.g., at the SHC only 41% and 6% of SPs were screened for alcohol and vaping, respectively;at the public clinics, 25% and 20% were screened for depression and vaping, respectively). Participant feedback reports highlight performance across core domains and provide resources for improvement. DISCUSSION / REFLECTION / LESSONS LEARNED: Our ongoing telemedicine training program demonstrates a highly scalable educational assessment methodology that can be leveraged to optimize common care practices. Data confirm that SPs, ASPs, and USPs can be used across the health care system in simulated and real-world scenarios to identify areas for intervention.
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It is not often that a group of health executives, educators, and professionals gather with the goal of identifying a preferred future for their profession and the patients they serve. It is even more rare when such an assembly results in a clear and actionable plan to follow to achieve that desired future. Nevertheless, the Bridging Pharmacy Education and Practice (BPEP) Summit, an unprecedented collaborative event in June 2022 that involved six sites across the country and more than 300 participants, was just such a convening. In this Commentary we provide a brief overview of this extraordinary summit and the events that led up to it. Keywords: educational innovation, practice transformation, competency-based learning, professional identity formation, continuum of learning
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The Korean New Deal emerged as an economic concept that aimed to transform the economy to make it greener by incorporating more digital services with stronger safety nets. This approach seemed to act as a countermeasure to overcome social dilemmas and address the economic recession caused by COVID-19. Additionally, the Serious Disaster Punishment Act came into effect on January 27, 2022. This bill focuses on strengthening criminal penalties for business owners in the event of an industrial accident that causes serious human harm. After its enforcement, significant interest was placed on construction sites, eventually leading to changes being made for a safer working environment and developing a more effective construction method. Off-Site-Construction (OSC) is one of the safest construction methods with minimal on-site work, ultimately avoiding potential industrial accidents. Increasingly, the need for the Building Information Modeling (BIM) design process along with modular architecture based on OSC is in demand. This research intends to suggest modular architecture based on OSC as an alternative in response to the increasing demand for on-site safety and for constructing reasonable, eco-friendly buildings for future generations. The ‘Modular Co-living Complex’ apartment house is considered the most applicable architectural form, therefore, technological improvements and overall efficiency is required. To propose a safer, more efficient, and sustainable building construction method, this study seeks to focus on the analysis of domestic and international case studies of the preceded modular co-living complexes;the applicability of BIM technology to maximize the performance in the modular architectural design process was also examined. Ultimately, this study suggests the ‘BIM-based modular integrated design’ model where the architectural project easily converges into a much simpler process and explores the most useful, effective methods in practice. © 2022 Architectural Institute of Korea.
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In the face of an economic crisis caused by COVID-19, Korea announced the Green New Deal initiative to boost the economy and address the climate crisis. As one of the key projects under this initiative, the Green-Smart School Project is aimed at building temporary classrooms and promoting relocatable modular classrooms to mitigate classroom overcrowding in 2021. However, the sheer diversity and complexity of architectural technologies applicable to the project have engendered serious difficulties in actual implementation of this project. To address the situation through a realistic approach, this study proposes a process model incorporating each stage of the design process. The integrated design process for the green-smart relocatable modular school building is aimed at solving the decision-making issues inherent in the early design stages through joint efforts of forming a consultative body for this project. This interactive approach allows for the evaluation of the planning, design, and construction stages and integrates elements from each area, thus representing one of the most realistic approaches based on the Korean system. © 2022 Architectural Institute of Korea.
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Background. Patients who are hospitalized with Coronavirus 2019 (COVID-19) are known to have increased risk for thrombosis. Several mechanisms have been proposed for increased thrombogenesis, including antiphospholipid antibodies (APLs). We sought to better understand the relationship between a commonly used marker of thrombosis, D-dimer, and antiphospholipid antibodies in relation to thrombosis in COVID-19. Methods. This was a single-center prospective cohort study. Participants were adults admitted to the hospital with COVID-19 between March and December of 2020. Included patients required a positive COVID-19 nasopharyngeal nucleic acid amplification testing (NAAT), coagulation studies, and regular assessment of D-dimer levels. Patients who were excluded were pregnant adults, use of oral anticoagulants prior to admission, and absence of a positive COVID-19 nasopharyngeal NAAT. We tested 52 patients for antiphospholipid antibodies (APLs), including lupus anticoagulant (LA), anti-beta-2 glycoprotein antibodies (B2GP), and anti-cardiolipin antibodies (aCL). The endpoint for analysis was hospital discharge or development of a confirmed thrombosis. Results. Twenty-nine of fifty-two patients (55.7%) with COVID-19 had non-negative APLs. Of these patients, twenty-seven (93.1%) had non-negative aCLs, the majority of which were IgM antibodies. There was a total of 7 thrombotic events in our cohort. The sensitivity of D-dimer alone was 85% and the sensitivity of APLs alone was 71%. In patients with an intermediate D-dimer level (i.e., greater than 2 milligrams per liter (mg/L) but less than 5 mg/L), the addition of non-negative APLs increased the sensitivity of D-dimer to 100%. In patients with a high D-dimer (i.e., greater than 5), the combined sensitivity of D-dimer and APLs was 60%. Out of the 7 thrombotic events in our cohort, two patients had negative APLs, however both patients had a D-dimer of greater than 5 mg/L. Conclusion. The use of APLs can assist in risk-stratifying patients in an intermediate-risk D-dimer group to consider prophylactic anticoagulation if APLs are negative and to consider therapeutic anticoagulation if APLs are non-negative. In the high-risk group (i.e., a D-dimer greater than 5 mg/dL), a therapeutic anticoagulation approach may be more appropriate.
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Introduction: In Korea, the first imported case of coronavirus disease 2019 (COVID-19) was confirmed on January 20, 2020. After the first case in the Daegu-Gyeongbuk area reported on February 18, 2020, there was a rapid increase in the number of patients, which was the first large outbreak in countries other than China. The COVID-19 outbreak in the Daegu-Gyeongbuk area in 2020 has caused difficulties in the daily life and hospital care of children with type 1 diabetes (T1DM). Objectives: We detected an increase in overall blood sugar levels compared to the levels before COVID-19 in patients with T1DM in the Daegu-Gyeongbuk area and also encountered new patients who were hospitalized with more severe diabetic ketoacidosis (DKA). Methods: This study was conducted in a single center, Kyungpook National University Hospital. The following patient groups were included: (1) 45 returning patients diagnosed with T1DM and undergoing insulin treatment for more than 2 years and (2) 20 newly diagnosed T1DM patients were selected by age matching before and after COVID-19. Returning patients before and after the outbreak were selected, and changes in hemoglobin A1c (HbA1c) was retrospectively reviewed. The HbA1c level and the severity of symptoms of newly diagnosed patients during hospitalization were examined. Results: HbA1c levels in returning patients with T1DM were significantly increased after COVID-19 (before: 7.70%±1.38% vs. after: 8.30%±2.05%, p=0.012). There were 10 and 10 newly diagnosed patients before and after COVID-19. The proportion of patients with drowsiness and dyspnea at the time of admission was higher after COVID-19 than before (before: 2/10 [20%] vs. after: 4/10 [40%]). The HbA1c level was higher in newly diagnosed patients hospitalized after COVID-19 than before (before: 11.15% vs. after: 13.60%, p=0.036). Conclusions: Due to COVID-19 in the Daegu-Gyeongbuk area, there was an increase in blood sugar level in children with T1DM and in severe DKA incidence in newly diagnosed diabetes patients.
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Introduction & Objective: In March 2020, hospitals across America locked down to prevent the spread of COVID-19. This resulted in catastrophic financial losses and massive surgical backlog. While multiple groups have shown that ambulatory percutaneous nephrolithotomy (aPCNL) is safe and feasible, to our knowledge, a cost-analysis comparing aPCNL against standard PCNL (sPCNL) has not been performed. Prior to March 2020, our group was not performing routine aPCNL, but to conserve hospital resources, we performed aPCNL more often. Our objective was to compare the safety and cost-effectiveness of sPCNL vs. aPCNL. Methods: 98 patients underwent PCNL at Indiana University Methodist hospital, a tertiary referral center, by three expert surgeons from January 2020 to September 2020. sPCNL (n = 75) and aPCNL (n = 23). All patients had at least 30-days of follow up. The primary outcome of the study was to compare the 30-day rates of ED-visits, readmissions, and complications between sPCNL and aPCNL. Secondary outcomes included: cost analysis and stone free rates (SFRs). Statistical analysis was performed using SPSSv26 using independent t-tests for continuous variables and chi-square analyses for categorical variables. Results: We found no difference in 30-day ED-visits, readmissions, or complications between the two groups. aPCNL resulted in cost savings of $5689 ± 237 per case, a 29.6% reduction. Conclusions: aPCNL appears safe to perform and does not have a higher rate of ED-visits or readmissions compare to sPCNL. aPCNL also is also costeffective compared to sPCNL. Patients undergoing same-day discharge were not at higher risk of EDvisits or readmission to the hospital. (Table Presented).