Last year challenge of Nuclear Medicine: medical radioisotopes supply

Aim/Introduction: 99mTc is used in about 80% of the convencional diagnostic nuclear imaging procedures and represent yearly approximately 30 million examinations/year worldwide a year in diagnostic tests in hospitals, among others by oncology, cardiology and neurology.The production of radiopharmaceuticals for use in Nuclear Medicine has a complex system. It involves carefully calculated production schedules that take into account supply, demand and many logistical operations.The aim of this study is to show how our nuclear medicine department manage the impact of the shortly 99Mo supply chain and consequently, in the 99mTc availability and other radiopharmaceuticals produced in nuclear reactora. Material(s) and Method(s): European nuclear medicine organizations had just pay attention to how the COVID-19 pandemic might affect different parts of the 99Mo supply chain when had to dealt again faced with a new problem;the shortness 99Mo production. There are only five nuclear reactors involved in the production of 99Mo on industrial scale. These aging reactors are subject to unscheduled shutdowns and longer maintenance periods making the 99Mo supply chain vulnerable. In the last few months at our nuclear medicine department we had to reinvent ourselves so as not to completely stop carrying out the previously scheduled exams and therapies. Result(s): The use of technetium generators in Europe represents about 17% - 25% of the worldwide consumption of 99Mo, representing 30,000 exams per day and about 1.1 million doses per month. The main consequences at the IPO-Porto was;Delays in diagnosis/staging, rescheduling exams, change of surgery dates (Sentinel Ganglion and Myocardial Perfusion Cardiacs), weeks of overbooking, delay in follow-up of Glomerular Filtration Rate in pre- or post-transplant patients, postponement of 131I Therapies, Scintigraphy and Whole Body Scintigraphy in patients who were already in hypothyroidism. we had to reinvent the use of 99mTc generators, change exams appointments times, reagroup exams types by defined days and other radiopharmaceutical management tools that were not commonly used. Conclusion(s): Approximately 2/3 of scheduled exams were postponed and we had to deal with weekly and daily stock updates. Our department suggest some measures and procedures that could help with future 99Mo shortages, in order to be ready in future situations and to avoid shortness of production: the creation of a centralized European radiopharmacy system, European policies to encourage long-term investment, homogenization of marketing specifications in the Member States, solid databases of radiopharmaceuticals used/ available in Europe and encouraging cooperation between other countries outside the European Union.

Last year challenge of Nuclear Medicine: medical radioisotopes supply

Aim/Introduction: 99mTc is used in about 80% of the convencional diagnostic nuclear imaging procedures and represent yearly approximately 30 million examinations/year worldwide a year in diagnostic tests in hospitals, among others by oncology, cardiology and neurology.The production of radiopharmaceuticals for use in Nuclear Medicine has a complex system. It involves carefully calculated production schedules that take into account supply, demand and many logistical operations.The aim of this study is to show how our nuclear medicine department manage the impact of the shortly 99Mo supply chain and consequently, in the 99mTc availability and other radiopharmaceuticals produced in nuclear reactora. Material(s) and Method(s): European nuclear medicine organizations had just pay attention to how the COVID-19 pandemic might affect different parts of the 99Mo supply chain when had to dealt again faced with a new problem;the shortness 99Mo production. There are only five nuclear reactors involved in the production of 99Mo on industrial scale. These aging reactors are subject to unscheduled shutdowns and longer maintenance periods making the 99Mo supply chain vulnerable. In the last few months at our nuclear medicine department we had to reinvent ourselves so as not to completely stop carrying out the previously scheduled exams and therapies. Result(s): The use of technetium generators in Europe represents about 17% - 25% of the worldwide consumption of 99Mo, representing 30,000 exams per day and about 1.1 million doses per month. The main consequences at the IPO-Porto was;Delays in diagnosis/staging, rescheduling exams, change of surgery dates (Sentinel Ganglion and Myocardial Perfusion Cardiacs), weeks of overbooking, delay in follow-up of Glomerular Filtration Rate in pre- or post-transplant patients, postponement of 131I Therapies, Scintigraphy and Whole Body Scintigraphy in patients who were already in hypothyroidism. we had to reinvent the use of 99mTc generators, change exams appointments times, reagroup exams types by defined days and other radiopharmaceutical management tools that were not commonly used. Conclusion(s): Approximately 2/3 of scheduled exams were postponed and we had to deal with weekly and daily stock updates. Our department suggest some measures and procedures that could help with future 99Mo shortages, in order to be ready in future situations and to avoid shortness of production: the creation of a centralized European radiopharmacy system, European policies to encourage long-term investment, homogenization of marketing specifications in the Member States, solid databases of radiopharmaceuticals used/ available in Europe and encouraging cooperation between other countries outside the European Union.

Hotel workers’ perceptions on soft and hard skills in Porto, Portugal

The present study assesses hotel workers’ perceptions regarding their soft and hard skills, during COVID-19 pandemic. To this end, data were collected through a survey applied to 4 and 5 star hotel workers in the Historical Center of Porto (Portugal). The results show that workers have a generally positive perception on their skills, especially in the case of teamwork, interpersonal relationship and flexibility (soft skills). Digital competencies (hard skills), present the lowest level of confidence. Data also show that essential competencies are rarely provided by the employer. Moreover, the evaluation of workers with a higher education degree only differs significantly regarding hard skills (linguistic). © 2022 Taylor & Francis Group, LLC.

Hotel Technology Innovations as Drivers of Safety and Hygiene in Hotel Customers

Technology innovations are making their mark within the hospitality industry, and in the present COVID-19 sanitary crisis, they will be a major driver of hotel strategy. The COVID-19 disease is highly contagious, and its fear is likely to lead to distrust of facilities and spaces shared by different people, particularly in hotels where hotel customers encounter various people and use a variety of spaces. Such contact and use may expose individuals to a perceived health risk what raised issues in the hospitality industry and lead to the redesigning of safety measures and hygiene standards and to the introduction of technology innovations to help manual processes or replace personal interactions to make them secure and safe. As the hotel customer’s perception of sanitary and hygienic procedures and health safety is crucial for the recovery of the hotel industry, in this article, the main objective is to understand how hotel technology innovations influence hotel customers’ perception of hygiene and safety which influences their perceived health risk and hotel selection behaviors. Therefore, this study focused on different scenarios associated with hotel technologies, such as kiosk check-in system, mobile check-in system, robot cleaning system, and ultraviolet (UV) light cleaning system. The findings indicate that robotics, artificial intelligence, and human–robot interactions have gained an increased presence to help manage the spread of COVID-19, and that these new preferred technologies for making a safe and secure hotel environment for the guests and employees are paving their way to the new normal in post-COVID-19 pandemic times. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

CHANGES IN SURGICAL ACCESS AND ASSOCIATED OUTCOMES DURING THE COVID-19 PANDEMIC

Purpose/Background: COVID-19 has caused significant surgical delays as institutions mitigate patient interaction with hospital settings to slow the spread of the pandemic. We aimed to assess changes in surgical access and associated outcomes during the COVID-19 pandemic within the Division of Colorectal Surgery. Hypothesis/Aim: We aimed to determine factors associated with surgical timing, access, and post-operative outcomes when comparing surgeries before the COVID-19 pandemic and during. Methods/Interventions: Patients who underwent colorectal surgery Jan 2018 to Jul 2021 at a tertiary care academic center in Alabama were reviewed via billing data. Clinic visits billed as New Patient visits closest to the date of surgery and <120 days from surgery were determined to be pre-operative visits. Days from pre-operative visit to surgery was time-tosurgery (TTS). Cases before Mar 17, 2020 were the control cohort;cases after were the case cohort. Post-operative outcomes included hospital length of stay (LOS). Linear and logistic regression were used to determine factors associated with the primary outcome, TTS, and the secondary outcome of case cohort factors. Results/Outcome(s): Overall (n=779), patients were 70% White and 25% Black, 56% female, 41% privately insured, 32% insured via Medicaid, with mean age of 56 yr (SD=16). Cases were 64% inpatient, 55% laparoscopic, 32% EUA, 12% Open, and 26% for cancer. Mean TTS was 26 days (SD=24). Mean LOS was 3.6 days (SD=4.8). On bivariate analysis, patients in the case cohort were younger (53 vs 59 yr, p<0.001) and more privately insured (46% vs 36%, p<0.001) compared to patients in the control cohort. Surgeries were less likely to be for cancer (23% vs 29%, p = 0.06). LOS was shorter during the case period (3.1 vs 3.9 days, p=0.02). There were no differences in TTS (25 vs 27 days, p=0.14). On multivariable linear regression, non-Black or White race (Asian, Hispanic, and Other grouped, n=38) was associated with increased TTS (coeff: 11.0, 95% CI: 3.1-18.9). Increased TTS was associated with increased LOS (coeff: 0.4, 95% CI: 0.0-0.8). On multivariable logistic regression, patients in the case cohort were more likely to be younger (OR: 0.98, 95% CI: 0.97-1.0), and less likely to be insured with Medicaid (OR: 0.57, 95% CI: 0.39-0.83). Limitations: Pre-operative visits are approximated by billing data. Delays in surgery and post-operative outcomes are affected by additional variables not included in the billing data. Conclusions/Discussion: Increased TTS is associated with increased LOS. During the COVID-19 pandemic, case volumes have decreased. Patients receiving surgery are younger and more privately insured, indicating disparities in surgical access among the colorectal population. However it appears that TTS was not significantly different when averaged over the pandemic. Additional research is needed to determine the reasons for surgical delay and if delays were different in other specialties.

BARRIERS AND FACILITATORS TO THE USE OF TELEMEDICINE IN COLORECTAL SURGERY PATIENTS

Purpose/Background: Telemedicine use has increased during the COVID-19 pandemic, but uptake among patient populations has not been equitable. Lack of access to technology or broadband connection contributes to the digital divide, but additional factors at the provider-level may contribute. Hypothesis/Aim: We aimed to identify barriers and facilitators to colorectal patient use of telemedicine with a focus on trust and the patient-provider relationship. Methods/Interventions: Patients 18 years and older who were seen via telemedicine at a colorectal surgery clinic at a high-volume, tertiary care academic center were contacted for participation in this study. Patient demographics including age at surgery, race, sex, and diagnosis were recorded. Patient health literacy was evaluated using the BRIEF Health Literacy Screening Tool. The Wake Forest Physician Trust Scale (WFPTS) was used to measure patient trust in providers. Individual semi-structured interviews based on developed guides explored barriers and facilitators to telemedicine use. Interviews were recorded and transcribed using Landmark. Qualitative analysis was conducted using NVivo12 software. Each coder reviewed the transcript independently, convening after initial review for discussion. Final themes were analyzed by disease process. Results/Outcome(s): Among 29 participants, 52% identified as female, 67% White, 30% Black, and 4% Latino, which closely mirrors the racial demographics of the study region. 33.3% of patients had limited health literacy with a mean BRIEF score of 17.6 out of 20 (SD 3.33). The WFPTS scale ranged from 44 to 50, with a mean of 48.5 (SD 2.1) in both IBD and cancer patients. Three major themes were identified as important with respect to trust during telemedicine visits: trust in providers, trust in the institution, and trust in the surgical process. Of these, provider-level trust appeared to most influence patient trust in telemedicine. All participants noted that institution reputation and surgeon confidence affected trust in telemedicine. Among cancer participants, the impact of transparency and established expectations emerged as important themes. Among IBD patients, the duration of the patient encounter and time spent answering questions appeared most relevant. Limitations: The generalizability of our results may be limited because all patients were seen via telemedicine at a single institution. Conclusions/Discussion: Provider-level trust may have an increased role in colorectal surgery patients. To improve patient trust and telemedicine engagement in the colorectal patient population, particularly for those affected by chronic disease, providers and healthcare systems should build and integrate interventions that enhance communication and interpersonal skills.

Tourists’ Willingness to Pay for Environmental and Sociocultural Sustainability in Destinations: Underlying Factors and the Effect of Age

As recent studies show, tourists increasingly favour hotels and other tourism businesses that adopt more environmentally sustainable practices. A tourism depends on and significantly impacts cultural heritage and local communities’ well-being, sociocultural sustainability also plays a significant role on tourists’ decisions. Despite this trend, price is still the main determinant factor in tourists’ choices, and most sustainable practices tend to add operational costs, and consequently, make services more expensive. In this context, more than knowing which sustainable practices are valued the most by tourists, it is important to know how much they are willing to pay a premium price to visit destinations where those practices are carried out. In this context, the present study aimed to explore the dimensions of willingness to pay for sustainability in tourism destinations and the sustainability attitudes that might affect them. Additionally, as previous studies suggest young travellers attribute a greater value to sustainability, differences between age groups were also explored. To this end, data were collected through a survey questionnaire (n = 562) with Portuguese tourists. The questionnaire included 16 willingness to pay items and 22 sustainability attitude items. The results point to two main willingness to pay dimensions and four sustainability attitude factors. Moreover, a higher willingness to pay for environmental and sociocultural sustainability, as well as higher levels of pro-environmental private behaviour, was found amongst younger travellers. The findings offer useful insights for destination managers, which must consider them when planning and promoting innovative tourism products based on nature and cultural heritage. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

INEQUITY EXISTS IN TELEMEDICINE USE DURING THE COVID-19 PANDEMIC FOR GASTROINTESTINAL SURGERY PATIENTS IN THE DEEP SOUTH

Introduction: Telemedicine is designed to increase healthcare access and is increasingly used during the COVID-19 pandemic. However, its use among historically vulnerable populations is poorly characterized and may further exacerbate healthcare disparities. We aimed to characterize telemedicine use among a diverse surgical population in the Deep South during the COVID-19 pandemic. Methods: All patients seen in gastrointestinal (GI) surgery clinics at a tertiary care academic center in Alabama were reviewed from March 18, 2020 to September 30, 2020. Demographics including age, race, sex, insurance, date of service, and home ZIP code were recorded. Internet availability according to the FCC and median income of home ZIP codes were recorded. Patients were stratified by clinic visit type (in-person versus telemedicine, and within telemedicine, phone versus video) and compared by socioecological factors. Chi-square and ANOVA tests were performed to compare patient groups and logistic regression was used to predict telemedicine use. Results: Of the 2,580 GI surgery patients seen, 50.5% (n=1,302) were in-person and 49.5% (n=1,278) were via telemedicine, including video (43.4%) and phone (56.6%) visits. Patients were predominantly female (59.3%) and white (62.1%), with private insurance (53.8%) and a mean age of 52.1 years. Patients seen in-person and via telemedicine were similar except patients using telemedicine lived further from the hospital (mean distance 60.6 mi vs 49.6 mi, p<0.001). Living 100 mi or more from the hospital and in a ZIP code with the highest quintile of median income were independent predictors of telemedicine use (OR 1.51, 95% CI 1.16-1.97;OR 1.39, 95% CI 1.04-1.85, respectively). Among patients who used telemedicine, those with phone use were more likely to be Black compared to those with video use (35.3%, vs 29.4%, p=0.043). Patients with phone use were older (mean age = 54.0 yr vs 50.5 yr, p<0.001) and came from ZIP codes with lower median income ($35,618 vs $37,846, p=0.037). They were more likely to have Medicaid (10.7% vs 6.1%) or Medicare (32.1% vs 25.0%) and less likely to be privately insured (50.5% vs 60.2%) compared to patients with video use (p=0.001). Living 100 mi or more from the hospital was an independent predictor of video use (OR 2.27, 95% CI 1.56-3.30). Having Medicaid and age greater than 80 were independent predictors of phone use (OR 0.46, 95% CI 0.29-0.73;OR 0.37, 95% CI 0.16-0.86, respectively). Conclusion: Patients who live further from the hospital are more likely to use telemedicine. Phone visits are used more by patients who are Black, older, from lower income ZIP codes, publicly insured, and live closer to the hospital. Variations in patient telemedicine use exist across a diverse surgical population in the Deep South, suggesting telemedicine be tailored to patient preferences and available resources.

The impact of COVID-19 in colorectal cancer care

Introduction: During the peaks of the COVID-19 pandemic, many patients avoided or lacked access to healthcare, while providers and healthcare institutions temporarily suspended routine cancer screening and diagnostic procedures due to resource limitations. This disruption of cancer care services has potentially delayed diagnosis, referral and treatment of cancer patient, with consequent impact on prognosis and mortality. Aims & Methods: Aims: To evaluate the potential changes in the diagnosis and treatment of colon, rectal and anal cancer patients referred to a colorectal cancer (CRC) multidisciplinary team during the first 6 months of the COVID-19 pandemic. Methods: Cohort comparison of colon, rectal and anal cancer patients referred to CRC multidisciplinary team from 19.03.2020 to 19.09.2020 with patients referred from 19.03.2019 to 19.09.2019. Data on type and stage of cancer, CRC and anal cancer case volume, time for first appointment, time to decision, time to treatment, type of treatment, outcome and mortality were analysed. Results: A global decline in CRC and anal cancer case volume was seen in the first 6 months of the COVID-19 pandemic, with 105 new cancers referred in 2020 vs 134 in 2019, representing a -21.6% change. There was no statistically significant difference between 2019 and 2020 in the type of cancer diagnosed (colon, rectal or anal cancer). Mean age at cancer diagnosis did not differ significantly between the two groups (66.1±13.7 years in 2020 vs 67.7±12.8 years in 2019, p=0.341). A higher proportion of patients presented more advanced tumours (T4) (17.1% in 2020 vs 9.0% in 2019), with a trend towards significancy (p=0.058). No significant difference was found in the percentage of patients presenting with metastatic disease. A significantly higher number of patients was referred only for best supportive care at the first Multidisciplinary Group evaluation during the pandemic (4.8% in 2020 vs 0. in 2019, p=0.015). During the pandemic, the mean time between the referral to CRC multidisciplinary team and first appointment at our institution was significantly reduced (10.8±9.0 days in 2020 vs 20.2± 17.7 days in 2019, p<0.01). In the same way, time that mediated between the decision and the beginning of treatment was significantly reduced (31.9 ±28.6 days in 2020 vs 45.1 ±21.9 days in 2019, p<0.01). In terms of short-term mortality, the pandemic did not negatively affect patients in our cohort, as no differences were seen in mortality in the first 6 months following cancer diagnosis (9.7% in 2020 vs 12.3% in 2019, p= 0.764). Conclusion: Our data confirms the decline in the number of diagnosis of CRC and anal cancers patients seen during the COVID-19 pandemic, with a higher proportion of patients presenting with more advance disease and receiving only best supportive care. As an oncological hospital, our institution remained COVID-19 free and the fewer numbers of patients received allowed for shorter response times. Mortality at 6 months after diagnosis remained unchanged, but longer follow-ups are required to assess the true impact of the pandemic.

Covid-19 and organisational development: important signs of a new pillar for sustainability

Purpose: The global pandemic has had a considerable effect on organisations’ performance and development and on the daily lives of the general population. This study aims to analyse the recent literature on the topics of Covid-19 and sustainability and proposes to rethink and redefine sustainability with the intersection of human health as a fourth sustainable pillar. Design/methodology/approach: Using the Scopus and ISI Web of Science databases, 119 articles were analysed in detail and classified according to concepts and principles for achieving sustainable development, based on the Brundtland Report, 1987. Findings: The results indicate a high number of publications in the social dimension, with a relevant proportion of studies in the health sector. This study allows us to conclude that all sectors of society are being affected by the pandemic. However, the enormous tension and the immediate impact felt by the health sector during the pandemic reflect directly on the population, and there are clear signs that in the medium and long term, instability and uncertainty in the environmental, economic and social dimensions will remain. In national health systems, monitoring, innovating in human resource management and investing in information technology can ensure organizations’ reliability and sustainability. The conclusion involves the suggestion of introducing health as a new pillar for sustainability to consolidate the basis and structure of the United Nations’ Sustainable Development Objectives. The use of fundamental concepts is necessary and must be aligned to reassess the results obtained in studies, in comparison with observational data. Practical implications: The implications arising from the inclusion of health as a fourth pillar of sustainability are diverse. The need to build a new theoretical and conceptual framework for sustainability derives from the fact that health reflects the concern of many postulants in this field of practices. The determining or conditioning conditions of the observed effects of the pandemic by COVID-19, whether situated simply as factors and/or economic, environmental or social reflexes that precede them, requires a conceptual development that allows its approach, as a complex object, whose determinations are subject to variable degrees of uncertainty and diversity. Originality/value: This study aims to redefine the concept of sustainability, considering that health has become a public health emergency of international interest. Health affects the supply chain, cash flow, interferes with the educational format and interrupts the workforce’s routine, among other aspects, showing the true nature of its importance and its impact in all spheres (economic, environmental and social). © 2021, Emerald Publishing Limited.

Intra and inter-rater remote assessment of bradykinesia in Parkinson's disease.

INTRODUCTION: Reliable assessment of individuals with Parkinson's disease (PD) is essential for providing adequate treatment. Clinical assessment is a complex and time-consuming task, especially for bradykinesia, since its evaluation can be influenced by the degree of experience of the examiner, patient collaboration and individual bias. Improvement of the clinical evaluation can be obtained by considering assessments from several professionals. However, this is only true when inter and intra-rater agreement are high. Recently, the Movement Disorder Society highlighted, during the COVID-19 pandemic, the need to develop and validate technologies for remote assessment of the motor status of people with PD. Thus, this study introduces an objective strategy for the remote evaluation of bradykinesia using multi-specialist analysis. METHODS: Twelve volunteers with PD participated and these were asked to execute finger tapping, hand opening/closing and pronation/supination movements. Each task was recorded and rated by fourteen PD health experts for each patient. The scores were assessed on an individual basis. Intra and inter-rater agreement and correlation were estimated. RESULTS: The results showed that agreements and correlations between experienced examiners were high with low variability. In addition, group analysis was noted as possessing the potential to solve individual inconsistency bias. CONCLUSION: Furthermore, this study demonstrated the need for a group with prior training and experience, along with indicating the importance for the development of a clinical protocol that can use telemedicine for the evaluation of individuals with PD, as well as the inclusion of a specialized mediating group. In Addition, this research helps to the development of a valid remote assessment of bradykinesia.

High level of infection by toxoplasma gondii in pigs slaughtered in the city of são luís, maranhão

The article presents an exploratory, descriptive study on Bad News Communication skills (CMN) of medical interns. The student’s perception was on learning for the CMN was investigated with a cross-sectional design and a mixed approach. A questionnaire was applied, 176 participants were obtained, and a focus group was held with 12 students. The data were analyzed through the calculation of means and standard deviations for quantitative variables and the focus group reports were subjected to Content Analysis. It was observed that in the group that had training, compared to the one who did not, ocurred twice frequency with more skill for CMN. In the CMN’s management, it was considered harder to be “honest without taking away hope” (69%) and “to deal with the patient’s emotion” (59%). 99.4% knew the SPIKES protocol, of which 41.5% considered the expression of emotions as its most difficult stage. Communication and handling of emotions were pointed out as the main difficulties in the doctorpatient relationship, with deficits in the teaching of CMN. It was found that CMN is not limited to the technical issue, but it involves attitudes that need to be addressed with different methodologies, as well as the implementation of educational policies in the medical field, especially given the demands that emerges with the covid-19 pandemic. © 2021, Brazilain Coll Veterinary Parasitology. All rights reserved.