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Background: Managing patients with cancer during the coronavirus disease 2019 (COVID-19) pandemic has been challenging. Disruptions in cancer management have been observed due to cancellation of treatment, issues related to commuting, and dearth of health-care workers. Objective(s): This study was conducted during the first wave of the COVID-19 pandemic and was aimed at evaluating the 30-day all-cause mortality among patients with cancer and COVID-19 infection and the factors affecting it. Material(s) and Method(s): In this retrospective study, we collected secondary data from nine tertiary care centers in South India over a period of 10 months from March to Dec 2020. Patients across all age groups with histopathologically confirmed diagnosis of cancer who were affected by COVID-19 during their evaluation or treatment were included in the study. The primary outcome variables of the present study were 30-day all-cause mortality, cancer outcomes, and COVID-19 outcomes. Result(s): A total of 206 patients were included. Median age of the cohort was 55.5 years, and the male-To-female ratio was 1:1.03. The 30-day mortality rate was 12.6%. Twenty-Two patients (10.7%) had severe COVID-19 infection at the initial presentation. Predictors for severe pneumonia at the initial presentation were incomplete remission at the time of COVID-19 diagnosis and palliative intent of treatment. Severe pneumonia at the initial presentation, diagnosis of COVID-19 on or before August 2020, and need for ventilator support were associated with increased mortality. Conclusion(s): Severity of infection at the initial presentation, cancer status, and the intent of cancer treatment impact COVID-19 outcomes in patients with cancer.Copyright © 2022 Iranian Society of Ophthalmology. All rights reserved.
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Background: We pilot-tested the feasibility and short-term impacts of "Healthier Wealthier Families" (HWF), which seeks to reduce financial hardship by developing a referral pathway between universal child and family health (CFH) services and financial counselling. Method(s): Setting: CFH services in five sites (Victoria, New South Wales), coinciding with the COVID-19 pandemic. Participant(s): Caregivers of children aged 0-5 years. Eligible clients disclosed financial hardship using a study-designed screening tool. Design(s): Pilot randomised controlled trial (RCT). With mixed progress in Sites 1-3, we conducted an implementation evaluation and adapted the protocol to a simplified RCT (Site 4) and direct referral with pre-post evaluation (Site 5). Intervention(s): Financial counselling. The comparator was usual care. Measures: Feasibility was assessed via proportions of clients screened, enrolled, followed-up, and who accessed financial counselling. Impacts (quantitative surveys, qualitative interviews) included finances to 6 months post-enrolment. Result(s): 72%-100% of clients across sites answered the financial screen. In RCT sites (1-4), less than one-quarter enrolled. In Site 5, n = 44/64 (64%) clients were eligible and engaged with financial counselling. Common challenges facing these clients were utility debts (73%), obtaining government entitlements (43%) and material aid/emergency relief (27%). On average, their household income increased $250 per fortnight ($6504 annually), and families received average single payments of $784. Caregivers identified benefits including reduced stress, practical help, increased knowledge and empowerment. Conclusion(s): Financial hardship screening via CFH, and direct referral, were acceptable to caregivers. Individual randomisation was infeasible. Matching between populations and CFH practice is necessary to incorporate a HWF model of care.
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BACKGROUND: The COVID-19 pandemic and the associated economic recession has increased parental psychosocial stress and mental health challenges. This has adversely impacted child development and wellbeing, particularly for children from priority populations (culturally and linguistically diverse (CALD) and rural/regional communities) who are at an already increased risk of health inequality. The increased mental health and psychosocial needs were compounded by the closure of in-person preventive and health promotion programs resulting in health organisations embracing technology and online services. Watch Me Grow- Electronic (WMG-E) - developmental surveillance platform- exemplifies one such service. WMG-E was developed to monitor child development and guide parents towards more detailed assessments when risk is identified. This Randomised Controlled Trial (RCT) aims to expand WMG-E as a digital navigation tool by also incorporating parents' mental health and psychosocial needs. Children and families needing additional assessments and supports will be electronically directed to relevant resources in the 'care-as-usual' group. In contrast, the intervention group will receive continuity of care, with additional in-person assessment and 'warm hand over' by a 'service navigator' to ensure their needs are met. METHODS: Using an RCT we will determine: (1) parental engagement with developmental surveillance; (2) access to services for those with mental health and social care needs; and (3) uptake of service recommendations. Three hundred parents/carers of children aged 6 months to 3 years (recruited from a culturally diverse, or rural/regional site) will be randomly allocated to the 'care-as-usual' or 'intervention' group. A mixed methods implementation evaluation will be completed, with semi-structured interviews to ascertain the acceptability, feasibility and impact of the WMG-E platform and service navigator. CONCLUSIONS: Using WMG-E is expected to: normalise and de-stigmatise mental health and psychosocial screening; increase parental engagement and service use; and result in the early identification and management of child developmental needs, parental mental health, and family psychosocial needs. If effective, digital solutions such as WMG-E to engage and empower parents alongside a service navigator for vulnerable families needing additional support, will have significant practice and policy implications in the pandemic/post pandemic period. TRIAL REGISTRATION: The trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819 ) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.
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COVID-19 , Child Development , Child , Electronics , Humans , Mental Health , Parents , Randomized Controlled Trials as Topic , SARS-CoV-2ABSTRACT
In our inaugural editorial, we, the incoming Editorial Collective (EC) of Engaging Science, Technology, and Society (ESTS), describe the digital and social infrastructural work that we have undertaken since assuming editorship of the journal. We also note some of the changes we have introduced in terms of the journal's content and policies. A key argument is that even though publishing infrastructures shape the form and movement of scholarly content in crucial ways, they often remain black-boxed, rendering invisible the time, labor, and skill in developing and sustaining them.
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This paper examines the determinants of social distancing during the shutdown phase of the COVID-19 epidemic. We classify state and local government actions, and we study multiple proxies for social distancing based on data from smart devices. Mobility fell substantially in all states, even ones that did not adopt major distancing mandates. Most of the fall in mobility occurred prior to the most stringent sanctions against movement, such as stay-at-home laws. However, we find evidence suggesting that state and local policies did have an independent effect on mobility even after the large initial reductions occurred. Event studies show that early and information-focused actions such as first case announcements, emergency declarations, and school closures reduced mobility by 1–5 percent after five days. Between March 1 and April 14, average time spent at home grew from 9.1 hours to 13.9 hours. We find, for example, that without state emergency declarations, hours at home would have been 11.3 hours in April, suggesting that 55 percent of the growth is associated with policy and 45 percent is associated with (non-policy) trends. State and local government actions induced changes in mobility on top of a large and private response across all states to the prevailing knowledge of public health risks. © 2021 American Society of Health Economists.
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This paper examines the determinants of social distancing during the COVID-19 epidemic. We classify state and local government actions, and we study multiple proxies for social distancing based on data from smart devices. Mobility fell substantially in all states, even ones that have not adopted major distancing mandates. There is little evidence, for example, that stay-at-home mandates induced distancing. In contrast, early and information-focused actions have had bigger effects. Event studies show that first case announcements, emergency declarations, and school closures reduced mobility by 1-5% after 5 days and 7-45% after 20 days. Between March 1 and April 11, average time spent at home grew from 9.1 hours to 13.9 hours. We find, for example, that without state emergency declarations, event study estimates imply that hours at home would have been 11.3 hours in April, suggesting that 55% of the growth comes from emergency declarations and 45% comes from secular (non-policy) trends. State and local government actions induced changes in mobility on top of a large response across all states to the prevailing knowledge of public health risks. Early state policies conveyed information about the epidemic, suggesting that even the policy response mainly operates through a voluntary channel.
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Thrombocytopenia in coronavirus disease-2019 (COVID-19) can be attributed to multiple factors. Most often it is disease related. It is usually mild and if severe often associated with severe COVID-19 disease. It can also be due to drugs (Remdesivir, Tocilizumab) or coinfection with other viruses. Here we report two cases of severe thrombocytopenia in COVID-19 due to dengue coinfection. Most often the thrombocytopenia in dengue is self-resolving, and a careful "wait and watch" should suffice unlike COVID-19, where steroids can help if the cytopenia is due to cytokine storm or immune-mediated effects. HOW TO CITE THIS ARTICLE: Adarsh MB, Abraham A, Kavitha P, Nandakumar MM, Vaman RS. Severe Thrombocytopenia in COVID-19: A Conundrum in Dengue-endemic Areas. Indian J Crit Care Med 2021;25(4):465-466.
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Uncertainty in manufacturing networks has created barriers to closing the gap between design enterprises and the American industrial base. Uncertainty arises from the lack of transparent access to manufacturer capabilities, the inability to auto-discover service providers who are best capable for a given job request, and the dependence on human word-of-mouth trust network relationships that exist in the manufacturing supply chain. This uncertainty slows down the pace of product development lifecycles from a viewpoint of inefficient forms of supplier assessment, vetting, selection, and compliance, leading to a trust tax tacked onto the final price of products. In times of global crisis such as the coronavirus disease pandemic, this uncertainty also leads to inefficient forms of gathering information on manufacturing capability, available capacity, and registered licenses and assessing compliance. This technical note outlines solution pathways that can help ease the search and discovery process of connecting clients and manufacturing service providers through digitally enabled technologies. Copyright © 2020 by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959.
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The novel coronavirus (COVID-19) pandemic has had a major impact on how patients are evaluated and treated for diseases and conditions in normal patient care. Due to lack of effective treatments for this virus or vaccines to prevent infection, focus is placed on infection prevention through use of social distancing, quarantine, and face masks. To prevent COVID-19 infections in healthcare settings, the Centers for Disease Control and Prevention has recommended decreasing or eliminating nonurgent office visits. Telehealth has emerged as an alternative way to deliver effective patient care, while reducing patient and physician exposure to the virus. Telehealth is any remote healthcare process, including provider training or team meetings, whereas telemedicine refers to use of specific technology to connect a patient to a provider. High quality of care can and must be provided by Female Pelvic Medicine and Reconstructive Surgeons (FPMRS) as well as other specialists and health professionals using telemedicine. Because of the health care emergency during the pandemic, the Centers for Medicare and Medicaid Services have broadened access to and reimbursement for telemedicine services. Rapid advances in communications technology and widespread wireless access in many modern households have allowed the adoption and integration of telemedicine into urogynecology and other health practices. There are no clear guidelines for the use of telemedicine in FPMRS. The aim of this study was to conduct an expedited review of the evidence and to provide guidance for managing common outpatient FPRMS conditions during the COVID pandemic using telemedicine. FPMRS conditions were grouped into those that likely to require different treatment with virtual management compared with in-person visits, and those that could use accepted behavioral counseling and not deviate from current management paradigms. Rapid systematic review methodology was used to screen for articles related to 4 topics: (1) telemedicine in FPMRS, (2) pessary management, (3) urinary tract infections, and (4) urinary retention. In addition, 4 other topics were addressed (based on past systematic reviews and national or international society guidelines): (1) urinary incontinence, (2) vaginal prolapse, (3) fecal incontinence, and (4) defecatory dysfunction. Finally, clinical experience and expertise were pooled to reach consensus on 4 remaining areas: (1) FPMRS conditions amenable to virtual management, (2) urgent care scenarios requiring in-person visits, (3) symptoms that should alert providers to a possible COVID infection, and (4) special consideration for managing patients with known or suspected COVID-19. Overall, behavioral, medical, and conservative management provided in a virtual setting (via phone or Internet communication) will be valuable as first-line treatments. Certain situations were identified that require different treatments in the virtual setting than in person, whereas others were shown to require an in-person visit despite risks of COVID-19 exposure and spread of infection. This study presents guidance for treating FPMRS conditions via telemedicine in a format that can be actively referenced. The strengths of the study include use of an expedited review method, extensive experience of the authors in conducting systematic reviews, as well as being seasoned FPMRS practitioners. Main limitations include the rapid methodology, lack of data regarding many of the pertinent questions, and missed salient studies, because of the expedited evidence methods.