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What do pedestrian crossings, ATMs, elevators and ticket machines have in common? These are just a few of the ubiquitous yet essential elements of public-space infrastructure that rely on physical buttons or touchscreens;common interactions that, until recently, were considered perfectly safe to perform. This work investigates how we might integrate touchless technologies into public-space infrastructure in order to minimise physical interaction with shared devices in light of the ongoing COVID-19 pandemic. Drawing on an ethnographic exploration into how public utilities are being used, adapted or avoided, we developed and evaluated a suite of technology probes that can be either retrofitted into, or replace, these services. In-situ community deployments of our probes demonstrate strong uptake and provide insight into how hands-free technologies can be adapted and utilised for the public domain;and, in turn, used to inform the future of walk-up-and use public technologies.
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Outcomes: 1. Evaluate the comprehensiveness of palliative care consultations in different clinical settings and time periods quantitatively by utilizing national consensus project guidelines. 2. Analyze patient sociodemographic and administrative data and palliative care consultation charts to infer variables that predict the comprehensiveness of consultations. Background(s): COVID-19 has caused unprecedented suffering, strained healthcare systems, and jeopardized the well-being of healthcare providers. Few studies exist to characterize how inpatient specialist palliative care (PC) teams managed an increase in demand for consultations while maintaining the quality of their service. Objective(s): This quantitative study aims to: (1) examine the comprehensiveness of inpatient PC consultations conducted from 2019 through 2022 at a tertiary academic hospital in Toronto, Canada, and (2) assess the predictors of comprehensiveness of PC consultations. Method(s): We are conducting a retrospective cohort study examining a 33% random sample of inpatient palliative care consultation notes (n=600) completed for adult (>18 years old) inpatients at Mount Sinai Hospital between January 1, 2019, and July 1, 2022. Our definition of comprehensiveness is informed by a recent publication addressing necessary clinical domains (eg, performing a spiritual history, code status discussion) in a palliative care assessment. We will code each inpatient palliative care consult note for the completion of individual clinical domains using template analysis. We will dual code a random selection of 10% of the transcripts to evaluate interrater reliability. Informed by Andersen's behavioral model for health services utilization, we will sociodemographic (age, gender, rurality, English language proficiency) and clinical pathophysiological variables (primary diagnosis, referral service, reason for referral, disposition, etc.) from the consult notes and linked administrative data. We will calculate frequencies and distributions of all study variables and use multiple linear regressions to examine predictors of comprehensiveness of PC consultations. Conclusion(s): This study will provide novel data on the clinical work completed by inpatient palliative care clinicians during the COVID-19 pandemic. The data will offer critical insights into how palliative care clinicians prioritize clinical domains during initial assessments of inpatients with varying sociodemographic and clinical backgrounds.Copyright © 2023
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BACKGROUND: The availability and use of telehealth to support health care access from a distance has expanded in response to the COVID-19 pandemic. Telehealth services have supported regional and remote health care access for many years and could be augmented to improve health care accessibility, acceptability and overall experiences for both consumers and clinicians. This study aimed to explore health workforce representatives' needs and expectations to move beyond existing telehealth models and plan for the future of virtual care. METHODS: To inform recommendations for augmentation, semi-structured focus group discussions were held (November-December 2021). Health workforce representatives with experience in health care delivery via telehealth across country Western Australia were approached and invited to join a discussion. RESULTS: Focus group participants included 53 health workforce representatives, with between two and eight participants per discussion. In total, 12 focus groups were conducted: seven were specific to regions, three with staff in centralised roles, and two with a mixture of participants from regional and central roles. Findings identified four key areas for telehealth augmentation: improvements required to existing service practice and processes; equity and access considerations; health workforce-focussed opportunities; and consumer-focussed opportunities. CONCLUSIONS: Following the onset of the COVID-19 pandemic and the rapid increase in health services delivered via telehealth modalities, it is timely to explore opportunities to augment pre-existing models of care. Workforce representatives consulted in this study suggested modifications to existing process and practice that would improve the current models of care, and recommendations on ways to improve clinician and consumer experiences with telehealth. Improving experiences with virtual delivery of health care is likely to support continued use and acceptance of this modality in health care delivery.
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COVID-19 , Telemedicine , Humans , Health Workforce , Pandemics , Health Services AccessibilityABSTRACT
Wastewater-based epidemiology (WBE) has been utilized for outbreak monitoring and response efforts in university settings during the coronavirus disease 2019 (COVID-19) pandemic. However, few studies examined the impact of university policies on the effectiveness of WBE to identify cases and mitigate transmission. The objective of this study was to retrospectively assess relationships between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wastewater outcomes and COVID-19 cases in residential buildings of a large university campus across two academic semesters (August 2020-May 2021) under different COVID-19 mitigation policies. Clinical case surveillance data of student residents were obtained from the university COVID-19 response program. We collected and processed building-level wastewater for detection and quantification of SARS-CoV-2 RNA by RT-qPCR. The odds of obtaining a positive wastewater sample increased with COVID-19 clinical cases in the fall semester (OR = 1.50, P value = 0.02), with higher odds in the spring semester (OR = 2.63, P value < 0.0001). We observed linear associations between SARS-CoV-2 wastewater concentrations and COVID-19 clinical cases (parameter estimate = 1.2, P value = 0.006). Our study demonstrated the effectiveness of WBE in the university setting, though it may be limited under different COVID-19 mitigation policies. As a complementary surveillance tool, WBE should be accompanied by robust administrative and clinical testing efforts for the COVID-19 pandemic response. © 2022 American Chemical Society.
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Objectives To become familiar with the appearance of SIADH in infant botulism Methods A-43 day old male with no significant history presented to the ED with difficulty latching and decreased activity for 2 days. At the ED, he was afebrile, hypoxic to 82% with moderate respiratory distress. Non-invasive positive pressure ventilation was started and he was placed on systemic antibiotics due to concern for sepsis. Initial labs showed positive rhinovirus/enterovirus, but otherwise normal CMP (Na 140 mmol/l), CBC, CRP, VBG, UA, negative COVID-19 and blood culture after 48 hours. CXR showed right upper lobe consolidation. Patient received a bolus of NS and maintenance IVF afterwards for less than 24 hours. He was placed on continuous orogastric feeds during the second day of hospitalization with his usual home formula regimen while weaning IVF. Patient started showing periorbital edema and his neurologic status deteriorated with hypotonia, diminished reflexes and lethargy. During the 5th day of hospitalization, he had a focal seizure of the left lower extremity that lasted about 2 minutes that promptly resolved after lorazepam administration. Labs sent during that episode were significant with Na of 113 mmol/l, urine Na of 94 mmol/l, urine Osm of 383 mOs/kg, and serum Osm of 271 mOs/kg consistent with SIADH, however, he did not have increased urine output. Rest of labs and imaging of the head and spine were normal. Patient received 0.9% NS and 3% hypertonic solution and sodium started to normalize over the course of 24 hours and remained stable during the rest of the hospital course on IV fluids. Due to profound hypotonia and aforementioned progressive clinical course while ruling out other possible causes with different specialties, concern for infant botulism was discussed and infectious disease was consulted. Recommendations included sending stool sample for botulism, avoiding the use of any aminoglycoside, and starting botulism immune globulin (BabyBIG) Results Patient received BabyBIG 50mg/kg about 10 days after initial admission and started improving immediately the day after administration. Neurologic status and respiratory effort subsequently started improving significantly and patient was able to be extubated after a week. Infant was eventually confirmed for botulism toxin A via stool Conclusions SIADH is thought to be due to reduced atrial filling from venous pooling in paralysis and is known to be a common complication of infant botulism and should be considered when patient has hyponatremia.
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Wastewater-based epidemiology (WBE) has been utilized for outbreak monitoring and response efforts in university settings during the coronavirus disease 2019 (COVID-19) pandemic. However, few studies examined the impact of university policies on the effectiveness of WBE to identify cases and mitigate transmission. The objective of this study was to retrospectively assess relationships between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wastewater outcomes and COVID-19 cases in residential buildings of a large university campus across two academic semesters (August 2020-May 2021) under different COVID-19 mitigation policies. Clinical case surveillance data of student residents were obtained from the university COVID-19 response program. We collected and processed building-level wastewater for detection and quantification of SARS-CoV-2 RNA by RT-qPCR. The odds of obtaining a positive wastewater sample increased with COVID-19 clinical cases in the fall semester (OR = 1.50, P value = 0.02), with higher odds in the spring semester (OR = 2.63, P value < 0.0001). We observed linear associations between SARS-CoV-2 wastewater concentrations and COVID-19 clinical cases (parameter estimate = 1.2, P value = 0.006). Our study demonstrated the effectiveness of WBE in the university setting, though it may be limited under different COVID-19 mitigation policies. As a complementary surveillance tool, WBE should be accompanied by robust administrative and clinical testing efforts for the COVID-19 pandemic response.
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Managing the design of complex engineering systems requires an organisational structure and an information system to support collaboration among all stakeholders. Technological developments in information management have the potential to facilitate interactions across physical boundaries, even more during the Covid-19 pandemic. Visual Management (VM) is an information management strategy, as well as a means for communication between individuals, supporting collaborative work. However, there is a lack of effective understanding of how digital VM can support infrastructure engineering design. The adoption of digital collaborative VM in the context addressed is new, under rapid evolution, and there is limited understanding of how the users embrace VM while interacting with it. The aim of the paper is to explore the adoption of VM, focusing on digital whiteboards, to support collaborative practices in design processes. The ongoing investigation is carried out in collaboration with an infrastructure design and consultancy company, and follows the action research approach. The VM effectiveness was investigated by analysing the whiteboards applicability to diverse functions and comparing digital and manual implementations. Initial findings include understanding digital whiteboards as a means for collaboration among individuals with different perceptions to establish a common point of view, as it allows the information to be transferred across time and space, identifies abnormalities, and supports problem-solving. By creating a common ground, it has the potential to support complex and emergent interactions in the collaborative space.
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Background and Aims: During the covid-19 pandemic revisions were recommended to the gestational diabetes diagnostic criteria. Given the characteristics of our inner city multi-ethnic cohort, we continued with the NICE 2015 criteria. We aimed to determine the incidence of gestational diabetes during the first wave of the covid-19 pandemic. Methods: Women diagnosed with gestational diabetes in March-July 2020 were retrospectively reviewed and compared to two separate historical time-matched cohorts (03-07/ 2018 and 03-07/ 2017). Maternal demographics, gestational diabetes incidence and fetal outcomes were compared. Results: 953 pregnancies were registered in 2020, 963 in 2018 and 1162 in 2017. The highest gestational diabetes incidence was observed in the covid-19 cohort (12.6% (n = 120), 7.3% (n = 70) and 4.4% (n = 52) respectively, p < 0.001). On average, women were diagnosed with GDM later in 2020 (mean gestational age (GA) 28.6 weeks, 27.0 and 27.0 weeks, p < 0.001). Mean ( ± SD) age, height, and early pregnancy weight/ body mass index were similar. Proportional differences in women with gestational diabetes of non-white ethnicity were exhibited, with the lowest proportion in 2020 (77.0%, 86.4% and 82.9% respectively, p < 0.001). Mean ( ± SD) fetal birth weight varied across the groups (3237.5 ( ± 473)g, 3117 ( ± 647)g and 2981 ( ± 845)g, p < 0.001). There were no differences in adjusted fetal birth weight centiles. Mean (SD) GA at birth was higher in 2020 (38.8 ( ± 1.26), 38.4 ( ± 2.38), 37.60 ( ± 5.1) weeks, p = 0.03). Conclusions: A significant increase in the diagnosis of gestational diabetes during the covid-19 epidemic was observed. The implementation of national lockdowns may have resulted in reduced physical activity and excess gestational weight gain, which could explain this.
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Aims: Gestational diabetes group education was delivered face to face prior to the covid-19 pandemic. An online workshop was set up in September 2020 to deliver remote group training on diet and lifestyle for blood glucose management in pregnancy. This created a safe, supportive environment to deliver education to patients and allowed efficient use of staffing during the pandemic response. Methods: An Eventbrite page for gestational diabetes workshop was set up and a presentation with additional resources created. A midwife referral system was created from two hospital sites and participants recruited weekly. Sessions were delivered online via Microsoft Teams and emails with resources sent to patients after the workshop. Data was collected on Excel regarding attendance and a follow up questionnaire via Survey Monkey. Results: Twenty six online workshops over eight months (November 2020-June 2021) had a total of 166 patient bookings. There was equal distribution across the two sites and an attendance rate of 59%. Forty patients completed the Survey Monkey questionnaire where it was found that 100% enjoyed and would recommend the session;47.5% strongly agree and 52.5% agree that they have a good understanding of Gestational Diabetes and how to manage it and 40% strongly agree, 57.5% agree and 2.5% neither agree/disagree with being confident to manage Gestational diabetes with diet and exercise. Conclusion: Virtual group workshops are an effective way to educate gestational diabetes patients on their diet and lifestyle to manage their blood glucose.
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Due to public concerns over touch-based disease transmission, tangible and embedded interfaces are perhaps the most unsuited technology during a pandemic. Even so, this case study documents the development and evaluation of such a system from early 2020 when people were told to avoid actions that might spread the virus (e.g., touch). Adding to the challenge, the Lookout was installed outside in a city centre for widespread public use. Despite these challenges, a COVID-safe touchable device was embedded and extensively used. This Case Study reports the co-creation of the device noting COVID restriction adaptations over a nine-month deployment. Our contributions are twofold: the study acts as a case-point of the impact of the unique COVID design context, with lessons for future pandemic scenarios;and, given we had over 10,000 users at a time when people were cautious about using shared devices or services, we surface some design characteristics that can promote the use of public technology. © 2022 Owner/Author.
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Background. The Walter Reed National Military Medical Center (WRNMMC) established a consolidated COVID-19 screening area (CSA) beginning in March 2020 to provide beneficiary and staff testing via a drive-through site. Testing was available to all patients and WRNMMC staff regardless of beneficiary status. Presented is a descriptive analysis of our testing operations and positivity rates within a closed medical system from March 2020 to April 2021. Methods. For quality and process improvement, we compiled daily testing logs from March 2020 to April 2021 from the CSA. These logs included patient demographics, reason for testing, test result, testing platform, and occupational status at the hospital. We determined positivity rates in various subgroups -asymptomatic, symptomatic, pre-operative, in order to track testing use and access. Additionally, we compared the overall positivity rate to the surrounding civilian community by pulling data from the Maryland Department of Health's COVID database. Results. Over the course of nearly 14 months of testing availability, 34,694 beneficiaries were screened with 41,582 individual tests. After May 2020, the monthly overall positivity rate varied from 1.99% to 11.92%, peaking in December 2020 (with high rates in November 2020, 7.52% and January 2021, 9.53%), correlating with or exceeding elevated positivity rates in Montgomery County (November 2020: 4.91%;December 2020: 6.48%;January 2021: 6.51%). When examining only symptomatic individuals, the positivity rate is notably much higher, with monthly rates varying from 6.40% to 21.10%, with a similar peak in December 2020. After full implementation of pre-operative screening for procedures with aerosolization potential in June 2020, the range of positivity rates was 0.28%-1.66%. Since vaccination for COVID-19 became widely available beginning in Feb 2021, the preoperative positivity rate has remained below 0.85%. Conclusion. Our institutional experience is unique in its ability to offer universal access to COVID-19 testing for beneficiaries and staff of the DoD under direction of the ID service. Our process serves as a model for public and occupational health response, and may guide lab resource and real-time staffing management in support of COVID-19 diagnostics at a medical center.
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Background. In response to the ongoing COVID-19 pandemic, an emergency use authorization (EUA) was issued for neutralizing antibody therapies including BAM. Licensing trials suggest that use of BAM reduces hospitalizations when compared with placebo (1.6% vs 6.3%). However, the real world impact of BAM is not well-described. In this study, risk factors, outcomes, and hospitalization rates among high-risk outpatients presenting with mild-to-moderate COVID-19 who received BAM were examined. Methods. This is a single center retrospective analysis of all patients who received BAM monotherapy between 11/11/2020 and 3/16/2021. Electronic health records were reviewed for baseline demographics, EUA indications, comorbidities, and outcomes to include infusion reactions, hospitalizations, and deaths occurring within 29 days of BAM administration. Moderate COVID-19 was defined as having any infiltrate on chest imaging prior to BAM administration. Chi-squared or Fisher's exact tests were used to compare categorical values as appropriate, and Mann-Whitney U for continuous variables. Results. Of the 101 patients who received BAM (median age 64 years;21% black;4% Hispanic;55% male), 13 were subsequently admitted. 22 patients (22%) had moderately severe disease as evidenced by abnormal imaging. Severity on presentation, number of indications for therapy, hypertension, stroke, diabetes, and number of co-morbidities were significantly associated with subsequent admission (table 1). No patients had adverse infusion reactions. Of those hospitalized, 8 (61.5%) were for COVID-19, the median duration of hospitalization was 2 days, and 4 received guideline-directed treatment for COVID-19 (table 2). Conclusion. In a high-risk population, hospitalization rates were higher than those observed in clinical trials, with 8% of subjects being admitted for COVID-19. Disease severity on presentation, multiple indications for therapy, and the presence of multiple co-morbidities were all associated with subsequent admission. Reassuringly, BAM was well tolerated, and in those requiring admission, hospitalizations were short, resource utilization was low, and there were no deaths.
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Background: In September 2019 Sláintecare helped establish an Integrated Care team for Older People. The aim of this service was to provide a Comprehensive Geriatric Assessment (CGA) to older people within a community network. Service user experience/feedback are critically important for development of a team and a service. To give service users a platform to evaluate the service a patient experience survey was conducted. Methods: The survey was designed by the multidisciplinary team, consisting of 13 closed/3 open questions. A Likert scale was utilised for closed questions and thematic analysis for open questions. A question on impact of COVID-19 was also included. 150 of the 950 service users who received a CGA from June 2020 to June 2021 were selected randomly and invited to participate in the postal survey. All participants received a covering letter, questionnaire and a stamped address envelope to return their completed surveys. Results: 47% response rate (71/150). 77% were aged ≥75. 52% completed the survey themselves, 48% required assistance. 61% attendedmore than twice and most would prefer to attend a local spoke clinic. 96% agreed/strongly agreed that they were satisfied with the service. 99% felt they were treated with dignity/respect and had confidence in the service. 93% agreed that they were involved in care decisions. 82% reported their carers had the opportunity to discuss concerns. Themes emerging included importance of care close to home, avoiding acute hospital, difficulty parking at tertiary centres. 42% highlighted isolation and loneliness due to COVID-19 as a major issue. Conclusion: Service users had an overwhelmingly positive experience especially when care was delivered in clinics close to their homes. Development of the hub and spoke model is acceptable and feasible to older people and their carers' in this region and will be the focus for expansion of this service.
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Chinese migrant workers are very exposed to the shocks caused by the COVID-19 pandemic. Falling remittances adversely affect their families who rely on remittance incomes. The impacts of COVID-19 on migrants and remittance-receiving households are assessed using a nationally representative household dataset and a microsimulation model. We found about 70 percent of migrant workers lost part of their wage income during the pandemic lockdown period and rural migrants working in small and medium enterprises were affected the most. This led to about 50 percent of remittance-receiving households being affected adversely by falling remittances, and the average decline in such income was more than 45 percent. Nearly 13 percent of pre-pandemic nonpoor remittance-receiving households could fall into poverty, raising the poverty rate among remittance-receiving households by 4 percentage points. Many households that were poor prior to the pandemic became more impoverished. The results indicate that social protection programs targeting vulnerable migrants and their families at home are important.
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Introduction: Strategies for radiotherapy in rectal cancer have changed significantly in the past year, with the publication of the RAPIDO trial and the COVID-19 pandemic. As part of our COVID-19 response we audited and compared our radiotherapy treatments during the first COVID-19 peak with the equivalent period in 2019. Methods: All neoadjuvant rectal radiotherapy patients between 01/03/2019-30/ 06/2019 and 01/03/2020-30/ 06/2020 were identified. Patient demographics, tumour characteristics, radiotherapy treatment and outcome data were collected from electronic hospital records and radiotherapy planning software. Results: Eighteen patients underwent neoadjuvant (chemo-) radiotherapy in 2020 compared to 8 during 2019, >100% increase. 'Ugly' disease was present in 83% (15/18) in 2020 and 88% (7/8) in 2019. More patients received short course radiotherapy (SCRT) (56%, 10/18) and total neoadjuvant therapy (TNT) (72%, 13/18) in 2020 compared to 2019, 12% (1/8) and 50% (4/8) respectively. Surgery was performed in 56% (10/18) with 7 complete resections in 2020, 4 patients await exenteration, 3 declined surgery and 1 progressed. Local control rates were 78% (14/18). Whilst in 2019 surgery was performed in 75% (6/8) with 3 complete resections, 1 patient opted for watch and wait and 1 patient progressed. Local control rates were 75% (6/8). Radiological and pathological response will be presented. Conclusion: Radiotherapy practice has changed significantly in the last 12 months with increased volume of patients, more SCRT and more TNT. This pragmatic response to external pressures shows early indicators of equivalent outcomes. Longer follow up is needed to fully assess the benefit of TNT on reducing distant recurrence.