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Background: Covid-19 pandemic caused havoc in both people, the health care system and more so in patients with malignancies. Breast malignancies being one of the most common and relatively curable malignancies got hit a lot due to the impact of the Covid-19 pandemic. The multistep impact of pandemic delayed the diagnosis as also the treatment of this multidisciplinary approach disease. Objective(s): To determine the effect of the Covid-19 pandemic on the diagnosis of breast lesions. Method(s): This is a descriptive type of histopathological study in which we have collected and studied the data of Breast lesions over the Five years (Jan 2015-Dec 2019) and compared it with the data of Breast lesions in the Covid-19 year (the year 2020). Result(s): The number of cases of breast specimens received for histopathology per year declined from an average of 224/year to 124/year in the Covid-19 year of 2020. Conclusion(s): The decrease in the number of cases alludes to the downfall in the number of patients coming for diagnosis and in turn getting treatment. This study also highlights the importance of anticipation of various cases which will cluster shortly.
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This article explores the impact of social media (SM) on the marketing goals of organizations in Iran during the COVID-19 pandemic. We examine the extent to which firms utilize social media marketing to promote their products in Iran compared to the pre-COVID-19 era. The validity and reliability of the 279 survey results are confirmed using internal and external validity and Cronbach's alpha. The results show that there is a significant positive relationship between the use of SM and the distraction level. Moreover, the gender of the marketer has an impact on the perceived usefulness and application of SM. Finally, a positive effect of working hours per day on the SM usage and the marketing performance is observed. Despite a negative distraction effect, there is no evidence of reduced marketing performance. This research could help organizations to influence the purchasing processes of customers more effectively and at a lower cost. © 2022 by the authors.
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The year 2020 saw the emergence of a novel, highly contagious, coronavirus disease (COVID-19) that originated in the Wuhan province of China and spread across the globe. This led to a worldwide pandemic. The World Health Organisation (WHO), within a month of cases being detected, declared the illness as a -public health emergency of international concern". COVID-19 caused by SARS-CoV-2 not only affected the public health resulting in neurological manifestations (headache, dizziness, or cerebrovascular symptoms), but also initiated a plethora of mental health issues like anxiety, depression and suicidal tendencies. Having spread to over 200 countries, this virus has been a dire cause of concern for primarily two reasons: the threat they possess to the physiological and psychosocial health of the individuals;and the fear, anxiety and panic that has arisen as a result of the pandemic. Most nations, including India, underwent a complete lockdown with stringent norms of social distancing, self-isolation, and quarantine (for infected patients). As the nation tried to manage the situation, guidelines were set up for all its citizens by providing personal protective equipment (PPE), instilling practices like wearing a protective mask, gloves and frequent sanitisation in order to curb the spread of disease and safeguard public health. This review discusses the influence of COVID-19 on the mental health of the general population, focusing on the adolescent, pregnant and elderly;its proposed mechanism of action, and possible strategic interventions to protect the people, offer supportive measures to enhance quality of life, and prevent the spread.Copyright © 2020 Ubiquity Press. All rights reserved.
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Background: The COVID-19 pandemic has substantially affected the antibiotic stewardship activities in most hospitals of India. Aims: We conducted an antibiotic point prevalence survey (PPS) immediately after the decline of a major COVID-19 wave at a dedicated COVID-19 hospital. By doing so we aimed to identify the antibiotic prescription patterns, identify factors influencing the choice of antibiotics, and identify/develop strategies to improve the antibiotic stewardship program in such setups. Methods: The PPS was single-centred, cross-sectional, and retrospective in nature. Patients admitted in various wards and intensive care units (ICUs) between September 2021 to October 2021 were included in our PPS. Results: Of the included 460 patients, 192 were prescribed antibiotics. Of these 192 patients, ICU-admitted patients had the highest number of antibiotics prescribed i.e. 2.09 ± 0.92. Only a minor fraction (7.92 %) of antibiotics prescriptions were on the basis of culture reports. Most of the antibiotics were prescribed empirically by the parenteral route. The most common group of antibiotics prescribed were third-generation cephalosporins. Carbapenems were the most common designated antibiotics prescribed. A large number of patients (22.40 %) were prescribed a double anaerobic coverage. Conclusion: The strategies that we identified to improve the antibiotic stewardship program at our institute included reviving the culture of sending culture reports to prescribe antibiotics, improving surgical prophylaxis guidelines, training resident doctors to categorize antibiotic prescriptions appropriately, closely monitoring prescriptions providing double anaerobic coverage, and improving the electronic medical record system for improving prescription auditing.
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The mobile health check device is an IoT based system that has been designed to play a vital role in checking people's health status. It has become very crucial to monitor people's health especially now with this COVID-19 pandemic. Through this device it will be possible for people to check for blood oxygen levels, temperature, blood pressure and heart beat rate without the use of sphygmomanometers at health care centres. Furthermore, the device is not only limited to COVID-19 symptoms detection, but it can also be used for monitoring pneumonia, asthma and other common critical conditions related to the stated parameters. The results of the device are displayed on an LCD screen and also sent to the cloud servers for storage and record keeping. The mobile device proofs to be a quick health screening device for different organisations and at different public places such as at airports, borders, shopping malls, industries, religious centres and educational institutions. © 2022 IEEE.
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The mobile health check device is an IoT based system that has been designed to play a vital role in checking people's health status. It has become very crucial to monitor people's health especially now with this COVID-19 pandemic. Through this device it will be possible for people to check for blood oxygen levels, temperature, blood pressure and heart beat rate without the use of sphygmomanometers at health care centres. Furthermore, the device is not only limited to COVID-19 symptoms detection, but it can also be used for monitoring pneumonia, asthma and other common critical conditions related to the stated parameters. The results of the device are displayed on an LCD screen and also sent to the cloud servers for storage and record keeping. The mobile device proofs to be a quick health screening device for different organisations and at different public places such as at airports, borders, shopping malls, industries, religious centres and educational institutions. © 2022 IEEE.
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This study proposes Facebook-Prophet model for understanding and forecasting of corona virus (COVID-19) mortality in Southern African Development Community (SADC) region over a 90-day time period. Findings showed that COVID-19 mortality in SADC region is expected to degrade in the near future. Model performance metrics were used to compute prediction performance. These results implied that the selected model was satisfactory and reliable. Findings of the study are expected to raise situational awareness into better understanding of the pandemic and to provide support for strategic health decisions for better management of COVID-19 disease. Moreover, the study provides a series of recommendations to be followed in order to decline COVID-19 related deaths in SADC countries. © 2022 IEEE.
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Literature suggests integrative pain management strategies reduce chronic pain and opioid use. However, many older adults are unaware of these options. The Aging and Integrative Pain Assessment and Management Initiative (AI-PAMI) launched in 2020, providing webinars and recorded presentations on integrative pain management for adults > age 50, caregivers and healthcare providers. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was used to evaluate AI-PAMI via the following measures: participant demographics, survey results, program elements and qualitative findings. Reach: There have been > 20,000 views of recorded content and 48% (885/1,859) of registrants attended a live webinar. Effectiveness: Survey results demonstrate 75% of providers and 73% of older adults/caregivers reported new knowledge gain;and 80% of providers and 60% of older adults/caregivers reported changing their pain management practice/routine. Adoption: Presentations were delivered by 33 multidisciplinary experts from 12 different institutions. Six regional stakeholders promoted AI-PAMI using their dissemination networks. Implementation: The COVID-19 pandemic changed program delivery from an in-person model to virtual. To date, AI-PAMI has delivered 17 live webinars and 25 recorded presentations. Live webinars are delivered with a didactic, Q&A discussion and follow-up email. To refine AI-PAMI, 11 healthcare providers and 16 older adults participated in focus groups or in-depth interviews. Maintenance: AI-PAMI is in its third year and will be maintained under a long-standing institution-wide program. Website content will be sustained and remain free access. AI-PAMI is a valuable educational resource for older adults, caregivers, and healthcare providers. Virtual delivery is accommodating for a post-COVID environment.
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BodyThere is a growing interest and use of cellular therapies in almost all fields of medicine. Mesenchymal stromal cells (MSCs) are pluripotent in their ability to differentiate in chondrocytes, adipocytes and osteoblasts. They more recently were reported to have significant immune activity, primarily by producing anti-inflammatory molecules. They can be derived from umbilical cords, adipose tissue and bone marrow primarily. Recent studies have tested their safety and efficacy in immune mediated diseases including graft versus host disease, inflammatory bowel disease and Type I diabetes among others. Reports of uncontrolled trials of MSCs in China suggest safety and efficacy of MSCs as treatment for refractory lupus. Based on encouraging results of a Phase I trial of 6 patients with lupus treated with MSCs, we initiated the first placebo- controlled trial of MSCs to treat lupus patients refractory to standard of care medications. There are nine participating centers across the US. The trial has two cohorts, one receiving low dose MSCs (one million cells/kg) and a high dose cohort of five million cells per kg, given as a one- time infusion. Patients then attend 10 follow-up visits over a year. Primary outcome is a decrease in the SRI of 4 at week 24. Inclusion criteria are patients with confirmed lupus refractory to 6 months of standard of care therapy defined by a SLEDAI of 6 or greater at screening. Exclusions were ongoing use of biologics, pregnancy, active infections, cancer, active CNS lupus or advanced renal disease. The first patient was screened in November of 2018. Patients are randomized with a 2/1 ratio of MSCs/placebo. Cohort 1 consisting of 41 patients was completed in May of 2021. We have infused 10 out of 40 patients in Cohort 2 to this point. Extensive studies of B cell, T cell, monocyte, dendritic cell and PMN number, function and phenotype are being performed. To this point there are no safety signals or concerns with DSMB reviews quarterly. There have been no SAEs attributed to the investigational product. Given the blind of the study, we cannot report on efficacy, though there are a number of participants who met the primary outcome of an SRI of 4 at 24 weeks. COVID had a profound impact on the study due to halting of enrollment for 5 months and a need for video visits due to institutional policies. A significant issue was protocol changes regarding disease activity measures in video visits. Other delays included a designed 12-week safety assessment upon completion of Cohort 1 prior to enrollment in Cohort 2 as well as a staggered start for the first six patients in Cohort 2 requiring a safety assessment by the DSMB chair at week 1 post infusion prior to the screening of the next patient. ConclusionsThere is no safety signal between the active treatment and placebo group in either Cohort to this date. Efficacy assessments await completion of the study as the two cohorts are combined for determination of efficacy. COVID has a profound impact on enrollment and management of the study. Results of the validity of assessment of different disease measures via video appointments is being assessed to inform future trials. We believe we will reach our enrollment goal and the study will answer the primary aim of whether MSCs are a potential therapeutic for patients with refractory lupus.
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Co-occurrence of chronic diseases in the elderly is a common problem in the field of healthcare worldwide. In countries where life expectancy is high and non-communicable diseases are more common than communicable diseases, it has been reported that more than half of the elderly have at least two chronic diseases with different pathologies. The most common diseases in the elderly with Covid-19 are high blood pressure, diabetes, obesity, cardiovascular diseases and respiratory system diseases. Studies have shown that patients with multiple chronic diseases have a worse prognosis than patients with only one disease. However, the relationship between the type of disease and the number of concurrent diseases with the prognosis of elderly patients with Covid-19 is not definitely known. Due to the vulnerability of the elderly, prevention of the exacerbation of the disease, triage and prioritization of patients and reduction of mortality caused by Covid-19 is a big challenge. Many studies have focused on the clinical characteristics of Covid-19 patients, and information about the factors affecting the severity and lethality of the disease among the elderly is still limited. Therefore, this study was conducted in order to describe the demographic and clinical characteristics and investigate the relationship between co-morbidity and underlying diseases with the severity and mortality caused by Covid-19 in the elderly. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Background: Coronavirus disease 2019 (COVID-19), is rapidly spreading globally due to high transmissibility and pathogenicity. Aim: The purpose of this study is to determine the growth rate and CFR of COVID-19 in Palestine, as well as to compare them in the pre and post-vaccination periods. Methods: A retrospective analytical design was used. The data of daily confirmed cases and daily deaths were taken from the Worldometer statistics, WHO websites, and MOH report for the two politically split regions of Palestine, the Gaza Strip, and the West Bank. The data was gathered to include one hundred days before initiating vaccination against the disease, beginning on December 7, 2020, and ending on June 25, 2021. The growth rate and case fatality rate were calculated using related formulas and the Microsoft Excel program was used to analyze the data. Results: During the study period, there were 217386 cases of COVID-19 and 2772 deaths in Gaza and the west bank. The high growth rate was found in two months December 2020 (38.3%), and March 2021 (30.8%), and was declined in May and June 2021. The case fatality rate, on the other hand, fluctuated throughout the research period. During the study period, the number of patients with COVID-19 and the number of deaths from this disease is decreasing in Palestine. Conclusion: The intervention measures in Palestine seem to be effective in controlling the COVID-19 epidemic and reducing the reproduction rate in the study period. Continuous preventive measures and vaccination for the population are recommended. © 2022 Pravnehistoricke Studie. All rights reserved.
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Introduction: The Older Person's Assessment and Liaison (OPAL) team at Good Hope Hospital (GHH), part of the University Hospitals Birmingham NHS Foundation Trust, provides multidisciplinary, patient-centred comprehensive assessment to patients presenting to the hospital front door. The team takes a 'home first' approach and where possible aims to discharge patients home with support by community teams. The service is part of the Birmingham wide Early Intervention programme. A front door OPAL service therefore enables early discharge for frail patients who would otherwise be likely to have a prolonged hospital admission. This has to be balanced against ensuring readmission rates do not exceed that of a comparable hospital inpatient population. Method: We measured the 7 and 28-day readmission rate of all patients who received OPAL input and were discharged from A&E, the Medical Admissions Unit or the Acute Medical unit from July 2020January 2021. This was compared with an inpatient short stay frailty unit however data was not available beyond November 2020 due to changes in response to the Covid-19 pandemic. Results: 2096 patients were discharged by OPAL with a 7-day readmission rate of 9.2% (95% CI 4.6-13.7%) and a 28-day readmission rate of 20.2% (95% CI 14.0-26.4%). From JulyOctober 2020 the short stay frailty unit at GHH had a 7-day readmission rate of 9.7% (95% CI 3.1-16.3%) and a 28-day readmission rate of 25.2% (95% CI 8.2-42.2%). In the same period OPAL had a 7-day readmission rate of 8.7% (95% CI 3.2-14.2%) and a 28-day readmission rate of 19.9% (95% CI 13.3-26.5%). Conclusion: The OPAL service enabled the early discharge of patients without compromising readmission rates. The readmission rates for patients discharged by the OPAL team were better than the inpatient frailty unit with over 20% fewer 28 day readmissions.
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Introduction & Objectives: The purpose of prioritisation is to minimise harm while safeguarding access to health care in times of reduced clinical resources. The EAU Guideline Office Rapid Reaction Group (GORRG) issued priority recommendations for use during the COVID-19 pandemic. We evaluated if the clinical prioritisation for suspected renal cell carcinoma (RCC) planned for surgery matched final pathological risk. Materials & Methods: From 23 March 2020 at the beginning of the first lock-down in the UK, patients with suspected RCC were prioritised according to GORRG recommendations until 10 October 2020. To increase statistical power, GORRG prioritisation was also retrospectively assigned to pre-lockdown RCC surgical cases, dating back to April 5 2019. Patient and tumour characteristics were assessed, as was priority group according to GORRG, TNM, and postoperative risk according to 2003 Leibovich scores. We assessed concordance between pre-operative GORGG prioritisation group and post-operative risk, and if stratification could be further improved by subgrouping of size. Results: 351 patients with suspected RCC were prioritised and underwent surgery, of which 16 were benign and 335 were RCC after specimen analysis. The intermediate priority group did not match the pathological risk group in 47.7%, with 25.7% and 16.4% of the group being pathological low and high risk, respectively. The low GORRG priority group harboured 14.9% intermediate and 1.06% high risk RCC, and the high GORRG priority group 27.9% intermediate and no low risk RCC respectively. Within the GORRG intermediate group, 34.2% of cT1b tumours were low risk, and 32.3% of cT2a tumours high risk. Analysing at 1 cm increments, 45.1% of 4-5cm tumours were low risk. The area under the receiver operating characteristics curve for priority groups in predicting matched postoperative risk group was 0.60 (95% CI 0.55-0.65). The sankey diagram shows patients categorised according to EAU GORGG guidelines (left) and pathological risk (right).(Figure Presented)Conclusions: The recommended prioritisation system can be error prone and should be prudently applied based on the centre’s needs. Particularly amongst the intermediate group, centres with clinical capacity should not defer intervention of cT2a tumours for longer than absolutely necessary and in severely limited resources may consider intermediate priority tumours <5cm as low priority.
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Study Objectives: Amid the US opioid epidemic, emergency providers and patients are searching for non-opioid or nonpharmacologic pain treatment options. The challenge of managing pain without opioids was escalated by the COVID-19 pandemic with opioid related overdoses and deaths increasing by 20-40%. Most healthcare professionals have limited knowledge, resources or time for pain education, especially in the emergency department (ED). To address these needs a novel pain coaching program was designed including a menu of nonpharmacologic patient discharge toolkit materials. Study objectives were to determine descriptive patient and toolkit utilization data and challenges in the first 4 months of a novel pain program. Methods: Target population consisted of patients ≥14 years of age seen by a new ED Pain Coaching staff from January 4, 2021- April 30, 2021. The two ED sites consisted of an urban, academic center with trauma center, pediatric ED, etc. and an affiliated community ED. Patients were determined by ED rounding, ED census review and consultation by ED staff, physicians, physical therapy, palliative care and pharmacy. Summary statistics for patient demographics, pain type, REALM-SF score, educational topics, toolkit materials, challenges and other data were ed from coaching and patient notes on a daily basis using a REDCap database for analysis. Upon request, there were select inpatient and repeat coaching encounters. Results: During this 4-month pilot, 296 coaching sessions were completed on 276 unique patients;20 screen outs for severe pain, procedures, violent behavior or other obstacles. Average age was 43 with 85% between 20-70 years of age;62% female;60% African American. Pain was 46% acute, 50% acute on chronic and 4% chronic with patients often having multiple pain etiologies: musculoskeletal (74%), inflammatory (71%), post-trauma (15%), headache (14%), post-surgical (4%) and neuropathic (3%). Education topics provided with accompanying toolkit items: hot/cold gel packs (90%), car with 4 flat tires analogy (90%), pain neuroscience education (88%), aromatherapy inhalers (82%), breathing techniques (69%), virtual reality (51%), exercise (38%), stretching (35%), diet (20%), acupressure (11%). The majority of patients were seen in 2 EDs or associated trauma center (87%);however, the coach received referrals for selected inpatients (13%). Seventeen educational brochures were made available to patients with aromatherapy, managing pain, pain and stress, and nonpharmacologic management being most utilized. Challenges to coaching included medical condition (14%), too much pain (11%), time constraints (7%);52% had no challenges. Regarding patient feedback, 61% indicated the session was helpful and 39% were unsure at the time. Conclusion: Results from this novel ED pain coach and discharge toolkit model provide valuable insights for development of a national pain coach model. Coaching scripts, note template, brochures, videos, inventory and other programmatic materials will be published for further implementation. Future plans include longitudinal patient follow-up, staff satisfaction assessment and addition of new modalities.
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How did India's capital of more than 20 million widen its food security net to reach underserved populations during the 2020 COVID-19 lockdown? Using publicly available data, government orders and insights from informal settlements, the article discusses the lessons from the Delhi government's food relief efforts on universalising food security benefits.