ABSTRACT
Introduction: The enhanced recovery after surgery (ERAS) pathway comprises a series of evidence-based interventions accelerating recovery after surgery. COVID-19 disrupted perioperative processes, and vulnerable populations were at exceptionally high risk. Objective: To facilitate and improve adherence to preoperative ERAS pathways, preoperative chlorhexidine (CHG) and prenutritional drinks were mailed directly to patients (ERAS kit). We hypothesized that shipping kits direct to women undergoing gynecological surgery would increase adherence and provide more equitable care. Methods: This study is a retrospective cohort study of all adult cis-gender female patients undergoing gynecological surgery at a large tertiary hospital from October to November of 2021. Adherence and access to the pathway at the time of surgery were compared between White patients and other racial minority groups in October and November 2019, 2020, and 2021 (before COVID-19, during COVID-19, and intervention period). Patient demographics were described using frequency and percent for categorical variables and mean and standard deviation for continuous variables. SPC 3-sigma p-charts were used to evaluate changes in the utilization of pre-surgical ERAS interventions. Results: Compared to White patients, women from racial minority groups undergoing hysterectomy were less likely to adhere to ERAS pre-surgical interventions such as pre-surgery carbohydrate hydration (20.9 vs. 42.9%, P = 0.005) or use the preoperative CHG soap (60.4% vs. 77.6%, P = 0185). From October 1st to November 30th of 2021, a total of 127 patients that had a hysterectomy received an ERAS pre-surgery kit at home. White patients had a 91.9% adherence to pre-surgical nutrition, while other racial minority groups had 96.4% adherence (P = 0.713). During the study period, White patients had 98.0% adherence to the CHG portion of the pathway, and other racial minorities groups had 96.3% (P = 0.188). Conclusions: t baseline, non-White patients undergoing hysterectomy were less likely to adhere to ERAS pre-surgical interventions such as pre-surgery carbohydrate hydration and CHG use. Delivering ERAS pre-surgical kits directly to the patients' homes is associated with large increases in utilization of the ERAS pathway among both White patients and patients of color.
ABSTRACT
Respiratory viral infections are a major public health concern because of their global occurrence, ease of spread and considerable morbidity and mortality. Medical treatments for viral respiratory diseases primarily involve providing relief from symptoms like pain and discomfort rather than treating the infection. Very few antiviral medications have been approved with restrictive usage, high cost, unwanted side effects and limited availability. Plants with their unique metabolite composition and high remedial values offer unique preventive and therapeutic efficacy in treatment of viral infections. The present review is focused on the types and mode of action of plant secondary metabolites that have been used successfully ί in the treatment of infections caused by respiratory viruses like Influenza, SARS, MERS, RSV etc. Plant metabolites such as phenolics, alkaloids, terpenoids and oligosaccharides inhibit attachment and entry of the virus. Others such as flavonoids, viz quercetin and baicalein, alkaloids viz sanguinarine, berberine and emetine, specific lipids and fatty acids prevent viral replication and protein synthesis. These metabolites have the potential to be used as lead molecules that can be optimized to develop potent drugs for effectively combating pandemics caused by respiratory viruses.