Hand hygiene practices in Caribbean and Latin American countries: An integrative review.

AIM AND OBJECTIVE: To explore what is known about knowledge, attitudes and beliefs that influence hand hygiene practices in in low- and middle-income Caribbean and Latin American countries. BACKGROUND: With the emergence of infectious diseases such as the recent COVID-19 pandemic, handwashing is key to preventing communicable diseases as they disproportionately affect populations in low-income countries. While hand hygiene is known to be the single most effective method for avoiding the transmission of infection, little is known about the beliefs and practices of individuals in these regions. METHODS: Following PRISMA 2020 Checklist, an integrative review of studies published from 2008-2020 was conducted (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Whittemore and Knafl's method was used to review the literature. Six databases were searched, and the Johns Hopkins Evidence Based Rating Scale was used for study appraisal. RESULTS: The review yielded 18 studies conducted across Latin America. Poor handwashing practices are influenced by various factors including inadequate education and training, cultural beliefs, lack of resources and substandard government regulations. Communicable diseases and other diarrheal illnesses were highly prevalent, especially after a major disease outbreak. CONCLUSION: Future post-disaster campaigns aimed at improving hand hygiene and handwashing practices should focus on beliefs and attitudes to affect behaviour change since there was a higher disease susceptibility during those times. Barriers to proper hand hygiene include false attitudes such as, washing hands only after touching bodily fluids/patient contact or not washing hands at all after open defecation. RELEVANCE TO CLINICAL PRACTICE: Researchers working with populations in Latin America and the Caribbean should partner with local community health workers to improve compliance to recommended hand hygiene practices.

Ophthalmology practice during the COVID-19 pandemic

OBJECTIVE: To present an established practice protocol for safe and effective hospital-setting ophthalmic practice during the coronavirus disease 2019 (COVID-19) pandemic. METHODS AND ANALYSIS: Literature was reviewed to identify articles relevant to COVID-19 pandemic and ophthalmology. The following keywords were used: COVID-19, SARS-CoV-2 and telemedicine, combined with eye, ophthalmology, conjunctivitis and tears. Data were extracted from the identified manuscripts and discussed among subspecialists to obtain consensus evidence-based practice. RESULT(S): A protocol for ophthalmic practice in the era of COVID-19 pandemic was established. The protocol covered patient screening, clinic flow, required personal protective equipment and modifications of ophthalmic equipment for improved safety. CONCLUSION(S): Important literature emerged with respect to the practice of ophthalmology in the era of COVID-19. An evidence-based ophthalmic practice protocol was established and should be modified in the future to accommodate new insights on the COVID-19 pandemic.Copyright © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Efficacy, Safety, and Molecular Response Predictors of Oral Ixazomib and Short-Course Rituximab in Untreated iNHL.

Indolent B-cell non-Hodgkin lymphoma (iNHL) patients generally require treatment but experience normal survival, emphasizing the need for simpler, safer therapies. Proteasome inhibitors target aberrant signaling pathways within iNHL and have manageable toxicities. We evaluated the oral proteasome inhibitor ixazomib as initial monotherapy, and combined with rituximab, for first-line treatment of iNHL. Treatment-naïve iNHL patients needing therapy received oral ixazomib 4 mg weekly until progressive disease or unacceptable adverse events. A 4-week course of rituximab was added during month 7. The primary endpoint was overall response rate (ORR) during the ixazomib monotherapy window. Correlates included gene expression profiling and response to SARS-CoV-2 vaccination. Thirty-three patients with follicular lymphoma (FL) (n=20), marginal zone lymphoma (n=7), and other iNHL were treated with median follow-up of 30.3 months. During the 6-month ixazomib window the ORR was 24%, including 35% in FL. Best ORR over the entire study period was 52% overall and 65% in FL; CR was achieved in 33% and 45%, respectively. The median duration of response was 25.8 months (range, 0 - 49.7), and the 24-month progression-free and overall survival were 51% (95% CI 32-67%) and 91% (95% CI 74-97%). Ixazomib was well-tolerated. Baseline downregulation of proteasome genes PSMB9 (P = 0.03) and PSMB8 (P = 0.007) were associated with response. All evaluated patients generated anti-S antibodies to SARS-CoV-2 vaccination, median 254.9 BAU/mL. Ixazomib demonstrated efficacy alone and with short course rituximab in untreated iNHL while exhibiting favorable toxicity, convenience, and retention of B-cell immune response. This trial is registered at www.clinicaltrials.gov as NCT02339922.

Prospective teachers’ cognitive engagement during virtual teaching in the time of COVID-19 using ICT: the case of GeoGebra and Desmos

This article focuses on teacher educators’ reflections on prospective teachers’ cognitive engagement in the teaching and learning of mathematics during the pandemic. Using three interacting aspects that can foster learners’ cognitive engagement as a lens, observations and reflections from two teacher educators and anonymous screenshots of students’ work were gathered and analysed by a mathematics teacher educator. The prospective teachers’ self-regulated learning, engagement in solving tasks, and participation in productive discourse were positively surprising, showing the cognitive presence of the learners during virtual teaching. The influence of digital platforms like Blackboard and digital tools like GeoGebra, Desmos, Padlet, Google Docs, Google Forms and Google Sheets in teaching helped us observe the learners’ cognitive engagement in real time. Contribution: The GeoGebra Class function and the Desmos Teacher feature helped us to observe the prospective teachers’ cognitive engagement during the online teaching. However, continuously and rapidly creating digital content on said digital platforms can be demanding for educators.

A Quality Improvement Pathway to Promote Health Equity by Increasing Compliance with Diagnostic Testing Following Telemedicine Visits in an Underserved Population

Objective: The primary aim of this quality improvement project focuses on improving compliance with diagnostic testing by 20% over a 6 month period. Background(s): Following the COVID-19 pandemic, there was a rapid upscaling in the use of telehealth. Telehealth is now being used to provide follow up visits in our pediatric gastroenterology fellows clinic, which is comprised of an underserved patient population. Limited access to care has been shown to disproportionately affect underserved populations. Prior to the use of telemedicine, diagnostic testing including blood work was completed or scheduled at the time of visit to promote compliance. With expansion of telemedicine, compliance with diagnostic testing in this patient population became a concern due to limited access and health literacy. Without timely completion of testing and results, there is potential for missed and delayed diagnoses, impeding the ability to treat effectively. Method(s): Prior to initiating intervention, preliminary data was collected including blood work, imaging, and stool studies completed at 2 weeks and by next visit. In PDSA 1, a standardized phrase was created to limit variability amongst providers. Our intervention involved sending Epic patient portal reminder messages within 24 hours of each appointment. In PDSA 2, a second reminder was added 2 weeks post visit. The quality improvement study began August of 2021 and is ongoing. Result(s): Background data was collected for compliance of diagnostic testing at 2 weeks for blood work (33%), imaging (17%), and stool samples (0%). We also collected data on diagnostic testing completed by next visit for blood work (50%), imaging (50%), and stool samples (0%). Post intervention data was then collected over a 6 month period. Our data showed improvement to 50% compliance for completed blood work and 20% compliance for submitted stool samples 2 weeks out from visit. Data showed 100% compliance with blood work and 60% compliance with submitted stool studies prior to next visit, surpassing our goal of 20% improvement in compliance over a 4 month period. Our team also looked at completion of imaging orders, and scheduling of upper endoscopy and colonoscopy procedures prior to next visit. However the numbers were insufficient to draw any meaningful conclusions at this time. Conclusion(s): Our data supports the use of electronic medical record portal messaging systems as a valuable tool for promoting compliance with diagnostic testing in an underserved population following telemedicine visits. This is an opportunity to improve access to care and health equity. Data collection is ongoing for PDSA 2.

Development of a prevention tool for caregivers in a Swiss regional hospital during COVID-19

In the context of the spread of the COVID-19 virus in March 2020 and the health alert declared by the Swiss Confederation, hospitals had to rethink the provision of several services in order to meet the needs of this new patient population. Health professionals had to adapt to this exceptional situation, both professionally and personally. Supporting the mental health of healthcare staff by providing psychological support became necessary. In the northern region of the canton of Vaud, a liaison psychiatry team quickly set up a COVID-19 psychological unit to provide psychological support for the nursing staff of a general hospital. As part of this activity, a psycho-educational tool (COVID-19 psychological booklet) was developed and distributed during supervision sessions. The COVID-19 booklet included information such as challenges for care staff, warning signs, mental health risks, and strategies for maintaining mental well-being. Between March and April 2020, a total of 61 carers received the psychological booklet, of whom 10 agreed to participate in a feedback interview to assess the relevance of this prevention tool. The feedback from the carers indicated that the structure of the booklet needed to evolve to a form closer to reality in the field, and that some content needed to be distanced from a lexicon perceived as stigmatising or psychiatric. More generally, many of the warning signs and risks to mental health resonated with the experiences of the carers, thus validating the relevance of the tool. Taking into account the feedback from the participants, a second version of the brochure was developed and distributed to all the care institutions in the northern region of the canton of Vaud. © 2021 EMH Swiss Medical Publishers Ltd.. All rights reserved.

The Impact of Degree of Anticoagulation on Thrombotic and Other Complications in Hospitalized COVID-19 Patients

Introduction: In hospitalized patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the frequency of venous thromboembolism (VTE) is increased. Retrospective studies suggested that an elevated D-dimer level is associated with increased mortality and predictive of thrombosis in these patients. In the spring of 2020, our institution developed a risk protocol for stratification of hospitalized COVID-19 patients into high, intermediate, or low risk groups, based upon history of thrombosis and D-dimer level. These patients were treated with full-dose anticoagulation, high- or standard-dose prophylaxis, respectively. The goal of this project was to determine the impact of this protocol on VTE frequency, need for intensive care unit (ICU) admission, organ failure and in-hospital mortality while assessing the frequency of hemorrhagic complications when compared to standard prophylactic anticoagulation. Methods: We performed a retrospective chart review of adults hospitalized between March 1 - June 1, 2020 who tested positive for SARS-CoV-2 by nasopharyngeal polymerase chain reaction (PCR). Patients were excluded if they were initially admitted to the ICU. VTE was defined as either a deep vein thrombosis (DVT) on Duplex ultrasound and/or pulmonary embolism (PE) on computed tomography (CT) angiogram. We collected demographic data, medical histories, laboratory and radiologic data on all subjects. Data were analyzed using the Chi Square test and Fisher's Exact Test to establish significant association with clinical outcomes between 3 anticoagulation regimens. Statistical significance was assessed at the p<0.05 level. Results: Data were analyzed from 910 patients;496 (54.6%) were male and the mean age was 57.8 ± 16.9 years. 419 (46%) subjects were Black, 151 (16.6%) Caucasian, 133 (14.6%) Latinx. Diabetes mellitus (35.3%) and hypertension (59.8%) were common in our cohort as were tobacco (12.6%) and alcohol (20.4%) use. Only 69 (7.6%) were treated with chronic anticoagulation and 216 (23.7%) were on antiplatelet agents. 123 (13.5%) required an ICU transfer and the overall mortality was 5.3%. Most patients, 809 (88.9%), received standard prophylactic anti-coagulation initially (Group A);32 (3.5%) received high dose prophylaxis (Group B) and 69 (7.6%) received therapeutic dose anticoagulation (Group C). In the entire cohort, 46 (5.1%) developed VTE;29 (3.6%) in Group A, 2 (6.3%) in Group B, and 15 (22%) in Group C (p<0.0001). ICU admission was required for 102 (12.6%) in Group A, 7 (21.9%) in Group B, and 14 (20.3%) in Group C (p=0.075). 73 ICU patients (8%) required vasopressors, including 57 (7%) in Group A, 6 (18.8%) in Group B and 10 (14.5%) in Group C (p=0.175). 81 ICU patients (8.9%) required mechanical ventilation, including 66 (8.2%) in Group A, 6 (18.8%) in Group B, and 9 (13%) in Group C (p=0.513). One patient in Group B developed an intracerebral hemorrhage. Gastrointestinal hemorrhage occurred in 11 (1.2%) of the cohort;similar rates were observed across treatment arms. The overall in-hospital mortality was 5.3% in this cohort (4.7% in Group A, 12.5% in Group B, and 8.6% in Group C, p=0.064). Conclusion: The rate of VTE in COVID-19 patients receiving any form of anti-coagulation was low. There was an increased rate of VTE, but not rates of ICU admission, mortality, mechanical ventilation nor vasopressor use in those receiving either high dose prophylaxis or therapeutic anticoagulation, suggesting an increased propensity for thrombosis either related to prior thrombotic events or reflected by increased D-dimer levels. These findings need to be confirmed in prospective studies. Disclosures: DiLorenzo: Abbott: Current holder of individual stocks in a privately-held company;Merck & Co: Current holder of individual stocks in a privately-held company;Glaxo Smith Kline: Current holder of individual stocks in a privately-held company. Sloan: Pharmacosmos: Membership on an entity's Board of Directors or advisory committees;Astra Zeneca: Membership on an entity's Board of Directors or adv sory committees;Abbvie: Honoraria;Stemline: Honoraria. Weinberg: Janssen Pharmaceuticals: Other: Serve on data safety monitoring boards;Merck & Co: Current holder of individual stocks in a privately-held company. Klings: CSL Behring: Other: Consultant;Omeros: Other: Consultant;Bluebird Bio: Other: Consultant;Bayer: Research Funding;Novartis: Research Funding;FORM therapeutics: Research Funding.

Multi-Level Group Testing with Application to One-Shot Pooled COVID-19 Tests

One of the main challenges in containing the Coronoavirus disease 2019 (COVID-19) pandemic stems from the difficulty in carrying out efficient mass diagnosis over large populations. The leading method to test for COVID-19 infection utilizes qualitative polymerase chain reaction, implemented using dedicated machinery which can simultaneously process a limited amount of samples. A candidate method to increase the test throughput is to examine pooled samples comprised of a mixture of samples from different patients. In this work we study pooling-based COVID-19 tests. We identify the specific requirements of COVID-19 testing, including the need to characterize the infection level and to operate in a one-shot fashion, which limit the application of traditional group-testing (GT) methods. We then propose a multi-level GT scheme, designed specifically to meet the unique requirements of COVID-19 tests, while exploiting the strength of GT theory to enable accurate recovery using much fewer tests than patients. Our numerical results demonstrate that multi-level GT reliably and efficiently detects the infection levels, while achieving improved accuracy over previously proposed one-shot COVID-19 pooled-testing methods.

COVID-19: Putting Stock Markets Back on Recovery among the Crude Oil Producing Economies

COVID-19 poses an unprecedented threat to components of global business cycles including stock markets, industrial production and employment. This study investigated its impact on stock markets of 24 oil producing COVID-19-hit economies in North America, South America, Europe, Asia, Oceania and Africa. It examined the nature of asymmetry in the business cycles of the sampled countries and the impact of COVID-19 on the asymmetry. Switching regression techniques were estimated with data covering the period from October 1, 2019 to April 14, 2020. The results confirmed the presence of negative asymmetry in stock market cycles in 54.2% of the sampled countries, out of which 38.5%, 46.2% and 15.4% are high, middle and low-middle income countries, respectively. This is significantly connected to the COVID-19 pandemic for 29.2% of the sample. The expected duration of being in the state of low stock market performance, due to COVID-19, reduces with levels of countries’ income, if regimes are dependent. Opposite was observed if regimes are independent. Hence, the negative impact of COVID-19 on stock markets in lower-income countries will linger compared to higher-income countries. Reducing COVID-19-associated risks will go a long way to revive investors’ confidence in the market and help to restart the engine of economic recovery in the sampled countries.

Automatic Chest CT Image Findings of Novel Coronavirus Pneumonia (COVID-19) Using U-Net Based Convolutional Neural Network

The continuing outbreak of COVID-19 pneumonia is globally concerning. Timely detection of infection ensures prompt quarantine of patient which is crucial for preventing the rapid spread of this contagious disease and also supports the patient with necessary medication. Due to the high infection rate of COVID-19, our health management system needs an automatic diagnosis tool that equips the health workers to pay immediate attention to the needy person. Chest CT is an essential imaging technique for diagnosis and staging of 2019 novel coronavirus disease (COVID-19). The identification of COVID-19 CT findings assists health workers on further clinical evaluation, especially when the findings on CT scans are trivial, the person may be recommended for Reverse-transcription polymerase chain reaction (RT-PCR) tests. Literature reported that the ground-glass opacity (GGO) with or without consolidation are dominant CT findings in COVID-19 patients. In this paper, the UNet based segmentation approach is proposed to automatically segment and analyze the GGO and consolidation findings in the chest CT scan. The performance of this system is evaluated by comparing the auto-segmented infection regions with the manually-outlines ones on 100 axial chests CT scans of around 40 COVID-19 patients from SIRM dataset. The proposed U-Net with pre-process approach yields specificity of 0.91 ± 0.09 and sensitivity of 0.87 ± 0.07 on segmenting GGO region and specificity of 0.81 ± 0.13 and sensitivity of 0.44 ± 0.17 on segmenting consolidation region. Also the experimental results confirmed that the automatic detection method identifies the CT finding with a precise opacification percentage from the chest CT image. © University of Tehran, Faculty of Management