How to evaluate surgical tourism service organizations in China: indicators system development and a pilot application.

BACKGROUND: Surgical tourism is an emerging economic sector, with the most growth potential demonstrated in China's health industry before the COVID-19 pandemic. Surgical tourism accounts for a large part of medical tourism services in China, with high requirements in terms of quality and safety. By contrast, China suffers from insufficient measurement tools and theoretical research. The aim of this study was to develop a set of reliable and feasible indicators by augmenting the Donabedian model to evaluate the quality of surgical tourism services. METHODS: A literature review and focus group interview were used to generate indicators for the quality of surgical tourism services. The basic framework of the evaluation system was based on the structure-process-outcome Donabedian model. The screening and weight setting were conducted through an analytical hierarchy process (AHP) and a two-round Delphi consultation with 13 panelists. The validity and reliability of experts were tested by the experts' positive coefficient, authority coefficient, and coordination coefficient. The reliability of the questionnaire was assessed by a pre-test distributed within an International Medical Department of a public hospital in China. RESULTS: Based on the Donabedian quality theory, a novel evaluation system of surgical tourism service institutions was constructed with three dimensions, nine first-level items and 39 second-level items. The three dimensions consisted of the structure (0.315), process (0.287), and outcome (0.398), with several indicators for each dimension and each indicator was given a weight. Of the two rounds of Delphi consultation, the response rates were 86.67% and 100%. The coordination coefficient of expert opinions in the two rounds of consultation were 0.49 and 0.65 (p < 0.05). For the empirical study, the self-evaluation score of a public hospital was 86, which could rate as a two-star institution. CONCLUSIONS: Our evaluation system identified three suitable quality dimensions of surgical tourism services to improve the safety and quality of practical healthcare. It reflects the access criterion of surgical tourism institutions, provides references for the best choice of surgical services for tourists, and can be applied by healthcare managers and policy makers to allocate resources more efficiently and promote more surgical tourism services with international standards.

Metaverse and Virtual Health Care in Ophthalmology: Opportunities and Challenges.

ABSTRACT: The outbreak of the coronavirus disease 2019 has further increased the urgent need for digital transformation within the health care settings, with the use of artificial intelligence/deep learning, internet of things, telecommunication network/virtual platform, and blockchain. The recent advent of metaverse, an interconnected online universe, with the synergistic combination of augmented, virtual, and mixed reality described several years ago, presents a new era of immersive and real-time experiences to enhance human-to-human social interaction and connection. In health care and ophthalmology, the creation of virtual environment with three-dimensional (3D) space and avatar, could be particularly useful in patient-fronting platforms (eg, telemedicine platforms), operational uses (eg, meeting organization), digital education (eg, simulated medical and surgical education), diagnostics, and therapeutics. On the other hand, the implementation and adoption of these emerging virtual health care technologies will require multipronged approaches to ensure interoperability with real-world virtual clinical settings, user-friendliness of the technologies and clinical efficiencies while complying to the clinical, health economics, regulatory, and cybersecurity standards. To serve the urgent need, it is important for the eye community to continue to innovate, invent, adapt, and harness the unique abilities of virtual health care technology to provide better eye care worldwide.

Evaluation of a Rapid Antigen Test for the Diagnosis of SARS-CoV-2 during the COVID-19 Pandemic.

OBJECTIVES: Reverse transcriptase-polymerase chain reaction (RT-PCR), the reference laboratory method of confirmed SARS-CoV-2 diagnosis, though requiring equipment, is time-consuming. There is a crucial demand for rapid techniques such as antigen detection test during the pandemic. This study assessed whether a rapid antigen detection (RAD) test was an effective and essential method for the early diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the COVID-19 pandemic. The probability of public screening at home and the application of RAD during the novel SARS-CoV-2 outbreak were also topics of interest. METHODS: A retrospective analysis based on the systemic screening for COVID-19 was conducted at Taipei City Hospital (TCH) from May 28 to June 06, 2021, the first week of outbreak in Taiwan. The results of the RAD and RT-PCR tests were collected from 5 major branches of the TCH. RESULTS: We collected a total number of 6368 cases. We found that the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy ranged from 60.5% to 78.6% (mean 66.0%), 98.2% to 99.9% (mean 99.0%), 74.4% to 97.8% (mean 82.8%), 94.0% to 98.4% (mean 97.5%), and 93.8% to 98.3% (mean 94.2%), respectively. Although the sensitivity score was not high (up to 95% or higher), the other results were satisfactory, with an accuracy of more than 93% in all branches. Furthermore, it had high specificity, PPV, NPV, and accuracy. CONCLUSION: We concluded that RAD could be a quick and feasible method to identify individuals infected with SARS-CoV-2 from non-contagious individuals during the COVID-19 outbreak. A RAD test was an effective and essential method for the early diagnosis of SARS-CoV-2 during the COVID-19 pandemic.

Systematic Screening for SARS-CoV-2 to Detect Asymptomatic Infections: An Epitome of Taiwan's Outbreak

Background Increased studies have revealed that asymptomatic carriers substantially impact the epidemic and that asymptomatic transmission is very common. Therefore, the asymptomatic transmission threat to the spread of the pandemic should not be neglected. Methods The local outbreak in Taiwan, especially in Taipei City, is unprecedented and paramount and has claimed hundreds of lives, tens of thousands of cases, and enormous economic costs. As care providers and gatekeepers of infectious diseases, Taipei City Hospital has to perform regular polymerase chain reaction (PCR) results of admitted patients and healthcare workers (HCWs) to achieve these goals. Results In this study, the results revealed a low positive rate of less than 1%, but the asymptomatic proportions could range from 42% to 46%, which bolsters that systematic screening was effective in controlling coronavirus disease-19 (COVID-19) of Novel Coronavirus or Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) and might be an exemplar to other similar scenarios. Universal screening of admitted patients may be important and necessary, especially in asymptomatic patients. Conclusions Regular screening for healthcare providers is also important during this pandemic, and it is recommended that admitted patients and healthcare providers undergo systemic PCR testing.

Evaluation Index System of Surgical Tourism Service Organizations in China: An Empirical Research (preprint)

Background: Healthcare tourism is an emerging economy with the most potential in China's health industry before the COVID-19 pandemic. Surgical medical health tourism accounts for a large part of medical tourism services in China, which has higher requirements for quality and safety. By contrast, measurement tools and theoretical research are insufficient in China. The aim of this study was to develop a set of reliable and feasible indicators by augmenting the original Donabedian’s quality model to evaluate surgical tourism services’ quality. Methods: : Literature review and focus group interview were used to generate indicators for surgical tourism services’ quality. The basic framework of the evaluation system was based on the structure-process-outcome Donabedian model. The screening and weight setting were conducted through analytic hierarchy process (AHP) and a two-round Delphi consultation with 13 panelists. Validity and reliability of experts were tested by the experts' positive coefficient, authority coefficient, and coordination coefficient. Reliability of the questionnaire was assessed by a pretest distributed within an international medical department of a public hospital in China. Results: : Based on the Donabedian’s quality theory, the novel evaluation system of surgical tourism service institutions with 3 dimensions, 9 first-level items and 39 second-level items was constructed. The three dimensions consist of structure (0.315), process (0.287), and outcome (0.398), with each dimension set several indicators and each indicator given a weight. Of the two rounds of Delphi consultation, the response rates were 86.67% and 100%. The coordination coefficient of expert opinions in the two rounds of consultation were 0.49 and 0.65 (p<0.05). For the empirical study, the self-evaluation score of a public hospital was 86, which could obtain a rating of two stars. Conclusions: : The established evaluation system identified three different dimensions of surgical tourism services’ quality which fit for practical healthcare improvement in safety and quality. It can reflect the access criterion of surgical tourism institutions, provide references on better choices of surgical services for tourists, and can be applied by healthcare managers and policy makers to allocate resources more efficiently and promote more surgical tourism services to international standards.

Facing the Coronavirus Pandemic: An Integrated Continuing Education Program in Taiwan.

This study aimed to identify knowledge gaps regarding coronavirus disease 2019 (COVID-19) and develop an integrated educational program for healthcare workers. First, we designed and validated ten multiple-choice questions to identify knowledge gaps among healthcare workers. Within one month of the online test and curriculum offering, 5533 staff had completed the test, with a completion rate of 84.97%. There were 2618 healthcare workers who answered the pre-test 100% correctly. Those who did not answer the pre-test 100% correctly took multiple tests after learning through the online teaching materials. Eventually, 5214 staff passed the test (pre-test or post-test with 100% correct answers). The result showed that all staff had a low correct rate for personal protective equipment (PPE) use recommendations. The Infection Control Center conducted training sessions for hospital staff on how to wear protective clothing. Information on the selection and use of PPE for infection prevention was provided, and participants were allowed time to practice and familiarize themselves with the correct way to wear PPE. Moreover, the Department of Education and Research continued updating the online learning materials based on the most important updated peer-reviewed published articles. The attending teaching physicians helped to search, translate, and take notes on articles in the local language (traditional Chinese) for other colleagues to read easily. We expect to increase learning opportunities for healthcare workers, even during uncertain times such as the current coronavirus pandemic through (1) the hospital-wide course announcements, (2) the continuous placement of test questions and learning files on the digital learning platform, (3) the placement of journal highlights in cloud folders, and (4) the use of the digital learning platform on mobile phones accessible outside the hospital.

Epidemiological and Clinical Characteristics of Asymptomatic COVID-19 Infection

目的：新型冠狀病毒自2019年12月在中國武漢發現後，不但傳播至其他省分，甚而導致周邊的國家及全世界的大流行。其中無症狀感染者可能的占率有多少？還有傳染力的強弱、是否可能引發社區感染，形成更大的風險？隨著疫情進展，越來越受到重視。方法：本文藉由回顧全球最新的文獻，整理分析其中數據，進而檢視無症狀感染者之占率及其傳播狀態。結果：無症狀之確診人數占率，一般群體有18～57%不等的報告，而在特定群體中，兒童為14%，妊娠孕婦33%，遊民88%。許多文獻顯示無症狀感染者可以傳播COVID-19，也有報告指出，無症狀感染者的可傳播性與有症狀感染者的可傳播性相當。確診病患遭到潛伏期無症狀感染者傳染的比例，新加坡是48∼66%，天津則是62∼77%。結論：無症狀感染者在確診案例中的高占率以及其高傳染性的特性，也許是COVID-19快速席捲全球的原因之一，也意味著我們應該重視無症狀者對疫情傳播的威脅。 Objectives: The purpose of this article is to describe the epidemiological and clinical characteristics of asymptomatic novel coronavirus pneumonia (COVID-19) patients. The outbreak of novel coronavirus disease 2019 has been widely discussed recently. Most of the current studies focused on clinical symptoms. However, COVID-19 infection might present as an asymptomatic carrier state. Adults seemed to represent the population with the highest infection rate;In addition, neonates, children, pregnant women, and elderly patients could also be infected by SARS-CoV-2 without symptoms noted. Moreover, nosocomial infection of hospitalized patients and healthcare personnel (HCP), and viral transmission from asymptomatic carriers were also possible. Methods: This article reviewed the current literature and analyzed the data to examine the proportion of asymptomatic infections and possible transmission. Results: The proportion of asymptomatic carriers ranged from 18 to 57% (14% among children and 33% in pregnant women). Many literature showed that asymptomatic infections might transmit COVID-19. There were also reports indicated that the asymptotic cases can transmit or deliver the virus like the symptomatic cases. Conclusions: Asymptomatic carrier state of COVID-19 is a possible cause of epidemic rebound. This article presents the available data about asymptomatic cases and their possible contributions to the overall epidemic of COVID-19. Emergence of a pandemic of COVID-19 caused by asymptomatic cases is likely to occur.

Olfactory disorder in patients infected with SARS-CoV-2.

Three (60%) of five patients with coronavirus disease 2019 (COVID-19) had olfactory disorder. Two exhibited anosmia at the onset of COVID-19, while one had hyposmia 4 days after the onset of COVID-19. All patients with olfactory disorder were completely recovered with a mean recovery length of 11.3 days.

Guideline for diagnosis and treatment of spine trauma in the epidemic of COVID-19.

Outbreak of COVID-19 is ongoing all over the world. Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against COVID-19 and resumption of work and production. Patients with unstable spine fractures or continuous deterioration of neurological function require emergency surgery. The COVID-19 epidemic has brought tremendous challenges to the diagnosis and treatment of such patients. To coordinate the diagnosis and treatment of infectious disease prevention and spine trauma so as to formulate a rigorous diagnosis and treatment plan and to reduce the disability and mortality of the disease, multidisciplinary collaboration is needed. This expert consensus is formulated in order to (1) prevent and control the epidemic, (2) diagnose and treat patients with spine trauma reasonably, and (3) reduce the risk of cross-infection between patients and medical personnel during the treatment.

A single dose of an adenovirus-vectored vaccine provides complete protection of the upper and lower respiratory tracts against SARS-CoV-2 challenge (preprint)

The unprecedented coronavirus disease 2019 (COVID-19) epidemic has created a worldwide public health emergency, and there is an urgent need to develop an effective vaccine to control this severe infectious disease. Here, we found that a single vaccination with a replication-defective human type 5 adenovirus encoding the SARS-CoV-2 spike protein (Ad5-nCoV) protected mice completely against SARS-CoV-2 infection in the upper and lower respiratory tracts. Additionally, a single vaccination with Ad5-nCoV protected ferrets from SARS-CoV-2 infection in the upper respiratory tract. This study suggested that a combination of intramuscular and mucosal vaccination maybe provide a desirable protective efficacy and different Ad5-nCoV delivery modes are worth further investigation in human clinical trials.

Single-cell RNA-seq and V(D)J profiling of immune cells in COVID-19 patients (preprint)

Coronavirus disease 2019 (COVID-19) has caused over 220,000 deaths so far and is still an ongoing global health problem. However, the immunopathological changes of key types of immune cells during and after virus infection remain unclear. Here, we enriched CD3+ and CD19+ lymphocytes from peripheral blood mononuclear cells of COVID-19 patients (severe patients and recovered patients at early or late stages) and healthy people (SARS-CoV-2 negative) and revealed transcriptional profiles and changes in these lymphocytes by comprehensive single-cell transcriptome and V(D)J recombination analyses. We found that although the T lymphocytes were decreased in the blood of patients with virus infection, the remaining T cells still highly expressed inflammatory genes and persisted for a while after recovery in patients. We also observed the potential transition from effector CD8 T cells to central memory T cells in recovered patients at the late stage. Among B lymphocytes, we analyzed the expansion trajectory of a subtype of plasma cells in severe COVID-19 patients and traced the source as atypical memory B cells (AMBCs). Additional BCR and TCR analyses revealed a high level of clonal expansion in patients with severe COVID-19, especially of B lymphocytes, and the clonally expanded B cells highly expressed genes related to inflammatory responses and lymphocyte activation. V-J gene usage and clonal types of higher frequency in COVID-19 patients were also summarized. Taken together, our results provide crucial insights into the immune response against patients with severe COVID-19 and recovered patients and valuable information for the development of vaccines and therapeutic strategies.

Epidemiological characteristics and the effectiveness of countermeasures to control coronavirus disease 2019 in Ningbo City, China (preprint)

Background: A novel coronavirus (SARS-CoV-2) has spread widely and led to high disease burden around the world. This study aimed to explore key parameters of SARS-CoV-2 infection and to assess the effectiveness of interventions to control the coronavirus disease 2019 (COVID-19).Methods: A susceptible – exposed – infectious – asymptomatic – recovered (SEIAR) model was developed for the assessment. Data of symptomatic and asymptomatic infection of SARS-CoV-2 were collected to calculate the key parameters of the model in Ningbo City, China.Results: A total of 157 confirmed COVID-19 cases (including 51 imported cases and 106 secondary cases) and 30 asymptomatic infections were reported in Ningbo City. The proportion of asymptomatic has an increasing trend. The proportion of asymptomatic of elder people was lower than younger people, and the difference was statistical significant (Fisher’s Exact Test, P = 0.034). There were 22 clusters associated with 167 SARS-CoV-2 infections, among which 29 cases were asymptomatic, with a proportion of 17.37%. We found that the secondary attack rate of asymptomatic was almost the same as that of symptomatic cases, and no significance was observed (χ2 = 1.350, P = 0.245) by Kruskal-Wallis test. The effective reproduction number (Reff) was 1.43 which revealed that the transmissibility of SARS-CoV-2 was moderate. If the interventions were not strengthened, the duration of the outbreak would last about 16 months with a simulated attack rate of 44.15%. The total attack rate and duration of the outbreak would increase along with the increasing delay of intervention.Conclusions: SARS-CoV-2 had moderate transmissibility in Ningbo City, China. Asymptomatic infection has the same transmissibility as symptomatic. The integrated interventions were implemented at different stages during the outbreak, which found to be exceedingly effective in China.