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Blackground and objective: Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are not data of models between clinicians. Our objective is to analyse the impact of the COVID-19 pandemic on the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our area. Methods: Patients with at least one e-consultation between 2018 and 2021 were selected. We analysed the impact of the COVID-19 pandemic on activity and waiting time for care, hospitalizations and mortality, taking as a reference the consultations carried out during 2018. Results: We analysed 25,121 patients. Through logistic regression analysis, it was observed that a shorter delay in care and resolution of the e-consultation without the need for face-to-face care were associated with a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated with worse health outcomes compared to 2018. Conclusions: The results of our study show a significant reduction in e-consult referrals during the first year of the COVID-19 pandemic with a subsequent recovery in the demand for care without the pandemic periods being associated with worse outcomes. The reduction in the time elapsed for solving the e-consult and no need for in-person visit were associated with better outcomes.
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Background and objective Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are no data corresponding to models between clinicians. An analysis was made of the impact of the COVID-19 pandemic upon the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our healthcare area. Methods Patients with at least one e-consultation between 2018 and 2021 were selected. We analyzed the impact of the COVID-19 pandemic upon activity and waiting time for care, hospitalizations and mortality, taking as reference the consultations carried out during 2018. Results A total of 25,121 patients were analyzed. Logistic regression analysis showed a shorter delay in care and resolution of the e-consultation without the need for face-to-face care to be associated to a better prognosis. The COVID-19 pandemic periods (2019–2020 and 2020–2021) were not associated to poorer health outcomes compared to 2018. Conclusions The results of our study show a significant reduction in e-consultation referrals during the first year of the COVID-19 pandemic, with a subsequent recovery in the demand for care, and without the pandemic periods being associated to poorer outcomes. The reduction in time elapsed for resolving the e-consultations and no need for face-to-face visits were associated to improved outcomes.
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BACKGROUND AND OBJECTIVE: Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are no data corresponding to models between clinicians. An analysis was made of the impact of the COVID-19 pandemic upon the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our healthcare area. METHODS: Patients with at least one e-consultation between 2018 and 2021 were selected. We analyzed the impact of the COVID-19 pandemic upon activity and waiting time for care, hospitalizations and mortality, taking as reference the consultations carried out during 2018. RESULTS: A total of 25,121 patients were analyzed. Logistic regression analysis showed a shorter delay in care and resolution of the e-consultation without the need for face-to-face care to be associated to a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated to poorer health outcomes compared to 2018. CONCLUSIONS: The results of our study show a significant reduction in e-consultation referrals during the first year of the COVID-19 pandemic, with a subsequent recovery in the demand for care, and without the pandemic periods being associated to poorer outcomes. The reduction in time elapsed for resolving the e-consultations and no need for face-to-face visits were associated to improved outcomes.
Subject(s)
COVID-19 , Cardiologists , General Practitioners , Remote Consultation , Humans , COVID-19/epidemiology , Pandemics , Referral and ConsultationABSTRACT
The COVID-19 outbreak represented a remarkable challenge in universities and colleges since it forced the transition from a face-to-face model in classrooms and laboratories to a remote, online model using computers, tablets, and cell phones. In Mexico and other Latin American countries, the return to educational activities was a slow-paced process. The lack of presential activities had a deep impact on education, particularly in under- and graduate Chemistry courses, where laboratory work allows students to develop skills and abilities by applying their knowledge to solve experimental problems. As a consequence, institutional and personal efforts were put together to overcome this situation. These efforts led to remarkable experiences and outcomes with high educational value. This work presents experiences and outcomes of the Instrumental Analysis course offered in the Chemistry Clinical Biologist bachelor program throughout three nonconsecutive semesters, each time on different contexts, to describe the challenges faced, and the emerging opportunities from the experience throughout the pandemic. Each experience is described in a case study. Case 1 exemplifies a regular, pre-COVID-19 semester, in 2019, in a fully face-to-face teaching modality. Case 2 describes a semester in the middle of the COVID-19 crisis in 2020, in a 100% online teaching modality. Finally, Case 3 presents a semester with low prevalence of COVID-19 cases, using a hybrid modality, in 2021. Our observations suggest significant differences related to the knowledge integration process when laboratory work was interrupted, and provide evidence about how online activities impacted the learning process in experimental chemistry courses. © 2023 American Chemical Society and Division of Chemical Education, Inc.
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Patients with inflammatory bowel disease (IBD) treated with biologic and/or immunosuppressant drugs are at increased risk for opportunistic infections. Seroprevalence studies can confirm the diagnosis of SARS-CoV-2 infections as well as the associated risk factors. This is a descriptive study which primary endpoints were to highlight the prevalence of SARS-CoV-2 antibodies in a cohort of IBD patients in March 2021, and to analyze seroconversion in patients with known COVID-19 infection and its relationship with IBD treatments. Patients filled in a questionnaire about symptoms of COVID-19 infection and clinical information about their IBD. All included patients were tested for SARS-CoV-2 antibodies. 392 patients were included. Among patients with clinical infection, 69 patients (17,65%) were IgG-positive, 286 (73,15%) IgG-negative and 36 (9,21%) indeterminate. In relation to seroconversion among patients under biologic treatment, 13 patients of the 23 with a previous positive CRP developed antibodies (56.5%). However, when the influence of immunosuppressive treatment on the probability of developing antibodies was analyzed, no significant differences were seen between those patients with or without treatment (77.8% vs. 77.1%, p = 0.96). In our cohort of IBD patients, after one year of pandemic, there were 18.64% IgG positive patients, a higher prevalence than the general population (15.7%).
Subject(s)
Biological Products , COVID-19 , Inflammatory Bowel Diseases , Humans , COVID-19/epidemiology , Seroepidemiologic Studies , SARS-CoV-2 , Antibodies, Viral , Immunosuppressive Agents/therapeutic use , Inflammatory Bowel Diseases/drug therapy , Inflammatory Bowel Diseases/epidemiology , Immunoglobulin G , Biological Products/therapeutic useABSTRACT
Purpose: This study investigated how organizations can maintain their supply chain (SC) resilience in situations where high-impact shocks cannot be absorbed and what capabilities are needed. The article is an empirical exploration of a socio-ecological view of resilience in the SC context. Design/methodology/approach: The case under study in this article is that of Médecins sans Frontières (MSF) and MSF's reconfiguration of its supply management processes in response to the supply shocks during the coronavirus disease 2019 (COVID-19) pandemic. In total, 503 internal documents and ERP extractions from six databases from late 2019 to September 2020, 43 semi-structured interviews and a 3-round policy Delphi process were used to investigate this phenomenon. Findings: The authors' results show that throughout the pandemic, MSF adapted its procurement and supply processes to cope with supply shortages at both the international and local levels of the SC. This was possible due to the organization's capacity to use its exploitation and exploration capabilities of the organization at the same time. Research limitations/implications: This research is based on the single in-depth case study of a medical aid organization. Further research should investigate this phenomenon in commercial companies with similar or different organizational structures. Originality/value: This study constitutes a first attempt to empirically demonstrate that the four phases of the adaptive cycle put forth in the panarchy theory constitute a suitable representation of the reconfigurations that SCs follow in response to a high-impact shock. The study also adds to the growing body of knowledge on resilience by including ambidexterity as a mechanism to achieve resilience. © 2022, Diego Vega, Ala Arvidsson and Félicia Saïah.
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Purpose: The purpose of this study is to analyse the crisis network response of European countries and the role played by defence organizations (DOs) during the early response phase of the pandemic, here set to encompass 75 days. Design/methodology/approach: Published materials – reports, news and communications – provided by authorities and DOs were used. Some of the authors actively participated in national pandemic response networks. An exploratory approach and qualitative content analysis were applied. The data were collected in national languages from 13 European countries, and they were coded and analysed using the actors, resources and activities (ARA) framework. Findings: This study identified three main categories of activity structures in which the DOs interacted with civilian members of response networks, health-related services, logistics services and public support services. These networks among actors were found within formal response systems and emergent networks. The DOs engaged as actors that provided a range of services when civil authorities could not cope with the huge demand for specific services and when resources were scarce in the initial response phase. Originality/value: This study contributes by filling an important research gap with regard to the civil-military relations associated with the use of DO resources in the civil response to the pandemic crisis in Europe, which is described as an untraditional response. The ARA network approach provides a framework for arranging ARA and extends the wider civil-military network to expand the formal networks of the early crisis response. The study lays knowledge about the co-operation between civilian and military actors in different contexts and provides a broader understanding of the roles that DOs played in the response operations. © 2022, Elvira Kaneberg, Wojciech D. Piotrowicz, Jana Abikova, Tore Listou, Sarah Aline Schiffling, Claudia Paciarotti, Diego Vega and Kristjana Adalgeirsdottir.
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In March 2020, schools had to move to an online format as a result of the pandemic. Subsequently, they returned to the classroom in a hybrid format until full face-to-face. This paper analyses the perception of management teams regarding the implementation of digital competences during the pandemic by COVID-19. To this end, eight interviews were conducted with management teams from public, subsidized and private schools in the Community of Madrid. Three very marked scenarios were obtained: a first stage of survival and uncertainty for schools without a technological development plan;a second stage of coexistence of face-to-face and digital with a considerable reinforcement of the latter as a result of the experience of the previous stage. And finally, a continuation of digital competences in the face-to-face format. At the same time, many schools were faced with a digital divide among families and a lack of teacher training in digital skills. This was compensated for by the coordinated work of the management teams, a positive attitude and a great adaptability to adapt to this new situation and determine appropriate plans to achieve the learning of their students. © 2022, Hipatia Editorial. All rights reserved.
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Background: Our objective is to evaluate the serologic response to the SARS-CoV-2 vaccine in patients with Inflammatory Bowel Disease (IBD). In addition to that, we want to analyze the influence of immunosuppressive drugs in that response, as well as describe the adverse events in this population. Methods: We included 266 patients in a unicentric prospective study. All patients signed informed consent. A serologic blood test was made days before the first dose and 2-4 weeks after the complete immunization. We used Siemens Atellica Anti-SARS-CoV-2 (N) and Vircell Virclia (S and N) electrochemiluminescence immunoassay to detect antibodies to SARS-CoV-2). If they were discordant, the results were considered as undetermined. The IBD treatment was stable along the study. The statistics analysis of data was done with Stata 16. Results: Basal characteristics are described in table 1. The patients were on treatment with: 15 (5.66%) had no treatment, 47 (17.7%) had mesalamine, 4 (1.51%) had corticosteroids, 41 (15.47%) had immunomodulator, 113 (42.64%) had biologic and 45 (16.98%) had combo. Amongst the biologic drugs: Infliximab 51 (32,3%), Adalimumab 50 (31,6%), Vedolizumab 19 (12,03%) y Ustekinumab 31 (19,6%). The vaccines were messenger RNA BNT162b2 (Pfizer-BioNTech) in 154 12 months are presented as a real world evidence (RWE) comparison of UST vs anti-TNF. Methods: After exclusion of other biologics than UST and anti-TNF and missing outcomes, the final sample consisted of 607 CD-patients. Clinical remission (HBI ≤ 4) was the predefined endpoint at month 12. Patients were analyzed on a modified intent-to-treat basis (mITT;switchers considered as outcome failure). To reduce the effect of confounders, propensity score (PS) adjustment with inverse probability of treatment weighting (IPTW) was implemented. A weighted logistic regression was used, and the results were reported as odds ratio (OR) and 95% confidence interval (CI). Results: 343 UST (naïve: 35) and 264 anti-TNF (naïve: 175) (ADA 61%, IFX 39%) CD-patients were included. PS removed systematic differences between both groups (mean of both groups: 15% perianal disease, 36% surgical resection, 41% EIM). Overall, the number of switches was lower in the UST group than in the anti- TNF group (Tab. 1). However, the number of switches within 12 months was significantly lower in the UST group only when compared to the IFX group (16.3% vs 27.2%;p=0.045) (Fig. 1). Clinical remission rates at 1 year (Tab. 2) were not statistically different for the overall UST vs. anti-TNF groups (65.8% vs 60.0%). Remission rates were similar for UST vs ADA, while these were significantly higher for UST vs. IFX (61.6% vs 41.8%;p=0.009). Looking at clinical remission in the week 16 responder group (Tab. 3), a statistically significantly higher remission rate was found in the overall group for UST (77.6%) vs anti-TNF (65.4%) (p=0.041), which was mainly driven by the higher UST remission rate in biologic-naïve CD patients (p=0.026). Conclusion: This 1-year maintenance phase RWE-comparison with UST vs anti-TNF showed remarkably high clinical remission rates in both groups. Also due to a more frequent switching within the IFX group, the clinical remission rate at 1 year was significantly higher with UST than with IFX and higher with UST vs anti-TNF in the biologic-naïve groups. These results support together with the known favorable safety profile consideration of UST as a first-line targeted therapy for CD.
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Introduction: Patients with inflammatory bowel disease (IBD) treated with biologic and/or immunosuppressant drugs are at increased risk for opportunistic infections, including viral infections (1) Previous studies have postulated that patients with IBD were not at increased risk of severe SARS-CoV-2 infections (2) although given the absence of microbiological confirmation at the onset of the pandemic, past infection could not be confirmed. Seroprevalence studies can confirm the diagnosis of SARS-CoV-2 infections as well as the associated risk factors. Aims & Methods: This is a descriptive study which primary endpoint was to highlight the prevalence of SARS-CoV-2 antibodies in a cohort of patients diagnosed with IBD followed in our unit, between 26 February and 26 March 2021, one year after the start of the pandemic. Patients with scheduled on-site visits to our unit were included;they filled in a detailed questionnaire about symptoms of COVID-19 infection, demographic data and clinical information about their IBD. All included patients were tested for SARS-CoV-2 antibodies by ELISA. Results: 338 patients were included: 181 with a diagnosis of Crohn's disease, 132 with ulcerative colitis and 25 with indeterminate colitis;baseline characteristics are shown in Table 1. There were 74 patients with clinically suspected infection compared to 264 without compatible clinical features. Among patients with clinical infection, 63 patients (18,64%) were IgG-positive, 243 (71,89%) IgG-negative and 32 (9,47%) indeterminate;These results were compared with the prevalence data of the Spanish Government in the community of Madrid (IgG positive 15,7%);differences were not statistically significant (p<0.05) (5). The positivity rate was analysed according to the treatment received. At the beginning of the pandemic, there were 46 patients without treatment (serological positivity rate 13,04%), 90 patients receiving mesalazine (IgG positive 27,78%), 51 patients receiving immunomodulators (IgG positive 27,45%), 85 patients with biological treatment (IgG positive 17,64%) and 56 patients combined biological and immunosuppressive treatment (serological positivity rate 5,36%).);these results were statistically significant (p <0,05). It is difficult to establish whether these differences between treatments are due to a lower number of infections (more patient care in the immunocompromised groups) or a lower seroconversion rate. (Table Presented) Conclusion: Although SARS-CoV-2 infection has been a diagnostic challenge in some cases, the presence of antibodies by ELISA allows confirmation of past infection. In our cohort of IBD patients, after one year of pandemic, there were 18.64% IgG positive patients, a higher prevalence than the general population (15.7%) (4). These differences may be justified by a higher number of hospital visits, the inflammatory disease itself or the treatments received.