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Medical misinformation is more pervasive today because of widespread and near instantaneous dissemination of information via the internet and social media platforms. Consequences of medical misinformation may include decreased uptake of needed health care resources, delays in seeking care, vaccine hesitancy, medication non-compliance, increased disease outbreaks and/or burden, and increased hospitalization and mortality. It disproportionately impacts underserved populations, including Black patients, those who identify as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and more), and patients with reduced health literacy skills or who are digitally disadvantaged. Medical misinformation challenges health care professionals not only to provide the best care possible, but to assist patients in finding accurate information. Preprint publications, although potentially beneficial in rapidly disseminating new scientific discoveries, often have not undergone peer review and may contribute to the widespread propagation of inaccurate or overstated results, thereby perpetuating the spread of medical misinformation when it exists. The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of practicing evidence-based medicine and the need for cautious review of preprint publications and articles from predatory publishers in addition to usual and customary literature evaluation techniques. Everyone plays a role in preventing the spread of medical misinformation, with pharmacists uniquely positioned as trusted and highly accessible professionals who may help combat its spread. The goal of this article is to define medical misinformation and related terms, outline mechanisms by which it is spread, describe its clinical impact, highlight how it disproportionately impacts underserved populations, provide actionable strategies to prevent its spread, and give examples of practical tactics to help identify, correct, and alert individuals about the possible presence of medical misinformation.Copyright © 2023 Pharmacotherapy Publications, Inc.
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Background. Adults aged >=65 years and those with underlying medical conditions, including residents of long-term care facilities (LTCF), are at increased risk for COVID-19-associated hospitalizations and other severe outcomes. Methods. Hospitalizations among LTCF residents aged >= 65 years from March 2020-January 2022 were described using data on a representative sample of hospitalizations from the CDC's COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance network of > 250 acute care hospitals in 99 counties across 14 states. A Poisson regression model adjusting for age, race/ethnicity, underlying medical conditions, vaccination status, month of admission, and do-not-resuscitate/intubate-or-provide comfort-measures-only (DNR/DNI/CMO) code status examined the relationship of LTCF residency to death during COVID-19-associated hospitalization. Results. Of 11,901 hospitalizations among adults aged >= 65 years reported during the study period, 2,965 (24.9%) were LTCF residents;most resided in nursing homes (53.8%) or assisted living facilities (26.8%). LTCF residents hospitalized with COVID-19 were older and more likely to have cardiovascular disease, congestive heart failure, a neurologic condition, dementia, or >= 3 underlying medical conditions than non-residents (Figure). The proportion of LTCF residents vs non-residents who required intensive care unit admission or invasive mechanical ventilation were not statistically different (23.2% vs 23.5% and 10.7 vs 13.5%, respectively). The proportion of in-hospital death was higher among LTCF residents than non-residents (22.8% vs 14.4%, p < 0.01). More LTCF residents have a DNR/DNI/CMO code status (48%) compared to non-residents (19%). The fully adjusted regression model found the risk ratio for death was 1.03 (95% CI, 1.01-1.05) among LTCF residents compared to non-residents. Conclusion. Compared to non-residents, LTCF residents were older, had more underly ingconditions, and had a higher risk of in-hospital death. After adjusting formultiple potential confounders, results suggest that LTCF residency is a weak but significant independent risk factor for death during COVID-19-associated hospitalization.
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Chemistry simulations using interactive graphic user interfaces (GUIs) represent uniquely effective and safe tools to support multidimensional learning. Computer literacy and coding skills have become increasingly important in the chemical sciences. In response to both of these facts, a series of Jupyter notebooks hosted on Google Colaboratory were developed for undergraduate students enrolled in physical chemistry. These modules were developed for use during the COVID-19 pandemic when Millsaps College courses were virtual and only virtual or online laboratories could be used. These interactive exercises employ the Python programming language to explore a variety of chemical problems related to kinetics, the Maxwell-Boltzmann distribution, numerical versus analytical solutions, and real-world application of concepts. All of the modules are available for download from GitHub (https://github.com/Abravene/Python-Notebooks-for-Physical-Chemistry). Accessibility was prioritized, and students were assumed to have no prior programming experience;the notebooks are cost-free and browser-based. Students were guided to use widgets to build interactive GUIs that provide dynamic representations, immediate access to multiple investigations, and interaction with key variables. To evaluate the perceived effectiveness of this introduction to Python programming, participants were surveyed at the beginning and end of the course to gauge their interest in pursuing programming and data analysis skills and how they viewed the importance of programming and data analysis for their future careers. Student reactions were generally positive and showed increased interest in programming and its importance in their futures, so these notebooks will be incorporated into the in-person laboratory in the future.
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P75 Figure 1Home ventilation delivery and dependence[Figure omitted. See PDF]ConclusionsThe apparent association between home non-invasive ventilator dependence and increased mortality in the second year of COVID-19 in the UK warrants investigation of unmet need in this patient group, compared with the invasively ventilated. Targeted review is planned in the local setting, facilitated by utilisation of home ventilation registry as a method of population surveillance.ReferencesLloyd-Owen SJ, et al. Patterns of home mechanical ventilation use in Europe: results from the Eurovent survey. ERJ 2005;25: 1025–1031.Allen M. Respiratory Medicine: GIRFT Programme National Specialty Report. London: GIRFT, 2021.
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This article analyses the role played by brands, producer-country governments, and unions in mitigating the impact of disruptions caused to garment supply chains by COVID-19 in Cambodia, Indonesia, and Myanmar. Its findings challenge brand-centric accounts, highlighting the need for more serious consideration of the dynamic, relational nature of labor governance—and, in particular, of the role of the state–labor nexus in determining producer-country unions' ability to exercise strategic agency within global supply chains. © 2022 The Authors. Industrial Relations published by Wiley Periodicals LLC on behalf of Regents of the University of California (RUC).
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Background The LA County Department of Health Services (LAC DHS) implemented The Care Ecosystem1, a phone-based dementia care support and education program utilizing Dementia Navigators (DNs) to address unmet needs of patients with dementia and their caregivers (dyads). This is the first time that this program has been implemented in an underserved, multilingual and multicultural population. We used the Replicating Effective Programs (REP) framework to identify implementation barriers at multiple levels including patient, staff, system and external barriers. Barriers and challenges not identified by REP were captured by the Practical, Robust Implementation and Sustainability Model (PRISM). Methods The program was implemented in 4 distinct DHS clinical sites over 18 months. Dyads were enrolled in months 11-18. Monthly meetings were used to track enrollment data and staff engagement as well as to identify barriers at the patient, site, and systems levels. Results One hundred and three patients were referred to the program across all 4 sites, and 47 were enrolled (45.6%). The site with the highest level of PI engagement had the highest number of referrals (N = 63) and patients enrolled (N=22). The site with the highest level of DN engagement had the highest percentage (78.3%) of enrolled patients (N=18) from those referred (N = 23). REP-PRISM factors impacting staff engagement, patient referral, and enrollment identified during the monthly meetings include staff turnover, competing obligations, and administrative support. Other factors include dyad health status, stigma associated with dementia diagnosis, and access to communication technology. COVID-19, an external factor, significantly impacted the implementation process. Conclusions The REP-PRISM framework helped identify implementation barriers at multiple levels while establishing a dementia support program in a safety net health system, and will help inform future implementation projects within this population. Engagement by all study personnel in regular meetings improved program implementation by enhancing communication, support and problem-solving.
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Background: The COVID-19 pandemic led to delays in medical care in the United States. We examined changes in patterns of cancer diagnosis and surgical treatment in 2020 using real-time electronic pathology report data from population-based SEER cancer registries in Georgia and Louisiana. Methods: Bi-weekly numbers, distributions, and patterns of pathology reports were compared between January 1 and December 31 in 2020 and the same period in 2019 by age group and cancer site. Results: During 2020, there were 29,905 fewer pathology reports than in 2019, representing a 10.2% decline. Absolute declines were greatest among adults aged ≥50 years (N=23,065);percentage declines were greatest among children and young adults ≤18 years (38.3%). By cancer site, percentage declines were greatest for lung cancer (17.4%), followed by colorectal (12.0%), breast (9.0%) and prostate (5.8%) cancers. Biweekly reports were statistically significantly lower in 2020 than in 2019 from late March through the end of December in most biweekly periods. The nadir was the month of April 2020 - the number of reports was at least 40% lower than in April 2019. The number of reports in 2020 compared with 2019 also declined sharply in early November (26.8%) and late December (32.0%). Numbers of reports in 2020 never consistently exceeded those in 2019 after the first decline. Patterns were similar by cancer site, with variation in magnitude and duration of declines. Conclusions: Significant declines in cancer pathology reports from population-based registries during 2020 suggest substantial delays in screening, evaluation of signs and symptoms, diagnosis, and treatment services for cancers with effective screening tests as well as in cancer sites and age groups without effective screening tests as an indirect result of the COVID-19 pandemic. Ongoing evaluation will be critical for informing public health efforts to minimize any lasting adverse effects of the pandemic on cancer screening, diagnosis, treatment, and survival.
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Introduction Frailty and multimorbidity have been suggested as risk factors for severe COVID-19 disease. We therefore investigated whether frailty and multimorbidity were associated with risk of hospitalisation with COVID-19 in the UK Biobank. Method 502,640 participants aged 40–69 years at baseline (54–79 years at COVID-19 testing) were recruited across UK 2006–10. A modified assessment of frailty using Fried’s classification was generated from baseline data. COVID-19 test results (England) were available 16/03/2020–01/06/2020, mostly taken in hospital settings. Logistic regression was used to discern associations between frailty, multimorbidity and COVID-19 diagnoses, adjusting for sex, age, BMI, ethnicity, education, smoking and number of comorbidity groupings, comparing COVID-19 positive, COVID-19 negative and non-tested groups. Results 4,510 participants were tested for COVID-19 (positive = 1,326, negative = 3,184). 497,996 participants were not tested. Compared to the non-tested group, after adjustment, COVID-19 positive participants were more likely to be frail (OR = 1.4 [95%CI = 1.1, 1.8]), report slow walking speed (OR = 1.3 [1.1, 1.6]), report two or more falls in the past year (OR = 1.3 [1.0, 1.5]) and be multimorbid (≥4 comorbidity groupings vs 0–1: OR = 1.9 [1.5, 2.3]). However, similar strength of associations were apparent when comparing COVID-19 negative and non-tested groups. Furthermore, frailty and multimorbidity were not associated with COVID-19 diagnoses, when comparing COVID-19 positive and COVID-19 negative participants. Conclusions Frailty and multimorbidity do not appear to aid risk stratification, in terms of a positive versus negative results of COVID-19 testing. Investigation of the prognostic value of these markers for adverse clinical sequelae following COVID-19 disease is urgently needed.
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Introduction: There remains a paucity of data comparing ambulatory initiation of home non-invasive ventilation (NIV) with a model requiring inpatient admission. In our institution, a Quality Improvement (QI) project was performed where an ambulatory model for NIV initiation was developed and evaluated. Methods: Ambulatory pathways were formulated for NIV initiation in the outpatient setting, alongside outreach and initiation of NIV for inpatients referred within regional hospitals. The primary outcome measure was 'compliance with NIV' defined as NIV use ≥4 hours/night for ≥75% of nights. Results: Between 6.1.20 and 1.7.20, 76 referrals for home NIV were assessed within the ambulatory model. Of these, NIV was not indicated in 3 cases and contraindicated in 1 case, while 2 trialled NIV and declined it, leaving 70 patients who commenced home NIV (n=36 following COVID-19 ward 'closure'). Neuromuscular disease was the principal diagnosis in 41% (29/70) with MND comprising 20/29 neuromuscular cases;see table 1. Ventilator interaction data was available for 68 patients where mean NIV use was 5.21 (SD 3.98) hours/night. Of those established by ambulatory pathway, 62% (42/68) were deemed 'compliant' with NIV in comparison to previous data reporting compliance in 62% (56/90) of subjects established through inpatient admission. It was calculated that delivery of the ambulatory pathway resulted in a cost saving of £197,967 (Table presented) for this period, achieved principally by admission avoidance based on previous length of stay data and Level 2 bed costings. Conclusions: An ambulatory model for initiation of home NIV appears to be as effective in achieving compliance as inpatient admission, while carrying health economic benefits. Ambulatory treatment pathways enabled us to deliver service continuity during the COVID-19 pandemic.
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Urban infrastructure has appeared as a central feature in a range of commentaries on the COVID-19 pandemic. Understanding the imprint of the pandemic on cities and the power-laden processes through which they are being rebuilt requires an attention to the politics and governance of infrastructure. In this intervention, we understand the pandemic as a moment to rethink claims over how infrastructures work and how they might be studied. We focus on three dimensions where COVID-19 has underscored the importance of infrastructure governance: as pandemic condition, as pandemic vulnerability, and as pandemic response. We argue that a strand of future academic work must be attuned to the continued importance of the governance of and by urban infrastructures in a world of cities in which COVID-19 and its associated economic, environmental, and social implications are likely to remain pervasive. © 2021 Informa UK Limited, trading as Taylor & Francis Group.
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Reagents typically used in diagnostic test kits for diseases such as COVID-19 tend to contain reactive components such as enzymes or antibodies, which can be challenging to stabilise for commercial use. Lyophilisation (freeze-drying) may be considered a relatively gentle drying process, but there are still risks and pitfalls when applying it to such reagents, not least due to freeze-concentration effects and the low volumes of liquid involved. Furthermore, the selection of stabilisers must be made with final assay compatibility in mind, as well as their suitability for the lyophilisation process itself. This presentation will explore various aspects of formulation and cycle development for diagnostic reagents, including the design/selection of container-closure systems, which can be critical to maintaining activity and stability during transport and storage, especially if the cold chain cannot be maintained throughout distribution. It will also cover aspects of how the approach to developing COVID-19 diagnostics - and the associated priorities for the formulation and process development scientist - can differ from the approaches and priorities that are typically applied to more ‘conventional’ products. Funding: Not applicable Conflict of Interest: None to disclose