Mitigating the impact of COVID-19 on quality and value

The impact of the COVID-19 pandemic on hospital care quality operations and reporting is substantial. The authors experienced it as members of the care and leadership teams directly managing large "surges" of COVID-19 patients in one of the United States' early COVID "hotspots, " the Greater New Orleans area. Leadership, structural, operational, clinical, documentation, and regulatory impacts are described. We also share the mitigation efforts our teams were able to mount to counteract the impact of the COVID surges on patient safety, care team safety, documentation accuracy, and the health of our community. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Diabetes-related Amputations: A Pandemic within a Pandemic.

This editorial accompanies "Diabetes-Related Major and Minor Amputation Risk Increased During the COVID-19 Pandemic," by Dominick J. Casciato, DPM, Sara Yancovitz, DPM, John Thompson, DPM, Steven Anderson, DPM, Alex Bischoff, DPM, Shauna Ayres, MPH, CHES, and Ian Barron, DPM, available at https://doi.org/10.7547/20-224.

All Feet On Deck-The Role of Podiatry During the COVID-19 Pandemic: Preventing hospitalizations in an overburdened healthcare system, reducing amputation and death in people with diabetes.

The COVID-19 pandemic is driving significant change in the healthcare system and disrupting the best practices for diabetic limb preservation, leaving large numbers of patients without care. Patients with diabetes and foot ulcers are at increased risk for infections, hospitalization, amputations, and death. Podiatric care is associated with fewer diabetes-related amputations, ER visits, hospitalizations, length-of-stay, and costs. But podiatrists must mobilize and adopt the new paradigm of shifts away from hospital care to community-based care. Implementing the proposed Pandemic Diabetic Foot Triage System, in-home visits, higher acuity office visits, telemedicine, and remote patient monitoring can help podiatrists manage patients while reducing the COVID-19 risk. The goal of podiatrists during the pandemic is to reduce the burden on the healthcare system by keeping diabetic foot and wound patients safe, functional, and at home.

Modulation of in Vitro SARS-CoV-2 Infection by Stephania tetrandra and Its Alkaloid Constituents.

Botanical natural products have been widely consumed for their purported usefulness against COVID-19. Here, six botanical species from multiple sources and 173 isolated natural product compounds were screened for blockade of wild-type (WT) SARS-CoV-2 infection in human 293T epithelial cells overexpressing ACE-2 and TMPRSS2 protease (293TAT). Antiviral activity was demonstrated by an extract from Stephania tetrandra. Extract fractionation, liquid chromatography-mass spectrometry (LC-MS), antiviral assays, and computational analyses revealed that the alkaloid fraction and purified alkaloids tetrandrine, fangchinoline, and cepharanthine inhibited WT SARS-CoV-2 infection. The alkaloids and alkaloid fraction also inhibited the delta variant of concern but not WT SARS-CoV-2 in VeroAT cells. Membrane permeability assays demonstrate that the alkaloids are biologically available, although fangchinoline showed lower permeability than tetrandrine. At high concentrations, the extract, alkaloid fractions, and pure alkaloids induced phospholipidosis in 293TAT cells and less so in VeroAT cells. Gene expression profiling during virus infection suggested that alkaloid fraction and tetrandrine displayed similar effects on cellular gene expression and pathways, while fangchinoline showed distinct effects on cells. Our study demonstrates a multifaceted approach to systematically investigate the diverse activities conferred by complex botanical mixtures, their cell-context specificity, and their pleiotropic effects on biological systems.

Association of Time to Surgery After COVID-19 Infection With Risk of Postoperative Cardiovascular Morbidity.

Importance: The time interval between COVID-19 infection and surgery is a potentially modifiable but understudied risk factor for postoperative complications. Objective: To examine the association between time to surgery after COVID-19 diagnosis and the risk of a composite of major postoperative cardiovascular morbidity events within 30 days of surgery. Design, Setting, and Participants: This single-center, retrospective cohort study was conducted among 3997 adult patients (aged ≥18 years) with a previous diagnosis of COVID-19, as documented by a positive polymerase chain reaction test result, who were undergoing surgery from January 1, 2020, to December 6, 2021. Data were obtained through Structured Query Language access of an existing perioperative data warehouse. Statistical analysis was performed March 29, 2022. Exposure: The time interval between COVID-19 diagnosis and surgery. Main Outcomes and Measures: The primary outcome was the composite occurrence of major cardiovascular comorbidity, defined as deep vein thrombosis, pulmonary embolism, cerebrovascular accident, myocardial injury, acute kidney injury, and death within 30 days after surgery, using multivariable logistic regression. Results: A total of 3997 patients (2223 [55.6%]; median age, 51.3 years [IQR, 35.1-64.4 years]; 667 [16.7%] African American or Black; 2990 [74.8%] White; and 340 [8.5%] other race) were included in the study. The median time from COVID-19 diagnosis to surgery was 98 days (IQR, 30-225 days). Major postoperative adverse cardiovascular events were identified in 485 patients (12.1%). Increased time from COVID-19 diagnosis to surgery was associated with a decreased rate of the composite outcome (adjusted odds ratio, 0.99 [per 10 days]; 95% CI, 0.98-1.00; P = .006). This trend persisted for the 1552 patients who had received at least 1 dose of COVID-19 vaccine (adjusted odds ratio, 0.98 [per 10 days]; 95% CI, 0.97-1.00; P = .04). Conclusions and Relevance: This study suggests that increased time from COVID-19 diagnosis to surgery was associated with a decreased odds of experiencing major postoperative cardiovascular morbidity. This information should be used to better inform risk-benefit discussions concerning optimal surgical timing and perioperative outcomes for patients with a history of COVID-19 infection.

COVID-19 Impact on the Energy Sector in the United States (2020)

This study comprehensively examines the effects of the COVID-19 pandemic on energy consumption in the United States. The purpose of the study is to quantify the effects of lockdowns and pandemic disruptions on energy consumption trends in order to inform policymakers and utilities on how to prepare for such events in the future. The study focuses on 2020 data collected by the Federal government. The effects are quantified using descriptive statistics. State-wise and sector-wise data have been presented using plots and heat maps. Related metrics like COVID case data, GDP, emissions, and expenditures were also presented. The total energy consumption fell by 7.5% in 2020. Besides Alaska, every state saw a decrease in energy, with some as high as 26%. The residential sector had the most states that saw an increase in energy, stemming from lockdowns and working from home. Similarly, petroleum consumption saw a decrease of 11.4% as a result of a decrease in travel. Biomass-related renewable energy generation fell by 23% due to decreased demand, while all other sources increased by 7.3%. Carbon dioxide emissions fell by 10.4%, methane by 2.8%, and nitric oxide by 6.7%. The overall per capita energy expenditure for the country dropped by 18.5%. There was a stronger correlation between GDP and energy consumption than between GDP and COVID case counts. The pandemic did not affect each state or sector evenly. The statistics and correlations presented here can be used in the ongoing effort to study the global impact of the pandemic and prepare for future challenges.

PATIENT EXPERIENCE OF OSTEOPOROSIS TELEPHONE CONSULTATIONS

Background/Aims The COVID-19 pandemic resulted in a rapid change to the use of virtual consultations in both primary and secondary care. Since April 2020, our osteoporosis clinic appointments have predominantly been undertaken by telephone. We wanted to assess our patients' experience of telephone consultations. Methods A patient feedback questionnaire was developed by the osteoporosis team which was validated by the Patient Advice and Liaison Service team (PALS) at the Royal United Hospital Bath. A questionnaire consisting of 15 questions was sent to patients following their telephone consultation. Patient consent to receive the questionnaire was requested by the consulting clinician for each participant. The patients were provided with a stamped addressed envelope to return the completed anonymous questionnaire. Thematic analysis was used to identify themes in the qualitative data. Results A total of 39 questionnaires were completed. More than 86% of patients reported that their telephone consultation definitely met their needs. Over 89% answered 'yes definitely' to questions regarding understanding of the reason for their appointment, opportunities for questions, clear understandable answers, feeling listened to, and treatment plans. 59% of patients responded 'yes definitely' that they were given information prior to the appointment about what would happen in the consultation, 10% reported they hadn't, with 31% responding they had but to some extent only. 72% of respondents reported that it was clear who they should contact if they had any further questions following the consultation. Regarding preference for future appointments, 47% of patients indicated that they would prefer a mixture of telephone, face to face and video consultations;24% preferred telephone, 16% preferred hospital face to face, and 3% preferred video. 11% reported that they had no preference. Thematic analysis of individual comments identified positive themes such as flexibility, good communication with clinicians and convenience. Areas for development are around communication with regard to physical barriers such as hearing and telephone signal problems. There are also limitations around both physical examination and the transmission of implicit information (non-verbal communication). Conclusion Virtual consultations provide an opportunity to safely assess patients whilst meeting social distancing requirements and minimising patient flow through the hospital. Questionnaire analysis indicates an overall positive experience of telephone consultations. However, most patients would prefer a mixture of face to face, video and telephone consultations in future. There are a number of areas for improvement including: a review of the information provided to patients prior to the consultation, review of contact information for patients following the consultation, and mechanisms for identifying patients with physical/ sensory limitations. The information gained through this small review will help us improve the overall telephone consultation experience for our patients.

Locked Down with the Perpetrator: The Hidden Impacts of COVID-19 on Domestic and Family Violence in Australia

Prior to the COVID-19 global pandemic, domestic and family violence (DFV) had been recognised globally as an epidemic in its own right. Further, research has established that during times of crisis and/or after disasters, rates of DFV can escalate. The COVID-19 pandemic has been no exception, with emerging research from around the world confirming that the public health measures and social effects associated with COVID-19 have increased the frequency and severity of DFV in various countries. In contributing to this evolving body of literature, this paper reports on the findings of a national research project that examined the impact of the COVID-19 global pandemic on DFV in Australia. This nationwide survey of service providers indicates the public health responses to COVID-19 such as lockdowns and travel restrictions, while necessary to stem the pandemic, have had profound effects on increasing women's risk and vulnerability to domestic violence, while at the same time making it more difficult for women to leave violent relationships and access support. However, this vulnerability is not evenly distributed. The pandemic pushed marginalised voices further underground, with many unable to seek help, locked down with their abuser. Our survey sought to amplify the experiences of culturally and linguistically diverse (CALD) communities;Indigenous communities;lesbian, gay, bisexual, transgender, intersex, queer, + (LGBTIQ+) communities;women locked down with school-age children;those already in violent relationships;and those whose first experience of domestic violence coincided with the onset of the pandemic. For logistical and ethical reasons, we could only access their voices through the responses from the domestic violence sector.

Exploring protein hotspots by optimized fragment pharmacophores.

Fragment-based drug design has introduced a bottom-up process for drug development, with improved sampling of chemical space and increased effectiveness in early drug discovery. Here, we combine the use of pharmacophores, the most general concept of representing drug-target interactions with the theory of protein hotspots, to develop a design protocol for fragment libraries. The SpotXplorer approach compiles small fragment libraries that maximize the coverage of experimentally confirmed binding pharmacophores at the most preferred hotspots. The efficiency of this approach is demonstrated with a pilot library of 96 fragment-sized compounds (SpotXplorer0) that is validated on popular target classes and emerging drug targets. Biochemical screening against a set of GPCRs and proteases retrieves compounds containing an average of 70% of known pharmacophores for these targets. More importantly, SpotXplorer0 screening identifies confirmed hits against recently established challenging targets such as the histone methyltransferase SETD2, the main protease (3CLPro) and the NSP3 macrodomain of SARS-CoV-2.

Otitis externa: a roundtable discussion

Otitis externa is a common problem in both primary care and referral practice. A wide range of factors contribute to the successful management of disease. A logical approach and investigation are important and should always include an appreciation of underlying primary causes, predisposing and perpetuating factors, and secondary infection. Cytology is essential to help choose appropriate therapy and represents an opportunity to use the expertise of the nurses within the veterinary team. COVID-19 has forced many veterinary professionals to use remote consultation techniques to provide care for patients and it may be that some of the lessons we have learned during lockdown can be applied to our working practices to improve the level of veterinary care in the future. The selection of appropriate topical anti-microbial and anti-inflammatory drugs is, of course, important but without good levels of owner compliance even the best therapy is ineffective. This article presents the outcome of a workshop in which a group of experts discussed many of these topics.

Low-cost measurement of face mask efficacy for filtering expelled droplets during speech.

Mandates for mask use in public during the recent coronavirus disease 2019 (COVID-19) pandemic, worsened by global shortage of commercial supplies, have led to widespread use of homemade masks and mask alternatives. It is assumed that wearing such masks reduces the likelihood for an infected person to spread the disease, but many of these mask designs have not been tested in practice. We have demonstrated a simple optical measurement method to evaluate the efficacy of masks to reduce the transmission of respiratory droplets during regular speech. In proof-of-principle studies, we compared a variety of commonly available mask types and observed that some mask types approach the performance of standard surgical masks, while some mask alternatives, such as neck gaiters or bandanas, offer very little protection. Our measurement setup is inexpensive and can be built and operated by nonexperts, allowing for rapid evaluation of mask performance during speech, sneezing, or coughing.