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Introduction: Most modern healthcare systems are striving to improve patient outcomes in an evidence-based manner. Increasingly, performance metrics are seen as key tools for accurately measuring and improving patient outcomes and healthcare value.1 However, in order to achieve better outcomes, process measures need to be identified. Process measures are evidence-based, best practices metrics that can be measured and thus, used to identify if outcomes are being met. Good process measures can improve patient outcomes by reducing the amount of variation in care delivery. During the Covid-19 pandemic, vast quantities of data were generated while managing ARDS (Acute Respiratory Distress Syndrome) on the ICU. Furthermore, there was as a concomitant evolution of treatment strategies, which made it exceedingly difficult to identify processes that were actually improving patient outcomes. Objective(s): The aim of our quality improvement project was to promote standardised high quality care for intubated Covid-19 patients by identifying potential quality indicators and trends in their management. It is our intention to expand on this work to report metrics on all severe acute respiratory failure patients. Method(s): 15 process metrics surrounding the early care of intubated of Covid-19 patients were selected via a consultant led review process and a literature review in an effort to identify markers of quality surrounding intubation on our ITU. The variables selected included: - P/F ratio 24 hours pre-intubation, CPAP (continuous positive airway pressure) duration prior to intubation, Recording intubation location, Enhanced thromboprophylaxis prescribed, Permissive hypercapnia, Driving pressure documented, prone position and paralysis initiated if P/F ratio was less than 20 kPa, Echo post intubation. Result(s): Data surrounding the intubation of Covid-19 patients was collected over an 11 week period between September and November 2021. The data was collected in a standardised fashion from patient notes and nursing notes, then stored in an excel file. Our data showed more than half the patients admitted were either intubated on the ward or immediately following arrival onto our ICU, possible indicating a delay in admitting Covid-19 patients. Our data also demonstrated heterogeneity of duration in CPAP prior to intubation which may also indicate delayed intubation for these patients.2 Conclusion(s): Our data demonstrated a reasonable degree of heterogeneity in our approach to the early care of intubated Covid-19 Patients. Areas of concern highlighted were the number of patients intubated on the ward or immediately upon arrival to ITU, rather than admitting prior to deterioration (most likely due to bed pressure) and variation in post intubation respiratory sampling between invasive and non-invasive broncheoalveolar lavage. Ongoing PDSA (plan-do-study-act) cycling are in progress to refine the data collection processes and reporting for all severe acute respiratory failure patients.
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Introduction/Aim: Since 1992, the Lung Health Promotion Centre has delivered a broad syllabus of respiratory and sleep medicine topics, respiratory function tests and smoking cessation for multidisciplinary health care professionals (MDHCP) at the Alfred and regional sites. When the COVID-19 pandemic came to Australia in early 2020, there were prolonged and severe restrictions imposed in Melbourne, which greatly affected people's ability to travel and to have gatherings. As a result, the Centre had to rapidly adapt the educational model to be able to continue to offer its courses. As attendees could no longer attend in person, the courses were provided through live webinars, pre-recorded webinars and self-directed learning via an online learning portal. Aim(s): To compare the participation in and satisfaction with the Centre's courses before and during the COVID-19 pandemic. Method(s): 2019 Course Data is compared with data from courses in 2020, 2021 and 2022. Pre and post questionnaires were provided to participants at each course. Result(s): 2019 2020 2021 2022 Course Streams (Course Presentations) 12 (23) 6 (17) 4 (10) 7 (17) Sessions - On Site 23 4 - 1 Sessions - Live Webinar - 9 6 10 Sessions - Self Directed - 2 4 6 Attendance (Days) 228 204 136 203 On Site 228 84 - 26 Live Webinar (1st Webinar, Assist Required). - 119 (87%, 20%) 134 (75%, 23%) 171 (71%, 12%) Self-Directed - 1 2 6 Domicile - Victoria, Interstate 86% 14% 83% 17% 63% 37% 77% 23% Satisfaction (Rating out of 5) 4.8 4.1 4.5 4.4 Conclusion(s): Lung Health Promotion centre was agile during the pandemic and able to provide ongoing well evaluated programmes responsive to the change in participant needs and educational opportunities. Pivot of presentations to live webinars encouraged attendance of more rural and interstate participants. Educational Support: Nil.
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Background: Coronavirus Disease 2019 (COVID-19) pandemic disrupted routine program implementation worldwide with significant impact on quality and extent of technical oversight of implementation. Diverse digital reporting solutions and online meetings were some strategies designed to bridge program implementation supervision and reporting gaps worldwide. This paper evaluates usefulness and efficiency of digital solutions deployed by USAIDNigeria to ensure adequate oversight to sustain access and reporting of HIV viral load (VL) services Methods: To promote accountability and encourage peer-to-peer review and learning among USAID Implementing Partners, daily reporting via digital platforms and virtual weekly peer-review meetings were introduced. This enabled USAID team to monitor IPs' performance at health facilities and during community VL drives against set targets of 100% and 95% patient VL coverage and suppression (VLC/S) respectively. The platforms include National Laboratory Information Management System, remote sample login and Googlebased VL Status and Daily Lab Performance dashboards. This study assesses uptake of VL services and clinical outcomes in 16 states of Nigeria between October2019 through March2021 during various levels of COVID-19 lock down. Chi Square test was used to compare the pre-COVID (October2019-March2020), during lockdown (April2020-September2020) and post-COVID lockdown (October2020-March2021) performances at 95 confidence interval and < 0.05 level of significance. Result(s): Significant improvements in VL indicators were reported among eight USAID partners across 16 states. Pre-COVID, 591,906 clients on treatment were eligible for VL monitoring, 455,099 were tested and had documented VL results with a 76.9% and 89% VLC/S. During-COVID lockdown, 685,915 became eligible for VL monitoring, 531,371 had documented VL results, with 77.5% and 90% VLC/S. VLC/S increased to 93% each post-COVID lockdown, when 771,149 had documented VL out of 833,463 eligible. There was a significant increase number of clients on treatment who became eligible for VL test and had documented VL results and suppression from pre- during-COVID, and post-COVID lockdown (p=0.001) Conclusion(s): Digital solutions deployed by USAID were instrumental to sustaining service delivery with significant growth in access and efficiency to HIV VL services in 16 States in Nigeria despite impact of COVID-19. Program managers should continue to explore cost-efficient innovative approaches for program oversight.
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Background: Monitoring of HIV-infected individuals on antiretroviral treatment requires periodic viral load(VL) measurements to ascertain adequate response to treatment. While plasmaVL is widely available in health facilities, it is difficult for use among key populations(KPs) due to their high mobility and sophisticated sample storage and transport requirements, which are not available for community VL sample collection. Use of Dried Blood Spot(DBS) VL measurement has shown promise as an alternative to plasma specimens for KPs. Studies to investigate the performance of DBSVL quantification against the standard plasma VL assay has proven to be within acceptable range. DBSVL was introduced for sample collection among KPs when it became difficult to safely and appropriately collect, store and transport samples during COVID-19 lockdown. This study assessed the usefulness of the use of DBSVL deployed by USAID to ensure access to HIV VL services among KPs in 7 states of Nigeria during COVID-19 lockdown Methods: To mitigate the impact of COVID-19 lockdown, virtual trainings were conducted for one-stop-shops and community VL champions of USAID partners providing KPs services in seven states of Nigeria on DBS sample collection, storage and transportation and remote test ordering was activated for service providers. Standard operating procedures and job aids were deployed to points of service and laboratory equipment were verified for DBSVL testing. VL sample collection rate(SCR), VL coverage(VLC), VL suppression(VLS), turnaround time (TAT) and cost savings for the program between March2019 and February2021 were compared using the two-sample independent t test pre-COVID (March2019- February2020) and during-COVID lockdown (March2020 -February2021) at 95 confidence interval and < 0.05 level of significance. Result(s): There was a significant increase (p< 0.05) in SCR from 73% to 94%, VLC 44% to 85%, and VLS 78% to 95% pre-COVID to during-COVID respectively despite increase in number of clients eligible for VL. However, the median TAT remained unchanged at 29 days. There was a 60% cost savings for the program due to reduction in consumables needed for sample collection and processing and convenience in sampling among KP clients. Conclusion(s): Implementation of DBSVL resulted in increases in both VLC and VLS with an improved TAT for KPs clients in seven states of Nigeria. KPs Program implementers should consider introduction of DBSVL sampling among KPs for a better VL access and clinical outcome.
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Purpose of Study: Health policy regarding possible mother-to-child transmission of SARS-CoV-2 via breastfeeding was highly debated during the first months of the COVID-19 pandemic. However, subsequent research revealed that mother-to-infant transmission of SARS-COV-2 through breastmilk is highly unlikely, and the World Health Organization continues to recommend breastfeeding for all mothers, including those with confirmed COVID-19. Another mode of viral transmission and diagnostic testing that garnered scientific interest is the fecal route.The purpose of this study was to determine the detection rate of SARS-CoV-2 RNA in fecal samples collected from breastfeeding mothers with and without confirmed COVID-19. Methods Used: From April 2020 to March 2021, fecal samples were collected repeatedly over an 8-wk period from 28 nursing mothers with confirmed COVID-19 (162 total fecal samples) and from 24 healthy nursing mothers with no known exposure to COVID-19 (93 total fecal samples). For mothers enrolled within 7 d of a positive COVID-19 test, up to 7 repeated samples were collected: 3 in the first wk and 1 each at wk 2, 3, 4, and 8. For self-reported healthy mothers, up to 4 samples were collected: d 1, d 7, wk 3, and wk 8. RNA was isolated, and the presence of SARS-CoV-2 RNA was determined using RT-qPCR following a modified version of the CDC's SARS-CoV-2 assay. Summary of Results: Among COVID-19-positive mothers, 7/28 (25%) had SARS-CoV-2 in at least one fecal sample. Among these mothers, mean duration of presence of SARS-CoV-2 in feces was 1.6 +/- 1.4 wk. One mother had SARS-CoV-2 in feces in five samples (d 1, d 3, d 7, wk 2, wk 4), while two mothers only had SARS-CoV-2 in a single fecal sample. Among healthy breastfeeding mothers without known COVID-19 exposures, 1/24 (4.2%) had SARS-CoV-2 in a single sample (d 7). Conclusion(s): We detected SARS-CoV-2 in feces of 25% of breastfeeding mothers with COVID-19 and 4.2% of breastfeeding mothers who self-reported no known COVID-19 sickness or exposures. Our data reveal that only 5/28 (17.9%) of d 1 fecal samples collected from mothers with COVID-19 had detectable SARS-CoV-2. (Table Presented).
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Background: People with HIV (PWH) may be at increased risk for severe COVID-19 outcomes compared with people without HIV. However, COVID-19 vaccination coverage among PWH is largely unknown, especially among those with advanced HIV or comorbidities. Method(s): We conducted a cohort study to evaluate coverage of the initial COVID-19 vaccine primary series and factors associated with the completion in adult PWH (>=18 years) enrolled in 8 healthcare organizations participating in the Vaccine Safety Datalink (VSD) project during December 1, 2020- December 31, 2021. Completion of two doses of the Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines or one dose of the single-dose Janssen COVID-19 vaccine was assessed. Multivariable analysis was conducted using a robust Poisson regression model to estimate the rate ratio (RR) for factors associated with primary series completion, accounting for follow-up time. Result(s): A total of 22,063 PWH were identified, among which 89% were male and 93% were viral suppressed (viral load, VL <=200 copies/ml). Chronic comorbid conditions were prevalent, with 25% having a Charlson comorbidity score of 1-2 and 13% having a score of 3 or greater. About 23% were overweight and 17% were obese. The majority (90%) completed the primary series and 1,782 PWH (8%) did not receive any dose during the study period. A rapid uptake was achieved within the 6 months after the national COVID-19 vaccination program launched on December 14, 2020. (Figure 1) PWH who received one dose of mRNA vaccine (i.e., partially vaccinated) were excluded (n=314) from the analysis for the primary series completion. Having received an influenza vaccination in the past 2 years was the strongest predictor of completion (RR=1.17, 95%CI: 1.15, 1.20). Males (RR= 1.06, 95%CI: 1.04-1.08) and those of Asian race (RR=1.05, 95%CI: 1.03-1.06, vs. White) were more likely to complete the primary series. However, PWH with baseline CD4 counts < 200 (RR=0.97, 95%CI: 0.94-0.99) and those failing to achieve viral suppression (VL= 201-10k: RR= 0.89, 95%CI: 0.85-0.94;VL >10k: RR= 0.92, 95%CI: 0.87-0.98) were less likely to complete the primary series. Body mass index, Charlson comorbidity score, and neighborhood household income level were not associated with completion. Conclusion(s): Coverage of the COVID-19 vaccine primary series was high in adult PWH in the VSD. However, targeted vaccination outreach is warranted for PWH with low CD4 counts and uncontrolled HIV viral load.
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Introduction/Aim: Acute hypoxaemic respiratory failure occurs often in people with COVID-19 pneumonia, with high need for respiratory support therapies (RST). We aimed to examine the clinical management of COVID-19 pneumonia including use of ward-based RST. Method(s): A ambispective electronic medical record review was conducted at an Australian tertiary hospital for COVID-19 patients requiring ward-based RST between 28/02/2020 and 18/03/2022. Result(s): Of 964 patient records identified, 670 were included, with 61% male and mean age 62 years (SD=19). 344 (51.4%) were unvaccinated, with 120 (17.9%) having >=1respiratory comorbidities. Prone positional therapy was achieved in 63 (9.4%) and recommended in 221 (33%) patients. High flow nasal oxygen (HFNO;n = 243, 36.2%), continuous positive airway pressure (CPAP;n = 131, 19.5%) and non-invasive ventilation (NIV;n = 4, 0.6%) were frequently administered to patients. 120 (49.4%) patients received both HFNO and CPAP. Arterial blood gases were infrequently measured prior to initiation of HFNO (n = 23, 9.5%) or CPAP (n = 25,19.1%). Target saturation aims were documented in 547 (81.6%) patients with a medical prescription for RST in 486 (72.5%). Patients using HFNO/CPAP/NIV had a daily respiratory nurse consultant review 236 (97.1%) with documented RST prescriptions and aims. Medical verification occurred at least once per admission from a consultant or advanced trainee for 213 (87.6%) HFNO patients and 117 (89.3%) CPAP patients. Median usage of HFNO was 2 days (IQR 1-4) and for CPAP 1 days (IQR 0.5-3). The median length of stay was 5 days (IQR 3-8). Clinical escalation with transfer to ICU occurred in 90 (13.4%) patients, with 24 (26.6%) intubated. 44 (6.6%) patients died. Most (n = 424, 63.2%) were discharged directly home without requiring domiciliary respiratory supports. Conclusion(s): Multidisciplinary, ward-based RST was successfully provided to most patients with COVID-19 pneumonia with clear documentation of processes of care. Support for and expansion of ward-based RST models of care should be considered longer term. Conflict of Interest: Nil.
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The book was inadvertently published with an incorrect name information for one of the Chapter author as "M. Yousef", whereas it should be "M. Yousif" in the front matter and Chapter 3. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.
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Purpose: Hand osteoarthritis (OA) is more common in women. Hand OA incidence increases further in females around the age of 50, the typical age of menopause. Estrogen-deficient states are associated with increased musculoskeletal pain and inflammation and with increased rates of symptomatic OA. Estrogen replacement and selective estrogen receptor modulators (SERMs) can improve pain and structure in some pre-clinical models of OA associated with estrogen loss, and in exploratory analysis from hormone replacement therapy (HRT) trials. However, no randomised clinical trials (RCTs) of HRT had been performed in symptomatic OA populations, specifically hand OA. By carrying out a RCT feasibility study of a form of HRT (conjugated estrogens (CE)-bazedoxifene) in post-menopausal women with painful hand OA, we set out to determine the feasibility and acceptability of this. We also aimed to generate proof-of concept data on likely outcomes, calculate a sample size and refine methods for a full trial. Method(s): We recruited females aged 40-65 years and 1-10 years after final menstrual period with definite hand OA and >=2 painful hand joints across three primary/secondary care sites and from the community. Medical exclusions included those typical for clinical HRT use. Design was parallel group, double-blind 1:1 randomisation of CE-bazedoxifene or placebo, taken orally once daily for 24 weeks, then tapering for 4 weeks before study end at Week 28. Primary feasibility outcomes were rates of eligible participant identification, recruitment, randomisation, retention, compliance, and likelihood of unblinding. Adverse events (AEs) were collected. Secondary clinical outcomes included the anticipated primary outcome in a full trial of mean hand pain over 14 days prior to each visit, scored on a 0-10 numerical rating scale (NRS) where 10 is worst pain possible, as well as hand function, appearance and menopause symptoms. Progression criteria to a full RCT were: (i) recruitment >=30 participants across all sites in 18 months (or proportionate to time open);(ii) a drop-out rate of <=30% of randomised individuals;and (iii) acceptability to the majority of participants, including acceptable AE rates. All clinical outcomes were analysed on an intention-to-treat basis. Though not powered to detect a treatment difference, change and treatment effects (the difference in the outcome between the two groups) were indicated with 95% CIs, with all models adjusted for clinical subtype of painful hand joint, study site, and baseline values. The sample size for a full trial was estimated using the standard deviation (SD) of week 24 mean hand pain. Result(s): Due to the COVID-19 pandemic, the recruitment window was reduced to 12-15 months. From May 2019 to December 2020, 434 enquiries/referrals were received. Of 96 telephone pre-screens, 35 individuals were potentially eligible and of these, 33 gave consent to participate. Of the remaining, 250/401 (62%) were ineligible, whilst 55/401 (14%) chose not to proceed, with the most common reason being not wanting to take HRT. 28/35 (80% (95%CI 63%,92%)) eligible participants were randomised to study medication. All 28 participants completed all follow-ups with high compliance (100% active, 13/14[93%] placebo) and outcome measure completeness (100%, mean hand pain). All three AE-related treatment withdrawals were on placebo when unblinded. No serious AEs occurred. Participants/investigators were well blinded (participant blinding index 0.50[95%CI 0.25 to 0.75]). All three prespecified progression criteria were therefore met for a full trial. The treatment effect difference over 24 weeks in mean hand pain between active and placebo was -0.71 (95% CI -2.20 to 0.78) (Fig 1A). During tapering/stopping medication, mean hand pain increased by 1.31 points in the active arm compared with 0.17 in the placebo arm, indicating a possible effect of cessation of medication (Fig 1A). Furthermore, 6/13 (46%) participants in the active group reported worsening pain at week 28 compared with week 24, but only 2/12 (17%) were worse on withdrawing placebo (Fig 1B). The sample size for a full trial was estimated as 296 (based on MCID 0.8 on NRS, SD 2.0, 90% power, 10% drop-out, alpha 5%). Conclusion(s): This first study of a RCT of HRT for painful hand OA met its progression criteria, indicating that a full trial of an HRT in this population is feasible and acceptable. Although not powered to detect an effect, there was a trend towards improvement in hand pain on treatment and worsening of hand pain on tapering in the active arm only. This adds to proof-of-concept data in this area, justifying more work.ISRCTN12196200. Funded by Research for Patient Benefit programme, National Institute for Health Research (UK) PB-PG-0416-20023 [Formula presented]Copyright © 2023
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We examine post-adoptive IT use of fitness tracking technologies longitudinally using three data sets gathered before, during, and after the COVID-19 lockdowns in the United States. Using adaptive structuration theory (AST) as a meta-theory, we model post-adoptive IT use as having two fundamental types (continued and novel), each having distinct psychological and sociological antecedents. Sociological antecedents are further broken down into those coming from society and those coming from the technology. Findings indicate there are strong correlations between antecedents and the two types of use in all three data sets. Post-hoc analysis indicates continued and novel use vary across time. These variations are not static and appear to be non-linear. Implications and future research directions are also discussed. © 2022 IEEE Computer Society. All rights reserved.
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COVID-19 resulted in impacts across life experiences;this study focuses on impact on becoming a mother. People who were pregnant or gave birth in the US during the first year of the pandemic (April 2020-June 2021) were interviewed: six pregnant and 29 who had birthed. Interviews were analyzed using Interpretive Phenomenological Analysis. Themes included Missing Out Isolation, First-time Mom Experiences, Pervasive Uncertainty, and Depression. Subthemes were loss of celebration, missed events, somewhat helpful role of technology, less education and perinatal care, not having elder wisdom, COVID-specific anxiety, anxiety, and less postpartum support. Implications for research and practice are presented. © 2023 Taylor & Francis.
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The primary defence against COVID-19 has been the implementation of public health measures that rely on voluntary compliance with behavioural directives. Compliance is often conceptualised as a single dimension, but there may be distinct patterns of compliance with COVID-19 preventative behaviours. This study examined behavioural profiles in response to preventative behaviour directives during the early stages of the COVID-19 pandemic in Australia. A representative sample of Australian residents (n = 978) responded to a survey measuring self-reported compliance with a range of preventative measures, trust in various institutions and a range of psychological and demographic variables. The latent class analysis identified five distinct behavioural profiles characterised by different degrees of compliance with different health behaviours. In addition to those who complied with most measures and those who complied with none, there were profiles that complied with most measures except specific ones, including limiting interactions with others and visitations. These profiles were associated with a number of demographic and psychological characteristics, including trust. Implications for public health interventions are discussed. © 2023 The Authors. Journal of Community & Applied Social Psychology published by John Wiley & Sons Ltd.
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This paper discusses the key elements of a research study that focused on training an important procedure called 'Endotracheal intubation' to novice students. Such a procedure is a virtual part of treating patients who are infected with the covid-19 virus. A virtual reality environment was created to facilitate the training of novice nurses (or nurse trainees) using the HTC Vive platform. The primary interaction with the virtual objects inside this simulation-based training environment was using the hand controller. However, the small mouth of the virtual patient and the necessity of utilizing both hands to pick up the laryngoscope and endotracheal tube at the same time (during training), led to collisions involving the hand controllers and hampered the immersive experience of the participants. A multi-sensory conflict notion-based approach was proposed to address this problem. We used 'Haptic retargeting' method to solve this issue. And we compared the result of the haptic retargeting method with reference condtion. Initial Results (through a questionnaire) suggest that this Haptic retargeting approach increases the participants' sense of presence in the virtual environment. © 2022 IEEE.
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The associated morbidity and mortality from COVID-19 and the public health response to prevent the spread of the virus has repeatedly demonstrated the significant impact of social determinants of health (SDoH) and social inequities on health outcomes. Social prescriptions are interventions aimed at tackling SDoH. In 2019, NHS-England committed to support the use of social prescribing across England. NHS-England commissioned the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network to monitor the distribution of social prescribing services within English primary care and, within that, monitor the impact of the COVID-19 pandemic response on SDoH. To track incidence of people presenting to primary care with SDoH-related issues, we implemented an ontological approach to curate SDoH indicators in computerised medical records (CMR) using the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT). These indicators were then extracted from the RCGP-RSC sentinel network database to present weekly incidence rates per 10,000 people to assess the impact of the pandemic on these SDoH. Pre- versus peri-pandemic, we observed an increase in the recording of several of our SDoH indicators;namely issues related to homelessness, unemployment, mental health, harmful substance use and financial difficulties. As far as we are aware, this is the first time that routinely collected primary care CMR data has been utilised for the monitoring and surveillance of SDoH and demonstrates the feasibility of this approach for future surveillance. © 2022, Springer Nature Switzerland AG.
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Mental health conditions are a significant contributor to morbidity and mortality and cost an estimated £1.6 trillion per year globally. The COVID-19 pandemic and its associated lockdowns have contributed to increases in common mental health problems (CMHP) like depression. Bodies in the UK recommend the use of non-medical interventions like social prescriptions to support individuals suffering from CMHP. In 2019, NHS-England committed to support the use of social prescribing across England. Despite this commitment, the proportion of eligible individuals with a CMHP that actually receive a social prescription remains unknown. To overcome this knowledge gap, a novel ontological approach was used to estimate the proportion of individuals with a CMHP that received a social prescription, disaggregated by different attributes (region, ethnicity, socio-economic status, sex, age) across a four-year period from 2017–2020. We discovered two general trends. First, there was a 1.4-fold increase in the presentation of individuals, across all attributes, to primary care with a CMHP across the four-year period analysed. There was also marked variation in the presentation to primary care with a CMHP based on different attributes (2020 variation figures - regions: 2.8-fold;ethnicity: 1.8-fold;socio-economic status: 1.4-fold;sex: 1.7-fold;age: 3.9-fold). Second, despite an increase in the use of social prescribing for mental health, there was still substantial underuse of it across all attributes in England (the highest percentage seen across all attributes in 2020 was 14%). The general trends revealed through our analyses provide valuable insights that can help to inform both policy and practice to address variation, health inequalities as well as to proactively design and implement appropriate services. © 2022, Springer Nature Switzerland AG.
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Objectives/Scope: The Praline project was awarded and executed during the COVID-19 pandemic and demonstrated how the right project management principles created transparency and trust between Contractor and Company so that both parties worked openly during project execution to successfully execute the scope in the required timeframe. Methods, Procedures, Process: This project showcases how creating the right project environment fostered creative engineering, operational flexibility and collaborative decision making. A gate system was developed which enabled several solutions to run in parallel and focused on key dates for specific decisions which allowed for the final offshore scenario to be vetted. In addition, daily task orientated meetings were held with a small team to communicate updates and plans on specific topics between key stakeholders. All attendees were empowered to make decisions and progress tasks in the meeting. A lean and agile approach was deployed. Results, Observations, Conclusions: The project was able to overcome numerous challenges during a pandemic in a short timeframe by implementing a fast-paced decision-making process which was underpinned by high-level trust between LLOG and Subsea 7. The project shifted from a plan to install the entire pipeline, In-Line Sled (ILS) and Pipeline End Termination (PLET) in a single trip to using multiple assets and mobilisations. The asset changes were required to maintain LLOG's first oil requirements and meant that the design, installation engineering, and procurement activities needed to be condensed and yet still meet high quality and safety standards. The changes in installation assets impacted the structures designs due to the installation equipment and this had a knock-on impact to the procurement and fabrication activities. One example was that the ILS needed to be redesigned to change the mudmat foundation and use an existing foundation from another project. This scope was completed in less than four weeks from the implementation of the vessel change and could only have been done through the transparent and collaborative approach established on the project. © 2022, Offshore Technology Conference. All rights reserved.
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OBJECTIVE: To examine whether racial disparities in access to pediatric mental health care were affected during the COVID-19 telemedicine transition at both The Children's Hospital of Philadelphia (CHOP) and Boston Children's Hospital (BCH). METHOD: Electronic health records were queried for all unique outpatient visits from a pre-pandemic period in 2019 and a within-pandemic period in 2020. Changes in the proportion of patients were compared based on insurance status, clinic location, and racial identification. Hypotheses were tested via logistic regression analyses. RESULTS: At CHOP, from 2019 to 2020, the proportion of racially minoritized patients significantly declined within a 1-month period from 62% to 51%, whereas the proportion of White-identifying patients increased from 38% to 49% (ß = 0.47; z = 3.60; p =.0003), after controlling for insurance status and clinic location. At BCH, the proportion of racially minoritized patients significantly declined within a longer 6-month period between 2019 and 2020, from 62% to 59%, whereas the proportion of White-identifying patients increased from 38% to 41% (ß = 0.13; z = 2.8; p = .006), after controlling for insurance status. CONCLUSION: At CHOP and BCH, the COVID-19 telemedicine transition exacerbated pre-existing racial disparities in pediatric mental health services. Our findings suggest that racially minoritized patients receiving services in urban areas may be particularly at risk for losing access when telemedicine is implemented. Although there are limitations to this racial dichotomization, examining differences between White and racially minoritized patients can highlight ways in which White-identifying individuals have disproportionately received enhanced access to healthcare resources.
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Small- and medium-sized enterprises (SMEs) can have significant resources, capacities, and influence in their communities, suggesting they have the potential to be agents for transformative sustainability. However, SMEs will need to move beyond firm-centered sustainable business practices towards strategic approaches that encompass and contribute to resilience-building processes. Amid the unfolding COVID-19 pandemic, we explored what types of sustainable business practices of SMEs can contribute to individual, organizational, and community resilience. We identified six clusters of practice that are important in this regard. The clusters are not solely technical or "environmental” but rather illustrative of deeper sustainable values shaped by organizational structure, culture, and behavior. This paper suggests that SMEs can pursue transformative approaches to sustainability that are more environmentally, socially, and economically sustainable and better able to withstand shocks like the COVID-19 pandemic and can be significant contributors to community resilience. We conclude with a series of future research priorities critical to examine a largely unexplored nexus in the private sector, the linkages and dynamics between sustainability practice, resilience building, and broader community pathways. © 2022 ERP Environment and John Wiley & Sons Ltd.
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PURPOSE: In March 2020, a 1-week adjuvant breast radiotherapy schedule, 26 Gy in 5 fractions, was adopted to reduce the risk of COVID19 for staff and patients. This study quantifies acute toxicity rates and the effect on linac capacity. MATERIALS AND METHODS: This is a report of consecutive patients receiving ultrafractionated breast radiotherapy ( ± sequential boost) Mar-Aug 2020. Virtual consultations assessed acute skin toxicity during treatment and weeks 1, 2, 3 and 4 post treatment using CTCAE V5 scoring criteria. The number of linac minutes saved was estimated accounting for boost and DIBH use. RESULTS: In total, 128/135 (95%) patients, including 31/33 boost patients, completed at least 3/5 assessments. 0/128 (0%) reported moist desquamation not confined to skin folds or minor bleeding (Grade 3), 41/128 (32%) reported brisk erythema, moist desquamation confined to skin folds or breast swelling (Grade 2), 62/128 (48%) reported faint erythema or dry desquamation (Grade 1) as their worst skin toxicity, with the remaining 20% reporting no skin toxicity. The highest prevalence of grade 2 toxicity occurred week 1 following treatment (20%), reducing to 3% by week 4. There was no difference in toxicity between those who received a boost versus not (p = 1.00). Delivering this schedule to 135 patients over six months saved 21,300 linac minutes and 1485 hospital visits compared to a 3-week schedule. CONCLUSION: Rapidly implementing ultrahypofractionated breast radiotherapy is feasible and acute toxicity rates are acceptable even when followed by boost.