Effect of Peer Benchmarking on Specialist Electronic Consult Performance in a Los Angeles Safety-Net: a Cluster Randomized Trial.

BACKGROUND: Since the advent of COVID-19, accelerated adoption of systems that reduce face-to-face encounters has outpaced training and best practices. Electronic consultations (eConsults), structured communications between PCPs and specialists regarding a case, have been effective in reducing face-to-face specialist encounters. As the health system rapidly adapts to multiple new practices and communication tools, new mechanisms to measure and improve performance in this context are needed. OBJECTIVE: To test whether feedback comparing physicians to top performing peers using co-specialists' ratings improves performance. DESIGN: Cluster-randomized controlled trial PARTICIPANTS: Eighty facility-specialty clusters and 214 clinicians INTERVENTION: Providers in the feedback arms were sent messages that announced their membership in an elite group of "Top Performers" or provided actionable recommendations with feedback for providers that were "Not Top Performers." MAIN MEASURES: The primary outcomes were changes in peer ratings in the following performance dimensions after feedback was received: (1) elicitation of information from primary care practitioners; (2) adherence to institutional clinical guidelines; (3) agreement with peer's medical decision-making; (4) educational value; (5) relationship building. KEY RESULTS: Specialists showed significant improvements on 3 of the 5 consultation performance dimensions: medical decision-making (odds ratio 1.52, 95% confidence interval 1.08-2.14, p<.05), educational value (1.86, 1.17-2.96) and relationship building (1.63, 1.13-2.35) (both p<.01). CONCLUSIONS: The pandemic has shed light on clinicians' commitment to professionalism and service as we rapidly adapt to changing paradigms. Interventions that appeal to professional norms can help improve the efficacy of new systems of practice. We show that specialists' performance can be measured and improved with feedback using aspirational norms. TRIAL REGISTRATION: clinicaltrials.gov NCT03784950.

Combining subsidiary and synchronous approaches for concurrent spectrofluorimetric assurance of lopinavir and ritonavir in tablets utilized in convention for treatment of coronavirus infection (COVID-19) and biological fluids.

In this think about, assurance of lopinavir and ritonavir down to organic concentration level has been carried out. The assurance is based on expanding the selectivity of the spectrofluorimetric procedure by combining both subordinate and synchronous spectrofluorimetric approaches, which allow effective estimation of lopinavir at 248.8 nm and ritonavir at 300.1 nm within the nearness of each other at Δλ of 60 nm. Worldwide Conference on Harmonization approval rules were taken after to completely approve the strategy, and linearity was gotten for the two drugs over the extend of 0.4-2.4 µg mL-1 for Lopinavir and 0.1-0.6 µg mL-1 for ritonavir. Application of of the strategy was successfully carried out within the commercial tablets with great understanding with the comparison strategies. As the detection limits were down to 0.133 and 0.022 µg mL-1 and quantitation limits were 0.395 and 0.068 µg mL-1 for lopinavir and ritonavir, individually; the in vivo assurance of lopinavir and ritonavir in spiked plasma tests was pertinent. The rate recuperations in natural tests were 99.10 ± 0.77 and 99.54 ± 0.60 for lopinavir and ritonavir, individually. Water was utilized as the ideal weakening dissolvable within the proposed strategy which includes an eco-friendly justify.

Monitoring COVID-19 Vaccine Acceptance in Kuwait During the Pandemic: Results from a National Serial Study.

BACKGROUND: With COVD-19 cases on the rise globally and two approved vaccines, determining vaccine acceptance is imperative to avoid low inoculation rates. The aim of this study was to evaluate the changes and determinants of vaccine acceptance among citizens and non-citizens, over time during the pandemic in Kuwait. METHODS: Data were obtained from the COVID-19 Snapshot Monitoring (COSMO Kuwait) study that was implemented according to the WHO tool for behavioral insights on COVID-19. Data was collected online, every two weeks throughout the pandemic. Individuals living in Kuwait during the pandemic were surveyed, representing an independent sample of the population during each data collection wave. RESULTS: A total of 7241 adults living in Kuwait participated. Sixty-seven percent of those participating agreed to take a vaccine if it was available and recommended. However, the proportion of vaccine acceptance drastically dropped overtime as COVID-19 related restrictions were eased, among citizens (73 to 47%) and noncitizens (80 to 60%). Some factors associated with increased odds of agreeing to take the COVID-19 vaccine, among citizens and non-citizens, included increased frequency of informing oneself about the virus (OR, 1.34-1.83; 95% confidence interval 1.16-2.55), having high versus low confidence in doctors (OR, 1.79-2.11; CI 1.17-3.80), increased agreement with containment policies (OR, 1.11-1.27; CI 1.05-1.41), expressing more fears and worries (OR, 1.05-1.12; 1.01-1.24), and the increased perceived likelihood of getting infected with influenza (OR, 1.3-1.4; CI 1.03-1.84). Decreased odds of agreement were associated with increased age (OR, 0.37-0.61; CI 0.26-0.95), being female (OR, 0.56-0.62; CI 0.43-0.73), and not taking the influenza vaccine in 2019 (OR, 0.61; CI 0.43-0.87). CONCLUSION: Vaccine acceptance was multifactorial, heterogenous among citizens and non-citizens, and changed over time. While acceptance was relatively high, it decreased throughout the pandemic and as restrictions in the country loosened. This increase in vaccine hesitancy reveals a challenge in achieving high inoculation levels, and the need for effective vaccine-promotion campaigns and increased health education in the country.