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1.
Scientific reports ; 12(1):14575, 2022.
Article in English | MEDLINE | ID: covidwho-2008311

ABSTRACT

Public access automated external defibrillators (AEDs) represent emergency medical devices that may be used by untrained lay-persons in a life-critical event. As such their usability must be confirmed through simulation testing. In 2020 the novel coronavirus caused a global pandemic. In order to reduce the spread of the virus, many restrictions such as social distancing and travel bans were enforced. Usability testing of AEDs is typically conducted in-person, but due to these restrictions, other usability solutions must be investigated. Two studies were conducted, each with 18 participants: (1) an in-person usability study of an AED conducted in an office space, and (2) a synchronous remote usability study of the same AED conducted using video conferencing software. Key metrics associated with AED use, such as time to turn on, time to place pads and time to deliver a shock, were assessed in both studies. There was no difference in time taken to turn the AED on in the in-person study compared to the remote study, but the time to place electrode pads and to deliver a shock were significantly lower in the in-person study than in the remote study. Overall, the results of this study indicate that remote user testing of public access defibrillators may be appropriate in formative usability studies for determining understanding of the user interface.

2.
Journal of Obstetrics and Gynaecology Canada ; 44(5):600, 2022.
Article in English | EMBASE | ID: covidwho-2004254

ABSTRACT

Objectives: Universal testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within birthing units is an effective strategy to contain infection and estimate community prevalence. Given the high-prevalence of COVID-19 cases in Ontario, the objective of this study was to determine the prevalence of active and recovered SARS-CoV-2 infection among pregnant individuals in Ottawa through universal SARS-CoV-2 and serology testing. Methods: From October 19th to November 27th, 2020, pregnant individuals admitted to triage assessment units at The Ottawa Hospital (TOH) were consented for SARS-CoV-2 testing. Swab and serology samples were analyzed using digital droplet polymerase chain reaction (ddPCR) and enzyme-linked immunosorbent assays, respectively. SARS-CoV-2 seropositivity was defined as a positive result for immunoglobulin (Ig) G, either alone or in combination with IgM and/or IgA. Results: From the 395 enrolled participants, 284 swab and 353 serology samples were collected. We found that 18 of 395 (4.6%) participants had evidence of SARS-CoV-2 exposure: 2/284 (0.70%) were positive for SARS-CoV-2 and 16/353 (4.5%) were positive for anti–SARS-CoV-2 IgG. Seropositive participants were similar to seronegative participants in terms of demographics, clinical characteristics, and pregnancy outcomes. Conclusions: The prevalence of SARS-CoV-2 ddPCR positivity and seropositivity in the obstetrical population at TOH was 0.70% and 4.5%, respectively in the fall of 2020. According to local public health data, the infection rate peaked at 0.6% during the study time period. Universal SARS-CoV-2 testing programs may help approximate community prevalence, however, justification of this strategy depends on testing capabilities and the local context of COVID-19 infection. Keywords: pregnancy;COVID-19;SARS-CoV-2;universal testing;seroprevalence

3.
American Journal of Respiratory and Critical Care Medicine ; 205:3, 2022.
Article in English | English Web of Science | ID: covidwho-1880133
4.
Lancet ; 399(10324): 518-519, 2022 02 05.
Article in English | MEDLINE | ID: covidwho-1665562
5.
Am J Epidemiol ; 190(7): 1435-1436, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1585175
7.
BJS Open ; 5(SUPPL 1):i22, 2021.
Article in English | EMBASE | ID: covidwho-1493719

ABSTRACT

Introduction: In response to the disruption to medical education caused by COVID-19, there is a need for wide-scale robust medical education research and the generation of research capacity for the future. Trainee research collaboratives have demonstrated they can nurture the research skills of students and trainees while delivering high quality research outputs. However, we have been unable to identify a permanent medical education research collaborative for trainees and students. Methods: We started the MedEd Collaborative in September 2020 to fill this gap, consisting of a trainee-and student-led medical education research collaborative supported by senior medical education experts and clinicians. Results: Our vision is to increase engagement of students and trainees in high-quality medical education research that informs practice. The MedEd Collaborative will engage students and trainees in medical education research by completing at least one national multicentre study per year, the first being the COVID Ready 2 study. This is a national cross-sectional survey of the educational impact of medical student volunteering during the COVID-19 pandemic. Conclusions: We anticipate the MedEd collaborative will: increase exposure to medical education research, thereby increasing the number of medical students and trainees aiming to pursue an academic medical education career;provide training in medical education research methodologies, such as qualitative analysis;improve the quality of medical education research outputs from students and trainees;encourage collaboration between medical schools and deaneries;and provide support to other trainee research collaboratives that aim to explore education research in their own specialties.

8.
BJS Open ; 5(SUPPL 1):i11, 2021.
Article in English | EMBASE | ID: covidwho-1493706

ABSTRACT

Introduction: COVID-19 led to global disruption of healthcare and many students volunteered to provide clinical support. Volunteering to work was a unique medical education opportunity;however, it is unknown whether this was a positive learning experience. Methods: The COVID Ready 2 study is a national cross-sectional study of all medical students at UK medical schools. We will compare opinions of those who did and did not volunteer to determine the educational benefit and issues they faced. We will use thematic analysis to identify themes in qualitative responses, in addition to quantitative analysis. Results: The primary objective is to explore the effect of volunteering during the pandemic on medical education in comparison to those who did not volunteer. Our secondary objectives are to identify: whether students would be willing to assume similar roles in a non-pandemic setting;if students found the experience more or less beneficial than traditional hospital placements and reasons for this;what the perceived benefits and disadvantages of volunteering were;the difference in perceived preparedness between students who did and did not volunteer for foundation training year one and the next academic year;training received by volunteers;and to explore issues associated with volunteering, including safety issues and issues with role and competence. Conclusions: We anticipate this study will help identify volunteer structures that have been beneficial for students, so that similar infrastructures can be used in the future;and help determine whether formal voluntary roles should be introduced into the non-pandemic medical curriculum.

9.
National Institute Economic Review ; 257:83-100, 2021.
Article in English | Scopus | ID: covidwho-1469937

ABSTRACT

This article shows how new time series models can be used to track the progress of an epidemic, forecast key variables and evaluate the effects of policies. The univariate framework of Harvey and Kattuman (2020, Harvard Data Science Review, Special Issue 1 - COVID-19, https://hdsr.mitpress.mit.edu/pub/ozgjx0yn) is extended to model the relationship between two or more series and the role of common trends is discussed. Data on daily deaths from COVID-19 in Italy and the UK provides an example of leading indicators when there is a balanced growth. When growth is not balanced, the model can be extended by including a non-stationary component in one of the series. The viability of this model is investigated by examining the relationship between new cases and deaths in the Florida second wave of summer 2020. The balanced growth framework is then used as the basis for policy evaluation by showing how some variables can serve as control groups for a target variable. This approach is used to investigate the consequences of Sweden's soft lockdown coronavirus policy in the spring of 2020. © 2021 SAGE Publications Ltd. All rights reserved.

10.
Rev Cardiovasc Med ; 22(3): 545-546, 2021 09 24.
Article in English | MEDLINE | ID: covidwho-1439019
11.
Med Hypotheses ; 153: 110622, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1270617

ABSTRACT

The outbreak of COVID-19 from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world with tremendous morbidity and mortality in the elderly. In-hospital treatment addresses the multifaceted nature of the illness including initial viral replication, cytokine storm, and endothelial injury with thrombosis. We identified nine reports of early treatment outcomes in COVID-19 nursing home patients. Multi-drug therapy including hydroxychloroquine with one or more anti-infectives, corticosteroids, and antithrombotic anti-blood clotting agents can be extended to seniors in the nursing home setting without hospitalization. Data from nine studies found hydroxychloroquine-based multidrug regimens were associated with a statistically significant > 60% reduction in mortality. Going forward, we conclude that early empiric treatment for the elderly with COVID-19 in the nursing home setting (or similar congregated settings with elderly residents/patients e.g. LTF or ALF) has a reasonable probability of success and acceptable safety. This group remains our highest at-risk group and warrants acute treatment focus prior to symptoms worsening. Given the rapidity and severity of SARS-CoV-2 outbreaks in nursing homes, in-center treatment of acute COVID-19 patients is a reasonable strategy to reduce the risks of hospitalization and death. If elderly high-risk patients in such congregated nursing home type settings are allowed to worsen with no early treatment, they may be too sick and fragile to benefit from in-hospital therapeutics and are at risk for pulmonary failure, life-ending micro-thrombi of the lungs, kidneys etc. The issue is timing of therapeutics, and we argue that early treatment before hospitalization, is the right time and can potentially save lives, especially among our higher-risk elderly populations hit hardest by severe illness and death from COVID-19. We must reiterate, we are talking about 'early' treatment before the disease is far along in the disease sequelae where the patient then needs hospitalization and aggressive interventions. We are referring to the initial days e.g. day one, post infection when symptoms emerge or there is strong clinical suspicion. This early therapeutic option deserves serious and urgent consideration by the medical establishment and respective decision-makers. Doctors must be allowed their clinical discretion in how they optimally treat their patients. Doctors must be brave and trust their skilled judgements and do all to save the lives of their patients. We therefore hypothesize that early outpatient ambulatory treatment, once initiated as soon as symptoms begin in high-risk positive persons, would significantly reduce hospitalizations and prevent deaths. Specifically, the provision of early multi-drug sequenced therapy with repurposed drugs will reduce hospitalization and death in elderly patients being cared for in long-term-care facilities. The most important implications of our hypothesis are: 1) hospitalizations and deaths would be reduced 2) transmission would be reduced due to the mitigation of symptoms and 3) recovery following infection and treatment provides for natural exposure immunity that is broad based, durable, and robust (helping towards natural immunity within the population). The end result is reduced strain on hospitals and systems that would allow for other non-COVID illnesses to receive care.


Subject(s)
COVID-19 , SARS-CoV-2 , Aged , Humans , Hydroxychloroquine , Nursing Homes , Outpatients
13.
British Journal of Surgery ; 108(SUPPL 2):ii54, 2021.
Article in English | EMBASE | ID: covidwho-1254548

ABSTRACT

Introduction: We aimed to identify motivators and barriers to volunteering during a disaster and knowledge and medical school curriculum of disaster and pandemic medicine. Method: We systematically searched the literature on 28/6/2020, following PRISMA guidelines. Results: A total of 37 studies met inclusion criteria including 11,168 medical students and 91 medical schools. 24 studies evaluated knowledge (64.9%), 16 evaluated volunteering (43.2%), and five evaluated medical school curricula (13.5%). Weighted mean willingness to volunteer during a disaster was 68.4% (SD=21.7%, n=2911), and there was a significant difference between those planning to volunteer and those who actually volunteered (P<.001). We identified a number of modifiable barriers which may contribute to this difference. Overall, knowledge of disasters was poor with a weighted mean of 48.9% (SD=15.1%, n=2985). Conclusions: There is a large number of students who are willing to volunteer during pandemics. However, they are likely to be under-prepared for these roles due to poor overall knowledge and limited teaching. During the current COVID-19 pandemic and in future disasters, medical students may be required to volunteer as auxiliary staff. Medical schools need to develop infrastructure to facilitate this process. as well as providing education and training to ensure students are adequately prepared for these roles.

14.
Am J Epidemiol ; 189(11): 1444-1449, 2020 11 02.
Article in English | MEDLINE | ID: covidwho-950677
15.
Rev Cardiovasc Med ; 21(4): 517-530, 2020 12 30.
Article in English | MEDLINE | ID: covidwho-1005377

ABSTRACT

The SARS-CoV-2 virus spreading across the world has led to surges of COVID-19 illness, hospitalizations, and death. The complex and multifaceted pathophysiology of life-threatening COVID-19 illness including viral mediated organ damage, cytokine storm, and thrombosis warrants early interventions to address all components of the devastating illness. In countries where therapeutic nihilism is prevalent, patients endure escalating symptoms and without early treatment can succumb to delayed in-hospital care and death. Prompt early initiation of sequenced multidrug therapy (SMDT) is a widely and currently available solution to stem the tide of hospitalizations and death. A multipronged therapeutic approach includes 1) adjuvant nutraceuticals, 2) combination intracellular anti-infective therapy, 3) inhaled/oral corticosteroids, 4) antiplatelet agents/anticoagulants, 5) supportive care including supplemental oxygen, monitoring, and telemedicine. Randomized trials of individual, novel oral therapies have not delivered tools for physicians to combat the pandemic in practice. No single therapeutic option thus far has been entirely effective and therefore a combination is required at this time. An urgent immediate pivot from single drug to SMDT regimens should be employed as a critical strategy to deal with the large numbers of acute COVID-19 patients with the aim of reducing the intensity and duration of symptoms and avoiding hospitalization and death.


Subject(s)
COVID-19/drug therapy , Leprostatic Agents/therapeutic use , Pandemics , SARS-CoV-2 , Telemedicine/methods , COVID-19/epidemiology , Drug Therapy, Combination , Humans
17.
Travel Med Infect Dis ; 38: 101906, 2020.
Article in English | MEDLINE | ID: covidwho-894245

ABSTRACT

BACKGROUND: For the past few months, HMOs have faced crowded emergency rooms and insufficient hospital and intensive-care-unit beds, all from the worst pandemic of this century, COVID-19. METHODS: In a large HMO in Brazil, our approach was to allow treating physicians to prescribe antiviral medications immediately at presentation, and prednisone starting on day-6 of symptoms to treat pulmonary inflammation. We implemented this COVID-19 protocol for outpatients and studied 717 consecutive SARS-CoV-2-positive patients age 40 years or older presenting at our emergency rooms. RESULTS: Use of hydroxychloroquine (HCQ), prednisone or both significantly reduced hospitalization risk by 50-60%. Ivermectin, azithromycin and oseltamivir did not substantially reduce risk further. Hospitalization risk was doubled for people with type-2 diabetes or obesity, increased by two-thirds for people with heart disease, and by 75% for each decade of age over age 40. Similar magnitudes of reduced risk with HCQ and prednisone use were seen for mortality risk, though were not significant because of only 11 deaths among the 717 patients. No cardiac arrhythmias requiring medication termination were observed for any of the medications. CONCLUSIONS: This work adds to the growing literature of studies that have found substantial benefit for use of HCQ combined with other agents in the early outpatient treatment of COVID-19, and adds the possibility of steroid use to enhance treatment efficacy.


Subject(s)
COVID-19/drug therapy , Hospitalization , SARS-CoV-2 , Adult , Aged , Brazil , COVID-19/complications , Drug Therapy, Combination , Female , Humans , Hydroxychloroquine/therapeutic use , Logistic Models , Male , Middle Aged , Outpatients , Prednisone/therapeutic use
18.
Am J Med ; 134(1): 16-22, 2021 01.
Article in English | MEDLINE | ID: covidwho-696227

ABSTRACT

Approximately 9 months of the severe acute respiratory syndrome coronavius-2 (SARS-CoV-2 [COVID-19]) spreading across the globe has led to widespread COVID-19 acute hospitalizations and death. The rapidity and highly communicable nature of the SARS-CoV-2 outbreak has hampered the design and execution of definitive randomized, controlled trials of therapy outside of the clinic or hospital. In the absence of clinical trial results, physicians must use what has been learned about the pathophysiology of SARS-CoV-2 infection in determining early outpatient treatment of the illness with the aim of preventing hospitalization or death. This article outlines key pathophysiological principles that relate to the patient with early infection treated at home. Therapeutic approaches based on these principles include 1) reduction of reinoculation, 2) combination antiviral therapy, 3) immunomodulation, 4) antiplatelet/antithrombotic therapy, and 5) administration of oxygen, monitoring, and telemedicine. Future randomized trials testing the principles and agents discussed will undoubtedly refine and clarify their individual roles; however, we emphasize the immediate need for management guidance in the setting of widespread hospital resource consumption, morbidity, and mortality.


Subject(s)
Ambulatory Care , COVID-19/therapy , SARS-CoV-2 , Anticoagulants/therapeutic use , COVID-19/physiopathology , Humans , Immunologic Factors/administration & dosage , Immunologic Factors/therapeutic use , Oxygen/therapeutic use
19.
Am J Epidemiol ; 189(11): 1218-1226, 2020 11 02.
Article in English | MEDLINE | ID: covidwho-381806

ABSTRACT

More than 1.6 million Americans have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and more than 10 times that number carry antibodies to it. High-risk patients with progressing symptomatic disease currently have only hospitalization treatment, with its high mortality, available to them. An outpatient treatment that prevents hospitalization is desperately needed. Two candidate medications have been widely discussed: remdesivir and hydroxychloroquine (HCQ) + azithromycin (AZ). Remdesivir has shown mild effectiveness in hospitalized inpatients, but no trials in outpatients have been registered. HCQ + AZ has been widely misrepresented in both clinical reports and public media, and results of outpatient trials are not expected until September. Early outpatient illness is very different from later florid disease requiring hospitalization, and the treatments differ. Evidence about use of HCQ alone, or of HCQ + AZ in inpatients, is irrelevant with regard to the efficacy of HCQ + AZ in early high-risk outpatient disease. Five studies, including 2 controlled clinical trials, have demonstrated significant major outpatient treatment efficacy. HCQ + AZ has been used as the standard of care in more than 300,000 older adults with multiple comorbid conditions; the estimated proportion of such patients diagnosed with cardiac arrhythmia attributable to the medications is 47 per 100,000 users, among whom estimated mortality is less than 20% (9/100,000 users), as compared with the 10,000 Americans now dying each week. These medications need to be made widely available and promoted immediately for physicians to prescribe.


Subject(s)
Antiviral Agents/therapeutic use , Azithromycin/therapeutic use , Coronavirus Infections/drug therapy , Hydroxychloroquine/therapeutic use , Pneumonia, Viral/drug therapy , Aged , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Female , Humans , Hydroxychloroquine/adverse effects , Male , Outpatients , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Treatment Outcome
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