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1.
10th International Workshop on Innovative Simulation for Health Care, IWISH 2021 ; : 84-89, 2021.
Article in English | Scopus | ID: covidwho-2156275

ABSTRACT

Simulation has, over multiple decades, achieved a remarkable record of improving operational efficiency and effectiveness in many areas - manufacturing, supply chains (including commercial transportation and logistics), health care, public-sector transport, service industries, and military operations. About 2/3 through the twentieth century, simulation's earliest successes appeared in the manufacturing sector. These successes began with attention to value-added operations (e.g., at machines often entailing high capital investments) and rapidly spread to the non-value-added but very necessary material-handling requirements within factories. SARS-CoV-2, (COVID-19) has caused a rapid, widespread change in patient care across the globe. New health and safety guidelines have been established by the Centers for Disease Control and Prevention (CDC) (Health Care Guidelines, 2020). Still, it has been left to individual facilities to address and implement solutions to new standards for social distancing and cleanliness. Here we develop a discrete-event simulation model to simulate an outpatient laboratory clinic, including check-in and patient interaction, to determine if changes lead to increased efficiency and reduce patient wait times, without increasing staffing or additional resources. Under the aegis of the University of Michigan Medical Group (UMMG), this simulation is validated against real data of waiting time at the University of Michigan Canton Health Center (UMCHC) during the height of the pandemic. © 2021 The Authors.

2.
27th Summer School Francesco Turco, 2022 ; 2022.
Article in English | Scopus | ID: covidwho-2147567

ABSTRACT

This period of pandemic has had important consequences on the flow and the entire organization of any hospital. In particular, the number of accesses to the emergency room has increased, with the consequent urgent need to reorgani ze it quickly. The model proposed in this paper allows to respond to these needs by freeing not only shifts of nursing staff but also surgical staff. This workforce can then be relocated in the emergency room or of the intensive care unit who are in fact at the forefront of emergency management. The aim of this study conducted by the authors is to analyze, inside the context of a midsize Italian hospital, the actual organization model, and then to approach it by Business Process Reengineering (BPR) methodology with the goal to propose a KPI management system that evaluates the efficiency of the whole surgical path. The second objective of the study is to verify if the Operating Rooms (ORs) are properly sized to cover the surgical workload or if it would be necessary to build new ORs (answer to this question is the project mandate by Surgical Wards Chiefs). The last objective is to implement a flexible to cope with emergency situations such as a pandemic. The main result is the approximate maintenance of surgical annual activity (8169 vs 7889). The fewer resources required can be reallocated to deal with emergencies such as the current COVID-19 pandemic. In fact, the surgical shifts decreased during the test case from 464 versus 365 (-15,32%). The rooms’ utilization coefficient rose from 41% to over 52%, whereas the surgeons’ utilization coefficient rose to 61% (with values over 68% for parallel shifts). The results achieved demonstrate that improving efficiency of surgical processes is feasible and a systematic approach allows to respond to new global health challenges. © 2022, AIDI - Italian Association of Industrial Operations Professors. All rights reserved.

3.
Proceedings of the Nutrition Society ; 81(OCE5):E188, 2022.
Article in English | EMBASE | ID: covidwho-2133056

ABSTRACT

Sarcopenia is the reduction of muscle mass and strength associated with ageing(1). Resistance exercise alone and in combination with protein is thought to lead to increased muscle protein synthesis and may help combat sarcopenia(2). Resistance exercise is traditionally undertaken in a gym setting, using fixed-machines and free weights, however, this environment can be unappealing to middle-older age adults. Access to gyms was also prohibited during COVID-19 UK lockdowns leading us to explore alternative approaches to delivering nutrition and exercise intervention trials. The aim of this study was to evaluate the feasibility of remote delivery of a homebased resistance exercise and protein intervention. This was a six week, 3-arm parallel intervention trial. Participants aged between 40-65 years were recruited via a social media advertising campaign and randomised to one of 3 treatment arms: i) resistance exercise, ii) resistance exercise and 15 g of protein/day (taken alongside lunch) or iii) resistance exercise and 30 g of protein/day (15 g taken alongside breakfast and 15 g taken alongside lunch.) The home-based resistance exercise intervention was conducted using resistance bands and consisted of 50-minute exercise sessions delivered live via videoconferencing. Participants were asked to participate in two exercise sessions per week. Protein was consumed as a gel supplement (Pro-source Plus) supplied by Nutrinovo (www.nutrinovo.com). Participants were asked to record their engagement and experience in a trial logbook and took part in semi-structured interviews at the end of the intervention period. In-person assessments of muscle strength and function, physical activity and diet were made at baseline and end of the intervention. Thirty-two individuals responded to the recruitment campaign within a three-week timeframe and a final total of eleven volunteers were eligible to participate and gave informed consent (all female, age range 40-61). No participants dropped out of the trial;however, one participant engaged in only 3 out of the 12 exercise classes and the same participant consumed only 14% of the protein supplement supplied. The remaining 10 participants had good compliance with both the exercise and protein intervention, and overall, there was 87% adherence to exercise sessions (2 or more classes a week) and adherence of 68% and 88% to the protein supplement in the 15 g and 30 g protein intervention arms respectively. Acceptability and adherence were in line with the study requirements for most participants. These findings are encouraging and support the feasibility of a remote exercise and protein intervention trial. Qualitative analysis of the semi-structured interviews will provide further information to inform the design of a larger intervention trial.

4.
Journal of Head Trauma Rehabilitation ; 37(6):E510-E510, 2022.
Article in English | Web of Science | ID: covidwho-2124657
6.
BMJ Paediatr Open ; 6(1), 2022.
Article in English | PMC | ID: covidwho-2042868

ABSTRACT

Background: Neonatal units across the world have altered their policies to prevent the spread of infection during the COVID-19 pandemic. Our aim was to report parental experience in two European neonatal units during the pandemic. Methods: Parents of infants admitted to each neonatal unit were asked to complete a questionnaire regarding their experience during the COVID-19 pandemic. At King’s College Hospital, UK (KCH), data were collected prospectively between June 2020 and August 2020 (first wave). At the Hospital Clínic Barcelona (HCM), data were collected retrospectively from parents whose infants were admitted between September 2020 and February 2021 (second and third wave). Results: A total of 74 questionnaires were completed (38 from KCH and 36 from HCM). The parents reported that they were fully involved or involved in the care of their infants in 34 (89.4%) responses in KCH and 33 (91.6%) responses in HCM. Quality time spent with infants during the pandemic was more negatively affected at KCH compared with HCM (n=24 (63.2%) vs n=12 (33.3%)). Parents felt either satisfied or very satisfied with the updates from the clinical care team in 30 (79.0%) responses at KCH and 30 (83.4%) responses in HCM. The parents felt that the restrictions negatively affected breast feeding in six (15.8%) responses at KCH and two (5.6%) responses in HCM. Travelling to the hospital was reported overall to be sometimes difficult (39.2%);this did not differ between the two units (14 (36.8%) respondents at KCH and 15 (41.6%) from HCM). Furthermore, the self-reported amount of time spent giving kangaroo care also did not differ between the two countries. Conclusion: Restrictive policies implemented due to the COVID-19 pandemic had a negative impact on the perception of quality of time spent by parents with their newborns admitted to neonatal units.

7.
J Am Acad Dermatol ; 87(3):AB74, 2022.
Article in English | PMC | ID: covidwho-2041859
9.
Journal of Addiction Medicine ; 02:02, 2022.
Article in English | MEDLINE | ID: covidwho-1973276

ABSTRACT

BACKGROUND: We explored syringe service program (SSP) perspectives on barriers, readiness, and programmatic needs to support coronavirus disease 2019 (COVID-19) vaccine uptake among people who use drugs. METHODS: We conducted an exploratory qualitative study, leveraging an existing sample of SSPs in the United States. Semistructured, in-depth interviews were conducted with SSP staff between February and April 2021. Interviews were analyzed using a Rapid Assessment Process, an intensive, iterative process that allows for rapid analysis of time-sensitive qualitative data. RESULTS: Twenty-seven SSPs completed a qualitative interview. Many SSP respondents discussed that COVID-19 vaccination was not a priority for their participants because of competing survival priorities, and respondents shared concerns that COVID-19 had deepened participant mistrust of health care. Most SSPs wanted to participate in COVID-19 vaccination efforts;however, they identified needed resources, including adequate space, personnel, and training, to implement successful vaccine programs. CONCLUSIONS: Although SSPs are trusted resources for people who use drugs, many require additional structural and personnel support to address barriers to COVID-19 vaccination among their participants. Funding and supporting SSPs in the provision of COVID-19 prevention education and direct vaccine services should be a top public health priority.

10.
Alcoholism-Clinical and Experimental Research ; 46:177A-177A, 2022.
Article in English | Web of Science | ID: covidwho-1894160
11.
Visions in Leisure and Business ; 24(1):72-89, 2022.
Article in English | CAB Abstracts | ID: covidwho-1837746

ABSTRACT

In a journey spanning almost 20 years the Southern Food & Beverage Museum has become established as a solid and reliable museum and attraction in New Orleans, Louisiana. Its journey to established museum has been fraught with disaster and determination - from Hurricane Katrina in 2005, the financial crisis of 2008, the BP Oil Spill, and COVID - to more local disasters like floods and hurricanes. Today it is ready for whatever may happen, as well as prepared with a plan to pivot, innovate, and re-invent itself, all the while deepening its mission and continuing to be the Southern Food & Beverage Museum.

12.
National Technical Information Service; 2021.
Non-conventional in English | National Technical Information Service | ID: grc-753708

ABSTRACT

The NASA Resilient Autonomy Project developed a software framework that implemented a Run Time Assurance (RTA) architecture that leveraged ASTM International’s F3269 Industry Standard for safely bounding complex behavior in aircraft. This framework was called the Expandable Variable Autonomy Architecture, or EVAA. EVAA was developed during the height of the Covid-19 lockdown that caused the Resilient Autonomy team to pivot from flight test to distributed simulator testing. EVAA was developed to be platform and mission agnostic where platform specifics were behind a hardware abstraction layer that EVAA called a Coupler. EVAA was able to host multiple safety monitors that could resolve individual safety hazards. EVAA was able to resolve priority conflicts when multiple safety hazards needed to be resolved simultaneously and was able to resolve highly complex situations in a safe manner that could exceed human capabilities.

13.
Colorectal Disease ; 24(SUPPL 1):133-134, 2022.
Article in English | EMBASE | ID: covidwho-1745941

ABSTRACT

Purpose/Background: The COVID-19 pandemic has resulted in global disruptions to the delivery of healthcare.(1) The national responses of Australia and New Zealand has resulted in unprecedented changes to the care of colorectal cancer patients, amongst others. This paper aims to determine the impact of COVID-19 on colorectal cancer diagnosis and management in Australia and New Zealand. Methods/Interventions: This is a multicentre retrospective cohort study using the prospectively maintained Binational Colorectal Cancer Audit (BCCA) registry. Data is contributed by over 200 surgeons in Australia and New Zealand. Patients receiving colorectal cancer surgery during the pandemic were compared to averages from the same period over the preceding three years. Results/Outcomes: There were fewer operations in 2020 than the historical average. During April to June patients were younger, more likely to have operations in public hospitals and more likely to have urgent or emergency operations. By October to December proportionally less patients had stage I disease, proportionally more had stage II or III disease and there was no difference in stage IV disease. Patients were less likely to have rectal cancer, were increasingly likely to have urgent or emergency surgery and more likely to have a stoma created. Conclusion/Discussion: This study shows that the response to COVID-19 has had measurably negative effects on the diagnosis and management of colorectal cancer in two countries that have had significantly fewer COVID-19 cases than many other countries. The long-term effects on survival and recurrence are yet to be known, but could be significant. Findings will be updated with 2021 data at the completion of the year. (Figure Presented).

14.
Journal of Community Nursing ; 35(1):12-14, 2021.
Article in English | GIM | ID: covidwho-1716796

ABSTRACT

The Covid-19 pandemic has put healthcare and care workers in the UK under unprecedented pressure. For nurses, the pandemic has highlighted and exacerbated many of the pre-pandemic problems, including inequality, inadequate working conditions and chronically overburdened workloads. King's Fund's recent report, The Courage of Compassion: Helping nurses and midwives deliver high-quality care, investigated important changes to the nurse's work environment. nurses and midwives needed to help them thrive and thrive at work. This paper presents some of the key research findings and questions what needs to be done to better support nurses working in the community, now and in the future.

16.
Blood ; 138:1788, 2021.
Article in English | EMBASE | ID: covidwho-1582404

ABSTRACT

Introduction The clinical manifestations of COVID-19 infection in recipients of allogeneic hematopoietic stem cell transplantation (HSCT) have been reported in multiple retrospective cohorts of patients, but there have been no prospective studies to date. Previous studies report that HSCT recipients are at higher risk, with cumulative incidence of death between 17-35%. Although an excessive pro-inflammatory viral response has been documented in the general population, its role in the immune incompetent HSCT setting has not been documented. We present a combined prospective and retrospective national study run through the UK IMPACT trial network to characterize the clinical and immunological features of COVID-19 infection in 96 adult and pediatric recipients of HSCT in the United Kingdom. Methods HSCT recipients of any age and transplanted for any indication, with an RT-PCR-proven COVID-19 infection, were eligible for this study. Patients within 72 hours of COVID-19 diagnosis, who had not received cytokine-targeted treatment, were recruited to a prospective cohort. All other patients were eligible for a retrospective cohort. Prospective patients provided blood samples within 72 hours of COVID-19 diagnosis, and again within 72 hours of clinical deterioration (defined as requirement for oxygen administration) if applicable. Follow-up data were collected on patients 30 and 100 days after COVID-19 diagnosis. Results 100 patients were recruited from 16 sites across the UK between May 2020-June 2021, comprising 12 in a prospective cohort and 88 recruited retrospectively. 96 patients were evaluable, as 4 proved ineligible post-registration. Patients were diagnosed with COVID-19 at a median of 11 months after HSCT. Patient/HSCT characteristics are shown Table 1. The most common symptoms associated with the onset of COVID-19 were fever in 8 prospective (73%) and 35 (41%) retrospective patients, followed by cough in 5 (45%) prospective and 35 (41%) retrospective patients and dyspnea in 4 (36%) prospective and 16 (19%) retrospective patients. 8 (73%) prospective and 40 (47%) retrospective patients were actively immunosuppressed at the time of COVID-19 infection. 16% of the patients had moderate/severe disease at baseline. At day 30 (±2 days) after COVID-19 diagnosis, 2 prospective and 8 retrospective patients continued to demonstrate SARS-CoV-2 positivity on respiratory PCR testing. The median time to viral clearance was 40 (IQR 17-78) days for the prospective and 34 (IQR 15-70) days for the retrospective cohort. Prolonged (more than 14 days) neutropenia was reported in 4 (5%) patients in the retrospective cohort, prolonged thrombocytopenia in 2 (18%) prospective and 11 (13%) retrospective patients. 1 retrospective patient developed secondary hemophagocytic lymphohistiocytosis, and graft rejection was reported in 1 (1%) retrospective patient, within 30 days of COVID-19 diagnosis. In the prospective cohort, 3 (27%) patients died, all by day 30, and all due to COVID-19. In the retrospective cohort, 13 (17%) patients died by day 30, rising to 18 (21%) by day 100, 61% of deaths were attributed to COVID-19. Lower baseline platelets (p=0.013, Mann-Whitney U test), lymphocytes (p=0.012), albumin (p=0.028), and higher baseline CRP (p=0.007), were seen in patients who died following COVID-19 diagnosis. Additionally, exploratory univariate logistic regression of the retrospective cohort found mortality at day 100 to be associated with increased age at diagnosis (OR 1.04, 95% CI 1.01-1.08, p=0.04), and no requirement compared with requirement for invasive ventilation (OR 0.02, 95% CI 0.00-0.16, p=0.001). The 11 prospective patients showed normal levels of interleukin (IL)-2, -4, -10, interferon gamma and tumor necrosis factor alpha at COVID-19 presentation. IL-6 was minimally raised (up to 127 pg/ml, nv<50) in 3/11 pts at presentation. Respiratory deterioration was not associated with detectable cytokine storm. Conclusion Our study confirms a significant mortality rate in patients affected by COVID-19 post HSCT and confirms age as well s requirement for invasive ventilation to be independent risk factors associated with death at day 100. Baseline laboratory data at disease presentation can identify patients at higher risk of COVID-19 related death. In the prospective cohort of our study, pathophysiology of the viral disease did not seem related to cytokine storm-mediated inflammation. [Formula presented] Disclosures: Protheroe: Jazz Pharmaceuticals: Honoraria;Astellas: Honoraria;Kite Gilead: Honoraria. Peggs: Autolus: Consultancy, Current equity holder in publicly-traded company. Craddock: Novartis Pharmaceuticals: Other: Advisory Board;Celgene/BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding. Nicholson: BMS/Celgene: Consultancy;Kite, a Gilead Company: Other: Conference fees, Speakers Bureau;Novartis: Consultancy, Other: Conference fees;Pfizer: Consultancy. Amrolia: ADC Therapeutics: Other: Named inventor on a patent which is being transferred to ADCT.;Autolus: Patents & Royalties.

18.
Leadership & Organization Development Journal ; ahead-of-print(ahead-of-print):13, 2021.
Article in English | Web of Science | ID: covidwho-1437892

ABSTRACT

Purpose Although important for organizational performance, much is still unknown about the relationship between employee well-being and transformational leadership. The authors answer calls to consider the relationship (1) in an extreme context (i.e. coronavirus pandemic), (2) at the dimension level and (3) differences that exist depending on the employee's gender. Design/methodology/approach The authors employed a two-wave study with data collected from 212 working individuals. Respondents reported their level of COVID-19 anxiety and leadership experiences at time 1 starting at the height of the pandemic and three weeks later reported well-being. Findings The authors found COVID-19 anxiety weakened the influence of transformational leadership style on well-being, and this was only the case for females. Further, the authors found that while the moderator of COVID-19 anxiety weakened the influence of core transformational leadership behaviors and intellectual stimulation on well-being, the more individualized and short-term focused transformational behaviors of individualized consideration and performance expectations proved to have resilient effects on well-being with no moderating effects. Looking at gender differences, the authors found that this was only the case for females. Originality/value The findings extend research by capturing an external shock concerning the coronavirus pandemic to better understand how transformational leadership style, its dimensions and employee gender, influence well-being. While the authors expected COVID-19 anxiety to weaken the positive effects of transformational leadership style on well-being, paradoxically the authors also expected differential effects when examining individual dimensions.

19.
Pathology ; 53(6): 773-779, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1366648

ABSTRACT

Serological assays for SARS-CoV-2 infection are now widely available for use in diagnostic laboratories. Limited data are available on the performance characteristics in different settings, and at time periods remote from the initial infection. Validation of the Abbott (Architect SARS-CoV-2 IgG), DiaSorin (Liaison SARS-CoV-2 S1/S2 IgG) and Roche (Cobas Elecsys Anti-SARS-CoV-2) assays was undertaken utilising 217 serum samples from 131 participants up to 7 months following COVID-19 infection. The Abbott and DiaSorin assays were implemented into routine laboratory workflow, with outcomes reported for 2764 clinical specimens. Sensitivity and specificity were concordant with the range reported by the manufacturers for all assays. Sensitivity across the convalescent period was highest for the Roche at 95.2-100% (95% CI 81.0-100%), then the DiaSorin at 88.1-100% (95% CI 76.0-100%), followed by the Abbott 68.2-100% (95% CI 53.4-100%). Sensitivity of the Abbott assay fell from approximately 5 months; on this assay paired serum samples for 45 participants showed a significant drop in the signal-to-cut-off ratio and 10 sero-reversion events. When used in clinical practice, all samples testing positive by both DiaSorin and Abbott assays were confirmed as true positive results. In this low prevalence setting, despite high laboratory specificity, the positive predictive value of a single positive assay was low. Comprehensive validation of serological assays is necessary to determine the optimal assay for each diagnostic setting. In this low prevalence setting we found implementation of two assays with different antibody targets maximised sensitivity and specificity, with confirmatory testing necessary for any sample which was positive in only one assay.


Subject(s)
Antibodies, Viral/analysis , COVID-19 Serological Testing/methods , COVID-19/diagnosis , Antibodies, Viral/blood , Humans , Laboratories , Longitudinal Studies , SARS-CoV-2 , Sensitivity and Specificity
20.
Blood ; 136:26-27, 2020.
Article in English | EMBASE | ID: covidwho-1348339

ABSTRACT

Background: Sickle cell disease (SCD) is an inherited disorder in which sickle hemoglobin (HbS) polymerization triggers red blood cell sickling, chronic hemolysis, anemia and episodic vaso-occlusion. Complications include cumulative organ damage and disability as well as accelerated mortality. OxbrytaTM is a first-in-class therapy that increases hemoglobin (Hb) levels and reduces markers of hemolysis and is FDA-approved for treatment of SCD in patients 12 years of age or older. We report here the single-center experience of patient-perceived benefit in 27 consecutive patients treated with OxbrytaTM tablets for at least 8 weeks. Methods: We collected clinical data on 27 consecutive patients with SCD at The University of Texas Comprehensive Sickle Cell Center under an approved data collection protocol for standard-of-care clinical data. All patients with at least 8 weeks of data collection are included. The Standing Data Collection Protocol was amended to allow collection of Patient Global Impression - Improvement scale (PGI-I) data. Four patients did not have complete laboratory and PGI-I data. Data analysis was done on 23 patients for whom there is information on Hb, retic %, CGI-I, and PGI-I. Seventeen of the patients had complete laboratory data while 23 patients provided PGI-I information. Laboratory test frequency was limited by COVID-19 pandemic restrictions. Results: Twenty-three patients whose data were analyzed ranged in age from 20 to 66 years, with 65 % being female. HbS genotypes were 91 % SS and 9 % Sβ°-thalassemia. No patient had Sβ+-thalassemia or hemoglobin SC. Table 1 shows the impact of OxbrytaTM on key laboratory parameters. The Hb improved with treatment to a degree comparable to that seen in the HOPE Trial. The healthcare provider assessed each patient for improvement with OxbrytaTM treatment using the 7-point Clinical Global Impression - Improvement scale (CGI-I). In addition, each patient provided an assessment of improvement with OxbrytaTM treatment using the 7-point PGI-I scale. Figure 1 shows the results of these assessments. Most patients report substantial improvement which correlates with the clinician impression. We noticed that for some of the patients who reported significant clinical improvement (very much better or much better symptoms) hemoglobin values declined or improved only slightly from baseline (Figure 2). Hence, Hb increase of > 1 g/dL is not needed for clinical improvement. About 30% of the patients reported mild to moderate diarrhea, that was managed with reduction in OxbrytaTM dose until diarrhea improved followed by titration back to recommended dose. For more severe diarrhea, OxbrytaTM was interrupted for 2 to 3 days followed by restart at a lower dose. Conclusions: This study is the first to utilize the 7-point PGI-I scale and CGI-I to assess SCD improvement with OxbrytaTM treatment. Figure 1 shows patient and clinician assessment of change in symptoms or clinical status with OxbrytaTM therapy. Most patients report substantial improvement, which correlates with the clinician impression. The majority of patients (16/23;70%) reported much improved or very much improved symptoms while 22% reported minimally improved and only 8% reported no change in symptoms. The clinician impression correlated well with patients' impression of their improvement. Most of the responses, (19/23;83%), were much improved and very much improved;whereas, 13% were minimally improved and 4% no change. Some patients also mentioned that their energy level improved significantly and that they had less pain at their typical sites of chronic pain while on OxbrytaTM therapy. In this study, patient hemoglobin values improved with treatment to a degree comparable to that seen in the HOPE Trial. Figure 2 shows that clinical improvement can occur for patients whose hemoglobin declined or improved only slightly from baseline. Our data collection is limited due to COVID-19 pandemic restrictions;most of the patients were unable to have laboratory assessments as frequently as desired. In summary, our s udy suggests that most sickle cell disease patients perceive benefit with OxbrytaTM therapy in terms of improvement in their condition and level of functioning. [Formula presented] Disclosures: Idowu: Cyclerion Therapeutics, Inc: Research Funding;Pfizer: Research Funding;Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding;Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau.

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