Impact of ICER Assessments on Payer Decision Making in the United States

Objectives: To evaluate how payers utilize Institute for Clinical and Economic Review (ICER) assessments to inform coverage or formulary decisions. Method(s): Double-blinded, web-based survey was fielded through Xcenda's research panel, the Managed Care Network, from June to July 2022. Result(s): A total of 51 payers from health plans (n=27), integrated delivery networks (n=12), and pharmacy benefit managers (n=12) participated in the survey. When assessing the usefulness of ICER's value assessment framework (VAF) to inform formulary decisions within their organizations, 57% of payers indicated it was extremely/very useful, 33% indicated somewhat useful, and 10% indicated not at all/not very useful. Most respondents (73%) agreed that ICER assessments are aligned with their organization's internal assessment. Utilization of ICER's VAF was most prevalent in high-cost drug or disease states (78%), rare/orphan disease states (71%), and oncology/hematology disease states (67%). Payers reported less use in primary care disease states (29%), COVID-19 (8%), and digital therapeutics (4%). In the last 24 months, 20% of payers reported ICER's recommendations often influenced coverage decisions, 59% indicated occasional influence, and 22% indicated no influence. In the last 24 months, payers indicated the top 5 ICER assessments that influenced their coverage decisions included high cholesterol (38%), Alzheimer's disease (36%), atopic dermatitis (33%), multiple myeloma (31%), and chemotherapy-induced neutropenia (28%). ICER assessments that were less impactful included beta thalassemia (3%), digital health technologies (3%), and supervised injection facilities (3%). Payers reported using ICER assessments to inform both expanded and restricted coverage decisions. Conclusion(s): Payers find ICER's VAF useful to inform their organization's formulary decisions. ICER's assessments often align with payers' internal assessments and are most frequently utilized for high-cost drugs or disease states. Payers indicate ICER assessments have affected both expansion and restriction in their coverage policies.Copyright © 2023

Skills Training of Infectious Diseases in the Community：a Survey Research of Questions

Background As the most basic unit of infectious disease prevention and control，community health service institutions are the frontline and important gateway for the prevention and control of infectious disease. Primary care physicians are responsible for epidemic surveillance，vaccination，health promotion and assistance to centers for disease control in investigating and disposing outbreaks and public health emergencies in their districts，and play an active role in disease prevention and control by groups，susceptible population protection，infectious source control and health education，as well as the effective prevention and control of infectious diseases. Objective To understand the ability of primary care physicians to diagnose and treat infectious diseases in the community，analyse their existing problems and shortcomings，design and conduct a series of intensive training related to infectious diseases for improving the capacity of infectious disease prevention and control at the primary level；To evaluate the effectiveness of online continuing medical education，so as to provide a reference for better continuing medical education on infectious diseases in the community. Methods All participants of the National Community Infectious Diseases Continuing Education Conference held by the Department of Family Medicine of the University of Hong Kong-Shenzhen Hospital in November 2021 were selected as research subjects from November 2021 to March 2022. The questionnaires were distributed to all registered attendees before and after the conference through the QR code of the questionnaire star，and the content of pre-conference questionnaire included demographic characteristics of the participants，participation in infectious disease training in the community since started working，diagnosis and treatment of infectious diseases in the community，subjective attitudes towards the prevention and control of infectious diseases in the community（willingness to manage infectious diseases in the community，satisfaction with their own infectious disease management skills），expertise in infectious disease prevention and control and knowledge related to conference content，attitude towards hepatitis B. The content of the post-conference questionnaire mainly included knowledge about the content of conference，attitude towards hepatitis B and satisfaction survey of this online conference. A total of 301 primary care physicians completed the questionnaire before and after the conference，and a total of 194 completed the questionnaire before and after the conference. Results Among all participants，166 （55.1%） had attended infectious disease training in the community，of whom 49（29.5%） were satisfied with their infectious disease diagnosis and treatment ability；135（44.8%） had not attended the training，of whom 22（16.3%） were satisfied with their infectious disease diagnosis and treatment ability. 143（86.1 %） of 166 participants who had attended infectious disease training in the community indicated their willingness to manage community infectious diseases，99（73.3%） of 135 participants who had not attended infectious disease training in the community indicated their willingness to manage community infectious diseases. 66（27.3%） of participants who were satisfied with their infectious disease diagnosis and treatment ability indicated their willingness to manage community infectious diseases. The top three infectious disease tests conducted by the institutions were hepatitis B，AIDS，and hepatitis C；the top three infectious diseases treated in the past six months were hepatitis B，influenza，hand，foot and mouth disease. Different self-evaluation and willingness to train may affect the willingness to manage community infectious diseases（P<0.05）. Among the participants who completed the questionnaire both before and after the conference，the highest correct answer rate for compulsory management of statutory infectious diseases before the conference was 89.7%，the owest accuracy rate for the type of disinfection of the COVID-19 infection was only 17.0%，the correct rates of other questions ranged from 34.0% to 40.7%. The correct rates of the questions after the conference were higher than those before the conference，and the correct rates ranged from 48.9% to 52.6%. The score of attitude towards hepatitis B after the conference was higher than that before the conference （P<0.05）. In terms of feedback after conference，254（98.1%） expressed satisfaction in the total of 259 questionnaires. In terms of suggestions for online conference，179（69.1%） and 174（67.2%） participants believed that online fluency and online interaction need to be improved. Conclusion The primary care physicians receive relatively less infectious diseases training in the community，inadequate infectious diseases training in the community can improve the confidence of self-competence，attitude of active management of infectious diseases and diagnosis and treatment ability in the primary care physicians. The future direction of continuing medical education should focus on the training of emerging infectious diseases and novel medical concepts，relevant experts should be invited to comment on the necessity and effectiveness of training in the community. © 2023 Chinese General Practice. All rights reserved.

Effect of Distant Education on Children's Academic Achievement in Primary Schools During Corona Pandemic in Dubai Emirate- Field Study

This study aimed to examine the effect of distance education on the level of educational achievement of children during the Corona period in ten primary schools in the Emirate of Dubai. To achieve the objectives of the study the researchers adopted the descriptive analytical approach. The quantitative method of data collection had been applied using the electronic questionnaire tool consisted of four main axes for data collection and had been distributed to the study sample consisted of 190 students' parents and administrators selected by using simple random techniques. The results of the study indicated that the participation of students in the educational process, and in the establishment of appropriate educational programs and applications for the transmission to distance learning have contributed to reducing the negative effects of the process of shifting from traditional education / face-to-face education classroom teaching to virtual classroom (ZOOM).The study recommended the need for strengthening distance education mechanisms, which contribute in developing the student's interests, tendencies, attitudes, concentrating on the study material, and using of safe and secured electronic devices to increase the search for additional information to reach the correct knowledge. Also, the school administration should have good e-learning plan ahead with required financial credits that will help in overcoming the crisis and mange distance learning processes to reach future objectives successfully. © 2022 Owner/Author.

Healthcare Resource Utilization and Costs Associated with Acute COVID in Adult Patients Managed in the Community or Hospital Setting in England: A Population-Based Study

Objectives: The COVID pandemic has imposed significant direct medical cost and resource use burden on healthcare systems. This study described the patient demographic and clinical characteristics, healthcare resource utilization and costs associated with acute COVID in adults in England. Method(s): This population-based retrospective study used linked primary care (Clinical Practice Research Datalink, CPRD, Aurum) and secondary care (Hospital Episode Statistics) data to identify: 1) hospitalized (admitted within 12 weeks of a positive COVID-19 PCR test between August 2020 and March 2021) and 2) non-hospitalized patients (positive test between August 2020 and January 2022 and managed in the community). Hospitalization and primary care costs, 12 weeks after COVID diagnosis, were calculated using 2021 UK healthcare reference costs. Result(s): We identified 1,706,368 adult COVID cases. For hospitalized (n=13,105) and non-hospitalized (n=1,693,263) cohorts, 84% and 41% considered high risk for severe COVID using PANORAMIC criteria and 41% and 13% using the UKHSA's Green Book for prioritized immunization groups, respectively. Among hospitalized cases, median (IQR) length of stay was 5 (2-7), 6 (4-10), 8 (5-14) days for 18-49 years, 50-64 years and >= 65 years, respectively;6% required mechanical ventilation support, and median (IQR) healthcare costs (critical care cost excluded) per-finished consultant episode due to COVID increased with age (18-49 years: 4364 (1362-4471), 50-64 years: 4379 (4364-5800), 65-74 years: 4395 (4364-5800), 75-84 years: 4473 (4364-5800) and 85+ years: 5800 (4370-5807). Among non-hospitalized cases, older adults were more likely to seek GP consultations (13% of persons age 85+, 9% age 75-84, 7% age 65-74, 5% age 50-64, 3% age 18-49). Of those with at least 1 GP visit, the median primary care consultation total cost in the non-hospitalized cohort was 16 (IQR 16-31). Conclusion(s): Our results quantify the substantial economic burden required to manage adult patients in the acute phase of COVID in England.Copyright © 2023

Evaluation of COVID-19 Vaccines in Primary Prevention Against Infections and Reduction in Severity of Illness Following the Outbreak of Sars-Cov-2 Omicron Variant in Shanghai

Objectives: To evaluate COVID-19 vaccines in primary prevention against infections and lessening the severity of illness following the most recent outbreak of the SARS-CoV-2 Omicron variant in Shanghai. Method(s): To investigate whether inactivated vaccines were effective in protecting against COVID-19 infections, we estimated the odds ratio (OR) of the vaccination in COVID-19 cases vs. matched community-based healthy controls. To evaluate the potential benefits of vaccination in lowering the risk of symptomatic infection (vs. asymptomatic), we estimated the relative risk (RR) of symptomatic infections among diagnosed patients. We also applied the multivariate stepwise Logistic regression analyses to measure the risk of disease severity (symptomatic vs. asymptomatic and moderate/severe vs. mild) in COVID-19 patient cohort with vaccination status as an independent variable while controlling for potential confounding factors. Result(s): Out of the 153,544 COVID-19 patients included in the analysis, 118,124 (76.9%) patients had been vaccinated and 143,225(93.3%) were asymptomatic patients. Of the 10,319 symptomatic patients, 10,031(97.2%), 281(2.7%) and 7(0.1%) experienced mild, moderate, and severe infections, respectively. There is no evidence that the vaccination helped protect from infections (OR=0.82, p=0.613). The vaccination, however, offered a small but significant protection against symptomatic infections (RR=0.92, p < 0.001) and halved the risk of moderate/severe infections (OR=0.48, 95% CI: 0.37 - 0.61). Older age (> 60 years) and malignant tumors were significantly associated with moderate/severe infections. Gender also appeared to be a risk factor for symptomatic infections, with females being associated with a lower risk for moderate/severe illness. Conclusion(s): Inactivated COVID-19 vaccines helped provide a small but significant protection against symptomatic infections and halved risk of moderate/severe illness among symptomatic patients. The vaccination was not effective in blocking COVID-19 Omicron variant community spread.Copyright © 2023

Evaluating real world clinical response of once weekly subcutaneous semaglutide and its daily oral formulation for the treatment of type 2 diabetes in primary care practice

Objective: Semaglutide is the first glucagon-like peptide- 1 receptor agonist with oral and subcutaneous formulations. We studied patient adherence and clinical response following their prescription in a primary care setting. Method(s): We searched for patients starting semaglutide between October 2020 to November 2021 in primary care registries in Dudley, West Midlands. We tracked their collection of medications for up to six months, changes in HbA1C and weight if these data were available at 26 weeks (range 22-52 weeks), with significance tested using a t-test. Patients prescribed both formulations were excluded. Result(s): Clinical data were available in 180 of the 443 patients. Baseline HbA1c was 79.0 +/- 18.6mmol/mol (Ozempic) and 81.9 +/- 19.3mmol/mol (Rybelsus) and pre-treatment weight was 108.4 +/- 10.5 kg (Ozempic) and 104.3 +/- 26.7 kg (Rybelsus). 62.8% of patients were of non-white ethnicity and 82.8% were on >= two anti-diabetic drugs. In patients with six-month follow-up data, mean reduction in HbA1c and weight was 17.1 +/- 20.8mmol/ mol and 3.9 +/- 6.2 kg (Ozempic n = 53, p < 0.01) and 18.2 +/- 14.5mmol/mol and 5.9 +/- 4.2 kg (Rybelsus n = 5, p < 0.05). Drug continuation rates were measured in 324 patients. 3.2% and 19.0% of patients for Ozempic and Rybelsus respectively did not obtain further prescriptions after their initial script. At six months, 87.2% continued with Ozempic and 57.2% with Rybelsus. Conclusion(s): This study demonstrates similarly significant reductions in HbA1c and weight with Ozempic and Rybelsus, despite the complexity of follow-up during Covid-19 restrictions. The lower adherence to Rybelsus warrants further study.

Evidence of Stress Reactions and Positive Changes in Primary School Children During the COVID-19 Pandemic

Theoretical Background: The COVID-19 pandemic is a global crisis, and international studies reveal the psychosocial effects on children from both the children's and the parents' perspectives. Objective: Because the COVID-19 pandemic is a novel crisis that affects everyone, the present qualitative substudy of the COVID-19 Children's Study explored the changes in children resulting from this emergency from the perspective of primary school pedagogues. Method: To this end, we conducted 11 focus-group discussions in spring 2021 with 31 primary school teachers and principals from North Tyrol. We analyzed the focus groups using thematic analysis. Results: The primary school pedagogues observed both stress reactions and positive changes in the pupils. Stress reactions were devided into behavioral, emotional and physical symptoms. Positive changes observed were behavioral changes, such as more independence;and emotional changes, such as more connectedness. Discussion and conclusion: It is important to take the numerous stress reactions of children described above seriously in schools and society. In addition to the negative effects, positive changes also took place in the children, and these should be promoted and strengthened as resources in the sense of resilience in the further course of the COVID-19 pandemic and beyond.

THE PREVALENCE AND INCIDENCE OF PSORIASIS AND PSORIATIC ARTHRITIS IN ENGLAND FROM 2009-2019: AN OBSERVATIONAL STUDY USING PRIMARY CARE DATA

BackgroundPsoriasis (PsO) and psoriatic arthritis (PsA) can greatly impact quality of life and result in substantial personal and societal costs. Complete and up to date data on the prevalence and incidence of these conditions and whether these change over time and vary by age is important for healthcare service planning so that specialist care and funding can be appropriately allocated.ObjectivesTo determine the prevalence and incidence of PsO and PsA in males and females from 2009-2019 across all age groups in England.MethodsWe used Clinical Practice Research Datalink AURUM, a primary care electronic health record database, including 20% of the English population. The codes used to identify patients with PsO and PsA were selected by rheumatologists and dermatologists and cross-checked with published code lists from other studies to ensure inclusion of all relevant codes. All included patients must have data for at least 1 year before their diagnosis. The annual incidence and point prevalence were calculated from 2009-2019 and stratified by age/sex. The study period ended in 2019 to avoid COVID-19 pandemic affecting results.ResultsThe prevalence of PsO and PsA in males and females increased annually, peaking in 2019 (PsO males 2.41% [95% confidence interval (CI) 2.40, 2.42];PsO females 2.60% [95% CI 2.59-2.61];PsA males 0.20% [95% CI 0.20-0.20];PsA females 0.21% [95% CI 0.21- 0.22]), as illustrated in Table 1. In 2019, the prevalence of PsO and PsA was highest in the over 65 years age group;PsO 4.25% [95% CI 4.22-4.28] and PsA 0.38% [95% CI 0.37-0.38]. The annual incidence (per 100,000 person years) of PsO has gradually decreased in males (from 168 (164-171) in 2009 to 148 (145-151) in 2019) but in females it has been stable with a slight annual decrease (from 180 (177-184) in 2009 to 173 (170-176) in 2019). The annual incidence for PsA has increased in both males and females (13 (12-14) in 2009 and 15 (14-16) in 2019 for males and 12 (11-13) in 2009 and 18 (17-19) in 2019 for females).ConclusionThe increasing prevalence of PsO and PsA highlights the importance of organising healthcare services to meet this need, particularly in the elderly population.ReferencesNIL.Table 1.Prevalence of PsO and PsA from 2009-2019 in EnglandYear20092010201120122013201420152016201720182019Population (n)1073383110910802110318501118036711343299112249341137842211657996119336261223432512420998PsO (n)216841229106239819250667259988268032276804286499295712304568311104PsO prevalence (%, 95%CI)-Male1.98 (1.96-1.99)2.06 (2.05- 2.07)2.13 (2.12-2.14)2.19 (2.18-2.20)2.24 (2.23- 2.25)2.33 (2.32- 2.34)2.37 (2.36- 2.38)2.39 (2.38- 2.40)2.40 (2.39- 2.41)2.40 (2.39- 2.42)2.41 (2.40- 2.42)-Female2.07 (2.05- 2.08)2.14 (2.13- 2.16)2.22 (2.21- 2.23)2.29 (2.28- 2.31)2.35 (2.33- 2.36)2.45 (2.43- 2.46)2.50 (2.49- 2.51)2.53 (2.52- 2.54)2.56 (2.54- 2.57)2.58 (2.56- 2.59)2.60 (2.59- 2.61)PsO incidence (100,000 person years)-Male168 (164-171)158 (155- 162)161 (158-165)153 (150-157)161 (157- 164)156 (153- 159)155 (152- 159)154 (151- 157)153 (150-156)150 (147-153)148 (145-151)-Female180 (177-184)176 (172-179)181 (177-184)171 (167-174)175 (171-178)176 (172-180)179 (176-183)178 (174-181)177 (174-181)174 (170-177)173 (170-176)PsA (n)1444515443164681752218545196182072021994232572451425683PsA prevalence (%, 95%CI)-Male0.14 (0.14- 0.14)0.15 (0.14- 0.15)0.15 (0.15- 0.16)0.16 (0.16- 0.16)0.17 (0.16- 0.17)0.18 (0.17- 0.18)0.18 (0.18- 0.19)0.19 (0.18- 0.19)0.19 (0.19- 0.20)0.20 (0.19- 0.20)0.20 (0.20- 0.20)-Female0.13 (0.13- 0.13)0.14 (0.13- 0.14)0.15 (0.14- 0.15)0.15 (0.15- 0.16)0.16 (0.16- 0.16)0.17 (0.17- 0.18)0.18 (0.18- 0.18)0.19 (0.19- 0.19)0.20 (0.19- 0.20)0.20 (0.20- 0.21)0.21 (0.21- 0.22)PsA incidence (100,000 person years)-Male13 (12- 14)12 (11- 13)13 (12- 14)12 (11- 13)13 (12-14)14 (13- 15)14 (13- 15)14 (13-15)1514-16)14(13- 15)15 (14-16)-Female12 (11- 13)13 (12- 14)13 (12- 14)14 (13-15)14 (13-15)15 (14-16)17 (16- 18)16 (15- 17)17 (16- 18)18 (17-19)18 (17-19)Acknowledgements:NIL.Disclosure of InterestsArani Vivekanantham: None declared, Edward Burn: None dec ared, Marta Pineda-Moncusí: None declared, Sara Khalid Grant/research support from: SK has received research grant funding from the UKRI and Alan Turing Institute outside this work. SK's research group has received grant support from Amgen and UCB Biopharma., Daniel Prieto-Alhambra Grant/research support from: DPA's department has received grant/s from Amgen, Chiesi-Taylor, Lilly, Janssen, Novartis, and UCB Biopharma. His research group has received consultancy fees from Astra Zeneca and UCB Biopharma. Amgen, Astellas, Janssen, Synapse Management Partners and UCB Biopharma have funded or supported training programmes organised by DPA's department., Laura Coates Speakers bureau: LC has been paid as a speaker for AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Medac, Novartis, Pfizer and UCB., Consultant of: LC has worked as a paid consultant for AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Novartis, Pfizer and UCB., Grant/research support from: LC has received grants/research support from AbbVie, Amgen, Celgene, Eli Lilly, Novartis and Pfizer.

Student experiences of learning how to teach primary physical education during the Covid-19 pandemic

This paper offers a snapshot into the unexpected and yet positive results of a small-scale survey about learning to teach Physical Education within initial teacher education and school-based settings. It shares data from four institutions about how pre-service teachers explained their learning and teaching experiences within Physical Education during the COVID-19 pandemic, often working within a number of social and physical restrictions and teaching within enforced bubbles. [ FROM AUTHOR] Copyright of Journal of Education for Teaching is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Impact of COVID-19 Lock Down on Quality of Life among Primary Caregivers of Individuals with Schizophrenia in Rural Areas

BACKGROUND: The lockdown would become the primary strategy for facing covid-19 as it quickly mutates which might cause repeated pandemics;however, it negatively affects individuals' quality of life (QOL). The schizophrenia caregivers experience considerable stress. The research on the impact of the COVID-19 lockdown on QOL of schizophrenia caregivers is essential, especially for those who reside in rural areas. AIM: This study aimed to investigate the impact of lockdown-related COVID-19 on QOL among primary caregivers of schizophrenia patients living in a rural area. METHOD(S): This study recruited 204 primary caregivers (15-79 years). This study used the World Health Organization Quality of Life instrument (WHOQOL-BREF) to asses QOL's primary caregiver. Evaluate the possible change in caregivers' QOL before and during the COVID-19 lockdown using paired t-test for repeated measures. RESULT(S): The mean age of the caregivers was 46.61 years (SD = 12.79), ranging from 15 to 79 years, with a preponderance of male (54.5%), aged 38-47 years old (29.7%), married (81.2%), employed (57.4%), and had senior high school level of education (34.7%). Majority were parents (26.2%) of the ill relative, and took care of the patients more than 5 years (52.5%). There was a statistical difference (p < 0.05) in caregivers' QOL between before and during the COVID-19 lockdown, including in physical health, psychological, social relationships, and environment domain. CONCLUSION(S): Implementing a lockdown policy related to COVID-19 has negatively impacted the caregivers' QOL. The degradation of caregivers' QOL showed from before to during COVID-19 lockdown. Further study needs to explore the QOL of other mental illness caregivers regarding COVID-19 lockdown. This finding becomes a reference for a government to modify some policy-related lockdowns to minimize their negative impact.Copyright © 2023 Utomo Utomo, Eko Mulyadi, Endang Fauziyah.

A regional clinical audit of the provision of adjuvant systemic anti-cancer treatment following lung cancer resection in eligible patients across Greater Manchester to support national benchmarking

Introduction: Adjuvant anti-cancer systemic therapy (SACT) following lung resection improves overall survival in stage II/II non-small cell lung cancer (NSCLC). The Getting It Right First Time (GIRFT) National Specialty Report for Lung Cancer recommends centres publish adjuvant SACT rates for National benchmarking and proposes a target of >40% of eligible patients undergo SACT. We report a regional audit into the uptake of adjuvant SACT in Greater Manchester (GM). Method(s): A retrospective case review of all patients undergoing curative-intent NSCLC surgery with a pathological stage of II/III from 01/01/21 to 30/04/21. Data collected included patient demographics, uptake of adjuvant SACT, reasons for no adjuvant SACT and tolerance and complications of SACT. Result(s): 58 patients underwent surgical resection within the audit period and were eligible for adjuvant SACT. Median age was 70 years (range 45 - 81) and 60% were female. 47% (27/58) commenced adjuvant SACT;41% (24/58) were treated with chemotherapy and 7% (4/58) were treated with tyrosine kinase inhibitors. 58% (14/24) of patients that commenced adjuvant chemotherapy completed 4 cycles. Carboplatin/Vinorelbine was the commonest regimen (82%, 18/22). There were no grade III-V complications and no chemotherapy-related deaths. Dose reduction due to toxicity was required in 14% (3/22). The reasons adjuvant systemic therapy was not given were patient choice in 32% (10/31), poor physical health such that risks outweighed benefits in 42% (13/31), and other reasons (e.g. need to treat synchronous primary tumours) in 26% (8/31). COVID-19 was not recorded as a cause for adjuvant omission/ dose reduction. Conclusion(s): This data provides national benchmarking information for adjuvant SACT in NSCLC and suggests the target of >40% is achievable and appropriate. Interventions that improve patient fitness pre- and post-operatively might increase adjuvant SACT uptake. This regional audit will be extended to review all eligible patients in 2021 and further data will be presented. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

Telehealth and its impact on the management of type 2 diabetes

The recent Covid-19 pandemic has created many challenges and barriers in healthcare, which includes the treatment and management of patients with type 2 diabetes (Robson & Hosseinzadeh, 2021). The purpose of this Evidence-Based Project (EBP) project is to evaluate the effectiveness of type 2 diabetes management through telehealth and answers the following PICOT question: In patients with diabetes type 2 who have difficulties with medical visit compliance (P), will the telehealth platform (I), compared to patient's previous visit HbA1c (C) improve the Hemoglobin A1c (HbA1c) diagnostic marker (O) over a 12-week period(T)? An extensive literature search of five databases was performed, citation chasing, and a hand search yielded fourteen pieces of evidence ranging from level I to VI (Melnyk & Fineout-Overholt, 2019). The pieces of evidence selected for this project support the evidence that telehealth implementation is as effective as the "usual care" or in-person visits to treat type 2 diabetes. The John Hopkins Nursing Evidence-Based Practice (JHNEBP) model was selected. Patients with a HbA1c of greater than 6.7% have been asked to schedule two six-week telehealth visits. During the live video visit, a review of medications, and diabetes self-management education (DSME) will be conducted. Participants will be provided with education to promote lifestyle modifications. The visits will be conducted through an Electronic Medical Record (EMR) system that is Health Insurance Portability and Accountability Act (HIPAA) compliant. A paired t-Test will be used with the data collected from the pre-and post-HbA1c. Improve the management of type 2 diabetes with the incorporation of telemedicine in primary care. Research supports the need to further expand the use of telehealth in primary care, to improve patient outcomes and decrease co-morbidities related to type 2 diabetes.

Faktory ovplyvňujúce duševné zdravie sestier v období pandémie covidu-19

Súhrn Úvod: Zdravotnícki pracovníci, predovšetkým sestry, môžu byť v exponovanom období počas pandémie covidu-19 vystavení zvýšenej psychickej záťaži. Cieľ: Zistiť, aký je dopad zvýšených nárokov na poskytovanie zdravotnej starostlivosti spojený s koronakrízou, na úroveň psychickej záťaže a kvality života sestier na rôznych pracoviskách. Metodika: Prierezová, prieskumná štúdia merania duševného zdravia u 504 sestier. Bol použitý štandardizovaný dotazník SF-36 a Meisterov dotazník miery neuropsychickej záťaže. Výsledky: Škála preťaženia a monotónnosti významne (p < 0,05) a negatívne (r < 0) koreluje s kvalitou života v každej z domén. Celková záťaž významne (p < 0,05) a negatívne (r < 0) koreluje s kvalitou života v každej z domén. Vek respondentov významne (p < 0,05) a pozitívne (r > 0) koreluje s kvalitou života v doménach vitalita, mentálne zdravie a duševné zdravie a negatívne (r < 0) koreluje s kvalitou života v oblastiach fyzické fungovanie, telesná bolesť, celkové vnímanie zdravia a celkové fyzické zdravie. Záťaž signifikantne lepšie zvládali muži. Signifikantne vyššia bola v skupine respondentov pracujúcich na jednotkách intenzívnej starostlivosti a v primárnej zdravotnej starostlivosti. Záver: Zvýšené nároky na poskytovanie zdravotnej starostlivosti spojené s koronakrízou negatívne pôsobili na úroveň psychickej záťaže a kvalitu života sestier. Horšie výsledky boli zaznamenané u sestier pracujúcich na jednotkách intenzívnej starostlivosti a v primárnej zdravotnej starostlivosti.Alternate :Introduction: Health care workers, especially nurses, may be exposed to increased psychological stress during the COVID-19 pandemic. Objective: To determine how the increased demands on health care delivery associated with the coronavirus crisis affect the level of psychological stress and quality of life of nurses in different workplaces. Methods: A cross-sectional exploratory study of mental health in 504 nurses. The standardized SF-36 questionnaire and Meister's questionnaire for neuropsychological strain were used. Results: The overload and monotony scales are significantly (p < 0.05) and negatively (r < 0) correlated with quality of life in each of the domains. The total load is significantly (p < 0.05) and negatively (r < 0) correlated with quality of life in each of the domains. The age of respondents is significantly (p < 0.05) and positively (r < 0) correlated with quality of life in the domains of Vitality, Mental Health, and Mental Component Summary, and negatively (r > 0) correlated with quality of life in the domains of Physical Functioning, Bodily Pain, General Health, and Physical Component Summary. Men handled the stress significantly better. Stress levels were significantly higher in the group of respondents working in intensive care units and in primary care. Conclusions: The increased demands on health care delivery associated with the coronavirus crisis had a negative impact on the level of psychological load and the quality of life of nurses. Worse results were found in nurses working in intensive care units and in primary care.

Point-of-Care Testing in Primary Care

Point-of-care testing (POCT) in pediatric primary care is essential for clinicians to make a timely and accurate diagnosis. The COVID-19 pandemic has highlighted the importance of timely and accurate testing strategies to correctly identify the etiology of upper and lower respiratory infections. Additionally, pediatric POCT continues to be important in rural and underserved communities where access to hospital laboratories may be less available. This chapter will focus on seven rapid tests: Group A streptococcus (GAS), influenza A & B, SARS-CoV-2 (COVID-19), human immunodeficiency virus (HIV), C-reactive protein (CRP), human chorionic gonadotropin (hCG), and hemoglobin A1c (HbA1c). © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Epidemiological investigation of an outbreak of human rhinovirus in a primary school in northern shaanxi

Objective To analyze the epidemiological characteristics of a Human rhinovirus outbreak in a primary school in northern Shaanxi, and to provide scientific evidence for the prevention and control. Methods On - site epidemiological investigation of an unexplained febrile aggregated outbreak reported in a primary school in northern Shaanxi on May 22, 2020. Nasopharyngeal swabs were collected from typical cases, and nucleic acid testing was performed to test for SARS COV 2, and 16 respiratory pathogens. Results A total of 37 cases were reported, including 1 adult teacher and 36 students, with the overall incidence rate of 1.75%, a male and female ratio of 3:1, and the incidence age mainly concentrated in 6 to 12 years old. The cases were mainly concentrated in 3 first-grade classes and 7 second-grade classes on the same floor, and the first grade cases accounted for 75.68% of the total number of cases. There was a statistically significant difference in the incidence rate of the cases in the classes (χ2 = 49.29, P<0.01). The clinical features of the cases were mainly fever (body temperature between 37.3 and 38.8°C), sore throat, runny nose, nasal congestion and cough, and some of which were accompanied by diarrhea and vomiting, and other gastrointestinal symptoms. Of the 33 nasopharyngeal swabs detected by laboratory, 14 were positive for Rhinovirus, and the positive rate was 42.42%. Conclusion This aggregated outbreak is caused by Rhinovirus infection. Primary and secondary schools in northern Shaanxi should be alert for aggregated unexplained fever due to Rhinovirus outbreaks during the epidemic season of respiratory infectious diseases. © 2023, Editorial Department of Medical Pest Control. All rights reserved.

Mild COVID-19 clinical course among paediatric patients with primary immunodeficiency

Background: The clinical course of coronavirus disease-2019 (COVID-19) varies from those who are asymptomatic, experience mild symptoms such as fever, cough, and dyspnea, to more severe outcomes including acute respiratory distress, pneumonia, renal failure, and death. Early reports suggested severe outcomes in patients with primary immunodeficiency (PID), particularly those with type 1 interferon signalling defects. This prompted a rigid approach to social distancing to protect this patient population, particularly children. To date, real-world data describing the course and outcome of COVID-19 in paediatric PID patients remains scarce. Method(s): In this retrospective case series, we describe the clinical course of 36 paediatric patients with underlying primary immunodeficiency (PID) followed by SickKids Hospital (Toronto, Canada) who were symptomatic and tested positive for SARS-CoV-2 infection between October 2020 to November 2022. Result(s): Our cohort consisted of patients with combined immunodeficiency (66.7%), antibody deficiency (22.2%), neutrophil dysfunction (8.3%), and immune dysregulation (2.8%). The median age was 7.5 years (range: 8 months - 17 years), with 21 male and 15 female patients. Three (8.3%) patients were post-hematopoietic stem cell transplant (HSCT) and 12 (33%) patients were on immunoglobulin replacement. Nine (25%) patients had underlying lung problems including bronchiectasis (1), interstitial lung disease on home oxygen therapy (1), and underlying asthma (7). Most patients had mild clinical course and were managed at home. The most common symptoms were fever (80%), cough (75%) and other upper respiratory tract symptoms (72%). Nineteen (52.7%) patients experienced other symptoms which included headache, lethargy, or gastrointestinal upset. At the time of the infection, 13 patients (36.1%) had received 2 doses of a SARS-CoV-2 vaccine, 5 patients (13.9%) had received 1 dose, and 18 (50%) were not vaccinated. None of the patients received antiviral or monoclonal antibody as prophylaxis or treatment. Only 1 patient required hospital admission out of precaution given the close proximity to HSCT. All patients recovered without complications. Conclusion(s): The paediatric patients with PID followed by our centre experienced mild to moderate COVID-19 symptoms and recovered fully without complications. These findings support the return of much needed social interactions among children, which were impacted severely during the COVID-19 pandemic.Copyright © 2023 Elsevier Inc.

Effects of the Covid-19 Pandemic on Primary Education System of Lahore, Pakistan

Background: The pandemic of Covid-19 impeded all socio-economical, pedagogic, and recreational activities. Pakistan is facing an intensified educational crisis due to previous educational differences, so the era of the pandemic has shown difficulties in the educational framework. Aim(s): Awareness among parents and students to combat challenges of pandemic. Method(s): The current study is based on random quantitatively study which gathered data from 300 respondents assembled from different areas of Lahore, Pakistan from June 2020 to July 2021. The responses were collected from students, teachers, and parents that how homeschooling compromises student's physical, psychological, and emotional health. Result(s): About 76% of the students favoured traditional classes over online classes whereas only 20% of the students found the online session interactive. In the other section, only 15.33% of the teachers were satisfied by the online results and they complained about the poor performance and interaction with the students. Overall, 81.67% parents agreed that there is a decline in the physical activity of their children. The results of this study suggested that social distancing and the emerging challenges associated with Covid- 19 have entirely changed the education system that has caused number of problems for children, parents, and teachers in Pakistan. Practical implication: This study highlights pros and cons of online study;such studies give students and teachers a way to prepare for future challenges. Conclusion(s): Considering all outcomes of study, it is highlighted that policy-level interventions were needed, along with well-designed interactive courses. Hence, integrated approaches based on the mental as well as physical capabilities of the students must be executed, and e-tools must also be practiced in traditional classes to fill the gap of homeschooling.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Function and interaction of coronavirus ion channel proteins

Objective: COVID-19 has emerged as a significant global health crisis causing devastating effects on world population accounting for over 6 million deaths worldwide. Although acute RTI is the prevalent cause of morbidity, kidney outcomes centered on a spectrum of AKI have evolved over the course of the pandemic. Especially the emerging variants have posed a daunting challenge to the scientific communities, prompting an urging requirement for global contributions in understanding the viral dynamics. In addition to canonical genes, several subgroup- specific accessory genes are located between the S and E genes of coronaviruses regarding which little is known. Previous studies have shown that accessory proteins (aps) in viruses function as viroporins that regulate viral infection, propagation and egress [1]. In this study we attempted to characterize the function of aps of coronavirus variants as ion channels. Furthermore, we also probed the interaction of ap4 with the host system. Method(s): Serial passaging (selection pressure), growth kinetics, confocal imaging, genome sequence analysis and proteomics were performed in Huh-7, MRC5 cells and/or human monocyte derived macrophages. Potassium uptake assay was performed in a Saccharo myces cerevisiae strain, which lacks the potassium transporters trk1 and trk2. Ion conductivity experiments were performed in Xenopus laevis oocytes using Two Electrode Voltage Clamp (TEVC) method. Result(s): Serial passaging demonstrated the acquisition of several frameshift mutations in ORF4 resulting in C-terminally truncated protein versions (ap4 and ap4a) and indicate a strong selection pressure against retaining a complete ORF4 in vitro. Growth kinetics in primary cells illustrated a reduction of viral titers when the full-length ap4 was expressed compared to the C-terminally truncated protein ap4a. Confocal imaging showed that ap4 and ap4a are not exclusively located in a single cellular compartment. Potassium uptake assay in yeast and TEVC analyses in Xenopus oocytes showed that ap4 and ap4a act as a weak K+ selective ion channel. In addition, accessory proteins of other virus variants also elicited microampere range of currents. Conclusion(s): Our study provides the first evidence that ap4 and other accessory proteins of coronavirus variants act as viroporins. Future studies are aimed at demonstrating the role of ap4 during the viral life cycle by modulating ion homeostasis of host cell in vivo (interacting proteins obtained from proteomic studies) and thereby serve as a tool for potential drug target.

You & type 2 @ home: Testing a fully remote model for diabetes annual reviews using the you & type 2 personalised care and support planning pathway in combination with remote monitoring technologies at two primary care practices in South London

Aims: A proof-of- concept pilot investigating the profile of person who engaged with remote testing for their annual diabetes review, and service user (SU) and primary care practice acceptability for completing annual diabetes review tests remotely (blood pressure, finger-stick blood test and urine test). Method(s): A mixed methods evaluation based on SU surveys sent to all 144 pilot participants, semi-structured SU and staff interviews, and demographic and clinical data extraction from primary care electronic patient record system. Result(s): Profile: The pathway was considered suitable for people who were working, digitally capable, younger, had household support to complete the tests, had non-complex diabetes, or a combination of these attributes. It was deemed less suitable for the very elderly, the less digitally capable, those with complex health needs or socially isolated. SU Acceptability: Interviewees and survey respondents overall deemed the remote tests acceptable for use. Convenience and reduced exposure to Covid-19 were motivating factors for participation. Preference for face-to- face care or concerns around using digital technologies were key reasons for decline. Staff Acceptability: The pathway was deemed acceptable and was successfully implemented at both practices. Support from a designated pathway co-ordinator and project manager were key factors linked to acceptability and success. The remote pathway was seen as an opportunity to reduce primary care pressures on in-person care. Conclusion(s): It is possible to successfully conduct annual diabetes reviews remotely. Although not appropriate nor desirable to everyone, remote testing provides a viable alternative to in-person testing for certain individuals.