ABSTRACT
Introduction: The COVID-19 pandemic led governments to take a number of restrictive measures, which had an impact on the consumption of psychoactive substances among the world population. Objective(s): The present study, carried out by the Addictology Center of Ar-razi Hospital in Sale, aimed to evaluate the behavior of addicted patients followed in ambulatory care, during the Covid- 19 pandemic. Method(s): We conducted a cross-sectional study with 128 patients, through a questionnaire assessing sociodemographic factors, psychiatric history, type and quantity of substances used during the pandemic, and withdrawal attempts. Result(s): The primary substance used was tobacco, followed by Cannabis, alcohol, hypnotics, and then Cocaine. 63% of patients reported an increase in their consumption during the pandemic, 64% started new substances, mainly Cannabis, followed by organic solvents. The monthly amount spent by our patients varied from 300 to 40,000 dhs/month, the source of this amount was legal in 92.2% of the cases, 43.8% had already been incarcerated or taken into custody as a result of this consumption. 78% of our patients had already tried to wean themselves off the drug, but only 39% were able to succeed. Conclusion(s): The pandemic had a profound effect on the incidence of substance use. Confining the population has indeed reduced the transmission of the virus, but it is far from harmless for the mind.
ABSTRACT
Purpose of Study Emergency department (ED) visits for mental health (MH) concerns have increased over the past decade. While a sharp decrease was noted in overall ED volume at the start of the COVID-19 pandemic, the prevalence of visits for MH concerns was significantly higher compared to previous years. The objectives of this study were to assess the proportion and acuity of MH visits in the ED for patients aged 5-21 during the initial months of the COVID-19 pandemic compared to the previous three years. Methods Used A retrospective, cohort study was conducted in a suburban ED with 130,000 annual visits (2019) that includes a dedicated pediatric ED. Data was retrieved from the hospital's electronic medical records searching for MH chief complaints. Proportion of MH visits during the COVID- 19 pandemic year (Y4: March 1, 2020- February 28, 2021) was compared to the previous three rolling years (Y1: 2017- 18;Y2: 2018-19;Y3: 2019-20). Patients with substance abuse/ intoxication were excluded. High acuity was defined as patients presenting after intentional ingestion of a substance, direct physical harm requiring medical hospitalization, or presenting under an emergency/temporary custody order. Acuity was assessed through random sampling of each cohort. Outcomes were stratified by age: 5-13, 14-17, 18-21. Chi-square methods (including exact tests) were used to evaluate all frequency measures. All analyses were conducted using SAS software (v9.4, SAS Institute). Summary of Results During Y4, 1677 patients aged 5-21 with a MH chief complaint were identified, of whom 1505 patients met inclusion criteria. The proportion of ED visits for mental health concerns was 8.8%, compared with 4.25%, 5.07%, and 5.43% for Y1-Y3, respectively (p< 0.0001). The median age was 16 years, 74.3% were female, and 33.3% presented with high acuity. There were no statistically significant differences in overall acuity when compared to prior years. However, for the cohort aged 14-17 years, the proportion presenting with high acuity increased from Y1 to Y4 with a clinically significant increase from Y3 (14.1%) to Y4 (18.7%). Conclusions The proportion of MH encounters to the ED increased significantly during the pandemic year. Additionally, we saw a clinically significant increase in patients aged 14-17 presenting with high acuity. (Table Presented).
ABSTRACT
Introduction: The emergence of the SARS-CoV-2 virus, the cause of the COVID-19 pandemic, in late 2019 put every country on high alert and led to major changes in global diagnostic testing capability in infectious disease. From the outset it was apparent that local health authorities were under-prepared and under-staffed to cope with the rapid onset and spread of the disease. Demand for SAR-CoV-2 testing soared, highlighting the limitations of capacity in existing infectious disease laboratories along with requests from governments to support growing testing need. We partnered with US and UK Governments to establish, supply, staff and operate three large-scale, high-throughput SARS-CoV-2 testing facilities. These were ultimately established in Valencia, CA, offering testing of up to 150k samples per day, and in Loughborough and Newport, UK, offering a combined testing of up to 70k samples per day. The biggest challenge faced globally was the unprecedented scale of testing required and the timeframe to deliver a reliable and sensitive high-throughput assay. The benefits of industry and government partnerships become evident along with having a dedicated supply chain to feed the reagent and consumable needs for high-throughput testing as well as a highly accurate test with a fast turnaround time. Experts from multiple divisions, including R&D, Genomics, Enterprise, and regional centres were bought into the project, resulting in the establishment of SARS-CoV-2 testing within the three facilities in approximately eight weeks. Clinical testing experts in high-throughput, newborn screening, and rare disease testing, built molecular testing pipelines for the facilities based around the use of real-time polymerase chain reaction (RT-PCR) assays and sequencing. Laboratories were setup to meet the requirements set by various regulatory and accreditation agencies such as Clinical Laboratory Improvement Amendments, College of American Pathologies, the UK National Health Service validation group and ISO15189. Methods: Underpinning the testing was the massive IT and bioinformatics effort to enable reporting of the testing outcomes to the relevant authorities. We were able to deploy a novel LIMS system that is used throughout the laboratories to maintain sample chain of custody from arrival at the facility to reporting of results and incorporating interpretive software to support clinical interpretation of the resulting RT-PCR data. The LIMS systems are constantly undergoing improvement to support interpretation and troubleshooting. Local experts in clinical interpretation and reporting were onboarded to augment data analysis and ensure high-quality and reliable reporting whilst ensuring that clinical governance remains at the centre of all activities. Results: Before any SARS-CoV-2 testing was able to commence, several significant challenges were overcome by combining the expertise of our global teams with the local knowledge and support of the respective Governments. Experts in logistics and program management were able to convert three empty facilities with no pre-existing laboratory infrastructure into fully functional clinical testing laboratories within eight weeks. Our assay manufacturing capacity was majorly expanded to accommodate the requirements of SARS-CoV-2 testing, with all three facilities operating on automated platforms and utilizing chemistry with a dedicated secure supply chain. The final major challenge was rapid onboarding and training of staff for the facilities, and a year out, the two active facilities are currently employing over 600 individuals. Conclusion: To date the three facilities have performed over 12 million SARS-CoV-2 RT-PCR assays and SARS-CoV-2 testing will continue into 2022. The number of cases is again growing globally, and with the emergence of new variants and continual uncertainty about the impact on existing vaccines, there is an ongoing requirement for this scale of testing. From the experience of the SARS-CoV-2 global pandemic, the benefits of industry and government collaboration or the public has become much clearer, including greater access to large-scale testing options, significant reductions in time-to-testing and reporting and the rapid deployment of modern, cutting edge technology in diagnostic and monitoring programmes and eventually reduced costs to health services from mass-production. Ultimately the longevity of the individual testing facilities is unclear, but the future of large-scale clinical testing has changed forever and the legacy of this is the clear benefit to everybody when industry and governments work together to provide the public high quality and reliable testing operations.
ABSTRACT
Study Objective: The contribution of social determinants of health (SDOH) to poor health outcomes is well established, and the emergency department (ED) is the most common site of contact between socially vulnerable patients and the healthcare system. The ED is thus uniquely well positioned to screen patients for social determinants of health and connect those identified as having social needs with appropriate community resources. Before such programs are developed, more information regarding the needs and characteristics of the target patient population is required. Our objective was to characterize the prevalence of common social determinants of health among adult patients presenting to a high volume, urban ED at an academic medical center in New England. Methods: During April 2021, four research assistants (RAs) administered a SDOH survey based on Boston Medical Center’s THRIVE Social Determinants of Health Screening and Referral Program. Patients were screened during 8-hr shifts over 16 days, corresponding to 24-hr coverage over 7 days. Exclusion criteria included patients with age under 18 yr, medical or cognitive inability to participate, or currently in state or federal custody. Patients were verbally consented in their preferred language and survey responses were entered into a dedicated REDCap database;interpreter services were used for all low-English proficiency patients. All patients were offered referrals to local community resources via text or email through the platform at the conclusion of the survey. Patients were considered to have a positive screen for social risk factors if they responded “Sometimes true” or “Often true” to Likert scale questions regarding the frequency of risk, or “Yes” to binary risk questions. Results: A total of 650 patients were approached by RAs, of whom 343 were eligible to participate in the survey;122 eligible patients (35.6%) were identified as screen positive for SDOH risk factors. Patients screening positive were significantly more likely to be of Hispanic ethnicity (23.0% v. 9.1%, p<0.001), nonwhite race (30.3% v. 16.9%, p=0.004), and income < $40, 000/yr (51.0% v. 23.7%, p<0.001). Among patients with positive screens, the most common risks identified were concerns regarding food insecurity (n=59, 48.4%), access to transportation for medical appointments (n=36, 29.5%), cost of medications (n=34, 27.9%), and heat or electricity bills (n=34, 27.9%). A significantly greater proportion of patients with positive SDOH screens reported an increase in their needs during the COVID-19 pandemic (55.9% v. 21.0%, p<0.001). Conclusion: This SDOH screening study indicates that our ED population has significant unmet social risks and needs. More research on ED-based solutions will be necessary address this growing need in our population, and thereby improve health outcomes.