Analysis of the assessment profile of KrasSMU students providing medical aid to COVID-19 patients.

The aim of the research. To conduct a cluster analysis of the assessment profile of students who participated in work of medical organisations providing care to COVID-19 patients to develop recommendations for its correction. Material and methods. The study was carried out at the premises of Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University (KrasSMU). The study group was constituted by 66 students in 3-6 years of study of the Medical and the Paediatric faculties of the University who took part in activities of medical organisations providing healthcare to patients with COVID-19. The items were presented in the form of binary questions and ranking scales. The analysis of qualitative attributes was carried out in the form of relative values with calculation of the standard error of the proportion. For ranking and nonparametric quantitative characteristics, the mode, median, centiles (Me [P25;P75]) and other nonparametric criteria for comparative statistics and communication statistics were used. For segmentation of respondents according to some criteria, depending on the answers, the method "two-step cluster analysis" and the method of "decision tree" were used. Results. The results of the study indicate a high motivational component related to practical medical activity of medical students during the difficult epidemiological situation since 94.1% of the respondents declared the readiness to support practical healthcare. Almost half of the surveyed 47.0% of students included in cluster 2, in contrast to students of clusters 1 and 3, are characterised by a high opinion on the degree of their contribution to the struggle against the COVID-19 epidemic and a high level of knowledge and skills, rating themselves at about 9.0 points out of 10 possible. In addition, the results of the study indicate an association between the level of students' self-esteem in regard to their contribution to the fight against COVID-19 with the level of the students' self-esteem of knowledge and skills and the duration of work in a medical organisation. Conclusion. The analysis performed has made it possible to formulate guidelines for support of medical students' professional attitudes within the framework of practice-oriented education, including distance learning.Copyright © 2021, Krasnoyarsk State Medical University. All rights reserved.

Comprehensive medication management services provided via telehealth or hybrid models: A scoping review

Comprehensive medication management (CMM) is increasingly provided by health care teams through telehealth or hybrid modalities. The purpose of this scoping literature review was to assess the published literature and examine the economic, clinical, and humanistic outcomes of CMM services provided by pharmacists via telehealth or hybrid modalities. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Randomized controlled trials (RCTs) and observational studies were included if they: reported on economic, clinical, or humanistic outcomes;were conducted via telehealth or hybrid modalities;included a pharmacist on their interprofessional team;and evaluated CMM services. The search was conducted between January 1, 2000, and September 28, 2021. The search strategy was adapted for use in Medline (PubMed);Embase;Cochrane;Cumulative Index to Nursing and Allied Health Literature;PsychINFO;International Pharmaceutical s;Scopus;and grey literature. Four reviewers extracted data using a screening tool developed for this study and reviewed for risk of bias. Authors screened 3500 articles, from which 11 studies met the inclusion criteria (9 observational studies, 2 RCTs). In seven studies, clinical outcomes improved with telehealth CMM interventions compared to either usual care, face-to-face CMM, or educational controls, as shown by the statistically significant changes in chronic disease clinical outcomes. Two studies evaluated and found increased patient and provider satisfaction. One study described a source of revenue for a telehealth CMM service. Overall, study results indicate that telehealth CMM services, in select cases, may be associated with improved clinical outcomes, but the methods of the included studies were not homogenous enough to conclude that telehealth or hybrid modalities were superior to in-person CMM. To understand the full impact on the Quadruple Aim, additional research is needed to investigate the financial outcomes of CMM conducted using telehealth or hybrid technologies.Copyright © 2022 Pharmacotherapy Publications, Inc.

Quality of life of a group of Ecuadorian health professionals in covid-19

Introduction: Covid-19 was the cause of a pandemic that claimed thousands of human lives. The pandemic has caused health professionals mental health problems that influence emotional, psychological and social well-being, which affects the way they think, feel and act in daily life. Objective(s): To de-termine the quality of life of health personnel during the Co-vid-19 pandemic in public institutions in the city of Cuenca. Material(s) and Method(s): Descriptive, cross-sectional and observational study. The study sample was 338 health professionals belonging to the Ministry of Public Health of the Canton Cuenca, province of Azuay-Ecuador, doctors, nurses, dentists, psychologists, assistants and biochemists who work at differ-ent levels of care were included. Two WHOQOL surveys and the Lazarus and Folkman scale of coping modes were used, for the tabulation of the data the RStudio statistical program was used. Result(s): In the psychological domain, no significant destructuring was found in the personnel studied. In the field of health, it should be noted that the personnel studied reported the inability to carry out the activities they need and the diffi-culty in moving from one place to another. Conclusion(s): When investigating the relationship of health personnel with the envi-ronment, no statistically significant alteration was found, but it was evidenced that social support is a protective factor for the mental health of personnel.Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.

Improving mycobacterial sputum culture collection in adult patients during the highly effective modulator therapy era

Background: Taking annual mycobacterial sputum cultures (MSCx) is a best practice standard for surveillance of nontuberculous mycobacterium (NTM) infection. MSCx collection among sputum-producing people with CF (PwCF) is essential for early identification and management of NTM. Initiation of highly effective modulator therapy (HEMT), elexacaftor/ tezacaftor/ivacaftor in 2019, resulted in a reduction in sputum production in PwCF. The concurrent emergence of the COVID-19 pandemic led to a shift from in-person to virtual clinic visits. These two events led to a dramatic decline in the rate of MSCx collection at our center-from 52.7% (2019) to 26.5% (2020) based on our CF Patient Registry report. We used a multidisciplinary approach to evaluate and implement continuous quality improvement (CQI) measures with the aim of increasing MSCx collection from 52.7% to 65% in 12 months. Eligibility was defined as producing 1 mL or more of sputum and no MSCx within the past 12 months. Method(s): The Minnesota CF Center care team consists of multidisciplinary specialties and approximately 450 PwCF. The CQI team generated the aim and developed a process map highlighting key stakeholders and barriers to MSCx collection. The team used a plan-do-study-act (PDSA) model to optimize key steps involved in MSCx collection. The first PDSA model included microbiology lab leadership identifying optimal (5-10 mL) and acceptable (>=1 mL) sputum volumes to avoid rejected specimens. Next, providers approved a new protocol to prioritize first sputum collection for MSCx and subsequent collection for CF bacterial cultures in eligible PwCF. Development of a certified medical assistant flowchart guided determination of eligibility for MSCx collection (Figure 1). Certified medical assistant then used a paper tool to document eligibility, specimen type, and lab orders placed for PwCF in clinic during the 4-week PDSA cycle. The paper tool was adapted using electronic health record (EHR) capabilities to generate date of last MSCx and allow electronic documentation of specimen collection type and orders placed. Result(s):With the use of HEMT, the percentage of sputum-producing PwCF declined from 74% to 40%. Use of process mapping and paper tool identified barriers to collecting MSCx in our clinic. Workflows were established through recurrent PDSA cycles to identify actionable interventions (education of lab personnel, paper tool, EHR documentation), which has led to collection of 53% of eligible samples-up from 26.5% in 2020 and on Figure 1 : Certified medical assistant (CMA) flowchart for mycobacterial sputum culture (MSCx) collection to determine patient eligibility and order placement(Figure Presented) track for 65% MSCx collection for the year. The paper tool revealed that the greatest barrier to obtaining MSCx was lab cancellation. By November, the team will complete another PDSA cycle after further lab education with the aim of decreasing the number of MSCx that the lab erroneously rejects. Conclusion(s): Despite the reduction in sputum production after use of HEMT, approximately 40% of PwCF still produce sufficient sputum for MSCx monitoring. Applying effective CQI tools including process mapping, PDSA cycles, pareto charts, and run charts to implement an improved, standardized workflow can increase the rate of MSCx, which will aid in detection and management of NTM infections and inform the epidemiology of NTM in the era of HEMT Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Changes of working conditions and job-related challenges due to the SARS-CoV-2 pandemic for medical assistants in general practices in Germany: a qualitative study.

BACKGROUND: In Germany, general practices are usually contacted first by patients with health complaints, including symptoms characteristic of SARS-CoV-2. Within general practices, medical assistants (MAs) are the first contact person for patients and perform various tasks in close physical patient contact. Working conditions of MAs have been characterized as challenging, e.g., due to low salaries, a high workload, time pressure and frequent interruptions. The potential changes of working conditions and job-related challenges experienced by MAs due to the SARS-CoV-2 pandemic have not been fully explored. We aimed to address this knowledge gap among MAs working in general practices in Germany. METHODS: Semi-structured telephone interviews were conducted between March and April 2021 with 24 MAs. Medical assistants of legal age, who worked in general practices in Germany, and who were continuously employed and without change of employer in 2020 were eligible for participation. Interview recordings were transcribed verbatim and content-analyzed using MAXQDA, using deductive and inductive coding. RESULTS: The SARS-CoV-2 pandemic posed great challenges for MAs, including a dramatic increase in workload, changes in occupational tasks, increased hygiene measures, rearrangements of work organization, childcare issues, and structural and personnel challenges within their practice. Participants described both improved but also worsened collaboration with their employers and colleagues due to the pandemic. Many MAs complained about issues regarding SARS-CoV-2-related billing processes and an increase in unpleasant patient behavior, including disregard of practice rules or frequent verbal insults. Many also did not feel adequately appreciated by politics, media, or society for their efforts during the pandemic. Positive changes were perceived to be the expansion of digital communication channels and a growing social cohesiveness of practice teams. CONCLUSIONS: Our study suggests that the SARS-CoV-2 pandemic posed great challenges for MAs. The pandemic seems to have worsened MAs' working conditions, which had been described as challenging already prior to the pandemic. In order to improve job satisfaction and to prevent loss of healthcare personnel, measures must be taken to improve working conditions of MAs in general practices.

A NOVEL APPROACH FOR TRAINING RESUSCITATION TEAM LEADERS FOR IN-HOSPITAL CARDIAC ARRESTS: A GUIDE AND SIMULATION-BASED PROGRAM

SESSION TITLE: Trainees: Mental Well-Being and Performance SESSION TYPE: Original Investigations PRESENTED ON: 10/16/22 10:30 am - 11:30 am PURPOSE: Advanced Cardiovascular Life Support (ACLS) certification provides an essential foundation for the recognition and management of cardiac arrests. However, there remains a significant gap between ACLS certification and the competence and confidence required to effectively deploy gained skills to lead an ACLS team. Here we present preliminary data on a novel approach to bridge this gap in Internal Medicine second-year residents (PGY-2) at an academic center through the creation of an ACLS leadership guide and interdisciplinary manikin-based simulation program for in-hospital cardiac arrest (IHCA). METHODS: A pocket card guide for ACLS team leaders was created, focusing on providing a structured approach to leading any ACLS team. This guide included, but was not limited to, a mnemonic offering ordered steps to address during resuscitation as well as an approach for assessment and management of underlying causes of cardiac arrest (e.g. ‘Hs and Ts’), including ultrasound utilization. The simulation program, developed for training ACLS-certified PGY-2s, provides one-on-one learning for 2-4 residents per month with introduction and review of the aforementioned guide followed by cardiac arrest simulation with a resident leader, nurses, pharmacists, respiratory therapists, and medical assistants. Immediately after the simulation, there is a group followed by individual video-based feedback and debrief. Trainees are surveyed pre- and post-session on their perceptions of comfort and proficiency on variable components in leading resuscitation of IHCAs, using a 5-point Likert scale (1=strongly disagree;5=strongly agree). The program was launched on 07/15/21, but simulations were temporarily suspended during the peak Delta COVID-19 surge. The Mann-Whitney test was used for comparing pre- and post-session responses. Results are reported as frequencies and medians (interquartile range [IQR]). RESULTS: Seventeen PGY-2s have completed the training sessions to date, of which 17 and 14 have completed the pre- and post-session surveys, respectively. Compared to pre-session responses regarding leading a cardiac arrest team, there was marked post-session increase in feeling comfortable [generally] (3 [2-3] vs. 4 [4-5];p=<0.0001), feeling proficient (3 [2-3] vs. 4 [4-5];p=<0.0001), and feeling comfortable searching for the underlying cause of cardiac arrest (3 [2-3.25] vs. 4 [3-4];p=0.0359). CONCLUSIONS: These preliminary data show marked improvement in self-reported confidence and competence in leading a cardiac arrest team during IHCA among ACLS-certified Internal Medicine residents, following deployment of an ACLS leadership guide combined with a realistic, high-fidelity, and interdisciplinary, leadership-focused simulation program. CLINICAL IMPLICATIONS: This novel program may enhance trainees’ leadership performance during IHCA, though its generalizability and impact on patients’ outcomes requires further study. DISCLOSURES: No relevant relationships by Christopher Dayton No relevant relationships by Jenny Heins No relevant relationships by Lee Oud

New medication-related developments in The Hungarian Electronic Prescription System and other eHealth services

In all countries, where electronic health services such as e-prescriptions have been introduced, patient safety has improved and the standard of medical and pharmaceutical care has increased. ePrescription (eRecept) - launched in Hungary as well - has become the most used eHealth module of the EE SZT (National eHealth Infrastructure) by all healthcare providers in the past near 3 years. During the COVID epidemic emergency e-prescription system has been a huge help to patients, relatives and caregivers too. In this period the proportion of electronic issued prescriptions exceeded 90% of all prescriptions written. The e-prescription system contributes to the better and faster information of healthcare professionals, supports the well-based therapy decisions, helps preventing and eliminating medication errors. Adverse drug reactions (allergies, interactions, polypharmacy etc.) can be more easily identified with the daily use of this service. Less paper administration can increase the time and quality of patient counseling both at the doctor's and in the pharmacies. Medication adherence can also be simply monitored by pharmacist as well. After patient registration - using social security number (SSN / TAJ) -, written maximum 1 year earlier and/ or by other pharmacy dispensed prescriptions will be also downloadable soon from the central database. These functions and real time data contribute to the implementation of high-quality pharmacotherapy advising services in pharmacies as healthcare institutions, made in accordance with the specific standards and protocols. The new functions of the Patient Portal (e.g. Legal Representation) and mobile surfaces provide patients and their relatives access to follow their care process, prescriptions, labs, etc., already on their smartphone too. From the beginning of May 2020, serial-produced medical aids mostly sold in pharmacies, can be electronically issued. The full integration of all the medical aids may be completed next year in a separated module. A simple web-based prescriber (socalled miniHIS) has been developed for connected private doctors, who do not consult in institutions. Measured values of the (smart) medical devices can be uploaded into the personal data repository of the Patient Portal on a voluntary basis. Good measurement results of the blood pressure, sugar, body weight, etc. recorded here demonstrate therapy fidelity, providing feedback to the patient and professionals. Telemonitoring services can be build on this module, so the software can send alerts to the assigned doctor, pharmacist or family member. Keeping data protection rules strict, depersonalized pharmacotherapy data uploaded to the central eHealth database will be searchable soon for professional and scientific purposes.

BP CONNECT: REFERRING UROGYNECOLOGY PATIENTS WITH HIGH BLOOD PRESSURE FOR PRIMARY CARE FOLLOW-UP

Introduction: Elevated blood pressure (BP) is the leading modifiable risk factor for cardiovascular disease (CVD), the leading cause of death in women. Timely referral to primary care from subspecialty care occurs infrequently. BP Connect, a staff protocol for specialty clinics, almost doubled timely primary care follow-up for rheumatology patients with elevated BP (AOR 1.9, 1.4 - 2.5;from 29% to 42%). Objective: To evaluate the feasibility and impact of implementing BP Connect in urogynecology and gynecology clinics. Methods: In two academic urogynecology and gynecology clinics, the BP Connect intervention trained medical assistants and nurses to Check (re-measure) BPs above 140/90, Advise patients of links between BP and CVD, and Connect patients with confirmed high BP for timely primary care follow-up. Implementation included (1) tailored staff engagement focus groups;(2) staff education defining elevated BP (above 140/90) and CVD risk;(3) electronic health record (EHR) alerts prompting staff to re-measure elevated BPs and order timely (within 4 weeks) follow-up for confirmed high BP;(4) staff feedback (monthly audits);and (5) patient education and tools (brochure and BP log). Clinic staff were surveyed pre- and post-implementation about confidence and comfort with BP discussion and referral. Descriptive analyses compared rates of BP re-measurement, offers for and fulfillment of timely primary care follow-up in the 6 months before (08/2020-02/2021) and after (02/2021-08/2021) BP Connect implementation. Multivariable logistic regression, controlling for age, insurance, hypertension, and CVD, evaluated impacts on timely primary care follow-up. Results: BP was elevated in 676 pre-implementation and 708 post-implementation visits. Table 1 describes demographic and relevant medical history for these patient visits. The only statistically significant difference between the pre- and post-implementation visits was a higher proportion insured by Medicaid during pre-implementation (16% vs. 10%). The rate of BP re-measurement increased from 19% pre- to 75% post-implementation (p less than .0001). During postimplementation, among visits where patients had confirmed high BP, staff provided patient education in 83% and offered referral for primary care follow-up in 60% of instances. Overall, the rate of timely primary care follow-up for high BP increased from 28% before to 48% after implementation (p less than .0001) despite implementation during the COVID pandemic. BP Connect implementation resulted in a 12-fold increase in BP re-measurement among patients with high BP and a 2-fold increase in timely follow-up with primary care (Table 2). Staff confidence to do something about high BP increased from 27 to 67%;comfort discussing high BP with patients increased from 27 to 83%, and comfort coordinating referral to primary care for high BP increased from 9 to 42% (all p less than .05). Conclusions: BP Connect implementation was feasible in academic urogynecology and gynecology clinics and doubled the likelihood of patients with high BP having timely primary care follow-up without creating undue burden on subspecialty clinics. The impact of BP Connect in urogynecology and gynecology clinics on timely primary care follow-up was almost identical to that seen in the rheumatology clinics where the intervention was initially developed and tested. Future work will examine adaptation and expansion of BP Connect to other specialties and health systems (Table Presented).

COMBATING COVID-19 IN PARTICULARLY VULNERABLE COMMUNITY: A RESIDENT QUALITY IMPROVEMENT PROJECT

BACKGROUND: At the beginning of 2021, the FDA officially issued the first emergency use authorization of COVID-19 vaccines. Vaccination hesitancy has been an ongoing issue over the years but is now an even more serious problem ever since the newly developed COVID-19 vaccine was released for emergency use. Due to the rapid event of COVID-19, community clinics have been unable to develop effective methods to inform patients about the vaccines, thus the vaccination rates have been low. Our goal is to increase vaccination uptake in our ethnically diverse community in Trenton, New Jersey. METHODS: The study was conducted between January 1-December 31, 2021. The QI team includes faculty and resident physicians, nurses, and medical assistants. The charts of unvaccinated patients were isolated. The team intervened in two PDSA cycles in order to systematically assess our performance and track improvements in vaccination rates. A standardized educational flyer was created and incorporated in EMR in multiple languages. Thereafter, the team added informational visits during each encounter. RESULTS: A total of 2,374 patients were listed, of which 63% were female. Most of our population is Hispanic with 73.8%, followed by Black by 9.7%. At the end of our study, a total of 52.6% of the patients were vaccinated. Among the vaccinated population, 75.7% of the patients were fully vaccinated. The highest monthly vaccination rate was reached inMay 2021 (29.6%) (Figure 1). The most commonly utilized vaccine was Moderna with 48.3% followed by the Pfizer-Biontech vaccine (35.2%). The vaccination rate was significantly positively associated with age, female gender, and Hispanic race ( all p values< 0.05). CONCLUSIONS: Our project demonstrates the importance of patient and staff education, close follow-up, and a systematic PDSA model process. Our patients have low health literacy and lack of knowledge about vaccines' safety and efficacy. Additionally, social media is broadcasting conspiracy theories and misperceptions about the COVID-19 vaccines, thus creating fear in patients. Unfortunately, COVID-19 will not be eliminated anytime soon due to the new variants coming as a threat to the world. Our QI team recommends others collect all the necessary data to move forward in similar projects like ours.

Mental health status and influencing factors of China medical team members in Africa during COVID-19

Objective: To analyze the mental health status and influencing factors of China medical team (CMT) members in Africa during COVID-19 pandemic. Methods: From July 2021 to August 2021, 72 members of the 8th CMT in Malawi, the 36th CMT in Sudan and the 22nd CMT in Zambia were tested by 12-item General Health Questionnaire (GHQ-12), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9(PHQ-9), general information form and influencing factors form. Results: The results of GHQ-12 were positive for 33.3% (24/72) of the CMT members. 51.4% (37/72) of the CMT members showed different levels of anxiety: 40.3% (29/72) of them had mild anxiety, 8.3% (6/72) of them had moderate anxiety, and 2.8% (2/72) of them had severe anxiety. 52.8% (38/72) of the CMT members had different degrees of depression: 34.7% (25/72) of them had mild depression, 11.1% (8/72) of them had moderate depression, 4.2% (3/72) of them had moderate-severe depression, and 2.8% (2/72) of them had severe depression. The CMT members who contacted with COVID-19 patients got significantly high scores of GHQ-12, GAD-7 and PHQ-9 (P<0.05) compared to those who did not have contact with COVID-19 patients. And CMT members who did not adapt to the local social life got significantly higher scores than those who adapted to the local social life (P<0.05). These factors were the main factors affecting the mental health of the CMT members. Conclusion: During COVID-19, the psychological pressure of CMT members was increased significantly, and both the incidence and severity of anxiety and depression were increased. Paying attention to and improving CMT members' mental health status can ensure the smooth development of medical aid to Africa.

Healthcare Professionals' Different Attitudes Towards Life-Support Triage Based on Survival Likelihood, Life-Expectancy, and Life-Stage

RATIONALE: There is controversy regarding which factors should guide resource allocation decisions during triage. Healthcare professionals' different roles and experiences may influence their beliefs and be relevant to development and implementation of triage protocols. We therefore sought to compare views of healthcare professionals in different roles on how strongly various health factors should influence patients' likelihood of receiving life-support in triage. METHODS: Secondary analysis of UC-COVID data. We analyzed responses from an online volunteer sample of 1,935 adult participants, including 582 healthcare professionals (HCPs) recruited from community organizations and direct media messaging. The survey was fielded from May-September, 2020. The main outcome measures were how likely patients should be to receive life support, rated on a Likert scale, from 1 (should be much less likely) to 9 (should be much more likely). Responses were combined into terciles with 1-3 coded as “deprioritized”, 4-6 as “neither deprioritized or prioritized” and 7-9 as “prioritized”. Health factors assessed included patients who (1) are deemed less likely to survive, (2) have shorter expected lifespans due to chronic illness, (3) are elderly, and (4) are children. Differences between healthcare groups were assessed using Pearson's chi-squared test. RESULTS: Of the 582 HCPs, 26% identified as physicians, 8% as advanced practice providers (including, nurse practitioners, physician's assistants, or other), 33% as primary bedside providers (including nurses, medical assistants, or respiratory therapists), and 33% as some other HCP. A majority of physicians (75%), advance practice providers (67%) and primary bedside providers (64%) deprioritized patients deemed less likely to survive compared to a minority of other HCPs (46%, p<.0001). A minority in each group deprioritized patients with shorter expected lifespans due to chronic illness, but physicians were more likely to deprioritize (49%) compared to advance practice providers (42%), primary bedside providers (37%), and other HCPs (20%, p<.0001). Fewer than 25% in all groups deprioritized patients who are elderly physicians (23%), advance practice providers (24%), primary bedside providers (18%), and other HCPs (11%, p=0.046). Less than 10% in any group thought children should be deprioritized (p=0.20). CONCLUSIONS:There was broad agreement among all groups that children and the elderly should not be deprioritized in triage decisions. There was more disagreement on how to prioritize patients deemed less likely to survive or patients with shorter expected lifespans due to chronic illness. It was also notable that physicians more often deprioritized based on these health factors compared to other groups.

Indoor Auto-Navigate System for Electric Wheelchairs in a Nursing Home

We are currently living in an age of COVID, where we wish to reduce physical contact as much as possible. It is even more important for patients who live in nursing homes and need wheelchairs. It is noticeable that people who live in nursing homes usually have an elder average age, and are more likely to have some underlying disease. Therefore they need extra care to resist COVID. As we all know, the most common and effective countermeasure against COVID is to avoid close contact. However, for most people who lives in a nursing home, there are plenty of daily activities that are mandatory for them. They have to spend considerable time moving on a wheel chair with a assistant pushing the wheelchair. Which made the assistant and the user a close contact to each other. We plan to design a auto-navigation computer system for electric wheelchairs. So it can be possible for electric wheelchair users to go to various places in nursing home without a assistant aside, reducing the risk of infection, as well as the human resource needed. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

EFFECTS of the COVID-19 LOCKDOWN on MENTAL HEALTH CARE USE in PEOPLE LIVING with HIV

Background: Mental health complications are highly prevalent among people living with HIV. Left untreated mental health complications can negatively affect HIV treatment outcomes. In March 2020, South Africa introduced a lockdown in response to the COVID-19 pandemic. Lockdowns might induce or exacerbate mental health conditions and limit access to treatment. We studied the effect of the lockdown on mental health care use among HIV-positive beneficiaries of a South African private sector medical aid scheme. Methods: We performed an interrupted time series analysis using insurance claims from January 1, 2017, to June 1, 2020 of HIV-positive beneficiaries aged 18 years or older from a large private sector medical aid scheme. Weekly outpatient consultation and hospital admission rates were calculated for substance use disorders (ICD10 F10-F19), serious mental disorders (F20-F29, F31), depression (F32, F34.1, F54), anxiety (F40-F48), and any mental disorder (F00-F99). We estimated adjusted odds ratios (OR) for the effect of the lockdown on weekly hospital admission and outpatient consultation rates. Results: 61,873 adults living with HIV were followed up for a median of 151 weeks. Hospital admission rates (OR 0.38;95% CI 0.27-0.54) and outpatient consultation rates (OR 0.72;95% CI 0.64-0.82) for any mental disorder decreased substantially after the implementation of the lockdown in March 2020 and did not recover to pre-lockdown levels until June 1, 2020 (Figure). Substantial decreases were observed in hospital admissions rates for substance use disorders (OR 0.13;95% CI 0.02-0.73), depression (OR 0.30;95% CI 0.16-0.54), and serious mental disorders (OR 0.58;95%CI 0.17-2.02). Decreases in outpatient consultation rates were observed for substance use disorders (OR 0.21;95% CI 0.08-0.55), anxiety disorders (OR 0.64;95% CI 0.54-0.76), depression (OR 0.71;95% CI 0.62-0.82), and serious mental disorders (OR 0.85;95% CI 0.72-1.00). Conclusion: Reduced mental health care contact rates during the COVID-19 lockdown likely reflect a substantial unmet need for mental health services with potential long-term consequences for people living with HIV and comorbid mental health complications. Steps to ensure access and continuity of mental health services during future lockdowns should be considered.

Telemonitoring: An Opportunity to Improve Multidisciplinary Care in Lung Transplanted Patients

Purpose: Telemedicine has been successfully employed in a wide range of specialties. We hereby present the results of a pivotal study we ran in our centre just before the COVID19 pandemic. Methods: This was a prospective study including all adult cystic fibrosis patients who underwent lung transplant (LuTx) from September 2017 to August 2019. Patients were randomized into two groups;patients assigned to the first arm (intervention) received a home medical assistant (HMA) system device, to which a pulse oximeter and a spirometer with reusable turbine were integrated;they were asked to perform a spirometry and register their SpO2 at rest and on effort on a twice-weekly basis. All the data were digitally transmitted to our centre, where physiotherapists and physicians were able to analyse them real-time. Both the groups received traditional hospital-based follow-up. Results: 32 patients were enrolled, 16 in each group. No statistically significant difference was found between the two groups (see Table 1).With reference to the telemonitoring group:- Adherence to telemonitoring significantly decreased during the 12months period of follow up (see figure 1).- Hospital reported data were consistent with the last being registered with the HMA device.- Of note, two patients were requested to anticipate their hospital routine visit because of a FEV1 decrease being reported on their HMA device, in order to rule out possible acute lung allograft dysfunction.- 13 out of 16 patients reported a high degree of satisfaction with the telemonitoring experience. Conclusion: The COVID19 pandemic highlighted the necessity to investigate alternative practices to treat chronically ill individuals. In our study, telemonitoring proved to be a valuable tool to improve quality health care to LuTx recipients, especially for those who live far from the transplant centre. We are now implementing this approach scheduling online video consultations. Further research should be focused on standardizing quality of telemedicine services.

Overcoming challenges through an academic-community health center collaborative to conduct cancer screening, prevention, & control among Asian Americans and sustainability initatives

The purpose of this presentation is to report accomplishments of a 3-year [5/1/2018-4/30/2021] Bristol-Meyers Squibb Foundation-funded collaboration between UC Davis and the Health and Life Organization (HALO), a Federally Qualified Health Center Look-Alike in increasing cancer screenings and cancer prevention/control behaviors among Asian Americans. HALO was selected for this study becuase it is the largest health system serving Asian Americans in Sacramento Co., CA. About one-third of their patients (9000) are Asian [primarily Hmong and other SE Asains). The hypothesis we tested was based on UC Davis's prior completed research that bilingual/bicultural Hmong lay health workers significantly increased screenings for HBV and colorectal cancer screening in randomized controlled community trials among Asians who largely had limited English proficiency. Our premise was to apply this concept to a clinical setting through HALO's bilingual/bicultural medical assistants (MAs). By comparing baseline (prior to the initiation of our funding) to 3 years of collaboration, we observed an overall 13.3% increase (surpassing our 10% goal) in cancer screenings & prevention/control behaviors. The largest percentage increases were in mammography (20.3%), colorectal cancer screening (11.6%), and Pap tests (7.9%).vaccination (2.8%). Since this was our first collaboration, much was shared through our monthly UCD-HALO leadership meetings where adjustments were made. A major adjustment was to learn that the electronic health systems used by community health centers such as HALO were not intended for reseearch purposes. While primary care provider time was less flexible, we found that MAs who reflect the HALO patient population were very receptive to training. We provided training through 10 Saturday academies, in-person and later delivered virtually during the COVID-19 pandemic. All of the topics related to the above metrics as well as other topics such as cultural competence, resources for patients, and optimizing patient workflows. Effectiveness of these academies were documented through gains in average scores from pre-tests [58%] to post-tests [84%] and qualitative feedback. Fifity-eight participants attended. More rigorous evaluation approaches to link our efforts to the impact of our work would have been preferred, but would have needed to be more resource-intensive. However, we anticipate that the equipping of MAs in new competencies and tools we provided for patients in various languages as infographics will be the bases for sustained effectiveness. Another measure of success was that this collaborative contributed to the receipt of a major Federal grant to eliminate perinatal HBV transmission through HALO. A UC Davis You-Tube style interactive modules as refresher materials and for new MAs will be another means of sustaining impact.

Research ready: Strategies for successful implementation of research in clinical settings

Through our experience implementing pragmatic studies, the Louisiana Public Health Institute recognized clinic support staff as unique stakeholders in clinicbased research whose role in study implementation is often overlooked. Our project, Research Ready, aimed to find innovative ways to engage staff in the design and implementation of research studies. Specifically, the project team designed, piloted, and disseminated materials to improve clinic staff capacity to partner in research. During this pandemic, reliance on clinical staff for study adherence is critical. COVID-related research has been rapidly implemented, which relies upon having well-prepared staff to handle the rapid implementation of new protocols. The team developed and piloted two tools for improving staff engagement in research activities: a training for clinic support staff and a guide for researchers. The staff training was developed to inform clinic staff, such as medical assistants and nurses, about basic research principles and considerations for supporting the implementation of research in a clinical setting. The training is available in three formats: e-learning, facilitated session, and self-guided workbook. The researcher guide was created to share insights and best practices for engaging and partnering with clinic staff to successfully implement pragmatic research. Both resources are available on Louisiana Public Health Institute's website. The Research Ready resources were informed by interviews conducted with clinic support staff and researchers (including principal investigators, study managers, and clinical research coordinators) who had implemented studies in outpatient settings. Clinic staff from a variety of settings were interviewed, including Federally Qualified Health Centers, private healthcare systems, and academic medical centers. Research staff were either affiliated with academic institutions or clinical research firms. Major themes identified in the key-informant interviews include (1) clinic staff play key roles in implementing research: they are gatekeepers of clinic workflow and brokers of patient trust;(2) clinic staff lack knowledge about research and the research process, which is a barrier to implementing studies in clinic settings;(3) communication and relationship-building are important facilitators for researchers seeking to work with clinical staff;(4) clinic staff prioritize the care and wellbeing of their patients, which can be both a barrier and a facilitator of clinic-based research. The training was piloted in three sites with a total of 52 participants. Participants were surveyed after completing the training. Survey results showed that participants thought the training was easy to understand and increased their knowledge about research. Results also showed that participants felt the information from their training was applicable to their jobs. As more research is conducted in clinic settings, researchers and clinic staff will benefit from best practices to assure a mutual understanding of research objectives and processes. Identifying strategies for successful implementation of research in clinical settings will enhance the conduct of pragmatic research and allow it to equitably reach patients in diverse outpatient care settings. Using the Research Ready materials, researchers can ensure that clinic staff have adequate understanding of research principles and that staff concerns about time and competing priorities are addressed and accounted for in study workflows.

COVID-19: Ventilation of African VIPs despite ressource deprivation in Malawi?

Introduction Our Critical Care Unit is a precious ressource in Malawi. Covid (C) could have lead to even more challenges on the withholding of ventilation. Often our non-physicians are involved in this decision. Not much is known about their opinions. Object To assess in a pilot study which hierarchical and social realities might influence the allocation of our ICU beds for our clinical officers (COs) and medical assistants (MAs). Methods Six patients in need of artificial respiration had to be evaluated in a questionnaire (Q).4 suffered from Covid (2 high ranking Ministry of Health [MoH] officials responsible for the countrywide response either against malaria or against Covid, the son of a business woman offering 100000 $ for ventilators to hospital and a tribal leader. 1 lady suffering from hemorrhagic shock after cesarean section and 1 from rabies. Non-physicians were asked to decide on the order of admission. The first patient to be admitted scores 1 point, the last 6 points. Lowest scoring is admitted first. The answers were compared with a Q our collaborators filled out previously (17 septic/nonseptic reasons for ICU). Moreover we tried in a series of confidental informal interviews to learn about life's reality on Covid ventilation. Results 19 Q were filled out correctly, so representing 90.5 % of our colleagues. 1st to admit was the mother after CS (1.1 points);2 nd: Patient with rabies (3 p.);All four dignitaries suffering from Covid scored worse: 3 rd: The donating business-woman (3.63 p.);4th: MOH collaborator for Covid (3.95 p.);5th: MoH collaborator for malaria (4.37 p.);6th: Traditional leader (4.95 p.). The same participants rated in the previous survey again CS 1 st, for admission, but rabies 2 nd last. Covid was then admitted as last and 3rd last. CS, but even rabies scored in comparison to 4 Covid cases even higher than in the first survey against 2 covid cases and several other non-covid related reasons for ICU admission. The patients with non-covid disease scored 2.05 points vs. the four dignitaries with a mean of 4.22 p. The business woman scored higher (3.63 p.) than the three potentially important members of government and civil society (mean 4.42 p.). We found in the previous survey that the dignitaries there (policeman, priest and businesswoman) scored uimpressively. The confidental background check discovered that at least four real life VIPs were admitted to hospital, and died there through Covid-without being ventilated. Conclusion Non-dignitaries with non-covid diseases scored higher than all dignitaries with Covid. MoH personal and traditional leaders are not seen as important in the fight against epidemics. An impressive implementation of a tough health policy was found.

Sepsis and COVID-19: Some ethical considerations in an African ICU

Background Sepsis (S) is one of the most important reason to be admitted in ICU in Malawi. ICU is a precious ressource in developing countries. The Covid (C) pan-demic added pressure on us. In this country (<1 anaesthetist per 2.5 mio) ICUbeds are allocated with clinical officers (Cos) and medical assistants (Mas). Not much is known about the non-physicians ethical convictions. In Queens Hospital we tried to find a basis for decisions. Object To enhance our knowledge about the rel. weight of sepsis (S), C. and non-septic diseases for our 19 COs and MAs and to compare it with our future doctors, (34 fourth year medical students [MS]. Methods A questionnaire (Q) presents 17 existing patients in critical care was given to 19 Cos/Mas and 34 MS. All 17 were needed ventilation. Reasons: Covid (twice), sleeping sick-ness, haemorragic shock after cesarean section (CS), malaria, tetanus, Guillain-Barre-Syndrome, rabies, traumatic brain injury (TBI), measles, typhoid fever, Tb, bowel resection, PCP with HIV, bact. pneumonia, meningitis and polytrauma. Pat. were devided in 7 groups. Group 1: Patients suffering from S or very much prone to develop S. G. 2: Covid patients. G 3: Groups 1 plus 2 (Covid as S) G 4: S. after an infection. G 5 S. after a non-infect. disease. G 6: Pneumonia (main culprit for sepsis), G 7: Patients, not likely to develop S.The CO and MAs ranked them for ICU admission. First to be admitted got 1 point, the last 17 points. Lowest scoring one admitted first. Results 53 Q were filled out, representing 66.6 % of the colleagues. CO &Ma: Group1: 8.58 points, G2: 11.55 p, G3: 9.24 p, G4: 9.6 p, G5: 6.44 p, G6: 10.04 p, G7: 8.13 p Med. stud.: Group1: 9.77 points, G2: 7.47 p, G3: 9.26 p, G4: 10 p, G5: 6.59 p, G6: 9.48 p, G7: 8.71 p. Overall: Group 1: 9.34 points, G2: 8.93 p, G3: 9.25 p, G4: 9.88 p, G5: 6.54 p, G6: 9.68 p, G7: 8.50 p.The most important admission for CO/MAs were: 1. CS (2.16 points), 2. TBI (4.68 p.), 3. Malaria (7.05 p.). The least important: Last: Covid (12.37 p.), 2nd last: Rabies, (12.1 p.);Second Covid pa tient shared 3rd last with a PCP patient who was HIV+ (10.74 p.). For our MS: 1. Polytrauma (4.56 points), 2. TBI (5.0 p.). 3. Malaria (10.26 p.). Least:Rabies (13.85 p.), 2nd last: Bact. Pneumonia (13.21 p.), 3rd last: Covid (12.59 p.). verall 1st admission is TBI, 2. CS, 3. Malaria. Least important: Rabies. Gender did only play a minor role as criterion for ICU admin.MS. admitted male patients 1 place earlier, COs and MAs it made no diff. Conclusion S. after non-infect. is more important than S. to infections or C. This is the difference between MS and our non-academics. Mothers and TBI scoredhigher than infect. &plain S.