ABSTRACT
Background: Due to the unprecedented magnitude of the current Coronavirus disease 2019 (COVID-19) pandemic, vaccine development was fast-tracked;yet, there were barriers to vaccination uptake. Aim and Objectives: The objectives of this study were to understand the factors promoting vaccination and the barriers to vaccination, to explore the infection prevention and control practices followed after vaccination. Materials and Methods: A qualitative study using in depth interviews, both face to face and telephonic;among beneficiaries willing to participate and given at least one dose of COVID-19 vaccine in the institutions’ vaccination center, stratified sampling technique was used. Informed consent was obtained. Absolute confidentiality was ensured. The interviews were recorded and transcribed verbatim and validated by back translation into vernacular. The results obtained were analyzed using framework approach and categorized into themes and subthemes and valid conclusions drawn. Results: Various factors promoting willingness for vaccination and barriers perceived by the participants in their community, social, and occupational setting have been revealed in the present study. Availability of vaccine along with clear and accurate information can go a long way in overcoming vaccine hesitancy and promoting vaccine literacy. Conclusion: Clear and accurate information should be disseminated. The role of social media, mass media, and dissemination of information by word of mouth cannot be undermined. It is hoped that results of the present study will aid in formulating future vaccination programs.
ABSTRACT
Background: COVID-19 has become a major health emergency worldwide. The characteristics and outcome of COVID-19 in patients with CLD remain unclear. Aims: CLD represents a major disease burden globally. Given this high burden, how different underlying liver conditions influence the outcome in patients with COVID-19 needs to be meticulously evaluated. So, we conducted this study to see the outcome of the patient and to look for predictors of severity and mortality in patients with CLD with COVID-19 infection. Methods: This was a single-center, observational study conducted at a tertiary care center. We recruit 50 consecutive patients of COVID-19 with CLD. Matched comparison group patients with CLD without COVID-19 collected retrospectively from historical data with 1:2 ratio using stratified sampling. Results: Mean age of the study population was 51 ± 12 years with the majority were male. Most patients (21/50) were presented with predominantly respiratory symptoms of which fever was the most common symptom (85%). Jaundice (70%) was the most common GI symptom. Twenty patients had ACLF. All patients with ACLF were having severe COVID-19 infection and succumb to multi-organ failure. Mortality was double in a patient with CLD with COVID-19 infection than historical control. Diabetes was the only comorbidity which was associated with severe infection. Patients in the severely ill subgroup had higher mortality, high creatinine, and raised D-dimer but lower lymphocytes count. (P <0.05). Multivariate logistic regression for severity showed that only D-dimer reached significance. CURB-65 score on admission and Child Turcotte Pugh score on admission correlates with mortality (P <0.05). Serum D-dimer level and reduced lymphocyte counts were associated with mortality on multivariate analysis. Conclusion: The presence of CLD in covid-19 patients was associated with a poor outcome. Raised D-dimer on admission can predict severe infection. Child-Pugh and CRUB65 scores were highly associated with non-survival among these patients.
ABSTRACT
Introduction: Community pharmacy is one of the most accessible sectors in the health service and played a key role in responding to COVID-19 (1). Efforts to tackle COVID-19 have required an immediate response from the community pharmacy workforce. Aim: To examine views and experiences of community pharmacists regarding changes in practice/processes in preparation for and response to the COVID-19 pandemic. Methods: A telephone questionnaire was conducted across a geographically stratified sample of community pharmacists in Northern Ireland (NI). Based on the total number of pharmacies (N=528) and an anticipated response rate of 30%, up to 433 pharmacies were to be contacted to achieve a target sample size of n=130 (sampling fraction 24%). The questionnaire sections comprised: (1) measures taken to prevent COVID-19 infection;(2) response to the pandemic, i.e. immediate actions taken, effect on service provision and new/innovative ways of working;(3) pandemic preparedness;(4) communication with GPs and patients;(5) professional knowledge;(6) recovery and future outlook. Data were coded, entered into SPSS v27, and analysed descriptively. Free-text comments were summarised using thematic analysis. Results: One hundred and thirty community pharmacists (175 approached) completed the questionnaire (74% response rate). Pharmacists responded comprehensively to implementing infection control measures, e.g. management of social distancing in the shop (n=125, 96.2%), making adjustments to premises, e.g. barriers/screens (n=124, 95.4%), while maintaining medicines supply (n=130, 100.0%) and advice to patients (n=121, 93.1%). Patient-facing services such as minor ailments and smoking cessation were initially stopped by 115 (88.5%) and 93 (71.5%) pharmacies respectively during the first wave of the pandemic (March-May 2020);by the second wave (Sep-Dec 2020), modified services had resumed in 121 (93.1%) and 104 (79.9%) pharmacies respectively. Newly commissioned services were provided, e.g. emergency supply service (n=121, 93.1%), flu vaccination for healthcare workers (n=101, 77.7%) and volunteer deliveries to vulnerable people (n=71, 54.6%);new initiatives were developed, e.g. measures to flag/assist patients with sensitive issues (n=73, 56.2%). Pharmacies with a business continuity plan increased from 85 (65.4%) pre-pandemic to 101 (77.7%) during the second wave. Free-text responses indicated how pharmacists adapted practice in the front line to reassure and advise the public and maintain essential medicines supply. Pharmacists were least prepared for the increased workload and patients' challenging behaviour, but 126 (96.9%) reported that they felt better prepared during the second wave. Telephone was the main method of communication with patients (n=107, 82.3%) and GPs (n=114, 87.7%). Pharmacists felt they had sufficient training resources available (n=113, 86.9%) to maintain professional knowledge. Pharmacists agreed/strongly agreed that they would be able to re-establish normal services (n=114, 87.7%), were willing to administer COVID-19 vaccines (n=105, 80.7%) and provide COVID-19 testing (n=79, 60.8%) in the future. Conclusion: The high response rate is a strength of the study, but the impact is limited by not including patients or service commissioners. The pharmacy workforce remained accessible and maintained supply of essential medicines and advice to patients throughout the pandemic. Provision of modified and additional services such as vaccination reinforced the clinical and public health role of pharmacy.
ABSTRACT
Introduction: Coronavirus-2 is the virus responsible for the COVID-19 pandemic. People with certain risk factors, such as having chronic obstructive pulmonary disease (COPD) may be more likely to develop complications. Research has identified that ∼7% of patients with COVID-19 have a bacterial infection, however antibiotic prescribing rates have been found to vary from 38% to 72% (1,2). Primary care is estimated to make up 75% of antibiotic prescribing and was therefore a key target to evaluate whether antimicrobial stewardship principles were being followed during the COVID-19 pandemic. Aim: To audit the adherence of antibiotic prescribing in people with COPD during the COVID-19 pandemic across a primary care network (PCN) in England against national and local guidelines. Methods: The management of patients with COPD should follow NICE Guideline (NG) 114, NG168 and the local formulary. Three audit standards were created: 1) 100% of COPD patients should not be started on prophylactic antibiotics to reduce risk from COVID-19;2) 100% of COPD patients should not be prescribed antibiotics for COVID-19 symptoms;3) 90% of antibiotic prescription regimens should adhere to local and national guidelines. Prescribing data was collected from 12 practices linked to the PCN. Data of patients who had COPD, were prescribed an antibiotic, and had an indication for the antibiotic between 01/03/20 and the 30/06/20 were extracted and transferred into an anonymised spreadsheet. A total of 1088 data points were extracted. Random stratified sampling provided 300 data points for analysis, ensuring each GP surgery was represented proportionally;the required sample size to determine significance was 291. For each practice, the total number of antibiotics prescribed to COPD patients between March-June 2019 and March-June 2020 was extracted. Descriptive statistics were used to determine antibiotic prescribing adherence and overall rates of prescribing. Inferential statistics were used to compare rates of prescribing pre-vs-during the pandemic. Results: Antibiotics were not prescribed for any patient for prophylaxis against COVID-19 (100% adherence to criteria 1). Two patients were prescribed antibiotics for suspected disease caused by COVID-19' (99.4% adherence to criteria 2). In only 28.7% of cases, the antibiotic was prescribed in line with the national and local guidelines (criteria 3). In most cases, treatment duration was the main reason for poor adherence, with longer courses of antibiotics being prescribed (7 rather than 5 days). Prescribing rates did not change significantly in 2020 compared to 2019 (1134 antibiotic prescriptions vs 1029 antibiotic prescriptions;p>0.05). Conclusion: The audit was successful in determining that the COVID-19 pandemic did not significantly affect antibiotic prescribing rates across the PCN for people with COPD. Adherence to NICE and local guidelines was low, specifically concerning the duration of antibiotic treatment. This highlights an area for improvement;to ensure healthcare professionals across the PCN prescribe in-line with antimicrobial stewardship principles. Extracted data was limited to antibiotic prescribing and could have been expanded to include steroids to provide a fuller audit of prescribing in COPD exacerbations. A re-audit may be beneficial since the publication of NG191.
ABSTRACT
Objective To explore the classification performance of combined model constructed from CT signs combined with radiomics for discriminating COVID-19 pneumonia and other viral pneumonia. Methods The clinical and CT imaging data of 181 patients with viral pneumonia confirmed by reverse transcription-polymerase chain reaction in 15 hospitals of Yunnan Province from March 2015 to March 2020 were analyzed retrospectively. The 181 patients were divided into COVID-19 group (89 cases) and non-COVID-19 group (92 cases), which were further divided into training cohort (126 cases) and test cohort (55 cases) at a ratio of 7∶3 using random stratified sampling. The CT signs of pneumonia were determined and the radiomics features were extracted from the initial unenhanced chest CT images to build independent and combined models for predicting COVID-19 pneumonia. The diagnostic performance of the models were evaluated using receiver operating characteristic (ROC) analysis, continuous net reclassification index (NRI) calibration curve and decision curve analysis. Results The combined models consisted of 3 significant CT signs and 14 selected radiomics features. For the radiomics model alone, the area under the ROC curve (AUC) were 0.904 (sensitivity was 85.5%, specificity was 84.4%, accuracy was 84.9%) in the training cohort and 0.866 (sensitivity was 77.8%, specificity was 78.6%, accuracy 78.2%) in the test cohort. After combining CT signs and radiomics features, AUC of the combined model for the training cohort was 0.956 (sensitivity was 91.9%, specificity was 85.9%, accuracy was 88.9%), while that for the test cohort was 0.943 (sensitivity was 88.9%, specificity was 85.7%, accuracy was 87.3%). The AUC values of the combined model and the radiomics model in the differentiation of COVID-19 group and the non-COVID-19 group were significantly different in the training cohort (Z=-2.43, P=0.015), but difference had no statistical significance in the test cohort (Z= -1.73, P=0.083), and further analysis using the NRI showed that the combined model in both the training cohort and the test cohort had a positive improvement ability compared with radiomics model alone (training cohort: continuous NRI 1.077, 95%CI 0.783-1.370;test cohort: continuous NRI 1.421, 95%CI 1.051-1.790). The calibration curve showed that the prediction probability of COVID-19 predicted by the combined model was in good agreement with the observed value in the training and test cohorts;the decision curve showed that a net benefit greater than 0.6 could be obtained when the threshold probability of the combined model was 0-0.75. Conclusion The combination of CT signs and radiomics might be a potential method for distinguishing COVID-19 and other viral pneumonia with good performance.
ABSTRACT
The study is devoted to measuring the impact of the element changes on the bias and variance of the estimator of the total in a sample business survey. Stratified simple random sampling is usually used in business surveys. Enterprises may join, split or change the stratum between sample selection and data collection. Assuming a model for enterprises joining and a model for the enterprises changing the stratum with some probability, expressions for the adjusted estimators of the total and the adjusted estimators of their variances are proposed. The influence of the enterprise changes on the variances of the estimators of the total is measured by the relative differences, i.e., by comparing them with the estimators, if there were no changes. The analytic results are illustrated with a simulation study using modified enterprise data. The simulation results demonstrate a large impact of the enterprise changes on the accuracy of the estimates, even in the case of the low probability of changes. The simulation results justify the need for adjustment of the enterprise changes between the sample selection and data collection, in order to improve the accuracy of results and the adjustment method available.
ABSTRACT
Background: The coronavirus disease 2019 (COVID-19) pandemic has spread with alarming speed, infecting millions globally, including Eswatini. Despite the institutionalization of measures by the Ministry of Health (MoH) to fight the pandemic, the cumulative number of people infected with COVID-19 has kept increasing daily. We sought to assess risk factors for COVID-19 infections among Health care workers (HCWs) in selected health facilities of the Lubombo region of Eswatini. Methods: A cross-sectional design and systematic stratified sampling were used to select the participants. Results: The study enrolled 333 HCWs, with the majority (201, 60.4%) being females, and the participants’ mean age was 33 years. The study showed that not having an isolation arrangement in a health facility for people suspected to have COVID-19 presents risk to HCWs for COVID-19 (Crude Odds Ratio (COR) = 2.5, 95%CI: 1.0–6.2), p = 0.50;Adjusted Odds Ratio (AOR) = 3.0, 95% confidence interval (CI) 1.0–8.7, p = 0.038). Likewise, HCWs who rarely followed infection prevention and control (IPC) measures were at higher risk of COVID-19 infection than those who followed such measures (COR = 4.2, 95%CI: 1.1–17.2, p = 0.041;AOR = 6.5, 95%CI: 1.4–30.0, p = 0.016), and HCWs exposed to a colleague diagnosed with COVID-19 were at higher risk of being infected themselves (AOR = 11.4;95%CI: 0.9–135.7;p = 0.054). Conclusion: An active COVID-19 symptoms screening, triage and isolation arrangement for suspected COVID-19 clients for all clients entering the facility increases protection of HCWs from COVID-19. Reinforcement of all infection prevention and control measures to prevent exposures from infected patients and colleagues is essential.
ABSTRACT
Since the beginning of the SARS-CoV-2 pandemic a main metric is the amount of infected people at any given time. We present a valid assessment of the population acutely infected by SARS-CoV-2 in Austria at three distinct points in time: April, May and November 2020. The population of these sample surveys includes people aged 16 or older living in private households. Participants were tested with PCR (polymerase chain reaction) tests using nose-throat swabs. Based on these tests, it is assumed that the number of acute SARS-CoV-2 infections was below 11,000 individuals, or 0.15% of the target population, in April, below 6,000, in May and below 265,000 in November (i.e. the upper limit of the 95% confidence interval). In November a comparison with the Austrian Epidemiological Reporting System reveals that more than estimated 50% of acute infections remain undetected by the official reporting obligations.