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1.
Revista Cubana de Salud Publica ; 48:1, 2022.
Article in Spanish | GIM | ID: covidwho-1888092

ABSTRACT

Introduction: The Health Surveillance System reported in December 2019 cases with pneumonia in the city of Wuhan, China. The new disease, caused by SARS-CoV-2, was named COVID-19. On March 11, 2020, the first three imported cases were diagnosed in Cuba. The gradual introduction of different viral variants caused several outbreaks. It became necessary to look for alternatives that would allow epidemiological control to be achieved.

2.
Developmental Medicine and Child Neurology ; 64(SUPPL 2):106-107, 2022.
Article in English | EMBASE | ID: covidwho-1886662

ABSTRACT

Objective: Delayed diagnosis of cerebral palsy (CP) limits access to early interventions when the infant brain has the most neuroplastic potential, particularly in low-and middle-income countries (LMICs). The 2017 clinical guideline on the early diagnosis of CP outlines best practice tools to support diagnosis. We aimed to assess the feasibility of implementing these tools for early detection of CP in Bangladesh. Design: Prospective cohort study. Method: Neonates admitted to a regional tertiary hospital neonatal intensive care unit (NICU) in Bangladesh with major risk factors for CP (preterm birth, hypoxic ischemic encephalopathy/ neonatal encephalopathy [HIE/NE], neonatal sepsis and/or severe jaundice/kernicterus) were enrolled. A physician identified eligible neonates via physical assessment, medical record review and parent interview using a risk factor questionnaire developed for this study. General Movements Assessment (GMA) were completed at the time of recruitment (writhing period) and 13 weeks corrected age (fidgety age);neuroimaging data collected from the NICU;and Hammersmith Infant Neurological Examination (HINE) conducted at 12 months corrected age. Due to the impact of COVID-19, a proportion of the cohort were not able to have GMA fidgety videos completed and the first HINE assessment was delayed to 12 months. GMA data is not currently reported in this . Results: A total of 227 high risk neonates were recruited between November 2019 to March 2020. All neonates had evidence for prematurity and infection/sepsis on physical examination, 83.7% (n = 190) had HIE/NE and 14.5% (n = 33) had severe jaundice/kernicterus. Only 1.8% (n = 4) had cranial ultrasound and none had magnetic resonance imaging. Of the surviving (76.7%, n = 174) infants, 77.0% (n = 134) were assessed at 12 months. Among them, writhing videos and fidgety videos were previously collected for 100% (n = 134) and 29.9% (n = 40) respectively. At 12 months, 32.1% (n = 43) infants were identified to have CP of whom 90.7% (n = 39) infants had global HINE score <66 (sensitivity 90.7% and specificity: 97.8%). Conclusion: Despite study attrition and the impact of COVID-19, it was feasible to collect GMA videos in inpatient setting and infants at risk of CP were diagnosed as early as 12 months in a LMIC. Use of the structured risk factor questionnaire and adherence to best practice guidelines ensured a highly sensitive screening process and diagnostic outcomes. Our interim findings demonstrate the scope of this simple and scalable protocol in supporting clinicians for the early identification of infants with CP to facilitate early intervention and shared decision-making with families for best outcomes in LMICs.

3.
Journal of Urology ; 207(SUPPL 5):e529, 2022.
Article in English | EMBASE | ID: covidwho-1886516

ABSTRACT

INTRODUCTION AND OBJECTIVE: Insertion of a urinary catheter in the acute hospital ward is a commonly seen for a variety of indications. In these cases, where a patient is well enough for discharge from acute services yet may not be able to void without a catheter, a trial without catheter after a period of recuperation is warranted. In aged care facilities, where patients often have poor functional status, transfer to a hospital clinic may prove burdensome. We assess the feasibility of performing trials without catheters within the aged care home using a mobile geriatric service that can review patients within their residence. METHODS: We retrospectively analyse the electronic medical records of a tertiary teaching hospital for patients referred for a trial without catheter after an acute hospital admission. Patients who reside in aged care facilities where a trial without catheter performed within their home were identified. Data collection period was from 1st January 2018 to 30th April 2021. For patients who had voided successfully, follow up telephone reviews were performed for all patients the next day to identify any issues prior to formal discharge from the service. RESULTS: A total of 65 cases were identified. Mean age of the cases was 85.6 years. 44 referrals were for male patients and 21 were for female patients with 40 (61.5%) of all cases also having delirium or dementia, and 35 (53.8%) requiring assistance or hoist for transfers. Trial without catheter were performed successfully in 45 (69.2%) of cases. Of the remainder, 14 (21.5%) cases failed a trial without catheter and 6 cases were referred for acute admission for reasons unrelated to the urinary catheter. Of those that failed, 3 were planned for another trial without catheter and the remainder 11 (16.9%) were referred to outpatient urology review. On follow up telephone reviews for the 45 cases were trial without catheter were successful, no further voiding issues were identified. No new issues pertaining to patient's cognitive and mobility status were identified. CONCLUSIONS: Trial without catheter within the aged care facility is safe and feasible. Visiting clinicians were able to effectively manage trials without catheters, including patients who failed to void. All of these cases would otherwise require attendance to the trial without catheter clinic. In the current pandemic climate where services are limited to accommodate for COVID-19 patients, minimising transfer of frail, aged care residents to the hospital reduces urology clinic workload and keeps this vulnerable cohort away from potential COVID-19 exposure.

4.
Journal of Urology ; 207(SUPPL 5):e169, 2022.
Article in English | EMBASE | ID: covidwho-1886483

ABSTRACT

INTRODUCTION AND OBJECTIVE: Nephrectomy and venous thrombectomy is a challenging procedure with potential morbidity and mortality. Despite the increasing use of immune checkpoint inhibitors (ICI) in the management of advanced renal cell carcinoma (RCC), data regarding the outcomes of venous thrombectomy following ICI is limited. We evaluated the feasibility and perioperative outcomes of nephrectomy and venous thrombectomy following ICIs. METHODS: Patients with locally advanced or metastatic RCC with venous thrombus undergoing nephrectomy following ICI therapy were evaluated in four high-volume US academic centers between June 2017 and June 2021. Clinical data, perioperative outcomes, and 90-day complications were recorded. RESULTS: Out of 79 patients who received post-ICI nephrectomy, 27 had venous thrombus. Median (IQR) age was 64 (55-71) years. ICI regimens were Nivolumab ± Ipilimumab (n=19), and Pembrolizumab± Axitinib (n=8). Nephrectomy was indicated following either a good clinical response to ICI (n=24) or as a palliative surgery (n=3). Venous thrombi levels are shown in Table-1. Among all patients, 26 (96%) underwent radical and 1 (4%) partial nephrectomy;12 (44.5%) open, 12 (44.5%) robotic and 3 (11%) laparoscopic. One robotic case converted electively to open. Vascular procedures included renal vein thrombectomy (n=6), IVC thrombectomy and primary repair (n=19), IVC patch repair (n=1), and suprarenal cavectomy (n=1). No intraoperative complications were reported. Nine patients showed no viable tumor in the thrombus, of whom 2 had complete response in the primary tumor as well (ypT0N0). 90-day complication rate was 33% (n=9), with 8 patients (30%) requiring readmission (Table-2). One death was reported within 90 days due to COVID-19 infection. CONCLUSIONS: Nephrectomy and venous thrombectomy following systemic immune checkpoint inhibitor therapy is feasible. One third of patients show no viable tumor in the thrombus. Larger studies are needed to predict pathological response.

5.
Journal of Urology ; 207(SUPPL 5):e108, 2022.
Article in English | EMBASE | ID: covidwho-1886481

ABSTRACT

INTRODUCTION AND OBJECTIVE: To our knowledge no study has implemented virtual support groups in conjunction with the standard of care as a potential additional supportive measure for patients with interstitial cystitis (IC). The aim of this study was to assess feasibility and the patient experience of virtual support group sessions in this population. METHODS: Adult IC patients seen at our institution within the past 6 months were identified by ICD-10 diagnosis code N30.10. Eligible patients were offered to attend two predetermined virtual support groups. Three, hour-long sessions were held over Zoom for each group, with each session separated by two weeks. After the concluding session, participants completed a survey assessing their experience with the virtual support group. A free text response was also prompted regarding patient's overall experience. RESULTS: 12 patients formed two support groups (5 females in one, 5 females and 2 males in the other). 10 attended all three virtual sessions, with 2 missing the last session. All 12 completed the survey. 9 patients (75%) agreed that a virtual setting was more convenient compared to inperson meetings (3 were neutral) and 8 patients (67%) stated they would be more likely to attend virtually even without health risks related to COVID-19 (3 were neutral, 1 preferred in-person). Logistically, 10 patients (83%) were able to successfully navigate the technology involved (2 were neutral). As an overall experience, 9 patients (75%) reported benefit from attending (2 neutral and 1 disagreed). Only 4 patients (33%) indicated they felt more comfortable managing their IC as a result of participation in the group (3 were neutral, 4 disagreed). Feedback in free text comments expressed appreciation for hearing others' journey with IC. Other comments included discomfort with a mixed sex group, a wish for more than 3 sessions to allow for better connection in a virtual setting, and a wish for patient education by the session moderator. CONCLUSIONS: Offering interstitial cystitis support groups in a virtual setting is a viable alternative to in-person meetings. IC patients who otherwise would not attend an in-person support group may be inclined to participate virtually. Future support groups may benefit from being as longitudinal as possible to facilitate comfort among participants in a virtual setting. (Table Presented) .

6.
Journal of Urology ; 207(SUPPL 5):e3, 2022.
Article in English | EMBASE | ID: covidwho-1886477

ABSTRACT

INTRODUCTION AND OBJECTIVE: BPH affects tens of millions of men across the world. Most procedures require either general or regional anesthesia or a transurethral approach. Herein, we present the 3 & 6 months results of NCT04760483 is a phase I prospective, single center, interventional pilot study evaluating transperineal laser ablation (TPLA) of BPH tissues, carried in Office setting under local anesthesia. A detailed step by step video depiction of this procedure is available at the AUA video library. The objectives call for safety, feasibility, and impact in pertinent outcomes measures, such as Uroflowmetry, IPSS, Hematuria, Erectile function, and ejaculation METHODS: The study contemplated accrual of 20 men between 50 and 80 years with prostate volumes between 30 and 120 cc, IPSS scores >9, peak flows between 5 and 15 cc/s and void residuals under <250 ml. Any patient neurological conditions, history of any surgical intervention or urinary retention were excluded. IPSS assessments, Flow studies and prostate volume measures were conducted at 3 months. Herein we present the results. Bayesian analysis for continuous measurements were performed and non-parametric differences were evaluated using chi2 tests. RESULTS: Patients enrolled between December 2020 and February of 2021. The median (IQR) for age and BMI was 68 (58,73) and 29 (27,31), respectively. These parameters for room time, ablation time, watts and total joules were 29 (23,32), 9 minutes (7,12), 6 (5,7) watts and 3,400 (2,600, 3600) joules, respectively. 8(40%) were discharged with a Foley due to elevated residuals. 16 patients had erections and ejaculations before and 3 months after TPLA. 17/20 (85%) had significant improvement in their urinary profile after TPLA (See TABLE for details). One of the initial responders suffered from COVID- 19 infection and developed a CVA that hindered his urinary function. CONCLUSIONS: TPLA in the office setting is feasible and safe. Three month outcomes showed subjective and objective sustained improvement in over 80% of patients for at least 6 months. Furthermore, erections or ejaculations were not affected. This novel and promising approach demands further evaluation in phase II-III trials. (Figure Presented).

7.
Gastrointestinal Endoscopy ; 95(6):AB65, 2022.
Article in English | EMBASE | ID: covidwho-1885778

ABSTRACT

DDW 2022 Author Disclosures: Louise Krott: NO financial relationship with a commercial interest ;Lynn Debels: NO financial relationship with a commercial interest ;Christophe Schoonjans: NO financial relationship with a commercial interest ;John Anderson: NO financial relationship with a commercial interest ;Roland Valori: NO financial relationship with a commercial interest ;Lobke Desomer: NO financial relationship with a commercial interest ;David Tate: NO financial relationship with a commercial interest Introduction: Colonoscopy is a complex practical skill, which is highly operator dependent. The consistent attainment of key performance indicators (KPIs) by a colonoscopist depends primarily upon training. Local factors, outside of a trainee’s control, may mean their training is unstructured and contingent upon the observed practice of a small number of trainers. This is particularly true given current travel restrictions imposed by the worldwide COVID-19 pandemic. We sought to demonstrate the feasibility and impact of a one-day virtual-live colonoscopy-training course with remote, experienced trainers. Aims and methods: 6 endoscopy trainees [Belgium] underwent a one-day course (the intervention) involving training by consciously competent colonoscopists who were physically remote [United Kingdom]. The intervention comprised 5 interactive sessions on colonoscopy theory combined with 6 live sessions, where trainees performed colonoscopy in their local endoscopy unit, receiving real-time instruction and performance enhancing feedback via a tele-conference monitor situated next to the endoscopic image. Trainers and the five trainees not doing the colonoscopy could follow the procedure in real-time including room view, view of the magnetic colonoscope imager and the endoscopic image. Colonoscopy KPIs were assessed on trainee-performed colonoscopies [unsedated or midazolam/fentanyl sedation] for 3 weeks prior and 4 weeks after the training. Qualitative trainee and trainer feedback regarding the course was obtained. Results: 6 experienced colonoscopy trainees (median 26 months prior-training) underwent the intervention. Trainees performed 60 colonoscopies, (33 pre-, and 27 post-training). Favorable trends in cecal intubation rate (CIR) and adenoma detection rate (ADR) were observed, (91% vs 96% (P=0.386), and 39% vs 63% (P=0.069) respectively). A trend to improved endoscopist-reported comfort scores ([Gloucester Comfort Score (GCS)>3] 18% vs 11% (P=0.375)) and nurse-reported comfort scores (GCS>3 22% vs 8% (P=0.189)) was observed (Table 1). Course participants and trainers alike reported globally favourable qualitative experiences with the expert trainers finding the format feasible and specifically mentioning they could focus on the training without distraction due to reduced cognitive load. Conclusions: Standardization of colonoscopy training is critical to the consistent attainment of KPIs by practicing colonoscopists and improving patient experience. This is the first demonstration of delivering live colonoscopy training remotely: an approach acceptable to trainees and trainers that has a positive impact on KPIs. Pending larger studies focused on efficacy, this approach has the potential to create a standardized curriculum for colonoscopy training, removing the barriers of travel, and allowing expanded exposure to consciously-competent expert trainers. [Formula presented]

8.
Pediatric Blood and Cancer ; 69(SUPPL 2):S229-S230, 2022.
Article in English | EMBASE | ID: covidwho-1885440

ABSTRACT

Background: Infections are a common cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Prolonged immune recovery post-HSCT increases the risk of infection and raises concern for poor response to vaccinations. Reimmunization is recommended for all pediatric HSCT patients by transplant and infectious disease organizations1,2, and individual institutions often develop revaccination guidelines. Objective: At Vanderbilt Children's Hospital (VCH), the clinical practice guideline (CPG) instituted in June 2015 recommends early initiation (6 months) of reimmunization in immunologically appropriate patients, starting with Haemophilus influenzae type B (Hib) and pneumococcal conjugate (PCV13) vaccinations. Therefore, we examined the feasibility of early vaccination for allogeneic HSCT patients and determined the causes of delayed or lack of vaccination. Methods:A retrospective chart review of the electronic medical record was conducted under an IRB-approved protocol. Data was gathered and entered in a REDCap database, including dates of vaccination, immune reconstitution studies (IgG concentration, T/B cell subsets) and clinical outcomes [e.g., intravenous immunoglobulin (IVIg) administration, graft versus host disease (GvHD), relapse] through 6-month (+/- 30 days) post-HSCT. Early revaccination was defined as Hib and PCV13 administration within 210 days post-HSCT. Patients not meeting this definition were further examined for factors that led to delay or lack of vaccinations. Patients were included if they were alive without underlying disease progression or graft failure 6-months post-HSCT. Results: Between June 15, 2015 and June 30, 2021, 66 patients met inclusion criteria. Early revaccination occurred in 21/66 patients (32%). Of the 45/66 (68%) that did not receive 6-month vaccinations, the most common reason was concern for impaired immune reconsti- tution (n = 33/45, 73%). Indicators of poor immune recovery included recent IVIg administration (n = 15), ongoing immunosuppression (n = 24), and poor B cell recovery (n = 4);many patients had multiple indications. Other reasons for delay included patient or parent refusal (n = 4), prioritization of COVID vaccinations (n = 3), scheduling conflicts (n = 4), and other (n = 1). Conclusions: Early vaccination occurred in 32% of patients. At 6 months post-HSCT, 50% of patients had poor immune reconstitution resulting in appropriate vaccination delays. However, scheduling conflicts and vaccine hesitancy despite eligibility were small but significant contributors, accounting for 17% of delays. This is a small, single center study but highlights significant challenges with delivery of best practice guidelines. Future directions could include engagement with other institutions regarding best practices to address vaccine hesitancy and to further explore if early revaccination reduces risk of infectious complications post-HSCT.

9.
JMIR Dermatol ; 5(2): e33833, 2022.
Article in English | MEDLINE | ID: covidwho-1887064

ABSTRACT

Background: Implementation science has been recognized for its potential to improve the integration of evidence-based practices into routine dermatologic care. The COVID-19 pandemic has resulted in rapid teledermatology implementation worldwide. Although several studies have highlighted patient and care provider satisfaction with teledermatology during the COVID-19 pandemic, less is known about the implementation process. Objective: Our goal was to use validated tools from implementation science to develop a deeper understanding of the implementation of teledermatology during the COVID-19 pandemic. Our primary aims were to describe (1) the acceptability and feasibility of the implementation of teledermatology and (2) organizational readiness for the implementation of teledermatology during the COVID-19 pandemic. We also sought to offer an example of how implementation science can be used in dermatologic research. Methods: An anonymous, web-based survey was distributed to Association of Professors of Dermatology members. It focused on (1) the acceptability, feasibility, and appropriateness of teledermatology and (2) organizational readiness for implementing teledermatology. It incorporated subscales from the Organizational Readiness to Change Assessment-a validated measure of organizational characteristics that predict implementation success. Results: Of the 518 dermatologists emailed, 35 (7%) responded, and all implemented or scaled up teledermatology during the pandemic. Of the 11 care providers with the highest level of organizational readiness, 11 (100%) said that they plan to continue using teledermatology after the pandemic. Most respondents agreed or strongly agreed that they had sufficient training (24/35, 69%), financial resources (20/35, 57%), and facilities (20/35, 57%). However, of the 35 respondents, only 15 (43%) agreed or strongly agreed that they had adequate staffing support. Most respondents considered the most acceptable teledermatology modality to be synchronous audio and video visits with supplemental stored digital photos (23/35, 66%) and considered the least acceptable modality to be telephone visits without stored digital photos (6/35, 17%). Overall, most respondents thought that the implementation of synchronous audio and video with stored digital photos (31/35, 89%) and telephone visits with stored digital photos (31/35, 89%) were the most feasible. When asked about types of visits that were acceptable for synchronous video/audio visits (with stored digital photos), 18 of the 31 respondents (58%) said "new patients," 27 (87%) said "existing patients," 19 (61%) said "medication monitoring," 3 (10%) said "total body skin exams," and 22 (71%) said "lesions of concern." Conclusions: This study serves as an introduction to how implementation science research methods can be used to understand the implementation of novel technologies in dermatology. Our work builds upon prior studies by further characterizing the acceptability and feasibility of different teledermatology modalities. Our study may suggest initial insights on how dermatology practices and health care systems can support dermatologists in successfully incorporating teledermatology after the pandemic.

10.
BMC Prim Care ; 23(1): 149, 2022 Jun 11.
Article in English | MEDLINE | ID: covidwho-1886919

ABSTRACT

BACKGROUND: PCR testing is considered the gold standard for SARS-CoV-2 diagnosis but its results are earliest available hours to days after testing. Rapid antigen tests represent a diagnostic tool enabling testing at the point of care. Rapid antigen tests have mostly been validated by the manufacturer or in controlled laboratory settings only. External validation at the point of care, particularly in general practice where the test is frequently used, is needed. Furthermore, it is unclear how well point of care tests are accepted by the practice staff. METHODS: In this prospective multicenter validation study in primary care, general practitioners included adult individuals presenting with symptoms suggesting COVID-19. Each patient was tested by the general practitioner, first with a nasopharyngeal swab for the point of care test (Roche SARS-CoV-2 Rapid Antigen Test) and then with a second swab for PCR testing. Using the RT-PCR result as a reference, we calculated specificity, sensitivity, positive predictive value and negative predictive value, with their 95% confidence intervals. General practitioners and medical assistants completed a survey to assess feasibility and usefulness of the point of care tests. RESULTS: In 40 practices in Würzburg, Germany, 1518 patients were recruited between 12/2020 and 06/2021. The point of care test achieved a sensitivity of 78.3% and a specificity of 99.5% compared to RT-PCR. With a prevalence of 9.5%, the positive predictive value was 93.9% and the negative predictive value was 97.8%. General practitioners rated the point of care test as a helpful tool to support diagnostics in patients with signs and symptoms suggestive for infection, particularly in situations where decision on further care is needed at short notice. CONCLUSION: The point of care test used in this study showed a sensitivity below the manufacturer's specification (Sensitivity 96.25%) in the practice but high values for specificity and high positive predictive value and negative predictive value. Although widely accepted in the practice, measures for further patient management require a sensitive interpretation of the point of care test results.


Subject(s)
COVID-19 , General Practice , Adult , COVID-19/diagnosis , COVID-19 Testing , Clinical Laboratory Techniques/methods , Feasibility Studies , Humans , Prospective Studies , SARS-CoV-2/genetics , Sensitivity and Specificity
11.
Journal of Clinical Outcomes Management ; 28(5):216-220, 2021.
Article in English | EMBASE | ID: covidwho-1884738

ABSTRACT

Objective: The pandemic has forced closures of primary schools, resulting in loss of learning time on a global scale. In addition to face coverings, social distancing, and hand hygiene, an efficient testing method is important to mitigate the spread of COVID-19 in schools. We evaluated the feasibility of a saliva-based SARS-CoV-2 polymerase chain reaction testing program among 18 primary schools in the Emirate of Abu Dhabi, United Arab Emirates. Qualitative results show that children 4 to 5 years old had difficulty producing an adequate saliva specimen compared to those 6 to 12 years old. Methods: A short training video on saliva collection beforehand helps demystify the process for students and parents alike. Informed consent was challenging yet should be done beforehand by school health nurses or other medical professionals to reassure parents and maximize participation. Results: Telephone interviews with school administrators resulted in an 83% response rate. Overall, 93% of school administrators had a positive experience with saliva testing and felt the program improved the safety of their schools. The ongoing use of saliva testing for SARS-CoV-2 was supported by 73% of respondents. Conclusion: On-campus saliva testing is a feasible option for primary schools to screen for COVID-19 in their student population to help keep their campuses safe and open for learning.

12.
BJPsych Open ; 7(5), 2021.
Article in English | EMBASE | ID: covidwho-1883558

ABSTRACT

Background Cognitive-behavioural therapy (CBT) is recommended for all patients with psychosis, but is offered to only a minority. This is attributable, in part, to the resource-intensive nature of CBT for psychosis. Responses have included the development of CBT for psychosis in brief and targeted formats, and its delivery by briefly trained therapists. This study explored a combination of these responses by investigating a brief, CBT-informed intervention targeted at distressing voices (the GiVE intervention) administered by a briefly trained workforce of assistant psychologists. Aims To explore the feasibility of conducting a randomised controlled trial to evaluate the clinical and cost-effectiveness of the GiVE intervention when delivered by assistant psychologists to patients with psychosis. Method This was a three-arm, feasibility, randomised controlled trial comparing the GiVE intervention, a supportive counselling intervention and treatment as usual, recruiting across two sites, with 1:1:1 allocation and blind post-treatment and follow-up assessments. Results Feasibility outcomes were favourable with regard to the recruitment and retention of participants and the adherence of assistant psychologists to therapy and supervision protocols. For the candidate primary outcomes, estimated effects were in favour of GiVE compared with supportive counselling and treatment as usual at post-treatment. At follow-up, estimated effects were in favour of supportive counselling compared with GiVE and treatment as usual, and GiVE compared with treatment as usual. Conclusions A definitive trial of the GiVE intervention, delivered by assistant psychologists, is feasible. Adaptations to the GiVE intervention and the design of any future trials may be necessary.

13.
Topics in Antiviral Medicine ; 30(1 SUPPL):337-338, 2022.
Article in English | EMBASE | ID: covidwho-1880981

ABSTRACT

Background: Although cisgender MSM (cis-MSM) and transgender women (TGW) suffer the highest burden due to the HIV epidemic in Latin America (LA), PrEP implementation is limited. ImPrEP was an implementation study to assess safety and feasibility of same-day PrEP initiation (daily-oral TDF/FTC) for cis-MSM and TGW vulnerable to HIV infection in Brazil, Peru and Mexico;results on factors associated with long-term PrEP engagement (LTPE) and HIV incidence are reported here. Methods: Eligible cis-MSM and TWG (HIV-negative, ≥18 years-old, reporting 1+ risk criteria) were screened and enrolled on the same-day, receiving a 30-day PrEP supply. Follow-up visits were scheduled at week 4 after enrollment and quarterly thereafter. Main outcomes were LTPE (3+ follow-up visits within 52 weeks of enrollment) and HIV incidence. A multivariable model controlling for country, education, gender, substance use, STIs, and self-reported adherence is presented. Results: From March 2018-June 2021, 9522 participants were enrolled (Brazil: 3928, Mexico: 3301, Peru: 2293), with 12348.92 person-years (PY) follow-up;follow-up time accrued for LTPE analysis affected by Covid-19 restrictions was shorter in Brazil than in Mexico and Peru. Overall, 26% were aged 18-24, 94.3% cis-MSM, 5.7% TGW, 73.2% non-white and 76.0% >secondary education;92.8% reported condomless anal sex (CAS), 17.3% sex-work, 57.8% had >5 sex partners. Overall, 8.8% attended only the enrollment visit and 68.2% showed LTPE (Brazil:80.1%;Mexico:67.2%;Peru:45.0%). Participants aged 18-24 years (aOR 0.53[95%CI:0.46-0.62]), 10 sex partners (aOR 1.48[95%CI:1.28-1.70]), reporting receptive CAS (aOR 1.24[95%CI:1.12-1.39]), complete adherence at week-4 (aOR:3.11[95%CI:2.79-3.45]) and CAS with HIV+ partner (aOR:1.48[95%CI:1.28-1.71]) were more likely. HIV incidence was 0.84/100 PY (95% CI:0.69-1.02), higher in Peru, among TGW and 18-24 years-old participants. Conclusion: Same-day PrEP is feasible and safe among cis-MSM and TGW in LA. Overall LTPE was high;COVID-19 restrictive measures may partially explain the differences across countries. Social and structural levels of HIV risk need to be addressed for full PrEP benefits realization.

14.
Fertility and Sterility ; 116(3 SUPPL):e33-e34, 2021.
Article in English | EMBASE | ID: covidwho-1879937

ABSTRACT

OBJECTIVE: Due to the COVID-19 pandemic, video-based telemedicine visits have become the standard in many clinical practices. Many reproductive endocrinology consultations do not require a physical exam, allowing for integration of telemedicine. The purpose of this study is to evaluate patient satisfaction with telemedicine visits in the Reproductive Endocrinology and Infertility (REI) office. MATERIALS AND METHODS: This is a prospective cross-sectional study that includes any person undergoing a new patient visit at Washington University's Reproductive Endocrinology clinic from March 1st-April 20th 2021. After the visit, patients were contacted via telephone to obtain consent to participate in an online one-time research survey. A link was sent to their email with the survey through RedCap secure web application. The survey is 25 questions which includes the telehealth usability questionnaire (TUQ) survey, a previously published tool to evaluate usability and quality of telehealth interaction, along with questions specific to the REI clinic and the participation of learners during visits. Baseline patient demographics including age, race/ethnicity, BMI, distance from clinic, and recommended treatment were collected. RESULTS: 117 participants were contacted, 78% (n=91) agreed to participate in the study, and 45% (n=41) completed the survey. There were no significant differences in age, BMI, distance from clinic or length of infertility with response to survey. 92.5% responders would use telemedicine services again and were satisfied with the telehealth system. Telehealth improved access to healthcare for 82.5% and travel time for 95%. The mean distance from clinic was 76 miles, and there was no significance difference in satisfaction with telemedicine services (p=0.46) or perceived access to healthcare services (p= 0.43) between those living closer or further than 76 miles. Those living further also had no preference for telemedicine visits over in person visits (p=0.134). CONCLUSIONS: In the era of COVID-19, healthcare implementation has dramatically changed with a drastic increase in telemedicine services. Based on our survey, majority of patients were satisfied with telemedicine visits and believed it saved travel time while improving access to REI care. Despite no differences in patient preference for in person versus telemedicine depending on their distance from clinic, this finding is reassuring because patients are satisfied with telemedicine for reasons other than distance from clinic. IMPACT STATEMENT: Patient satisfaction surveys demonstrate the feasibility of using telemedicine services for new-patient visits to provide quality care to patients who perceive telemedicine similar to in-person visits. Given the wide acceptance of telemedicine, reimbursement by insurance companies should continue when the pandemic is over.

15.
Informatica ; 46(1):1-12, 2022.
Article in English | ProQuest Central | ID: covidwho-1879799

ABSTRACT

Operating surgeons are constrained when interacting with computer systems as they traditionally utilize hand-held devices such as keyboard and mouse. Studies have previously proposed and shown the use of hand gestures is an efficient, touchless way of interfacing with such systems to maintain a sterile field. In this paper, we propose a Deep Computer Vision-based Hand Gesture Recognition framework to facilitate the interaction. We trained a 3D Convolutional Neural Network with a very large scale dataset to classify hand gestures robustly. This network became the core component of a prototype application requiring intraoperative navigation of medical images of a patient. Usability evaluation with surgeons demonstrates the application would work and a hand gesture lexicon that is germane to Medical Image Navigation was defined. By completing one cycle of usability engineering, we prove the feasibility of using the proposed framework inside the Operating Room.

16.
Echocardiography ; 2022 Jun 06.
Article in English | MEDLINE | ID: covidwho-1879022

ABSTRACT

BACKGROUND: The association between COVID-19 infection and the cardiovascular system necessitates the use of an echocardiogram in this setting. Information on the utilization, safety, and quality of point-of-care cardiac and lung ultrasound using a hand-held device in these patients is scarce. AIMS: To investigate the safety, technical aspects, quality indices, and interpretive accuracy of a hand-held echocardiogram in patients with COVID-19. METHODS: From April-28 through July-27, 2020, consecutive patients with COVID-19 underwent hand-held echocardiogram and lung ultrasound evaluation (Vscan Extend™; GE Healthcare) within 48-h of admission. The operators recorded a series of technical parameters and graded individual experiences. The examinations were further analyzed by a blinded fellowship-trained echocardiographer for general quality, proper acquisition, and right ventricular (RV) demonstration. RESULTS: Among 103 patients, 66 (64.1%) were male. Twenty-nine (28.2%) patients could not turn on their left side and 23 (22.3%) could not maintain effective communication. The mean length of each echocardiogram study was 8.5 ± 2.9 min, battery usage was 14 ± 5%, and mean operator-to-patient proximity was 59 ± 11 cm. Ninety-five (92.2%) examinations were graded as fair/good quality. A fair agreement was demonstrated between the operator and the echocardiographer for general ultrasound quality (Kappa = 0.329, p < 0.001). A fair-good correlation (r = 0.679, p < 0.001) and substantial agreement (Kappa = 0.612, p < 0.001) were demonstrated between the operator and echocardiographer for left ventricular ejection fraction (LVEF), whereas a fair agreement was demonstrated for RV systolic function (Kappa = 0.308, p = 0.002). LVEF agreement was also assessed using the Bland-Altman analysis revealing a mean bias of -0.96 (95% limits of agreement 9.43 to -11.35; p = 0.075). CONCLUSIONS: Among patients with COVID-19, echocardiography with a hand-held ultrasound is a safe and reasonable alternative for a complete formal study (<10% poor-quality indices). Echocardiogram assessment by the operators during the exam acquisition is reliable for LVEF, while RV systolic function should be subsequently offline reassessed.

17.
Sustainability ; 14(10):5877, 2022.
Article in English | ProQuest Central | ID: covidwho-1875753

ABSTRACT

Mexico has more than 40 years of researching, investing, and obtaining electric power through wind energy. Within the country, there are highly windy areas, such as the Isthmus of Tehuantepec or the state of Tamaulipas, and there are about 2500 MW installed and 70,000 MW tested, all onshore. There are still no offshore wind farms in Mexico, despite having two main coasts, the East and the West, with the Gulf of Mexico and the Pacific Ocean, respectively. Although the Mexican coastal states of the Gulf of Mexico are Tamaulipas, Veracruz, Tabasco, Campeche, and Yucatán, this work focuses on the study and feasibility of offshore wind energy use on the coasts of the states of Tabasco, Campeche, and Yucatán. This is because of the availability of data in that region;however, sustainability criteria that can be used in other regions are also presented. MN1 -https://media.proquest.com/media/hms/PFT/1/QWW6N?_a=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%3D%3D&_s=bqizVgXfGC1ulIdNL9ljg0AkJAU%3D ERRA-2 and ERA5 data were used employing WAsP and Windographer software. It was found that the capacity factor in the area of Tabasco, Campeche, and Yucatán is 32%, 37%, and 46%. It can be noted that, in the WF100% scenario, each of the wind farms could contribute more than 35% of the region’s electricity consumption;those of Campeche and Yucatán stand out with contributions of more than 70%.

18.
JMIR Diabetes ; 7(2): e37534, 2022 May 30.
Article in English | MEDLINE | ID: covidwho-1875302

ABSTRACT

BACKGROUND: Latinos living in rural South Texas have a higher prevalence of diabetes, but their access to diabetes self-management education and support (DSMES) is limited. OBJECTIVE: We aimed to test the feasibility of a community health worker-led, mobile health (mHealth)-based DSMES intervention to reduce disparities in accessing DSMES in underserved rural Latino residents in South Texas. METHODS: This 12-week, single-arm, pre-post trial was delivered by trained community health workers to 15 adults with type 2 diabetes. The intervention consisted of digital diabetes education, self-monitoring, a cloud-based connected platform, and community health worker support. Feasibility was evaluated as retention, actual intervention use, program satisfaction, and barriers to implementation. We also explored the intervention's effect on weight loss and hemoglobin A1c (HbA1c). RESULTS: All 15 participants were Latino (mean age 61.87 years, SD 10.67; 9/15 female, 60%). The retention rate at posttest was 14 of 15 (93%). On average, the participants completed 37 of 42 (88%) digital diabetes education lessons with 8 participants completing all lessons. Participants spent 81/91 days (89%) step tracking, 71/91 days (78%) food logging, 43/91 days (47%) blood glucose self-monitoring, and 74/91 days (81%) weight self-monitoring. The level of program satisfaction was high. On average, participants lost 3.5 (SD 3.2) kg of body weight (P=.001), while HbA1c level remained unchanged from baseline (6.91%, SD 1.28%) to posttest (7.04%, SD 1.66%; P=.668). CONCLUSIONS: A community health worker-led mHealth-based intervention was feasible and acceptable to improve access to DSMES services for Latino adults living in rural communities. Future randomized controlled trials are needed to test intervention efficacy on weight loss and glycemic control.

19.
European Journal of Hospital Pharmacy. Science and Practice ; 29(Suppl 1):A168, 2022.
Article in English | ProQuest Central | ID: covidwho-1874611

ABSTRACT

Background and importanceEmpathy is an essential part of good patient communication. However, pharmacists often provide information without taking patients’ preferences into account. Narrative medicine is an innovative approach, where empathic skills are nurtured through close reading of literary texts and creative writing.Aim and objectivesThe purpose was to investigate the feasibility of a narrative medicine course for pharmacists and to explore the experiences of the participating pharmacists.Material and methodsA 2-day course of narrative medicine was offered to Danish community and hospital pharmacists in Summer 2020. The course capacity was set at 16 pharmacists. The course consisted of close reading of short literary texts about illness and related creative writing, facilitated by both experienced literary and health care professional lecturers. Pharmacists’ empathy was assessed before and after participating in the course with the Jefferson Scale of Empathy (JSE). Feasibility was assessed focusing on acceptability, demand, implementation, practicality and limited efficacy using focus group interviews, participant observation and a satisfaction questionnaire.ResultsIn total, 8 pharmacists participated in the course. All pharmacists answered the questionnaire, and 5 focus group interviews were held with participants and lecturers. The practicality of the course can be optimised, as only half of the course capacity was filled. This could, however, be due to the situation with the COVID-19 pandemic, as the workload at the pharmacies was unpredictable in that period. The pharmacists accepted participation in the course, even though some of the sessions required a personal investment far from their normal routines and education. The pharmacists were, in general, very satisfied with the course and found it useful in their daily patient communication as it helped them to envision the life of each patient. As expected, no significant change was found in the JSE, but the pharmacists found the scale acceptable to complete.Conclusion and relevanceThe course in narrative medicine was feasible on all assessed parameters, even though the course capacity was not fully utilised. A course in narrative medicine has potential for improving pharmacists’ general communication with patients. Yet, the results should be tested in larger studies, including patient-reported outcomes, to provide distinct evidence on eventual effect.References and/or acknowledgementsConflict of interestNo conflict of interest

20.
International Journal of Migration, Health, and Social Care ; 18(2):164-178, 2022.
Article in English | ProQuest Central | ID: covidwho-1874095

ABSTRACT

Purpose>The stay-at-home orders were necessary to contain the spread of COVID-19 but have worsened social isolation and loneliness among older persons. Strategies to maintain social connections have been proposed. It is unclear if the reported experiences of social isolation and loneliness are comparable for older immigrants and if the proposed strategies are relevant to this vulnerable population. This study aimed to address this knowledge gap.Design/methodology/approach>This scoping review addressed two questions: What evidence exists on the experience of social isolation and loneliness in older immigrants? What strategies can be beneficial to keep older immigrants socially connected during the COVID-19 pandemic? The search for relevant articles was done in several databases covering the scientific and gray literature, using keywords that reflect the diversity of terminology referring to the main concepts (isolation and loneliness) and target population (older immigrants). Discussion papers and research studies were reviewed, and the main points or findings were documented on data ion forms and summarized in a table. The information in the table was compared and contrasted to identify common themes.Findings>Only six articles (four discussion papers and two studies) met the scoping review’s eligibility criteria. Concerns about interruptions of older immigrants’ social connection during the pandemic were partially corroborated with the studies’ results. Most participants shifted the medium of their contacts from in-person to telephone or social media, and perceived no change in the experience of loneliness. Those with high levels of loneliness reported heightened anxiety and depression. The proposed strategies entailed the use of technology to connect with others and to deliver services, outdoor group activities within the constraints of containment measures and provision of culturally tailored social programs or services.Research limitations/implications>The acceptability, feasibility and effectiveness of the proposed strategies should be examined to determine the best practices aimed to promote social connection among older immigrants within and outside the context of the pandemic.Originality/value>The scoping review identified strategies that can be used to address social isolation and loneliness among older immigrants during the pandemic.

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