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1.
JMIR Hum Factors ; 9(4): e41499, 2022 Nov 04.
Article in English | MEDLINE | ID: covidwho-2079999

ABSTRACT

BACKGROUND: Due to the upsurge of COVID-19, nations are increasingly adopting telemedicine programs in anticipation of similar crises. Similar to all nations worldwide, Jordan is implementing efforts to adopt such technologies, yet it is far from complete. OBJECTIVE: This study aims to assess the knowledge, attitudes, and perceptions of Jordanians toward telemedicine, to identify key factors predisposing individuals to its use or acting as barriers to its implementation. METHODS: We implemented a cross-sectional design using an online, self-administered questionnaire executed in Google Forms and distributed through social media. Differences in knowledge and attitude scores were examined using independent sample t tests and ANOVA. A multivariate linear regression model was computed to assess predictors of awareness toward telemedicine. RESULTS: A total of 1201 participants fully completed the questionnaire. Participants were characterized by a mean age of 36.3 (SD 14.4) years and a male-to-female ratio of nearly 1:1. About 50% (619/1201, 51.5%) of our studied population were aware of telemedicine, while nearly 25% (299/1201, 24.9%) declared they had observed it in action. Approximatively 68% (814/1201, 67.8%) of respondents were willing to use telemedicine. The majority of the sample portrayed favorable and positive views toward telemedicine. Higher educational degrees, living in urban districts, and having a higher perception of electronic usage ability were associated with higher knowledge and better attitudes toward telemedicine (all P<.05). The multivariate linear regression analysis demonstrated that perceived ability to use electronics was associated with positive attitudes (ß=0.394; 95% CI 0.224 to 0.563), while living in Southern Jordan predicted poor attitudes toward telemedicine (ß=-2.896; 95% CI -4.873 to -0.919). CONCLUSIONS: Jordanians portray favorable perceptions of telemedicine. Nonetheless, concerns with regards to privacy, medical errors, and capacity for accurate diagnoses are prevalent. Furthermore, Jordanians believe that integrating telemedicine within the health care system is not applicable due to limited resources.

2.
Orv Hetil ; 163(42): 1654-1662, 2022 Oct 16.
Article in English | MEDLINE | ID: covidwho-2079839

ABSTRACT

INTRODUCTION: COVID-19 pandemic has reduced the capacity of health and social care systems. The limited availability of care systems and the specific challenges of the pandemic have increased the burden and stress on family caregivers. OBJECTIVE: This paper focuses on the burden of family caregivers in the light of their experiences with health and social services. METHODS: Online questionnaire survey (n = 1004; active caregivers during COVID-19 pandemic: n = 491); data were analyzed using quantitative and qualitative (content analysis) methods. RESULTS: More than half of the active caregivers experienced an increasing burden in caregiving after the release of COVID-19. Associations are between the increase in caregiving burden during COVID-19 and the municipality type of caregiver's home, the cared for's dementia involvement, the use of home help or other care assistance, and employment. In addition, those who reported an increased burden due to the pandemic also perceived the caregiving role as more stressful. The most significant additional burden was the increased mental and psychological strain caused by restrictions, difficulties in providing care, and the pandemic. DISCUSSION: Our results suggest that the increase in caregiving burden during COVID-19 can be explained by the specific challenges of the pandemic. CONCLUSION: Family caregivers are particularly vulnerable and need special emergency services in such situations. The significantly increased mental strain in emergency situations draws attention to the need for mental health care for carers. Orv Hetil. 2022; 163(42): 1654-1662.


Subject(s)
COVID-19 , COVID-19/epidemiology , Caregivers , Humans , Pandemics , Social Support , Surveys and Questionnaires
3.
Curr Psychol ; : 1-10, 2021 Jul 22.
Article in English | MEDLINE | ID: covidwho-2075656

ABSTRACT

This study explores the mediating role of health literacy on the association between health care system distrust and vaccine hesitancy. An online survey including Personal Information Form, Health Care System Distrust Scale, Vaccine Hesitancy Scale, and Health Literacy Scale were applied to 620 participants. The degree of applying mask-wearing, hygiene rule and physical distance, and the level of COVID-19 vaccine literacy were modeled with hierarchical multiple regression analysis to have a deeper analysis of participants' actions towards COVID-19 vaccine hesitancy. It was found that health care system distrust and health literacy were the most important variables that had an impact on vaccine hesitancy. Based on the mediation analysis, the total effect of health care system distrust on vaccine hesitancy was statistically significant. Participants who held a low level of health literacy and a high perception of the health care system distrust experienced more vaccine hesitancy. The findings suggested the health literacy mediated the relationship between health care system distrust and vaccine hesitancy. Health authorities need to consider the dynamic and complex factors around the health care system distrust and health literacy to reduce vaccine hesitancy during COVID-19.

4.
Journal of Acute Disease ; 11(4):127-132, 2022.
Article in English | EMBASE | ID: covidwho-2066824

ABSTRACT

This narrative review aims to highlight some of the factors contributing to challenges faced by many countries in controlling the spread of COVID-19 pandemic that continues to rage around the world, especially after stoppage of official prevention and control activities. A literature search was conducted on PubMed, and Google using search terms 'COVID-19', 'challenges', 'prevention', and 'control' in different combinations. COVID-19 prevention and control challenges are related to health-system, vaccines, administration, and society culture. Controlling the spread of COVID-19 necessitates cooperation between community leaders, healthcare professionals, religious leaders, and the public.

5.
Neurology Asia ; 27(3):599-607, 2022.
Article in English | EMBASE | ID: covidwho-2067765

ABSTRACT

Objective: This study aimed to determine if the coronavirus disease 2019 (COVID-19) pandemic had any impact on admission patterns for subarachnoid hemorrhage (SAH) during 1st and 2nd waves and in-between in a tertiary institution in southeastern Turkey. Method(s): Three periods were determined during the pandemic: First and second peaks (April 1-May 1, 2020 and November 18-December 18, 2020, respectively) and the slowdown period (July 5-August 4, 2020) where the daily new cases hit its lowest. We retrospectively collected data of the patients with SAH who were admitted to our institution within these periods during 2020 (the pandemic) and 2019 (the year before the pandemic). Demographic data, time between symptom onset and admission, Glasgow Coma Scale (GCS), Fisher score, World Federation of Neurosurgical Societies (WFNS), presence of intracerebral hemorrhage, intraventricular hemorrhage, hydrocephalus, type of SAH (aneurysmal vs non-aneurysmal) were recorded and compared between the pandemic and pre-pandemic periods. Result(s): The number of admissions in first peak, slowdown, and second peak during the pandemic was 11, 15, and 17, respectively. They did not differ significantly from corresponding periods in 2019 (17, 7, and 10, respectively) (all P>0.05). The mean time from onset to admission to hospital was similar between pandemic and 2019 (ranging between 0.40-2.00 days in 2020 compared to ranging between 1.12-2.29 days in 2019). The rate of cases with worse neurological condition on admission turned out to be lower during the first peak of the pandemic compared to previous year (9.1% vs 29.4%, P=0.029), but showed no difference in the remaining two periods. The incidence of accompanying pathologies (intracerebral hemorrhage, intraventricular hemorrhage, and hydrocephalus) was also similar between the periods in 2020 and their counterparts in 2019. Rate of non-aneurysmal cases ranged between 11.1%-45.5% in 2020 compared to 10.0%-57.1% in 2019 (all P>0.05). Conclusion(s): The study showed that hospital admission patterns for SAH was not affected by COVID-19 pandemic in the southeastern Turkey, unlike other reports. This may be due to different behavioral characteristics of the study population and capability of health care system to cope with high number of patient admissions. Copyright © 2022, ASEAN Neurological Association. All rights reserved.

6.
NeuroQuantology ; 20(11):1652-1657, 2022.
Article in English | EMBASE | ID: covidwho-2067332

ABSTRACT

In this present era of 21st Century due to the dangerous infected disease Covid-19 all over the world telemedicine has played a major role in many parts of the world for remote monitoring of the covid-19 patients. Still there are many gaps in online remote monitoring in telemedicine process and as a result effective monitoring of the patients is not possible in many areas in the world. The detection of patients from remote place is considered as need of the day. This study presents the new challenges in the area of telemedicine or e-healthcare system. In this study we carefully analysed the present telemedicine process and we found that effective application of IoT, blockchain technologies and data mining can enhance the telemedicine process. This paper presents the new challenges in IoT, blockchain technologies and data mining where the researchers can work to fill the gaps in telemedicine process.

7.
NeuroQuantology ; 20(10):6860-6870, 2022.
Article in English | EMBASE | ID: covidwho-2067308

ABSTRACT

The year 2019 is a outbreak year during which the whole globe has suffered from Covid19 pandemic which has been spotted initially in China and later spread to the whole world;as a result of this viral disease, the whole world had shut down affecting billions of people but till today the Covid battle is on and people are suffering not only from this disease but also in terms of economy, starving being jobless etc. This paper briefs about Corona virus, its types, and structure;the replication and spreading of this virus, Covid19 detection methods, research on vaccination developed across the world to curb this virus;virus impact on various sectors, precautions to be taken to stay away from this virus and Ayurvedic remedy for it. The waves of corona had taken many lives on the globe & have its effect on life style of people. To curb this virus, prevention vaccination has to be found and we people must change in a way so that we could avoid future consequences for the upcoming generation. Keywords.

8.
JMIR Hum Factors ; 9(4): e39670, 2022 Nov 10.
Article in English | MEDLINE | ID: covidwho-2065324

ABSTRACT

BACKGROUND: Implementing mass vaccination clinics for COVID-19 immunization has been a successful public health activity worldwide. However, this tightly coupled system has many logistical challenges, leading to increased workplace stress, as evidenced throughout the pandemic. The complexities of mass vaccination clinics that combine multidisciplinary teams working within nonclinical environments are yet to be understood through a human systems perspective. OBJECTIVE: This study aimed to holistically model mass COVID-19 vaccination clinics in the Region of Waterloo, Ontario, Canada, to understand the challenges centered around frontline workers and to inform clinic design and technological recommendations that can minimize the systemic inefficiencies that contribute to workplace stress. METHODS: An ethnographic approach was guided by contextual inquiry to gather data on work as done in these ad-hoc immunization settings. Observation data were clarified by speaking with clinic staff, and the research team discussed the observation data regularly throughout the data collection period. Data were analyzed by combining aspects of the contextual design framework and cognitive work analysis, and building workplace models that can identify the stress points and interconnections within mass vaccination clinic flow, developed artifacts, culture, physical layouts, and decision-making. RESULTS: Observations were conducted at 6 mass COVID-19 vaccination clinics over 4 weeks in 2021. The workflow model depicted challenges with maintaining situational awareness about client intake and vaccine preparation among decision-makers. The artifacts model visualized how separately developed tools for the vaccine lead and clinic lead may support cognitive tasks through data synthesis. However, their effectiveness depends on sharing accurate and timely data. The cultural model indicated that perspectives on how to effectively achieve mass immunization might impact workplace stress with changes to responsibilities. This depends on the aggressive or relaxed approach toward minimizing vaccine waste while adapting to changing policies, regulations, and vaccine scarcity. The physical model suggested that the co-location of workstations may influence decision-making coordination. Finally, the decision ladder described the decision-making steps for managing end-of-day doses, highlighting challenges with data uncertainty and ways to support expertise. CONCLUSIONS: Modeling mass COVID-19 vaccination clinics from a human systems perspective identified 2 high-level opportunities for improving the inefficiencies within this health care delivery system. First, clinics may become more resilient to unexpected changes in client intake or vaccine preparation using strategies and artifacts that standardize data gathering and synthesis, thereby reducing uncertainties for end-of-day dose decision-making. Second, improving data sharing among staff by co-locating their workstations and implementing collaborative artifacts that support a collective understanding of the state of the clinic may reduce system complexity by improving shared situational awareness. Future research should examine how the developed models apply to immunization settings beyond the Region of Waterloo and evaluate the impact of the recommendations on workflow coordination, stress, and decision-making.

9.
Pharmaceutical Journal ; 306(7950), 2022.
Article in English | EMBASE | ID: covidwho-2064960
10.
Pharmaceutical Journal ; 306(7949), 2022.
Article in English | EMBASE | ID: covidwho-2064955
11.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P127-P128, 2022.
Article in English | EMBASE | ID: covidwho-2064495

ABSTRACT

Introduction: Pediatric epistaxis is highly prevalent, yet patient characteristics, frequency of office cauterizations, and outcomes have been minimally described. This study examined the epidemiology and prevalence of epistaxis and potential impact by COVID-19. Method(s): A retrospective summary was performed on all patients (0-18 years) seen/treated for epistaxis by pediatric otolaryngologists within a single health care system across northeast and southeast United States between January 1, 2013, and October 31, 2021. Demographics, geographics, medical history, and office and operating room cauterization were reviewed. Data were analyzed using chi2 and logistic regression. Result(s): Of 9770 unique patients, with 26,699 epistaxis encounters, 62% were male. Median age at first encounter was 8.5 years;50% of patients were White. Encounters were most frequent during the fall (September-November) and least frequent during winter (December-February) with no significant differences. The incidence of epistaxis has significantly increased since the onset of the COVID-19 pandemic (P<.001). Overall, 27% received a procedural intervention, 54% required more than a single visit. Logistic regression revealed age, ethnicity, and geographical region as independent predictors of receiving a procedure on the first encounter, with a model receiver-operating characteristic (ROC) curve with area=0.75 (95% CI, 0.73-0.76). Similarly, procedural intervention, history of allergies, and nasal steroid use were independent predictors of recurrent visits, with a model ROC curve with area=0.79 (95% CI, 0.78-0.80). Conclusion(s): The incidence of pediatric epistaxis is not significantly correlated with seasonality. However, there has been a significant increase in epistaxis encounters during the COVID-19 pandemic. Recurrent visits for pediatric epistaxis were significantly predicted by procedural intervention, allergies, and nasal steroid use.

12.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P109, 2022.
Article in English | EMBASE | ID: covidwho-2064491

ABSTRACT

Introduction: Human papillomavirus (HPV) vaccination remains inadequate in the United States, and lack of provider-prompted initiation presents a critical barrier to broader coverage. This study aims to determine the efficacy of an electronic health record (EHR) intervention on primary and catch-up HPV vaccination. Method(s): A retrospective analysis was performed of 22,517 patients aged 9 to 26 years receiving HPV 9-valent or quadrivalent vaccines by primary care providers in a single health care system from 2016 to 2021. Vaccine administrations and sociodemographic characteristics were compared before and after the implementation of an EHR health maintenance reminder (HMR) prompting HPV vaccination in February 2020. Multivariate logistic regression modeling was used to ascertain independent variables associated with early (<18 years) vs late vaccination (>18 years) across the study period. Result(s): In the cohort, most were female (52.7%) and White (55.9%). Mean age was 15.4 and 16.3 years before and after HMR implementation, respectively (P<.001). There was a 48% increase in vaccinations given in those over 18 years in 2020 compared with the year prior. Of patients, 34.5% receiving the vaccine post-HMR were older than 18 years, compared with 26.2% pre-HMR (P<.001). On multivariate analysis, Black (odds ratio [OR]=1.27;95% CI, 1.18-1.36;P<.001) and Asian (OR=1.52;95% CI, 1.36-1.71;P<.001) patients were more likely to be greater than 18. Notably, outpatient visits decreased by about 18% in 2020 during the pandemic compared with the prior 3 years. Conclusion(s): EHR reminders are an effective provider-level intervention in improving catch-up HPV vaccination numbers, despite waning health care utilization during the COVID- 19 pandemic. This may be particularly important for patients who are more likely to have received the vaccine at a later age.

13.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P272, 2022.
Article in English | EMBASE | ID: covidwho-2064413

ABSTRACT

Introduction: This study investigates the role of distortion product otoacoustic emissions (DPOAE), tympanometry, and acoustic stapedial reflex testing (ASR) and their combined potential utility in the setting of replacing classic automated auditory brainstem response (AABR) testing in newborns with referred hearing screens. This was done to determine whether these tests could be used in isolation so to reduce the follow-up burden on families and improve compliance with our screening protocols by replacing the need for additional tests, especially in a health care system with limited resources and with current travel and visitor restrictions. Method(s): Data were prospectively collected on new clinic patients with the following inclusion criteria: children 0 to 6 months old with referred newborn hearing screens via AABR from August 2020 to October 2020 at Children's Hospital of Michigan. All patients were initially rescreened with repeat AABR. ASR, DPOAE, and tympanometry data from selected patients were collected. Patients were noted to have either normal or abnormal responses from each test using preset parameters. Screening methods were then compared. Result(s): Thirty-eight children were recruited in the study including 76 ears. On repeat AABR, 13% of children and 6% of ears were referred again. Of those that failed the second AABR, 40% had abnormal tympanometry compared with 6% of those that passed. The DPOAE results correlated with AABR findings in all but 1 patient. Acoustic reflex testing was abnormal in 2.6% of patients, which all correlated with referred AABRs. Further statistical analysis is being done to evaluate for significant correlations. Conclusion(s): AABR revealed equivocal results when compared with results of DPOAE, ASR, and tympanometry. This study was limited by the number of patients included, given the current COVID-19 pandemic. Many sites lack AABR capabilities, and given our findings, these alternative auditory tests can be considered in health care settings with limited resources. With further research and greater sample size, these readily available audiologic tests may be considered as simple, reproducible, and sensitive screening alternatives.

14.
Archives of Disease in Childhood ; 107(Supplement 2):A478-A479, 2022.
Article in English | EMBASE | ID: covidwho-2064062

ABSTRACT

Aims To understand barriers of implementing a near-miss reporting and sharing of lessons as part of patient safety II culture. Staff must be encouraged to report less serious incidents and near misses as well as more serious errors if lessons are to be learned and patient safety enhanced.1 A key task in the enhancement of patient safety involves the ability to learn from error.2 The intention is that any staff member, irrespective of role, grade, seniority, or experience, can call 'Stop the Line' if they see that required safety procedures and checks are not being followed. All members of staff are encouraged to 'Stop the Line' if they notice a series of steps/process that could potentially cause harm to a patient. The event/incident that is stopped is referred to as a 'near miss'. Methods Stop the line piloted in specific clinical area in our trust (Paediatrics unit, surgical ward, neurosurgical theatres). This project was commenced on 1st November 2020. But due to Covid 19 clinical workload pressure it was paused from April 2021, I took over the project last September 2021. -Despite the project being piloted since last year, still considerable number of staff not fully understanding the project and what are near misses and small numbers of near misses reported throughout following months. -A survey formulated and distributed to health staff across the trust to explore their knowledge of near misses and the barriers for lack of reporting. Results The survey designed and published to the staff through global email. Survey structured of four segments including the Department and Job position, Knowledge about the project, definition of a near miss event and how to report a near miss, questions to check situations classifications as near misses or not and questions regarding their perception of barriers for reporting near misses. -Total 60 Respondents from different departments and roles: -Respondents included variant range of roles in the health care system including Consultants, Support workers, Junior doctors, Staff Nurses, Head of Outpatient Services, Healthcare assistants, ward clerks, Pharmacist, Digital Communications Managers, Project officers, members from Patient Safety & Improvement, Resuscitation officers. 90% of respondents reported knowledge of near miss definition, and similar proportion acknowledges that near misses should be reported (87%) (figure 1). -Approximately two thirds of staff respondents were knowledgeable how to report near misses (63%) compared to 37% who did not (figure 1). -Among variable scenarios 73-88% of respondents could identify the near miss events. -Main suggested barriers to reporting near miss events were time constraints, lack of awareness of importance of near misses reporting and fear of reporting on colleagues involved in the event. Conclusion There is a gap between staff intent to record a near miss occurrence and actual event reporting which could be either due to low incidence of near misses in the health organization or simply because of under reporting. (Figure Presented).

15.
Archives of Disease in Childhood ; 107(Supplement 2):A396-A397, 2022.
Article in English | EMBASE | ID: covidwho-2064052

ABSTRACT

Aims The British Sudanese Association of Paediatrics and Child Health is a non-profit professional and educational body established in 2003 by a group of enthusiastic paediatricians and paediatric trainees of Sudanese origin working in the UK and the Republic of Ireland. The purpose was to assist members in developing their careers and participating and coordinating efforts towards the common goal of advancing services provided to children and child health providers in Sudan. We aimed at the current term to support international medical graduates (IMGs) applying to join the paediatrics training or securing their first NHS non-training posts. This was to help them overcome the hurdles of entering a new healthcare system, which comes in line with the GMC current approach. We also provided educational activities for paediatrics trainees and trust grade doctors to develop further in their careers. In this , we present the educational activities offered by BSAPCH and its impact on trainees and trust grade doctors by reviewing their feedback. Methods All the educational activities and feedback provided by the participants over the last 12 months were reviewed and summarised. Results With each national round of applications for both ST1 and ST3/ST4 levels, BSAPCH offered support to applicants by reviewing their application form contents and providing oneto- one mentoring and guidance. The applicants also attended two days of interview workshops that covered interview stations topics on the first day and mock practice sessions with constructive written and verbal feedback on the second day. BSAPCH organised training sessions to support the trainees and trust grade doctors, such as using the E-portfolio, preparing for ARCP, getting your work published, leadership and management, audit and QIP. In addition, we held workshops on reflective learning and giving and receiving effective feedback. We also arranged regular series of presentations on clinical topics such as paediatric emergencies and COVID19 (table 1) A mentoring program was built to support junior doctors, particularly those new to the NHS. All activities are recorded and made public on the BSAPCH Youtube channel and website. In addition, BSAPCH members are actively involved voluntarily in the organisation and management of all these projects to help them build confidence and gain management and leadership skills. In both 2021 - 2022, the number of applicants for paediatric training who received support and mentoring was 58 (ST1= 27, ST3/4=31). The Number of ST1 applicants shortlisted for interviews was 16. ST3/4 shortlisting results not released at the time of submission. Conclusion We received constructive feedback from participants (table 2). The feedback demonstrated that the activities helped change the thinking and attitude of IMGs junior doctors towards many aspects of their practice in the NHS. We need to continue the support we are providing and collect more data about the impact of the activities on their learning and practice.

16.
Archives of Disease in Childhood ; 107(Supplement 2):A338, 2022.
Article in English | EMBASE | ID: covidwho-2064039

ABSTRACT

Aims Oral disease poses significant health, social and economic burden globally, often causing pain, infection, hospital admission and mortality. Dental caries (tooth decay) is amongst the most common health conditions despite being non-communicable and entirely preventable. The Global Burden of Disease Study estimated that greater than 530 million children suffer from caries in their primary dentition (WHO, 2020). Within the NHS, is it estimated that 25-30% of the overall paediatric waiting list consists of cases that require removal of grossly decayed teeth under general anaesthesia (GA) (figure 1). Between 2015 and 2016, the financial cost to the NHS of extractions amounted to 50.5M. Before the COVID-19 pandemic, there was an existing burden within London NHS trusts of children on waiting lists for exodontia under GA. This issue has been further compounded by the cessation of elective dental activity in primary and secondary care settings due to the pandemic. Project Tooth Fairy was thus conceived to manage the growing paediatric GA waiting list. Methods Project Tooth Fairy is a collaborative, pan-London initiative designed to address London's growing paediatric GA waiting list. The new facility will employ clinical and non-clinical staff in a passport-type scheme allowing clinicians from different units to deliver care centrally in a purpose-built unit. The initiative started in November 2021. The project will deliver paediatric extractions, comprehensive care and complex oral surgery under GA. It will also serve as a source of training for dental trainees and anaesthetic trainees. Results Early results demonstrate that Project Tooth Fairy has treated over 250 children over two months, working with staff from over six NHS trusts, most cases comprising paediatric dental extractions. In March 2021, the total number of children waiting for paediatric GA across 19 London hospitals was around 14,400. To tackle the existing (and future) paediatric GA waiting lists in London, Project Tooth Fairy aims to increase capacity to treat 290 children over six days each week across three procedure rooms. Demand and capacity analysis suggests that approximately 212 procedures would be required each week (not including the backlog resulting from the pandemic). The backlog has seen a 61% increase from approximately 2,500 children waiting in March 2020 to an estimated 4,000 today, with projections of 7,000 by the time capacity is restored for P4 category work across London. It is estimated that 72% of these children have waited longer than 30 weeks, with greater than 1000 children waiting more than 52 weeks - a 96% increase in 52 week-waits compared to pre-COVID figures. The initiative also provides a more cost-effective solution due to the collaborative approach between trusts and staffing with an estimated saving of approximately 850,000 over 17 months compared to a more traditional system using two modular theatres. Conclusion Project Tooth Fairy is a more cost-effective and collaborative approach to tackling spiralling waiting lists within individual trusts. Nonetheless, a conceptual shift is needed away from 'downstream' strategies and those addressing the 'upstream' underlying inequalities in oral health across the population to achieve a more sustainable healthcare system.

17.
Archives of Disease in Childhood ; 107(Supplement 2):A60, 2022.
Article in English | EMBASE | ID: covidwho-2064016

ABSTRACT

Aims Covid testing and primary care data for Children and Young People (CYP) has not yet been linked at the national level in England. However, such linkage has been established using the Discover Whole System Integrated Care (WSIC) database in Northwest London (NWL). We describe pattern of primary care utilisation, among CYP of 0 - 24 years of age in NWL before and after testing positive for Covid-19 infection. The insights are needed in understanding the impact of Covid-19 infection on both the patient and the health care system. Methods We conducted a retrospective cohort study using routinely collected primary care health care data in NWL from the Discover WSIC de-identified database. It is a local warehouse of electronic patient records for research, the database is de-identified. Four cohorts were studied to represent CYP at various key Covid-19 vaccination focused age groups of 0-4 years, 5-11 years, 12-15 years and 16-24 years. Their GP events 180 days preceding and following the confirmed PCR positive test result were analysed. GP events were counted as number of distinct days with one recorded activity. Results By 16th February 2022, positive PCR results were obtained for 104,702 CYP, 14% (d=745,268) of registered CYP population in NWL. The frequency of GP events in the first seven days of the post-test period was similar to the frequency in the seven days preceding, however outside this period they differed substantially, from 279 per 1,000 pre-test to 92 per 1,000 post-test. The 16-24 year age group showed the largest decrease at 150 to 180 days after a confirmed positive PCR test result, from 1,290 GP events pre-test to 195 post-tests. There was no increase in GP events for any age group from two weeks post confirmed PCR positive test. Conclusion Our analyses showed that there is evidence of increase GP activity by CYP a week before and after a Covid- 19 infection diagnosis. However, we did not find any evidence at population level of prolonged post Covid-19 infection symptoms for which GPs were contacted.

18.
American Journal of Transplantation ; 22(Supplement 3):1063, 2022.
Article in English | EMBASE | ID: covidwho-2063419

ABSTRACT

Purpose: KTRs comprise a high-risk group for COVID-19 infection due to comorbidities and immunosuppression. Studying how vaccination hesitancy in inner-city KTRs has changed since the onset of the pandemic and their attitudes towards the vaccine in general is integral in the advancement of a successful vaccination effort. Method(s): A random sample of 30 KTRs in 2020 and 9 recipients in 2021 were surveyed about attitudes towards and history of vaccines. Respondents who received both doses, one dose, or were planning on doing so were recorded as VACYES while those who were unsure or refused were recorded as VACNO. Respondents were also asked their top reasons for receiving or not receiving the vaccine. Result(s): Mean age in 2020 was 57.8 +/- 10.6 yrs, time since transplant was 8.9 +/- 6.6 yrs with18 (60%) men, 20 (71.4%) identified as black. Mean age in 2021 was 50.9 yrs +/- 9.1 yrs, time since transplant 6.8 yrs +/- 8.6 yrs with 3 (33.3%) men. There was no significant difference between the two samples for time since transplant, age sex, race, or percent with diabetes or hypertension. Prior to vaccine availability in 2020 only 36.7% indicated they would accept a COVID-19 vaccination. By 2021, the number had increased to 66.7% who had either received or were planning on receiving the vaccine (p < 0.001). Among the pts who were VACNO in 2020, the most commonly cited reason was concern about vaccine safety (53%). Between VACYES and VACNO patients in 2021, there were no statistically significant differences with respect to time since transplant, sex, race, education or comorbidities but VACYES pts were older (58.8+/-2.3 vs 47.0+/-8.7 yrs, p=0.021). Among VACYES, the most commonly cited reason for vaccine acceptance was that it was recommended for people with underlying conditions (80%). 100% of VACYES felt confident about the safety and efficacy of the COVID-19 vaccines compared to 33% of VACNO. 100% of VACYES believed it is okay for the government to mandate vaccinations compared to 0% of VACNO. 100% of VACNO pts felt COVID-19 was preventable vs 100% of VACYES who stated they did not know (p<0.05). 86% of both VACYES and VACNO believe that the hospital system could take care of them if sick with COVID-19. Conclusion(s): In our population: 1. Vaccine hesitancy has decreased in our inner-city KTR sample compared to the previous year, but almost 40% remain unvaccinated. 2. The most important reason cited for receiving the vaccine was because it was recommended for patients with underlying conditions. 3. Pts who received the vaccine were older, feel more confident about its safety and efficacy, and believe a government mandate is ok. 4. Pts who refused were more likely to believe that COVID-19 is preventable. 5. Regardless of vaccination status, pts believed that the healthcare system could help them if sick with COVID-19. 6. Understanding the motivation for acceptance and reasons for refusal in underserved KTR populations will be important in increasing vaccine acceptance.

19.
American Journal of Transplantation ; 22(Supplement 3):399-400, 2022.
Article in English | EMBASE | ID: covidwho-2063391

ABSTRACT

Purpose: In organ transplant, med errors, adverse drug events, and nonadherence lead to increased healthcare utilization and graft loss. Veterans with transplants are a high-risk population. Method(s): A med safety dashboard was created to identify potential issues that included missing pertinent labs, concerning trends in labs, drug-drug interactions, immunosuppressant non-adherence (refill gaps, expired meds), and transitions in care. This system was tested through a 24-month, prospective, cluster-randomized controlled multicenter study. Pharmacists at 5 intervention sites used the dashboard to identify and address potential med safety issues, which was compared with usual care provided at 5 control sites. Interim findings regarding dashboard functionality and interventions are reported here. Result(s): The study opened Mar 2019 and closed Jun 2021, with a COVID-19 induced hiatus (Apr to Jun 2020). As of the last interim analysis (18m follow-up), there were 1,928 patients enrolled across the 10 sites (1,181 intervention vs 815 control). Mean age was 65 years, 95% male, and 27% Black. Mortality was 9.3%, with no difference between arms (intervention 9.5% vs control 9.0%). ED visits (intervention 38.4% vs control 45.6%) and hospitalizations (intervention 25.6% vs control 37.6%) were higher in the control arm. The dashboard produced a total of 18,132 alerts from the 5 intervention sites;a rate of 1-2 per pt-month. Lab-based issues were most common (Figure 1), followed by non-adherence and transitions in care;70% of alerts were addressed (Figure 2 blue bars) in about 40 days (Figure 2 orange line). Actions taken by pharmacists are displayed in Figure 3, which were often already addressed or not clinically relevant. Adjustments made to med regimens based on dashboard alerts were uncommon. Multivariable modeling demonstrated location site, type of alert, and transplant type were predictors of alerts being addressed (Table 1). Conclusion(s): This multicenter cluster-randomized controlled trial demonstrates that a med safety dashboard is feasibly deployable across the VA healthcare system, creating valid alerts;although most alerts were already addressed by other providers or deemed not to be clinically actionable. Future dashboard refinements should focus on reducing non-actionable alerts and addressing workload barriers to timely review. (Figure Presented).

20.
Chest ; 162(4):A2658-A2659, 2022.
Article in English | EMBASE | ID: covidwho-2060979

ABSTRACT

SESSION TITLE: Late Breaking Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: The science continues to develop in terms of the epidemiology of persistent, or long COVID, especially in the pediatric population. The impact of persistent COVID-19 on cardiorespiratory fitness in the form of physical activity and athletic performance among children/adolescents is not well described, especially among vulnerable populations. METHODS: A retrospective electronic health record review identified children/adolescents with previously diagnosed COVID (N=312, 52.9% male, mean age at diagnosis 6.6 [SD 5.9] years, 20.5% non-Hispanic White [NHW], 19.2% non-Hispanic Black [NHB], and 54.5% Hispanic, 85.26% hospitalized due to COVID-19 illness) from one pediatric healthcare system that serves predominantly Medicaid-dependent families. Patients or caregivers completed a follow-up telephone survey from March 2021- February 2022 to estimate the prevalence of persistent COVID symptoms, defined as the presence of symptoms lasting ≥ 30 days. Multiple logistic regression models explored the association between physical activity and the presence of long COVID. RESULTS: 71 (22.8%) patients reported long COVID and the most prevalent symptoms included tiredness (21 [6.7%]), shortness of breath (18 [5.8%]), cough (16 [5.1%]), headache (14 [4.5%]), difficulty with thinking/concentration (14 [4.5%]), disrupted sleep (14 [4.5%]), other symptoms (12 [3.8%]), anxiety (11 [3.5%]), body aches (11 [3.5%]), joint pain (10 [3.2%]) chest pain (9 [2.9%]), intermittent fever (6 [1.9%]), and loss taste/smell (5 [1.6%]). Almost a third (32%, N = 24) of patients who participated in any athletics or physical activity in or outside of school reported a negative impact on physical or athletic performance, and 66.7% reported it was directly related to COVID-19 illness. Specific complaints when returning to physical activity post-COVID illness included tiredness (7 [36.8%]) and shortness of breath (2 [10.5%]). The odds of a decline in physical activity performance was over twice that (OR 2.17, 95% CI 0.54-8.71, p = 0.28) among children with long COVID versus those reporting no long COVID after adjusting for demographics. There was no difference by age (mean 9.8 vs. 9.7 years, p = 0.93), sex (50% girls vs. 50% boys, p =0.71), or race/ethnicity (25% NHW vs. 25% NHB vs. 37.5% Hispanic, p = 0.25) in terms of decline in physical activity performance. Two children were recommended to delay re-entry into physical activity. CONCLUSIONS: A substantial proportion of ethnically diverse children from low resource backgrounds who had severe COVID illness are reporting long-term impacts on physical activity and cardiorespiratory fitness. Findings can inform pediatricians about this vulnerable population in post-COVID-19 recovery efforts. CLINICAL IMPLICATIONS: Pediatric pulmonologists and other sub-specialists should screen and monitor patients who have had previous severe COVID-19 illness for persistent cardiorespiratory impacts. DISCLOSURES: No relevant relationships by Kubra Melike Bozkanat No relevant relationships by Jackson Francis No relevant relationships by Weiheng He No relevant relationships by Alejandra Lozano No relevant relationships by Matthew Mathew No relevant relationships by Sarah Messiah No relevant relationships by Angela Rabl No relevant relationships by Sumbul shaikH No relevant relationships by Nimisha Srikanth No relevant relationships by Apurva Veeraswamy No relevant relationships by Sitara Weerakoon No relevant relationships by Luyu Xie

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