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1.
Vaccine ; 2022 Nov 14.
Article in English | MEDLINE | ID: covidwho-2119721

ABSTRACT

BACKGROUND: Immunity gaps caused by COVID-19-related disruptions highlight the importance of catch-up vaccination. Number of countries offering vaccines in second year of life (2YL) has increased, but use of 2YL for catch-up vaccination has been variable. We assessed pre-pandemic use of 2YL for catch-up vaccination in three countries (Pakistan, the Philippines, and South Africa), based on existence of a 2YL platform (demonstrated by offering second dose of measles-containing vaccine (MCV2) in 2YL), proportion of card availability, and geographical variety. METHODS: We conducted a secondary data analysis of immunization data from Demographic and Health Surveys (DHS) in Pakistan (2017-2018), the Philippines (2017), and South Africa (2016). We conducted time-to-event analyses for pentavalent vaccine (diphtheria-tetanus-pertussis-Hepatitis B-Haemophilus influenzae type b [Hib]) and MCV and calculated use of 2YL and MCV visits for catch-up vaccination. RESULTS: Among 24-35-month-olds with documented dates, coverage of third dose of pentavalent vaccine increased in 2YL by 2%, 3%, and 1% in Pakistan, Philippines, and South Africa, respectively. MCV1 coverage increased in 2YL by 5% in Pakistan, 10% in the Philippines, and 3% in South Africa. In Pakistan, among 124 children eligible for catch-up vaccination of pentavalent vaccine at time of a documented MCV visit, 45% received a catch-up dose. In the Philippines, among 381 eligible children, 38% received a pentavalent dose during an MCV visit. In South Africa, 50 children were eligible for a pentavalent vaccine dose before their MCV1 visit, but only 20% received it; none with MCV2. CONCLUSION: Small to modest vaccine coverage improvements occurred in all three countries through catch-up vaccination in 2YL but many missed opportunities for vaccination continue to occur. Using the 2YL platform can increase coverage and close immunity gaps, but immunization programmes need to change policies, practices, and monitor catch-up vaccination to maximize the potential.

2.
Chest ; 162(4):A838-A839, 2022.
Article in English | EMBASE | ID: covidwho-2060702

ABSTRACT

SESSION TITLE: Sepsis: Beyond 30cc/kg and Antibiotics SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: The Sepsis Prediction Model (SPM) is a proprietary decision support tool created by Epic Systems. The basis of the SPM is a Predicting Sepsis Score (PSS) calculated from demographic, comorbidity, vitals, labs, medication, and procedural data. We assessed the diagnostic accuracy and timeliness of the PSS for sepsis as defined by Centers for Disease Control (CDC) Adult Sepsis Event (ASE) criteria. The performance of the PSS was compared to, Systemic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), and SOFA scores. METHODS: Retrospective review of 62,460 adults admitted to 4 Wake Forest Baptist Health System hospitals from June 1, 2019 through December 31, 2020 with PSS scores calculated every 15 minutes. A sepsis event was defined as receipt of 4 or more days of antimicrobials, blood cultures collected within 48 hours of initial antimicrobial administration, and at least one organ dysfunction. This definition of sepsis was modified to also include Covid-19 infection with organ dysfunction. Time zero was defined as time of first contact for the healthcare encounter. 30-day readmissions, facility transfers, and deaths in the Emergency Department were excluded. RESULTS: The prevalence of sepsis in the sample was 4.5%. The optimal PSS threshold based on Youden’s J statistic was a score of 8 (sensitivity 0.72, specificity 0.74, Youden’s J 0.46). SIRS (sensitivity 0.90, specificity 0.42), qSOFA (sensitivity 0.64, specificity 0.69), and SOFA (sensitivity 0.89, specificity 0.43) had a Youden’s J statistic for sepsis of 0.32, 0.33, and 0.32, respectively. At a PSS score of ≥ 8, median time to score positivity among those who reached that score (28.4% of sample) was 217 minutes (IQR 74-1477 minutes). For SIRS, qSOFA and SOFA, median time to score positivity was 54 minutes (IQR 24-456), 360 minutes (IQR 53-1593) and 107 minutes (IQR 39-474), respectively. CONCLUSIONS: Discrimination of the PSS for detection of sepsis was highest at a threshold score of 8. Overall, the PSS discriminated better than SIRS, qSOFA and SOFA. Positive SIRS and SOFA scores occurred at an earlier time-point than PSS score. The time to positivity appears to limit the tool’s best expected performance to improve time to initial antimicrobial and compliance with the 3-hour sepsis bundle. CLINICAL IMPLICATIONS: Clinical application of the Epic SPM to improve adherence with sepsis treatment goals is constrained by time to positive screen as compared to other screening tools. DISCLOSURES: No relevant relationships by Alain Bertoni No relevant relationships by Kristin Lenoir No relevant relationships by Beverly Levine No relevant relationships by Morgana Mongraw-Chaffin No relevant relationships by Adam Schertz Stock Ownership Interest relationship with Johnson & Johnson Please note: years Added 04/15/2022 by Karl Thomas, value=Ownership interest stock ownership relationship with Gilead Sciences Please note: years Added 04/15/2022 by Karl Thomas, value=Ownership Stock ownership interest relationship with Bristol-Myers Squibb Please note: years Added 04/15/2022 by Karl Thomas, value=Ownership interest Stock Ownership Interest relationship with Pfizer Please note: years Added 04/15/2022 by Karl Thomas, value=Ownership interest Stock Ownership Interest relationship with Doximity Please note: 1 year Added 04/15/2022 by Karl Thomas, value=Ownership interest No relevant relationships by Brian Wells No relevant relationships by Jack White

3.
Journal of the Canadian Association of Gastroenterology ; 4, 2021.
Article in English | EMBASE | ID: covidwho-2032045

ABSTRACT

Background: The global COVID-19 pandemic has resulted in a dramatic re-alignment of clinical service delivery. In mid-March 2020 the Division of Digestive Care and Endoscopy at Dalhousie University leveraged eHealth technology to rapidly implemented a new referral management and triage system and established a new rapid outpatient consultation service to facilitate urgent virtual and face-to-face appointments. Standardized procedures for triaging, booking, and staffing the urgent gastroenterology consultation service were implemented. Aims: The aim of this study was to evaluate the impact of the implementation of a standardized triage and consultation process on access to urgent gastroenterology consultative services at a single tertiary care center during the COVID-19 pandemic. Methods: We performed a pre- and post-implementation study comparing efficiency metrics for urgent triage and urgent consultation. The pre-implementation cohort included all patients referred and triaged to an urgent clinic appointment between April 1, 2019 to September 30, 2019. The post-implementation cohort included all patients referred and triaged to an urgent clinic appointment between April 1, 2020 to September 30, 2020. Healthcare efficiency data was extracted through electronic record review with specific dates and times for referral receipt (a), triage completion (b), appointment wait-listing (c), and clinic appointment (d). The time to triage (TT), time to visit (TV), and total time to consult (TC) were calculated (TT = c - a;TV = d - c;TC = TT + TV) for each patient. The Mann-Whitney U test was used to compare TT, TV, CT between patient cohorts. Results: A total of 429 patients were booked for urgent clinic consultation, 176 during the pre-implementation period and 253 in the post-implementation period. The mean TT for the pre-and post-implementation cohorts was 4.8 days and 3.3 days, respectively (U=18,149, p=0.001). Mean TV was decreased from 16.2 days for the pre-implementation cohort to 3.6 days for the post-implementation cohort (U=6095, p=0.000). The mean time from a referral being received to the patient being seen in consultation (TC) decreased by 67% from 21 days to 6.9 days, Figure 1 (U=6,419, p=0.000). Conclusions: The COVID-19 pandemic has had a dramatic impact on healthcare delivery in Nova Scotia. One positive result is that it facilitated the motivation and alignment needed to make a large health system change that may not have otherwise been possible. This study demonstrates that a standardized pathway for urgent outpatient gastroenterology assessment improves the timeliness of care delivery.

4.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009577

ABSTRACT

Background: The COVID-19 pandemic rapidly altered cancer care delivery globally, providing a compelling opportunity to empirically study how these changes impacted persistent disparities in care. Cervical cancer is one of the most common female cancers worldwide, with approximately 90% of cases and deaths occurring in low- and middle-income countries (LMICs). In Botswana, a LMIC with a particularly high prevalence of HIV and cervical cancer, delays in cervical cancer diagnosis and treatment have been documented but is unknown how these delays may have been mitigated or exacerbated since the pandemic. Methods: The objective of this analysis is to evaluate patterns of cervical cancer diagnosis and treatment initiation before (January 2015-March 2020) and during the pandemic (April 2020-July 2021) using longitudinal clinical and patient-reported data from a cohort of over 1,000 patients receiving care for gynecologic cancers in Botswana. The primary outcome is timeliness of treatment defined by the number of days between first clinical visit and initiation of first-line treatment and categorized dichotomously (> 30 days classified as delay). Primary exposure is the time period (prepandemic and pandemic) defined by the month of first visit. We calculated unadjusted proportion of delays and covariates stratified by time period and used bivariate analysis to examine factors associated with each time period. We used multivariable logistic regression models to examine the association between delay and time period, adjusting for all covariates (age, stage, HIV status, rurality, screening history, and partner status). Results are presented as unadjusted proportions, adjusted odds ratios (AOR), and 95% confidence intervals. Results: Of the 1,200 patients treated for cervical cancer at the multidisciplinary clinic, 990 (82.5%) were diagnosed pre-pandemic and 210 (17.5%) during the pandemic. Among all patients with gynecologic cancers (n = 1,568), the proportion of patients with cervical cancer significantly decreased from 78.6% pre-pandemic to 68.0% during the pandemic (p < 0.001). In comparison to pre-pandemic, patients with cervical cancer during the pandemic were significantly less likely to have attended a screening clinic prior to their treatment (57.6% vs 15.3%;p < 0.001) and significantly more likely to experience treatment delays (61.6% vs 92.9%;p < 0.001). In the multivariable model, patients diagnosed during the pandemic had a 7-fold higher likelihood of treatment delays than those patients diagnosed pre-pandemic (AOR: 7.95;95% CI: 4.45-14.19). Conclusions: The pandemic significantly increased delays in treatment for nearly all patients with cervical cancer in Botswana. Given persistent global disparities in cervical cancer, there is a great need to implement evidence-based strategies for improving screening and timeliness of care in Botswana and other LMICs.

5.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009518

ABSTRACT

Background: Screening mammography programs often require patients undergo multiple visits (screening exam, diagnostic exam, and biopsy) before tissue diagnoisis of screen-detected abnormalities. During the COVID-19 pandemic, same-day breast imaging services were leveraged to decrease the number of visits following abnormal screening exams. Specifically, in May 2020, we implemented an immediate-read screening mammography program to synergize with our pre-existing same-day breast biopsy program, such that every effort was made to perform diagnostic imaging during the same visit after an abnormal screening mammogram. This study aims to evaluate the impact of these same-day breast imaging services on time and number of patient visits to undergo breast biopsy after an abnormal screening mammogram. Methods: Consecutive screening mammograms performed during normal business hours pre- (6/1/16 to 5/30/17) and post-implementation (6/1/20 to 5/30/21) of same-day services were identified. Patient demographics, imaging and biopsy results, and visit dates were extracted from the medical record. Multivariable logistic, linear, and ordinal regression models estimated with generalized estimating equations were fit to assess the association of period (pre- versus post-implementation), patient age, and race and ethnicity (White versus races other than White) with having a same-day biopsy (biopsy on the same day as the abnormal screening exam), number of days to biopsy, and number of visits. Adjusted odds ratios (aOR) and beta estimates (aBeta) of each covariate and corresponding 95% confidence intervals (CI) were estimated. Results: A total of 409/25,922 (1.6%) of patients (median age 61, IQR 50-70) pre-implementation and 221/20,452 (1.1%) patients (median age 62, IQR 49-71) post-implementation had screen-detected abnormalities leading to diagnostic breast imaging and biopsy. Median number of days from screening to biopsy decreased from 16 days pre-implementation to 5 days post-implementation (p < 0.001). Pre-implementation, 86.8% of patients required 3 visits between screening and biopsy, while post-implementation only 23.1% required 3 visits (p < 0.001). Compared to pre-implementation, the post-implementation period was associated with increased odds of undergoing same-day biopsy (aOR 20.7, 95% CI 8.3-51.7), p < 0.001), fewer days from abnormal screening mammogram to biopsy (aBeta -13.3, 95% CI -15.7 to -10.9, p < 0.001), and fewer visits (aOR 0.05, 95% CI 0.02-0.09), p < 0.001), controlling for age and race and ethnicity. Conclusions: Same-day breast imaging services decreased time and patient visits between abnormal screening mammogram and breast biopsy. Same-day services implemented out of necessity during the COVID-19 pandemic should be continued after the pandemic has subsided to improve timeliness of care.

6.
Journal of Public Health in Africa ; 13:77-78, 2022.
Article in English | EMBASE | ID: covidwho-2006796

ABSTRACT

Introduction/ Background: The index case for SARS-CoV-2 entered in February 2020 through the international airport in Lagos, the most populous state in Nigeria. This epicenter recorded 77,676 confirmed cases as of October 15, 2021. Particularly at the onset, there was a dearth of information on preparedness of health facilities to manage COVID-19. Methods: We developed and applied SafeCare4Covid, a paper-based preparedness checklist, and organized webinars for health providers jointly with the Lagos State Health Management Agency. The tool was digitized, and evolved into a free, globally available self-assessment application, following World Health Organization guidelines. It quantifies COVID-19-related capabilities with 31 questions (score range, 0-100) and availability of COVID-19- related essential medical supplies with a 23- supplies checklist (0-100). Preparedness is assessed r.e. infrastructure, infection prevention, triaging, COVID-19 trainings, staffing, emergency response team, referral, and supplies (PPEs and oxygen). Each facility received an automated quality improvement plan. Data was shared through dashboards with stakeholders for decisionmaking. Results: Between July 2020-March 2021, 66 health facilities in Nigeria completed the SafeCare4Covid selfassessment (56 in Lagos, 44 of those private and 12 public). The average capability score (n=66) was 71 (interquartile range, 61-86), and the average supply score (n=51) was 80 (74-91). Majority of facilities did not offer COVID-19 tests/did not report test-access status (95.5%, 63/66), nor had guidelines for the management of confirmed cases, COVID-19 sample processing/referral, staff mental support and contact tracing. Many centers did not have infection prevention policies (44%, 29/66). Supply of N95/FFP2 respirators was limited. Impact: The SafeCare4Covid tool generated an automated customized quality improvement plan outlining corrective actions to improve the facility's preparedness (processes, infrastructure and supplies) to prevent the spread of COVID-19 and other infections within and to the community. Conclusion: Digitizing the SafeCare4Covid tool improved the efficiency and timeliness of assessing health facility epidemic readiness. The tool facilitated corrective actions focusing on capacity building of case management, infection prevention protocols, and procurement of PPEs to prevent facility-acquired COVID-19 infections.

7.
Journal of General Internal Medicine ; 37:S255-S256, 2022.
Article in English | EMBASE | ID: covidwho-1995584

ABSTRACT

BACKGROUND: The COVID-19 pandemic has diverted health care resources from the management of chronic diseases toward acute care, with potential long-term consequences, especially among vulnerable populations. Incarcerated populations bear a higher chronic disease burden than the general community, while simultaneously experiencing COVID-19 outbreaks of higher acuity and associated mortality. The extent to which COVID-19 disrupted routine medical care within prison health systems has not been fully characterized. METHODS: We analyzed data from the California Department of Corrections and Rehabilitation (CDCR) for each California state prison (N=35) by month describing the delivery of medical care from January 1, 2019, to July 31, 2021. These data included quality measures describing the timeliness of clinical services for preventive care and chronic disease management, grouped by the CDCR into three categories (diagnostic, general medical, and specialty care). Statewide mean rates for each measure were weighted by prison population. Comparing these measures with prison-level COVID-19 incidence data from the CDCR for this period, we conducted a descriptive analysis of trends in the timely delivery of medical care in the CDCR during the COVID-19 pandemic relative to a pre-pandemic baseline period (2019). RESULTS: Populations housed within CDCR facilities experienced an initial wave of COVID-19 cases between June and October 2020, followed by a larger wave between November 2020 and February 2021. During the second wave, timely delivery of non-urgent PCP services decreased from a baseline of 91.7% to 79.0% (mean difference -12.7%;95% [CI], -16.6 to -8.9). Timely delivery of non-urgent specialty services decreased from a baseline of 87.3% to 56.4% (mean difference -31.0%;95% [CI], -36.8 to -25.1). Smaller, but statistically significant declines were seen in the timeliness of urgent PCP services (mean difference -7.8%;95% [CI], -10.2 to -5.5) and high priority specialty services (mean difference -13.8%;95% [CI], -17.1 to -10.4). CONCLUSIONS: The population incarcerated in California state prisons experienced sustained, significant delays in receipt of routine care during the COVID-19 pandemic. In comparison, outpatient visit volume in nonincarcerated populations nationwide decreased by up to 58% during the initial wave, but volumes recovered rapidly with a shift toward virtual care and remained stable despite the second wave. Policies to bolster prison health care systems during the ongoing pandemic will be critical for a stable recovery in access to chronic disease management and preventive care for this vulnerable population.

8.
European Stroke Journal ; 7(1 SUPPL):455, 2022.
Article in English | EMBASE | ID: covidwho-1928075

ABSTRACT

Background and aims: National clinical quality registries facilitate reliable monitoring of stroke care by providing local hospital teams with data on their performance compared to national benchmarks. We aimed to assess changes in stroke care over time from public hospitals participating in the Australian Stroke Clinical Registry (AuSCR). Methods: AuSCR stroke quality care indicators were compared between 2017 and 2020, using a matched-hospital design. Analyses were limited to adults with stroke or transient ischaemic attack admitted to hospitals contributing ≥30 episodes each year during the study period. Descriptive statistics and linear tests for trend were used to assess changes in quality indicators across years. Results: Among 47 eligible hospitals, admissions increased from 13,508 (2017) to 18,139 (2020). Overall, half were aged ≥75 years, 45% were female, and 59% had a severe stroke (no differences by year). Between 2017 and 2020, improvements were observed for: endovascular retrieval (+8%;P<0.001), hyperacute antithrombotics (+6%;P<0.001), mobilisation during admission (+3%;P<0.001), swallow screen/assessment within 4 hours (+12%;P<0.001), discharge care planning (+11%;P<0.001), and discharge secondary prevention medications (+10%;P<0.001). However, delivery of thrombolysis remained unchanged (-1%;P=0.07), door-toneedle within 60 minutes decreased (-6%;P=0.008), and access to stroke unit care declined in 2020 (76% 2019 vs 72% 2020;P<0.001). Conclusion: Improvements in many indicators of quality stroke care have been observed within Australian hospitals participating in a national registry. Declines in timeliness to thrombolysis and access to stroke units in 2020 represent a likely consequence of the COVID-19 pandemic that requires national action.

9.
European Stroke Journal ; 7(1 SUPPL):485-486, 2022.
Article in English | EMBASE | ID: covidwho-1928128

ABSTRACT

Background and aims: TIA presentations are challenging to diagnose. The rapidly escalating pandemic due to Covid-19 demanded an integrated TIA clinic( telephone and Face to face clinics). It is unclear if first specialist assessment can be safely undertaken in selected patients using telephone clinics, there by reducing patient movement to reduce risk of transmission. The aim of this study is to evaluate timeliness, diagnostic accuracy and 28-day readmission of the integrated TIA clinic in comparison to usual set up. Methods: Two groups of patients (Pre-Covid and Covid Groups) were identified from the TIA clinic registry maintained for quality assurance and governance. Statistical analysis was done using Statistical Package of Social Sciences (SPSS) version 23 (IBM, 2015). Results: There was a 25% drop in the number of cases during the study period. Conclusion: Integrated model of care can be used to provide timely, safe and comparable service to usual care. The risk of missing key signs can be reduced by the provision of face-to-face clinics. It offers patient choice, service closer to patient and creates flexibility within the system during unprecedented emergencies. A prospective study with a larger cohort of patients will add strength to these findings.

10.
European Stroke Journal ; 7(1 SUPPL):324, 2022.
Article in English | EMBASE | ID: covidwho-1928096

ABSTRACT

Background and aims: Acute ischemic stroke (AIS) is a possible complication of coronavirus disease (COVID-19). Data on reperfusion therapies (RT) - intravenous thrombolysis and endovascular treatment (EVT) - and long-term outcomes in COVID-19 stroke patients is lacking. We sought to evaluate functional outcome (mRS) and 3-month case fatality in COVID-19 stroke patients after RT. Methods: We performed a retrospective nation-wide pair-matched analysis of COVID-19 patients with AIS who underwent RT. We included adult COVID-19 AIS patients, treated with RT between March 16, 2020 and June 30, 2021. All subjects were paired with non-infected controls, matched for age, sex, stroke arterial vascular territory, and RT modality. Results: 31 subjects and 31 matched controls were included. Median baseline NIHSS score in the COVID-19 group was 16, compared to 12 among controls (P=0.028). The timeliness metrics (onset-to-door, doorto- needle and door-to-puncture times) did not differ significantly between the two groups. Rates of ischemic changes and symptomatic intracranial hemorrhages did not differ significantly between the two groups at 24 hours after RT. Higher rate of respiratory failure was observed in the COVID-19 group in compare to controls (64.5% vs. 22%, P = 0.007). Median NIHSS 24 hours after reperfusion was 16 in COVID-19 group and 5 in controls (P=0.003). mRS 0-2 at discharge was observed in 22.6% of COVID-19 patients compared to 51.8% of controls (P=0.018). Threemonth case fatality was 54.8% in COVID-19 group versus 12.9% in controls (P=0.001). Conclusions: COVID-19 positive stroke patients had worse functional outcomes at discharge and higher 3-month case fatality.

11.
Current Nanoscience ; 18(4):409, 2022.
Article in English | EMBASE | ID: covidwho-1917106
12.
Journal of Paediatrics and Child Health ; 58(SUPPL 2):75, 2022.
Article in English | EMBASE | ID: covidwho-1916239

ABSTRACT

Background: Domestic and family violence (DFV) and mental health screening are core components of antenatal care. However, the COVID-19 pandemic both increased the prevalence of DFV and mental health issues and resulted in many antenatal visits becoming telehealth. DFV and mental health screening were consequently often delayed, potentially resulting in insufficient time to establish support systems before birth. This study assessed pandemic effects on DFV and mental health screening from the perspective of local maternity service providers. Methods: Maternity staff (midwives, doctors, allied health) at three Sydney metropolitan hospitals were surveyed regarding perceived impact of COVID-19 on the delivery, timeliness, and quality of overall pregnancy care, DFV and mental health screening and care, and their telehealth perceptions. Responses by hospital and maternity care provider subtype were compared. Results: Of 109 respondents, most felt the pandemic negatively impacted overall pregnancy care (60%), DFV screening/care (57%), and mental health screening/care (57%), significantly more believing COVID-19 'extremely' negatively impacted DFV screening (p = 0.02). Staff at the hospital with highest sociodemographic diversity were significantly more concerned about DFV screening/ care. Nominated telehealth advantages e.g. reduced travel (69%) and clinic overcrowding (62%) were fewer than disadvantages including no physical examinations (90%), difficulties picking up non-verbal cues (84%), and certain questions unsafe (62%). Fiftysix percent believed telehealth should be used for some antenatal care for select women (low-risk, multiparous). Conclusions: Telehealth may have an ongoing limited role in maternity care in Australia for low-risk women. Staff considered those high-risk for physical and/or psychosocial reasons unsuited to telehealth care.

13.
Econ Lett ; 217: 110678, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1894999

ABSTRACT

Using Chinese data, this study examines the effect of COVID-19 pandemic on tendencies and characteristics of information disclosure. Results show that, due to uncertainty caused by the pandemic, it is difficult to make earnings forecasts. Further, during the pandemic, forecast precision and timeliness decrease. The results remain unchanged under difference-in-difference (DiD) estimation. The findings of this paper extend existing studies on the economic consequences of COVID-19 pandemic and the influencing factors of information disclosure, providing implications for corporate managers, investors, and regulators.

14.
Journal of Urology ; 207(SUPPL 5):e479, 2022.
Article in English | EMBASE | ID: covidwho-1886505

ABSTRACT

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic limited global surgical missions. As a vaccine has been developed and deployed with low-/middle-income countries (LMICs) adjusting to a post-pandemic landscape, the question remains of how and when to restart surgical missions to these locations. This study reports the experience of International Volunteers in Urology (IVUmed) with identifying metrics of “readiness” for return to global health surgical workshops. METHODS: A survey was created and emailed in September 2021 to LMIC international partners where IVUmed has previously performed or is planning surgical workshops. The survey queried if international sites were ready for the return of surgical workshops, the timing of readiness, type workshop requested first, challenges faced including equipment limitations, and vaccination status. Results were tabulated. RESULTS: Of 30 emails sent, there were 12 responses. This represented 11 unique hospitals in 10 unique cities in 9 countries. The majority of respondents were from the continent of Africa (n=9) while the others were from Asia (n=2) and the Caribbean (n=1). Most respondents lived in countries where vaccines were available (75%) with all respondents stating they were vaccinated and are required to wear masks out in public. Most sites (66.7%) responded being ready for IVUmed workshops, with a start date of February 2022 (55.6%). 83% of respondents stated their hospital infrastructure could support a workshop, with 75% stating good access to personal protective equipment;58%, however, noted difficulty obtaining surgical supplies. Two respondents stating their hospitals continue to only perform emergent surgical cases. The most popular first workshops requested were pediatric urology and laparoscopy/endourology (30% each). Themes of the biggest challenge noted since the start of COVID-19 included 7 comments on performing operations, 4 about lack of supplies, and 2 about lost learning opportunities. CONCLUSIONS: It is unclear how and when to restart global health surgical mission programs since the start of the COVID-19 pandemic, which impacted the already critically limited global surgical volumes in LMICs. While LMIC partners queried report a high vaccination status, the vaccination status of the general population in surveyed countries has not been established. While this is an ongoing research project, important considerations for resumption of surgical missions must include careful assessment of timeliness, surgical and anesthetic capacity, facility resources, and safety. Direct communication with local sites is imperative.

15.
Topics in Antiviral Medicine ; 30(1 SUPPL):347, 2022.
Article in English | EMBASE | ID: covidwho-1880115

ABSTRACT

Background: Case investigation and contact tracing (CI/CT) is a key component of the response to COVID-19. CI/CT seeks to ensure that people exposed to SARS-CoV2 learn of their exposure and that infected persons and their contacts adhere to isolation and quarantine (I/Q) guidance. CI/CT programs also have the potential to address pandemic-related health inequities through the provision of support services. We evaluated the Public Health-Seattle & King County (PHSKC) CI/CT program, including its reach, timeliness, and case-reported impact on I&Q adherence. Methods: The PHSKC CI/CT case interview assessed case demographics, recently visited places, contacts, and service needs. In March 2021, a random sample of cases completed an End of I&Q Survey to assess their adherence to I&Q guidance and opinions of CI/CT. We calculated descriptive statistics to evaluate survey and programmatic data collected between July 2020 and June 2021. Results: The PHSKC CI/CT team interviewed 42,018 cases (81% of cases contacted) a mean of 6.1 days after symptom onset, and 3.4 days after SARS-CoV2 testing. Cases disclosed the names and addresses of 10,650 worksites (mean= 0.8/interview) and 11,269 other recently visited locations (mean= 0.5/interview), and provided contact information for 61,969 household members (mean=2.7/interview) and 8,753 non-household contacts (mean= 0.3/interview). The CI/CT team helped arrange COVID-19 testing for 5,660 contacts from 3,104 households, facilitated grocery delivery for 7,257 households, and referred 9,127 households for financial assistance. End of I&Q Survey participants (n=304, 54% of sampled) reported self-notifying an average of 4 non-household contacts and 69% agreed that the information and referrals provided by the CI/CT team helped them stay in isolation. Conclusion: CI/CT reached many persons with COVID-19 and their household contacts and identified thousands of possible exposure venues. The intervention's effectiveness was likely limited by the inability to interview cases during their period of peak infectiousness and cases' reluctance to name non-household contacts, though cases notified many non-household contacts themselves. CI/CT was effective in linking people to testing, food, and financial assistance, and most cases reported that the intervention helped them isolate. These findings provide evidence that CI/CT can help mitigate the impact of COVID-19 on disproportionately impacted communities through the promotion of I&Q guidance and provision of support services.

16.
Medical News of North Caucasus ; 17(1):27-31, 2022.
Article in Russian | EMBASE | ID: covidwho-1863362

ABSTRACT

The article provides information about the anti-epidemic measures that took place in Republic of Kazakhstan (RK) related to the Coronavirus infection. An analysis of morbidity and mortality, caused by COVID-19 in RK, in comparison with numerous countries, was carried out. The materials for assessment were: regulatory documents regarding stop spreading of coronavirus infection in the RK, official epidemiological and statistical data. The analysis showed the adequacy and timeliness of the applied anti-epidemic measures in the RK, which contributed to the retention of morbidity and mortality at relatively low, globally, levels. Differences in morbidity and mortality, caused by COVID-19, in various countries and regions of the RK, may have been associated with the quarantine policy measures and medical or social factors (comorbidities diseases, life expectancy, income of the population).

17.
Geriatric Orthopaedic Surgery and Rehabilitation ; 12:11, 2021.
Article in English | EMBASE | ID: covidwho-1817119

ABSTRACT

Introduction: The care of patients with hip fractures is a surrogate marker of trauma care. Irish hip Fracture Standard 1 involves patients with a hip fracture being admitted to an orthopaedic ward bed within 4 hours of attending the ED. We wanted to audit our current practice and introduce a quality improvement project to improve the timeliness and efficiency of care of our hip fracture patients compared with the gold standard IHFS 1. We introduced a 90-minute multidisciplinary simulation training programme on the hip fracture pathway to our ED in February 2021. All key stakeholders were represented;from Emergency Medicine, Orthopaedics, Nursing (EM and Orthopaedic), Radiology, Radiography, Porters (32 people overall). Because of Covid-19, the training was available in person and online via zoom. Methods: We performed a retrospective audit of patients presenting to TUH ED with a proximal third of femur fracture between 4th February and 31st March inclusive in 2020 and 2021, pre and post introduction of multidisciplinary simulation based medical education on the hip fracture pathway. Data was collected from the electronic record database (symphony). Results: 2020 n = 31;Average time to ward-8hrs 29 mins. 26% patients reached ward <4 hours. (8/31). 2021 n = 25;Average time to ward-5hrs 58 mins (32% reduction vs 2020). 72% patients reached ward <4 hours. (18/25) (46% increase vs 2020). Conclusion: Simulation based medical education is a successful intervention to improve compliance with our hip fracture pathway, time from presentation to transfer to an orthopaedic ward bed and achieve IHFS 1.

18.
Journal of Burn Care and Research ; 43(SUPPL 1):S127-S128, 2022.
Article in English | EMBASE | ID: covidwho-1816142

ABSTRACT

Introduction: Inexperience of frontliners and referring physicians from non-specialty centers in burn wound assessment results to the incorrect triage of patients, thereby aggravating the current hospital situations and causing unnecessary exposures. Emergency care in burn centers in developing countries must strike a balance between doctor and patient safety, and uncompromised care of burn patients. Telemedicine is deemed a valid and sound option to maintain social distancing and promote safety, yet provide proper burn care. It is a valuable and indispensable tool for all doctors of all branches of medicine and surgery. Although many of its limitations in developing countries are still being unraveled, the benefits of this technology are being realized worldwide. This study determined the accuracy and timeliness in diagnosing and classifying burn patients assessed by a frontliner non-burn specialist in-person (NBSP), a Burn Specialist online (BSO), and a Burn Specialist in-person (BSP). Methods: All burn patients (January to March 2021) with signed consent for participation were photographed in a standardized manner by the NBSP and referred to a BSO via an online messaging application. These patients were also assessed independently by the BSP. The % total body surface area (TBSA), burn depth classification, and the time the patients were seen by the NBSP, the time the online referrals were sent to the BSO through the messaging application, the time the BSO sent the diagnoses, and the time of assessment by the BSP, were recorded. One-Way Repeated Measures Analysis of Variance (ANOVA) with and without blocking were done.Post-hoc Tukey-Test was used to analyze the pair-wise differences for any ANOVA that showed significant statistical differences. Results: Data gathered from 82 patients throughout the 3-month study duration demonstrated that burn size (% TBSA) among the three different physicians (NBSP, BSO, BSP) was not statistically significant (p=0.8794). Our analysis also showed no statistical difference for the 19 different body parts per patient and burn depth classification (p=0.9718). One-way ANOVA tests on timeliness were statistically significant with a p-value of p< 0.0001. A post-hoc comparison using Tukey test revealed no statistical significance between the BSO and BSP (p=0.892). Conclusions: Smartphone telemedicine platform through photographic transfer and analysis is an accurate method in estimating burn size and depth classification. Timeliness can be improved with a dedicated 24/7 online available burn specialists and a reliable network access. Hence, frontliners can refer to burn specialists in a developing country using this telemedicine platform for optimum burn care with an accurate diagnosis and overcome the challenges during and even after this pandemic.

19.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779479

ABSTRACT

Background: During the COVID pandemic, we designed and implemented a program, called BQual-D, to maintain high quality care for patients with HR+, HER2 negative MBC who were taking oral anti-cancer therapy and needed to shelter at home. This program augmented available clinical resources with (1) trained nurse coaches to manage side effects, improve adherence, monitor for cancer progression and screen for psychological distress via telehealth, and (2) a care coordinator to arrange blood testing at local labs to facilitate timely medication dose adjustments. BQual-D served patients from August, 2020 through April of 2021. Here, we describe survey results assessing provider satisfaction with BQual-D. Methods: Surveys assessing provider satisfaction were distributed in December, 2020 (Survey#1) and in April, 2021 (Survey#2). Provider demographics were collected with Survey#1. Eight questions assessed satisfaction with different aspects of the BQual-D program, including content of the nurse coach notes, communication with the program, timeliness of communication, frequency of notes, ease of reading the notes, ease of Sreferring patients, and turnaround time for labs, which were rated on a Likert scale of 1 (strongly dissatisfied) to 10 (strongly satisfied), with an additional response choice of 0 (unable to assess). Providers were also asked if BQual-D led to changes in patient management (yes/no), the degree to which BQual-D supported the medical management of the patient (from 1=not at all to 7=significantly), the influence of BQual-D on patient wellbeing (positive effects, no change, negative effects), and the overall quality of care delivered by the program (from 1=excellent to 4=poor). Finally, we asked providers if they would continue to recommend their patients to BQual-D (yes, in the same way as the program has been deployed;yes but with improvements;or no). Results are described by frequencies and means. Results: Nineteen providers responded to Survey#1. Providers were physicians (31.6%), advanced practice providers (31.6%), nurses (31.6%) and a clinical pharmacist (5.3%). Respondents were 89.5% female, 94.7% White, and had a mean age of 44 years and mean 11 years in practice. Providers rated the quality of care provided by the BQual-D program as excellent (44%) or good (57%), all providers surveyed indicated that they would continue to recommend the program to patients, and 95% of providers indicated that the program had a positive effect on patients' well-being. Half of the respondents indicated that BQual-D resulted in changes in or addition to patient management and 90% indicated that BQual-D significantly supported medical management. Providers were strongly satisfied (scores of 8-10 on the Likert scale) with overall communication with the BQual-D team (74%) and timeliness of communications (79%). Providers were also strongly satisfied with the content (68.4%), frequency (74%), and ease of reading (68%) program notes. Seven providers completed Survey#2, in which providers rated the overall quality of the program as excellent (57%) or good (43%);86% indicated that they would continue to recommend the program to patients, and 86% indicated that the program had a positive effect on patients' well-being. Conclusions: During the COVID pandemic, when sheltering at home was encouraged, provider satisfaction with BQual-D, which provided additional health resources (nurse coaches, care coordinator) to support patients on oral therapy for HR+ MBC, was high. Resources needed to implement BQual-D should be explored as a way of providing additional support for patients and providers in order to minimize the requirement for in-person visits.

20.
The International Journal of Bank Marketing ; 40(2):297-320, 2022.
Article in English | ProQuest Central | ID: covidwho-1735732

ABSTRACT

Purpose>The purpose of this study is to explore digital financial services experience, investigate the antecedents to digital financial services experience and examine familiarity as a moderator.Design/methodology/approach>The study uses dual methods: qualitative and quantitative. Multiple case studies are applied as a qualitative method to explore and capture recent development in rapidly changing digital finance. An empirical, survey-based approach is used to collect data from 258 respondents about their experiences with digital financial services experience using constructs, such as perceived ease of use, timeliness, lifestyle and digital financial element. The study used structural equation modeling using smart-PLS.Findings>Using word count, hierarchy chart, items clustered by similarity and qualitative analysis by applying NVivo 12, the study validates the constructs and captures recent developments. Using smart PLS, the structural equation model reveals that the digital functional element positively affects the digital financial services experience. It is observed that lifestyle mediated between perceived ease of use and timeliness with digital financial services experience. Further, familiarity moderates the relationship between the digital financial element and digital financial services experience. Moreover, while this research analyzed the relationship regarding financial services customers, we suggest a comparative study between different entities.Originality/value>The study can be considered one of its kind using qualitative and quantitative research methods. It integrates theory from both the information system and marketing domain. As the increased number of digital channels and interfaces has increased, companies need to understand how to improve the digital financial services experience.

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