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1.
Rev. bras. estud. popul ; 39: e0184, 2022. tab, graf
Article in Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-1698767

ABSTRACT

A sífilis, uma infecção vertical e sexualmente transmissível, curável e prevenível, é um problema de saúde pública no Brasil. Métodos diagnósticos e tratamentos são importantes no controle da doença. A pandemia de Covid-19 causou atrasos em diagnósticos e no tratamento na atenção primária em várias doenças e em diversos países, pois interrompeu padrões usuais de atendimento à saúde. O objetivo do estudo é identificar se houve menor número de procedimentos diagnósticos e de tratamento realizados para sífilis nos primeiros sete meses de 2020, comparativamente à média dos mesmos meses entre 2016 e 2019, no Brasil e nas unidades federativas. A redução no número de procedimentos seria um indicativo de atraso no diagnóstico, na detecção e no tratamento da sífilis em 2020. Foram utilizadas informações disponibilizadas no Sistema de Informações Ambulatoriais (SIA/SUS). Os achados para o Brasil indicaram queda de 1/3 nos procedimentos de diagnóstico e de tratamento referentes à sífilis nos sete primeiros meses do ano da pandemia, comparados com a média dos sete primeiros meses nos quatro anos anteriores (2016-2019). Indicadores mostram diferenças importantes por unidades da federação, apontando para maiores quedas proporcionais nos volumes de procedimentos no Norte e Nordeste, com ênfase nos estados do Maranhão, Roraima, Pará, Bahia, Rio Grande do Norte, Amazonas, Pernambuco e Amapá.


Syphilis, a vertical and sexually transmitted infection, curable and preventable, is a public health problem in Brazil. Diagnostic methods and treatments are important in controlling the disease. The COVID-19 pandemic caused delays in diagnosis and lack of treatment in primary care in several diseases and in several countries, as the pandemic disrupted usual health care standards. The aim of the study was to identify whether there were fewer diagnostic and treatment procedures performed for syphilis in the first seven months of 2020, compared to the average for the same months between 2016 and 2019, in Brazil and Federative Units. The reduction in the number of procedures would be indicative of a delay in the diagnosis, detection and treatment of syphilis in 2020. Information used came from the Outpatient Information System (SIA / SUS). The findings for Brazil indicated a 1/3 drop in diagnosis and treatment procedures for syphilis in the first seven months of the year of the COVID-19 pandemic, compared with the first seven months of the previous four years (2016-2019). Indicators showed important differences by Federation Units, pointing to greater proportional decrease in the volume of procedures in the North and Northeast, with an emphasis on Maranhão, Roraima, Pará, Bahia, Rio Grande do Norte, Amazonas, Pernambuco and Amapá.


La sífilis, una infección vertical y de transmisión sexual, curable y prevenible, es un problema de salud pública en Brasil. Los métodos de diagnóstico y los tratamientos son importantes para controlar la enfermedad. La pandemia de Covid-19 provocó retrasos en el diagnóstico y tratamiento en la atención primaria de variadas enfermedades en varios países, ya que interrumpió los estándares habituales de atención de la salud. El objetivo del estudio fue identificar si se realizaron menos procedimientos de diagnóstico y tratamiento de la sífilis en los primeros siete meses de 2020 en comparación con la media de los mismos meses entre 2016 y 2019, en Brasil y en sus unidades federativas. La reducción del número de procedimientos indicaría indicativo de un retraso en el diagnóstico, la detección temprana y el tratamiento de la sífilis en 2020. Para ello se utilizó la información disponible en el Sistema de Información Ambulatoria (SIA/SUS). Los hallazgos indicaron una caída de un tercio en los procedimientos de diagnóstico y tratamiento de la sífilis en los primeros siete meses del año de la pandemia de Covid-19 para Brasil, en comparación con los primeros siete meses de los cuatro años anteriores (2016-2019). Los indicadores mostraron diferencias importantes por unidades de la Federación, apuntando a mayores caídas proporcionales en el volumen de trámites en el Norte y Nordeste, con énfasis en Maranhão, Roraima, Pará, Bahia, Rio Grande do Norte, Amazonas, Pernambuco y Amapá.


Subject(s)
Humans , Unified Health System , Brazil , Syphilis/diagnosis , Diagnostic Techniques and Procedures , Pandemics , Sexually Transmitted Diseases , Fluorescent Treponemal Antibody-Absorption Test , Delivery of Health Care
2.
Int J Mol Sci ; 23(3)2022 Feb 03.
Article in English | MEDLINE | ID: covidwho-1674668

ABSTRACT

CRISPR/Cas is a prokaryotic self-defense system, widely known for its use as a gene-editing tool. Because of their high specificity to detect DNA and RNA sequences, different CRISPR systems have been adapted for nucleic acid detection. CRISPR detection technologies differ highly among them, since they are based on four of the six major subtypes of CRISPR systems. In just 5 years, the CRISPR diagnostic field has rapidly expanded, growing from a set of specific molecular biology discoveries to multiple FDA-authorized COVID-19 tests and the establishment of several companies. CRISPR-based detection methods are coupled with pre-existing preamplification and readout technologies, achieving sensitivity and reproducibility comparable to the current gold standard nucleic acid detection methods. Moreover, they are very versatile, can be easily implemented to detect emerging pathogens and new clinically relevant mutations, and offer multiplexing capability. The advantages of the CRISPR-based diagnostic approaches are a short sample-to-answer time and no requirement of laboratory settings; they are also much more affordable than current nucleic acid detection procedures. In this review, we summarize the applications and development trends of the CRISPR/Cas13 system in the identification of particular pathogens and mutations and discuss the challenges and future prospects of CRISPR-based diagnostic platforms in biomedicine.


Subject(s)
Diagnostic Techniques and Procedures/trends , Disease/genetics , Gene Editing/methods , COVID-19/genetics , CRISPR-Cas Systems/genetics , DNA/genetics , Diagnosis , Humans , Reproducibility of Results , SARS-CoV-2/genetics , SARS-CoV-2/pathogenicity
3.
Clin Infect Dis ; 74(2): 271-277, 2022 01 29.
Article in English | MEDLINE | ID: covidwho-1662113

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused one of the worst pandemics in recent history. Few reports have revealed that SARS-CoV-2 was spreading in the United States as early as the end of January. In this study, we aimed to determine if SARS-CoV-2 had been circulating in the Los Angeles (LA) area at a time when access to diagnostic testing for coronavirus disease 2019 (COVID-19) was severely limited. METHODS: We used a pooling strategy to look for SARS-CoV-2 in remnant respiratory samples submitted for regular respiratory pathogen testing from symptomatic patients from November 2019 to early March 2020. We then performed sequencing on the positive samples. RESULTS: We detected SARS-CoV-2 in 7 specimens from 6 patients, dating back to mid-January. The earliest positive patient, with a sample collected on January 13, 2020 had no relevant travel history but did have a sibling with similar symptoms. Sequencing of these SARS-CoV-2 genomes revealed that the virus was introduced into the LA area from both domestic and international sources as early as January. CONCLUSIONS: We present strong evidence of community spread of SARS-CoV-2 in the LA area well before widespread diagnostic testing was being performed in early 2020. These genomic data demonstrate that SARS-CoV-2 was being introduced into Los Angeles County from both international and domestic sources in January 2020.


Subject(s)
COVID-19 , SARS-CoV-2 , Diagnostic Techniques and Procedures , Humans , Los Angeles/epidemiology , Retrospective Studies
4.
Int Urol Nephrol ; 54(3): 493-498, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1653676

ABSTRACT

The COVID-19 pandemic and subsequent lockdown had a substantial impact on normal research operations. Researchers needed to adapt their methods to engage at-home participants. One method is crowdsourcing, in which researchers use social media to recruit participants, gather data, and collect samples. We utilized this method to develop a diagnostic test for Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). Participants were recruited via posts on popular social-media platforms, and enrolled via a website. Participants received and returned a mail kit containing bladder symptom surveys and a urine sample cup containing room-temperature preservative. Using this method, we collected 1254 IC/BPS and control samples in 3 months from all 50 United States. Our data demonstrate that crowdsourcing is a viable alternative to traditional research, with the ability to reach a broad patient population rapidly. Crowdsourcing is a powerful tool for at-home participation in research, particularly during the lockdown caused by the COVID-19 pandemic.


Subject(s)
Biomedical Research , COVID-19 , Crowdsourcing/methods , Cystitis, Interstitial , Patient Participation , Urinalysis , Biomedical Research/organization & administration , Biomedical Research/trends , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Cystitis, Interstitial/diagnosis , Cystitis, Interstitial/epidemiology , Diagnostic Techniques and Procedures/trends , Female , Humans , Male , Middle Aged , Patient Participation/methods , Patient Participation/statistics & numerical data , Patient Selection , Reagent Kits, Diagnostic/supply & distribution , Research Design , SARS-CoV-2 , Social Media , Specimen Handling/methods , United States/epidemiology , Urinalysis/instrumentation , Urinalysis/methods
6.
J Ethnopharmacol ; 285: 114905, 2022 Mar 01.
Article in English | MEDLINE | ID: covidwho-1611829

ABSTRACT

ETHNOPHARMACOLOGICAL RELEVANCE: Tongue coating has been used as an effective signature of health in traditional Chinese medicine (TCM). The level of greasy coating closely relates to the strength of dampness or pathogenic qi in TCM theory. Previous empirical studies and our systematic review have shown the relation between greasy coating and various diseases, including gastroenteropathy, coronary heart disease, and coronavirus disease 2019 (COVID-19). However, the objective and intelligent greasy coating and related diseases recognition methods are still lacking. The construction of the artificial intelligent tongue recognition models may provide important syndrome diagnosis and efficacy evaluation methods, and contribute to the understanding of ethnopharmacological mechanisms based on TCM theory. AIM OF THE STUDY: The present study aimed to develop an artificial intelligent model for greasy tongue coating recognition and explore its application in COVID-19. MATERIALS AND METHODS: Herein, we developed greasy tongue coating recognition networks (GreasyCoatNet) using convolutional neural network technique and a relatively large (N = 1486) set of tongue images from standard devices. Tests were performed using both cross-validation procedures and a new dataset (N = 50) captured by common cameras. Besides, the accuracy and time efficiency comparisons between the GreasyCoatNet and doctors were also conducted. Finally, the model was transferred to recognize the greasy coating level of COVID-19. RESULTS: The overall accuracy in 3-level greasy coating classification with cross-validation was 88.8% and accuracy on new dataset was 82.0%, indicating that GreasyCoatNet can obtain robust greasy coating estimates from diverse datasets. In addition, we conducted user study to confirm that our GreasyCoatNet outperforms TCM practitioners, yet only consuming roughly 1% of doctors' examination time. Critically, we demonstrated that GreasyCoatNet, along with transfer learning, can construct more proper classifier of COVID-19, compared to directly training classifier on patient versus control datasets. We, therefore, derived a disease-specific deep learning network by finetuning the generic GreasyCoatNet. CONCLUSIONS: Our framework may provide an important research paradigm for differentiating tongue characteristics, diagnosing TCM syndrome, tracking disease progression, and evaluating intervention efficacy, exhibiting its unique potential in clinical applications.


Subject(s)
COVID-19 , Diagnostic Techniques and Procedures , Ethnopharmacology/methods , Medicine, Chinese Traditional/methods , Tongue , Artificial Intelligence , COVID-19/diagnosis , COVID-19/therapy , Humans , Neural Networks, Computer , Outcome Assessment, Health Care/methods , Qi , SARS-CoV-2 , Tongue/microbiology , Tongue/pathology
7.
Emerg Infect Dis ; 28(1): 148-156, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1581412

ABSTRACT

We compared case definitions for suspected, probable, and confirmed coronavirus disease (COVID-19), as well as diagnostic testing criteria, used in the 25 countries with the highest reported case counts as of October 1, 2020. Of the identified countries, 56% followed World Health Organization (WHO) recommendations for using a combination of clinical and epidemiologic criteria as part of the suspected case definition. A total of 75% of identified countries followed WHO recommendations on using clinical, epidemiologic, and diagnostic criteria for probable cases; 72% followed WHO recommendations to use PCR testing to confirm COVID-19. Finally, 64% of countries used testing eligibility criteria at least as permissive as WHO. We observed marked heterogeneity in testing eligibility requirements and in how countries define a COVID-19 case. This heterogeneity affects the ability to compare case counts, transmission, and vaccine effectiveness, as well as estimates derived from case surveillance data across countries.


Subject(s)
COVID-19 , Diagnostic Techniques and Procedures , Humans , SARS-CoV-2 , World Health Organization
8.
J Med Internet Res ; 23(2): e22841, 2021 02 23.
Article in English | MEDLINE | ID: covidwho-1574897

ABSTRACT

BACKGROUND: Misdiagnosis, arbitrary charges, annoying queues, and clinic waiting times among others are long-standing phenomena in the medical industry across the world. These factors can contribute to patient anxiety about misdiagnosis by clinicians. However, with the increasing growth in use of big data in biomedical and health care communities, the performance of artificial intelligence (Al) techniques of diagnosis is improving and can help avoid medical practice errors, including under the current circumstance of COVID-19. OBJECTIVE: This study aims to visualize and measure patients' heterogeneous preferences from various angles of AI diagnosis versus clinicians in the context of the COVID-19 epidemic in China. We also aim to illustrate the different decision-making factors of the latent class of a discrete choice experiment (DCE) and prospects for the application of AI techniques in judgment and management during the pandemic of SARS-CoV-2 and in the future. METHODS: A DCE approach was the main analysis method applied in this paper. Attributes from different dimensions were hypothesized: diagnostic method, outpatient waiting time, diagnosis time, accuracy, follow-up after diagnosis, and diagnostic expense. After that, a questionnaire is formed. With collected data from the DCE questionnaire, we apply Sawtooth software to construct a generalized multinomial logit (GMNL) model, mixed logit model, and latent class model with the data sets. Moreover, we calculate the variables' coefficients, standard error, P value, and odds ratio (OR) and form a utility report to present the importance and weighted percentage of attributes. RESULTS: A total of 55.8% of the respondents (428 out of 767) opted for AI diagnosis regardless of the description of the clinicians. In the GMNL model, we found that people prefer the 100% accuracy level the most (OR 4.548, 95% CI 4.048-5.110, P<.001). For the latent class model, the most acceptable model consists of 3 latent classes of respondents. The attributes with the most substantial effects and highest percentage weights are the accuracy (39.29% in general) and expense of diagnosis (21.69% in general), especially the preferences for the diagnosis "accuracy" attribute, which is constant across classes. For class 1 and class 3, people prefer the AI + clinicians method (class 1: OR 1.247, 95% CI 1.036-1.463, P<.001; class 3: OR 1.958, 95% CI 1.769-2.167, P<.001). For class 2, people prefer the AI method (OR 1.546, 95% CI 0.883-2.707, P=.37). The OR of levels of attributes increases with the increase of accuracy across all classes. CONCLUSIONS: Latent class analysis was prominent and useful in quantifying preferences for attributes of diagnosis choice. People's preferences for the "accuracy" and "diagnostic expenses" attributes are palpable. AI will have a potential market. However, accuracy and diagnosis expenses need to be taken into consideration.


Subject(s)
Artificial Intelligence , Diagnosis , Patient Preference , Physicians , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , China , Choice Behavior , Diagnostic Techniques and Procedures/economics , Female , Health Expenditures , Humans , Latent Class Analysis , Logistic Models , Male , Middle Aged , Pandemics , SARS-CoV-2 , Surveys and Questionnaires , Time Factors , Young Adult
9.
Clin Infect Dis ; 73(10): 1822-1830, 2021 11 16.
Article in English | MEDLINE | ID: covidwho-1522141

ABSTRACT

BACKGROUND: Prompt identification of infections is critical for slowing the spread of infectious diseases. However, diagnostic testing shortages are common in emerging diseases, low resource settings, and during outbreaks. This forces difficult decisions regarding who receives a test, often without knowing the implications of those decisions on population-level transmission dynamics. Clinical prediction rules (CPRs) are commonly used tools to guide clinical decisions. METHODS: Using early severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) as an example, we used data from electronic health records to develop a parsimonious 5-variable CPR to identify those who are most likely to test positive. To consider the implications of gains in daily case detection at the population level, we incorporated testing using the CPR into a compartmentalized model of SARS-CoV-2. RESULTS: We found that applying this CPR (area under the curve, 0.69; 95% confidence interval, .68-.70) to prioritize testing increased the proportion of those testing positive in settings of limited testing capacity. We found that prioritized testing led to a delayed and lowered infection peak (ie, "flattens the curve"), with the greatest impact at lower values of the effective reproductive number (such as with concurrent community mitigation efforts), and when higher proportions of infectious persons seek testing. In addition, prioritized testing resulted in reductions in overall infections as well as hospital and intensive care unit burden. CONCLUSION: We highlight the population-level benefits of evidence-based allocation of limited diagnostic capacity.SummaryWhen the demand for diagnostic tests exceeds capacity, the use of a clinical prediction rule to prioritize diagnostic testing can have meaningful impact on population-level outcomes, including delaying and lowering the infection peak, and reducing healthcare burden.


Subject(s)
COVID-19 , SARS-CoV-2 , Clinical Decision Rules , Diagnostic Techniques and Procedures , Diagnostic Tests, Routine , Hospitals , Humans
10.
Circ Heart Fail ; 14(10): e008573, 2021 10.
Article in English | MEDLINE | ID: covidwho-1443687

ABSTRACT

BACKGROUND: An unprecedented shift to remote heart failure outpatient care occurred during the coronavirus disease 2019 (COVID-19) pandemic. Given challenges inherent to remote care, we studied whether remote visits (video or telephone) were associated with different patient usage, clinician practice patterns, and outcomes. METHODS: We included all ambulatory cardiology visits for heart failure at a multisite health system from April 1, 2019, to December 31, 2019 (pre-COVID) or April 1, 2020, to December 31, 2020 (COVID era), resulting in 10 591 pre-COVID in-person, 7775 COVID-era in-person, 1009 COVID-era video, and 2322 COVID-era telephone visits. We used multivariable logistic and Cox proportional hazards regressions with propensity weighting and patient clustering to study ordering practices and outcomes. RESULTS: Compared with in-person visits, video visits were used more often by younger (mean 64.7 years [SD 14.5] versus 74.2 [14.1]), male (68.3% versus 61.4%), and privately insured (45.9% versus 28.9%) individuals (P<0.05 for all). Remote visits were more frequently used by non-White patients (35.8% video, 37.0% telephone versus 33.2% in-person). During remote visits, clinicians were less likely to order diagnostic testing (odds ratio, 0.20 [0.18-0.22] video versus in-person, 0.18 [0.17-0.19] telephone versus in-person) or prescribe ß-blockers (0.82 [0.68-0.99], 0.35 [0.26-0.47]), mineralocorticoid receptor antagonists (0.69 [0.50-0.96], 0.48 [0.35-0.66]), or loop diuretics (0.67 [0.53-0.85], 0.45 [0.37-0.55]). During telephone visits, clinicians were less likely to prescribe ACE (angiotensin-converting enzyme) inhibitor/ARB (angiotensin receptor blockers)/ARNIs (angiotensin receptor-neprilysin inhibitors; 0.54 [0.40-0.72]). Telephone visits but not video visits were associated with higher rates of 90-day mortality (1.82 [1.14-2.90]) and nonsignificant trends towards higher rates of 90-day heart failure emergency department visits (1.34 [0.97-1.86]) and hospitalizations (1.36 [0.98-1.89]). CONCLUSIONS: Remote visits for heart failure care were associated with reduced diagnostic testing and guideline-directed medical therapy prescription. Telephone but not video visits were associated with increased 90-day mortality.


Subject(s)
COVID-19 , Cardiologists/trends , Heart Failure/therapy , Practice Patterns, Physicians'/trends , Telemedicine/trends , Aged , Aged, 80 and over , Diagnostic Techniques and Procedures/trends , Drug Prescriptions , Drug Utilization/trends , Emergency Service, Hospital/trends , Female , Guideline Adherence/trends , Heart Failure/diagnosis , Heart Failure/mortality , Heart Failure/physiopathology , Hospitalization/trends , Humans , Male , Middle Aged , Practice Guidelines as Topic , Telephone/trends , Time Factors , Treatment Outcome , Videoconferencing/trends
12.
Front Public Health ; 9: 640009, 2021.
Article in English | MEDLINE | ID: covidwho-1389254

ABSTRACT

A simple, common-sense, three-component procedure-the Carrier Separation Plan (CSP)-can immediately halt the transmission of SARS-CoV-2 or a comparable pathogen, allow the safe reopening of an entire economy without the need for social distancing, and quickly eradicate the pathogen from the population (assuming the pathogen can be killed by the immune systems of the carriers). The three components are (a) nearly simultaneous self-testing for the pathogen by an entire population, followed rapidly by (b) nearly simultaneous self-isolation of carriers, and (c) secondary screening at entrances to facilities where people congregate. After a period of preparation lasting roughly 5-10 weeks, these steps could and probably should be taken in a single day. The power of this methodology has already been demonstrated in varying degrees with groups ranging in size from 1,000 to 11 million. Although this plan might seem daunting, its costs are minimal compared to the losses we have incurred by relying on half measures, and the US and other countries have the technological, logistical, and industrial capacities to implement this plan in a matter of weeks. With proper messaging during the weeks leading up to the testing, compliance in such a program is likely to be high given the potential benefits, and because participation is voluntary and testing is noninvasive, the legal and ethical issues associated with such a program are minimal - trivial, in fact, compared to those associated with imposing a months-long lockdown on an entire population. A SIRD/CSP model suggests that the single-day testing and separation procedure will substantially lower the number of infections, even if compliance with the procedure is modest. Modeling also suggests that when long-term secondary screening is added to the 1-day procedure, over time, the pathogen is eradicated from the population. This can occur even when compliance with secondary screening is itself relatively low.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/methods , Diagnostic Techniques and Procedures/standards , Mass Screening/methods , Physical Distancing , Population Surveillance/methods , Public Health/standards , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Models, Theoretical , Practice Guidelines as Topic , SARS-CoV-2
14.
Epidemiology ; 32(6): 811-819, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1320344

ABSTRACT

BACKGROUND: SARS-CoV-2 antigen-detection rapid diagnostic tests can diagnose COVID-19 rapidly and at low cost, but lower sensitivity compared with reverse-transcriptase polymerase chain reaction (PCR) has limited clinical adoption. METHODS: We compared antigen testing, PCR testing, and clinical judgment alone for diagnosing symptomatic COVID-19 in an outpatient setting (10% COVID-19 prevalence among the patients tested, 3-day PCR turnaround) and a hospital setting (40% prevalence, 24-hour PCR turnaround). We simulated transmission from cases and contacts, and relationships between time, viral burden, transmission, and case detection. We compared diagnostic approaches using a measure of net benefit that incorporated both clinical and public health benefits and harms of the intervention. RESULTS: In the outpatient setting, we estimated that using antigen testing instead of PCR to test 200 individuals could be equivalent to preventing all symptomatic transmission from one person with COVID-19 (one "transmission-equivalent"). In a hospital, net benefit analysis favored PCR and testing 25 patients with PCR instead of antigen testing achieved one transmission-equivalent of benefit. In both settings, antigen testing was preferable to PCR if PCR turnaround time exceeded 2 days. Both tests provided greater net benefit than management based on clinical judgment alone unless intervention carried minimal harm and was provided equally regardless of diagnostic approach. CONCLUSIONS: For diagnosis of symptomatic COVID-19, we estimated that the speed of diagnosis with antigen testing is likely to outweigh its lower accuracy compared with PCR, wherever PCR turnaround time is 2 days or longer. This advantage may be even greater if antigen tests are also less expensive.


Subject(s)
COVID-19 , Diagnostic Techniques and Procedures , Diagnostic Tests, Routine , Humans , SARS-CoV-2 , Sensitivity and Specificity
15.
Infect Control Hosp Epidemiol ; 42(7): 864-868, 2021 07.
Article in English | MEDLINE | ID: covidwho-1316684

ABSTRACT

Rapid diagnostic testing (RDT) can provide prompt, accurate identification of infectious organisms and be a key component of antimicrobial stewardship (AMS) programs. However, their use is less widespread in Asia Pacific than western countries. Cost can be prohibitive, particularly in less resource-replete settings. A selective approach is required, possibly focusing on the initiation of antimicrobials, for differentiating bacterial versus viral infections and identifying locally relevant tropical diseases. Across Asia Pacific, more data are needed on RDT use within AMS, focusing on the impact on antimicrobial usage, patient morbidity and mortality, and cost effectiveness. Moreover, in the absence of formal guidelines, regional consensus statements to guide clinical practice are warranted. These will provide a regionally relevant definition for RDT; greater consensus on its role in managing infections; advice on implementation and overcoming barriers; and guidance on optimizing human resource capacity. By addressing these issues, the outcomes of AMS programs should improve.


Subject(s)
Anti-Infective Agents , Antimicrobial Stewardship , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents/therapeutic use , Asia , Diagnostic Techniques and Procedures , Humans
16.
Foot Ankle Spec ; 14(5): 453-457, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1277892

ABSTRACT

The era of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is rapidly evolving. To comply to the guidelines for social distancing and reducing travel to prevent the spread of disease, many centers made rapid adjustments to conduct follow-up appointments through telehealth mediums. We explore our center's adaptation to the pandemic, reflecting on how we formulated telehealth clinics for our patients. We share our experience, discuss the challenges encountered, the feedback received, as well as consider the future role of telehealth in everyday orthopaedic practice.Levels of Evidence: Level V.


Subject(s)
Ankle , COVID-19/epidemiology , Diagnostic Techniques and Procedures , Foot Diseases/diagnosis , Orthopedics/methods , Pandemics , Telemedicine/methods , Comorbidity , Foot Diseases/epidemiology , Humans , SARS-CoV-2
18.
Am J Epidemiol ; 190(9): 1908-1917, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1172642

ABSTRACT

Estimates of the reproductive number for novel pathogens, such as severe acute respiratory syndrome coronavirus 2, are essential for understanding the potential trajectory of epidemics and the levels of intervention that are needed to bring the epidemics under control. However, most methods for estimating the basic reproductive number (R0) and time-varying effective reproductive number (Rt) assume that the fraction of cases detected and reported is constant through time. We explored the impact of secular changes in diagnostic testing and reporting on estimates of R0 and Rt using simulated data. We then compared these patterns to data on reported cases of coronavirus disease 2019 and testing practices from different states in the United States from March 4, 2020, to August 30, 2020. We found that changes in testing practices and delays in reporting can result in biased estimates of R0 and Rt. Examination of changes in the daily numbers of tests conducted and the percentages of patients who tested positive might be helpful for identifying the potential direction of bias. Changes in diagnostic testing and reporting processes should be monitored and taken into consideration when interpreting estimates of the reproductive number of coronavirus disease.


Subject(s)
COVID-19/diagnosis , COVID-19/epidemiology , Basic Reproduction Number , COVID-19/transmission , Computer Simulation , Diagnostic Techniques and Procedures , Documentation , Epidemics , Humans , Models, Theoretical , Reproducibility of Results , SARS-CoV-2 , United States/epidemiology
19.
Crit Care ; 24(1): 642, 2020 11 10.
Article in English | MEDLINE | ID: covidwho-916979

ABSTRACT

BACKGROUND: Invasive pulmonary aspergillosis (IPA) is an increasingly recognized complication in intensive care unit (ICU) patients, especially those with influenza, cirrhosis, chronic obstructive pulmonary disease, and other diseases. The diagnosis can be challenging, especially in the ICU, where clinical symptoms as well as imaging are mostly nonspecific. Recently, Aspergillus lateral flow tests were developed to decrease the time to diagnosis of IPA. Several studies have shown promising results in bronchoalveolar lavage fluid (BALf) from hematology patients. We therefore evaluated a new lateral flow test for IPA in ICU patients. METHODS: Using left-over BALf from adult ICU patients in two university hospitals, we studied the performance of the Aspergillus galactomannan lateral flow assay (LFA) by IMMY (Norman, OK, USA). Patients were classified according to the 2008 EORTC-MSG definitions, the AspICU criteria, and the modified AspICU criteria, which incorporate galactomannan results. These internationally recognized consensus definitions for the diagnosis of IPA incorporate patient characteristics, microbiology and radiology. The LFA was read out visually and with a digital reader by researchers blinded to the final clinical diagnosis and IPA classification. RESULTS: We included 178 patients, of which 55 were classified as cases (6 cases of proven and 26 cases of probable IPA according to the EORTC-MSG definitions, and an additional 23 cases according to the modified AspICU criteria). Depending on the definitions used, the sensitivity of the LFA was 0.88-0.94, the specificity was 0.81, and the area under the ROC curve 0.90-0.94, indicating good overall test performance. CONCLUSIONS: In ICU patients, the LFA performed well on BALf and can be used as a rapid screening test while waiting for other microbiological results.


Subject(s)
Diagnostic Techniques and Procedures/standards , Invasive Pulmonary Aspergillosis/diagnosis , Aged , Belgium/epidemiology , Diagnostic Techniques and Procedures/statistics & numerical data , Female , Humans , Intensive Care Units/organization & administration , Intensive Care Units/statistics & numerical data , Invasive Pulmonary Aspergillosis/epidemiology , Male , Middle Aged , Netherlands/epidemiology , Point-of-Care Testing , ROC Curve , Sensitivity and Specificity , Time Factors
20.
Bull World Health Organ ; 99(4): 312-318, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1167260

ABSTRACT

Since January 2020, the coronavirus disease 2019 (COVID-19) pandemic has had a far-reaching impact on global morbidity and mortality. The effects of varying degrees of implementation of public health and social measures between countries is evident in terms of widely differing disease burdens and levels of disruption to public health systems. Despite Thailand being the first country outside China to report a positive case of COVID-19, the subsequent number of cases and deaths has been much lower than in many other countries. As of 7 January 2021, the number of confirmed COVID-19-positive cases in Thailand was 9636 (138 per million population) and the number of deaths was 67 (1 per million population). We describe the nature of the health workforce and function that facilitated the capacity to respond to this pandemic. We also describe the public health policies (laboratory testing, test-and-trace system and mandatory 14-day quarantine of cases) and social interventions (daily briefings, restriction of mobility and social gatherings, and wearing of face masks) that allowed the virus to be successfully contained. To enhance the capacity of health-care workers to respond to the pandemic, the government (i) mobilized staff to meet the required surge capacity; (ii) developed and implemented policies to protect occupational safety; and (iii) initiated packages to support morale and well-being. The results of the policies that we describe are evident in the data: of the 66 countries with more than 100 COVID-19-positive cases in health-care workers as at 8 May 2020, Thailand ranked 65th.


Depuis janvier 2020, la pandémie de maladie à coronavirus (COVID-19) a eu un impact considérable sur la morbidité et la mortalité à l'échelle globale. Les degrés de mise en œuvre des mesures sociales et sanitaires, qui varient d'un pays à l'autre, ont des conséquences évidentes, notamment sur les différences de charge que représente la maladie et sur l'ampleur des perturbations touchant les systèmes de santé publique. Même si la Thaïlande est, après la Chine, la première nation à avoir signalé un cas positif de COVID-19, le nombre de cas et de décès qui ont suivi a été nettement moins élevé que dans de nombreux autres pays. Au 7 janvier 2021, la Thaïlande comptait 9636 cas positifs confirmés de COVID-19 (138 par million d'habitants) et 67 décès (1,0 par million d'habitants). Dans le présent document, nous décrivons la nature des professionnels de santé et des fonctions qui ont renforcé les capacités de réaction face à cette pandémie. Nous détaillons également les politiques de santé publique (tests en laboratoire, système de dépistage et de suivi, quarantaine obligatoire de 14 jours pour les cas détectés) et les interventions sociales (séances d'information quotidiennes, restriction des déplacements et des rassemblements, port du masque) qui ont permis de contenir le virus avec succès. Afin d'aider les soignants à lutter contre la pandémie, le gouvernement (i) a mobilisé du personnel pour fournir les capacités d'intervention requises; (ii) a développé et appliqué des mesures de protection pour garantir la sécurité au travail; et enfin, (iii) a proposé des programmes de soutien au moral et au bien-être. Les politiques que nous évoquons se traduisent par des résultats sans équivoque: sur les 66 pays dépassant les 100 cas positifs de COVID-19 chez les professionnels de santé au 8 mai 2020, la Thaïlande se classait à la 65e place.


Desde enero de 2020, la pandemia de la enfermedad por coronavirus (COVID-19) ha tenido un impacto de gran alcance en la morbilidad y la mortalidad mundial. Los efectos de los diferentes grados de aplicación de las medidas sociales y de salud pública entre los países son evidentes en términos de cargas virales muy diferentes y niveles de perturbación de los sistemas de salud pública. A pesar de que Tailandia fue el primer país fuera de China en notificar un caso positivo de COVID-19, el número posterior de casos y muertes ha sido mucho menor que en muchos otros países. Hasta el 7 de enero de 2021, el número de casos positivos confirmados de COVID-19 en Tailandia era de 9.636 (138 por millón de población) y el número de muertes era de 67 (1,0 por millón de población). Describimos la naturaleza del personal sanitario y la función que facilitó la capacidad de respuesta a esta pandemia. También describimos las políticas de salud pública (pruebas de laboratorio, sistema de prueba y rastreo y cuarentena obligatoria de 14 días), así como las intervenciones sociales (sesiones informativas diarias, restricción de la movilidad y de las reuniones sociales, uso de mascarillas, etc.) que permitieron contener el virus con éxito. Para mejorar la capacidad de los trabajadores sanitarios para responder a la pandemia, el gobierno (i) movilizó al personal para satisfacer la capacidad de respuesta requerida; (ii) desarrolló y aplicó políticas para proteger la seguridad laboral; y (iii) puso en marcha paquetes para apoyar la moral y el bienestar de la población. Los resultados de las políticas que describimos son evidentes en los datos: de los 66 países con más de 100 casos positivos de COVID-19 en trabajadores sanitarios a 8 de mayo de 2020, Tailandia ocupaba el puesto 65.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/organization & administration , Health Personnel/organization & administration , Health Policy , Diagnostic Techniques and Procedures , Humans , Mental Health , Occupational Health , Pandemics , SARS-CoV-2 , Thailand
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