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1.
Panminerva Med ; 63(3): 324-331, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1504553

ABSTRACT

BACKGROUND: New messenger RNA (mRNA) and adenovirus-based vaccines (AdV) against Coronavirus disease 2019 (COVID-19) have entered large scale clinical trials. Since healthcare professionals (HCPs) and armed forces personnel (AFP) represent a high-risk category, they act as a suitable target population to investigate vaccine-related side effects, including headache, which has emerged as a common complaint. METHODS: We investigated the side-effects of COVID-19 vaccines among HCPs and AFP through a 38 closed-question international survey. The electronic link was distributed via e-mail or via Whatsapp to more than 500 contacts. Responses to the survey questions were analyzed with bivariate tests. RESULTS: A total of 375 complete surveys have been analyzed. More than 88% received an mRNA vaccine and 11% received AdV first dose. A second dose of mRNA vaccine was administered in 76% of individuals. No severe adverse effects were reported, whereas moderate reactions and those lasting more than 1 day were more common with AdV (P=0.002 and P=0.024 respectively). Headache was commonly reported regardless of the vaccine type, but less frequently, with shorter duration and lower severity that usually experienced by participants, without significant difference irrespective of vaccine type. CONCLUSIONS: Both mRNA and AdV COVID-19 vaccines were safe and well tolerated in a real-life subset of HCPs and AFP subjects.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Headache/chemically induced , Vaccination/adverse effects , Adolescent , Adult , Aged , COVID-19/transmission , Cross-Sectional Studies , Female , Headache/diagnosis , Headache/epidemiology , Health Care Surveys , Health Personnel , Humans , Incidence , Male , Middle Aged , Occupational Health , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Young Adult
2.
Ann R Coll Surg Engl ; 103(9): 694-700, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1480440

ABSTRACT

INTRODUCTION: The Vascular Society of Great Britain and Ireland (VSGBI) Peripheral Arterial Disease Quality Improvement Framework (PAD QIF) stipulates targets for managing patients with chronic limb-threatening ischaemia (CLTI); however, it is unknown whether these are achievable. This survey aims to evaluate contemporary practice for managing CLTI in the UK. METHODS: A questionnaire was developed in conjunction with the VSGBI to survey the management of CLTI and canvass opinions on the PAD QIF. The survey was distributed to all consultant members of the VSGBI and through a targeted social media campaign. RESULTS: Forty-seven consultant vascular surgeons based at 36 arterial centres across the UK responded (response rate from arterial centres = 46%). Only 14.3% of centres provided outpatient consultation within the target of seven days from referral, with only one centre providing revascularisation within the target of seven days from consultation. For inpatient management, 31.6% provided surgical and 23.8% endovascular revascularisation within the target of three days from assessment. While 60% of participants believe the PAD QIF's 5-day 'admitted care' pathway is achievable, only 28.6% thought the 14-day 'non-admitted care' pathway was feasible. Challenges to meeting these targets include the availability of theatre space and angiography lists, and availability of outpatient appointments for patient assessment. CONCLUSIONS: The opinion of UK vascular surgeons indicates that achieving the targets of the PAD QIF represents a major challenge based upon current services. Adapting existing services with a greater focus on providing an 'urgent' model of care may help to potentially overcome these challenges.


Subject(s)
Ischemia/surgery , Lower Extremity/blood supply , Lower Extremity/surgery , Peripheral Arterial Disease/surgery , Practice Patterns, Physicians' , Specialties, Surgical , Vascular Surgical Procedures , Chronic Disease , Health Care Surveys , Humans , Limb Salvage , United Kingdom
3.
Hong Kong Med J ; 26(3): 176-183, 2020 06.
Article in English | MEDLINE | ID: covidwho-1468777

ABSTRACT

INTRODUCTION: This study evaluated the preparedness of family doctors during the early phase of the coronavirus disease 2019 (COVID-19) outbreak in Hong Kong. METHODS: All members of the Hong Kong College of Family Physicians were invited to participate in a cross-sectional online survey using a 20-item questionnaire to collect information on practice preparedness for the COVID-19 outbreak through an email followed by a reminder SMS message between 31 January 2020 and 3 February 2020. RESULTS: Of 1589 family doctors invited, 491 (31%) participated in the survey, including 242 (49%) from private sector. In all, 98% surveyed doctors continued to provide clinical services during the survey period, but reduced clinic service demands were observed in 45% private practices and 24% public clinics. Almost all wore masks during consultation and washed hands between or before patient contact. Significantly more private than public doctors (80% vs 26%, P<0.001) experienced difficulties in stocking personal protective equipment (PPE); more public doctors used guidelines to manage suspected patients. The main concern of the respondents was PPE shortage. Respondents appealed for effective public health interventions including border control, quarantine measures, designated clinic setup, and public education. CONCLUSION: Family doctors from public and private sectors demonstrated preparedness to serve the community from the early phase of the COVID-19 outbreak with heightened infection control measures and use of guidelines. However, there is a need for support from local health authorities to secure PPE supply and institute public health interventions.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Disease Outbreaks/prevention & control , Family Practice/organization & administration , Health Care Surveys/methods , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Surveys and Questionnaires , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Clinical Laboratory Techniques/statistics & numerical data , Communicable Disease Control/methods , Coronavirus Infections/diagnosis , Disease Outbreaks/statistics & numerical data , Female , Hong Kong/epidemiology , Humans , Male , Outcome Assessment, Health Care , Physicians, Family/statistics & numerical data
4.
MMWR Morb Mortal Wkly Rep ; 70(41): 1435-1440, 2021 Oct 15.
Article in English | MEDLINE | ID: covidwho-1468852

ABSTRACT

Immunization is a safe and cost-effective means of preventing illness in young children and interrupting disease transmission within the community.* The Advisory Committee on Immunization Practices (ACIP) recommends vaccination of children against 14 diseases during the first 24 months of life (1). CDC uses National Immunization Survey-Child (NIS-Child) data to monitor routine coverage with ACIP-recommended vaccines in the United States at the national, regional, state, territorial, and selected local levels.† CDC assessed vaccination coverage by age 24 months among children born in 2017 and 2018, with comparisons to children born in 2015 and 2016. Nationally, coverage was highest for ≥3 doses of poliovirus vaccine (92.7%); ≥3 doses of hepatitis B vaccine (HepB) (91.9%); ≥1 dose of measles, mumps, and rubella vaccine (MMR) (91.6%); and ≥1 dose of varicella vaccine (VAR) (90.9%). Coverage was lowest for ≥2 doses of influenza vaccine (60.6%). Coverage among children born in 2017-2018 was 2.1-4.5 percentage points higher than it was among those born in 2015-2016 for rotavirus vaccine, ≥1 dose of hepatitis A vaccine (HepA), the HepB birth dose, and ≥2 doses of influenza vaccine. Only 1.0% of children had received no vaccinations by age 24 months. Disparities in coverage were seen for race/ethnicity, poverty status, and health insurance status. Coverage with most vaccines was lower among children who were not privately insured. The largest disparities between insurance categories were among uninsured children, especially for ≥2 doses of influenza vaccine, the combined 7-vaccine series, § and rotavirus vaccination. Reported estimates reflect vaccination opportunities that mostly occurred before disruptions resulting from the COVID-19 pandemic. Extra efforts are needed to ensure that children who missed vaccinations, including those attributable to the COVID-19 pandemic, receive them as soon as possible to maintain protection against vaccine-preventable illnesses.


Subject(s)
Vaccination Coverage/statistics & numerical data , Vaccines/administration & dosage , /statistics & numerical data , Health Care Surveys , Healthcare Disparities/statistics & numerical data , Humans , Immunization Schedule , Infant , Insurance, Health/statistics & numerical data , Poverty/statistics & numerical data , United States
5.
MMWR Morb Mortal Wkly Rep ; 70(39): 1365-1371, 2021 Oct 01.
Article in English | MEDLINE | ID: covidwho-1444553

ABSTRACT

Estimates from the 2019 American Community Survey (ACS) indicated that 15.2% of adults aged ≥18 years had at least one reported functional disability (1). Persons with disabilities are more likely than are those without disabilities to have chronic health conditions (2) and also face barriers to accessing health care (3). These and other health and social inequities have placed persons with disabilities at increased risk for COVID-19-related illness and death, yet they face unique barriers to receipt of vaccination (4,5). Although CDC encourages that considerations be made when expanding vaccine access to persons with disabilities,* few public health surveillance systems measure disability status. To describe COVID-19 vaccination status and intent, as well as perceived vaccine access among adults by disability status, data from the National Immunization Survey Adult COVID Module (NIS-ACM) were analyzed. Adults with a disability were less likely than were those without a disability to report having received ≥1 dose of COVID-19 vaccine (age-adjusted prevalence ratio [aPR] = 0.88; 95% confidence interval [CI] = 0.84-0.93) but more likely to report they would definitely get vaccinated (aPR = 1.86; 95% CI = 1.43-2.42). Among unvaccinated adults, those with a disability were more likely to report higher endorsement of vaccine as protection (aPR = 1.29; 95% CI = 1.16-1.44), yet more likely to report it would be or was difficult to get vaccinated than did adults without a disability (aPR = 2.69; 95% CI = 2.16-3.34). Reducing barriers to vaccine scheduling and making vaccination sites more accessible might improve vaccination rates among persons with disabilities.


Subject(s)
COVID-19 Vaccines/administration & dosage , Disabled Persons/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Vaccination/psychology , Vaccination/statistics & numerical data , Adolescent , Adult , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Female , Health Care Surveys , Humans , Intention , Male , Middle Aged , United States/epidemiology , Young Adult
6.
Int J Immunopathol Pharmacol ; 35: 20587384211044344, 2021.
Article in English | MEDLINE | ID: covidwho-1440890

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has changed many aspects of everyday life. Patients with primary immunodeficiency (PID) are in a particularly difficult situation. The purpose of the present study was to contribute to the very limited research on the everyday aspects of functioning in PID patients during the COVID-19 pandemic. METHODS: The survey included 85 adult PID patients treated with immunoglobulin replacement therapy in four reference centers for immunology. Everyday functioning of the patients as well as their opinion concerning new solutions in medical care were analyzed. RESULTS: During the pandemic, the percentage of patients experiencing fear/anxiety has increased from 47% to 70%. The wide dissemination of information about the SARS-CoV-2 in the media has increased anxiety in 40% of the patients. Patients diagnosed with PID were most afraid of the exposure to contact with strangers, especially in public places. As many as 67 respondents (79%) considered the introduction of restrictions concerning social functioning as good. Only every fifth person learned about the pandemic from reliable sources. Eighty three percent of the patients receiving immunoglobulin substitution experienced less fear of SARS-CoV-2 infection. The patients positively evaluated the solutions related to the direct delivery of drugs to the place of residence in order to continue home IgRT therapy. Fifty three respondents (62.5%) believed that the possibility of a remote consultation was a very good solution. CONCLUSION: It is necessary to increase educational activities concerning the pandemic provided by health care professionals, as patients obtain information mainly from the media and the Internet, which adversely affects the feeling of anxiety. The pandemic, in addition to the very negative impact on patients and the deterioration of their daily functioning, has made patients appreciate their life more, devote more time to family and friends, and do things they like.


Subject(s)
Activities of Daily Living , COVID-19 , Immunocompromised Host , Immunoglobulin G/therapeutic use , Primary Immunodeficiency Diseases/drug therapy , Access to Information , Adult , Affect , Anxiety/etiology , Anxiety/psychology , Cost of Illness , Drug Substitution , Fear , Female , Health Care Surveys , Health Knowledge, Attitudes, Practice , Humans , Immunoglobulin G/adverse effects , Male , Middle Aged , Patient Education as Topic , Poland , Primary Immunodeficiency Diseases/diagnosis , Primary Immunodeficiency Diseases/immunology , Primary Immunodeficiency Diseases/psychology , Social Behavior , Telemedicine , Treatment Outcome
7.
J Healthc Manag ; 66(1): 63-74, 2021.
Article in English | MEDLINE | ID: covidwho-1402712

ABSTRACT

EXECUTIVE SUMMARY: Shifts in healthcare policy, patient consumerism, and organizational consolidation are driving the need for hospitals and health systems to adapt if they are to achieve sustainability. Prior research has suggested that businesses with strong leadership development practices also demonstrate greater financial success and competitive performance. However, few studies have examined the impact of leadership development on organization-level outcomes, generally, or in the healthcare industry, specifically.Our goal in this study was to examine the association between organizational leadership development practices and external perceptions of creditworthiness in the form of bond ratings. Data were drawn from the 2014 and 2016 distributions of the National Center for Healthcare Leadership's National Health Leadership Survey; organizational credit ratings were obtained from Moody's Investors Service and S&P Global Solutions. Spearman's rho correlations and polynomial ranked regressions were used to determine the significance of the relationships between leadership development practices and bond ratings. Results provide preliminary evidence of associations between investing in leadership development and organizational creditworthiness. They also suggest, however, that the most financially successful health systems may de-emphasize certain kinds of leadership development practices relative to their peers. We discuss implications of these findings for organizational leaders investing in human capital as well as healthcare executives evaluating the development potential of prospective employers.


Subject(s)
Hospitals , Leadership , Delivery of Health Care , Health Care Surveys , Humans , Prospective Studies
8.
MMWR Morb Mortal Wkly Rep ; 70(35): 1183-1190, 2021 Sep 03.
Article in English | MEDLINE | ID: covidwho-1395455

ABSTRACT

The Advisory Committee on Immunization Practices (ACIP) recommends that adolescents aged 11-12 years routinely receive tetanus, diphtheria, and acellular pertussis (Tdap); meningococcal conjugate (MenACWY); and human papillomavirus (HPV) vaccines. Catch-up vaccination is recommended for hepatitis B (HepB); hepatitis A (HepA); measles, mumps, and rubella (MMR); and varicella (VAR) vaccines for adolescents whose childhood vaccinations are not current. Adolescents are also recommended to receive a booster dose of MenACWY vaccine at age 16 years, and shared clinical decision-making is recommended for the serogroup B meningococcal vaccine (MenB) for persons aged 16-23 years (1). To estimate coverage with recommended vaccines, CDC analyzed data from the 2020 National Immunization Survey-Teen (NIS-Teen) for 20,163 adolescents aged 13-17 years.* Coverage with ≥1 dose of HPV vaccine increased from 71.5% in 2019 to 75.1% in 2020. The percentage of adolescents who were up to date† with HPV vaccination (HPV UTD) increased from 54.2% in 2019 to 58.6% in 2020. Coverage with ≥1 dose of Tdap, ≥1 dose (and among adolescents aged 17 years, ≥2 doses) of MenACWY remained similar to coverage in 2019 (90.1%, 89.3%, and 54.4% respectively). Coverage increased for ≥2 doses of HepA among adolescents aged 13-17 years and ≥1 dose of MenB among adolescents aged 17 years. Adolescents living below the federal poverty level§ had higher HPV vaccination coverage than adolescents living at or above the poverty level. Adolescents living outside a metropolitan statistical area (MSA)¶ had lower coverage with ≥1 MenACWY and ≥1 HPV dose, and a lower proportion being HPV UTD than adolescents in MSA principal cities. In 2020, the COVID-19 pandemic disrupted routine immunization services. Results from the 2020 NIS-Teen reflect adolescent vaccination coverage before the COVID-19 pandemic. The 2020 NIS-Teen data could be used to assess the impact of the COVID-19 pandemic on catch-up vaccination but not on routine adolescent vaccination because adolescents included in the survey were aged ≥13 years, past the age when most routine adolescent vaccines are recommended, and most vaccinations occurred before March 2020. Continued efforts to reach adolescents whose routine medical care has been affected by the COVID-19 pandemic are necessary to protect persons and communities from vaccine-preventable diseases and outbreaks.


Subject(s)
Diphtheria-Tetanus-acellular Pertussis Vaccines/administration & dosage , Meningococcal Vaccines/administration & dosage , Papillomavirus Vaccines/administration & dosage , Vaccination Coverage/statistics & numerical data , Adolescent , Advisory Committees , COVID-19/epidemiology , Centers for Disease Control and Prevention, U.S. , Female , Health Care Surveys , Humans , Immunization Schedule , Male , Practice Guidelines as Topic , Socioeconomic Factors , United States/epidemiology , Vaccines, Conjugate/administration & dosage
9.
South Med J ; 114(9): 593-596, 2021 09.
Article in English | MEDLINE | ID: covidwho-1395358

ABSTRACT

OBJECTIVES: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, many US clinics have shifted some or all of their practice from in-person to virtual visits. In this study, we assessed the use of telehealth among primary care and specialty clinics, by targeting healthcare administrators via multiple channels. METHODS: Using an online survey, we assessed the use of, barriers to, and reimbursement for telehealth. Respondents included clinic administrators (chief executive officers, vice presidents, directors, and senior-level managers). RESULTS: A total of 85 complete responses were recorded, 79% of which represented solo or group practices and 63% reported a daily patient census >50. The proportion of clinics that delivered ≥50% of their consults using telehealth increased from 16% in March to 42% in April, 35% in May, and 30% in June. Clinics identified problems with telehealth reimbursement; although 63% of clinics reported that ≥75% of their telehealth consults were reimbursed, only 51% indicated that ≥75% of their telehealth visits were reimbursed at par with in-person office visits. Sixty-five percent of clinics reported having basic or foundational telehealth services, whereas only 9% of clinics reported advanced telehealth maturity. Value-based care participating clinics were more likely to report advanced telehealth services (27%), compared with non-value-based care clinics (3%). CONCLUSIONS: These findings highlight the adaptability of clinics to quickly transition and adopt telehealth. Uncertainty about reimbursement and policy changes may make the shift temporal, however.


Subject(s)
COVID-19/prevention & control , Medicine/statistics & numerical data , Mental Health Services/statistics & numerical data , Primary Health Care/statistics & numerical data , Telemedicine/statistics & numerical data , Health Care Surveys , Humans , Medicine/methods , Primary Health Care/methods , SARS-CoV-2 , Telemedicine/methods , Texas
10.
S Afr Fam Pract (2004) ; 63(1): e1-e6, 2021 08 26.
Article in English | MEDLINE | ID: covidwho-1395089

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented international emergency, resulting in a need to adapt the existing healthcare systems, in order to enable ongoing patient care despite the current disruptions. Telemedicine may be a viable option to continue hospital workflow, however there are barriers to its implementation. We set out to establish what barriers might exist and to assess the viability of teleclinics within the province KwaZulu-Natal (KZN), as perceived by doctors. METHODS: This was a quantitative, observational, survey-based study targeted at medical doctors working in both the public as well as the private healthcare sector in University of KwaZulu-Natal (UKZN). RESULTS: One hundred and forty-seven (147) responses were included. The majority (86%) of respondents felt that telemedicine could provide a useful means to continuing hospital workflow, however, only 47% believed that it was a viable option for their unit. The major barrier identified was a feeling that doctors would-be at-increased medico-legal risk. Only 38.4% of doctors were familiar with the Health Professions Council of South Africa (HPCSA) guidelines on telemedicine usage. Other major barriers included: doctors feeling uncomfortable with not seeing a patient in person or not being able to perform a thorough physical examination. Other reasons identified as potential barriers were doctors foreseeing difficulty in accessing patient medical records and the absence of available systems to order investigations without the patient being physically present. CONCLUSION: Telemedicine is currently not widely utilised in KZN; although most doctors were of the opinion that it could be a useful tool in order to continue the workflow during the pandemic. The major barrier identified were issues surrounding medico-legal coverage.


Subject(s)
Attitude of Health Personnel , Medical Staff, Hospital/psychology , Remote Consultation/methods , Telephone , COVID-19/epidemiology , Female , Health Care Surveys , Humans , Liability, Legal , Male , Medical Records , Pandemics , Practice Guidelines as Topic , SARS-CoV-2 , South Africa/epidemiology
11.
Psychodyn Psychiatry ; 49(3): 453-462, 2021.
Article in English | MEDLINE | ID: covidwho-1394606

ABSTRACT

Introduction: Most psychotherapists had no choice during the COVID-19 pandemic but to offer teletherapy in order to provide needed treatment. Several psychoanalytic theorists wondered if the very concept of treatment would change without an embodied relationship in an office setting. Methods: To attempt to understand the current concept of effective psychodynamic treatment in the new norm of teletherapy, we surveyed practitioners from 56 countries and regions who remotely treated patients psychodynamically during the beginning months of the pandemic. We asked the practitioners to rank six factors felt to be important to psychodynamic treatment: use of the couch during sessions, session in-office or via teletherapy, cultural similarity between therapist and patient, number of sessions a week, patient factors (motivation, insightfulness, and high functioning) and therapist factors (empathy, warmth, wisdom, and skillfulness). Results: We received 1,490 survey responses. As predicted, we found that the therapist and patient variables were considered much more important (both tied as highest rankings) to effective treatment than any of the other variables, including if the therapy was in-office or by teletherapy. Discussion: Psychodynamic practitioners worldwide confirmed that the empathy, warmth, wisdom, and skillfulness of the therapist and the motivation, insightfulness, and level of functioning of the patient are most important to treatment effectiveness regardless if the treatment is remote or embodied.


Subject(s)
COVID-19/prevention & control , Health Care Surveys/methods , Internationality , Psychoanalytic Therapy/methods , Telemedicine/methods , Adult , Aged , Female , Humans , Male , Middle Aged , Pandemics , Professional-Patient Relations , SARS-CoV-2 , Treatment Outcome
12.
J Clin Pharm Ther ; 46(6): 1743-1749, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1388307

ABSTRACT

WHAT IS KNOWN AND OBJECTIVE: Continuing education is essential for pharmacists to acquire and maintain the knowledge, skills, and ethical attitudes necessary for clinical practice. However, with the emergence of COVID-19, the social circumstances and face-to-face learning environments have changed. The objectives of this study were to determine Japanese pharmacists' perception of a web-based educational programme in oncology, and assess changes in their understanding of pharmaceutical care in oncology before and after their participation in the webinar. METHODS: Questionnaire-based surveys were conducted for the participants of the web-based educational programme to determine their perspectives on the webinar, and their degree of comprehension of the five cancer types covered before and after watching the webinar. RESULTS AND DISCUSSION: Of the 1936 pharmacists taking the programme, all participated in the pre-webinar survey, and 1861 (96.1%) in the post-webinar survey. Compared with previous seminars that were held in the offline mode before the COVID-19 pandemic, 76.8% of respondents were significantly satisfied with the web-based educational programme. The median post-webinar comprehension scores in all modules were significantly higher than the median pre-webinar scores (p < 0.0001). A majority of the participants agreed that a web-based educational programme was satisfactory in acquiring knowledge. WHAT IS NEW AND CONCLUSION: This web-based educational programme was effective for Japanese pharmacists for postgraduate education in pharmaceutical care in oncology. To the best of our knowledge, our study is the first to report the effectiveness of a web-based educational programme for oncology pharmacists using a large population.


Subject(s)
COVID-19/prevention & control , Education, Continuing/methods , Education, Distance/methods , Education, Pharmacy/methods , Internet , Pharmacists/statistics & numerical data , Program Evaluation/methods , Adult , Female , Health Care Surveys/methods , Humans , Japan , Male , Middle Aged , Pandemics , Professional Role , SARS-CoV-2 , Young Adult
13.
Respir Res ; 21(1): 320, 2020 Dec 02.
Article in English | MEDLINE | ID: covidwho-1388763

ABSTRACT

BACKGROUND: The disposable bronchoscope is an excellent alternative to face the problem of SARS-CoV-2 and other cross infections, but the bronchoscopist's perception of its quality has not been evaluated. METHODS: To evaluate the quality of the Ambu-aScope4 disposable bronchoscope, we carried out a cross-sectional study in 21 Spanish pulmonology services. We use a standardized questionnaire completed by the bronchoscopists at the end of each bronchoscopy. The variables were described with absolute and relative frequencies, measures of central tendency and dispersion depending on their nature. The existence of learning curves was evaluated by CUSUM analysis. RESULTS: The most frequent indications in 300 included bronchoscopies was bronchial aspiration in 69.3% and the median duration of these was 9.1 min. The route of entry was nasal in 47.2% and oral in 34.1%. The average score for ease of use, image, and aspiration quality was 80/100. All the planned techniques were performed in 94.9% and the bronchoscopist was satisfied in 96.6% of the bronchoscopies. They highlighted the portability and immediacy of the aScope4TM to start the procedure in 99.3%, the possibility of taking and storing images in 99.3%. The CUSUM analysis showed average scores > 70/100 from the first procedure and from the 9th procedure more than 80% of the scores exceeded the 80/100 score. CONCLUSIONS: The aScope4™ scored well for ease of use, imaging, and aspiration. We found a learning curve with excellent scores from the 9th procedure. Bronchoscopists highlighted its portability, immediacy of use and the possibility of taking and storing images.


Subject(s)
Attitude of Health Personnel , Bronchoscopes , Bronchoscopy/instrumentation , Disposable Equipment , Health Knowledge, Attitudes, Practice , Pulmonologists , Clinical Competence , Cross-Sectional Studies , Equipment Design , Health Care Surveys , Humans , Learning Curve , Prospective Studies , Spain
15.
Emerg Med J ; 38(10): 789-793, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1371897

ABSTRACT

BACKGROUND: The aim was to describe the organisational changes in French EDs in response to the COVID-19 pandemic with regard to architectural constraints and compare with the recommendations of the various bodies concerning the structural adjustments to be made in this context. METHODS: As part of this cross-sectional study, all heads of emergency services or their deputies were contacted to complete an electronic survey. This was a standardised online questionnaire consisting of four parts: characteristics of the responding centre, creation of the COVID-19 zone and activation of the hospital's emergency operations plan, flow and circulation of patients and, finally, staff management. Each centre was classified according to its workload related to COVID-19 and its size (university hospital centre, high-capacity hospital centre and low-capacity hospital centre). The main endpoint was the frequency of implementation of international guidelines for ED organisation. RESULTS: Between 11 May and 20 June 2020, 57 French EDs completed the online questionnaire and were included in the analysis. Twenty-eight EDs were able to separate patient flows into two zones: high and low viral density (n=28/57, 49.1%). Of the centres included, 52.6% set up a specific triage area for patients with suspected COVID-19 (n=30/57). Whereas, in 15 of the EDs (26.3%), the architecture made it impossible to increase the surface area of the ED. CONCLUSION: All EDs have adapted, but many of the changes recommended for the organisation of ED could not be implemented. ED architecture constrains adaptive capacities in the context of COVID-19.


Subject(s)
COVID-19 , Emergency Service, Hospital/organization & administration , Health Services Needs and Demand , Pandemics , SARS-CoV-2 , Cross-Sectional Studies , France , Health Care Surveys , Hospital Design and Construction , Humans
16.
Int J Gynecol Cancer ; 31(10): 1363-1368, 2021 10.
Article in English | MEDLINE | ID: covidwho-1370903

ABSTRACT

OBJECTIVE: COVID-19 is a global public health emergency. The increasing spread of COVID-19 presents challenges for the clinical care of patients with gynecological tumors. The Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO) performed a survey to evaluate the impact of the COVID-19 pandemic on medical treatment of gynecological cancer, with a focus on chemotherapy and oral treatment with poly(ADP)-ribose polymerase inhibitors (PARP-i). METHODS: The survey consisted of a self-administered online questionnaire, sent via email between November 2020 and January 2021 to all members of MITO group. RESULTS: Forty-nine centers completed the questionnaire. The majority of respondents (83%) use screening tests to determine COVID-19 status in patients who were to undergo chemotherapy or oral medications. All respondents to our survey continued cancer therapy in patients who tested negative for COVID-19 during the pandemic. Seventy-three percent of respondents declared they stopped treatment with chemotherapy or PARP-i only after a positive swab and resumed therapy when negative tests were confirmed. CONCLUSIONS: COVID-19 positivity impacted patterns of treatment in patients diagnosed with ovarian cancer within the MITO group. Further investigations are needed to evaluate whether these modifications influence oncological clinical outcomes.


Subject(s)
Antineoplastic Agents/therapeutic use , COVID-19 Testing/statistics & numerical data , COVID-19/diagnosis , Genital Neoplasms, Female/drug therapy , Poly(ADP-ribose) Polymerase Inhibitors/therapeutic use , Practice Patterns, Physicians'/statistics & numerical data , Withholding Treatment/statistics & numerical data , Administration, Oral , Adult , Aged , COVID-19/complications , COVID-19/prevention & control , Female , Genital Neoplasms, Female/complications , Health Care Surveys , Health Services Accessibility/statistics & numerical data , Humans , Italy , Male , Middle Aged
17.
Expert Rev Vaccines ; 20(10): 1361-1367, 2021 10.
Article in English | MEDLINE | ID: covidwho-1366933

ABSTRACT

BACKGROUND: Clinicians in intensive care units (ICUs) have been prioritized for COVID-19 vaccination. We aim to understand the reasons behind vaccination refusal, and assess preferences for COVID-19 vaccines among Chinese ICU clinicians. RESEARCH DESIGN AND METHODS: ICU clinicians throughout China's mainland were contacted to participate in an online survey. We compared concerns with vaccination status, and through a discrete choice experiment (DCE) assessed preferences for vaccines in terms of effectiveness, risk of adverse reactions, duration of immunity, and whether coworkers have been vaccinated. RESULTS: Among 11,951 ICU respondents from 252 prefecture-level regions, vaccination coverage was 75.4%, with an additional 9.2% not vaccinated but intending to, and 16.1% not vaccinated and not intending to. ICU clinicians not intending to be vaccinated significantly expressed more concerns about the speed of vaccine development (30.1%) and adverse reactions (65.9%). In the DCE, the only significant difference in preferences of a COVID-19 vaccine was for safety, with those not intending to have a stronger preference for a vaccine with fewer adverse reactions (OR = 4.49), compared to those already vaccinated (OR = 2.90) or those intending to vaccinate (OR = 3.46). CONCLUSION: Increasing vaccination coverage among Chinese ICU clinicians will require strong norms surrounding vaccination and transparency about safety information.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Health Personnel/statistics & numerical data , Intensive Care Units , Vaccination Refusal/psychology , Adult , China , Choice Behavior , Female , Health Care Surveys , Humans , Male , Middle Aged , Vaccination/psychology , Vaccination/statistics & numerical data , Vaccination Coverage/statistics & numerical data
18.
Am J Addict ; 30(5): 445-452, 2021 09.
Article in English | MEDLINE | ID: covidwho-1360443

ABSTRACT

BACKGROUND AND OBJECTIVES: The rapid scale-up of telehealth services for substance use disorders (SUDs) during the COVID-19 pandemic presented a unique opportunity to investigate patient experiences with telehealth. This study examined patient perceptions of telehealth in an outpatient SUD treatment program offering individual therapy, group therapy, and medication management. METHODS: Two hundred and seventy adults receiving SUD outpatient treatment were eligible to complete a 23-item online survey distributed by clinicians; 58 patients completed/partially completed the survey. Data were summarized with descriptive statistics. RESULTS: Participants were predominately male, White, and well-educated. The majority (86.2%) were "very satisfied" or "satisfied" with the quality of telehealth care. "Very satisfied" ratings were highest for individual therapy (90%), followed by medication management (75%) and group therapy (58%). Top reasons for liking telehealth included the ability to do it from home (90%) and not needing to spend time commuting (83%). Top reasons for disliking telehealth were not connecting as well with other members in group therapy (28%) and the ability for telehealth to be interrupted at home or work (26%). DISCUSSION AND CONCLUSIONS: Telehealth visits were a satisfactory treatment modality for most respondents receiving outpatient SUD care, especially those engaging in individual therapy. Challenges remain for telehealth group therapy. SCIENTIFIC SIGNIFICANCE: This is the first study examining patients' perceptions of telehealth for outpatient SUD treatment during the COVID-19 pandemic by treatment service type. Importantly, while many participants found telehealth more accessible than in-person treatment, there was variability with respect to the preferred mode of treatment delivery.


Subject(s)
Ambulatory Care , COVID-19 , Outpatients , Pandemics , Patient Satisfaction , Substance-Related Disorders , Telemedicine , Adult , Ambulatory Care/methods , COVID-19/epidemiology , Female , Health Care Surveys , Humans , Male , Outpatients/psychology , Outpatients/statistics & numerical data , Patient Satisfaction/statistics & numerical data , Psychotherapy, Group , Substance-Related Disorders/therapy
19.
JAMA ; 326(7): 649-659, 2021 08 17.
Article in English | MEDLINE | ID: covidwho-1359741

ABSTRACT

Importance: Measuring health care spending by race and ethnicity is important for understanding patterns in utilization and treatment. Objective: To estimate, identify, and account for differences in health care spending by race and ethnicity from 2002 through 2016 in the US. Design, Setting, and Participants: This exploratory study included data from 7.3 million health system visits, admissions, or prescriptions captured in the Medical Expenditure Panel Survey (2002-2016) and the Medicare Current Beneficiary Survey (2002-2012), which were combined with the insured population and notified case estimates from the National Health Interview Survey (2002; 2016) and health care spending estimates from the Disease Expenditure project (1996-2016). Exposure: Six mutually exclusive self-reported race and ethnicity groups. Main Outcomes and Measures: Total and age-standardized health care spending per person by race and ethnicity for each year from 2002 through 2016 by type of care. Health care spending per notified case by race and ethnicity for key diseases in 2016. Differences in health care spending across race and ethnicity groups were decomposed into differences in utilization rate vs differences in price and intensity of care. Results: In 2016, an estimated $2.4 trillion (95% uncertainty interval [UI], $2.4 trillion-$2.4 trillion) was spent on health care across the 6 types of care included in this study. The estimated age-standardized total health care spending per person in 2016 was $7649 (95% UI, $6129-$8814) for American Indian and Alaska Native (non-Hispanic) individuals; $4692 (95% UI, $4068-$5202) for Asian, Native Hawaiian, and Pacific Islander (non-Hispanic) individuals; $7361 (95% UI, $6917-$7797) for Black (non-Hispanic) individuals; $6025 (95% UI, $5703-$6373) for Hispanic individuals; $9276 (95% UI, $8066-$10 601) for individuals categorized as multiple races (non-Hispanic); and $8141 (95% UI, $8038-$8258) for White (non-Hispanic) individuals, who accounted for an estimated 72% (95% UI, 71%-73%) of health care spending. After adjusting for population size and age, White individuals received an estimated 15% (95% UI, 13%-17%; P < .001) more spending on ambulatory care than the all-population mean. Black (non-Hispanic) individuals received an estimated 26% (95% UI, 19%-32%; P < .001) less spending than the all-population mean on ambulatory care but received 19% (95% UI, 3%-32%; P = .02) more on inpatient and 12% (95% UI, 4%-24%; P = .04) more on emergency department care. Hispanic individuals received an estimated 33% (95% UI, 26%-37%; P < .001) less spending per person on ambulatory care than the all-population mean. Asian, Native Hawaiian, and Pacific Islander (non-Hispanic) individuals received less spending than the all-population mean on all types of care except dental (all P < .001), while American Indian and Alaska Native (non-Hispanic) individuals had more spending on emergency department care than the all-population mean (estimated 90% more; 95% UI, 11%-165%; P = .04), and multiple-race (non-Hispanic) individuals had more spending on emergency department care than the all-population mean (estimated 40% more; 95% UI, 19%-63%; P = .006). All 18 of the statistically significant race and ethnicity spending differences by type of care corresponded with differences in utilization. These differences persisted when controlling for underlying disease burden. Conclusions and Relevance: In the US from 2002 through 2016, health care spending varied by race and ethnicity across different types of care even after adjusting for age and health conditions. Further research is needed to determine current health care spending by race and ethnicity, including spending related to the COVID-19 pandemic.


Subject(s)
/statistics & numerical data , Health Expenditures/statistics & numerical data , Healthcare Disparities/ethnology , /statistics & numerical data , Health Care Surveys , Humans , United States
20.
Open Heart ; 8(2)2021 08.
Article in English | MEDLINE | ID: covidwho-1346091

ABSTRACT

OBJECTIVES: We aimed to explore the impact of the COVID-19 pandemic on cardiac diagnostic testing and practice and to assess its impact in different regions in Europe. METHODS: The online survey organised by the International Atomic Energy Agency Division of Human Health collected information on changes in cardiac imaging procedural volumes between March 2019 and March/April 2020. Data were collected from 909 centres in 108 countries. RESULTS: Centres in Northern and Southern Europe were more likely to cancel all outpatient activities compared with Western and Eastern Europe. There was a greater reduction in total procedure volumes in Europe compared with the rest of the world in March 2020 (45% vs 41%, p=0.003), with a more marked reduction in Southern Europe (58%), but by April 2020 this was similar in Europe and the rest of the world (69% vs 63%, p=0.261). Regional variations were apparent between imaging modalities, but the largest reductions were in Southern Europe for nearly all modalities. In March 2020, location in Southern Europe was the only independent predictor of the reduction in procedure volume. However, in April 2020, lower gross domestic product and higher COVID-19 deaths were the only independent predictors. CONCLUSION: The first wave of the COVID-19 pandemic had a significant impact on care of patients with cardiac disease, with substantial regional variations in Europe. This has potential long-term implications for patients and plans are required to enable the diagnosis of non-COVID-19 conditions during the ongoing pandemic.


Subject(s)
COVID-19 , Cardiac Imaging Techniques/trends , Cardiologists/trends , Healthcare Disparities/trends , Heart Diseases/diagnostic imaging , Practice Patterns, Physicians'/trends , Europe , Health Care Surveys , Humans , Predictive Value of Tests
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