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2.
BMC Fam Pract ; 22(1): 146, 2021 07 03.
Article in English | MEDLINE | ID: covidwho-1295439

ABSTRACT

BACKGROUND: Early in the COVID-19 pandemic, general practices were asked to expand triage and to reduce unnecessary face-to-face contact by prioritizing other consultation modes, e.g., online messaging, video, or telephone. The current study explores the potential barriers and facilitators general practitioners experienced to expanding triage systems and their attitudes towards triage during the COVID-19 pandemic. METHOD: A mixed-method study design was used in which a quantitative online survey was conducted along with qualitative interviews to gain a more nuanced appreciation for practitioners' experiences in the United Kingdom. The survey items were informed by the Theoretical Domains Framework so they would capture 14 behavioral factors that may influence whether practitioners use triage systems. Items were responded to using seven-point Likert scales. A median score was calculated for each item. The responses of participants identifying as part-owners and non-owners (i.e., "partner" vs. "non-partner" practitioners) were compared. The semi-structured interviews were conducted remotely and examined using Braun and Clark's thematic analysis. RESULTS: The survey was completed by 204 participants (66% Female). Most participants (83%) reported triaging patients. The items with the highest median scores captured the 'Knowledge,' 'Skills,' 'Social/Professional role and identity,' and 'Beliefs about capabilities' domains. The items with the lowest median scores captured the 'Beliefs about consequences,' 'Goals,' and 'Emotions' domains. For 14 of the 17 items, partner scores were higher than non-partner scores. All the qualitative interview participants relied on a phone triage system. Six broad themes were discovered: patient accessibility, confusions around what triage is, uncertainty and risk, relationships between service providers, job satisfaction, and the potential for total digital triage. Suggestions arose to optimize triage, such as ensuring there is sufficient time to conduct triage accurately and providing practical training to use triage efficiently. CONCLUSIONS: Many general practitioners are engaging with expanded triage systems, though more support is needed to achieve total triage across practices. Non-partner practitioners likely require more support to use the triage systems that practices take up. Additionally, practical support should be made available to help all practitioners manage the new risks and uncertainties they are likely to experience during non-face-to-face consultations.


Subject(s)
COVID-19 , General Practice , General Practitioners , Remote Consultation , Triage , Attitude of Health Personnel , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/therapy , Clinical Competence , England/epidemiology , Female , General Practice/organization & administration , General Practice/standards , General Practice/trends , General Practitioners/psychology , General Practitioners/standards , Health Knowledge, Attitudes, Practice , Humans , Infection Control/methods , Infection Control/standards , Male , Practice Patterns, Physicians'/ethics , Practice Patterns, Physicians'/trends , Remote Consultation/ethics , Remote Consultation/methods , Risk Management/trends , SARS-CoV-2 , Triage/ethics , Triage/methods , Triage/organization & administration , Triage/standards
4.
Contemp Clin Trials ; 104: 106368, 2021 05.
Article in English | MEDLINE | ID: covidwho-1155430

ABSTRACT

OBJECTIVES: COVID-19 pandemic caused several alarming challenges for clinical trials. On-site source data verification (SDV) in the multicenter clinical trial became difficult due to travel ban and social distancing. For multicenter clinical trials, centralized data monitoring is an efficient and cost-effective method of data monitoring. Centralized data monitoring reduces the risk of COVID-19 infections and provides additional capabilities compared to on-site monitoring. The key steps for on-site monitoring include identifying key risk factors and thresholds for the risk factors, developing a monitoring plan, following up the risk factors, and providing a management plan to mitigate the risk. METHODS: For analysis purposes, we simulated data similar to our clinical trial data. We classified the data monitoring process into two groups, such as the Supervised analysis process, to follow each patient remotely by creating a dashboard and an Unsupervised analysis process to identify data discrepancy, data error, or data fraud. We conducted several risk-based statistical analysis techniques to avoid on-site source data verification to reduce time and cost, followed up with each patient remotely to maintain social distancing, and created a centralized data monitoring dashboard to ensure patient safety and maintain the data quality. CONCLUSION: Data monitoring in clinical trials is a mandatory process. A risk-based centralized data review process is cost-effective and helpful to ignore on-site data monitoring at the time of the pandemic. We summarized how different statistical methods could be implemented and explained in SAS to identify various data error or fabrication issues in multicenter clinical trials.


Subject(s)
COVID-19 , Clinical Trials as Topic , Data Accuracy , Multicenter Studies as Topic , Research Design/trends , Risk Management , COVID-19/epidemiology , COVID-19/prevention & control , Change Management , Clinical Trials Data Monitoring Committees/organization & administration , Clinical Trials as Topic/economics , Clinical Trials as Topic/methods , Clinical Trials as Topic/organization & administration , Communicable Disease Control/methods , Cost-Benefit Analysis , Humans , Risk Adjustment/methods , Risk Adjustment/trends , Risk Assessment/methods , Risk Management/methods , Risk Management/trends , SARS-CoV-2 , Travel-Related Illness
5.
Psychiatriki ; 32(2): 165-166, 2021 Jul 10.
Article in Greek, English | MEDLINE | ID: covidwho-1148407

ABSTRACT

The current coronavirus pandemic (COVID-19) has led mental health systems to uncertainty regarding safe continuation of clozapine monitoring protocols. Clozapine is without doubt the only antipsychotic available with repeatedly proven efficacy in treatment resistant schizophrenia.1 Replacing clozapine with an alternative antipsychotic in patients stabilized with clozapine can potentially lead to higher risk of relapse or exacerbation of severity of illness.1 Clozapine, as already known, has a number of side effects, some of which can be serious, thus patients receiving clozapine require ongoing scheduled monitoring. Side effects of clozapine include neutropenia or agranulocytosis, myocarditis, fever, hypersalivation, weight gain and constipation. These side effects can be detected and treated when recognized on time decreasing the possibility of serious consequences making the implementation of an ongoing treatment monitoring protocol for patients on clozapine mandatory.2 Since it was advised for all mental health providers in most countries worldwide to limit non-urgent hospital visits and procedures to reduce the risk of contamination a challenge arose for patients' ability to access health care facilities for their routine clozapine monitoring. Nevertheless, the majority of Mental Health Care Authorities decided to ensure access for all patients on clozapine to their routine monitoring protocol.3,4 To date, no data exist on any potential relationship between antipsychotic use and the risk of contamination with SARS-CoV-2 or the development of severe symptoms of the infection. The literature suggests that patients receiving antipsychotics, especially clozapine, have an increased risk of developing pneumonia, leading to the assumption that patients receiving clozapine are at higher risk to develop COVID-19. 1 Balancing the importance of monitoring continuation against the increased risk for COVID-19, an International Consensus Statement was recently published addressing a monitoring protocol with reduced visits. The Consensus suggested reduced hematologic monitoring frequency of every 3 months with a prescription of 90 days clozapine supply (if safe). The above applies to patients receiving clozapine for at least one year without neutropenia. Τhe risk of neutropenia after 12 months of clozapine treatment falls significantly.4 Based on the above it is suggested to all clozapine clinics to implement a guidance monitoring protocol for all patients on clozapine to ensure safety during the pandemic. Besides hematological monitoring that requires physical contact with healthcare workers it is significant to implement a telemedicine appointment in frequent intervals to monitor symptoms of infection, symptoms of cardiovascular diseases and constipation. Patient should also be advised to regularly monitor one's blood pressure and pulses and ideally be educated on how by a member of the staff. If a patient is detected with any symptoms related to the above an emergency appointment for evaluation should be planned. Overall, since both the consequences and the duration of the pandemic are unknown, mental health services must work jointly to implement a clozapine monitoring plan to ensure safe continuation in such a vulnerable population.


Subject(s)
COVID-19 , Clozapine , Drug Monitoring , Drug-Related Side Effects and Adverse Reactions/prevention & control , Mental Health Services , Risk Management/trends , Schizophrenia/drug therapy , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/adverse effects , COVID-19/epidemiology , COVID-19/prevention & control , Clozapine/administration & dosage , Clozapine/adverse effects , Drug Monitoring/methods , Drug Monitoring/standards , Health Services Accessibility/standards , Health Services Needs and Demand , Humans , Infection Control/methods , Mental Health Services/organization & administration , Mental Health Services/standards , Organizational Innovation , SARS-CoV-2 , Schizophrenia/epidemiology
8.
Risk Anal ; 40(S1): 2272-2299, 2020 11.
Article in English | MEDLINE | ID: covidwho-948522

ABSTRACT

One-fifth of the way through the 21st century, a commonality of factors with those of the last 50 years may offer the opportunity to address unfinished business and current challenges. The recommendations include: (1) Resisting the tendency to oversimplify scientific assessments by reliance on single disciplines in lieu of clear weight-of-evidence expressions, and on single quantitative point estimates of health protective values for policy decisions; (2) Improving the separation of science and judgment in risk assessment through the use of clear expressions of the range of judgments that bracket protective quantitative levels for public health protection; (3) Use of comparative risk to achieve the greatest gains in health and the environment; and (4) Where applicable, reversal of the risk assessment and risk management steps to facilitate timely and substantive improvements in public health and the environment. Lessons learned and improvements in the risk assessment process are applied to the unprecedented challenges of the 21st century such as, pandemics and climate change. The beneficial application of the risk assessment and risk management paradigm to ensure timely research with consistency and transparency of assessments is presented. Institutions with mandated stability and leadership roles at the national and international levels are essential to ensure timely interdisciplinary scientific assessment at the interface with public policy as a basis for organized policy decisions, to meet time sensitive goals, and to inform the public.


Subject(s)
Public Health , Risk Assessment , Risk Management , COVID-19/prevention & control , COVID-19/transmission , Climate Change/history , Environmental Health , Evidence-Based Medicine , History, 20th Century , History, 21st Century , Humans , Pandemics/prevention & control , Policy Making , Public Health/history , Public Health/trends , Public Policy/history , Public Policy/trends , Risk Assessment/history , Risk Assessment/trends , Risk Management/history , Risk Management/trends , SARS-CoV-2 , United States , United States Government Agencies
9.
Aust J Gen Pract ; 49(11): 745-751, 2020 11.
Article in English | MEDLINE | ID: covidwho-895902

ABSTRACT

METHOD: A national cross-sectional online survey of Australian general practitioners was conducted in April and May 2020, with 572 respondents. RESULTS: The COVID-19 pandemic in Australia has resulted in major changes to general practice business models. Most practices have experienced increased workload and reduced income. DISCUSSION: Australian general practices have undertaken major innovation and realignment to respond to staff safety and patient care challenges during the COVID-19 pandemic. Increased administration, reduced billable time, managing staffing and pivoting to telehealth service provision have negatively affected practice viability. Major sources of information for general practice are primary care-specific, but many practices turn to colleagues for support and resources.


Subject(s)
Communicable Disease Control/organization & administration , Coronavirus Infections , General Practice , Pandemics , Pneumonia, Viral , Risk Management , Attitude of Health Personnel , Australia/epidemiology , Betacoronavirus , COVID-19 , Civil Defense/standards , Civil Defense/statistics & numerical data , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Cross-Sectional Studies , General Practice/organization & administration , General Practice/trends , General Practitioners , Health Care Surveys , Humans , Mortality , Organizational Innovation , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Risk Management/organization & administration , Risk Management/trends , SARS-CoV-2 , Telemedicine/statistics & numerical data
10.
Disaster Med Public Health Prep ; 14(4): 494-503, 2020 08.
Article in English | MEDLINE | ID: covidwho-653142

ABSTRACT

The co-occurrence of the 2020 Atlantic hurricane season and the ongoing coronavirus disease 2019 (COVID-19) pandemic creates complex dilemmas for protecting populations from these intersecting threats. Climate change is likely contributing to stronger, wetter, slower-moving, and more dangerous hurricanes. Climate-driven hazards underscore the imperative for timely warning, evacuation, and sheltering of storm-threatened populations - proven life-saving protective measures that gather evacuees together inside durable, enclosed spaces when a hurricane approaches. Meanwhile, the rapid acquisition of scientific knowledge regarding how COVID-19 spreads has guided mass anti-contagion strategies, including lockdowns, sheltering at home, physical distancing, donning personal protective equipment, conscientious handwashing, and hygiene practices. These life-saving strategies, credited with preventing millions of COVID-19 cases, separate and move people apart. Enforcement coupled with fear of contracting COVID-19 have motivated high levels of adherence to these stringent regulations. How will populations react when warned to shelter from an oncoming Atlantic hurricane while COVID-19 is actively circulating in the community? Emergency managers, health care providers, and public health preparedness professionals must create viable solutions to confront these potential scenarios: elevated rates of hurricane-related injury and mortality among persons who refuse to evacuate due to fear of COVID-19, and the resurgence of COVID-19 cases among hurricane evacuees who shelter together.


Subject(s)
COVID-19/prevention & control , Cyclonic Storms/prevention & control , Pandemics/prevention & control , Risk Management/methods , Atlantic Ocean/epidemiology , COVID-19/epidemiology , COVID-19/mortality , Climate Change , Cyclonic Storms/mortality , Cyclonic Storms/statistics & numerical data , Emergency Shelter/methods , Emergency Shelter/trends , Humans , Pandemics/statistics & numerical data , Public Health/instrumentation , Public Health/methods , Public Health/trends , Risk Management/standards , Risk Management/trends
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