Association of Molnupiravir and Nirmatrelvir-Ritonavir with preventable mortality, hospital admissions and related avoidable healthcare system cost among high-risk patients with mild to moderate COVID-19

Background Real-world data is currently limited on the association between oral antiviral therapy and healthcare system burden in patients with mild-to-moderate COVID-19. This study aims to evaluate the clinical and cost effec-tiveness of Molnupiravir and Nirmatrelvir-ritonavir use in reducing mortality in this population. Methods This is a retrospective cohort study involving 54,355 COVID-19 patients during February 22-March 31,2022 in Hong Kong. Inverse probability of treatment weighting (IPTW) was used to adjust patient characteristics. Our exposure of interest was Molnupiravir/Nirmatrelvir-Ritonavir prescription, with all-cause mortality as the pri-mary outcome. IPTW-adjusted multivariate regressions were used to estimate treatment impact on clinic re -atten-dance and unplanned admissions. Finally, attributed cost and incremental cost-effectiveness ratios (ICER) were estimated. Findings In the outpatient cohort (N = 33,217, 61.1%), 16.1% used Molnupiravir and 13.4% used Nirmatrelvir-Ritona-vir, while in the inpatient cohort (N = 21,138, 38.9%), 3.8% used Molnupiravir and 1.3% used Nirmatrelvir-Ritonavir. IPTW-adjusted Cox model estimated that Molnupiravir (hazard ratio (HR)(95%CI)=0.31 (0.24-0.40), P< 0.0001) and Nirmatrelvir-Ritonavir (HR=0.10 (95%CI 0.05-0.21), P< 0.0001) were significantly associated with a reduced mortality hazard. In the outpatient cohort, both antiviral prescriptions were associated with reduced odds for unplanned hospital admissions (Molnupiravir: odds ratio (OR) =0.72 (0.52-0.98), P=0.039;Nirmatrelvir-Ritonavir: OR=0.37 (0.23-0.60), P<0.0001). Among hospitalised patients, both antiviral prescriptions were associated with sig-nificant reductions in the odds ratios for 28-days readmission (Molnupiravir: OR=0.71 (0.52-0.97), P=0.031;Nirma-trelvir-Ritonavir: OR=0.47 (0.24-0.93), P=0.030). ICERs for death averted for Molnupiravir stood at USD493,345.09 in outpatient settings and USD2,629.08 in inpatient settings. In outpatient settings, Nirmatrelvir-ritonavir cost USD331,105.27 to avert one death, but saved USD5,502.53 to avert one death in comparison with standard care. Interpretation In high-risk patients in Hong Kong with mild-to-moderate COVID-19, Molnupiravir and Nirmatrel-vir-Ritonavir prescriptions were associated with reduced all-cause mortality and significant cost savings.

Using the technology acceptance model to examine acceptance of telemedicine by cancer patients in an ambulatory care setting

Background: Telemedicine has demonstrated benefits for cancer patients including the potential to improve care coordination and patient outcomes. Since June 2020, teleconsultations have been implemented in the National Cancer Centre Singapore. Objective(s): This study aims to assess cancer patients acceptance of telemedicine as a complement to traditional in-person care and identify factors affecting their acceptance. Method(s): An online self-administered questionnaire was designed using a modified technology acceptance model (TAM) previously validated to predict acceptance of telemedicine by patients and factors affecting acceptance. Descriptive statistics were used to summarise data on demographic factors and TAM construct scores. Univariate and multivariate logistic regression were used to determine how demographics factors and TAM constructs influenced acceptance. Result(s): Respondents (n = 278;mean age 59 years) were mostly female (67.6%), Chinese (86.3%) and received parenteral chemotherapy (72.6%). Technology access and confidence were generally moderate to high, while past telemedicine use was low (18%). Overall, more than half (59.7%) expressed acceptance. The odds of acceptance were significantly higher if respondents agreed that their healthcare access would improve by using telemedicine (OR 4.17, 95% CI 1.71-10.16) or they would have the necessary resources for using telemedicine (OR 4.54, 95% CI 2.30-8.97). Conclusion(s): Acceptance of telemedicine was high amongst respondents. Facilitating conditions such as having necessary resources and perceived improved access were identified as main predictors of high acceptance. Telemedicine services should work to improve these aspects, leverage on advantages and address disadvantages brought up by patients. Copyright © The Author(s) 2022.

A New Low-Cost and Accurate Diagnostic mHealth System for Patients with COVID-19 Pneumonia

Over the last two years, COVID-19 pneumonia has killed more than six million people worldwide. To self-triage pneumonia patients, many mobile Health (mHealth) solutions have been developed. Some of these solutions only provide guidelines and trace outbreaks. Others collect inaccurate vitals and/or are considered costly. To address these challenges, a cost-effective and accurate mHealth system was designed in this paper. The system consists of several biosensors (e.g., oxygen saturation) as they are considered significant for the disease assessment. In addition, a new mobile application was developed to collect biometric vitals and transmit them to a HIPPA compliant server. Our real-world experiments demonstrated that the new system was strongly correlated with the gold standard systems in terms of pulse rate and temperature (e.g., 90%). Moreover, the difference in the rate of change between the two systems for the measurements were mostly insignificant (e.g., p-value ≈ 0.77). Lastly, the prototype cost is approximately 20 USD. © 2022 IEEE.

Elevated occupational safety risks for home care workers: Policy gaps in a pandemic

Introduction: Personal Support Workers (PSWs) regularly enter private dwellings to care for clients. The work is low-paid, insecure and physically and emotionally demanding. In Ontario, the ‘assisting occupations in support of health services’ occupation ties with ‘motor vehicle and transit drivers’ for the worst rate of lost-time workers’ compensation claims (8% according to the Workers Safety & Insurance Board). Materials and Methods: This qualitative research included in-depth, semi-structured interviews with 16 key informants in government, industry, and advocacy organisations. Data were coded thematically, and analysis drew on Interpretive Policy Analysis. This research was approved by a university Research Ethics Board. Results: We found work conditions for PSWs worsened during the pandemic. Worldwide PPE shortages led to conserving PPE so that PSWs often had to use the same mask for all sites they visited in a day. A shortage of workers led to creation of rapid PSW education programs and caused elevated concern about training adequacy for complex care needs. Remote assessments limited supervisors’ ability to evaluate client conditions or home environments. Taking public transportation between client homes, others living in the home, and clients themselves, were seen as increasing risk of exposure to COVID-19. Participants described that PSWs may feel morally obliged to work despite the right to refuse unsafe work. Conclusion: Some emergency policies had unintended consequences that elevated risk for workers and their clients.

"It's a whole new way of doing things": the digital divide and leisure as resistance in a time of physical distance

The COVID-19 pandemic continues to have a profound impact on the well-being and social connectedness of older adults. In an era of physical distancing, older adults' connections are changing. While digital leisure spaces are often described to enhance social connections, little is written about older adults and digital connectedness in a time of physical distancing. We completed 20 in-depth interviews with older Canadians (average age 77) during the initial wave (Spring 2020). This paper draws on critical tenets of Age Studies, leisure as resistance, and an understanding of the digital divide to reflect on interviews with older adults about their technology use during the COVID-19 pandemic. We reflect on technology use as resistance to ageist stereotypes, discuss facilitators of technology use as lived privilege that deepen the digital divide during COVID-19 for some, and identify opportunities for supporting older adults not presently using technology for social connection.

Premature infant born to a convalescent mother with COVID-19 in mid-term pregnancy

We report a female infant born preterm to a woman at 35 gestational weeks and four days in a normal pregnancy prior to delivery, with normal liquor volume and good maternal and infant outcomes. The baby was transferred to the neonatal department 30 min after birth at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, on March 21, 2020. The infant weighed 2 800 g with 7 and 9 Apgar scores respectively at 1 and 5 min. The mother had been diagnosed with COVID-19 at 26+6 weeks of pregnancy and the maternal serum level of IgM was negative and that of IgG was 20.77 AU/ml (normal reference <10 AU/ml) before delivery. The baby had hypoglycemia on admission, and the blood sugar stabilized after treatment. Though early mild feeding intolerance occurred, the baby was able to feed normal by eight days after birth. The baby was in good condition during hospitalization and discharged. Throat swab specimens obtained from the infant on the 2nd, 3rd and 8th day after birth for SARS-Cov-2 RNA detection were all negative. On the 2nd and 8th day after birth, SARS-Cov-2 IgM in the neonatal serum were negative, while elevated IgG levels of 30.2 AU/ml and 25.3 AU/ml (normal reference value <10 AU/ml) were observed, suggesting that the infant's IgG antibody of SARS-CoV-2 may have come from the mother. According to this case report, no intrauterine vertical transmission was found in the pregnancy with SARS-CoV-2 infection in the second trimester, while further follow-up is still needed. Copyright © 2020 by the Chinese Medical Association.

[Nursing strategies for the facial skin injuries caused by wearing medical-grade protective equipment].

For effective resistance to virus attack and infection and reducing virus transmission chance, it is extremely important for the medical staff and related workers to have their own safe protection. The paper summarizes the occurrence causes, common locations, and prevention ways about the device related pressure ulcers on the face resulted from wearing medical-grade protective equipment for a long working time. The paper proposes the prevention and nursing strategies for device related pressure ulcers and other related skin injuries during application of medical-grade protective equipment. The paper aims to provide reference for the prevention and nursing of device related pressure ulcers and related skin diseases for clinical medical staff, especially to the respectable personnel in front line of fighting against coronavirus disease 2019.