Teaching vaccine development in schools: Learnings from a survey and curriculum design for a course

Although vaccines are being developed and administered to people for more than a century, the understanding of the steps involved in vaccine development is a relatively new subject to the general public. During the current pandemic, there has been an explosion of non-validated news about COVID-19 and vaccines. To enhance the understanding of this critical societal science, there is an urgent need to teach these topics in the early education systems. Defining the essential subjects and courses for high school and developing syllabi for undergraduate courses in immunology and vaccinology can be difficult, as students choose diverse career options after their studies. To define these curricula, understanding the current level of awareness regarding vaccinology and immunology among students becomes essential. Thus, we have undertaken an exploratory survey of 650 high school and undergraduate college students in India on their awareness of the processes of vaccine development. Our results confirmed our hypothesis that there is a very limited understanding of this topic among school-going students. In this article, we propose an outline for a course for teaching in high schools. We recommend that this course should be interdisciplinary and a mix and match of majors and minors. It should train students with soft skills and prepare them for their careers in biomedical research. Copyright © 2023 Ghosh, Lalsare, Chirmule, Khare, Kalakuntla, Zarkar, Pawar and Sheth.

Pilot Implementation of a Health Equity Checklist to Improve the Identification of Equity-Related Adverse Events

In assessing the occurrence of an unexpected medical adverse event following pharmaceutical,medical, or surgical treatment, the causal or contributory roles played by bias, systemic racism, and social determinants of health should be investigated. Up to 80% of clinical outcomes are estimated to be driven by social determinants including the environments in which patients live, work, learn, worship, and play. Among women, there are racial health disparities in sterilization procedures, method of hysterectomy, cesarean birth rates, preterm birth rates, and, most recently, the rates of COVID-19 death and hospitalizations. At the same time, there is little specific guidance of how to investigate social determinants of health that affect patient outcomes. Differences in health equity-related factors affect the quality of gynecologic care. There is immeasurable potential for bias in patient characteristics: race;ethnicity;persons with obesity;LGBTQ+ (lesbian, gay, bisexual, transgender, queer+) persons;socioeconomic factors;and young and old age. Within existing models for patient safety, inclusion of equity-related aspects of care may improve the current understanding of the causes of medical adverse events. It is critical to consider social determinants of health, structural racism, and both overt and implicit bias. The aim of this studywas to establish a sustainable and trackable process to determine the role of social determinants of health, bias, and racism in adverse gynecologic events. Each adverse event case is assessed for preventability, harm, and standards of care. Cases are identified for review utilizing existing hospital event-reporting systems (RLDatix) and enhanced by resident and attending physician self-reporting. The following equity-focused process was used: (1) creating a standardized health equity checklist;(2) applying the checklist to each gynecologic adverse event beginning on September 1, 2020;(3) collecting event review data in a secure central digital repository;(4) reviewing each adverse case to understand apparent causes of the event;(5) exploring areas for improvement using standard fields;and (6) identifying specific ideas for improvement. Within 15 months (between September 1, 2020, and November 30, 2021), 46 safety cases were identified using standard criteria. Twenty-four of these were deemed preventable.Of the 24 cases, 12 cases were identified inwhich social determinants of health, bias, or both had a role. Delays in diagnosis and care were attributed to social determinants of health and implicit bias. This process has mapped areas of infrastructure as well as the need for culture improvement and restorative work to address implicit bias and improve approaches to shared decision-making. These findings show that with use of a health equity checklist, it is feasible to create a systematic and trackable process to begin delineating the role of social determinants of health, bias, and racism in adverse gynecologic events. Copyright © 2023 Lippincott Williams and Wilkins. All rights reserved.

A COVID-19 Clinical Management Committee to Standardize Care in a 2-Hospital System

Objective: The COVID-19 pandemic has been a challenge for hospital medical staffs worldwide due to high volumes of patients acutely ill with novel syndromes and prevailing uncertainty regarding optimum supportive and therapeutic interventions. Additionally, the response to this crisis was driven by a plethora of nontraditional information sources, such as email chains, websites, non-peer-reviewed preprints, and press releases. Care patterns became idiosyncratic and often incorporated unproven interventions driven by these nontraditional information sources. This report evaluates the efforts of a health system to create and empower a multidisciplinary committee to develop, implement, and monitor evidence-based, standardized protocols for patients with COVID-19. Method(s): This report describes the composition of the committee, its scope, and its important interactions with the health system pharmacy and therapeutics committee, research teams, and other work groups planning other aspects of COVID-19 management. It illustrates how the committee was used to demonstrate for trainees the process and value of critically examining evidence, even in a chaotic environment. Result(s): Data show successful interventions in reducing excessive ordering of certain laboratory tests, reduction of nonrecommended therapies, and rapid uptake of evidence-based or guidelines-supported interventions. Conclusion(s): A multidisciplinary committee dedicated solely to planning, implementing, and monitoring standard approaches that eventually became evidence-based decision-making led to an improved focus on treatment options and outcomes for COVID-19 patients. Data presented illustrate the attainable success of a committee that is both adaptable and suitable for similar emergencies in the future. Copyright © 2022 Turner White Communications Inc.. All rights reserved.

Global impact of the COVID-19 pandemic on stroke care and intravenous thrombolysis

Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods. Background: The COVID-19 pandemic led to widespread repercussions on the delivery of health care worldwide. Design/Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by ICD-10 codes and/or classifications in stroke center databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI,-11.7 to-11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI,-13.8 to-12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI,-13.7 to-10.3, p=0.001). There were greater declines in primary compared to comprehensive stroke centers (CSC) for stroke hospitalizations (-17.3% vs-10.3%, p<0.0001) and IVT (-15.5% vs-12.6%, p=0.0001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) months of the pandemic, with greater recovery in hospitals with lower COVID-19 hospitalization volume, high volume stroke center, and CSC. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months, with greater recovery in hospitals with lower COVID-19 hospitalizations, high volume stroke centers, and CSCs.

Effect of COVID-19 on acute ischemic stroke: Population-level experience

Introduction Several studies report substantial decreases in the volume of acute ischemic stroke (AIS) during the early stage of coronavirus disease 2019 (COVID-19) pandemic. Differences in characteristics of strokes such as increasing rates of large vessel occlusion (LVO) stroke were also observed comparing between pre-COVID and COVID eras. However, these findings were often based on data from selected hospitals or networks and estimates may be biased by level of stroke care and baseline case mix. A population-based study including rural hospitals and non-stroke centers covering a longer observation period beyond the early-pandemic epoch may lead to more accurate insights. Methods We conducted a retrospective population-based study using the Texas Inpatient Public Use Data File, capturing all discharges from hospitals in the State of Texas excluding federal hospitals. We assessed quarterly changes in volume, characteristics, care of AIS, and patient outcomes from April 1, 2019-June 30, 2020 and compared two time periods. 2020Q2 was defined as the pandemic period and the previous one year as the pre-pandemic period. Cases were defined as inpatient hospitalizations to acute care hospitals with a primary diagnosis of AIS. ICD-10 diagnosis and procedure codes were used to identify AIS, LVO, use of intravenous tissue plasminogen activator (IV-tPA) and endovascular treatment (EVT). Hospitals were determined as CSC (Comprehensive Stroke Center) and non-CSC based on designation by the Texas Department of State Health Services. Results The number of AIS cases dropped substantially from 10,745 per quarter in the pre-pandemic period to 9,277 in the pandemic period (-14%) in Texas. The percentage of patients aged younger than 65 (39.0% vs 40.4%, p=0.014) and LVO stroke (30.0% vs 32.7%, p<0.001) slightly increased. Percentages of admission to CSC (39.1% vs 39.5%, p=0.57) and admission through inter-hospital transfer (9.6% vs 9.3%, p=0.35) remained similar between pre-pandemic and pandemic periods. There was also no significant change in the use of IV-tPA (14.1% vs 13.6%, P=0.20) or EVT (5.4% VS 5.8%, P=0.12). In-hospital mortality slightly increased from 2.9% to 3.2% but it was not statistically significant (p=0.13). However, the percentage of death or hospice discharge increased from 7.6% to 8.4% (p=0.003) and age and LVO type adjusted odds ratio was 1.13 (95% CI 1.04-1.23). Conclusion In this population-level study, significant decreases in AIS volume were observed with slightly higher incidence in younger population and higher LVO strokes. Rates of thrombolysis and thrombectomy remained unchanged but patients appeared to have worse outcomes.

P-043 Elevated D-dimer levels predicts mortality in COVID-19 with stroke: analysis of multi-center electronic health record data

P-043 Figure 1A Receiver operator characteristic curves for D-dinier to predict deaths in COVID-19;B. Kaplan-Meier survival estimates[Figure omitted. See PDF]ConclusionsPeak D-dimer levels above 5.15 µg/ml feu are associated with increased mortality in COVID-19 patients with AIS.DisclosuresY. Kim: None. S. Khose: None. R. Abdelkhaleq: None. S. Salazar-Marioni: None. S. Sheth: None.