Impact of Social Distancing and Travel Restrictions on Non–Coronavirus Disease 2019 (Non–COVID-19) Respiratory Hospital Admissions in Young Children in Rural Alaska

Abstract Hospitalizations due to non-coronavirus disease 2019 (non-COVID-19) respiratory illnesses decreased dramatically after social distancing was implemented in a high-risk population in rural Alaska; an unprecedented decline compared to the past 10 respiratory seasons. This demonstrates the potential secondary benefits of implementing social distancing and travel restrictions on respiratory illnesses.

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THE RIPPLE EFFECT OF COVID-19 PANDEMIC IN HEALTHCARE

International Journal of Research -GRANTHAALAYAH ◽

10.29121/granthaalayah.v8.i12.2020.2518 ◽

2020 ◽

Vol 8 (12) ◽

pp. 30-35

Author(s):

Aaminah Najmus Sahar

Keyword(s):

Working Conditions ◽

Hospital Admissions ◽

Healthcare Systems ◽

Ripple Effect ◽

Limited Information ◽

Frontline Workers ◽

The Past ◽

First Case ◽

Travel Restrictions ◽

Diagnosis Of Diseases

The COVID-19 Pandemic has disrupted life and changed what we knew as normal, for the past 9 months. Although the first case of COVID-19 was identified in Wuhan, China in mid-December 2019, it was coined as a Pandemic by WHO in March 2020. The COVID-19 Pandemic has impacted each and everyone and caused a ripple effect in all areas of life, the healthcare is no exception. With its novel nature, limited information, lack of resources, risky working conditions, and high spikes in cases, it has caused a massive overload on the healthcare systems. It has caused mental health disturbances not just in the frontline workers and COVID-19 survivors but also in the general public owing to uncertainty, isolation, fear, anxiety, andmisinformation. In addition to this, there has also been an increase in the prescription of antibiotics which stems from the inability to examine the patient physically and obtain samples for cultures as consultations are scheduled through telemedicine. Antimicrobial resistance(AMR) is considered to be further potentiated during the Pandemic as Antimicrobial stewardship programs (ASP) have been disrupted and there is an increase in hospital admissions and intubations of patients. Measures like lockdown and travel restrictions placed to curb the spread of the virus have negatively impacted individuals with addictions and substance use disorders (SUD’s) due to inability to access de-addiction centers, increased isolation, and inability to obtain toxicants which lead to the use of adulterated substances and in some cases withdrawal symptoms. The lockdown has also caused delays in the treatment of chronic and co-morbid diseases like Diabetes, Cardiovascular diseases, Cancer, Dialysis leading to poor disease management and progression of the disease. It has also impacted regular vaccination schedules and periodic health checkups leading to late diagnosis of diseases.

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Fundamental limitations of contact tracing for COVID-19

FACETS ◽

10.1139/facets-2021-0016 ◽

2021 ◽

Vol 6 ◽

pp. 1993-2001

Author(s):

Paul Tupper ◽

Sarah P. Otto ◽

Caroline Colijn

Keyword(s):

High Risk ◽

Exponential Growth ◽

Contact Tracing ◽

Loss Of Control ◽

Social Distancing ◽

Pooled Testing ◽

Fundamental Limitations ◽

Travel Restrictions

Contact tracing has played a central role in COVID-19 control in many jurisdictions and is often used in conjunction with other measures such as travel restrictions and social distancing mandates. Contact tracing is made ineffective, however, by delays in testing, calling, and isolating. Even if delays are minimized, contact tracing triggered by testing of symptomatic individuals can only prevent a fraction of onward transmissions from contacts. Without other measures in place, contact tracing alone is insufficient to prevent exponential growth in the number of cases in a population with little immunity. Even when used effectively with other measures, occasional bursts in call loads can overwhelm contact tracing systems and lead to a loss of control. We propose embracing approaches to COVID-19 contact tracing that broadly test individuals without symptoms, in whatever way is economically feasible—either with fast and cheap tests that can be deployed widely, with pooled testing, or with screening of judiciously chosen groups of high-risk individuals. These considerations are important both in regions where widespread vaccination has been deployed and in those where few residents have been immunized.

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Evaluation of a Pharmacist-Based Intervention to Reduce Readmissions in Geriatric High-Utilizer Patients: A Pilot Study

INNOVATIONS in pharmacy ◽

10.24926/iip.v10i2.1999 ◽

2019 ◽

Vol 10 (2) ◽

pp. 9

Author(s):

Sara Turbow ◽

Kruti Shah ◽

Katherine Penziner ◽

Michael Knauss

Keyword(s):

Pilot Study ◽

High Risk ◽

Hospital Admissions ◽

Safety Net ◽

High Risk Population ◽

Original Research ◽

Beers Criteria ◽

Southeastern Us ◽

Safety Net Hospital ◽

High Utilizer

Purpose: The goal of this study was to determine if a pharmacist-led intervention to improve medication safety at hospital discharge reduced the number of hospital readmissions among geriatric high-utilizer patients. This study is the first to test a pharmacist-based intervention in a high-utilizer population. Methods: This was a quasi-experimental pilot study done at a safety-net hospital in the southeastern US. Fifty-seven patients 65 years old and older who were in the 95th percentile for number of hospital admissions in a year were included. On the day of discharge, one of the study pharmacists reviewed the discharge medication list and calculated the Medication Appropriateness Index (MAI) for each medication and reviewed for Beers Criteria. Any medication identified as potentially high-risk or inappropriate was flagged by the pharmacist and discussed with the team. The primary outcome was the number of admissions in the year following the intervention in the intervention group versus the control group. Results: There were no statistically significant differences in the number of admissions, the MAI scores, or the number of medications meeting Beers Criteria between the two groups. Conclusion: Although this study did not demonstrate a decrease in hospital admissions, it shows that pharmacist review of medications at discharge can identify potentially unnecessary medications that could lead to confusion or adverse events. Further research is necessary to identify interventions to prevent readmissions in this high-risk population. Article Type: Original Research

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LCIS and tamoxifen use: A single institution review

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.1527 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 1527-1527 ◽

Cited By ~ 1

Author(s):

L. J. Kirstein ◽

Y. Martei ◽

C. Roche ◽

B. L. Smith ◽

M. C. Specht ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

Retrospective Chart Review ◽

Invasive Cancer ◽

High Risk Population ◽

Single Institution ◽

Entire Cohort ◽

The Past ◽

Risk Patients ◽

Available Information

1527 Background: Results of the NSABP-P1 trial were published in 1998 showing a 50% reduction in breast cancer in the high- risk population with the use of tamoxifen. The use of tamoxifen is individualized, and depends on both patient and physician factors. We looked at the recommendations for and the use of tamoxifen in women with LCIS. Methods: A retrospective chart review at a single institution was performed from March 27, 1980 through September 19, 2005 for patients diagnosed with LCIS. Pathology and operative reports, as well as patient notes were reviewed for discussions about tamoxifen. Data was collected on whether a discussion took place, whether tamoxifen was or was not advised, whether the patient declined to take tamoxifen, whether they took it in the past or were currently on tamoxifen. We also examined the rate of DCIS and invasive cancer in this population. Results: There were 321 patients diagnosed with LCIS. Of those patients 193 were diagnosed after the publication of the P1 trial. Of these 193 patients we identified 104(54%) patients whose charts contained notes indicating a discussion about tamoxifen. The results of the discussion about tamoxifen are as follows: 21(20%) patients were currently taking tamoxifen, 16(15%) had taken it in the past, 37(36%) patients declined to take tamoxifen, and 17(16%) had not made a decision about taking tamoxifen. There were 13(13%) patients for whom tamoxifen was advised against. In the entire cohort of 321 patients, 15% went on to develop DCIS or invasive cancer in the first 12 years of follow up. We did not look at cancer rate Vs tamoxifen use due to the small numbers with available information. Conclusions: While the P1 trial recommends tamoxifen for breast cancer prevention in high-risk patients, in our experience, almost half of the patients did not have a documented discussion about the medication, and the majority of those who did decided not to take tamoxifen. This will likely have a large impact on the rate of DCIS and invasive breast cancer in this group. No significant financial relationships to disclose.

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Immunogenicity and Immune Memory after a Pneumococcal Polysaccharide Vaccine Booster in a High-Risk Population Primed with 10-Valent or 13-Valent Pneumococcal Conjugate Vaccine: A Randomized Controlled Trial in Papua New Guinean Children

Vaccines ◽

10.3390/vaccines7010017 ◽

2019 ◽

Vol 7 (1) ◽

pp. 17 ◽

Cited By ~ 2

Author(s):

Anita van den Biggelaar ◽

William Pomat ◽

Geraldine Masiria ◽

Sandra Wana ◽

Birunu Nivio ◽

...

Keyword(s):

High Risk ◽

Young Children ◽

Pneumococcal Disease ◽

Controlled Trial ◽

Immune Memory ◽

High Risk Population ◽

Pneumococcal Infections ◽

Vaccine Booster ◽

To Receive ◽

Papua New Guinean

We investigated the immunogenicity, seroprotection rates and persistence of immune memory in young children at high risk of pneumococcal disease in Papua New Guinea (PNG). Children were primed with 10-valent (PCV10) or 13-valent pneumococcal conjugate vaccines (PCV13) at 1, 2 and 3 months of age and randomized at 9 months to receive PPV (PCV10/PPV-vaccinated, n = 51; PCV13/PPV-vaccinated, n = 52) or no PPV (PCV10/PPV-naive, n = 57; PCV13/PPV-naive, n = 48). All children received a micro-dose of PPV at 23 months of age to study the capacity to respond to a pneumococcal challenge. PPV vaccination resulted in significantly increased IgG responses (1.4 to 10.5-fold change) at 10 months of age for all PPV-serotypes tested. Both PPV-vaccinated and PPV-naive children responded to the 23-month challenge and post-challenge seroprotection rates (IgG ≥ 0.35 μg/mL) were similar in the two groups (80–100% for 12 of 14 tested vaccine serotypes). These findings show that PPV is immunogenic in 9-month-old children at high risk of pneumococcal infections and does not affect the capacity to produce protective immune responses. Priming with currently available PCVs followed by a PPV booster in later infancy could offer improved protection to young children at high risk of severe pneumococcal infections caused by a broad range of serotypes.

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Fundamental Limitations of Contact Tracing for COVID-19

10.1101/2020.12.15.20248299 ◽

2020 ◽

Author(s):

P. Tupper ◽

S. Otto ◽

C. Colijn

Keyword(s):

High Risk ◽

Exponential Growth ◽

Contact Tracing ◽

Loss Of Control ◽

Social Distancing ◽

Pooled Testing ◽

Fundamental Limitations ◽

Travel Restrictions ◽

Asymptomatic Individuals

AbstractContact tracing has played a central role in COVID-19 control in many jurisdictions and is often used in conjunction with other measures such as travel restrictions and social distancing mandates. Contact tracing is made ineffective, however, by delays in testing, calling, and isolating. Even if delays are minimized, contact tracing can only prevent a fraction of onward transmissions from contacts. Without other measures in place, contact tracing alone is insufficient to prevent exponential growth in the number of cases. Even when used effectively with other measures, occasional bursts in call loads can overwhelm contact tracing systems and lead to a loss of control. We propose embracing approaches to COVID-19 control that broadly test individuals without symptoms, in whatever way is economically feasible – either with fast cheap tests that can be deployed widely, with pooled testing, or with screening of judiciously chosen groups of high-risk individuals. Only by ramping up testing of asymptomatic individuals can we avoid the inherent delays that limit the efficacy of contact tracing.

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