scholarly journals Preprocedural SARS-CoV-2 Testing to Sustain Medically Needed Health Care Delivery During the COVID-19 Pandemic: A Prospective Observational Study

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Ghady Haidar ◽  
Ashley Ayres ◽  
Wendy C King ◽  
Mackenzie McDonald ◽  
Alan Wells ◽  
...  
Keyword(s):  
Health Care ◽  
New York ◽  
Prospective Observational Study ◽  
Care Delivery ◽  
Community Hospitals ◽  
Symptom Screening ◽  
Academic Hospitals ◽  
Hospital Patients ◽  
Polymerase Chain ◽  
A Prospective Study

Abstract Background We implemented a preprocedural severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening initiative designed to sustain health care during a time when the extent of SARS-CoV-2 infection was unknown. Methods This was a prospective study of patients undergoing procedures at 3 academic hospitals in Pittsburgh, Pennsylvania (April 21–June 11), and 19 community hospitals across Middle/Western Pennsylvania and Southwestern New York (May 1–June 11). Patients at academic hospitals underwent symptom screening ≤7 days preprocedure, then SARS-CoV-2 nasopharyngeal polymerase chain reaction (PCR) testing 1–4 days preprocedure. A subset also underwent day-of-procedure testing. Community hospital patients underwent testing per local protocols. We report SARS-CoV-2 PCR positivity rates, impact, and barriers to testing encountered through June 11. PCR positivity rates of optional preprocedural SARS-CoV-2 testing for 2 consecutive periods following the screening initiative are also reported. Results Of 5881 eligible academic hospital patients, 2415 (41.1%) were tested (April 21–June 11). Lack of interest, distance, self-isolation, and nursing home/incarceration status were barriers. There were 11 PCR-positive patients (10 asymptomatic) among 10 539 patients tested (0.10%; 95% CI, 0.05%–0.19%): 3/2415 (0.12%; 95% CI, 0.02%–0.36%) and 8/8124 (0.10%; 95% CI, 0.04%–0.19%) at academic and community hospitals, respectively. Procedures were performed as scheduled in 40% (4/10) of asymptomatic PCR-positive patients. Positivity increased during subsequent coronavirus disease 2019 (COVID-19) surges: 54/34 948 (0.15%; 95% CI, 0.12%–0.20%) and 101/24 741 (0.41%; 95% CI, 0.33%–0.50%) PCR-positive patients from June 12–September 10 and September 11–December 15, respectively (P < .0001). Conclusions Implementing preprocedural PCR testing was complex and revealed low infection rates (0.24% overall), which increased during COVID-19 surges. Additional studies are needed to define the COVID-19 prevalence threshold at which universal preprocedural screening is warranted.

Community Care, Competition and Coercion: A Legal Perspective on Privatized Mental Health Care

1993 ◽  
Vol 19 (1-2) ◽  
pp. 145-175
Author(s):  
Ronald L. Wisor
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Care Delivery ◽  
State Level ◽  
Legal Perspective ◽  
Community Tenure ◽  
Hospital Patients ◽  
Lofty Goal ◽  
Wide Scale

Even as the Clinton administration considers an increased federal commitment to mental health care, delivery of such care remains fixed at the state level. In Massachusetts, state officials are privatizing mental health care on an unprecedented scale, an experiment that promises to provide better care at lower cost. This Note explores whether privatization can achieve that lofty goal, given a legal system that has made individual patient autonomy its preeminent value. The author concludes that wide-scale privatization and modern notions of self-determination can only coexist with a significant investment in the support services that are critical to the community tenure of former state hospital patients.

scholarly journals Use of Telemedicine for Chronic Liver Disease at a Single Care Center During the COVID-19 Pandemic: Prospective Observational Study (Preprint)

2020 ◽  
Author(s):  
Maria Guarino ◽  
Valentina Cossiga ◽  
Andrea Fiorentino ◽  
Giuseppina Pontillo ◽  
Filomena Morisco
Keyword(s):  
Health Care ◽  
Liver Disease ◽  
Observational Study ◽  
Chronic Liver Disease ◽  
Prospective Observational Study ◽  
Care Delivery ◽  
Care Center ◽  
Social Distancing ◽  
The Impact

BACKGROUND The COVID-19 outbreak has overwhelmed and altered health care systems worldwide, with a substantial impact on patients with chronic diseases. The response strategy has involved implementing measures like social distancing, and care delivery modalities like telemedicine have been promoted to reduce the risk of transmission. OBJECTIVE The aim of this study was to analyze the benefits of using telemedicine services for patients with chronic liver disease (CLD) at a tertiary care center in Italy during the COVID-19–mandated lockdown. METHODS From March 9 to May 3, 2020, a prospective observational study was conducted in the Liver Unit of the University Hospital of Naples Federico II to evaluate the impact of (1) a fully implemented telemedicine program, partially restructured in response to COVID-19 to include video consultations; (2) extended hours of operation for helpline services; and (3) smart-working from home to facilitate follow-up visits for patients with CLD while adhering to social distancing regulations. RESULTS During the lockdown in Italy, almost 400 visits were conducted using telemedicine; only patients requiring urgent care were admitted to a non–COVID-19 ward of our hospital. Telemedicine services were implemented not only for follow-up visits but also to screen patients prior to hospital admission and to provide urgent evaluations during complications. Of the nearly 1700 patients with CLD who attended a follow-up visit at our Liver Unit, none contracted COVID-19, and there was no need to alter treatment schedules. CONCLUSIONS Telemedicine was a useful tool for following up patients with CLD and for reducing the impact of the COVID-19 pandemic. This system of health care delivery was appreciated by patients since it gave them the opportunity to be in contact with physicians while respecting social distancing rules.

scholarly journals Study of blood donor complications after whole blood donation in our center

2020 ◽  
Vol 9 (1) ◽  
pp. 243
Author(s):  
Garima Vijayvergiya ◽  
Parag Fulzele ◽  
Naveen Vairyamoorthy
Keyword(s):  
Health Care ◽  
Blood Donors ◽  
Blood Donation ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Medical Attention ◽  
Blood Products ◽  
Blood Donations ◽  
History Of ◽  
A Prospective Study

Background: Despite the advent of many synthetic and semi-synthetic products, the importance of biological blood products cannot be undermined in the current era. The blood donors are the backbone of any health care delivery system that has a well-organized blood transfusion service.Methods: A prospective study conducted for the period of 16 months aimed to find out various complications and their frequencies before, during or after the blood donations. The donors who developed any complications were followed up for at least three weeks to assess the late reactions if any. Blood donation was carried out with proper precautions and asepsis by experienced phlebotomists.Results: Out of 10346 blood donations, 9887 were from replacement donors, while 459 were from voluntary donors. Total donation associated complications were 113, out of which the majority were VVRs (n=74), followed by venous hematomas (n=34) and arterial punctures (n=5). Of the 74 donors who had a VVR after blood donation, the incidence was higher in females (1.64% versus 0.69%). A higher incidence of VVRs was seen among the donors who had a history of previous blood donation.Conclusions: This study strengthened the fact that though blood donation is relatively safe, it still has a complication rate of nearly 1%. To encourage for blood donation at a regular interval, all the possible steps should be taken to minimize the rate of complications. More medical attention should be given to the “at-risk” donors.

A Prospective Study of Infants of Human Immunodeficiency Virus Seropositive and Seronegative Women with a History of Intravenous Drug Use or of Intravenous Drug-Using Sex Partners, in the Bronx, New York City

PEDIATRICS ◽  
1991 ◽  
Vol 88 (6) ◽  
pp. 1248-1256
Author(s):  
Marguerite M. Mayers ◽  
Katherine Davenny ◽  
Ellie E. Schoenbaum ◽  
Anat R. Feingold ◽  
Peter A. Selwyn ◽  
...  
Keyword(s):  
New York ◽  
Drug Use ◽  
Hiv Infection ◽  
Intravenous Drug ◽  
Intravenous Drug Use ◽  
Sex Partners ◽  
Immunodeficiency Virus ◽  
History Of ◽  
Polymerase Chain ◽  
A Prospective Study

A prospective study was conducted in the Bronx, New York, of 70 infants of human immunodeficiency virus (HIV)-infected (n = 33) and uninfected (n = 37) mothers who had a history of intravenous drug use or of intravenous drug-using sex partners. Infants were observed from birth to a median age of 23 months (range 3 to 54 months). HIV infection was confirmed in seven infants (21%) of seropositive mothers; six developed HIV disease, with symptoms observed in the first year. Of these, three died (3, 9, and 36 months) of HIV-related causes; 3 of 4 survivors were >25 months of age. HIV symptoms preceded or were concurrent with abnormalities in T-lymphocyte subsets; postneonatal polymerase chain reaction confirmed HIV infection in five infants with symptoms and one without symptoms. Among infants of seropositive mothers, seven without laboratory evidence of HIV (including polymerase chain reaction) had findings suggestive of HIV infection, including persistent generalized lymphadenopathy, hepatosplenomegaly, oral candidiasis, parotitis, and inverted T-lymphocyte ratios. These findings were not observed in infants of seronegative mothers. Although the presence of HIV proviral sequences was associated with HIV disease, the observation of indeterminate symptoms in at-risk infants indicates the importance of long-term clinical follow-up to exclude HIV infection. Disease manifestations in comparable infants of seronegative mothers are important for assessment of the impact of maternal drug use, development of specific clinical criteria for early diagnosis of HIV and eligibility for antiretroviral therapy.

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