scholarly journals Guidelines for Reopening a Nation in a SARS-CoV-2 Pandemic: A Path Forward

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 496
Author(s):  
Terrance L. Baker ◽  
Jack V. Greiner
Keyword(s):  
Viral Load ◽  
High Risk Patient ◽  
Routine Care ◽  
Urgent Care ◽  
Public Health Issue ◽  
Educational Systems ◽  
Air Filtration ◽  
Medical Testing ◽  
Patient Protection ◽  
Environmental Air

Action, not fear, is the path forward in the coronavirus infectious disease 2019 (COVID-19) pandemic. Since early 2020, the world’s nations have faced conundrums over severe acute respiratory syndrome corona virus type 2 (SARS-CoV-2) infections resulting in COVID-19 resulting in national closures, and thus, a clear understandable plan that nations can implement is required to reopen. The healthcare benefits of reopening a nation more likely than not exceed the benefits of continued pandemic-related closure. Pandemic-related closures have resulted in countless delayed or avoided urgent care evaluations. Furthermore, routine care of acute and chronic illnesses, including evaluations, diagnoses, and treatments, has also been delayed. Isolation, loss of income, and fear have resulted in mental health conditions or exacerbated existing conditions. The magnitude of untoward ramifications is unknown and may ultimately represent an inestimable degree of danger and morbidity, and even death. Purpose. The pandemic of SARS-CoV-2 has created an atmosphere of fear of COVID-19 that has directly and indirectly injured the world’s population. Since this has resulted in increasing morbidity and mortality, creating economic chaos, and near systemic collapse of educational systems with no well described plan forward, it is the purpose of this study to provide guidelines that provide a path forward to safely open a nation. Physicians often equipped by their education, training, and experiences across disciplines are uniquely positioned to comprehend, coordinate, and teach other physicians, business owners, and municipal and government leaders from guidelines. As such, physicians may take the lead in a path forward to reopening a nation, including opening businesses, educational facilities, and religious establishments, while minimizing the risk of SARS-CoV-2 infection. Method. Reviews of the literature among the disciplines of environmental air, sanitation, social interaction, medical testing, vaccination, protection, and disease prevention and safety allowed for the conceptualization and eventual genesis of identifiable interventions which either reduce the viral load in the environment or inactivate the virus from replication. Each of the guidelines was selected based on the principle that it involved the elimination or inactivation of the viral particle. With a reduction in viral load or inactivation of replication, the implementation of these guidelines is expected to allow for reopening a nation with an increased level of safety. Results. The guidelines identified, including air exchange (ventilation), air filtration, personal protective filtering devices (masks), hand hygiene, social distancing, screening and testing, vaccines, high-risk patient protection, medical management, and adjunctive therapies, are described and referenced. Conclusions. In that the pandemic is primarily a public health issue, the path forward is best coordinated by local, regional, and national physicians. Many physicians with a breadth of experiences are uniquely positioned to coordinate the implementation of these interdisciplinary guidelines. Using these guidelines as a planned, coordinated action, not fear, is a path forward. Nations have a decision to make: closuring versus opening.

Atmospheric pollution and cardiovascular risk

ESC CardioMed ◽  
2018 ◽  
pp. 1075-1078
Author(s):  
Mark R. Miller ◽  
Anoop S. V. Shah ◽  
Nicholas L. Mills ◽  
David E. Newby
Keyword(s):  
Risk Factors ◽  
Air Pollution ◽  
Cardiovascular Health ◽  
Urban Environments ◽  
Rapid Expansion ◽  
Public Health Issue ◽  
The United Kingdom ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Environmental Air

The air that we breathe remains a growing problem, with environmental air pollution generated by traffic, industry, and households continuing to be a serious public health issue. Increasing industrialization and the rapid expansion of urban environments across society mean that, for many, exposure to pollutants is unavoidable. Recent estimates suggest that air pollution is responsible for between 3 and 7 million deaths worldwide per year accompanied by high levels of morbidity (3.1% of global disability-adjusted life years) and associated economic risks (£16 billion per year in the United Kingdom alone). A recent report placed both indoor and outdoor air pollution within the top ten risk factors for all-cause disease, greater than that caused by risk factors such as sedentary lifestyle or high cholesterol. Importantly, the majority of deaths are caused by cardiovascular-related disease. This chapter provides an overview of how air pollution can have multiple detrimental effects on cardiovascular health.

scholarly journals Correlation of Provider Burnout With Patient Experience

2020 ◽  
Vol 7 (6) ◽  
pp. 931-936
Author(s):  
Kathleen E McKee ◽  
Andrea Tull ◽  
Marcela G del Carmen ◽  
Susan Edgman-Levitan
Keyword(s):  
Patient Experience ◽  
Healthcare Providers ◽  
Maslach Burnout Inventory ◽  
Integrated Approach ◽  
Routine Care ◽  
Urgent Care ◽  
Physician Burnout ◽  
Care Appointment ◽  
Consumer Assessment ◽  
Improve Patient

Initiatives to mitigate physician burnout and improve patient experience occur largely in isolation. At the level of the department/division, we found lower physician burnout was associated with a more positive patient experience. Physician Maslach Burnout Inventory data and patient Consumer Assessment of Healthcare Providers and Systems Clinician and Group experience scores were significantly correlated with 5 of 12 patient experience questions: “Got Routine Care Appointment” (−0.632, P = .001), “Recommend Provider” (−0.561, P = .005), “Provider Knew Medical History” (−0.532, P = .009), “Got Urgent Care Appointment” (−0.518, P = .014), and “Overall Rating” (−0.419, P = .047). These correlations suggest burnout and experience might be better addressed in tandem. Principles to guide an integrated approach are suggested.

Characterization of sick visits at an enhanced oncology urgent care center.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 285-285
Author(s):  
Anish Parikh ◽  
Donna Berizzi ◽  
Che-Kai Tsao ◽  
Cardinale B. Smith
Keyword(s):  
High Risk ◽  
Average Length ◽  
Care Center ◽  
High Risk Patient ◽  
Mount Sinai Hospital ◽  
Urgent Care ◽  
Entire Group ◽  
Oncology Patients ◽  
Urgent Care Center ◽  
Therapeutic Services

285 Background: The Oncology Care Unit (OCU) is an urgent care center open during after-hours and weekends for patients with cancer and blood disorders at the Mount Sinai Hospital. This 6-bed, nurse practitioner-run unit aims to decrease the need for emergency room (ER) visits and hospitalization in this high risk patient population. Herein we characterize utilization of this unit for urgent clinical management (“sick visits”). Methods: We identified all patients treated in the OCU between 5/12/17 and 4/8/18, and collected information on diagnosis, treatment, and utilization of the ER or hospitalization. We used descriptive statistics to identify characteristics of those patients treated in the OCU. Results: Of the 1,934 visits to the OCU, 100 (5%) were coded as “sick visits”. Of this cohort, 39% had solid tumors, 44% liquid tumors, and 17% benign hematologic conditions. Among the oncology patients, the average number of prior treatment lines was 4.6 and average time since diagnosis was 51.3 months. Of all cancers, 84% were classified as advanced stage or high-risk. Treatments for the entire group included: transfusion (T, 20%), hydration (H, 20%), and infusion (I, 13%). Similarly, 39% of visits were for H+I, 3% for T+H, 4% for T+I, and 1% for T+H+I. 5% of patients had a repeat, unplanned OCU sick visit in the next 7 days. Among the sick visits, 28% resulted in hospitalization, with a 14-day average length of stay. Further results are shown in Table 1. Conclusions: The OCU provides enhanced diagnostic and therapeutic services for high-risk hematology/oncology patients. These services often exceed the capabilities of a busy practice and would otherwise prompt an ER visit and/or hospitalization. We now aim to study the effect of the OCU on ER utilization and admission rates as well as to analyze its cost effectiveness. [Table: see text]

scholarly journals Emergency Intervention Need for Community Dental Services (Pathfinder Survey in North Mamuju Regency, West Sulawesi, Indonesia)

2021 ◽  
Vol 2 (4) ◽  
pp. 1-5
Author(s):  
Burhanuddin Daeng Pasiga ◽  
Arifurrahman Burhanuddin
Keyword(s):  
Dental Care ◽  
Dental Health ◽  
Age Groups ◽  
Routine Care ◽  
Urgent Care ◽  
Observational Research ◽  
Care Needs ◽  
Dental Services ◽  
Cross Sectional ◽  
Cross Sectional Design

Background: Oral health is considered an important component of public health, but there are still many people who are less concerned with oral and dental health. Objective: to describe emergency dental care interventions for communities based on age groups in North Mamuju.West of Sulawesi, Indonesia. Materials, and Methods: The age categories in the survey were three age groups: children (6-12 years old), young (12-17 years old), and adults (18-60 years old). Analytical observational research with Cross-sectional design, which is a survey of oral pathfinder, determined by simply taking, they are Sarjo and Bambaira Districts. Results: The sample of 935 men with male sex was 39.7% and women 63.3%. The percentage of distribution of dental care needs is 97.4%. Emergency care needed is preventive care / routine care needed as much as 13.5%, rapid care needs as much as 65.8%, urgent care needs due to pain, and dental infections as much as 17.2%. Conclusion: The need for emergency and immediate dental care in the community is still quite high.

scholarly journals Big Data tools for integrated care and high-risk patient protection

2019 ◽  
Vol 19 (4) ◽  
pp. 15
Author(s):  
Ricard Gavaldà ◽  
Martí Zamora ◽  
Julianna Ribera
Keyword(s):  
Big Data ◽  
High Risk ◽  
Integrated Care ◽  
High Risk Patient ◽  
Risk Patient ◽  
Patient Protection

scholarly journals Self-reported antiretroviral therapy adherence and viral load in criminal justice-involved populations

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
William E. Cunningham ◽  
Robin M. Nance ◽  
Carol E. Golin ◽  
Patrick Flynn ◽  
Kevin Knight ◽  
...  
Keyword(s):  
Viral Load ◽  
Criminal Justice ◽  
Significant Interaction ◽  
Analogue Scale ◽  
Routine Care ◽  
Mixed Effects ◽  
Art Adherence ◽  
Reported Health ◽  
Self Reported Health Status ◽  
Living With Hiv

Abstract Background Self-reported antiretroviral therapy (ART) adherence measures that are associated with plasma viral load (VL) are valuable to clinicians and researchers, but are rarely examined among groups vulnerable to dropping out of care. One-seventh of all those living with HIV pass through incarceration annually and criminal-justice (CJ) involved people living with HIV (PLH) are vulnerable to falling out of care. We examined the association of self-reported ART adherence with VL in a criminal-justice sample compared to a routine-care sample. Methods Samples: We examined data from a multisite collaboration of studies addressing the continuum of HIV care among CjJ involved persons in the Seek, Test, Treat, and Retain cohort. Data pooled from seven CJ- studies (n = 414) were examined and compared with the routine-care sample from the Centers for AIDS Research Network of Integrated Clinical Systems’ seven sites (n = 11,698). Measures: In both samples, data on self-reported percent ART doses taken were collected via the visual analogue scale adherence measure. Viral load data were obtained by blood-draw. Analysis: We examined the associations of adherence with VL in both cohorts using mixed effects linear regression of log-VL, and mixed effects logistic regression of binary VL (≥ 200 copies/mL) outcomes. Interactions by CD4 count and self-reported health status were also tested. Results Among the CJ sample, the coefficient for log-VL was − 0.31 (95% CI = − 0.43, − 0.18; P < 0.01) and that in the routine-care sample was − 0.42 (95% CI = − 0.45, − 0.38; P < 0.01). For the logistic regression of binary detectable VL on 10% increments of adherence we found the coefficient was − 0.26 (95% CI = − 0.37, − 0.14; P < 0.01) and in the routine-care sample it was − 0.38 (95% CI = − 0.41, − 0.35; P < 0.01). There was no significant interaction by CD4 count level in the CJ sample, but there was in the routine-care sample. Conversely, there was a significant interaction by self-reported health status level in the criminal-justice sample, but not in the routine-care sample. Conclusions The visual analogue scale is valid and useful to measure ART adherence, supporting treatment for CJ- involved PLH vulnerable to falling out of care. Research should examine adherence and VL in additional populations.

scholarly journals INTEGRATING PRINCIPLES OF VALUE-BASED CARE THROUGH COMMUNITY-BASED ORGANIZATION PARTNERSHIPS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S372-S372
Author(s):  
Marla Berg-Weger ◽  
Catherine Taylor
Keyword(s):  
Patient Outcomes ◽  
High Risk Patient ◽  
Routine Care ◽  
Cognitive Stimulation ◽  
Policy Implications ◽  
Geriatric Syndromes ◽  
Community Based ◽  
Saint Louis ◽  
Physician Practices ◽  
Value Based Care

Abstract To develop programming consistent with value-based care principles, two GWEPs share strategies and policy implications when partnering with community-based organizations (CBO). Because the aims of value-based care – better patient outcomes and population health, reduced health care costs – cannot be achieved by changing medical practice alone, RI Geriatric Education Center (RIGEC) partners with multiple CBOs to deliver evidence-based patient education programming to empower patients/caregivers to take charge of their health. RIGEC will work directly with physician practices to bring education directly to their high-risk patient census. Saint Louis University CBO partners integrated geriatric assessment into routine care to identify geriatric syndromes. Introduction of protocols for Medicare Annual Wellness Visits, Cognitive Stimulation Therapy and exercise/strengthening enables CBOs to offer interventions. Value-based care is achieved by reducing costs as geriatric syndromes are identified earlier, enabling diagnosis, treatment, and management; improving patient outcomes and satisfaction; and strengthening provider competence in geriatric care.

scholarly journals Inexpensive workflow for simultaneous monitoring of HIV viral load and detection of SARS-CoV-2 infection

2021 ◽  
Author(s):  
Gaurav K Gulati ◽  
Nuttada Panpradist ◽  
Samuel W A Stewart ◽  
Ingrid A Beck ◽  
Ceejay Boyce ◽  
...  
Keyword(s):  
Viral Load ◽  
Low Cost ◽  
Severe Disease ◽  
Extraction Methods ◽  
Routine Care ◽  
Molecular Testing ◽  
Current Standard ◽  
Hiv Viral Load ◽  
Clinical Specimens ◽  
Commercial Method

AbstractBackgroundCOVID-19 pandemic interrupted routine care for individuals living with HIV, putting them at risk of becoming virologically unsuppressed and ill. Often they are at high risk for exposure to SARS-CoV-2 infection and severe disease once infected. For this population, it is urgent to closely monitor HIV plasma viral load (VL) and screen for SARS-COV-2 infection.MethodWe have developed a non-proprietary method to isolate RNA from plasma, nasal secretions (NS), or both. HIV, SARS-CoV-2, and human RP targets in extracted RNA are then RT-qPCR to estimate the VL and classify HIV/SARS-CoV-2 status (i.e., HIV as VL failure or suppressed; SARS-CoV-2 as positive, presumptive positive, negative, or indeterminate). We evaluated this workflow on 133 clinical specimens: 40 plasma specimens (30 HIV-seropositive), 67 NS specimens (31 SARS-CoV-2-positive), and 26 pooled plasma/NS specimens (26 HIV-positive with 10 SARS-CoV-2-positive), and compared the results obtained using the in-house extraction to those using a commercial extraction kit.ResultsIn-house extraction had a detection limit of 200-copies/mL for HIV and 100-copies/mL for SARS-CoV-2. In-house and commercial methods yielded positively correlated HIV VL (R2: 0.98 for contrived samples; 0.81 for seropositive plasma). SARS-CoV-2 detection had 100% concordant classifications in contrived samples, and in clinical NS extracted by in-house method, excluding indeterminate results, was 95% concordant (25 positives, 6 presumptive positives, and 31 negatives) to those using the commercial method. Analysis of pooled plasma/NS showed R2 of 0.91 (contrived samples) and 0.71 (clinical specimens) for HIV VL correlations obtained by both extraction methods, while SARS-CoV-2 detection showed 100% concordance in contrived and clinical specimens.InterpretationOur low-cost workflow for molecular testing of HIV and SARS-CoV-2 could serve as an alternative to current standard assays for laboratories in low-resource settings.

scholarly journals Cost-effectiveness and Feasibility of Conditional Economic Incentives and Motivational Interviewing to Improve HIV Health Outcomes of Adolescents Living with HIV in Anambra State, Nigeria

2021 ◽  
Author(s):  
Obinna Ikechukwu Ekwunife ◽  
Chinelo Janefrances Ofomata ◽  
Charles Ebuka Okafor ◽  
Maureen Ugonwa Anetoh ◽  
Stephen Okorafor Kalu ◽  
...  
Keyword(s):  
Viral Load ◽  
Cost Effectiveness ◽  
Service Delivery ◽  
Motivational Interviewing ◽  
Undetectable Viral Load ◽  
Routine Care ◽  
Economic Incentives ◽  
Additional Patient ◽  
The Cost ◽  
The Impact

Abstract Background: In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. Method: A cost-effectiveness analysis from the healthcare provider’s perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. A one-way sensitivity analysis examined the effect of the regimen change to Dolutegravir-based combination (which occurred during the trial) on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria.Result: The ICER of the intervention compared to routine care was US$1,593.2 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold suggested by the World Health Organization (WHO) Commission on Macroeconomics and Health, the intervention was very cost-effective as it costs less than one Nigerian GDP/capita of US$2028.2. The effect of regimen change increased the ICER to US$2,094.38. Healthcare professionals reported that patients’ acceptance of the intervention was very high.Conclusion: The conditional economic incentives and motivational interviewing were very cost-effective. Patients’ acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed.Trial registration This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network (https://pactr.samrc.ac.za/: PACTR201806003040425).

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