scholarly journals Sustaining community event-based surveillance in Sierra Leone

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Eilidh M. Higgins ◽  
Erin Polich ◽  
Maitreyi Sahu ◽  
Stacey Mearns ◽  
Ruwan Ratnayake
Keyword(s):  
Policy Change ◽  
Ebola Virus ◽  
Health Workers ◽  
Virus Disease ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Period 2 ◽  
Before And After ◽  
Using Data ◽  
Event Based

ObjectiveTo assess whether the change in death swabbing policy in SierraLeon has begun to affect community death reporting, we analyzedtrends in death reporting before and after the policy change.IntroductionStemming from the 2014-6 Ebola virus disease (EVD) outbreak,community event based surveillance (CEBS) was implemented inSierra Leone using community health workers to generate alerts fortrigger events suggestive of EVD transmission. Through September30, 2015 (last month of active EVD transmission), the majority (86%)of alerts reflected community deaths; this was beneficial as Ebola-related deaths were detected with delay during the epidemic’s peak.The Government had implemented a policy of mandatory swabbingand testing of all dead bodies. The policy changed on June 30, 2016wherein only swabbing of deaths deemed to be high-risk for EVD isrequired. To assess whether this policy change has begun to affectcommunity death reporting, we analyzed trends in death reportingbefore and after the policy change.MethodsThis analysis was conducted using data from nine districts duringperiod 1 (January-June 2016) and period 2 (July 2016). Weeklychanges in the reporting of death alerts during the two periods wereassessed. An interrupted time series analysis (ITS) with a segmentedlinear regression was also used to assess the immediate impact of thepolicy change.ResultsDuring period 1, monthly changes in death alerts across districtswere variable (-8% to 16%). Comparison of the weekly averagebetween periods 1 and 2 showed a 33% reduction in death alerts.During period 1 (before the policy change), there was an overallsignificant increase of 3.2 death alerts per week (p=0.00) andno immediate impact or changes in the trend afterwards. At thedistrict level, on average 354 death alerts were generated weekly inJune, compared to 237 in July (33% reduction); Moyamba districtexperienced the largest drop in death alerts from 46 to 16 (65%).ConclusionsCommunity death reporting provides early warning of EVDtransmission by rapidly capturing death alerts where vital registrationis not fully functional. Although we have one month of data post-policy change, this preliminary analysis suggests that the changein swabbing policy may have halted an observed increase in deathreporting. Further community mobilization efforts and training arewarranted to prevent a drop in death reporting.

scholarly journals A Mathematical Model of Contact Tracing during the 2014–2016 West African Ebola Outbreak

Mathematics ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 608
Author(s):  
Danielle Burton ◽  
Suzanne Lenhart ◽  
Christina J. Edholm ◽  
Benjamin Levy ◽  
Michael L. Washington ◽  
...  
Keyword(s):  
Mathematical Model ◽  
Disease Management ◽  
Ebola Virus ◽  
Virus Disease ◽  
Infected Individual ◽  
Vital Role ◽  
West African ◽  
Contact Tracing ◽  
The Novel ◽  
Using Data

The 2014–2016 West African outbreak of Ebola Virus Disease (EVD) was the largest and most deadly to date. Contact tracing, following up those who may have been infected through contact with an infected individual to prevent secondary spread, plays a vital role in controlling such outbreaks. Our aim in this work was to mechanistically represent the contact tracing process to illustrate potential areas of improvement in managing contact tracing efforts. We also explored the role contact tracing played in eventually ending the outbreak. We present a system of ordinary differential equations to model contact tracing in Sierra Leonne during the outbreak. Using data on cumulative cases and deaths, we estimate most of the parameters in our model. We include the novel features of counting the total number of people being traced and tying this directly to the number of tracers doing this work. Our work highlights the importance of incorporating changing behavior into one’s model as needed when indicated by the data and reported trends. Our results show that a larger contact tracing program would have reduced the death toll of the outbreak. Counting the total number of people being traced and including changes in behavior in our model led to better understanding of disease management.

Impact of Legislation on Opioid Prescribing following Hysterectomy and Hysteroscopy in Arizona and Florida

2021 ◽  
pp. 1-9
Author(s):  
Aakriti R. Carrubba ◽  
Amy E. Glasgow ◽  
Elizabeth B. Habermann ◽  
Amanda P. Stanton ◽  
Megan N. Wasson ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Cohort Analysis ◽  
Oral Morphine ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Before And After ◽  
Legislative Changes

<b><i>Objectives:</i></b> This study aimed to determine the oral morphine equivalents (OMEs) prescribed and refill rates following hysterectomy and hysteroscopy in the setting of opioid prescribing practice changes in 2 states. <b><i>Design:</i></b> This is a retrospective cohort analysis consisting of 2,916 patients undergoing hysterectomy or hysteroscopy between July 2016 and September 2019 at 2 affiliated academic hospitals in states that underwent legislative changes in opioid prescribing in 2018. <b><i>Methods:</i></b> Participants were identified using the Current Procedural Terminology procedure codes in Arizona and Florida. Hysterectomy was chosen as the most invasive gynecologic procedure, while hysteroscopy was chosen as the least invasive. Medical records were abstracted to find opioid prescriptions from 90 days before surgery to 30 days after discharge. Patients with opioid use between 90 and 7 days before surgery were excluded. Prescriptions were converted to OMEs and were calculated per quarter year. Statistical analysis included Wilcoxon rank sum <i>t</i> tests for OMEs and χ<sup>2</sup> <i>t</i> tests for refill rates. Interrupted time-series analysis was used to determine significant change in OMEs before and after legislative change. Statistical analysis was performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). <b><i>Results:</i></b> In Arizona, 1,067 hysterectomies were performed; 459 (43%) vaginal, 561 (52.6%) laparoscopic/robotic, and 47 (4.4%) abdominal. There were 530 hysteroscopies. Overall median OMEs decreased from 225 prior to July 2018 to 75 after July 2018 (<i>p</i> &#x3c; 0.0001). The opioid refill rate remained unchanged at 7.4% (<i>p</i> = 0.966). In Florida, there were 769 hysterectomies; 241 (31.3%) vaginal, 476 (61.9%) laparoscopic/robotic, and 52 (6.8%) abdominal. There were 549 hysteroscopies. Overall median OMEs decreased from 150 prior to July 2018 to 0 after July 2018 (<i>p</i> &#x3c; 0.0001). The opioid refill rate was similar (7.8% before July 2018 and 7.3% after July 2018; <i>p</i> = 0.739). <b><i>Limitations:</i></b> Limitations include involvement of a single hospital institution with a total of 10 fellowship-trained surgeons and biases inherent to retrospective study design. <b><i>Conclusions:</i></b> Legislative and provider-led changes coincided with decreases in opioid prescribing after 2018 in both states without increasing rates of refills and showed actual data reflected in the medical record. Gynecologists must actively participate in safe prescribing practices to decrease opioid dependence and misuse.

scholarly journals Assessment of Community Event–Based Surveillance for Ebola Virus Disease, Sierra Leone, 2015

2016 ◽  
Vol 22 (8) ◽  
pp. 1431-1437 ◽  
Author(s):  
Ruwan Ratnayake ◽  
Samuel J. Crowe ◽  
Joseph Jasperse ◽  
Grayson Privette ◽  
Erin Stone ◽  
...  
Keyword(s):  
Sierra Leone ◽  
Ebola Virus ◽  
Virus Disease ◽  
Ebola Virus Disease ◽  
Event Based

scholarly journals Digital cognitive behavioural therapy for insomnia and primary care costs in England: an interrupted time series analysis

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0146
Author(s):  
Chris Sampson ◽  
Eleanor Bell ◽  
Amanda Cole ◽  
Christopher B Miller ◽  
Tracey Marriott ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Cognitive Behavioural Therapy ◽  
Interrupted Time Series ◽  
Behavioural Therapy ◽  
Interrupted Time Series Analysis ◽  
Cognitive Behavioural ◽  
Before And After ◽  
Quasi Experimental ◽  
Care Costs

BackgroundSleepio is an automated digital programme that delivers cognitive behavioural therapy for insomnia (dCBT-I). Sleepio has been proven effective in improving sleep difficulties. However, evidence for the possible impact of Sleepio use on health care costs in the United Kingdom has not previously been developed.AimWe sought to identify the effect of a population-wide rollout of Sleepio in terms of primary care costs in the National Health Service (NHS) in England.Design & settingThe study was conducted in the Thames Valley region of England, where access to Sleepio was made freely available to all residents between October 2018 and January 2020. The study relies on a quasi-experimental design, using an interrupted time series to compare the trend in primary care costs before and after the rollout of Sleepio.MethodWe use primary care data for people with relevant characteristics from nine general practices in Buckinghamshire. Primary care costs include general practice contacts and prescriptions. Segmented regression analysis was used to estimate primary and secondary outcomes.ResultsFor the 10,704 patients included in our sample, the total saving over the 65-week follow-up period was £71,027. This corresponds to £6.64 per person in our sample or around £70.44 per Sleepio user. Secondary analyses suggest that savings may be driven primarily by reductions in prescribing.ConclusionSleepio rollout reduced primary care costs. National adoption of Sleepio may reduce primary care costs by £20 million in the first year. The expected impact on primary care costs in any particular setting will depend on the uptake of Sleepio.

ED syphilis and gonorrhea/chlamydia cotesting practices before and after the implementation of an electronic health record-based alert

2021 ◽  
pp. emermed-2020-210331
Author(s):  
James S Ford ◽  
Tasleem Chechi ◽  
Michella Otmar ◽  
Melissa Baker ◽  
Sarah Waldman ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Underserved Populations ◽  
Cohort Analysis ◽  
Treponema Pallidum ◽  
Interrupted Time Series ◽  
Health Record ◽  
Interrupted Time Series Analysis ◽  
Syphilis Testing ◽  
Before And After ◽  
Electronic Health

BackgroundThe prevalence of syphilis is increasing in many countries, including the USA. The ED is often used by underserved populations, making it an important setting to test and treat patients who are not evaluated in outpatient clinical settings. We aimed to assess the utility of an ED-based syphilis and gonorrhoea/chlamydia cotesting protocol by comparing testing practices before and after its implementation.MethodsWe implemented an electronic health record (EHR) alert that prompted clinicians to order syphilis testing in patients undergoing gonorrhoea/chlamydia testing. We performed a retrospective cohort analysis that compared outcomes between the preimplementation period (January–November 2018) and the postimplementation period (January–November 2019). Patients were tested for Treponema pallidum antibody (TPA) using a multiplex flow immunoassay (MFI), and positive results were confirmed by rapid plasma reagin (RPR). The primary implementation outcome was the number of syphilis tests/month, and the primary clinical outcome was the number of syphilis diagnoses/month (defined as positive TPA MFI and RPR). We performed an interrupted time-series analysis to evaluate the effect of implementing the alert over time.ResultsFour-hundred and ninety-four and 1106 unique patients were tested for syphilis in the preimplementation and postimplementation periods, respectively. Syphilis testing increased by 55.6 tests/month (95% CI 45.9 to 65.3, p<0.001) following alert implementation. Patients tested in the postimplementation period who were tested using the alert were much younger (difference: 14 years (95% CI 12 to 15)) and were more likely to be female (difference: 15% (95% CI 8 to 21)) and African-American (difference: 11% (95% CI 5 to 17)) than patients tested by clinician-initiated testing. Presumptive syphilis diagnoses increased from 3.4 diagnoses/month to 7.9 diagnoses/month (difference, 4.5 (95% CI 2.2 to 6.9), p<0.001).ConclusionsOur study demonstrates that use of a targeted EHR alert testing protocol can increase syphilis testing and diagnosis and may reduce clinician bias in testing.

scholarly journals Priorities, Barriers, and Facilitators towards International Guidelines for the Delivery of Supportive Clinical Care during an Ebola Outbreak: A Cross-Sectional Survey

Viruses ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 194 ◽  
Author(s):  
Marie-Claude Battista ◽  
Christine Loignon ◽  
Lynda Benhadj ◽  
Elysee Nouvet ◽  
Srinivas Murthy ◽  
...  
Keyword(s):  
Supportive Care ◽  
Ebola Virus ◽  
Health Workers ◽  
Virus Disease ◽  
Clinical Care ◽  
Barriers And Facilitators ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Treatment Protocols ◽  
Key Stakeholders

During the Ebola outbreak, mortality reduction was attributed to multiple improvements in supportive care delivered in Ebola treatment units (ETUs). We aimed to identify high-priority supportive care measures, as well as perceived barriers and facilitators to their implementation, for patients with Ebola Virus Disease (EVD). We conducted a cross-sectional survey of key stakeholders involved in the response to the 2014–2016 West African EVD outbreak. Out of 57 email invitations, 44 responses were received, and 29 respondents completed the survey. The respondents listed insufficient numbers of health workers (23/29, 79%), improper tools for the documentation of clinical data (n = 22/28, 79%), insufficient material resources (n = 22/29, 76%), and unadapted personal protective equipment (n = 20/28, 71%) as the main barriers to the provision of supportive care in ETUs. Facilitators to the provision of supportive care included team camaraderie (n in agreement = 25/28, 89%), ability to speak the local language (22/28, 79%), and having treatment protocols in place (22/28, 79%). This survey highlights a consensus across various stakeholders involved in the response to the 2014–2016 EVD outbreak on a limited number of high-priority supportive care interventions for clinical practice guidelines. Identified barriers and facilitators further inform the application of guidelines.

Ambush Killings of the Police, 1970–2018: A Longitudinal Examination of the “War on Cops” Debate

2020 ◽  
Vol 23 (4) ◽  
pp. 451-471
Author(s):  
Michael D. White
Keyword(s):  
International Association ◽  
Extended Period ◽  
Interrupted Time Series ◽  
Temporal Coding ◽  
Interrupted Time Series Analysis ◽  
High Profile ◽  
Chiefs Of Police ◽  
Recent Trends ◽  
Using Data ◽  
Definition Of

Over the last few years, there has been a series of high-profile, premeditated ambush attacks on police, which has led some to conclude there is a “war on cops.” Unfortunately, prior research has not examined the prevalence of police ambushes over an extended period of time, and the most recent study only analyzed the phenomenon through 2013. Moreover, the “war on cops” thesis implies a very specific motivation for an ambush: hatred of police or desire to seek vengeance in response to police killings of citizens. Prior research has not sufficiently explored the motivations of ambush attacks, or whether recent trends in ambushes are linked to a “war on cops” motive. I investigate ambush killings of police from 1970 to 2018 using data from the Officer Down Memorial Page in an attempt to address these research gaps. I apply a temporal coding scheme of when the attack occurred to isolate killings of police that are consistent with the International Association of Chiefs of Police definition of an ambush. Results from linear regression show that the annual rates of ambush killings of police have declined by more than 90% since 1970. Although ambushes spiked in 2016 and 2018 to the highest rates in 20 years, interrupted time series analysis indicates no statistically significant increase post-2013. Spikes have also occurred in nonambush killings since 2014. Police leaders and researchers should monitor trends in ambush and nonambush killings of police, as the recent spikes may presage the emergence of a chronic problem.

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