scholarly journals Geospatial Hotspots Need Point-of-Care Strategies to Stop Highly Infectious Outbreaks

2020 ◽  
Vol 144 (10) ◽  
pp. 1166-1190 ◽  
Author(s):  
Gerald J. Kost
Keyword(s):  
Infectious Disease ◽  
Emergency Response ◽  
Point Of Care ◽  
Diagnostic Testing ◽  
Community Resilience ◽  
The United States ◽  
Standards Of Care ◽  
Healthcare Personnel ◽  
Cloud Databases ◽  
Public Health Practitioners

Context.— Point-of-care testing (POCT), diagnostic testing at or near the site of patient care, is inherently spatial, that is, performed at points of need, and also intrinsically temporal, because it produces fast actionable results. Outbreaks generate geospatial “hotspots.” POC strategies help control hotspots, detect spread, and speed treatment of highly infectious diseases. Objectives.— To stop outbreaks, accelerate detection, facilitate emergency response for epidemics, mobilize public health practitioners, enhance community resilience, and improve crisis standards of care. Data Sources.— PubMed, World-Wide Web, newsprint, and others were searched until Coronavirus infectious disease-19 was declared a pandemic, the United States, a national emergency, and Europe, the epicenter. Coverage comprised interviews in Asia, email to/from Wuhan, papers, articles, chapters, documents, maps, flowcharts, schematics, and geospatial-associated concepts. EndNote X9.1 (Clarivate Analytics) consolidated literature as abstracts, ULRs, and PDFs, recovering 136 hotspot articles. More than 500 geospatial science articles were assessed for relevance to POCT. Conclusions.— POCT can interrupt spirals of dysfunction and delay by enhancing disease detection, decision-making, contagion containment, and safe spacing, thereby softening outbreak surges and diminishing risk before human, economic, and cultural losses mount. POCT results identify where infected individuals spread Coronavirus infectious disease-19, when delays cause death, and how to deploy resources. Results in national cloud databases help optimize outbreak control, mitigation, emergency response, and community resilience. The Coronavirus infectious disease-19 pandemic demonstrates unequivocally that governments must support POCT and multidisciplinary healthcare personnel must learn its principles, then adopt POC geospatial strategies, so that onsite diagnostic testing can ramp up to meet needs in times of crisis.

scholarly journals Geospatial Spread of Antimicrobial Resistance, Bacterial and Fungal Threats to COVID-19 Survival, and Point-of-Care Solutions

2020 ◽  
Author(s):  
Gerald J. Kost
Keyword(s):  
Antimicrobial Resistance ◽  
San Francisco ◽  
Point Of Care ◽  
Diagnostic Testing ◽  
The United States ◽  
Pathogen Resistance ◽  
Standards Of Care ◽  
Healthcare Personnel ◽  
Diagnostic Challenge ◽  
Antimicrobial Drugs

ABSTRACT Context. Point-of-care testing (POCT) is inherently spatial, that is, performed where needed, and intrinsically temporal, because it accelerates decision making. POCT efficiency and effectiveness have the potential to facilitate antimicrobial resistance (AMR) detection, decrease risks of co-infections for critically ill COVID-19 patients, and improve the cost-effectiveness of healthcare. Objectives. To assess AMR identification using POCT, describe the United States AMR Diagnostic Challenge, and improve global standards of care for infectious diseases. Data Sources PubMed, WWW, and other sources were searched for papers focusing on AMR and POCT. EndNote X9.1 (Clarivate Analytics) consolidated abstracts, URLs, and PDFs representing ~500 articles assessed for relevance. Panelist insights at Tri•Con 2020 in San Francisco and finalist POC technologies competing for a US $20,000,000 AMR prize are summarized. Conclusions. Co-infections represent high risks for COVID-19 patients. POCT potentially will help target specific pathogens, refine choices for antimicrobial drugs, and prevent excess morbidity and mortality. POC assays that identify patterns of pathogen resistance can help tell us how infected individuals spread AMR, where geospatial hotspots are located, when delays cause death, and how to deploy preventative resources. Shared AMR data “clouds” could help reduce critical care burden during pandemics and optimize therapeutic options, similar to use of antibiograms in individual hospitals. Multidisciplinary healthcare personnel should learn the principles and practice of POCT, so they can meet needs with rapid diagnostic testing. The stakes are high. AMR is projected to cause millions of deaths annually and cumulative financial loses in the trillions by 2050.

scholarly journals The Laboratory Diagnosis of HIV Infections

2005 ◽  
Vol 16 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Margaret Fearon
Keyword(s):  
Point Of Care ◽  
Diagnostic Testing ◽  
Clinical Information ◽  
Hiv Infections ◽  
Laboratory Diagnosis ◽  
The United States ◽  
Specific Information ◽  
Antibody Testing ◽  
Diagnostic Laboratory ◽  
Laboratory Results

HIV diagnostic testing has come a long way since its inception in the early 1980s. Current enzyme immunoassays are sensitive enough to detect antibody as early as one to two weeks after infection. A variety of other assays are essential to confirm positive antibody screens (Western blot, polymerase chain reaction [PCR]), provide an adjunct to antibody testing (p24 antigen, PCR), or provide additional information for the clinician treating HIV-positive patients (qualitative and quantitative PCR, and genotyping). Most diagnostic laboratories have complex testing algorithms to ensure accuracy of results and optimal use of laboratory resources. The choice of assays is guided by the initial screening results and the clinical information provided by the physician; both are integral to the laboratory's ability to provide an accurate laboratory diagnosis. Laboratories should also provide specific information on specimen collection, storage and transport so that specimen integrity is not compromised, thereby preserving the accuracy of laboratory results. Point of Care tests have become increasingly popular in the United States and some places in Canada over the past several years. These tests provide rapid, on-site HIV results in a format that is relatively easy for clinic staff to perform. However, the performance of these tests requires adherence to good laboratory quality control practices, as well as the backup of a licensed diagnostic laboratory to provide confirmation and resolution of positive or indeterminate results. Laboratory quality assurance programs and the participation in HIV proficiency testing programs are essential to ensure that diagnostic laboratories provide accurate, timely and clinically relevant laboratory results.

scholarly journals The Arizona Healthcare, Emergency Response, and Other Essential Workers Study (AZ HEROES): Protocol (Preprint)

2021 ◽  
Author(s):  
Karen Lutrick ◽  
Katherine D. Ellingson ◽  
Zoe Baccam ◽  
Patrick Rivers ◽  
Shawn Beitel ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Emergency Response ◽  
Natural Infection ◽  
Diagnostic Testing ◽  
Vaccine Dose ◽  
Demographic Characteristics ◽  
Healthcare Personnel ◽  
Molecular Diagnostic ◽  
Vaccination History ◽  
Baseline Information

UNSTRUCTURED Background: The Arizona Healthcare, Emergency Response, and Other Essential workers Study (AZ HEROES) aims to examine the epidemiology of SARS-CoV-2 infection and COVID-19 illness among adults with high occupational exposure risk. Methods: Eligible participants include Arizona residents aged 18–85 years who work at least 20 hours per week in an occupation involving regular direct contact (within three feet) with others. Recruitment goals are stratified by demographic characteristics (50% aged 40 or older, 50% women, and 50% Hispanic or American Indian), by occupation (40% healthcare personnel, 30% first responders, and 30% other essential workers), and by prior SARS-CoV-2 infection (with up to 50% seropositive at baseline). Information on sociodemographics, health and medical history, vaccination status, exposures to individuals with suspected or confirmed SARS-CoV-2 infection, use of personal protective equipment, and perceived risks are collected at enrollment and updated through quarterly surveys. Every week, participants complete active surveillance for COVID-19–like illness (CLI) and self-collect nasal swabs. Additional self-collected nasal swab and saliva specimens are collected in the event of CLI onset. Respiratory specimens are sent to Marshfield Laboratories and tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction (rRT-PCR) assay. CLI symptoms and impact on work and productivity are followed through illness resolution. Serum specimens are collected every 3 months and additional sera are collected following incident rRT-PCR positivity and after each COVID-19 vaccine dose. Incidence of SARS-CoV-2 infections will be calculated by person-weeks at risk and compared by occupation and demographic characteristics and by seropositivity status and infection and vaccination history. Discussion: AZ HEROES is unique in aiming to recruit a diverse sample of essential workers and prospectively following strata of SARS-CoV-2 seronegative and seropositive adults. Survey results combined with active surveillance data on exposure, CLI, weekly molecular diagnostic testing, and periodic serology will be used to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infection, assess the intensity and durability of immune responses to natural infection and COVID-19 vaccination, and contribute to the evaluation of COVID-19 vaccine effectiveness.

Testing Emergency Medical Personnel Response to Patients with Suspected Infectious Disease

2004 ◽  
Vol 19 (3) ◽  
pp. 256-265 ◽  
Author(s):  
Kelly R. Klein ◽  
Jenny G. Atas ◽  
Jerry Collins
Keyword(s):  
Infectious Disease ◽  
Emergency Response ◽  
Medical Personnel ◽  
Health Department ◽  
The United States ◽  
Local Health ◽  
Healthcare Organizations ◽  
Ambulance Personnel ◽  
Disaster Plan ◽  
Emergency Medical Personnel

AbstractObjectives:In the United States (US), hospitals are required to have disaster plans and stage drills to test these plans in order to satisfy the Joint Accreditation Commission of Healthcare Organizations. The focus of this drill was to test if emergency response personnel, both prehospital and hospital, would identify a patient with a potentially communicable infectious disease, and activate their respective disaster plan.Methods:Twelve urban/suburban emergency departments (ED) received patients via car and ambulance. Patients were moulaged to imitate a smallpox infection. Observers with checklists recorded what happened. The drill's endpoints were: (1) predetermined end time; (2) identification of the patient and hospital “lock-down”; and (3) breach of drill protocol.Results:None of the ambulance personnel correctly identified their patients. Of the total 13 mock patients assessed in the ED, seven (54%) were identified by the ED staff as possibly being infected with a highly contagious agent and, in turn, the hospital's bio-agent protocol was initiated. Of the correctly identified patients, five (71%) were placed in isolation, and the remaining two (29%), although not isolated, were identified prior to their ED discharge and the appropriate protocol was activated. The six remaining mock patients (46%) were incorrectly diagnosed and discharged. Of the hospitals that had correctly identified their “infected” patients, only two (29%) followed their notification protocol and contacted the local health department.Conclusion:This drill was successful in identifying this area's shortcomings, highlighted positive reactions, and raised some interesting questions about the ability to detect a patient with a possibly highly contagious disease.

Fiduciary Principles in Contemporary Common Law Systems

2019 ◽  
pp. 564-582
Author(s):  
Matthew Conaglen
Keyword(s):  
United States ◽  
Common Law ◽  
The United States ◽  
Good Faith ◽  
Fiduciary Duty ◽  
Standards Of Care ◽  
Duty Of Care ◽  
Fiduciary Duties ◽  
Similarities And Differences ◽  
Fiduciary Relationships

This chapter examines the principles of fiduciary doctrine that are found in contemporary common law systems. More specifically, it considers the current similarities and differences between various jurisdictions such as England, Australia, Canada, and the United States. The similarities focus on the duties of loyalty, care and skill, and good faith, as well as when fiduciary duties arise and the kinds of interests that are protected by recognition of fiduciary relationships. The chapter also discusses the issue of differences between various jurisdictions with regard to the duty of care and skill before concluding with an analysis of differences between remedies that are made available in the various contemporary common law jurisdictions when a breach of fiduciary duty arises. It shows that the regulation of fiduciaries appears to be reasonably consistent across common law jurisdictions and across various types of actors, even as such actors are expected to meet differing standards of care. Statute plays a key role in the regulation of various kinds of fiduciary actors, especially corporate directors.

scholarly journals Verification of Healthcare Personnel Immunity as a Strategy for Measles Preparedness

2020 ◽  
Vol 41 (S1) ◽  
pp. s431-s432
Author(s):  
Rachael Snyders ◽  
Hilary Babcock ◽  
Christopher Blank
Keyword(s):  
Infectious Diseases ◽  
Multidisciplinary Team ◽  
The United States ◽  
Transmission Risk ◽  
Healthcare Personnel ◽  
Serological Tests ◽  
Preparedness Plan ◽  
Vaccine Preventable Diseases ◽  
Measles Outbreaks ◽  
Centralized Database

Background: Immunization resistance is fueling a resurgence of vaccine-preventable diseases in the United States, where several large measles outbreaks and 1,282 measles cases were reported in 2019. Concern about these measles outbreaks prompted a large healthcare organization to develop a preparedness plan to limit healthcare-associated transmission. Verification of employee rubeola immunity and immunization when necessary was prioritized because of transmission risk to nonimmune employees and role of the healthcare personnel in responding to measles cases. Methods: The organization employs ∼31,000 people in diverse settings. A multidisciplinary team was formed by infection prevention, infectious diseases, occupational health, and nursing departments to develop the preparedness plan. Immunity was monitored using a centralized database. Employees without evidence of immunity were asked to provide proof of vaccination, defined by the CDC as 2 appropriately timed doses of rubeola-containing vaccine, or laboratory confirmation of immunity. Employees were given 30 days to provide documentation or to obtain a titer at the organization’s expense. Staff with negative titers were given 2 weeks to coordinate with the occupational heath department for vaccination. Requests for medical or religious accommodations were evaluated by occupational heath staff, the occupational heath medical director, and the human resources department. All employees were included, though patient-interfacing employees in departments considered higher risk were prioritized. These areas were the emergency, dermatology, infectious diseases, labor and delivery, obstetrics, and pediatrics departments. Results: At the onset of the initiative in June 2019, 4,009 employees lacked evidence of immunity. As of November 2019, evidence of immunity had been obtained for 3,709 employees (92.5%): serological evidence of immunity was obtained for 2,856 (71.2%), vaccine was administered to 584 (14.6%), and evidence of previous vaccination was provided by 269 (6.7%). Evidence of immunity has not been documented for 300 (7.5%). The organization administered 3,626 serological tests and provided 997 vaccines, costing ∼$132,000. Disposition by serological testing is summarized in Table 1. Conclusions: A measles preparedness strategy should include proactive assessment of employees’ immune status. It is possible to expediently assess a large number of employees using a multidisciplinary team with access to a centralized database. Consideration may be given to prioritization of high-risk departments and patient-interfacing roles to manage workload.Funding: NoneDisclosures: None

scholarly journals Learning health systems in primary care: a systematic scoping review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Danielle M. Nash ◽  
Zohra Bhimani ◽  
Jennifer Rayner ◽  
Merrick Zwarenstein
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Health Systems ◽  
Scoping Review ◽  
Early Stage ◽  
Point Of Care ◽  
The United States ◽  
Stage Of Development ◽  
Integrated Health ◽  
Google Search

Abstract Background Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. Methods We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature. Results We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research. Conclusions We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.

scholarly journals Epidemiologic and Microbiologic Characteristics of 28 Hospitalized Patients Cocolonized With Multiple Carbapenem-Resistant Enterobacteriaceae (CRE) in the United States

2020 ◽  
Vol 41 (S1) ◽  
pp. s62-s62
Author(s):  
Timileyin Adediran ◽  
Anthony Harris ◽  
J. Kristie Johnson ◽  
David Calfee ◽  
Loren Miller ◽  
...  
Keyword(s):  
United States ◽  
Secondary Analysis ◽  
Positive Culture ◽  
The United States ◽  
Healthcare Personnel ◽  
Surveillance Culture ◽  
E Coli ◽  
Carbapenem Resistant ◽  
Multicenter Prospective Cohort Study ◽  
Epidemiological Significance

Background: As carbapenem-resistant Enterobacteriaceae (CRE) prevalence increases in the United States, the risk of cocolonization with multiple CRE may also be increasing, with unknown clinical and epidemiological significance. In this study, we aimed to describe the epidemiologic and microbiologic characteristics of inpatients cocolonized with multiple CRE. Methods: We conducted a secondary analysis of a large, multicenter prospective cohort study evaluating risk factors for CRE transmission to healthcare personnel gown and gloves. Patients were identified between January 2016 and June 2019 from 4 states. Patients enrolled in the study had a clinical or surveillance culture positive for CRE within 7 days of enrollment. We collected and cultured samples from the following sites from each CRE-colonized patient: stool, perianal area, and skin. A modified carbapenem inactivation method (mCIM) was used to detect the presence or absence of carbapenemase(s). EDTA-modified CIM (eCIM) was used to differentiate between serine and metal-dependent carbapenemases. Results: Of the 313 CRE-colonized patients enrolled in the study, 28 (8.9%) were cocolonized with at least 2 different CRE. Additionally, 3 patients were cocolonized with >2 different CRE (1.0%). Of the 28 patients, 19 (67.6%) were enrolled with positive clinical cultures. Table 1 summarizes the demographic and clinical characteristics of these patients. The most frequently used antibiotic prior to positive culture was vancomycin (n = 33, 18.3%). Among the 62 isolates from 59 samples from 28 patients cocolonized patients, the most common CRE species were Klebsiella pneumoniae (n = 18, 29.0%), Escherichia coli (n = 10, 16.1%), and Enterobacter cloacae (n = 9, 14.5%). Of the 62 isolates, 38 (61.3%) were mCIM positive and 8 (12.9%) were eCIM positive. Of the 38 mCIM-positive isolates, 33 (86.8%) were KPC positive, 4 (10.5%) were NDM positive, and 1 (2.6%) was negative for both KPC and NDM. Also, 2 E. coli, 1 K. pneumoniae, and 1 E. cloacae were NDM-producing CRE. Conclusion: Cocolonization with multiple CRE occurs frequently in the acute-care setting. Characterizing patients with CRE cocolonization may be important to informing infection control practices and interventions to limit the spread of these organisms, but further study is needed.Funding: NoneDisclosures: None

Greenness and the Potential Resilience to Sexual Violence: “Your Neighborhood Is Being Neglected Because People Don’t Care. People With Power Don’t Care”

2021 ◽  
pp. 088626052110280
Author(s):  
Gibran C. Mancus ◽  
Andrea N. Cimino ◽  
Md Zabir Hasan ◽  
Jacquelyn C. Campbell ◽  
Phyllis Sharps ◽  
...  
Keyword(s):  
Quantitative Analysis ◽  
Violent Crime ◽  
Green Space ◽  
A Priori ◽  
Community Resilience ◽  
The United States ◽  
Green Spaces ◽  
Traffic Density ◽  
Black Communities ◽  
Black Neighborhoods

There is increasing evidence that green space in communities reduces the risk of aggression and violence, and increases wellbeing. Positive associations between green space and resilience have been found among children, older adults and university students in the United States, China and Bulgaria. Little is known about these associations among predominately Black communities with structural disadvantage. This study explored the potential community resilience in predominately Black neighborhoods with elevated violent crime and different amounts of green space. This embedded mixed-methods study started with quantitative analysis of women who self-identified as “Black and/or African American.” We found inequality in environments, including the amount of green space, traffic density, vacant property, and violent crime. This led to 10 indepth interviews representing communities with elevated crime and different amounts of green space. Emergent coding of the first 3 interviews, a subset of the 98 in the quantitative analysis, led to a priori coding of barriers and facilitators to potential green space supported community resilience applied to the final 7 interview data. Barriers were a combination of the physical and social environment, including traffic patterns, vacant property, and crime. Facilitators included subjective qualities of green space. Green spaces drew people in through community building and promoting feelings of calmness. The transformation of vacant lots into green spaces by community members affords space for people to come together and build community. Green spaces, a modifiable factor, may serve to increase community resilience and decrease the risk of violence.

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