Reducing Unnecessary Respiratory Viral Testing to Promote High-Value Care

BACKGROUND AND OBJECTIVES: Viral respiratory infections are common in children, and practice guidelines do not recommend routine testing for typical viral illnesses. Despite results often not impacting care, nasopharyngeal swabs for viral testing are frequently performed and are an uncomfortable procedure. The aim of this initiative was to decrease unnecessary respiratory viral testing (RVT) in the emergency department (ED) and the pediatric medicine wards (PMWs) by 50% and 25%, respectively, over 36 months. METHODS: An expert panel reviewed published guidelines and appropriate evidence to formulate an RVT pathway using plan-do-study-act cycles. A multifaceted improvement strategy was developed that included implementing 2 newer, more effective tests when testing was deemed necessary; electronic order modifications with force functions; audit and feedback; and education. By using statistical process control charts, the outcomes analyzed were the percentage of RVT ordered in the ED and the rate of RVT ordered on the PMWs. Balancing measures included return visits leading to admission and inpatient viral nosocomial outbreaks. RESULTS: The RVT rate decreased from a mean of 3.0% to 0.5% of ED visits and from 44.3 to 30.1 per 1000 patient days on the PMWs and was sustained throughout the study. Even when accounting for the new rapid influenza test available in the ED, a 50% decrease in overall ED RVT was still achieved without any significant impact on return visits leading to admission or inpatient nosocomial infections. CONCLUSIONS: Through implementation of a standardized, electronically integrated RVT pathway, a decrease in unnecessary RVT was successfully achieved. Audit and feedback, reminders, and biannual education all supported long-term sustainability of this initiative.

Prospective and Concurrent Effects of Traits, Coping Beliefs, Social Support, Preventive Beliefs and Behaviors, and Sickness Experiences on Coronavirus Vaccine Inclination

The present study examined prospective and concurrent associations between traits, political orientation, well-being, coping and positive social relations, infection and preventive behavior beliefs, preventive behaviors, symptoms, exposure, viral testing, and coronavirus vaccine intention and likelihood following the FDA emergency use authorization for the Pfizer-BioNTech vaccine. The pre-registered study used a stratified online U.S. sample assessed from March, 2020, to January, 2021 (N = 500). Three assessments were aligned with “15 days to slow the spread” in March 2020; the first mortality surge in April/May, 2020; and the overlapping FDA EUA in mid-December, 2020, and major case/mortality surge during December, 2020 and January, 2021. Consistent with contemporaneous polling, 66.4 % of participants agreed a little or strongly agreed that they intended to receive an approved vaccine. Modeling results showed less education (β = .11, p < .01), child(ren) in the household (β = -.14, p < .001), baseline conservative political orientation (β = -.17, p < .001), weaker concurrent perceived health consequences (β = .13, p < .05), weaker concurrent norms for preventive behaviors (β = .23, p < .001), and less frequent concurrent mask wearing (β = .23, p < .001) were associated with weaker vaccine inclination. None of the trait, coping, or sickness experience variables was associated with vaccine inclination in the model. The results clarify the parental, political, and preventive factors associated with vaccine inclination and suggest the need for a multi-pronged vaccination campaign immediately before approval and upon availability of a novel vaccine.

Evaluation of the ESGE recommendations for COVID-19 pre-endoscopy risk-stratification in a high-volume center in Germany

Background and study aims The European Society of Gastrointestinal Endoscopy (ESGE) has defined COVID-19 infection prevention and control strategies within the endoscopy unit. These include pre-endoscopic questionnaire-based risk-stratification as well as pre-procedure viral testing. Real-life data on the effectiveness of these measures are presented here. Patients and methods Data from the outpatient endoscopic unit of the University Hospital Augsburg between July 1, 2020 and December 31, 2020 including the second pandemic wave were reviewed retrospectively. All patients were assessed with a pre-endoscopic risk-stratification questionnaire as well as viral testing using an antigen point-of-care test (Ag-POCT) in conjunction with a standard polymerase chain reaction (PCR) test. Highly elective procedures were postponed. The theoretically expected number of SARS-CoV-2-positive patients was simulated and compared with the actual number. In addition, endoscopy staff was evaluated with a rapid antibody test to determine the number of infections among the personnel. Results In total, 1029 procedures, 591 questionnaires, 591 Ag-POCTs, and 529 standard PCR tests were performed in 591 patients. 247 procedures in 142 patients were postponed. One Ag-POCT was positive but with a negative PCR test, while one PCR test was positive but with a negative Ag-POCT. This was lower than the theoretically expected number of COVID-19-positive patients (n = 15). One of 43 employees (2.3 %) in the outpatient endoscopy unit was seropositive. Conclusions Pre-endoscopic risk management including questionnaire-based risk stratification and viral testing seems to be an effective tool in combination with personal protective equipment for SARS-CoV-2 infection prevention and control within the endoscopy unit even in a high-prevalence setting.

Immune Thrombocytopenic Purpura in a Child with COVID-19: A Case Report

Introduction: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It may have many undescribed clinical manifestations. Case Presentation: In this study, we report a 7-year-old male COVID-19 patient with low platelet count who presented with gingival bleeding and ecchymosis and had a good response to corticosteroid therapy. Conclusions: This case highlights the need to be vigilant for atypical presentations or complications of COVID-19, one of which is SARS-CoV-2-induced immune thrombocytopenic purpura (ITP). It is necessary to pay attention to platelet count in addition to typical clinical features and radiographic findings. On the other hand, viral testing in thrombocytopenic patients should be considered for timely diagnosis of COVID-19 and taking necessary measurements for patient isolation in order to prevent the spread of disease and healthcare workers’ infection during this pandemic.

Antibiotic Use and Outcomes in Young Children Hospitalized with Uncomplicated Community-Acquired Pneumonia

Objectives: To compare children aged 36 months or younger hospitalized with uncomplicated community-acquired pneumonia (CAP) that are not treated with antibiotics to those treated with antibiotics in terms of clinical features and outcome measures. Methods: Administrative data and medical record review were used to identify patients from 3-36 months of age hospitalized from 2011-2019 with uncomplicated CAP. Patients were considered treated if they received antibiotics for more than 2 inpatient days and/or at discharge, and not treated if they received 2 or fewer inpatient days and no antibiotics at discharge. Demographic features, clinical characteristics, radiologic findings, viral testing, illness severity, length of stay and 30-day hospital readmissions were assessed and compared according to antibiotic treatment. Results: 322 CAP cases were included. 266/322 (83%) received antibiotics for more than 48 hours and/or at discharge. 56 patients received 2 or fewer inpatient days of antibiotics and no antibiotics at discharge; the majority received no inpatient antibiotics. There were no differences between the two groups in illness severity, length of stay or hospital readmissions. The proportion of patients treated with antibiotics decreased from 88% (2011-2013) to 66% during the most recent years studied (2017-2019). Conclusion: There was no difference in outcome of uncomplicated CAP in previously healthy children less than 36 months of age between those treated and not treated with antibiotics. Additional tools are needed to facilitate identification of viral CAP in young children and decrease unnecessary antibiotic use.

Spring 2020 COVID-19 Surge: Prospective Relations between Demographic Factors, Personality Traits, Social Cognitions and Guideline Adherence, Mask Wearing, and Symptoms in a U.S. Sample

Background To date, much of the research on individual difference correlates of coronavirus guideline adherence is cross-sectional, leaving prospective associations between these factors unaddressed. Additionally, investigations of prospective predictors of mask-wearing, COVID-19 symptoms, and viral testing remain wanting. Purpose The present study examined prospective relations between demographic factors, personality traits, social cognitions and guideline adherence, mask-wearing, symptoms, and viral testing in a U.S. sample (N = 500) during the initial surge of COVID-19 deaths in the United State between late March and early May 2020. Methods Guided by a disposition-belief-motivation framework, correlational analyses, and path models tested associations among baseline personality traits, guideline adherence social cognitions, health beliefs, guideline adherence and follow-up guideline adherence, mask-wearing, symptom counts, and 30-day viral testing. Results Modeling results showed greater baseline agreeableness, conscientiousness, and extraversion were associated with more frequent baseline guideline adherence. More liberal political beliefs, greater guideline adherence intentions, and more frequent guideline adherence at baseline predicted more frequent mask-wearing at follow-up. Sex (female), lower perceived health, and greater neuroticism at baseline predicted greater symptom counts at follow-up. Reports of viral testing were quite low (1.80%), yet were consistent with concurrent national reporting and limited availability of testing. Conclusions Results show how inconsistencies and politicization of health policy communication were concomitant with the effects of individual-level political beliefs on mask-wearing during the initial surge. The results further clarify how personality traits related to social responsibility (i.e., agreeableness, conscientiousness) are associated with following new norms for prescribed behaviors and how symptom reporting can be as much a marker of perceived health as emotional stability.

SARS-CoV-2 serological assay and viral testing: a report of professional football setting

Purpose of the studyPCR is the current standard test for the diagnosis of SARS-CoV-2 infection. However, due to its limitations, serological testing is considered an alternative method for detecting SARS-CoV-2 exposure. In this study, we measured the level of SARS-CoV-2 IgM and IgG antibodies of male professional football players and compared the results with the standard PCR test to investigate the association between the two tests.Study designParticipants were male professional football players and team officials. Nasopharyngeal swabs and peripheral blood samples were collected for the PCR and serological tests, respectively. Also, previous records of COVID-19 testing and symptoms were gathered. Those with previous positive PCR tests who tested negative for the second time were considered to be recovered patients.ResultsOf the 1243 subjects, 222 (17.9%) were seropositive, while 29 (2.3%) tested positive for the SARS-CoV-2 PCR test. Sixty percent of symptomatic cases with a negative PCR were found to be seropositive. The mean level of IgM was significantly higher in PCR-positive and symptomatic subjects, whereas the recovered cases showed significantly higher levels of IgG.ConclusionOur study revealed an inconsistency of results between the two tests; therefore, although application of serological assays alone seems insufficient in diagnosing COVID-19 disease, the findings are beneficial in the comprehension and the management of the disease.

COVID-19 in aged care homes: a comparison of effects initial government policies had in the UK (primarily focussing on England) and Australia during the first wave

Background COVID-19 pandemic has had a major impact globally, with older people living in aged care homes suffering high death rates. Objectives We aimed to compare the impact of initial government policies on this vulnerable older population between the UK and Australia during the first wave of attack. Methods We searched websites of governments in the UK and Australia and media outlets. We examined the key policies including the national lockdown dates and the distribution of some important resources (personal protective equipment and testing) and the effects of these initial policies on the mortality rates in the aged care homes during the first wave of attack of COVID-19. Results We found that both countries had prioritized resources to hospitals over aged care homes during the first wave of attack. Both countries had lower priority for aged care residents in hospitals (e.g. discharging without testing for COVID-19 or discouraging admissions). However, deaths in aged care homes were 270 times higher in the UK than in Australia as on 7 May 2020 (despite UK having a population only 2.5 times larger than Australia). The lower fatality rate in Australia may have been due to the earlier lockdown strategy when the total daily cases were low in Australia (118) compared to the UK (over 1000), as well as the better community viral testing regime in Australia. Conclusion In conclusion, the public health policy in Australia aimed towards earlier intervention with earlier national lockdown and more viral testing to prevent new cases. This primary prevention could have resulted in more lives being saved. In contrast, the initial policy in the UK focussed mainly on protecting resources for hospitals, and there was a delay in national lockdown intervention and lower viral testing rate, resulting in more lives lost in the aged care sector.

Spring 2020 COVID-19 Surge: Prospective Relations between Psychosocial Factors and Guideline Adherence, Mask Wearing, and Symptoms in a U.S. Sample

Background: To date, much of the research on psychosocial correlates of coronavirus guideline adherence is cross-sectional, leaving prospective associations between these factors unaddressed. Additionally, investigations of prospective predictors of mask-wearing, COVID-19 symptoms, and viral testing remain wanting.Purpose: The present study examined prospective relations between psychosocial factors and guideline adherence, mask-wearing, symptoms, and viral testing in a U.S. sample (N = 500) during the initial surge of COVID deaths in the U.S. between late March and early May, 2020.Methods: Guided by a disposition-belief-motivation framework, correlational analyses and path models tested associations among baseline personality traits, guideline adherence social cognitions, health beliefs, guideline adherence and follow-up guideline adherence, mask-wearing, symptom counts, and 30-day viral testing. Results: Modeling results showed greater baseline agreeableness, conscientiousness, and extraversion were associated with more frequent baseline guideline adherence. More liberal political beliefs, greater guideline adherence intentions, and more frequent guideline adherence at baseline predicted more frequent mask-wearing at follow-up. Sex (female), lower perceived health, and greater neuroticism at baseline predicted greater symptom counts at follow-up. Reports of viral testing were quite low (1.80 %) yet were consistent with concurrent national reporting and limited availability of testing.Conclusions: Results show how inconsistencies and politization of health policy communication were concomitant with effects of individual-level political beliefs on mask-wearing during the initial surge. The results further clarify how personality traits related to social responsibility (i.e., agreeableness, conscientiousness) are associated with following new norms for prescribed behaviors and how symptom reporting can be as much a marker of perceived health as emotional stability.