Setting up a drug treatment service in a COVID-protect hotel in inner London

At the start of the UK's COVID-19 lockdown, the government announced an ‘Everyone In’ strategy to get homeless people off the streets and into accommodation. An Inner London borough opened a hotel to house up to 100 homeless people to address their health needs. Local healthcare providers were asked to provide in-reach services. This article describes the setting up and delivery of a drug treatment service to provide substitute opioid therapy. Thirty-five people were taken into drug treatment in the hotel between April and December 2020. During this time various challenges had to be addressed including same-day prescribing, delivering and supervising controlled drugs and responding to drug dealing in the hotel. Partnership work between the different healthcare providers was essential for the success of this project and offers a model that could be used going forward to deliver comprehensive wrap-around services to hard-to-engage individuals with multiple health needs.

Different Rates of the SLC26A4-Related Hearing Loss in Two Indigenous Peoples of Southern Siberia (Russia)

Hereditary hearing loss (HL) is known to be highly locus/allelic heterogeneous, and the prevalence of different HL forms significantly varies among populations worldwide. Investigation of region-specific landscapes of hereditary HL is important for local healthcare and medical genetic services. Mutations in the SLC26A4 gene leading to nonsyndromic recessive deafness (DFNB4) and Pendred syndrome are common genetic causes of hereditary HL, at least in some Asian populations. We present for the first time the results of a thorough analysis of the SLC26A4 gene by Sanger sequencing in the large cohorts of patients with HL of unknown etiology belonging to two neighboring indigenous Turkic-speaking Siberian peoples (Tuvinians and Altaians). A definite genetic diagnosis based on the presence of biallelic SLC26A4 mutations was established for 28.2% (62/220) of all enrolled Tuvinian patients vs. 4.3% (4/93) of Altaian patients. The rate of the SLC26A4-related HL in Tuvinian patients appeared to be one of the highest among populations worldwide. The SLC26A4 mutational spectrum was characterized by the presence of Asian-specific mutations c.919-2A>G and c.2027T>A (p.Leu676Gln), predominantly found in Tuvinian patients, and c.2168A>G (p.His723Arg), which was only detected in Altaian patients. In addition, a novel pathogenic variant c.1545T>G (p.Phe515Leu) was found with high frequency in Tuvinian patients. Overall, based on the findings of this study and our previous research, we were able to uncover the genetic causes of HL in 50.5% of Tuvinian patients and 34.5% of Altaian patients.

Adaptation and implementation of the Batz guide for bedside advocacy in two hospitals

BACKGROUND: The patients’ guide by the Batz Patient Safety Foundation promotes patients’ active participation in healthcare and a safe hospital experience. OBJECTIVE: The aim was to adapt the Spanish version of the guide to the local context and evaluate its acceptability from healthcare professionals’ and patients’ perspectives in two hospitals in Buenos Aires, Argentina. METHODS: This implementation study had a formative research phase to adapt the guide with input from individual interviews and focus group discussions. The intervention comprised training sessions for professionals on patient-centered care and use of the guide, the appointment of coordinators, and distribution of the guide. The adapted guide (section During Admission) was distributed in two hospitals. Before and after intervention, we administered surveys to explore acceptability, utility, and patient satisfaction. RESULTS: Findings from formative research showed that the Batz guide needed to be shortened and adapted to the local healthcare context Although professionals had agreed on the importance of clinical guidelines; after using the Batz guide, they found it complex and difficult to implement. Patients’ satisfaction with healthcare before and after implementing the guide did not differ significantly. Best scores were found in items related to availability of nurses, staff competence and staff kindness. A 78% of patients found the Batz guide useful. CONCLUSION: It is of critical importance to adapt the guide to the local culture, pilot it, and provide training to promote its implementation, improving acceptability and utility.

A modified Delphi approach to enhance nurturing of professionalism in postgraduate medical education in Singapore

Introduction: Nurturing professional identities instils behavioural standards of physicians, in turn facilitating consistent professional attitudes, practice, and patient care. Identities are socioculturally constructed efforts, thus we must account for the social, cultural, and local healthcare factors that shape physicians’ roles, responsibilities and expectations. This study aims to forward a program to nurture professionalism amongst physicians in Singapore. Methods: A 3-phased-evidenced-based-approach was used. First, a systematic scoping review (SSR) was conducted to identify professionalism elements. Second, a questionnaire was created drawing from the SS’s findings. Third, a modified Delphi involving local experts identifying socioculturally appropriate elements to nurture professionalism was conducted. Results: The 124 included articles in the SSR revealed definitions, knowledge, skills, and approaches to nurturing professionalism. The modified Delphi identified professional traits, virtues, communication, ethical, self-care, teaching and assessment methods, and support mechanisms. Conclusion: Results formed the basis to a holistic and longitudinal program focused on instilling professional traits and competencies over time through personalised and holistic support of physicians. Findings will be of interest to medical communities in the region and beyond.

Federated learning enables intelligent reflecting surface in fog-cloud enabled cellular network

The intelligent reflecting surface (IRS) is a ground-breaking technology that can boost the efficiency of wireless data transmission systems. Specifically, the wireless signal transmitting environment is reconfigured by adjusting a large number of small reflecting units simultaneously. Therefore, intelligent reflecting surface (IRS) has been suggested as a possible solution for improving several aspects of future wireless communication. However, individual nodes are empowered in IRS, but decisions and learning of data are still made by the centralized node in the IRS mechanism. Whereas, in previous works, the problem of energy-efficient and delayed awareness learning IRS-assisted communications has been largely overlooked. The federated learning aware Intelligent Reconfigurable Surface Task Scheduling schemes (FL-IRSTS) algorithm is proposed in this paper to achieve high-speed communication with energy and delay efficient offloading and scheduling. The training of models is divided into different nodes. Therefore, the trained model will decide the IRSTS configuration that best meets the goals in terms of communication rate. Multiple local models trained with the local healthcare fog-cloud network for each workload using federated learning (FL) to generate a global model. Then, each trained model shared its initial configuration with the global model for the next training round. Each application’s healthcare data is handled and processed locally during the training process. Simulation results show that the proposed algorithm’s achievable rate output can effectively approach centralized machine learning (ML) while meeting the study’s energy and delay objectives.

Prevalence of Depressive Symptoms in Patients With Psoriatic Arthritis: Have Numbers Changed During the COVID-19 Pandemic?

This longitudinal analysis compares the prevalence of depressive symptoms in patients with psoriatic arthritis in the context of the COVID-19 pandemic. Data from a national patient register in Germany were analyzed regarding the Patient Health Questionnaire 2 (PHQ-2) to identify cases suspicious for depression at two time points, i.e., before and during the COVID-19 pandemic. Only patients with complete concurrent information on the Disease Activity in Psoriatic Arthritis Score (DAPSA) were included in the analysis. The frequency of depressive symptoms in psoriatic arthritis patients during the COVID-19 pandemic did not differ from the prevalence rates measured before. In addition, prevalence rates for depressive symptoms did not differ when stratifying the patient sample for DAPSA levels of disease activity measured before the pandemic. These results were confirmed further in a sensitivity analysis, limiting the second PHQ-2 assessment to lockdown periods only. However, longitudinal data on the prevalence of depressive symptoms in patients with rheumatic diseases, in general, and psoriatic arthritis, in particular, are scarce in the context of the COVID-19 pandemic. For a sensible comparison of prevalence rates for depressive symptoms in the future, underlying SARS-CoV-2 infection rates and resulting local healthcare disruptions need to be taken into account, besides the potential use of different depression screening tools to evaluate resulting numbers sensibly and draw corresponding conclusions for patient care.

Healthcare under pressure: modelling COVID-19 fatalities with multiscale geographically weighted regressions

PurposeThe paper aims to disentangle the factors behind territorial disparities in the coronavirus disease 2019 (COVID-19) case fatality ratio, focusing on the pressure put by the pandemic on healthcare services and adopting a spatial perspective.Design/methodology/approachMultiscale geographically weighted regression (MGWR) models have been used for uncovering the spatial variability in the impact of healthcare services on COVID-19 case fatality ratio, allowing authors to better capture the real spatial patterns at local level. The authors proved that this approach yields better results, and the MGWR model outperforms traditional regression methods. The selected case studies are two of the biggest UE countries, among the first affected by a high incidence of COVID-19 cases, namely Italy and Germany.FindingsThe authors found sizeable regional differences in COVID-19 mortality rates within each of the analysed countries, and the stress borne by local healthcare systems seems to be the most powerful factor in explaining them. In line with other studies, the authors found additional factors of influence, such as age distribution, gender ratio, population density and regional development.Originality/valueThis research clearly indicated that COVID-19 related deaths are strongly associated with the degree of resilience of the local healthcare systems. The authors supply localized results on the factors of influence, useful for assisting the decision-makers in prioritizing limited healthcare resources. The authors provide a scientific argument in favour of the decentralization of the pandemic management towards local authorities not neglecting, however, the necessary regional or national coordination.

Teledermatology Utilization and Integration in Residency Training Over the COVID-19 Pandemic

Background During the 2019 Coronavirus (COVID-19) pandemic, the Division of Dermatology, University of Ottawa, adapted pre-existing local healthcare infrastructures to provide increased provider-to-provider teledermatology services as well as integrated teledermatology into the dermatology residency training program. Objectives (1) To assess the differences in utilization of provider-to-provider teledermatology services before and during the COVID-19 pandemic; and (2) to assess dermatology resident and faculty experiences with the integration of teledermatology into dermatology residency training at the University of Ottawa. Methods We conducted a cross-sectional analysis comparing provider-to-provider teledermatology consults submitted to dermatologists from April 2019 to October 2019 pre-pandemic with the same period during the pandemic in 2020. Two different questionnaires were also disseminated to the dermatology residents and faculty at our institution inquiring about their perspectives on teledermatology, education, and practice. Results The number of dermatologists completing consults, the number of providers submitting a case to Dermatology, and the number of consults initiated all increased during the pandemic period. Ninety-one percent of residents agreed that eConsults and teledermatology enhanced their residency education, enabled continuation of training during the pandemic, and that eConsult-based training should be incorporated into the curriculum. Ninety-six percent of staff incorporated a virtual dermatology practice model, and one-third used teledermatology with residents during the pandemic. Most staff felt there was value in providing virtual visits in some capacity during the pandemic. Conclusions Our study confirms that the use of teledermatology services continues to increase accessibility during the pandemic. Teledermatology enhances the education and training of residents and will be incorporated into dermatology residency programs.