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BMC Infectious Diseases, 6.08.2022
Tilføjet 7.08.2022
Abstract
Background
The incidence of high-risk human papillomavirus (hrHPV)-driven head and neck squamous cell carcinoma, in particular oropharyngeal cancers (OPC), is increasing in high-resource countries. Patients with HPV-induced cancer respond better to treatment and consequently have lower case-fatality rates than patients with HPV-unrelated OPC. These considerations highlight the importance of reliable and accurate markers to diagnose truly HPV-induced OPC.
Methods
The accuracy of three possible test strategies, i.e. (a) hrHPV DNA PCR (DNA), (b) p16(INK4a) immunohistochemistry (IHC) (p16), and (c) the combination of both tests (considering joint DNA and p16 positivity as positivity criterion), was analysed in tissue samples from 99 Belgian OPC patients enrolled in the HPV-AHEAD study. Presence of HPV E6*I mRNA (mRNA) was considered as the reference, indicating HPV etiology.
Results
Ninety-nine OPC patients were included, for which the positivity rates were 36.4%, 34.0% and 28.9% for DNA, p16 and mRNA, respectively. Ninety-five OPC patients had valid test results for all three tests (DNA, p16 and mRNA). Using mRNA status as the reference, DNA testing showed 100% (28/28) sensitivity, and 92.5% (62/67) specificity for the detection of HPV-driven cancer. p16 was 96.4% (27/28) sensitive and equally specific (92.5%; 62/67). The sensitivity and specificity of combined p16 + DNA testing was 96.4% (27/28) and 97.0% (65/67), respectively. In this series, p16 alone and combined p16 + DNA missed 1 in 28 HPV driven cancers, but p16 alone misclassified 5 in 67 non-HPV driven as positive, whereas combined testing would misclassify only 2 in 67.
Conclusions
Single hrHPV DNA PCR and p16(INK4a) IHC are highly sensitive but less specific than using combined testing to diagnose HPV-driven OPC patients. Disease prognostication can be encouraged based on this combined test result.
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Isaac Kohane, Gilbert S. Omenn
New England Journal of Medicine, 6.08.2022
Tilføjet 7.08.2022
Cristian Apetrei, Preston A. Marx, John W. Mellors, Ivona Pandrea
Trends in Microbiology, 6.08.2022
Tilføjet 7.08.2022
‘Infodemia’ is a portmanteau between ‘information’ and ‘epidemics’, referring to wide and rapid accumulation and dissemination of information, misinformation, and disinformation about a given subject, such as a disease. As facts, rumors and fears mix and disperse, the misinfodemic creates loud background noise, preventing the general public from discerning between accurate and false information. We compared and contrasted key elements of the AIDS and COVID-19 misinfodemics, to identify common features, and, based on experience with the AIDS pandemic, recommend actions to control and reverse the SARS-CoV-2 misinfodemic that contributed to erode the trust between the public and scientists and governments and has created barriers to control of COVID-19.
Læs mere Tjek på PubMedImmunity, 26.10.2022
Tilføjet 6.08.2022
Publication date: Available online 5 August 2022Source: ImmunityAuthor(s): Karlijn van der Straten, Denise Guerra, Marit J. van Gils, Ilja Bontjer, Tom G. Caniels, Hugo D.G. van Willigen, Elke Wynberg, Meliawati Poniman, Judith A. Burger, Joey H. Bouhuijs, Jacqueline van Rijswijk, Wouter Olijhoek, Marinus H. Liesdek, A. H. Ayesha Lavell, Brent Appelman, Jonne J. Sikkens, Marije K. Bomers, Alvin X. Han, Brooke E. Nichols, Maria Prins
Læs mere Tjek på PubMedBMC Infectious Diseases, 5.08.2022
Tilføjet 6.08.2022
Abstract
Background
Infected pancreatic necrosis (IPN) is a life-threatening complication of acute pancreatitis (AP). Timely diagnosis of IPN could facilitate appropriate treatment, but there is a lack of reliable non-invasive screening tests. In this study, we aimed to evaluate the diagnostic value of plasma metagenomic next-generation sequencing (mNGS) based on circulating microbial cell-free DNA in patients with suspected IPN.
Methods
From October 2020 to October 2021, 44 suspected IPN patients who underwent plasma mNGS were reviewed. Confirmatory diagnosis of IPN within two weeks after the index blood sampling was considered the reference standard. The confirmation of IPN relied on the microbiological results of drains obtained from the necrotic collections. The distribution of the pathogens identified by plasma mNGS was analyzed. Positive percent agreement (PPA) and negative percent agreement (NPA) were evaluated based on the conformity between the overall mNGS results and culture results of IPN drains. In addition, the clinical outcomes were compared between mNGS positive and negative patients.
Results
Across all the study samples, thirteen species of bacteria and five species of fungi were detected by mNGS. The positivity rate of plasma mNGS was 54.55% (24/44). Of the 24 mNGS positive cases, twenty (83.33%, 95% CI, 68.42–98.24%) were consistent with the culture results of IPN drains. The PPA and NPA of plasma mNGS for IPN were 80.0% (20/25; 95% CI, 64.32–95.68%) and 89.47% (17/19; 95% CI, 75.67–100%), respectively. Compared with the mNGS negative group, patients in the positive group had more new-onset septic shock [12 (50.0%) vs. 4 (20.0%), p = 0.039].
Conclusion
IPN relevant pathogens can be identified by plasma mNGS, potentially facilitating appropriate treatment. The clinical application of mNGS in this cohort appears feasible.
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Malaria Journal, 5.08.2022
Tilføjet 6.08.2022
Abstract
Background
To contribute to the mission of the National Malaria Control Programme (NMCP) and guide future interventions in Cameroon in general, and in Makenene in particular, this study assessed the knowledge, attitudes and practices of the population of Makenene towards the fight against malaria.
Methods
Using a semi-structured questionnaire, a descriptive cross-sectional household community survey was carried out in randomly selected households in Makenene, a locality situated between forest and savannah ecotypes.
Results
Out of the 413 households surveyed, all (100%) claimed to have heard of malaria with over 94% (n = 391) associating disease transmission with mosquito bites. The main mosquito control tools used in the area were mosquito nets (92.25%). The majority of participants had good knowledge (55.93%; n = 231), good practices (71.67%, n = 296) but moderate attitudes (47.94%; n = 198) towards malaria control and fight. Good knowledge and practices were recorded mostly in educated persons including public servants and students. Good attitudes were adopted mostly by public servants and students of secondary and higher levels of education.
Conclusion
In Makenene, the population exhibits good knowledge and practices towards malaria and its control. However, despite high LLINs ownership and use, people still complain about malaria in the area. Control tools should be monitored, repaired or replaced when necessary to support the achievement of the NMCP mission.
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Florian Reizine, Agathe Delbove, Pierre Tattevin, Alexandre Dos Santos, Laetitia Bodenes, Pierre Bouju, Pierre Fillâtre, Aurélien Frérou, Guillaume Halley, Olivier Lesieur, Patricia Courouble, Florian Berteau, Jean Morin, Flora Delamaire, Rémy Marnai, Anthony Le Meur, Cécile Aubron, Jean Reignier, Arnaud Gacouin, Jean-Marc Tadié
Clinical Microbiology and Infection, 5.08.2022
Tilføjet 6.08.2022
Pneumonia is the most frequent infectious complication among drowning patients requiring intensive care unit (ICU) admission. We aimed to describe clinical, microbiological and therapeutic data as well as predictors and impacts on patients ‘outcomes of such pneumonia.
Læs mere Tjek på PubMedLirong Zou, Huan Zhang, Zhonghua Zheng, Yushan Jiang, Yushi Huang, Shujian Lin, Jianxiang Yu, Xiaoling Deng, Jianfeng He, Chenguang Shen, Baisheng Li
Journal of Medical Virology, 6.08.2022
Tilføjet 6.08.2022
Lancet Infectious Diseases, 6.08.2022
Tilføjet 6.08.2022
Jiang L, Tang K, Levin M, et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis 2020; 20: e276–88—In this Review, the fourth sentence of the fourth paragraph in the COVID-19 pathophysiology and link with MIS-C section should have read “…Gruber and colleagues91 have reported that patients with MIS-C had neutralising antibodies against SARS-CoV-2, which are associated with interleukin-18 (IL-18) and IL-6 activation…”. This correction has been made to the online version as of Aug 5, 2022.
Læs mere Tjek på PubMedAnming Xu, Daniel J. Wozniak, Jie Zhou, Min Jiang, Weiliang Dong
Trends in Microbiology, 5.08.2022
Tilføjet 6.08.2022
Hyper-biofilm strains form robust biofilms, are highly adaptable, and form highly tolerant subpopulations in biofilms grown in vivo and in vitro. Such subpopulations are formed by a wide range of bacteria and thus have been given different names in different species. This situation calls for the establishment of a unified nomenclature for strains with hyper-biofilm phenotypes.
Læs mere Tjek på PubMedYa-Wen He, Yinyue Deng, Yansong Miao, Subhadeep Chatterjee, Tuan Minh Tran, Jing Tian, Steven Lindow
Trends in Microbiology, 5.08.2022
Tilføjet 6.08.2022
While most bacteria are unicellular microbes they communicate with each other and with their environments to adapt their behaviors. Quorum sensing (QS) is one of the best-studied cell–cell communication modes. QS signaling is not restricted to bacterial cell-to-cell communication – it also allows communication between bacteria and their eukaryotic hosts. The diffusible signal factor (DSF) family represents an intriguing type of QS signal with multiple roles found in diverse Gram-negative bacteria.
Læs mere Tjek på PubMedCarly C.Y. Chan, Ian A. Lewis
Trends in Microbiology, 5.08.2022
Tilføjet 6.08.2022
Uropathogenic Escherichia coli (UPEC) is responsible for more than 75% of urinary tract infections (UTIs) and has been studied extensively to better understand the molecular underpinnings of infection and pathogenesis. Although the macromolecular adaptations UPEC employs – including the expression of virulence factors, adhesion molecules, and iron-acquisition systems – are well described, the role that metabolism plays in enabling infection is still unclear. However, a growing body of literature shows that metabolic function can have a profound impact on which strains can colonize the urinary tract.
Læs mere Tjek på PubMedSamantha Bannister, Bowon Kim, Jorge Domínguez-Andrés, Gizem Kilic, Brendan R. E. Ansell, Melanie R. Neeland, Simone J. C. F. M. Moorlag, Vasiliki Matzaraki, Amanda Vlahos, Rebecca Shepherd, Susie Germano, Melanie Bahlo, Nicole L. Messina, Richard Saffery, Mihai G. Netea, Nigel Curtis, Boris Novakovic
Science Advances, 5.08.2022
Tilføjet 5.08.2022
Haitao Liu, Xupeng Hong, Ji Xi, Stephan Menne, Jianming Hu, Joseph Che-Yen Wang
Science Advances, 5.08.2022
Tilføjet 5.08.2022
Portela, G. T., Leong, T., Webster, A., Giarrusso, A., Fridkin, S., Ray, S. M., Swerdlow, D., Immergluck, L. C.
BMJ Open, 5.08.2022
Tilføjet 5.08.2022
Objective
To characterise individual and area-level risks associated with invasive or skin and soft tissue (SSTIs) Staphylococcus aureus infections comparing methicillin-resistant S. aureus (MRSA) with methicillin-sensitive S. aureus (MSSA); and highlight differences between children and adults.
Setting
A population-based study from 21 reporting laboratories located in Georgia Health District 3 (HD3), an eight-county catchment area around metro Atlanta.
Participants
A case is a resident of HD3 from whom S. aureus had been isolated in 2017.
Primary outcome
Culture-confirmed S. aureus infections, classified as skin and soft tissue (proxy for non-invasive) or invasive, by methicillin-sensitivity status.
Results
The incidence of SSTIs was 19.7/100 000, compared with 5.2/100 000 for invasive infections. Adults experienced higher rates of SSTIs (22.3/100 000) and invasive infections (6.7/100 000) compared with children with SSTIs (13.0/100 000) and invasive infections (1.3/100 000). Risks of MRSA versus MSSA SSTIs were similar for children and adults. Black individuals with SSTIs were more likely to have MRSA than white individuals (children (OR 1.43, 95% CI 1.16 to 1.76); adults (OR 1.24, 95% CI 1.08 to 1.42)). Adults with invasive MRSA were more likely to be black (adjusted OR 1.69, 95% CI 1.25 to 2.29) compared with those with invasive MSSA. Children with invasive MRSA were more likely from a racial-ethnic concentrated area (OR 4.66, 95% CI 1.85 to 11.71). Hotspots of MRSA were found in crowded areas with higher rates of black populations.
Conclusions
The risk of MRSA infections in children and adults can be defined by unique area-level sociodemographic characteristics which were distinct for those areas associated with MSSA infections. Place-based risks of MRSA or MSSA can be used to develop target public health interventions to decrease transmission and incidence.
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Barajas-Nava, L. A., Garduno-Espinosa, J., Mireles Dorantes, J. M., Medina-Campos, R., Garcia-Pena, M. C.
BMJ Open, 5.08.2022
Tilføjet 5.08.2022
Introduction
Ageing entails a variety of physiological changes that increase the risk of chronic non-communicable diseases. The prevalence of these diseases leads to an increase in the use of health services. The care models implemented by health systems should provide comprehensive long-term healthcare. We conducted this systematic review to determine whether any model of care for older persons have proven to be effective.
Methods
A systematic review of literature was carried out to identify randomised clinical trials that have assessed how effective a care model for older patients with chronic diseases. A searches electronic databases such as MEDLINE, Turning Research Into Practice Database, Cochrane Library and Cochrane Central Register of controlled Trials was conducted from January 1966 to January 2021. Two independent reviewers assessed the eligibility of the studies. Interventions were identified and classified according to the taxonomies developed by the Cochrane Effective Practice and Organisation of Care and Cochrane Consumers and Communication groups.
Results
Of the 4952 bibliographic references that were screened, 577 were potentially eligible and the final sample included 25 studies that evaluated healthcare models in older people with chronic diseases. In the 25 care models, the most frequently implemented interventions were educational, and those based on the provision of healthcare. Only 22% of the outcomes of interventions were identified as being effective, whereas 21% were identified as being partially effective; thus, more than 50% of the outcomes were identified as being ineffective.
Conclusions
It was not possible to determine a care model as effective. The interventions implemented in the models are variable. The most effective outcomes were focused on improving the patient–healthcare professional relationship in the early stages of the intervention. The interventions addressed in the studies were similar to public health interventions as their main objectives focused on promoting health. Most studies were of low methodological quality.
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Jaffry, Z., Raj, S., Sallam, A., Lyman, S., Negida, A., Yiu, C. F. A., Sobti, A., Bua, N., Field, R. E., Abdalla, H., Hammad, R., Qazi, N., Singh, B., Brennan, P. A., Hussein, A., Narvani, A., Jones, A., Imam, M. A., The OrthoGlobe Collaborative, Abbas, Adeyeye, Althaher, Arnaout, Arnaud, Elhadi, Freitas, Govindarajan, Kale, Lakshmi, Nakano, Nasir, Pata, Ravichandran, Roslani, Yau, Zanin
BMJ Open, 5.08.2022
Tilføjet 5.08.2022
Objectives
To investigate the impact of COVID-19 on the well-being of surgeons and allied health professionals as well as the support provided by their institutions.
Design
This cross-sectional study involved distributing an online survey through medical organisations, social media platforms and collaborators.
Setting
It included all staff based in an operating theatre environment around the world.
Participants
1590 complete responses were received from 54 countries between 15 July and 15 December 2020. The average age of participants was 30–40 years old, 64.9% were men and 32.5% of a white ethnic background. 79.5% were surgeons with the remainder being nurses, assistants, anaesthetists, operating department practitioners or classified other.
Main outcome measures
Participants that had experienced any physical illness, changes in mental health, salary or time with family since the start of the pandemic as well as support available based on published recommendations.
Results
32.0% reported becoming physically ill. This was more likely in those with reduced access to personal protective equipment (OR 4.62; CI 2.82 to 7.56; p<0.001) and regular breaks (OR 1.56; CI 1.18 to 2.06; p=0.002). Those with a decrease in salary (29.0%) were more likely to have an increase in anxiety (OR 1.50; CI 1.19 to 1.89; p=0.001) and depression (OR 1.84; CI 1.40 to 2.43; p<0.001) and those who spent less time with family (35.2%) were more likely to have an increase in depression (OR 1.74; CI 1.34 to 2.26; p<0.001). Only 36.0% had easy access to occupational health, 44.0% to mental health services, 16.5% to 24/7 rest facilities and 14.2% to 24/7 food and drink facilities. Fewer measures were available in countries with a low Human Development Index.
Conclusions
This work has highlighted a need and strategies to improve conditions for the healthcare workforce, ultimately benefiting patient care.
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Wong, M. C. P., Tan, C. S., Chan, A. Y., Khaled, N., Hasan, M. T., Panchapakesan, C., Tripathi, S., Afsana, K., Lwin, M. O., Chen, M. I.-C., Hildon, Z. J.-L.
BMJ Open, 5.08.2022
Tilføjet 5.08.2022
Introduction
Measures to mitigate the COVID-19 outbreak in the migrant worker dormitories in Singapore included lockdown and isolation of residents for prolonged periods. In this paper, we explore efforts to ease tensions and support mental health under these conditions.
Methods
Case study of dormitory residents under lockdown from April to August 2020 comprises a nested mixed-method approach using an online questionnaire (n=175) and semistructured interviews (n=23) of migrant workers sampled from the survey (August to September 2020). Logistic regression models were used to analyse survey data. Semistructured interviews were analysed using applied thematic analysis.
Results
Survey and interview data showed that mental health was largely protected despite initial rising tensions over restrictions during lockdown. Sources of tension negatively affecting low stress responses included job related worries, OR=0.07 (95% CI 0.03 to 0.18, p<0.001), poor communication with employers, OR=0.12 (95% CI 0.03 to 0.44, p<0.001) and loneliness, OR=0.24 (95% CI 0.10 to 0.55, p<0.001). Interview narratives concurrently revealed themes around job insecurity and the effects of the lockdown ‘not being good for mind and body’, the imposition of new rules and regulations compounded by the most emphasised concern—worry about family back home.
Interviewees shared how their adaptive capability played a pivotal protective role alongside social support and solidarity; aided by regular use of messaging applications, which supported mental health, OR=4.81 (95% CI 1.54 to 15.21, p<0.01). Employers were described as central to alleviating tensions, providing feedback loops to improve dorm conditions. Employees feeling their employers cared about their health and well-being was especially protective to mental health, OR=17.24 (95% CI 4.00 to 85.74, p<0.001). Gratitude and trust in government and healthcare provision was widely acknowledged. Concurrently, related attitudes such as believing in the timeliness and appropriateness of the lockdown also protected mental health, OR 2.85 (95% CI 1.08 to 7.39, p=0.03).
Conclusion
Tensions are mapped to protective solutions informing guidelines for future outbreak stress management response.
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Zenbaba, D., Sahiledengle, B., Beressa, G., Desta, F., Atlaw, D., Bogale, D., Chattu, V. K.
BMJ Open, 5.08.2022
Tilføjet 5.08.2022
Objective
Compliance with COVID-19 prevention measures limits infection occurrence and spread in healthcare settings. According to research conducted in Ethiopia, compliance with COVID-19 preventative strategies is inconsistent among healthcare providers. This systematic review and meta-analysis aimed to estimate the national pooled proportion of healthcare workers (HCWs) who adhere to COVID-19 preventive measures and associated factors with good compliance.
Design
A systematic review and meta-analysis of all identified studies with cross-sectional study design.
Data sources
A comprehensive search was conducted in PubMed/MEDLINE, POPLINE, HINARI, Science Direct, Cochrane Library databases and Google Scholar search engines from January 2020 to September 2021.
Data extraction and synthesis
This review included all observational studies conducted in Ethiopia that reported the proportion of compliance with COVID-19 preventive measures and associated factors among HCWs. Two independent authors assessed the methodological quality of studies using Joanna Briggs Institute’s meta-analysis of statistical assessment and review instrument. The effect estimates for pooled proportion and pooled OR (POR) were determined.
Results
From retrieved 611 original studies, 21 studies were included in the meta-analysis with a total of n=7933 HCWs. The pooled proportion of good compliance with COVID-19 preventive measures among HCWs was 49.7% (95% CI: 42.3% to 57.1%). Being male (POR=2.21, 95% CI: 1.52 to 3.21), service years (>3 years) (POR=2.65, 95% CI: 1.94 to 3.64), training (POR=2.30, 95% CI: 1.78 to 2.98), positive attitude (POR=3.14, 95% CI: 1.66 to 5.94) and good knowledge (POR=2.36, 95% CI: 1.92 to 2.89) were factors significantly associated with good compliance towards COVID-19 preventive measures.
Conclusion
Our study indicated that approximately one in every two HCWs had good compliance with COVID-19 preventive measures. There must be more emphasis on providing further training sessions for the HCWs to improve their compliance with COVID-19 preventative measures.
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Lognon, T., Plourde, K. V., Aubin, E., Giguere, A. M. C., Archambault, P. M., Stacey, D., Legare, F.
BMJ Open, 5.08.2022
Tilføjet 5.08.2022
Objectives
Decision aids (DAs) for clients in home and community care can support shared decision-making (SDM) with patients, healthcare teams and informal caregivers. We aimed to identify DAs developed for home and community care, verify their adherence to international DA criteria and explore the involvement of interprofessional teams in their development and use.
Design
Systematic review reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Data sources
Six electronic bibliographic databases (MEDLINE, Embase, CINAHL Plus, Web of Science, PsycINFO and the Cochrane Library) from inception to November 2019, social media and grey literature websites up to January 2021.
Eligibility criteria
DAs designed for home and community care settings or including home care or community services as options.
Data extraction and synthesis
Two reviewers independently reviewed citations. Analysis consisted of a narrative synthesis of outcomes and a thematic analysis. DAs were appraised using the International Patient Decision Aid Standards (IPDAS). We collected information on the involvement of interprofessional teams, including nurses, in their development and use.
Results
After reviewing 10 337 database citations and 924 grey literature citations, we extracted characteristics of 33 included DAs. DAs addressed a variety of decision points. Nearly half (42%) were relevant to older adults. Several DAs did not meet IPDAS criteria. Involvement of nurses and interprofessional teams in the development and use of DAs was minimal (33.3% of DAs).
Conclusion
DAs concerned a variety of decisions, especially those related to older people. This reflects the complexity of decisions and need for better support in this sector. There is little evidence about the involvement of interprofessional teams in the development and use of DAs in home and community care settings. An interprofessional approach to designing DAs for home care could facilitate SDM with people being cared for by teams.
PROSPERO registration number
CRD42020169450.
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Goldstein, K. M., Perry, K. R., Lewinski, A., Walsh, C., Shepherd-Banigan, M. E., Bosworth, H. B., Weidenbacher, H., Blalock, D. V., Zullig, L. L.
BMJ Open, 5.08.2022
Tilføjet 5.08.2022
Objective
The COVID-19 pandemic sparked exponential growth in video visit use in primary care. The rapid shift to virtual from in-person care exacerbated digital access disparities across racial groups and rural populations. Moving forward, it is critical to understand when and how to incorporate video visits equitably into primary care. We sought to develop a novel clinical algorithm to guide primary care clinics on how and when to employ video visits as part of care delivery.
Design
Qualitative data collection: one team member conducted all patient semistructured interviews and led all focus groups with four other team members taking notes during groups.
Setting
3 rural primary care clinics in the USA.
Participants
24 black veterans living in rural areas and three primary care teams caring for black veterans living in rural areas.
Primary and secondary outcome measures
Findings from semistructured interviews with patients and focus groups with primary care teams.
Results
Key issues around appropriate use of video visits for clinical teams included having adequate technical support, encouraging engagement during video visits and using video visits for appropriate clinical situations. Patients reported challenges with broadband access, inadequate equipment, concerns about the quality of video care, the importance of visit modality choice, and preferences for in-person care experience over virtual care. We developed an algorithm that requires input from both patients and their care team to assess fit for each clinical encounter.
Conclusions
Informed matching of patients and clinical situations to the right visit modality, along with individual patient technology support could reduce virtual access disparities.
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Marozoff, S., Lu, N., Loree, J. M., Xie, H., Lacaille, D., Kopec, J. A., Esdaile, J., Avina-Zubieta, J. A.
BMJ Open, 5.08.2022
Tilføjet 5.08.2022
Objectives
To assess the risk of severe COVID-19 outcomes in patients with autoimmune rheumatic diseases (ARDs) and transplant recipients compared with matched general population comparators.
Design
Population-based matched cohort study using administrative health data sets.
Setting
British Columbia, Canada.
Participants
All adults with test-positive SARS-CoV-2 infections. SARS-CoV-2-positive patients with ARDs and those with transplantation were matched to SARS-CoV-2-positive general population comparators on age (±5 years), sex, month/year of initial positive SARS-CoV-2 test and health authority.
Outcome measures
COVID-19-related hospitalisations, intensive care unit (ICU) admissions, invasive ventilation and COVID-19-specific mortality. We performed multivariable conditional logistic regression models adjusting for socioeconomic status, Charlson Comorbidity Index, hypertension, rural address and number of previous COVID-19 PCR tests.
Results
Among 6279 patients with ARDs and 222 transplant recipients, all SARS-CoV-2 test positive, risk of hospitalisation was significantly increased among patients with ARDs (overall ARDs (adjusted OR (aOR) 1.30; 95% CI 1.19 to 1.43)); highest within ARDs: adult systemic vasculitides (aOR 2.18; 95% CI 1.17 to 4.05) and transplantation (aOR 10.56; 95% CI 6.88 to 16.22). Odds of ICU admission were significantly increased among patients with ARDs (overall ARDs (aOR 1.30; 95% CI 1.11 to 1.51)); highest within ARDs: ankylosing spondylitis (aOR 2.03; 95% CI 1.18 to 3.50) and transplantation (aOR 8.13; 95% CI 4.76 to 13.91). Odds of invasive ventilation were significantly increased among patients with ARDs (overall ARDs (aOR 1.60; 95% CI 1.27 to 2.01)); highest within ARDs: ankylosing spondylitis (aOR 2.63; 95% CI 1.14 to 6.06) and transplantation (aOR 8.64; 95% CI 3.81 to 19.61). Risk of COVID-19-specific mortality was increased among patients with ARDs (overall ARDs (aOR 1.24; 95% CI 1.05 to 1.47)); highest within ARDs: ankylosing spondylitis (aOR 2.15; 95% CI 1.02 to 4.55) and transplantation (aOR 5.48; 95% CI 2.82 to 10.63).
Conclusions
The risk of severe COVID-19 outcomes is increased in certain patient groups with ARDs or transplantation, although the magnitude differs across individual diseases. Strategies to mitigate risk, such as booster vaccination, prompt diagnosis and early intervention with available therapies, should be prioritised in these groups according to risk.
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Halas, G., Singer, A., Katz, A., Labine, L., Baldwin, A., Wong, S. T., Kirby, S., Bohm, E., Abrams, E., MacKay, K., Francois, J., Talpade, S.
BMJ Open, 5.08.2022
Tilføjet 5.08.2022
Introduction
COVID-19 prompted rapid shifts to virtual primary care; however, the secondary implications and ideal applications of this change require further consideration. Patient and public stakeholder input has been bypassed. To integrate virtual care (VC) in what currently appears to be a lengthier battle against COVID-19 and related sequelae, further investigation is needed to support ideal implementation and use. This study aims to describe factors associated with the use of virtual visits in primary care practices, along with more in-depth description of users’ experiences and perspectives.
Methods and analysis
This study will be conducted in three phases, using a mixed-methods approach and in consultation with community advisors. Phase 1 will analyse data from electronic medical records (EMRs) to characterise the use and users of VC in primary care during the early phase of the COVID-19 pandemic. Analysis will be primarily descriptive; regression modelling will assess associations between patient and provider factors with a virtual visit. In phase 2, we will use an EMR-facilitated process to automate the distribution of patient surveys within an estimated 10 clinics. These surveys aim to describe care experiences, transactional use and perspectives of VC. In phase 3, focus groups with patients, caregivers and primary care clinicians will seek more in-depth exploration of VC regarding accessibility of care, acceptability and perceptions of quality care. Interpretive phenomenological analysis will be used for thematic analysis. The framework method will employ a matrix structure to organise the data and to facilitate comparison, integration and further interpretation.
Ethics and dissemination
This study has been approved by the University of Manitoba’s Health Research Ethics Board (HS24197). A co-designed dissemination strategy will include reports and infographics to policymakers and the public, manuscripts and presentations to academic and clinician audiences, and contributions to a learning plan for professional development.
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Lau, J., Ding, P., Lo, S., Fazelzad, R., Furlan, A. D., Isenberg, S. R., Spithoff, S., Tedesco, A., Zimmermann, C., Buchman, D. Z.
BMJ Open, 5.08.2022
Tilføjet 5.08.2022
Objectives
When resources are strained during communicable disease outbreaks, novel palliative care interventions may be required to optimally support people who use substances with life-limiting illnesses. Therefore, we asked the question, ‘what is known about communicable disease outbreaks, palliative care and people who use substances?’, such as palliative care interventions that can improve the quality of life of patients with life-limiting illnesses.
Design
We conducted a scoping review that involved comprehensive searches in six bibliographic databases from inception to April 2021 (Medline ALL (Medline and Epub Ahead of Print and In-Process and Other Non-Indexed Citations), Embase Classic+Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trial, PsycInfo all from the OvidSP platform, Scopus from Elsevier) and grey literature searches. We included English and French records about people ≥18 years old with life-limiting illnesses who use substances during communicable disease outbreaks. We identified, summarised and presented the findings about palliative care interventions in figures, tables and narrative descriptions.
Results
We identified 32 records about palliative care interventions for people who use substances during communicable disease outbreaks. The majority focused on palliative care for people who use substances with AIDS during HIV epidemics (n=27, 84.4%), and approximately half were published in the USA (n=15, 46.9%). Most common substances used were alcohol (n=18, 56.3%), opioids (n=14, 43.8%) and cocaine (n=10, 31.3%). Four groups of palliative care interventions were identified: (1) symptom management (n=20, 62.5%), (2) psychosocial support (n=15, 46.9%), (3) advance care planning (n=8, 25.0%) and (4) healthcare provider training (n=6, 18.8%).
Conclusions
Beyond studies on HIV epidemics, there is limited knowledge about palliative care interventions for people who use substances during communicable disease outbreaks. Research and guidance are needed about how best to provide palliative care to this population with complex needs including in resource-limited countries.
Protocol
Buchman DZ, Ding P, Lo S, et al. Palliative care for people who use substances during communicable disease epidemics and pandemics. BMJ Open 2021; 11: e053124
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Boniol, M., Siyam, A., Desai, S., Gurung, S., Mirelman, A., Nair, T. S., Diallo, K., Campbell, J.
BMJ Open, 5.08.2022
Tilføjet 5.08.2022
Objectives
The implementation of COVID-19 vaccination globally poses unprecedented stress to health systems particularly for countries with persisting health workforce shortages prior the pandemic. The present paper estimates the workforce requirement to reach 70% COVID-19 vaccination coverage in all countries by mid-2022 using service target–based estimation.
Methods
Health workforce data from National Health Workforce Accounts and vaccination coverage reported to WHO as of January 2022 were used. Workload parameters were used to estimate the number of health workers needed with a service target–based approach, the gap and the scale-up required partially accounting for countries’ challenges, as well as the associated costs in human resources.
Results
As of 1 January 2022, only 34 countries achieved 70% COVID-19 vaccination coverage and 61 countries covered less than a quarter of their population. This analysis showed that 1 831 000 health workers working full time would be needed to reach a global coverage of 70% COVID-19 vaccination by mid-2022. To avoid severe disruptions to health system, 744 000 additional health workers should be added to domestic resources mostly (77%) in low-income countries. In a sensitivity analysis, allowing for vaccination over 12 months instead of 6 months would decrease the scale-up to 476 000 health workers. The costing for the employment of these 744 000 additional health workers is estimated to be US$2.5 billion. In addition to such a massive scale-up, it is estimated that 29 countries would have needed to redeploy more than 20% of their domestic workforce, placing them at serious risk of not achieving the mid-year target.
Conclusion
Reaching 70% global coverage with COVID-19 vaccination by mid-2022 requires extraordinary efforts not before witnessed in the history of immunisation programmes. COVID-19 vaccination programmes should receive rapid and sustainable investment in health workforce.
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Caughey, G. E., Lang, C. E., Bray, S. C. E., Sluggett, J. K., Whitehead, C., Visvanathan, R., Evans, K., Corlis, M., Cornell, V., Barker, A. L., Wesselingh, S., Inacio, M. C.
BMJ Open, 5.08.2022
Tilføjet 5.08.2022
Objectives
To develop and examine the prevalence of quality and safety indicators to monitor care of older Australians receiving home care packages (HCPs), a government-funded aged care programme to support individuals to live at home independently.
Design
Cross-sectional.
Setting
Home care recipients, Australia.
Participants
90 650 older individuals (aged ≥65 years old and ≥50 years old for people of Aboriginal or Torres Strait Islander descent) who received a HCP between 1 January 2016 and 31 December 2016 nationally were included.
Primary and secondary outcome measures
The Registry of Senior Australians developed 15 quality and safety indicators: antipsychotic use, high sedative load, chronic opioid use, antimicrobial use, premature mortality, home medicines reviews, chronic disease management plan, wait-time for HCP, falls, fractures, medication-related adverse events, weight loss/malnutrition, delirium/dementia-related hospitalisations, emergency department (ED) presentations and pressure injuries. Risk adjusted prevalence (%, 95% CI) and geographical area (statistical level 3) variation during 2016 were examined.
Results
In 2016, a total of 102 590 HCP episodes were included for 90 650 individuals, with 66.9% (n=68 598) level 1–2 HCP episodes (ie, for basic care needs) and 33.1% (n=33 992) level 3–4 HCP (ie, higher care needs). The most prevalent indicators included: antibiotic use (52.4%, 95% CI 52.0 to 52.7), chronic disease management plans (38.1%, 95% CI 37.8 to 38.4), high sedative load (29.1%, 95% CI 28.8 to 29.4) and ED presentations (26.4%, 95% CI 25.9 to 26.9). HCP median wait time was 134 days (IQR 41–406). Geographical variation was highest in chronic disease management plans and ED presentations (20.7% of areas outside expected range).
Conclusion
A comprehensive outcome monitoring system to monitor the quality and safety of care and variation for HCP recipients was developed. It provides a pragmatic, efficient and low burden tool to support evidence-based quality and safety improvement initiatives for the aged care sector.
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Richard, L., Nisenbaum, R., Liu, M., McGeer, A., Mishra, S., Gingras, A.-C., Gommerman, J. L., Sniderman, R., Pedersen, C., Spandier, O., Jenkinson, J. I. R., Baral, S., Mejia-Lancheros, C., Agarwal, A., Jamal, A. J., Ostrowski, M., Dhalla, I., Stewart, S., Gabriel, M., Brown, M., Hester, J., Hwang, S. W.
BMJ Open, 5.08.2022
Tilføjet 5.08.2022
Introduction
Initial reports suggest people experiencing homelessness (PEH) are at high risk for SARS-CoV-2 infection and associated morbidity and mortality. However, there have been few longitudinal evaluations of the spread and impact of COVID-19 among PEH. This study will estimate the prevalence and incidence of COVID-19 infections in a cohort of PEH followed prospectively in Toronto, Canada. It will also examine associations between individual-level and shelter-level characteristics with COVID-19 infection, adverse health outcomes related to infection and vaccination. Finally, the data will be used to develop and parameterise a mathematical model to characterise SARS-CoV-2 transmission dynamics, and the transmission impact of interventions serving PEH.
Design, methods and analysis
Ku-gaa-gii pimitizi-win will follow a random sample of PEH from across Toronto (Canada) for 12 months. 736 participants were enrolled between June and September 2021, and will be followed up at 3-month intervals. At each interval, specimens (saliva, capillary blood) will be collected to determine active SARS-CoV-2 infection and serologic evidence of past infection and/or vaccination, and a detailed survey will gather self-reported information, including a detailed housing history. To examine the association between individual-level and shelter-level characteristics on COVID-19-related infection, adverse outcomes, and vaccination, shelter and healthcare administrative data will be linked to participant study data. Healthcare administrative data will also be used to examine long-term (up to 5 years) COVID-19-related outcomes among participants.
Ethics and dissemination
Ethical approval was obtained from the Unity Health Toronto and University of Toronto Health Sciences Research Ethics Boards (# 20-272). Ku-gaa-gii pimitizi-win was designed in collaboration with community and service provider partners and people having lived experience of homelessness. Findings will be reported to groups supporting Ku-gaa-gii pimitizi-win, Indigenous and other community partners and service providers, funding bodies, public health agencies and all levels of government to inform policy and public health programs.
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