Lean manufacturing has been used for the last few decades as a process and performance improvement tool.Initially known as Toyota production system(TPS),lean is now used in almost all service and manufacturing sectors...Lean manufacturing has been used for the last few decades as a process and performance improvement tool.Initially known as Toyota production system(TPS),lean is now used in almost all service and manufacturing sectors to deliver favorable results such as decreased operational cost,increased customer satisfaction,decreased cycle time,and enhanced profits.During the coronavirus disease(COVID 19)pandemic,the manufacturing sector struggled immensely and could not function well even after lockdown was eased in many countries.Many companies found out there are not ready to conform with new regulations made by authorities in many countries.This paper proposes the use of simulation and multi response optimization in addition to other typical lean tools in order to arrive at optimum performance at the end of each project through an established optimization framework.The framework is used in a real case study performed at an aluminum extrusion factory.Lean manufacturing helps organizations to operate with smaller number of resources.It standardizes all processes so that most of the jobs can be done by most of the workers,but this is not enough to create a healthy,sanitized work place.Our framework utilizes the strengths of lean tools and adds pandemic readiness factor to them to ensure improvement in performance and health pandemic readiness.Implementation of the framework in the case company resulted in 50%reduction in labor,$730000 in expected annual cost savings,reduction in inventory levels,improved employee morale and the achievement of pandemic ready status.展开更多
The aim of this study was to find a simple and effective way to screen patients for Covid 19, prior to them being submitted to neurophysiological or neuro-psycholoigical testing in order to protect employees from bein...The aim of this study was to find a simple and effective way to screen patients for Covid 19, prior to them being submitted to neurophysiological or neuro-psycholoigical testing in order to protect employees from being infected during the pandemic from patient contact. On May 18, 2020 when Michigan, a critically affected pandemic area, reopened for medical business after lockdown declared by the Governor on March 23, 2020, medical personnel in our office-which is an academic neurology practice-EEG and sleep technicians, medical Assistants, physician assistants and myself fretted about potential Covid 19 transmission during neuro-diagnostic procedures-EEG, video-EEG, ambulatory EEG, PSG, MSLT, CPAP titration, neuropsychological testing, EMG/NCV, VNG/Balance test and autonomic testing including the tilt table test, which require an intimate patient contact and risk of exposure. We screened all unselected and consecutive patients who were scheduled for neuro-diagnostic testing in our facility by infrared thermometer, a standard Covid 19 questionnaire and a single Covid 19 PCR nasal/throat swab prior to these tests. 542 consecutive unselected neurological or sleep/wake disorder patients aged 18 - 90, 65% males, 35% females were tested over six months as a part of this project. A total of 1109 diagnostic tests were performed. No test was limited in scope or duration. Standard PPE precautions were still taken despite the negative screening, room door left open and relatives’ presence limited during the test procedure. All were afebrile and negative on questionnaire and only 3 were found to be positive for Covid 19 PCR, indicating that a negative infrared temperature reading and a standard Covid 19 questionnaire is over 99 percent effective in prescreening for intimate neurological diagnostic testing. The technician, administering most of these tests, never contracted the virus. The technician collecting the nasal/throat swab never contracted the virus. One PA, two sleep technicians and one medical assistant came down with Covid 19 but were all felt to have contracted that from domestic exposure from family members or friends and not when at the job. All had mild disease and rapidly recovered. Infrared temperature testing and standard Covid 19 questionnaire are sufficient prior to intimate neuro-diagnostic testing when combined with standard PPE precautions to limit exposure to Covid 19 in medical personnel in a neurology office with on-site diagnostic testing.展开更多
<strong>Background. </strong>The COVID 19 pandemic affected healthcare delivery systems worldwide. There was a redistribution of health care resources in order to deal with the effects of the pandemic, wit...<strong>Background. </strong>The COVID 19 pandemic affected healthcare delivery systems worldwide. There was a redistribution of health care resources in order to deal with the effects of the pandemic, with a corresponding consequence on other clinical services rendered. The extent of this effect on other non COVID 19 related services has been reported in other centres worldwide. In our own setting, health care resources are limited with suboptimal access even in normal situations. <strong>Objective. </strong>We sought to evaluate the effects of the COVID 19 pandemic on elective surgical services in our hospital. <strong>Methods.</strong> This was a cross sectional comparative study carried out at the Jos University Teaching hospital, (North central, Nigeria) of the elective surgical services rendered during the first wave of the COVID 19 pandemic lockdown covering the period April to June 2020 with a corresponding period of the preceding year 2019. Data was obtained from the hospital records department, theatres and service areas for clinic attendance, elective surgeries and ward occupancy. The paired sample t-test was used to compare the assessed variables across the three months of both years with a level of significance of P < 0.05. <strong>Results.</strong> There was mean clinic attendance of 2859.33 ± 223.36 covering the three months in 2019 as against a mean attendance of 648.67 ± 578.24 covering a similar period in 2020, P = 0.037. The elective surgical procedures carried out across the surgical specialties over the period in 2019 gave a mean of 352.33 ± 44.60 as opposed to 64.001 ± 7.32 over the corresponding period in 2020, P = 0.018. Ward occupancy over April to June 2019 was a mean 297.33 ± 18.58 across the various surgical wards and 158.33 ± 25.70 in the same period in 2020, P = 0.007. <strong>Conclusion.</strong> There was a significant reduction in the elective surgical services rendered in the hospital during the first wave of the COVID 19 pandemic compared to a corresponding period in the preceding year. This decline in elective surgical services would have negatively affected the access to health care. Thus measures to clear the backlog of elective surgical procedures would be required.展开更多
<strong>Background</strong><span style="font-family:Verdana;"> <strong>:</strong></span><span style="font-family:Verdana;">Anxiety and depression are two c...<strong>Background</strong><span style="font-family:Verdana;"> <strong>:</strong></span><span style="font-family:Verdana;">Anxiety and depression are two common psychiatric conditions encountered in cancer treatment. Prevalence rate and risk factors show wide variations in different countries and the environment. COVID 19 outbreak has increased psychological disorders in general public and health workers. Whether this pandemic has increased the psychiatric morbidity in cancer patients need</span><span style="font-family:Verdana;">s</span><span style="font-family:""><span style="font-family:Verdana;"> to be addressed for planning strategies. </span><b><span style="font-family:Verdana;">Methods</span></b></span><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">This cross-sectional study was conducted in the Department of Radiation Oncology, a tertiary cancer centre in the state of Kerala, India. The aim was to assess hospital prevalence and risk factors of anxiety and depression among cancer patients during COVID 19 pandemic. Patients on treatment for cancer and willing for the study were recruited. Hospital Anxiety and Depression Scale (HADS)</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> a self-assessment valid tool for screening both anxiety (HADS-A) and depression (HADS-D) are used. HADS-A &</span><span style="font-family:""> </span><span style="font-family:Verdana;">D were calculated separately & categorized as normal, borderline and abnormal with a score of 0</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">7, 8</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">10 & 11</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">21 respectively. Separate structured questionnaire for COVID19 related questions and patient master file for patient</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">& treatment characteristics were used in risk assessment. Data were entered in an Excel sheet and SPSS version 22 for statistical analysis. </span><b><span style="font-family:Verdana;">Findings</span></b></span><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">208 patients were included in this study. The overall prevalence rate of anxiety was 7</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">2%, with borderline cases 4</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">3% and abnormal cases 2</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">9%. The overall prevalence of the rate of depression was 5</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">3% (3</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">4% borderline & 1</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">9% abnormal). Risk factors like age, sex, socioeconomic status, primary site, stage of the disease and default of disease had no statistical significance.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Interpretation</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">The prevalence rate of anxiety and depression among cancer patients in this study is one among the lowest ever reported. COVID 19 outbreak has not brought any impact in the rate of psychological distress in our patients and the low rate may be due to the robust medical care including mental health interventions and reassurance by the Government.</span>展开更多
<strong>Objective: </strong>To describe the implementation and outcomes of using telehealth in combination with a differentiated ART delivery model to improve HIV antiretroviral therapy pick up at a large ...<strong>Objective: </strong>To describe the implementation and outcomes of using telehealth in combination with a differentiated ART delivery model to improve HIV antiretroviral therapy pick up at a large treatment facility in Trinidad and Tobago during COVID-19. <strong>Design and Methods:</strong> Beginning in April 2020, a list of patients was generated daily prior to their scheduled ART appointments. Nurses, doctors and social workers conducted telephone consultations to first screen patients for COVID-19 symptoms, conducted brief medical and behavioural health screenings, and helped patients to identify barriers to ART retention. Patients were recommended for 1) fast track ART refill collection at facility, 2) community ART refills, and 3) ART pick-up through patient peers. The uptake and outcomes of telehealth and ART pick up were compared with the corresponding period in 2019. Data was analyzed using SPSS 21.0. <strong>Results:</strong> During the period April-June 2020, 1361 patients were identified for telephone consultations, 1084 (80%) were successfully contacted and 984 patients (88%) participated in phone session. The independent t test showed a significant increase in ART pick-up when compared to the corresponding period in 2019. 59% of patients collected via fast-track ART refill, 30% had community refills, and 11% pick-up medications through patient peers. <strong>Conclusion: </strong>Telehealth is an integral component of DSD as part of the COVID-19 response at the MRF. Understanding the medium and longer-term outcomes of Telehealth can provide additional insights on the scale up of telehealth as a component of DSD to improve ART outcomes for patients in the context of the developing countries of the Caribbean.展开更多
Covid 19 epidemic has caused a lot of concern especially in the obstetric and neonatal populations. The fact that it is a new disease and the fact that there are sparse studies available have doubled our worries. Our ...Covid 19 epidemic has caused a lot of concern especially in the obstetric and neonatal populations. The fact that it is a new disease and the fact that there are sparse studies available have doubled our worries. Our study provides some answers. This a retrospective study carried out in Mediclinic Al-Noor hospital in Abu Dhabi. Our study revealed no adverse effects on the neonates and no vertical transmission. Given the physiologic and immune function changes in pregnancy, they might be considered at a higher risk of developing more complications, but it needs a longer duration of the study with larger sample size. Statistical analysis could not be possible in our study due to the smaller sample size, and we plan to continue the study further in the future to obtain a larger pool of data to validate the findings more accurately. The incidence of covid positive mothers might not reflect today’s covid situation because we carried out the study during the lockdown and there might be an increase in the incidence after lockdown.展开更多
COVID 19 has caused capitulation from healthcare entities all over the world. First described in Hubei, China, the virus has spread to 185 countries, showing little signs of eradication or eradication. There does not ...COVID 19 has caused capitulation from healthcare entities all over the world. First described in Hubei, China, the virus has spread to 185 countries, showing little signs of eradication or eradication. There does not exist a medical treatment regimen or a vaccine to address COVID 19 definitively. The best response, to date, has been early diagnosis and immediate isolation or quarantine of the patient, with supportive care. As medical institutions all around the world struggle to keep up with this pandemic, there is not a consensus amongst medical professionals in the rapid diagnosis of this disease entity. Purpose: The purpose of our study was to review the literature and establish a test, or tests, that would aid the clinician in attaining a swift, yet accurate diagnosis. Methods: We searched PubMed and Google scholar and reviewed 32 articles. Keyword searches consisted of COVID 19, pandemic, diagnoses, diagnostic testing, pandemic amongst others. We compared the data obtained from these studies in an effort to find the best diagnostic test. Results: There were a total of 12,270 patients that were in our study [1]-[32]. This is the largest study to date in the literature addressing diagnosis of COVID 19. Fever, cough and fatigue, in that respective order were the most common clinical symptoms. Laboratory findings consisted of leukopenia, elevated erythrocyte sedimentation (ESR) and elevated C-reactive protein, CRP. The gold standard test described in multiple studies was the RT-PCR. Serum assays of IgM and IgG were also drawn and found to be accurate in 93% of the time. CT Chest was both sensitive and specific, 90% and 86%. This diagnostic imaging was even more successful when coupled with clinical symptoms and approaching days 7 - 12 since the onset of clinical symptoms. Discussion: This is the largest study compiled to address diagnostic testing in COVID 19 patients. The patient population is spread vastly around the world, with access to many reported tests limited in certain countries. Given the significant sensitivity and specificity of diagnostic imaging, in the setting of clinical symptoms, we recommend patient undergo CT Chest in the face of COVID 19 exposure and clinical symptoms. While RT-PCR, IgM-IgG assays are beneficial, isolation, treatment, and possible quarantine of presumptive positive COVID 19 patients (based upon clinical symptoms and imaging) should not be delayed, for fear of increased infectivity and further risk to society at large.展开更多
目的:分析新型冠状病毒感染(COVID-19)相关心律失常的文献,探索该领域的研究现状、热点并预测未来的趋势,为后来的研究者提供借鉴。方法:选择Web of Science的核心合集数据库,每项研究都进行了文献计量和视觉分析,使用CiteSpace和VOSvie...目的:分析新型冠状病毒感染(COVID-19)相关心律失常的文献,探索该领域的研究现状、热点并预测未来的趋势,为后来的研究者提供借鉴。方法:选择Web of Science的核心合集数据库,每项研究都进行了文献计量和视觉分析,使用CiteSpace和VOSviewer软件生成知识图谱。结果:共鉴定出768篇文章,发文涉及美国、意大利和中国为首的319个国家/地区和4 366个机构,领先的研究机构是梅奥诊所和哈佛医学院。New England Journal of Medicine是该领域最常被引用的期刊。在6 687位作者中,Arbelo Elena撰写的研究最多,Guo T被共同引用的次数最多,心房纤颤是最常见的关键词。结论:随着COVID-19的暴发,对COVID-19所致新发/进行性心律失常事件的研究蓬勃发展,未来的研究者可能会对COVID-19感染后新发或遗留的快速性心律失常/缓慢性心律失常的发生机制进行进一步的探索。展开更多
Importance: The best respiratory support technique to reduce intubation and mortality in patients with respiratory failure due to COVID-19 is controversial. Objective: To determine the respiratory support technique th...Importance: The best respiratory support technique to reduce intubation and mortality in patients with respiratory failure due to COVID-19 is controversial. Objective: To determine the respiratory support technique that could reduce the need for tracheal intubation and mortality in patients with respiratory failure due to COVID-19 admitted to intensive care units (ICUs) of Military’s Hospital (HIAOBO) in Gabon. Design, Setting, and Participants-Methodology: Prospective observational study over 10 months (January 2021-October 2021). We included patients admitted to intensive care for SARS Cov2 pneumonia who had benefited from available ventilatory support: high concentration face mask, High Flow Nasal cannula (HFNC), NIV (Non Invasive Ventilation), Continuous Positive Airway Pressure (CPAP). The choice was guided by the clinical condition, and the choice of the prescribing physicians. Recourse to mechanical ventilation was decided when faced with a Glasgow score of less than 13, an SpO<sub>2</sub>/FiO<sub>2</sub> ratio ≤ 300, a FR ≥ 35/min, the impossibility of drainage of secretions. Main Outcomes and Measures: The primary outcome was the proportion of patients requiring intubation. The secondary outcomes were mortality in ICU. Results: The sample included 97 patients, the average age was55.6 years, hypertension was the main comorbidity (51.1%). Mean respiratory rate (RR) was 30.8 cycles/min, admission SpO2 was 83%, respiratory alkalosis was present in 63% of patients, mean CT involvement was 51%.Respiratory support was NIV (56.7%), CPAP (21.65%), high concentration face mask (18.55%). Sixteen percent (16%) of patients were intubated, 93% of them following failure of NIV. Mortality was 30%, mechanical ventilation was an independent risk factor for mortality. Conclusions: Non Invasive Ventilation, CPAP, and high-concentration face mask were frequently used in patients with COVID-related acute respiratory failure. The CPAP has reduced the need for intubation. Mechanical ventilation is a risk factor for death.展开更多
目的基于传染病动力学SEAIQR(susceptible-exposed-asymptomatic-infected-quarantined-removed)模型和Dropout-LSTM(Dropout long short term memory network)模型预测西安市新型冠状病毒肺炎(COVID-19)疫情的发展趋势,为评估“动态清...目的基于传染病动力学SEAIQR(susceptible-exposed-asymptomatic-infected-quarantined-removed)模型和Dropout-LSTM(Dropout long short term memory network)模型预测西安市新型冠状病毒肺炎(COVID-19)疫情的发展趋势,为评估“动态清零”策略防控效果提供科学依据。方法考虑到西安市本轮疫情存在大量的无症状感染者、依时变化的参数以及采取的管控举措等特点,构建具有阶段性防控措施的时变SEAIQR模型。考虑到COVID-19疫情数据的时序性特征及它们之间的非线性关系,构建深度学习Dropout-LSTM模型。选用2021年12月9日-2022年1月31日西安市新增确诊病例数据进行拟合,用2022年2月1日-2022年2月7日数据评估预测效果,计算有效再生数(R_(t))并评价不同参数对疫情发展的影响。结果SEAIQR模型预测的新增确诊病例拐点预计在2021年12月26日出现,约为176例,疫情将于2022年1月24日实现“动态清零”,模型R^(2)=0.849。Dropout-LSTM模型能够体现数据的时序性与非线性特征,预测出的新增确诊病例数与实际情况高度吻合,R^(2)=0.937。Dropout-LSTM模型的MAE和RMSE均较SEAIQR模型低,说明预测结果更为理想。疫情暴发初期,R 0为5.63,自实施全面管控后,R_(t)呈逐渐下降趋势,直到2021年12月27日降至1.0以下。随着有效接触率不断缩小、管控措施的提早实施及免疫阈值的提高,新增确诊病例在到达拐点时的人数将会持续降低。结论建立的Dropout-LSTM模型实现了较准确的疫情预测,可为COVID-19疫情“动态清零”防控决策提供借鉴。展开更多
文摘Lean manufacturing has been used for the last few decades as a process and performance improvement tool.Initially known as Toyota production system(TPS),lean is now used in almost all service and manufacturing sectors to deliver favorable results such as decreased operational cost,increased customer satisfaction,decreased cycle time,and enhanced profits.During the coronavirus disease(COVID 19)pandemic,the manufacturing sector struggled immensely and could not function well even after lockdown was eased in many countries.Many companies found out there are not ready to conform with new regulations made by authorities in many countries.This paper proposes the use of simulation and multi response optimization in addition to other typical lean tools in order to arrive at optimum performance at the end of each project through an established optimization framework.The framework is used in a real case study performed at an aluminum extrusion factory.Lean manufacturing helps organizations to operate with smaller number of resources.It standardizes all processes so that most of the jobs can be done by most of the workers,but this is not enough to create a healthy,sanitized work place.Our framework utilizes the strengths of lean tools and adds pandemic readiness factor to them to ensure improvement in performance and health pandemic readiness.Implementation of the framework in the case company resulted in 50%reduction in labor,$730000 in expected annual cost savings,reduction in inventory levels,improved employee morale and the achievement of pandemic ready status.
文摘The aim of this study was to find a simple and effective way to screen patients for Covid 19, prior to them being submitted to neurophysiological or neuro-psycholoigical testing in order to protect employees from being infected during the pandemic from patient contact. On May 18, 2020 when Michigan, a critically affected pandemic area, reopened for medical business after lockdown declared by the Governor on March 23, 2020, medical personnel in our office-which is an academic neurology practice-EEG and sleep technicians, medical Assistants, physician assistants and myself fretted about potential Covid 19 transmission during neuro-diagnostic procedures-EEG, video-EEG, ambulatory EEG, PSG, MSLT, CPAP titration, neuropsychological testing, EMG/NCV, VNG/Balance test and autonomic testing including the tilt table test, which require an intimate patient contact and risk of exposure. We screened all unselected and consecutive patients who were scheduled for neuro-diagnostic testing in our facility by infrared thermometer, a standard Covid 19 questionnaire and a single Covid 19 PCR nasal/throat swab prior to these tests. 542 consecutive unselected neurological or sleep/wake disorder patients aged 18 - 90, 65% males, 35% females were tested over six months as a part of this project. A total of 1109 diagnostic tests were performed. No test was limited in scope or duration. Standard PPE precautions were still taken despite the negative screening, room door left open and relatives’ presence limited during the test procedure. All were afebrile and negative on questionnaire and only 3 were found to be positive for Covid 19 PCR, indicating that a negative infrared temperature reading and a standard Covid 19 questionnaire is over 99 percent effective in prescreening for intimate neurological diagnostic testing. The technician, administering most of these tests, never contracted the virus. The technician collecting the nasal/throat swab never contracted the virus. One PA, two sleep technicians and one medical assistant came down with Covid 19 but were all felt to have contracted that from domestic exposure from family members or friends and not when at the job. All had mild disease and rapidly recovered. Infrared temperature testing and standard Covid 19 questionnaire are sufficient prior to intimate neuro-diagnostic testing when combined with standard PPE precautions to limit exposure to Covid 19 in medical personnel in a neurology office with on-site diagnostic testing.
文摘<strong>Background. </strong>The COVID 19 pandemic affected healthcare delivery systems worldwide. There was a redistribution of health care resources in order to deal with the effects of the pandemic, with a corresponding consequence on other clinical services rendered. The extent of this effect on other non COVID 19 related services has been reported in other centres worldwide. In our own setting, health care resources are limited with suboptimal access even in normal situations. <strong>Objective. </strong>We sought to evaluate the effects of the COVID 19 pandemic on elective surgical services in our hospital. <strong>Methods.</strong> This was a cross sectional comparative study carried out at the Jos University Teaching hospital, (North central, Nigeria) of the elective surgical services rendered during the first wave of the COVID 19 pandemic lockdown covering the period April to June 2020 with a corresponding period of the preceding year 2019. Data was obtained from the hospital records department, theatres and service areas for clinic attendance, elective surgeries and ward occupancy. The paired sample t-test was used to compare the assessed variables across the three months of both years with a level of significance of P < 0.05. <strong>Results.</strong> There was mean clinic attendance of 2859.33 ± 223.36 covering the three months in 2019 as against a mean attendance of 648.67 ± 578.24 covering a similar period in 2020, P = 0.037. The elective surgical procedures carried out across the surgical specialties over the period in 2019 gave a mean of 352.33 ± 44.60 as opposed to 64.001 ± 7.32 over the corresponding period in 2020, P = 0.018. Ward occupancy over April to June 2019 was a mean 297.33 ± 18.58 across the various surgical wards and 158.33 ± 25.70 in the same period in 2020, P = 0.007. <strong>Conclusion.</strong> There was a significant reduction in the elective surgical services rendered in the hospital during the first wave of the COVID 19 pandemic compared to a corresponding period in the preceding year. This decline in elective surgical services would have negatively affected the access to health care. Thus measures to clear the backlog of elective surgical procedures would be required.
文摘<strong>Background</strong><span style="font-family:Verdana;"> <strong>:</strong></span><span style="font-family:Verdana;">Anxiety and depression are two common psychiatric conditions encountered in cancer treatment. Prevalence rate and risk factors show wide variations in different countries and the environment. COVID 19 outbreak has increased psychological disorders in general public and health workers. Whether this pandemic has increased the psychiatric morbidity in cancer patients need</span><span style="font-family:Verdana;">s</span><span style="font-family:""><span style="font-family:Verdana;"> to be addressed for planning strategies. </span><b><span style="font-family:Verdana;">Methods</span></b></span><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">This cross-sectional study was conducted in the Department of Radiation Oncology, a tertiary cancer centre in the state of Kerala, India. The aim was to assess hospital prevalence and risk factors of anxiety and depression among cancer patients during COVID 19 pandemic. Patients on treatment for cancer and willing for the study were recruited. Hospital Anxiety and Depression Scale (HADS)</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> a self-assessment valid tool for screening both anxiety (HADS-A) and depression (HADS-D) are used. HADS-A &</span><span style="font-family:""> </span><span style="font-family:Verdana;">D were calculated separately & categorized as normal, borderline and abnormal with a score of 0</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">7, 8</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">10 & 11</span><span style="font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">21 respectively. Separate structured questionnaire for COVID19 related questions and patient master file for patient</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">& treatment characteristics were used in risk assessment. Data were entered in an Excel sheet and SPSS version 22 for statistical analysis. </span><b><span style="font-family:Verdana;">Findings</span></b></span><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">208 patients were included in this study. The overall prevalence rate of anxiety was 7</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">2%, with borderline cases 4</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">3% and abnormal cases 2</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">9%. The overall prevalence of the rate of depression was 5</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">3% (3</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">4% borderline & 1</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;">9% abnormal). Risk factors like age, sex, socioeconomic status, primary site, stage of the disease and default of disease had no statistical significance.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Interpretation</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">The prevalence rate of anxiety and depression among cancer patients in this study is one among the lowest ever reported. COVID 19 outbreak has not brought any impact in the rate of psychological distress in our patients and the low rate may be due to the robust medical care including mental health interventions and reassurance by the Government.</span>
文摘<strong>Objective: </strong>To describe the implementation and outcomes of using telehealth in combination with a differentiated ART delivery model to improve HIV antiretroviral therapy pick up at a large treatment facility in Trinidad and Tobago during COVID-19. <strong>Design and Methods:</strong> Beginning in April 2020, a list of patients was generated daily prior to their scheduled ART appointments. Nurses, doctors and social workers conducted telephone consultations to first screen patients for COVID-19 symptoms, conducted brief medical and behavioural health screenings, and helped patients to identify barriers to ART retention. Patients were recommended for 1) fast track ART refill collection at facility, 2) community ART refills, and 3) ART pick-up through patient peers. The uptake and outcomes of telehealth and ART pick up were compared with the corresponding period in 2019. Data was analyzed using SPSS 21.0. <strong>Results:</strong> During the period April-June 2020, 1361 patients were identified for telephone consultations, 1084 (80%) were successfully contacted and 984 patients (88%) participated in phone session. The independent t test showed a significant increase in ART pick-up when compared to the corresponding period in 2019. 59% of patients collected via fast-track ART refill, 30% had community refills, and 11% pick-up medications through patient peers. <strong>Conclusion: </strong>Telehealth is an integral component of DSD as part of the COVID-19 response at the MRF. Understanding the medium and longer-term outcomes of Telehealth can provide additional insights on the scale up of telehealth as a component of DSD to improve ART outcomes for patients in the context of the developing countries of the Caribbean.
文摘Covid 19 epidemic has caused a lot of concern especially in the obstetric and neonatal populations. The fact that it is a new disease and the fact that there are sparse studies available have doubled our worries. Our study provides some answers. This a retrospective study carried out in Mediclinic Al-Noor hospital in Abu Dhabi. Our study revealed no adverse effects on the neonates and no vertical transmission. Given the physiologic and immune function changes in pregnancy, they might be considered at a higher risk of developing more complications, but it needs a longer duration of the study with larger sample size. Statistical analysis could not be possible in our study due to the smaller sample size, and we plan to continue the study further in the future to obtain a larger pool of data to validate the findings more accurately. The incidence of covid positive mothers might not reflect today’s covid situation because we carried out the study during the lockdown and there might be an increase in the incidence after lockdown.
文摘COVID 19 has caused capitulation from healthcare entities all over the world. First described in Hubei, China, the virus has spread to 185 countries, showing little signs of eradication or eradication. There does not exist a medical treatment regimen or a vaccine to address COVID 19 definitively. The best response, to date, has been early diagnosis and immediate isolation or quarantine of the patient, with supportive care. As medical institutions all around the world struggle to keep up with this pandemic, there is not a consensus amongst medical professionals in the rapid diagnosis of this disease entity. Purpose: The purpose of our study was to review the literature and establish a test, or tests, that would aid the clinician in attaining a swift, yet accurate diagnosis. Methods: We searched PubMed and Google scholar and reviewed 32 articles. Keyword searches consisted of COVID 19, pandemic, diagnoses, diagnostic testing, pandemic amongst others. We compared the data obtained from these studies in an effort to find the best diagnostic test. Results: There were a total of 12,270 patients that were in our study [1]-[32]. This is the largest study to date in the literature addressing diagnosis of COVID 19. Fever, cough and fatigue, in that respective order were the most common clinical symptoms. Laboratory findings consisted of leukopenia, elevated erythrocyte sedimentation (ESR) and elevated C-reactive protein, CRP. The gold standard test described in multiple studies was the RT-PCR. Serum assays of IgM and IgG were also drawn and found to be accurate in 93% of the time. CT Chest was both sensitive and specific, 90% and 86%. This diagnostic imaging was even more successful when coupled with clinical symptoms and approaching days 7 - 12 since the onset of clinical symptoms. Discussion: This is the largest study compiled to address diagnostic testing in COVID 19 patients. The patient population is spread vastly around the world, with access to many reported tests limited in certain countries. Given the significant sensitivity and specificity of diagnostic imaging, in the setting of clinical symptoms, we recommend patient undergo CT Chest in the face of COVID 19 exposure and clinical symptoms. While RT-PCR, IgM-IgG assays are beneficial, isolation, treatment, and possible quarantine of presumptive positive COVID 19 patients (based upon clinical symptoms and imaging) should not be delayed, for fear of increased infectivity and further risk to society at large.
文摘目的:分析新型冠状病毒感染(COVID-19)相关心律失常的文献,探索该领域的研究现状、热点并预测未来的趋势,为后来的研究者提供借鉴。方法:选择Web of Science的核心合集数据库,每项研究都进行了文献计量和视觉分析,使用CiteSpace和VOSviewer软件生成知识图谱。结果:共鉴定出768篇文章,发文涉及美国、意大利和中国为首的319个国家/地区和4 366个机构,领先的研究机构是梅奥诊所和哈佛医学院。New England Journal of Medicine是该领域最常被引用的期刊。在6 687位作者中,Arbelo Elena撰写的研究最多,Guo T被共同引用的次数最多,心房纤颤是最常见的关键词。结论:随着COVID-19的暴发,对COVID-19所致新发/进行性心律失常事件的研究蓬勃发展,未来的研究者可能会对COVID-19感染后新发或遗留的快速性心律失常/缓慢性心律失常的发生机制进行进一步的探索。
文摘Importance: The best respiratory support technique to reduce intubation and mortality in patients with respiratory failure due to COVID-19 is controversial. Objective: To determine the respiratory support technique that could reduce the need for tracheal intubation and mortality in patients with respiratory failure due to COVID-19 admitted to intensive care units (ICUs) of Military’s Hospital (HIAOBO) in Gabon. Design, Setting, and Participants-Methodology: Prospective observational study over 10 months (January 2021-October 2021). We included patients admitted to intensive care for SARS Cov2 pneumonia who had benefited from available ventilatory support: high concentration face mask, High Flow Nasal cannula (HFNC), NIV (Non Invasive Ventilation), Continuous Positive Airway Pressure (CPAP). The choice was guided by the clinical condition, and the choice of the prescribing physicians. Recourse to mechanical ventilation was decided when faced with a Glasgow score of less than 13, an SpO<sub>2</sub>/FiO<sub>2</sub> ratio ≤ 300, a FR ≥ 35/min, the impossibility of drainage of secretions. Main Outcomes and Measures: The primary outcome was the proportion of patients requiring intubation. The secondary outcomes were mortality in ICU. Results: The sample included 97 patients, the average age was55.6 years, hypertension was the main comorbidity (51.1%). Mean respiratory rate (RR) was 30.8 cycles/min, admission SpO2 was 83%, respiratory alkalosis was present in 63% of patients, mean CT involvement was 51%.Respiratory support was NIV (56.7%), CPAP (21.65%), high concentration face mask (18.55%). Sixteen percent (16%) of patients were intubated, 93% of them following failure of NIV. Mortality was 30%, mechanical ventilation was an independent risk factor for mortality. Conclusions: Non Invasive Ventilation, CPAP, and high-concentration face mask were frequently used in patients with COVID-related acute respiratory failure. The CPAP has reduced the need for intubation. Mechanical ventilation is a risk factor for death.
文摘目的基于传染病动力学SEAIQR(susceptible-exposed-asymptomatic-infected-quarantined-removed)模型和Dropout-LSTM(Dropout long short term memory network)模型预测西安市新型冠状病毒肺炎(COVID-19)疫情的发展趋势,为评估“动态清零”策略防控效果提供科学依据。方法考虑到西安市本轮疫情存在大量的无症状感染者、依时变化的参数以及采取的管控举措等特点,构建具有阶段性防控措施的时变SEAIQR模型。考虑到COVID-19疫情数据的时序性特征及它们之间的非线性关系,构建深度学习Dropout-LSTM模型。选用2021年12月9日-2022年1月31日西安市新增确诊病例数据进行拟合,用2022年2月1日-2022年2月7日数据评估预测效果,计算有效再生数(R_(t))并评价不同参数对疫情发展的影响。结果SEAIQR模型预测的新增确诊病例拐点预计在2021年12月26日出现,约为176例,疫情将于2022年1月24日实现“动态清零”,模型R^(2)=0.849。Dropout-LSTM模型能够体现数据的时序性与非线性特征,预测出的新增确诊病例数与实际情况高度吻合,R^(2)=0.937。Dropout-LSTM模型的MAE和RMSE均较SEAIQR模型低,说明预测结果更为理想。疫情暴发初期,R 0为5.63,自实施全面管控后,R_(t)呈逐渐下降趋势,直到2021年12月27日降至1.0以下。随着有效接触率不断缩小、管控措施的提早实施及免疫阈值的提高,新增确诊病例在到达拐点时的人数将会持续降低。结论建立的Dropout-LSTM模型实现了较准确的疫情预测,可为COVID-19疫情“动态清零”防控决策提供借鉴。
