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Mounica B, Pushker N, Kashyap S, Sen S, Agrawal S, Meel R, Bajaj MS, Bakhshi S. Clinicopathological presentations of eyelid malignancy in COVID era versus pre-COVID era. Indian J Ophthalmol 2024; 72:1442-1447. [PMID: 39331434 DOI: 10.4103/ijo.ijo_3332_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/28/2024] [Indexed: 09/28/2024] Open
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic led to overall interrupted medical care, resulting in disease progression and morbidity. The study aimed to evaluate clinicopathological presentations and severity of eyelid malignancy during the COVID era, comparing the results with patients presented during pre-COVID era and evaluating the reasons for delayed presentation in patients with advanced eyelid malignancy in the COVID-era. METHODS This was a comparative, ambispective observational study. Data regarding demographic, clinical, histopathology, and treatment modalities of confirmed cases of eyelid malignancy admitted during the period from March 2020 to September 2022 (defined as COVID era group) were collected and compared with retrospectively collected data from March 2017 to March 2020 (defined as pre-COVID era group). COVID era patients were further categorized as localized and advanced disease. Patients with advanced eyelid malignancy during COVID era were further subjected to a questionnaire to evaluate the reasons for delayed presentation. RESULTS In total, 115 patients of eyelid malignancy were studied [COVID era group 40 (35%) and pre-COVID era group 75 (65%)]. A statistically significant increase in the duration of disease (P = 0.0001) and advanced tumor T-stage (P = 0.03) was noticed in the COVID era group. Demographic, histopathology, and ocular morbidity details were similar in both groups. The common reasons that led to delay in presentation and treatment in advanced T-stage patients during the COVID era were fear of acquiring COVID, lockdown, and lack of medical facilities. CONCLUSION During the COVID-19 pandemic, both hospital- and patient-related factors contributed to delay in presentation, leading to advanced-stage disease indicating need of triaging of eyelid malignancy in the event of such pandemics in future.
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Affiliation(s)
- B Mounica
- Oculoplasty and Oncology Services (Dr. Rajendra Prasad Centre for Ophthalmic Sciences), All India Institute of Medical Sciences, New Delhi, India
| | - Neelam Pushker
- Oculoplasty and Oncology Services (Dr. Rajendra Prasad Centre for Ophthalmic Sciences), All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kashyap
- Department of Ocular Pathology (Dr Rajendra Prasad Centre of Ophthalmic Sciences), All India Institute of Medical Sciences, New Delhi, India
| | - Seema Sen
- Department of Ocular Pathology (Dr Rajendra Prasad Centre of Ophthalmic Sciences), All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Agrawal
- Oculoplasty and Oncology Services (Dr. Rajendra Prasad Centre for Ophthalmic Sciences), All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Meel
- Oculoplasty and Oncology Services (Dr. Rajendra Prasad Centre for Ophthalmic Sciences), All India Institute of Medical Sciences, New Delhi, India
| | - Mandeep S Bajaj
- Oculoplasty and Oncology Services (Dr. Rajendra Prasad Centre for Ophthalmic Sciences), All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology (Institute Rotary Cancer Hospital), All India Institute of Medical Sciences, New Delhi, India
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Goldhaber NH, Ramesh K, Horton LE, Longhurst CA, Huang E, Horgan S, Jacobsen GR, Sandler BJ, Broderick RC. The Long Haul to Surgery: Long COVID Has Minimal Burden on Surgical Departments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1205. [PMID: 39338088 PMCID: PMC11431659 DOI: 10.3390/ijerph21091205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 09/06/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024]
Abstract
Many patients infected with the SARS-CoV-2 virus (COVID-19) continue to experience symptoms for weeks to years as sequelae of the initial infection, referred to as "Long COVID". Although many studies have described the incidence and symptomatology of Long COVID, there are little data reporting the potential burden of Long COVID on surgical departments. A previously constructed database of survey respondents who tested positive for COVID-19 was queried, identifying patients reporting experiencing symptoms consistent with Long COVID. Additional chart review determined whether respondents had a surgical or non-routine invasive procedure on or following the date of survey completion. Outcomes from surgeries on patients reporting Long COVID symptoms were compared to those from asymptomatic patients. A total of 17.4% of respondents had surgery or a non-routine invasive procedure in the study period. A total of 48.8% of these patients reported experiencing symptoms consistent with Long COVID. No statistically significant differences in surgical outcomes were found between groups. The results of this analysis demonstrate that Long COVID does not appear to have created a significant burden of surgical disease processes on the healthcare system despite the wide range of chronic symptoms and increased healthcare utilization by this population. This knowledge can help guide surgical operational resource allocation as a result of the pandemic and its longer-term sequelae.
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Affiliation(s)
- Nicole Hamilton Goldhaber
- Department of Surgery, School of Medicine, University of California San Diego, La Jolla, San Diego, CA 92037, USA
| | - Karthik Ramesh
- School of Medicine, University of California San Diego, La Jolla, San Diego, CA 92093, USA
| | - Lucy E Horton
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, San Diego, CA 92037, USA
| | - Christopher A Longhurst
- Division of Biomedical Informatics, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, San Diego, CA 92037, USA
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, San Diego, CA 92037, USA
| | - Estella Huang
- Department of Surgery, School of Medicine, University of California San Diego, La Jolla, San Diego, CA 92037, USA
| | - Santiago Horgan
- Department of Surgery, School of Medicine, University of California San Diego, La Jolla, San Diego, CA 92037, USA
| | - Garth R Jacobsen
- Department of Surgery, School of Medicine, University of California San Diego, La Jolla, San Diego, CA 92037, USA
| | - Bryan J Sandler
- Department of Surgery, School of Medicine, University of California San Diego, La Jolla, San Diego, CA 92037, USA
| | - Ryan C Broderick
- Department of Surgery, School of Medicine, University of California San Diego, La Jolla, San Diego, CA 92037, USA
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Iftimie S, López-Azcona AF, Corchero-Valverde M, Peralta-Vázquez A, López-Cordón LR, García-Cervera C, Fernández-Domínguez LM, Camps J, Joven J, Castro A. Retrospective Analysis of Clostridioides difficile Infection Rates and Outcomes in Hospitalized Patients during the COVID-19 Pandemic: A Unicenter Study in Reus, Spain. J Clin Med 2024; 13:2799. [PMID: 38792341 PMCID: PMC11122305 DOI: 10.3390/jcm13102799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Background:Clostridioides difficile infections (CDI) vary in severity from mild diarrhea to life-threatening conditions like pseudomembranous colitis or toxic megacolon, often leading to sepsis and death. The COVID-19 pandemic prompted changes in healthcare practices, potentially affecting CDI incidence, though reported data are inconclusive. We studied factors influencing CDI incidence and outcomes at a university hospital throughout the COVID-19 pandemic years. Methods: We conducted a retrospective study on all adult hospitalized CDI cases from 1 January 2020 to 31 December 2022 in Hospital Universitari de Sant Joan in Reus. We collected demographic information, comorbid conditions, and concurrent infections. Results: While overall CDI and COVID-19 rates decreased in 2022, a notable increase in CDI infections was observed among oncological patients and those undergoing some aggressive treatments, such as colonoscopies or gastroscopies. The prevalence of comorbidities remained unmodified, and there were declines in prior gastrointestinal surgeries and proton pump inhibitor prescriptions. Factors associated with patient fatality or prolonged hospitalization included older age, cancer, chronic kidney disease, higher Charlson and McCabe indices, elevated C-reactive protein, and low albumin concentrations. Conclusions: Our study shows the evolving landscape of CDI during the COVID-19 pandemic and emphasizes the impact of delayed diagnoses and treatments exacerbated by telemedicine adoption. Identified risk factors for CDI-related mortality or prolonged hospital stays underscore the importance of targeted interventions in high-risk populations.
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Affiliation(s)
- Simona Iftimie
- Department of Internal Medicine, Institut d’Investigació Sanitària Pere Virgili, Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, 43204 Reus, Spain; (S.I.); (A.F.L.-A.); (M.C.-V.); (A.P.-V.); (L.R.L.-C.); (C.G.-C.); (A.C.)
| | - Ana F. López-Azcona
- Department of Internal Medicine, Institut d’Investigació Sanitària Pere Virgili, Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, 43204 Reus, Spain; (S.I.); (A.F.L.-A.); (M.C.-V.); (A.P.-V.); (L.R.L.-C.); (C.G.-C.); (A.C.)
| | - Mireia Corchero-Valverde
- Department of Internal Medicine, Institut d’Investigació Sanitària Pere Virgili, Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, 43204 Reus, Spain; (S.I.); (A.F.L.-A.); (M.C.-V.); (A.P.-V.); (L.R.L.-C.); (C.G.-C.); (A.C.)
| | - Antonio Peralta-Vázquez
- Department of Internal Medicine, Institut d’Investigació Sanitària Pere Virgili, Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, 43204 Reus, Spain; (S.I.); (A.F.L.-A.); (M.C.-V.); (A.P.-V.); (L.R.L.-C.); (C.G.-C.); (A.C.)
| | - Laia Revuelta López-Cordón
- Department of Internal Medicine, Institut d’Investigació Sanitària Pere Virgili, Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, 43204 Reus, Spain; (S.I.); (A.F.L.-A.); (M.C.-V.); (A.P.-V.); (L.R.L.-C.); (C.G.-C.); (A.C.)
| | - Carles García-Cervera
- Department of Internal Medicine, Institut d’Investigació Sanitària Pere Virgili, Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, 43204 Reus, Spain; (S.I.); (A.F.L.-A.); (M.C.-V.); (A.P.-V.); (L.R.L.-C.); (C.G.-C.); (A.C.)
| | | | - Jordi Camps
- Unitat de Recerca Biomèdica, Institut d’Investigació Sanitària Pere Virgili, Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, 43204 Reus, Spain;
| | - Jorge Joven
- Unitat de Recerca Biomèdica, Institut d’Investigació Sanitària Pere Virgili, Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, 43204 Reus, Spain;
| | - Antoni Castro
- Department of Internal Medicine, Institut d’Investigació Sanitària Pere Virgili, Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, 43204 Reus, Spain; (S.I.); (A.F.L.-A.); (M.C.-V.); (A.P.-V.); (L.R.L.-C.); (C.G.-C.); (A.C.)
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4
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Kumar A, Pushkar K, Mathur Y, Kumar R, Patnaik U, Ahmed FHM, Yendamuri S, Dawra S. Association of socio-demographic factors with clinical outcome among hospitalized patients in first and second waves of COVID-19 pandemic: Study from the developing world. J Family Med Prim Care 2024; 13:1636-1642. [PMID: 38948593 PMCID: PMC11213441 DOI: 10.4103/jfmpc.jfmpc_57_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/28/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2024] Open
Abstract
Background Recent disease resurgence in China indicates that corona virus infectious disease is still a pertinent public health problem. We stand at a juncture where we are still unsure about the initial dilemmas regarding its birth, therapies, and the emerging novel strains. Medical literature has focused on the clinical, laboratory, radiological, and therapeutic aspects of disease management. There is paucity of literature on the association between socio-demographic variables on disease severity and clinical outcome. Materials and Methods This retrospective observational study analyzing the socio-demographic variables was performed at a dedicated COVID care center in western Maharashtra, India. Electronic records of all individuals who were admitted to this hospital from July 29 2020, to June 14, 2021, and diagnosed COVID-19 positive by reverse transcriptase polymerase chain reaction (RT-PCR) were identified after due institutional ethical clearance. Patients admitted from July 29, 2020, to February 27, 2021, were categorized as patients presenting during the 'first wave of viral pandemic'. Those admitted from March 01, 2021, to June 14, 2021, have been included as patients admitted during 'second wave of viral pandemic'. The following outcome parameters were collected (presenting symptoms, duration of symptoms before the individual presented for diagnostic RT-PCR, total duration of symptoms, severity of disease at onset, duration of hospital stay, the final outcome (discharge/death) and Charlson's comorbidity index). The linear regression model was used to establish association between socio-demographic factors and disease severity at onset (mild/moderate/severe/critical). Results A total of 37033 patients were screened, and the positivity rate with RT-PCR was 16.99% (n = 6275) during the study period. Out of which 45% (n = 2824) of the patients had mild disease requiring home isolation and the remaining 55% of patients required admission. 1590 patients from the first wave and 910 from the second wave of COVID-19 were hospitalized and included in the study after exclusion. The mean age of patients in first wave was 49 years and that in second wave was 54 years with 77.6% and 70.6% males in two waves, respectively. The burden of critical cases was higher in second wave as computed to first wave (10% vs 8%). The second wave had more outreach in the rural population as compared to second one (17.8% vs 12.2%). The mean duration from the onset of symptoms to hospitalization was 03 and 04 days, respectively, in two waves. Mortality associated in two waves was 11.9% and 24%, respectively (P < 0.05). Higher Charlson's comorbidity index was associated with higher mortality, and the cumulative survival from urban area was more as compared to the rural population (log rank - 9.148, P = 0.0002). Conclusion The second COVID-19 wave had significantly higher case mortality. It affected elderly patients and those with rural background. The factors associated with higher mortality during COVID-19 pandemic were rural background, higher Charlson's comorbidity index and late presentation to the hospital. Ongoing vaccine campaigns, thus, should focus on rural areas and individuals with comorbidities especially in developing and least developed countries.
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Affiliation(s)
- Ankit Kumar
- Department of Medicine, Military Hospital, Shimla, Himachal Pradesh, India
| | - Kumar Pushkar
- Associate Professor, Department of Community Medicine, Command Hospital, Pune, Maharashtra, India
| | - Yashvir Mathur
- Associate Professor, Department of Radio-diagnosis, Command Hospital, Pune, Maharashtra, India
| | - Ravi Kumar
- Resident, Department of Internal Medicine, Command Hospital, Pune, Maharashtra, India
| | - Uma Patnaik
- Professor, Department of ENT, Command Hospital, Pune, Maharashtra, India
| | - F H M Ahmed
- Professor, Department of Medicine, Command Hospital, Kolkata, West Bengal, India
| | - Sushma Yendamuri
- Resident, Department of Internal Medicine, Command Hospital, Pune, Maharashtra, India
| | - Saurabh Dawra
- Associate Professor, Department of Medicine, Command Hospital, Pune, Maharashtra, India
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5
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Asghar A, Khalid A, Baqar Z, Hussain N, Saleem MZ, Sairash, Rizwan K. An insights into emerging trends to control the threats of antimicrobial resistance (AMR): an address to public health risks. Arch Microbiol 2024; 206:72. [PMID: 38252323 DOI: 10.1007/s00203-023-03800-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024]
Abstract
Antimicrobial agents are used to treat microbial ailments, but increased use of antibiotics and exposure to infections in healthcare facilities and hospitals as well as the excessive and inappropriate use of antibiotics at the society level lead to the emergence of multidrug-resistant (MDR) bacteria. Antimicrobial resistance (AMR) is considered a public health concern and has rendered the treatment of different infections more challenging. The bacterial strains develop resistance against antimicrobial agents by limiting intracellular drug accumulation (increasing efflux or decreasing influx of antibiotics), modification and inactivation of drugs and its targets, enzymatic inhibition, and biofilm formation. However, the driving factors of AMR include the sociocultural and economic circumstances of a country, the use of falsified and substandard medicines, the use of antibiotics in farm animals, and food processing technologies. These factors make AMR one of the major menaces faced by mankind. In order to promote reciprocal learning, this article summarizes the current AMR situation in Pakistan and how it interacts with the health issues related to the COVID-19 pandemic. The COVID-19 pandemic aids in illuminating the possible long-term impacts of AMR, which are less immediate but not less severe since their measures and effects are equivalent. Impact on other sectors, including the health industry, the economy, and trade are also discussed. We conclude by summarizing the several approaches that could be used to address this issue.
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Affiliation(s)
- Ayesha Asghar
- School of Biochemistry and Biotechnology, University of the Punjab, Quaid-E-Azam Campus, Lahore, Pakistan
| | - Aneeza Khalid
- School of Biochemistry and Biotechnology, University of the Punjab, Quaid-E-Azam Campus, Lahore, Pakistan
| | - Zulqarnain Baqar
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Nazim Hussain
- Centre for Applied Molecular Biology (CAMB), University of the Punjab, Quaid-E-Azam Campus, Lahore, Pakistan.
| | - Muhammad Zafar Saleem
- Centre for Applied Molecular Biology (CAMB), University of the Punjab, Quaid-E-Azam Campus, Lahore, Pakistan
| | - Sairash
- Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Komal Rizwan
- Department of Chemistry, University of Sahiwal, Sahiwal, 57000, Pakistan.
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He Q, Tan Z, Zhou L. Litigation on kidney transplantation: 10-year experience from China. Int J Surg 2023; 109:3700-3702. [PMID: 37526123 PMCID: PMC10651275 DOI: 10.1097/js9.0000000000000625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 08/02/2023]
Affiliation(s)
| | - Zhimin Tan
- Department of Anaesthesiology, West China Hospital of Sichuan University, Sichuan Province, Chengdu, People’s Republic of China
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Co M, Chiu S, Billy Cheung HH. Extended reality in surgical education: A systematic review. Surgery 2023; 174:1175-1183. [PMID: 37640664 DOI: 10.1016/j.surg.2023.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/06/2023] [Accepted: 07/13/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND This review aims to evaluate the effectiveness of extended reality-based training in surgical education. METHODS This systematic review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS A total of 33 studies were included in the qualitative analysis. Nine studies evaluated the effectiveness of virtual reality-based training against no substitutional training. Seven studies looked at training for laparoscopic surgery, and the results were contradicting. Two studies focused on orthopedics training, and the outcomes were positive. Fourteen studies compared the outcomes of virtual reality-based training to conventional didactic teaching, all demonstrating superior outcomes for virtual reality-based training. Nine studies compared the outcomes of virtual reality simulation training to dry lab simulation training. The inferior outcomes of virtual reality simulation training were demonstrated by 5 studies for laparoscopic surgery, 1 study for arthroscopic procedures, 1 study for robotic surgery, and 1 study for dental procedures. One study found potential benefits of virtual reality simulation training on orthopedics surgeries. One study found virtual reality simulation training to be superior to cadaveric training, and 3 studies found augmented reality and virtual reality-based training to be comparable to supervised operative opportunities. CONCLUSION Extended reality-based training is a potentially useful modality to serve as an adjunct to the current physical surgical training.
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Affiliation(s)
- Michael Co
- Centre of Education and Training, Department of Surgery, University of Hong Kong, China.
| | - Shirley Chiu
- Centre of Education and Training, Department of Surgery, University of Hong Kong, China
| | - Ho Hung Billy Cheung
- Centre of Education and Training, Department of Surgery, University of Hong Kong, China
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Wright LM, Skinner AM, Cheknis A, McBurney C, Ge L, Pacheco SM, Leehey D, Gerding DN, Johnson S. Effect of the COVID-19 Pandemic on Rates and Epidemiology of Clostridioides difficile Infection in One VA Hospital. Antibiotics (Basel) 2023; 12:1159. [PMID: 37508255 PMCID: PMC10376799 DOI: 10.3390/antibiotics12071159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 pandemic was associated with increases in some healthcare-associated infections. We investigated the impact of the pandemic on the rates and molecular epidemiology of Clostridioides difficile infection (CDI) within one VA hospital. We anticipated that the potential widespread use of antibiotics for pneumonia during the pandemic might increase CDI rates given that antibiotics are a major risk for CDI. Hospital data on patients with CDI and recurrent CDI (rCDI) were reviewed both prior to the COVID-19 pandemic (2015 to 2019) and during the pandemic (2020-2021). Restriction endonuclease analysis (REA) strain typing was performed on CD isolates recovered from stool samples collected from October 2019 to March 2022. CDI case numbers declined by 43.2% in 2020 to 2021 compared to the annual mean over the previous 5 years. The stool test positivity rate was also lower during the COVID-19 pandemic (14.3% vs. 17.2%; p = 0.013). Inpatient hospitalization rates declined, and rates of CDI among inpatients were reduced by 34.2% from 2020 to 2021. The mean monthly cases of rCDI also declined significantly after 2020 [3.38 (95% CI: 2.89-3.87) vs. 1.92 (95% CI: 1.27-2.56); p = <0.01]. Prior to the pandemic, REA group Y was the most prevalent CD strain among the major REA groups (27.3%). During the first wave of the pandemic, from 8 March 2020, to 30 June 2020, there was an increase in the relative incidence of REA group BI (26.7% vs. 9.1%); After adjusting for CDI risk factors, a multivariable logistic regression model revealed that the odds of developing an REA group BI CDI increased during the first pandemic wave (OR 6.41, 95% CI: 1.03-39.91) compared to the pre-pandemic period. In conclusion, the incidence of CDI and rCDI decreased significantly during the COVID-19 pandemic. In contrast, REA BI (Ribotype 027), a virulent, previously epidemic CD strain frequently associated with hospital transmission and outbreaks, reappeared as a prevalent strain during the first wave of the pandemic, but subsequently disappeared, and overall CDI rates declined.
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Affiliation(s)
- Lorinda M. Wright
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
| | - Andrew M. Skinner
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
- Chicago Stritch School of Medicine, Loyola University, 2160 S. First Ave., Maywood, IL 60153, USA
| | - Adam Cheknis
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
| | - Conor McBurney
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
| | - Ling Ge
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
| | - Susan M. Pacheco
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
- Chicago Stritch School of Medicine, Loyola University, 2160 S. First Ave., Maywood, IL 60153, USA
| | - David Leehey
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
- Chicago Stritch School of Medicine, Loyola University, 2160 S. First Ave., Maywood, IL 60153, USA
| | - Dale N. Gerding
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
| | - Stuart Johnson
- Edward Hines Jr. VA Hospital, 5000 S. 5th Ave., Hines, IL 60141, USA; (A.M.S.); (A.C.); (C.M.); (L.G.); (S.M.P.); (D.L.); (D.N.G.); (S.J.)
- Chicago Stritch School of Medicine, Loyola University, 2160 S. First Ave., Maywood, IL 60153, USA
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Troesch A, Magdalena H, Forchhammer S, Del Regno L, Lodde G, Turko P, Cheng PF, Levesque ML, Hadaschik E, Livingstone E, Peris K, Flatz L, Peter K, Dummer R, Dimitriou F. The impact of the COVID-19 pandemic on the diagnosis of cutaneous melanomas: A retrospective cohort study from five European skin cancer reference centres. J Eur Acad Dermatol Venereol 2023; 37:922-931. [PMID: 36785973 DOI: 10.1111/jdv.18953] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The COVID-19 lockdown had a dramatic impact on primary care access and resulted in postponed skin cancer screenings. This raises concerns for a diagnostic delay on primary cutaneous melanomas, which can subsequently increase morbidity and mortality. OBJECTIVES The aim of the study was to investigate the impact of the COVID-19-related restrictions on the melanoma diagnosis in five European skin cancer reference centres in Switzerland, Germany, Austria and Italy. METHODS A total of 7865 cutaneous melanoma cases were collected between 01 September 2018 and 31 August 2021. The time period was stratified into pre-COVID (pre-lockdown) and post-COVID (lockdown and post-lockdown) according to the established restrictions in each country. The data collection included demographic, clinical and histopathological data from histologically confirmed cutaneous melanomas. Personal and family history of melanoma, and presence of immunosuppression were used to assess the diagnosis delay in high-risk individuals. RESULTS There was an overall increase of the Breslow tumour thickness (mean 1.25 mm vs. 1.02 mm) during the post-COVID period, as well as an increase in the proportion of T3-T4 melanomas, rates of ulceration and the number of mitotic rates ≥2 (all, p < 0.001). Patients with immunosuppression and personal history of melanoma showed a decrease in the mean log10-transformed Breslow during lockdown and post-COVID. In the multivariate analysis, age at melanoma diagnosis (p < 0.01) and personal history of melanoma (p < 0.01) showed significant differences in the mean Breslow thickness. CONCLUSIONS The study confirms the diagnostic delay in cutaneous melanomas due to the COVID-19 lockdown. High-risk individuals, such as patients with personal history of melanoma and elderly individuals, were more hesitant to restart their regular skin cancer screenings post-COVID. Further studies with longer follow-up are required to evaluate the consequences of this diagnostic delay in long-term outcomes.
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Affiliation(s)
- Alexander Troesch
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Hoellwerth Magdalena
- Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Stephan Forchhammer
- Department of Dermatology, Eberhard Karls University of Tübingen, Tuebingen, Germany
| | - Laura Del Regno
- Dermatology, Universita' Cattolica, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Georg Lodde
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Patrick Turko
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Phil F Cheng
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Mitchell L Levesque
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Eva Hadaschik
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ketty Peris
- Dermatology, Universita' Cattolica, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Lukas Flatz
- Department of Dermatology, Eberhard Karls University of Tübingen, Tuebingen, Germany
| | - Koelblinger Peter
- Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Jeremić J, Suđecki B, Radenović K, Mihaljević J, Radosavljević I, Jovanović M, Milić N, Pavlović V, Brašanac D, Jović M. Impact of the COVID-19 Pandemic on Melanoma Diagnosis: Increased Breslow Thickness in Primary Melanomas-A Single Center Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16806. [PMID: 36554683 PMCID: PMC9779520 DOI: 10.3390/ijerph192416806] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Early melanoma diagnosis plays a key role in ensuring best prognosis with good survival rates. The ongoing global COVID-19 pandemic has greatly impacted global and national healthcare systems, thus making it a real challenge. The aim of this study was to evaluate the impact of the pandemic on diagnostic delay in melanoma patients in Serbia. In this retrospective study, we included patients treated at the university hospital in Serbia's capitol over a period of five years and three months. We compared the prepandemic (01/JAN/17-14/MAR/20) and pandemic periods (15/MAR/20-31/MAR/22) by evaluating patient demographic data, melanoma subtype, Breslow thickness, Clark level, ulceration status, mitotic index rate and pT staging. We observed a significant reduction in the number of diagnosed patients (86.3 vs. 13.7%; p = 0.036), with melanomas having an increased median Breslow thickness (1.80 vs. 3.00; p = 0.010), a higher percentage of Clark IV-V level lesions (44.0% vs. 63.0%; p = 0.009), an increase in median mitotic index rate (2 vs. 5; p < 0.001) and a trend of increase in lesions thicker than 2 mm (37.8% vs. 53.7%; p = 0.026). We believe that this study can be a useful scenario guide for future similar events, highlighting the importance of preventive measures and timely diagnosis for the best patient outcomes.
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Affiliation(s)
- Jelena Jeremić
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Branko Suđecki
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Kristina Radenović
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jovan Mihaljević
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ivan Radosavljević
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Jovanović
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nataša Milić
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Vedrana Pavlović
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dimitrije Brašanac
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Jović
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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11
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Ogunleye VO, Oluwalusi OP, Popoola O, Kehinde A, Agbi S, Akintayo I, Udofia I, Bamidele F, Alonge T, Mogeni OD, Adekanmbi O, Ajiboye JJ, Marks F, Okeke IN. Restoring non-COVID-19 clinical research and surveillance in Oyo state, Nigeria during the SARS-CoV-2pandemic. J Public Health Afr 2022; 13:1720. [PMID: 36393921 PMCID: PMC9664379 DOI: 10.4081/jphia.2022.1720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 09/21/2021] [Indexed: 11/06/2022] Open
Abstract
Background Many sub-Saharan African patients receive clinical care from extramurally-supported research and surveillance. Dur- ing the COVID-19 pandemic, pausing these activities reduces pa- tient care, surveillance, and research staff employment, increasing pandemic losses. In Oyo State, Nigeria, we paused a multi-country invasive salmonellosis surveillance initiative and a rural clinical bac- teriology project. Objective Working with research partners raises health facility con- cerns about SARS-CoV-2 transmission risks and incurs infection pre- vention costs, so we developed and implemented re-opening plans to protect staff and patients and help health facilities deliver care. Methods Our reopening plan included appointing safety and per- sonal protective equipment (PPE) managers from existing project staff cadres, writing new standard operating procedures, implement- ing extensive assessed training, COVID-19 testing for staff, procuring and managing PPE, and providing secondary bacteraemia blood culture support for COVID-19 patients in State isolation facilities. Results Surveillance data showed that the pandemic reduced care access and negatively affected patient unsupervised antibacterial use. The re-opening plan repurposed human and material resources from national and international extramurally-supported programs to mitigate these effects on public health. Conclusions A structured reopening plan restarted care, surveil- lance, and infection prevention and control.
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Affiliation(s)
- Veronica O. Ogunleye
- Severe Typhoid in Africa Project, College of Medicine, Univ. of Ibadan, Nigeria
- Univ. College Hospital, Ibadan, Nigeria
| | | | - Oluwafemi Popoola
- Severe Typhoid in Africa Project, College of Medicine, Univ. of Ibadan, Nigeria
- Univ. College Hospital, Ibadan, Nigeria
- Dept. of Community Medicine, Clinical Sciences, College of Medicine, Univ. of Ibadan, Nigeria
| | - Aderemi Kehinde
- Severe Typhoid in Africa Project, College of Medicine, Univ. of Ibadan, Nigeria
- Univ. College Hospital, Ibadan, Nigeria
| | - Sarah Agbi
- Severe Typhoid in Africa Project, College of Medicine, Univ. of Ibadan, Nigeria
| | - Ifeoluwa Akintayo
- Dept. of Pharmaceutical Microbiology, Pharmacy, Univ. of Ibadan, Nigeria
| | - Ifiok Udofia
- Severe Typhoid in Africa Project, College of Medicine, Univ. of Ibadan, Nigeria
| | - Folasade Bamidele
- Univ. College Hospital, Ibadan, Nigeria
- Infectious Disease Hospital, Ibadan, Nigeria
| | - Temitope Alonge
- Univ. College Hospital, Ibadan, Nigeria
- Oyo State Government, COVID-19 Task Force, Ibadan, Nigeria
- Dept. of Surgery, College of Medicine, Univ. of Ibadan, Nigeria
| | | | - Olukemi Adekanmbi
- Univ. College Hospital, Ibadan, Nigeria
- Dept. of Medicine, College of Medicine, Univ. of Ibadan, Nigeria
| | - Jolaade J. Ajiboye
- Dept. of Pharmaceutical Microbiology, Pharmacy, Univ. of Ibadan, Nigeria
| | - Florian Marks
- International Vaccine Institute Seoul, Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Univ. of Cambridge School of Med., UK
- Madagascr Institute for Vaccine Research, University of Antananarivo, Madagascar
- Institute of Global Health, Univ. of Heidelberg, Germany
| | - Iruka N. Okeke
- Severe Typhoid in Africa Project, College of Medicine, Univ. of Ibadan, Nigeria
- Dept. of Pharmaceutical Microbiology, Pharmacy, Univ. of Ibadan, Nigeria
- Corresponding Author: Iruka N. Okeke, Department of Pharmaceutical Microbiology, Fac-ulty of Pharmacy, University of Ibadan, Nigeria. .
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12
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Arsenault C, Gage A, Kim MK, Kapoor NR, Akweongo P, Amponsah F, Aryal A, Asai D, Awoonor-Williams JK, Ayele W, Bedregal P, Doubova SV, Dulal M, Gadeka DD, Gordon-Strachan G, Mariam DH, Hensman D, Joseph JP, Kaewkamjornchai P, Eshetu MK, Gelaw SK, Kubota S, Leerapan B, Margozzini P, Mebratie AD, Mehata S, Moshabela M, Mthethwa L, Nega A, Oh J, Park S, Passi-Solar Á, Pérez-Cuevas R, Phengsavanh A, Reddy T, Rittiphairoj T, Sapag JC, Thermidor R, Tlou B, Valenzuela Guiñez F, Bauhoff S, Kruk ME. COVID-19 and resilience of healthcare systems in ten countries. Nat Med 2022; 28:1314-1324. [PMID: 35288697 PMCID: PMC9205770 DOI: 10.1038/s41591-022-01750-1] [Citation(s) in RCA: 153] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/17/2022] [Indexed: 02/07/2023]
Abstract
Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People's Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26-96% declines). Total outpatient visits declined by 9-40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA, USA.
| | - Anna Gage
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA, USA
| | - Min Kyung Kim
- Seoul National University College of Medicine, Seoul, South Korea
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA, USA
| | | | - Freddie Amponsah
- Policy, Planning, Monitoring and Evaluation, Ghana Health Services, Accra, Ghana
| | - Amit Aryal
- Office of the Member of Federal Parliament Gagan Kumar Thapa, Kathmandu, Nepal
| | - Daisuke Asai
- World Health Organization, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | | | - Wondimu Ayele
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Paula Bedregal
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Mahesh Dulal
- Office of the Member of Federal Parliament Gagan Kumar Thapa, Kathmandu, Nepal
| | | | | | | | - Dilipkumar Hensman
- World Health Organization, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | - Jean Paul Joseph
- Hôpital Universitaire de Mirebalais, Zanmi Lasante, Arrondissement de Mirebalais, Mirebalais, Haïti
| | | | | | | | - Shogo Kubota
- World Health Organization, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | - Borwornsom Leerapan
- Faculty of Medicine Ramathibodi Hospital, Madidol University, Bangkok, Thailand
| | - Paula Margozzini
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Suresh Mehata
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Londiwe Mthethwa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Adiam Nega
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Juhwan Oh
- Seoul National University College of Medicine, Seoul, South Korea
| | - Sookyung Park
- Korea National Health Insurance Services, Health Insurance Research Institute, Gangwon-do, South Korea
| | - Álvaro Passi-Solar
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Inter-American Development Bank, Kingston, Jamaica
| | - Alongkhone Phengsavanh
- Faculty of Medicine, University of Health Sciences, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | | | - Jaime C Sapag
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roody Thermidor
- Studies and Planning Unit, Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Boikhutso Tlou
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Sebastian Bauhoff
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA, USA
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13
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Impending Backlog of Cleft Palate Patients Due to COVID-19. Ann Glob Health 2022; 88:9. [PMID: 35087709 PMCID: PMC8782091 DOI: 10.5334/aogh.3534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has placed an unprecedented strain on healthcare systems worldwide, but while high-income countries (HICs) have been able to adapt, low- and middle-income countries (LMICs) have been much slower to do so due to a lack of funding, skilled healthcare providers, equipment, and facilities. The redistribution of resources to combat the pandemic in LMICs has resulted in decreased surgical volumes at local surgical centers as well as a dramatic reduction in the number of humanitarian aid missions. Despite recent global investment in improving the surgical capacities of LMICs, even in the pre-COVID-19 era there was a vast unmet surgical need. This deficit in surgical capacity has grown during the pandemic and it will be a significant struggle to overcome the resulting backlog of patients. A topic of particular concern to the authors is the effect that the pandemic will have on the delivery of time-sensitive surgical care to patients with cleft palate deformities as delay in providing care can have enormous physical and psychosocial consequences. This paper draws increased attention to the lasting impact that the COVID-19 pandemic may have on cleft palate patients in LMICs. SSRN Pre-print server link: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3898055
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15
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Wambua S, Malla L, Mbevi G, Nwosu AP, Tuti T, Paton C, Cheburet S, Manya A, English M, Okiro EA. The indirect impact of COVID-19 pandemic on inpatient admissions in 204 Kenyan hospitals: An interrupted time series analysis. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000029. [PMID: 36962093 PMCID: PMC10021711 DOI: 10.1371/journal.pgph.0000029] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/25/2021] [Indexed: 11/19/2022]
Abstract
The first case of severe acute respiratory coronavirus 2 (SARS-CoV-2) was identified in March 2020 in Kenya resulting in the implementation of public health measures (PHM) to prevent large-scale epidemics. We aimed to quantify the impact of COVID-19 confinement measures on access to inpatient services using data from 204 Kenyan hospitals. Data on monthly admissions and deliveries from the District Health Information Software version 2 (DHIS 2) were extracted for the period January 2018 to March 2021 stratified by hospital ownership (public or private) and adjusting for missing data using multiple imputation (MI). We used the COVID-19 event as a natural experiment to examine the impact of COVID-19 and associated PHM on use of health services by hospital ownership. We estimated the impact of COVID-19 using two approaches; Statistical process control (SPC) charts to visualize and detect changes and Interrupted time series (ITS) analysis using negative-binomial segmented regression models to quantify the changes after March 2020. Sensitivity analysis was undertaken to test robustness of estimates using Generalised Estimating Equations (GEE) and impact of national health workers strike on observed trends. SPC charts showed reductions in most inpatient services starting April 2020. ITS modelling showed significant drops in April 2020 in monthly volumes of live-births (11%), over-fives admissions for medical (29%) and surgical care (25%) with the greatest declines in the under-five's admissions (59%) in public hospitals. Similar declines were apparent in private hospitals. Health worker strikes had a significant impact on post-COVID-19 trends for total deliveries, live-births and caesarean section rate in private hospitals. COVID-19 has disrupted utilization of inpatient services in Kenyan hospitals. This might have increased avoidable morbidity and mortality due to non-COVID-19-related illnesses. The declines have been sustained. Recent data suggests a reversal in trends with services appearing to be going back to pre- COVID levels.
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Affiliation(s)
- Steven Wambua
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Lucas Malla
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - George Mbevi
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Amen-Patrick Nwosu
- Oxford Centre for Global Health Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Timothy Tuti
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Chris Paton
- Oxford Centre for Global Health Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Oxford Centre for Global Health Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Emelda A. Okiro
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Oxford Centre for Global Health Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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16
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Piersa AP, Tung A, Dutton RP, Shahul S, Glick DB. December Is Coming: A Time Trend Analysis of Monthly Variation in Adult Elective Anesthesia Caseload across Florida and Texas Locations of a Large Multistate Practice. Anesthesiology 2021; 135:804-812. [PMID: 34525169 DOI: 10.1097/aln.0000000000003959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Anesthesia staffing models rely on predictable surgical case volumes. Previous studies have found no relationship between month of the year and surgical volume. However, seasonal events and greater use of high-deductible health insurance plans may cause U.S. patients to schedule elective surgery later in the calendar year. The hypothesis was that elective anesthesia caseloads would be higher in December than in other months. METHODS This review analyzed yearly adult case data in Florida and Texas locations of a multistate anesthesia practice from 2017 to 2019. To focus on elective caseload, the study excluded obstetric, weekend, and holiday cases. Time trend decomposition analysis was used with seasonal variation to assess differences between December and other months in daily caseload and their relationship to age and insurance subgroups. RESULTS A total of 3,504,394 adult cases were included in the analyses. Overall, daily caseloads increased by 2.5 ± 0.1 cases per day across the 3-yr data set. After adjusting for time trends, the average daily December caseload in 2017 was 5,039 cases (95% CI, 4,900 to 5,177), a 20% increase over the January-to-November baseline (4,196 cases; 95% CI, 4,158 to 4,235; P < 0.0001). This increase was replicated in 2018: 5,567 cases in December (95% CI, 5,434 to 5,700) versus 4,589 cases at baseline (95% CI, 4,538 to 4,641), a 21.3% increase; and in 2019: 6,103 cases in December (95% CI, 5,871 to 6,334) versus 5,045 cases at baseline (95% CI, 4,984 to 5,107), a 21% increase (both P < 0.001). The proportion of commercially insured patients and those aged 18 to 64 yr was also higher in December than in other months. CONCLUSIONS In this 3-yr retrospective analysis, it was observed that, after accounting for time trends, elective anesthesia caseloads were higher in December than in other months of the year. Proportions of commercially insured and younger patients were also higher in December. When compared to previous studies finding no increase, this pattern suggests a recent shift in elective surgical scheduling behavior. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Anastasia Pozdnyakova Piersa
- From the University of Chicago Pritzker School of Medicine and Booth School of Business, Chicago, Illinois; Current Position: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Avery Tung
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
| | | | - Sajid Shahul
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
| | - David B Glick
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
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17
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Tomczyk S, Taylor A, Brown A, de Kraker MEA, El-Saed A, Alshamrani M, Hendriksen RS, Jacob M, Löfmark S, Perovic O, Shetty N, Sievert D, Smith R, Stelling J, Thakur S, Vietor AC, Eckmanns T. Impact of the COVID-19 pandemic on the surveillance, prevention and control of antimicrobial resistance: a global survey. J Antimicrob Chemother 2021; 76:3045-3058. [PMID: 34473285 PMCID: PMC8499888 DOI: 10.1093/jac/dkab300] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has had a substantial impact on health systems. The WHO Antimicrobial Resistance (AMR) Surveillance and Quality Assessment Collaborating Centres Network conducted a survey to assess the effects of COVID-19 on AMR surveillance, prevention and control. METHODS From October to December 2020, WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) national focal points completed a questionnaire, including Likert scales and open-ended questions. Data were descriptively analysed, income/regional differences were assessed and free-text questions were thematically analysed. RESULTS Seventy-three countries across income levels participated. During the COVID-19 pandemic, 67% reported limited ability to work with AMR partnerships; decreases in funding were frequently reported by low- and middle-income countries (LMICs; P < 0.01). Reduced availability of nursing, medical and public health staff for AMR was reported by 71%, 69% and 64%, respectively, whereas 67% reported stable cleaning staff availability. The majority (58%) reported reduced reagents/consumables, particularly LMICs (P < 0.01). Decreased numbers of cultures, elective procedures, chronically ill admissions and outpatients and increased ICU admissions reported could bias AMR data. Reported overall infection prevention and control (IPC) improvement could decrease AMR rates, whereas increases in selected inappropriate IPC practices and antimicrobial prescribing could increase rates. Most did not yet have complete data on changing AMR rates due to COVID-19. CONCLUSIONS This was the first survey to explore the global impact of COVID-19 on AMR among GLASS countries. Responses highlight important actions to help ensure that AMR remains a global health priority, including engaging with GLASS to facilitate reliable AMR surveillance data, seizing the opportunity to develop more sustainable IPC programmes, promoting integrated antibiotic stewardship guidance, leveraging increased laboratory capabilities and other system-strengthening efforts.
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Affiliation(s)
- Sara Tomczyk
- Robert Koch Institute, WHO Collaborating Center for Emerging Infections and Biological Threats, Berlin, Germany
| | - Angelina Taylor
- Robert Koch Institute, WHO Collaborating Center for Emerging Infections and Biological Threats, Berlin, Germany
| | - Allison Brown
- Centers for Disease Control and Prevention, WHO Collaborating Centre for International Monitoring of Bacterial Resistance to Antimicrobial Agents, Atlanta, GA, USA
| | - Marlieke E A de Kraker
- Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety, Geneva, Switzerland
| | - Aiman El-Saed
- King Abdulaziz Medical City, WHO Collaborating Centre for Infection Prevention and Control and Anti-Microbial, Riyadh, Saudi Arabia
| | - Majid Alshamrani
- King Abdulaziz Medical City, WHO Collaborating Centre for Infection Prevention and Control and Anti-Microbial, Riyadh, Saudi Arabia
| | - Rene S Hendriksen
- Technical University of Denmark, National Food Institute, WHO Collaborating Centre for Antimicrobial Resistance in Foodborne Pathogens and Genomics, Kongens Lyngby, Denmark
| | - Megan Jacob
- College of Veterinary Medicine, North Carolina State University, WHO Collaborating Centre for Global One Health and Antimicrobial Resistance Initiatives, Raleigh, NC, USA
| | - Sonja Löfmark
- Public Health Agency of Sweden, WHO Collaborating Centre for Antimicrobial Resistance Containment, Stockholm, Sweden
| | - Olga Perovic
- National Institute for Communicable Diseases and School of Pathology at University of Witwatersrand, WHO Collaborating Centre for Antimicrobial Resistance, Johannesburg, South Africa
| | - Nandini Shetty
- National Infection Service Laboratories, Public Health England, WHO Collaborating Centre for Reference & Research on Antimicrobial Resistance and Healthcare Associated Infections, London, UK
| | - Dawn Sievert
- Centers for Disease Control and Prevention, WHO Collaborating Centre for International Monitoring of Bacterial Resistance to Antimicrobial Agents, Atlanta, GA, USA
| | - Rachel Smith
- Centers for Disease Control and Prevention, WHO Collaborating Centre for International Monitoring of Bacterial Resistance to Antimicrobial Agents, Atlanta, GA, USA
| | - John Stelling
- Brigham and Women’s Hospital, WHO Collaborating Centre for Surveillance of Antimicrobial Resistance, Boston, MA, USA
| | - Siddhartha Thakur
- College of Veterinary Medicine, North Carolina State University, WHO Collaborating Centre for Global One Health and Antimicrobial Resistance Initiatives, Raleigh, NC, USA
| | - Ann Christin Vietor
- Robert Koch Institute, WHO Collaborating Center for Emerging Infections and Biological Threats, Berlin, Germany
| | - Tim Eckmanns
- Robert Koch Institute, WHO Collaborating Center for Emerging Infections and Biological Threats, Berlin, Germany
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SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study. Br J Surg 2021; 108:1056-1063. [PMID: 33761533 PMCID: PMC7995808 DOI: 10.1093/bjs/znab101] [Citation(s) in RCA: 163] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. METHODS The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. RESULTS NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. CONCLUSION As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.
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Lv H, Li B, Deng J, Ye L, Gao W, Shu CM, Bi M. SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study. Br J Surg 2021; 108:1056-1063. [PMID: 33761533 DOI: 10.1016/j.energy.2021.121093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 05/24/2023]
Abstract
BACKGROUND Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. METHODS The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. RESULTS NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. CONCLUSION As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.
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Gisondi P, Cazzaniga S, Di Leo S, Piaserico S, Bellinato F, Pizzolato M, Gatti A, Eccher A, Brunelli M, Saraggi D, Girolomoni G, Naldi L. Impact of the COVID-19 pandemic on melanoma diagnosis. J Eur Acad Dermatol Venereol 2021; 35:e714-e715. [PMID: 34236721 PMCID: PMC8447457 DOI: 10.1111/jdv.17493] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- P Gisondi
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - S Cazzaniga
- Centro Studi GISED, Bergamo, Italy.,Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
| | - S Di Leo
- Division of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - S Piaserico
- Department of Medicine, Section of Dermatology, University of Padua, Padua, Italy
| | - F Bellinato
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - M Pizzolato
- Division of Dermatology, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | - A Gatti
- Division of Dermatology, Ospedale Ca' Foncello di Treviso, Treviso, Italy
| | - A Eccher
- Department of Pathology and Diagnostics, Section of Pathology, University Hospital of Verona, Verona, Italy
| | - M Brunelli
- Department of Pathology and Diagnostics, Section of Pathology, University Hospital of Verona, Verona, Italy
| | - D Saraggi
- Division of Pathology, San Bortolo Hospital, Vicenza, Italy
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - L Naldi
- Centro Studi GISED, Bergamo, Italy.,Division of Dermatology, San Bortolo Hospital, Vicenza, Italy
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21
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Moll V, Mariano ER, Kitzman JM, O'Reilly-Shah VN, Jabaley CS. Regional anesthesia educational material utilization varies by World Bank income category: A mobile health application data study. PLoS One 2021; 16:e0244860. [PMID: 33524031 PMCID: PMC7850494 DOI: 10.1371/journal.pone.0244860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Regional anesthesia offers an alternative to general anesthesia and may be advantageous in low resource environments. There is a paucity of data regarding the practice of regional anesthesia in low- and middle-income countries. Using access data from a free Android app with curated regional anesthesia learning modules, we aimed to estimate global interest in regional anesthesia and potential applications to clinical practice stratified by World Bank income level. METHODS We retrospectively analyzed data collected from the free Android app "Anesthesiologist" from December 2015 to April 2020. The app performs basic anesthetic calculations and provides links to videos on performing 12 different nerve blocks. Users of the app were classified on the basis of whether or not they had accessed the links. Nerve blocks were also classified according to major use (surgical block, postoperative pain adjunct, rescue block). RESULTS Practitioners in low- and middle-income countries accessed the app more frequently than in high-income countries as measured by clicks. Users from low- and middle-income countries focused mainly on surgical blocks: ankle, axillary, infraclavicular, interscalene, and supraclavicular blocks. In high-income countries, more users viewed postoperative pain blocks: adductor canal, popliteal, femoral, and transverse abdominis plane blocks. Utilization of the app was constant over time with a general decline with the start of the COVID-19 pandemic. CONCLUSION The use of an in app survey and analytics can help identify gaps and opportunities for regional anesthesia techniques and practices. This is especially impactful in limited-resource areas, such as lower-income environments and can lead to targeted educational initiatives.
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Affiliation(s)
- Vanessa Moll
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Edward R. Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States of America
| | - Jamie M. Kitzman
- Department of Pediatric Anesthesiology, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Vikas N. O'Reilly-Shah
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, United States of America
| | - Craig S. Jabaley
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
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22
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Affiliation(s)
- Dominique L Monnet
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Stephan Harbarth
- Infection Control Program and Division of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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