• Patient clinical documentation in telehealth environment: are we collecting appropriate and sufficient information for best practice?

      Houser, Shannon H.; Flite, Cathy A.; Foster, Susan L.; Hunt, Thomas J.; Morey, Angela; Palmer, Miland N.; Peterson, Jennifer; Pope, Roberta Darnez; Sorenson, Linda (2022-01-20)
      Background: During the COVID-19 pandemic, the use of telehealth for patient visits grew rapidly and served an important role as a valuable and necessary resource. Although clinical documentation is critical for telehealth patient visits, there is limited information about how healthcare facilities manage telehealth patient visit documentation, technology used for telehealth visits, and challenges encountered with telehealth patient visit documentation. This study aimed to assess the use of telehealth during the pandemic, the quality of clinical documentation in telehealth practice and to identify challenges and issues encountered with telehealth patient visits in order to develop a strategy for best practices for telehealth documentation and data management. Methods: Data were collected for this cross-sectional study in January-February 2021 via a self-designed survey of administrators/managers from physicians’ offices and mental health facilities. Survey questions included four categories: health organization demographic information; telehealth visits; clinical documentation for telehealth visit; and challenges and barriers related to telehealth documentation technology use. Results: Of 76 respondents, more than half (62%) of the healthcare facilities started using telehealth for patient visits within one year of the onset of the COVID-19 pandemic, with 94% of respondents indicating an increased use of telehealth for patient visits since the pandemic. The most common types of telehealth patient care provided during the pandemic included pediatrics, primary care, cardiology, and women’s health. The most consistent data documentation of telehealth visits included: date of service, patient identification number, communication methods, patient informed consent, diagnosis and impression, evaluation results, and recommendations. The telehealth visit data was most commonly used for patient care and clinical practice, billing and reimbursement, quality improvement and patient satisfaction, and administrative planning. The top barriers to telehealth use by the healthcare professionals included patient challenges with telehealth services, such as inequities in quality of technology, lack of patient understanding, and lack of patient satisfaction; this was followed by frustration with constant updates of telehealth guidelines and procedures, understanding required telehealth documentation for reimbursement purposes, payer denial for telehealth visits, and legal and risk issues. Conclusions: Findings from this study can assist government entities, policymakers, and healthcare organizations in developing and advocating best practices in telehealth usage and clinical documentation improvement strategies.
    • Patient Experiences with the Transition to Telephone Counseling during the COVID-19 Pandemic

      Kang, Augustine W.; Walton, Mary; Hoadley, Ariel; DelaCuesta, Courtney; Hurley, Linda; Martin, Rosemarie; Hoadley|0000-0003-1360-0358 (2021-06-02)
      Background: To identify and document the treatment experiences among patients with opioid use disorder (OUD) in the context of the rapid move from in-person to telephone counseling due to the COVID-19 pandemic. Methods: Participants (n = 237) completed a survey with open-ended questions that included the following domains: (1) satisfaction with telephone counseling, (2) perceived convenience, (3) changes to the therapeutic relationship, (4) perceived impact on substance use recovery, and (5) general feedback. Responses were coded using thematic analysis. Codes were subsequently organized into themes and subthemes (covering 98% of responses). Interrater reliability for coding of participants’ responses ranged from 0.89 to 0.95. Results: Overall, patients reported that telephone counseling improved the therapeutic experience. Specifically, 74% of respondents were coded as providing responses consistently indicating “positive valency”. “Positive valency” responses include: (1) feeling supported, (2) greater comfort and privacy, (3) increased access to counselors, and (4) resolved transportation barriers. Conversely, “negative valency” responses include: (1) impersonal experience and (2) reduced privacy. Conclusions: Telephone counseling presents its own set of challenges that should be investigated further to improve the quality of care and long-term patient outcomes.
    • Perspectives on Humanizing and Liberatory Qualitative Research with Racially/Ethnically Minoritized Youth

      Savage, Shawn S.; Johnson, Royel M.; Kenney, Alex J.; Haynes, DaVonti' D. (2021-10-01)
      The visible impacts of COVID-19 and racial injustice have resulted in renewed funding commitments and research within minoritized communities. However, this work is too often anchored in deficit and damage-centered research approaches and practices. In this brief, we call on the qualitative research community to reframe their perspectives and terminate harmful, pain-driven research. We underscore the importance of humanizing and liberatory approaches to research with youth who are racially/ethnically minoritized. Specifically, we contend that the emotional health and overall well-being of youth are impacted by the approaches employed by researchers and the experiences racially/ethnically minoritized youth have with research. Thus, we offer specific anti-oppressive strategies and recommendations for qualitative researchers to consider in their work with racial/ethnically minoritized youth and communities.
    • Physical Activity Levels and Related Energy Expenditure during COVID-19 Quarantine among the Sicilian Active Population: A Cross-Sectional Online Survey Study

      Center for Biotechnology, Sbarro Institute for Cancer Research and Molecular Medicine (Temple University) (2020-05-26)
      Background: During the coronavirus disease 2019 (COVID-19) pandemic, the Italian government has adopted containment measures to control the virus’s spread, including limitations to the practice of physical activity (PA). The aim of this study was to estimate the levels of PA, expressed as energy expenditure (MET–minute/week), among the physically active Sicilian population before and during the last seven days of the COVID-19 quarantine. Furthermore, the relation between this parameter and specific demographic and anthropometric variables was analyzed. Methods: 802 Sicilian physically active participants (mean age: 32.27 ± 12.81 years; BMI: 23.44 ± 3.33 kg/m2) were included in the study and grouped based on gender, age and BMI. An adapted version of the International Physical Activity Questionnaire—short form (IPAQ-SF) was administered to the participants through an online survey. The Wilcoxon signed-rank test and the Kruskal-Wallis rank-sum test were used for statistical analyses. Results: As expected, we observed a significant decrease of the total weekly energy expenditure during the COVID-19 quarantine (p < 0.001). A significant variation in the MET–min/wk in the before quarantine condition (p = 0.046) and in the difference between before and during quarantine (p = 0.009) was found for males and females. The male group decreased the PA level more than the female one. Moreover, a significant difference in the MET–min/wk was found among groups distributions of BMI (p < 0.001, during quarantine) and of age (p < 0.001, both before and during quarantine). In particular, the highest and the lowest levels of PA were reported by the young and the elderly, respectively, both before and during quarantine. Finally, the overweight group showed the lowest level of PA during quarantine. Conclusion: Based on our outcomes, we can determine that the current quarantine has negatively affected the practice of PA, with greater impacts among males and overweight subjects. In regards to different age groups, the young, young adults and adults were more affected than senior adults and the elderly.
    • Pneumothorax bei COVID-19-Erkrankung – Inzidenz und klinische Merkmale

      Zantah, Massa; Dominguez-Castillo, Eduardo; Townsend, Ryan; Dikengil, Fusun; Criner, Gerard J. (2021-02)
      Background: Spontaneous pneumothorax is a rarely occurring complication of viral pneumonia in COVID-19. The exact incidence and risk factors are still unclear. In the present work we examine the incidence and outcomes of more than 3,000 patients with pneumothorax who were admitted to our clinic with suspected COVID-19 pneumonia. METHODS: We retrospectively reviewed the cases of COVID-19 patients admitted to our clinic. To calculate the incidence of this event, patients diagnosed with spontaneous pneumothorax were identified and their clinical features were extensively documented. Clinical outcome data were collected. The individual cases are each presented in the form of a short summary. Results: Between March 1st and March 8th June 2020, 3368 patients with suspected COVID-19 pneumonia were admitted to our clinic; of these, 902 patients had a positive nasopharyngeal smear. Six COVID-19 patients who developed spontaneous pneumothorax were identified (0.66%). Baseline imaging showed diffuse bilateral frosted glass opacities and consolidations in these patients, predominantly in the posterior and peripheral lung regions. Four of the six patients were mechanically ventilated. Chest drainage was required in all patients. In all cases there was no direct relationship between the pneumothorax and mortality (66.6%). Conclusion: Spontaneous pneumothorax is a rare complication of viral pneumonia in COVID-19 that can occur without mechanical ventilation.
    • Pneumothorax in COVID-19 disease- incidence and clinical characteristics

      Zantah, Massa; Dominguez Castillo, Eduardo; Townsend, Ryan; Dikengil, Fusun; Criner, Gerard J.; 0000-0002-3030-6639; 0000-0002-1828-6524 (2020-09-16)
      Background: Spontaneous pneumothorax is an uncommon complication of COVID-19 viral pneumonia. The exact incidence and risk factors are still unknown. Herein we review the incidence and outcomes of pneumothorax in over 3000 patients admitted to our institution for suspected COVID-19 pneumonia. Methods: We performed a retrospective review of COVID-19 cases admitted to our hospital. Patients who were diagnosed with a spontaneous pneumothorax were identified to calculate the incidence of this event. Their clinical characteristics were thoroughly documented. Data regarding their clinical outcomes were gathered. Each case was presented as a brief synopsis. Results: Three thousand three hundred sixty-eight patients were admitted to our institution between March 1st, 2020 and June 8th, 2020 for suspected COVID 19 pneumonia, 902 patients were nasopharyngeal swab positive. Six cases of COVID-19 patients who developed spontaneous pneumothorax were identified (0.66%). Their baseline imaging showed diffuse bilateral ground-glass opacities and consolidations, mostly in the posterior and peripheral lung regions. 4/6 cases were associated with mechanical ventilation. All patients required placement of a chest tube. In all cases, mortality (66.6%) was not directly related to the pneumothorax. Conclusion: Spontaneous pneumothorax is a rare complication of COVID-19 viral pneumonia and may occur in the absence of mechanical ventilation. Clinicians should be vigilant about the diagnosis and treatment of this complication.
    • Policing and public health calls for service in Philadelphia

      Ratcliffe, Jerry; Ratcliffe|0000-0002-0730-6761 (2021-03-02)
      This contribution outlines various spatial and temporal aspects of medical or public-health related calls for service from the public to police in Philadelphia in 2019. These incidents comprise about 8% of the police department’s workload that originates from the public. Calls appear to be highly concentrated in a few areas, and specifically the Center City and Kensington neighborhoods. They are also more likely to occur late afternoon and evening. The article shows that some medical or public health activity initially masquerades as crime or other policing work and some events eventually determined to be police/crime activity can initially appear to be public health related. About 20% of activity in this area does not appear predictable from the initial call type as handled by police dispatch.
    • Population health science as a unifying foundation for translational clinical and public health research

      Cullen, Mark R.; Baiocchi, Michael; Chamberlain, Lisa; Chu, Isabella; Horwitz, Ralph I.; Mello, Michelle; O'Hara, Amy; Roosz, Sam (2022-03-01)
      Separated both in academics and practice since the Rockefeller Foundation effort to “liberate” public health from perceived subservience to clinical medicine a century ago, research in public health and clinical medicine have evolved separately. Today, translational research in population health science offers a means of fostering their convergence, with potentially great benefit to both domains. Although evidence that the two fields need not and should not be entirely distinct in their methods and goals has been accumulating for over a decade, the prodigious efforts of biomedical and social sciences over the past year to address the COVID-19 pandemic has placed this unifying approach to translational research in both fields in a new light. Specifically, the coalescence of clinical and population-level strategies to control disease and novel uses of population-level data and tools in research relating to the pandemic have illuminated a promising future for translational research. We exploit this unique window to re-examine how translational research is conducted and where it may be going. We first discuss the transformation that has transpired in the research firmament over the past two decades and the opportunities these changes afford. Next, we present some of the challenges—technical, cultural, legal, and ethical— that need attention if these opportunities are to be successfully exploited. Finally, we present some recommendations for addressing these challenges.
    • Predicting the mutational drivers of future SARS-CoV-2 variants of concern

      Institute for Genomics and Evolutionary Medicine (iGEM) (Temple University) (2021-06-22)
      SARS-CoV-2 evolution threatens vaccine- and natural infection-derived immunity, and the efficacy of therapeutic antibodies. Herein we sought to predict Spike amino acid changes that could contribute to future variants of concern. We tested the importance of features comprising epidemiology, evolution, immunology, and neural network-based protein sequence modeling. This resulted in identification of the primary biological drivers of SARS-CoV-2 intra-pandemic evolution. We found evidence that resistance to population-level host immunity has increasingly shaped SARS-CoV-2 evolution over time. We identified with high accuracy mutations that will spread, at up to four months in advance, across different phases of the pandemic. Behavior of the model was consistent with a plausible causal structure wherein epidemiological variables integrate the effects of diverse and shifting drivers of viral fitness. We applied our model to forecast mutations that will spread in the future, and characterize how these mutations affect the binding of therapeutic antibodies. These findings demonstrate that it is possible to forecast the driver mutations that could appear in emerging SARS-CoV-2 variants of concern. This modeling approach may be applied to any pathogen with genomic surveillance data, and so may address other rapidly evolving pathogens such as influenza, and unknown future pandemic viruses.
    • Preliminary predictive criteria for COVID-19 cytokine storm

      COVID-19 Research Group (Temple University) (2020-09-25)
      Objectives: To develop predictive criteria for COVID-19-associated cytokine storm (CS), a severe hyperimmune response that results in organ damage in some patients infected with COVID-19. We hypothesised that criteria for inflammation and cell death would predict this type of CS. Methods: We analysed 513 hospitalised patients who were positive for COVID-19 reverse transcriptase PCR and for ground-glass opacity by chest high-resolution CT. To achieve an early diagnosis, we analysed the laboratory results of the first 7 days of hospitalisation. We implemented logistic regression and principal component analysis to determine the redictive criteria. We used a ’genetic algorithm’ to derive the cut-offs for each laboratory result. We validated the criteria with a second cohort of 258 patients. Results: We found that the criteria for macrophage activation syndrome, haemophagocytic lymphohistiocytosis and the HScore did not identify the COVID-19 cytokine storm (COVID-CS). We developed new predictive criteria, with sensitivity and specificity of 0.85 and 0.80, respectively, comprising three clusters of laboratory results that involve (1) inflammation, (2) cell death and tissue damage, and (3) prerenal electrolyte imbalance. The criteria identified patients with longer hospitalisation and increased mortality. These results highlight the relevance of hyperinflammation and tissue damage in the COVID-CS. Conclusions: We propose new early predictive criteria to identify the CS occurring in patients with COVID-19. The criteria can be readily used in clinical practice to determine the need for an early therapeutic regimen,block the hyperimmune response and possibly decrease mortality.
    • Preschoolers Benefit Equally From Video Chat, Pseudo-Contingent Video, and Live Book Reading: Implications for Storytime During the Coronavirus Pandemic and Beyond

      Gaudreau, Caroline; King, Yemimah A.; Dore, Rebecca A.; Puttre, Hannah; Nichols, Deborah; Hirsh-Pasek, Kathy; Golinkoff, Roberta Michnick; 0000-0003-2947-4544 (2020-09-03)
      During the unprecedented coronavirus disease (COVID-19) crisis, virtual education activities have become more prevalent than ever. One activity that many families have incorporated into their routines while at home is virtual storytime, with teachers, grandparents, and other remote adults reading books to children over video chat. The current study asks how dialogic reading over video chat compares to more traditional forms of book reading in promoting story comprehension and vocabulary learning. Fifty-eight 4-year-olds (Mage = 52.7, SD = 4.04, 31 girls) were randomly assigned to one of three conditions (Video chat, Live, and Prerecorded). Across conditions, children were read the same narrative storybook by a female experimenter who used the same 10 scripted dialogic reading prompts during book reading. In the Video chat (n = 21) and Live conditions (n = 18), the experimenter gave the scripted prompts and interacted naturally and contingently, responding in a timely, relevant manner to children’s behaviors. In the Prerecorded condition (n = 19), children viewed a video of an experimenter reading the book. The Prerecorded condition was pseudo-contingent; the reader posed questions and paused for a set period of time as if to wait for a child’s response. After reading, children completed measures of vocabulary and comprehension. Results revealed no differences between conditions across six different outcome measures, suggesting that children comprehended and learned from the story similarly across book formats. Further, children in the three experimental conditions scored significantly higher on measures than children in a fourth condition (control) who had never read the book, confirming that children learned from the three different book formats. However, children were more responsive to the prompts in the Live and Video chat conditions than the Prerecorded condition, suggesting that children recognized that these interactions were contingent with their responses, a feature that was lacking in the Prerecorded condition. Results indicate that children can comprehend books over video chat, suggesting that this technology is a viable option for reading to children, especially during the current pandemic.
    • Profiles of Social Distance Compliance: Psychological and Situational Predictors of Risky Behavior during COVID-19

      Haupt, Michael Robert; Meredith Weiss, Staci; Chiu, Michelle; Cuomo, Raphael; Chein, Jason; Mackey, Tim; 0000-0002-9178-6680; 0000-0002-8430-7899 (2020-06-05)
      The purpose of this study was to explore the factors underlying variability in compliance with CDC guidelines in response to the novel coronavirus, or COVID-19. To do this, we examined the frequency of once ordinary, but newly risky behavior (as deemed by CDC guidelines) in a sample of 482 MTurkers. We ran analyses probing the situational and dispositional variables that predicted variance in risky behavior using data-driven and hypothesis-generated approaches. We found situational and dispositional variables contributed unique variance to risky behavior, controlling for variability accounted for by demographic factors. More frequent report of risky activity was associated with higher extraversion, need for cognitive closure, behavior activation, and perceived resource scarcity; in contrast, more frequent report of risky activity was associated with less empathy and living space access, as well as younger age. To break down these findings, we used a cluster analysis to profile individuals, using only situational and dispositional variables belonging to seven clusters. Combined with testing differences in risk taking by cluster identity, we suggest this profile approach might allow consideration of multi-faceted attributes that influence adherence with public health guidance in the context of health emergencies like the COVID-19 pandemic.
    • Progress for Journal of Functional Morphology and Kinesiology in 2020

      Sbarro Institute for Cancer Research and Molecular Medicine (Temple University) (2021-01-22)
    • Prospective arrhythmia surveillance after a COVID-19 diagnosis

      Dewland, Thomas A.; Whitman, Isaac R.; Win, Sithu; Sanchez, Jose M.; Olgin, Jeffrey E.; Pletcher, Mark J.; Santhosh, Lekshmi; Kumar, Uday; Joyce, Sean; Yang, Vivian; Hwang, Janet; Ogomori, Kelsey; Peyser, Noah; Horner, Cathy; Wen, David; Butcher, Xochitl; Marcus, Gregory M. (2022-01-20)
      Background: Cardiac arrhythmias have been observed among patients hospitalised with acute COVID-19 infection, and palpitations remain a common symptom among the much larger outpatient population of COVID-19 survivors in the convalescent stage of the disease.Objective: To determine arrhythmia prevalence among outpatients after a COVID-19 diagnosis. Methods: Adults with a positive COVID-19 test and without a history of arrhythmia were prospectively evaluated with 14-day ambulatory electrocardiographic monitoring. Participants were instructed to trigger the monitor for palpitations. Results: A total of 51 individuals (mean age 42±11 years, 65% women) underwent monitoring at a median 75 (IQR 34–126) days after a positive COVID-19 test. Median monitoring duration was 13.2 (IQR 10.5–13.8) days. No participant demonstrated atrial fibrillation, atrial flutter, sustained supraventricular tachycardia (SVT), sustained ventricular tachycardia or infranodal atrioventricular block. Nearly all participants (96%) had an ectopic burden of <1%; one participant had a 2.8% supraventricular ectopic burden and one had a 15.4% ventricular ectopic burden. While 47 (92%) participants triggered their monitor for palpitation symptoms, 78% of these triggers were for either sinus rhythm or sinus tachycardia. Conclusions: We did not find evidence of malignant or sustained arrhythmias in outpatients after a positive COVID-19 diagnosis. While palpitations were common, symptoms frequently corresponded to sinus rhythm/sinus tachycardia or non-malignant arrhythmias such as isolated ectopy or non-sustained SVT. While these findings cannot exclude the possibility of serious arrhythmias in select individuals, they do not support a strong or widespread proarrhythmic effect of COVID-19 infection after resolution of acute illness.
    • Protection of Hamsters Challenged with SARS-CoV-2 after Two Doses of MVC-COV1901 Vaccine Followed by a Single Intranasal Booster with Nanoemulsion Adjuvanted S-2P Vaccine

      Lin, Yi-Jiun; Lin, Meei-Yun; Chuang, Ya-Shan; Liu, Luke Tzu-Chi; Kuo, Tsun-Yung; Chen, Charles; Ganesan, Shyamala; Fattom, Ali; Bitko, Vira; Lien, Chia-En (2022-02-26)
      Intramuscular vaccines have greatly reduced hospitalization and death due to severe COVID-19. However, most countries are experiencing a resurgence of infection driven predominantly by the Delta and Omicron variants of SARS-CoV-2. In response, booster dosing of COVID-19 vaccines has been implemented in many countries to address waning immunity and reduced protection against the variants. However, intramuscular boosting fails to elicit mucosal immunity and therefore does not solve the problem of persistent viral carriage and transmission, even in patients protected from severe disease. In this study, two doses of stabilized prefusion SARS-CoV-2 spike (S-2P)-based intramuscular vaccine adjuvanted with Alum/CpG1018, MVC-COV1901, were used as a primary vaccination series, followed by an intranasal booster vaccination with nanoemulsion (NE01)-adjuvanted S-2P vaccine in a hamster model to demonstrate immunogenicity and protection from viral challenge. Here we report that this vaccination regimen resulted not only in the induction of robust immunity and protection against weight loss and lung pathology following challenge with SARS-CoV-2, but also led to increased viral clearance from both upper and lower respiratory tracts. Our findings showed that intramuscular MVC-COV1901 vaccine followed by a booster with intranasal NE01-adjuvanted vaccine promotes protective immunity against both viral infection and disease, suggesting that this immunization protocol may offer a solution in addressing a significant, unmet medical need for both the COVID-19 and future pandemics.
    • Protection of Hamsters Challenged with SARS-CoV-2 Variants of Concern by Two Doses of MVC-COV1901 Vaccine Followed by a Single Dose of Beta Variant Version of MVC-COV1901

      Kuo, Tsun-Yung; Lien, Chia-En; Lin, Yi-Jiun; Lin, Meei-Yun; Wu, Chung-Chin; Tang, Wei-Hsuan; Campbell, John D.; Traquina, Paula; Chuang, Ya-Shan; Liu, Luke Tzu-Chi; Cheng, Jinyi; Chen, Charles (2022-01-06)
      The current fight against COVID-19 is compounded by the Variants of Concern (VoCs), which can diminish the effectiveness of vaccines and potentially increase viral transmission and severity of disease. MVC-COV1901 is a protein subunit vaccine based on the prefusion SARS-CoV-2 spike protein (S-2P) and is adjuvanted with CpG 1018 and aluminum hydroxide. In this study, we used the Delta variant to challenge hamsters inoculated with S-2P from the Wuhan wildtype and the Beta variant in two-dose or three-dose regimens. Two doses of wildtype S-2P followed by the third dose of Beta variant was shown to induce the highest neutralizing antibody titer against live SARS-CoV-2 of the wildtype and all current VoCs, as well as improved neutralization against Omicron variant pseudovirus compared to three doses of wildtype S-P. All regimens of vaccination were able to protect hamsters from SARS-CoV-2 Delta variant challenge and resulted in reduced lung live virus titer and pathology. Three doses of vaccination also significantly reduced lung viral RNA titer, regardless of whether the wildtype or Beta variant S-2P was used as the third dose. Based on the immunogenicity and viral challenge data, two doses of wildtype S-2P followed by the third dose of Beta variant S-2P induced potent antibody immune responses against the VoCs.
    • Providing Opportunities for Meaningful Activities for Covid-19 Patients: A Community Response

      Knowles, Emily; O'Donnell, Casey; Lynch, Amy; Snethen, Gretchen; Snethen|0000-0002-0721-3661 (2020-12-22)
      Context: Patients hospitalized for Covid-19 are at high risk for experiencing isolation, boredom, anxiety, and depression. These psychosocial issues can contribute to poorer health outcomes. Objective: The purpose of this project was to bridge the gap between patient needs and available resources: bringing supplies to the patients, such that they could participate in meaningful activities in the isolation of their rooms, with hopes of mitigating aspects of loneliness and boredom. Case Report: This case study describes the activities of the occupational and recreational therapy academic programs initiated in order to resource supplies from the community in response to a request from the hospital. A carload of technology and non-technology activity resources were delivered to the hospital and distributed to patients. A treating physician provided an overview of the patient response. Patient Experience: Staff reported fewer complaints of isolation and boredom following the delivery of resources. This also increased staff morale. Conclusion: Providing resources patients can independently utilize may reduce feelings of isolation and boredom, which may improve health outcomes.
    • Providing Quality of Care in Fragile and Vulnerable Settings: Lessons from South Sudan

      Gianaris, Kevin; Atem, Jacob; Chen, Allison P.; Chang, Alexander; Russell, Anna; Hsu, Edbert B.; Chang|0000-0002-5104-2468 (2021-12-22)
      Background: In 2020, the World Health Organization (WHO) released a report concerning planning and actions to provide quality of care in fragile, conflict-affected, and vulnerable areas. South Sudan, the world’s newest country, has encountered both natural and man-made disasters in recent years that have posed marked challenges to delivery of care. The Southern Sudan Healthcare Organization (SSHCO) operates as a non-governmental organization (NGO) in this setting, delivering and improving healthcare through war, flooding, and infectious outbreaks. Objective: The goal of this paper is to highlight the challenges faced in providing care in South Sudan from an NGO perspective and apply the recent WHO guidelines on quality of care to optimize practical implementation. Method: Each of the WHO’s eight elements for quality of care in South Sudan were examined in relation to the experience of SSHCO from 2013–2021. Analysis included: 1. summary of the WHO element; 2. examples of successful implementation; 3. barriers to implementation; and 4. recommendations to improve implementation. Findings: The team found that communication and coordination were the most important aspects of improving quality of care in South Sudan. These should be prioritized and include intergovernmental partners, the local and national Ministry of Health (MOH), NGOs, and community stakeholders. Communication and coordination should foster community engagement, improved data collecting and reporting, and sharing of publicly accessible information. Better clinical staff training and governance are also required to ensure the most effective use of limited resources. Conclusion: South Sudan faces many barriers to quality of care with communication and coordination identified among the foremost issues. Practical application of the WHO elements of quality of care can assist NGOs in effectively identifying areas for improvement to deliver better quality essential health services.
    • QAIS-DSNN: Tumor Area Segmentation of MRI Image with Optimized Quantum Matched-Filter Technique and Deep Spiking Neural Network

      Ahmadi, Mohsen; Sharifi, Abbas; Hassantabar, Shayan; Enayati, Saman (2021-01-21)
      Tumor segmentation in brain MRI images is a noted process that can make the tumor easier to diagnose and lead to effective radiotherapy planning. Providing and building intelligent medical systems can be considered as an aid for physicians. In many cases, the presented methods’ reliability is at a high level, and such systems are used directly. In recent decades, several methods of segmentation of various images, such as MRI, CT, and PET, have been proposed for brain tumors. Advanced brain tumor segmentation has been a challenging issue in the scientific community. The reason for this is the existence of various tumor dimensions with disproportionate boundaries in medical imaging. This research provides an optimized MRI segmentation method to diagnose tumors. It first offers a preprocessing approach to reduce noise with a new method called Quantum Matched-Filter Technique (QMFT). Then, the deep spiking neural network (DSNN) is implemented for segmentation using the conditional random field structure. However, a new algorithm called the Quantum Artificial Immune System (QAIS) is used in its SoftMax layer due to its slowness and nonsegmentation and the identification of suitable features for selection and extraction. The proposed approach, called QAIS-DSNN, has a high ability to segment and distinguish brain tumors from MRI images. The simulation results using the BraTS2018 dataset show that the accuracy of the proposed approach is 98.21%, average error-squared rate is 0.006, signal-to-noise ratio is 97.79 dB, and lesion structure criteria including the tumor nucleus are 80.15%. The improved tumor is 74.50%, and the entire tumor is 91.92%, which shows a functional advantage over similar previous methods. Also, the execution time of this method is 2.58 seconds.
    • Rapid Adoption of Telemedicine in Rheumatology Care During the COVID-19 Pandemic Highlights Training and Supervision Concerns Among Rheumatology Trainees

      The Global Rheumatology Alliance (2021-11-17)
      Objective: To evaluate the impact of telemedicine use during the coronavirus disease 2019 (COVID-19) pandemic on rheumatology trainees. Methods: A voluntary, anonymous, web-based survey was administered in English, Spanish, or French from August 19 to October 5, 2020. Adult and pediatric rheumatology trainees were invited to participate via social media and email. Using multiple-choice questions and Likert scales, the survey assessed prior and current telemedicine use, impact on training, and supervision after COVID-19 prompted rapid telemedicine implementation. Results: Surveys were received from 302 trainees from 33 countries, with 83% in adult rheumatology training programs. Reported telemedicine use increased from 13% before the pandemic to 82% during the pandemic. United States trainees predominantly used video visits, whereas outside the United States telemedicine was predominantly audio only. Most (65%) evaluated new patients using telemedicine. More respondents were comfortable using telemedicine for follow-up patients (69%) than for new patients (25%). Only 39% of respondents reported receiving telemedicine-focused training, including instruction on software, clinical skills, and billing, whereas more than half of United States trainees (59%) had training. Postconsultation verbal discussion was the most frequent form of supervision; 24% reported no supervision. Trainees found that telemedicine negatively impacted supervision (50%) and the quality of clinical teaching received (70%), with only 9% reporting a positive impact. Conclusions: Despite widespread uptake of telemedicine, a low proportion of trainees received telemedicine training, and many lacked comfort in evaluating patients, particularly new patients. Inadequate supervision and clinical teaching were areas of concern. If telemedicine remains in widespread use, ensuring appropriate trainee supervision and teaching should be prioritized.