Airborne

Airborne diseases are spread when droplets containing pathogens, viruses and/or bacteria, are expelled into the air due to coughing, sneezing or talking. These droplets, or aerosols, can remain suspended in the air for quite some time in contained environments. Diseases are also transmitted by close physical contact and by rubbing eyes, mouth and nose after touching a contaminated surface. Radically increased mobility among humans, our treatment of animals and climate changes have increased the frequency of epidemics and the probability that a novel or mutated virus can spread rapidly. With the help of WHO and a high level of international collaboration and transparency, more alarms of pandemic alerts will be heard. The research of this topic begun with news articles about current viral events and the bigger picture; pandemics. This was accompanied by a deeper dive into the world of viruses and airborne diseases by the help of scientific articles. Interviews with experts in the field; a Surgeon, Infectious Disease Specialist, Infection Control Practitioner and a Health Care Hygiene Specialist lead to an understanding of why today’s respiratory masks are not efficient enough and why we are not relying on physical barriers today. The specialists could provide with more scientific articles on the topic of constraints and threats with respirators and also when and where the risks of transmission occurs. Microorganisms can penetrate through respirator filters, sealing surfaces or other parts of the respirator. Wearing disposable and reusable respirators causes difficulties in breathing and communicating. The chosen strategy was to avoid a health threat rather than curing a symptom. The intended target group is individuals whom due to their profession are exposed to many others while being in a confined space. These people could be a danger to others should they become infectious themselves. The conceptual respirator was developed firstly by sketching and by making rough prototypes for testing. The final concept can be reused for weeks with disposable filters and a full face piece respirator and it prevents the three ways of transmission. The respirator consists of a lightweight plastic visor which is combined with adhesive and stretchy silicone. The soft and gentle adhesive edges makes the respirator more effective and safe than disposable ones by completely sealing the edges to the face. Adhesive silicone is reattachable and reusable. This also prohibits casual and easy donning and doffing, which is linked to a higher risk of user error and contracting diseases. This new user scenario instead is in need of a mirror and sink and the donning and doffing therefor encourages a ritual of adequate hygiene of both hands and respirator. The impact of air travel on the spread of infectious diseases has given rise to considerable concern however limited research. During the early phases of a pandemic, strategies that rely on physical barriers will be more prominent and respiratory protection has been largely overlooked. A generally neglected possible portal of entry for viruses is the conjunctiva. Modern research on nanofibrous filtering material is welcomed news, as well as the aim to provide adequate information to the public in time

eVisits in the digital era of Swedish primary care

Objective: To evaluate asynchronous digital visits (eVisits) with regard to digital communication, clinical decisionmaking,and subsequent care utilization in the digital era of primary care in Sweden.Methods: A mixed-methods approach was adopted across the various papers in the thesis, with all studiesevaluating the eVisit platform Flow in various clinical contexts.- Paper I was a comparative study of digital triage decisions when presented with automated patienthistory reports generated by the platform. Inter-rater reliability of triage decisions by majority vote in apanel of five physicians was compared to triage decisions by a machine learning model trained usingdata labelled by an expert primary care physician.- Paper II was a qualitative focus group study of nurse and physician experiences of digitalcommunication at three primary health care centers using the platform. Themes were generated usingqualitative content analysis as described by Graneheim and Lundman.- Papers III and IV were observational studies comparing office visits in the Skåne Region from Capio,a large private health care provider, to eVisit patients from Capio Go, a national eVisit service. Adultpatients with a chief complaint of sore throat, dysuria, or cough/common cold/influenza were recruited.eVisit patients were recruited prospectively digitally prior to their eVisit, while the office visit controlgroup was recruited retrospectively using letters. Paper III primarily compared antibiotic prescriptionrates per sore throat visit, while paper IV primarily compared subsequent physical health careutilization within two weeks for patients in the Skåne Region.Results: Interrater reliability was low (Cohen κ 0.17) between the panel majority vote and the machine learningmodel. Physicians and nurses experienced digitally filtered primary care, adjusting to a novel medium ofcommunication highlighting challenges in interpreting symptoms through text as well as alterations in practiceworkflow using asynchronous communication. Antibiotics prescription rate within three days was not higher aftereVisits compared to office visits (169/798 (21.2%) vs. 124/312 (39.7%) for sore throat, respectively; P<.001). Nosignificant differences in subsequent physical visits within two weeks (excluding the first 48 h of expected “digi-physical”care) were noted following eVisits compared to office visits (179 (18.0%) vs. 102 (17.6%); P = .854).Conclusions: eVisits do not seem to be associated with over-prescription of antibiotics, or over-utilization ofphysical health care when assessing common infectious symptoms. Given staff experiencing uncertainties ininterpretation of symptoms and triage decisions being inconsistent, eVisits may be best used as one of manymodalities to access primary care, with focus placed on facilitating patient-centered professional judgement bystaff, rather than automation of complex decisions

A study on biological occupational hazards in emergency medicine in Hospital Universiti Sains Malaysia

Background: Hazards in working environment have posed significant risk to health care workers (HCWs). Biological hazard is one of the hazards and exists in most departments in hospital, including Emergency Department (ED). The objectives of this study were to look at the prevalence of biological hazards in ED, determine the association of different work shift and different triage zones with type of biological hazards. The associated factors of blood-borne and non-blood-borne diseases were also being determined. Methodology This was a prospective study conducted from 1st August 2013 to 30th November 2013. All patients who presented to ED, Hospital Universiti Sains Malaysia (HUSM) were reviewed based on the ED records. Hospital records of the patients with biological hazards were traced and reviewed. Demographic data and type of biological hazards were collected and association of work shift and triage zone were also analysed. Final diagnosis of those with biological hazards was also being determined by reviewing discharge note of the patients. All the data were entered using SPSS based on the sample size of each type of biological hazards. In order to avoid missing data, work sheet form year 2013 from Microbiology department was reviewed for all patients with blood-borne biological hazards. Based on the registered number of the patients, their visits to ED HUSM were traced and correlated with the study period. All the data was collected using a standardised proforma form. Results: A total of 200 cases that presented to ED HUSM had biological hazards. Majority of the cases was Malay (96.5%) and community acquired pneumonia .Apart from CAP and scabies there were no statistically significant association between biological hazards and the different time of the work shift. Majority of CAP and scabies cases came during PM shift with the percentage of 42.6% and 78.1% respectively. Most of the biological hazards had statistically significant association with triage zone except Human immunodeficiency virus (HIV) and Hepatitis B virus (HBV). Majority of tuberculosis (TB), CAP and Hepatitis C virus (HCV) cases presented to yellow zone with the percentage of 54.6%, 42.6% and 48.7% respectively. Majority of scabies and impetigo cases presented to the green zone. Age and gender were significant association factors of blood-borne diseases. Conclusion: Yellow zone had higher biological hazards exposure for CAP, TB and HCV while green zone had higher exposure for scabies and impetigo to HCWs in ED HUSM. PM shift had higher exposure for CAP and scabies. Age and male gender were the only significant predictors for the blood-borne biological hazards exposure to the HCWs in ED HUSM

2020-06-19/20/21 DAILY UNM GLOBAL HEALTH COVID-19 BRIEFING

Executive Summary: NM Highlights: Dr. Scrase on-line briefing. NM cases. Campgrounds closed through July 4th. Otero prison reports. Navajo nation’s first police dies. Santa Fe cancels 4th July fireworks. Face coverings donated. NM infection rate drops. US Highlights: AZ Governor issues Exec Order. Economics, Workforce, Supply Chain, PPE: Epidemiology Highlights: Reopening hospitals metric. Comparison of mask effectiveness. Private practices suffer. Healthcare Policy Recommendations: Maternal mortality. Practice Guidelines: Recommendations on hepatobiliary surgery and neonate management. Drugs, Vaccines, Therapies, Clinical Trials: Animal studies generate new vaccine candidates and vaccine platform. 16 new clinical trials registered. Other Science: Respiratory secretions detected by trained dogs. MRI findings show brain lesions in non-survivors. Healthy blood vessels may protect children. Meta-analysis on pneumonia severity. Smoking and COVID-19 severity meta-analysis

Ann Intern Med

BackgroundConsensus guidelines recommend that adults at low risk for group A streptococcal (GAS) pharyngitis be neither tested nor treatedObjectiveTo help patients decide when to visit a clinician for the evaluation of sore throat.DesignRetrospective cohort study.SettingA national chain of retail health clinics.Patients71 776 patients aged 15 years or older with pharyngitis who visited a clinic from September 2006 to December 2008.MeasurementsThe authors created a score using information from patient-reported clinical variables plus the incidence of local disease and compared it with the Centor score and other traditional scores that require clinician-elicited signs.ResultsIf patients aged 15 years or older with sore throat did not visit a clinician when the new score estimated the likelihood of GAS pharyngitis to be less than 10% instead of having clinicians manage their symptoms following guidelines that use the Centor score, 230 000 visits would be avoided in the United States each year and 8500 patients with GAS pharyngitis who would have received antibiotics would not be treated with them.LimitationReal-time information about the local incidence of GAS pharyngitis, which is necessary to calculate the new score, is not currently available.ConclusionA patient-driven approach to pharyngitis diagnosis that uses this new score could save hundreds of thousands of visits annually by identifying patients at home who are unlikely to require testing or treatment.Primary Funding SourceCenters for Disease Control and Prevention and the National Library of Medicine, National Institutes of Health.1G08LM009778/LM/NLM NIH HHS/United StatesR01 LM007677/LM/NLM NIH HHS/United StatesR01 AI077780/AI/NIAID NIH HHS/United StatesP01 HK000088/HK/PHITPO CDC HHS/United StatesG08 LM009778/LM/NLM NIH HHS/United StatesK01 HK000055/HK/PHITPO CDC HHS/United StatesK01HK000055/HK/PHITPO CDC HHS/United StatesP01HK000088/HK/PHITPO CDC HHS/United States2014-05-05T00:00:00Z24189592PMC39534567487vault:236