A Survey of County Health Departments of Kansas Regarding COVID-19

Introduction. SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2) causing COVID-19 (Coronavirus Disease 2019) initially was identified in China in December 2019. It has resulted in a pandemic with increasing spread of the virus in the US. The county health departments around US are spearheading the response to contain the spread of this virus. Methods. This project was a survey of county health departments in the state of Kansas with data collection period from 4/15 to 4/24/2020. This study evaluated the staffing, resources, and funding of these health departments and how it was affecting the efforts to contain COVID-19. Descriptive statistics were used to summarize the responses. Results. A total of 75% of the county health departments in Kansas responded to the survey. In 89% of locations, the staffing had not increased. Most health departments had an average of five people and the four largest ones had 30 to 98 staff working on COVID-19. Most locations used the Kansas Department of Health and Environment criteria for testing and used a combination of state or private laboratories. The results of the tests were available three days or longer in 62% and after five days in 14% of sites. All locations were active in contact tracing, but most had 1-3 people for this purpose and in 90% the contact tracing interview was via phone calls. There was no change in funding in 21% and decreased funding in 8.5% of health departments. Most locations had an average of five nasopharyngeal swabs on the day of the survey. The most common needs expressed were help to increase testing capability, more public education, more personal protective equipment, increased personnel, and assistance with contract tracing. Conclusions. There is an urgent need in Kansas to increase support to county health departments for testing capability, personal protective equipment, increased number of staff, increased help with contact tracing, and especially increase support for public education

Second Survey of County Health Departments of Kansas and COVID 19: Time for Change in Model for Pandemic Response

Introduction. SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) causing COVID-19 (Coronavirus Disease 2019) continues to be widespread in Kansas.  County health departments are trying to contain this pandemic.  Methods. This second survey of Kansas county health department directors occurred from August 7 to September 7, 2020.  Since the first survey in April, there have been significant increases in the number of positive cases of COVID-19 and related deaths.  Thus, the aim of the study was to re-evaluate county-level containment efforts and assess shortfalls that were previously identified in the April 2020 survey. Results. In total, 41 out of 105 directors responded to the survey.  Generally, respondents said there were increased supplies for testing, increased testing centers, shorter time to get test results, and in some cases, increased funding.  However, the number of people involved in contact tracing had not substantially increased, which was one of the recommended changes for improving containment.  Moreover, of those persons who were tested, only a few (18%) counties inquired if they wear masks in public.  From comments reported, there was a sense of employees being overwhelmed, especially among the smaller county health departments. Conclusions. As the cases of and deaths from COVID-19 are increasing in the state, especially in high density areas, the respondents to our survey indicate there is continued need for additional  funding with easy access, increased staffing, especially for contact tracing, and significant help for effective messaging to improve adherence to public health directives

Group Evaluations of Individual Faculty Hospitalists

Introduction Faculty evaluations are important tools for improving faculty-to-resident instruction, but residents in our pediatric and internal medicine/pediatric residency programs would seldom evaluate individual pediatric faculty hospitalists. Our objectives were to: (1) increase the percentage of completed evaluations of individual pediatric hospitalists to greater than 85%, (2) improve the quality of pediatric hospitalist feedback as measured by resident and faculty satisfaction surveys, and (3) to reduce the resident concern of lack of anonymity of evaluations. Methods Members of the resident inpatient team (pediatric and internal medicine/pediatric residents) completed group-based evaluations of individual pediatric hospitalists. A survey to evaluate this change in process was distributed to the pediatric hospitalists (n = 6) and another survey was distributed to residents, both based on a 5-point Likert-type scale. Surveys were completed before and four months after implementation of the changes. Pre- and post-survey data of resident and hospitalist responses were compared using the Mann-Whitney test and probability proportion test. Results The percent of completed evaluations increased from 0% to 86% in one month and to 100% in two months. Thereafter, the percent of completed evaluations remained at 100% through the end of the data collection period at seven months. Hospitalists reported (n = 6, 100% participation) their satisfaction regarding the feedback they received from residents significantly increased for all survey questions. Resident satisfaction (n = 24, 89% participation in postintervention surveys) increased significantly with regards to the evaluation process. Conclusions For hospitalists, group-based resident evaluations of individual hospitalists led to an increased percentage of completed evaluations, improved the quality and quantity of feedback to hospitalists, and increased satisfaction with evaluations. For residents, these changes led to increased satisfaction with the evaluation process

Assessing Physician Response Rate Using a Mixed-Mode Survey

Background. It is important to minimize time and cost of physician surveys while still achieving a reasonable response rate. Mixed-mode survey administration appears to improve response rates and decrease bias. A literature review revealed physician response rates to mixed-mode surveys averaged about 68%. However, no identified studies used the combination of e-mail, fax, and telephone. The purpose of this study was to evaluate physician response rates based on surveys first administered by e-mail, then fax, then telephone. Methods. Surveys initially were administered by e-mail to 149 physicians utilizing SurveyMonkey©. Two follow-up reminder e-mails were sent to non-respondents at two-week intervals. Surveys then were faxed to physicians who had not responded. A follow-up fax was sent to non-respondents one week later. Finally, phone interviews were attempted with physicians who had not responded by e-mail or fax; each physician was called at least twice. Results. Of the 149 eligible physicians, 102 completed the survey for a response rate of 68.5%. Of those who responded, 49 (48%) responded by e-mail, 25 (24.5%) by fax, and 28 (27.5%) by phone. Mode of response did not differ by gender, specialization, or years in practice. In addition, mode of response was not related to the primary study question, physician willingness to use text messaging for immunization reminders. Conclusions. This mix of survey methodologies appeared to be a feasible combination for achieving physician responses and may be more cost effective than other mixed methods

Spatiotemporal transcriptomic maps of whole mouse embryos at the onset of organogenesis

Spatiotemporal orchestration of gene expression is required for proper embryonic development. The use of single-cell technologies has begun to provide improved resolution of early regulatory dynamics, including detailed molecular definitions of most cell states during mouse embryogenesis. Here we used Slide-seq to build spatial transcriptomic maps of complete embryonic day (E) 8.5 and E9.0, and partial E9.5 embryos. To support their utility, we developed sc3D, a tool for reconstructing and exploring three-dimensional ‘virtual embryos’, which enables the quantitative investigation of regionalized gene expression patterns. Our measurements along the main embryonic axes of the developing neural tube revealed several previously unannotated genes with distinct spatial patterns. We also characterized the conflicting transcriptional identity of ‘ectopic’ neural tubes that emerge in Tbx6 mutant embryos. Taken together, we present an experimental and computational framework for the spatiotemporal investigation of whole embryonic structures and mutant phenotypes

Monoprophylaxis with cephalosporins for transrectal prostate biopsy after the fluoroquinolone-era: a multi-institutional comparison of severe infectious complications

Background: To compare severe infectious complication rates after transrectal prostate biopsies between cephalosporins and fluoroquinolones for antibiotic monoprophylaxis. Material and Methods: In the multi-institutional cohort, between November 2014 and July 2020 patients received either cefotaxime (single dose intravenously), cefpodoxime (multiple doses orally) or fluoroquinolones (multiple-doses orally or single dose intravenously) for transrectal prostate biopsy prophylaxis. Data were prospectively acquired and retrospectively analyzed. Severe infectious complications were evaluated within 30 days after biopsy. Logistic regression models predicted biopsy-related infectious complications according to antibiotic prophylaxis, application type and patient- and procedure-related risk factors. Results: Of 793 patients, 132 (16.6%) received a single dose of intravenous cefotaxime and were compared to 119 (15%) who received multiple doses of oral cefpodoxime and 542 (68.3%) who received fluoroquinolones as monoprophylaxis. The overall incidence of severe infectious complications was 1.0% (n=8). No significant differences were observed between the three compared groups (0.8% vs. 0.8% vs. 1.1%, p=0.9). The overall rate of urosepsis was 0.3% and did not significantly differ between the three compared groups as well. Conclusion: Monoprophylaxis with third generation cephalosporins was efficient in preventing severe infectious complications after prostate biopsy. Single intravenous dose of cefotaxime and multiday regimen of oral cefpodoxime showed a low incidence of infectious complications <1%. No differences were observed in comparison to fluoroquinolones

Full functional-length urethral sphincter- and neurovascular bundle preservation improves long-term continence rates after robotic-assisted radical prostatectomy

The objective of the study was to test the impact of implementing standard full functional-length urethral sphincter (FFLU) and neurovascular bundle preservation (NVBP) with intraoperative frozen section technique (IFT) on long-term urinary continence in patients undergoing robotic-assisted radical prostatectomy (RARP). We relied on an institutional tertiary-care database to identify patients who underwent RARP between 01/2014 and 09/2019. Until 10/2017, FFLU was not performed and decision for NVBP was taken without IFT. From 11/2017, FFLU and IFT-guided NVBP was routinely performed in all patients undergoing RARP. Long-term continence (≥ 12 months) was defined as the usage of no or one safety- pad. Uni- and multivariable logistic regression models tested the correlation between surgical approach (standard vs FFLU + NVBP) and long-term continence. Covariates consisted of age, body mass index, prostate volume and extraprostatic extension of tumor. The study cohort consisted of 142 patients, with equally sized groups for standard vs FFLU + NVBP RARP (68 vs 74 patients). Routine FFLU + NVBP implementation resulted in a long-term continence rate of 91%, compared to 63% in standard RARP (p  5 pads/24 h). No significant differences in patient or tumor characteristics were recorded between both groups. In multivariable logistic regression models, FFLU + NVBP was a robust predictor for continence (Odds ratio [OR]: 7.62; 95% CI 2.51–27.36; p < 0.001). Implementation of FFLU and NVBP in patients undergoing RARP results in improved long-term continence rates of 91%