Background The surge of telemedicine use during the early stages of the COVID-19 pandemic has been well documented. However, scarce evidence considers the use of telemedicine in the subsequent period. Objective This study aims to evaluate use patterns of video-based telemedicine visits for ambulatory care and urgent care provision over the course of recurring pandemic waves in 1 large health system in New York City (NYC) and what this means for health care delivery. Methods Retrospective electronic health record (EHR) data of patients from January 1, 2020, to February 28, 2022, were used to longitudinally track and analyze telemedicine and in-person visit volumes across ambulatory care specialties and urgent care, as well as compare them to a prepandemic baseline (June-November 2019). Diagnosis codes to differentiate suspected COVID-19 visits from non–COVID-19 visits, as well as evaluating COVID-19–based telemedicine use over time, were compared to the total number of COVID-19–positive cases in the same geographic region (city level). The time series data were segmented based on change-point analysis, and variances in visit trends were compared between the segments. Results The emergence of COVID-19 prompted an early increase in the number of telemedicine visits across the urgent care and ambulatory care settings. This use continued throughout the pandemic at a much higher level than the prepandemic baseline for both COVID-19 and non–COVID-19 suspected visits, despite the fluctuation in COVID-19 cases throughout the pandemic and the resumption of in-person clinical services. The use of telemedicine-based urgent care services for COVID-19 suspected visits showed more variance in response to each pandemic wave, but telemedicine visits for ambulatory care have remained relatively steady after the initial crisis period. During the Omicron wave, the use of all visit types, including in-person activities, decreased. Patients between 25 and 34 years of age were the largest users of telemedicine-based urgent care. Patient satisfaction with telemedicine-based urgent care remained high despite the rapid scaling of services to meet increased demand. Conclusions The trend of the increased use of telemedicine as a means of health care delivery relative to the pre–COVID-19 baseline has been maintained throughout the later pandemic periods despite fluctuating COVID-19 cases and the resumption of in-person care delivery. Overall satisfaction with telemedicine-based care is also high. The trends in telemedicine use suggest that telemedicine-based health care delivery has become a mainstream and sustained supplement to in-person-based ambulatory care, particularly for younger patients, for both urgent and nonurgent care needs. These findings have implications for the health care delivery system, including practice leaders, insurers, and policymakers. Further investigation is needed to evaluate telemedicine adoption by key demographics, identify ongoing barriers to adoption, and explore the impacts of sustained use of telemedicine on health care outcomes and experience.
more »
« less
Stopping the COVID-19 pandemic in dental offices: A review of SARS-CoV-2 transmission and cross-infection prevention
Due to the essential role of dentists in stopping the COVID-19 pandemic, the purpose of this review is to help dentists to detect any weaknesses in their disinfection and cross-contamination prevention protocols, and to triage dental treatments to meet the needs of patients during the pandemic. We used PRISMA to identify peer-reviewed publications which supplemented guidance from the center for disease control about infection control and guidelines for dentists. Dentists must triage dental treatments to meet the needs of patients during the pandemic. The ongoing pandemic has changed the practice of dentistry forever, the changes make it more cumbersome, time-consuming, and costly due to the possible pathways of transmission and mitigation steps needed to prevent the spread of COVID-19. Dental chairside rapid tests for SARS-CoV-2 are urgently needed. Until then, dentists need to screen patients for COVID-19 even though 75% of people with COVID-19 have no symptoms. Despite the widespread anxiety and fear of the devastating health effects of COVID-19, only 61% of dentists have implemented a change to their treatment protocols. As an urgent matter of public health, all dentists must identify the additional steps they can take to prevent the spread of COVID-19. The most effective steps to stop the pandemic in dental offices are to; vaccinate all dentists, staff, and patients; triage dental treatments for patients, separate vulnerable patients, separate COVID-19 patients, prevent cross-contamination, disinfect areas touched by patients, maintain social distancing, and change personal protective equipment between patients.
more »
« less
- Award ID(s):
- 2031227
- NSF-PAR ID:
- 10344192
- Date Published:
- Journal Name:
- Experimental Biology and Medicine
- Volume:
- 246
- Issue:
- 22
- ISSN:
- 1535-3702
- Page Range / eLocation ID:
- 2381 to 2390
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
More Like this
-
-
Calderaro, Adriana (Ed.)The World Health Organization (WHO) declared coronavirus disease-2019 (COVID-19) a global pandemic on 11 March 2020. In Ecuador, the first case of COVID-19 was recorded on 29 February 2020. Despite efforts to control its spread, SARS-CoV-2 overran the Ecuadorian public health system, which became one of the most affected in Latin America on 24 April 2020. The Hospital General del Sur de Quito (HGSQ) had to transition from a general to a specific COVID-19 health center in a short period of time to fulfill the health demand from patients with respiratory afflictions. Here, we summarized the implementations applied in the HGSQ to become a COVID-19 exclusive hospital, including the rearrangement of hospital rooms and a triage strategy based on a severity score calculated through an artificial intelligence (AI)-assisted chest computed tomography (CT). Moreover, we present clinical, epidemiological, and laboratory data from 75 laboratory tested COVID-19 patients, which represent the first outbreak of Quito city. The majority of patients were male with a median age of 50 years. We found differences in laboratory parameters between intensive care unit (ICU) and non-ICU cases considering C-reactive protein, lactate dehydrogenase, and lymphocytes. Sensitivity and specificity of the AI-assisted chest CT were 21.4% and 66.7%, respectively, when considering a score >70%; regardless, this system became a cornerstone of hospital triage due to the lack of RT-PCR testing and timely results. If health workers act as vectors of SARS-CoV-2 at their domiciles, they can seed outbreaks that might put 1,879,047 people at risk of infection within 15 km around the hospital. Despite our limited sample size, the information presented can be used as a local example that might aid future responses in low and middle-income countries facing respiratory transmitted epidemics.more » « less
-
more » « less
Abstract Background Prior to the availability of pharmaceutical control measures, non-pharmaceutical control measures, including travel restrictions, physical distancing, isolation and quarantine, closure of schools and workplaces, and the use of personal protective equipment were the only tools available to public health authorities to control the spread of COVID-19. The implementation of these non-pharmaceutical control measures had unintended impacts on the ability of state and territorial domestic violence coalitions to provide services to victims.
Methods A semi-structured interview guide to assess how the COVID-19 pandemic impacted service provision and advocacy generally, and how COVID-19 control measures specifically, created barriers to services and advocacy, was developed, pilot tested, and revised based on feedback. Interviews with state and territorial domestic violence coalition executive directors were conducted between November 2021 and March 2022. Transcripts were inductively and deductively coded using both hand-coding and qualitative software.
Results Forty-five percent (25 of 56) of state and territorial domestic violence coalition executive directors representing all 8 National Network to End Domestic Violence (NNEDV) regions were interviewed. Five themes related to the use of non-pharmaceutical pandemic control measures with impacts on the provision of services and advocacy were identified.
Conclusions The use of non-pharmaceutical control measures early in the COVID-19 pandemic had negative impacts on the health and safety of some vulnerable groups, including domestic violence victims. Organizations that provide services and advocacy to victims faced many unique challenges in carrying out their missions while adhering to required public health control measures. Policy and preparedness plan changes are needed to prevent unintended consequences of control measure implementation among vulnerable groups as well as to identify lessons learned that should be applied in future disasters and emergencies.
-
null (Ed.)In June 2020, at the annual conference of the American Society for Engineering Education (ASEE), which was held entirely online due to the impacts of COVID-19 (SARS-CoV-2), engineering education researchers and social justice scholars diagnosed the spread of two diseases in the United States: COVID-19 and racism. During a virtual workshop (T614A) titled, “Using Power, Privilege, and Intersectionality as Lenses to Understand our Experiences and Begin to Disrupt and Dismantle Oppressive Structures Within Academia,” Drs. Nadia Kellam, Vanessa Svihla, Donna Riley, Alice Pawley, Kelly Cross, Susannah Davis, and Jay Pembridge presented what we might call a pathological analysis of institutionalized racism and various other “isms.” In order to address the intersecting impacts of this double pandemic, they prescribed counter practices and protocols of anti-racism, and strategies against other oppressive “isms” in academia. At the beginning of the virtual workshop, the presenters were pleasantly surprised to see that they had around a hundred attendees. Did the online format of the ASEE conference afford broader exposure of the workshop? Did recent uprising of Black Lives Matter (BLM) protests across the country, and internationally, generate broader interest in their topic? Whatever the case, at a time when an in-person conference could not be convened without compromising public health safety, ASEE’s virtual conference platform, furnished by Pathable and supplemented by Zoom, made possible the broader social impacts of Dr. Svihla’s land acknowledgement of the unceded Indigenous lands from which she was presenting. Svihla attempted to go beyond a hollow gesture by including a hyperlink in her slides to a COVID-19 relief fund for the Navajo Nation, and encouraged attendees to make a donation as they copied and pasted the link in the Zoom Chat. Dr. Cross’s statement that you are either a racist or an anti-racist at this point also promised broader social impacts in the context of the virtual workshop. You could feel the intensity of the BLM social movements and the broader political climate in the tone of the presenters’ voices. The mobilizing masses on the streets resonated with a cutting-edge of social justice research and education at the ASEE virtual conference. COVID-19 has both exacerbated and made more obvious the unevenness and inequities in our educational practices, processes, and infrastructures. This paper is an extension of a broader collaborative research project that accounts for how an exceptional group of engineering educators have taken this opportunity to socially broaden their curricula to include not just public health matters, but also contemporary political and social movements. Engineering educators for change and advocates for social justice quickly recognized the affordances of diverse forms of digital technologies, and the possibilities of broadening their impact through educational practices and infrastructures of inclusion, openness, and accessibility. They are makers of what Gary Downy calls “scalable scholarship”—projects in support of marginalized epistemologies that can be scaled up from ideation to practice in ways that unsettle and displace the dominant epistemological paradigm of engineering education.[1] This paper is a work in progress. It marks the beginning of a much lengthier project that documents the key positionality of engineering educators for change, and how they are socially situated in places where they can connect social movements with industrial transitions, and participate in the production of “undone sciences” that address “a structured absence that emerges from relations of inequality.”[2] In this paper, we offer a brief glimpse into ethnographic data we collected virtually through interviews, participant observation, and digital archiving from March 2019 to August 2019, during the initial impacts of COVID-19 in the United States. The collaborative research that undergirds this paper is ongoing, and what is presented here is a rough and early articulation of ideas and research findings that have begun to emerge through our engagement with engineering educators for change. This paper begins by introducing an image concept that will guide our analysis of how, in this historical moment, forms of social and racial justice are finding their way into the practices of engineering educators through slight changes in pedagogical techniques in response the debilitating impacts of the pandemic. Conceptually, we are interested in how small and subtle changes in learning conditions can socially broaden the impact of engineering educators for change. After introducing the image concept that guides this work, we will briefly discuss methodology and offer background information about the project. Next, we discuss literature that revolves around the question, what is engineering education for? Finally, we introduce the notion of situating engineering education and give readers a brief glimpse into our ethnographic data. The conclusion will indicate future directions for writing, research, and intervention.more » « less
-
Objective We aimed to identify opportunities for application of human factors knowledge base to mitigate disaster management (DM) challenges associated with the unique characteristics of the COVID-19 pandemic. Background The role of DM is to minimize and prevent further spread of the contagion over an extended period of time. This requires addressing large-scale logistics, coordination, and specialized training needs. However, DM-related challenges during the pandemic response and recovery are significantly different than with other kinds of disasters. Method An expert review was conducted to document issues relevant to human factors and ergonomics (HFE) in DM. Results The response to the COVID-19 crisis has presented complex and unique challenges to DM and public health practitioners. Compared to other disasters and previous pandemics, the COVID-19 outbreak has had an unprecedented scale, magnitude, and propagation rate. The high technical complexity of response and DM coupled with lack of mental model and expertise to respond to such a unique disaster has seriously challenged the response work systems. Recent research has investigated the role of HFE in modeling DM systems’ characteristics to improve resilience, accelerating emergency management expertise, developing agile training methods to facilitate dynamically changing response, improving communication and coordination among system elements, mitigating occupational hazards including guidelines for the design of personal protective equipment, and improving procedures to enhance efficiency and effectiveness of response efforts. Conclusion This short review highlights the potential for the field’s contribution to proactive and resilient DM for the ongoing and future pandemics.more » « less
- Free Publicly Accessible Full Text
-
Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1177/15353702211034164
