Change In Healthcare Practice Research Articles

Retrospective Analysis of Clostridioides difficile Infection Rates and Outcomes in Hospitalized Patients during the COVID-19 Pandemic: A Unicenter Study in Reus, Spain.

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.

Remanufacturing as a circular design strategy in healthcare: integrating socio-technical and environmental-economic assessments

AbstractThis paper examines the role of remanufacturing in healthcare as a key circular design strategy, particularly for medical devices, assessing its socio-technical, environmental, and economic dimensions of sustainability. Through a detailed case of ultrasound catheters, it demonstrates how remanufacturing can lead to resource conservation, cost savings, and enhanced product lifecycles in health care without compromising quality and patient safety. The study argues for systemic changes in healthcare practices to fully integrate remanufacturing, underscoring its role beyond a technical solution.

Indigenous people's experiences of primary health care in Canada: a qualitative systematic review.

Indigenous people in Canada encounter negative treatment when accessing primary health care (PHC). Despite several qualitative accounts of these experiences, there still has not been a qualitative review conducted on this topic. In this qualitative systematic review, we aimed to explore Indigenous people's experiences in Canada with PHC services, determine urban versus rural or remote differences and identify recommendations for quality improvement. This review was guided by the Joanna Briggs Institute's methodology for systematic reviews of qualitative evidence. MEDLINE, CINAHL, PubMed, PsycInfo, Embase and Web of Science as well as grey literature and ancestry sources were used to identify relevant articles. Ancestry sources were obtained through reviewing the reference lists of all included articles and determining the ones that potentially met the eligibility criteria. Two independent reviewers conducted the initial and full text screening, data extraction and quality assessment. Once all data were gathered, they were synthesized following the meta-aggregation approach (PROSPERO CRD42020192353). The search yielded a total of 2503 articles from the academic databases and 12 articles from the grey literature and ancestry sources. Overall, 22 articles were included in this review. Three major synthesized findings were revealed-satisfactory experiences, discriminatory attitudes and systemic challenges faced by Indigenous patients-along with one synthesized finding on their specific recommendations. Indigenous people value safe, accessible and respectful care. The discrimination and racism they face negatively affect their overall health and well-being. Hence, it is crucial that changes in health care practice, structures and policy development as well as systemic transformation be implemented immediately.

Patients’ recommendations to improve help-seeking for vaginismus: a qualitative study

BackgroundResearch to improve healthcare experiences for women with vaginismus tends to be produced from the perspective of healthcare professionals or health-based researchers. There is lacking research on women’s experiences and recommendations to improve help-seeking for vaginismus from their perspective. To address this research gap, this qualitative study aimed to identify the issues that women face when help-seeking for vaginismus and their recommendations to address it. This sought to support the wellbeing of patients to advocate for their healthcare needs which is often overlooked.MethodsUsing a feminist theoretical approach, semi-structured interviews were conducted with 21 participants who sought help for their vaginismus. Thematic analysis was employed to analyse participants’ recommendations.ResultsFour main themes emerged: Increase awareness of vaginismus, Dismantle myths about sex, Destigmatise vaginismus, and Empower people with vaginismus during medical consultations. Subthemes were identified as actionable strategies that participants recommended to improve help-seeking and healthcare for vaginismus.ConclusionsThe findings from this study can inform healthcare practice and policy to foster better synchronicity between health professionals and their patients’ perceptions and expectations of treating vaginismus. This can promote more acceptance of patients’ advocacy of their needs and goals to improve the therapeutic alliance and treatment outcomes for vaginismus in healthcare practice. The strategies recommended to increase awareness of vaginismus and challenge its stigma should be considered in policy to incite a culture of change in healthcare practice and broader society.

Decline in ESBL Production and Carbapenem Resistance in Urinary Tract Infections among Key Bacterial Species during the COVID-19 Pandemic.

The COVID-19 pandemic has led to significant changes in healthcare practices, including increased antibiotic usage. This study aimed to investigate the impact of the pandemic on the prevalence of extended-spectrum β-lactamase (ESBL) production and carbapenem resistance among key bacterial species causing urinary tract infections (UTIs). Conducted at King Fahad Medical City in Riyadh from January 2018 to December 2022, the study analyzed urine samples from 9697 UTI patients. Patients were categorized into 'pre-COVID-19' and 'during COVID-19' groups. Bacterial isolates were identified, and antimicrobial susceptibility testing was performed following guidelines. ESBL production was detected using the Double-Disc Synergy Test. Escherichia coli and Klebsiella pneumoniae were the main pathogens. During the pandemic, ESBL production decreased in E. coli by 1.9% and in K. pneumoniae by 6.0%. Carbapenem resistance also declined, with E. coli displaying a 1.2% reduction and K. pneumoniae and Pseudomonas aeruginosa displaying 10.7% and 7.9% reductions, respectively. Notably, logistic regression analysis revealed that the odds of ESBL presence were 10% lower during the COVID-19 pandemic (OR 0.91; 95% CI 0.83-0.99; p = 0.040), and there was a significant reduction in the odds of carbapenem resistance (OR 0.43; 95% CI 0.37-0.51; p < 0.001). This study reveals a significant decrease in ESBL production and carbapenem resistance among UTI pathogens during the COVID-19 pandemic, hinting at the impact of modified antibiotic and healthcare approaches. It emphasizes the need for persistent antimicrobial resistance surveillance and policy adaptation to address resistance challenges, offering key directions for future public health actions.

Rapid Group Analysis Process (Rap-GAP): A Novel Approach to Expedite Qualitative Health Research Data Analysis

To contribute to healthcare improvements, qualitative health research must adapt to the demanding pace of constantly changing healthcare practices and policies. To meet this challenge, researchers need methods for rigorous and rapid data analysis. This article introduces the Rapid Group Analysis Process (Rap-GAP), a new approach for rapid qualitative data analysis. This method is more efficient than other rapid qualitative analysis methods. It allows for the direct involvement of diverse participants in the analysis process, including patients or healthcare decision-makers with limited qualitative research experience, while keeping the analysis grounded in the primary data (e.g., transcripts). These attributes make Rap-GAP a unique and valuable alternative to traditional qualitative analysis. This article describes the 5-step Rap-GAP process and 3 case studies that demonstrate how to use the method and adapt it for different analytical goals. Future research will evaluate and describe the outcomes of Rap-GAP compared to traditional qualitative analysis.

Best practice implementation on reporting of coronavirus disease 2019 vaccine adverse events following immunization in Uasin Gishu County, Kenya.

This project's aim was to implement vaccine safety surveillance best practices to improve reporting of adverse events following immunization (AEFI) during coronavirus disease 2019 (COVID-19) vaccination roll out in Uasin Gishu County. Weak vaccine safety surveillance systems in developing countries has contributed to underreporting of AEFIs undermining public confidence in immunization efforts, contributing to low uptake of vaccines critical in the fight against communicable diseases. The JBI Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) audit tool for promoting change in healthcare practice was utilized. Preimplementation and postimplementation audit cycles carried out utilized six best practice recommendations. Context-specific strategies and resources were used to address the gaps identified. Less than half of the AEFIs reported were in accordance with the local policy recommendation, and most of the AEFIs reported were submitted in a timely manner in the baseline and follow-up cycle. Slight improvement was recorded in the number of health facilities with AEFIs reporting forms. An improvement of 33.7% was recorded in the number of health workers providing COVID-19 vaccination services who had received education and practical training on vaccine pharmacovigilance. Underreporting and delayed submission of COVID-19 vaccine AEFI was evident among the healthcare providers offering COVID-19 vaccination services, the majority of healthcare providers had received training on vaccine pharmacovigilance, and AEFI hard copy reporting forms were not adequate in the health facilities. Public education on vaccine safety before administration of vaccine needs emphasis in order to improve reporting of AEFI.

COVID-19 Pandemic and Healthcare Communication: A Patient-Centric Evaluation of Treatment and Diagnostic Procedures in Poland.

BACKGROUND The COVID-19 pandemic necessitated swift and often abrupt changes in healthcare practices, significantly influencing treatment and diagnostic procedures. This study aimed to gauge patient perceptions regarding these changes and their overall impact on the treatment and diagnosis process (ITDP). MATERIAL AND METHODS In March 2022, we conducted a cross-sectional online survey among 1860 Polish residents (mean age: 48.82&plusmn;16.57 years), who had accessed medical services within the preceding 24 months. We employed a binary logistic regression model to pinpoint independent factors contributing to a wholly negative perception of the pandemic's influence on the ITDP. RESULTS Around 64.3% of respondents perceived the ITDP during the pandemic negatively, with 20.8% reporting mixed impacts. Of 22 factors considered, 16 were significantly associated with ITDP perceptions in univariate analyses, and 8 qualified for the final multivariate model. The most potent predictors of negative ITDP perceptions included impeded communication with medical personnel due to the emphasis on COVID-19 (OR=2.82; 95% CI: 2.04-3.90) and worsening family financial circumstances during the pandemic (OR=2.03; 95% CI: 1.26-3.27). Other significant predictors comprised viewing remote services as a hindrance to medical communication, higher education, and use of self-funded private healthcare. CONCLUSIONS Our findings confirm that negative perceptions of the ITDP during the COVID-19 pandemic are associated with the remote delivery of medical services and communication challenges. These insights underscore the need to improve these domains for better healthcare delivery amid ongoing or future health crises.

Perspectives on the Person-Centered Practice of Healthcare Professionals at an Inpatient Hospital Department: A Descriptive Study

The characteristics of health professionals and their understanding of person-centeredness may have important implications for the development of person-centered practice in specific care settings. In this study, we characterized the perceptions of the person-centered practice of a multidisciplinary team of health professionals working in the internal medicine inpatient unit of a Portuguese hospital. Data were collected using a brief sociodemographic and professional questionnaire and the person-centered practice inventory-staff (PCPI-S), and the effect of different sociodemographic and professional variables on each PCPI-S domain was determined using an analysis of variance (ANOVA). The results showed that a person-centered practice was positively perceived in the major constructs of prerequisites (M = 4.12; SD = 0.36), the practice environment (M = 3.50; SD = 0.48), and person-centered process (M = 4.08; SD = 0.62) domains. The highest scored construct was developed interpersonal skills (M = 4.35; SD = 0.47), and the lowest was supportive organization systems (M = 3.08; SD = 0.80). Gender was found to influence the perceptions of knowing self (F(2,75) = 3.67, p = 0.03, partial η2 = 0.089) and the physical environment (F(2,75) = 3.63, p = 0.03, partial η2 = 0.088), as was profession on shared decision-making systems (F(2,75) = 5.38, p < 0.01, partial η2 = 0.125) and commitment to the job (F(2,75) = 5.27, p < 0.01, partial η2 = 0.123), and the educational level on being professionally competent (F(1,75) = 4.99, p = 0.03, partial η2 = 0.062) and having commitment to the job (F(2,75) = 4.49, p = 0.04, partial η2 = 0.056). In addition, the PCPI-S proved to be a reliable instrument for characterizing healthcare professionals' perceptions of the person-centeredness of care in this context. Identifying personal and professional variables that influence these perceptions could provide a starting point for defining strategies to move practice toward person-centeredness and for monitoring changes in healthcare practice.

Promoting sleep and rest of infants using nonpharmacological interventions within the neonatal intensive care unit at Children's of Mississippi.

This project aimed to promote evidence-based practices regarding the promotion of sleep and rest using nonpharmacological interventions for infants in the neonatal intensive care unit (NICU) at Children's of Mississippi. Sleep is a basic physiological need that plays a fundamental role in the growth and development of infants. Unfortunately, infants admitted to the NICU after birth may not receive adequate sleep and rest, especially when compared to infants discharged home after delivery. The project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research in Practice audit tool for promoting change in healthcare practice. A baseline audit of NICU staff and patient caregivers was conducted and measured against five best practice recommendations, followed by implementation of targeted strategies and a follow-up audit. The project team discovered two barriers to sleep promotion and rest in the NICU at Children's of Mississippi: lack of nurse knowledge of evidence-based practices for promotion of sleep and rest for infants in the NICU and a lack of location in the electronic health record to document sleep quality of infants. Strategies were implemented to address these barriers and compliance improved in four of the five audit criteria. Implementation of an educational PowerPoint that focused on sleep promotion of infants in the NICU was developed and distributed to all of the nurses and resulted in average increased compliance from 43% to 53% for all audit criteria.

Rhinoplasty in the COVID-19 Era: Practice and Safety Considerations.

The COVID-19 pandemic has required changes in health care practices to decrease the risk of disease transmission during the provision of medical care. The risk of transmission is high in procedures involving the nasopharyngeal and oropharyngeal tissues. This article describes simple preventative strategies at a single institution to minimize the risk of disease transmission during rhinoplasty procedures. In particular, the utility of povidone-iodine in prophylaxis during the perioperative period is discussed.

Person-Centered Practice in Hospitalized Older Adults with Chronic Illness: Clinical Study Protocol.

The aging trend in the population, the high rate of hospitalization, the affliction by multiple chronic illnesses, and the increased vulnerability of older people when hospitalized undoubtedly require a person-centered approach to healthcare—an approach that values a person’s participation in the healthcare relationship, supports shared decision making and mutual understanding, and respects a person’s values, preferences, and beliefs. However, despite widespread recognition that the adoption of such a clinical practice paradigm is paramount, its implementation and development are still challenging for various health systems and professionals worldwide. The implementation strategy for such a healthcare paradigm must be based on each country’s health system organization and practice contexts, as well as the professionals involved. The present work aims to provide guidelines for the understanding of the state of development of person-centered practice in the daily care of hospitalized older adults with chronic illnesses within the internal medicine department of a secondary hospital in an urban area of Portugal. We focus on the characterization of (i) the perceptions of a multidisciplinary team working at an inpatient hospital department of person-centered practice, (ii) the perceptions of hospitalized older adults with chronic illnesses about person-centered practice, (iii) the work culture of an inpatient hospital department with a high prevalence of older adults with chronic illnesses, (iv) the Person-Centred Practice Framework at the organizational and structural levels of the healthcare system, and (v) the elements that influence the implementation of person-centered practice at the individual, organizational, and structural levels in this specific hospital context. To this end, a mixed-methods analysis with a convergent design was planned to use questionnaire instruments to collect data in parallel and independently from distinct samples of health professionals and older inpatient adults within this department. Furthermore, health policies and strategic plans will be analyzed to identify and evaluate references and guidelines for the practice of person-centered care. Studying the dimensions of clinical practice in this specific healthcare context following the Person-Centred Practice Framework can allow us to understand the extent of its development in terms of prerequisites, care environment, care processes, and the macro-context of the healthcare system. Therefore, it is possible to identify and characterize the dimensions achieved and those that need to be improved and, thus, establish a starting point for the definition of new strategies to advance practice towards person-centeredness and monitor changes in healthcare practice.

Medical device-related pressure injury prevention related to fixation of nutritional and derivative probes: a best practice implementation project.

The main objective was to improve the provision of clinical care in pressure injury prevention related to the use of medical devices focused on nasogastric probes. The insertion of nasogastric probes could lead to the formation of medical device-related pressure injuries (MDRPI). The risk increases with the length of the probe insertion and is higher in patients in intensive care. MDRPI prevention is mostly based on appropriate skin and mucosa membrane and tissue monitoring and positioning of the medical devices. The project has been conducted based on JBI Implementation approach for promoting change in healthcare practice. A baseline audit on MDRPI prevention was undertaken and involved 21 nurses and 12 patients using a questionnaire for nurses and a record sheet for patient's monitoring. The intervention included education, clinical practice training, consultation, and other strategies. A follow-up audit was undertaken, including all original participants. Results data on changes in compliance were measured using descriptive statistics embedded in JBI-PACES in the form of percentage changes from baseline. There were significantly improved outcomes across all best practice criteria. The level of knowledge of nurses increased. Skin barrier creams and mass-supplied fixation are now used to prevent skin injuries on the nose. The new monitoring and documentation is more accurate and in line with evidence-based practice. Overall, the project achieved an improvement in evidence-based practice in the prevention of MDRPI in patients with nasogastric probes based on nurses' increased level of knowledge and usage of appropriate preventative measures.

Portable Biosafety Barrier Innovations to Limit Transmissibility of Infectious Diseases during Patient Care in Resource-limited Settings during the COVID-19 Pandemic.

ABSTRACTBackgroundThe coronavirus disease-2019 (COVID-19) pandemic has brought about a change in healthcare practices that are likely to persist into the foreseeable future. In particular, is the exposure risk to the healthcare practitioners in the emergency department (ED) and the intensive care units. Mitigating this issue in a low-resource setting remains challenging, and in particular, in developing nations such as India, where ED patient flows can overwhelm a system and its human resources, breaking down processes and infecting healthcare workers (HCWs).TechniqueTo tackle this and the possible lack of appropriate personal protective equipment (PPE), we designed and built biosafety barrier devices using local resources for use in patient stabilization, transport, and continued care in the ED or the intensive care units.ResultsFour biosafety devices bio-safe levels 1 and 2, ultra-ductile portable interface of interventions in infections, and tented transport trolley for transmissibility (4T) were tested for the feasibility of usage for patient care during the pandemic with simulation.ConclusionWe anticipate that with time it may be common practice for in situ isolation of patients in the emergency departments with a suspicion of an infectious disease. With the proof of concept, simulation, hospital infection control committee (HICC) approval, and trial run, we look to close the gaps that exist in these initial innovations.How to cite this articleBalakrishnan JM, Sirur FM, Prakash N, Bhat R, Wilson W, Angadi B, et al. Portable Biosafety Barrier Innovations to Limit Transmissibility of Infectious Diseases during Patient Care in Resource-limited Settings during the COVID-19 Pandemic. Indian J Crit Care Med 2022;26(9):1036–1038.

‘Listening from a Personal Perspective’: Does Co-Designed Mental Health Education Shift Stigma? A Mixed Method Evaluation Study

AbstractMental health stigma by health care practitioners is well established with few education interventions implemented in Australia. Depth of field is a growing body of health humanities research that draws on healthcare consumers as legitimate experts (by experience) to co-design health professions education.This research aimed to explore whether a co-designed (with mental health consumers) education intervention shifts knowledge, attitudes and behavioural intentions of current and future health care practitioners towards caring for people who have experienced mental health issues.A convergent parallel mixed method design was used to collect data utilising a validated anti-stigma assessment tool at two time points pre- and post-intervention (n = 80) followed by qualitative data from semi-structured interviews (n = 10). Descriptive analysis, Wilcoxon Sign-Rank test to compare pre-post responses and interview data were thematically analysed.Collectively, data showed positive shifts in knowledge, attitudes and behavioural intentions towards people who have experienced mental health issues. Three main themes: Making connections: The power of storytelling; Knowledge and attitudes towards Borderline Personality Disorder: Shape, strengthen, challenge; and Inspiring change in health care practice.Co-designed education can positively impact health care practitioners’ knowledge, attitudes and behavioural intentions and has the potential to reframe mental health education toward recovery-oriented practice.

Continuing chronic care services during a pandemic: results of a mixed-method study

BackgroundPatients with chronic diseases have seen unprecedented changes to healthcare practices since the emergence of COVID-19. Traditional ‘on-site’ clinics have had to innovate to continue services. Whether these changes are acceptable to patients and are effective for care continuation are largely unreported.MethodsWe evaluated the effectiveness of care provision at a re-structured chronic care clinic and elicited the patient experiences of care and self-management. We conducted a convergent, parallel, mixed-methods study. Adult patients attending a chronic care clinic were included. We extracted data from 4,849 clinic visits before and during the COVID-19 pandemic, including operational metrics and attendee profile. We also conducted fifteen interviews with patients from the same clinic using a semi-structured interview guide.ResultsRe-structuring the chronic clinic, including the introduction of teleconsultations, home-delivery of prescriptions and use of community-based phlebotomy services, served to maintain continuity of care while adhering to COVID-19 containment measures. Qualitatively, five themes emerged. Patients were able to adjust to healthcare practice changes and adapt their own lifestyles, although poor self-management practices were adopted. While most were apprehensive about attending the clinic, they valued ongoing care access and were reassured by the on-site containment measures.ConclusionsContinuation of routine services is desired by patients and can be achieved through the adoption of containment measures, by greater collaboration with community partners, and the use of technology. Patients adapted to service changes, but poor self-management was evident. To prevent chronic disease relapse, services must strive to innovate rather than suspend services during pandemics.

ATTITUDE OF MILLENNIALS AND GENERATION Z TOWARDS ARTIFICIAL INTELLIGENCE IN SURGERY

Because of its increasing ability to turn ambiguity and complexity in data into actionable-though imperfect-clinical choices or suggestions, artificial intelligence (AI) has the potential to change health care practices. Trust is the only mechanism that influences physicians use and adoption of AI in the growing interaction between humans and AI. Trust is a psychological process that enables people to deal with ambiguity in what they know and do not know. The purpose of this online survey was to determine the relationship between age groups, familiarity, and trustworthiness present towards AI through the question of whether particular participants would prefer a human or an AI surgeon if they had to undergo a surgery.The results showed that age groups and trustworthiness are not correlated, due to a variety of factors, and,also, familiarity is not correlated with age group.

A Lesson / An Eye Opener

The pandemic of Coronavirus disease 2019 (COVID-19) has led to serious implications throughout the globe ranging from finance, education, social support to health. There is hardly any aspect left untouched by this fatality. It has also opened our eyes about unequal and unjust distribution of resources among the world where the deprived have seen the worse scenarios. The developed nations tried to cope this situation with their assets while the rest have either suffered or have emerged even stronger. The major burden was definitely on the health services delivery and provision, where the scares means from equipment to space and man power have all played their role. The pandemic has opened the eyes of health policy makers and service providers who were living in deception and have never been ready for certain contagion. We have come to know that the medical services are never enough to deal with similar situation. COVID-19 has taught us the skill of how to be prepared and fight in a worse situation but unfortunately, we have learned this after losing many precious lives. The changes in healthcare practices have also been modified. The infection control (IC) system which should have been a focus prior became a highlight after pandemic. The IC practices in hospitals (public and private sector) were not sufficient and adherence to them wasn’t observed either. Even the majority of services providers and heath care professionals weren’t aware of use of personal protective equipment (PPE); their use and sequences of donning and doffing, except for those working in intensive care units and isolation areas. Thanks to COVID-19 who taught us to be familiar with these things whether their use is un-common. COVID-19 has also been a guide for people in rehabilitation who are prime part of recovery from all illnesses including this pandemic. COVID-19 was found to be a cause of multiple complications i.e. pulmonary, cardiac, neurological, musculoskeletal, psychological and social. Attention was also diverted to recovery in all the mentioned aspects which led to provision and improvements in tertiary care setups with focus on rehabilitation as a mode of full recovery. The stakeholders have started to be more focused on improving the mental and physical aspects of disease along with the physiological. The rehabilitation and physical therapy services have not been spared from the pandemic. Where the physical therapy professionals were not ready and well trained to deal with contagious diseases and safety measures it put us in a bigger challenge. Many clinics and hospitals had scares availability of personnel protective equipment (PPE) which also lead to seriousness of situation. As for provision of physical therapy care direct contact with patients cannot be limited, and lack of knowledge on unavailability of PPE could put therapist’s or the patient’s life in danger. Covid-19 opened the eyes and importance of teaching safety measures and donning and doffing of PPEs was learned with appropriate sequence. Although the well-organized hospitals were also working as per global standard protocols had least difficulty dealing with such issues. The physical therapists are trained to deal with such emergencies and critical situations but not being exposed to a pandemic and emergency like this has made the suppression of such reflexes in practice. The therapist learned to manage patients with optimum precautions making sure that the quality of care is not compromised. Several tele-rehabilitation models have also been develop and practiced to encounter the issue.1, 2 Hence we would take COVID-19 as an eye opener and as taught to be fair in the division of global resources and be prepared for a disaster that doesn’t discriminate among developed and undeveloped nations. The efficient use of services and being aware of emergency and safe healthcare practices can save us from unpredictable disasters like COVID-19.

Scaling Evidence-Based Interventions to Improve the Cardiovascular Health of People With Serious Mental Illness.

People with serious mental illnesses (SMIs) experience excess mortality, driven in large part by high rates of cardiovascular disease (CVD), with all cardiovascular disease risk factors elevated. Interventions designed to improve the cardiovascular health of people with SMI have been shown to lead to clinically significant improvements in clinical trials; however, the uptake of these interventions into real-life clinical settings remains limited. Implementation strategies, which constitute the “how to” component of changing healthcare practice, are critical to supporting the scale-up of evidence-based interventions that can improve the cardiovascular health of people with SMI. And yet, implementation strategies are often poorly described and rarely justified theoretically in the literature, limiting the ability of researchers and practitioners to tease apart why, what, how, and when implementation strategies lead to improvement. In this Perspective, we describe the implementation strategies that the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness is using to scale-up three evidenced-based interventions related to: (1) weight loss; (2) tobacco smoking cessation treatment; and (3) hypertension, dyslipidemia, and diabetes care for people with SMI. Building on concepts from the literature on complex health interventions, we focus on considerations related to the core function of an intervention (i.e., or basic purposes of the change process that the health intervention seeks to facilitate) vs. the form (i.e., implementation strategies or specific activities taken to carry out core functions that are customized to local contexts). By clearly delineating how implementation strategies are operationalized to support the interventions' core functions across these three studies, we aim to build and improve the future evidence base of how to adapt, implement, and evaluate interventions to improve the cardiovascular health of people with SMI.

Changing Patterns of Bloodstream Infections in the Community and Acute Care Across 2 Coronavirus Disease 2019 Epidemic Waves: A Retrospective Analysis Using Data Linkage.

BackgroundWe examined community- and hospital-acquired bloodstream infections (BSIs) in coronavirus disease 2019 (COVID-19) and non–COVID-19 patients across 2 epidemic waves.MethodsWe analyzed blood cultures of patients presenting to a London hospital group between January 2020 and February 2021. We reported BSI incidence, changes in sampling, case mix, healthcare capacity, and COVID-19 variants.ResultsWe identified 1047 BSIs from 34 044 blood cultures, including 653 (62.4%) community-acquired and 394 (37.6%) hospital-acquired. Important pattern changes were seen. Community-acquired Escherichia coli BSIs remained below prepandemic level during COVID-19 waves, but peaked following lockdown easing in May 2020, deviating from the historical trend of peaking in August. The hospital-acquired BSI rate was 100.4 per 100 000 patient-days across the pandemic, increasing to 132.3 during the first wave and 190.9 during the second, with significant increase in elective inpatients. Patients with a hospital-acquired BSI, including those without COVID-19, experienced 20.2 excess days of hospital stay and 26.7% higher mortality, higher than reported in prepandemic literature. In intensive care, the BSI rate was 421.0 per 100 000 intensive care unit patient-days during the second wave, compared to 101.3 pre–COVID-19. The BSI incidence in those infected with the severe acute respiratory syndrome coronavirus 2 Alpha variant was similar to that seen with earlier variants.ConclusionsThe pandemic have impacted the patterns of community- and hospital-acquired BSIs, in COVID-19 and non–COVID-19 patients. Factors driving the patterns are complex. Infection surveillance needs to consider key aspects of pandemic response and changes in healthcare practice.