Coronavirus Disease 2019 Protocols Research Articles

The Impact of a Pandemic on a Military Oral and Maxillofacial Pathology Biopsy Service.

Coronavirus disease 2019 (COVID-19) and the resulting societal reaction presented new challenges to the medical community by limiting patient access to care in 2020 and 2021. The Navy Postgraduate Dental School (NPDS) oral and maxillofacial pathology biopsy service is dependent on in-office physician or dentist appointments and patient biopsies. The purpose of this study was to understand the regulatory and societal impacts of COVID-19 restrictions on biopsy service submissions by assessing NPDS biopsy submission quantities and disease distribution. All NPDS oral and maxillofacial pathology biopsy submissions from calendar years 2015 to 2016 and 2019 to 2021 were evaluated, and patient demographics and biopsy diagnoses were recorded in a biopsy registry. Data collected included age, sex, biopsy site, and diagnosis. Data from 2015, 2016, and 2019 were defined as pre-COVID and 2020 and 2021 as COVID. Biopsy reports for each year were organized in quarters. Diagnoses were categorized as malignant, pre-malignant, or benign. Categorical and continuous data were evaluated and presented as counts with percentages and means or medians with standard deviations, respectively. Significant differences in proportions or means were assessed using chi-square analysis or Student t-test, respectively. Cases were aggregated by quarter and year and assessed for temporal trends using linear regression analysis. The study evaluated 9,351 biopsy submission reports. The annual pre-COVID count mean (± standard deviation) and yearly counts for 2020 and 2021 were 2,063 ± 33.3, 1,421, and 1,742, respectively. The mean (± standard deviation) percentage of diagnoses classified as malignant from pre-COVID, 2020, and 2021 were 2.46 ± 0.005%, 3.59%, and 3.04%, respectively. Case counts and representation as a percentage of all biopsy diagnoses for Human Papillomavirus (HPV)-associated squamous cell carcinoma increased significantly during COVID compared to pre-COVID years (P < .05). Overall, preventative COVID-19 health measures and protocols resulted in a reduction in biopsy submission frequency, particularly during the second quarter (April to June) of 2020. However, case counts for malignant biopsies remained consistent between pre-COVID and COVID time intervals, suggesting that the identification and analysis of cases requiring follow-on care were unaffected by COVID-19 protocols.

Determining the nurses' perception regarding the effectiveness of COVID-19 protocols implemented in Eastern Province: Saudi Arabia.

The global impact of Coronavirus Disease 2019 (COVID-19) has been profound, affecting public health, the global economy, and overall human life. Past experiences with global pandemics underscored the significance of understanding the perception of HCWs and hospital staff in developing and implementing preventive measures. The World Health Organization (WHO) provided protocols to manage the spread of COVID-19 and assist healthcare workers and health systems globally in maintaining high-quality health services. This study aims to assess nurses' perception, awareness, and compliance regarding the implementation of COVID-19 protocols and explore factors influencing their perception. A quantitative cross-sectional survey-based study was conducted, distributing a constructed survey among nurses in the Eastern Province of Saudi Arabia. Out of 141 participants, most adhered to protocols such as hand sanitization, social distancing, and proper personal protective equipment (PPE) usage. The predominant age group among respondents was 31 to 40 years (n = 71, 50%). A significant portion of participants reported holding a bachelor's degree (n = 86, 61%), with only 14% possessing advanced degrees (n = 19). Nearly a third of the nurses in the study had accumulated 6 to 10 years of professional experience (n = 49, 34.8%). A noteworthy percentage of nurses were engaged in daily shifts exceeding 8 h (n = 98, 70%). Gender differences were observed, with females exhibiting a higher tendency to avoid shaking hands and social gatherings. Saudi nationals were more inclined to shake hands and engage in gatherings. Non-Saudi nurses and those aged between <25 to 40 years demonstrated proper donning/doffing practices. Nurses with over 6 years of experience avoided social gatherings, while those working >8 h adhered better to PPE usage, proper donning/doffing, and disposal of PPE in designated bins. Understanding COVID-19 protocols is crucial for tailoring interventions and ensuring effective compliance with COVID-19 preventive measures among nurses. More efforts should be made toward preparing the healthcare nursing to deal with the outbreak. Preparing healthcare nursing with the right knowledge, attitude, and precautionary practices during the COVID-19 outbreak is very essential to patient and public safety.

Impact of COVID-19 infection during the postoperative period in patients who underwent gastrointestinal surgery: a retrospective study.

The coronavirus disease 2019 (COVID-19) pandemic has led to significant global casualties. This study examines the postoperative impact of COVID-19 on patients who underwent gastrointestinal surgery, considering their heightened vulnerability to infections and increased morbidity and mortality risk. This retrospective observational study was conducted at a tertiary center and patients who underwent gastrointestinal surgery between January 2022 and February 2023 were included. Postoperative COVID-19 infection was defined as the detection of severe acute respiratory syndrome coronavirus 2 RNA by RT-PCR within 14 days after surgery. Propensity score matching was performed including age, sex, American Society of Anesthesiology physical status classification, and emergency operation between the COVID-19-negative (-) and -positive (+) groups. Following 1:2 propensity score matching, 21 COVID-19(+) and 42 COVID-19(-) patients were included in the study. In the COVID-19(+) group, the postoperative complication rate was significantly higher (52.4% vs. 23.8%, P = 0.023). Mechanical ventilator requirement, intensive care unit (ICU) admission, and readmission rate did not significantly differ between the 2 groups. The median length of ICU (19 days vs. 4 days, P < 0.001) and hospital stay (18 vs. 8 days, P = 0.015) were significantly longer in the COVID-19(+) group. Patients with COVID-19 had a 2.4 times higher relative risk (RR) of major complications than patients without COVID-19 (RR, 2.37; 95% confidence interval, 1.254-4.467; P = 0.015). COVID-19 infection during the postoperative period in gastrointestinal surgery may have adverse outcomes which may increase the risk of major complications. Preoperative COVID-19 screening and protocols for COVID-19 prevention in surgical patients should be maintained.

Pandemic politics: Exploring the intersection of state political affiliation and public universities' COVID-19 policies and messaging.

As coronavirus disease 2019 (COVID-19) spread within the United States, the challenge of responding to a large-scale health crisis was compounded as the federal government struggled to deliver a unified response. Decision-making powers for pandemic protocols were passed to individual states, whose responses were heavily influenced by their administrations' partisan political leanings. This study explores differences in the transparency of COVID-19 information on university websites and the restrictiveness of the measures they implemented by examining university messaging in all-Republican and all-Democrat controlled states. This study employs a quantitative content analysis of a census of websites (N = 265) from public universities located in states with government trifectas. The data reveal that masking, vaccination, and testing measures were significantly more restrictive among universities located in Democratic trifectas than in Republican trifectas. Additionally, universities in Democratic trifectas communicated more transparently, such that they were more likely to have a direct link to COVID-19 information on their homepages. The results indicate that universities in states where a single political party holds power implemented COVID-19 protocols that reflected the political -viewpoints on the health and economic responses to the pandemic. This finding offers important evidence that both governments and public universities based their public health decisions on political factors.

COVID-19 Guidelines Adherence and Vaccine Acceptability Among Pregnant Women in Niger Foundation Hospital Enugu, South-Eastern Nigeria: A Mixed Method Study

Objectives: This study aimed to determine the acceptability of coronavirus disease 2019 (COVID-19) vaccines and adherence to the preventive protocol among pregnant antenatal attendees in Niger Foundations Hospital Enugu, South-Eastern Nigeria. Materials and Methods: Using a cross-sectional descriptive survey and in-depth interviews, we conducted a mixed method study from June to December 2021. We administered a structured questionnaire to 210 pregnant women to assess their knowledge and adherence to COVID-19 guidelines and interviewed 25 individuals. Quantitative and qualitative data were analyzed using SPSS v.28 and thematic analysis, respectively. Results: The participants’ age range was 20-43 years, with a mean of 29.9 (4.8) years. Most individuals (81.9%) had a university degree, 40.5% were skilled workers, and 73.3% had parity 0-1. They identified close contact (87.1%), respiratory distress (96.2%), and handwashing with soap (96.2%) as the commonest mode of transmission, symptom, and preventive strategy of COVID-19, respectively. Older women and individuals with higher parity had lower knowledge and adherence to COVID-19 precautions. Most participants rejected the vaccines due to fear of the side effects on themselves and the fetus. Conclusions: Although there was good adherence to COVID-19 protocols among the pregnant women in this study, vaccine acceptance/uptake rate was low. Education on vaccine advantages and correction of conspiracy theories are recommended.

Impact of health workers observance of the COVID-19 protocols on medication adherence among persons living with HIV/AIDS attending an ART clinic in Central Hospital Warri, Nigeria

The interruption of the continuum of care of persons living with Human Immundeficiency Virus /Acquired Immunodeficiency Syndrome (HIV/AIDS) by the Coronavirus Disease 2019 (COVID-19) pandemic could lead to the worsening of their state. This study assessed the impact of the observance of COVID-19 protocols by healthcare providers on patients’ adherence to their antiretrovirals. This was a retrospective study carried out in Central Hospital, Warri-Nigeria. Patients (18 years and above) attending the Heart-to-heart clinic and receiving Antiretroviral Therapy (ART) for at least six months prior to and during the COVID-19 pandemic were included in the study, socio-demographic data , viral load and appointment diaries in the period preceding and during the pandemic were obtained. Descriptive statistics were done for demographic data, relationship between viral suppression and COVID-19 era were determined using a chi squared test, mean difference in appointment visits kept before and during COVID -19 pandemic was determined with the aid of a paired sample t- test. One hundred and fifty-six cases were assessed, mean age was 49.12±0.83, 115 (73.4%) were female, 108(59%) married, self-employment, 93(59.6%), was the commonest means of livelihood and the majority, 132(84.6%), had been on ART for a duration of 11-15 years. There was a significant relationship between viral load suppression and the periods studied (p&lt;0.001), mean appointments kept was significantly higher during than before the COVID-19 pandemic (p=0.002). The observance of measures to curb the spread of COVID-19 by healthcare workers did not reduce the level of adherence to antiretroviral therapy (ART) in persons living with HIV/AIDS (PLWHA).

Diffracting the Global: Exploring the Implementation of WHO’s COVID-19 Protocols in Sub-Saharan Africa

The coronavirus disease 2019 (COVID-19) has impacted the world in unprecedented ways. To deal with the virus, countries across the world implemented COVID-19-related protocols that include social distancing, washing hands, wearing masks and restricting movements of people. While the literature on the impact of COVID-19 is emerging, it is still relatively unknown how the virus affected countries in sub-Saharan Africa. This article explores the impact of COVID-19 protocols in sub-Saharan Africa. The article broadly argues that an all-assuming and globalised approach of COVID-19 protocols is antithetical to the sub-Saharan African continent with its vast territories and unique populations. The article highlights that the African continent that houses the world’s poorest populations cannot be adequately served by COVID-19 protocols in similar ways to Western countries. It is further suggested that COVID-19 protocols that reify universalism may need to be adapted and domesticated to fit the African context. The article provides critical insights into the experience of COVID-19 protocols that has several policy implications for future pandemics and disease outbreaks in the African continent.

Effect of Home-based Pulmonary Rehabilitation Program on Anxiety and Depression in COVID-19 Patients

Background: Respiratory failure caused by pneumonia is the leading cause of death in coronavirus disease 2019 (COVID-19) patients; furthermore, anxiety and depression caused by this disease and its complications, as the most common psychological disorders might harm the mental health of COVID-19 patients. Objectives: This study aimed to look into the effect of a home-based pulmonary rehabilitation (HBPR) program on anxiety and depression in COVID-19 patients (severe acute respiratory syndrome). Methods: This randomized clinical trial was conducted on 70 COVID-19 patients in Kerman, Iran, in 2021, randomly allocated into 2 equal groups of control (n = 35) and intervention (n = 35). In the control group, the patients received only routine post-discharge care, and in the intervention group, the patients received HBPR procedures based on the “Guide to Restoring Movement COVID-19 Protocol” by John Hopkins University, the United States, that teaches to patients after discharge. The Hospital Anxiety and Depression Scale was used to determine anxiety and depression status and scores before and after 4-week procedures. Additionally, the chi-square, Fisher’s exact, and Mann-Whitney U tests were used to compare anxiety and depression status and scores between the 2 groups. P &lt; 0.05 was considered statistically significant. Results: The median score of anxiety (5 vs. 14, P &lt; 0.0001) and depression (6 vs. 10, P &lt; 0.0001), 4 weeks after discharge from the hospital in the intervention group, was significantly lower than in the control group based on the Mann-Whitney U test (P &lt; 0.0001). Conclusions: This rehabilitation procedure is effective in the reduction of anxiety and depression in COVID-19 patients and their pulmonary status. Therefore, it can be used as a treatment procedure for mental recovery in these patients.

Link between COVID-19 vaccines and myocardial infarction.

BACKGROUNDVaccines for coronavirus disease 2019 (COVID-19) include ChAdOx1-SARS-COV-2 (AstraZeneca), Ad26.COV2.S (Janssen), mRNA-1273 (Moderna), BNT162b2 (Pfizer), BBIBP-CorV (Sinopharm), CoronaVac (Sinovac), and Bharat Biotech BBV152 (Covaxin).AIMTo find the association between COVID-19 vaccines and myocardial infarction (MI).METHODSThis is a systematic review that involved searching databases such as MEDLINE, EMBASE, and PakMediNet after making a search strategy using MeSH and Emtree terms. Eligibility criteria were set, and studies having no mention of MI as a complication of COVID-19 vaccination, protocols, genetic studies, and animal studies were excluded. Data was extracted using a predesigned extraction table, and 29 studies were selected after screening and applying the eligibility criteria.RESULTSThe majority of studies mentioned AstraZeneca (18 studies) followed by Pfizer (14 studies) and Moderna (9 studies) in subjects reporting MI after vaccination. Out of all the studies, 69% reported MI cases after the first COVID-19 vaccination dose and 14% after the second, 44% reported ST-segment elevation MI, and 26% reported non-ST-segment elevation MI. The mortality rate was 29% after MI.CONCLUSIONIn conclusion, many studies linked MI to COVID-19 vaccinations, but no definitive association could be found.

Efficacy and safety of sonographer discretion to terminate a venous duplex ultrasound for diagnosis of deep vein thrombosis in coronavirus disease 2019 patients

ObjectiveSonographers performing venous duplex ultrasound (VDUS) of patients with coronavirus disease 2019 (COVID-19) have an increased risk of exposure owing to their close contact with these patients for an extended period. The objective of the present study was to evaluate the efficacy of a modified COVID-19 VDUS protocol to reduce sonographer exposure to COVID-19 patients. MethodsWe performed a single-center retrospective review. Patients who had undergone VDUS under the modified COVID-19 protocol between March 1, 2020, and June 30, 2020, with a confirmed or presumed COVID-19 diagnosis at the VDUS were included. The modified COVID-19 protocol was defined as the ability of the sonographer to terminate the examination on detection of an acute deep vein thrombosis (DVT). The primary outcome measures were the number of anatomic deep venous segments recorded by the sonographer, which was used as a surrogate measure for sonographer exposure time, and the number of acute DVTs found on follow-up examinations in segments not visualized at the index VDUS. ResultsA total of 160 lower extremity VDUS (LEVDUS) scans and 72 upper extremity VDUS (UEVDUS) scans were performed using the modified COVID-19 protocol. The index VDUS had found an acute DVT for 44 of 160 patients (27.5%) who had undergone LEVDUS and 26 of 72 (36.6%) who had undergone UEVDUS. On follow-up imaging, 7 of 38 LEVDUS scans (17.9%) and 1 of 10 UEVDUS scans (10%) had demonstrated a new acute DVT. Malignancy and surgery 30 days before imaging were significantly associated with acute lower extremity DVT, and mechanical ventilation and extracorporeal membrane oxygenation were associated with acute upper extremity DVT. On the index VDUS, the average was 10.6 of 12 total visualized segments on LEVDUS and 6.4 of 10 total segments on UEVDUS. Of the index VDUS scans, 35.6% of the LEVDUS and 78.6% of the UEVDUS scans had been abbreviated. The index VDUS scans that were positive for acute DVT had had significantly fewer visualized segments for both lower (8.4 vs 11.5; P < .0001) and upper (4.2 vs 7.6) extremities (P < .0001). On the follow-up examinations, only one of eight new acute DVTs had been found in a patient whose index VDUS had been abbreviated and the corresponding segment not assessed. These findings did not affect the patient’s clinical course. ConclusionsThe modified COVID-19 VDUS protocol reduced sonographers’ potential exposure time to COVID-19. Additionally, the clinical efficacy was maintained, with no missed DVTs, despite the abbreviation of the VDUS examinations.

Assessing the influence of COVID-19 protocol on online health information seeking intention of athletes in India

PurposeThe Internet is used as a tool to seek health information by individuals. Mental health concerns are the high prevalence of the novel coronavirus disease 2019 (COVID-19) and preventive steps are required to curb the illness. Therefore, to gain more insight into health concerns, it is now a common practice to seek health information on the Internet. This study propose an integrated theoretical model to explore the relationship between COVID-19 protocols and perceived online trust with online health information seeking intention (OHISI) and a moderating effect of perceived severity and perceived urgency.Design/methodology/approachData are collected from 325 athletes in the category of individual and team sports through an online survey in a Likert-scale questionnaire. The analysis is performed with a quantitative methodology.FindingsThe study reveals the bright side of online health information (OHI), which brings athletes together and has played out with virtual happy hours, meetings and events. The bright side of OHI reflects social, cultural, technological and economic benefits. An OHI chatbot offers bright personalised side information to the individual seeker, which is more convenient and efficient than human capabilities.Originality/valueThe pivotal contribution is the integrated theoretical framework that is derived from multidisciplinary literature to capture the complexity of OHI. Also, it conceptualises the constructs in the context of OHI and COVID-19.

Characteristics of 100 consecutive patients with COVID-19 referred to consultation-liaison psychiatry services in Qatar: A comparison of patients with delirium versus other psychiatric diagnoses.

Introduction: Coronavirus disease 2019 (COVID-19) can present with various neuropsychiatric manifestations. This study reports on patients with COVID-19 who were referred to the consultation–liaison (CL) psychiatry services in Qatar and compares the clinical and sociodemographic characteristics of those diagnosed with delirium versus other psychiatric diagnoses. Methods: This is a retrospective review of the first 100 consecutive patients with COVID-19 who were referred to the CL services. Results: Within the total cohort (n=100), most patients (92%) were male, and the mean age was 46 years. About 27% of patients had asymptomatic COVID-19, 35% had a past psychiatric history, and 48% reported pandemic related psychosocial stress. Delirium was the most common psychiatric diagnosis (n=29), followed by acute stress reaction/adjustment disorder, depression, mania, anxiety, non-affective psychosis, and dementia. Among patients with delirium, agitation was the most common symptom (76%), 86% were treated with psychotropic medications, and 17% died. Higher age, longer hospital stays, lower oxygen saturation, lower lymphocytic count, and higher C-reactive protein (CRP) values were significantly associated with delirium versus other psychiatric diagnoses. Higher age and lower oxygen saturations predicted delirium.Conclusion: Delirium was associated with a range of clinical variables and had significant mortality, despite the relatively young age of the patients. COVID-19 should be considered in patients presenting with delirium. Finally, early identification and management of delirium should be integral to COVID-19 protocols.

The Impact of COVID-19 Protocols on the Continuity of Care for Patients with Hypertension.

The aim of this study was to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the continuity of care (COC) for patients with hypertension. Additionally, the factor of whether participants were treated via telemedicine was also considered. This study used the National Health Insurance and Medical Aid claims data of the Republic of Korea between 2019 and 2020. Multivariable regression analysis was performed to identify the differences in the number of visits and the most frequent provider continuity (MFPC) of hypertensive patients before and after the appearance of COVID-19 in Korea. Additional analysis was performed with data that excluded cases of patients who received telemedicine services. A total of 5,791,812 hypertensive patients were included in this study. The MFPC decreased by 0.0031 points after the appearance of COVID-19, and it showed the same decrease even when telemedicine cases were excluded. The number of outpatient clinic visit days decreased by 0.2930 days after the appearance of COVID-19. Without the telemedicine cases, the number of outpatient clinic visit days decreased by 0.3330 days after the appearance of COVID-19. Accordingly, the COVID-19 protocols did not affect hypertension patients’ COC but impacted the frequency of their outpatient visits. In other words, with or without telemedicine, the utilization of healthcare was not disrupted, but there was a significant difference in the volume of healthcare use depending on the inclusion of telemedicine cases.

Perception of healthcare workers towards the government's Coronavirus disease 2019 pandemic response in Ekiti State, Nigeria: A cross sectional study

Background: Globally, coronavirus 2019 pandemic has led to severe illnesses, loss of lives, and social disruption in Nigeria. Ekiti State government introduced different strategies, protocols, and standard operating procedures in the control of the pandemic. This study assessed the perception of primary healthcare workers (HCWs) to the measures introduced to combat the coronavirus disease 2019 (COVID-19) pandemic in Ekiti State, Nigeria. Methods: This study was a descriptive cross-sectional study conducted between August and September 2020 among primary HCWs in Ekiti State. A Google survey tool was used to create an online questionnaire which was administered to respondents on social media platform. Analysis was done using STATA SE 12. Descriptive and bivariate analysis were conducted with a level of significance set at P < 0.05. Results: The mean ± standard deviation age of the respondents was 44.2 ± 6.7 years. Almost all (99.4%) of respondents had heard of COVID-19 pandemic while less than three-quarter (67.7%) had been trained on COVID-19. About half (54.6%) and (50.0%), respectively had good knowledge and perception of COVID-19, while three-quarter (75%) had good practice. About half (50.4%) had good perception about government's response toward COVID-19 prevention and protocols. Social and news media and family and friends were significantly associated with respondents' perception toward government' response (P = 0.000; 0.006 and 0.011) respectively. Similarly, the level of perception and practice of respondents were found to be statistically significant with respondent's perception of government response to COVID-19 (P = 0.001 and 0.040) respectively. Conclusion: Only about half of the respondents had good knowledge of COVID-19 and positive perception toward government's response to COVID-19 pandemic. Intensification of government's efforts toward the pandemic control in Nigeria is recommended.

A cross-sectional study on the seroprevalence of the SARS-CoV-2 IgG antibody in patients with cancer from central Kerala

Background: Patients with cancer are vulnerable to coronavirus disease 2019 (COVID-19). Given the rising number of COVID-19 cases and relaxation of stringent COVID-19 protocols, assessment of the level of protective immunity to COVID-19 in patients with cancer has assumed importance.Objectives: Our primary objective was to evaluate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in patients with cancer.Materials and Methods: We conducted a cross-sectional study on 100 patients with solid tumors attending our Oncology Department at the Believers Church Medical College, Kerala, India, between December 2020 and June 2021. Seroprevalence was assessed using the VITROS® Anti-SARS-CoV-2 IgG test (Ortho-Clinical Diagnostics, Rochester, NY, USA). Additionally, we assessed the factors associated with seropositivity and collected data regarding the general experience of patients with cancer during the pandemic.Results: The median age of the participants was 62 years (IQR, 53 - 69.8); 52 (52%) were males. The seroprevalence of the SARS-CoV-2 IgG antibodies was 11% (95% CI, 4.8–17.1). Age < 50 years was the only factor that was significantly associated with a higher rate of COVID-19 antibodies (77% vs 8.9% in patients ≥ 50 years; P = 0.007), and sex, smoking, and the use of alcohol did not show any association. The majority (77/100, 77%) of the patients were worried about contracting COVID-19 infection; some even deferred cancer-directed treatment because of the fear of visiting health care settings.Conclusion: Low seroprevalence of SARS-CoV-2 IgG antibodies in unvaccinated patients with cancer is a matter of concern as it indicates that many of these patients are still vulnerable to infection. There is an urgent need to continue implementing strict safety measures in oncology centers and to encourage widespread COVID-19 vaccination to prevent the uncontrolled spread of COVID-19 among patients with cancer. (Funded by the institution, Believers Church Medical College, Kerala)

Community engagement and compliance monitoring of COVID-19 safety protocols: innovative approach combining indigenous practice and GIS technology in Oyo State, Nigeria

Background: One of the major challenges that has driven the spread of Coronavirus Disease 2019 (COVID-19) worldwide is the burden of enforcing the preventive measures required to contain the pandemic. Enforcement of COVID-19 precautionary behaviour should not be homogenous; every country needs to be creative to ensure that humane considerations guide all decisions during the extraordinary experience that COVID-19 pandemic portends. The model of self-policing is acceptable and maintained principally because the citizens of any communities operate, recognize, and accept them as preferred alternatives to the official models of policing for enforcement. Hence the approach presented in this paper, which deployed existing indigenous alternative systems in ensuring compliance with COVID-19 precautionary behaviour. This article therefore documents the unique approach deployed for the containment of COVID-19 in Oyo State, Nigeria. Objective: This intervention was designed to explore established indigenous alternative systems and models of control, justice, law, security, and enforcement in Nigeria. Additionally, geographic information system (GIS) technology and investigative journalism was used to monitor and evaluate the effectiveness of the intervention. Method: The method employed was community conversation; a method of increasing inclusive, community-based engagement harnessing the expertise and motivation of key stakeholders. The community conversations were convened after the pattern of a traditional Town-hall meeting. Community conversations were organized as a qualitative framework focusing on deploying the indigenous practice of self-policing associated with Nigerias trade unions and aims to inform COVID-19 preventive behaviour at the community level. Geographical information system technology was used to develop COVID-19 Containment Compliance Citizens Reporter App. The App was developed using ESRI ArcGIS online platform to crowd source public feedback on compliance or contravention of COVID-19 protocols. Social media platforms were also deployed for monitoring and evaluation of the intervention post townhall meeting. Results: The establishment of a State-wide Containment response network provided the required inroad for advocacy and deployment of state-wide community conversation framework in the different communities comprising diverse ethnic groups, religious leaders, market leaders, National Union of Road Transport Workers (NURTW), and so on. Testimonials from the various communities showed that the people have embraced the self-policing strategy and the network system was effective with good outcomes in terms of response to decontamination, containment, and advocacy. The COVID-19 Containment Compliance Citizens Reporter App, investigative reporting by mass media were highly effective tools for monitoring and evaluation of the outcome of the intervention as well as possible evidence for melting out incentive and disincentive measures as necessary. This approach is a template, which could be adapted and replicated in other parts of Nigeria and other African societies with similar structures, demographics, and indigenous practices.

Effects of an Infection Control Protocol for Coronavirus Disease in Emergency Mechanical Thrombectomy.

ObjectiveSince the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, neurointerventionists have been increasingly concerned regarding the prevention of infection and time delay in performing emergency thrombectomy procedures in patients with acute stroke. This study aimed to analyze the effects of changes in mechanical thrombectomy protocol before and after the COVID-19 pandemic on procedure time and patient outcomes and to identify factors that significantly impact procedure time. MethodsThe last-normal-to-door, first-abnormal-to-door, door-to-imaging, door-to-puncture, and puncture-to-recanalization times of 88 patients (45 treated with conventional pre-COVID-19 protocol and 43 with COVID-19 protection protocol) were retrospectively analyzed. The recanalization time, success rate of mechanical thrombectomy, and modified Rankin score of patients at discharge were assessed. A multivariate analysis was conducted to identify variables that significantly influenced the time delay in the door-to-puncture time and total procedure time. ResultsThe door-to-imaging time significantly increased under the COVID-19 protection protocol (p=0.0257) compared to that with the conventional pre-COVID-19 protocol. This increase was even more pronounced in patients who were suspected to be COVID-19-positive than in those who were negative. The door-to-puncture time showed no statistical difference between the conventional and COVID-19 protocol groups (p=0.5042). However, in the multivariate analysis, the last-normal-to-door time and door-to-imaging time were shown to affect the door-to-puncture time (p=0.0068 and 0.0097). The total procedure time was affected by the occlusion site, last-normal-to-door time, door-to-imaging time, and type of anesthesia (p=0.0001, 0.0231, 0.0103, and 0.0207, respectively). ConclusionThe COVID-19 protection protocol significantly impacted the door-to-imaging time. Shortening the door-to-imaging time and performing the procedure under local anesthesia, if possible, may be required to reduce the door-to-puncture and door-to-recanalization times. The effect of various aspects of the protection protocol on emergency thrombectomy should be further studied.

Masks, Empathy, and a Pediatric Cancer Diagnosis During COVID-19.

Masks, Empathy, and a Pediatric Cancer Diagnosis During COVID-19.

Impact of COVID-19 pandemic on indigenous contractors in a developing economy

PurposeThe purpose of this study is to examine the impact of coronavirus disease 2019 (COVID-19) on indigenous contractors in a developing economy with a view to enhancing their performance.Design/methodology/approachThe study used a purposive sampling technique to select 37 indigenous contractors with ongoing construction contracts in Osun State, Nigeria who provided data for the study. A structured interview protocol was used to elicit the required information from the interviewees and frequency, percentage and content analysis were used for data analysis.FindingsThe results showed that the critical impact of COVID-19 on indigenous contractors in a developing economy is: time overrun, loss of profit and creation of dispute. Further results showed that other impacts are a disruption in supply of labour, locally sourced materials are with additional cost, the additional cost of implementing COVID-19 protocols, difficulty in sourcing imported materials and absence of new jobs with the corresponding retrenchment of workers.Practical implicationsThe study recommended special palliatives for the indigenous contractors from the government so as to cushion the impact of the pandemic on them, thereby enhance their survival and performance. A special arbitration panel is set up in each state of the federation to look at disputes arising from the aftermath of the pandemic, this is with a view to adequately compensate indigenous contractors with genuine and properly compiled claims. inferring from the findings of the study, it suffices to say that the severity of the impact of the pandemic is very high on indigenous contractors in developing economies, as such a better preparedness strategy could lessen the impact of such pandemic in the future.Originality/valueThe study is an attempt to unearth the impact of COVID-19 on indigenous contractors with ongoing construction contracts in a developing economy. The study will be of value to construction stakeholders in providing the information needed to devise strategies to minimise the impact of a pandemic on indigenous contractors in future projects thereby enhance their performance.

Modified PACU Discharge Process During COVID-19 Pandemic

Background InformationCoronavirus disease-2019 (COVID-19) has become a worldwide pandemic that presented challenges and brought extensive changes in the healthcare delivery. Restricting visitation in peri-operative setting is one of the steps adapted by the institution to enhance safety of patients, families and healthcare workers. This had a great impact on the discharge process in the Post-anesthesia Care Unit (PACU).Objectives of ProjectImplement a modified discharge process to ensure safe transfer and continuation of care of post-operative patients.Process of ImplementationVisitor's restriction led to no visitors in perioperative setting except for pediatrics and patients with physical / cognitive limitations. This new process demanded a modified discharge process for outpatients. The two methods used were:•Virtual instruction: Given to family or responsible person by phone before discharging patients from PACU.•Face-to-Face discharge instruction: Provided in one of the four temporary discharge centers created at the entrance to minimize visitation time and exposure to other patients in PACU. Patient families who required one- on -one demonstration and practice identified and escorted to discharge center after COVID screening.Prescriptions for all patients delivered by pharmacy. Copy of after visit summary and patient education provided to family and included in electronic medical record.Statement of Successful PracticeSuccessfully implemented the modified PACU discharge workflow in April 2020. Data collected from 4/1/20 to 1/31/2021 shows that 7,409 patients used the modified discharge process. Out of the 7,409, 86% received instruction through phone call and 14% used the discharge center. Press Ganey patient satisfaction rate with discharge remained high at 96%.Implications for Advancing the PracticeThis project demonstrated the importance of adapting new process to enable safe delivery of care during emergencies. The modified workflow allowed effective transfer of discharge information and patient education for PACU patients while following COVID-19 protocol for visitation. This new model of discharge process can be replicated in similar healthcare environment.