COVID-19 Emergency Research Articles

The impact of emergency guidance to the COVID-19 pandemic on treatment entry, retention and mortality among patients on methadone in Ukraine.

Ukraine's Ministry of Health released urgent COVID-19 guidelines, allowing for early implementation of take-home dosing (THD) for opioid agonist therapies (OAT) such as methadone. Enrollment in OAT and retention in the program are the most effective HIV prevention strategies for people who inject drugs (PWID). This study aimed to evaluate the impact of Ukraine's COVID-19 emergency guidance on OAT treatment enrollment, retention on treatment and mortality. Using Ukraine's national OAT registry for 252 governmental clinics across 25 regions, we conducted a 12-month comparative prospective cohort survival analysis. This study compared newly enrolled methadone patients within the initial 6 months following the COVID-19 guidance (COVID) with patients from the preceding year (pre-COVID) in a country with high adult HIV prevalence (1.2%) that is concentrated in PWID. In the nation-wide sample of newly enrolled PWID in Ukraine, comprising 2798 individuals, 1423 were in the COVID cohort and 1375 were in the pre-COVID cohort. The majority were male (86.7%), with an average age of 39.3years. Primary outcomes were average monthly enrollment per cohort, treatment retention and mortality, with internal time-dependent predictors, including THD and optimal (> 85 mg) methadone dosing. Relative to the pre-COVID period, the monthly average patient enrollment was statistically significantly higher during the COVID period (283.7 versus 236.0; P < 0.0001), where patients were more likely to transition to THD and achieve optimal dosing earlier. Significant differences were observed in the proportions of person-months on THD (41 versus 13%, P < 0.0001) and optimal dosing (38 versus 31%, P < 0.0001) between the COVID and pre-COVID cohorts. Predictors of treatment retention, expressed as adjusted hazard ratios (aHR), included early THD [aHR = 1.90, 95% confidence interval (CI) = 1.47-2.45], early optimal dosing (aHR = 1.71, 95% CI = 1.37-2.13) and prior methadone treatment (aHR = 1.39, 95% CI = 1.15-1.68). These factors persisted, respectively, in the pre-COVID (aHR = 2.28, 95% CI = 1.41-3.70; aHR = 1.84, 95% CI = 1.32-2.56; and aHR = 1.36, 95% CI = 1.06-1.74) and COVID (aHR = 1.91, 95% CI = 1.40-2.59; aHR = 1.61, 95% CI = 1.20-2.16; and aHR = 1.49, 95% CI = 1.08-1.94) cohorts. Survival did not differ significantly between the two prospective cohorts. Ukraine's prompt adoption of early take-home dosing for opioid agonist therapies, such as methadone, following the emergency COVID-19 guidance appears to have increased enrollment into methadone and improved treatment retention for people who inject drugs without adverse effects on patient survival.

Bronchial Asthma and COVID-19: Etiology, Pathological Triggers, and Therapeutic Considerations.

Bronchial asthma (BA) continues to be a difficult disease to diagnose. Various factors have been described in the development of BA, but to date, there is no clear evidence for the etiology of this chronic disease. The emergence of COVID-19 has contributed to the pandemic course of asthma and immunologic features. However, there are no unambiguous data on asthma on the background and after COVID-19. There is correlation between various trigger factors that provoke the development of bronchial asthma. It is now obvious that the SARS-CoV-2 virus is one of the provoking factors. COVID-19 has affected the course of asthma. Currently, there is no clear understanding of whether asthma progresses during or after COVID-19 infection. According to the results of some studies, a significant difference was identified between the development of asthma in people after COVID-19. Mild asthma and moderate asthma do not increase the severity of COVID-19 infection. Nevertheless, oral steroid treatment and hospitalization for severe BA were associated with higher COVID-19 severity. The influence of SARS-CoV-2 infection is one of the protective factors. It causes the development of severe bronchial asthma. The accumulated experience with omalizumab in patients with severe asthma during COVID-19, who received omalizumab during the pandemic, has strongly suggested that continued treatment with omalizumab is safe and may help prevent the severe course of COVID-19. Targeted therapy for asthma with the use of omalizumab may also help to reduce severe asthma associated with COVID-19. However, further studies are needed to prove the effect of omalizumab. Data analysis should persist, based on the results of the course of asthma after COVID-19 with varying degrees of severity.

First analytical confirmation of drug-induced crystal nephropathy in felines caused by GS-441524, the active metabolite of Remdesivir

GS-441524 is an adenosine nucleoside antiviral demonstrating significant efficacy in the treatment of feline infectious peritonitis (FIP), an otherwise fatal illness, resulting from infection with feline coronavirus. However, following the emergence of COVID-19, veterinary development was halted, and Gilead pursued clinical development of a GS-441524 pro-drug, resulting in the approval of Remdesivir under an FDA emergency use authorization. Despite lack of regulatory approval, GS-441524 is available without a prescription through various unlicensed online distributors and is commonly purchased by pet owners for the treatment of FIP. Herein, we report data obtained from the analytical characterization of two feline renal calculi, demonstrating the propensity for GS-441524 to cause renal toxicity through drug-induced crystal nephropathy in vivo. As definitive diagnosis of drug-induced crystal nephropathy requires confirmation of the lithogenic material to accurately attribute a mechanism of toxicity, renal stone composition and crystalline matrix were characterized using ultra-performance liquid chromatography photodiode array detection (UPLC-PDA), ultra-performance liquid chromatography mass spectrometry (LCMS), nuclear magnetic resonance (NMR) spectroscopy, X-ray powder diffraction (XRD), and Fourier-transform infrared spectroscopy (FTIR). This work serves to provide the first analytical confirmation of GS-441524-induced crystal nephropathy in an effort to support toxicologic identification of adverse renal effects caused by administration of GS-441524 or any pro-drug thereof.

The Representations of Generalist TV: The Role of Talk Shows in Polarisation. Dynamics of the Mediatisation of Political Communication During the COVID-19 Emergency in Gender Issues. The Italian Case

The present proposal aims to analyse the dynamics of mediatisation of the political discourse that was inflamed around the COVID-19 emergency within the main talk shows transmitted by Italian generalist TV networks in the period from 24 February 2020 to 24 March 2020 which corresponds to the COVID-19 pandemic’s first wave, offering a first quantitative and, subsequently, a qualitative overview of the Italian case concerning the narration of the pandemic in the phases just before and after the first total lockdown, following a mixed methods approach. The final aim of the proposal is to bring out the dynamics of mediatisation of the political discourse around the pandemic alongside the role played by the media in proposing/imposing possible aspects of polarisation of the discourse, e.g. the role of experts and the role of politics, or gender issues, starting from the assumption that, in addition to their function of reporting facts, the media perform another one, that of “polltakers”, i.e. they provide indirect representations of the public’s response to the issues they themselves tend to provide.

COVID-19 therapeutics.

SUMMARYSince the emergence of COVID-19 in 2020, an unprecedented range of therapeutic options has been studied and deployed. Healthcare providers have multiple treatment approaches to choose from, but efficacy of those approaches often remains controversial or compromised by viral evolution. Uncertainties still persist regarding the best therapies for high-risk patients, and the drug pipeline is suffering fatigue and shortage of funding. In this article, we review the antiviral activity, mechanism of action, pharmacokinetics, and safety of COVID-19 antiviral therapies. Additionally, we summarize the evidence from randomized controlled trials on efficacy and safety of the various COVID-19 antivirals and discuss unmet needs which should be addressed.

Unvaccinated employees during Covid-19 emergency: Debating the Italian labour court referral

This contribution examines the inadmissibility of a preliminary reference order submitted by the Court of Padua, Italy to the Court of Justice of the European Union (CJEU). The case involved the suspension of a worker, who, while legally obliged, declined to have the Covid-19 vaccine. The Italian court temporarily halted proceedings initiated by the worker's appeal. The author provides a comprehensive analysis facts of the case, the applicable national legislation, and the content of the preliminary reference order. The order scrutinised the compatibility of the conditional authorisation issued by the European Commission for the release of vaccines in circulation at that time. Additionally, it explored potential discrimination against workers who, by refusing vaccination, faced suspension from work without pay, as per explicit legal provisions. The contribution concludes by addressing the specific details of the inadmissibility ruling from the CJEU. Case: Judgment of the Court (Second Chamber) of 13 July 2023. D. M. v Azienda Ospedale-Università di Padova. Request for a preliminary ruling from the Tribunale Ordinario di Padova. Reference for a preliminary ruling – Public health – National legislation imposing a vaccination obligation on health professionals – Suspension from duty without pay for personnel refusing the vaccine – Regulation (EC) No 726/2004 – Medicinal products for human use – Vaccines against Covid-19 – Regulation (EC) No 507/2006 – Validity of conditional marketing authorisations – Regulation (EU) 2021/953 – Prohibition of discrimination between vaccinated and unvaccinated persons – Inadmissibility.

SARS-CoV-2 Neutralization Assays Used in Clinical Trials: A Narrative Review.

Since the emergence of COVID-19, extensive research efforts have been undertaken to accelerate the development of multiple types of vaccines to combat the pandemic. These include inactivated, recombinant subunit, viral vector, and nucleic acid vaccines. In the development of these diverse vaccines, appropriate methods to assess vaccine immunogenicity are essential in both preclinical and clinical studies. Among the biomarkers used in vaccine evaluation, the neutralizing antibody level serves as a pivotal indicator for assessing vaccine efficacy. Neutralizing antibody detection methods can mainly be classified into three types: the conventional virus neutralization test, pseudovirus neutralization test, and surrogate virus neutralization test. Importantly, standardization of these assays is critical for their application to yield results that are comparable across different laboratories. The development and use of international or regional standards would facilitate assay standardization and facilitate comparisons of the immune responses induced by different vaccines. In this comprehensive review, we discuss the principles, advantages, limitations, and application of different SARS-CoV-2 neutralization assays in vaccine clinical trials. This will provide guidance for the development and evaluation of COVID-19 vaccines.

Optimizing ventilatory support in ARDS: A comprehensive guide for ICU nurses on patient care

The emergence of COVID-19 as a global pandemic has placed an unprecedented strain on healthcare systems worldwide, highlighting a critical shortage of trained healthcare professionals equipped to manage such a crisis. This deficit poses a significant challenge to the delivery of healthcare services, particularly in the context of intensive care units (ICUs) where the use of advanced medical technologies, such as ventilators, is paramount. For nurses with limited experience in ICU settings, navigating the complexities of invasive positive pressure ventilation (IPPV), a principal method of mechanical ventilation for critically ill patients can be daunting. This article aims to serve as a comprehensive guide for nurses less familiar with the intricacies of managing patients on IPPV, offering insights and strategies to enhance their competence and confidence in this critical aspect of patient care.

Developing a Community of Practice through Social Media to Facilitate Continuing Education of Medical Practitioners in Medical Research

The emergence of COVID-19 has highlighted the significance of research in medical practice, particularly in low- and middle-income countries (LMICs) like Indonesia, where healthcare challenges are prominent. Therefore, this study introduces Arcandcoresearch, a non-institutional-based virtual Community of Practice (vCoP), aiming to address the research capacity gaps among medical practitioners. This study aimed to understand the possibility of using several social media platforms (Instagram, YouTube, and WhatsApp) in the vCoP for continuing medical education of general practitioners regarding medical research. Through Instagram, the project has gained substantial follower growth (1003 followers within 19 months); most were 25-34 years old (69%). Within six months, 124 medical practitioners participated in five sharing sessions via Zoom meetings. All participants who completed the feedback form were satisfied with the content delivery of the sessions. The recorded sharing sessions were then uploaded to the YouTube channel. It already had 150 subscribers until September 2023, with 397 viewers for the videos uploaded in 2022. We facilitated participants to discuss any concerns related to medical research in the WhatsApp group, which already had 24 participants. These preliminary results highlight the potential of Arcandcoresearch to impact medical research culture positively in LMICs. The next steps should be conducting thorough program evaluations and developing strategies for sustaining virtual engagement.

Developing a Community of Practice through Social Media to Facilitate Continuing Education of Medical Practitioners in Medical Research

The emergence of COVID-19 has highlighted the significance of research in medical practice, particularly in low- and middle-income countries (LMICs) like Indonesia, where healthcare challenges are prominent. Therefore, this study introduces Arcandcoresearch, a non-institutional-based virtual Community of Practice (vCoP), aiming to address the research capacity gaps among medical practitioners. This study aimed to understand the possibility of using several social media platforms (Instagram, YouTube, and WhatsApp) in the vCoP for continuing medical education of general practitioners regarding medical research. Through Instagram, the project has gained substantial follower growth (1003 followers within 19 months); most were 25-34 years old (69%). Within six months, 124 medical practitioners participated in five sharing sessions via Zoom meetings. All participants who completed the feedback form were satisfied with the content delivery of the sessions. The recorded sharing sessions were then uploaded to the YouTube channel. It already had 150 subscribers until September 2023, with 397 viewers for the videos uploaded in 2022. We facilitated participants to discuss any concerns related to medical research in the WhatsApp group, which already had 24 participants. These preliminary results highlight the potential of Arcandcoresearch to impact medical research culture positively in LMICs. The next steps should be conducting thorough program evaluations and developing strategies for sustaining virtual engagement.

An entropy-based study on the mutational landscape of SARS-CoV-2 in USA: Comparing different variants and revealing co-mutational behavior of proteins

COVID-19 emergency has pushed the international scientific community to use every resource to combat the spread of the virus, to understand its biology and predict its possible evolution in terms of new variants. Since the first SARS-CoV-2 virus nucleotide and amino acid sequences were made available, information theory was used to study how viral information content was changing over time and then trace the evolution of its mutational landscape. In this work we analyzed SARS-CoV-2 sequences collected mainly in the USA in a period from March 2020 until December 2022 and computed mutation profiles of viral proteins over time through an entropy-based approach using Shannon Entropy and Hellinger distance. This representation allows an at-a-glance view of the mutational landscape of viral proteins over time and can provide new insights on the evolution of the virus from different points of view. Non-structural proteins typically showed flat mutation profiles, characterized by a very low Average mutation Entropy, while accessory and structural proteins showed mostly non uniform and high mutation profiles, often coupled with the predominance of variants. Interestingly NSP2 protein, whose function is currently still debated, falls in the same branch of NSP14 and NSP10 in the phylogenetic tree of mutations constructed through correlations of mutation profiles, suggesting a co-evolution of those proteins and a possible functional link with each other. To the best of our knowledge this is the first study based on a massive amount of data (n = 107,939,973) that analyzes from an entropy point of view the mutational landscape of SARS-CoV-2 over time and depicts a mutational temporal profile of each protein of the virus.

The impact of COVID-19 on HIV treatment and care delivery in South and Southeast Asia: a qualitative study

The COVID-19 pandemic has significantly impacted HIV treatment worldwide, but its effects on South and Southeast Asia, particularly in India, Indonesia, and Thailand, have been less evident. Our aim was to study the perceptions of providers and policymakers to understand how interventions were implemented as part of pandemic responses and how their effectiveness was viewed. We conducted a qualitative study with semi-structured interviews focusing on the shifts in HIV care in response to the pandemic. Between June and July 2021, 40 individuals were invited for interviews; 33 (83%) agreed. Participants included 25 (76%) providers and 8 (24%) policymakers, who were from India (10; 30%), Indonesia (10; 30%), and Thailand (10; 30%), along with 3 (9.1%) regional policymakers. Sixteen (48%) were female. Our findings revealed four major themes: (1) limitations in accessing HIV care due to movement restrictions and shutdowns, such as transportation issues; (2) diversion of healthcare resources away from HIV care to COVID-19 responses, leading to reallocation of providers and hospital space; (3) setbacks in HIV-related policy implementation as COVID-19 emergency responses took priority; (4) the expansion of HIV differentiated service delivery interventions, allowing longer gaps between visits and larger-volume prescription refills to delay returns to healthcare facilities. These changes have raised concerns about the long-term consequences on HIV epidemic control and future pandemic responses. However, they have also presented opportunities for innovative care delivery, which should be sustained to address these challenges effectively.

Progress in the diagnose and treatment of pulmonary arterial thrombosis in situ

In situ pulmonary arterial thrombosis (ISPAT) refers to the formation of new blood clots in the pulmonary arterial system in the absence of pre-existing clots in the peripheral venous system. With the emergence and prevalence of COVID-19, ISPAT has become an increasingly important cause of pulmonary arterial thrombosis (PAT) alongside thromboembolism. Several factors such as hypoxia, inflammation, endothelial dysfunction, and hypercoagulable state can lead to ISPAT, which is associated with a number of conditions such as thoracic trauma, partial lung resection, pulmonary infectious disease, pulmonary vasculitis, connective tissue diseases, severe pulmonary hypertension, radiation pneumonitis, and acute chest syndrome in sickle cell disease. It is important to differentiate between pulmonary thromboembolism (PTE) and ISPAT for proper disease management and prognosis. In this review, we summarized the characteristics of ISPAT under different disease conditions, the methods to distinguish ISPAT from PTE, and the best treatment strategies. We hoped that this review could improve clinicians' understanding of this independent disease and provide guidance for the refined treatment of patients with PAT.

Population-based denominators matter: Bias in U.S. Virgin Islands COVID-19 vaccination coverage under changing population counts

PurposeThe U.S. Virgin Islands (USVI) receives an updated population count once every 10 years and used 2010 decennial census population counts to estimate COVID-19 vaccination coverage during the COVID-19 emergency response. We investigated whether using outdated (2010) or modeled (2020 international database [IDB]) population counts biased vaccination coverage estimates used to inform public health priorities during the 2020–2022 COVID-19 response. MethodsWe estimated percentage of USVI residents with a completed primary COVID-19 vaccination series during December 16, 2020–September 20, 2022. Vaccination coverage was calculated as number of persons who completed the vaccination series divided by 2010 and 2020 decennial census population counts and 2020 IDB intercensal estimate. ResultsCOVID-19 vaccination coverage using the 2020 population count was 12 % points higher than coverage using 2010 denominator (2010 denominator: 51 %; 2020 denominator: 63 %). Vaccination coverage estimated using 2020 IDB was approximately equal with the 2010 decennial census estimate (52 %). ConclusionsUsing 2010 and modeled population counts underestimated 2020 USVI COVID-19 vaccination coverage given the 18 % population decline during 2010–2020, potentially limiting USVI’s ability to assess vaccination progress. Identifying mechanisms for more reliable population enumeration or improved estimate modeling are essential for accurately guiding USVI public health decision-making.

The Challenges of Developing an Indonesian Travel Corridor: Bintan Resorts in Singapore as a Study Case

Indonesia has the best international cross-border tourism called Bintan Resorts or better known as Lagoi. The emergence of Covid-19 made the tourism sector in Lagoi slumped. This condition makes Bintan Resorts and tenants, local governments, and the central government strive to revive Lagoi tourism through promotion by using a business diplomacy strategy through a travel bubble approach to attract Singaporean tourists as Lagoi's main target market. This research uses a qualitative method that shows the results that the concept of a travel bubble between Bintan Resorts and Singapore has not been fully implemented. This is because Indonesia's diplomacy has not been followed by domestic policies that are consistent and of the same standard as Singapore. This study argues the need for a middle ground in the form of a mutual agreement, where the Indonesian government can apply all Singaporean requirements as national standards, especially in tourism management. Keywords: Economy; Management; Travel Bubble; Business; Building Capacity

Perceptions of Wearable Health Tools Post the COVID-19 Emergency in Low-Income Latin Communities: Qualitative Study.

Mobile health (mHealth) wearable devices are increasingly being adopted by individuals to help manage and monitor physiological signals. However, the current state of wearables does not consider the needs of racially minoritized low-socioeconomic status (SES) communities regarding usability, accessibility, and price. This is a critical issue that necessitates immediate attention and resolution. This study's aims were 3-fold, to (1) understand how members of minoritized low-SES communities perceive current mHealth wearable devices, (2) identify the barriers and facilitators toward adoption, and (3) articulate design requirements for future wearable devices to enable equitable access for these communities. We performed semistructured interviews with low-SES Hispanic or Latine adults (N=19) from 2 metropolitan cities in the Midwest and West Coast of the United States. Participants were asked questions about how they perceive wearables, what are the current benefits and barriers toward use, and what features they would like to see in future wearable devices. Common themes were identified and analyzed through an exploratory qualitative approach. Through qualitative analysis, we identified 4 main themes. Participants' perceptions of wearable devices were strongly influenced by their COVID-19 experiences. Hence, the first theme was related to the impact of COVID-19 on the community, and how this resulted in a significant increase in interest in wearables. The second theme highlights the challenges faced in obtaining adequate health resources and how this further motivated participants' interest in health wearables. The third theme focuses on a general distrust in health care infrastructure and systems and how these challenges are motivating a need for wearables. Lastly, participants emphasized the pressing need for community-driven design of wearable technologies. The findings from this study reveal that participants from underserved communities are showing emerging interest in using health wearables due to the COVID-19 pandemic and health care access issues. Yet, the needs of these individuals have been excluded from the design and development of current devices.

Evaluating Pharmacy Students’ Teamwork Attitudes in Virtual COVID-19 Emergency Department Simulations: A Pilot Study

ObjectiveThis study explores the impact of virtual simulation training on the transformation of teamwork attitudes among pharmacy students in a simulated severe COVID-19 pneumonia scenario in the emergency department. MethodsFrom July 2022 to January 2023, 16 pharmacy students, along with other health care students, participated in interprofessional simulation rounds. Each pharmacy student was assigned specific days for participation, using either a 3-dimensional computer or a virtual reality headset to manage a patient with severe COVID-19 pneumonia in the virtual emergency department. The TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) was used for pre- and post-training assessments. ResultsThe mean baseline T-TAQ score was 119.44 ± 10.63, showing a significant post-training improvement to a mean score of 130.88 ± 8.98 (Hedges’ g = 1.52). Stratification by academic year and device type revealed no significant impact on the learning experience. Remarkable enhancements in teamwork attitudes were observed after training, specifically in team structure, situation monitoring, mutual support, and communication domains. ConclusionThese findings indicate that virtual simulation training in scenarios such as severe COVID-19 effectively augments teamwork attitudes among pharmacy students, preparing them for collaborative practice in high-stakes emergency medicine settings.

Talent management and employees with disabilities: a systematic literature review in the context of COVID-19

PurposeThe purpose of this literature review is, first, to understand how employees with disabilities in the context of COVID-19 have been studied under the talent management (TM) approach; second, to explore what we know about the predictors and outcomes that have been linked to TM practices in that area; and third, to identify gaps in our understanding and provide insights for future research.Design/methodology/approachThis paper presents a systematic literature review (SLR) based on 38 academic sources published in high-impact indexes from 2020 to 2023.FindingsThe existing research shows COVID-19 as a crucial context that led organizations to more precarious and segmented TM practices, which had negative consequences for employees with disabilities, both at the individual level (reduced satisfaction and income, and increased health issues) and the organizational level (increased unemployment, turnover and discrimination as well as declining performance and productivity).Originality/valueThis paper provides essential contributions to the field of TM in the relatively unexplored context of employees with disabilities since the emergence of COVID-19. Our literature review suggests there is significant room for developing and implementing adjusted TM strategies and practices to foster effective inclusiveness, accommodations and supportive work environments for employees with disabilities. From this evidence, a number of key avenues for future research and key implications for academics and practitioners are provided.

Community interventions for pandemic preparedness: A scoping review of pandemic preparedness lessons from HIV, COVID-19, and other public health emergencies of international concern.

Community action is broadly recognised as central to comprehensive and effective system responses to pandemics. However, there is uncertainty about how and where communities can be best supported to bolster long-term resilience and preparedness. We applied a typology of community interventions (Community Informing, Consulting, Involving, Collaborating or Empowering-or CICICE) to cover the diverse range of interventions identified across the literature and used this to structure a scoping review addressing three linked topics: (i) how CICICE interventions have been understood and applied in the literature on epidemic and pandemic preparedness; (ii) the spectrum of interventions that have been implemented to strengthen CICICE and (iii) what evidence is available on their effectiveness in influencing preparedness for current and future emergencies. We drew on peer-reviewed and grey literature from the HIV (from 2000) and COVID-19 pandemics and recent public health emergencies of international concern (from 2008), identified through systematic searches in MEDLINE, Scopus, the Cochrane Collaboration database, supplemented by keyword-structured searches in GoogleScholar and websites of relevant global health organisations. Following screening and extraction, key themes were identified using a combined inductive/deductive approach. 130 papers met the criteria for inclusion. Interventions for preparedness were identified across the spectrum of CICICE. Most work on COVID-19 focused on informing and consulting rather than capacity building and empowerment. The literature on HIV was more likely to report interventions emphasising human rights perspectives and empowerment. There was little robust evidence on the role of CICICE interventions in building preparedness. Evidence of effect was most robust for multi-component interventions for HIV prevention and control. Much of the reporting focused on intermediate outcomes, including measures of health service utilisation. We put forward a series of recommendations to help address evidence shortfalls, including clarifying definitions, organising and stratifying interventions by several parameters and strengthening evaluation methods for CICICE.

Using quality improvement approaches to increase emergency department provider engagement in research participant enrollment during COVID-19 and opioid overdose public health emergencies.

We utilized quality improvement (QI) approaches to increase emergency department (ED) provider engagement with research participant enrollment during the opioid crisis and coronavirus disease (COVID-19) pandemic. The context of this work is the Evaluating Microdosing in the Emergency Department (EMED) study, a randomized trial offering buprenorphine/naloxone to ED patients through randomization to standard or microdosing induction. Engaging providers is crucial for participant recruitment to our study. Anticipating challenges sustaining long-term engagement after a 63% decline in provider referrals four months into enrollments, we applied Plan-Do-Study-Act (PDSA) cycles to develop and implement an engagement strategy to increase and sustain provider engagement by 50% from baseline within 9months. Our engagement strategy was centered on Coffee Carts rounds: 5-min study-related educational presentations for providers on shift; and a secondary initiative, a Suboxone Champions program, to engage interested providers as study-related peer educators. We used provider referrals to our team as a proxy for study engagement and report the percent change in mean weekly referrals across two PDSA cycles relative to our established referral baseline. A QI approach afforded real-time review of interventions based on research and provider priorities, increasing engagement via mean weekly provider referrals by 14.5% and 49% across two PDSA cycles relative to baseline, respectively. Our Coffee Carts and Suboxone Champions program are efficient, low-barrier, educational initiatives to convey study-related information to providers. This work supported our efforts to maximally engage providers, minimize burden, and provide life-saving buprenorphine/naloxone to patients at risk of fatal overdose.