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BACKGROUND Central line-associated bloodstream infections (CLABSI) are a major source of sepsis in modern intensive care medicine. Some years ago bundle interventions have been introduced to reduce CLABSI. The use of checklists may be an additional tool to improve the effect of these bundles even in highly specialized institutions. In this study we investigate if the introduction of a checklist reduces the frequency of CLABSI. METHODS During the study period from October 2011 to September 2012, we investigated the effect of implementing a checklist for the placement of central venous lines (CVL). Patients were allocated either to the checklist group or to the control group, roughly in a 1:2 ratio. The frequency of CLABSI was compared between the two groups. RESULTS During the study period 4416 CVL were inserted; 1518 in the checklist group and 2898 in the control group. The use of the checklist during CVL placement resulted in a lower CLABSI frequency. The incidence in the checklist group was 3.8 per 1000 catheter days as compared to 5.9 per 1000 catheter days in the control group (IRR = 0.57; p = 0.001). The use of the checklist also reduced the frequency of catheter colonisation significantly, 36.3 per 1000 catheter days in the checklist group vs 21.2 per 1000 catheter days in the control group, respectively (IRR = 0.58; p < 0.001). CONCLUSION The introduction of a checklist to improve the adherence to hygiene standards while placement of central venous lines reduced the frequency of infections significantly.
Efficacy of introducing a checklist to reduce central venous line associated bloodstream infections in the ICU caring for adult patients.
BACKGROUND & AIMS Pediatric feeding disorder (PFD) is defined as impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. As PFD is prevalent and increasing, so are publications on the topic; however, the research literature is often disparate in terminology used and siloed by discipline. Greater understanding of the current research concerning PFD will help identify areas in need of further study. The purpose of this scoping review is to examine the extent, range, and nature of research activities concerning PFD and to identify gaps in the empirical literature. METHODS Three electronic databases (PubMed/Medline, CINAHL, PsycINFO) were searched using terms related to pediatric feeding disorder, which include, but not limited to, "feeding disorder/problem/difficulty", "avoidant restrictive food intake disorder (ARFID)", "dysphagia", "selective/picky eating", "problematic mealtime behaviors" or "food refusal". The following limits were placed on the search: full text, humans, English, and age limit (up to 18 years old), and publication date (last 10 years). Covidence software was used to facilitate a systematic data management/analysis. Two people in the research team independently reviewed each result (screening titles and abstracts first, then moving to the full texts) to identify studies that met our inclusion/exclusion criteria and conflicts were resolved through a team discussion. Data were charted regarding disciplines of the authors, study purposes, study settings/locations, study methodologies, and study participants. Descriptive statistics and thematic analyses were used to summarize the characteristics of the studies. RESULTS The initial search resulted in 5354 articles after removing duplicates between the databases. With a final set of articles (n = 415), data charting was completed. The majority of studies were completed by authors from Psychology (n = 171) and Medicine (n = 123). The most studied aims were to examine attributes of feeding problems (n = 168) and/or factors associated with feeding problems (n = 183). Sample size median was 53. A total of 166 of the 415 studies examined the effect of an intervention, treatment, or program, but dose of the intervention was difficult or impossible to report across studies. Feeding was studied as an outcome in 400 out of the 415 studies. A closer accounting of the systematically developed parent-report tools revealed 50 distinct parent report tools used across the subset of studies utilizing parent report outcomes (n = 123). CONCLUSIONS The results of this scoping review highlight the designs and methods used in research on PFD. This reveals critical gaps in knowledge generation and barriers to intervention replication.
Mapping the gaps: A scoping review of research on pediatric feeding disorder.
BACKGROUND: Central retinal vein occlusion (CRVO) is one of the most common retinal vascular diseases, which is closely related to systemic diseases like hypertension, diabetes and arteriosclerosis. Due of its blinding, it will seriously reduce the quality of life. Macular edema (ME) caused by CRVO is one of the serious complications of visual impairment. We found that the severity of ME in CRVO was positively associated with vascular endothelial growth factor (VEGF) in the anterior chamber. With the accelerated pace of modern life and the changed dietary structure, the incidence of this disease will continue to rise. Therefore, it is of great practical significance to seek effective treatment methods. Intraocular injection of anti-VEGF can effectively alleviate ME and improve visual acuity, showing excellent clinical application prospects. In recent years, there have been some new understandings and advances on the etiology and treatment methods of the present disease, such as the deepening into the molecular biology and gene level. Clinical studies on the efficacy of the disease have emerging. Therefore, a network meta-analysis (NMA) of anti-VEGF treatment for CRVO is particularly necessary to systematically compare its efficacy. METHODS: The two reviewers will comprehensively retrieved electronic databases such as PubMed, The Cochrane Library, Wanfang database, Web of Science, Chinese Scientifific Journals Database, EMBASE, China National Knowledge Infrastructure, and China BioMedical Literature. A randomized controlled trial for CRVO against VEGF between January 2010 and June 2021 was included according to the relevant content of the study. In addition, 2 researchers will screen the literature to assess the risk bias for the included articles. We will evaluate the collected evidence and data using a Bayesian NMA method, and analyzed it with STATA and WinBUGS software. RESULTS: Anti-VEGF is one of the effective methods for ME in CRVO patients, accordingly, this study will evaluate its efficacy and safety using a Bayesian NMA system. CONCLUSION: This study can provide an effective rationale for the clinical application of anti-VEGF for CRVO, contribute to the treatment of CRVO and patient condition rehabilitation in clinical work. ETHICS AND DISSEMINATION: Do not require. INPLASY REGISTRATION NUMBER: INPLASY2021110073.
Comparative efficacy and safety of antivascular endothelial growth factors for central retinal vein occlusion: A protocol for systematic review and network meta-analysis
Student mental health crises have increasingly been a point of concern for campus safety officials (as well as other administrators on campus). The COVID\19 pandemic has only increased reports of mental health concerns, according to a survey by the Center for Collegiate Mental Health at Penn State University.
Survey shows mental health concerns rising due to COVID\19
SARS-CoV-2 uses subgenomic (sg)RNA to produce viral proteins for replication and immune evasion. We applied long-read RNA and cDNA sequencing to in vitro human and primate infection models to study transcriptional dynamics. Transcription-regulating sequence (TRS)-dependent sgRNA was upregulated earlier in infection than TRS-independent sgRNA. An abundant class of TRS-independent sgRNA consisting of a portion of ORF1ab containing nsp1 joined to ORF10 and 3UTR was upregulated at 48 hours post infection in human cell lines. We identified double-junction sgRNA containing both TRS-dependent and independent junctions. We found multiple sites at which the SARS-CoV-2 genome is consistently more modified than sgRNA, and that sgRNA modifications are stable across transcript clusters, host cells and time since infection. Our work highlights the dynamic nature of the SARS-CoV-2 transcriptome during its replication cycle. Our results are available via an interactive web-app at http://coinlab.mdhs.unimelb.edu.au/.
Transcriptional and epi-transcriptional dynamics of SARS-CoV-2 during cellular infection
This article was published whilst it was still in peer review due to a technical error at the publisher and has been temporarily removed.
Correlation of Racial Effect with Severity of Disease and In-Hospital Outcome in Individuals Diagnosed with COVID-19
Objective: to analyze the association between Body Mass Index and the clinical outcomes of confirmed COVID-19 cases. Method: an epidemiological study conducted with secondary data from 618 confirmed COVID-19 cases, notified from March to December 2020 in a municipality from western Santa Catarina, Brazil. An inferential analysis was performed between Body Mass Index and several clinical and assistance-related aspects. Results: a significant association was found between Body Mass Index and the following symptoms: dyspnea (p=0.003), decreased appetite (p=0.004), runny nose (p=0.039) and diarrhea (p=0.029). There was also an association with previous comorbidities (p=0.000) and worse saturation mean values (p=0.00). Obese individuals presented more chances of: hospitalization in a ward (p=0.027);hospitalization in an Intensive Care Unit (p=0.002);and evolution to death (p=0.00). Conclusion: the need to implement effective educational actions for the prevention and treatment of obesity is evidenced, focusing on quality of life and mitigation of the clinical deterioration of this population in the face of pathologies such as COVID-19. ? The Authors.
Association between Body Mass Index and the Clinical Outcomes of Covid-19 Cases
The COVID-19 pandemic and its accompanying restrictions, apart from the destructive global economic and social impact, brought negative psychological consequences to the world. The aim of the current study is to investigate the factors that help individuals maintain psychological well-being under the condition of self-isolation, a global restriction against the spread of the pandemic. Specifically, the role of trait emotional intelligence, self-compassion, and rumination was explored in order to determine how these variables relate to psychological well-being. According to the results, trait emotional intelligence and self-compassion positively correlate with psychological well-being, while rumination is negatively correlated. Self-compassion mediates the relationship between emotional intelligence and well-being. The relationship between rumination and well-being is affected by emotional intelligence and self-compassion: Self-compassion mediates the relationship between depression related rumination and well-being, while self-control and emotionality factors of trait emotional intelligence moderate the relationship between reflection rumination and well-being. The findings of the current study provide insight about self-compassion, rumination, and emotional intelligence as different contributing factors to the individuals well-being in self-isolation, suggesting further implications about the use of these strategies to help people cope with this stressful situation.
Well-being and Pandemic Lockdown: the Role of Emotional Intelligence, Self-compassion and Rumination
We consider a novel method to increase the reliability of COVID-19 virus or antibody tests by using specially designed pooled testings. Instead of testing nasal swab or blood samples from individual persons, we propose to test mixtures of samples from many individuals. The pooled sample testing method proposed in this paper also serves a different purpose: for increasing test reliability and providing accurate diagnoses even if the tests themselves are not very accurate. Our method uses ideas from compressed sensing and error-correction coding to correct for a certain number of errors in the test results. The intuition is that when each individual's sample is part of many pooled sample mixtures, the test results from all of the sample mixtures contain redundant information about each individual's diagnosis, which can be exploited to automatically correct for wrong test results in exactly the same way that error correction codes correct errors introduced in noisy communication channels. While such redundancy can also be achieved by simply testing each individual's sample multiple times, we present simulations and theoretical arguments that show that our method is significantly more efficient in increasing diagnostic accuracy. In contrast to group testing and compressed sensing which aim to reduce the number of required tests, this proposed error correction code idea purposefully uses pooled testing to increase test accuracy, and works not only in the "undersampling" regime, but also in the "oversampling" regime, where the number of tests is bigger than the number of subjects. The results in this paper run against traditional beliefs that, "even though pooled testing increased test capacity, pooled testings were less reliable than testing individuals separately."
Error Correction Codes for COVID-19 Virus and Antibody Testing: Using Pooled Testing to Increase Test Reliability
INTRODUCTION: Hypoxemia is a cardinal sign of patients with severe COVID-19 respiratory failure Current guidelines recommend an SpO2 of 92-96% to ensure adequate oxygenation and prevent anaerobic metabolism However, hyperoxia is associated with cellular toxicity and worse outcomes in critically ill patients The aim of this study was to examine the prevalence of hyperoxia and determine oxygenation utilization in a cohort of patients with severe COVID-19 respiratory failure METHODS: Between March 24 to April 9, 2020, 8 patients intubated for severe COVID-19 respiratory failure had nearsimultaneous drawings of arterial blood gas, central venous blood gas, central venous O2 (ScvO2) and arterial lactate levels at a mean of 6 1 days into their hospitalization Three patients were managed with the FloTrac sensor and Vigileo monitor (Edwards Lifesciences, Irvine, CA) to measure indirect cardiac output and determine the oxygen extraction fraction (OEF;CaO2-CvO2/CaO2 x 100) Also, the oxygen extraction index (OEI;SaO2-ScvO2/SaO2) and delta pCO2 (PcvO2-PaCO2) were calculated Hyperoxia was defined as a ScvO2 &gt; 90% based on the literature Mean values were calculated for the results RESULTS: The mean age of the cohort was 55 3 years, 63% were men, and 50% were Hispanic The mean SaO2 was 96% and PaO2 was 102 mm Hg None of the patients had evidence of anaerobic metabolism as assessed by arterial lactate levels (mean=1 2 mmol/dL) or delta pCO2 (mean=1 1 mm Hg) Although the mean ScvO2 was 71 8%, 1 patient had evidence of hyperoxia Two patients had relative hyperoxia as evidenced by reduced OEI (mean 14 4%) and reduced OEF (15 9%) CONCLUSIONS: Our results suggest that a subset of patients with severe COVID-19 respiratory failure are at risk for hyperoxia based on ScvO2 Furthermore, a larger proportion of patients may have relative hyperoxia based on O2 utilization indexes Further prospective data are needed on the prevalence of hyperoxia in severe COVID-19 respiratory failure This may influence oxygenation targets and outcomes in patients with this deadly disease
Hyperoxia and reduced oxygen utilization in patients with severe COVID-19 respiratory failure
Urdu Abstract: ?-19 ?? ? ?? ? ?? ?? ?? ? ?? ?? ? ?? ?? ?? ?? ?? ?? ? ?? ?? ?? ? ? ? ?? ? ?? ?? ?? ?? ?? ?? ? ? ?? ? ?? ? ? ?? ?? ?? ? ?? ?? ?? ?? ?? ? ? English Abstract: The damaging public health and economic effects of the coronavirus (COVID-19) pandemic have not materialized in Pakistan to the degree that was anticipated. Due to a variety of structural, demographic, and proactive policy factors, Pakistan has emerged from the pandemic in a much better condition than India, Brazil or the United States. This paper sheds light on the structural and administrative factors that helped Pakistan outperform India and other countries in the fight against coronavirus from multiple dimensions.
The Important Factors Underlying Pakistan's Early Success against Coronavirus
Sequence-specific NMR assignments of the globular core comprising the residues 1066C1181 within the non-structural protein nsp3e from the SARS coronavirus have been obtained using triple-resonance NMR experiments with the uniformly [(13)C,(15)N]-labeled protein. The backbone and side chain assignments are nearly complete, providing the basis for the ongoing NMR structure determination. A preliminary identification of regular secondary structures has been derived from the (13)C chemical shifts.
NMR assignment of the nonstructural protein nsp3(1066C1181) from SARS-CoV
OBJECTIVES: This study aimed to compare the risk of infection of children with that of adults and to explore risk factors of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by following up close contacts of COVID-19 patients. METHOD: The retrospective cohort study was performed among close contacts of index cases diagnosed with COVID-19 in Guangzhou, China. Demographic characteristics, clinical symptoms and exposure information were extracted. Logistic regression analysis was employed to explore the risk factors. The restricted cubic spline was conducted to examine to the dose-response relationship between age and SARS-CoV-2 infection. RESULTS: The secondary attack rate (SAR) was 4.4% in 1,344 close contacts. The group of household contacts (17.2%) had the highest SAR. The rare-frequency contact (p < 0.001) and moderate-frequency contact (p < 0.001) were associated with lower risk of infection. Exposure to index cases with dry cough symptoms was associated with infection in close contacts (p = 0.004). Compared with children, adults had a significantly increased risk of infection (p = 0.014). There is a linear positive correlation between age and infection (p = 0.001). CONCLUSIONS: Children are probably less susceptible to COVID-19. Close contacts with frequent contact with patients and those exposed to patients with cough symptoms are associated with an increased risk of infection.
Retrospective study identifies infection related risk factors in close contacts during COVID-19 epidemic
BACKGROUND: Though uncommon, retinal detachments are medically urgent and can result in permanent vision loss if untreated. Bilateral retinal detachments in healthy individuals are even more rare. Additionally, there are no cases to date of retinal detachment associated with either COVID-19 or after receiving the Moderna (mRNA-1273) SARS-CoV-2 vaccine. CASE REPORT: A 22-year-old female with myopia but no ocular trauma or other major past medical history presented to the emergency department with five days of progressive, painless vision loss in her right eye. On examination, her visual acuity with corrective lenses was 20/70 in the right eye, 20/20 in the left eye, and 20/25 with both eyes open. Point-of-care ultrasound (POCUS) of the eye showed a retinal detachment in the right eye. She was subsequently seen by ophthalmology and diagnosed with bilateral retinal detachments (macula-off in the right, macula-on in the left) despite being asymptomatic in her left eye. She underwent bilateral vitrectomies for simultaneous rhegmatogenous retinal detachments. Although the patient denied any preceding trauma, she did note having received her second dose of the COVID-19 vaccine 10 days before the onset of symptoms. Why should an emergency physician be aware of this: We present a rare and unusual case of simultaneous bilateral retinal detachments in a healthy young female with no major past medical history or medications aside from receiving the COVID-19 vaccine a few days prior. Our case outlines a possible adverse effect of the vaccine and emphasizes the importance of ultrasonography in diagnosing time-sensitive medical conditions.
Bilateral Retinal Detachments in a Healthy 22-year-old Female Following Moderna SARS-CoV-2 Vaccination
Background: Vaccines are among the most effective and cost-efficient public health interventions for promoting child health. However, uptake is considerably affected by vaccine hesitancy. An example is Malawi, with a decline in second vaccine doses and the highest cervical cancer incidence and mortality rate in Sub-Saharan Africa. Understanding vaccine hesitancy is especially important when new vaccines are introduced. This study explores factors contributing to vaccine hesitancy for routine childhood immunization and the human papillomavirus vaccine in Malawi. Methods: The study used a cross-sectional survey design targeting caregivers of children under five years old and adolescent girls. The sample population was derived using three inclusion criteria: one district with low vaccine uptake (Dowa), one district with high vaccine uptake (Salima), and one district where human papillomavirus vaccine was piloted earlier (Zomba). A convenience sample of one primary and one secondary health facility was selected within each district, and participants were systematically included (n = 600). The measures were based on 5C scale for measuring vaccine hesitancy. Multiple regression analyses were performed to explore vaccination intention predictors. Results: Confidence in vaccine safety was the strongest predictor of routine childhood immunization, followed by constraints due to everyday stress. Caregivers had lower confidence in vaccine safety and efficacy when they believed rumors and misinformation and were unemployed. Confidence was higher for those who had more trust in healthcare workers. Age, gender, religion, education, employment, belief in rumors, and trust in healthcare workers were considered predictors of vaccination intention. A husbands positive attitude (approval) increased childhood vaccination intention. For human papillomavirus, vaccination intentions were higher for those with lower education, more trust in healthcare workers, lower complacency, and a lower tendency toward calculating the benefits and risks of vaccination. Knowledge of human papillomavirus did not increase vaccination intention, but the need to attain a husbands approval did. Being a young adult and unemployed increased belief in rumors, while trust in healthcare workers reduced the belief. Conclusions: This study provides good insights into the drivers of vaccine hesitancy across different contexts in Malawi. However, further studies are necessary to understand low risk perception among elderly people and the declining trend in second vaccine doses.
Caregivers Willingness to Vaccinate Their Children against Childhood Diseases and Human Papillomavirus: A Cross-Sectional Study on Vaccine Hesitancy in Malawi
BACKGROUND: COVID-19 has thrust video consulting into the limelight, as health care practitioners worldwide shift to delivering care remotely. Evidence suggests that video consulting is acceptable, safe, and effective in selected conditions and settings. However, research to date has mostly focused on initial adoption, with limited consideration of how video consulting can be mainstreamed and sustained. OBJECTIVE: This study sought to do the following: (1) review and synthesize reported opportunities, challenges, and lessons learned in the scale-up, spread, and sustainability of video consultations, and (2) identify transferable insights that can inform policy and practice. METHODS: We identified papers through systematic searches in PubMed, CINAHL, and Web of Science. Included articles reported on synchronous, video-based consultations that had spread to more than one setting beyond an initial pilot or feasibility stage, and were published since 2010. We used the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability (NASSS) framework to synthesize findings relating to 7 domains: an understanding of the health condition(s) for which video consultations were being used, the material properties of the technological platform and relevant peripherals, the value proposition for patients and developers, the role of the adopter system, organizational factors, wider macro-level considerations, and emergence over time. RESULTS: We identified 13 papers describing 10 different video consultation services in 6 regions, covering the following: (1) video-to-home services, connecting providers directly to the patient; (2) hub-and-spoke models, connecting a provider at a central hub to a patient at a rural center; and (3) large-scale top-down evaluations scaled up or spread across a national health administration. Services covered rehabilitation, geriatrics, cancer surgery, diabetes, and mental health, as well as general specialist care and primary care. Potential enablers of spread and scale-up included embedded leadership and the presence of a telehealth champion, appropriate reimbursement mechanisms, user-friendly technology, pre-existing staff relationships, and adaptation (of technology and services) over time. Challenges tended to be related to service development, such as the absence of a long-term strategic plan, resistance to change, cost and reimbursement issues, and the technical experience of staff. There was limited articulation of the challenges to scale-up and spread of video consultations. This was combined with a lack of theorization, with papers tending to view spread and scale-up as the sum of multiple technical implementations, rather than theorizing the distinct processes required to achieve widespread adoption. CONCLUSIONS: There remains a significant lack of evidence that can support the spread and scale-up of video consulting. Given the recent pace of change due to COVID-19, a more definitive evidence base is urgently needed to support global efforts and match enthusiasm for extending use.
Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework
BACKGROUND The COVID-19 pandemic and subsequent social distancing guidelines greatly impacted the quality of life (QoL) of nursing faculty. PURPOSE The purpose of this study was to examine the relationship of QoL, resilience, and associated factors among nursing faculty during the COVID-19 pandemic. METHODS In April 2020, a cross-sectional, anonymous survey was conducted with nursing faculty in a public university in rural Appalachia (n = 52). Instruments included QoL, resilience scales, work-related, and demographic variables. Descriptive, bivariate, and multiple linear regression analyses were used to analyze data. A content analysis was used to analyze an open-ended question. RESULTS Resilience was the strongest variable to predict each of the QoL domains. Nursing faculty who reported better QoL were those who were able to adapt to changes and challenges mandated during the COVID-19 pandemic. CONCLUSIONS Evidence-based programs to build resilience and improve nursing faculty working conditions and their QoL are needed.
Relationship of Quality of Life, Resilience, and Associated Factors Among Nursing Faculty During COVID-19.
This report presents school district leaders' views about staff turnover, hiring, and districts' financial outlooks at the end of the 2020-2021 school year. Based on the survey responses of 292 district leaders from the American School District Panel (ASDP), the authors found that teacher and principal turnover had not increased substantially beyond pre-pandemic rates in most districts. They also found that a majority of school districts have increased or are trying to increase their number of staff--especially for substitute teachers and mental health staff--for the 2021-2022 school year. District leaders also reported budget concerns. Four in ten district leaders anticipate a fiscal cliff around the time coronavirus disease 2019 (COVID-19) federal aid expires in September 2024, and over half of the districts that anticipate a funding increase from federal stimulus funds are concerned about their ability to spend the money, even though virtually all district leaders said that they have some level of discretion in how to spend those funds. Although districts' reported impacts have not led to much-feared budget and staffing crises for their school districts, these survey findings suggest systemic problems that could outlast the COVID-19 pandemic. [For a related report, "Technical Documentation for the Third American School District Panel Survey. Research Report. RR-A956-6," see ED615291.]
The K-12 Pandemic Budget and Staffing Crises Have Not Panned Out - Yet: Selected Findings from the Third American School District Panel Survey. Data Note: Insights from the American Educator Panels. Research Report. RR-A956-3
BACKGROUND: This meta-ethnography investigates how young adults describe their tobacco use, smoking identities and pathways into and out of regular smoking, to inform future smoking prevention and harm reduction interventions. METHODS: Eight databases were systematically searched using keywords and indexed terms. Studies were included if they presented qualitative data from young adults aged 16C25 reporting smoking histories and/or smoking identities from countries culturally similar to the UK. A systematic and rigorous meta-ethnographic approach was employed, consistent with Noblit and Hares methodology. RESULTS: Thirty papers were included. Reasons stated for taking up smoking and becoming a smoker included alleviating stress, transforming ones identity, and coping with the transition to further education, employment or leaving home. Many used smoking to aid acceptance within new peer groups, particularly when alcohol was present. Smoking was also perceived as an act of resistance and a coping mechanism for those with marginalised identities. Barriers to quitting smoking included young adults minimisation or denial of the health risks of smoking and not identifying with being a smoker. CONCLUSIONS: This meta-ethnography may provide a blueprint to inform the development of health and wellbeing interventions designed specifically for young adults. Smoking cessation interventions should be co-designed with young adults based on their perceived needs, resonant with their desire to quit in the future at key milestones. Harm reduction interventions should address the social aspect of addiction, without reinforcing stigma, particularly for those with marginalised identities. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13011-022-00451-9.
Tobacco use, smoking identities and pathways into and out of smoking among young adults: a meta-ethnography
IMPORTANCE: Telehealth use greatly increased in 2020 during the first year of the COVID-19 pandemic. Patient preferences for telehealth or in-person care are an important factor in defining the role of telehealth in the postpandemic world. OBJECTIVE: To ascertain patient preferences for video visits after the ongoing COVID-19 public health emergency and to identify patient perceptions of the value of video visits and the role of out-of-pocket cost in changing patient preference for each visit modality. DESIGN, SETTING, AND PARTICIPANTS: This survey study was conducted using a nationally representative sample of adult members of the RAND American Life Panel. The data were obtained from the American Life Panel Omnibus Survey, which was fielded between March 8 and 19, 2021. MAIN OUTCOMES AND MEASURES: Preferences for video visits vs in-person care were analyzed in the survey. The first question was about participants baseline preference for an in-person or a video visit for a nonemergency health issue. The second question entailed choosing between the preferred visit modality with a cost of $30 and another modality with a cost of $10. Questions also involved demographic characteristics, experience with video visits, willingness to use video visits, and preferences for the amount of telehealth use after the COVID-19 pandemic. RESULTS: A total of 2080 of 3391 sampled panel members completed the survey (participation rate, 61.3%). Participants in the weighted sample had a mean (SE) age of 51.1 (0.67) years and were primarily women (1079 [51.9%]). Most participants (66.5%) preferred at least some video visits in the future, but when faced with a choice between an in-person or a video visit for a health care encounter that could be conducted either way, more than half of respondents (53.0%) preferred an in-person visit. Among those who initially preferred an in-person visit when out-of-pocket costs were not a factor, 49.8% still preferred in-person care and 23.5% switched to a video visit when confronted with higher relative costs for in-person care. In contrast, among those who initially preferred a video visit, only 18.9% still preferred a video visit and 61.7% switched to in-person visit when confronted with higher relative costs for video visits. CONCLUSIONS AND RELEVANCE: This survey study found that participants were generally willing to use video visits but preferred in-person care, and those who preferred video visits were more sensitive to paying out-of-pocket cost. These results suggest that understanding patient preferences will help identify telehealths role in future health care delivery.
Assessment of Patient Preferences for Telehealth in PostCCOVID-19 Pandemic Health Care

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