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On that basis, only three patients had to be seen by a rheumatologist to diagnose one. Conclusion The earlier proposed referral system worked well but was outperformed by other combinations with high sensitivity and better specificity, which deserve to be prospectively studied.We found a low prevalence of SARS-CoV-2 (2.7% [5/188]) among pregnant and postpartum patients after initiating universal testing. Prevalence among symptomatic patients (22.2% [4/18]) was similar to initial targeted screening approaches (19.1% [8/42]). Among 170 asymptomatic patients, two were positive or inconclusive, respectively; repeat testing at 24 hours was negative.Background COVID-19 was introduced in Korea early and experienced a large outbreak in mid-February. We aimed to review the public health interventions used during the COVID-19 outbreak and describe the impact on seasonal influenza activity in Korea. buy Ivarmacitinib Methods National response strategies and public health interventions, along with daily COVID-19 confirmed cases in Korea were reviewed during the pandemic. National influenza surveillance data were compared between seven sequential seasons. Characteristics of each season, including the rate of influenza-like illness (ILI), duration of epidemic, date of termination of epidemic, distribution of influenza virus strain and hospitalization were analyzed. Results After various public health interventions including enforced public education on hand hygiene, cough etiquette and staying at home with respiratory symptoms, universal mask use in public places, refrain from non-essential social activities and school closure, the duration of the influenza epidemic in 2019/2020 decreased by 6-12 weeks and the influenza activity peak rated 49.8 ILI/1,000 visits compared to 71.9-86.2 ILI/1,000 visits of previous seasons. During the period of enforced social distancing from week 9 to 17 of 2020, influenza hospitalization cases were 11.9-26.9-fold lower compared with previous seasons. During the 2019/2020 season, influenza B accounted for only 4%, in contrast with previous seasons in which influenza B accounted for 26.6% to 54.9% of all cases. Conclusions Efforts to activate high level national response not only led to a decrease in COVID-19, but also substantial decrease in seasonal influenza activity. Interventions applied to control COVID-19 may serve as useful strategies for prevention and control of influenza in upcoming seasons.Objective To determine the effect of social accountability strategies on pediatric quality of care. Design and setting A non-randomized quasi experimental study was conducted in four districts in Cambodia and all operational public health facilities were included. Participants Five patients under five years and their caretakers were randomly selected in each facility. Interventions To determine the effect of maternal and child health interventions integrating citizen voice and action (CVA) using community scorecards (CSC) on quality of pediatric care. Outcome measures Patient observations were conducted to determine quality of screening and counseling, followed by exit interviews with caretakers. Results Results indicated significant differences between intervention and comparison facilities; screening by IMCI trained providers (100% vs 67%,p less then 0.019), screening for danger signs; ability to drink/breastfeed (100% vs 86.7%, p less then 0.041), lethargy (86.7% vs 40%, p less then 0.004) and convulsions (83.3 vs 46.7%, p less then 0.023). Screening was significantly higher for patients in the intervention facilities for edema (56.7% vs 6.7%, P less then 0.000), immunization card (90% vs 40%, p less then 0.002), child weight (100 vs 86.7, p less then 0.041) and checking growth chart (96.7% vs 66.7%, p less then 0.035). The IMCI index, constructed from key performance indicators, was significantly higher for patients in the intervention facilities than comparison facilities (Screening Index 8.8 vs 7.0, p less then 0.018, Counseling Index 2.7 vs 1.5, p less then 0.001). Predictors of screening quality were child age, screening by IMCI trained provider, wealthier quintiles, and intervention facilities. Conclusion The institution of social accountability mechanisms to engage communities and facility providers showed some improvements in quality of care for common pediatric conditions, but socioeconomic disparities were evident.Background COVID-19 poses a risk to the endoscopic skull base surgeon. Significant efforts to improving safety have been employed, including the use of personal protective equipment, preoperative COVID-19 testing, and recently the use of a modified surgical mask barrier. Objective To reduce the risks of pathogen transmission during endoscopic skull base surgery. Methods This study was exempt from Institutional Review Board approval. Our study utilizes a 3-dimensional (3D)-printed mask with an anterior aperture fitted with a surgical glove with ports designed to allow for surgical instrumentation and side ports to accommodate suction ventilation and an endotracheal tube. As an alternative, a modified laparoscopic surgery trocar served as a port for instruments, and, on the contralateral side, rubber tubing was used over the endoscrub endosheath to create an airtight seal. Surgical freedom and aerosolization were tested in both modalities. Results The ventilated mask allowed for excellent surgical maneuverability and freedom. The trocar system was effective for posterior surgical procedures, allowing access to critical paramedian structures, and afforded a superior surgical seal, but was limited in terms of visualization and maneuverability during anterior approaches. Aerosolization was reduced using both the mask and nasal trocar. Conclusion The ventilated upper airway endoscopic procedure mask allows for a sealed surgical barrier during endoscopic skull base surgery and may play a critical role in advancing skull base surgery in the COVID-19 era. The nasal trocar may be a useful alternative in instances where 3D printing is not available. Additional studies are needed to validate these preliminary findings.
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