Understanding the Potential Impact of Different Drug Properties on Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Transmission and Disease Burden: A Modelling Analysis.

BACKGROUND: The public health impact of the coronavirus disease 2019 (COVID-19) pandemic has motivated a rapid search for potential therapeutics, with some key successes. However, the potential impact of different treatments, and consequently research and procurement priorities, have not been clear. METHODS: Using a mathematical model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, COVID-19 disease and clinical care, we explore the public-health impact of different potential therapeutics, under a range of scenarios varying healthcare capacity, epidemic trajectories; and drug efficacy in the absence of supportive care. RESULTS: The impact of drugs like dexamethasone (delivered to the most critically-ill in hospital and whose therapeutic benefit is expected to depend on the availability of supportive care such as oxygen and mechanical ventilation) is likely to be limited in settings where healthcare capacity is lowest or where uncontrolled epidemics result in hospitals being overwhelmed. As such, it may avert 22% of deaths in high-income countries but only 8% in low-income countries (assuming R = 1.35). Therapeutics for different patient populations (those not in hospital, early in the course of infection) and types of benefit (reducing disease severity or infectiousness, preventing hospitalization) could have much greater benefits, particularly in resource-poor settings facing large epidemics. CONCLUSIONS: Advances in the treatment of COVID-19 to date have been focused on hospitalized-patients and predicated on an assumption of adequate access to supportive care. Therapeutics delivered earlier in the course of infection that reduce the need for healthcare or reduce infectiousness could have significant impact, and research into their efficacy and means of delivery should be a priority.

Comorbidities and COVID-19 status influence the survival rate of geriatric patients in intensive care units: a prospective cohort study from the Indonesian Society of Anaesthesiology and Intensive Therapy.

BACKGROUND: With the more advanced science in the field of medicine and disease management, the population of geriatric intensive care patients is increasing. The COVID-19 pandemic has impacted healthcare management around the globe, especially on critically-ill elderly patients. We aim to analyse the relationship between underlying illnesses, including COVID-19, and the survival rate of elderly patients who are treated in the intensive care setting. METHODS: We conducted a prospective cohort study at 14 teaching hospitals for Anaesthesiology and Intensive Therapy Education in Indonesia. We selected all subjects with 60 years of age or older in the period between February to May 2021. Variables recorded included subject characteristics, comorbidities, and COVID-19 status. Subjects were followed for 30-day mortality as an outcome. We analysed the data using Kaplan-Meier survival analysis. RESULTS: We recruited 982 elderly patients, and 728 subjects were in the final analysis (60.7% male; 68.0 ± 6.6 years old). The 30-day mortality was 38.6%. The top five comorbidities are hypertension (21.1%), diabetes (16.2%), moderate or severe renal disease (10.6%), congestive heart failure (9.2%), and cerebrovascular disease (9.1%). Subjects with Charlson's Comorbidity Index Score > 5 experienced 66% death. Subjects with COVID-19 who died were 57.4%. Subjects with comorbidities and COVID-19 had lower survival time than subjects without those conditions (p < 0.005). Based on linear correlation analysis, the more comorbidities the geriatric patients in the ICU had, the higher chance of mortality in 30 days (p < 0.005, R coefficient 0.22). CONCLUSION: Approximately one in four elderly intensive care patients die, and the number is increasing with comorbidities and COVID-19 status.

Indonesian Anesthesiologists Preparedness for COVID-19 Surge Capacity in the Early Pandemic.

Background: Anesthesiologists play a crucial role in every disaster event, including biological disasters by COVID-19. This medical specialty should be prepared for a surge in patients due to a pandemic. The present study aims to evaluate the preparedness of anesthesiologists in facing the surge in the number of COVID-19 patients at the beginning of the pandemic in Indonesia. Methods: This is a descriptive cross-sectional study using an online survey to Anesthesiologists in Indonesia, with snowballing sampling method. A distribution frequency was used to describe the univariate analysis results of the variables. Pearson correlation was used to test the correlation between perceived resource adequacy/availability and perceived preparedness to face the surge. Results: A total of 141 anesthesiologists participated in our online survey; 47% of responders said they do not have enough staff, while 53% said that their staff did not have sufficient knowledge of handling the critical COVID-19 patients. They also reported limited resources, especially the limited isolation space and N95 masks. The correlation analysis indicated a strong and significant relationship between limited resources and the preparedness of anesthesiologists. Conclusion: At the beginning of the pandemic, Indonesian Anesthesiologists felt that they still had very limited resources, leading to unpreparedness to deal with the surge in the number of COVID-19 patients with critical conditions.

The application of augmented reality for improving clinical skills: a scoping review.

Augmented reality technology had developed rapidly in recent years and had been applied in many fields, including medical education. Augmented reality had potential to improve students' knowledge and skills in medical education. This scoping review primarily aims to further elaborate the current studies on the implementation of augmented reality in advancing clinical skills. This study was conducted by utilizing electronic databases such as PubMed, Embase, and Web of Science in June 2022 for articles focusing on the use of augmented reality for improving clinical skills. The Rayyan website was used to screen the articles that met the inclusion criteria, which was the application of augmented reality as a learning method in medical education. Total of 37 articles met the inclusion criteria. These publications suggested that using augmented reality could improve clinical skills. The most researched topics explored were laparoscopic surgery skills and ophthalmology were the most studied topic. The research methods applied in the articles fall into two main categories: randomized control trial (RCT) (29.3%) and non-RCT (70.3%). Augmented reality has the potential to be integrated in medical education, particularly to boost clinical studies. Due to limited databases, however, any further studies on the implementation of augmented reality as a method to enhance skills in medical education need to be conducted.

Indonesian Translation and Cross-Cultural Validation of Pediatric Anesthesia Parent Satisfaction (PAPS) Questionnaire.

BACKGROUND: Many questionnaires have been widely used to assess patient satisfaction. One of them is the Pediatric Anesthesia Parent Satisfaction (PAPS) questionnaire. However, in Indonesia, the parent satisfaction of pediatric patients undergoing surgery has never been studied. Knowing patient satisfaction can provide feedback to improve the quality of anesthesia services. Furthermore, the PAPS questionnaire has never been used in Indonesia, so it needs to be translated and tested for validity and reliability before being implemented in Indonesia. AIM: to validate the Indonesian version of the PAPS questionnaire Method: This study uses a descriptive-analytic method with a cross-sectional design. The PAPS Questionnaire was translated into Indonesian version with the following steps (1) forward translation, (2) establish an expert committee, and (3) backward translation. After that, pilot testing and FGD with the expert were conducted to obtain the final questionnaire. Pearson's correlation and confirmatory factor analysis (CFA) were employed for the validity test. Sampling measurement before CFA was carried out with Keyser-Meyer-Olkin (KMO) and Bartlett's test. Cronbach's alpha determined the reliability test evaluation. RESULT: Total number of subjects is 125 subjects. The PAPS questionnaire in the Indonesian version was obtained with help from INCULS and an anesthesiologist expert. Pearson's correlation found that all items ranged from r = 0.531-0.796 with p < 0.001. The CFA showed two factors that explained 65% of the total variance, with KMO being 0.937 (X2=1283.452, p < 0.001). Cronbach's alpha coefficient was 0.937. CONCLUSION: Indonesian version of the PAPS questionnaire is valid and reliable for assessing parents' satisfaction with the anesthesia services their child received.

Perioperative Factors Impact on Mortality and Survival Rate of Geriatric Patients Undergoing Surgery in the COVID-19 Pandemic: A Prospective Cohort Study in Indonesia.

Background: The COVID-19 pandemic continues to have an impact on geriatric patients worldwide since geriatrics itself is an age group with a high risk due to declined physiological function and many comorbidities, especially for those who undergo surgery. In this study, we determine the association between perioperative factors with 30-day mortality and a survival rate of geriatric patients undergoing surgery during COVID-19 pandemic. Methods: A prospective cohort study was conducted at 14 central hospitals in Indonesia. The recorded variables were perioperative factors, 30-day mortality, and survival rate. Analyses of associations between variables and 30-day mortality were performed using univariate/multivariable logistic regression, and survival rates were determined with Kaplan−Meier survival analysis. Results: We analyzed 1621 elderly patients. The total number of patients who survived within 30 days of observation was 4.3%. Several perioperative factors were associated with 30-day mortality (p < 0.05) is COVID-19 (OR, 4.34; 95% CI, 1.04−18.07; p = 0.04), CCI > 3 ( odds ratio [OR], 2.33; 95% confidence interval [CI], 1.03−5.26; p = 0.04), emergency surgery (OR, 3.70; 95% CI, 1.96−7.00; p ≤ 0.01), postoperative ICU care (OR, 2.70; 95% CI, 1.32−5.53; p = 0.01), and adverse events (AEs) in the ICU (OR, 3.43; 95% CI, 1.32−8.96; p = 0.01). Aligned with these findings, COVID-19, CCI > 3, and comorbidities have a log-rank p < 0.05. The six comorbidities that have log-rank p < 0.05 are moderate-to-severe renal disease (log-rank p ≤ 0.01), cerebrovascular disease (log-rank p ≤ 0.01), diabetes with chronic complications (log-rank p = 0.03), metastatic solid tumor (log-rank p = 0.02), dementia (log-rank p ≤ 0.01), and rheumatology disease (log-rank p = 0.03). Conclusions: Having at least one of these conditions, such as COVID-19, comorbidities, emergency surgery, postoperative ICU care, or an AE in the ICU were associated with increased mortality in geriatric patients undergoing surgery during the COVID-19 pandemic.