Film production during the Covid-19 pandemic.

BACKGROUND: The COVID-19 pandemic created unprecedented challenges for the film industry. Following a shutdown of productions, The Safe Way Forward document was developed to outline disease mitigation protocols. Despite this framework, many unanticipated scenarios arose during reopening of film production with the ongoing pandemic. AIMS: To identify and document promising practices for mitigating COVID-19 transmission in the film industry that can inform future pandemics and other industries. METHODS: We conducted a literature search to review research regarding COVID-19 disease mitigation efforts in the film industry. Through client-facing consultancy and consultant group meetings, we identified those factors most important for disease mitigation in the film industry and applicable to future pandemics and other industries. The Delphi Method enabled experts to review lessons learned as studio consultants during the COVID-19 pandemic; learnings were coded and analyzed for recurring themes. RESULTS: We identified anxiety, mistrust, and poor communication as key contributors to decreased compliance with COVID-19 protocols. In response, our team demonstrated multi-specialty expertise, provided scientific explanations, and developed trust by listening empathetically and responding with clear, consistent messaging. These measures served to alleviate anxiety, improve compliance, and provide a safe return to production. CONCLUSIONS: This study demonstrates the ability and agility of multi-disciplinary experts acting in the absence of clear guidance to support a safe return to film production. Workplace anxiety and non-compliance can be alleviated through effective communication by trusted experts. Lessons learned by our consultancy group can help protect workers across diverse industries in future pandemics.

Sequential screening for lung cancer in a high-risk group: randomised controlled trial: LungSEARCH: a randomised controlled trial of Surveillance using sputum and imaging for the EARly detection of lung Cancer in a High-risk group.

BACKGROUND: Low-dose computed tomography (LDCT) screening detects early-stage lung cancer and reduces mortality. We proposed a sequential approach targeted to a high-risk group as a potentially efficient screening strategy. METHODS: LungSEARCH was a national multicentre randomised trial. Current/ex-smokers with mild/moderate chronic obstructive pulmonary disease (COPD) were allocated (1:1) to have 5 years surveillance or not. Screened participants provided annual sputum samples for cytology and cytometry, and if abnormal were offered annual LDCT and autofluorescence bronchoscopy (AFB). Those with normal sputum provided annual samples. The primary end-point was the percentage of lung cancers diagnosed at stage I/II (nonsmall cell) or limited disease (small cell). RESULTS: 1568 participants were randomised during 2007-2011 from 10 UK centres. 85.2% of those screened provided an adequate baseline sputum sample. There were 42 lung cancers among 785 screened individuals and 36 lung cancers among 783 controls. 54.8% (23 out of 42) of screened individuals versus 45.2% (14 out of 31) of controls with known staging were diagnosed with early-stage disease (one-sided p=0.24). Relative risk was 1.21 (95% CI 0.75-1.95) or 0.82 (95% CI 0.52-1.31) for early-stage or advanced cancers, respectively. Overall sensitivity for sputum (in those randomised to surveillance) was low (40.5%) with a cumulative false-positive rate (FPR) of 32.8%. 55% of cancers had normal sputum results throughout. Among sputum-positive individuals who had AFB, sensitivity was 45.5% and cumulative FPR was 39.5%; the corresponding measures for those who had LDCT were 100% and 16.1%, respectively. CONCLUSIONS: Our sequential strategy, using sputum cytology/cytometry to select high-risk individuals for AFB and LDCT, did not lead to a clear stage shift and did not improve the efficiency of lung cancer screening.

Shifting into third gear: current options and controversies in third-year postgraduate family medicine programs in Canada.

OBJECTIVE: To summarize current options for postgraduate third-year programs in family medicine in Canada and compile current controversies about the expanding number of programs available and the trend toward subspecialization in family medicine. DESIGN: A literature search was conducted by the Regina Qu'Appelle Health Region Library research staff for Canadian family medicine fellowships and residency programs using MEDLINE, PubMed, and the Cumulative Index to Nursing and Allied Health Literature from the beginning of 2005 to September 1, 2011. All available websites for programs offering third-year options were reviewed. SETTING: Canadian family medicine residency programs. METHODS: A list of current third-year residency programs was generated from the Canadian Post-MD Education Registry. In addition, the current Canadian Resident Matching Service website was reviewed, along with every program-specific website, for current third-year programs offered. MAIN FINDINGS: More than 30 different options for third-year residency programs are available, including a number of community-influenced and resident-directed enhanced-skills programs. In 2010 to 2011 there were 237 postgraduate third-year family medicine residents compared with 128 in 2010 to 2011, an increase of 109 positions. CONCLUSION: Controversies over the benefits to the patient population, the practice patterns of third-year residency graduates, and the influence of a subspecialty trend against a stated goal of comprehensive family medicine continue to exist, while the number of available third-year residency options continues to expand.

Improving surgical outpatient efficiency through mobile phone text messaging.

INTRODUCTION: Currently, 175,000 people are on outpatient waiting lists in Irish hospitals. Many clinic slots are taken by patients returning for routine review postoperatively. METHODS: A Nokia mobile phone was used to send an outpatient text (OPT) to patients 2 weeks postdischarge. Patients replying that they were well were discharged. If no reply after 2 attempts was received, they were scheduled for the next outpatient clinic. RESULTS: Overall, 55 patients were offered the service over a 4-month period. Of these, 74.5% of patients were discharged from follow-up using text message surveillance. Patients were surveyed regarding their perception of the surveillance model, with all respondents ranking OPT surveillance as their preferred method of follow-up. There was a 13.6% decrease in outpatient visits over the study period. In addition, 6 emergency department visits were also avoided. CONCLUSION: Text message surveillance decreases outpatient waiting times and increases quality of care.

Vancouver Convention Health Centre (COVID-19 Response): Planning, implementation, and four lessons learned.

The Vancouver Convention Health Centre (VCHC) was rapidly set up as a part of the COVID-19 response in Brit-ish Columbia in order to create surge hospital capacity bed space. Multiple field hospitals were set up across the country in preparation for a possible surge and the VCHC utilized a non-traditional health care space and overlaid it with medical infrastructure. Maximum flexibility was required in planning for multiple patient populations and a novel four-box concept to plan for the requirements of the respective possible populations was developed. Key difficulties that needed to be overcome in planning COVID-19 medical care delivery in a non-traditional space included oxygen delivery, unknown future patient populations, and staffing. A clear recommendation can also now be made that healthcare provision should be considered during the design and build of new recreational or convention facilities in all communities.

A quantitative day in the life of a Saskatchewan rural physician.

INTRODUCTION: Rural family physicians are often required to meet a wide variety of medical service demands that are otherwise the responsibility of specialty physicians in urban centres. However, many rural physicians enjoy the practice variety and ability to meet patients' medical needs through this wider spectrum of care. We aimed to quantify and summarize the workload and clinical disorders seen by rural family physicians in Saskatchewan relative to urban family physicians. METHODS: We used Saskatchewan Ministry of Health billing data for 2015/16 to compare rural and urban care provision. The data were summarized in a graphic 1-month format to portray a typical month in the life of a rural physician in the province. RESULTS: In the office setting, rural family physicians saw 16.8% more cardiac presentations in adults over 65 years of age than did urban family physicians; otherwise, there were no significant differences in the top office diagnosis categories seen by the 2 groups. Differences were apparent, however, in the hospital setting: urban family physicians saw more patients presenting with pain and, reflective of centralization of obstetric delivery services, performed more deliveries than did rural physicians. CONCLUSION: There are differences in the clinical presentations seen by rural and urban family physicians, and these need to be considered by new physicians considering rural practice. Our simple visual depiction of average workload, vacation and activity levels of rural physicians can further inform medical residents on the realities of working in rural Saskatchewan as a family physician. A more complete understanding of clinical workload expectations may promote recruitment of resident physicians.

INTRODUCTION: Les médecins de famille en milieu rural sont souvent appelés à fournir des services médicaux très variés qui sont par ailleurs la responsabilité des médecins spécialistes, en milieu urbain. Cela dit, beaucoup de médecins en milieu rural apprécient la variété et la capacité de répondre aux besoins médicaux des patients dans ce contexte de soins plus étendu. Nous avons tenté de quantifier et de résumer la charge de travail ainsi que les troubles cliniques des patients reçus par les médecins de famille en milieu rural en Saskatchewan par rapport aux médecins de famille en milieu urbain. METHODS: Nous avons utilisé les données de facturation du ministère de la Santé de la Saskatchewan pour 2015­2016 afin de comparer la prestation des soins en milieu rural et urbain. Les données ont été résumées sous forme de graphique représentant un mois typique dans la vie d'un médecin exerçant en milieu rural dans la province. RESULTS: En cabinet, les médecins de famille en milieu rural ont reçu 16,8 % plus de patients de 65 ans atteints d'une cardiopathie que les médecins de famille en milieu urbain. Par ailleurs, il n'y avait pas de différences significatives dans les principales catégories de diagnostics en cabinet entre les deux groupes. Toutefois, des différences étaient évidentes en milieu hospitalier : les médecins de famille en milieu urbain ont reçu plus de patients présentant une douleur et ont pratiqué un nombre plus élevé d'accouchements que les médecins en milieu rural, ce qui reflète la centralisation des services obstétriques. CONCLUSION: Les troubles cliniques des patients reçus par les médecins de famille en milieu rural et urbain diffèrent et doivent être pris en compte par les nouveaux médecins qui envisagent la pratique en milieu rural. Notre représentation visuelle simple de la charge de travail, des vacances et du taux d'activité moyen des médecins en milieu rural peut éclairer les médecins résidents sur les réalités de la pratique du médecin de famille en région rurale en Saskatchewan. Une compréhension plus complète des attentes en matière de charge clinique pourrait favoriser le recrutement des médecins résidents.

Medical Encounters During a Joint Canadian/U.S. Exercise in the High Arctic (Exercise Arctic Ram).

The Arctic Ram Exercise was conducted in February 2016, near Resolute Bay on Cornwallis Island in Nunavut, Canada, to demonstrate the ability of the Canadian Armed Forces (CAF) to rapidly deploy to the arctic as an immediate response team. This report describes medical problems experienced by the 187 CAF and 28 U.S. forces involved in the exercise. Sixty-six airborne soldiers performed tactical static line jumps and linked up with soldiers on the ground for the exercise. Medical events were recorded by medics on the drop zone and by medical personnel at the Unit Medical Station in Resolute Bay. Average temperature during the exercise was -21°C and wind chill was -44°C. Two U.S. soldiers were injured in association with the jump and an additional 62 patients presented at the clinic during the exercise for an overall medical event incidence of 30%. The incidence of frostbite was 17%. At the end of the exercise, a physician actively examined CAF soldiers in one unit (n = 126) and found that 21% had experienced frostbite. The incidence of frostbite was high in this exercise compared to past cold-weather military operations, likely related to the very low temperatures and wind chills.

Surviving stroke in an Ebola Treatment Centre.

A middle aged woman presented to an Ebola Treatment Centre in West Africa with a 4-day history of fever, fatigue, joint pain and vomiting. She tested positive for Ebola virus disease (EVD) and a standard treatment platform of care was started. On day 3 of her admission, she was found to have suffered a left-sided CVA of unknown aetiology. Treatment was largely supportive within a resource-constrained environment and the added layer of providing care with extensive personal protective equipment, and human resource and safety constraints. The patient was able to clear the EVD and did regain some functional use of her arm and leg. She was discharged on day 15 of her stay, as a survivor of both stroke and Ebola.

Palliative care conundrums in an Ebola treatment centre.

We describe the treatment course and last days of a 33-year-old man from Western Africa who died from Ebola-related complications. Specifically, the issues around declaring a patient palliative in a low resource environment while dealing with a largely unknown entity, Ebola viral disease, make this an important discussion-stimulating case. The patient presented as a confirmed Ebola-positive case from a peripheral holding centre and then proceeded to deteriorate under our care. Significant neurological decline was noted and the prognosis was felt to be grim by certain providers. Other providers disagreed and a number of treatment algorithms were started and stopped during the patient's last days. He succumbed to Ebola complications after 17 days under our care.

The Haitian Health Cluster Experience: A comparative evaluation of the professional communication response to the 2010 earthquake and the subsequent cholera outbreak.

UNLABELLED: The 2010 Haitian earthquake and consequent Cholera epidemic taxed the already fragile health system. A large number of humanitarian organizations participated in the disaster response and the health communication response was analysed. Health Cluster updates from both periods were analysed for contents with a World Health Organization draft check list for monitoring and evaluating the quality of epidemiological data contained in WHO and Health Cluster emergency reports. The Pan-American Health Organization Emergency Operations Centre reports from the Earthquake had the lowest score with an average score of 2.54/17 and the Health Cluster - Cholera reports had the highest average score of 11/17. There is a wide variety and quality of information published in terms of epidemiological information in emergency reports with a distinct difference found between the earthquake reporting and the cholera event. A comprehensive and modifiable template for emergency reporting could alleviate these differences and allow for improved reporting. CITATION: Dhillon P, Annunziata G. The Haitian Health Cluster Experience: A comparative evaluation of the professional communication response to the 2010 earthquake and the subsequent cholera outbreak. PLOS Currents Disasters. 2012 Sep 5. doi: 10.1371/5014b1b407653.

Health emergencies in large populations: a disaster medicine learning experience.

The Health Emergencies in Large Populations course, organized by the International Committee of the Red Cross and Red Crescent Societies, is delivered in a decentralized manner by a number of academic centers around the world. It was one of the first formal educational opportunities developed for those in humanitarian assistance organizations, and its initial aim was to upgrade professionalism in humanitarian assistance programs conducted in emergency situations. This article summarizes the history and describes the current content, structure, and costs of the course.

Does rituximab aggravate pre-existing hypogammaglobulinaemia?

Rituximab, an anti-CD20 chimeric antibody, is the first monoclonal agent to be used in the therapy of cancer. It has been hailed as one of the most important therapeutic developments of the decade. While transient peripheral B cell depletion is common after rituximab therapy, immunoglobulin levels are generally not affected. This is because CD20 is expressed on pre-B and mature B lymphocytes but not on stem cells or plasma cells. Two adult patients with pre-existing primary antibody deficiency who presented with recurrent infections immediately following rituximab use for the treatment of refractory idiopathic thrombocytopenic purpura (ITP) are described. Both were previously treated with various immunosuppressive agents without any notable infective problems. However, a few weeks after treatment with rituximab, these patients presented with clinically significant immunodeficiency requiring intravenous immunoglobulin replacement therapy. This striking temporal relationship between rituximab administration and onset of infections suggests that rituximab has accelerated the presentation of immune deficiency in these patients. Increased vigilance around the use of newer immunomodulatory agents such as rituximab is recommended.

Endobronchial cancer detection using an integrated bronchoscopy system for simultaneous imaging and noncontact spectral measurement.

INTRODUCTION: Quantitative spectroscopy has been proposed as a means of improving the specificity of autofluorescence bronchoscopy by discriminating between true malignancy and suspicious but benign lesions before biopsy. This study investigated the potential discrimination ability of microvascular tissue-related parameters and relative intensity of autofluorescence, as estimated by noncontact spectroscopy. METHODS: Patients undergoing bronchoscopy for suspicion of lung cancer were enrolled from 4 sites (Canada, Russia, Slovenia, and the United Kingdom). In lesions selected for biopsy, light from a special fiberoptic bronchoscope was diverted to a spectrophotometer to obtain spectral measurements. The mucosa blood volume fraction and oxygen saturation were estimated from the computer model and, along with the autofluorescence intensity, were analyzed for discrimination potential for severe dysplasia or worse against lower histology grades. RESULTS: A total of 485 patients were enrolled, from whom 352 suspicious, adequate biopsy specimens were collected. Of these, 8 specimens were severe dysplasia or carcinoma in situ, and 66 were cancer. All measures were found to be significantly altered (receiver operating characteristic curve area: 0.83, 0.74, and 0.80 for autofluorescence intensity, the blood volume fraction, and oxygen saturation, respectively) in lesions found by biopsy to have severe dysplasia or higher grade present. In addition, the estimated volume fraction of desaturated blood was found to be significantly more discriminatory than that of oxygen-saturated blood (receiver operating characteristic curve area: 0.83 vs. 0.63). Study center differences were evident and suggest that results may depend on study population or bronchoscopist experience. CONCLUSIONS: Noncontact measurement and estimation of the above microvascular-related parameters, obtained during regular bronchoscope examination, may have potential for improving discrimination of severe dysplasia and cancer in lesions suspicious under white light bronchoscopy/autofluorescence bronchoscopy.