Attitudes toward COVID-19 vaccination among urogynecology patients.

Objective: Urogynecology patients skew older and often require intimate exams to treat non-life-threatening conditions, thus making care particularly susceptible to the effects of COVID-19. We aim to understand COVID-19 vaccination attitudes amongst urogynecology patients during the pandemic, which has adversely affected healthcare delivery, to identify measures that can be undertaken to improve care going forward. Study design: Cross-sectional surveys of urogynecology patients were conducted in three different states (Delaware, New Jersey, and Pennsylvania) between March and August 2021. Demographics, vaccination status, and COVID-19 attitudes were analyzed. Chi-square tests investigated group differences between vaccine-hesitant and unhesitant subjects. Results: Out of 158 surveys, eighty-three percent of respondents were vaccinated or planning to get vaccinated. Older age and regular flu vaccination predicted COVID-19 vaccination. Ninety-three percent of subjects were comfortable attending in-person visits. However, vaccine-hesitant individuals were less comfortable attending in-person and were significantly less likely to be comforted by clinic interventions, such as masking. Hesitant and unhesitant groups trusted doctors or medical professionals most for their source of COVID-19 information. Conclusions: Urogynecology patients mirror the general older population's COVID-19 vaccination attitudes, with distinct differences between hesitant and unhesitant groups. Vaccine-hesitant subjects appear less comfortable coming to in-person visits and less comforted by possible interventions, posing a difficult obstacle for clinics to overcome. High levels of patient trust suggest healthcare providers can play a crucial role in encouraging COVID-19 vaccination and combating misinformation.

Managing uncertainty in complex interventional fluoroscopic procedures.

There was a concern for potential patient skin burns indicated by air kerma as recorded by fluoroscopy equipment during two interventional fluoroscopic procedures. Two sentinel events as defined by The Joint Commission were indicated. Dose reconstruction based on measurements of machine output showed the air kerma readings were high by approximately a factor of four and no patient injury or sentinel event occurred. The radiation safety program in effect at the time of the incidents allowed discovery of equipment problems before a serious patient injury occurred, but additional controls have been implemented as a result, including quality control checks performed by cardiology, additional training, a database for tracking equipment maintenance, and mandatory entry of patient dose into electronic health records with follow-up orders automatically generated by the electronic health records. Most unexpected injuries are a result of multiple failures, but there are also multiple opportunities to prevent the injury. This paper provides a comprehensive look at patient safety concerns during two interventional cardiology fluoroscopic procedures and offers ways to further reduce risks to patients. It focuses on lessons learned and a systems-based approach to improving and promoting radiation safety during complex interventional fluoroscopic procedures.