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Purpose This paper describes the effect that the COVID-19 pandemic, and subsequent shift from in-person to virtual (video-based) home visiting, had on the Los Angeles County Welcome Baby Home Visiting Program. Description The Welcome Baby (WB) Program is a voluntary, universal home visiting program for expectant women and women with infants in Los Angeles County implemented in 14 hospitals in Los Angeles County. Oversight of the program is managed by LA Best Babies Network (LABBN) and funded by First 5 LA. The COVID-19 pandemic forced Welcome Baby Home visitors to shift from in-person home visits to virtual visits, which had an impact on programmatic outcomes. Assessment LABBN manages a database utilized by WB sites. In assessing data trends before and during the pandemic, shifting to virtual visits resulted in an increase in both missed visits and completed visits, and a decrease in overall visit length. Completion of required assessments and overall client program completion were not affected by the COVID-19 pandemic. Conclusion The Welcome Baby sites across Los Angeles County were able to successfully migrate in-person visits to a virtual platform, proving that virtual visits are possible and do provide some programmatic benefits. However, the long-term efficacy of virtual visits remains to be seen, and further research is warranted., Author(s): Martha J. Bock [sup.1] , Kayla Kakavand [sup.1] , Diana Careaga [sup.2] , Sharlene Gozalians [sup.1] Author Affiliations: (1) Technical Assistance and Training Team, LA Best Babies Network, , [...]

Background: Early sepsis diagnosis has emerged as one of the main challenges in the emergency room. Measurement of sepsis biomarkers is largely used in current practice to improve the diagnosis accuracy. Monocyte distribution width (MDW) is a recent new sepsis biomarker, available as part of the complete blood count with differential. The objective was to evaluate the performance of MDW for the detection of sepsis in the emergency department (ED) and to compare to procalcitonin (PCT) and C-reactive protein (CRP). Methods: Subjects whose initial evaluation included a complete blood count were enrolled consecutively in 2 EDs in France and Spain and categorized per Sepsis-2 and Sepsis-3 criteria. The performance of MDW for sepsis detection was compared to that of procalcitonin (PCT) and C-reactive protein (CRP). Results: A total of 1,517 patients were analyzed: 837 men and 680 women, mean age 61 ± 19 years, 260 (17.1%) categorized as Sepsis-2 and 144 patients (9.5%) as Sepsis-3. The AUCs [95% confidence interval] for the diagnosis of Sepsis-2 were 0.81 [0.78–0.84] and 0.86 [0.84–0.88] for MDW and MDW combined with WBC, respectively. For Sepsis-3, MDW performance was 0.82 [0.79–0.85]. The performance of MDW combined with WBC for Sepsis-2 in a subgroup of patients with low sepsis pretest probability was 0.90 [0.84–0.95]. The AUC for sepsis detection using MDW combined with WBC was similar to CRP alone (0.85 [0.83–0.87]) and exceeded that of PCT. Combining the biomarkers did not improve the AUC. Compared to normal MDW, abnormal MDW increased the odds of Sepsis-2 by factor of 5.5 [4.2–7.1, 95% CI] and Sepsis-3 by 7.6 [5.1–11.3, 95% CI]. Conclusions: MDW in combination with WBC has the diagnostic accuracy to detect sepsis, particularly when assessed in patients with lower pretest sepsis probability. We suggest the use of MDW as a systematic screening test, used together with qSOFA score to improve the accuracy of sepsis diagnosis in the emergency department. Trial Registration ClinicalTrials.gov (NCT03588325). [ABSTRACT FROM AUTHOR]