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Adherence to guidelines for prevention of surgical complications was found to be low in our institution. A multifaceted intervention significantly increased use of prophylaxis for venous thromboembolism but not for coronary events. This differential response suggests that the success of a quality improvement project strongly depends on topic content and its phase of acceptance.

Health is greatly influenced by the resources of the population, and social determinants of health have always played a major role in health outcomes. It comes as no surprise that disparities have resulted in a major disproportion of incidences of COVID-19 in the most impoverished populations. The focus of the study is to correlate the incidence of COVID-19 to socioeconomic status and race. METHODS: Demographic information from positive test results of Covid-19 by RT-PCR from four testing locations in Houston, Texas between March 2020 to May 2020. These were correlated and ranked according to the 2020 SocioNeeds Index. The index value is a measurement and comparison of needs and health outcomes in communities across the United States. Zero indicating the lowest need and 100 indicating the highest need. RESULTS: A total of 39,505 tests were completed across the testing locations, out of those 2,306 (6%) were positive. A positive linear correlation was obtained between a higher SocioNeeds Index and the of incidence of Covid-19 to a given zip code, unstandardized B coefficient 0.215, p¼<0.001. Populations were ranked based on their index value, with RANK 1 from 0.20 to 16.99, RANK 2 from 17 to 41, RANK 3 from 41 to 62.9, RANK 4 from 63 to 85 and RANK 5>85. RANK 1 had significantly less incidence compared to RANK 3 (p¼0.036), RANK 4 (p¼0.016) and RANK 5 (p¼<0.001). RANK 2 showed less incidence compared to RANK 5 (p¼<0.001). CONCLUSIONS: Social determinants of health such as socioeconomic status have a major influence in the incidence of Covid-19. As the data illustrates, the incidence of COVID-19 is proportional to the population need. CLINICAL IMPLICATIONS: People from communities with higher incidence of COVID-19 could be at a greater risk for complications, since health outcomes from these communities are poor due to multiple barriers. As challenging as the current COVID-19 pandemic could be, it is critical to address the prevailing social disparities between populations and close the gap in health inequity. This could serve for the future prioritization of needs among these populations and the implementation of further strategies to improve their health outcomes.

The problems with management of haemophilia in developing countries are poor awareness, inadequate diagnostic facilities and scarce factor concentrates for therapy. The priorities in establishing services for haemophilia include training care providers, setting up care centres, initiating a registry, educating affected people and their families about the condition, providing low-cost factor concentrates, improving social awareness and developing a comprehensive care team. A coagulation laboratory capable of reliably performing clotting times with correction studies using normal pooled, FVIII and FIX deficient patient plasma and factor assay is most essential for diagnosis. More advanced centralized laboratories are also needed. Molecular biology techniques for mutation detection and gene tracking should be established in each country for accurate carrier detection and antenatal diagnosis. Different models of haemophilia care exists. In India, there is no support from the government. Services, including import of factor concentrates, are organized by the Haemophilia Federation of India, with support from other institutions. Haemophilia is managed with minimal replacement therapy (about 2000 i.u./PWH/year). In Malaysia, where the system is fully supported by the government, facilities are available at all public hospitals and moderate levels of factor concentrates are available 'on-demand' (about 11,000 i.u./PWH/year) at the hospitals. Haemophilia care in South Africa is provided through major public hospitals. Intermediate purity factor concentrates are locally produced (about 12,000 i.u./PWH/year) at low cost. The combined experience in the developing world in providing haemophilia services should be used to define standards for care and set achievable goals.

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