Strategic optimization of patient flow and staffing schemes during the COVID-19 pandemic through Operations Management in a Neonatal Intensive Care Unit

Background@#The COVID-19 pandemic posed challenges in making time-bound hospital management decisions. The University of the Philippines -Philippine General Hospital (UP-PGH) is a tertiary COVID-19 referral center located in Manila, Philippines. The mismatch of increasing suspected or confirmed COVID-19 infected mothers with few documented cases of infected infants has caused significant patient overflow and manpower shortage in its NICU.@*Objective@#We present an evaluated scheme for NICU bed reallocation to maximize capacity performance, staff rostering, and resource conservation, while preserving COVID-19 infection prevention and control measures.@*Methods@#Existing process workflows translated into operational models helped create a solution that modified cohorting and testing schemes. Staffing models were transitioned to meet patient flow. Outcome measurements were obtained, and feedback was monitored during the implementation phase.@*Results@#The scheme evaluation demonstrated benefits in (a) achieving shorter COVID-19 subunit length of stay; (b) better occupancy rates with minimal overflows; (c) workforce shortage mitigation with increased non-COVID workforce pool; (d) reduced personal protective equipment requirements; and (e) zero true SARS-CoV-2 infections.@*Conclusion@#Designed for hospital operations leaders and stakeholders, this operations process can aid in hospital policy formulation in modifying cohorting schemes to maintain quality NICU care and service during the COVID-19 pandemic.

Rational use of Polymyxins against multi-drug resistant Gram-Negative bacteria

@#The current strategy in treating multi-drug resistant gram-negative bacterial (MDR-GNB) infections is salvage therapy by using polymyxins. However, the beginning emergence of polymyxin resistance should enforce strict antimicrobial stewardship programs to preserve polymyxin efficacy. Knowledge of structural characteristics, pharmacodynamic, and pharmacokinetic profiles of polymyxins, as well as consideration of efficacy, safety, suitability, and cost, will help in the choice of the appropriate polymyxin for therapy. Polymyxin B is the recommended polymyxin for systemic use, while colistin is recommended for lower urinary tract infections, intraventricular, and intrathecal use. Either polymyxin can be used for hospital-acquired and ventilator-associated pneumonia. Combination therapy over monotherapy remains to be advantageous due to synergism and decreased resistance development. The choice of the second drug to be used should be based on full susceptibility, or if unavailable, a drug with the least minimum inhibitory concentration relative to the breakpoint set by the Clinical and Laboratory Standards Institute. Using the mnemonic ESCAPE can also guide physicians in their polymyxin prescription process: (1) Checking if the pathogen is Extensively resistant or multi-drug resistant; (2) checking the patient’s clinical status if compatible with Significant infection; (3) using Combination therapy; (4) ensuring Adequate dosing; (5) Proper preparation and administration of drug; and (6) keeping an Eye for response and adverse effects.

Effectiveness of digital media technology-based interventions on HIV STI Risk Reduction among young people: A meta-analysis

Background@#Prevention strategies delivered through digital media technology (DMT) have been developed to reduce HIV incidence among young people. However, no best-practice DMT intervention strategies exist in handling HIV prevention programs among young people. @*Objectives@#To determine the effectiveness of DMT-based interventions in reducing risk-taking behaviours among young people that may predispose them to acquiring HIV and other sexually transmitted infections.@*Subjects and Selection Criteria@#Randomized controlled trials and quasi-experimental studies with rigorous controls comparing DMT-based interventions and controls on reducing risk-taking behaviors among young people aged 10-24 years were included. Data Collection: Search methods were done on the following: MEDLINE, CENTRAL, Trials Register, Google Scholar, ScienceDirect, TRIP database, HERDIN, reference lists, & local databases until December 2017.