ABSTRACT
The COVID-19 pandemic has profoundly impacted the Brazilian service sector. With the health crisis, challenges and changes in the business models of car dealerships are also intensified. Creativity is discussed by several conceptual approaches. From the point of view of neuroscience, it is a response to the human need of solving problems. It is within this premise that the present work aims to enhance value proposition for a business model centered on automobile e-commerce. This purpose unfolds in an exploratory research on approaches, methodologies, and tools of creativity, as well as the application of Cristiano Alves's creative framework in this business model. The analysis of the results signals improvements in solutions for car e-commerce. With this, it is concluded that collective creativity is efficient in the discovery of potentially innovative ideas. © 2022, IGI Global.
ABSTRACT
Background The COVID-19 pandemic significantly impacted the Brazilian healthcare system, resulting in deferral of elective cardiac procedures and avoidance of medical care due to social distancing. We aimed to evaluate the impact of COVID-19 on hospital admissions and death rates associated with coronary events in a Brazilian large-scale private health system. Methods From March 18 - Sep 30, 2020 we evaluated the administrative database of UNIMED-BH, a cooperative Brazilian private insurance, with over 1.25 million clients from a large urban center. We collected data from admissions in all owned and accredited hospitals related to urgent and elective coronary events (acute coronary syndromes, coronary interventions, clinical management of coronary artery disease and invasive diagnostic procedures). Admissions in 2020 were compared to the 2-year historical series (2018, 2019), and rates/100,000 were calculated considering the mean covered population. Outcomes were assessed until October 15th, 15 days after the last enrollment. Results In the 196-day period, the number of coronary admissions in 2018, 2019 and 2020 were, respectively, 2,789, 3,519 and 2,348, and patients had a median age of 67 [58-76] years, being 59% men. The mean length of hospital stay was 6.7±9.3 days, and 27% had >1 admission in 3 years. The adjusted rates of admissions were 221, 278 and 184/100,000 clients, resulting in a significant 26% (95% CI 22 - 30) reduction in 2020 compared to the historical series (p<0.001). The reduction was more pronounced from March to May (36%) - when social isolation started - compared to the peak of the pandemic (June to September, 19%). In-hospital mortality was also significantly higher in 2020 (5.4%, 95% CI 4.5 - 6.4) compared to 2018/2019 (3.6%, 95% CI 3.2 - 4.1), p<0.001, despite the similar age (67 [57-76) vs. 67 [58-76], p=0.15) and length of hospital stay (6.9±8.9 vs. 6.7±9.5 days, p=0.43). Conclusion There was a significant decrease in admissions due to coronary events during the COVID-19 pandemic in Brazil, in parallel with increased in-hospital mortality. Deferral of elective procedures and avoidance of medical care possibly resulted in delayed presentation and unfavorable outcomes.
ABSTRACT
INTRODUCTION: Cardiac involvement seems to impact prognosis of COVID-19, being more frequent in critically ill patients. We aimed to assess the prognostic value of right ventricular (RV) and left ventricular (LV) dysfunction, evaluated by bedside echocardiography (echo), in patients hospitalized with COVID-19. METHODS: Patients admitted in 2 reference hospitals in Brazil from Jul to Sept/2020 with confirmed COVID-19 and moderate/severe presentations underwent clinical and laboratory evaluation, and focused bedside echo (GE Vivid-IQ), at the earliest convenience, with remote interpretation. The association between demographics, clinical comorbidities and echo variables with all-cause hospital mortality was assessed, and factors significant at p<0.10 were put into multivariable models. RESULTS: Total 163 patients were enrolled, 59% were men, mean age 64+/-16 years, and 107 (66%) were admitted to intensive care. Comorbidities were present in 144 (88%) patients: hypertension 115 (71%), diabetes 61 (37%) and heart failure 22 (14%). In-hospital mortality was 34% (N=56). In univariate analysis, echo variables significantly associated with death were: LV ejection fraction (LVEF, OR=0.94), RV fractional area change (OR=0.96), tricuspid annular plane systolic excursion (TAPSE, OR=0.83) and RV dysfunction (OR=5.3). In multivariate analysis, after adjustment for clinical and demographic variables, independent predictors of mortality were age>=63 years (OR=5.53, 95%CI 1.52-20.17), LVEF<64% (OR=7.37, 95%CI 2.10-25.94) and TAPSE<18.5 mm (OR=9.43, 95% CI 2.57-35.03), and the final model had good discrimination, with C-statistic=0.83 (95%CI 0.75-0.91). CONCLUSION: Markers of RV and LV dysfunction assessed by bedside echo are independent predictors of mortality in hospitalized COVID-19 patients, after adjustment for clinical variables.