Digital transformation in Latin America: a systematic review

The objective of the research was to explore the digital transformation in Latin America, seen from the themes worked on in recent research. The methodology consisted of a systematic review that allows knowing the state of the art of the variable addressed from the question: What are the areas or topics of interest linked to digital transformation in Latin America? The databases used were WOS and Science Direct, taking the period from 2019 to 2022. The results show that research on the subject of digital transformation in the region was oriented according to three areas: education, companies and people. It is concluded that global digitalization is a phenomenon that had been developing, but that it experienced an unexpected acceleration as a result of the COVID-19 pandemic. © 2022, Universidad del Zulia. All rights reserved.

The agri-food system in rural areas of Mexico City in the context emerging by SARS-CoV-2. Systemic approach reflections

The agri-food system depends on global variations such as economic changes that generate insecurity or food shortfall, in addition to the current health emergency that mainly affects small producers in rural areas. This work reviews the conditions of rural producers of Xochimilco in Mexico City and proposes a structure that promotes the viability of the agri-food system. The study was carried out in two stages, the ethnographic method was first used and, then from the Systemic Approach, the Soft Systems Methodology (SSM) in complementarity with Viable System Model (VSM) was applied to contextualize the effects of the current health emergency in this area. The results show that these communities are facing the pandemic from their limited capacities, so mechanisms and organizational structures are needed to make food systems robust to meet the challenges that their environment presents. It is proposed that the necessary linkage should be based on systemic models capable of managing the complexity of rural systems, such as the joint use of SSM and VSM, which through its systemic functions process environmental complexity and improve adaptation to the environment to ensure their survival.

Preventing tipping points in high comorbidity patients: A lifeline from health coaches

Introduction/Background This pragmatic cluster randomized clinical trial (cRCT) enrolls patients with multiple chronic diseases (MCDs) who are at highest risk for destabilization (unplanned hospitalizations, increased disability). Patients with multiple chronic diseases are often excluded from clinical trials because of their multiple medical conditions and worse health outcomes, which significantly confound Results. Few evidenced- based strategies exist to comprehensively address the needs of these patients. Objective(s) Among 1920 adult patients with multiple chronic diseases defined as a Charlson Comorbidity Index (CCI) > 4, who are established primary care patients of 16 Federally Qualified Health Centers (FQHCs) in NYC (n=8) and Chicago (n=8), which serve predominantly low income, Black and Latino patients, this pragmatic cluster RCT evaluates the comparative effectiveness of two approaches to preventing significant destabilization ('tipping points') that leads to unplanned hospitalization and increased disability. Methods Federally Qualified Health Centers (FQHCs, n=16) are cluster-randomized to: 1) Patient Centered Medical Home (PCMH) (Usual Care);or 2) PCMH plus a Health Coach (PCMH + HC) intervention that employs a positive affect/ self-affirmation strategy to motivate patients to set life goals, improve self-management and handle psychosocial and other stressors (Experimental). Primary and secondary outcomes include: unplanned hospitalizations and emergency department (ED) visits aggregated by PCORnet Clinical Research Networks, Health Information Exchange (New York City), and hospital alerts (Chicago), at baseline, 6, 12, 24-months and changes in disability. With the COVID-19 pandemic, we shifted to remote recruitment, and added oral consenting, egift cards and mailed letters. Results The PCMH + HC arm is designed to identify and prevent destabilization leading to hospitalization or ED visits that are more often triggered by psychosocial issues-family, community and environmental-than by medical issues. The study is powered to detect a 33% relative reduction in% hospitalized (a 5% absolute reduction) in PCMH + HC compared to PCMH only. Additionally, we expect that reducing hospitalization will result in reduced disability. Conclusion This intervention is designed to help participants manage life events that lead to 'tipping points' or overwhelming situations that result in unplanned hospitalizations and increased disability. FQHCs with PCMH recognition focus on care coordination. Patients need assistance to deal with many social and health related challenges they face and need help in communicating with health care providers and navigating a complex health care system. The PCMH + HC intervention will determine if adding health coaches helps patients to better manage their sources of stress, improve self-care and reduce unplanned hospitalizations. The impact of COVID-19 on changes to study processes and patient outcomes will be examined.

Clinical outcomes of COVID-19 patients treated with convalescent plasma or remdesivir alone and in combination at a community hospital in California's central valley

Rationale: The optimal treatment regimen for hospitalized patients with COVID-19 infection remains to be determined. The purpose of this study was to compare how treatment with convalescent plasma (CP) monotherapy, remdesivir (RDV) monotherapy, and combination therapy (CP + RDV) in patients with COVID-19 affected clinical outcomes. Methods: This retrospective observational study was conducted between May-August 2020 at a 150-bed academic community hospital in San Joaquin County, California. Patients with COVID-19 infection who were hospitalized during the study period received CP, RDV, or a combination of both. Clinical outcomes including mortality, discharge disposition, hospital length of stay, ICU length of stay, and total ventilation days were compared between each treatment group and stratified by ABO blood group. An exploratory analysis identified risk factors for mortality. Adverse effects were also evaluated. Results: A total of 213 patients with COVID-19 were admitted and 106 patients received one of the three prespecified treatments during the study period. 53 received CP alone, 11 received RDV alone, and 42 received combination therapy. RDV monotherapy showed an increased chance of survival compared to combination therapy or CP monotherapy (p = 0.052) (Figure 1). There were 15, 3, and 6 deaths in the CP, RDV, and CP + RDV groups, respectively. The median number of ventilation days was the longest in the CP + RDV group (8, IQR 4.5-14, p = 0.091). The median ICU length of stay was also longest in the CP + RDV group (8, IQR 4.5-15.5, p = 0.220). The median hospital length of stay was longest in the CP group (11, IQR 7-15.5, p = 0.175). Age (p = 0.036), initial SOFA score (p = 0.013), and intubation (p = 0.005) were statistically significant predictors of mortality. Patients with type O blood had less ventilation days, ICU LOS, and total LOS but the difference was not statistically significant. Thirteen treatment-related adverse events occurred. Conclusion: No significant differences in clinical outcomes including mortality, length of stay, or total ventilator days were observed between hospitalized patients with COVID 19 treated with RDV, CP, or CP + RDV. Elderly patients, those with a high initial SOFA score, and those who require intubation are at increased risk of mortality associated with COVID-19. Blood type did not demonstrate significant differences in clinical outcomes.

Clinical characteristics of patients with sars-cov-2 infection in san joaquin valley: A single center experience

Introduction: In December 2019 a new respiratory disease known as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2) was identified in Wuhan, China. Three months later it was declared a pandemic by WHO. In the United States, the first case was identified on January 19, 2020, and in San Joaquin County, California on March 9, 2020. Since then the case count has surged to over 36,000 in San Joaquin county with more than 500 deaths and community transmission is believed to be widespread. Our aim was to study the patient's initial characteristics, presentation and outcomes at San Joaquin General Hospital providing care to underserved population. Methods: This was a retrospective observational study of patients with SARS-COV-2 infection in 150-bed county hospital between March-October 2020. Confirmed cases of SARS-COV-2 were defined by a positive result on a reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay from a nasopharyngeal swab. Clinical Characteristics of SARS-COV-2 were obtained through review of Electronic Medical Records. Results: Data was obtained from 1168 positive cases with SARS-COV-2 infection. Average age was 42 years, 54% were male, by ethnicity majority were Hispanic (60%), Asians (9%), African American (9%), White (9%) and others (11%). Of the overall positive cases, 28% (n=323) were hospitalized and 9% (n=102) were admitted to ICU. On admission, the most common symptom was cough (57%), followed by fever (50%) and dyspnea (38%). Average of Comorbidities among hospitalized patients was 3, most common was Obesity (36%, n=419), followed by hypertension (24%, n=275), diabetes (20%, n=236) and cardiovascular disease (excluding hypertension) (6%, n=72). Of the 323 hospitalizations, 31.5% patients were admitted to ICU for acute respiratory failure, and 21% patients required invasive mechanical ventilation. Mean ICU length of stay was 9.3 days and mean duration of invasive mechanical ventilation was 10.9 days. Overall mortality was 3% for all positive cases, 16% in hospitalized patients, 33% in ICU admits and was 49% in intubated patients. Conclusion: Major risk factors for SARS-COV-2 include male gender, Hispanic ethnicity, obesity and hypertension. Patients admitted to ICU, especially requiring invasive mechanical ventilation had the worse prognosis.

Pulmonary and critical care medicine as a single specialty. The mandatory response in the era of respiratory pandemics

Mexico experiences great challenges in public health and its health system. Demographic transition combines the coexistence of infectious and chronic-degenerative diseases. Respiratory diseases are some of the major public health problems and have been aggravated by the advent of respiratory pandemics: Influenza A H1N1 in 2009 and COVID-19 by SARS-CoV-2 during 2020. In this period, the National Institute of Respiratory Diseases (INER), the main training center for specialized human resources in Mexico, like other centers for the specialty of pulmonary medicine, has undergone a profound transformation towards the healthcare integration of respiratory and critical care medicine. Nevertheless, the great lack of specialized human resources in this area has become more evident during the current epidemiological emergency. It confirms that the proposal to integrate pulmonary and critical care medicine into a single specialty may be one of the compelling and effective responses to match some of the greatest challenges of medicine in our country.