Hospital management and game theory

The COVID-19 pandemic has highlighted that we are stronger when joined around a shared vision. A challenging task in hospitals is to define the scenarios and face change in a manner that benefits the patients, clinical practices and themselves institutions. Game theory provides frames of study for healthcare decision-making at high levels as the government and professional societies. This allows us to study and incorporate this theory to define and approach solutions that can hold the different health systems feasible and wholesome. This chapter presents a conceptual framework that sheds light on medical tutoring in a hospital. Intensive care units are the focus of this study because they have a relevant role in this scenario. The new educational challenges in critical care services must face from a perspective that provides a proper response to changing actuality. This is done through enhanced practice to make decisions using game theory. The principles of this theory predict human behaviour, helping with decision-making and describing how determined results can appear that are not optimal for the entire group. The implementation of critical thinking between an intensive care unit and another service is studied. The results obtained agree with the expected behaviour. The study indicates that game theory provides a framework which manages educational collaboration between clinical units in the hospital. It can get suitable models for strategic interactions that frequently occur in education training and application in medicine. The chapter studies the environments wherein the theory has been applied and the upcoming challenges in this sector. © 2023 Nova Science Publishers, Inc. All rights reserved.

Fostering the Next Generation of Healthcare Leaders in a Pandemic World

Purpose of Study: Since the COVID pandemic began, there have been a dearth of opportunities for pre-medical students to work with practicing physicians. This is even truer in health care shortage areas such as California's impoverished San Joaquin Valley where the majority of its residents live below the poverty line and face a number of socioeconomic and educational hardships. Inequitable educational opportunities, lack of STEM identity, as well as lack of access to local mentors contribute to underrepresentation of individuals with diverse racial and ethnic backgrounds in STEM professions, including medicine. In partnership with the UCSF Fresno Department of Pediatrics we created a summer virtual Medical Education Apprentice Fellowship to help address some of these issues. Methods Used: This seven-week summer program was directed towards disadvantaged high school and undergraduate students living in the San Joaquin Valley. Four pediatric subspecialists, 4 medical students, 64 undergraduate students, and 4 high school students participated in the program. Participants were divided into specialty teams based on their interests, with each team (burn surgery, endocrinology, gastroenterology, or pulmonology) led by a medical student and faculty. Overall, this program had three primary components: (1) creating animated medical education videos for use in clinics, (2) hosting patient case study series, and (3) providing mentorship and professional development. Summary of Results: Forty-seven percent of students reported being the first in their family to pursue a STEM-related field. Prior to entering this program, only 50% of students felt strongly confident in their ability to be successful in a STEM-related field, and only 30% had a mentor that they fully trusted for guidance and resources. After completing the seven week program, 93% of students reported that they felt the program allowed them to explore medicine in innovative ways, 88% reported that they had made fruitful connections and now have a mentor and resources to guide them, and nearly 75% of students indicated a desire to address the social and health needs of the San Joaquin Valley as a healthcare professional. Conclusion(s): Our Medical Education Apprentice Fellowship provided disadvantaged students in the San Joaquin Valley with an opportunity to improve their digital literacy skills and medical knowledge while receiving mentorship from medical students and physicians. Grassroots programs such as this that form collaborative partnerships between students and health care professionals can be used to foster future healthcare leaders in order to address the health provider shortage in the San Joaquin Valley while providing underrepresented youth the chance to become healthcare champions.

[Analysis of the XIDE system in the management of overdemand for care]. / Análisis del sistema XIDE en la gestión de la sobredemanda asistencial.

OBJECTIVE: To assess the impact and suitability of the XIDE citation system in the management of over-demand for care at the Monforte de Lemos Health Center (Lugo, Spain). MATERIAL AND METHODS: Descriptive, cross-sectional, observational and analytical study. The study population was the patients with appointments to the elderly in the ordinary agenda as «forced¼ or «urgent forced¼. The population sample was obtained during the period from July 15 to August 15, 2022. The comparative analysis was performed with periods prior to the implementation of XIDE and the XIDE/observer concordance was estimated by calculating Cohen's kappa index. RESULTS: We observed an increase in care pressure, both in the number of consultations/day and in the proportion of forced consultations, which have increased by 30-34%. The group over 85 years of age and women are the majority in excess demand. The 83.04% of urgent consultations were cited through the XIDE system, the most frequent reason for consultation being «suspected COVID¼ (24.64%), with a concordance of 51.4% in this group and 65.5% globally. We appreciate a high overtriage in the assigned attention times, even when the reason for consultation coincides, with a poor statistical concordance with the observers. The high proportion in the overdemand of patients belonging to other places in the health center stands out, so that adequate management of human resources with adequate coverage of absences would reduce it by 48.5%, while the XIDE system (in the ideal assumption of absolute concordance) would only manage to reduce it by 43%. CONCLUSIONS: The low reliability of the XIDE is mainly due to inadequate triage, rather than the failure to reduce overdemand, so it cannot replace a triage system performed by health personnel.

Kidney Function After SARS-CoV-2 Infection in Patients With and Without AKI During Hospital Admission in Western Mexico

Background: Kidney damage in COVID-19 patients has been of special concern. Kidney function after COVID-19 has not been comprehensively studied, and there is scarce information comparing kidney function among patients with or without AKI during hospital admission. Method(s): Retrospective cohort study in a secondary level center in Guadalajara, Mexico. Patients who were admitted due to COVID-19 from April-December 2020 and who survived at discharge and who had at least one follow-up visit in the outpatient clinic 6 months after initial symptoms were included. Information was obtained from outpatient electronic medical files. Result(s): From a total of 1085 patients, 733 survived at discharge. 113 had AKI during admission and only 33 (29.2%) had any kind of outpatient follow-up. Their mean age was 60.6 years, 63.6% were men, 48.4% had DM and 66.6% had HTN. Mean baseline SCr was 0.82 mg/dL with a mean eGFR of 90.82 ml/min. On follow-up mean stable SCr increased to 1.49 mg/dL, with a mean eGFR of 65.71 ml/min, a mean decrease of 25.11 ml/min. 15 patients (45.45%) developed CKD and 1 patient (3.03%) started RRT. Mean follow-up time was 451 days. 34 patients with no AKI during admission had a follow-up visit;mean age was 58.1 years, 58.8% were men, 47.1% had DM and 70.6% had HTN. Mean baseline SCr was 0.78 mg/dL and mean eGFR was 92.33 ml/min. On follow-up mean stable SCr increased to 0.86 mg/dL, with a mean eGFR of 86.64 ml/min, a mean decrease of 5.69 ml/min. 1 patient (2.94%) developed CKD and none required to start RRT. Mean follow-up time was 468 days. Conclusion(s): AKI during COVID-19 was associated to a significant decrease in eGFR on follow-up. Those with COVID19 without AKI during admission also had a small decrease in eGFR on follow-u. Timely and more intense follow-up strategies after COVID19 and AKI are needed.

SAFETY AND EFFICACY OF THYMIC PEPTIDES IN THE TREATMENT OF HOSPITALIZED COVID-19 PATIENTS IN HONDURAS.

Coronavirus disease 2019 (Covid-19) active cases continue to demand the development of safe and effective treatments. This is the first clinical trial to evaluate the safety and efficacy of oral thymic peptides. ; We conducted a nonrandomized phase 2 trial with a historic control group to evaluate the safety and efficacy of a daily 250-mg oral dose of thymic peptides in the treatment of hospitalized Covid-19 patients. Comparisons based on standard care from registry data were performed after propensity score matching. The primary outcomes were survival, time to recovery, and number of participants with treatment-related adverse events or side effects by day 20. ; A total of 44 patients were analyzed in this study: 22 in the thymic peptide group and 22 in the standard care group. There were no deaths in the intervention group compared to 24% mortality in standard care by day 20 (log-rank P=0.02). Kaplan-Meier analysis showed a significantly shorter time to recovery by day 20 in the thymic peptide group than in the standard care group (median, 6 days vs. 12 days; hazard ratio for recovery, 2.75 [95% confidence interval, 1.34 to 5.62]; log-rank P=0.002). No side effects or adverse events were reported. ; In patients hospitalized with Covid-19, the use of thymic peptides resulted in no side effects, adverse events, or deaths by day 20. Compared with the registry data, a significantly shorter time to recovery and mortality reduction were measured.

Humanitarian engineering, global sociotechnical competency, and student confidence: A comparison of in-person, virtual, and hybrid learning environments

The PIRE Responsible Mining, Resilient Communities (RMRC) project is a multi-country, interinstitutional, and interdisciplinary global research collaboration whose goal is to co-design socially responsible and sustainable gold mining practices with communities, engineers, and social scientists. This paper will investigate two key research questions. The first question considers how participating in the summer session influences students' global sociotechnical competency with the second question analyzing how the changes in sociotechnical competency impact the students' confidence in their engineering ability. The project hosted three intensive summer field sessions that each enrolled a different group of students. In 2019, the students conducted research in the field in Colombia while in 2020, the students completed the research completely virtual due to the Covid-19 pandemic. In 2021, the students participated in the project in a hybrid format with time split between the field and virtual work. To assess changes in students' learning and attitudes, we collected data from the students before and after the summer sessions in the form of interviews, surveys, and essays. The data will be analyzed to investigate whether the format of the summer session (in person, virtual, and hybrid) differently influenced students' global sociotechnical competency and their confidence as engineers. Other research has shown that service learning increases engineering students' confidence in their engineering ability. The data analyzed from this project describes how this may be context-specific. This paper will shed light on broader concerns in engineering education about if and how specific kinds of service learning can enhance students' global sociotechnical competency and their confidence as engineers. © American Society for Engineering Education, 2022

An Augmented Reality Update of a Classic Game: “Where in the World is Carmen Sandiego?”, Case Study

37 years after its original launch, it is proposed a study comparing the Augmented Reality (AR) prototype of the game “Where in the World is Carmen Sandiego?” with this classic edutainment game. The main goal of the experiment is to determine if there is a significant difference between the 13th mission (last level) of the game, and it was done with a sample of 20 individuals aged between 5 and 7 years. The results could be a promising future for both, gaming and education areas. The author used 3 investigation tools to reach the answer: Perceived Understanding, Perceived Usability and a version of the PSSUQ (Post-Study System Usability Questionnaire). A big constraint for this study was the COVID-19 pandemic that the world is living at the time it was completed, however, the use of technology played a big role to make it possible. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

ENGAGING PHARMACIES TO INCREASE ADHERENCE FOR MEDICARE MEMBERS

BACKGROUND: Maintaining member adherence requires careful coordination between health plans, providers and PBMs. Too often, however, pharmacies are left without the resources they need to make a meaningful impact. As COVID-19 brings new challenges to adherence, engaging pharmacies in member health is more important than ever. OBJECTIVE: Increase member adherence for a large Medicare plan by engaging community pharmacists in a comprehensive pharmacy incentive program and improving medication access. METHODS: In 2019, Abarca reintroduced the RxTarget pharmacy incentive program and made it available to its entire pharmacy network.Through the program, pharmacies have access to: A technology platform that allows them to access advanced analytics and reporting, prioritize members who may require intervention and track their progress throughout the year;continuing pharmacy education program focused on improving patient outcomes;and daily training sessions that provide support and resources. Abarca provides the Medicare plan with weekly updates on its pharmacy network's progress in the RxTarget program, ensuring ongoing communication on the results and allowing timely decision making. In March of 2020, Abarca launched Puerto Rico's first home delivery pharmacy program to ensure members across the island had safe, reliable and convenient access to medications while social distancing amidst the global pandemic. RESULTS: In the first two years of the program, the Medicare plan saw significant year-over-year increases in adherence across three chronic conditions-even amid COVID-19. In 2020, participating pharmacies achieved a cumulative 6% increase in adherence metrics compared to 2019 and a 10% increase compared to 2018. Pharmacies that participated in the daily training sessions achieved a 20% increase in adherence in 2020, while those who did not participate achieved a 4% increase versus the previous year. 73% of prescriptions ordered through the home delivery app are 90-day supplies-a strong indicator of ongoing adherence. 7 out of 10 active pharmacies are satisfiedwith the RxTarget pharmacy program (Margin of error: 6.01%;Confidence Level: 95%). CONCLUSIONS: Engaging pharmacies and empowering them with advanced technology can significantly increase member adherence-and allow interventions to be made before a member's health has been compromised. This can also contribute to health plan CMS Star Ratings. Additionally, the availability of the home delivery pharmacy program eliminates barriers to medication access, which can also facilitate higher adherence and help members maintain their health amid unforeseen events.

Case fatality rates and risk factors by COVID-19 in Mexico

Introduction: COVID-19 is a viral disease disseminated worldwide, considered a pandemic with a high mortality rate, whose epidemiological study is fundamental to understand the risk associated with specific populations. Objectives: Estimate the case fatality rates and risk factors associated with mortality from COVID-19 in the five states with more infections in Mexico.

Making the Most of Virtual Community Engagement for International Projects During the COVID-19 Pandemic

The Responsible Mining, Resilient Communities project is a multi-country, interinstitutional, and interdisciplinary global research collaboration whose goal is to co-design socially responsible and sustainable gold mining practices with communities, engineers, and social scientists. A key component of this work is engineering education research that investigates how situated learning enhances undergraduate students' global sociotechnical competency, especially as it relates to their ability to define and solve problems with people from diverse disciplinary backgrounds and life experiences. Situated learning refers to how students learn under different a) configurations of social relations (e.g., graduate/undergraduate;expert/non-expert;US/non-US students, etc.);b) pedagogical strategies for engineering problem definition and solution (e.g., remote vs. in-person;in-class vs. in-field);and c) different geographical contexts (e.g., in the US vs. in Colombia) affect faculty and student learning. Global sociotechnical competency refers to having the knowledge, skills, and attitudes to define and solve engineering problems as socio-technical in different international settings. Knowledge is understanding how engineering problems are always socio-technical and shaped by the historical, cultural, economic, and physical dimensions of a place. Skills are learning to define and solve problems with perspectives different than their own. Attitudes are the desires to continue engaging other expert and non-expert perspectives, working abroad, and serving communities after graduation. In 2019 a diverse group of engineering undergraduate students from the Colorado School of Mines, United States Air Force Academy, and Universidad Nacional de Colombia - Medellín participated in a two-week field session in Colombia, where they visited mine sites and processing facilities, in addition to the partner university in Colombia. In 2020, however, the burgeoning COVID-19 pandemic made international fieldwork impossible. This paper will describe how we developed and executed a meaningful distance-based fieldwork experience that maintained direct engagement with international students and community members. We will offer a preliminary assessment of these methods' efficacy for developing global sociotechnical competency through remote community engagement and learning. We will analyze the situated learning of the student participants as they differently identified stakeholders for engineering projects and changed their understanding of mining as a sociotechnical process as a result of the summer session. As a part of this analysis, we will also compare 2019 (in the field) and the 2020 (virtual) learning outcomes for the two different sets of students. © American Society for Engineering Education, 2021

Opportunities for increased collaboration to advance the development of OEM expertise internationally

Introduction The objective of this analysis was to connect the findings of the IOMSC survey on the development of OEM expertise with the ICOH goals for training in occupational health. Materials and Methods The findings of the international survey on the development of OEM expertise were considered in the context of the goals of ICOH. The needs and opportunities identified in the survey were also considered in the context of the vision and goals and the International Occupational Medicine Society Collaborative (IOMSC). Results The survey identified opportunities for the development of expertise in OEM which align with the goals of ICOH Scientific Committee on Education and Training in Occupational Health. The IOMSC is positioned to support the international development of OEM expertise by sharing information on competencies, best practices in medical curriculum content and examples of specialty certification pathways from different countries. Conclusions The development of expertise in OEM internationally can be amplified by increased collaboration between organisations and growth in international partnerships. The COVID-19 pandemic has further highlighted the value of developing OEM expertise for the advancement of occupational health.

Assessing widening disparities in hba1c and systolic blood pressure re-testing during the COVID-19 pandemic in LGBTQ+ focused federally qualified health centers in Chicago

Introduction: The COVID-19 pandemic caused disruptions in the health services delivery, especially among vulnerable populations. We assessed if the pandemic widened disparities in care for cardiometabolic conditions in a LGBTQ+-focused federally qualified health system in Chicago. Hypothesis: Disparities in monitoring cardiometabolic conditions present in 2019 worsened in 2020. Methods: We analyzed electronic health records from Howard Brown Health. We assessed HbA1c re-testing and control (≤9%) in 2019 and 2020 among people with diabetes (DM) and ≥1 HbA1c test in the prior year (2018 for 2019, 2019 for 2020) (n2019=818, n2020=1033). A similar assessment was done for hypertension (HTN) with systolic blood pressure (SBP) (n2019=2813, n2020=3660). Comparisons per demographic group per year were done using logistic regression adjusting for socio-demographic variables. Results: Re-testing rates declined from 2019 to 2020 for both HbA1c and SBP overall and across all groups. Adjusted analysis showed gay people with DM had higher rates of HbA1c re-testing than people of other sexual orientations in 2019 and experienced a significantly lower re-testing rate decline in 2020. Adjusted analysis for SBP showed that white (vs Hispanic) and straight (vs gay) people with HTN had lower SBP re-testing rates in 2019 and 2020. Rates of controlled SBP (<140mmHg), but not HbA1c (≤9%), declined from 2019 to 2020. Adjusted analyses showed that straight (vs gay) patients had lower controlled HbA1c and SBP rates. Cis males (vs trans males) had lower controlled SBP and white (vs Asian/other) had lower controlled HbA1c. These disparities did not worsen in 2020. Conclusion: The pandemic had mixed impacts on cardiometabolic service disparities in a large LGBTQ+-focused health system. Disparities by sexual orientation for HbA1c widened during the pandemic. Similar worsening was not found for systolic blood pressure, nor for other demographic groups.

Case Study: Use of the platform and digital tools for education sustainable development, within the framework of the "COVID-19" pandemic

Proposed to achieve the paradigm shift from presential to virtual training for the training of teachers of state educational units. Faced with the pandemic, face-to-face training is impossible, therefore, the project focuses on the training of trainers for teachers, where they are in charge of training their secondary-level students in nutrition, energy and energy efficiency and agriculture issues. sustainable, everything focused through the cognitive, socio-emotional, and behavioral domains established by the ESD. The problem to be solved was "The educational units of secondary training do not have environments that promote the SDGs articulated within the A Lifetime Plan of the National Government." The project aims to contribute to education on long-term sustainable development issues through the application of a sustainability training model as a key factor for socio-economic recovery, post COVID-19. To this end, an educational platform has been developed where the didactic material for the training of trainers on issues of nutrition and well-being, energy and efficiency, and sustainable agriculture are contemplated, presented in two modalities;asynchronous and synchronous, training more than 100 teachers from secondary educational institutions. The results obtained have identified that virtual teaching can be achieved in both synchronous and asynchronous modalities can be achieved from well-structured teaching materials that capture the participation and commitment of teachers to achieve replicability to their school students. Finally, it is concluded that age is not an influential factor for the use of technology for virtual teaching, and the level of training in the framework of the ESD contributes directly to the fulfillment of the goals established in the Sustainable Development Goals [SDG]. © 2021 Latin American and Caribbean Consortium of Engineering Institutions. All rights reserved.

Air quality in the Port of Veracruz, Mexico

The increase in the ships operations in the Port of Veracruz, Mexico represents a potential source of air pollution of gases and particles from maritime transport for coastal communities, having a negative impact on air quality. The estimation of emissions was performed by applying emission factors (EF) from ships in the hoteling phase of important pollutants, e.g., criteria, toxics, and greenhouse gases (GHG), of which resulted of real-time air quality monitoring for SO2 and PM2.5 were presented for one year (October 2019 to October 2020). The air quality and meteorology monitoring station is located within the Veracruz Port Area to determine the spatio-temporal variation of atmospheric pollutants during the expansion and operation activities. In December 2019, present days that coincide in the increase of the species of interest and also appear on some days in February and March, registering two days with SO2 concentrations of 2.5 and 2.3 ppb, being the highest concentration recorded during the year and compared with its ambient air quality standard (MAAQS) established for periods of 24 hr (40 ppb) comply with current environmental regulations. Regarding the concentrations registered for PM2.5 in the months of April and June (56 and 60 μg /cu m, respectively), they exceededed its MAAQS which establishes a concentration of 45 μg /cu m for 24 hr. Regarding the SO2 estimated emissions, ships with rolling cargo in the months of January and February presented a greater contribution, while container ships increased it as of April. Concentrations could be directly related to combustion processes by mobile sources that occur in the region derived from port activity, which have increased since April, after a period of confinement derived from the COVID 19 pandemic.