Innovation and Control of Health Technology Management Procedures Applying Six Sigma Methodology

The National Institute of Respiratory Diseases (INER. Its acronym in Spanish) is a public healthcare institution that provides medical attention, teaching and scientific research centered on diseases of the respiratory system. In 2019, the hospital held 228 beds and over six thousand medical devices for diagnosis, treatment, and rehabilitation of patients. In 2020, the COVID-19 pandemic pushed the Hospital to convert 215 conventional care beds to intensive care beds, assigned exclusively to critical COVID-19 patients. This resulted in a higher demand of Health Technology Management (HTM) resources which were reflected by a 60% increase in the Hospital’s medical devices. Therefore, the technical staff of the Department of Biomedical Engineering grew by 300%. Thus, the objective of this work was to innovate HTM procedures through the application of Six Sigma Methodology and two Lean tools: 5S and Kanban, to control the activities carried out at the Hospital. Procedures for dealing with work orders and inventory control of supplies (accessories, consumables, and spare parts) that medical equipment require for its operation were analyzed. Additionally, three activities related to HTM were analyzed: tool control, work area control and information flow among all 5 personnel work shifts. In total, seven innovation strategies were proposed and implemented in the Department of Biomedical Engineering at the INER. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Perceived benefits of a remote yoga and mindfulness program for student musicians during COVID-19

This qualitative study was conducted with participants from a previous investigation that explored the applicability and perceived impact of a program based on yoga, mindfulness, emotional intelligence, and positive psychology, to enhance student musicians' health and well-being during the lockdown. This program is named CRAFT, the acronym of which stands for the following Spanish terms that constitute its 5 elements: Consciencia, Relajacion, Atencion, Felicidad, and Transcendencia. The current study aimed to gain a greater understanding of participants' CRAFT-based practice implementation experience and their perceived benefits derived from it during the lockdown. Participants were higher education student musicians (n = 26) attending CRAFT-based elective subjects of Mindfulness and Emotional Intelligence, once a week for 1 hr throughout the academic year 2019/2020;at a Royal Conservatory of Music in Spain. Participants' responses to an open-ended question were content analyzed following a deductive approach guided by the framework of the 5 CRAFT elements. The content analysis revealed 6 overarching themes, 1 for each CRAFT element and an additional 1 labeled "other." Participants' perceived benefits aligned with the 5 CRAFT elements and included developments such as enhanced conscious awareness, emotional self-regulation, psychological distress, mind clearance, relaxation, concentration, wellness, vitality, hope, transforming attitudes, equanimity, positivity, and resilience. These findings suggest that curricular exposure with the CRAFT program was beneficial among higher education student musicians to cope with their health and well-being lockdown demands, having thus relevant implications in both higher education and clinical settings for health and well-being promotion, support, and prevention during stressful pandemic times. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Covid infection among kidney transplant recipients: Management and outcomes

Purpose: COVID pandemic has posed a significant challenge among kidney transplant recipients (KTR) due to their immunocompromised state. There is uncertainty on immunosuppression management among those who have COVID infection. We sought to better understand the clinical course, management, and outcomes of our KTR who developed COVID infection. Methods: Single-center experience of COVID infected KTR. Baseline demographics, clinical data, management, and outcomes were obtained by manual chart abstraction of the EMR. Results: 50 KTR had COVID infection. Mean age was 53;50% males;74% African-Americans. Fever was the most common symptom (71%);36 patients (71%) required hospitalization;11 (22%) required ICU admission and 8 (16%) required mechanical ventilation. 23 developed AKI with one-third requiring RRT;50% of patients requiring RRT eventually had renal recovery. Majority of admitted patients received dexamethasone, remdesivir, and convalescent plasma. In terms of immunosuppression, 28 of 49 (57%) had their MMF held while 8% had MMF dose reductions;one had everolimus held and one had AZA held;7 (14%) had CNI dose reductions with none held. Six patients (12%) died. Those who died were significantly more likely to receive dexamethasone (42% vs 2%;p=0.002), remdesivir (33% vs 7%;p=0.027), and convalescent plasma (40% vs 0%;p=0.001). Mortality rates were similar across those who had immunosuppressive agents dose reduced vs held vs not adjusted (11% vs 17% vs 12%, respectively;p=0.919). CNI dose reductions tended to be more common in those who died (43% vs 7%;p=0.122). There were no subsequent acute rejections or graft losses in those who recovered. Conclusions: KTR represent a vulnerable patient population during COVID. Due to their immunocompromised state and often more severe clinical presentation, the majority require hospitalization, with a significant number needing ICU admission and mechanical ventilation. Severe illness led to higher use of dexamethasone, remdesivir and covalescent plasma in those who ultimately died of COVID. It is unclear what impact immunosuppression dose reductions had on the COVID clinical course, but these reductions did not appear to increase risk of rejection or graft loss.

Developing Resilience During the COVID-19 Pandemic: Yoga and Mindfulness for the Well-Being of Student Musicians in Spain.

Here, we report on a quasi-experimental study to explore the applicability and perceived benefits of the CRAFT program, which is based on mindfulness, yoga, positive psychology, and emotional intelligence, to improve higher education student musicians' health and well-being during the lockdown. A subset of student musicians at a Higher Conservatory of Music in Spain followed the CRAFT program during the academic year 2019/2020, 1 h per week as part of their curriculum. Students enrolled in CRAFT-based elective subjects formed the CRAFT program group (n = 40), while other students represented the control group (n = 53). The onset of the national lockdown elicited by the COVID-19 pandemic occurred halfway through the program, which was subsequently delivered in an online format. We administered an online survey to explore the effect that the exposure to the CRAFT program had in terms of how participants dealt with various health and well-being concerns arising from the COVID-19 lockdown. There was a significantly higher proportion of proactive participants in the CRAFT program group, 92%, than in the control group, 58%, in terms of implementing practices to improve their health and well-being during the lockdown. Additionally, significantly more participants acknowledged perceived benefits from their practices in the CRAFT program group, 78%, than in the control group, 52%. Among proactive participants, yoga/meditation was the most implemented in the CRAFT program group, followed by exercise, and other yoga/meditation practices, whereas in the control group, exercise and Alexander technique-based practices were the most applied. In the CRAFT program group, the highest rate of perceived benefits was from yoga/meditation CRAFT-based practices, 51%, followed by exercise, 32%, and other yoga/meditation practices, 27%, whereas in the control group, benefits were reported by 29% of exercising participants and 16% for those having practiced the Alexander technique. A similar pattern was observed when excluding participants with previous yoga/meditation experience. This study revealed how participants can independently apply learned skills from the CRAFT program in response to a naturally occurring life event of unprecedented global impact, suggesting that previous exposure to mindfulness and yoga is likely to have a beneficial effect on how young adults react towards exceptionally stressful conditions.

Raas inhibition, mortality, and severity in COVID-19 patients: A systematic review and meta-analysis

Background: The effect of angiotensin-receptor blockers (ARBs) and angiotensinconverting enzyme inhibitors (ACEi) on outcome and severity in COVID-19 patients has been postulated. Methods: We performed a systematic review in different databases to identify studies and research work that assessed the association of ACEi/ARBs on the severity of illness and mortality in COVID-19 subjects. Inclusion criteria for our meta-analysis were all studies that included human subjects with COVID-19 infection, reported mortality and severity of the disease, and described ACEi/ARB treatment. The data collected were the name of the first author, journal title, the country of the study, sample size, relative risk and confidence intervals for association of ACEi/ARB treatment and mortality and severity. We used the random-effects model for the meta-analysis and the funnel plot analysis to assess potential publication bias. Results: Out of 4,702 records reviewed in different databases, 11 papers were included in our meta-analysis. Altogether, 8,643 patients were included in the final analysis. Random effects model (REM) for the relationship between ACEi/ARB and survival showed that ACEi/ARB does not affect survival (relative risk [RR]=0.81, confidence interval ranges [CIR] from 0.53 to 1.23). There was no evidence of heterogeneity with I-squared =25.5% and p<0.235. By applying Egger's test, there was no evidence of small studies effect with P=0.64. REM for the relationship between ACEi/ARB and disease severity showed that ACEi/ARB are not related to disease severity (RR=0.90, CIR from 0.70 to 1.15). There was evidence of heterogeneity with I-squared =56.2% and p=0.01. By applying Egger's test, there was no evidence of small studies effect with P=0.93. Conclusions: Based on the results of this meta-analysis, ACEi/ARB are not associated with increased mortality or severity in COVID-19 subjects.