ABSTRACT
Background: During the COVID-19 pandemic, individuals residing in long-term care facilities (LTCF) are particularly vulnerable to adverse outcomes due to their higher rates of frailty, disabilities, cognitive impairment, dementia, and chronic illnesses. In low and middle-income nations, research on immunizing frail populations is lacking, while most studies on COVID-19 in LTCF come from wealthier nations and may not fully capture the situation in emerging countries. Methods: We aimed to evaluate the effectiveness of first, second and third COVID-19 vaccine doses, against infections, hospitalizations, and deaths, and their association with frailty, age, sex and chronic disease, among older adults, in a social vulnerability context. This retrospective cohort study, comprises a total of 712 older adults, in a social vulnerability context, of 29 LTCF, in Brazil. Continuous variables were described by medians and interquartile ranges and categorical variables were represented by absolute and relative frequencies. The Mann-Whitney test was used. For evaluating the relation between categorical variables, Pearson's chi-square test was used. When comparing proportions, the Z test of proportion was applied. A significance level of 5% was considered. Results: Median age was 81.37 years, 72.8% were female, 94.61% were frail, 79.97% had a cognitive impairment, 69.54% had a mobility impairment, 78.37% have, at least, one chronic disease and 72.73% use five or more medications per day. Before the vaccine, mobility impairment was associated with great contamination rates (p=.03); frailty (p=.02) and previous pulmonary disease (p=.03) with symptoms of gravity; frailty (p=.02), pulmonary disease (p=.04) and male sex (p=.02) with emergency care or hospital admission. After the third vaccine dose, only frailty remains associated with admissions (p=.03). The number of positive cases (p=.001), symptomatic patients (p<.001), admissions (p=.001) and deaths (p<.001) were substantially reduced after the three vaccine doses. Conclusions and Implications: Even in a frail population, the vaccine was effective, in the reduction of positive cases, the number of symptomatic patients, admission to emergency or hospital care and deaths. Before the vaccine, frailty, previous pulmonary disease and male sex were associated with worse outcomes. After the vaccine, frailty remains associated with a major number of admissions.
Subject(s)
Dementia , Lung Diseases , Tooth Mobility , Chronic Disease , COVID-19 , Cognition DisordersABSTRACT
Condition:
Community-acquired PneumoniaIntervention:
Drug: Amoxicillin;Drug: Amoxicillin/clavulanatePrimary outcome:
Non-inferiorityCriteria:
Inclusion Criteria:
1. Patient aged 65 years or older with or without comorbidities defined by chronic
diseases in immunocompetent patients,
2. Patient admitted to the hospital for a CAP defined by at least two clinical signs of
pneumonia (cough, sputum production, dyspnea, tachypnea, or pleuritic pain, abnormal
lung auscultatory sounds, fever (temperature > 38°C) or hypothermia (<36°C)), and had
radiological evidence of a new infiltrate confirming pneumonia
3. Patient understanding oral and written French
4. Written informed consent obtained from patient prior to participation in the study (if
the patient is unable to express in writing: consent by a trusted person).
5. Patients should be able to call and to answer to a phone call or to be with a relative
who can help him to call or to answer questions notably raised by a medical staff
belonging to the investigational site
Exclusion Criteria:
1. Signs of severe CAP (abscess, massive pleural effusion, serious chronic respiratory
insufficiency, ICU admission)
2. Patient requiring ICU admission,
3. Estimated Glomerular Filtration Rate < 30 ml/min,
4. Known immunosuppression (asplenia, neutropenia, agammaglobulinemia, transplant,
myeloma, lymphoma, known HIV and CD4<200/mm3),
5. Exacerbation of chronic obstructive pulmonary disease,
6. Life-threatening state expected to lead to possible imminent death,
7. Suspected atypical bacteria requiring combined antibiotics therapy,
8. Legionella suspected,
9. Subjects with clinical or epidemiological environment leading to suspect a healthcare
associated pneumonia with antibiotic resistant pathogen (including long-term care
facility)
10. Patient known to be colonized with Pseudomonas aeruginosa or Enterobacteriaceae in the
respiratory tract,
11. Suspicion of aspiration pneumonia,
12. Intercurrent infection requiring antibiotic treatment,
13. Administration of beta-lactam therapy for more than 24 hours before inclusion,
14. History of jaundice/hepatic impairment associated with amoxicillin/clavulanate acid,
15. History of bacterial pneumonia less than 1 month prior to study inclusion
16. History of hypersensitivity or allergy to beta-lactam or to any excipients included in
study antibiotics,
17. Subject without health insurance,
18. Subject without home address or difficulty in terms of follow-up (vacation, job
transfer, geographical distance, lack of motivation),
19. Patient under judicial protection,
20. Diagnosis confirmed of SAR-Cov2 infection (PCR Test, covid antigen rapid test, chest
computed tomography (CT) scan),
21. Participation to another interventional study and having an exclusion period that is
still in force during the screening phase or expected participation to another
interventional study during participation to the CAPTAIN study
ABSTRACT
In this paper, we introduce an algorithm designed to solve a Multilevel MOnoObjective Linear Programming Problem (ML(MO)OLPP). Our approach is a refined adaptation of Sinha and Sinha's linear programming method, incorporating the development of an "interval reduction map" that precisely refines decision variable intervals based on the influence of the preceding level's decision maker. Each construction stage is meticulously examined. The effectiveness of the algorithm is validated through a detailed numerical example, illustrating its practical applicability in resource management challenges. With a specific focus on vaccination planning within long-term care facilities and its relevance to the COVID-19 pandemic, our study addresses the optimization of resource allocation, placing a strong emphasis on the equitable distribution of COVID-19 vaccines.
Subject(s)
COVID-19ABSTRACT
Condition:
Corona
COVID19;10047438;10024970;Corona;COVID19
Intervention:
;long-term outcome;SARSCoV-2;Viro-immunology
Primary outcome:
1: To identify socio-demographic, clinical, virological and/or host factors
predictive of disease progression
2: To investigate the induction of lasting protective SARS-CoV-2-specific
antibody (titers and breadth) and SARS-CoV-2-specific T cell responses (numbers
and quality) in relation to disease severity, clinical recovery and patient
characteristics or re-infection over time;
3: Asses the mid-term (4 weeks - 3 months post diagnosis) and long-term (until
2 year post diagnosis) sequelae of individuals who have experienced a
SARS-CoV-2 infection, particularly with respect to respiratory function,
socio-psychological outcomes and quality of life.
Criteria:
Inclusion criteria:- informed consent documented by signature
- age between 16 - 85 years
- sufficient understanding of Dutch or English
Exclusion criteria:
- Unlikely to comply with the study procedures, as deemed by the recruiting
research doctor/nurse
- mental disorder that in the view of the investigator would interfere with
adherence to the study procedures, or the decision to participate in the study.
- Investigators or otherwise dependent persons
- living in long term care facility
ABSTRACT
Background The epidemiological relevance of viral acute respiratory infections (ARIs) has been dramatically highlighted by COVID-19. However, other viruses cannot be neglected, such as the influenza virus, respiratory syncytial virus, human adenovirus. These viruses thrive in closed spaces, influenced by human and environmental factors. High-risk closed communities are the most vulnerable settings, where the real extent of viral ARIs is often difficult to evaluate, due to the natural disease progression and case identification complexities. During the COVID-19 pandemic, wastewater-based epidemiology has demonstrated its great potential for monitoring the circulation and evolution of the virus in the environment. The “Prevention of ARIs in indoor environments and vulnerable communities” study (Stell-ARI) addresses the urgent need for integrated surveillance and early detection of ARIs within enclosed and vulnerable communities such as Long-Term Care Facilities (LTCFs), prisons and primary schools. The rapid transmission of ARIs in such environments underscores the importance of comprehensive surveillance strategies to minimise the risk of outbreaks and safeguard community health, enabling proactive prevention and control strategies to protect the health of vulnerable populations.Methods The Stell-ARI study consists of designing and validating tools for integrated clinical and environmental-based surveillance for each setting, coupled with analytical methods for environmental matrices. The study design encompasses the development of specialised clinical surveillance involving pseudonymized questionnaires and nasopharyngeal swabs for virus identification, while the environmental surveillance includes air and surface microbiological and chemical monitoring, and virological analysis of wastewater. Integrating this information and the collection of behavioural and environmental risk factors into predictive and risk assessment models will provide a useful tool for early warning, risk assessment and informed decision-making.Discussion This study seeks to integrate clinical, behavioural, and environmental data to establish and validate a predictive model and risk assessment tool for the early warning and risk management of viral ARIs in closed and vulnerable communities prior to the onset of an outbreak.
Subject(s)
COVID-19ABSTRACT
Condition:
Exercise Intervention;Protein SupplementationIntervention:
Behavioral: Comprehension Exercise Training;Dietary Supplement: Placebo milk;Dietary Supplement: Protein SupplementPrimary outcome:
Short Physical Performance Battery (SPPB)Criteria:
Inclusion Criteria:
1. Age is 65 years or older
2. Placement is greater than or equal to 6 months
3. Less dependency in activities of daily life (ADL) function50 (severe to moderate
dependency, Barthel index: 21 = score = 90)
4. Able to understand the exercise instructions and follow the order.
Exclusion Criteria:
1. Skeletomuscular (severe osteoarthritis (OA) or recent or mal- or non-union fracture,
etc.) or cardiopulmonary diseases (COVID-19 or unstable angina or controlled
hypertension, etc.) that are unstable and pose a threat to safety
2. Mental disorders that prevent the subject from following instructions (severe mental
disorder, Short Portable Mental State Questionnaire (SPMSQ): 8 = score = 10).
3. Protein supplementations are contraindicated.
ABSTRACT
Condition:
Decrease in chronic oral inflammation in community living (independent and assisted living) older adults and older adults living in long-term care.Oral Health
Intervention:
Phase A: Residents of the greater Ottawa community, Bruyere Village and Bruyère long-term care will undergo an oral health examination by a registered dental hygienist. The examination will note the number of teeth, the number of decayed, missing and filled teeth, cavities, gum disease by stage, dental pain, visits to the dentist, oral hygiene behavior, medical conditions, medications that are taken, and basic demographic data.Phase B: Of the individuals screened, those who meet the eligibility criteria will be invited to the randomized placebo-controlled trial. The participants will be split evenly between the 3 cohorts (independent living, assisted living, long-term care), and will be randomized equally into active and placebo arms. Participants will have 4 treatment applications over approximately 8 weeks and will be treated with Prevora or its placebo (sterile water). The application hygienist or nurse will apply the treatment with a small brush over the teeth and gumline of the participant in a short procedure that will take approximately 5-7 minutes. A final visit will be a dental reassessment conducted by the initial hygienist to note any changes in the primary and secondary oral health outcomes.
Primary outcome:
Change in the mean number of Bleeding on Probing (BOP) sites measured using a periodontal probe during an oral assessment at Screening and Visit 5, active versus controlCriteria:
Inclusion criteria: Phase A:1. Older adults (65 years of age and over at screening)
2. Residents of the Greater Ottawa community and Bruyère independent living, assisted living and longterm care
Phase B:
1. Matches the criteria of Phase A
2. Clears the dental screening performed in Phase A:
2.1. Bleeding on probing at = 12 sites at Screening
2.2. Minimum of 15 natural teeth
2.3. Willing and able to provide informed consent
2.4. Able to complete the study as judged by the investigators
2.5. Fully vaccinated against COVID 19
Exclusion criteria: Phase B
1. Not 65 years of age or over
2. No bleeding on probing at 12 or more sites at Screening
3. Not having 15 natural teeth or more
4. Active caries which, in the judgement of the investigators, could require major surgical restoration and referral to a dentist. Those that can be readily managed by the examining hygienist (for example, small caries only requiring a temporary filling or silver diamine fluoride) will still be included in Part B.
5. Severe periodontal disease which, in the judgement of the investigators, could require surgery or a level of periodontal scaling such that participation in the study will be delayed
6. Undergoing periodontal care by a dentist or hygienist which in the judgement of the investigators could confound the study results.
7. Known allergies to the ingredients of the study medications (chlorhexidine, Sumatra benzoin, ethanol and polymethylmethacrylate)
8. Taking anti-inflammatory medication (excluding baby aspirin, prednisone or NSAIDS) or medications for periodontal conditions (e.g. Periostat, chlorhexidine rinse, PerioChip or Arestin).
9. At Screening, taking antibiotics for oral abscesses, oral pain or taking antibiotics for more than 14 days
10. Uncontrolled epilepsy
11. A gag reflex
12. Cancer that is in an active stage or has been treated with chemotherapy and/or radiation in the past year or in the next 12 months
13. Severe bleeding disorders (given the need to conduct debridement in this study)
14. Behavioral disorders which in the judgement of the investigators threaten the patient’s tolerance to treatment and participation in the study
15. Involved in another drug trial
16. Unwilling or unable to provide informed consent including consent by the Substitute decision maker
17. An evident inability to complete the study as judged by the investigators
18. Not fully vaccinated against COVID 19
ABSTRACT
Post-acute health care costs following SARS-CoV-2 infection are not known. Beginning 56 days following SARS-CoV-2 polymerase chain reaction (PCR) testing, we compared person-specific total and component health care costs across their distribution for the following year (test-positive versus test-negative, matched people; January 1, 2020-March 31, 2021). For 531,182 individuals, mean person-specific total health care costs were $513.83 (95% CI $387.37-$638.40) higher for test-positive females and $459.10 (95% CI $304.60-$615.32) higher for test-positive males, or >10% increase in mean per-capita costs, driven by hospitalization, long-term care, and complex continuing care costs. At the 99th percentile of each subgroup, person-specific health care costs were $12,533.00 (95% CI $9,008.50-$16,473.00) higher for test-positive females and $14,604.00 (95% CI $9,565.50-$19,506.50) for test-positive males, driven by hospitalization, specialist (males), and homecare costs (females). Cancer costs were lower. Six-month and 1-year costs differences were similar. These findings can inform planning for post-acute SARS-CoV-2 health care costs.
Subject(s)
COVID-19 , NeoplasmsABSTRACT
BackgroundUse of masks and respirators for prevention of respiratory infectious disease transmission is not new, but has proven controversial, and even politically polarizing during the SARS-CoV-2 pandemic. In the Canadian province of Ontario, mask mandates were introduced by the 34 regional health authorities in an irregular fashion from June to September 2020, creating a quasi-experiment that can be used to evaluate impact of community mask mandates. Ontario SARS-CoV-2 case counts were strongly biased by testing focussed on long-term care facilities and healthcare workers. We developed a simple regression-based test-adjustment method that allowed us to adjust cases for undertesting by age and gender. We used this test- adjusted time series to evaluate mask mandate effectiveness. MethodsWe evaluated the effect of masking using count-based regression models that allowed adjustment for age, sex, public health region and time trends with either reported (unadjusted) cases, or testing-adjusted case counts, as dependent variables. Mask mandates were assumed to take effect in the week after their introduction. Model based estimates of effectiveness were used to estimate the fraction of SARS- CoV-2 cases, severe outcomes, and costs, averted by mask mandates. ResultsModels that used unadjusted cases as dependent variable identified protective effects of masking (effectiveness 15-42%), though effectiveness was variably statistically significant, depending on model choice. Mask effectiveness in models predicting test-adjusted case counts was substantially higher, ranging from 49% (44- 53%) to 73% (48-86%) depending on model choice. Effectiveness was greater in women than men (P = 0.016), and in urban health units as compared to rural units (P < 0.001). The prevented fraction associated with mask mandates was 46% (41-51%), averting approximately 290,000 clinical cases, averting 3008 deaths and loss of 29,038 QALY. Costs averted represented $CDN 610 million in economic wealth. ConclusionsLack of adjustment for SARS-CoV-2 undertesting in younger individuals and males generated biased estimates of infection risk and obscures the impact of public health preventive measures. After adjustment for under-testing, the effectiveness of mask mandates emerges as substantial, and robust regardless of model choice. Mask mandates saved substantial numbers of lives, and prevented economic costs, during the SARS-CoV-2 pandemic in Ontario, Canada.
Subject(s)
Death , Communicable DiseasesABSTRACT
Objectives: Site-specific wastewater surveillance could potentially control COVID-19 outbreaks more effectively at long-term care facilities (LTCF). It could identify the presence of pre-symptomatic and asymptomatic COVID-19 infections in the facility and therefore initiate timely outbreak control measures. Besides, compared to repetitive screenings of residents and staff using diagnostic tests, screenings based on positive wastewater test results incur fewer costs and less discomfort. We evaluated the effectiveness of LTCF-site-specific wastewater surveillance in preventing COVID-19 outbreaks, by comparing the scenario where more diagnostic tests were initiated due to positive wastewater test results and the base case of no action. Method(s): We built a susceptible-infected-cases-recovered model to study COVID-19 transmission at LTCF under the base-case and wastewater surveillance scenario. We used data from an outbreak during the Omicron wave in one LTCF in Edmonton, Canada (December 2021 - March 2022), where wastewater data did not initiate actions. We fit base-case model parameters with daily cases and testing data using the nonlinear least-squares method. We hypothesized 10%-50% more diagnostic tests in the wastewater scenario. We compared the outbreak size, i.e., predicted numbers of infections, to measure the effectiveness. We used the Mann-Whitney U test to identify whether the outbreak size in the wastewater scenario was significantly smaller. Result(s): Results reported are subject to minor changes as modelling work is ongoing. The number of infections peaked on day 25 in the base case, with 23.8% of individuals being infected. In the wastewater scenario, all hypothesized values resulted in a significantly smaller outbreak size;only 10% more diagnostic tests could lead to 5.4% fewer infections (p=0.03) at the peak. Conclusion(s): This pilot study demonstrates the potential effectiveness of LTCF-site-specific wastewater surveillance to prevent COVID-19 outbreaks. Future works include engaging policymakers in analyzing specific wastewater-based actions and estimating the costs of controlling COVID-19 to explore the cost-effectiveness of wastewater surveillance.Copyright © 2023
ABSTRACT
This article addresses selected issues relating to the current situation of Social Europe, examining a possible legal basis for a Directive on short-time work as proposed by Sylvaine Laulom. Subsequently, it discusses the legal basis for the proposed Directive on minimum wages, concluding that there is no sufficient legal basis in EU primary law as a result of Article 153 (5) Treaty on the Functioning of the European Union (TFEU). The article then provides a brief overview of developments in long-term care and collective bargaining for self-employed persons. Finally, it concludes with examples taken from Austrian case law of how the COVID pandemic can open up a new perspective for dealing with existing problems in labour and social security law. © 2023 Kluwer Law International BV, The Netherlands
ABSTRACT
Background: Patients with COVID-19 may experience symptoms for a long time. Objectives: The aim of this study is to determine the prevalence of COVID-19 related problems after discharge from the hospital. Methods: This cross-sectional study was conducted on 194 hospitalized COVID-19 patients (110 [56.7%] men and 84 [43.3%] women) using the census method in 2021-2022. The patients were followed up for 4 weeks. Results: Themeanage andbody mass index (BMI) of the patients were 57.57 ± 16.79 years and 25.9 ± 4.64kg/m². The major complaint was fever (75,3%), followed by dyspnea (62%), general weakness (60.8%), cough (59.3%), and anorexia (49%). On admission, lung highresolution computed tomography (HRCT) scans were normal in 51 patients (26.3%). Regardless of the underlying disease, at least 1 symptomwas present in 63 (32%) of patients at the end of the study. Increased appetite was observed in 16 (8.2%) patients at discharge and thereafter. Hair loss was reported in 2% at the beginning and 8% at the end of the study. Conclusions: Prolonged symptoms in COVID-19 patients are common and require long-term care.
ABSTRACT
We situate the contemporary crisis of COVID‐19 deaths in seniors' care facilities within the restructuring and privatisation of this sector. Through an ethnographic comparison in a for‐profit and nonprofit facility, we explore what we identify as brutal and soft modes of privatisation within publicly subsidised long‐term seniors' care in Vancouver, British Columbia, and their influence on the material and relational conditions of work and care. Workers in both places are explicit that they deliver only bare‐bones care to seniors with increasingly complex care needs, and we document the distinct forms and extent to which these precarious workers give gifts of their time, labour and other resources to compensate for the gaps in care that result from state withdrawal and the extraction of profits within the sector. We nonetheless locate more humane and hopeful processes in the nonprofit facility, where a history of cooperative relations between workers, management and families suggest the possibility of re‐valuing the essential work of care. [ FROM AUTHOR] Copyright of Antipode is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Practices of creativity and compliance intersect in interaction when directing local dances remotely for people living with dementia and their carers in institutional settings. This ethnomethodological study focused on how artistic mechanisms are understood and structured by participants in response to on-screen instruction. Video data were collected from two long-term care facilities in Canada and Finland in a pilot study of a dance program that extended internationally from Canada to Finland at the onset of COVID-19. Fourteen hours of video data were analyzed using multimodal conversation analysis of initiation–response sequences. In this paper, we identify how creative instructed actions are produced in compliance with multimodal directives in interaction when mediated by technology and facilitated by copresent facilitators. We provide examples of how participants' variably compliant responses in relation to dance instruction, from following a lead to coordinating with others, produce different creative actions from embellishing to improvising. Our findings suggest that cocreativity may be realized at intersections of compliance and creativity toward reciprocity. This research contributes to interdisciplinary discussions about the potential of arts-based practices in social inclusion, health, and well-being by studying how dance instruction is understood and realized remotely and in copresence in embodied instructed action and interaction. © 2023 by the authors.
ABSTRACT
This book broadens the visioning on new care environments that are designed to be inclusive, progressive, and convergent with the needs of an aging population. The contents cover a range of long-term care (LTC) settings in a single collection to address the needs of a wide audience. Due to the recent COVID-19 pandemic, rethinking the spatial design of care facilities in order to prepare for future respiratory and contagious pathogens is one of the prime concerns across the globe, along with social connectedness and autonomy in care settings. This book contributes to the next generation of knowledge and understanding of the growing field of the design of technology, programs, and environments for LTC that are more effective in infection prevention and control as well as social connectedness. To address these issues, the chapters are organized in four sections: Part I: Home- and community-based care;Part II: Facility-based care;Part III: Memory care and end-of-life care;and Part IV: Evidence-based applied projects and next steps. (Re)designing the Continuum of Care for Older Adults is an essential resource for researchers, practitioners, educators, policymakers, and students associated with LTC home and healthcare settings. With diverse topics in theory, substantive issues, and methods, the contributions from notable researchers and scholars cover a range of innovative programming, environments, and technologies which can impact the changing needs and support for older adults and their families across the continuum of care. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
The COVID-19 (coronavirus disease 2019) pandemic has posed greater challenges to older adults, especially those who live in congregated long-term care facilities (LTCFs) in dense urban settings. These facilities struggle with high rates of COVID-19 infections and other challenges that undermine LTCF residents' well-being. These challenges, including social isolation and limited access to nature and community, have been exacerbated by the pressures of the pandemic. This has led to feelings of loneliness, depression, and other mental health issues among residents and a higher risk of psychological stress and infection among nurses. The pandemic has challenged the existing built environment of LTCFs. Issues regarding physical and mental health, quality of life (QoL), infection control, and pandemic resiliency have been shown to be increasingly interwoven. This chapter envisions innovative approaches toward a post-COVID-19 environment for older adults and their caregivers. This chapter provides an extensive review and synthesis of the lessons learned from LTCFs during the pandemic, with a focus on how their experience was impacted by design. The authors also draw from current design trends to identify their potential to support residents', staff, and visitors' needs during and after pandemics. From these learnings, the following design principles were developed: (1) small household model, (2) biophilic design, (3) intergenerational community, and (4) multi-tier infection control strategies. These design principles were then translated to a prototype through a graduate capstone studio project, which provides a visual illustration of how these evidence-based design solutions can be applied within a dense urban environment. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
Úvod: Hygiena rukou je považována za jedno z nejdůležitějších a nejúčinnějších opatření v prevenci a kontrole šíření infekcí. Hraje také zásadní roli při snižování výskytu infekcí spojených se zdravotní péčí. Hlavním cílem je posoudit dodržování hygieny rukou - se zvláštním zaměřením v používání rukavic při poskytování péče v lůžkových zařízeních. Metody: Průřezový dotazníkový průzkum dodržování standardů bezpečné zdravotní péče v lůžkových zařízeních na území České republiky v roce 2018 před pandemií COVID-19. Osloveno bylo celkem 80 lůžkových poskytovatelů zdravotních služeb v České republice. Odpovědi byly hodnoceny na 6stupňové škále od "vždy" (100 bodů) do "nikdy" (0 bodů). Analýza dat byla provedena pomocí IBM SPSS Statistics verze 22. Výsledky: Dotazník vyplnilo 2 049 zdravotnických pracovníků z 80 oslovených lůžkových zdravotnických zařízení na území České republiky. Respondenti byli rozděleni dle medicínského oboru. Respondenti pracovali v interních oborech (43 %), chirurgických oborech (28 %), na psychiatrii (14 %), v zařízeních dlouhodobé lůžkové péče (9 %) a v ostatních nezařazených oborech (6 %). Závěr: Předkládaná studie ověřila dobrou úroveň v dodržování hygienických standardů u poskytovatelů lůžkové péče v České republice. Identifikovány byly rozdíly v metodickém opatření pro hygienu rukou v České republice a mezinárodních doporučených postupech, které jsou podloženy vysokou úrovní vědeckých důkazů. Vhodným opatřením by bylo zavést národně akceptované klinické doporučené postupy s přesně vymezenou úrovní důkazů.Alternate :Introduction: Hand hygiene is considered one of the most important and effective measures for infection prevention and control. It also plays a vital role in reducing healthcare-associated/acquired infections. The main goal is to assess hand hygiene compliance - with a special focus on using gloves when providing care in inpatient settings. Methods: A cross-sectional survey on compliance with hand hygiene was conducted in health care facilities in the Czech Republic in 2018 before the COVID-19 pandemic. The participants were from 80 inpatient health care providers in the Czech Republic. Responses were scored on a 6-level scale, from "always" (100 points) to "never" (0 points). Data analysis was performed using IBM SPSS Statistics version 22. Results: The questionnaire was filled in by 2,049 health care personnel from 80 inpatient health care facilities in the Czech Republic. Respondents were further divided according to the medical specialty. Respondents worked in the field of internal medicine (43%), surgical fields (28%), psychiatry (14%), long-term care facilities (9%), and other non-classified fields (6%). Conclusions: The presented study verified the good level of declared compliance with hygiene standards in inpatient healthcare providers in the Czech Republic. Significant differences were found between the observed hand hygiene measures established in the Czech Republic and international best practices based on a high scientific evidence level. An appropriate measure would be to establish national clinical best practices based on convincing scientific evidence at the national level.
ABSTRACT
None is inconsequential: advancing digital technology, globalization of clinical trials, changes in clinical trial design, the inflow of private equity dollars, fewer sponsors lost to mergers and acquisitions, more CROs, the costs of clinical trials, precision medicine, lack of available talent, and-an under the radar trend-the continuing challenges of chronic disease. A 2020 report called them a "primary factor" in the growth of global CRO services market.2 Casey McTigue, an executive director at SRS Acquiom, an M&A services firm, put it this way: "We have seen record setting volumes for M&A." Market attention In 2019, the life sciences recruiter Pr°Clinical considered the following CROs worthy of close attention from investors and pharma alike: PPD, Medpace, PRA Health Sciences, KCR, ICON, IQVIA, PSI, Parexel.3 Of the eight, three still stand alone;the rest have merged or been acquired. Combined, their network covers 2,800 hospitals, clinics and long-term care facilities, and 200 research and pharmaceutical companies, a press release says. Since the combined R&D outlay of the top pharma houses now hovers at the $100 billion-and that majority of trials have CRO involvement-even the math challenged can appreciate the CRO industry's losses, or gains, depending on the road chosen.6 But the CRO industry has already proved its resiliency. Despite changes in market conditions between 2008 and 2019, SRS Acquiom found that of the 227 private life sciences deals in which it was the shareholder representative, 163 had earnouts, the potential dollar figure more than $37 billion.