In-Person Versus Virtual Instruction and Simulation for Unplanned Out-of-Hospital Births

INTRODUCTION: Unplanned out-of-hospital births are uncommon and associated with serious complications. Most emergency medical services (EMS) personnel receive little or no instruction on emergent vaginal delivery. Our in-person (IP) lecture and simulation training on emergent vaginal delivery for EMS personnel previously demonstrated improvement in knowledge and confidence. With COVID-19 we adapted the same curriculum into a virtual training session (VTS). In-person simulation increases confidence and knowledge, but less is known about virtual simulation training. The purpose of this study was to assess EMS personnel's knowledge and confidence after IP versus VTS in emergent vaginal delivery. METHODS: The IP and VTS participants received the same lecture on emergent delivery either in-person or virtually. The IP group received in-person simulation training using a birth simulator. The VTS group received simulation training via virtual demonstration on the same model. Participants completed pretraining and posttraining surveys to assess knowledge and confidence. Responses were analyzed and compared using Student's t test. RESULTS: Ninety-eight participants (59 IP, 39 VTS) participated with 100% survey completion. Pretraining knowledge scores were similar (IP 45% versus VTS 37%, P =.22). Although both groups showed improvement, the IP group had significantly higher posttraining knowledge scores (IP 99% versus VTS 75%, P <.01). More IP participants reported confidence in performing emergent delivery after training (IP 100% versus VTS 51%, P <.01). CONCLUSION: Live in-person instruction and simulation training of emergent vaginal delivery among EMS personnel results in higher knowledge scores and confidence when compared to virtual instruction and simulation training. Further evaluation is needed to determine generalizability to other learner groups. [ FROM AUTHOR] Copyright of Obstetrics & Gynecology is the property of Lippincott Williams & Wilkins 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.)

An Analytical Approach for Dispatch Operations of Emergency Medical Services: A Case Study of COVID-19

: Emergency medical services (EMS) aims to deliver timely ambulatory care to incidents in communities. However, the operations of EMS may contend with suddenly increasing demands resulting from unexpected disasters such as disease outbreaks (e.g., COVID-19) or hurricanes. To this end, it usually requires better strategical decisions to dispatch, allocate, and reallocate EMS resources to meet the demand changes over time in terms of demographic and geographic distribution of incidents. In this study, we focus on the operation of the EMS resources (i.e., ambulance dispatch) in response to a demand disruption amid the COVID-19 pandemic. Specifically, we present a analytical framework to (1) analyze the underlying demographic and geographic patterns of emergency incidents and EMS resources;(2) develop a mathematical programming model to identify potential demand gaps of EMS coverage across different districts;and (3) provide a remedial reallocation solution to the EMS system with the existing ambulance capacity. The proposed method is validated with emergency response incident data in New York City for the first COVID-19 surge from March to April 2020. We found that it takes a long incident response time to scenes which reflects unexpected incident demands during COVID-19 surge. To cover such disruptive demands, ambulances need to be reallocated between service districts while meeting the response time standard. The proposed framework can be potentially applied to similar disruptive scenarios in the future and other operational systems disrupted by other disasters. Highlights: We propose an analytical framework using optimization modeling and simulation techniques for EMS resource allocation in response to a demand disruption amid the COVID-19 pandemic.We propose mathematical programming models to identify potential demand gaps of EMS coverage across different districts.We provide a remedial reallocation solution to the EMS system with the existing ambulance capacity. © 2023, The Author(s).

Engineering Design of a Health Service Station Sewage Treatment Station under COVID-19 Epidemic

Health service station is a place in which close contacts with the COVID-19 and other key populations are centralized quarantined for medical observation.A newly built health service station is equipped with 4 700 beds and a supporting sewage treatment station with a designed treatment scale of2 200 m~3/d.The treatment process consists of enhanced biological treatment system,sewage virus disinfection and sterilization system,aerosol disinfection and sterilization system and sludge disinfection and sterilization system.After treatment,the effluent and waste gas can meet the limit specified in Discharge Standard of Water Pollutants for Medical Organization （GB 18466-2005）.The average COD,NH3-N and SS in effluent are 14.53 mg/L,1.26 mg/L and 9.11 mg/L,respectively,and the average concentrations of H2S,NH3 and odor at the outlet are 0.01 mg/L,0.8 mg/L and 6.3,respectively.The sludge is disinfected regularly and then transported outside for disposal.This project can provide reference for sewage treatment design of emergency medical temporary isolation and observation facility and cabin hospital.

Decision on non-conveyance of patients suspected of COVID-19 in a novel arrangement with assessment visits by paramedics at home.

BACKGROUND: During the first weeks of the outbreak of the coronavirus disease 2019 (COVID-19), the North Denmark emergency medical services authorised paramedics to assess patients suspected of COVID-19 at home, and then decide if conveyance to a hospital was required. The aim of this study was to describe the cohort of patients who were assessed at home and their outcomes in terms of subsequent hospital visits and short-term mortality. METHODS: This was a historical cohort study in the North Denmark Region with consecutive inclusion of patients suspected of COVID-19 who were referred to a paramedic's assessment visit by their general practitioner or an out-of-hours general practitioner. The study was conducted from 16 March to 20 May 2020. The outcomes were the proportion of non-conveyed patients who subsequently visited a hospital within 72 hours of the paramedic's assessment visit and mortality at 3, 7 and 30 days. Mortality was estimated using a Poisson regression model with robust variance estimation. RESULTS: During the study period, 587 patients with a median age of 75 (IQR 59-84) years were referred to a paramedic's assessment visit. Three of four patients (76.5%, 95% CI 72.8;79.9) were non-conveyed, and 13.1% (95% CI 10.2;16.6) of the non-conveyed patients were subsequently referred to a hospital within 72 hours of the paramedic's assessment visit. Within 30 days from the paramedic's assessment visit, mortality was 11.1% [95% CI 6.9;17.9] among patients directly conveyed to a hospital and 5.8% [95% CI 4.0;8.5] among non-conveyed patients. Medical record review revealed that deaths in the non-conveyed group had happened among patients with 'do-not-resuscitate' orders, palliative care plans, severe comorbidities, age ≥ 90 years or nursing home residents. CONCLUSIONS: The majority (87%) of the non-conveyed patients did not visit a hospital for the following three days after a paramedic's assessment visit. The study implies that this newly established prehospital arrangement served as a kind of gatekeeper for the region's hospitals in regard to patients suspected of COVID-19. The study also demonstrates that implementation of non-conveyance protocols should be accompanied by careful and regular evaluation to ensure patient safety.

Opioid prescriptions and patients' health services utilization and cost before and during the COVID-19 pandemic: an exploratory population-based administrative data analysis.

The objective was to explore percentages of the population treated with prescribed opioids and costs of opioid-related hospitalizations and emergency department (ED) visits among individuals treated with prescription opioids and costs of all opioid-related hospitalizations and ED visits in the province (i.e., provincial costs) before and during the coronavirus disease 2019 (COVID-19) pandemic in Alberta, Canada. In administrative data, we identified individuals treated with prescription opioids and opioid-related hospitalizations and ED visits among those individuals and among all individuals in the province between 2015/16 and 2021/22 fiscal years. Services used were counted on an item-by-item basis and costed using case-mix approaches. Annually, from 9.98% (2020/21-2021/22) to 14.52% (2017/18) of the provincial population was treated with prescription opioids. Between 2015/16 and 2021/22, annual costs of opioid-related hospitalizations and ED visits among individuals treated with prescription opioids were ∼$5 and ∼$2 million, respectively. In 2020/21-2021/22, the provincial costs of opioid-related hospitalizations (∼$14 million) and ED visits (∼$7.0 million) were almost twice the costs observed in 2015/16 and immediately before the pandemic (2019/20). Our findings suggest that increases in the opioid-related utilization of inpatient and ED services between 2015/16 and 2021/22, including the drastic increases observed during the COVID-19 pandemic, were likely driven by unregulated substances.

Evaluation of the psychological distress and mental well-being of pre-hospital care providers in Saudi Arabia during COVID-19.

Background: Pre-hospital care providers are the first line of contact when emergencies occur. They are at high risk of mental health disorders associated with trauma and stress. The magnitude of their stress could increase during difficult times such as the COVID-19 pandemic. Objectives: This study reports on the state of mental well-being and the degree of psychological distress among pre-hospital care workers (paramedics, emergency medical technicians, doctors, paramedic interns and other healthcare practitioners) during the COVID-19 pandemic in Saudi Arabia. Methods: The study was a cross-sectional survey study in Saudi Arabia. A questionnaire was distributed among pre-hospital care workers in Saudi Arabia during the first wave of the COVID-19 pandemic. The questionnaire was based on the Kessler Psychological Distress Scale (K10) and the World Health Organization Well-Being Index (WHO-5). Results: In total, 427 pre-hospital care providers completed the questionnaire; 60% of the respondents had scores of more than 30 in the K10 and were likely to have a severe disorder. The WHO-5 showed a similar percentage of respondents with a score of more than 50 and coded as having poor well-being. Conclusions: The findings of this study provide evidence around mental health and well-being for pre-hospital care workers. They also highlight the need to better understand the quality of mental health and well-being for this population and to provide appropriate interventions to improve their quality of life.

The role of lean in healthcare during COVID-19 pandemic

PurposeThe impact of the COVID-19 pandemic on healthcare operations has raised questions about the applicability and capacity of the lean approach to respond to critical events. Thus, with a dearth of studies addressing this issue, this study aims to understand the role of lean in healthcare operations under the disruptive impact of the COVID-19 pandemic.Design/methodology/approachDrawing on a case study carried out in an emergency department in Brazil during the COVID-19 outbreak, the author presents results from semi-structured interviews and document analysis.FindingsThe results show three prominent themes that respond to this study's purpose: lean applicability during the pandemic, lean challenges during the pandemic and the pandemic impact on the lean processes. Furthermore, the study underscores that lean is not the panacea to operational problems caused by the pandemic in healthcare organisations, but it eases the impact on their operations. Finally, this study contributes to the discipline of operations management and highlights the need to rethink lean applications during disruptive events, focusing on flexibility, adaptability and patients' needs.Research limitations/implicationsThe literature addressing the pandemic impact on healthcare operations is still new and emerging;therefore, it is possible that some of the studies that are under review and could contribute to this study were not considered.Practical implicationsThe study provides a better understanding of the lessons learned from the real-world experiences gained during the pandemic, helping managers to make informed decisions when developing contingency plans to improve healthcare readiness and responsiveness under crisis conditions (e.g. untenable demand and constrained capacity).Originality/valueGiven the contemporary nature of this pandemic, only few emerging studies addressing the impact of the pandemic on lean healthcare operations are available and scholars are calling for more empirical studies. Furthermore, there is an increasing criticism and scepticism about the applicability of lean in healthcare during a pandemic. Thus, this research both provides original contributions by responding to scholars' calls for novel research in this area and further contributes towards filling the void in the literature.

Smart Ambulance Monitoring System Using Iot

A vehicle which is used to transport patients to hospitals is called as ambulance, this ambulance vehicle is equipped with some vital lifesaving equipment's and first aid medicines. With these medicines and equipment's, the patients are given first aid till it reaches the desired hospital. Whenever a patient is in life-threatening emergency, then the ambulance paramedics should act promptly and must update the status of the patient to their doctors. This type of treatment or service is called Emergency Medical Service (EMS). It deals with immediate treatment and timely movement of the patients. For implementing EMS in ambulance several solutions have been developed for faster means of communication between the equipment's used in ambulance and the doctors. But the solutions are not viable in emergency situations. In additions during Covid wave in 2020 there was a scarcity for hospitals beds, it was filled with many covid patients. In many hospitals there was a queue of ambulances with patients waiting outside the hospitals. In some cases, the patients even died before getting any treatment, to overcome such crucial situations we have come out with a new system combining IoT, Sensor system and Embedded Controllers. The system developed here has sensors to monitor patients' vital parameters and transmits to the hospital server, such that a doctor can know the live condition of the patient and he can give instructions to the paramedics to do emergency aids. The system is a compactable and connects to the server with a mobile hotspot. The information is updated every 10 seconds. By implementing this system in ambulances, it saves many valuable lives of the people.

The value of probabilistic forecasting in emergency medical resource planning under uncertainty

PurposeMost epidemic transmission forecasting methods can only provide deterministic outputs. This study aims to show that probabilistic forecasting, in contrast, is suitable for stochastic demand modeling and emergency medical resource planning under uncertainty.Design/methodology/approachTwo probabilistic forecasting methods, i.e. quantile regression convolutional neural network and kernel density estimation, are combined to provide the conditional quantiles and conditional densities of infected populations. The value of probabilistic forecasting in improving decision performances and controlling decision risks is investigated by an empirical study on the emergency medical resource planning for the COVID-19 pandemic.FindingsThe managerial implications obtained from the empirical results include (1) the optimization models using the conditional quantile or the point forecasting result obtain better results than those using the conditional density;(2) for sufficient resources, decision-makers' risk preferences can be incorporated to make tradeoffs between the possible surpluses and shortages of resources in the emergency medical resource planning at different quantile levels;and (3) for scarce resources, the differences in emergency medical resource planning at different quantile levels greatly decrease or disappear because of the existing of forecasting errors and supply quantity constraints.Originality/valueVery few studies concern probabilistic epidemic transmission forecasting methods, and this is the first attempt to incorporate deep learning methods into a two-phase framework for data-driven emergency medical resource planning under uncertainty. Moreover, the findings from the empirical results are valuable to select a suitable forecasting method and design an efficient emergency medical resource plan.

Infection prevention and control practices and related factors among paramedics during the coronavirus disease 2019 outbreak in Korea.

This study aimed to investigate the coronavirus disease 2019 (COVID-19) infection prevention and control (IPC) practices and related factors among paramedics. We selected 249 paramedics using convenience sampling from three areas in Korea. Data on the demographics, infection-related characteristics, awareness, and practice of IPC were collected using self-reported questionnaires. The mean IPC practice score was 4.47 ± 0.54. The compliance with IPC practices was relatively high among those with a disease history (B = 0.194, p = 0.045) and who were aware of the safety management standard guidelines. Provision of sufficient protective equipment and infection prevention monitoring were associated with higher IPC practice scores. Education for increasing awareness of the recent IPC guidelines and the allocation of personal protective equipment would be helpful in improving the practice.

Reasons for the termination of resuscitation in out-of-hospital cardiac arrests before and after the COVID-19 pandemic in Korea

The incidence of out-of-hospital cardiac arrest (OHCA) gradually increased during the coronavirus disease 2019 (COVID-19) pandemic, and the number of cases requiring termination of resuscitation (TOR) also rose. This study aimed to analyze the reasons for TOR of OHCA cases over 2 years (2019–2020). This retrospective observational study was conducted using data gathered from prehospital emergency medical service (EMS) care reports generated in Seoul between 01 January 2019, and 31 December 2020. We included OHCA cases reported to the EMS system in this study. Patients who experienced cardiac arrest for a non-medical cause and received cardiopulmonary resuscitation (CPR) from EMS paramedics at the scene were excluded. The variables of demographics and comorbidities, arrest location, identity of the bystander, cause of cardiac arrest, first monitored electrocardiographic (ECG) rhythm, and reason for TOR were investigated. We compared data for 1 year before and after the start of the COVID19 pandemic. A total of 10,872 OHCAs with TOR were included in this study;of these, 6238 cardiac arrest cases were terminated without resuscitation attempts during the COVID-19 period compared to 4634 during the pre-COVID-19 period. During the COVID-19 period, the proportion of women in the total population decreased, while the median age increased (p < 0.001). Patients with comorbidities, the frequency of asystole rhythm at first monitoring, and the number of witnessed cardiac arrests significantly increased (p < 0.001). The proportion of TOR cases due to decisions made by a medical director and refusal of CPR by family members also significantly increased, while that due to clear evidence of death decreased (p < 0.001). In conclusion, there was a significant change in the reason for TOR before and after the COVID-19 pandemic in Korea. [ FROM AUTHOR] Copyright of Signa Vitae is the property of Pharmamed Mado Ltd. 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.)

Challenges of Emergency Medical Services Response to Arasbaran Twin Earthquakes; a Content Analysis.

Introduction: One of the most important concerns in responding to disasters is providing Basic Life Support (BLS) services. Considering the key role of Emergency Medical Services (EMS) in providing BLS, the purpose of this study is to investigate the experience of provincial EMS during their response to the Arasbaran twin earthquakes and its challenges in Iran. Methods: This study was conducted using a qualitative approach and the conventional content analysis method. Data were collected through Focused Group Discussions (FGD) and semi-structured in-depth interviews with purposively-selected EMS paramedics and officials in East Azerbaijan Province, Iran. To form the main categories, the interviews were encoded in three stages and the similar codes were placed under the same subcategories and merged. Results: A total of 26 EMS paramedics participated in the study. The codes extracted from the interviews, after three stages of reduction, were placed in the top ten categories, including the lack of preparedness and coordination, dead bodies' management challenges, responders' psychosocial support, deficiencies in supplies and ambulances, difficulty of access to rural areas, volunteer management, non-documentation of the experiences, communication challenges, recalling, and deploying of EMS responders. Conclusion: Timely response of the EMS and paramedics' sense of responsibility for providing services were positive and successful points about the emergency response operations. The weaknesses of EMS should, therefore, be addressed through transferring of experiences and by planning and arranging training courses.

Required Personal Protective Equipment for Prehospital Healthcare Provider in COVID-19 Pandemic: A Systematic Review

Aims. Coronavirus Disease 2019 (COVID-19) is a highly contagious disease, and a variety of personal protective equipment (PPE) has been recommended as preventive measures for prehospital emergency personnel, which has led to considerable challenges and a great confusion for the personnel. This review aims to identify different types of PPE required in the care of COVID-19 patients in prehospital emergency system.Material and methods. This study was carried out by searching through databases including: Pubmed, Proqust, Google Scholar, and Cinahl. All articles that recommended different types of PPE against COVID-19 and infectious diseases for prehospital emergency personnel were collected in a table.Results. After carrying out the initial search in the databases, 1,009 studies were obtained and then 16 articles were selected. The findings seem to suggest using equipment including: gloves, face shields (shield/goggles), protective clothes (medical jumpsuit/scrubs), surgical masks, N-95 masks, powered air purifying respirators (PAPR), hair covers, shoe covers and washing up the hands by the emergency medical service (EMS) personnel.Discussion. The scrutiny of the relevant studies showed that each of them advised the EMS personnel to use a number of PPE. The present study highlighted the fact that there are other components of the PPE which can be useful to them.Conclusion. This study identified the most appropriate PPE needed for prehospital emergency personnel against COVID-19, and it is believed that planning for adequate access to this equipment and training on how to use them can significantly help to reduce the infection among the personnel.

Professional quality of life and resilience in pre-hospital emergency technicians during COVID-19 in Iran: a cross-sectional study.

The professional quality of life of pre-hospital emergency technicians has been adversely affected during the COVID-19 pandemic. The present study was performed to investigate the professional quality of life and resilience and their relationships in pre-hospital emergency technicians of Kermanshah Province, Iran during the COVID-19 pandemic. This cross-sectional, descriptive correlational study was conducted on 412 pre-hospital emergency technicians in Kermanshah Province in 2020 using the census method. Data collection tools were the Stamm Professional Quality of Life Questionnaire and the Emergency Medical Services Resilience scale. Pre-hospital emergency technicians experienced moderate levels of the professional quality of life dimensions and high/acceptable levels of resilience. There was a significant correlation between resilience and the dimensions of the professional quality of life. The results of the regression test showed that resilience had a significant effect on all three components of the professional quality of life. Therefore, the use of resilience enhancement strategies is recommended to improve the professional quality of life of pre-hospital emergency technicians.

News Focus

This section offers medical-related news briefs for the year 2023 in the United Kingdom (UK) which includes funding allocated by the Department for Health and Social Care for women's health hubs in England, plan for the spring Covid-19 booster campaign, and areas with highest emergency admissions and death rates for lung conditions.

Emergency medical service planning considering dynamic and stochastic demands of infected and non-infected patients during epidemics

During a large-scale epidemic, a local healthcare system can be overwhelmed by a large number of infected and non-infected patients. To serve the infected and non-infected patients well with limited medical resources, effective emergency medical service planning should be conducted before the epidemic. In this study, we propose a two-stage stochastic programming model, which integrally deploys various types of emergency healthcare facilities before an epidemic and serves infected and non-infected patients dynamically at the deployed healthcare facilities during the epidemic. With the service equity of infected patients and various practical requirements of emergency medical services being explicitly considered, our model minimizes a weighted sum of the expected operation cost and the equity cost. We develop two comparison models and conduct a case study on Chengdu, a Chinese city influenced by the COVID-19 epidemic, to show the effectiveness and benefits of our proposed model. Sensitivity analyses are conducted to generate managerial insights and suggestions. Our study not only extends the existing emergency supply planning models but also can facilitate better practices of emergency medical service planning for large-scale epidemics. © Operational Research Society 2023.

Seroincidencia de anticuerpos IgG del SARS-CoV-2 y factores de riesgo en trabajadores sanitarios asintomáticos del Hospital Departamental de Villavicencio

Objetivo: Estimar la seroincidencia acumulada de inmunoglobulinas (Ig) clase G (IgG) anti-SARS-CoV-2 en trabajadores de la salud asintomáticos y su asociación epidemiológica dentro de las áreas funcionales del Hospital Departamental de Villavicencio (HDV). Metodología: Se llevó a cabo un estudio observacional analítico longitudinal de una cohorte de trabajadores, donde cada 21 días, en tres oportunidades, se midieron IgG anti-SARS-CoV-2 en suero sanguíneo, a través de ELISA indirecto, en una muestra representativa aleatoria (n = 105) de trabajadores sanitarios del hospital (N = 756). Como instrumento de recolección de datos se utilizó una encuesta, donde cada trabajador sanitario declaró no haber sido diagnosticado con COVID-19, e igualmente registró la información sobre las variables independientes: sexo, edad, condición laboral, área funcional y comorbilidades. Resultados: La prevalencia inicial para SARS-CoV-2 entre los trabajadores sanitarios asintomáticos del HDV fue de 9,52 % (IC 95 % 5,25-16,65). La seroincidencia acumulada durante 42 días fue de 12,38 % (IC 95 % 7,38-20,04). El riesgo relativo (RR) se utilizó para establecer los factores de riesgo asociados a las variables independientes. El sexo masculino (RR ajustado = 3,34, IC 95 % 1,98-5,86), obesidad (RR ajustado = 10,98, IC 95 % 1,41-85,98) y sexo femenino (RR ajustado = 2,15, IC 95 % 1,12-4,31) en las áreas funcionales de Hospitalización, Medicina Crítica y Urgencias, respectivamente, son factores de riesgo en el HDV. Conclusión: Un total de 13 de 105 trabajadores sanitarios del hospital seroconvirtieron positivamente para SARS-CoV-2 y fueron asintomáticos durante 42 días de seguimiento epidemiológico. Además, existen factores de riesgo importantes en su exposición a este virus en el HDV.Alternate : Objetivo: Estimar a incidência zero acumulada de imunoglobulinas (Ig) classe G (IgG) anti-SARS-CoV-2 em profissionais de saúde assintomáticos e sua associação epidemiológica dentro das áreas funcionais do Hospital Estadual de Villavicencio (HDV). Metodologia: Foi realizado um estudo observacional analítico longitudinal de uma coorte de profissionais, no qual a cada 21 dias, em três ocasiões mediram-se IgG anti-SARS-CoV-2 em soro sanguíneo, através de ELISA indireto, em uma amostra representativa aleatória (n = 105) de profissionais de saúde do hospital (N =756). Como instrumento de recolecção de dados foi usada uma pesquisa, onde cada profissional de saúde declarou não ter sido diagnosticado com COVID-19, e igualmente registrou a informação sobre as variáveis independentes: sexo, idade, condições de trabalho, área de atuação e comorbidades. Resultados: A prevalência inicial para SARS-CoV-2 entre os profissionais de saúde assintomáticos do HDV foi de 9,52% (IC 95% 5,25-16,65). A incidência zero acumulada durante 42 dias foi de 12,38% (IC 95% 7,38-20,04). O risco relativo (RR) foi utilizado para estabelecer os fatores de risco associados às variáveis independentes. O sexo masculino (RR ajustado 3,34, IC 95% 1,98-5,86), obesidade (RR ajustado 10,98, IC 95% 1,41-85,98) e sexo feminino (RR ajustado 2,15, IC 95% 1,12-4,31) nas áreas funcionais de Internação, Unidade de Terapia Intensiva e Urgências, respectivamente, são fatores de risco no HDV. Conclusão: Um total de 13 de 105 profissionais de saúde do hospital foram detectados positivamente para SARS-CoV-2 e foram assintomáticos durante 42 dias de seguimento epidemiológico. Além disso, existem importantes fatores de risco na sua exposição a este vírus no HDV.Alternate : Objective: To estimate the cumulative seroincidence of anti-sars-CoV-2 immunoglobulin (Ig) class G (IgG) in asymptomatic health care workers and its epidemiological association within the functional areas of the Villavicencio Departmental Hospital (HDV). Methodology: A longitudinal analytical observational study of a cohort of workers was conducted in which anti-SARS-CoV-2 IgG levels in blood serum were measured every 21 days on three occasions using an in irect ELISA in a random representative sample (n = 105) of hospital health workers (N = 756). The data collection tool was a survey in which each healthcare worker indicated that they had not been diagnosed with COVID-19 and provided information on the independent variables: sex, age, job status, functional area, and comorbidities. Results: The baseline prevalence for SARS-CoV-2 among asymptomatic HDV healthcare workers was 9.52% (CI 95% 5.25-16.65). Cumulative seroincidence over 42 days was 12.38% (CI 95% 7.38-20.04). Relative risk (RR) was used to establish the risk factors associated with the independent variables. Male sex (adjusted RR 3.34, CI 95% 1.98-5.86), obesity (adjusted RR 10.98, CI 95% 1.41-85.98) and female sex (adjusted RR 2.15, CI 95% 1.12-4.31) in the functional areas of Hospitalization, Critical Medicine and Emergency, respectively, are risk factors in the HDV. Conclusion: During 42 days of epidemiological follow-up, 13 out of 105 hospital healthcare workers seroconverted positively for SARS-CoV-2 and remained asymptomatic. Additionally, significant risk factors are associated with their exposure to this virus in the HDV.

Impacts of the COVID-19 response on frontline healthcare workers

The COVID-19 pandemic, and the responses to it that were required from frontline healthcare providers and others working in healthcare settings including environmental, clerical, and security staff, has challenged our healthcare systems in unprecedented ways. The threats to the financial, physical, and psychological well-being of healthcare professionals-many of whom entered the field due at least in part to a deep commitment to caring for and helping others-will have profound and long-lasting personal and professional impacts. Early in the pandemic response, healthcare professionals knew little about the risks they, their patients, and their loved ones faced from COVID-19 as they operated under crisis standards of care and without adequate supplies of personal protective equipment. As the pandemic response progressed, the lack of clear, science-based guidance, and the politicization of the pandemic presented new medical, ethical, and moral dilemmas. New psychological support mechanisms, including crisis counseling and evidence-based interventions, are needed for all workers in healthcare settings, regardless of their job role. © 2023 The authors.

PbDinEHR: A Novel Privacy by Design Developed Framework Using Distributed Data Storage and Sharing for Secure and Scalable Electronic Health Records Management

Privacy in Electronic Health Records (EHR) has become a significant concern in today's rapidly changing world, particularly for personal and sensitive user data. The sheer volume and sensitive nature of patient records require healthcare providers to exercise an intense quantity of caution during EHR implementation. In recent years, various healthcare providers have been hit by ransomware and distributed denial of service attacks, halting many emergency services during COVID-19. Personal data breaches are becoming more common day by day, and privacy concerns are often raised when sharing data across a network, mainly due to transparency and security issues. To tackle this problem, various researchers have proposed privacy-preserving solutions for EHR. However, most solutions do not extensively use Privacy by Design (PbD) mechanisms, distributed data storage and sharing when designing their frameworks, which is the emphasis of this study. To design a framework for Privacy by Design in Electronic Health Records (PbDinEHR) that can preserve the privacy of patients during data collection, storage, access and sharing, we have analysed the fundamental principles of privacy by design and privacy design strategies, and the compatibility of our proposed healthcare principles with Privacy Impact Assessment (PIA), Australian Privacy Principles (APPs) and General Data Protection Regulation (GDPR). To demonstrate the proposed framework, ‘PbDinEHR', we have implemented a Patient Record Management System (PRMS) to create interfaces for patients and healthcare providers. In addition, to provide transparency and security for sharing patients' medical files with various healthcare providers, we have implemented a distributed file system and two permission blockchain networks using the InterPlanetary File System (IPFS) and Ethereum blockchain. This allows us to expand the proposed privacy by design mechanisms in the future to enable healthcare providers, patients, imaging labs and others to share patient-centric data in a transparent manner. The developed framework has been tested and evaluated to ensure user performance, effectiveness, and security. The complete solution is expected to provide progressive resistance in the face of continuous data breaches in the patient information domain.

Clinical-epidemiological profile of patients with covid-19 admitted to a university hospital reference

Objective: To characterize the epidemiological profile of patients hospitalized with COVID-19 in a referral emergency unit in northern Paraná;analyze the profile of patients affected by COVID-19 regarding gender, color/race, age, marital status, origin and type of referral;measure the average length of hospital stay, from the date of admission of the patient until discharge, determine the percentage of the main hospital outcomes. Method: It was field research with a quantitative, observational, unicentric, descriptive, exploratory and retrospective approach, carried out at the University Hospital of the State University of Londrina, located in the north of the Paraná. The study population consisted of data from 2,800 patients admitted and hospitalized with a confirmed diagnosis of COVID-19 in the Emergency Room of the hospital in question, according to records of the epidemiology center and Medical and Statistical Archive Service, from January 2021 to July 2021. Results: It was observed that most of those affected were male, had a white color, were single and were between 58 and 67 years old. The mean length of hospitalization was 16 days. The Mobile Emergency Care Service obtained the highest referral records and the discharge and death outcomes had very close values. Conclusion: It is concluded that the second wave of COVID-19 was devastating in all segments, reflecting the change in the age profile of those affected, the increase in hospitalization rates, high mortality rates and the close relationship between the hospitalization period and the evolution to death © COPYRIGHT Servicio de Publicaciones - Universidad de Murcia