ABSTRACT
Acute severe symptoms and long-term sequelae caused by the novel coronavirus disease (COVID-19) are still major concerns for public health. In particular, it is an emerging need to prevent the overburn of health workers as well as the collapse of health care systems. To reach this purpose, it should be necessary to evaluate a standardized pre-hospital management for COVID-19 patients, but data about it are lacking. Thus, the aim of the present chapter is to analyze the in-hospital gesture hypothesizing its reproducibility at bedside.Meta-analyses and randomized clinical trials assessed were focused on the following topics: (1) early diagnosis through viral demonstration and serological testing;(2) home setting evaluation;(3) standardized multidimensional assessment of COVID-19 patients, including an early identification of specific clinical symptoms as well as a prognostic stratification through laboratory biomarkers and portable imaging techniques;(4) safe and easily administrable drugs, considering both new medications and repurposed molecules;(5) protocols regarding bedside oxygen therapy, prone positioning, and pulmonary rehabilitation.To date, several procedures for the in-hospital management of COVID-19 patients could be easily and safely applied in the outpatients' care. The institution of dedicated international open-access data banks could be useful to realize standardized pre-hospital protocols, and the implementation of remote approaches could provide the possibility to guarantee a continuous follow-up for these patients. Global efforts focused on this goal could represent the only way to decrease the pressure on health care systems and to restore their essential function, still allowing an effective management of mild-to-moderate COVID-19 stages. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
ABSTRACT
A significant number of people, following acute SARS-CoV-2 infection, report persistent symptoms or new symptoms that are sustained over time, often affecting different body systems. This condition, commonly referred to as Long-COVID, requires a complex clinical management. In Italy new health facilities specifically dedicated to the diagnosis and care of Long-COVID were implemented. However, the activity of these clinical centers is highly heterogeneous, with wide variation in the type of services provided, specialistic expertise and, ultimately, in the clinical care provided. Recommendations for a uniform management of Long-COVID were therefore needed. Professionals from different disciplines (including general practitioners, specialists in respiratory diseases, infectious diseases, internal medicine, geriatrics, cardiology, neurology, pediatrics, and odontostomatology) were invited to participate, together with a patient representative, in a multidisciplinary Panel appointed to draft Good Practices on clinical management of Long-COVID. The Panel, after extensive literature review, issued recommendations on 3 thematic areas: access to Long-COVID services, clinical evaluation, and organization of the services. The Panel highlighted the importance of providing integrated multidisciplinary care in the management of patients after SARS-CoV-2 infection, and agreed that a multidisciplinary service, one-stop clinic approach could avoid multiple referrals and reduce the number of appointments. In areas where multidisciplinary services are not available, services may be provided through integrated and coordinated primary, community, rehabilitation and mental health services. Management should be adapted according to the patient's needs and should promptly address possible life-threatening complications. The present recommendations could provide guidance and support in standardizing the care provided to Long-COVID patients.
Subject(s)
COVID-19 , Geriatrics , Humans , Child , Post-Acute COVID-19 Syndrome , COVID-19/epidemiology , COVID-19/therapy , SARS-CoV-2 , Health Services AccessibilityABSTRACT
Background and Objectives: Mobile integrated health (MIH) interventions have not been well described in older adult populations. The objective of this systematic review was to evaluate the characteristics and effectiveness of MIH programs on health-related outcomes among older adults. Research Design and Methods: We searched Ovid MEDLINE, Ovid EMBASE, CINAHL, AgeLine, Social Work Abstracts, and The Cochrane Library through June 2021 for randomized controlled trials or cohort studies evaluating MIH among adults aged 65 and older in the general community. Studies were screened for eligibility against predefined inclusion/exclusion criteria. Using at least 2 independent reviewers, quality was appraised using the Downs and Black checklist and study characteristics and findings were synthesized and evaluated for potential bias. Results: Screening of 2,160 records identified 15 studies. The mean age of participants was 67 years. The MIH interventions varied in their focus, community paramedic training, types of assessments and interventions delivered, physician oversight, use of telemedicine, and post-visit follow-up. Studies reported significant reductions in emergency call volume (5 studies) and immediate emergency department (ED) transports (3 studies). The 3 studies examining subsequent ED visits and 4 studies examining readmission rates reported mixed results. Studies reported low adverse event rates (5 studies), high patient and provider satisfaction (5 studies), and costs equivalent to or less than usual paramedic care (3 studies). Discussion and Implications: There is wide variability in MIH provider training, program coordination, and quality-based metrics, creating heterogeneity that make definitive conclusions challenging. Nonetheless, studies suggest MIH reduces emergency call volume and ED transport rates while improving patient experience and reducing overall health care costs.
ABSTRACT
Spurred by the expansive shared prosperity of its Belt and Road Initiative, China was winning the economic component of its Great Power Competition with the United States in Africa. Then Covid-19 spread to Africa in February 2020. By spring Africa's honeymoon with China was over. China's Covid-19 related discrimination against Africa as well as disruption in both the supply chain and the Belt and Road Initiative weakened bilateral ties. While nobody expects China to lose its place as Africa's biggest bilateral lending and trading partner, Sino-African ties are strained. Not surprisingly, Africa turned inward and focused on its fight against the invisible Covid-19 enemy. But Africa soon found itself in a new tradeoff between battling Covid-19 and violent extremism. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
ABSTRACT
Internet of Things applications with various sensors in public network are vulnerable to cyber physical attacks. The technology of IoT in smart health monitoring systems popularly known as Internet of Medical Things (IoMT) devices. The rapid growth of remote telemedicine has witnessed in the post COVID era. Data collected over IoMT devices is sensitive and needs security, hence provided by enhancing a light weight encryption module on IoMT device. An authenticated Encryption with Associated Data is employed on the IoMT device to enhance the security to the medical wellness of patient. This paper presents FPGA-based implementation of ASCON-128, a light weight cipher for data encryption. A LUT6 based substitution box (SBOX) is implemented on FPGA as part of cipher permutation block. The proposed architecture takes 1330 number of LUTs, which is 35% less compared to the best existing design. Moreover, the proposed ASCON architecture has improved the throughput by 45% compared to the best existing design. This paper presents the results pertaining to encryption and decryption of medical data as well as normal images. © 2022 IEEE.
ABSTRACT
This letter discusses individuals with mental illness in psychiatric facilities during the COVID-19 pandemic. COVID-19 pandemic has presented an unprecedented event for healthcare systems across the world and an additional stressor for population with mental illness. Current healthcare systems are focused on providing prevention, screening, and finding vaccine and treatment for the infection and thus ensuring access to mental healthcare should also be part of the continuity of treatment. Psychological distress in the general population has been reported during COVID-19 quarantine. However, disasters disproportionally affect vulnerable populations and individuals with serious mental illness could confer a worst prognosis from COVID-19 and the consequential social distancing measures as well. Residential instability, homelessness, lack of family and social support, lockdown and social distancing can raise the risk of infection and make it harder for assessment and management of those who would be infected from population with serious mental illness. Limited social networking and social distancing may limit opportunities to obtain support from friends and family members' poses more adverse threats to individuals with mental illness. These factors may lead to elevated mental health issues and could have worst prognosis in this population. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
This letter discusses mental health care after the COVID-19 outbreak by presenting preliminary findings from a public general hospital in Madrid. The pandemic caused by the SARS-CoV-2 poses a major challenge for national health systems around the globe. In these situations, healthcare centers are urged to adjust their structures to the demands of the outbreak in order to protect both the users and the workers. However, this emergency has no precedent in the recent history, and entire hospitals and clinics need further adaptations for which there is no previous evidence. This affects mental healthcare teams, which deal with the unknown psychological consequences of an overwhelming, global crisis. La Paz University Hospital is a public general hospital that provides healthcare to a catchment area of more than half a million people in Madrid. So far, more than 2,700 confirmed cases of SARS-CoV-2 have been attended in this hospital, which required a complete restructuring process. A few days after the outbreak, its mental health team managed to develop a COVID-19 intervention protocol that was based on its previous experience during the 2014 Ebola crisis in Madrid and on the reports that were coming from China. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
In March 2020, the first Covid-19 patients were admitted to Shaare Zedek Medical Center in Jerusalem. At the height of the first wave, six Covid-19 wards and a Covid-19 Intensive Care Unit operated at the medical center, treating over 3,700 patients. The Covid-19 epidemic presented the health system with conditions never seen before. The chapter describes several treatment protocols and illustrates with specific examples some of the challenges experienced by patients, families, and medical staff. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
In the large literature on the spatial-level correlates of COVID-19, the association between quality of hospital care and outcomes has received little attention to date. To examine whether county-level mortality is correlated with measures of hospital performance, we assess daily cumulative deaths and pre-crisis measures of hospital quality, accounting for state fixed-effects and potential confounders. As a measure of quality, we use the pre-pandemic adjusted five-year penalty rates for excess 30-day readmissions following pneumonia admissions for the hospitals accessible to county residents based on ambulance travel patterns. Our adjustment corrects for socio-economic status and down-weighs observations based on small samples. We find that a one-standard-deviation increase in the quality of local hospitals is associated with a 2% lower death rate (relative to the mean of 20 deaths per 10,000 people) one and a half years after the first recorded death.
ABSTRACT
BACKGROUND AND AIM: Worldwide health systems have been strained by the COVID-19 pandemic. Surging numbers of critically ill adult patients demanded urgent system-wide responses. Our Paediatric Intensive Care Unit (PICU) underwent a care delivery model redesign and rapid shift in processes and resources to care for critically ill adults at the peak of the pandemic. We describe novel adaptions made to accommodate adult patients for the first time in this paediatric setting. Personal insights of clinical staff, leaders and adult care partners about the experience of caring for critically ill adult patients are shared. METHOD(S): Program components included;preparation, education, collaboration (both interprofessional and interorganizational), continuous process improvement, and staff well-being initiatives. Interprofessional team impacts gathered during the implementation phase of the program and 10 months following were analysed using Havelock's Theory of Change framework1. RESULT(S): The Adult COVID-19 program facilitated rapid team capacity building and supported responsive care for adult patients. Over 12 weeks, 35 adults (426 patient days) received care in the PICU. Staff acknowledged;1] the burden of providing high quality care for adults, 2] the opportunity for individual and team growth and 3] guiding paediatric principals of strength-based, family-centered care enhanced the quality of care provided and provider perceptions of accomplishment. CONCLUSION(S): This program facilitated a rapid transformation and expansion in models of care and processes, successfully enhanced the team's capacity to deliver quality evidence-based service to adults with COVID-19 and was a source of personal growth and meaning for the health care team.
ABSTRACT
Background: Telehealth has rapidly expanded since COVID-19. Veterans Health Administration (VHA), the largest integrated health care system in the United States, was well-positioned to incorporate telehealth across specialties due to existing policies and infrastructure. Objectives: The objective of this study is to investigate predictors of occupational therapy (OT) practitioners' adoption of video telehealth. Methods: This study presents data from a convenience sample of VHA occupational therapy (OT) practitioners administered pre-pandemic, in fall 2019. Survey development was guided by the Promoting Action on Research Implementation in Health Services framework, and gathered clinician attitudes, experiences, and perspectives about video telehealth to deliver OT services. Items included telehealth usage, perceived effectiveness of specific OT interventions, and perceptions about evidence. Our outcome variable denoted practitioners' level of adoption of video telehealth: telehealth users (adopters), non-users who want to use telehealth (potential adopters and reference group), and non-users who do not want to use telehealth (non-adopters). In multiple multinomial logistic regressions, we tested whether level of adoption was associated with years of VHA work experience and perceived strength of evidence. Results: Of approximately 1455 eligible practitioners, 305 VHA occupational therapy practitioners participated in the survey (21% response rate). One hundred and twenty-five (41%) reported using video telehealth, whereas 180 (59%) reported not using video telehealth. Among non-users, 107 (59%) indicated willingness to adopt telehealth whereas 73 (41%) were not willing. More VHA work experience predicted higher odds of being an adopter than a potential adopter; perceptions of stronger evidence regarding video telehealth predicted higher odds of being a potential adopter than a non-adopter. Conclusion: Clinician beliefs and years of experience exerted an influence on clinicians' use or willingness to use video telehealth. Efforts to enhance adoption of video telehealth should address clinicians' beliefs regarding the innovative nature of and organizational resources necessary to foster utilization.
ABSTRACT
In March 2020, the first Covid-19 patients were admitted to Shaare Zedek Medical Center in Jerusalem. At the height of the first wave, six Covid-19 wards and a Covid-19 Intensive Care Unit operated at the medical center, treating over 3,700 patients. The Covid-19 epidemic presented the health system with conditions never seen before. The chapter describes several treatment protocols and illustrates with specific examples some of the challenges experienced by patients, families, and medical staff. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
This study aims to investigate the efficiency of the Italian regional health care system and how the emergency policy adopted by the local government can influence those performances. For this purpose, a two-step empirical analysis was performed. At first, a directional distance frontier model was used to assess the efficiency of the regional health care systems. Successively through a fixed-effect panel method, the effects of the policy on the performances were evaluated. The article presents evidence on how local policy influences the performance of the health care system. In particular, the two-step method proposed highlights how the reduction of the workload on the hospitals, obtained preferring home isolation of the infected to hospitalizations, and more stringent control on the public activities, by means of local ordinances, lead to higher performance of the health care system. Those results are considered useful to local government to identify more specific and efficient solutions for the management of creeping crisis as the Covid-19. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
The emergence of COVID-19 pandemic has caused severe damage to many aspects of lives and its management has equally brought about different approach where many have witnessed lockdowns, state of emergencies, and travel restrictions. These measures in their own spectrum have achieved many results identified as successful or otherwise. To many, being liberal on the approach to managing the pandemic is key to ensuring continue flow of resources to promote economic sustainability. Others also have the view that, stringent measures ensure safety and healthy population which are essential to restarting economic structuring in postpandemic. However, adopting flexible but principled approach may be important in the midst of many approaches. This chapter looks at the governance system of Japan from the perspective of state emergency system and its application during the COVID-19 pandemic. It is discussed with some local context while placing it in other jurisdictional contexts to enhance the understanding of adaptive governance. © 2022 Elsevier Inc. All rights reserved.
ABSTRACT
OBJECTIVE: In 2020, the COVID-19 pandemic overburdened the US health care system because of extended and unprecedented patient surges and supply shortages in hospitals. We investigated the extent to which several US hospitals experienced emergency department (ED) and intensive care unit (ICU) overcrowding and ventilator shortages during the COVID-19 pandemic. METHODS: We analyzed Health Pulse data to assess the extent to which US hospitals reported alerts when experiencing ED overcrowding, ICU overcrowding, and ventilator shortages from March 7, 2020, through April 30, 2021. RESULTS: Of 625 participating hospitals in 29 states, 393 (63%) reported at least 1 hospital alert during the study period: 246 (63%) reported ED overcrowding, 239 (61%) reported ICU overcrowding, and 48 (12%) reported ventilator shortages. The number of alerts for overcrowding in EDs and ICUs increased as the number of COVID-19 cases surged. CONCLUSIONS: Timely assessment and communication about critical factors such as ED and ICU overcrowding and ventilator shortages during public health emergencies can guide public health response efforts in supporting federal, state, and local public health agencies.
Subject(s)
COVID-19 , COVID-19/epidemiology , Emergency Service, Hospital , Hospitals , Humans , Intensive Care Units , Pandemics , Ventilators, MechanicalABSTRACT
BACKGROUND: The COVID-19 pandemic had its first peak in the United States between April and July of 2020, with incidence and prevalence rates of the virus the greatest in the northeastern coast of the country. At the time of study implementation, there were few studies capturing the perspectives of nurses working the frontlines of the pandemic in any setting as research output in the United States focused largely on treating the disease. OBJECTIVE: The purpose of this study was to capture the perspectives of nurses in the United States working the frontlines of the COVID-19 pandemic's first wave. We were specifically interested in examining the impact of the pandemic on nurses' roles, professional relationships, and the organizational cultures of their employers. DESIGN: We conducted an online qualitative study with a pragmatic design to capture the perspectives of nurses working during the first wave of the United States COVID-19 pandemic. Through social networking recruitment, frontline nurses from across the country were invited to participate. Participants provided long form, text-based responses to four questions designed to capture their experiences. A combination of Latent Dirichlet Allocation--a natural language processing technique--along with traditional summative content analysis techniques were used to analyze the data. SETTING: The United States during the COVID-19 pandemic's first wave between May and July of 2020. RESULTS: A total of 318 nurses participated from 29 out of 50 states, with 242 fully completing all questions. Findings suggested that the place of work mattered significantly in terms of the frontline working experience. It influenced role changes, risk assumption, interprofessional teamwork experiences, and ultimately, likelihood to leave their jobs or the profession altogether. Organizational culture and its influence on pandemic response implementation was a critical feature of their experiences. CONCLUSIONS: Findings suggest that organizational performance during the pandemic may be reflected in nursing workforce retention as the risk for workforce attrition appears high. It was also clear from the reports that nurses appear to have assumed higher occupational risks during the pandemic when compared to other providers. The 2020 data from this study also offered a number of signals about potential threats to the stability and sustainability of the US nursing workforce that are now manifesting. The findings underscore the importance of conducting health workforce research during a crisis in order to discern the signals of future problems or for long-term crisis response. TWEETABLE ABSTRACT: Healthcare leaders made the difference for nurses during the pandemic. How many nurses leave their employer in the next year will tell you who was good, who wasn't.
Subject(s)
COVID-19 , Nurses , Nursing Staff , Humans , Nurse's Role , Pandemics , United StatesABSTRACT
The main results in terms of inter-regional and intra-regional variations of the application of the concept of "health macro-region" are presented in the first part of the article in order to show how the European health care systems have differently coped with the COVID-19 outbreak. Given the high levels of intra-regional variation found, it seemed appropriate to also add an analysis by country in order to identify those "sentinel cases", given their alert value, which recorded the worst ratio between the infection rates (cases/population) and the lethality rates (deaths/cases). In order to explore the possible reasons behind the problematic coping with the pandemic of these "sentinel cases", a conceptual framework for the analysis of vulnerability, resilience and their governance in terms of sustainability of health care systems is developed in the second part, hoping its application could represent a useful contribution for best-practice solutions that could guide the management of future pandemics. © 2021 Franco Angeli Edizioni. All rights reserved.
ABSTRACT
The aim of the present study is to investigate a possible delay in diagnosis and therapy administration for Head and Neck oncological patients, during the Sars-Cov2 pandemic and to compare the median tumor stage (MTS) at presentation. This is a retrospective review on patients who presented at the University Hospital of Modena with a newly diagnosis of Head and Neck cancer (HNC), comparing the first pandemic period (from March 1st, to October 15th 2020) to the same period of 2019. The time in days from the diagnostic suspicion to the beginning of the treatment, hereafter referred to as delay in treatment initiation (DTI), and the tumor stage were calculated for all the enrolled patients. Mean percentage of reduction of the clinical and surgical activities was - 25.8% (range: - 66-1.5%), with higher percentages in phase 1 for all the analyzed activities. 125 HNC patients were enrolled in the analysis as the study group, compared with a cohort of 140 patients from the previous year. The MTS was III for both groups, however a significant statistical difference was determined in the stage comparison, p = 0.023. When DTI was analyzed no statistically significant differences were appreciated. A more advanced stage at presentation was demonstrated at our institution for HNC patients during the first phase of the Covid-19 pandemic in 2020. However, a statistically significant delay in time between diagnosis and therapy administration was not assessed, thus confirming the maintenance of a high level of care even in the COVID-19 era.
ABSTRACT
BACKGROUND: The COVID-19 pandemic has had devastating consequences on health care systems worldwide. While the world was slowly moving towards achieving health for all, the pandemic destroyed progress made over the past 25 years and exposed the vulnerability of health care systems and health insurance schemes as well as their lack of resilience. Heath care systems failed to respond in a timely and efficient manner, lives have been, and continue to be, lost and vulnerable populations, especially refugees and migrants, are more at risk than ever as many are left out of country vaccination programmes. AIMS: The Eastern Mediterranean region hosts 13 million internally displaced persons and 12 million refugees as of 2018. Thus, adopting inclusive health financing mechanisms is crucial to addressing the crisis and protecting indigenous and displaced populations. METHODS: By looking at regional best practices and the response of the United Nations, we outline possible financing tools for including refugees and migrants in health insurance schemes for COVID 19 and introduce novel solutions for addressing gaps in funding. RESULTS: Among the suggested solutions are the inclusion of refugees and migrants in national health care systems, setting up community-based health insurance for migrant and refugee populations, as well as introducing a catastrophe bond financing scheme. CONCLUSIONS: While COVID-19 is far from over, many countries in the EMR have included migrants in their COVID-19 vaccine rollout plans. While this is not the first instance of inclusion in some countries, many others are unable or do not prioritize migrants in their health systems, to the detriment of the entire country. This paper, therefore, tackles the possible health financing measures which curb or prevent migrants from accessing such systems and presents possible solutions to change the status quo.