Pre-hospital Management of COVID-19: Looking for a Future Perspective

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.

"Money is not an issue!": Hospital CFOs' narratives about handling a sudden shift in managerial focus

The sustained political and managerial focus on cost containment and efficiency in hospitals has been altered by COVID-19-related concerns about public health. Through a novel qualitative study in Denmark, we explore CFOs' narratives of their experiences during a sudden shift in managerial logic. All of the CFOs describe engagement in key operational procedures and change management that was fostered by the constant search for stability that strongly depended on bottom-up decision-making and flexibility. During this process, the existing competing logics of managerialism and medical professionalism vanished. The CFOs describe new forms of dynamic and collaborative approaches. The possibility of adhering to the core logic of administrative accounting techniques combined with urgency and emotional encounters appears to enable this approach. Thus, we document a moment when well-known opposing logics were suspended by exogenous urgency. This finding suggests possibilities for moving beyond deep-rooted views on established public administration structures and logics. Points for practitioners Financial managers show administrative skills that are useful for public administration changes in both administration and daily operations. These managers appear to have a strong core identity and willingness to dynamically engage with and facilitate acute frontline operational issues. In an emergency situation such as COVID-19, we find co-dependency across subject fields (administration and medical professions) which enables collaborations.

Post-COVID Challenges in Occupational Medicine as a Branch of Clinical and Educational Medicine

BACKGROUND: The COVID-19 pandemic has exhausted the employees of hospital center and had a negative impact on medical students. AIM: The aims are to show the efforts of Occupational Medicine to provide support for healthcare workers and to increase student's interest in O.M. MATERIALS AND METHODS: Out of the total number of employees of the Clinical Hospital Center Rijeka, which is 3500, 275 of them claim for recognition of COVID-19 occupational diseases in 2022. The 6th-year medical students of the Rijeka Faculty of Medicine, 130 in total and 22 sanitary engineers were surveyed by the quality service regarding their satisfaction with the Occupational Medicine classes. Statsoft Statistica 10 was used to calculate the results. RESULT(S): All HCW are recognized as having COVID-19 as a professional disease. Older age correlated with greater absenteeism. Hospital employees are dissatisfied, tired, they demand work benefits, contraindications for shift work, night work, work in COVID centers, and requesting maternity leave. Many also quit their jobs the hospital management is looking for and hiring new employees, who quickly leave due to difficult working conditions and low incomes. Occupational medicine also has a problem with students. During the pandemic, classes were held online. Interest in classes declined, a small number of students joined the lectures, but all responded to the survey. The answers showed a lack of interest in the Occupational Medicine course. With subsiding of the pandemic, it would be obligatory to continue "live" classes, take students on a tour of industrial facilities, and cancel the failed evaluation of teachers. CONCLUSION(S): Easing of working conditions for HCW and changes in teaching is necessary.Copyright © 2023, Scientific Foundation SPIROSKI. All rights reserved.

Executive summary of the XXIV State Annual conference of Medicolegal Association of Maharashtra (MLAM): Forensicon 2021

The XXIV annual state conference of the Medicolegal Association of Maharashtra: Forensicon 2021 organized by the department of Forensic and Toxicology, Lokmanya Tilak Municipal Medical College and Hospital, Mumbai. Previous conference "Forensicon 2020” was held at TNMC & BYL Nair Ch. Hospital, Mumbai in the month of April 2021 as COVID pandemic prevented the continuity of the conference in the year 2020. Responsibility of organizing XXIV annual State conference was allotted to Department of Forensic Medicine and Toxicology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai on 22nd November 2021. The organizing committee have magnificently conducted the annual state conference in the very short duration of 24 days on 17th and 18th December 2021 at main auditorium, Lokmanya Tilak Municipal Medical College and hospital, Mumbai. Dr Rajesh Dere, professor and head, Forensic Medicine Dept, LTMMC & hospital and Dean BKC Jumbo COVID 19 facility, Mumbai through his valiant efforts as team leader overcoming all the obstacles brought this conference to epitome of success. © 2022, Medicolegal Association of Maharashtra. All rights reserved.

An Assessment of the Financial Performance of Hospital Services Sub-Sector in Turkey by Ratio Analysis Method

The present study made use of the sector balance sheets of "Q-861 Hospital Services Sub-Sector” for the years 2015–2020, which was recently published by the Central Bank of the Republic of Turkey (TCMB), which maintains the largest financial data on the hospital services sub-sector. The 6-year time period above was selected for the purposes of the study on the grounds that TCMB published the most up-to-date sector balance sheets for the said timeframe. The present study also aimed to investigate the financial structure of the hospitals operating in this sector in Turkey prior to the COVID-19 pandemic across the world. In general, ratio analysis, parametric, and non-parametric methods are used to measure the performance levels of hospital enterprises. The present study employed ratio analysis, a financial analysis method to assess the performance levels thereof. The financial performance of the sector was assessed in the study using 15 criteria, including liquidity, financial, activity, and profitability ratios. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Depression, anxiety and stress among nurses during COVID-19 in Hospital Pakar Sultanah Fatimah

Introduction: The ongoing COVID-19 epidemic has impacted negatively on the physical, emotional, and psychological wellbeing of frontline healthcare workers in hospitals. This study is to determine the prevalence of depression, anxiety, and stress among nurses working in HPSF, as well as the risk factors that lead to these conditions. Method(s): A cross-sectional study was conducted among 254 nurses using a self-administered questionnaire and stratified random sampling were used. The Depression Anxiety Stress Scale (DASS-21) and demographic questions were used to assess the presence of psychological problems and their related variables. Data was analysed using IBM SPSS version 26. Result(s): The prevalence of mild to extremely severe depression, anxiety and stress was 11.8%, 24.8% and 5.9%, respectively. Meanwhile, Mann Whitney U test showed that depression (U= 4506.000, p=0.525), anxiety (U= 4767.500, p=0.970) and stress (U= 4523.000, p=0.557) were not significantly different among nurses who had experience attending to COVID-19 patients (frontline) and did not have experience nursing with COVID-19 patients (second line). Conclusion(s): While mental distress outcome is low in this hospital, it does exist, and hospital management should consider training all nurses, including other health workers, keeping continued public awareness of COVID-19, and providing financial and mental support for frontline staff in order to address and manage risk factors of mental problems.

The Impact of the COVID-19 Pandemic on the Management of Mental Health Services for Hospitalized Patients in Sibiu County-Central Region, Romania.

INTRODUCTION: The COVID-19 pandemic brought a burden and represented a challenge for the Romanian medical system. This study explored the consequences that COVID epidemiological measures had on the quality of the mental health care provided to hospitalized patients in a regional psychiatric hospital in Romania. MATERIALS AND METHODS: Both patient-level and hospital-level indicators were considered for this comparative retrospective study. On the one hand, we extracted patient-level indicators, such as sociodemographics, diagnosis, admission, and discharge dates for 7026 hospitalized patients (3701 women, average age = 55.14) from hospital records. On the other hand, for the hospital-level indicators, we included indicators referring to the aggregated concept of mental health services, such as case mix index, length of stay, bed occupancy rate and patients' degree of satisfaction. Data extracted covered a period of two years (1 March 2019-28 February 2021) before and during the first year of the COVID-19 pandemic. RESULTS: We found that, compared to the pre-pandemic period, the pandemic period was marked by a drastic decrease in hospitalized patient admissions, coupled with an increase in emergency-based admissions. Other management indicators, such as the case mix index, the number of cases contracted/performed, and the degree of patient satisfaction, decreased. In contrast, the average length of stay and bed occupancy rate increased. CONCLUSIONS: The COVID-19 pandemic, especially in the first year, raised multiple difficult issues for the management of psychiatric hospitals. It imposed an application of strict measures designed to face these new and unprecedented challenges. Our findings offer a detailed snapshot of the first year of the COVID-19 pandemic in terms of its impact on mental health services and suggest some future directions. Implications for hospital management are discussed.

Epidemiological profile of SARS-COV-2 infection in pediatrics.

Objective: To describe the epidemiological and clinical profile of pediatric patients who were treated for suspected COVID-19 infecion, between March and October 2020, at the Hospital Universitario San Ignacio (HUSI), in Bogota, Colombia. Material(s) and Method(s): Cross-sectional design. Description of patients aged 1 month to 1 day before their 18th birthday, assessed between March and October 2020, who were approached by any pediatric care service of a university hospital for suspected COVID-infection. 19, according to current national and institutional protocols. Demographic variables and the reason for consultation of all individuals with suspected infection were recorded. Only when SARS-CoV-2 infection was confirmed were variables related to clinical aspects of the disease and its evolution recorded. Result(s): 920 medical records of pediatric patients with suspected SARS-CoV-2 infection were evaluated, of which there were 157 confirmed cases with COVID-19 infection. The main reason for consultation to suspect infection was fever in 50% of the cases. In patients with virological confirmation, 32.48% of the cases attended required hospital management. MIS-C was suspected in 5 patients who required intensive care unit management. In the evaluated period, there were no deaths associated with COVID-19 infection. Conclusion(s): SARS-CoV-2 infection is related in most cases to a spectrum of mild disease in the pediatric population. This study may be larger than pediatric patients presenting with gastrointestinal rather than respiratory symptoms, and the frequency of renal complications should be taken into account in patients in whom the systemic inflammatory syndrome associated with COVID-19 is suspected.Copyright © 2023 Asociacion Colombiana de Infectologia. All rights reserved.

Impact of in-hospital medical management for COVID-19 pandemic on door-to-balloon time in patients with ST-elevation myocardial infarction

Background: Delayed door-to-balloon (DTB) time and deterioration of inhospital mortality during the coronavirus disease 2019 (COVID-19) pandemic have been reported. Little is known about the impact of changes in in-hospital medical management before primary percutaneous coronary intervention (PCI) for COVID-19 such as screening test (antigen or polymerase chain reaction (PCR) tests, chest CT for excluding the pneumoniae) and primary PCI under full personal protective equipment (PPE) on DTB time and in-hospital mortality. Purpose(s): The purpose of this study was to evaluate the impact of inhospital medical management for COVID-19 on DTB time and in-hospital mortality during COVID-19 pandemic period. Method(s): We compared DTB time and in-hospital mortality of 502 STelevation myocardial infarction (STEMI) patients during COVID-19 pandemic (February 2020 and January 2021) with 2035 STEMI patients before pandemic (February 2016 and January 2020) using date from Mie ACS registry, a retrospective and multicenter registry. Result(s): The COVID-19 screening tests before primary PCI and/or primary PCI under full PPE was performed on 173/502 (34.5%) patients (antigen or PCR tests;39 (7.8%), chest CT;156 (31.3%), full PPE;11 (2.2%)). These patients had lower rate of achievement of DTB time <=90 min compared with others (Figure 1A). Moreover, In-hospital management of COVID-19 screening tests and/or primary PCI under full PPE was an independent factor of DTB time>90 min with odds ratio of 1.94 (95% confidential interval: 1.37-2.76, p<0.001). In addition, in-hospital mortality of those patients was higher compared with others (Figure 1B). Conclusion(s): In-hospital medical management for COVID-19 screening tests before primary PCI and/or primary PCI under full PPE was the independent factor of DTB time>90 min. This study reinforces the need to focus efforts on shortening DTB time, while controlling the epidemic of infection.

Do hospitals need to establish multiple hospital districts? A hospital-based perspective on the benefits of scale.

Background: During the fight against COVID-19, China's public hospitals played the main role in taking on the most urgent, dangerous and arduous medical treatment and work. Therefore, in order to promote the high-quality development of hospitals, it is necessary to support some potential public hospitals to build and develop a "One Hospital with Multiple Campuses System" (OHMC) based on controlling the size of single hospitals, and to quickly convert their functions in the event of a severe epidemic. Methods: The Cobb-Douglas production function and log-transformed production function were used to measure the appropriate hospital size for 22 public hospitals in a region of China. Results: The eight OHMC hospitals that planned to be build are basically qualified to handle the conditions and potential of multi-districts from the perspective of economy of scale. The OHMC hospitals in operation appear to have weakened incremental scale rewards, because they are in the process of development, but they are still higher than the overall level of single-campus hospitals. Conclusion: The expansion of hospital scale may bring the advantages of group development, but it may also bring about problems including rising hospital cost, increasing management and operation cost, inefficient allocation of medical resources and unbalanced development.

Measures against COVID-19 pandemic - a single tertiary center experience.

This paper reports the measures taken to manage the impact of the COVID-19 pandemic on O&G services in a tertiary referal centre and their outcomes. All the patients included in this study received inpatient treatment and underwent surgery between March 10 2020 and end of June 2020, including obstetric or gynaecologic cases combined. Data including age, diagnosis, operation, duration of preoperative and postoperative hospital stay, COVID-19 status were recorded. COVID-19 status of the patients was diagnosed with a nasopharyngeal swab test. Thirty-seven (20%) of 177 operations were performed because of gynaecologic reasons. The rest of them were caesarean sections (C/S). In gynaecologic cases, 22 (59%) of 37 were emergent operations, nine (24%) cases were oncologic and six (16%) cases were elective gynaecological surgeries. On the other hand, 43 (30%) of 140 patients, who underwent caesarean sections, were urgent surgeries. The rest were elective and planned caesarean sections. Only five patients (2.8%) who had undergone caesarean sections were tested positive for COVID-19. No COVID-19 transmission to staff was recorded in this period. Measures against the COVID-19 pandemic must be multidisciplinary and is crucial to prevent the spread of the disease to staff in close contact.Impact StatementWhat is already known on this subject? COVID-19 pandemic has been a crucial health problem worldwide. Healthcare workers work intensely to protect people from the pandemic. It is especially important to protect healthcare professionals and hospitalized patients from virus transmission. Therefore, utilization of personal protective equipment such as masks, gloves and goggles is obligatory, and hygiene rules such as sanitization of hands are strictly followed.What the results of this study add? This study adds the experience and success of a tertiary centre regarding the measure against COVID-19 to the literature. No viral transmission was detected to healthcare workers and other patients from COVID-19 patients. Hence, measures that mentioned in the present study should be an example to other centres for protection against pandemic.What the implications are of these findings for clinical practice and/or further research? As mentioned above, measures that are explained in the present study should be an example to other centres for protection against the pandemic. Further larger size clinical studies are needed to prove the beneficial effect of the measures that still used against pandemic.

Glucose variability is a marker for COVID-19 severity and mortality.

Objective: We aimed to investigate the association between glucose coefficient of variation (CV) and mortality and disease severity in hospitalized patients with coronavirus disease-19 (COVID-19). Subjects and Methods: Retrospective cohort study in a tertiary center of patients with COVID-19 admitted to designated departments between March 11th, 2020, and November 2nd, 2020. We divided patients based on quartiles of glucose CV after stratification to those with and without diabetes mellitus (DM). Main outcomes were length of stay and in-hospital mortality. Results: The cohort included 565 patients with a mean age of 67.71 ± 15.45 years, and 62.3% were male. Of the entire cohort, 44.4% had DM. The median glucose CV was 32.8% and 20.5% in patients with and without DM, respectively. In patients with DM, higher glucose CV was associated with a longer hospitalization in the unadjusted model (OR = 2.7, 95% CI [1.3,5.6] for Q4), and when adjusted for age, sex, comorbidities, and laboratory markers, this association was no longer statistically significant (OR = 1.3, 95% CI [0.4,4.5] for Q4). In patients with and without DM, higher glucose CV was associated with higher rates of in-hospital mortality in the unadjusted model, but adjustment for comorbidities and laboratory markers eliminated the association (OR = 0.5, 95% CI [0.1,3.4] for Q4 in patients with DM). Conclusion: Higher glucose CV was associated with increased in-hospital mortality and length of stay, but this association disappeared when the adjustment included laboratory result data. Glucose CV can serve as a simple and cheap marker for mortality and severity of disease in patients with COVID-19.

Impact of the Covid-19 crisis on the hospital work environment and organization: A mixed-methods study

To date, it is still largely unclear how the changes, as a result of Covid-19, affect the work environment and the perceived organizational and managerial context (OMC). Through a mixed methods design, this study aims, (1) to identify changes in the hospital OMC before and during the first wave of the Covid-19 crisis;(2) to further analyze and compare the impact of the crisis on the perceptions of the staff. For the quantitative phase, questionnaire measuring the OMC was used in Covid and Non-Covid wards. For the qualitative phase, we performed semi-structured interviews to identify positive and negative elements from the crisis management. Results from linear mixed models highlighted multiple tendencies following the Covid crisis. Differences appeared between Covid and Non-Covid units, with the latter showing greater difficulties following the crisis. A significant increase in participants' scores on interprofessional relationships was reported (P < 0.05). We found a significant decrease in job satisfaction (P < 0.001), absence of burnout (P = 0.001) and perceived efficiency of the service (P < 0.001). These findings suggest that hospital management strategies should aim at providing transformational leadership and information flow, as well as equal support for all working units, so that healthcare professionals feel motivated and work towards a shared meaning. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

A Remote Visiting and Monitoring System for Neonatal Intensive Care Units via Internet of Things

To meet the visiting needs of families of children in neonatal intensive care unit and reduce the burden of hospital management during the COVID-19 epidemic, we developed a remote visiting and monitoring system using the internet of things. The Raspberry Pi is used as the core hardware platform. The real-time signal of the bedside monitor is converted into a virtual camera, and is connected to the Raspberry Pi which has a real camera with CMOS Serial Interface (CSI). The frames of the two cameras are collected via FFmpeg technology, and then are pushed to the cloud server through Real-Time Messaging Protocol (RTMP). The video streams are then transferred and distributed via a Nginx server running RTMP protocol, and finally are displayed on the web page via the Flask framework. When tested, the system ran stably, and the real-time pictures from the camera and the bedside monitor screen in the hospital were clearly shown on a personal computer or a mobile phone in a remote distance out of the hospital, just by click the link of the associated web page. We think this system is helpful for families to remotely visit the babies anywhere any time, and it is also helpful for hospitals to reduce the human workload and the financial expenditure. © 2022 ACM.

Monitoring of CT dose and analysis of radiological protection in CT modules applied for COVID-19.

Objective: To investigate the safety and protection level of radiological treatment in the CT modules in the makeshift hosptials in Wuhan during the prevention and treatment of COVID-19 cases. Method(s): The layout of the CT modules in makeshift hospitals, radiological protection facilities and personal protective equipment were investigated. Based on the national standards, the CT dose index was estimated and the radiological protection level at the CT modules were measured. Result(s): The layout of the CT modules in makeshift hospitals is reasonable, with well-equipped radiological protection facilities. Of 23 CT modules, 20 were up to standards with acceptability of 87.0%. The other three were unqualified each with 1 detection points having values in excess of the national standards. Which, after being modified immediately reached the national standards. In addition, CT dose index for 7 CT modules were estimated, with CTDIW within +/-7.5%. Conclusion(s): The CT modules in Wuhan meet the requirements of radiological safety and protection during the prevention and treatment of COVID-19 cases.Copyright © 2020 by the Chinese Medical Association.

Features of Anesthesiologists-Reanimatologists' Emotional States in Different COVID-19 Pandemic Periods in Russia

Introduction: The COVID-19 pandemic is one of the most stressful events in recent times. Medical professionals, including anesthesiologists-reanimatologists, suffered the main blow in this difficult and stressful environment. Aim(s): This study aimed at identifying the features of anesthesiologists-reanimatologists' emotional states in different COVID-19 pandemic periods. Method(s): The study was conducted through an anonymous questionnaire among anesthesiologists-reanimatologists in two periods. In the First stage - which was carried out in May 2020 (during the first COVID-19 pandemic wave) - 58 anesthesiologists-reanimatologists in the Arkhangelsk region took part. During the Second segment - which took place in October 2020 (in the second COVID-19 pandemic wave) - 43 anesthesiologistsreanimatologists were examined. Repeated questioning was carried out among the same participants. Result(s): In October 2020, compared to May, the number of doctors who noted a high intensity of professional activity increased. Regardless of the study period, one-third of the subjects experienced constant pronounced anxiety. Anesthesiologists-reanimatologists, whose professional activity was directly related to the patients in COVID-19 care, noted a poorer emotional state more frequently in October, accompanied by anxiety, depressed mood, irritability and a high burnout level, which may indicate a depletion of internal resources in this group. Conclusion(s): The study results showed that for anesthesiologists-reanimatologists, a further depletion of emotional resources accompanied the second pandemic wave. The anesthesiologists-reanimatologists' emotional state was mediated by a number of social and gender factors, as well as specific labor organization features.Copyright © 2022 The Authors. Published by Semmelweis University, Institute of Mental Health, Budapest.

COVID-19 diagnosis and disease severity prediction assessment through an innovative AI-based model

Introduction: CT imaging has been widely used during the COVID-19 pandemic to diagnose and assess disease severity. Its use for diagnosis is not indicated apart from specific settings such as triage of patients for referral to RTPCR testing or severity assessment. Nowadays, the added value of AI-based models is still unknown and has to be addressed. Method(s): We evaluated the added value of an automated lung involvement assessment tool, named icolung. Since software version 7.0, icolung automatically extracts the Severity Score proposed by Pan F. et al., (2020, Radiology), to help radiologists assess the severity of lung involvement in COVID-19 infected patients. We evaluate retrospectively a group of 785 COVID-19 positive patients compared to a group of 1049 COVID-19 negative patients. We used the severity score (SS) in order to predict the positivity of COVID-19 PCR testing and evaluated the potential impact in the prediction of patients' outcome. Result(s): The icolung SS allows to identify infected (PCR-proven) COVID-19 patients with a sensitivity of 83% and a specificity of 77% (AUC of 0.86, 95% CI 0.85-0.88) for patients with a SS of more than 1.5 on a scale of 0 to 25. An SS of > 7.5 identifies patients at risk of ICU admission with a sensitivity of 70% and specificity of 65% (AUC of 0.74, p<0.0001). Conclusion(s): The severity score as estimated via icolung allows to identify positive PCR-tested COVID-19 patients and helps to predict ICU admission. This automated evaluation tool can support clinicians with the in-hospital management of patients (suspected to be) infected with COVID-19.

A qualitative analysis of the main factors in bed management in high complexity hospital emergencies

Overcrowding in the emergency department is a problem that generates several implications for bed management, which is deemed one of a hospital's most critical processes. Effective management of hospital production capacity includes bed management processes, which can be improved in order to leverage hospital performance. Thus, this study sought to understand how bed management works and identify the main factors that influence its management. The study was performed through a case study, with data collected from semi-structured interviews and bibliographic research, which were triangulated. Thematic content analysis of the interviews and cross-analysis were performed. As a result, the main factors that influence hospital Bed management were identified: communication between teams and units;definition of performance goals;decisions shared between units;occupation and discharge planning by the teams;length of stay;the role of the nurses;and COVID-19. The greatest difficulties in the management process are related to these factors. Additionally, suggestions are provided to mitigate such reported difficulties.Alternate :A superlotação no departamento de emergência é um problema que gera várias implicações para a gestão de camas, o que é considerado um dos processos mais críticos de um hospital. O gerenciamento efetivo da capacidade de produção do hospital inclui processos de gerenciamento de leitos, que podem ser melhorados a fim de alavancar o desempenho do hospital. Assim, este estudo procurou entender como funciona o gerenciamento de leitos e identificar os principais fatores que influenciam sua gestão. O estudo foi realizado através de um estudo de caso, com dados coletados a partir de entrevistas semi-estruturadas e pesquisas bibliográficas, que foram trianguladas. Foram realizadas análises de conteúdo temático das entrevistas e análises cruzadas. Como resultado, foram identificados os principais fatores que influenciam a administração do hospital: comunicação entre equipes e unidades;definição de metas de desempenho;decisões compartilhadas entre unidades;planejamento de ocupação e alta pelas equipes;tempo de permanência;o papel dos enfermeiros;e COVID-19. As maiores dificuldades no processo de gestão estão relacionadas a estes fatores. Além disso, são fornecidas sugestões para mitigar tais dificuldades relatadas.

Challenges Faced by Hilly Hospitals during Covid-19 Second Wave Disaster: Quantitative Study in Garhwal Region, Uttarakhand

Covid -19 second wave was considered a disaster in India as it was more havoc than the first one. Shortness of breath in patients leads to more demand for oxygen and hospitalization. So, there was a challenge for the hospitals to combat this disease. In the covid second wave, moderate to severe cases were treated at three hospital levels (CHC, Sub-district, and District hospital). This disease was not limited to bigger cities but spread to rural and hilly areas. We conducted quantitative research among government hospitals in five hilly districts of Uttarakhand at three levels of hospitals. Data were collected from a close-ended questionnaire using a judgmental sampling technique and analysed with the help of tables and bar charts. Questions were set based on the pilot study. The challenges explored through this study were divided into five main headings and eleven sub-headings. The main headings were Manpower, Surge capacity, logistics, coordination, and management of non-covid patients. Sub-headings were a shortage of medical staff, shortage of paramedical staff, shortage of sweepers, shortage of ambulance drivers, shortage of ICU beds, shortage of oxygen beds, shortage of covid drugs (Remdesivir and Steroids), oxygen cylinders, PPE kits, difficulty in coordination with staff and difficulty in managing non- covid patients.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Out-of-hospital management strategies for gastric cancer patients during the COVID-19 outbreak.

Since the outbreak of Corona Virus Disease 2019 occurred in December 2019, the reduction of population mobility has curbed the spread of the epidemic to some extent but also prolonged the waiting time for the treatment of patients with gastric cancer. Based on fully understanding the different staging characteristics of gastric cancer, clinical departments should develop reasonable out-of-hospital management strategies. On one hand, reasonable communication channels should be established to allow patients to receive adequate guidance out of the hospital. On the other hand, shared decisions with patients should be made to adjust treatment strategies, and education on viral prevention should be implemented to minimize the impact of the epidemic on tumor treatment.Copyright © 2020 by the Chinese Medical Association.