ANTIPHOSPHOLIPID ANTIBODIES AND VASCULAR THROMBOSIS IN PATIENTS WITH THE MOST SEVERE FORMS OF COVID-19

BackgroundThe presence of antiphospholipid antibodies (aPL) has been observed in patients with COVID-19 (1,2), suggesting that they may be associated with deep vein thrombosis, pulmonary embolism, or stroke in severe cases (3). Antiphospholipid syndrome (APS) is a systemic autoimmune disorder and the most common form of acquired thrombophilia globally. At least one clinical criterion, vascular thrombosis (arterial, venous or microthrombosis) or pregnancy morbidity and at least one laboratory criterion- positive aPL two times at least 12 weeks apart: lupus anticoagulant (LA), anticardiolipin (aCL), anti-β2-glycoprotein 1 (anti-β2GPI) antibody, have to be met for international APS classification criteria(4). Several reports also associate anti-phosphatidylserine/prothrombin antibodies (aPS/PT) with APS.ObjectivesTo combine clinical data on arterial/venous thrombosis and pregnancy complications before and during hospitalisation with aPL laboratory findings at 4 time points (hospital admission, worsening of COVID-19, hospital discharge, and follow-up) in patients with the most severe forms of COVID-19 infection.MethodsPatients with COVID-19 pneumonia were consequetively enrolled, as they were admitted to the General hospital Pancevo. Exclusion criteria were previous diagnosis of inflammatory rheumatic disease and diagnosis of APS. Clinical data were obtained from the medical records. Laboratory results, including LA, aCL, anti-β2GPI, and aPS/PT antibodies were taken at hospital admission, worsening (defined as cytokine storm, connection of the patient to the respirator, use of the anti-IL-6 drug- Tocilizumab), at hospital discharge and at 3-months follow-up and sent to University Medical Centre Ljubljana, Slovenia for analysis. Statistics was performed by using SPSS 21.Results111 patients with COVID-19 pneumonia were recruited;7 patients died during hospitalisation (none were aPL-positive on admission and at the time of worsening), 3 due to pulmonary artery embolism. All patients were treated according to a predefined protocol which included antibiotics, corticosteroids, anticoagulation therapy and specific comorbidity drugs;patients with hypoxia were supported with oxygen. During hospitalisation, pulmonary artery thrombosis occurred in 5 patients, one was aPL-positive at all time points (was diagnosed with APS), others were negative. In addition, 9/101 patients had a history of thrombosis (5 arterial thrombosis (coronary and cerebral arteries), none of whom was aPL-positive on admission and at follow-up, and 4 venous thrombosis, one of which was aPL-positive at all time points and received an APS diagnosis). Among 9/101 patients with a history of thrombosis, 55.6% were transiently positive at the time of discharge, compared to patients without prior thrombosis, in whom 26.1% were transiently positive at the hospital release (p=0.074). Two patients had a history of pregnancy complications (both had miscarriage after 10th week of gestation), but did not have aPL positivity at any time point.ConclusionAlthough aPL was expected to be associated with vascular disease in the most severe forms of COVID-19, all patients that have died in our cohort were aPL negative. At hospital discharge, 56% of patients with a history of arterial or venous thrombosis had positive aPL that became negative at the 3-months follow-up (were transienlty positive), which should be considered when prescribing therapy after hospitalisation.References[1]Trahtemberg U, Rottapel R, Dos Santos CC, et al. Anticardiolipin and other antiphospholipid antibodies in critically ill COVID-19 positive and negative patients. Annals of the Rheumatic Diseases 2021;80:1236-1240.[2]Stelzer M, Henes J, Saur S. The Role of Antiphospholipid Antibodies in COVID-19. Curr Rheumatol Rep. 2021;23(9):72-4.[3]Xie Y, Wang X, Yang P, Zhang S. COVID-19 complicated by acute pulmonary embolism. Radiology: Cardiothoracic Imaging 2020: 2: e200067.[4]Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, et al. J.Thromb.Haemost. 2006;4: 295-306.Acknowledgements:NIL.Disclosure of nterestsNone Declared.

Embracing DDMT Teaching Model and Design Thinking for Organization Development

The multi-generational workforce presents challenges for organizations, as the needs and expectations of employees vary greatly between different age groups. To address this, organizations need to adapt their development and learning principles to better suit the changing workforce. The DDMT Teaching Model of Tsing Hua STEAM School, which integrates design thinking methodology, aims to address this challenge. DDMT stands for Discover, Define, Model & Modeling, and Transfer. The main aim of this study is to identify the organization development practices (OD) and gaps through interdisciplinary models such as DDMT and design thinking. In collaboration with a healthcare nursing home service provider, a proof of concept using the DDMT-DT model was conducted to understand the challenges in employment and retention of support employees between nursing homes under the healthcare organization. The paper highlights the rapid change in human experiences and mindsets in the work culture and the need for a design curriculum that is more relevant to the current and future workforce. The DDMT-DT approach can help organizations address these challenges by providing a framework for HR personnel to design training curricula that are more effective in addressing the issues of hiring and employee retention. By applying the DDMT-DT model, HR personnel can better understand the needs and motivations of the workforce and design training programs that are more relevant to their needs. The proof-of-concept research pilot project conducted with the healthcare nursing home service provider demonstrated the effectiveness of the DDMT-DT model in addressing the issues of hiring and employee retention. The project provides a valuable case study for other organizations looking to implement the DDMT-DT model in their HR practices. Overall, the paper highlights the importance of adapting HR practices to better suit the changing workforce. The DDMT-DT model provides a useful framework for organizations looking to improve their HR practices and better address the needs of their workforce.

Anxiety and depression among epilepsy patients in low-risk areas for COVID-19 in the northern part of Guizhou Province, China, during the COVID-19 pandemic

BackgroundThis study was aimed to investigate whether patients with epilepsy (PWE) have higher depression and anxiety levels than the normal population in low-risk areas for coronavirus disease 2019 (COVID-19) in the northern part of Guizhou Province, China, during the COVID-19 epidemic, to evaluate their knowledge on COVID-19, and to analyze related factors for the psychological distress of PWE at this special time.MethodsThe survey was conducted online from February 28, 2020 to March 7, 2020 via a questionnaire. PWE from the outpatient clinic of epilepsy of the Affiliated Hospital of Zunyi Medical University, and healthy people matched for age and sex, participated in this study. Mental health was assessed via a generalized anxiety self-rating scale (GAD-7) and the self-rating depression scale (PHQ-9). The knowledge of COVID-19 in both groups was investigated.ResultsThere were no significant differences in the general demographics between the PWE and healthy control groups. The scores of PHQ-9 (P < 0.01) and GAD-7 (P < 0.001) were higher in the PWE group than in the healthy group. There was a significant difference in the proportions of respondents with different severities of depression and anxiety, between the two groups, which revealed significantly higher degree of depression and anxiety in PWE than in healthy people (P = 0, P = 0). Overwhelming awareness and stressful concerns for the pandemic and female patients with epilepsy were key factors that affect the level of anxiety and depression in PWE. Further, the PWE had less accurate knowledge of COVID-19 than healthy people (P < 0.001). There was no statistically significant difference between the two groups in the knowledge of virus transmission route, incubation period, susceptible population, transmission speed, clinical characteristics, and isolation measures on COVID-19 (P > 0.05). PWE knew less about some of the prevention and control measures of COVID-19 than healthy people.ConclusionsDuring the COVID-19 epidemic, excessive attention to the epidemic and the female sex are factors associated with anxiety and depression in PWE, even in low-risk areas.

The evaluation of telemedicine-online health services during Covid-19 in Turkey private hospitals: Thematic analysis

Aim: With the Covid-19 outbreak, it has been observed that people wanted to receive healthcare services remotely. In other words, people wanted to reach healthcare services or healthcare professionals from their homes without going to the hospital. Thus, this study aimed to determine how telemedicine-online health services of private hospitals are handled on websites and social media channels. Material(s) and Method(s): Data was collected by conducting qualitative content analysis to the websites and corporate social media of hospitals in Istanbul, the city where the most private hospitals in Turkey are located. Overall, 608 data from 76 hospitals were analysed using the thematic analysis method. Result(s): When the analysis of the information was received a total of 8 themes emerged. These were divided into thematic codes as the telemedicine-online health service status, including the number of hospital beds, the content of written, visuals etc. posts, features of the branches of the application and details of other online health services. Discussion(s): The use of telemedicine-online health services in private hospitals is found to be at the initial stage and written and visual posts are insufficient. The information collected can help determine the current situation and contribute to private hospitals when determining new strategies.Copyright © 2021, Derman Medical Publishing. All rights reserved.

Emotional risk work during the pandemic: Healthcare professionals' perceptions from a COVID-19 ward

In March 2020, COVID-19 wards were established in hospitals in Denmark. Healthcare professionals from a variety of specialities and wards were transferred to these new wards to care for patients admitted with severe COVID-19 infections. Based on ethnographic fieldwork in a COVID-19 ward at a hospital in Copenhagen, Denmark, including focus group interviews with nursing staff, we intended to explore practices in a COVID-19 ward by seeking insight into the relation between the work carried out and the professionals' ways of talking about it. We used a performative approach of studying how the institutional ways of handling pandemic risk work comes into being and relates to the health professionals' emerging responses. The empirical analysis pointed at emotional responses by the nursing staff providing COVID-19 care as central. To explore these emotional responses we draw on the work of Mary Douglas and Deborah Lupton's concept of the ‘emotion-risk-assemblage'. Our analysis provides insight into how emotions are contextually produced and linked to institutional risk understandings. We show that work in the COVID-19 ward was based on an institutional order that was disrupted during the pandemic, producing significant emotions of insecurity. Although these emotions are structurally produced, they are simultaneously internalised as feelings of incompetence and shame.

A quantitative framework for health‐care service quality assessment in India

PurposeThe present situation of COVID-19 pandemic has put the health-care systems under tremendous stress and stringent tests for their ability to offer expected quality of health-care services, as it decides the sustainability and growth of health-care service providers. This study aims to deliver a quantitative framework for service quality assessment in the health-care industry by classifying the health-care service quality parameters into four balanced scorecard (BSC) perspectives.Design/methodology/approachTo determine the service quality for the Indian health-care system, decision-making trial and evaluation laboratory and analytical network process are integrated in a fuzzy environment to contemplate the interaction among BSC perspectives and respective performance measures.FindingsThe results indicate "internal processes” perspective assumes the key role within BSC perspectives, while performance measures "nursing staff turnover” and "staff training” play the key roles. The results also signify that "patient satisfaction” is the most vital issue and can be strongly influenced by measures belonging to the "learning and growth” perspective. In "learning and growth” perspective, "staff training” is the most decisive criteria, very highly influencing "patient satisfaction”, highly influencing "profitability,” "change of cost per patient (both in and out patients)” and "outpatient waiting time” while moderately influencing "staff satisfaction,” "bed occupancy” and "nursing staff turnover”. Moreover, "staff training” criteria have a positive influence on "nursing staff turnover.”Originality/valueThe contributions of this study are in two folds in the domain of quantification of service quality for the health-care system. First, it delivers an assessment framework for Indian health-care service quality. Second, it demonstrates an application of the framework for a case situation and validates the proposed framework.

Building Geographic Information System Story Maps for Jakarta's Local Community Health Infrastructures Awareness

COVID-19 is caused by the novel coronavirus SARS-CoV-2. First started in Wuhan, COVID-19 has spread everywhere, including Indonesia. COVID-19 can cause severe pneumonia, severe acute respiratory distress syndrome (ARDS) symptoms, and multiple organ failure. According to the WHO, COVID-19 generally has an incubation period of 5-6 days, ranging from 1 to 14 days. However, in Jakarta, the cases have decreased significantly since the implementation of PPKM (Restrictions of Activity), running since early July 2021. The government claimed that the PPKM rule has significantly impacted COVID-19 cases, decreasing every day, especially in Jawa-Bali Region. In addition, the Vaccination rate in Indonesia also played a significant part in decreasing COVID-19 cases, with Jakarta currently standing with 9 million people fully vaccinated per December 2021. To monitor the development of COVID-19 in Jakarta and provide information to the public about health facilities, especially hospitals in Jakarta, in this study, the distribution area of COVID-19 cases will be mapped with CHIME using ArcGIS Online tools. The analysis results obtained based on the mapping results that most cases were in the Cengkareng area, and the area with the most hospitals werein East Jakarta. © 2022 IEEE.

Leadership in the process of ensuring a safe hospital environment in nursing practice during the COVID-19 pandemic

A pandemic is a complex phenomenon that requires multi-directional corrective actions and, above all, preventive measures. Managing crises such as the COVID-19 pandemic has proven to be the biggest challenge facing healthcare organizations. In the process of ensuring a safe hospital environment for patients and staff, various models and adequate approaches to crisis management were applied. In order to explore the opinion of health care managers on the challenges and practices of providing a safe hospital environment in the management of the COVID-19 pandemic, a qualitative survey - a semi-structured interview - was conducted among 35 health care managers. Based on the results of the interviews with head and senior nurses, the main themes related to "challenges" and "practices" during the pandemic related to the practice of health care professionals were identified. Challenges include: developing and implementing measures to manage safe hospital environment during the COVID-19 pandemic;staff shortages and psychological problems. Practices include changes in nurses' work schedules, nurse rotation, staff training, organizational support. Healthcare managers have provided new and safe practices for managing staff and the environment during the COVID-19 pandemic. The results of this study show that healthcare managers perceive management during the COVID-19 pandemic differently than other crises. In their opinion, managing in these difficult conditions is very complex and requires greater flexibility on the part of managers in accordance with constantly changing circumstances.

Kenneth Peter Goldman

Ken's first registrar job was at Paddington Green, then he had a fruitful experience at Sully Hospital in south Wales between 1960 and 1963, which at the time was the Welsh Regional Centre for Thoracic and Cardiac Surgery. When 92 years old, he, his wife and one of their sons developed covid-19 symptoms, Ken was admitted to hospital, and later died from covid-19 pneumonia. Consultant physician, general and chest disease, Dartford and Gravesham (b 1928;q Cambridge/St Mary's Hospital Medical School 1957;MD, FRCP), died from covid-19 pneumonia on 14 April 2020

Challenges faced in biomedical waste management by waste handlers amidst the COVID-19 pandemic in a tertiary care hospital: a qualitative study

Introduction : Coronavirus disease 2019 (COVID-19) saw an overhaul in the biomedical waste management (BMWM) practices. Waste handlers were at the brunt of these changes. If the challenges pertaining to BMWM at the ground level are better understood, more effective measures to overcome them can be formulated. Objectives: 1. To identify myths and concerns regarding BMWM in the context of COVID-19 pandemic. 2. To explore the challenges faced in BMWM amidst the COVID-19 pandemic. 3.To explore opportunities and future perspectives of BMWM. Method: In-depth interviews were conducted among 17 purposively selected Class IV health care workers during August to November 2021 in a tertiary care institute in Mumbai. Data was reported using thematic analysis. Results: Three major themes - challenges and concerns faced by BMW handlers, enablers/motivators, opportunities and future practices were generated from the transcripts. Various challenges faced by waste handlers were- difficulties in segregation and transport of BMW, exhaustion from PPE usage and fear of acquiring and spreading COVID-19 from work, stigma faced from public, and handling COVID-19 deaths. Support from family and colleagues, incentives and a positive change in public perception enabled them to work. Forming redressal committees, addressing job security concerns and timely provision of good quality equipment can improve hospital waste management measures in the future. Conclusion: It is of utmost importance to address challenges faced by waste handlers in BMWM. Onus should also be on periodic training in BMWM.

The UK's public health response to covid-19

Too little, too late, too flawed

Metrics of efficient use of operating rooms during the SARS-CoV-2 (COVID-19) pandemic

Introduction: the COVID-19 pandemic has induced a transformation in the way hospitals function, causing a decrease in the time and efforts dedicated to surgical activity, which in turn has caused delays in the surgery schedule of most hospitals. This represents a major public health problem, significantly compromising the principle of equity that inspires public health systems throughout the world. To address this problem, it would be of the utmost importance to put in place initiatives to measure and improve surgical efficiency. Objective: evaluate indicators of efficiency in the use of operating rooms during the COVID-19 pandemic. Material and methods: a descriptive, longitudinal retrospective study was conducted on 3554 patients scheduled for surgery during a one-year period of the COVID-19 pandemic. Indicators of efficiency in they use of operating rooms were measured. The data was processed using SPSS v-25.0. Results: a total of 3,554 surgeries were scheduled, 1,309 of them emergency surgeries, 1,979 elective surgeries, and 266 deferred surgeries. The following parameters were estimated: Starting time of the procedure (42.32 ± 37.04 min);opportunity for emergency surgeries (104.69 ± 102.55 min);starting time of anesthesia (10.11 ± 9.85 min);starting time of surgery (40.03 ± 24.68 min);time of admission to post-anesthesia care unit/intensive care unit (PACU/ICU) (15.35 ± 29.94 min);turnover or replacement time (177.97 ± 174.33 min);active surgery time (27.70%). Conclusions: the COVID-19 pandemic negatively impacted the indicators of efficient use of operating rooms, posing new challenges for the management and organization of surgical work. (English) [ FROM AUTHOR] Introducción: la pandemia por COVID-19 ha emplazado una transformación hospitalaria, esto acarreó un decremento de la actividad quirúrgica e implicó un aplazamiento en la programación, lo que representó un problema, ya que comprometió sensiblemente el principio de equidad que inspira a los sistemas sanitarios. Así, resultó imperativa la implementación de iniciativas para medir y mejorar la eficiencia quirúrgica. Objetivo: medir los indicadores de uso eficiente del quirófano durante la pandemia por COVID-19. Material y métodos: se realizó un análisis descriptivo, longitudinal y retrospectivo en 3,554 pacientes programados para cirugía, durante la pandemia en un período de un año, además se midieron los indicadores de uso eficiente del quirófano. Los datos fueron procesados en SPSS v-25.0. Resultados: se programaron 3,554 cirugías, 1,309 urgencias, 1,979 electivas, 266 diferidas. Se estimó un tiempo de inicio del procedimiento 42.32 ± 37.04 min, oportunidad para urgencias quirúrgicas 104.69 ± 102.55 min, tiempo de inicio de anestesia 10.11 ± 9.85 min, tiempo de inicio de cirugía 40.03 ± 24.68 min, tiempo para la admisión en la unidad de cuidados postanestésicos/unidad de terapia intensiva (UCPA/UTI) 15.35 ± 29.94 min, tiempo de rotación o recambio 177.97 ± 174.33 min y tiempo quirúrgico activo 27.70%. Conclusiones: la pandemia por COVID-19 impactó negativamente en los indicadores de uso eficiente del quirófano, lo que implicará nuevos retos en la gestión y organización de la jornada quirúrgica para su mejora. (Spanish) [ FROM AUTHOR] Copyright of Revista Mexicana de Anestesiologia is the property of Colegio Mexicano de Anestesiologia 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.)

A critique of clinical economy: reassessing value and care during covid-19—an essay by Eric Reinhart and Daniel Brauner

For decades, American medical practice has been organised around billing codes, with severe consequences for patient care and physician morale. The interruption of routine clinic visits owing to covid-19 presents an opportunity to reconsider the guiding principles of clinical care, write Eric Reinhart and Daniel Brauner

Long-Term Urban Epidemic and Disaster Resilience: The Planning and Assessment of a Comprehensive Underground Resilience Core

This study utilizes the enclosed and stable environment of underground space for long-term sustainable planning for urban epidemics and disasters. Owing to the COVID-19 epidemic, cities require long-term epidemic-disaster management. Therefore, this study proposed a strategy for integrating multiple functions to plan a comprehensive Underground Resilience Core (URC). A planning and assessment methods of URC were proposed. With this methodology, epidemic- and disaster- URCs were integrated to construct a comprehensive-URC in underground spaces. The results show: (1) Epidemic-resilient URCs adopting a joint progressive approach with designated hospitals can rapidly suppress an epidemic outbreak. (2) The regularity of the morphology of underground spaces determines the area of the URC. Bar-shaped underground spaces have the potential for planning disaster-URCs. (3) The URC planning efficiency ranking is as follows: Bar shapes lead overall, T shapes are second under seismic resilience, and Cross shapes are second under epidemic resilience. (4) The potential analysis of planning a comprehensive-URC in the underground parking in Chinese cities showed that the recovery time can be advanced from 29% to 39% and the comprehensive resilience can be improved by 37.63%. The results of this study can serve as sustainable urban planning strategies and assessment tools for long-term epidemic-disaster management.

Medically safe for discharge (MSFD): reducing doctor input in MSFD patients across geriatric medicine wards at a DGH in Somerset

ContextMusgrove Park Hospital is a district general hospital in Taunton, Somerset, in the South West of England.Issue/ChallengeIncreasingly NHS hospitals are under capacity pressures. Since the COVID pandemic, Musgrove Park Hospital is struggling with high numbers of medical admissions, coupled with increasing lengths of patient stay. This is multifaceted but largely due to a lack of social care packages and pressures on community services.Assessment of issue and analysis of its causesThe pressure on social care has resulted in increased numbers of patients in acute hospital beds that do not have a ‘criteria to reside’. These patients are deemed medically safe to be residing in their own homes or residential care. They do not require inpatient medical care and therefore a routine daily doctor review.ImpactThis project looked to trial a system where medically safe for discharge (MSFD) patients are identified by the medical team (senior doctor) and are flagged as not requiring daily ward round reviews. These patients are discussed daily at board rounds and continue to receive nursing care and therapy input. The MDT are encouraged to escalate concern about a ‘MSFD patient’ to the medical team who will then review as clinically indicated. This would allow rationalisation and re-prioritisation of doctor-time to the most unwell patients.InterventionWe initially trialled this project on Mendip, a 19 bedded care of the older person (COOP). A rapid PDSA cycles allowed the creation and improvement of a sticker to identify MSFD patients. This A6 sticker was placed in the medical notes as soon as a patient was deemed MSFD. It included an option for highlight any ongoing issues that would otherwise be addressed as an outpatient, and signalled that the patient would not be included on daily ward rounds.Data collected during the 3 week trial period showed 46% of bed days were occupied by MSFD patients. An average of 8 MSFD patients were not reviewed each day, with 0.6 unplanned reviews of these patients needed due to MDT concern, saving an average of 7.4 patient reviews per working day. In addition, 3.3 hours/day were saved, allowing rationalisation of doctor time and resources to understaffed, busier wards whilst not causing detriment to patient care. This equates to half a doctor per day per medical ward.Involvement of stakeholders, such as patients, carers or family members:Creating a MSFD process required multi-disciplinary working from medical teams alongside nursing and therapy colleagues, as well as the wider hospital management team. There were no complaints from patients or family members as a result of this change, and no adverse outcomes to patient care were noted either.Key MessagesThe use of a MSFD process has helped our hospital to address the challenges of capacity and demand for limited NHS resources, with respect to both the physical bed-space and precious doctor time. This has enabled reallocation of that saved time to care for and treat more patients, as well as provide education to the next generation of medics.Lessons learntThe current NHS bed crisis will not be solved by a ‘quick-fix' as the situation is complex and multi-faceted. However, projects like this enable the resources we do have to be used effectively and efficiently. We were fortunate to have buy-in from the hospital management when our trial was still in infancy which enabled rapid testing and development of the process, due to support from members of the MDT throughout the hospital. This may not always be the case for other projects.Measurement of improvementData was collected to measure the number of patients being seen each day on the ward, and the time saved from not seeing MSFD patients. We balanced our intervention by measuring the number of complaints from patients or families, as well as the number of unplanned reviews from patients who became sick. The work on Mendip was presented to the hospital clinical leadership group alongside the date we had collected to support its efficiency and safety, who subseque tly approved the standard operating procedure we wrote to formalise our work. This is currently being rolled out within the care of the older person department at Musgrove Park.Strategy for improvementThe next step of the project is to establish MSFD ward. This cohorts the patients who would otherwise be discharged into the community if their pathway/care was available. The ward will require reduced doctor input, allowing medical staff to be redistributed to busier parts of the hospital, with the ultimate aim to run this as a ‘doctor-free' ward, similar to the care provided in the community.

Attitudes among physicians toward vaccine mandates for emerging infectious disease: the case of the COVID-19 vaccine

Objectives: The outbreak of SARS-CoV-2 resulted in a global pandemic. Vaccine mandates were implemented in several countries, including in Taiwan, and often targeted health-care workers in particular. This study investigated attitudes among Taiwanese physicians toward such policies and how ethical beliefs and logic influenced attitudes. Methods: A total of 16 physicians were recruited by using the snowball method from hospitals in northern Taiwan. Data were collected through semi-structured interviews. Results: Physicians tended not to support mandatory vaccination. Five themes emerged: (1) Individual rights, including violation of autonomy and labor rights;(2) vaccine performance, including safety and efficacy;(3) institutional norms, including the degree of relevancy of the policy-issuing unit and the employment relationship between physicians and institutions;(4) social and workplace stigma resulting from coercive policies in different job categories or departments;and (5) professional ethics of physicians. Conclusions: Autonomy and professional ethics among physicians influence attitudes toward vaccine mandates. Vaccine performance, institutional norms, and stigma also influence attitudes toward vaccine mandates and decision-making. Even with high ethical awareness, the study participants tended not to support vaccine mandates. The government should formulate mandatory vaccination policy means for healthcare workers that can be used by hospitals. Each hospital should assess their unique risks and implement policies that best suit their needs. (Taiwan J Public Health. 2023;42(1):75-87)

A Quantitative Analysis of Barriers to International Telemedicine Education: The Case of the Philippines

A multitude of studies have investigated the opportunities and limitations of telemedicine pre- and post-COVID-19 pandemic. However, most of the research has focused on telemedicine's constraints in the context of international, regional, and developed nations, with few studies examining the specific challenges that may affect telemedicine's progress in developing countries where the pandemic may have exacerbated existing technological and geographical difficulties. This study takes the Philippines as a case study due to its archipelagic location, use of English as an official language, and other factors that influence its adaptability to international telemedicine. We assessed the barriers and challenges to the advancement of telemedicine from four viewpoints: policy, organization, individual, and collaboration between organizations. Therefore, the significance of this study is twofold: (a) to concentrate on international telemedicine education by contrasting domestic and international practices, and (b) to newly reveal connections between each component, as prior research highlighted barriers and difficulties but did not clarify relationships among different elements. We surveyed and interviewed 38 physicians, technicians, coordinators, and staff involved in telemedicine education in the Philippines. The study found that (1) public support yields favourable results, (2) a strong correlation exists between domestic and international telemedicine, (3) communication and technical obstacles are interconnected, (4) unity and cooperation in intra-hospital collaboration are critical, and (5) comprehending the "significance of work" has a positive impact. This study underscores the intersectionality of several barriers to telemedicine development. It also recommends providing greater support for telemedicine education in developing nations and promoting collaboration between developing and developed nations. Copyright © 2023 by SCITEPRESS - Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

Factors for prolonged hospital length of stay in discharged patients with COVID-19

Hospitals were overburdened during peak periods of Coronavirus disease 2019 (COVID-19) pandemic, and bed occupancy was full. The ability to predict and plan patients' hospital length of stay allows predictability in terms of the free capacity of hospital facilities. The purpose of this article is to evaluate the factors that influence the hospital length of stay among discharged (recovered) from COVID-19 patients. This will allow the prediction of the likely number of bed days in the conditions of intensive workload of medical facilities for hospital care. A total of 441 discharged after hospital treatment for COVID-19 patients are followed up. Factors for prolonged hospital length of stay are searched among the indicators recorded at admission. Median hospital length of stay of the patients discharged from COVID-19 ward is 9 days (IQR 6-12) and in the COVID-19 intensive care unit 12 days (IQR 9.75-18.75). The median length of stay assessed by a survival analysis is 35 days in the COVID-19 unit and only 8 days in intensive care, due to the high mortality in the intensive care unit. The longer hospital length of stay of patients discharged from the COVID-19 wards is associated with the presence of hypertension (median 10 vs. 8 days for patients without the disease, p=0.006), ischemic heart disease (10 vs. 8 days, p<0.001), cerebrovascular disease (10 vs. 8 days, p=0.061 - did not reach significance), peripheral arterial disease (12 vs. 8 days, p=0.024), chronic renal failure or chroniodialysis (14 vs. 8 days, p<0.001), oncological illness (11 vs. 8 days, p=0.024), presence of at least one comorbidity (9 vs. 8 days, p=0.006), arrival at the hospital by ambulance vs. the patient's own transport (11 vs. 8 days, p=0.003), severe lung involvement shown on X-ray (10 vs. 8 days, p=0.030) or CT (18 vs. 10 days, p=0.045). Prolonged hospital length of stay is associated with older age (Spearman's rho=0.185, p<0.001), greater number of comorbidities (Spearman's rho=0.200, p<0.001), lower oxygen saturation on admission (Spearman's rho=- 0.294, p<0.001) and lower lymphocytes count (Spearman's rho=-0.209, p<0.001), as well as higher CRP (Spearman's rho=0.168, p<0.001), LDH (Spearman's rho=0.140, p=0.004), ferritin (Spearman's rho=0.143, p=0.004) and d-dimer (Spearman's rho=0.207, p<0.001). The multiple linear regression model found that the increase in the number of bed days of discharged from COVID-19 unit patients depends on the way the patient arrived at the Emergency Department (by ambulance instead of on their own transportation) and the presence of an accompanying oncological disease (R2=0.628, p<0.001). The hospital length of stay of patients discharged from COVID-19 intensive care unit is associated with the presence of hypertension (median 14 vs. 9 days for patients without the disease, p=0.067 - significance not reached) and at least one comorbidity (14 vs. 9 days, p=0.067 - significance not reached). The number of bed days is higher when recorded more comorbidities (Spearman's rho=0.818, p=0.004), lower oxygen saturation (Spearman's rho=-0.605, p=0.067 - significance not reached) and higher leukocytes count (Spearman's rho=0.546, p=0.102 - significance not reached). A multiple linear regression model demonstrated the hospital length of stay of patients in the COVID-19 intensive care unit as an outcome of the number of comorbidities only (R2=0.826, p=0.003). The ability to estimate and forecast quickly the number of bed-days based on a small number of variables would help reduce the burden on the healthcare system during a pandemic.

Optimizing Medical Healthcare Services Using Big Data Analytics

Big data is a very large size of datasets which come from many different sources and are in a wide variety of forms. Due to its enormous potential, big data has gained popularity in recent years. Big data enables us to investigate and reinvent numerous fields, including the healthcare industry, education, and others. Big data specifically in the healthcare sector comes from a variety of sources, including patient medical information, hospital records, findings from physical exams, and the outcomes of medical devices. Covid19 recently, one of the most neglected areas to concentrate on has come under scrutiny due to the pandemic: healthcare management. Patient duration of stay in a hospital is one crucial statistic to monitor and forecast if one wishes to increase the effectiveness of healthcare management in a hospital, even if there are many use cases for data science in healthcare management. At the time of admission, this metric aids hospitals in identifying patients who are at high Length of Stay namely LS risk (patients who will stay longer). Once identified, patients at high risk for LS can have their treatment plans improved to reduce LS and reduce the risk of infection in staff or visitors. Additionally, prior awareness of LS might help with planning logistics like room and bed allotment. The aim of the suggested system is to precisely anticipate the length of stay for each patient on an individual basis so that hospitals can use this knowledge for better functioning and resource allocation using data analytics. This would contribute to improving treatments and services. © 2023 IEEE.

The Evolution of the Normative Regulation in Hospital Safety and Security

The aim of the law is to ensure personal, material and organisational conditions for safe work without endangering human health, to prevent work accidents and occupational diseases by defining the rights and obligations of the state, employers and employees. Since 2003, the concept of occupational safety and health commissioning has been included in the law, which plays a prominent role in the commissioning of dangerous technology or work equipment in health care. [...]of the epidemic, not only the so-called back office area, but also in patient care, the concept of remote work appeared in the field of telemedicine, and some other areas, such as in the case of finding analysis. According to the legislation, the employer must register and Investigate all accidents at work. [...]of this, a wave of insourcing started and in several health institutions they started to employ their own doormen again, wh ich raises further problems.