The impact of COVID-19 on the experiences of patients and their family caregivers with medical assistance in dying in hospital.

BACKGROUND: The COVID-19 pandemic and its containment measures have drastically impacted end-of-life and grief experiences globally, including those related to medical assistance in dying (MAiD). No known qualitative studies to date have examined the MAiD experience during the pandemic. This qualitative study aimed to understand how the pandemic impacted the MAiD experience in hospital of persons requesting MAiD (patients) and their loved ones (caregivers) in Canada. METHODS: Semi-structured interviews were conducted with patients who requested MAiD and their caregivers between April 2020 and May 2021. Participants were recruited during the first year of the pandemic from the University Health Network and Sunnybrook Health Sciences Centre in Toronto, Canada. Patients and caregivers were interviewed about their experience following the MAiD request. Six months following patient death, bereaved caregivers were interviewed to explore their bereavement experience. Interviews were audio-recorded, transcribed verbatim, and de-identified. Transcripts were analyzed using reflexive thematic analysis. RESULTS: Interviews were conducted with 7 patients (mean [SD] age, 73 [12] years; 5 [63%] women) and 23 caregivers (mean [SD] age, 59 [11] years; 14 [61%] women). Fourteen caregivers were interviewed at the time of MAiD request and 13 bereaved caregivers were interviewed post-MAiD. Four themes were generated with respect to the impact of COVID-19 and its containment measures on the MAiD experience in hospital: (1) accelerating the MAiD decision; (2) compromising family understanding and coping; (3) disrupting MAiD delivery; and (4) appreciating rule flexibility. CONCLUSIONS: Findings highlight the tension between respecting pandemic restrictions and prioritizing control over the dying circumstances central to MAiD, and the resulting impact on patient and family suffering. There is a need for healthcare institutions to recognize the relational dimensions of the MAiD experience, particularly in the isolating context of the pandemic. Findings may inform strategies to better support those requesting MAiD and their families during the pandemic and beyond.

"And Then COVID Hit": (Re)flexibility of Digital Storytelling in Qualitative Health Research

The purpose of our qualitative health research study was to understand the experiences of Ontarians who accompanied someone throughout their dying process using medical assistance in dying (MAiD). The second phase used digital stories as a method to examine and share these experiences at the end of life. And then the COVID-19 pandemic hit, and we faced a pivot to our original plan. This pivot resulted in reinforcing the myriad benefits of using digital storytelling in qualitative health research. And rather than detracting from the initial study, we also learned that digital storytelling is a flexible method that can be creatively, compassionately, and effectively conducted in virtual spaces. We will employ digital storytelling in future qualitative health research as both a component of studies but also as a conduit for explorations of other tools of data collection and dissemination. [ FROM AUTHOR] Copyright of International Journal of Qualitative Methods is the property of Sage Publications Inc. 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.)

Avoiding Catastrophe in a High-Risk Environment: AUSMAT at Howard Springs

The Australian Medical Assistance Team (AUSMAT) led the implementation, establishment and management of Howard Springs International Quarantine Facility at the Centre for National Resilience from October 2020 to May 2021. The operation is internationally renowned for its success to mitigate leakage of the coronavirus disease from the quarantine facility to the community during a national policy of virus elimination or suppression. The operations success led to other Australian jurisdictions seeking to replicate the quarantine model. Here, we use three theoretical frameworks to describe AUSMATs approach to risk mitigation at the quarantine facility. © 2022 The Author(s).

Android App to Monitor the Position of a Group of Robots in a Hospital

This article presents the design of an Application in Android operating system, with the aim of monitoring movements in real time through a 2D graphic representation system for a group of Mobile Robots with medical assistance capabilities, in a portable and economical way. In addition, to provide information about the robots positioning in Cartesian coordinates, percentage of current battery and state of operation during their navigation. The robots are link to an Android mobile device through wireless communication in MQTT or WiFi protocol, depending on the technical case available. As a basis of application there is in the first instance a Covid hospital, the need arises as a means of medical assistance between the patient with Covid symptoms and the doctor, nurses and support staff in their treatment and isolation, in order to avoid contact, contagion and the additional expense of wearing special clothing to treat the patient. © 2022 IEEE.

Evaluation of a New Triage Protocol for Palliative Care for Patients with COVID-19 in Brazil.

Objectives: To evaluate the implementation of a triage protocol for palliative care (PC) during the COVID-19 pandemic (PALI-COVID) at a referral center in Brazil. Methods: A retrospective observational study was conducted. Based on the triage protocol, patients were classified into a red group, a yellow group, and a green group (GG). Patients should receive PC as recommended for each group. Results: A total of 1517 patients were included in the analysis. About 11% (n = 162) of patients received PC. About 35% (n = 529) of all patients died. There was a significant difference in the mortality rate between the groups; the GG had the highest mortality rate. Most patients who died (77.1%) did not receive PC. Conclusion: PALI-COVID was effective in identifying patients who had a higher risk of death and needed end-of-life support. Despite the protocol, few patients received PC.

Mask Diplomacy? Understanding China's Goals in Delivering Medical Aid in the First Wave of the COVID-19 Pandemic

In the first wave of the COVID-19 pandemic, China provided medical assistance on an unprecedented scale. While some observers have underscored the strategic purposes of China's COVID-19 aid, referred to as "mask diplomacy,” they have yet to assess this argument against empirical evidence. We seek to examine whether China's medical aid was used as a strategic tool, or it remained reactionary and fragmented, by combining a new dataset on the global distribution of Chinese in-kind medical aid with a qualitative analysis of government and news reports during the first wave of the pandemic. Our findings show that although COVID-19 aid did have the potential to strengthen China's influence over recipients and promote Chinese knowledge of health governance, Chinese policymakers were underprepared to use aid strategically during the pandemic. The reactionary and fragmented nature of China's COVID-19 aid was reflected in its allocation, its policy-making processes, and its implementation. © The Author(s) 2023.

Psychophysical Risk Perceptions and Sleep Quality of Medical Assistance Team Members in Square Cabin Hospitals: A Repeated Cross-Sectional Study.

Objective: This study aimed to evaluate the association between the perceptions of psychophysical risks and sleep quality of Medical Assistance Team Members (MATMs) in Square Cabin Hospitals. Methods: Repeated cross-sectional data collection was conducted in Square Cabin Hospitals during two large-scale lockdowns. The first wave was sampled from MATMs dispatched to Wuhan and the second was from MATMs dispatched to Shanghai. Participants completed online questionnaires comprised of the Risk Perception Questionnaire (RPQ), Positive and negative emotions scale (PANAS), and Sleep Quality Scale (SQS), measuring the psychophysical risk perceptions about the MATMs' current work, emotional states, and sleep quality. Changes across two waves of data collection were statistically parsed using the exploratory factor analysis and regression models. Results: Data of 220 participants from first-wave samples [S1] and 300 from second-wave samples [S2] were analyzed. Participants reported more worries about physical risks, such as inadequate protection methods and being infected, and S1 rated higher on all risks compared with S2 (as the biggest p-value was 0.021). Across the different situations, the dominant emotional states of MATMs were positive; a higher level of psychophysical risk perceptions, negative emotional states, and poor sleep quality were consistently interrelated. The psychophysical risk perceptions predicted sleep quality. Negative emotions as a state variable intensified the relationship between physical risk perceptions and sleep quality (bindirect effect = 1.084, bootstrapped CI = [0.705, 1.487]). Conclusions: The results provide important evidence that MATMs' higher level of psychophysical risk perceptions associated with negative emotions could indicate worse sleep quality.

An outdoor hotel quarantine facility model in Australia: best practice with optimal outcomes.

OBJECTIVE: To describe the operationalisation of a novel outdoor quarantine facility managed by the Australian Medical Assistance Team, the Howard Springs International Quarantine Facility (HSIQF) at the Centre for National Resilience in the Northern Territory, Australia. METHODS: We collated documentation and data from HSIQF to describe policies and procedures implemented and performed a descriptive analysis of key procedures and outcomes. RESULTS: From 23 October 2020 to 31 March 2021, 2.2% (129/5,987) of residents were confirmed COVD-19 cases. On average per day, 82 [Interquartile Range (IQR): 29-95] staff completed personal protective equipment (PPE) training, 94 [IQR: 90-104] staff completed antigen testing and 51 [IQR: 32-136] staff completed polymerase chain reaction testing. The operation focused on building a safe environment with infection prevention and control adherence and workforce sustainability. There was no leakage of SARS-CoV-2 to staff or the community and no PPE compromises requiring staff to quarantine for 14 days. CONCLUSION: HSIQF demonstrates the operationalisation of an effective, safe and replicable quarantine system. IMPLICATIONS FOR PUBLIC HEALTH: Quarantine is a critical public health tool for pandemic control. The HSIQF operations may be useful to inform the establishment and management of quarantine facilities for future and current disease outbreaks.

Remote Medical Assistance Vehicle in Covid-19 Quarantine Areas: A Case Study in Vietnam

The pain, namely “Covid-19 epidemic", has caused many sacrifices, loss, and loneliness. Only those who have experienced traumatic losses can fully understand the pain that is hard to erase by the epidemic. This study focuses on designing a remote medical assistance vehicle used in quarantine areas in Vietnam to support epidemic prevention with simple, cheap, easy-to-use, and multi-function criteria. The proposed system includes a 3-layer vehicle for transporting supplies controlled remotely via Radio Frequency (RF) signals to help limit cross-infection for medical staff and volunteers. The main component is the RF transceiver circuit, which transmits and receives data wirelessly over 2.4 GHZ RF using IC Nrf24l01, Nordic standard SPI interface for remote control. DC motor driver circuit BTS7960 43A controls the motor to prevent overvoltage and current drop. Moreover, the vehicle integrates an electric sprayer to support disinfecting spray a Xiaomi camera to stream video and communicate directly with patients and healthy in isolation. Ultrasonic sensors and infrared sensors aim to scan obstacles through reflected waves. The reflected signals received from the barrier objects are used as input to the microcontroller. The microcontroller is then used to determine the distance of objects around the vehicle. If an obstacle is detected, the disinfectant sprayer can stop for several seconds to ensure the safety of medical staff if there is a pass. The system has a built-in light sensor that works at night. The system is deployed at a low cost and is evaluated through some experiments. It is expected to be easy to use and is an innovative solution for hospitals. Once the outbreak is over, the product can still be used in infectious disease areas. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Merchant Shipping during Global Health Pandemics: A Review of International Regulations

This article examines the impact of COVID-19 on the international regulation of merchant shipping. First, it provides an overview of the international regulatory framework established by the WHO, IMO and ILO to respond to the impact of global health emergencies on international merchant shipping. It then examines the responses of these organisations and the shipping industry to the impact of the COVID-19 pandemic on merchant shipping. The COVID-19 pandemic has demonstrated that global health emergencies require enhanced preparedness and response planning and cooperation between the IMO, WHO and ILO, which includes consultation and cooperation with global shipping associations and seafarers' unions. The objective of the preparedness and response planning should be to keep maritime supply chains open while preventing the spread of infectious disease from ship-to-ship, ship-to-shore or shore-to-ship. Equally important, the enhanced cooperation at the global level must be matched by enhanced inter-agency cooperation at the national level. © 2022 Koninklijke Brill NV.

Medical Assistance in Dying (MAiD) for Canadian Prisoners: A Case Series of Barriers to Care in Completed MAiD Deaths.

Background: As of August 2020, 11 patients who were federally incarcerated in a Canadian prison requested medical assistance in dying (MAiD), and three received it. This case study seeks to understand the process of care as described by physicians involved in each of the cases that resulted in MAiD. Methods: During the summer of 2020, semistructured interviews were conducted with physicians involved in each known Correctional Service of Canada (CSC) MAiD case. Transcripts were summarized to illuminate details of the care process for each patient, highlighting barriers to patient-centered care. Results: Each case took place in a different province. One MAiD provision took place in a prison hospital, and two provisions took place after the incarcerated patients were transferred to external community hospitals. Case summaries highlight the physicians' efforts and challenges in assuring patient-centered care. Discussion: Physician experiences illuminate several barriers to care: CSC bureaucratic processes that forced longer wait times than typical for patients in the general public; challenges related to accessing release before MAiD application; knowledge of patient preference for location of death; concerns of voluntariness and confidentiality that are unique to CSC patients; and ethical considerations surrounding the presence of prison guards, police officers, and shackles at the time of assessment or provision. Reporting by the Office of the Correctional Investigator highlights additional challenges in these cases. Further inquiry is necessary to include the perspectives of prisoners and prison staff, and to consider how the evolution of new MAiD legislation will affect MAiD for prisoners.

Covisstance chatbot

In this paper we propose an intelligent chatbot that helps tackle the critical COVID-19 situation in India, which is a detrimental issue affecting the population of the country. Patients wait in long queues outside hospitals to obtain critical resources such as beds but return back in vain due to unavailability. The Covisstance Chatbot that we propose helps users locate available beds and ventilators in all hospitals at the user's location, without the need for them to travel. The proposed virtual assistant is implemented integrating several serverless services from Microsoft Power Virtual Agent, Power Automate flows to define actions, Microsoft Lists as a test database and Microsoft's Language Understanding Artificial Intelligence service (LUIS) that performs language and semantic analysis of user's queries. Experimental results show that the proposed chatbot successfully responds to all users' queries related to hospital information about beds and oxygen cylinders availability. © 2021 Association for Computing Machinery.

COVID-19 and seafarers' rights to shore leave, repatriation and medical assistance: a pilot study.

BACKGROUND: The well-being of the world's 1.65 million seafarers is expected to be secured by the rights established under the Maritime Labour Convention (MLC), 2006 with active monitoring of its implementation by the flag administrations through the International Maritime Organisation (IMO) and International Labour Organisation (ILO). However, the substantial gains achieved since entry into force of MLC in August 2013 appear to have been severely dented by the COVID-19 global pandemic. The aim of the study was to examine, on a pilot basis, the disruptions and challenges to the observance of seafarers' rights to shore leave, repatriation and medical assistance as an immediate consequence of COVID-19. MATERIALS AND METHODS: The impact of COVID-19 on seafarers' rights was examined in three dimensions - shore leave, repatriation and medical assistance. Questionnaires were administered online from June to August 2020 to 450 seafarers, top 10 ship-management companies, 35 shipping companies and maritime administrations of top 5 seafarer supplying countries. The paper discusses the results of the survey. RESULTS: The research revealed a previously unknown majority preference for shore leave, that diminished sharply during COVID-19. Impact on work-performance and well-being of seafarers was revealed with only a fifth of the seafarers having willingly agreed to an extension of contract. This study revealed incidence rates at 6 months into the pandemic of several parameters - delayed repatriations (21.44%) that includes crew with contract extensions (12.48%), crew with completed contract awaiting repatriation (8.96%) and crew that had exceeded 12-month continuous service (0.82%). Compensation, if provided, is meagre and was affecting ratings the most. Deprivation of medical assistance was also revealed. CONCLUSIONS: The well being of seafarers would likely remain vulnerable to breaches, unless measures are put in place to safeguard the rights assured under MLC in the face of uncertainties caused by a pandemic such as COVID-19.

AI-assisted CT imaging analysis for COVID-19 screening: Building and deploying a medical AI system.

The sudden outbreak of novel coronavirus 2019 (COVID-19) increased the diagnostic burden of radiologists. In the time of an epidemic crisis, we hope artificial intelligence (AI) to reduce physician workload in regions with the outbreak, and improve the diagnosis accuracy for physicians before they could acquire enough experience with the new disease. In this paper, we present our experience in building and deploying an AI system that automatically analyzes CT images and provides the probability of infection to rapidly detect COVID-19 pneumonia. The proposed system which consists of classification and segmentation will save about 30%-40% of the detection time for physicians and promote the performance of COVID-19 detection. Specifically, working in an interdisciplinary team of over 30 people with medical and/or AI background, geographically distributed in Beijing and Wuhan, we are able to overcome a series of challenges (e.g. data discrepancy, testing time-effectiveness of model, data security, etc.) in this particular situation and deploy the system in four weeks. In addition, since the proposed AI system provides the priority of each CT image with probability of infection, the physicians can confirm and segregate the infected patients in time. Using 1,136 training cases (723 positives for COVID-19) from five hospitals, we are able to achieve a sensitivity of 0.974 and specificity of 0.922 on the test dataset, which included a variety of pulmonary diseases.