Remote monitoring in telehealth care delivery across the U.S. cystic fibrosis care network.

BACKGROUND: Cystic fibrosis (CF) programs and people with CF (PwCF) employed various monitoring methods for virtual care during the COVID-19 pandemic. This paper characterizes experiences with remote monitoring across the U.S. CF community. METHODS: The CF Foundation (CFF) sponsored distribution of home spirometers (April 2020 to May 2021), surveys to PwCF and CF programs (July to September 2020), and a second program survey (April to May 2021). We used mixed methods to explore access, use, and perspectives regarding the use of remote monitoring in future care. RESULTS: By October 2020, 13,345 spirometers had been distributed, and 19,271 spirometers by May 2021. Programs (n=286) estimated proportions of PwCF with home devices increased over seven months: spirometers (30% to 70%), scales (50% to 70%), oximeters (5% to 10%) with higher estimates in adult programs for spirometers and oximeters. PwCF (n=378) had access to scales (89%), followed by oximeters (48%) and spirometers (47%), often using scales and oximeters weekly, and spirometers monthly. Over both surveys, some programs had no method to collect respiratory specimens for cultures associated with telehealth visits (47%, n=132; 41%, n=118). Most programs (81%) had a process for phlebotomy associated with a telehealth visit, primarily through off-site labs. Both PwCF and programs felt future care should advance remote monitoring and recommended improvements for access, training, and data collection systems. CONCLUSIONS: PwCF and programs experienced unprecedented access to remote monitoring and raised its importance for future care. Improvements to current systems may leverage these shared experiences to augment future care models.

A Statewide Voluntary Movement Addressing the Shortage of Medical Supplies During the COVID-19 Pandemic.

During the COVID-19 pandemic, a shortage of personal protective equipment compromised efficient patient care and provider safety. Volunteers from many different backgrounds worked to meet these demands. Additive manufacturing, laser cutting, and alternative supply chains were used to produce, test, and deliver essential equipment for health care workers and first responders. Distributed equipment included ear guards, face shields, and masks. Contingent designs were created for powered air-purifying respirator hoods, filtered air pumps, intubation shields, and N95 masks.

COVID-19, Workforce Autonomy and the Health Supply Chain.

During the COVID-19 pandemic, the rapid surge in demand for critical supplies and public health efforts needed to guard against virus transmission have placed enormous pressure on health systems worldwide. These pressures and the uncertainty they have created have impacted the health workforce in a substantial way. This paper examines the relationship between health supply chain capacity and the impact of the COVID-19 pandemic on Canada's health workforce. The findings of this research also highlight the impact of the pandemic on health workers, specifically the relationship between the health supply chain and the autonomy of the health workforce.

An Implementation Research Approach to Re-orient Health Supply Chains Toward an Equity Agenda in the COVID-19 Era.

The Covid-19 pandemic has exposed critical inequities in global healthcare supply chains and the need for these systems to be analyzed and reoriented with an equity lens. Implementation research methodology can guide the use of evidence-based interventions to re-orient health supply chains towards equity and optimize health outcomes. Using this approach, private and public sector entities can adapt their strategies to focus not just on efficiency and cost savings but ensuring that vulnerable populations have access to essential medications, vaccines, and supplies. Findings can inform regulations that address supply chain inequities at the global level, strengthen existing systems to fill structural gaps at the national level, and address contextual challenges at the subnational level. This methodology can help account for historical practices from prior health initiatives, identify contemporary barriers and facilitators for positive change, and have applicability to the Covid-19 pandemic and ongoing vaccine distribution efforts. An implementation research approach is critical in equipping health supply chains with a path for more resilient and equitable distribution of necessary supplies, vaccines, and delivery of care.

ARC: An Open Web-Platform for Request/Supply Matching for a Prioritized and Controlled COVID-19 Response.

In 2020 the world was hit by the COVID-19 pandemic putting entire governments and civil societies in crisis mode. Around the globe unprecedented shortages of equipment and qualified personnel were reported in hospitals and diagnostic laboratories. When a crisis is global, supply chains are strained worldwide and external help may not be readily available. In Switzerland, as part of the efforts of the Swiss National COVID-19 Science Task Force, we developed a tailor-made web-based tool where needs and offers for critical laboratory equipment and expertise can be brought together, coordinated, prioritized, and validated. This Academic Resources for COVID-19 (ARC) Platform presents the specialized needs of diagnostic laboratories to academic research groups at universities, allowing the sourcing of said needs from unconventional supply channels, while keeping the entities tasked with coordination of the crisis response in control of each part of the process. An instance of the ARC Platform is operated in Switzerland (arc.epfl.ch) catering to the diagnostic efforts in Switzerland and sourcing from the Swiss academic sector. The underlying technology has been released as open source so that others can adopt the customizable web-platform for need/supply match-making in their own relief efforts, during the COVID-19 pandemic or any future disaster.

"Flying Blind": Canada's Supply Chain Infrastructure and the COVID-19 Pandemic.

Canada's COVID-19 response has been described as slow, with reactive decision making that has left the most vulnerable populations at risk of infection and death from the virus. Yet, within and across the provincial health systems, the supply chain processes and data infrastructure needed to generate the relevant data for, and evidence of, the spread of COVID-19 and the health system's capacity to respond to the pandemic are non-existent in Canada. Emerging evidence from a national research study highlights the significance of supply chain data infrastructure and processes that offer transparent, real-time data to inform decisions that support a coordinated, evidence-informed pandemic strategy that is proactive and capable of protecting the health of every Canadian.

On collaborative reinforcement learning to optimize the redistribution of critical medical supplies throughout the COVID-19 pandemic.

OBJECTIVE: This work investigates how reinforcement learning and deep learning models can facilitate the near-optimal redistribution of medical equipment in order to bolster public health responses to future crises similar to the COVID-19 pandemic. MATERIALS AND METHODS: The system presented is simulated with disease impact statistics from the Institute of Health Metrics, Centers for Disease Control and Prevention, and Census Bureau. We present a robust pipeline for data preprocessing, future demand inference, and a redistribution algorithm that can be adopted across broad scales and applications. RESULTS: The reinforcement learning redistribution algorithm demonstrates performance optimality ranging from 93% to 95%. Performance improves consistently with the number of random states participating in exchange, demonstrating average shortage reductions of 78.74 ± 30.8% in simulations with 5 states to 93.50 ± 0.003% with 50 states. CONCLUSIONS: These findings bolster confidence that reinforcement learning techniques can reliably guide resource allocation for future public health emergencies.

Iran, sanctions, and the COVID-19 crisis.

With an over 80 million population, Iran is the second-largest country in the Middle East. The coronavirus disease 2019 (COVID-19) has spread over all 31 provinces of Iran, leading to the most cases and death among the Eastern Mediterranean countries. At the same time, Iran is under the United States political and economic sanctions that compromised Iran's health system. Although medicines and basic medical equipment exempted from the economic sanctions, direct and indirect effects of sanctions have restricted Iran's banking system, and consequently has led to a wide range of limitation on trade, manufacturing sector, insurance and ventures. All these circumstances have meant that Iran is restricted to provide the essential basic medical equipment for diagnosis, treatment and prevention of the COVID-19. Although sanctions are not the sole reason for this high rate of mortality and morbidity in a short time period, the chronic and long-term effects of sanctions may be more tangible than their acute impact. In conclusion, providing health services is one of the major problems of Iran's health system during this pandemic that potentially influence on morbidity and mortality of the COVID-19. Iran needs to be free from sanctions for battling against this crisis.Key messagesIran is one of the countries that significantly impacted by the COVID-19 pandemic.Iran is under political and economic sanctions that consequently influence on their health system during the COVID-19 crisis.The chronic and long-term effects of sanctions may be more tangible than their acute impact.

Integrated 3D printing solution to mitigate shortages of airway consumables and personal protective equipment during the COVID-19 pandemic.

BACKGROUND: To cope with shortages of equipment during the COVID-19 pandemic, we established a nonprofit end-to-end system to identify, validate, regulate, manufacture, and distribute 3D-printed medical equipment. Here we describe the local and global impact of this system. METHODS: Together with critical care experts, we identified potentially lacking medical equipment and proposed solutions based on 3D printing. Validation was based on the ISO 13485 quality standard for the manufacturing of customized medical devices. We posted the design files for each device on our website together with their technical and printing specifications and created a supply chain so that hospitals from our region could request them. We analyzed the number/type of items, petitioners, manufacturers, and catalogue views. RESULTS: Among 33 devices analyzed, 26 (78·8%) were validated. Of these, 23 (88·5%) were airway consumables and 3 (11·5%) were personal protective equipment. Orders came from 19 (76%) hospitals and 6 (24%) other healthcare institutions. Peak production was reached 10 days after the catalogue was published. A total of 22,135 items were manufactured by 59 companies in 18 sectors; 19,212 items were distributed to requesting sites during the busiest days of the pandemic. Our online catalogue was also viewed by 27,861 individuals from 113 countries. CONCLUSIONS: 3D printing helped mitigate shortages of medical devices due to problems in the global supply chain.

The pharmacist facing the logistics of safely dispensing, storing and preserving drugs in healthcare units.

In response to the SARS-CoV-2 pandemic, the Hospital Pharmacy Services have  quickly adapted to respond to a critical situation characterized by the constant  and continuous admission of patients with severe pneumonia who needed  treatment, requiring a transformation of the hospital in order to increase the  number of hospital and critical beds. Moreover, other out-ofhospital spaces have  been transformed into hospitalization units to absorb the large number of  patients that had to be treated and isolated. To guarantee the distribution of  medicines and the quality of the pharmaceutical care, drug distribution systems,  such as unit dose and automated dispensing systems, have undergone  transformations. Standard stocks were assigned for COVID units, and different  dispensing circuits to avoid the risk of cross-contamination between COVID and  non-COVID units were created, as well as disinfection protocols for medication  transport systems and medication return protocols. All this without forgetting  COVID treatment protocol's changes that were affected by the availability of the  drugs. The increase in the number of beds in out-of-hospital spaces, such as  field hospitals, hotels, socio-medical centers and nursing homes, has challenged  Pharmacy Services, since new medication dispensing and conciliation circuits  have been created forcing the increase of pharmacy staff's presence and  modifying work shifts, to afford all the new tasks successfully. Development of  contingency plans for the different Pharmacy Service activities and providing  fluent communication channels are key elements for crisis situations or health  emergencies such as the current pandemic.

Ante la pandemia por SARS-CoV-2, los servicios de farmacia de los hospitales se han adaptado rápidamente para dar respuesta a una situación muy grave  caracterizada por el ingreso constante y continuo de pacientes con neumonía  que necesitaban tratamiento, siendo necesaria una transformación del hospital  para poder aumentar el número de camas de hospitalización y de críticos que se  requerían. Asimismo, otros dispositivos extrahospitalarios se han transformado  en unidades de hospitalización para absorber el elevado número de pacientes  que debían tratarse y aislarse. Para garantizar la distribución de los  medicamentos y la calidad de la atención farmacéutica, los sistemas de  distribución de fármacos, como la unidosis y los sistemas automatizados de  dispensación, han sufrido a su vez transformaciones. Se diseñaron stocks  estándar para las plantas COVID, y circuitos de dispensación diferentes para  evitar el riesgo de contaminación cruzada entre plantas COVID y no-COVID, así  como protocolos de desinfección de los sistemas de transporte de medicación y  protocolos de gestión de las devoluciones de medicación. Todo esto sin olvidar  los cambios en los protocolos de tratamiento de la COVID que se vieron  afectados por la disponibilidad de los fármacos. El incremento del número de  camas en dispositivos extrahospitalarios, como hospitales de campaña, hoteles,  centros sociosanitarios y residencias geriátricas, ha sido un reto para los  servicios de farmacia, ya que se han tenido que crear nuevos circuitos de  dispensación y de conciliación de la  medicación, obligando a reforzar la plantilla  del servicio de farmacia y modificar los turnos de trabajo, estableciendo guardias presenciales para poder llevar a cabo todas las nuevas tareas con éxito. La  elaboración de planes de contingencia de las diferentes actividades del servicio  de farmacia y el establecimiento de canales de comunicación fluidos son  elementos clave para situaciones de crisis o emergencias sanitarias como la  actual.