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4.
Am J Nurs ; 121(8): 16, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1546036
7.
Chest ; 161(2): 504-513, 2022 02.
Article in English | MEDLINE | ID: covidwho-1401308

ABSTRACT

BACKGROUND: Faced with possible shortages due to COVID-19, many states updated or rapidly developed crisis standards of care (CSCs) and other pandemic preparedness plans (PPPs) for rationing resources, particularly ventilators. RESEARCH QUESTION: How have US states incorporated the controversial standard of rationing by age and/or life-years into their pandemic preparedness plans? STUDY DESIGN AND METHODS: This was an investigator-initiated, textual analysis conducted from April to June 2020, querying online resources and in-state contacts to identify PPPs published by each of the 50 states and for Washington, DC. Analysis included the most recent versions of CSC documents and official state PPPs containing triage guidance as of June 2020. Plans were categorized as rationing by (A) short-term survival (≤ 1 year), (B) 1 to 5 expected life-years, (C) total life-years, (D) "fair innings," that is, specific age cutoffs, or (O) other. The primary measure was any use of age and/or life-years. Plans were further categorized on the basis of whether age/life-years was a primary consideration. RESULTS: Thirty-five states promulgated PPPs addressing the rationing of critical care resources. Seven states considered short-term prognosis, seven considered whether a patient had 1 to 5 expected life-years, 13 rationed by total life-years, and one used the fair innings principle. Seven states provided only general ethical considerations. Seventeen of the 21 plans considering age/life-years made it a primary consideration. Several plans borrowed heavily from a few common sources, although use of terminology was inconsistent. Many documents were modified in light of controversy. INTERPRETATION: Guidance with respect to rationing by age and/or life-years varied widely. More than one-half of PPPs, many following a few common models, included age/life-years as an explicit rationing criterion; the majority of these made it a primary consideration. Terminology was often vague, and many plans evolved in response to pushback. These findings have ethical implications for the care of older adults and other vulnerable populations during a pandemic.


Subject(s)
COVID-19 , Civil Defense/standards , Crew Resource Management, Healthcare , Critical Care , Health Care Rationing/standards , Standard of Care/organization & administration , Triage , Aged , COVID-19/epidemiology , COVID-19/therapy , Crew Resource Management, Healthcare/ethics , Crew Resource Management, Healthcare/methods , Crew Resource Management, Healthcare/organization & administration , Critical Care/ethics , Critical Care/organization & administration , Critical Care/standards , Humans , SARS-CoV-2 , Surge Capacity/standards , Triage/ethics , Triage/organization & administration , Triage/standards , United States/epidemiology , Vulnerable Populations
10.
Int J Technol Assess Health Care ; 37(1): e77, 2021 Jul 16.
Article in English | MEDLINE | ID: covidwho-1315573

ABSTRACT

Emergency preparedness is a continuous quality improvement process through which roles and responsibilities are defined to effectively anticipate, respond to, and recover from the impact of emergencies. This process results in documented plans that provide a backbone structure for developing the core capacities to address health threats. Nevertheless, several barriers can impair an effective preparedness planning, as it needs a 360° perspective to address each component according to the best evidence and practice. Preparedness planning shares common principles with health technology assessment (HTA) as both encompass a multidisciplinary and multistakeholder approach, follow an iterative cycle, adopt a 360° perspective on the impact of intervention measures, and conclude with decision-making support. Our "Perspective" illustrates how each HTA domain can address different component(s) of a preparedness plan that can indeed be seen as a container of multiple HTAs, which can then be used to populate the entire plan itself. This approach can allow one to overcome preparedness barriers, providing an independent, systematic, and robust tool to address the components and ensuring a comprehensive evaluation of their value in the mitigation of the impact of emergencies.


Subject(s)
Civil Defense/organization & administration , Disaster Planning/organization & administration , Technology Assessment, Biomedical/organization & administration , Civil Defense/economics , Civil Defense/standards , Disaster Planning/economics , Disaster Planning/standards , Evidence-Based Practice/standards , Humans
11.
J Am Geriatr Soc ; 69(10): 2963-2972, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1304114

ABSTRACT

BACKGROUND: Although more than seven million older adults struggle or are unable to leave their homes independently, only a small minority access home-based primary care (HBPC). Despite substantial growth of HBPC, fueled by growing evidence supporting positive patient outcomes and cost savings, the population remains dramatically underserved and many evidence gaps still exist around scope of practice and key issues in care delivery and quality. Understanding the current state of the field is critical to the delivery of high-quality home-based care. METHODS: We conducted a systematic search of the peer-reviewed literature on HBPC, published between January 2010 and January 2020, using Medline, CINAHL, Embase, Web of Science, and Scopus online libraries. All studies were evaluated by two members of the research team, and key findings were extracted. RESULTS: The initial search yielded 1730 unique studies for screening. Of these initial results, 1322 were deemed not relevant to this review. Of the 408 studies deemed potentially relevant, 79 were included in the study. Researchers identified five overarching themes: the provision of HBPC, the composition of care teams, HBPC outcomes, the role of telehealth, and emergency preparedness efforts. CONCLUSION: The need and desire for growth of HBPC has been highlighted by the recent COVID-19 pandemic. Current research on HBPC finds a diverse scope of practice, successful use of interdisciplinary teams, positive outcomes, and increasing interest in telehealth with many areas ripe for further research.


Subject(s)
COVID-19 , Civil Defense/standards , Delivery of Health Care/standards , Home Care Services , Primary Health Care , Telemedicine , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Health Services Needs and Demand , Home Care Services/organization & administration , Home Care Services/standards , Home Care Services/trends , Humans , Primary Health Care/methods , Primary Health Care/organization & administration , Professional Practice Gaps , SARS-CoV-2 , Telemedicine/methods , Telemedicine/trends , United States
12.
Ann Glob Health ; 87(1): 45, 2021 05 19.
Article in English | MEDLINE | ID: covidwho-1248345

ABSTRACT

This Covid-19 pandemic has been a trying time for all countries, governments, societies, and individuals. The physical, social, and organizational infrastructure of healthcare systems across the world is being stressed. This pandemic has highlighted that the healthcare of the country is as strong as its weakest link and that no aspect of life, be it social or economic, is spared from this pandemic. The authors would like to highlight some of the lessons learned from Singapores management of the Covid-19 pandemic. During the Singaporean Covid-19 pandemic, public health policy planning was all encompassing in its coverage, involving various stakeholders in government and society. The important role of individuals, governments, industry, and primary healthcare practitioners when tackling COVID-19 are highlighted. Singapores management of the Covid-19 pandemic involved an approach that involved the whole of society, with a particular focus on supporting the vulnerable foreign worker population, which formed the majority of Covid-19 cases in the country. Hopefully amidst the trying times, valuable lessons are learnt that will be etched into medical history and collective memory. We hope to highlight these lessons for future generations, both for members of the public and fellow healthcare practitioners.


Subject(s)
COVID-19 , Public Health , Public Policy , Social Marginalization , COVID-19/epidemiology , COVID-19/prevention & control , Civil Defense/standards , Government Regulation , Health Services Needs and Demand/organization & administration , Humans , Public Health/methods , Public Health/standards , SARS-CoV-2 , Singapore/epidemiology , Transients and Migrants/statistics & numerical data
13.
Lupus Sci Med ; 8(1)2021 04.
Article in English | MEDLINE | ID: covidwho-1194228

ABSTRACT

OBJECTIVE: To report the results of a survey exploring the experience of patients with SLE facing hydroxychloroquine (HCQ) shortage that occurred during the early phases of the COVID-19 pandemic. METHODS: A survey was designed by Lupus Europe's patient advisory network and distributed through its social media, newsflash and members' network. People with lupus were asked about their last HCQ purchases and their level of anxiety (on a 0-10 scale) with regard to not being able to have access to HCQ, once in April 2020 (first wave) and after 11 August (second wave). The results were compared. RESULTS: 2075 patients responded during the first wave; 1001 (48.2%) could get HCQ from the first place they asked, 230 (11.1%) could get the drug by going to more than one pharmacy, 498 (24.0%) obtained HCQ later from their usual pharmacy and 126 (6.1%) from other sources. 188 (9.1%) could not get any; 32 (1.5%) did not respond to this question. All countries showed significant improvement in HCQ availability during the second wave. 562 (27.4%) patients reported an extremely high level of anxiety in wave 1 and 162 (10.3%) patients in wave 2; 589 (28.7%) and 268 (17.1%) patients reported a high level of anxiety in wave 1 and wave 2, respectively. CONCLUSIONS: The HCQ shortage had a significant impact on patients with SLE and has been responsible for psychological consequences including anxiety. Indeed, despite an objective improvement in drug availability, the event is leaving significant traces in patients' mind and behaviours.


Subject(s)
Anxiety , COVID-19 , Community Pharmacy Services/statistics & numerical data , Health Services Accessibility , Hydroxychloroquine , Lupus Erythematosus, Systemic , Antirheumatic Agents/supply & distribution , Antirheumatic Agents/therapeutic use , Anxiety/diagnosis , Anxiety/etiology , COVID-19/drug therapy , COVID-19/epidemiology , Civil Defense/methods , Civil Defense/standards , Europe/epidemiology , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Humans , Hydroxychloroquine/supply & distribution , Hydroxychloroquine/therapeutic use , Lupus Erythematosus, Systemic/drug therapy , Lupus Erythematosus, Systemic/epidemiology , Lupus Erythematosus, Systemic/psychology , Psychological Distress , SARS-CoV-2 , Self Report/statistics & numerical data , Surveys and Questionnaires
16.
Am J Public Health ; 111(5): 860-866, 2021 05.
Article in English | MEDLINE | ID: covidwho-1140582

ABSTRACT

The COVID-19 pandemic has precipitated an acute blood shortage for medical transfusions, exacerbating an already tenuous blood supply system in the United States, contributing to the public health crisis, and raising deeper questions regarding emergency preparedness planning for ensuring blood availability. However, these issues around blood availability during the pandemic are related primarily to the decline in supply caused by reduced donations during the pandemic rather than increased demand for transfusion of patients with COVID-19.The challenges to ensure a safe blood supply during the pandemic will continue until a vaccine is developed, effective treatments are available, or the virus goes away. If this virus or a similar virus were capable of transmission through blood, it would have a catastrophic impact on the health care system, causing a future public health emergency that would jeopardize the national blood supply.In this article, we identify the impact of the COVID-19 pandemic on blood supply adequacy, discuss the public health implications, propose recovery strategies, and present recommendations for preparing for the next disruption in blood supply driven by a public health emergency.


Subject(s)
Blood Safety/standards , COVID-19 , Civil Defense/standards , Public Health , Public Policy , Delivery of Health Care , Humans , United States
17.
Am J Public Health ; 111(4): 602-603, 2021 04.
Article in English | MEDLINE | ID: covidwho-1133765
19.
Vascular ; 29(6): 856-864, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1052392

ABSTRACT

BACKGROUND/OBJECTIVE: The unprecedented pandemic spread of the novel coronavirus has severely impacted the delivery of healthcare services in the United States and around the world, and has exposed a variety of inefficiencies in healthcare infrastructure. Some states have been disproportionately affected such as New York and Michigan. In fact, Detroit and its surrounding areas have been named as the initial Midwest epicenter where over 106,000 cases have been confirmed in April 2020. METHOD, RESULTS AND CONCLUSIONS: Facilities in Southeast Michigan have served as the frontline of the pandemic in the Midwest and in order to cope with the surge, rapid, and in some cases, complete restructuring of care was mandatory to effect change and attempt to deal with the emerging crisis. We describe the initial experience and response of 4 large vascular surgery health systems in Michigan to COVID-19.


Subject(s)
COVID-19 , Health Care Rationing , Hospital Restructuring , Infection Control , Resource Allocation , Vascular Diseases , Vascular Surgical Procedures , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/therapy , Civil Defense/standards , Hospital Restructuring/methods , Hospital Restructuring/organization & administration , Humans , Infection Control/methods , Infection Control/organization & administration , Michigan/epidemiology , Organizational Innovation , Patient Selection , SARS-CoV-2 , Telemedicine/organization & administration , Vascular Diseases/diagnosis , Vascular Diseases/epidemiology , Vascular Diseases/surgery , Vascular Surgical Procedures/organization & administration , Vascular Surgical Procedures/statistics & numerical data
20.
Tunis Med ; 98(10): 657-663, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1040299

ABSTRACT

OBJECTIVE: To compile the lessons learned in the Greater Maghreb, during the first six months of the fight against the COVID-19 pandemic, in the field of "capacity building" of community resilience. METHODS: An expert consultation was conducted during the first week of May 2020, using the "Delphi" technique. An email was sent requesting the formulation of a lesson, in the form of a "Public Health" good practice recommendation. The final text of the lessons was finalized by the group coordinator and validated by the signatories of the manuscript. RESULTS: A list of five lessons of resilience has been deduced and approved : 1. Elaboration of "white plans" for epidemic management; 2. Training in epidemic management; 3. Uniqueness of the health system command; 4. Mobilization of retirees and volunteers; 5. Revision of the map sanitary. CONCLUSION: Based on the evaluation of the performance of the Maghreb fight against COVID-19, characterized by low resilience, this list of lessons could constitute a roadmap for the reform of Maghreb health systems, towards more performance to manage possible waves of COVID-19 or new emerging diseases with epidemic tendency.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Delivery of Health Care/organization & administration , Delivery of Health Care/standards , Health Care Reform , Africa, Northern/epidemiology , Algeria/epidemiology , Attitude of Health Personnel , Civil Defense/methods , Civil Defense/organization & administration , Civil Defense/standards , Community Participation/methods , Conflict of Interest , Delivery of Health Care/statistics & numerical data , Delphi Technique , Expert Testimony , Global Health/standards , Health Care Reform/organization & administration , Health Care Reform/standards , Hospital Bed Capacity/standards , Hospital Bed Capacity/statistics & numerical data , Humans , Mauritania/epidemiology , National Health Programs/organization & administration , National Health Programs/standards , Pandemics , Public Health/methods , Public Health/standards , SARS-CoV-2/physiology , Tunisia/epidemiology
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