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2.
BMJ Open ; 10(11): e040547, 2020 11 27.
Article in English | MEDLINE | ID: covidwho-1024238

ABSTRACT

OBJECTIVE: To characterise published evidence regarding preclinical and clinical interventions to overcome mask shortages during epidemics and pandemics. DESIGN: Systematic scoping review. SETTINGS: All healthcare settings relevant to epidemics and pandemics. SEARCH STRATEGY: English peer-reviewed studies published from January 1995 to June 2020 were included. Literature was identified using four databases (Medline-OVID, EMBASE, CINAHL, Cochrane Library), forwards-and-backwards searching through Scopus and an extensive grey literature search. Assessment of study eligibility, data extraction and evidence appraisal were performed in duplicate by two independent reviewers. RESULTS: Of the 11 220 database citations, a total of 47 articles were included. These studies encompassed six broad categories of conservation strategies: decontamination, reusability of disposable masks and/or extended wear, layering, reusable respirators, non-traditional replacements or modifications and stockpiled masks. Promising strategies for mask conservation in the context of pandemics and epidemics include use of stockpiled masks, extended wear of disposable masks and decontamination. CONCLUSION: There are promising strategies for overcoming face mask shortages during epidemics and pandemics. Further research specific to practical considerations is required before implementation during the COVID-19 pandemic.


Subject(s)
Health Personnel , Infection Control/methods , Masks/supply & distribution , Pandemics , /prevention & control , /virology , Delivery of Health Care , Equipment Reuse , Humans , Respiratory Protective Devices
3.
Eur J Gen Pract ; 26(1): 129-133, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1024059

ABSTRACT

The COVID-19 pandemic has modified organisation and processes of primary care. In this paper, we aim to summarise experiences of international primary care systems. We explored personal accounts and findings in reporting on the early experiences from primary care during the pandemic, through the online Global Forum on Universal Health Coverage and Primary Health Care. During the early stage of the pandemic, primary care continued as the first point of contact to the health system but was poorly informed by policy makers on how to fulfil its role and ill equipped to provide care while protecting staff and patients against further spread of the infection. In many countries, the creativity and initiatives of local health professionals led to the introduction or extension of the use of telephone, e-mail and virtual consulting, and introduced triaging to separate 'suspected' COVID-19 from non-COVID-19 care. There were substantial concerns of collateral damage to the health of the population due to abandoned or postponed routine care. The pandemic presents important lessons to strengthen health systems through better connection between public health, primary care, and secondary care to cope better with future waves of this and other pandemics.


Subject(s)
Coronavirus Infections/epidemiology , Health Behavior , Physicians, Primary Care , Pneumonia, Viral/epidemiology , Primary Health Care/methods , Telemedicine , Triage , Betacoronavirus , Delivery of Health Care , Humans , Pandemics , Patient Acceptance of Health Care , Primary Health Care/organization & administration , Qualitative Research , Telephone
8.
Adv Chronic Kidney Dis ; 27(5): 383-389, 2020 09.
Article in English | MEDLINE | ID: covidwho-1019900

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2, has led to the death of hundreds of thousands of people worldwide. If infected, older individuals and those with diabetes, hypertension, cardiovascular disease, and compromised immune systems are at higher risk for unfavorable outcomes. These comorbidities are prevalent in patients with kidney disease, hence the significant burden of COVID-19 on kidney transplant programs. Multiple case series of kidney transplant recipients with COVID-19 have shown increased mortality compared to nontransplant patients. To date, we do not have high-level evidence to inform immunosuppression minimization strategies in infected transplant recipients. Most centers however have adopted early antimetabolite withdrawal in addition to other interventions. This review summarizes the published COVID-19 literature as it relates to outcomes and immunosuppression management in kidney transplant recipients. It also discusses challenges pertaining to pretransplant evaluation and wait-listed patients.


Subject(s)
/therapy , Graft Rejection/prevention & control , Immunosuppressive Agents/therapeutic use , Kidney Failure, Chronic/surgery , Kidney Transplantation , Telemedicine , /mortality , Cross Infection/prevention & control , Delivery of Health Care/methods , Deprescriptions , Humans , Immunosuppression/methods , Personal Protective Equipment , Preoperative Care , Waiting Lists
10.
JAMA ; 324(23): 2373-2375, 2020 12 15.
Article in English | MEDLINE | ID: covidwho-1017849
11.
Environ Monit Assess ; 193(1): 41, 2021 Jan 07.
Article in English | MEDLINE | ID: covidwho-1012228

ABSTRACT

The availability of safe drinking water and the proper management of wastewater in healthcare facilities are important pillars for maintaining safety of workers, patients, and visitors and protecting human health and environment. Water and sanitation services at 495 healthcare facilities in the West Bank of Palestine are assessed using the results of PCBS and MoH (2014) survey study. Services are reassessed after the COVID-10 pandemic using personal interviews with experts from healthcare facilities, regulatory authorities, and service providers. The results show that 92.1% of healthcare facilities were connected to public water networks, 12.9% of them purchased water tanks, and 10.8% of them depended on harvested rainwater which may cause contamination and waterborne diseases. Regardless the source of freshwater, the water quality has to be regularly examined and compared to local guidelines and international standards for health promotion. Almost 63.4% of healthcare facilities were not connected to wastewater networks and used either tight or porous cesspits. Once these cesspits are filled off, wastewater is randomly disposed into nearby valleys causing adverse environmental impacts on air, water, and land resources. Medical wastewater of hazardous substances should be treated before discharged to wastewater networks. Experts assured that although heightened procedures have been made by service providers to curb the spread of the COVID-19 disease, yet, more consistent protocols and stringent procedures are crucial. There have not been any new directives or procedures regarding the management of water supplies and wastewater services in the healthcare facilities. Stakeholder collaboration can help prevent the COVID-19 disease.


Subject(s)
Sanitation , Arabs , Delivery of Health Care , Environmental Monitoring , Humans , Middle East , Water , Water Supply
14.
Br J Cancer ; 123(5): 689-690, 2020 09.
Article in English | MEDLINE | ID: covidwho-1007652

ABSTRACT

The COVID-19 pandemic has had a devastating effect on human lives and society. The accompanying editorial summarises some of the major effects on cancer patients and impacts on cancer research. These may be mitigated by appropriate responses from governments, research funders, charities, universities, industry and the public. It is already clear that different approaches to management have drastically different outcomes.


Subject(s)
Betacoronavirus , Biomedical Research/trends , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Neoplasms/drug therapy , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Biomedical Research/economics , Coronavirus Infections/virology , Delivery of Health Care/trends , Humans , Neoplasms/immunology , Patient Isolation , Pneumonia, Viral/virology , Quarantine , Risk Factors
16.
N C Med J ; 82(1): 21-28, 2021.
Article in English | MEDLINE | ID: covidwho-1006795

ABSTRACT

BACKGROUND An integrated nonprofit health care system with 13 North Carolina medical centers conducted a time-pressured quality improvement simulation of its plan to implement the "North Carolina Protocol for Allocating Scarce Inpatient Critical Care Resources in a Pandemic" attendant to pandemic scenario planning. Simulation objectives included assessing the plan in terms of a) efficiency and effectiveness; b) comorbidity scoring validity; c) impact by race/ethnicity, gender, age, and payer status; and d) simulation participant impressions of potential impact on clinicians.METHOD The simulation scenario involved scoring 14 patients with the constraint that only 10 could be afforded critical care resources. Also included were independent scoring validation by four clinicians, structured debriefs with simulation participants and observers, and tracking patient outcomes for 30 days.RESULTS Triage scoring was identical among four triage teams. Lack of concordance in clinician comorbidity scoring did not alter patient prioritization for withdrawal of treatment in this small cohort. Protocol scoring was not correlated with resource utilization or near-term mortality.LIMITATIONS The simulation sample was small and selected when COVID-19 census was temporarily waning. No protocol for pediatric patients was tested.CONCLUSIONS The simulation yielded resource allocation concordance using comorbidity scoring by attending physicians, which significantly accelerated triage team decision-making and did not result in notable disparities by race/ethnicity, gender, or advanced age. Qualitative findings surfaced tensions in balancing de-identified data with individualized assessment and in trusting the clinical judgments of other physicians. Additional research is needed to validate the protocol's predictive value related to patient outcomes.


Subject(s)
Critical Care , Pandemics , Child , Delivery of Health Care , Hospitals , Humans , Inpatients , North Carolina/epidemiology
17.
Colomb Med (Cali) ; 51(3): e204534, 2020 Sep 30.
Article in English | MEDLINE | ID: covidwho-1005347

ABSTRACT

Background: Valle del Cauca is the region with the fourth-highest number of COVID-19 cases in Colombia (>50,000 on September 7, 2020). Due to the lack of anti-COVID-19 therapies, decision-makers require timely and accurate data to estimate the incidence of disease and the availability of hospital resources to contain the pandemic. Methods: We adapted an existing model to the local context to forecast COVID-19 incidence and hospital resource use assuming different scenarios: (1) the implementation of quarantine from September 1st to October 15th (average daily growth rate of 2%); (2-3) partial restrictions (at 4% and 8% growth rates); and (4) no restrictions, assuming a 10% growth rate. Previous scenarios with predictions from June to August were also presented. We estimated the number of new cases, diagnostic tests required, and the number of available hospital and intensive care unit (ICU) beds (with and without ventilators) for each scenario. Results: We estimated 67,700 cases by October 15th when assuming the implementation of a quarantine, 80,400 and 101,500 cases when assuming partial restrictions at 4% and 8% infection rates, respectively, and 208,500 with no restrictions. According to different scenarios, the estimated demand for reverse transcription-polymerase chain reaction tests ranged from 202,000 to 1,610,600 between September 1st and October 15th. The model predicted depletion of hospital and ICU beds by September 20th if all restrictions were to be lifted and the infection growth rate increased to 10%. Conclusion: Slowly lifting social distancing restrictions and reopening the economy is not expected to result in full resource depletion by October if the daily growth rate is maintained below 8%. Increasing the number of available beds provides a safeguard against slightly higher infection rates. Predictive models can be iteratively used to obtain nuanced predictions to aid decision-making.


Subject(s)
/therapy , Delivery of Health Care/statistics & numerical data , Health Resources/statistics & numerical data , Models, Statistical , /epidemiology , Colombia , Health Resources/supply & distribution , Hospital Bed Capacity/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data
18.
Sr Care Pharm ; 36(1): 6-10, 2021 Jan 01.
Article in English | MEDLINE | ID: covidwho-1004901

ABSTRACT

The Veterans' Medicines Advice and Therapeutics Education Services (MATES) program is a national data driven, behaviorally informed, health intervention to improve the use of medicines among Australian veterans. The program, which has been operating since 2004, has led the way in the use of government held data assets to generate evidenced-based health information, which, when provided to clinicians alongside educational materials, can make demonstrable improvements in health and promote practice change.


Subject(s)
Public Health , Australia , Delivery of Health Care , Humans
19.
Clin Cancer Res ; 26(22): 5809-5813, 2020 11 15.
Article in English | MEDLINE | ID: covidwho-1004223

ABSTRACT

Coronavirus disease 2019 (COVID-19) has fundamentally disrupted the practice of oncology, shifting care onto virtual platforms, rearranging the logistics and economics of running a successful clinical practice and research, and in some contexts, redefining what treatments patients with cancer should and can receive. Since the start of the pandemic in early 2020, there has been considerable emphasis placed on the implications for patients with cancer in terms of their vulnerability to the virus and potential exposure in healthcare settings. But little emphasis has been placed on the significant, and potentially enduring, consequences of COVID-19 for how cancer care is delivered. In this article, we outline the importance of a focus on the effects of COVID-19 for oncology practice during and potentially after the pandemic, focusing on key shifts that are already evident, including: the pivot to online consultations, shifts in access to clinical trial and definitions of "essential care," the changing economics of practice, and the potential legacy effects of rapidly implemented changes in cancer care. COVID-19 is reshaping oncology practice, clinical trials, and delivery of cancer care broadly, and these changes might endure well beyond the short- to mid-term of the active pandemic. Therefore, shifts in practice brought about by the pandemic must be accompanied by improved training and awareness, enhanced infrastructure, and evidence-based support if they are to harness the positives and offset the potential negative consequences of the impacts of COVID-19 on cancer care.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/complications , Delivery of Health Care/standards , Neoplasms/therapy , Pneumonia, Viral/complications , Practice Guidelines as Topic/standards , Telemedicine/methods , Coronavirus Infections/virology , Humans , Neoplasms/epidemiology , Neoplasms/virology , Pandemics , Pneumonia, Viral/virology
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