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1.
J Cyst Fibros ; 20 Suppl 3: 16-20, 2021 12.
Article in English | MEDLINE | ID: covidwho-1587336

ABSTRACT

BACKGROUND: Chronic care delivery models faced unprecedented financial pressures, with a reduction of in-person visits and adoption of telehealth during the COVID-19 pandemic. We sought to understand the reported financial impact of pandemic-related changes to the cystic fibrosis (CF) care model. METHODS: The U.S. CF Foundation State of Care surveys fielded in Summer 2020 (SoC1) and Spring 2021 (SoC2) included questions for CF programs on the impact of pandemic-related restrictions on overall finances, staffing, licensure, and reimbursement of telehealth services. Descriptive analyses were conducted based on program type. RESULTS: Among the 286 respondents (128 pediatric, 118 adult, 40 affiliate), the majority (62%) reported a detrimental financial impact to their CF care program in SoC1, though fewer (42%) reported detrimental impacts in SoC2. The most common reported impacts in SoC1 were redeployment of clinical staff (68%), furloughs (52%), hiring freezes (51%), decreases in salaries (34%), or layoffs (10%). Reports of lower reimbursement for telehealth increased from 30% to 40% from SoC1 to SoC2. Projecting towards the future, only a minority (17%) of program directors in SoC2 felt that financial support would remain below pre-pandemic levels. CONCLUSIONS: The COVID-19 pandemic resulted in financial strain on the CF care model, including challenges with reimbursement for telehealth services and reductions in staffing due to institutional changes. Planning for the future of CF care model needs to address these short-term impacts, particularly to ensure a lack of interruption in high-quality multi-disciplinary care.


Subject(s)
COVID-19 , Continuity of Patient Care , Cystic Fibrosis , Health Services Accessibility , Models, Organizational , Telemedicine , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Child , Continuity of Patient Care/organization & administration , Continuity of Patient Care/standards , Costs and Cost Analysis , Cystic Fibrosis/economics , Cystic Fibrosis/epidemiology , Cystic Fibrosis/therapy , Health Services Accessibility/organization & administration , Health Services Accessibility/trends , Health Services Needs and Demand , Humans , Organizational Innovation , Personnel Staffing and Scheduling/organization & administration , Reimbursement Mechanisms/trends , SARS-CoV-2 , Telemedicine/economics , Telemedicine/methods , United States/epidemiology
6.
Curr Med Res Opin ; 37(11): 1957-1959, 2021 11.
Article in English | MEDLINE | ID: covidwho-1500877
7.
J Public Health Manag Pract ; 27(5): 492-500, 2021.
Article in English | MEDLINE | ID: covidwho-1501235

ABSTRACT

OBJECTIVES: To examine levels of expenditure and needed investment in public health at the local level in the state of Ohio pre-COVID-19. DESIGN: Using detailed financial reporting from fiscal year (FY) 2018 from Ohio's local health departments (LHDs), we characterize spending by Foundational Public Health Services (FPHS). We also constructed estimates of the gap in public health spending in the state using self-reported gaps in service provision and a microsimulation approach. Data were collected between January and June 2019 and analyzed between June and September 2019. PARTICIPANTS: Eighty-four of the 113 LHDs in the state of Ohio covering a population of almost 9 million Ohioans. RESULTS: In FY2018, Ohio LHDs spent an average of $37 per capita on protecting and promoting the public's health. Approximately one-third of this investment supported the Foundational Areas (communicable disease control; chronic disease and injury prevention; environmental public health; maternal, child, and family health; and access to and linkages with health care). Another third supported the Foundational Capabilities, that is, the crosscutting skills and capacities needed to support all LHD activities. The remaining third supported programs and activities that are responsive to local needs and vary from community to community. To fully meet identified LHD needs in the state pre-COVID-19, Ohio would require an additional annual investment of $20 per capita on top of the current $37 spent per capita, or approximately $240 million for the state. CONCLUSIONS: A better understanding of the cost and value of public health services can educate policy makers so that they can make informed trade-offs when balancing health care, public health, and social services investments. The current environment of COVID-19 may dramatically increase need, making understanding and growing public health investment critical.


Subject(s)
Health Care Costs/statistics & numerical data , Health Services Needs and Demand/economics , Public Health Practice/economics , Public Health/economics , COVID-19/economics , Financing, Government/economics , Humans , Local Government , Ohio
8.
Can J Surg ; 64(5): E540, 2021.
Article in English | MEDLINE | ID: covidwho-1496554
12.
Acta Myol ; 40(3): 113-115, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1464223

ABSTRACT

COVID-19 outbreak has quickly reached alarming morbidity and mortality with vaccines being the only weapon to fight. Although the critical situation, no international guidelines on the vaccination management of patients with neuromuscular disorders (NMDs) has still been issued. We aimed to address some unmet needs about the management of COVID-19 vaccination in patients with NMDs.


Subject(s)
COVID-19 Vaccines/administration & dosage , Health Services Needs and Demand , Neuromuscular Diseases , Female , Humans , Male , Pandemics , Patient Safety , SARS-CoV-2
14.
Lancet Psychiatry ; 8(10): 929-936, 2021 10.
Article in English | MEDLINE | ID: covidwho-1415873

ABSTRACT

Informal (unpaid) carers are an integral part of all societies and the health and social care systems in the UK depend on them. Despite the valuable contributions and key worker status of informal carers, their lived experiences, wellbeing, and needs have been neglected during the COVID-19 pandemic. In this Health Policy, we bring together a broad range of clinicians, researchers, and people with lived experience as informal carers to share their thoughts on the impact of the COVID-19 pandemic on UK carers, many of whom have felt abandoned as services closed. We focus on the carers of children and young people and adults and older adults with mental health diagnoses, and carers of people with intellectual disability or neurodevelopmental conditions across different care settings over the lifespan. We provide policy recommendations with the aim of improving outcomes for all carers.


Subject(s)
COVID-19/psychology , Caregivers/psychology , Health Policy/legislation & jurisprudence , Health Services Needs and Demand/legislation & jurisprudence , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Caregivers/economics , Child , Child, Preschool , Female , Health Services Needs and Demand/trends , Humans , Intellectual Disability/epidemiology , Intellectual Disability/psychology , Life Change Events , Male , Mental Disorders/epidemiology , Mental Disorders/psychology , Morbidity/trends , Neurodevelopmental Disorders/epidemiology , Neurodevelopmental Disorders/psychology , SARS-CoV-2/genetics , Social Support , United Kingdom/epidemiology , Young Adult
15.
Br J Radiol ; 94(1126): 20210221, 2021 Oct 01.
Article in English | MEDLINE | ID: covidwho-1406740

ABSTRACT

OBJECTIVES: For optimal utilization of healthcare resources, there is a critical need for early identification of COVID-19 patients at risk of poor prognosis as defined by the need for intensive unit care and mechanical ventilation. We tested the feasibility of chest X-ray (CXR)-based radiomics metrics to develop machine-learning algorithms for predicting patients with poor outcomes. METHODS: In this Institutional Review Board (IRB) approved, Health Insurance Portability and Accountability Act (HIPAA) compliant, retrospective study, we evaluated CXRs performed around the time of admission from 167 COVID-19 patients. Of the 167 patients, 68 (40.72%) required intensive care during their stay, 45 (26.95%) required intubation, and 25 (14.97%) died. Lung opacities were manually segmented using ITK-SNAP (open-source software). CaPTk (open-source software) was used to perform 2D radiomics analysis. RESULTS: Of all the algorithms considered, the AdaBoost classifier performed the best with AUC = 0.72 to predict the need for intubation, AUC = 0.71 to predict death, and AUC = 0.61 to predict the need for admission to the intensive care unit (ICU). AdaBoost had similar performance with ElasticNet in predicting the need for admission to ICU. Analysis of the key radiomic metrics that drive model prediction and performance showed the importance of first-order texture metrics compared to other radiomics panel metrics. Using a Venn-diagram analysis, two first-order texture metrics and one second-order texture metric that consistently played an important role in driving model performance in all three outcome predictions were identified. CONCLUSIONS: Considering the quantitative nature and reliability of radiomic metrics, they can be used prospectively as prognostic markers to individualize treatment plans for COVID-19 patients and also assist with healthcare resource management. ADVANCES IN KNOWLEDGE: We report on the performance of CXR-based imaging metrics extracted from RT-PCR positive COVID-19 patients at admission to develop machine-learning algorithms for predicting the need for ICU, the need for intubation, and mortality, respectively.


Subject(s)
COVID-19/diagnostic imaging , Machine Learning , Pneumonia, Viral/diagnostic imaging , Radiography, Thoracic , Adult , Aged , COVID-19/therapy , Critical Care/statistics & numerical data , Early Diagnosis , Female , Health Services Needs and Demand , Humans , Male , Middle Aged , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Predictive Value of Tests , Prognosis , Respiration, Artificial/statistics & numerical data , Retrospective Studies , SARS-CoV-2
17.
Exp Clin Transplant ; 18(Suppl 2): 31-42, 2020 07.
Article in English | MEDLINE | ID: covidwho-1405517

ABSTRACT

Tamil Nadu, Gujarat, Telangana, Maharashtra, Kerala, Chandigarh, Karnataka, National Capital Territory of Delhi, and Rajasthan are states and union territories having active deceased-donor organ transplant programs in India. Transplant data (2013-2018) have been collected by the National Organ and Tissue Transplant Organization from all states and union territories of India and submitted to the Global Observatory on Donation and Transplantation. From 2013 to 2018, 49155 transplants were reported in India, including 39000 living-donor organ recipients and 10 155 deceased-donor organ recipients. These transplants were for kidney (living donor = 32584, deceased donor = 5748), liver (living donor = 6416, deceased donor = 2967), heart (deceased donor = 895), lung (deceased donor = 459), pancreas (deceased donor = 78), and small bowel (deceased donor = 8). According to 2018 data, India was the second largest transplanting country in the world in terms of the absolute number of transplants. Here, we discuss the status, progress, challenges, and solutions for deceaseddonor organ transplantation. The plan to increase rates of organ donation in India include the following points: teamwork and focus by intensive care unit doctors; public education on organ donation using social media; professional education and family donation conversation programs for brain death declaration and donor management; organ procurement organizations; international collaboration and regular meetings and updates for organizations working in the field of organ transplantation; grief counseling and reporting of potential donation for families of recently deceased people; nonfinancial incentivization to families of potential organ donors; expert committees and standard operating protocols for use of marginal donor organs, donation after circulatory death programs, and machine perfusion; maintenance of transparency and ethics in organ donation, allocation, and transplantation as directed by governmental, nongovernmental, and intergovernmental entities; and regular audit of progress and registry data.


Subject(s)
Brain Death , Organ Transplantation , Tissue Donors/supply & distribution , Tissue and Organ Procurement , Attitude to Death , COVID-19 , Health Education , Health Knowledge, Attitudes, Practice , Health Services Needs and Demand , Humans , India , Religion and Medicine , Time Factors
18.
PLoS One ; 16(9): e0256361, 2021.
Article in English | MEDLINE | ID: covidwho-1403300

ABSTRACT

BACKGROUND: Critical illness is common throughout the world and has been the focus of a dramatic increase in attention during the COVID-19 pandemic. Severely deranged vital signs such as hypoxia, hypotension and low conscious level can identify critical illness. These vital signs are simple to check and treatments that aim to correct derangements are established, basic and low-cost. The aim of the study was to estimate the unmet need of such essential treatments for severely deranged vital signs in all adults admitted to hospitals in Malawi. METHODS: We conducted a point prevalence cross-sectional study of adult hospitalized patients in Malawi. All in-patients aged ≥18 on single days Queen Elizabeth Central Hospital (QECH) and Chiradzulu District Hospital (CDH) were screened. Patients with hypoxia (oxygen saturation <90%), hypotension (systolic blood pressure <90mmHg) and reduced conscious level (Glasgow Coma Scale <9) were included in the study. The a-priori defined essential treatments were oxygen therapy for hypoxia, intravenous fluid for hypotension and an action to protect the airway for reduced consciousness (placing the patient in the lateral position, insertion of an oro-pharyngeal airway or endo-tracheal tube or manual airway protection). RESULTS: Of the 1135 hospital in-patients screened, 45 (4.0%) had hypoxia, 103 (9.1%) had hypotension, and 17 (1.5%) had a reduced conscious level. Of those with hypoxia, 40 were not receiving oxygen (88.9%). Of those with hypotension, 94 were not receiving intravenous fluids (91.3%). Of those with a reduced conscious level, nine were not receiving an action to protect the airway (53.0%). CONCLUSION: There was a large unmet need of essential treatments for critical illness in two hospitals in Malawi.


Subject(s)
COVID-19/epidemiology , Critical Illness/epidemiology , Health Services Needs and Demand/statistics & numerical data , Hypotension/epidemiology , Hypoxia/epidemiology , Pandemics , Adult , Aged , Cross-Sectional Studies , Female , Hospitalization , Humans , Malawi/epidemiology , Male , Middle Aged
19.
BMC Neurol ; 21(1): 345, 2021 Sep 09.
Article in English | MEDLINE | ID: covidwho-1403229

ABSTRACT

BACKGROUND: The nature of COVID-19 pandemic measures has altered the clinical management of migraine, and has also created barriers to evaluate the impact of such measures of migraine patients. Using the Migraine Buddy smartphone application, we assessed the impact of the COVID-19 pandemic on migraine in users residing in the United States. METHODS: Migraine Buddy is a smartphone application by individuals to record their migraine headache episodes, characteristics, and coping mechanisms. For this study, anonymized self-reported data from 163,176 adult Migraine Buddy users in the United States between January 2020 and May 2020, were analyzed for migraines associated with stress. A stress-related migraine is defined as one in which stress or anxiety was reported as a trigger or symptom. A questionnaire on the impact of COVID-19 on migraine and its management was also completed by 923 users from the United States in the app between April 2020 and May 2020. RESULTS: 88% of the Migraine Buddy database extract and 84% of the respondents are female, with a mean age of 36.2 years. The proportion of stress-related migraine attacks peaked at 53% on March 21 to 23, although the number of migraine attacks decreased. This followed the declaration of the COVID-19 national emergency on March 13 and a spike in the number of COVID-19 cases in the United States. Questionnaire respondents felt that the following added more stress: social isolation (22.6%), information overdose (21.2%), access to essentials (food, medication, etc.) (18.7%), and financial concerns (17.8%). To help manage migraine during COVID-19, respondents suggested stress and diet coaching programs and resources (medical articles, etc.) (34.0%), having the option for home delivery of medication (30.6%) and tele-consulting (25.5%). CONCLUSION: Here, we report the change in the proportion of self-reported stress-related migraine in relation to evolution of the COVID-19 pandemic, as well as its impact of migraine management. Our data will help increase the understanding of patients' needs and help with planning and execution of mitigating strategies.


Subject(s)
COVID-19 , Migraine Disorders , Mobile Applications , Adult , Female , Health Services Needs and Demand , Humans , Male , Middle Aged , Migraine Disorders/drug therapy , Migraine Disorders/epidemiology , Pandemics , SARS-CoV-2 , United States/epidemiology , Young Adult
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