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4.
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
10.
Inquiry ; 58: 46958021997337, 2021.
Article in English | MEDLINE | ID: covidwho-1120253

ABSTRACT

The coronavirus disease pandemic has created a crisis for patients with chronic kidney disease, as far as getting treatment facilities are concerned. The crisis is more intense in developing countries where the health system is more vulnerable due to poor infrastructures and insufficient health professionals. Bangladesh, being a developing nation, is also facing similar challenges to provide sufficient services to patients with chronic kidney disease. In this short report, we have discussed the challenges and barriers non-COVID chronic kidney disease patients are facing in terms of healthcare access along with getting proper medical interventions and suggested probable strategies to minimize the suffering.


Subject(s)
COVID-19/epidemiology , Health Services Accessibility/organization & administration , Health Services Needs and Demand/organization & administration , Renal Insufficiency, Chronic/therapy , Telemedicine/organization & administration , Bangladesh , Developing Countries , Humans , Preventive Health Services/organization & administration , Severity of Illness Index
12.
J Am Board Fam Med ; 34(Suppl): S85-S94, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1099981

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak poses serious health risks, particularly for older adults and persons with underlying chronic medical conditions. Community health centers (CHCs) serve as the patient medical home for populations that are disproportionately more susceptible to COVID-19; yet, there is a lack of understanding of current efforts in place by CHCs to prepare for and respond to the pandemic. METHODS: We used a comprehensive cross-sectional survey and focus groups with health care personnel to understand the needs and current efforts in place by CHCs, and we derived themes from the focus group data. RESULTS: Survey respondents (n = 234; 19% response rate) identified COVID-19 infection prevention and control (76%), safety precautions (72%), and screening, diagnostic testing, and management of patients (66%) as major educational needs. Focus group findings (n = 39) highlighted 5 key themes relevant to readiness: leadership, resources, workforce capacity, communication, and formal policies and procedures. CONCLUSION: The COVID-19 pandemic has exacerbated long-standing CHC capacity issues making it challenging for them to adequately respond to the outbreak. Policies promoting greater investment in CHCs may strengthen them to better meet the needs of the most vulnerable members of society, and thereby help flatten the curve.


Subject(s)
Capacity Building , Community Health Centers/organization & administration , Delivery of Health Care/organization & administration , Health Services Needs and Demand/organization & administration , COVID-19/economics , COVID-19/prevention & control , Community Health Centers/economics , Cross-Sectional Studies , Focus Groups , Humans , Pandemics , Qualitative Research , SARS-CoV-2 , Surveys and Questionnaires , Workforce/organization & administration
14.
Int J Epidemiol ; 49(5): 1443-1453, 2020 10 01.
Article in English | MEDLINE | ID: covidwho-1066328

ABSTRACT

BACKGROUND: While the COVID-19 outbreak in China now appears suppressed, Europe and the USA have become the epicentres, both reporting many more deaths than China. Responding to the pandemic, Sweden has taken a different approach aiming to mitigate, not suppress, community transmission, by using physical distancing without lockdowns. Here we contrast the consequences of different responses to COVID-19 within Sweden, the resulting demand for care, intensive care, the death tolls and the associated direct healthcare related costs. METHODS: We used an age-stratified health-care demand extended SEIR (susceptible, exposed, infectious, recovered) compartmental model for all municipalities in Sweden, and a radiation model for describing inter-municipality mobility. The model was calibrated against data from municipalities in the Stockholm healthcare region. RESULTS: Our scenario with moderate to strong physical distancing describes well the observed health demand and deaths in Sweden up to the end of May 2020. In this scenario, the intensive care unit (ICU) demand reaches the pre-pandemic maximum capacity just above 500 beds. In the counterfactual scenario, the ICU demand is estimated to reach ∼20 times higher than the pre-pandemic ICU capacity. The different scenarios show quite different death tolls up to 1 September, ranging from 5000 to 41 000, excluding deaths potentially caused by ICU shortage. Additionally, our statistical analysis of all causes excess mortality indicates that the number of deaths attributable to COVID-19 could be increased by 40% (95% confidence interval: 0.24, 0.57). CONCLUSION: The results of this study highlight the impact of different combinations of non-pharmaceutical interventions, especially moderate physical distancing in combination with more effective isolation of infectious individuals, on reducing deaths, health demands and lowering healthcare costs. In less effective mitigation scenarios, the demand on ICU beds would rapidly exceed capacity, showing the tight interconnection between the healthcare demand and physical distancing in the society. These findings have relevance for Swedish policy and response to the COVID-19 pandemic and illustrate the importance of maintaining the level of physical distancing for a longer period beyond the study period to suppress or mitigate the impacts from the pandemic.


Subject(s)
COVID-19 , Communicable Disease Control , Health Care Costs/trends , Health Services Needs and Demand , Mortality/trends , COVID-19/economics , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/methods , Communicable Disease Control/statistics & numerical data , Epidemiological Monitoring , Health Services Needs and Demand/organization & administration , Health Services Needs and Demand/trends , Humans , Models, Theoretical , Patient Isolation , Physical Distancing , SARS-CoV-2 , Sweden/epidemiology
15.
Am J Phys Med Rehabil ; 100(4): 327-330, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1048465

ABSTRACT

ABSTRACT: Since March 2020, when COVID-19 pandemic broke out, the world's healthcare systems' main concern has been fighting the pandemic. However, patients with other diseases, also requiring rehabilitation evaluations and treatments, continued to need care. Our rehabilitation unit managed to maintain contact with patients through alternative communication methods even during the lockdown period and in a situation of staff shortage. If face-to-face evaluations and treatments were necessary, preventive measures were followed to avoid hospital-associated contagion. Rehabilitation beds were cleared to leave them to the acute wards, and consultations for the acute care patients were carried out using personal protective equipment. In the future, the lessons from our experience could contribute toward drawing a plan of measures applicable in similar situations and some of these actions could become part of the rehabilitative practice.


Subject(s)
Health Services Needs and Demand/organization & administration , Organizational Innovation , Referral and Consultation/organization & administration , Rehabilitation Centers/organization & administration , Telemedicine/organization & administration , COVID-19 , Humans , Italy , National Health Programs/organization & administration
16.
Clin Lab ; 67(1)2021 Jan 01.
Article in English | MEDLINE | ID: covidwho-1045292

ABSTRACT

BACKGROUND: The COVID-19 outbreak, which began in late 2019, continues to ravage the globe and has become the greatest threat to human health. As nucleic acid test is the primary means of screening for COVID-19, this makes the laboratory the most important node in the epidemic prevention and control system. METHODS: As a small laboratory in the hospital, we can meet a large number of demands for nucleic acid test by optimizing staff process, strictly disinfecting experimental batches and changing experimental methods. RESULTS: Through the improvement of the above aspects, our daily maximum detection quantity has been increased from 256/day to 1,012/day. Besides, none of the medical staff has been infected. And there have been no nosocomial infections. CONCLUSIONS: Nucleic acid laboratories, especially small laboratories, should promptly adjust their strategies in the face of unexpected outbreaks and conduct risk assessment in accordance with laboratory activities.


Subject(s)
COVID-19 Nucleic Acid Testing , COVID-19/diagnosis , COVID-19/virology , Health Services Needs and Demand/organization & administration , Mass Screening/organization & administration , Specimen Handling , Workflow , Workload , Humans , Infection Control/organization & administration , Occupational Health , Predictive Value of Tests
18.
J Am Heart Assoc ; 9(14): e017443, 2020 07 21.
Article in English | MEDLINE | ID: covidwho-980909

ABSTRACT

Coronavirus disease 2019 is a global pandemic affecting >3 million people in >170 countries, resulting in >200 000 deaths; 35% to 40% of patients and deaths are in the United States. The coronavirus disease 2019 crisis is placing an enormous burden on health care in the United States, including residency and fellowship training programs. The balance between mitigation, training and education, and patient care is the ultimate determinant of the role of cardiology fellows in training during the coronavirus disease 2019 crisis. On March 24, 2020, the Accreditation Council for Graduate Medical Education issued a formal response to the pandemic crisis and described a framework for operation of graduate medical education programs. Guidance for deployment of cardiology fellows in training during the coronavirus disease 2019 crisis is based on the principles of a medical mission, and adherence to preparation, protection, and support of our fellows in training. The purpose of this review is to describe our departmental strategic deployment of cardiology fellows in training using the Accreditation Council for Graduate Medical Education framework for pandemic preparedness.


Subject(s)
Cardiologists/organization & administration , Certification/organization & administration , Coronavirus Infections/therapy , Delivery of Health Care/organization & administration , Education, Medical, Graduate , Health Services Needs and Demand/organization & administration , Health Workforce/organization & administration , Personnel Staffing and Scheduling/organization & administration , Pneumonia, Viral/therapy , Betacoronavirus/pathogenicity , COVID-19 , Cardiologists/economics , Clinical Competence , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Humans , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Program Development , Program Evaluation , SARS-CoV-2 , Specialization , Workload
19.
Anesth Analg ; 131(2): 351-364, 2020 08.
Article in English | MEDLINE | ID: covidwho-980720

ABSTRACT

Health care systems are belligerently responding to the new coronavirus disease 2019 (COVID-19). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance. When a patient requires intubation and invasive ventilation, the outcome is poor, and the length of stay in the intensive care unit (ICU) is usually 2 or 3 weeks. In this article, the authors review several technological devices, which could support health care providers at the bedside to optimize the care for COVID-19 patients who are sedated, paralyzed, and ventilated. Particular attention is provided to the use of videolaryngoscopes (VL) because these can assist anesthetists to perform a successful intubation outside the ICU while protecting health care providers from this viral infection. Authors will also review processed electroencephalographic (EEG) monitors which are used to better titrate sedation and the train-of-four monitors which are utilized to better administer neuromuscular blocking agents in the view of sparing limited pharmacological resources. COVID-19 can rapidly exhaust human and technological resources too within the ICU. This review features a series of technological advancements that can significantly improve the care of patients requiring isolation. The working conditions in isolation could cause gaps or barriers in communication, fatigue, and poor documentation of provided care. The available technology has several advantages including (a) facilitating appropriate paperless documentation and communication between all health care givers working in isolation rooms or large isolation areas; (b) testing patients and staff at the bedside using smart point-of-care diagnostics (SPOCD) to confirm COVID-19 infection; (c) allowing diagnostics and treatment at the bedside through point-of-care ultrasound (POCUS) and thromboelastography (TEG); (d) adapting the use of anesthetic machines and the use of volatile anesthetics. Implementing technologies for safeguarding health care providers as well as monitoring the limited pharmacological resources are paramount. Only by leveraging new technologies, it will be possible to sustain and support health care systems during the expected long course of this pandemic.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/therapy , Critical Care/organization & administration , Delivery of Health Care, Integrated/organization & administration , Health Resources/organization & administration , Health Services Accessibility/organization & administration , Infection Control/organization & administration , Pneumonia, Viral/therapy , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Coronavirus Infections/virology , Health Services Needs and Demand/organization & administration , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Needs Assessment/organization & administration , Occupational Exposure/adverse effects , Occupational Exposure/prevention & control , Occupational Health , Pandemics , Patient Care Team/organization & administration , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Point-of-Care Systems/organization & administration , Point-of-Care Testing/organization & administration , Risk Factors , SARS-CoV-2 , Severity of Illness Index
20.
Acad Med ; 96(3): 340-342, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-983936

ABSTRACT

During the COVID-19 pandemic, there has been a global shift toward online distance learning due to travel limitations and physical distancing requirements as well as medical school and university closures. In low- and middle-income countries like Nepal, where medical education faces a range of challenges-such as lack of infrastructure, well-trained educators, and advanced technologies-the abrupt changes in methodologies without adequate preparation are more challenging than in higher-income countries. In this article, the authors discuss the COVID-19-related changes and challenges in Nepal that may have a drastic impact on the career progression of current medical students. Outside the major cities, Nepal lacks dependable Internet services to support medical education, which frequently requires access to and transmission of large files and audiovisual material. Thus, students who are poor, who are physically disadvantaged, and who do not have a home situation conducive to online study may be affected disproportionately. Further, the majority of teachers and students do not have sufficient logistical experience and knowledge to conduct or participate in online classes. Moreover, students and teachers are unsatisfied with the digital methodologies, which will ultimately hamper the quality of education. Students' clinical skills development, research activities, and live and intimate interactions with other individuals are being affected. Even though Nepal's medical education system is struggling to adapt to the transformation of teaching methodologies in the wake of the pandemic, it is important not to postpone the education of current medical students and future physicians during this crisis. Looking ahead, medical schools in Nepal should ensure that mechanisms are proactively put into place to embrace new educational opportunities and technologies to guarantee a regular supply of high-quality physicians capable of both responding effectively to any future pandemic and satisfying the nation's future health care needs.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Developing Countries , Education, Medical/organization & administration , Clinical Competence , Education, Distance/organization & administration , Education, Distance/trends , Education, Medical/trends , Forecasting , Health Services Needs and Demand/organization & administration , Health Services Needs and Demand/trends , Humans , Industrial Development/trends , Nepal , Research/organization & administration , Research/trends , Teaching/organization & administration , Teaching/trends
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