Establishment of medical service protocols in large public hospitals for the prevention and control of coronavirus disease 2019.

Coronavirus disease 2019(COVID-19) poses a challenge to hospitals for the prevention and control of public health emergencies. As the main battlefield of preventing and controlling COVID-19, large public hospitals should develop service protocols of diagnosis and treatment for outpatient, emergency, hospitalization, surgery, and discharge. The construction of medical protocols should be based on the risk factors of key points and focused on pre-inspection triage and screening, to establish a rapid response mechanism to deal with exogenous and endogenous risk factors. Implementation of all-staff training and assessment, strengthening the information system, and use of medical internet service are important. This study explores the construction of medical protocols in large public hospitals during the pandemic, and provides a reference for the orderly diagnosis and treatment in hospitals during the pandemic.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.

Information Systems Resilience: The Role of Flexibility and Stability

This paper contributes to conceptualization of information system resilience. By building upon and extending the framework of Heeks and Ospina (2019), we argue that an information system's ability to be resilient lies in its balance between stability and flexibility. Based on empirical findings we suggest that a stable core and flexibility to change is crucial when a digital system is faced with unforeseen adversities. We hope to contribute to more theorizing of the information system resilience and inspire further research on this subject. The paper may also have practical value for stakeholders working with implementation of national information systems in the health sector. This is a qualitative case study conducted together with the Health Information Systems Programme (HISP) at the Institute of Informatics, University of Oslo. Our findings are based on empirical insights related to the DHIS2 software during the Covid-19 response. © 2022 Owner/Author.

The Effect of the COVID- 19 Outbreak on Intensive Care in Northern Saitama, Japan

Background: The 2020 COVID- 19 pandemic had various effects on local healthcare. The aim of this study was to assess the extent to which local healthcare and healthcare workers were affected by the COVID- 19 pandemic. Method(s): In this observational study we examined and compared intensive care units (ICUs) before (2019) and during (2020) the COVID- 19 pandemic to assess its effects. Emergency patient data were obtained from the Saitama Prefecture Emergency Medical Information System. The effect of COVID- 19 on emergency care responses was compared with the admission and refusal of patients in 2019 and 2020. We also examined the number of patients who were admitted to ICUs and required surgery. The effect on ICUs was examined with the number of Nurses' incident reports and severity percentages calculated from the integrated team medical care and safety system. We also compared the overtime hours of physicians on the basis of employment records. Result(s): In 2019, 2,136 emergency requests were made to admit patients, and 1,811 patients (85%) were admitted. In contrast, in 2020, 2,371 emergency requests were made, and 1,822 patients (76%) were admitted, representing a decrease to 76% (p = 0.931). The percentage of patients for whom admission was refused was significantly greater in 2020 (506 patients, 21.3%) than in 2019 (303 patients, 14.1%;p = 0.0004). In 2020, the number of neurosurgical, cardiac, and vascular operations increased and, over time, the number of operations increased for all surgical units. The number of incidents reported in ICUs increased significantly from 396 in 2019 to 510 in 2020 (p = 0.001). Conclusion(s): Although intensive care management was restricted, the numbers of patients and physician overtime hours were greater during the COVID- 19 pandemic than before, and the resulting environment led to an increase in the number of incidents. The ICU environments must be proactively improved to prepare for more severe situations in the future.Copyright © 2022 Jikei University School of Medicine. All rights reserved.

OPTIMIZATION OF INTERDEPARTMENTAL ELECTRONIC INTERACTION OF THE MILITARY COMMISSARIAT IN THE ORGANIZATION AND CONDUCT OF MEDICAL EXAMINATION OF CITIZENS SUBJECT TO CONSCRIPTION

The military commissariat requests information characterizing their state of health in order to study the state of health of citizens subject to conscription before the next conscription of citizens for military service. An interdepartmental request for this information's provision to medical organizations and institutions of medical and social expertise is encouraging to be issued in the form of an electronic document using a unified system of interdepartmental electronic interaction, taking into account the trends in the development of the public administration system. Interdepartmental interaction optimization through creation of an electronic interaction mechanism will allow military commissariats to promptly exchange information in real-time characterizing the citizens' state of health subject to conscription for military service with medical organizations of the state and municipal health care system, and federal state institutions of medical and social expertise. The direct connection of the military commissariat to the state information system in the field of healthcare of the subject of the Russian Federation by means of cryptographic protection of information will contribute to improving the quality as well as deceasing the medical examination time of citizens subject to conscription, thus improving the efficiency of providing medical services to citizens in medical organizations. The public administration system was successfully reoriented to provide state and municipal services in a remote format during the unstable epidemiological situation caused by the pandemic of a new coronavirus infection. Optimization of interdepartmental electronic interaction will allow military commissariats to take additional preventive measures to avoid infection and avert the spread of a new coronavirus infection during the recruitment campaign. Modern digital technologies and solutions are able to provide a qualitative leap in the organization of conscription of citizens for military service, which can be implemented without significant financial costs in the short term. However, there is a growing need to involve a proper number of participants of the military command and other state authorities in solving this complex problem. All rights reserved © Eco-Vector, 2022.

Current status of telemedicine in Japan: implications for Korea. TT -:.

Background: Since the coronavirus disease 2019 outbreak, telemedicine has become an important means of providing medical care worldwide. This study aims to highlight the implications of establishing telemedicine policies in Korea. Japan's telemedicine policies were reviewed from the time of the first trial to the present official allowance. Current Concepts: Since telemedicine demonstration work began in 1971, telemedicine in Japan has advanced in four stages. The first stage was the operation of a remote regional comprehensive medical information system from 1971 to 1997. The second stage was when telemedicine was officially institutionalized from 1997 to 2018. The third stage was the time of expansion of telemedicine, from the announcement of the "Guidelines for the Implementation of Proper Online Care" in 2018 to when online first-time examinations were temporarily allowed in 2020. The fourth stage began in 2021 when the "Permanent Establishment of Special Cases for Online Care" was announced, and telemedicine has been officially allowed to supplement face-to-face care. Telemedicine usage was estimated to be about 53.65 million in 2021, and the total number of treatments in Japan in 2021 was estimated to be about 1.32 billion, accounting for about 4.1% of medical care. Discussion and Conclusion(s): For the Korean government to establish telemedicine, it needs to be promoted step by step through discussions with the medical community. Also, an appropriate medical remuneration system needs to be prepared along with guidelines reflecting the opinions of the medical community to secure the safety of telemedicine.Copyright © Korean Medical Association.

Development of a model of care based on the chronic care and collaborative care models to improve cardiometabolic health in low-to- middle income countries

Background: Non-communicable diseases (NCDs) are rising in low middle income countries (LMICs) mainly driven by cardiometabolic disease (cardiovascular disease, diabetes, and hypertension). Aim(s): To develop a model of care, based on the chronic care model and collaborative care model, to improve care, outcomes and risk factor control for adults with cardio metabolic disease in LMICs in the Covid-19 era. This will contribute to the sustainable development goals of promoting good health, well-being and reducing inequalities. Method(s): Using an iterative consultative approach with healthcare workers, clients, and community leaders in Kenya, Ghana and Mozambique, we developed a model of care, which includes core features from chronic care models: self-management support;decision support;clinical information systems;delivery system design;and community linkages. Result(s): We produced a culturally adapted self-management education programme, a training package for educators delivering the programme, as well as a training package for community and healthcare professional leaders to increase awareness and self-care for cardiometabolic disease. Given the lack of a robust health information system, we are offering a global registry to provide real world data on patient management and quality of care for people with type 2 diabetes, hypertension, heart failure and chronic kidney disease. Conclusion(s): This intervention will be tested in a mixed-methods single-arm feasibility study in five sites across three African countries: Kenya, Ghana, Mozambique.

Development of a Web-Portal Health Information System for Barangay

In the Philippines, a barangay is the smallest administrative unit serving as suburban neighborhoods' first line of defense. According to Bautista, barangays conduct a manual file-based process of storing the community's health information. Therefore, the need for a single platform enables a small government unit to manage its resources while being transparent to its community. The study aims to develop a web- based barangay health information system portal for Barangay 69 District 1 in Tondo Manila. The system would be a reference tool for barangays as their platform provides inventory management, the barangay's health programs, and a dashboard for data visualization inventory management, tracking of Covid cases, administration of health activities, and a dashboard for data visualization. As a result, the web portal is functional, and different test scenarios show above-average results. The study concludes that the system provided a platform for the barangay and its residents. It also concludes that it is user-friendly and efficiently disseminates the barangay's health programs and activities. © 2023 IEEE.

Metaheuristic secured transmission in Telecare Medical Information System (TMIS) in the face of post-COVID-19.

The outbreak of novel corona virus had led the entire world to make severe changes. A secured healthcare data transmission has been proposed through Telecare Medical Information System (TMIS) based on metaheuristic salp swarm. Patients need proper medical remote treatments in this Post-COVID-19 time from their quarantines. Secured transmission of medical data is a significant challenge of digitally overwhelmed environment. The objective is to impart the patients' data by encryption with confidentiality and integrity. Eavesdroppers can carry sniffing and spoofing in order to deluge the data. In this paper, a novel scheme on metaheuristic salp swarm based intelligence has been sculptured to encrypt electrocardiograms (ECG) for data privacy. Metaheuristic approach has been blended in cryptographic engineering to address the TMIS security issues. Session key has been derived from the weight vector of the fittest salp from the salp population. The exploration and exploitation control the movements of the salps. The proposed technique baffles the eavesdroppers by the key strength and other robustness factors. The results, thus obtained, were compared with some existing classical techniques with benchmark results. The proposed MSE and RMSE were 28,967.85, and 81.17 respectively. The time needed to decode 128 bits proposed session key was 8.66 × 1052 years. The proposed cryptographic time was 8.8 s.

COVID-19 spatialization by empirical Bayesian model in São Paulo, Brazil.

The new Acute Respiratory Syndrome, COVID-19, has affected the health and the economy worldwide. Therefore, scientists have been looking for ways to understand this disease. In this context, the main objective of this study was the spatialization of COVID-19, thinking in distinguishing areas with high transmissibility yet, verifying if these areas were associated with the elderly population occurrence. The work was delineated, supposing that spatialization could support the decision-making to combat the outbreak and that the same method could be used for spatialization and prevent other diseases. The study area was a municipality near Sao Paulo Metropolis, one of Brazil's main disease epicenters. Using official data and an empirical Bayesian model, we spatialized people infected by region, including older people, obtaining reasonable adjustment. The results showed a weak correlation between regions infected and older adults. Thus, we define a robust model that can support the definition of actions aiming to control the COVID-19 spread.

Effective medical center finding during COVID-19 pandemic using a spatial DSS centered on ontology engineering.

The global spread of the coronavirus has generated one of the most critical circumstances forcing healthcare systems to deal with it everywhere in the world. The complexity of crisis management, particularly in Iran, the unfamiliarity of the disease, and a lack of expertise, provided the foundation for researchers and implementers to propose innovative solutions. One of the most important obstacles in COVID-19 crisis management is the lack of information and the need for immediate and real-time data on the situation and appropriate solutions. Such complex problems fall into the category of semi-structured problems. In this respect, decision support systems use people's mental resources with computer capabilities to improve the quality of decisions. In synergetic situations, for instance, healthcare domains cooperating with spatial solutions, coming to a decision needs logical reasoning and high-level analysis. Therefore, it is necessary to add rich semantics to different classes of involved data, find their relationships, and conceptualize the knowledge domain. For the COVID-19 case in this study, ontologies allow for querying over such established relationships to find related medical solutions based on description logic. Bringing such capabilities to a spatial decision support system (SDSS) can help with better control of the COVID-19 pandemic. Ontology-based SDSS solution has been developed in this study due to the complexity of information related to coronavirus and its geospatial aspect in the city of Tehran. According to the results, ontology can rationalize different classes and properties about the user's clinical information, various medical centers, and users' priority. Then, based on the user's requests in a web-based SDSS, the system focuses on the inference made, advises the users on choosing the most related medical center, and navigates the user on a map. The ontology's capacity for reasoning, overcoming knowledge gaps, and combining geographic and descriptive criteria to choose a medical center all contributed to promising outcomes and the satisfaction of the sample community of evaluators.

Multiscale Geographically Weighted Regression in the Investigation of Local COVID-19 Anomalies Based on Population Age Structure in Poland.

A growing number of various studies focusing on different aspects of the COVID-19 pandemic are emerging as the pandemic continues. Three variables that are most commonly used to describe the course of the COVID-19 pandemic worldwide are the number of confirmed SARS-CoV-2 cases, the number of confirmed COVID-19 deaths, and the number of COVID-19 vaccine doses administered. In this paper, using the multiscale geographically weighted regression, an analysis of the interrelationships between the number of confirmed SARS-CoV-2 cases, the number of confirmed COVID-19 deaths, and the number of COVID-19 vaccine doses administered were conducted. Furthermore, using maps of the local R2 estimates, it was possible to visualize how the relations between the explanatory variables and the dependent variables vary across the study area. Thus, analysis of the influence of demographic factors described by the age structure and gender breakdown of the population over the course of the COVID-19 pandemic was performed. This allowed the identification of local anomalies in the course of the COVID-19 pandemic. Analyses were carried out for the area of Poland. The results obtained may be useful for local authorities in developing strategies to further counter the pandemic.

A Retrospective Case Control Study to Assess the Effectiveness of Baricitinib among Moderate to Severe Covid-19 Cases, Experience from a South Indian Tertiary Care Centre

Intro: Dysregulated inflammation plays a key role in the development of severe SARS-CoV-2 infection. One of the key cellular signaling pathway involved in the inflammatory response is JAK/STAT signaling. Among the hospitalized Covid patients with hypoxia to reduce the progression to ARDS, immunomodulators have a definite role. Baricitinib is an oral selective Janus kinase 1/2 inhibitor with anti-inflammatory properties. This study evaluates the efficacy and all-cause mortality among moderate to severe Covid patients who received Baricitinib. Method(s): A retrospective case-control study was carried out among moderate to severe Covid patients who had received Baricitinib. COVID severity matched group from the same time period was selected as the control. We evaluated the efficacy (based on WHO-ordinal scale) and difference in all-cause mortality among case and control groups. Baseline characteristics and outcome variables were retrospectively captured from the hospital health information system. Finding(s): During our study period, 2547 active Covid patients have admitted, out of which 105 patients received Baricitinib. Based on the retrospective analysis 75 patients were selected as the case group and 75 covidpositive patients of similar age and sex were identified by a simple random selection technique to serve as a control group. The age group of the baricitinib group 60.82 (+/- 13) and the Control group 62.34 (+/-13). Among the participants, 62.66% were severe (58% Baricitinib group & 66% control), 36% were with moderate severity (40% Baricitinib group & 33.33% control). The all-cause mortality of cohort was 43% (n=64), 36% (n=27) of cases as compared to 49.3% (n=37) of control group, (P Value= 0.06). Improvement in WOS score by at least 1-point cases 47% and 37.3 % in controls, (P Value= 0.09). Conclusion(s): Baricitinib when combined with standard of care, among hospitalized patients with moderate to severe Covid infection, showed a trend towards clinical improvement and decreased all-cause mortality.Copyright © 2023

Heterologous Third and Fourth Dose Vaccine to Reduce Severity and Mortality in Covid-19 Patients during Delta and Omicron Predominant in Thailand

Intro: To ensure adequate coverage against numerous waves of different variants of concern, Thailand has proactively adopted heterologous primary and booster vaccination schedules. While studies have assessed homologous schedules in detail, the effectiveness of heterologous booster vaccine schedules against severity and mortality of COVID-19 patients, particularly with newer variants, remains to be explored fully. Method(s): Utilising an active Hospital Information System for COVID-19 (CMC-19 HIS) network established in Chiang Mai, Thailand, we conducted a cohort study by linking patient-level data on laboratory-confirmed hospitalised COVID-19 cases to the national immunization records, during delta-predominant (1st October - 31st December 2021) and omicron predominant (1st February - 30th April 2022) periods. Demographic and baseline clinical characteristics associated with severe COVID-19 outcomes, mortality were examined for each period. Finding(s): Patients hospitalised during delta predominance were ten times more likely to have severe COVID-19 outcomes, in-hospital deaths, and a longer median hospital stay as compared to omicron predominance. During omicron predominance, a third vaccine dose was associated with 89% reduced risk of both severe COVID-19 and deaths, as compared to the unvaccinated group. Those who received the third dose 14-90 days prior to the date of positive SARS- CoV-2 test had the highest protection against severe COVID-19 outcomes (93%) followed by a drop to 87% among those who received their last dose >90 days prior. Severe outcomes were not observed among third dose recipients during delta predominance and fourth dose recipients during omicron predominance. All the vaccine types used for boosting in Thailand offered similar protection against severe COVID-19. Conclusion(s): The risk of severe outcomes were significantly lower for COVID-19 patients hospitalised with omicron as compared to delta. Booster doses provided very high level of protection against severe COVID-19 outcomes and deaths. Ongoing booster campaigns should focus on improving coverage utilising all available vaccines to ensure optimal protection.Copyright © 2023

Shared longitudinal health records for clinical and population health

The ability of a health information exchange (HIE) to consolidate information, collected from multiple, disparate information systems, into a single, person-centric health record can provide a comprehensive and longitudinal representation of an individual's medical history. Shared, longitudinal health records can be leveraged to enhance the delivery of individual clinical care and provide opportunities to improve health outcomes at the population level. This chapter describes the clinical benefits imparted by the shared health record (SHR) component an HIE infrastructure. It also characterizes the potential public health benefits of the aggregate level, population health indicators calculated, stored, and distributed by a health management information system (HMIS) component. Tools for visualizing health indicators from the HMIS, including disease surveillance systems developed during the COVID-19 pandemic, are also described. Postpandemic components such as the SHR and HMIS will likely play critical roles in strengthening health information infrastructures in states and nations. © 2023 Elsevier Inc. All rights reserved.

Mobile medical complexes in Russia

Pandemic of a new coronavirus infection is accompanied by advanced need for emergency medical care in Russia. However, this process is hampered by state of roads and no electricity sources in some cases. Mobile medical complexes are able to compensate this need. These ones include feldsher obstetric stations, complexes for medical examination, specialized medical complexes (Thyromobil, Mammography, mobile Diabetes Center and others), as well as convoys with diagnostic equipment (mammography, magnetic resonance imaging, computed tomography) and fully equipped offices of various specialists (therapist, urologist, gynecologist, ophthalmologist, endocrinologist). However, spread of such medical complexes is currently difficult in Russia. The manuscript is based on the author's analysis of publicly available documents on the state and number of mobile medical complexes in Russia. Mobile hospitals are not used in all Russian regions. Nevertheless, there is a need for qualified preventive and therapeutic services, especially in the northern and mountainous regions of our country (Pskov, Arkhangelsk regions, the republics of Komi, Karelia, Dagestan and others). The authors analyzed current situation and experience of mobile medical complexes in the Novgorod, Rostov regions and the Republic of Tatarstan. Introduction of mobile hospitals in all Russian regions within the national health strategy will improve population health including working age people and reduce costs in health care system. Medical organizations cooperate with mobile hospitals to qualifiedly meet the needs of patients in diagnosis and treatment. However, projects of mobile medical complexes and their routine implementation in each region of our country are required. This is a priority task for the state and local health authorities of the Russian Federation.Copyright © R.N. ABDULLABEKOV, V.E. FEDORCHUK, T.V. MINNIKOVA.

Epidemiological characteristics of four times of community transmission of COVID-19 in Hebei

Objective To analyze the epidemiological characteristics of community transmission of the coronavirus disease 2019 (COVID-19) caused by four imported cases in Hebei Province, and to provide a scientific basis for the prevention and control of the disease. Methods Descriptive epidemiological methods were used to analyze the epidemiological characteristics of four community-transmitted COVID-19 outbreaks reported in the China Disease Control and Prevention Information System from January 1, 2020 to December 31, 2021 in Hebei Province. Results From January 1, 2020 to December 31, 2021, four community-transmitted COVID-19 outbreaks caused by imported COVID-19 occurred in Hebei Province, respectively related of Hubei (Wuhan) Province, Beijing Xinfadi market, Overseas cases and Ejina banner of Inner Mongolia Autonomous Region. Total of 1 656 cases (1 420 confirmed cases and 236 asymptomatic cases) were reported, including 375 cases in phase A (From January 22 to April 16, 2020), and phase B (from June 14 to June 24, 2020) 27 cases were reported, with 1 116 cases reported in the third phase (Phase C, January 2 to February 14, 2021), and 138 cases reported in the fourth phase (Phase D, October 23 to November 14, 2021). The 1 656 cases were distributed in 104 counties of 11 districts (100.00%), accounting for 60.46% of the total number of counties in the province. There were 743 male cases and 913 female cases, with a male to female ratio of 0.81:1. The minimum age was 13 days, the maximum age was 94 years old, and the average age (median) was 40.3 years old. The incidence was 64.01% between 30 and 70 years old. Farmers and students accounted for 54.41% and 14.73% of the total cases respectively. Of the 1 420 confirmed cases, 312 were mild cases, accounting for 21.97%;Common type 1 095 cases (77.11%);There was 1 severe case and 12 critical cases, accounting for 0.07% and 0.85%, respectively. 7 patients died from 61.0 to 85.7 years old. The mean (median) time from onset to diagnosis was 1.9 days (0-31 days), and the mean (median) time of hospital stay was 15 days (1.5-56 days). Conclusions Four times in Hebei province COVID-19 outbreak in scale, duration, population, epidemic and type of input source, there are some certain difference, but there are some common characteristics, such as the outbreak occurs mainly during the legal holidays or after starting and spreading epidemic area is mainly in rural areas, aggregation epidemic is the main mode of transmission, etc. To this end, special efforts should be made to strengthen the management of people moving around during holidays, and strengthen the implementation of epidemic prevention and control measures in places with high concentration of people. To prevent the spread of the epidemic, we will step up surveillance in rural areas, farmers' markets, medical workers and other key areas and groups, and ensure early detection and timely response.Copyright © 2022 China Tropical Medicine. All rights reserved.

VACtrac: enhancing access immunization registry data for population outreach using the Bulk Fast Healthcare Interoperable Resource (FHIR) protocol.

COVID-19 vaccination uptake has been suboptimal, even in high-risk populations. New approaches are needed to bring vaccination data to the groups leading outreach efforts. This article describes work to make state-level vaccination data more accessible by extending the Bulk Fast Healthcare Interoperability Resource (FHIR) standard to better support the repeated retrieval of vaccination data for coordinated outreach efforts. We also describe a corresponding low-foot-print software for population outreach that automates repeated checks of state-level immunization data and prioritizes outreach by social determinants of health. Together this software offers an integrated approach to addressing vaccination gaps. Several extensions to the Bulk FHIR protocol were needed to support bulk query of immunization records. These are described in detail. The results of a pilot study, using the outreach tool to target a population of 1500 patients are also described. The results confirmed the limitations of current patient-by-patient approach for querying state immunizations systems for population data and the feasibility of a Bulk FHIR approach.

Effectiveness of CoronaVac vaccine against severe acute respiratory infections (SARI) hospitalizations in Sibu District, Malaysia: A retrospective test-negative design

Introduction: The COVID-19 vaccination campaign was implemented in Sibu, Malaysia in February 2021. We assessed the effectiveness of the CoronaVac vaccine against severe acute respiratory infections (SARI) hospitalisation associated with laboratory-confirmed SARS-CoV-2 by time since vaccination. Method(s): A test-negative case-control design was employed using a web-based national information system for PCR results of SARS-CoV-2 infection and COVID-19 vaccination, and the hospitalisation dataset in Sibu Hospital. Eligible SARI cases with SARS-CoV-2 RT-PCR positive were matched to those SARI cases with negative RT-PCR tests by age and workplace. Vaccine effectiveness was measured by conditional logistic regression with adjustment for gender, comorbidity, smoking and education level. Result(s): Between 15 March and 30 September 2021, in the dominance of lineages B.1.466.2 and B.1.617.2 (Delta variant), a total of 838 eligible SARI patients were identified. Vaccine effectiveness was 42.4% (95% confidence interval [CI]: -28.3, 74.1), and 76.5% (95% CI: 45.6, 89.8) for partial vaccination (after the first dose through 14 days after the second dose) and complete vaccination (at 15 days or more after receipt of the second dose), respectively. Sensitivity analysis using propensity score matching yielded a conservative estimate of 57.4% (95% CI: 9.2, 80.1) for complete vaccination. Conclusion(s): Primary immunisation with two doses of CoronaVac vaccine provided satisfactory protection against SARI caused by SARS-CoV-2 in the short term. However, the duration of protection, incremental effectiveness induced by boosting, as well as performance against new variants need to be studied continuously.