Hospital Governance During the COVID-19 Pandemic: A Multiple-Country Case Study.

In response to the disruptions caused by COVID-19, hospitals around the world proactively or reactively developed and/or re-organized their governance structures to manage the COVID-19 response. Hospitals' governance played a crucial role in their ability to reorganize and respond to the pressing needs of their staff. We discuss and compare six hospital cases from four countries on different continents: Brazil, Canada, France, and Japan. Our study examined how governance strategies (e.g., special task forces, communications management tools, etc.) were perceived by hospital staff. Key findings from a total of 177 qualitative interviews with diverse hospital stakeholders were analyzed using three categories drawn from the European Observatory on Health Systems and Policies framework on health systems resilience during the COVID-19 pandemic: 1) delivering a clear and timely COVID-19 response strategy; 2) coordinating effectively within (horizontally) and across (vertically) levels of decision-making; and 3) communicating clearly and transparently with the hospital's diverse stakeholders. Our study gleaned rich accounts for these three categories, highlighting significant variations across settings. These variations were primarily determined by the hospitals' environment prior to the COVID-19 crisis, namely whether there already existed a culture of managerial openness (including spaces for social interactions among hospital staff) and whether preparedness planning and training had been routinely integrated into their activities.

Human Centered Decision-Making for COVID-19 Testing Center Location Selection: Tamil Nadu-A Case Study.

This paper proposes a blend of three techniques to select COVID-19 testing centers. The objective of the paper is to identify a suitable location to establish new COVID-19 testing centers. Establishment of the testing center in the needy locations will be beneficial to both public and government officials. Selection of the wrong location may lead to lose both health and wealth. In this paper, location selection is modelled as a decision-making problem. The paper uses fuzzy analytic hierarchy process (AHP) technique to generate the criteria weights, monkey search algorithm to optimize the weights, and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method to rank the different locations. To illustrate the applicability of the proposed technique, a state named Tamil Nadu, located in India, is taken for a case study. The proposed structured algorithmic steps were applied for the input data obtained from the government of India website, and the results were analyzed and validated using the government of India website. The ranks assigned by the proposed technique to different locations are in aligning with the number of patients and death rate.

Home-based, supervised, and mixed exercise intervention on functional capacity and quality of life of colorectal cancer patients: a meta-analysis.

This systematic review and meta-analysis of randomized controlled trials tested the effects of home-based, supervised, or mixed exercise interventions on the functional capacity (FC) and quality of life (QoL) in colorectal cancer patients. A literature search was performed using the PubMed, Embase, Cochrane, and Medline databases. Two reviewers screened the literature through March 10, 2021 for studies related to exercise and colorectal cancer. Of the 1161 screened studies in the initial search, 13 studies met the eligibility criteria (home-based = 6 studies; supervised or mixed = 7 studies). Overall, 706 patients were enrolled in the trials, and 372 patients were submitted to home-based, supervised, or mixed exercise intervention. The overall results from the main meta-analysis showed a significant effect regarding supervised or mixed intervention (6 studies; p = 0.002; I2 = 43%; PI 0.41-1.39); however, no significant effect was observed for home-based intervention (5 studies; p = 0.05; I2 = 25%; PI - 0.34-0.76). A sensitivity analysis based on studies with intervention adherence ≥ 80% (home-based = 3 studies; supervised or mixed = 4 studies) revealed that home-based intervention or intervention entirely supervised or with some level of supervision (mixed) are effective in improving the QoL and FC of CRC patients. In summary, this meta-analysis verified that supervised and home-based exercise can modify QoL and FC when intervention adherence ≥ 80%. Regardless of the supervision characteristics, future RCTs are strongly encouraged to provide a detailed description of the exercise variables in physical interventions for CRC prescription. This perspective will allow a refined exercise prescription for patients with CRC, mainly according to their clinical status.

Area efficient camouflaging technique for securing IC reverse engineering.

Reverse engineering is a burning issue in Integrated Circuit (IC) design and manufacturing. In the semiconductor industry, it results in a revenue loss of billions of dollars every year. In this work, an area efficient, high-performance IC camouflaging technique is proposed at the physical design level to combat the integrated circuit's reverse engineering. An attacker may not identify various logic gates in the layout due to similar image output. In addition, a dummy or true contact-based technique is implemented for optimum outcomes. A library of gates is proposed that contains the various camouflaged primitive gates developed by a combination of using the metal routing technique along with the dummy contact technique. This work shows the superiority of the proposed technique's performance matrix with those of existing works regarding resource burden, area, and delay. The proposed library is expected to make open source to help ASIC designers secure IC design and save colossal revenue loss.

Estimation of health impact from digitalizing last-mile Logistics Management Information Systems (LMIS) in Ethiopia, Tanzania, and Mozambique: A Lives Saved Tool (LiST) model analysis.

BACKGROUND: Digital health has become a widely recognized approach to addressing a range of health needs, including advancing universal health coverage and achieving the Sustainable Development Goals. At present there is limited evidence on the impact of digital interventions on health outcomes. A growing body of peer-reviewed evidence on digitalizing last-mile electronic logistics management information systems (LMIS) presents an opportunity to estimate health impact. METHODS: The impact of LMIS on reductions in stockouts was estimated from primary data and peer-reviewed literature, with three scenarios of impact: 5% stockout reduction (conservative), 10% stockout reduction (base), and 15% stockout reduction (optimistic). Stockout reduction data was inverted to stock availability and improved coverage for vaccines and essential medicines using a 1:1 conversion factor. The Lives Saved Tool (LiST) model was used to estimate health impact from lives saved in newborns and children in Mozambique, Tanzania, and Ethiopia between 2022 and 2026 across the three scenarios. RESULTS: Improving coverage of vaccines with a digital LMIS intervention in the base scenario (conservative, optimistic) could prevent 4,924 (2,578-6,094), 3,998 (1,621-4,915), and 17,648 (12,656-22,776) deaths in Mozambique, Tanzania, and Ethiopia, respectively over the forecast timeframe. In addition, scaling up coverage of non-vaccine medications could prevent 17,044 (8,561-25,392), 21,772 (10,976-32,401), and 34,981 (17,543-52,194) deaths in Mozambique, Tanzania, and Ethiopia, respectively. In the base model scenario, the maximum percent reduction in deaths across all geographies was 1.6% for vaccines and 4.1% for non-vaccine medications. INTERPRETATION: This study projects that digitalization of last-mile LMIS would reduce child mortality by improving coverage of lifesaving health commodities. This analysis helps to build the evidence base around the benefits of deploying digital solutions to address health challenges. Findings should be interpreted carefully as stockout reduction estimates are derived from a small number of studies.

[The importance of the logistic warehouse in pandemic period: the experience of the USL Umbria 1 (Perugia, Italy) during covid-19.] / L'importanza del magazzino logistico in periodo di pandemia: l'esperienza dell'USL Umbria 1 durante covid-19.

The pandemic period has generated major problems in the pharmacies of hospitals and local health care companies regarding the distribution of drugs to patients undergoing treatment with chronic drugs. This is because the patient, during the lockdown, was forced to leave the house and go several miles away to reach the place where the drug was dispensed. Moreover, very often, the place was placed in covid-19 hospitals, like the one in Perugia, and was also a risk for the patient himself. The logistical organization allows, in addition to the advantages of traceability, efficiency and savings, with the arrival of the drug at home, a very high patient compliance that also translates into greater security in a pandemic period. To the Usl Umbria 1 of Perugia (Italy) has been centralized the activity of warehouse for all the South area that includes three hospitals and four sanitary districts. Such warehouse, through computerized procedure, guarantees the direct distribution with sending of the medicines directly to the district of belonging of the patient. In this way the patient was not forced to make long and risky trips to continue their chronic therapies. Moreover, this logistic warehouse has also allowed to cope with the correct management of many medicinal specialties that have been used against the SARS-CoV-2 virus avoiding their temporary deficiency for patients already on therapy according to the normal therapeutic indications (anti-inflammatory, antiretroviral and immunomodulatory). This paper aims to demonstrate how logistical organization is of vital importance for a National Health System that has to face increasing costs, ensure the traceability of all processes and, last but not least, survive a worldwide pandemic period.

Work disability negotiations between supervisors and occupational health services: factors that support supervisors in work disability management.

PURPOSE: A work disability negotiation takes place between a supervisor, the disabled employee and the occupational health service (OHS) to support the disabled employee in returning to their work, often with temporary work accommodation. The objective of this study was to define the factors of a work disability negotiation with OHS that supported or hindered supervisors in their task/role in work disability management. METHODS: The study setting comprised two parts: the creation of survey questions and the actual survey of supervisors (N = 254) from six public and private organizations in Finland. Of these, 133 (52%) had participated in one or more work disability negotiations. The responses covered about 240 work disability cases and considerably more negotiations. RESULTS: The study identified four key elements that the supervisors expressed as major success factors in the negotiations. First, it was crucial that the supervisors learned about the employee's health restrictions and understood the issues relating to their work disability. Second, the parties should aim for common solutions and conclusions through collaboration. Third, active participation of all the negotiation parties is important. The supervisors gave a high rating to OHS taking their views seriously. Last, the supervisors appreciated collaboration in a constructive atmosphere. CONCLUSION: In order for a negotiation to help supervisors in their challenges, it should reach solutions, conclusions and a restructured comprehension of the work disability problem in a constructive atmosphere and with active communication between stakeholders.

Improving Inpatient Tobacco Treatment Measures: Outcomes Through Standardized Treatment, Care Coordination, and Electronic Health Record Optimization.

INTRODUCTION: The Centers for Disease Control and Prevention states that tobacco use is the largest and most preventable cause of disease and mortality in the United States. The Joint Commission implemented inpatient tobacco treatment measures (TTMs) in 2012 to encourage healthcare systems to create processes that help patients quit tobacco use through evidence-based care. METHODS: A tobacco cessation care delivery system was implemented at James A. Haley Veterans' Hospital and Clinics, which included: standardized pathways within the Veterans Health Administration (VHA) electronic health record system to improve nicotine replacement therapy ordering; evidence-based tobacco cessation counseling; and improved care coordination for tobacco cessation treatment through the use of technological innovation. RESULTS: Outcomes were obtained from the VHA quality metric reporting system known as Strategic Analytics for Improvement and Learning (SAIL). TOB-2 and TOB-3 (two Joint Commission inpatient TTMs) equivalent to tob20 and tob40 within SAIL improved by greater than 300% after implementation at James A. Haley Veterans' Hospital and Clinics. CONCLUSION: Implementation of a tobacco cessation care system at James A. Haley Veterans' Hospital and Clinics enhanced interdisciplinary coordination of tobacco cessation care and resulted in improvements of The Joint Commission inpatient TTMs by greater than threefold.

Logistical Considerations and Clinical Outcomes Associated With Converting Operating Rooms Into an Intensive Care Unit During the Coronavirus Disease 2019 Pandemic in a New York City Hospital.

BACKGROUND: Coronavirus disease 2019 (COVID-19) emerged as a public health crisis that disrupted normal patterns of health care in the New York City metropolitan area. In preparation for a large influx of critically ill patients, operating rooms (ORs) at NewYork-Presbyterian/Columbia University Irving Medical Center (NYP-Columbia) were converted into a novel intensive care unit (ICU) area, the operating room intensive care unit (ORICU). METHODS: Twenty-three ORs were converted into an 82-bed ORICU. Adaptations to the OR environment permitted the delivery of standard critical care therapies. Nonintensive-care-trained staff were educated on the basics of critical care and deployed in a hybrid staffing model. Anesthesia machines were repurposed as critical care ventilators, with accommodations to ensure reliable function and patient safety. To compare ORICU survivorship to outcomes in more traditional environments, we performed Kaplan-Meier survival analysis of all patients cared for in the ORICU, censoring data at the time of ORICU closure. We hypothesized that age, sex, and obesity may have influenced the risk of death. Thus, we estimated hazard ratios (HR) for death using Cox proportional hazard regression models with age, sex, and body mass index (BMI) as covariables and, separately, using older age (65 years and older) adjusted for sex and BMI. RESULTS: The ORICU cared for 133 patients from March 24 to May 14, 2020. Patients were transferred to the ORICU from other ICUs, inpatient wards, the emergency department, and other institutions. Patients remained in the ORICU until either transfer to another unit or death. As the hospital patient load decreased, patients were transferred out of the ORICU. This process was completed on May 14, 2020. At time of data censoring, 55 (41.4%) of patients had died. The estimated probability of survival 30 days after admission was 0.61 (95% confidence interval [CI], 0.52-0.69). Age was significantly associated with increased risk of mortality (HR = 1.05, 95% CI, 1.03-1.08, P < .001 for a 1-year increase in age). Patients who were ≥65 years were an estimated 3.17 times more likely to die than younger patients (95% CI, 1.78-5.63; P < .001) when adjusting for sex and BMI. CONCLUSIONS: A large number of critically ill COVID-19 patients were cared for in the ORICU, which substantially increased ICU capacity at NYP-Columbia. The estimated ORICU survival rate at 30 days was comparable to other reported rates, suggesting this was an effective approach to manage the influx of critically ill COVID-19 patients during a time of crisis.

Feedback That Helps Trainees Learn to Practice Without Supervision.

Feedback pedagogies and research tend to focus on immediate corrective actions rather than learning for the longer term. This approach means that feedback may not support trainees who are managing complex, competing, and ambiguous practice situations, often with limited supervision. There is an opportunity to consider how feedback can help medical trainees sustain their own development into the future, including when they have completed formal training. This article explores how feedback pedagogies can facilitate medical trainees' abilities to develop challenging aspects of practice across multiple clinical environments to eventually practice without supervision. From a sociocultural perspective, clinical training takes place within a practice curriculum; each clinical environment offers varying opportunities, which the trainees may choose to engage with. The authors propose feedback as an interpersonal process that helps trainees make sense of both formal training requirements and performance relevant information, including workplace cues such as patient outcomes or colleagues' comments, found within any practice curriculum. A significant pedagogic strategy may be to develop trainees' evaluative judgment or their capability to identify and appraise the qualities of good practice in both themselves and others. In this way, feedback processes may help trainees surmount complex situations and progressively gain independence from supervision.

Policy and Pandemic: The Changing Practice of Nephrology During the Coronavirus Disease-2019 Outbreak.

The coronavirus (coronavirus disease-2019) pandemic has changed care delivery for patients with end-stage kidney disease. We explore the US healthcare system as it pertains to dialysis care, including existing policies, modifications implemented in response to the coronavirus disease-2019 crisis, and possible next steps for policy makers and nephrologists. This includes policies related to resource management, use of telemedicine, prioritization of dialysis access procedures, expansion of home dialysis modalities, administrative duties, and quality assessment. The government has already established policies that have instated some flexibilities to help providers focus their response to the crisis. However, future policy during and after the coronavirus disease-2019 pandemic can bolster our ability to optimize care for patients with end-stage kidney disease. Key themes in this perspective are the importance of policy flexibility, clear strategies for emergency preparedness, and robust health systems that maximize accessibility and patient autonomy.

Logistics of an advanced therapy medicinal product during COVID-19 pandemic in Italy: successful delivery of mesenchymal stromal cells in dry ice.

BACKGROUND: During the coronavirus disease-2019 (COVID-19) pandemic, Italian hospitals faced the most daunting challenges of their recent history, and only essential therapeutic interventions were feasible. From March to April 2020, the Laboratory of Advanced Cellular Therapies (Vicenza, Italy) received requests to treat a patient with severe COVID-19 and a patient with acute graft-versus-host disease with umbilical cord-derived mesenchymal stromal cells (UC-MSCs). Access to clinics was restricted due to the risk of contagion. Transport of UC-MSCs in liquid nitrogen was unmanageable, leaving shipment in dry ice as the only option. METHODS: We assessed effects of the transition from liquid nitrogen to dry ice on cell viability; apoptosis; phenotype; proliferation; immunomodulation; and clonogenesis; and validated dry ice-based transport of UC-MSCs to clinics. RESULTS: Our results showed no differences in cell functionality related to the two storage conditions, and demonstrated the preservation of immunomodulatory and clonogenic potentials in dry ice. UC-MSCs were successfully delivered to points-of-care, enabling favourable clinical outcomes. CONCLUSIONS: This experience underscores the flexibility of a public cell factory in its adaptation of the logistics of an advanced therapy medicinal product during a public health crisis. Alternative supply chains should be evaluated for other cell products to guarantee delivery during catastrophes.

[Supervision during the internship, a learning process for everyone]. / L'encadrement en stage, un apprentissage pour tous.

With the 2009 reference frame, the internship became a clinical apprenticeship. It is not up to the supervisors in the departments and in the training environment to assess the student, but the tutor. Disparities in learning persist, often linked to the organisation of the departments.

Risk prediction and risk factor analysis of urban logistics to public security based on PSO-GRNN algorithm.

For the complicated operation process, many risk factors, and long cycle of urban logistics, it is difficult to manage the security of urban logistics and it enhances the risk. Therefore, to study a set of effective management mode for the safe operation of urban logistics and improve the risk prediction mechanism, is the primary research item of urban logistics security management. This paper summarizes the risk factors to public security in the process of urban logistics, including pick up, warehouse storage, transport, and the end distribution. Generalized regression neural network (GRNN) is combined with particle swarm optimization (PSO) to predict accidents, and the Apriori algorithm is used to analyze the combination of high-frequency risk factors. The results show that the method of combining GRNN with PSO is effective in accident prediction and has a powerful generalization ability. It can prevent the occurrence of unnecessary urban logistics public accidents, improve the ability of relevant departments to deal with emergency incidents, and minimize the impact of urban logistics accidents on social and public security.

Brief Hospital Supervision of Exercise and Diet During Adjuvant Breast Cancer Therapy Is Not Enough to Relieve Fatigue: A Multicenter Randomized Controlled Trial.

Supervised exercise dietary programs are recommended to relieve cancer-related fatigue and weight increase induced by adjuvant treatment of early breast cancer (EBC). As this recommendation lacks a high level of evidence, we designed a multicenter randomized trial to evaluate the impact of an Adapted Physical Activity Diet (APAD) education program on fatigue. We randomized 360 women with EBC who were receiving adjuvant chemotherapy and radiotherapy to APAD or usual care at eight French cancer institutions. Data were collected at baseline, end of chemotherapy, end of radiotherapy, and 6 months post-treatment. The primary endpoint was the general cancer-related fatigue score using the MFI-20 questionnaire. Fatigue correlated with the level of precariousness, but we found no significant difference between the two groups in terms of general fatigue (p = 0.274). The APAD arm has a smaller proportion of patients with confirmed depression at the end of follow-up (p = 0.052). A transient modification in physical activity levels and dietary intake was reported in the experimental arm. However, a mixed hospital- and home-based APAD education program is not enough to improve fatigue caused by adjuvant treatment of EBC. Cancer care centers should consider integrating more proactive diet-exercise supportive care in this population, focusing on precarious patients.

Impact of managerial overconfidence on abnormal audit fee: From the perspective of balance mechanism of shareholders.

Overconfidence, as a psychological feature that is difficult to measure, means that managers are overconfident in their management ability, investment judgment ability and knowledge richness, thus overestimating their ability and making irrational behavior. Based on the sample of Chinese listed firms from 2014 to 2018, we measure managerial overconfidence in terms of age, gender, education, position and salary, and analyzed the relationship between overconfidence, abnormal audit fees, and the balance mechanism of shareholders. The research results show that there is a significant positive correlation between managerial overconfidence and abnormal audit fees, and the balance mechanism of shareholders can significantly inhibit the positive correlation between managerial overconfidence and abnormal audit fees. The research results of this paper are conducive to the supervision department to further improve the relevant supervision measures, improve the audit quality, and provide theoretical support for the more specific requirements of audit fee information disclosure.