A systems approach for resources management during the COVID-19 pandemic: Multi-agency perspectives from New England.

The emergence of COVID-19 in the United States has overwhelmed local hospitals, produced shortages in critical protective supplies for medical staff, and created backlogs in burials and cremations. Because systemic disruptions occur most acutely at a local scale, facilitating resource coordination across a broad region can assist local responses to COVID-19 surges. This article describes a structured systems approach for coordinating COVID-19 resource distribution across the six New England states of the United States. The framework combines modeling tools to anticipate resource shortages in medical supplies, personnel needs, and fatality management for individual states. The approach allows decision makers to understand the magnitude of local outbreaks and equitably allocate resources within a region based on the present and future needs. This model contributed to determining material distribution in New England as the 2020 COVID-19 surges unfolded in the spring and fall seasons. Using a systems analysis, the model demonstrates the translation of anticipated COVID-19 cases into resource demands to enable regional coordination of scarce resources.

Can Comorbidity Data Explain Cross-State and Cross-National Difference in COVID-19 Death Rates?

Many efforts to predict the impact of COVID-19 on hospitalization, intensive care unit (ICU) utilization, and mortality rely on age and comorbidities. These predictions are foundational to learning, policymaking, and planning for the pandemic, and therefore understanding the relationship between age, comorbidities, and health outcomes is critical to assessing and managing public health risks. From a US government database of 1.4 million patient records collected in May 2020, we extracted the relationships between age and number of comorbidities at the individual level to predict the likelihood of hospitalization, admission to intensive care, and death. We then applied the relationships to each US state and a selection of different countries in order to see whether they predicted observed outcome rates. We found that age and comorbidity data within these geographical regions do not explain much of the international or within-country variation in hospitalization, ICU admission, or death. Identifying alternative explanations for the limited predictive power of comorbidities and age at the population level should be considered for future research.

Information security climate and the assessment of information security risk among healthcare employees.

Since 2009, over 176 million patients in the United States have been adversely impacted by data breaches affecting Health Insurance Portability and Accountability Act-covered institutions. While the popular press often attributes data breaches to external hackers, most breaches are the result of employee carelessness and/or failure to comply with information security policies and procedures. To change employee behavior, we borrow from the organizational climate literature and introduce the Information Security Climate Index, developed and validated using two pilot samples. In this study, four categories of healthcare professionals (certified nursing assistants, dentists, pharmacists, and physician assistants) were surveyed. Likert-type items were used to assess the Information Security Climate Index, information security motivation, and information security behaviors. Study results indicated that the Information Security Climate Index was related to better employee information security motivation and information security behaviors. In addition, there were observed differences between occupational groups with pharmacists reporting a more favorable climate and behaviors than physician assistants.

Cardiopulmonary resuscitation using the cardio vent device in a resuscitation model.

To compare the "Bellows on Sternum Resuscitation" (BSR) device that permits simultaneous compression and ventilation by one rescuer with two person cardiopulmonary resuscitation (CPR) with bag-valve-mask (BVM) ventilation in a single blind crossover study performed in the laboratory setting. Tidal volume and compression depth were recorded continuously during 12-min CPR sessions with the BSR device and two person CPR. Six CPR instructors performed a total of 1,894 ventilations and 10,532 compressions in 3 separate 12-min sessions. Mean tidal volume (MTV) and compression rate (CR) with the BSR device differed significantly from CPR with the BVM group (1242 mL vs. 1065 mL, respectively, p = 0.0018 and 63.2 compressions per minute (cpm) vs. 81.3 cpm, respectively, p = 0.0076). Error in compression depth (ECD) rate of 9.78% was observed with the BSR device compared to 8.49% with BMV CPR (p = 0.1815). Error rate was significantly greater during the second half of CPR sessions for both BSR and BVM groups. It is concluded that one-person CPR with the BSR device is equivalent to two-person CPR with BVM in all measured parameters except for CR. Both groups exhibited greater error rate in CPR performance in the latter half of 12-min CPR sessions.

Cervical pregnancy: two case reports.

REASON FOR STUDY: To determine if there is a safe and effective treatment for cervical pregnancy. MAIN FINDINGS: There is no study presently which shows whether the medical vs surgical vs medical and surgical treatment combined for cervical pregnancy is more efficient. Continued studies are necessary to validate any treatment and confirm which would increase survival with fewer complications. PRINCIPAL CONCLUSION: There is no definitive treatment for cervical ectopic pregnancies. The risk and benefits of each treatment must be entertained before a decision is made on either medical or surgical treatment.