Learning from public health and hospital resilience to the SARS-CoV-2 pandemic: protocol for a multiple case study (Brazil, Canada, China, France, Japan, and Mali).

BACKGROUND: All prevention efforts currently being implemented for COVID-19 are aimed at reducing the burden on strained health systems and human resources. There has been little research conducted to understand how SARS-CoV-2 has affected health care systems and professionals in terms of their work. Finding effective ways to share the knowledge and insight between countries, including lessons learned, is paramount to the international containment and management of the COVID-19 pandemic. The aim of this project is to compare the pandemic response to COVID-19 in Brazil, Canada, China, France, Japan, and Mali. This comparison will be used to identify strengths and weaknesses in the response, including challenges for health professionals and health systems. METHODS: We will use a multiple case study approach with multiple levels of nested analysis. We have chosen these countries as they represent different continents and different stages of the pandemic. We will focus on several major hospitals and two public health interventions (contact tracing and testing). It will employ a multidisciplinary research approach that will use qualitative data through observations, document analysis, and interviews, as well as quantitative data based on disease surveillance data and other publicly available data. Given that the methodological approaches of the project will be largely qualitative, the ethical risks are minimal. For the quantitative component, the data being used will be made publicly available. DISCUSSION: We will deliver lessons learned based on a rigorous process and on strong evidence to enable operational-level insight for national and international stakeholders.

How Hospitals Overcame Disruptions in the Early Stages of the COVID-19 Pandemic: A Case Study from Tokyo, Japan.

The COVID-19 pandemic has caused serious disruptions to health systems across the world. While the pandemic has not ended, it is important to better understand the resilience of health systems by looking at the response to COVID-19 by hospitals and hospital staff. Part of a multi-country study, this study looks at the first and second waves of the pandemic in Japan and examines disruptions experienced by hospitals because of COVID-19 and the processes through which they overcame those disruptions. A holistic multiple case study design was employed, and two public hospitals were selected for the study. A total of 57 interviews were undertaken with purposively selected participants. A thematic approach was used in the analysis. The study found that in the early stages of the pandemic, faced with a previously unknown infectious disease, to facilitate the delivery of care to COVID-19 patients while also providing limited non-COVID-19 health care services, the case study hospitals undertook absorptive, adaptive, and transformative actions in the areas of hospital governance, human resources, nosocomial infection control, space and infrastructure management, and management of supplies. The process of overcoming the disruptions caused by the pandemic was complex, and the solution to one issue often caused other problems. To inform preparations for future health shocks and promote resilience, it is imperative to further investigate both organizational and broader health system factors that build absorptive, adaptive, and transformative capacity in hospitals.

Factors for Consideration When Setting Prices for Private Healthcare Providers Operating in Public Systems: A Comparison of France and Japan.

Background: Most publicly-funded health systems purchase healthcare from private providers, but the optimal purchasing arrangements between public purchasers and private healthcare providers are yet to be determined. Objective: This study compares the healthcare purchasing arrangements made with private providers in 2 social health insurance (SHI)-based systems to identify factors that influence the prices paid for private healthcare service provision. Results: France and Japan use different approaches to determine the payment arrangements with public and private providers. The presence of for-profit healthcare providers in the French health system explains the different payment rates for public and private healthcare providers in that country. In both France and Japan, in addition to payment rates, several policy tools are used to assure the provision of public good services and the availability of necessary healthcare for all, which public providers are required to deliver but private providers can choose to deliver. Conclusion: This study highlights the importance of considering the profit-making status of the private healthcare providers operating in the healthcare market, and clarity in the roles and responsibilities of the public, for-profit and not-for-profit providers when determining healthcare purchasing arrangements. Regulatory policy instruments, used alongside payment rates, are essential to influence efficiency, equity, and quality in mixed (public-private) health systems.

The role of community nurse in the implementation of health policy for the elderly in Thailand.

In the implementation of the policy for the elderly, the nurses who have the competency to pull out their potential power to continue living with several stakeholders' support are required to provide care in the community. Community nurse in Thailand has the responsibility to deliver adequate medical care and also social care for the elderly. The study aimed to identify the role of community nurse in the implementation of Thai health policy for the elderly. Codes regarding the role of community nurse in the implementation of Thai health policy for the elderly were extracted from descriptive data interviewed with 15 policy implementors in Thailand. The codes were categorized by similarities using thematic analysis. The role of community nurse was 16 categories and 102 codes out of factors promoting implementation of Thai health policy for the elderly, with 27 categories and 416 codes. The main roles were Coordination, Service delivery, and Monitoring and evaluation, composing seven categories and 45 codes, eight categories and 51 codes, and one category and six codes, respectively. It was conspicuous in coordination mechanisms, especially between the organizations and disciplines in providing Primary Health Care. Both health promotion activities and medical treatment were crucial roles for community nurses. The role of community nurse was one of promoting factors of Thai health policy for the elderly. The community nurse acts as a lubricant between the hospital and the community, which means that the community nurse implements seamless service delivery for the elderly integrating medical care and welfare.

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.

How should support for hospital staff during health shocks be improved? A discussion from Japan's experience during the COVID-19 pandemic.

Human resources for health are at the center of healthcare service delivery and play an important role in ensuring the resilience of health systems. Utilizing the results from a case study examining hospital resilience during COVID-19, this article draws on the experience of individual hospital staff during the first and second waves of the pandemic, briefly describes government responses to support human resources for health during the early stages of the pandemic, and argues the importance of constructive discussions about strategies to create an enabling work environment for healthcare providers, both clinical and non-clinical, during future health shocks.

Reporting on the implementation to set up a "care and isolation facility" for mild COVID-19 cases in Tokyo.

The increasing number of COVID-19 cases has placed pressure on medical facilities. Against this backdrop, the Tokyo Metropolitan Government established a facility for mild and asymptomatic COVID-19 cases by using existing hotels. These kinds of facilities were established in several countries, and represented a spectrum from hotel-like to hospital-like care. In this article, we focused on implementation and related strategies for establishing such a facility in Tokyo as implementation research, while ensuring patient and staff safety. This facility had three functions: care, isolation, and buffering. For the implementation strategy, we used several strategies from the Expert Recommendations for Implementing Change (ERIC) to implement functions similar to an ordinary hospital, but using fewer inputs. This experience can be applied to other resource-limited settings such as that in less developed countries.

COVID-19 control during a humanitarian crisis; the need for emergency response at the Thai-Myanmar border as an alternative channel.

Following the coup in Myanmar, humanitarian assistance, including coronavirus disease 2019 (COVID-19) control, must be implemented on the Thai-Myanmar border in the framework of international cooperation. The actual number of refugees was expected to increase in the Karen state at the end of March 2021, and they are at risk of contracting COVID-19 as they live in overcrowded conditions without access to basic sanitation. The global community has been hesitant to provide direct support because of fearing that such support would benefit the military. To reach this most vulnerable population, further strengthening of support through the Thai-Myanmar border as an alternative channel that was used before Myanmar's democratic transition in 2011 is necessary.

Service Delivery Reforms for Asian Ageing Societies: A Cross-Country Study Between Japan, South Korea, China, Thailand, Indonesia, and the Philippines.

INTRODUCTION: Japan's health policies to address the most advanced-aged society have been the target of focus in Asia, but no studies have investigated this issue using tools for cross-country comparisons. THEORY AND METHODS: A cross-country study design was used to compare healthcare reform policies with a framework in Japan, Korea, Thailand, China, Indonesia, and the Philippines. Data were collected via document reviews and key informant interviews. RESULTS: Three distinctions were identified. First, all countries except for the Philippines have policy decisions regarding reforms for the existing service delivery systems for healthcare, long-term care and welfare. Second, the most extensive service delivery reform is currently being implemented in Japan, whose system is shifting to primary health care. Third, the direction of the transformation of service delivery system is different between Thailand and China despite a similar level of ageing society. China has made progress on facility-based care integration between health and social care, whereas Thailand is focusing on home-based care. CONCLUSIONS AND DISCUSSION: Doctor and hospital-based healthcare delivery system requires more drastic reform for an aged society. This fact implies that strengthening primary health care is not only useful for current health issues but also an investment for the aged society near future in low- and middle-income countries.

[A case of rectal cancer combined with intraperitoneal abscess responding completely to uracil/tegafur (UFT) plus oral leucovorin (LV) therapy].

The patient was a 55-year-old man who complained of lower abdominal pain and fever, and was admitted to an emergency clinic. His diagnosis was rectal perforation combined with intraperitoneal abscess. Because his condition was in the preseptic state, an emergency operation was performed for colostomy and abscess drainage. After operation, he was diagnosed with rectal cancer colonoscopically. He refused reoperation and selected an oral chemotherapy regimen (UFT+LV therapy). 18 months later, he underwent Hartmann's operation. Histologically, cancer cells were absent. Complete response to chemotherapy was confirmed. He is free from any sign of recurrence until now.

Epidemiology and quarantine measures during COVID-19 outbreak on the cruise ship Diamond Princess docked at Yokohama, Japan in 2020: a descriptive analysis.

The outbreak of coronavirus disease 2019 (COVID-19) on the cruise ship Diamond Princess docked at Yokohama, Japan was highlighted due to its number of cases in the early stage of the global epidemic when the picture of the virus itself, as well as epidemiological characteristics, were being established. We conducted an observational epidemiological study of the outbreak, focusing on a total of 403 individuals who developed a fever of ≥ 37.5°C from 20 January to 22 February 2020. Quarantine measures are also discussed with a descriptive method. Of a total of 3,711 individuals (2,031 males) from 57 countries, 2,666 (71.8%) and 1,045 (28.2%) were passengers and crew with mean age of 66.0 (range: 2-98) and 36.6 (range: 19-64), respectively. Among 403 febrile individuals, 165 passengers and 58 crew members were diagnosed as laboratory-confirmed COVID-19 cases. Until 6 February, the number of confirmed cases was three or less per day. However, distribution of thermometers on 7 February revealed 43 confirmed cases, and it then started decreasing. The outbreak was initiated from decks for passengers and expanded to areas for crew. As of 17 March, when more than14 days had passed after disembarkation of all passengers and crew, there was no report of forming a cluster of infections in Japan from them. At the time of the initiation of quarantine, the outbreak had already expanded to most of the decks from those for passengers, and the results might suggest the contribution of the set of quarantine measures in unprecedented challenges of the control operation.

Sustainable implementation of international health cooperation projects while Japanese technical experts cannot go to low- and middle-income countries because of the COVID-19 pandemic travel restrictions.

Due to the COVID-19 pandemic, Japanese technical experts who have been supporting health in low-and middle- income countries (LMICs) are facing unprecedented travel restrictions. As of 11 April 2020, of 195 countries Japan has diplomatic relationship with, 181 countries have entry restrictions and 69 countries have post-entry movement restrictions (self-quarantine) for Japanese nationals or travellers from Japan. In order for technical experts to assist LMICs technically from Japan to meet the increased demand and needs in the health sector due to COVID-19, it is important to prioritize and reorganize the project activities in accordance with the local situation in particular to address three challenges i) to communicate from Japan; ii) to prioritize activities to match to the increased COVID-19 related tasks; and iii) to advocate health workers' rights and working environment.

Japan's healthcare policy for the elderly through the concepts of self-help (Ji-jo), mutual aid (Go-jo), social solidarity care (Kyo-jo), and governmental care (Ko-jo).

Elderly care is an emerging global issue threatening both developed and developing countries. The elderly in Japan increased to 26.7% of the population in 2015, and Japan is classified as a super-aged society. In this article, we introduce the financial aspects of the medical care and welfare services policy for the elderly in Japan. Japan's universal health insurance coverage system has been in place since 1961. Long-term care includes welfare services, which were separated from the medical care insurance scheme in 2000 when Japan was already recognized as an aging society. Since then, the percentage of the population over 65 has increased dramatically, with the productive-age population on the decrease. The Japanese government, therefore, is seeking to implement "The Community-based Integrated Care System" with the aim of building comprehensive up-to-the-end-of-life support services in each community. The system has four proposed elements: self-help (Ji-jo), mutual aid (Go-jo), social solidarity care (Kyo-jo), and government care (Ko-jo). From the financial perspective, as the government struggles against the financial burdens of an aging population, they are considering self-help and mutual aid. Based on Japan's present situation, both elements could lead to positive results. The Japanese government must also entrust the responsibility for implementing preventive support to municipalities through strongly required regional autonomy. As Japan has resolved this new challenge through several discussions over a long period of time, other aging countries could learn from the Japanese experience of solving barriers to healthcare policy for the elderly.

[Evaluation of hepatic artery infusion chemotherapy for liver metastasis of colorectal cancer using a side-hole catheter].

In our department forty cases of hepatic artery infusion chemotherapy using a side-hole catheter were analyzed with liver metastasis of colorectal cancer from December 2000 to December 2003. This easily placed catheter is able to inject the agent effectively from the side hole. The efficacy of high dose 5-FU (1,000 mg/m2/week) of hepatic artery injected chemotherapy was evaluated. The catheter was inserted from femoral or the left subclavian artery, and the side hole positioned at the base of proper hepatic artery or common hepatic artery. This method resulted in catheter trouble only 18% of the time. As for arterial infusion chemotherapy, system management and an evaluation of the drug distribution is essential. The one-year survival rate was 71.9%, the 50% survival time was 23.4 months, and the response rate was 71%. In conclusion, this therapy was effective and useful for hepatic metastasis.

A cross-sectional survey of blood pressure of a coastal city's resident victims of the 2011 Tohoku tsunami.

BACKGROUND: Blood pressure (BP) increase as a reaction to major disasters has been well documented; however, the impact has been underdocumented for tsunamis. This study aimed to confirm whether different levels of flooding/inundation and other damage caused by the 2011 Tohoku (northeast Japan) tsunami were associated with BP among resident victims in Higashi-Matsushima, Miyagi. METHODS: Cross-sectional household screening was conducted 7-19 weeks after the disaster in administrative areas totally or partially flooded by the tsunami. Systolic and diastolic BP (SBP/DBP) were measured in 4,311 residents. RESULTS: There was a degree-dependent association between SBP/DBP and flooding height above sea level among victims not on antihypertensive medication (P < 0.01 for both). Disruption of the gas supply was also significantly associated with SBP/DBP (P < 0.01 for both). Among individuals on antihypertensive medication, the discontinuation of medication was associated with SBP/DBP (P < 0.01 for both). After adjusting for confounding and multiplicity, a matched case-control analysis did not identify any significant associations between the tsunami or lifeline indicators and high BP (SBP ≥160mm Hg or DBP ≥100mm Hg). CONCLUSIONS: This study suggests that after a major tsunami, resident victims in areas highly inundated by flood waters and those with disrupted gas supply are more likely to have higher BP and thus might warrant getting BP screening earlier than other residents. Those with hypertension should be given assistance to resume or commence antihypertensive medication as soon as possible to reduce the risk of cardiovascular morbidity and mortality.