RESUMO
In the context of the COVID-19 pandemic, there has been a scarcity of resources with various effects on the care of cancer patients. This paper provides an English summary of a German guideline on prioritization and resource allocation for colorectal and pancreatic cancer in the context of the pandemic. Based on a selective literature review as well as empirical and ethical analyses, the research team of the CancerCOVID Consortium drafted recommendations for prioritizing diagnostic and treatment measures for both entities. The final version of the guideline received consent from the executive boards of nine societies of the Association of Scientific Medical Societies in Germany (AWMF), 20 further professional organizations and 22 other experts from various disciplines as well as patient representatives. The guiding principle for the prioritization of decisions is the minimization of harm. Prioritization decisions to fulfill this overall goal should be guided by (1) the urgency relevant to avoid or reduce harm, (2) the likelihood of success of the diagnostic or therapeutic measure advised, and (3) the availability of alternative treatment options. In the event of a relevant risk of harm as a result of prioritization, these decisions should be made by means of a team approach. Gender, age, disability, ethnicity, origin, and other social characteristics, such as social or insurance status, as well as the vehemence of a patient's treatment request and SARS-CoV-2 vaccination status should not be used as prioritization criteria. The guideline provides concrete recommendations for (1) diagnostic procedures, (2) surgical procedures for cancer, and (3) systemic treatment and radiotherapy in patients with colorectal or pancreatic cancer within the context of the German healthcare system.
Assuntos
COVID-19 , Neoplasias Colorretais , Neoplasias Pancreáticas , Alocação de Recursos , SARS-CoV-2 , Humanos , Neoplasias Colorretais/terapia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/diagnóstico , COVID-19/epidemiologia , Alemanha , Alocação de Recursos para a Atenção à Saúde/organização & administração , Prioridades em Saúde , Neoplasias Pancreáticas/terapia , Neoplasias Pancreáticas/epidemiologia , Pandemias , Guias de Prática Clínica como AssuntoRESUMO
BACKGROUND: Data access through smartphone applications (apps) has reframed procedure and policy in healthcare, but its impact in trauma remains unclear. Citizen is a free app that provides real-time alerts curated from 911 dispatch data. Our primary objective was to determine whether app alerts occurred earlier than recorded times for trauma team activation and emergency department arrival. METHODS: Trauma registry entries were extracted from a level one urban trauma center from January 1, 2018 to June 30, 2019 and compared with app metadata from the center catchment area. We matched entries to metadata according to description, date, time, and location then compared metadata timestamps to trauma team activation and emergency department arrival times. We computed percentage of time the app reported traumatic events earlier than trauma team activation or emergency department arrival along with exact binomial 95% confidence interval; median differences between times were presented along with interquartile ranges. RESULTS: Of 3,684 trauma registry entries, 209 (5.7%) matched app metadata. App alerts were earlier for 96.1% and 96.2% of trauma team activation and emergency department arrival times, respectively, with events reported median 36 (24-53, IQR) minutes earlier than trauma team activation and 32 (25-42, IQR) minutes earlier than emergency department arrival. Registry entries for younger males, motor vehicle-related injuries and penetrating traumas were more likely to match alerts (P < .0001). CONCLUSION: Apps like Citizen may provide earlier notification of traumatic events and therefore earlier mobilization of trauma service resources. Earlier notification may translate into improved patient outcomes. Additional studies into the benefit of apps for trauma care are warranted.
Assuntos
Sistemas de Comunicação entre Serviços de Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Aplicativos Móveis , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Despacho de Emergência Médica/organização & administração , Feminino , Alocação de Recursos para a Atenção à Saúde/organização & administração , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Smartphone , Triagem/organização & administração , Ferimentos e Lesões/diagnósticoRESUMO
OBJECTIVE: The impact of coronavirus disease 2019 (COVID-19) on the postoperative course of patients after cardiac surgery is unknown. We experienced a major severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in our cardiac surgery unit, with several patients who tested positive early after surgery. Here we describe the characteristics, postoperative course, and laboratory findings of these patients, along with the fate of the health care workers. We also discuss how we reorganize and reallocate hospital resources to resume the surgical activity without further positive patients. METHODS: After diagnosis of the first symptomatic patient, surgery was suspended. Nasopharyngeal swabs were performed in all patients and health care workers. Patients who were positive for SARS-CoV-2 were isolated and monitored throughout the in-hospital stay and followed up after discharged until death or clinical recovery. RESULTS: Twenty patients were found to be positive for SARS-CoV-2 sometime after cardiac surgery (mean age 69 ± 10.4 years; median European System for Cardiac Operative Risk Evaluation II score 3 [interquartile range, 5.1]); the median time from surgery to diagnosis was 15 days (interquartile range, 11). Among the patients, 18 had undergone cardiac surgery and 2 of them transcatheter aortic valve replacement. Overall mortality was 15%. Specific COVID-19-related symptoms were identified in 7 patients (35%). Among the 12 health care workers infected, 1 developed a bilateral mild-grade interstitial pneumonia. CONCLUSIONS: COVID-19 infection after cardiac surgery, regardless the time of the onset, is a serious condition. The systemic inflammatory state that follows extracorporeal circulation may mask the typical COVID-19 laboratory findings, making the diagnosis more difficult. A strict reorganization of the hospital resources is necessary to safely resume the cardiac surgical activity.
Assuntos
COVID-19/etiologia , Procedimentos Cirúrgicos Cardíacos , Surtos de Doenças , Complicações Pós-Operatórias , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Surtos de Doenças/prevenção & controle , Feminino , Seguimentos , Alocação de Recursos para a Atenção à Saúde/métodos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Itália , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Centros de Atenção TerciáriaRESUMO
Despite COVID-19's significant morbidity and mortality, considering cost-effectiveness of pharmacologic treatment strategies for hospitalized patients remains critical to support healthcare resource decisions within budgetary constraints. As such, we calculated the cost-effectiveness of using remdesivir and dexamethasone for moderate to severe COVID-19 respiratory infections using the United States health care system as a representative model. A decision analytic model modelled a base case scenario of a 60-year-old patient admitted to hospital with COVID-19. Patients requiring oxygen were considered moderate severity, and patients with severe COVID-19 required intubation with intensive care. Strategies modelled included giving remdesivir to all patients, remdesivir in only moderate and only severe infections, dexamethasone to all patients, dexamethasone in severe infections, remdesivir in moderate/dexamethasone in severe infections, and best supportive care. Data for the model came from the published literature. The time horizon was 1 year; no discounting was performed due to the short duration. The perspective was of the payer in the United States health care system. Supportive care for moderate/severe COVID-19 cost $11,112.98 with 0.7155 quality adjusted life-year (QALY) obtained. Using dexamethasone for all patients was the most-cost effective with an incremental cost-effectiveness ratio of $980.84/QALY; all remdesivir strategies were more costly and less effective. Probabilistic sensitivity analyses showed dexamethasone for all patients was most cost-effective in 98.3% of scenarios. Dexamethasone for moderate-severe COVID-19 infections was the most cost-effective strategy and would have minimal budget impact. Based on current data, remdesivir is unlikely to be a cost-effective treatment for COVID-19.
Assuntos
Tratamento Farmacológico da COVID-19 , COVID-19/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Alocação de Recursos para a Atenção à Saúde/economia , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/economia , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/economia , Alanina/uso terapêutico , COVID-19/diagnóstico , COVID-19/economia , COVID-19/mortalidade , COVID-19/virologia , Tomada de Decisão Clínica/métodos , Simulação por Computador , Análise Custo-Benefício , Dexametasona/economia , Dexametasona/uso terapêutico , Alocação de Recursos para a Atenção à Saúde/organização & administração , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/estatística & dados numéricos , Pessoa de Meia-Idade , Oxigênio/administração & dosagem , Oxigênio/economia , Anos de Vida Ajustados por Qualidade de Vida , Respiração Artificial/economia , SARS-CoV-2 , Índice de Gravidade de Doença , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
Introducción: La tasa de letalidad por COVID-19 ha generado mucha preocupación entre los ciudadanos y los medios de comunicación con respecto a los números oficiales proporcionados por distintos gobiernos. La salud pública en la actualidad debe hacer frente a la pandemia más significativa del siglo xxi. Objetivo: Analizar la tasa de letalidad por COVID-19 y su relación con recursos hospitalarios críticos, en el contexto de la pandemia de la COVID-19. Métodos: Se analizó la tasa de letalidad sobre la base de datos oficiales. Se subestimó el número de casos para obtener una estimación más real del alcance de la infección, de los indicadores de recursos hospitalarios importantes (críticos) en transición pandémica que podrían elevar la tasa de letalidad posterior al estudio. Se emplearon curvas de tendencia exponencial doblemente suavizadas, distribución S y técnicas de regresión. Resultados: La curva que mejor explicó el comportamiento de fallecidos por COVID-19 en Chile fue una ecuación de regresión cúbica. La variable hospitalización básica se distribuyó como una curva S. Las variables hospitalización media, pacientes críticos, unidad tratamiento intensivo, unidad cuidado intensivo, ventiladores mecánicos totales y ventiladores mecánicos ocupados; se pudieron explicar mediante regresiones cúbicas. En todos los casos, los valores de R2 fueron superiores al 95 por ciento. Conclusiones: El número de fallecidos seguirá en aumento. Se sugiere fortificar las unidades de hospitalización básica para imposibilitar el colapso de la red sanitaria. Es necesario seguir creciendo en términos de hospitalización de media complejidad, unidad tratamiento intensivo, unidad cuidado intensivo y número total de ventiladores mecánicos para asegurar el soporte sanitario(AU)
Introduction: The fatality rate by COVID-19 has generated a lot of concern among citizens and the media regarding the official numbers provided by different governments. Public health today must cope with the most significant pandemic of the twenty-first century. Objective: Analyze the fatality rate due to COVID-19 and its relation with critical hospital resources, in the context of the COVID-19 pandemic. Methods: The fatality rate was analyzed on the basis of official data. The number of cases was underestimated to obtain a more real estimate of the extent of the infection, of the indicators of important (critical) hospital resources in pandemic transition that could raise the post-study fatality rate. Double-smoothed exponential trend curves, S-distribution and regression techniques were used. Results: The curve that best explained the behavior of COVID-19 deaths in Chile was a cubic regression equation. The basic hospitalization variable was distributed as an S-curve. The variables called mean hospitalization, critical patients, intensive treatment unit, intensive care unit, total mechanical ventilators and busy mechanical ventilators could be explained by cubic regressions. In all cases, R2 values were greater than 95percent. Conclusions: The number of deaths will continue to rise. It is suggested to fortify the basic hospitalization units to prevent the collapse of the health network. It is necessary to continue growing in terms of medium complexity hospitalization, intensive treatment unit, intensive care unit and total number of mechanical ventilators to ensure health support(AU)
Assuntos
Humanos , Masculino , Feminino , Alocação de Recursos para a Atenção à Saúde/organização & administração , SARS-CoV-2 , COVID-19/mortalidade , ChileRESUMO
BACKGROUND Length of stay (LOS) in the emergency department (ED) should be measured and evaluated comprehensively as an important indicator of hospital emergency service. In this study, we aimed to analyze clinical characteristics of critically ill patients admitted to the ED and identify the factors associated with LOS. MATERIAL AND METHODS All patients with level 1 and level 2 of the Emergency Severity Index who were admitted to the ED from January 2018 to December 2019 were included in this retrospective study. The patients were divided into 2 groups: LOS ≥4 h and LOS <4 h. Variables were comprehensively analyzed and compared between the 2 groups. RESULTS A total of 19 616 patients, including 7269 patients in the LOS ≥4 h group and 12 347 patients in the LOS <4 group, were included. Advanced age, admission in winter and during the night shift, and diseases excluding nervous system diseases, cardiovascular diseases, and trauma were associated with higher risk of LOS. Nervous system diseases, cardiovascular diseases, trauma, and procedures including tracheal intubation, surgery, percutaneous coronary intervention, and thrombolysis were associated with lower risk of LOS. CONCLUSIONS Prolonged LOS in the ED was associated with increased age and admission in winter and during the night shift, while shortened LOS was associated with nervous system diseases, cardiovascular diseases, and trauma, as well as with procedures including tracheal intubation, surgery, percutaneous coronary intervention, and thrombolysis. Our findings can serve as a guide for ED physicians to individually evaluate patient condition and allocate medical resources more effectively.
Assuntos
Estado Terminal , Emergências , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Tempo de Internação/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , China/epidemiologia , Estado Terminal/epidemiologia , Estado Terminal/terapia , Emergências/classificação , Emergências/epidemiologia , Serviços Médicos de Emergência/classificação , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Humanos , Pessoa de Meia-Idade , Avaliação das Necessidades , Seleção de Pacientes , Estudos Retrospectivos , Estações do Ano , Jornada de Trabalho em Turnos/estatística & dados numéricosAssuntos
Vacinas contra COVID-19 , COVID-19/prevenção & controle , Programas de Imunização/organização & administração , Programas Nacionais de Saúde/organização & administração , Pandemias , SARS-CoV-2/imunologia , Vacinas contra COVID-19/provisão & distribuição , Colômbia , Alocação de Recursos para a Atenção à Saúde/legislação & jurisprudência , Alocação de Recursos para a Atenção à Saúde/organização & administração , Alocação de Recursos para a Atenção à Saúde/normas , Prioridades em Saúde , Humanos , Programas de Imunização/legislação & jurisprudência , Vacinação em Massa , Programas Nacionais de Saúde/legislação & jurisprudência , Seleção de PacientesRESUMO
COVID-19 pandemic of 2020 has impacted all aspects of clinical practice in the UK. Cataract services suffered severe disruption due to necessary measures taken to reduce elective surgery in order to release capacity to support intensive care requirements. Faced with a potential 50% increase in cataract surgery workload per week in the post-COVID-19 world, eye units should use this event to innovate, not just survive but to also evolve for a sustainable future. In this article, we discuss the inadequacies of existing service rationing options to tackle the COVID-19 cataract backlog. This includes limiting rationing based on visual acuity, limiting surgery to first or only seeing eyes, and postponing clinic and surgical dates according to referral dates. We propose units use the lockdown time to reset and develop a comprehensive patient-centred care pathway using principles of value-based healthcare: the cataract integrated practice units. Developing an agile surgical database that incorporates all aspects of patient need from education to follow-up in their individual cataract journey will allow units to react and plan quickly in the early phase of recovery and beyond. We also discuss the considerations units should bear in mind on telemedicine, modifications for face-to-face clinics, theatre organisation and options of expanding cataract throughput capacity. The pause in elective surgery due to the pandemic may have provided cataract services a rare opportunity to reset and transform cataract service pathways for the digital era.
Assuntos
COVID-19/epidemiologia , Extração de Catarata , Atenção à Saúde/organização & administração , Oftalmologia/organização & administração , SARS-CoV-2 , Alocação de Recursos para a Atenção à Saúde/organização & administração , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Planejamento em Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Oftalmologia/estatística & dados numéricos , Padrões de Prática Médica/normas , Encaminhamento e Consulta , Medicina Estatal/organização & administração , Medicina Estatal/tendências , Inquéritos e Questionários , Reino Unido , Listas de EsperaAssuntos
COVID-19/epidemiologia , Alocação de Recursos para a Atenção à Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Oncologia/organização & administração , Neoplasias , COVID-19/imunologia , COVID-19/prevenção & controle , COVID-19/transmissão , Vacinas contra COVID-19/administração & dosagem , Institutos de Câncer/organização & administração , Institutos de Câncer/normas , Controle de Doenças Transmissíveis/normas , Efeitos Psicossociais da Doença , Alocação de Recursos para a Atenção à Saúde/normas , Acessibilidade aos Serviços de Saúde/normas , Humanos , Índia/epidemiologia , Oncologia/normas , Neoplasias/diagnóstico , Neoplasias/imunologia , Neoplasias/mortalidade , Neoplasias/terapia , Pandemias/prevenção & controle , SARS-CoV-2/imunologia , SARS-CoV-2/patogenicidadeAssuntos
COVID-19/prevenção & controle , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/prevenção & controle , Detecção Precoce de Câncer , Alocação de Recursos para a Atenção à Saúde , Acessibilidade aos Serviços de Saúde , Controle de Infecções , COVID-19/epidemiologia , Neoplasias do Colo/epidemiologia , Colonoscopia/normas , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Saúde Global , Alocação de Recursos para a Atenção à Saúde/métodos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Pandemias , Guias de Prática Clínica como Assunto , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Crisis Standards of Care (CSC) provide a framework for the fair allocation of scarce resources during emergencies. The novel coronavirus disease (COVID-19) has disproportionately affected Black and Latinx populations in the USA. No literature exists comparing state-level CSC. It is unknown how equitably CSC would allocate resources. METHODS: The authors identified all publicly available state-level CSC through online searches and communication with state governments. Publicly available CSC were systematically reviewed for content including ethical framework and prioritization strategy. RESULTS: CSC were identified for 29 states. Ethical principles were explicitly stated in 23 (79.3%). Equity was listed as a guiding ethical principle in 15 (51.7%); 19 (65.5%) said decisions should not factor in race, ethnicity, disability, and other identity-based factors. Ten states (34.4%) allowed for consideration of societal value, which could lead to prioritization of health care workers and other essential personnel. Twenty-one (72.4%) CSC provided a specific strategy for prioritizing patients for critical care resources, e.g., ventilators. All incorporated Sequential Organ Failure Assessment scores; 15 (71.4%) of these specific CSC considered comorbid conditions (e.g., cardiac disease, renal failure, malignancy) in resource allocation decisions. CONCLUSION: There is wide variability in the existence and specificity of CSC across the USA. CSC may disproportionately impact disadvantaged populations due to inequities in comorbid condition prevalence, expected lifespan, and other effects of systemic racism.
Assuntos
COVID-19/etnologia , Alocação de Recursos para a Atenção à Saúde/ética , Alocação de Recursos para a Atenção à Saúde/organização & administração , Equidade em Saúde , Padrão de Cuidado , Humanos , Estados Unidos/epidemiologiaRESUMO
Coronavirus (COVID-19) has been a life-changing experience for both individuals and institutions. We describe changes in our practice based on real-time assessment of various national and international trends of COVID-19 and its effectiveness in the management of our resources. Initial risk assessment and peak resource requirement using the COVID-19 Hospital Impact Model for Epidemics (CHIME) and McKinsey models. Strengths, weaknesses, opportunities, and threats (SWOT) analysis of our practice's approach during the pandemic. Based on CHIME the community followed 60% social distancing, the number of expected new patients hospitalized at maximum surge would be 401, with 100 patients requiring ventilator support. In contrast, when the community followed 15% social distancing, the maximum surge of hospitalized new patients would be 1823 and 455 patients would require a ventilator. on April 15, the expected May requirement of ICU beds at peak would be 68, with 61 patients needing ventilators. The estimated surge numbers improved throughout April, and on April 22 the expected ICU bed peak in May would be 11.7, and those requiring ventilator would be 10.5. Simultaneously, within a month, our surgical waitlist grew from 585 to over 723 patients. Our SWOT analysis revealed our internal strengths and inherent weakness, relevant to the pandemic. A graded and a guarded response to this type of situation is crucial in managing patients in a large practice.
Assuntos
COVID-19/prevenção & controle , Acessibilidade aos Serviços de Saúde/organização & administração , Controle de Infecções/organização & administração , Modelos Teóricos , Administração da Prática Médica/organização & administração , Neoplasias da Próstata , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Florida/epidemiologia , Alocação de Recursos para a Atenção à Saúde/métodos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Humanos , Controle de Infecções/métodos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Pandemias , Distanciamento Físico , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/terapia , Listas de EsperaRESUMO
INTRODUCTION: During the SARS-CoV-2 pandemic, the majority of healthcare resources of the affected Italian regions were allocated to COVID-19 patients. Due to lack of resources and high risk of death, most cancer patients have been shifted to non-surgical treatments. The following reports our experience of a Gynaecologic Oncology Unit's reallocation of resources in a COVID-19 free surgical oncologic hub in order to guarantee standard quality of surgical activities. MATERIALS AND METHODS: This is a prospective observational study performed in the Gynaecologic Oncology Unit, on the outcomes of the reallocation of surgical activities outside the University Hospital of Bologna, Italy, during the Italian lockdown period. Here, we described our COVID-19 free surgical oncologic pathway, in terms of lifestyle restrictions, COVID-19 screening measures, and patient clinical, surgical and follow up outcomes. RESULTS: During the lockdown period (March 9th - May 4th, 2020), 83 patients were scheduled for oncological surgery, 51 patients underwent surgery. Compared to pre-COVID period, we performed the same activities: number of cases scheduled for surgery, type of surgery and surgical and oncological results. No cases of COVID-19 infection were recorded in operated patients and in medical staff. Patients were compliant and well accepted the lifestyle restrictions and reorganization of the care. CONCLUSIONSONCLUSIONS: Our experience showed that the prioritization of oncological surgical care and the allocation of resources during a pandemic in COVID-19 free surgical hubs is an appropriate choice to guarantee oncological protocols.
Assuntos
COVID-19/prevenção & controle , Neoplasias dos Genitais Femininos/cirurgia , Alocação de Recursos para a Atenção à Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Controle de Infecções/organização & administração , Adulto , Idoso , COVID-19/epidemiologia , Surtos de Doenças , Feminino , Procedimentos Cirúrgicos em Ginecologia , Alocação de Recursos para a Atenção à Saúde/métodos , Hospitais Universitários/organização & administração , Humanos , Controle de Infecções/métodos , Itália/epidemiologia , Pessoa de Meia-Idade , Pandemias , Estudos ProspectivosRESUMO
Published series on COVID-19 support the notion that patients with cancer are a particularly vulnerable population. There is a confluence of risk factors between cancer and COVID-19, and cancer care and treatments increase exposure to the virus and may dampen natural immune responses. The available evidence supports the conclusion that patients with cancer, in particular with hematologic malignancies, should be considered among the very high-risk groups for priority COVID-19 vaccination.
Assuntos
Vacinas contra COVID-19 , COVID-19/prevenção & controle , Alocação de Recursos para a Atenção à Saúde/organização & administração , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/epidemiologia , Humanos , Imunidade , Programas de Imunização/organização & administração , Razão de Chances , Modelos de Riscos Proporcionais , Saúde Pública/métodos , Risco , Fatores de Risco , Resultado do Tratamento , VacinaçãoRESUMO
The COVID-19 pandemic created a global health emergency that has changed the practice of medicine and has shown the need for palliative care as an essential element of hospital care. In our small South Florida hospital, a palliative care service was created to support the frontline caregivers. Thanks to the hospital support, our team was formed rapidly. It consisted of 3 advanced care practitioners, a pulmonary physician with palliative care experience and the cooperation of community resources such as hospice and religious support. We were able to support patients and their families facilitating communication as visitation was not allowed. We also addressed goals of care, providing comfort care transition when appropriate, and facilitating allocation of scarce resources to patients who were most likely to benefit from them. With this article we describe a simplified framework to replicate the creation of a Palliative Care Team for other hospitals that are experiencing this need.
Assuntos
COVID-19/epidemiologia , Administração Hospitalar , Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Comunicação , Família/psicologia , Alocação de Recursos para a Atenção à Saúde/organização & administração , Humanos , Pandemias , Planejamento de Assistência ao Paciente/organização & administração , Conforto do Paciente/organização & administração , SARS-CoV-2RESUMO
OBJECTIVES: Italy has been one of the countries most severely affected by the coronavirus disease 2019 (COVID-19). The Italian government was forced to introduce quarantine measures quickly, and all elective health services were stopped or postponed. This emergency has dramatically changed the management of paediatric and adult patients with congenital heart disease. We analysed data from 14 Italian congenital cardiac surgery centres during lockdown, focusing on the impact of the pandemic on surgical activity, patients and healthcare providers and resource allocation. METHODS: Fourteen centres participated in this study. The period analysed was from 9 March to 4 May. We collected data on the involvement of the hospitals in the treatment of patients with COVID-19 and on limitations on regular activity and on the contagion among patients and healthcare providers. RESULTS: Four hospitals (29%) remained COVID-19 free, whereas 10 had a 39% reduction in the number of beds for surgical patients, especially in the northern area. Two hundred sixty-three surgical procedures were performed: 20% elective, 62% urgent, 10% emergency and 3% life-saving. Hospital mortality was 0.4%. Compared to 2019, the reduction in surgical activity was 52%. No patients operated on had positive test results before surgery for severe acute respiratory syndrome coronavirus 2, the virus responsible for COVID-19. Three patients were infected during the postoperative period. Twenty-nine nurses and 12 doctors were infected. Overall, 80% of our infected healthcare providers were in northern centres. CONCLUSIONS: Our study shows that the pandemic had a different impact on the various Italian congenital cardiac surgery centres based on the different patterns of spread of the virus across the country. During the lockdown, the system was able to satisfy all emergency clinical needs with excellent results.
Assuntos
COVID-19/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/tendências , Alocação de Recursos para a Atenção à Saúde/tendências , Acessibilidade aos Serviços de Saúde/tendências , Cardiopatias Congênitas/cirurgia , COVID-19/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Procedimentos Cirúrgicos Eletivos/tendências , Emergências , Alocação de Recursos para a Atenção à Saúde/métodos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Pesquisas sobre Atenção à Saúde , Política de Saúde , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Controle de Infecções/métodos , Itália/epidemiologia , Doenças Profissionais/epidemiologia , Doenças Profissionais/prevenção & controle , Pandemias , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , QuarentenaRESUMO
The rapid spread of coronavirus disease 2019 (COVID-19) has exceeded the standard capacity of many hospital systems and led to an unprecedented scarcity of resources, including the already limited resource of extracorporeal membrane oxygenation (ECMO). With the large amount of critically ill patients and the highly contagious nature of the virus, significant consideration of ECMO candidacy is crucial for both appropriate allocation of resources as well as ensuring protection of health care personnel. As a leading pediatric ECMO program in the epicenter of the pandemic, we established new protocols and guidelines in order to continue caring for our pediatric patients while accepting adult patients to lessen the burden of our hospital system which was above capacity. This article describes our changes in consultation, cannulation, and daily care of COVID-19 positive patients requiring ECMO as well as discusses strategies for ensuring safety of our ECMO healthcare personnel and optimal allocation of resources. LEVEL OF EVIDENCE: Level V.
Assuntos
COVID-19/terapia , Oxigenação por Membrana Extracorpórea , Alocação de Recursos para a Atenção à Saúde , Adulto , Criança , Oxigenação por Membrana Extracorpórea/economia , Oxigenação por Membrana Extracorpórea/normas , Alocação de Recursos para a Atenção à Saúde/economia , Alocação de Recursos para a Atenção à Saúde/organização & administração , Humanos , Guias de Prática Clínica como Assunto , SARS-CoV-2RESUMO
INTRODUCTION: Cancer projections can provide key information to help prioritize cancer control strategies, allocate resources and evaluate current treatments and interventions. Canproj is a cancer-projection tool that builds on the Nordpred R-package by adding a selection of projection models. The objective of this project was to validate the Canproj R-package for the short-term projection of cancer rates. METHODS: We used national cancer incidence data from 1986 to 2014 from the National Cancer Incidence Reporting System and Canadian Cancer Registry. Cross-validation was used to estimate the accuracy of the projections generated by Canproj and relative bias (RB) was used as validation measure. The Canproj automatic model selection decision tree was also assessed. RESULTS: Five of the six models had mean RB between 5% and 10% and median RB around 5%. For some of the cancer sites that were more difficult to project, a shorter time period improved reliability. The Nordpred model was selected 79% of the time by Canproj automatic model selection although it had the smallest RB only 24% of the time. CONCLUSIONS: The Canproj package was able to provide projections that closely matched the real data for most cancer sites.
Assuntos
Previsões/métodos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Neoplasias , Canadá/epidemiologia , Confiabilidade dos Dados , Técnicas de Apoio para a Decisão , Humanos , Incidência , Modelos Estatísticos , Neoplasias/classificação , Neoplasias/economia , Neoplasias/epidemiologia , Neoplasias/terapia , Sistema de Registros/estatística & dados numéricos , Alocação de Recursos/métodosRESUMO
In this article, I review the ethical issues that arise in the allocation of deceased-donor organs to children and young adults. By analyzing the public media cases of Sarah Murnaghan, Amelia Rivera, and Riley Hancey, I assess whether public appeals to challenge inclusion and exclusion criteria for organ transplantation are ethical and under which circumstances. The issues of pediatric allocation with limited evidence and candidacy affected by factors such as intellectual disability and marijuana use are specifically discussed. Finally, I suggest that ethical public advocacy can coexist with well-evidenced transplant allocation if and when certain conditions (morally defensible criteria, expert evidence, nonprioritization of the poster child, and greater advocacy for organ transplantation in general) are met.