Impact of the SARS-COV-2 Pandemic on the Endovascular Treatment of Acute Stroke - an Italian Single-Center Experience.

OBJECTIVES: The SARS-CoV-2 pandemic greatly influenced the overall quality of healthcare. The purpose of this study was to compare the time variables for acute stroke treatment and evaluate differences in the pre-hospital and in-hospital care before and during the SARS-CoV-2 pandemic, as well as between the first and second waves. MATERIALS AND METHODS: Observational and retrospective study from an Italian hospital, including patients who underwent thrombectomy between January 1st 2019 and December 31st 2020. RESULTS: Out of a total of 594 patients, 301 were treated in 2019 and 293 in 2020. The majority observed in 2019 came from spoke centers (67,1%), while in 2020 more than half (52%, p < 0.01) were evaluated at the hospital's emergency room directly (ER-NCGH). When compared to 2019, time metrics were globally increased in 2020, particularly in the ER-NCGH groups during the period of the first wave (N = 24 and N = 56, respectively): "Onset-to-door":50,5 vs 88,5, p < 0,01; "Arrival in Neuroradiology - groin":13 vs 25, p < 0,01; "Door-to-groin":118 vs 143,5, p = 0,02; "Onset-to-groin":180 vs 244,5, p < 0,01; "Groin-to-recanalization": 41 vs 49,5, p = 0,03. When comparing ER-NCGH groups between the first (N = 56) and second (N = 49) waves, there was an overall improvement in times, namely in the "Door-to-CT" (47,5 vs 37, p < 0,01), "Arrival in Neuroradiology - groin" (25 vs 20, p = 0,03) and "Onset-to-groin" (244,5 vs 227,5, p = 0,02). CONCLUSIONS: During the SARS-CoV-2 pandemic, treatment for stroke patients was delayed, particularly during the first wave. Reallocation of resources and the shutting down of spoke centers may have played a determinant role.

COVID-19 outbreak: organisation of a geriatric assessment and coordination unit. A French example.

Older people are particularly affected by the COVID-19 outbreak because of their vulnerability as well as the complexity of health organisations, particularly in the often-compartmentalised interactions between community, hospital and nursing home actors. In this endemic situation, with massive flows of patients requiring holistic management including specific and intensive care, the appropriate assessment of each patient's level of care and the organisation of specific networks is essential. To that end, we propose here a territorial organisation of health care, favouring communication between all actors. This organisation of care is based on three key points: To use the basis of territorial organisation of health by facilitating the link between hospital settings and geriatric sectors at the regional level.To connect private, medico-social and hospital actors through a dedicated centralised unit for evaluation, geriatric coordination of care and decision support. A geriatrician coordinates this multidisciplinary unit. It includes an emergency room doctor, a supervisor from the medical regulation centre (Centre 15), an infectious disease physician, a medical hygienist and a palliative care specialist.To organise an ad hoc follow-up channel, including the necessary resources for the different levels of care required, according to the resources of the territorial network, and the creation of a specific COVID geriatric palliative care service. This organisation meets the urgent health needs of all stakeholders, facilitating its deployment and allows the sustainable implementation of a coordinated geriatric management dynamic between the stakeholders on the territory.

The impact of COVID-19 pandemic in the colorectal cancer prevention.

BACKGROUND: The coronavirus disease 2019 (COVID-19) has led to a policy of severe restrictions in almost all countries strongly involved by the pandemic. National Health System is among activities suffering from the COVID-19 and the lockdown. AIM: To evaluate the impact of COVID-19 in colorectal cancer (CRC) prevention. METHODS: We report the change in the hospital organization to meet the growing healthcare needs determined by COVID-19. The limitations of CRC prevention secondary to COVID-19 and their effects on the healthcare are analyzed considering the features of the CRC screening programs in the average-risk population and endoscopic surveillance in patients with inflammatory bowel diseases (IBD). RESULTS: The interruption of CRC prevention may lead to a delayed diagnosis of CRC, possibly in a more advanced stage. The economic burden and the impact on workload for gastroenterologists, surgeons, and oncologists will be greater as long as the CRC prevention remains suspended. To respond to the increased demand for colonoscopy once COVID-19 will be under control, we should optimize the resources. It will be necessary to stratify the CRC risk and reach an order of priority. It should be implemented the number of health workers, equipment, and spaces dedicated to performing colonoscopy for screening purpose and in subjects with alarm symptoms in the shortest time. To this aim, the funds earmarked for healthcare should be increased. CONCLUSION: The economic impact will be dramatic, but COVID-19 is the demonstration that healthcare has to be the primary goal of humans.

Rationing of nursing care, a deviation from holistic nursing: A systematic review.

BACKGROUND: Rationing of care in nursing is nurses' inability to complete all care activities for patients because of scarcity in time and resource. Literature suggests that rationing of care is closely related to patient safety and quality of care. The phenomena have been defined and studied from varied perspectives and contexts. A systematic review of studies related to the concept was aimed at identifying and synthesizing the finding. METHODS: The review followed Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, and literature searches were conducted in MEDLINE, CINAHL, PsycInfo, Web of Science and EMBASE databases. Fifty-seven quantitative studies were included in the review. FINDINGS: The review observed that nursing activities addressing the emotional, educational, mobility and hygiene needs of the patients were commonly rationed. Antecedents of rationing included resource inadequacy and organizational work environment. Rationing influenced patient satisfaction, mortality and a number of adverse events and was associated with decreased job satisfaction, increased intention to leave and high turnover among nurses. DISCUSSIONS: This review concludes that rationing in nursing is ubiquitous, embedded in the work environment and poses a threat to the professional health and philosophical base of nursing in addition to having serious implications on patients' safety. Strategies to reframe and reconsider organizational traits, and open discussion with other healthcare stakeholders can reduce rationing of nursing care. The review suggests future researchers adopt different methodological layout to study rationing.

Delivering medicines in a challenging environment: the pharmaceutical sector in East Timor (a descriptive study)

Background: The health status of the East Timorese population is very poor and much of the health system was destroyed during the violence of 1999. As in other developing countries, the lack of appropriate and high quality medicines significantly compromises patient care throughout the health system. The aim of this study was to examine the purchase, distribution and supply of pharmaceuticals in East Timor, and to identify the challenges faced by the pharmaceutical sector. Methods: Key informant interviews were held with health professionals and others involved in health care and the pharmaceutical sector in East Timor; documents (including regulations and rules) were reviewed; and daily activities observed at the Central Store, health centers, pharmacies and retail shops. Results: Some of the major challenges facing the pharmaceutical sector include lack of trained staff, sub-optimal facilities and lack of basic equipment. These lead to unsafe practices, and reliance on outside agencies. Conclusions: There are significant threats to the supply and quality of medicines in East Timor. There is currently a high level of dependence on foreign expertise, which is unsustainable in the long term (AU)

Antecedentes: El estado de salud de la población timoresa es muy pobre y la mayoría del sistema sanitario fue destruido durante la revuelta de 1999. Al igual que en otros países en vías de desarrollo, la faltad e medicamentos apropiados y de alta calidad compromete significativamente la atención a pacientes desde el sistema sanitario. El objetivo de este estudio fue examinar la compra, distribución y provisión de medicamentos en Timor Oriental, e identificar los retos a los que se enfrenta el sector farmacéutico. Métodos: Se realizaron entrevistas informativas a relevantes profesionales de la salud y otros involucrados en el sistema sanitario de Timor Oriental; se revisaron documentos (incluyendo reglamentos y leyes); y se observaron las actividades diarias en el Almacén Central, centros sanitarios, farmacias y tiendas detallistas. Resultados: Algunos de los mayores retos al os que se enfrenta el sector farmacéutico incluyen la falta de personal formado, establecimientos sub-óptimos y carencia de equipo básico. Esto lleva a prácticas inseguras, y dependencia de agencias externas. Conclusiones: Existen amenazas significativas para el suministro y calidad del as medicinas en Timor Oriental. Actualmente hay un alto nivel de dependencia del os expertos extranjeros, que es insostenible a largo plazo (AU)

Los niveles de la justicia sanitaria y la distribución de los recursos / The levels of health justice and the distribution of resources

El derecho a la asistencia sanitaria es una conquista social de los Estados democráticos de derecho. Para que esto se haga efectivo de una manera justa se requiere el concurso de muchos elementos que se analizan en este artículo en sus diversos momentos: el Estado como garante de este derecho y limitador de las prestaciones; las instituciones sanitarias, gestoras directas de la asistencia, que deben combinar la eficiencia y la equidad; y por último los profesionales de la salud verdaderos distribuidores finales de los recursos. La medicina tradicional siempre dejó fuera de su ámbito la evaluación de los factores socioeconómicos. Incluso llegó a considerar que estas cuestiones eran opuestas al buen ejercicio de la medicina. En la actualidad tal afirmación es insostenible. Para un profesional sanitario el camino hacia la eficiencia pasa por asegurar la efectividad clínica, garantizando de esta manera tanto el bien del paciente como la adecuada distribución de los recursos

The right to health care is a social achievement of democratic states based on law. In order for this to become effective in a just way, it is necessary for many elements to come together. This article analyses these elements in their different moments: the state as a guarantor of this right and to limit assistance; the health institutions, direct managers of care, which must combine efficiency and equity; and, finally, the health professionals, who are in the final instance the real distributors of resources. Traditionally medicine always omitted evaluation of the socio-economic factors from its sphere. It even came to consider that these questions were opposed to good medical practice. Today such an assertion is unsustainable. For a health professional the path to efficiency passes by way of assuring clinical effectiveness, in this way guaranteeing both the patient’s interest and the suitable distribution of resources

Inequalities in health in Latin America and the Caribbean: descriptive and exploratory results for self-reported health problems and health care in twelve countries

Objective: To explore and describe inequalities in health and use of health care as revealed by self-report in 12 countries of Latin America and the Caribbean. Methods: A descriptive and exploratory study was performed based on the responses to questions on health and health care utilization that were included in general purpose household surveys. Inequalities are described by quintile of household expenditures (or income) per capita, sex, age group (children, adults, and older adults), and place of residence (urban vs. rural area). For those who sought health care, median polishing was performed by economic status and sex, for the three age groups. Results: Although the study is exploratory and descriptive, its findings show large economic gradients in health care utilization in these countries, with generally small difference between males and females and higher percentages of women seeking health care than men, although there were some exceptions among the lower economic strata in urban areas. Conclusions: Inequalities in self-reported health problems among the different economic strata were small, and such problems were usually more common among women than men. The presence of small inequalities may be due to cultural and social differences in the perception of health. However, in most countries included in the study, large inequalities were found in the use of health care for the self-reported health problems. It is important to develop regional projects aimed at improving the questions on self-reported health in household interview surveys so that the determinants of the inequalities in health can be studied in depth. The authors conclude that due to the different patterns of economic gradients among different age groups, and among males and females, the practice of standardization used in constructing concentration curves and in computing concentration indices should be avoided. At the end is a set of recommendations on how to improve these sources of data. Despite their shortcomings, household interview surveys are very useful in understanding the dimensions of health inequalities in these countries (AU)

[Quality of child guidance counseling--current developments at the beginning of the 21st century]. / Qualität in der Erziehungsberatung--Aktuelle Entwicklungen zu Beginn des 21. Jahrhunderts.

Development of quality is not a new discussion in child guidance. There has been a long tradition about this theme. The continuously changing conditions of society and law demands child guidance on the other hand to changing reactions also. In modern child guidance we can find them in changed concepts and methods. So quality will be developed. The complete analysis shows us also, were new discussions are necessary.

Health planning and resource allocation in a changing Vietnam.

Vietnam is rapidly changing from a centrally planned to a market economic system. Explores the existing constraints and the degree of flexibility for management in the Government health system. Analyses the potential influence of the recent changes in health sector resource allocation with budgets becoming less under the direct control of the local authority, and based on population rather than the current number of beds. These changes create new possibilities, and responsibilities, for managers actively to manage health services and preventive programmes. Health managers are ill-prepared for this challenge.