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1.
Arch Argent Pediatr ; 119(2): 76-82, 2021 04.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33749192

RESUMO

INTRODUCTION: The objective of this study was to analyze available resources, guidelines in use, and preparedness to care for newborn infants at maternity centers in Argentina during the COVID-19 pandemic. METHOD: Cross-sectional study based on a survey administered to medical and nursing staff. In May 2020, Argentine facilities with more than 500 annual births were contacted; 58 % of these were from the public sector. RESULTS: In total, 104/147 facilities answered (71 %). All had guidelines for care during the pandemic, and 93 % indicated they had been trained on how to use them. A companion was not allowed during childbirth in 26 % of private facilities and in 60 % of public ones (p < 0.01). Deferred cord clamping was recommended in 87 %; rooming-in with asymptomatic newborns was promoted in 62 %; breastfeeding using protective measures was recommended in 70 %; and breast milk using a bottle, in 23 %. In 94 %, family visiting in the Neonatology Unit was restricted. Difficulties included the unavailability of individual rooms for symptomatic newborn infants and a potential shortage of health care staff and personal protective equipment. CONCLUSIONS: All facilities are aware of the national guidelines to fight the pandemic. Most have the resources to comply with the recommended protective measures. There is uncertainty as to whether personal protective equipment, staff, and physical space available at the different facilities would be enough if cases increased significantly.


Assuntos
/prevenção & controle , Recursos em Saúde/provisão & distribução , Cuidado do Lactente/organização & administração , Controle de Infecções/organização & administração , Serviços de Saúde Materna/organização & administração , Argentina/epidemiologia , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Política de Saúde , Humanos , Cuidado do Lactente/estatística & dados numéricos , Recém-Nascido , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/estatística & dados numéricos , Masculino , Serviços de Saúde Materna/estatística & dados numéricos , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Guias de Prática Clínica como Assunto , Gravidez
2.
Cien Saude Colet ; 26(3): 1001-1012, 2021 Mar.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33729354

RESUMO

The American response to the pandemic involves a prominent volume of federal resources, especially for developing and acquiring products for internal use, such as diagnostics or vaccines. Investment mechanisms and historical aspects justify this expenditure. Thus, the social construction of nationalism in American society hinders access to health technologies. The review of such aspects shows how the United States (U.S.) secured a large number of potential products, ensuring excessive local production. This unilateral foreign policy has influenced other countries or regional blocs and undermined global cooperation and solidarity, affecting the collective health of several nations.


Assuntos
/epidemiologia , Saúde Global , Cooperação Internacional , Pandemias , /diagnóstico , /estatística & dados numéricos , Custos e Análise de Custo , Países em Desenvolvimento , Difusão de Inovações , Economia , Recursos em Saúde/economia , Recursos em Saúde/provisão & distribução , Acesso aos Serviços de Saúde , Humanos , Sistemas Políticos , Alocação de Recursos/economia , Alocação de Recursos/métodos , Estados Unidos/epidemiologia , United States Dept. of Health and Human Services/economia
3.
Medicine (Baltimore) ; 100(7): e24871, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607861

RESUMO

BACKGROUND: Idiopathic short stature (ISS) causes a high economic burden worldwide. As part of a research project that synthesizes economic evidence for Korean medicine treatment of ISS, we describe the methods that will be used for the comprehensive review of articles that analyze health-related economic evaluation for available interventions for ISS using a systematic review methodology. METHODS: Eight electronic English, Korean, and Chinese databases will be searched from their inception until December 2020 to identify studies on the economic evaluation of available interventions on ISS, without language, study design, or publication status restrictions. From the included studies, the effectiveness, utility, and cost data will be collected as the outcome measures by two researchers independently. Descriptive analysis of individual studies will be conducted. If it is judged that the interventions and outcomes of the included studies are sufficiently homogeneous, we will attempt a quantitative synthesis through meta-analysis using Review Manager version 5.4 software (Cochrane, London, UK). RESULTS: This study will summarize the evidence regarding the economic evaluation of available interventions for ISS. CONCLUSIONS: The findings of this review will help clinicians and patients in evidence-based decision-making in clinical settings and help policy makers develop effective policies and distribute resources based on the available evidence.


Assuntos
Análise Custo-Benefício/métodos , Nanismo/economia , Nanismo/terapia , Acupuntura/métodos , Pessoal Administrativo/legislação & jurisprudência , Tomada de Decisão Clínica/ética , Efeitos Psicossociais da Doença , Gerenciamento de Dados , Nanismo/epidemiologia , Feminino , Recursos em Saúde/provisão & distribução , Medicina Herbária/métodos , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Masculino , Ensaios Clínicos Controlados não Aleatórios como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , República da Coreia/epidemiologia
4.
Mo Med ; 118(1): 45-49, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33551485

RESUMO

Healthcare providers perform lifesaving work in unusually stressful work environments due to the challenges and related risks of battling the unprecedented COVID-19 pandemic. The potential personal and professional toll is substantial. This article describes how one healthcare facility benefited from existing peer support resources to address workforce well-being, ensuring that resources were available to support workforce resilience throughout the protracted COVID response.


Assuntos
/psicologia , Pessoal de Saúde/psicologia , Mão de Obra em Saúde/estatística & dados numéricos , Saúde do Trabalhador/normas , Local de Trabalho/psicologia , Adaptação Psicológica/fisiologia , Adulto , /epidemiologia , Assistência à Saúde/organização & administração , Recursos em Saúde/provisão & distribução , Humanos , Masculino , Saúde Mental/tendências , Missouri/epidemiologia , Estresse Ocupacional/epidemiologia , Estresse Ocupacional/psicologia , /isolamento & purificação , Grupos de Autoajuda/organização & administração , Universidades/organização & administração , Local de Trabalho/estatística & dados numéricos
5.
Bone Joint J ; 103-B(2): 264-270, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517718

RESUMO

AIMS: Few studies have investigated potential consequences of strained surgical resources. The aim of this cohort study was to assess whether a high proportion of concurrent acute surgical admissions, tying up hospital surgical capacity, may lead to delayed surgery and affect mortality for hip fracture patients. METHODS: This study investigated time to surgery and 60-day post-admission death of patients 70 years and older admitted for acute hip fracture surgery in Norway between 2008 and 2016. The proportion of hospital capacity being occupied by newly admitted surgical patients was used as the exposure. Hip fracture patients admitted during periods of high proportion of recent admissions were compared with hip fracture patients admitted at the same hospital during the same month, on similar weekdays, and times of the day with fewer admissions. RESULTS: Among 60,072 patients, mean age was 84.6 years (SD 6.8), 78% were females, and median time to surgery was 20 hours (IQR 11 to 29). Overall, 14% (8,464) were dead 60 days after admission. A high (75th percentile) proportion of recent surgical admission compared to a low (25th percentile) proportion resulted in 20% longer time to surgery (95% confidence interval (CI) 16 to 25) and 20% higher 60-day mortality (hazard ratio 1.2, 95% CI 1.1 to 1.4). CONCLUSION: A high volume of recently admitted acute surgical patients, indicating probable competition for surgical resources, was associated with delayed surgery and increased 60-day mortality. Cite this article: Bone Joint J 2021;103-B(2):264-270.


Assuntos
Fixação de Fratura/estatística & dados numéricos , Recursos em Saúde/provisão & distribução , Fraturas do Quadril/cirurgia , Hospitalização/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fraturas do Quadril/mortalidade , Humanos , Masculino , Noruega/epidemiologia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 100(6): e24507, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578544

RESUMO

BACKGROUND: As nursing resources is directly related to patient outcomes in the intensive care unit setting, identifying factors related to nursing resources at various levels could contribute to improving those outcomes. This study aims to determine the association of nursing resources with outcomes of intensive care unit patients. METHOD: This study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Protocols. Chinese electronic Database (Chinese Biomedical Literature Database, Wanfang, and China National Knowledge Infrastructure) and international electronic databases (PubMed, Embase, Cochrane Library, and Web of Science) will be searched for all relevant published articles, with no restrictions on the year of publication or language. Study selection, data collection and assessment of study bias will be conducted independently by a pair of independent reviewers. The Newcastle-Ottawa Scale tool will be used for the risk of bias assessment. The Grading of Recommendations Assessment Development and Evaluation system will be used to assess the quality of evidence. The statistical analysis of this meta-analysis will be calculated by Review manager version 5.3. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: The findings of this systematic review will provide a high-quality synthesis of latest evidence and provide a basis for assessing the association of nursing resources on patients' outcomes in intensive care units. TRIAL REGISTRATION NUMBER: 10.17605/OSF.IO/9FNEX.


Assuntos
Enfermagem de Cuidados Críticos , Unidades de Terapia Intensiva , Enfermagem de Cuidados Críticos/métodos , Enfermagem de Cuidados Críticos/estatística & dados numéricos , Recursos em Saúde/provisão & distribução , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Resultado do Tratamento
8.
Workplace Health Saf ; 69(4): 174-181, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33514301

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted the health and psychological well-being of hospital nursing staff. While additional support is needed to better cope with increased job stressors, little is known about what types of hospital resources have been provided and how nursing staff perceive them. This study addressed this gap by describing nursing staff perceptions of resources provided by hospitals during the COVID-19 pandemic in the United States. METHODS: Registered nurses and nursing assistants who were working in hospitals during the pandemic were recruited to an online survey via social media posts and emails between May and June 2020. A total of 360 free-text responses to an open-ended survey question were analyzed using content analysis. RESULTS: Over half of participants reported being provided with hospital resources. "Basic needs" resources that included food on-site, groceries, and childcare support were the most frequently reported compared with four other types of resources (personal health and safe practice, financial support, managerial support, communication). Four themes emerged related to staff perceptions of support: community support, unequal benefits, decreasing resources, and insufficient personal protective equipment. CONCLUSION: Our findings can assist organizational leaders in the planning and allocation of different types of resources that are meaningful to nursing staff and thus ensure sustainability, optimal performance, and worker well-being during crises.


Assuntos
Recursos em Saúde/provisão & distribução , Recursos Humanos de Enfermagem no Hospital/psicologia , Percepção , Alocação de Recursos/normas , Adaptação Psicológica , Adulto , Idoso , Estudos Transversais , Feminino , Recursos em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Alocação de Recursos/estatística & dados numéricos , Inquéritos e Questionários
9.
mSphere ; 6(1)2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33441410

RESUMO

Information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread in Africa is limited by insufficient diagnostic capacity. Here, we assessed the coronavirus disease (COVID-19)-related diagnostic workload during the onset of the pandemic in the central laboratory of Benin, Western Africa; characterized 12 SARS-CoV-2 genomes from returning travelers; and validated the Da An RT-PCR-based diagnostic kit that is widely used across Africa. We found a 15-fold increase in the monthly laboratory workload due to COVID-19, dealt with at the cost of routine activities. Genomic surveillance showed near-simultaneous introduction of distinct SARS-CoV-2 lineages termed A.4 and B.1, including the D614G spike protein variant potentially associated with higher transmissibility from travelers from six different European and African countries during March-April 2020. We decoded the target regions within the ORF1ab and N genes of the Da An dual-target kit by MinION-based amplicon sequencing. Despite relatively high similarity between SARS-CoV-2 and endemic human coronaviruses (HCoVs) within the ORF1ab target domain, no cross-detection of high-titered cell culture supernatants of HCoVs was observed, suggesting high analytical specificity. The Da An kit was highly sensitive, detecting 3.2 to 9.0 copies of target-specific in vitro transcripts/reaction. Although discrepant test results were observed in low-titered clinical samples, clinical sensitivity of the Da An kit was at least comparable to that of commercial kits from affluent settings. In sum, virologic diagnostics are achievable in a resource-limited setting, but unprecedented pressure resulting from COVID-19-related diagnostics requires rapid and sustainable support of national and supranational stakeholders addressing limited laboratory capacity.IMPORTANCE Months after the start of the COVID-19 pandemic, case numbers from Africa are surprisingly low, potentially because the number of SARS-CoV-2 tests performed in Africa is lower than in other regions. Here, we show an overload of COVID-19-related diagnostics in the central laboratory of Benin, Western Africa, with a stagnating average number of positive samples irrespective of daily sample counts. SARS-CoV-2 genomic surveillance confirmed a high genomic diversity in Benin introduced by travelers returning from Europe and other African countries, including early circulation of the D614G spike mutation associated with potentially higher transmissibility. We validated a widely used RT-PCR kit donated by the Chinese Jack Ma Foundation and confirmed high analytical specificity and clinical sensitivity equivalent to tests used in affluent settings. Our assessment shows that although achievable in an African setting, the burden from COVID-19-related diagnostics on national reference laboratories is very high.


Assuntos
/diagnóstico , /isolamento & purificação , Adulto , Benin/epidemiologia , /transmissão , /métodos , Países em Desenvolvimento , Feminino , Genoma Viral , Recursos em Saúde/provisão & distribução , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Doença Relacionada a Viagens , Carga de Trabalho/estatística & dados numéricos
10.
Eur J Anaesthesiol ; 38(4): 344-347, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33350712

RESUMO

BACKGROUND: In light of the coronavirus disease-2019 (COVID-19) pandemic, how resources are managed and the critically ill are allocated must be reviewed. Although ethical recommendations have been published, strategies for dealing with overcapacity of critical care resources have so far not been addressed. OBJECTIVES: Assess expert opinion for allocation preferences regarding the growing imbalance between supply and demand for medical resources. DESIGN: A 10-item questionnaire was developed and sent to the most prominent members of the European Society of Anaesthesiology and Intensive Care (ESAIC). SETTING: Survey via a web-based platform. PATIENTS: Respondents were members of the National Anaesthesiologists Societies Committee and Council Members of the ESAIC; 74 of 80 (92.5%), responded to the survey. MEASUREMENTS AND MAIN RESULTS: Responses were analysed thematically. The majority of respondents (83.8%), indicated that resources for COVID-19 were available at the time of the survey. Of the representatives of the ESAIC governing bodies, 58.9% favoured an allocation of excess critical care capacity: 69% wished to make them available to supraregional patients, whereas 30.9% preferred to keep the resources available for the local population. Regarding the type of distribution of resources, 35.3% preferred to make critical care available, 32.4% favoured the allocation of medical equipment and 32.4% wished to support both options. The majority (59.5%) supported the implementation of a central European institution to manage such resource allocation. CONCLUSION: Experts in critical care support the allocation of resources from centres with overcapacity. The results indicate the need for centrally administered allocation mechanisms that are not based on ethically disputable triage systems. It seems, therefore, that there is wide acceptance and solidarity among the European anaesthesiological community that local medical and human pressure should be relieved during a pandemic by implementing national and international re-allocation strategies among healthcare providers and healthcare systems.


Assuntos
Anestesiologistas , Alocação de Recursos para a Atenção à Saúde/organização & administração , Recursos em Saúde/provisão & distribução , Pandemias , Alocação de Recursos , Triagem , /epidemiologia , Cuidados Críticos , Assistência à Saúde , Europa (Continente)/epidemiologia , União Europeia , Pessoal de Saúde , Humanos , Inquéritos e Questionários
11.
Pan Afr Med J ; 35(Suppl 2): 137, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193952

RESUMO

Sudan is facing a formidable task of fighting COVID-19. The country is suddenly challenged by this health issue that will test its path towards peace, stability, and development. The fragile task of handling COVID-19 epidemic in Sudan is brought about by several factors such as the weak healthcare system and political conflicts, that have been intertwined with the recent regime. Even before the COVID-19 pandemic, there was already high unemployment, soaring inflation and lack of social protection and safety nets for its populace. The government has been trying its best to address the pandemic, however, much still needs to be done. Neglecting Sudan by the international community in terms of support towards containment of COVID-19 has grievous implications for transition out of military dictatorship and efforts to curb the pandemic globally. As no country is safe if all is not safe. It is essential that Sudan should leverage on innovations, country-compatible measures, and other tailor-made strategies for effective responses.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Conflitos Armados , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Países em Desenvolvimento , Abastecimento de Alimentos , Política de Saúde , Prioridades em Saúde , Recursos em Saúde/provisão & distribução , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pobreza , Refugiados , Condições Sociais , Sudão/epidemiologia , Doença Relacionada a Viagens
12.
Pan Afr Med J ; 35(Suppl 2): 143, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193958

RESUMO

Zimbabwe reported its first case of COVID-19 on 20 March 2020, and since then the number has increased to over 4000. To contain the spread of the causative SARS-CoV-2 and prepare the healthcare system, public health interventions, including lockdowns, were imposed on 30 March 2020. These resulted in disruptions in healthcare provision, and movement of people and supply chains. There have been resultant delays in seeking and accessing healthcare by the patients. Additionally, disruption of essential health services in the areas of maternal and child health, sexual and reproductive health services, care for chronic conditions and access to oncological and other specialist services has occurred. Thus, there may be avoidable excess morbidity and mortality from non-COVID-19 causes that is not justifiable by the current local COVID-19 burden. Measures to restore normalcy to essential health services provision as guided by the World Health Organisation and other bodies needs to be considered and implemented urgently, to avoid preventable loss of life and excess morbidity. Adequate infection prevention and control measures must be put in place to ensure continuity of essential services whilst protecting healthcare workers and patients from contracting COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Assistência à Saúde , Pandemias , Pneumonia Viral/epidemiologia , Doença Crônica/epidemiologia , Controle de Doenças Transmissíveis/organização & administração , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/prevenção & controle , Guias como Assunto , Recursos em Saúde/provisão & distribução , Acesso aos Serviços de Saúde , Humanos , Pessoas sem Cobertura de Seguro de Saúde , Medicina , Modelos Teóricos , Mortalidade , Neoplasias/terapia , Pandemias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/prevenção & controle , Serviços de Saúde Reprodutiva/provisão & distribução , Organização Mundial da Saúde , Zimbábue/epidemiologia
13.
PLoS One ; 15(10): e0239430, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33006993

RESUMO

BACKGROUND: The achievement of the World Health Organization's END TB goals will depend on the successful implementation of strategies for early diagnosis and retention of patients on effective therapy until cure. An estimated 150,000 cases are missed annually in South Africa. It is necessary to look at means for identifying these missed cases. This requires the implementation of active surveillance for TB, a policy adopted by the National Department of Health. AIM: To explore the views of managers of the TB program on the implementation of active surveillance for TB in the resource constrained setting of the Eastern Cape, South Africa. METHODS: A descriptive, explorative, thematically analysed qualitative study based on 10 semi-structured interviews of managers of the TB program. Interviews were transcribed verbatim and analysed using the framework method and Atlas-ti. RESULTS: Active case finding of people attending health facilities was the dominant approach, although screening by community health workers (CHWs) was available. Both government and non-government organisations employed CHWs to screen door to door and sometimes as part of campaigns or community events. Some CHWs focused only on contact tracing or people that were non-adherent to TB treatment. Challenges for CHWs included poor coordination and duplication of services, failure to investigate those identified in the community, lack of transport and supportive supervision as well as security issues. Successes included expanding coverage by government CHW teams, innovations to improve screening, strategies to improve CHW capability and attention to social determinants. CONCLUSION: A multifaceted facility- and community-based approach was seen as ideal for active surveillance. More resources should be targeted at strengthening teams of CHWs, for whom this would be part of a comprehensive and integrated service in a community-orientated primary care framework, and community engagement to strengthen community level interventions.


Assuntos
Monitoramento Epidemiológico , Recursos em Saúde/provisão & distribução , Tuberculose/epidemiologia , Humanos , Avaliação de Resultados em Cuidados de Saúde , África do Sul/epidemiologia
14.
Emergencias ; 32(5): 320-331, 2020 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33006832

RESUMO

OBJECTIVES: To estimate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the organization of Spanish hospital emergency departments (EDs). To explore differences between Spanish autonomous communities or according to hospital size and disease incidence in the area. MATERIAL AND METHODS: Survey of the heads of 283 EDs in hospitals belonging to or affiliated with Spain's public health service. Respondents evaluated the pandemic's impact on organization, resources, and staff absence from work in March and April 2020. Assessments were for 15-day periods. Results were analyzed overall and by autonomous community, hospital size, and local population incidence rates. RESULTS: A total of 246 (87%) responses were received. The majority of the EDs organized a triage system, first aid, and observation wards; areas specifically for patients suspected of having COVID-19 were newly set apart. The nursing staff was increased in 83% of the EDs (with no subgroup differences), and 59% increased the number of physicians (especially in large hospitals and locations where the COVID-19 incidence was high). Diagnostic tests for the severe acute respiratory syndrome coronavirus 2 were the resource the EDs missed most: 55% reported that tests were scarce often or very often. Other resources reported to be scarce were FPP2 and FPP3 masks (38% of the EDs), waterproof protective gowns (34%), and space (32%). More than 5% of the physicians, nurses, or other emergency staff were on sick leave 20%, 19%, and 16% of the time. These deficiencies were greatest during the last half of March, except for tests, which were most scarce in the first 15 days. Large hospital EDs less often reported that diagnostic tests were unavailable. In areas where the COVID-19 incidence was higher, the EDs reported higher rates of staff on sick leave. Resource scarcity differed markedly by autonomous community and was not always associated with the incidence of COVID-19 in the population. CONCLUSION: The COVID-19 pandemic led to organizational changes in EDs. Certain resources became scarce, and marked differences between autonomous communities were detected.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Absenteísmo , Adulto , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Surtos de Doenças , Serviço Hospitalar de Emergência/organização & administração , Recursos em Saúde/provisão & distribução , Necessidades e Demandas de Serviços de Saúde , Mão de Obra em Saúde/estatística & dados numéricos , Número de Leitos em Hospital , Hospitais Públicos/organização & administração , Hospitais Públicos/estatística & dados numéricos , Humanos , Incidência , Recursos Humanos em Hospital/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Alocação de Recursos , /etiologia , Espanha/epidemiologia , Triagem/organização & administração
16.
PLoS One ; 15(10): e0241027, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33085729

RESUMO

As the number of cases of COVID-19 continues to grow, local health services are at risk of being overwhelmed with patients requiring intensive care. We develop and implement an algorithm to provide optimal re-routing strategies to either transfer patients requiring Intensive Care Units (ICU) or ventilators, constrained by feasibility of transfer. We validate our approach with realistic data from the United Kingdom and Spain. In the UK, we consider the National Health Service at the level of trusts and define a 4-regular geometric graph which indicates the four nearest neighbours of any given trust. In Spain we coarse-grain the healthcare system at the level of autonomous communities, and extract similar contact networks. Through random search optimisation we identify the best load sharing strategy, where the cost function to minimise is based on the total number of ICU units above capacity. Our framework is general and flexible allowing for additional criteria, alternative cost functions, and can be extended to other resources beyond ICU units or ventilators. Assuming a uniform ICU demand, we show that it is possible to enable access to ICU for up to 1000 additional cases in the UK in a single step of the algorithm. Under a more realistic and heterogeneous demand, our method is able to balance about 600 beds per step in the Spanish system only using local sharing, and over 1300 using countrywide sharing, potentially saving a large percentage of these lives that would otherwise not have access to ICU.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Recursos em Saúde/provisão & distribução , Modelos Teóricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Algoritmos , Infecções por Coronavirus/virologia , Cuidados Críticos , Número de Leitos em Hospital , Humanos , Unidades de Terapia Intensiva/provisão & distribução , Pandemias , Transferência de Pacientes , Pneumonia Viral/virologia , Espanha/epidemiologia , Reino Unido/epidemiologia , Ventiladores Mecânicos/provisão & distribução
17.
Hastings Cent Rep ; 50(5): 17-19, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33095490

RESUMO

The Covid-19 pandemic has brought about renewed conversation about equality and equity in the distribution of medical resources. Much of the recent conversation has focused on creating and implementing policies in times of crisis when resources are exhausted. Depending on how the pandemic develops, some communities may implement crisis measures, but many health care facilities are currently experiencing shortages of staff and materials even if the facilities have not implemented crisis standards. There is a need for shared conversation about equality and equity in these times of contingency between conventional and crisis medicine. To respond well to these challenges, I recommend that institutions rely on policy, professional education, and ethics consultation. As is the case with crisis policies, creating contingency policies requires that health care professionals decide on how, specifically, to achieve equity. A policy is only as effective as its implementation; therefore, institutions should invest in context-specific education on contingency policies. Finally, ethics consultation should be available for questions that contingency policies cannot address.


Assuntos
Infecções por Coronavirus , Medicina de Desastres , Alocação de Recursos para a Atenção à Saúde , Equidade em Saúde , Recursos em Saúde/provisão & distribução , Disparidades em Assistência à Saúde , Pandemias , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Medicina de Desastres/ética , Medicina de Desastres/normas , Consultoria Ética , Alocação de Recursos para a Atenção à Saúde/ética , Alocação de Recursos para a Atenção à Saúde/métodos , Política de Saúde , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Alocação de Recursos
19.
Cuad Bioet ; 31(102): 167-182, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32910670

RESUMO

In this paper present, from a bioethical perspective, a reflection on how to reconcile efforts to combat the COVID-19 pandemic with the safeguard of human rights. To do this, I develop three points. First, the regulatory framework that justifies the restriction or suspension of rights in the face of serious threats to public health. Second, the declarations of the international bioethics committees on the way in which human rights should be protected during public health crisis. And third, a review of the main rights threatened both by the public health crisis and by the means adopted to combat it. Before going into each of these points, I offer a preliminary note to clarify certain legal concepts and underline the need to overcome disjunctive approaches in considering human rights.


Assuntos
Betacoronavirus , Controle de Doenças Transmissíveis/legislação & jurisprudência , Direitos Humanos/ética , Pandemias/prevenção & controle , Saúde Pública/ética , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Comissão de Ética , União Europeia , Liberdade , Recursos em Saúde/ética , Recursos em Saúde/provisão & distribução , Acesso aos Serviços de Saúde/ética , Direitos Humanos/legislação & jurisprudência , Humanos , Pandemias/ética , Pandemias/legislação & jurisprudência , Direitos do Paciente/ética , Direitos do Paciente/legislação & jurisprudência , Autonomia Pessoal , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Saúde Pública/legislação & jurisprudência , Quarentena/ética , Quarentena/legislação & jurisprudência , Sujeitos da Pesquisa , Alocação de Recursos/ética , Espanha , UNESCO
20.
Cuad Bioet ; 31(102): 151-165, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32910669

RESUMO

The public health crisis caused by COVID-19 disease has bring again to the public arena the old debate of the role in decision-making process of politics and science. In this paper we analyze, in the context of the current pandemics, how politics has left a stellar role for science, either because science has anticipated in its proposals to politics, or because politics has opted for it as a premeditated strategy. The references to the opinion of scientists as a decision-making criterion or, furthermore, their presence as true spokesmen for authority have been so frequent. This means rediscovering science and health as instruments of power, in terms that remind us of what Foucault denounced almost fifty years ago with his Biopolitics.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Política , Ciência , Infecções por Coronavirus/prevenção & controle , Tomada de Decisões , Democracia , Teoria Ética , Política de Saúde , Prioridades em Saúde , Recursos em Saúde/provisão & distribução , Humanos , Pandemias/ética , Pandemias/legislação & jurisprudência , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Poder Psicológico , Saúde Pública , Anos de Vida Ajustados por Qualidade de Vida , Alocação de Recursos/ética , Papel (figurativo) , Valores Sociais , Sociedades Científicas , Espanha , Vacinas Virais
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