Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 3.769
Filter
1.
Washington; Organización Panamericana de la Salud; mayo 5 , 2020. 3 p.
Non-conventional in English, Spanish | Coleciona SUS | ID: biblio-1096877

ABSTRACT

El uso de túneles u otras estructuras físicas (cabinas, gabinetes, puertas) con rociado de productos para la desinfección, los dispositivos de pulverización y la radiación UV-C (200-280 nm) no se recomiendan para humanos.


Promoting handwashing is essential to minimize transmission of SARS-COV-2, the virus that causes COVID-19, and to save lives. One of the most commons ways of transmission of SARS-COV-2 is from contaminated hands touching the mouth, nose and eyes. The virus can also be transferred from one surface to another through contaminated hands. Free access and mandatory use of handwashing stations would help to minimize SARS-COV-2 transmission and save lives.


Subject(s)
Humans , Pneumonia, Viral/prevention & control , Ultraviolet Rays , Disinfection/instrumentation , Coronavirus Infections/prevention & control , Chemical Compounds/prevention & control , Biomedical Technology/standards , Pandemics/prevention & control , Betacoronavirus
2.
Int J Drug Policy ; 81: 102766, 2020 May 13.
Article in English | MEDLINE | ID: mdl-32416525

ABSTRACT

BACKGROUND: Recent advances in the safety, tolerability, and efficacy of hepatitis C virus (HCV) treatments have led to the introduction of policy changes that include, in some settings, universal coverage of direct-acting antiviral (DAA) treatment for people living with HCV. However, people who inject drugs (PWID), a population with disproportionately high rates of HCV, often experience significant social and structural barriers to care, including when seeking treatment and care for blood-borne viruses. The objective of this study is to identify implementation challenges and opportunities for improving HCV-related care and scaling up DAA treatment for PWID living with HCV in a setting with universal DAA coverage since 2018. METHODS: Informed by a critical interpretive framework, this study thematically analyzes data from in-depth, semi-structured interviews conducted between October 2018 and February 2019 with a purposive sample of 15 expert stakeholders (e.g., clinicians, community-based organization representatives, policy makers) related to HCV care or research in British Columbia, Canada. RESULTS: Our analysis revealed two key thematics: First, participants described existing challenges for scaling up DAA treatment, including how contextual factors (e.g., housing, stigma) restrict opportunities for PWID to engage in care. Participants also described how strained and compartmentalized health services are onerous to navigate for patients. Second, participants described opportunities for improving HCV-related care through various structural interventions (e.g., improved housing, decriminalization of substance use), and enhanced and more accessible models of care (e.g., decentralized, integrated, outreach-focused, and peer- and nurse-led services). CONCLUSIONS: These findings emphasize that several key service delivery and system-level adaptations are required in order to equitably scale up access of DAAs to PWID living with HCV, including policies and programs that are responsive to socio-structural determinants of health.

3.
Article in English | MEDLINE | ID: mdl-32357397

ABSTRACT

This study aimed to identify orphan drug accessibility and impact on pharmaceutical budgets in South Korea by analyzing the status of orphan drug designation, approval, reimbursement, and pharmaceutical expenditure. We analyzed the dataset on orphan drugs designated, approved, and reimbursed from 2007 to 2019 based on long-term real-world data. The designated and approved orphan drugs were 165 and 156, respectively, and 88 out of 156 approved products were reimbursed. Total expenditure on orphan drugs increased annually to account for about 1.44% of total pharmaceutical expenditure in 2018. Orphan drug expenditure per patient increased on average by 8.7% per year. The average annual cost of orphan drugs was USD 27,000-USD 47,000, with the maximum value of USD 260,000-USD 560,000. As there are a number of orphan drugs that have not yet been reimbursable after approval, a reimbursement policy should be established that considers the characteristics of orphan drugs. Since the rapid increase in orphan drug expenditure can be a potential threat to the insurance budget, budget management should also be considered. In conclusion, it is necessary to take preemptive measures to manage the health insurance budget efficiently while improving patient accessibility to orphan drugs.

4.
Adv Emerg Nurs J ; 42(2): 119-127, 2020.
Article in English | MEDLINE | ID: mdl-32358428

ABSTRACT

More than 5 million central lines are placed in the United States each year. Advanced practice providers place central lines and must understand the importance of ultrasound guidance technology. The use of anatomic landmarks to place central lines has been employed in the past and in some instances is still used. This method may make accessing the target vessel difficult in the patient with anomalous anatomy or in the obese patient. These characteristics decrease successful placement and increase complications. Different organizations have agreed that the use of ultrasound during central venous access has decreased rates of complication and cost. In addition to cannulating and accessing a central vein, ultrasound can be used to rapidly confirm placement and to rule out complications such as pneumothorax. Utilizing ultrasound to assist in performance of procedures, and in assessment of patients, is a skill that should be optimized by nurse practitioners.

6.
J Vet Med Educ ; : e20190033, 2020 May 15.
Article in English | MEDLINE | ID: mdl-32412373

ABSTRACT

Swine medicine resources and caseloads for teaching and supporting extracurricular training activities vary widely among veterinary colleges and are concentrated in specific regions. Student interest and demand for swine medicine training is broader in geographical distribution. This is illustrated by student membership and attendance at the American Association of Swine Veterinarians (AASV) annual meetings, for example. To explore how concentrated resources might be made more widely available in a cost-effective manner, the Swine Medicine Education Center (SMEC) at Iowa State University's College of Veterinary Medicine looked for ways to leverage existing extracurricular resources with a broader geography of schools and students. This article describes the organization of student chapters of the AASV and the outcomes of a multi-session live audio and video webcast focused on swine medicine topics across North America over a 3-year period. SMEC organized the series with funding provided by the AASV and AASV Foundation. The broadcast series covered a wide range of swine-related topics, including pet pigs, emerging diseases, and regulation of antimicrobials. In its third year, 25 North American and 4 international veterinary schools participated in the series and provided feedback from attendees.

8.
BMC Med Ethics ; 21(1): 40, 2020 May 14.
Article in English | MEDLINE | ID: mdl-32408869

ABSTRACT

BACKGROUND: The world is threatened by future pandemics. Vaccines can play a key role in preventing harm, but there will inevitably be shortages because there is no possibility of advance stockpiling. We therefore need some method of prioritising access. MAIN TEXT: This paper reports a critical interpretative review of the published literature that discusses ethical arguments used to justify how we could prioritise vaccine during an influenza pandemic. We found that the focus of the literature was often on proposing different groups as priorities (e.g. those with pre-existing health conditions, the young, the old, health care workers etc.). Different reasons were often suggested as a means of justifying such priority groupings (e.g. appeal to best overall outcomes, fairness, belonging to a vulnerable or 'at risk' group etc.). We suggest that much of the literature, wrongly, assumes that we are able to plan priority groups prior to the time of a particular pandemic and development of a particular vaccine. We also point out the surprising absence of various issues from the literature (e.g. how vaccines fit within overall pandemic planning, a lack of specificity about place, issues of global justice etc.). CONCLUSIONS: The literature proposes a wide range of ways to prioritise vaccines, focusing on different groups and 'principles'. Any plan to use pandemic vaccine must provide justifications for its prioritisation. The focus of this review was influenza pandemic vaccines, but lessons can be learnt for future allocations of coronavirus vaccine, if one becomes available.

9.
Am Soc Clin Oncol Educ Book ; 40: 1-10, 2020 May.
Article in English | MEDLINE | ID: mdl-32412804

ABSTRACT

Patients and their families, physicians, drug companies, and regulatory agencies have common goals: to find effective therapies for life-threatening conditions. In oncology, the lines between clinical research and treatment are often blurred; parents and physicians of patients who have exhausted standard-of-care treatments and cannot participate in a clinical trial are likely to consider seeking compassionate use access to investigational drugs; however, knowledge and perspectives about compassionate use may differ among these groups. There are unique considerations associated with providing compassionate use to children diagnosed with cancer, including evaluation for potential developmental toxicities, the need for pediatric-specific dosing and formulations, informed consent, and, when appropriate, patient assent. Positive impacts of providing access to investigational therapies to children include potential treatment benefits to patients who obtain investigational agents as well as benefits to future patients if data from expanded access support drug development for childhood cancer. Challenges for physicians seeking compassionate use access to investigational drugs for their patients include obtaining the drug sponsor's agreement to provide the investigational drug as well as lack of knowledge about the process and regulatory requirements. Clinical trials in oncology provide the possibility of therapeutic benefit for pediatric patients; when feasible and warranted, these benefits should also be available to patients on a compassionate use basis outside of trials.

10.
Telecomm Policy ; : 101988, 2020 May 06.
Article in English | MEDLINE | ID: mdl-32377031

ABSTRACT

The field of artificial intelligence (AI) is experiencing a period of intense progress due to the consolidation of several key technological enablers. AI is already deployed widely and has a high impact on work and daily life activities. The continuation of this process will likely contribute to deep economic and social changes. To realise the tremendous benefits of AI while mitigating undesirable effects will require enlightened responses by many stakeholders. Varying national institutional, economic, political, and cultural conditions will influence how AI will affect convenience, efficiency, personalisation, privacy protection, and surveillance of citizens. Many expect that the winners of the AI development race will dominate the coming decades economically and geopolitically, potentially exacerbating tensions between countries. Moreover, nations are under pressure to protect their citizens and their interests-and even their own political stability-in the face of possible malicious or biased uses of AI. On the one hand, these different stressors and emphases in AI development and deployment among nations risk a fragmentation between world regions that threatens technology evolution and collaboration. On the other hand, some level of differentiation will likely enrich the global AI ecosystem in ways that stimulate innovation and introduce competitive checks and balances through the decentralisation of AI development. International cooperation, typically orchestrated by intergovernmental and non-governmental organisations, private sector initiatives, and by academic researchers, has improved common welfare and avoided undesirable outcomes in other technology areas. Because AI will most likely have more fundamental effects on our lives than other recent technologies, stronger forms of cooperation that address broader policy and governance challenges in addition to regulatory and technological issues may be needed. At a time of great challenges among nations, international policy coordination remains a necessary instrument to tackle the ethical, cultural, economic, and political repercussions of AI. We propose to advance the emerging concept of technology diplomacy to facilitate the global alignment of AI policy and governance and create a vibrant AI innovation system. We argue that the prevention of malicious uses of AI and the enhancement of human welfare create strong common interests across jurisdictions that require sustained efforts to develop better, mutually beneficial approaches. We hope that new technology diplomacy will facilitate the dialogues necessary to help all interested parties develop a shared understanding and coordinate efforts to utilise AI for the benefit of humanity, a task whose difficulty should not be underestimated.

11.
BMC Health Serv Res ; 20(1): 424, 2020 May 14.
Article in English | MEDLINE | ID: mdl-32410676

ABSTRACT

BACKGROUND: More alternatives have become available for the diagnosis and treatment of cancer in low- and middle-income countries. Because of increasing demands, governments are now facing a problem of limited affordability and availability of essential cancer medicines. Yet, precise information about the access to these medicines is limited, and the methodology is not very well developed. We assessed the availability and affordability of essential cancer medicines in Mexico, and compared their prices against those in other countries of the region. METHODS: We surveyed 21 public hospitals and 19 private pharmacies in 8 states of Mexico. Data were collected on the availability and prices of 49 essential cancer medicines. Prices were compared against those in Chile, Peru, Brazil, Colombia and PAHO's Strategic Fund. RESULTS: Of the various medicines, mean availability in public and private sector outlets was 61.2 and 67.5%, respectively. In the public sector, medicines covered by the public health insurance "People's Health Insurance" were more available. Only seven (public sector) and five (private sector) out of the 49 medicines were considered affordable. Public sector procurement prices were 41% lower than in other countries of the region. CONCLUSIONS: The availability of essential cancer medicines, in the public and private sector, falls below World Health Organization's 80% target. The affordability remains suboptimal as well. A national health insurance scheme could serve as a mechanism to improve access to cancer medicines in the public sector. Comprehensive pricing policies are warranted to improve the affordability of cancer medicines in the private sector.

12.
J Nurs Care Qual ; 35(3): E41-E46, 2020.
Article in English | MEDLINE | ID: mdl-32433157

ABSTRACT

BACKGROUND: The management of acute gastrointestinal hemorrhage (GIH) is focused on early resuscitation through 2 large-bore intravenous (2LBIV) catheters, although adherence to this recommendation is low. LOCAL PROBLEM: Of 100 patients hospitalized with GIH in 2017, only 14 received 2LBIV access. The goal of this study was to improve this measure. METHODS: A multidisciplinary team used the DMAIC (define, measure, analyze, improve, and control) framework to perform a quality improvement initiative. INTERVENTIONS: The team used quality tools including a stakeholder survey, swimlane diagram, and fishbone diagram. The first intervention involved education of the hospitalists directing admissions, and the second intervention involved education of emergency department (ED) physicians and nurses regarding the importance of 2LBIV placement. RESULTS: Following the second intervention, there was a substantial increase in 2LBIV placement to 37 of 86 (43%). CONCLUSIONS: Carefully directed education of ED physicians and nurses with monthly feedback was effective in improving appropriate intravenous placement in patients with GIH.

13.
Washington, D.C.; OPS; 2020-05-14.
in Spanish | PAHO-IRIS | ID: phr-52150

ABSTRACT

Las transfusiones de sangre son necesarias para mejorar o salvar la vida de niños con anemias graves, madres en emergencias obstétricas, pacientes con hemoglobinopatías, pacientes con cáncer, pacientes trasplantados, pacientes con enfermedades crónicas relacionadas con la edad, como hemorragias causadas por problemas vasculares y cirugías ortopédicas, personas heridas en accidentes, entre otras causas. La provisión y el acceso a sangre segura para transfusiones están estrechamente relacionados con la organización y el grado de desarrollo de los servicios de sangre, con la gobernanza y la participación de la sociedad a través de la donación voluntaria no remunerada. Desde 2004, la Organización Panamericana de la Salud (OPS) ha estado recopilando y publicando indicadores relacionados con el suministro de sangre en los países de América Latina y el Caribe. En 2014, los países de la Región reafirmaron su compromiso con la salud universal a través de la aprobación del Plan de acción para el acceso universal a sangre segura 2014-2019, aprobado por el 53.º Consejo Directivo celebrado en octubre de 2014 (CD53.6), este plan promueve el acceso universal a sangre segura para transfusiones en la región, a través de donaciones voluntarias no remuneradas, la organización de servicios de sangre, la implementación de estándares de calidad y seguridad y la aplicación de acciones de gobernanza. Los datos presentados aquí permiten monitorear e informar sobre el progreso y las limitaciones en la aplicación del Plan de acción para el acceso universal a sangre segura 2014-2019. Asimismo, se espera que estos datos promuevan el análisis y la evaluación de los indicadores a nivel nacional, subregional y que se fortalezcan o modifiquen las estrategias que mejoren la seguridad de la sangre y la accesibilidad a las transfusiones. La información fue proporcionada por las autoridades de los países y corresponde a los años 2016 y 2017.


Subject(s)
Neglected Diseases , Access to Essential Medicines and Health Technologies , Equipment and Supplies , Identity and Quality Standard for Products and Services
14.
Washington, D.C.; PAHO; 2020-05-08. (PAHO/HSS/MT/COVID-19/20-0014).
in English | PAHO-IRIS | ID: phr-52098

ABSTRACT

Considering the advance of the COVID-19 (novel coronavirus SARS-CoV-2) pandemic and the resulting declarations of health emergencies in the countries of the Region of the Americas, it is necessary to clarify the role and responsibility of each country’s National Regulatory Authority (NRA) regarding medicines and to establish appropriate channels for its participation in a coordinated strategy at the country level to provide an agile response in the pandemic. To ensure timely access to essential medicines and health technologies during the pandemic, countries will almost certainly need to develop, update, or even relax their regulatory frameworks, processes, and procedures. These actions may be necessary, for example, to use registered products for off-label uses, ensure the quality of donated products, deal with shortages of health products, etc. The actions that the NRA will implement must be effective and time-saving, which means that the country should create a coordinating group or committee with clear functions. The objective of this document is to provide guidance to NRAs on how to establish/review/implement regulatory committees for crisis management, how to coordinate with other health authorities, and how to promote improvements in communication with other government entities, civil society, and other relevant actors, in the framework of the regulatory response to the COVID-19 pandemic.


Subject(s)
Coronavirus Infections , Coronavirus , Access to Essential Medicines and Health Technologies , Regulatory Frameworks
15.
Washington, D.C.; OPS; 2020-05-08. (OPS/HSS/MT/COVID-19/20-0014).
in Spanish | PAHO-IRIS | ID: phr-52093

ABSTRACT

Para asegurar el acceso oportuno a medicamentos y tecnologías sanitarias esenciales durante la pandemia de COVID-19, es altamente probable que los países tengan que elaborar, actualizar o incluso flexibilizar sus marcos, procesos y procedimientos regulatorios. Estas acciones pueden ser necesarias, por ejemplo, para utilizar productos registrados fuera de lo aprobado, para asegurar la calidad de productos donados, enfrentar casos de escasez de productos sanitarios, etc. Por tanto, las acciones que implementará la autoridad reguladora nacional deben ser eficaces y en tiempos abreviados, por lo que el país deberá crear un grupo o comité coordinador con atribuciones claras.


Subject(s)
Coronavirus Infections , Coronavirus , Drug and Narcotic Control , Regulatory Frameworks , Access to Essential Medicines and Health Technologies
18.
Article in English | MEDLINE | ID: mdl-32387575

ABSTRACT

Section 2 of the 2019 World Health Organization (WHO) Model List of Essential Medicines includes opioid analgesics formulations commonly used for the control of pain and respiratory distress, as well as sedative and anxiolytic substances such as midazolam and diazepam. These medicines, essential to palliative care, are regulated under the international drug control conventions overseen by United Nations (UN) specialized agencies and treaty bodies and under national drug control laws. Those national laws and regulations directly affect bedside availability of Internationally Controlled Essential Medicines (ICEMs). The complex interaction between national regulatory systems and global supply chains (now impacted by COVID-19 pandemic) directly affects bedside availability of ICEMs and patient care. Despite decades of global civil society advocacy in the UN system, ICEMs have remained chronically unavailable, inaccessible and unaffordable in Lower-and-Middle Income Countries, and there are recent reports of shortages in High Income Countries as well. The most prevalent symptoms in COVID-19 are breathlessness, cough, drowsiness, anxiety, agitation and delirium. Frequently used medicines include opioids such as morphine or fentanyl and midazolam, all of them listed as ICEMs. This paper describes the issues related to the lack of availability and limited access to ICEMs during the COVID-19 pandemic in both intensive and palliative care patients in countries of all income levels and makes recommendations for improving access.

19.
BMJ Open ; 10(5): e035132, 2020 May 15.
Article in English | MEDLINE | ID: mdl-32414824

ABSTRACT

OBJECTIVES: The objective of this study was to determine the availability and prices of medicines for non-communicable diseases (NCDs) in health facilities and private for-profit drug outlets in Kenya. DESIGN: Cross-sectional study. METHODS: All public and non-profit health facilities in eight counties (Embu, Kakamega, Kwale, Makueni, Narok, Nyeri, Samburu and West Pokot) that purchased medicines from the Mission for Essential Drugs and Supplies, a major wholesaler, were surveyed in September 2016. For each health facility, one nearby private for-profit drug outlet was also surveyed. Data on availability and price were analysed for 24 NCD and 8 acute medicine formulations. Availability was analysed separately for medicines in the national Essential Medicines List (EML) and those in the Standard Treatment Guidelines (STGs). Median price ratios were estimated using the International Medical Products Price Guide as a reference. RESULTS: 59 public and 78 non-profit facilities and 135 drug outlets were surveyed. Availability of NCD medicines was highest in private for-profit drug outlets (61.7% and 29.3% for medicines on the EML and STGs, respectively). Availability of STG medicines increased with increasing level of care of facilities: 16.1% at dispensaries to 31.7% at secondary referral facilities. The mean proportion of availability for NCD medicines listed in the STGs (0.25) was significantly lower than for acute medicines (0.61), p<0.0001. The proportion of public facilities giving medicines for free (0.47) was significantly higher than the proportion of private non-profit facilities giving medicines for free (0.09) (p<0.0001). The mean price ratio of NCD medicines was significantly higher than for acute medicines in non-profit facilities (4.1 vs 2.0, respectively; p=0.0076), and in private for-profit drug outlets (3.5 vs 1.7; p=0.0013). CONCLUSION: Patients with NCDs in Kenya appear to have limited access to medicines. Increasing access should be a focus of efforts to achieve universal health coverage.

20.
Article in English | MEDLINE | ID: mdl-32418181

ABSTRACT

COVID-19 infection has shown rapid growth worldwide, and different therapies have been proposed for treatment, in particular, the combination of immune response modulating drugs such as chloroquine and hydroxychloroquine (antimalarials) alone or in combination with azithromycin. Although the clinical evidence supporting their use is scarce, the off label use of these drugs has spread very quickly in face of the progression of the epidemic and the high mortality rate in susceptible populations. However, these medications can pathologically prolong the QT interval and lead to malignant ventricular arrhythmias such that organized guidance on QT evaluation and management strategies are important to reduce morbidity associated with the potential large-scale use.

SELECTION OF CITATIONS
SEARCH DETAIL