Last-mile delivery increases vaccine uptake in Sierra Leone.

Less than 30% of people in Africa received a dose of the COVID-19 vaccine even 18 months after vaccine development1. Here, motivated by the observation that residents of remote, rural areas of Sierra Leone faced severe access difficulties2, we conducted an intervention with last-mile delivery of doses and health professionals to the most inaccessible areas, along with community mobilization. A cluster randomized controlled trial in 150 communities showed that this intervention with mobile vaccination teams increased the immunization rate by about 26 percentage points within 48-72 h. Moreover, auxiliary populations visited our community vaccination points, which more than doubled the number of inoculations administered. The additional people vaccinated per intervention site translated to an implementation cost of US $33 per person vaccinated. Transportation to reach remote villages accounted for a large share of total intervention costs. Therefore, bundling multiple maternal and child health interventions in the same visit would further reduce costs per person treated. Current research on vaccine delivery maintains a large focus on individual behavioural issues such as hesitancy. Our study demonstrates that prioritizing mobile services to overcome access difficulties faced by remote populations in developing countries can generate increased returns in terms of uptake of health services3.

Testing data envelopment analysis models on the performance of European Union regions in sustainable waste management.

Achieving a Circular Economy requires effective waste management. Monitoring the transformation path taken by the European Union (EU) and its Member States is crucial for assessing the impact and effectiveness of current European waste legislation. Even though numerous studies have shown positive performance and convergence in waste treatment, regional efficiency evaluation studies are still lacking. This research aims to benchmark the performance of municipal solid waste management in 167 regions - at level 2 of the Nomenclature of Territorial Units for Statistics - across European Member States during the period from 2008 to 2013. It looks to assess whether there is any positive convergence among these regions. The efficiency assessment employs four different Data Envelopment Analysis models. One of these models, the Benefit-of-Doubt, is a non-parametric approach and represents a special case within the Data Envelopment Analysis framework. Our findings indicate a yearly reduction in the coefficient of variation of 3.6%. Despite this progressive convergence, substantial differences in municipal solid waste management performance exist between EU-20 regions, even within the same country. Particularly, the analysis demonstrates that the best performers are registered in the Central and Northern EU regions, while the Eastern and Southern EU regions performed worse.

Adherence to 2018 WCRF/AICR Cancer Prevention Recommendations and Risk of Cancer: The Melbourne Collaborative Cohort Study.

BACKGROUND: We examined associations between adherence to adaptations of the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations and total, exposure-related and site-specific cancer risk. METHODS: A total of 20,001 participants ages 40 to 69 years at enrollment into the Melbourne Collaborative Cohort Study in 1990 to 1994, who had diet, body size, and lifestyle reassessed in 2003 to 2007 ("baseline"), were followed-up through June 2021. We constructed diet and standardized lifestyle scores based on core WCRF/AICR recommendations on diet, alcohol intake, body size and physical activity, and additional scores incorporating weight change, sedentary behavior, and smoking. Associations with cancer risk were estimated using Cox regression, adjusting for confounders. RESULTS: During follow-up (mean = 16 years), 4,710 incident cancers were diagnosed. For highest quintile ("most adherent") of the standardized lifestyle score, compared with lowest ("least adherent"), a HR of 0.82 [95% confidence interval (CI): 0.74-0.92] was observed for total cancer. This association was stronger with smoking included in the score (HR = 0.74; 95% CI: 0.67-0.81). A higher score was associated with lower breast and prostate cancer risk for the standardized score, and with lung, stomach, rectal, and pancreatic cancer risk when the score included smoking. Our analyses identified alcohol use, waist circumference and smoking as key drivers of associations with total cancer risk. CONCLUSIONS: Adherence to WCRF/AICR cancer prevention recommendations is associated with lower cancer risk. IMPACT: With <0.2% of our sample fully adherent to the recommendations, the study emphasizes the vast potential for preventing cancer through modulation of lifestyle habits.

Extinction risk of the world's freshwater mammals.

The continued loss of freshwater habitats poses a significant threat to global biodiversity. We reviewed the extinction risk of 166 freshwater aquatic and semiaquatic mammals-a group rarely documented as a collective. We used the International Union for the Conservation of Nature Red List of Threatened Species categories as of December 2021 to determine extinction risk. Extinction risk was then compared among taxonomic groups, geographic areas, and biological traits. Thirty percent of all freshwater mammals were listed as threatened. Decreasing population trends were common (44.0%), including a greater rate of decline (3.6% in 20 years) than for mammals or freshwater species as a whole. Aquatic freshwater mammals were at a greater risk of extinction than semiaquatic freshwater mammals (95% CI -7.20 to -1.11). Twenty-nine species were data deficient or not evaluated. Large species (95% CI 0.01 to 0.03) with large dispersal distances (95% CI 0.03 to 0.15) had a higher risk of extinction than small species with small dispersal distances. The number of threatening processes associated with a species compounded their risk of extinction (95% CI 0.28 to 0.77). Hunting, land clearing for logging and agriculture, pollution, residential development, and habitat modification or destruction from dams and water management posed the greatest threats to these species. The basic life-history traits of many species were poorly known, highlighting the need for more research. Conservation of freshwater mammals requires a host of management actions centered around increased protection of riparian areas and more conscientious water management to aid the recovery of threatened species.

Riesgo de extinción de los mamíferos de agua dulce Resumen La pérdida continua de hábitats de agua dulce representa una amenaza importante para la biodiversidad mundial. Analizamos el riesgo de extinción de 166 especies de mamíferos acuáticos y semiacuáticos de agua dulce-un grupo que se documenta pocas veces como colectivo. Usamos las categorías de la Lista Roja de Especies Amenazadas de la Unión Internacional para la Conservación de la Naturaleza de diciembre 2021 para determinar el riesgo de extinción. Después comparamos este riesgo entre grupos taxonómicos, áreas geográficas y caracteres biológicos. El 30% de los mamíferos de agua dulce están categorizados como amenazados. La declinación de las tendencias poblacionales fue común (44.0%), incluyendo una mayor tasa de declinación (3.6% en 20 años) que para los mamíferos o las especies de agua dulce como conjunto. Los mamíferos acuáticos de agua dulce se encuentran en mayor riesgo de extinción que los mamíferos semiacuáticos (95% IC -7.20 a -1.11). Veintinueve especies no contaban con suficientes datos o no estaban evaluadas. Las especies grandes (95% IC 0.01 a 0.03) con distancias de dispersión amplias (95% IC 0.03 a 0.15) tuvieron un mayor riesgo de extinción que las especies pequeñas con menores distancias de dispersión. El número de procesos amenazantes asociados a alguna especie agravó su riesgo de extinción (95% CI 0.28 a 0.77). Las principales amenazas para estas especies fueron la cacería, el desmonte de tierras para tala y agricultura, la contaminación, los desarrollos residenciales y la destrucción o modificación del hábitat causados por presas o manejo hidrológico. Se sabe poco sobre los caracteres básicos de la historia de vida de muchas especies, lo que destaca la necesidad de más investigación al respecto. La conservación de mamíferos de agua dulce requiere una serie de acciones gestoras centradas en el incremento de la protección de las áreas ribereñas y una gestión hidrológica más consciente para ayudar a la recuperación de las especies amenazadas.

Environmental management cycles for chemicals and climate change, EMC4 : A new conceptual framework contextualizing climate and chemical risk assessment and management.

The environmental management cycles for chemicals and climate change (EMC4 ) is a suggested conceptual framework for integrating climate change aspects into chemical risk management. The interaction of climate change and chemical risk brings together complex systems that are imperfectly understood by science. Making management decisions in this context is therefore difficult and often exacerbated by a lack of data. The consequences of poor decision-making can be significant for both environmental and human health. This article reflects on the ways in which existing chemicals management systems consider climate change and proposes the EMC4 conceptual framework, which is a tool for decision-makers operating at different spatial scales. Also presented are key questions raised by the tool to help the decision-maker identify chemical risks from climate change, management options, and, importantly, the different types of actors that are instrumental in managing that risk. Case studies showing decision-making at different spatial scales are also presented highlighting the conceptual framework's applicability to multiple scales. The United Nations Environment Programme's development of an intergovernmental Science Policy Panel on Chemicals and Waste has presented an opportunity to promote and generate research highlighting the impacts of chemicals and climate change interlinkages. Integr Environ Assess Manag 2024;20:433-453. © 2023 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Sustainable governance of drinking water conservation areas based on adaptive thresholds.

Drinking water quality is integral to the Sustainable Development Goals framework. At the present, China's drinking water conservation faces a number of challenges that are partially brought on by strict conservation measures that don't fully take into account human-land conflict and sustainable development. Taking the idea of adaptive governance, this study seeks to identify adaptive thresholds and adaptive solutions for compatible drinking water conservation and local development. Pressure and resistance to drinking water quality in its status, future potential, and adaptive thresholds were explored to identify sustainable governance for the Baimei Conservation Area, Fujian Province. Field research, local governance forums, and the Soil and Water Assessment Tool (SWAT) model were utilized to explore the drinking water quality pressure and resistance to drinking water quality. In order to uncover potential future changes in pressure and resistance, suitability analyses and multi-scenario simulations were used to examine the status quo, pressure, and resistance scenarios. Adaptive thresholds were then identified through SWAT modeling of each scenario to guarantee the drinking water quality is greater than Class II in the Core Conservation Area and Class Ⅲ in 2nd-grade Conservation Area, respectively. The research finds that construction land development and farming are the key pressures on drinking water quality, and forests and wetlands are the primary resistances. The expansion of construction lands and the increased wetlands was centered on potential future scenarios because farming has no room for growth and forests are already heavily covered. The adaptive threshold of construction land expansion is identified to be 10% without new wetlands but can be 20% by adding 10% wetlands in subbasins, 5, 8, and 9. This study confirms the potential of adaptive sustainability for drinking water conservation areas. A similar analysis procedure can also be adapted to enhance adaptive governance for the sustainability of other conservation areas nationally and globally.

Improvement in Nurses' Knowledge of Subcutaneous Catheter Use for Pain Management.

BACKGROUND: Nurses often have insufficient knowledge of subcutaneous catheter use for pain management. This quality improvement project evaluated implementation of an evidence-based subcutaneous catheter nursing policy with education to improve pain management for hospitalized patients. METHOD: A convenience sample of nurses (N = 515) completed a posttest after online training on effective subcutaneous pain management. Patient pain ratings were assessed to evaluate whether they changed after nurses' training. RESULTS: Posttest scores showed the online learning module effectively contributed to nurses' knowledge of subcutaneous catheter pain management. A statistically significant reduction occurred in patient pain ratings (p < .001) postintervention. The number of patients experiencing moderate or severe pain decreased by 58%, for a significant reduction in pain. CONCLUSION: An online learning module was successful in educating nurses on pain medication administration through an indwelling subcutaneous catheter. [J Contin Educ Nurs. 2024;55(1):13-20.].

Economic incentives surrounding fertility: Evidence from Alaska's permanent fund dividend.

The Alaska Permanent Fund Dividend provided an incentive that increased fertility. This paper estimates the impact of the dividend transfer on fertility rates in Alaska compared to other states using the synthetic control methodology. For the period from 1982 to 1988, fertility on average increased annually in Alaska by 11.3 births per 1000 women aged 15-44-a 13.1 percent increase over the counterfactual. This was driven by women over 20. Fertility increased for women aged 20-24 by 12.4 percent, those aged 25-34 by 14.3 percent, and those aged 35-44 by 16.9 percent. The paper also finds support that narrowing the gap between births, increase in total fertility rate, and no change in abortion are potential channels for the observed increase in fertility. No change in the fertility for the adolescents combined with no change in abortion suggests that the increase in fertility in Alaska was planned.

Structural Equation Modeling of Associations Between Nursing Practice Environment And Missed Nursing Care: A Cross-sectional Study.

BACKGROUND: Missed nursing care (MNC) negatively impacts the quality of patient care. There may be a relationship between the nursing practice environment (NPE) and MNC; however, this relationship has not been examined in developing countries during the COVID-19 pandemic. PURPOSE: To determine the relationship between the NPE and MNC during the COVID-19 pandemic. METHODS: A cross-sectional study of 300 participants was conducted in 4 teaching hospitals in Iran. Data were collected using a demographic and clinical form, the Nursing Professional Practice Environment Questionnaire, and MISSCARE survey and analyzed using structural equation modeling. RESULTS: The hypothesized model was well fit, showing that 1 unit improvement of the NPE domains of patient-centered care , effective leadership , and policy transparency decreased MNC by 0.18, 0.12, and 0.05, respectively. CONCLUSION: The model confirmed the association between the dimensions of the NPE and MNC. These findings can assist health policymakers and nursing managers in improving the NPE.

A Global Overview of Missed Nursing Care During the COVID-19 Pandemic: A Systematic Review.

The coronavirus disease 2019 (COVID-19) pandemic has placed unparalleled pressure on many countries' healthcare systems, impacting the delivery of health and nursing care services. Despite the growing number of missed care studies during the pandemic, a broader perspective is essential when designing theory-driven strategies to improve nursing care delivery. This review aimed to synthesize evidence of missed nursing care during the COVID-19 pandemic in acute care settings through a systematic review and narrative synthesis. An electronic search of articles published since the emergence of the pandemic was conducted using 5 databases (Scopus, PubMed, Web of Science, CINAHL, and PsycINFO). A total of 470 articles were identified during the initial search, and 10 articles were included in the review. The sample sizes of the studies ranged from 37 to 536 nurses. Results of the content analysis were grouped into 5 categories: (1) prevalence of missed care, (2) frequency of missed care, (3) reasons for missed care, (4) nurses' and organizational variables contributing to missed care, and (5) work environment elements contributing to missed care. The review's findings revealed a shift in the nature of missed nursing care during the pandemic, with an emphasis on nursing care tasks vital for the recovery of patients with COVID-19. Despite the unique circumstances brought about by the pandemic, an inadequate nursing workforce continued to be identified as the primary reason for missed care, consistent with the pre-pandemic period.

Health Resource Utilization among Patients with Type 2 Diabetes Mellitus In Nigeria: An Analysis from the International Diabetes Management Practice Study (IDMPS).

PURPOSE: To assess the data on health resource utilization collected from patients with T2DM in Nigeria, within the seventh wave (2016) of the International Diabetes Management Practices Study (IDMPS). METHODS: In this cross-sectional study, adults (≥25 years) with T2DM, who had requisite diabetes treatment data and were attended by participating physicians during the two-week recruitment period, were included. Results: Thirty-one participating physicians enrolled 304 eligible patients (mostly 40-60 years of age) with the duration of T2DM ranging from 1 to 31 years (median: 7). Only 34.2% (102/298) patients possessed health insurance and 46.8% (138/295) co-paid for medications outside the insurance. About 70.1% of patients had T2DM-related complications; 19.7% of patients were hospitalized in the past 12 months due to these complications. Altogether, 275 patients with T2DM received oral glucose-lowering drugs, with (88/275) or without (187/275) insulin. The cost of medications/strips was the reason reported for not achieving glycemic targets in ~60.0% (50/84) insulin users and 54.3% (114/210) patients self-monitoring blood glucose, respectively. Specialists in diabetes care attended to a lower number of patients/day than non-specialists (31.61±30.74 vs. 49.25±49.64). Most of the specialists (14/22; 63.6%) reported insulin use in 20%-40% patients; while non-specialists (6/9; 66.6%) reported insulin use in <20% patients. Conclusion: In Nigeria, low insurance coverage and high out-of pocket payments for healthcare limit access to healthcare. Physicians are overburdened and medical resources trained in diabetes care seem insufficient. These findings highlight the need to formulate effective healthcare strategies for patients with T2DM.

Objectif: Évaluer les données sur l'utilisation des ressources de santé collectées auprès des patients atteints de DT2 au Nigéria dans le cadre de la septième vague (2016) de l'Étude Internationale sur les Pratiques de Gestion du Diabète (IDMPS). Méthodes: Dans cette étude transversale, les adultes (≥25 ans) atteints de DT2, qui disposaient de données de traitement du diabète nécessaires et qui ont été pris en charge par des médecins participants au cours de la période de recrutement de deux semaines, ont été inclus. Résultats: Trente et un médecins participants ont inscrit 304 patients éligibles (principalement âgés de 40 à 60 ans) avec une durée du DT2 variant de 1 à 31 ans (médiane : 7). Seuls 34,2% (102/298) des patients étaient assurés santé, et 46,8% (138/295) payaient eux-mêmes pour les médicaments en dehors de l'assurance. Environ 70,1% des patients présentaient des complications liées au DT2 ; 19,7% des patients avaient été hospitalisés au cours des 12 derniers mois en raison de ces complications. Au total, 275 patients atteints de DT2 ont reçu des antidiabétiques oraux, avec (88/275) ou sans (187/275) insuline. Le coût des médicaments/ bandelettes était la raison invoquée pour ne pas atteindre les objectifs glycémiques chez ~60,0% (50/84) des utilisateurs d'insuline et 54,3% (114/210) des patients effectuant l'autosurveillance de la glycémie, respectivement. Les spécialistes en diabétologie prenaient en charge un nombre inférieur de patients par jour que les non-spécialistes (31,61±30,74 contre 49,25±49,64). La plupart des spécialistes (14/22 ; 63,6%) ont signalé l'utilisation de l'insuline chez 20 à 40% des patients ; tandis que les non-spécialistes (6/9 ; 66,6%) ont signalé l'utilisation de l'insuline chez moins de 20% des patients. Conclusion: Au Nigéria , une faible couverture d'assurance et des paiements élevés directement par les patients limitent l'accès aux soins de santé. Les médecins sont surchargés et les ressources médicales formées dans la prise en charge du diabète semblent insuffisantes. Ces résultats soulignent la nécessité de formuler des stratégies de santé efficaces pour les patients atteints de Dt2. Mots-clés: Nigeria, diabète, utilisation des ressources, hospitalisation.

Sleep Quality in Older People: The Impact of Age, Professional Activity, Financial Situation, and Chronic Diseases During the SARS-CoV-2 Pandemic.

BACKGROUND The SARS-CoV-2 pandemic negatively affected health and social life, notably deteriorating sleep quality in older adults. Studies report inconsistent findings on sleep disturbances during this period, influenced by various physiological, emotional, and sociodemographic factors. This study aimed to identify these determining factors. MATERIAL AND METHODS The study was conducted among 342 people 60 years of age or older participating in online classes of randomly selected Senior Clubs and the University of the Third Age in the southern regions of Poland. RESULTS Sleep problems (PSQI >5 points) were diagnosed in 250 subjects (83.6%). Logistic regression analysis showed that the quality of sleep significantly depends on: age, as people aged 66-70 were more likely to have better sleep quality than people aged 60-65 (OR=3.07), and those over 70 scored better than people aged 60-65 (OR=2.87); current job - employed people have a better chance of better sleep quality (OR=3.08) than unemployed people; financial situation, people assessing their financial situation as very good/good had a better chance of better sleep quality (OR=2.00) compared to people assessing their financial situation as very bad, bad/average; chronic diseases, people without chronic diseases had a chance of better sleep quality (OR=2.45) than people with chronic diseases. CONCLUSIONS Age, financial situation, current job, and chronic disease were the most important factors determining sleep quality in older people. The identification of factors affecting sleep quality can be used as important data to develop interventions and programs to improve sleep quality.

From disease- to people-centred pandemic management: organized communities, community-oriented primary care and health information systems.

BACKGROUND: The COVID-19 pandemic exposed the health equity gap between and within countries. Western countries were the first to receive vaccines and mortality was higher among socially deprived, minority and indigenous populations. Surprisingly, many sub-Saharan countries reported low excess mortalities. These countries share experiences with community organization and participation in health. The aim of this article was to analyse if and how this central role of people can promote a successful pandemic response. METHODS: This analysis was partly based on local and national experiences shared during an international and Latin American conference on person-and people-centred care in 2021. Additionally, excess mortality data and pandemic control-relevant data, as well as literature on the pandemic response of countries with an unexpected low excess mortality were consulted. RESULTS: Togo, Mongolia, Thailand and Kenya had a seven times lower mean excess mortality for 2020 and 2021 than the United States of America. More successful pandemic responses were observed in settings with experience in managing epidemics like Ebola and HIV, well-established community networks, a national philosophy of mutual aid, financial government assistance, more human resources for primary care and paid community health workers. DISCUSSION: Since trust in authorities and health needs vary greatly, local strategies are needed to complement national and international pandemic responses. Three key levers were identified to promote locally-tailored pandemic management: well-organized communities, community-oriented primary care, and health information systems. An organized community structure stems from a shared ethical understanding of humanity as being interconnected with each other and the environment. This structure facilitates mutual aid and participation in decision making. Community-oriented primary care includes attention for collective community health and ways to improve health from its roots. A health information system supports collective health and health equity analysis by presenting health needs stratified for social deprivation, ethnicity, and community circumstances. CONCLUSIONS: The difference in excess mortality between countries during the COVID-19 pandemic and various country experiences demonstrate the potential of the levers in promoting a more just and effective health emergency response. These same levers and strategies can promote more inclusive and socially just health systems.

RESUMEN: ANTECEDENTES: La pandemia de COVID-19 expuso la brecha de equidad en salud dentro y entre países. Los países occidentales fueron los primeros en recibir vacunas y la mortalidad fue mayor entre las poblaciones indígenas, minoritarias y socialmente desfavorecidas dentro de los países. Sorprendentemente, muchos países subsaharianos reportaron un exceso de mortalidad bajo. Estos países comparten experiencias de organización y participación comunitaria en salud. El objetivo es analizar si y cómo este papel central de las personas puede promover una respuesta exitosa a la pandemia. MéTODOS: Este análisis se basa en parte en las experiencias locales y nacionales compartidas durante una conferencia internacional y latinoamericana sobre la atención centrada en las personas y comunidades en 2021. Además, se consultó los datos de exceso de mortalidad y los datos relevantes para el control de la pandemia, así como la literatura sobre la respuesta a la pandemia de países con un exceso de mortalidad inesperadamente bajo. RESULTADOS: Togo, Mongolia, Tailandia y Kenia tuvieron un exceso de mortalidad promedio por 2020 y 2021 siete veces menor que los Estados Unidos de América. Se observaron respuestas pandémicas más exitosas en entornos con experiencia en el manejo de epidemias como el ébola y el VIH, redes comunitarias bien establecidas, una filosofía nacional de ayuda mutua, asistencia financiera del gobierno, más recursos humanos para atención primaria y trabajadores de salud comunitarios remunerados. DISCUSIóN: Dado que la confianza en autoridades y las necesidades en salud varían mucho, se necesitan estrategias locales para complementar las respuestas nacionales e internacionales a la pandemia. Se identificaron tres palancas clave para promover la gestión de pandemias adaptada localmente: comunidades bien organizadas, atención primaria orientada a la comunidad y sistemas de información de salud. Una estructura comunitaria organizada surge de una comprensión ética compartida que concibe a la humanidad interconectada entre sí y con el medio ambiente. Esta estructura facilita la ayuda mutua y la participación en la toma de decisiones. La atención primaria orientada a la comunidad incluye la atención a la salud comunitaria colectiva y las formas de mejorar la salud desde sus raíces. Un sistema de información de salud puede apoyar el análisis de la salud colectiva y la equidad en salud al presentar las necesidades de salud estratificadas por privación social, etnicidad y circunstancias de la comunidad. CONCLUSIONES: La diferencia en el exceso de mortalidad entre países durante la pandemia de COVID-19 y las experiencias de varios países, demuestran el potencial de las palancas para promover una respuesta de emergencia sanitaria más justa y eficaz. Estas mismas palancas y estrategias pueden promover sistemas de salud más inclusivos y socialmente justos.

Análise das ações tomadas pela comissão de farmácia e terapêutica do Instituto Dante Pazzanese de Cardiologia em 2021 e 2022 / Analysis of the actions taken by the pharmacy and therapeutics committee of the Instituto Dante Pazzanese de Cardiologia in 2021 and 2022

INTRODUÇÃO E OBJETIVOS: A Comissão de Farmácia e Terapêutica (CFT) é uma instância de caráter consultivo e deliberativo que assessora a Diretoria Geral com objetivo de formular diretrizes e promover uso racional de medicamentos. O objetivo foi mensurar decisões tomadas pela CFT que impactem positivamente para economia de recurso orçamentário sem prejuízo assistencial. MÉTODOS: Estudo descritivo realizado no período de janeiro de 2021 a dezembro de 2022 sobre as ATAS mensais da CFT e sistema de gestão hospitalar eletrônica. Os dados coletados foram: assuntos discutidos, deliberação, valor unitário do medicamento. Foi considerado assuntos com impacto financeiro: substituição da padronização, despadronização, inclusão de medicamento com dosagem de melhor manejo, inclusão de restrição de prescrição para itens de alto valor. Os dados foram coletados em planilha Excel. RESULTADOS E DISCUSSÃO: Foram avaliadas 24 ATAS de CFT, em que foram selecionados temas voltados para farmacoeconomia. Do total, havia 5 pautas (21%) focadas no assunto: despadronização: 2 (40%): metoprolol 100 mg (tem de 50 mg), bosentana 62,5 mg (pertence ao Componente Especializado e o paciente já faz uso domiciliar e passa a ser orientado a trazer de casa), substituição: 1 (20%) sildenafila de 20 mg para 50 mg (preço unit de $12,20 para $0,49), inclusão de dosagem: 1 (20%) alteplase 10 mg ($491,19) sendo que o alteplase 50 mg custa $ 2.356,55 (dose depende do peso e havia desperdício) e inclusão de restrição 1 (20%): levosimendana ($4.900,00). Baseado no consumo anual, fizemos o cálculo de economia: metoprolol e bosentana ($4.373,37), sildenafila ($109.383,11), alteplase ($17.971,22), levosimendana ($ 88.200,00). Essa mudança não deixou o paciente desassistido, pois foi considerado substituições viáveis envolvendo o corpo clínico para adequação de prescrições médicas e apoio da Diretoria Clínica. CONCLUSÃO: Na busca de diminuir gastos com medicamentos sem afetar a assistência do paciente, a Comissão de Farmácia e Terapêutica possibilitou meios para economizar recurso orçamentário, promovendo reuniões extras com alguns setores estratégicos para demonstrar gastos com determinados itens e propor medidas que pudessem minimizar esse impacto financeiro. Houve uma compreensão e aceitação das áreas envolvidas. No montante, o hospital conseguiu economizar R$ 219.927,70. Financiamento e agradecimento: Aos membros da Comissão de Farmácia e Terapêutica que opinaram e sugeriram alternativas terapêuticas plausíveis.

A comparative study on patient safety culture among high-risk hospital staff in the context of the COVID-19 and non-COVID-19 pandemic: a cross-sectional study in Taiwan.

The study aimed to compare the evolution of patient safety culture perceived by high-risk hospital staff in the context of the COVID-19 pandemic and non-COVID-19 pandemic and to examine the variations in patient safety culture across demographic variables. The study found that the COVID-19 pandemic has significantly impacted patient safety culture in healthcare settings, with an increased focus on safety climate, job satisfaction, teamwork climate, stress recognition, and emotional exhaustion. Safety culture and work stress vary among medical professionals of different age groups. To reduce stress, workload should be minimized, work efficiency improved, and physical and mental health promoted. Strengthening safety culture can reduce work-related stress, improve job satisfaction, and increase dedication towards work. The study recommends interventions such as psychological and social support, along with emotional management training, to reduce emotional exhaustion. Healthcare institutions can set up psychological counseling hotlines or support groups to help medical professionals reduce stress and emotional burden.

Social justice in medical education: a student-led approach to addressing COVID-19 vaccine equity in the Hispanic/Latinx community.

The current healthcare system disproportionately affects vulnerable populations, leading to disparities in health outcomes. As a result, medical schools need to equip future physicians with the tools to identify and address healthcare disparities. The University of Nevada, Reno School of Medicine implemented a Scholarly Concentration in Medical Social Justice (SCiMSJ) program to address this issue. Three medical students joined the program and pioneered a project to address the equitable vaccine distribution within the local Hispanic/Latinx community. After identifying the disparity in vaccine uptake and high levels of vaccine hesitancy, they collaborated with local organizations to address vaccine misinformation and accessibility. They organized outreach events, provided vaccine education, and hosted a vaccine clinic at a Catholic church with a high Hispanic/Latinx congregation. Through their efforts, they administered 1,456 vaccines. The estimated economic and societal impacts of their work was 879 COVID-19 cases avoided, 5 deaths avoided, 45 life years saved, and $29,286 in economic value. The project's success highlights the effectiveness of a student-led approach to promote skill development in social justice training. Leadership skills and coalition building were crucial in overcoming resource limitations and connecting organizations with the necessary volunteer force. Building trust with the Hispanic/Latinx community through outreach efforts and addressing vaccine hesitancy contributed to the well-attended vaccine clinic. The project's framework and approach can be adopted by other medical students and organizations to address health disparities and improve health outcomes in their communities.

Clinical supervision under pressure: a qualitative study amongst health care professionals working on the ICU during COVID-19.

PURPOSE: The unprecedented influx of patients in 2020 with COVID-19 to intensive care units (ICU) required redeployment of healthcare professionals without adequate previous ICU-training. In these extraordinary circumstances, pivotal elements of effective clinical supervision emerged. This study sets out to explore the nature, aspects and key features of supervision under highly demanding circumstances among certified and redeployed health-care professionals on COVID-19 ICUs. MATERIALS AND METHODS: A prospective qualitative, single center, semi-structured interview study among healthcare professionals at COVID-19 ICUs at University Medical Center Utrecht, the Netherlands between July and December 2020. Interview data were analyzed using an inductive coding style. RESULTS: A total of 13 certified and 13 redeployed health'hcare professionals, including physicians, nurses, and operation room technicians participated. Seven themes were identified as essential for both certified (supervisors) and redeployed (trainees) personnel: an open attitude, observing boundaries, gauging coworkers' capacities, being available, providing feedback, continuity in care and teams, and combining supervision with workload. CONCLUSIONS: This study provides seven recommendations for both supervisors and trainees to help optimize clinical supervision. They align with the known five factors determining entrustment and supervision (trainee, supervisor, task, context, and relationship). To ensure good clinical supervision, be it either during normal circumstances or under pressure, efforts should primarily focus on factors that are within a supervisor or trainee's span of control. MESH: Clinical supervision, interprofessional, COVID-19, Intensive Care.

The importance of expert selection when identifying threatened ecosystems.

Identifying threatened ecosystem types is fundamental to conservation and management decision-making. When identification relies on expert judgment, decisions are vulnerable to inconsistent outcomes and can lack transparency. We elicited judgements of the occurrence of a widespread, critically endangered Australian ecosystem from a diverse pool of 83 experts. We asked 4 questions. First, how many experts are required to reliably conclude that the ecosystem is present? Second, how many experts are required to build a reliable model for predicting ecosystem presence? Third, given expert selection can narrow the range opinions, if enough experts are selected, do selection strategies affect model predictions? Finally, does a diverse selection of experts provide better model predictions? We used power and sample size calculations with a finite population of 200 experts to calculate the number of experts required to reliably assess ecosystem presence in a theoretical scenario. We then used boosted regression trees to model expert elicitation of 122 plots based on real-world data. For a reliable consensus (90% probability of correctly identifying presence and absence) in a relatively certain scenario (85% probability of occurrence), at least 17 experts were required. More experts were required when occurrence was less certain, and fewer were needed if permissible error rates were relaxed. In comparison, only ∼20 experts were required for a reliable model that could predict for a range of scenarios. Expert selection strategies changed modeled outcomes, often overpredicting presence and underestimating uncertainty. However, smaller but diverse pools of experts produced outcomes similar to a model built from all contributing experts. Combining elicited judgements from a diverse pool of experts in a model-based decision support tool provided an efficient aggregation of a broad range of expertise. Such models can improve the transparency and consistency of conservation and management decision-making, especially when ecosystems are defined based on complex criteria.

La importancia de seleccionar expertos para identificar ecosistemas amenazados Resumen La identificación de los tipos de ecosistemas amenazados es fundamental para decidir sobre su conservación y gestión. Cuando la identificación se basa en la opinión de expertos, las decisiones son vulnerables a resultados incoherentes y pueden carecer de transparencia. Recabamos la opinión de 83 expertos sobre la presencia de un ecosistema australiano extendido y en peligro crítico. Se plantearon cuatro preguntas: ¿Cuántos expertos son necesarios para concluir con fiabilidad que el ecosistema está presente?; ¿Cuántos expertos son necesarios para construir un modelo fiable de predicción de la presencia del ecosistema?; ya que la selección de expertos puede reducir el rango de opiniones, si se seleccionan suficientes expertos, ¿afectan las estrategias de selección a las predicciones del modelo; y ¿Una selección diversa de expertos proporciona mejores predicciones del modelo? Utilizamos cálculos de potencia y tamaño de muestra con una población finita de 200 expertos para obtener el número de expertos necesarios para evaluar de forma fiable la presencia de ecosistemas en un escenario teórico. Después usamos árboles de regresión reforzada para modelar la consulta de expertos de 122 parcelas basadas en datos del mundo real. Para obtener un consenso fiable (90% de probabilidad de identificar correctamente la presencia y la ausencia) en un escenario relativamente seguro (85% de probabilidad de ocurrencia), se necesitaban al menos 17 expertos. Se necesitaban más expertos cuando la ocurrencia era menos segura, y menos si se relajaban los porcentajes de error permitidos. En comparación, sólo se necesitaron unos 20 expertos para obtener un modelo fiable que pudiera predecir una serie de escenarios. Las estrategias de selección de expertos modificaron los resultados modelados, a menudo con sobre predicción de la presencia y subestimación de la incertidumbre. Sin embargo, los grupos de expertos más pequeños pero diversos produjeron resultados similares a los de un modelo construido a partir de todos los expertos participantes. La combinación de las opiniones obtenidas de un grupo diverso de expertos en una herramienta de apoyo a la toma de decisiones basada en un modelo proporcionó una agregación eficiente de una amplia gama de conocimientos. Estos modelos pueden mejorar la transparencia y coherencia de la toma de decisiones en materia de conservación y gestión, especialmente cuando los ecosistemas se definen en función de criterios complejos.

Economic viability analysis of recycling waste plastic as aggregates in green sustainable concrete.

Plastic waste management is one of the major global challenges at present. Recycling single used plastic waste as partial replacement of natural aggregates in concrete may reduce problems regarding mismanagement of plastic waste and unsustainable utilisation of natural resources as aggregates. This concept has been explored in many studies and positive results are obtained, but it has not been materialized at a large scale due to the uncertainty regarding economic viability. The present study therefore focuses on the economic aspects of using Polyethylene based fine aggregates and Polyethylene Terephthalate based coarse aggregates as partial replacement (10%, 20%, 30% and 40%) of natural fine and coarse aggregates separately and simultaneously, with special emphasis given on environmental and social cost. A material flow diagram using STAN is first developed to calculate plastic waste generation. An industrial survey has been conducted to estimate production cost of plastic aggregates, while social cost as WTP is determined through CVM method. The result shows that the total cost of concrete decreases with increase of replacement percentage and cost reduction varies between 0.65% and 7.58% compare to conventional concrete depending on the percentage and type of replacement without compromising strength. So, alongside being hugely beneficial to environment and society in terms of reduction of leachate and greenhouse gas generation, micro-plastic pollution, requirement of landfill area, mosquito borne diseases, erosion, sedimentation, land loss etc.; the concept of recycling plastic waste as partial replacement of natural aggregates in concrete has been proved to be economically viable and beneficial too.