Capacity Of Health Care System Research Articles

Factors influencing nursing students' willingness to volunteer during wartime emergencies: A cross sectional study in Israel

BackgroundDuring wartime emergencies, the Ministry of Health in Israel faces workforce shortages, prompting consideration of nursing students as auxiliary support. Understanding the factors influencing nursing students' willingness to volunteer, is essential for effective crisis preparedness. AimThe research seeks to identify how self-efficacy, positive attitudes, institutional support, knowledge, age, gender, prior experience, and familial obligations impact nursing students' readiness to volunteer during mass casualty events in wartime. DesignThis study employed a descriptive, cross-sectional research approach. SettingsNursing schools in Israel. ParticipantsA convenience sample of 300 nursing students who had commenced their studies for at least one month. The study targeted nursing students across Israel, regardless of their specific school affiliation. Recruitment was conducted through various channels, including face-to-face recruitment, emails, and synchronous chat groups. MethodsData were collected using a structured self-report questionnaire based on Bandura's self-efficacy theory and adapted from existing literature. Statistical analyses, included t-tests, Pearson correlation, and linear rand logistic regressions. ResultsThe study found high levels of intent (M = 3.33, SD = 0.83), perceived self-efficacy (M = 3.25, SD = 0.54), and positive attitudes towards volunteering during wartime (M = 3.57, SD = 0.54) among nursing students towards volunteering during wartime. Significant correlations were observed between students' willingness to volunteer during wartime and factors such as positive attitudes to volunteer during wartime (r = 0.543, p < 0.01), perceived self-efficacy (r = 0.313, p < 0.01), institutional support (r = 0.313, p < 0.01), knowledge (r = 0.138, p < 0.05), age (r = 0.179, p < 0.01), and previous volunteering experience (r = 0.158, p < 0.01). Regression analyses indicated that positive attitudes towards wartime volunteering, perceived self-efficacy, institutional support, and prior volunteering were significant predictors of the intention to volunteer. ConclusionsNursing students in Israel demonstrate a high willingness to volunteer during wartime, influenced by factors such as perceived self-efficacy, positive attitudes towards volunteering, and institutional support. While these findings suggest potential areas for enhancing volunteerism, further research is needed to assess the effectiveness of targeted training and support interventions. Nonetheless, fostering these key factors could strengthen the healthcare system's capacity to respond to wartime emergencies.

Current Capacity for Diagnosing Alzheimer's Disease in Germany and Implications for Wait Times.

Amyloid-targeting therapies for Alzheimer's disease (AD) might become available in Germany soon. The combination of a large pool of prevalent cases and a complex diagnostic process to determine eligibility for these treatments is likely to challenge health systems' capacity. To analyze Germany's healthcare system capacity to identify treatment-eligible patients in a timely and equitable manner. We modeled patients' diagnostic journey and projects wait times due to capacity constraints for AD specialist visits and PET scans from 2024 to 2043. Model parameters were derived from published data and expert input. Wait times would be ∼50 months over the model horizon, if patients were referred to specialists based on a brief cognitive assessment in primary care. Wait times for patients with social health insurance are projected to be 1.9 times those of patients with private insurance, with peak wait times of around 76 and 40 months, respectively. Adding a blood test for the AD pathology as additional triage step would reduce wait times to below 24 months. In spite of having a well-resourced health system, Germany is projected to be unable to cope with the demand for biomarker-based AD diagnosis, if a disease-modifying AD treatment were introduced. As these treatments might become available by the end of 2024, decisive action, in particular dissemination of high-performing AD blood tests for triage in primary care, will be needed to prevent delays in access and potentially avoidable and inequitable disease progression.

The Impact of Vaccination Programs on the Prevention of Infectious Disease Tuberculosis: A Case Study with Gasabo District in Rwanda

Introduction Tuberculosis (TB) remained a significant public health challenge globally, including in Gasabo District, Rwanda. Vaccination programs, particularly Bacille Calmette-Guérin (BCG) vaccination, played a crucial role in TB prevention. This study aimed to assess the impact of vaccination programs on TB prevention in Gasabo District, Rwanda, by analyzing vaccination coverage, TB incidence rates, demographic characteristics, and healthcare system factors.  Methods A retrospective cohort study design was employed, utilizing secondary data sources from healthcare facilities in Gasabo District. Data on vaccination coverage, TB incidence rates, demographic characteristics, and healthcare system factors were collected and analyzed. Statistical methods, including regression analysis and descriptive statistics, were used to assess the association between vaccination programs and TB prevention outcomes.  Findings The study found a significant association between BCG vaccination coverage and lower TB incidence rates in Gasabo District. Higher vaccination coverage was associated with reduced TB incidence rates, particularly among children. However, challenges such as incomplete vaccination data, potential confounding factors, and socio-economic disparities were identified. Despite these challenges, vaccination programs were found to be effective in reducing TB transmission and protecting vulnerable populations from TB infection.  Conclusion The findings highlighted the importance of vaccination programs in TB prevention efforts in Gasabo District, Rwanda. Strengthening vaccination coverage, enhancing healthcare system capacity, addressing socio-economic determinants, fostering collaborations, promoting research and innovation, and strengthening surveillance and monitoring systems are essential for optimizing TB prevention efforts. By implementing these recommendations, we can accelerate progress towards ending the TB epidemic and improving public health outcomes in Gasabo District and beyond.

Identifying Dementia research priority for Qatar national dementia research plan: A Cross-sectional Survey.

The World Health Organization (WHO) published the Global Action Plan 2017-2025 seven years ago to address the dementia burden for those impacted, including persons living with dementia, their families, and health-care providers. There were seven action areas in the global action plan; the least achieved was action area seven (dementia research and innovation). The primary objective of the study was to assess the top 10 dementia research priorities among healthcare professionals, patients, caregivers, the public, and stakeholders to develop the Qatar National Dementia Research Plan. Convenience sampling was used in this cross-sectional survey. The study was conducted online with the involvement of HMC staff (physicians, nurses, and allied health staff) from all HMC facilities, patients and caregivers from Rumailah Hospital's Geriatric Department, and the public who attended the 2022 Advanced Dementia Research Conference. The survey was conducted during 22nd of October 2022 till April 31, 2024. Overall, 2000 participants provided their responses, which included health care professionals under HMC, including physicians, nurses, allied health staff, patients, caregivers, the public, and stakeholders in Qatar. Dementia Risk Reduction (79%) was the top priority for the survey participants. The remaining nine priorities were the impact of early treatment (76%), health system capacity (73%), implementation of best practices for care (73), access to information and services post-diagnosis (71), caregiver support (70%), emotional well-being (67%), care provider education (65%), end-of-life care (65%), and non-drug approaches to managing symptoms (65%). The survey results clearly indicated that most participants ranked Dementia Risk Reduction as their top priority, indicating the essential focus on dementia prevention. These findings, together with goals such as early treatment, healthcare system capacity, and caregiver support, highlight the importance of an integrated, multidisciplinary approach to dementia management.

“They made me feel like I mattered”: a qualitative study of how mobile crisis teams can support people experiencing homelessness

BackgroundMobile crisis teams (MCTs) can be important alternatives to emergency medical services or law enforcement for low-acuity 911 calls. MCTs address crises by de-escalating non-violent situations related to mental health or substance use disorders and concurrent social needs, which are common among people experiencing homelessness (PEH). We sought to explore how an MCT in one city served the needs and supported the long- and short-term goals of PEH who had recently received MCT services.MethodsWe conducted 20 semi-structured interviews with service recipients of the Street Crisis Response Team, a new 911-dispatched MCT implemented in San Francisco in November 2020. In the weeks after their encounter, we interviewed respondents about their overall MCT experience and comparisons to similar services, including perceived facilitators and barriers to the respondent’s self-defined life goals. We analyzed interview transcripts with thematic analysis to capture salient themes emerging from the text and organized within a social-ecological model.ResultsNearly all respondents preferred the MCT model over traditional first responders, highlighting the team’s person-centered approach. Respondents described the MCT model as effectively addressing their most immediate needs (e.g., food), short-term relief from the demands of homelessness, acute mental health or substance use symptoms, and immediate emotional support. However, systemwide resource constraints limited the ability of the team to effectively address longer-term factors that drive crises, such as solutions to inadequate quality and capacity of current housing and healthcare systems and social services navigation.ConclusionsIn this study, respondents perceived this MCT model as a desirable alternative to law enforcement and other first responders while satisfying immediate survival needs. To improve MCT’s effectiveness for PEH, these teams could collaborate with follow-up providers capable of linking clients to resources and services that can meet their long-term needs. However, these teams may not be able to meaningfully impact the longstanding and complex issues that precipitate crises among PEH in the absence of structural changes to upstream drivers of homelessness and fragmentation of care systems.

Longitudinal Decline of Exercise Capacity in Male and Female Mice.

The population of older adults is exponentially expanding. Alongside aging comes the onset of chronic disease, decline of functional capacity, and reduced quality of life. Thus, this population increase will stress the capacity and financial viability of health and long-term care systems. Developing pre-clinical models for age-related functional decline is imperative to advancing therapies that extend healthspan and prolong independence. Previously in a cross-sectional study, we established a powerful composite scoring system we termed CFAB (comprehensive functional assessment battery). CFAB measures physical function and exercise capacity using well-validated determinants to measure overall motor function, fore-limb strength, four-limb strength/endurance, aerobic capacity, and volitional exercise/activity rate. In the current work, we used CFAB to track cohorts of male and female C57BL/6 mice over the lifespan (measuring CFAB at 6, 12, 18, 24, and 28 months of age). Overall, we found statistically significantly declining function as the mice aged, with some differences between males and females in trajectory and slope. We also determined that body mass changes presented differently between sexes, and tracked body composition (fat percentage, using magnetic resonance imagery) in females. In a subset of mice, we tracked in vivo contractile physiology noting declines in plantar flexor maximum isometric torque. In summary, our data suggest that males and females declined at different rates. We confirmed the efficacy of CFAB to track longitudinal changes in exercise capacity and physical fitness in both males and females, further validating the system to track age-related functional decline.

How ready is the health care system in Northeast India for surgical delivery? a mixed-methods study on surgical capacity and need.

Surgical services are scarce with persisting inequalities in access across populations and regions globally. As the world's most populous county, India's surgical need is high and delivery rates estimated to be sub-par to meet need. There is a dearth of evidence, particularly sub-regional data, on surgical provisioning which is needed to aid planning. This mixed-methods study examines the state of surgical care in Northeast India, specifically health care system capacity and barriers to surgical delivery. It involved a facility-based census and semi-structured interviews with surgeons and patients across four states in the region. Abdominal conditions constituted a large portion of the overall surgeries across public and private facilities in the region. Workloads varied among surgical providers across facilities. Task-shifting occurred, involving non-specialist nursing staff assisting doctors with surgical procedures or surgeons taking on anaesthetic tasks. Structural factors dis-incentivised facility-level investment in suitable infrastructure. Facility functionality was on average higher in private providers compared to public providers and private facilities offer a wider range of surgical procedures. Facilities in general had adequate laboratory testing capability, infrastructure and equipment. Public facilities often do not have surgeon available around the clock while both public and private facilities frequently lack adequate blood banking. Patients' care pathways were shaped by facility-level shortages as well as personal preferences influenced by cost and distance to facilities. Skewed workloads across facilities and regions indicate uneven surgical delivery, with potentially variable care quality and provider efficiency. The need for a more system-wide and inter-linked approach to referral coordination and human resource management is evident in the results. Existing task-shifting practices, along with incapacities induced by structural factors, signal the directions for possible policy action.

Implementing A Diabetes Risk Screening and Prevention Program in Community Pharmacies in the United Arab Emirates

The United Arab Emirates (UAE) faces a critical need to enhance its healthcare system to address the rising prevalence of prediabetes. Early detection is key in preventing its progression to type 2 diabetes. Implementing screening programs in community pharmacies offers a convenient and accessible solution to reach a broad demographic. Prediabetes often goes undetected until it develops into diabetes, leading to significant health complications and straining the healthcare system. By expanding the healthcare system's capacity through pharmacy-based screening programs, the UAE can proactively identify individuals at risk and implement timely intervention strategies. A novel prediabetes screening program that aligns with the UAE's healthcare vision, emphasizing preventative care and community outreach, was developed, implemented, and tested. Community pharmacies serve as trusted hubs for health-related services, making them ideal for engaging individuals in screenings and promoting health literacy. Through education and counseling, community pharmacists can provide valuable guidance on lifestyle modifications and resources for managing prediabetes, empowering individuals to take charge of their health. Our study demonstrated that expanding the healthcare system's capacity through pharmacy-based screening programs represents a proactive and practical approach to early prediabetes detection in the UAE. Establishing a national, structured, evidence-based, easily accessible diabetes prevention program can mitigate the burden of diabetes and enhance the overall health and well-being of the UAE population.

Large language models could change the future of behavioral healthcare: a proposal for responsible development and evaluation

Large language models (LLMs) such as Open AI’s GPT-4 (which power ChatGPT) and Google’s Gemini, built on artificial intelligence, hold immense potential to support, augment, or even eventually automate psychotherapy. Enthusiasm about such applications is mounting in the field as well as industry. These developments promise to address insufficient mental healthcare system capacity and scale individual access to personalized treatments. However, clinical psychology is an uncommonly high stakes application domain for AI systems, as responsible and evidence-based therapy requires nuanced expertise. This paper provides a roadmap for the ambitious yet responsible application of clinical LLMs in psychotherapy. First, a technical overview of clinical LLMs is presented. Second, the stages of integration of LLMs into psychotherapy are discussed while highlighting parallels to the development of autonomous vehicle technology. Third, potential applications of LLMs in clinical care, training, and research are discussed, highlighting areas of risk given the complex nature of psychotherapy. Fourth, recommendations for the responsible development and evaluation of clinical LLMs are provided, which include centering clinical science, involving robust interdisciplinary collaboration, and attending to issues like assessment, risk detection, transparency, and bias. Lastly, a vision is outlined for how LLMs might enable a new generation of studies of evidence-based interventions at scale, and how these studies may challenge assumptions about psychotherapy.

The impact of the COVID-19 pandemic on neurosurgery in the elderly population in Sweden

BackgroundThe COVID-19 pandemic prompted a refocus of health care resources to acute care which has impacted on the capacity of healthcare systems to conduct neurological surgeries. The elderly population has been shown to be particularly vulnerable to the consequences of the pandemic. Less neurosurgery can result in great impact on public health by increasing morbidity and mortality in patients with malignancies and traumatic injuries. The aim of this study was to investigate the effects of the COVID-19 pandemic on neurosurgical procedures in the elderly population in Sweden.MethodsIn this retrospective observational study, the reported incidence of all neurosurgical procedures registered in the 21 Regions of Sweden during 2015–2021 in people aged 65 year or older was collected. Surgical procedures were classified according to the NOMESCO system of classification. Neurosurgery incidence was defined as the number of NOMESCO associated interventions per 100.000 inhabitants. ICD-10 codes associated with neurosurgery-related diagnoses and deaths were also collected. Expected incidence of neurosurgery, neurosurgery-associated deaths and brain cancer diagnoses was estimated and compared to actual outcomes. Decrease in the incidence of neurosurgery was compared to regional COVID-19 incidence, other types of surgery and surgery waiting times.ResultsThe incidence of several categories of neurosurgery decreased in Sweden during 2020 and 2021, although not as much as other surgical categories. Women were more affected than men by the decrease in neurosurgery which could be partly explained by a decrease in brain cancer diagnoses amongst women. There was an association between regional decrease in neurosurgery incidence and longer surgery waiting time. COVID-19 incidence in the region did not have an effect on regional decreases in neurosurgery incidence.ConclusionsThe COVID-19 pandemic resulted in a reduction in the number of neurosurgical procedures performed in Sweden during 2020–2021, although not as much as in other European countries. There was regional difference in Sweden with respect to number of surgeries, and waiting time for elective surgeries although there was no increase in mortality.

The impact of early large-scale screening on the evolution of pandemics

We study the problem of large-scale screening in the early stages of a pandemic. In this setting, resources such as testing kits, budget, and hospital beds are scarce, and testing in early stages has the potential to control the dynamics of disease spread. We thus devise a screening framework in which subjects are randomly sampled from the population for screening. We investigate two screening strategies - individual and group testing - and identify settings in which each is more effective. To model disease spread dynamics, we utilize a compartmental susceptible-infected-quarantined-removed-deceased model in which we embed sampling and screening decisions that account for testing misclassification errors. We perform a sensitivity analysis over the parameters that govern the disease dynamics and show the efficacy of our proposed screening solutions. We then calibrate our model using data on the COVID-19 pandemic in the United States and demonstrate the effectiveness of our model in reducing total number of infections while meeting healthcare system capacity.

Factors Influencing Physiotherapy Attendance among Stroke Patients during the COVID-19 Era

Background: Stroke can greatly impact both physical capabilities and overall quality of life (An and Shaughnessy, 2011, Bártlová et al., 2022). While the 2019 novel Coronavirus (COVID-19) significantly impacted various sectors including access to healthcare services, access to routine stroke rehabilitation were not well documented in referral hospitals of Lusaka. Objectives: To assess factors affecting routine rehabilitation of stroke survivors during COVID-19 in referral hospital settings of Lusaka. Method: This was a cross-sectional study involving 26 stroke survivors who were present before and during the COVID-19 pandemic lockdown. All respondents were from 5 referral hospitals in Lusaka. Data was collected using researcher-administered structured questionnaires and analyzed using SPSS v27.0. Bivariate analysis was carried out using chi-squared and Fishers exact test of association. Results: There was an overall higher stroke patient response rate from females (57.7%, n=15) than males (42.3%, n=11). The outcome variable was significantly associated with only two intrinsic factors namely fear (mean rank of 1.69) seconded by patients’ perception of physiotherapist’s attitude (mean rank of 2.50). An overall decline in physiotherapy attendance from 2-3 times a week (69.2%, n=18) to once in a week (54%, n=14) was observed. Conclusion: A notable shift inclination towards home-based rehabilitation raises important considerations for healthcare practitioners and policymakers. It prompts a critical examination of the potential consequences of this shift on the quality and effectiveness of rehabilitation. Clinical implications: The identified barriers, particularly fear, highlight the need for targeted interventions. The study serves as a reminder of the complexities inherent in balancing patient needs, safety considerations, and healthcare system capacities.

Cost-Effectiveness of Faricimab in the Treatment of Diabetic Macular Oedema (DMO): A UK Analysis.

The aim of this work was to evaluate the cost-effectiveness of faricimab against relevant therapeutic alternatives used in clinical practice for the treatment of diabetic macular oedema (DMO) in the UK. A state-transition (Markov) model, with health states based on visual acuity scores and treatment pathways, was developed to conduct cost-utility analysis of faricimab treat and extend (T&E) regimen versus ranibizumab pro re nata (PRN) and aflibercept PRN over a time horizon of 25 years. Comparison against bevacizumab PRN was considered in scenario analysis. Effectiveness data for faricimab was sourced from the pivotal YOSEMITE and RHINE double-blind randomised controlled trials, and from a network meta-analysis for comparators. Costs and (dis)utilities were taken from nationally published sources or literature. The base case included indirect costs (productivity gains, informal care) given the wider impacts of DMO on society. Sensitivity analyses were conducted. In the base case, faricimab T&E dominated ranibizumab PRN and aflibercept PRN, being more effective and resulting in cost savings (between 0.16 and 0.36 mean QALYs gained, and £5483-9655 mean cost savings). In scenario analysis, faricimab was more effective but costlier compared with bevacizumab, with an incremental cost-effectiveness ratio (ICER) of £8898 per QALY gained. Considering only healthcare payer costs, the ICER of faricimab compared with ranibizumab PRN was £7991 per QALY gained and faricimab dominated aflibercept PRN. Faricimab T&E has the potential to reduce the burden of vision loss on society, giving people living with DMO greater independence and contributing to increased healthcare system capacity. At a threshold of £20,000, faricimab T&E is cost-effective compared with relevant comparators, and potentially cost saving.

Death Unpreparedness Due to the COVID-19 Pandemic: A Concept Analysis.

The COVID-19 pandemic imposed changes upon the capacity of healthcare systems, with significant repercussions on healthcare provision, particularly at end-of-life. This study aims to analyze the concept map of death unpreparedness due to the COVID-19 pandemic, capturing the relationships among the attributes, antecedents, consequences, and empirical indicators. Walker and Avant's method was used to guide an analysis of this concept. A literature search was performed systematically, between May 2022 and August 2023, using the following electronic databases on the Elton Bryson Stephens Company (EBSCO) host platform: Medical Literature Analysis and Retrieval System Online (Medline), Psychological Information Database (PsycINFO), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Cochrane Library, and Nursing and Allied Health Collection. Thirty-four articles were retrieved. The unexpected and unpredictable impositions associated with inexperience and unskillfulness in dealing with COVID-19 configured challenges for healthcare professionals, family/caregivers, and even the dying person. Nine key attributes emerged in three main domains: (1) Individual: (a) disease-related conditions, (b) separation distress, and (c) scarcity of death and grief literacy; (2) Relational: (a) Dying alone, (b) poor communication, and (c) existential issues; and (3) Contextual: (a) disrupted collective mourning and grieving, (b) disrupted compassionate care and, (c) pandemic social stigma. This study contributed a full definition of death unpreparedness in a global pandemic scenario such as COVID-19. In this sense, feeling unprepared or unready for death brought new challenges to the bioecological resources of those affected. It is essential to embrace strategies capable of providing emotional and spiritual support in the dying process and to respect patient wishes. The lessons learned from COVID-19 should be applied to events with a comparable impact to minimize their consequences.

The impact of healthcare system quality and economic factors on the older adult population: a health economics perspective.

This study investigates the influence of economic conditions, healthcare system capacity, and health-related variables on the proportion of the older adult population (Population ages 65 and above) in European Union countries. It aims to identify how factors such as GDP, unemployment, inflation, healthcare expenditure, hospital bed availability, and the prevalence of chronic diseases impact the aging demographic. This study explores the dynamic interactions and temporal relationships between economic stability, healthcare capacity, chronic disease prevalence, and demographic aging patterns. The research employs a mixed-method approach, utilizing System GMM and wavelet coherence analysis on panel data from 27 EU countries between 2000 and 2021. The findings reveal significant positive associations between economic prosperity and healthcare resources with the size of the older adult population. Increased GDP, efficient healthcare spending, and hospital bed availability are positively correlated with a larger older adult demographic. In contrast, high unemployment and inflation are linked to negative outcomes for the older adult population, reducing available resources and access to healthcare. Wavelet coherence analysis further uncovers how fluctuations in the prevalence of chronic diseases influence aging trends across different periods and frequencies. The study highlights the importance of integrated economic and healthcare policies to support the growing older adult population. Ensuring economic stability, enhancing healthcare infrastructure, and effectively managing chronic diseases are essential for improving quality of life and promoting sustainable aging in EU societies.

Staging and Management of Cervical Cancer at the Colposcopy Clinic of Bangabandhu Sheikh Sheikh Mujib Medical University (BSMMU), Bangladesh.

Anjuman SultanaCervical cancer (CC) ranks as the second most common cancer among women in Bangladesh. Unfortunately, due to late-stage diagnosis and inadequate treatment facilities, the mortality rate remains high. The stage at which CC is diagnosed plays a crucial role in predicting a woman's survival. This study aimed to determine the staging patterns of CC at presentation in the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) and the subsequent management provided to these women. This retrospective study was conducted at the BSMMU colposcopy clinic from January 2019 to June 2020. It included CC cases with known staging, spanning from January 2016 to June 2019. Data were collected from the colposcopy registry book, telephone interviews, and face-to-face discussions during follow-up appointments. The mean age of women diagnosed with CC was 48.59 years (±2 standard deviations). Among the 523 women studied, 107 (20.5%) were diagnosed at stage I, 124 (23.7%) at stage IIA, 240 (45.9%) at stage IIB, while the remaining 52 (9.90%) were diagnosed with Stage III and IV disease. Within the study population, 39 (7.5%) women underwent radical hysterectomy alone, 110 (21.00%) underwent radical hysterectomy followed by adjuvant therapy, and 184 (35.14%) received primary radiotherapy or concurrent chemoradiation. A significant portion of CC cases presented at an early stage, underscoring the importance of an effective screening program to prevent advanced-stage disease and enhance early detection rates. Establishing a patient navigation system immediately after diagnosis is crucial to prevent the loss of follow-up and ensure timely treatment. It is imperative to enhance the healthcare system's capacity to ensure timely treatment for cancer patients.

Exploring resilience among hospital workers: a Bayesian approach.

Healthcare professionals face significant workloads, as their roles are among the most demanding and stressful. Resilience serves as a crucial factor in helping them cope with the challenges encountered in their work environment and effectively manage stress. Assessing the level of resilience among healthcare workers and identifying potential variations across different groups is essential for effective public health management, preventing burnout, and ultimately enhancing patient care. To assess the resilience of various categories of workers operating within a tertiary care multisite hospital and understanding if there are any differences in resilience, based on their characteristics, the type of department they work in, and personality traits. This was a cross-sectional study conducted in January 2024 at EOC, a multi-site tertiary care hospital located in Southern Switzerland. 1,197 hospital workers answered an online survey which included: (1) an ad hoc questionnaire on personal and job characteristics, well-being-related activities, satisfaction level regarding communication, collaboration, support, and training opportunities in the workplace, (2) the Connor-Davidson Resilience Scale 10-Item on resilience, and (3) the Big Five Personality Inventory 10-item on personality traits. Proportion of resilient and highly resilient individuals within the various categories of workers were analyzed with Bayesian approach and Bayesian robust regression. Being part of the hospitality staff, working as a doctor, and having a male sex were associated to the highest scores of resilience. Surgery and emergency departments had the highest proportion of highly resilient individuals. Male sex, older age, seniority, higher hierarchical rank, engagement in physical activities, relaxation or mindfulness practices, religiosity, perception of good collaboration, communication, support, and physical activity correlated with higher resilience skills. This cross-sectional study found that physicians and hospitality staff within our multi-site Swiss hospital are more resilient compared to other categories of hospital workers, and among departments, those working in surgery and Emergency Medicine. Enhancing our comprehension of resilience is crucial for more precise management of healthcare systems and the development of employment policies aimed at sustaining the capacity of healthcare systems to serve patients effectively, while also mitigating shortages of healthcare professionals.

Optimal non-pharmaceutical interventions considering limited healthcare system capacity and economic costs in the Republic of Korea

Due to the relatively low severity and fatality rates of the omicron variant of COVID-19, strict non-pharmaceutical interventions (NPIs) with high economic costs may not be necessary. We develop a mathematical model of the COVID-19 outbreak in Korea that considers NPIs, variants, medical capacity, and economic costs. Using optimal control theory, we propose an optimal strategy for the omicron period. To suggest a realistic strategy, we consider limited hospital beds for severe cases and incorporate it as a penalty term in the objective functional using a logistic function. This transforms the constrained problem into an unconstrained one. Given that the solution to the optimal control problem is continuous, we propose the adoption of a sub-optimal control as a more practically implementable alternative. Our study demonstrates how to strategically balance the trade-off between minimizing the economic cost for NPIs and ensuring that the number of severe cases in hospitals is manageable.

IMPLEMENTATION OF BRAINCHECK FOR COGNITIVE ASSESSMENT AND CARE PLANNING IN THE CLINICAL SETTING

Abstract With the growth of the older adult population (age ≥ 65 years), age-associated neurocognitive disorders, such as Alzheimer’s disease and related dementias (ADRD), are becoming more common in America and worldwide. The increasing number of patients has surpassed the capacity of healthcare systems. Thus, there is a need for time-efficient, cost-effective solutions for better allocation of limited clinical resources that can benefit clinicians and patients. Here, we conducted a quality improvement study in collaboration with Savannah Neurology Specialists and Dent Neurologic Institute. We evaluated users’ perspectives on the usability and feasibility of implementing BrainCheck, a computerized tool for cognitive assessment and care planning. One neurologist and their team from each institute received 45 minutes of training on BrainCheck and used it on an iPad from mid-November to the end of December 2022. In total, 49 patients have completed BrainCheck Cognitive Assessment, and 7 of them also completed BrainCheck Cognitive Care Planning during the study period. On average, it took 13-18 minutes to administer BrainCheck Cognitive Assessment, interpret the result, and document it in EHR. The majority of patients (96%) reported satisfaction with the testing experience and found the instructions easy to understand. Both providers reported high usability of BrainCheck (6.2/7.0) as measured by the Post-Study System Usability Questionnaire. These results demonstrate the great potential of BrainCheck for clinical use, as it can support providers in assessing the cognitive function of their patients in a timely and efficient manner.

Antivirals for the treatment of mild and moderate COVID-19 in South Africa

While the majority of COVID‐19 cases in South Africa (SA) are mild, patients with severe COVID‐19 requiring hospitalisation present with significant morbidity and mortality and place a substantial burden on healthcare services. Given the low vaccine uptake in SA and other low‐ and middle‐income countries in sub‐Saharan Africa, the high prevalence of comorbidities and limited healthcare system capacity, evidence‐based interventions that reduce the risk of severe disease and death should be considered for implementation. Several antiviral classes have been newly developed or repurposed to treat COVID‐19 early after infection to retard progression to severe disease and reduce the risk of death, particularly in the elderly and/or in patients with comorbidities. COVID‐19 antivirals such as remdesivir, nirmatrelvir/ ritonavir and molnupiravir are safe and cost‐effective and have received either full approval or emergency use authorisation from regulators. Using a proposed test‐and‐treat strategy, judicious use of antivirals could be impactful.