Medical Beds Research Articles

Changes in a Hospital’s Costs and Revenues Before and After COVID-19: A Case Study of an Iranian Hospital

Background: The Coronavirus Disease 2019 (COVID-19) pandemic has caused a severe shock to the world economy and, consequently, healthcare systems. Objectives: The current study aimed to investigate changes in costs and revenues of an Iranian hospital before and after the COVID-19 pandemic to answer the following question: "How can hospital costs and revenues change during the COVID-19 pandemic?" Methods: This descriptive cross-sectional study was conducted retrospectively at the Masih Daneshvari Hospital in 2020. Accounting software available at the hospital (Azarakhsh for salary costs and PMQ for medical equipment costs) was used to collect cost information. Also, the hospital information system software was used to collect revenue information. The 2019 financial year was considered the base year, and the period February-August 2020 was considered the COVID-19 outbreak period. The data were entered into Excel software and analyzed using descrip¬tive statistics methods. Results: Before the COVID-19 outbreak, the Masih Daneshvari Hospital was facing many cost problems, and the new crisis added to the severity of the problems. In total, the hospital's revenue declined by 9%, and its costs increased by 70%. Therefore, in the fiscal year ending in March 2020, the hospital balance was reported to be $-607,143 (-68,000 million Iranian Rial). Conclusions: The soaring healthcare expenditures revealed that the hospital was not ready to deal with the disease. As the COVID-19 outbreak grows rapidly in Iran, there is a pressing need to increase medical capacities and inpatient beds to treat infected patients. Hospitals in the country face financial problems and should be supported by the Ministry of Health and Medical Education.

Spatial Inequality in China’s Housing Market and the Driving Mechanism

Housing inequality is a widespread phenomenon around the world, and it varies widely across countries and regions. The housing market is naturally spatial in its attributes, and with the transformation of China’s urbanization, industrialization, and globalization, the spatial inequality in the housing market is increasingly severe. According to the geospatial differences in the housing market supply, demand, and price, and by integrating the influencing factors of economic, social, innovation, facility environment, and structural adjustment, this paper constructs a “spatial–supply–demand–price” integrated housing market inequality research framework based on the methods of CV, GI, and Geodetector, and it empirically studies the spatial inequality of provincial housing markets in China. The findings show that the spatial inequality in China’s housing market is significant and becomes increasingly serious. According to the study, we have confirmed the following. (1) Different factors vary greatly in influence, and they can be classified into three types, that is, “Key factors”, “Important factors”, and “Auxiliary factors”. (2) The spatial inequalities in housing supply, demand, and price vary widely in their driving mechanisms, but factors such as the added value of the tertiary industry, number of patents granted, and revenue affect all these three at the same time and have a comprehensive influence on the development and evolution of spatial inequalities in the housing market. (3) All the factors are bifactor-enhanced or non-linearly enhanced in relationships between every pair, and they are classified into three categories of high, medium, and low according to the mean of interacting forces; in particular, the factors of GDP, expenditure, permanent resident population, number of medical beds, and full-time equivalent of R&D personnel are in a stronger interaction with other factors. (4) Based on housing supply, demand, price, and their coordination, 31 provinces are classified into four types of policy zones, and the driving mechanisms of spatial inequalities in the housing market are further applied to put forward suggestions on policy design, which provides useful references for China and other countries to deal with housing spatial inequality.

Does the ageing population correctly predict the need for medical beds?: Part one: fundamental principles

The World War II baby boom, coupled with increasing life expectancy, will lead to increasing numbers of deaths for the next 40 years. The last year of life represents a large proportion (55%) of lifetime hospital bed occupancy. This is called the nearness to death effect. However, the nearness to death effect has not been factored into NHS capacity planning, which largely relies on age-based forecasting, often called the ageing population. In certain locations, deaths are predicted to rise far more rapidly than the national average of 1% per annual growth. These locations are highly susceptible to capacity pressures emanating from the nearness to death effect, which is not compatible with recent policies that aim to build smaller hospitals. This article is the first of a two-part series discussing these trends in deaths and bed demand, as well as the likely impact on NHS capacity and the implications for the NHS funding formula.

The experiences of NHS hospital acute medicine departments in England during the first wave of the COVID-19 pandemic

We conducted a survey exploring the experiences of NHS hospital acute medicine services in England during the 1st wave of the COVID-19 pandemic. Responses were collected from 26th May to 8th July 2020. The results of 91 sites are presented. The total number of patients referred to the medical take for assessment and admitted from the medical take decreased from pre-pandemic levels compared to peak COVID-19 activity. The total number of acute medical beds decreased, however critical care beds increased by 162%. We report the median timeline from first admission of COVID-19 to when baseline critical care capacity was reached. We found regional variation across the results. These findings can assist healthcare leaders prepare for future pandemics.

ADL-dependent older adults were identified in medico-administrative databases

ObjectiveWe aimed to develop an algorithm for the identification of basic Activities of Daily Living (ADL)-dependency in health insurance databases. Study Design and SettingWe used the AMI (Aging Multidisciplinary Investigation) population-based cohort including both individual face-to-face assessment of ADL-dependency and merged health insurance data. The health insurance factors associated with ADL-dependency were identified using a LASSO logistic regression model in 1000 bootstrap samples. An external validation on a 1/97 representative sample of the French Health Insurance general population of Affiliates has been performed. ResultsAmong 995 participants of the AMI cohort aged ≥ 65y, 114 (11.5%) were ADL-dependent according to neuropsychologists individual assessments. The final algorithm developed included: age, sex, four drug classes (dopaminergic antiparkinson drugs, antidepressants, antidiabetic agents, lipid modifying agents), three type of medical devices (medical bed, patient lifter, incontinence equipment), four medical acts (GP's consultations at home, daily and non-daily nursing at home, transport by ambulance) and four long-term diseases (stroke, heart failure, coronary heart disease, Alzheimer and other dementia). Applying this algorithm, the estimated prevalence of ADL-dependency was 12.3% in AMI and 9.5% in the validation sample. ConclusionThis study proposes a useful algorithm to identify ADL-dependency in the health insurance data.

Exploring a Fuzzy Rule Inferred ConvLSTM for Discovering and Adjusting the Optimal Posture of Patients with a Smart Medical Bed.

Several countries nowadays are facing a tough social challenge caused by the aging population. This public health issue continues to impose strain on clinical healthcare, such as the need to prevent terminal patients’ pressure ulcers. Provocative approaches to resolve this issue include health information technology (HIT). In this regard, this paper explores one technological solution based on a smart medical bed (SMB). By integrating a convolutional neural network (CNN) and long-short term memory (LSTM) model, we found this model enhanced performance compared to prior solutions. Further, we provide a fuzzy inferred solution that can control our proposed proprietary automated SMB layout to optimize patients’ posture and mitigate pressure ulcers. Therefore, our proposed SMB can allow autonomous care to be given, helping prevent medical complications when lying down for a long time. Our proposed SMB also helps reduce the burden on primary caregivers in fighting against staff shortages due to public health issues such as the increasing aging population.

Nurses’ Moral Distress in Caring for COVID-19 Patients

Dear Editor romoting the principles of professional practice is an approach to build trust among individuals concerning the medical profes sion. Individuals’ trust in nurses plays a cru cial role in patient care; thus, is of signifi cant importance. The main cornerstone in nursing care is the existence of nurses with professional ethics. Due to the epidemic of Coronavirus Disease 2019 (COVID-19), numerous patients have been hospital ized in the Intensive Care Unit (ICU) and some have expired in Iran and around the world. COVID-19 high lighted various difficult ethical issues encountered by healthcare providers in caring for patients and families. Nurses, as frontline healthcare workers, spend most of their time with patients; therefore, it is essential to ad dress the ethical concerns they face [1]. Attention to safety in nurses In the fight against COVID-19, ensuring the safety of nurses and other forefront healthcare workers is an important ethical concern. Nurses have to work under conditions that pose fundamental and uncertain risks to their health. Although nurses often voluntarily care for patients in high-risk situations, deficiencies and inappro priate conditions (e.g. the lack of protective facilities), prolonged presence in the wards to compensate for staff shortages, and patient care threaten their health; accord ingly, such conditions jeopardize more effective patient care. Due to these limitations, nurses cannot provide ef fective care and experience moral distress, psychological distress, and Post-Traumatic Stress Disorder (PTSD) [2]. Providing healthcare resources for patients COVID-19-induced conditions have necessitated more serious (and ethical) attention to the prioritization of care and resources in different care units. Making the right decision about the patient is among the ethical as pects that nurses encounter in special wards; it imposes a great moral burden on the healthcare staff. Nurses must provide care, justice, transparency, and protection in a way that does not incur legal and conscientious re sponsibilities. Patients with COVID-19 are admitted to hospital wards with different care needs. They require adequate medical care, beds, ventilators and oxygen therapy, medicine, and so on. When nurses are unable to provide effective care due to a large number of hospital ized patients and the lack of facilities, they face moral contradictions. Even in the UK, due to a large number of patients, the situation changed; normally, in the ICU, the ratio of nurses to patients was 1: 1, i.e., altered to 1: 6. Consequently, it affected care and caused ethical

Control Technique of a Medical Bed for Ulcer Prevention Equipped with Body Pressure Sensors

Control Technique of a Medical Bed for Ulcer Prevention Equipped with Body Pressure Sensors

Foldable Bed Design Concept for COVID-19 Patient: A Machine Design Case Study

Coronavirus disease 2019 (COVID-19) has become a serious problem around the world. The pandemic has given several bad impacts, especially in the medical operation. Hospitals are facing problems in which they are lacking the patient bed facility. The objective of this paper is to propose an adjustable medical bed that can be folded as a chair for COVID-19 patients. This foldable bed is employing the hydraulic system as the lifting mechanism. It can raise up from 0.62 to 1 meter height and withstand loads up to 400 kg. Other supporting features and mechanisms will be explained in this paper. Furthermore, the theoretical strength analyses of this proposed design are conducted under the static and fatigue loading. In the static analysis, the safety factor due to the normal and shear stress is 7.5 based on the Maximum Shear Stress failure criterion theorem. Meanwhile, in the fatigue analysis, the safety factor based on the Modified Goodman and ASME-Eliptic criteria are 3.6 and 3.9, respectively. The infinite life of this design is predicted. In addition, this paper is expected to be used as a reference for developing a more reliable design for COVID-19 patients due to lack of bed facilities.

CHARACTERISTICS OF RURAL AREAS AND NATIONAL SECURITY ISSUES (2020)

This article discusses the results of an array correlation analysis ministries and departments relevant statistical indicators in the Russian Federation regions in order to create a typical portrait of a region with rural population high proportion. Comprehensive data of the Federal State Statistics Service of Russia, the Main Directorate of the Ministry of Internal Affairs of Russia, the General Prosecutor's Office of Russia, the Ministry of Education and Science and the Ministry of Health of Russia, which are available in the public domain, were used. The village is characterized by lower wages, availability of labor resources, but also the need for them. The high number of rural population in the region also means an increase in the number of external migrants, tax arrears, an increase in turnover and a decrease in the cost of food products, and an increase in crime. Despite the decrease in the number of medical organizations in rural areas, the provision of rural areas with medical personnel and beds remains high. The village at the beginning of the XXI century is still a supplier of future university entrants.

Health System Efficiency in European Countries: Network Data Envelopment Analysis Approach

Purpose: The article's main aim is to investigate the effectiveness of health systems in European countries based on EUROSTAT data. A comparative analysis of the health systems' effectiveness in different countries is based on their improvement (reform), using the best practices approach. Design/Methodology/Approach: The network DEA model and a slack-based model (NDEA – SBM) are used. A non-oriented model is used. The research sample covers 30 countries (28 EU plus Norway and Island). The health system considers two factors: lifestyle (LF) and primary medical care resources (MC). Lifestyle factors included, alcohol consumption, smoking, and being overweight. The primary resources of medical care are medical personnel, hospital beds, and finances. The subjective assessment of health status and healthy life expectancy is taken as direct outputs. As an intermediate product (link), the expenditure on prevention is assumed as a percentage of GDP. Findings: Health systems in five countries are identified as fully efficient. These countries have also achieved total efficiency for both divisions, lifestyle factors and medical care. The average efficiency of health systems for all countries is low and amounts to 0.619, and the average efficiency for the LF division is 0.580, with huge variations between countries. In the MC division, the average efficiency for all countries is 0.72. However, the difference between countries is more minor. For inefficient countries, the projection of necessary changes to achieve total efficiency has been calculated. Practical Implications: The network DEA model allows a better understanding of the functioning of the complex health care system by analyzing the effectiveness of two separate areas (lifestyle and health care). The values of the forecasted variables are also determined, inputs, outputs, and the linking variable that may help determine priority actions in the field of improving the efficiency of health systems. Originality/value: This paper contributes to the literature by applying the network model to assess the effectiveness of health systems. It enables simultaneous research of various areas related to health. Few publications have attempted to use the network model in the area of health protection.

A Non-Linear Biostatistical Graphical Modeling of Preventive Actions and Healthcare Factors in Controlling COVID-19 Pandemic.

Background: With the insurgence of the COVID-19 pandemic, many people died in the past several months, and the situation is ongoing with increasing health, social, and economic panic and vulnerability. As most of the countries relying on different preventive actions to control the outcomes of COVID-19, it is necessary to boost the knowledge about the effectiveness of such actions so that the policymakers take their country-based appropriate actions. This study generates evidence of taking the most impactful actions to combat COVID-19. Objective: In order to generate community-based scientific evidence, this study analyzed the outcome of COVID-19 in response to different control measures, healthcare facilities, life expectancy, and prevalent diseases. Methods: It used more than a hundred countries’ data collected from different databases. We performed a comparative graphical analysis with non-linear correlation estimation using R. Results: The reduction of COVID-19 cases is strongly correlated with the earliness of preventive initiation. The apathy of taking nationwide immediate precaution measures has been identified as one of the critical reasons to make the circumstances worse. There is significant non-linear relationship between COVID-19 case fatality and number of physicians (NCC = 0.22; p-value ≤ 0.001), nurses and midwives (NCC = 0.17; p-value ≤ 0.001), hospital beds (NCC = 0.20; p-value ≤ 0.001), life expectancy of both sexes (NCC = 0.22; p-value ≤ 0.001), life expectancy of female (NCC = 0.27; p-value ≤ 0.001), and life expectancy of male (NCC = 0.19; p-value ≤ 0.001). COVID-19 deaths were found to be reduced with increased medical personnel and hospital beds. Interestingly, no association between the comorbidities and severity of COVID-19 was found excluding asthma, cancer, Alzheimer’s, and smoking. Conclusions: Enhancing healthcare facilities and early imposing the control measures could be valuable to prevent the COVID-19 pandemic. No association between COVID-19 and other comorbidities warranted further investigation at the pathobiological level.

Revision Of A Standard For The Test Of A Toilet-Incorporated Medical Electric Bed

We developed a toilet-incorporated electric medical bed for bedridden patients, in which a toilet basin, or a commode, is incorporated in the pelvic plate of an electric medical bed. A replaceable toilet seat is located in the mattress of the bed, and toilet basin was tightly attached on the pelvic plate the bed. The excretion slides through a storage tube that angles toward the side of the bed and is automatically collected in a disposable plastic bag. We, however, encountered a problem with testing this newly developed medical bed with the relevant international standard IEC 60601-2-52:2009, or with the corresponding Korean standard KS P 0388:2012--Electrically operated adjustable bed for home care. There was no clear indication in the scopes of the above standards as to whether this standard testing method is applicable to an electric medical bed embedded with a commode. We revised the Korean standard KS P 0388:2012 to accommodate the toilet-incorporated medical bed in the scope of the standard and successfully performed the mechanical tests including the durability, impact, and deformation test of the bed, proving that the newly developed toilet-incorporated medical bed is mechanically strong and durable enough to pass the standard tests.

A Medical Electric Bed Incorporated with a Toilet: Standard Revision for Safety and Durability Test and Current User Status

A Medical Electric Bed Incorporated with a Toilet: Standard Revision for Safety and Durability Test and Current User Status

Are regions equal in adversity? A spatial analysis of spread and dynamics of COVID-19 in Europe.

Often presented as a global pandemic spreading all over the world, COVID-19, however, hit not only countries but also regions differently. The objective of this paper is to focus on the spatial heterogeneity in the spread of the COVID-19 pandemic and to contribute to an understanding of the channels by which it spread, focusing on the regional socioeconomic dimension. For this, we use a dataset covering 125 European regions in 12 countries. Considering that the impact of the COVID-19 crisis differed sharply not only across countries but also across regions within the same country, the empirical strategy is based, on the one hand, on an exploratory analysis of spatial autocorrelations, which makes it possible to identify regional clusters of the disease. On the other hand, we use spatial regression models to capture the diffusion effect and the role of different families of regional factors in this process. We find that the share of older people in the population, GDP per capita, distance from achieving EU objectives, and the unemployment rate are correlated with high COVID-19 death rates. In contrast, the number of medical practitioners and hospital beds and the level of social trust are correlated with low COVID-19 death rates.

Reflections on the Pharmacotherapy Aspects of Cov-2 Variants

Reflections on the Pharmacotherapy Aspects of Cov-2 Variants

Impact of the COVID-19 pandemic on the management of chronic limb-threatening ischemia in Northern Jordan: Case series and literature review

IntroductionThe novel COVID-19 pandemic has imposed unprecedented restrictions on healthcare services worldwide. In developing nations such as Jordan, appreciable impacts on healthcare delivery ensued owing to limited resources. As a result, managing chronic limb-threatening ischemia (CLTI) has been modified to accommodate altercations in the system. This study assessed the impact of the COVID-19 pandemic on managing patients with critical limb-threatening ischemia (CLTI) during the lockdown. MethodsObjectives were accomplished by retrieving records of clinical data and perioperative results for patients diagnosed with CLTI at King Abdullah University Hospital between March 17 and June 1, 2020. Patients’ demographics, Rutherford classification, type of intervention, and intervention variables during the outbreak were retrospectively analyzed (pandemic Group A) and compared with patients from the same period last year (control Group B). ResultsA total of 96 patients with CLTI were included in the study; Groups A and B consisted of 28 and 68 patients, respectively. The mean ages for Groups A and B were 62.8 and 60.2 years, respectively. Conservative management was applied to 53.6% (P < 0.01) of Group A patients, whereas endovascular revascularization was the primary approach in Group B (39.7%, P < 0.01). After the intervention, the majority of patients in Group A were classified as category six on the Rutherford classification system (46.4%, P < 0.01), whereas the majority in group B were classified as category five (55.9%, P < 0.01). ConclusionsThe more unsatisfactory outcome of CLTI during the pandemic entails substantial measures to ensure conscientious virtual encounters and ambulatory community-based services during current and future pandemics. The endovascular-first policy should be endorsed in future pandemics as it is better at reducing aerosol transmission than standard surgical intervention. Moreover, endovascular procedures are minimally invasive and associated with favorable outcomes when medical optimization and hospital beds are limited.

Alternative cardiac intensive care unit locations during the COVID-19 pandemic at an academic medical center

Alternative cardiac intensive care unit locations during the COVID-19 pandemic at an academic medical center

The association between physician staff numbers and mortality in English hospitals.

BackgroundPhysician medical specialties place specific demands on medical staff. Often patients have multiple co-morbidities, frailty is common, and mortality rates are higher than other specialties such as surgery. The key intervention for patients admitted under physician subspecialties is the care provided on the ward. The current evidence base to inform staffing in physician medical specialty wards is limited. The aim of this analysis is to investigate the association between medical staffing levels within physician medical specialties and mortality.MethodsThis study is a cross-sectional analysis of national data, which is aggregated at provider level. Medical beds per senior, middle grade and junior physicians employed in physician medical specialties were calculated from national employment records for acute hospitals in England, in 2017. Outcome measures included unadjusted mortality rate and Summary Hospital-level Mortality Indicator (SHMI) in physician medical specialties. Both Raw mortality and SHMI include deaths during admission or within 30 days following discharge. Linear regression models were constructed for each medical staffing grade for unadjusted mortality, SHMI and SHMI adjusted for local provider factors.FindingsThe mean number of medical beds per senior, middle grade and junior physicians were 7.3(SD 2.5), 19.7(11.5), 10.1(3.1) respectively. Lower bed numbers per medical staff grade were associated with lower than expected mortality by SHMI; senior(Coefficient 0.012(95%CI:0.005–0.018),p = 0.001), middle grade(0.002(0.0002–0.005),p = 0.032) and junior(0.008(0.002–0.015),p = 0.014). Hospital providers were more likely to achieve a better than expected mortality (SHMI<1) if beds per physician were lower than; 5.3, 14.6 and 9.0 for senior, middle grade and junior doctors respectively.InterpretationAcute hospital providers with fewer beds per medical staff of all grades are associated with lower than expected mortality.FundingNo external funding is associated with this analysis.

Rhythmicity of patient flow in an acute medical unit: relationship to hospital occupancy, 7-day working and the effect of COVID-19.

BackgroundThe Acute Medical Unit (AMU) provides care for unscheduled hospital admissions. Seven-day Consultant presence and morning AMU discharges have been advocated to improve hospital bed management.AimsTo determine whether a later time of daily peak AMU occupancy correlates with measures of hospital stress; whether seven-day Consultant presence, for COVID-19, abolished weekly periodicity of discharges.DesignRetrospective cohort analysisMethodsAnonymised AMU admission and discharge times were retrieved from the Profile Information Management System (PIMS), at a large, urban hospital from 14th April 2014—31st December 2018 and 20th March—2nd May 2020 (COVID-19 peak). Minute-by-minute admission and discharge times were combined to construct a running total of AMU bed occupancy. Fourier transforms were used to determine periodicity. We tested association between i) average AMU occupancy and ii) time of peak AMU occupancy, with measures of hospital stress (total medical bed occupancy and ‘medical outliers’ on non-medical wards).ResultsDaily, weekly and seasonal patterns of AMU bed occupancy were evident. Timing of AMU peak occupancy was unrelated to each measure of hospital stress: total medical inpatients (Spearman’s rho, rs=0.04, P = 0.24); number of medical outliers (rs=-0.06, P = 0.05). During COVID-19, daily bed occupancy was similar, with continuation of greater Friday and Monday discharges than the weekend.ConclusionsTiming of peak AMU occupancy did not alter with hospital stress. Efforts to increase morning AMU discharges are likely to have little effect on hospital performance. Seven-day Consultant presence did not abolish weekly periodicity of discharges – other factors influence weekend discharges.