Treatment Of COVID-19 Patients Research Articles

Navigating patient journeys across healthcare borders: hot potatoes, medical professionalism and a negotiated order

PurposeThis study explores the dynamics of patient transfers within the Polish healthcare system during the COVID-19 pandemic, focusing on the roles of negotiation, boundary work and systemic flexibility. Despite extensive literature on patient transfers, gaps remain in understanding the general mechanisms that complicate these processes, especially under crisis conditions.Design/methodology/approachBy interviewing 18 specialists across various medical fields, our research provides empirical evidence from Poland, highlighting the experiences of medical practitioners who navigated the complex landscape of patient transfers during the pandemic.FindingsBy integrating negotiation and boundary work theories, we reveal how healthcare professionals manage patient flows and the challenges they face. Our findings show that during the unique situation caused by the uncertainties and lack of preparedness for the pandemic, while standardization and rationalization tools have limited effectiveness, proactive involvement and strategic negotiation are crucial for successful patient management.Research limitations/implicationsThe study's primary limitation is its focus solely on the Polish healthcare system during the COVID-19 pandemic, which may not fully represent other contexts or healthcare systems.Originality/valueThe study underscores the importance of communication and interpersonal skills in facilitating patient transfers. We also argue that the previous experiences with negotiating orders, dealing with limited resources and making constant compromises had, in a way, built resilience in Polish medical experts and prepared them for the uncertainties encountered while treating COVID-19 patients. These insights contribute to academic theories and offer practical recommendations for enhancing healthcare system resilience and adaptability in future crises. Ultimately, the study emphasizes that flexibility and strategic negotiation are key to managing patient transfers in a fragmented and complex healthcare environment.

Experience with the use of janus kinase inhibitors in the treatment of COVID-19 in patients in Volgograd

The new coronavirus infection (COVID-19) is characterized by high morbidity and mortality. The main approach to COVID-19 therapy should be the proactive administration of treatment before the development of a complete symptom complex of life-threatening conditions, including acute respiratory distress syndrome. The use of a selective and reversible inhibitor of janus kinase 1 and 2 prevents viral endocytosis, reduces excessive inflammatory response. The purpose of the study - to evaluate the effectiveness of the use of the Janus kinase inhibitor of the drug Baricitinib (Olumiant, manufacturer Lilly del Caribe Inc., Spain) in the treatment of patients with moderate COVID-19 in a hospital setting. During the clinical use of Baricitinib, significant positive changes were obtained compared with the initial level of vital signs and laboratory data. Significant positive changes in the following indicators were obtained: oxygen saturation increased (from 95.3 ± 4.0 to 97.5 ± 3.2 %, p = 0.011), body temperature decreased (from 37.3 ± 0.7 to 36.7 ± 0.5 °C, p = 0.000), C-reactive protein decreased (from 47.1 ± 46.0 to 32.5 ± 41.7 g/l, p = 0.010), the number of platelets increased (from 178.0 ± 59.5 to 249.5 ± 84.5; p = 0.000), when assessing the condition of patients in points on the NEWS-2 scale positive dynamics (from 1.6 ± 1.2 to 1.1 ± 1.3, p = 0.001). The level of C-reactive protein increased simultaneously with an increase in interleukin-6, an increase to 200.0 ± 6.2 pg/ml was recorded. The positive dynamics is an increase in the number of lymphocytes to 2.0 • 109/l. By the end of inpatient treatment, ferritin levels had normalized to reference values of 27.7±2.1 mmol/l and D-dimer to the upper limit of normal. Positive dynamics of changes on the CT scan of the chest organs in the form of a decrease in infiltration. According to the combination of changes in clinical, laboratory signs and CT scan results, the therapy of patients was effective.

Filipino Rehabilitation Practitioners’ COVID-19 knowledge, practice and attitude: A cross-sectional study

Background: The rehabilitation team, consisting of physiatrists, physical and occupational therapists, and speech pathologists, faces heightened risk of COVID-19 exposure because of treatment practices in rehabilitation settings.Aim: The study aimed to assess the knowledge, practices and attitudes of rehabilitation professionals in treating COVID-19 patients and to determine potential associations with respondents’ demographic factors (e.g., age, gender, type of profession).Setting: The study was conducted in the Philippines.Methods: This cross-sectional study was conducted from June 2021 to July 2021. Researchers employed snowballing and purposive homogenous convenient sampling methods. Participants completed a 31-item online questionnaire via Google Forms.Results: A total of 410 rehabilitation professionals participated in the study. The total mean scores for knowledge, practices and attitudes are 41.14 ± 3.16, 104.54 ± 33.65 and 37.13 ± 3.55, respectively which were considered adequate. However, only 9.8% (n = 40) professional was actively treating COVID-19 patients with analysis of variance indicated that age, type of profession and gender did not significantly impact COVID-19 knowledge. However, age (p = 0.005) and type of profession (p = 0.004) were found to influence COVID-19 practices, with physiatrists exhibiting higher adherence. There was a strong positive correlation between age and positive COVID-19 attitudes (p 0.000).Conclusion: Filipino rehabilitation professionals have positive attitude, adequate knowledge and skills about COVID-19.Contribution: The study provides information to modify training courses and curricula to further improve the knowledge and practices related to COVID-19.

Prevalence and influencing factors of suicidal ideation among doctors and nurses during the surge period of the COVID-19 pandemic in China: a multicenter cross-sectional study.

From November 2022 to February 2023, China has experienced a surge period of COVID-19 pandemic and doctors and nurses working in hospitals have suffered from serious psychological crisis because of the medical crowding, which may result in the occurrence of suicidal ideation (SI). This study aims to explore the prevalence and influencing factors of SI during this surge phase. A multicenter cross-sectional study was conducted in China from January 5 to February 9, 2023. Data were collected by online questionnaires, with SI measured by a single item. Ordinal logistic regression analysis and stratified analyses were preformed to identify influencing factors. A total of 5696 doctors and nurses were retained for further analysis, with 25.28% reporting SI during the COVID-19 surge phase. Participants experiencing anxiety symptoms or supporting other departments treating COVID-19 patients were more likely to report SI. Additionally, higher levels of resilience, mindfulness, and perceived social support were protective factors against SI. During the COVID-19 surge phase, over a quarter of doctors and nurses in China suffered from SI, which should be of great concern. Tailored interventions should be implemented to alleviate SI among doctors and nurses when new infectious diseases outbreak in the future.

Analysis of the course and outcomes of COVID-19 at different stages of the pandemic in hemodialysis patients

The purpose of this study was a comparative analysis of the characteristics of the course and outcomes of COVID-19 in HD patients at different stages of the pandemic, focusing on the of the use of immunomodulatory therapy.Materials and methods. The retrospective study included 897 HD patients with COVID-19 (mean age 60.7 years, M 58.5%) who were hospitalized at Moscow City Hospital № 52. Group 1 (n=720) consisted of patients infected between the end of March 2020 and April 2021, group 2 (n=177) included patients hospitalized in May-December 2021. Each of group was divided into 2 subgroups based on treatment approaches. Subgroup 1a (n=231) included patients of the initial period of the pandemic who did not receive adequate immunomodulatory therapy, while Subgroup 1b (n=489) included patients of the late stage, were treated with IL-6 receptor blockers and corticosteroids. In group 2, 108 patients in Subgroup 2a received similar therapy, while 69 patients in Subgroup 2b were treated with neutralizing monoclonal antibodies in the early stages of the disease.Results. Mortality rates in Group 1 and Group 2 was 20.1% and 14.7%, respectively (p<0.09). The incidence of unfavorable outcome was highest in Subgroup 1a and lowest in Subgroup 2b (31.2% vs 5.8%, p<0.01). Mortality in Subgroups 1b and 2a was comparable (14.9% and 20.4%), despite more severe initial lung damage according to CT data in Subgroup 2a. In these patients, immunomodulators was more frequently combined with therapeutic plasma exchange (TPE). Independent risk factors for an unfavorable outcome were the progression of pulmonary pathology, with the transformation of stages CT 1-2 to CT 3-4, and a high comorbidity index.Conclusions. The use of immunomodulatory drugs imprtoved the effectiveness of COVID-19 treatment in patients with CKD5D. In severe cases, the most favorable outcomes were achieved with a combination of immunobiological drugs, corticosteroids, and TPE. An even more significant reduction in mortality was observed following the introduction of neutralizing monoclonal antibodies into clinical practice. Independent predictors of unfavorable outcome of COVID-19 in HD patients were a high comorbidity index and the progression of CT 1-2 into CT 3-4.

The Resilience of Healthcare Workers in Hospital During Covid-19 Crisis

The outbreak of the COVID-19 pandemic in all corners of the world has made all activities from various sectors difficult and even experience complete paralysis. As a result of the COVID-19 pandemic, a crisis emerged in various organizations engaged in the medical and non-medical fields. With the crisis due to the COVID-19 pandemic, a transformational leadership role is needed as a form to overcome feelings of worry, fear, and anxiety that arise in healthcare workers. The purpose of this review is to examine the resilience of healthcare workers amid the outbreak of the COVID-19 pandemic. Through well-established adopted questionnaires, data were collected from healthcare workers (N=134) treating COVID-19 patients in the Islamic Hospital in Surabaya, Indonesia. This type of research uses a quantitative approach, a sampling method with census technicalities, and the Partial Least Square (PLS) analysis method. The results showed that transformational Leadership had a positive effect on health workers. Then, there was no significant influence of transformational Leadership on negative effects on health workers. At the same time, from positive effects, it was found to have a significant influence on the resilience of health workers of Islamic Hospital during the COVID-19 crisis.

Fighting fear: the buffering of well-being-HRM on the effects of nurses’ fear of COVID-19 on job stress and patient care

PurposePre-pandemic research demonstrated the challenges of the nursing workforce and the provision of quality of patient care. Such challenges have been significantly intensified during the COVID-19 pandemic, not least in the workplace and fear of staff catching and transmitting COVID-19. We draw on conservation of resources (COR) theory to examine the impact of the fear of COVID-19 on nurses and the role of well-being-HRM (WBHRM) in negating the fear of COVID-19 and its impact on job stress and perceived quality of patient care.Design/methodology/approachWe collected data from 260 nurses (treating COVID-19 patients) employed in US hospitals across two-waves. Data were analyzed using mediated regression and moderated mediation.FindingsThe results indicated that when nurses report higher levels of fear of COVID-19, this translates into higher levels of nursing job stress. This, in turn, reduces nurses’ perceptions of quality of patient care they can provide. As previous research has found, decreased perceptions of quality of patient care is a significant factor driving intentions to leave the profession. The results demonstrated that WBHRM practices buffer the negative impact of fear of COVID-19 on job stress, and in turn, the perceived quality of patient care.Originality/valueOur paper contributes to new knowledge for healthcare managers on WBHRM bundles and their efficacy in buffering the effects of fear on job stress and quality of patient care. We contribute new knowledge on fear at work and how to manage employees’ fear through WBHRM practices.

Mapping a Decade (2014-2024) of Research on Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: A Visual Analysis with CiteSpace and VOSviewer.

Acute Respiratory Distress Syndrome (ARDS) stands as a primary cause of mortality among critically ill patients. Extracorporeal Membrane Oxygenation (ECMO) is increasingly employed in the rescue therapy of ARDS patients. However, the current status of research in the field of ECMO-assisted ARDS remains unclear. This research aims to categorize and evaluate the literature regarding Extracorporeal Membrane Oxygenation (ECMO) support for Acute Respiratory Distress Syndrome (ARDS), offering a comprehensive analysis of bibliometric properties, research hotspots, and developmental trends within the domain of ECMO-assisted ARDS. A literature search was conducted for ECMO-assisted support for patients with ARDS in the Web of Science Core Collection (WoSCC) database from 2014 to 2024. We employed visualization tools such as CiteSpace and VOSviewer to explore and assess connections among nations, institutions, researchers, and co-cited journals, authors, references, and keywords. This study included 1739 publications. The United States leads in publication volume with Columbia University at the forefront of ECMO research. Intensive Care Medicine has been identified as the most cited journal in this field. Alain Combes from France stands out as a key contributor, particularly in his 2018 publication in the New England Journal of Medicine, which is the most cited work in the discipline. Furthermore, keyword analysis identified three distinct research phases: examining complications associated with ECMO therapy, exploring optimal strategies for mechanical ventilation under ECMO support, and compiling insights into the application of ECMO in treating COVID-19 patients and in the development of predictive models for patient outcomes. Using bibliometric visualization techniques, this study revealed significant progress in the use of ECMO for treating ARDS respiratory support, evaluated the impact of these findings, and outlined potential areas for future studies.

Repurposed Drugs during the Outbreak of Pandemic COVID-19: A Mini-Review on Their Molecular Structures and Hit-and-Trial Results.

One of the most significant threats to global public health in the 21st century is the novel coronavirus disease (COVID-19) caused by SARS-CoV-2. It rapidly turned into a global pandemic after it was identified in late 2019, and the World Health Organization announced the end of the pandemic on May 5, 2023. Current strategies for managing this disease include vaccination and repurposing antimalarial and antibiotic medications to alleviate symptoms like fever and throat pain, which are associated with acute respiratory distress syndrome (ARDS). Antiviral drugs such as chloroquine, hydroxychloroquine, azithromycin, remdesivir, and favipiravir have been repurposed for the treatment of COVID-19. They were previously recommended for treating SARS-CoV and MERS-CoV. However, the inefficacy and adverse side effects of these repurposed drugs led to a decrease in their widespread use in treating COVID-19 patients. The lack of approved drugs for combating this coronavirus and its unpredictable variants remains a significant challenge.

Boosting immunity: synergistic antiviral effects of luteolin, vitamin C, magnesium and zinc against SARS-CoV-2 3CLpro.

SARS-CoV-2 was first discovered in 2019 and has disseminated throughout the globe to pandemic levels, imposing significant health and economic burdens. Although vaccines against SARS-CoV-2 have been developed, their long-term efficacy and specificity have not been determined, and antiviral drugs remain necessary. Flavonoids, which are commonly found in plants, fruits, and vegetables and are part of the human diet, have attracted considerable attention as potential therapeutic agents due to their antiviral and antimicrobial activities and effects on other biological activities, such as inflammation. The present study uses a combination of biochemical, cellular, molecular dynamics, and molecular docking experiments to provide compelling evidence that the flavonoid luteolin (2-(3,4-dihydroxyphenyl)-5,7-dihydroxy-4H-chromen-4-one) has antiviral activity against SARS-CoV-2 3-chymotrypsin-like protease (3CLpro) that is synergistically enhanced by magnesium, zinc, and vitamin C. The IC50 of luteolin against 2 µM 3CLpro is 78 µM and decreases 10-fold to 7.6 µM in the presence of zinc, magnesium, and vitamin C. Thermodynamic stability analyses revealed that luteolin has minimal effects on the structure of 3CLpro, whereas metal ions and vitamin C significantly alter the thermodynamic stability of the protease. Interactome analysis uncovered potential host-virus interactions and functional clusters associated with luteolin activity, supporting the relevance of this flavone for combating SARS-CoV-2 infection. This comprehensive investigation sheds light on luteolin's therapeutic potential and provides insights into its mechanisms of action against SARS-CoV-2. The novel formulation of luteolin, magnesium, zinc, and vitamin C may be an effective avenue for treating COVID-19 patients.

A Bayesian approach to reveal the role of psychological factors on turnover intention among nurses during the COVID-19 pandemic

BackgroundTurnover intention is considered a significant challenge for healthcare and treatment organizations. The challenging conditions of treating COVID-19 patients and the physical and mental stress imposed on nurses during the pandemic may lead them to leave their jobs. The present study aimed to determine the role of psychological factors (general health, mental workload, work-family conflicts, and resilience) on turnover intention using a Bayesian approach during the COVID-19 pandemic.MethodsThe present cross-sectional study was carried out during the winter of 2021 at three hospitals in Khuzestan Province, Iran. To collect data for this investigation, 300 nurses were chosen based on Cochran’s formula and random sampling technique. Seven questionnaires, including General Health, Mental Workload, Work-Family Conflict, Resilience, Job Stress, Fear of COVID-19, and Turnover Intention Questionnaires. Bayesian Networks (BNs) were used to draw probabilistic and graphical models. A sensitivity analysis also was performed to study the effects of the variables. The GeNIe academic software, version 2.3, facilitated the examination of the Bayesian network.ResultsThe statistically significant associations occurred between the variables of fear of COVID-19 and job stress (0.313), job stress and turnover intention (0.302), and resilience and job stress (0.298), respectively. Job stress had the highest association with the fear of COVID-19 (0.313), and resilience had the greatest association with the work-family conflict (0.296). Also, the association between turnover intention and job stress (0.302) was higher than the association between this variable and resilience (0.219). At the low resilience and high job stress with the probability of 100%, the turnover intention variable increased by 20%, while at high resilience and low job stress with the probability of 100%, turnover intention was found to decrease by 32%.ConclusionIn general, the results showed that four psychological factors affect job turnover intention. However, the greatest impact was related to job stress and resilience. These results can be used to manage job turnover intention in medical environments, especially in critical situations such as COVID-19.

Evaluation of Adverse Drug Events of Remdesivir for the Treatment of COVID-19 in Patients Contacting the 13-Aban Pharmacy Drug and Poison Information Center

Background: One of the FDA-approved treatments for COVID-19 is remdesivir. In this study, we investigated adverse drug events (ADEs) of remdesivir in COVID-19 patients who contacted 13-Aban pharmacy’s drug and poison information center (DPIC). Methods: In this study, data of patients receiving remdesivir who contacted the 13-Aban pharmacy’s DPIC between April 2021 and May 2022 were extracted. For the evaluation of potential ADEs, we reviewed all contacts related to remdesivir recipients. Results: Out of 223 patients enrolled, 108 (48.40%) developed 120 ADEs. Elevated liver transaminase levels (26.67%) were the most common ADE, followed by weakness (7.5%), nausea, and vomiting (7.5%). The causality assessment of ADE using the Naranjo scale revealed that 41.67% were probable and 58.33% were possible. Conclusion: Based on the results of this study, hepatic dysfunction was the most prevalent ADE among remdesivir recipients; thus, in order to ensure safe use of remdesivir, patients should be closely monitored for this ADE.

New coronavirus infection SARS-CoV-2 in adult patients with inborn errors of immunity

BACKGROUND: Diagnosis and treatment of COVID-19 in patients with primary immunodeficiency, or inborn errors of immunity, are often challenging. AIM: Description of the COVID-19 course and therapy of adult patients with primary immunodeficiency treated in medical organizations of Moscow Healthcare Department. MATERIALS AND METHODS: We analyzed a cohort of 68 patients over 18 years (median ― 35 years) with primary immunodeficiency; 91% of patients have primary immunodeficiency with predominantly antibody deficiencies. Altogether 90 cases of the new СOVID-19 were analyzed: in 68 cases infection occurred for the first time, in 22 cases it recurred. The duration of the disease ranged from 3 to 80 days. Duration of PCR-positivity ranged from 0 to 59 days, median 8 days. RESULTS: Patients with Wuhan and Delta strains had more severe inflammatory signs according to C-reactive protein and lactate dehydrogenase, in patients with Wuhan lung involvement on CT-scam was larger. In demonstrated group of patients higher C-reactive protein correlated with larger lung involvement, longer duration of the disease and PCR-positivity, significant lymphopenia also correlated with higher C-reactive protein. To our data regularity of intravenous immunoglobulin therapy and IgG trough level didn’t correlate with infection severity and duration of the disease and virus-carriage. Indirectly, the change in the spectrum of medicine used in patients of the analyzed group coincided with the virus strain evolution. Anti-inflammatory therapy was mainly presented by dexamethasone and antagonists to interleukin 6 or its receptor (anti-IL-6): 55% and 73% for Wuhan, 63% and 50% for Delta, 17% and 39% for Omicron. Then, preference was gradually given to the target anti-cytokine medicine. Etiotropic antiviral therapy was more often used to treat infection caused by Wuhan and Delta strains ― 32% and 38%, respectively (in 17% for Omicron). With shifting toward immunotherapy by specific against COVID-19 immunoglobulins and monoclonal antibody to SARS-CoV-2: 5% and 9% for Wuhan, 0% and 75% for Delta, 48% and 83% for Omicron, respectively. Immune and etiotropic therapy was not carried out in Wuhan in 39%, in Delta in 43%, in Omicron in 41% of cases. The overall mortality rate from COVID-19 in the analyzed group was 3%. CONCLUSION: Patients with primary immunodeficiency represent a vulnerable group to the SARS-CoV-2 virus with a high risk of not only severe, but also a protracted and undulating course of infection, what must be taken into account for the correct interpretation of the patient's condition and the timely administration of the appropriate therapy.

Evaluation of Healthcare Workers Attitudes Toward Handling and Treating COVID-19 Patients in Diyala Governorate, Iraq

Background: In 2019, the World Health Organization (WHO) declared a global state of emergency due to the spread of the COVID-19 pandemic. Objective: This study aimed to determine the attitudes of healthcare workers in various Iraqi health institutions towards treating patients with COVID-19. Additionally, it aimed to identify the most important reasons behind preventing them from doing their job. Methods: Between Nov. 2021 to Dec. 2022, we conducted a self-administered cross-sectional survey of 207 healthcare worker participants. The data were collected using a questionnaire that included three parts. The first part included sociodemographic data, the second part aimed to assess the participants’ information concerning how they dealt with this pandemic, and the third part was designed to identify the participants’ attitudes. The statistic data were analysed by using (SPSS), 25.0/ IBM Crop., Armonk, NY. The scientific content of the questionnaire items was taken from the online literature as well as updated information on the WHO website. Results: The results study revealed that 135 (65.22\%) of the participants were willing to receive and treat COVID-19 patients in hospitals and private clinics. While 72 (34.78\%) of the study participants showed their unwillingness to treat infected patients. The most crucial reasons behind their reluctance were the fear of transmission of infection and the lack of protective equipment. Conclusion: The study concluded that the participants' willingness was good. This was indicated by their positive attitudes toward carrying out their medical duties and commitment to providing health care and treatment for COVID-19 patients. There is an urgent need to reduce psychological and physical stress as well as the pressures that health workers suffer from because they are facing large numbers of daily infections. This reduction is achieved via training, continuous education and equipping hospitals with the latest protective supplies to confront epidemics and pandemics.

Comparison of high-flow nasal cannula and conventional oxygen therapy in treating COVID-19 patients referred to the emergency department: A randomized, single-blind clinical trial

Objective: High-flow nasal cannula (HFNC) oxygen therapy has been recently implicated in the treatment of patients with acute respiratory failure (ARF). This study investigated the effect of this treatment on COVID-19 patients. Methods: This was a prospective, randomized, single-blind clinical trial performed between June and November 2021 (Delta variant of the coronavirus) at Al-Zahra Hospital in Iran, on patients with COVID-19 referred to the emergency department (ED). COVID-19 patients who had peripheral oxygen saturation (SpO2)≤90% despite receiving nasal oxygen (up to 6 L/min) were included in the study and randomly assigned to receive either HFNC or conventional oxygen therapy (COT) treatment. The patients were compared regarding vital signs, SpO2, and the need for endotracheal intubation and intensive care unit (ICU) admission. The calculated sample size was 35 patients in each group. The variables were compared using the chi-square, student’s t-test, or Mann-Whitney U tests. The data was analyzed using SPSS version 25. Results: Eighty-seven patients with a mean age of 65.3±14.8 (62.1% male) were included. The two groups were similar in terms of age, sex, time interval from onset to diagnosis, and underlying diseases (hypertension, diabetes, coronary artery disease, etc.) (P<0.05). No statistically significant difference was reported between SpO2 and PaO2/FiO2 vital signs at the beginning of treatment between the two groups. One hour after treatment, respiratory rate, SpO2, and PaO2/ FiO2 were better in the HFNC group compared to the COT group (P<0.05). Also, there was no significant difference between the two groups regarding in-hospital mortality or the need for endotracheal intubation or ICU admission. Conclusion: Early use of HFNC oxygen therapy in patients with COVID-19 can improve SpO2, respiratory rate, and PaO2/FiO2 levels, making it highly valuable from a clinical point of view.

Supply chain network design based on Big Data Analytics: heuristic-simulation method in a pharmaceutical case study

Digital technology is a pivotal aspect of the ongoing digital transformation upon which supply chain networks (SCNs) heavily rely. Through the utilization of Big Data Analytics (BDA), organizations can gain insights into sales, production and formulate decision support systems. The pharmaceutical supply chain emerges as a crucial player in producing and distributing medications vital for treating COVID-19 patients. In this study, we have innovatively designed a multi-echelon Pharmaceutical Supply Chain Network (PSCN) using BDA during the COVID-19 pandemic. We have developed a novel Mixed-Integer Non-Linear Programming model addressing allocation, production planning, and inventory control decisions, known as the LAPI problem. A transformation method is employed to convert the non-linear model into a linear one to enhance computational efficiency. The primary objective of our mathematical model is to minimize the total cost and CO2 emissions of the transportation system and established centres while maximizing the shelf life of medicines. Our experiments reveal that medium- and large-scale problems, characterized by the three main attributes of BDA – variety, velocity and volume (3 V‟s), pose challenges for optimal solutions. We present a case study of Iran to validate the mathematical model for large-scale problems. Employing a simulation approach, we estimate the demand for required pharmaceuticals, underscoring our proposed model’s real-world applicability and effectiveness. This research contributes to the growing necessity of eco-friendly and efficient supply chain strategies, especially in the critical domain of pharmaceuticals during pandemic situations.

Quality of care and emergency department throughput during the COVID-19 pandemic in a community health system Pandemic in a Community Health System

Objective: This retrospective study explores the strategic plan formulated by AHMC Health System in California, USA, to sustain and improve quality of care and emergency department (ED) efficiency during the COVID-19 pandemic. It also analyzes the plan’s outcomes.Background: The COVID-19 pandemic has posed challenges for both individuals and healthcare industries alike, impacting decision-making and access to care. AHMC faced staff and resource shortages, patient reluctance, and difficulties adapting to rapidly evolving public health guidelines. These challenges highlighted the critical need for effective plans to maintain or improve healthcare quality and ED performance.Methods: AHMC adopted a comprehensive three-layer strategic plan in 2020. The first layer, “Pandemic Response,” focused on leadership, staff training and education, infection control, new treatments, and employee vaccination rates. The second layer, “ED Throughput,” set objectives for metrics such as door-to-doctor (door-to-doc) time, ancillary turnaround time (TAT), ED length of stay (LOS), and the left-without-being-seen (LWBS) rates. Progress was monitored through monthly improvement meetings. The third layer, “Quality Excellence,” tracked improvements in COVID-adapted objectives on quality initiatives, based on CMS Quality Star Ratings, Leapfrog Hospital Safety Grades, and Yelp review scores.Results: By 2023, the three-layer strategic plan had led to many improvements in the quality of care and ED efficiency. AHMC identified 22,287 positive COVID-19 cases, expanded its ventilator inventory by 50%, and enhanced patient outcomes by applying updated treatments. Additionally, AHMC saw a 3% reduction in ED wait times and sustained its overall patient satisfaction rates, CMS Quality Star Rating, and Leapfrog Hospital Safety Grade scores.Conclusions: AHMC’s three-layer strategic plan showed effectiveness in maintaining quality of care and ED efficiency during the COVID-19 pandemic. By focusing on “Pandemic Response,” “ED Throughput,” and “Quality Excellence,” AHMC was able to adapt to the rapidly evolving public health guidelines, expand its capacity to treat COVID-19 patients and sustain its overall patient safety, satisfaction, and quality ratings. The implementation of this plan highlights the importance of proactive and comprehensive strategies in managing healthcare crises.

Antibiotic prescribing and bacterial infection in COVID-19 inpatients in Southeast Asia: a systematic review and meta-analysis.

The prescribing of antibiotics to treat COVID-19 patients has been observed to occur frequently, often without clear justification. This trend raises concerns that it may have exacerbated antimicrobial resistance (AMR). Despite longstanding concerns over AMR in Southeast Asian countries, data on this issue are notably lacking. To explore the impact of COVID-19 on antibiotic prescribing, bacterial infection prevalence and common resistant pathogens in COVID-19 inpatients. We searched PubMed, EMBASE, Web of Science and ThaiJO (a Thai academic database) to identify studies conducted in ASEAN member countries and published between December 2019 and March 2023. Screening and data extraction were done by two independent reviewers, with results synthesized using random-effects meta-analyses and descriptive statistical analyses. This review was registered with PROSPERO (CRD42023454337). Of the 29 studies (19 750 confirmed COVID-19 cases) included for final analysis, the antibiotic prescribing rate was 62.0% (95%CI: 46.0%-76.0%) with a prescribing rate of 58.0% (21.0%-91.0%) in mild/moderate cases versus 91.0% (82.0%-98.0%) in severe/critical cases. Notably, 80.5% of antibiotics prescribed fall under the WHO AWaRe 'Watch' list, followed by 'Access' at 18.4% and 'Reserve' at 1.0%. The reported bacterial infection prevalence was 16.0% (7.0%-29.0%), with Acinetobacter baumannii being the most common resistant bacterium at 7.7%. Singapore was notable for its lower antibiotic prescribing rate of 17.0% and a lower bacterial infection rate of 10.0%. High antibiotic prescribing rates, disproportionate to bacterial infections and varying practices for COVID-19 inpatients across countries highlight the urgent need for this region to collaborate to tackle and mitigate AMR.

Towards a Notion of Relational Sacrifices: Nursing During the COVID-19 Pandemic in Wuhan

ABSTRACT In this article, we examine the relationship between nursing and sacrifice in the context of Shanghai-based nurses volunteering to treat COVID-19 patients in Wuhan during the pandemic in 2019 and 2020. In the paper, we explore the relationship between metaphors, such as ‘the war on COVID’ with the notion of sacrifice among our participants. The contribution that this article makes is to examine the lived experiences of the sacrifices made by individual nurses in a wider ‘relational’ framework. This relational framework examines, not just the sacrifices of the nurses but also the sacrifices made by their families during their service in Wuhan. As such, the article explores not only the relationship (or conflict) between self-love, self-prolonging and self-preservation and ‘self-sacrifice’ in the moral philosophical tradition of Kant – through the lived experiences of our participants – we extend sacrifice and the sacrificial beyond the individual (nurse) to examine the relational and familial lived experiences of the sacrifice of the nurses and their families in the context of their nursing on the COVID-19 wards in Wuhan.

Mental Health Burden and Facilitators Among Frontline Healthcare Professionals in Nigeria Amid COVID-19 Pandemic: A Cross-sectional Study.

During the COVID-19 pandemic, the frontline healthcare providers faced significant mental health stressors. Previous pandemics have revealed the need for psychosocial support and healthy coping mechanisms to mitigate mental health risks. The study aimed to assess psychological impact and supportive mechanisms experienced by frontline healthcare workers treating COVID-19 patients in Kaduna State. This study involved 38 frontline healthcare providers mainly from Kaduna State Infectious Disease Treatment Center. Participants' mental health burden was captured through Hospital Anxiety and Depression Scale. Mental health facilitators were assessed through six tools: Ten-Item Values Inventory, healthy defense section of the Defense Style Questionnaire, Existential Anxiety Questionnaire, Brief Resilience Scale, Oslo Social Support Scale, and the Insomnia Severity Index. The mean age of the study participants was 35.5 ± 6.6 years, with the majority being males (68.4%) and doctors (39.5%). More than a quarter of the participants showed appreciable symptoms of depression and anxiety. Psychosocial facilitators such as moral values, openness to change, self-transcendence, sublimation, anticipation, and humor scored above average for more than half of the participants. Most participants demonstrated moderate resilience and social support, with few experiencing sleep challenges. Comparisons of variables indicated "openness to change" was significantly higher among males, whereas symptoms of depression and anxiety were associated with higher levels of existential concerns and sleep challenges. Our study finds that Nigerian frontline health workers experienced significant mental health challenges during the COVID-19 pandemic. It identified specific facilitators linked to gender and psychological burdens, informing the need for tailored support interventions.