Abstract 14881: Impact of a Large-scale Telemedicine Network on Emergency Visits and Hospital Admissions During the Covid-19 Pandemic in Brazil: Data From the UNIMED-BH System

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Bruno R Nascimento ◽  
Ana Cristina T Castro ◽  
Luiz Eduardo V Fróes ◽  
Antonio L Ribeiro ◽  
Cynthia B Araújo ◽  
...  
Keyword(s):  
Large Scale ◽  
Hospital Admissions ◽  
Positive Impact ◽  
Diagnosis Related Groups ◽  
Mobile App ◽  
Multiple Systems ◽  
Phone Calls ◽  
Surge Control ◽  
Coronary Syndromes ◽  
The Impact

Introduction: A strategy for healthcare surge control in the Covid-19 pandemic is forward triage by on-demand telemedicine (TM), implemented by several providers. We aimed to evaluate the impact of a large-scale Covid-19 TM system on visits to emergency medical services (EMS) and all-cause and cardiovascular (CV) hospital admissions during the pandemic in Brazil. Methods: From March 18 - May 18, 2020 we evaluated the database of UNIMED-BH, a cooperative Brazilian private health insurance, with over 1.25 million clients. The Covid-19 TM system consisted of: a) online mobile app with questions about Covid-19 symptoms, which redirects to teleconsultations in case of moderate/severe manifestations; b) telemonitoring system, with regular phone calls to all clients with reported flu-like symptoms or Covid-19 diagnosis, to monitor disease progression; c) 24/7 emergency call and ambulance system (GMOV), with VOIP triage and counselling by 2 physicians: calls with suspected Covid-19 or respiratory abnormalities were computed. EMS visits and admissions in all accredited hospitals were recorded, with diagnoses assessed by the Diagnosis Related Groups (DRG) method. Covid-19 lab diagnosis and deaths were identified from the patients’ registries, and outcomes assessed until June 1 st . Results: In 60 days, 24,351 patients (1.9% of clients) accessed one of the TM systems, 59% women, median age was 35±18 years. The most frequently utilized system was telemonitoring (16,717, 69%), followed by teleconsultation (13,350, 55%) and GMOV (683, 3%); 6,330 patients accessed multiple systems. The rates of EMS and hospital admissions for each system were: telemonitoring 19.7% (3,296) and 4.6% (774); teleconsultation 17.3% (2,312) and 2.3% (311) and GMOV: 55.9% (382) and 56.2% (384) patients. At total 4.1% (996) had at least 1 hospital admission, 32% (321) with respiratory diseases (41 requiring mechanical ventilation) and 5.6% (56) with CV diagnoses (12 acute coronary syndromes). Overall, 277 (1.1%) patients had confirmed Covid-19 diagnosis, and 160 (0.7%) died, 9 with Covid-19. Conclusion: The TM system resulted in low rates of EMS visits and hospital admissions, suggesting a positive impact on healthcare utilization. The percent of admissions due to CV causes was low.

scholarly journals Impact of a large-scale telemedicine network on emergency visits and hospital admissions during the coronavirus disease 2019 pandemic in Brazil: Data from the UNIMED-BH system

2020 ◽  
pp. 1357633X2096952
Author(s):  
Bruno R Nascimento ◽  
Luisa CC Brant ◽  
Ana Cristina T Castro ◽  
Luiz Eduardo V Froes ◽  
Antonio Luiz P Ribeiro ◽  
...  
Keyword(s):  
Large Scale ◽  
Hospital Admissions ◽  
Diagnosis Related Groups ◽  
Mobile App ◽  
Telemedicine System ◽  
Phone Calls ◽  
Emergency Ambulance ◽  
Surge Control ◽  
Ed Visits ◽  
The Impact

Introduction Triage by on-demand telemedicine is a strategy for healthcare surge control in the COVID-19 pandemic. We aimed to assess the impact of a large-scale COVID-19 telemedicine system on emergency department (ED) visits and all-cause and cardiovascular hospital admissions in Brazil. Methods From March 18-May 18, 2020 we evaluated the database of a cooperative private health insurance, with 1.28 million clients. The COVID-19 telemedicine system consisted of: a) mobile app, which redirects to teleconsultations if indicated; b) telemonitoring system, with regular phone calls to suspected/confirmed COVID-19 cases to monitor progression; c) emergency ambulance system (EAS), with internet phone triage and counselling. ED visits and hospital admissions were recorded, with diagnoses assessed by the Diagnosis Related Groups method. COVID-19 diagnosis and deaths were identified from the patients’ registries, and outcomes assessed until June 1st. Results In 60 days, 24,354 patients accessed one of the telemedicine systems. The most frequently utilized was telemonitoring (16,717, 69%), followed by teleconsultation (13,357, 55%) and EAS (687, 3%). The rates of ED and hospital admissions were: telemonitoring 19.7% (3,296) and 4.7% (782); teleconsultation 17.3% (2,313) and 2.4% (318) and EAS: 55.9% (384) and 56.5% (388) patients. At total 4.1% (1,010) had hospital admissions, 36% (363) with respiratory diseases (44 requiring mechanical ventilation) and 4.4% (44) with cardiovascular diagnoses. Overall, 277 (1.1%) patients had confirmed COVID-19 diagnosis, and 160 (0.7%) died, 9 with COVID-19. Conclusion Telemedicine resulted in low rates of ED visits and hospital admissions, suggesting positive impacts on healthcare utilization. Cardiovascular admissions were remarkably rare.

scholarly journals Impact of COVID-19 pandemic on stroke admissions in Qatar

2021 ◽  
Vol 3 (1) ◽  
pp. e000084
Author(s):  
Naveed Akhtar ◽  
Salman Al Jerdi ◽  
Ziyad Mahfoud ◽  
Yahia Imam ◽  
Saadat Kamran ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Small Vessel Disease ◽  
Tertiary Care ◽  
Relative Increase ◽  
Large Vessel ◽  
Tertiary Care Centre ◽  
Transient Ischaemic Attacks ◽  
Stroke Mimics ◽  
Coronary Syndromes ◽  
The Impact

IntroductionThe COVID-19 pandemic has resulted in a dramatic unexplained decline in hospital admissions due to acute coronary syndromes and stroke. Several theories have emerged aiming to explain this decline, mostly revolving around the fear of contracting the disease and thus avoiding hospital visits.AimsIn this study, we aim to examine the impact of the COVID-19 pandemic on stroke admissions to a tertiary care centre in Qatar.MethodsThe Hamad General Hospital stroke database was interrogated for stroke admissions between September 2019 and May 2020. The number of stroke admissions, stroke subtypes and short-term outcomes was compared between the ‘pre-COVID-19’ period (September 2019 to February 2020) and the COVID-19 pandemic period (March to May 2020).ResultsWe observed a significant decline in monthly admissions in March (157), April (128) and May (135) compared with the pre-COVID-19 6-month average (229) (p=0.024). The reduction in admissions was most evident in functional stroke mimics. The average admissions decreased from 87 to 34 per month (p=0.0001). Although there were no significant differences in admissions due to ischaemic stroke (IS), intracranial haemorrhage or transient ischaemic attacks between the two periods, we noted a relative decrease in IS due to small vessel disease and an increase in those due to large vessel atherosclerosis in March to May 2020.ConclusionsThe decline in overall stroke admissions during the COVID-19 pandemic is most likely related to concerns of contracting the infection, evidenced mainly by a decline in admissions of stroke mimics. However, a relative increase in large vessel occlusions raises suspicion of pathophysiological effects of the virus, and requires further investigation.

Hospitalization Rates Among Dialysis Patients During Hurricane Katrina

2012 ◽  
Vol 27 (4) ◽  
pp. 325-329 ◽  
Author(s):  
David Howard ◽  
Rebecca Zhang ◽  
Yijian Huang ◽  
Nancy Kutner
Keyword(s):  
Hurricane Katrina ◽  
Large Scale ◽  
Service Use ◽  
Hospital Admissions ◽  
Gulf Coast ◽  
The United States ◽  
Time Varying ◽  
Dialysis Patients ◽  
Hospitalization Rates ◽  
The Impact

AbstractIntroductionDialysis centers struggled to maintain continuity of care for dialysis patients during and immediately following Hurricane Katrina's landfall on the US Gulf Coast in August 2005. However, the impact on patient health and service use is unclear.ProblemThe impact of Hurricane Katrina on hospitalization rates among dialysis patients was estimated.MethodsData from the United States Renal Data System were used to identify patients receiving dialysis from January 1, 2001 through August 29, 2005 at clinics that experienced service disruptions during Hurricane Katrina. A repeated events duration model was used with a time-varying Hurricane Katrina indicator to estimate trends in hospitalization rates. Trends were estimated separately by cause: surgical hospitalizations, medical, non-renal-related hospitalizations, and renal-related hospitalizations.ResultsThe rate ratio for all-cause hospitalization associated with the time-varying Hurricane Katrina indicator was 1.16 (95% CI, 1.05-1.29; P = .004). The ratios for cause-specific hospitalization were: surgery, 0.84 (95% CI, 0.68-1.04; P = .11); renal-related admissions, 2.53 (95% CI, 2.09-3.06); P < .001), and medical non-renal related, 1.04 (95% CI, 0.89-1.20; P = .63). The estimated number of excess renal-related hospital admissions attributable to Katrina was 140, representing approximately three percent of dialysis patients at the affected clinics.ConclusionsHospitalization rates among dialysis patients increased in the month following the Hurricane Katrina landfall, suggesting that providers and patients were not adequately prepared for large-scale disasters.Howard D, Zhang R, Huang Y, Kutner N. Hospitalization rates among dialysis patients during Hurricane Katrina. Prehosp Disaster Med. 2012;27(4):1-5.

scholarly journals Smoking Ban: A Long-term Analysis of the Malta Paradox in a Population of over 400,000 Subjects

2015 ◽  
Vol 1 (4) ◽  
pp. 184 ◽  
Author(s):  
Caroline Magri ◽  
Robert Xuereb ◽  
Sandra Distefano ◽  
Neville Calleja ◽  
Victor Grech
Keyword(s):  
Hospital Admissions ◽  
Public Awareness ◽  
Age Groups ◽  
Admission Rate ◽  
Coronary Heart Disease Mortality ◽  
Smoking Ban ◽  
Annual Data ◽  
Public Areas ◽  
Coronary Syndromes ◽  
The Impact

Objectives: The introduction of laws that make indoor public areas and workplaces smoke-free has resulted in a significant<br />reduction in the incidence of acute coronary syndromes (ACS). Malta was the second European country to introduce the<br />smoking ban legislation in April 2004. The purpose of the study was to investigate the impact of the smoking ban in Malta on<br />ACS morbidity and mortality.<br />Methods: The number of ACS hospital admissions and the number of cardiovascular deaths were retrospectively analysed.<br />The annual data for 5 years prior to and following the introduction of the Tobacco Act were obtained according to age-groups<br />for both genders. Poisson regression analyses were performed to assess for decline in ACS admission and cardiovascular<br />death.<br />Results: The ACS admission rate increased throughout the 5 years following the introduction of the smoking ban. There was<br />no change in mortality rate in the 5 years following the legislation, except in 2007 when a small but significant decline was<br />noted.<br />Conclusions: The Malta smoking ban did not have a significant impact on cardiovascular mortality and ACS admissions<br />rates, indicating the need for proper enforcement of the public smoking ban and increase in public awareness regarding the<br />adverse effects of smoking.<br />Key words: Coronary heart disease; Mortality; Prevention; Smoking.

Design of Microplastics Citizen Science Kit

2020 ◽  
Author(s):  
Rachael Hughson-Gill
Keyword(s):  
Data Collection ◽  
Citizen Science ◽  
Large Scale ◽  
Positive Impact ◽  
Research Process ◽  
Freshwater Ecosystems ◽  
Freshwater Systems ◽  
The Public ◽  
Plastic Bags ◽  
The Impact

&lt;p&gt;Microplastics are an ever-increasing problem. Every river that was tested in a recent study found the presence of microplastics, with 80% of all plastic in the ocean coming from upstream. Despite this, there is little understanding into the abundance of plastic, its characteristics and the full impact that is it having on marine, freshwater ecosystems and wider ecological systems.&lt;/p&gt;&lt;p&gt;&amp;#160;&lt;/p&gt;&lt;p&gt;Current fresh water monitoring does not consider the fluid dynamics of rivers, is difficult to use and is inaccessible to the wider public. My project will focus on creating a product that allows for the large-scale data collection of microplastic through citizen science. Allowing groups of people to analyse their local natural environment for the presence and abundance of microplastics within the water. This method of data collection could provide information on a scale that is not possible with traditional methods and would allow for the comparison between freshwater systems. This comparison is fundamental to begin to fill the knowledge gaps around the understanding of microplastics.&lt;/p&gt;&lt;p&gt;&amp;#160;&lt;/p&gt;&lt;p&gt;Inaccessibility of monitoring to the public is not just through tools but also through the current communication of data with research rarely breaking into the public domain. Citizen science offers not just an improvement in understanding but also offers an opportunity for engagement with the public body. Increasing awareness of the impact of habits round plastic through the sharing of monitoring data can generate the much-needed change on both an individual and policy level to address the problem from the source. This method of change through public opinion can be seen to have an effect on freshwater systems through microbeads ban, plastic bags, plastic straws and industrial pollution regulation.&lt;/p&gt;&lt;p&gt;&amp;#160;&lt;/p&gt;&lt;p&gt;Through the creation of this product a multidisciplinary approach that blends engineering and design practices is implemented. The wholistic approach to creation is something that is fundamental in the success of tools and therefore the success of the research that is implemented through them. A tool such as this whose function is within the public engagement of its use - increased awareness, as well as the outcome of its use - microplastics data, is required to have an engaging user experience as well as data integrity implemented through engineering design.&lt;/p&gt;&lt;p&gt;&amp;#160;&lt;/p&gt;&lt;p&gt;This project offers an opportunity to show the importance of the design process within research tools to aid the research process and the positive impact that can come from it.&lt;/p&gt;

Impact of Coupling with an Ice–Ocean Model on Global Medium-Range NWP Forecast Skill

2018 ◽  
Vol 146 (4) ◽  
pp. 1157-1180 ◽  
Author(s):  
Gregory C. Smith ◽  
Jean-Marc Bélanger ◽  
François Roy ◽  
Pierre Pellerin ◽  
Hal Ritchie ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Large Scale ◽  
Weather Forecasting ◽  
Positive Impact ◽  
Weather Prediction ◽  
Ocean Model ◽  
Forecast Skill ◽  
Medium Range ◽  
Forecasting System ◽  
The Impact

The importance of coupling between the atmosphere and the ocean for forecasting on time scales of hours to weeks has been demonstrated for a range of physical processes. Here, the authors evaluate the impact of an interactive air–sea coupling between an operational global deterministic medium-range weather forecasting system and an ice–ocean forecasting system. This system was developed in the context of an experimental forecasting system that is now running operationally at the Canadian Centre for Meteorological and Environmental Prediction. The authors show that the most significant impact is found to be associated with a decreased cyclone intensification, with a reduction in the tropical cyclone false alarm ratio. This results in a 15% decrease in standard deviation errors in geopotential height fields for 120-h forecasts in areas of active cyclone development, with commensurate benefits for wind, temperature, and humidity fields. Whereas impacts on surface fields are found locally in the vicinity of cyclone activity, large-scale improvements in the mid-to-upper troposphere are found with positive global implications for forecast skill. Moreover, coupling is found to produce fairly constant reductions in standard deviation error growth for forecast days 1–7 of about 5% over the northern extratropics in July and August and 15% over the tropics in January and February. To the authors’ knowledge, this is the first time a statistically significant positive impact of coupling has been shown in an operational global medium-range deterministic numerical weather prediction framework.

Impact of the Clinical Pharmacist on Readmission in Patients with Acute Coronary Syndrome

2005 ◽  
Vol 39 (9) ◽  
pp. 1423-1427 ◽  
Author(s):  
Kate M O'Del ◽  
Suzan N Kucukarslan
Keyword(s):  
Unstable Angina ◽  
Clinical Pharmacist ◽  
Positive Impact ◽  
Patient Care Team ◽  
Direct Patient Care ◽  
Control Group ◽  
Study Group ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
The Impact

BACKGROUND: Previous studies have reported a positive impact of pharmacists on care of patients with chronic illnesses. The impact of the clinical pharmacist on hospital readmission in patients with acute coronary syndromes (ACS) has yet to be evaluated, as of this writing. OBJECTIVE: To evaluate the impact of the clinical pharmacist as a direct patient-care team member on cardiac-related readmission in patients admitted to the general cardiology unit with ACS. METHODS: A prospective, nonrandomized observational study compared patients who received standard practice care with patients admitted to a service with a clinical pharmacist to provide care at the bedside. Patients admitted to and discharged from the general cardiology unit for ACS were included. The primary endpoint of the study was cardiac-related readmission at 30 days following hospital discharge. Secondary endpoints included length of stay and medication utilization. Interventions provided by the clinical pharmacist in the study group were documented. RESULTS: Cardiac readmission at 30 days was similar between the groups (p = 0.59%). In the subset of patients with unstable angina, readmission in the study group was significantly lower than in the control group (1.3% vs 9.1%; p = 0.04%). Patients in both groups were similarly managed using drug therapy and invasive coronary interventions. The medical staff's rate of acceptance of recommendations provided by the pharmacist was 94.4%. The most common interventions were medication education and identification of indicated therapy. CONCLUSIONS: The addition of pharmacists did not decrease readmission in patients with ACS. The finding of significant reduction in readmission in the subset of patients with unstable angina should be considered “hypothesis generating” for future randomized studies to confirm the results.

scholarly journals The impact of religious attendance on trust, volunteering, and cooperation: A cross-lagged panel analysis with individual fixed-effects

2021 ◽  
Author(s):  
Ozan Aksoy ◽  
Dingeman Wiertz
Keyword(s):  
Fixed Effects ◽  
Large Scale ◽  
Positive Impact ◽  
Religious Involvement ◽  
Religious Attendance ◽  
Religious Service ◽  
Religious Service Attendance ◽  
Reverse Causality ◽  
The Impact ◽  
Service Attendance

Does religious involvement make people more trusting, prosocial, and cooperative? In view of conflicting theories and mixed prior evidence, we subject this question to a stringent test using large-scale, representative panel data from the British Household Panel Survey (1991-2009, N ≈ 26,000) and the UK Household Longitudinal Study (2009-2019, N ≈ 77,000). We employ cross-lagged panel models with individual fixed effects to account for time-invariant confounders and reverse causality as two issues that have haunted earlier research. We find that religious involvement, measured by frequency of religious service attendance, on average has a positive impact on generalized trust, volunteering, and cooperation. Compared with religious attendance, other indicators of religious involvement, such as subjective importance of religion or whether one is religiously affiliated, have weaker effects on trust, volunteering, and cooperation. We also document substantial variation across religious traditions: the effects of religious attendance are strongest for Anglicans and other Protestants, but weaker and mostly statistically insignificant for Catholics, Hindus, and the nonreligious, while for Muslims we observe a negative effect of religious attendance on cooperation. Our findings are robust to the inclusion of potential confounders and a range of alternative model set-ups. Our study thus shows that religious involvement can indeed foster prosocial behaviours and attitudes, although this effect is in the current study context mostly restricted to religious service attendance and majority religions.

scholarly journals Do City Size and Population Density Influence Regional Innovation Output Evidence from China?

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Cai Shukai ◽  
Wang Haochen ◽  
Zhou Xiaohong
Keyword(s):  
Population Density ◽  
Large Scale ◽  
Positive Impact ◽  
Threshold Value ◽  
Threshold Effect ◽  
The Other ◽  
City Size ◽  
Regional Innovation ◽  
Innovation Output ◽  
The Impact

This paper proposed a substantial gap to a large-scale population density and city size on regional innovation output. To measure the impact of population density and city size on regional innovation output, this study employs the threshold effect model with panel data of 230 prefectures and cities from 2007 to 2016. Based on the econometric analysis, the results exhibit a positive and significant relationship between population density, city size, and innovation output. This correlation suggests that when one factor increases, the other increases in the parallel direction and vice versa. Moreover, when the city size expands the threshold value of 2.934 percent, the innovation promotes and increases the effects of urban-scale expansion. On the other hand, for medium- and low-density cities, the increase of urban population density has a significant and positive impact on urban innovation output. However, for high-density cities, the increase of population density has no significant impact on innovation output.

The impact of the institutional environment on green consumption in India

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Naman Sreen ◽  
Rambalak Yadav ◽  
Sushant Kumar ◽  
Mark Gleim
Keyword(s):  
Large Scale ◽  
Online Survey ◽  
Survey Methodology ◽  
Institutional Environment ◽  
Positive Impact ◽  
Theoretical Perspective ◽  
Institutional Framework ◽  
Content Type ◽  
Green Consumption ◽  
The Impact

Purpose This paper aims to develop an institutional framework to examine the role of governmental and social pressures on green product purchase intentions. Because of the increased focus on environmental issues in emerging markets, an examination of the institutional environment in India can provide unique insights into the drivers of green consumption. Design/methodology/approach A large-scale data collection is conducted via an online survey to test the validity of the theorized model. A survey methodology is used to collect responses from a sample of 400 consumers in India and analyzed via Smart PLS 3.0. Findings The findings suggest moral norms, injunctive and descriptive, have varying influences on consumers. Further, governmental influence, at least in India, may not have a positive impact one would expect. The results indicate the institutional framework developed in this research has a good predictive ability in green marketing settings and offers insights for businesses and policymakers to enhance consumers’ motivations to purchase green products. Originality/value From a theoretical perspective, this research is the first to examine the institutional environment on green consumption in India and provides unique insights into the influences of green consumption. The results suggest the institutional environment in India presents unique opportunities for practitioners and policymakers.

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