scholarly journals Outcomes of mechanically ventilated patients with COVID-19 associated respiratory failure

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242651
Author(s):  
Christopher S. King ◽  
Dhwani Sahjwani ◽  
A. Whitney Brown ◽  
Saad Feroz ◽  
Paula Cameron ◽  
...  
Keyword(s):  
Health Care ◽  
Mechanical Ventilation ◽  
Health System ◽  
Health Care System ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Advanced Age ◽  
Record Review ◽  
Care System

Purpose The outcomes of patients requiring invasive mechanical ventilation for COVID-19 remain poorly defined. We sought to determine clinical characteristics and outcomes of patients with COVID-19 managed with invasive mechanical ventilation in an appropriately resourced US health care system. Methods Outcomes of COVID-19 infected patients requiring mechanical ventilation treated within the Inova Health System between March 5, 2020 and April 26, 2020 were evaluated through an electronic medical record review. Results 1023 COVID-19 positive patients were admitted to the Inova Health System during the study period. Of these, 164 (16.0%) were managed with invasive mechanical ventilation. All patients were followed to definitive disposition. 70/164 patients (42.7%) had died and 94/164 (57.3%) were still alive. Deceased patients were older (median age of 66 vs. 55, p <0.0001) and had a higher initial d-dimer (2.22 vs. 1.31, p = 0.005) and peak ferritin levels (2998 vs. 2077, p = 0.016) compared to survivors. 84.3% of patients over 70 years old died in the hospital. Conversely, 67.4% of patients age 70 or younger survived to hospital discharge. Younger age, non-Caucasian race and treatment at a tertiary care center were all associated with survivor status. Conclusion Mortality of patients with COVID-19 requiring invasive mechanical ventilation is high, with particularly daunting mortality seen in patients of advanced age, even in a well-resourced health care system. A substantial proportion of patients requiring invasive mechanical ventilation were not of advanced age, and this group had a reasonable chance for recovery.

scholarly journals Outcomes of Mechanically Ventilated Patients with COVID-19 Associated Respiratory Failure

2020 ◽  
Author(s):  
Christopher King ◽  
Dhwani Sahjwani ◽  
A Whitney Brown ◽  
Saad Feroz ◽  
Paula Cameron ◽  
...  
Keyword(s):  
Health Care ◽  
Mechanical Ventilation ◽  
Data Analysis ◽  
Health System ◽  
Health Care System ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Advanced Age ◽  
Care System

Purpose: The outcomes of patients requiring invasive mechanical ventilation for COVID-19 remain poorly defined. We sought to determine clinical characteristics and outcomes of patients with COVID-19 managed with invasive mechanical ventilation in an appropriately resourced US health care system. Methods: Outcomes of COVID-19 infected patients requiring mechanical ventilation treated within the Inova Health System between March 5, 2020 and April 26, 2020 were evaluated through an electronic medical record review. Results: 1023 COVID-19 positive patients were admitted to the Inova Health System during the study period. Of these, 165 (16.1%) were managed with invasive mechanical ventilation. At the time of data censoring, 63/165 patients (38.1%) had died and 102/165 (61.8%) were still alive. Of the surviving 102 patients, 17 (10.3%) remained on mechanical ventilation, 51 (30.9%) were extubated but remained hospitalized, and 34 (20.6%) had been discharged. Deceased patients were older (median age of 66 vs. 55, p <0.0001). 75.7% of patients over 70 years old had died at the time of data analysis. Conversely, 71.2% of patients age 70 or younger were still alive at the time of data analysis. Younger age, non-Caucasian race and treatment at a tertiary care center were all associated with survivor status. Conclusion: Mortality of patients with COVID-19 requiring invasive mechanical ventilation is high, with particularly daunting mortality seen in patients of advanced age, even in a well-resourced health care system. A substantial proportion of patients requiring invasive mechanical ventilation were not of advanced age, and this group had a reasonable chance for recovery.

scholarly journals Searching for Elysium: teaching universal health care as a human right

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
I Souza ◽  
T C Garcia ◽  
M N Sayão
Keyword(s):  
High School ◽  
Health Care ◽  
Health System ◽  
Health Care System ◽  
Human Right ◽  
School Class ◽  
Federal Constitution ◽  
High School Class ◽  
Free Health Care ◽  
Care System

Abstract Background Brazil have a huge free health care system. Inspired on UK National Health System (NHS), the Sistema Único de Saúde (SUS, that means Unified Health System) was consolidate as a right for all citizens after 1988's Brazilian Federal Constitution. Despite your spread, part of Brazilian citizens have an opposite opinions about SUS. So, the main question is: How to teach the relevance of a universal free health care system as a human right. Objectives The main aim of this work is teaching the recognize of SUS as a human right and ratified by Brazilian Federal Constitution in a High School class. In this sense, we used the cinema and debate for stimulate an effective comprehension of Universal Declaration of Human Rights (UDHR) and health promotion as a human right in a high school class. We used the movie Elysium (Neill Blomkamp, 2013) that show a dystopian world with two social class: citizen and non-citizen of Elysium (an artificial satellite of the Earth with high technology of cure for your citizens). Results The class has three Lessons: in first lesson we teaching about different notions about rights and the UDHR. In the second lesson we teaching about free health care systems in the world and a historical perspective about SUS. The third lesson we show the movie Elysium and proceed a debate. In debate we discuss about citizenship and rights, how the movie show two societies with different rights about work, transport and health, and how this aspects impact the quality of life of human being. Conclusions What options we have? The notion of free health care as a human right isn't an easy concept. So, efforts are needed for this comprehension and cinema can be used, followed by discussion, as a significant teaching tool for achieving humanistic educational objectives about free health care system as a human right in the high school curriculum. Key messages Health care is a human right and free health care system is a concretization of this right. Cinema can be used for stimulate a critical evaluation and effective understanding of rights in a high school classroom.

Public-private: unequal competition Israeli public hospitals vs the private health-care system following government reforms

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Lior Naamati Schneider
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care System ◽  
Data Gathering ◽  
State Regulation ◽  
Public Hospitals ◽  
Content Type ◽  
Creative Solutions ◽  
Government Reforms ◽  
Care System

Purpose This study aims to map perceptions and changes in public hospitals in response to competition with the private health system, describes solutions adopted by the public hospitals and considers their implications for the business and strategic management of those hospitals. Design/methodology/approach This paper opted for a qualitative study using the open-ended approach of grounded theory, including 40 in-depth interviews with key figures in the health system and administrators at various levels of management. Findings Public hospitals are constantly adopting changes because of state-mandated reforms and growing competition with private hospitals. Notable measures include making hospitals customer-oriented and adopting business-oriented behaviors and competitive and marketing strategies. However, because public hospitals are unable to institute radical changes, they typically introduce hybrid services (private services within public services) and other creative solutions such as business-funded research foundations operating alongside them. Research limitations/implications The main methodological limitation of this study was the difficulty in obtaining data because of the limited cooperation and lack of transparency of Israel’s health-care system. The interviewees expressed concerns that their department or hospital would appear in a negative light, especially as motivated solely by financial considerations. In anticipation of this difficulty, requests for participation were addressed individually and contained extensive detail regarding the study, the ethics committee’s approval, the data gathering and the strict maintenance of anonymity and confidentiality. Originality/value Adopting business-oriented behaviors in public hospitals is somewhat contrary to the principles of public medicine. Their adaptation to the market is partial, and their creative hybrid solutions require state regulation. The absence of controls leads to duplication and waste, causing various problems, including increased social inequality, costs and deficits.

Cost-effectiveness of continuous positive airway pressure therapy for obstructive sleep apnea: health care system and societal perspectives

SLEEP ◽  
2019 ◽  
Vol 42 (12) ◽  
Author(s):  
Jared Streatfeild ◽  
David Hillman ◽  
Robert Adams ◽  
Scott Mitchell ◽  
Lynne Pezzullo
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Health System ◽  
Health Care System ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Cpap Therapy ◽  
System Perspective ◽  
Obstructive Sleep ◽  
Care System

Abstract Study Objectives To determine cost-effectiveness of continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) in Australia for 2017–2018 to facilitate public health decision-making. Methods Analysis was undertaken of direct per-person costs of CPAP therapy (according to 5-year care pathways), health system and other costs of OSA and its comorbidities averted by CPAP treatment (5-year adherence rate 56.7%) and incremental benefit of therapy (in terms of disability-adjusted life years [DALYs] averted) to determine cost-effectiveness of CPAP. This was expressed as the incremental cost-effectiveness ratio (= dollars per DALY averted). Direct costs of CPAP were estimated from government reimbursements for services and advertised equipment costs. Costs averted were calculated from both the health care system perspective (health system costs only) and societal perspective (health system plus other financial costs including informal care, productivity losses, nonmedical accident costs, deadweight taxation and welfare losses). These estimates of costs (expressed in US dollars) and DALYs averted were based on our recent analyses of costs of untreated OSA. Results From the health care system perspective, estimated cost of CPAP therapy to treat OSA was $12 495 per DALY averted while from a societal perspective the effect was dominant (−$10 688 per DALY averted) meaning it costs more not to treat the problem than to treat it. Conclusions These estimates suggest substantial community investment in measures to more systematically identify and treat OSA is justified. Apart from potential health and well-being benefits, it is financially prudent to do so.

scholarly journals Physicians' Perspective on Prescribing Patterns and Knowledge on Antimicrobial Use and Resistance in Penang, Malaysia: A Qualitative Study

2020 ◽  
Vol 8 ◽  
Author(s):  
Ali Akhtar ◽  
Amer Hayat Khan ◽  
Hadzliana Zainal ◽  
Mohamed Azmi Ahmad Hassali ◽  
Irfhan Ali ◽  
...  
Keyword(s):  
Health Care ◽  
Antimicrobial Resistance ◽  
Qualitative Study ◽  
Health Care System ◽  
Tertiary Care ◽  
Prescribing Patterns ◽  
Antimicrobial Use ◽  
Prescribing Practices ◽  
The Impact ◽  
Care System

Background: Unnecessary antimicrobial use is an emerging problem throughout the world. To design future interventions to ensure rational antimicrobial use and decrease the risk of antimicrobial resistance, physician's knowledge and prescribing practices of antimicrobials should be assessed. Therefore, the main objective of this study is to investigate the physician's knowledge along with their prescribing patterns of antimicrobials in their health care system.Methods: The present qualitative study was conducted in a tertiary care public hospital located at Penang island, situated in Northwest of Malaysia. A total of 12 semi-structured, face to face interviews were conducted with purposive sampling technique. Physicians recruited had different specialties. All interviews were audio recorded, then transcribed into English language and analyze by thematic content analysis.Results: Four major themes were identified: (1) prescribing patterns of physicians regarding antimicrobials; (2) physician's knowledge about antimicrobials; (3) antimicrobial resistance; (4) satisfaction with management of infections. Physicians believed in regular educational activities and updates about the latest antimicrobial guidelines may change the prescribing behavior of physicians to optimize the use of antimicrobials. This may lead to decrease in burden of antimicrobial resistance in their health care system. Physicians emphasized that stricter rules and regular monitoring of antimicrobial use should be implemented to overcome the main challenges of antimicrobial resistance.Conclusion: Different factors were identified to assist optimized use of antimicrobials and decrease the risk of antimicrobial resistance. The present study helps to design targeted future interventions to ensure rational antimicrobial use and decrease the impact of antimicrobial resistance in Malaysia.

Mohalla Clinics in Delhi: A Preliminary Assessment of their Functioning and Coverage

2019 ◽  
Vol 13 (2) ◽  
pp. 195-210 ◽  
Author(s):  
Taniya Sah ◽  
Rituparna Kaushik ◽  
Neha Bailwal ◽  
Neisetuonuo Tep
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Tertiary Care ◽  
Access To Health Services ◽  
Geographical Access ◽  
Access To Health ◽  
Minor Ailments ◽  
The Government ◽  
Major Section ◽  
Care System

The Government of Delhi introduced the policy of Mohalla Clinics in 2015 in order to improve its health care system. It was aimed at providing primary health care to people in their neighbourhood, with a particular focus on people residing in poor localities of Delhi. This article seeks to assess the role of Mohalla Clinics in the urban health care system. Based on a primary survey conducted in various areas of Delhi, we find that these clinics have helped in easing the pressure on tertiary care hospitals by providing treatment of minor ailments within the vicinity of neighbourhood. Overall, people positively endorse this initiative which contributed to a decline in out-of-pocket expenditure on medicines and tests. We find that Mohalla Clinics are ensuring better geographical access to health services by reducing time in commuting and waiting. Their scope, however, can be further broadened by introducing provisions for pregnant and lactating women, who constitute a major section of the patients visiting these clinics.

scholarly journals Development of a gender-relevant tobacco cessation intervention for women in Brazil—an intervention mapping approach to planning

2019 ◽  
Vol 34 (5) ◽  
pp. 505-520
Author(s):  
N�dia Kienen ◽  
Tha�s Dist�fano Wiltenburg ◽  
Lorna Bittencourt ◽  
Isabel C Scarinci
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health System ◽  
Health Care System ◽  
Tobacco Cessation ◽  
Public Health System ◽  
Intervention Mapping ◽  
The Public ◽  
Cessation Intervention ◽  
Care System

Abstract The purpose of this article is to describe the development of a theory-based, culturally and gender-relevant Community Health Worker (CWH)-led tobacco cessation intervention for low-income Brazilian women who augments the tobacco cessation program offered through the public health system using Intervention Mapping (IM). We began with the establishment of a network of representatives from different segments of society followed by comprehensive needs assessments. We then established a logical planning process that was guided by a theoretical framework (Social Cognitive Theory) and existing evidence-based tobacco cessation programs, taking into account socio-political context of a universal health care system. Given the gender-relevance of our intervention and the importance of social support in tobacco cessation among women, we chose an intervention that would be delivered within the public health system but augmented by CHWs that would be trained in behavior change by researchers. One of major advantages of utilizing IM was that decisions were made in a transparent and supportive manner with involvement of all stakeholders throughout the process. Despite the fact that this process is very taxing on researchers and the health care system as it takes time, resources and negotiation skills, it builds trust and promotes ownership which can assure sustainability.

Health Care System Structure in the State of Israel

2019 ◽  
Vol 88 (1) ◽  
pp. 39-46
Author(s):  
Mohammad Yasser Sabbah
Keyword(s):  
Health Care ◽  
Medical Treatment ◽  
Health System ◽  
Health Care System ◽  
The State ◽  
The Public ◽  
The Right ◽  
To Receive ◽  
State Of Israel ◽  
Care System

The health care system in the State of Israel consists of two sectors - the public sector, which includes government-owned hospitals and medical institutes. The public health sector includes the community health system, health funds, family medicine, the general care system and the mental health care system. The second sector is the private sector, which includes private hospitals and medical institutes. Both sectors are supervised by the Israeli Ministry of Health, which is the supreme governmental authority through which it implements its policy in the entire health system in Israel. The law provides and guarantees medical insurance for every resident of Israel, the right to receive medical treatment, the prohibition of discrimination, informed consent to medical treatment, the right to receive an additional medical opinion, the dignity and privacy of the patient and the right to attend. Health funds in Israel were established before the State of Israel was established. The ideological concept of the health funds was based on the principle of equality and mutual assistance.

scholarly journals Swedish health care system – some trends of its reforming

2010 ◽  
Vol 1 (1) ◽  
pp. 151-164 ◽  
Author(s):  
Marcin Moks
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care System ◽  
Service Providers ◽  
Diagnosis Related Groups ◽  
Health Care Facilities ◽  
System Reform ◽  
Swedish Health Care ◽  
Care Facilities ◽  
Care System

The constant increase in public health expenditure, which is being observed from the 60s, initiated research into way to optimize it. The aim the article is to show concepts of the health reforms which have been applied in the Swedish health service. In the article are presented main proposals of changes in the system financing and service provision. Article characterizes patient participation in costs of services, private health insurance, privatisation of health care facilities, purchase-provider split and providers reimbursement. The articles begins with the overview of concepts related to health care system reform. Next, the health system in Sweden is shortly presented. The main part of the article presents the reforms which has been implemented in the financing and services provision. Patients’ participation in financing of the health system has been extended by fees for service. The importance of private medical insurance is marginal. Purchaser-provider split has been introduced in most of counties. In general primary care facilities have been privatised. In regard to service providers reimbursement is generally used global budgeting, feed for service or diagnosis-related groups.

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