scholarly journals Rational Use of Oxygen in COVID-19 Pandemic – Are We Doing Enough?

2021 ◽  
Vol 59 (236) ◽  
Author(s):  
Gentle Sunder Shrestha ◽  
Ritesh Lamsal
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Oxygen Therapy ◽  
Oxygen Supply ◽  
Supply System ◽  
Scarce Resources ◽  
Resource Limitations ◽  
Collective Effort ◽  
Oxygen Stores ◽  
Large Case

During the episodes of large case surge of COVID-19, the health care system of many nations have struggled, more so in nations with resource limitations. Recently, Nepal and the neighboring nation India are being hit hard by the pandemic. Management of patients with moderate and severe COVID-19 remains largely supportive, with oxygen therapy being the cornerstone of the management. Procurement, maintenance of oxygen supply system, coupled with avoiding misuse and wastage of oxygen is of paramount importance to better utilize the scarce resources amidst the peaks of a pandemic. Nepal needs to adopt policies to make best use of its oxygen stores and supplies with a collective effort from all stakeholders to save additional lives.

scholarly journals Telemanagement of Home-Isolated COVID-19 Patients Using Oxygen Therapy With Noninvasive Positive Pressure Ventilation and Physical Therapy Techniques: Randomized Clinical Trial (Preprint)

2020 ◽  
Author(s):  
Aya Sedky Adly ◽  
Mahmoud Sedky Adly ◽  
Afnan Sedky Adly
Keyword(s):  
Health Care ◽  
Clinical Trial ◽  
Physical Therapy ◽  
Randomized Clinical Trial ◽  
Health Care System ◽  
Oxygen Therapy ◽  
Early Stage ◽  
Home Based ◽  
Group A ◽  
Group B

BACKGROUND With the growing stress on hospitals caused by the COVID-19 pandemic, the need for home-based solutions has become a necessity to support these overwhelmed hospitals. OBJECTIVE The goal of this study was to compare two nonpharmacological respiratory treatment methods for home-isolated COVID-19 patients using a newly developed telemanagement health care system. METHODS In this single-blinded randomized clinical trial, 60 patients with stage 1 pneumonia caused by SARS-CoV-2 infection were treated. Group A (n=30) received oxygen therapy with bilevel positive airway pressure (BiPAP) ventilation, and Group B (n=30) received osteopathic manipulative respiratory and physical therapy techniques. Arterial blood gases of PaO<sub>2</sub> and PaCO<sub>2</sub>, pH, vital signs (ie, temperature, respiratory rate, oxygen saturation, heart rate, and blood pressure), and chest computed tomography scans were used for follow-up and for assessment of the course and duration of recovery. RESULTS Analysis of the results showed a significant difference between the two groups (<i>P</i>&lt;.05), with Group A showing shorter recovery periods than Group B (mean 14.9, SD 1.7 days, and mean 23.9, SD 2.3 days, respectively). Significant differences were also observed between baseline and final readings in all of the outcome measures in both groups (<i>P</i>&lt;.05). Regarding posttreatment satisfaction with our proposed telemanagement health care system, positive responses were given by most of the patients in both groups. CONCLUSIONS It was found that home-based oxygen therapy with BiPAP can be a more effective prophylactic treatment approach than osteopathic manipulative respiratory and physical therapy techniques, as it can impede exacerbation of early-stage COVID-19 pneumonia. Telemanagement health care systems are promising methods to help in the pandemic-related shortage of hospital beds, as they showed reasonable effectiveness and reliability in the monitoring and management of patients with early-stage COVID-19 pneumonia. CLINICALTRIAL ClinicalTrials.gov NCT04368923; https://clinicaltrials.gov/ct2/show/NCT04368923

scholarly journals Avoiding Routine Oxygen Therapy in Patients With Myocardial Infarction Saves Significant Expenditure for the Health Care System—Insights From the Randomized DETO2X-AMI Trial

2022 ◽  
Vol 9 ◽  
Author(s):  
Robin Hofmann ◽  
Tamrat Befekadu Abebe ◽  
Johan Herlitz ◽  
Stefan K. James ◽  
David Erlinge ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Health Care ◽  
Clinical Trial ◽  
Health Care System ◽  
Oxygen Therapy ◽  
Cost Savings ◽  
Ambient Air ◽  
Clinical Trial Registration ◽  
Study Population ◽  
Care System

Background: Myocardial infarction (MI) occurs frequently and requires considerable health care resources. It is important to ensure that the treatments which are provided are both clinically effective and economically justifiable. Based on recent new evidence, routine oxygen therapy is no longer recommended in MI patients without hypoxemia. By using data from a nationwide randomized clinical trial, we estimated oxygen therapy related cost savings in this important clinical setting.Methods: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial randomized 6,629 patients from 35 hospitals across Sweden to oxygen at 6 L/min for 6–12 h or ambient air. Costs for drug and medical supplies, and labor were calculated per patient, for the whole study population, and for the total annual care episodes for MI in Sweden (N = 16,100) with 10 million inhabitants.Results: Per patient, costs were estimated to 36 USD, summing up to a total cost of 119,832 USD for the whole study population allocated to oxygen treatment. Applied to the annual care episodes for MI in Sweden, costs sum up to between 514,060 and 604,777 USD. In the trial, 62 (2%) patients assigned to oxygen and 254 (8%) patients assigned to ambient air developed hypoxemia. A threshold analysis suggested that up to a cut-off of 624 USD spent for hypoxemia treatment related costs per patient, avoiding routine oxygen therapy remains cost saving.Conclusions: Avoiding routine oxygen therapy in patients with suspected or confirmed MI without hypoxemia at baseline saves significant expenditure for the health care system both with regards to medical and human resources.Clinical Trial Registration:ClinicalTrials.gov, identifier: NCT01787110.

scholarly journals Telemanagement of Home-Isolated COVID-19 Patients Using Oxygen Therapy With Noninvasive Positive Pressure Ventilation and Physical Therapy Techniques: Randomized Clinical Trial

10.2196/23446 ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. e23446
Author(s):  
Aya Sedky Adly ◽  
Mahmoud Sedky Adly ◽  
Afnan Sedky Adly
Keyword(s):  
Health Care ◽  
Clinical Trial ◽  
Physical Therapy ◽  
Randomized Clinical Trial ◽  
Health Care System ◽  
Oxygen Therapy ◽  
Early Stage ◽  
Home Based ◽  
Group A ◽  
Group B

Background With the growing stress on hospitals caused by the COVID-19 pandemic, the need for home-based solutions has become a necessity to support these overwhelmed hospitals. Objective The goal of this study was to compare two nonpharmacological respiratory treatment methods for home-isolated COVID-19 patients using a newly developed telemanagement health care system. Methods In this single-blinded randomized clinical trial, 60 patients with stage 1 pneumonia caused by SARS-CoV-2 infection were treated. Group A (n=30) received oxygen therapy with bilevel positive airway pressure (BiPAP) ventilation, and Group B (n=30) received osteopathic manipulative respiratory and physical therapy techniques. Arterial blood gases of PaO2 and PaCO2, pH, vital signs (ie, temperature, respiratory rate, oxygen saturation, heart rate, and blood pressure), and chest computed tomography scans were used for follow-up and for assessment of the course and duration of recovery. Results Analysis of the results showed a significant difference between the two groups (P<.05), with Group A showing shorter recovery periods than Group B (mean 14.9, SD 1.7 days, and mean 23.9, SD 2.3 days, respectively). Significant differences were also observed between baseline and final readings in all of the outcome measures in both groups (P<.05). Regarding posttreatment satisfaction with our proposed telemanagement health care system, positive responses were given by most of the patients in both groups. Conclusions It was found that home-based oxygen therapy with BiPAP can be a more effective prophylactic treatment approach than osteopathic manipulative respiratory and physical therapy techniques, as it can impede exacerbation of early-stage COVID-19 pneumonia. Telemanagement health care systems are promising methods to help in the pandemic-related shortage of hospital beds, as they showed reasonable effectiveness and reliability in the monitoring and management of patients with early-stage COVID-19 pneumonia. Trial Registration ClinicalTrials.gov NCT04368923; https://clinicaltrials.gov/ct2/show/NCT04368923

scholarly journals Ethical compass for medical solutions in the COVID-19 pandemic

2021 ◽  
Vol 77 (2) ◽  
pp. 9-25
Author(s):  
L. P. Petrashko ◽  
◽  
O. V. Martyniuk ◽  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Medical Staff ◽  
Critical Conditions ◽  
Ethical Values ◽  
Medical Decisions ◽  
Medical Resources ◽  
Scarce Resources ◽  
World State ◽  
Care System

The article actualizes and structures significant problems of the medical sphere that arise in the context of the COVID-19 pandemic, in terms of the relations vectors: global world – state – person, state – clinic – society, clinic – doctor (medical staff), clinic – patient, doctor (medical staff) – the patient. The authors presented the evolutionary context of the norming process of medical resources and emphasized the hierarchical scheme of the regulation process of scarce resources norming in the health care system under the pandemic crisis conditions. The paper substantiates approaches to making medical decisions on “sorting” and applying a number of its forms depending on various regional, national, religious, and local models of the ethical values system formation. Emphasis is placed on American and European models of bioethics. The authors consider the utilitarian approach to preparing medical solutions of “clinical sorting” to level ethical catastrophes in a pandemic based on Catholic ethics. The issues of regulated norming of scarce medical resources and the “clinical triage” of patients during the COVID-19 pandemic in Ukraine have been investigated. The main bioethical dilemma of the COVID-19 pandemic is outlined. The authors actualize criteria and models of ethical medical solutions for equitable allocation of scarce medical resources in the context of the COVID-19 pandemic. These criteria and models are defined in the Ethical Guidelines for Responding to COVID-19 of the Bioethics Committee at the Council of Europe, the US Department of Health and Human Services; in normative documents in the field of ethics of medical decisions during the COVID-19 pandemic of the National Medical Associations, chambers, centres of bioethics of Italy, Hungary, USA, Great Britain; in the guidelines of national, religious and local institutions for the preparation of medical decisions for the levelling ethical catastrophes during the pandemic and the studies of international bioethics experts. The paper identified the need to formalize the fair distribution of scarce resources during the COVID-19 pandemic in Ukraine. The authors suggested recommendations for the implementation of ethical values and priorities for their application in critical conditions of shortage of medical resources and personnel in the COVID-19 pandemic in the health care system of Ukraine.

scholarly journals Teleradiology and Emergency Neurosurgery-Presence in a Small Asian City State and Need in a Large Canadian Province

2009 ◽  
Vol 1 ◽  
pp. JCNSD.S2216
Author(s):  
Wai Hoe Ng ◽  
Ernest Wang ◽  
Ivan Ng ◽  
Mark Bernstein
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Patient Information ◽  
Small City ◽  
Geographic Isolation ◽  
Canadian Province ◽  
Scarce Resources ◽  
Strategic Implementation ◽  
City State ◽  
Care System

Teleradiology involving the transfer of vital patient information such as scan images is an important technology to facilitate effective and efficient provision of neurosurgical care in the setting of scarce resources and geographic isolation. We review the implementation of teleradiology initiatives in the small city state of Singapore and its potential and need in the large province of Ontario and draw parallels in their strategic implementation. Although it may seem intuitive that teleradiology has greater applications in regions of vast geographical size, the technology has universal usefulness if applied appropriately in any neurosurgical or health care system.

In Search of Informed Input: A Systematic Approach to Involving the Public in Community Decision Making

1996 ◽  
Vol 9 (4) ◽  
pp. 48-52 ◽  
Author(s):  
Julia Abelson ◽  
Jonathan Lomas
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Public Participation ◽  
Health Care System ◽  
Public Involvement ◽  
Systematic Approach ◽  
Decision Makers ◽  
Scarce Resources ◽  
The Public ◽  
Community Decision

Given the task of distributing scarce resources, decision makers are faced with the question of how to involve an increasingly threatened and disenfranchised public in decisions affecting their communities. This article introduces a systematic approach to public involvement in community decision-making and identifies key elements in the design of institutionally driven public participation exercises. Examples are drawn from the health care system restructuring experiences of three Ontario communities.

scholarly journals Speech-Language Pathology and Audiology Care in the COVID-19 Era: Shared Experiences

2020 ◽  
Vol 5 (6) ◽  
pp. 1776-1778
Author(s):  
David W. Rule ◽  
Mathew K. Karia
Keyword(s):  
Health Care ◽  
Global Health ◽  
Close Contact ◽  
Treatment Phase ◽  
Scarce Resources ◽  
Resource Limitations ◽  
Global Partnership ◽  
Global Pandemic ◽  
Language Pathology ◽  
Limit Resource

Purpose The COVID-19 pandemic has rapidly altered the global health-care system and stretched scarce resources to the limit. Resource limitations include personal protective equipment and medical devices; however, limited resources also include the more valuable health-care professional. Recent focus has been on the acute management of COVID-19. Still, there is a need to focus on the long-term rehabilitation of patients moving out of the acute treatment phase and into survivorship due to chronic respiratory concerns and other COVID-19 complications. Multidisciplinary, collaborative teams will support positive outcomes. Thus, speech-language pathologists too must carefully consider their role in patient care during a global pandemic. What makes the COVID-19 pandemic unique is the rapid minimally mitigated spread of the disease from close contact to most regions of the world. However, what appears to be true is a collective experience and common bond across regional borders. Conclusions Perhaps, this global pandemic may lead to a global partnership, a shared experience, and mutually dependent relationships. Global health is no longer “international service” or something that happens “over there”; global health is our reality.

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