Increasing Burden of Nursing Care on the Treatment of COVID-19 Patients in the Aging Society: Analyses During the First to the Third Wave of Pandemic in Kyoto City, Japan

Background: The coronavirus disease 2019 (COVID-19) pandemic is associated with a heavy burden on patient's mental and physical health, regional healthcare resources, and global economic activity. An aging society such as Japan has many retirement homes and long-term stay hospitals for the elderly and their inhabitants. During the COVID-19 pandemic, disease clusters are often identified in retirement homes and long-term stay hospitals. Although we hypothesize that additional burdens of nursing care for elderly patients will reinforce the anxiety and exhaustion of medical staff and healthcare resources in the aging society, the actual situation is not well understood. In this study, we aimed to evaluate the current situation and countermeasures of the COVID-19 pandemic in the aging society.Methods: We reviewed COVID-19 patients who required hospitalization at the National Hospital Organization Kyoto Medical Center, a 600-bed capacity hospital located in Kyoto, Japan, between 1 April 2020 and 31 March 2021. We assessed the characteristics of the COVID-19 patients, disease severity, duration of hospitalization, outcome at discharge, degree of activities of daily living (ADLs), and complications unique to elderly patients.Results: We enrolled 118 patients who required hospitalization during the study period. Approximately 40% of the patients were aged ≥ 80 years. Dementia (27.1%) was the most prevalent underlying disease, followed by diabetes mellitus (23.7%) and chronic kidney disease (23.7%). Approximately 60% of hospitalized COVID-19 patients had impaired ADL at admission. The COVID-19 patients aged 80 years or older required significantly more longer-term hospitalization than the COVID-19 patients aged under 80 years (15.5 ± 8.2 vs. 13.1 ± 7.7, P = 0.032). In elderly patients aged 80 years or older, approximately 50% of patients had geriatric mental disorders, and approximately 70% had bedridden status and feeding difficulty. Poor ADL at admission was significantly associated with COVID-19 mortality (Odds ratio, 5.6; 95% confidence interval, 1.04–45.2; p-value = 0.044).Conclusions: The proportion of elderly patients aged 80 years or older was relatively high during the hospitalization for COVID-19. Poor ADL at admission in these elderly patients was significantly associated with poor prognosis of COVID-19. We should keep in mind that healthcare workers are forced to have an additional burden of nursing care in the aging society during the COVID-19 pandemic. Therefore, interventions to reduce the burden are urgently required.

Glass Ceiling: Heating Back Women

In India men and women rights are equal but Women have to work twice as much as men to get recognition, high qualifications alone do not guarantee satisfying careers, as working women carry the double burden of work and family and often face conflicts and stressful situations in their life as well as in their career when family, society, and situations stop their growth then it becomes the form of glass ceiling which heats the back of women and try to stop their growth. The purpose of this study is to clear the image that how glass ceiling heating women and become an obstacle to their carrier path. The present study is a fair attempt to present the current situation of women in the workplace. In this paper, I have tried to summarize the journey of women who have faced issues like gender inequality, discrimination, social issues, and harassment at the workplace. The population of the study comprises all the female employees working in the private sector of the Delhi NCR region. The sample size for this study is 345 women (banking, education, hospital, organization) from the private sector. To collect the response from the respondent the questionnaire and interview tools are used. With the help of the percentage analysis method demographic data are analyzed and to measure the degree of agreeableness the composite/mean score and standard deviation were calculated. Thus selected mean score implies that respondents favor that particular statement. It has been observed that the Mean score of Statement 1i.e. At the workplace due to sexual harassment by their male colleagues or bosses women prefer to change the job rather than victimizing again and again is highest. Limitations of the study are that it considered only female employees and covered only the Delhi NCR region.

Exploring the Environment behind In-Patient Falls and Their Relation to Hospital Overcrowdedness—A Register-Based Observational Study

(1) Background: Inpatient falls are a serious threat to patients’ safety and their extrinsic factors are, at present, insufficiently described. Additionally, hospital overcrowdedness is known for its malicious effects but its relation to the inpatient falls is currently underexplored. The aim of this study was to explore the distribution of falls and their extrinsic characteristics amongst a range of different clinics, and to explore the correlation and predictive ability of hospital overcrowding in relation to inpatient falls. (2) Methods: An observational, cross-sectional, registry-based study was conducted using retrospective data from an incidence registry of a hospital organization in Sweden during 2018. The registry provided data regarding the extrinsic factors of inpatient falls, including the clinics’ overcrowdedness. Simple descriptive statistics, correlation analysis and simple linear regression analysis were used. (3) Results: Twelve clinics were included. A total of 870 inpatient falls were registered during 2018. Overcrowdedness and total amount of falls were positively and very strongly correlated (r = 0.875, p < 0.001). Overcrowdedness was a significant predictor of the total amount of inpatient falls (p < 0.001, α = 0.05). (4) Conclusions: The characteristics regarding inpatient falls vary among the clinics. Inpatient overcrowding might have a significant role in the prevalence of inpatient falls, but further high-evidence-level studies are required.

Analisis Hubungan Tingkat Kesejahteraan Tanggung Jawab dan Motivasi terhadap Kepuasan Kerja Perawat dan Bidan

Health worker is everyone who devotes him/herself in the health sector and has knowledge and skills through education in the health sector, such as nurse and midwife. The maximum service of a health worker can be achievd if the level of satisfaction is good. Various factors can affect the satisfaction of nurses and midwives working in an hospital organization, such as welfare, responsibility, and work motivation. This study was aimed to assess the relation-ship between welfare, responsibility, work motivation and satisfaction among nurses and mid-wives. This was an analytical, observational, and quantitative study with a cross sectional design. There were 119 health workers of General Hospital GMIBM Monompia Kotamobagu involved in this study consisting of 107 nurses and 12 midwives obtained by using the total sampling method. The multiple linear test showed that the level of welfare affected job satisfaction (p=0.000), while responsibility and motivation did not affect job satisfaction (p=0.371 and p=0.415). The simultaneous test resulted in an F-value of 6.112 where welfare/income, respon-sibility, and motivation simultaneously affected the job satisfaction of nurses and midwives. In conclusion, welfare significantly influenced the satisfaction of nurses and midwives meanwhile responsibility and motivation did not.Keywords: level of welfare; responsibility; motivation and job satisfaction Abstrak: Tenaga kesehatan adalah setiap orang yang mengabdikan diri dalam bidang kesehatan serta memiliki pengetahuan dan keterampilan melalui pendidikan di bidang kesehatan seperti perawat dan bidan. Pemberian pelayanan yang maksimal dari tenaga kesehatan dapat tercapai bila tingkat kepuasan kerja perawat dan bidan baik. Berbagai faktor dapat mempengaruhi kepuasan kerja pada perawat dan bidan dalam suatu organisasi rumah sakit, di antaranya tingkat kesejahteraan, tanggung jawab, dan motivasi kerja. Penelitian ini bertujuan untuk mengetahui hubungan antara tingkat kesejahteraan, tanggung jawab, dan motivasi dengan kepuasan kerja pada perawat dan bidan. Jenis penelitian ialah kuantitatif dan analitik observasional dengan desain potong lintang. Subyek penelitian berjumlah 119 orang tenaga kesehatan Rumah Sakit Umum GMIBM Monompia Kotamobagu, terdiri dari 107 perawat dan 12 bidan diperoleh dengan teknik total sampling. Hasil penelitian uji linear berganda mendapatkan tingkat kesejahteraan memengaruhi kepuasan kerja (p=0.,00), sedangkan tanggung jawab dan motivasi tidak meme-ngaruhi kepuasan kerja (p=0,371 dan p=0,415). Pada hasil uji simultan didapatkan nilai F=6,112 dimana kesejahteraan/pendapatan, tanggung jawab, dan motivasi secara serempak memengaruhi kepuasan kerja. Simpulan penelitian ini ialah kesejahteraan/pendapatan mempunyai pengaruh bermakna terhadap kepuasan kerja perawat dan bidan sedangkan tanggung jawab dan motivasi tidak mempunyai pengaruh terhadap kepuasan kerja perawat dan bidan.Kata kunci: kesejahteraan; tanggung jawab; motivasi kerja dan kepuasan kerja

Distinct association of VEGF-C and VEGF-D with prognosis in patients with chronic heart failure: the PREHOSP-CHF study

Background The lymphatic system has been suggested to play an important role in cardiovascular (CV) diseases including heart failure (HF). Vascular endothelial growth factor C (VEGF-C) and VEGF-D are key regulators of lymphoangiogenesis. Purpose To investigate the association of VEGF-C and VEGF-D with prognosis in patients with chronic HF (CHF). Methods The PREHOSP-CHF study is a multicenter prospective cohort study to determine the predictive value of angiogenesis-related biomarkers in CHF. A total of 1,024 patients (mean age, 75.5±12.6 years; male, 58.7%) admitted to acute decompensated HF were included in the analyses. The primary outcome was MACE defined as a composite of CV death or HF hospitalization. The secondary outcomes were all-cause death, CV death, and HF hospitalizations. Serum levels of VEGF-C and VEGF-D, as well as N-terminal pro B-type natriuretic peptide (NT-proBNP), high sensitivity cardiac troponin-I (hs-cTnI), high sensitive C reactive protein (hs-CRP), VEGF, and soluble VEGF receptor-2 (sVEGFR-2) were measured at the time of discharge. Patients were followed-up over two years. Results Median [interquartile range] of VEGF-C and VEGF-D levels were 4821 [3633–6131] pg/ml and 404 [296–559] pg/ml, respectively. In multivariate stepwise regression analysis, independent determinants of VEGF-C levels were younger age, female gender, absence of prior HF hospitalization, chronic kidney disease, and anemia, lower ejection fraction, lower NT-proBNP levels, higher VEGF levels, and higher sVEGFR-2 levels, while those of VEGF-D levels were lower body mass index, presence of diabetes and atrial fibrillation, and higher NT-proBNP levels. During the follow-up, a total of 209 (20.4%) all-cause deaths, 112 (10.9%) CV deaths, and 309 (30.2%) HF hospitalizations occurred. After adjusting for established risk factors and CV biomarkers, VEGF-C levels were significantly and inversely associated with the incidence of MACE and non-CV death (Fig.1, model 4). On the other hand, VEGF-D levels were significantly and positively associated with the incidence of HF hospitalization (Fig. 1, model 4). When we divided the patients into 4 groups based on the median of VEGF-C and VEGF-D levels, patients with low VEGF-C and high VEGF-D showed significantly higher incidence of MACE, all-cause death, CV death, and HF hospitalization compared to those with high VEGF-C and low VEGF-D (Fig. 2). Conclusions Among patients with CHF, VEGF-C and VEGF-D had different characteristic and association with the incidence of adverse events. VEGF-C levels were inversely associated with the incidence of MACE and non-CV death, and VEGF-D levels were positively associated with the incidence of HF hospitalization. These results suggests different effects of VEGF-C and VEGF-D in CHF. Combination of VEGF-C and VEGF-D enables us to make good risk stratification in patients with CHF. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant-in-Aid for Clinical Research from the National Hospital Organization Figure 1 Figure 2

Fighting Against Stroke in Latin America: A Joint Effort of Medical Professional Societies and Governments

Introduction: Stroke is one of the leading causes of death in Latin America, a region with countless gaps to be addressed to decrease its burden. In 2018, at the first Latin American Stroke Ministerial Meeting, stroke physician and healthcare manager representatives from 13 countries signed the Declaration of Gramado with the priorities to improve the region, with the commitment to implement all evidence-based strategies for stroke care. The second meeting in March 2020 reviewed the achievements in 2 years and discussed new objectives. This paper will review the 2-year advances and future plans of the Latin American alliance for stroke.Method: In March 2020, a survey based on the Declaration of Gramado items was sent to the neurologists participants of the Stroke Ministerial Meetings. The results were confirmed with representatives of the Ministries of Health and leaders from the countries at the second Latin American Stroke Ministerial Meeting.Results: In 2 years, public stroke awareness initiatives increased from 25 to 75% of countries. All countries have started programs to encourage physical activity, and there has been an increase in the number of countries that implement, at least partially, strategies to identify and treat hypertension, diabetes, and lifestyle risk factors. Programs to identify and treat dyslipidemia and atrial fibrillation still remained poor. The number of stroke centers increased from 322 to 448, all of them providing intravenous thrombolysis, with an increase in countries with stroke units. All countries have mechanical thrombectomy, but mostly restricted to a few private hospitals. Pre-hospital organization remains limited. The utilization of telemedicine has increased but is restricted to a few hospitals and is not widely available throughout the country. Patients have late, if any, access to rehabilitation after hospital discharge.Conclusion: The initiative to collaborate, exchange experiences, and unite societies and governments to improve stroke care in Latin America has yielded good results. Important advances have been made in the region in terms of increasing the number of acute stroke care services, implementing reperfusion treatments and creating programs for the detection and treatment of risk factors. We hope that this approach can reduce inequalities in stroke care in Latin America and serves as a model for other under-resourced environments.

A Great Approach for Medium Size Hospital Network Infrastructure Architecture

To get first-hand experience for setting up a network infrastructure in a medium size hospital to manage the patient’s services, check-ups, follow-up plans from different parts of the hospital primes and store the data into the secured and safe manner in the database and use the data whenever required from the management team for their references. The network architecture based on the concept of the Three- layer network architecture combination of Mesh topology & Bus topology taking into the consideration of the primary data security, remote access to the network, size of the hospital organization, cost-effective, user-friendly and most importantly scalability required in the network architecture for future changes based on the size of the database, utilization of applications remotely, and for security of the data, changing technology etc. The goal of any network architecture is to protect the DATA from any attacks both internally and externally. For internal DATA security it is protected through various user permissions in different layers in the network for the end users. For Outside threat VPN tunnel, Policies, traffic filtering configured at the firewall level. Keywords: HIS-Hospital Information System, VPN- virtual private network tunnel, VLAN- Virtual LAN, HL7- Health Level Seven International, L3- Layer 3, ISP- Internet service provider

Epidemiokinetic Tools to Monitor Lockdown Efficacy and Estimate the Duration Adequate to Control SARS-CoV-2 Spread

Various key performance indicators (KPIs) are communicated daily to the public by health authorities since the COVID-19 pandemic has started. “Upstream” KPIs mainly include the incidence of detected Sars-CoV-2-positive cases in the population, and “downstream” KPIs include daily hospitalizations, intensive care unit admissions and fatalities. Whereas “downstream” KPIs are essential to evaluate and adapt hospital organization, “upstream” KPIs are the most appropriate to decide on the strength of restrictions such as lockdown set up and evaluate their effectiveness. Here, we suggested tools derived from pharmacokinetic calculations to improve understanding the epidemic progression. From the time course of the number of new cases of SARS-coV-2 infection in the population, it is possible to calculate the infection rate constant using a simple linear regression and determine its corresponding half-life. This epidemic regression half-life is helpful to measure the potential benefits of restriction measures and to estimate the adequate duration of lockdown if implemented by policymakers in relation to the decided public health objectives. In France, during the first lockdown, we reported an epidemic half-life of 10 days. Our tools allow clearly acknowledging that the zero-COVID target is difficult to reach after a period of lockdown as seven half-lives are required to clear 99.2% of the epidemic and more than 10 half-lives to almost reach the objective of eliminating 100% of the contaminations.

Occupational accidents in Yazd University of Medical Sciences hospitals

Introduction: Health care workers are exposed to numerous occupational accidents and injuries, the occurrence of which leads to physical and psychological problems for employees. Accident control is an important factor in reducing risks; Ensuring the health of staff and patients and efforts to prevent occupational accidents, especially in clinical settings. This study was conducted to investigate occupational accidents in three hospitals of Yazd. Materials and Methods: This is a descriptive-analytical cross-sectional study that was conducted in three teaching hospitals in Yazd. A total of 186 non-physicians from different wards of these three hospitals were included in the study by simple stratified random sampling. Data collection was performed using an 18-item occupational accident questionnaire. Data analysis was performed using SPSS21 software using descriptive statistics and Mann-Whitney and Kruskal-Wallis statistical tests. Results: Among understudy accidents, exposure to blood or body fluids showed the highest frequency while falling had the lowest frequency. The results showed that there was no relationship between gender and the number and type of accidents, but in some of the accidents, there was a significant relationship between the number and type of accidents, workplace, work experiences, educational level, shift work, and hospital type (p<0.05). Conclusion: Because these accidents occurred at least once in each of the three selected hospitals, it is necessary to prevent these accidents. Regarding the complex nature of hospital accidents and prevention of incidents, management of hospital accidents and prevention of accidents, requires the determination of all staff and management of the hospital organization.

MENELISIK KESIAPAN SUMBER DAYA MANUSIA NON KESEHATAN DALAM MENDUKUNG PELAYANAN RUMAH SAKIT DI ERA NEW NORMAL

The readiness of Human Resources is an important element of the success of the Hospital organization in providing good health services to Covid-19 patients. Non-Health Workers are competent workers who must be ready to face the Services in the New Era. The purpose of this study is to see how the readiness of non-health human resources in supporting hospital services in the New Era is normal. The type of research used is a case study using a qualitative descriptive research approach with data collection techniques: in-depth interviews and documentation. Data processing in this study uses thematic analysis. The results of the study indicate that socialization or fair information about the Covid-19 disease intensively, carrying out continuous evaluations and ensuring the implementation of the Director's policy regarding the application of health protocols at work and the budgeting policy for the provision of Personal Protective Equipment greatly affect the Readiness of Non-Health Human Resources in supporting services. Hospitals in the New Era are normal. This is in accordance with the technical guidelines for hospital services during the adaptation period of new habits issued by the Indonesian Ministry of Health in 2020 that hospital administrators prepare service management according to national health protocol standards by prioritizing health and safety by preventing and controlling the transmission of COVID-19 so that can provide protection for human resources in hospitals. It is recommended that regularly socialize the application of health protocols on an ongoing basis, carry out monitoring and evaluation in stages.