ML-Enabled Informed Intervention for Crowdsourcing-Based Optimization of Medical Resources

It is said that every adversity presents the opportunity to grow. The current pandemic is a lesson to all healthcare infrastructure stakeholders to look at existing setups with an open mind. This chapter's proposed solution offers technology assistance to manage patient data effectively and extends the hospital data management system's capability to predict the upcoming need for healthcare resources. Further, the authors intend to supplement the proposed solution with crowdsourcing to meet hospital demand and supply for unprecedented medical emergencies. The proposed approach would demonstrate its need in the current pandemic scenario and prepare the healthcare infrastructure with a more streamlined and cooperative approach than before.

Resources for Cardiovascular Healthcare associated with 30-day Mortality in Acute Myocardial Infarction with Cardiogenic Shock

Background Although primary percutaneous coronary intervention (PCI) and mechanical circulatory support (MCS), such as extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pumping (IABP), have been widely used for acute myocardial infarction patients with cardiogenic shock (AMICS), their in-hospital mortality remains high. This study aimed to investigate the association of cardiovascular healthcare resources with 30-day mortality in AMICS. Methods This was an observational study using a Japanese nationwide administrative data (JROAD-DPC) of 260,543 AMI patients between April 2012 and March 2018. Of these, 45,836 AMICS patients were divided into three categories based on MCS use: with MCS (ECMO with/without IABP), IABP only, or without MCS. Certified hospital density and number of board-certified cardiologists were used as a metric of cardiovascular care supply. We estimated the association of MCS use, cardiovascular care supply, and 30-day mortality. Results The 30-day mortality was 71.2% for the MCS, 23.9% for IABP only, and 37.8% for the group without MCS. The propensity score-matched and inverse probability-weighted Cox frailty models showed that primary PCI was associated with a low risk for mortality. Higher hospital density and larger number of cardiologists in the responsible hospitals were associated with a lower risk for mortality. Conclusions Although the 30-day mortality remained extremely high in AMICS, indication of primary PCI and improvement in providing cardiovascular healthcare resources associated with the short-term prognosis of AMICS.

Study of the impact of available healthcare resources on the population’s mortality rate using the hierarchical linear modelling

Introduction. The uneven development of the medical material and technical base and resources is observed worldwide. At the same time, healthcare resource availability is associated with the territorial characteristics of the population’s mortality rate. In order to reduce mortality, a better understanding of this relationship is needed. The purpose of the study is to assess the impact of healthcare resource availability on mortality, taking into account the hierarchical nesting of municipalities in subjects of the Russian Federation with further funding for health care and demographic indicators. Material and methods. For these purposes, hierarchical linear modelling is used. The assessment was carried out on the data of 265 municipalities attributed to 6 constituent entities of the Russian Federation. The data sources are the Territorial Bodies of the Federal State Statistics Service and the Unified Interdepartmental Information and Statistical System (www.fedstat.ru). Results. As a result of modelling, the health care resources (doctors, medical personnel, beds) at the municipal level were determined to reduce the population mortality rate positively. At the same time, an ambiguous influence of the actual cost of the territorial compulsory medical insurance program was revealed at the regional level. Conclusion. The results obtained correspond to studies devoted to the regional diversity of the population mortality rate and the available healthcare resources. However, they make it possible to determine the influence of factors taking into account the level of their formation (regional, municipal). The proposed models make it possible to improve the quality of managerial decision-making in the health care system since, taking into account the hierarchical nesting, they share the influence of regional and local factors on the variation of municipalities in terms of the mortality rate of the population.

A Country-Level Empirical Study on the Fiscal Effect of Elderly Population Health: The Mediating Role of Healthcare Resources

Demographic shifts towards an aging population are becoming a significant fiscal challenge for governments. Previous research has explored the fiscal consequences of the expanding elderly population, but the impact on the elderly’s health quality is less mentioned. The balanced relationship between elderly population health and public finance is a major concern of the global political agenda on the aging society. This article used cross-country panel data from 2000 to 2019 to examine the fiscal effect of the elderly health burden and the mediating role of healthcare resources. The results are demonstrated: The elderly health burden has a negative impact on fiscal balance, especially in aged society and longevity countries. Moreover, the mediating effect of healthcare resources is significant, whereby various forms of healthcare resources such as funds, labor, and facilities all have significant effects. Thus, the conceptual framework of elderly population health, healthcare resources, and public finance is confirmed that the elderly health burden specifically leads to the growing consumption of healthcare resources, which reduces the fiscal balance. It is concluded that reducing the elderly health burden and improving healthcare resource efficiencies are two feasible strategies to enhance fiscal sustainability.

Comparison of four different threshold values of shock index in predicting mortality of COVID-19 patients

Objective: The object of this study was to examine the accuracy in pre-hospital shock index (SI) for predicting intensive care unit (ICU) requirement and 30-day mortality among from COVID-19 patients transported to the hospital by ambulance. Method: All consecutive patients who were the age ≥18 years, transported to the emergency department (ED) by ambulance with a suspected or confirmed COVID-19 in the pre-hospital frame were included in the study. Four different cut-off points were compared (0.7, 0.8, 0.9, and 1.0) to examine the predictive performance of both the mortality and ICU requirement of the SI. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) was employed to evaluate each cut-off value discriminatory for predicting 30-day mortality and ICU admission. Results: The total of 364 patients was included in this study. The median age in the study population was 69 (55-80), of which 196 were men and 168 were women. AUC values for 30-day mortality outcome were calculated as 0.672, 0.674, 0.755, and 0.626, respectively, for threshold values of 0.7, 0.8, 0.9 and 1.0. ICU admission was more likely for the patients with pre-hospital SI> 0.9. Similarly, the mortality rate was higher in patients with pre-hospital SI> 0.9. Conclusion: Early triage of COVID-19 patients will ensure efficient use of healthcare resources. The SI could be a helpful, fast and powerful tool for predicting mortality status and ICU requirements of adult COVID-19 patients. It was concluded that the most useful threshold value for the shock index in predicting the prognosis of COVID-19 patients is 0.9.

Pediatric Endoscopy During COVID-19 Times

The global COVID-19 pandemic has led to healthcare resources being diverted or stretched, especially during periods of lock-down in affected countries. Disruptions to normal services have resulted in reduced or delayed provision of endoscopy in many countries, with consequent impacts on diagnosis or management of digestive diseases and upon endoscopy training. This review article aims to highlight key aspects of the impact of the pandemic upon endoscopy services, with a focus upon endoscopy in children.

COVID-19 and Dengue Co-infection in a Young Girl: A Case Report

During COVID-19 pandemic, the increasing incidence of dengue in Monsoon season has become a further threat especially in the dengue endemic countries of Southeast Asia like Bangladesh. Co-infection of dengue with COVID-19 has created a number of practical challenges to combat the diseases simultaneously, especially at a time when healthcare resources are already exhausted tackling the COVID pandemic. We are presenting the case report of a 14 year old girl who suffered from both RT-PCR positive COVID -19 infection & NS1 positive Dengue. She was managed in a Private Hospital of Dhaka as Dengue fever Group C (due to severe plasma leakage) with severe COVID-19 infection (as required oxygen therapy). She had a critical course of illness, having continued fever, cough, breathlessness, desaturation along with thrombocytopenia & plasma leakage. However, to our great satisfaction, the patient was ultimately improved & could be discharged in a happy face. Bangladesh J Medicine July 2022; 33(1) : 104-108

Supporting Decision Making in Intensive Care: Ethical Principles for Managing Access to Care During the COVID-19 Pandemic

The pandemic from COVID-19 causes a health threat for many countries and requires an internationally coordinated response due to the high spread of the infection. The current local and international situation gives rise to logistical and ethical considerations regarding the imbalance between needs for assistance and availability of health resources in the continuation of the emergency. A shortage condition will require healthcare professionals to choose between patients who will have access to respiratory support and those who will have to continue without. The sharing of criteria for the introduction of patients to the different therapeutic paths is fundamental to prevent the onset of ethical issues. The present paper analyzes the critical issues related to the scarcity of healthcare resources and the limitation of access to intensive care with the aim of proposing ethically sustainable principles for the management of the current pandemic situation.

Community-Based Brain Health Promotion During the COVID-19 Pandemic: Efforts of AARP in the USA

The pandemic has created new barriers for the delivery of healthcare resources and information, as well as in-person delivery of health care, caregiving, and social engagement. AARP created trainings designed for volunteer-led community-based brain health promotion. Due to the COVID, we have had to convert them to virtual presentations, distributed through technology. Staying Sharp is AARP’s online platform that educates users about integrated, holistic, lifestyle-based approaches for maintaining brain health as we age. This platform was created for convenience and scalability – we currently have over 800,000 users. During a period of necessary isolation, this platform has performed as an ideal way to get helpful information about maintaining brain health to our consumers, who are now stuck at home without access to in-person (e.g., community-based) alternatives. We will discuss lessons learned from these two different approaches along with preliminary data on behavior change based on these engagements.

Eetilised valikud COVID-19 pandeemia tingimustes

The COVID-19 pandemic has caused unprecedented interest in ethics, as societies are confronted with difficult ethical choices: life versus economic well-being, individual freedom versus health, free movement of people versus public health. All democratic societies have witnessed disagreements concerning restrictions to the free movement of people, vaccination policies, and distribution of healthcare resources. The adopted policies and formulated guidelines showed that different countries prioritized values differently. Amongst the most challenging ethical debates during the COVID-19 pandemic were attempts to formulate clinical ethical guidelines on how limited medical resources and services ought to be allocated should the need exceed availability. This article provides an overview of the process of compiling the clinical ethics recommendations for Estonian hospitals concerning the allocation of limited healthcare resources during the COVID-19 pandemic. The article describes the stakeholder involvement, engagements with comparable international documents, main internal debates and lessons learned for the future.