The COVID-19 – related problems encountered by nursing homes in Poland and the steps undertaken to prevent disease spread in the first phase of the epidemic

Nursing Homes (NHs) are institutions of social assistance run by local governments or non-government organizations. Their purpose is to provide individuals with basic services. On March 20, 2020, the Regulation of the Minister of Health issued the declaration of the COVID-19 epidemic in Poland. The introduction of legal regulations allowed the authorities to take actions to prevent infections at NHs. The aim of the study was to analyze the COVID-19 – related problems encountered by nursing homes in Poland and the steps undertaken to prevent disease spread in the first phase of the epidemic. The survey was conducted with use of an original questionnaire e-mailed to 532 NHs throughout Poland in May 2020. Results were analysed by way of the IBM SPSS Statistics program. A total of 89 completed questionnaires were received from: 40 NHs organized by local government (44.9%), 24 run by churches (27.0%), 13 established by non-governmental organizations (14.6%) and 12 operating privately (13.5%). Among them, 78 NHs had less than 100 employees (87.6%) and 11 had more than 100 employees (12.4%), while 68 had up to 100 inhabitants (76.4%) and 21 had more than 100 inhabitants (23.6%). All NHs had problems with recruiting and retaining enough nursing staff. The most commonly used method of COVID-19 spread prevention at NHs in the first phase of the pandemic was establishing an increased sanitary regime, monitoring of temperature of residents and staff members and preparing isolation rooms. The greatest problem was personnel shortages.

Point-of-Care COVID-19 Antigen Testing in Exposed German Healthcare Workers—A Cost Model

Background: Hospital staffing shortages are again (mid-year 2021) becoming a significant problem as the number of positive COVID-19 cases continues to increase worldwide. Objective: To assess the costs of sending HCW into quarantine (Scenario 1) from the hospital’s and the taxpayer’s perspective versus the costs arising from implementing point-of-care COVID-19 antigen testing (POCT) for those staff members who, despite learning that they have been exposed to hospital patients later found to be infected with COVID-19, continue to report to work (Scenario 2). Methods: A mathematical model was built to calculate the costs of a sample-and-stay strategy for exposed healthcare workers (HCW) in Germany by utilizing a high-quality antigen fluorescent immunoassay (FIA), compared to the costs of quarantine. Direct costs and wage costs were evaluated from the hospital as well as from the taxpayer perspective assuming a SARS-CoV-2 infection prevalence of 10%. Results: Serial POCT testing of exposed HCW in Germany (Scenario 2) who do not go into quarantine but continue to work during a post-exposure period of 14 days at their working place raises costs of EUR 289 (±20%: EUR 231 to EUR 346, rounded) per HCW at the expense of the employing hospital while the extra-costs to the taxpayer per exposed HCW are limited to EUR 16 (±20%: EUR 13 to EUR 19). In contrast, sending HCW into quarantine (Scenario 1) would result in costs of EUR 111 (±20%: EUR 89 to EUR 133) per exposed HCW for the hospital but EUR 2235 (±20%: EUR 1744 to EUR 2727) per HCW at the expense of the taxpayer. Conclusions: Monitoring exposed HCW who continued working by sequential POCT may considerably reduce costs from the perspective of the taxpayer and help mitigate personnel shortages in hospitals during pandemic COVID-19 waves.

ANALYSIS OF THE STRUCTURE OF CEREBROVASCULAR DISEASES

Рассматриваются вопросы анализа структуры системы реабилитации больных инсультом в Тверском регионе. Целью исследования является анализ структуры и оценка эффективности маршрутизации больных инсультами в Тверском регионе. Авторами проведен последовательный анализ развития системы медицинской реабилитации больных инсультом в зависимости от прогрессивного увеличения коечной мощности ЛПУ. Обосновано, что в связи с территориальной удаленностью, кадровым дефицитом в районах Тверского региона, отсутствием необходимого оборудования увеличение выделенных ТФОМС объемов СБО (случай больничного обслуживания) не приводит к увеличению доли профиля «нейрореабилитация». Научная новизна полученных результатов заключается в том, что выявленные организационные проблемы системы медицинской реабилитации в Тверской области позволят переформатировать процесс перспективного планирования развития системы медицинских учреждений, оказывающих помощь по данному профилю, что необходимо для повышения эффективности лечения, снижения заболеваемости и инвалидизации больных инсультом. The issues of analysis of the structure of the system of rehabilitation of stroke patients in the Tver region are considered. The purpose of the study is to analyze the structure and evaluate the effectiveness of routing stroke patients in the Tver region. The author conducted a consistent analysis of the development of the medical rehabilitation system for stroke patients depending on the progressive increase in the bed power of LPU. It is justified that due to the territorial remoteness, personnel shortages in the regions of the Tver region, the lack of necessary equipment, the increase in the allocated TFOMS volumes of SBO (case of hospital services) does not lead to an increase in the share of the “neurorehabilitation” profile. The scientific novelty of the results is that the identified organizational problems of the medical rehabilitation system in the Tver region will allow reformatting the process of prospective planning for the development of a system of medical institutions providing assistance in this profile, which is necessary to increase the effectiveness of treatment, reduce the incidence and disability of stroke patients.

DIGITAL TECHNOLOGIES IN EDUCATION: STATE AND PROSPECTS OF DEVELOPMENT

Статья посвящена проблеме перехода от традиционных методов и форм к современным цифровым технологиям обучения, ведения занятий и их роли в образовательном процессе. В статье дан анализ цифровых технологий в образовании и выявлено влияние на уровень успеваемости. На современных этапах перехода от традиционных форм обучения к цифровым образовательным технологиям возникает ряд проблем, которые в первую очередь связаны с недостаточным финансированием учебных учреждений, кадровым дефицитом в области информационных технологий в образовании. На государственном уровне в рамках цифровой экономики внедряется программа «Развитие образования РФ», которая направлена на внедрение в образовательную среду современных образовательных технологий, повышение компьютерной грамотности специалистов любых профилей. The article is devoted to the problem of transition from traditional methods and forms to modern digital technologies of teaching, conducting classes and their role in the educational process. The article analyzes digital technologies in education and reveals the impact on the level of academic performance. At the current stages of the transition from traditional forms of education to digital educational technologies, a number of problems arise, which are primarily associated with insufficient funding of educational institutions, personnel shortages in the field of information technologies in education. In our region directly to specialists for information technologies in education produces only our Department «Information technologies» GGNT. At the state level, within the framework of the digital economy, the program «Development of education in the Russian Federation»is being implemented, which is aimed at introducing modern educational technologies into the educational environment and improving the computer literacy of specialists of any profile.

Biased Technical Change in Hospital Care and the Demand for Physicians

Background The development of labour productivity is relevant for accurately planning future staffing requirements, especially in sectors where technological developments may drive labour substitution. The present study investigates how labour productivity has developed across Dutch medical specialists (2007-2017) and discusses its implications for workforce planning, also in relation to the existing literature. Methods A regression model is developed in which the number of full-time equivalents is related to production (admissions), hospital characteristics and a trend parameter. The trend parameter captures the average annual change in the number of full-time equivalents per output and is a measure for labour productivity. The model is applied to a micro-data set of Dutch hospitals in the period 2007-2017 across 24 different specialties using regression methods. Results The results indicate that the number of full-time equivalents per admission has increased for most specialisms and that labour productivity has thus decreased. However, there is considerable heterogeneity and uncertainty across different specialisms. Conclusions The results amplify the issue of medical personnel shortages driven by the growing demand for health care. The research outcomes are linked to the existing literature regarding physicians’ productivity. Changes in accountability such as using relative value units, incentive payments, use of staff and mid-level providers, and technology have been discussed and some consensus has been reached.

Challenges in early phase clinical trials for childhood cancer during the COVID-19 pandemic: A report from the New Agents Group of the Spanish Society of Paediatric Haematology and Oncology (SEHOP)

Purpose: The COVID-19 pandemic has forced healthcare stakeholders towards challenging decisions. We analyse the impact of the pandemic on the conduct of phase I-II trials for paediatric cancer during the first month of state of alarm in Spain.Methods: A questionnaire was sent to all five ITCC-accredited Spanish Paediatric Oncology Early-Phase Clinical Trial Units, including questions about impact on staff activities, recruitment, patient care, supply of investigational products and legal aspects.Results: All units suffered personnel shortages and difficulties in enrolling patients, treatment continuity or performing trial assessments. Monitoring activity was frequently postponed (73%), and 49% of on-going trials interrupted recruitment. Only two patients could be recruited during this period (75% reduction in the expected rate).Conclusions: The COVID-19 crisis has significantly impacted clinical research practice and access to innovation for children with cancer. Structural and functional changes are under way to better cope with the expected future restrictions.

83. During A Million Patient-Days of Surveillance, Low Levels of Infection Prevention Staff Correlated with Higher Rates of Some Healthcare-Associated Infections

Background Reports regarding the correlations between infection preventionist (IP) staffing levels and healthcare-associated infections (HAI) are scarce, conflicting, and crucial for resource allocation and effort prioritization. We evaluated such correlations from January 1, 2012 to March 1, 2019 at a 528-bed teaching hospital in Rochester, NY; a period when IP staffing levels fluctuated between the recommended ratio of 1 IP: 80 patients and a critically low of 1 IP: >375. Methods Standardized National Health Safety Network (NHSN) definitions, along with laboratory events, re-admissions, interactions with surgical teams, and an independent data management company were used for case finding of catheter-associated urinary tract infection (CAUTI), Clostridiodes difficile (CDI), central line-associated bloodstream infection (CLABSI), carbapenem-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus (MRSA). Colon, prosthetic knee and hip joint, hysterectomies, and coronary artery bypass graft surgical site infections (SSI) were also studied. Standardized infection ratios (SIR) were extracted from NHSN. Staffing levels were grouped into low (/ = 7 FTE). Correlations between HAI rates, SIR, and staffing levels were examined using Poisson and T-tests with the R statistical package. Results The average daily census of 451 resulted in 1.18 million total patient-days of surveillance. Periods of low and recommended IP levels occurred at similar seasons and for similar durations. There were fewer CDI, CAUTI, CLABSI, and MRSA infections when IP staff were at recommended levels than when IP staff were at the lowest level, but only CDI and CLABSI rates were significantly lower (P = 0.003 and 0.005, respectively). CLABSI SIR was 1.07 and 0.64 during periods of low and recommended staffing levels, respectively (P = 0.004). No significant differences occurred in SSI, either by type or by combined. Conclusion Hospitals often cannot achieve or maintain recommended IP staffing levels. Our findings suggest that, during critical personnel shortages, IP may have more impact by focusing on the types of HAI that correlated with preventionist staffing levels. This is among the largest such study to date, and uniquely includes the most types of HAI. Disclosures All Authors: No reported Disclosures.