Embracing Healthcare Delivery Challenges during a Pandemic. Review from a nodal designated COVID-19 center in Qatar

Avicenna ◽  
2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Manish Barman ◽  
Tanweer Hussain ◽  
Hatem Abuswiril ◽  
Memon Noor Illahi ◽  
Muhammad Sharif ◽  
...  
Keyword(s):  
Economies Of Scale ◽  
Patient Flow ◽  
Healthcare Delivery ◽  
Developed Countries ◽  
Population Based ◽  
System Capacity ◽  
Complex Situation ◽  
Healthcare Waste ◽  
Work Arrangements ◽  
Trade Offs

Hospitals and healthcare systems are instrumental in the formulation and delivery of a coordinated response to disaster management especially epidemics. In healthcare policy and strategy formation, there are only trade-offs, which with uncertainty are akin to gambles. National organizations play a key role in pandemics through the expression of physician motivation. Effective strategies can facilitate physician action through economies of scale that lower the costs for physicians to meet both community and patients' needs. Moreover, no matter how well clinicians are motivated and positioned to act, their collective actions are likely to fall short without complementary systems for population-based care that require the operational support of an organization. This review of institutional policy implementation and frameworks intends to highlight how a nodal-designated COVID-19 center in Qatar managed to control the menace by altering its procedural sets and work arrangements to augment an integrated, intrinsic response to a briskly emerging, conceivably complex situation. This outcome was achieved under the guidance of a national leadership team, effectively adapted to its specific challenges by building on current medical evidence, management routines, proficiencies, and health system capacity. This ambitious drive started with the cohesion of services and implementation of evidence-based protocols by assigning a physician-led team to research, strategize and organize improved patient flow and information by arranging analytical compliance and preparedness. Through these service approaches and ongoing efforts, HMGH has realized significant outcome improvements, such as increasing capacity building, reducing healthcare waste, and increasing patient satisfaction rates whilst successfully achieving significantly lower COVID-19 mortality both in terms of absolute numbers and as percent population compared to many developed countries in the world. The strategies outlined in this article might not be all-inclusive or fit other healthcare system models, but they generate a veritable interest to pursue and be subjected to further rigorous study.

P3352Telemedicine transcends national boundaries in quest of creating a behemoth ami program

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Mehta ◽  
R Botelho ◽  
F Fernandez ◽  
F Feres ◽  
A Abizaid ◽  
...  
Keyword(s):  
Community Health Centers ◽  
Developed Countries ◽  
Population Based ◽  
Primary Pci ◽  
Small Community ◽  
Hub And Spoke ◽  
Web Based ◽  
National Boundaries ◽  
Intelligent Tools ◽  
Time Of Presentation

Abstract Background The Latin America Telemedicine Infarct Network (LATIN) has exploited the remarkable competence of telemedicine for remote guidance. In doing so, LATIN created a mammoth population-based AMI network that employed experts located several hundred miles away to guide the reperfusion strategies for almost 800,000 screened patients. In this pioneering project, telemedicine was initially utilized to guide AMI management within national confines. We speculated whether LATIN telemedicine navigation could outstrip countrywide borders. Purpose To maximally harness the vast possibilities of telemedicine for improving AMI care. Methods During its pilot phase, LATIN began as a hub and spoke, AMI system in Colombia where 20 spokes (small community health centers and rural clinics) were configured with 3 hubs that could perform Primary PCI. These sites were linked through web-based connectivity. Expert cardiologists, located 50–250 miles away in Bogota, Colombia, used sophisticated telemedicine platforms for urgent EKG diagnosis and teleconsultation of the entire AMI process. Based upon the duration of chest pain and travel time to the hub, these experts guided patients through guideline-based strategies of thrombolysis, pharmaco invasive management or primary PCI. Efficiency of the telemedicine process was measured with the new metric of time to telemedicine diagnosis (TTD). Cloud computing, GPS navigation, and numerous business intelligent tools were gradually incorporated into LATIN telemedicine. As systems became more scalable, the program was expanded to Brazil, where LATIN flourished. Over the last 18 months, LATIN telemedicine capabilities have been pressed across national boundaries. Presently, all 82 LATIN centers in Mexico are guided by experts located in Bogota, Colombia and the 7 Argentina centers channeled through Santiago, Chile. Results 784,947 patients were screened for AMI at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). Navigation pathways are depicted in the attached figure. TTD remains extremely low in all four countries, and comparable efficiency and tele-accuracy have been achieved. With expanded geographic reach, 8,448 (1.08%) patients were diagnosed with STEMI and 3,911 (46.3%) urgently reperfused, including 3,049 (78%) with Primary PCI. Time to TTD ranged between 2.8 to 5.8 minutes, with a mean of 3.5 min. Tele-accuracy was 98.5%, D2B 51 min, and in-hospital mortality 5.2%. Various other comparative metrics for the 4 countries are being gathered and will be available at the time of presentation. Conclusions LATIN demonstrates the robust ability of telemedicine to transcend national boundaries to guide AMI management. This strategy can be adopted in under-developed countries in Asia and Africa to provide an umbrella of AMI care for the millions of disadvantaged patients.

scholarly journals Integration of various dimensions in food-based dietary guidelines via mathematical approaches Report of a DGE/FENS Workshop in Bonn, Germany, 23-24 September 2019

2020 ◽  
pp. 1-18
Author(s):  
Anne Carolin Schäfer ◽  
Annemarie Schmidt ◽  
Angela Bechthold ◽  
Heiner Boeing ◽  
Bernhard Watzl ◽  
...  
Keyword(s):  
Population Based ◽  
Dietary Guidelines ◽  
Dietary Recommendations ◽  
Mathematical Methods ◽  
Trade Offs ◽  
Simultaneous Integration ◽  
Joint Workshop ◽  
Different Dimensions ◽  
Diverse Data ◽  
Mathematical Optimisation

Abstract In the past, food-based dietary guidelines (FBDGs) were derived nearly exclusively by using systematic reviews on diet-health-relationships and translating dietary reference values for nutrient intake into foods. This approach neglects many other implications that dietary recommendations have on society, the economy and environment. In view of pressing challenges, such as climate change and the rising burden of diet-related diseases, the simultaneous integration of evidence-based findings from different dimensions into FBDGs is required. Consequently, mathematical methods and data processing are evolving as powerful tools in nutritional sciences. The possibilities and reasons for the derivation of FBDGs via mathematical approaches were the subject of a joint workshop hosted by the German Nutrition Society (DGE) and the Federation of European Nutrition Societies (FENS) in September 2019 in Bonn, Germany. European scientists were invited to discuss and exchange on the topics of mathematical optimisation for the development of FBDGs and different approaches to integrate various dimensions into FBDGs. We concluded that mathematical optimisation is a suitable tool to formulate FBDGs finding trade-offs between conflicting goals and taking several dimensions into account. We identified a lack of evidence for the extent to which constraints and weights for different dimensions are set and the challenge to compile diverse data that suit the demands of optimisation models. We also found that individualisation via mathematical optimisation is one perspective of FBDGs to increase consumer acceptance, but the application of mathematical optimisation for population-based and individual FBDGs requires more experience and evaluation for further improvements.

scholarly journals Does access to care play a role in liver cancer survival? The ten-year (2006–2015) experience from a population-based cancer registry in Southern Italy

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Walter Mazzucco ◽  
Francesco Vitale ◽  
Sergio Mazzola ◽  
Rosalba Amodio ◽  
Maurizio Zarcone ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Access To Care ◽  
Cancer Registry ◽  
Health Care Services ◽  
Cancer Survival ◽  
Developed Countries ◽  
Population Based ◽  
Easy Access ◽  
Net Survival ◽  
Poor Access

Abstract Background Hepatocellular carcinoma (HCC) is the most frequent primary invasive cancer of the liver. During the last decade, the epidemiology of HCC has been continuously changing in developed countries, due to more effective primary prevention and to successful treatment of virus-related liver diseases. The study aims to examine survival by level of access to care in patients with HCC, for all patients combined and by age. Methods We included 2018 adult patients (15–99 years) diagnosed with a primary liver tumour, registered in the Palermo Province Cancer Registry during 2006–2015, and followed-up to 30 October 2019. We obtained a proxy measure of access to care by linking each record to the Hospital Discharge Records and the Ambulatory Discharge Records. We estimated net survival up to 5 years after diagnosis by access to care (“easy access to care” versus “poor access to care”), using the Pohar-Perme estimator. Estimates were age-standardised using International Cancer Survival Standard (ICSS) weights. We also examined survival by access to care and age (15–64, 65–74 and ≥ 75 years). Results Among the 2018 patients, 62.4% were morphologically verified and 37.6% clinically diagnosed. Morphologically verified tumours were more frequent in patients aged 65–74 years (41.6%), while tumours diagnosed clinically were more frequent in patients aged 75 years or over (50.2%). During 2006–2015, age-standardised net survival was higher among HCC patients with “easy access to care” than in those with “poor access to care” (68% vs. 48% at 1 year, 29% vs. 11% at 5 years; p < 0.0001). Net survival up to 5 years was higher for patients with “easy access to care” in each age group (p < 0.0001). Moreover, survival increased slightly for patients with easier access to care, while it remained relatively stable for patients with poor access to care. Conclusions During 2006–2015, 5-year survival was higher for HCC patients with easier access to care, probably reflecting progressive improvement in the effectiveness of health care services offered to these patients. Our linkage algorithm could provide valuable evidence to support healthcare decision-making in the context of the evolving epidemiology of hepatocellular carcinoma.

Epidemiology of Twin Births in Southeast China: 1993–2005

2013 ◽  
Vol 16 (2) ◽  
pp. 608-613 ◽  
Author(s):  
Xinrong Lu ◽  
Jun Zhang ◽  
Yinghui Liu ◽  
Ting Wang ◽  
Yanyu Lu ◽  
...  
Keyword(s):  
Urban Areas ◽  
Birth Rate ◽  
Perinatal Care ◽  
Care Program ◽  
Developed Countries ◽  
Population Based ◽  
Fertility Treatment ◽  
Birth Rates ◽  
Southeast China ◽  
Twin Birth

Recently, there has been a significant increase in the rate of multiple births in most developed countries. However, few population-based studies have been conducted in China regarding the epidemiology of twin births in recent years. We performed a descriptive analysis of twin births from 1993 to 2005 using data from a population-based perinatal care program in southeast China. The twin birth rate in southeast China was 0.65%, and the twin birth rates from 1993 to 2005 fluctuated between 0.60% and 0.70%. During the three periods of 1993–1996, 1997–2000, and 2001–2005, the twin birth rate increased from 0.57% to 0.71% in urban areas (p = .005) and from 0.59% to 0.68% in mothers who had an education level of high school or higher (p = .046). After 2000, the twin birth rate of primiparae 30 years of age and older significantly increased from 0.72% to greater than 1.20%. We concluded that the twin birth rates in southeast China from 1993 to 2005 stayed constant in the overall population but increased in certain subgroups of women, presumably due to increased use of fertility treatment and the development of assisted reproductive technology.

Abstract T P259: What Should Really be Happening to Our Stroke Patients Post-Acute Care?: A System Best Practice Model for Inpatient Rehab

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Shelley Sharp ◽  
Elizabeth Linkewich ◽  
Jacqueline Willems ◽  
Nicola Tahair ◽  
Charissa Levy ◽  
...  
Keyword(s):  
Acute Care ◽  
Stroke Unit ◽  
Best Practice ◽  
Patient Flow ◽  
System Capacity ◽  
Stroke Patients ◽  
Practice Model ◽  
Term Care ◽  
Stroke Unit Care ◽  
The Right

Background: A regional Stroke Report Card identified poor performance on system efficiency, effectiveness, and integration of stroke best practice. This engaged regional funders and 17 organizations (11 acute, 6 rehab) to collaborate in stroke system planning. The focus included stroke unit care and access to timely and appropriate rehabilitation, including increased access for severe stroke. Changes in acute care, including pre-hospital, have facilitated access to stroke unit care in the city. A model of patient flow from acute care was needed to understand other system capacity needs. Purpose: To use best practice and benchmarks to delineate post-acute patient flow and facilitate alignment of resources for inpatient rehabilitation. Methods: Administrative data from national reporting and local rehab referral system databases were used to review current system usage from acute care. A model of proportional distribution of cases from acute, specifically to inpatient rehab, was established using provincial benchmarks, evidence informed targets, and organization market share of total inpatient rehab system capacity. Iterative discussions were required to confirm the organizations’ commitment to stroke best practice. New volume and case mix changes were applied to determine capacity and resource planning needs across organizations. Results: The best practice model, approved by all stakeholders, proposes 40% of stroke patients discharged alive from acute care should access inpatient, 13% outpatient rehabilitation and 6% to Complex Continuing Care and Long Term Care. Current practice is 26%, <5% and 13% respectively. A projected volume increase of 278 patients is distributed across 5/6 rehab providers. This results in a total proportional system shift from 20% (n=160) to 41.5% (n =446) of severe patients receiving access to high intensity rehab. A reduction in the overall proportion of moderate and mild stroke patients from 65% (519) to 49.5% (n=534) and 15% (n=119) to 9% (n=96) respectively. Conclusion: Significant investment/redistribution of resources within the system is required to support patient flow and provide care in the right place at the right time. System funder support is critical to create a quality of care (best practice) system.

scholarly journals Management of Hypertension: A Bangladeshi Perspective

1970 ◽  
Vol 39 (1) ◽  
pp. 40-43
Author(s):  
SM Mustafa Zaman ◽  
Mohammad Salman ◽  
Kaniz Fatema
Keyword(s):  
Cardiovascular Disease ◽  
Fruits And Vegetables ◽  
Lifestyle Modification ◽  
Clinical Care ◽  
Cost Effective ◽  
Developed Countries ◽  
Population Based ◽  
Lifestyle Changes ◽  
Optimum Level ◽  
Lifestyle Modifications

Hypertension is a silent killer. Bangladeshis are racially predisposed to cardiovascular disease, and the increasing burden of hypertension has only added to the problem. Economic constraints and the allure of additional benefits without adverse effects have made lifestyle modifications an attractive proposition in developing and developed countries alike. Blood pressure is a continuum and any increase above optimum level confers additional independent risk of cardiovascular disease. We review screening, diagnosis and management using lifestyle measures and pharmacotherapy. We then discuss the barriers and challenges to implementing this approach and what can be done regarding prevention, screening, lifestyle modification and pharmacotherapy in our country. By adopting a comprehensive population based approach including policy level interventions directed at promoting lifestyle changes; a healthy diet (appropriate calories, low in saturated fats and salt and rich in fruits and vegetables), increased physical activity, and a smoking free society, properly balanced with a high risk approach of cost effective clinical care, Bangladesh can effectively control hypertension and improve public health. DOI: 10.3329/bmj.v39i1.6232 Bangladesh Medical Journal 2010; 39(1): 40-43

scholarly journals Heterogeneous effects of hospital competition on inpatient expenses: an empirical analysis of diseases grouping basing on conditions’ complexity and urgency

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Liyong Lu ◽  
Xiaojun Lin ◽  
Jay Pan
Keyword(s):  
Regression Model ◽  
Patient Flow ◽  
Statistical Significance ◽  
Healthcare Delivery ◽  
Hospital Competition ◽  
Process Of Care ◽  
Healthcare Delivery System ◽  
Discharge Data ◽  
Heterogeneous Effects ◽  
Hospital Administrative

Abstract Background Multiple pro-competition policies were implemented during the new round of healthcare reform in China. Differences in conditions’ complexity and urgency across diseases associating with various degrees of information asymmetry and choice autonomy in the process of care provision, would lead to heterogeneous effects of competition on healthcare expenses. However, there are limited studies to explore it. This study aims to examine the heterogeneous effects of hospital competition on inpatient expenses basing on disease grouping according to conditions’ complexity and urgency. Methods Collecting information from discharge data of inpatients and hospital administrative data of Sichuan province in China, we selected representative diseases. K-means clustering was used to group the selected diseases and Herfindahl-Hirschman Index (HHI) was calculated based on the predicted patient flow to measure the hospital competition. The log-linear multivariate regression model was used to examine the heterogeneous effects of hospital competition on inpatient expenses. Results We selected 19 representative diseases with significant burdens (more than 1.1 million hospitalizations). The selected diseases were divided into three groups, including diseases with highly complex conditions, diseases with urgent conditions, and diseases with less complex and less urgent conditions. For diseases with highly complex conditions and diseases with urgent conditions, the estimated coefficients of HHI are mixed in the direction and statistical significance in the identical regression model at the 5% level. For diseases with less complex and less urgent conditions, the coefficients of HHI are all positive, and almost all of them significant at the 5% level. Conclusions We found heterogeneous effects of hospital competition on inpatient expenses across disease groups: hospital competition does not play an ideal role in reducing inpatient expenses for diseases with highly complex conditions and diseases with urgent conditions, but it has a significant effect in reducing inpatient expenses of diseases with less complex and less urgent conditions. Our study offers implications that the differences in condition’s complexity and urgency among diseases would lead to different impacts of hospital competition, which would be given full consideration when designing the pro-competition policy in the healthcare delivery system to achieve the desired goal.

scholarly journals THE EMERGENCE OF THE AUTOMOTIVE INDUSTRY IN CHINA

2021 ◽  
Author(s):  
Olga Krause ◽  
◽  
Nadiya Golda ◽  
Iryna Pinyak ◽  
◽  
...  
Keyword(s):  
Automotive Industry ◽  
Automobile Industry ◽  
Economies Of Scale ◽  
Joint Venture ◽  
Developed Countries ◽  
Engineering Industry ◽  
General Motors ◽  
Small Range ◽  
Foreign Companies ◽  
Car Market

The engineering industry, including the automotive industry, belongs to the strategic branches of the country’s economy and to a large extent determines the level of development. The Chinese automobile industry dates back to 1953, and the first automobile factory, the First Automobile Works (FAW), was started in Beijing. Over the next few years, several more car factories were established in Nanjing, Khanhai, Jinan and Beijing. The requirements of funds, technologies and automotive modernization stimulated the attraction of external investment. A number of restrictive measures have been adopted to curb external competition, reduce car imports and attract innovative technologies, including high tariff and non-tariff barriers, screening, and restrictions on foreign capital, Limiting market share to foreign companies. When signing the joint-venture agreement, the Chinese side insisted on technology transfer and subordination to the Chinese leadership. Volkswagen first built a car factory in China. Today almost every progressive car company is represented in the Chinese car market, such as Mercedes-Bens, Ford, General Motors, Suzuki, Daihatsu, Honda, Subaru, Citreon, Toyota. Most of them have partnerships with one of China’s top three car manufacturers. American, European, and Japanese automakers see China as a promising market as demand for vehicles in the US and Europe shrinks. To the Chinese automobile market, the cars are made according to the requirements of the local consumer – conservative, with high-quality design, low and middle price segment. Since 2009, foreign automobile companies have accounted for 85% of the Chinese car market. About 60% of the cars sold in China are locally produced. However, China’s automobile industry is highly fragmented and mostly consists of small companies that produce a small range of components. Such production is labour-intensive with relatively low use of advanced technologies compared to car manufacturers in developed countries, often lacking economies of scale. Research expenditure accounts for a large part of the expenditure structure. Most companies produce low-tech parts with significant import presence.

scholarly journals PREVALENCE OF HYPERTENSION IN ADULT POPULATION OF HAYATABAD PESHAWAR

1969 ◽  
Vol 5 (1) ◽  
pp. 644-647
Author(s):  
SARA GUL ◽  
ATIF HUSSAIN ◽  
KASHIF UR REHMAN KHALIL ◽  
IMRANULLAH ◽  
MUHAMMAD ISHTIAQ ◽  
...  
Keyword(s):  
Communicable Disease ◽  
Adult Population ◽  
Positive Association ◽  
Developed Countries ◽  
Population Based ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Study Results ◽  
History Of ◽  
Study Population

BACKGROUND: Hypertension is one of the common non communicable disease and is reported to beprevalent in 20% to 50% of the adult population, hypertension is one of the major contributor ofmortality and morbidity in developing and developed countries. The cross-sectional descriptive studywas formulated to find the prevalence and to assess different etiological factors of hypertension.MATERIAL & METHODS: This cross-sectional study among 400 adults of age 25-75 years wasconducted in months of June to December 2014 in Phase 5, Hayatabad Peshawar. A detailed structuredproforma having important questions was used to collect important data regarding various variables.RESULTS: Our study results showed that 22.75% of the study people were hypertensive i.e. 10.25% ofmales and 12.5% of females; and the prevalence of hypertension showed positive association withadvancing age. Out of all respondents; 60.25% were males while 39.75% were females; 28.5% weresmokers; 5.25% consume predominantly meat; 32.5% were obese & overweight; 36.75% checked theirB.P regularly; and 19.75% had positive history of hypertension in family.CONCLUSION: We conclude that hypertension prevalence was high among our study population andwas associated with various modifiable and non modifiable risk factors thus population based preventivestrategies are needed to control and prevent hypertension.KEY WORDS: Hypertension, Age, Diet, Smokers, Hayatabad, Peshawar.

scholarly journals INFORMATION ABOUT SCIENTIFIC STUDDING LEVEL ON PROBLEM OF HYPERTENSION-MEDIATED ORGAN DAMAGE IN MONGOLIA

2019 ◽  
Vol 23 (1) ◽  
pp. 25-39
Author(s):  
T. M. Maksikova ◽  
Ts. Barsuren ◽  
A. N. Kalyagin ◽  
E. B. Babanskaya
Keyword(s):  
Arterial Hypertension ◽  
Developed Countries ◽  
Organ Damage ◽  
Population Based ◽  
Small Samples ◽  
International Studies ◽  
High Prevalence ◽  
Damage Structure ◽  
Scientific Papers ◽  
Guidelines And Recommendations

Despite of arterial hypertension high prevalence and its complications in Mongolia, the epidemiology and structure of hypertension-mediated organ damage remains insufficiently studied. Aim. To assess elaboration level of the problem of AH-associated hypertension-mediated organ damage in Mongolia. Materials and methods. Leading international guidelines and recommendations, reviews, meta-analyzes, randomized controlled, population-based research and Mongolian scientific papers with different evidential value, related to hypertension-mediated organ damage were analyzed. Results and discussion. In developed countries, hypertension-mediated organ damage structure and their contribution to total cardiovascular risk stratification in patients with hypertension is well studied. In 2018 ESC/ESH Guidelines for the management of arterial hypertension hypertension-mediated organ damage criteria were only slightly extended. Data on arterial hypertension epidemiology, including hypertension-mediated organ damage structure, in Mongolian population, mainly obtained from ethnic Mongols living in the territory of Inner Mongolia and other provinces of China, or in international studies with Mongolia participation. Directly in Mongolia, hypertension-mediated organ damage were studied in small samples; a systemic epidemiological analysis of hypertension-mediated organ damage was not carried out. Conclusions. Given arterial hypertension significance in Mongolia and insufficient scientific elaboration of problem, population studies are needed to clarify hypertension-mediated organ damage prevalence and structure in order for improving arterial hypertension management.

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