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Aubert BA, Barker JR, Beaton C, Gonzalez PA, Ghalambor-Dezfuli H, O'Donnell D, Sears K, Yu B. Investigating the impact of the COVID-19 pandemic on the occurrence of medication incidents in Canadian community pharmacies. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100379. [PMID: 38145238 PMCID: PMC10746502 DOI: 10.1016/j.rcsop.2023.100379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/04/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
As the COVID-19 pandemic unfolded, community pharmacies adapted rapidly to broaden and adjust the services they were providing to patients, while coping with severe pressure on supply chains and constrained social interactions. This study investigates whether these events had an impact on the medication incidents reported by pharmacists. Results indicate that Canadian pharmacies were able to sustain such stress while maintaining comparable safety levels. At the same time, it appears that some risk factors that were either ignored or not meaningful in the past started to be reported, suggesting that community pharmacists are now aware of a larger set of contributing factors that can lead to medication incidents, notably for medication incidents that can lead to harm.
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Affiliation(s)
| | | | | | | | | | | | - Kim Sears
- School of Nursing, Queen's University, Canada
| | - Bo Yu
- Rowe School of Business, Dalhousie University, Canada
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Nates JL, Oropello JM, Badjatia N, Beilman G, Coopersmith CM, Halpern NA, Herr DL, Jacobi J, Kahn R, Leung S, Puri N, Sen A, Pastores SM. Flow-Sizing Critical Care Resources. Crit Care Med 2023; 51:1552-1565. [PMID: 37486677 PMCID: PMC11192408 DOI: 10.1097/ccm.0000000000005967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
OBJECTIVES To describe the factors affecting critical care capacity and how critical care organizations (CCOs) within academic centers in the U.S. flow-size critical care resources under normal operations, strain, and surge conditions. DATA SOURCES PubMed, federal agency and American Hospital Association reports, and previous CCO survey results were reviewed. STUDY SELECTION Studies and reports of critical care bed capacity and utilization within CCOs and in the United States were selected. DATA EXTRACTION The Academic Leaders in the Critical Care Medicine Task Force established regular conference calls to reach a consensus on the approach of CCOs to "flow-sizing" critical care services. DATA SYNTHESIS The approach of CCOs to "flow-sizing" critical care is outlined. The vertical (relation to institutional resources, e.g., space allocation, equipment, personnel redistribution) and horizontal (interdepartmental, e.g., emergency department, operating room, inpatient floors) integration of critical care delivery (ICUs, rapid response) for healthcare organizations and the methods by which CCOs flow-size critical care during normal operations, strain, and surge conditions are described. The advantages, barriers, and recommendations for the rapid and efficient scaling of critical care operations via a CCO structure are explained. Comprehensive guidance and resources for the development of "flow-sizing" capability by a CCO within a healthcare organization are provided. CONCLUSIONS We identified and summarized the fundamental principles affecting critical care capacity. The taskforce highlighted the advantages of the CCO governance model to achieve rapid and cost-effective "flow-sizing" of critical care services and provide recommendations and resources to facilitate this capability. The relevance of a comprehensive approach to "flow-sizing" has become particularly relevant in the wake of the latest COVID-19 pandemic. In light of the growing risks of another extreme epidemic, planning for adequate capacity to confront the next critical care crisis is urgent.
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Affiliation(s)
- Joseph L Nates
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | | | | | - Nitin Puri
- Cooper University Health Care, Camden, NJ
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Alfano V, Capasso S, Limosani M. On the determinants of anti-COVID restriction and anti-vaccine movements: the case of IoApro in Italy. Sci Rep 2023; 13:16784. [PMID: 37798271 PMCID: PMC10556032 DOI: 10.1038/s41598-023-42133-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 09/05/2023] [Indexed: 10/07/2023] Open
Abstract
Following restrictions to control the spread of COVID-19, and subsequent vaccination campaigns, sentiments against such policies were quick to arise. While individual-level determinants that led to such attitudes have drawn much attention, there are also reasons to believe that the macro context in which these movements arose may contribute to their evolution. In this study, exploiting data on business activities which supported a major Italian anti-restriction and anti-vaccine movement, IoApro, using quantitative analysis that employs both a fractional response probit and logit model and a beta regression model, we investigate the relationship between socio-economic characteristics, institutional quality, and the flourishing of this movement. Our results suggest a U-shaped relationship between income and the proliferation of the movement, meaning that support for these movements increases the greater the degree of economic decline. Our results further indicate that the share of the population between 40 and 60 years old is positively related to support for such movements, as is institutional corruption.
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Affiliation(s)
- Vincenzo Alfano
- DiSEGIM, University of Napoli Parthenope, Naples, Italy.
- Center for Economic Studies - CES-Ifo, Munich, Germany.
| | - Salvatore Capasso
- Department of Human and Social Sciences, Italian National Research Council, Rome, Italy
- University of Napoli Parthenope, Naples, Italy
- CSEF, University of Naples Federico II, Naples, Italy
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Malaeb R, Haider A, Abdulateef M, Hameed M, Daniel U, Kabilwa G, Seyni I, Ahmadana KE, Zelikova E, Porten K, Godard A. High mortality rates among COVID-19 intensive care patients in Iraq: insights from a retrospective cohort study at Médecins Sans Frontières supported hospital in Baghdad. Front Public Health 2023; 11:1185330. [PMID: 37719728 PMCID: PMC10501727 DOI: 10.3389/fpubh.2023.1185330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Background The Coronavirus Disease 2019 (COVID-19) pandemic has highlighted the challenges of the healthcare system in Iraq, which has limited intensive care unit beds, medical personnel, and equipment, contributing to high infection rates and mortality. The main purpose of the study was to describe the clinical characteristics, the length of Intensive Care Unit (ICU) stay, and the mortality outcomes of COVID-19 patients admitted to the ICU during the first wave and two subsequent surges, spanning from September 2020 to October 2021, in addition to identify potential risk factors for ICU mortality. Methods This retrospective cohort study analyzed data from COVID-19 patients admitted to the COVID-19 ICU at Al-Kindi Ministry of Health hospital in Baghdad, Iraq, between September 2020 and October 2021. Results The study included 936 COVID-19 patients admitted to the ICU at Al-Kindi Hospital. Results showed a high mortality rate throughout all waves, with 60% of deaths due to respiratory failure. Older age, male gender, pre-existing medical conditions, ICU procedures, and complications were associated with increased odds of ICU mortality. The study also found a decrease in the number of complications and ICU procedures between the first and subsequent waves. There was no significant difference in the length of hospital stay between patients admitted during different waves. Conclusion Despite improvements in critical care practices, the mortality rate did not significantly decrease during the second and third waves of the pandemic. The study highlights the challenges of high mortality rates among critical COVID-19 patients in low-resource settings and the importance of effective data collection to monitor clinical presentations and identify opportunities for improvement in ICU care.
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Affiliation(s)
- Rami Malaeb
- Department of Epidemiology and Training, Epicentre, Dubai, United Arab Emirates
| | - Amna Haider
- Department of Epidemiology and Training, Epicentre, Dubai, United Arab Emirates
| | | | - Mustafa Hameed
- Médecins Sans Frontières, Operational Centre Paris, Baghdad, Iraq
| | - Uche Daniel
- Médecins Sans Frontières, Operational Centre Paris, Baghdad, Iraq
| | - Gabriel Kabilwa
- Médecins Sans Frontières, Operational Centre Paris, Baghdad, Iraq
| | - Ibrahim Seyni
- Médecins Sans Frontières, Operational Centre Paris, Baghdad, Iraq
| | - Khalid E. Ahmadana
- Médecins Sans Frontières, Operational Centre Paris, Dubai, United Arab Emirates
| | - Evgenia Zelikova
- Médecins Sans Frontières, Operational Centre Paris, Paris, France
| | - Klaudia Porten
- Department of Epidemiology and Training, Epicentre, Paris, France
| | - Aurelie Godard
- Médecins Sans Frontières, Operational Centre Paris, Paris, France
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Issever D, Catalbas MC, Duran F. Examining Factors Influencing Cognitive Load of Computer Programmers. Brain Sci 2023; 13:1132. [PMID: 37626489 PMCID: PMC10452396 DOI: 10.3390/brainsci13081132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
In this study, the factors influencing the cognitive load of computer programmers during the perception of different code tasks were investigated. The eye movement features of computer programmers were used to provide a significant relationship between the perceptual processes of the sample codes and cognitive load. Thanks to the relationship, the influence of various personal characteristics of programmers on cognitive load was examined. Various personal parameters such as programming experience, age, native language, and programming frequency were used in the study. The study was performed on the Eye Movements in Programming (EMIP) dataset containing 216 programmers with different characteristics. Eye movement information recorded during two different code comprehension tasks was decomposed into sub-information, such as pupil movement speed and diameter change. Rapid changes in eye movement signals were adaptively detected using the z-score peak detection algorithm. Regarding the cognitive load calculations, canonical correlation analysis was used to build a statistically significant and efficient mathematical model connecting the extracted eye movement features and the different parameters of the programmers, and the results were statistically significant. As a result of the analysis, the factors affecting the cognitive load of computer programmers for the related database were converted into percentages, and it was seen that linguistic distance is an essential factor in the cognitive load of programmers and the effect of gender on cognitive load is quite limited.
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Affiliation(s)
- Didem Issever
- Department of Computer Engineering, Faculty of Technology, Gazi University, 06560 Ankara, Turkey;
| | - Mehmet Cem Catalbas
- Department of Electronics and Automation, 1st Organized Industrial Zone Vocational School, Ankara University, 06935 Ankara, Turkey;
| | - Fecir Duran
- Department of Computer Engineering, Faculty of Technology, Gazi University, 06560 Ankara, Turkey;
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Dipaola F, Gatti M, Giaj Levra A, Menè R, Shiffer D, Faccincani R, Raouf Z, Secchi A, Rovere Querini P, Voza A, Badalamenti S, Solbiati M, Costantino G, Savevski V, Furlan R. Multimodal deep learning for COVID-19 prognosis prediction in the emergency department: a bi-centric study. Sci Rep 2023; 13:10868. [PMID: 37407595 DOI: 10.1038/s41598-023-37512-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/22/2023] [Indexed: 07/07/2023] Open
Abstract
Predicting clinical deterioration in COVID-19 patients remains a challenging task in the Emergency Department (ED). To address this aim, we developed an artificial neural network using textual (e.g. patient history) and tabular (e.g. laboratory values) data from ED electronic medical reports. The predicted outcomes were 30-day mortality and ICU admission. We included consecutive patients from Humanitas Research Hospital and San Raffaele Hospital in the Milan area between February 20 and May 5, 2020. We included 1296 COVID-19 patients. Textual predictors consisted of patient history, physical exam, and radiological reports. Tabular predictors included age, creatinine, C-reactive protein, hemoglobin, and platelet count. TensorFlow tabular-textual model performance indices were compared to those of models implementing only tabular data. For 30-day mortality, the combined model yielded slightly better performances than the tabular fastai and XGBoost models, with AUC 0.87 ± 0.02, F1 score 0.62 ± 0.10 and an MCC 0.52 ± 0.04 (p < 0.32). As for ICU admission, the combined model MCC was superior (p < 0.024) to the tabular models. Our results suggest that a combined textual and tabular model can effectively predict COVID-19 prognosis which may assist ED physicians in their decision-making process.
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Affiliation(s)
- Franca Dipaola
- Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas Research Hospital, Humanitas University, Via A. Manzoni, 56, 20089, Rozzano, Milan, Italy
| | | | - Alessandro Giaj Levra
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Roberto Menè
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | - Dana Shiffer
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Italy
| | - Roberto Faccincani
- Emergency Department, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Zainab Raouf
- IRCCS-Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | - Antonio Secchi
- IRCCS-Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Italy
- Emergency Department, IRCCS - Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Italy
| | - Salvatore Badalamenti
- Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas Research Hospital, Humanitas University, Via A. Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Monica Solbiati
- Emergency Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy
| | - Giorgio Costantino
- Emergency Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy
| | - Victor Savevski
- AI Center, IRCCS - Humanitas Research Hospital, Via Manzoni 56, Rozzano, Italy
| | - Raffaello Furlan
- Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas Research Hospital, Humanitas University, Via A. Manzoni, 56, 20089, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Italy.
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Alharbi AA, Alqassim AY, Muaddi MA, Alghamdi SS. Regional Differences in COVID-19 Mortality Rates in the Kingdom of Saudi Arabia: A Simulation of the New Model of Care. Cureus 2021; 13:e20797. [PMID: 34987945 PMCID: PMC8716006 DOI: 10.7759/cureus.20797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 12/23/2022] Open
Abstract
Background This study aimed to assess regional COVID-19 mortality rates and compare the five proposed business units (BUs). Methods A cross-sectional study was conducted in the Ministry of Health (MOH) hospitals in the Kingdom of Saudi Arabia (KSA). We included 1743 adults (≥ 18 years of age) with COVID-19 admitted to any of 30 MOH hospitals. Results The inpatients had confirmed mild to severe COVID-19 between March and mid-July 2020. The central BU (Riyadh) was used as the reference. MOH electronic health record data were reviewed and utilized, including variables reflecting hospital course (mortality and discharge status). The primary outcome was COVID-19-related inpatient death. Covariates included patient demographics, pre-existing chronic diseases, and COVID-19-related complications. The data were analysed using univariate and multivariate logistic regression. KSA inpatient mortality was 30%. Univariate and multivariate logistic regression analysis suggested that COVID-19-related mortality was significantly higher in the northern and western BUs and significantly lower in the southern and eastern BUs than in the central BU. On controlling for other variables, adjusted odds ratios (AORs) for essential COVID-19 mortality predictors during admission, using the central BU as a reference, were as 9.90 [95% CI, 4.53-21.61] and 1.55 [95% CI, 1.04-2.13] times higher in the northern and western BUs, respectively, and 0.60 [95% CI, 0.36-0.99] and 0.23 [95% CI, 0.14-0.038] times lower in the southern and eastern BUs, respectively. Conclusion The five BUs differed in COVID-19 mortality rates after adjusting for patient and disease characteristics, with the differences consistent with those in the regions comprising the BUs. These outcome differences apparently relate to differences in healthcare resources and quality.
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Affiliation(s)
- Abdullah A Alharbi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Ahmad Y Alqassim
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Mohammed A Muaddi
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Saleh S Alghamdi
- Clinical Audit General Directorate, Ministry of Health, Riyadh, SAU
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Cobre ADF, Stremel DP, Noleto GR, Fachi MM, Surek M, Wiens A, Tonin FS, Pontarolo R. Diagnosis and prediction of COVID-19 severity: can biochemical tests and machine learning be used as prognostic indicators? Comput Biol Med 2021; 134:104531. [PMID: 34091385 PMCID: PMC8164361 DOI: 10.1016/j.compbiomed.2021.104531] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study aimed to implement and evaluate machine learning based-models to predict COVID-19' diagnosis and disease severity. METHODS COVID-19 test samples (positive or negative results) from patients who attended a single hospital were evaluated. Patients diagnosed with COVID-19 were categorised according to the severity of the disease. Data were submitted to exploratory analysis (principal component analysis, PCA) to detect outlier samples, recognise patterns, and identify important variables. Based on patients' laboratory tests results, machine learning models were implemented to predict disease positivity and severity. Artificial neural networks (ANN), decision trees (DT), partial least squares discriminant analysis (PLS-DA), and K nearest neighbour algorithm (KNN) models were used. The four models were validated based on the accuracy (area under the ROC curve). RESULTS The first subset of data had 5,643 patient samples (5,086 negatives and 557 positives for COVID-19). The second subset included 557 COVID-19 positive patients. The ANN, DT, PLS-DA, and KNN models allowed the classification of negative and positive samples with >84% accuracy. It was also possible to classify patients with severe and non-severe disease with an accuracy >86%. The following were associated with the prediction of COVID-19 diagnosis and severity: hyperferritinaemia, hypocalcaemia, pulmonary hypoxia, hypoxemia, metabolic and respiratory acidosis, low urinary pH, and high levels of lactate dehydrogenase. CONCLUSION Our analysis shows that all the models could assist in the diagnosis and prediction of COVID-19 severity.
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Affiliation(s)
| | - Dile Pontarolo Stremel
- Department of Forest Engineering and Technology, Universidade Federal Do Paraná, Curitiba, Brazil
| | | | - Mariana Millan Fachi
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal Do Paraná, Curitiba, Brazil
| | - Monica Surek
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal Do Paraná, Curitiba, Brazil
| | - Astrid Wiens
- Department of Pharmacy, Universidade Federal Do Paraná, Curitiba, Brazil
| | - Fernanda Stumpf Tonin
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal Do Paraná, Curitiba, Brazil
| | - Roberto Pontarolo
- Department of Pharmacy, Universidade Federal Do Paraná, Curitiba, Brazil,Corresponding author
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