Associations between the COVID-19 Pandemic and Hospital Infrastructure Adaptation and Planning—A Scoping Review

Leite

et al. 2022

IJERPH

Objective: To analyze COVID-19 deaths in public hospitals in a Brazilian state, stratified by the three waves of the pandemic, and to test their association with socio-clinical variables. Methods: Observational analytical study, where 5436 deaths by COVID-19 occurred in hospitals of the public network of Espírito Santo, between 1 April 2020, and 31 August 2021, stratified by the three waves of the pandemic, were analyzed. For the bivariate analyses, the Pearson’s chi-square, Fisher’s Exact or Friedman’s tests were performed depending on the Gaussian or non-Gaussian distribution of the data. For the relationship between time from diagnosis to death in each wave, quantile regression was used, and multinomial regression for multiple analyses. Results: The mean time between diagnosis and death was 18.5 days in the first wave, 20.5 days in the second wave, and 21.4 days in the third wave. In the first wave, deaths in public hospitals were associated with the following variables: immunodeficiency, obesity, neoplasia, and origin. In the second wave, deaths were associated with education, O2 saturation < 95%, chronic neurological disease, and origin. In the third wave, deaths were associated with race/color, education, difficulty breathing, nasal or conjunctival congestion, irritability or confusion, adynamia or weakness, chronic cardiovascular disease, neoplasms, and diabetes mellitus. Origin was associated with the outcome in the three waves of the pandemic, in the same way that education was in the second and third waves (p < 0.05). Conclusion: The time interval between diagnosis and death can be impacted by several factors, such as: plasticity of the health system, improved clinical management of patients, and the start of vaccination at the end of January 2021, which covered the age group with the higher incidence of deaths. The deaths occurring in public hospitals were associated with socio-clinical characteristics.

Section: Discussionmentioning

confidence: 99%

COVID-19 Mortality in Public Hospitals in a Brazilian State: An Analysis of the Three Waves of the Pandemic

Leite

et al. 2022

IJERPH

“…We found that DHTs allowed them to provide a wide variety of services, from diagnosis to treatment and palliative care, as well as preventative and vaccine drives. In addition, DHTs were utilised to increase the number of non-COVID-19 consultations and referrals to secondary care [9,66] that would have been otherwise dismissed due to COVID-19's early responses, such as cancelling non-urgent treatment, implementing lockdowns, and so on.…”

Section: Dhts To Ensure Continued Phc Delivery During Covid-19mentioning

confidence: 99%

“…The response to the Sars-Cov-2 pandemic, also known as COVID-19 [6], revealed missed opportunities to provide PHC to all. Many health-care services have been postponed in many countries in order to focus on COVID-19 patients [7][8][9]. Other reports show how health systems have faced compounding weaknesses in delivering PHC during COVID-19 [10], including underfunding and postponing some care services.…”

Section: Introductionmentioning

confidence: 99%

A systematic scoping review of digital health technologies during COVID-19: a new normal in primary health care delivery

2023

Self Cite

This scoping review compiled information concerning digital health technologies (DHTs) evolution to support primary health care (PHC) during COVID-19 and lessons for the future of PHC. The identified literature was published during the COVID-19 peak years (2019–2021), retrieved from PubMed, Scopus, and Google Scholar, as well as hand searched on the internet. Predefined inclusion criteria were used, thematic analysis was applied, and reporting followed the PRISMA for Scoping Reviews.A total of 46 studies were included in the final synthesis (40 articles, one book, two book chapters, one working paper, and two technical reports). These studies scrutinized various aspects of DHTs, entailing 19 types of DHTs with 20 areas of use that can be compressed into five bigger PHC functions: general PHC service delivery (teleconsultations, e-diagnosis, e-prescription, etc.); behavior promotion and digital health literacy (e.g., combating vaccine hesitancy); surveillance functions; vaccination and drugs; and enhancing system decision-making for proper follow-up of ongoing PHC interventions during COVID-19.DHTs have the potential to solve some of the problems that have plagued us even prior to COVID-19. Therefore, this study uses a forward-looking viewpoint to further stimulate the use of evidence-based DHT, making it more inclusive, educative, and satisfying to people’s needs, both under normal conditions and during outbreaks. More research with narrowed research questions is needed, with a particular emphasis on quality assurance in the use of DHTs, technical aspects (standards for digital health tools, infrastructure, and platforms), and financial perspectives (payment for digital health services and adoption incentives).

“…In different countries, different approaches have been used for treating COVID-19 patients; entire buildings were converted into fully functioning hospitals, full hospitals or only parts of some hospitals were designated for treating COVID patients, or completely new COVID-19 hospitals were built [ 9 , 10 , 11 ]. In Serbia, different places for the healthcare of COVID-19 patients were also used.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Risk Factors for Clostridioides difficile Infections in Non-COVID and COVID-19 Patients: Experience from a Tertiary Care Hospital

et al. 2023

(1) Background: The aim of this study was to assess the incidence and the risk factors for healthcare-associated Clostridioides difficile infection (HA-CDI) in patients with COVID-19 and without this infection. (2) Methods: A single-center, prospective observational study was conducted at the University Clinical Hospital Center in Belgrade, Serbia, from January 2019 to December 2021. The entire hospital was a COVID-dedicated hospital for 12 months during the study period. The incidence density rates and risk factors for HA-CDI in patients with and without COVID-19 are presented. (3) Results: The incidence rates of HA-CDIs were three times higher in patients with COVID-19. The HA-CDI–COVID-patients were younger (69.9 ± 12.6 vs. 72.5 ± 11.6; p = 0.017), admitted from another hospital (20.5% vs. 2.9; p < 0.001), had antimicrobial therapy before CDI (99.1% vs. 91.3%, p < 0.001), received two or more antibiotics (p = 0.030) during a longer period (p = 0.035), received proton pump inhibitors (95.9% vs. 50.0%, p < 0.001) during a longer period (p = 0.012) and steroids (32.8% vs. 20.4%, p < 0.001). During the last month before their current hospitalization, a higher percentage of patients without COVID-19 disease were hospitalized in our hospital (p < 0.001). Independent predictors for HA-CDIs in patients with COVID-19 were admission from another hospital (p = 0.003), the length of antibiotic administration (0.020), and the use of steroids in therapy (p < 0.001). The HA-CDI predictors in the non-COVID patients were older age (p = 0.017), advanced-stage renal failure (p = 0.005), chemotherapy (p = 0.003), and a low albumin level (0.005). (4) Conclusion: Higher incidence rates of HAI-CDIs in COVID-19 patients did not occur due to reduced infection control precautions and hygiene measures but due to antibiotic therapy and therapy with other drugs used during the pandemic.