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Автор: Grafiati

Опубліковано: 4 червня 2021

Оновлено: 19 лютого 2022

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Статті в журналах з теми "321215 Health Care Administration":

MacMillan, Carllene B. "Health Care Administration." AORN Journal 63, no. 3 (March 1996): 636. http://dx.doi.org/10.1016/s0001-2092(06)63407-8.

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Levey, Samuel, and N. Paul Loomba. "Health Care Administration." Health Care Management Review 10, no. 3 (January 1985): 92. http://dx.doi.org/10.1097/00004010-198501030-00018.

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Wolper, Lawrence F. "Health Care Administration." Journal For Healthcare Quality 19, no. 4 (July 1997): 34. http://dx.doi.org/10.1097/01445442-199707000-00009.

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Editorial Submission, Haworth. "HEALTH CARE FINANCING ADMINISTRATION." Health Care on the Internet 4, no. 1 (January 1, 2000): 88–89. http://dx.doi.org/10.1300/j138v04n01_15.

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Stacey, James. "The Health Care Financing Administration." JAMA: The Journal of the American Medical Association 258, no. 6 (August 14, 1987): 822. http://dx.doi.org/10.1001/jama.1987.03400060098038.

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Stacey, J. "The Health Care Financing Administration." JAMA: The Journal of the American Medical Association 258, no. 6 (August 14, 1987): 822. http://dx.doi.org/10.1001/jama.258.6.822.

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Alexander, Rinda. "Handbook of Home Health Care Administration." Journal of Gerontological Nursing 21, no. 5 (May 1, 1995): 45–46. http://dx.doi.org/10.3928/0098-9134-19950501-11.

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Wilensky, Gail R. "From the Health Care Financing Administration." JAMA: The Journal of the American Medical Association 266, no. 19 (November 20, 1991): 2677. http://dx.doi.org/10.1001/jama.1991.03470190023009.

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Fife, Patricia. "Health Care and the New Administration." AJN, American Journal of Nursing 117, no. 5 (May 2017): 10. http://dx.doi.org/10.1097/01.naj.0000516251.38817.fc.

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Jones, Kendell. "Health Care and the New Administration." AJN, American Journal of Nursing 117, no. 5 (May 2017): 10. http://dx.doi.org/10.1097/01.naj.0000516252.46440.d6.

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Дисертації з теми "321215 Health Care Administration":

Kerr, Karolyn. "The institutionalisation of data quality in the New Zealand health sector." Thesis, University of Auckland, 2006. http://hdl.handle.net/2292/1899.

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This research began a journey towards improved maturity around data quality management in New Zealand health care, where total data quality management is 'business as usual" institutionalised into the daily practices of all those who work in health care. The increasingly information intensive nature of health care demands a proactive and strategic approach to data quality to ensure the right information is available to the right person at the right time in the right format, all in consideration of the rights of the patient to have his/her health data protected and used in an ethical way. The work extends and tests principles to establish good practice and overcome practical barriers. This thesis explores the issues that define and control data quality in the national health data collections and the mechanisms and frameworks that can be developed to achieve and sustain good data quality. The research is interpretive, studying meaning within a social setting. The research provides the structure for learning and potential change through the utilisation of action research. Grounded theory provides the structure for the analysis of qualitative data through inductive coding and constant comparison in the analysis phase of the action research iterative cycle. Participatory observation provided considerable rich data as the researcher was a member of staff within the organisation. Data were also collected at workshops, focus groups, structured meetings and interviews. The development of a Data Quality Evaluation Framework and a national Data quality Improvement Strategy provides clear direction for a holistic and 'whole of health sector' way of viewing data quality, with the ability for organisations to develop and implement local innovations through locally developed strategies and data quality improvement programmes. The researcher utilised the theory of appreciative enquiry (Fry, 2002) to positively encourage change, and to encourage the utilisation of existing organisational knowledge. Simple rules, such as the TDQM process and the data quality dimensions guided the change, leaving room for innovation. The theory of 'complex systems of adjustment' (Champagne, 2002; Stacey, 1993) can be instilled in the organisation to encourage change through the constant interaction of people throughout the organisation.

Donato, Francis A. "Reforming health care through managed care." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1995. http://www.kutztown.edu/library/services/remote_access.asp.

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Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1995.
Source: Masters Abstracts International, Volume: 45-06, page: 2939. Abstract precedes thesis as [1] preliminary leaf. Typescript. Includes bibliographical references (leaves 91-92).

Holmberg, Leif. "Health-care processes a study of medical problem-solving in the Swedish health-care organization /." Lund : Lund University Press, 1997. http://books.google.com/books?id=1jNrAAAAMAAJ.

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Catena, Rodolfo. "Essays on health care operations management." Thesis, University of Oxford, 2015. http://ora.ox.ac.uk/objects/uuid:3c2035a6-b5d0-43b7-9b12-4883e5db4526.

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The aim of operations management in health care is to enhance the provision of services to patients and to decrease costs. Overall worldwide health care expenditures represent around 10.5% of the global GDP and are projected to increase at an annual rate of 5.3% from 2015 to 2017 [74]. In order to investigate how to curb health care costs, I study the English NHS, a health care system that provided universal care to around 54 million people in 2014 [243]. The NHS has launched many initiatives to improve the performance of hospital operations such as the "QIPP" program, which has the objective to save £20 billion of costs by 2015 [98]. Given this framework, this research aims to contribute to the theory that is guiding these operational changes, using data on all admissions to hospitals and focussing on the inguinal hernia, one of the most common surgical procedures [86]. In the next chapters, this research describes inguinal hernia care delivery in the English NHS, examines the impact of spillovers and complementarities on costs, and investigates the effects of length of stay reduction on risk of re-admission and risk of death. The findings of this thesis indicate that one of the possible problems in the delivery of inguinal hernia care in the NHS is the decrease in the number of elective operations performed and the increase in readmission rates. They also clarify how decisions on allocation of resources can affect hospital expenditures by showing that loss in focus can increase health care costs and by pointing out that there is little evidence to support the theory of spillovers and complementarities in the surgical context. Finally, the results of this research can be used to suggest the logic of a policy to decrease length of stay that can inform hospital decisions and can decrease hospital costs.

Phelps, John Clayton. "Health Care Leaders' Strategies to Reduce Nursing Turnover." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7326.

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Health care leaders who lack effective nurse turnover strategies can negatively affect patient quality of care, productivity, and profitability. The purpose of this single case study was to explore strategies health care leaders used to reduce nursing turnover in a health care organization. The conceptual framework for this study was Herzberg's 2-factor theory. Data were collected from semistructured interviews with 4 health care leaders in the West Texas region who had a history of reducing nurse turnover for a minimum of 5 years from the date of hire, and from review of organizational documents related to the strategies to reduce nurse turnover, including policy handbooks and annual reports. Data were analyzed using word frequency and coding to distinguish patterns. Three key themes emerged: leadership support, job satisfaction, and compensation. The results of this study might contribute to social change through an increased understanding of nurse turnover strategies that would improve productivity and the overall quality of patient care to yield organizational success, decreased mortality rates, and improved community health.

Marti-Morales, Madeline. "Care coordination, family-centered care and functional ability in children with special health care needs in the United States." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/870.

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Children with special health care needs (CSHCN) generally have physical, mental, or emotional conditions that require a broader range and greater quantity of health and related services compared to typical children. Care coordination (CC) and family-centered care (FCC) are necessary in the quality of health care for CSHCN. A gap exists in the literature regarding the impact of CC and FCC on children's functional ability (FA). Previous researchers have focused on met and unmet health care needs, but not on health outcomes or functionality. The purpose of this study was to determine if there was an association between CC, FCC, and FA in CSHCN. The design of this study was a secondary analysis of data from the 2005--2006 National Survey of CSHCN. The study was guided by an adapted socioecological multilevel conceptual framework. Statistical methods included univariate, bivariate, and multiple logistic regression analysis. Results indicated that CC was associated with FA in CSHCN. CSHCN that did not receive CC had a 53% increased risk (OR =1.53, 95%CI 1.21--1.94, p < 0.001) for a limitation in FA compared to CSHCN that received CC, controlling for age, gender, number of conditions, household poverty level, parental educational level, and health insurance. FCC was not associated with a limitation in FA in CSHCN ( p = 0.61). Findings from this study were consistent with the socioecological multilevel framework and the literature on care coordination. This study contributed to positive social change by providing information that can be used by public health officials, health care providers and policy makers in developing policies to assure that care coordination is provided to CSHCN and their families in order to improve their health outcomes and functionality.

Haque, Rezwan. "Organizational Innovation in Health Care." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17463146.

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This dissertation investigates whether differences in organizational innovation amongst health care providers can explain the huge variation in costs and outcomes. I specifically consider two facets of organizational innovation: the deployment of information technology and the relationships between hospitals and physicians. In the first chapter, I investigate IT adoption in a service setting by considering the impact of electronic medical records (EMRs) on the length of stay and clinical outcomes of patients in US hospitals. To uncover the distinct impacts of EMRs on operational efficiency and care coordination, I present evidence of heterogeneous effects by patient complexity. I find that EMRs have the largest impact for relatively less complex patients. Admission to a hospital with an EMR is associated with a 2\% reduction in length of stay and a 9\% reduction in thirty-day mortality for such patients. In contrast, there is no statistically significant benefit for more complex patients. However, I present three additional results for complex cases. First, patients returning to the same hospital benefit relative to those who previously went to a different hospital, which could be due to easier access to past electronic records. Second, computerized order entry is associated with higher billed charges. Finally, hospitals that have a high share of publicly insured patients, and hence a bigger incentive to curb resource use, achieve a greater reduction in length of stay for complex patients after EMR adoption. In the second chapter, co-authored with Robert Huckman, I investigate the role of process specialists in guiding customers through such complex service transactions by considering the management of patients admitted to U.S hospitals. Traditionally, a patient's primary care physician has been in charge of his or her hospital admission. Over the past decade, however, there has been a steady rise in the use of hospitalists - physicians who spend all their professional time at the hospital - in managing inpatient care. Using data from the American Hospital Association and the Agency for Healthcare Research and Quality's Nationwide Inpatient Sample (NIS) database, we find that hospitals with hospitalist programs achieve reductions in the risk-adjusted length of stay of inpatients over the time period 2003 to 2010. The effect is strongest for complex patients who have a higher number of comorbidities. Our findings support the view that process specialists such as hospitalists are particularly beneficial for complex transactions that entail a greater degree of coordination. In the final chapter, I document the positive relationship between consolidation in the health care industry and technology adoption. I propose several mechanisms that could explain the association between the adoption of electronic medical records and greater hospital-physician integration. I show that the positive correlation between technology adoption and hospital consolidation has been increasing over time. I show that hospitals located in concentrated markets are more likely to adopt electronic medical records and to use hospitalists. Moreover, for a limited set of hospitals, the quality of management is positively associated with the adoption of electronic medical records and the use of hospitalists.
Business Economics

Robisnon, Brenda Joyce. "Is there an Association between Non-VA Medical Care Coordination and Utilization of Care?" ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2376.

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The Non-Veteran Administration Care (NVC) is a program in which the Veterans Health Administration purchases health care when it cannot provide the health services needed for eligible Veterans. The rising cost of this program led to audits by the Office of the Inspector General and other entities. The scholarly problem for this DNP Project was the lack of oversight, accountability, and management, found throughout the audits of NVC, as well as a lack of evaluation of NVC. The purpose of this project was to ascertain if there was a relationship between the Non-VA Care Coordination program (NVCC) and utilization of care. The NVCC was implemented to eliminate the deficiencies cited by audits. Sleep study and chiropractic consults for FY 2013 (pre-NVCC) and FY 2014 (post-NVCC) were examined. Sleep apnea service was available at the local Veteran Administration Medical Center and chiropractic service was not. Utilization of care was determined by emergency room (ER) visits and admissions related to the consult. A logic model was used to conceptualize the project and the longer-term implementation and evaluation of NVCC, and descriptive statistics were used to analyze trends in the chiropractic data (sleep study consults were excluded from the analysis due to the minute number). There were a total of 859 chiropractic consults and 2,184 approved visits analyzed. The results revealed that Veterans who utilized the consults had no ER visits or admissions related to referrals for chiropractic consults. Completed chiropractic consults remained proportionality the same both years. NVCC had no association with the utilization of care. This scholarly project contributes to social change by empowering consumers and providing transparency in the government through audits that facilitate quality improvement and evaluation of the NVCC program.

Gaikwad, Neha Kiran. "Easy care home health agency -- Business plan." Thesis, California State University, Long Beach, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10118894.

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Home health care has become a popular long term care option as most seniors prefer to age and heal in the comfort of their homes and among their loved ones. With the advent of the Affordable Care Act (ACA) and a rise in baby boomers, home health care has become an integral part of the health care delivery system. Additionally, these have led to an increased demand for Home Health Agencies - HHA’s, and created a good market for the home health business. The following business plan is developed for the establishment of a Home Health Agency, in Long Beach, California. Chapter 1 Market analysis discusses the market structure and potential for the Home health business and analysis of the company, customers, and competitors. It also presents the marketing strategies, goals and objectives. Chapter 2 Feasibility and SWOT Analysis explains the operational feasibility and financial viability of the business plan. This chapter also explores the strengths and weaknesses of the business, opportunities for the business and threats to the business. Chapter 3 Legal and Regulatory issues, describes various legal aspects and regulatory requirements in a home health agency business. Chapter 4 Financial Analysis, gives detailed explanation of the financial plan and structure for the business like costs, expenses, budget and compensation.

Hale-Hanes, Heidi A. "Hand In Hand Home Health Care." Thesis, California State University, Long Beach, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10164122.

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The need for home health care is a growing need in the United States due to the shift of the “baby-boomers” into the post retirement years. However, there is a growing niche market within this aging population: the lesbian, gay, bisexual and transgendered (LGBT) elders who have lived their adult lives “out of the closet” and who are facing difficulty receiving care which is compassionate and culturally sensitive at the same time. The mission of Hand-In-Hand Home Health Care is to provide exceptional home health care with a team of professionals that provide patient-centered care which is culturally sensitive and compassionate, achieved with employee training developed by SAGE (Services & Advocacy for GLBT Elders). Hand-In-Hand Home Health Care will achieve economic viability within the first year through optimal cash flow management with Axxess client software and the initial capital assistance with a 7a Small Business Loan.

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Книги з теми "321215 Health Care Administration":

Schulmerich, Susan Craig. Home health care administration. Albany, N.Y: Delmar Publishers, 1996.

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Hodgetts, Richard M. Modern health care administration. 2nd ed. Madison, Wis: Brown & Benchmark, 1993.

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Accountability, Florida Office of Program Policy Analysis and Government. Health Care Regulation Program, Agency for Health Care Administration. Tallahassee, FL: Office of Program Policy Analysis and Government Accountability, 2001.

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Horowitz, Marcia. Health care management. New York: Ferguson Pub., 2010.

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Horowitz, Marcia. Health care management. New York: Ferguson, 2009.

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Horowitz, Marcia. Health care management. New York: Ferguson, 2010.

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Wheeler, Neil. Management in health care. Cheltenham, Glos: Stanley Thornes, 2000.

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Davis, Winborn E. Introduction to health care administration. 4th ed. Bossier City, LA: Publicare Press, 1985.

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Davis, Winborn E. Introduction to health care administration. 3rd ed. Bossier City, LA: Publicare Press ; La Grange, Tex. (P.O. Box 268, La Grange 78945-0268) : Distributed by M. & H. Pub. Co., 1991.

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Barr, Jill. Leadership in health care. 2nd ed. Los Angeles: SAGE, 2012.

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Частини книг з теми "321215 Health Care Administration":

Balogun, Joseph A. "Administration of health care education departments." In Health Care Education in Nigeria, 74–86. Abingdon, Oxon ; New York, NY : Routledge, 2021.: Routledge, 2020. http://dx.doi.org/10.4324/9781003127529-4.

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Grieves, Marion. "Drug Usage: Legislation and Administration." In Foundations of Health and Social Care, 174–83. London: Macmillan Education UK, 2007. http://dx.doi.org/10.1007/978-0-230-22933-4_18.

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Moini, Jahangir, and Morvarid Moini. "Occupational Safety and Health Administration (OSHA) standards." In Fundamentals of U.S. Health Care, 303–34. Abingdon, Oxon; New York, NY: Routledge, 2017.: Routledge, 2017. http://dx.doi.org/10.4324/9781315620374-13.

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Chen, Ke. "Health-Care Policy in America." In Global Encyclopedia of Public Administration, Public Policy, and Governance, 1–8. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-31816-5_2850-1.

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Chen, Ke. "Health-Care Policy in America." In Global Encyclopedia of Public Administration, Public Policy, and Governance, 3034–41. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-20928-9_2850.

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Callaghan, Karen A. "Establishing Community-Based Primary Health Care." In International Perspectives on Social Policy, Administration, and Practice, 23–38. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-24654-9_3.

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Lyons, Judith A. "Veterans Health Administration: Reducing barriers to access." In Rural behavioral health care: An interdisciplinary guide., 217–29. Washington: American Psychological Association, 2003. http://dx.doi.org/10.1037/10489-017.

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Wellington, Heather. "Legal Medicine in the Administration of Health Care." In Textbook of Medical Administration and Leadership, 71–98. Singapore: Springer Singapore, 2018. http://dx.doi.org/10.1007/978-981-10-5454-9_6.

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Loh, Erwin. "Legal Medicine in the Administration of Health Care." In Legal and Forensic Medicine, 197–222. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013. http://dx.doi.org/10.1007/978-3-642-32338-6_24.

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Schumaker, Bernadette. "Funding of Transplantation The Health Care Financing Administration." In Pediatric Brain Death and Organ/Tissue Retrieval, 319–23. Boston, MA: Springer US, 1989. http://dx.doi.org/10.1007/978-1-4684-5532-8_33.

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Тези доповідей конференцій з теми "321215 Health Care Administration":

Lv, Q., Y. Jiang, J. Qi, Y. Zhang, X. Zhang, Z. Liao, Z. Lin, and J. Gu. "AB1278 Mobile device-aided health care: administration of new health care in china." In Annual European Congress of Rheumatology, EULAR 2018, Amsterdam, 13–16 June 2018. BMJ Publishing Group Ltd and European League Against Rheumatism, 2018. http://dx.doi.org/10.1136/annrheumdis-2018-eular.3499.

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Lu, C., and R. Fenske. "274. Salivary Excretion of the Herbicide, Atrazine, After Oral Administration in Rats." In AIHce 1996 - Health Care Industries Papers. AIHA, 1999. http://dx.doi.org/10.3320/1.2764944.

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Roh, J., Y. Ahn, H. Kim, and C. Kim. "400. Urinary Excretion of Benzedine and Its Metabolites in Rats after Oral Administration of Direct Black 38 and Benzidine." In AIHce 1996 - Health Care Industries Papers. AIHA, 1999. http://dx.doi.org/10.3320/1.2765081.

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Campbell, Catherine, Avi Parush, Thomas Ellis, Jacqueline Garvey, Régis Vaillancourt, and Daniel Lebreux. "Addressing Risk Factors in Morphine Administration: A Collaborative Prototyping Approach." In 2012 Symposium on Human Factors and Ergonomics in Health Care. Human Factors and Ergonomics Society, 2012. http://dx.doi.org/10.1518/hcs-2012.945289401.010.

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Collins, A. C., M. Lemma Woldehanna, G. Sese, O. A. Shlobin, C. S. King, K. Ahmad, S. D. Nathan, and A. W. Brown. "Administration of COVID-19 Convalescent Plasma in a Metropolitan Health Care System." In American Thoracic Society 2021 International Conference, May 14-19, 2021 - San Diego, CA. American Thoracic Society, 2021. http://dx.doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2509.

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Alshami, Noura, Amerah NAl Saleh, Amjed Abu Alburak, Regina Manlulu, Saif Al Saif, Mark Anthony Castro, Eden Grace Abainza, et al. "7 Reduce medication administration delay in neonatal intensive care unit." In Patient Safety Forum 2019, Conference Proceedings, Kingdom of Saudi Arabia, Ministry of National Guard Health Affairs. British Medical Journal Publishing Group, 2019. http://dx.doi.org/10.1136/bmjoq-2019-psf.7.

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Taylor, Lesley, Scott D. Wood, and Roger J. Chapman. "Analysis and Mitigation of Reported Informatics Patient Safety Adverse Events at the Veterans Health Administration." In 2012 Symposium on Human Factors and Ergonomics in Health Care. Human Factors and Ergonomics Society, 2012. http://dx.doi.org/10.1518/hcs-2012.945289401.001.

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Zhang, Chen, Hamza Hanchi, and Sebastiaan Meijer. "Evaluating the Effect of Centralized Administration on Health Care Performances Using Discrete-Event Simulation." In 2017 Portland International Conference on Management of Engineering and Technology (PICMET). IEEE, 2017. http://dx.doi.org/10.23919/picmet.2017.8125405.

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Croteau, G., J. Camp, M. Yost, D. Martin, and A. Heald. "3. Evaluation of Exposure and Health Care Worker Response to Nebulized Administration of tgAAVCF to Patients With Cystic Fibrosis." In AIHce 2006. AIHA, 2006. http://dx.doi.org/10.3320/1.2753430.

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Ursini, CL, D. Cavallo, E. Omodeo Salè, AM Fresegna, A. Ciervo, C. Jemos, R. Maiello, et al. "1194 Biomonitoring of health care personnel involved in the preparation and administration of anticancer drugs in three italian hospitals." In 32nd Triennial Congress of the International Commission on Occupational Health (ICOH), Dublin, Ireland, 29th April to 4th May 2018. BMJ Publishing Group Ltd, 2018. http://dx.doi.org/10.1136/oemed-2018-icohabstracts.916.

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Watson, Monte R. Factors Associated with Student Stress in the U.S. Army - Baylor University Graduate Program in Health Care Administration. Fort Belvoir, VA: Defense Technical Information Center, July 1986. http://dx.doi.org/10.21236/ada209758.

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McCurdy, Rodney K. A Comparison of the Audit and Accreditation Tools Used By The Health Care Financing Administration, The Texas Department of Insurance, and The National Committee on Quality Assurance: The Cost of Multi-Agency Oversight on Medicare+Choice Plans in Texas. Fort Belvoir, VA: Defense Technical Information Center, April 2001. http://dx.doi.org/10.21236/ada420956.

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Stall, Nathan M., Kevin A. Brown, Antonina Maltsev, Aaron Jones, Andrew P. Costa, Vanessa Allen, Adalsteinn D. Brown, et al. COVID-19 and Ontario’s Long-Term Care Homes. Ontario COVID-19 Science Advisory Table, January 2021. http://dx.doi.org/10.47326/ocsat.2021.02.07.1.0.

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Key Message Ontario long-term care (LTC) home residents have experienced disproportionately high morbidity and mortality, both from COVID-19 and from the conditions associated with the COVID-19 pandemic. There are several measures that could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes, if implemented. First, temporary staffing could be minimized by improving staff working conditions. Second, homes could be further decrowded by a continued disallowance of three- and four-resident rooms and additional temporary housing for the most crowded homes. Third, the risk of SARS-CoV-2 infection in staff could be minimized by approaches that reduce the risk of transmission in communities with a high burden of COVID-19. Summary Background The Province of Ontario has 626 licensed LTC homes and 77,257 long-stay beds; 58% of homes are privately owned, 24% are non-profit/charitable, 16% are municipal. LTC homes were strongly affected during Ontario’s first and second waves of the COVID-19 pandemic. Questions What do we know about the first and second waves of COVID-19 in Ontario LTC homes? Which risk factors are associated with COVID-19 outbreaks in Ontario LTC homes and the extent and death rates associated with outbreaks? What has been the impact of the COVID-19 pandemic on the general health and wellbeing of LTC residents? How has the existing Ontario evidence on COVID-19 in LTC settings been used to support public health interventions and policy changes in these settings? What are the further measures that could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes? Findings As of January 14, 2021, a total of 3,211 Ontario LTC home residents have died of COVID-19, totaling 60.7% of all 5,289 COVID-19 deaths in Ontario to date. There have now been more cumulative LTC home outbreaks during the second wave as compared with the first wave. The infection and death rates among LTC residents have been lower during the second wave, as compared with the first wave, and a greater number of LTC outbreaks have involved only staff infections. The growth rate of SARS-CoV-2 infections among LTC residents was slower during the first two months of the second wave in September and October 2020, as compared with the first wave. However, the growth rate after the two-month mark is comparatively faster during the second wave. The majority of second wave infections and deaths in LTC homes have occurred between December 1, 2020, and January 14, 2021 (most recent date of data extraction prior to publication). This highlights the recent intensification of the COVID-19 pandemic in LTC homes that has mirrored the recent increase in community transmission of SARS-CoV-2 across Ontario. Evidence from Ontario demonstrates that the risk factors for SARS-CoV-2 outbreaks and subsequent deaths in LTC are distinct from the risk factors for outbreaks and deaths in the community (Figure 1). The most important risk factors for whether a LTC home will experience an outbreak is the daily incidence of SARS-CoV-2 infections in the communities surrounding the home and the occurrence of staff infections. The most important risk factors for the magnitude of an outbreak and the number of resulting resident deaths are older design, chain ownership, and crowding. Figure 1. Anatomy of Outbreaks and Spread of COVID-19 in LTC Homes and Among Residents Figure from Peter Hamilton, personal communication. Many Ontario LTC home residents have experienced severe and potentially irreversible physical, cognitive, psychological, and functional declines as a result of precautionary public health interventions imposed on homes, such as limiting access to general visitors and essential caregivers, resident absences, and group activities. There has also been an increase in the prescribing of psychoactive drugs to Ontario LTC residents. The accumulating evidence on COVID-19 in Ontario’s LTC homes has been leveraged in several ways to support public health interventions and policy during the pandemic. Ontario evidence showed that SARS-CoV-2 infections among LTC staff was associated with subsequent COVID-19 deaths among LTC residents, which motivated a public order to restrict LTC staff from working in more than one LTC home in the first wave. Emerging Ontario evidence on risk factors for LTC home outbreaks and deaths has been incorporated into provincial pandemic surveillance tools. Public health directives now attempt to limit crowding in LTC homes by restricting occupancy to two residents per room. The LTC visitor policy was also revised to designate a maximum of two essential caregivers who can visit residents without time limits, including when a home is experiencing an outbreak. Several further measures could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes. First, temporary staffing could be minimized by improving staff working conditions. Second, the risk of SARS-CoV-2 infection in staff could be minimized by measures that reduce the risk of transmission in communities with a high burden of COVID-19. Third, LTC homes could be further decrowded by a continued disallowance of three- and four-resident rooms and additional temporary housing for the most crowded homes. Other important issues include improved prevention and detection of SARS-CoV-2 infection in LTC staff, enhanced infection prevention and control (IPAC) capacity within the LTC homes, a more balanced and nuanced approach to public health measures and IPAC strategies in LTC homes, strategies to promote vaccine acceptance amongst residents and staff, and further improving data collection on LTC homes, residents, staff, visitors and essential caregivers for the duration of the COVID-19 pandemic. Interpretation Comparisons of the first and second waves of the COVID-19 pandemic in the LTC setting reveal improvement in some but not all epidemiological indicators. Despite this, the second wave is now intensifying within LTC homes and without action we will likely experience a substantial additional loss of life before the widespread administration and time-dependent maximal effectiveness of COVID-19 vaccines. The predictors of outbreaks, the spread of infection, and deaths in Ontario’s LTC homes are well documented and have remained unchanged between the first and the second wave. Some of the evidence on COVID-19 in Ontario’s LTC homes has been effectively leveraged to support public health interventions and policies. Several further measures, if implemented, have the potential to prevent additional LTC home COVID-19 outbreaks and deaths.

Dy, Sydney M., Arjun Gupta, Julie M. Waldfogel, Ritu Sharma, Allen Zhang, Josephine L. Feliciano, Ramy Sedhom, et al. Interventions for Breathlessness in Patients With Advanced Cancer. Agency for Healthcare Research and Quality (AHRQ), November 2020. http://dx.doi.org/10.23970/ahrqepccer232.

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Objectives. To assess benefits and harms of nonpharmacological and pharmacological interventions for breathlessness in adults with advanced cancer. Data sources. We searched PubMed®, Embase®, CINAHL®, ISI Web of Science, and the Cochrane Central Register of Controlled Trials through early May 2020. Review methods. We included randomized controlled trials (RCTs) and observational studies with a comparison group evaluating benefits and/or harms, and cohort studies reporting harms. Two reviewers independently screened search results, serially abstracted data, assessed risk of bias, and graded strength of evidence (SOE) for key outcomes: breathlessness, anxiety, health-related quality of life, and exercise capacity. We performed meta-analyses when possible and calculated standardized mean differences (SMDs). Results. We included 48 RCTs and 2 retrospective cohort studies (4,029 patients). The most commonly reported cancer types were lung cancer and mesothelioma. The baseline level of breathlessness varied in severity. Several nonpharmacological interventions were effective for breathlessness, including fans (SMD -2.09 [95% confidence interval (CI) -3.81 to -0.37]) (SOE: moderate), bilevel ventilation (estimated slope difference -0.58 [95% CI -0.92 to -0.23]), acupressure/reflexology, and multicomponent nonpharmacological interventions (behavioral/psychoeducational combined with activity/rehabilitation and integrative medicine). For pharmacological interventions, opioids were not more effective than placebo (SOE: moderate) for improving breathlessness (SMD -0.14 [95% CI -0.47 to 0.18]) or exercise capacity (SOE: moderate); most studies were of exertional breathlessness. Different doses or routes of administration of opioids did not differ in effectiveness for breathlessness (SOE: low). Anxiolytics were not more effective than placebo for breathlessness (SOE: low). Evidence for other pharmacological interventions was limited. Opioids, bilevel ventilation, and activity/rehabilitation interventions had some harms compared to usual care. Conclusions. Some nonpharmacological interventions, including fans, acupressure/reflexology, multicomponent interventions, and bilevel ventilation, were effective for breathlessness in advanced cancer. Evidence did not support opioids or other pharmacological interventions within the limits of the identified studies. More research is needed on when the benefits of opioids may exceed harms for broader, longer term outcomes related to breathlessness in this population.

Innovative Solutions to Human-Wildlife Conflicts: National Wildlife Research Center Accomplishments, 2010. U.S. Department of Agriculture, Animal and Plant Health Inspection Service, April 2011. http://dx.doi.org/10.32747/2011.7291310.aphis.

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As the research arm of Wildlife Services, a program within the U.S. Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS), NWRC develops methods and information to address human-wildlife conflicts related to agriculture, human health and safety, property damage, invasive species, and threatened and endangered species. The NWRC is the only Federal research facility in the United States devoted entirely to the development of methods for effective wildlife damage management, and it’s research authority comes from the Animal Damage Control Act of 1931. The NWRC’s research priorities are based on nationwide research needs assessments, congressional directives, APHIS Wildlife Services program needs, and stakeholder input. The Center is committed to helping resolve the ever-expanding and changing issues associated with human-wildlife conflict management and remains well positioned to address new issues through proactive efforts and strategic planning activities. NWRC research falls under four principal areas that reflect APHIS’ commitment to “protecting agricultural and natural resources from agricultural animal and plant health threats, zoonotic diseases, invasive species, and wildlife conflicts and diseases”. In addition to the four main research areas, the NWRC maintains support functions related to animal care, administration, information transfer, archives, quality assurance, facility development, and legislative and public affairs.