Addressing COVID-19 Communication and Management by a Systems Thinking Approach

A systemic stock-flow diagram is proposed for the communication and management of health services and strategies concerning the COVID-19 epidemic. The possible role of government interventions in activating systemic leverage points is also addressed. The presented approach, based on Systems Thinking, can create the basis for creating an analytical simulator of the disease spread, and at the same time the diagram can constitute a powerful tool for improving the quality of information for both policy-makers and the general public in situations of epidemics

A qualitative study on family carers views on how end-of-life communication contributes to palliative oriented care in nursing home.

Background. Although family-centered communication about end-of-life care has been recognized to promote palliative-oriented care in nursing home (NH), how this communication may work is still unknown. Therefore, we explored the mechanisms by which end-of-life communication may contribute to palliative-oriented care in NH from the perspective of bereaved family carers.Methods. A descriptive qualitative design was performed. Interviews were conducted with 32 bereaved family carers whose relative had died between 45 days to 9 months prior from 13 different NHs. A two-steps analysis process firstly with deductive and then with inductive content analysis was adopted.Results. Four mechanisms by which end-of-life communication contributed to palliative-oriented care were identified: a) promoting family carers understanding about their relative's health conditions, prognosis, and treatments available; b) fostering shared decision-making between healthcare professionals and residents/family carers; c) improving knowledge of residents' preferences; and d) improving knowledge of family carers' preferences.Conclusion. Clear and in-depth communication provides insight into residents' and family carers' preferences for care and treatment at the end-of-life, and increases understanding and shared decision-making

Quality improvement interventions to prevent the use of hospital services among nursing home residents: protocol for a systematic review and meta-analysis

Introduction: Quality improvement interventions are a promising strategy for reducing hospital services use among nursing home residents. However, evidence for their effectiveness is limited. It is unclear which characteristics of the quality improvement intervention and activities planned to facilitate implementation may promote fidelity to organisational and system changes. This systematic review and meta-analysis will assess the effectiveness of quality improvement interventions and implementation strategies aimed at reducing hospital services use among nursing home residents. Methods and analysis: The MEDLINE, CINAHL, Cochrane Library, Embase and Web of Science databases will be comprehensively searched in September 2023. The eligible studies should focus on the implementation of a quality improvement intervention defined as the systematic, continuous approach that designs, tests and implements changes using real-time measurement to reduce hospitalisations or emergency department visits among long-stay nursing home residents. Quality improvement details and implementation strategies will be deductively categorised into effective practice and organisation of care taxonomy domains for delivery arrangements and implementation strategies. Quality and bias assessments will be completed using the Quality Improvement Minimum Quality Criteria Set and the Joanna Briggs Institute Critical Appraisal Tools.The results will be pooled in a meta-analysis, by combining the natural logarithms of the rate ratios across the studies or by calculating the rate ratio using the generic inverse-variance method. Heterogeneity will be assessed using the I2 or H2 statistics if the number of included studies will be less than 10. Raw data will be requested from the authors, as required. Ethics and dissemination: Ethical approval is not required. The results will be published in a peer-review journal and presented at (inter)national conferences. Prospero registration number: CRD42022364195

Comment on a recent sensitivity analysis of radial base function and multi-layer feed-forward neural network models - Response

Contains fulltext : 112420.pdf (publisher's version ) (Open Access

Applying and validating the PTVA-3 Model at the Aeolian Islands, Italy: assessment of the vulnerability of buildings to tsunamis

The volcanic archipelago of the Aeolian Islands (Sicily, Italy) is included on the UNESCO World Heritage list and is visited by more than 200 000 tourists per year. Due to its geological characteristics, the risk related to volcanic and seismic activity is particularly high. Since 1916 the archipelago has been hit by eight local tsunamis. The most recent and intense of these events happened on 30 December 2002. It was triggered by two successive landslides along the north-western side of the Stromboli volcano (Sciara del Fuoco), which poured approximately 2–3×10<sup>7</sup> m<sup>3</sup> of rocks and debris into the Tyrrhenian Sea. The waves impacted across the whole archipelago, but most of the damage to buildings and infrastructures occurred on the islands of Stromboli (maximum run-up 11 m) and Panarea. <br><br> The aim of this study is to assess the vulnerability of buildings to damage from tsunamis located within the same area inundated by the 2002 event. The assessment is carried out by using the PTVA-3 Model (Papathoma Tsunami Vulnerability Assessment, version 3). The PTVA-3 Model calculates a Relative Vulnerability Index (RVI) for every building, based on a set of selected physical and structural attributes. Run-up values within the area inundated by the 2002 tsunami were measured and mapped by the Istituto Italiano di Geofisica e Vulcanologia (INGV) and the University of Bologna during field surveys in January 2003. Results of the assessment show that if the same tsunami were to occur today, 54 buildings would be affected in Stromboli, and 5 in Panarea. The overall vulnerability level obtained in this analysis for Stromboli and Panarea are "average"/"low" and "very low", respectively. Nonetheless, 14 buildings in Stromboli are classified as having a "high" or "average" vulnerability. For some buildings, we were able to validate the RVI scores calculated by the PTVA-3 Model through a qualitative comparison with photographs taken by INGV and the University of Bologna during the post-tsunami survey. With the exception of a single structure, which is partially covered by a coastal dune on the seaward side, we found a good degree of accuracy between the PTVA-3 Model forecast assessments and the actual degree of damage experienced by buildings. This validation of the model increases our confidence in its predictive capability. Given the high tsunami risk for the archipelago, our results provide a framework for prioritising investments in prevention measures and addressing the most relevant vulnerability issues of the built environment, particularly on the island of Stromboli