Supply source – Jops Web http://www.jopsweb.org/ Wed, 06 Oct 2021 13:17:19 +0000 en-US hourly 1 https://wordpress.org/?v=5.8 https://www.jopsweb.org/wp-content/uploads/2021/08/icon-10-150x150.png Supply source – Jops Web http://www.jopsweb.org/ 32 32 Allocating scarce resources to the time of Covid: who will live when everyone can’t live? https://www.jopsweb.org/2021/09/03/allocating-scarce-resources-to-the-time-of-covid-who-will-live-when-everyone-cant-live/ Fri, 03 Sep 2021 15:05:45 +0000 https://www.jopsweb.org/2021/09/03/allocating-scarce-resources-to-the-time-of-covid-who-will-live-when-everyone-cant-live/ Allocating scarce resources to the time of Covid: who will live when everyone can’t live? By Jody Cramsie I’m mad. Vital treatments are denied to patients. Elective surgeries are canceled and suspended. Do not confuse the benign-sounding term “your choice” with frivolous or optional. Choice refers to procedures that are medically necessary but may not […]]]>

Allocating scarce resources to the time of Covid: who will live when everyone can’t live?

By Jody Cramsie

I’m mad.

Vital treatments are denied to patients. Elective surgeries are canceled and suspended. Do not confuse the benign-sounding term “your choice” with frivolous or optional. Choice refers to procedures that are medically necessary but may not be an immediate emergency. Elective surgeries save lives. If they didn’t, doctors wouldn’t be justified in executing them. And time matters, even with elective procedures – hearts may not continue to beat with a damaged valve; cancerous tumors can metastasize the longer they stay in the body. These patients are getting sicker and some die.

Why is this happening? Hospitals everywhere, including here, are explicitly rationing health care. Hospitals are using their meager resources to treat intentionally unvaccinated Covid patients. Hospitals are overrun and overwhelmed by the overwhelming waves of these Covid sufferers – those people who have made personal and socially destructive decisions and now want to lead the way, despite their own guilt in their current condition. And hospitals agree with that and prioritize these patients over others.

Every fiber of my being says it’s not right. But what does fairness have to do with this? Does equity still matter? What are the biomedical ethical rules and considerations that hospitals use to justify their decisions on this allocation of life or death of scarce resources? Are there other ethically defensible decisions that could be made by these organizations in these perilous times?

There are four fundamental principles recognized in biomedical ethics:

1. Beneficence – the positive obligation to act for the benefit of the patient

2. Non-maleficence – the obligation not to harm the patient

3. Autonomy – the recognition that the patient has the power to make decisions and choices by exercising his capacity for self-determination

4. Justice – the fair and equitable distribution of benefits and burdens

Autonomy requires taking into account the right of the individual to freely make decisions concerning his health. This includes the individual’s ability to understand these choices, including the consequences of the decision. The patient then moves forward voluntarily.

Of course, a person’s autonomy is not uncontrolled; it may be limited when the autonomous action of this person causes prejudice to one or more other persons. While autonomy is primarily about the rights of the individual, justice requires a balance of benefits and burdens between all concerned. It involves social cooperation, serving the common good and maximizing benefits within the system as a whole, while making the difficult choices to balance actions.

Let’s be clear: I’m talking about post-vaccine treatment issues for Covid. I think this is a morally relevant distinction in this discussion of allocating scarce resources. This pandemic can be a crisis of such magnitude that many principles of biomedical ethics could / should be called into question.

In many ways, the voluntarily unvaccinated Covid patient has made his treatment priorities known. They voluntarily took the risk and refused to mitigate any possible harm to themselves, their families and society. Why not respect this autonomous decision when it comes to allocating scarce resources, which at the same time serve the objectives of equity and justice required by justice?

As a result, I suggest that hospitals (not doctors or nurses) could adopt an ethically defensible policy to queue sick Covid patients and not automatically prioritize them. I think this could be done by fully respecting the prior decision of the voluntarily unvaccinated Covid patient to refuse medically appropriate and possibly life-saving treatment.

I think the actions could be balanced by hospitals developing a planned policy, based on principles and justified by a call for ethical standards. It would be well argued with input from ethicists, legal advisers, risk managers, hospital administrators and staff, and other stakeholders. The policy would be announced and widely disseminated so that everyone knows and understands that it is not responsive to any specific individual or group of individuals, but transparent and objective and consistent with the hospital’s mission and responsibility to the hospital. whole community.

The government has not taken the lead on this issue. It has a vital and legitimate role in alleviating the horrific conditions in which hospitals operate. It has left hospitals and communities with the heavy burden of moral distress caused by the forced allocation of hospital resources. The government should mobilize its resources to set up Covid-specific treatment centers, creating space in hospitals for the care of other sick patients. If hospitals, themselves, are setting up temporary treatment areas in staff rooms, hallways and parking lots (!!), then appropriate temporary treatment areas should surely be put in place for Covid patients with government action of first priority.

Autonomy is crucial. Ever increasing levels of self-determination and the development of individual potential are hallmarks of human progress. None of us can live happily or productively without it. But it’s nothing without justice, which is often elusive. It could bring the arc of justice a little closer to the reach of society.

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  • Allocating scarce resources to the time of Covid: who will live when everyone can’t live? – September 3, 2021
  • UNDERSTANDING PRAYER: Prayer is recognizing the sacred in us – June 19, 2021
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  • What happened on the first day of Easter? (Part 2) – April 1, 2021
  • What happened on the first day of Easter? (Part one) – March 31, 2021
  • Hope is a verb of action – March 8, 2021
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  • Confidence in the justice system shaken by Amy Coney Barrett – October 27, 2020
  • Should we vote according to the golden rule? – October 15, 2020

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Ballad by the Numbers: Invocation of the “Allocation of Rare Resources” protocol does not hold water | Rogersville https://www.jopsweb.org/2021/09/02/ballad-by-the-numbers-invocation-of-the-allocation-of-rare-resources-protocol-does-not-hold-water-rogersville/ Thu, 02 Sep 2021 21:00:00 +0000 https://www.jopsweb.org/2021/09/02/ballad-by-the-numbers-invocation-of-the-allocation-of-rare-resources-protocol-does-not-hold-water-rogersville/ I have read that 400 is the magic number. It is the projected number of COVID-19 patients admitted in the coming weeks that will put a strain on the Ballad Health system and may force them to invoke their “scarce resource allocation” protocol. If you haven’t heard it, this protocol will be used if Ballad […]]]>

I have read that 400 is the magic number. It is the projected number of COVID-19 patients admitted in the coming weeks that will put a strain on the Ballad Health system and may force them to invoke their “scarce resource allocation” protocol.

If you haven’t heard it, this protocol will be used if Ballad Health’s resources exceed limits, and a triage team will make decisions about who gets medical supplies, drugs, treatments, etc. The health care system even has a form for you to sign stating that you understand the medical decisions they can make for you.

This document states: “Because you are admitted to the hospital for a period when the system may deem it necessary to implement standards of crisis care, you should be aware that there is a chance, however unlikely, that, what whatever the reason for your admission to hospital, some resources may not exist to provide you with life-saving treatment if you become seriously ill because the healthcare system is overwhelmed with COVID-19 admissions. “

Let’s look at some other numbers given by Ballad Health:

21 counties in Tennessee and Virginia. This is the established service area that Ballad Health covers.

20 medical hospitals (Wood Ridge Hospital is not counted for this summary)

Capacity of 2,338 published medical hospital beds

The factor in the total population of the Ballad service area is 945,362, and Ballad’s health is stressful on a census of 400.

The high COVID-19 count is also nothing new for Ballad. Internal admissions remained between 306 and 361 patients from last December 2020 to the first two weeks of January 2021. I don’t remember hearing about a COVID emergency plan or a resource allocation protocol rare or at the time. What is different now?

However, I am not sure I can trust their published figures. Ballad publishes a daily COVID dashboard detailing system COVID admissions, discharges, total count, intensive care and ventilated patients. In August alone, there were some deviations.

As of August 20, Ballad Health reported no changes in its internal census, but they also reported 22 discharges and 18 admissions (more outdoors than indoors). On August 26, they reported an increase in their COVID-19 hospital count of 8 patients compared to the previous day.

They also reported the exact same total number of admissions and discharges (46 admissions and 46 discharges) that day. Finally, on August 27, the system reported an increase in the COVID-19 hospital census of 6 patients from the previous day, but there were only 40 admissions and 45 discharges. Again, more patients are leaving than being admitted, but their internal numbers continue to increase.

Asked on Facebook about the discrepancies in their reports, Ballad Health replied, “Due to technical difficulties, the state-reported data for our region (listed above) was not updated yesterday. Today’s figures are correct.

Their response to the question referred to the state-reported data they are passing on regarding COVID positivity and death rates. The inconsistencies throughout August (and other months if one were to investigate) come from Ballad’s own reporting system, not from an outside site. When asked again to decipher the variance of the internal number, they declined to give further details.

Is it any wonder that a healthcare system that cannot keep up with the actual current number of patients it treats is unable to manage treatment resources? I have serious safety concerns due to Ballad Health’s statement regarding the lack of assets and the harm that could result to patients. I further contend that Ballad Health has abundant resources throughout its 21-year-old hospital system and mismanages these resources in times of a declared health crisis.

Amy Williams is a resident of Rogersville, a longtime resident of East Tennessee and a retired nurse with 25 years of experience in the healthcare industry. Amy is married to a retired police officer and is the proud mother of three children, two of whom are currently serving in the US Navy. You can email him at amy.whatshername@gmail.com


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Subsidy payment drains scarce resources, officials say https://www.jopsweb.org/2021/08/27/subsidy-payment-drains-scarce-resources-officials-say/ Fri, 27 Aug 2021 00:40:12 +0000 https://www.jopsweb.org/2021/08/27/subsidy-payment-drains-scarce-resources-officials-say/ The House of Representatives on Thursday described the under-collection of payments by the Nigerian National Petroleum Corporation to subsidize Premium Motor Spirit (gasoline) as a major drain on the country’s scarce resources. House of Representatives finance committee chairman Abiodun Faleke said this at the end of his 10-day panel with heads of federal ministries, departments […]]]>

The House of Representatives on Thursday described the under-collection of payments by the Nigerian National Petroleum Corporation to subsidize Premium Motor Spirit (gasoline) as a major drain on the country’s scarce resources.

House of Representatives finance committee chairman Abiodun Faleke said this at the end of his 10-day panel with heads of federal ministries, departments and agencies on the 2022-2024 medium-term spending framework and the budget strategy document.

Data released by the Federal Ministry of Finance this year showed that claims for under-collection or subsidies deducted from oil revenues by the NNPC amounted to 25.37 billion naira in February, 60.396 billion naira in March and 61.966 billion naira in April.

Data revealed that the subsidy increased to 126.298 billion naira in May but was reduced to 114 billion naira in June 2021.

Faleke stressed the need to improve the economy’s fiscal performance by establishing data that would detail daily gasoline consumption in Nigeria.

He said: “There is an urgent need to establish the actual daily consumption of PMS in the country, as the data from relevant stakeholders in the downstream sector has been shown to be contradictory.

“It should also be noted that the current PMS under recovery payments is a major drain on the country’s scarce resources. ”

He expressed optimism, however, that with the signing of the Oil Industry Law, this would soon end.

He lamented that federal agencies have “taken advantage of their establishment laws to spend their internally generated revenues, thus depriving the government of necessary revenues.”

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How to ration scarce resources equitably https://www.jopsweb.org/2021/05/27/how-to-ration-scarce-resources-equitably/ Thu, 27 May 2021 07:00:00 +0000 https://www.jopsweb.org/2021/05/27/how-to-ration-scarce-resources-equitably/ Among the many failures of America’s first COVID-19 disaster response, unprepared federal authorities mismanaged the allocation of emergency medical equipment as the pandemic grew. The decisions of the Federal Emergency Management Agency “were inconsistent and lacked transparency, which frustrated state officials,” according to Yale’s Vahideh Manshadi, Chicago Booth’s Rad Niazadeh and Yale doctoral student Scott […]]]>

Among the many failures of America’s first COVID-19 disaster response, unprepared federal authorities mismanaged the allocation of emergency medical equipment as the pandemic grew. The decisions of the Federal Emergency Management Agency “were inconsistent and lacked transparency, which frustrated state officials,” according to Yale’s Vahideh Manshadi, Chicago Booth’s Rad Niazadeh and Yale doctoral student Scott Rodilitz.

To be fair, the government’s stockpile of emergency medical and personal protective equipment was designed to help manage localized emergencies, not a pandemic. But rationing – during a pandemic or in other disaster response settings – can be done fairly and efficiently, the researchers say.

A tough time to keep things fair

Researchers turned to April 2020, as COVID-19 infections spread across the United States, to test their model. This series of maps illustrates when each state’s demand for emergency medical equipment was expected to peak, forcing authorities to calculate the amount of the nation’s stock to deploy and hold from week to week. ‘other.

When states were expected to peak demand for medical equipment in April 2020

First wave
Five States April 1-7

Second wave
Seven more states plus Washington, DC, April 8-14
Data visualization: A map of the United States highlighting a group of states with an expected average demand for 2,193 additional intensive care beds, with a standard deviation of 710: Alaska, Connecticut, Delaware, Maine, Massachusetts, New Hampshire, Washington and the District of Columbia.

Third wave
17 other states from April 15 to 21
Data Visualization: A map of the United States highlighting a group of states with an expected average demand for 9,719 additional intensive care beds, with a standard deviation of 3,600: Alabama, Colorado, Georgia, Illinois, Indiana , Minnesota, Mississippi, Nebraska, Nevada, New Mexico, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee and Utah.

20 states remaining after April 21
Data visualization: A map of the United States highlighting a group of states with an average expected demand for 3,831 additional intensive care beds, with a standard deviation of 1,763: Arizona, Arkansas, California, Florida, Hawaii , Idaho, Iowa, Kansas, Kentucky, Maryland, Missouri, Montana, North Carolina, Oregon, South Carolina, South Dakota, Texas, Virginia, West Virginia, Wisconsin and Wyoming.

Manshadi et al., 2021

They have developed a method that they call Proportionate Projected Allocation that makes a good faith effort to deploy public resources not only to alleviate current suffering, but also to care for future victims who would be left behind in a first-come system. , first served.

As the coronavirus began to spread from the first hot spots, government planners realized the disease would spread rapidly nationwide and had to decide how to allocate resources between communities already in pain and those who will subsequently be infected. . Faced with global equipment shortages, FEMA has struggled to keep up, prioritizing deliveries to medical facilities that risk running out within 72 hours, according to testimony to Congress from Administrator Peter Gaynor. This left some communities on their own as a stockpile of FEMA protective medical equipment that would normally have lasted a year ran out within weeks.

The researchers base their proportional allocation alternative on the theory of justice proposed by the late philosopher John Rawls, which defines fairness from the perspective of a neutral observer. As a result, they aim to maximize the well-being of the most disadvantaged communities. The aim is to balance fairness and efficiency, as well as being simple and transparent, two qualities that are particularly important for public policy, they say. To achieve this, their model takes into account the complicated correlation structure of future demands when making allocation recommendations for a community in need. It is then based on a simple statistical analysis of needs and likely outcomes, which tend to be difficult to predict with high accuracy in various communities during a pandemic such as COVID-19.

Using the April 1, 2020 projections from the University of Washington’s Institute for Health Metrics and Evaluation, researchers divided U.S. states into four groups based on when they were expected to reach peak demand for beds. intensive care. They then performed 10,000 simulations using their mathematical model of medical and protective equipment distribution. The result was a fill rate (FR) which determines what fraction of a community’s needs can be met while maintaining enough emergency stock for future needs.

The researchers calculate that their model, which focuses on maximizing RF in all communities, outperforms other rationing policies by up to 33% when evaluated using their efficiency and equity metric. . A limited supply of essential goods is a common problem in disasters such as natural disasters, and their approach can be used in these contexts as well. “Our framework lends itself to extensions such as taking into account generalized objectives and rationing several types of resources,” they write. “More broadly, it serves as a basic model for theoretically studying sequential allocation problems with a goal beyond utility maximization.”


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Limited resources for Kerala, MP for Karnataka and a call for Gadkari to wage the ‘war’ of Covid https://www.jopsweb.org/2021/05/08/limited-resources-for-kerala-mp-for-karnataka-and-a-call-for-gadkari-to-wage-the-war-of-covid/ Sat, 08 May 2021 07:00:00 +0000 https://www.jopsweb.org/2021/05/08/limited-resources-for-kerala-mp-for-karnataka-and-a-call-for-gadkari-to-wage-the-war-of-covid/ R. Prasad | Economic times Text size: A- A + The selected cartoons first appeared in other publications, either in print or online, or on social media, and are appropriately credited. In today’s cartoon, R. Prasad sharply criticizes the allegedly joint remarks by BJP MP Tejasvi Surya during his inspection of the Covid war rooms […]]]>
R. Prasad | Economic times

Text size:

The selected cartoons first appeared in other publications, either in print or online, or on social media, and are appropriately credited.

In today’s cartoon, R. Prasad sharply criticizes the allegedly joint remarks by BJP MP Tejasvi Surya during his inspection of the Covid war rooms in Bengaluru. While Surya’s remarks drew much criticism, the cartoonist points out how nurses in Kerala have ensured zero vaccine waste in the state.

Alok Nirantar | Sakal Media Group

Alok Nirantar sweeps the tweet from BJP MP Rajya Sabha, Subramanian Swamy, expressing his displeasure with the PMO’s handling of the Covid situation. The top BJP leader also requested a delegation led by Union Minister Nitin Gadkari to wage the “war” against Covid-19.

Kirtish Bhatt | BBC Hindi News

Kirtish Bhatt draws as India braces for a third wave of the Covid-19 pandemic.

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