Abstract

The application of Artificial Intelligence (AI) is rapidly transforming various industries, and the pharmaceutical industry is no exception. AI is increasingly being used to automate, optimize and personalize various aspects of the pharmacy industry, from drug discovery to drug dispensing. In this context, this paper explores the potential of AI to revolutionize the pharmacy industry, by discussing the current and future applications of AI in the industry. We will examine how AI is being used in drug discovery, personalized medicine, drug safety and quality control, inventory management, and patient counselling. We will also discuss the challenges and limitations of AI in the pharmacy industry, such as data privacy, ethical concerns and regulatory barriers. The paper will argue that AI has the potential to revolutionize the pharmacy industry by enabling faster drug discovery, improving patient outcomes, reducing costs, and increasing the efficiency and accuracy of various pharmacy operations. The old pharmacy system relied on manual processes and human decision-making, while the new AI pharmacy system automates routine tasks, provides personalized treatment plans, and reduces costs while improving patient outcomes. However, it is important to ensure that AI is used ethically and responsibly, and that its impact on the workforce and society is carefully considered. The major benefit of integrating AI into specific applications within the pharmacy field is improved accuracy and efficiency in patient care. Overall, this paper will provide an insight into the future of the pharmacy industry, and the transformative potential of AI in this field.

Introduction

The conventional pharmacy system relies heavily on manual processes and human expertise, which can lead to inefficiencies, errors, and delays. For example, the process of filling a prescription involves several manual steps, such as interpreting the prescription, dispensing the medication, and verifying the dosage and frequency1, 2, 3. These manual processes are prone to errors and can be time-consuming. Moreover, the conventional pharmacy system lacks the ability to personalize medication regimens for individual patients, which can limit the efficacy of drug therapy. However, by using AI-powered tools like AI, pharmacies can enhance their operations and overcome these limitations. AI can help automate various aspects of the pharmacy workflow, from prescription interpretation to drug dispensing, reducing the risk of errors and improving efficiency. Additionally, by analyzing large amounts of patient data, AI can assist pharmacists in developing personalized medication regimens that are tailored to the patient’s unique needs and medical history. While the conventional pharmacy system has been effective in providing patients with necessary medications, it is limited by its manual processes and lack of personalization. The use of AI-powered tools like AI can overcome these limitations, making the pharmacy system more efficient, accurate, and personalized, ultimately leading to better patient outcomes4, 5, 6, 7.

Conclusion, scope for future work and limitations

In conclusion, the potential applications of AI in pharmacy can revolutionize the industry, providing numerous benefits for both pharmacists and patients. From medication management to drug discovery and chronic disease management, AI technology can improve the accuracy and safety of medication dispensing, accelerate the drug development process, and help to improve patient outcomes. The implementation of AI technology can also help to reduce healthcare costs by improving efficiency and reducing errors. However, it is important to note that the implementation of AI in pharmacy also presents some limitations and challenges that need to be addressed. For example, there may be concerns around patient privacy and security when using AI-powered systems to monitor patient data. Additionally, there may be a need for pharmacists to undergo additional training to effectively use and integrate AI technology into their practice. Nonetheless, with proper implementation and management, the benefits of AI in pharmacy far outweigh the potential limitations and challenges, paving the way for a brighter future in healthcare.

While the potential applications of AI in pharmacy are vast, there is still much work that needs to be done in terms of research and development. One potential area for future study could be the integration of AI technology with other healthcare systems, such as electronic health records (EHRs) or telemedicine platforms. This could allow for a more comprehensive and coordinated approach to healthcare delivery, improving patient outcomes and reducing healthcare costs. Another area for future research could be the ethical considerations around the use of AI technology in pharmacy. As the technology continues to evolve, it is important to consider issues such as data privacy and security, algorithmic bias, and the potential for AI systems to replace human jobs. Addressing these issues in a thoughtful and proactive manner can help to ensure that the implementation of AI in pharmacy is both effective and ethical. By continuing to explore these areas of study, we can further unlock the potential of AI technology in pharmacy and pave the way for a more efficient and effective healthcare system.

Abstract

Introduction

Materials and methods

DPPH

Microbial studies

Result and discussion

Microbial studies

Conclusion

Acknowledgements

References

Abstract

     Nanotechnology involving biopolymers is comprehensively used in biomedical applications, planning sciences, and food development. The present work describes the synthesis, characterization, and application of carrageenan and zinc oxide nanoparticles (ZnONPs) based hydrogel. The synthesized hydrogels were subsequently characterized using FTIR, XRD, SEM, and TG-DTA. The swelling property, antioxidant activity, and whole blood clotting effectiveness of the Carrageenan hydrogel, and Carrageenan Hydrogels Impregnated with Zinc Oxide Nanoparticles were evaluated. The Carrageenan + ZnONPs (C/ZnONPs) hydrogels showed good antioxidant, and blood clotting activity than the pure carrageenan hydrogel. In addition, the stable C/ZnONPs hydrogels exhibit good antimicrobial activities against both Gram-negative and Gram-positive bacterial strains. Biofilm analysis showed that C/ZnONPs hydrogels have excellent anti-biofilm potential in both inhibition and disruption of preformed biofilm. The obtained results suggested that the carrageenan and Zinc oxide nanoparticles based hydrogel have promising biological applications.

Introduction

     Pathogenic microorganism resistance to frequently used antibiotic substances have become an important health concern in the 21st century. The development of microorganism resistance to antibiotics has significantly increased morbidity and mortality, longer hospitalization and increased health care costs.[1] Resistance is increasing against antibiotics, particularly to the first line, inexpensive, and broad-spectrum antibiotics, but also to the newly developed antibiotics; since the development of novel alternative is necessary.[2,3]

In the specific case of wound management there are several reports of the microorganism resistance to the drug used to manage wounds.[4] The role of microbial infections in the development of wound infections is well established, the life threatening nature of the wound infections has maximized its importance in human health. In addition, the cost of medication for wound management is also high.[5,6] Hence the exploration of new substance for the wound management is very important.

Conclusion

     The synthesized C/ZnONPs hydrogels was produced by a simple and efficient method, performing proper swelling capacity and much better mechanical properties. It exhibited better antioxidant, blood clotting activity and also possess excellent antibacterial and biofilm efficacy against B. subtilis, S. aureus, E. coli and K. pneumonia. The present study confirmed that C/ZnONPs hydrogel have multi-potential property. Thus, the present study suggests that this bio-reduction practice is a well suitable system for large-scale production. The blood clotting and biofilm efficacy were tested in this study only at the grassroot stage which needs to be addressed further.

Abstract

Introduction

Materials and methods

Characterizations

Results and discussion

Optimized reaction conditions

FTIR spectra analysis

SEM–EDS analysis

XRD analysis

TGA analysis

Conclusion

Declarations

References

Abstract

     An interpenetrating polymer network (IPN) containing gum acacia (GA), poly(methacrylic acid) (MAA), and poly(acrylic acid) (AA) was developed using a two-step aqueous polymerization method. Firstly, semi-IPNs were produced by radical polymerization of MAA chains onto GA in the presence of ammonium persulfate as a free radical initiator and N, N′-methylene-bisacrylamide (MBA) as a cross-linking agent using a microwave heating. To obtain a semi-IPN with a higher swelling percentage, several reaction parameters such as initiator, monomer, and crosslinker concentrations were varied. The percentage swelling (%S) was highly dependent upon the reaction conditions. The optimal reaction conditions for maximal %S were 2.55 × 10–2 mol/L initiator concentration, 12 mL solvent, 0.424 × 10–3 mol/L of monomer, and 2.16 × 10–2 mol/L cross-linker concentration, according to the findings. GA-g-poly(MAA) was the name to given to the semi-IPN. Second, IPN was created by grafting AA chains onto a GA-g-poly(MAA) matrix that had been optimized. The IPN was named as a GA-g-poly(MAA-IPN-AA). The reduction of silver ions to silver nanoparticles (AgNPs) was carried out by heating the mixture of flower extract of Koelreuteria apiculate under microwave radiation.

Introduction

     Hydrogels are three-dimensional (3D) networks formed by the crosslinking of hydrophilic polymers [1, 2]. They might swell while maintaining their network structure by absorbing signifcant amounts of water or biological fluids. The inclusion of hydrophilic groups such as -OH, -CONH, -CONH2, -COOH, and -SO3H along the polymer chain contributes to their ability to absorb a large amount of water [1]. Polysaccharide hydrogel networks have received a lot of attention in recent years [3–5]. The physico-chemical properties of these hydrogels frequently differ significantly from those of the macromolecular constituents. Hydrogel characteristics can also be altered utilizing a range of physical and chemical crosslinking techniques [3, 6]. Various researchers have examined a number of polymeric systems to create hydrogels [7]. The polymer composition can be classified as natural polymeric hydrogels, synthetic polymer hydrogels, and or a combination of both [7]. Because of their non-toxicity, low cost, permeability, and biocompatibility, hydrogels have gotten a lot of attention in a variety of sectors [8–10].

Conclusion

     Antimicrobial materials have been studied extensively in response to rising microbial resistance to traditional antibiotics and disinfectants. Natural polysaccharidebased hydrogels and their composites containing metal nanoparticles could be suitable for antibacterial applications in some cases. Using a microwave irradiation approach, we were able to successfully synthesis GA-gpoly(MAA) and GA-g-poly(MAA-IPN-AA) based hydrogels from GA. APS and MBA being used as initiator and cross-linker, respectively. To achieve maximum %S of semi-IPN (588%) and IPN (500%), diferent parameters were optimized. The formation of cross-linked hydrogels and hydrogel composites with AgNPs was successfully demonstrated using FTIR analysis. The SEM investigation of hydrogel networks reveals a variety of morphologies, which could be attributed to structural diferences between semi-IPN, IPN, and their composites with AgNPs. SemiIPN, IPN and their composite showed superb antibacterial potential against E. coli, M. luteus, P. aeruginosa, Rihzobium species, and S. aureus, and may be used to treat a variety of infected efuents. Such interconnected hydrogels will give superior material properties, particularly in biomedical research, to prevent biomaterialassociated infections as well as general pathogenic invasions into the body. The synthesized hydrogel samples will lead to enhanced applications in the future, as well as a deeper knowledge of material interactions. The eforts to improve the property profle of cross-linked hydrogels are still on, with the hope of improving overall performance in terms of water uptake capacity, biocompatibility, and biodegradability.

Abstract

Keywords

Introduction

Methods

Results

Discussion

Conclusion

Author contributions

Availability of data

Conflicts of interest

Acknowledgements

References

Article Info

Figures

Tables

Related Articles

Abstract

Introduction It has been suggested that the future of diagnostic imaging relies on engagement in research and evidence-based practice. This implies a role transition from a clinical radiographer to a clinical radiographer-researcher. Clinical radiographers’ stimuli for engaging in research in Nordic countries are unknown. This study aimed to address this gap.

Methods
Cross-sectional data collection via an online questionnaire on facilitators for and barriers to participation in radiography research was carried out among 507 clinical radiographers in public healthcare in the Nordic countries: Denmark, Finland, Norway and Sweden.

Results
Support from colleagues (odds ratio [OR] 2.62) and other professionals (OR 2.74), and self-esteem in research skills (OR ≥ 2.21), were facilitators for radiography research. Lack of knowledge and skills to conduct research (OR 2.48) was revealed to hinder radiographers’ participation in research. The absence of a radiography research culture in the workplace explained non-participation in research (OR 1.75).

Introduction 

It has been suggested that the future of diagnostic imaging relies on engagement in research and evidence-based practice (EBP).1e4 While radiologists and physicists have a long tradition of conducting research in medicine and radiation physics, radiographers are still in the initial stages of radiography research, but academic development of radiographers is ongoing while they usually perform research studies alongside university teaching.5e7 Radiography research has been found to address, for example, radiographic technology and patient well-being and care.8,9 There are several reasons to investigate clinical radiographers’ stimuli for engaging in radiography research. One is radiographers’ responsibility for and expertise in patient care in diagnostic imaging.

Abstract

1. Introduction

2. Experimental section

3. Result

4. Discussion

5. Conclusion

Declaration of competing interest

Acknowledgements

References

Abstract

     Hydrogel is a nature scaffold that can degraded in animal body and can be used as a drug delivery system, we hypothesized that patch made of three layers of hydrogel with different PLGA nanoparticle drugs (bio-patch) can be used to decrease venous neointimal hyperplasia. Rat inferior vena cava (IVC) patch venoplasty model was used. Samples from rat IVC direct suture (DS), decellularized thoracic artery patch (TA) venoplasty and bovine pericardial patch (BPP) venoplasty were examined at day 14 after implantation. Sodium alginate and hyaluronic acid (SA/HA) hydrogel was used, three layers hydrogel patch (control) and three layers hydrogel patch with PLGA nanoparticle drugs (bio-patch) were used in rat IVC venoplasty. Patches were harvested at day 14 and analyzed. In rats, TA and BPP patch showed a thicker neointima and adventitia compared to the DS, there were larger numbers of CD68 and PCNA positive cells in both groups. The control hydrogel patch showed much thinner neointima and adventitia compared to TA and BPP patches. In both of the neointima and peri-patch area, bio-patch showed significantly fewer smooth muscle cells, fewer CD68, fewer PCNA positive cells, fewer collagen-1 positive cells, fewer p-smad2 positive cells, fewer TNF-α positive cells compared to control hydrogel patch. Bio-patch made of hydrogel and PLGA nanoparticle drugs showed a thinner neointimal thickness, and is biocompatible to the animal body.

Introduction

     Prosthetic vascular grafts like Dacron and expanded poly tetra fluoroethylene (ePTFE) have a lower patency rate in peripheral bypass surgeries [1,2]. Both grafts showed poor long-term patency rate when the diameter is smaller than 6 ​mm [3]. In addition, biological graft like cryopreserved allografts, bovine or porcine pericardium, are also commonly developed as vascular grafts [[4], [5], [6]]. However, these materials have a risk of infection, foreign body reaction as non-autologous materials, meanwhile they cannot be absorbed by the body, which limit their application [7]. Along with the advancement of material science and technologies, various of novel materials are emerging and under investigation in vascular surgery [[8], [9], [10]]. Decellularized fish swim bladder also showed potential application as tube and patch grafts [3], plant leaf can also be used a patch to repair rat inferior vena cava (IVC) [11,12]. Great progress has been made in the field of vascular patches recently, however, the big challenge of neointima formation still not be solved [13,14].

Conclusion

     In conclusion, we showed a novel idea to fabricate a three layers vascular patch with different PLGA nanoparticle drugs (bio-patch), this bio-patch can effectively decrease neointimal hyperplasia in a rat IVC venoplasty model; this research showed that the bio-patch may be a potential substitute of other prosthetic patches in vascular surgery.

Abstract

     This study integrated multiple objective decision-making approaches including data envelopment analysis (DEA), rough set theory and TOPSIS method for exploring the competitiveness of pharmaceutical multinational enterprises. Firstly, this study applied an advanced two-stage network DEA to measure the R&D efficiency and business performance of pharmaceutical multinational enterprises (PMNEs) listed in the Forbes Global 2000 and ranked these PMNEs by using rough set theory, DEA and TOPSIS method. In addition, differences in environmental, social, and governance (ESG) performance across three continents were investigated. Findings show that North America is significantly the best (worst) region in terms of business performance (R&D efficiency) while Europe is significantly the best (worst) region in terms of R&D efficiency (business performance). Alfresa Holdings Corporation, a PMNE from Japan, is the only PMNE that is efficient from both an R&D and business performance perspective. European PMNEs have significantly better environmental and social performance than other regions, however, they have the worst governance performance. Overall, this study provides insights to managers and investors into the application of various methods for accurately measuring performance and ranking multinational enterprises.

Introduction

     The pharmaceutical industry is one of the most important and competitive industries in the world, it not only has a critical role in the health maintenance of individuals but also in economic growth (Sharma & Modgil, 2019). Pharmaceutical firms have spent a substantial proportion of their time and investment in research and development (R&D) (Rao, 2020). In 2018, R&D expenditure in the pharmaceutical industry was 179 billion U.S. dollars globally (Mikulic, 2020). A correct grasp of the R&D efficiency of the industry is required to improve resource allocation and thereby prevent either excess or shortage of resource inputs (Liu & Lyu, 2020). According to Lu et al. (2019), evaluating multiple indicators simultaneously is useful for appropriate decision-making. An overall efficiency can be decomposed into two stages of efficiencies (Kao & Hwang, 2008), suggesting that we should also evaluate the sub-processes of a firm (Kao & Hwang, 2011). That is, managers should evaluate their firm performance not only from a multidimensional perspective but also from those of its internal processes. As mentioned in the research of Sharma and Modgil (2019), business performance additionally depends on cost reduction of manufacturing operations and improving the firm’s innovative ability. Recently, Hsieh et al. (2020) have applied two-stage data envelopment analysis (DEA) to investigate organizations’ innovation and business performance by investigating the network structures of decision-making units (DMUs).

Conclusion

     This study measures the firm performance of 41 PMNEs from a two-stage perspective, namely R&D efficiency and business performance, by integrating a two-stage network DEA and SOCP technique. Moreover, this study integrates the DEA approach and rough set theory to rank PMNEs. The findings of this research can serve as a reference for managers of PMNEs in their decision-making process. Besides, we examine differences in the ESG scores of the PMNEs among different geographic regions (America, Asia, and Europe). This acts as a guide for investors, managers, and other stakeholders when attempting to move their ESG initiatives further.

     R&D performances in the operation of the observed PMNEs are not attracting enough attention. Alfresa Holdings Corporation is the only efficient PMNE for both R&D efficiency and business performance. North America is significantly the best (worst) region in terms of business performance (R&D efficiency) while Europe is significantly the best (worst) region in terms of R&D efficiency (business performance). From the perspective of ESG performance, European PMNEs significantly have better environmental and social performance than other regions whereas they are the worst concerning governance performance.

Abstract

Graphical abstract

Keywords

Abbreviations

1. Introduction

2. Materials and methods

3. Results

4. Discussion

5. Conclusions

Author contributions

Declaration of Competing Interest

Acknowledgments

Appendix A. Supplementary data

References

Abstract

The immune checkpoint blockade therapy has profoundly revolutionized the field of cancer immunotherapy. However, despite great promise for a variety of cancers, the efficacy of immune checkpoint inhibitors is still low in colorectal cancer (CRC). This is mainly due to the immunosuppressive feature of the tumor microenvironment (TME). Emerging evidence reveals that certain chemotherapeutic drugs induce immunogenic cell death (ICD), demonstrating great potential for remodeling the immunosuppressive TME. In this study, the potential of ginsenoside Rg3 (Rg3) as an ICD inducer against CRC cells was confirmed using in vitro and in vivo experimental approaches. The ICD efficacy of Rg3 could be significantly enhanced by quercetin (QTN) that elicited reactive oxygen species (ROS). To ameliorate in vivo delivery barriers associated with chemotherapeutic drugs, a folate (FA)-targeted polyethylene glycol (PEG)-modified amphiphilic cyclodextrin nanoparticle (NP) was developed for co-encapsulation of Rg3 and QTN. The resultant nanoformulation (CD-PEG-FA.Rg3.QTN) significantly prolonged blood circulation and enhanced tumor targeting in an orthotopic CRC mouse model, resulting in the conversion of immunosuppressive TME. Furthermore, the CD-PEG-FA.Rg3.QTN achieved significantly longer survival of animals in combination with Anti-PD-L1. The study provides a promising strategy for the treatment of CRC.

1. Introduction

As the third leading cause of cancer-related deaths worldwide (e.g., 881,000 deaths estimated in 2018)1, colorectal cancer (CRC, a cancer of the colon or rectum) is an obvious disease burden requiring effective, safe and widely-applicable treatments. Recent research in cancer immunology has led to the development of different immunotherapeutic strategies2, 3, 4. Among these, strategies that exert the blockade of immune checkpoint pathways [e.g., cytotoxic T lymphocyte antigen 4 (CTLA-4) and programmed death-ligand 1 (PD-L1)] have achieved favorable outcomes in a range of solid tumors5. However, it has been reported that only a minority of patients (up to 15% of the CRC population), who are identified with mismatch repair (MMR)-deficient CRC, respond positively to immune checkpoint blockade therapy6, while the response rate remains low in MMR-proficient CRC patients7. This failure is strongly attributed to the immunosuppressive feature of the tumor microenvironment (TME)8. Therefore, approaches designed to reprogram the TME may improve the therapeutic efficacy of immune checkpoint inhibitors9, potentially providing therapeutic benefit for the wide spectrum of CRC patients.

Immunogenic cell death (ICD) is characterized as immunogenic apoptosis that activates damage-associated molecular patterns (DAMPs) in dying or dead tumor cells in response to certain stimuli10. DAMPs as danger signals activate dendritic cells (DCs) for the presentation of tumor-associated antigens (TAAs), which subsequently induce T cell-mediated immunological responses against living tumor cells of the same kind10. The concept of ICD has revolutionized the traditional view of chemotherapeutic agents that are considered cytotoxic and poorly immunogenic. For example, chemotherapeutic drugs such as anthracyclines11, oxaliplatin12, bortezomib13 and cardiac glycosides14 have been identified as the putative ICD inducers. Recently, evaluation of chemotherapeutics as potential ICD inducers has gained increasing attention. In addition, ICD is often concomitant with the production of reactive oxygen species (ROS)10, and the efficacy of ICD may be enhanced by ROS-inducing strategies15, 16, 17. Therefore, it is hypothesized that a combination of ICD- and ROS-inducing strategies will mediate the remodeling of immunosuppressive TME and achieve synergistic immunotherapeutic efficacy with immune checkpoint blockade.

Abstract

Graphical abstract

Keywords

1. Introduction

2. Materials and methods

3. Results and discussion

4. Conclusions

Author contributions

Declaration of Competing Interest

Acknowledgments

Appendix A. Supplementary data

References

Abstract

Precisely delivering combinational therapeutic agents has become a crucial challenge for anti-tumor treatment. In this study, a novel redox-responsive polymeric prodrug (MW: 93.5 kDa) was produced by reversible addition-fragmentation chain transfer (RAFT) polymerization. The amphiphilic block polymer-doxorubicin (DOX) prodrug was employed to deliver a hydrophobic photosensitizer (PS), chlorin e6 (Ce6), and the as-prepared nanoscale system [NPs(Ce6)] was investigated as a chemo-photodynamic anti-cancer agent. The glutathione (GSH)-cleavable disulfide bond was inserted into the backbone of the polymer for biodegradation inside tumor cells, and DOX conjugated onto the polymer with a disulfide bond was successfully released intracellularly. NPs(Ce6) released DOX and Ce6 with their original molecular structures and degraded into segments with low MWs of 41.2 kDa in the presence of GSH. NPs(Ce6) showed a chemo-photodynamic therapeutic effect to kill 4T1 murine breast cancer cells, which was confirmed from a collapsed cell morphology, a lifted level in the intracellular reactive oxygen species, a reduced viability and induced apoptosis. Moreover, ex vivo fluorescence images indicated that NPs(Ce6) retained in the tumor, and exhibited a remarkable in vivo anticancer efficacy. The combinational therapy showed a significantly increased tumor growth inhibition (TGI, 58.53%). Therefore, the redox-responsive, amphiphilic block polymeric prodrug could have a great potential as a chemo-photodynamic anti-cancer agent.

1. Introduction

Chemotherapy is generally considered to be one of the most efficient methods for antitumor therapy, while photodynamic therapy (PDT), which uses light to excite photosensitizers (PSs) to generate reactive oxygen species (ROS) for oxidizing intracellular biomacromolecules to induce the death of tumor cells, offers minimal invasive treatment for assisting in chemotherapy1,2. However, a low antitumor efficiency and severe systemic toxic effects of chemotherapeutics and poor water solubility and insufficient tumor accumulation of PDT agents have hampered their application3. To overcome these challenges, nanomedicines derived from liposomes, micelles, nanoparticles, dendrimers and other polymers have been applied as drug delivery systems (DDSs) for anti-tumor agents4, 5, 6, 7, 8, 9, 10. These nanomedicines have improved their accumulation owing to the enhanced permeability and retention (EPR) effect, which can decrease side effects and enhance therapeutic efficacies11, 12, 13, 14. Among these reported systems, functional polymers in response to the tumor microenvironment have been designed as smart DDSs with great potential for cancer diagnosis and therapy.

Abstract

Keywords

1. Introduction

2. Emergency management in healthcare

3. Methods

4. Data analysis

5. Results

6. Discussion

7. Limitations

8. Practical recommendations

9. Conclusion

Funding

Declaration of competing interest

Appendix. Kendall Tau Correlation

References

Abstract

Emergency management (EM) professionals play an integral role in preparing healthcare organizations for disasters but evidence of their pervasiveness in Canadian healthcare is limited. Through an exploratory Canada-wide survey of EM in healthcare organizations, we aim to develop understanding of the prevalence and effectiveness of the disaster preparedness activities enacted in preparation for COVID-19. The online survey generated 161 responses; 150 (93%) had EM responsibility. EM reported that reviewing infectious disease (pandemic) plans and protocols was the most widespread activity (82%), while simulation-based exercises was the least (26%). Organizational incident management response to COVID-19 was led by a sole ‘incident commander’ 61% of the time, while 39% of ‘incident commands’ were led by multiple individuals. Of all those assigned to lead IM, only 68% received training in that role. Overall, the prevalence of disaster preparedness activities in healthcare organizations was positively associated with leaders who received training in incident response and having a dedicated EM resource. Meanwhile, the overall effectiveness of activities was positively correlated with having a sole ‘incident commander’ and was found to improve as the overall prevalence of activities rose. The study provides strong evidence for regional, organizational, and EM resource variation in the delivery of disaster preparedness activities and training for leaders in Canadian healthcare. Hence, we recommend the creation of a national health emergency preparedness system which includes legislated standards and a national training centre to ensure Canadian healthcare is bolstered against future disasters including pandemics.

1. Introduction

1Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) was declared a pandemic by the World Health Organization (WHO) in March 2020 [1] and as of April 2021, has infected over 132 million and claimed more than 2 million lives [2]. As of May 2021 Canada has 1,305,770 cases with 64,802 hospitalizations and 24,766 deaths [3]. Prior to the COVID pandemic the Canadian Health System was already under immense pressure to provide equitable access to coordinated care, notably specialist and elective surgical services [4]. As news coming out of China became more difficult to ignore and cases were detected internationally in early 2020, public health entities and epidemiological experts within Canada started sounding the alarm. In healthcare organizations preparedness activities intensified as cases appeared in the Toronto area.

Evidence soon showed widespread community transmission within most Canadian provinces. As a result, efforts related to planning and preparedness quickly shifted to response with case counts rising rapidly. By March 22nd all Canadian provinces and territories had declared states of emergency [5]. Provincial health systems struggled to provide consistent guidance to health providers and services were constricted to focus efforts on building capacity for anticipated COVID-19 patients. Canada’s ability to mount a coordinated and standardized response to national health crisis suffers from untested emergency management plans and struggles over jurisdictional issues [6,7]. As a result, many healthcare organizations in Canada remain chronically un-prepared for potential disasters, including global pandemics [8]. While evidence for the impact of COVID-19 on hospital services and operations, including switching to virtual care delivery models, are beginning to emerge [9], what remains unclear is just how effective, and wide-spread, were emergency preparedness activities undertaken by healthcare organizations in the response to COVID-19.