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Background and Purpose: This narrative review focuses on the role of mobile MRI and CT units in addressing the challenges of healthcare accessibility and patient wait times in Saudi Arabia. It underscores the growing demand for diagnostic imaging amid infrastructural and geographical barriers, emphasizing mobile units as innovative solutions for enhancing radiological services across diverse Saudi landscapes. The purpose of this study is to assess how these mobile technologies can mitigate service delays, improve patient outcomes, and support healthcare delivery in remote or underserved areas, reflecting on global trends towards more dynamic, patient-centered healthcare models., Methods: This review utilizes an expanded database search and refined keywords to ensure comprehensive literature coverage. The study focused on peer-review articles and grey literatures that directly examined the impact of these mobile units on healthcare accessibility, wait times, and service delivery. A thematic analysis identified significant contributions to accessibility improvements, emergency responses, and rural healthcare, highlighting areas for further research and policy development., Discussion: Mobile units have advanced technical specifications with high-field magnets and multi-slice CT scanners on par with fixed facilities. They prioritize patient comfort and safety with examination areas, control rooms, and waiting areas. Telemedicine capabilities allow real-time image transmission to specialists. Strategic deployment can address workforce shortages by distributing services equitably. Mobile units represent cost-effective solutions to expand healthcare access without fixed infrastructure., Conclusion: Integration of mobile MRI and CT units in Saudi Arabia can transform access to diagnostic imaging by decentralizing services and directly reaching patients, including rural areas. Evidence shows mobile units reduce diagnostic delays and optimize resource use. Despite challenges, strategic investments and collaborations can overcome obstacles to make radiological services more equitable, flexible and patient-focused in Saudi Arabia., (Copyright © 2024. Published by Elsevier Inc.)

Background: Mobile stroke units have been shown to deliver faster patient care and improve clinical outcomes. However, costs associated with staffing limit their use to densely populated cities. Using the Melbourne mobile stroke unit, we aim to evaluate the safety, timeliness, and resource efficiency of a telemedicine model, where the neurologist assesses a patient remotely, via telemedicine, compared with an onboard neurologist model. We hypothesize that, without compromising patient safety, the telemedicine model will provide timely care and superior resource efficiency., Methods: Using a prospective, randomized, blinded end-point controlled design, 270 participants consecutively assessed on the Melbourne mobile stroke unit over ≈12 months will be assigned into 2 arms: (1) telemedicine neurologist assessment (intervention) versus (2) onboard assessment (comparator). Enrollment is based on prospectively designated randomized days of neurologist review onboard versus telemedicine. The primary outcome will be the odds that a randomly selected participant in the telemedicine arm will have a better outcome than a randomly selected participant in the onboard arm, measured using a desirability-of-outcome ranking, an outcome measure that includes, in order of importance: (1) safety, (2) scene-to-treatment-decision time metrics, and (3) resource usage. All participants within each arm will be compared with those in the other, resulting in a "win/tie/loss" distribution for telemedicine compared with the onboard model., Conclusions: The study will establish whether use of a telemedicine neurologist delivers superior resource efficiency without compromising patient care. This would enable the broader use of mobile stroke units, particularly relevant to regions with limited access to neurologists, thus improving equity in access to time-critical, lifesaving stroke care., Registration: URL: clinicaltrials.gov; Unique Identifier: NCT05991310.

Background: The Munich Oktoberfest, the largest folk festival in the world, attracts around 6.2 million visitors over 16-18 days. Some of the visitors exhibit certain risky behaviors, leading to a significantly increased number of medical emergencies during the festival. During Oktoberfest, the prehospital and clinical emergency services of the city are heavily strained, as one-third more ambulances are needed, and over 7000 patients must be treated on-site each year. Until 2022, there was no option for guideline-compliant radiological assessment on-site for patients with head or facial trauma and suspected serious trauma-related injuries. This required a large number of emergency service admissions to hospitals, mostly for outpatient assessments. To relieve the overburdened medical system, a mobile computed tomography (CT) scanner was set up on the Oktoberfest grounds in 2022 for the first time., Methods: A mobile CT scanner at the Munich Oktoberfest was utilized for diagnosing injuries to the face, cranium, and cervical spine. For an indication of cranial CT, we used a combination of the Canadian CT Head Rule and NEXUS criteria. Despite the complex structural conditions, this integration seamlessly fit into the structured processes of the on-site medical service. Since this deployment was, to our knowledge, the first of its kind globally, we had to develop and implement new clinical concepts and procedures tailored to the unique conditions of a folk festival., Results: We demonstrated that a CT scanner could be effectively integrated into the preclinical processes of a medical service without direct hospital connection. On-site CT diagnostics proved to be a highly effective means of avoiding unnecessary transportation to the hospital. Consequently, a reduction in emergency medical service provision and stabilization of clinical emergency medicine during the Oktoberfest became feasible., Conclusion: From the authors' perspective, establishing a mobile CT scanner at events with high or very high demands on preclinical and clinical emergency medicine is feasible and provides significant relief for the system. The primary goal of stabilizing prehospital and clinical emergency structures, as well as improving the detection and treatment of potentially life-threatening patients on-site, was successfully achieved. Careful integration into the overall process flow is essential., Competing Interests: Declarations. Conflict of interest: W. Flatz, P. Reidler, P. Kampmann, K.-G. Kanz, J. Ricke, J.J. Bazarian, D. Hinzmann and V. Bogner-Flatz declare that they have no competing interests. For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case. The supplement containing this article is not sponsored by industry., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Participating in antenatal clinics is a major determinant in reducing poor maternal and neonatal birth outcomes. We aimed to evaluate the utilization of antenatal clinic (ANC) services provided by a mobile clinic led by skilled midwives and determine the acceptability in the Pwani region, Tanzania. For a year, the mobile clinic, nicknamed "Mkunga Kitaani" and equipped with necessary tools and staff, served seven villages in the Kisarawe district that lacked health facilities. The research was conducted using a descriptive study design, incorporating both qualitative and quantitative methods. Qualitative and quantitative data were collected through 12 interviews and 214 medical records among pregnant women, respectively. The results show that approximately 17% of the women initiated ANC early, while 36% made their visit during their third trimester. Participants generally preferred the mobile clinic over traditional facilities due to its provision of comprehensive care. However, challenges such as clinic unreliability during the rainy season and limited availability of tests, including obstetric ultrasounds, were noted. Despite hurdles, the study highlighted increased ANC access and community engagement, suggesting potential for expansion to other underserved rural areas. The findings underscore the importance of innovative approaches to ANC delivery in regions with limited healthcare infrastructure.

Youth have been increasingly struggling with their mental health, leading to an unprecedented rise in emergency room visits and inpatient psychiatric admissions. It is prudent for mental health providers to be familiar with all services within a continuum of care that can address the early phases of a crisis, allowing youth to remain in the community while being treated. The system of care (SOC) approach has demonstrated positive effects in mitigating the need for hospital-based services. There is a call among experts to integrate SOC concepts during inpatient psychiatric admissions to promote youth remaining within a community after discharge., Competing Interests: Disclosure The authors have no disclosures or conflict of interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To model the potential impact of mobile methadone unit implementation in Louisiana on net medication for opioid use disorder (MOUD) treatment rates., Data Sources/study Setting: We use secondary Louisiana Medicaid claims data between 2020 and 2021., Study Design: We simulate the impact of mobile methadone units in Louisiana using two approaches: (1) a "Poisson regression approach," which predicts the number of opioid use disorder (OUD) patients that might use methadone at mobile locations based on the underlying association between methadone use and proximity to a brick-and-mortar methadone clinic; (2) a "policy approach," which leverages local treatment uptake rates following the expansion of methadone coverage to Louisiana Medicaid beneficiaries in 2020 to estimate methadone use following mobile unit implementation. Models were run in cases where mobile methadone operators could choose their operation locations freely and in a separate instance where they were restricted to serving rural locations., Data Collection: Our analytic sample includes 43,341 Louisiana Medicaid beneficiaries with one or more primary or secondary diagnoses for opioid dependence., Principal Findings: We predict that 10 new mobile methadone units in Louisiana would increase the net MOUD treatment rate in the state by 0.54-2.39 percentage points. If these mobile units delivered Methadone exclusively to rural areas, they could increase rural MOUD treatment by 8.54-13.67 percentage points. Further, roughly 20% of all beneficiaries residing in rural areas being treated with methadone would be an average of 24 miles closer to a methadone treatment provider following mobile unit implementation., Conclusions: Mobile methadone units represent a promising innovation in the delivery of methadone that is likely to increase methadone use, especially in underserved rural locations. However, we find significant variation in their impact conditional on where they choose to operate, and so careful location planning will be required to maximize their benefit., (© 2023 Health Research and Educational Trust.)

With an ever-increasing number of humanitarian emergencies being declared around the globe, identifying effective methods to provide healthcare access to affected communities is all the more relevant to health practitioners. Mobile health services have been widely implemented by international and national actors to reach underserved communities in humanitarian contexts. Nonetheless, little rigorous evidence exists on the effects of such services. Our work contributes to filling the knowledge gap by studying the role of mobile health teams (MHTs) in Afghanistan after the institution of the Taliban De Facto Authority in 2021. We conduct correlational and quasi-experimental analysis of country-wide survey data and matched with geo-localised information on MHTs and their related service delivery points (SDPs) - at least in part of the country - from WHO and UNICEF. Our findings show mobile services enhance recent access to health care by about 11 percentage points (about 14% over comparison) based on our preferred model. We also identify a decreasing effect of number of MHTs and SDPs on healthcare access. Our results indicate that higher number of mobile services do not necessarily translate to better access, although strong differences exist between underserved and better served areas within the country., Competing Interests: Declaration of competing interest The authors are affiliated with UNICEF Evaluation Office. The views expressed in this paper are the authors’ alone and do not reflect the views of UNICEF in any shape or form., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Care of the critically ill in resource-limited areas, inside or outside the intensive care unit (ICU), is indispensable. Murthy and Adhikari noted that about 70% of patients in low-middle income (LMIC) areas could benefit from good critical care. Many patients in resource-limited settings still die before getting to the hospital. Investing in capacity building by strengthening and expanding ICU capability and training intensivists, critical care nurses, respiratory therapists, and other ICU staff is essential, but this process will take years. Also, having advanced healthcare facilities that are still far from remote areas will not do much to alleviate distance and mode of transportation as barriers to achieving good critical care. This paper discusses the importance of mobile critical care units (MCCUs) in supporting and enhancing existing emergency medical systems. MCCUs will be crucial in addressing critical delays in transportation and time to receive appropriate lifesaving critical care in remote areas. They are incredibly versatile and could be used to transfer severely ill patients to a higher level of care from the field, safely transfer critically ill patients between hospitals, and, sometimes, almost more importantly, provide standalone short-term critical care in regions where ICUs might be absent or immediately inaccessible. MCCUs should not be used as a substitute for primary care or to bypass readily available services at local healthcare centers. It is essential to rethink the traditional paradigm of 'prehospital care' and 'hospital care' and focus on improving the care of critically ill patients from the field to the hospital., Competing Interests: The author has no competing interests to declare., (Copyright: © 2024 The Author(s).)

In this article, the authors wish to offer the product of their reflections on the concept of coercive control, and share various findings from their day-to-day practice. The text should be read as an invitation to clinical reflection on the conceptualization of a specific form of abuse. Reflection on this approach, initially ignored by the authors, has enriched clinical thinking on certain care situations., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

The purpose of this article is to discuss the importance of policy transfer by humanitarian NGOs to post-disaster regions and the effectiveness of mobile Primary Health Care (PHC) services immediately after disasters. This study also focused on analysing the first 3 months aftermath of the earthquake and assessed the changes in the access and needs of vulnerable groups in emergency response creation and systematic interventions after disasters. In disasters that require urgent response such as earthquakes, the importance of the existing NGOs (Such as MdM) capacity in the countries has emerged in terms of rapid response and experience sharing. During the field work, it is observed that MdM Mobile Medical Units (MMU) teams had played a key role in terms of tracking PHC needs, functioning as early warning system for epidemics, and prevention of communicable diseases in the EQ effected areas. In this aspect, the changes in diagnoses in the first trimester is examined using the comparative analysis methods. This study used a cross-sectional mixed-method approach in terms of objective evaluation. The results from a quantitative needs assessment were complemented by qualitative data. Herein, the data were collected in two stages: First, primary data was collected through the field activities of MMU, and second field-based assessments was conducted with health professionals who have been working in the MMU teams since the first moments of the earthquake., (© 2024 John Wiley & Sons Ltd.)

In the last decade, mobile stroke units (MSUs) have shown the potential to transform prehospital stroke care, marking a paradigm shift in delivering ultra-rapid thrombolysis and streamlining triage processes. These units bring acute stroke care directly to patients, significantly shortening treatment times. This review outlines the rationale for MSU care and discusses the potential applications beyond the original purpose of delivering thrombolysis, including large vessel occlusion detection, intracerebral hemorrhage management, and innovative forms of prehospital research., Competing Interests: Declaration of Competing Interest None of the authors declare conflicts of interest related to this data. In the early stages of drafting, we used Chat-GPT (version 3.5) to aid with grammar and readability of select sections. All conceptualization, literature review, development of the ideas discussed in the article, and revisions were carried out by the authors., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: In the German rehabilitation system, gaps in care exist that particularly affect people with complex impairments under 60 years of age. Home-based rehabilitation, an outreach form of outpatient rehabilitation, could bridge this gap by providing access to rehabilitation for this group of patients. Corresponding facilities so far barely exist in Germany. In view of the likely complexity and the associated problems of this group of people, needs-based care may also require a cross-indication approach in order to adequately address rehabilitation needs across different organ systems. The aim of this study is to assess 1) the general need for home-based rehabilitation and associated potentials, 2) attitudes towards a cross-indication approach, and 3) indication and allocation criteria for this approach from an expert perspective., Methods: Data was collected from 08/2022 to 10/2022 through semi-structured individual telephone interviews with experts in the field of rehabilitation. Data were analyzed using qualitative content analysis according to Kuckartz and Rädiker., Results: A total of n = 22 experts were interviewed. The experts see a high need for home-based rehabilitation for people with complex health impairments under the age of 60 in order to counteract existing care gaps within current rehabilitative offers. The potentials offered by home-based rehabilitation include, amongst others, flexibility, participation orientation and involvement of the social environment (e.g., of relatives). A cross-indication approach is considered relevant by the majority of the experts, especially in order to meet more complex needs (e.g., in the case of multimorbidity) in a holistic and needs-based manner., Conclusion: The results demonstrate the relevance of this topic and the necessity of expanding (cross-indication) home-based rehabilitation in Germany. According to the experts, (cross-indication) home-based rehabilitation can help to ensure the participation of a group of patients with complex and severe impairments under the age of 60., (Copyright © 2024. Published by Elsevier GmbH.)

Background: Overdose deaths continue to rise within the United States, despite effective treatments such as buprenorphine and methadone for opioid use disorder (OUD). Mobile medical units with the ability to dispense buprenorphine have been developed to engage patients and eliminate barriers to accessing OUD treatment. This study reports survey responses of patients of a mobile medical unit dispensing buprenorphine in areas of Chicago, IL with high overdose rates., Methods: All patients who were dispensed buprenorphine via the mobile medical unit were invited to participate in a 7-item anonymous survey between May 24, 2023, and August 25, 2023. The survey included 5-point satisfaction scale, multiple-choice, and open-ended questions. Outcomes included satisfaction with buprenorphine dispensing from the mobile medical unit, satisfaction with filling buprenorphine at a pharmacy in the past, barriers experienced at pharmacies when filling buprenorphine, and whether the client would have started treatment that day if the mobile medical unit had not been present. Satisfaction scale and multiple-choice question responses were assessed using descriptive statistics. Wilcoxon signed-rank test was used to compare median satisfaction levels between receiving buprenorphine from the mobile medical unit versus filling a buprenorphine prescription at a community pharmacy. Open-ended questions were analyzed qualitatively using inductive thematic analysis., Results: 106 unique patients were dispensed buprenorphine from the mobile unit during the study period. Of these patients, 54 (51%) completed the survey. Respondents reported high satisfaction with the buprenorphine dispensing process as a part of a mobile medical unit. Of those who had previously filled buprenorphine at a pharmacy, 83% reported at least one barrier, with delays in prescription dispensing from a community pharmacy, lack of transportation to/from the pharmacy, and opioid withdrawal symptoms being the most common barriers. 87% reported they would not have started buprenorphine that same day if the mobile medical unit had not been present. Nearly half of survey participants reported having taken buprenorphine that was not prescribed to them. Qualitative analysis of open-ended survey responses noted the importance of convenient accessibility, comprehensive care, and a non-judgmental environment., Conclusions: Mobile medical units that dispense buprenorphine are an innovative model to reach patients with OUD who have significant treatment access barriers. This study found that patients who experienced barriers to accessing buprenorphine from a pharmacy were highly satisfied with the mobile medical unit's buprenorphine dispensing process. Programs seeking to develop mobile buprenorphine dispensing programs should consider patient priorities of accessibility, comprehensive care, and welcoming, non-judgmental environments., (© 2024. The Author(s).)

Perinatal psychiatry is now defined in the French Public Health Code as joint parent-baby care. It focuses on parent-baby interactions, the baby's development and the parents' psychological health. "Mobile teams" for joint (parent-baby) care, the very first of which date back to the 1990s, have been developed modestly thanks to the call for perinatal psychiatry projects in 2021 and those for child and adolescent psychiatry since 2019. These mobile units complement full-time outpatient and inpatient joint care units., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Introduction: Lung cancer is a leading cause of cancer deaths globally. Despite favorable recommendations, low-dose computed tomography (LDCT) lung screening adoption remains low in China. Barriers such as limited infrastructure, costs, distance, and personnel shortages restrict screening access in disadvantaged regions. We initiated a telemedicine-enabled lung cancer screening (LCS) program in a medical consortium to serve people at risk in underserved communities. The objective of this study was to describe the implementation and initial results of the program. Methods: From 2020 to 2021, individuals aged 40-80 years were invited to take LCS by mobile computed tomography (CT) units in three underserved areas in Western China. Numerous CT scans were remotely reported by radiologists aided by artificial intelligence (AI) diagnostic systems. Abnormal cases were tracked through an integrated hospital network for follow-up. A retrospective cohort study documented participant demographics, health history, LDCT results, and outcomes. Descriptive analysis was conducted to report baseline characteristics and first-year follow-up results. Results: Of the 28,728 individuals registered in the program, 19,517 (67.94%) participated in the screening. The study identified 2.68% of participants with high-risk pulmonary nodules and diagnosed 0.55% with lung cancer after a 1-year follow-up. The majority of high-risk participants received timely treatment in hospitals. Conclusions: This study demonstrated mobile CT units with remote AI assistance improved access to LCS in underserved areas, with high participation and early detection rates. Our implementation supports the feasibility of deploying telemedicine-enabled LCS to increase access to a large scale of basic radiology and diagnostic services in resource-limited settings. Clinical Trial Registration Number: ChiCTR1900024623 .

With annual point-in-time counts indicating a rise in unsheltered homelessness in the United States, much attention has been paid to how to best provide care to this population. Mobile medical units (MMUs) have been utilized by many programs. However, little is known regarding the evidence behind their effectiveness. A scoping review is conducted of research on MMU provision of medical services for populations experiencing homelessness in the USA to examine the extent and nature of research activity, summarize available evidence, and identify research gaps in the existing literature. Following guidelines for scoping reviews, PubMed and Google Scholar were used to identify an initial 294 papers published from January 1, 1980, to May 1, 2023, using selected keywords, which were distilled to a final set of 50 studies that met eligibility criteria. Eligible articles were defined as those that pertain to the provision of healthcare (inclusive of dental, vision, and specialty services) to populations experiencing homelessness through a MMU in the United States and have been published after peer review. Of the 50 studies in the review, the majority utilized descriptive (40%) or observational methods (36%), with 4 review and 8 controlled studies and no completed randomized controlled trials. Outcome measures utilized by studies include MMU services provided (58%), patient demographics (34%), health outcomes (16%), patient-centered measures (14%), healthcare utilization (10%) and cost analysis (6%). The studies that exist suggest MMUs can facilitate effective treatment of substance use disorders, provision of primary care, and services for severe mental illness among people experiencing homelessness. MMUs have potential to provide community-based healthcare services in settings where homeless populations reside, but the paucity of randomized controlled trials indicates further research is needed to understand if MMUs are more effective than other care delivery models tailored to populations experiencing homelessness., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Since its creation in 1993, Samusocial de Paris has been working with homeless people as part of its "outreach" approach. Mission Migrants, a mobile healthcare access service, works throughout the inner suburbs of Paris, helping precarious exiles wherever they are, and wherever they are at (in their pathways and access to healthcare). Its teams of nurses and mediator-interpreters visit camps, squats, shelters, day shelters and temporary accommodation centers to mediate, assess and guide them towards the care they need., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Less than 30% of people in Africa received a dose of the COVID-19 vaccine even 18 months after vaccine development 1 . Here, motivated by the observation that residents of remote, rural areas of Sierra Leone faced severe access difficulties 2 , we conducted an intervention with last-mile delivery of doses and health professionals to the most inaccessible areas, along with community mobilization. A cluster randomized controlled trial in 150 communities showed that this intervention with mobile vaccination teams increased the immunization rate by about 26 percentage points within 48-72 h. Moreover, auxiliary populations visited our community vaccination points, which more than doubled the number of inoculations administered. The additional people vaccinated per intervention site translated to an implementation cost of US $33 per person vaccinated. Transportation to reach remote villages accounted for a large share of total intervention costs. Therefore, bundling multiple maternal and child health interventions in the same visit would further reduce costs per person treated. Current research on vaccine delivery maintains a large focus on individual behavioural issues such as hesitancy. Our study demonstrates that prioritizing mobile services to overcome access difficulties faced by remote populations in developing countries can generate increased returns in terms of uptake of health services 3 ., (© 2024. The Author(s).)

Background: Health care access for migrant farmworkers is limited given the nature of seasonal farm work, including migration patterns, capacity, and availability of local community health services. Consideration of these contextual elements when exploring a community-academic partnership to increase access to care for migrant farmworkers is essential., Objective: Explore the partnerships and processes for integrating nursing faculty and students from a regional public university's school of nursing into a farmworker health outreach program's mobile clinic process., Methods: A feasibility study was undertaken using Bowen et al.'s feasibility framework., Results: Integrating faculty and students into the farmworker health outreach program's mobile clinic process was determined to be feasible., Conclusions: Integrating faculty providers and students into a farmworker outreach program's mobile health process has several nuances requiring consideration before operationalizing the partnership, including nursing faculty practice (e.g., credentialing, malpractice insurance), student clinical placement processes, the farmworker outreach program's processes, and farmworker availability.

In 2022, Penn State College of Medicine launched the LION Mobile Clinic, a teaching mobile health clinic offering preventive health services in rural Snow Shoe, Pennsylvania. We outline four challenges the clinic team faced in implementation, along with adaptations made to tailor the model to Snow Shoe's needs and opportunities.

Introduction: This article describes the surgical component of the Continuing Promise 2018 (CP-18) medical training and military cooperation mission. We report on the surgical experience and lessons learned from performing peacetime ambulatory surgeries in a tent-based facility constructed on partner nation territory., Methods: This CP mission was unique in utilizing a land-based expeditionary surgical facility. Institutional Review Board approval was obtained to collect prospective deidentified patient data and aggregate information on all surgical cases performed. Specific aims of this study included describing surgical patient characteristics and evaluating conservatively selected cases performed in this environment. Body mass index (BMI) was used as a crude screening tool for perioperative risk to assist patient selection. Our secondary aim was to report lessons learned from preparation, logistics, and host nation exchanges. The team coordinated medical credentialing and documentation of all medical supplies with each host nation. Advance teams collaborated with local physicians in country to arrange training exchanges and identify surgical candidates., Results: The mission was conducted from February to April 2018. Only two of five planned partner nation visits were completed. The surgical facility supported 78 procedures over 14 surgical days, averaging over six cases performed per core surgical day. Patients were predominantly female, with a mean age of 25.4 and a mean BMI of 31.1. The average surgical time was 37.5 minutes, the average anesthesia time was 70 minutes, and the average recovery time was 47.6 minutes. No significant complications or adverse events were noted., Conclusions: CP-18 was the first CP mission to perform elective ambulatory surgery on foreign soil using a tent-based facility in a noncombat, nondisaster environment instead of a hospital or amphibious ship. This mission demonstrated that such a facility may be employed to safely perform low-risk ambulatory surgeries on carefully selected patients. The Expeditionary Medical Unit, coupled with the fast transport vessel enabled rapid expeditionary surgical facility setup with significant military and disaster relief applications. Expansion of surgical indications should be performed carefully and deliberately to avoid complications and damage to international relationships., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: Mobile clinics have been implemented in diverse clinical and geographical settings to provide proximal health care for specific populations. Primary health care mobile clinics have been implemented widely for Indigenous populations, with a paucity of research evaluations around service delivery models internationally. To redress factors impeding service accessibility for Aboriginal and Torres Strait Islander Peoples, Budja Budja Aboriginal Cooperative (Aboriginal Community Controlled Health Organisation located in a small rural town in Victoria, Australia), developed and implemented the Tulku wan Wininn primary health mobile clinic., Methods: A qualitative process evaluation methodology was used to explore contextual factors mediating the implementation of the mobile clinic, including the acceptability of the service to health service personnel, external key informants, and Aboriginal and/or Torres Strait Islander clients. A synthesis of international ethical guidelines, (Consolidated Criteria for strengthening reporting of health research involving Indigenous peoples (CONSIDER statement), was prospectively applied to shape the study design and research process. Semi-structured interviews were conducted with participants. Data collection occurred from July 2019 to October 2021. Inductive thematic data analysis was undertaken concurrently with data collection., Results: Data was collected from 19 participants which included 12 health service personnel and key informants, and 7 Aboriginal clients. In total, data from 22 interviews were included as interviews with three clients were undertaken twice. Four themes were developed: considerations for early implementation, maintaining face-to-face services during COVID-19, acceptability as a model of service delivery, and maintaining the mobile clinic as a service delivery model., Conclusion: Evidence supporting the acceptability of a primary health care mobile clinic for Aboriginal Peoples residing in rural Victoria is provided. Despite the experience of early implementation challenges and adaptations, the mobile clinic addressed known transport and cultural barriers to accessing primary health care services. In the context of COVID-19 lockdowns, the mobile clinic was valued for the provision of face-to-face care for Aboriginal clients. Key issues for maintaining the mobile clinic include health workforce and funding. Findings are of value to other organizations seeking to implement a primary health mobile clinic service delivery model to redress barriers to accessibility experienced by the communities they serve., (© 2022. The Author(s).)

Abstract: Rehabilitation experts play an important role in preventing hospital-acquired debility, increasing patients' abilities to safely perform activities of daily living, and facilitating discharge to the home setting for patients with COVID-19. Surges in COVID-19 hospitalization rates combined with increases in length of hospital stay and decreases in postacute care placements have necessitated the opening of COVID-19 field hospitals around the country. Most field hospitals lack the resources to offer a full suite of rehabilitation services, but there are opportunities for small teams of rehabilitation experts to increase their reach by using innovative strategies. This article describes the implementation of a small team of rehabilitation experts in a COVID-19 field hospital and strategies used by this team to maximize patient activity and mobility, facilitate timely discharge, and maximize the number of patients discharged to the home setting. Strategies include training nonclinical staff to assist with activity and mobility promotion and using a rehabilitation triage system to determine needs of individual patients and facilitate efficient resource utilization. The authors reflect on successful aspects of these strategies, as well as barriers to rehabilitation implementation, and make recommendations for other field hospitals seeking to implement rehabilitation during the COVID-19 pandemic or future health crises., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To understand the role of nurses in field hospitals aimed at patients with Covid-19., Methods: Qualitative research based on Alfred Schütz's social phenomenology. Twenty nurses working in São Paulo were interviewed between May and June 2020. The testimonies were organized and analyzed based on the theoretical-methodological and thematic framework., Results: The following categories emerged: "Nurses' challenges in field hospital care", "Visibility of nursing in the Covid-19 pandemic scenario" and "Covid-19 post-pandemic professional valorization"., Final Considerations: The reflection on the results that emerged in this study may contribute to support improvements in training, working conditions and valuing nurses, considering the importance of this professional category in the scope of health services. New investigations may increase knowledge in the area, providing subsidies for professional role in this and other health situations that require nursing intensity and excellence.

Competing Interests: Competing interests: None declared.

Objective: To assess the implementation of a mobile dispensing service to improve opioid users' access to methadone maintenance therapy., Methods: In March 2019, we started mobile methadone dispensing in an urban underprivileged locality in Delhi, India. The doctor was available only at the main community drug treatment clinic for clinical services, while the nurse dispensed methadone from a converted ambulance. We involved patients in identifying community leaders for sensitization and in deciding the location and timings for dispensing. We conducted a retrospective chart review of the programme data collected during delivery of clinical services. We compared the numbers of patients registered for methadone therapy and their retention and adherence to therapy in the 12-month periods before and after implementation of the mobile service., Findings: The number of patients registered for therapy at the clinic increased from 167 in the year before implementation to 671 in the year after. A significantly higher proportion of patients were retained in therapy at 3, 6 and 9 months after enrolment; 9-month retention rates were 19% (32/167 patients) and 45% (44/97 patients) in the year before and after implementation, respectively. There was no significant difference in patients' adherence to therapy between the two periods. Challenges included providing suitable dispensing hours for patients in employment and concerns of local community near to the dispensing sites., Conclusion: It is feasible to dispense methadone by a mobile team in an urban setting, with better retention rates in therapy compared with dispensing through a stationary clinic., ((c) 2021 The authors; licensee World Health Organization.)

Alternate care sites (ACS) are locations that can be converted to provide either in-patient and/or out-patient health care services when existing facilities are compromised by a hazard impact or the volume of patients exceeds available capacity and/or capabilities. In March through May of 2020, Michigan Medicine (MM), the affiliated health system of the University of Michigan, planned a 500 bed ACS at an off-site location. Termed the Michigan Medicine Field Hospital (MMFH), this ACS was intended to be a step-down care facility for low-acuity COVID-19 positive MM patients who could be transitioned from the hospital setting and safely cared for prior to discharge home, while also allowing increased bed capacity in the remaining MM hospitals for additional critical patient care. The planning was organized into six units: personnel and labor, security, clinical operations, logistics and supply, planning and training, and communications. The purpose of this report is to describe the development and planning of an ACS within the MM academic medical center (AMC) to discuss anticipated barriers to success and to suggest guidance for health systems in future planning.

Abstract: To describe and advise on management protocols and infection-protection experience of the radiology department in makeshift hospitals in Wuhan during the coronavirus disease 2019 (COVID-19) outbreak.Based on the literature review and the experience in the frontline, we retrospectively reviewed the configuration of the radiology department, human resource, personal protection, examination procedures for patients confirmed with COVID-19 in Wuhan fangcang shelter hospital.From February 11, 2020 to March 10, 2020, 2730 and 510 CT examinations were performed in the Hanjiang shelter hospital and Hanyang Sports School shelter hospital, respectively, including initial examinations and re-examinations. The maximum number of daily CT examinations reached 289. The CT scanned a patient approximately once every 13 mins.Fangcang shelter radiology department could be powerful components of both global and national responses to the COVID-19 pandemic., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

As hospitals across the world realized their surge capacity would not be enough to care for patients with coronavirus disease-2019 (COVID-19) infection, an urgent need to open field hospitals prevailed. In this article the authors describe the implementation process of opening a Boston field hospital including the development of a culture unique to this crisis and the local community needs. Through first-person accounts, readers will learn (1) about Boston Hope, (2) how leaders managed and collaborated, (3) how the close proximity of the care environment impacted decision-making and management style, and (4) the characteristics of leaders under pressure as observed by the team., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Fangcang shelter (Cabin) hospitals were set up in order to cope with the rapid growth of confirmed cases of coronavirus disease 2019 (COVID-19) in Wuhan, China at a time when there were insufficient beds in designated hospitals. This paper describes the layout and functioning of a typical Fangcang shelter hospital, Wuhan Dongxihu Fangcang shelter Hospital, where the author has worked, the working mechanism, experience and effectiveness. A set of patient management protocols was employed for daily practice, which included preset criteria and procedure for admission, examination, medication treatment, referral and discharge. WeChat platform with different groups was used for communication, ward round, test appointments and patient data communication. All these procedures and mechanisms of working enabled the effective management of a larger number of patients with relatively few doctors. As a result, 442 mild or moderate COVID-19 patients in Hall C were successfully managed by a team of 40 doctors, with 246 (56%) patients were cured and discharged from the Fangcang shelter hospital while the remaining 196 (44%) patients were referred on to designated hospitals for further treatment. The reasons for referral included poor resolution in computerized tomography (CT) scan (59%), persistently positive severe acute respiratory syndrome coronavirus 2 by PCR after 9 days of admission (16%), deterioration in CT image (4%), development of dyspnoea (1%) and other (4%) or unclear reasons (16%) due to no record of reasons for referral on the document. There were no deaths and no complaints from the patients in Hall C. In summary, the Fangcang shelter hospital could be run successfully with a set of patient management protocols under conditions of limited facilities and medical staff. It was effective and safe in isolating patients, providing basic medical care and early identification of potential severe cases. This experience may provide a successful example of a working mechanism for the prevention and control of the COVID-19 pandemic worldwide., (© 2020 The Authors. The Clinical Respiratory Journal published by John Wiley & Sons Ltd.)

Background: The need for rapid point-of-care (POC) diagnostics is now becoming more evident due to the increasing need for timely results and improvement in healthcare service. With the recent COVID-19 pandemic outbreak, POC has become critical in managing the spread of disease. Applicable diagnostics should be readily deployable, easy to use, portable, and accurate so that they fit mobile laboratories, pop-up treatment centers, field hospitals, secluded wards within hospitals, or remote regions, and can be operated by staff with minimal training. Complete blood count (CBC), however, has not been available at the POC in a simple-to-use device until recently. The HemoScreen, which was recently cleared by the FDA for POC use, is a miniature, easy-to-use instrument that uses disposable cartridges and may fill this gap., Content: The HemoScreen's analysis method, in contrast to standard laboratory analyzers, is based on machine vision (image-based analysis) and artificial intelligence (AI). We discuss the different methods currently used and compare their results to the vision-based one. The HemoScreen is found to correlate well to laser and impedance-based methods while emphasis is given to mean cell volume (MCV), mean cell hemoglobin (MCH), and platelets (PLT) that demonstrate better correlation when the vision-based method is compared to itself due to the essential differences between the underlying technologies., Summary: The HemoScreen analyzer demonstrates lab equivalent performance, tested at different clinical settings and sample characteristics, and might outperform standard techniques in the presence of certain interferences. This new approach to hematology testing has great potential to improve quality of care in a variety of settings., (© American Association for Clinical Chemistry 2020. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: To eliminate hepatitis C, Rwanda is conducting national mass screenings and providing to people with chronic hepatitis C free access to Direct Acting Antivirals (DAAs). Until 2020, prescribers trained and authorized to initiate DAA treatment were based at district hospitals, and access to DAAs remains expensive and geographically difficult for rural patients. We implemented a mobile clinic to provide DAA treatment initiation at primary-level health facilities among people with chronic hepatitis C identified through mass screening campaigns in rural Kirehe and Kayonza districts., Methods: The mobile clinic team was composed of one clinician authorized to manage hepatitis, one lab technician, and one driver. Eligible patients received same-day clinical consultations, counselling, laboratory tests and DAA initiation. Using clinical databases, registers, and program records, we compared the number of patients who initiated DAA treatment before and during the mobile clinic campaign. We assessed linkage to care during the mobile clinical campaign and assessed predictors of linkage to care. We also estimated the cost per patient of providing mobile services and the reduction in out-of-pocket costs associated with accessing DAA treatment through the mobile clinic rather than the standard of care., Results: Prior to the mobile clinic, only 408 patients in Kirehe and Kayonza had been initiated on DAAs over a 25-month period. Between November 2019 and January 2020, out of 661 eligible patients with hepatitis C, 429 (64.9%) were linked to care through the mobile clinic. Having a telephone number and complete address recorded at screening were strongly associated with linkage to care. The cost per patient of the mobile clinic program was 29.36 USD, excluding government-provided DAAs. Providing patients with same-day laboratory tests and clinical consultation at primary-level health facilities reduced out-of-pocket expenses by 9.88 USD., Conclusion: The mobile clinic was a feasible strategy for providing rapid treatment initiation among people chronically infected by hepatitis C, identified through a mass screening campaign. Compared to the standard of care, mobile clinics reached more patients in a much shorter time. This low-cost strategy also reduced out-of-pocket expenditures among patients. However, long-term, sustainable care would require decentralization to the primary health-centre level.

In confronting the sudden epidemic of COVID-19, China and other countries have been under great deal of pressure to block virus transmission and reduce death cases. Fangcang shelter hospital, which is converted from large-scale public venue, is proposed and proven to be an effective way for administering medical care and social isolation. This paper presents the practice in information technology support for a Fangcang shelter hospital in Wuhan, China. The experiences include the deployment strategy of IT infrastructure, the redesign of function modules in the hospital information system (HIS), equipment maintenance and medical staff training. The deployment strategy and HIS modules have ensured smoothness and efficiency of clinical work. The team established a quick response mechanism and adhered to the principle of nosocomial infection control. Deployment of network and modification of HIS was finished in the 48 hours before patient admittance. A repair hotline and remote support for equipment and software were available whenever medical workers met with any questions. No engineer ever entered the contaminated areas and no one was infected by the coronavirus during the hospital operation. Up to now, Fangcang shelter hospital is adopted by many regions around the world facing the collapse of their medical systems. This valuable experience in informatization construction and service in Wuhan may help participators involving in Fangcang shelter hospital get better information technology support, and find more practical interventions to fight the epidemic.

This article reports the establishment of an isolated, fully functional field intensive care unit (FICU) unit equipped with all necessary critical care facilities as a part of the national pre-emptive preparedness to treat an unexpected surge outbreak of coronavirus disease 2019 (COVID-19) patients in Bahrain. One floor of an existing car parking structure was converted into a 130-bed FICU set-up by the in-house project implementation team comprised of multidisciplinary departments. The setting was a military hospital in the Kingdom of Bahrain, and the car park was on the hospital premises. The FICU contained a 112-bed fully equipped ICU and an 18-bed step-down ICU, and was built in 7 d to cater to the intensive care of COVID-19 patients in Bahrain.

Mobile Swab Collection Vehicle is a concept that has been innovated by a team of medical and non-medical personals based upon the dire need to perform throat or nasopharyngeal swab collections to do reverse transcription polymerase chain reaction  'RT-PCR' quickly, safely, and comfortably during this Corona Virus Diseases 2019, 'COVID-19' pandemic in a resource-poor country like Nepal. Inputs from the health care workers, beneficiaries, and engineers have been taken to construct this vehicle-mounted booth for swab collection. This vehicle is the 'first of its kind' in Nepal. Keywords: COVID-19; Nepal; swab collection vehicle.

Abstract: This study aimed to systematically analyze the effect of Wuhan mobile cabin hospitals (WMCHs) on the novel coronavirus-caused pneumonia (COVID-19) prevention and control in China. Between February 5, 2020 and March 10, 2020, a total of 16 mobile cabin hospitals were constructed in 3 batches to offer over 13,000 beds and admitted more than 12,000 patients in Wuhan City. The strategy of implementing WMCHs in 3 batches played a key role in fighting against COVID-19 in China. (1) The first batch of WMCHs increased hospital admission capacity of COVID-19 patients in Wuhan, which showed initial effect on COVID-19 epidemic control. (2) The operation of the second batch of WMCHs greatly contributed to the rapid growth in discharged patients. (3) After launching the third batch of WMCHs, the COVID-19 epidemic situation in Wuhan improved considerably. The last batch of WMCHs made a substantial contribution to defeating the COVID-19 epidemic in Wuhan., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Ischemic stroke caused by arterial occlusion is the cause of most strokes. The focus of treatment is rapid reperfusion through intravenous thrombolysis and intravascular thrombectomy. Two acute stroke management including prehospital thrombolysis and in hospital have been widely used clinically to treat ischemic stroke with satisfied efficacy. However, there is no systematic review comparing the effectiveness of these 2 therapies. The aim of this study is to compare the effect of prehospital thrombolysis versus in hospital for patients with ischemic stroke., Methods and Analysis: The following electronic databases will be searched: Web of Science, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Wanfang Database, and Chinese Scientific Journal Database.The randomized controlled trials of prehospital thrombolysis versus in hospital for ischemic stroke will be searched in the databases from their inception to December 2020 by 2 researchers independently. Onset to therapy (OTT) duration and National Institute Health Stroke Scale (NIHSS) scores will be assessed as the primary outcomes; safety assessment including intracerebral hemorrhage (ICH) and mortality will be assessed as the secondary outcomes. The Review Manager 5.3 will be used for meta-analysis and the evidence level will be assessed by using the method for Grading of Recommendations Assessment, Development and evaluation Continuous outcomes will be presented as the weighted mean difference or standardized mean difference with 95% confidence interval (CI), whereas dichotomous data will be expressed as relative risk with 95% CI. If heterogeneity existed (P < .05), the random effect model was used. Otherwise, we will use the fixed effect model for calculation., Ethics and Dissemination: Ethical approval is not required because no primary data are collected. This review will be published in a peer-reviewed journal., Prospero Registration Number: CRD42020200708., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Hospital admissions from COVID-19 initially increased rapidly within the UK. National Health Service (NHS) field hospitals are part of a capacity building response built at great scale and speed to respond to the anticipated increased demand the NHS faces during this time. NHS Nightingale Hospital Birmingham (NHB) is modelled to treat mild to moderate (non-critical care) COVID-19 disease, to provide step-down capacity for patients in recovery, or for palliating patients in the dying phase of their disease in the Midlands. Opportunities and challenges presented for optimal medicines management (MM) during the development of the NHB are investigated, and a framework developed to support future NHS field hospitals of this model., Methods: A team, comprised of an associate medical director, trust chief pharmacist and senior pharmacists iteratively developed a framework to convert the large non-hospital setting into a functioning NHS field hospital with standardised MM processes adjusted appropriately to cope with operational constraints in the pandemic situation. NHB has, because of its repurposing, both challenges and advantages affecting MM that influence development of the framework. Throughout implementation, a 7-week period between announcement and opening, there was continuous evaluation, external stakeholder validation and peer review., Results: The PESTLE model, a mechanism of analysis to identify elements of a project environment (Political, Environmental, Social, Technological, Legal and Economic), was applied to identify influencing factors and support detailed project planning. Compliance with medicines legislation was at the forefront of all MM process development for the NHB field hospital. Internal factors were identified by the core MM team, resulting in a workforce, education & training and clinical pharmacy MM plan., Discussion: MM processes are extensive and integral to NHS field hospitals. The presented framework of influencing factors may support future NHS field hospital development. It is pertinent to have a broad team working approach to any large-scale project such as outlined here, and suggest the identified factors be used as a core framework for development of any future MM processes in NHS field hospitals., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Purpose: Triage of patients with emergent large vessel occlusion stroke to primary stroke centers followed by transfer to comprehensive stroke centers leads to increased time to endovascular therapy. A Mobile Interventional Stroke Team (MIST) provides an alternative model by transferring a MIST to a Thrombectomy Capable Stroke Center (TSC) to perform endovascular therapy. Our aim is to determine whether the MIST model is more time-efficient and leads to improved clinical outcomes compared with standard drip-and-ship (DS) and mothership models., Methods: This is a prospective observational cohort study with 3-month follow-up between June 2016 and December 2018 at a multicenter health system, consisting of one comprehensive stroke center, 4 TSCs, and several primary stroke centers. A total of 228 of 373 patients received endovascular therapy via 1 of 4 models: mothership with patient presentation to a comprehensive stroke center, DS with patient transfer from primary stroke center or TSC to comprehensive stroke center, MIST with patient presentation to TSC and MIST transfer, or a combination of DS with patient transfer from primary stroke center to TSC and MIST. The prespecified primary end point was initial door-to-recanalization time and secondary end points measured additional time intervals and clinical outcomes at discharge and 3 months., Results: MIST had a faster mean initial door-to-recanalization time than DS by 83 minutes ( P <0.01). MIST and mothership had similar median door-to-recanalization times of 192 minutes and 179 minutes, respectively ( P =0.83). A greater proportion had a complete recovery (National Institutes of Health Stroke Scale of 0 or 1) at discharge in MIST compared with DS (37.9% versus 16.7%; P <0.01). MIST had 52.8% of patients with modified Rankin Scale of ≤2 at 3 months compared with 38.9% in DS ( P =0.10)., Conclusions: MIST led to significantly faster initial door-to-recanalization times compared with DS, which was comparable to mothership. This decrease in time has translated into improved short-term outcomes and a trend towards improved long-term outcomes. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03048292.

Objective: To design models of the spread of coronavirus disease-2019 (COVID-19) in Wuhan and the effect of Fangcang shelter hospitals (rapidly-built temporary hospitals) on the control of the epidemic., Methods: We used data on daily reported confirmed cases of COVID-19, recovered cases and deaths from the official website of the Wuhan Municipal Health Commission to build compartmental models for three phases of the COVID-19 epidemic. We incorporated the hospital-bed capacity of both designated and Fangcang shelter hospitals. We used the models to assess the success of the strategy adopted in Wuhan to control the COVID-19 epidemic., Findings: Based on the 13 348 Fangcang shelter hospitals beds used in practice, our models show that if the Fangcang shelter hospitals had been opened on 6 February (a day after their actual opening), the total number of COVID-19 cases would have reached 7 413 798 (instead of 50 844) with 1 396 017 deaths (instead of 5003), and the epidemic would have lasted for 179 days (instead of 71)., Conclusion: While the designated hospitals saved lives of patients with severe COVID-19, it was the increased hospital-bed capacity of the large number of Fangcang shelter hospitals that helped slow and eventually stop the COVID-19 epidemic in Wuhan. Given the current global pandemic of COVID-19, our study suggests that increasing hospital-bed capacity, especially through temporary hospitals such as Fangcang shelter hospitals, to isolate groups of people with mild symptoms within an affected region could help curb and eventually stop COVID-19 outbreaks in communities where effective household isolation is not possible., ((c) 2020 The authors; licensee World Health Organization.)