RESUMO
WHAT IS KNOWN AND OBJECTIVE: The aim of this survey, conducted by the Gruppo Italiano per il Trapianto di Midollo Osseo (GITMO), was to evaluate the involvement of pharmacists in the haematopoietic stem cell transplant (HSCT) program in Italian adult and paediatric centres. METHODS: A 63-item online questionnaire was developed and sent to the Italian Transplant Programs on behalf of GITMO. RESULTS AND DISCUSSION: Overall, 54.7% of the Italian HSCT centres participated in the survey (88.5% adult, 7.7% paediatric, 3.8% mixed), of which 50% were in public hospitals and 50% affiliated with public universities. Just over 80% declared that a pharmacist is involved in the HSCT centre, and 86.5% reported the presence of a documentation system to signal of adverse events, accessible by physicians, nurses and pharmacists in 57.7%. Chemotherapy drugs were centralized in the pharmacy in 98.1% of HSCT centres, while parenteral nutrition was centralized in 55.8%. The use of off-label drugs was authorized by an internal committee and by the regional health authorities in 88.5% of the centres. On univariate analysis, few statistically significant differences were found on response frequencies between public hospitals and university centres or between HSCT centres performing only autologous stem cell transplantation versus other centres performing autologous and allogeneic stem cell transplantation. WHAT IS NEW AND CONCLUSION: This survey suggests that there is good collaboration between pharmacists and physicians and nurses in Italian HSCT transplantation centres. The enhancement of pharmacists dedicated to HSCT programs could improve some problems, for example, the centralization of parenteral nutrition.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Hospitais Especializados/organização & administração , Assistência Farmacêutica/organização & administração , Sistemas de Notificação de Reações Adversas a Medicamentos/organização & administração , Atitude do Pessoal de Saúde , Comportamento Cooperativo , Humanos , ItáliaRESUMO
Hematopoietic cell transplantation (HCT) is the curative treatment for many malignant and non-malignant blood disorders and some solid cancers. However, transplant procedures are considered tertiary level care requiring a high degree of technicality and expertise and generating very high costs for hospital structures in developing countries as well as for patients without health insurance. During the 11th annual harmonization workshops of the francophone Society of bone marrow transplantation and cellular therapy (SFGM-TC), a designated working group reviewed the literature in order to elaborate unified guidelines, for developing the transplant activity in emerging countries. Access to infrastructure must comply with international standards and therefore requires a hospital system already in place, capable of accommodating and supporting the HCT activity. In addition, the commitment of the state and the establishment for the financing of the project seems essential.
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Países em Desenvolvimento , Transplante de Células-Tronco Hematopoéticas , Desenvolvimento de Programas , Fatores Etários , Aloenxertos , Autoenxertos , Características Culturais , Países em Desenvolvimento/economia , Apoio Financeiro , Transplante de Células-Tronco Hematopoéticas/economia , Transplante de Células-Tronco Hematopoéticas/normas , Hospitais Especializados/organização & administração , Hospitais Especializados/normas , Humanos , Pessoas sem Cobertura de Seguro de Saúde , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Qualidade da Assistência à Saúde , Sociedades Médicas , Fatores Socioeconômicos , Atenção Terciária à Saúde/economia , Condicionamento Pré-Transplante/métodos , Condicionamento Pré-Transplante/normasRESUMO
AIM: Home parenteral nutrition (HPN) is one of the most demanding medical therapies as it is the only option for patients for intestinal failure (IF). No unequivocal policy on how to start and progress with HPN has ever been presented. The IF Center at the Stanley Dudrick's Memorial Hospital in Skawina is one of the biggest centers in Poland, celebrating its twentieth birthday last year. It offered the unique chance to present how to create and grow the IF center, increasing the quality of care. The above became the aim of this study. METHODS: A retrospective analysis of all medical records of HPN patients from the University Hospital and Stanley Dudrick's Memorial Hospital in Skawina. Patient profile, clinical course and treatment outcomes were assessed. The evolution of all aspects of HPN is presented. A brief historical perspective has been added to better illustrate the center's growth and transformation. RESULTS: 608 patients (363 female, 245 male, mean age 55.55 year) from all over Poland were treated between December 1999 and December 2019. The most frequent indication for HPN was mechanical obstruction (277, 45.7%), followed by short bowel syndrome (SBS, 208, 34.3%) and intestinal fistula (46, 7.59%). The most common primary disease was cancer (n = 267), followed by mesenteric ischemia (n = 104), and surgical complications (n = 62). 314 patients (51.8%) died. 73 (12.04%) were successfully weaned off PN. The catheter infection rate reached 0.39/1000 catheter days. CONCLUSIONS: the founding of the HPN center and its further development is possible provided that there is team of dedicated people, supported by hospital base. The real growth opportunity is guaranteed by the reimbursement. It is necessary to adapt to the changing circumstances.
Assuntos
Atenção à Saúde/história , Hospitais Especializados/história , Insuficiência Intestinal/terapia , Nutrição Parenteral no Domicílio/história , Pacientes/estatística & dados numéricos , Atenção à Saúde/métodos , História do Século XX , História do Século XXI , Hospitais Especializados/organização & administração , Humanos , Nutrição Parenteral no Domicílio/métodos , Polônia , Estudos RetrospectivosRESUMO
OBJECTIVE: To report the experience of adapting the stomatherapy service during the COVID-19 pandemic. METHOD: Experience report related to adaptations in the work routine in times of COVID-19 pandemic, from March to May 2020, in a specialized stomatherapy center in a city in the South of Brazil. RESULTS: The work routines were adapted to suit the protection measures for workers and users who used stomatherapy services. Some assistance processes were implemented to make users' access to care more flexible, and to modify routines to increase the safety of health professionals and users. CONCLUSION: The need to adapt the physical area, rethink the dynamics of care, use personal protective equipment, and guidance for servers and patients were of fundamental importance to continue attending the population safely in times of pandemic.
Assuntos
COVID-19/epidemiologia , Atenção à Saúde/organização & administração , Estomia , Pandemias , Estomas Cirúrgicos , Bandagens/provisão & distribuição , Brasil/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Atenção à Saúde/estatística & dados numéricos , Hospitais Especializados/organização & administração , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Estomia/enfermagem , Equipamento de Proteção IndividualRESUMO
PROBLEM: Medical education academies have been instrumental in providing greater recognition of and promotion for clinician-educators. However, producing education scholarship is essential for clinician-scholar-educator career advancement. Grant funding for education research and protected time to produce scholarship are still lacking for interested physicians, in part due to institutional budget constraints and competing priorities. APPROACH: The Hospital for Special Surgery Academy of Rheumatology Medical Educators was founded in 2011 to promote education scholarship through grants awarded to educators interested in research. Educators were asked to submit proposals aimed at the development of new teaching programs and curricular change. Selected applicants received up to $50,000 per year for one year. Grant money was obtained through directed fundraising from donors. Information from annual grant updates and survey responses from grant recipients in 2017 were used to assess the academy's effectiveness. OUTCOMES: Since 2012, 32 grants have been awarded, totaling $954,045 in funding. Recipients have produced national meeting abstracts, posters, oral presentations, and manuscripts and created unique curricula and electronic learning tools for medical students, residents, fellows, faculty, and patients. Four educators with demonstrated interest and research outcomes were identified during the pilot and received additional funding and support from a dedicated education research assistant. NEXT STEPS: The academy and the innovations grants program highlight the talents of under-supported and under-recognized teaching faculty by allowing them to distinguish themselves academically as clinician-scholar-educators. The success of these educators emphasizes the clear advantages of a formalized structure to achieve the hospital's education goals. Next steps include providing support for a rheumatology fellow to develop an education research career rather than one in bench, clinical, or translational research.
Assuntos
Academias e Institutos/organização & administração , Pesquisa Biomédica/economia , Educação Médica/métodos , Hospitais Especializados/economia , Reumatologia/educação , Pesquisa Biomédica/estatística & dados numéricos , Currículo/estatística & dados numéricos , Bolsas de Estudo/economia , Feminino , Hospitais Especializados/organização & administração , Humanos , Aprendizagem , Masculino , Tutoria/economia , Cidade de Nova Iorque , Médicos/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Apoio ao Desenvolvimento de Recursos Humanos/economiaRESUMO
BACKGROUND: After the first case of infection with the novel coronavirus, SARS-CoV-2, in China, an outbreak rapidly spread, finally evolving into a global pandemic. The new disease was named coronavirus disease 2019 (COVID-19) and by May 10, 2020, it has affected more than 4 million people worldwide and caused more than 270,000 deaths. METHODS: We describe the Greek experience regarding the response to COVID-19, with particular focus on 2 COVID-19 reference hospitals in the metropolitan area of Athens, the capital of Greece. RESULTS: The first case of SARS-CoV-2 infection in Greece was reported on February 26, 2020, and prompted a decisive response from the Greek government. The primary focus was containment of virus spread, considering shortage of ICU beds. A general lockdown was implemented early on, and the national Health Care System underwent massive re-structuring. Our 2 gastrointestinal (GI) centers, which provide care for more than 1500 inflammatory bowel disease (IBD) patients, are located in hospitals that were transformed to COVID-19 reference centers. To maintain sufficient care for our patients, while also contributing to the fight against COVID-19, we undertook specific measures. These included provision of telemedicine services, electronic prescriptions and home delivery of medications, isolation of infusion units and IBD clinics in COVID-free zones of the hospitals, in addition to limiting endoscopies to emergencies only. Such practices allowed us to avoid interruption of appropriate therapies for IBD patients. In fact, within the SECURE-IBD database, there have been only 4 Greek IBD patients, to date, who have been reported as positive for SARS-CoV-2. CONCLUSION: Timely application of preventive measures and strict compliance to guidelines limited the spread of COVID-19 in Greece and minimally impacted our IBD community, without interfering with therapeutic management.
Assuntos
Controle de Doenças Transmissíveis/organização & administração , Doenças Transmissíveis Emergentes/prevenção & controle , Infecções por Coronavirus/epidemiologia , Atenção à Saúde/organização & administração , Avaliação de Resultados em Cuidados de Saúde , Pneumonia Viral/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Adulto , COVID-19 , Defesa Civil , Infecções por Coronavirus/prevenção & controle , Feminino , Grécia , Hospitais Especializados/organização & administração , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Medição de Risco , Síndrome Respiratória Aguda Grave/prevenção & controle , População UrbanaRESUMO
BACKGROUND AND PURPOSE: The purpose of the study is to analyze how the coronavirus disease 2019 (COVID-19) pandemic affected acute stroke care in a Comprehensive Stroke Center. METHODS: On February 28, 2020, contingency plans were implemented at Hospital Clinic of Barcelona to contain the COVID-19 pandemic. Among them, the decision to refrain from reallocating the Stroke Team and Stroke Unit to the care of patients with COVID-19. From March 1 to March 31, 2020, we measured the number of emergency calls to the Emergency Medical System in Catalonia (7.5 million inhabitants), and the Stroke Codes dispatched to Hospital Clinic of Barcelona. We recorded all stroke admissions, and the adequacy of acute care measures, including the number of thrombectomies, workflow metrics, angiographic results, and clinical outcomes. Data were compared with March 2019 using parametric or nonparametric methods as appropriate. RESULTS: At Hospital Clinic of Barcelona, 1232 patients with COVID-19 were admitted in March 2020, demanding 60% of the hospital bed capacity. Relative to March 2019, the Emergency Medical System had a 330% mean increment in the number of calls (158 005 versus 679 569), but fewer Stroke Code activations (517 versus 426). Stroke admissions (108 versus 83) and the number of thrombectomies (21 versus 16) declined at Hospital Clinic of Barcelona, particularly after lockdown of the population. Younger age was found in stroke admissions during the pandemic (median [interquartile range] 69 [64-73] versus 75 [73-80] years, P=0.009). In-hospital, there were no differences in workflow metrics, angiographic results, complications, or outcomes at discharge. CONCLUSIONS: The COVID-19 pandemic reduced by a quarter the stroke admissions and thrombectomies performed at a Comprehensive Stroke Center but did not affect the quality of care metrics. During the lockdown, there was an overload of emergency calls but fewer Stroke Code activations, particularly in elderly patients. Hospital contingency plans, patient transport systems, and population-targeted alerts must act concertedly to better protect the chain of stroke care in times of pandemic.
Assuntos
Betacoronavirus , Infecções por Coronavirus , Hospitais Especializados/organização & administração , Hospitais Urbanos/organização & administração , Pandemias , Pneumonia Viral , Acidente Vascular Cerebral/terapia , Doença Aguda , Distribuição por Idade , COVID-19 , Infecções por Coronavirus/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência , Número de Leitos em Hospital/estatística & dados numéricos , Hospitais Especializados/estatística & dados numéricos , Hospitais Urbanos/normas , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Neuroimagem/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Admissão do Paciente/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Alocação de Recursos , SARS-CoV-2 , Espanha/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/cirurgia , Trombectomia/estatística & dados numéricos , Resultado do TratamentoRESUMO
BACKGROUND: This study compares perspectives on specialized ophthalmic medical institutions, identifies the gaps in property and geographic offerings, and explores the ways that ophthalmic medical institutions can better allocate resources. The results of this research will increase patient's access to equitable and high-quality ophthalmic care in China. METHODS: The data for this research was gathered from the Survey of China National Eye Care Capacity and Resource for the year 2015. The paper specified the number, professional level of expertise, and educational background of ophthalmic health personnel. The authors of the paper analyzed and compared the differences in ophthalmic care in public vs. private and urban vs. rural regions in China. Descriptive statistics were used. RESULTS: Of the 395 specialized ophthalmic hospitals surveyed, 332 were private medical institutions (84%), and 63 were public (16%). Of the 26 607 ophthalmic personnel surveyed, working in specialized ophthalmic hospitals, 17 561 were in private hospitals (66%) and 9 046 were in public ones (34%). Furthermore, 22 578 of those personnel worked in urban ophthalmic institutions (85%) and 4 029 worked in rural ones (15%). As for regional differences, 14 090 personnel were located in eastern China (53%), 8 828 in central regions (33%), and 3 689 in the western regions (14%). CONCLUSIONS: Public ophthalmic medical institutions still face challenges in providing equitable and widespread care. The availability of well-staffed health centers varies significantly by region. These variations impact resource allocation and directly lead to inequalities and inaccessibility of health services in certain regions of China.
Assuntos
Pessoal de Saúde/organização & administração , Hospitais Especializados/organização & administração , Hospitais Especializados/estatística & dados numéricos , Oftalmologia/organização & administração , Oftalmologia/estatística & dados numéricos , Pessoal Técnico de Saúde/organização & administração , Pessoal Técnico de Saúde/estatística & dados numéricos , China , Alocação de Recursos para a Atenção à Saúde/organização & administração , Pessoal de Saúde/estatística & dados numéricos , Humanos , Administração de Recursos Humanos em Hospitais/métodos , Administração de Recursos Humanos em Hospitais/estatística & dados numéricos , Setor Privado/organização & administração , Setor Privado/estatística & dados numéricos , Setor Público/organização & administração , Setor Público/estatística & dados numéricos , Serviços de Saúde Rural/organização & administração , Serviços de Saúde Rural/estatística & dados numéricos , Fatores Socioeconômicos , Serviços Urbanos de Saúde/organização & administração , Serviços Urbanos de Saúde/estatística & dados numéricos , Recursos Humanos/organização & administração , Recursos Humanos/estatística & dados numéricosRESUMO
Since December 2019, a number of patients with novel coronavirus pneumonia (NCP) have been identified in Wuhan, Hubei Province, China. NCP has rapidly spread to other provinces and cities in China and other countries in the world. Due to the rapid increase in reported cases in China and around the world, on January 30, 2020, the World Health Organization (WHO) Emergency Committee announced that NCP is a Public Health Emergency of International Concern (PHEIC). However, there are relatively few suggestions and measures for tumor patients, especially patients with head and neck tumors. This article summarizes the prevention and control of disease in our medical institution to provide a reference for front-line head and neck surgeons.
Assuntos
Institutos de Câncer/organização & administração , Doenças Transmissíveis/transmissão , Infecções por Coronavirus/epidemiologia , Atenção à Saúde/organização & administração , Neoplasias de Cabeça e Pescoço/terapia , Pneumonia Viral/epidemiologia , Betacoronavirus , COVID-19 , China , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Emergências/epidemiologia , Serviço Hospitalar de Emergência/organização & administração , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/epidemiologia , Hospitais Especializados/organização & administração , Humanos , Masculino , Pandemias/prevenção & controle , Segurança do Paciente , Pneumonia Viral/prevenção & controle , SARS-CoV-2 , TriagemRESUMO
From February 24, 2020, a COVID-19 obstetric task force was structured to deliver management recommendations for obstetric care. From March 1, 2020, six COVID-19 hubs and their spokes were designated. An interim analysis of cases occurring in or transferred to these hubs was performed on March 20, 2020 and recommendations were released on March 24, 2020. The vision of this strict organization was to centralize patients in high-risk maternity centers in order to concentrate human resources and personal protective equipment (PPE), dedicate protected areas of these major hospitals, and centralize clinical multidisciplinary experience with this disease. All maternity hospitals were informed to provide a protected labor and delivery room for nontransferable patients in advanced labor. A pre-triage based on temperature and 14 other items was developed in order to screen suspected patients in all hospitals to be tested with nasopharyngeal swabs. Obstetric outpatient facilities were instructed to maintain scheduled pregnancy screening as per Italian guidelines, and to provide pre-triage screening and surgical masks for personnel and patients for pre-triage-negative patients. Forty-two cases were recorded in the first 20 days of hub and spoke organization. The clinical presentation was interstitial pneumonia in 20 women. Of these, seven required respiratory support and eventually recovered. Two premature labors occurred.
Assuntos
Instituições de Assistência Ambulatorial/normas , Infecções por Coronavirus , Alocação de Recursos para a Atenção à Saúde , Maternidades/normas , Obstetrícia/normas , Pandemias , Assistência ao Paciente/normas , Pneumonia Viral , Instituições de Assistência Ambulatorial/organização & administração , COVID-19 , Feminino , Alocação de Recursos para a Atenção à Saúde/organização & administração , Alocação de Recursos para a Atenção à Saúde/normas , Maternidades/organização & administração , Hospitais Especializados/organização & administração , Hospitais Especializados/normas , Humanos , Itália , Equipamento de Proteção Individual/provisão & distribuição , GravidezRESUMO
Fangcang shelter hospitals are a novel public health concept. They were implemented for the first time in China in February, 2020, to tackle the coronavirus disease 2019 (COVID-19) outbreak. The Fangcang shelter hospitals in China were large-scale, temporary hospitals, rapidly built by converting existing public venues, such as stadiums and exhibition centres, into health-care facilities. They served to isolate patients with mild to moderate COVID-19 from their families and communities, while providing medical care, disease monitoring, food, shelter, and social activities. We document the development of Fangcang shelter hospitals during the COVID-19 outbreak in China and explain their three key characteristics (rapid construction, massive scale, and low cost) and five essential functions (isolation, triage, basic medical care, frequent monitoring and rapid referral, and essential living and social engagement). Fangcang shelter hospitals could be powerful components of national responses to the COVID-19 pandemic, as well as future epidemics and public health emergencies.
Assuntos
Infecções por Coronavirus , Emergências , Arquitetura de Instituições de Saúde , Hospitais Especializados , Unidades Móveis de Saúde , Pandemias , Pneumonia Viral , Betacoronavirus , COVID-19 , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Controle de Custos , Surtos de Doenças , Hospitais Especializados/organização & administração , Hospitais Especializados/estatística & dados numéricos , Humanos , Controle de Infecções , Unidades Móveis de Saúde/organização & administração , Unidades Móveis de Saúde/estatística & dados numéricos , Isolamento de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , SARS-CoV-2RESUMO
PURPOSE: This article aims to share northern Italy's experience in hospital re-organization and management of clinical pathways for traumatic and orthopaedic patients in the early stages of the COVID-19 pandemic. METHODS: Authors collected regional recommendations to re-organize the healthcare system during the initial weeks of the COVID-19 pandemic in March, 2020. The specific protocols implemented in an orthopaedic hospital, selected as a regional hub for minor trauma, are analyzed and described in this article. RESULTS: Two referral centres were identified as the hubs for minor trauma to reduce the risk of overload in general hospitals. These two centres have specific features: an emergency room, specialized orthopaedic surgeons for joint diseases and trauma surgeons on-call 24/7. Patients with trauma without the need for a multi-disciplinary approach or needing non-deferrable elective orthopaedic surgery were moved to these hospitals. Authors report the internal protocols of one of these centres. All elective surgery was stopped, outpatient clinics limited to emergencies and specific pathways, ward and operating theatre dedicated to COVID-19-positive patients were implemented. An oropharyngeal swab was performed in the emergency room for all patients needing to be admitted, and patients were moved to a specific ward with single rooms to wait for the results. Specific courses were organized to demonstrate the correct use of personal protection equipment (PPE). CONCLUSION: The structure of the orthopaedic hubs, and the internal protocols proposed, could help to improve the quality of assistance for patients with musculoskeletal disorders and reduce the risk of overload in general hospitals during the COVID-19 pandemic.
Assuntos
Betacoronavirus , Infecções por Coronavirus , Administração Hospitalar , Ortopedia , Pandemias , Pneumonia Viral , Traumatologia , COVID-19 , Procedimentos Clínicos/organização & administração , Atenção à Saúde/organização & administração , Procedimentos Cirúrgicos Eletivos/tendências , Administração Hospitalar/métodos , Hospitais/normas , Hospitais Gerais/organização & administração , Hospitais Especializados/organização & administração , Humanos , Controle de Infecções/métodos , Itália , Doenças Musculoesqueléticas/terapia , Ortopedia/organização & administração , Ortopedia/normas , Qualidade da Assistência à Saúde/organização & administração , SARS-CoV-2 , Centros de Traumatologia/organização & administração , Traumatologia/organização & administração , Traumatologia/normas , Ferimentos e Lesões/terapiaRESUMO
BACKGROUND: Chronic kidney disease (CKD) is increasing worldwide, and the majority of the CKD burden is in low- and middle-income countries (LMICs). However, there is wide variability in global access to kidney care therapies such as dialysis and kidney transplantation. The challenges health professionals experience while providing kidney care in LMICs have not been well described. The goal of this study is to elicit health professionals' perceptions of providing kidney care in a resource-constrained environment, strategies for dealing with resource limitations, and suggestions for improving kidney care in Guatemala. METHODS: Semi-structured interviews were performed with 21 health professionals recruited through convenience sampling at the largest public nephrology center in Guatemala. Health professionals included administrators, physicians, nurses, technicians, nutritionists, psychologists, laboratory personnel, and social workers. Interviews were recorded and transcribed in Spanish. Qualitative data from interviews were analyzed in NVivo using an inductive approach, allowing dominant themes to emerge from interview transcriptions. RESULTS: Health professionals most frequently described challenges in providing high-quality care due to resource limitations. Reducing the frequency of hemodialysis, encouraging patients to opt for peritoneal dialysis rather than hemodialysis, and allocating resources based on clinical acuity were common strategies for reconciling high demand and limited resources. Providers experienced significant emotional challenges related to high patient volume and difficult decisions on resource allocation, leading to burnout and moral distress. To improve care, respondents suggested increased budgets for equipment and personnel, investments in preventative services, and decentralization of services. CONCLUSIONS: Health professionals at the largest public nephrology center in Guatemala described multiple strategies to meet the rising demand for renal replacement therapy. Due to systems-level limitations, health professionals faced difficult choices on the stewardship of resources that are linked to sentiments of burnout and moral distress. This study offers important lessons in Guatemala and other countries seeking to build capacity to scale-up kidney care.
Assuntos
Atitude do Pessoal de Saúde , Alocação de Recursos para a Atenção à Saúde , Hospitais Especializados/organização & administração , Ambulatório Hospitalar/organização & administração , Insuficiência Renal Crônica/terapia , Esgotamento Profissional , Tomada de Decisão Clínica , Guatemala , Hospitais Especializados/normas , Humanos , Ambulatório Hospitalar/normas , Diálise Peritoneal , Recursos Humanos em Hospital/psicologia , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Diálise Renal , Estresse PsicológicoRESUMO
PURPOSE: The rapid spread of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has strained the resources of healthcare systems around the world. In accordance with recommendations from the World Health Organization, Centers for Disease Control and Prevention, and US Department of Defense, Intermountain Medical Center (IMED) in Murray, UT, has developed a plan to provide remote clinical pharmacy services to protect the health of pharmacy caregivers while maintaining appropriate clinical pharmacy coverage to optimally care for patients. SUMMARY: The utilization of telemedicine technology permits clinical pharmacists to readily communicate with nurses, physicians, other caregivers, and patients. We have identified strategies to allow clinical pharmacists to continue to participate in daily rounds, provide consultations under collaborative practice agreements, verify medication orders, collect medication histories, provide antimicrobial stewardship, and deliver medication education to patients from off-site locations. The pharmacy department at IMED proactively tested telemedicine technologies, defined the roles of clinical pharmacists, and identified communication strategies prior to a rapid rise in COVID-19 cases in the state of Utah. CONCLUSION: The proactive measures described can help ensure that pharmacy caregivers have appropriate remote access and are capable of confidently using the resources. These steps allow for optimal care of hospitalized patients and promote social distancing, which may have the added benefit of decreasing the spread of SARS-CoV-2 among patients and caregivers.
Assuntos
COVID-19/prevenção & controle , Hospitais Especializados/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Telemedicina/organização & administração , Recursos Humanos/organização & administração , COVID-19/epidemiologia , COVID-19/transmissão , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/normas , Comunicação , Humanos , Conduta do Tratamento Medicamentoso/organização & administração , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/normas , Papel Profissional , Acidente Vascular Cerebral/tratamento farmacológico , Telemedicina/normas , Utah/epidemiologia , Ferimentos e Lesões/tratamento farmacológicoRESUMO
This survey evaluates whether the Cystic Fibrosis (CF)-specific infection prevention and control (IPC) recommendations released by the Commission for Hospital Hygiene and Infection Prevention (KRINKO) in 2012 have been implemented in specialized German CF facilities. Of 35 participating centers (response rate 32.7%), 37% care for more than 100 patients and 44% treat mainly adults. Clinics for adult CF patients report a shortage of qualified personnel for intensified environmental cleaning. Some hospitals struggle to provide single patient rooms with an adjacent sanitary area to segregate CF patients strictly. Most centers offer at least one decolonization cycle (including systemic and inhalative antibiotics) to patients colonized with MRSA. In CF centers in Germany, the KRINKO IPC recommendations are considered helpful by the attending physicians and thoroughly implemented. There is room for improvement concerning strict segregation of inpatients with CF in single patient rooms, in particular in large CF centers mainly caring for adults.
Assuntos
Fibrose Cística , Hospitais Especializados , Isolamento de Pacientes/organização & administração , Infecções por Pseudomonas , Pseudomonas aeruginosa/isolamento & purificação , Infecções Respiratórias , Adulto , Infecção Hospitalar/prevenção & controle , Fibrose Cística/epidemiologia , Fibrose Cística/microbiologia , Fibrose Cística/terapia , Monitoramento Ambiental/métodos , Monitoramento Ambiental/normas , Feminino , Alemanha/epidemiologia , Fidelidade a Diretrizes/normas , Pesquisas sobre Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde , Mão de Obra em Saúde/normas , Hospitais Especializados/organização & administração , Hospitais Especializados/normas , Humanos , Masculino , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/prevenção & controle , Infecções por Pseudomonas/terapia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Infecções Respiratórias/prevenção & controleRESUMO
Diabetes mellitus is considered a public health issue worldwide, with a high prevalence. It is a direct cause of death, disability, and high health costs. In addition, it generates a series of complications of variable types and degrees that have frequent negative effects on the quality of life of the people who suffer from it. Efficiency in public health implies a reduction in costs and improvements in citizens' quality of life. With the twofold aim of rationalizing costs and promoting an improvement in the care of people with diabetes, we propose a project: a Diabetes Day Hospital (DDH) in Extremadura (Spain). This involves a new organizational model which has already been implemented in other European regions, generating satisfactory results. This study includes details on the structure and operation of the DDH, as well as the expected costs. The DDH allows for a proper coordination among the parties involved in the monitoring and treatment of the disease, and reduces the costs derived from unnecessary admissions and chronic complications. Results show that efficiency in the regional health system could be improved and a significant amount of money could be saved.
Assuntos
Diabetes Mellitus/terapia , Hospitais Especializados/organização & administração , Controle de Custos , Diabetes Mellitus/economia , Custos de Cuidados de Saúde , Hospitais Especializados/economia , Humanos , Qualidade de Vida , EspanhaRESUMO
AIMS: In this observational study, we investigated whether specialized care improves outcomes for acute pancreatitis (AP). METHODS: Consecutive patients admitted to two university hospitals with AP were enrolled in this study between 1 January 2016 and 31 December 2016 (Center A: specialized center; Center B: general hospital). Data on demographic characteristics and AP etiology, severity, mortality and quality of care (enteral nutrition and antibiotic use) were extracted from the Hungarian Acute Pancreatitis Registry. An independent sample t-test, Mann-Whitney test, chi-squared test or Fisher's test were used for statistical analyses. Costs of care were calculated and compared in the two models of care. RESULTS: There were 355 patients enrolled, 195 patients in the specialized center (Center A) and 160 patients in the general hospital (Center B). There was no difference in mean age (57.02 +/-17.16 vs. 57.31 +/-16.50 P=0.872) and sex ratio (56% males vs. 57% males, P=0.837) between centres, allowing a comparison without selection bias. Center A had lower mortality (n=2, 1.03% vs. n=16, 6.25%, p=0.007), more patients received enteral feeding (n=179, 91.8%, vs. n=36, 22.5%, p<0.001) and fewer patients were treated with antibiotics (n=85, 43.6% vs. n=123, 76.9%, p=0.001). In Center A the median length of hospitalization was shorter (Me 6, IQR 5-9 vs. Me 8, IQR 6-11, p=0.02) and the costs of care were by 25% lower. CONCLUSION: Our data suggests that treatment of AP in specialized centers reduces mortality, length of hospitalization and thus might reduce the costs.
Assuntos
Atenção à Saúde/organização & administração , Pancreatite/terapia , Doença Aguda , Adulto , Idoso , Atenção à Saúde/economia , Feminino , Custos Hospitalares/estatística & dados numéricos , Hospitais Gerais/economia , Hospitais Gerais/organização & administração , Hospitais Especializados/economia , Hospitais Especializados/organização & administração , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pancreatite/economia , Pancreatite/mortalidade , Qualidade da Assistência à Saúde , Sistema de Registros , Romênia/epidemiologia , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
BACKGROUND: Although considered an outpatient specialty, dermatology plays an important role in inpatient medicine. We characterized the activity and structure of dermatology consultation services in select U.S. hospitals. METHODS: In this cross sectional study, a 31-question survey was distributed in person to 32 board-certified dermatologists at the 2017 Society of Dermatology Hospitalists meeting. RESULTS: Thirty participants completed the survey (yield 93.8%). Most dermatology hospitalists spend 41-52 weeks on service (50%), with 37% spending between 11 and 30 weeks. Coverage was organized by continuous weeks (68%) or months (21%). While on service, hospitalists staffed an average of 4 outpatient clinics per week. Consultative teams also included internal medicine residents (43%), medical students (47%), pediatric residents (10%), and fellows from other specialties (27%). Consultation services saw approximately 3.7 new inpatients and 4.2 follow-up inpatients per day, with daily rounds lasting approximately 2.6 hours. CONCLUSIONS: The results suggest that hospital dermatologists in the U.S. consider inpatient care their niche and devote a majority of their time staffing consults over clinic. The diverse composition of inpatient teams and the number of academic duties held by these physicians suggests they play an important role in medical education.
Assuntos
Dermatologistas/normas , Médicos Hospitalares/normas , Hospitais Especializados/organização & administração , Padrões de Prática Médica/organização & administração , Encaminhamento e Consulta/organização & administração , Atitude do Pessoal de Saúde , Estudos Transversais , Dermatologistas/tendências , Dermatologia/organização & administração , Feminino , Médicos Hospitalares/tendências , Humanos , Relações Interprofissionais , Masculino , Inovação Organizacional , Inquéritos e Questionários , Estados UnidosRESUMO
Patients with complex palliative care needs can experience delayed discharge, which causes an inappropriate occupancy of hospital beds. Post-acute care facilities (PACFs) have emerged as an alternative discharge destination for some of these patients. The aim of this study was to investigate the frequency of admissions and characteristics of palliative care patients discharged from hospitals to a PACF. We conducted a retrospective analysis of PACF admissions between 2014 and 2016 that were linked to hospital discharge reports and electronic health records, to gather information about hospital-to-PACF transitions. In total, 205 consecutive patients were discharged from 6 different hospitals to our PACF. Palliative care patients were involved in 32% (n = 67) of these discharges. The most common conditions were terminal cancer (n = 42, 63%), advanced dementia (n = 17, 25%), and stroke (n = 5, 8%). During acute hospital stays, patients with cancer had significant shorter lengths of stay (13 vs 99 days, P = .004), a lower use of intensive care services (2% vs 64%, P < .001) and mechanical ventilation (2% vs 40%, P < .001), when compared to noncancer patients. Approximately one-third of discharges from hospitals to a PACF involved a heterogeneous group of patients in need of palliative care. Further studies are necessary to understand the trajectory of posthospitalized patients with life-limiting illnesses and what factors influence their decision to choose a PACF as a discharge destination and place of death. We advocate that palliative care should be integrated into the portfolio of post-acute services.