Competências gerenciais: conhecimento de enfermeiros / Managerial competencies: knowledge of nurses / Competencias de gestión: conocimiento de las enfermeras

Introdução: A enfermagem é considerada uma das ocupações mais versáteis dentro da força de trabalho de saúde. A gestão dos serviços de enfermagem é essencial para o sucesso da instituição de saúde e para a qualidade e segurança da assistência ao paciente. O enfermeiro gestor precisa ser apto a trabalhar e conduzir com cooperação e dinamismo a sua equipe, com respaldo em conhecimento técnico e valores éticos. Objetivo: Investigar o conhecimento dos enfermeiros quanto às competências gerenciais. Método: Estudo descritivo, exploratório, de abordagem qualitativa, realizado com enfermeiros, de um hospital universitário de pequeno porte, situado na região noroeste do estado do Paraná. As entrevistas foram pautadas na seguinte questão norteadora "Fale-me sobre as competências gerenciais executadas pelo enfermeiro?", após coleta dos dados, os mesmos foram transcritos e analisados segundo análise de conteúdo de Bardin. Resultados: Participaram do estudo sete enfermeiros, com idades entre 22 a 35 anos, a maioria desses profissionais terminaram a graduação em menos de três anos e atuavam naquela unidade de saúde, há menos de menos de um ano. A partir da análise das entrevistas emergiram três categorias, sendo elas: Habilidades para gestão; Dificuldades para gerenciar; e, Potencialidades/Facilidades para gerenciar. Principais resultados: por meio deste estudo foi possível notar que as percepções acerca das atribuições dos enfermeiros foram bem esclarecidas, demonstrando que a gerência está ligada às questões técnicas e burocráticas, e da sua relevância na condução eficiente da equipe sob sua liderança. Conclusão: Observa-se que há a necessidade de os profissionais de enfermagem compreenderem que a formação teórica e prática das atividades de educação continuada devem ser buscadas com afinco e não devem somente aguardar que os serviços de saúde as ofereçam.

Objective: To investigate nurses' knowledge of managerial skills. Method: Descriptive, exploratory study, with a qualitative approach, carried out with nurses from a small university hospital, located in the northwest region of the state of Paraná. The interviews were guided by the following guiding question "Tell me about the managerial competences performed by the nurse?", after collecting the data, they were transcribed and analyzed according to Bardin's content analysis. Results: Seven nurses participated in the study, aged between 22 and 35 years, most of these professionals finished their graduation in less than three years and worked in that health unit for less than less than a year. From the analysis of the interviews, three categories emerged, namely: Management skills; Difficulties to manage; and, Potential/Facilities to manage. Main results: through this study, it was possible to notice that the perceptions about the nurses' attributions were well clarified, demonstrating that the management is linked to technical and bureaucratic issues, and their relevance in the efficient management of the team under their leadership. Conclusion: It is observed that there is a need for nursing professionals to understand that the theoretical and practical training of continuing education activities should be pursued diligently and should not just wait for the health services to offer them.

Introducción: La enfermería se considera una de las ocupaciones más versátiles dentro del personal sanitario. La gestión de los servicios de enfermería es esencial para el éxito de la institución sanitaria y para la calidad y seguridad de la atención al paciente. El enfermero gestor debe ser capaz de trabajar y dirigir a su equipo con cooperación y dinamismo, apoyándose en conocimientos técnicos y valores éticos. Objetivo: Investigar los conocimientos de las enfermeras sobre las competencias de gestión. Método: Estudio descriptivo, exploratorio, de abordaje cualitativo, realizado con enfermeros, de un hospital universitario de pequeño porte, situado en la región noroeste del estado de Paraná. Las entrevistas se basaron en la siguiente pregunta orientadora: "Háblame de las competencias directivas que desempeñan las enfermeras". Tras la recogida de datos, se transcribieron y analizaron según el análisis de contenido de Bardin. Resultados: Participaron en el estudio siete enfermeros, con edades comprendidas entre los 22 y los 35 años, la mayoría de estos profesionales terminaron el grado en menos de tres años y permanecieron en la unidad de salud, por lo menos un año. Del análisis de las entrevistas surgieron tres categorías, a saber Habilidades para la gestión; Dificultades para la gestión; y, Potencialidades/Facilidades para la gestión. Principales resultados: a través de este estudio se ha podido constatar que las percepciones sobre las atribuciones de los enfermeros se han esclarecido, demostrando que la gerencia está ligada a las cuestiones técnicas y brocráticas, y a su relevancia en la conducción eficiente del equipo bajo su liderazgo. Conclusión: Se observa que existe la necesidad de que los profesionales de la enfermería comprendan que la formación teórica y práctica de las actividades de educación continuada debe ser buscada con afán y no debe aguantar que los servicios de salud los ofrezcan.

Identification and assessment of a comprehensive set of structural factors associated with hospital costs in Switzerland.

Structural factors can influence hospital costs beyond case-mix differences. However, accepted measures on how to distinguish hospitals with regard to cost-related organizational and regional differences are lacking in Switzerland. Therefore, the objective of this study was to identify and assess a comprehensive set of hospital attributes in relation to average case-mix adjusted costs of hospitals. Using detailed hospital and patient-level data enriched with regional information, we derived a list of 23 cost predictors, examined how they are associated with costs, each other, and with different hospital types, and identified principal components within them. Our results showed that attributes describing size, complexity, and teaching-intensity of hospitals (number of beds, discharges, departments, and rate of residents) were positively related to costs and showed the largest values in university (i.e., academic teaching) and central general hospitals. Attributes related to rarity and financial risk of patient mix (ratio of rare DRGs, ratio of children, and expected loss potential based on DRG mix) were positively associated with costs and showed the largest values in children's and university hospitals. Attributes characterizing the provision of essential healthcare functions in the service area (ratio of emergency/ ambulance admissions, admissions during weekends/ nights, and admissions from nursing homes) were positively related to costs and showed the largest values in central and regional general hospitals. Regional attributes describing the location of hospitals in large agglomerations (in contrast to smaller agglomerations and rural areas) were positively associated with costs and showed the largest values in university hospitals. Furthermore, the four principal components identified within the hospital attributes fully explained the observed cost variations across different hospital types. These uncovered relationships may serve as a foundation for objectifying discussions about cost-related heterogeneity in Swiss hospitals and support policymakers to include structural characteristics into cost benchmarking and hospital reimbursement.

Organizational aspects of pediatric anesthesia and surgery between two waves of Covid-19.

BACKGROUND: The initial wave of the Covid-19 pandemic has hit Italy, and Lombardy in particular, with violence, forcing to reshape all hospitals' activities; this happened even in pediatric hospitals, although the young population seemed initially spared from the disease. "Vittore Buzzi" Children's Hospital, which is a pediatric/maternal hospital located in Milan (Lombardy Region), had to stop elective procedures-with the exception of urgent/emergent ones-between February and May 2020 to leave space and resources to adults' care. We describe the challenges of reshaping the hospital's identity and structure, and restarting pediatric surgery and anesthesia, from May on, in the most hit area of the world, with the purpose to avoid and contain infections. Both patients and caregivers admitted to hospital have been tested for Sars-CoV-2 in every case. METHODS: Observational cohort study via review of clinical charts of patients undergoing surgery between 16th May and 30th September 2020, together with SARS-CoV -2 RT-PCR testing outcomes, and comparison to same period surgeries in 2019. RESULTS: An increase of approximately 70% in pediatric surgeries (OR 1.68 [1.33-2.13], P < .001) and a higher increase in the number of surgeries were reported (OR 1.75 (1.43-2.15), P < .001). Considering only urgent procedures, a significant difference in the distribution of the type of surgery was observed (Chi-squared P-value < .001). Sars-CoV-2-positive patients have been 0.8% of total number; 14% of these was discovered through caregiver's positivity. CONCLUSION: We describe our pathway for safe pediatric surgery and anesthesia and the importance of testing both patient and caregiver.

Virtual Interviews May Fall Short for Pediatric Surgery Fellowships: Lessons Learned From COVID-19/SARS-CoV-2.

BACKGROUND: As a result of the coronavirus disease 2019 pandemic, many Pediatric Surgery Fellowship programs were forced to convert their normal in-person interviews into virtual interviews. This study sought to determine the perceived value of virtual interviews for Pediatric Surgery Fellowship. METHODS: An anonymous survey was distributed to the applicants and faculty at a university-affiliated, free-standing children's hospital with a Pediatric Surgery fellowship program that conducted one of three interview days using a virtual format. RESULTS: All applicants who responded to the survey had at least one interview that was converted to a virtual interview. Faculty (75%) and applicants (87.5%) preferred in-person interviews over virtual interviews; most applicants (57%) did not feel they got to know the program as well with the virtual format. Applicants and faculty felt that virtual interviews could potentially be used as a screening tool in the future (7/10 Likert) but did not recommend they be used as a complete replacement for in-person interviews (3.5-5/10 Likert). Applicants were more likely than faculty to report that interview type influenced their final rank list (5 versus 3/10 Likert). CONCLUSIONS: Faculty and applicants preferred in-person interviews and did not recommend that virtual interviews replace in-person interviews. As the coronavirus disease 2019 pandemic continues, more virtual interviews will be necessary, and innovations may be necessary to ensure an optimal interview process. TYPE OF STUDY: Survey. LEVEL OF EVIDENCE: N/A.

Ultrasound assessment of deep tissue on the wound bed and periwound skin: A classification system using ultrasound images.

AIMS: Given the utility of ultrasonography in assessing pressure injury, some ultrasonographic findings have already been used as indicators of deep tissue pressure injury. Despite reports showing that a cloud-like ultrasonographic pattern reflected the presence of deep tissue necrosis, identifying cloud-like patterns was difficult given the presence of similar findings, such as a cobblestone-like pattern. This case series reports patients with pressure injuries who presented with a cloud-like (five cases) and cobblestone-like (four cases) pattern during ultrasonography. METHODS: This study was conducted at a Japanese university hospital. Participants included patients who underwent routine examination by an interdisciplinary pressure injury team. Pressure injury severity was assessed using the DESIGN-R® scoring system and the wound size were measured using ImageJ software based on the wound photograph. RESULTS: Among the five cases showing a cloud-like pattern upon ultrasonography, all exhibited an increase in the total DESIGN-R® score, while three exhibited an increase in wound size. On the other hand, all four cases showing a cobblestone-like pattern displayed no increase in the total DESIGN-R® score and a decrease in wound size. CONCLUSION: This study suggested that distinguishing between cloud-like and cobblestone-like ultrasonography patterns is necessary for determining the presence or absence of deep tissue pressure injury. In order to comprehensively assess pressure injuries with ultrasonography, future studies should be conducted in a large number of participants.

COVID-19 free oncologic surgical hub: The experience of reallocation of a gynecologic oncology unit during pandemic outbreak.

INTRODUCTION: During the SARS-CoV-2 pandemic, the majority of healthcare resources of the affected Italian regions were allocated to COVID-19 patients. Due to lack of resources and high risk of death, most cancer patients have been shifted to non-surgical treatments. The following reports our experience of a Gynaecologic Oncology Unit's reallocation of resources in a COVID-19 free surgical oncologic hub in order to guarantee standard quality of surgical activities. MATERIALS AND METHODS: This is a prospective observational study performed in the Gynaecologic Oncology Unit, on the outcomes of the reallocation of surgical activities outside the University Hospital of Bologna, Italy, during the Italian lockdown period. Here, we described our COVID-19 free surgical oncologic pathway, in terms of lifestyle restrictions, COVID-19 screening measures, and patient clinical, surgical and follow up outcomes. RESULTS: During the lockdown period (March 9th - May 4th, 2020), 83 patients were scheduled for oncological surgery, 51 patients underwent surgery. Compared to pre-COVID period, we performed the same activities: number of cases scheduled for surgery, type of surgery and surgical and oncological results. No cases of COVID-19 infection were recorded in operated patients and in medical staff. Patients were compliant and well accepted the lifestyle restrictions and reorganization of the care. CONCLUSIONSONCLUSIONS: Our experience showed that the prioritization of oncological surgical care and the allocation of resources during a pandemic in COVID-19 free surgical hubs is an appropriate choice to guarantee oncological protocols.

Ocular oncology service during the COVID-19 outbreak in Florence (Italy): Practical considerations for the management of patients.

The Coronavirus disease 2019 (COVID-19) outbreak has imposed the adoption of strategies to limit the risk of contagion for cancer patients without compromising their healthcare. As well as cancers of other sites, the treatment of certain ocular and periocular malignancies is considered non-deferrable and should proceed despite the pandemic. Delays in treatment of these patients may result in negative outcomes. Herein, we provide some practical considerations deriving from our experience at the Ocular Oncology Unit of Careggi University Hospital (Florence, Italy).

Rethinking Trauma Hospital Services in one of Spain's Largest University Hospitals during the COVID-19 pandemic. How can we organize and help? Our experience.

INTRODUCTION: The severe disruptions caused by the SARS-CoV-2 coronavirus have necessitated a redistribution of resources to meet hospitals' current service needs during this pandemic. The aim is to share our experiences and outcomes during the first month of the Covid-19 pandemic, based on the strategies recommended and strategies we have implemented. METHODS: Our experience comes from our work at a referral hospital within the Spanish National Health System. Changes to clinical practice have largely been guided by the current evidence and four main principles: (1) patient and health-care worker protection, (2) uninterrupted necessary care, (3) conservation of health-care resources, (4) uninterrupted formation for residents. Based on these principles, changes in the service organization, elective clinical visits, emergency visits, surgical procedures, and inpatient and outpatient care were made. RESULTS: Using the guidance of experts, we were able to help the hospital address the demands of the Covid-19 outbreak. We reduced to a third of our orthopaedics and trauma hospital beds, provided coverage for general emergency services, and five ICUs, all continuing to provide care for our patients, in the form of 102 trauma surgeries, 6413 phone interviews and 520 emergency clinic visits. Also in the third week, we were able to restart morning meetings via telematics, and teaching sessions for our residents. On the other hand, eight of the healthcare personnel on our service (10.8%) became infected with Covid-19. CONCLUSIONS: As priorities and resources increasingly shift towards the COVID-19 pandemic, it is possible to maintain the high standard and quality of care necessary for trauma and orthopaedics patients while the pandemic persists. We must be prepared to organize our healthcare workers in such a way that the needs of both inpatients and outpatients are met. It is still possible to operate on those patients who need it. Unfortunately, some healthcare workers will become infected. It is essential that we protect those most susceptible to severer consequences of Covid-19. Also crucial are optimized protective measures.

Experience on how to implement a preanalytical and POCT unit in Madrid's IFEMA field hospital during this unprecedented COVID-19 emergency.

To fight the virus SARS-CoV-2 spread to Europe from China and to give support to the collapsed public health system, the Spanish Health Authorities developed a field hospital located in the facilities of Madrid exhibition centre (IFEMA) to admit and treat patients diagnosed with SARS-CoV-2 infectious disease (COVID-19). The Department of Laboratory Medicine of La Paz University Hospital in Madrid (LMD-HULP) was designated to provide laboratory services. Due to the emergency, the IFEMA field hospital had to be prepared for patient admission in less than 1 week and the laboratory professionals had to collaborate in a multidisciplinary group to assure that resources were available to start on time. The LMD-HULP participated together with the managers in the design of the tests portfolio and the integration of the healthcare information systems (IS) (hospital IS, laboratory IS and POCT management system). Laboratorians developed a strategy to quickly train clinicians and nurses on test requests, sample collection procedures and management/handling of the POCT blood gas analyser both by written materials and training videos. The IFEMA´s preanalytical unit managed 3782 requests, and more than 11,000 samples from March 27th to April 30th. Furthermore, 1151 samples were measured by blood gas analysers. In conclusion, laboratory professionals must be resilient and have to respond timely in emergencies as this pandemic. The lab's personnel selection, design and monitoring indicators to maintain and further improve the quality and value of laboratory services is crucial to support medical decision making and provide better patient care.

Administrative Burden and Costs of Prior Authorizations in a Dermatology Department.

Importance: Insurance companies use prior authorizations (PAs) to address inappropriate prescribing or unnecessary variations in care, most often for expensive medications. Prior authorizations negatively affect patient care and add costs and administrative burden to dermatology offices. Objective: To quantify the administrative burden and costs of dermatology PAs. Design, Setting, and Participants: The University of Utah Department of Dermatology employs 2 full-time and 8 part-time PA staff. In this cross-sectional study at a large academic department spanning 11 clinical locations, these staff itemized all PA-related encounters over a 30-day period in September 2016. Staff salary and benefits were publicly available. Data were analyzed between December 2018 and August 2019. Main Outcomes and Measures: Proportion of visits requiring PAs, median administrative time to finalize a PA (either approval or denial after appeal), and median cost per PA type. Results: In September 2016, 626 PAs were generated from 9512 patient encounters. Staff spent 169.7 hours directly handling PAs, costing a median of $6.72 per PA. Biologic PAs cost a median of $15.80 each and took as long as 31 business days to complete. The costliest PA equaled 106% of the associated visit's Medicare reimbursement rate. Approval rates were 99.6% for procedures, 78.9% for biologics, and 58.2% for other medications. After appeal, 5 of 23 (21.7%) previously denied PAs were subsequently approved. Conclusions and Relevance: Prior authorizations are costly to dermatology practices and their value appears limited for some requests. Fewer unnecessary PAs and appeals might increase practice efficiency and improve patient outcomes.

Responding to COVID-19: how an academic infectious diseases division mobilized in Singapore.

BACKGROUND: On January 30, COVID-19 was declared a Public Health Emergency of International Concern-a week after Singapore's first imported case and 5 days before local transmission. The National University Hospital (NUH) is Singapore's third largest hospital with 1200 beds, heavy clinical workloads, and major roles in research and teaching. MAIN BODY: With memories of SARS still vivid, there was an urgent requirement for the NUH Division of Infectious Diseases to adapt-undergoing major reorganization to face rapidly changing priorities while ensuring usual essential services and standards. Leveraging on individual strengths, our division mobilized to meet the demands of COVID-19 while engaging in high-level coordination, strategy, and advocacy. We present our experience of the 60 days since the nation's first case. During this time, our hospital has managed 3030 suspect cases, including 1300 inpatients, 37 confirmed cases, and overseen 4384 samples tested for COVID-19. CONCLUSION: Complex hospital adaptations were supported by an unprecedented number of workflows and coordination channels essential to safe and effective operations. The actions we describe, aligned with international recommendations and emerging evidence-based best practices, may serve as a framework for other divisions and institutions facing the spread of COVID-19 globally.

Effective control of SARS-CoV-2 transmission between healthcare workers during a period of diminished community prevalence of COVID-19.

Previously, we showed that 3% (31/1032)of asymptomatic healthcare workers (HCWs) from a large teaching hospital in Cambridge, UK, tested positive for SARS-CoV-2 in April 2020. About 15% (26/169) HCWs with symptoms of coronavirus disease 2019 (COVID-19) also tested positive for SARS-CoV-2 (Rivett et al., 2020). Here, we show that the proportion of both asymptomatic and symptomatic HCWs testing positive for SARS-CoV-2 rapidly declined to near-zero between 25th April and 24th May 2020, corresponding to a decline in patient admissions with COVID-19 during the ongoing UK 'lockdown'. These data demonstrate how infection prevention and control measures including staff testing may help prevent hospitals from becoming independent 'hubs' of SARS-CoV-2 transmission, and illustrate how, with appropriate precautions, organizations in other sectors may be able to resume on-site work safely.

Pharmaceutical management of the COVID-19 pandemic in a mid-size hospital.

The purpose of this article is to report the experience of the Department of Hospital Pharmacy of a mid-size hospital during the peak of the COVID-19 pandemic. The human and material resources available in a mid-size hospital were more limited than in larger hospitals of the region. In this article, we describe how this Department of Hospital Pharmacy was reorganized to meet the increase in activity, the strategies developed and the  lessons learned for future pandemics. The COVID-19 pandemic had a higher  impact in Leganes, a city in the south of Madrid, with a population of 190,000.  In the face of the dramatic increase in the proportion of patients attending our  hospital between March and April 2020, the Severo Ochoa University Hospital  increased the number of beds by 24.5% and fitted out new premises inside and  outside the hospital (sports centers). The mean number of patients seen in our  Emergency Department every day passed from 70-80 to a peak of 286 patients, with 652 hospitalized patients. The situation of emergency created by  this infectious disease, with management protocols changing constantly, had a  dramatic impact on the activity of hospital pharmacies. Thus, the pandemic has  affected areas of economic management, magistral preparation, dispensing of  medication to inpatients, ambulatory patients, patients monitored at home,  institutionalized patients, and patients from private hospitals and field hospitals.  Other areas affected include training, clinical trials, pharmacovigilance, and  counseling boards. Two strategies were adopted to overcome these problems: a  strategy centered on human resources (staff reinforcement, reallocation of  responsibilities), and a strategy centered on processes (some processes were  reinforced to meet the increase in activity, whereas other were temporarily suspended or reduced to the minimum).Conclusions: The Department of Hospital Pharmacy plays a key role  in hospitals and has been significantly reinforced to meet the dramatic impact of  the pandemic on this service. This Department has been able to reorganize its  processes and take over new responsibilities such as telepharmacy and home  dispensing. Hospital pharmacies play a crucial role in  pharmacotherapeutic decisions in hospitals. As in other Departments, training is  the area more significantly affected by the pandemic.

El objetivo de este artículo es describir la experiencia del servicio de farmacia de un hospital mediano, en el período álgido de la pandemia de COVID-19, con  recursos humanos y materiales más limitados que otros hospitales de su entorno de mayor tamaño. Se analiza cómo afrontó su reorganización, debido al  incremento de su actividad, así como las estrategias desarrolladas y las  lecciones aprendidas para afrontar el futuro. La pandemia por COVID-19 tuvo  especial repercusión en el municipio de Leganés, una ciudad de 190.000  habitantes al sur de Madrid. Ante el incremento de la afluencia de pacientes  entre los meses de marzo y abril de 2020, el Hospital Universitario Severo  Ochoa llegó a asumir un 24,5% más de camas, incluyendo nuevas ubicaciones  tanto dentro como fuera del hospital (pabellón deportivo). Siendo la media de  frecuentación del Servicio de Urgencias de 70-80 pacientes, se llegó a alcanzar  un pico de 286 pacientes y 652 pacientes ingresados. Esta situación de  emergencia y el abordaje de una patología infecciosa, con protocolos de  tratamiento en continua revisión, impactó en todas las áreas y actividades del  servicio de farmacia: adquisiciones, gestión económica, elaboración de  medicamentos y dispensación a pacientes hospitalizados, pacientes externos y  ambulantes, domiciliaria, a centros geriátricos, hospitales de gestión privada y  hospitales de campaña. Se vieron afectadas áreas como la formación, los  ensayos clínicos, la farmacovigilancia y las comisiones hospitalarias. Para  superar los problemas, se aplicaron dos estrategias: una centrada en los  recursos humanos (reforzamiento de áreas, reasignación de responsabilidades) y otra focalizada en los procesos (procesos que se reforzaron por un aumento de  la actividad, procesos que se suspendieron temporalmente por la pandemia y  procesos que se redujeron al mínimo).Conclusiones: El servicio de farmacia es una pieza clave en el hospital cuyas  funciones principales son las primeras perjudicadas, pero a la vez las más  reforzadas durante la pandemia. Ha tenido la capacidad de reorganizar sus  procesos para asimilar nuevas actividades, como la telefarmacia y la  dispensación domiciliaria. Juega un papel importante en las decisiones  farmacoterapéuticas del hospital. Al igual que otros servicios clínicos, la  formación ha sido el área más perjudicada.

Pharmaceutical care to hospital outpatients during the COVID-19 pandemic. Telepharmacy.

Hospital Pharmacy Service (HPS) in Spain have been impacted by the health  crisis caused by the COVID-19 pandemic. Thus, the outbreak has forced HPSs to adapt their outpatient consultation services to Telepharmacy to optimize clinical  outcomes and reduce the risk of contagion. The purpose of this article is to  describe and analyze the experience of HPSs with outpatient Telepharmacy  during the COVID-19 pandemic and expose the lessons learned. Measures have  been adopted in on-site outpatient pharmacy clinics to prevent exposure of  patients and professionals to the virus. These measures are based on national  and international recommendations on social distancing and hygiene. With  regard to remote outpatient pharmacy services, teleconsultation with drug  dispensing has been promoted based on five basic procedures, each with its  advantages and limitations: home drug delivery from HPSs, with the advantage  of universal access and the limitation of entailing a substantial investment in  resources; HPS coordination with primary care pharmacists, which requires no  investments but with limited access to some geographic areas; HPS coordination with community pharmacists based on a large network of pharmacies, which  requires the patient to go to the pharmacy, without confidentiality being  guaranteed for any patient; geolocation and hospital-based medication  dispensing, which provides universal access and direct traceability, but entails  investment in human resources; and HPS coordination with associations of  patients, which does not entail any additional cost but limits the information  available on the diseases of society members. Three main lessons have been learned during the pandemic: the satisfactory capacity of HPS to provide outpatient pharmacy consultation services in the setting of a public health crisis; the usefulness of Telepharmacy for the clinical follow-up, healthcare coordination, outpatient counseling, and informed dispensing and delivery of  medication (with a high level of satisfaction among patients); and the need to  foster Telepharmacy as a complementary tool through a mixed model of  outpatient pharmacy consultation service that incorporates the advantages of  each procedure and adapts to the individual needs of each patient in a context of humanized healthcare.

Los servicios de farmacia hospitalaria (SFH) en España se han visto afectados  por la crisis sanitaria provocada por SARS-CoV-2 y han tenido que adoptar sus  procedimientos de atención farmacéutica (AF) al paciente externo (PE) mediante estrategias de Telefarmacia, con los objetivos de maximizar los resultados en  salud y reducir el riesgo de contagio. El objetivo de ese artículo es describir y  analizar los procedimientos AFPE durante la pandemia SARS-CoV-2 y comunicar  las lecciones aprendidas en los SFH. En relación con las consultas externas de AF presenciales, se han adoptado medidas para minimizar el contagio viral de  pacientes y profesionales, siguiendo las recomendaciones nacionales e  internacionales de referencia de distanciamiento temporal, espacial y  recomendaciones higiénicas. En cuanto a las consultas externas de AF no  presenciales, se han potenciado las teleconsultas con dispensación del  tratamiento en base a cinco procedimientos básicos, cada uno de ellos con sus  ventajas y limitaciones: dispensación domiciliaria desde SFH que presenta las  ventajas de la universalidad de acceso, pero requiere una elevada inversión en  recursos; coordinación del SHF con farmacéuticos de atención primaria, que  conlleva una nula inversión en recursos, pero limita el acceso a determinadas zonas geográficas; coordinación del SFH con farmacéuticos comunitarios, que  utiliza una amplia red de oficinas de farmacia, pero exige el desplazamiento del  paciente sin garantías de confidencialidad para todos los casos; geolocalización y dispensación hospitalaria, que permite un acceso universal y trazabilidad directa, pero requiere un incremento en recursos humanos; y coordinación del SFH con  asociaciones de pacientes, que no requiere inversión económica, pero limita el  acceso a las patologías de los asociados. Destacamos finalmente tres lecciones  aprendidas: la capacidad de AFPE de SFH españoles ante una crisis sanitaria; la  utilidad de la Telefarmacia para el seguimiento clínico, la coordinación  asistencial, información al PE, dispensación y entrega informada (con elevada  satisfacción de los pacientes); y la necesidad de potenciar la Telefarmacia como herramienta complementaria, en un modelo mixto de AFPE que incorpore las  ventajas de cada uno de los procedimientos adaptándose a las necesidades individuales de los pacientes en un entorno de humanización de la asistencia  sanitaria.

Patient satisfaction in Kazakhstan: Looking through the prism of patient healthcare experience.

OBJECTIVES: This study aimed to explore the relationship between patient satisfaction and patient experience after exposure to inpatient hospitalization. METHODS: A cross-sectional self-completed survey at the bedside in the Inpatient departments of the University Medical Center hospitals (UMC) in Nur-Sultan city, Kazakhstan was submitted. A total of 153 patients completed the survey from September 2017 to June 2018. The survey used the Picker Patient Experience questionnaire validated in Russian and Kazakh languages. RESULTS: The majority of patients were satisfied with their hospital stay (90.8 %). Only self-rated health status was associated with overall satisfaction (OR 1.922, 95 % CI 1.09-3.37). Patient experience assessment revealed an association of physical comfort and respect for patient preferences with overall satisfaction (OR 0.101, 95 % CI 0.01-0.91 and OR 0.317, 95 % CI 0.11-0.92). CONCLUSIONS: Study findings support that patient satisfaction is an exaggerated image of healthcare performance. Groups with negative experience have shown lower overall satisfaction in the dimensions 'physical comfort' and 'respect for patient preferences'. PRACTICE IMPLICATIONS: Improving patient centered communication and pain control in clinical practice may lead to the improvement in patient satisfaction.

Systematic symptom and problem assessment at admission to the palliative care ward - perspectives and prognostic impacts.

BACKGROUND: Symptom assessment is essential in palliative care, but holds challenges concerning implementation and relevance. This study aims to evaluate patients' main symptoms and problems at admission to a specialist inpatient palliative care (SIPC) ward using physician proxy- and patient self-assessment, and aims to identify their prognostic impact as well as the agreement between both assessments. METHODS: Within 12 h after admission, palliative care specialists completed the Symptom and Problem Checklist of the German Hospice and Palliative Care Evaluation (HOPE-SP-CL). Patients either used the new version of the minimal documentation system for patients in palliative care (MIDOS) or the Integrated Palliative Care Outcome Scale (IPOS) plus the Distress Thermometer (DT). RESULTS: Between 01.01.2016-30.09.2018, 1206 patients were included (HOPE-SP-CL 98%; MIDOS 21%, IPOS 34%, DT 27%) whereof 59% died on the ward. Proxy-assessment showed a mean HOPE-SP-CL Total Score of 24.6 ± 5.9 of 45. Most frequent symptoms/problems of at least moderate intensity were weakness (95%), needs of assistance with activities of daily living (88%), overburdening of family caregivers (83%), and tiredness (75%). Factor analysis identified four symptom clusters (SCs): (1) Deteriorated Physical Condition/Decompensation of Home Care, (2) Emotional Problems, (3) Gastrointestinal Symptoms and (4) Other Symptoms. Self-assessment showed a mean MIDOS Total Score of 11.3 ± 5.3 of 30, a mean IPOS Total Score of 32.0 ± 9.0 of 68, and a mean distress of 6.6 ± 2.5 of 10. Agreement of self- and proxy-assessment was moderate for pain (ƙ = 0.438) and dyspnea (ƙ = 0.503), fair for other physical (ƙ = 0.297 to 0.394) and poor for psychological symptoms (ƙ = 0.101 to 0.202). Multivariate regression analyses for single symptoms and SCs revealed that predictors for dying on the SIPC ward included impaired ECOG performance status, moderate/severe dyspnea, appetite loss, tiredness, disorientation/confusion, and the SC Deteriorated Physical Condition/Decompensation of Home Care. CONCLUSION: Admissions to a SIPC ward are mainly caused by problems impairing mobility and autonomy. Results demonstrate that implementation of self- and reliability of proxy- and self-assessment is challenging, especially concerning non-physical symptoms/problems. We identified, specific symptoms and problems that might provide information needed for treatment discussions regarding the medical prognosis.