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ABSTRACT Objective to understand the best management practices in the health care provided to people living with HIV in Primary Health Care services from Florianópolis, Santa Catarina. Method a qualitative research study anchored in the Constructivist Grounded Theory. The study participants were nurses and managers involved with management practices in the care provided to people living with HIV in the municipality. The data were collected between July and September 2020 from intensive interviews with 12 nurses in four Basic Health Units and with five managers of the Municipal Health Department, Florianópolis, Santa Catarina, Brazil, totaling 17 participants. Data collection and analysis took place concomitantly, following the initial and focused coding phases. Results this resulted in the phenomenon entitled "Unveiling the best management practices in the care provided to people living with HIV related to decentralized, shared and evidence-based care", supported by three categories that point to decentralization of the clinical management of the HIV infection to Primary Health Care in Florianópolis, to instrumentalization and training of professionals to manage the infection through the use of scientific evidence, and to the care practices developed in the face of the COVID-19 pandemic. Conclusion decentralization of care for people living with HIV to Primary Health Care was presented as the foundation of the best practices, supported by teamwork and evidence-based clinical management.
RESUMEN Objetivo comprender las mejores prácticas de gestión de la atención médica provista a personas que viven con VIH en los servicios de Atención Primaria de la Salud de Florianópolis, Santa Catarina. Método investigación cualitativa, basada en la Teoría Fundamentada en los Datos constructivista. Los participantes del estudio fueron enfermeros y gerentes con participación en las prácticas de gestión de la atención provista a personas que viven con VIH en el municipio. Los datos se recolectaron entre julio y septiembre de 2020 a partir de entrevistas intensivas con 12 enfermeros en cuatro Unidades Básicas de Salud y con cinco gerentes de la Secretaría Municipal de Salud de Florianópolis, Santa Catarina, Brasil, totalizando 17 participantes. La recolección y el análisis de los datos tuvieron lugar simultáneamente, para luego desarrollar las fases de codificación inicial y focalizada. Resultados se arribó al fenómeno llamado "Revelando las mejores prácticas de gestión de la atención provista a personas que viven con VIH relacionadas con la asistencia descentralizada, compartida y basada en evidencias", sustentado por tres categorías que apuntan a la descentralización del manejo clínico de la infección por VIH al ámbito de la Atención Primaria de la Salud en Florianópolis, a la instrumentalización y capacitación de los profesionales para el manejo de la infección aplicando evidencias científicas, y a las prácticas de atención desarrolladas frente a la pandemia de COVID-19. Conclusión la descentralización de la atención provista a personas que viven con VIH al ámbito de la Atención Primaria de la Salud se presentó como la base de las mejores prácticas, sustentadas en el trabajo en equipo y el manejo clínico basado en evidencias.
RESUMO Objetivo compreender as melhores práticas de gestão no cuidado à saúde das pessoas que vivem com HIV em serviços de Atenção Primária à Saúde em Florianópolis, Santa Catarina. Método pesquisa qualitativa, ancorada na teoria fundamentada nos dados construtivista. Os participantes do estudo foram enfermeiros e gestores envolvidos com as práticas de gestão no cuidado às pessoas que vivem com HIV no município. Os dados foram coletados entre julho e setembro de 2020, a partir de entrevistas intensivas com 12 enfermeiros, em quatro Unidades Básicas de Saúde e cinco gestores da Secretaria Municipal de Saúde, de Florianópolis, Santa Catarina, Brasil, totalizando 17 participantes. A coleta e análise dos dados ocorreram de forma concomitante, seguindo as fases de codificação inicial e focalizada. Resultados chegou-se ao fenômeno intitulado "Desvelando as melhores práticas de gestão no cuidado às pessoas que vivem com HIV relacionadas com o cuidado descentralizado, compartilhado e baseado em evidências," sustentado por três categorias que apontam para a descentralização do manejo clínico da infecção por HIV para a Atenção Primária à Saúde em Florianópolis, a instrumentalização e treinamento dos profissionais para o manejo da infecção mediante o uso de evidências científicas e as práticas de cuidado desenvolvidas frente à pandemia de Covid-19. Conclusão a descentralização do cuidado às pessoas que vivem com HIV para a Atenção Primária à Saúde foi apresentada como alicerce das melhores práticas, amparadas no trabalho em equipe e manejo clínico baseado em evidências.
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INTRODUCTION: The objective is to analyze the impact of the COVID-19 pandemic on the pediatric emergencies and hospital admissions. METHODS: Retrospective cohort study of patients treated in a tertiary hospital, from March 14 to April 26, 2020, compared to the same period of the previous 3 years. RESULTS: A notable overall reduction in emergency room visits and admissions is observed in all pediatric areas, maintaining care in neonatology and scheduled admissions in oncology. DISCUSSION: The reduction in global activity in pediatric emergencies is not only explained by the decrease in contagious diseases. The decrease in inadequate demand and inappropriate income may have contributed. The availability of pediatric beds would make the reduction of programmed surgical activity unnecessary and would allow the redistribution of resources to areas with greater healthcare pressure.
Тема - темы
COVID-19 , Humans , Child , Pandemics , Tertiary Care Centers , SARS-CoV-2 , Emergencies , Retrospective Studies , Emergency Service, Hospital , HospitalizationРеферат
INTRODUCTION: The objective is to analyze the impact of the COVID-19 pandemic on the pediatric emergencies and hospital admissions. METHODS: Retrospective cohort study of patients treated in a tertiary hospital, from March 14 to April 26, 2020, compared to the same period of the previous 3 years. RESULTS: A notable overall reduction in emergency room visits and admissions is observed in all pediatric areas, maintaining care in neonatology and scheduled admissions in oncology. DISCUSSION: The reduction in global activity in pediatric emergencies is not only explained by the decrease in contagious diseases. The decrease in inadequate demand and inappropriate income may have contributed. The availability of pediatric beds would make the reduction of programmed surgical activity unnecessary and would allow the redistribution of resources to areas with greater healthcare pressure.
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INTRODUCTION: Introduction: the SARS-CoV-2 pandemic has forced major organizational and care changes in the health system. However, in Spain, the circumstances suffered by the health professionals who have cared for pandemic patients from a clinical nutrition standpoint has remained unknown up to this moment. Objectives: the management and care changes made in clinical nutrition units in Spain, and their impact on clinical practice are described. Material and methods: a cross-sectional study was carried out using a survey directed at SENPE members (June 2020). Responses sent by health professionals in the field of clinical nutrition who had treated patients with COVID-19 in Spanish hospitals were included in the study. Resultados: a total of 116 survey forms were analyzed, mostly filled out by doctors (57.8 %) working at hospitals with more than 500 beds (56 %); 46 % of survey respondents were on telework. There was a nutritional care plan in 68 % of cases, such plan being present mainly in hospitals with more than 500 beds (p < 0.001). In these hospitals more specific diets for COVID-19 were implemented than in those under 500 beds: 18 (35.3 %) vs 44 (67.7 %), (p < 0.001). The use of recommendations issued by scientific societies was reported in 86 % of cases. Never or almost never could a satisfactory nutritional assessment be performed for 38.8 %. The prescription of nutritional supplements was not less than 50 %. Health workers rated their performance as satisfactory or very satisfactory (51.7 %), and this was not related to hospital size but to having implemented a COVID-19 diet (p < 0.05). Conclusions: clinical nutrition in Spain has responded to the COVID-19 pandemic with organizational and managerial changes and, although care has been clearly affected, some quality standards were ultimately maintained. Larger hospitals have had some advantages in making these adjustments.
INTRODUCCIÓN: Introducción: la pandemia ocasionada por el SARS-CoV-2 ha obligado a realizar importantes cambios organizativos y asistenciales en el sistema sanitario. Sin embargo, hasta ahora se desconoce cuáles han sido las circunstancias que han sufrido los profesionales sanitarios que han atendido esta pandemia desde los servicios de nutrición clínica en España. Objetivos: describir los cambios de gestión y asistenciales realizados en las unidades de nutrición clínica en España y su repercusión en la práctica clínica. Material y métodos: estudio transversal mediante técnica de encuesta dirigida a socios de la SENPE (junio 2020). Se incluyen en el estudio respuestas remitidas por profesionales sanitarios del ámbito de la nutrición clínica que atendieron a pacientes con COVID-19 en hospitales españoles. Resultados: se analizan 116 encuestas provenientes en su mayoría de médicos (57,8 %) y de hospitales de más de 500 camas (56 %); el 46 % de los encuestados teletrabajó. Se contó con la presencia de un plan de atención nutricional en el 68 % de los casos, plan que fue mayoritario en los hospitales con más de 500 camas (p < 0,001). En estos hospitales se implantaron más dietas específicas para COVID-19 que en los menores de 500 camas: 18 (35,3 %) vs. 44 (67,7 %), (p < 0,001). El uso de las recomendaciones de las sociedades científicas se notificó en el 86 % de los casos. El 38,8 % nunca o casi nunca pudieron hacer una valoración nutricional satisfactoria. La prescripción de suplementos nutricionales fue no inferior al 50 %. El 51,7 % de los encuestados calificaron su actuación como satisfactoria o muy satisfactoria, y esta no se relacionó con el tamaño de hospital pero sí con haber implantado una dieta para la COVID-19 (p < 0,05). Conclusiones: la nutrición clínica en España ha respondido a la pandemia de COVID-19 con cambios organizativos y de gestión y, aunque la asistencia se ha visto claramente afectada, se han podido mantener algunos estándares de calidad. Los hospitales de mayor tamaño han tenido cierta ventaja para realizar estos ajustes.
Тема - темы
COVID-19/therapy , Hospital Units , Nutrition Surveys , Nutrition Therapy , Cross-Sectional Studies , Humans , SpainРеферат
INTRODUCTION: The overload of the healthcare system and the organisational changes made in response to the COVID-19 pandemic may be having an impact on acute stroke care in the Region of Madrid. METHODS: We conducted a survey with sections addressing hospital characteristics, changes in infrastructure and resources, code stroke clinical pathways, diagnostic testing, rehabilitation, and outpatient care. We performed a descriptive analysis of results according to the level of complexity of stroke care (availability of stroke units and mechanical thrombectomy). RESULTS: The survey was completed by 22 of the 26 hospitals in the Madrid Regional Health System that attend adult emergencies, between 16 and 27 April 2020. Ninety-five percent of hospitals had reallocated neurologists to care for patients with COVID-19. The numbers of neurology ward beds were reduced in 89.4% of hospitals; emergency department stroke care pathways were modified in 81%, with specific pathways for suspected SARS-CoV2 infection established in 50% of hospitals; and SARS-CoV2-positive patients with acute stroke were not admitted to neurology wards in 42%. Twenty-four hour on-site availability of mechanical thrombectomy was improved in 10 hospitals, which resulted in a reduction in the number of secondary hospital transfers. The admission of patients with transient ischaemic attack or minor stroke was avoided in 45% of hospitals, and follow-up through telephone consultations was implemented in 100%. CONCLUSIONS: The organisational changes made in response to the SARS-Co2 pandemic in hospitals in the Region of Madrid have modified the allocation of neurology department staff and infrastructure, stroke units and stroke care pathways, diagnostic testing, hospital admissions, and outpatient follow-up.