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BACKGROUND: Intravenous (IV) antibiotic use in secondary care in England is widespread. Timely appropriate intravenous to oral switch (IVOS) has the potential to deliver significant clinical and operational benefits. To date, antimicrobial stewardship (AMS) efforts around IVOS have not focused on the nursing staff who administer antibiotics, which represents a significant gap in AMS programmes. AIM: To determine the involvement of bedside nurses in acute trusts in the Midlands region of England in IVOS in their organizations and describe their views regarding how to improve IVOS. METHODS: An anonymous self-administered mixed-methods online survey was developed and distributed to nursing staff in acute trusts via antimicrobial stewardship networks between March and May 2023. Quantitative data was analysed to describe participant demographics and behaviours, whereas barriers and enablers to IVOS were explored through thematic content analysis of responses to open-ended questions. FINDINGS: A total of 545 nursing staff responded to the survey. The majority (65.3%) routinely suggested IVOS to clinicians, despite only 50.6% being aware of local IVOS policies. One-third (34.7%) did not suggest IVOS, relying on doctors, believing their patients needed IV treatment, or lacked knowledge and skills to request IVOS. Content analysis of suggestions for improving the rate of IVOS proposed three major themes (People, Process, System) and identified that education and training, improved confidence and interprofessional relationships, and prompts were important drivers. CONCLUSION: Nursing staff suggest IVOS to other clinicians, but more education and resources are needed to enable and empower them in this role.
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Administración Intravenosa , Antibacterianos , Actitud del Personal de Salud , Humanos , Inglaterra , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Femenino , Encuestas y Cuestionarios , Administración Oral , Masculino , Programas de Optimización del Uso de los Antimicrobianos/métodos , Adulto , Centros de Atención Secundaria/estadística & datos numéricos , Persona de Mediana Edad , Enfermeras y Enfermeros/psicología , Atención Secundaria de Salud , Adulto JovenRESUMEN
Although disease-associated undernutrition is still an important problem in hospitalized children that is often underrecognized, follow-up studies evaluating post-discharge nutritional status of children with undernutrition are lacking. The aim of this multicentre prospective observational cohort study was to assess the rate of acute undernutrition (AU) and/or having a high nutritional risk (HR) in children on admission to seven secondary-care level Dutch hospitals and to evaluate the nutritional course of AU/HR group during admission and post-discharge. STRONGkids was used to indicate HR, and AU was based on anthropometric data (z-score < -2 for weight-for-age (WFA; <1 year) or weight-for-height (WFH; ≥1 year)). In total, 1985 patients were screened for AU/HR over a 12-month period. On admission, AU was present in 9.9% of screened children and 6.2% were classified as HR; 266 (13.4%) children comprised the AU/HR group (median age 2.4 years, median length of stay 3 days). In this group, further nutritional assessment by a dietitian during hospitalization occurred in 44% of children, whereas 38% received nutritional support. At follow-up 4-8 weeks post-discharge, 101 out of orginal 266 children in the AU/HR group (38%) had available paired anthropometric measurements to re-assess nutrition status. Significant improvement of WFA/WFH compared to admission (-2.48 vs. -1.51 SD; p < 0.001) and significant decline in AU rate from admission to outpatient follow-up (69.3% vs. 35.6%; p < 0.001) were shown. In conclusion, post-discharge nutritional status of children with undernutrition and/or high nutritional risk on admission to secondary-care level pediatric wards showed significant improvement, but about one-third remained undernourished. Findings warrant the need for a tailored post-discharge nutritional follow-up.
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Evaluación Nutricional , Estado Nutricional , Humanos , Femenino , Estudios Prospectivos , Masculino , Preescolar , Lactante , Niño , Estudios de Seguimiento , Países Bajos/epidemiología , Desnutrición/epidemiología , Desnutrición/diagnóstico , Hospitalización/estadística & datos numéricos , Centros de Atención Secundaria/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Apoyo Nutricional , Tiempo de Internación/estadística & datos numéricos , Trastornos de la Nutrición del Niño/epidemiología , AdolescenteRESUMEN
BACKGROUND: While the benefit of admission to trauma centers compared to non-trauma centers is well-documented and differences in outcomes between Level-I and Level-II trauma centers are well-studied, data on the differences in outcomes between Level-II trauma centers (L2TCs) and Level-III trauma centers (L3TCs) are scarce. OBJECTIVES: We sought to compare mortality risk between patients admitted to L2TCs and L3TCs, hypothesizing no difference in mortality risk for patients treated at L3TCs compared to L2TCs. METHODS: A retrospective analysis of the 2016 Trauma Quality Improvement Program (TQIP) database was performed. Patients aged 18+ years were divided into 2 groups, those treated at American College of Surgeons (ACS) verified L2TCs and L3TCs. RESULTS: From 74,486 patients included in this study, 74,187 (99.6%) were treated at L2TCs and 299 (.4%) at L3TCs. Both groups had similar median injury severity scores (ISSs) (10 vs 10, P < .001); however, L2TCs had a higher mean ISS (14.6 vs 11.9). There was a higher mortality rate for L2TC patients (6.0% vs 1.7%, P = .002) but no difference in associated risk of mortality between the 2 groups (OR .46, CI .14-1.50, P = .199) after adjusting predictors of mortality. L2TC patients had a longer median length of stay (5.0 vs 3.5 days, P < .001). There was no difference in other outcomes including myocardial infarction (MI) and cerebrovascular accident (CVA) (P > .05). DISCUSSION: Patients treated at L2TCs had a longer LOS compared to L3TCs. However, after controlling for covariates, there was no difference in associated mortality risk between L2TC and L3TC patients.
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Mortalidad Hospitalaria , Centros de Atención Secundaria/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Centros Traumatológicos/estadística & datos numéricos , Heridas y Lesiones/mortalidad , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Tiempo de Internación , Masculino , Persona de Mediana Edad , Mejoramiento de la Calidad , Estudios Retrospectivos , Heridas y Lesiones/epidemiología , Heridas y Lesiones/etiologíaRESUMEN
In December 2019, a novel coronavirus was detected in Wuhan, China, and rapidly spread worldwide. In Brazil, to date, there have been more than 20,000,000 confirmed cases of COVID-19 and more than 550,000 deaths. The purpose of the current study was to determine the clinical and epidemiological profile of the population affected by COVID-19 that have attended referral hospitals in Southern region of Bahia State, to better understand the disease and its risk factors in order to enable more appropriate conduct for patients. An observational, descriptive, cross-sectional, exploratory study was conducted using secondary data collected from the Laboratório de Farmacogenômica e Epidemiologia Molecular, Universidade Estadual de Santa Cruz (LAFEM/UESC). Chi-squared and Fisher's exact tests were applied to determine the association between clinical symptoms and laboratory results, and to identify risk factors associated with SARS-CoV-2 infection. A total of 3135 individuals with suspected severe respiratory illness were analyzed and 41.4% of them tested positive for SARS-CoV-2 infection. Male individuals and having comorbidities were risk factors significantly associated with SARS-CoV-2 infection (OR = 1.17 and OR = 1.37, respectively). Interestingly, being a healthcare professional was a significantly protective factor (OR = 0.81, p < 0.001). Our findings highlight the importance of routinely testing the population for early identification of infected individuals, and also provide important information to health authorities and police makers to improve control measures, management, and screening protocols.
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COVID-19/epidemiología , Centros de Atención Secundaria/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , COVID-19/diagnóstico , Niño , Preescolar , Estudios Transversales , Femenino , Personal de Salud , Humanos , Lactante , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2/aislamiento & purificación , Adulto JovenRESUMEN
BACKGROUND: Leishmaniasis is a neglected disease caused by different species of the protozoa Leishmania spp. Cutaneous lesions are the most common clinical manifestation. This disease is prevalent in tropical and subtropical areas, including the Mediterranean basin. In Spain, Leishmania (L.) infantum is the only endemic species, but imported cases are often diagnosed. Different classical parasitological methods can be performed for cutaneous leishmaniasis (CL) diagnosis; but currently molecular techniques serve as a relevant tool for the detection and characterization of Leishmania parasites. We aimed to evaluate clinical and epidemiological characteristics of CL diagnosed patients by real-time PCR in a tertiary hospital over a six-year period. METHODOLOGY/PRINCIPAL FINDINGS: Clinical, epidemiological and microbiological data were retrospectively collected and analyzed. In our study, CL was confirmed in 59 (31.4%) out of 188 patients by real-time PCR, showing an increase over recent years: 11 cases of CL between 2014 and 2016 and 48 between 2017 and 2019. Real-time PCR was performed on skin swabs and/or biopsies samples, with a positivity of 38.5% and 26.5%, respectively. Results were 100% concordant when biopsy and skin swab were performed simultaneously. L. (L.) infantum was the most frequent species detected (50%), followed by L. (L.) major (45%) and Viannia subgenus (5%), which were detected only in imported cases. L. (L.) major was almost entirely detected in travelers/migrants from Morocco. Multiple and atypical skin lesions were more common in imported cases than in autochthonous cases (44.4% vs. 21.8%). CONCLUSIONS/SIGNIFICANCE: An increase in both autochthonous and imported CL cases has been observed in past years in our hospital. Molecular techniques assist in improving CL diagnosis and characterization of the Leishmania species, mainly in imported cases.
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Leishmania/aislamiento & purificación , Leishmaniasis Cutánea/parasitología , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Leishmania/clasificación , Leishmania/genética , Leishmaniasis Cutánea/diagnóstico , Leishmaniasis Cutánea/epidemiología , Masculino , Persona de Mediana Edad , Reacción en Cadena en Tiempo Real de la Polimerasa , Estudios Retrospectivos , Centros de Atención Secundaria/estadística & datos numéricos , España/epidemiología , Adulto JovenRESUMEN
Vaccine hesitancy remains a serious global threat to achieve herd immunity, and this study aimed to assess the magnitude and associated factors of coronavirus disease-19 (COVID-19) vaccine hesitancy among healthcare workers (HCWs) in Amhara regional referral hospitals. A web-based anonymised survey was conducted among 440 HCWs in the Amhara region referral hospitals. The questionnaire was designed using Google Forms and distributed using telegram and e-mail from 15 May to 10 June 2021 to the randomly selected participants in each hospital. The data were analysed with Stata 14.0 and described using frequency tables. A multivariable binary logistic regression model was fitted and model fitness was checked with the Hosmer-Lemeshow goodness of fit test. Out of 440 participants, 418 were willing to participate in the study and the mean age was about 30 years. Overall, 45.9% (n = 192) of participants reported vaccine hesitancy. After applying multivariate analysis, age ≤25 years (adjusted odds ratio (aOR) = 5.6); do not wear a mask (aOR = 2.4); not compliance with physical distancing (aOR = 3.6); unclear information by public health authorities (aOR = 2.5); low risk of getting COVID-19 infection (aOR = 2.8); and not sure about the tolerability of the vaccine (aOR = 3.76) were associated with COVID-19 vaccine hesitancy. A considerable proportion of HCWs were hesitant towards COVID-19 vaccine, and this can be tackled with the provision of clear information about the vaccine.
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Vacunas contra la COVID-19/uso terapéutico , COVID-19/prevención & control , Personal de Hospital/psicología , Negativa a la Vacunación/psicología , Adulto , Actitud Frente a la Salud , Estudios Transversales , Etiopía/epidemiología , Femenino , Estado de Salud , Humanos , Modelos Logísticos , Masculino , Personal de Hospital/estadística & datos numéricos , Distanciamiento Físico , Factores de Riesgo , Centros de Atención Secundaria/estadística & datos numéricos , Encuestas y Cuestionarios , Negativa a la Vacunación/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: The health care systems of low-income countries have severely limited capacity to treat surgical diseases and conditions. There is limited information about which hospital mortality outcomes are suitable metrics in these settings. METHODS: We did a 1-year observational cohort study of patient admissions to the Surgery and the Obstetrics and Gynecology departments and of newborns delivered at a Ugandan secondary referral hospital. We examined the proportion of deaths captured by standardized metrics of mortality. RESULTS: There were 17,015 admissions and 9612 deliveries. A total of 847 deaths were documented: 385 (45.5%) admission deaths and 462 (54.5%) perinatal deaths. Less than one-third of admission deaths occurred during or after an operation (n = 126/385, 32.7%). Trauma and maternal mortality combined with perioperative mortality produced 79.2% (n = 305/385) of admission deaths. Of 462 perinatal deaths, 412 (90.1%) were stillborn, and 50 (10.9%) were early neonatal deaths. The combined metrics of the trauma mortality rate, maternal mortality ratio, thirty-day perioperative mortality rate, and perinatal mortality rate captured 89.8% (n = 761/847) of all deaths documented at the hospital. CONCLUSIONS: The combination of perinatal, maternal, trauma, and perioperative mortality metrics captured most deaths documented at a Ugandan referral hospital.
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Anestesia/mortalidad , Parto Obstétrico/mortalidad , Mortalidad Hospitalaria , Centros de Atención Secundaria/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/mortalidad , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Recién Nacido , Mortalidad Materna , Persona de Mediana Edad , Mortalidad Perinatal , Periodo Perioperatorio/mortalidad , Embarazo , Reproducibilidad de los Resultados , Mortinato , Uganda , Heridas y Lesiones/mortalidad , Adulto JovenRESUMEN
ABSTRACT: Hypertension is the leading cause of increased morbidity and mortality rates worldwide. Despite adherence to therapies is the important determinant of treatment success to reduce apparent resistant hypertension, maintaining good adherence to antihypertensive medications remained the most serious challenge. Thus, this study aimed to assess adherence to antihypertensive medications among adult hypertensive patients in Dessie Referral Hospital.A cross-sectional study design was conducted among hypertensive patients during May and June 2020. The study participants were selected using a systematic random sampling technique. The collected data were entered into EpiData version 4.4 and exported to SPSS version 25.0 software for data cleaning and analysis. Data were analyzed using bivariable and multivariable logistic regression at a 95% confidence interval (CI). A variable that has a P-valueâ<â.05 was declared as statistically significant. Hosmer-Lemeshow test was used to test goodness-of-fit and multicollinearity was tested.The overall good adherence to antihypertensive medications was 51.9%; 95% CI: (46.8-58.3%) and poor adherence was 48.1%. Factors associated with good adherence were: sex-female adjusted odd ratio (AOR)â=â1.31; 95% CI (1.06-2.52), occupational status-employed AORâ=â2.24; 95% CI (1.33-3.72), good knowledge of the disease AORâ=â2.20; 95% CI (1.34-3.72) and good self-efficacy AORâ=â1.38; 95% CI (1.20-2.13).This study revealed that almost half of the hypertensive patients in Dessie Referral Hospital had good antihypertensive medication adherence. Sex, occupational status, knowledge, and self-efficacy were factors associated with good adherence. Therefore, health education should be given to patients on the importance of complying with medication and patients should be monitored by health extension workers.
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Antihipertensivos/uso terapéutico , Hipertensión , Cumplimiento de la Medicación , Adulto , Causalidad , Indicadores de Enfermedades Crónicas , Estudios Transversales , Empleo , Etiopía/epidemiología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Hipertensión/psicología , Masculino , Cumplimiento de la Medicación/psicología , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Prevalencia , Centros de Atención Secundaria/estadística & datos numéricos , Autoeficacia , Factores SexualesRESUMEN
PURPOSE: The objective of the ongoing study was to investigate how SARS-CoV-2 infection spread within two hospitals in North Rhine-Westphalia, Germany by testing the employees working in high-risk, intermediate-risk and low-risk-areas for the presence of SARS-CoV-2 IgG antibodies. Presented intermediate results evaluate the first infection period until the end of September 2020. METHODS: The study "COVID-19: Hotspot hospital?- Seroprevalence of SARS-CoV-2 antibodies in hospital employees in a secondary care hospital network in Germany " is a prospective, single centre observational cohort study conducted at the St. Vincenz Hospital Datteln with 316 beds. The presented data include one other hospital: St. Laurentius Stift Waltrop, Germany with 172 beds. RESULTS: Between June 2020 and September 2020 we analyzed serum samples of 907 employees which represents 62.1% of all employees. Thirteen employees (1.4%), respectively 13/696 healthcare workers (HCWs) (1.9%) had detectable SARS-CoV-2 IgG antibodies. Among them, 4 (30.8%) were aware of COVID-19 exposure, and 5 (38.5%) reported clinical symptoms. HCWs working in high-risk areas had a seroprevalence rate of 1.6% (1/64), HCWs working in intermediate-risk area 1.7% (11/632) and 0.5% employees (1/211) in low-risk areas with no contact to patients were seropositive. CONCLUSION: Even if we treated COVID-19 positive patients, we found no clear evidence that infection was transmitted to HCWs in contact to these patients. As knowledge about SARS-CoV-2 transmission evolves, the concept of infection prevention must be continuously reviewed and adapted as needed to keep hospitals a safe place.
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COVID-19/epidemiología , Personal de Salud/estadística & datos numéricos , SARS-CoV-2/inmunología , Centros de Atención Secundaria/estadística & datos numéricos , Adolescente , Adulto , Anticuerpos Antivirales/sangre , COVID-19/diagnóstico , COVID-19/prevención & control , Punto Alto de Contagio de Enfermedades , Femenino , Alemania/epidemiología , Humanos , Inmunoglobulina G/sangre , Estudios Longitudinales , Masculino , Estudios Prospectivos , Factores de Riesgo , SARS-CoV-2/aislamiento & purificación , Estudios Seroepidemiológicos , Adulto JovenRESUMEN
BACKGROUND: Ethiopia launched free access for antiretroviral therapy in 2005. The number of patients on second line antiretroviral treatment has increased with each passing year. The objectives of this study were to describe the clinical, immunological and virologic outcomes of children and adolescents receiving second line anti-retroviral therapy in two referral hospitals, Yekatit 12 and Zewditu Memorial Hospitals, in Addis Ababa, Ethiopia. METHODS: This was a hospital based retrospective cohort study conducted among children and adolescents aged 18 years and less and receiving a second line antiretroviral drugs. Data was collected using structured questionnaires. Means and percentages were used for nominal variables. Statistical analysis was made using statistical software-SPSS 23.0. Kaplan Meier analysis, long rank test and multivariate Cox proportion model were used to identify factors affecting survival. RESULTS: A total of 75 children and adolescents were studied with a mean age of 13.28 years (SD: 4) with a mean treatment period on second line regimens of 35.2 months (SD: 21.8 months). Forty-eight participants were experiencing successful measures (in all three parameters) for their second line anti-retroviral treatment. Ten had virologic treatment failure while seven had died. Both treatment failure and death rates were higher within the first two years of treatment. Poor treatment adherence (Adjusted hazard ratio: 5.1 (95% CI: 1.1-23.2; p-value = 0.02)) and advanced World Health Organization clinical stage at start of the second line antiretrovirals (Adjusted hazard ratio: 7.51 (95% CI: 1.35-18.02; p-value = 0.002)) correlated significantly with survival of children and adolescents receiving treatment. CONCLUSIONS: The study describes clinical, immunological and virologic outcomes of second line antiretroviral treatment in a pediatric cohort under care in two hospitals in Addis Ababa, Ethiopia. Poor adherence and pre-treatment advanced clinical stages were predictors of survival.
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Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Centros de Atención Secundaria/estadística & datos numéricos , Adolescente , Adulto , Niño , Preescolar , Estudios de Cohortes , Etiopía/epidemiología , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/inmunología , Infecciones por VIH/virología , Humanos , Masculino , Estudios Retrospectivos , Insuficiencia del TratamientoRESUMEN
BACKGROUND: Induction of labor is an artificial initiation of uterine contractions after fetal viability with the aim of vaginal delivery prior to the onset of spontaneous labor. Prevalence of induction of labor is increasing worldwide with subsequent increase in failure rate. However, there is limited evidence on labor induction in Ethiopia. Therefore, this study was aimed at assessing the prevalence and associated factors of failed induction of labor among women undergoing induction of labor at referral hospitals of Amhara national regional state, Ethiopia, 2016. METHOD: A multicenter cross-sectional study was conducted at referral hospitals found in Amhara national regional state from February 01 to September 30, 2016. Multistage sampling technique was employed to select a total of 484 women who underwent labor induction. Pre-tested structured questionnaires and checklists were used to collect the data. Data were entered into EPI info version 7 and analyzed using SPSS version 20 software. Stepwise Binary Logistic regression model was fitted to identify factors associated with failed induction of labor. The level of significance was determined based on the adjusted odds ratio with 95% confidence interval at the p-value of ≤0.05. RESULT: The prevalence of failed induction of labor among women undergoing induction of labor was 31.4% (95% CI: 27.0, 36.0). Failed induction of labor was independently predicted by a Bishop score of ≤5 (AOR = 2.1; 95% CI: 1.3, 3.6), prolonged latent first stage of labor (AOR = 2.0; 95% CI: 1.2, 3.5), induction with oxytocin alone (AOR = 4.2; 95% CI: 2.2, 8.1), nulliparity (ARO = 1.9; 95% CI: 1.2, 2.9), post term pregnancy (AOR = 4.1; 95% CI: 1.8, 9.3) and hypertensive disorder of pregnancy (AOR = 2.4; 95% CI: 1.5, 5.1). CONCLUSION: Failed induction of labor was high in the study area compared to the reports of previous studies done in Ethiopia. The majority of the determinants of failed induction of labor were connected with unjustifiable and inconsistent indication of induction of labor. Thus, preparing standardized practical guidelines and preventing unjustifiable case selection may help reduce the current high failure rates.
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Trabajo de Parto Inducido/estadística & datos numéricos , Atención Perinatal/normas , Adolescente , Adulto , Cesárea/estadística & datos numéricos , Toma de Decisiones Clínicas , Estudios Transversales , Etiopía , Extracción Obstétrica/estadística & datos numéricos , Femenino , Edad Gestacional , Hospitales Públicos/normas , Hospitales Públicos/estadística & datos numéricos , Humanos , Recién Nacido , Trabajo de Parto Inducido/efectos adversos , Masculino , Selección de Paciente , Guías de Práctica Clínica como Asunto , Embarazo , Centros de Atención Secundaria/normas , Centros de Atención Secundaria/estadística & datos numéricos , Insuficiencia del Tratamiento , Adulto JovenRESUMEN
PURPOSE: This study aimed to identify the risk factors of carbapenem-resistant Enterobacteriaceae (CRE) acquisition to build a nomogram for CRE acquisition risk prediction and evaluate its performance. METHODS: This unmatched case-control study included 352 adult patients (55 patients and 297 controls) admitted to the intensive care unit (ICU) of a 453-bed secondary referral hospital between January 1, 2018, and September 31, 2019, in Busan, South Korea. The nomogram was built with the identified risk factors using multiple logistic regression analysis. Its performance was analyzed using calibration-in-the-large, the slope of the calibration plot, concordance statistic (c-statistic), and the sensitivity and specificity of the training set, subsets, and a new test set. RESULTS: The risk factors of CRE acquisition among ICU patients at a secondary referral hospital were Acute Physiology and Chronic Health Evaluation II score at the time of admission, use of a central venous catheter and a nasogastric tube, as well as use of cephalosporin antibiotics. At 20.0% of the predicted CRE acquisition risk in the training set, the calibration-in-the-large was 0, slope of the calibration plot was 1, c-statistic was .93, sensitivity was 85.5%, and specificity was 84.8%. The performance was relatively good in the subsets and new test set. CONCLUSION: The nomogram can be used to monitor the CRE acquisition risk for ICU patients who have a similar case mix to patients in the study hospitals. Future studies need to involve more rigorous methodology and larger samples.
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Carbapenémicos/uso terapéutico , Infección Hospitalaria/etiología , Infecciones por Enterobacteriaceae/etiología , Unidades de Cuidados Intensivos , Nomogramas , Centros de Atención Secundaria , Anciano , Estudios de Casos y Controles , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/etiología , Infecciones Relacionadas con Catéteres/microbiología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/epidemiología , Femenino , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Modelos Logísticos , Masculino , Modelos Estadísticos , Medición de Riesgo , Factores de Riesgo , Centros de Atención Secundaria/estadística & datos numéricos , Resistencia betalactámicaRESUMEN
OBJECTIVES: In 2019 Chinese authorities alerted of the appearance of a cluster of cases of unknown pneumonia related to a new type of coronavirus. Spain is among the most affected countries. Our aim is to describe the cases of COVID-19 at Infanta Sofía University Hospital (Madrid), a public secondary hospital that increased its hospital beds to provide assistance during the outbreak. METHODS: Retrospective descriptive study of cases that met COVID-19 clinical diagnosis criteria or had a positive PCR test from February 27 to June 29, 2020. A description of demographic variables, hospital stay, mortality and the epidemiological curve was performed. RESULTS: Of 1,828 confirmed cases, 64.4% were hospitalised, 5.6% were admitted to the ICU. About 52.2% were male. The median age was 63.2 years. About 13.1% were nursing home residents. Nineteen percent were of Latin American origin of which 6.8% were admitted to the ICU. Overall case fatality was 14.6%. We observed a biphasic epidemiological curve. CONCLUSIONS: Sixty to 79-year-old males were admitted and deceased more often than women. Mortality reached 14.7%. Latin Americans were admitted more often to the ICU. Further studies about epidemiological characteristics of COVID-19 in hospitals are necessary.
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COVID-19/mortalidad , Brotes de Enfermedades/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Centros de Atención Secundaria/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , SARS-CoV-2 , España/epidemiologíaRESUMEN
INTRODUCTION: Kangaroo mother care (KMC) involves continuous skin-to-skin contact of baby on mother's chest to provide warmth, frequent breastfeeding, recognizing danger signs of illness, and early discharge. Though KMC is safe, effective and recommended by the World Health Organization, implementation remains limited in practice. The objective of this study is to understand barriers and facilitators to KMC practice at tertiary and secondary health facilities in southern Malawi from the perspective of health workers. METHODS: This study is part of the "Integrating a neonatal healthcare package for Malawi" project in the Innovating for Maternal and Child Health in Africa initiative. In-depth interviews were conducted between May-Aug 2019 with a purposively drawn sample of service providers and supervisors working in newborn health at a large tertiary hospital and three district-level hospitals in southern Malawi. Data were analyzed using a thematic approach using NVivo 12 software (QSR International, Melbourne, Australia). FINDINGS: A total of 27 nurses, clinical officers, paediatricians and district health management officials were interviewed. Staff attitudes, inadequate resources and reliance on families emerged as key themes. Health workers from Malawi described KMC practice positively as a low-cost, low-technology solution appropriate for resource-constrained health settings. However, staff perceptions that KMC babies were clinically stable was associated with lower prioritization in care and poor monitoring practices. Neglect of the KMC ward by medical staff, inadequate staffing and reliance on caregivers for supplies were associated with women self-discharging early. CONCLUSION: Though routine uptake of KMC was policy for stable low birthweight and preterm infants in the four hospitals, there were gaps in monitoring and maintenance of practice. While conceptualized as a low-cost intervention, sustainable implementation requires investments in technologies, staffing and hospital provisioning of basic supplies such as food, bedding, and KMC wraps. Strengthening hospital capacities to support KMC is needed as part of a continuum of care for premature infants.
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Personal de Salud/estadística & datos numéricos , Método Madre-Canguro/estadística & datos numéricos , Familia , Personal de Salud/psicología , Humanos , Lactante , Método Madre-Canguro/psicología , Malaui , Centros de Atención Secundaria/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricosRESUMEN
BACKGROUND: Emergency departments (EDs) worldwide have been in the epicentre of the novel coronavirus disease (COVID-19). However, the impact of the pandemic and national emergency measures on the number of non-COVID-19 presentations and the assessed acuity of those presentations remain uncertain. METHODS: We acquired a retrospective cohort containing all ED visits in a Finnish secondary care hospital during years 2018, 2019 and 2020. We compared the number of presentations in 2020 during the national state of emergency, i.e. from March 16 to June 11, with numbers from 2018 and 2019. Presentations were stratified using localized New York University Emergency Department Algorithm (NYU-EDA) to evaluate changes in presentations with different acuity levels. RESULTS: A total of 27,526 presentations were observed. Compared to previous two years, total daily presentations were reduced by 23% (from 113 to 87, p < .001). In NYU-EDA classes, Non-Emergent visits were reduced the most by 42% (from 18 to 10, p < .001). Emergent presentations were reduced by 19 to 28% depending on the subgroup (p < .001). Number of injuries were reduced by 25% (from 27 to 20, p < .001). The NYU-EDA distribution changed statistically significantly with 4% point reduction in Non-Emergent visits (from 16 to 12%, p < .001) and 0.9% point increase in Alcohol-related visits (from 1.6 to 2.5%, p < .001). CONCLUSIONS: We observed a significant reduction in total ED visits in the course of national state of emergency. Presentations were reduced in most of the NYU-EDA groups irrespective of the assessed acuity. A compensatory increase in presentations was not observed in the course of the 3 month lockdown. This implies either reduction in overall morbidity caused by decreased societal activity or widespread unwillingness to seek required medical advice.
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COVID-19/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Algoritmos , Finlandia/epidemiología , Humanos , Trastornos Mentales/epidemiología , New York , Pandemias , Estudios Retrospectivos , SARS-CoV-2 , Centros de Atención Secundaria/estadística & datos numéricos , Factores de Tiempo , Universidades , Heridas y Lesiones/epidemiologíaAsunto(s)
Ansiedad/epidemiología , Actitud del Personal de Salud , Betacoronavirus , Infecciones por Coronavirus/psicología , Depresión/epidemiología , Medicina de Emergencia , Pandemias , Médicos/psicología , Neumonía Viral/psicología , Adulto , Ansiedad/etiología , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/etiología , COVID-19 , Infecciones por Coronavirus/epidemiología , Depresión/etiología , Trastorno Depresivo/epidemiología , Trastorno Depresivo/etiología , Femenino , Hospitales Urbanos , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/etiología , Neumonía Viral/epidemiología , SARS-CoV-2 , Centros de Atención Secundaria/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Horario de Trabajo por Turnos , España/epidemiología , Encuestas y Cuestionarios , Centros de Atención Terciaria/estadística & datos numéricosRESUMEN
This study aimed to determine the differences in antibiotic usage patterns in the treatment of acute pyelonephritis according to hospital type and region in Korea.The claims database of the Health Insurance Review and Assessment Service in Korea was used to select patients with the International Classification of Diseases, Tenth Revision code N10 (acute tubulo-interstitial nephritis) or N12 (tubulo-interstitial nephritis, neither acute nor chronic) as the primary discharge diagnosis in 2010-2014. Usage of each class of antibiotics was expressed as the defined daily dose (DDD)/event.The average antibiotic usage per inpatient event was 11.3 DDD. The average antibiotic usage was the highest among patients admitted to tertiary hospitals (13.8 DDD), followed by those admitted to secondary hospitals (11.5 DDD), clinics (10.0 DDD), and primary hospitals (9.8 DDD). According to the geographic analyses, third-generation cephalosporins were highly prescribed in some southern regions; fluoroquinolones and aminoglycosides were highly prescribed in some centrally located regions of the Korean peninsula. The hotspots for carbapenem usage included Seoul and Gyeonggi province cluster and Busan cluster: these regions include the capital city and the second biggest city in Korea, respectively.In conclusion, the antibiotic usage patterns for acute pyelonephritis in Korea differ according to the hospital type and region.
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Antibacterianos/uso terapéutico , Utilización de Medicamentos/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Pielonefritis/tratamiento farmacológico , Enfermedad Aguda , Adolescente , Adulto , Aminoglicósidos/uso terapéutico , Cefalosporinas/uso terapéutico , Bases de Datos Factuales , Femenino , Fluoroquinolonas/uso terapéutico , Geografía , Humanos , Masculino , Persona de Mediana Edad , República de Corea , Centros de Atención Secundaria/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Adulto JovenRESUMEN
INTRODUCTION: This study aimed to determine the incidence of chronic mesenteric ischemia (CMI) and to examine the influence of the etiological cause, location, and severity of a mesenteric artery stenosis on the probability of having CMI. METHODS: A prospective database, containing the details of all patients with suspected CMI referred to a renowned CMI expert center, was used. Patients residing within the expert centers' well-defined region, between January 2014 and October 2019, were included. CMI was diagnosed when patients experienced sustained symptom improvement after treatment. RESULTS: This study included 358 patients, 75 had a ≥50% atherosclerotic stenosis of 1 vessel (CMI 16%), 96 of 2 or 3 vessels (CMI 81%), 81 celiac artery compression (CMI 25%), and 84 no stenosis (CMI 12%). In total, 138 patients were diagnosed with CMI, rendering a mean incidence of 9.2 (95% confidence interval [CI] 6.2-13.7) per 100,000 inhabitants. Atherosclerotic CMI was most common, with a mean incidence of 7.2 (95% CI 4.6-11.3), followed by median arcuate ligament syndrome 1.3 (95% CI 0.5-3.6) and chronic nonocclusive mesenteric ischemia 0.6 (95% CI 0.2-2.6). The incidence of CMI was highest in female patients (female patients 12.0 [95% CI 7.3-19.6] vs male patients 6.5 [95% CI 3.4-12.5]) and increased with age. CMI was more prevalent in the presence of a ≥70% atherosclerotic single-vessel stenosis of the superior mesenteric artery (40.6%) than the celiac artery (5.6%). DISCUSSION: The incidence of CMI is higher than previously believed and increases with age. Probability of CMI seems highest in suspected CMI patients with multivessel disease or a ≥70% atherosclerotic single-vessel superior mesenteric artery stenosis.
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Aterosclerosis/epidemiología , Síndrome del Ligamento Arcuato Medio/epidemiología , Arteria Mesentérica Superior/patología , Isquemia Mesentérica/epidemiología , Adulto , Factores de Edad , Anciano , Aterosclerosis/complicaciones , Enfermedad Crónica/epidemiología , Constricción Patológica/diagnóstico , Constricción Patológica/epidemiología , Constricción Patológica/etiología , Femenino , Humanos , Incidencia , Masculino , Síndrome del Ligamento Arcuato Medio/complicaciones , Isquemia Mesentérica/etiología , Persona de Mediana Edad , Países Bajos/epidemiología , Estudios Prospectivos , Factores de Riesgo , Centros de Atención Secundaria/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Factores SexualesAsunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Neoplasias Pulmonares/complicaciones , Pandemias , Neumonía Viral/complicaciones , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Antivirales/uso terapéutico , COVID-19 , Comorbilidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Femenino , Cardiopatías/epidemiología , Mortalidad Hospitalaria , Humanos , Hipertensión/epidemiología , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/terapia , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Insuficiencia Renal Crónica/epidemiología , Estudios Retrospectivos , SARS-CoV-2 , Centros de Atención Secundaria/estadística & datos numéricos , España/epidemiología , Resultado del TratamientoRESUMEN
INTRODUCTION: The numbers of people infected with SARS-CoV-2 in Indonesia especially in Jakarta as the epicenter continue to rise. Limited published clinical data, scarcity and long turn over time of diagnostic testing put clinician in dilemma to make diagnosis. METHODOLOGY: This is an observational case series study from confirmed COVID-19 patient in our hospital from first case admission on 17 March 30 April, 2020. We collected patient's demography, symptoms, comorbidities, therapy, laboratory, chest x-ray and ECG consecutively. RESULTS: Between 17 March 2020 and 30 April 2020, there were 30 confirmed COVID-19 cases, 16 (53.3%) were male. Clinical symptoms were dyspnea in 22 (73.3%) and dry cough 16 (53.3%). Comorbidities were diabetes in 14 (46.6%), hypertension 10 (33.3%) and Coronary Artery Disease (CAD) in 10 (33.3%) patients respectively. Laboratory findings showed lymphopenia in 21 (70%) patients, increased inflammation marker in Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP) and Lactate Dehydrogenase (LDH) 21 (70%), 23 (76.6%) and 12 (40%) patients respectively. Twenty-seven (90%) cases had abnormal Chest X-Ray (CXR) and mostly severe 18 (60%). Descriptive finding for images included consolidation 16 (53.3%) and Ground Glass Opacities (GGO) in 10 (33.3%) patients. CONCLUSIONS: Based on our findings, most cases of COVID-19 admitted in secondary referral hospital were already in moderate to severe stages. This is most likely due to late referral from primary care and unspecific clinical features resemblance of other infectious diseases. Inflammation marker and CXR are cost effective findings and can be used as marker to determine further referral.