Efectividad de la implantación de una gestión clínico-epidemiológica durante la Covid-19 en un hospital de media-larga estancia / Effectiveness of the implementation of clinical-epidemiological management during Covid-19 in a medium-long-stay hospital

OBJETIVO: Los efectos de la emergencia sanitaria por la Covid-19 han demostrado la alta vulnerabilidad de las personas que residen en centros de media y larga estancia, con altas tasas de mortalidad. Se disponen de pocos datos acerca de los protocolos de contingencia para minimizar la propagación del virus en estos centros. El objetivo de este estudio fue describir las características clínicas y epidemiológicas de los pacientes afectados por el SARS-CoV-2, así como las medidas preventivas y de gestión adoptadas en el Hospital Nacional de Parapléjicos (Toledo) para minimizar el riesgo de transmisión de la Covid-19. MÉTODOS: Un equipo formado por especialistas en Medicina Preventiva y en Medicina Interna del Hospital Nacional de Parapléjicos estableció un protocolo de vigilancia activa, identificación de casos sospechosos y confirmados, así como de seguimiento de contactos. Además, se creó una Unidad para la atención de los casos confirmados, con personal formado específicamente en Covid-19, para intentar lograr una mejor atención de los pacientes y optimización de los recursos materiales disponibles. Para el análisis de los datos se han utilizado medidas estadísticas descriptivas. RESULTADOS: La prevalencia de la Covid-19 fue del 12,2%, con una incidencia acumulada del 8,2%. Tras la instauración del protocolo se logró el control de la enfermedad, sin transmisión intrahospitalaria posterior a su aplicación. Debido a la alarma generada al inicio de la pandemia, hasta un 45% de las RT-PCR solicitadas no cumplían los criterios del Ministerio de Sanidad, siendo todas negativas. Las características clínicas de nuestros pacientes difirieron ligeramente de las observadas en otros estudios publicados en población general, siendo la tos y la astenia los síntomas más frecuentes, presentes en el 69,2% y el 38,5% respectivamente. El 100% de los pacientes infectados no presentaron complicaciones que precisaran asistencia en Unidad de Cuidados Intensivos. CONCLUSIONES: Con la aplicación de las acciones preventivas y organizativas consideramos que hemos presentado una incidencia baja de infectados. Es indispensable la elaboración de protocolos y su supervisión para la rápida identificación de casos y optimizar las pruebas solicitadas. Pese a ser un hospital de media y larga estancia, no hemos presentado mortalidad ni complicaciones que requirieran ingreso en Unidad de Cuidados Intensivos

OBJECTIVE: The effects of the Covid-19 health emergency have demonstrated the high vulnerability of people residing in medium and long-stay centers, with high mortality rates. Little data is available about contingency protocols to minimize the spread of the virus in these centers. The goal of this study was to describe the clinical and epidemiological features of patients affected by SARS-CoV-2 and the preventive and management measures adopted at the National Hospital for Paraplegics (Toledo, Castilla-La Mancha, Spain) to minimize the risk of transmission of Covid-19. METHODS: A team of specialists in Preventive and Internal Medicine established a protocol for active surveillance, identification of suspected and confirmed cases, and follow-up of contacts. Also, a Unit for the care of confirmed cases was created with personnel specifically trained in Covid-19, to achieve better patient care and optimize the available resources. Descriptive statistical measures have been used to analyze the data. RESULTS: The prevalence of Covid-19 was 12.2%, with a cumulative incidence of 8.2%. After the protocol was established, control of the disease was achieved without hospital transmission after its application. Due to the alarm generated at the start of the pandemic, up to 45% of the requested RT-PCRs did not meet the criteria of the Ministry of Health, all of which were negative. The clinical characteristics of our patients differed slightly from those observed in other studies published in the general population, with cough and asthenia being the most frequent symptoms, present in 69.2% and 38.5%, respectively. 100% of the infected patients did not present complications that required assistance in the Intensive Care Unit. CONCLUSIONS: With the application of preventive and organizational actions, we consider that we have presented a low incidence of those infected. The preparation of protocols and their supervision is essential for the rapid identification of cases and optimization of the tests requested. Despite being a medium and long-stay hospital, we have not presented any mortality or complications that required admission to the Intensive Care Unit

Plagued by Politics: Cuba's National Sanatorium Project, 1936-59.

In 1936, Fulgencio Batista, the head of the Cuban military (and the de facto ruler of Cuba), founded the National Tuberculosis Council (CNT) to lead a state-directed anti-tuberculosis campaign. While most national and colonial governments neglected tuberculosis until the postwar period, populist politics pushed Batista to prioritize a disease of poverty by the mid-1930s. However, national politics also undermined efforts to control the disease in Cuba. Authoritarianism facilitated Batista's considerable influence over tuberculosis policy, and he and his advisors pursued political objectives rather than following the technical advice offered by professional groups. As a result, the administration of the campaign was inefficient, nowhere more notably than in the CNT's premiere project, the Topes de Collantes National Sanatorium. Citizen and physician discontent with this project, the anti-tuberculosis campaign, and the state health sector fed into processes of political delegitimation and regime change in the 1950s.

Concordancia entre sistemas de estratificación e identificación de pacientes crónicos complejos en Atención Primaria / Concordance between stratification systems and identification of patients with multiple chronic diseases in Primary Care

Objetivo. Conocer la prevalencia de pacientes crónicos complejos en el ámbito de Atención Primaria utilizando los criterios de pluripatología y los Clinical Risk Groups y el grado de concordancia entre estos 2 sistemas de identificación de los pacientes que precisan gestión de caso. Material y método. Estudio observacional transversal de 240 pacientes, seleccionados por muestreo aleatorio de 16 cupos asistenciales de 2 centros de salud de Atención Primaria de un área sanitaria. Solicitado consentimiento informado para acceder a su historia clínica electrónica con fines de investigación. Se registró la edad, el sexo, el estado de salud según los Clinical Risk Groups, nivel de gravedad, los criterios de pluripatológico e índice de Charlson por su médico durante la práctica clínica. Se excluyeron 3 pacientes por datos incompletos. Resultados. La prevalencia de pacientes pluripatológicos, siguiendo los criterios del Ministerio de Sanidad entre los demandantes, fue del 4,1% (IC 95% 2,1-7,3). La frecuencia de pacientes con Clinical Risk Groups de alto riesgo denominados G3 en la estrategia de cronicidad de la Comunidad Valenciana fue del 7,5% (IC 95% 4,7-11,7), que sumó los pacientes estado de salud 6 con nivel de complejidad 5 y 6 y los estados de salud 7, 8 y 9. La concordancia entre ambas clasificaciones fue baja con un índice kappa 0,17 (IC 95% 0-0,5). Conclusiones. Las prevalencias no difirieron significativamente de lo esperado y la concordancia entre ambas estratificaciones fue muy débil, no seleccionando a los mismos pacientes de alta complejidad para gestión de casos (AU)

Objective. To determine the prevalence of patients with multiple chronic diseases in Primary Care using the multiple morbidity criteria and Clinical Risk Groups, and the agreement in identifying high-risk patients that require case management with both methods. Material and method. A cross-sectional study was conducted on 240 patients, selected by random sampling of 16 care quotas from two Primary Health Care centres of a health area. Informed consent was obtained to access their electronic medical records for the study, and a record was made of age, sex, health status of Clinical Risk Groups, severity, multiple morbidity criteria, and Charlson index by physicians during clinical practice. Three patients were excluded due to incomplete data. Results. The prevalence of patients with multiple chronic diseases following the criteria of the Ministry of Health among users was 4.11 (95% CI; 2.13-7.30). The frequency of patients with high risk Clinical Risk Groups (G3) in the chronicity strategy of Valencian Community was 7.59 (95% CI; 4.70-11.70), which includes patients with health status 6 and complexity level 5-6, and health status 7, 8, and 9. Agreement between the two classifications was low, with a kappa index 0.17 (95% CI; 0-0.5). Conclusions. The prevalence did not differ significantly from that expected, and the agreement between the two stratifications was very weak, not selecting the same patients for highly complex case management (AU)

Improving chronic care delivery and outcomes: the impact of the cystic fibrosis Care Center Network.

Cystic fibrosis (CF) is a multisystem, life-shortening genetic disease that requires complex care. To facilitate this expert, multidisciplinary care, the CF Foundation established a Care Center Network and accredited the first care centres in 1961. This model of care brings together physicians and specialists from other disciplines to provide care, facilitate basic and clinical research, and educate the next generation of providers. Although the Care Center Network has been invaluable in achieving substantial gains in survival and quality of life, additional opportunities for improvements in CF care exist. In 1999, analysis of data from the CF Foundation's Patient Registry detected variation in care practices and outcomes across centres, identifying opportunities for improvement. In 2002, the CF Foundation launched a comprehensive quality improvement (QI) initiative to enhance care by assembling national experts to develop a strategic plan to disseminate QI training and processes throughout the Care Center Network. The QI strategies included developing leadership (nationally and within each care centre), identifying best CF care practices, and incorporating people with CF and their families into improvement efforts. The goal was to improve the care for every person with CF in the USA. Multiple tactics were undertaken to implement the strategic plan and disseminate QI training and tools throughout the Care Center Network. In addition, strategies to foster collaboration between care centre staff and individuals with CF and their families became a cornerstone of QI efforts. Today it is clear that the application of QI principles within the CF Care Center Network has improved adherence to clinical guidelines and achievement of important health outcomes.

A comparative study of tuberculosis patients initiated on ART and receiving different models of TB-HIV care.

SETTING: Although health policy in South Africa calls for the integration of services, the effectiveness of different models of integration on patient outcomes has not been well demonstrated. OBJECTIVE: To evaluate the outcomes of coinfected patients starting antiretroviral treatment (ART) in a tuberculosis (TB) hospital who received different models of ongoing care. DESIGN: This cohort study compared outcomes for 271 coinfected patients who started ART in a TB hospital in the Western Cape. After discharge, one group of patients received anti-tuberculosis treatment and ART from different providers, in the same or in different clinics (vertical care). The other group received anti-tuberculosis treatment and ART at the same visit from the same service provider (integrated care). Demographic and clinical data and TB and ART outcomes were compared. RESULTS: The vertical care model had more unfavourable outcomes for anti-tuberculosis treatment (28.7% vs. 5.9%, P < 0.001) and ART (30.1% vs. 7.4%, P < 0.001) than the integrated care model. The vertical care model showed no difference whether services were provided by two service providers in the same or in geographically separate primary health care clinics. CONCLUSION: Patient outcomes were better when TB and HIV care was received from the same service provider at the same visit.

Evaluation of clinical pharmacy interventions in a Veterans Affairs medical center primary care clinic.

PURPOSE: The development of an electronic tool to quantify and characterize the interventions made by clinical pharmacy specialists (CPSs) in a primary care setting is described. SUMMARY: An electronic clinical tool was developed to document the clinical pharmacy interventions made by CPSs at the Veterans Affairs Medical Center in West Palm Beach, Florida. The tool, embedded into the electronic medical record, utilizes a novel reminder dialogue to complete pharmacotherapy visit encounters and allows CPSs to document interventions made during patient care visits. Interventions are documented using specific electronic health factors so that the type and number of interventions made for both disease-specific and other pharmacotherapy interventions can be tracked. These interventions were assessed and analyzed to evaluate the impact of CPSs in the primary care setting. From February 2011 through January 2012, a total of 16,494 pharmacotherapy interventions (therapeutic changes and goals attained) were recorded. The average numbers of interventions documented per patient encounter were 0.96 for the management of diabetes mellitus, hypertension, dyslipidemia, and heart failure and 1.36 for non-disease-specific interventions, independent of those interventions being made by the primary physician or other members of the primary care team. CONCLUSION: A clinical reminder tool developed to quantify and characterize the interventions provided by CPSs found that for every visit with a CPS, approximately one disease-specific intervention and one additional pharmacotherapy intervention were made, independent of those interventions being made by the primary physician or other members of the primary care team.

[Branch of the 1st Federal Budget Institution "3rd Central Military Clinical Hospital n. a. A. A. Vishnevskii of the Russian Defense Ministry"--60 years].

The history of creation and development of the Central Tuberculosis Hospital of the Ministry of Defense of the USSR--now branch No 1 FBU "3 TsVKG of the Russian Defense Ministry n. a. A.A. Vishnevsky". The contribution into the hospital, not only in organizing of effective treatment, but also into study the state of TB control in the armed forces, the development of methods for differential diagnosis of pulmonary tuberculosis and extrapulmonary forms are presented. The incidence of tuberculosis in the country remains high, so the problem faced by the institution, remain relevant and responsible.

The tuberculosis hospital in Hohenkrug, Stettin. Department of Genitourinary Tuberculosis.

Towards the end of the 19th century, Europe turned particular attention to the problem of tuberculosis, at that time the most serious social disease. In the majority of cases, pulmonary tuberculosis had a fatal outcome owing to the lack of effective drugs and methods of treatment. Due to poor sanitary conditions, particularly as regards dwellings, pulmonary tuberculosis was able to spread rapidly. Hospital departments were reluctant to admit patients suffering from tuberculosis. It was only after the discoveries of Robert Koch (bacillus tubercle in 1882) that the cause of the disease became understood and methods of treatment began to be developed. A modern sanatorium and hospital with 270 beds was erected in Hohenkrug (today Szczecin-Zdunowo) between 1915 and 1930. Patients could now be treated with modern methods, surgically in most cases. After the Second World War, pulmonary tuberculosis was still an enormous epidemiologic problem. In 1949, the Polish authorities opened a 400-bed sanatoriumin Zdunowo. The methods of treatment were not much different from pre-war practice and it was only the routine introduction of antituberculotic drugs during the fifties of the past century that brought about a radical change in the fight against tuberculosis. The growing numbers of patients with tuberculosis of the genitourinary system led to the opening in 1958 of a 40-bed specialist ward at the Tuberculosis Sanatorium in Zdunowo. It should be emphasized that the Department of Genitourinary Tuberculosis in Szczecin-Zdunowo was a historical necessity and a salvation for thousands of patients from Northern Poland. The Department totally fulfilled its social duties thanks to the commitment of many outstanding persons dedicated to helping the patients. This unit was finally closed in 1987 because the demand for surgical treatment of tuberculosis was declining concurrently with the advent of new and potent antituberculotics and falling number of new cases of genitourinary tuberculosis. Today, the decision to close the Department of Genitourinary Tuberculosis is deeply regretted by urologists in Stettin.

The role of the long-term acute care hospital.

Long-term acute care hospitals (LTACHs) have a niche role in the health care system. They specialize in caring for patients who are ventilator-dependent, are on inpatient dialysis, or have multi-organ or multi-system failure, postsurgical or organ transplant complications, complex wounds that need care, or traumatic or acquired brain injury. Many physicians are unfamiliar with the work done by the interdisciplinary teams that serve these facilities.This article describes LTACHs and their approach to care.

[Medium-term strategy for the specific management of pneumology hospitals and wards after the decentralization of the sanitary system]. / Strategie pe termen mediu privind managementul specific al spitalelor si sectiilor de pneumologie dupa descentralizarea sistemului de sanatate.

Identifying and promoting new management techniques for the descentralized pneumology hospitals or wards was one of the most ambitious objectives of the project "Quality in the pneumology medical services through continuous medical education and organizational flexibility", financed by the Human Resourses Development Sectorial Operational Programme 2007-2013 (ID 58451). The "Medium term Strategy on the specific management of the pneumology hospitals or wards after the descentralization of the sanitary system" presented in the article was written by the project's experts and discussed with pneumology managers and local authorities representatives. This Strategy application depends on the colaboration of the pneumology hospitals with professional associations, and local and central authorities.

Hospital nurses' perceptions of the geriatric care environment in one Canadian health care region.

PURPOSE: To identify and compare perceptions of the geriatric care environment among nurses in three different urban hospital types in one health authority in a Midwestern Canadian province. DESIGN: The Geriatric Institutional Assessment Profile developed by the Nurses Improving Healthsystem Elders (NICHE) program was administered to staff in eight urban hospitals between 2005 and 2006: two geriatric-chronic care hospitals, four community hospitals, and two tertiary hospitals. The study focused on 1,189 nurses who completed the survey (n= 298 for geriatric-chronic care hospitals; n= 387 for community hospitals, n= 504 for tertiary hospitals). METHODS: Analyses focused on items related to the concept of the geriatric nursing practice environment, including a composite measure of overall perceptions and three subscales (institutional values regarding older adults and staff, resource availability, and capacity for collaboration). Nurses' perceptions of the extent to which facilities supported the provision of aging-sensitive or aging-relevant care to older adults and their families was also examined. Univariate analysis of variance was performed to determine significant group differences among nurses in the three hospital types. FINDINGS: Perceptions of the geriatric nurse practice environment (both in terms of the composite scale and the three subscales) were least positive among nurses in community hospitals relative to the other two hospital types. Perceptions in tertiary hospitals were significantly more positive than those in community hospitals in terms of institutional values and resource availability, albeit not capacity for collaboration. Perceptions were most positive in the geriatric-chronic care hospitals. Perceptions of aging-sensitive care delivery were also less positive in community and tertiary hospitals, relative to geriatric-chronic care hospitals; perceptions in community and tertiary hospitals did not differ from each other. CONCLUSIONS: In this Canadian study, nurses' perception of the care environment varied by hospital type, with nurses in community hospitals expressing the most concern and nurses in geriatric-chronic care hospitals being the most positive. This research highlights the importance of the hospital setting in understanding nurses' ability to provide quality geriatric care. CLINICAL RELEVANCE: Enhancing the quality of care for older patients requires an understanding of the challenges and obstacles experienced by nurses. Assessing their perceptions of the care environment they work in, therefore, becomes a key issue in targeting policy and programs.

[The beginnings of antituberculosis service in Stettin. Hermann Braeuning--the first director of the Tuberculosis Hospital in Stettin-Hohenkrug (Szczecin-Zdunowo)]. / Poczatki lecznictwa przeciwgruzliczego w Szczecinie. Hermann Braeuning (1880-1946)--pierwszy dyrektor Szpitala Przeciwgruzliczego w Szczecinie-Zdunowie (Hohenkrug).

The beginnings of organized treatment for patients with tuberculosis (TB) in Stettin date back to the last decade of the nineteenth century and are traced to the Municipal Hospital in Stettin-Pommerensdorf (Szczecin-Pomorzany). Treatment of patients with TB in Pomerania improved with the opening of the Tuberculosis Hospital in Hohenkrug (Szczecin-Zdunowo). The author presents the history of the leading German Tuberculosis Hospital in Hohenkrug from its opening in 1915 till 1945 highlighting its important role in the health care system of the entire Pomerania. Biographical details of the first director of the Hospital, Professor Hermann Braeuning, are provided. The Tuberculosis Hospital in Hohenkrug (Szczecin-Zdunowo) quickly emerged as a modern research, educational, and therapeutic facility.

The IMCO scheme as a tool in developing team-based treatment for people with multiple sclerosis.

BACKGROUND: The Danish Multiple Sclerosis Society (a patient organization) has initiated a research-based bridge-building and integrative treatment project to take place from 2004 to 2010 at a specialized MS hospital. The background for initiating the project was an increasing use of alternative treatment documented among persons with multiple sclerosis (PwMS). From PwMS there has been an increasing demand upon The Danish Multiple Sclerosis Society to initiate the project. OBJECTIVE: The overall purpose of the project is to examine whether collaboration between 5 conventional and 5 alternative practitioners may optimize treatment results for people who have multiple sclerosis (MS). The specific aim of this paper is to present tools used in developing collaboration between the conventional and alternative practitioners. MATERIALS AND METHODS: Two main tools in developing collaboration between the practitioners are described: (1) the planning and conduction of 4 practitioner-researcher seminars in the prephase of the project before recruiting patients with MS; and (2) the IMCO scheme (which is an abbreviation of Intervention, Mechanism, Context, and Outcomes). This tool was developed and used at practitioner-researcher seminars to make visible the different practitioners' treatment models and the patient-related treatment courses. RESULTS: Examples of IMCO schemes filled in by the medical doctor and the classical homeopath illustrate significant differences in interventions, assumptions concerning effect mechanisms, and awareness of contexts facilitating and inhibiting the intervention to generate the outcomes expected and obtained. CONCLUSIONS: The IMCO schemes have been an important tool in developing the team-based treatment approaches and to facilitate self-reflection on the professional role as a health care provider. We assume that the IMCO scheme will be of real value in the development of effective treatment based on collaboration between conventional and alternative practitioners.

[AIDS Prevention Group: 15 years of sustained efforts for the prevention of HIV/AIDS]. / Grupos de Prevención del SIDA (GPSIDA): 15 años de trabajo sostenido en la prevención del VIH/sida.

An AIDS epidemic is an important challenge to human survival. Although the prevalence in Cuba is below 0.1% in adult people, this disease is a priority problem. The AIDS Prevention Group (known as GPSIDA in Cuba) was created to contribute to the response of the Ministry of Public Health to this slow but growing epidemic. GPSIDA, made up of HIV seropositive and seronegative people, carry out actions aimed at educating the population. avoiding new infections and supporting the infected people and their relatives. This paper was intended to document the development of the group since its inception in 1991 up to 2006, that is, its first 15 years of existence. An infrastructure for GPSIDA at provincial level has been built in addition to the strengthening of the communication and exchange network. There are at present 16 AIDS prevention groups in the country that group over 300 members and 500 collaborators working for the prevention of STI and HIV/AIDS.

[Organization of hospital care to patients with tuberculosis concurrent with HIV infection in Tuberculosis care hospital No. seven].

HIV-infection morbidity rates continue to increase in Moscow, the Moscow Region, and in the whole country. The epidemiological situation associated with tuberculosis concurrent with HIV infection remains tense in Moscow and its region, as judged from the data of an analysis of this disease at tuberculosis hospital seven (TH-7) over 9 years. A total of 411 patients with tuberculosis concurrent with HIV infection were treated at TH-7 in 1996 to December 2004. Among them, 49.6% were Moscow residents, 15.1 and 26.5% of the patients lived in the Moscow Region and other regions of the Russian Federation, respectively; 6.8% were homeless persons and 2% foreigners. The number of patients with tuberculosis concurrent with HIV infection has been annually increasing at TH-7. Among the total number of patients, their proportion was 13.4% in 2004. In the structure of patients with comorbidity, the proportion of surgical patients has been on the rise and it was 51.8% in 2004. Among the surgical patients with tuberculosis concurrent with HIV, the proportion of patients with generalized (multiple organ) tuberculosis has increased; it was 50% in 2004. Patients with tuberculosis concurrent with HIV infection need a greater scope of surgical interventions al number of patients for therapeutic and diagnostic purposes.

Characteristics of Ryan White and non-Ryan White funded HIV medical care facilities across four metropolitan areas: results from the Antiretroviral Treatment and Access Studies site survey.

The Ryan White Comprehensive AIDS Resources Emergency Act 1990 (CARE Act) is one of the largest federal programmes funding medical and support services for individuals with HIV disease. Data that report services and gaps in service coverage from the organizational perspective are very limited. The Antiretroviral Treatment and Access Studies included a mail survey of 176 HIV medical care facilities in four US inner cities on clinic characteristics, services and practices, and patient characteristics. Characteristics of 143 (85%) responding Ryan White (RW) funded and non-RW funded facilities are described. RW funded facilities reported offering more services than non-funded facilities including evening/weekend hours (49% vs. 18%), transportation (71% vs. 22%), and on-site risk reduction counselling (88% vs. 55%). More RW funded facilities reported offering on-site adherence support services, such as support groups (44% vs. 12%), formal classes (20% vs. 2%), and pillboxes (83% vs. 43%), and served a larger proportion of uninsured patients (41% vs. 4%) than non-funded facilities. Our analysis showed that the RW funded HIV care facilities offered more clinic, non-clinic, and adherence support services than non-RW funded facilities, indicating that the disparities in services were still related to CARE Act funding, controlling for private-public facility type.