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1.
BMC Surg ; 21(1): 177, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33794852

RESUMEN

BACKGROUND: Postoperative nausea and vomiting (PONV) and postoperative pain (POP) are most commonly experienced in the early hours after surgery. Many studies have reported high rates of PONV and POP, and have identified factors that could predict the development of these complications. This study aimed to evaluate the relationship between PONV and POP, and to identify some factors associated with these symptoms. METHODS: This was a prospective, multicentre, observational study performed at An-Najah National University Hospital and Rafidia Governmental Hospital, the major surgical hospitals in northern Palestine, from October 2019 to February 2020. A data collection form, adapted from multiple previous studies, was used to evaluate factors associated with PONV and POP in patients undergoing elective surgery. Patients were interviewed during the first 24 h following surgery. Multiple binary logistic regression was applied to determine factors that were significantly associated with the occurrence of PONV. RESULTS: Of the 211 patients included, nausea occurred in 43.1%, vomiting in 17.5%, and PONV in 45.5%. Multiple binary logistic regression analysis, using PONV as a dependent variable, showed that only patients with a history of PONV [odds ratio (OR) = 2.28; 95% confidence interval (CI) = 1.03-5.01; p = 0.041] and POP (OR = 2.41; 95% CI = 1.17-4.97; p = 0.018) were significantly associated with the occurrence of PONV. Most participants (74.4%) reported experiencing pain at some point during the first 24 h following surgery. Additionally, the type and duration of surgery were significantly associated with POP (p-values were 0.002 and 0.006, respectively). CONCLUSIONS: PONV and POP are common complications in our surgical patients. Factors associated with PONV include a prior history of PONV and POP. Patients at risk should be identified, the proper formulation of PONV protocols should be considered, and appropriate management plans should be implemented to improve patients' outcomes.


Asunto(s)
Dimensión del Dolor , Dolor Postoperatorio , Náusea y Vómito Posoperatorios , Procedimientos Quirúrgicos Electivos/efectos adversos , Hospitales Públicos , Hospitales Universitarios , Humanos , Medio Oriente/epidemiología , Dolor Postoperatorio/epidemiología , Náusea y Vómito Posoperatorios/epidemiología , Periodo Posoperatorio , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo
3.
Biomed Res Int ; 2021: 6627430, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33748271

RESUMEN

Introduction: Although the efforts at global and national levels have attempted to decrease the COVID-19 pandemic, the low level of preparedness among healthcare providers is a challenge mainly in developing countries. Hence, this study is aimed at assessing the level of preparedness for COVID-19 and its associated factors among frontline healthcare providers in South Gondar public hospitals, northwest Ethiopia. Methods and Materials: A hospital-based cross-sectional study was conducted among 207 selected healthcare providers who were working in South Gondar public hospital from July 08 to August 29, 2020. A pretested structured questionnaire was used to collect data. The healthcare providers were selected through simple random sampling techniques. Both bivariable and multivariable logistic regressions with a 95% confidence interval were fitted with 95% CI to establish the associated factors with a low level of preparedness. A p value < 0.05 was considered statistically significant. Results: The overall level of preparedness among healthcare providers for COVID-19 was found to be 41.3% (95% CI: 37.4, 44.7). Only 81 (40.1%) healthcare providers had prepared for telling their family and friends if they are infected with COVID-19. Besides, only 23.8% of healthcare providers obtained alcohol-based hand sanitizer in every patient room. Factors associated with a low level of preparedness include being male (AOR = 2.5, 95% CI: 1.22-4.94), unmarried (AOR = 3.4, 95% CI: 1.44-8.00), and working experience less than five years (AOR = 3.4, 95% CI: 1.29-9.09). Conclusion: The level of preparedness among frontline healthcare providers towards COVID-19 was found to be very low. In the future, more emphasis should be placed on healthcare providers who are male, unmarried, and had working experience of lower than five years to decrease the burden of the COVID-19 pandemic.


Asunto(s)
/prevención & control , Personal de Salud/estadística & datos numéricos , Hospitales Públicos/estadística & datos numéricos , Adulto , Estudios Transversales , Etiopía , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Modelos Logísticos , Masculino , Pandemias/prevención & control , Pandemias/estadística & datos numéricos , Encuestas y Cuestionarios
4.
Arch Ital Urol Androl ; 93(1): 111-114, 2021 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-33754622

RESUMEN

The SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) was first reported in December 2019, then its rapid spread around the world caused a global pandemic in March 2020 recording a high death rate. The epicenter of the victims moved from Asia to Europe and then to the United States. In this Pandemic, the different governance mechanisms adopted by local health regional authorities made the difference in terms of contagiousness and mortality together with a community strong solidarity. This document analyzes the andrological urgencies management in public hospitals and in private practice observed in Italy and in particular in the most affected Italian Regions: Emilia-Romagna and Marche.


Asunto(s)
Andrología/estadística & datos numéricos , Infertilidad Masculina/terapia , Pandemias , Manejo de la Enfermedad , Hospitales Públicos/estadística & datos numéricos , Humanos , Italia , Masculino , Práctica Privada/estadística & datos numéricos , Enfermedades Urológicas/terapia
5.
BMC Surg ; 21(1): 119, 2021 Mar 08.
Artículo en Inglés | MEDLINE | ID: mdl-33685436

RESUMEN

BACKGROUND: During March and April 2020, reductions in non-COVID-19 hospital admissions were observed around the world. Elective surgeries, visits with general practitioners, and diagnoses of medical emergencies were consequently delayed. OBJECTIVE: To compare the characteristics of patients admitted to a northern Israeli hospital with common surgical complaints during three periods: the lockdown due to the COVID-19 outbreak, the Second Lebanon War in 2006, and a regular period. METHODS: Demographic, medical, laboratory, imaging, intraoperative, and pathological data were collected from electronic medical files of patients who received emergency treatment at the surgery department of a single hospital in northern Israel. We retrospectively compared the characteristics of patients who were admitted with various conditions during three periods. RESULTS: Patients' mean age and most of the clinical parameters assessed were similar between the periods. However, pain was reportedly higher during the COVID-19 than the control period (8.7 vs. 6.4 on a 10-point visual analog scale, P < 0.0001). During the COVID-19 outbreak, the Second Lebanon War, and the regular period, the mean numbers of patients admitted daily were 1.4, 4.4, and 3.0, respectively. The respective mean times from the onset of symptoms until admission were 3, 1, and 1.5 days, P < 0.001. The respective proportions of surgical interventions for appendiceal disease were 95%, 96%, and 69%; P = 0.03. CONCLUSIONS: Compared to a routine period, patients during the COVID-19 outbreak waited longer before turning to hospitalization, and reported more pain at arrival. Patients during both emergency periods were more often treated surgically than non-operatively.


Asunto(s)
Servicio de Urgencia en Hospital , Cirugía General , Hospitales Públicos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Cirugía General/estadística & datos numéricos , Humanos , Israel/epidemiología , Estudios Retrospectivos
6.
Medicine (Baltimore) ; 100(11): e25133, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725994

RESUMEN

ABSTRACT: The purpose of this research was to identify whether a certain set of drivers of satisfaction/perceived quality of healthcare (PQHC) could indirectly affect patients' confidence/trust in the emergency department (ED).Patients were seen at an ED in the public hospital in Lisbon, Portugal between January and December 2016. Data were collected between May and November 2017, using a questionnaire, by mail or e-mail. The total sample size comprised 382 patients. The data analysis included structural equation modeling to test the conceptual model with specific drivers of satisfaction/PQHC (privacy; accessibility and availability; doctors; meeting expectations; waiting time for triage [perception]; waiting time to be called back by the doctor following examinations and/or tests [perception]; information about possible delays in receiving treatment/waiting times) and with the main outcome (confidence/trust in the ED) using path analysis.The analysis of the coefficients revealed that all the mediated paths are statistically significant (P ≤ .05). Although, altogether, the direct paths did not prove statistically significant (P > .05), the overall satisfaction with doctors (P ≤ .01) and meeting expectations (P = .01) can still directly explain the confidence/trust in the ED without the mediating role of satisfaction and PQHC. Hence, overall satisfaction with doctors and meeting expectations can influence, both directly and indirectly, confidence/trust in the ED. All other variables can only indirectly affect confidence/trust in the ED, either through PQHC or through satisfaction.Even though there are more variables that influence confidence/trust in the ED through PQHC (1)waiting time to be called back by the doctor following examinations and/or tests [perception]; 2) privacy; 3) accessibility and availability; 4) doctors; 5) meeting expectations than through satisfaction (1)waiting time for triage [perception]; 2) information about possible delays in receiving treatment/waiting times; 3) doctors; 4) meeting expectations), we observe the strongest contribution in the mediation model through satisfaction, which reveals its dominant role over PQHC.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Servicio de Urgencia en Hospital/normas , Aceptación de la Atención de Salud/psicología , Satisfacción del Paciente/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Encuestas de Atención de la Salud , Hospitales Públicos , Humanos , Masculino , Persona de Mediana Edad , Percepción , Portugal , Factores de Tiempo , Triaje/normas , Triaje/estadística & datos numéricos , Listas de Espera , Adulto Joven
7.
JAMA Netw Open ; 4(3): e210490, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33651111

RESUMEN

Importance: Several jurisdictions in the United States have secured hotels to temporarily house people experiencing homelessness who require isolation or quarantine for confirmed or suspected coronavirus disease 2019 (COVID-19). To our knowledge, little is known about how these programs serve this vulnerable population outside the hospital setting. Objective: To assess the safety of a hotel-based isolation and quarantine (I/Q) care system and its association with inpatient hospital capacity. Design, Setting, and Participants: This retrospective cohort study of a hotel-based I/Q care system for homeless and unstably housed individuals in San Francisco, California, was conducted from March 19 to May 31, 2020. Individuals unable to safely isolate or quarantine at home with mild to moderate COVID-19, persons under investigation, or close contacts were referred from hospitals, outpatient settings, and public health surveillance to 5 I/Q hotels. Of 1009 I/Q hotel guests, 346 were transferred from a large county public hospital serving patients experiencing homelessness. Exposure: A physician-supervised team of nurses and health workers provided around-the-clock support, including symptom monitoring, wellness checks, meals, harm-reduction services, and medications for opioid use disorder. Main Outcomes and Measures: Characteristics of I/Q hotel guests, program retention, county hospital readmissions, and mean length of stay. Results: Overall, the 1009 I/Q hotel guests had a median age of 44 years (interquartile range, 33-55 years), 756 (75%) were men, 454 (45%) were Latinx, and 501 (50%) were persons experiencing sheltered (n = 295) or unsheltered (n = 206) homelessness. Overall, 463 (46%) received a diagnosis of COVID-19; 303 of 907 (33%) had comorbid medical disorders, 225 of 907 (25%) had comorbid mental health disorders, and 236 of 907 (26%) had comorbid substance use disorders. A total of 776 of 955 guests (81%) completed their I/Q hotel stay; factors most strongly associated with premature discontinuation were unsheltered homelessness (adjusted odds ratio, 4.5; 95% CI, 2.3-8.6; P < .001) and quarantine status (adjusted odds ratio, 2.6; 95% CI, 1.5-4.6; P = .001). In total, 346 of 549 patients (63%) were transferred from the county hospital; of 113 ineligible referrals, 48 patients (42%) had behavioral health needs exceeding I/Q hotel capabilities. Thirteen of the 346 patients transferred from the county hospital (4%) were readmitted for worsening COVID-19. Overall, direct transfers to I/Q hotels from emergency and outpatient departments were associated with averting many hospital admissions. There was a nonsignificant decrease in the mean hospital length of stay for inpatients with confirmed or suspected COVID-19 from 5.5 to 2.7 days from March to May 2020 (P = .11). Conclusions and Relevance: To support persons experiencing homelessness during the COVID-19 pandemic, San Francisco rapidly and safely scaled a hotel-based model of I/Q that was associated with reduced strain on inpatient capacity. Strategies to improve guest retention and address behavioral health needs not met in hotel settings are intervention priorities.


Asunto(s)
/terapia , Personas sin Hogar , Aislamiento de Pacientes , Cuarentena , Adulto , Femenino , Hospitales Públicos , Vivienda , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pandemias , Grupo de Atención al Paciente , Cooperación del Paciente , Readmisión del Paciente , Transferencia de Pacientes , Estudios Retrospectivos , San Francisco , Poblaciones Vulnerables
8.
J. healthc. qual. res ; 36(1): 3-11, ene.-feb. 2021. tab, graf
Artículo en Español | IBECS | ID: ibc-196570

RESUMEN

OBJETIVO: Describir el proceso de planificación y ejecución de un estudio masivo de seroprevalencia para SARS-CoV-2 en los profesionales del Hospital Universitario Fundación Alcorcón (HUFA) (España). MÉTODO: Se efectúa una descripción del plan diseñado y desarrollado en el HUFA para la realización de las extracciones de las muestras para serología en el total de los profesionales que prestan servicio en el hospital, entre el 14 y el 29 de abril del 2020. Se lleva a cabo un análisis descriptivo de la participación de los profesionales en el estudio. De igual manera, se planificaron zonas de extracción, personal sanitario y tiempos de ejecución. Se asignaron 2.326 extracciones a personal sanitario, el resto fueron a trabajadores de las empresas externas. RESULTADOS: Participaron en el estudio 2.641 trabajadores (90,5%) de 2.918 candidatos. La categoría profesional que más se analizó globalmente fue la de enfermería con un 28,3% (n = 590). El porcentaje de cumplimiento de la organización de los horarios fue del 28,6%. Se planificó hasta un máximo de 298 extracciones diarias. El día con más afluencia fue el cuarto con 399 extracciones. CONCLUSIONES: El hecho de organizar un dispositivo tan grande con un alcance al 100% de los trabajadores que prestan servicio en el hospital, y con una respuesta tan mayoritaria por parte de ellos, ha permitido que el estudio de seroprevalencia realizado obtenga unos resultados con alta fiabilidad. Aunque el porcentaje de participación fue muy alto, el grado de cumplimiento de la planificación fue reducido


OBJECTIVE: To describe the planning and execution process of a massive seroprevalence study for SARS-CoV-2 in professionals of the Hospital Universitario Fundación Alcorcón (HUFA) (Spain). METHODS: A description is presented of the plan designed and developed at the HUFA for the execution of the extraction of the samples for serology from all the professionals who worked in the hospital between 14 and 29 April 2020. A descriptive analysis of the participation of the professionals in the study is carried out. Extraction areas, health personnel, and execution times were planned. A total of 2326 extractions were assigned to health personnel, the remaining extractions were assigned to workers from external companies. RESULTS: A total of 2641 workers (90.5%) out of 2918 candidates participated in the study. The professional category most analysed was nursing with 28.3% (n = 590). The percentage of compliance with schedule planning was 28.6%. Up to a maximum of 298 daily extractions were planned. The busiest day was the 4th day of the study with 399 extractions. CONCLUSIONS: The organising of such a large study, with a 100% coverage of those who worked in the hospital, and with such a great response from the workers involved, has led to obtaining results of high reliability in the seroprevalence study carried out. Although the percentage of participation was very high, the level of compliance with the planning was low


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Pandemias , Personal de Hospital/estadística & datos numéricos , Hospitales Públicos/estadística & datos numéricos , Estudios Seroepidemiológicos , España/epidemiología
10.
BMC Infect Dis ; 21(1): 233, 2021 Feb 27.
Artículo en Inglés | MEDLINE | ID: mdl-33639871

RESUMEN

BACKGROUND: The risk of hepatitis B virus infection among medical waste handlers who undergo collection, transportation, and disposal of medical wastes in the health institutions is higher due to frequent exposure to contaminated blood and other body fluids. There is limited evidence on the seroprevalence of hepatitis B among medical waste handlers in eastern Ethiopia. The study was aimed at studying the seroprevalence of Hepatitis B Virus and associated risk factors among medical waste collectors at health facilities of eastern Ethiopia. METHODS: A facility-based cross-sectional study was conducted among randomly selected medical waste collectors from public health facilities in eastern Ethiopia from March to June 2018. A pre-tested and well-structured questionnaire was used to collect data on socio-demographic characteristics and hepatitis B infection risk factors. A2.5ml venous blood was also collected, centrifuged and the serum was analyzed for hepatitis B surface antigen using the instant hepatitis B surface antigen kit. Descriptive summary measures were done. Chi-square and Fisher exact tests were used to assess the risk of association. Multivariate logistic regression was conducted with 95% CI and all value at P-value < 0.05 was declared statistically significant. RESULTS: From a total of 260 (97.38%) medical waste collectors participated, HBV was detected in 53 (20.4%) of the participants [95%CI; 15.8, 25.6]. No significant differences were observed in the detection rates of HBV with respect to socio-demographic characteristics. In both bivariate and multivariable logistic regression analysis, being unvaccinated (AOR = 6.35; 95%CI = [2.53-15.96], P = 0.001), history of blood transfusion (receiving) (AOR; 3.54; 95%CI; [1.02-12.24], P = 0.046), history of tattooing (AOR = 2.86; 95%CI = [1.12-7.27], p = 0.03), and history of multiple sexual partner (AOR = 10.28; 95%CI = [4.16-25.38], P = 0.001) remained statistically significantly associated with HBsAg positivity. CONCLUSION: This cross-sectional study identified that HBV infection is high among medical waste collectors in eastern Ethiopia. Immunization and on job health promotion and disease prevention measures should be considered in order to control the risk of HBV infection among medical waste collectors in eastern Ethiopia.


Asunto(s)
Hepatitis B/epidemiología , Servicio de Limpieza en Hospital/estadística & datos numéricos , Eliminación de Residuos Sanitarios/estadística & datos numéricos , Exposición Profesional/estadística & datos numéricos , Personal de Hospital/estadística & datos numéricos , Adulto , Centros Comunitarios de Salud/estadística & datos numéricos , Infección Hospitalaria/sangre , Infección Hospitalaria/epidemiología , Infección Hospitalaria/etiología , Estudios Transversales , Escolaridad , Etiopía/epidemiología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Hepatitis B/sangre , Hepatitis B/etiología , Antígenos de Superficie de la Hepatitis B/sangre , Virus de la Hepatitis B/aislamiento & purificación , Virus de la Hepatitis B/fisiología , Hospitales Públicos/estadística & datos numéricos , Humanos , Masculino , Residuos Sanitarios/efectos adversos , Residuos Sanitarios/estadística & datos numéricos , Persona de Mediana Edad , Exposición Profesional/análisis , Instalaciones Públicas/estadística & datos numéricos , Factores de Riesgo , Estudios Seroepidemiológicos , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
11.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 52(1): 87-91, 2021 Jan.
Artículo en Chino | MEDLINE | ID: mdl-33474895

RESUMEN

Objective: To understand the level of job satisfaction and work engagement of physicians in public hospitals, to analyze the interaction between job satisfaction and work engagement, and to discuss how each dimension of job satisfaction affects work engagement so as to provide information and reference for improving the level of work engagement of physicians in public hospitals. Methods: Covering 6 public hospitals in Sichuan (3 tertiary-level hospitals and 3 secondary-level hospitals), 638 questionnaires were obtained from physicians through convenient sampling for data description and analysis. Pearson correlation method was used to analyze the correlation between job satisfaction and work engagement, and multiple linear stepwise regression method was used to analyze work engagement and the influencing factors of each dimension. Results: With regard to job satisfaction, physicians showed high levels of satisfaction in personal safety (3.77±0.87), leadership identification and support (3.59±0.77), and job pressure (3.51±0.81). The mean points of work engagement and each dimension were as follows: total mean points of work engagement (4.02±0.99), dedication (4.21±1.13), absorption (4.19±1.08) and vigor (3.63±1.04). In job satisfaction, salary and benefits, work environment, social recognition, organizational management, leadership identification and support are positively correlated to work engagement and all dimensions. In job satisfaction, 5 dimensions, including social recognition, leadership recognition and support, work achievement, personal safety and organizational management, had a significant influence on work engagement and all dimensions. Conclusion: Emphasis on the high-level needs for recognition and self-actualization of doctors, doctor-patient communication, and personal development of doctors may improve doctors' job satisfaction and work engagement.


Asunto(s)
Satisfacción en el Trabajo , Médicos , Estudios Transversales , Hospitales Públicos , Humanos , Encuestas y Cuestionarios , Compromiso Laboral
12.
Arq Bras Cir Dig ; 33(3): e1544, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33470374

RESUMEN

BACKGROUND: In Brazil, the goal-based approach was named Project ACERTO and has obtained good results when applied in elective surgeries with shorter hospitalization time, earlier return to activities without increased morbidity and mortality. AIM: To analyze the impact of ACERTO on emergency surgery care. METHODS: An intervention study was performed at a trauma hospital. Were compared 452 patients undergoing emergency surgery and followed up by the general surgery service from October to December 2018 (pre-ACERTO, n=243) and from March to June 2019 (post-ACERTO, n=209). Dietary reintroduction, volume of infused postoperative venous hydration, duration of use of catheters, probes and drains, postoperative analgesia, prevention of postoperative vomiting, early mobilization and physiotherapy were evaluated. RESULTS: After the ACERTO implantation there was earlier reintroduction of the diet, the earlier optimal caloric intake, earlier venous hydration withdrawal, higher postoperative analgesia prescription, postoperative vomiting prophylaxis and higher physiotherapy and mobilization prescription were achieved early in all (p<0.01); in the multivariate analysis there was no change in the complication rates observed before and after ACERTO (10.7% vs. 7.7% (p=0.268) and there was a decrease in the length of hospitalization after ACERTO (8,5 vs. 6,1 dias (p=0.008). CONCLUSION: The implementation of the ACERTO project decreased the length of hospital stay, improved medical care provided without increasing the rates of complications evaluated.


Asunto(s)
Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/prevención & control , Procedimientos Quirúrgicos Operativos/normas , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Protocolos Clínicos , Femenino , Hospitales Públicos , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Recuperación de la Función , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
13.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(1): 114-119, 2021 Jan 06.
Artículo en Chino | MEDLINE | ID: mdl-33455142

RESUMEN

Objective: This study investigated the professional identity of administrators in 3rd class hospitals in Shanghai, analyzing the professional identity of administrators and associated factors in public hospitals. Methods: In May 2019, Huashan Hospital conducted a questionnaire survey. Through the analysis of the survey data, this study discussed the correlation between the professional identity degree and the external factors. Three main dimensions of occupational identity were extracted by principal component analysis, namely the professional self-identity, organizational identity and social identity. External influencing factors were analyzed by factor analysis, and five main factors were extracted. Results: It was found that the professional self-identity was much higher than the organizational and social identity. The degree of organizational identity was significantly related to external factors (r=0.212,0.426,0.146,0.580,0.610,P <0.01). Respect factors (r=0.553,0.580,0.570) and self-realization factors (r=0.563,0.610,0.433) had the highest correlation with professional identity. Conclusion: Initiating with improving organizational identity, the authorities and hospitals should establish a scientific and reasonable promotion and incentive mechanism to enhance the degree of professional identity.


Asunto(s)
Hospitales Públicos , Identificación Social , China , Humanos , Encuestas y Cuestionarios
14.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-33431439

RESUMEN

We describe a case of a middle-aged woman who presented with progressive jaundice and was suspected to have rebound choledocholithiasis, which was initially managed with balloon extraction through endoscopic retrograde cholangiopancreatography at her first presentation. Healthcare in Pakistan, like many other developing countries, is divided into public and private sectors. The public sector is not always completely free of cost. Patients seeking specialised care in the public sector may find lengthy waiting times for an urgent procedure due to a struggling system and a lack of specialists and technical expertise. Families of many patients find themselves facing 'catastrophic healthcare expenditure', an economic global health quandary much ignored.


Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica/economía , Coledocolitiasis/terapia , Tratamiento Conservador/economía , Accesibilidad a los Servicios de Salud/economía , Ictericia Obstructiva/terapia , Coledocolitiasis/complicaciones , Coledocolitiasis/diagnóstico , Coledocolitiasis/economía , Conducto Colédoco/diagnóstico por imagen , Conducto Colédoco/cirugía , Tratamiento Conservador/métodos , Países en Desarrollo/economía , Progresión de la Enfermedad , Femenino , Fuerza Laboral en Salud/economía , Hospitales Privados/economía , Hospitales Públicos/economía , Humanos , Ictericia Obstructiva/economía , Ictericia Obstructiva/etiología , Persona de Mediana Edad , Pakistán , Cuidados Paliativos , Índice de Severidad de la Enfermedad , Tiempo de Tratamiento/economía , Ultrasonografía
16.
J Nurs Scholarsh ; 53(2): 171-179, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33476482

RESUMEN

PURPOSE: Nurses have an increased risk for acquiring COVID-19 infection. This study assessed levels of risk for exposure to COVID-19 among nurses, and determined those at the greatest risk. DESIGN: A cross-sectional design was used to assess risk for exposure to COVID-19 in nurses from five randomly selected governmental hospitals in the United Arab Emirates. Participants completed an online survey (including the World Health Organization survey) to assess their risk for exposure to COVID-19. Descriptive statistics were used to describe classes of risk for exposure, and logistic regression was used to identify factors associated with greater risk. FINDINGS: Of the 552 participants, 284 nurses (51.4%) were classified at high risk for COVID-19 exposure as they did not report adherence to infection control and prevention (ICP) guidelines at all times during healthcare interactions and when performing aerosol procedures, or had accidental exposure to biological fluid and respiratory secretions. Compared with adherence to wearing medical masks, gloves, and hand hygiene practices, adherence to wearing face shields or goggles and disposable gowns and decontaminating high-touch surfaces was less frequent. Shifting to work in critical care units, not having adequate critical care experience, and reporting a need for training in ICP practices were factors that contributed to high-risk exposure (p values for Ex (Bs) = 2.60, 2.16, 1.75, ≤ 0.05, consecutively). CONCLUSIONS: A considerable number of nurses were classified at high risk for COVID-19 exposure. Critical care work experience and adequate evidence-based training in ICP practices related to COVID-19 must be considered to mitigate the risk for exposure to COVID-19 in nurses. CLINICAL RELEVANCE: This study provided a strong message regarding protecting nurses at high risk for exposure to COVID-19. Clinical leaders must stay vigilant to ensure nurses' adherence to ICP practices in the context of COVID-19, and to proactively address any related deficits.


Asunto(s)
/transmisión , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Personal de Enfermería en Hospital , Exposición Profesional/efectos adversos , Adulto , /prevención & control , Estudios Transversales , Femenino , Adhesión a Directriz/estadística & datos numéricos , Hospitales Públicos , Humanos , Control de Infecciones/métodos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Unidades de Cuidados Intensivos , Masculino , Personal de Enfermería en Hospital/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Medición de Riesgo , Autoinforme , Encuestas y Cuestionarios , Emiratos Árabes Unidos/epidemiología
17.
Int J Qual Health Care ; 33(1)2021 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-33313859

RESUMEN

INTRODUCTION: COVID-19 has challenged healthcare systems worldwide. Some countries collapsed under surge conditions, while others (such as Malta) showed resilience. Public health measures in Malta quickly reined in COVID-19 spread. This review summarizes pandemic preparedness measures in Malta and the impact on routine services. METHODS: A literature search was conducted using Google, Google Scholar and PubMed and by reviewing Maltese online newspapers. A comprehensive summary of internal operations conducted at Mater Dei Hospital (MDH) was made available. RESULTS: A hospital 'Incident Command Group' was set up to plan an optimal COVID-19 response strategy. A 'rapid response team' was also created to cater for the logistics and management of supplies. A 'COVID-19 Emergency Operation Centre' simulated different COVID-19 scenarios. All elective services were suspended and all staff were mandatorily trained in wearing personal protective equipment. Staff were also retrained in the care of COVID-19 patients. In preparation for potential admission surges, MDH underwent rapid expansion of normal and intensive care beds. Swabbing was ramped up to one of the highest national rates worldwide. The cost for hospital COVID-19 preparedness exceeded €100 million for Malta's half a million population. CONCLUSION: Malta and its sole acute hospital coped well with the first wave with 680 cases and 9 deaths. The increased ability to deal with COVID-19 (a principally respiratory pathogen) will serve well for the anticipated combined annual influenza and the COVID-19 second wave this coming winter.


Asunto(s)
/epidemiología , Hospitales Públicos/organización & administración , Humanos , Malta/epidemiología , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/virología
18.
Health Policy ; 125(4): 526-534, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33309182

RESUMEN

PURPOSE: To assess the future direction of sustainable development in public hospitals, focusing on their short- versus long-term time horizons, top-down versus bottom-up paths, and intra-organizational versus inter-organizational actions. DESIGN/METHODOLOGY/APPROACH: The selection of significant health care organizations was based on judgmental sampling. This study applied an inductive approach. The interviewees were identified according to their knowledge of the future direction of their organizations' sustainable development. FINDINGS: The sustainable development of the studied public hospitals is aimed at the synchronization of actions with other hospitals in the public healthcare system. The public hospitals studied differ in their interconnected elements of time (short- versus long-time horizons), paths (top-down versus bottom-up) and specific actions (intra-organizational versus inter-organizational). RESEARCH LIMITATIONS/: implications Offers insights into how to assess the direction of sustainable development in public hospitals. We stress the importance of time, path and action in conjunction. Furthermore, this study provides a three-dimensional framework to assess the future direction of sustainable development in organizations as well as in industries. Both the former and latter characteristics are shaped by the elements of time, path and action. MANAGERIAL IMPLICATIONS: Provides a three-dimensional framework of criteria to assess the direction of sustainable development in organizations. The assessment criteria may be used by organizations to assess the direction of other organizations in their industry. Industry associations or authorities may look into the status and future direction of sustainable development in industries or sectors as a whole. The assessment criteria provide an opportunity and foundation to benchmark against others in the same industry and insights to face pandemic as Covid-19. ORIGINALITY/VALUE: First study to consider a three-dimensional framework based on time, path and action to assess the future direction of sustainable development in an organization.


Asunto(s)
Predicción , Hospitales Públicos , Objetivos Organizacionales , Desarrollo Sostenible , Sector de Atención de Salud , Humanos , España , Factores de Tiempo
20.
J Stroke Cerebrovasc Dis ; 30(3): 105551, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33348248

RESUMEN

OBJECTIVES: The efficacy of thrombolytic therapy with tissue plasminogen activator (tPA) is highly time dependent. Although clinical guidelines do not recommend written informed consent as it may cause treatment delays, local policy can supersede and require it. From 2014 to 2017, three out of five public hospitals in Singapore changed from written to verbal consent at different time points. We aimed to examine the association of hospital policy changes regarding informed consent on door-to-needle (DTN) times. MATERIALS AND METHODS: Using data from the Singapore Stroke Registry and surveys of local practice, we analyzed data of 915 acute ischemic stroke patients treated with tPA within 3 hours in all public hospitals between July 2014 to Dec 2017. Patient-level DTN times before and after policy changes were examined while adjusting for clinical characteristics, within-hospital clustering, and trends over time. RESULTS: Patient characteristics and stroke severity were similar before and after the policy changes. Overall, the median DTN times decreased from 68 to 53 minutes after the policy changes. After risk adjustment, changing from written to verbal informed consent was associated with a 5.6 minutes reduction (95% CI 1.1-10.0) in DTN times. After the policy changed, the percentage of patients with DTN ≤60 minutes and ≤45 minutes increased from 35.6% to 66.1% (adjusted OR 1.75; 95% CI 1.12-2.74) and 9.3% to 36.0% (adjusted OR 2.42; 95% CI 1.37-4.25), respectively. CONCLUSION: Changing from written to verbal consent is associated with significant improvement in the timeliness of tPA administration in acute ischemic stroke.


Asunto(s)
Fibrinolíticos/uso terapéutico , Consentimiento Informado , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Tiempo de Tratamiento , Activador de Tejido Plasminógeno/uso terapéutico , Anciano , Femenino , Fibrinolíticos/efectos adversos , Hospitales Públicos , Humanos , Masculino , Persona de Mediana Edad , Formulación de Políticas , Sistema de Registros , Estudios Retrospectivos , Singapur , Accidente Cerebrovascular/diagnóstico , Terapia Trombolítica/efectos adversos , Factores de Tiempo , Activador de Tejido Plasminógeno/efectos adversos , Resultado del Tratamiento , Conducta Verbal
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