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1.
Brain Nerve ; 74(1): 45-47, 2022 Jan.
Artículo en Japonés | MEDLINE | ID: mdl-34992171

RESUMEN

The percentage of female faculty members in university hospitals remain low in Japan. This is especially true for the posts of lecturer and above. It remains difficult for women to continue working at university hospitals after going through various life events. However, this situation is definitely changing. There are many challenging and rewarding jobs that can only be found in university hospitals, and I hope that many female doctors will consider a career in a university as one of their options.


Asunto(s)
Liderazgo , Médicos , Femenino , Hospitales Universitarios , Humanos , Japón
2.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2022 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-35015386

RESUMEN

PURPOSE: Hospital mergers are common in the United Kingdom and internationally. However, mergers rarely achieve their intended benefits and are often damaging. This study builds on existing literature by presenting a case study evaluating a merger of two hospitals in Oxford, United Kingdom with three distinct characteristics: merger between two university hospitals, merger between a generalist and specialist hospital and merger between two hospitals of differing size. In doing so, the study draws practical lessons for other healthcare organisations. DESIGN/METHODOLOGY/APPROACH: Mixed-methods single-case evaluation. Qualitative data from 19 individual interviews and three focus groups were analysed thematically, using constant comparison to synthesise and interpret findings. Qualitative data were triangulated with quantitative clinical and financial data. To maximise research value, the study was co-created with practitioners. FINDINGS: The merger was a relative success with mixed improvement in clinical performance and strong improvement in financial and organisational performance. The merged organisation received an improved inspection rating, became debt-free and achieved Foundation Trust status. The study draws six lessons relating to the contingencies that can make mergers a success: (1) Develop a strong clinical rationale, (2) Communicate the change strategy widely and early, (3) Increase engagement and collaboration at all levels, (4) Be transparent and realistic about the costs and benefits, (5) Be sensitive to the feelings of the other organisation and (6) Integrate different organizational cultures effectively. ORIGINALITY/VALUE: This case study provides empirical evidence on the outcome of merger in a university hospital setting. Despite the relatively positive outcome, there is no strong evidence that the benefits could not have been achieved without merger. Given that mergers remain prevalent worldwide, the practical lessons might be useful for other healthcare organisations considering merger.


Asunto(s)
Instituciones Asociadas de Salud , Hospitales Universitarios , Humanos , Cultura Organizacional , Reino Unido
3.
Rev Paul Pediatr ; 40: e2020490, 2022.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-35019009

RESUMEN

OBJECTIVE: To map the transition process from the perspective of pediatricians and their adolescent patients, and to suggest a transition protocol. METHODS: This is a descriptive, cross-sectional study conducted in a pediatric outpatient clinic of a public tertiary hospital. Pediatricians answered a questionnaire about the transition process, and that was evaluated in a descriptive manner. The Transition Readiness Assessment Questionnaire (TRAQ) on health autonomy was answered by the adolescents and the analysis was performed using the χ2 and Mann-Whitney tests. p<0.05 were considered significant. RESULTS: 31 pediatricians (16 residents, 15 supervisors) were enrolled, with a mean age of 40.1 (±16.9), 87% women, with years working in Pediatrics ranging from 2 to 45 years (median of 5 years). Most doctors agreed that there was no transition plan, but they stimulated the patient's autonomy and talked to the patient and family members about any existing chronic diseases. A total of 102 adolescent patients participated, with a median age of 15; 56% were female. The TRAQ median was 58, with similar scores between females and males, and higher scores in those older than 16 years of age (Mann-Whitney U test, p=0.01). The patients reported ease in face-to-face communication with their doctors, but great difficulty in talking about health issues over the phone. CONCLUSIONS: Even without a transition protocol, adolescents developed several self-care skills as they aged. The lack of a transitional protocol led to conflicting opinions, which reinforces the need for improvement. We suggest a flowchart and transition protocol.


Asunto(s)
Transición a la Atención de Adultos , Adolescente , Adulto , Anciano , Niño , Estudios Transversales , Femenino , Hospitales Universitarios , Humanos , Masculino , Pediatras , Encuestas y Cuestionarios
4.
Acta Orthop ; 93: 198-205, 2022 01 03.
Artículo en Inglés | MEDLINE | ID: mdl-34984481

RESUMEN

Background and purpose - Facemasks play a role in preventing the respiratory spread of SARS-CoV-2, but their impact on the physician-patient relationship in the orthopedic outpatient clinic is unclear. We investigated whether the type of surgeons' facemask impacts patients' perception of the physician-patient relationship, influences their understanding of what the surgeon said, or affects their perceived empathy. Patients and methods - All patients with an appointment in the orthopedic outpatient clinic of a tertiary university hospital during the 2-week study period were included. During consultations, all surgeons wore a non-transparent (first study week) or transparent facemask (second study week). Results of 285 of 407 eligible patients were available for analysis. The doctor-patient relationship was evaluated using the standardized Patient Reactions Assessment (PRA) and a 10-point Likert-scale questionnaire ranging from 0 (strongly disagree) to 10 (strongly agree). Results - A non-transparent facemask led to more restrictions in the physician-patient communication and a worse understanding of what the surgeon said. Patients' understanding improved with a transparent facemask with greatest improvements reported by patients aged 65 years and older (non-transparent: 6 [IQR 5-10] vs. transparent: 10 [IQR 9-10], p < 0.001) and by patients with a self-reported hearing impairment (non-transparent: 7 [IQR 3-7] vs. transparent: 9 [IQR 9-10], p < 0.001). The median PRA score was higher when surgeons wore a transparent facemask (p= 0.003). Interpretation - Surgeons' non-transparent facemasks pose a new communication barrier that can negatively affect the physician-patient relationship. While emotional factors like affectivity and empathy seem to be less affected overall, the physician-patient communication and patients' understanding of what the surgeon said seem to be negatively affected.


Asunto(s)
COVID-19/prevención & control , Diseño de Equipo , Máscaras , Cirujanos Ortopédicos , Pandemias/prevención & control , Relaciones Médico-Paciente , Adulto , Anciano , Estudios de Cohortes , Femenino , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , SARS-CoV-2 , Encuestas y Cuestionarios
5.
Br J Nurs ; 31(1): 57, 2022 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-35019742

RESUMEN

Sam Foster, Chief Nurse, Oxford University Hospitals, considers the lessons from research into the trainee nurse associate role and the implications for workforce planning.


Asunto(s)
Medicina Estatal , Hospitales Universitarios , Humanos , Reino Unido , Recursos Humanos
6.
Ann Otol Rhinol Laryngol ; 131(1): 12-26, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33779296

RESUMEN

OBJECTIVE: To analyze trends in otolaryngology consultations and provide algorithms to guide management during the COVID-19 pandemic. METHODS: A retrospective cohort study at a single institution tertiary care hospital. A total of 95 otolaryngology consultations were performed from March 1, 2020 to April 26, 2020 (COVID-era) and 363 were performed from September 1, 2019 to February 29, 2020 (pre-COVID-era) at the UPMC Oakland campus. Data collected included patient demographics, COVID-19 status, reason for consult, location of consult, type of consult, procedures performed, need for surgical intervention, length of hospital stay and recommended follow up. RESULTS: Patient populations in the pre-COVID-era and COVID-era were similar in terms of their distribution of demographics and chief complaints. Craniofacial trauma was the most common reason for consultation in both periods, followed by vocal fold and airway-related consults. We saw a 21.5% decrease in the rate of consults seen per month during the COVID-era compared to the 6 months prior. Review of trends in the consult workflow allowed for development of several algorithms to safely approach otolaryngology consults during the COVID-19 pandemic. CONCLUSIONS: Otolaryngology consultations provide valuable services to inpatients and patients in the emergency department ranging from evaluation of routine symptoms to critical airways. Systematic otolaryngology consult service modifications are required in order to reduce risk of exposure to healthcare providers while providing comprehensive patient care.


Asunto(s)
Algoritmos , COVID-19 , Otolaringología , Enfermedades Otorrinolaringológicas , Derivación y Consulta/tendencias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Protocolos Clínicos , Estudios de Cohortes , Femenino , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Otorrinolaringológicas/diagnóstico , Enfermedades Otorrinolaringológicas/terapia , Pennsylvania , Estudios Retrospectivos , Adulto Joven
7.
Ulus Travma Acil Cerrahi Derg ; 28(1): 27-32, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34967425

RESUMEN

BACKGROUND: With the rapid and effective change created by the COVID-19 pandemic in all medical practice, we aimed to evaluate the impact of the first 100 days of the COVID-19 pandemic on the operations performed in a reference university hospital in the field of orthopedics and traumatology. Compare the results with the same period of the previous year and aim to evaluate importance of restrictions. METHODS: The operations performed in orthopedics and traumatology clinic between March 18, 2020 (the day we stopped the elective surgeries), and July 1, 2020 (when the normalization process began), were collected from the electronic archive to compare with the same period of 2019. RESULTS: Comparing the same periods of the year, it was seen that 102 surgeries were performed in the 2020 COVID-19 period compared to 380 operations performed in 2019. Although most of the operations performed during the COVID-19 period were traumas, the comparison revealed that trauma cases decreased by 25% from 73 to 58 (p<0.001). Among trauma patients operated in the restraint period, decrease in the pediatric group and the increase in patients over 65 years of age had seen statistically significant. Compared to the same period of the previous year, 50% increase seen in amputation cases related to diabetic foot (p<0.001). CONCLUSION: The postponement of elective cases due to the COVID-19 pandemic enabled us to manage trauma cases despite decreasing capacity utilization. In addition, it was observed that the transition of schools to online education and the implementation of curfews significantly reduced the number of trauma in the pediatric group. Separation of operating rooms and wards had a huge effect on protection of non-COVID patients. We hope that, in light of this study, we can guide health policies and help other colleagues to manage the possible new waves of the pandemic process or similar processes that may occur in the future.


Asunto(s)
COVID-19 , Ortopedia , Niño , Hospitales Universitarios , Humanos , Pandemias , SARS-CoV-2
8.
Ann Lab Med ; 42(1): 36-46, 2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-34374347

RESUMEN

Background: The emergence of carbapenemase-producing Enterobacteriaceae (CPE) represents a major clinical problem. Recently, the occurrence of CPE has increased globally, but epidemiological patterns vary across region. We report the trends in the genotypic distribution and antimicrobial susceptibility of CPE isolated from rectal and clinical samples during a four-year period. Methods: Between January 2016 and December 2019, 1,254 nonduplicated CPE isolates were obtained from four university hospitals in Korea. Carbapenemase genotypes were determined by multiplex real-time PCR. Antimicrobial susceptibility was profiled using the Vitek 2 system (bioMérieux, Hazelwood, MO, USA) or MicroScan Walkaway-96 system (Siemens West Sacramento, CA, USA). The proportions of carbapenemase genotypes and nonsusceptibility were analyzed using Pearson's chi-square test. Results: Among the 1,254 CPE isolates, 486 (38.8%), 371 (29.6%), 357 (28.5%), 8 (0.6%), 8 (0.6%), and 24 (1.9%) were Klebsiella pneumoniae carbapenemase (KPC), oxacillinase (OXA)-48-like, New Delhi metallo-ß-lactamase (NDM), imipenemase (IMP), Verona integron-encoded metallo-ß-lactamase (VIM), and multiple producers, respectively. The predominant species was K. pneumoniae (72.6%), followed by Escherichia coli (6.5%). More than 90% of the isolates harboring KPC, NDM, and OXA-48-like were nonsusceptible to cephalosporins, aztreonam, and carbapenems. Conclusions: The impact of CPE is primarily due to KPC-, NDM-, and OXA-48-like-producing K. pneumoniae isolates. Isolates carrying these carbapenemase are mostly multidrug-resistant. Control strategies based on these genotypic distributions and antimicrobial susceptibilities of CPE isolates are required.


Asunto(s)
Antiinfecciosos , Enterobacteriaceae Resistentes a los Carbapenémicos , Infecciones por Enterobacteriaceae , Antibacterianos/farmacología , Proteínas Bacterianas/genética , Infecciones por Enterobacteriaceae/epidemiología , Genotipo , Hospitales Universitarios , Humanos , Klebsiella pneumoniae , Pruebas de Sensibilidad Microbiana , República de Corea , beta-Lactamasas/genética
9.
Int Emerg Nurs ; 60: 101113, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34942538

RESUMEN

BACKGROUND: Risky alcohol consumption can occur from a young age and affects people of all age groups, sometimes requiring the intervention of the emergency medical services. OBJECTIVES: Determining the timing and characteristics of emergency calls (to the "118" emergency number) relating to subjects in all age groups, in which alcohol was a contributing factor, along with the biochemical correlates, in a great metropolitan area. On the basis of these, future interventions would target specific training for nurses and paramedics working in emergency medical services. METHOD: An observational single-centre retrospective study carried out from 1 January 2014 to 31 December 2018 involving patients requiring emergency care and attending the Emergency Department of an University Hospital. RESULTS: Out of a total of 47,252 emergency calls, 2.22% were for alcohol-related conditions and mainly involved male patients (78.4%). A high incidence of alcoholic coma was found in patients aged 11 to 17 years. Emergency medical assistance was required mainly at night on weekdays by patients aged 11-17, 25-44 years and during the weekend and on weekdays by patients aged 18-24 years. A blood alcohol concentration higher than 50 mg/dL was found in more than 67% of patients aged 11-17 and 18-24 years at weekends. CONCLUSIONS: The most alarming finding from our data is that, despite prevention policies, young people requiring emergency medical assistance showed similar alcohol levels as adults and a high incidence of alcoholic coma.


Asunto(s)
Intoxicación Alcohólica , Servicios Médicos de Urgencia , Adolescente , Adulto , Intoxicación Alcohólica/complicaciones , Intoxicación Alcohólica/epidemiología , Nivel de Alcohol en Sangre , Servicio de Urgencia en Hospital , Hospitales Universitarios , Humanos , Masculino , Estudios Retrospectivos
10.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1353024

RESUMEN

Objective: the study's goal has been to describe the experience of the accompanying father in the birth process by caesarean section at the Obstetric Center and point out the favorable and unfavorable conditions that influence this process.Methods: qualitative research, carried out at a University Hospital from august to september 2016 with 10 accompanying parents. The data collection was established by a semi-structured interview, submitted to Bardin's content analysis. Results: through the analysis, two categories emerged: possibilities and limitations in the experience of accompanying parents and emotional aspects in the birth process, which include the physical aspects of the operating room, the welcoming and guidance of the multidisciplinary team and the feelings presented by the parents. Conclusion: the father's participation in the cesarean delivery provides positive impacts for the mother-child-family trinomial, making crucial his presence since prenatal care and the physical adequacy of the cesarean environment


Objetivo: descrever a vivência do pai acompanhante no processo de nascimento por cesariana no Centro Obstétrico e apontar as condições favoráveis e desfavoráveis que influenciaram neste processo. Métodos: pesquisa qualitativa, realizada em um Hospital Universitário de agosto a setembro de 2016 com 10 pais acompanhantes. A coleta de dados se estabeleceu por meio de uma entrevista semiestruturada, submetida à análise de conteúdo de Bardin. Resultados: pela análise, emergiram duas categorias: possibilidades e limitações na vivência do pai acompanhante e aspectos emocionais no processo de nascimento, que compreenderam: os aspectos físicos da sala de cirurgia, o acolhimento e orientação da equipe multiprofissional e os sentimentos apresentados pelos pais. Conclusão: a participação do pai no parto cesárea proporciona impactos positivos ao trinômio mãe-filho-família, tornando cruciais a sua presença desde o pré-natal e a adequação física do ambiente da cesárea


Objetivo: describir la experiencia del padre acompañante en el proceso de parto por cesárea en el Centro de Obstetricia y señalar las condiciones favorables y desfavorables que influyeron en este proceso. Métodos: investigación cualitativa realizada en un Hospital Universitario de agosto a septiembre de 2016 con 10 padres acompañantes. La recopilación de datos se estableció mediante una entrevista semiestructurada, sometida al análisis del contenido de Bardin. Resultados: por análisis, surgieron dos categorías: posibilidades y limitaciones en la experiencia del padre acompañante y aspectos emocionales en el proceso del parto, que incluyeron los aspectos físicos de la sala de operaciones, la bienvenida y la orientación del equipo multidisciplinario y los sentimientos presentados por los padres. Conclusión: la participación del padre en la cesárea proporciona impactos positivos para el trinomio madre-hijo-familia, lo que hace que su presencia desde la atención prenatal y la adecuación física del entorno de la cesárea sean cruciales


Asunto(s)
Humanos , Masculino , Padres , Cesárea/psicología , Enfermería Obstétrica/tendencias , Paternidad , Salas de Parto/tendencias , Investigación Cualitativa , Relaciones Familiares , Hospitales Universitarios
11.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(10): 1249-1254, 2021 Oct.
Artículo en Chino | MEDLINE | ID: mdl-34955137

RESUMEN

OBJECTIVE: To compare the clinical characteristics of critically ill pregnant women admitted to the intensive care unit (ICU) with different admission methods, in order to make more effective and rational use of ICU resources. METHODS: A retrospective study was conducted. The clinical data of critically ill pregnant women admitted to ICU of Peking University Third Hospital from January 2006 to July 2019 were analyzed. According to the admission mode to ICU, the pregnant women were divided into emergency admission group (transferred to ICU on the same day or the next day due to critical illness) and planned admission group (transferred to ICU 2 days after admitting in obstetric ward). The clinical characteristics of ICU critical pregnant women, such as the incidence, causes of admission, severity of the disease, main treatment measures, mortality, and medical expenses were collected, and a comparative analysis between the two groups was performed. RESULTS: During the nearly 14 years, a total of 576 critical pregnant women in ICU were enrolled, accounting for 0.8% (576/71 790) of the total number of obstetric inpatients and 4.6% (576/12 412) of the total number of ICU inpatients. Seven maternal deaths accounted for 1.2% of all critically pregnant women transferred to ICU, and the overall mortality of pregnant women was 10/100 thousand. Of the 576 critically pregnant women, there were 327 patients (56.8%) in the emergency admission group and 249 patients (43.2%) in the planned admission group. Compared with the planned admission group, the proportion of elective cesarean section in the emergency admission group was significantly lower (17.7% vs. 94.0%, P < 0.01), and the proportion of emergency cesarean section was significantly higher (65.1% vs. 2.4%, P < 0.01), the acute physiology and chronic health evaluation (APACHE II, APACHE III) scores, simplified acute physiology score II (SAPS II) and Marshall score were significantly higher [APACHE II score: 6.0 (4.0, 9.8) vs. 4.0 (3.0, 7.0), APACHE III score: 14.0 (11.0, 20.3) vs. 12.0 (9.0, 16.0), SAPS II score: 8 (0, 12) vs. 3 (0, 8), Marshall score: 2 (1, 4) vs. 1 (1, 3), all P < 0.01]. The length of ICU stay in the emergency admission group was significantly longer than that in the planned admission group [days: 2 (1, 5) vs. 2 (1, 3), P < 0.01], and the total length of hospital stay was significantly shorter [days: 9 (7, 13) vs. 13 (10, 18), P < 0.01]. Both in the emergency admission group and the planned admission group, obstetric factors were the main reason for admission, 60.9% (199/327) and 70.3% (175/249), respectively. The proportion of postpartum hemorrhage was the highest [35.2% (115/327) and 57.0% (142/249)], followed by preeclampsia/eclampsia [7.0% (23/327) and 7.6% (19/249)]. Only 7 of the 19 critically pregnant women with puerperal infection were planned admission. All 21 patients with acute fatty liver of pregnancy (AFLP) during pregnancy were emergency admission. Among the emergency and planned admission patients, 73 patients (22.3%) and 42 patients (16.9%) required mechanical ventilation (duration of mechanical ventilation > 24 hours), 99 patients (30.3%) and 35 patients (14.1%) needed vasoactive agents, 67 patients (20.5%) and 20 patients (8.0%) received hemodynamic monitoring, and 123 patients (37.6%) and 154 patients (61.8%) were given anticoagulation therapy, respectively. In terms of severity score of critical pregnant women, there were significant differences in APACHE II, APACHE III, SAPS II and Marshall scores of pregnant women with different diseases. Among them, the APACHE III, SAPS II and Marshall scores of AFLP were the highest [21.0 (15.0, 32.5), 12.0 (6.0, 16.5) and 6.0 (3.5, 8.0), respectively]. The APACHE II and APACHE III scores of postpartum hemorrhage were the lowest [4.0 (3.0, 7.0), 12.0 (10.0, 16.0)]. The SAPS II score of pneumonia was the lowest [2.0 (0, 14.0)]. The Marshall score for puerperal infection was the lowest [1.0 (0, 3.0)]. In terms of the total medical expenses, the cost in the emergency admission group was significantly lower than that in the planned admission group [10 thousand Yuan: 3.1 (2.0, 4.7) vs. 4.1 (2.9, 5.8), P < 0.05]. CONCLUSIONS: Compared with the critically ill pregnant women who planned to be admitted to ICU, the patients emergency admitted to ICU were more complicated and urgent, and the severity of the condition was scored higher. At present, the severity scoring system commonly used in ICU can only partly evaluate the severity of critically ill pregnant women, therefore, it is necessary to design the specific severity scoring system for critically ill pregnant women to effectively and rationally use the precious ICU resources.


Asunto(s)
Enfermedad Crítica , Mujeres Embarazadas , Análisis del Polimorfismo de Longitud de Fragmentos Amplificados , Cesárea , Análisis de Datos , Femenino , Mortalidad Hospitalaria , Hospitales Universitarios , Humanos , Unidades de Cuidados Intensivos , Embarazo , Estudios Retrospectivos
12.
Inquiry ; 58: 469580211067477, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34932417

RESUMEN

INTRODUCTION: A number of medications have been demonstrated to lower blood glucose. However, current-day management has failed to achieve and maintain the optimal glycemic level for diabetic patients. Patients' non-adherence is among the most contributing factors. Therefore, the aim of this study was to explore the prevalence of non-adherence to anti-diabetic medications and associated factors. METHODS: A hospital based cross-sectional study was conducted from November 2020 to January 2021. A systematic random sampling technique was used. Data were collected by structured questionnaire adapted from different literatures. Then, data were entered into SPSS version 25 and analyzed. To determine the association of dependent and independent variables, multiple logistic regression was done. P-value <.05 was considered statistically significant. RESULTS: A total of 275 study participants were interviewed with a response rate of 100%. From this 53.8% were females, 59.3% were in the age group of 41-60 years, 35.3% were college/university graduates and 79.3% were not using social drugs. One hundred eighty-seven (68%) of them were adherent to their anti-diabetic medication. Factors found to be significantly associated with anti-diabetic medication adherence were age >60 years (AOR = .276, 95% CI = .124-.611) attending higher education (AOR = 6.203, 95% CI = 1.775-21.93), retired (AOR = 7.771, 95% CI = 1.458-41.427), housewife (AOR = 7.023, 95% CI = 1.485-33.215), average monthly income 1001birr-2000 birr (AOR = .246, 95% CI = .067-.911) and social drug use (AOR = 3.695, 95% CI = 1.599-8.542). Forgetfulness, not affording, side effects, misunderstanding of instructions, and poly-pharmacy were identified reasons for non-adherence. CONCLUSIONS AND RECOMMENDATIONS: Patients' adherence to anti-diabetic medications in the current study is sub-optimal. Age, monthly income, level of education, occupational status, and social drug use were associated with adherence. Forgetfulness, not affording, and side effects were reasons identified to contribute to non-adherence. Therefore, adherence counseling, use of alarms, and the way to mitigate non-affordability, including anti-diabetic medications into a program drug should be considered.


Asunto(s)
Diabetes Mellitus , Preparaciones Farmacéuticas , Adulto , Estudios Transversales , Diabetes Mellitus/tratamiento farmacológico , Femenino , Hospitales Universitarios , Humanos , Cumplimiento de la Medicación , Persona de Mediana Edad , Universidades
13.
Stud Health Technol Inform ; 284: 163-165, 2021 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-34920495

RESUMEN

A digital care pathway is a secure digital service channel for patients in a care relationship with a specialized health care hospital in Finland. It is part of the Health Village portal built in co-operation with the Virtual Hospital project by five Finnish university hospitals led by Helsinki University Hospital. Health Village services make healthcare services available to all Finns regardless of place of residence and income level, thus improving the equality of citizens.


Asunto(s)
Vías Clínicas , Hospitales Especializados , Atención a la Salud , Finlandia , Hospitales Universitarios , Humanos
14.
Inquiry ; 58: 469580211067930, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34910605

RESUMEN

BACKGROUND: Although efforts to manage coronavirus disease 2019 (COVID-19) pandemic have understandably taken immediate priority, the impacts on traditional healthcare-associated infection (HAI) surveillance and prevention efforts remain concerning. AIM: To describe trends in HAIs in a Tunisian university hospital through repeated point prevalence surveys over 9 years, assess the impact of measures implemented for COVID-19 pandemic, and to identify associated factors of HAI. METHODS: The current study focused on data collected from annual point prevalence surveys conducted from 2012 to 2020. All types of HAIs as defined by the Centers for Disease Control and Prevention (CDC) were included. Data collection was carried out using NosoTun plug. Univariate and multivariate logistic analysis were used to identify HAI risk factors. RESULTS: Overall, 2729 patients were observed in the 9 surveys; the mean age was 48.3 ± 23.3 years and 57.5% were male. We identified 267 infected patients (9.8%) and 296 HAIs (10.8%). Pneumonia/lower respiratory tract infections were the most frequent HAI (24%), followed by urinary tract infection (20.9%).The prevalence of infected patients increased from 10.6% in 2012 to 14.9% in 2020. However, this increase was not statistically significant. The prevalence of HAIs increased significantly from 12.3% to 15.5% (P =.003). The only decrease involved is bloodstream infections (from 2% to 1%). Independent risk factors significantly associated with HAI were undergoing surgical intervention (aOR = 1.7), the use of antibiotic treatment in previous 6 months (aOR = 1.8), peripheral line (aOR=2), parenteral nutrition (aOR=2.4), urinary tract within 7 days (aOR=2.4), central line (aOR = 6.3), and prosthesis (aOR = 12.8), length of stay (aOR = 3), and the year of the survey. Young age was found as protective factor (aOR = .98). CONCLUSION: Contrary to what was expected, we noticed an increase in the HAIs rates despite the preventive measures put in place to control the COVID-19 pandemic. This was partly explained by the vulnerability of hospitalized patients during this period.


Asunto(s)
COVID-19 , Adulto , Anciano , Atención a la Salud , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Pandemias , SARS-CoV-2 , Estados Unidos
15.
J Prev Med Hyg ; 62(3): E751-E758, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34909504

RESUMEN

Introduction: In case of a contamination of water-supplying systems in hospitals with legionella, usually chemical disinfection measures are used for remediation. Unfortunately, it is reported, that these methods may not be sustainable, have an impact on water quality, and can even fail. As an alternative, the superheat and flush method does not need any special equipment, can be initiated in a short lead of time and does not affect the water quality. However, evidence on this disinfection measurement against legionella is lacking. We therefore investigated and report on the effectiveness and long-term results of the superheat and flush disinfection method. Methods: During routine periodical examinations, a rising count of legionella was detected in the cold-water supplying system at a German university hospital. Adapted to an analysis of risks, effort and benefit, the superheat and flush procedure was applied twice within 6 months. Results: While 33 out of 70 samples had a higher legionella count than the legal threshold of 100 CFU/100 mL (CFU - Colony Forming Units) before the first disinfection was carried out, this number could be reduced to 1 out of 202 samples after the first intervention. Additionally, in contrast to previously published studies, the effect was long-lasting, as no relevant limit exceedance occurred during the following observation period of more than two years. Conclusion: The superheat and flush disinfection can provide an economic and highly effective measure in case of legionella contamination and should be shortlisted for an eradication attempt of affected water-supplying systems in hospitals.


Asunto(s)
Infección Hospitalaria , Legionella pneumophila , Legionella , Enfermedad de los Legionarios , Infección Hospitalaria/prevención & control , Desinfección , Hospitales Universitarios , Humanos , Microbiología del Agua , Abastecimiento de Agua
16.
Cien Saude Colet ; 26(12): 5935-5944, 2021 Dec.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-34909986

RESUMEN

The transport of patients by ambulance is part of the services offered by a Hospital and its importance lies in facilitating the connection between the institutes involved in patient care. However, a significant amount of complaints about irritability and aggressiveness of drivers was registered after a strategic change in the organizational structure that directly affected these professionals. This study aimed to survey the health issues of ambulance drivers at this hospital, from the reorganization of work, through an ergonomic analysis of work. The data were obtained through observation and interviews with managers, leaders, and drivers of the transport sector of the hospital. The main results found were: 1) the key performance measurement is time, which is a measure that does not consider all variabilities that occur during transport, 2) prescribed work of drivers only considers the task of driving an ambulance, while their real work includes taking care and paying attention to the needs of the patient and other professionals, 3) after the restructuring and centralization of the transport sector, drivers stopped feeling as part of the team of health professionals and started to feel like a "shared service".


Asunto(s)
Ambulancias , Conducción de Automóvil , Hospitales Universitarios , Humanos , Organizaciones , Encuestas y Cuestionarios
17.
PLoS One ; 16(12): e0261024, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34936655

RESUMEN

BACKGROUND: Tracheostomy has been proposed as an option to help organize the healthcare system to face the unprecedented number of patients hospitalized for a COVID-19-related acute respiratory distress syndrome (ARDS) in intensive care units (ICU). It is, however, considered a particularly high-risk procedure for contamination. This paper aims to provide our experience in performing tracheostomies on COVID-19 critically ill patients during the pandemic and its long-term local complications. METHODS: We performed a retrospective analysis of prospectively collected data of patients tracheostomized for a COVID-19-related ARDS in two university hospitals in the Paris region between January 27th (date of first COVID-19 admission) and May 18th, 2020 (date of last tracheostomy performed). We focused on tracheostomy technique (percutaneous versus surgical), timing (early versus late) and late complications. RESULTS: Forty-eight tracheostomies were performed with an equal division between surgical and percutaneous techniques. There was no difference in patients' characteristics between surgical and percutaneous groups. Tracheostomy was performed after a median of 17 [12-22] days of mechanical ventilation (MV), with 10 patients in the "early" group (≤ day 10) and 38 patients in the "late" group (> day 10). Survivors required MV for a median of 32 [22-41] days and were ultimately decannulated with a median of 21 [15-34] days spent on cannula. Patients in the early group had shorter ICU and hospital stays (respectively 15 [12-19] versus 35 [25-47] days; p = 0.002, and 21 [16-28] versus 54 [35-72] days; p = 0.002) and spent less time on MV (respectively 17 [14-20] and 35 [27-43] days; p<0.001). Interestingly, patients in the percutaneous group had shorter hospital and rehabilitation center stays (respectively 44 [34-81] versus 92 [61-118] days; p = 0.012, and 24 [11-38] versus 45 [22-71] days; p = 0.045). Of the 30 (67%) patients examined by a head and neck surgeon, 17 (57%) had complications with unilateral laryngeal palsy (n = 5) being the most prevalent. CONCLUSIONS: Tracheostomy seems to be a safe procedure that could help ICU organization by delegating work to a separate team and favoring patient turnover by allowing faster transfer to step-down units. Following guidelines alone was found sufficient to prevent the risk of aerosolization and contamination of healthcare professionals.


Asunto(s)
COVID-19/cirugía , Traqueostomía/métodos , Anciano , COVID-19/mortalidad , COVID-19/terapia , Cuidados Críticos/métodos , Femenino , Estudios de Seguimiento , Hospitales Universitarios , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Paris , Personal de Hospital , Respiración Artificial , Estudios Retrospectivos , Traqueostomía/efectos adversos , Resultado del Tratamiento
18.
Eur Rev Med Pharmacol Sci ; 25(23): 7268-7271, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34919225

RESUMEN

OBJECTIVE: The COVID-19 pandemic has severely affected otolaryngology and head and neck activities, also involving diagnosis and treatment of patients with oncology diseases with consequent delays and tumor upstaging. The aim of this study was to describe the experience of our otolaryngology unit during the pandemic on patients with cancer of the head and neck, comparing data on anatomical site of origin and preferred treatment with pre-pandemic data. PATIENTS AND METHODS: This study retrospectively analyzed the clinical records of patients treated for oncology disorders of the head and neck in the Otolaryngology Unit of the Policlinico Umberto I, Sapienza University of Rome, between March 10, 2020, and March 9, 2021. Data were compared with the same period of the previous year (March 10, 2019 - March 9, 2020). RESULTS: During the pandemic, we treated 92 patients with malignant tumor of the head and neck, compared to 101 patients treated during the same period of 2019 (-8.91%). The most common anatomical sites of origin of the neoplasms were larynx, oral cavity, and oropharynx. Surgical approach was preferred in 57 patients (61.95%); non-surgical treatments were performed in 35 cases (38.05%). Compared to the same period of the previous year, we found a 12.90% decrease in the number of oncology patients undergoing surgery, while patients treated exclusively with non-surgical approaches increased by 18.42%. CONCLUSIONS: Despite the impact of COVID-19 on the activity of our otolaryngology unit and on the whole healthcare system, diagnostic and therapeutic procedures for patients affected by malignancy of head and neck region were only minimally impacted.


Asunto(s)
COVID-19/epidemiología , Quimioterapia/estadística & datos numéricos , Neoplasias de Cabeza y Cuello/terapia , Procedimientos Quirúrgicos Otorrinolaringológicos/estadística & datos numéricos , Radioterapia/estadística & datos numéricos , Diagnóstico Tardío , Neoplasias de Cabeza y Cuello/clasificación , Hospitales Universitarios , Humanos , Masculino , Oncología Médica , Prioridad del Paciente , Estudios Retrospectivos , Tiempo de Tratamiento
19.
Rev. colomb. anestesiol ; 49(4): e300, Oct.-Dec. 2021. tab, graf
Artículo en Inglés | LILACS, COLNAL | ID: biblio-1341239

RESUMEN

Abstract Introduction A broad range of practices aimed at improving the effectives and safety of this process have been documented over the past few years. Objective To establish the effectiveness, safety and results of the implementation of these strategies in adult patients in university hospitals. Methodology A review of systematic reviews was conducted, in addition to a database search in the Cochrane Library of Systematic Reviews, Embase, Epistemonikos, LILACS and gray literature. Any strategy aimed at reducing prescription-associated risks was included as intervention. This review followed the protocol registered in the International Prospective Registry of Systematic Reviews (PROSPERO): CRD42020165143. Results 7,637 studies were identified, upon deleting duplicate references. After excluding records based on titles and abstracts, 111 full texts were assessed for eligibility. Fifteen studies were included in the review. Several interventions grouped into 5 strategies addressed to the prescription process were identified; the use of computerized medical order entry systems (CPOE), whether integrated or not with computerized decision support systems (CDSS), was the most effective approach. Conclusions The beneficial effects of the interventions intended to the prescription process in terms of efficacy were identified; however, safety and implementation results were not thoroughly assessed. The heterogeneity of the studies and the low quality of the reviews, preclude a meta-analysis.


Resumen Introducción En los últimos años se han documentado gran variedad de prácticas dirigidas a mejorar la efectividad y la seguridad de este proceso. Objetivo Establecer la efectividad, seguridad y resultados de implementación de estas estrategias en pacientes adultos en hospitales universitarios. Metodología Se realizó una revisión de revisiones sistemáticas. Igualmente, la búsqueda en las bases de datos de la Biblioteca Cochrane de Revisiones Sistemáticas, Medline, Embase, Epistemonikos, LILACS y literatura gris. Se incluyó como intervención cualquier estrategia dirigida a reducir el riesgo asociado a un error de prescripción. Esta revisión siguió el protocolo registrado en el Registro Prospectivo Internacional de Revisiones Sistemáticas (PROSPERO): CRD42020165143. Resultados Se identificaron 7.637 estudios después de eliminar las referencias duplicadas. Después de la exclusión de registros basados en títulos y resúmenes, se evaluaron 111 textos completos para elegibilidad. Se incluyeron quince estudios en la revisión. Se identificaron varias intervenciones agrupadas en 5 estrategias dirigidas al proceso de prescripción, de las cuales el uso de sistemas computarizados de entrada de órdenes médicas (CPOE) integrados o no a sistemas de soporte de decisión computarizados (CDSS) la estrategia más eficaz. Conclusiones Se identificaron efectos benéficos de las intervenciones dirigidas al proceso de prescripción en términos de eficacia; sin embargo, la seguridad y los resultados de implementación no fueron ampliamente evaluados. La heterogeneidad de los estudios y la baja calidad de las revisiones impiden la realización de un metaanálisis.


Asunto(s)
Humanos , Adulto , Persona de Mediana Edad , Anciano , Prescripciones de Medicamentos , Servicios Preventivos de Salud , Hospitales Universitarios , Errores de Medicación , Evaluación de Resultado en la Atención de Salud , Errores Médicos , Prescripción Electrónica , Prescripción Inadecuada
20.
BMC Infect Dis ; 21(1): 1196, 2021 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-34837973

RESUMEN

BACKGROUND: Carbapenem resistant (CR) Klebsiella pneumoniae (Kp) and Acinetobacter baumannii (Ab) are emerging multidrug resistant bacteria with very limited treatment options in case of infection. Both are well-known causes of nosocomial infections and outbreaks in healthcare facilities. METHODS: A retrospective study was conducted to investigate the epidemiology of inpatients with CR Kp and CR Ab in a 1500-bed German university hospital from 2015 to 2019. We present our infection control concept including a weekly microbiologic screening for patients who shared the ward with a CR Kp or CR Ab index patient. RESULTS: Within 5 years, 141 CR Kp and 60 CR Ab cases were hospitalized corresponding to 118 unique patients (74 patients with CR Kp, 39 patients with CR Ab and 5 patients with both CR Ab and CR Kp). The mean incidence was 0.045 (CR Kp) and 0.019 (CR Ab) per 100 inpatient cases, respectively. Nosocomial acquisition occurred in 53 cases (37.6%) of the CR Kp group and in 12 cases (20.0%) of the CR Ab group. Clinical infection occurred in 24 cases (17.0%) of the CR Kp group and in 21 cases (35.0%) of the CR Ab group. 14 cases (9.9%) of the CR Kp group and 29 cases (48.3%) of the CR Ab group had a history of a hospital stay abroad within 12 months prior to admission to our hospital. The weekly microbiologic screening revealed 4 CR Kp cases caused by nosocomial transmission that would have been missed without repetitive screening. CONCLUSIONS: CR Kp and CR Ab cases occurred infrequently. A history of a hospital stay abroad, particularly in the CR Ab group, warrants pre-emptive infection control measures. The weekly microbiologic screening needs further evaluation in terms of its efficiency.


Asunto(s)
Acinetobacter baumannii , Infecciones por Klebsiella , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Carbapenémicos/farmacología , Carbapenémicos/uso terapéutico , Hospitales Universitarios , Humanos , Control de Infecciones , Infecciones por Klebsiella/tratamiento farmacológico , Infecciones por Klebsiella/epidemiología , Klebsiella pneumoniae , Estudios Retrospectivos
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