Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.688
Filtrar
2.
Washington; Organización Panamericana de la Salud; feb. 19, 2021. 5 p.
No convencional en Inglés, Español | LILACS | ID: biblio-1150950

RESUMEN

Proporcionar condiciones térmicas y sistemas de ventilación adecuados que eviten la dispersión de patógenos es fundamental para proteger la salud de los pacientes, de los profesionales médicos y de enfermería, y del resto del personal, así como para el funcionamiento general de los equipos sensibles. Esta segunda versión presenta recomendaciones generales para evitar la transmisión del SARS-CoV-2 a través de sistemas de calefacción, ventilación y aire acondicionado en establecimientos de salud.


Providing adequate thermal conditions and ventilation systems that prevent the dispersion of pathogens, is fundamental to protect the health of patients, caregivers and staff, and to the overall operation of sensitive equipment. This technical note presents general recommendations to prevent the transmission of SARS-CoV-2 through heating, ventilation, and air conditioning systems in ​health care facilities.


Asunto(s)
Humanos , Neumonía Viral/prevención & control , Control de la Calidad del Aire , Infecciones por Coronavirus/prevención & control , Aire Acondicionado/normas , Pandemias/prevención & control , Filtros de Aire/normas , Betacoronavirus , Hospitales/normas
3.
Am J Nurs ; 121(3): 48-52, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33625011

RESUMEN

ABSTRACT: This article describes the case of a chronically ill patient whose care was grossly mismanaged as a result of the policies and practices of a dysfunctional health system. This case illustrates the importance of truly listening to patients and communicating effectively with colleagues within the health care system. It also discusses appropriate steps for the practice of patient-centered care, including a reevaluation of late arrival policies at hospitals and clinics.


Asunto(s)
Neoplasias de la Mama Masculina/diagnóstico , Enfermedad Crónica , Prestación de Atención de Salud/normas , Hernia Abdominal/cirugía , Atención Dirigida al Paciente , Infecciones Urinarias/tratamiento farmacológico , Anciano , Hospitales/normas , Humanos , Masculino , Enfermeras Practicantes
4.
JAMA Netw Open ; 4(2): e2037320, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33595661

RESUMEN

Importance: The Hospital Readmissions Reduction Program publicly reports and financially penalizes hospitals according to 30-day risk-standardized readmission rates (RSRRs) exclusively among traditional Medicare (TM) beneficiaries but not persons with Medicare Advantage (MA) coverage. Exclusively reporting readmission rates for the TM population may not accurately reflect hospitals' readmission rates for older adults. Objective: To examine how inclusion of MA patients in hospitals' performance is associated with readmission measures and eligibility for financial penalties. Design, Setting, and Participants: This is a retrospective cohort study linking the Medicare Provider Analysis and Review file with the Healthcare Effectiveness Data and Information Set at 4070 US acute care hospitals admitting both TM and MA patients. Participants included patients admitted and discharged alive with a diagnosis of acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia between 2011 and 2015. Data analyses were conducted between April 1, 2018, and November 20, 2020. Exposures: Admission to an acute care hospital. Main Outcomes and Measures: The outcome was readmission for any reason occurring within 30 days after discharge. Each hospital's 30-day RSRR was computed on the basis of TM, MA, and all patients and estimated changes in hospitals' performance and eligibility for financial penalties after including MA beneficiaries for calculating 30-day RSRRs. Results: There were 748 033 TM patients (mean [SD] age, 76.8 [83] years; 360 692 [48.2%] women) and 295 928 MA patients (mean [SD] age, 77.5 [7.9] years; 137 422 [46.4%] women) hospitalized and discharged alive for AMI; 1 327 551 TM patients (mean [SD] age, 81 [8.3] years; 735 855 [55.4%] women) and 457 341 MA patients (mean [SD] age, 79.8 [8.1] years; 243 503 [53.2%] women) for CHF; and 2 017 020 TM patients (mean [SD] age, 80.7 [8.5] years; 1 097 151 [54.4%] women) and 610 790 MA patients (mean [SD] age, 79.6 [8.2] years; 321 350 [52.6%] women) for pneumonia. The 30-day RSRRs for TM and MA patients were correlated (correlation coefficients, 0.31 for AMI, 0.40 for CHF, and 0.41 for pneumonia) and the TM-based RSRR systematically underestimated the RSRR for all Medicare patients for each condition. Of the 2820 hospitals with 25 or more admissions for at least 1 of the outcomes of AMI, CHF, and pneumonia, 635 (23%) had a change in their penalty status for at least 1 of these conditions after including MA data. Changes in hospital performance and penalty status with the inclusion of MA patients were greater for hospitals in the highest quartile of MA admissions. Conclusions and Relevance: In this cohort study, the inclusion of data from MA patients changed the penalty status of a substantial fraction of US hospitals for at least 1 of 3 reported conditions. This suggests that policy makers should consider including all hospital patients, regardless of insurance status, when assessing hospital quality measures.


Asunto(s)
Hospitales/normas , Readmisión del Paciente/estadística & datos numéricos , Garantía de la Calidad de Atención de Salud/métodos , Indicadores de Calidad de la Atención de Salud , Anciano , Anciano de 80 o más Años , Centers for Medicare and Medicaid Services, U.S. , Femenino , Insuficiencia Cardíaca/terapia , Hospitalización , Humanos , Seguro de Salud , Masculino , Medicare , Medicare Part C , Infarto del Miocardio/terapia , Neumonía/terapia , Formulación de Políticas , Ajuste de Riesgo , Estados Unidos
5.
BMC Infect Dis ; 21(1): 212, 2021 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-33632137

RESUMEN

BACKGROUND: Healthcare-associated infections (HAIs) are relevant in developing countries where frequencies can be at least 3 times higher than in developed countries. The purpose of this research was to describe the intervention implemented in intensive care units (ICUs) to reduce HAIs through collaborative project and analyze the variation over 18 months in the incidence density (ID) of the three main HAIs: ventilator associated pneumonia (VAP), central line-associated bloodstream infections (CLABSIs) and catheter-related urinary tract infections (CAUTIs) and also the length of stay and mortality in these ICUs. METHODS: A quasi-experimental study in five public adult clinical-surgical ICUs, to reduce HAIs, through interventions using the BTS-IHI "Improvement Model", during 18 months. In the project, promoted by the Ministry of Health, Brazilian philanthropic hospitals certified for excellence (HE), those mostly private, certified as excellence and exempt from security contributions, regularly trained and monitored public hospitals in diagnostics, data collection and in developing cycles to improve quality and to prevent HAIs (bundles). In the analysis regarding the length of stay, mortality, the IDs of VAP, CLABSIs and CAUTIs over time, a Generalized Estimating Equation (GEE) model was applied for continuous variables, using the constant correlation (exchangeable) between assessments over time. The model estimated the average difference (ß coefficient of the model) of the measures analyzed during two periods: a period in the year 2017 (prior to implementing the project) and in the years 2018 and 2019 (during the project). RESULT: A mean monthly reduction of 0.427 in VAP ID (p = 0.002) with 33.8% decrease at the end of the period and 0.351 in CAUTI ID (p = 0.009) with 45% final decrease. The mean monthly reduction of 0.252 for CLABSIs was not significant (p = 0.068). Length of stay and mortality rates had no significant variation. CONCLUSIONS: Given the success in reducing VAP and CAUTIs in a few months of interventions, the achievement of the collaborative project is evident. This partnership among public hospitals/HE may be applied to other ICUs including countries with fewer resources.


Asunto(s)
Infección Hospitalaria/prevención & control , Hospitales/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Asociación entre el Sector Público-Privado/estadística & datos numéricos , Adulto , Brasil/epidemiología , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/prevención & control , Infección Hospitalaria/epidemiología , Hospitales/normas , Humanos , Incidencia , Unidades de Cuidados Intensivos/normas , Neumonía Asociada al Ventilador/epidemiología , Neumonía Asociada al Ventilador/prevención & control , Asociación entre el Sector Público-Privado/organización & administración , Asociación entre el Sector Público-Privado/normas
6.
J Med Internet Res ; 23(3): e24804, 2021 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-33617458

RESUMEN

BACKGROUND: The COVID-19 pandemic poses a major challenge to people's everyday lives. In the context of hospitalization, the pandemic is expected to have a strong influence on affective reactions and preventive behaviors. Research is needed to develop evidence-driven strategies for coping with the challenges of the pandemic. Therefore, this survey study investigates the effects that personality traits, risk-taking behaviors, and anxiety have on medical service-related affective reactions and anticipated behaviors during the COVID-19 pandemic. OBJECTIVE: The aim of this study was to identify key factors that are associated with individuals' concerns about hygiene in hospitals and the postponement of surgeries. METHODS: We conducted a cross-sectional, web-based survey of 929 residents in Germany (women: 792/929, 85.3%; age: mean 35.2 years, SD 12.9 years). Hypotheses were tested by conducting a saturated path analysis. RESULTS: We found that anxiety had a direct effect on people's concerns about safety (ß=-.12, 95% CI -.20 to -.05) and hygiene in hospitals (ß=.16, 95% CI .08 to .23). Risk-taking behaviors and personality traits were not associated with concerns about safety and hygiene in hospitals or anticipated behaviors. CONCLUSIONS: Our findings suggest that distinct interventions and information campaigns are not necessary for individuals with different personality traits or different levels of risk-taking behavior. However, we recommend that health care workers should carefully address anxiety when interacting with patients.


Asunto(s)
/psicología , Hospitales/normas , Higiene/normas , Adulto , Estudios Transversales , Femenino , Humanos , Internet , Masculino , Pandemias , Encuestas y Cuestionarios
8.
Medicine (Baltimore) ; 100(1): e23676, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33429734

RESUMEN

INTRODUCTION: Ischemic stroke caused by arterial occlusion is the cause of most strokes. The focus of treatment is rapid reperfusion through intravenous thrombolysis and intravascular thrombectomy. Two acute stroke management including prehospital thrombolysis and in hospital have been widely used clinically to treat ischemic stroke with satisfied efficacy. However, there is no systematic review comparing the effectiveness of these 2 therapies. The aim of this study is to compare the effect of prehospital thrombolysis versus in hospital for patients with ischemic stroke. METHODS AND ANALYSIS: The following electronic databases will be searched: Web of Science, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Wanfang Database, and Chinese Scientific Journal Database.The randomized controlled trials of prehospital thrombolysis versus in hospital for ischemic stroke will be searched in the databases from their inception to December 2020 by 2 researchers independently. Onset to therapy (OTT) duration and National Institute Health Stroke Scale (NIHSS) scores will be assessed as the primary outcomes; safety assessment including intracerebral hemorrhage (ICH) and mortality will be assessed as the secondary outcomes. The Review Manager 5.3 will be used for meta-analysis and the evidence level will be assessed by using the method for Grading of Recommendations Assessment, Development and evaluation Continuous outcomes will be presented as the weighted mean difference or standardized mean difference with 95% confidence interval (CI), whereas dichotomous data will be expressed as relative risk with 95% CI. If heterogeneity existed (P < .05), the random effect model was used. Otherwise, we will use the fixed effect model for calculation. ETHICS AND DISSEMINATION: Ethical approval is not required because no primary data are collected. This review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020200708.


Asunto(s)
Protocolos Clínicos , Hospitales/normas , Unidades Móviles de Salud/normas , Terapia Trombolítica/normas , Hospitales/estadística & datos numéricos , Humanos , Metaanálisis como Asunto , Unidades Móviles de Salud/organización & administración , Unidades Móviles de Salud/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto , Revisiones Sistemáticas como Asunto , Terapia Trombolítica/métodos , Terapia Trombolítica/estadística & datos numéricos
9.
Am J Nurs ; 121(2): 18, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33497116
10.
J Patient Saf ; 17(2): 122-130, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33480644

RESUMEN

OBJECTIVES: The aim of this study was to explore if, and in what ways, there has been changes in the supervisory approach toward Norwegian hospitals due to the implementation of a new management and quality improvement regulation (Regulation on Management and Quality Improvement in the Healthcare Services, hereinafter referred to as "Quality Improvement Regulation"). Moreover, we aimed to understand how inspectors' work promotes or hampers resilience potentials of adaptive capacity and learning in hospitals. METHODS: The study design is a case study of implementation and impact of the Quality Improvement Regulation. We performed a document analysis, and conducted and analyzed 3 focus groups and 2 individual interviews with regulatory inspectors, recruited from 3 county governor offices who are responsible for implementation and supervision of the Quality Improvement Regulation in Norwegian regions. RESULTS: Data analysis resulted in 5 themes. Informants described no substantial change in their approach owing to the Quality Improvement Regulation. Regardless, data pointed to a development in their practices and expectations. Although the Norwegian Board of Health Supervision, at the national level, occasionally provides guidance, supervision is adapted to specific contexts and inspectors balance trade-offs. Informants expressed concern about the impact of supervision on hospital performance. Benefits and disadvantage with positive feedback from inspectors were debated. Inspectors could nurture learning by improving their follow-up and add more hospital self-assessment. CONCLUSIONS: A nondetailed regulatory framework such as the Quality Improvement Regulation provides hospitals with room to maneuver, and self-assessment might reduce resource demands. The impact of supervision is scarce with an unfulfilled potential to learn from supervision. The Government could contribute to a shift in focus by instructing the county governors to actively reflect on and communicate positive experiences from, and smart adaptations in, hospital practice.


Asunto(s)
Administración Hospitalaria/normas , Hospitales/normas , Mejoramiento de la Calidad/normas , Humanos
12.
Med Care ; 59(1): 6-12, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32925454

RESUMEN

BACKGROUND: US hospitals are penalized for excess 30-day readmissions and mortality for select conditions. Under the Centers for Medicare and Medicaid Services policy, readmission prevention is incentivized to a greater extent than mortality reduction. A strategy to potentially improve hospital performance on either measure is by improving nursing care, as nurses provide the largest amount of direct patient care. However, little is known as to whether achieving nursing excellence, such as Magnet status, is associated with improved hospital performance on readmissions and mortality. OBJECTIVE: The purpose of this study was to examine the relationship between hospitals' Magnet status and performance on readmission and mortality rates for Medicare beneficiaries. RESEARCH DESIGN: This is a cross-sectional analysis of Medicare readmissions and mortality reduction programs from 2013 to 2016. A propensity score-matching approach was used to take into account differences in baseline characteristics when comparing Magnet and non-Magnet hospitals. SUBJECTS: The sample was comprised of 3877 hospitals. MEASURES: The outcome measures were 30-day risk-standardized readmission and mortality rates. RESULTS: Following propensity score matching on hospital characteristics, we found that Magnet hospitals outperformed non-Magnet hospitals in reducing mortality; however, Magnet hospitals performed worse in reducing readmissions for acute myocardial infarction, coronary artery bypass grafting, and stroke. CONCLUSIONS: Magnet hospitals performed better on the Hospital Value-Based Purchasing Mortality Program than the Hospital Readmissions Reduction Program. The results of this study suggest the need for The Magnet Recognition Program to examine the role of nurses in postdischarge activities as a component of its evaluation criteria.


Asunto(s)
Hospitales/normas , Medicare , Mortalidad/tendencias , Infarto del Miocardio/epidemiología , Readmisión del Paciente/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud/normas , Accidente Cerebrovascular/epidemiología , Estudios Transversales , Hospitales/estadística & datos numéricos , Humanos , Medicare/economía , Medicare/estadística & datos numéricos , Infarto del Miocardio/mortalidad , Alta del Paciente , Readmisión del Paciente/tendencias , Accidente Cerebrovascular/mortalidad , Estados Unidos/epidemiología , Compra Basada en Calidad/organización & administración , Compra Basada en Calidad/normas
13.
Am J Infect Control ; 49(4): 489-491, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33321131

RESUMEN

During the COVID-19 crisis, disposable N-95 filtering face piece respirators became a critical supply in many health care institutions. Infection preventionists nationwide struggled with ensuring their facilities had personal protective equipment available while utilizing crisis capacity strategies. Many facilities began using US Centers for Disease Control and Prevention and US Food and Drug Administration guidance to disinfect and reprocess N95 respirators for extended use. N95 respirators are collected for all clinical units on a scheduled basis by the sterile processing department (SPD) in individually labeled bins. Bins are checked into SPD and logged into electronic system to track mask volumes by unit. Masks are inspected by SPD team members, packaged in sterile peel packs on the decontamination side and sent to the clean side of the department. Masks are then reprocessed in the appropriate equipment based on the US Food and Drug Administration Emergency Use Authorization guidelines. The facility was able to provide a consistent method of N95 reprocessing throughout the facility. Utilizing an interdisciplinary team to include the operating room, infection preventionist, SPD, and nursing leadership to troubleshoot and identify barriers on a routine basis was key to making the program a success for the many months of the COVID-19 pandemic.


Asunto(s)
/prevención & control , Desinfección/métodos , Departamentos de Hospitales/organización & administración , Hospitales/normas , /normas , Descontaminación , Equipo Reutilizado/normas , Humanos
14.
Medicine (Baltimore) ; 99(52): e23942, 2020 Dec 24.
Artículo en Inglés | MEDLINE | ID: mdl-33350799

RESUMEN

ABSTRACT: The levels of indoor air pollutants are increasing. However, the indoor air quality of only operating rooms, intensive care units, and radiology departments is usually monitored in hospitals. Hence, we aimed to evaluate the indoor air quality of an otorhinolaryngology outpatient clinic and compare air quality indices among different areas in a hospital.We prospectively measured indoor air quality using air quality sensors in different areas of a hospital from February 1, 2019 to January 31, 2020. Carbon dioxide (CO2), total volatile organic compounds (VOCs), particulate matter with diameter of <2.5 µm (PM2.5), and nitrogen dioxide concentrations were measured in the otorhinolaryngology clinic, orthopedic clinic, and reception area. The intervention efficacy was compared between otorhinolaryngology clinics employing and not employing air-cleaners.The overall concentrations of CO2, VOCs, and PM2.5 in the otorhinolaryngology clinic were significantly higher than those in the orthopedic clinic or reception area. The indoor air quality was the worst in winter. The intervention effect was observed only in PM2.5 concentrations in otorhinolaryngology clinics employing an air-cleaner.Medical practitioners and patients are frequently exposed to ambient indoor air pollution in otorhinolaryngology clinics. Hence, health-related strategies to protect against ambient indoor air pollution in otorhinolaryngology clinics are warranted.


Asunto(s)
Contaminación del Aire Interior/análisis , Contaminación del Aire/análisis , Instituciones de Atención Ambulatoria , Dióxido de Carbono/análisis , Hospitales , Dióxido de Nitrógeno/análisis , Otolaringología , Compuestos Orgánicos Volátiles/análisis , Contaminantes Atmosféricos , Instituciones de Atención Ambulatoria/normas , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Monitoreo del Ambiente/métodos , Hospitales/normas , Hospitales/estadística & datos numéricos , Humanos , Evaluación de Necesidades , Estaciones del Año
15.
Farm. hosp ; 44(6): 272-278, nov.-dic. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-197695

RESUMEN

OBJETIVO: La Comisión de Farmacia y Terapéutica, como órgano asesor de la Dirección Médica del hospital y bajo las condiciones del Real Decreto 86/2015, por el que se regula la Comisión de Farmacoterapéutica de las Islas Baleares, elabora un informe técnico donde evalúa la posibilidad de empleo interno de medicamentos off-label, uso compasivo y medicamentos no incluidos en la Guía Farmacoterapéutica del hospital. Asimismo, esta comisión realiza un seguimiento prospectivo de cada una de las solicitudes. El objetivo fue analizar la respuesta clínica alcanzada con el empleo de estos medicamentos, así como el coste asociado. MÉTODO: Estudio retrospectivo de los medicamentos solicitados a la Comisión de Farmacia y Terapéutica del hospital entre enero y diciembre de 2018. Se analizó si con cada tratamiento solicitado se alcanzó el objetivo propuesto por el clínico. Para el cálculo del coste se consideró la duración del tratamiento hasta alcanzar el objetivo propuesto o hasta su interrupción. RESULTADOS: De un total de 70 solicitudes analizadas, un 59% alcanzaron el objetivo terapéutico esperado, un 34% fueron consideradas como fracaso terapéutico y hubo un 7% de pérdidas de seguimiento. El coste de las 70 peticiones fue de 1.140.240 (Euro). La media de coste por solicitud fue de 16.288 (Euro). Más del 50% de las solicitudes fueron realizadas por los servicios de oncología y hematología y más del 75% del presupuesto fue destinado a estos dos servicios. CONCLUSIONES: Más de la mitad de los tratamientos considerados por la Comisión de Farmacia y Terapéutica del hospital alcanzan la finalidad terapéutica deseada, si bien el impacto económico de su empleo es elevado


OBJECTIVE: The Pharmacy and Therapeutics Committee is an advisory body to the medical management of our hospital. Following Royal Decree 86/2015, which regulates the Pharmacy and Therapeutics Committee of the Balearic Islands, this committee prepared a technical report in which it assessed the possible internal use of off-label drugs, drugs for compassionate use, and drugs not included in the hospital's pharmacotherapeutic guide. The objective was to analyse the clinical response achieved with the use of these drugs and their associated costs. METHOD: Retrospective study of drugs whose use was requested from the hospital's Pharmacy and Therapeutics Committee hospital between January and December 2018. We analysed whether the requested treatment achieved the objective established by the physician. The cost was calculated based on the duration of the treatment until the objective was achieved or until treatment was discontinued. RESULTS: In total, 70 requests were analysed: 59% achieved the expected therapeutic goal, 34% were considered to be therapeutic failures, and 7% were lost to follow-up. The overall cost of the 70 authorized treatments was (Euro)1,140,240. The average cost per request was (Euro)16,288. Oncology and Haematology services submitted more than 50% of the requests, and more than 75% of the budget was allocated to these medical services. CONCLUSIONS: More than half of the treatments analysed by the Pharmacy and Therapeutics Committee of the hospital achieved their therapeutic goal, although the economic cost of their use was high


Asunto(s)
Humanos , Preparaciones Farmacéuticas/economía , Resultado del Tratamiento , Análisis Costo-Beneficio/economía , Hospitales/normas , Ensayos de Uso Compasivo/métodos , Auditoría Clínica/legislación & jurisprudencia , Auditoría Clínica/normas , Estudios Retrospectivos
16.
J Glob Health ; 10(2): 020507, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33110590

RESUMEN

Background: In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide. Methods: During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, <100). Results: A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%; P < 0.001). Of the 295 centers that experienced in-hospital COVID-19 infection, 122 (41.4%) failed to trace it and 58 (19.7%) reported the infection originating from asymptomatic patients/staff members. Higher risk countries adopted more preventive measures including universal testing, routine testing of hospital staff and use of dedicated personal protective equipment in operation theatres, but there were remarkable discrepancies across the countries. Conclusions: This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions. Study registration: Registered in ClinicalTrials.gov: NCT04344197.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Infección Hospitalaria/prevención & control , Control de Infecciones/estadística & datos numéricos , Tamizaje Masivo/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Pautas de la Práctica en Medicina/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/normas , Betacoronavirus , Infecciones por Coronavirus/transmisión , Infección Hospitalaria/virología , Estudios Transversales , Hospitales/normas , Hospitales/estadística & datos numéricos , Humanos , Control de Infecciones/normas , Tamizaje Masivo/normas , Neumonía Viral/transmisión , Políticas , Pautas de la Práctica en Medicina/normas , Procedimientos Quirúrgicos Operativos/efectos adversos , Encuestas y Cuestionarios
17.
PLoS Comput Biol ; 16(10): e1008388, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33057438

RESUMEN

A stochastic compartmental network model of SARS-CoV-2 spread explores the simultaneous effects of policy choices in three domains: social distancing, hospital triaging, and testing. Considering policy domains together provides insight into how different policy decisions interact. The model incorporates important characteristics of COVID-19, the disease caused by SARS-CoV-2, such as heterogeneous risk factors and asymptomatic transmission, and enables a reliable qualitative comparison of policy choices despite the current uncertainty in key virus and disease parameters. Results suggest possible refinements to current policies, including emphasizing the need to reduce random encounters more than personal contacts, and testing low-risk symptomatic individuals before high-risk symptomatic individuals. The strength of social distancing of symptomatic individuals affects the degree to which asymptomatic cases drive the epidemic as well as the level of population-wide contact reduction needed to keep hospitals below capacity. The relative importance of testing and triaging also depends on the overall level of social distancing.


Asunto(s)
Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Pandemias/prevención & control , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Aislamiento Social , Betacoronavirus , Técnicas de Laboratorio Clínico/normas , Control de Enfermedades Transmisibles , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Servicio de Urgencia en Hospital , Hospitales/normas , Humanos , Modelos Teóricos , Neumonía Viral/epidemiología , Políticas , Factores de Riesgo
18.
Curr Med Sci ; 40(5): 985-988, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32980900

RESUMEN

At the end of 2019, the novel coronavirus infection outbroke in Wuhan, Hubei Province. On Feb. 2, 2020, Wuhan, as the worst-hit region, began to build "shelter hospital" rapidly to treat patients with mild illness. The shelter hospital has multiple functions such as emergency treatment, surgical treatment and clinical test, which can adapt to emergency medical rescue tasks. Based on the characteristics that shelter hospital only treats patients with mild illness, tests of shelter laboratory, including coronavirus nucleic acid detection, IgM/IgG antibody serology detection, monitoring and auxiliary diagnosis and/or a required blood routine, urine routine, C-reactive protein, calcitonin original, biochemical indicators (liver enzymes, myocardial enzymes, renal function, etc.) and blood coagulation function test etc, were used to provide important basis for the diagnosis and treatment of the disease. In order to ensure laboratory biosafety, it is necessary to first evaluate the harm level of various specimens. In the laboratory biosafety management, the harm level assessment of microorganisms is the core work of biosafety, which is of great significance to guarantee biosafety. As an emergency deployment affected by the environment, shelter laboratory must possess strong mobility. This paper will explore how to combine the biosafety model of traditional laboratory with the particularity of shelter laboratory to carry out effective work in response to the current epidemic.


Asunto(s)
Betacoronavirus/patogenicidad , Contención de Riesgos Biológicos/métodos , Infecciones por Coronavirus/virología , Neumonía Viral/virología , China , Contención de Riesgos Biológicos/instrumentación , Brotes de Enfermedades/prevención & control , Hospitales/normas , Humanos , Pandemias
19.
PLoS One ; 15(9): e0239159, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32956378

RESUMEN

BACKGROUND: Tuberculosis infection control is a combination of measures designed to minimize the risk of tuberculosis transmission within populations. Healthcare workers are not sufficiently protected from tuberculosis infection in healthcare facilities where infection control protocols are not followed completely. Studies conducted in Ethiopia about tuberculosis infection control practices were self-report. OBJECTIVE: To assess tuberculosis infection control practices and associated factors among health care workers in hospitals of Gamo Gofa Zone, Southern Ethiopia. METHOD: A facility-based cross-sectional study was conducted from March 6 to April 2, 2019. The sample size was 422. The sample was proportionally allocated to each hospital and the respective discipline. Simple random sampling was used to select participants from each discipline. Data were entered into EpiData version 4.4.2.1 and analyzed using SPSS Version 21 software. Multicollinearity and Model goodness-of-fit was checked. A multivariate logistic regression model at 95% CI was used to identify the predictors. RESULT: The response rate was 97.4%. The proportion of good tuberculosis infection control practice was 39.9% [95% CI (35.5, 44.9)]. Knowledge on tuberculosis infection control measures [AOR = 3.65, 95% CI (2.07, 6.43)], educational level of degree and above [AOR = 2.78, 95% CI (1.7, 4.53)] and ever having tuberculosis-related training [AOR = 2.02, 95% CI (1.24, 3.31)] were significantly associated with good tuberculosis infection control practice. CONCLUSION AND RECOMMENDATION: The proportion of good tuberculosis infection control practice among healthcare workers in hospitals of the Gamo Gofa Zone was 39.9%. The good practice of tuberculosis infection control was determined by educational level, working department, knowledge on tuberculosis infection control measures, and having tuberculosis-related training. Hence, training of healthcare workers, targeting diploma-holders in upgrading educational level programs, developing knowledge on tuberculosis infection control measures, and qualitative research to explore reasons for not practicing infection control measures is recommended.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Control de Infecciones/métodos , Tuberculosis/prevención & control , Adolescente , Adulto , Estudios Transversales , Escolaridad , Etiopía/epidemiología , Femenino , Personal de Salud/normas , Hospitales/normas , Humanos , Control de Infecciones/normas , Control de Infecciones/estadística & datos numéricos , Masculino , Autoempalme del ARN Ribosómico , Autoinforme/estadística & datos numéricos , Tuberculosis/epidemiología , Tuberculosis/transmisión , Adulto Joven
20.
Value Health ; 23(9): 1191-1199, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32940237

RESUMEN

OBJECTIVES: Hospital comparisons to improve quality of care require valid and reliable quality indicators. We aimed to test the validity and reliability of 6 breast cancer indicators by quantifying the influence of case-mix and random variation. METHODS: The nationwide population-based database included 79 690 patients with breast cancer from 91 Dutch hospitals between 2011 and 2016. The indicator-scores calculated were: (1) irradical breast-conserving surgery (BCS) for invasive disease, (2) irradical BCS for ductal carcinoma-in-situ, (3) breast contour-preserving treatment, (4) magnetic resonance imaging (MRI) before neo-adjuvant chemotherapy, (5) radiotherapy for locally advanced disease, and (6) surgery within 5 weeks from diagnosis. Case-mix and random variation adjustments were performed by multivariable fixed and random effect logistic regression models. Rankability quantified the between-hospital variation, representing unexplained differences that might be the result of the level of quality of care, as low (<50%), moderate (50%-75%), or high (>75%). RESULTS: All of the indicators showed between-hospital variation with wide (interquartile) ranges. Case-mix adjustment reduced variation in indicators 1 and 3 to 5. Random variation adjustment (further) reduced the variation for all indicators. Case-mix and random variation adjustments influenced the indicator-scores of individual hospitals and their ranking. Rankability was poor for indicator 1, 2, and 5, and moderate for 3, 4, and 6. CONCLUSIONS: The 6 indicators lacked validity and/or reliability to a certain extent. Although measuring quality indicators may stimulate quality improvement in general, comparisons and judgments of individual hospital performance should be made with caution if based on indicators that have not been tested or adjusted for validity and reliability, especially in benchmarking.


Asunto(s)
Neoplasias de la Mama/terapia , Hospitales/normas , Indicadores de Calidad de la Atención de Salud/normas , Benchmarking , Neoplasias de la Mama/epidemiología , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Humanos , Masculino , Países Bajos/epidemiología , Mejoramiento de la Calidad , Reproducibilidad de los Resultados
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...