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1.
Stud Health Technol Inform ; 281: 669-673, 2021 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-34042660

RESUMEN

The purpose of this study is to present the design, development and initial evaluation of a smartphone software (mobile app), for the needs of nursing bedside shift reporting and documentation. The app records and process nursing handovers concerning haemodialysis patient data, and it runs on Android smartphones, offering a structured and friendly user interface. Data are collected, processed, stored and accessed easily, quickly and securely by authorized users. The evaluation, based on discussions and semi-structured interviews with a group of nurses, showed positive feedback on the user interface, structure and functions of the prototype. It can be a useful and efficient tool for the reporting and communication needs between nurses. Conclusions about the limitations of the study and future developments are reported.


Asunto(s)
Aplicaciones Móviles , Pase de Guardia , Unidades Hospitalarias , Humanos , Diálisis Renal , Teléfono Inteligente
2.
Rev Bras Enferm ; 74(suppl 3): e20200735, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-34037177

RESUMEN

OBJECTIVE: To analyze the experiences that generate pleasure and suffering in the work of nurses in an oncopediatric inpatient unit. METHODS: Qualitative, exploratory, descriptive study. Data collection took place from March to May 2018, through interviews with eight nurses in an oncopediatric inpatient unit. RESULTS: The verbalized experiences of pleasure were the work developed with children, participation in the treatment and cure of patients and the recognition of family members in relation to the work performed. The suffering experiences were palliative care and death of patients, performing invasive procedures and organizing work. FINAL CONSIDERATIONS: It was possible to analyze the experiences of pleasure and suffering of nurses in an oncopediatric unit through the psychodynamics of work, allowing to reinvent prevention and intervention measures by managers in health/mental illness processes at work.


Asunto(s)
Neoplasias/enfermería , Enfermeras Pediátricas/psicología , Dolor , Enfermería Pediátrica , Placer , Adulto , Niño , Preescolar , Unidades Hospitalarias , Humanos , Entrevistas como Asunto , Persona de Mediana Edad , Neoplasias/psicología , Cuidados Paliativos , Investigación Cualitativa
3.
BMC Nephrol ; 22(1): 144, 2021 04 21.
Artículo en Inglés | MEDLINE | ID: mdl-33882842

RESUMEN

BACKGROUND: SARS-CoV-2 (COVID-19) is a novel coronavirus associated with high mortality rates. The use of Continuous Positive Airway Pressure (CPAP) has been recognised as a management option for severe COVID-19 (NHS, Specialty guides for patient management during the coronavirus pandemic Guidance for the role and use of non-invasive respiratory support in adult patients with coronavirus (confirmed or suspected), https://www.nice.org.uk/guidance/ng159 ). We offered ward-based CPAP to COVID-19, dialysis patients not suitable for escalation to ICU. The aim of the study was to evaluate the use of CPAP for COVID-19 dialysis patients compared to non-dialysis COVID-19 patients outside of the intensive care setting. We further aimed to investigate factors associated with improved outcomes. METHODS: Data was collected from a single centre (Royal Preston Hospital, UK), from March to June 2020. Treatment outcomes were compared for dialysis and non-dialysis dependent patients who received CPAP with limitations on their escalation and resuscitation status. Kaplan-Meier survival curves and Cox regression models were used to compare outcomes. The primary study outcome was 30 day mortality. Confounders including length of admission, systemic anticoagulation and ultrafiltration volumes on dialysis were also analysed. RESULTS: Over the study period, 40 dialysis patients tested positive for COVID-19, with 30 requiring hospital admission. 93% (n = 28) required supplementary oxygen and 12% (n = 9) required CPAP on the ward. These patients were compared to a serial selection of 14 non-dialysis patients treated with CPAP during the same period. Results showed a significant difference in 30 day survival rates between the two groups: 88.9% in the dialysis group vs. 21.4% in the non-dialysis group. Statistical modelling showed that anticoagulation was also an important factor and correlated with better outcomes. CONCLUSION: This is to the best of our knowledge, the largest series of COVID-19 dialysis patients treated with CPAP in a ward-based setting. In general, dialysis dependent patients have multiple co-morbidities including cardiovascular disease and diabetes mellitus making them vulnerable to COVID-19 and not always suitable for treatment in ICU. We showed a significantly lower 30 day mortality rate with the use of CPAP in the dialysis group (11.1%) compared to the non-dialysis group (78.6%). Despite a small sample size, we believe this study provides impetus for further work clarifying the role of CPAP in treating COVID-19 dialysis dependent patients.


Asunto(s)
/terapia , Presión de las Vías Aéreas Positiva Contínua/métodos , Fallo Renal Crónico/terapia , Insuficiencia Respiratoria/terapia , Anciano , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Femenino , Unidades Hospitalarias , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Fallo Renal Crónico/complicaciones , Masculino , Persona de Mediana Edad , Mortalidad , Nefrología , Diálisis Renal , Tasa de Supervivencia
4.
Front Public Health ; 9: 632608, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33829007

RESUMEN

Background: SARS-CoV-2 spreads rapidly around the world, and some patients present gastrointestinal symptoms. The existence of the virus in the gastrointestinal tract makes digestive endoscopy a high-risk operation, which associated with an increased risk of infection rate in healthcare workers. This study aimed at exploring current knowledge, practice and attitudes of healthcare workers in endoscopy units in China regarding the status of occupational protection during COVID-19 pandemic. Methods: A cross-sectional study of a national online survey involving 717 healthcare workers in endoscopy units from 94 medical structures in 24 provinces and municipalities around China was conducted online via a questionnaire platform called Wenjuanxing (wjx.cn). The data were analyzed using correlation approaches, Kruskal-Wallis test for independent samples, and linear regression models. Results: Most Chinese healthcare workers in endoscopy units had a good knowledge of COVID-19 (median: 10; range: 7-12), showed a strikingly positive attitude (median: 65; range: 39-65), and carried out good practice (median: 47; range: 14-50) in strengthening the protection, disinfection and management of COVID-19. In terms of attitudes, female staff was more concerned about protection against COVID-19 than male staff (KW = 8.146, P = 0.004). Nurses performed better in both attitude (KW = 2.600, P = 0.009) and practice (KW = 6.358, P < 0.001) than endoscopic physicians when carrying out personal protection, patient care and environmental disinfection against SARS-CoV-2 infection. More positive attitudes in protection were related to better protective behavior in endoscopic daily medical work (r = 0.312; P < 0.001). Conclusion: The findings of this study suggest that Chinese endoscopy healthcare workers have an excellent mastery of knowledge about COVID-19, which is transformed into positive beliefs and attitudes, contributing to good practice during daily endoscopic procedures. Medical staff may benefit from further education. With the gradual normalization amid the ongoing COVID-19 pandemic, protection and management in endoscopy units may be changed accordingly.


Asunto(s)
/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Exposición Profesional/prevención & control , Adulto , Anciano , China/epidemiología , Estudios Transversales , Endoscopía , Femenino , Unidades Hospitalarias , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Adulto Joven
5.
Int J Med Sci ; 18(10): 2146-2154, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33859521

RESUMEN

Objectives: To report a COVID-19 outbreak among workers and inpatients at a medical ward for especially vulnerable patients. Methods: Descriptive study of a nosocomial COVID-19 outbreak registered in March-April 2020 at medical ward of onco-hematological patients in an Spanish hospital. Confirmed cases were hospitalized patients, healthcare and non-healthcare workers who tested positive by PCR on a nasopharyngeal swab. Results: Twenty-two COVID-19 cases (12 workers and 10 inpatients) were laboratory-confirmed. Initial cases were a healthcare provider and a visitor who tested positive. The median patients age was 73 years (range 62-88). The main reason of admission was haematological in 8 patients and oncologic in 2. All patients followed an immunosuppressive treatment, 5/10 with high-flow oxygen nebulizations. Five patients presented a moderate/serious evolution, and 5 patients died. The mean workers age was 42.1±10.9. One healthworker required Intensive Care Unit admission, and all of them recovered completely. Conclusions: In the hospital setting, close patients surveillance for SARS-CoV-2 is essential, especially in immunosuppressed patients. Replacing nebulizations or high-flow oxygen therapies, when other equivalent options were available, to reduce dispersion, and controlling ventilation ducts, together with hygiene measures and an active follow-up on inpatients, visitors and workers appear to be important in preventing nosocomial outbreaks.


Asunto(s)
/epidemiología , Infección Hospitalaria/epidemiología , Control de Infecciones/métodos , Adulto , Anciano , Anciano de 80 o más Años , Brotes de Enfermedades , Femenino , Personal de Salud , Enfermedades Hematológicas/terapia , Unidades Hospitalarias , Humanos , Huésped Inmunocomprometido , Pacientes Internos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Nebulizadores y Vaporizadores , España
6.
BMC Gastroenterol ; 21(1): 98, 2021 Mar 03.
Artículo en Inglés | MEDLINE | ID: mdl-33657994

RESUMEN

BACKGROUND: Health care professionals in endoscopic labs have an elevated risk for COVID-19 infection, therefore, we aimed to determine the effect of current pandemic on the workflow and infection prevention and control strategies of endoscopy units in real-life setting. METHODS: All members of Hungarian Society of Gastroenterology were invited between 7 and 17 April 2020 to participate in this cross-section survey study and to complete an online, anonymous questionnaire. RESULTS: Total of 120 endoscopists from 83 institutes were enrolled of which 35.83% worked in regions with high cumulative incidence of COVID-19. Only 33.33% of them had undergone training about infection prevention in their workplace. 95.83% of endoscopists regularly used risk stratification of patients for infection prior endoscopy. While indications of examinations in low risk patients varied widely, in high-risk or positive patients endoscopy was limited to gastrointestinal bleeding (95.00%), removal of foreign body from esophagus (87.50%), management of obstructive jaundice (72.50%) and biliary pancreatitis (67.50%). Appropriate amount of personal protective equipment was available in 60.85% of endoscopy units. In high-risk or positive patients, surgical mask, filtering facepiece mask, protective eyewear and two pairs of gloves were applied in 30.83%, 76.67%, 90.00% and 87.50% of cases, respectively. Personal protective equipment fully complied with European guideline only in 67.50% of cases. CONCLUSIONS: Survey found large variability in indications of endoscopy and relative weak compliance to national and international practical recommendations in terms of protective equipment. This could be improved by adequate training about infection prevention.


Asunto(s)
/prevención & control , Endoscopía Gastrointestinal , Gastroenterología/organización & administración , Unidades Hospitalarias/organización & administración , Control de Infecciones/organización & administración , Flujo de Trabajo , /epidemiología , Estudios Transversales , Humanos , Hungría , Selección de Paciente , Equipo de Protección Personal
9.
J Trop Pediatr ; 67(1)2021 01 29.
Artículo en Inglés | MEDLINE | ID: mdl-33594419

RESUMEN

Lack of quality care is associated with newborn mortality and stillbirth. India launched the Special newborn care unit (SNCU) Quality of Care Index (SQCI) for measuring quality indicators in SNCU. The USAID Vriddhi project provided support to the use of SQCI in 19 SNCU across aspirational districts of Jharkhand, Uttarakhand, Himachal Pradesh, Punjab and Haryana. The objective was to provide holistic support to quality care processes by generating analyzed quarterly reports for action with the goal toward sustainability by capacitating SNCU personnel and program officers to use SQCI, over a 1period from April 2019 to June 2020. The composite index has seven indicators and converts them into indices, each having a range from 0.1 to 1, to measure performance of SNCU.7 of the 18 SNCU improved their composite scores from the first to the last quarter. Rational use of antibiotics showed improvement in 12 SNCU. Survival in newborns >2500 g and <2500, low birth weight admission and optimal bed utilization had the most variations between and within facilities. Based on quarterly data analysis, all facilities introduced KMC, 10 facilities improved equipment and drug supply, 9 facilities launched in-house capacity building to improve asphyxia management. The SQCI implementation helped to show a process of using SQCI data for identifying bottlenecks and addressing quality concerns. The project has transitioned to complete responsibility of SQCI usage by the district and facility teams. Use of an existing mechanism of quality monitoring without any major external support makes the SQCI usable and doable.


Asunto(s)
Recién Nacido de Bajo Peso , Calidad de la Atención de Salud , Niño , Unidades Hospitalarias , Humanos , India/epidemiología , Recién Nacido
10.
BMJ Open ; 11(2): e045000, 2021 02 24.
Artículo en Inglés | MEDLINE | ID: mdl-33627354

RESUMEN

INTRODUCTION: COVID-19 pandemic has affected people all over the world. In this context, health disparities are already evident in becoming ill and dying from this condition, further accentuating historical racial inequalities. METHODS AND ANALYSIS: This protocol will be developed based on the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. For this, searches will be carried out in PubMed, Web of Science, Scopus, Lilacs and ScienceDirect databases searching for cross-sectional studies that assessed the prevalence of black people with COVID-19 at different levels of complexity. All cross-sectional studies that analysed the prevalence of COVID-19 in black people assisted in primary care, hospital wards and intensive care units will be included. The research will be carried out by two independent researchers who will identify the articles; they will exclude duplicate studies. Through blind evaluation, they will select the articles using the Rayyan QCRI application. The instrument proposed by Downs and Black will be used to assess the risk of bias. The meta-analyses will be performed according to the data conditions included. ETHICS AND DISSEMINATION: For this study's development, there is no need for an ethical appraisal considering that it is a systematic review that will use secondary studies. This study's findings will be disseminated through peer-reviewed publications, conference presentations and condensed summaries for main stakeholders and partners in the field. The database search is expected to begin on 1 February 2021. It is expected to complete the entire review process by 30 October 2021 TRIAL REGISTRATION NUMBER: CRD42020209079.


Asunto(s)
Afroamericanos , Pandemias , Proyectos de Investigación , /diagnóstico , Estudios Transversales , Unidades Hospitalarias , Humanos , Unidades de Cuidados Intensivos , Metaanálisis como Asunto , Prevalencia , Atención Primaria de Salud , Revisiones Sistemáticas como Asunto
11.
Int J Palliat Nurs ; 27(1): 10-19, 2021 Feb 02.
Artículo en Inglés | MEDLINE | ID: mdl-33629914

RESUMEN

BACKGROUND: Children with life-limiting conditions have a high risk of colonisation with a multidrug-resistant organism (MDRO). To avoid the spread of hospital-aquired infections to other patients, children with a MDRO are moved to an isolated room or ward. However, such isolation prevents social participation, which may reduce the child's quality of life (QoL). To overcome this challenge of conflicting interests on a paediatric palliative care inpatient unit, a hygiene concept for patients colonised with MDRO, called PALLINI, was implemented. PALLINI advises that, instead of isolating the affected children, strict barrier nursing should be used. AIM: To identify the impact of a complex hygiene concept on children's and parents' QoL and social participation. METHODS: Cross-sectional mixed-methods research approach, comprising semi-structured interviews with parents and staff members, and a QoL-questionnaire focusing on the child which was completed by parents. FINDINGS: In paediatric patients with life-limiting conditions who have MDRO colonisation, using a complex hygiene protocol resulted in both benefits and barriers to social participation. However, the child's QoL did not appear to be affected. CONCLUSION: All staff members and families have to be familiar with the hygiene concept and the concept has to be self-explanatory and easy to apply.


Asunto(s)
Resistencia a Múltiples Medicamentos , Control de Infecciones/organización & administración , Calidad de Vida , Participación Social , Enfermo Terminal , Niño , Preescolar , Infección Hospitalaria/prevención & control , Estudios Transversales , Femenino , Unidades Hospitalarias , Humanos , Lactante , Capacitación en Servicio , Entrevistas como Asunto , Masculino , Evaluación en Enfermería , Cuidados Paliativos , Padres , Aislamiento de Pacientes , Seguridad del Paciente , Estereotipo , Encuestas y Cuestionarios
12.
Rev Esp Salud Publica ; 952021 Feb 12.
Artículo en Español | MEDLINE | ID: mdl-33576346

RESUMEN

OBJECTIVE: Despite its great ubiquity and morbidity and mortality, the scientific evidence on the hospital control of multiresistant Acinetobacter baumanii (ABMR) outside the Intensive Care Units in Spain is scarce. The objective was to describe an epidemic outbreak by MRAB and analyze the effectiveness of the actions carried out. METHODS: Prospective observational study of admitted-rotated patients in a multipathological control at the University Hospital of Guadalajara, Spain, during the outbreak (September 20-November 3, 2017); using Mambrino Electronic Health Record. A genetic study of the resistance mechanism and molecular characterization of the strains were carried out. Frequency measurements were estimated, with subsequent comparative analysis of cases vs controls. RESULTS: The median age of the study population (N=138) was 83.2 years (Interquartile Range [IR]=69.7-90.1). There were 3 cases of ABMR infection among them. Thirteen percent required issolation, 17% because of MRAB. The MRAB incidence was 2.2 cases/100 admitted-rotated (mortality rate=33%). The excess stay for cases was 17±4.3 (95%CI=8.5-25.6), with an incidence density of 3 cases/103 days. The responsible strain was carbapenemase OXA-23. We found a single case in the colonization study of contacts. No MRAB was isolated from environmental samples. CONCLUSIONS: Along with epidemiological research, coordination and compliance with precautions; prompt identification and management of an outbreak are crucial to minimize the colonization pressure and to stop dissemination.


Asunto(s)
Infecciones por Acinetobacter/epidemiología , Acinetobacter baumannii/enzimología , Proteínas Bacterianas/metabolismo , Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Unidades Hospitalarias , beta-Lactamasas/metabolismo , Acinetobacter baumannii/aislamiento & purificación , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Estudios Prospectivos , España/epidemiología
13.
Nefrología (Madrid) ; 41(1): 15-16, ene.-feb. 2021.
Artículo en Español | IBECS | ID: ibc-199568

RESUMEN

1. La ERC tiene una elevada incidencia y prevalencia con un alto impacto sobre la calidad de vida y mortalidad de los pacientes, lo que supone un importante consumo de recursos sanitarios. 2. En un porcentaje relevante de pacientes no se dispone de un diagnóstico etiológico de la ERC, lo que limita sus posibilidades de tratamiento y curación. 3. Las acciones dirigidas a mejorar el diagnóstico permitirán favorecer un mejor conocimiento de las causas de la ERC y optimizar el tratamiento. 4. La biopsia renal, constituye el procedimiento necesario para el estudio histopatológico del tejido renal que permitirá establecer el diagnóstico, las posibilidades de tratamiento y el pronóstico del daño renal. 5. El trasplante renal constituye la mejor opción de TRS. La causa más frecuente de pérdida del injerto renal es el rechazo. La biopsia renal es el único método para establecer el tipo de rechazo e iniciar el tratamiento más adecuado. 6. La planificación del tratamiento de la enfermedad renal se establece con base en un diagnóstico preciso y este se basa en el diagnóstico histológico. La falta de una adecuada interpretación diagnóstica, bien por inexperiencia del patólogo, bien por falta de medios diagnósticos (microscopia electrónica), condiciona y limita las opciones de tratamiento en perjuicio del enfermo


No disponible


Asunto(s)
Humanos , Necesidades y Demandas de Servicios de Salud/tendencias , Nefrología/organización & administración , Unidades Hospitalarias/organización & administración , Sociedades Médicas , Patología , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/diagnóstico , Biopsia/normas
14.
BMC Infect Dis ; 21(1): 116, 2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-33494707

RESUMEN

BACKGROUND: The burden of cardiovascular (CV) complications in patients hospitalised for community-acquired pneumonia (CAP) is still uncertain. Available studies used different designs and different criteria to define CV complications. We assessed the cumulative incidence of acute of CV complications during hospitalisation for CAP in Internal Medicine Units (IMUs). METHODS: This was a prospective study carried out in 26 IMUs, enrolling patients consecutively hospitalised for CAP. Defined CV complications were: newly diagnosed heart failure, acute coronary syndrome, new onset of supraventricular or ventricular arrhythmias, new onset hemorrhagic or ischemic stroke or transient ischemic attack. Outcome measures were: in-hospital and 30-day mortality, length of hospital stay and rate of 30-day re-hospitalisation. RESULTS: A total of 1266 patients were enrolled, of these 23.8% experienced at least a CV event, the majority (15.5%) represented by newly diagnosed decompensated heart failure, and 75% occurring within 3 days. Female gender, a history of CV disease, and more severe pneumonia were predictors of CV events. In-hospital (12.2% vs 4.7%, p < 0.0001) and 30-day (16.3% vs 8.9%, p = 0.0001) mortality was higher in patients with CV events, as well as the re-hospitalisation rate (13.3% vs 9.3%, p = 0.002), and mean hospital stay was 11.4 ± 6.9 vs 9.5 ± 5.6 days (p < 0.0001). The occurrence of CV events during hospitalisation significantly increased the risk of 30-day mortality (HR 1.69, 95% CI 1.14-2.51; p = 0.009). CONCLUSION: Cardiovascular events are frequent in CAP, and their occurrence adversely affects outcome. A strict monitoring might be useful to intercept in-hospital CV complications for those patients with higher risk profile. TRIAL REGISTRATION: NCT03798457 Registered 10 January 2019 - Retrospectively registered.


Asunto(s)
Infecciones Comunitarias Adquiridas , Infarto del Miocardio/epidemiología , Neumonía Bacteriana , Anciano , Anciano de 80 o más Años , Femenino , Unidades Hospitalarias , Hospitalización , Humanos , Incidencia , Italia/epidemiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/mortalidad , Prevalencia , Estudios Prospectivos , Factores de Riesgo
15.
Gen Hosp Psychiatry ; 69: 126-128, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33431231

RESUMEN

OBJECTIVE: A Canada-wide survey was disseminated to collect information regarding changes in processes related to providing care to patients on inpatient psychiatry units in response to the COVID-19 pandemic. Our aim was to share this information with those who have an interest in problem-solving these significant and unique challenges. METHOD: The survey was distributed through the Association of Chairs of Psychiatry of Canada to Department Heads of Psychiatry at all sixteen medical schools. Information was collected via SurveyMonkey April 26-May 9, 2020. Eleven psychiatrists representing 11 different Canadian city/centre/zone(s) completed the survey. RESULTS: Information was collected about process changes: physical separation on the wards, symptom and vital signs screening, testing, isolation, rationales for number of beds allocated for COVID-positive, -suspect and -negative patients and for selecting a particular hospital to provide care to these different groupings of patients. One subsection of the information is presented in this letter. Further information is available upon request. CONCLUSION: Similarities and differences existed between city/centre/zone(s) regarding approaches to providing care to patients on inpatient psychiatry wards. Significant preparation and consideration was put into determining necessary changes in response to this pandemic, and this is reflected in the information provided from each city/centre/zone.


Asunto(s)
Asignación de Recursos para la Atención de Salud , Capacidad de Camas en Hospitales , Unidades Hospitalarias , Servicio de Psiquiatría en Hospital , Canadá , Planificación Hospitalaria , Humanos , Aislamiento de Pacientes , Encuestas y Cuestionarios
16.
Rev Esp Enferm Dig ; 113(2): 119-121, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33393333

RESUMEN

The COVID-19 pandemic meant that the population-based colorectal cancer (CRC) screening programs had to be suspended. Modifications were made to the organization in order to reduce SARS-CoV-2 transmission. We report the experience of the Galician CRC screening program and patient safety results. Endoscopy was suspended between 13/03/2020 and 11/05/2020. After resumption, a total of 3,310 colonoscopies were performed (1,702 positive fecal occult blood tests and 1,608 endoscopy monitoring) and no SARS-CoV-2 infections were detected in the subsequent two weeks. Thus, resumption of activity associated with population screening was safe.


Asunto(s)
Colonoscopía , Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer , Unidades Hospitalarias/organización & administración , Seguridad del Paciente , Cuarentena , Anciano , /prevención & control , Humanos , Persona de Mediana Edad , España/epidemiología
17.
Clin Infect Dis ; 72(Suppl 1): S1-S7, 2021 01 29.
Artículo en Inglés | MEDLINE | ID: mdl-33512524

RESUMEN

BACKGROUND: The key epidemiological drivers of Clostridioides difficile transmission are not well understood. We estimated epidemiological parameters to characterize variation in C. difficile transmission, while accounting for the imperfect nature of surveillance tests. METHODS: We conducted a retrospective analysis of C. difficile surveillance tests for patients admitted to a bone marrow transplant (BMT) unit or a solid tumor unit (STU) in a 565-bed tertiary hospital. We constructed a transmission model for estimating key parameters, including admission prevalence, transmission rate, and duration of colonization to understand the potential variation in C. difficile dynamics between these 2 units. RESULTS: A combined 2425 patients had 5491 admissions into 1 of the 2 units. A total of 3559 surveillance tests were collected from 1394 patients, with 11% of the surveillance tests being positive for C. difficile. We estimate that the transmission rate in the BMT unit was nearly 3-fold higher at 0.29 acquisitions per percentage colonized per 1000 days, compared to our estimate in the STU (0.10). Our model suggests that 20% of individuals admitted into either the STU or BMT unit were colonized with C. difficile at the time of admission. In contrast, the percentage of surveillance tests that were positive within 1 day of admission to either unit for C. difficile was 13.4%, with 15.4% in the STU and 11.6% in the BMT unit. CONCLUSIONS: Although prevalence was similar between the units, there were important differences in the rates of transmission and clearance. Influential factors may include antimicrobial exposure or other patient-care factors.


Asunto(s)
Infecciones por Clostridium , Infecciones por Clostridium/epidemiología , Unidades Hospitalarias , Humanos , Estudios Retrospectivos
18.
Hosp Pract (1995) ; 49(2): 127-132, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33433241

RESUMEN

We piloted a triad leadership model consisting of a unit-based hospitalist medical director, nurse manager, and case manager on five medical inpatient units. The purpose of this explanatory case study was to determine what, if any, impact the triad team would have on commonly measured operational and quality metrics: observed to expected length of stay, likelihood to recommend the hospital, hand-washing compliance, all-cause 30-day readmission rates, percent of discharges by noon, and percent of discharge to skilled nursing facilities. Over the course of a year triad units demonstrated improvement in most metrics in comparison to the baseline period. While trends for the metrics were favorable, most striking was a statistically significant improvement in the observed to expected length of stay ratio (1.25 to 1.15, p < 0.001) which is the organization's most widely used marker for efficient hospital patient flow.As a result of these sustained operational, safety, quality, and financial performance metrics the model is being generalized to other medical as well as surgical units, including our observation unit. Intangible benefits include creating leadership development path for hospitalist, nursing, and case management colleagues.


Asunto(s)
Unidades Hospitalarias , Liderazgo , Indicadores de Calidad de la Atención de Salud , Manejo de Caso , Connecticut , Médicos Hospitalarios , Humanos , Tiempo de Internación , Enfermeras Administradoras , Estudios de Casos Organizacionales
19.
MMWR Morb Mortal Wkly Rep ; 70(2): 56-57, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33444298

RESUMEN

In July 2020, the Florida Department of Health was alerted to three Candida auris bloodstream infections and one urinary tract infection in four patients with coronavirus disease 2019 (COVID-19) who received care in the same dedicated COVID-19 unit of an acute care hospital (hospital A). C. auris is a multidrug-resistant yeast that can cause invasive infection. Its ability to colonize patients asymptomatically and persist on surfaces has contributed to previous C. auris outbreaks in health care settings (1-7). Since the first C. auris case was identified in Florida in 2017, aggressive measures have been implemented to limit spread, including contact tracing and screening upon detection of a new case. Before the COVID-19 pandemic, hospital A conducted admission screening for C. auris and admitted colonized patients to a separate dedicated ward.


Asunto(s)
/terapia , Candida/aislamiento & purificación , Candidiasis/epidemiología , Brotes de Enfermedades , Unidades Hospitalarias , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Florida/epidemiología , Humanos , Masculino , Persona de Mediana Edad
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