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1.
Farm Hosp ; 44(7): 40-42, 2020 06 12.
Artículo en Inglés | MEDLINE | ID: mdl-32533669

RESUMEN

Since the implementation of the Antimicrobial Therapy Optimization Programme, hospital pharmacy specialists have collaborated with infectious disease specialists on a regular basis in most hospitals in Spain.  Cooperation between these professionals ensures the integrated management of patients with infectious diseases and the appropriate use of antimicrobials in  hospitals. The COVID-19 pandemic forced hospital pharmacists to abruptly  suspend all their structured activities and concentrate on the health crisis.  Realtime information sharing between different medicine specialties is an  effective strategy to generate and maintain treatment protocols adapted to each center, with continuous evidence-based modifications as new publications appear. Hospital pharmacies had to reorganize their activities to  respond to the pandemic. On the one side were patients with COVID-19, and on  the other were routine hospital pharmacy tasks, with the added difficulty of  adapting to individual protection measures. New communication and  collaboration strategies were adopted. Protocols were established for the  management of COVID-19 patients, with continuous changes; special  medications had to be prepared and distributed; circuits were designed for the  home- or institution-based care of patients; internal circuits were created to  minimize the movements of hospital staff and professionals caring for COVID-19  patients. The most effective antiviral drug and anti inflammatory therapy  remains elusive. In this scenario, hospital pharmacists emerge as a key player,  as they have a deep understanding of the mechanisms of action of drugs and  potential interactions. In a setting where experimental drugs preferably tested in clinical trials are being used, the role of hospital pharmacists in interdisciplinary  teams has become essential for the optimization of clinical outcomes.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Unidades Hospitalarias , Comunicación Interdisciplinaria , Pandemias , Grupo de Atención al Paciente , Farmacéuticos , Servicio de Farmacia en Hospital/organización & administración , Neumonía Viral , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Cuidados Críticos , Toma de Decisiones , Manejo de la Enfermedad , Necesidades y Demandas de Servicios de Salud , Hospitales Universitarios , Humanos , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Infectología/organización & administración , Pacientes Internos , Unidades de Cuidados Intensivos/organización & administración , Preparaciones Farmacéuticas/provisión & distribución , Comité Farmacéutico y Terapéutico/organización & administración , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/epidemiología , Neumonía Viral/terapia , España/epidemiología
2.
Geriatr Psychol Neuropsychiatr Vieil ; 18(2): 125-133, 2020 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-32554344

RESUMEN

The COVID-19 epidemic that started in November in China became a national epidemic from March 16, 2020 with the declaration of population containment in order to reduce the spread of the virus in France. From March 17 to March 27, 2020, the monitoring unit of the French society of geriatrics and gerontology decided to conduct a survey to analyze the implementation of the mobilization of geriatric units, given that this epidemic had shown that it resulted in excess mortality mainly among the elderly. The survey was able to bring together the response of 34 services, nine of which were located in a high epidemic cluster zone. Dedicated acute geriatric units for patients infected with COVID-19 were present in eight facilities, only outside the cluster zones. Nine geriatric follow-up and rehabilitation services were dedicated, an additional telemedicine activity concerned 35% of the facilities, and family listening and tablet communication facilities concerned 36% of the facilities. This survey is a snapshot of an initial moment in the epidemic. It provides an opportunity to describe the context in which this epidemic occurred in terms of geriatric policy, and to assess the responsiveness and inventiveness of these services in meeting the needs of the elderly.


Asunto(s)
Infecciones por Coronavirus/terapia , Geriatría , Unidades Hospitalarias/estadística & datos numéricos , Neumonía Viral/terapia , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Femenino , Francia/epidemiología , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Encuestas y Cuestionarios , Telemedicina
3.
Farm Hosp ; 44(7): 53-56, 2020 06 13.
Artículo en Inglés | MEDLINE | ID: mdl-32533672

RESUMEN

In response to the SARS-CoV-2 pandemic, the Hospital Pharmacy Services have  quickly adapted to respond to a critical situation characterized by the constant  and continuous admission of patients with severe pneumonia who needed  treatment, requiring a transformation of the hospital in order to increase the  number of hospital and critical beds. Moreover, other out-ofhospital spaces have  been transformed into hospitalization units to absorb the large number of  patients that had to be treated and isolated. To guarantee the distribution of  medicines and the quality of the pharmaceutical care, drug distribution systems,  such as unit dose and automated dispensing systems, have undergone  transformations. Standard stocks were assigned for COVID units, and different  dispensing circuits to avoid the risk of cross-contamination between COVID and  non-COVID units were created, as well as disinfection protocols for medication  transport systems and medication return protocols. All this without forgetting  COVID treatment protocol's changes that were affected by the availability of the  drugs. The increase in the number of beds in out-of-hospital spaces, such as  field hospitals, hotels, socio-medical centers and nursing homes, has challenged  Pharmacy Services, since new medication dispensing and conciliation circuits  have been created forcing the increase of pharmacy staff's presence and  modifying work shifts, to afford all the new tasks successfully. Development of  contingency plans for the different Pharmacy Service activities and providing  fluent communication channels are key elements for crisis situations or health  emergencies such as the current pandemic.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Pandemias , Farmacéuticos , Servicio de Farmacia en Hospital/organización & administración , Neumonía Viral , Desinfección , Almacenaje de Medicamentos , Prescripción Electrónica , Equipos y Suministros/provisión & distribución , Predicción , Necesidades y Demandas de Servicios de Salud , Capacidad de Camas en Hospitales , Unidades Hospitalarias , Humanos , Unidades de Cuidados Intensivos , Sistemas de Medicación en Hospital/organización & administración , Alta del Paciente , Admisión y Programación de Personal , Recursos Humanos
5.
In Vivo ; 34(3 Suppl): 1667-1673, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32503827

RESUMEN

BACKGROUND: COVID-19 pandemic required a marked re-allocation of healthcare resources, including at Breast Units. A patient-tailored program was developed to assess its efficacy regarding prevention of COVID-19 infection among patients with breast cancer undergoing surgery and healthcare workers (HCWs). PATIENTS AND METHODS: From March 9th to April 9th 2020, 91 patients were selected for elective surgery by means of: i) Pre-hospital screening aimed at avoiding hospitalization of symptomatic or suspicious COVID-19 patients, and ii) prioritisation of surgical procedure according to specific disease features. RESULTS: Eighty-five patients (93.4%) were fit for surgery, while five patients (5.5%) were temporarily excluded through 'telephone triage'; another two patients were excluded at in-hospital triage. A total of 71 out of 85 patients (83.5%) were diagnosed with invasive cancer, most of whom were undergoing breast-conserving surgery (61 out of 85 patients, 71.8%). The mean in-hospital stay was 2.2 days (SD=0.7 days). After hospital discharge, no patient needed re-admission due to post-operative complications; moreover, no COVID-19 infection among patients or HCWs was detected. CONCLUSION: Safe breast cancer surgery was accomplished for both patients and HCWs by means of a careful preoperative selection of patients and in-hospital preventative measures. This screening program can be transferred to high-volume Breast Units and it may be useful in implementing European Community recommendations for prevention of COVID-19 infection.


Asunto(s)
Neoplasias de la Mama/cirugía , Carcinoma/cirugía , Infecciones por Coronavirus/prevención & control , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Control de Infecciones/métodos , Mastectomía/estadística & datos numéricos , Pandemias/prevención & control , Selección de Paciente , Neumonía Viral/prevención & control , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/enfermería , Carcinoma/tratamiento farmacológico , Carcinoma/epidemiología , Carcinoma/enfermería , Técnicas de Laboratorio Clínico , Terapia Combinada , Infecciones por Coronavirus/diagnóstico , Femenino , Unidades Hospitalarias/organización & administración , Humanos , Italia/epidemiología , Tiempo de Internación/estadística & datos numéricos , Metástasis Linfática/diagnóstico por imagen , Linfocintigrafia , Mastectomía Segmentaria/estadística & datos numéricos , Terapia Neoadyuvante , Alta del Paciente , Equipos de Seguridad , Biopsia del Ganglio Linfático Centinela , Evaluación de Síntomas , Telemedicina , Triaje
6.
World J Emerg Surg ; 15(1): 33, 2020 05 15.
Artículo en Inglés | MEDLINE | ID: mdl-32414390

RESUMEN

BACKGROUND: A novel coronavirus pneumonia outbreak began in Wuhan, Hubei Province, in December 2019; the outbreak was caused by a novel coronavirus previously never observed in humans. China has imposed the strictest quarantine and closed management measures in history to control the spread of the disease. However, a high level of evidence to support the surgical management of potential trauma patients during the novel coronavirus outbreak is still lacking. To regulate the emergency treatment of trauma patients during the outbreak, we drafted this paper from a trauma surgeon perspective according to practical experience in Wuhan. MAIN BODY: The article illustrates the general principles for the triage and evaluation of trauma patients during the outbreak of COVID-19, indications for emergency surgery, and infection prevention and control for medical personnel, providing a practical algorithm for trauma care providers during the outbreak period. CONCLUSIONS: The measures of emergency trauma care that we have provided can protect the medical personnel involved in emergency care and ensure the timeliness of effective interventions during the outbreak of COVID-19.


Asunto(s)
Infecciones por Coronavirus , Transmisión de Enfermedad Infecciosa/prevención & control , Control de Infecciones/normas , Pandemias , Neumonía Viral , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/terapia , Algoritmos , Anestesia/normas , China , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Urgencias Médicas , Unidades Hospitalarias/normas , Humanos , Pandemias/prevención & control , Atención Perioperativa/normas , Equipo de Protección Personal/normas , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Procedimientos Quirúrgicos Operativos/normas , Tomografía Computarizada por Rayos X/normas , Triaje/normas
8.
Clin Rheumatol ; 39(7): 2063-2065, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32462423

RESUMEN

COVID-19 outbreak has quickly spread worldwide, causing a high pressure on the health-care system. In Italy, from March 8, 2020, all the deferrable clinical activities have been suspended to increase the health care offer for COVID-19 patients. The hospital organization has been modified also in order to assure non-COVID-19 patients assistance. The Scleroderma Unit of ASST Pini-CTO Hospital, in Milan, in the region mostly hit by SARS-CoV-2 in Italy, follows more than 600 patients affected by systemic sclerosis (SSc). Patients with SSc need a close follow-up with a regular screening of organ involvement and frequent intravenous treatments. All SSc patients have been educated about ministerial directives to limit COVID-19 spread. The organization of our Scleroderma Unit has been quickly rethought to assure SSc patients assistance in safety for them and for health-care workers during urgent visits or infusion therapies. Using electronic way of communication with frequent virtual contact and guarantying home deliveries of some therapies, we allowed a continuity of care also outside the Hospital.


Asunto(s)
Infecciones por Coronavirus , Vías Clínicas , Unidades Hospitalarias/organización & administración , Control de Infecciones/organización & administración , Pandemias , Neumonía Viral , Esclerodermia Sistémica , Betacoronavirus/aislamiento & purificación , Comorbilidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Vías Clínicas/organización & administración , Vías Clínicas/tendencias , Manejo de la Enfermedad , Humanos , Italia/epidemiología , Innovación Organizacional , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Reumatología/métodos , Esclerodermia Sistémica/epidemiología , Esclerodermia Sistémica/terapia
9.
Soins Gerontol ; 25(143): 19-21, 2020.
Artículo en Francés | MEDLINE | ID: mdl-32444076

RESUMEN

Non-drug therapies are an integral part of inpatient care in cognitive-behavioural units. As such, the rehabilitators working in the Corentin-Celton Hospital unit participate in the individualized care and rehabilitation project for the patient by conducting numerous individual and group workshops in co-therapy.


Asunto(s)
Terapia Cognitivo-Conductual , Unidades Hospitalarias , Rehabilitación , Hospitalización , Humanos , Resultado del Tratamiento
10.
J Hosp Med ; 15(5): 262-267, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32379022

RESUMEN

BACKGROUND: Hand hygiene is key to preventing healthcare-associated infection and the spread of respiratory viruses like the novel coronavirus that causes COVID-19. Unfortunately, hand hygiene adherence of healthcare workers (HCWs) in Japan is suboptimal according to previous studies. OBJECTIVES: Our objectives were to evaluate hand hygiene adherence among physicians and nurses before touching hospitalized patients and to evaluate changes in hand hygiene adherence after a multimodal intervention was implemented. DESIGN, SETTING, AND PARTICIPANTS: We conducted a pre- and postintervention study with HCWs at four tertiary hospitals in Niigata, Japan. Hand hygiene observations were conducted from June to August 2018 (preintervention) and February to March 2019 (postintervention). INTERVENTION: The multimodal hand hygiene intervention recommended by the World Health Organization was tailored to each hospital and implemented from September 2018 to February 2019. MAIN OUTCOMES AND MEASURES: We observed hand hygiene adherence before touching patients in each hospital and compared rates before and after intervention. Intervention components were also evaluated. RESULTS: There were 2,018 patient observations preintervention and 1,630 postintervention. Overall, hand hygiene adherence improved from 453 of 2,018 preintervention observations (22.4%) to 548 of 1,630 postintervention observations (33.6%; P < .001). Rates improved more among nurses (13.9 percentage points) than among doctors (5.7 percentage points). Improvement varied among the hospitals: Hospital B (18.4 percentage points) was highest, followed by Hospitals D (11.4 percentage points), C (11.3 percentage points), and Hospital A (6.5 percentage points). CONCLUSIONS: A multimodal intervention improved hand hygiene adherence rates in physicians and nurses in Niigata, Japan; however, further improvement is necessary. Given the current suboptimal hand hygiene adherence rates in Japanese hospitals, the spread of COVID-19 within the hospital setting is a concern.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Infección Hospitalaria/prevención & control , Adhesión a Directriz , Desinfección de las Manos/normas , Pandemias/prevención & control , Neumonía Viral/prevención & control , Infecciones por Coronavirus/transmisión , Unidades Hospitalarias , Humanos , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Neumonía Viral/transmisión , Guías de Práctica Clínica como Asunto
11.
Eur J Endocrinol ; 183(2): 161-167, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32449698

RESUMEN

Introduction: Intravenous etomidate infusion is effective to rapidly lower cortisol levels in severe Cushing's syndrome (CS) in the intensive care unit (ICU). Recently, etomidate treatment has also been proposed at lower doses in non-ICU wards, but it is not yet clear how this approach compares to ICU treatment. Methods: We compared data from patients with severe CS treated with high starting doses of etomidate (median: 0.30 mg/kg BW/day) in ICU or with lower starting doses (median: 0.025 mg/kg BW/day) in non-ICU medical wards. Results: Fourteen patients were included, among which ten were treated with low starting doses (LD) and four with high starting doses etomidate (HD). All patients had severe and complicated CS related to adrenal carcinoma (n = 8) or ectopic ACTH secretion (n = 6). Etomidate was effective in reducing cortisol levels below 500 nmol/L in a median of 1 day in the HD group compared to 3 days in the LD group (P = 0.013). However, all patients of the HD group had etomidate-induced cortisol insufficiency and needed frequent monitoring, while no patient from the LD group required hydrocortisone supplementation. No patient in either group died from complications of CS or etomidate treatment, but final outcome was poor as six patients in the LD group and all four patients in the HD group died from their cancer during follow-up. Conclusion: Our study suggests that, for patients with severe CS who do not require intensive organ-supporting therapy, the use of very low doses of etomidate in medical wards should be considered.


Asunto(s)
Síndrome de Cushing/tratamiento farmacológico , Etomidato/administración & dosificación , Etomidato/efectos adversos , Síndrome de ACTH Ectópico/complicaciones , Neoplasias de las Glándulas Suprarrenales/complicaciones , Adulto , Anciano , Síndrome de Cushing/sangre , Síndrome de Cushing/complicaciones , Relación Dosis-Respuesta a Droga , Femenino , Unidades Hospitalarias , Humanos , Hidrocortisona/sangre , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
12.
J Nurs Adm ; 50(6): 328-334, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32433112

RESUMEN

Information about pediatric observation and limited-stay unit design and function is lacking in the literature. A quality improvement approach was used to create new care processes on an inpatient unit within a large children's hospital. Outcomes included the use of advanced practice nurse patient care management, creation of 30 clinical pathways to model care, and consistent and faster transfer from emergency department to inpatient unit, resulting in high-level parent and patient satisfaction and decreased nursing turnover.


Asunto(s)
Continuidad de la Atención al Paciente , Vías Clínicas/normas , Unidades Hospitalarias/organización & administración , Tiempo de Internación , Innovación Organizacional , Pediatría , Enfermería de Práctica Avanzada , Niño , Servicio de Urgencia en Hospital/organización & administración , Hospitales Pediátricos , Humanos , Pacientes Internos , Calidad de la Atención de Salud
14.
J Neurol Sci ; 414: 116889, 2020 07 15.
Artículo en Inglés | MEDLINE | ID: mdl-32416370

RESUMEN

BACKGROUND: The COVID-19 pandemics required several changes in stroke management and it may have influenced some clinical or functional characteristics. We aimed to evaluate the effects of the COVID-19 pandemics on stroke management during the first month of Italy lockdown. In addition, we described the emergency structured pathway adopted by an Italian University Hub Stroke Unit in the cross-border Italy-Slovenia area. METHODS: We analyzed admitted patients' clinical features and outcomes between 9th March 2020 and 9th April 2020 (first month of lockdown), and compared them with patients admitted during the same period in 2019. RESULTS: Total admissions experienced a reduction of 45% during the lockdown compared to the same period in 2019 (16 vs 29, respectively), as well as a higher prevalence of severe stroke (NIHSS>10) at admission (n = 8, 50% vs n = 8, 28%). A dramatic prevalence of stroke of unknown symptom onset was observed in 2020 (n = 8, 50% vs n = 3, 10%). During lockdown, worse functional and independence outcomes were found, despite the similar proportion of reperfused patients. Similar 'symptoms alert-to-admission' and 'door-to-treatment' times were observed. During lockdown hospitalization was shorter and fewer patients completed the stroke work-up. CONCLUSION: In conclusion, the adopted strategies for stroke management during the COVID-19 emergency have suggested being effective, while suffering a reduced and delayed reporting of symptoms. Therefore, we recommend raising awareness among the population against possible stroke symptoms onset. Thus, think F.A.S.T. and do not stay-at-home at all costs.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Prestación de Atención de Salud , Manejo de la Enfermedad , Accesibilidad a los Servicios de Salud , Pandemias , Neumonía Viral , Accidente Cerebrovascular/terapia , Anciano , Anciano de 80 o más Años , Protocolos Clínicos , Comorbilidad , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Diagnóstico Tardío , Prestación de Atención de Salud/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Miedo , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Unidades Hospitalarias , Hospitalización/estadística & datos numéricos , Hospitales Universitarios/organización & administración , Hospitales Universitarios/estadística & datos numéricos , Humanos , Italia , Masculino , Persona de Mediana Edad , Admisión del Paciente/estadística & datos numéricos , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Cuarentena , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/mortalidad , Tiempo de Tratamiento/estadística & datos numéricos
15.
Anesth Analg ; 131(1): 43-54, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32345861

RESUMEN

The outbreak of the coronavirus disease 2019 (COVID-19) and its rapid global spread have created unprecedented challenges to health care systems. Significant and sustained efforts have focused on mobilization of personal protective equipment, intensive care beds, and medical equipment, while substantially less attention has focused on preserving the psychological health of the medical workforce tasked with addressing the challenges of the pandemic. And yet, similar to battlefield conditions, health care workers are being confronted with ongoing uncertainty about resources, capacities, and risks; as well as exposure to suffering, death, and threats to their own safety. These conditions are engendering high levels of fear and anxiety in the short term, and place individuals at risk for persistent stress exposure syndromes, subclinical mental health symptoms, and professional burnout in the long term. Given the potentially wide-ranging mental health impact of COVID-19, protecting health care workers from adverse psychological effects of the pandemic is critical. Therefore, we present an overview of the potential psychological stress responses to the COVID-19 crisis in medical providers and describe preemptive resilience-promoting strategies at the organizational and personal level. We then describe a rapidly deployable Psychological Resilience Intervention founded on a peer support model (Battle Buddies) developed by the United States Army. This intervention-the product of a multidisciplinary collaboration between the Departments of Anesthesiology and Psychiatry & Behavioral Sciences at the University of Minnesota Medical Center-also incorporates evidence-informed "stress inoculation" methods developed for managing psychological stress exposure in providers deployed to disasters. Our multilevel, resource-efficient, and scalable approach places 2 key tools directly in the hands of providers: (1) a peer support Battle Buddy; and (2) a designated mental health consultant who can facilitate training in stress inoculation methods, provide additional support, or coordinate referral for external professional consultation. In parallel, we have instituted a voluntary research data-collection component that will enable us to evaluate the intervention's effectiveness while also identifying the most salient resilience factors for future iterations. It is our hope that these elements will provide guidance to other organizations seeking to protect the well-being of their medical workforce during the pandemic. Given the remarkable adaptability of human beings, we believe that, by promoting resilience, our diverse health care workforce can emerge from this monumental challenge with new skills, closer relationships, and greater confidence in the power of community.


Asunto(s)
Infecciones por Coronavirus/psicología , Personal de Salud/psicología , Unidades Hospitalarias/organización & administración , Neumonía Viral/psicología , Resiliencia Psicológica , Agotamiento Profesional/prevención & control , Agotamiento Profesional/psicología , Humanos , Salud Mental , Pandemias , Estrés Psicológico/prevención & control , Estrés Psicológico/psicología
16.
J Rehabil Med ; 52(4): jrm00041, 2020 Apr 14.
Artículo en Inglés | MEDLINE | ID: mdl-32253445

RESUMEN

OBJECTIVE: A prospective, observational study to describe levels of physical activity in patients with stroke on day 2 and day 5 or 6 after admission to a comprehensive stroke unit in Sweden. METHODS: The study was performed at the stroke unit at Sahlgrenska University Hospital during a period of 4 months between 2017 and 2018. Consecutive patients with stroke were observed for 1 min every 10 min while the multidisciplinary team was at work. The level of physical activity, location and the people present were noted at each time-point. RESULTS: A total of 46 patients were observed on day 2, of whom 29 were observed a second time on day 5 or 6. Patients were in bed half of the time and engaged in upright activity for less than 10% of day 2. Patients spent 73% of day 2 in the bedroom and 56% of this day alone. Over time, there was a significant shift of 10% from "in bed" activity to "sitting" (p §lt;0.001). CONCLUSION: Patients are physically inactive, alone and in their rooms for a majority of the time during the first days at a comprehensive stroke unit. There is some increase in physical activity during the first week after admission.


Asunto(s)
Ejercicio Físico , Rehabilitación de Accidente Cerebrovascular , Anciano , Anciano de 80 o más Años , Femenino , Unidades Hospitalarias , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Conducta Sedentaria , Aislamiento Social , Suecia
17.
Nursing ; 50(5): 54-60, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32332507

RESUMEN

Oncology nurses are at increased risk for compassion fatigue compared with those in other specialties. This article describes a quality improvement project to create self-compassion tool kits by incorporating the input and opinions of the frontline staff.


Asunto(s)
Desgaste por Empatía/prevención & control , Neoplasias/enfermería , Personal de Enfermería en Hospital/psicología , Enfermería Oncológica , Mejoramiento de la Calidad/organización & administración , Agotamiento Profesional/prevención & control , Desgaste por Empatía/psicología , Unidades Hospitalarias/organización & administración , Humanos , Investigación en Evaluación de Enfermería , Medición de Riesgo , Autocuidado , Encuestas y Cuestionarios
19.
Br J Nurs ; 29(8): 476-480, 2020 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-32324457

RESUMEN

BACKGROUND: Temporary epicardial pacing wires are inserted after cardiac surgery. However, there are no international guidelines on which to base best practice regarding wire insertion or removal. METHODS: Data were collected on patients following cardiopulmonary bypass and analysed in terms of use, duration of use and complications of pacing wires after surgery. RESULTS: Wires were inserted in 164 of the 167 patients. Most (74%) did not require pacing. Patients were categorised into those who had aortic valve replacement (AVR) (n=42) and those who did not (n=122). Of the AVR group, 26% (n=11) were pacemaker dependent after surgery and 10% (n=4) required permanent pacemakers. Most pacing wires were removed by day 4. The only noted complication was delayed discharge. CONCLUSION: Unused pacing wires are normally removed on day 4, but for 77 (47%) of patients they remained in place longer. Forty patients (24%) had delayed wire removal because of a policy of wire removal during business hours only. Of these 40 patients, 27 (17% of the 77 with delayed removal) had delayed discharge as a result of our wire removal policy.


Asunto(s)
Puente Cardiopulmonar , Marcapaso Artificial , Adulto , Anciano , Estudios Transversales , Remoción de Dispositivos/estadística & datos numéricos , Femenino , Unidades Hospitalarias/organización & administración , Humanos , Irlanda , Masculino , Persona de Mediana Edad , Política Organizacional , Marcapaso Artificial/efectos adversos , Guías de Práctica Clínica como Asunto , Factores de Tiempo
20.
J Dig Dis ; 21(4): 199-204, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32267098

RESUMEN

An epidemic of an acute respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, now known as coronavirus disease 2019 (COVID-19), beginning in December 2019, has attracted an intense amount of attention worldwide. As the natural history and variety of clinical presentations of this disease unfolds, extrapulmonary symptoms of COVID-19 have emerged, especially in the digestive system. While the respiratory mode of transmission is well known and is probably the principal mode of transmission of this disease, a possibility of the fecal-oral route of transmission has also emerged in various case series and clinical scenarios. In this review article, we summarize four different aspects in published studies to date: (a) gastrointestinal manifestations of COVID-19; (b) microbiological and virological investigations; (c) the role of fecal-oral transmission; and (d) prevention and control of SARS-CoV-2 infection in the digestive endoscopy room. A timely understanding of the relationship between the disease and the digestive system and implementing effective preventive measures are of great importance for a favorable outcome of the disease and can help climnicians to mitigate further transmission by taking appropriate measures.


Asunto(s)
Infecciones por Coronavirus/transmisión , Infección Hospitalaria/prevención & control , Enfermedades del Sistema Digestivo , Endoscopía del Sistema Digestivo/normas , Gastroenterología/normas , Control de Infecciones/normas , Neumonía Viral/transmisión , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/virología , Infección Hospitalaria/etiología , Infección Hospitalaria/virología , Enfermedades del Sistema Digestivo/diagnóstico , Enfermedades del Sistema Digestivo/etiología , Enfermedades del Sistema Digestivo/microbiología , Enfermedades del Sistema Digestivo/virología , Unidades Hospitalarias/normas , Humanos , Pandemias , Equipo de Protección Personal/normas , Neumonía Viral/complicaciones , Neumonía Viral/virología
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