Ease in Emergency Hospital Visits Due to Covid-19 Following Implementation of a Telemedicine Service in Ceará, Brazil.

Background: We assessed the impact of implementing a virtual emergency room (VER) in easing emergency room (ER) visits in patients suspected of having COVID-19. Materials and Methods: Retrospective observational cohort study conducted in May 2020 and in March 2021, during the first and second waves in Brazil. Patients could choose to either visiting ER or using the VER (implemented in March 2021). Medical records were revised for demographic and clinical data. The primary outcome was the number of visits. Results: A total of 32,822 visits were evaluated. HR was more than three times less in the VER group with <10% VER clients going to ER. The trend and volume of use of the emergency sector in the periods did not show a statistically significant difference, despite the higher number of cases in the second period. Conclusion: This telemedicine strategy led to a reduction in visits to the ER. Also, our results suggest the safety of this intervention.

Dealing with the impact of the COVID-19 pandemic on a rapid response team operation in Brazil: Quality in practice.

QUALITY PROBLEM OR ISSUE: Up to 13 July 2020, >12 million laboratory-confirmed cases of coronavirus disease of 2019 (COVID-19) infection have been reported worldwide, 1 864 681 in Brazil. We aimed to assess an intervention to deal with the impact of the COVID-19 pandemic on the operations of a rapid response team (RRT). INITIAL ASSESSMENT: An observational study with medical record review was carried out at a large tertiary care hospital in Fortaleza, a 400-bed quaternary hospital, 96 of which are intensive care unit beds. All adult patients admitted to hospital wards, treated by the RRTs during the study period, were included, and a total of 15 461 RRT calls were analyzed. CHOICE OF SOLUTION: Adequacy of workforce sizing. IMPLEMENTATION: The hospital adjusted the size of its RRTs during the period, going from two to four simultaneous on-duty medical professionals. EVALUATION: After the beginning of the pandemic, the number of treated cases in general went from an average of 30.6 daily calls to 79.2, whereas the extremely critical cases went from 3.5 to 22 on average. In percentages, the extremely critical care cases went from 10.47 to 20%, with P < 0.001. Patient mortality remained unchanged. The number of critically ill cases and the number of treated patients increased 2-fold in relation to the prepandemic period, but the effectiveness of the RRT in relation to mortality was not affected. LESSONS LEARNED: The observation of these data is important for hospital managers to adjust the size of their RRTs according to the new scenario, aiming to maintain the intervention effectiveness.

Silicose em cavadores de poços da regiäo de Ibiapaba(CE): da descoberta ao controle / Silicosis among PIT diggers in the region of Ibiapaba, state of Ceará, Brazil: from detection to control

A ocorrência de silicose em cavadores de poços foi descoberta em 1984. Em 1988, foi evidenciado um foco da doença na regiäo da Ibiapaba, Estado do Ceará (Brasil). O presente estudo teve por objetivos: 1) apresentar a intervençäo educativa preventiva primária (IEPP) criada, segundo o método de conscientizaçäo crítica de Paulo Freire, e aplicada aos cavadores de poços e seus familiares; 2) conhecer o papel dessas medidas no aprendizado sobre silicose e nas mudanças de atitude promovidas na prática dessa atividade na regiäo da Ibiapaba. Dos 1.202 cavadores de poços da regiäo, 687 de cinco municípios selecionados para o estudo foram submetidos à IEPP e, destes, 283 participaram do estudo do papel da IEPP no controle da silicose. Todos eram homens, com idades variando de 18 a 78 anos; 115 eram silicóticos, 122 näo silicóticos e 46 ignoravam o diagnóstico. Os resultados mostraram que a IEPP promoveu apresendizado sólido sobre a relaçäo entre cavar poços e silicose, independentemente dos indivíduos serem ou näo portadores da doença, induzindo a maioria deles (85,8 por cento) a abandonarem a atividade. A IEPP foi capaz de promover a conscientizaçäo do problema nos cavadores de poços, interrompendo o ciclo epidemiológico da silicose na regiäo da Ibiapaba.