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1.
Rev. enferm. UERJ ; 28: e35054, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1117622

RESUMO

Objetivo: avaliar a mobilidade do cliente com dermatose imunobolhosa antes e após aplicação do curativo com gaze vaselinada. Método: estudo quase experimental, interinstitucional, com clientes com dermatoses imunobolhosas hospitalizados em um hospital estadual e um hospital federal do Estado do Rio de Janeiro e uma instituição do Mato Grosso do Sul. Utilizou-se a lógica fuzzy para classificar a mobilidade dos sujeitos antes, 24 horas após e uma semana após aplicação do curativo. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa. Resultados: Incluídos 14 participantes, sendo nove com pênfigo vulgar, dois com pênfigo foliáceo e três com penfigóide bolhoso, entre 27 e 82 anos, predominando 11 mulheres. Após 24 horas, nenhum participante se considerou com baixa mobilidade, sete passaram a mobilidade média, e sete, alta, o que foi mantido uma semana após aplicação do curativo. Conclusão: constatou-se significativo aumento da mobilidade logo nas primeiras 24 horas após aplicação do curativo.


Objective: to assess the mobility of clients with immunobullous dermatoses, before and after applying vaseline gauze dressings. Method: in this quasi-experimental, interinstitutional study of inpatients with immunobullous dermatoses at a state hospital and a federal hospital in Rio de Janeiro State and an institution in Mato Grosso do Sul (Brazil), patient mobility before, 24 hours after, and one week after applying the dressing was classified using fuzzy logic. The study was approved by the research ethics committee. Results: 14 participants, nine with pemphigus vulgaris, two with pemphigus foliaceus, and three with bullous pemphigoid, aged between 27 and 82 years old, and predominantly (11) women. After 24 hours, none of the participants considered their mobility to be poor, seven began to be moderately mobile, and seven were highly mobile, and continued so one week after applying the dressing. Conclusion: mobility increased significant in the first 24 hours after applying the dressing.


Objetivo: evaluar la movilidad de clientes con dermatosis inmunobullosa, antes y después de la aplicación de apósitos de gasa con vaselina. Método: en este estudio cuasi-experimental, interinstitucional de pacientes hospitalizados con dermatosis inmunobullosa en un hospital estatal y un hospital federal en el estado de Río de Janeiro y una institución en Mato Grosso do Sul (Brazil), la movilidad del paciente antes, 24 horas después y una semana después la aplicación del apósito se clasificó mediante lógica difusa. El estudio fue aprobado por el comité de ética en investigación. Resultados: se incluyeron 14 participantes, nueve con pénfigo vulgar, dos con pénfigo foliáceo y tres con penfigoide ampolloso, con edades comprendidas entre 27 y 82 años, y predominantemente mujeres (n=11). Después de 24 horas, ninguno de los participantes consideró que su movilidad fuera pobre, siete comenzaron a ser moderadamente móviles y siete eran altamente móviles, y así continuaron una semana después de la aplicación del apósito. Conclusión: la movilidad aumentó significativamente en las primeras 24 horas después de la aplicación del apósitoconsideraba con baja movilidad, siete comenzaron a tener movilidad media y siete, alta, que se mantuvo una semana después de aplicar el apósito. Conclusión: hubo un aumento significativo en la movilidad en las primeras 24 horas después de aplicar el apósito.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Vaselina/uso terapêutico , Bandagens , Dermatopatias Vesiculobolhosas/terapia , Penfigoide Bolhoso/terapia , Pênfigo/terapia , Limitação da Mobilidade , Brasil , Lógica Fuzzy , Lesão por Pressão/prevenção & controle , Prevenção Secundária , Ensaios Clínicos Controlados não Aleatórios como Assunto , Hospitais Públicos , Pacientes Internados , Cuidados de Enfermagem
2.
BMJ ; 371: m3884, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-33032985
3.
BMC Public Health ; 20(1): 1561, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33066745

RESUMO

BACKGROUND: With many medical equipment in hospitals coming in direct contact with healthcare workers, patients, technicians, cleaners and sometimes care givers, it is important to pay close attention to their capacity in harboring potentially harmful pathogens. The goal of this study was to assess the role that medical equipment may potentially play in hospital acquired infections in four public health facilities in Uganda. METHODS: A cross-sectional study was conducted from December 2017 to January 2018 in four public health facilities in Uganda. Each piece of equipment from the neonatal department, imaging department or operating theatre were swabbed at three distinct points: a location in contact with the patient, a location in contact with the user, and a remote location unlikely to be contacted by either the patient or the user. The swabs were analyzed for bacterial growth using standard microbiological methods. Seventeen bacterial isolates were randomly selected and tested for susceptibility/resistance to common antibiotics. The data collected analyzed in STATA version 14. RESULTS: A total of 192 locations on 65 equipment were swabbed, with 60.4% of these locations testing positive (116/192). Nearly nine of ten equipment (57/65) tested positive for contamination in at least one location, and two out of three equipment (67.7%) tested positive in two or more locations. Of the 116 contaminated locations 52.6% were positive for Bacillus Species, 14.7% were positive for coagulase negative staphylococcus, 12.9% (15/116) were positive for E. coli, while all other bacterial species had a pooled prevalence of 19.8%. Interestingly, 55% of the remote locations were contaminated compared to 66% of the user contacted locations and 60% of the patient contacted locations. Further, 5/17 samples were resistant to at least three of the classes of antibiotics tested including penicillin, glycylcycline, tetracycline, trimethoprim sulfamethoxazole and urinary anti-infectives. CONCLUSION: These results provides strong support for strengthening overall disinfection/sterilization practices around medical equipment use in public health facilities in Uganda. There's also need for further research to make a direct link to the bacterial isolates identified and cases of infections recorded among patients in similar settings.


Assuntos
Infecção Hospitalar/epidemiologia , Contaminação de Equipamentos/estatística & dados numéricos , Equipamentos e Provisões/microbiologia , Hospitais Públicos , Centros de Atenção Terciária , Estudos Transversais , Humanos , Uganda/epidemiologia
4.
Emergencias ; 32(5): 320-331, 2020 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33006832

RESUMO

OBJECTIVES: To estimate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the organization of Spanish hospital emergency departments (EDs). To explore differences between Spanish autonomous communities or according to hospital size and disease incidence in the area. MATERIAL AND METHODS: Survey of the heads of 283 EDs in hospitals belonging to or affiliated with Spain's public health service. Respondents evaluated the pandemic's impact on organization, resources, and staff absence from work in March and April 2020. Assessments were for 15-day periods. Results were analyzed overall and by autonomous community, hospital size, and local population incidence rates. RESULTS: A total of 246 (87%) responses were received. The majority of the EDs organized a triage system, first aid, and observation wards; areas specifically for patients suspected of having COVID-19 were newly set apart. The nursing staff was increased in 83% of the EDs (with no subgroup differences), and 59% increased the number of physicians (especially in large hospitals and locations where the COVID-19 incidence was high). Diagnostic tests for the severe acute respiratory syndrome coronavirus 2 were the resource the EDs missed most: 55% reported that tests were scarce often or very often. Other resources reported to be scarce were FPP2 and FPP3 masks (38% of the EDs), waterproof protective gowns (34%), and space (32%). More than 5% of the physicians, nurses, or other emergency staff were on sick leave 20%, 19%, and 16% of the time. These deficiencies were greatest during the last half of March, except for tests, which were most scarce in the first 15 days. Large hospital EDs less often reported that diagnostic tests were unavailable. In areas where the COVID-19 incidence was higher, the EDs reported higher rates of staff on sick leave. Resource scarcity differed markedly by autonomous community and was not always associated with the incidence of COVID-19 in the population. CONCLUSION: The COVID-19 pandemic led to organizational changes in EDs. Certain resources became scarce, and marked differences between autonomous communities were detected.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Absenteísmo , Adulto , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Surtos de Doenças , Serviço Hospitalar de Emergência/organização & administração , Recursos em Saúde/provisão & distribução , Necessidades e Demandas de Serviços de Saúde , Mão de Obra em Saúde/estatística & dados numéricos , Número de Leitos em Hospital , Hospitais Públicos/organização & administração , Hospitais Públicos/estatística & dados numéricos , Humanos , Incidência , Recursos Humanos em Hospital/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Alocação de Recursos , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/etiologia , Espanha/epidemiologia , Triagem/organização & administração
5.
Rev. SOBECC ; 25(3): 128-135, 30-09-2020.
Artigo em Inglês | LILACS | ID: biblio-1122400

RESUMO

Objetivo: Analisar o processo de produção e execução do protocolo de cirurgia segura em dois hospitais terciários do município de Manaus. Método: Pesquisa guiada pelo design thinking, com ênfase na técnica do duplo diamante, realizada em dois hospitais públicos no município de Manaus, de julho de 2018 a março de 2019. Foi feita nas etapas: investigativa (observação e questionário) e interventiva (síntese, ideação e entrega). Resultados: Na primeira etapa, com 120 horas de observação, constatou-se que as três fases do protocolo não foram cumpridas; analisando-se as repostas a 63 questionários, reforçou-se a não adesão ao checklist. Com base nesses achados, na etapa de síntese, elegeu-se como foco a aplicação do checklist do protocolo; na etapa de ideação, realizou-se a proposição de solução e a testagem-piloto; a etapa de entrega da solução aos hospitais encerrou o ciclo. Conclusão: A análise do processo de execução do protocolo indicou seu descumprimento, o que sugere o comprometimento da segurança do paciente. A solução testada poderá, após entrega e implementação, contribuir para a execução efetiva do protocolo.


Objective: To analyze the process of elaboration and implementation of the surgical safety checklist in two tertiary hospitals in the city of Manaus. Method: This study was based on design thinking, focusing on the double diamond technique. It was conducted in two public hospitals in Manaus, from July 2018 to March 2019. The following stages were adopted for this research: investigation (observation and questionnaire) and intervention (synthesis, ideation, and delivery). Results: The first stage, consisting of 120 hours of observation, showed the non-fulfillment of the three phases of the process. After analyzing the answers to the 63 questionnaires, we confirmed the non-adherence to the checklist. Based on these findings, the synthesis phase focused on the use of the checklist; the ideation phase involved the proposal of solutions and the pilot testing; the delivery phase concluded the cycle by providing solutions to the hospitals. Conclusion: The analysis of the process of implementation of the checklist indicated non-compliance, suggesting risk to patient safety. After delivery and implementation, the tested solution may contribute to the effective execution of the checklist.


Objetivo: Analizar el proceso de producción y ejecución del Protocolo de Cirugía Segura en dos hospitales terciarios de la ciudad de Manaus. Método: Investigación guiada por Design Thinking, con énfasis en la técnica Double Diamond, llevada a cabo en dos hospitales públicos de la ciudad de Manaus, desde julio de 2018 hasta marzo de 2019. Se realizó por etapas: de investigación (observación y cuestionario) e intervencionista (síntesis, ideación y entrega). Resultados: En la primera etapa, con 120 horas de observación, se encontró que las tres fases del protocolo no se cumplieron; En base a las respuestas a 63 cuestionarios, se reforzó la no adhesión a la lista de verificación. Con base en estos hallazgos, en la etapa de síntesis, la aplicación de la lista de verificación del protocolo fue elegida como el foco; en la etapa de ideación, se llevaron a cabo la propuesta de solución y la prueba piloto;La etapa de entrega de la solución a los hospitales finalizó el ciclo. Conclusión: El análisis del proceso de ejecución del protocolo indicó incumplimiento, lo que sugiere comprometer la seguridad del paciente. La solución probada puede, después de la entrega y la implementación, contribuir a la ejecución efectiva del protocolo.


Assuntos
Humanos , Cirurgia Geral , Lista de Checagem , Segurança do Paciente , Protocolos , Hospitais , Hospitais Públicos
6.
S Afr Med J ; 110(6): 519-524, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880565

RESUMO

BACKGROUND: Delirium is a common, serious, underdiagnosed condition in medical and surgical inpatients with acute conditions. It is associated with increased risk of mortality and morbidity. Data of geriatric cohorts are largely limited to developed countries. OBJECTIVES: To describe prevalence, risk factors and outcomes of delirium among general medical patients admitted to two hospitals in Cape Town, South Africa. METHODS: This was a prospective cohort study of patients with acute conditions admitted to a general medical inpatient service in secondary- and tertiary-level public hospitals in the Metro West area of Cape Town. Patients ≥18 years of age were recruited daily from all acute medical admissions. Patients were excluded if they were aphasic or their Glasgow coma scale was <8/15. Delirium was diagnosed using the validated confusion assessment method (CAM) tool and performed by trained neuropsychologists. Demographic data were collected by a clinical team and short- and long-term mortality data were obtained using linkage analysis of hospitalised patients and routinely collected provincial death certification records. RESULTS: The median age of inpatients was 51 (interquartile range 36 - 65) years, 29% were HIV-infected and the overall prevalence of delirium was 12.3%. Multivariate predictors of delirium included the presence of an indwelling urinary catheter (odds ratio (OR) 4.47; confidence interval (CI) 2.43 - 8.23), admission with a central nervous system disease (OR 4.34; CI 2.79 - 7.90), pre-existing cognitive impairment (OR 3.02; CI 1.22 - 7.43) and immobility (OR 1.88; CI 1.01 - 3.51). HIV infection was not associated with increased risk of delirium. Delirium was associated with an increased risk of inhospital (delirium v. no delirium: 29% v. 12%; p<0.01) and 12-month (30% v. 20%; p<0.01) mortality, as well as increased length of hospital stay (7 days v. 5 days; p<0.01). CONCLUSIONS: In this cohort of medical inpatients (relatively young and with a high HIV prevalence) 1 of 8 (12.3%) patients was delirious. Delirium was associated with adverse outcomes. Delirium risk factors in this young cohort were similar to those in geriatric cohorts in developed countries, and neither HIV nor opportunistic infections increased risk.


Assuntos
Delírio/epidemiologia , Pacientes Internados , Adulto , Idoso , Delírio/mortalidade , Feminino , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Prevalência , Estudos Prospectivos , Fatores de Risco , África do Sul/epidemiologia
8.
S Afr Med J ; 110(9): 916-919, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32880278

RESUMO

BACKGROUND: In preparation for the COVID-19 pandemic, South Africa (SA) began a national lockdown on 27 March 2020, and many hospitals implemented measures to prepare for a potential COVID-19 surge. OBJECTIVES: To report changes in SA hospital surgical practices in response to COVID-19 preparedness. METHODS: In this cross-sectional study, surgeons working in SA hospitals were recruited through surgical professional associations via an online survey. The main outcome measures were changes in hospital practice around surgical decision-making, operating theatres, surgical services and surgical trainees, and the potential long-term effect of these changes. RESULTS: A total of 133 surgeons from 85 hospitals representing public and private hospitals nationwide responded. In 59 hospitals (69.4%), surgeons were involved in the decision to de-escalate surgical care. Access was cancelled or reduced for non-cancer elective (n=84; 99.0%), cancer (n=24; 28.1%) and emergency operations (n=46; 54.1%), and 26 hospitals (30.6%) repurposed at least one operating room as a ventilated critical care bed. Routine postoperative visits were cancelled in 33 hospitals (36.5%) and conducted by telephone or video in 15 (16.6%), 74 hospitals (87.1%) cancelled or reduced new outpatient visits, 64 (75.3%) reallocated some surgical inpatient beds to COVID-19 cases, and 29 (34.1%) deployed some surgical staff (including trainees) to other hospital services such as COVID-19 testing, medical/COVID-19 wards, the emergency department and the intensive care unit. CONCLUSIONS: Hospital surgical de-escalation in response to COVID-19 has greatly reduced access to surgical care in SA, which could result in a backlog of surgical needs and an excess of morbidity and mortality.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Cirurgia Geral/educação , Admissão e Escalonamento de Pessoal , Pneumonia Viral/epidemiologia , Centro Cirúrgico Hospitalar , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Betacoronavirus , Tomada de Decisão Clínica , Estudos Transversais , Educação de Pós-Graduação em Medicina , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Emergências , Hospitais Privados , Hospitais Públicos , Humanos , Salas Cirúrgicas , Pandemias , Seleção de Pacientes , África do Sul/epidemiologia , Inquéritos e Questionários , Telefone , Comunicação por Videoconferência
10.
Int J Equity Health ; 19(1): 152, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32887629

RESUMO

BACKGROUND: General Government Health Expenditure (GGHE) in Mauritius accounted for only 10% of General Government Expenditure for the fiscal year 2018. This is less than the pledge taken under the Abuja 2001 Declaration to allocate at least 15% of national budget to the health sector. The latest National Health Accounts also urged for an expansion in the fiscal space for health. As public hospitals in Mauritius absorb 70% of GGHE, maximising returns of hospitals is essential to achieve Universal Health Coverage. More so, as Mauritius is bracing for its worst recession in 40 years in the aftermath of the COVID-19 pandemic public health financing will be heavily impacted. A thorough assessment of hospital efficiency and its implications on effective public health financing and fiscal space creation is, therefore, vital to inform ongoing health reform agenda. OBJECTIVES: This paper aims to examine the trend in hospital technical efficiency over the period 2001-2017, to measure the elasticity of hospital output to changes in inputs variables and to assess the impact of improved hospital technical efficiency in terms of fiscal space creation. METHODS: Annual health statistics released by the Ministry of Health and Wellness and national budget of the Ministry of Finance, Economic Planning and Development were the principal sources of data. Applying Stochastic Frontier Analysis, technical efficiency of public regional hospitals was estimated under Cobb-Douglas, Translog and Multi-output distance functions, using STATA 11. Hospital beds, doctors, nurses and non-medical staff were used as input variables. Output variable combined inpatients and outpatients seen at Accident Emergency, Sorted and Unsorted departments. Efficiency scores were used to determine potential efficiency savings and fiscal space creation. FINDINGS: Mean technical efficiency scores, using the Cobb Douglas, Translog and Multi-output functions, were estimated at 0.83, 0.84 and 0.89, respectively. Nurses and beds are the most important factors in hospital production, as a 1% increase in the number of beds and nurses, result in an increase in hospital outputs by 0.73 and 0.51%, respectively. If hospitals are to increase their inputs by 1%, their outputs will increase by 1.16%. Hospital output process has an increasing return to scale. With technical efficiencies improving to scores of 0.95 and 1.0 in 2021-2022, potential savings and fiscal space creation at hospital level, would amount to MUR 633 million (US$ 16.2 million) and MUR 1161 million (US$ 29.6 million), respectively. CONCLUSION: Fiscal space creation through full technical efficiency, is estimated to represent 8.9 and 9.2% of GGHE in fiscal year 2021-2022 and 2022-2023, respectively. This will allow without any restrictions the funding of the national response for HIV, vaccine preventable diseases as well as building a resilient health system to mitigate impact of emerging infectious diseases as experienced with COVID-19.


Assuntos
Eficiência Organizacional/estatística & dados numéricos , Financiamento Governamental/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Hospitais Públicos/economia , Hospitais Públicos/organização & administração , Infecções por Coronavirus/epidemiologia , Reforma dos Serviços de Saúde , Humanos , Maurício , Pandemias , Pneumonia Viral/epidemiologia , Cobertura Universal do Seguro de Saúde
11.
J Nepal Health Res Counc ; 18(2): 166-171, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32969371

RESUMO

BACKGROUND: The study assesses the perspective of doctors working in government hospitals of Nepal regarding hospital preparedness for infection prevention measures, isolation services provisions, critical care service readiness, and training of staff for COVID-19 pandemic management. METHODS: This cross-sectional study was done in central, provincial, and local level health centers of the Government of Nepal to assess the perspective of medical doctors regarding COVID-19 pandemic readiness in their facility. Nonprobability sampling was used to collect 56 responses from doctors working in different hospitals of Nepal. An online survey was performed using a questionnaire tool, which was adapted from the guidelines of the World Health Organization and the Centers for Disease Control and Prevention. RESULTS: Most of the participants were medical officers with an MBBS degree (32) followed by anesthesiologists (10). Thirteen participants worked in central hospitals (23.2%), 24 in provincial hospitals (42.8%) and 19 in local health centers (33.92%). The availability of adequate facemask was 84% in central hospitals, which was higher than provincial hospitals (66.7%), and local level health centers (77.8%). There were only 53.8% trained critical care providers in central hospitals and 29.2% in provincial hospitals. Nearly 38.5% (5) of central hospitals had measures for airborne isolation in place, whereas this was only found in 8.3% (2) of provincial hospitals surveyed for critical care facilities. Overall, only 2 hospitals had the provision of a negative pressure room with air exchanges. Only 8 participants working in central hospitals (61.5%) and 14 working in provincial hospitals (58.3%) had performed hands-on training for donning and doffing personal protective equipment. CONCLUSIONS: The majority of medical doctors working in government hospitals of Nepal perceive that provision of facemask distribution, airborne isolation rooms, critical care preparedness, and hands-on training to staff were not adequate.


Assuntos
Infecções por Coronavirus/epidemiologia , Planejamento Hospitalar , Hospitais Públicos/organização & administração , Controle de Infecções/organização & administração , Capacitação em Serviço , Corpo Clínico Hospitalar/psicologia , Pneumonia Viral/epidemiologia , Adulto , Betacoronavirus , Estudos Transversais , Humanos , Nepal/epidemiologia , Pandemias , Equipamento de Proteção Individual , Inquéritos e Questionários
12.
Rev Esp Enferm Dig ; 112(10): 748-755, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32954775

RESUMO

INTRODUCTION: the global SARS-CoV-2 pandemic forced the closure of endoscopy units. Before resuming endoscopic activity, we designed a protocol to evaluate gastroscopies and colonoscopies cancelled during the pandemic, denying inappropriate requests and prioritizing appropriate ones. METHODS: two types of inappropriate request were established: a) COVID-19 context, people aged ≤ 50 years without alarm symptoms and a low probability of relevant endoscopic findings; and b) inappropriate context, requests not in line with clinical guidelines or protocols. Denials were filed in the medical record. Appropriate requests were classified into priority, conventional and follow-up. Requests denied by specialty were compared and the findings of priority requests were evaluated. RESULTS: between March 16th and June 30th 2020, 1,658 requests (44 % gastroscopies and 56 % colonoscopies) were evaluated, of which 1,164 (70 %) were considered as appropriate (priority 8.5 %, conventional 48 %, follow-up 43 % and non-evaluable 0.5 %) and 494 (30 %) as inappropriate (20 % COVID-19 context, 80 % inappropriate context). The reasons for denial of gastroscopy were follow-up of lesions (33 %), insufficiently studied symptoms (20 %) and relapsing symptoms after a previous gastroscopy (18 %). The reasons for denial of colonoscopies were post-polypectomy surveillance (25 %), colorectal cancer after surgery (21 %) and a family history of cancer (13 %). There were significant differences in denied requests according to specialty: General Surgery (52 %), Hematology (37 %) and Primary Care (29 %); 31 % of priority cases showed relevant findings. CONCLUSIONS: according to our study, 24 % of endoscopies were discordant with scientific recommendations. Therefore, their denial and the prioritization of appropriate ones optimize the use of resources.


Assuntos
Betacoronavirus , Colonoscopia/normas , Infecções por Coronavirus/prevenção & controle , Gastroscopia/normas , Alocação de Recursos para a Atenção à Saúde/normas , Acesso aos Serviços de Saúde/normas , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Colonoscopia/tendências , Feminino , Gastroscopia/tendências , Alocação de Recursos para a Atenção à Saúde/tendências , Acesso aos Serviços de Saúde/tendências , Hospitais Públicos/normas , Hospitais Públicos/tendências , Humanos , Controle de Infecções/normas , Controle de Infecções/tendências , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Espanha , Centros de Atenção Terciária/normas , Centros de Atenção Terciária/tendências , Adulto Jovem
13.
Arch. argent. pediatr ; 118(4): 258-264, agosto 2020. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1118499

RESUMO

La oxigenación por membrana extracorpórea (extracorporeal membrane oxygenation; ECMO, por sus siglas en inglés) es una terapia de rescate muy invasiva, para pacientes críticamente enfermos. El objetivo es mostrar los resultados de los pacientes tratados con ECMO en el Área de Terapia Intensiva Neonatal del Hospital de Pediatría Juan P. Garrahan, en los primeros diez años del programa, y analizar los factores de riesgo asociados a mortalidad en ECMO. Método. Estudio descriptivo, retrospectivo, con análisis de factores de riesgo. Se incluyeron todos los pacientes tratados con ECMO desde abril de 2008 a febrero de 2019. Resultados. Ingresaron 77 pacientes, 72 recién nacidos y 5 pacientes pediátricos, menores de 1 año. La mediana de edad al ingresar fue de 2días (1-150). Peso: 3200 g±730; edad gestacional: 37,5 semanas ± 4,2; el 53 %, del sexo masculino, y el 50 %, nacidos por cesárea. Los diagnósticos más frecuentes fueron hernia diafragmática congénita y síndrome de aspiración meconial. Sobrevivieron a ECMO 56 pacientes (el 73 %); de estos, fallecieron antes del alta 17 (el 30 %). Las variables asociadas con mortalidad en ECMO fueron la hemorragia en el sistema nervioso central (p: < 0,01), la necesidad de hemodiafiltración (p: < 0,01), el requerimiento de inotrópicos durante ECMO (p: < 0-01) y la presencia de hemorragia sin compromiso del sistema nervioso central (p: < 0-01). Conclusiones. Este estudio refleja los resultados de los primeros 10 años de ECMO respiratoria neonatal. La aparición de complicaciones aumentó la mortalidad durante el procedimiento


Extracorporeal membrane oxygenation (ECMO) is a highly invasive rescue treatment for criticallyill patients. The objective of the study was to show the outcomes of patients treated with ECMO in the neonatal intensive care unit of Hospital de Pediatría Juan P. Garrahan in the first 10 years of the program, and to analyze the risk factors associated with mortality on ECMO. Method. Descriptive, retrospective study with risk factor analysis. All patients treated with ECMO between April 2008 and February 2019 were included. Results. A total of 77 patients were included: 72 neonates and 5 infants younger than 1 year. Patients' median age at admission was 2 days (1-150); weight: 3200 g ± 730 g; gestational age: 37.5 weeks ± 4.2; 53 % were males; and 50 % had been born by C-section. The most common diagnoses included congenital diaphragmatic hernia and meconium aspiration syndrome. Fifty-six patients (73%) survived ECMO; of them, 17 (30 %) died before discharge. The outcome measures associated with mortality on ECMO were central nervous system hemorrhage (p < 0.01), hemodiafiltration requirement (p < 0.01), inotrope requirement during ECMO (p < 0.01), and presence of hemorrhage not affecting the central nervous system (p < 0.01). Conclusions. This study describes the outcomes of the first 10 years of the neonatal respiratory ECMO program. The onset of complications increased mortality during ECMO


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Oxigenação por Membrana Extracorpórea , Insuficiência Respiratória , Epidemiologia Descritiva , Estudos Retrospectivos , Fatores de Risco , Cuidados Críticos , Hospitais Públicos
14.
Rev. Hosp. El Cruce ; (26): 17-27, Ago 2020.
Artigo em Espanhol | LILACS | ID: biblio-1117088

RESUMO

El dolor postoperatorio (DPO) es tratado insuficientemente. La incidencia del DPO es 40-53%. Objetivo general: Evaluar el DPO en pacientes internados en cuidados intermedios de adultos (CIADU) del Hospital El Cruce durante septiembre, octubre y noviembre de 2016. Objetivos específicos: Describir la intensidad y la prevalencia en pacientes ingresados a CIADU con DPO inmediato, a las 24 y 48 horas, las drogas utilizadas y los efectos adversos, estimar la efectividad del tratamiento y la satisfacción de los pacientes a las 24hs. Métodos: Estudio observacional, prospectivo. Se incluyeron 62 pacientes mayores de 18 años que ingresaron a CIADU cursando postoperatorio inmediato. Se analizaron las variables edad, sexo, comorbilidades, tratamientos previos del dolor, fecha de ingreso y egreso, tipo de cirugía, analgesia al ingreso, presencia e intensidad del dolor al ingreso, a las 24 y a las 48 horas, tratamiento instaurado en las primeras 24 horas, escala de Impresión Global Del Cambio a las 24 hs y registros en historia clínica del dolor. Resultados: La edad media fue de 43.5 años, 60% mujeres, las cirugías fueron programadas en el 97%, con técnica convencional el 68%. La mediana de días de internación fue de 3.1. El 51,6% tenía comorbilidades. Los tipos de cirugías fueron en el 29% traumatológicas, 18% generales, 15% neurológicas, 11% urológicas, 10% bariátricas. Al ingreso el 58% tenían dolor severo, 24 % moderado y 16% leve; 10% tenían tratamiento analgésico al ingreso; el 11% habían recibido tratamiento preventivo del dolor. A las 24hs el 11% tenía dolor severo y 36% moderado. A las 48 hs el 2% tenía dolor severo y 11% moderado. La adherencia a las guías de dolor fue 47%. Efectos adversos se dieron en el 11%. El registro en la historia clínica fue 6%.


Postoperative pain (DPO) is insufficiently treated. The incidence of DPO is 40-53%. General Objective: To evaluate the DPO in patients admitted in adult intermediate care (CIADU) of the El Cruce Hospital during September, October and November 2016. Specific objectives: To describe the intensity and prevalence in patients admitted to CIADU with immediate OPD, at 24 and 48 hours, the drugs used and the adverse effects, to estimate the effectiveness of the treatment and the satisfaction of the patients at 24 hours. Methods: Observational, prospective study. Sixty-two patients over 18 years of age who entered the CIADU undergoing immediate postoperative period were included. The variables age, sex, comorbidities, previous pain treatments, date of admission and discharge, type of surgery, analgesia at admission, presence and intensity of pain at admission, at 24 and 48 hours, treatment established in the first were analyzed. 24 hours, Global Impression of Change scale at 24 hours and records in the medical history of pain. Results: The average age was 43.5 years, 60% women, surgeries were scheduled in 97%, with conventional technique 68%. The median days of hospitalization was 3.1. 51.6% had comorbidities. The types of surgeries were 29% traumatic, 18% general, 15% neurological, 11% urological, 10% bariatric. On admission 58% had severe pain, 24% moderate and 16% mild; 10% had analgesic treatment on admission; 11% had received preventive pain treatment. At 24 hours, 11% had severe pain and 36% moderate. At 48 hours, 2% had severe pain and 11% moderate. Adherence to pain guidelines was 47%. Adverse effects occurred in 11%. The record in the medical record was 6%.


Assuntos
Dor Pós-Operatória , Argentina , Terapia Combinada , Hospitais Públicos , Instituições para Cuidados Intermediários
15.
Medicine (Baltimore) ; 99(30): e21241, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791698

RESUMO

Financial crisis has forced health systems to seek alternatives to hospitalization-based healthcare. Quick diagnosis units (QDUs) are cost-effective compared to hospitalization, but the determinants of QDU costs have not been studied.We aimed at assessing the predictors of costs of a district hospital QDU (Hospital Plató, Barcelona) between 2009 and 2016.This study was a retrospective longitudinal single center study of 404 consecutive outpatients referred to the QDU of Hospital Plató. The referral reason was dichotomized into suggestive of malignancy vs other. The final diagnosis was dichotomized into organic vs nonorganic and malignancy vs nonmalignancy. All individual resource costs were obtained from the finance department to conduct a micro-costing analysis of the study period.Mean age was 62 ±â€Š20 years (women = 56%), and median time-to-diagnosis, 12 days. Total and partial costs were greater in cases with final diagnosis of organic vs nonorganic disorder, as it was in those with symptoms suggestive or a final diagnosis of cancer vs noncancer. Of all subcosts, imaging showed the stronger correlation with total cost. Time-to-diagnosis and imaging costs were significant predictors of total cost above the median in binary logistic regression, with imaging costs also being a significant predictor in multiple linear regression (with total cost as quantitative outcome).Predictors of QDU costs are partly nonmodifiable (i.e., cancer suspicion, actually one of the goals of QDUs). Yet, improved primary-care-to-hospital referral circuits reducing time to diagnosis as well as optimized imaging protocols might further increase the QDU cost-effectiveness process. Prospective studies (ideally with direct comparison to conventional hospitalization costs) are needed to explore this possibility.


Assuntos
Custos Hospitalares/estatística & dados numéricos , Hospitais Públicos/economia , Ambulatório Hospitalar/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Públicos/organização & administração , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Ambulatório Hospitalar/organização & administração , Ambulatório Hospitalar/estatística & dados numéricos , Encaminhamento e Consulta/economia , Estudos Retrospectivos , Espanha , Fatores de Tempo
16.
BMC Public Health ; 20(1): 1232, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787826

RESUMO

BACKGROUND: Diabetes is a huge growing problem, and causes high and escalating costs to society. Self- care practice for adults with diabetes is not well addressed in sub-Saharan Africa including Ethiopia. To prevent serious morbidity and mortality, diabetes treatment requires a commitment to demanding self-care practice. This study aimed to assess self- care practices and its associated factors among adults with diabetes in Dire Dawa public hospitals of Eastern, Ethiopia. METHODS: A cross-sectional study was conducted among 513 adults with diabetes. The study participants were selected through systematic random sampling. Data were collected from February 1st to March 1st, 2018. Patients were interviewed using a structured questionnaire. Data were entered into Epi-data version 3.3.1 and exported to SPSS version 22.0 for analysis. Bivariable and multivariable logistic regression with crude and adjusted odds ratios along with the 95% confidence interval was computed and interpreted accordingly. Good self-care was defined based on mean calculation; a result above the mean value had a good self-care practice, and a P-value of < 0.05 was considered to declare a result as statistically significant. RESULT: The result of the study showed that 55.9%, (95% CI: 51.4, 60.3) of participants had good self-care practices. Good self-care practice was associated with having family support, treatment satisfaction, diabetes education, having glucometer, higher educational status, duration of the disease, high economic status, and having good knowledge. Self-care practice was significantly associated with good diabetes knowledge (AOR = 2.14, 95% CI: 1.37, 3.35), family support system (AOR = 2.69, 95% CI:1.56, 4.62), treatment satisfaction (AOR = 2.07, 95% CI:1.18, 3.62), diabetes education (AOR = 2.21, 95% CI: 1.35, 3.63), high economic status (AOR = 1.89, 95% CI: 1.01, 3.48), having glucometer,(AOR = 2.69, 95% CI:1.57, 4.63),higher educational status (AOR = 2.68, 95% CI: 1.31, 5.49), and duration of disease greater than 10 years AOR = 2.70, 95% CI: 1.17, 6.26). CONCLUSION: In this study, a large number of adults had poor self-care practices which are very significant in controlling diabetes. Providing diabetes education, about self-care practices to the respondents and their families should be considerable.


Assuntos
Diabetes Mellitus/terapia , Autocuidado/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Etiópia , Feminino , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-32823922

RESUMO

Objective: To evaluate the relationship between the ownership structure of hospitals and the possibility of their being positioned on the frontier of technical efficiency in the economic crisis period 2010-2012, adjusting for hospital variables and regional characteristics in the areas where the Spanish National Health System (SNHS) hospitals are located. Methods: 230 National Health System hospitals were studied over the two-year period 2010-2012 according to their ownership structure-public hospitals, private hospitals and public-private partnership (PPP)-data envelopment analysis orientated to inputs was used to measure the overall technical efficiency, pure efficiency and efficiency of scale. A generalised linear mixed model (GLMM) with binomial distribution and logit link function was used to analyse the hospital and regional variables associated with positioning on the frontier. Results: There are substantial differences between the average pure technical efficiency of public, private and PPP hospitals, as well as a greater number of PPP models being positioned on the efficiency frontier (91.67% in 2012). The odds of being positioned on the frontier are 41.7 times higher in PPP models than in public hospitals. The average annual household income per region is related to the greater odds of hospitals being positioned on the frontier of efficiency. Conclusions: During the most acute period of recession in the Spanish economy, PPP formulas favoured hospital efficiency, by increasing the odds of being positioned on the frontier of efficiency when compared to private and public hospitals. The position on the frontier of efficiency of a hospital is related to the wealth of its region.


Assuntos
Eficiência Organizacional , Hospitais Privados/organização & administração , Hospitais Públicos/organização & administração , Análise Multinível , Propriedade , Humanos , Parcerias Público-Privadas , Espanha
20.
PLoS One ; 15(8): e0235591, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790671

RESUMO

Adverse drug reactions (ADRs) are associated with morbidity and mortality worldwide. Although national systems for reporting ADRs exist there is a low reporting rate. The aim of the current study was to evaluate an intervention plan for improving ADRs reporting among medical professionals (physicians and nurses). A multicentre intervention study was conducted, in which one medical centre was randomly assigned to the intervention group and two medical centres to the control group. The study consisted of 3 phases: baseline data collection, intervention and follow-up of the reporting rate. The questionnaire that was filled in at base line and at the end of study, contained questions about personal/professional demographic variables, and statements regarding knowledge of and behaviour toward ADRs reporting. The intervention program consisted of posters, lectures, distant electronic learning and reminders. An increase in the number of ADRs reports was noted in the intervention group (74 times higher than in the control group) during the intervention period, which was gradually decreased with as the study progressed (adjusted O.R = 74.1, 95% CI = 21.11-260.1, p<0.001). The changes in the "knowledge related to behaviour" (p = 0.01) and in the "behaviour related to reporting" (p<0.001) score was significantly higher in the intervention group. Specialist physicians and nurses (p<0.001), fulfilling additional positions (p<0.001) and those working in other places (p = 0.05) demonstrated a high rate of report. Lectures were preferable as a method to encourage ADRs reporting. The most convenient reporting tools were telephone and online reporting. Thus, implementation and maintenance of a continuous intervention program, by a pharmacovigilance specialist staff member, will improve ADRs reporting rates.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/normas , Educação Profissional em Saúde Pública/métodos , Pessoal de Saúde/educação , Hospitais Públicos/estatística & dados numéricos , Humanos , Melhoria de Qualidade
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