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2.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431439

RESUMO

We describe a case of a middle-aged woman who presented with progressive jaundice and was suspected to have rebound choledocholithiasis, which was initially managed with balloon extraction through endoscopic retrograde cholangiopancreatography at her first presentation. Healthcare in Pakistan, like many other developing countries, is divided into public and private sectors. The public sector is not always completely free of cost. Patients seeking specialised care in the public sector may find lengthy waiting times for an urgent procedure due to a struggling system and a lack of specialists and technical expertise. Families of many patients find themselves facing 'catastrophic healthcare expenditure', an economic global health quandary much ignored.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/economia , Coledocolitíase/terapia , Tratamento Conservador/economia , Acesso aos Serviços de Saúde/economia , Icterícia Obstrutiva/terapia , Coledocolitíase/complicações , Coledocolitíase/diagnóstico , Coledocolitíase/economia , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Tratamento Conservador/métodos , Países em Desenvolvimento/economia , Progressão da Doença , Feminino , Mão de Obra em Saúde/economia , Hospitais Privados/economia , Hospitais Públicos/economia , Humanos , Icterícia Obstrutiva/economia , Icterícia Obstrutiva/etiologia , Pessoa de Meia-Idade , Paquistão , Cuidados Paliativos , Índice de Gravidade de Doença , Tempo para o Tratamento/economia , Ultrassonografia
3.
Diabetes Metab Syndr ; 15(1): 129-135, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33338951

RESUMO

BACKGROUND AND AIMS: The novel corona virus disease which was first detected in China, December 2019 is caused by severe acute respiratory syndrome corona virus 2. In Ethiopia, the number of infected peoples has been increased from day to day, despite government mitigation measures. But in our country the psychological impact of COVID-19 on patients with chronic diseases was unknown. Hence, this study was aimed to assess the psychological impact of COVID-19 and its associated factors among chronic disease patients. METHODS: A facility based cross-sectional study design was conducted among 413 chronic disease patients in Dessie town government and private hospitals from July 20 to August 5, 2020. Impact of event scale revised questionnaire was used for data collection. Both binary and multivariable logistic regression analyses were utilized to show the association between outcomes and independent variables. In multivariable analysis, significant association was declared at p-value of <0.05. RESULTS: Overall, COVID-19 had abnormal psychological impact on 22.8% (95% CI: 18.6-27.1) of chronic disease patients. Age, sex, duration of chronic disease, respiratory symptoms and having no social support were factors for abnormal psychological impact. CONCLUSION: COVID-19 had abnormal psychological impact on one-fourth of chronic disease patients. Therefore, the government, health professionals and researchers should contribute to prevent the psychological impact ofCOVID-19 on chronic disease patients.


Assuntos
/epidemiologia , Doença Crônica/epidemiologia , Doença Crônica/psicologia , Hospitais Privados/tendências , Governo Local , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Etiópia/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Adulto Jovem
4.
Rev. Saúde Pública Paraná (Online) ; 3(supl. 1): 276-287, dez. 11, 2020.
Artigo em Português | LILACS, Coleciona SUS, CONASS, SESA-PR | ID: biblio-1151359

RESUMO

Os serviços de saúde estão vivenciando um novo cenário devido à pandemia ocasionada por um novo subtipo da Síndrome Respiratória Aguda Grave (SARS-CoV-2), denominado de Covid-19. Com isso, se fez necessário ações voltadas para um cuidado especializado à população. O objetivo deste estudo é descrever a experiência de gestão de um hospital privado do litoral Paranaense. O método utilizado foi o relato de experiência no período de seis meses, relatando o fluxo desenvolvido para atendimento aos pacientes suspeitos ou confirmados de Covid-19 durante a pandemia e a descrição das ações de enfrentamento adotadas pela instituição. Concluiu-se que foi evidenciada a atuação de áreas estratégicas como a Gestão de pessoas e Financeira. Houve a necessidade de contratação de profissionais e remanejamentos para a atuação in loco e o monitoramento diário dos custos visto esta imprevisibilidade, bem como a antecipação dos processos para a continuação e validação do plano de contingência. (AU)


Health services are experiencing a new scenario due to the pan-demic caused by a new subtype of Severe Acute Respiratory Syndrome (SARS--CoV-2), called Covid-19. With this, actions directed to a specialized care of the population were necessary. The objective of this study is to describe the management experience of a private hospital on the coast of Paraná. The method used was the report of experience in the period of six months, reporting the flow developed to care for patients suspected or confirmed of Covid-19 during the pandemic and the description of the actions of confrontation adopted by the institution. It was concluded that the performance of strategic areas such as Personnel and Financial Management was evidenced. There was the need to hire professionals and relocations for the performance in loco and the daily monitoring of costs given this unpredictability, as well as the anticipation of processes for the continuation and validation of the contingency plan. (AU)


Assuntos
Administração de Recursos Humanos , Hospitais Privados , Infecções por Coronavirus , Monitoramento , Administração Financeira , Serviços de Saúde , Custos e Análise de Custo
5.
Rev. enferm. UERJ ; 28: e51314, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1120156

RESUMO

Objetivo: identificar e descrever como é desenvolvida a competência relacional no cotidiano do trabalho de enfermeiros cirúrgicos e identificar em que momento/situações o enfermeiro utiliza essa competência. Método: estudo exploratório, qualitativo. O cenário foram unidades cirúrgicas pertencentes a cinco instituições hospitalares privadas de um município no Estado de Minas Gerais e a amostra composta por 43 enfermeiros atuantes destas unidades. Foi realizada a técnica de grupo focal em 2018 e os dados foram interpretados pela análise temática indutiva. Resultados: evidenciou-se que a competência relacional se dá por meio do desenvolvimento de capacidades a serem adquiridas pelos enfermeiros, tais como o gerenciamento de conflitos, comunicação assertiva, gestão de pessoas por meio do dimensionamento de pessoal e inteligência emocional. Considerações finais: O ambiente cirúrgico demanda atividades que potencializam o desgaste físico e emocional do enfermeiro com demais membros da equipe de saúde, o que torna imprescindível o aprimoramento de capacidades/aptidões associadas a competência relacional.


Objective: to identify and describe how relational competence is developed in surgical nurses' day-to-day work and identify when and in what situations nurses use this competence. Method: qualitative, exploratory study. The scenario were surgical units at five private hospitals in a municipality in Minas Gerais, and the sample comprised 43 nurses working in these units. The focal group technique was applied in 2018 and the data were interpreted by inductive thematic analysis. Results: relational competence was found to be developed by the nurses' acquiring and developing capacities/skills, such as conflict management, assertive communication, people management by appropriate personnel scaling, and emotional intelligence. Final considerations: the surgical environment demands activities that heighten nurses' physical and emotional exhaustion, and its effects on other members of the health team, making it essential to improve capacities/skills in relational competence.


Objetivo: identificar y describir cómo se desarrolla la competencia relacional en el trabajo diario del enfermero quirúrgico e identificar cuándo y en qué situaciones el enfermero utiliza esta competencia. Método: estudio exploratorio cualitativo. El escenario fueron unidades quirúrgicas de cinco hospitales privados de un municipio de Minas Gerais, y la muestra estuvo conformada por 43 enfermeras que laboran en estas unidades. La técnica del grupo focal se aplicó en 2018 y los datos se interpretaron mediante análisis temático inductivo. Resultados: se encontró que la competencia relacional es desarrollada por las enfermeras adquiriendo y desarrollando capacidades / habilidades, tales como manejo de conflictos, comunicación asertiva, manejo de personas por escalamiento apropiado del personal e inteligencia emocional. Consideraciones finales: el ambiente quirúrgico demanda actividades que aumenten el agotamiento físico y emocional del enfermero, y sus efectos sobre otros miembros del equipo de salud, por lo que es fundamental mejorar las capacidades / habilidades en la competencia relacional.


Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Enfermagem de Centro Cirúrgico , Equipe de Assistência ao Paciente , Competência Profissional , Comunicação , Relações Interpessoais , Administração de Recursos Humanos , Centros Cirúrgicos , Brasil , Hospitais Privados , Pesquisa Qualitativa , Inteligência Emocional
6.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-47986

RESUMO

A Organização Pan-Americana da Saúde (OPAS) e a Associação Nacional de Hospitais Privados (Anahp) assinaram na noite desta quinta-feira (15) um acordo para reduzir o número de óbitos por hemorragia puerperal (após o parto ou aborto) no Brasil. Essa é a segunda maior causa direta de mortalidade materna no país e na região das Américas.


Assuntos
Mortalidade Materna , Hospitais Privados , Organização Pan-Americana da Saúde , Brasil , Hemorragia Pós-Parto , Aborto
7.
J Med Life ; 13(3): 362-370, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33072209

RESUMO

Transformational management properties could make the weakest organizations strong with the right and efficient approach build. The aim of this study was to determine the transformational management properties among hospital managers in Gonbad-e-Kavus. In terms of data collection, the present study is an an applied research involving objective and descriptive-analytical surveys. The statistical population includes all staff hospitals that were selected randomly in Gonbad-e-Kavous city. The present study was performed including 7 hospitals and 346 respondents. Castiglion transformational management properties questionnaire (2006) was used to collect the required data, with Cronbach's alpha coefficient (0.946). Based on the findings of the research, 67.3% (233 subjects) of the participants in the study evaluated the transformational management properties of the managers of the hospitals at a good level (with a score of 140. 76 ± 27.76), with Payambar Hospital having the highest (151.57 ± 20.31) and Taleghani Hospital the lowest score (130.22 ± 28.10) attributed to the management properties affecting change management. Based on the findings of the research and the impact of effective transformational management properties among the managers of the understudy hospitals, it is recommended to form all effective management transformational management properties, through founding special educational units and holding classes for hospital managers, in order to form various skills and competencies such as communication skills, skills to influence others, trusting, attention skills, and providing sufficient independence which all play an essential role in the success of managers and pave the ground for the flourishment of transformation and innovation in the hospitals.


Assuntos
Pessoal de Saúde , Hospitais Privados/organização & administração , Hospitais Públicos/organização & administração , Liderança , Cidades , Humanos , Irã (Geográfico) , Masculino , Inquéritos e Questionários
8.
Medicina (B Aires) ; 80(5): 433-438, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-33048785

RESUMO

Infection with the SARS coronavirus type 2 (COVID-19) has a variety of presentations, with little data on the evolution of affected patients in Argentina. This is a retrospective and observational study of patients with virological confirmation of coronavirus treated during the months of March to May in a private third-level university hospital in Buenos Aires. O ne hundred and fifty-five adult patients were included, of which 30.3% attended only for a swab; 59.4% were admitted to the hospital and 10.3% were hospitalized at home with daily telephone follow-up. Fifty-four point two percent of participants were women and the median age was 35 years (ICQ 29 to 50). About 59.3% of patients had some risk factor, including age (65 years old or more), underlying chronic disease, were health workers or personnel/residents in a nursing home. The most frequent symptom was fever (75.9%), followed by cough (65.7%), and odyno phagia (48.2%). Globally, 93.5% experienced some symptoms while 17.6% of the participants presented some symptoms but without fever. Chest tomographies were performed to 5 patients. Their chest radiograph was normal or non-diagnostic. Fourteen patients required intensive therapy and 6 of them required mechanical ventilation, 4 of them died. The remaining 2 patients were referred to chronic care centers. No patient with home hospitalization required admission to hospital or died. While this observation is encouraging, it will need to be confirmed with new studies.


Assuntos
Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Adulto , Argentina/epidemiologia , Betacoronavirus , Feminino , Hospitais Privados , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
PLoS One ; 15(10): e0239649, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031397

RESUMO

BACKGROUND: The rate of Caesarean Section (CS) deliveries has shown an alarming rise in recent years. CS is a surgical procedure used when there is apprehension of risk to the life of mother or baby in case of vaginal delivery, but its rates higher than 10-15 per cent are not justifiable. It is well recognised that a CS delivery could have a large number of adverse impacts on women and infants. Several studies, especially in developing countries, have revealed that delivery in private hospitals is one of the most contributing factors in CS deliveries. The present study conceptualises a causal pathway in which the possible risk factors, socio-economic, maternal and pregnancy-related, as well as institutional, influence the chances of CS delivery. It is hypothesised that certain factors would contribute to CS deliveries largely indirectly through the place of delivery, that is, either a public or private institution. METHODS AND FINDINGS: To test the hypotheses, this study analysed 146,280 most recent live births delivered in hospitals during the five years preceding the fourth round of India's National Family Health Survey (NFHS-4), carried out during 2015-2016. The analysis, using generalised structural equation modelling (GSEM), revealed that many exogenous variables considered in the path models influence CS deliveries significantly, directly and/or indirectly through the place of delivery factor. Prominent among these are wealth index and receiving ANC services at only private hospitals; the total effects of these variables are even higher than the direct/total effect of place of delivery. CONCLUSION: From this finding, it could be said that the place of delivery is a proximate determinant of a CS delivery or a mediator of other co-factors. Interventions to curb higher CS deliveries should be focused on improving the quality of public health sectors and on developing protocols for CS deliveries.


Assuntos
Cesárea/estatística & dados numéricos , Hospitais Privados , Adolescente , Adulto , Cesárea/efeitos adversos , Cesárea/tendências , Parto Obstétrico/efeitos adversos , Parto Obstétrico/estatística & dados numéricos , Parto Obstétrico/tendências , Feminino , Inquéritos Epidemiológicos , Hospitais Públicos , Humanos , Índia , Recém-Nascido , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Parto , Gravidez , Probabilidade , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
10.
Niger J Clin Pract ; 23(10): 1333-1338, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33047688

RESUMO

Backround: The fiduciary duty of a managing physician makes paediatric discharges against medical advice (DAMA) particularly challenging as children lack the legal power or authority to make their health decisions. Aim: It is aimed in the present study to determine the prevalence of paediatric DAMA in a mission tertiary hospital. Methods: This was a prospective descriptive study carried out from June 2018 to May 2019 among paediatric inpatients at the Bowen University Teaching Hospital, Ogbomoso, Nigeria whose parent/ care giver signed DAMA, despite adequate counselling. Data was analysed using SPSS version 23. Results: The prevalence of DAMA in the study was of 4.1%, and the neonatal group accounted for the largest bulk of DAMA. Birth asphyxia was the commonest diagnosis among this group. There was a slight female predominance among the patients whose parents signed DAMA. Financial constraint was the commonest reason [13(30.2%)] given for DAMA and none of the children whose parents signed DAMA was enrolled on the National Health Insurance Scheme (NHIS). Conclusion: Rate of DAMA in a private mission tertiary hospital was lower than previously reported from government tertiary hospitals in the present-day Nigeria.


Assuntos
Cuidadores/estatística & dados numéricos , Hospitais Religiosos/estatística & dados numéricos , Pais/psicologia , Alta do Paciente/estatística & dados numéricos , Pediatria , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Cuidadores/psicologia , Criança , Pré-Escolar , Aconselhamento , Feminino , Hospitais Privados , Humanos , Pacientes Internados , Masculino , Nigéria/epidemiologia , Prevalência , Estudos Prospectivos , Fatores Socioeconômicos
11.
Acta Cir Bras ; 35(9): e202000908, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32996999

RESUMO

PURPOSE: To compare the operative outcomes of laparoscopic surgical treatment for bowel endometriosis in a public teaching hospital versus in a private referral hospital. METHODS: The indications for surgery, type and time of operation, length of hospital stay, need for a temporary stoma, rate of conversion to open surgery, and postoperative complications were evaluated. RESULTS: One hundred eighty-one patients were included (150 patients, 82.9%, in a private hospital). In the private hospital, there were more patients with infertility [56% vs. 29%; P=0.01] as an indication for surgery) and segmental resection was more common in the private hospital (48% vs. 29%, p=0.05). The average operative time (211.9±83.4 minutes vs. 128 ± 55 minutes, p<0.001) as well as the length of hospital stay (3.97±1.7 days vs. 1.56±0.85 days, p<0.001) was higher in the public hospital; the rate of conversion to open surgery was significantly lower in the private hospital (2% vs. 32.3%, p<0.001). Operations performed at the public hospital were associated with higher rates of postoperative complications (Clavien-Dindo II and II) (38.7% x 11.3%, p=0.021; OR 3.2, CI 95% 1.2-8.0). CONCLUSION: Laparoscopic surgery in private centers was associated with reductions in major complications, surgical times, lengths of stay and rates of conversion to open surgery compared to that in public teaching hospitals.


Assuntos
Endometriose , Laparoscopia , Endometriose/cirurgia , Feminino , Hospitais Privados , Hospitais Públicos , Hospitais de Ensino , Humanos , Encaminhamento e Consulta
12.
PLoS One ; 15(9): e0239454, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32966323

RESUMO

BACKGROUND: The application of digital technology to improve health service delivery is increasing rapidly in Low- and Middle- Income Countries (LMICs). Digital tools such as electronic health (e-health) have been shown to improve healthcare quality, efficiency and patient satisfaction. However, evidence on health workers' experiences using e-health services is limited in LMICs. This study examined the relationship between e-health usage and health workers' motivation and job satisfaction. METHODS: This was a cross-sectional survey design involving health workers across public and private hospitals in the Accra Metropolitan Assembly (AMA). A structured questionnaire was designed and self-administered to 305 respondents. Partial Least Square-Structural Equation Modelling (PLS-SEM) was employed to analyse the data. RESULTS: Findings showed a significant positive association of job satisfaction with e-health (p < 0.01) and type of hospital (p < 0.01) but not motivation (p = 0.42). Although type of hospital significantly influenced job satisfaction (p < 0.01), it had no significant mediating effect on the relationship between e-health and job satisfaction. Finally, type of hospital interacted with e-health to moderate the association between e-health usage and job satisfaction. CONCLUSION: The findings suggest that e-health systems can catalyse health workers job satisfaction. Thus, measures to strengthen e-health structures to improve on their efficiency and effectiveness is crucial.


Assuntos
Pessoal de Saúde/psicologia , Satisfação no Emprego , Telemedicina , Adulto , Estudos Transversais , Feminino , Gana , Hospitais Privados , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Inquéritos e Questionários , Telemedicina/estatística & dados numéricos
13.
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
15.
PLoS One ; 15(8): e0235411, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822368

RESUMO

BACKGROUND: Delayed treatment initiation of Tuberculosis patients results in increased infectivity, poor treatment outcome, and increased mortality. However, there is a paucity of evidence on the delay in new adult pulmonary Tuberculosis patients to initiate treatment in Tigray, Northern Ethiopia. OBJECTIVE: To assess the factors associated with treatment initiation delay among new adult pulmonary tuberculosis patients in Tigray, Northern Ethiopia. METHODS: The study design was cross-sectional. A total of 875 new adult pulmonary tuberculosis patients were recruited from 21 health facilities from October 2018 to October 2019. Health facilities were selected by simple random sampling technique and tuberculosis cases from the health facilities were consecutively enrolled. Data were collected using structured questionnaire within the first 2 weeks of treatment initiation. Delay was categorized as patient, health system and total delays. Data were analyzed using SPSS version 21 and logistic regression was used to identify factors associated with the odds of delays to initiate treatment. A p-value of less than 0.05 was reported as statistically significant. RESULTS: The median patient, health system and total delays were 30, 18 and 62 days, respectively. Rural residence, being poor, visiting non-formal medication sources, being primary health care and the private clinic had higher odds of patient delay whereas being HIV positive had lower odds of patient delay. Illiteracy, first visit to primary health care and private clinic had higher odds of health system delay whereas a visit to health facility one time and have no patient delay had lower odds of health system delay. CONCLUSION: The median patient delay was higher than the median health system delay before initiating treatment. Hence, improved awareness of the community and involving the informal medication sources in the tuberculosis pathways would reduce patient delay. Similarly, improved cough screening and diagnostic efficiency of the lower health facilities would shorten health system delay.


Assuntos
Tempo para o Tratamento/estatística & dados numéricos , Tuberculose Pulmonar/tratamento farmacológico , Adolescente , Adulto , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Comorbidade , Etiópia , Feminino , Hospitais Privados/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Tuberculose Pulmonar/epidemiologia
16.
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
17.
J Stroke Cerebrovasc Dis ; 29(9): 105059, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807464

RESUMO

BACKGROUND AND PURPOSE: Since the declaration of the Novel Coronavirus Disease (COVID-19) pandemic, ensuring the safety of our medical team while delivering timely management has been a challenge. Acute stroke patients continue to present to the emergency department and they may not have the usual symptoms of COVID-19 infection. Stroke team response and management must be done within the shortest possible time to minimize worsening of the functional outcome without compromising safety of the medical team. METHODS: Infection control recommendations, emergency department protocols and stroke response pathways utilized prior to the COVID 19 pandemic within our institution were evaluated by our stroke team in collaboration with the multidisciplinary healthcare services. Challenges during the COVID-19 scenario were identified, from which a revised acute stroke care algorithm was formulated to adapt to this pandemic. RESULTS: We formulated an algorithm that incorporates practices from internationally devised protocols while tailoring certain aspects to suit the available resources in our system locally. We highlighted the significance of the following: team role designation, coordination among different subspecialties and departments, proper use of personal protective equipment and resources, and telemedicine use during this pandemic. CONCLUSIONS: This pandemic has shaped the stroke team's approach in the management of acute stroke patients. Our algorithm ensures proper resource management while optimizing acute stroke care during the COVID-19 pandemic in our local setting. This algorithm may be utilized and adapted for local practice and other third world countries who face similar constraints.


Assuntos
Algoritmos , Infecções por Coronavirus/terapia , Procedimentos Clínicos/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Países em Desenvolvimento , Hospitais Privados/organização & administração , Pneumonia Viral/terapia , Acidente Vascular Cerebral/terapia , Centros de Atenção Terciária/organização & administração , Comportamento Cooperativo , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Controle de Infecções/organização & administração , Comunicação Interdisciplinar , Saúde do Trabalhador , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Segurança do Paciente , Filipinas/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento , Fluxo de Trabalho
18.
PLoS One ; 15(7): e0235696, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32634164

RESUMO

BACKGROUND: Non-communicable diseases (NCDs) are increasingly prevalent in low- and middle-income countries. Successful management requires consistent access to appropriate medicines. Availability of NCD medicines is generally low, especially in the public sector, however, little is known about other factors affecting access. We explored barriers and facilitators of access to medicines for diabetes and hypertension at public and private health facilities in Uganda. METHODS: We conducted a qualitative descriptive study at six public hospitals and five private health facilities in different regions of Uganda. Data collection included 36 in-depth interviews and 14 focus group discussions (n = 128) among purposively selected adult outpatients with diabetes and/or hypertension and 26 key informant interviews with healthcare workers and patient association leaders. Transcripts were coded and emerging themes identified using the Framework method. RESULTS: Four main themes emerged: Stocking of medicines and supplies, Financial factors, Individual behaviour and attitudes, and Service delivery at health facilities. Stocking of medicines and supplies mainly presented barriers to access at public facilities including frequent stockouts, failure to stock certain medicines and low quality brands often rejected by patients. Financial factors, especially high cost of medicines and limited insurance coverage, were barriers in private facilities. Free service provision was a facilitator at public facilities. Patients' confusion resulting from mixed messages and their preference for herbal treatments were cross-sector barriers. While flexibility in NCD service provision was a facilitator at private facilities, provider burnout and limited operating hours were barriers in public facilities. Patient-driven associations exist at some public facilities and help mitigate inadequate medicine stock. CONCLUSION: Access to NCD medicines in Uganda is influenced by both health system and patient factors. Some factors are sector-specific, while others cross-cutting between public and private sectors. Due to commonalities in barriers, potential strategies for overcoming them may include patient-driven associations, public-private partnerships, and multi-modal health education platforms.


Assuntos
Diabetes Mellitus/tratamento farmacológico , Instalações de Saúde , Acesso aos Serviços de Saúde , Hipertensão/tratamento farmacológico , Doenças não Transmissíveis/tratamento farmacológico , Pessoal de Saúde , Hospitais Privados , Hospitais Públicos , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Uganda
19.
S Afr Med J ; 110(4): 327-331, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32657746

RESUMO

BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is one of the main contributors to morbidity and mortality in South Africa (SA). Timeous intervention by means of percutaneous coronary intervention (PCI) or fibrinolysis can significantly improve the outcome of STEMI. OBJECTIVES: To determine the median time interval between diagnosis and fibrinolysis in patients presenting to centres within the drainage area of Tygerberg Hospital, Cape Town, SA, and compare it with the European Society of Cardiology (ESC) recommendation of 10 minutes. METHODS: A retrospective medical record review of patients presenting to the abovementioned centres between 1 March 2017 and 28 February 2018 was performed. The primary presenting centre, time between diagnosis and fibrinolysis and discharge medication were recorded, in addition to other relevant demographic information. RESULTS: A total of 492 patients were identified, of whom 447 were included in the study. Three hundred and eighteen patients received fibrinolysis, of whom 18 (5.7%) were treated within 10 minutes of diagnosis. The median time interval between diagnosis and fibrinolysis was 67 (interquartile range (IQR) 32.5 -122.5) minutes. CONCLUSIONS: Most patients received fibrinolysis >10 minutes after diagnosis, which indicates suboptimal therapy when compared with the ESC guidelines. Future studies should investigate the factors prolonging this therapeutic delay.


Assuntos
Instituições de Assistência Ambulatorial , Hospitais de Distrito , Hospitais Privados , Transferência de Pacientes , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Centros de Atenção Terciária , Terapia Trombolítica/métodos , Tempo para o Tratamento/estatística & dados numéricos , Centros Médicos Acadêmicos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , África do Sul
20.
Medicina (B Aires) ; 80 Suppl 3: 37-41, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32658846

RESUMO

To contain the coronavirus pandemic (COVID-19), a strict nationwide lockdown has been enforced and the health systems have been reorganized to deal with this entity. During this period, changes in the care of non-infectious diseases have been observed. Our aim was to describe the impact of the COVID-19 pandemic in the care of non-communicable diseases. A structured retrospective survey was carried out in 31 healthcare centers affiliated with the Asociación de Clínicas, Sanatorios y Hospitales Privados de la República Argentina y Cámara de Entidades de Diagnóstico y Tratamiento. We compared data for April 2019 versus April 2020 regarding emergency room consultations, hospital admissions, invasive procedures and treatments, and bed occupancy. In April 2020, we observed a decrease in emergency room visits (75%) and hospitalizations (48%). A 62% decrease in admissions was noted for angina pectoris and acute coronary syndromes and a 46% decrease in admissions for stroke and transient ischemic attack. A meaningful decrease was found in coronary angioplasties (59%) and total percutaneous interventions (65%), and also a decrease in general surgeries (73%), and cardiac surgeries (58%). Although social distancing measures are a key public health strategy to flatten the infection curve, the observed decrease in medical visits and interventions may impact negatively on cardiovascular, cerebrovascular and cancer related morbidity and mortality. A collective effort is required to avoid the unintended consequences and collateral damage of the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Assistência à Saúde/organização & administração , Doenças não Transmissíveis/terapia , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , Pneumonia Viral , Argentina , Betacoronavirus , Efeitos Psicossociais da Doença , Hospitais Privados , Humanos , Quarentena , Estudos Retrospectivos , Isolamento Social
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