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1.
Ann R Coll Surg Engl ; 103(3): 218-222, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33645281

RESUMO

BACKGROUND: Cauda equina syndrome, a rare but disabling spinal surgical emergency, requires prompt investigation, ideally using magnetic resonance imaging as patients may require decompressive surgery. Out of hours access to magnetic resonance imaging is only routinely available in major trauma centres and neurosurgical units. Patients in regional hospitals with suspected cauda equina syndrome may require transfer for diagnostic imaging. We retrospectively studied the proportion of patients referred with suspected cauda equina syndrome who required out of hours transfer for magnetic resonance imaging and decompressive surgery. MATERIALS ANDS METHODS: Retrospective cohort study of patients referred using online referral platforms with suspected acute cauda equina syndrome and transferred out of hours between 6pm to 8am on weekdays and all day on weekends to two of the largest neurosurgical units in the UK in Birmingham and Cambridge. RESULTS: A total of 441 patients were referred across both sites with a suspicion of acute cauda equina syndrome; 339 patients were transferred for diagnostic scans and only 16 of them (4.7%) were positive for cauda equina compression, necessitating prompt decompressive surgery. Of the patients with negative magnetic resonance scans, 50% had their discharge or transfer back to referring hospitals delayed by more than 24 hours. CONCLUSIONS: Over 95% of patients who were transferred for imaging did not undergo emergency decompression. The authors propose a greater role for the provision of out of hours magnetic resonance imaging in all hospitals admitting emergency patients to streamline management.


Assuntos
Plantão Médico , Síndrome da Cauda Equina/diagnóstico por imagem , Descompressão Cirúrgica , Imagem por Ressonância Magnética , Procedimentos Neurocirúrgicos , Transferência de Pacientes , Encaminhamento e Consulta , Centros de Traumatologia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Síndrome da Cauda Equina/cirurgia , Feminino , Hospitais de Distrito , Hospitais Gerais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Reino Unido
2.
JMIR Mhealth Uhealth ; 9(2): e23737, 2021 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-33605886

RESUMO

BACKGROUND: Lack of trained health care workers and nonadherence to national guidelines are key barriers to achieving high-quality newborn care in health care facilities in low- and middle-income countries. Traditional didactic approaches addressing these barriers fail to account for high staff turnover rates and result in temporary behavior change. NoviGuide, a clinical decision support software designed to standardize neonatal care through point-of-care assessments, has the potential to align bedside practice to national guidelines in settings lacking subspecialty neonatal providers. OBJECTIVE: This study aims to determine the adaptation, adoption, feasibility, acceptability, and sustainability of NoviGuide and its impact on nurse-midwives' knowledge in a rural hospital in eastern Uganda. METHODS: This mixed methods observational study was guided by the Proctor framework. Experts reviewed the clinical content of NoviGuide to ensure fidelity to Uganda guidelines. We enrolled nurses and midwives providing newborn care at Tororo District Hospital, trained them on NoviGuide use, and followed them for 12 months. We assessed adoption, feasibility, acceptability, and sustainability by analyzing NoviGuide use data, comparing it with maternity registry data and administering the System Usability Scale (SUS) and the Center for Health Care Evaluation Provider Satisfaction Questionnaire. We compared the mean knowledge assessment score at baseline, 6 months, and 12 months using a two-tailed t test. RESULTS: Five Ugandan experts suggested two minor changes to NoviGuide: the inclusion of an unsterile birth environment as an indication for empiric antibiotics and the addition of a reminder to follow-up with newborns with temperatures between 37.7°C and 37.9°C. Of the 19 nurse-midwives enrolled in February 2017, 74% (n=14) completed the follow-up in March 2018. The participants entered a total of 1705 assessments of varying newborn characteristics into NoviGuide throughout the day, evening, and night nursing shifts. The SUS score at the end of the study was very high (93.5, above the average of 68). Participants had a positive perception about NoviGuide, reporting that NoviGuide saved time (mean 5, SD 0) and prevented mistakes (mean 5, SD 0), and that they felt more confident in taking care of newborns when they used NoviGuide (mean 5, SD 0). Participants were highly satisfied with NoviGuide (mean 4.86, SD 0.36), although they lacked medical supplies and materials needed to follow NoviGuide recommendations (mean 3.3, SD 1.22). The participants' knowledge scores improved by a mean change of 3.7 (95% CI 2.6-4.8) at 6 months and 6.7 (95% CI 4.6-8.2) at 12 months (P<.001). CONCLUSIONS: NoviGuide was easily adapted to the Uganda guidelines. Nurse-midwives used NoviGuide frequently and reported high levels of satisfaction despite challenges with medical supplies and high staff turnover. NoviGuide improved knowledge and confidence in newborn care without in-person didactic training. NoviGuide use has the potential to scale up quality newborn care by facilitating adherence to national guidelines.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Hospitais Rurais , Estudos de Viabilidade , Feminino , Hospitais de Distrito , Humanos , Recém-Nascido , Gravidez , Software , Uganda
3.
PLoS One ; 16(2): e0246154, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33606678

RESUMO

BACKGROUND: Coronavirus disease 19 (COVID-19) is currently a global health threat and public health emergency of international concern. Africa is the last continent to be hit by this pandemic and the population is still prone to misconceptions and may not take it seriously. In developing countries including Ethiopia, where trained human resources and equipment for the treatment of COVID-19 are scarce, working on prevention of the viral spread should be a priority as a feasible intervention strategy. The aim of this study was to determine the level of knowledge, attitude, practice (KAP) towards COVID-19 and its prevalence among hospital visitors. METHODS: Health institution based cross sectional study was conducted among 513 hospital visitors who are recruited by using simple random sampling technique at Ataye district hospital, Northeast Ethiopia from June 3, 2020 to August 10, 2020. A pre-tested structured questionnaire was used to obtain information related to socio-demographic characteristics, knowledge (11 questions), attitude (9 questions) and practice (9 questions). Oro-pharyngeal specimen was collected by trained healthcare provider and processed in a molecular laboratory. After extraction of viral nucleic acid, the Real-time fluorescent polymerase chain reaction (RT-PCR) kit was used for detecting novel coronavirus (2019-nCoV). Data was analyzed using bi-variable and multivariable logistic regression model with 95% CI (confidence interval). From the bi-variable analysis, variables having a P-value <0.25 were retained into multivariable analysis. From the multivariable analysis, variables with a P-value <0.05 was declared as associated factors. RESULTS: Majority (72.9%) of the study participants were male; and most were urban dwellers. From the total study participants, 17 (3.3%) were found to be infected with the virus. The magnitude of low-level of knowledge was 4.9%; and of the analyzed risk factors, female gender, age (category less than 16 years and category between 16 and 65 years), and usual alcohol drinking habit had statistically significant association with low level knowledge. The proportion of study participants who had low level of practice was 75/513 (14.62%). Family size, age category between 16 and 65 years, and low-level knowledge were associated with low-level practice. CONCLUSION: Limited number of study participants had high-level knowledge and practice towards COVID-19; while majority of the study candidates demonstrated moderate level of knowledge and practice. Good knowledge, positive attitude and good practice can be a guarantee for the prevention and control of COVID-19. Hence, various measurements to combat the pandemic should be taken by different stakeholders including the community members, religious leader, health professionals and others.


Assuntos
/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Hospitais de Distrito , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
4.
BMJ Open ; 11(1): e047016, 2021 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500292

RESUMO

OBJECTIVES: To describe the characteristics, clinical management and outcomes of patients with COVID-19 at district hospitals. DESIGN: A descriptive observational cross-sectional study. SETTING: District hospitals (4 in metro and 4 in rural health services) in the Western Cape, South Africa. District hospitals were small (<150 beds) and led by family physicians. PARTICIPANTS: All patients who presented to the hospitals' emergency centre and who tested positive for COVID-19 between March and June 2020. PRIMARY AND SECONDARY OUTCOME MEASURES: Source of referral, presenting symptoms, demographics, comorbidities, clinical assessment and management, laboratory turnaround time, clinical outcomes, factors related to mortality, length of stay and location. RESULTS: 1376 patients (73.9% metro, 26.1% rural). Mean age 46.3 years (SD 16.3), 58.5% females. The majority were self-referred (71%) and had comorbidities (67%): hypertension (41%), type 2 diabetes (25%), HIV (14%) and overweight/obesity (19%). Assessment of COVID-19 was mild (49%), moderate (18%) and severe (24%). Test turnaround time (median 3.0 days (IQR 2.0-5.0 days)) was longer than length of stay (median 2.0 day (IQR 2.0-3.0)). The most common treatment was oxygen (41%) and only 0.8% were intubated and ventilated. Overall mortality was 11%. Most were discharged home (60%) and only 9% transferred to higher levels of care. Increasing age (OR 1.06 (95% CI 1.04 to 1.07)), male (OR 2.02 (95% CI 1.37 to 2.98)), overweight/obesity (OR 1.58 (95% CI 1.02 to 2.46)), type 2 diabetes (OR 1.84 (95% CI 1.24 to 2.73)), HIV (OR 3.41 (95% CI 2.06 to 5.65)), chronic kidney disease (OR 5.16 (95% CI 2.82 to 9.43)) were significantly linked with mortality (p<0.05). Pulmonary diseases (tuberculosis (TB), asthma, chronic obstructive pulmonary disease, post-TB structural lung disease) were not associated with increased mortality. CONCLUSION: District hospitals supported primary care and shielded tertiary hospitals. Patients had high levels of comorbidities and similar clinical pictures to that reported elsewhere. Most patients were treated as people under investigation. Mortality was comparable to similar settings and risk factors identified.


Assuntos
/diagnóstico , /terapia , Hospitais de Distrito/estatística & dados numéricos , /genética , Adulto , Causas de Morte , Comorbidade , Estudos Transversais , Gerenciamento Clínico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Oxigenoterapia , Alta do Paciente , Encaminhamento e Consulta , Respiração Artificial , África do Sul/epidemiologia , Avaliação de Sintomas , Fatores de Tempo , Resultado do Tratamento
5.
PLoS One ; 16(1): e0244726, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33493181

RESUMO

INTRODUCTION: Quality work environment has been established as a marker of employee value creation. A plethora of qualitative evidence suggested that sustained focus on employee satisfaction through changes in the work environment, communication of patient-centered care strategic vision, management of staff workload, and workplace social support are factors that stimulate Patient-centered care. Yet, it seems that the effect of work environment on the patient-centered behavior of hospital employees has not been statistically estimated, and it is unclear which of the elements of the work environment best predict patient-centered behavior. METHODS: Using a survey design and quantitative methods to gather and analyze data, a sample of 179 respondents from three district hospitals were included in the study using a multi-stage proportional sampling technique. Data were collected using self-administered Likert item questionnaires. Simple linear regression was used to estimate the influence of work environment elements on patient-centered behavior. Stepwise multiple regression was used to determine the best predictors of patient-centered behavior of hospital employees. RESULTS: Perceived internal communication of patient-centered care strategies (ß = 0.23; P<0.001), supervisor support (ß = 0.31; P<0.001), coworker support (ß = 0.50; P<0.001), and working conditions (ß = 0.18; P<0.013) had a positive significant effect on patient-centered behavior of employees. Good predictors of employees' patient-centered behavior were perceived coworker support (ß = 0.51; P<0.001) and job characteristics (ß = 0.16; P<0.01). CONCLUSION: The work environment of hospital employees significantly affects their patient-centered behavior. Co-worker support and job characteristics were the best predictors of the patient-centered behavior of hospital employees. Hospitals Managers seeking to improve patient-centered behavior through employee value creation may consider improved job characteristics in combination with workplace social support and or communication of PCC strategies and goals.


Assuntos
Pessoal de Saúde , Hospitais de Distrito , Adulto , Atitude do Pessoal de Saúde , Feminino , Gana , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente , Apoio Social , Desempenho Profissional , Carga de Trabalho , Local de Trabalho , Adulto Jovem
7.
Med J Malaysia ; 76(1): 24-28, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33510104

RESUMO

INTRODUCTION: COVID-19 is a highly transmissible respiratory virus that has affected millions of people worldwide in the span of months. The burden of disease among healthcare workers (HCW) has not been well studied despite reports of infectivity and transmission around the world. Two HCW in Hospital Teluk Intan (HTI) contracted COVID-19 while attending a social event. They were in close proximity with colleagues upon returning to work, resulting in the spread of infection among other HCW in HTI. OBJECTIVE: The objectives of this paper are to gain a better understanding of the key presenting symptoms of COVID-19 in HCWs in a district specialist hospital, to establish the proportion of symptomatic COVID-19 cases among HCWs and its severity and to determine the time taken from onset of symptoms or perceived exposure to diagnostic testing. METHODOLOGY: This is a retrospective descriptive analysis of clinical characteristics of subjects infected with COVID-19 among HCW in HTI. Their demography and clinical characteristics were recorded. RESULTS: There were 47 HCW in HTI who tested positive for COVID-19. The mean age of the patients was 37.5 years old. 7 patients (15.2%) had at least more than one comorbidity. Average duration of time from perceived close contact to onset of symptom was 4.5 days, while the mean duration of time from symptoms to first positive RT-PCR result was 3.4 days. Six patients (13.0%) were asymptomatic throughout, whereas 40 (87.0%) had at least one symptom prior to hospitalization. The most commonly reported symptoms were fever (65.2%), sore throat (39.1%) and cough (37.0%). In terms of severity of symptoms, the majority of patients experienced mild symptoms (Group 2, 52.2%). Two patients (4.3%) with multiple comorbidities had severe disease requiring ICU admission and mechanical ventilation. There were no mortalities, and the longest staying patient was hospitalized for 18 days. The high rates of infectivity among HCW in HTI can be attributed to working in close proximity while in the asymptomatic incubation phase, while no HCW directly involved in the care of COVID-19 positive patients were tested positive. CONCLUSION: We report that HCW share similar clinical characteristics of COVID-19 infection as those of non HCW patients in earlier studies. The infection can spread rapidly within healthcare settings via close contacts among infected HCWs. As such, we advocate distancing when working and usage of personal protective equipment when treating patients with respiratory illness to reduce transmission of COVID-19.


Assuntos
/diagnóstico , Exposição Ocupacional , Recursos Humanos em Hospital/estatística & dados numéricos , Adulto , Infecções Assintomáticas , /transmissão , Comorbidade , Tosse/virologia , Cuidados Críticos/estatística & dados numéricos , Feminino , Febre/virologia , Hospitais de Distrito , Humanos , Tempo de Internação/estatística & dados numéricos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Gravidade do Paciente , Faringite/virologia , Sintomas Prodrômicos , Estudos Retrospectivos , Fatores de Tempo
8.
Clin Med (Lond) ; 21(1): e71-e76, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33355197

RESUMO

Antibiotic stewardship during the COVID-19 pandemic is an important part of a comprehensive strategy to improve patient outcomes and reduce long-term adverse effects secondary to rising antibiotic resistance. This report describes a quality improvement project which incorporates the use of procalcitonin (PCT) testing to rationalise antibiotic prescribing in patients with suspected or confirmed COVID-19 at Chesterfield Royal Hospital. Data were collected from 118 patients with a total of 127 PCT levels checked over a period of 20 days. Each PCT level was correlated with the subsequent antibiotic outcome as well as the result of the COVID-19 PCR swab. Results indicate that antibiotics were either never started or were stopped within 48 hours in 72% of COVID-confirmed cases with a PCT less than 0.25 µg/L. Our findings suggest that procalcitonin testing, when used in combination with thorough clinical assessment, is a safe, simple and sustainable way of reducing antibiotic use in COVID-19.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana/efeitos dos fármacos , Hospitais de Distrito , Pró-Calcitonina/uso terapêutico , RNA Viral/análise , /genética , /epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos
9.
J Formos Med Assoc ; 120(1 Pt 2): 422-428, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32563581

RESUMO

BACKGROUND/PURPOSE: Population aging and unequal accessibility of health care are increasingly important in developed countries. One strategy to overcome these issues is utilizing telemedicine, which is recently made possible technologically by the advancement of internet speed, high speed zooming cameras, and the information storages. In Taiwan, the telemedicine is granted legally by the amendment for Taiwan's Physician Act in 2018. METHODS: Kaohsiung Chang Gung Memorial Hospital (Kaohsiung CGMH) is the first hospital in Taiwan to provide the telemedicine service connecting to Cheng Kung Branch of Taitung Hospital since Nov 2018. Consultation services from Dermatology, ENT, and Ophthalmology have been delivered in the live-interactive and face to face module every week. RESULTS: Dermatology consultation comprises the majorities. In the first year, there were totally 426 dermatology consultation services. Eczema, fungal infections, and scabies infestation were the three most common diseases in the beginning. The disease diagnosis became more diverse after several months, including some ready-to-treat diseases pending correct diagnosis, such as pediculosis, psoriasis, and urticaria. Coupled with dermoscopic images, diseases such as hair loss, pediculosis capitis, skin tumor, and scabies, were diagnosed promptly. The subjective patient improvement rate was more than 75% year-round and the case closure rate was more than 85% year-round. CONCLUSION: Teledermatology is a promising approach to serve the remote medical-underprivileged regions. The teledermatology is anticipated to help underserved regions, nursing homes, prisons, and in situations with severe pandemic infections, such as COVID-19.


Assuntos
Dermatologia/métodos , Acesso aos Serviços de Saúde/organização & administração , Hospitais de Distrito , Hospitais Rurais , Serviços de Saúde Rural/organização & administração , Dermatopatias , Telemedicina/métodos , Dermatologia/organização & administração , Humanos , Dermatopatias/diagnóstico , Dermatopatias/terapia , Taiwan , Telemedicina/organização & administração
10.
Afr J Prim Health Care Fam Med ; 12(1): e1-e5, 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-33054265

RESUMO

The COVID-19 global pandemic forced healthcare facilities to put special isolation measures in place to limit nosocomial transmission. Cohorting is such a measure and refers to placing infected patients (or under investigation) together in a designated area. This report describes the physical reorganisation of the emergency centre at Khayelitsha Hospital, a district level hospital in Cape Town, South Africa in preparation to the COVID-19 pandemic. The preparation included the identification of a person under investigation (PUI) room, converting short stay wards into COVID-19 isolation areas, and relocating the paediatric section to an area outside the emergency centre. Finally, we had to divide the emergency centre into a respiratory and non-respiratory side by utilising part of the hospital's main reception. We are positive that the preparation and reorganization of the emergency centre will limit nosocomial transmission during the expected COVID-19 surge. Our experience in adapting to COVID-19 may have useful implications for ECs throughout South Africa and in low-and-middle income countries that are preparing for this pandemic.


Assuntos
Infecções por Coronavirus , Serviço Hospitalar de Emergência/organização & administração , Instalações de Saúde , Hospitais de Distrito , Controle de Infecções/métodos , Pandemias , Pneumonia Viral , Betacoronavirus , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Emergências , Tratamento de Emergência , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , África do Sul
11.
Clin Med (Lond) ; 20(6): e253-e254, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33067187

RESUMO

The COVID-19 pandemic has impacted the training of foundation doctors across the UK. A survey of foundation year 1 doctors across several district general hospitals in the East of England and East Midlands deaneries was carried out to investigate their perceptions of the impact on their training.


Assuntos
Infecções por Coronavirus , Educação de Pós-Graduação em Medicina , Hospitais de Distrito/organização & administração , Hospitais Gerais/organização & administração , Pandemias , Médicos/estatística & dados numéricos , Pneumonia Viral , Betacoronavirus , Competência Clínica , Inglaterra , Humanos
12.
PLoS One ; 15(8): e0237263, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764812

RESUMO

BACKGROUND: Chronic infected wounds are generally difficult to manage and treatment can be particularly challenging in resource-limited settings where diagnostic testing is not readily available. In this study, the epidemiology of microbial pathogens in chronically infected wounds in rural Ghana was assessed to support therapeutic choices for physicians. METHODS: Culture-based bacterial diagnostics including antimicrobial resistance testing were performed on samples collected from patients with chronic wounds at a hospital in Asante Akim North Municipality, Ghana. Fungal detection was performed by broad-range fungal PCR and sequencing of amplicons. RESULTS: In total, 105 patients were enrolled in the study, from which 207 potential bacterial pathogens were isolated. Enterobacteriaceae (n = 84, 41%) constituted the most frequently isolated group of pathogens. On species level, Pseudomonas aeruginosa (n = 50, 24%) and Staphylococcus aureus (n = 28, 14%) were predominant. High resistance rates were documented, comprising 29% methicillin resistance in S. aureus as well as resistance to 3rd generation cephalosporins and fluoroquinolones in 33% and 58% of Enterobacteriaceae, respectively. One P. aeruginosa strain with carbapenem resistance was identified. The most frequently detected fungi were Candida tropicalis. CONCLUSIONS: The pathogen distribution in chronic wounds in rural Ghana matched the internationally observed patterns with a predominance of P. aeruginosa and S. aureus. Very high resistance rates discourage antibiotic therapy but suggest an urgent need for microbiological diagnostic approaches, including antimicrobial resistance testing to guide the management of patients with chronic wounds in Ghana.


Assuntos
Antibacterianos/farmacologia , Bactérias/isolamento & purificação , Fungos/isolamento & purificação , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/microbiologia , Adulto , Idoso , Animais , Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Candida tropicalis/efeitos dos fármacos , Candida tropicalis/isolamento & purificação , Farmacorresistência Bacteriana , Farmacorresistência Fúngica , Feminino , Fungos/efeitos dos fármacos , Gana/epidemiologia , Hospitais de Distrito , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/isolamento & purificação , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Infecção dos Ferimentos/epidemiologia , Adulto Jovem
13.
World J Surg ; 44(11): 3590-3594, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32860140

RESUMO

INTRODUCTION: Covid-19 has had a significant impact on all aspects of health care. We aimed to characterise the trends in emergency general surgery at a district general hospital in Scotland. METHODS: A prospective cohort study was performed from 23/03/20 to 07/05/20. All emergency general surgery patients were included. Demographics, diagnosis and management were recorded along with Covid-19 testing and results. Thirty-day mortality and readmission rates were also noted. Similar data were collected on patients admitted during the same period in 2019 to allow for comparison. RESULTS: A total of 294 patients were included. There was a 58.3 per cent reduction in admissions when comparing 2020 with 2019 (85 vs 209); however, there was no difference in age (53.2 vs 57.2 years, p = 0.169) or length of stay (4.8 vs 3.7 days, p = 0.133). During 2020, the diagnosis of appendicitis increased (4.3 vs 18.8 per cent, p = < 0.05) as did severity (0 per cent > grade 1 vs 58.3 per cent > grade 1, p = < 0.05). The proportion of patients undergoing surgery increased (19.1 vs 42.3 per cent, p = < 0.05) as did the mean operating time (102.4 vs 145.7 min, p = < 0.05). Surgery was performed in 1 confirmed and 1 suspected Covid-19 patient. The latter died within 30 days. There were no 30-day readmissions with Covid-19 symptoms. CONCLUSION: Covid-19 has significantly impacted the number of admissions to emergency general surgery. However, emergency operating continues to be needed at pre-Covid-19 levels and as such provisions need to be made to facilitate this.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Cirurgia Geral/tendências , Pandemias , Admissão do Paciente/tendências , Pneumonia Viral , Padrões de Prática Médica/tendências , Procedimentos Cirúrgicos Operatórios/tendências , Adulto , Idoso , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Emergências , Feminino , Hospitais de Distrito/tendências , Hospitais Gerais/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Readmissão do Paciente/tendências , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Estudos Prospectivos , Escócia
14.
Clin Rheumatol ; 39(9): 2817-2821, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32712743

RESUMO

COVID-19 has significantly affected healthcare systems around the world. To prepare for this unprecedented emergency, elective patient care was put on hold across the National Health Service (NHS). Rheumatology service had to be reorganised with a cancellation of elective clinics and clinical reconfiguration to continue to deliver care to patients, support frontline, and prevent viral transmission. The rheumatology community's responsibility of providing a continuity of care for patients had to be balanced with measures to reduce the risk of viral transmission and also protection of both the patients and staff. We describe our experience of delivering rheumatology service as recommended by the National Institute for Health and Care Excellence (NICE NG167) guidelines at a district general hospital during the current pandemic. Key Points • Prepare to deliver a rapid mass communication; ensure email and mobile phones registered in patients' records; enable access to text and video messaging. • To ensure wider access to innovative digital technology in clinical practice; implement telephone and video consultations where appropriate. • To consider setting up community OP clinics, for example, mobile and satellite clinics.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência à Saúde/métodos , Pneumonia Viral/epidemiologia , Doenças Reumáticas/terapia , Reumatologia/métodos , Telemedicina , Administração Intravenosa , Assistência Ambulatorial , Antirreumáticos/uso terapêutico , Betacoronavirus , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Substituição de Medicamentos , Hospitais de Distrito , Hospitais Gerais , Humanos , Infusões Subcutâneas , Enfermeiras e Enfermeiros , Pandemias/prevenção & controle , Admissão e Escalonamento de Pessoal , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Reumatologistas , Medição de Risco , Medicina Estatal , Reino Unido
15.
Clin Med (Lond) ; 20(5): e173-e177, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32719035

RESUMO

We describe the details of a COVID-19 outbreak in a 25-bedded Birmingham neurology/stroke ward in the early phase of the pandemic (March to May 2020). Twenty-one of 133 admissions (16%) tested positive for COVID-19 and of those, 8 (6% of all admissions to the ward) were determined to be nosocomial. Thus 38% (8/21) of COVID-19 infections were hospital-acquired. Ten of the patients that contracted COVID-19 died; of these three were hospital-acquired cases. Five of the 21 patients had negative swabs prior to receiving a positive test result. This study highlights the importance of appropriate use of personal protective equipment (PPE) with high-risk patients (including those with stroke and complex brain injury with tracheostomies) and the difficulties of COVID-19 management in a high-risk patient population.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/epidemiologia , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Acidente Vascular Cerebral/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/prevenção & controle , Feminino , Departamentos Hospitalares , Hospitais de Distrito , Hospitais Gerais , Humanos , Incidência , Masculino , Auditoria Médica , Neurologia/organização & administração , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Reino Unido , Populações Vulneráveis
16.
Injury ; 51(10): 2142-2147, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32654849

RESUMO

INTRODUCTION: The COVID -19 outbreak has had a profound effect on the management of healthcare service provision in the UK. Orthopaedic departments have been no exception to this and have needed to adapt to the changing circumstances by releasing resources and focusing on 'essential' activity. The aim of this study is to quantify the reduction in trauma and, in addition, describe any changes in the type of referrals to the trust which may have been affected by the pandemic itself and the social distancing measures employed by the UK government. METHODS: The study was performed in a UK District Hospital which is also a Trauma Unit providing trauma and orthopaedic care to a population of 625,000 people. The trust based electronic database of trauma referrals was used to compare the numbers of, and types of referral to our trauma service during the COVID-19 pandemic and the corresponding time periods in the previous 3 years. RESULTS: The mean number of referrals per week to the service reduced by 33% in the time period following the confirmation of the outbreak as a pandemic (p<0.0001). Number of operations performed per week reduced by 26% (p = 0.001). There was no change in the number of referrals relating to domestic abuse or non-accidental injury. In addition, numbers of hip fractures, periprosthetic fractures and prosthetic joint dislocations were unchanged. There was a significant reduction in the number of referrals for simple fractures, native joint dislocations, wounds and soft tissue injuries. Within the paediatric population, similarly, a reduction in simple fracture referrals was demonstrated. DISCUSSION: An association between the outbreak of the pandemic and a reduction in referral numbers to our department has been demonstrated. The direct cause of this may be multifactorial but proposing that it is, in part, due to the social distancing measures introduced by the government is certainly conceivable. The patterns of injury would reflect this also with low energy and fragility trauma persisting whilst injuries associated with younger people have reduced. We would suggest that information such as this could be useful in healthcare planning and resource allocation in future pandemic situations.


Assuntos
Infecções por Coronavirus/epidemiologia , Ortopedia/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Carga de Trabalho , Ferimentos e Lesões/epidemiologia , Adulto , Betacoronavirus , Hospitais de Distrito , Hospitais Gerais , Humanos , Pessoa de Meia-Idade , Procedimentos Ortopédicos/estatística & dados numéricos , Pandemias , Encaminhamento e Consulta/estatística & dados numéricos , Reino Unido
17.
S Afr Med J ; 110(5): 374-376, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32657720

RESUMO

BACKGROUND: Previous work from KwaZulu-Natal (KZN) Province, South Africa, has suggested that public sector district hospitals are not providing adequate access to surgical care in the form of bellwether operations (caesarean section (CS), open reduction of fractures (ORF) and laparotomy). OBJECTIVES: To review the surgical output of regional and tertiary institutions, to quantify their contribution to providing bellwether procedure coverage for the province. METHODS: Data on bellwether operations conducted at all district, regional, tertiary and central hospitals in the public health sector of KZN for the period 1 July - 31 December 2015 were collected from operating theatre registers. RESULTS: Between 1 July and 31 December 2015, a total of 20 926 CSs, 3 947 laparotomies and 3 098 ORFs were performed in KZN provincial hospitals. This translates to a provincial rate for each bellwether procedure of 192/100 000 (CS), 36/100 000 (laparotomy) and 28/100 000 (ORF). The rate of  bellwether operations across the province during the study period was 256/100 000, with numbers as follows: CSs - 10 542 in district hospitals, 8 712 in regional hospitals, 1 538 in tertiary hospitals and 134 in the central hospital; laparotomies - 235 in district hospitals, 2 314 in regional hospitals, 1 259 in tertiary hospitals and 139 in the central hospital; and ORFs - 196 in district hospitals, 1 660 in regional hospitals, 1 201 in tertiary hospitals and 41 in the central hospital. CONCLUSIONS: Regional and tertiary hospitals are performing the bulk of non-obstetric bellwether operations in KZN. This imbalance has major implications for planning future delivery of surgical care in the province.


Assuntos
Cesárea/estatística & dados numéricos , Laparotomia/estatística & dados numéricos , Redução Aberta/estatística & dados numéricos , Programas Médicos Regionais/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Feminino , Fraturas Ósseas/terapia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais de Distrito/estatística & dados numéricos , Humanos , Gravidez , África do Sul
18.
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
19.
Stud Health Technol Inform ; 272: 280-283, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32604656

RESUMO

World Health Organisation (WHO) has updated the International Classification of Diseases to version 11 (ICD-11) which was recently adopted for use by countries in 2019. ICD-11 can be used in Electronic Medical Records (EMR) systems with support of extended technologies like Application Program Interface (API). Integration of ICD-11 in Rwandan EMR (OpenMRS) in two health facilities was conducted in July-October 2019. Findings indicated that adapting ICD11-API in EMR is feasible. More than 50% of diagnoses were recorded using ICD-11. Healthcare providers perceived ICD-11 API as easy to learn and useful for harmonization of diagnosis, data reporting and insurance reimbursement. Integration of ICD-11 API in EMR can be scaled up to all hospitals for use in Rwanda and other countries using similar system.


Assuntos
Registros Eletrônicos de Saúde , Classificação Internacional de Doenças , Hospitais de Distrito , Ruanda , Software
20.
Clin Med (Lond) ; 20(5): e148-e153, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32709637

RESUMO

BACKGROUND: This retrospective cohort study aims to define the clinical findings and outcomes of every patient admitted to a district general hospital in Surrey with COVID-19 in March 2020, providing a snapshot of the first wave of infection in the UK. This study is the first detailed insight into the impact of frailty markers on patient outcomes and provides the infection rate among healthcare workers. METHODS: Data were obtained from medical records. Outcome measures were level of oxygen therapy, discharge and death. Patients were followed up until 21 April 2020. RESULTS: 108 patients were included. 34 (31%) died in hospital or were discharged for palliative care. 43% of patients aged over 65 died. The commonest comorbidities were hypertension (49; 45%) and diabetes (25; 23%). Patients who died were older (mean difference ±SEM, 13.76±3.12 years; p<0.0001) with a higher NEWS2 score (median 6, IQR 2.5-7.5 vs median 2, IQR 2-6) and worse renal function (median differences: urea 2.7 mmol/L, p<0.01; creatinine 4 µmol/L, p<0.05; eGFR 14 mL/min, p<0.05) on admission compared with survivors. Frailty markers were identified as risk factors for death. Clinical Frailty Scale (CFS) was higher in patients over 65 who died than in survivors (median 5, IQR 4-6 vs 3.5, IQR 2-5; p<0.01). Troponin and creatine kinase levels were higher in patients who died than in those who recovered (p<0.0001). Lymphopenia was common (median 0.8, IQR 0.6-1.2; p<0.005). Every patient with heart failure died (8). 26 (24%) were treated with continuous positive airway pressure (CPAP; median 3 days, IQR 2-7.3) and 9 (8%) were intubated (median 14 days, IQR 7-21). All patients who died after discharge (4; 6%) were care home residents. 276 of 699 hospital staff tested were positive for COVID-19. CONCLUSIONS: This study identifies older patients with frailty as being particularly vulnerable and reinforces government policy to protect this group at all costs.


Assuntos
Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Fragilidade/mortalidade , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Idoso , Estudos de Coortes , Terapia Combinada , Feminino , Fragilidade/fisiopatologia , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Hospitais de Distrito/organização & administração , Hospitais Gerais/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Estudos Retrospectivos , Medição de Risco , Reino Unido , Populações Vulneráveis/estatística & dados numéricos
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