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1.
Braz. j. biol ; 84: e253065, 2024. tab
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1350311

RESUMO

Abstract Routine blood culture is used for the detection of bloodstream infections by aerobic and anaerobic bacteria and by common pathogenic yeasts. A retrospective study was conducted in a public hospital in Maceió-AL, by collecting data of all medical records with positive blood cultures. Out of the 2,107 blood cultures performed, 17% were positive with Staphylococcus coagulase negative (51.14%), followed by Staphylococcus aureus (11.21%) and Klebsiella pneumoniae (6.32%). Gram-positive bacteria predominated among positive blood cultures, highlighting the group of Staphylococcus coagulase-negative. While Gram-negative bacteria had a higher number of species among positive blood cultures.


Resumo A cultura sanguínea de rotina é usada para a detecção de infecções na corrente sanguínea por bactérias aeróbias e anaeróbias e por leveduras patogênicas comuns. Estudo retrospectivo realizado em hospital público de Maceió-AL, por meio da coleta de dados de todos os prontuários com culturas sanguíneas positivas. Das 2.107 culturas sanguíneas realizadas, 17% foram positivas com Staphylococcus coagulase negativo (51,14%), seguido por Staphylococcus aureus (11,21%) e Klebsiella pneumoniae (6,32%). As bactérias Gram-positiva predominaram entre as culturas de sangue positivas, destacando-se o grupo das Staphylococcus coagulase-negativo. Enquanto as bactérias Gram-negativas apresentaram um número maior de espécies entre as culturas de sangue positivas.


Assuntos
Humanos , Sepse , Bactérias Gram-Negativas , Brasil , Estudos Retrospectivos , Hospitais
2.
Health Aff (Millwood) ; 41(2): 237-246, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35130071

RESUMO

Examining how spatial access to health care varies across geography is key to documenting structural inequalities in the United States. In this article and the accompanying StoryMap, our team identified ZIP Code Tabulation Areas (ZCTAs) with the largest share of minoritized racial and ethnic populations and measured distances to the nearest hospital offering emergency services, trauma care, obstetrics, outpatient surgery, intensive care, and cardiac care. In rural areas, ZCTAs with high Black or American Indian/Alaska Native representation were significantly farther from services than ZCTAs with high White representation. The opposite was true for urban ZCTAs, with high White ZCTAs being farther from most services. These patterns likely result from a combination of housing policies that restrict housing opportunities and federal health policies that are based on service provision rather than community need. The findings also illustrate the difficulty of using a single metric-distance-to investigate access to care on a national scale.


Assuntos
Acesso aos Serviços de Saúde , Feminino , Geografia , Hospitais , Humanos , Gravidez , Estados Unidos
3.
Am J Disaster Med ; 17(1): 75-89, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35913185

RESUMO

OBJECTIVE: Hospitals are the basic infrastructure for disaster response. While they themselves are exposed to disasters, they also play an important role during the disaster response period. Therefore, they are expected to be able to maintain their performance during and immediately after disasters. The aim of this study is to discover strategies to improve the hospital disaster risk management. DESIGN: This study is a systematic qualitative study with thematic analysis. Data sources including Persian and international databases were searched using the "Hospital, Disaster, Risk management, Risk reduction, Improvement, and Strategy" keywords and their combinations of them. The search time period ranged from January 2010 to January 2020. Data were extracted by two independent arbitrators for qualitative thematic analysis. RESULTS: In total, 889 articles and documents were retrieved. Of which, 166 articles were deleted due to duplication, 436 articles did not meet the objectives of the research, and 263 articles did not meet the eligibility criteria and were deleted. Finally, 24 articles were included in the study. After thematic analysis, 33 subthemes were obtained and classified into five themes of organizational-managerial strategies, preventive and risk reduction strategies, preparedness strategies, response strategies, and recovery strategies. Not all articles discuss all categories. CONCLUSION: Applying strategies to improve the hospital disaster risk management resulting from this study can be useful in improving the preparedness of hospitals in the face of disasters.


Assuntos
Planejamento em Desastres , Desastres , Hospitais , Pesquisa Qualitativa , Gestão de Riscos
4.
BMJ Open ; 12(8): e051833, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35914920

RESUMO

OBJECTIVE: To determine the budget impact of virtual care. METHODS: We conducted a budget impact analysis of virtual care from the perspective of a large teaching hospital in the Netherlands. Virtual care included remote monitoring of vital signs and three daily remote contacts. Net budget impact over 5 years and net costs per patient per day (costs/patient/day) were calculated for different scenarios: implementation in one ward, in two different wards, in the entire hospital, and in multiple hospitals. Sensitivity analyses included best-case and worst-case scenarios, and reducing the frequency of daily remote contacts. RESULTS: Net budget impact over 5 years was €2 090 000 for implementation in one ward, €410 000 for two wards and €-6 206 000 for the entire hospital. Costs/patient/day in the first year were €303 for implementation in one ward, €94 for two wards and €11 for the entire hospital, decreasing in subsequent years to a mean of €259 (SD=€72), €17 (SD=€10) and €-55 (SD=€44), respectively. Projecting implementation in every Dutch hospital resulted in a net budget impact over 5 years of €-445 698 500. For this scenario, costs/patient/day decreased to €-37 in the first year, and to €54 in subsequent years in the base case. CONCLUSIONS: With present cost levels, virtual care only saves money if it is deployed at sufficient scale or if it can be designed such that the active involvement of health professionals is minimised. Taking a greenfield approach, involving larger numbers of hospitals, further decreases costs compared with implementing virtual care in one hospital alone.


Assuntos
Orçamentos , Pacientes Internados , Análise Custo-Benefício , Hospitais , Humanos , Países Baixos , Assistência ao Paciente
5.
Eur Rev Med Pharmacol Sci ; 26(14): 5053-5062, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35916801

RESUMO

OBJECTIVE: To explore whether anesthesiologists' efficiency can be increased via the use of intelligent equipment, thereby improving the quality of surgical anesthesia. SUBJECTS AND METHODS: This paper first introduces the intelligent management system and work flow of drugs and consumables in the department of anesthesiology in our hospital, and then compares the time before and after the use of intelligent equipment, the time for anesthesiologists and nurses to manage drugs and consumables, the misdistribution rate of drugs distributed by anesthetic nurses, and the inventory time and accuracy of narcotic drugs. RESULTS: For the intelligent management with intelligent drug cabinets and logistics robots as the terminal, compared with traditional management, the anesthesiologist saves an average of 24±1 (min) per day in acquisition of drugs and consumables, and the total error rate in drugs and consumables distribution by anesthesia nurses is reduced from 4% to 1%, the inventory time of anesthetic drugs is 12±5 (min) earlier than before, and inventory accuracy has been increased from 94.6% to 98.6%. The anesthesia nurses save an average of 53.1±10 (min) per day from taking medicines to operating anesthesia billing than before. CONCLUSIONS: The intelligent management of drugs and consumables in the Anesthesiology Department improves management efficiency, ensures medication safety for surgical patients, increases anesthesia management time for anesthesiologists, and improves the quality of surgical anesthesia.


Assuntos
Anestesia , Anestesiologia , Anestesiologistas , Hospitais , Humanos
6.
Environ Monit Assess ; 194(9): 629, 2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-35918614

RESUMO

Bacteria in a hospital environment potentially cause hospital-acquired infections (HAIs), particularly in immunocompromised individuals. Treatments of HAIs with antibiotics, however, are ineffective due to the emergence of antibiotic-resistant bacteria (ARB). This study aims to identify airborne bacteria in a tertiary hospital in Malaysia and screen for their resistance to commonly used broad-spectrum antibiotics. Airborne bacteria were sampled using active sampling at the respiratory ward (RW), physician clinic (PC) and emergency department (ED). Physical parameters of the areas were recorded, following the Industry Code of Practice on Indoor Air Quality 2010 (ICOP IAQ 2010). Bacterial identification was based on morphological and biochemical tests. Antibiotic resistance screening was carried out using the Kirby-Bauer disk diffusion method. Results showed that the highest bacterial population was found in the highest density occupancy area, PC (1024 ± 54 CFU/m3), and exceeded the acceptable limit. Micrococcus spp., Staphylococcus aureus, α- and ß-Streptococcus spp., Bacillus spp. and Clostridium spp. colonies were identified at the sampling locations. The antibiotic resistance screening showed a vast percentage of resistance amongst the bacterial colonies, with resistance to ampicillin observed as the highest percentage (Micrococcus spp.: 95.2%, S. aureus: 100%, Streptococcus spp.: 75%, Bacillus spp.: 100% and Clostridium spp.: 100%). This study provides awareness to healthcare practitioners and the public on the status of the emergence of ARB in a hospital environment. Early detection of bacterial populations and good management of hospital environments are important prevention measures for HAI.


Assuntos
Infecção Hospitalar , Staphylococcus aureus , Antagonistas de Receptores de Angiotensina/farmacologia , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Antibacterianos/farmacologia , Bactérias , Farmacorresistência Bacteriana , Resistência Microbiana a Medicamentos , Monitoramento Ambiental , Hospitais , Humanos
7.
Ulus Travma Acil Cerrahi Derg ; 28(8): 1095-1099, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35920414

RESUMO

BACKGROUND: Appendicitis is one of the most common surgical emergencies among children. In this retrospective clinical study, we attempted to determine the effects of the COVID-19 pandemic period on hospital admission time and length of hospital stay (LOS) in pediatric appendicitis cases. METHODS: We retrospectively compared pediatric appendectomies from the date of the first reported COVID-19 case to June 1, 2020, which is considered as the start of the normalization process, with pre-pandemic pediatric appendectomies of the same number of days in terms of age, gender, hospital admission time, LOS, parental educational level, laboratory values, and histopathological findings. RESULTS: There was an average increase of 2 days in the time from the onset of symptoms to hospital admission in pediatric appen-dicitis patients in the COVID-19 period (p=0.001). Furthermore, C-reactive protein value was statistically significantly higher in the COVID-19 period (p=0.018). Given the LOS, it was calculated as an average of 5 days in the pre-pandemic period and 4 days in the COVID-19 period, and this difference was statistically insignificant (p=0.273). There was no significant difference between the groups in terms of histopathological findings (p=0.176). The parental educational level had no effect on the admission time. CONCLUSION: The hospital admission time of pediatric appendicitis patients is significantly prolonged in the COVID-19 pandemic, but this prolongation had no histopathological effect. During the pandemic, the recovery of patients who required urgent treatment during the 'stay-at-home' period was also negatively affected. Notwithstanding, we are of the opinion that the absence of an increase in the LOS may be due to the willingness of both families and physicians to keep the LOS as short as possible. Despite the increase in hospital admission time in pediatric appendicitis during the Covid 19 pandemic process, the lack of increase in the rate of complicated appendicitis may be an indicator of the importance of other factors in the development of complicated appendicitis.


Assuntos
Apendicite , COVID-19 , Apendicectomia/efeitos adversos , Apendicite/diagnóstico , Apendicite/epidemiologia , Apendicite/cirurgia , COVID-19/epidemiologia , Criança , Hospitais , Humanos , Tempo de Internação , Pandemias , Estudos Retrospectivos
8.
Ulus Travma Acil Cerrahi Derg ; 28(8): 1122-1127, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35920428

RESUMO

BACKGROUND: Earthquakes are natural events, but the destruction they cause is quite high. Since it is not possible to prevent an earthquake, it is necessary to raise conscious and sensitive individuals about earthquakes and to seek solutions. It was aimed to present the triage, consumables, fluids, and drugs used in the 2020 Elazig earthquake. METHODS: After the earthquake, the epicenter of which was Sivrice/Elazig on January 24, 2020, all affected victims, pre-hospital triage status, management of emergency, and other inpatient services during the hospitalization, medical interventions including sur-geries, consumables, fluids, and drugs were evaluated retrospectively with the data in the first 24 h. RESULTS: The total number of injured after the earthquake in Elazig, which had a magnitude of 6.6 on the Richter scale and lasted for 22 s, was 974. While 37 (3.7%) people died, 18 (1.8%) of them were women. While 34 people died in the wreckage and 3 people in the emergency department, their mean age was 46.0±12.5 years. While 654 patients were registered in the first 24 h, 30 of them were by 112 Command and Control Center and 624 were outpatients. Temporary registration was provided to 320 people as they did not have their identity information. CONCLUSION: Being prepared and organized before an earthquake, and taking early intervention will provide significant success in the survival of the disaster victims.


Assuntos
Planejamento em Desastres , Desastres , Terremotos , Adulto , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Triagem
9.
Ulus Travma Acil Cerrahi Derg ; 28(8): 1100-1108, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35920435

RESUMO

BACKGROUND: Mass trauma is an event in which the number of patients temporarily exceeds the capacity of medical personnel to provide optimal care. Looking at the global terrorism index, Syria is one of the most terrorism-affected countries in the Middle East, and the threat of terrorist attacks that can cause mass trauma persists. When it comes to dealing with mass trauma, the damage control approach has come to the forefront in recent years. In our study, we aimed to assess the awareness and training effectiveness of emergency physicians and surgeons on damage control surgery and resuscitation in Northwest Syria, where mass trauma due to terrorist attacks and social events is common. METHODS: A trauma team from Çobanbey Hospital in Northwest Syria conducted training on damage control and resuscitation. Syrian physicians who participated in this training were administered a damage control and resuscitation questionnaire before and after the training. RESULTS: A total of 43 subjects were enrolled in the study, and their mean age was 44.04±9.01 years. The majority of the physicians who participated in the training were from Elbab (23.3%), Afrin (23.3%), and Çobanbey (20.9%). The average work experience of the physicians was 14 years and the average number of non-elective surgeries performed in the last year was 47.5. While the average total score (pre-test) before the training was 67, the average total score (post-test) after the training increased to 72, and this difference was statistically significant (p=0.008). While the pre-test and post-test scores of those who were trained and had practiced placing intrathoracic clamp-wound clamp and trauma laparotomy were significantly higher than those who were not trained and had not used them (p<0.05), the difference between the pre-test and post-test scores of those who were not trained and had not used them was statistically significant (p<0.05). CONCLUSION: It is well known that there have been internal unrest and terrorist attacks in Northwest Syria for more than 10 years. It is important for physicians in this region to know the damage control strategies. In this regard, we have found that awareness among physicians has increased as a result of the training we have provided on damage control.


Assuntos
Cirurgiões , Terrorismo , Adulto , Hospitais , Humanos , Pessoa de Meia-Idade , Ressuscitação , Síria
10.
PLoS One ; 17(8): e0272570, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35930572

RESUMO

INTRODUCTION: With fragile health care systems, sub-Saharan Africa countries like Ethiopia are facing a complex epidemic, and become difficult to control the noble coronavirus. The use of COVID-19 preventive measures is strongly recommended. This study aimed to assess the adherence of COVID-19 mitigation measures and associated factors among health care workers. METHODS: A facility-based cross-sectional study was conducted among health care workers at referral hospitals in the Amhara regional state of Ethiopia from May 15 to June 10; 2021. It was a web-based study using an online questionnaire. STATA 14.2 was used for data analysis. Variables with a p-value<0.05 at 95% confidence level in multivariable analysis were declared as statistically significant using binary logistic regression. RESULT: Adherence to COVID-19 mitigation measures was 50.24% in the current study. The odd of adherence of participants with a monthly income of ≥12801birr was 15% whereas the odds of adherence of participants who hesitate to take the COVID 19 vaccine were 10% as compared to those who don't hesitate. Participants who had undergone COVID-19 tests adhered 6.64 times more than their counterparts. Those who believe adequate measurements are taken by the government adhered 4.6 times more than those who believe not adequate. Participants who believe as no risk of severe disease adhered 16% compared to those with fear of severe disease. Presence of households aged >60years adhered about 7.9 times more than with no households aged>60. Participants suspected of COVID-19 diagnosis adhered 5.7 times more than those not suspected. CONCLUSION: In this study, a significant proportion of healthcare workers did not adhere to COVID-19 mitigation measures. Hence, giving special attention to healthcare workers with a monthly income of ≥12801 birr, being hesitant towards COVID-19 vaccine, being aged 26-30, and perceiving no risk of developing a severe infection is crucial to reduce non-adherence.


Assuntos
COVID-19 , COVID-19/epidemiologia , COVID-19/prevenção & controle , Teste para COVID-19 , Vacinas contra COVID-19 , Estudos Transversais , Etiópia/epidemiologia , Pessoal de Saúde , Hospitais , Humanos , Encaminhamento e Consulta
11.
Age Ageing ; 51(8)2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-35932242

RESUMO

BACKGROUND: falls are common in older people, but associations between falls, dementia and frailty are relatively unknown. The impact of the COVID-19 pandemic on falls admissions has not been studied. AIM: to investigate the impact of dementia, frailty, deprivation, previous falls and the differences between years for falls resulting in an emergency department (ED) or hospital admission. STUDY DESIGN: longitudinal cross-sectional observational study. SETTING: older people (aged 65+) resident in Wales between 1 January 2010 and 31 December 2020. METHODS: we created a binary (yes/no) indicator for a fall resulting in an attendance to an ED, hospital or both, per person, per year. We analysed the outcomes using multilevel logistic and multinomial models. RESULTS: we analysed a total of 5,141,244 person years of data from 781,081 individuals. Fall admission rates were highest in 2012 (4.27%) and lowest in 2020 (4.27%). We found an increased odds ratio (OR [95% confidence interval]) of a fall admission for age (1.05 [1.05, 1.05] per year of age), people with dementia (2.03 [2.00, 2.06]) and people who had a previous fall (2.55 [2.51, 2.60]). Compared with fit individuals, those with frailty had ORs of 1.60 [1.58, 1.62], 2.24 [2.21, 2.28] and 2.94 [2.89, 3.00] for mild, moderate and severe frailty respectively. Reduced odds were observed for males (0.73 [0.73, 0.74]) and less deprived areas; most deprived compared with least OR 0.75 [0.74, 0.76]. CONCLUSIONS: falls prevention should be targeted to those at highest risk, and investigations into the reduction in admissions in 2020 is warranted.


Assuntos
COVID-19 , Demência , Fragilidade , Idoso , COVID-19/epidemiologia , Estudos Transversais , Demência/diagnóstico , Demência/epidemiologia , Serviço Hospitalar de Emergência , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Hospitais , Humanos , Masculino , Pandemias , Reino Unido/epidemiologia , País de Gales/epidemiologia
12.
Geriatr Psychol Neuropsychiatr Vieil ; 20(2): 190-198, 2022 06 01.
Artigo em Francês | MEDLINE | ID: mdl-35929383

RESUMO

Background: Nursing homes' (NH) residents present a mix of medical, psychological and social needs associated with a high risk of hospitalization. The intervention of the hospitalization at home (HAH) in NH has been implemented in France to better fit the residents' needs and decrease the risk of hospitalization. No study has described the population of residents receiving this intervention. This study aimed to define the profile and the care pathway of residents and compare their characteristics according to the referrals (NH or hospitals). Methods: A retrospective study on 1,436 residents' stays in the intervention of the Assistance Publique-Hôpitaux de Paris'HAH in Ile de France between 2014 and 2019 was implemented. The Programme de Médicalisation des Systèmes d'Information (PMSI) data was used for the analysis. Results: Residents were 88 years old with 69 % of women with functional disability and the care was mainly represented by the complex dressing (68 %). For the care pathway, 65 % of the referrers were from the NH and 35 % from the hospital settings, 33 % of the residents died at the end of the stay in the NH and 25 % were transferred to hospitals. When the referrer was the hospital, the residents were mainly men (p < 0.001), younger (p < 0.001), receiving more often intravenous treatment and palliative care (p < 0.01) with a higher level of indice of Karnofsky (p < 0.01). When the NH was the referrer, deaths were more frequent, whereas the transfers to hospitals were less common (p < 0.001). Discussion : Residents had complex clinical situation and their care pathway were different according to the referrer. From the NH, the HAH was used to provide more often end of life care, and from hospital setting, the residents received more acute care with a higher risk of readmission. Readmission causes should be analyzed.


Introduction: Les résidents d'Établissement d'hébergement pour personnes âgées dépendantes (Ehpad) présentent un haut risque d'hospitalisation. Afin d'éviter le recours à l'hôpital, l'hospitalisation à domicile (HAD) en Ehpad s'est développée. Cette étude a pour objectifs de caractériser le profil clinique et le parcours de soins des résidents d'Ehpad ayant bénéficié de l'HAD, et de comparer leur profil selon la provenance de l'intervention (Ehpad ou hôpital). Méthodes: Une étude rétrospective des séjours de résidents d'Ehpad ayant bénéficié de l'HAD de l'Assistance publique-Hôpitaux de Paris entre 2014 et 2019 a été mise en place à partir des données du PMSI. Résultats: Les résidents étaient âgés de 88 ans en moyenne avec 69 % de femmes. Ils étaient principalement pris en charge pour des plaies complexes (68 %). Concernant les séjours, 65 % étaient en provenance de l'Ehpad. Les modes de sortie montraient 33 % de décès en Ehpad et 25 % de réhospitalisations. Selon la provenance du séjour, les résidents présentaient un profil clinique et des parcours de soins différents. Discussion/conclusion: L'intervention de l'HAD en Ehpad permet de répondre aux caractéristiques et aux besoins spécifiques des résidents tout en évitant un recours systématique à l'hospitalisation.


Assuntos
Procedimentos Clínicos , Casas de Saúde , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Hospitais , Humanos , Masculino , Estudos Retrospectivos
13.
BMC Med Imaging ; 22(1): 138, 2022 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-35931973

RESUMO

BACKGROUND: Low back pain (LBP) is one of the most serious public health problem globally with substantial socioeconomic implications. Degenerative disc disease is an important cause of LBP in the elderly. Magnetic resonance imaging (MRI) is routinely ordered by physicians in evaluation of patients with suspected degenerative disc disease in the lumbar spine. However there is no unanimous agreement in the literatures when it comes to the association of degree of disability to that of severity of lumbar MRI findings. OBJECTIVE: The aim of this study is to assess the association between degree of disability measured using Oswestry Disability Index (ODI) and findings on lumbar spine MRI in patients with degenerative disc disease at University of Gondar comprehensive Specialized Hospital, North West Ethiopia, 2020. METHODS AND MATERIALS: A prospective cross-sectional study was conducted on 72 consecutively enrolled patients with degenerative disc disease who underwent lumbar MRI scan. Degree of disability was measured using ODI questionnaire translated to local language. Association between lumbar spine MRI parameters and ODI score and category was tested using Spearman's rank correlation coefficient and Chi square tests. RESULTS: The mean age of the study subjects was 43.81 ± 1.88 years (range 22-83 years). Forty-three (59.7%) of the study population were female. In terms of ODI category, most fell under minimal 33 (45.8%) or moderate 25 (34.7%) disability. Disc bulge (81.9%) and foraminal stenosis were the most frequent MRI abnormalities detected. ODI score showed weak correlation with grade of spinal canal stenosis. Grade of foraminal stenosis showed no correlation with ODI score. CONCLUSION: The clinical relevance of MRI findings in predicting degree of disability in patients with degenerative disc disease is limited and MRI study should be sparingly ordered in evaluation of these patients particularly in resource constrained settings.


Assuntos
Degeneração do Disco Intervertebral , Dor Lombar , Adulto , Idoso , Idoso de 80 Anos ou mais , Constrição Patológica/complicações , Estudos Transversais , Etiópia , Feminino , Hospitais , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
14.
BMC Prim Care ; 23(1): 196, 2022 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-35931991

RESUMO

BACKGROUND: Diabetes is a progressive condition requiring long-term medical care and self-management. The ineffective transition from hospital to community or home health care may result in poor glycemic control and increase the risk of serious diabetes-related complications. In China, the most common transitional care model is home visits or telephone interventions led by a single healthcare setting, with a lack of cooperation between specialists and primary care, which leads to inadequate service and discontinuous care. Thus, an integrated hospital-community-home (i-HCH) transitional care program was developed to promote hospital and community cooperation and provide comprehensive and continuous medical care for type 2 diabetes mellitus (T2DM) via mobile health (mHealth) technology. METHODS: This protocol is for a multicenter randomized controlled trial in T2DM patients. Hospitalized patients diagnosed with T2DM who meet the eligibility criteria will be recruited. The patients will be randomly allocated to either the intervention or the control group and receive the i-HCH transitional care or usual transitional care intervention. The change in glycated hemoglobin is the primary outcome. Secondary outcome measures are blood pressure, lipids (total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein), body mass index, self-management skills, quality of life, diabetes knowledge, transitional care satisfaction and the rate of readmission. The follow-up period of this study is six months. DISCUSSION: The study will enhance the cooperation between local hospitals and communities for diabetes transitional care. Research on the effectiveness of diabetes outcomes will have potentially significant implications for chronic disease patients, family members, health caregivers and policymakers. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900023861: June 15, 2019.


Assuntos
Diabetes Mellitus Tipo 2 , Telemedicina , Cuidado Transicional , Diabetes Mellitus Tipo 2/terapia , Hospitais , Humanos , Estudos Multicêntricos como Assunto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Telemedicina/métodos
15.
BMC Anesthesiol ; 22(1): 250, 2022 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-35933333

RESUMO

BACKGROUND: Humane treatment requires the provision of appropriate sedation and analgesia during medical diagnosis and treatment. However, limited information is available about the status of procedural analgesic interventions in Chinese hospitals. Therefore, a nationwide survey was established to identify challenges and propose potential improvement strategies. METHODS: Forty-three members of the Pain Group of Chinese Society of Anesthesiology established and reviewed the questionnaire, which included (1) general information on the hospitals, (2) the sedation/analgesia rate in gastrointestinal endoscopy, labor, flexible bronchoscopy, hysteroscopy in China, (3) staff assignments, (4) drug use for procedural analgesic interventions, and (5) difficulties in procedural analgesic interventions. The data were obtained using an online questionnaire sent to the chief anesthesiologists of Chinese hospitals above Grade II or members of the Pain Group of Chinese Society of Anesthesiology. RESULTS: Valid and complete questionnaires were received from 2198 (44.0%) hospitals, of which 64.5% were Grade III. The overall sedation/analgesia rates were as follows: gastroscopy (50.6%), colonoscopy (53.7%), ERCP (65.9%), induced abortion (67.5%), labor (42.3%), hysteroscopy (67.0%) and fiber bronchoscopy (52.6%). Compared with Grade II hospitals, Grade III hospitals had a higher proportion of procedural analgesic interventions services except for induced abortion. On average (median [IQR]), each anesthesiologist performed 5.7 [2.3-11.4] cases per day, with 7.3 [3.2-13.6] performed in Grade III hospitals and 3.4 [1.8-6.8] performed in Grade II hospitals (z = -7.065, p < 0.001). CONCLUSIONS: Chinese anesthesiologists have made great efforts to achieve procedural analgesic interventions, as evidenced by the increased rate. The uneven health care provided by hospitals at different levels and in different regions and the lack of anesthesiologists are the main barriers to optimal procedural analgesic interventions.


Assuntos
Analgesia , Anestesiologia , Analgésicos/uso terapêutico , Feminino , Hospitais , Humanos , Dor , Gravidez
16.
Med Trop Sante Int ; 2(2)2022 Jun 30.
Artigo em Francês | MEDLINE | ID: mdl-35919256

RESUMO

Introduction: Neurofibromatosis 1 (NF1) is an inherited disease, in an autosomal dominant manner, with complex multi-system involvements. Prevalence varies from one country to another. However, little is known about neurofibromatosis in African countries, particularly in Madagascar. Methodology: A descriptive retrospective study from 2014 to 2019 was conducted at the service of dermatology at University Hospital Joseph Raseta Befelatanana in Antananarivo, including all patients with neurofibromatosis according to National Institutes of Health Consensus Conference criteria for whom genealogical investigation could be made. Results: Among 32 cases of NF1 seen during 6 years, 28 cases were included with a sex ratio M/F of 0.87. The mean age was 24 years ranging from 11 to 54 years. Seventeen patients presented sporadic forms. All patients had "café au lait" spots and cutaneous neurofibromatosis. Three cases presented plexiform neurofibromas which cause significant cosmetic and functional problems by their size and their displayed topography. Fifteen patients had Lisch nodules but no case of optic glioma was identified. Neurological symptoms such as learning difficulties, epilepsy and headache were frequent in our case series. However, access to medical imaging was very limited. Scoliosis was the most common orthopedic complication. Conclusion: The clinical manifestations of NF1 are extremely variable. Although the possibility of systemic complications seems to be low, patients must be followed up.


Assuntos
Manchas Café com Leite , Neurofibromatose 1 , Adulto , Manchas Café com Leite/complicações , Manchas Café com Leite/epidemiologia , Dermatologia , Hospitais , Humanos , Madagáscar/epidemiologia , Neurofibromatose 1/diagnóstico , Neurofibromatose 1/epidemiologia , Estudos Retrospectivos , Adulto Jovem
17.
Anaesthesiologie ; 71(8): 579-585, 2022 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-35925199

RESUMO

The quality of postoperative pain therapy in Germany shows a heterogeneous treatment practice and large differences in quality between individual institutions, The patient representatives in the Federal Joint Committee (G-BA) have therefore decisively campaigned for many years that instruments of non-legislative standards are employed in order to noticeably improve the quality of perioperative pain therapy for patients in Germany. As a result of these efforts, in October 2020 a binding specification for internal quality management was included in the quality management guidelines (QM-RL) by the G­BA. This describes in concrete terms the structural and procedural requirements for an internal quality management of acute pain for all institutions in which operations and comparable potentially painful interventions are carried out. This article describes the content of this regulation and the resulting consequences for the institutions, the medical and administrative management and especially the role of anesthesia.


Assuntos
Dor Aguda , Manejo da Dor , Dor Aguda/diagnóstico , Alemanha , Hospitais , Humanos , Medição da Dor
18.
Urologie ; 61(8): 823-828, 2022 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-35925292

RESUMO

The affiliated physician is one of the oldest types of self-employed physicians who work between outpatients and inpatient sectors. The number of physicians affiliated with hospitals in Germany has been decreasing steadily in recent decades. The reasons for this decline are diverse and include political and financial problems that need to be resolved. The new political changes aimed at the expansion of out-patient services in the sense of the AOP Catalog 115 b SGB V can be a new opportunity for affiliated physicians and the departments that they are affiliated with.


Assuntos
Médicos , Alemanha , Hospitais , Humanos , Pacientes Internados
19.
PLoS One ; 17(8): e0272370, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35925951

RESUMO

Hospitals acquire and maintain long-term operating assets such as land, buildings, and equipment. In this study, we analyzed hospitals' long-term assets acquisitions data extracted from the Medicare Cost Report, a mandatory annual filing for all Medicare-certified hospitals. The first objective of this study is to examine the time trend of land, buildings, and equipment acquisitions of all general acute care hospitals in the U.S. from 2005 to 2019 to understand the relative magnitude and temporal changes for the operating assets. The second objective is to examine the 15-year accumulated acquisitions of land, buildings, and equipment per capita in each state to understand the variations of potential access to hospital operating resources across states. To understand the longitudinal changes in acquisitions of operating assets for each year from 2005 to 2019, we calculated the total acquisition amounts across all hospitals for land, buildings, and equipment, respectively, and adjusted the amounts to 2019 dollars based on the consumer price index (CPI). For each state (including Washington D.C.) and the whole nation, the 15-year accumulated CPI-adjusted acquisition amounts per capita for land, buildings, and equipment were also calculated, respectively. The nationwide acquisitions of those operating assets grew rapidly from 2005 to 2008 followed by a negative overall growth from 2008 to 2014 and since 2015, started increasing steadily again. In 2019, U.S. general acute care hospitals acquired $3.0 billion of land, $44.6 billion of buildings, and $33.9 billion of equipment. Huge geographical variation in per capita cumulative total asset investment were also found with the first place North Dakota having a per capita investment that is almost four times higher than that in the lowest ranked state of Alabama.


Assuntos
Investimentos em Saúde , Medicare , Alabama , Hospitais , North Dakota , Estados Unidos
20.
PLoS One ; 17(8): e0272123, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35925985

RESUMO

PURPOSE: This study systematically reviewed studies to determine the frequency and nature of medication administration errors in Latin American hospitals. SUMMARY: We systematically searched the medical literature of seven electronic databases to identify studies on medication administration errors in Latin American hospitals using the direct observation method. Studies published in English, Spanish, or Portuguese between 1946 and March 2021 were included. A total of 10 studies conducted at 22 hospitals were included in the review. Nursing professionals were the most frequently observed during medication administration and were observers in four of the ten included studies. Total number of error opportunities was used as a parameter to calculate error rates. The administration error rate had a median of 32% (interquartile range 16%-35.8%) with high variability in the described frequencies (9%-64%). Excluding time errors, the median error rate was 9.7% (interquartile range 7.4%-29.5%). Four different definitions of medication errors were used in these studies. The most frequently observed errors were time, dose, and omission. Only four studies described the therapeutic classes or groups involved in the errors, with systemic anti-infectives being the most reported. None of the studies assessed the severity or outcome of the errors. The assessment of the overall risk bias revealed that one study had low risk, three had moderate risk, and three had high risk. In the assessment of the exploratory, observational, and before-after studies, two were classified as having fair quality and one as having poor quality. CONCLUSION: The administration error rate in Latin America was high, even when time errors were excluded. The variation observed in the frequencies can be explained by the different contexts in which the study was conducted. Future research using direct observation techniques is necessary to more accurately estimate the nature and severity of medication administration errors.


Assuntos
Hospitais , Erros de Medicação , Bases de Dados Factuais , Humanos , América Latina , Preparações Farmacêuticas
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