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Anaesthesia ; 76(3): 336-345, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33338259


Postoperative critical care is a finite resource that is recommended for high-risk patients. Despite national recommendations specifying that such patients should receive postoperative critical care, there is evidence that these recommendations are not universally followed. We performed a national survey aiming to better understand how patients are risk-stratified in practice; elucidate clinicians' opinions about how patients should be selected for critical care; and determine factors which affect the actual provision of postoperative critical care. As part of the second Sprint National Anaesthesia Project, epidemiology of critical care after surgery study, we distributed a paper survey to anaesthetists, surgeons and intensivists providing peri-operative care during a single week in March 2017. We collected data on respondent characteristics, and their opinions of postoperative critical care provision, potential benefits and real-world challenges. We undertook both quantitative and qualitative analyses to interpret the responses. We received 10,383 survey responses from 237 hospitals across the UK. Consultants used a lower threshold for critical care admission than other career grades, indicating potentially more risk-averse behaviour. The majority of respondents reported that critical care provision was inadequate, and cited the value of critical care as being predominantly due to higher nurse: patient ratios. Use of objective risk assessment tools was poor, and patients were commonly selected for critical care based on procedure-specific pathways rather than individualised risk assessment. Challenges were highlighted in the delivery of peri-operative critical care services, such as an overall lack of capacity, competition for beds with non-surgical cases and poor flow through the hospital leading to bed 'blockages'. Critical care is perceived to provide benefit to high-risk surgical patients, but there is variation in practice about the definition and determination of risk, how patients are referred and how to deal with the lack of critical care resources. Future work should focus on evaluating 'enhanced care' units for postoperative patients, how to better implement individualised risk assessment in practice, and how to improve patient flow through hospitals.

Atitude do Pessoal de Saúde , Tomada de Decisão Clínica/métodos , Cuidados Críticos/métodos , Pesquisas sobre Serviços de Saúde/métodos , Cuidados Pós-Operatórios/métodos , Anestesistas/estatística & dados numéricos , Cuidados Críticos/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Seleção de Pacientes , Médicos/estatística & dados numéricos , Cuidados Pós-Operatórios/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Reino Unido
Mult Scler Relat Disord ; 48: 102702, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33360914


BACKGROUND: COVID-19 pandemic has changed the way to manage MS and NMOSD, not only concerning treatment, but also regarding social distance and the increasing use of telemedicine (TM) to minimize the risk of infection. Currently, there is no data regarding TM among MS and NMOSD South American experts. OBJECTIVE: To investigate TM experiences from South American MS and/or NMOSD experts in the follow-up of their patients focusing on TM. METHODS: A cross-sectional study was performed. 141 MS and/or NMOSD experts from Argentina, Chile, Colombia and Brazil were invited to answer an web-based survey. RESULTS: A total of 129 (91.48 %) experts completed the survey. Only 19.4% had experience in TM previous COVID-19 pandemic, while 79.8% are currently using TM, most using video call (52.3%). Using TM, 44.1% of the experts were able to perform neurological examination, 85.6% believed to be able to identify a relapse, 48.6% use Patient Determined Disease Steps and 38.7% kept using the conventional Expanded Disability Status Scale. CONCLUSION: Our survey demonstrates preparedness and responsiveness among South American MS and/or NMOSD experts.  Despite scarce prior TM experience, most experts felt confident to use TM as a new tool for monitoring their patients.

Esclerose Múltipla/terapia , Neurologistas/estatística & dados numéricos , Neuromielite Óptica/terapia , Padrões de Prática Médica/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adulto , Argentina , Brasil , Chile , Colômbia , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade
Rev Esp Anestesiol Reanim ; 68(2): 114-116, 2021 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33371977
Rehabilitación (Madr., Ed. impr.) ; 54(4): 260-268, oct.-dic. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193476


OBJETIVO: El objetivo de este estudio es analizar el impacto y la organización tanto asistencial como docente en los Servicios de Medicina Física y Rehabilitación de España ante el nuevo y cambiante escenario debido a la pandemia por la COVID-19. MÉTODOS: Se realiza una encuesta dirigida a los tutores de los Servicios de Rehabilitación. Un total de 31 preguntas divididas en 6 apartados: información general de los Servicios, adaptación del Servicio durante el periodo COVID, labor asistencial de los médicos rehabilitadores, abordaje rehabilitador de pacientes COVID, consecuencia de la pandemia sobre la salud de los rehabilitadores y labores de tutoría durante ese periodo. RESULTADOS: Se recibieron un total de 54 encuestas. Casi la mitad de los Servicios cancelaron todas las consultas presenciales (40%) y las salas de terapias se destinaron a camas de pacientes COVID (48%). En 30 hospitales (55,6%) los facultativos han trabajado en plantas COVID. La gran mayoría de los Servicios han elaborado material gráfico y audiovisual con ejercicios, así como protocolos de derivación y tratamiento rehabilitador de pacientes COVID ingresados. Casi la mitad de los Servicios encuestados han tenido algún caso de ansiedad en el personal médico. Las labores de tutoría se han anulado (40,7%) o disminuido (35,2%). CONCLUSIONES: La organización de los Servicios de Rehabilitación para hacer frente a la pandemia ha sido similar en todo el territorio español. La respuesta de los Servicios a la crisis sanitaria ha visualizado la versatilidad de trabajo de los médicos rehabilitadores

OBJECTIVE: The aim of this study was to analyse both the impact of the pandemic and clinical and teaching organisation in Spanish Physical Medicine and Rehabilitation Departments during the COVID-19 pandemic. METHODS: A survey was conducted of the tutors of rehabilitation departments. The questionnaire contained 31 questions divided into 6 parts about the following: general information on the department, adaptation of rehabilitation departments to the COVID pandemic, clinical work of rehabilitation physicians, the approach to rehabilitation in COVID patients, and the effects of the pandemic on the health and teaching activity of rehabilitation physicians during this period. RESULTS: A total of 54 responses were obtained. Almost half of the departments cancelled face-to-face medical consultations (40%) and 48% of the treatment rooms were turned into COVID beds. In 30 hospitals (55.6%), the physicians worked in COVID units. Most of the rehabilitation departments developed both graphic and audiovisual material with exercises, referral protocols and guidelines for the rehabilitation management and treatment of COVID 19 patients. Half of the departments reported some anxiety symptoms in medical staff. Tutorial work has been cancelled (40.7%) or reduced (35.2%). CONCLUSIONS: The organisation of Spanish rehabilitation departments in response to the COVID pandemic has been very similar throughout the country. The response of these departments to the healthcare crisis has revealed the versatility of rehabilitation physicians

Humanos , Infecções por Coronavirus/reabilitação , Medicina Física e Reabilitação/organização & administração , Vírus da SARS/patogenicidade , Planejamento de Instituições de Saúde/organização & administração , Serviços de Reabilitação , Pandemias/estatística & dados numéricos , Infecções por Coronavirus/complicações , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Estudos Transversais
Arch Ital Urol Androl ; 92(4)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33348951


OBJECTIVE: Overview of bladder cancer (BC) management in Italy during the first month of the COVID-19 pandemic (March 2020) with head to head comparison of the data from March 2019, considered "usual activity" period. The aim is to analyze performance of different Italian Centers in North, Center and South, with a special eye for Lombardy (the Italian epicenter). PATIENTS AND METHODS: During April 2020, a survey containing 14 multiple-choice questions focused on general staffing and surgical activity related to BC during the months of March 2019 and March 2020 was sent to 32 Italian Centers. Statistical analysis was performed using IBM SPSS Statistics (v26) software. A Medline search was performed, in order to attempt a comparative analysis with published papers. RESULTS: 28 Centers answered, for a response rate of 87.5%. Most of the urology staff in the Lombardy region were employed in COVID wards (p = 0.003), with a statistically significant reduction in the number of radical cystectomies (RC) performed during that time (p = 0.036). The total amount of RC across Italy remained the same between 2019 and 2020, however there was an increase in the number of surgeries performed in the Southern region. This was most likely due to travel restrictions limiting travel the North. The number of Trans-Urethral Resection of Bladder Tumors (TURBT) (p = 0.046) was higher in Academic Centers (AC) in 2020 (p = 0.037). CONCLUSIONS: The data of our survey, although limited, represents a snap shot of the management of BC during the first month of the COVD-19 pandemic, which posed a major challenge for cancer centers seeking to provide care during an extremely dynamic clinical and political situation which requires maximum flexibility to be appropriately managed.

/epidemiologia , Pandemias , Neoplasias da Bexiga Urinária/cirurgia , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Hospitais/provisão & distribução , Humanos , Itália/epidemiologia , Fatores de Tempo , Procedimentos Cirúrgicos Urológicos Masculinos/estatística & dados numéricos
Pediatrics ; 146(5)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33033176


OBJECTIVES: To describe the practice of high-flow nasal cannula (HFNC) use in the pediatric ward setting across North America. METHODS: A survey was distributed through the Pediatric Research in Inpatient Settings Network, which represents 114 hospital sites. Questions included indication for HFNC use, flow and oxygen parameters, guideline availability, and use of outcomes measures. RESULTS: There was a response rate of 68% to the survey from sites representing all regions from the United States. Thirty-seven sites (48%) used HFNC in the pediatric ward setting. All 37 sites used HFNC for patients with bronchiolitis. All children's hospital sites providing HFNC on the wards had an on-site ICU, compared with only 60% of non-children's hospital sites (P = .003). Seventy-six percent of sites used local protocols, including parameters for patient assessment, initiation, weaning, and feeding practices. CONCLUSIONS: HFNC is used outside the ICU in nearly 50% of responding hospitals, with variation related to flow rate, feeding, and protocol use. HFNC is used for management of acute respiratory distress due to bronchiolitis, asthma, and pneumonia. Study findings suggest that HFNC is often used by pediatric hospitalists, but its use across North American hospitals remains variable and based on local consensus.

Unidades Hospitalares/estatística & dados numéricos , Oxigenoterapia/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Asma/terapia , Bronquiolite/terapia , Canadá , Cateterismo/métodos , Cateterismo/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Oxigenoterapia/métodos , Pneumonia/terapia , Estados Unidos
Pharm. pract. (Granada, Internet) ; 18(3): 0-0, jul.-sept. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-192938


OBJECTIVE: This study aimed to evaluate the content available on Facebook pharmacy groups in Jordan regarding the perception of the pharmacists' role during the coronavirus pandemic in Jordan. METHODS: Researchers identified Facebook pharmacy groups through the search engine on the Facebook website. The main search keywords were pharmacy, pharmacist, pharmacists, and Jordan using both Arabic and English. Two researchers analyzed the posts and discussion threads on local pharmacy Facebook groups in a period between March 20th and April 3rd. A total of 184 posts and threads were identified for the purpose of the study. RESULTS: Identified threads and responses resulted in three overarching themes: pharmacists having a positive role during the pandemic, taking additional responsibilities and services, and having passive or negative roles. A positive role was seen in pharmacists acting as first-line healthcare providers, creating public's awareness regarding COVID-19, and being responsible for chronic medication refill during the pandemic. Taking additional responsibilities was summarized in home deliveries and involvement in industrial and corporate efforts to deal with the pandemic. A passive/negative role was seen mostly among hospital pharmacists not being proactive during the pandemic and by pharmacists trying to maximize profits during pandemic time. CONCLUSIONS: Pharmacists perceived their role as a positive role during the coronavirus pandemic. Not only they took responsibilities for their daily services during the crises, but they took additional responsibilities to assure patient safety and satisfaction

No disponible

Humanos , Assistência Farmacêutica/tendências , Pandemias/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Papel Profissional , Jordânia/epidemiologia , Farmacêuticos/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Rede Social
Pan Afr Med J ; 36: 108, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32821319


Introduction: novel corona virus infection has become a public health crisis leading the world to a standstill including dentistry. However, since the dental services cannot be stopped for a long period it is important that dentist be fully prepared before resuming their services. Therefore, the current study was carried out for evaluating knowledge, attitude and practices (KAP) along with perceived barriers to practice dentistry during pandemic. Methods: this cross-sectional study was conducted through an online survey questionnaire on dentists of India. Dentists were enquired for demographics, KAP and perceived barriers regarding practicing dentistry during pandemic. The knowledge was assessed based on 16 items in true or false or multiple choice questions format getting score of 1 or 0. The attitude and practices by 8 items each, on 5-point Likert scale and 4 items perceived barriers were enquired. The differences between the median scores among demographic variables were determined by applying student's t-test and keeping level of significance at below 0.05. Results: out of 500 dentists who were approached through email, a total of 296 dentists returned the questionnaire (response rate, 59.2%) among which 22 questionnaires were incomplete and thus excluded making 274 as final study participants. Overall poor median scores of knowledge and practices were obtained whereas for attitude total median score was good. Median practice scores were significantly higher among female respondents (20(6)). Median knowledge and practice scores were significantly better in study participants with age <40 years (6(4) and 19(5), respectively). Conclusion: with the recent claims of authorities that virus is going to stay in world for quite some time it is essential that dentists must be fully prepared before resuming their services and must attain proper awareness to limit the disease spread.

Betacoronavirus , Assistência Odontológica/organização & administração , Odontólogos , Pesquisas sobre Serviços de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Atitude do Pessoal de Saúde , Infecções por Coronavirus , Estudos Transversais , Odontólogos/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 46(5): 306-312, jul.-ago. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197317


OBJETIVO: Estudiar la frecuencia de consultas médicas en las poblaciones autóctona e inmigrante en España, antes y después de una medida del Gobierno del 2012 que restringió el uso de servicios sanitarios públicos a los inmigrantes indocumentados. MATERIAL Y MÉTODOS: Los datos proceden de las Encuestas Europeas de Salud en España de 2009 y 2014. Se han analizado las consultas al médico de familia y al especialista en autóctonos e inmigrantes de 18 a 64 años. Se calcularon los incrementos porcentuales en la frecuencia de personas que consultaron en 2014 respecto a 2009 y, en cada año, la razón de porcentaje (RP) de consultas en inmigrantes frente autóctonos, con intervalos de confianza del 95% (IC del 95%). RESULTADOS: La frecuencia de consultas se incrementó en 2014 respecto a 2009, a excepción de la consulta al médico de familia en mujeres autóctonas. Los incrementos más altos se produjeron en las consultas al médico especialista en inmigrantes (39,9%) y en autóctonos (21,6%), y en las consultas al médico de familia en mujeres inmigrantes. Tras ajustar por edad y variables socioeconómicas e indicadoras de necesidad de asistencia, en ambos años no se observaron diferencias significativas entre inmigrantes y autóctonos en los 2 tipos consultas. CONCLUSIONES: En España no se redujo la frecuencia de consultas médicas al médico de familia ni al especialista entre 2009 y 2014 en la población inmigrante

OBJECTIVE: To study the frequency of medical consultations in autochthonous and immigrant populations in Spain, before and after a government measure of 2012 that restricted the use of public health services to undocumented immigrants. MATERIAL AND METHODS: The data were taken from the European Health Surveys in Spain in 2009 and 2014. An analysis was made of the consultations with the family doctor and the consultations with the medical specialist in autochthonous and immigrant populations from 18 to 64 years. Percentage increases were calculated in the frequency of people who consulted in 2014 with respect to 2009, and, in each year, the percentage ratio (PR) of consultation in immigrants with respect autochthonous, with 95% confidence intervals (95% CI). RESULTS: The frequency of consultations increased in 2014 compared to 2009, with the exception of family doctor's consultation with the autochthonous women. The highest increases occurred in visits to medical specialists in immigrants (39.9%), in autochthonous (21.6%), and in visits by the family doctor to immigrant women. After adjusting for age and socioeconomic variables and indicators of need for assistance, there were no significant differences in both years between immigrants and autochthonous in the 2 types of consultations. CONCLUSIONS: The frequency of consultations to the family doctor or medical specialist did not decrease in Spain between 2009 and 2014 in the immigrant population

Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Utilização de Instalações e Serviços/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Espanha/epidemiologia , Imigrantes Indocumentados/legislação & jurisprudência , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Estudos Transversais
J Child Neurol ; 35(13): 924-933, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32666891


OBJECTIVE: To evaluate the effect of the COVID-19 pandemic on global access to care and practice patterns for children with epilepsy. METHODS: We conducted a cross-sectional, online survey of pediatric neurologists across the world affiliated with the International Child Neurology Association, the Chinese Child Neurology Society, the Child Neurology Society, and the Pediatric Epilepsy Research Consortium. Results were analyzed in relation to regional burden of COVID-19 disease. RESULTS: From April 10 to 24, 2020, a sample of 212 respondents from 49 countries indicated that the COVID-19 pandemic has dramatically changed many aspects of pediatric epilepsy care, with 91.5% reporting changes to outpatient care, 90.6% with reduced access to electroencephalography (EEG), 37.4% with altered management of infantile spasms, 92.3% with restrictions in ketogenic diet initiation, 93.4% with closed or severely limited epilepsy monitoring units, and 91.3% with canceled or limited epilepsy surgery. Telehealth use had increased, with 24.7% seeing patients exclusively via telehealth. Changes in practice were related both to COVID-19 burden and location. CONCLUSIONS: In response to COVID-19, pediatric epilepsy programs have implemented crisis standards of care that include increased telemedicine, decreased EEG use, changes in treatments of infantile spasms, and cessation of epilepsy surgery. The long-term impact of these abrupt changes merit careful study.

Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/métodos , Epilepsia/terapia , Pesquisas sobre Serviços de Saúde/métodos , Internacionalidade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/métodos , Criança , Estudos Transversais , Eletroencefalografia/estatística & dados numéricos , Saúde Global , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Neurologistas , Neurologia/métodos , Pediatras , Pediatria/métodos
Rev Soc Bras Med Trop ; 53: e20200354, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32638888


INTRODUCTION: COVID-19 emerged in late 2019 and quickly became a serious public health problem worldwide. This study aim to describe the epidemiological course of cases and deaths due to COVID-19 and their impact on hospital bed occupancy rates in the first 45 days of the epidemic in the state of Ceará, Northeastern Brazil. METHODS: The study used an ecological design with data gathered from multiple government and health care sources. Data were analyzed using Epi Info software. RESULTS: The first cases were confirmed on March 15, 2020. After 45 days, 37,268 cases reported in 85.9% of Ceará's municipalities, with 1,019 deaths. Laboratory test positivity reached 84.8% at the end of April, a period in which more than 700 daily tests were processed. The average age of cases was 67 (<1 - 101) years, most occurred in a hospital environment (91.9%), and 58% required hospitalization in an ICU bed. The average time between the onset of symptoms and death was 18 (1 - 56) days. Patients who died in the hospital had spent an average of six (0 - 40) days hospitalized. Across Ceará, the bed occupancy rate reached 71.3% in the wards and 80.5% in the ICU. CONCLUSIONS: The first 45 days of the COVID-19 epidemic in Ceará revealed a large number of cases and deaths, spreading initially among the population with a high socioeconomic status. Despite the efforts by the health services and social isolation measures the health system still collapsed.

Ocupação de Leitos/estatística & dados numéricos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Infecções por Coronavirus/mortalidade , Análise de Dados , Feminino , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Unidades Hospitalares/estatística & dados numéricos , Humanos , Lactente , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/mortalidade , Distribuição por Sexo , Fatores de Tempo , Adulto Jovem
Pediatr Surg Int ; 36(7): 809-815, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32488401


BACKGROUND/PURPOSE: The purpose of this study was to characterize current practices to prevent venous thromboembolism (VTE) in children and measure adherence to recent joint consensus guidelines from the Pediatric Trauma Society and Eastern Association for the Surgery of Trauma (PTS/EAST). METHODS: An 18-question survey was sent to the membership of PTS and the Trauma Center Association of American. Responses were compared with Chi-square test. RESULTS: One hundred twenty-nine members completed the survey. Most respondents were from academic (84.5%), Level 1 pediatric (62.0%) trauma centers. Criteria for VTE prophylaxis varied between hospitals with freestanding pediatric trauma centers significantly more likely to stratify children by risk factors than adult trauma centers (p = 0.020). While awareness of PTS/EAST guidelines (58.7% overall) was not statistically different between hospital types (44% freestanding adult, 52% freestanding pediatric, 71% combined adult pediatric, p = 0.131), self-reported adherence to these guidelines was uniformly low at 37.2% for all respondents. Lastly, in three clinical scenarios, respondents chose VTE screening and prophylaxis plans in accordance with a prospective application of PTS/EAST guidelines 55.0% correctly. CONCLUSION: Currently no consensus regarding the prevention of VTE in pediatric trauma exists. Prospective application of PTS/EAST guidelines has been limited, likely due to poor quality of evidence and a reliance on post-injury metrics. Results of this survey suggest that further investigation is needed to more clearly define the risk of VTE in children, evaluate, and prospectively validate alternative scoring systems for VTE prevention in injured children. LEVEL OF EVIDENCE: N/A-Survey.

Pesquisas sobre Serviços de Saúde/métodos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Tromboembolia Venosa/prevenção & controle , Ferimentos e Lesões/complicações , Adulto , Criança , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Pediatras/estatística & dados numéricos , Fatores de Risco , Sociedades Médicas , Estados Unidos , Tromboembolia Venosa/etiologia
Br J Radiol ; 93(1113): 20200082, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32584595


OBJECTIVE: To understand the status of pre-procedural safety practices in radiological examinations at radiology residency training institutions in various Asian regions. METHODS: A questionnaire based on the Joint Commission International Accreditation Standards was electronically sent to 3 institutions each in 10 geographical regions across 9 Asian countries. Questions addressing 45 practices were divided into 3 categories. A five-tier scale with numerical scores was used to evaluate safety practices in each institution. Responses obtained from three institutions in the United States were used to validate the execution rate of each surveyed safety practice. RESULTS: The institutional response rate was 70.0% (7 Asian regions, 21 institutions). 44 practices (all those surveyed except for the application of wrist tags for identifying patients with fall risks) were validated using the US participants. Overall, the Asian participants reached a consensus on 89% of the safety practices. Comparatively, most Asian participants did not routinely perform three pre-procedural practices in the examination appropriateness topic. CONCLUSION: Based on the responses from 21 participating Asian institutions, most routinely perform standard practices during radiological examinations except when it comes to examination appropriateness. This study can provide direction for safety policymakers scrutinizing and improving regional standards of care. ADVANCES IN KNOWLEDGE: This is the first multicenter survey study to elucidate pre-procedural safety practices in radiological examinations in seven Asian regions.

Consenso , Pesquisas sobre Serviços de Saúde , Segurança do Paciente/normas , Qualidade da Assistência à Saúde/normas , Radiografia/normas , Ásia , China , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Internato e Residência , Japão , Imagem por Ressonância Magnética/normas , Malásia , Tomografia por Emissão de Pósitrons , Radiologia/educação , República da Coreia , Gestão da Segurança/normas , Singapura , Taiwan , Tomografia Computadorizada por Raios X/normas
Cien Saude Colet ; 25(suppl 1): 2447-2456, 2020 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-32520288


The scope of this work is to explore the feelings and expectations that COVID-19 has generated in Argentina during the first stage of the pandemic. A survey of the World Health Organization adapted to the local context was applied. Open-ended questions were included to study people's feelings about COVID-19, and content analysis was subsequently conducted. In terms of results, it is revealed that the population surveyed feels uncertainty, fear and anguish, albeit a feeling of responsibility and care in the face of COVID-19 also emerges. Moreover, positive feelings regarding society stand out as an achievement of social interdependence. The results obtained show that the impact on mental health differs in accordance with gender, educational level, and perceived comfort in the home. The study concludes that the emotional and bonding dimensions of people are central to confronting the COVID-19 pandemic in Argentina. It is recommended that these dimensions, as well as their subjective and differential social impact among the different population groups, should be considered in the planning of policies to address the COVID-19 pandemic.

Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Emoções , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Adulto , Fatores Etários , Idoso , Ansiedade/epidemiologia , Argentina/epidemiologia , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Escolaridade , Medo , Feminino , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Avaliação do Impacto na Saúde/estatística & dados numéricos , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Incerteza , Populações Vulneráveis/psicologia
Rev. Rol enferm ; 43(6): 436-444, jun. 2020. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-192580


La pandemia COVID-19 ha representado un reto hasta ahora desconocido para nuestro sistema sanitario. Una parte significativa de la gestión de la crisis y adaptación durante este periodo ha correspondido a los mandos de enfermería. Este artículo muestra las dificultades y los éxitos de esta gestión, así como las oportunidades futuras que estos cambios pueden suponer para la profesión enfermera. Se realizó una encuesta telemática de 17 preguntas a las responsables de gestionar la adaptación de los servicios hospitalarios a la pandemia COVID-19, mediante la reestructuración de diferentes áreas: la comunicación interna con participación en la toma de decisiones, la formación para la seguridad de los pacientes, la dotación de materiales, la dotación y rotación de los profesionales y la actualización de los protocolos. Mediante el análisis de una encuesta realizada por responsables de enfermería de diversos hospitales públicos y mutuas laborales situados en Cataluña, hemos podido identificar las principales dificultades surgidas y las decisiones tomadas en un tiempo record para poder adaptar nuestros hospitales a la pandemia, preservando la seguridad del personal y dar una respuesta profesional y humana a nuestros pacientes. La crisis sanitaria vivida representa un incentivo para consolidar logros y proponer cambios que afiancen los aciertos, realizar autocrítica de los errores y devolver así a la sociedad, mediante cambios estructurales, aquello que hayamos aprendido. Defender este cambio supone impulsar perspectivas valientes en la redefinición de las enfermeras del futuro

The COVID-19 pandemic has represented a hitherto unknown challenge for our healthcare system. A significant part of management and adaptation during this period has been the responsibility of middle management nursing staff. This article shows the difficulties and successes of this management, in addition to the future opportunities that these changes, if they are known how to take advantage of, may represent for the nursing profession. An online survey was carried out with 17 questions to those responsible for managing the adaptation of various hospital services to the COVID-19 pandemic, through the internal communication redesign, the participation in the decision making process, the education for the patient's safety and the management of personnel, systems and materials. Through the analysis of a survey carried out by nursing managers from various public hospitals and labour mutual societies located in Catalonia, we have been able to identify the main difficulties encountered and the decisions taken in record time to be able to adapt our hospitals to the pandemic, preserving the safety of the staff and give a professional and humane response to our patients. The lived health crisis represents an incentive to consolidate achievements and propose changes that strengthen the successes, carry out self-criticism of mistakes and thus return to society, through structural changes, what we have learned. Defending this paradigm shift means promoting courageous perspectives in redefining the nurses of the future

Humanos , Infecções por Coronavirus/enfermagem , Diagnóstico de Enfermagem/tendências , Governança Compartilhada de Enfermagem/tendências , Controle de Doenças Transmissíveis/organização & administração , Conversão de Leitos/tendências , Planejamento de Instituições de Saúde/métodos , Prioridades em Saúde/organização & administração , Pandemias/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos
Enferm. nefrol ; 23(2): 148-159, abr.-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192928


OBJETIVO: Profundizar en el conocimiento sobre las experiencias de vida y el soporte percibido por las enfermeras/os que atendieron a pacientes con enfermedad de COVID-19 en tratamiento con hemodiálisis hospitalaria durante los meses de mayor prevalencia de la pandemia en España. MATERIAL Y MÉTODO: Estudio cualitativo fenomenológico. El grupo participante fue de diez enfermeras/o de hospitales públicos de España que habían dializado a pacientes con COVID-19. La recolección de los datos se realizó mediante entrevistas semiestructuradas a través del programa Skype©, hasta conseguir la saturación de las unidades de significado. El análisis se hizo mediante el método de Colaizzi-7 pasos. RESULTADOS: Del análisis de los discursos emergieron cuatro dimensiones asociadas a diferentes subcategorías: desconocimiento sobre la enfermedad, sufrimiento del paciente, soporte percibido y capacidad de afrontamiento de los profesionales. CONCLUSIONES: En las enfermeras han coexistido emociones positivas y negativas. En la etapa álgida del brote epidémico las vivencias de las enfermeras de hemodiálisis fueron provocadas por el desconocimiento, por no saber actuar adecuadamente y por el miedo al contagio, agravado por la falta de medios de protección. Las vivencias positivas fueron el crecimiento personal, el apoyo del equipo y de la familia. También cabe destacar el control racional de la situación, debido a que en las unidades de diálisis hay gran experiencia en el control de la trasmisión de enfermedades infecciosas

AIM: To deepen the knowledge about life experiences and support perceived by nurses who attended in-hospital patients with COVID-19 disease on haemodialysis during the months with the highest prevalence of the pandemic in Spain. MATERIAL AND METHOD: Qualitative phenomenological study. The participating group was ten nurses from public hospitals in Spain who had dialyzed patients with COVID-19. Data collection was performed using semi-structured interviews through Skype© program, until the units of meaning were saturated. The analysis was done using the Colaizzi's seven-step method. RESULTS: Four dimensions emerged from the speech analysis associated with different subcategories: ignorance about the disease, patient suffering, perceived support and professionals' ability to cope. CONCLUSIONS: Positive and negative emotions have coexisted in nurses. In the peak stage of the epidemic outbreak, the experiences of hemodialysis nurses were caused by ignorance, not knowing how to act appropriately, and fear of infection, aggravated by the lack of means of protection. The positive experiences were personal growth, the support of the team and the family. It is also worth noting the rational control of the situation, because in the dialysis units there is great experience in controlling the transmission of infectious diseases

Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Síndrome Respiratória Aguda Grave/epidemiologia , Vírus da SARS/isolamento & purificação , Insuficiência Renal Crônica/complicações , Diálise Renal/enfermagem , Enfermagem em Nefrologia/organização & administração , Adaptação Psicológica/classificação , Vírus da SARS/patogenicidade , Insuficiência Renal Crônica/terapia , Unidades Hospitalares de Hemodiálise/organização & administração , Precauções Universais/métodos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Acontecimentos que Mudam a Vida
Ann Emerg Med ; 76(4): 454-458, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32461010


STUDY OBJECTIVE: Single-payer health care is supported by most Americans, but the effect of single payer on any particular sector of the health care market has not been well explored. We examine the effect of 2 potential single-payer designs, Medicare for All and an alternative including Medicare and Medicaid, on total payments and out-of-pocket spending for treat-and-release emergency care (patients discharged after an emergency department [ED] visit). METHODS: We used the 2013 to 2016 Medical Expenditure Panel Survey to determine estimates of payments made for ED visits by insurance type, and the 2015 National Hospital Ambulatory Medical Care Survey to estimate the proportion of ED visits covered by each insurance type. RESULTS: We found that total payments were predicted to increase from $85.5 billion to $89.0 billion (range $81.3 to $99.8 billion) in the Medicare-only scenario and decrease to $79.4 billion (range $71.6 to $87.2 billion) under Medicare/Medicaid, whereas out-of-pocket costs were predicted to decrease from $116 per visit to $45 with Medicare and to $36 with Medicare/Medicaid. CONCLUSION: In this study of ED treat-and-release patients, a transition to a Medicare for All system may increase ED reimbursement and reduce consumer out-of-pocket costs, whereas a system that maintains Medicaid in addition to Medicare could reduce total payments for emergency care.

Serviços Médicos de Emergência/economia , Medicare/tendências , Mecanismo de Reembolso/tendências , Serviços Médicos de Emergência/métodos , Tratamento de Emergência/economia , Tratamento de Emergência/métodos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Estados Unidos
Br J Anaesth ; 125(1): e54-e60, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32444066


BACKGROUND: Deficiencies in airway management skills and judgement contribute to poor outcomes. Airway management practice guidelines emphasise the importance of education. Little is known about the global uptake of guidelines, availability of equipment, provision of training, assessment of skills, and confidence with procedures. METHODS: We devised a survey to examine these issues. Initially, 24 127 anaesthetists were questioned in New Zealand, Canada, South Africa, UK, India, and Germany, representing the home countries of the members of the Worldwide Airway Meeting (2015) Education Group; however, the survey could be forwarded to others. The survey was open for a maximum of 90 days. RESULTS: We received 4948 fully or partially completed surveys from 61 countries: 33 high-income and 28 middle- or low-income countries. Most respondents were consultants (77.2%, n=4948), and the remainder trainees, with a male/female ratio of 1.8:1 (3105 males, n=4866). Of those responding, 1358 (76.6%, n=1798) were members of an airway interest group. Most respondents (91.3% of 2910) agreed with assessment of airway skills, fewer (2237; 59.7%, n=3750) reported requiring airway training for completion of training, and only 810 (33.6%, n=2408) reported it as a requirement for continuing medical education. Reported confidence was lowest for awake tracheal intubation, front-of-neck access, and retrograde intubation. CONCLUSIONS: Global training is variable in its delivery and necessity. Confidence is limited in potentially life-saving techniques. The desire for assessment appears universal and may improve standards, but in resource- or time-limited environments this will be challenging.

Manuseio das Vias Aéreas , Anestesiologia/educação , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Canadá , Competência Clínica , Educação Médica Continuada , Educação de Pós-Graduação em Medicina , Feminino , Alemanha , Humanos , Índia , Masculino , Nova Zelândia , África do Sul , Reino Unido