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1.
Medicine (Baltimore) ; 99(50): e23566, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327314

RESUMO

Improving understanding of the prognostic factors associated with death resulting from sepsis in obstetric patients is essential to allow management to be optimized. This retrospective cohort study aimed to determine the risk factors for death in patients with sepsis admitted to the obstetric intensive care unit of a tertiary teaching hospital in northeastern Brazil between April 2012 and April 2016.The clinical, obstetric, and laboratory data of the sepsis patients, as well as data on their final outcome, were collected. A significance level of 5% was adopted. Risk factors for death in patients with sepsis were evaluated in a multivariate analysis.During the period analyzed, 155 patients with sepsis were identified and included in the study, representing 5.2% of all obstetric intensive care unit (ICU) admissions. Of these, 14.2% (n = 22) died. The risk factors for death were septic shock at the time of hospitalization (relative risk [RR] = 3.45; 95% confidence interval [CI]: 1.64-7.25), need for vasopressors during hospitalization (RR = 17.32; 95% CI: 4.20-71.36), lactate levels >2 mmol/L at the time of diagnosis (RR = 4.60; 95% CI: 1.05-20.07), and sequential organ failure assessment score >2 at the time of diagnosis (RR = 5.97; 95% CI: 1.82-19.94). Following multiple logistic regression analysis, only the need for vasopressors during hospitalization remained as a risk factor associated with death (odds ratio [OR] = 26.38; 95% CI: 5.87-118.51).The need for vasopressors during hospitalization is associated with death in obstetric patients with sepsis.


Assuntos
Unidades de Terapia Intensiva , Unidade Hospitalar de Ginecologia e Obstetrícia , Complicações Infecciosas na Gravidez/mortalidade , Sepse/mortalidade , Adulto , Brasil/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Unidade Hospitalar de Ginecologia e Obstetrícia/estatística & dados numéricos , Gravidez , Estudos Retrospectivos , Fatores de Risco , Choque Séptico/mortalidade , Adulto Jovem
2.
Am J Perinatol ; 37(13): 1301-1309, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32892329

RESUMO

OBJECTIVE: This study aimed to describe the response of labor and delivery (L&D) units in the United States to the novel coronavirus disease 2019 (COVID-19) pandemic and determine how institutional characteristics and regional disease prevalence affect viral testing and personal protective equipment (PPE). STUDY DESIGN: A cross-sectional survey was distributed electronically through the Society for Maternal-Fetal Medicine e-mail database (n = 584 distinct practices) and social media between April 14 and 23, 2020. Participants were recruited through "snowballing." A single representative was asked to respond on behalf of each L&D unit. Data were analyzed using Chi-square and Fisher's exact tests. Multivariable regression was performed to explore characteristics associated with universal testing and PPE usage. RESULTS: A total of 301 surveys (estimated 51.5% response rate) was analyzed representing 48 states and two territories. Obstetrical units included academic (31%), community teaching (45%) and nonteaching hospitals (24%). Sixteen percent of respondents were from states with high prevalence, defined as higher "deaths per million" rates compared with the national average. Universal laboratory testing for admissions was reported for 40% (119/297) of units. After adjusting for covariates, universal testing was more common in academic institutions (adjusted odds ratio [aOR] = 1.73, 95% confidence interval [CI]: 1.23-2.42) and high prevalence states (aOR = 2.68, 95% CI: 1.37-5.28). When delivering asymptomatic patients, full PPE (including N95 mask) was recommended for vaginal deliveries in 33% and for cesarean delivery in 38% of responding institutions. N95 mask use during asymptomatic vaginal deliveries remained more likely in high prevalence states (aOR = 2.56, 95% CI: 1.29-5.09) and less likely in hospitals with universal testing (aOR = 0.42, 95% CI: 0.24-0.73). CONCLUSION: Universal laboratory testing for COVID-19 is more common at academic institutions and in states with high disease prevalence. Centers with universal testing were less likely to recommend N95 masks for asymptomatic vaginal deliveries, suggesting that viral testing can play a role in guiding efficient PPE use. KEY POINTS: · Heterogeneity is seen in institutional recommendations for viral testing and PPE.. · Universal laboratory testing for COVID-19 is more common at academic centers.. · N95 mask use during vaginal deliveries is less likely in places with universal testing..


Assuntos
Infecções por Coronavirus , Parto Obstétrico , Controle de Infecções , Unidade Hospitalar de Ginecologia e Obstetrícia , Pandemias , Equipamento de Proteção Individual/estatística & dados numéricos , Pneumonia Viral , Complicações Infecciosas na Gravidez , Adulto , Betacoronavirus , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Masculino , Máscaras/estatística & dados numéricos , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia/normas , Unidade Hospitalar de Ginecologia e Obstetrícia/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Prevalência , Estados Unidos/epidemiologia
3.
Rev. chil. obstet. ginecol. (En línea) ; 85(supl.1): S16-S22, set. 2020. graf
Artigo em Espanhol | LILACS | ID: biblio-1138644

RESUMO

La pandemia por COVID-19 ha generado un estancamiento mundial en la atención y resolución de todas las patologías graves y crónicas, debido al colapso de los sistemas de salud, a la dificultad de consulta, dada por la disminución de movilidad de las personas, por las cuarentenas establecidas y también por el temor de los pacientes al contagio en los centros de salud. Los enfermos oncológicos han visto canceladas sus atenciones, suspendidos o postergado sus tratamientos y diferidas sus cirugías. Esto no ha sido ajeno a las pacientes con cáncer de mama. En el presente trabajo, se reporta la experiencia de una Unidad de Patología Mamaria de un hospital público de Santiago de Chile y de las acciones realizadas para mantener la continuidad de atención en una comuna con una alta tasa de infección por SARS-CoV-2.


The COVID-19 pandemic has generated a global stagnation in the care and medical treatment of serious and chronic illnesses due to the collapse of the health systems, the difficulty of consulting due to decreased mobility caused by forced quarantines and also because of the fear of infection when attending a health center. Cancer patients have had their medical appointments canceled, their treatments suspended or postponed, and their surgeries delayed. Breast cancer patients have not been the exception. We report the experience of a Breast Pathology Unit of a public hospital in Santiago of Chile, and the actions carried out to maintain continuity of care in a community with a high infection rate of SARS-CoV-2.


Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Pneumonia Viral/epidemiologia , Neoplasias da Mama/terapia , Infecções por Coronavirus/epidemiologia , Continuidade da Assistência ao Paciente/organização & administração , Oncologia/métodos , Pneumonia Viral/complicações , Unidade Hospitalar de Ginecologia e Obstetrícia , Chile , Epidemiologia Descritiva , Estudos Prospectivos , Assistência de Longa Duração/métodos , Telemedicina , Infecções por Coronavirus/complicações , Betacoronavirus
4.
Rev. chil. obstet. ginecol. (En línea) ; 85(supl.1): S9-S15, set. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1138643

RESUMO

INTRODUCCIÓN: La infección por el coronavirus SARS-CoV2 (COVID 19), causal de la pandemia actual, ha significado a nivel mundial la hospitalización simultánea de múltiples pacientes poniendo a prueba la infraestructura hospitalaria y la capacidad de reacción del personal de salud. Una de las estrategias para el manejo es la reconversión de camas y servicios clínicos. OBJETIVOS: presentar experiencia de un equipo ginecológico en el manejo integral de pacientes no gineco-obstétricas con COVID 19, durante el mes de junio de 2020 en un hospital público de la Región Metropolitana. MÉTODOS: Estudio de corte transversal observacional, descriptivo. Se consideró el total de pacientes adultos hombres y mujeres sin patología gineco-obstétrica con COVID 19 ingresados al puerperio del Hospital Santiago Oriente, obteniéndose datos clínicos y demográficos a través del registro interno de la unidad y del sistema de información de red asistencial. RESULTADOS: Ingresaron 82 pacientes, 32 mujeres y 50 hombres, promedio de edad 64. El promedio de días de hospitalización fue 5, con diagnóstico de ingreso principal neumonía viral por COVID-19. Las comorbilidades frecuentes fueron hipertensión arterial sistémica y diabetes mellitus. La complicación más frecuente fue el tromboembolismo pulmonar agudo. Hubo una alta cobertura de entrega de información vía telefónica a familiares. De los 82 ingresos, 54 pacientes egresaron a su domicilio. El resto a otras unidades dentro de la institución, centros de menor complejidad o residencias sanitarias. Una paciente sexo femenino de 75 años fallece a causa de descompensación de patologias de base secundario a neumonia por Staphylococus aereus. En ella, se descarta la infección por COVID 19 dado tres exámenes por reacción de polimerasa en cadena negativos realizado antes y durante su hospitalización. CONCLUSIONES: Esta experiencia constituyó un desafío para todo el equipo de salud gineco-obstétrico, considerando que nos enfrentamos a otro tipo de pacientes y a una patología nueva. Los resultados médicos son promisorios, la experiencia humana y sentido de trabajo en equipo fue extraordinario.


INTRODUCTION: The infection by the SARS-CoV2 coronavirus (COVID 19), the cause of the current pandemic we are experiencing, has meant the simultaneous hospitalization of many patients worldwide, putting the hospital infrastructure and the reaction capacity of health personnel to the test. One of the management strategies is the reconversion of clinical services. OBJECTIVES: present the experience of a gynecological team in the comprehensive management of non-gyneco-obstetric patients with COVID 19, during the month of June 2020 in a public hospital in the Metropolitan Region. METHODS: descriptive, observational cross-sectional study. The total number of patients admitted to the ex-puerperium of the Santiago Oriente Hospital was considered, obtaining clinical and demographic data through the unit's internal registry and the healthcare network information system. RESULTS: 82 patients were admitted, 32 women and 50 men, average age 64. The average number of days of hospitalization was 5, with the main admission diagnosis being viral pneumonia due to COVID-19. Frequent comorbidities were systemic arterial hypertension and diabetes mellitus. The most frequent complication was acute pulmonary thromboembolism. There was a high coverage of the delivery of information via telephone to relatives. Of the 82 admissions, 54 patients were discharged home and the rest to other units within the institution, less complex centers or health residences. One 75 years old female patient dies from concomitant pathologies, and she wasn't positive for COVID-19. CONCLUSIONS: This experience was a challenge for the entire gynecological-obstetric health team, considering that we are facing other types of patients and a new pathology. The medical results are promising, the human experience and sense of teamwork was extraordinary.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pneumonia Viral/terapia , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Infecções por Coronavirus/terapia , Alta do Paciente/estatística & dados numéricos , Pneumonia Viral/complicações , Conversão de Leitos , Unidade Hospitalar de Ginecologia e Obstetrícia/estatística & dados numéricos , Comorbidade , Epidemiologia Descritiva , Estudos Transversais , Infecções por Coronavirus/complicações , Pandemias , Betacoronavirus , Tempo de Internação
5.
Rev. chil. obstet. ginecol. (En línea) ; 85(supl.1): S2-S8, set. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1138642

RESUMO

INTRODUCCIÓN Y OBJETIVOS: El Síndrome Respiratorio Agudo Grave Coronavirus 2 (SARSCoV-2) es una enfermedad altamente contagiosa y que puede ser transmitida por pacientes asintomáticos. Por esto surge el interés de poder determinar la prevalencia de la infección por SARS-Cov-2 en pacientes embarazadas que ingresan para interrupción de la gestación. MÉTODOS: Se realizó un análisis descriptivo, retrospectivo en el Servicio de Obstetricia y Ginecología de Hospital de Carabineros de Chile entre el 15 de mayo y el 30 junio del 2020. Se incluyeron todas las mujeres embarazadas que ingresaron para interrupción de la gestación, a las que se les realizó el examen PCR SARS-CoV-2; y una encuesta de signos y síntomas sugerentes de la enfermedad. RESULTADOS: Se realizaron 73 interrupciones de la gestación, con toma de PCR a 72 mujeres; de estas pacientes 65 (90.3%) fueron negativas, 5 (6.9%) positivas y 2 (2.8%) indeterminadas; los resultados indeterminados fueron considerados como positivos, por lo que la prevalencia de positividad fue de 9,5%. De estas pacientes, sólo 1 de ellas tenía síntomas sugerentes de la enfermedad, todas las demás (6) eran pacientes asintomáticas, y se mantuvieron así durante toda la hospitalización. CONCLUSIÓN: La realización del examen PCR para SARS-CoV-2 a todas las embarazadas que ingresan a un servicio de Ginecología y Obstetricia ayuda a identificar a las pacientes asintomáticas contagiadas con el virus. Ya que la consulta por presencia de signos y síntomas no permite identificar los casos positivos, es necesario considerar la realización de este examen en los protocolos de ingreso hospitalario a lo largo de nuestro país.


INTRODUCTION AND OBJECTIVES: Severe Acute Respiratory Syndrome Coronavirus (SARSCoV-2) is a highly contagious disease that can be transmitted by asymptomatic patients. Therefore, is of interest to determine the prevalence of SARS-Cov-2 infection in pregnant patients entering for interruption. METHODS: A descriptive, retrospective analysis was performed in the Obstetrics and Gynecology Service of the Hospital de Carabineros de Chile between May 15 and June 30, 2020. Pregnant women who entered for interruption of their pregnancy and who were given the SARS-CoV-2 PCR exam were included. A survey of signs and symptoms suggestive of the disease was applied. RESULTS: There were 73 pregnancy interruptions, 72 of them were tested by SARS-CoV-2 PCR exam. Among these patients, 65 (90.3%) resulted negative, 5 (6.9%), were positive and 2 (2.8%) were indeterminate; indeterminate results were considered positive, so the prevalence of positivity was 9.5%. Of these patients only 1 had symptoms suggestive of the disease, all the others (6) were asymptomatic, and remained so throughout the hospitalization. CONCLUSION: Conducting the PCR test for SARS-CoV-2 for all pregnant women entering a Gynecology and Obstetrics service helps to identify asymptomatic patients infected with the virus. As a survey of signs and symptoms cannot identify positive patiens, it is necessary to consider conducting universal screeing in hospital admission protocols throughout our country.


Assuntos
Humanos , Feminino , Gravidez , Adulto , Adulto Jovem , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Infecções por Coronavirus/epidemiologia , Betacoronavirus , Pneumonia Viral/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Unidade Hospitalar de Ginecologia e Obstetrícia/estatística & dados numéricos , Resultado da Gravidez , Cesárea/estatística & dados numéricos , Chile , Programas de Rastreamento , Reação em Cadeia da Polimerase , Prevalência , Inquéritos e Questionários , Estudos Retrospectivos , Infecções por Coronavirus/diagnóstico , Pandemias
6.
Malawi Med J ; 32(1): 13-18, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32733654

RESUMO

Background: This paper reports on part of a larger study, the aim of which was to develop an intervention to collaboratively develop innovative strategies to promote effective collaborative practices among midwives and medical professionals working in intrapartum care unit. Collaborative practice is a critical marker for success in improving quality of maternity care. To date, there has been limited exploration of collaborative practices between midwives and medical professionals working in intrapartum care from the African perspective. Aim: This paper reports findings of the discovery phase of appreciative inquiry (AI) set out to understand the perspectives of midwives and medical professionals on collaborative practices at Queen Elizabeth Central Hospital labour and delivery ward in Malawi. Methods: The study used an exploratory qualitative approach framed in an Appreciative Inquiry theoretical perspective. Appreciative Inquiry consists of four phases :(discovery, dream, design and destiny).The discovery phase consisted of 16 in-depth interviews and 2 focus group discussions among purposively selected midwives (4 nurse midwives, 2 midwifery unit matrons) and medical professionals (2 obstetricians, 4 registrars, 2 intern doctors, 2 clinical officers) working in the labour ward. All interviews and discussions were audiotaped and transcribed verbatim. Data were analysed using thematic analysis. Results: Five dominant themes emerged: collaborative breakdown, benefits of collaboration, the importance of positive and respectful attitude, barriers to effective collaborative practices and strategies to improve collaborative practice. Conclusion/Recommendations: Aligning the perspectives of the members of the two disciplines is significant to effective implementation of collaborative intrapartum care. Participants demonstrated that there is increased parallel working of midwives and doctors at QECH. This is not professionally healthy. Therefore, putting together the viewpoints of the professions to create a mutually agreeable professional framework of collaborative intrapartum practice is significant. Additionally, there is an obvious need to address the professional concerns of both disciplines.


Assuntos
Comportamento Cooperativo , Relações Interprofissionais , Serviços de Saúde Materna/organização & administração , Tocologia , Enfermeiras Obstétricas/psicologia , Médicos/psicologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Hospitais Universitários , Humanos , Entrevistas como Assunto , Trabalho de Parto , Malaui , Unidade Hospitalar de Ginecologia e Obstetrícia , Gravidez , Pesquisa Qualitativa
9.
Nursing ; 50(9): 64-68, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32826681

RESUMO

PURPOSE: To examine the effect of Benson's relaxation technique on occupational stress in midwives working in a Labor and Delivery (L&D) unit. METHODS: This pre- and post-quasi-experimental study involved 65 midwives with a minimum 1 year of experience using convenience sampling. After training, the participants performed Benson's relaxation technique twice a day for 4 weeks. RESULTS: Occupational stress was measured using standard questionnaires of occupational stress. Data were analyzed using the Statistical Package for Social Sciences software. Statistical analysis was performed using the Kolmogorov-Smirnov goodness-of-fit test, Student's t-test, and Wilcoxon signed rank test. CONCLUSION: This study demonstrated that Benson's relaxation technique may be effective in reducing occupational stress among midwives in L&D units.


Assuntos
Enfermeiras Obstétricas/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Estresse Ocupacional/prevenção & controle , Terapia de Relaxamento/métodos , Adulto , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Pessoa de Meia-Idade , Enfermeiras Obstétricas/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Unidade Hospitalar de Ginecologia e Obstetrícia , Estresse Ocupacional/epidemiologia , Gravidez , Inquéritos e Questionários , Adulto Jovem
11.
Isr Med Assoc J ; 8(22): 417-422, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32812715

RESUMO

BACKGROUND: Channeling medical resources for coronavirus disease-2019 (COVID-19) management can potentially endanger routine healthcare practices. As a preventive measure, a department of obstetrics and gynecology in Israel constructed a separate, designated complex for its COVID-19-exposed patients. OBJECTIVES: To evaluate the effect of the COVID-19 pandemic infection control measures on obstetric care in the obstetrical emergency department and delivery unit. METHODS: The authors collected data retrospectively from February 2020 to March 2020 and compared it to data of a parallel period in 2019. RESULTS: From 1 February 2020 to 28 March 2020, 3897 women were referred to the emergency department (ED), compared to 4067 the previous year. Mean duration of treatment until decision and referral indications did not differ between 2020 and 2019 (207 vs. 220 minutes, P = 0.26; urgent referrals 58.8% vs. 59.2%, P = 0.83). A per-week comparison showed a significant reduction in ED referrals only in the last week of the period (337 [2020] vs. 515 [2019], P < 0.001). The proportion of women admitted to the delivery unit in active labor was significantly higher in the last three weeks (39.1% vs. 28.2%, P = 0.005). During February and March 2020, 1666 women delivered, compared to 1654 during February and March 2019. The proportion of types and modes of delivery did not differ. In a per-week comparison, the number of deliveries did not differ (mean 208 vs. 206, P = 0.88). CONCLUSIONS: With timely preparation and proper management, negative impact of COVID-19 can be reduced in obstetrical emergency departments.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Salas de Parto/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Controle de Infecções/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Pneumonia Viral/terapia , Complicações Infecciosas na Gravidez/terapia , Adulto , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Parto Obstétrico/métodos , Surtos de Doenças , Feminino , Humanos , Recém-Nascido , Controle de Infecções/métodos , Israel , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Estudos Retrospectivos
13.
Aust N Z J Obstet Gynaecol ; 60(4): 628-632, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32648254

RESUMO

COVID-19 has posed major challenges for health care. Hospitals around the world have needed to rapidly prepare for the emerging pandemic. Translational simulation - simulation that is integrated and focused on emerging clinical priorities - offers numerous opportunities to aid in pandemic preparation. We describe our approach to preparing our institution's maternity services for the COVID-19 pandemic using translational simulation. We suggest lessons for providers of maternity services, and for those who support them through simulation activities.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Serviços de Saúde Materna/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Treinamento por Simulação
14.
Am J Obstet Gynecol ; 223(5): 715.e1-715.e7, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32697956

RESUMO

As an academic department, we sought to identify effective strategies to engage our faculty and staff in diversity, equity, and inclusion initiatives and programs to build an inclusive department that would address our needs and those of our community and partners. Over a 4-year period, our faculty and staff have participated in town hall meetings, focus group discussions, surveys, and community-building activities to foster stakeholder engagement that will build a leading academic department for the future. We noted that our faculty and staff were committed to building diversity, equity, and inclusion, and our mission and vision were reflective of this. However, communication and transparency may be improved to help support a more inclusive department for all. In the future, we hope to continue with the integration of diversity, equity, and inclusion into our department's business processes to achieve meaningful, sustained change and impact through continued focus on recruitment, selection, retention, development, and wellness of faculty and staff-in addition to the continued recruitment of faculty and staff from underrepresented minority groups. Our findings should serve as a call to action for other academic obstetrics and gynecology departments to improve the health and well-being of the individuals we serve.


Assuntos
Diversidade Cultural , Docentes de Medicina , Grupos Minoritários , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Relações Médico-Paciente , Ginecologia/educação , Humanos , Obstetrícia/educação , Seleção de Pessoal , Reorganização de Recursos Humanos , Desenvolvimento de Pessoal , Participação dos Interessados , Visitas com Preceptor , Local de Trabalho
15.
Am J Perinatol ; 37(10): 975-981, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32516817

RESUMO

Recently, a novel coronavirus, precisely severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), that causes the disease novel coronavirus disease 2019 (COVID-19) has been declared a worldwide pandemic. Over a million cases have been confirmed in the United States. As of May 5, 2020, New York State has had over 300,000 cases and 24,000 deaths with more than half of the cases and deaths occurring in New York City (NYC). Little is known, however, of how this virus impacts pregnancy. Given this lack of data and the risk for severe disease in this relatively immunocompromised population, further understanding of the obstetrical management of COVID-19, as well as hospital level preparation for its control, is crucial. Guidance has come from expert opinion, professional societies and public health agencies, but to date, there is no report on how obstetrical practices have adapted these recommendations to their local situations. We therefore developed an internet-based survey to elucidate the practices put into place to guide the care of obstetrical patients during the COVID-19 pandemic. We surveyed obstetrical leaders in four academic medical centers in NYC who were implementing and testing protocols at the height of the pandemic. We found that all sites made changes to their practices, and that there appeared to be agreement with screening and testing for COVID-19, as well as labor and delivery protocols, for SARS-CoV-2-positive patients. We found less consensus with respect to inpatient antepartum fetal surveillance. We hope that this experience is useful to other centers as they formulate their plans to face this pandemic. KEY POINTS: · Practices changed to accommodate public health needs.. · Most practices are screened for novel COVID-19 on admission.. · Fetal testing in COVID-19 patients varied..


Assuntos
Infecções por Coronavirus/epidemiologia , Parto Obstétrico/métodos , Controle de Infecções/organização & administração , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Padrões de Prática Médica , Centros Médicos Acadêmicos , Adulto , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Incidência , Trabalho de Parto , Cidade de Nova Iorque , Unidade Hospitalar de Ginecologia e Obstetrícia/estatística & dados numéricos , Pandemias/prevenção & controle , Segurança do Paciente , Pneumonia Viral/prevenção & controle , Gravidez , Medição de Risco , Inquéritos e Questionários
16.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(2): 39-39, abr.-jun. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-191313

RESUMO

OBJETIVO: El posible impacto de la histerectomía sobre la función sexual genera ansiedad a las mujeres. Los estudios han mostrado controversia. Dada la frecuencia de esta intervención, nuestro objetivo es saber si la función sexual cambia tras la misma. MATERIAL Y MÉTODOS: Comparamos la función sexual antes de la histerectomía, a los 3 meses tras la misma y a los 9 meses, de las 299 mujeres a las que se les programa dicha intervención entre el 1 de noviembre de 2012 y el 31 de noviembre de 2014 en el Complejo Hospitalario Universitario de Albacete. Finalmente forman parte de nuestro estudio 166 mujeres. Se estudia la función sexual con el Cuestionario de Función Sexual de la Mujer (FSM ®). RESULTADOS: Encontramos que, tras la histerectomía, la función sexual de la mujer mejora en algunos aspectos y no cambia en otros. Las menores de 55 años presentan mejoría en el Deseo, en la Excitación y en la Frecuencia de la actividad sexual, y disminución de Problemas con la penetración vaginal; todo esto es ya manifiesto a los 3 meses de la intervención, sin cambios posteriores. La Ansiedad anticipatoria también mejora entre el tercer y noveno mes. Observamos tendencia a la mejoría en el dominio de Capacidad para disfrutar de su vida sexual en general. En mayores de 55 años solo encontramos aumento en la Frecuencia de actividad sexual a los 9 meses de la cirugía. CONCLUSIONES: Tras la histerectomía, la función sexual de la mujer mejora o no cambia. La mejoría se encuentra principalmente en menores de 55 años


OBJECTIVE: Women may experience anxiety because of the possible effects of hysterectomy on sexual function, but studies have shown conflicting results on this topic. Given the frequency of this procedure, the aim of this study is to determine whether sexual function changes after hysterectomy. MATERIAL AND METHODS: A comparison was made of sexual function before hysterectomy to sexual function at 3 and 9 months after the procedure in 299 women who underwent hysterectomy between 1 November 2012 and 30 November 2014, at the Hospital and University Complex of Albacete, Spain. A total of 166 women were finally included in the study. Sexual function was studied using the Women's Sexual Function Questionnaire (Cuestionario de Función Sexual de la Mujer, FSM ®). RESULTS: It was found that some aspects of female sexual function improved after hysterectomy, whereas others did not change. Those younger than 55 years old experience improvements in sexual desire, excitement, and frequency of sexual activity, and had a decrease in problems with vaginal penetration. These changes were all evident 3 months post-intervention, and no changes occurred thereafter. Anticipatory anxiety also improved between the third and ninth month. An upward trend was observed in the general enjoyment of sex life. In those older than 55 years, an increase was only found in the frequency of sexual activity at 9 months post-operation. CONCLUSIONS: After hysterectomy, female sexual function either improves or remains unchanged. Improvement is primarily found in women younger than 55 years old


Assuntos
Humanos , Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle , Pandemias/prevenção & controle , Fatores de Risco , Unidade Hospitalar de Ginecologia e Obstetrícia/tendências , Pessoal de Saúde/organização & administração
17.
Ceska Gynekol ; 85(1): 59-66, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32414286

RESUMO

OBJECTIVE: Evaluation of the quality of the hospital care at individual departments of the clinic from the patient's perspective using a standard questionnaire. DESIGN: Retrospective observational studies. SETTING: 2nd Department of Obstetrics and Gynecology, University hospital Bratislava, Faculty of Medicine, Comenius University Bratislava, Slovakia. MATERIAL AND METHODS: In the study we included all patients who were hospitalized in II. GPK from 1. 1. 2019 to 1. 3. 2019. When the patient was released, they received a HCAHPS questionnaire. Obtained results were statistically processed and compared with publicly available data from all USA hospitals. RESULTS: We received 481 questionnaires suitable for processing. 53.2% of patients evaluated the clinic as the best possible. 57.4% of patients would definitely recommend the clinic to their family and friends. The biggest difference between patients who rated the clinic as the best and those who rated it low were in nurse communication (OR: 6.19, CI: 4.46-8.63). At maternity ward we haven't found any statistical effect in impact of age, but in nurses communication, pain management, communiation about medicines we found significant statistical differences in impact of different education between women. CONCLUSION: The quality of nurses and doctors communication and instructing patients about medication has a significant impact on the clinic's evaluation. Women with university education at maternity ward evaluate quality of hospital care stricter, regardles of age.


Assuntos
Hospitalização/estatística & dados numéricos , Pacientes Internados/psicologia , Unidade Hospitalar de Ginecologia e Obstetrícia/normas , Satisfação do Paciente , Qualidade da Assistência à Saúde/organização & administração , Feminino , Humanos , Obstetrícia , Gravidez , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Eslováquia , Inquéritos e Questionários
18.
J Perinat Med ; 48(5): 435-437, 2020 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-32374289

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has placed great demands on many hospitals to maximize their capacity to care for affected patients. The requirement to reassign space has created challenges for obstetric services. We describe the nature of that challenge for an obstetric service in New York City. This experience raised an ethical challenge: whether it would be consistent with professional integrity to respond to a public health emergency with a plan for obstetric services that would create an increased risk of rare maternal mortality. We answered this question using the conceptual tools of professional ethics in obstetrics, especially the professional virtue of integrity. A public health emergency requires frameshifting from an individual-patient perspective to a population-based perspective. We show that an individual-patient-based, beneficence-based deliberative clinical judgment is not an adequate basis for organizational policy in response to a public health emergency. Instead, physicians, especially those in leadership positions, must frameshift to population-based clinical ethical judgment that focuses on reduction of mortality as much as possible in the entire population of patients served by a healthcare organization.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Acesso aos Serviços de Saúde/ética , Serviços de Saúde Materna/ética , Unidade Hospitalar de Ginecologia e Obstetrícia/ética , Obstetrícia/ética , Pandemias , Pneumonia Viral , Saúde Pública , Beneficência , Infecções por Coronavirus/terapia , Emergências , Feminino , Alocação de Recursos para a Atenção à Saúde/ética , Alocação de Recursos para a Atenção à Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Humanos , Serviços de Saúde Materna/organização & administração , Cidade de Nova Iorque , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Pneumonia Viral/terapia , Gravidez
19.
Eur J Obstet Gynecol Reprod Biol ; 250: 250-252, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32466867

RESUMO

BACKGROUND: Since the first report of the new coronavirus (COVID-19) infection in December of 2019, it has become rapidly prevalent and been declared as a Public Health Emergency of International Concern by the World Health Organization. There are quite a few cases reported involving delivery with COVID-19 infection, but little valuable suggestion was provided about what healthcare providers of obstetrics and neonatology should do in their clinic practice for unknown status or presumed negative women. Here, we summarized the current practice of delivery management in China that successfully prevented rapid increase in adverse pregnancy outcomes and nosocomial infection in departments of obstetrics and neonatology during the pandemic of COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Controle de Infecções/métodos , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Infecções por Coronavirus/virologia , Infecção Hospitalar/virologia , Parto Obstétrico/normas , Feminino , Humanos , Pneumonia Viral/virologia , Gravidez , Complicações Infecciosas na Gravidez/virologia
20.
J Perinat Med ; 48(5): 453-461, 2020 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-32432568

RESUMO

The rapid progression of the coronavirus disease 2019 (COVID-19) outbreak presented extraordinary challenges to the US health care system, particularly straining resources in hard hit areas such as the New York metropolitan region. As a result, major changes in the delivery of obstetrical care were urgently needed, while maintaining patient safety on our maternity units. As the largest health system in the region, with 10 hospitals providing obstetrical services, and delivering over 30,000 babies annually, we needed to respond to this crisis in an organized, deliberate fashion. Our hospital footprint for Obstetrics was dramatically reduced to make room for the rapidly increasing numbers of COVID-19 patients, and established guidelines were quickly modified to reduce potential staff and patient exposures. New communication strategies were developed to facilitate maternity care across our hospitals, with significantly limited resources in personnel, equipment, and space. The lessons learned from these unexpected challenges offered an opportunity to reassess the delivery of obstetrical care without compromising quality and safety. These lessons may well prove valuable after the peak of the crisis has passed.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Alocação de Recursos para a Atenção à Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Hospitais Urbanos/organização & administração , Serviços de Saúde Materna/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Pandemias , Pneumonia Viral , Parto Obstétrico , Feminino , Humanos , New York , Gravidez , Telemedicina/métodos , Telemedicina/organização & administração , Saúde da População Urbana , Serviços Urbanos de Saúde/organização & administração
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