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2.
Ann Biol Clin (Paris) ; 78(6): 609-616, 2020 Dec 01.
Artigo em Francês | MEDLINE | ID: mdl-33361015

RESUMO

Confronted with the COVID-19 crisis, healthcare professionals have had to tackle an epidemic crisis of a huge magnitude for which they were not prepared. Medical laboratories have been on the front line, from collecting samples to performing the analysis required to diagnose this new pathology. Responding to the needs and to the urgency of the situation, the authorities relied on the network of private laboratories. In France, private laboratory medicine represents 70% of overall activity, and with a network of more than 4,000 local laboratories, private laboratory medicine has been the cornerstone of the « screen-trace-isolate ¼ strategy. This article gives feedback from private laboratory medicine professionals, directly involved in the reorganization carried out at the pre-analytical, analytical and post-analytical stages, during the crisis from March to October 2020.


Assuntos
/epidemiologia , Serviços de Laboratório Clínico/organização & administração , Pandemias , Setor Privado/organização & administração , Manejo de Espécimes/normas , /diagnóstico , Serviços de Laboratório Clínico/normas , Técnicas de Laboratório Clínico/instrumentação , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/normas , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Segurança de Equipamentos/métodos , Segurança de Equipamentos/normas , França/epidemiologia , Unidades Hospitalares/organização & administração , Humanos , Colaboração Intersetorial , Corpo Clínico/organização & administração , Corpo Clínico/normas , Segurança do Paciente/normas , Fase Pré-Analítica/métodos , Fase Pré-Analítica/normas , Setor Privado/normas , Manejo de Espécimes/métodos
3.
Soins Psychiatr ; 41(331): 16-20, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33357662

RESUMO

The COVID-19 health crisis forced Charles-Perrens General Hospital in Bordeaux to convert a conventional psychiatric unit into a specific unit to care for patients with mental disorders who are potentially infected with the SARS-Cov-2 virus. Resources and competences from across the hospital were mobilised to enable the unit's health professionals to accomplish this mission. This article looks back at the experience.


Assuntos
/terapia , Unidades Hospitalares/organização & administração , Transtornos Mentais/terapia , /epidemiologia , França/epidemiologia , Humanos
4.
Nephrol Nurs J ; 47(5): 457-460, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107718

RESUMO

Making a business case to match staffing-to-patient care needs sometimes requires new approaches. Partnering with departments outside of nursing proved successful in one acute hemodialysis department. Working with Lean Six Sigma teammates to define our workflow processes and utilizing the resulting data led to developing a business case, which gained the department 2.5 additional full-time equivalent registered nurses. A staffing template was created to evaluate ongoing patient volumes against current staffing. This staffing template can be used by any hemodialysis unit to aid in determining ongoing staffing requirements.


Assuntos
Unidades Hospitalares/organização & administração , Recursos Humanos de Enfermagem no Hospital/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Diálise Renal/enfermagem , Gestão da Qualidade Total/métodos , Humanos
5.
Inflamm Bowel Dis ; 26(11): e134-e136, 2020 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-33029612
6.
J Vasc Interv Radiol ; 31(11): 1857-1863, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33041175

RESUMO

PURPOSE: To assess changes in operational utilization following conversion of a single IR suite to a hybrid CT/angiography (Angio-CT) system at an academic tertiary care center. MATERIALS AND METHODS: The total number of interventional procedures and diagnostic CT examinations performed in 29 rooms (20 diagnostic radiology, 7 IR, 2 shared between divisions) was calculated in the 24 months before conversion of an IR suite to Angio-CT and 12 months after conversion. The total number of IR procedures (global IR/month) and diagnostic CT scans per month (global CT/month) in both before and after conversion periods was calculated and defined as baseline institutional growth. This was compared against the change in the number of IR procedures performed in the before and after periods in the converted room (Angio-CT/month) as well as the number of diagnostic CT scans performed in the shared rooms (shared CT/month). RESULTS: The percent change in global CT and global IR from the before to the after periods was 39.2% and 3.1%, respectively. Shared CT per month and Angio-CT per month increased by 46.7% and 12.0% across the same time periods, respectively. The ratio of the percent increase in Angio-CT per month to percent increase in global IR per month was 3.87. The ratio of the percent increase in shared CT per month to percent increase in global CT per month was 1.19. CONCLUSIONS: Operational utilization improved in both diagnostic radiology and IR sections following conversion of a conventional fluoroscopic IR suite to an Angio-CT room.


Assuntos
Agendamento de Consultas , Angiografia por Tomografia Computadorizada , Unidades Hospitalares/organização & administração , Radiografia Intervencionista , Serviço Hospitalar de Radiologia/organização & administração , Sistemas de Informação em Radiologia/organização & administração , Eficiência Organizacional , Fluoroscopia , Humanos , Estudos Retrospectivos , Fluxo de Trabalho , Carga de Trabalho
7.
Rev. neurol. (Ed. impr.) ; 71(6): 199-204, 16 sept., 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-195512

RESUMO

INTRODUCCIÓN: Las consultas por cefalea son el motivo más frecuente de demanda de atención de causa neurológica en la atención primaria y en los servicios de neurología. Las unidades de cefalea mejoran la calidad asistencial, reducen las listas de espera, facilitan el acceso a nuevos tratamientos de eficacia contrastada y optimizan el gasto sanitario. No obstante, la implantación de estas unidades no está extendida en España debido a la relativa importancia atribuida a la patología y a la suposición de que su coste es elevado. OBJETIVO: Definir la estructura y los requerimientos mínimos de una unidad de cefalea con la intención de contribuir a su extensión en los hospitales de España. SUJETOS Y MÉTODOS: Estudio de consenso entre profesionales tras la revisión de la bibliografía sobre la estructura, las funciones y los recursos de una unidad de cefalea para un área de 350.000 habitantes. RESULTADOS: Se tomaron como referencia ocho publicaciones para la identificación de recursos mínimos necesarios de una unidad de cefalea. El panel de expertos estuvo integrado por 12 profesionales de diferentes especialidades. El principal recurso para la implementación de estas unidades son profesionales (superiores y técnicos), lo que puede suponer un coste adicional para el primer año de alrededor de 107.287,19 euros. CONCLUSIONES: Si consideramos los costes directos e indirectos debidos a las pérdidas por productividad laboral por paciente y los comparamos con los costes estimados de implantación de estas unidades y su expectativa de resultados, todo apunta a que es necesaria la generalización de unidades de cefalea en España


INTRODUCTION: Visits due to headaches are the most frequent cause of demand for neurological treatment in primary care and neurology services. Headache units improve the quality of care, reduce waiting lists, facilitate access to new treatments of proven efficacy and optimise healthcare expenditure. However, these units have not been implemented on a widespread basis in Spain due to the relatively low importance attributed to the condition and also the assumption that such units have a high cost. AIM: To define the structure and minimum requirements of a headache unit with the intention of contributing to their expansion in hospitals in Spain. SUBJECTS AND METHODS: We conducted a consensus study among professionals after reviewing the literature on the structure, functions and resources required by a headache unit designed to serve an area with 350,000 inhabitants. RESULTS: Eight publications were taken as a reference for identifying the minimum resources needed for a headache unit. The panel of experts was made up of 12 professionals from different specialties. The main resource required to be able to implement these units is the professional staff (both supervisory and technical), which can mean an additional cost for the first year of around 107,287.19 euros. CONCLUSIONS: If we bear in mind the direct and indirect costs due to losses in labour productivity per patient and compare them with the estimated costs involved in implementing these units and their expected results, everything points to the need for headache units to become generalised in Spain


Assuntos
Humanos , Cefaleia/epidemiologia , Unidades Hospitalares/organização & administração , Neurologia/organização & administração , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Unidades Hospitalares/economia , Espanha/epidemiologia , Neurologia/economia , Consenso , Pesquisa Qualitativa
8.
Am Heart J ; 229: 121-126, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32957030

RESUMO

Myocarditis Disease Unit (MDU) is a functional multidisciplinary network designed to offer multidisciplinary assistance to patients with myocarditis. More than 300 patients coming from the whole Country are currently followed up at a specialized multidisciplinary outpatient clinic. Following the pandemic outbreak of the SARS-CoV-2 infection in Italy, we present how the MDU rapidly evolved to a "tele-MDU", via a dedicated multitasking digital health platform.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Unidades Hospitalares/organização & administração , Comunicação Interdisciplinar , Miocardite/terapia , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/epidemiologia , Telemedicina/organização & administração , Adulto , Assistência Ambulatorial/organização & administração , Arritmias Cardíacas/terapia , Feminino , Sistemas de Informação Hospitalar , Humanos , Pacientes Internados , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Centros de Atenção Terciária/organização & administração , Navegador
9.
Hu Li Za Zhi ; 67(5): 65-73, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-32978767

RESUMO

BACKGROUND & PROBLEMS: Efficient handover is essential to ensuring high levels of caring quality and patient safety. In our psychiatric acute ward, it was noticed that there were many valueless tasks being performed during the nursing handover process that negatively affected efficiency. PURPOSE: To apply lean management principles to improve the nursing handover process in the psychiatric acute ward. RESOLUTION: In order to find the rightful solution, our task team analyzed the problem using the Value Chart of Lean Management and detected that the handover process was slowed down by motion, waiting, and defects. According to the rules of lean management, group discussion, decision making, and the cost-benefit matrix, we proposed improvement solutions including visual stocktaking, adjusting handover patterns, switching the handover location, and systematizing nursing handover procedures. RESULTS: The time required for stocktaking was shortened from 5 to 2 minutes (60% improvement). The waiting time was shortened from 114 to 49.6 minutes (56.6% improvement). The efficiency of the handover process increased from 66% to 90%. CONCLUSIONS: Applying lean management principles helped detect critical problems and reduce waste, which enhanced efficiency, improved handover, and helped maximize nursing value and benefit in an increasingly complex environment.


Assuntos
Unidades Hospitalares/organização & administração , Transtornos Mentais/enfermagem , Transferência da Responsabilidade pelo Paciente/organização & administração , Melhoria de Qualidade/organização & administração , Eficiência Organizacional/estatística & dados numéricos , Humanos , Pesquisa em Avaliação de Enfermagem
12.
Pflege ; 33(4): 247-255, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32811329

RESUMO

Between dream and distress - Setting up and running a cohort ward for COVID-19 Patients at an acute hospital - A case study Abstract. Background: In the context of the pandemic, hospitals must be able to care for COVID-19 patients within a very short timeframe. OBJECTIVE: Description of the setting up of a cohort ward for patients with COVID-19 on a surgical ward including the development of the nursing team. METHODS: The intrinsic retrospective case study describes the situation, identifies special phenomena in a reflective manner and links them to existing knowledge. Data were anecdotal, routine data were collected in the context of nursing practice development. RESULTS: Setting up the cohort ward in a Swiss hospital consisted of structural and technical planning, infection control measures, the establishment of interprofessional structures, and internal communication. During the four-week operation, 71 patients were treated. The use of practice development methodology initiated a cultural change. The reflection describes a field of tension between "dream and distress": As a dream, the lived experience of optimal care, with well-functioning processes, sufficient material, sufficient personnel and a very good interprofessional cooperation was evaluated. Distress in the form of high infection rates as well as psychological and physical stress did not occur. After the cohort ward was closed, there was a risk working back in normal operations based on existing economical and organizational conditions, with the knowledge that a different cooperation and organization is possible. CONCLUSIONS: Positive experiences from the "crisis mode" should be used to further develop essential operations during normal times.


Assuntos
Infecções por Coronavirus/enfermagem , Unidades Hospitalares/organização & administração , Recursos Humanos de Enfermagem no Hospital/psicologia , Pandemias , Pneumonia Viral/enfermagem , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , Angústia Psicológica , Estudos Retrospectivos , Suíça/epidemiologia
13.
BMC Public Health ; 20(1): 1234, 2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-32791972

RESUMO

BACKGROUND: Kangaroo mother care (KMC) has been proved to be a safe and cost-effective standard of care for preterm babies. China hasn't adopted the KMC practice widely until recently. We aim to assess barriers and facilitators of KMC adoption in neonatal intensive care units (NICUs) and postnatal wards in China. METHODS: We conducted clinical observations and semi-structured interviews with nurses, physicians, and parents who performed KMC in seven NICUs and postnatal wards housed in five hospitals in different provinces of China between August and September 2018. The interviews provided first-hand stakeholder perspectives on barriers and facilitators of KMC implementation and sustainability. We further explored health system's readiness and families' willingness to sustain KMC practice following its pilot introduction. We coded data for emerging themes related to financial barriers, parent- and hospital-level perceived barriers, and facilitators of KMC adoption, specifically those unique in the Chinese context. RESULTS: Five hospitals with KMC pilot programs were selected for clinical observations and 38 semi-structured interviews were conducted. Common cultural barriers included concerns with the conflict with traditional postpartum confinement (Zuo-yue-zi) practice and grandparents' resistance, while a strong family support is a facilitator for KMC adoption. Some parents reported anxiety and guilt associated with having a preterm baby, which can be a parental-level barrier to KMC. Hospital-level factors such as fear of nosocomial infection and shortage of staff and spaces impeded the KMC implementation, and supportive community and peer group organized by the hospital contributed to KMC uptake. Financial barriers included lodging costs for caregivers and supply costs for hospitals. CONCLUSIONS: We provided a comprehensive in-depth report on the multi-level KMC barriers and facilitators in China. We recommend policy interventions specifically addressing these barriers and facilitators and increase family and peer support to improve KMC adoption in China. We also recommend that well-designed local cultural and economic feasibility and acceptability studies should be conducted before the KMC uptake.


Assuntos
Acesso aos Serviços de Saúde , Unidades Hospitalares/organização & administração , Unidades de Terapia Intensiva Neonatal/organização & administração , Método Canguru/estatística & dados numéricos , Cuidado Pós-Natal/organização & administração , China , Hospitais , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Pesquisa Qualitativa
14.
Knee Surg Sports Traumatol Arthrosc ; 28(9): 2730-2746, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32844246

RESUMO

PURPOSE: The Covid-19 pandemic has disrupted health care systems all over the world. Elective surgical procedures have been postponed and/or cancelled. Consensus is, therefore, required related to the factors that need to be in place before elective surgery, including hip and knee replacement surgery, which is restarted. Entirely new pathways and protocols need to be worked out. METHODS: A panel of experts from the European Hip Society and European Knee Association have agreed to a consensus statement on how to reintroduce elective arthroplasty surgery safely. The recommendations are based on the best available evidence and have been validated in a separate survey. RESULTS: The guidelines are based on five themes: modification and/or reorganisation of hospital wards. Restrictions on orthopaedic wards and in operation suite(s). Additional disinfection of the environment. The role of ultra-clean operation theatres. Personal protective equipment enhancement. CONCLUSION: Apart from the following national and local guidance, protocols need to be put in place in the patient pathway for primary arthroplasty to allow for a safe return.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/métodos , Pneumonia Viral/epidemiologia , Antropologia Médica , Betacoronavirus , Consenso , Assistência à Saúde/métodos , Desinfecção/métodos , Desinfecção/normas , Europa (Continente) , Unidades Hospitalares/organização & administração , Unidades Hospitalares/normas , Humanos , Salas Cirúrgicas/organização & administração , Salas Cirúrgicas/normas , Procedimentos Ortopédicos , Ortopedia , Pandemias , Equipamento de Proteção Individual , Inquéritos e Questionários
15.
Eur Rev Med Pharmacol Sci ; 24(15): 8202-8209, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32767350

RESUMO

OBJECTIVE: The recent outbreak of SARS-CoV-2 infection in Italy has resulted in a sudden and massive flow of patients into emergency rooms, and a high number of hospitalizations with the need for respiratory isolation. Massive admission of patients to the Policlinico "Agostino Gemelli" Foundation of Rome, Italy, determined the need for reengineering the entire hospital. MATERIALS AND METHODS: In this article, we consider some of the structural and organizational changes that have been necessary to deal with the emergency, with particular reference to non-intensive medicine wards, and the preventive measures aimed at limiting the spread of SARS-CoV-2 infection among hospital staff and patients themselves. RESULTS: 577 staff members were subjected to molecular tests in 1-month period and 3.8% of the total were positive. 636 patients admitted to the COVID-19 pathway were included and analyzed: 45.4% were identified as SARS-CoV-2 positive. More SARS-CoV-2 negative patients were discharged in comparison to SARS-CoV-2 positive patients (59% vs. 41%, respectively). On the other hand, more SARS-CoV-2 positive patients were transferred to ICUs in comparison to SARS-CoV-2 negative patients (16% vs. 1%, respectively). Occurrence of death was similar between the two groups, 11% vs. 7%, for SARS-CoV-2 negative and positive patients, respectively. 25% of ≥80 years old SARS-CoV-2 positive patients died during the hospitalization, while death rate was lower in other age groups (5% in 70-79 years old patients and 0% in remaining age groups). CONCLUSIONS: Rapid hospital reengineering has probably had an impact on the management of patients with and without SARS-CoV-2 infection, and on in-hospital mortality rates over the reporting period.


Assuntos
Infecções por Coronavirus/epidemiologia , Unidades Hospitalares/organização & administração , Controle de Infecções/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Pneumonia Viral/epidemiologia , Centros de Atenção Terciária/organização & administração , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Feminino , Pessoal de Saúde/educação , Número de Leitos em Hospital , Hospitais Especializados , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Unidades de Terapia Intensiva , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Isolamento de Pacientes , Equipamento de Proteção Individual , Pneumonia Viral/terapia , Pneumonia Viral/transmissão
16.
Neurology ; 95(13): 583-592, 2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-32732292

RESUMO

In response to the COVID-19 pandemic epicenter in Bronx, NY, the Montefiore Neuroscience Center required rapid and drastic changes when considering the delivery of neurologic care, health and safety of staff, and continued education and safety for house staff. Health care leaders rely on principles that can be in conflict during a disaster response such as this pandemic, with equal commitments to ensure the best care for those stricken with COVID-19, provide high-quality care and advocacy for patients and families coping with neurologic disease, and advocate for the health and safety of health care teams, particularly house staff and colleagues who are most vulnerable. In our attempt to balance these principles, over 3 weeks, we reformatted our inpatient neuroscience services by reducing from 4 wards to just 1, in the following weeks delivering care to over 600 hospitalized patients with neuro-COVID and over 1,742 total neuroscience hospital bed days. This description from members of our leadership team provides an on-the-ground account of our effort to respond nimbly to a complex and evolving surge of patients with COVID in a large urban hospital network. Our efforts were based on (1) strategies to mitigate exposure and transmission, (2) protection of the health and safety of staff, (3) alleviation of logistical delays and strains in the system, and (4) facilitating coordinated communication. Each center's experience will add to knowledge of best practices, and emerging research will help us gain insights into an evidence-based approach to neurologic care during and after the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Departamentos Hospitalares/organização & administração , Corpo Clínico Hospitalar/organização & administração , Neurologia/organização & administração , Pandemias , Pneumonia Viral , Assistência Ambulatorial , Betacoronavirus , Comunicação , Assistência à Saúde , Unidades Hospitalares/organização & administração , Hospitalização , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Neurologia/educação , Enfermagem em Neurociência , Recursos Humanos de Enfermagem no Hospital/organização & administração , Equipamento de Proteção Individual , Admissão e Escalonamento de Pessoal , Telemedicina , Envio de Mensagens de Texto
17.
Epileptic Disord ; 22(4): 439-442, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32759092

RESUMO

The COVID-19 pandemic shook European healthcare systems, with unavoidable gaps in the management of patients with chronic diseases. We describe the impact of the pandemic on epilepsy care in three tertiary epilepsy centres from Spain and Italy, the most affected European countries. The three epilepsy centres, members of the European EpiCARE network, manage more than 5,700 people with epilepsy. In Bologna and Barcelona, the hospitals housing the epilepsy centres were fully converted into COVID-19 units. We describe the reorganization of the clinics and report on the frequency of SARS-CoV-2 in people with epilepsy as well as the frequency of seizures in patients admitted to the COVID units. Finally, we elaborate on critical issues regarding the second phase of the pandemic. The activities related to epilepsy care were reduced to less than 10% and were deprioritized. Discharges were expedited and elective epilepsy surgeries, including vagal nerve stimulator implantations, cancelled. Hospitalizations and EEG examinations were limited to emergencies. The outpatient visits for new patients were postponed, and follow-up visits mostly managed by telehealth. Antiseizure medication weaning plans and changes in vagal nerve stimulator settings were halted. Among the 5,700 people with epilepsy managed in our centres, only 14 tested positive for SARS-CoV-2, without obvious impact on their epilepsy. None of the 2,122 patients admitted to COVID units experienced seizures among the early symptoms. Epilepsy care was negatively impacted by the pandemic, irrespective of COVID-19 epidemiology or conversion of the hospital into a COVID-19 centre. The pandemic did not silence the needs of people with epilepsy, and this must be considered in the planning of the second phase.


Assuntos
Infecções por Coronavirus , Epilepsia/terapia , Necessidades e Demandas de Serviços de Saúde/tendências , Pandemias , Pneumonia Viral , Infecções por Coronavirus/complicações , Eletroencefalografia/estatística & dados numéricos , Epilepsia/complicações , Epilepsia/cirurgia , Europa (Continente) , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Unidades Hospitalares/organização & administração , Hospitalização/estatística & dados numéricos , Humanos , Itália , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Pneumonia Viral/complicações , Convulsões/epidemiologia , Convulsões/etiologia , Espanha , Telemedicina
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