Environmental spreading of clinically relevant carbapenem-resistant gram-negative bacilli: the occurrence of blaKPC-or-NDM strains relates to local hospital activities.

BACKGROUND: Aquatic matrices impacted by sewage may shelter carbapenem-resistant (CR) Gram-negative bacilli (GNB) harboring resistance genes of public health concern. In this study, sewage treatment plants (STPs) servicing well-defined catchment areas were surveyed for the presence of CR-GNB bearing carbapenemase genes (blaKPC or blaNDM). RESULTS: A total of 325 CR-GNB were recovered from raw (RS) and treated (TS) sewage samples as well as from water body spots upstream (UW) and downstream (DW) from STPs. Klebsiella-Enterobacter (KE) group amounted to 116 isolates (35.7%). CR-KE isolates were recovered from TS, DW (35.7%) and RS samples (44.2%) (p = 0.001); but not from UW samples. KE isolates represented 65.8% of all blaKPC or blaNDM positive strains. The frequency of blaKPC-or-NDM strains was positively associated with the occurrence of district hospitals located near STPs, as well as with the number of hospitalizations and of sewer connections serviced by the STPs. blaKPC-or-NDM strains were recovered from ST samples in 7 out of 14 STPs, including four tertiary-level STPs; and from 6 out of 13 DW spots whose RS samples also had blaKPC-or-NDM strains. CONCLUSIONS: Clinically relevant GNB bearing blaKPC-or-NDM resist sewage treatments and spread into environmental aquatic matrices mainly from STPs impacted by hospital activities.

[Public health impact of a remote diagnosis system implemented in regional and district hospitals in Paraguay]. / Impacto en la salud pública del sistema de telediagnóstico implementado en Paraguay.

OBJECTIVE: Determine the viability of a remote diagnosis system implemented to provide health care to remote and scattered populations in Paraguay. METHODS: The study was conducted in all regional and general hospitals in Paraguay, and in the main district hospitals in the country's 18 health regions. Clinical data, tomographic images, sonography, and electrocardiograms (ECGs) of patients who needed a diagnosis by a specialized physician were entered into the system. This information was sent to specialists in diagnostic imaging and in cardiology for remote diagnosis and the report was then forwarded to the hospitals connected to the system. The cost-benefit and impact of the remote diagnosis tool was analyzed from the perspective of the National Health System. RESULTS: Between January 2014 and May 2015, a total of 34 096 remote diagnoses were made in 25 hospitals in the Ministry of Health's telemedicine system. The average unit cost of remote diagnosis was US$2.6 per ECG, tomography, and sonography, while the unit cost of "face-to-face" diagnosis was US$11.8 per ECG, US$68.6 per tomography, and US$21.5 per sonography. As a result of remote diagnosis, unit costs were 4.5 times lower for ECGs; 26.4 times lower for tomography, and 8.3 times lower for sonography. In monetary terms, implementation of the remote diagnosis system during the 16 months of the study led to average savings of US$2 420 037. CONCLUSION: Paraguay has a remote diagnosis system for electrocardiography, tomography, and sonography, using low-cost information and communications technologies (ICTs) based on free software that is scalable to other types of remote diagnostic studies of interest for public health. Implementation of remote diagnosis helped to strengthen the integrated network of health services and programs, enabling professionals to optimize their time and productivity, while improving quality, increasing access and equity, and reducing costs.

Prevalence of Vitamin D Insufficiency and Deficiency among Young Physicians at University District Hospital in San Juan, Puerto Rico.

Vitamin D has been attracting increased attention because of higher prevalences of vitamin D insufficiency and deficiency than expected in areas with sufficient sun exposure. Even though sunlight exposure and diet are the main determinants of vitamin D status, other factors, such as age, race, the use (or not) of sunscreen, medications, and malabsorptive conditions, also affect vitamin D levels. Recent studies have found high prevalences of vitamin D deficiency and insufficiency in different populations. However, there are limited data regarding the prevalence of vitamin D deficiency and insufficiency in Puerto Rico. To shed more light on the subject, we evaluated a sample of 51 internal medicine residents and research fellows, aged from 25 to 39 years at the University District Hospital in San Juan, Puerto Rico, doing so by means of a questionnaire that explored basic socio demographic and lifestyle characteristics and collected anthropometric data; in addition, we obtained blood samples in order to determine 25-hydroxyvitamin D levels. The median 25-hydroxyvitamin D level was 21 ng/mL (range, 7-38 ng/mL). Forty-five participants (88.2%) had 25-hydroxyvitamin D concentrations of lower than 30 ng/mL. We found vitamin D deficiencies in 43.1% of the population and insufficiencies in 45.1%. Contributory factors to our findings include limited exposure to sunlight during periods of high sun intensity, increased body mass index, and a limited area of the body being exposed to sunlight. A relationship between reduced physical activity levels and hypovitaminosis D was also found. Both calcium intake and vitamin D intake, which were markedly below recommended daily allowances, were positively correlated with 25-hydroxy vitamin D levels, but with a weak association.

Prioritizing essential surgery and safe anesthesia for the Post-2015 Development Agenda: operative capacities of 78 district hospitals in 7 low- and middle-income countries.

BACKGROUND: Surgery has been neglected in low- and middle-income countries for decades. It is vital that the Post-2015 Development Agenda reflect that surgery is an important part of a comprehensive global health care delivery model. We compare the operative capacities of multiple low- and middle-income countries and identify critical gaps in surgical infrastructure. METHODS: The Harvard Humanitarian Initiative survey tool was used to assess the operative capacities of 78 government district hospitals in Bangladesh (n = 7), Bolivia (n = 11), Ethiopia (n = 6), Liberia (n = 11), Nicaragua (n = 10), Rwanda (n = 21), and Uganda (n = 12) from 2011 to 2012. Key outcome measures included infrastructure, equipment availability, physician and nonphysician surgical providers, operative volume, and pharmaceutical capacity. RESULTS: Seventy of 78 district hospitals performed operations. There was fewer than one surgeon or anesthesiologist per 100,000 catchment population in all countries except Bolivia. There were no physician anesthesiologists in any surveyed hospitals in Rwanda, Liberia, Uganda, or in the majority of hospitals in Ethiopia. Mean annual operations per hospital ranged from 374 in Nicaragua to 3,215 in Bangladesh. Emergency operations and obstetric operations constituted 57.5% and 40% of all operations performed, respectively. Availability of pulse oximetry, essential medicines, and key infrastructure (water, electricity, oxygen) varied widely between and within countries. CONCLUSION: The need for operative procedures is not being met by the limited operative capacity in numerous low- and middle-income countries. It is of paramount importance that this gap be addressed by prioritizing essential surgery and safe anesthesia in the Post-2015 Development Agenda.

[Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in a hospital in Distrito Federal]. / Síndrome de Stevens-Johnson e Necrólise Epidérmica Tóxica em um hospital do Distrito Federal.

This study aimed to analyze demographic and clinical aspects of patients diagnosed with Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), as well as identifying the actions of health professionals for the management of Adverse Drug Reactions (ADR) in a public hospital in Distrito Federal, Brazil. A descriptive and retrospective research was held, with quantitative approach. Data collected from all the records of 22 patients admitted with diagnosed with SJS and TEN, from January 2005 to September 2012. Data were analyzed using descriptive statistics. Of these cases, 9 were diagnosed with NET and 7, with SJS; there were more females (14); aged from 21 to 40 years (10); 21 were cured; the drugs more used were the antiepileptic ones (10). Fragility in clinical registers and in the actions to monitor the cases of ADR in this health service was observed.

The influence of the cultural climate of the training environment on physicians' self-perception of competence and preparedness for practice.

BACKGROUND: In current supervisory practice, the learning environment in which the training of specialist registrars (SpRs) takes place is important. Examples of such learning environments are the hospital settings and/or geographical locations where training occurs. Our objective was to investigate whether the cultural climate of different learning environments influences physicians' perceived level of competence and preparedness for practice. METHODS: An electronic questionnaire was sent to an equal group of paediatricians who had trained in clinical settings located in Europe and the Caribbean. 30 items (Likert scale 1-4 = totally disagree-totally agree) were used to measure the level of preparedness of the respondents in 7 physician competencies. RESULTS: 42 participants were included for analysis. The distribution of participants in both groups was comparable. The overall perception of preparedness in the Caribbean group was 2.93 (SD = 0.47) and 2.86 (SD = 0.72) in the European group. The European group felt less prepared in the competency as manager 1.81 (SD = 1.06) compared to their Caribbean counterparts 2.72 (SD = 0.66). The difference was significant (p = 0.006). CONCLUSION: The training in the different environments was perceived as adequate and comparable in effect. The learning environment's cultural climate appeared to influence the physician's perception of their competencies and preparedness for clinical practice.

Utilization of patient classification systems in Swedish hospitals and the degree of satisfaction among nursing staff.

BACKGROUND: Although patient classification tools have been used in Sweden since the 1980s, few studies have examined how they are utilized and monitored. AIM: This paper investigates the patient classification systems implemented in hospitals in the country as well as the level of satisfaction of nurses with the implemented instrument. METHOD: A postal survey method was used in which a total of 128 questionnaires were sent to nurse managers. Twenty-three hospitals were identified with patient classification systems currently in operation. RESULTS AND CONCLUSION: The Zebra and Beakta systems are the most commonly used instruments. Nurse managers appear to be satisfied with the patient classification systems in use on their wards as a whole except for their inability to measure the quality of care provided, the time spent to use the instruments and the fact that the administration do not estimate nursing staff requirements using the system.

Conocer y disminuir el tiempo de espera de los clientes que acuden por una atencion medica al Hospital Alto Beni de Palos Blancos / s

El objetivo de la investigacion es conocer y disminuir el tiempo de espera de los clientes que acuden por una atencion medica al hospital alto Beni de Palos Blancos..

Manual de organización y funciones distritos urbanos / Manual on organization and functions urban districts

El presente manual de Organización y Funciones de Distritos de Salud es el resultado de talleres participativos con los diferentes equipos de gestión en la implementación de los procesos de gestión pública.

Manual de organización y funciones de enfermería y personal administrativo distritos rurales / Manual on organization and functions of nursing and administrative personnel rural districts

Este documento desarrolla las funciones a desempeñar por el personal de salud en los distritos rurales, centros de salud, postas de salud, laboratorio, hospital, personal de limpieza y responsable de seguridad

[Analysis of liver biopsy experience in a regional hospital]. / Análisis de la experiencia en biopsia hepática en un hospital regional.

UNLABELLED: Hepatic biopsy is a safe procedure. Its findings contribute to precise diagnoses and in selecting or modifying the treatment of some patients with liver diseases. AIM: To analyze indications, findings and complications of hepatic biopsy. MATERIAL AND METHODS: Retrospective study of patients with hepatic disease in which a hepatic biopsy was obtained. Information pertaining to clinical characteristics, biopsy indications and its results were collected. All tissue samples were stained with hematoxylin-eosin, Masson and Perl. The analysis was performed by descriptive statistics, chi 2 test and the Fisher exact test. RESULTS: There were 54.6% were women and 45.4% were men. In 361 patients the major diagnoses were: Hepatic cirrhosis 19.1%, hepatic metastases 16.3%, chronic hepatitis 11.6%, alcoholic hepatitis 11.1% and nonalcoholic steatohepatitis 9.7%. In 66.2% of the biopsies were preformed meanwhile patients were in the Hospital. The procedure was ultrasound-assisted in 76%. There were major complications in 1.4%. CONCLUSION: The hepatic disease is more common in the woman and the pathologic results show that the etiology of liver diseases in our hospital are similar to reports of third level hospitals in Mexico, its major complications were fewer.

Análisis de la experiencia en biopsia hepática en un hospital regional / Analysis of liver biopsy experience in a regional hospital

Hepatic biopsy is a safe procedure. Its findings contribute to precise diagnoses and in selecting or modifying the treatment of some patients with liver diseases. AIM: To analyze indications, findings and complications of hepatic biopsy. MATERIAL AND METHODS: Retrospective study of patients with hepatic disease in which a hepatic biopsy was obtained. Information pertaining to clinical characteristics, biopsy indications and its results were collected. All tissue samples were stained with hematoxylin-eosin, Masson and Perl. The analysis was performed by descriptive statistics, chi 2 test and the Fisher exact test. RESULTS: There were 54.6 were women and 45.4 were men. In 361 patients the major diagnoses were: Hepatic cirrhosis 19.1, hepatic metastases 16.3, chronic hepatitis 11.6, alcoholic hepatitis 11.1 and nonalcoholic steatohepatitis 9.7. In 66.2 of the biopsies were preformed meanwhile patients were in the Hospital. The procedure was ultrasound-assisted in 76. There were major complications in 1.4. CONCLUSION: The hepatic disease is more common in the woman and the pathologic results show that the etiology of liver diseases in our hospital are similar to reports of third level hospitals in Mexico, its major complications were fewer.

[Detection of vancomycin-resistant Enterococcus faecium: 2 years' experience in a high complexity hospital ]. / Detección de Enterococcus faecium resistente a vancomicina: experiencia de dos años en un hospital de alta complejidad.

The presence of vancomycin-resistant enterococci (VRE) in our hospital prompted us to apply an appropriate method for assessing its rectal carriage. A screening method with bile-esculin azide agar plus different concentrations of vancomycin was used. The antimicrobial susceptibility study of enterococci isolated from clinical samples was also emphasized. The present study includes the surveillance and detection of VRE in our hospital during two years. A total of 260 samples corresponding to 138 patients were studied, 158 of them resulting positive. All EVR were Van A Enterococcus faecium, with MICs of vancomycin > or = 256 micrograms/ml. The analysis of susceptibility patterns shows variations with chloramphenicol, tetracycline and high level gentamicin concentrations. This method was easily applied because materials could be available in any clinical microbiology laboratory, and in our hands it has demonstrated to be useful for epidemiological surveillance for EVR.

Distrito 2-3 "Centenario"

Facilitar la articulacion de las Redes Sociales con la Red de Servicios de Salud a fin de que las funciones de Manzaneras y Defensorias se cumplan de manera adecuada en la generacion de demanda y en el control social de los servicios.(au)

Condicionantes que intervienen en la detección precoz de cáncer cervico uterino, en el personal de salud del distrito 5-6 nor este de El Alto-Bolivia 2002 / Conditioners that take part in the precocious detection of cancer cervico uterine in the personnel of health of the district the 5-6 northeast El Alto

El presente trabajo se realisó, en el distrito de salud 5-6 Noreste de la ciudad de el Alto, conformado por 7 centros de salud públicos, con 63 proveedoras de salud. Tiene como propósito identificar las condiciones que influyen para que el personal de salud del Distrito 5-6 de El Alto tenga baja motivación en al realización del examen de papanicolau, para una detección precoz de cáncer cérvicouterino, además describir el nivel socieconómico y la historia sexual y reproductiva, asimismo evaluar el conocimiento, las actitudes y prácticas referentes a lo que es el Papanicolau. El diseño de este trabajo es: descriptivo, transversal y el universo es el personal femenino de salud, sexualmente aactivas, de diferentes estratos socioevonómicos, que trabajan en el distrito de Salud 5-6 de la ciudad de El Alto. La técnica de recolección de la información, fue a través de encuestas, con la tabulación y presentación de los datos. Los siguientes resultsdos constituyen los valores más importantes: el 98,1 porciento de las mujeres conoce verídicamente lo que es el Papanicolau; con relación al tiempo en el que se realizaron el último Papanicolau el 32,1 porciento lo efectuó hace un año y el 26,4 porciento hace dos años. El 32,1 porciento se realizaron en los centros de salud del distrito seguido por el 26,4 porciento que se presedieron en la Caja Nacional de Seguridad Social. Las principales condicionantes por las que no se hicieron el examen del Papanicolauen este año fueron: falta de tiempo 60,4 porciento, miedo 22,7 porciento y verguenza 9,4 porciento.

Holding up a mirror: changing obstetric practice through criterion-based clinical audit in developing countries.

The objective of the study described is to assess the feasibility and effectiveness of using a criterion-based clinical audit to measure and improve the quality of obstetric care at the district hospital level in developing countries. The focus is on the management of five life-threatening obstetric complications--hemorrhage, eclampsia, genital tract infection, obstructed labor and uterine rupture was audited using a "before and after" design. The five steps of the audit cycle were followed: establish criteria of good quality care; measure current practice (Review I); feedback findings and set targets; take action to change practice; and re-evaluate practice (Review II). Systematic literature review, panel discussions and pilot work led to the development of 31 audit criteria. Review I included 555 life-threatening complications occurring over 66 hospital-months; Review II included 342 complications over 42 hospital-months. Many common areas for improvement were identified across the four hospitals. Agreed mechanisms for achieving these improvements included clinical protocols, reviews of staffing, and training workshops. Some aspects of clinical monitoring, drug use and record keeping improved significantly between Reviews I and II. Criterion-based clinical audit in four typical district hospitals in Ghana and Jamaica is a feasible and acceptable method for quality assurance and appears to have improved the management of life-threatening obstetric complications.

Proyecto de equipamiento de los puestos de salud Huaraya y Pichuya. Equipo de salud Distrito de Sacaca / Project of equipment of the posts of health Huaraya and Pichuya. Team of health District of Sacaca

El objetivo de este proyecto es mejorar la capacidad instalada y resolutiva de la red de servicios de salud, para contribuir la demanda de salud de la población del municipio de Sacaca y dotar de quipamiento a los puestos de salud Huaraya y Pichuya con el objeto de mejorar la calidad y la demanda al servicio.