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1.
BMC Infect Dis ; 21(1): 1100, 2021 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-34702208

RESUMO

BACKGROUND: Tuberculosis (TB) is an airborne chronic infectious disease mainly caused by Mycobacterium tuberculosis complex bacteria. Currently, about 1.7 billion (26%) of the world's population are considered to be infected with M. tuberculosis. The risk of acquiring tuberculosis is higher on some segments of societies including people with severe mental illness. As a result, World health organization (WHO) strongly recommends screening for tuberculosis in such risk groups and setting. METHODS: A cross-sectional study was conducted to assess the prevalence of active tuberculosis and associated factors among patients with chronic psychotic disorders admitted at St. Amanuel Mental Specialized Hospital and Gergesenon Mental rehabilitation center from February to June, 2020. All admitted patients were screened for any sign of TB as recommended by WHO. Presumptive TB cases were identified. Sputum samples were collected and tested by Xpert MTB/RIF assay. Data analysis was performed using SPSS version 25.0 statistical software and Chi square analysis was used to test the statistical association. RESULTS: From a total 3600 pschotic patients screened for TB, 250 (6.94%) presumptive tuberculosis cases were detected. From these, 27 (10.8%) were positive by Xpert MTB/RIF assay. Most of the patients were males (68.4%). The mean ± SD age of the participant was 36.5 ± 9.7 years. The overall prevalence of tuberculosis was found to be 750 per 100,000 population. The number of patients per room (p = 0.039) was associated with Xpert MTB/RIF positive active tuberculosis. CONCLUSION: The prevalence of active tuberculosis among chronic psychotic patients was high. Number of admitted patients per room was identified as risk factors for Xpert MTB/RIF positive active tuberculosis. Therefore, to control TB transmission in chronic mental health treatment facilities, efforts should be directed to periodic screening for early case detection and improving the number of patients per room.


Assuntos
Transtornos Mentais , Mycobacterium tuberculosis , Transtornos Psicóticos , Tuberculose Pulmonar , Tuberculose , Adulto , Estudos Transversais , Etiópia/epidemiologia , Hospitais Especializados , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Transtornos Psicóticos/epidemiologia , Centros de Reabilitação , Sensibilidade e Especificidade , Escarro , Tuberculose/epidemiologia , Tuberculose Pulmonar/epidemiologia
2.
PLoS One ; 16(10): e0257229, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34597312

RESUMO

BACKGROUND: Visceral leishmaniasis (VL) is a life-threatening parasitic disease next to malaria, which is responsible for the death of 50,000 patients annually. It has three major clinical stages, including visceral, cutaneous, and mucocutaneous leishmaniasis. Ethiopia is one of the east African countries commonly affected with leishmanisis disease. There are many drugs for leishmaniasis, including sodium stibogluconate and paromomycin combined therapy. However, the adverse effect of those combined drugs is not well-defined. Therefore, the purpose of this study was to assess serum amylase, lipase, and associated factors among patients with VL treatment with those combined drugs. METHODS: Hospital-based cross-sectional study was conducted at the University of Gondar Comprehensive Specialized Hospital Leishmaniasis Research and Treatment Center from February to September 2020 G.C. Simple random sampling technique was utilized to select study participants. The study participants who fulfill the inclusion criteria were included in the study with written informed consent. 5 ml of blood was withdrawn by an experienced health professional to analyze serum amylase and lipase level. Descriptive data was presented by tables, charts and graphs. Data was cleared, entered by Epi-data version 3.1 then transfer to STATA 14.1 SE version and for analysis paired t-test was used, for factors correlation and regression was used. Those factor variable who have p-value <0.25 was filtered and goes to multivariate regression and p-value <0.05 was considered as significant variables. RESULTS: The result of this study showed that there was a significant mean difference between serum pancreatic amylase and lipase before and after treatment. The mean ± SD level of serum amylase after treatment showed a statistically significant elevation (P<0.001) as compared to its level before treatment. Similarly, the mean ± SD level of serum lipase after treatment showed a statistically significant elevation (P<0.001) as compared to its level before treatment. There was also significant association between age and baseline serum amylase as compared to serum amylase after treatment. Similarly, there was also significant relation of age and serum lipase with serum lipase after treatment. CONCLUSION: In this study, the level of serum amylase and lipase at treatment of cure was higher and there was an increase in mean serum amylase and lipase after a patient taking sodium stibogluconate and paromomycin combined drugs. Consequently, the elevated result of these biochemical profiles mainly associated with drug induced adverse effect and associated risk factors in VL patients.


Assuntos
Amilases/sangue , Gluconato de Antimônio e Sódio/uso terapêutico , Antiprotozoários/uso terapêutico , Leishmaniose Visceral/tratamento farmacológico , Lipase/sangue , Paromomicina/uso terapêutico , Adolescente , Adulto , Estudos Transversais , Etiópia , Feminino , Hospitais Especializados , Humanos , Leishmaniose Visceral/sangue , Masculino , Resultado do Tratamento , Adulto Jovem
3.
BMC Infect Dis ; 21(1): 1016, 2021 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-34583644

RESUMO

BACKGROUND: Anemia is the most common hematologic abnormalities in AIDS patients usually associated with disease progression and poor clinical outcomes. Zidovudine (AZT), which is one of the nucleoside reverse transcriptase inhibitor drug families of the first line antiretroviral therapy regimen for HIV/AIDS patients, causes anemia due to early long-term of higher-dose therapy. This study was aimed to assess the magnitude and associated factors of anemia among AZT containing HAART experienced adult HIV/ADIS patients at University of Gondar Comprehensive Specialized Referral Hospital, northwest, Ethiopia, 2019. METHODS: A retrospective cohort study was conducted among a total of 320 adult AZT based HAART experienced HIV/AIDS patients from January 2016 to December 2018. Systematic random sampling technique was used to select the patients' charts. All required data for this study were extracted from patients' medical charts. Data were coded, cleared and entered into Epi Info version 3.5.3, and transformed to SPSS version 20 for analysis. Descriptive statistics, bivariable and multivariable logistic regression models were fitted to identify associated factors of anemia and P-value < 0.05 was considered as statistically significance. RESULTS: A total of 320 adult AZT based HAART experienced HIV/AIDS patients' charts were assessed. Of the total patients, 198 (61.9%) were females and 133 (41.6%) were within the age range of 35-45 years. More than half, 237(76.9%) of the patients were from the urban area and 186 (58.1%) were on WHO clinical stage III at the baseline. The prevalence of anemia was 50% (95% CI 44.7-55.0%), 44.1% (95% CI 38.4-50.0%), 35.6% (95% CI 30.3-40.6%), 40% (95% CI 34.4-45.6%), 40.6% (95% CI 35.0-46.3) and 39.1% (95% CI 33.4-44.1%) at baseline, 6 months, 12 months, 18 months, 24 months and 30 months of follow-up period, respectively. The overall prevalence of anemia was 41.6%. Anemia had significant association with WHO clinical stage and base line Hgb values. CONCLUSIONS: A significant number of participants were anemic in this study. WHO clinical stage and baseline Hgb value were the contributing factors for anemia among these patients. Therefore, anemia needs an immediate intervention on associated factor to improve the anemic status and living condition of HIV patient.


Assuntos
Anemia , Infecções por HIV , Adulto , Anemia/induzido quimicamente , Anemia/epidemiologia , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Etiópia/epidemiologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Hospitais Especializados , Humanos , Pessoa de Meia-Idade , Encaminhamento e Consulta , Estudos Retrospectivos , Zidovudina/efeitos adversos
4.
Medicine (Baltimore) ; 100(32): e26832, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397889

RESUMO

ABSTRACT: Previous studies on hospital specialization in spinal joint disease have been limited to patients requiring surgical treatment. The lack of similar research on the nonsurgical spinal joint disease in specialized hospitals provides limited information to hospital executives.To analyze the relationship between hospital specialization and health outcomes (length of stay and medical expenses) with a focus on nonsurgical spinal joint diseases.The data of 56,516 patients, which were obtained from the 2018 National Inpatient Sample, provided by the Health Insurance Review and Assessment Service, were utilized. The study focused on inpatients with nonsurgical spinal joint disease and used a generalized linear mixed model with specialization status as the independent variable. Hospital specialization was measured using the Inner Herfindahl-Hirschman Index (IHI). The IHI (value ≤1) was calculated as the proportion of hospital discharges accounted for by each service category out of the hospital's total discharges. Patient and hospital characteristics were the control variables, and the mean length of hospital stay and medical expenses were the dependent variables.The majority of the patients with the nonsurgical spinal joint disease were female. More than half of all patients were middle-aged (40-64 years old). The majority did not undergo surgery and had mild disease, with Charlson Comorbidity Index score ≤1. The mean inpatient expense was 1265.22 USD per patient, and the mean length of stay was 9.2 days. The specialization status of a hospital had a negative correlation with the length of stay, as well as with medical expenses. An increase in specialization status, that is, IHI, was associated with a decrease in medical expenses and the length of stay, after adjusting for patient and hospital characteristics.Hospital specialization had a positive effect on hospital efficiency. The results of this study could inform decision-making by hospital executives and specialty hospital-related medical policymakers.


Assuntos
Tratamento Conservador , Hospitais Especializados , Artropatias , Doenças da Coluna Vertebral , Tratamento Conservador/economia , Tratamento Conservador/métodos , Eficiência Organizacional/normas , Feminino , Custos Hospitalares , Hospitais Especializados/classificação , Hospitais Especializados/estatística & dados numéricos , Humanos , Artropatias/economia , Artropatias/epidemiologia , Artropatias/terapia , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Alta do Paciente/estatística & dados numéricos , República da Coreia/epidemiologia , Índice de Gravidade de Doença , Doenças da Coluna Vertebral/economia , Doenças da Coluna Vertebral/epidemiologia , Doenças da Coluna Vertebral/terapia
5.
Bone Joint J ; 103-B(8): 1373-1379, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34334036

RESUMO

AIMS: Single-stage revision total knee arthroplasty (rTKA) is gaining popularity in treating chronic periprosthetic joint infections (PJIs). We have introduced this approach to our clinical practice and sought to evaluate rates of reinfection and re-revision, along with predictors of failure of both single- and two-stage rTKA for chronic PJI. METHODS: A retrospective comparative cohort study of all rTKAs for chronic PJI between 1 April 2003 and 31 December 2018 was undertaken using prospective databases. Patients with acute infections were excluded; rTKAs were classified as single-stage, stage 1, or stage 2 of two-stage revision. The primary outcome measure was failure to eradicate or recurrent infection. Variables evaluated for failure by regression analysis included age, BMI, American Society of Anesthesiologists grade, infecting organisms, and the presence of a sinus. Patient survivorship was also compared between the groups. RESULTS: A total of 292 consecutive first-time rTKAs for chronic PJI were included: 82 single-stage (28.1%); and 210 two-stage (71.9%) revisions. The mean age was 71 years (27 to 90), with 165 females (57.4%), and a mean BMI of 30.9 kg/m2 (20 to 53). Significantly more patients with a known infecting organism were in the single-stage group (93.9% vs 80.47%; p = 0.004). The infecting organism was identified preoperatively in 246 cases (84.2%). At a mean follow-up of 6.3 years (2.0 to 17.6), the failure rate was 6.1% in the single-stage, and 12% in the two-stage groups. All failures occurred within four years of treatment. The presence of a sinus was an independent risk factor for failure (odds ratio (OR) 4.97; 95% confidence interval (CI) 1.593 to 15.505; p = 0.006), as well as age > 80 years (OR 5.962; 95% CI 1.156 to 30.73; p = 0.033). The ten-year patient survivorship rate was 72% in the single-stage group compared with 70.5% in the two-stage group. This difference was not significant (p = 0.517). CONCLUSION: Single-stage rTKA is an effective strategy with a high success rate comparable to two-stage approach in appropriately selected patients. Cite this article: Bone Joint J 2021;103-B(8):1373-1379.


Assuntos
Artroplastia do Joelho , Articulação do Joelho , Prótese do Joelho/efeitos adversos , Padrões de Prática Médica , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Estudos de Coortes , Feminino , Hospitais Especializados , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
6.
BMC Infect Dis ; 21(1): 626, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210269

RESUMO

OBJECTIVE: To quantitatively evaluate the effectiveness of Fangcang shelter hospitals, designated hospitals, and the time interval from illness onset to diagnosis toward the prevention and control of the COVID-19 epidemic. METHODS: We used SEIAR and SEIA-CQFH warehouse models to simulate the two-period epidemic in Wuhan and calculate the time dependent basic reproduction numbers (BRNs) of symptomatic infected individuals, asymptomatic infected individuals, exposed individuals, and community-isolated infected individuals. Scenarios that varied in terms of the maximum numbers of open beds in Fangcang shelter hospitals and designated hospitals, and the time intervals from illness onset to hospitals visit and diagnosis were considered to quantitatively assess the optimal measures. RESULTS: The BRN decreased from 4.50 on Jan 22, 2020 to 0.18 on March 18, 2020. Without Fangcang shelter hospitals, the cumulative numbers of cases and deaths would increase by 18.58 and 51.73%, respectively. If the number of beds in the designated hospitals decreased by 1/2 and 1/4, the number of cumulative cases would increase by 178.04 and 92.1%, respectively. If the time interval from illness onset to hospital visit was 4 days, the number of cumulative cases and deaths would increase by 2.79 and 6.19%, respectively. If Fangcang shelter hospitals were not established, the number of beds in designated hospitals reduced 1/4, and the time interval from visiting hospitals to diagnosis became 4 days, the cumulative number of cases would increase by 268.97%. CONCLUSION: The declining BRNs indicate the high effectiveness of the joint measures. The joint measures led by Fangcang shelter hospitals are crucial and need to be rolled out globally, especially when medical resources are limited.


Assuntos
COVID-19/prevenção & controle , COVID-19/terapia , Simulação por Computador , Unidades Móveis de Saúde , SARS-CoV-2 , COVID-19/epidemiologia , COVID-19/mortalidade , China/epidemiologia , Hospitais Especializados , Humanos , Modelos Biológicos , Saúde Pública
7.
J Laryngol Otol ; 135(S1): S1-S12, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34240690

RESUMO

BACKGROUND: It was in twentieth-century Britain that the two distinct surgical disciplines, otology and laryngology, became united under the title oto-laryngology. Aural departments were established in general hospitals in the hands of specialists long before throat departments. The development and politics of the specialty occurred in London, while provincial services commenced in the early eighteenth century, with ophthalmologists, setting up a clinic or dispensary, progressing onto a hospital. METHODS: The following resources were used: the Nottinghamshire Archives; Manuscripts and Special Collections at the University of Nottingham Libraries and The Local Studies Library, Nottingham Central Library. RESULTS: The Nottingham and Nottinghamshire Hospital for Diseases of the Throat, Ear and Nose was established in 1886, staffed by part-time general practitioners. The Nottingham Children's Hospital appointed two qualified surgeons in the 1910s and subsequently the General Nottingham Hospital appointed them as honorary assistant surgeons. Both hospitals provided access to beds, not available to the Nottingham and Nottinghamshire Hospital for Diseases of the Throat, Ear and Nose. Following The Education Act of 1907, Nottingham created a School Health Services. By the 1920s, Nottingham had four institutions providing clinical and surgical ENT services. The National Hospitals Survey conducted in 1945 recommended that the Nottingham and Nottinghamshire Hospital for Diseases of the Throat, Ear and Nose be closed and amalgamated with The General Hospital Nottingham. CONCLUSION: The General Hospital Nottingham was slow to create a service for the diagnosis and treatment of ENT diseases and disorders, but established a Departmental Service by 1927. The surgical staffing was common to all four of the ENT services from mid-1930.


Assuntos
Instituições de Assistência Ambulatorial/história , Hospitais Especializados/história , Otolaringologia/história , Medicina Estatal/história , Serviços Urbanos de Saúde/história , História do Século XIX , História do Século XX , Humanos , Reino Unido
8.
J Ayub Med Coll Abbottabad ; 33(2): 299-302, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34137549

RESUMO

BACKGROUND: The permanent maxillary lateral incisor (PMLI) shows morphological variations, in the form of different crown shapes such as peg-shaped, cone-shaped, barrel-shaped and canine-shaped. The frequency of developmentally malformed permanent maxillary lateral incisors varies among different populations. The aim of this study was to document the frequency of different shapes of developmentally malformed permanent maxillary lateral incisors in patients visiting the three teaching dental hospitals of Peshawar. METHODS: It was a cross-sectional study conducted in the Oral Diagnosis department of Peshawar Dental College, Sardar Begum Dental College, and Khyber College of Dentistry from 1st Sep 2018 to 15th June 2019. A total of 82 subjects were included that fulfilled the inclusion criteria. Shape of the malformed PMLI was determined using Computer-aided design/Computer-aided manufacturing software. Descriptive statistics including frequencies and percentages for observed developmental malformation and their types were computed and Chi-square test was applied to see the relation between various shapes and their occurrence with respect to site and position within the jaws. RESULTS: The peg shaped PMLI was seen in 81 (98.87%) patients and barrel shaped was present in 1 (1.22%) patient. The malformed PMLIs was found to be unilateral in 38 (46.3%) and bilateral in 44 (53.7%) patients, with more common presence on both sides 44 (53.7%) followed by right side 20 (24.4%) and left side 18 (22.0%). CONCLUSIONS: The subjects having predominant developmental malformation in case of permanent maxillary lateral incisor was peg-shaped permanent maxillary lateral incisor.


Assuntos
Incisivo/patologia , Maxila/patologia , Adulto , Distribuição de Qui-Quadrado , Desenho Assistido por Computador , Estudos Transversais , Odontologia , Hospitais Especializados , Hospitais de Ensino , Humanos , Masculino , Paquistão , Adulto Jovem
10.
PLoS One ; 16(6): e0251709, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34077431

RESUMO

BACKGROUND: Diabetes mellitus (DM) patients are at increased risk of developing drug therapy problems (DTPs). The patients had a variety of comorbidities and complications, and they were given multiple medications. Medication therapy management (MTM) is a distinct service or group of services that optimize therapeutic outcomes for individual patients. The study assessed the impact of provision of MTM service on selected clinical and humanistic outcomes of diabetes patients at the diabetes mellitus clinic of Tikur Anbessa Specialized Hospital (TASH). METHODS: A pre-post interventional study design was carried out at DM clinic from July 2018 to April 2019. The intervention package included identifying and resolving drug therapy problems, counseling patients in person at the clinic or through telephone calls, and providing educational materials for six months. This was followed by four months of post-intervention assessment of clinical outcomes, DTPs, and treatment satisfaction. The interventions were provided by pharmacist in collaboration with physician and nurse. The study included all adult patients who had been diagnosed for diabetes (both type I & II) and had been taking anti-diabetes medications for at least three months. Patients with gestational diabetes, those who decided to change their follow-up clinic, and those who refused to participate in the study were excluded. Data were analyzed using Statistical Package for the Social Sciences (SPSS). Descriptive statistics, t-test, and logistic regressions were performed for data analyses. RESULTS: Of the 423 enrolled patients, 409 fulfilled the criteria and included in the final data analysis. The intervention showed a decrease in average hemoglobin A1c (HbA1c), fasting blood sugar (FBS), and systolic blood pressure (SBP) by 0.92%, 25.04 mg/dl, and 6.62 mmHg, respectively (p<0.05). The prevalence of DTPs in the pre- and post-intervention of MTM services was found to be 72.9% and 26.2%, respectively (p<0.001). The overall mean score of treatment satisfaction was 90.1(SD, 11.04). Diabetes patients of age below 40 years (92.84 (SD, 9.54)), type-I DM (93.04 (SD, 9.75)) & being on one medication regimen (93.13(SD, 9.17)) had higher satisfaction score (p<0.05). CONCLUSION: Provision of MTM service had a potential to reduce DTPs, improve the clinical parameters, and treatment satisfaction in the post-intervention compared to the pre-intervention phase.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/organização & administração , Assistência Farmacêutica/organização & administração , Adulto , Etiópia , Feminino , Hospitais Especializados , Humanos , Masculino , Conduta do Tratamento Medicamentoso/tendências , Pessoa de Meia-Idade , Farmacêuticos/organização & administração , Inquéritos e Questionários
11.
PLoS One ; 16(6): e0253086, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34129616

RESUMO

BACKGROUND: Pain is an unpleasant sensory and emotional experience associated with or resembling that actual or potential tissue damage. Different study findings show that about 55% to 78.6% of inpatients experience moderate-to-severe pain. Nurses are one of the health professional who may hear of pain suffered by the patients and who can manage patient suffering by themselves. Therefore, their correct skill is very important in non- pharmacology and pharmacology pain management methods. OBJECTIVE: To assess non-pharmacological pain management practice and barriers among nurses working in Debre Tabor Comprehensive Specialized Hospital, Ethiopia. METHODS: Data were collected using structured observational check list with interviewer administered questionnaires that measure nurses' practice on non-pharmacological pain management. Data were entered using Epi Data version 3.1 and analyzed using SPSS (Stastical Package for Social Sciences) version 23. Bivariable and multivariable analysis were conducted to examine the association between independent and outcome variables. RESULTS: A total of 169 nurses participated in the study, with a response rate of 100%. Among the study participants 94 (55.6%) were females, and the mean age of nurses were 34.9(SD = 5.7) years. Only 44(26%) of nurses had good practice on non- pharmacology pain management methods. About 130(77.55%), 125(74.0%), and 123(72.8%) of nurses reported that inadequate cooperation of physicians, multiple responsibilities of nurses and insufficient number of nurses per patient ratio as barriers for practice of non -pharmacology pain management respectively. CONCLUSION: Majority of nurses didn't apply non-pharmacological pain management practices for their patients in pain and the overall practice level of nurses was very poor. The major identified obstacle factors for the poor practice of non-pharmacological pain management methods were nurses' fatigue, inadequate cooperation of physicians, heavy workload, multiple responsibilities of nurses, and insufficient number of nurses per patient ratio and unfavorable attitude of nurse on non-pharmacology pain management. Even if nurses experiences different challenges, they shall use non-pharmacological pain management methods complementary to pharmacological treatment of pain as they are low cost and safe. And also boosting nurse's attitude towards the effect of non-pharmacological pain management methods is crucial.


Assuntos
Manejo da Dor/enfermagem , Padrões de Prática em Enfermagem , Adulto , Competência Clínica , Tomada de Decisão Clínica , Estudos Transversais , Etiópia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Especializados , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
13.
CMAJ Open ; 9(2): E460-E465, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33958381

RESUMO

BACKGROUND: People living with HIV and multiple comorbidities have high rates of health service use. This study evaluates system usage before and after admission to a community facility focused on HIV care. METHODS: We used Ontario administrative health databases to conduct a pre-post comparison of rates and costs of hospital admissions, emergency department visits, and family physician and home care visits among medically complex people with HIV in the year before and after admission to Casey House, an HIV-specific hospital in Toronto, for all individuals admitted between April 2009 and March 2015. Negative binomial regression was used to compare rates of health care utilization. We used Wilcoxon rank sum tests to compare associated health care costs, standardized to 2015 Canadian dollars. To contextualize our findings, we present rates and costs of health service use among Ontario residents living with HIV. RESULTS: During the study period, 268 people living with HIV were admitted to Casey House. Emergency department use declined from 4.6 to 2.5 visits per person-year (p = 0.02) after discharge from Casey House, and hospitalization rates declined from 1.4 to 1.1 admissions per person-year (p = 0.05). Conversely, home care visits increased from 24.3 to 35.6 visits per person-year (p = 0.01) and family physician visits increased from 18.3 to 22.6 visits per person-year (p < 0.001) in the year after discharge. These changes were associated with reduced overall costs to the health care system. The reduction in overall costs was not significant (p = 0.2); however, costs of emergency department visits (p < 0.001) and physician visits (p < 0.001) were significantly less. INTERPRETATION: Health care utilization by people with HIV was significantly different before and after admission to a community hospital focused on HIV care. This has implications for health care in other complex patient populations.


Assuntos
Infecções por HIV , Serviços de Assistência Domiciliar , Hospitais Comunitários , Hospitais Especializados , Múltiplas Afecções Crônicas , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Feminino , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Custos de Cuidados de Saúde , Serviços de Assistência Domiciliar/economia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Hospitais Comunitários/economia , Hospitais Comunitários/estatística & dados numéricos , Hospitais Especializados/economia , Hospitais Especializados/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Múltiplas Afecções Crônicas/economia , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/terapia , Ontário/epidemiologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Alta do Paciente/estatística & dados numéricos
14.
Clin Chest Med ; 42(2): 347-355, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34024409

RESUMO

Comprehensive interstitial lung disease (ILD) care delivery models have several key components including diagnosis, treatment, monitoring, coordination with other health care providers, patient support/advocacy, education, and research. ILD is rapidly evolving, and specialized centers with ILD-specific expertise have emerged as ways to care for complex patients. The role of the specialized center in care delivery is multifaceted and aimed at improving patient care and advancing the field of ILD. Widespread access to specialized centers is a barrier to ILD care delivery worldwide. Creative and innovative strategies that leverage technology are needed to bridge gaps in ILD care.


Assuntos
Hospitais Especializados , Doenças Pulmonares Intersticiais/terapia , Animais , Atenção à Saúde , Humanos , Modelos Biológicos
15.
Bull World Health Organ ; 99(5): 374-380, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33958825

RESUMO

A surge in the number of international arrivals awaiting coronavirus disease 2019 (COVID-19) screening overwhelmed health-care workers and depleted medical resources in designated hospitals in Beijing, China in March 2020. The People's Government of Beijing Municipality therefore issued a policy which required the mandatory transfer of all asymptomatic passengers arriving from a foreign country to designated quarantine hotels, and the transfer of passengers with fever or respiratory symptoms to designated hospitals. Xiaotangshan Designated Hospital, a severe acute respiratory syndrome hospital in 2003, was rapidly renovated and put into operation with the main tasks of screening and isolating symptomatic international arrivals at Beijing Capital International Airport, providing basic medical care for mild to moderate COVID-19-positive cases, and rapidly referring severe to critical COVID-19-positive cases to higher-level hospitals. During the month-long period of its operation, 2171 passengers were screened and 53 were confirmed as having COVID-19 (six severe to critical). We describe how the use of Xiaotangshan Designated Hospital in this way enabled the efficient grouping and assessment of passengers arriving from a foreign country, the provision of optimal patient care without compromising public safety and the prioritization of critically ill patients requiring life-saving treatment. The designated hospital is a successful example of the World Health Organization's recommendation to renovate existing medical infrastructures to improve the COVID-19 response capacity. The flexible design of Xiaotangshan Designated Hospital means that it can be repurposed and reopened at any time to respond to the changing pandemic conditions.


Assuntos
Aeroportos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Hospitais Especializados/organização & administração , Programas de Rastreamento/organização & administração , China/epidemiologia , Humanos , Internacionalidade , Pandemias , SARS-CoV-2 , Índice de Gravidade de Doença
16.
Rev Gaucha Enferm ; 42(spe): e20200214, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34037181

RESUMO

OBJECTIVE: To report the experience of adapting the stomatherapy service during the COVID-19 pandemic. METHOD: Experience report related to adaptations in the work routine in times of COVID-19 pandemic, from March to May 2020, in a specialized stomatherapy center in a city in the South of Brazil. RESULTS: The work routines were adapted to suit the protection measures for workers and users who used stomatherapy services. Some assistance processes were implemented to make users' access to care more flexible, and to modify routines to increase the safety of health professionals and users. CONCLUSION: The need to adapt the physical area, rethink the dynamics of care, use personal protective equipment, and guidance for servers and patients were of fundamental importance to continue attending the population safely in times of pandemic.


Assuntos
COVID-19/epidemiologia , Atenção à Saúde/organização & administração , Estomia , Pandemias , Estomas Cirúrgicos , Bandagens/provisão & distribuição , Brasil/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Atenção à Saúde/estatística & dados numéricos , Hospitais Especializados/organização & administração , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Estomia/enfermagem , Equipamento de Proteção Individual
17.
PLoS One ; 16(5): e0251295, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33999930

RESUMO

The World Health Organization (WHO) declared coronavirus disease-2019 (COVID-19) a global pandemic on 11 March 2020. In Ecuador, the first case of COVID-19 was recorded on 29 February 2020. Despite efforts to control its spread, SARS-CoV-2 overran the Ecuadorian public health system, which became one of the most affected in Latin America on 24 April 2020. The Hospital General del Sur de Quito (HGSQ) had to transition from a general to a specific COVID-19 health center in a short period of time to fulfill the health demand from patients with respiratory afflictions. Here, we summarized the implementations applied in the HGSQ to become a COVID-19 exclusive hospital, including the rearrangement of hospital rooms and a triage strategy based on a severity score calculated through an artificial intelligence (AI)-assisted chest computed tomography (CT). Moreover, we present clinical, epidemiological, and laboratory data from 75 laboratory tested COVID-19 patients, which represent the first outbreak of Quito city. The majority of patients were male with a median age of 50 years. We found differences in laboratory parameters between intensive care unit (ICU) and non-ICU cases considering C-reactive protein, lactate dehydrogenase, and lymphocytes. Sensitivity and specificity of the AI-assisted chest CT were 21.4% and 66.7%, respectively, when considering a score >70%; regardless, this system became a cornerstone of hospital triage due to the lack of RT-PCR testing and timely results. If health workers act as vectors of SARS-CoV-2 at their domiciles, they can seed outbreaks that might put 1,879,047 people at risk of infection within 15 km around the hospital. Despite our limited sample size, the information presented can be used as a local example that might aid future responses in low and middle-income countries facing respiratory transmitted epidemics.


Assuntos
COVID-19/diagnóstico por imagem , COVID-19/epidemiologia , Hospitais Especializados/organização & administração , Hospitais Especializados/tendências , Pandemias/prevenção & controle , SARS-CoV-2/genética , Triagem/métodos , Adulto , Idoso , Inteligência Artificial , COVID-19/prevenção & controle , COVID-19/virologia , Teste de Ácido Nucleico para COVID-19 , Equador/epidemiologia , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Radiografia Pulmonar de Massa/métodos , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos
18.
Am J Emerg Med ; 47: 90-94, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33794475

RESUMO

BACKGROUND & PURPOSE: Alteplase is the standard of care for early pharmacologic thrombolysis after acute ischemic stroke (AIS). Alteplase is also considered a high-alert medication and is fraught with potential for error. We sought to describe the difference in medication error rates in in patients receiving alteplase for acute ischemic stroke from regional hospitals compared to patients receiving alteplase at the Comprehensive Stroke Center. METHODS: This was a retrospective cohort comparison of patients who were greater than 18 years old that received intravenous alteplase for the treatment of AIS from June 2015 to June 2018. Several institution specific databases were utilized to obtain pertinent data. A standardized taxonomy was utilized to classify medication errors. Patients were excluded if they received any fibrinolytic other than alteplase or if alteplase was used for a non-stroke indication. Two cohorts (from regional hospitals or the Comprehensive Stroke Center (CSC)) were compared. RESULTS: A total of 676 patients received alteplase during the study period (34% from the CSC and 66% from regional hospitals). There were 133 (19.8%) errors identified. Ten errors (1.6%) occurred at the CSC and 123 (18.2%) errors occurred at regional hospitals. More patients who had an error with alteplase administration (12.7%) experienced a hemorrhagic conversion compared to those with no error in administration (7.2%, p= 0.04). CONCLUSION: The error rate of alteplase infusion for ischemic stroke is high, particularly in patients from referring centers. Errors may be associated with adverse events. Further education and administration safeguards should be implemented to decrease the risk of medication errors.


Assuntos
Fibrinolíticos/administração & dosagem , AVC Isquêmico/tratamento farmacológico , Erros de Medicação/estatística & dados numéricos , Ativador de Plasminogênio Tecidual/administração & dosagem , Administração Intravenosa , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Fibrinolíticos/efeitos adversos , Hospitais Especializados/estatística & dados numéricos , Humanos , AVC Isquêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/efeitos adversos
19.
Cancer Control ; 28: 10732748211009252, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33858225

RESUMO

Cancer causes the highest economic loss of all of the leading 15 causes of death worldwide. The economic loss includes the loss of income and the expenses associated with health care costs. The Low awareness of the community toward cancer, the inadequacy of professionals and service providers, and the high budget consuming nature of the treatments are creating a great burden on the cancer patients. The objective of this study was to calculate patient side cancer treatment cost and to assess the contributing factors, among the cancer patients who were treated at Hawassa University Comprehensive Specialized Hospital. The health facility based cross-sectional study design was employed using a consecutive sampling technique. Questionnaires was used to collect primary data; while chart was used to collect the secondary data. Indirect costs incurred on these patients due to off job days were checked. Descriptive and inferential statistics were applied to illustrate the data. On average, $209.99 was spent on treatment by each cancer patients. Of these, medication cost is the highest ($20.77, IQR = 0.53-112.56) from the direct medical costs, and transportation cost is the highest ($58.33, IQR = 22.0-131.67) from the indirect medical costs. Inpatients paid $245.16 (IQR = 147.64-439.20); while outpatients paid $147.37 (IQR = 81.42-240.50). The patients lose about 55.99% of their average annual income. Outpatients pay $0, 92 less than in patients (P = 0.00, CI -0.72-0.34), and the cost increases by $0.2 for the patients who came from Oromia. The cost of transportation and medication were the one which were significantly affecting the burden; but the total cost of treatment was lesser when compared to similar studies done in different areas. The cost balances toward the patients who came from the Oromiya region. Treatment service has to be extended to West Arsi Zone to minimize the cost of transportation and awareness about cancer is needed in the first place and due attention has to be given to thyroid cancer. Furthermore, facility side study should be done to see the complete picture of the burden.


Assuntos
Efeitos Psicossociais da Doença , Neoplasias/economia , Neoplasias/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Etiópia , Feminino , Hospitais Especializados , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
PLoS One ; 16(4): e0249252, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33826648

RESUMO

BACKGROUND: Globally, studies have shown conflicting results regarding the association of blood groups with SARS CoV-2 infection. OBJECTIVE: To observe the association between ABO blood groups and the presentation and outcomes of confirmed COVID-19 cases. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective cohort study of patients with mild-to-moderately severe COVID-19 infections who presented in the COVID-19 unit of Dhaka Medical College Hospital and were enrolled between 01 June and 25 August, 2020. Patients were followed up for at least 30 days after disease onset. We grouped participants with A-positive and A-negative blood groups into group I and participants with other blood groups into group II. RESULTS: The cohort included 438 patients; 52 patients were lost to follow-up, five died, and 381 completed the study. The prevalence of blood group A [144 (32.9%)] was significantly higher among COVID-19 patients than in the general population (p < 0.001). The presenting age [mean (SD)] of group I [42.1 (14.5)] was higher than that of group II [38.8 (12.4), p = 0.014]. Sex (p = 0.23) and co-morbidity (hypertension, p = 0.34; diabetes, p = 0.13) did not differ between the patients in groups I and II. No differences were observed regarding important presenting symptoms, including fever (p = 0.72), cough (p = 0.69), and respiratory distress (p = 0.09). There was no significant difference in the median duration of symptoms in the two group (12 days), and conversion to the next level of severity was observed in 26 (20.6%) and 36 patients (13.8%) in group I and II, respectively. However, persistent positivity of RT-PCR at 14 days of initial positivity was more frequent among the patients in group I [24 (19%)] than among those in group II [29 (11.1%)]. CONCLUSIONS: The prevalence of blood group A was higher among COVID-19 patients. Although ABO blood groups were not associated with the presentation or recovery period of COVID-19, patients with blood group A had delayed seroconversion.


Assuntos
Sistema ABO de Grupos Sanguíneos/sangue , COVID-19/sangue , COVID-19/mortalidade , Hospitais Especializados , SARS-CoV-2/metabolismo , Adulto , Bangladesh/epidemiologia , COVID-19/terapia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida
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