Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 24.908
Filtrar
1.
Acta Biomed ; 92(S6): e2021450, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34739472

RESUMO

BACKGROUND AND AIM: Comirnaty® was the first COVID-19 vaccine available for the vaccination campaign of healthcare workers in Italy. With the aim of assessing vaccine safety, we conducted a cross-sectional survey administrating a voluntary-based questionnaire on adverse events following immunisation (AEFIs) in San Raffaele Hospital, Milano, Italy. METHODS: From 4th January 2021 to 27th April 2021, we collected 2,659 questionnaires (response rate: 24,5%). We analyzed data, reporting AEFIs by gender, age, self-reported severity, type, time of insurgence and duration, and estimating relative-risk ratios (RRR) and corresponding 95% confidence intervals (CI). RESULTS: The most reported symptoms were injection site pain, fatigue, headache, myalgia, chills, fever, and arthralgia. Severe systemic reactions were more frequent after receiving the second dose (RRR 6.25, 95% CI 4.57-8.55), in women (RRR 3.33, 95% CI 2.30-4.82), and less frequent in individuals aged 60 or more (RRR 0.26, 95% CI 0.14-0.49). In addition, we noted a wide range of adverse events of special interest (AESIs). CONCLUSIONS: Consistently with clinical trials and pharmacovigilance surveillance, AEFIs were frequent, but severe ones were uncommon, supporting the massive implementation of the COVID-19 vaccination campaign and providing valuable data for a risk profiling of vaccinees. (www.actabiomedica.it).


Assuntos
Vacinas contra COVID-19 , COVID-19 , Vacinação , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Estudos Transversais , Feminino , Hospitais de Ensino , Humanos , Itália/epidemiologia , Masculino , RNA Mensageiro , Vacinação/efeitos adversos
2.
Acta Biomed ; 92(S6): e2021447, 2021 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-34739469

RESUMO

BACKGROUND AND AIM: Seasonal influenza exerts a deep and multi-level impact on population and public health systems. Among at risk groups, healthcare workers (HCWs) represent a crucial one due to the threat of absenteeism and consequent disruption of healthcare services (and economic losses). Also in this group vaccine hesitancy is a well known issue, therefore innovative and 360-degree strategies are urgently needed to overcome the problem. METHODS: in the 2020-21 influenza vaccination campaign in a research and teaching hospital in Milan, Italy, the working group implemented three different strategies: the offer of vaccination through both an ad hoc ambulatory and several itinerant (on site) vaccinating teams, a promotional and educational communication campaign, a gaming strategy Results: vaccinated employees nearly doubled (2103 vs 1153 in 2019-20 flu vaccination campaign), reaching a comprehensive vaccination coverage rate (VCR) of 43,1%. A highly significant increase in the 40-59 age group was registered. While physicians and nursing staff confirmed to be the most represented categories among vaccinated subjects, administrative and auxiliary staffs performed the greatest increase compared to the previous campaign. The on site vaccination was clearly preferred than the ad hoc one (1693 HCWs, 80,5% vs 410, 19,5%). Vaccinated for the first time registered a significant increase (40,2% vs 36,2% in 2019-20 campaign). CONCLUSIONS: such meaningful results confirm the effectiveness of the strategies implemented in the present campaign, suggesting their possible application in the debated COVID19-third-dose vaccination campaign.


Assuntos
COVID-19 , Influenza Humana , Vacinas contra COVID-19 , Pessoal de Saúde , Hospitais de Ensino , Humanos , Programas de Imunização , Influenza Humana/prevenção & controle , SARS-CoV-2 , Vacinação
3.
Front Cell Infect Microbiol ; 11: 673503, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34765565

RESUMO

Background: Over the last two decades, the prevalence of colistin resistance among the members of Enterobacteriaceae has been increasing, particularly among Klebsiella pneumoniae isolates; this limits the potential use of colistin and leads to worsened clinical outcomes. Methods: We investigated the prevalence and genetic characteristics of colistin-resistant K. pneumoniae (COLR-KP) in clinical isolates using genomic sequencing. Results: In total, 53 K. pneumoniae isolates (4.5%, 53/1,171) were confirmed as COLR-KP, of which eight isolates carried mobile colistin-resistant (mcr) gene. Although the overall prevalence rate (0.7%, 8/1,171) of mcr-like genes in clinical K. pneumoniae remained relatively low, the presence of mcr (15.1%, 8/53) among the COLR-KP isolates indicated that the mobile resistance gene was already widespread among K. pneumoniae isolates in hospital setting. We randomly selected 13 COLR-KP isolates (four mcr-bearing and nine non-mcr-bearing isolates) for whole-genome sequencing, including two pandrug-resistant and four sequence type 11 (ST11) isolates. Phylogenetic analysis revealed that all COLR-KP isolates were genetically diverse. Among the four mcr-bearing isolates, three (KP4, KP18, and KP30) were positive for mcr-1 and one (KP23) for mcr-8; none of the other mcr genes were detected. The mcr-1 in the KP4 and KP30 isolates were located in an IncX4 plasmid (approximately 33 kb) and could be successfully transferred to Escherichia coli J53AZR. In contrast, for the mcr-8-bearing plasmid in KP23 (IncFII), colistin resistance could not be transferred by conjugation. The mcr-1-producing isolate KP18 coexists a novel plasmid-carried tigecycline resistance gene tmexCD1-toprJ1. The most common chromosomal mutation associated with colistin resistance was a T246A amino acid substitution in PmrB, which was identified in most COLR-KP isolates (11/13, 84.6%). All ST11 isolates additionally had an R256G amino acid substitution. Critical virulence factors associated with hypervirulent K. pneumoniae were detected in four COLR-KP isolates; these virulence factors included aerobactin, salmochelin, and yersiniabactin. Conclusion: We found that mcr-bearing COLR-KP emerged in our hospital and was growing at an increasing rate. Simultaneous emergence of hypervirulence and colistin-tigecycline-carbapenem resistance in the epidemic clone ST11 K. pneumoniae was also observed; this highlights the significance of active and continuous surveillance.


Assuntos
Infecções por Klebsiella , Klebsiella pneumoniae , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Proteínas de Bactérias/genética , Colistina/farmacologia , Farmacorresistência Bacteriana/genética , Hospitais de Ensino , Humanos , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/genética , Testes de Sensibilidade Microbiana , Filogenia , Plasmídeos , Atenção Terciária à Saúde
4.
Am J Manag Care ; 27(11): e365, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34784143

RESUMO

This letter describes the experience of long-stay patients and provides a perspective of the need for more studies on outliers' impact on health care.


Assuntos
Hospitais de Ensino , Colômbia , Humanos , Tempo de Internação
5.
Wiad Lek ; 74(9 cz 2): 2345-2351, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34824182

RESUMO

OBJECTIVE: The aim: The goal of this research is to find out how much medical staff is acknowledged about radiation protection. PATIENTS AND METHODS: Materials and methods: In Teaching Hospitals, Wasit Province, a questionnaire study in 165 medical personnel was conducted. Part 1 of the questionnaire included sociodemographic information such as age, gender, and employment, whereas part 2 included 16 knowledge-related questions, divided into two sections: health risk (8 questions) and preventative strategies (8 questions). The descriptive analysis was carried out according to the data types: qualitative data were described using frequency and percentages, while quantitative data was described using the mean and standard deviation. The Chi-square test or Fisher's Exact Test were employed to analyze the relationship between the variables. Participants were given a score of 1 for all accurate answers, and a score of 0 for wrong and "don't know" responses. There were 165 participants general, among them 93 males and 72 females; with a mean age of 35.489.570. RESULTS: Results: Only 27 people (16.36%) had a good knowledge score, while more than half (61.21%) earned an average knowledge score. 30% of radiology technicians had a good level of knowledge, and 26.5 % of those working in radiology units had a good level of expertise as well. Increasing the frequency of radiation exposure showed to have a strong relationship with participant knowledge score, with those with repeated exposure during the day having the greatest proportion (21.4%) of good knowledge. CONCLUSION: Conclusions: This study had shown that there is a need to increase awareness about risks of radiation exposures among those who works in this field. Considering the above, the study recommends making training about the risks and methods of radiation protection compulsory, especially for workers in radiography units. In addition, the curricula of medical institutes must be updated and the latest research findings on ways to prevent radiation should be added. Finally, the issue of exposure to radiation is very important and dangerous, therefore, all sectors of society must join for the best awareness of its risks.


Assuntos
Exposição à Radiação , Proteção Radiológica , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hospitais de Ensino , Humanos , Masculino , Corpo Clínico , Exposição à Radiação/efeitos adversos
6.
Pan Afr Med J ; 40: 35, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34795816

RESUMO

Introduction: the use of ultrasound is one of the most vital tools in the management of pregnancies and contributes significantly in improving maternal and child health. Certain indications in pregnancy, guide the obstetrician as to which obstetric scan deems appropriate. The full realization of the benefits of ultrasound depends on whether it is being used appropriately or not, and hence this study aimed at auditing for the appropriate indications for obstetric ultrasound. Methods: a review of all request forms for obstetric scan between June 2019 and July 2020 was performed to assess the appropriateness of requests for obstetric ultrasound at the Cape Coast Teaching Hospital. The data obtained was analyzed using SPSS (SPSS Inc. Chicago, IL version 20.0). A Chi-squared test of independence was used to check for statistically significant differences between variables at p ≤ 0.05. Results: three hundred and fourteen (314) out of the 527 request forms had clinical indications stated. 174 (81.7%) of requests from Cape Coast Teaching Hospital and 39 (18.3%) from other health centers did not indicate patients clinical history/indication on the request forms. Majority 76 (68.5%) of scans in the first trimester were done without indications/history. Only 29 of requests with clinical history were inappropriate. Conclusion: practitioners should be mindful of adequately completing request forms for obstetric investigations since a large number of practitioners do not state the history/indications for the scans. There should be continuous medical education on the importance of appropriate indication for obstetric ultrasound.


Assuntos
Obstetrícia/métodos , Padrões de Prática Médica/estatística & dados numéricos , Ultrassonografia Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Feminino , Gana , Hospitais de Ensino , Humanos , Auditoria Médica , Pessoa de Meia-Idade , Obstetrícia/normas , Padrões de Prática Médica/normas , Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária , Ultrassonografia Pré-Natal/normas , Adulto Jovem
7.
Pan Afr Med J ; 40: 44, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34795825

RESUMO

Introduction: asthma tends to be more severe with worse symptoms in Africa due to late diagnosis and delayed initiation of treatment. To identify patient and treatment-related factors which influence the appropriate use of asthma medications. Methods: the study was institution based cross-sectional design. Patients were invited to provide information regarding the use of their asthma medications and factors potentially associated with appropriate use of these medications. A stepwise multivariate logistic regression analysis was used to evaluate the most important factor at a 0.05 level of significance. Results: respondents with better knowledge of their asthma medications were more likely to use them appropriately (OR 5.82 [CI 95% 2.25-15.04]) as were those with positive attitudes and beliefs towards asthma and asthma medications (OR 3.88 [CI 95% 1.44-10.44]). Conclusion: patients need to understand the importance of adhering to the prescribed regimen for their asthma medications even in the absence of overt symptoms in order to optimize clinical outcome.


Assuntos
Antiasmáticos/administração & dosagem , Asma/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Adesão à Medicação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Estudos Transversais , Feminino , Gana , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
Pan Afr Med J ; 40: 65, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34804333

RESUMO

Introduction: circulatory failure is a major childhood emergency. Several disease-related and patient-related factors can predispose children to shock. Early detection of such factors will improve its prevention, management and outcome. This study aimed to evaluate the incidence, socio-demographic characteristics and pre-hospital care of children presenting with circulatory failure (shock) in children´s emergency room (CHER). Methods: this study adopted cross-sectional design in CHER of the University of Benin Teaching Hospital, Nigeria, from October 2018 to March 2019. Data were collected using a semi-structured questionnaire eliciting demography, socio-economic status, pre-hospital care and presence of shock. In a sub-analysis, multiple logistic regression identified variables that are independently associated with circulatory failure in the participants, using adjusted odds ratio (OR) and 95% confidence intervals (CI). Results: a total of 554 acutely-ill children participated in the study. Their median age was 60 (IQR: 24-132) months. Shock was present in 79 (14.3%) of the children on arrival at CHER. Children referred from private clinics were more likely to arrive CHER in shock compared to those coming directly from home (OR = 2.67, 95%CI: 1.07-6.69; p = 0.036) while children from lower socio-economic class families presented more frequently with shock than those from higher class (OR = 14.39, 95% CI: 2.61-79.44; p = 0.002). Also, children that received oral rehydration solution as pre-hospital care seemed more likely to present with shock in CHER (OR = 6.63, 95% CI: 2.15-20.46; p =0.001). Conclusion: quality of pre-hospital care and parental socio-economic status influence the presence of shock in children seen at the emergency unit. Focused health education and prevention of finance-related delays in emergency care are needed.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência , Pais , Choque/terapia , Criança , Pré-Escolar , Estudos Transversais , Serviços Médicos de Emergência/economia , Feminino , Hospitais de Ensino , Humanos , Masculino , Nigéria , Fatores Socioeconômicos
9.
BMC Infect Dis ; 21(1): 1174, 2021 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-34809607

RESUMO

BACKGROUND: The COVID-19 vaccines provide renewed hope in the fight against the recent pandemic. To ensure widespread vaccination, it is crucial to analyze vaccine willingness and its determinants among physicians, key health care influencers. This study aimed to assess acceptance rate and identify factors associated with vaccine hesitancy among Thai physicians. METHODS: A cross-sectional online-based questionnaire was distributed to all physicians at King Chulalongkorn Memorial Hospital during March 31, 2021 to April 30, 2021 in order to assess their attitudes toward receiving the COVID-19 vaccine. Reasons for vaccine acceptance and refusal as well as predictors of vaccine hesitancy were analyzed by bivariate and multivariable analysis. RESULTS: A total of 705 complete responses were received with 95.6% (n = 675) of physicians expressing willingness to receive a COVID-19 vaccine. Only one of the 31 physicians (4.4%) who expressed a hesitancy or unwillingness to be vaccinated was a faculty member; the others were physicians-in-training. Approximately one-fifths of physicians surveyed were also not willing to recommend the vaccine to their family members (21.4%, n = 151) or patients (18.7%, n = 132). Using multivariable logistic regression, vaccine hesitancy was independently associated with preference for particular vaccines over the government allocated option, especially for mRNA vaccine (aOR 8.86; 95% CI 1.1-71.54; p = 0.041). Vaccine literacy showed an inverse relationship (aOR 0.34; 95% CI 0.13-0.9; p = 0.029) with vaccine hesitancy. Uncertainty of the vaccine efficacy (83.9%) and fear of adverse events (48.4%) were major concerns contributing to vaccine hesitancy. CONCLUSION: This study revealed a high rate of physician willingness to take the COVID-19 vaccine especially among staffs; however, a significant proportion would not currently suggest vaccination to their families or patients. Restrictions on vaccine choice and vaccine illiteracy, together with concerns over adverse effects and uncertainty of efficacy, were associated with negative attitudes toward vaccination. To raise acceptance of the vaccination program, efforts should be made to balance individual preference for vaccine type in addition to increasing the availability of accurate data on safety and efficacy for each vaccine.


Assuntos
COVID-19 , Médicos , Vacinas , Vacinas contra COVID-19 , Estudos Transversais , Hospitais de Ensino , Hospitais Universitários , Humanos , SARS-CoV-2 , Tailândia , Universidades , Vacinação
10.
Kathmandu Univ Med J (KUMJ) ; 19(74): 186-189, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34819433

RESUMO

Background The first step in laparoscopic surgery is to establish the pneumoperitoneum for which many approaches have been introduced to minimize the complications. Although controversies exist regarding the most efficient technique, till now the best entry technique is still unsettled. Objective To compare the safety, operating time and outcome of Direct Trocar Insertion with a well-established and widely practised Open Access Technique. Method This is a prospective study at Nobel Medical College Teaching Hospital from November 2019 to February 2021. Patients were grouped into either of the two groups, Group 1 for Direct Trocar Insertion and Group 2 for Open Access Technique. They were later analysed for major and minor complications of the technique and a comparison of either method was done at the end of the study period. Result A total of 823 patients were enrolled in the study. Among the study population, 411 patients had Direct Trocar Insertion while 412 patients had Open Access Technique. The majority of the operation that was done during the study period was laparoscopic cholecystectomy. Patients in the Open Access Technique group experienced more complications compared to Direct Trocar Insertion group. Conclusion Despite the fear of adopting the Direct Trocar Insertion, this is a safe, better and quick technique for laparoscopic port entry. However, any surgeon practising laparoscopic surgery should be competent to adopt either technique to overcome failure in either process during port entry.


Assuntos
Colecistectomia Laparoscópica , Laparoscopia , Hospitais de Ensino , Humanos , Estudos Prospectivos , Instrumentos Cirúrgicos
11.
Environ Health Prev Med ; 26(1): 99, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34592930

RESUMO

OBJECTIVES: In this article, we aim to share our experience in the hospital reorganization made to conduct the SARS-CoV-2 vaccination campaign, based on the principles of flexibility and adaptability. STUDY DESIGN: A descriptive study. METHODS: The data concerning the organization of the vaccination campaign were taken from the operative protocol developed by the hospital dedicated task force, composed by experts in hygiene, public health, occupational medicine, pharmacists, nurses, hospital quality, and disaster managers. Data about the numbers of vaccine administered daily were collected by the Innovation and Development Operative Unit database. RESULTS: Vaccinations against COVID-19 started across the EU on the 27th of December 2020. The first phase of the vaccination campaign carried out in our hospital was directed to healthcare workers immunization including medical residents, social care operators, administrative staff and technicians, students of medicine, and health professions trainees. The second phase was enlarged to the coverage of extremely fragile subjects. Thanks to the massive employment of healthcare workers and the establishment of dynamic pathways, it was possible to achieve short turnaround times and a large number of doses administered daily, with peaks of 870 vaccines per day. From the 27th of December up to the 14th of March a total of 26,341 doses of Pfizer have been administered. 13,584 were first doses and 12,757 were second doses. From the 4th to the 14th of March, 296 first doses of Moderna were dispensed. It was necessary to implement adequate spaces and areas adopting anti-contagion safety measures: waiting area for subjects to be vaccinated, working rooms for the dilution of the vaccine and the storage of the material, vaccination rooms, post-vaccination observation areas, room for observation, and treatment of any adverse reactions, with an emergency cart available in each working area. CONCLUSIONS: The teaching hospital of Pisa faced the beginning of the immunization campaign readjusting its spaces, planning an adequate hospital vaccination area and providing an organization plan to ensure the achievement of the targets of the campaign. This represented a challenge due to limited vaccine doses supplied and the multisectoral teams of professionals to coordinate in the shortest time and the safest way possible. The organizational model adopted proved to be adequate and therefore exploited also for the second phase aimed to extremely fragile subjects.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Programas de Imunização/organização & administração , SARS-CoV-2/imunologia , Hospitais de Ensino/organização & administração , Humanos , Itália/epidemiologia
12.
J Nepal Health Res Counc ; 19(2): 378-383, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34601534

RESUMO

BACKGROUND: Erectile dysfunction is a distressing complication of diabetes among male patients. Despite being a serious concern affecting sexual health, the issue regarding sexual dysfunction is seldom discussed by patients with physicians in developing countries. This study aimed to identify the prevalence of Erectile dysfunction and its association with other risk factors among type 2 Diabetic males attending the tertiary care hospital in Nepal. METHODS: A cross-sectional hospital-based study was carried out in the Diabetes Out Patient Department of Tribhuvan University Teaching Hospital, Kathmandu, Nepal. 160 male patients with a history of Type 2 Diabetes Mellitus (T2DM) meeting the inclusion criteria were enrolled in the study with informed consent. A validated questionnaire; an abridge 5 item version of the International Index of Erectile Function (IIEF 5) was used to assess the erectile function where the score below 22 was considered as having erectile dysfunction. The severity of erectile dysfunction was categorized based on IIEF 5 score. RESULTS: The prevalence of erectile dysfunction with varying degrees of severity was found to be 76.87% among T2DM male patients. There was a significant negative correlation of the IIEF5 Score with the duration of T2DM burden (r= -0.416, p<0.05) and the level of HbA1c (r= -0.391, p<0.05). CONCLUSIONS: There was a higher prevalence of erectile dysfunction among T2DM male patients that were also associated with poor glycemic control and the duration of T2DM burden.


Assuntos
Diabetes Mellitus Tipo 2 , Disfunção Erétil , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Disfunção Erétil/epidemiologia , Disfunção Erétil/etiologia , Hospitais de Ensino , Humanos , Masculino , Nepal/epidemiologia
13.
J Infect Dev Ctries ; 15(9): 1252-1256, 2021 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-34669592

RESUMO

INTRODUCTION: The COVID-19 pandemic highlights the role of environmental cleaning in controlling infection transmission in hospitals. However, cleaning practice remains inadequate. An important component of effective cleaning is to obtain feedback on actual cleaning practice. This study aimed to evaluate the cleaning process quality from an implementation perspective. METHODOLOGY: An observational study was conducted in a tertiary public hospital in Wuhan, China and 92 cleaning processes of units housing patients with multidrug-resistant organism infections were recorded. The bed unit cleaning quality and floor cleaning quality were measured by six and five process indicators respectively. Descriptive statistics were used to describe the cleaning quality. RESULTS: For bed unit cleaning quality, the appropriate rates of cleaning sequence, adherence to cleaning unit principle, use of cloth, use of cloth bucket, separation of clean and contaminated tools, and disinfectant concentration were 35.9%, 71.7%, 89.7%, 11.5%, 65.4%, and 48.7%, respectively. For floor cleaning quality, the appropriate rates of adherence to cleaning unit principle, use of cloth, use of cloth bucket, separation of clean and contaminated tools, and disinfectant concentration were 13.4%, 50.0%, 35.5%, 11.0%, and 36.7%, respectively. CONCLUSIONS: The cleaning staff showed poor environmental cleaning quality, especially the floor cleaning quality. The findings can help reveal deficiencies in cleaning practices, raise awareness of these deficiencies, and inform targeted strategies to improve cleaning quality and hospital safety.


Assuntos
Desinfecção/métodos , Controle de Infecções/métodos , China , Infecção Hospitalar/prevenção & controle , Estudos Transversais , Desinfecção/normas , Farmacorresistência Bacteriana Múltipla , Fidelidade a Diretrizes/estatística & dados numéricos , Hospitais Públicos , Hospitais de Ensino , Controle de Infecções/normas , Centros de Atenção Terciária
14.
Front Public Health ; 9: 729778, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34621721

RESUMO

Objective: This study aimed to evaluate the effects of intensified Chinese special rectification activity on clinical antibiotic use (CSRA) policy on a tertiary-care teaching hospital. Methods: A 48-month longitudinal dataset involving inpatients, outpatients, and emergency patients were collected. Study period included pre-intervention stage (adopting soft measures like systemic training) and post-intervention stage (applying antibiotic control system to intensify CSRA policy). Antibiotic use was evaluated by antibiotic use rate (AUR) or antibiotic use density (AUD). Economic indicator was evaluated by antibiotic cost in prescription or antibiotic expenditure in hospitalization. Data was analyzed by interrupted time series (ITS) analysis. Results: The medical quality indicators remained stable or improved during the study period. AUR of inpatients (AURI) declined 0.553% per month (P = 0.025) before the intervention and declined 0.354% per month (P = 0.471) after the intensified CSRA policy was implemented. AUD, expressed as defined daily doses per 100 patients per day (DDDs/100PD), decreased by 1.102 DDDs/100PD per month (P = 0.021) before and decreased by 0.597 DDDs/100PD per month (P = 0.323) thereafter. The ratio of antibiotic expenditure to medication expenditure (AE/ME) decreased by 0.510% per month (P = 0.000) before and fell by 0.096% (P = 0.000) per month thereafter. AE per patient decreased by 25.309 yuan per month (P = 0.002) before and decreased by 7.987 yuan per month (P = 0.053) thereafter. AUR of outpatient (AURO) decreased by 0.065% per month before (P = 0.550) and decreased by 0.066% per month (P = 0.994) thereafter. The ratio of antibiotic cost to prescription cost in outpatient (ACO/PCO) decreased by 0.182% per month (P = 0.506) before and decreased by 0.216% per month (P = 0.906) thereafter. AUR of emergency patient (AURE) decreased by 0.400% per month (P = 0.044) before and decreased by 0.092% per month (P = 0.164) thereafter. The ratio of antibiotic cost to prescription cost in emergency patient (ACE/PCE) decreased by 0.616% per month (P < 0.001) before and decreased by 0.151% per month (P < 0.001) thereafter. Conclusions: Implementation of CSRA policy was associated with declining antibiotic use and antibiotic expenditure in inpatients, outpatients, and emergency patients. However, it is also important to note that the declining trend of antibiotic consumption slowed due to the limited capacity for decline in the later stages of CSRA intervention.


Assuntos
Gestão de Antimicrobianos , Antibacterianos/uso terapêutico , China/epidemiologia , Gastos em Saúde , Hospitais de Ensino , Humanos , Políticas
15.
BMC Geriatr ; 21(1): 530, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620116

RESUMO

BACKGROUND: Older adult patients are prone to potentially inappropriate medication use (PIMU); its use has been associated with multiple adverse consequences. As a result, it is crucial to determine the magnitude and factors associated with PIMU. The present study was mainly aimed to determine and assess the magnitude and predictors of potentially inappropriate medication use in older adult patients on follow-up at the chronic care clinic of Jimma medical center. METHODS: A retrospective cross-sectional study was conducted involving 219 patients aged 65 years and above on treatment follow-up. Data was collected using a checklist. The 2019 updated American Geriatric Society (AGS) Beers Criteria® and Screening Tool of Older People's Potentially Inappropriate Prescriptions criteria and Screening Tool to Alert Doctors to Right Treatment (STOPP/START) criteria (version 2) were employed to assess PIMU. SPSS IBM (v22) was used for data entry and analysis. Categorical variables were described using frequency and percentage, whereas continuous variables were described using mean with standard deviation (SD) or median with interquartile range (IQR). Logistic regression was conducted to identify predictors of PIMU. RESULTS: The average number of medications prescribed per patient was 4.0 (IQR = 2.0). At least one PIMU was identified in 182 (83.1%) and 99 (45.2%) patients, based on Beers and STOPP criteria, respectively. Additionally, potential prescription omission (PPO) was observed in 24 (10.9%) patients. The risk of Beers PIMU was increased with age [AOR = 1.21, p <  0.001], hypertension [AOR = 4.17, p <  0.001], and polypharmacy [AOR = 14.10, p <  0.001], while a decrease in the risk was noted in patients with a diagnosis of ischemic stroke [AOR = 0.133, p = 0.01] and asthma [AOR = 0.03, p <  0.001]. Using STOPP criteria, hypertension [AOR = 2.10, p = 0.04], diabetes mellitus [AOR = 2.26, p = 0.04], ischemic heart disease [AOR = 2.84, p = 0.04], peripheral neuropathy [AOR = 10.61, p <  0.001], and polypharmacy [AOR = 6.10, p <  0.001] significantly increased the risk of PIMU. CONCLUSIONS: Regardless of the screening tool used to assess, the present study revealed PIMU in the large proportion of the participants. Multiple medication use and certain disease condition had increased the probability of PIMU. Hence, it is imperative to use screening tools for reviewing medications prescribed in older adult patients to ensure safety of medication therapy.


Assuntos
Prescrição Inadequada , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Estudos Transversais , Etiópia/epidemiologia , Seguimentos , Hospitais de Ensino , Humanos , Polimedicação , Estudos Retrospectivos
16.
Front Cell Infect Microbiol ; 11: 721439, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34604110

RESUMO

Background: The incidence of invasive candidiasis is increasing worldwide. However, the epidemiology, antifungal susceptibility, and virulence of Candida spp. in most hospitals remain unclear. This study aimed to evaluate invasive candidiasis in a tertiary care hospital in Nanchang City, China. Methods: MALDI-TOF MS and 18S rDNA ITS sequencing were used to identify Candida strains. Randomly amplified polymorphic DNA analysis was used for molecular typing; biofilm production, caseinase, and hemolysin activities were used to evaluate virulence. The Sensititre™ YeastOne YO10 panel was used to examine antifungal susceptibility. Mutations in ERG11 and the hotspot regions of FKS1 of drug-resistant strains were sequenced to evaluate the possible mechanisms of antifungal resistance. Results: We obtained 110 Candida strains, which included 40 Candida albicans (36.36%), 37 C. parapsilosis (33.64%), 21 C. tropicalis (19.09%), 9 C. glabrata (8.18%), 2 C. rugose (1.82%), and 1 C. haemulonii (0.91%) isolates. At a limiting point of 0.80, C. albicans isolates could be grouped into five clusters, C. parapsilosis and C. tropicalis isolates into seven clusters, and C. glabrata isolates into only one cluster comprising six strains by RAPD typing. Antifungal susceptibility testing revealed that the isolates showed the greatest overall resistance against fluconazole (6.36%), followed by voriconazole (4.55%). All C. albicans and C. parapsilosis isolates exhibited 100% susceptibility to echinocandins (i.e., anidulafungin, caspofungin, and micafungin), whereas one C. glabrata strain was resistant to echinocandins. The most common amino acid substitutions noted in our study was 132aa (Y132H, Y132F) in the azole-resistant strains. No missense mutation was identified in the hotpot regions of FKS1. Comparison of the selected virulence factors detectable in a laboratory environment, such as biofilm, caseinase, and hemolysin production, revealed that most Candida isolates were caseinase and hemolysin producers with a strong activity (Pz < 0.69). Furthermore, C. parapsilosis had greater total biofilm biomass (average Abs620 = 0.712) than C. albicans (average Abs620 = 0.214, p < 0.01) or C. tropicalis (average Abs620 = 0.450, p < 0.05), although all C. glabrata strains were either low- or no-biofilm producers. The virulence level of the isolates from different specimen sources or clusters showed no obvious correlation. Interesting, 75% of the C. albicans from cluster F demonstrated azole resistance, whereas two azole-resistant C. tropicalis strains belonged to the cluster Y. Conclusion: This study provides vital information regarding the epidemiology, pathogenicity, and antifungal susceptibility of Candida spp. in patients admitted to Nanchang City Hospital.


Assuntos
Antifúngicos , Candidíase Invasiva , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candida/genética , Candidíase Invasiva/epidemiologia , Farmacorresistência Fúngica , Hospitais de Ensino , Humanos , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Técnica de Amplificação ao Acaso de DNA Polimórfico , Atenção Terciária à Saúde , Virulência/genética
17.
BMC Public Health ; 21(1): 1793, 2021 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-34610815

RESUMO

BACKGROUND: HIV stigma undermines a person's wellbeing and quality of life and hinders HIV control efforts. This study examined the extent and drivers of HIV stigma in the teaching hospitals in Sana'a City, Yemen. The country has low HIV prevalence (4000 (2000-11,000) per 100,000) and limited HIV control funds, worsened by a long conflict and an economic crisis. METHODS: We conducted a cross-sectional study of 320 Yemeni health professionals in all the four teaching hospitals in Sana'a City. Data were collected anonymously, using an adapted self-completed Arabic version of the Health Policy Project HIV Stigma tool. The questionnaire covered the respondents' background, the stigmatising practices, and potential personal and professional drivers of stigma. RESULTS: The majority of the participants were: females (68%), 20-39 years old (85%), nurses (84%), and holding a nursing diploma (69%) or a bachelor's degree (27%). None of the hospitals had institutional policies against HIV stigma, and 93% of the participants believed the current infection control measures were inadequate. Less than half of the participants provided care for people living with HIV (PLHIV) (45%), had received HIV training (33%), and were confident that their HIV knowledge was adequate (23%). The majority indicated a preference to test patients for HIV prior to surgical procedures (77%) and disclose positive HIV results to others (99%) without prior knowledge or consent. All the participants had exhibited a form of HIV-related stigmatization, such as avoiding physical contact with PLHIV (87%) or wearing gloves throughout the consultation (96.5%). These practices were significantly correlated with the fear of infection, high perceived risk of infection, and poor work environment (p < 0.05). CONCLUSION: PLHIV face widespread stigmatizing behaviour in the teaching hospitals in Sana'a City, consistent with the higher level of stigma in low HIV prevalence countries and its links to the fear of infection, poor HIV knowledge, and limited funding for HIV control. Stigma reduction interventions are required at institutional and individual levels. In addition, anti-discrimination policies and structural adjustments are needed, in combination with training on HIV and universal precautions, and action to tackle negative attitudes towards PLHIV and key populations.


Assuntos
Infecções por HIV , Qualidade de Vida , Adulto , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Hospitais de Ensino , Humanos , Estigma Social , Iêmen/epidemiologia , Adulto Jovem
18.
BMC Health Serv Res ; 21(1): 1091, 2021 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-34645451

RESUMO

BACKGROUND: The lack of medication standards is a serious problem in paediatrics mainly because of age-related differences in organ development and physiological functions in children. Consequently, dosage measurement becomes inaccurate. For this reason, methods for evaluating and monitoring rational paediatric medications should be developed. Drug use indicators, such as those similar to the drug utilisation index (DUI) based on the Anatomical Therapeutic Chemical/Defined Daily Dose (DDD) and widely used for the assessment of appropriate dosage in adults, should be explored in terms of their applicability to children. METHODS: A total of 5,538 prescriptions of antibiotics selected from a general teaching hospital were included. Drug, dose, frequency and treatment duration were obtained from each prescription. The prescription daily dose (PDD) of each antibiotic drug was calculated as the average of the daily doses. Underdose and overdose were determined in terms of the PDD/DDD ratio for each prescription. Children's DUI (cDUI) was explored in terms of the appropriate dosage for children as follows: the meaning of children's DDD (cDDD) and the evaluation of paediatric drug dosage. RESULTS: The top five antibiotics and their utilisation rates were as follows: cefmetazole sodium injection (18.47 %), erythromycin lactobionate injection (15.07 %), amoxicillin/clavulanate potassium injection (10.72 %), ceftriaxone sodium injection (9.50 %) and azithromycin dry suspension (8.02 %). The ratio of cDUI and PDD/cDDD was mostly not close to 1. CONCLUSIONS: The establishment of a cDUI system is an effective means of paediatric dosage evaluation. In addition to DDDs, cDUI and PDD/cDDD should be used to analyse the utilisation of antibiotics in children.


Assuntos
Antibacterianos , Pediatria , Adulto , Antibacterianos/uso terapêutico , Criança , Estudos Transversais , Prescrições de Medicamentos , Uso de Medicamentos , Hospitais de Ensino , Humanos
19.
West Afr J Med ; 38(9): 903-906, 2021 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-34677920

RESUMO

INTRODUCTION: Odontomas are the most common odontogenic tumors worldwide and are usually chance findings seen on routine dental examinations. However, on progression, they may be associated with adjacent tooth displacement. CASE DESCRIPTION: We report a case of an 11-year-old girl who presented at the Lagos University Teaching Hospital (LUTH) pediatric dental clinic with a complaint of painless enlargement of the left anterior maxilla of 2-years duration. The swelling was located between teeth 21 and 22 and was associated with distal displacement and mesial angulation of tooth 22. Clinical, radiographic and histopathologic investigations revealed a compound odontoma. Surgical exposure and enucleation was done to remove the tumor. The patient's postoperative course and 6 months follow-up were uneventful. CONCLUSION: This report elucidates the importance of routine dental check-ups and minimally traumatic management of odontomas in pediatric dental patients to prevent adverse effects of odontomas, thereby, minimizing the interventions needed after surgical enucleation.


Assuntos
Odontoma , Criança , Feminino , Hospitais de Ensino , Humanos , Incisivo/diagnóstico por imagem , Incisivo/cirurgia , Maxila/diagnóstico por imagem , Maxila/cirurgia , Nigéria , Odontoma/diagnóstico por imagem , Odontoma/cirurgia
20.
BMJ Open ; 11(10): e051573, 2021 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663664

RESUMO

OBJECTIVE: To study the SARS-CoV-2 infection rate among hospital healthcare workers after the first wave of the COVID-19 pandemic, and provide more knowledge in the understanding of the relationship between infection, symptomatology and source of infection. DESIGN: A cross-sectional study in healthcare workers. SETTING: Northern Limburg, the Netherlands. PARTICIPANTS: All employees of VieCuri Medical Center (n=3300) were invited to enrol in current study. In total 2507 healthcare workers participated. INTERVENTION: Between 22 June 2020 and 3 July 2020, participants provided venous blood samples voluntarily, which were tested for SARS-CoV-2 antibodies with the Wantai SARS-CoV-2 Ig total ELISA test. Work characteristics, exposure risks and prior symptoms consistent with COVID-19 were gathered through a survey. MAIN OUTCOME MEASURE: Proportion of healthcare workers with positive SARS-CoV-2 serology. RESULTS: The overall seroprevalence was 21.1% (n=530/2507). Healthcare workers between 17 and 30 years were more likely to have SARS-CoV-2 antibodies compared with participants >30 years. The probability of having SARS-CoV-2 antibodies was comparable for healthcare workers with and without direct patient (OR 1.42, 95% CI 0.86 to 2.34) and COVID-19 patient contact (OR 1.62, 95% CI 0.80 to 3.33). On the contrary, exposure to COVID-19 positive coworkers (OR 1.83, 95% CI 1.15 to 2.93) and household members (OR 6.09, 95% CI 2.23 to 16.64) was associated with seropositivity. Of those healthcare workers with SARS-CoV-2 antibodies, 16% (n=85/530) had not experienced any prior COVID-19-related symptoms. Only fever and anosmia were associated with seropositivity (OR 1.90, 95% CI 1.42 to 2.55 and OR 10.51, 95% CI 7.86 to 14.07). CONCLUSIONS: Healthcare workers caring for hospitalised COVID-19 patients were not at an increased risk of infection, most likely as a result of taking standard infection control measures into consideration. These data show that compliance with infection control measures is essential to control secondary transmission and constrain the spread of the virus.


Assuntos
COVID-19 , SARS-CoV-2 , Anticorpos Antivirais , Estudos Transversais , Pessoal de Saúde , Hospitais de Ensino , Humanos , Países Baixos/epidemiologia , Pandemias , Estudos Soroepidemiológicos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...