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1.
Esc. Anna Nery Rev. Enferm ; 26: e20210137, 2022. tab, graf
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1350740

RESUMEN

Resumo Objetivo avaliar o tempo de atuação de médicos e enfermeiros na Atenção Primária à Saúde (APS) e qualidade das ações desenvolvidas para controle do câncer cervicouterino (CC). Métodos estudo transversal, conduzido de janeiro a março de 2019 em região de saúde compreendida em 19 municípios localizada no estado da Bahia, Brasil. A amostra foi de 241 médicos e enfermeiros da APS. Utilizou-se a linha de cuidado do CC como condição traçadora. Elegeram-se o desfecho tempo de atuação na APS no mesmo município, categorizado em < 2 anos e ≥ 2 anos, e indicadores representativos da qualidade da APS. Os testes χ2 de Pearson e exato de Fisher foram empregados. Resultados a prevalência de tempo de atuação na APS foi 43,57% (IC95%: 37,40%; 49,94%) para < 2 anos e 56,43% (IC95%: 50,06%; 62,60%) para ≥ 2 anos. Observaram-se maiores prevalências, com diferença estatística significativa, dos indicadores de qualidade para o maior tempo de atuação. Conclusões e implicações para a prática a rotatividade profissional parece afetar o cuidado longitudinal de mulheres na linha de cuidado eleita. Sugere-se a ampliação do número e do papel dos enfermeiros, especialmente nos serviços de APS, para maior resolutividade e eficiência do sistema de saúde.


Resumen Objetivo evaluar el tiempo de actuación de médicos y enfermeros en la Atención Primaria de Salud (APS) y la calidad de las acciones desarrolladas para el control del cáncer cérvicouterino (CC). Métodos estudio transversal realizado de enero a marzo de 2019, en una región sanitaria que comprende 19 municipios en el estado de Bahía, Brasil. La muestra fue de 241 médicos y enfermeros de APS. La línea de cuidados de CC fue la condición trazadora. Se eligió el resultado tiempo trabajando en APS en el mismo municipio, categorizado en < 2 años y ≥ 2 años e indicadores representativos de calidad de APS. Se utilizaron pruebas exactas de chi-cuadrado de Pearson y Fisher. Resultados la prevalencia del tiempo de actuación en APS fue del 43,57% (IC95%: 37,40%; 49,94%) para < 2 años y del 56,43% (IC95%: 50,06%; 62,60%) para ≥ 2 años, considerado incipiente. Se observó una mayor prevalencia, con diferencia estadísticamente significativa, de los indicadores de calidad para un mayor tiempo de actuación. Conclusiones e implicaciones para la práctica la rotación de profesionales parece afectar la atención longitudinal de las mujeres en la línea de cuidado elegida. Se sugiere la ampliación del número y el papel de enfermería, especialmente en los servicios de APS, para una mayor resolutividad y eficiencia del sistema sanitario.


Abstract Objective to assess the working length of physicians and nurses in Primary Health Care (PHC) and the quality of actions taken to control cervical cancer (CC). Methods this is a cross-sectional study, conducted from January to March 2019, in a health region comprised of 19 municipalities located in the state of Bahia, Brazil. The sample consisted of 241 PHC physicians and nurses. The CC care line was used as a tracer condition. The outcome experience length in PHC in the same municipality was chosen, categorized as < 2 years and ≥ 2 years and representative indicators of PHC quality. Pearson's χ2 and Fisher's exact tests were used. Results the prevalence of length of experience in PHC was 43.57% (95%CI: 37.40%; 49.94%) for < 2 years, and 56.43% (95%CI: 50.06%; 62.60%) for ≥ 2 years. There was a higher prevalence, with a statistically significant difference, of the quality indicators for the longest working length. Conclusions and implications for practice professional turnover seems to affect the longitudinal care of women in the chosen care line. It is suggested to expand the number and role of nurses, especially in PHC services, for greater resolution and efficiency of the health system.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Atención Primaria de Salud , Calidad de la Atención de Salud/estadística & datos numéricos , Evaluación en Salud/estadística & datos numéricos , Neoplasias del Cuello Uterino/prevención & control , Personal de Salud , Tamizaje Masivo , Estudios Transversales , Prueba de Papanicolaou
2.
J Infect Dev Ctries ; 15(11): 1593-1596, 2021 11 30.
Artículo en Inglés | MEDLINE | ID: mdl-34898483

RESUMEN

COVID-19 outbreak has resulted in a substantial morbidity and mortality, and has put the health system under tremendous stress. A need for devising and adopting newer methods and techniques is being emphasized in the healthcare facilities to combat the effects of the SARS-CoV-2. Besides patient care, focus needs to be laid on the effective and dignified management of the deceased and medico-legal services provided by the hospitals and medical institutions during the COVID-19 pandemic. Considering the likelihood of forensic experts and autopsy personnel being exposed to SARS-CoV-2 inadvertently during the autopsy, it is recommended to resort to safer and minimally invasive techniques of postmortem examination of the dead. In this regard, employing radiological techniques for postmortem examination appears to be a promising option during the COVID-19 pandemic. An inherent advantage of postmortem radiography over conventional autopsies is the minimization of the risk of transmission of infection to the health care workers. Our correspondence highlights on the possibility of using radiological facilities as an effective replacement of high-risk conventional autopsy procedures during the COVID-19 pandemic.


Asunto(s)
Autopsia , COVID-19/prevención & control , Instituciones de Salud , Enfermedades Profesionales/prevención & control , Radiología , SARS-CoV-2 , COVID-19/epidemiología , Humanos , India/epidemiología , Enfermedades Profesionales/epidemiología , Pandemias , Regionalización
3.
Cien Saude Colet ; 26(suppl 2): 3385-3396, 2021.
Artículo en Portugués | MEDLINE | ID: mdl-34468636

RESUMEN

The scope of this study was to analyze, from the standpoint of managers, the conformity of the process of regionalization in health in Brazil, with emphasis on the main advances and challenges. A mixed exploratory and descriptive study was conducted. In the first stage, an electronic questionnaire was given to managers from all health regions of the country. In the second stage, focus groups were staged with managers in all macro regions. A semi-structured interview was used to encourage managers to speak about the advances and main challenges of the process of regionalization. The data was analyzed using Iramuteq software, more specifically the Descending Hierarchical Classification (DHC), resulting in three main themes: the first deals with the efforts made for the regional organization at the macro level of management, with emphasis on reducing inequalities, actions and services to users; the second demonstrates the regional organization and the difficulties for the organization of the local system; the third reveals difficulties in accessing health services, especially those with greater technological complexity. The research results point to advances and challenges, involving a risk for the structuring of the regionalization process, with bureaucratic and fragmentation implications.


Asunto(s)
Regionalización , Brasil , Estados Unidos
4.
Asian Pac J Cancer Prev ; 22(9): 2945-2950, 2021 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-34582666

RESUMEN

The COVID-pandemic has shown significant impact on cancer care from early detection, management plan to clinical outcomes of cancer patients. The Asian National Cancer Centres Alliance (ANCCA) has put together the 9 "Ps" as guidelines for cancer programs to better prepare for the next pandemic. The 9 "Ps" are Priority, Protocols and Processes, Patients, People, Personal Protective Equipments (PPEs), Pharmaceuticals, Places, Preparedness, and Politics. Priority: to maintain cancer care as a key priority in the health system response even during a global infectious disease pandemic. Protocol and processes: to develop a set of Standard Operating Procedures (SOPs) and have relevant expertise to man the Disease Outbreak Response (DORS) Taskforce before an outbreak. Patients: to prioritize patient safety in the event of an outbreak and the need to reschedule cancer management plan, supported by tele-consultation and use of artificial intelligence technology. People: to have business continuity planning to support surge capacity. PPEs and Pharmaceuticals: to develop plan for stockpiles management, build local manufacturing capacity and disseminate information on proper use and reduce wastage. Places: to design and build cancer care facilities to cater for the need of triaging, infection control, isolation and segregation. Preparedness: to invest early on manpower building and technology innovations through multisectoral and international collaborations. Politics: to ensure leadership which bring trust, cohesion and solidarity for successful response to pandemic and mitigate negative impact on the healthcare system.


Asunto(s)
Instituciones Oncológicas/organización & administración , Planificación en Desastres/métodos , Control de Infecciones/métodos , Neoplasias/prevención & control , Pandemias/prevención & control , Regionalización/organización & administración , Telemedicina/métodos , Inteligencia Artificial , Asia/epidemiología , Atención a la Salud , Humanos , Neoplasias/epidemiología
5.
Med Care ; 59(Suppl 5): S420-S427, 2021 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-34524238

RESUMEN

BACKGROUND: As coronavirus disease 2019 (COVID-19) rapidly progressed throughout the United States, increased demand for health workers required health workforce data and tools to aid planning and response at local, state, and national levels. OBJECTIVE: We describe the development of 2 estimator tools designed to inform health workforce planning for COVID-19. RESEARCH DESIGN: We estimated supply and demand for intensivists, critical care nurses, hospitalists, respiratory therapists, and pharmacists, using Institute for Health Metrics and Evaluation projections for COVID-19 hospital care and National Plan and Provider Enumeration System, Provider Enrollment Chain and Ownership System, American Hospital Association, and Bureau of Labor Statistics Occupation Employment Statistics for workforce supply. We estimated contact tracing workforce needs using Johns Hopkins University COVID-19 case counts and workload parameters based on expert advice. RESULTS: The State Hospital Workforce Deficit Estimator estimated the sufficiency of state hospital-based clinicians to meet projected COVID-19 demand. The Contact Tracing Workforce Estimator calculated the workforce needed based on the 14-day COVID-19 caseload at county, state, and the national level, allowing users to adjust workload parameters to reflect local contexts. CONCLUSIONS: The 2 estimators illustrate the value of integrating health workforce data and analysis with pandemic response planning. The many unknowns associated with COVID-19 required tools to be flexible, allowing users to change assumptions on number of contacts and work capacity. Data limitations were a challenge for both estimators, highlighting the need to invest in health workforce data and data infrastructure as part of future emergency preparedness planning.


Asunto(s)
COVID-19/epidemiología , Planificación en Salud Comunitaria , Personal de Salud/estadística & datos numéricos , Fuerza Laboral en Salud/estadística & datos numéricos , Modelos Estadísticos , Regionalización , Trazado de Contacto , Humanos , Estados Unidos/epidemiología , Carga de Trabajo
6.
San Salvador; MINSAL; jul. 28, 2021. 32 p. ilus, tab.
No convencional en Español | LILACS, BISSAL | ID: biblio-1292939

RESUMEN

El presente Plan Estratégico Institucional (PEI) del Ministerio de Salud (MINSAL) constituye el mapa estratégico para la Secretaría de Estado, Direcciones Regionales de Salud, hospitales de segundo y tercer nivel de atención y establecimientos de salud del primer nivel de atención. Contiene los principales retos para el MINSAL en el marco de la recientemente aprobada Ley del Sistema Nacional Integrado de Salud (SNIS) en materia de rectoría y gobernanza, promoción de la salud, capacidad para entregar servicios de salud de calidad y el abordaje de la determinación social de la salud, teniendo como ejes trazadores la transformación digital y la mejora continua. Plantea alternativas para enfrentar los desafíos para, progresivamente y en comunión con el resto de las instituciones del SNIS, garantizar el derecho a la salud y mejorar la calidad de vida de la población, en ruta a la salud universal


This Institutional Strategic Plan (PEI) of the Ministry of Health (MINSAL) constitutes the strategic map for the Secretary of State, Regional Health Directorates, second and third level of care hospitals and first level of care health facilities. It contains the main challenges for the MINSAL within the framework of the recently approved Law of the National Integrated Health System (SNIS) in matters of stewardship and governance, health promotion, capacity to deliver quality health services and the approach to determination social health, having digital transformation and continuous improvement as tracing axes. It proposes alternatives to face the challenges to, progressively and in communion with the rest of the NHIS institutions, guarantee the right to health and improve the quality of life of the population, on the road to universal health


Asunto(s)
Regionalización , Salud Pública , Planes de Sistemas de Salud
7.
PLoS One ; 16(6): e0253334, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34185777

RESUMEN

By the time the etiologic agent of the COVID-19 was identified as a novel coronavirus, no country in the Americas Region had laboratory capacity for detecting this new virus. A strategic multilevel approach with specific reagent purchase and delivery, regional trainings, in-country missions, and the provision of technical support was established for timely preparedness of national reference laboratories for SARS-CoV-2 detection. All countries should be prepared to timely detect any potential pandemic emerging agent. The rapid SARS-CoV-2 molecular detection implementation throughout the Americas showed the importance of an efficient and coordinated laboratory response for preparedness. Here we present how in 25 days the Americas Region went from no SARS-CoV-2 diagnostic capacity, to molecular detection fully implemented in 28 Member States, under the coordinated strategy of the Pan American Health Organization and collaborative work at regional and country level with national authorities and public health laboratories.


Asunto(s)
COVID-19/diagnóstico , Laboratorios/estadística & datos numéricos , COVID-19/virología , América Central , Humanos , Laboratorios/normas , Regionalización , SARS-CoV-2/aislamiento & purificación , América del Sur
8.
BMC Pregnancy Childbirth ; 21(1): 410, 2021 Jun 02.
Artículo en Inglés | MEDLINE | ID: mdl-34078318

RESUMEN

INTRODUCTION: Cambodia has achieved significant progress in maternal health, yet remains in the group of countries with the highest maternal mortality ratio in South-East Asia. Extra efforts are needed to improve maternal health through assessing the coverage of maternal health services as a continuum of care (CoC) and identifying the gaps. Our study aims to explore the coverage level of the Optimal CoC by (1) measuring the continuity of optimal antenatal care (ANC), skilled birth attendance (SBA) and optimal post-natal care (PNC), (2) identifying the determinants of dropping out from one service to another and (3) of not achieving the complete CoC. METHOD: The study employed data from the Cambodia Demographic Health Survey 2014. We restricted our analysis to married women who had a live birth in the five years preceding the survey (n = 5678). Bi-variate and multivariate logistic regression were performed using STATA version 14. RESULTS: Almost 50% of women had achieved the complete optimal CoC, while the remaining have used only one or two of the services. The result shows that the level of women's education was positively associated with the use of optimal ANC, the continuation to using optimal PNC and achieving the complete CoC. More power of women in household decision making was also positively associated with receiving the complete CoC. The birth order was negatively associated with achieving the complete CoC, while exposure to the mass media and having health insurance increased the odds of achieving the complete CoC. Household wealth consequently emerged as an influential predictor of dropping out and not achieving the complete CoC. Receiving all different elements of ANC care improved the continuity of care from optimal ANC to SBA and from SBA to optimal ANC. CONCLUSION: The findings urge policy makers to approach maternal health care as a continuum of care with different determinants at each step. Household wealth was found to be the most influential factor, yet the study discovered also other barriers to optimal maternal health care which need to be addressed: future intervention should thus not only aim to increase wealth or health insurance coverage but also stimulate the education of women and empower women to claim power in household decision-making.


Asunto(s)
Continuidad de la Atención al Paciente/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Regionalización , Adolescente , Adulto , Cambodia , Demografía , Femenino , Humanos , Embarazo , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
9.
J Stroke Cerebrovasc Dis ; 30(8): 105843, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34000607

RESUMEN

OBJECTIVES: There are regional disparities in implementation rates of endovascular thrombectomy due to time and resource constraints such as endovascular thrombectomy specialists. In Hokkaido, Japan, Drive and Retrieve System (DRS), where endovascular thrombectomy specialists perform early endovascular thrombectomies by traveling from the facilities where they normally work to facilities closer to the patient. This study analyzed the cost-effectiveness of allocating a endovascular thrombectomy specialist for DRS to treat stroke patients. MATERIALS AND METHODS: he number of ischemic stroke patients expected to receive endovascular thrombectomy in Hokkaido in 2015 was estimated. It was assumed that an additional neutointerventionist was allocated for DRS. The analysis was performed from the government's perspective, which includes medical and nursing-care costs, and the personnel cost for endovascular thrombectomy specialist. The analysis was conducted comparing the current scenario, where patients received endovascular thrombectomy in facilities where endovascular thrombectomy specialists normally work, with the scenario with DRS within 60 min drive distance. Patient transport time was analyzed using geographic information system, and patient severity was estimated from the transport time. The primary outcome was incremental cost-effectiveness ratio (ICER) in each medical area which was calculated from the incremental costs and the incremental quality-adjusted life years (QALYs), estimated from patient severity using published literature. The entire process was repeated 100 times. RESULTS: DRS was most cost-effective in Kamikawachubu area, where the ICER was $14,173±16,802/QALY, significantly lower than the threshold that the Japanese guideline suggested. CONCLUSIONS: Since DRS was cost-effective in Kamikawachubu area, the area should be prioritized when a endovascular thrombectomy specialist for DRS is allocated as a policy.


Asunto(s)
Conducción de Automóvil , Accidente Cerebrovascular Embólico/economía , Accidente Cerebrovascular Embólico/terapia , Procedimientos Endovasculares/economía , Sistemas de Información Geográfica/economía , Costos de la Atención en Salud , Neurólogos/economía , Trombectomía/economía , Áreas de Influencia de Salud/economía , Simulación por Computador , Análisis Costo-Beneficio , Prestación Integrada de Atención de Salud/economía , Accidente Cerebrovascular Embólico/diagnóstico , Accidente Cerebrovascular Embólico/fisiopatología , Humanos , Evaluación de Programas y Proyectos de Salud , Años de Vida Ajustados por Calidad de Vida , Regionalización/economía , Factores de Tiempo , Resultado del Tratamiento
10.
Health Secur ; 19(4): 364-369, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33794098

RESUMEN

The COVID-19 pandemic has stretched limited public health resources beyond measures, particularly at the local level. What started as an interesting report of pneumonia of unknown etiology in late December 2019 in Wuhan, China, bloomed into an international crisis by mid-January 2020. However, it was not until late January, when the first case was reported in the United States, that a new reality took shape for US public health agencies. After all, severe acute respiratory syndrome never made it to this country, and the only 2 cases of Middle East respiratory syndrome here were imported and never spread. Local public health agencies are notoriously short-staffed and underfunded. Therefore, when a crisis looms, personnel from a multitude of areas within the agencies are called upon to help out. Under its innovative and forward-thinking leadership, the St. Louis County Department of Health internally implemented the Incident Command System, a component of the National Incident Management System. While reassignment of individuals to new responsibilities under a new and temporary reporting structure did not always go perfectly, Incident Command System kept its promise to be adaptable to a fast-evolving situation, to clearly outline needed areas of responsibility, and to provide scaffolding that kept the Department of Health functional in chaotic times. It was able to be implemented quickly within hours of the first confirmed COVID-19 case in St. Louis County and enhanced the quality and timeliness of the public health response. This experience is being shared to provide a model of how organizations with limited personnel can use the Incident Command System to reorganize and meet unexpected challenges with increased success.


Asunto(s)
COVID-19 , Comunicación , Planificación en Desastres/organización & administración , Gobierno Local , Salud Pública , Humanos , Missouri , Regionalización , Factores de Tiempo
11.
Epidemiol Serv Saude ; 30(1): e2020576, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33852697

RESUMEN

Health status indicators are an important tool for monitoring the performance of public health actions, identifying trends and priority regions for resource allocation. An R package was developed in order to increase the feasibility of handling and analyzing health status indicator data. The rtabnetsp package requests data from TabNet servers on the São Paulo State Department of Health website, retrieving and preprocessing the data for user manipulation. This article presents the rtabnetsp package and its functions, installation and use; as well as providing examples of its functionalities, which involve listing and searching among available indicators, selecting desired content and obtaining data aggregated according to regionalization level held on the data matrix, enabling greater agility in tasks regarding public health management in the state of São Paulo.


Asunto(s)
Atención a la Salud , Indicadores de Salud , Brasil , Humanos
12.
Palmas, TO; Secretaria da Saúde; 23 março 2021. 48 p. ilus.
Monografía en Portugués | LILACS, Coleciona SUS, CONASS, SES-TO | ID: biblio-1151469

RESUMEN

Trata de parâmetros da Educação Permanente em Saúde e a humanização sob a perspectiva do apoio institucional na escola de Saúde pública do Tocantins (Etsus-TO). Trata ainda a organização do coletivo EPS/Humanização no contexto da pandemia da covid-19, as competências da GEPSUS e objetivos da assessoria de humanização, o apoio institucional, a produção de coletivos e de redes, os caminhos e pistas metodológicas para a estruturação do PMA bem como seus objetivos e arranjo de gestão além da modalidade e dinâmica do trabalho no contexto da pandemia da covid-19 e da matriz de planejamento 2021. Traz o diagnostico de estratégias de planejamento, monitoramento e avaliação, o percurso proposto para o PMA na dinâmica dos coletivos do plano de 2020 e a indissociabilidade entre planejamento, monitoramento e avaliação para o plano 2021. Mostra ainda os instrumentos de monitoramento e avaliação e as reflexões acerca do trabalho colaborativo.


It deals with parameters of Permanent Education in Health and humanization from the perspective of institutional support in the public health school of Tocantins (Etsus-TO). It also deals with the organization of the EPS / Humanization collective in the context of the covid-19 pandemic, the skills of GEPSUS and objectives of humanization assistance, institutional support, the production of collectives and networks, the methodological paths and tracks for structuring the PMA as well as its objectives and management arrangement in addition to the modality and dynamics of work in the context of the pandemic of the covid-19 and the planning matrix 2021. It brings the diagnosis of planning, monitoring and evaluation strategies, the proposed route for the PMA in the dynamics of the 2020 plan collectives and the inseparability between planning, monitoring and evaluation for the 2021 plan. It also shows the monitoring and evaluation instruments and reflections on collaborative work.


Se trata de parámetros de Educación Permanente en Salud y humanización desde la perspectiva del apoyo institucional en la escuela de salud pública de Tocantins (Etsus-TO). También se ocupa de la organización del colectivo EPS / Humanización en el contexto de la pandemia del covid-19, las competencias del GEPSUS y los objetivos de la humanización asistencial, el apoyo institucional, la producción de colectivos y redes, los caminos y pistas metodológicas para estructurar PMA así como sus objetivos y arreglo de gestión además de la modalidad y dinámica de trabajo en el contexto de la pandemia del covid-19 y la matriz de planificación 2021. Trae el diagnóstico de estrategias de planificación, seguimiento y evaluación, la ruta propuesta para el PMA en la dinámica de los colectivos del plan 2020 y la inseparabilidad entre planificación, seguimiento y evaluación para el plan 2021. También muestra los instrumentos de seguimiento y evaluación y reflexiones sobre el trabajo colaborativo.


Il traite des paramètres de l'Education Permanente à la Santé et à l'humanisation dans la perspective de l'appui institutionnel à l'école de santé publique de Tocantins (Etsus-TO). Il traite également de l'organisation du collectif EPS / Humanisation dans le cadre de la pandémie de covid-19, des compétences de GEPSUS et des objectifs d'aide à l'humanisation, de soutien institutionnel, de la production de collectifs et de réseaux, des pistes méthodologiques et des pistes de structuration du PMA ainsi que ses objectifs et son dispositif de gestion en plus de la modalité et de la dynamique de travail dans le cadre de la pandémie du covid-19 et de la matrice de planification 2021. Il apporte le diagnostic des stratégies de planification, de suivi et d'évaluation, le tracé proposé pour le PMA dans la dynamique des collectifs du plan 2020 et l'inséparabilité entre planification, suivi et évaluation pour le plan 2021. Il montre également les instruments de suivi-évaluation et les réflexions sur le travail collaboratif.


Asunto(s)
Humanos , Regionalización/organización & administración , Informe Anual , Educación Continua , Evaluación Educacional , Humanización de la Atención
13.
Ann Thorac Surg ; 112(1): 349, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33631154
14.
Ann Vasc Surg ; 74: 73-79, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33549797

RESUMEN

BACKGROUND: The aim of the study is to evaluate the impact of COVID-19 pandemic on vascular surgery practice in a regional hub center for complex vascular disease. METHODS: This is an observational single-center study in which we collected clinical and surgical data during (P1) and after (P2) the COVID-19 outbreak and the lockdown measures implemented in Northern Italy. We compared those data with the two-month period before the pandemic (P0). RESULTS: Compared to P0, ambulatory activities were severely reduced during P1 and limited to hospitalized patients and outpatients with urgent criteria. We performed 61 operations (18 urgent and 43 elective), with a decrease in both aortic (-17.8%), cerebrovascular (-53.3%), and peripheral artery (-42.6%) disease treatments. We also observed a greater drop in open procedures (-53.2%) than in endovascular ones (-22%). All the elective patients were treated for notdeferrable conditions and they were COVID-19 negative at the ward admission screening; despite this one of them developed COVID19 during the hospital stay. Four COVID-19 positive patients were treated in urgent setting for acute limb ischemia. Throughout P2 we gradually rescheduled elective ambulatory (+155.5%) and surgical (+18%) activities, while remaining substantially lower than during P0 (respectively -45.6% and -25.7%). CONCLUSIONS: Despite COVID-19 pandemic, our experience shows that with careful patient's selection, dedicated prehospitalization protocol and proper use of personal protective equipment it is possible to guarantee continuity of care.


Asunto(s)
Centros Médicos Académicos/tendencias , COVID-19 , Pautas de la Práctica en Medicina/tendencias , Cirujanos/tendencias , Procedimientos Quirúrgicos Vasculares/tendencias , Anciano , Anciano de 80 o más Años , Toma de Decisiones Clínicas , Continuidad de la Atención al Paciente/tendencias , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Selección de Paciente , Regionalización/tendencias , Estudios Retrospectivos , Factores de Tiempo
16.
BMC Med ; 19(1): 2, 2021 01 05.
Artículo en Inglés | MEDLINE | ID: mdl-33397366

RESUMEN

BACKGROUND: Through a combination of strong routine immunization (RI), strategic supplemental immunization activities (SIA) and robust surveillance, numerous countries have been able to approach or achieve measles elimination. The fragility of these achievements has been shown, however, by the resurgence of measles since 2016. We describe trends in routine measles vaccine coverage at national and district level, SIA performance and demographic changes in the three regions with the highest measles burden. FINDINGS: WHO-UNICEF estimates of immunization coverage show that global coverage of the first dose of measles vaccine has stabilized at 85% from 2015 to 19. In 2000, 17 countries in the WHO African and Eastern Mediterranean regions had measles vaccine coverage below 50%, and although all increased coverage by 2019, at a median of 60%, it remained far below levels needed for elimination. Geospatial estimates show many low coverage districts across Africa and much of the Eastern Mediterranean and southeast Asian regions. A large proportion of children unvaccinated for MCV live in conflict-affected areas with remote rural areas and some urban areas also at risk. Countries with low RI coverage use SIAs frequently, yet the ideal timing and target age range for SIAs vary within countries, and the impact of SIAs has often been mitigated by delays or disruptions. SIAs have not been sufficient to achieve or sustain measles elimination in the countries with weakest routine systems. Demographic changes also affect measles transmission, and their variation between and within countries should be incorporated into strategic planning. CONCLUSIONS: Rebuilding services after the COVID-19 pandemic provides a need and an opportunity to increase community engagement in planning and monitoring services. A broader suite of interventions is needed beyond SIAs. Improved methods for tracking coverage at the individual and community level are needed together with enhanced surveillance. Decision-making needs to be decentralized to develop locally-driven, sustainable strategies for measles control and elimination.


Asunto(s)
Erradicación de la Enfermedad , Programas de Inmunización , Inmunización Secundaria , Sarampión , Regionalización/organización & administración , Cobertura de Vacunación/tendencias , África/epidemiología , Asia Sudoriental/epidemiología , COVID-19/epidemiología , COVID-19/prevención & control , Niño , Erradicación de la Enfermedad/métodos , Erradicación de la Enfermedad/estadística & datos numéricos , Humanos , Programas de Inmunización/métodos , Programas de Inmunización/organización & administración , Inmunización Secundaria/métodos , Inmunización Secundaria/estadística & datos numéricos , Sarampión/epidemiología , Sarampión/prevención & control , Vacuna Antisarampión/uso terapéutico , Región Mediterránea/epidemiología , SARS-CoV-2
17.
BMJ Open ; 11(1): e041536, 2021 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-33414147

RESUMEN

OBJECTIVES: To develop a regional model of COVID-19 dynamics for use in estimating the number of infections, deaths and required acute and intensive care (IC) beds using the South West England (SW) as an example case. DESIGN: Open-source age-structured variant of a susceptible-exposed-infectious-recovered compartmental mathematical model. Latin hypercube sampling and maximum likelihood estimation were used to calibrate to cumulative cases and cumulative deaths. SETTING: SW at a time considered early in the pandemic, where National Health Service authorities required evidence to guide localised planning and support decision-making. PARTICIPANTS: Publicly available data on patients with COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES: The expected numbers of infected cases, deaths due to COVID-19 infection, patient occupancy of acute and IC beds and the reproduction ('R') number over time. RESULTS: SW model projections indicate that, as of 11 May 2020 (when 'lockdown' measures were eased), 5793 (95% credible interval (CrI) 2003 to 12 051) individuals were still infectious (0.10% of the total SW population, 95% CrI 0.04% to 0.22%), and a total of 189 048 (95% CrI 141 580 to 277 955) had been infected with the virus (either asymptomatically or symptomatically), but recovered, which is 3.4% (95% CrI 2.5% to 5.0%) of the SW population. The total number of patients in acute and IC beds in the SW on 11 May 2020 was predicted to be 701 (95% CrI 169 to 1543) and 110 (95% CrI 8 to 464), respectively. The R value in SW was predicted to be 2.6 (95% CrI 2.0 to 3.2) prior to any interventions, with social distancing reducing this to 2.3 (95% CrI 1.8 to 2.9) and lockdown/school closures further reducing the R value to 0.6 (95% CrI 0.5 to 0.7). CONCLUSIONS: The developed model has proved a valuable asset for regional healthcare services. The model will be used further in the SW as the pandemic evolves, and-as open-source software-is portable to healthcare systems in other geographies.


Asunto(s)
COVID-19/epidemiología , Cuidados Críticos/estadística & datos numéricos , Capacidad de Camas en Hospitales/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Regionalización , Capacidad de Reacción , Adolescente , Adulto , Anciano , Niño , Preescolar , Toma de Decisiones , Inglaterra/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Modelos Teóricos , SARS-CoV-2 , Medicina Estatal , Adulto Joven
18.
Global Health ; 17(1): 9, 2021 01 09.
Artículo en Inglés | MEDLINE | ID: mdl-33422092

RESUMEN

Since COVID-19 was first discovered, it exploded into a pandemic resulting in devastating effects on human lives and a global recession. While there have been discussions that COVID-19 will accelerate the 'end of globalization and multilateralism', we have already seen the high costs of non-cooperation in responding to the virus resulting in sub-optimal use of resources, rapid spread of the virus between countries, and, ultimately, significant loss of life. In spite of their favorable demographic structures and relatively young populations, countries in the Global South are still harshly affected in both epidemiological and economic terms. Nations must find innovative ways to address health concerns and regional bodies are possible mechanisms for facilitating international cooperation on health. We delineate how regional organizations can support how countries address health threats namely by serving as a bridge between the global and national policy levels; strengthening disease surveillance; mobilizing supply chains and facilitating trade; supporting the production and procurement of medicines and supplies; and coordinating policies and work with other actors. We finalize by arguing that mechanisms for regional cooperation must be strengthened themselves in order to effectively contribute to positive health outcomes within member states.


Asunto(s)
Salud Global , Cooperación Internacional , Regionalización/organización & administración , COVID-19/epidemiología , COVID-19/prevención & control , Países en Desarrollo , Política de Salud , Humanos
19.
J Manag Care Spec Pharm ; 27(2): 147-156, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33506728

RESUMEN

BACKGROUND: Although medication therapy management (MTM) has specific eligibility criteria and is mandated for specific Medicare Part D enrollees, some health plans have expanded MTM eligibility beyond the minimum criteria to include other Medicare Part D enrollees, Medicaid, and commercial health plan patients. Differences exist in the mode of delivery, location of services, type of personnel involved in managing the service, and the subsequent outcomes. The type and intensity of MTM services delivered have evolved with time to more streamlined and robust interventions, necessitating ongoing evaluation of the effect on clinical and economic outcomes. OBJECTIVE: To assess the effect of changes to an existing MTM program on cost of care, utilization, and medication adherence. METHODS: UPMC Health Plan made changes to an existing MTM program by expanding eligibility (customized by the type of health plan), intervention types, pharmacist involvement, and patient followup contacts. After matching our intervention cohort (identified January 2017-June 2018) with the pre-2016 MTM historical controls (patients identified January 2014-June 2015 who would have been eligible if we used the intervention cohort eligibility criteria), we estimated that the effect of the program changes with a difference-in-difference model (preintervention [2014-2016] and postintervention [2017-2019]). Outcomes of interest included cost (total cost of care including medical, pharmacy, and unplanned care [i.e., unscheduled health care use such as emergency department visits] in 2017 U.S. dollars); utilization; medication adherence (proportion of days covered); and return on investment (ROI). Target population included continuously enrolled patients aged ≥ 21 years in the commercial, Medicare, and Medicaid health plans. RESULTS: Total propensity score-matched members was 10,747, 55% of which were in the historic control group. The average (SD) ages after matching the groups were similar (historical control group: 57.08 years [14.23], intervention group: 56.79 years [14.21]) and the majority was female (57%). Comorbidities identified most for patients included hypertension (77%), dyslipidemia (70%), and diabetes (52%). Forty-one percent were in the commercial, 37% in the Medicaid, and 23% in the Medicare health plans. Proportion of care activities undertaken in the intervention period compared with the control period were significantly different: "sent letter to physician" (67% vs. 87%), "sent letter to member" (15% vs. 0%), "pharmacist phone call to physician" (15% vs. 0.1%), and "pharmacist phone call to member" (13% vs. 7%). There were statistically significant reductions in unplanned care across all health plans especially in the Medicare population, in total cost of care, and increases in medication adherence in 4 therapeutic classes: anticoagulants (OR = 1.25, P = 0.005), cardiac medications (OR = 1.20, P < 0.001), statins (OR = 1.21, P < 0.001), and antidepressants (OR = 1.15, P < 0.001). There was a positive ROI of $18.50 per dollar spent, which equated to a cumulative net savings of $11 million over 24 months. CONCLUSIONS: In a large health plan, expanding MTM eligibility, intensifying patient follow-up contact and pharmacist involvement, and improving provider awareness had favorable clinical and economic benefits. DISCLOSURES: There was no funding for this project except employees' time. All authors are employees of UPMC and have no conflicts of interest to report.


Asunto(s)
Análisis Costo-Beneficio , Cumplimiento de la Medicación/estadística & datos numéricos , Administración del Tratamiento Farmacológico/organización & administración , Aceptación de la Atención de Salud/estadística & datos numéricos , Regionalización/organización & administración , Adulto , Anciano , Comorbilidad , Condicionamiento Operante , Ahorro de Costo , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/epidemiología , Dislipidemias/tratamiento farmacológico , Dislipidemias/epidemiología , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Masculino , Medicaid/economía , Medicaid/organización & administración , Medicare Part D/economía , Medicare Part D/organización & administración , Administración del Tratamiento Farmacológico/economía , Persona de Mediana Edad , Pennsylvania/epidemiología , Regionalización/economía , Estados Unidos
20.
Rev. baiana saúde pública ; 45(Especial 1): 187-203, 20210101.
Artículo en Portugués | LILACS | ID: biblio-1178385

RESUMEN

A Covid-19 é uma doença infecciosa causada pelo novo coronavírus, denominado SARS-CoV-2, que causou um surto de pneumonia viral incomum em pacientes em Wuhan, na China, no final do ano de 2019. O vírus se disseminou pelo mundo em grandes proporções, atingindo o status epidemiológico de pandemia. Diante desse cenário, que afetou toda a Federação brasileira, o Laboratório Central de Saúde Pública Professor Gonçalo Moniz (Lacen-BA) tem exercido papel fundamental no diagnóstico da Covid-19 e na vigilância genômica do SARS-CoV-2. Nesse sentido, este estudo tem como objetivo descrever as estratégias implementadas pelo Lacen-BA para ampliar a capacidade diagnóstica e atender a demanda da rede SUS-BA no contexto da pandemia da Covid-19. Trata-se de um estudo descritivo-observacional, orientado por um modelo lógico sustentado em quatro dimensões: parque tecnológico, metodologias analíticas, descentralização do exame e monitoramento de indicadores de resultados. As iniciativas de gestão possibilitaram ampliação da capacidade instalada e operacional, mediante modernização da estrutura física, renovação do parque tecnológico, reorganização dos fluxos e processos de trabalho, aporte de novas tecnologias analíticas e estruturação de dashboard para monitorar indicadores e subsidiar o processo decisório. O Lacen-BA, enquanto coordenador da Rede Estadual de Laboratórios de Saúde Pública e sistema de apoio da Rede de Atenção à Saúde (RAS), constitui-se então em estruturas policêntricas essenciais para o diagnóstico descentralizado e regionalizado da Covid-19, contribuindo para a integração sistêmica das ações e serviços no contexto da regionalização da saúde, de modo a garantir a universalidade do acesso e integralidade dos cuidados aos usuários do SUS.


Covid-19 is an infectious disease caused by the new coronavirus, called SARS-CoV-2, which caused an outbreak of unusual viral pneumonia in patients in Wuhan, China, at the end of 2019 and spread across the world, in large proportions, reaching the epidemiological status of a pandemic. Considering this epidemiological scenario that affected the entire Brazilian Federation, the Central Laboratory of Public Health Professor Gonçalo Moniz (Lacen-BA) has played a fundamental role in the diagnosis of Covid-19 and the genomic surveillance of SARS-CoV-2. In this sense, this study aims at describing the strategies implemented by Lacen-BA to expand the diagnostic capacity to meet the demand of the SUS-BA network, in the context of the Covid-19 pandemic. This is a descriptive-observational study, guided by a logical model based on four dimensions: technological park, analytical methodologies, decentralization of the exam and monitoring of result indicators. The management initiatives enabled the expansion of the installed and operational capacity by modernizing the physical structure, renewing the technological park, reorganizing workflows and processes, providing new analytical technologies, structuring the dashboard to monitor indicators and support the decision-making process. The Lacen-BA, as coordinator of the State Public Health Laboratory Network and support system of the Health Care Network (RAS), constitutes essential polycentric structures for the decentralized and regionalized diagnosis of Covid-19, which can contribute to the systemic integration of actions and services in the context of regionalization of health to guarantee the universality of access and comprehensive care to SUS users.


El covid-19 es una enfermedad infecciosa causada por el nuevo coronavirus, llamado SARS-CoV-2, que provocó un brote de neumonía viral inusual en pacientes en Wuhan, China, a fines de 2019, y que se extendió por el mundo, en grandes proporciones hasta alcanzar el estado epidemiológico de pandemia. Ante este escenario epidemiológico que afectó a Brasil, el Laboratorio Central de Salud Pública Profesor Gonçalo Moniz (Lacen-BA) ha jugado un papel fundamental en el diagnóstico del covid-19 y la vigilancia genómica del SARS-CoV-2. En este sentido, este estudio tiene como objetivo describir las estrategias implementadas por Lacen-BA para ampliar la capacidad de diagnóstico y atender la demanda de la red SUS-BA, en el contexto de la pandemia del Covid-19. Este estudio es descriptivo-observacional, guiado por un modelo lógico con base en cuatro dimensiones: parque tecnológico, metodologías analíticas, descentralización del examen y seguimiento de indicadores de resultado. Las iniciativas de gestión permitieron ampliar la capacidad instalada y operativa al modernizar la estructura física, renovar el parque tecnológico, reorganizar los flujos y procesos de trabajo, brindar nuevas tecnologías analíticas y estructuración del cuadro de mando para monitorear indicadores, y apoyar la toma de decisiones. Lacen-BA, como coordinador de la Red Estadual de Laboratorios de Salud Pública y sistema de apoyo de la Red de Atención a la Salud (RAS), constituye estructuras policéntricas imprescindibles para el diagnóstico descentralizado y regionalizado del Covid-19, que pueden contribuir a la integración sistémica de acciones y servicios en el contexto de la regionalización de la salud, a fin de garantizar la universalidad del acceso y la atención integral a los usuarios del SUS.


Asunto(s)
SARS-CoV-2/aislamiento & purificación , COVID-19/diagnóstico , Laboratorios , Genoma Viral , Prueba de Ácido Nucleico para COVID-19 , SARS-CoV-2/genética
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