scholarly journals Os Desafios dos Hospitais Perante a COVID-19 e a Gripe Sazonal Durante o Outono-Inverno de 2020/2021

2020 ◽  
Vol 33 (11) ◽  
pp. 716
Author(s):  
Luís Campos ◽  
Kamal Mansinho ◽  
Paulo Telles de Freitas ◽  
Victor Ramos ◽  
Constantino Sakellarides
Keyword(s):  
Emergency Departments ◽  
Hospital Care ◽  
Respiratory Viruses ◽  
High Level ◽  
Regional Solutions ◽  
Second Wave ◽  
Perfect Storm

The possibility of a second wave of the COVID-19 pandemic coexisting with a simultaneous epidemic of influenza and the co-circulation of other seasonal respiratory viruses sets the stage for a perfect storm. Preparing for the Autumn-Winter of 2020/2021 is complex, requiring centralized guidance but local and regional solutions, with strong leadership and a high level of coordination. It is essential to act upstream of hospitals in order to reduce demand on emergency departments, minimizing the risk of transmission that occurs there and the team overload, as well as downstream to ensure capacity for hospitalization and in the hospital itself to optimize resources and organization. The failure of this plan will create unbearable pressure on hospital care. The authors describe the challenges lying ahead for hospitals and the most important measures that should be included in this plan to prepare the Autumn-Winter of 2020/2021 in Portugal.

scholarly journals Presence of atopy increases the risk of asthma relapse

2017 ◽  
Vol 103 (4) ◽  
pp. 346-351 ◽  
Author(s):  
Laurel Teoh ◽  
Ian M Mackay ◽  
Peter P Van Asperen ◽  
Jason P Acworth ◽  
Mark Hurwitz ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Acute Asthma ◽  
Respiratory Viruses ◽  
Prick Test ◽  
Asthma Exacerbations ◽  
A Prospective Study ◽  
Micro Organisms ◽  
The Impact ◽  
Atypical Bacteria

ObjectivesTo describe the point prevalence of respiratory viruses/atypical bacteria using PCR and evaluate the impact of respiratory viruses/atypical bacteria and atopy on acute severity and clinical recovery in children with hospitalised and non-hospitalised asthma exacerbations.DesignThis was a prospective study performed during 2009–2011.SettingThe study was performed in the emergency departments of two hospitals.Patients244 children aged 2–16 years presenting with acute asthma to the emergency departments were recruited. A nasopharyngeal aspirate and allergen skin prick test were performed.Main outcome measuresThe outcomes were divided into (1) acute severity outcomes (Australian National Asthma Council assessment, hospitalisation, Functional Severity Scale, Acute Asthma Score, asthma quality of life questionnaires for parents (PACQLQ) on presentation, asthma diary scores (ADS) on presentation and length of hospitalisation) and (2) recovery outcomes (PACQLQ for 21 days, ADS for 14 days and representation for asthma for 21 days).ResultsPCR for viruses/atypical bacteria was positive in 81.7% of children (75.1% human rhinovirus, codetection in 14.2%). Mycoplasma pneumoniae and Chlamydophila pneumoniae were rarely detected. The presence of micro-organisms had little impact on acute asthma or recovery outcomes. Children with atopy were significantly more likely to relapse and represent for medical care by day 14 (OR 1.11, 95% CI 1.00 to 1.23).ConclusionsThe presence of any viruses is associated with asthma exacerbations but does not appear to influence asthma recovery. In contrast, atopy is associated with asthma relapse. M. pneumoniae and C. pneumoniae are rare triggers of acute asthma in young children.

scholarly journals EVALUATION OF DIAGNOSTIC QUALITY CRITERIA OF EMERGENCY CARE FOR DISEASES OF SURGICAL PROFILE AT EMERGENCY DEPARTMENTS

2020 ◽  
Vol 21 (3) ◽  
pp. 11-17
Author(s):  
R. R. Alimov ◽  
A. G. Miroshnichenko ◽  
E. L. Lataria ◽  
I. A. Turov
Keyword(s):  
Emergency Medicine ◽  
Medical Care ◽  
Diagnostic Criteria ◽  
Emergency Care ◽  
Emergency Departments ◽  
Quality Evaluation ◽  
Evaluation Criteria ◽  
Quality Criteria ◽  
Diagnostic Quality ◽  
High Level

The article presents an analysis of diagnostic criteria of quality evaluation for emergency medicine and specialized medical care in emergency departments. The results of the study of emergency medicine care in compliance with quality evaluation criteria showed that in groupe of general criteria for quality evaluation it was achieved in 100 prc cases, in groupe of evaluation criteria of extent of medical aid - in 97,4 prc cases, n groupe of evaluation criteria of timely diagnosis and treatment — 98,2 prc. It also shows the high level of medical care in this department.

scholarly journals The Oxford Service for the Young Adult Chronically Mentally Ill

1987 ◽  
Vol 11 (11) ◽  
pp. 377-379
Author(s):  
G. P. Pullen
Keyword(s):  
Hospital Care ◽  
Psychiatric Hospitals ◽  
Group Homes ◽  
Psychiatric Illnesses ◽  
Realistic Option ◽  
Wide Range ◽  
Active Rehabilitation ◽  
High Level ◽  
Oxford Group ◽  
The University

Oxfordshire is a pleasant, prosperous county dominated by the City where about one third of its 480,000 population lives. Oxford itself has nearly 15,000 students attending the University or Polytechnic. The active rehabilitation of long-stay patients was started in Oxford over 25 years ago, with the result that by 1986 there were only 40 non-dementing psychiatric-in-patients with a current admission of five or more years. This successful programme of rehabilitation, now virtually completed, was achieved by creating a wide range of sheltered work and other activities, and by the provision since 1963 of over 40 group homes and hostels by the Oxford Group Homes Organisation. However, many psychiatric illnesses still have a chronic and relapsing course; 65% of all admissions, aged 18 to 65 to the Oxford District mental illness units in 1982 and 1983, were readmissions. For those diagnosed as suffering from schizophrenia the figure rises to 80%. In 1972 and 1973 Mann & Cree surveyed 400 ‘new’ long-stay patients (current admission one to five years, aged 18 to 65) in 15 hospitals in England and Wales. They found a rate of 25 per 100,000 population and concluded that for about one third continuing hospital care was the only realistic option. If the remainder were to leave hospital, hostels providing a high level of support would be needed. The recent 1982 survey of ‘new chronic’ in-patients in 14 Scottish psychiatric hospitals still showed a rate of 17.2 per 100,000 population, of whom only 38% were not thought to be in need of continuing hospital care.

scholarly journals Improving the operational skills of the health personnel working in the emergency departments

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
R Arnone ◽  
G Romano ◽  
J Skinner ◽  
S Watt ◽  
C Poenicke ◽  
...  
Keyword(s):  
Best Practices ◽  
Emergency Departments ◽  
Health Personnel ◽  
Health Sector ◽  
Research Centre ◽  
The European Union ◽  
Research Activities ◽  
One Year ◽  
High Level ◽  
The University

Abstract In December 2013 the European Commission approved the project promoted by CEFPAS, The Centre for Training and Research in Public Health within the programme PROGRESS, “Improving the operational skills of health personnel working in the emergency departments. A useful tool to give concrete answers to EU policies on patients’ safety and to create new working opportunities”. This project aimed to combine the need to find innovative solutions in the field of healthcare with the objective of increasing the safety of patients in emergency departments, while also covering the need to promote worker mobility within the European Union. The key tool for implementing this goal is the exchange of experience and best practices. The project partners included: the Edinburgh University of Medicine, the Napier University (again in Edinburgh), the Dresden University of Technology, the Herlev Hospital (in Copenhagen) through the DIMS or the Danish Institute for Medical Simulation at the University of Copenhagen, as well as ISMETT and CREAM (the Research Centre of the University of Medicine) in Palermo. Every partner, during the planning, has provided the know how developed in the area of emergency. Specifically it has been analyzed the possibility to compare and visit the simulation Centres of Edinburgh, Dresden and Palermo, and to study the use, in each country, of innovative methodology during the training of the health personnel. The partner, during the planning of the project, studied also how to help people to find easier jobs opportunities in the health sector (so they thought to create a specific data base of the emergency departments operating in Italy, Scotland and Germany where to find a job or a chance for an internship). The project has lasted for one year and has provided research activities and the exchange of experience and best practices. Key messages There is a huge difference regarding the way in which the emergency system is organized within single countries around Europe. Comparing high-level organisations we have benefited in terms of ideas, projects and potential objectives to be set in order to improve our work and to improve results for patients.

scholarly journals The caring perspective during a COVID pandemic

2021 ◽  
Vol 31 (Supplement_3) ◽  
Author(s):  
Julian Mamo
Keyword(s):  
Health Care ◽  
Media Coverage ◽  
Hospital Care ◽  
Older Persons ◽  
Care Delivery ◽  
Health Care Practitioner ◽  
Specialist Care ◽  
Primary Health ◽  
Hospital Wards ◽  
Second Wave

Abstract Work as a private primary health care practitioner with a special interest in older persons has been a rollercoaster ride over the course of the pandemic with the need to improvise, provide a wider form of care and an inordinate amount of role changing. The initial recommendation was to stay away from any possible cases which may have remotely resembled COVID with a view to keeping physicians and their practice safe. This message was unheard after the start of the second wave as the health services struggled to cope, testing became ever more accessible and patients who did develop COVID-19 needed someone to care for them when state services were overstretched. Meanwhile, the availability of all forms of specialist care grew ever scarcer in the community and increasingly caregivers such as myself realised that boundaries were now blurred under such circumstances. As hospital wards became taken up with exclusively COVID-19 patients, other hospital care delivery became on an urgent only basis and this had an effect on care in the community for patients living with chronic diseases. Physicians such as myself became ever more involved in caring for persons with mental illness and with the plethora of anxiety prevalent in a community burdened with a pandemic, an overabundance of morbid media coverage and social media feeding on fear and doubt.

Paths to Reducing Medical Injury: Professional Liability and Discipline vs. Patient Safety — And the Need for a Third Way

2001 ◽  
Vol 29 (3-4) ◽  
pp. 369-380 ◽  
Author(s):  
Randall R. Bovbjerg ◽  
Robert H. Miller ◽  
David W. Shapiro
Keyword(s):  
Hospital Care ◽  
Systems Of Care ◽  
Institute Of Medicine ◽  
Third Way ◽  
Medical Practitioners ◽  
The Public ◽  
Medical Injury ◽  
Medical Institutions ◽  
Systematic Improvement ◽  
High Level

Too many patients are injured in the course of care. Clinicians may mistakenly cause new harm to a patient or fail to take established steps to improve the presenting condition. Medical institutions within which they work may lack mechanisms to reduce errors or prevent them from harming patients. Many, perhaps even most, injuries are preventable, probably numbering in the hundreds of thousands a year for hospital care alone. Long ignored by medical practitioners and health-care payers and little appreciated by the public, the problem of medical injury is finally receiving high-level policy attention. Much credit goes to the Institute of Medicine (IOM) for its landmark report of November 1999, which marshaled the evidence about medical injuries and highlighted new approaches to systematic improvement of safety within systems of care.

scholarly journals Healthcare-Associated Infections: Enterobacteriaceae Bloodstream Infections in the ICU Settings

2020 ◽  
Vol 41 (S1) ◽  
pp. s246-s247
Author(s):  
Marta KŁOS ◽  
Monika Pomorska-Wesołowska ◽  
Dorota Romaniszyn ◽  
Agnieszka Chmielarczyk ◽  
Jadwiga Wojkowska-Mach
Keyword(s):  
Drug Resistance ◽  
Hospital Care ◽  
Empirical Therapy ◽  
Bloodstream Infections ◽  
High Rate ◽  
Diffusion Method ◽  
Resistance Testing ◽  
High Level ◽  
Healthcare Associated ◽  
Hospital Acquired

Background: Bloodstream infections (BSIs) are one of the most frequently observed hospital-acquired infections (HAIs). Objectives: We aimed to describe the epidemiology and drug resistance of hospital-acquired Enterobacteriaceae BSIs and to check for any correlation with the type of hospital care. Methods: In 2015–2018, 333 Enterobacteriaceae isolates were collected from hospitalized internal medicine and surgical patients. The drug-resistance testing was conducted according to the EUCAST recommendations, using the disc-diffusion method to determine resistance to penicillin, cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and sulfamethoxazole with trimethoprim. Tests confirming the presence of extended-spectrum β-lactamases (ESBLs) and KPC, NDM, and OXA-48 carbapenemases were performed. We determined the minimum inhibitory concentration (MIC) values (mg/L) for selected antibiotics. To detect the resistance genes, a single PCR reaction, a multiplex PCR, and a real-time PCR were conducted. Results: The prevalence rate of Enterobacteriaceae bacilli in BSIs was 23.5%. Penicillin resistance remained at a very high level of almost 100%, with only the piperacillin-tazobactam resistance remaining at 19%–22%. The same was true for cephalosporins: the bacilli have only shown a high susceptibility to cefoperazone with sulbactam (4%–14% of them were resistant). Ciprofloxacin (53%–62%) and sulfamethoxazole with trimethoprim (48–55%) have proven highly resistant. Carbapenems were the only antibiotics with susceptibility at 98%–99%. No difference was found between the types of hospital care (surgical vs nonsurgical) and the levels of antimicrobial resistance in the studied Enterobacteriaceae isolates (Table 1). Conclusions: The high prevalence of Enterobacteriaceae bacilli in BSI is particularly worrying, as is the high rate of resistance to cephalosporins and aminoglycosides, which are often used in the empirical therapy. Unfortunately, our results indicate the need to base the empirical therapy on carbapenems.Funding: This work was supported by a grant from Jagiellonian Univerity Medical School (No. N41/DBS/000053)Disclosures: None

scholarly journals Nurses' Knowledge and Skills to Manage Patients with Psychological Distress in Emergency Departments

2020 ◽  
Vol 14 (1) ◽  
pp. 49-55
Author(s):  
Ahmad N. AlShibi ◽  
Ayman M. Hamdan-Mansour
Keyword(s):  
Mental Health ◽  
Psychological Distress ◽  
Emergency Departments ◽  
Signs And Symptoms ◽  
Previous Experience ◽  
Convenience Sample ◽  
Knowledge And Skills ◽  
Level Of Knowledge ◽  
High Level ◽  
Nurses Knowledge

Background: Identifying and managing patients with psychological distress is a challenge to nurses at emergency departments at hospitals not specialized in psychiatric mental health. This requires that nurses must be equipped with knowledge and skills to fulfill patients’ needs. Objectives: The purpose of this study is to identify the knowledge and skills of nurses to manage patients with psychological distress in emergency departments. Methods: A convenience sample of 307 registered nurses working at emergency departments completed and returned a package of surveys regarding knowledge and skills to manage patients with psychological distress in emergency departments. Results: Although nurses were found to have a high level of knowledge about managing psychological distress, their level of skills was lower. Nurses were found to encounter difficulty in identifying signs and symptoms of patients with psychological distress at emergency departments. A significant and positive correlation was found between nurses’ knowledge and skills (r =.68, p < .001). Statistical and significant differences were found in the knowledge of nursesin relation to their previous experience of receiving training and courses in managing psychological distress (p < .05). Conclusion: Nurses need to improve the level of knowledge in order toidentify the psychological and physical signs and symptoms of psychological distress, as well as to be equipped with skills that make them capable tof providing proper care and meeting patients’ needs with psychological distress at emergency departments.

scholarly journals Evaluation of Work Resumption Strategies after COVID-19 Reopening in the Chinese City of Shenzhen: A Mathematical Modeling Study

2020 ◽  
Author(s):  
Lu Bai ◽  
Haonan Lu ◽  
Hailin Hu ◽  
M. Kumi Smith ◽  
Katherine Harripersaud ◽  
...  
Keyword(s):  
Population Control ◽  
Epidemiological Data ◽  
Population Mobility ◽  
Mobility Data ◽  
Intervention Measures ◽  
Imported Cases ◽  
High Level ◽  
The Impact ◽  
Second Wave ◽  
Work Resumption

Abstract BackgroundAs China is facing a potential second wave of the epidemic, we reviewed and evaluated the intervention measures implemented in a major metropolitan city, Shenzhen, during the early phase of Wuhan lockdown. MethodsBased on published epidemiological data on COVID-19 and population mobility data from Baidu Qianxi, we constructed a compartmental model to evaluate the impact of work and traffic resumption on the epidemic in Shenzhen in various scenarios.ResultsImported cases account for the majority (58.6%) of the early reported cases in Shenzhen. We demonstrated that with strict inflow population control and a high level of mask usage following work resumption, various resumption schemes resulted in only an insignificant difference in the number of cumulative infections. Shenzhen may experience this second wave of infections approximately two weeks after the traffic resumption if the incidence risk in Hubei is high at the moment of resumption.ConclusionControl of imported cases and extensive use of facial masks were the key for the prevention of the COVID-19 epidemic in Shenzhen during its reopening and work resumption.

scholarly journals TREATMENTS, RESOURCE UTILIZATION, AND OUTCOMES OF COVID-19 PATIENTS PRESENTING TO EMERGENCY DEPARTMENTS ACROSS PANDEMIC WAVES: AN OBSERVATIONAL STUDY BY THE CANADIAN COVID-19 EMERGENCY DEPARTMENT RAPID RESPONSE NETWORK (CCEDRRN)

2021 ◽  
Author(s):  
Corinne M Hohl ◽  
Rhonda J Rosychuk ◽  
Jeffrey P Hau ◽  
Jake Hayward ◽  
Megan Landes ◽  
...  
Keyword(s):  
Emergency Department ◽  
Critical Care ◽  
Observational Study ◽  
Disease Severity ◽  
Acute Care ◽  
Resource Utilization ◽  
Emergency Departments ◽  
Patient Characteristics ◽  
Response Network ◽  
Second Wave

Background: Treatment strategies for coronavirus disease 2019 (COVID-19) evolved between pandemic waves. Our objective was to compare treatments, acute care resource utilization, and outcomes of COVID-19 patients presenting to Emergency Departments across two pandemic waves. Methods: This observational study enrolled consecutive eligible COVID-19 patients presenting to 46 Emergency Departments participating in the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) between March 1 and December 31, 2020. We collected data by retrospective chart review. Our primary outcome was in-hospital mortality. We used logistic regression modeling to assess the impact of pandemic wave on outcomes. Results: We enrolled 9,967 patients in 8 provinces, 3,336 from the first and 6,631 from the second wave. Patients in the second wave were younger, fewer met criteria for severe COVID-19, and more were discharged from the Emergency Department. Adjusted for patient characteristics and disease severity, steroid use increased (odds ratio [OR] 8.0; 95% confidence interval [CI] 6.4 — 10.0), while the use of invasive mechanical ventilation decreased (OR 0.5; 95%CI 0.4 — 0.6) in the second wave. After adjusting for differences in patient characteristics and disease severity, the odds of hospitalization (OR 0.7; 95%CI 0.6 — 0.8) and critical care admission (OR 0.6; 95%CI 0.4 — 0.7) decreased, while mortality remained unchanged (OR 1.0; 95%CI 0.7-1.4). Interpretation: In patients presenting to Canadian acute care facilities, rapid uptake of steroid therapy was evident. Mortality was stable despite lower critical care utilization in the second wave.

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