Latin American ophthalmology practitioner's perception on current COVID-19 pandemic / Percepção do profissional latino-americano de oftalmologia sobre a atual pandemia de COVID-19

ABSTRACT Purpose: To assess the perception of Latin American ophthalmology practitioners regarding coronavirus disease 2019 (COVID-19) exposure risk, knowledge about personal protection measures, and prioritization of patients. Methods: Self-administered voluntary anonymous survey (Google Drive forms) was distributed via text message to ophthalmology practitioners from May 01 to May 05, 2020. Results: Three hundred seventy-one practitioners (45% response rate) comprising 118 (27.6%) residents, 111 (40.5%) ophthalmologists, and 142 (32.8%) sub-specialists completed the survey. Among them, 106 (32.6%) thought that they were at a high risk of acquiring COVID-19 during the course of work. Furthermore, 273 (69.1%) believed that the current guidelines were insufficient to identify COVID-19 patients. The survey also revealed that 265 (59.5%) were not trained to use personal protective equipment (PPE), and even with its correct use, 341 (91.5%) still felt that they were at risk of acquiring COVID-19. Moreover, 80% of the respondents were of the view that staff members were not knowledgeable about national protocols for attending COVID-19 patients. However, only 9 (2%) considered changing their profession to ameliorate COVID-19 contagion risk. Conclusion: This survey has revealed the issues faced by ophthalmology practitioners in Latin America during their routine practice. These concerns and anxiety about COVID- 19 pandemic seem to be the same worldwide. It is important to reinforce the confidence of ophthalmology practitioners on current guidelines for attending COVID-19 patients. It is also necessary to conduct training programs on PPE usage and ensure that PPE items are available at all times to enhance the quality of care and minimize the spread of the disease.

RESUMO Objetivos: Avaliar a percepção do risco de exposição da Doença de Coronavírus 2019 (COVID-19), conhecimento sobre medidas de proteção pessoal entre os profissionais de oftalmologia latino-americanos e priorização de pacientes com Covid-19. Métodos: Pesquisa anônima voluntária autoadministrada (formulários do Google Drive) distribuída por mensagem de texto para profissionais de oftalmologia em 1º a 5 de maio de 2020. Resultados: Trezentos e setenta e um profissionais completaram a pesquisa (taxa de resposta de 45%), composta por 118 residentes (27,6%), 111 oftalmologistas (40,5%) e 142 subespecialistas (32,8%). 106 profissionais (32,6%) sentiram-se em alto risco de adquirir o COVID-19 no trabalho. 273 (69,1%) acreditavam que as diretrizes atuais não são suficientes para identificar os pacientes com COVID-19. 265 (59,5%) não tinham treinamento para usar os equipamentos de proteção individual (EPI) e, mesmo com seu uso correto, 341 (91,5%) ainda se sentiram em risco de adquirir COVID-19. 80% consideraram que a equipe de trabalho não tem conhecimento de protocolos nacionais para o atendimento aos pacientes com COVID-19. Apenas 9 dos profissionais (2%) consideraram mudar a profissão para minimizar o risco de contágio por COVID-19. Conclusão: Esta pesquisa mostra a escassez de pessoal e treinamento específico que os praticantes de oftalmologia na América Latina enfrentam em sua prática diária. Essas preocupações e ansiedade parecem ser as mesmas em todo o mundo com a pandemia de COVID- 19. É importante reforçar a confiança dos profissionais de oftalmologia nas diretrizes atuais de atendimento ao paciente com COVID-19 e também disponibilizar programas de treinamento sobre o uso de EPI e também itens de EPI disponíveis em todos os momentos para garantir a qualidade do atendimento e a disseminação mínima da doença.

Experiencia en el desarrollo e implementación de la metodología de grupos relacionados por diagnóstico en un hospital universitario chileno. Evaluación a diez años de funcionamiento / Implementation of diagnosis related groups methodology in a university hospital

Background The Diagnosis Related Groups (DRG) constitute a method of classifying hospital discharges. Aim To report its development and implementation in a Chilean University Hospital and global results of 10 years Material and Methods We included 231,600 discharges from 2007 to 2016. In the development we considered the physical plant, clinical record flow, progressively incorporated human resources and computer equipment for coding and analysis to obtain results. The parameters used were: average stay, average DRG weight, mean of diagnosis and codified procedures, behavior of upper outliers, hospital mortality, distribution by severity and its relationship with other variables. Results The global complexity index was 0.9929. The average of diagnoses coded was 4.35 and of procedures was 7.21. The average stay was 4.56 days, with a downward trend. The top outliers corresponded to 2.25%, with stable hospital days and average DRG weight. The median of hospital mortality was 1.65% with a tendency to decrease and stable DRG mean weight. Seventy two percent had a grade 1 severity, with low median hospital stay. They occupied 40% of bed days. Nine percent had a grade 3 severity with high median hospital stay and accounting for 31.5% of bed days. Conclusions DRG methodology is a valuable information tool for decision making and result assessment in hospital management.

Consumo de alcohol en la población colombiana. Encuesta Nacional de Salud Mental 2015 / Alcohol Consumption in the Colombian Population, 2015 National Mental Health Survey

Resumen Introducción: Introducción: La Encuesta Nacional de Salud Mental (ENSM) de 2015 indagó en Colombia, entre otros asuntos, sobre el de consumo de alcohol de las personas entre 12 y 17 años y de 18 y más años. Se presentaron los datos según edad y región, sin realizar cruces con otras variables de salud mental, problemas, trastornos, acceso a servicios, estados de salud y su valoración. Objetivo: Evaluar la prevalencia del consumo de alcohol en la población colombiana de edad ≥ 12 años teniendo en cuenta las variables sociodemográficas y el cribado clínico. Métodos: Análisis secundario de base de datos de la ENSM 2015; constituyeron la muestra 15.231 personas de 12 a 96 años de 13.200 hogares de cinco regiones del país (Atlántica, Bogotá, Central, Oriental y Pacífica). Se usó el Alcohol and Use Disorder Identification Test, corto y completo (AUDIT y AUDIT-C), con análisis estratificado según puntuación y otras variables incluidas en la encuesta. Resultados: El 2,7% de los menores estudiados entran en la categoría de bebedor de riesgo. El mayor porcentaje de bebedores de riesgo se ubica en la franja de 18 a 44 años, con clara mayoría de varones. Conclusiones: El estudio encuentra que un AUDIT-C positivo en mayores de edad se asocia con mayor porcentaje de no presentar síntomas ansiedad y menos problemas de ansiedad, eventos traumáticos y eventos traumáticos por conflicto armado reportados. Esto requiere más estudios. Las personas adultas con AUDIT-C positivo tienen mayor percepción de bienestar, aunque también se halla mayor porcentaje de hogares en estado de pobreza. El estudio de factores individuales, sociales, familiares y ambientales en poblaciones específicas se debe desarrollar para realizar intervenciones más adecuadas.

Abstract Introduction: National Survey of Mental Health (ENSM) in 2015 in Colombia asks, among other conditions, about alcohol consumption in people 12-17 years old, and 18 and older. Data were presented by age and region, with no cross-references to other categories of mental health problems, disorders, access to services, and health status. Objective: To assess alcohol consumption in Colombia, taking into account sociodemographic and clinical screening categories included. Methods: Secondary database analysis, sample size: 15,231 people from 13,200 households of five regions (Atlantic, Bogotá, Central, Eastern, and Pacific), with an age range from 12 to 96 years. AUDIT and AUDIT-C were used and stratified according to score and other variables included in the survey analysis. Results: The high-risk drinking category was observed in 2.7% of children studied, with the highest percentage of drinking risk lying in the range of 18 to 44 years, with a clear majority of men. Conclusions: The study finds that a positive AUDIT-C in adults is associated with a higher percentage of non-anxiety, less anxiety problems, and traumatic events and traumatic events related to armed conflict. This requires further studies. Adults with positive AUDIT-C have a greater perception of well-being, but also a higher percentage of households in poverty. The study of individual, social, family and environmental factors in specific populations should be developed in order to make more appropriate interventions.

Use of Emergency Medical Services and Characteristics of Urgent and Non-Urgent Adult Patients according to the Usual Source of Care: A Korea Medical Expenditure Panel Study

PURPOSE: Use of emergency rooms (ERs) has increased considerably in Korea. This increase has caused over-crowding and has increased the burden on ER services, created a lack of continuous service provided by ERs, and raised costs. The objective of this study was to examine the characteristics of ER use for urgent and non-urgent cases in 2009-2011. METHODS: In this multivariate analysis, we included data collected from the 2009-2011 Korea Medical Expenditure Panel Survey to assess independent factors associated with ER use in non-urgent settings. We consecutively included patients > or =19 years who had completed the survey until 2011. RESULTS: Among the 10,428 respondents, 19.1% of patients had used ERs. Patients who had used EDs were less likely to have attended graduate school (high school: odds ratio [OR], 0.78 [0.63-0.98]; university: OR, 0.69 [0.54-0.89]) or have chronic disease (OR: 0.68 [0.60-0.78]). In addition, patients who did not have a usual source of care (OR, 0.78 [0.70-0.87]) or those who did not have private insurance (OR, 0.86 [0.74-0.99]) were less likely to use ERs. In the 1,994 cases of ER use, however, the any factors were not affected in the non-urgent ER use group. CONCLUSION: The number of patients who used ERs has increased, and there were no significant differences in ER use between non-urgent and urgent patients. ERs may have been used for non-urgent cases owing to other reasons. Further studies on the reasons for non-urgent ER use and development of urgent patient criteria are required.

A Survey of Patients Who Were Admitted for Life-Sustaining Therapy in Nationwide Medical Institutions / 대한구급학회지

BACKGROUND: The study focused on figuring out the present status and distribution of the underlying diseases of Korean terminally ill patients (TIP) who were on life-support care (LSC) by conducting a nationwide health care survey. METHODS: The authors of this study requested that the 308 nationwide hospitals that operate intensive care units answer a questionnaire that asked about the number of admitted TIPs and their underlying diseases at 12 Am, 22 July, 2009. The proportion of TIPs among all the admitted patients and the percentages of the TIP's underlying diseases were calculated. RESULTS: In a total of 83.1% of the eligible hospitals responded, the proportion of TIP was 1.6 of 100 admitted patients. Terminal cancer was the leading underlying disease in the TIPs (42.4%). Five % of the patients on LSC were brain dead. More TIPs were admitted in the national/public or university hospitals than in the private or non-university hospitals. CONCLUSIONS: Futile treatment seems to be administered to the TIPs in Korean hospitals. The quality of terminal care in Korean hospitals should be improved by the application of socially acceptable LSC guidelines. Timely government health plans, including hospice care, to improve the quality of palliative care should be launched and maintained.

Survey of eye care services in Yunnan Province of China in 2007 / 眼科

Objective To investigate the status and capacity of eye care services in Yunnan Province in 2007. Design Cross-sectional questionnaire survey. Participants 165 medical institutions in Yunnan Province. Methods Using a standardized questionnaire designed by Ministry of Health,the all hospitals of county or above and eye hospitals in Yunnan Province were investigated during October to December 2007. Main Outcome Measures Number of ophthalmologists and ophthalmic nurses,surgical volume per year,out-patient volume per year and number of ophthalmologists who can operate cataract independently. Results Totally 165 hospitals covered Yunnan Province participated in this study (response rate was 100%). In all these institutions,there were 735 ophthalmologists and 771 nurses. 392 ophthalmologists could perform cataract surgery independently. Within 16 prefectures of Yunnan,Zhaotong prefecture had the least resources of ophthalmology (7 ophthalmologists per million population) while Kunming had 32 ophthalmologists per million populations. In 2006,58346 eye surgeries were performed in all these institutions,including 23833 cases of cataract surgeries. 27 hospitals were not able to provide cataract surgical services. Out 165 institutions,only 29 hospitals (17.6%) had advanced ophthalmic equipments and 6 hospitals (3.6%) did not have any ophthalmic equipment. Conclusion There are big differences of eye care services among different level and different location of medical institutions in Yunnan Province of China. Inappropriate distribution of human resources and low productivity are main issues. Further resources allocation and optimized use of resources in eye care services are needed to meet the needs of patients.