Experiencia de la pandemia por SARS-CoV-2 en un centro hospitalario de alta complejidad en Chile

Background: The knowledge about the epidemiological profile of patients admitted to the hospital for severe COVID infection, allows an adequate health care planning and resource allocation. Aim: To describe the epidemiology of patients with COVID-19 admitted to a public hospital between March 2020 and July 2021. Material and Methods: Demographic variables, comorbidities, ventilatory support requirements, and hospital resources were recorded from clinical records and hospital databases of diagnosis related groups. The primary outcomes were overall mortality and need of ventilatory support. Results: In the study period, 4,474 patients (56% males) were hospitalized with a diagnosis of COVID-19. Overall mortality was 25.8% and in-hospital mortality was 18%. Invasive and non-invasive ventilatory support was required in 1349 (30.2%) and 2060 (46%) patients, respectively. The most common comorbidities in admitted patients were diabetes mellitus (29.2%), chronic kidney disease (11.1%), and chronic liver disease (10.4%). The readmission rate was 3.2%. Conclusions: Mortality associated with COVID-19 in this hospital was similar to the rates reported abroad. Local risk predictors for this infection should be identified.

Behavioural intention of hand hygiene compliance in an average Ecuadorian hospital

SUMMARY OBJECTIVE: This study aimed to characterize hand hygiene behavioural intention by hospital services clusters in a medium-sized hospital in an Ecuadorian city. METHODS: This is a cross-sectional study based on the World Health Organization Hand Hygiene Knowledge Questionnaire for Health-Care Workers. The responses on hand hygiene behavioural intention for the Five Moments for hand hygiene according to the World Health Organization were recorded in three categories: before patient contact, before and after sterile technique and management of body fluids, and after contact with the environment of the patient. The variables were the knowledge regarding the source of germs causing nosocomial infections, the optimal time to achieve disinfection with alcohol, hospital services clusters (clinical medicine, surgery, and therapeutic services), and history of previous formal hand hygiene training. The variables in each moment were analysed using a saturated log-linear model. RESULTS: The average age of participants was 34 years (Q1 32.1-Q3 36.4). Of them, 62% belonged to the clinic cluster and 87.6% had previous formal hand hygiene training. The incorrect response rates for before and after sterile technique and management of body fluids, before patient contact, and after contact with the environment of the patient were 30.2, 88.4, and 99.2%, respectively. In before patient contact, the incorrect responses for optimal time depended on the department (worse surgery cluster situation), and in before and after sterile technique and management of body fluids and after contact with the environment of the patient, the incorrect responses for source of germs depended on the previous formal hand hygiene training and the department (worse surgery and clinic clusters). CONCLUSION: The incorrect answer related to hand hygiene behavioural intention was high compared to other reports, and the worse situation was found in after contact with the environment of the patient and before patient contact. These data suggest the need of strengthening permanently the hand hygiene programme.

Neumonía por COVID-19. Experiencia de un hospital público de Argentina / COVID-19 pneumonia. Experience of a public hospital in Argentina

Resumen El objetivo del presente estudio fue describir la presentación clínica y la evolución de los pacientes hospitalizados con neumonía por COVID-19. Se trata de un estudio descriptivo prospectivo. Se incluyeron individuos mayores de 16 años con diagnóstico de COVID-19 confirmado por reacción en cadena de la polimerasa en el 94.0% (n = 395) de los casos. Se realizaron determinaciones bioquímicas e imagenológicas. Se incluyeron 421 sujetos, 57.0% (n = 240) de sexo masculino, con una edad media de 56.1 ±15.1 años. El 41.0% (n = 172) comprendió a mayores de 60 años. El 79.7% (n = 333) tenía comorbilidades. Llevaban 7 días (IQR 5) de sintomatología al ingreso hospitalario. Los síntomas más frecuentes fueron: disnea (78.1%, n = 307), tos (76.5%, n = 297) y fiebre (73.6%, n = 289). El 50.2% (n = 204) tenía insuficiencia respiratoria al ingreso. En el 63.4% (n = 173) se observaron infiltrados patológicos en la radiografía y en el 96.0% (n = 312) en las tomo grafías de tórax. El score 4C fue de 8 (IQR 6). El 31.6% (n = 133) tuvo mala evolución clínica. La mortalidad intrahospitalaria fue del 18.9% (n = 80) y el 23.7% (n = 99) recibió asistencia respiratoria mecánica. El 21.9% (n = 92) presentó complicaciones intrahospitalarias. El 39.6% (n = 67) de los mayores de 60 años fue admitido a la Unidad de Cuidados Intensivos y el 31.4% (n = 54) falleció. Recibieron corticoides el 76.9% (n = 319) de los pacientes, antibióticos el 69.3% (n = 289) y plasma de convaleciente el 10.5% (n = 43). Esta serie se destaca por la alta tasa de comorbilidades y la gravedad de los pacientes incluidos. La mortalidad fue similar a otras series internacionales.

Abstract COVID-19 pneumonia represents a challenge for health systems. The objective of this study is to describe the clinical presentation and evolution of hospitalized patients with COVID-19 pneumonia. This is a prospective and descrip tive study. Patients older than 16 years with a PCR confirmed diagnosis of COVID-19 were included in 94.0% (n = 395) of the cases. Biochemical and imaging determinations were made. 421 patients were included, 57.0% male (n = 240), with a mean age of 56.1 ± 15.1 years. 41.0% (n = 172) were older than 60 years. 79.7% (n = 333) had comorbidities. They had seven days 7 days (IQR 5) from symptom onset to hospitalization. The most frequent symptoms were: dyspnea (78.1%, n = 307), cough (76.5%, n = 297) and fever (73.6%, n = 289). 50.2% (n = 204) presented respiratory failure upon admission. 63.4% (n = 173) presented pathological infiltrates on radiography and 96.0% (n = 312) on chest tomography. The 4C score was 8 (IQR 6). 31.6% (n = 133) had a poor clinical evolution. In-hospital mortality was 18.9% (n = 80) and 23.7% (n = 100) received mechanical ventilation. 21.9% (n = 92) presented in-hospital complications. 39.6% (n = 67) of those over 60 years of age were admitted to the Intensive Care Unit and 31.4% (n = 54) died. 76.9% (n = 319) of the patients received corticosteroids, 69.3% (n = 289) antibiotics, and convalescent plasma 10.5% (n = 43). This series stands out for the high rate of co morbidities and the severity of the patients included. Mortality was similar to other international series.

Diagnostic discrepancies between emergency department admissions and hospital discharges among older adults: secondary analysis on a population-based survey

BACKGROUND: Older adults frequently experience nonspecific clinical features. However, there is limited evidence on how often admission diagnoses for hospitalized older patients are incorrect, potentially leading to treatment delays. OBJECTIVES: To determine the consistency between hospital admission and discharge diagnoses, and identify factors associated with diagnostic discrepancies in older adults. DESIGN AND SETTING: Population-based cohort study in the United States. We included adults aged ≥ 18 years who were admitted from emergency departments (EDs) to hospitals, identified using the 2005-2010 National Hospital Ambulatory Medical Survey, a nationally representative survey. METHODS: Three admission diagnoses and the principal discharge diagnosis were captured and classified as discrepant if they involved considerably different conditions within the same organ system, or different organ systems altogether. RESULTS: Each year, 12 million adults were hospitalized following ED visits in the United States; 45% were aged ≥ 65 years. These patients' mean age was 79 years and 58% were women. Diagnostic discrepancies between admission and discharge were more common among adults ≥ 65 years (12.5 versus 8.3%; P < 0.001). Certain admission diagnoses had particularly high rates of diagnostic discrepancies: 26-27% of patients presenting with mental disorders or with endocrine and metabolic diseases had substantial diagnostic discrepancies between admission and discharge. Substantial diagnostic discrepancy was independently associated with longer hospitalization and higher in-hospital mortality. CONCLUSION: One out of eight older adults hospitalized from EDs was discharged with a principal diagnosis differing considerably from the admission diagnosis. Given that missed or delayed diagnoses are a critical safety problem, clinicians should be vigilant and frequently cogitate alternative diagnostic possibilities

Asociación entre niveles de vitamina B-12 y mortalidad en pacientes hospitalizados adultos mayores / Association between high vitamin B12 levels and one year mortality in older people admitted to the hospital

Background: Supplementation of vitamin B12 in older adults is a common practice to avoid vitamin B12 insufficiency. However, there is a paucity of information about the effects of cobalamin excess. Aim: To asses any potential effects of high levels vitamin B12 on mortality on adults aged ≥ 65 years admitted to an internal medicine service. Material and Methods: We Prospectively studied patients admitted to an internal medicine service of an academic hospital from September 2017 to September 2018, who were able to give their consent and answer questionnaires. We tabulated age, gender, medical history, comorbidity index (Charlson), frailty score (Fried scale), admission diagnosis and blood tests performed within 48 hours of admission. The primary outcome was death by any cause in less of 30 days or after one of year follow up, determined according to death certificates. Results: We included 93 patients aged 65 to 94 years (53% males). Fifteen patients died during the year of follow up (five within 30 days of admission). Those who died had higher cobalamin levels than survivors (1080.07 ± 788.09 and 656.68 ± 497.33 pg/mL respectively, p = 0.02). Patients who died had also a significantly lower corrected serum calcium, sodium (p = 0.04) and a medical history of chronic liver disease (p = 0.03). In the multivariable analysis, only vitamin B12 preserved the association with mortality (p = 0.009). Conclusions: There was a significant association between high levels of cobalamin and all-cause mortality in this group of patients aged ≥ 65 years-old.

Current status and directions of resident education

A resident is a preliminary specialist with a medical license. It is also the status of an employee at a training hospital who is trained by clinical faculty. This duality makes the role of a resident unique, because its interpretation differs dramatically depending on whether one focuses on a resident's status as a trainee or as an employee. Issues regarding patient safety have emerged as residents have come to emphasize their role as employees in discussions of how to balance their work duties with their learning responsibilities. The workload that was taken for granted is no longer considered natural. Two years have elapsed since the enactment of the resident law, which was passed to improve the training environment and working conditions of residents, and limits them to 80 hours of work per week. However, confusion persists in the field. In order to solve problems regarding resident education, new education program with hospitalists and the financial and administrative support from hospitals and the government are important.

Current status and future of internal medicine hospitalist in Korea

A hospitalist system was introduced in Korea in September in 2016 to improve the quality of in-patient care and to cope with the shortage of medical residents. This study aimed to outline the current situation of internal medicine hospitalist and to suggest a development strategy. By May 2019, the number of hospitalists in Korea had increased to 124. Patient safety issues, resident law, and the shortage of medical residents has led to an increase in the demand for hospitalists in Korea. Internal medicine hospitalist care in Korea has been associated with patient satisfaction, length of stay, and waiting time in emergency departments. There are three different hospitalist ward models in the Korean health care system, and each hospital needs the model that fits its specific situation. In the general ward model, the role of the hospitalist is similar to that of the chief residents because the wards are categorized into nine subspecialty areas, such as internal medicine (including gastroenterology, pulmonology, and cardiology). In the short-term admission ward model, patients are usually turned around within 72 hours; therefore, the hospitalist is able to care for patients independently. After that, patients are discharged or admitted to a specialty ward. In integrated care model, patients from all specialty areas are admitted to the same ward; therefore, hospitalists care for patients independently. In this model, consultation with specialists is required. There were strengths and weaknesses in each model. Therefore, the models should be considered based on the hospital's function. This study found some problems in the present hospitalist system, including undefined roles and responsibilities, unclear future employment prospects, burnout due to patient' severity of illness, and inadequate payment systems for weekend and night work. To further develop the hospitalists system in Korea, the Korean government, the Korean associated of internal medicine, hospitals, and hospitalists must work together to solve the present problems.

Development of the role of teaching hospitalists in the education of residents

Resident law was enacted to improve the training environment and working conditions. However, the law caused confusion in the field and resulted in a medical vacuum in inpatient care. It also resulted in a lack of training time. A hospitalist system was introduced to improve the quality of patient care and to cover the shortage of residents. This study aimed to outline a development strategy for hospitalists participation in resident education in Korea. The result of pilot study of the hospitalists in Korea showed that patients, nurses, and residents were satisfied with hospitalists. Eighty-five percent of surgical residents were helped in postoperative patient care and 70.7% of residents were willing to work with a hospitalist. The competency of surgical hospitalists includes understanding surgery and the appropriate management of postoperative complications. In order to shift the paradigm of resident education, the Korean government must pay the expenses for resident training. Through hospitalists' participation in the resident training, it may be possible to provide residents with more comprehensive and continuous education for inpatient care.

An Acute Medical Unit in a Korean Tertiary Care Hospital Reduces the Length of Stay and Waiting Time in the Emergency Department

A hospitalist-run acute medical unit (AMU) opened at a tertiary care hospital on August 2015 for the first time in Korea. Patients visiting the emergency department (ED) with acute medical problems are admitted to the AMU. They stay in that unit for less than 72 hours and are discharged or transferred to specialty wards if longer treatment is necessary. We reviewed 19,450 medical admissions through the ED from January 2014 to September 2016. The median length of stay (LOS) significantly decreased from 10.0 days (interquartile range [IQR], 5.5–16.7) to 9.1 days (IQR, 5.1–15.0) (P < 0.001) after the establishment of the AMU. The median waiting time in the ED significantly shortened by 40% (P < 0.001). Future studies on the impact of AMU on in-patient morbidity, mortality, re-admission rate, and patient or staff satisfaction are necessary.

Trends of US Hospitalist and Suggestions for Introduction of Korean Hospitalist / 대한내과학회지

A gap in the number of physicians caring for inpatients is expected in 2014 based on the restricted working hours for Korean medical residents. One potential solution is the use of hospitalists. The US hospitalist movement has proliferated due to high-quality care and economics. This movement has brought positive changes including a shorter length of hospital stay, increased quality of care, and greater patient satisfaction. Because the Korean government controls all suppliers and maintains a low financial compensation level for universal coverage, hospitals do not have the financial resources to introduce hospitalists. Therefore, in contrast to the US, the use of hospitalists must be developed as a cost-compensated system in Korea. Institutional strategies must be introduced to develop a hospitalist system in Korea. A hospitalist system in Korea would be distinct from that in the US. Further studies and specific strategies are needed that consider Korea's circumstances to effectively introduce a hospitalist system.

Historia del Hospital Universitario "Manuel Ascunce Domenech" / History of the University Hospital "Manuel Ascunce Domenech"

Fundamento: la historia del hospital Manuel Ascunce Domenech comenzó en 1946. Objetivo: Resaltar la importancia que tuvieron los trabajadores y decisores en la evolución histórica de la institución. Método: Es una investigación histórica basada en la investigación documental, se utiliza el submétodo cronológico para establecer el orden de los hechos que se describen. Se hicieron entrevistas a personalidades que laboran en el hospital desde o cercano a su fundación el 14 de enero de 1962 y se revisaron algunos artículos históricos publicados. Resultados: Fueron necesarios 16 años desde que el gobierno de turno en el 1946 procediera a la segregación y compraventa de una parcela de terreno para la construcción del Hospital hasta su inauguración. Solo con el triunfo de la revolución y la voluntad política se pudo terminar la obra. Conclusiones: El Hospital ha cumplido una importante función asistencial, docente, gerencial e investigativa.

Fundamental: the history of “Manuel Ascunce Domenech” hospital began in 1946.Objective: To highlight the importance that the workers and decision makers had in the historical evolution of the institution. Method: It is a historical research based on the documental research. The chronological sub method is used with the purpose to establish the order of the facts that are described here. Interviews to personalities that work in the hospital from or near the date of foundation on January 14, 1962 were made and some published historical articles were revised. Results: a period of 16 years was necessary since 1946 when the government of that moment proceeded to segregation, sale and purchase of a land parcel for the construction of the Hospital until its inauguration. The building work was possible to conclude just with the victory of the revolution and its political will. Conclusions: The Hospital has completed a staunch assistance, educational, managerial and investigative function.

Medicina hospitalaria a 15 años de su implementación: ¿Cuáles son los potenciales beneficios en nuestro medio? / Hospital medicine in Chile

After 15 years of development of Hospital Medicine in Chile, there are several benefits of this discipline. Among others, a reduction in the length of hospital stay, readmissions, costs, and improved medical teaching of students, residents and fellows have been observed. However, in South América there are only isolated groups dedicated to Hospital Medicine in Chile, Argentina and Brazil, with a rather slow growth. The unjustifiedfear of competitionfrom sub specialists, and the fee for service system ofpayment in our environment may be importantfactors to understand this phenomenon. The aging of the population makes imperative to improve the safety of our patients and to optimize processes and resources within the hospital, to avoid squandering healthcare resources. The following is a detailed and evidence-based article, on how hospital medicine might benefit both thepublic and prívate healthcare systems in Chile.

The Problems and Strategies for Hospital Medicine Management and Cost Accounting / 中国卫生经济

The new current versions of Hospital Finance System and Hospital Accounting System promote the reform of medicine accounting. It requires the method of the drugs cost accounting to change the retailing price accounting to the purchasing price accounting. It clearly defines individual valuation method, “first-in, first-out” method or weighted average method should be used to determine the actual cost of the materials based on the actual situation. It analyzes the problems of medical management and cost accounting, and proposes the practical solutions to strengthen the standard management of medicine and the medical cost accounting.

Problem and development of the hospital medicine preparation in Beijing / 国际中医中药杂志

Objective To realize the actuality and analyze the problem of the hospital medicine preparation in Beijing,then to discuss its developing methods.Methods By summarizing questionnaire of the hospital medicine preparation and combining with the problem showed in daily supervision,we analyzed the main existing problems and reasons for hospital medicine preparation and put forward the developing methods.Results The main existing problems of hospital preparation are the decreasing variety of medicine preparation,insufficient infrastructure and software.Conclusion Therefore we should enhance the input on the infrastructure,set up the software,improve the quality of the staff,and consummate the regulation means and system.

Ethics perspective of medicine managemem behavior in hospital / 中国医学伦理学

This article gives the investigation reports of medicine management in hospital of province .region (city) and county level. The result shows: many channels to introduce medicine unreasonable utiliation of expensive .importing,pool capital medicines make the health cost increasing .make the patient's economic burden heavier. The article also puts forwards some ethics countermeasures to enhance the medicine management of hospital.