Antibiotic consumption in secondary and tertiary hospitals in Colombia: national surveillance from 2018-2020 / Consumo de antibióticos en hospitales de segundo y tercer nivel en Colombia: vigilancia nacional entre 2018 y 2020 / Consumo de antibióticos em hospitais secundários e terciários da Colômbia: vigilância nacional de 2018 a 2020

ABSTRACT Objective. To assess the compliance in secondary and tertiary level hospitals with monthly reporting of antibiotic consumption to the Colombian National Public Health Surveillance System (SIVIGILA-INS), and to describe reported antibiotic consumption during 2018-2020. Methods. This study involved a secondary analysis of antibiotic consumption data reported to SIVIGILA-INS. Frequency of hospital reporting was assessed and compared against expected reports, disaggregated by intensive care units (ICU)/non-ICU wards and geographical regions. Consumption was expressed as defined daily dose (DDD) per 100 occupied beds for seven antibiotics. Results. More than 70% of hospitals reported antibiotic consumption at least once in each of the three years (79% in ICU and 71% in non-ICU wards). Of these, ICU monthly reporting was complete (12 monthly reports per year) for 59% in the period 2018-2019 but only 4% in 2020. Non-ICU reporting was complete for 52% in 2019 and for 2% in 2020. Most regions had an overall decrease in reporting in 2020. Analysis of antibiotic consumption showed an increase for piperacillin/tazobactam, ertapenem, and cefepime from 2019 to 2020. Conclusions. There were gaps in the consistency and frequency of reporting. Efforts are needed to improve compliance with monthly reporting, which declined in 2020, possibly due to the COVID-19 pandemic. Non-compliance on reporting and data quality issues should be addressed with the hospitals to enable valid interpretation of antibiotic consumption trends.

RESUMEN Objetivo. Evaluar el cumplimiento de los hospitales de segundo y tercer nivel en la presentación mensual de información sobre el consumo de antibióticos en el Sistema Nacional de Vigilancia en Salud Pública de Colombia (SIVIGILA-INS) y describir el consumo de antibióticos reportado en el período 2018-2020. Métodos. Este estudio incluyó un análisis secundario de los datos del consumo de antibióticos reportado en SIVIGILA-INS. Se evaluó la frecuencia de los informes hospitalarios y se comparó con los informes esperados, desglosados por unidad de cuidados intensivos (UCI) y otros servicios distintos a la UCI, y por región geográfica. El consumo se expresó en dosis diaria definida (DDD) por 100 camas ocupadas para siete antibióticos. Resultados. Más del 70% de los hospitales notificaron el consumo de antibióticos al menos una vez en cada uno de los tres años (79% en la UCI y 71% en los servicios distintos a la UCI). De estos, el 59% de las UCI completaron los informes mensuales (12 informes en un año) entre el 2018 y el 2019, pero solo el 4% en el 2020. El 52% de los servicios distintos a la UCI completó los informes en el 2019 y el 2% en el 2020. En la mayoría de las regiones hubo una disminución general de la notificación en el 2020. El análisis del consumo de antibióticos mostró un aumento de piperacilina/tazobactam, ertapenem y cefepima del 2019 al 2020. Conclusiones. Se encontraron disparidades en la coherencia y en la frecuencia de la presentación de informes. Es necesario destinar esfuerzos para mejorar el cumplimiento de la notificación mensual, que disminuyó en el 2020 posiblemente debido a la pandemia de COVID-19. La falta de cumplimiento en la presentación de los reportes y los problemas de calidad de los datos deben abordarse con los hospitales para facilitar la interpretación válida de las tendencias de consumo de antibióticos.

RESUMO Objetivo. Avaliar o cumprimento da exigência de notificar mensalmente o consumo de antibióticos em hospitais secundários e terciários ao Sistema Nacional de Vigilância em Saúde Pública da Colômbia (SIVIGILA-INS) e descrever o consumo informado de antibióticos de 2018 a 2020. Métodos. Este estudo envolveu uma análise secundária dos dados de consumo de antibióticos enviados para o SIVIGILA-INS. A frequência de notificação pelos hospitais foi avaliada e comparada com a frequência esperada. Os dados foram desagregados entre unidades de terapia intensiva (UTIs) e enfermarias gerais e por regiões geográficas. O consumo foi expresso como dose diária definida (DDD) por 100 leitos ocupados para sete antibióticos. Resultados. Mais de 70% dos hospitais notificaram consumo de antibióticos pelo menos uma vez em cada um dos três anos (79% na UTI e 71% nas enfermarias gerais). Entre eles, 59% dos hospitais enviaram todas as notificações relativas a UTIs (12 notificações mensais) no período de 2018 a 2019, mas apenas 4% o fizeram em 2020. No caso das enfermarias gerais, 52% dos hospitais enviaram todas as notificações em 2019 e 2% o fizeram em 2020. A maioria das regiões teve uma diminuição geral no número de notificações enviadas em 2020. A análise do consumo de antibióticos revelou um aumento no uso de piperacilina/tazobactam, ertapeném e cefepima de 2019 para 2020. Conclusões. Houve lacunas na uniformidade e frequência das notificações. São necessários esforços para melhorar o cumprimento da exigência de notificações mensais, que, possivelmente devido à pandemia de COVID‑19, diminuiu em 2020. Problemas relacionados ao não cumprimento da exigência de notificação e à qualidade dos dados devem ser resolvidos junto aos hospitais para permitir uma interpretação válida das tendências de consumo de antibióticos.

What can be expected to be seen in a Neurology ward? Eleven-year experience in a Brazilian university hospital / O que se espera encontrar em uma enfermaria de Neurologia? A experiência de 11 anos em um hospital universitário brasileiro

ABSTRACT Background: Neurological disorders are significant causes of morbidity and mortality worldwide. However, data about general neurological inpatient admissions in Brazil is limited. Objective: To investigate the prevalence of neurological disorders according to disease group and lesion site among patients admitted to a general Neurology ward. Methods: This was an observational and descriptive study. The hospital discharge database for the Neurology ward was surveyed in accordance with the International Classification of Diseases, 10th edition (ICD-10), from September 2008 to October 2019. The final diagnosis was classified into neurological disorder groups and site. Results: Overall, 2,606 clinical neurological patient files were included, with mean length of hospitalization of 16.7 days and a total of 325 readmissions (12.5%). The overall mortality rate in the ward was 3.8% (100 patients). Among all the diagnoses, cerebrovascular disease was the most prevalent (45.8%), followed by inflammatory disorders (22.2%). The brain was the most common lesion site (66.0%), followed by peripheral nerves (10.0%) and meninges and cerebrospinal fluid (7.7%). Conclusions: The disease pattern upon admission showed that a majority of the cases consisted of cerebrovascular disorders and that the brain was the most frequently affected structure, although we observed that a wide variety of cases were admitted, encompassing all neurological disorders.

RESUMO Introdução: As doenças neurológicas representam importante causa de morbidade e mortalidade globalmente, mas informações acerca de internações hospitalares em neurologia no Brasil são limitadas. Objetivo: Investigar a prevalência de admissões neurológicas por grupo de doenças e pela topografia atendidas em uma enfermaria de neurologia geral. Métodos: Estudo observacional e descritivo. Avaliados diagnósticos de saída de acordo com o Código Internacional de Doenças-10 (CID-10) no período de setembro de 2008 a outubro de 2019. Os diagnósticos foram classificados em grupos de doença e por topografia. Resultados: Foram incluídos 2,606 pacientes, com tempo médio de internação de 16,7 dias e um total de 325 (12,5%) readmissões. A mortalidade geral na enfermaria foi de 100 (3,8%) pacientes. A doença cerebrovascular foi mais prevalente (45,8%), seguida das doenças inflamatórias (22,2%). A topografia encefálica foi a mais comum (66,0%), seguida de nervos periféricos (10,0%), meninges e líquido cefalorraquidiano (7,7%). Conclusões: O perfil de doenças observado neste estudo demonstrou maior prevalência das doenças cerebrovasculares e da topografia encefálica, embora uma grande variedade de doenças tenha sido admitida dentro do espectro de doenças neurológicas.

Management strategy of Novel coronavirus pneumonia in burn and wound care ward / 中华烧伤杂志

The prevention and control of novel coronavirus pneumonia (NCP) has already entered a key period . The patients treated in the burn and wound care ward are susceptible to viral infection because of disease, age and other factors, so it is very important to manage the burn and wound care ward during the prevention and control of NCP epidemic. In this paper, combining with the key clinical problems of prevention and control in hospital during the epidemic period of NCP infection, medical evidence, and clinical and management experience, the author formulates prevention and control management strategy of the author's unit in order to provide reference for prevention and control of burn and wound care ward.

Puntaje predictivo de emergencias médicas en un servicio médico quirúrgico, usando variables clínicas y los diagnósticos de ingreso / A score to predict medical emergencies in hospitalized patients

Background: The medical alert system (MAS) was created for the timely handling of clinical decompensations, experienced by patients hospitalized at the Medical Surgical Service (MSS) in a private clinic. It is activated by the nurse when hemodynamic, respiratory, neurological, infectious or metabolic alterations appear, when a patient falls or complains of pain. A physician assesses the patient and decides further therapy. Aim: To analyze the clinical and demographic characteristics of patients who activated or not the MAS and develop a score to identify patients who will potentially activate MAS. Material and Methods: Data from 13,933 patients discharged from the clinic in a period of one year was analyzed. Results: MAS was activated by 472 patients (3.4%). Twenty two of these patients died during hospital stay compared to 68 patients who did not activate the alert (0.5%, p < 0.01). The predictive score developed considered age, diagnosis (based on the tenth international classification of diseases) and whether the patient was medical or surgical. The score ranges from 0 to 9 and a cutoff ≥ 6 provides a sensitivity and specificity of 37 and 81% respectively and a positive likelihood ratio (LR+) of 1.9 to predict the activation of MAS. The same cutoff value predicts death with a sensitivity and specificity of 80% and a negative predictive value of 99.8%. Conclusions: This score may be useful to identify hospitalized patients who may have complications during their hospital stay.

Adecuada prescripción antimicrobiana en servicios de medicina interna en un hospital público de Perú / Appropiate antimicrobial agent prescriptions in the internal medicine services of a public hospital in Peru

Objetivo: evaluar la adecuada prescripción de antimicrobianos en pacientes hospitalizados en salas de medicina de un hospital público peruano. Materiales y métodos: estudio descriptivo de corte transversal. Se incluyeron a los pacientes mayores de 16 años de edad, haber estado hospitalizado en servicios de medicina, haber recibido tratamiento antibiótico y haber sido dado de alta entre enero y febrero de 2014. Resultados: de un total de 358 historias clínicas se seleccionaron 198 (55,3%) que recibieron algún tipo de terapia antibiótica. Los diagnósticos más frecuentes fueron infección del tracto urinario, neumonía, celulitis y pie diabético. Los antimicrobianos más utilizados fueron ceftriaxona, clindamicina, ciprofloxacino y ceftazidima. El 63,6% del total de antimicrobianos usados tenían uno o más defectos en la prescripción. Los hallazgos más frecuentes fueron la duración prolongada de la terapia, indicación no correspondiente al diagnóstico y combinación inadecuada de antimicrobianos. No hubo diferencias estadísticamente significativas entre la prescripción y las diferentes salas de medicina, así como en las diferentes enfermedades infecciosas, excepto la ITU. Conclusiones: la prescripción antibiótica evaluada en las diversas salas de medicina fue inadecuada, por encima de resultados de otros estudios en diferentes países y regiones.

Objective: The objective of this study was to assess the appropiate antimicrobial agent prescription in the internal medicine service of a Peruvian public hospital. Materials and methods: this is an observational and descriptive cross-sectional study. We collected data from medical records of patients over 16 years of age who were hospitalized in medicine wards, received antimicrobial therapy, and were discharged between January and February 2014. Results: Of 358 medical records of patients discharged from January 01st to February 28th, 2014, 198 records were assessed (55.3%), which corresponded to patients who had received some kind of antibiotic therapy. The most common diagnoses were UTI, CAP, cellulitis, and diabetic foot. The antimicrobial agents most frequently used were ceftriaxone, clindamycin, ciprofloxacin and ceftazidime. Nearly two thirds (63.6%) of all antimicrobial agents used had one or more defects in their prescription. The most common defects were prolonged duration of therapy, the indication did not correlate with the diagnosis, and many combinations of agents were inadequate. There were no statistically significant differences between prescriptions when comparing different medicine wards and the different infectious diseases that were treated, except UTI. Conclusions: antimicrobial agent prescription in several medicine services was inadequate, in higher rates compared to other studies performed in different countries and regions.

Cuidados de Nightingale en la sala del enfermo y su repercusión en Rubio y Galí / Nightingale care in the sick room and its impact on Rubio y Galí / O cuidado de Nightingale na sala do doente e seu impacto sobre Rubio y Galí

Objetivo: verificar si existen semejanzas ideológicas en áreas de la formación enfermera fundada por Nightingale, en los cuidados relacionados con las condiciones de salubridad de la sala del paciente con la enseñanza enfermera instruida por Rubio y Galí. Metodología: análisis historiográfico basado en un análisis de contenido de textos históricos, mediante el programa WordSmith 6.0 y siguiendo las concepciones hermenéuticas de Gadamer y Beuchot se valora la posibilidad de que Rubio y Galí pudiese acogerse a los principios de la enfermera británica. Resultados: los resultados conducen a una influencia directa de los postulados de la enfermera británica en el cirujano español; siendo necesaria la valoración de otros postulados enfermeros y sanitarios en general, respondiendo a los mismos principios difundidos por Nightingale en la España Contemporánea. Conclusión: se demuestra una vinculación de los postulados enfermeros de Nightingale, relacionados con la ventilación, luz y ruido de las salas de los enfermos, en Rubio y Galí.

Objetivo: verificar se existem semelhanças ideológicas em áreas da formação em enfermagem fundada por Nightingale, nos cuidados relacionados com as condições de salubridade do quarto do paciente, com o ensino de enfermagem instruído por Rubio y Galí. Metodologia: análise historiográfica com base em uma análise de conteúdo dos textos históricos, mediante programa WordSmith 6,0, e seguindo as concepções hermenêuticas de Gadamer e Beuchot, verifica-se a possibilidade de que Rubio y Galí pudesse acolher os princípios da enfermagem britânica. Resultados: os resultados indicam uma influência direta dos postulados da enfermagem britânica no cirurgião espanhol, sendo necessária a valorização de outros postulados de enfermagem e sanitários em geral, respondendo aos mesmos princípios difundidos por Nightingale na Espanha Contemporânea. Conclusão: demonstra-se uma vinculação dos postulados de enfermagem de Nightingale, relacionados com a ventilação, luz e ruído dos quartos dos doentes, com os de Rubio y Galí.

Objective: to ascertain whether there are ideological similarities in areas of nursing education founded by Nightingale, in care relating to health conditions of the patient's room, with the teaching of nursing informed by Rubio y Galí. Methodology: this historiographical analysis was based on content analysis of historical texts, using WordSmith 6.0 software and following the hermeneutical conceptions of Gadamer and Beuchot, to investigate the possibility that Rubio and Galí took up the principles of British nursing. Results: the results indicate that the postulates of British nursing influenced the Spanish surgeon directly, making it necessary to acknowledge other nursing and general health tenets present in contemporary Spain that respond to the same principles spread by Nightingale. Conclusion: a connection is demonstrated between Nightingale's nursing principles regarding sickroom ventilation, light and noise and those of Rubio y Galí.

Comparative analysis on drug-resistant bacterial distribution and drug resistance characteristics of lower respiratory tract infection in different regions of respiratory department / 重庆医学

Objective To investigate the distribution and constituent of drug‐resistant bacteria of lower respiratory tract in‐fection among different regions (outpatient department ,wards ,RICU) to provide the basis for the clinical reasonable application of antimicrobial agents .Methods The K‐B disc diffusion method and the instrument method (VITEK‐TWO) were adopted and the detection results were interpreted according to the standards of CLSI 2010 .The detection data of 480 drug‐resistant strains isolated from the sputum ,branchoalveolar lavage fluid samples submitted in 3 regions of respiratory outpatients department by bacterial cul‐ture identification and drug susceptibility test were analyzed by using the WHONET5 .6 statistical software .Results The distribu‐tion and constituent of drug‐resistant bacteria of lower respiratory tract infection had obvious difference among 3 different regions . The top 4 of drug resistant bacteria were dominated by Gram‐negative bacteria .The drug resistance rate of Klebsiella pneumoniae in RICU was higher than that in the respiratory outpatients department and wards(P<0 .05) ,the resistance rate in the respiratory outpatients department ,wards and RICU to commonly used antibacterial drugs was similar;the multiple drug resistance of ESBLs‐producing strains was obviously higher than that of non‐ESBLs‐producing strains (P<0 .05) .Pseudomonas aeruginosa maintained the higher antibacterial activity to quinolone ,aminoglucosides ,cefepime ,imipenem ,cefoperazone/sulbactam ,and piperacillin/tazobactam ,but the resistance rate in RICU was significantly higher that in the respiratory outpatient department and wards (P<0 .05);the drug resistance of Acinetobacter baumanii in the respiratory wards and RICU was higher than that in the respiratory out‐patient department ,the resistances to imipenem were 64 .6% and 70 .4% respectively .The resistance of MRSA to rifampin in RICU was higher than that in the respiratory outpatient department and wards(P<0 .05) .Conclusion The distribution constituent and drug‐resistance rates have obvious differences among the respiratory outpatient department ,wards and RICU .Except being familiar with the drug resitant bacterial distribution and drug resistance rate monitoring situation ,clinical doctors should grasp the drug re‐sistance situation of drug resistant bacteria among different areas in various departments of own unit in order to rationally and effec‐tively use antibacterial drugs .

The research of distribution and drug resistance of pathogenic bacteria causing pulmonary infections in cardi-ology department of general hospital / 中国基层医药

Objective To observe the distribution and drug resistance of pathogenic bacteria causing pulmo-nary infections in cardiology department of general hospital ,and to provide advices for infection control and selection of drugs.Methods 110 sputum specimens of patients with pulmonary infections in cardiology department were col -lected.The distribution and drug resistance of pathogenic bacteria were analyzed .Results In the 110 sputum sam-ples,83 cases(75.5%) were infected by gram-negative bacterias,21 cases(19.1%) were infected by gram-positive bacterias,6 cases(5.4%) of fungal infection .The Escherichia coli and the Pseudomonas aeruginosa after the antibiot-ic resistance analysis were found a trend of multi resistance .Conclusion The major pathogenic bacterias causing pulmonary infections in cardiology department are gram-negative bacterias ,and they show a trend of multi resistance .

Current Status and Availability of Specialized Maternity Non-Standard Room for Delivering Mothers / 대한주산의학회잡지

PURPOSE: Demand of specialized maternity ward is increasing as national income level rises. However, the National Health Insurance limits the number of hospital's non-standard room to less than 50% of total hospital beds. Therefore, this research was performed to investigate the utilization rate of non-standard room among the Korean women who recently delivered baby in medical facilities in order to examine the factors affecting their selection. METHODS: One hundred sixty six medical facilities which deliver a minimum of ten cases in 2011 were selected and categorized by type, region, and size. A cross-sectional survey was done in November 2012 by a professional research survey company. Eight hundred and two pregnant women answered the questionnaire through a face-to-face interview. RESULTS: Of the 802 expecting mothers, 690 (86%) occupied non-standard room and 684 (85.2%) preferred non-standard room to the standard room. Satisfaction levels were significantly higher in mothers occupying non-standard room [5.9+/-1.0 vs. 5.4+/-1.2 (0-7 scale), P<0.01] and high-income families used non-standard room more often. Reasons for using non-standard room included adequate convalescence (78%), separate place for breastfeeding (6.1%), and convenience on receiving visitors (5.4%). Preference for non-standard room on next visit was higher in case of delivery compared to other cause of hospitalization (81.8% vs. 44.9%, P<0.001). CONCLUSIONS: Preference and actual use of non-standard room after delivery were significant. In spite of concrete preference, there was certain barrier in use of non-standard room according to the income and types of hospitals. Therefore, changes of policy such as insurance support for room charge may be needed in case of delivery.

Analysis of Cost and Efficiency of a Medical Nursing Unit Using Time-Driven Activity-Based Costing

PURPOSE: Time-driven activity-based costing was applied to analyze the nursing activity cost and efficiency of a medical unit. METHODS: Data were collected at a medical unit of a general hospital. Nursing activities were measured using a nursing activities inventory and classified as 6 domains using Easley-Storfjell Instrument. Descriptive statistics were used to identify general characteristics of the unit, nursing activities and activity time, and stochastic frontier model was adopted to estimate true activity time. RESULTS: The average efficiency of the medical unit using theoretical resource capacity was 77%, however the efficiency using practical resource capacity was 96%. According to these results, the portion of non-added value time was estimated 23% and 4% each. The sums of total nursing activity costs were estimated 109,860,977 won in traditional activity-based costing and 84,427,126 won in time-driven activity-based costing. The difference in the two cost calculating methods was 25,433,851 won. CONCLUSION: These results indicate that the time-driven activity-based costing provides useful and more realistic information about the efficiency of unit operation compared to traditional activity-based costing. So time-driven activity-based costing is recommended as a performance evaluation framework for nursing departments based on cost management.

Condutas no paciente com insuficiência cardíaca internado em enfermarias de medicina interna / Management of the inpatient with heart failure inan internal medicine ward

A crescente prevalência da Insuficiência Cardíaca na população, e a constante má-aderência aos tratamentos propostos em nível ambulatorial, fazem com que o quadro de descompensação desta doença esteja entre as recordistas em número de internações, causando grande impacto na saúde pública do Brasil. O propósito deste estudo é o de estabelecer um protocolo de condutas a ser aplicado em pacientes com Insuficiência Cardíaca internados em enfermaria de Clínica Médica Geral, como o Hospital Estadual de Ribeirão Preto (SP, Brasil), com o objetivo de garantir a recuperação de um quadro de descompensação recente, assim como reorientar o paciente quanto à importância da aderência ao tratamento instituído. Para tanto, serão propostas a utilização e otimização de ferramentas farmacológicas, além de reintrodução de medidas não-farmacológicas, de modo que se reduza o tempo de internação,o número de recorrências, e favoreça o melhor seguimento ambulatorial destes pacientes.

The increasing prevalence in heart failure and associated non adherence of patients to the proposed ambulatory-treatment regimen cause the decompensate clinical picture to be the cornerstone of the high incidence of hospitalization found in such disorder, which brings a greater impact in public health. The purpose of the present study is to establish a protocol to be applied to heart failure in patients at an internal medicine ward, such as the Hospital Estadual de Ribeirão Preto (SP, Brazil), in order to guarantee complete recovery from acute decompensated heart failure, as well as to reassure that patients understand the importance of following the proposed treatment protocols. Accordingly, pharmacological therapy and non pharmacological strategies will be either reintroduced or optimized, in order to reduce the period of hospitalization, rate of infirmary readmission, and also to favor a better ambulatory follow-upof these patients.

Avaliação da limpeza de unidade do paciente em hospitais do interior do estado de São Paulo / Evaluation of the procedures used for disinfecting patient's units in hospitals of the state of São Paulo / Evaluación de la limpieza de unidad del paciente en hospitales del interior de São Paulo

Este estudo objetiva avaliar o procedimento da limpeza de unidade do paciente assim como detectar, apontar e alertar sobre as possíveis falhas nesse processo de limpeza. Os resultados obtidos por entrevistas com os enfermeiros responsáveis pelo Serviço de Enfermagem revelam que o procedimento realizado nos hospitais em estudo não vem atendendo às normas preconizadas pela literatura o que acarreta um produto final com pouca confiabilidade do ponto de vista da desinfecção.

The objective of this investigation is to evaluate the procedure used for disinfecting patients' rooms, as well as to detect and indicate possible mistakes in this process. The results obtained through interviews with nursing professionals responsible for the Nursing Services reveal that the procedures used in the studied hospitals are not following the principles required by the literature. As a consequence there is little reliability concerning disinfecting procedures in those hospitals.

Este estudio pretende evaluar la limpieza de la unidad del paciente, así como detectar, señalar y alertar sobre posibles fallas en el proceso de limpieza. Los resultados que se obtuvieron, mediante entrevistas con los enfermeros responsables por el Servicio de Enfermería, revelan que los servicios de limpieza desarrollados en las unidades del paciente -de los hospitales en estudio, no está atendiendo a las normas preconizadas en la literatura. Ello acarrea un producto final con poca confiabilidad desde el punto de vista de la desinfección.