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1.
Enferm. foco (Brasília) ; 11(1,n.esp): 205-210, ago. 2020.
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1116672

ABSTRACT

Objetivo: descrever a experiência de enfrentamento e mudança às demandas de enfermeiras atuantes em uma Unidade de Pronto Atendimento 24 horas que se consolidou como unidade de referência para triagem de pacientes acometidos pela CoViD-19. Método: estudo descritivo, na modalidade relato de experiência, sobre a vivência de enfermeiras assistenciais atuantes em uma UPA 24h. Resultados: as enfermeiras desse relato assumiram na UPA um papel de liderança na equipe, a fim de gerenciar continuamente tanto os aspectos técnicos,quanto a gestão de suprimentos, tendo um plano de emergência para garantir o preparo e a segurança da força de trabalho da Enfermagem. Para tanto, foi necessário a essas profissionais se empoderar do conhecimento, de modo que fosse possível realizar treinamentos e capacitações com suas próprias equipes. Conclusão: a experiência relatada mostra que, mesmo em períodos críticos para o sistema de saúde como o determinado pela pandemia da CoViD-19, é possível realizar mudanças e adaptações necessárias ao momento. Além disso, a crise demonstra que as enfermeiras são mais do que trabalhadores da linha de frente, mas também são aqueles que tomam a frente para que as mudanças efetivamente aconteçam. (AU)


Objective: to describe the experience of coping and changing the demands of nurses working in a Emergency Care Unit that has consolidated itself as a reference unit for screening patients affected by COVID-19. Method: a descriptive study, in the experience report modality, about the experience of nursing assistants working in a Emergency Care Unit. Results: the nurses in this report assumed a leadership role in the team at the Emergency Care Unit, in order to continuously manage both technical aspects and supply management, with an emergency plan to ensure the preparation and safety of the nursing workforce. Therefore, it was necessary for these professionals to empower themselves with knowledge, so that it was possible to conduct training and qualifications with their own teams. Conclusion: the reported experience shows that, even in critical periods for the health system as determined by the COVID-19 pandemic, it is possible to make changes and adaptations necessary to the moment. In addition, the crisis demonstrates that nurses are more than frontline workers, but they are also the ones who take the lead to make the changes happen. (AU)


Objetivo: describir la experiencia de enfrentar y cambiar las demandas de las enfermeras que trabajan en una Unidad de Atención de Emergencia que se ha consolidado como una unidad de referencia para la detección de pacientes afectados por COVID-19. Método: un estudio descriptivo, en forma de informe de experiencia, sobre la experiencia de los auxiliares de enfermería que trabajan en una Unidad de Atención de Emergencia. Resultados: las enfermeras en este informe asumieron un papel de liderazgo en el equipo de la Unidad de Atención de Emergencia, con el fin de gestionar continuamente tanto los aspectos técnicos como la gestión de suministros, con un plan de emergencia para garantizar la preparación y la seguridad de la fuerza laboral de enfermería. Por lo tanto, era necesario que estos profesionales se empoderaran con el conocimiento, de modo que fuera posible realizar capacitaciones y calificaciones con sus propios equipos. Conclusión: la experiencia informada muestra que, incluso en períodos críticos para el sistema de salud según lo determinado por la pandemia da COVID-19, es posible realizar los cambios y adaptaciones necesarios en este momento. Además, la crisis muestra que las enfermeras son más que trabajadores de primera línea, pero también son quienes toman la iniciativa para que los cambios sucedan. (AU)


Subject(s)
Nurses , Coronavirus , Emergencies , Health Services
3.
Brasília; IPEA; jun. 2020. 20 p. (Nota Técnica / IPEA. Diset, 68).
Monography in Portuguese | LILACS (Americas), ECOS | ID: biblio-1102404

ABSTRACT

A pandemia da Covid-19 expôs ao mundo a fragilidade dos arranjos institucionais de suprimentos para os sistemas de saúde mundiais. Insumos básicos para o atendimento de saúde, como equipamentos de proteção individuais (EPIs), respiradores artificiais e higienizantes/saneantes, passaram a ser disputados por diversos países e a ensejar comportamentos fraticidas entre sistemas de saúde privado e público de diferentes esferas no Brasil: pelo menos seis estados e diversas prefeituras editaram atos administrativos para requisitar insumos e produtos como respiradores durante a pandemia, levando a União a reagir na Justiça e a defender uma centralização das compras desses produtos. Entes privados como a Associação Nacional de Hospitais Privados (ANAHP), a Confederação das Santas Casas de Misericórdia, Hospitais e Entidades Filantrópicas (CMB) e a Confederação Nacional de Saúde (CNS) questionaram judicialmente o privilégio dos hospitais públicos na distribuição de EPIs. Nesse contexto de ruptura da cadeia de suprimentos e de concorrência predatória entre compradores, a Organização Mundial da Saúde (OMS) recomenda, além da racionalização da demanda e do uso dos insumos hospitalares, a gestão centralizada dessas aquisições e a coordenação do abastecimento das unidades de saúde para evitar excessos e quebras de estoques (WHO, 2020). A transposição dessa reflexão para o cenário brasileiro requer uma apreciação dos desafios e das oportunidades de aperfeiçoar os mecanismos de agregação de demandas e as sistemáticas de compras conjuntas disponíveis para os gestores públicos envolvidos no enfrentamento da emergência de saúde pública da Covid-19, com maior colaboração entre os entes públicos e o possível envolvimento de entes privados que atendam majoritariamente pacientes do Sistema Único de Saúde (SUS), ao mesmo tempo que se preserve a transparência e se facilite a fiscalização. Algumas alterações legais e procedimentais são necessárias, parte delas no nível mais geral das compras e contratações, e sua implementação em caráter experimental, se alcançar resultados satisfatórios, pode se tornar definitiva e inclusive ser expandida para outros contextos (objetos de contratação, modalidades, poderes e entes). A nota tem mais cinco seções além desta introdução. Na próxima, fazemos uma motivação para um arcabouço de compras centralizadas em saúde. Em seguida, varremos algumas experiências internacionais de compras centralizadas e o que tem sido feito no Brasil a respeito. As seções seguintes detalham, então, o arcabouço legal para se implementar um Sistema de Registro de Preços de Emergência, que chamamos de Acordo-Marco, e um leque de propostas de implementação para esse sistema. A última seção consolida as considerações finais.


Subject(s)
Adaptation, Psychological , Public Health , Group Purchasing , Coronavirus , Emergencies , Pandemics , Personal Protective Equipment
5.
Rev. Asoc. Odontol. Argent ; 108(1): 1-5, ene.-abr. 2020.
Article in Spanish | LILACS (Americas) | ID: biblio-1096146

ABSTRACT

En medicina, los pacientes de riesgo son aquellos que, al momento de la consulta, presentan antecedentes y/o pa- decimientos que implican una mayor probabilidad de sufrir complicaciones, como personas inmunodeprimidas o con en- fermedades crónicas, ya sean cardíacas, pulmonares, renales, hepáticas, sanguíneas o metabólicas (por ejemplo, diabetes). Estos pacientes se encuentran en riesgo en el caso de prác- ticas que puedan exacerbar o provocar reacciones adversas a raíz de su padecimiento. En la actualidad, el grupo poblacional vulnerable ha au- mentado a partir de nuevos tratamientos médicos que han per- mitido mejorar padecimientos sistémicos severos y prolongar la esperanza de vida. Ante pacientes "de riesgo" o "en riesgo", el odontólogo debe estar alerta y actualizado, a fin de evitar provocar alteraciones sistémicas y de reaccionar pronta y eficazmente, en caso de ser necesario, ante las urgencias médicas que se presenten (AU)


In medicine, risk patients are those who at the consulta- tion have a history and/or conditions that could cause a great- er possibility of a complication; such as immunosuppressed, chronic heart, pulmonary, kidney, liver, blood or metabolic diseases (for example, diabetes).These patients are at risk during procedures that could in- crease or cause inadequate reactions due to their conditions. Currently, the vulnerable population group has increased since newest medical treatments have emerged; allowing se- vere systemic ailments to improve and prolong life expectancy. With risk or at-risk patients, the dentist must be alert and up-to-date to avoid systemic alterations and react promptly and efficiently if necessary in any medical emergency that might take place (AU)


Subject(s)
Humans , Male , Female , Risk Factors , Dental Care for Chronically Ill , Emergencies , Clinical Protocols , Chronic Disease , Immunocompromised Host , Heart Diseases
6.
Goiânia; SES-GO; 20/03/2020. 1-11 p. ilus, tab.
Non-conventional in Portuguese | LILACS (Americas), ColecionaSUS, CONASS, SES-GO | ID: biblio-1104182

ABSTRACT

Devido a declaração, pela OMS, da pandemia do Novo Coronavírus (COVID-19), a Superintendência do Complexo Regulador de Goiás sistematiza as ações de regulação do acesso, de modo a apoiar em caráter complementar, os demais setores de saúde pública do Estado de Goiás envolvidos na regulação do acesso aos leitos de internação e de urgência, para o enfrentamento de Emergências de Saúde Pública. A indicação de encaminhamentos varia conforme o quadro clínico do usuário, a partir da avaliação médica, sendo: • Casos leves: indicado isolamento domiciliar e tratamento sintomático (não necessita internação hospitalar). • Casos moderados: indicado internação hospitalar em leito de enfermaria em isolamento. • Casos graves: indicado internação hospitalar em Unidade de Terapia Intensiva (UTI)


Due to the declaration, by the WHO, of the pandemic of the New Coronavirus (COVID-19), the Superintendence of the Regulatory Complex of Goiás systematizes the actions of regulation of the access, in order to support, in a complementary character, the other public health sectors of the State of Goiás involved in the regulation of access to hospital and emergency beds, to face Public Health Emergencies. The indication of referrals varies according to the clinical picture of the user, based on the medical evaluation, being: • Mild cases: indicated home isolation and symptomatic treatment (does not require hospitalization). • Moderate cases: indicated hospitalization in an infirmary bed in isolation. • Severe cases: indicated hospital stay in Intensive Care Unit (ICU)


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Coronavirus Infections/classification , Protocols/methods , Pandemics , Patient Isolation , Emergencies
7.
J. health med. sci. (Print) ; 6(1): 57-63, ene.-mar. 2020. tab, ilus
Article in Spanish | LILACS (Americas) | ID: biblio-1096722

ABSTRACT

El objetivo de este trabajo fue determinar la relación entre el pronóstico visual según el Ocular Trauma Score (OTS) y la agudeza visual (AV) a los 6 meses de ocurrido el trauma ocular, en pacientes atendidos en la Unidad de Trauma Ocular del Hospital del Salvador, Santiago de Chile. Se hizo uso de un estudio descriptivo, longitudinal, retrospectivo. Se accedió a los registros clínicos de pacientes atendidos por trauma ocular grave entre el 1 de enero de 2014 al 15 de marzo 2015. 145 pacientes conformaron una muestra de 153 ojos. Se estableció la relación entre OTS obtenido y la AV a 6 meses del trauma mediante el coeficiente de correlación de Spearman. De los ojos estudiados, el grupo mayor N=68 (44,4%) calificó para OTS 3 y el menor N=16 (10,5%) para OTS 1. Se presentaron cinco categorías de visión, en un tiempo inicial la mayoría de los casos presentaron AV de luz, mala proyección-cuenta dedos (n=89). Tras seis meses dicha distribución se desplazó hacia la categoría 20/40 - 20/20 (n=68). Se encontró una fuerte asociación (r=0,711 p=0,000) entre el OTS calculado y la AV luego de seis meses de seguimiento. El OTS demostró poseer un gran valor predictivo y es una herramienta aplicable en nuestro medio, los datos obtenidos indican que existe un mejor pronóstico visual que los obtenidos en otro estudio. Cabe destacar que es la primera instancia en que se evalúa la aplicación del OTS en Chile.


This work aimed to determine the relationship between the visual prognosis according to the Ocular Trauma Score (OTS) and visual acuity (AV) 6 months after the ocular trauma in patients treated at the Eye Trauma Unit from the Hospital del Salvador, in Santiago, Chile. A descriptive, longitudinal and retrospective study was performed. We accessed registers of clinical patients attended for severe eye trauma from 1 January 2014 to 15 March 2015. 145 patients constitute a sample of 153 eyes. A connection was established between the OTS obtained and the AV 6 months after the trauma via the Spearman correlation coefficient. From the eyes studied, the greatest group N=68 (44.4%) qualified for OTS 3 and the smallest N=16 (10.5%) for OTS 1. Five eye categories were presented, in the beginning, most of the cases presented visual acuity with bad projection ­ hand motion (n=89). After six months of distribution, it moved to the category 20/40 ­ 20/20 (n=68). A strong relation (r=0,711 p=0,000) was found between the estimated OTS and the AV after six months of tracking. The OTS proved to have great predictive valor and is an applicable tool in our area, the data obtained showed that there is a better visual prognosis than the obtained in other studies. It is worth noting that this is the first stage where the application of OTS is assessed in Chile.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Visual Acuity/physiology , Trauma Severity Indices , Eye Injuries/diagnosis , Eye Injuries/physiopathology , Prognosis , Chile , Eye Injuries/therapy , Predictive Value of Tests , Retrospective Studies , Follow-Up Studies , Longitudinal Studies , Emergencies , Eye Health Services
8.
REVISA (Online) ; 9(1): 40-52, jan-mar.2020.
Article in English, Portuguese | LILACS (Americas) | ID: biblio-1050842

ABSTRACT

Objetivo: analisar o conhecimento das enfermeiras (os) da ESF de um município do recôncavo baiano frente ao SBV. Método: Trata-se de uma pesquisa epidemiológica, descritiva, realizada com 14 enfermeiras (os) de Unidades Básicas de Saúde e de Unidades de Saúde da Família em um município do recôncavo baiano, utilizando-se questionário sobre características sociodemográficas, ocupacionais e de formação geral e específica sobre SBV. Os dados foram analisados por meio de da análise descritiva das variáveis, calculando-se as frequências absoluta e relativa e medidas de tendência central e dispersão. Resultados: a maioria possuía conhecimento de como verificar o pulso da vítima em PCR (92,9%), sobre a frequência das compressões torácicas caso não fosse possível garantir as ventilações (57,1%), quanto a profundidade mínima das compressões torácicas (71,4%). 92,9% não sabia o local adequado para colocação das mãos e realização das compressões torácicas, 50% tinha conhecimento das situações em que pode ser utilizado o DEA; 57,1% conheciam os ritmos de PCR e 57,1% os ritmos chocáveis de PCR. Conclusão: Constatou-se que as enfermeiras (os) possuem conhecimento satisfatório sobre a atuação no SBV frente a PCR.


Objective: To analyze the knowledge of FHS nurses from a municipality of Recôncavo de Bahía against SBV. Method: This is a descriptive epidemiological research, conducted with 14 nurses from Basic Health Units and Family Health Units in a municipality of Bahia, using a questionnaire on sociodemographic, occupational and educational characteristics and about general and specific SBV education. Data were analyzed through descriptive analysis of variables, calculating absolute and relative frequencies and measures of central tendency and dispersion. Results: most had knowledge of how to check the victim's pulse on cardiac arrest (92.9%), the frequency of chest compressions if ventilation could not be guaranteed (57.1%), and the minimum depth of chest compressions ( 71.4%). 92.9% did not know the proper place for hand placement and chest compressions; 50% were aware of the situations in which AED could be used; 57.1% knew the PCR rates and 57.1% were shockable PCR rates. Conclusion: We found that nurses have satisfactory knowledge about the performance of SBV in relation to CRP.


Objetivo: analizar el conocimiento de las enfermeras de FHS de un municipio en el Recôncavo de Bahía contra SBV. Método: Esta es una investigación epidemiológica descriptiva, realizada con 14 enfermeras de Unidades Básicas de Salud y Unidades de Salud Familiar en un municipio de Bahía, utilizando un cuestionario sobre características sociodemográficas, ocupacionales y educativas, asi como formación general y específica sobre SBV. Los datos se analizaron mediante un análisis descriptivo de variables, calculando frecuencias absolutas y relativas y medidas de tendencia central y dispersión. Resultados: la mayoría tenía conocimiento de cómo verificar el pulso de la víctima en un paro cardíaco (92,9%), la frecuencia de las compresiones torácicas si no se podía garantizar la ventilación (57,1%) y la profundidad mínima de las compresiones torácicas ( 71,4%). 92.9% no conocía el lugar adecuado para la colocación de las manos y las compresiones torácicas, 50% estaba al tanto de las situaciones en las que se podía usar el DEA; 57.1% conocía las tasas de PCR y 57.1% eran tasas de PCR impactables. Conclusión: se encontró que las enfermeras tienen un conocimiento satisfactorio sobre el desempeño del SBV en relación con la PCR.


Subject(s)
Emergencies
9.
Arch. med ; 20(1): 107-115, 2020-01-18.
Article in Spanish | LILACS (Americas) | ID: biblio-1053242

ABSTRACT

Objetivo: esta investigación pretende estudiar las variables epidemiológicas relacionadas con la tentativa y el reintento de suicidio y si entre ellas los trastornos de ansiedad son importantes. En la conducta suicida existen fases previas menos investigadas que son altamente predictivas del suicidio consumado, como son los intentos o reintentos de suicidio. Materiales y métodos: consistió en recoger datos digitales en los servicios de urgencias hospitalarias durante 26 meses. Resultados: los resultados obtenidos por un proceso de regresión logística binaria muestran que el grupo de personas que han realizado más de una tentativa de suicidio son mujeres (ß =0,36; OR=2,70; I.C. 95%), entre 34 y 53 años de edad (ß =0,31; OR=6,99; I.C. 95%), desempleadas (ß =0,43; OR=4,98; I.C. 95%), con trastorno de ansiedad previo (ß =0,83; OR=3,95; I.C. 95%), que utilizan métodos únicos (ß =0,23; OR=4,72; I.C. 95%) y que suelen darle el alta en los servicios sanitarios de urgencias (ß =0,42; OR=6,89; I.C. 95%). Conclusiones:se discute la necesidad de realizar protocolos sanitarios específicos para la prevención de la tentativa de suicida adaptados a las características psicosociales y clínicas de este colectivo, mejorando a su vez las actuaciones sanitarias de urgencia existentes para los reintentos de suicidio como prevención del suicidio consumado..(AU)


Objective: this research intends to study the epidemiological variables related to the attempt and the suicide retry and if it enters them the anxiety disorders are important. In suicidal behavior there are less investigated previous phases that are highly predictive of completed suicide such as suicide attempts or retries. Materials and methods: consisted in the collection of digital data in the hospital emergency services for 26 months. Results: the results obtained by a binary logistic regression process show that the group of people who have made the most suicide attempt are women (ß = 0.36, OR = 2.70, 95% CI), between 34 and 53 years of age (ß = 0.31, OR = 6.99, 95% CI), unemployed (ß = 0.43, OR = 4.98, 95% CI), with previous anxiety disorders (ß = 0.83; OR = 3.95, 95% CI), who use unique methods (ß = 0.23, OR = 4.72, 95% CI) and who usually discharge them in emergency healthcare services (ß = 0.42; OR = 6.89, 95% CI). Conclusions: the need to carry out specific sanitary protocols for the prevention of attempted suicide adapted to the psychosocial and clinical characteristics of this group is discussed, improving in turn the existing emergency health actions for the suicide attempts as prevention of the consummated suicide..(AU)


Subject(s)
Humans , Patients , Emergencies , Neoplasms
10.
Arch. med ; 20(1): 133-147, 2020-01-18.
Article in Spanish | LILACS (Americas) | ID: biblio-1053256

ABSTRACT

Objetivo: caracterizar sociodemográfica y clínicamente los pacientes que después de ingresar a servicios de urgencias de dos centros de tercer nivel de atención de la ciudad de Manizales (Colombia), se les diagnosticó alguno de los tipos de cáncer más frecuentes según el Registro Poblacional de Cáncer de Manizales. Materiales y métodos: con base a la información aportada por el Registro Poblacional de Cáncer de Manizales entre los años 2008 y 2012, se escogieron los cinco tipos de cáncer más frecuentes en cada género para la realización del estudio. Fueron incluidos 116 casos de los que ingresaron por servicios de urgencias para extraer información a partir de las historias clínicas, la cual posteriormente fue tabulada y analizada mediante estadística descriptiva. Resultados: la mayoría los pacientes provenían de Manizales (60,3%), y pertenecían al régimen contributivo de seguridad social (50,0%). El promedio de edad fue de 72,4 años. El promedio de duración de los síntomas antes de consultar fue de 2,3 meses y los cánceres más frecuentes fueron el gástrico (41,4%), de colon (25,9%), CP (23,3%), cérvix (6%) y recto (3,5%) en estadios avanzados. Conclusiones: se continúan diagnosticando casos de cáncer de novo en estadio tardío, al ingresar por los servicios de urgencias. Resulta muy importante conocer la epidemiología de estos tipos de cáncer en cada una de las regiones y mejorar la formación médica con el fin de implementar estrategias para disminuir su aparición..(AU)


Objective: to characterize sociodemographicly and clinically those patients, who after admission by the emergency services of two tertiary level centers in Manizales (Colombia), were diagnosed with some of the most frequent cancers according to the Manizales Population Cancer Registry. Materials and methods: based on the information provided by the Manizales Population Cancer Registry between the years of 2008 to 2012, the five most frequent types of cancer in each gender were chosen for the study. There were 116 cases of those admitted through the emergency services for data extraction from the clinical record, which was later tabulated and analyzed using descriptive statistics. Results: most of the patients came from Manizales (60.3%), covered by the contributory social security scheme (50.0%), with a mean age of 72.4 years. The mean duration of symptoms before consulting the emergency service was 2.3 months. The most frequent cancers were gastric (41.4%), colon (25.9%) lung (23.3%), cervix (6%) and rectal cancer (3.5%) in advanced stages. Conclusions: new cases of late-stage cancer are still being diagnosed upon admission to emergency services. It is important to know the epidemiology of these cancers in each of the regions and to improve medical training in order to implement strategies to reduce their presentation..(AU)


Subject(s)
Humans , Patients , Neoplasms , Emergencies
11.
Rev. bras. promoç. saúde (Impr.) ; 33: 1-11, 03/01/2020.
Article in English, Portuguese | LILACS (Americas) | ID: biblio-1099888

ABSTRACT

Objetivo: Conhecer a percepção de profissionais de saúde e usuários em relação ao acolhimento com classificação de risco em um serviço de urgência/emergência. Métodos: Estudo exploratório descritivo, com abordagem qualitativa, realizado em uma unidade de urgência/emergência de um hospital do interior do Rio Grande do Sul, Brasil. A coleta de dados ocorreu em agosto e setembro de 2017, através de entrevista semiestruturada realizada com 15 profissionais de saúde e nove usuários do serviço. A análise obedeceu aos pressupostos da análise de conteúdo, emergindo três categorias temáticas: O cotidiano de trabalho dos profissionais em relação ao acolhimento e classificação de risco; Dificuldade do usuário em compreender a classificação de risco estabelecida pelos profissionais; Importância da capacitação para atuação em equipe no acolhimento com classificação de risco. Resultados: Os usuários possuem pouco conhecimento sobre o acolhimento com classificação de risco, assim como sobre o funcionamento do mesmo. Os profissionais não se sentem preparados para trabalhar com esse sistema em função da falta de treinamento adequado, por vezes classificando os usuários de forma inadequada, o que pode agravar o quadro clínico e o prognóstico, além de dificultar a efetivação da integralidade do cuidado. Conclusão: Evidenciou-se que os usuários não têm clareza a respeito dos critérios utilizados para a realização do Protocolo de acolhimento com classificação de risco, gerando conflitos entre profissionais e usuários. Há necessidade de se repensar as formas de esclarecer os usuários quanto à importância desse sistema.


Objective: To know health professionals' and users' perceptions of user embracement and risk classification in an urgency/emergency service. Methods: A qualitative exploratory descriptive study was conducted in an urgency/emergency center of a hospital in the countryside of Rio Grande do Sul, Brazil. Data were collected in August and September 2017 through semi-structured interviews with 15 health professionals and nine service users. The analysis followed the assumptions of content analysis and three thematic categories emerged: Professionals' daily work in relation to user embracement and risk classification; User's difficulty in understanding the risk classification made by professionals; Importance of training for teamwork in user embracement with risk classification Results: The users have little knowledge about user embracement with risk classification and its functioning. The professionals do not feel prepared to work with this system due to lack of adequate training and sometimes end up inappropriately classifying the users, which may worsen the clinical picture and prognosis in addition to hindering the delivery of comprehensive care. Conclusion: The users do not understand clearly the criteria adopted to carry out the user embracement with risk classification protocol, which generates conflicts between professionals and users. There is a need to rethink ways to inform users about the importance of this system.


Objetivo: Conocer la percepción de profesionales sanitarios y usuarios respecto la acogida con la clasificación de riesgo de un servicio de urgencia/emergencia. Métodos: Estudio exploratorio descriptivo de abordaje cualitativo realizado en una unidad de urgencia/emergencia de un hospital de Rio Grande do Sul, Brasil. La recogida de datos se dio entre agosto y septiembre de 2017 a través de entrevista semiestructurada realizada con 15 profesionales sanitarios y nueve usuarios del servicio. El análisis obedeció a los presupuestos del análisis de contenido del cual emergieron tres temáticas: El cotidiano de trabajo de los profesionales respecto la acogida y la clasificación de riesgo; Dificultad del usuario de comprender la clasificación de riesgo establecida por los profesionales; Importancia de un equipo preparado para la acogida con clasificación de riesgo. Resultados: Los usuarios tienen poco conocimiento sobre la acogida con clasificación de riesgo así como el funcionamiento del mismo. Los profesionales no están preparados para trabajar con ese sistema por no tener entrenamiento adecuado, algunas veces clasificando los usuarios de manera inadecuada lo que puede empeorar el cuadro clínico y el pronóstico además de dificultar la efectuación de la integralidad del cuidado. Conclusión: Se ha evidenciado que los usuarios no están seguros de los criterios utilizados para la realización del protocolo de acogida con clasificación de riesgo lo que genera conflictos entre profesionales y usuarios. Hay la necesidad de repensar las formas de aclarar los usuarios sobre la importancia de ese sistema.


Subject(s)
Risk , Nursing , Classification , Emergency Relief , Emergencies , User Embracement
12.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-816642

ABSTRACT

The 2019 novel coronavirus disease (COVID-19) outbreaks that emerged in Wuhan city, Hubei province, have led to a formidable number of confirmed cases that resulted in >5,700 deaths globally, including 143 countries in all 6 continents. The World Health Organization declared a Public Health Emergency of International Concern with a very high level of global risk assessment. Severe acute respiratory syndrome (SARS)-coronavirus-2 (SARS-CoV-2), the agent of COVID-19, has >79% nucleotide sequence homology to SARS-CoV; therefore, both belong to the genus betacoronavirus and subgenus sarbecovirus. The S1 domains of the two appeared to share the cellular receptor ACE2, but revealed a much higher S1-ACE2 binding affinity. As seen in many other human coronaviruses, SARS-CoV-2 also shows respiratory infection, but the basic reproductive number (R₀) in transmission and the clinical latency are quite dissimilar from those of SARS- or MERS-CoVs. Many scientists infer that the time point of cross-barrier transfer from bats to mediate animals or to humans should be a rather recent event based on the full-length genome analyses obtained from the very first patients. Copy-choice polymerization, which often leads to a significant genome recombination rate in most coronaviruses, predicts the continued emergence of novel coronaviruses.


Subject(s)
Animals , Base Sequence , Chiroptera , Coronavirus , Disease Outbreaks , Emergencies , Genome , Humans , Middle East Respiratory Syndrome Coronavirus , Molecular Biology , Polymerization , Polymers , Public Health , Recombination, Genetic , Risk Assessment , SARS Virus , Severe Acute Respiratory Syndrome , World Health Organization
13.
Article in English | WPRIM (Western Pacific) | ID: wprim-782522

ABSTRACT

A 12-year-old Warmblood mare was presented with an acute onset left hindlimb lameness associated with generalised soft tissue swelling of the entire limb and medial saphenous vein (MSV) thrombophlebitis. A presumptive diagnosis of extremity compartment syndrome (ECS) was made. Due to the clinical deterioration, emergency fasciotomy of the crural fascia and biopsy was performed. Histological and immunohistochemical examination of the samples confirmed a diagnosis of leiomyosarcoma likely originating from the tunica media of the MSV. This report is the first to describe an unique combination of ECS and thrombophlebitis associated with a leiomyosarcoma in a horse.


Subject(s)
Animals , Biopsy , Child , Compartment Syndromes , Diagnosis , Emergencies , Extremities , Fascia , Hindlimb , Horses , Humans , Leiomyosarcoma , Saphenous Vein , Thrombophlebitis , Tunica Media
14.
Article in English | WPRIM (Western Pacific) | ID: wprim-782271

ABSTRACT

OBJECTIVES: The aim of this study was to develop machine learning (ML) and initial nursing assessment (INA)-based emergency department (ED) triage to predict adverse clinical outcome.METHODS: The retrospective study included ED visits between January 2016 and December 2017 that resulted in either intensive care unit admission or emergency room death. We trained four classifiers using logistic regression and a deep learning model on INA and low dimensional (LD) INA, logistic regression on the Korea Triage and acuity scale (KTAS) and Sequential Related Organ Failure Assessment (SOFA). We varied the outcome ratio for external validation. Finally, variables of importance were identified using the random forest model's information gain. The four most influential variables were used for LD modeling for efficiency.RESULTS: A total of 86,304 patient visits were included, with an overall outcome rate of 3.5%. The area under the curve (AUC) values for the KTAS model were 76.8 (74.9–78.6) with logistic regression and 74.0 (72.1–75.9) for the SOFA model, while the AUC values of the INA model were 87.2 (85.9–88.6) and 87.6 (86.3–88.9) with logistic regression and deep learning, suggesting that the ML and INA-based triage system result more accurately predicted the outcomes. The AUC values for the LD model were 81.2 (79.4–82.9) and 80.7 (78.9–82.5) for logistic regression and deep learning, respectively.CONCLUSIONS: We developed an ML and INA-based triage system for EDs. The novel system was able to predict clinical outcomes more accurately than existing triage systems, KTAS and SOFA.


Subject(s)
Area Under Curve , Emergencies , Emergency Service, Hospital , Forests , Humans , Intensive Care Units , Korea , Learning , Logistic Models , Machine Learning , Nursing Assessment , Nursing , Retrospective Studies , Triage
15.
Article in English | WPRIM (Western Pacific) | ID: wprim-782269

ABSTRACT

OBJECTIVES: Foreign patients are more likely to receive inappropriate health service in the emergency room. This study aimed to investigate whether there is health inequality between foreigners and natives who visited emergency rooms with injuries and to examine its causes.METHODS: We analyzed clinical data from the National Emergency Department Information System database associated with patients of all age groups visiting the emergency room from 2013 to 2015. We analyzed data regarding mortality, intensive care unit admission, emergency operation, severity, area, and transfer ratio.RESULTS: A total of 4,464,603 cases of injured patients were included, of whom 67,683 were foreign. Injury cases per 100,000 population per year were 2,960.5 for native patients and 1,659.8 for foreign patients. Foreigners were more likely to have no insurance (3.1% vs. 32.0%, p < 0.001). Serious outcomes (intensive care unit admission, emergency operation, or death) were more frequent among foreigners. In rural areas, the difference between serious outcomes for foreigners compared to natives was greater (3.7% for natives vs. 5.0% for foreigners, p < 0.001). The adjusted odds ratio for serious outcomes for foreign nationals was 1.412 (95% confidence interval [CI], 1.336–1.492), and that for lack of insurance was 1.354 (95% CI, 1.314–1.394).CONCLUSIONS: Injured foreigners might more frequently suffer serious outcomes, and health inequality was greater in rural areas than in urban areas. Foreign nationality itself and lack of insurance could adversely affect medical outcomes.


Subject(s)
Emergencies , Emergency Service, Hospital , Emigrants and Immigrants , Ethnic Groups , Health Services , Healthcare Disparities , Humans , Information Systems , Insurance , Intensive Care Units , Mortality , Odds Ratio , Population Groups , Socioeconomic Factors , Wounds and Injuries
16.
Article in English | WPRIM (Western Pacific) | ID: wprim-782212

ABSTRACT

OBJECTIVE: Cesarean section is the most commonly performed obstetrical surgical procedure; however, there are no standard guidelines on appropriate skin closure techniques and materials. Only few comparative studies have been conducted on different skin closure techniques, and they have shown conflicting results. Therefore, we compared different skin closure techniques during emergency cesarean section to identify the best technique with minimal wound complication rates.METHODS: Patients were randomized into 3 groups (group A, n=100; group B, n=102; and group C, n=98). In group A, the skin was closed using staples; in group B, via the subcuticular technique using monocryl 3-0; and in group C, using mattress suture nylon (2-0). The primary outcome was a composite of wound complications, including infection, seroma, gaping, and need for resuturing and antibiotic administration. The secondary outcome included closure time, pain perception, patient satisfaction, and cost. Analyses were performed in accordance with the intention-to-treat principle.RESULTS: The composite wound complication rate in the entire cohort was 16.6% (n=50); the complication rate was significantly higher in group A than in the other groups. Infection was the most common wound complication observed in the entire study group (86%) and was significantly higher in group A than in groups B and C (P≤0.001).CONCLUSION: The use of staples for cesarean section skin closure is associated with an increased risk of wound complications and prolonged hospital stay postoperative visits.


Subject(s)
Cesarean Section , Cohort Studies , Emergencies , Female , Humans , Length of Stay , Nylons , Obstetric Surgical Procedures , Pain Perception , Patient Satisfaction , Pregnancy , Seroma , Skin , Sutures , Wounds and Injuries
17.
Article in English | WPRIM (Western Pacific) | ID: wprim-782168

ABSTRACT

OBJECTIVE: To survey care providers' willingness to use 2-mSv computed tomography (CT) in their usual practice for adolescents and young adults with suspected appendicitis.MATERIALS AND METHODS: An ethical committee approved this prospective study. We introduced 2-mSv CT in 20 hospitals through a pragmatic clinical trial. At the final phase of the trial, we invited 698 potentially-involved care providers in the survey regarding their willingness to use 2-mSv CT. Multivariable logistic regression analyses were performed to identify factors associated with willingness. Nine months after the completion of the trial patient recruitment, we surveyed whether the hospitals were using 2-mSv CT in usual practice.RESULTS: The analyses included responses from 579 participants (203 attendings and 376 trainees; 221 radiologists, 196 emergency physicians, and 162 surgeons). Regarding the willingness to immediately change their standard practice to 2-mSv CT, 158 (27.3%), 375 (64.8%), and 46 (7.9%) participants responded as “yes” (consistently), “partly” (selectively), and “no”, respectively. Willingness varied considerably across the hospitals, but only slightly across the participants' departments or job titles. Willingness was significantly associated with attendings (p = 0.004), intention to maintain the dedicated appendiceal CT protocol (p < 0.001), belief in compelling evidence on the carcinogenic risk of conventional-dose CT radiation (p = 0.028), and hospitals having more than 1000 beds (p = 0.031). Fourteen of the 20 hospitals kept using 2-mSv appendiceal CT in usual practice after the trial.CONCLUSION: Despite the extensive efforts over the years of this clinical trial, many care providers were willing to use 2-mSv CT selectively or not willing to use.


Subject(s)
Adolescent , Appendicitis , Emergencies , Humans , Intention , Logistic Models , Patient Selection , Pragmatic Clinical Trial , Prospective Studies , Radiation Dosage , Surgeons , Surveys and Questionnaires , Young Adult
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