Prevalence of severe acute malnutrition and its effect on under-five mortality at a regional hospital in South Africa

Introduction: Severe acute malnutrition (SAM) is an important global and national public health concern. It contributes tounder-five mortality but is also largely a preventable disease. Objective: This study aimed to assess the prevalence of and mortality associated with SAM. Design: A retrospective review of hospital files was conducted. Setting: Dora Nginza Hospital, Eastern Cape, South Africa was the site of the study. Subjects: The study included children from 6 to 59 months of age admitted to the paediatric ward between January 1, 2018 and December 31, 2018. Children with chronic disease were excluded. Ethics approval was granted by Walter Sisulu University (053/2019). Outcome measures: Anthropometric, co-morbid and outcomes data were retrieved and analysed. Results: A total of 1 296 children were included in the study, 93 with SAM. The prevalence of SAM was 7.2%. Children with SAM had a median age of 16 months (IQR 11­25). Gender distribution was 52 (56%) females and 41 (44%) males. The inpatient mortality rate for children with SAM was 6.5%. Children with SAM were at significantly increased risk of mortality (RR 5.97, 95% CI 3.1­11.6, p-value < 0.0005). Three factors were significantly associated with mortality: nutritional oedema, sepsis, and hypokalaemia. Conclusion: The prevalence of SAM at Dora Nginza Hospital is high, and children with SAM are at significantly increased risk of mortality. Specific risk factors for mortality include sepsis, urinary tract infection, nutritional oedema and hypokalaemia. Modifiable factors associated with SAM and SAM-related mortality need to be targeted urgently to improve outcomes.

Estrategias hospitalarias frente a una pandemia / Hospital strategies against a pandemic

La humanidad, que a lo largo de la historia ha sufrido pandemias que han ocasionado la muerte de millones de personas, es actualmente azotada por la pandemia de COVID-19. El propósito de este artículo es brindar estrategias para un manejo oportuno y eficiente que contribuya a disminuir la morbilidad y mortalidad a nivel hospitalario. Para la elaboración de este artículo se revisó bibliografía de instituciones certificadas en el tema, encontrando que la mayor parte de publicaciones se centran en el abordaje de una pandemia como país; es muy poca la literatura que se centra en el abordaje hospitalario. Es por ello que, de acuerdo con la experiencia actual, en la que hemos observado serias debilidades en los hospitales de la red hospitalaria del sector público, se sugieren estrategias, adecuadas a nuestro medio, para que las autoridades hospitalarias puedan hacerle frente a una pandemia...(AU)

Dotación fonoaudiológica para la atención de pacientes adultos en hospitales de alta complejidad en Chile / Speech and language therapists for attending adult patients in high-complexity hospitals in Chile

A nivel internacional se propone un mínimo de un profesional fonoaudiólogo por cada diez camas críticas o más, dependiendo de la complejidad de cada institución. En Chile no existen lineamientos similares, no obstante, el Ministerio de Salud ha generado recomendaciones para el cálculo de la brecha profesional según número y complejidad de las camas hospitalarias. El objetivo de este estudio es estimar el número de fonoaudiólogos y horas de contratación teóricas requeridas para la atención de pacientes adultos hospitalizados en instituciones públicas de alta complejidad en Chile. Para ello se realizó un estudio descriptivo, observacional, transversal. Se incluyeron todos los hospitales públicos de alta complejidad del país, excluyendo aquellos pediátricos y psiquiátricos. Como instrumentos se utilizaron el documento "Modelo de Gestión Red de Rehabilitación" del Ministerio de Salud, la base de datos actualizada del total de camas de la red hospitalaria y el software Microsoft Excel. El estudio fue aprobado por Comité Ético Científico del Hospital San Juan de Dios. En total 59 de 188 hospitales existentes en Chile fueron incluidos. De acuerdo con el análisis realizado basado en el número de camas en Chile, se requieren aproximadamente 269 fonoaudiólogos contratados 44 horas semanales para la atención de pacientes adultos en hospitales de alta complejidad. De ellos 104 se ubican en la Región Metropolitana; alrededor de 31 en la Región del BíoBío y cerca de 24 en la Región de Valparaíso. Se sugiere la revisión de las orientaciones ministeriales y la realización de un segundo estudio sobre la brecha profesional existente en Chile con los datos obtenidos.

International institutions have suggested one Speech and Language Therapist per ten critical beds, and possibly even more forhigh-complexity institutions. However, there are no similar recommendations in Chile, although the Ministry of Health has developed recommendations to calculate the number of professionals required according to the number and type of clinical bed. The aim of this study is to describe the number of Speech and Language Therapists along with the number of theorical working hours per week required for the attention of hospitalised adult patients in high-complexity hospitals in Chile, for which a descriptive, observational and transversal study was performed. High-complexity hospitals were included, excluding psychiatric and paediatric institutions. Microsoft Excel, the "Modelo de Gestión Red de Rehabilitación" guideline from the Ministry of Health, and the updated database of the clinical network beds were also used. This study was previously approved by a Research Ethics Committee from Hospital San Juan de Dios, and a total of 59 out of 188 hospitals were included. According to the analysis based on features of the clinical beds, 269 Speech and Language Therapists are required for 44 hours per week to attend adult patients in high-complexity hospitals across the country. Of the 269 professionals, 104 are needed in the Metropolitan region, approximately 31 in the Bío-Bío region and circa 24 in the Valparaíso region. According to these results, it is suggested the Ministry review its guidelines and undertake a further project in order to identify the current professional gap in Chile.

Categorización de la atención fonoaudiológica: una propuesta para adultos en contexto hospitalario / Categorizing speech-language pathology attention: a proposal for adults inpatient

Existe la necesidad de desarrollar herramientas que demuestren el impacto de la intervención fonoaudiológica en el ámbito hospitalario, lo que exige implementar modelos asistenciales y de gestión, que favorezcan la demanda clínica y la eficiencia de los procesos y de los equipos. Diversas profesiones del área sanitaria han empleado modelos de categorización de la atención que, junto con satisfacer las demandas de los pacientes, traducen las actividades de su disciplina en términos de gestión. Actualmente, en el ámbito fonoaudiológico no se cuenta con herramientas de este tipo que permitan determinar la cantidad de atenciones necesarias para una persona en contexto hospitalario. Debido a lo anterior, en el artículo se presenta la creación, desarrollo y aplicación de una matriz cuali-cuantitativa. El objetivo de la matriz es valorar y estandarizar la carga de trabajo fonoaudiológico requerido para cada paciente adulto hospitalizado, considerando su contexto clínico global. Esta matriz de categorización considera cinco variables clínicas evaluadas durante la rehabilitación del paciente y cuatro calificadores en relación con el orden de severidad. Se establecen y proponen diferentes categorías de atención que entregan una carga terapéutica recomendada (desde 1 a 2 atenciones semanales en casos leves hasta 2 atenciones diarias en casos complejos). Finalmente, se discute su uso y los beneficios de su implementación como una herramienta que permite optimizar procesos de gestión, determinar brechas y justificar la inclusión de nuevos fonoaudiólogos en el contexto hospitalario.

There is a need to develop tools that demonstrate the impact of speech therapy intervention in the hospital setting, which requires the implementation of care and management models that favor clinical demand and efficiency of processes and equipment. Various professions in the health area have used categorization models that, along with satisfying the demands of patients, translate the activities of their discipline into management terms. Currently, in the speech therapy field, there are no tools of this kind available that allow determining the amount of care necessary for a person in a hospital context. Due to the above circumstances, this article presents the creation, development and application of a qualitative-quantitative matrix. The objective of the matrix is to assess and standardize the speech therapy workload required for each hospitalized adult patient, considering their global clinical context. This categorization matrix considers five clinical variables evaluated during the patient's rehabilitation and four qualifiers in relation to the order of severity. Different categories of care that deliver a recommended therapeutic load (from 1 to 2 weekly visits in mild cases to 2 daily visits in complex cases) are established and proposed. Finally, their use and the benefits of their implementation are discussed as a tool that allows optimizing management processes, determining gaps and justifying the inclusion of new speech therapists in the hospital context.

Communication as a strategy for hospital accreditation maintenance / La comunicación como estrategia para el mantenimiento de la acreditación hospitalaria / A comunicação como estratégia para manutenção da acreditação hospitalar

ABSTRACT Objective: to analyze the communication strategies adopted by a General Hospital, which helped the accreditation's maintenance with excellence. Method: case study of a Private Hospital in Belo Horizonte, Brazil, accredited with excellence. Data were collected through semi-structured interviews and through analysis of institutional documents. The interviews were transcribed in full and submitted to content analysis. Results: instigating organizational and behavioral changes that have generated insecurity and resistance in employees. The development of strategies to improve internal communication contributed to the uniformity of information and the greater integration of professionals in their actions, promoting the change in the workers' attitudes, and engaging and involving them in the process. Conclusion: communication plays a prominent role in the consolidation of hospital care and the development of a priority strategy to reach and maintain it, with an emphasis on quality of care and patient safety.

RESUMEN Objetivo: analizar las estrategias de comunicación adoptadas por un Hospital General para el mantenimiento de la acreditación con excelencia. Método: estudio de caso de un hospital privado de Belo Horizonte, Brasil, acreditado con excelencia. Los datos fueron recolectados por medio de entrevistas con un guión semi-estructurado y el análisis de documentos institucionales. Las entrevistas fueron transcritas en su totalidad y sometidas al análisis de contenido. Resultados: la acreditación causó cambios organizacionales y comportamentales que generaron inseguridad y resistencia en los colaboradores inicialmente. El desarrollo de estrategias para mejorar la comunicación interna contribuyó a la uniformidad de las informaciones y más integración por parte de los profesionales en sus acciones, promoviendo el cambio en las actitudes de los trabajadores, haciéndolos comprometidos e involucrados con el proceso. Conclusión: la comunicación asume un papel destacado para la consolidación de la acreditación hospitalaria y el desarrollo de estrategia prioritaria para el alcance y mantenimiento de la misma, con énfasis en la calidad asistencial y la seguridad del paciente.

RESUMO Objetivo: analisar as estratégias de comunicação adotadas por um Hospital Geral, que colaboram para manutenção da acreditação com excelência. Método: estudo de caso de um Hospital Privado de Belo Horizonte, Brasil, acreditado com excelência. Os dados foram coletados por meio de entrevistas com roteiro semiestruturado e análise de documentos institucionais. As entrevistas foram transcritas na íntegra e submetidas à análise de conteúdo. Resultados: a acreditação provocou mudanças organizacionais e comportamentais que inicialmente geraram insegurança e resistência nos colaboradores. O desenvolvimento de estratégias para melhoraria da comunicação interna contribuiu para uniformidade das informações e maior compreensão por parte dos profissionais sobre suas ações, promovendo, assim, mudanças nas atitudes dos trabalhadores, tornando-os engajados e envolvidos com o processo. Conclusão: a comunicação assume papel de destaque para consolidação da acreditação hospitalar e deve ser estratégia prioritária para alcance e manutenção da mesma, visando à qualidade assistencial e a segurança do paciente.

Quality of nursing care of surgical patients at the regional hospital of Ngaoundere

Introduction. One way of assessing the quality of healthcare is to study the satisfaction of patients about the care which is provided by nursing personnel of surgical units. The aim of the study was to assess the healthcare quality provided to patients, and how satisfied they are with focus on the sociodemographic factors that can affect the patients' nursing at the Regional Hospital of Ngaoundere. Patients and methods. This was a cross sectional transversal prospective study that was carried in n the surgery unit of the Regional Hospital of Ngaoundéré from September to December 2015. Our tools were a questionnaire and observational audit. Our study variables were the knowledge and attitudes of patients in relation to aesthesia and surgery, and the level of satisfaction in all its dimensions during the various stages of the perioperative interventions. Results. Within three (03) months, we have got and handled a sample if sixty (60) patients, using a questionnaire that enabled us to record 3.75 for the total amount of satisfaction and 75% for the total rate. The technical competences were the highest proportion with a total rate of 91.8%, 92.6% for the esteem (respect) and 84.4% for the staff characteristics. But supporting was less, with 47.5%. Conclusion. Our results emphasize some factors that should be improved to provide a better nursing quality care plan to patients during surgical operations

Factors contributing to neonatal admissions and outcomes at Effia Nkwanta regional hospital: January to December 2015

Objectives: To investigate factors contributing to neonatal admission outcomes at Effia Nkwanta Regional Hospital (ENRH) Method: All neonatal admissions to the Neonatal & Intensive Care Unit (NICU) of the hospital that were entered into the DHIMS2 database were extracted and complemented with additional information from patients' folder review. The data from the two sources were merged and analysed using SPSS version 21. Univariate and multivariate regression analysis was performed to identify factors associated with admission outcomes, taking statistical significance as p < 0.05. ARC-GIS version 10.1 was used to describe the geospatial distribution of health facilities referring to ENRH. Setting: Neonatal & Intensive Care Unit of ENRH Participants: All neonates admitted to NICU between January and December 2015. Intervention: None Results: Nine Hundred and Ninety-Three out of the 1150 neonatal admissions were entered into DHIMS2. Fifty-two percent were males, 57.3% were delivered through Caesarean Section, 72% were admitted within 2 days of birth, and 56.8% had normal birth weight. FiftyEight percent of the neonates were delivered at the ENRH, whilst 39.9% were referred from health facilities located within Sekondi-Takoradi Metropolis. At 1 minute, only 14% of the neonates had normal Apgar score (8-10), and this improved to 50% at 5 minutes. The main causes of neonatal admission were birth asphyxia 21.0%, followed by prematurity 17.5%, neonatal jaundice 17.1% and neonatal sepsis 14.5%. The death rate was 18% with more than 80% of the deaths occurring during the early neonatal period. More than 80% of deaths were due to four admission diagnoses: birth asphyxia, prematurity, neonatal jaundice, neonatal sepsis. Factors associated with adverse admission outcome are: low birth weight, delivery by Caesarean Section and low Apgar score at 5 minutes. Conclusions: The institution of appropriate interventions to reduce or manage the four major causes of adverse neonatal admission outcomes will significantly reduce neonatal mortality in the hospital

A retrospective study of lower limb cellulitis in a regional hospital in Ghana

Background: Cellulitis is a non-necrotizing inflammation of the dermis of skin and subcutaneous tissues. Lower limb cellulitis is a common cause of hospitalization in Ghana but scarcely reported. Objective: To document management and outcomes of lower limb cellulitis at the Ashanti Regional Hospital in Ghana. Materials and Methods: Retrospective review of patients admitted to the Ashanti Regional Hospital with a diagnosis of lower limb cellulitis from November 2016 to October 2018. We reviewed patients' clinical records for data on patient demographics, risk factors, clinical presentation, treatment modality and outcome of cellulitis. A p-value of less than 0.05 was considered to be statistically significant. Results: Eighty two (82) patients with lower limb cellulitis were admitted over the study period. There were 47 (57.3%) females and 35 (42.7%) males. The mean age of patients was 38.8 years (standard deviation 21.6065). Among females, the majority, 10 (21.3%) were in the 6th decade whilst the majority, 9 (25.7%) of males were in the 4th decade. All the patients presented with swelling of the lower limb involving the left lower limb in 38(46.3%) and right in 44(53.7%) cases. The leg was the most common location involved 60 (73%). The mean duration of swelling prior to admission was 5. 2 days (SD 3.196). Antibiotics treatment resulted in complete resolution in 29 (35.4%) cases and complications in 53 (54.5%), cases requiring surgical treatment in 31(58.5%) patients. Conclusion: Lower limb cellulitis had a high complication rate influenced by duration of symptoms prior to hospitalization and antibiotic therapy

Monitoramento do plano de ação da Secretaria de Estado da Saúde do Tocantins SES-TO / Monitoring the action plan of the State Department of Health of Tocantins SES-TO

Apresenta o relatório sobre a responsabilidade sanitária dos profissionais da gestão em Saúde bem como o empenho de aperfeiçoar, fortalecer, organizar, modernizar e fazer cumprir os princípios do SUS também no Tocantins. Baseia-se em Governança e Gestão Integrada, e após monitorado alcança avanços registrados, também, como resultados e respostas aos 7 Macroeixos da Ação Civil Pública nº 10058-73.2015.4.01.4300. Apresenta ainda a Revisão da Política remuneratória do Setor Saúde, a Reestruturação do processo de compras e licitações, as ações de Educação Permanente quanto a Capacitação de profissionais, o planejamento de adequações nos hospitais regionais, o regimento Interno da Secretaria da Saúde do Estado do Tocantins, a Estrutura da secretaria, a Programação Anual de Saúde de 2018, portarias, formulários e Relatório de Necessidades de Recursos Financeiros do Tesouro.

It presents the report on the health responsibility of health management professionals, as well as the commitment to perfect, strengthen, organize, modernize and enforce SUS principles also in Tocantins. It is based on Governance and Integrated Management, and after monitored it achieves registered progress, also, as results and responses to the 7 Macro-axes of Public Civil Action nº 10058-73.2015.4.01.4300. It also presents the Review of the Health Sector's remuneration policy, the restructuring of the procurement and bidding process, the Permanent Education actions regarding the training of professionals, the planning of adaptations in regional hospitals, the Internal regulations of the State of Tocantins Health Department , the Secretariat Structure, the 2018 Annual Health Program, ordinances, forms and Treasury Financial Resource Needs Report.

Presenta el informe sobre la responsabilidad sanitaria de los profesionales de la gestión sanitaria, así como el compromiso de perfeccionar, fortalecer, organizar, modernizar y hacer cumplir los principios del SUS también en Tocantins. Se basa en la Gobernanza y la Gestión Integrada, y luego de monitoreado logra avances registrados, también, como resultados y respuestas a los 7 Macroejes de Acción Civil Pública nº 10058-73.2015.4.01.4300. También presenta la Revisión de la política de remuneraciones del Sector Salud, la reestructuración del proceso de adquisiciones y licitaciones, las acciones de Educación Permanente en materia de formación de profesionales, la planificación de adaptaciones en hospitales regionales, el Reglamento Interno del Departamento de Salud del Estado de Tocantins. , la Estructura de la Secretaría, el Programa Anual de Salud 2018, las ordenanzas, los formularios y el Informe de Necesidades de Recursos Financieros del Tesoro.

Il présente le rapport sur la responsabilité sanitaire des professionnels de la gestion de la santé, ainsi que l'engagement à perfectionner, renforcer, organiser, moderniser et appliquer les principes SUS également à Tocantins. Il est basé sur la Gouvernance et la Gestion Intégrée, et après suivi, il réalise des progrès enregistrés, aussi, comme résultats et réponses aux 7 Macro-axes de l'Action Civile Publique nº 10058-73.2015.4.01.4300. Il présente également la Revue de la politique de rémunération du Secteur de la Santé, la restructuration du processus d'achat et d'appel d'offres, les actions d'Education Permanente concernant la formation des professionnels, la planification des adaptations dans les hôpitaux régionaux, le Règlement Intérieur de la Direction de la Santé de l'Etat de Tocantins , la structure du Secrétariat, le programme annuel de santé 2018, les ordonnances, les formulaires et le rapport sur les besoins en ressources financières du Trésor.

Implantação de uma Unidade de Cuidados Paliativos num hospital de média complexidade de Londrina - PR: relato de experiência / Implementing a Palliative Care Unit in an intermediate-complexity hospital in the city of Londrina - Paraná: an experience report

A ocorrência de óbitos nos hospitais é frequente e exige destes serviços de saúde preparo para oferecer um cuidado integral até o fim da vida. O acesso aos Cuidados Paliativos (CP) é fundamental para o suporte nesta fase, mas ainda é limitado no Brasil. Assim, descreve-se a experiência de implantar uma unidade de CP num hospital de média complexidade. Inicialmente, foi formada uma comissão institucional, composta por profissionais do hospital, para planejar a implantação do atendimento em CP. Elaborou-se um protocolo institucional para organizar o fluxo de atendimento dos pacientes em fase avançada, definiram-se alterações na rotina do atendimento, na estrutura da unidade e realizou-se capacitação dos profissionais. A iniciativa é inovadora ao aplicar CP num hospital geral, com resultados iniciais satisfatórios. Por fim, apresenta-se uma discussão sobre este modelo de aplicação dos CP nas políticas públicas de saúde (AU)

The occurrence of deaths in hospitals is frequent, and requires preparation for these healthcare facilities to offer an integral care until the end of life. Palliative Care (PC) is essential to support patients in this stage, but is still limited in Brazil. Thus, the experience of implementing a PC unit in an intermediate-complexity hospital is described. Initially, a committee was created with a professional team of the hospital to plan the implementation of the PC unit. An institutional protocol was set to organize the workflow for the PC support of inpatients, to define modifications in the hospital routines, with allocation of a specific room, and professional training was provided. This initiative is innovative, since it applies PC in a general hospital, with satisfactory initial results. Finally, a discussion about this application model to include PC in the public health care policies is provided (AU).

Avaliação da produtividade de hospitais brasileiros pela metodologia do diagnosis related group (DRG) / Evaluation of the productivity of Brazilian hospitals by the methodology of diagnosis related group (DRG)

O gerenciamento de uma organização hospitalar exige provisionar seus custos/gastos com ferramentas que a aproximam da realidade. A tarefa de aferição da produtividade pode ser complexa e duvidosa, diversos métodos são experimentados e a utilização do DRG tem se mostrado eficiente, sendo utilizado na avaliação da produtividade através de desfechos assistenciais. Estudo transversal, avaliou 145.710 internações, no período de 2012-2014, utilizando a metodologia do DRG para medição de sua produtividade a partir da mediana do tempo de internação. Ao agruparmos todas as internações em clínicos (37,6%) e cirúrgicos (62,4%), várias análises puderam ser feitas de acordo com esse critério.O DRG como ferramenta para predição de dias de internação é uma alternativa eficiente, colaborando assim para o controle da produtividade que influencia diretamente nos gastos e custos dos produtos hospitalares e qualidade dos serviços.

The management requires a hospital organization to provision their costs/expenses with tools that approximate reality. The task of measuring productivity can be complex and uncertain, several methods are tested and the use of the DRG has been efficient, being used to assess the productivity through clinical outcomes. Cross-sectional study evaluated 145.710 hospitalizations in the period 2012-2014, using the DRG methodology for measuring productivity from the median length of hospitalization. When we group all hospitalizations in clinical (37.6%) and surgical (62.4%), multiple analyzes could be made according to this criterion. The DRG as a tool for prediction of hospital days is an effective alternative, thereby contributing tothe control of productivity that directly influences the costs of hospital expenses and product and service quality.

Cobre antimicrobiano contra patógenos intrahospitalarios en Perú / Antimicrobial copper against nosocomial pathogens in Peru

Las infecciones intrahospitalarias (IIH) constituyen un problema de salud pública que generan grandes gastos por parte de los gobiernos, debido a que los patógenos causantes de IIH presentan resistencia a fármacos y generan una mayor permanencia de los pacientes, pues la infraestructura hospitalaria constituye un reservorio favorable para los patógenos. Las superficies de cobre surgen como opción sanitaria y efectiva para controlar el crecimiento y propagación de estos patógenos. Objetivos: Evaluar la actividad bactericida de las superficies de cobre contra los principales bacterias patógenas causantes de IIH (Escherichia coli, Pseudomonas aeruginosa y Staphylococcus aureus). Diseño: Estudio experimental con muestreo no probabilístico. Lugar: Hospital Regional Docente las Mercedes (HRDLM) y Hospital Provincial Docente Belén (HPDB), Lambayeque, Perú. Materiales: Nueve cepas bacterianas, 3 de E. coli, 3 de P. aeruginosa y 3 de S. aureus; superficies metálicas (1 cm2) de cobre y acero inoxidable (control). Intervenciones: Las 9 cepas bacterianas fueron proporcionadas por los hospitales HRDLM (4 cepas) y HPDB (5 cepas). Los análisis de ANOVA y de Tukey fueron aplicados para evaluar la actividad bactericida de las superficies de cobre y acero inoxidable contra las 9 cepas causantes de IIH, usando los programas estadísticos Minitab y Sigmaplot, respectivamente. Principales medidas de resultados: Diferencias en el crecimiento bacteriano sobre superficies de cobre o acero inoxidable, con respecto al tiempo de exposición. Resultados: Las 9 cepas -3 de P. aeruginosa, 3 de E. coli y 3 de S. aureus- expuestas a superficies de cobre fueron eliminadas en 10, 15 y 60 minutos, respectivamente. La carga bacteriana de las células expuestas en superficies de acero inoxidable permaneció constante y viable por periodos mayores a 60 minutos. Además, las superficies de cobre eliminaron más rápido a las bacterias Gram negativas (P. aeruginosa y E. coli) con respecto...

Nosocomial infections (NI) generate large expenditures by governments, as NI pathogens are resistant to drugs and increase hospital stay. Copper surfaces seem a promising alternative to control growth and spread of these pathogens. Objectives: To evaluate copper surfaces bactericidal activity against pathogenic bacteria causing NI (E. coli, P. aeruginosa and S. aureus). Design: Experimental study with non-probability sampling. Institutions: Hospital Regional Docente las Mercedes (HRDLM) and Hospital Provincial Docente Belen (HPDB), Lambayeque, Peru. Materials: Nine bacterial strains of E. coli, P. aeruginosa and S. aureus, metal surfaces (1 cm2) of copper and stainless steel (control). Interventions: Bacterial strains were provided by HRDLM (4 strains) and HPDB (5 strains). ANOVA and Tukey analysis were applied to evaluate copper and stainless steel surfacesÆ bactericidal activity to strains causing NI; Minitab statistical software and Sigmaplot were used. Main outcome measures: Differences in bacterial growth on metal surfaces (copper or stainless steel) with respect to exposure time. Results: The nine strains of P. aeruginosa (3), E. coli (3) and S. aureus (3) exposed to copper surfaces were inactivated after 10, 15, and 60 minutes respectively. The bacterial load of cells exposed to stainless steel surfaces remained constant and viable for periods longer than 60 minutes. Copper surfaces removed Gram-negative bacteria (E. coli and P. aeruginosa) faster than Gram-positive bacteria (S. aureus). Conclusions: Copper surfaces completely eliminated studied nosocomial bacteria. Thus they could replace steel as contact surfaces in Peruvian health facilities with high incidence of NI...

The Long-Term Effect of an Independent Capacity Protocol on Emergency Department Length of Stay: A before and after Study

PURPOSE: In this study, we determined the long-term effects of the Independent Capacity Protocol (ICP), in which the emergency department (ED) is temporarily used to stabilize patients, followed by transfer of patients to other facilities when necessary, on crowding metrics. MATERIALS AND METHODS: A before and after study design was used to determine the effects of the ICP on patient outcomes in an academic, urban, tertiary care hospital. The ICP was introduced on July 1, 2007 and the before period included patients presenting to the ED from January 1, 2005 to June 31, 2007. The after period began three months after implementing the ICP from October 1, 2007 to December 31, 2010. The main outcomes were the ED length of stay (LOS) and the total hospital LOS of admitted patients. The mean number of monthly ED visits and the rate of inter-facility transfers between emergency departments were also determined. A piecewise regression analysis, according to observation time intervals, was used to determine the effect of the ICP on the outcomes. RESULTS: During the study period the number of ED visits significantly increased. The intercept for overall ED LOS after intervention from the before-period decreased from 8.51 to 7.98 hours [difference 0.52, 95% confidence interval (CI): 0.04 to 1.01] (p=0.03), and the slope decreased from -0.0110 to -0.0179 hour/week (difference 0.0069, 95% CI: 0.0012 to 0.0125) (p=0.02). CONCLUSION: Implementation of the ICP was associated with a sustainable reduction in ED LOS and time to admission over a six-year period.

Cancelamento de cirurgias em um hospital público na cidade de São Paulo / Surgeries cancellation in a public hospital at São Paulo city

Objetivos: Estabelecer a incidência de cancelamentos de procedimentos eletivos no centro cirúrgico, identificar as especialidades cirúrgicas mais envolvidas e os motivos mais frequentes de suspensões das cirurgias programadas. Métodos: Estudo descritivo, retrospectivo, com abordagem quantitativa e qualitativa, por meio de banco de dados e registro dos procedimentos cancelados, durante o período de janeiro de 2010 a dezembro de 2013. Resultados: Foram realizados 19.667 procedimentos no centro cirúrgico e cancelados 3.121 (13,6%). As principais causas de cancelamento foram o não comparecimento do paciente (33,8 %), condições clínicas desfavoráveis (20,0%), adiantado da hora (5,5%), falta de vaga na UTI (4,9%) e falta de material/equipamento (4,6%). As especialidades que mais apresentaram suspensões foram cirurgia da mão (19,3%), cirurgia vascular (18,2%), ortopedia/traumatologia (17,6 %) e gastrocirurgia (15,3%). Conclusões: Identificados a incidência de cancelamento de cirurgias e seus principais motivos de cancelamentos, orientamos medidas de planejamento e ações para melhoria contínua desses índices de qualidade hospitalar.

Objectives: To establish the incidence of cancellations of elective procedures in the surgical center, to identify to the more involved surgical specialties and the most frequent reasons of suspensions of the programmedsurgeries. Methods: Descriptive, retrospective study, with quantitative and qualitative approach, by meansof register and database of the cancelled procedures, during the period of January of 2010 the Decemberof 2013. Results: A total of 19,667 procedures in the operating room were accomplished and 3,121 were cancelled (13.6%). The main causes of cancellation were non attendance of the patient (33.8%), poor clinical conditions (20.0%), advancing of the hour (5.5%), lack of vacancy in the ICU (4.9%) and lack of material/equipment (4.6%). The specialties that more presented suspensions were hand surgery (19.3%), vascular surgery (18.2%), orthopedic surgery (17.6%) and general surgery (15.3%). Conclusions: Identified to the incidence of cancellation of surgeries and its main reasons of cancellations, we oriented planning measures and actions for continuous improvement of these ratios of hospital quality.

Mathematical modeling for selecting center locations for medical and health supplies reserve in Hainan Province

OBJECTIVE@#To explore how to choose the center locations to build the medical and health supplies reserve among many island towns.@*METHODS@#The center locations were selected from 18 towns Hainan Province, it's maximum service range (distance) was required to reach the minimum, or to minimize.@*RESULTS@#Three scenarios were considered, the center locations included only one town, two towns, three towns. By the use of graph theory and MATLAB programming, a mathematical model was established to obtain the shortest distance and the shortest path between arbitrary two towns.@*CONCLUSIONS@#We find out the center sites under certain conditions, and determine the specific service ranges of the center sites.

[Evaluation of effective factors on the rate of preparedness of Tehran University of Medical Sciences' selected hospitals in dealing with earthquake]

Having a preparedness program for earthquake in hospital, with regard to its function for victims of accidents, is very important. The main objective of this study was evaluation of effective factors on the rate of preparedness of Tehran University of Medical Sciences' teaching hospitals, to deal with earthquake danger of earthquake. This cross-sectional analytical survey was performed in the following hospitals: Sina, Farabi, Roozbeh, and Razi. Data was collected by checklists and questionnaire. Data analysis was performed using statistical software [SPSS 19] and Pearson correlation, ANOVA, t-test statistical tests. The most and the least preparedness against earthquake was in disaster management and construction mitigation plan fields respectively. Relationship between the field of hospital curriculums with construction mitigation plan [p= 0/045 and r=0/644] and hospital environmental health action plan [p=0/048 and r=0/636], was significant. Average of Hospitals preparation against earthquake was evaluated in an intermediate level [51.81 percent]. Due to the significant relationship between education and other fields that are listed above; it is suggested that in addition to short-term training programs, non-structural retrofitting of hospitals should be considered as a priority

Olhares sobre a loucura: os grupos na experiência de Gorizia / Miradas sobre la locura: grupos en la experiencia de Gorizia / Views on madness: groups in Gorizia's experience

Este artigo pretende destacar a importância dos grupos durante o processo de abertura do Hospital Psiquiátrico de Gorizia, na Itália, marco da reforma psiquiátrica italiana e influência no processo de reforma psiquiátrica brasileira. Com base no estudo do livro “Instituição Negada: relato de um hospital psiquiátrico”, coordenado pelo psiquiatra italiano Franco Basaglia, procurou-se mostrar o papel central das formações grupais - assembleias - no movimento de desmantelamento da lógica hospitalar e desconstrução das práticas de dominação e exclusão do antigo modelo asilar. Acredita-se que o estudo sobre essa singular experiência possa trazer contribuições para as práticas do trabalho em saúde mental na atualidade e para o estudo das situações grupais - campos em construção.

This article aims to highlight the importance of groups during the Gorizia Psychiatric Hospital opening process in Italy. Not only is it a landmark in the Italian psychiatric reform, but it is also a great influence upon Brazilian Psychiatric Reform. Based on the book coordinated by Franco Basaglia entitled “Instituição Negada: relato de um hospital psiquiátrico”, it was intended to accent the assemblies’ major role in the deconstruction of domineering and excluding practices in lunatic asylums. We expect this study to bring contributions to contemporary practices on mental health and to further studies on group situations, both in development.

Este artículo pretende destacar la importancia de los grupos durante el proceso de apertura del Hospital Psiquiátrico de Gorizia, en Italia, marco de la reforma psiquiátrica italiana e influencia en el proceso de reforma psiquiátrica brasileña. Con base en el estudio del libro “Institución Negada: relato de un hospital psiquiátrico”, coordinado por el psiquiatra italiano Franco Basaglia, se buscó mostrar el papel central de las formaciones grupales - asambleas - en el movimiento de desmantelamiento de la lógica de los hospitales y deconstrucción de las prácticas de denominación y exclusión del antiguo modelo de asilo. Se cree que el estudio sobre esa singular experiencia puede brindar contribuciones para las prácticas del trabajo en salud mental en la actualidad y para el estudio de las situaciones grupales - campos en construcción.

A passagem de plantão e a corrida de leito como instrumentos norteadores para o planejamento da assistência de enfermagem / Change of shift report and daily bedside rounding as guidelines for planning nursing assistance / Cambio de guardia y ronda por las camas como instrumentos de apoyo para la planificacion de la atencion de enfermeria

Trata-se de um relato de experiência das acadêmicas do curso de graduação em Enfermagem da Escola de Enfermagem da UFMG, que desenvolveram as atividades práticas da disciplina Estágio Curricular Supervisionado em Rede Hospitalar, numa unidade de clínica médica de um hospital universitário. Mediante a inserção na unidade e a elaboração do diagnóstico situacional, identificou-se a necessidade de discutir com os enfermeiros a importância da passagem de plantão e da corrida de leito como dois dos instrumentos administrativos primordiais para planejar e avaliar a assistência de enfermagem. Assim, constituíram-se objetivos deste estudo a revisão da Instrução Técnica de Trabalho (ITT), em vigor na instituição sobre passagem de plantão, e a elaboração de uma proposta de ITT sobre corrida de leito. A metodologia utilizada baseou-se no planejamento estratégico proposto por Cecílio (1997). O estudo proporcionou uma visão ampliada sobre a passagem de plantão e da corrida de leito como ferramentas para o planejamento, a execução e a avaliação da assistência de enfermagem, bem como sobre a utilização das ITTs como instrumentos orientadores das atividades diárias do enfermeiro nas unidades de serviço. Saliente-se a participação dos enfermeiros durante o desenvolvimento do estudo, expressando a corresponsabilidade na implementação das ITTs e, consequentemente, nas mudanças na sistematização da assistência de enfermagem na unidade, que garantirão a realização da passagem de plantão e da corrida de leito nos três turnos de trabalho. Ressalte-se, ainda, a oportunidade como acadêmicas de exercitar, deforma sistematizada, ações da coordenação da assistência de enfermagem numa unidade assistencial.

This is a report based on the experience of nursing students from a public nursing school (UFMG Nursing School). The students were registered in a supervised apprenticeship programat a university hospital. Following the students’ admission in the unit and the preparation of the situational diagnosis, the importance of the shift report and bedside rounding was presented as the primary administrative tools for planning and evaluating the nursing assistance. The study’ objectives were the review of the institution’s current technical instructions concerning shift report and the elaboration of a technical instruction scheme for bedside rounding. The methodology was based on the strategicplanning proposed by Cecílio (1997). The study enabled the students to have an broadened viewpoint about shift reportand bedside rounds as tools for planning, executing and evaluating nursing assistance as well as the use of technicalinstructions as a nursing activity guideline to health professionals in his/her service unit. It must be highlighted the nurses’contribution to the study’s development and their co-responsibility in the technical instruction implementation that will promote changes in nursing care systematization in the unit. Such changes will enable the change shift report and bedside rounding activities during the three hospital shifts. The experience was an opportunity for the students to practice in a systematic way how to coordinate nursing care in a hospital unit.

El presente estudio es un relato de la experiencia de alumnas de la Escuela de Enfermería de la UFMG en la materiaPasantía Curricular Supervisada en Hospitales Públicos realizada en la clínica médica de un hospital universitario. Conla inserción en dicha unidad y la elaboración de un diagnóstico situacional fue identificada la necesidad de discutircon los enfermeros la importancia del cambio de guardia y de la ronda por las camas como dos de los instrumentosadministrativos primordiales para planear y evaluar la atención de enfermería. Este estudio tiene como objetivo la revisión de la Instrucción Técnica de Trabajo (ITT) en vigor en la institución sobre el cambio de guardias y la elaboración de una propuesta de ITT sobre la ronda por las camas. La metodología utilizada se basó en la planificación estratégica propuesta por Cecílio (1997). El estudio proporciono una visión más amplia sobre el cambio de guardia y la ronda por las camas como herramientas para la planificación, ejecución y evaluación de la atención de enfermería y, asimismo, de la utilización de las ITT como instrumentos orientadores de las actividades diarias de los enfermeros en servicio. Sedestaca la participación de los enfermeros durante el desarrollo del estudio expresando su corresponsabilidad en la implementación de las ITT y, consecuentemente, de los cambios en la sistematización de la atención de enfermería, lo cual garantizará que el cambio de guardia y la ronda por las camas se realicen en los tres turnos de trabajo. También seenfatiza la oportunidad de las estudiantes de ejercitar de forma sistematizada acciones de coordinación de la atención de enfermería en una unidad asistencial.

A iniciativa hospital amigo da criança sob a ótica dos atores sociais que a vivenciam em Teresina, Piauí / The baby-friendly hospital initiative as perceived by the social actors who experience it in Teresina, Piauí, Brazil

OBJETIVO: Analisar os reflexos da Iniciativa Hospital Amigo da Criança nos atores sociais que a vivenciam. MÉTODOS: Estudo qualitativo. Utilizaram-se entrevistas semiestruturadas, com auxílio de um roteiro temático, junto a vinte mulheres e dez profissionais de saúde em cinco hospitais amigos da criança em Teresina (PI). Para a análise dos dados foi utilizada a técnica de análise de conteúdo do tipo temática. RESULTADOS: A análise das falas levou à construção de dois eixos de discussão: um relacionado à tríade de sustentação da Iniciativa - promoção, proteção e apoio; e o outro a seu próprio modus operandi, os quais permitiram evidenciar dificuldades na implementação das normas e rotinas da Iniciativa Hospital Amigo da Criança desenvolvidas nas instituições. CONCLUSÃO: Os resultados revelaram a necessidade de ajustes para melhorar a resolutividade do programa, com ênfase para: adoção de uma nova matriz ensino-aprendizagem pautada na educação reflexiva e na adoção dos referenciais da pedagogia da problematização; fortalecimento das redes de apoio à mulher; investimentos na melhoria do acolhimento, tornando a relação cliente-profissional mais respeitosa e definição de um processo de monitoramento contínuo que permita a adoção de medidas corretivas sempre que se fizer necessário.

OBJECTIVE: This study analyzed the way the Baby-Friendly Hospital Initiative is perceived by the social actors involved in it. METHODS: This qualitative study administered semi-structured interviews aided by a thematic guide to twenty female patients and ten health professionals from five Baby-Friendly Hospitals in Teresina (PI), in Northeast Brazil. Thematic content analysis was used to analyze the data. RESULTS: Analysis of the testimonials led to two axes of discussion: one related to the foundation triad of the initiative - promotion, protection and support; and the other related to its own modus operandi, highlighting the difficulties for implementing the BFHI norms and practices carried out in these institutions. CONCLUSION: The results showed that adjustments are necessary to improve the effectiveness of the program, with special emphasis to: adoption of a new teaching-learning matrix based on reflexive education; adoption of references from the pedagogy of questioning; strengthening of women's support networks; investments for improving the receptiveness, thus creating a more respectful relationship between customers and professionals; and the establishment of a continuous monitoring system that allows the implementation of corrective measures whenever necessary.