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BMC Health Serv Res ; 22(1): 680, 2022 May 21.
Article in English | MEDLINE | ID: covidwho-1849729


BACKGROUND: The existing digital healthcare solutions demand a service development approach that assesses needs, experience, and outcomes, to develop high-value digital healthcare services. The objective of this study was to develop a digital transformation of the patients' follow-up service after cardiac surgery, based on a remote patient monitoring service that would respond to the real context challenges. METHODS: The study followed the Design Science Research methodology framework and incorporated concepts from the Lean startup method to start designing a minimal viable product (MVP) from the available resources. The service was implemented in a pilot study with 29 patients in 4 iterative develop-test-learn cycles, with the engagement of developers, researchers, clinical teams, and patients. RESULTS: Patients reported outcomes daily for 30 days after surgery through Internet-of-Things (IoT) devices and a mobile app. The service's evaluation considered experience, feasibility, and effectiveness. It generated high satisfaction and high adherence among users, fewer readmissions, with an average of 7 ± 4.5 clinical actions per patient, primarily due to abnormal systolic blood pressure or wound-related issues. CONCLUSIONS: We propose a 6-step methodology to design and validate a high-value digital health care service based on collaborative learning, real-time development, iterative testing, and value assessment.

Cardiac Surgical Procedures , Delivery of Health Care , Follow-Up Studies , Humans , Learning , Pilot Projects
Revista Cient..fica Multidisciplinar RECIMA21 ; 2(11), 2021.
Article in Portuguese | CAB Abstracts | ID: covidwho-1727534


The aim of this study was to identify, in the scientific literature, the strategies used by health services to influence the formation of a culture of patient safety through hand hygiene among health professionals during the Covid-19 pandemic. This is a descriptive study of an integrative literature review. An advanced search was performed in the databases that make up the Virtual Health Library (VHL), of the 700 scientific publications identified, after applying the inclusion and exclusion criteria, 11 publications were selected that made up the final sample of the study, as they were from according to the proposed theme. During the study analysis process, the following thematic categories were highlighted: "Hand hygiene and its main public policies", "Nursing and the Covid-19 pandemic" and "Consequences of the breach of the hand hygiene protocol regarding safety of the patient". The studied literature showed that the consequences in relation to breaking the hand hygiene protocol regarding patient safety, especially in the Covid-19 pandemic, are worrisome because they affect both the patient's safety and the health professional's integrity. Furthermore, an increase in hospital stay and hospital costs, increased demand for the use of broad-spectrum antibiotics and increased morbidity and mortality rates were also identified.

United European Gastroenterology Journal ; 9(SUPPL 8):786-787, 2021.
Article in English | EMBASE | ID: covidwho-1491000


Introduction: At pediatric age, an emergency endoscopic procedure is required in a limited number of circumstances, mainly due to accidental foreign body ingestion (FBI), gastrointestinal bleeding and caustic ingestion. FBI may represent most of the procedures, occurring typically in young children (6 months to 3 years of age) at home. Although most FBIs in the gastrointestinal tract pass spontaneously without complications, endoscopic or surgical removal may be required in a few cases. SARS-CoV2 pandemic has led to significant family lifestyle changes, which forced children to stay at home for prolonged periods of time. It has been suggested that pandemic contingency may have increased the frequency of domestic accidents during lockdown period (namely FBI and caustic ingestion) and consequently the risk of potentially fatal episodes, as compared with non-pandemic periods. Aims & Methods: A retrospective analysis of the overall admissions to the pediatric emergency department of a tertiary referral hospital center with need of emergency endoscopy was performed. Children and adolescents aged between 0 and 18 years were included in the study. We compared the first 6 months of the pandemic (peak months April to September 2020-Group A) with the homologous period of the previous year (2019-Group B). The aim of the study was to evaluate if the changes in the lifestyle and hospital practices imposed by the pandemic had an impact on the frequency and profile of the emergency endoscopy. Chi-square and Mann-Whitney U tests were used for statistical analysis using IBM-SPSS®. Statistically significance was considered when p-value was under 0.05. Results: A total of 89 cases were analyzed (54% of the admissions in group A). Median age of admissions was 4.5 years. Groups did not differ for gender (p = 0.399) or age (p = 0.242). Concerning overall emergency endoscopies, 28% (25/89) occurred in children under the age of two, with most of these episodes occurring in Group A (19/89;p = 0.009). Groups did not differ considering the endoscopy indication (foreign body ingestion, caustic ingestion, food impaction and digestive hemorrhage) (p=0.899), nor about the presence of associated lesions (p = 0.597). The most frequent ingestions were caustics (18%, 16/89), coins (17%, 15/89), food impaction (12%, 11/89) and batteries (10%, 9/89). However, battery ingestions and food impactions were more frequent in 2020, respectively 67% (9/89;p = 0.419) and 64% (7/89;p = 0.49). There were no statistically significant differences on the time delay to reach the emergency department (p = 0.934) or on the time delay since emergency room admission until the endoscopic procedure (p = 0.266). More foreign bodies were removed in Group A (p = 0.026) and when lesions were present, they were more frequently seen on the esophagus (p = 0.007). Most of the patients (84%) were discharged home, after a brief recovery time after the procedure, with no difference between groups (p = 0.397). Conclusion: This study shows that there were no significant differences between both groups on the number and type of emergency endoscopies, on the time to reach the emergency room or to the performance of the endoscopy. Children under the age of 2 had more episodes with need of emergency endoscopy during the pandemic as compared to the homologous period. Overall, the pandemic did not seem to affect the quality of healthcare practice concerning emergency endoscopic procedures.