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1.
Ciudad Autónoma de Buenos Aires; Argentina. Ministerio de Salud de la Nación. Dirección de Investigación en Salud; 2020. 1-42 p. tab, graf.
Non-conventional in Spanish | ARGMSAL, BINACIS | ID: biblio-1379530

ABSTRACT

INTRODUCCIÓN La pandemia COVID-19 incrementó la carga de trabajo y expuso el impacto del multiempleo en los servicios de salud. El presente estudio busca caracterizar el multiempleo entre profesionales médicos y de enfermería que trabajaron en internación clínica y cuidados críticos durante la pandemia en la provincia de Buenos Aires (PBA). METODOS Se realizó un estudio exploratorio, descriptivo y transversal, mediante técnicas cuantitativas y cualitativas que combinaron fuentes primarias (encuesta estructurada, entrevistas) y secundarias (bases de datos de recursos humanos). RESULTADOS El cruce de datos arrojó un multiempleo explícito del 12,7% en enfermería y 28,3% en medicina. En la encuesta, 96,3% de médicos y 68,1% de enfermeros declara multiempleo. La media de empleos fue 3,1 para médicos y 1,89 para enfermeros. Los motivos más frecuentes de multiempleo son la subsistencia y el incremento de ingresos. En condiciones adecuadas, el 90% optaría por un empleo, principalmente mujeres y jóvenes. El hospital público surge como el ámbito elegido. No hay coincidencias ni confianza en lograr empleo único. DISCUSIÓN El multiempleo en PBA es difícil de medir mediante los registros vigentes y difiere de los datos auto informados. El problema del multiempleo requiere ser abordado desde la desprecarización del empleo, con perspectiva de género y mejoras en las condiciones económicas y de trabajo.


Subject(s)
Qualitative Research
3.
Intensive Care Med ; 31(8): 1058-65, 2005 Aug.
Article in English | MEDLINE | ID: mdl-15983759

ABSTRACT

OBJECTIVE: To assess renal dysfunction and outcome in patients treated exclusively with colistin vs. other antibiotics. DESIGN AND SETTING: Prospective cohort study in a mixed ICU in a university-affiliated hospital. PATIENTS: 185 patients infected with Acinetobacter baumannii and Pseudomonas aeruginosa after an ICU stay longer than 48 h: 55 in the colistin group and 130 in the noncolistin group, similar in age, APACHE II, medical status, and SOFA score. MEASUREMENTS AND RESULTS: We recorded data on epidemiology and severity of illness, site of infection, renal function before and after treatment, clinical cure, and mortality. Clinical cure was defined as simultaneous normalization of central temperature (< or = 38 degrees), leukocyte count (< or = 10,000/mm3), and PaO2/FIO2 ratio (>187). Before treatment creatinine was 0.9+/-0.2 in the colistin group and 0.9+/-0.1 in the noncolistin group; after treatment the value was 1.0+/-0.3 in both groups. The most frequent infection was ventilator-associated pneumonia: 53% vs. 66% in colistin and noncolistin groups, respectively, Acinetobacter was the cause in 65% and 60% and Pseudomonas in 35% and 53%. In the noncolistin group 81% of patients were treated with carbapenems. Inadequate empirical antimicrobial treatment was more frequent in the colistin group (100% vs. 8%), but there were no differences in the frequency of clinical cure on day 6 of treatment (15% and 17%) or in mortality (29% and 24%). CONCLUSIONS: Colistin appears to be as safe and as effective as other antimicrobials for treatment of sepsis caused by Acinetobacter and Pseudomonas in critically ill patients.


Subject(s)
Acinetobacter Infections/drug therapy , Anti-Bacterial Agents/therapeutic use , Colistin/therapeutic use , Pseudomonas Infections/drug therapy , APACHE , Acinetobacter/drug effects , Adult , Argentina , Blood Gas Analysis , Cohort Studies , Female , Humans , Intensive Care Units , Male , Middle Aged , Prospective Studies , Pseudomonas/drug effects , Treatment Outcome
4.
Chest ; 127(2): 598-603, 2005 Feb.
Article in English | MEDLINE | ID: mdl-15706002

ABSTRACT

STUDY OBJECTIVES: To determine the incidence of prolonged mechanical ventilation (PMV), which is associated with increased health-care costs and risks of adverse events, and to identify its early predictors. DESIGN: Retrospective cohort. SETTING: A medical-surgical ICU in a university-affiliated hospital. PATIENTS OR PARTICIPANTS: All patients admitted to the ICU over 3 years who received mechanical ventilation (MV) for > 12 h. INTERVENTIONS: None. MEASUREMENTS: PMV was defined as MV lasting > 21 days. We recorded epidemiologic data, severity scores, worst Pao(2)/fraction of inspired oxygen (Fio(2)), presence of shock on ICU admission day, cause for MV, length of MV, ICU length of stay (LOS), and hospital LOS. PMV patients were compared to patients weaned before 21 days (non-PMV group) to determine predictors of PMV. RESULTS: Of 551 hospital admissions, 319 patients (58%) required MV > 12 h. One hundred thirty patients died early and were excluded. Seventy-nine patients (14%) required PMV. The non-PMV group consisted of 110 patients. Simplified acute physiology score (SAPS) II, APACHE (acute physiology and chronic health evaluation) II, therapeutic intervention scoring system, Pao(2)/Fio(2), shock, ICU LOS, and hospital LOS differed significantly between groups. However, logistic regression identified shock on ICU admission day as the only independent predictor of PMV (odds ratio, 3.10; p = 0.001). SAPS II and Pao(2)/Fio(2) had the nearest coefficients and were used to build the predictive model. Sensitivity analysis was performed including the 130 patients who died early, and shock remained the most powerful predictor. CONCLUSIONS: PMV was a frequent event in this cohort. The presence of shock on ICU admission day was the only prognostic factor, even adjusting for severity of illness and hypoxemia.


Subject(s)
Health Status Indicators , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Severity of Illness Index , Shock/epidemiology , APACHE , Adult , Aged , Argentina , Cohort Studies , Female , Hospitals, University , Humans , Hypoxia/epidemiology , Logistic Models , Male , Middle Aged , Prognosis , Respiration, Artificial/statistics & numerical data , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Ventilator Weaning
6.
Crit Care Med ; 30(11): 2450-6, 2002 Nov.
Article in English | MEDLINE | ID: mdl-12441753

ABSTRACT

OBJECTIVE: To assess prospectively acute respiratory distress syndrome incidence, etiologies, physiologic and clinical features, and mortality and its predictors in four intensive care units in Argentina. DESIGN: Prospective inception cohort. SETTING: Four general intensive care units in teaching hospitals. PATIENTS: All consecutive adult patients admitted between January 3, 1999, and January 6, 2000, that met the criteria of the American-European Consensus Conference for acute respiratory distress syndrome. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 235 patients developed acute respiratory distress syndrome, and 217 survived for >24 hrs; these were further analyzed. Main risk factors were: sepsis (44%, including 65 pneumonia cases), shock (15%), trauma (11%), gastric aspiration (10%), and other (34%). At admission, nonsurvivors had significantly higher Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment and McCabe scores, and lower oxygenation and pH. During the first week, Pao2/Fio2, Sequential Organ Failure Assessment, pH, base excess, and driving pressure consistently discriminated between survivors and nonsurvivors. Hospital mortality was 58%. One third of patients died early. Main causes of death were multiple organ dysfunction syndrome, sepsis, and septic shock; refractory hypoxemia was uncommon. Factors independently associated with mortality were organ dysfunctions on day 3, Pao2/Fio2 on day 3, and McCabe score. CONCLUSIONS: Acute respiratory distress syndrome was a frequent syndrome in this cohort. Sepsis was its leading cause, and pneumonia was the most common single diagnosis. Mortality was high but similar to most recent series that included serious comorbidities. Independent predictors of death 72 hrs after admission emphasize the importance of both extrapulmonary and pulmonary factors together with preexisting severe illnesses.


Subject(s)
Respiratory Distress Syndrome/epidemiology , Adolescent , Adult , Aged , Argentina/epidemiology , Female , Humans , Incidence , Logistic Models , Male , Middle Aged , Multivariate Analysis , Prognosis , Prospective Studies , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/mortality , Risk Factors
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