COVID-19​ live Q&A with Dr Mike Ryan and Dr Maria Van Kerkhove. Ask WHO​ of 29 July 2020

#AskWHO​ series: This was the live discussion about the COVID-19 pandemic of 29 July 2020 with Dr Mike Ryan, Executive Director of WHO Health Emergencies Programme, and Dr Maria Van Kerkhove, WHO Technical Lead on COVID-19. Questions from the audience were taken.

Situaciones conflictivas en un área de atención especializada. Madrid. 2009-2013 / Conflictive situations in a specialized medical area of Madrid in 2009-2013

Objetivos: Determinar situaciones conflictivas con ciudadanos en un área específica de Atención Especializada de Madrid. Material y Métodos: Se realiza un análisis descriptivo, observacional y retrospectivo de incidentes con los ciudadanos en un Área Específica en Atención Especializada entre los años 2009 y 2013. Durante el periodo de estudio se analizaron 188 situaciones conflictivas incluyendo como variables a estudio, su edad y sexo, el tipo de agresión y agresor, el lugar de trabajo, la categoría laboral, la causa del incidente y las medidas propuestas. Los datos se obtuvieron del Sistema de Registro Madrileño de Agresiones y Conflictos (REMAC). Resultados: De las 188 situaciones conflictivas recogidas, predomina en el agresor con más de un 60% el sexo masculino. La mayoría, 25% ,se encuentran en edades comprendidas entre los 31 y 40 años. Predominó el tipo de agresión verbal con un 88,8%. Se identificó como el tipo de agresor más frecuente al familiar o acompañante con un 46,8%. Con un 31,3%, el lugar de trabajo en el que mayor número de situaciones ocurrieron fue hospitalización médica. Por categorías, la enfermería/ DUE con un 35,1% es la que presentó mayor porcentaje de incidente. Discusión: Las situaciones Conflictivas con usuarios en Atención Especializada han aumentado considerablemente en los últimos años, por lo que se ha hecho necesario establecer planes de prevención y actuación ante estas situaciones, (procedimiento de actuación, formación de los profesionales, asesoramiento jurídico, etc).; que contemplan medidas previstas en la Orden 212/2004 del 4 de Marzo del Consejero de Sanidad y Consumo de la Comunidad de Madrid (AU)

Objectives: Determine the conflictive situations that arise with citizens in a specific area of Specialized Care of Madrid. Material and Methods: A descriptive, observational and retrospective analysis of incidents with citizens in a Specific Area of Specialized Care that occurred between 2009 and 2013 was carried out. During the study period, 188 conflictive situations were analyzed including the following variables: level of education, age and sex, type of aggression and aggressor, workplace, job category, cause of the incident and proposed measures.The information was obtained from the Register of Aggressions and Conflicts of Madrid (REMAC, Registro Madrileño de Agresiones y Conflictos). Results: Of the 188 conflictive situations analyzed, more than 60% of them were committed by males. The majority, 25%, were between 31 and 40 years old. The predominant incident, 88.8%, was verbal aggression. The most frequent aggressor, 46.8%, was a relative or companion. The workplaces where more conflictive situations arose (AU)

[Validation of the Patient Classification System Rehabilitee-Management-Categories (RMK) in Patients with Chronic Back Pain in Regular Medical Treatment]. / Validierung der Gültigkeit des Patientenklassifikationsansatzes der Rehabilitanden-Management-Kategorien (RMK) für chronische Rückenerkrankungen im Heilverfahren.

BACKGROUND AND OBJECTIVE: The Rehabilitee-Management-Categories (RMK) have been developed by the Charite - University Medicine Berlin for 10 years. A content- and time-stable classification approach should support health care providers to offer therapy standards that are better adjusted to the needs of patients. At the same time, stability means for healthcare payers that the admission management to clinics with specialised services could be optimized. METHODS: The stability of the RMK classification was tested with the help of latent class analysis (LCA) in independent samples. The data sets are taken from 3 different studies carried out from 2006 to 2011. Only patients with chronic back pain (M40-M54) who were in regular medical treatment provided by the German Pension Fund were included. RESULTS: A statistically stable 4-class solution was found in all samples. Kappa-coefficients from 0.605 to 0.72 showed a good consistence of the RMK-algorithm from the first LCA with the respective latent class analyses. CONCLUSION: The RMK-approach offers possible uses for both healthcare providers and healthcare payers by assessing the need of treatments according to the ICF approach. Among other things, this approach can be used to fulfil the quality guideline in a differing way.

A new taxonomy for describing and defining adherence to medications.

Interest in patient adherence has increased in recent years, with a growing literature that shows the pervasiveness of poor adherence to appropriately prescribed medications. However, four decades of adherence research has not resulted in uniformity in the terminology used to describe deviations from prescribed therapies. The aim of this review was to propose a new taxonomy, in which adherence to medications is conceptualized, based on behavioural and pharmacological science, and which will support quantifiable parameters. A systematic literature review was performed using MEDLINE, EMBASE, CINAHL, the Cochrane Library and PsycINFO from database inception to 1 April 2009. The objective was to identify the different conceptual approaches to adherence research. Definitions were analyzed according to time and methodological perspectives. A taxonomic approach was subsequently derived, evaluated and discussed with international experts. More than 10 different terms describing medication-taking behaviour were identified through the literature review, often with differing meanings. The conceptual foundation for a new, transparent taxonomy relies on three elements, which make a clear distinction between processes that describe actions through established routines ('Adherence to medications', 'Management of adherence') and the discipline that studies those processes ('Adherence-related sciences'). 'Adherence to medications' is the process by which patients take their medication as prescribed, further divided into three quantifiable phases: 'Initiation', 'Implementation' and 'Discontinuation'. In response to the proliferation of ambiguous or unquantifiable terms in the literature on medication adherence, this research has resulted in a new conceptual foundation for a transparent taxonomy. The terms and definitions are focused on promoting consistency and quantification in terminology and methods to aid in the conduct, analysis and interpretation of scientific studies of medication adherence.

A national study of trauma level designation and renal trauma outcomes.

PURPOSE: We examined the initial management of renal trauma and assessed patterns of management based on hospital trauma level designation. MATERIALS AND METHODS: The National Trauma Data Bank is a comprehensive trauma registry with records from hospitals in the United States and Puerto Rico. Renal injuries treated at a member hospital from 2002 to 2007 were identified. We classified initial management as expectant, minimally invasive (angiography, embolization, ureteral stent or nephrostomy) or open surgical management based on ICD-9 procedure codes. The primary outcome was use of secondary therapies. RESULTS: Of 3,247,955 trauma injuries in the National Trauma Data Bank 9,002 were renal injuries (0.3%). High grade injuries demonstrated significantly higher rates of definitive success with the first urological intervention at level I trauma centers vs other trauma centers (minimally invasive 52% vs 26%, p <0.001), and were more likely treated successfully with conservative management (89% vs 82%, p <0.001). When adjusting for other known indices of injury severity, and examining low and high grade injuries, level I trauma centers were 90% more likely to offer an initial trial of conservative management (OR 1.90; 95% CI 1.19, 3.05) and had a 30% lower chance of patients requiring multiple procedures (OR 0.70; 95% CI 0.52, 0.95). CONCLUSIONS: Following multivariate analysis conservative therapy was more common at level I trauma centers despite the patient population being more severely injured. Initial intervention strategies were also more definitive at level I trauma centers, providing additional support for tiered delivery of trauma care.

Propuesta de inclusión curricular de la unidad temática: "Menejo de adolescentes con dependencia de sustancias psicoactivas en la residencia medica de pediatria, HMI, gestión 2001-2004 / Proposal of curriculum inclusion of the thematic unit: \"Management of adolecentes with dependency of psychoactive substances in the medical pediatric residence, HMI, management 2001-1004

El presente trabajo se realizo por la motivación surgida, al observar el tratamiento que realizan actualmente los Médicos Residentes de Pediatria en el Hospital Materno Infantil de la Caja Nacional de Salud, a pacientes hospitalizados en edad adolecente con dependencia de sustancias psicoactivas y por el incremento de hospitalizaciones en los últimos años de este grupo de pacientes. Actualmente, el tratamiento de éstos pacientes ha adquirido un sin fin de consideraciones, entre ellas es saber reconocer que es de orden integral, o sea, que intervienen además del Médico Pediatria, un equipo formado por Trabajadora Social, Psicólogo, Psiquiatra y una enfermera que trabajan simultáneamente para lograr éxito en el manejo; otras consideraciones a tener en cuenta es que los profesionales jóvenes son los que tienen más posiblidades se acercarse al paciente y logar que ellos acepten su recuperación y, una vez egresados Pediatras, los Residentes en su práctica cotidiana deberán de desenvolverse con la mayor sabiduraia rescatando los conocimientos que recibieron durante su formación...

A taxonomy for disease management: a scientific statement from the American Heart Association Disease Management Taxonomy Writing Group.

BACKGROUND: Disease management has shown great promise as a means of reorganizing chronic care and optimizing patient outcomes. Nevertheless, disease management programs are widely heterogeneous and lack a shared definition of disease management, which limits our ability to compare and evaluate different programs. To address this problem, the American Heart Association's Disease Management Taxonomy Writing Group developed a system of classification that can be used both to categorize and compare disease management programs and to inform efforts to identify specific factors associated with effectiveness. METHODS: The AHA Writing Group began with a conceptual model of disease management and its components and subsequently validated this model over a wide range of disease management programs. A systematic MEDLINE search was performed on the terms heart failure, diabetes, and depression, together with disease management, case management, and care management. The search encompassed articles published in English between 1987 and 2005. We then selected studies that incorporated (1) interventions designed to improve outcomes and/or reduce medical resource utilization in patients with heart failure, diabetes, or depression and (2) clearly defined protocols with at least 2 prespecified components traditionally associated with disease management. We analyzed the study protocols and used qualitative research methods to develop a disease management taxonomy with our conceptual model as the organizing framework. RESULTS: The final taxonomy includes the following 8 domains: (1) Patient population is characterized by risk status, demographic profile, and level of comorbidity. (2) Intervention recipient describes the primary targets of disease management intervention and includes patients and caregivers, physicians and allied healthcare providers, and healthcare delivery systems. (3) Intervention content delineates individual components, such as patient education, medication management, peer support, or some form of postacute care, that are included in disease management. (4) Delivery personnel describes the network of healthcare providers involved in the delivery of disease management interventions, including nurses, case managers, physicians, pharmacists, case workers, dietitians, physical therapists, psychologists, and information systems specialists. (5) Method of communication identifies a broad range of disease management delivery systems that may include in-person visitation, audiovisual information packets, and some form of electronic or telecommunication technology. (6) Intensity and complexity distinguish between the frequency and duration of exposure, as well as the mix of program components, with respect to the target for disease management. (7) Environment defines the context in which disease management interventions are typically delivered and includes inpatient or hospital-affiliated outpatient programs, community or home-based programs, or some combination of these factors. (8) Clinical outcomes include traditional, frequently assessed primary and secondary outcomes, as well as patient-centered measures, such as adherence to medication, self-management, and caregiver burden. CONCLUSIONS: This statement presents a taxonomy for disease management that describes critical program attributes and allows for comparisons across interventions. Routine application of the taxonomy may facilitate better comparisons of structure, process, and outcome measures across a range of disease management programs and should promote uniformity in the design and conduct of studies that seek to validate disease management strategies.

Light aircraft crash--a case analysis of injuries.

BACKGROUND: As air travel increases and the number of commercial and non-commercial flights rises, so does the number of aircraft accidents. The improved safety standards of the aviation industry result in a growing number of survivors of aircraft crashes, but there are no management guidelines for the treatment of these survivors. OBJECTIVES: To present our experience in treating five survivors of a light aircraft crash that occurred in August 1995 near Jerusalem. RESULTS: All five survivors sustained vertebral column injuries, which was the only injury in most of the survivors. We discuss the mechanism of injury. CONCLUSIONS: Investigation of injuries' pattern in survivors of aircraft crash is important for establishing management protocols in trauma centers.

[The assessment of exposure to and the activity of the manual lifting of patients in wards: methods, procedures, the exposure index (MAPO) and classification criteria. Movimientazione e Assistenza Pazienti Ospedalizzati (Lifting and Assistance to Hospitalized Patients)]. / Valutazione dell'esposizione ad attività di movimentazione manuale dei pazienti nei reparti di degenza: metodi, procedure, indice di esposizione (MAPO) e criteri di classificazione.

Since a method for quantifying exposure to patient handling in hospital wards is lacking, the authors describe and propose a model for identifying the main risk factors in this type of occupational exposure: presence of disabled patients, staff engaged on manual handling of patients, structure of the working environment, equipment and aids for moving patients, training of workers according to the specific risk. For each factor a procedure for identification and assessment is proposed that is easily applicable in practice. The authors also propose a formula for the calculation of a condensed exposure index (MAPO Index), which brings together the various factors. The exposure index, which requires further, detailed study and validation, makes it possible, in practice, to plan the preventive and health measures according to a specific order of priority, thus complying with the requirements of Chapter V of Law 626/94. From a practical point of view, in the present state of knowledge, it can be stated that for MAPO Index values between 0 and 1.5, risk is deemed negligible, average for values between 1.51 and 5, and high for values exceeding 5.