Gestión de la comunicación de los pacientes hospitalizados, aislados con sus familias por la COVID-19 / Management of communication between inpatients isolated due to COVID-19 and their families

ANTECEDENTES Y OBJETIVO: La calidad asistencial se ha podido ver afectada por las dimensiones de la pandemia de COVID-19 y el estricto aislamiento hospitalario al que han sido sometidos los pacientes. Por ello, se plantea describir el proceso diseñado para facilitar la comunicación de los pacientes aislados con sus familias, detectar sus necesidades y realizar intervenciones individualizadas. MÉTODO: Estudio cualitativo con metodología de investigación acción, respondiendo al siguiente algoritmo: planificar la acción, diagnóstico de la necesidad e hipótesis-acción; aplicar la acción, creación del grupo de gestores de casos y formación de los miembros; observar la acción, recoger y analizar la información. Durante el mes de abril del 2020. RESULTADOS: Se realizaron 1.754 interacciones que afectaron a 490 pacientes. Los gestores de casos realizaron 767 llamadas dirigidas principalmente a facilitar información sobre el ingreso (71,45%) y cambios de ubicación o funcionamiento de las unidades (18,84%). Recibieron un total de 1.098 llamadas de familiares solicitando: información médica (43,8%), comunicación con los pacientes (18,48%), entrega de enseres personales o gestión de objetos extraviados (12,84%) e información sobre la ubicación del paciente o gestión del alta (10,20%). En el 66% de los casos las llamadas fueron resueltas por los gestores, el 30% fueron derivadas y el 4% fallidas. CONCLUSIONES: La puesta en funcionamiento del grupo de gestores de casos ha contribuido a mejorar la comunicación de los pacientes ingresados y aislados por COVID-19 con sus familias, dando respuesta a las necesidades planteadas, mejorando la calidad asistencial y favoreciendo la humanización en los cuidados

BACKGROUND AND GOAL: Quality of healthcare has been affected by the current dimensions of the COVID-19 pandemic and the strict hospital isolation to which some inpatients have been subjected. Therefore, we propose to describe the process designed to facilitate the communication of inpatients with their families to detect their needs and perform individualized treatments in each case. METHOD: Qualitative study with action research methodology, responding to the following algorithm: plan the action, diagnosis of the need and hypothesis-action; apply the action, creation of the group of case managers and training of the members; observe the action, collect and analyse the information. During the month of April 2020. RESULTS: 1,754 interactions were undertaken, that affected 490 inpatients. Case Managers made 767 calls, to provide information about admissions (71.45%), changes in inpatient location or operation of units (18.84%), among others. One thousand and ninety-eight calls from family members were received requesting medical information (43.8%), to talk to inpatients (18.48%), to deliver personal articles or manage lost objects (12.84%), and seeking information about patient location or medical discharge (10.20%). Sixty-six percent of the requests were solved by Case Managers, 30% were referred on and 4% could not be solved. CONCLUSIONS: Implementation of the Case Manager Group contributed to encourage communication of inpatients isolated due to COVID-19 with their families, responding to needs raised, improving quality of care and promoting humanization of care

[Management of communication between inpatients isolated due to COVID-19 and their families]. / Gestión de la comunicación de los pacientes hospitalizados, aislados con sus familias por la COVID-19.

BACKGROUND AND GOAL: Quality of healthcare has been affected by the current dimensions of the COVID-19 pandemic and the strict hospital isolation to which some inpatients have been subjected. Therefore, we propose to describe the process designed to facilitate the communication of inpatients with their families to detect their needs and perform individualized treatments in each case. METHOD: Qualitative study with action research methodology, responding to the following algorithm: plan the action, diagnosis of the need and hypothesis-action; apply the action, creation of the group of case managers and training of the members; observe the action, collect and analyse the information. During the month of April 2020. RESULTS: 1,754 interactions were undertaken, that affected 490 inpatients. Case Managers made 767 calls, to provide information about admissions (71.45%), changes in inpatient location or operation of units (18.84%), among others. One thousand and ninety-eight calls from family members were received requesting medical information (43.8%), to talk to inpatients (18.48%), to deliver personal articles or manage lost objects (12.84%), and seeking information about patient location or medical discharge (10.20%). Sixty-six percent of the requests were solved by Case Managers, 30% were referred on and 4% could not be solved. CONCLUSIONS: Implementation of the Case Manager Group contributed to encourage communication of inpatients isolated due to COVID-19 with their families, responding to needs raised, improving quality of care and promoting humanization of care.

Sphenoid sinus metastatic lesion from a pyriform fossa squamous cell carcinoma.

Head and neck cancers represent a significant proportion of all malignancies; comparatively few occur in the nasal sinuses, and fewer still of these are metastatic in origin. This case describes the presentation and management of a sphenoid sinus metastasis from a primary squamous cell carcinoma of the pyriform fossa.

Idiopathic cervical osteomyelitis presenting as dysphagia.

We discuss a case of idiopathic cervical epidural abscess, complicated by osteomyelitis, presenting with dysphagia as the main complaint. No predisposing factors were identified and blood cultures were negative. Case was treated conservatively by long course of IV antibiotics. We present a review of presentation of spinal epidural abscesses and indications for surgical intervention.

An unusual case of warfarin-induced pinna skin necrosis.

INTRODUCTION: Warfarin-induced skin necrosis is a rare but recognised complication of this drug. The condition predominantly affects the breasts, buttocks and thighs of obese, peri-menopausal women. We present the case of a patient with the condition in an unusual site, and we discuss the management challenges involved. CASE REPORT: An 82-year-old man presented to the ENT department with a diagnosis of pinna haematoma. There was no history of trauma or infection. The patient was taking warfarin long-term for recurrent deep vein thrombosis. Two weeks prior to admission, the patient had had a loading course of warfarin following surgery. Multiple clinical teams were involved in treatment. The only abnormal laboratory investigation was a low protein S level; biopsy showed skin necrosis. CONCLUSION: In this case, the unusual presentation created diagnostic confusion, and may have precipitated aggressive surgical debridement. However, a more conservative management strategy was used, which we would recommend in future.

Complete recovery of an isolated left vocal fold palsy associated with a benign mediastinal thymic cyst.

OBJECTIVES: To present a case of benign mediastinal thymic cyst, and to review the published information on these cysts, including their incidence, presentation, diagnosis and management. METHODS: We report the case of a 55-year-old man who presented with a unilateral vocal fold palsy subsequently found to be due to the presence of a benign mediastinal thymic cyst. A literature search was undertaken to identify the incidence, key features and management of this rare condition. RESULTS: Benign mediastinal thymic cysts are a rare cause of mediastinal masses. Usually diagnosed incidentally, their management is usually surgical. Vocal fold palsy in isolation has not previously been reported in association with mediastinal thymic cysts. CONCLUSION: This report describes what we believe to be the first published case of a completely reversible vocal fold palsy presenting in association with a rare benign mediastinal thymic cyst.

Mediastinal foregut duplication cyst presenting as a rare cause of breathing difficulties in an adult.

Foregut duplication cysts are rare congenital anomalies of enteric origin. The diagnosis is usually made in infancy. We report the unusual case of a 71-year-old female presenting to the ENT department with shortness of breath and stridor due to an oesophageal reduplication cyst. The presentation, diagnosis and management of this potential pitfall for the unwary are outlined.

Contribution of the N-acetyltransferase 2 polymorphism NAT2*6A to age-related hearing impairment.

BACKGROUND: Age-related hearing impairment (ARHI) is the most common sensory impairment in older people, affecting 50% of those aged 80 years. The proportion of older people is increasing in the general population, and as a consequence, the number of people affected with ARHI is growing. ARHI is a complex disorder, with both environmental and genetic factors contributing to the disease. The first studies to elucidate these genetic factors were recently performed, resulting in the identification of the first two susceptibility genes for ARHI, NAT2 and KCNQ4. METHODS: In the present study, the association between ARHI and polymorphisms in genes that contribute to the defence against reactive oxygen species, including GSTT1, GSTM1 and NAT2, was tested. Samples originated from seven different countries and were combined into two test population samples, the general European population and the Finnish population. Two distinct phenotypes for ARHI were studied, Z(low) and Z(high), representing hearing in the low and high frequencies, respectively. Statistical analysis was performed for single polymorphisms (GSTM1, GSTT1, NAT2*5A, NAT2*6A, and NAT2*7A), haplotypes, and gene-environment and gene-gene interactions. RESULTS: We found an association between ARHI and GSTT1 and GSTM1 in the Finnish population sample, and with NAT2*6A in the general European population sample. The latter finding replicates previously published data. CONCLUSION: As replication is considered the ultimate proof of true associations in the study of complex disorders, this study provides further support for the involvement of NAT2*6A in ARHI.

Familial aggregation of tinnitus: a European multicentre study.

INTRODUCTION AND AIM: Tinnitus is a common condition affecting approximately 20% of the older population. There is increasing evidence that changes in the central auditory system following cochlear malfunctioning are responsible for tinnitus. To date, few investigators have studied the influence of genetic factors on tinnitus. The present report investigates the presence of a familial effect in tinnitus subjects. METHODS: In a European multicentre study, 198 families were recruited in seven European countries. Each family had at least 3 siblings. Subjects were screened for causes of hearing loss other than presbyacusis by clinical examination and a questionnaire. The presence of tinnitus was evaluated with the question "Nowadays, do you ever get noises in your head or ear (tinnitus) which usually last longer than five minutes". Familial aggregation was tested using three methods: a mixed model approach, calculating familial correlations, and estimating the risk of a subject having tinnitus if the disorder is present in another family member. RESULTS: All methods demonstrated a significant familial effect for tinnitus. The effect persisted after correction for the effect of other risk factors such as hearing loss, gender and age. The size of the familial effect is smaller than that for age-related hearing impairment, with a familial correlation of 0.15. CONCLUSION: The presence of a familial effect for tinnitus opens the door to specific studies that can determine whether this effect is due to a shared familial environment or the involvement of genetic factors. Subsequent association studies may result in the identification of the factors responsible. In addition, more emphasis should be placed on the effect of role models in the treatment of tinnitus.