RESUMEN
INTRODUCTION: To facilitate the implementation of controlled donation after circulatory death (cDCD) programs even in hospitals not equipped with a local extracorporeal membrane oxygenation (ECMO) team, some countries have launched a local cDCD network with an ECMO mobile team for normothermic regional perfusion (NRP). In the Tuscany region, in 2021, the Regional Transplant Authority launched a cDCD program to make the cDCD pathway feasible even in peripheral hospitals with NRP mobile teams, which were "converted" existing ECMO mobile teams, composed of highly skilled and experienced personnel. METHODS: We describe the Tuscany cDCD program, (2021-2023), for cDCD from peripheral hospitals with NRP mobile teams. RESULTS: Twenty-six cDCDs (26/40, 65%) came from peripheral hospitals. Following the launch of the cDCD program, cDCDs from peripheral hospitals increased, from 33% (2021) to 75% (2022 and 2023) of the overall cDCDs. The mean age was 63 years, with older donors (>75 years) in half the cases. The median warm ischemia time was 45 min (20 min are required by the Italian law for death certification), ranging from 35 to 59 min. Among the 20 livers retrieved and 18 kidneys retrieved, 16 livers, and 11 kidneys (single kidney transplantation) were transplanted, after ex vivo reperfusion, respectively. CONCLUSIONS: The use of NRP mobile teams proved to be feasible and safe in the management of cDCD in peripheral hospitals. No complications were reported with NRP despite the advanced age of most cDCDs.
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Preservación de Órganos , Perfusión , Donantes de Tejidos , Obtención de Tejidos y Órganos , Humanos , Masculino , Persona de Mediana Edad , Femenino , Obtención de Tejidos y Órganos/organización & administración , Obtención de Tejidos y Órganos/métodos , Preservación de Órganos/métodos , Italia , Perfusión/métodos , Anciano , Adulto , Donantes de Tejidos/provisión & distribución , Estudios de Seguimiento , Oxigenación por Membrana Extracorpórea , Pronóstico , Trasplante de Riñón , Trasplante de Hígado , Supervivencia de Injerto , Recolección de Tejidos y Órganos/métodosRESUMEN
BACKGROUND: As part of the fight against coronavirus disease, Nigeria received nearly 4 million doses of the COVID-19 vaccine via the COVID-19 Vaccines Global Access (COVAX) Facility, marking a historic step towards equitable global distribution of COVID-19 vaccines. Although evidence exists on COVID-19 hesitancy in Nigeria, yet, we are unaware of any study on the optimization of COVID-19 vaccination from the lenses of the mobile teams. OBJECTIVE: This study seeks to explore the perceptions and experiences of mobile teams in selected communities during the implementation of COVID-19 vaccination in Benue and Niger. METHODS: An exploratory approach was adopted, and the study was conducted in Niger and Benue states based on poor performance in COVID-19 vaccination. Focus Group Discussions (FDGs) were conducted among 12 mobile vaccination teams from 12 LGAs. The recorded discussions were transcribed and coded (inductively and deductively) using Dedoose software (v9.0). Four themes and seven sub-themes were generated from the participants' responses. RESULTS: Seventy-two (72) health workers including vaccinators, validators, Electronic Management of Immunization Data (EMID) recorders, social mobilizers, and paper recorders participated in this study. Health workers' perceptions and experiences were thematized using the health building blocks. The mobilization teams in Benue and Niger states perceived that their mobilization efforts contributed to improved coverage, increased accessibility, and reduced hesitancy among the community dwellers. Challenges reported by the teams were vaccine misconceptions, requests for incentives in exchange for vaccine uptake, poor network services, distance to communities, and vaccine stockout. CONCLUSION: This study concluded that social mobilizers play key roles in vaccine uptake, especially at the community level. Their roles in creating awareness, sensitization, and bringing the vaccine closer to hard-to-reach communities contributed to the success attained in the fight against COVID-19 in both states.
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Vacunas contra la COVID-19 , COVID-19 , Grupos Focales , Humanos , Vacunas contra la COVID-19/administración & dosificación , Nigeria , Niger , COVID-19/prevención & control , Femenino , Masculino , Unidades Móviles de Salud , Adulto , Vacilación a la Vacunación/psicología , Vacilación a la Vacunación/estadística & datos numéricos , SARS-CoV-2 , Persona de Mediana Edad , Investigación CualitativaRESUMEN
OBJECTIVE: The aim: To study the availability, quality and features of outpatient palliative and hospice care (PHC) to the population, including the elderly, in the COVID-19 pandemic context in order to optimize the PHC-mobile-teams service. PATIENTS AND METHODS: Materials and methods: Domestic and foreign literary sources; sociological research results. The research methods: biblio-semantic, sociological (questionnaires), systemic approach and systemic analysis, conventional medical-statistical methods. RESULTS: Results: Based on the analysis of international regulatory documents, domestic and foreign literary sources, the socio-medical importance of PHC is shown. In Ukraine, as in other countries, the number of elderly people is constantly growing, which leads to an increase in the PHC need. The results of the sociological survey determine: PHC needs in terms of age showed that in Ukraine almost 78.86% of people in need of PHC were aged 60 and over; the most popular (86.0% of responses) were PHC-mobile-teams and home-based services; about 80% of respondents said that pain limited their ability to work and affected on their psycho-emotional state and their quality of life; 86.3% of respondents reported an pain increased after COVID-19. The results of an online survey showed the effectiveness of PHC-mobile-teams service by improving the availability of PHC. CONCLUSION: Conclusions: To ensure high-quality PHC availability it should be integrated at the Health and Social Care Systems. According to the experience of the Kyiv PHC-mobile-teams service, it significantly increases PHC availability, which is especially important in the COVID-19 pandemic context.
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COVID-19 , Cuidados Paliativos al Final de la Vida , Anciano , Humanos , Persona de Mediana Edad , Dolor , Cuidados Paliativos/psicología , Pandemias , Calidad de VidaRESUMEN
Clinical research in outpatient healthcare, particularly in general practice, which is the first line of contact with the population, is now a public health issue. However, this type of research has specific characteristics that differentiate it from clinical research conducted in a hospital setting and requires an adaptation of its conditions of practice: in terms of organisation, the development of research in outpatient healthcare relies on the appropriation of its fundamentals by the investigators, which implies their presentation, upstream, from the initial cycle, and the participation of practitioners in training modules adapted to research in primary care, such as those already organised by several GIRCI (Groupement Inter régional de la Recherche Clinique et de l'Innovation [French Interregional Clusters for Clinical Research and Innovation]). To compensate for the fragmented nature of their location, on the model of the EMRCs (équipes mobiles de recherche clinique [mobile clinical research teams]) in oncology, mobile research teams should enable general medical practices to participate in clinical trials. This presupposes, on the one hand, the allocation of earmarked funding to ensure the sustainability of a base of dedicated personnel and, on the other hand, the impetus of a national dynamic through the setting up of a multi-organisation thematic institute for "research in primary care" associated, at the operational level, with a national scale investigation network supported by a platform of excellence. The use of digital tools and innovations (telemedicine; data collection via connected tools; e-consent; electronic signature) which make it possible to digitise and relocate all or part of the research procedures for both the participant and the investigation teams. An adaptation of the legal framework in order to bring the place of research closer to the patient and not the other way round, which means moving the equipment and investigations closer to the patient. Taking into account the acceptability of the patient, thus limiting the disruption that may be caused by his or her participation in a research protocol and motivating the practitioner by valuing his or her contribution and providing all the guarantees of scientific relevance and independence of practice. In view of the contextual analysis, positive feedback and the availability of organisational and digital support points facilitating the delocalisation and digitisation of the conduct of research activity as close as possible to the patient and his or her doctor, the round table concluded that opportunities exist today which favour the development of clinical research in general practice. It is important to seize this opportunity and make the most of it without delay.
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Atención Ambulatoria , Ensayos Clínicos como Asunto , Vías Clínicas , Ensayos Clínicos como Asunto/organización & administración , Ensayos Clínicos como Asunto/normas , Femenino , Hospitales , Humanos , Masculino , MédicosRESUMEN
This paper is devoted to the issue of medical care provision to the residents of the Techa riverside settlements affected by long-term radiation exposure. The river was contaminated due to operational and accidental releases of liquid radioactive waste (LRW) by the 'Mayak' Production Association from 1949 to 1956. Contamination of the river and its floodplain with radionuclides, including long-lived90Sr and137Cs, caused long-term external and internal exposure of the population, predominantly of the bone marrow. Protective countermeasures (resettlement of residents, introduction of restrictions on the use of the river and floodplain, construction of wells, etc) did not manage to prevent relatively high exposure doses to the population. The mean dose value of bone marrow exposure in residents of the riverside settlements was 0.35 Gy, whereas the maximum values were up to 7.92 Gy. The first medical examinations by mobile teams of the Moscow Institute of Biophysics were started approximately two years after the onset of LRW releases. Since 1955, exposed residents have been followed up and are undergoing medical treatment at the Clinic of the Urals Research Center for Radiation Medicine of the Federal Medical and Biological Agency (URCRM). This center was established in response to the necessity to study the biological effects of the combined external γ-exposure and exposure due to90Sr in order to arrange medical care for the exposed population. The URCRM Clinic focuses on the provision of hematological care since cases of chronic radiation syndrome were registered among the exposed population in the early period, and increased leukemia incidence has been observed in the long-term period.
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Exposición a la Radiación , Residuos Radiactivos , Contaminantes Radiactivos del Agua , Residuos Radiactivos/análisis , Ríos , Federación de Rusia/epidemiología , Radioisótopos de Estroncio , Contaminantes Radiactivos del Agua/análisisRESUMEN
BACKGROUND: In line with previous findings, in a recent randomized controlled trial (RCT), we found that home treatment (HT) for acute mental health care can reduce (substitute) hospital use among severely ill patients in crises. This study examined whether the findings of the RCT generalize to HT services provided under routine care conditions. METHODS: We compared patients who received HT during the RCT study phase with patients who received the same HT service after it had become part of routine mental health services in the same catchment area. Sociodemographic and clinical characteristics as well as service use (HT and hospital bed days) were compared between the RCT and the subsequent routine care study period. RESULTS: Compared to patients who received HT during the RCT, routine care HT patients were more often living with others, less often admitted compulsorily, more often diagnosed with anxiety and stress-related disorders (ICD-10 F4) and less often diagnosed with schizophrenia spectrum disorders (F2). When compared to patients who were exclusively treated on hospital wards, involvement of the HT team in patients' care was associated with a clear-cut reduction of hospital bed days both during the RCT and under routine care conditions. However, unlike during the RCT study period, involvement of HT was associated with longer overall treatment episodes (inpatient + HT days) under routine care conditions. CONCLUSIONS: HT seems to reduce the use of hospital bed days even under routine care conditions but is at risk of producing longer overall acute treatment episodes.
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Servicios de Atención de Salud a Domicilio/organización & administración , Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Femenino , Humanos , Masculino , Trastornos Mentales/psicologíaRESUMEN
The objective of this study was to evaluate the impact of the tuberculosis (TB) mobile teams on treatment outcomes in Riyadh Region by comparing patients who received treatment under mobile teams and those who did not, from 2013 to 2015. This was a retrospective descriptive study using National TB Control and Prevention Program data from 2013 to 2015 from Riyadh, Kingdom of Saudi Arabia. Descriptive analyses were used to summarize characteristics of TB case-patients served by mobile teams and those who were not served. The χ2 test measured the significant differences between mobile-served and non-mobile-served case-patients. Exposure was whether or not the TB case-patient was under the care of the mobile team; the outcome of interest was whether or not treatment was successful, defined as treatment completed and cured. We found that the ratio of treatment success among mobile team case-patients was 1.28 greater than among those not served by mobile teams. The χ2 test showed a statistically significant finding (probability ratio=1.28; 95% confidence interval=1.21-1.35, p<0.01). Mobile teams increased the treatment success rate to 92%, compared to 71.77% among those not served by mobile teams. This study shows that community mobilization of mobile teams is an effective strategy to enhance TB treatment, reduced mortality and loss to follow-up and improve TB treatment outcomes.
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Terapia por Observación Directa , Unidades Móviles de Salud , Tuberculosis/terapia , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Arabia Saudita , Resultado del TratamientoRESUMEN
At present, the problem of disparity of healthcare, including neurological care, in urban and rural settings is highly relevant. Medical care after acute stroke or other chronic disabling diseases (epilepsy, Parkinson's disease) in rural settings is quite challenging due to the lack of access to specialized medical treatment facilities, low level of resources in medical and obstetric centers, low quality of healthcare, personnel turnover in rural healthcare and insufficient coverage of population with outpatient follow-up services. The most promising optimization approaches, which proved to be effective both abroad and in the Russian Federation, including Tyumen district, are the development of multidisciplinary mobile teams and telemedicine. Introduction of these approaches provides an increased access of rural population to specialized medical care, which leads to improvement in overall population health status.