RESUMO
To verify if data obtained in the prehospital evaluation of patients with severe acute respiratory syndrome (SARS) during the initial response to the COVID-19 pandemic is associated with clinical outcomes: mechanical ventilation, hospital discharge, and death. This is a retrospective analysis involving secondary data from the Emergency Medical Service (EMS) records and the Health Surveillance Information System of patients assisted by the EMS in Manaus, from January to June 2020, the period of the first peak of COVID-19 cases. The combination of the two databases yielded a total of 1.190 patients, who received a first EMS response and were later admitted to hospital with SARS and had data on clinical outcomes of interest available. Patients were predominantly male (754, 63.4%), with a median age of 66 (IQR: 54.0-78.0) years. SARS illness before medical assistance was associated to need for invasive mechanical ventilation (IMV, p < 0.001). Lower pre-hospital SpO2 was associated to death (p = 0.025). Death was more common among patients with respiratory support needs, especially in the invasive ventilation group (262/287; 91.3%) (p < 0.001). In addition, IMV was more common among elderly individuals (p < 0.001). Patients admitted to ICU had a greater chance of dying when compared to non-ICU admitted patients (p < 0.001), and closely related to IMV (p < 0.001). Patients in ICU were also older (p = 0.003) and had longer hospital stay (p < 0.001). Mortality was associated with mechanical ventilation (p < 0.001), ICU admission (p < 0.001), and older age (p < 0.001). Patients who died had a shorter length of both ICU and total hospital stay (p < 0.001). Prehospital EMS may provide feasible and early recognition of critical patients with SARS in strained healthcare systems, such as in low-resource settings and pandemics.
Assuntos
COVID-19 , Serviços Médicos de Emergência , Respiração Artificial , Humanos , COVID-19/mortalidade , COVID-19/terapia , COVID-19/epidemiologia , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Estudos Retrospectivos , Saturação de Oxigênio , SARS-CoV-2/isolamento & purificação , Hospitalização , Mortalidade Hospitalar , Síndrome Respiratória Aguda Grave/terapia , Síndrome Respiratória Aguda Grave/mortalidade , Síndrome Respiratória Aguda Grave/epidemiologiaRESUMO
A historical account of the 30 years of the medical major of Health Management at Universidad Nacional Mayor de San Marcos is presented. The major was created in 1988 as Comprehensive General Medicine in response to the shortage of management specialists. The name of the major remained until 1994, when it changed to Integral Medicine and Health Management to emphasize its managerial orientation. In 2002, the curricular plan was modified considering the importance of having an exclusive medical specialization in management for the health sector. The specialty is a pioneer in a gradual education in three levels: micro-management, meso-management, and macro-management. The new curricular plan allowed residents the possibility to access better rotations at public and private institutions. Since 2007, the major is labeled Health Management, and its specialists maintain their solid training that enables them to perform in the decision-making, management, administration, and operation processes of the health systems. The vision of the creators of this major is current to this day; Health Management specialists work in the different institutions of the health system, contributing their knowledge and skills, and generating an impact on the health of the Peruvian population.
Se presenta un recuento histórico de los 30 años de la especialidad médica de Gestión en Salud en la Universidad Nacional Mayor de San Marcos. La especialidad fue creada en 1988 como Medicina General Integral en respuesta a la escasez de médicos especialistas en gestión. El nombre de la especialidad se mantuvo hasta 1994, cuando cambia a Medicina Integral y Gestión en Salud para enfatizar su orientación gerencial. En 2002, se modifica el plan curricular considerando la importancia de tener una especialización médica exclusiva de gestión para el sector salud. La especialidad es pionera en una formación gradual en tres niveles: microgestión, mesogestión y macrogestión. El nuevo plan curricular permitió a los residentes la posibilidad de mejores rotaciones en instituciones públicas y privadas. A partir del 2007, la especialidad es denominada Gestión en Salud, cuyos médicos especialistas mantienen su sólida formación para desempeñarse en los procesos de decisión, conducción, dirección y operatividad de los sistemas de salud. La visión de los creadores de la especialidad se encuentra vigente, los especialistas de Gestión en Salud se desempeñan en las diferentes instituciones del sistema de salud, aportando sus conocimientos y habilidades, y generando un impacto en la salud de la población peruana.
Assuntos
Educação Médica , Administração de Serviços de Saúde , Faculdades de Medicina , Universidades , Currículo , Educação Médica/história , Administração de Serviços de Saúde/história , História do Século XX , História do Século XXI , Peru , Fatores de TempoRESUMO
Se presenta un recuento histórico de los 30 años de la especialidad médica de Gestión en Salud en la Universidad Nacional Mayor de San Marcos. La especialidad fue creada en 1988 como Medicina General Integral en respuesta a la escasez de médicos especialistas en gestión. El nombre de la especialidad se mantuvo hasta 1994, cuando cambia a Medicina Integral y Gestión en Salud para enfatizar su orientación gerencial. En 2002, se modifica el plan curricular considerando la importancia de tener una especialización médica exclusiva de gestión para el sector salud. La especialidad es pionera en una formación gradual en tres niveles: microgestión, mesogestión y macrogestión. El nuevo plan curricular permitió a los residentes la posibilidad de mejores rotaciones en instituciones públicas y privadas. A partir del 2007, la especialidad es denominada Gestión en Salud, cuyos médicos especialistas mantienen su sólida formación para desempeñarse en los procesos de decisión, conducción, dirección y operatividad de los sistemas de salud. La visión de los creadores de la especialidad se encuentra vigente, los especialistas de Gestión en Salud se desempeñan en las diferentes instituciones del sistema de salud, aportando sus conocimientos y habilidades, y generando un impacto en la salud de la población peruana.
A historical account of the 30 years of the medical major of Health Management at Universidad Nacional Mayor de San Marcos is presented. The major was created in 1988 as Comprehensive General Medicine in response to the shortage of management specialists. The name of the major remained until 1994, when it changed to Integral Medicine and Health Management to emphasize its managerial orientation. In 2002, the curricular plan was modified considering the importance of having an exclusive medical specialization in management for the health sector. The specialty is a pioneer in a gradual education in three levels: micro-management, meso-management, and macro-management. The new curricular plan allowed residents the possibility to access better rotations at public and private institutions. Since 2007, the major is labeled Health Management, and its specialists maintain their solid training that enables them to perform in the decision-making, management, administration, and operation processes of the health systems. The vision of the creators of this major is current to this day; Health Management specialists work in the different institutions of the health system, contributing their knowledge and skills, and generating an impact on the health of the Peruvian population.