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La pandemia del COVID-19 destaco la importancia y la utilidad de la telemedicina para proporcionar una manera de poner en contacto a pacientes y profesionales de la salud cuando no es posible una consulta en persona en las zonas rurales. Se realizó una revisión sistemática de la Telemedicina y su impacto en la atención médica rural en épocas de COVID-19 desde el 2016 hasta el 2021.La estrategia de búsqueda identificó 1480 artículos de bibliotecas digitales como Google Scholar, ACM Digital Library, ProQuest, ARDI, Taylor & Francis Online, Wiley Online Libray y Microsoft Academic y después de filtrar, se consideraron 71 artículos basados en criterios de exclusión. Los resultados de la revisión sistemática se han centrado en estudios recientes de la Telemedicina donde se resalta la importancia en la atención de los pacientes en zonas rurales también proporciona gráficos estadísticos de los estudios extraídos para comparar por relevancia para sus entornos y situaciones(AU)
The COVID-19 pandemic highlighted the importance and utility of telemedicine in providing a way to connect patients and healthcare professionals when an in-person consultation is not possible in rural areas. A systematic review of Telemedicine and its impact on rural healthcare in times of COVID-19 was carried out from 2016 to 2021. The search strategy identified 1480 papers from digital libraries such as Google Scholar, ACM Digital Library, ProQuest, ARDI, Taylor & Francis Online, Wiley Online Libray and Microsoft Academic. Then 71 papers were considered based on exclusion criteria. The results of the systematic review have focused on recent studies of Telemedicine where it highlights the importance in the care of patients in rural areas also provides statistical graphs of the extracted studies to compare by relevance to their settings and situations(AU)
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Zona Rural , Telemedicina , Cuidados Médicos , COVID-19 , Sistema Único de Saúde , Pessoal de SaúdeRESUMO
BACKGROUND: UC San Diego Health System (UCSDHS) is the largest academic medical center and integrated care network in US-Mexico border area of California contiguous to the Northern Baja region of Mexico. The COVID-19 pandemic compelled several UCSDHS and local communities to create awareness around best methods to promote regional health in this economically, socially, and politically important border area. PURPOSE: To improve understanding of optimal strategies to execute critical care collaborative programs between academic and community health centers facing public health emergencies during the COVID-19 pandemic, based on the experience of UCSDHS and several community hospitals (one US, two Mexican) in the US-Mexico border region. METHODS: After taking several preparatory steps, we developed a two-phase program that included 1) in-person activities to perform needs assessments, hands-on training and education, and morale building and 2) creation of a telemedicine-based (Tele-ICU) service for direct patient management and/or educational coaching experiences.Findings.A clinical and educational program between academic and community border hospitals was feasible, effective, and well received. CONCLUSION: We offer several policy-oriented recommendations steps for academic and community healthcare programs to build educational, collaborative partnerships to address COVID-19 and other cross-cultural, international public health emergencies.
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OBJECTIVE: The objective of this study was to identify the time period during which a hospital bed could be virtually available according to the informatics and administrative hospital system while still being physically occupied by a patient in a hospital in Mexico. MATERIALS AND METHODS: A cross-sectional study was conducted in a 250-bed Academic Medical Center located in Central Northern Mexico during February 2015. Both administrative and real patient discharges were registered in a hospital format. Central tendency measures were used to present collected data and bed/day costs were obtained from official national published costs. RESULTS: Nine hundred and forty-three patients were followed up during their hospital discharge process. Overall, 2.4% of hospital beds were occupied by discharged patients. The annual cost only for cold beds was $959,220.00 US$ ($14,348,304.00 MNX), without bringing about any benefits for patients. Cold beds represented 1.31% of the 2015 annual hospital budget. CONCLUSIONS: Quality improvement initiatives must be implemented to allocate beds to patients more efficiently. The discharge process must be standardized to reduce bed/day direct hospital costs and strengthen the supervision of medical residents during this process.
OBJETIVO: Identificar el periodo de tiempo durante el cual una cama hospitalaria está virtualmente disponible en el sistema informático, mientras está ocupada por un paciente, en un hospital de México. MÉTODO: Se realizó un estudio transversal en un centro médico académico de 250 camas, localizado en el centro-norte de México, en febrero de 2015. El alta administrativa y real del paciente fueron registradas en un formato institucional. Se utilizaron medidas de tendencia central para presentar los datos. El costo del día/cama se obtuvo de lo oficial publicado para la nación. RESULTADOS: 943 pacientes fueron seguidos durante el proceso de egreso. El 2.4% del total de las camas estuvo ocupada por pacientes egresados. El costo anual por las camas frías/muertas fue de $959,220.00 US$ ($14,348,304.00 MNX), sin beneficio para los pacientes. Las camas frías/muertas representaron el 1.31% del presupuesto hospitalario anual en el año 2015. CONCLUSIONES: Es necesario implementar iniciativas de mejora para asignar eficientemente las camas a los pacientes. El proceso de egreso debe estandarizarse para reducir el costo directo hospitalario por día/cama. Hay que fortalecer la supervisión de médicos residentes que participan en este proceso.
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Ocupação de Leitos/estatística & dados numéricos , Alta do Paciente , Centros Médicos Acadêmicos , Ocupação de Leitos/economia , Estudos Transversais , Feminino , Custos Hospitalares , Humanos , Masculino , MéxicoRESUMO
Resumen Introducción. La publicación científica se debe incentivar desde el pregrado, sobre todo en carreras de ciencias de la salud. Objetivo. Determinar las características y los factores asociados a la publicación científica entre los miembros de la Asociación Científica de Estudiantes de Medicina de Colombia (ASCEMCOL). Materiales y métodos. Se realizó un estudio transversal analítico que se basó en una encuesta presencial aplicada a los miembros de la ASCEMCOL. Se definió como publicación la realizada en una revista científica indexada; la información recolectada se cruzó con variables para obtener estadísticos de asociación. Resultados. Al realizar el análisis multivariado, se asoció a mayor participación en investigaciones científicas el encontrarse en un semestre académico superior (RPa: 1.25; IC95%: 1.01-1.56; p=0.043) y tener más cantidad de investigaciones extracurriculares (RPa: 1.26; IC95%: 1.15-1.38; p<0.001); así mismo, la menor frecuencia de publicación se asoció a la percepción de pobre apoyo por parte de la universidad (RPa: 0.28; IC95%: 0.22-0.34; p<0.001), ajustado por la cantidad de trabajos presentados a congresos y la universidad de procedencia. Conclusión. La frecuencia de publicación fue baja en esta población. Se encontraron factores de gran importancia, como estar en un mayor semestre y tener mayor número de investigaciones realizadas y publicaciones.
Abstract Introduction: The scientific publication should be encouraged from the undergraduates, especially in science health careers. Objective: To determine the features and factors associated with scientific publication among members of the Scientific Association of Medical Students of Colombia (ASCEMCOL). Materials and methods: An analytic cross-sectional study, which was based on a face survey applied to the members of the ASCEMCOL. A publication was defined as a publication made in an indexed scientific journal; and the information collected was crossed with variables to obtain a statistical association. Results: When performing multivariate analysis, it was associated with increased participation in scientific research the fact of being in a superior academic semester (RPA: 1.25; 95% CI: 1.01-1.56; p value: 0.043), more of extracurricular investigations (RPA: 1.26; 95% CI: 1.15-1.38; p value <0.001). Likewise, the lower frequency of publications associated with the perception of poor support from the university (RPA: 0.28; 95% CI: 0.22-0.34; p value <0.001), adjusted to the number of papers presented in congresses and the university of origin. Conclusion: The publication frequency was low in this population; we find important factors like being in a superior academic semester, such as having a greater number of investigations and publications.
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Global health initiatives from academic medical centers have rapidly proliferated over the last decade. This paper endeavors to describe our 5-year experience as an academic medical collaborative supporting healthcare delivery, medical training, and research at Hôpital Saint Damien-Nos Petits Frères et Soeurs, the only freestanding children's hospital in Haiti. Descriptions of the history and current activities of our academic medical collaborative, its partnership and communication structure, its evolution to fill the expressed needs of our host site, its funding mechanisms, and its challenges and opportunities for the future are included.
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El personal sanitario se enfrenta frecuentemente a situaciones de vida y muerte, por lo que su trabajo puede ser física y emocionalmente agotador. La presencia del síndrome de Burnout representa un riesgo para la salud que afecta la moral y el bienestar psicológico, repercutiendo esto en la calidad y tratamiento que se proporciona al paciente. El objetivo del estudio es determinar la frecuencia del síndrome de Burnout en médicos residentes de especialidades médicas del Hospital Central "Dr. Emilio Cubas" del Instituto de Previsión Social, en el año 2013. El diseño es transeccional descriptivo. La muestra está constituida por 75 residentes de diversos años y especialidades. Se encontró un bajo porcentaje de residentes con este síndrome (6,67%). Si bien, la vida de un médico puede resultar desgastante, la satisfacción profesional que le brinda su trabajo, hace que sea placentera su jornada.
Health workers are often faced with situations of life and death, that is why their work can be physically and emotionally exhausting. The presence of Burnout syndrome represents a health risk that affects the moral and psychological welfare, and this influences the quality and treatment provided to the patient. The aim of the research was to determine the frequency of Burnout syndrome in medical residents medical specialties Hospital Central "Dr. Emilio Cubas' of Instituto de Previsión Social in 2013. The design was descriptive transactional. The sample consisted of 75 residents of different years and specialties. A low percentage of residents with this syndrome (6.67%) was found. Although the life of a doctor can be exhausting, job satisfaction provided by their work make their journey a pleasant one.
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Kikuchi disease is a self-limited disorder of unknown etiology characterized by focal painful lymphadenitis, fever, and weight loss that can be mistaken for malignancy. Diagnosis is established by node biopsy. Kikuchi disease is endemic in Asia; 10 cases have been reported in the US to date. We report 3 cases and review other US cases.
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Linfadenite Histiocítica Necrosante/diagnóstico , Linfonodos/patologia , Adolescente , Biópsia , Criança , Connecticut , Diagnóstico Diferencial , Feminino , Humanos , MasculinoRESUMO
BACKGROUND & AIMS: Cdc42 is a Rho GTPase that regulates diverse cellular functions, including proliferation, differentiation, migration, and polarity. In the intestinal epithelium, a balance among these events maintains homeostasis. We used genetic techniques to investigate the role of Cdc42 in intestinal homeostasis and its mechanisms. METHODS: We disrupted Cdc42 specifically in intestinal epithelial cells by creating Cdc42flox/flox-villin-Cre+ and Cdc42flox/flox-Rosa26-CreER+ mice. We collected intestinal and other tissues, and analyzed their cellular, molecular, morphologic, and physiologic features, compared with the respective heterozygous mice. RESULTS: In all mutant mice studied, the intestinal epithelium had gross hyperplasia, crypt enlargement, microvilli inclusion, and abnormal epithelial permeability. Cdc42 deficiency resulted in defective Paneth cell differentiation and localization without affecting the differentiation of other cell lineages. In mutant intestinal crypts, proliferating stem and progenitor cells increased, compared with control mice, resulting in increased crypt depth. Cdc42 deficiency increased migration of stem and progenitor cells along the villi, caused a mild defect in the apical junction orientation, and impaired intestinal epithelium polarity, which can contribute to the observed defective intestinal permeability. The intestinal epithelium of the Cdc42flox/flox-villin-Cre+ and Cdc42flox/flox-Rosa26-CreER+ mice appeared similar to that of patients with microvillus inclusion disease. In the digestive track, loss of Cdc42 also resulted in crypt hyperplasia in the colon, but not the stomach. CONCLUSIONS: Cdc42 regulates proliferation, polarity, migration, and differentiation of intestinal epithelial cells in mice and maintains intestine epithelial barrier and homeostasis. Defects in Cdc42 signaling could be associated with microvillus inclusion disease.
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Mucosa Intestinal/citologia , Intestino Delgado/citologia , Proteína cdc42 de Ligação ao GTP/fisiologia , Animais , Diferenciação Celular , Movimento Celular , Polaridade Celular , Proliferação de Células , CamundongosRESUMO
OBJECTIVE: To facilitate further assessment of transfusion-associated lead exposure by designing a procedure to test packed red blood cells (pRBCs) prepared for transfusion. STUDY DESIGN: The relationship between pRBCs and whole blood lead concentration was investigated in 27 samples using a modified clinical assay. Lead concentrations were measured in 100 pRBC units. RESULTS: Our sample preparation method demonstrated a correlation between whole blood lead and pRBC lead concentrations (R(2) = 0.82). In addition, all 100 pRBC units tested had detectable lead levels. The median pRBC lead concentration was 0.8 µg/dL, with an SD of 0.8 µg/dL and a range of 0.2-4.1 µg/dL. In addition, after only a few days of storage, approximately 25% of whole blood lead was found in the supernatant plasma. CONCLUSION: Transfusion of pRBCs is a source of lead exposure. Here we report the quantification of lead concentration in pRBCs. We found a >20-fold range of lead concentrations in the samples tested. Pretransfusion testing of pRBC units according to our proposed approach or donor screening of whole blood lead and selection of below-average units for transfusion to children would diminish an easily overlooked source of pediatric lead exposure.
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Segurança do Sangue/métodos , Poluentes Ambientais/sangue , Transfusão de Eritrócitos/efeitos adversos , Intoxicação do Sistema Nervoso por Chumbo na Infância/prevenção & controle , Chumbo/sangue , Eritrócitos/química , Humanos , Intoxicação do Sistema Nervoso por Chumbo na Infância/etiologia , Espectrometria de Massas , Plasma/químicaRESUMO
OBJECTIVES: To characterize variation and inequalities in neighborhood child asthma admission rates and to identify associated community factors within one US county. STUDY DESIGN: This population-based prospective, observational cohort study consisted of 862 sequential child asthma admissions among 167â653 eligible children ages 1-16 years in Hamilton County, Ohio. Admissions occurred at a tertiary-care pediatric hospital and accounted for nearly 95% of in-county asthma admissions. Neighborhood admission rates were assessed by geocoding addresses to city- and county-defined neighborhoods. The 2010 US Census provided denominator data. Neighborhood admission distribution inequality was assessed by the use of Gini and Robin Hood indices. Associations between neighborhood rates and socioeconomic and environmental factors were assessed using ANOVA and linear regression. RESULTS: The county admission rate was 5.1 per 1000 children. Neighborhood rates varied significantly by quintile: 17.6, 7.7, 4.9, 2.2, and 0.2 admissions per 1000 children (P < .0001). Fifteen neighborhoods containing 8% of the population had zero admissions. The Gini index of 0.52 and Robin Hood index of 0.38 indicated significant inequality. Neighborhood-level educational attainment, car access, and population density best explained variation in neighborhood admission rates (R(2) = 0.55). CONCLUSION: In a single year, asthma admission rates varied 88-fold across neighborhood quintiles in one county; a reduction of the county-wide admission rate to that of the bottom quintile would decrease annual admissions from 862 to 34. A rate of zero was present in 15 neighborhoods, which is evidence of what may be attainable.
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Asma/terapia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Adolescente , Asma/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Ohio , Estudos Prospectivos , Fatores SocioeconômicosRESUMO
OBJECTIVES: To test the hypothesis that instituting a process of routine daily review of rhythm alarms in non-cardiac patients in the pediatric intensive care unit would yield clinically important disturbances that would otherwise go undetected. STUDY DESIGN: A prospective observational study was performed over a consecutive 28-day period. Total bedside monitor alarms, rhythm alarms, and heart rate (HR) trends were recorded. Rhythm alarm recordings were reviewed independently by two study team members. Medical records for patients with critical arrhythmias were reviewed to evaluate for prior knowledge of the event and to correlate with clinical data. RESULTS: We evaluated 86 patients (343 patient-days). There were 54,656 total monitor alarms (159.3 alarms/patient-day), of which 19,970 (37%) were rhythm alarms, including 4032 (20%) critical arrhythmias. Fifty-six percent of the critical alarms were artifactual. Seventeen of the 1786 ventricular tachycardia alarms represented true episodes that occurred in 5 patients. Two patients' care were altered as a result of detection of the arrhythmia in the review process. Eight hundred sixty-five (98%) of the 883 true critical alarms reviewed were for extreme HR. Eighty-three percent (5172) of the 6239 true non-critical alarms reviewed were HR alarms. CONCLUSIONS: Daily review of rhythm alarms improves detection of clinically relevant arrhythmias in non-cardiac pediatric intensive care unit patients.
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Arritmias Cardíacas/diagnóstico , Unidades de Terapia Intensiva Pediátrica , Adolescente , Criança , Pré-Escolar , Alarmes Clínicos , Humanos , Lactente , Monitorização Fisiológica , Estudos Prospectivos , Adulto JovemAssuntos
Tipagem e Reações Cruzadas Sanguíneas/normas , Cardiomiopatia Restritiva/cirurgia , Rejeição de Enxerto , Transplante de Coração-Pulmão/efeitos adversos , Erros Médicos , Centros Médicos Acadêmicos/normas , Adolescente , Feminino , Humanos , México/etnologia , North Carolina , Qualidade da Assistência à Saúde , Falha de TratamentoRESUMO
When successful solid organ transplantation was initiated almost 40 years ago, its current success rate was not anticipated. But continuous efforts were undertaken to overcome the two major obstacles to success: injury caused by interrupting nutrient supply to the organ and rejection of the implanted organ by normal host defense mechanisms. Solutions have resulted from technologic medical advances, but also from using organs from different sources. Each potential solution has raised ethical concerns and has variably resulted in societal acclaim, censure, and apathy. Transplant surgery is now well accepted, and the list of transplant candidates has grown far quicker than the availability of organs. More than 30,000 patients were awaiting organs for transplantation at the end of March 1993. While most organs came from donors declared dead by brain criteria, the increasing shortage of donated organs has prompted a reexamination of prior restrictions of donor groups. Recently, organ procurement from donors with cardiac death has been reintroduced in the United States. This practice has been mostly abandoned by the U.S. and some, though not all, other countries. Transplantation has been more successful using organs procured from heart-beating, "brain dead" cadavers than organs from non-heart-beating cadavers. However, recent advances have led to success rates with organs from non-heart-beating donors that may portend large increases in organ donation and procurement from this source.
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Morte , Ética Médica/história , Transplante de Órgãos/história , Obtenção de Tecidos e Órgãos/história , Morte Encefálica , Cadáver , História do Século XX , Corpo Humano , Humanos , Internacionalidade , Obtenção de Tecidos e Órgãos/organização & administração , Obtenção de Tecidos e Órgãos/normas , Estados Unidos , Suspensão de TratamentoRESUMO
In the mid 1980s it was apparent that the need for organ donors exceeded those willing to donate. Some University of Pittsburgh Medical Center (UPMC) physicians initiated discussion of possible new organ donor categories including individuals pronounced dead by traditional cardiac criteria. However, they reached no conclusion and dropped the discussion. In the late 1980s and the early 1990s, four cases arose in which dying patients or their families requested organ donation following the elective removal of mechanical ventilation. Controversy surrounding these cases precipitated open discussion of the use of organ donors pronounced dead on the basis of cardiac criteria. Prolonged deliberations by many committees in the absence of precedent ultimately resulted in what is, to our knowledge, the country's first policy for organ donation following elective removal of life support. The policy is intricate and conservative. Care was taken to include as many interested parties as possible in an effort to achieve representative and broad based support. This paper describes the development of the UPMC policy on non-heart-beating organ donation.
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Revisão Ética , Ética Institucional , Guias como Assunto , Hospitais Universitários/normas , Política Organizacional , Obtenção de Tecidos e Órgãos/normas , Suspensão de Tratamento , Atitude do Pessoal de Saúde , Tomada de Decisões Gerenciais , Eticistas , Comissão de Ética , Comitês de Ética Clínica , Hospitais Universitários/organização & administração , Corpo Humano , Humanos , Comunicação Interdisciplinar , Advogados , Cuidados para Prolongar a Vida/normas , Modelos Organizacionais , Participação do Paciente , Pennsylvania , Autonomia Pessoal , Técnicas de Planejamento , Obtenção de Tecidos e Órgãos/organização & administraçãoRESUMO
The dead donor rule--that persons must be dead before their organs are taken--is a central part of the moral framework underlying organ procurement. Efforts to increase the pool of transplantable organs have been forced either to redefine death (e.g., anencephaly) or take advantage of ambiguities in the current definition of death (e.g., the Pittsburgh protocol). Society's growing acceptance of circumstances in which health care professionals can hasten a patient's death also may weaken the symbolic importance of the dead donor rule. We consider the implications of these efforts to continually revise the line between life and death and ask whether it would be preferable to abandon the dead donor rule and rely entirely on informed consent as a safeguard against abuse.