RESUMO
The World Health Organization (WHO) declared coronavirus disease-2019 (COVID-19) a global pandemic on 11 March 2020. In Ecuador, the first case of COVID-19 was recorded on 29 February 2020. Despite efforts to control its spread, SARS-CoV-2 overran the Ecuadorian public health system, which became one of the most affected in Latin America on 24 April 2020. The Hospital General del Sur de Quito (HGSQ) had to transition from a general to a specific COVID-19 health center in a short period of time to fulfill the health demand from patients with respiratory afflictions. Here, we summarized the implementations applied in the HGSQ to become a COVID-19 exclusive hospital, including the rearrangement of hospital rooms and a triage strategy based on a severity score calculated through an artificial intelligence (AI)-assisted chest computed tomography (CT). Moreover, we present clinical, epidemiological, and laboratory data from 75 laboratory tested COVID-19 patients, which represent the first outbreak of Quito city. The majority of patients were male with a median age of 50 years. We found differences in laboratory parameters between intensive care unit (ICU) and non-ICU cases considering C-reactive protein, lactate dehydrogenase, and lymphocytes. Sensitivity and specificity of the AI-assisted chest CT were 21.4% and 66.7%, respectively, when considering a score >70%; regardless, this system became a cornerstone of hospital triage due to the lack of RT-PCR testing and timely results. If health workers act as vectors of SARS-CoV-2 at their domiciles, they can seed outbreaks that might put 1,879,047 people at risk of infection within 15 km around the hospital. Despite our limited sample size, the information presented can be used as a local example that might aid future responses in low and middle-income countries facing respiratory transmitted epidemics.
Assuntos
COVID-19/diagnóstico por imagem , COVID-19/epidemiologia , Hospitais Especializados/organização & administração , Hospitais Especializados/tendências , Pandemias/prevenção & controle , SARS-CoV-2/genética , Triagem/métodos , Adulto , Idoso , Inteligência Artificial , COVID-19/prevenção & controle , COVID-19/virologia , Teste de Ácido Nucleico para COVID-19 , Equador/epidemiologia , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Radiografia Pulmonar de Massa/métodos , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVES: Although disparities in stroke care and outcomes have been well documented nationally, state-based registries to monitor acute stroke care in Florida (FL) and Puerto Rico (PR) have not been established. The FL-PR Collaboration to Reduce Stroke Disparities (CReSD) was developed to evaluate race-ethnicity and regional disparities in stroke care performance. The objective of this study was to assess and compare hospital characteristics within a large quality improvement registry to identify characteristics associated with better outcomes for acute ischemic stroke care. METHODS: Trained personnel from 78 FL-PR CReSD hospitals (69 FL, 9 PR) completed a 50-item survey assessing institutional characteristics across seven domains: acute stroke care resource availability, emergency medical services integration, stroke center certification, data collection and use, quality improvement processes, FL-PR CReSD recruitment incentives, and hospital infrastructure. RESULTS: The rate of survey completion was 100%. Differences were observed both within FL and between FL and PR. Years participating in Get With The Guidelines-Stroke (8.9 ± 2.6 years FL vs 4.8 ± 2.4 years PR, P < 0.0001) and proportion of hospitals with any stroke center certification (94.2% FL vs 11.1% PR, P < 0.0001) showed the largest variations. Smaller hospital size, fewer years in Get With The Guidelines-Stroke, and lack of stroke center designation and acute stroke care practice implementation may contribute to poorer outcomes. CONCLUSIONS: Results from our survey indicated variability in hospital- and system-level characteristics in stroke care across hospitals in Florida and Puerto Rico. Identification of these variations, which may explain potential disparities, can help clinicians understand gaps in stroke care and outcomes and targeted interventions to reduce identified disparities can be implemented.
Assuntos
Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hospitais Especializados/organização & administração , Colaboração Intersetorial , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/terapia , Florida , Fidelidade a Diretrizes , Pesquisas sobre Atenção à Saúde , Disparidades em Assistência à Saúde/tendências , Hospitais Especializados/tendências , Humanos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Porto Rico , Melhoria de Qualidade/organização & administração , Melhoria de Qualidade/tendências , Sistema de Registros , Acidente Vascular Cerebral/epidemiologiaAssuntos
Países em Desenvolvimento , Neurocirurgia/tendências , Comportamento Cooperativo , Currículo/tendências , Difusão de Inovações , Educação de Pós-Graduação em Medicina/tendências , Honorários Médicos/tendências , Previsões , Medicina Geral/educação , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/tendências , Hospitais Especializados/economia , Hospitais Especializados/tendências , Humanos , Comunicação Interdisciplinar , América Latina , Neurocirurgia/economia , Neurocirurgia/educação , Qualidade da Assistência à Saúde/tendências , Sociedades Médicas/tendências , Fatores SocioeconômicosAssuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Centros de Reabilitação/tendências , Centros de Reabilitação , Reforma dos Serviços de Saúde , Instalações de Saúde , Hospitais Especializados/tendências , Serviço Hospitalar de Fisioterapia/tendências , Serviço Hospitalar de Fisioterapia/estatística & dados numéricos , Previdência Social , Costa Rica , Pessoas com DeficiênciaAssuntos
Hospitais Especializados , Hospitais Especializados , Hospitais Especializados/organização & administração , Hospitais Especializados/normas , Hospitais Especializados/tendências , Hospitais Especializados/estatística & dados numéricos , Pneumologia , Pneumologia/instrumentação , Pneumologia/legislação & jurisprudência , Pneumologia/normasAssuntos
Humanos , Hospitais Especializados , Hospitais Especializados/história , Hospitais Especializados/normas , Hospitais Especializados/tendências , Hospitais Especializados/estatística & dados numéricos , Pneumologia , Pneumologia/história , Pneumologia/legislação & jurisprudência , Pneumologia/organização & administração , Pneumologia/normas , Pneumologia/tendênciasAssuntos
Hospitais Especializados , Hospitais Especializados/história , Hospitais Especializados/legislação & jurisprudência , Hospitais Especializados , Hospitais Especializados/organização & administração , Hospitais Especializados/normas , Hospitais Especializados/tendências , Hospitais Especializados/estatística & dados numéricos , Pneumologia , Pneumologia/legislação & jurisprudência , Pneumologia , Pneumologia/organização & administração , Pneumologia/normas , Pneumologia/estatística & dados numéricos , Pneumologia/tendênciasRESUMO
The Instituto Nacional de Enfermedades Neoplásicas was established by the government of Peru as an institution for the treatment of cancer patients in 1939; it has existed under different names until the current title was adopted in 1952. Between 1980 and 1987, attendance increased by 70% and a new and larger facility came into use at the beginning of 1988. This institution has national responsibility for cancer prevention, detection, treatment, education, and research and is currently organizing satellite treatment centers in other parts of the country. More than 80% of the medical staff has been trained in the institute's residency program, the majority of whom received additional postgraduate training in the United States and Europe; 90% of the medical staff hold academic appointments in medical schools. In 1952 the Institute became the first hospital in Peru with a formal postgraduate training system for various medical disciplines, including surgical oncology and medical oncology. So far we have trained about 500 surgical oncologists who are working in all parts of Peru. The Maes-Heller Institute for Cancer Research forms part of the National Cancer Institute complex. Research will be directed mainly toward new diagnostic and therapeutic approaches, multidisciplinary tumor therapy, and large-scale cancer screening. The Institute focuses on early detection and prevention of cancer and is active in breast self-examination education and antismoking campaigns. It enjoys community support evidenced in the women's organization, Adainen, involved in fundraising; 460 women volunteers give at least 4 hr service per week to the Institute. The Institute has grown from 9,000 patients seen per year in its early days to 215,000 attendances in 1986.