Adecuación del ingreso y estancia hospitalaria en el Servicio de Neumología del Hospital Daniel A. Carrión – 2005

El gasto sanitario institucional depende en gran medida de los servicios de hospitalización, siendo un factor muy importante la duración de la estancia. El incremento de los costes sanitarios en desmedro de la calidad del servicio es el argumento principal para la revisión de la utilización de los recursos para disminuir la hospitalización inadecuada. El objetivo principal es determinar la adecuación de los ingresos y estancias hospitalarias en el Servicio de Neumología del Hospital Daniel A. Carrión del Callao, e identificar las causas de los mismos, utilizando la versión AEP (Appropriateness Evaluation Protocol). Se revisaron 326 historias clínicas, que egresaron el 2005, con diagnósticos expresados como GRD (Grupos Relacionados por el diagnóstico). Se encontró que 176 (53.9 %) casos eran de genero femenino y 150 (46.1 %) del masculino. La edad media fue de 52.8 años (entre 15-97 años). Resultó que los GRD más frecuentes fueron: 800 (12.3 %), 801 (12.0 %), 87 (12.0 %), 79 (10.7 %), 89 (10.4 %), 101 (6.4 %), 82 (5.2 %), 96 (4.6 %), 97 (3.4 %), 88 (3.1 %). Del total de GRDs, el 10.1 % fueron ingresos inadecuados. La media de la estancia total fue 13.5 días y la mediana fue de 9.0. El 52.1% tuvo estancia inadecuada. El estudio concluye que la media de la estancia hospitalaria en el servicio de neumología sobrepasa el estándar internacional de referencia en 3.6 días. Además, es importante saber que los ingresos inadecuados dependen en gran medida de errores en la indicación médica, siendo la causa más frecuente que el paciente pueda recibir estudios y/o tratamiento vía ambulatoria (14 casos), mientras que las estancias prolongadas dependen mayormente de factores relacionados con el paciente y su entorno familiar (48 casos)

Gestión institucional de la pandemia de COVID-19 en un hospital privado de Lima, Perú

La pandemia del COVID-19 generó un reto institucional que requirió la implementación de medidas que garanticen lacontinuidad de los servicios sanitarios protegiendo a pacientes y cuidadores, utilizando todos los recursos disponibles y coordinaciones entre distintas áreas con metodologías ágiles y trabajo colaborativo. En la presente revisión hacemos una descripción de las medidas tomadas y los resultados de su implementación en un hospital privado de Lima, Perú.The COVID-19 pandemic generated an institutional challenge that required the implementation of measures that guaranteethe continuity of health services, protecting patients and caregivers, using all available resources and coordination between different areas with agile methodologies and collaborative work. In this review, we describe the measures taken and the results of their implementation in a private hospital in Lima, Peru

COVID-19 en pacientes con asma bronquial en Clínica Internacional 2020-2021. Serie de casos

Introducción: La confluencia del asma, una enfermedad respiratoria crónica importante y prevalente, en ocasiones inhabilitante, asociada a COVID-19, la peor de las patologías recientes, de presentación global y aguda, ha generadosituaciones clínicas aún no bien establecidas, reportándose amplia variabilidad desde asintomáticos hasta insuficiencia respiratoria aguda y muerte. Ante la interrogante si el asma representa un factor de riesgo para la severidad de la COVID-19 en nuestra realidad, se obtuvo información en nuestra institución. Objetivo: Describir características clínicas y epidemiológicas de la COVID-19 en una serie de casos de pacientes con asma en Clínica Internacional en 2020-2021.Metodología: Investigación observacional, descriptiva, retrospectiva, de 55 casos con asma atendidos regularmente en consultorio con COVID-19 confirmado. Los datos se obtuvieron bajo encuesta y revisión de la historia clínica y se analizaron mediante SPSS.25, con nivel de significancia del 95%. Resultados: El 60% fueron mujeres y una mediana de 44 años; 72,7 % tuvieron sobrepeso u obesidad y 34,5% presentaron exacerbación asmática; 83,6 % presentó COVID-19 con severidad leve, 9,1 % moderado y 7,3 % severo; reportándose neumonía en 69,1% de los cuales se hospitalizaron el 52,9 %. El 78,2% cursaron con asma bien controlada y COVID-19 leve (p=0.317) El 49,1% con COVID-19 leve tenían asma intermitente o persistente leve (p=0.515). Se encontró asociación entre el IMC y la severidad del COVID-19 (p=0.028). Conclusiones: No se encontró asociación entre la severidad de la Covid-19 y el nivel de control y/o severidad del asma; más sí existió con el IMC, en la población estudiada.Background: The confluence of asthma, an important and prevalent chronic respiratory disease, sometimes disabling, associated with COVID-19, the worst of recent pathologies, of global and acute presentation, has generated clinical situations not yet well established, reporting wide variability since asymptomatic to acute respiratory failure and death. Faced with the question of whether asthma represents a risk factor for the severity of COVID19 in our reality, we obtained information in our institution. Objective: To describe clinical and epidemiological characteristics of COVID-19 in a case series of patients with asthma in Clinic Internacional in 2020-2021. Methods: Observational, descriptive, retrospective research of 55 cases with asthma regularly seen in the medical office with COVID-19 confirmed. Data were obtained from survey and review of the clinical history. We analyzed using SPSS.25, with a significance level of 95%. Results: 60% of patients were women and the median was 44 years old. 72.7% were overweight or obese and 34.5% had asthma exacerbation. 83.6% had mild COVID-19, 9.1% moderate and 7.3% severe; reporting 69.1% pneumonia, 52.9% were hospitalized of them. 78.2% had well-controlled asthma and mild COVID-19 (p=0.317). 49.1% of patients with mild COVID-19 had intermittent or mild persistent asthma (p=0.515). Association was found between BMI and COVID-19 severity (p=0.028). Conclusions: It wasn’t association between the COVID-19’s severity with the control’s level and/or severity of asthma; but it exists with BMI, in the population studied

Risk of COVID-19 after natural infection or vaccinationResearch in context

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health

Risk of COVID-19 after natural infection or vaccinationResearch in context

Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health