Kinesiología en las unidades de hospitalización domiciliaria en Chile

Introduction: Home hospitalization was created with the aim of being an alternative to traditional hospitalization, similar in resources and complexity. Among the attentions that can be delivered, is kinesiology. However, there is no specific information on the profile or work of these professionals in these units. Therefore, this work seeks to describe and characterize the work of kinesiologists who work in home hospitalization units in public hospitals in Chile.Materials and Method: Cross-sectional descriptive study carried out by means of a survey of kinesiologists who work in home hospitalization units in public hospitals in Chile between March and August 2019. The Rstudio software was used for the statistical analysis.Results: Of 82 hospitals surveyed, 59 have home hospitalization, of these, 45 have kinesiology. Among the most developed areas in adults are respiratory kinesiology (95.3%), motor kinesiology (93.4%), and neurorehabilitation (90.1%). In pediatrics it is respiratory kinesiology (28.1%). 32% of the units have a coordinator by profession kinesiologist.Conclusions: Kinesiology allows delivering different benefits at home to both adults and children. However, this arises according to the need of each hospital and is not defined at the national level, so it is proposed to move towards guidelines that allow the standardization of the incorporation of this profession to all home hospitalization units.Introducción: La hospitalización domiciliaria nace con el objetivo de ser una alternativa a la hospitalización tradicional, similar en recursos y complejidad. Dentro de las prestaciones que se puede entregar, se encuentra la kinesiología. Sin embargo, no existen información específica sobre el perfil ni el quehacer de estos profesionales en dichas unidades. Por lo que se busca con este trabajo, describir y caracterizar el trabajo de los kinesiólogos/as que se desempeñan en unidades de hospitalización domiciliaria en hospitales públicos de Chile.Materiales y Método: Estudio descriptivo transversal realizado mediante una encuesta a kinesiólogos/as que trabajan en unidades de hospitalización a domicilio en hospitales públicos de Chile. Realizada entre marzo y agosto de 2019. Para el análisis estadístico se utilizó el software Rstudio.Resultados: De 82 hospitales encuestados, 59 cuentan con hospitalización domiciliaria, de estos, 45 cuentan con kinesiología. Dentro de las áreas más desarrolladas en adultos, son la kinesiología respiratoria (95,3%), la kinesiología motora (93,4%), y la neurorrehabilitación (90,1%). En pediatría es la kinesiología respiratoria (28,1%). El 32% de las unidades cuenta con un coordinador/a de profesión kinesiólogo/a.Conclusiones: La kinesiología permite entregar diferentes prestaciones en domicilio tanto a adultos como niños. Sin embargo, esto surge según la necesidad de cada hospital y no está definido a nivel nacional, por lo que se propone avanzar hacia lineamientos que permitan la estandarizar la incorporación de esta profesión a todas las unidades de hospitalización domiciliaria

Rehabilitación domiciliara de pacientes con síndrome post UCI por COVID-19

Objective: In March 2020, the disease caused by the coronavirus SARS-CoV-2 (COVID-19) was declared a pandemic. It was initially estimated that 5% of the population affected by COVID-19 required admission to intensive care units with invasive mechanical ventilation support, and may develop sequelae from hospitalization. The home rehabilitation team proposes the challenge of carrying out a series of evaluations in order to be able to assess rehabilitation in the home environment. Method: Uncontrolled clinical trial of patients from the home hospitalization unit who have suffered from COVID-19 with the use of IMV, between June 2020 and June 2021. 193 patients were admitted, who underwent surgery at the beginning and at the end of the rehabilitation process for a multidisciplinary team at the patient’s home. Results: Prevalence of comorbidities of arterial hypertension and obesity. in the severe form of this disease. Mean difference in all P (Wilcoxon) scores <0.001 between baseline and post-rehabilitation status, presence of greater impairment in upper extremities. Conclusions: Patients with multiple sequelae that require early evaluation and intervention by a multidisciplinary team, home hospitalization being a safe, efficient and effective alternative. The restoration of safe and independent ambulation, the prevention of falls, safe eating, recovery of cognitive-communicative skills, and the empowerment of the family in a home context were achieved.Objetivo: En marzo del año 2020, se declaró pandemia la enfermedad producida por el coronavirus SARS-CoV-2 (COVID 19). Se estimaba inicialmente que el 5% de la población afectada por COVID-19 requeriría ingreso a unidades de cuidados intensivos con soporte de ventilación mecánica invasiva, pudiendo desarrollar secuelas a partir de la hospitalización. El equipo de rehabilitación domiciliaria se propone el desafío de realizar una serie de evaluaciones con la finalidad de poder valorar la rehabilitación en el ámbito domiciliario. Método: Ensayo clínico no controlado de pacientes de la unidad de hospitalización domiciliaria que hayan sufrido COVID-19 con uso de VMI, entre junio 2020 y junio 2021. Ingresaron 193 pacientes, a los cuales se le realizó evaluaciones al inicio y al final del proceso de rehabilitación por un equipo multidisciplinar en el domicilio del paciente. Resultados: Prevalencia de comorbilidades de hipertensión arterial y obesidad. en la forma grave de dicha enfermedad. Diferencia significa en todas las evaluaciones P (Wilcoxon)<0,001 entre el estado inicial y posterior a la rehabilitación, presencia de mayor deterioro en extremidades superiores. Conclusión: Pacientes con múltiples secuelas que requieren de la evaluación e intervención precoz de un equipo multidisciplinario, siendo la hospitalización domiciliaria una alternativa segura, eficiente y eficaz. Se logró el restablecimiento de la deambulación segura e independiente, la prevención de caídas, alimentación segura, recuperación de las destrezas cognitivas-comunicativas, y el empoderamiento de la familia en un contexto domiciliario

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research