BACKGROUND: With a shortage of intensive care unit (ICU) beds and rising healthcare costs in resource-limited settings, clinicians need to appropriately triage admissions into ICU to avoid wasteful expenditure and unnecessary bed utilisation OBJECTIVE: To assess the nature, appropriateness and outcome of referrals to a tertiary centre ICU METHODS: A retrospective review of ICU consults from September 2016 to February 2017 at King Edward VIII Hospital was performed. The study was approved by the University of KwaZulu-Natal Biomedical Research Ethics Committee (BE291/17). Data pertaining to patients' demographics, referring doctor, diagnosis, comorbidities as well as biochemical and haemodynamic parameters were extracted. This information was then cross-referenced to the outcome of the ICU consultation. Data were descriptively analysed RESULTS: Five hundred consultations were reviewed over a 6-month period; 52.2% of patients were male and the mean age was 44 years. Junior medical officers referred 164 (32.8%) of the consultations. Although specialist supervision was available in 459 cases, it was only utilised in 339 (73.9%) of these cases. Most referrals were from tertiary (46.8%) or regional (30.4%) hospitals; however, direct referrals from district hospitals and clinics accounted for 20.4% and 1.4% of consultations, respectively. The appropriate referral pathway was not followed in 81 (16.2%) consultations. Forty-five percent of consults were accepted; however, 9.3% of these patients died before arrival in ICU. A total of 151 (30.2%) patients were refused ICU admission, with the majority (57%) of these owing to futility. Patients were unstable at the time of consult in 53.2% of referrals and 34.4% of consults had missing data CONCLUSION: Critically ill patients are often referred by junior doctors without senior consultation, and directly from low-level healthcare facilities. A large proportion of ICU referrals are deemed futile and, of the patients accepted for admission, almost 1 in 10 dies prior to ICU admission. More emphasis needs to be placed on the training of doctors to appropriately triage and manage critically ill patients and ensure appropriate ICU referral and optimising of patient outcomes

Abstract: The present research study aims to assess spatial accessibility conditions in relation to health care services, based on indicators of the Organization for Economic Cooperation and Development (OECD). Geospatial location of health care services available is obtained for the Central West Metropolitan Area (AMCO, in Spanish) in Colombia, which includes the city of Pereira, capital of the State of Risaralda, and its neighboring municipalities of Dosquebradas and La Virginia. The assessment is performed by applying the enhanced two-step floating catchment area (E2SFCA) method. The results show that most health services are concentrated in Pereira, which has 86.90% of all beds available in the State of Risaralda-only three healthcare service providers are not located in this city. It is concluded that the number of average beds and medics per one thousand inhabitants should be calculated by considering both population distribution and the location of health care services.

Resumen: La presente investigación tiene como objetivo analizar las condiciones de accesibilidad espacial en relación con los servicios de atención médica, basados en los indicadores de la Organización para la Cooperación y el Desarrollo Económicos (OCDE). Se realiza una localización geoespacial de los servicios de atención médica del Área Metropolitana Centro Occidente (AMCO) en Colombia, incluye la ciudad de Pereira, capital del Departamento de Risaralda, y los municipios de Dosquebradas y La Virginia. El análisis se hace mediante el método mejorado de área de captación flotante de dos pasos (E2SFCA, en inglés). Los resultados muestran que los servicios de atención médica están concentrados en Pereira, con el 86.90% de las camas del Departamento de Risaralda; únicamente tres de los servicios de atención médica no están situados en esta ciudad. Se concluye que el promedio de camas y de médicos por cada mil habitantes debe ser calculado considerando la distribución de la población y la localización de los servicios de atención médica.

BACKGROUND: Neonatal deaths (NNDs) are a global public health challenge, predominantly affecting low- and middle-income countries. The causes of most NNDs are preventable. Therefore, this study reviewed perinatal clinical audit data at Kgapane Hospital over a 4-year period with a special focus on the factors associated with NNDs METHODS: File audits were performed for all NNDs occurring at Kgapane Hospital and its catchment area from 2018 to 2021. The data from these audits were analysed to identify factors associated with NNDs RESULTS: The NND rate for the study period was 12.6/1000 live births. In this study (n = 236), 90% of the deaths could be associated with four factors, namely prematurity (44%); intrapartum complications (19%) including asphyxia, meconium aspiration and breech deliveries; neonatal infections (16%) of which human immunodeficiency virus (HIV) positivity was the most prevalent; and foetal congenital abnormalities (11%). The modifiable factors included inadequate intrapartum foetal monitoring; delays in management interventions; instances where no attempts were made to refer patients for specialised care, or where no beds were available at the next level of care; patient-related factors; and inadequate adherence to management protocols, such as for the management of prematurity and HIV CONCLUSION: Understanding factors associated with NNDs can guide health worker training and improvement strategies to reduce this heart-breaking complication of pregnancy CONTRIBUTION: Family physicians working in rural hospitals are also responsible for newborn care. Understanding the factors associated with NNDs will guide them to focus training and develop improvement strategies to reduce these preventable deaths

Abstract This article assesses the role played by the information design of the interactive visualization of the press in the spread of the COVID 19 pandemic, taking as a case study the newspaper The New York Times, a world reference in scientific journalism that has played a fundamental role as an informant on this health crisis. To do this, a content analysis method was integrated into different interactive journalistic visualizations (N=103) that the newspaper published from December 2019 (beginning of the pandemic) to December 2020 (beginning of the first acquisitions of vaccines), and were coded to determine, identify and examine detailed patterns in three axes of study: I) the informative approach; 2) visual and multimedia resources; and 3) type of interaction. The results indicate that the design of interactive press information in the dissemination of the COVID 19 pandemic focuses mainly on data journalism through visualizations with non-figurative and hybrid graphical interfaces with access to geo-located databases that offer the possibility of exploring the visualization of data in an innovative way and in real time on the total number of contagion cases per day (hospitalized, percentage of bed occupancy and number of beds available in hospitals), cases per capita and deaths from coronavirus by state and counties in the United States, as well as other countries. These practices are associated with interoperability activities and globally linked data, which provide the opportunity to generate greater knowledge about the behavior of this pandemic in the world and allow more effective management of risks to human health.

Resumen Este artículo valora el papel que desempeña el diseño de información en la visualización interactiva de prensa en la cobertura de la pandemia COVID-19, tomando como caso de estudio el periódico The New York Times, un referente mundial del periodismo científico que ha desempeñado un papel fundamental en informar acerca de esta crisis sanitaria. Se realizó un análisis de contenido para distintas visualizaciones periodísticas interactivas (N = 103), que el diario publicó a partir del mes de diciembre de 2019 (inicio de la pandemia) a diciembre de 2020 (inicio de las primeras adquisiciones de vacunas). Estas fueron codificadas para determinar, identificar y examinar patrones detallados en tres ejes de estudio: 1) el planteamiento informativo; 2) recursos visuales y multimedia; y 3) tipo de interacción. Los resultados indican que el diseño de información interactiva de prensa usado para la difusión de la pandemia COVID-19, se centra en un periodismo de datos que utiliza visualizaciones con interfaces gráficas no figurativas e híbridas, con acceso a bases de datos geolocalizadas que ofrecen la posibilidad de exploración de los datos de forma innovadora y en tiempo real sobre el total de muertes y casos de contagios por día (hospitalizados, porcentaje de ocupación de camas y número de camas disponibles en hospitales) y casos per cápita por coronavirus, pudiendo desagregarse por estado y condados en Estados Unidos, además de visibilizar a otros países. Estas prácticas se encuentran asociadas con actividades de interoperabilidad y datos que se hallan enlazados a nivel global y que brindan la oportunidad de generar un mayor conocimiento sobre el comportamiento de esta pandemia en el mundo, a la vez que permiten un manejo más efectivo de los riesgos para la salud humana.

Resumo Introdujo: os sistemas de saúde foram desafiados a desenvolver estratégias organizacionais para a prestacao de cuidados cirúrgicos. Objetivo: apresentar as estratégias dos servidos de saúde no que se refere as práticas de cuidados cirúrgicos em tempos de pandemia de COVID-19. Materiais e métodos: revisao integrativa, desenvolvida em seis etapas, cuja busca dos artigos ocorreu na Biblioteca Virtual de Saúde, SciELO, PubMed e ScienceDirect. Os descritores controlados em saúde adotados foram “Centros Cirúrgicos” e "Infeccóes por Coronavirus” de acordo com os sistemas DeCS e MeSH Terms. Foram selecionados 60 artigos de 405 estudos encontrados. Resultados: as principais estratégias utilizadas pelos servidos de saúde foram: a suspensao e adiamento de cirurgias eletivas durante as ondas de contágio da doenca; e a triagem cuidadosa dos pacientes para COVID-19 antes e após intervencóes cirúrgicas. Discussáo: a suspensao e o adiamento de cirurgias eletivas devem ser avaliados com cautela pela equipe de saúde, de forma individualizada, para cada paciente, visto que situacóes clinicas nao urgentes podem agravar ao longo do tempo, aumentando as chances de morbimortalidade desses pacientes. Conclusáo: a triagem dos pacientes e dos profissionais da saúde para COVID-19 sao estratégias importantes para evitar a contaminacao desses sujeitos. A suspensao e o adiamento de cirurgias eletivas, durante as ondas de contágio por COVID-19, sao recomendados para aumentar a capacidade de leitos disponiveis para pacientes graves hospitalizados por essa doenca. Essa recomendacao também auxilia no remanejamento de profissionais desse setor para as unidades com a demanda de cuidados de saúde mais elevada.

Abstract Introduction: Health systems were challenged to develop organizational strategies for the delivery of surgical care. Objective: to present the strategies of health services with regard to surgical care practices in times of the COVID-19 pandemic. Materials and methods: An integrative review was conducted following six stages; the search for articles was performed using the Virtual Health Library, SciELO, PubMed, and ScienceDirect. The science descriptors adopted were “Surgicenters” and “Coronavirus Infections,” according to the DeCS-MeSH terms system. We selected 60 articles from 405 studies found. Results: The main strategies used by the health services were to suspend and postpone elective surgeries during waves of disease transmission and careful screening of patients with COVID-19 before and after surgery. Discussion: The suspension and postponement of elective surgeries should be carefully evaluated by the health team, individually for each patient since non-urgent clinical situations may worsen over time, increasing the chances of morbidity and mortality in these patients. Conclusion: screening patients and health professionals for COVID-19, according to the reality of surgical units, centers or outpatient clinics, is an important strategy to avoid contamination of these subjects. The suspension and postponement of elective surgeries, during the waves of contagion by COVID-19, is recommended to increase the capacity of beds available for critically ill patients hospitalized for this disease. This recommendation also helps in the reassignment of professionals in this sector to the units with the highest demand for health care.

Resumen: Introducción: los sistemas de salud fueron desafiados a desarrollar estrategias organizacionales para la prestación de atención quirúrgica. Objetivo: presentar las estrategias de los servicios de salud en relación a las prácticas de atención quirúrgica en tiempos de la pandemia por COVID-19. Materiales y métodos: Revisión integradora, desarrollada en seis etapas, cuya búsqueda de artículos se realizó en la Biblioteca Virtual en Salud, SciELO, PubMed y ScienceDirect. Los descriptores de salud adoptados fueron “Centros Quirúrgicos” e “Infecciones por Coronavirus”, según los sistemas DeCS y MeSH Terms. Seleccionamos 60 artículos de 405 estudios encontrados. Resultados: Las principales estrategias utilizadas por los servicios de salud fueron: la suspensión y postergación de cirugías electivas durante las oleadas de contagio de la enfermedad; y la detección cuidadosa de pacientes para COVID-19 antes y después de las intervenciones quirúrgicas. Discusión: La suspensión y postergación de cirugías electivas debe ser cuidadosamente evaluada por el equipo de salud, ya que situaciones clínicas no urgentes pueden empeorar con el tiempo, aumentando las posibilidades de morbilidad y mortalidad en esos pacientes. Conclusión: El triaje de dos pacientes y dos profesionales de la salud para COVID-19 son estrategias importantes para evitar la contaminación de estos sujetos. Se recomienda la suspensión y postergación de cirugías electivas, durante las olas de contagio por COVID-19, para aumentar la capacidad de camas disponibles para pacientes críticos hospitalizados por esta enfermedad. Esta recomendación también ayuda en la reasignación de profesionales de este sector a las unidades con mayor demanda de atención en salud.

RESUMO Este artigo propõe um sistema térmico de higienização e secagem de lodo de esgoto em escala plena, alimentado por biogás e energia solar, para uma estação de tratamento de esgoto de pequeno porte. Para tal, realizou-se caracterização da estação de tratamento de esgoto investigada, determinando-se volumes mensais médios de lodo, biogás e metano disponíveis. Na sequência, a partir de experimentos em escala reduzida, avaliou-se o desempenho de duas diferentes configurações do referido sistema, com piso radiante metálico e em concreto. Três campanhas experimentais com diferentes cargas de lodo foram realizadas, variando-se teor de sólidos totais iniciais do lodo (5 e 40%) e espessura do material depositado sobre os pisos radiantes (10 e 20 cm). Os resultados obtidos subsidiaram a escolha da configuração e da carga de lodo mais favoráveis para a proposição em questão, possibilitando pré-dimensionamento do sistema para o tratamento de cerca de 211 m³ mês-1 de lodo, com 5% de sólidos totais. Assim, devem ser adaptados dois pisos metálicos radiantes com 50 m2, os quais devem ser carregados com lodo em camada de 10 cm, após o seu desaguamento prévio em leitos de secagem (40% sólidos totais). As temperaturas atingidas possibilitaram higienização do material, bem como elevação do teor de sólidos totais até 75%. Como a energia solar é utilizada, o consumo médio estimado de metano é de 11.363,19 Nm³ mês-1, volume disponível na estação de tratamento de esgoto e suficiente para o processamento de todo o lodo nela gerado ao longo de três ciclos mensais com nove dias de duração.

ABSTRACT This paper proposed a full-scale thermal sanitation and drying system for sewage sludge, powered by biogas and solar energy, from a small anaerobic sewage treatment plant. For that, the characterization of the investigated sewage treatment plant was carried out, determining the average monthly volumes of sludge, biogas, and methane available. Then, from small-scale experiments, the performance of two different configurations of the referred system was evaluated, with metallic and concrete underfloor heating. Three experimental campaigns with different sludge loads were carried out, varying the initial total solids content of the sludge (5 and 40%) and the thickness of the material deposited on the radiant floors (10 and 20 cm). The results obtained subsidized the choice of the configuration and the sludge load considered most favorable for the proposition in question, allowing the pre-dimensioning of the system for the treatment of about 211 m³ month-1 of sludge, with 5% total solids. Thus, two radiant metal floors with 50 m2 must be adapted, which must be loaded with sludge in a 10 cm layer, after their previous dewatering in drying beds (40% total solids). The temperatures reached made it possible to sanitize the material, as well as to increase the total solids content up to 75%. As solar energy is used, the estimated average consumption of methane is 11.363,19 Nm³ month-1, a volume available at the sewage treatment plant and sufficient to process all the sludge generated there over 3 monthly cycles lasting 9 days.

Resumo Objetivo Avaliar os indicadores hospitalares e suas repercussões, antes e após a implantação do Núcleo Interno de Regulação, no número de internações mensais em hospital universitário público. Método Pesquisa avaliativa, do tipo Estudo de Caso desenvolvida em hospital universitário público. Foram mensurados 28 indicadores relacionados à estrutura, produção, produtividade e qualidade, que integram o referencial de Benchmarking interno. Os dados foram analisados por estatística descritiva e regressão múltipla para identificar os fatores independentes e associados ao número de internações mensais com intervalos de confiança de 95%. Resultados A implantação do Núcleo aumentou significativamente (p<0,001) o número de altas, o fator de utilização e índice de renovação dos leitos, internação de urgência, porcentagem de ocupação dos leitos, procedimentos cirúrgicos realizados e média de paciente-dia (p=0,027). Houve redução (p<0,001) no número de atendimentos no pronto socorro médico, obstétrico e ortopédico, nas taxas de infecção hospitalar e de mortalidade infantil, bem como na diminuição média de permanência de 0,81/dia, aproximadamente um dia a menos de internação por paciente, ou um ganho de 40 leitos disponíveis ao mês. Conclusão Embora o número de leitos disponíveis tenha sido menor no período pós-implantação, o intervalo de substituição de leitos reduziu, representando o aumento de mais 40 leitos ao mês devido à diminuição do tempo de permanência dos pacientes na instituição.

Abstract Objective To evaluate the hospital indicators and their repercussions on the number of monthly admissions to a public university hospital, before and after implementing the Internal Regulation Center. Method An evaluative research study, of the Case Study type, developed in a public university hospital. A total of 28 indicators related to structure, production, productivity and quality were measured, which are part of internal Benchmarking. The data were analyzed by means of descriptive statistics and multiple regression to identify the independent factors and those associated with the number of monthly hospitalizations with 95% confidence intervals. Results Implementation of the Center significantly increased (p<0.001) the number of discharges, the bed utilization factor and the bed renewal rate, emergency hospitalization, bed occupancy percentage, surgical procedures performed and the patient-day mean value (p=0.027). There was a reduction (p<0.001) in the number of visits to the medical, obstetric and orthopedic emergency room, in the rates of in-hospital infection and infant mortality, as well as a mean reduction of 0.81/day, approximately one day less of hospitalization per patient, or a gain of 40 available beds per month. Conclusion Although the number of available beds was lower in the post-implementation period, the bed replacement interval was reduced, representing an increase of 40 more beds per month due to the reduction in the patients’ length of stay in the institution.

Resumen Objetivo Evaluar los indicadores hospitalarios y sus repercusiones, antes y después de la implantación del Centro Interno de Regulación, sobre el número de internaciones mensuales en un hospital universitario público. Método Investigación evaluativa, del tipo Estudio de Caso, desarrollada en un hospital universitario público. Se midieron 28 indicadores relacionados con la estructura, producción, productividad y calidad, que forman parte del Benchmarking interno. Los datos fueron analizados por estadística descriptiva y regresión múltiple para identificar factores independientes y asociados con el número de hospitalizaciones mensuales con un intervalo de confianza del 95%. Resultados La implantación del Centro incrementó significativamente (p<0,001) el número de altas, el factor de utilización y tasa de renovación de camas, la hospitalización de urgencia, el porcentaje de ocupación de camas, los procedimientos quirúrgicos realizados y el promedio de pacientes/día (p =0,027). Se registró una reducción (p<0,001) en el número de las consultas de emergencias médicas, obstétricas y ortopédicas, en las tasas de infección hospitalaria y mortalidad infantil, además de una disminución promedio de la estancia del 0,81/día, aproximadamente un día menos de hospitalización por paciente, o 40 camas disponibles más mes. Conclusión Aunque el número de camas disponibles fue menor en el período posterior a la implantación, el intervalo de sustitución de camas se redujo, lo que representó un aumento de 40 camas más por mes debido a la disminución de la estancia de los pacientes en la institución.

BACKGROUND: Globally there is increasing awareness of the need for end-of-life care and palliative care in hospitalised patients who are in their final year of life. Limited data are available on palliative care requirements in low- and middle-income countries, hindering the design and implementation of effective policies and health services for these patientsOBJECTIVES: To determine the proportion of patients who die within 1 year of their date of admission to public hospitals in South Africa (SA), as a proxy for palliative care need in SAMETHODS: This was a retrospective cohort study using record linkage of admission and mortality data. The setting was 46 acute-care public hospitals in Western Cape Province, SARESULTS: Of 10 761 patients (median (interquartile range (IQR)) age 44 (31 - 60) years) admitted to the 46 hospitals over a 2-week period in March 2012, 1 570 (14.6%) died within 1 year, the majority within the first 3 months. Mortality rose steeply with age. The median (IQR) age of death was 57.5 (45 - 70) years. A greater proportion of patients admitted to medical beds died within 1 year (21.3%) compared with those admitted to surgical beds (7.7%CONCLUSIONS: Despite a median age <60 years at admission, a substantial percentage of patients admitted to public sector hospitals in SA are in the final year of their lives. This finding should be seen in the context of SAs high communicable and non-communicable disease burden and resource-limited public health system, and highlights the need for policy development, planning and implementation of end-of-life and palliative care strategies for hospitals and patients

BACKGROUND. There are limited data about the coronavirus disease-19 (COVID-19)-related organisational responses and the challenges of expanding a critical care service in a resource-limited setting. OBJECTIVES. To describe the ICU organisational response to the pandemic and the main outcomes of the intensive care service of a large state teaching hospital in South Africa. METHODS. Data were extracted from administrative records and a prospective patient database with ethical approval. An ICU expansion plan was developed, and resource constraints identified. A triage tool was distributed to referring wards and hospitals. Intensive care was reserved for patients who required invasive mechanical ventilation (IMV). The total number of ICU beds was increased from 25 to 54 at peak periods, with additional non-COVID ICU capacity required during the second wave. The availability of nursing staff was the main factor limiting expansion. A ward-based high flow nasal oxygen (HFNO) service reduced the need for ICU admission of patients who failed conventional oxygen therapy. A team was established to intubate and transfer patients requiring ICU admission but was only available for the first wave. RESULTS. We admitted 461 COVID-19 patients to the ICU over a 13-month period from 5 April 2020 to 5 May 2021 spanning two waves of admissions. The median age was 50 years and duration of ICU stay was 9 days. More than a third of the patients (35%; n=161) survived to hospital discharge. CONCLUSIONS. Pre-planning, leadership, teamwork, flexibility and good communication were essential elements for an effective response. A shortage of nurses was the main constraint on ICU expansion. HFNO may have reduced the requirement for ICU admission, but patients intubated after failing HFNO had a poor prognosis.

Resumo: Resumo: Os enfermeiros desempenham um papel importante no gerenciamento em tempo real dos leitos hospitalares disponíveis, de forma a promover seu uso eficiente. Objetivo: analisar a percepção dos enfermeiros sobre o processo de trabalho na gestão de leitos. Método: estudo descritivo, exploratório, de abordagem qualitativa. Participaram 17 enfermeiros que atuam na gestão de leitos e na assistência, identificados por meio da técnica de Bola de Neve em Redes Sociais Virtuais, com envio eletrônico do instrumento de coleta de dados, no período de 22 de agosto a 21 de outubro de 2020. A análise dos dados foi feita conforme Bardin: pré-análise, exploração do material e tratamento dos resultados, inferência e interpretação. Resultados: foi possível encontrar três núcleos de sentido que foram divididos em três categorias:1- perfil da equipe da Gestão de Leitos segundo a qualificação e experiência profissional; 2- atuação do enfermeiro na Gestão de Leitos; e 3 - dificuldades e facilidades nos processos de trabalho da Gestão de Leitos. Conclusão: foram observadas potencialidades e dificuldades na atuação do enfermeiro na gestão de leitos, configurando-se como uma área em expansão que requer regulamentação e aperfeiçoamento.

Abstract: nurses play an important role in the real-time management of available hospital beds in order to promote their efficient use. Objective: to analyze nurses' perception of the work process in bed management. Method: a descriptive, exploratory study with a qualitative approach. Seventeen nurses who work in bed management and assistance participated, identified through the Snowball technique in Virtual Social Networks, with electronic sending of the data collection instrument, from August 22 to October 21, 2020. Data analysis carried out according to Bardin: pre-analysis, material exploration and treatment of results, inference, and interpretation. Results: it was possible to find three cores of meaning that were divided into three categories:1- profile of the Bed Management team according to qualification and professional experience; 2- performance of nurses in Bed Management; and 3 - difficulties and facilities in the work processes of Bed Management. Conclusion: potentials and difficulties in the nurse's performance in bed management were observed, taking shape in an expanding area that requires regulation and improvement.

BACKGROUND: In recent years there have been significant advances in the management of stroke. In particular, reperfusion therapies have been shown to confer significant benefit, with the possibility of reversing ischaemic stroke or reducing disability when administered to suitable patients. However, these therapies also carry significant risk, including death. The South African (SA) and other international guidelines for stroke care provide recommendations to optimise benefit and reduce risk of these novel treatments. Failure to adhere to recommended guidelines can lead to increased preventable morbidity and mortality in such patientsOBJECTIVES: To describe the acute and post-acute ischaemic stroke services offered to patients in level 1, 2 and 3 hospitals in the Cape Metro Health District, determine levels of adherence to the SA stroke guideline, and identify barriers to optimal stroke patient careMETHODS: This study in five level 1, one level 2 and two level 3 public hospitals involved semi-structured interviewer-administered questionnaires and reviews of ischaemic stroke patient discharge summaries, hospital staffing, stroke protocols, diagnostic investigations available and stroke education for patients and their caregivers. The findings were then compared with recommendations in the national guidelineRESULTS: Twenty-eight participants (18 doctors, 10 nurses) from the general medical wards, stroke units and emergency units of eight hospitals were invited to participate in interviews. Most level 1 and 2 hospitals experienced difficulties transferring patients to higher levels of care. There was also limited access to stroke management protocols, inadequate stroke education among health professionals, pre- and in-hospital delays in patients receiving medical attention, and limited access to diagnostic investigations. As only a total of 12 stroke unit beds were available at the two level 3 hospitals, the majority of ischaemic stroke patients were admitted to the general medical wards of level 1, 2 and 3 hospitals. The level of care at all these facilities was not homogeneousCONCLUSIONS: The two stroke units at the level 3 hospitals adhered most closely to the recommended SA stroke guideline. Elsewhere, ischaemic stroke care varied widely across general medical wards at all hospital levels. Adherence to the guideline was influenced by factors such as limited access to diagnostic investigations, patient delays in receiving medical attention, and shortages of staff. Monitoring systems for continuous evaluation of the quality of acute and post-acute stroke services are needed. The shortfall in compliance with recommended stroke treatment guidelines could lead to worse outcomes and exposure to litigation

RESUMO Objetivos: analisar as evidências científicas disponíveis na literatura sobre indicadores hospitalares após a implantação de estratégias de regulação de leitos. Métodos: revisão integrativa realizada com estudos disponíveis em cinco bases de dados e no banco de referências do Núcleo de Estudo e Pesquisa em Gestão de Serviços de Enfermagem em outubro de 2019. Utilizaram-se como critérios de inclusão artigos sobre gestão de leitos hospitalares, disponíveis na íntegra nos idiomas inglês, espanhol ou português, sem delimitação temporal. Resultados: encontraram-se 1.118 artigos elegíveis, desses, 37 apresentavam-se duplicados. Dentre 1.081 estudos pré-selecionados, 112 estudos eram elegíveis, sendo incluídos 11 artigos. Seis estudos abordavam os serviços de emergência. Três abordavam os indicadores hospitalares em geral; outro tinha como foco uma enfermaria psiquiátrica; um analisou os indicadores de dois hospitais administrados distintamente. Conclusões: o foco dos estudos concentra-se nos serviços de emergência, demonstrando a importância da organização desses serviços para as instituições de saúde.

ABSTRACT Objectives: to analyze the scientific evidence available in literature on hospital indicators after implementation of bed regulation strategies. Methods: this is an integrative review conducted with studies available in five databases and in the reference database of the Center for Study and Research in Nursing Services Management in October 2019. Articles on hospital bed management, available in full in English, Spanish or Portuguese, without temporal delimitation were included. Results: 1,118 eligible articles were found, of which 37 were duplicated. Among 1,081 pre-selected studies, 112 studies were eligible and 11 articles were included. Six studies addressed the emergency services. Three addressed hospital indicators in general, another focused on a psychiatric ward and one analyzed the indicators of two hospitals administered differently. Conclusions: the studies focused on emergency services, demonstrating the importance of organizing these services for health institutions.

RESUMEN Objetivos: analizar la evidencia científica disponible en la literatura sobre indicadores hospitalarios tras la implementación de estrategias de regulación de camas. Métodos: revisión integradora realizada con estudios disponibles en cinco bases de datos y en la base de datos de referencia del Centro de Estudios e Investigaciones en Gestión de Servicios de Enfermería en octubre de 2019. Los criterios de inclusión fueron artículos sobre manejo de camas hospitalarias, disponibles íntegramente en inglés, español o portugués, sin límite de tiempo. Resultados: se encontraron 1.118 artículos elegibles, de los cuales 37 fueron duplicados. Entre 1.081 estudios preseleccionados, 112 estudios fueron elegibles, incluidos 11 artículos. Seis estudios abordaron los servicios de emergencia. Tres indicadores hospitalarios abordados en general; otro centrado en un pabellón psiquiátrico; uno analizó los indicadores de dos hospitales administrados por separado. Conclusiones: el enfoque de los estudios está en los servicios de emergencia, lo que demuestra la importancia de organizar estos servicios para las instituciones de salud.

RESUMO Objetivo Analisar a pandemia da COVID-19 no Brasil, um país de dimensões continentais, considerado uma economia emergente, mas com inúmeras diferenças regionais, abordando a disponibilidade de recursos humanos, especialmente para unidades de terapia intensiva. Métodos Foi acessado o banco de dados do Cadastro Nacional de Estabelecimentos de Saúde. Os profissionais de saúde que atuavam nos cuidados para COVID-19 foram georreferenciados. O número de profissionais foi correlacionado com os parâmetros utilizados pela Organização Mundial da Saúde. De acordo com a Associação de Medicina Intensiva Brasileira, correlacionaram-se os dados de leitos de terapia intensiva adulta em cada unidade federativa com o número de profissionais para cada dez leitos de terapia intensiva. Os números de profissionais, leitos e casos foram, então, organizados por unidade federativa. Resultados O número de médicos por 100 mil habitantes seguiu as recomendações da Organização Mundial da Saúde; mas não o número de enfermeiras. O número de intensivistas, enfermeiros, técnicos de enfermagem especializados em terapia intensiva e fisioterapeutas respiratórios, necessário a cada dez leitos de terapia intensiva, não foi suficiente para nenhuma dessas categorias profissionais. Uma equipe completa desses especialistas esteve disponível para 10% dos leitos de terapia intensiva do Brasil. Conclusão Há carência de profissionais para unidade de terapia intensiva, como demonstrado no Brasil. Os recursos físicos da terapia intensiva, para serem usados de forma eficiente, precisam de recursos humanos extremamente especializados; portanto, o planejamento de recursos humanos é tão crucial quanto o planejamento de recursos físicos e estruturais.

ABSTRACT Objective To analyze the COVID-19 pandemic in Brazil, a continental-sized country, considered as an emerging economy but with several regional nuances, focusing on the availability of human resources, especially for intensive care units. Methods The database of the National Registry of Health Facilities was accessed. Healthcare professionals in the care of COVID-19 were georeferenced. We correlated the number of professionals with the parameters used by the World Health Organization. According to the Brazilian Intensive Care Medicine Association, we correlated the data for adult intensive care unit beds in each state with the number of professionals for each ten intensive care unit beds. The number of professionals, beds, and cases were then organized by state. Results The number of physicians per 100 thousand inhabitants followed the World Health Organization recommendations; however, the number of nurses did not. The number of intensivists, registered nurses, nurse technicians specialized in intensive care, and respiratory therapists, necessary for every ten intensive care beds, was not enough for any of these professional categories. A complete team of critical care specialists was available for 10% of intensive care unit beds in Brazil. Conclusion There is a shortage of professionals for intensive care unit, as we demonstrated for Brazil. Intensive care physical resources to be efficiently used require extremely specialized human resources; therefore, planning human resources is just as crucial as planning physical and structural resources.

Resumo Objetivo sintetizar as evidências disponíveis na literatura sobre os tipos de superfícies de compressão utilizadas na RCP e analisar quais características das superfícies de compressão têm impacto na eficácia da compressão torácica durante a RCP. Método revisão integrativa da literatura, cujos critérios de seleção e inclusão foram: artigos completos, em inglês, português ou espanhol e que respondessem a seguinte questão de pesquisa: “Quais são as características das superfícies de compressão que têm impacto na eficácia das compressões torácicas durante a RCP?”. Realizada entre os meses de junho e julho de 2019. Resultados inclui-se 12 artigos de estudos experimentais, cuja extração de dados revelou 13 tipos diferentes de colchões. Em relação às pranchas, seis tamanhos diferentes foram relatados, com diferentes materiais. Constatou-se influências do tipo de superfície de compressão na força necessária para realizar as compressões torácicas. Conclusão as evidências apontam que colchões de maiores dimensões e com tecnologia para redução de pressão e camas mais largas apresentam impactos negativos na qualidade das compressões torácicas. Implicação para prática o conhecimento sobre a influência do tipo e características das superfícies de apoio na qualidade das compressões torácicas podem subsidiar profissionais na escolha e incorporação de tecnologias no ambiente hospitalar.

Abstract Objective To synthesize the available evidence in the literature on the types of compression surfaces used in CPR and to analyze which characteristics of the compression surfaces impact the effectiveness of chest compression during CPR. Method Integrative literature review, whose selection and inclusion criteria were complete articles, in English, Portuguese or Spanish and that answered the following research question: “What are the characteristics of the compression surfaces that impact the effectiveness of chest compressions during CPR?”. It was carried out between June and July 2019. Results 12 articles from experimental studies were included. 13 different types of mattresses were found. Regarding the boards, six different sizes and many materials were reported. Influences of the type of compression surface on the force required to perform chest compressions were found. Conclusion Evidence points out that larger mattresses with pressure reduction technology and larger beds have negative impacts on the quality of chest compressions. Implication for practice Knowledge about the influence of the type and characteristics of support surfaces on the quality of chest compressions can support professionals in the choice and incorporation of technologies in the hospital environment.

Resumen Objetivo Sintetizar la evidencia disponible en la literatura sobre los tipos de superficies de compresión utilizadas en la RCP y analizar qué características de las superficies de compresión tienen un impacto en la efectividad de la compresión torácica durante la RCP. Método Revisión bibliográfica integradora, cuyos criterios de selección e inclusión fueron: artículos completos, en inglés, portugués o español y que respondieran a la siguiente pregunta de investigación: “¿Cuáles son las características de las superficies de compresión que inciden en la efectividad de las compresiones torácicas durante la RCP?”. Se llevó a cabo entre junio y julio de 2019. Resultados se incluyeron 12 artículos de estudios experimentales, cuya extracción de datos reveló 13 tipos diferentes de colchones. En cuanto a los Tabelaros, se reportaron seis tamaños diferentes, con diferentes materiales. Se encontraron influencias del tipo de superficie de compresión sobre la fuerza requerida para realizar las compresiones torácicas. Conclusión la evidencia señala que los colchones más grandes con tecnología de reducción de presión y las camas más grandes tienen impactos negativos en la calidad de las compresiones torácicas. Implicación para la práctica El conocimiento sobre la influencia del tipo y características de las superficies de apoyo en la calidad de las compresiones torácicas puede ayudar a los profesionales en la elección e incorporación de tecnologías en el ámbito hospitalario.

Abstract The coronavirus pandemic took Mexican society by surprise, however, the health personnel of our country received training in a record time and began the hospital reconversion to have the largest number of beds available to care for the vulnerable and susceptible population. this new form of covid-19. Nursing personnel as the cornerstone of the health system face the challenge of the pandemic with professionalism and humanism focused on caring for the person with a resilient attitude. This study aims to expose the experience of a nurse in the face of the Covid-19 pandemic when contracting the disease.

Resumen La pandemia de coronavirus tomó por sorpresa a la sociedad mexicana, sin embargo, el personal de salud de nuestro país se capacitó en un tiempo récord y comenzó la reconversión hospitalaria para contar con el mayor número de camas disponibles para atender a la población vulnerable y susceptible de presentar esta nueva modalidad de covid-19. El personal de enfermería como piedra angular del sistema de salud afrontó el reto de la pandemia con profesionalismo y humanismo centrado en el cuidado de la persona con una actitud resiliente. Este estudio tiene como objetivo exponer la vivencia de una enfermera ante la pandemia de Covid-19 al contraer la enfermedad.