Incidence of De Quervain’s Thyroiditis in an Area With High Prevalence of Sars-Cov-2 Infection

Purpose: To evaluate the possible association between Covid-19 infection and subacute thyroiditis. Patients and Methods: We reviewed the medical and imaging records of patients referred to our outpatient setting dedicated to “thyroid emergency” (“bollini verdi”) from April 2020 to October 2020 of our Department. This out-patient clinic is devoted to patients who required an evaluation for severe hypothyroidism, thyrotoxicosis and neck discomfort or pain. All patients with a newly diagnosed subacute thyroiditis were selected. A retrospective collection of the data of all patients receiving a diagnosis of subacute thyroiditis was performed taking into account the same period of time (April-October) starting from 2016.Results: During the COVID-19 outbreak in our Region, (April 2020 to October 2020), 396 patients attended the out-patient emergency clinic. Among them, 10 (2.7%) patients received a diagnosis of subacute thyroiditis. In a single patient, a 44 yr old man, Covid-19 pulmonary infection had been diagnosed seven weeks before the diagnosis of subacute thyroiditis. All of the remaining patients were and still are Covid-19 free as confirmed by phone interview. The percentage of patients who received diagnosis of subacute thyroiditis in the same period starting from 2016 was superimposable (2.9%, 2.9%, 2.6% and 3.0% in 2016, 2017, 2018 and 2019, respectively). Conclusions: Our data do not demonstrate an increase of the incidence of subacute thyroiditis in Brescia areas, a region with the highest prevalence of COVID-19 in Italy during the period of the pandemic outbreak.Trial registration: no. 4631

Severe injury to the brachial neurovascular bundle and muscles due to a horse bite: a case report

Introduction Only a small portion of horse injuries are related to horse bites. In the majority of these occurrences, injuries are minor and self-treated. However, in some cases, the injury may be destructive and limb- and life-threatening. In these instances, the patient requires complex surgery and compound perioperative care. Case report We present the case of a 35-year-old Albanian male farm-worker in whom a horse bite caused an extensive lacero-contusive and avulsive wound to the arm. The wound resulted in injury to the brachial artery, brachial and basilic vein, and biceps and brachialis muscles. Nerve structures and underlying humerus remained intact. The initial management of the severe hemorrhagic shock caused by the bleeding at the site of injury included reconstruction of the brachial artery by interposing saphenous graft and that of the brachial vein by termino-terminal anastomosis. Basilic vein was ligated. The wound was extensively debrided, and after a drain was placed in the wound, biceps and brachialis muscles were reconstructed. The patient received several units of red blood cells and fresh frozen plasma before and after surgery, as well as antibiotic, antitetanic, and antirabies prophylaxes. He had several consecutive necrectomies in the following days. However, due to postoperative sepsis and hemorrhagic shock at time of admission, the patient developed acute renal failure, therefore requiring several hemodialysis sessions. After his general and local condition was stabilized, the patient also underwent several reconstructive surgeries. Conclusion Horse bites of large extent require a multidisciplinary approach. The composition of the team of physicians needed for treatment varies depending on the degree of the injury and eventual complications. In the case of our patient, emergency department physicians, vascular and plastic surgeons, intensive care specialists, nephrologists, and infective care specialists were involved. In different instances, the inclusion of other specialists may be necessary to save and functionalize the limbs of the patient, or save his/her life.

HealthDesk-A One Stop Health Application Using Machine Learning Techniques

HealthDesk is a mobile solution for all health-related queries. The application is for all the users of the healthcare system. It covers all the major domains in the hierarchy. People have now started digitizing in this domain too. People have shown great trust in this. This helps us to provide the best. Despite this, individuals often face problems ordering their medicines online. There are high chances of people taking medications without a prescription. So, this application recommends top medicines that are similar to the one being ordered to avoid drug-drug interactions. In the scenario of patient emergency many applications for patient health monitoring and appointment scheduling have been developed. However, in the wake of an emergency, people tend to blank out or are unaware of nearby emergency services. So, the application has a feature that enables users to search the most nearby doctor and provide the doctor with the user's current location. The user can be provided with first aid immediately so that he doesn't succumb to death. The healthcare system has frequent updates. The doctors must remain at par with the updates. However, doctors find it strenuous to sit by and search. The app provides them with relevant news according to their preferences. Concluding, this app covers the most important stakeholders of the healthcare system.

Implementasi Standar Sumber Daya Manusia dan Pelayanan Minimal Kesehatan di Kota Pekalongan

<table width="614" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td valign="top" width="19"><p><em> </em></p></td><td valign="top" width="396"><p><em>Hospital is a health service facility that must provide services according to applicable service standards. One of the front guards of a hospital is an Emergency Room (IGD) which will provide emergency assistance to every patient. Emergency is a condition that threatens life and disability, so it needs fast, precise, effective and quality action. This can be achieved if the hospital has a standard of service in the Emergency Room. This study aims to determine the implementation of HR standards and minimal services in hospital emergency departments. This research is a qualitative research with a sociological juridical approach. Sociological juridical is legal research that uses secondary data as initial data, which is then followed by primary data or field data. The juridical aspect in this research is the regulation of the minister of health regarding the standards of the Hospital Emergency Room and the sociological aspect is the implementation of the rules in the ministerial decree by the hospital. Sources of legal materials for this research include primary and secondary legal materials. Data collection techniques used are through interviews and literature. The results showed that the Standard Emergency Room is regulated in Law No. 44 of 2009 concerning the Hospital. In particular, the IGD standard has been regulated in the Republic of Indonesia's Minister of Health Kepmenkes No.856 / Menkes / SK / IX / 2009 regarding the standard of Hospital Emergency Room Installation. But in reality in the field, the hospital has not fully implemented these regulations, so the quality of service in the ER is less. Thus the patient's right to get quality services is neglected. According to the Hospital Law Article 29 Paragraph 1 point (a) that "Hospitals are obliged to provide safe, quality, anti-discrimination, and effective health services by prioritizing the interests of patients in accordance with Hospital service standards". The supporting factors for implementation are high human resource motivation and the inhibiting factors, namely the opportunity and cost of further study for nurses, do not yet exist.</em></p><p><strong><em>Keywords:</em></strong></p><p><em>Implementation; Human Resource Standards; Minimum Service Standars; Hospital.</em></p></td></tr></tbody></table>

Just the Facts: Protecting frontline clinicians during the COVID-19 pandemic

There is no patient emergency more important than protecting health care workers during a pandemic.

IMPROVEMENT OF MANAGEMENT OF ORGANIZATIONS IN THE SPHERE OF MEDICAL SERVICES IN THE REPUBLIC OF CRIMEA

The article is devoted to the development of strategic directions for improving the management of organizations in the field of medical services based on the creation of stationary emergency departments in the Republic of Crimea. Within the framework of the national projects «Healthcare», «Demography», «Digital Economy», the need to create in-patient emergency departments in the region has been substantiated, which will allow for the proper provision of medical care to emergency patients, including those in need of short-term treatment, and thereby reduce unnecessary hospitalization of patients who do not require specialized medical care in a hospital setting.

Improving geriatric care and reducing hospitalisations in regional and remote areas: The benefits of telehealth

Introduction The aim of this study was to compare the effectiveness of two geriatrician models of care, the telegeriatric service (TGS) and visiting geriatrician (VG), in regional and remote settings in terms of potential cost-savings to the health system and impact on health service use (HSU). Furthermore, to establish whether longer wait-times for clinic appointments led to increased HSU by study participants. Methods Trends in patient emergency department presentations, hospitalisations and bed-days (HSU) were compared from 18 months before to 12 months after geriatrician appointment for the two services in the Western Australian Midwest region. The relationships between wait times, patient triage level and HSU were modelled. The costs of providing the services were offset against reductions in HSU after appointments. Results The sample comprised consecutive patients using the TGS ( n = 84) and VG service ( n = 124). Patient characteristics were similar, although patients using the VG service had longer wait-times, were triaged as more urgent and demonstrated the highest levels of HSU. Both models were effective with similar rates of reduced HSU following appointments. Increased wait-times and higher patient triage urgency were associated with increased HSU. Discussion Although TGS and VG showed similar reduced rates of HSU, TGS had the capacity to see a higher volume of patients, a broader geographical reach and improved waitlist management. Consequently, TGS was more effective at reducing avoidable hospitalisations and subsequent health deterioration due to shorter wait-times. Whilst face-to-face consultations are recognised as ‘gold standard’ a combination of the two models is most efficient.

Hospital Efficiency in Indonesia with Frontier Analysis

Hospitals are health care institutions for people who provide individual health services. Health services in hospitals are provided for inpatients, outpatients, and emergency unit patient. Facilities in the hospital are also provided for the fulfillment of health services for all patients. However, currently, there are still many doctors who are unbalanced in getting patients. For example, in a hospital, there is a doctor who is a favorite of patients, so they have a large queue of patients. However, on the other hand, some doctors are not favorites so that almost no patients come. This makes the hospital inefficient in terms of labor and time. This study discusses the efficiency of existing resources in hospitals which includes input variables (beds, general practitioners, specialist doctors, nurses, pharmacists, medical technicians, health workers, non-health workers, building area) and output variables (inpatient, outpatient, and patient emergency unit). The method used in this study is Stochastic Frontier Analysis using Frontier 4.1 software. The results indicated that more than 50% of the hospitals are below the efficiency average. This happens for the three types of output.