Telemedicine is an increasingly used strategy for providing care to patients. The prevention and ... more Telemedicine is an increasingly used strategy for providing care to patients. The prevention and treatment of Upper Respiratory Tract Infections (URTIs) during outbreaks still require new management approaches. We aimed to describe patients' characteristics and the care process after the creation and implementation of a virtual care program for patients with URTI during the epidemiological outbreak. We studied all consultations that took place between May, 21st, and September, 14th 2018 at Hospital Italiano de Buenos Aires (HIBA). After applying exclusion criteria 218 consultations were left for the analysis. Most patients did not need a referral to a care center for a face-to-face assessment. The consultation rate to the Emergency Department (ED) within 7 days was 11.92% (26/218) with a 95% CI of 7.94-16.99%. This new approach in patient care has a great potential for relieving the overcrowding in EDs, decreasing waiting times and preventing the infection spread in waiting rooms.
The objective of this study was to reveal how the COVID-19 pandemic process affected the number o... more The objective of this study was to reveal how the COVID-19 pandemic process affected the number of visits to an emergency department of a highly complex hospital located in the Ciudad Autónoma de Buenos Aires, to explore the characteristics and reasons for consultation. The monthly number of visits between January 2019 and December 2020 was analyzed. The data showed a strong decrease in the number of visits (176 370 in 2019 and 95 421 in 2020), with an abrupt drop after the lockdown disposal (In aprilshowed the maximum reduction: 77.1%), and the different stages are reflected in the evolution (a consequence of quarantine), yielding a global annual reduction of 45.9%. The number of patients admitted by ambulances increased (5.1% in 2019 to 10.4% in 2020; p < 0.05), and consequently, the number of patients in the more complex sector (area B 2019: 5.3%, 2020: 11.5%; p < 0.01), as well as unscheduled hospitalizations from 6.8% (95% CI 6.7-6.9) to 12.1% in 2020 (95%CI11.8-12.3), p < 0.01. The five most frequent reasons for consultation in 2020 were: fever (5.1%), odynophagia (4.7%), abdominal pain (2.6%), cough (1.8%) and headache (1.8%), probably all related to COVID-19. In conclusion, the number of emergency department visits decreased by half compared to the previous year.
The aim of this study was to analyze whether the coronavirus disease 2019 (COVID‐19) vaccine redu... more The aim of this study was to analyze whether the coronavirus disease 2019 (COVID‐19) vaccine reduces mortality in patients with moderate or severe COVID‐19 disease requiring oxygen therapy. A retrospective cohort study, with data from 148 hospitals in both Spain (111 hospitals) and Argentina (37 hospitals), was conducted. We evaluated hospitalized patients for COVID‐19 older than 18 years with oxygen requirements. Vaccine protection against death was assessed through a multivariable logistic regression and propensity score matching. We also performed a subgroup analysis according to vaccine type. The adjusted model was used to determine the population attributable risk. Between January 2020 and May 2022, we evaluated 21,479 COVID‐19 hospitalized patients with oxygen requirements. Of these, 338 (1.5%) patients received a single dose of the COVID‐19 vaccine and 379 (1.8%) were fully vaccinated. In vaccinated patients, mortality was 20.9% (95% confidence interval [CI]: 17.9–24), compar...
Cardiovascular diseases (CVD), mainly ischemic heart disease and stroke, is the main cause of dea... more Cardiovascular diseases (CVD), mainly ischemic heart disease and stroke, is the main cause of death worldwide and each year more people die from CVD than from any other cause. These data call for a paradigm shift, where health promotion and cardiovascular prevention will acquire a central role in health policies. From this perspective, dedicating time during the consultation to promoting the acquisition of heart-healthy habits would be indicated in all individuals, regardless of cardiovascular risk classification, the role of the internist being fundamental. This position document from the International Forum of Internal Medicine (FIMI) presents the main indications regarding changes in lifestyle and acquisition of healthy habits to prevent CVD. The different sections will address topics including: nutrition, physical activity, sedentary lifestyle, obesity, smoking, alcohol consumption, sleep, stress, environmental problems related to CVD and specific conditions in women. A section is included about starting CVD promotion and prevention measures at an early age, childhood and adolescence, also mentioning epigenetic aspects related to CVD. Social determinants in CVD are also taken into account, since some of these aspects, such as low socioeconomic level, modify cardiovascular risk and should be taken into account.
MEDINFO 2021: One World, One Health – Global Partnership for Digital Innovation
For immunosuppressed or transplanted patients, appropriate triage is a timely topic, especially i... more For immunosuppressed or transplanted patients, appropriate triage is a timely topic, especially in the Emergency Department (ED) of a high-volume referral center. We implemented a new Program called Rapid Clinical Care by Internal Medicine Specialists, as a preferential care route for these patients, which combines the proposed informatics framework in the field of total quality management in the healthcare units, as an example of digital technologies that can improve processes in the clinical routine. Our study aimed to describe waiting-time and attention-time in ED and to explore the effect on patients’ clinical outcomes after discharge. Findings were: shortened waiting time (median of 8 minutes versus 21, p<0.001), improved ED on-call time (median of 2 hours compared to 4, p<0.001), and greater follow-up after discharge, measured as 1-week scheduled-visits rate (69% with 95%CI 63-75; compared to 43% with 95%CI 35-51; p<0.001).
MEDINFO 2021: One World, One Health – Global Partnership for Digital Innovation
Since Argentina’s government declared a national emergency to combat the COVID-19 pandemic with a... more Since Argentina’s government declared a national emergency to combat the COVID-19 pandemic with a lockdown status, it has produced consequences on the healthcare system. We aimed to quantify the effect on the Emergency Department (ED) visits at Hospital Italiano de Buenos Aires. Our electronic health data showed that ED in-person visits declined 46% during the COVID-19 pandemic, from an overall of 176,370 visits during 2019 to 95,421 visits during 2020. Simultaneously, there was a telehealth visits boom when mandatory quarantine began (March 20, 2020): from a median of 12 daily in February 2020 to a median of 338 daily in April 2020; reaching a maximum daily peak of 1,132 on March 26 2020. For a while, teleconsultations replaced ED visits. Then, when face-to-face visits began to increase, teleconsultations began to decrease slowly, as the phenomenon reversed.
The main objective was to estimate the prevalence of diabetes mellitus (DM) among patients with C... more The main objective was to estimate the prevalence of diabetes mellitus (DM) among patients with COVID-19, to explore associ-ated factors;and to describe clinical evolution of hospitalized patients. A cross-sectional study was conducted, which included adults confirmed with COVID-19 between 03/12/2020 and 10/15/2020, at Hospital Italiano de Buenos Aires. From 6009 people with COVID-19, 408 had previous diagnosis of DM, yielding a prevalence of 6% (95%CI 6-7), higher prevalence was associated with age (12% in ≥ 60 years and 3% in < 60 years;p = 0.01). In-hospital mortality was 6% (95%CI 6-7), being 15% in DM and 6% compared in non-diabetics (p < 0.01). Associated factors with DM were cardiovascular variables such as male sex, hypertension, smoking, chronic renal failure, heart failure, previous coronary disease;and clinical variables proxy of frailty such as: age, dementia and previous institutionalization (all with p < 0.01). Only 23% (96/408) of DM had an HbA1c measurement ...
En diciembre de 2019 un nuevo coronavirus se identificó como causa de un brote de neumonía y dist... more En diciembre de 2019 un nuevo coronavirus se identificó como causa de un brote de neumonía y distrés respiratorio en Wuhan, China En marzo de 2020 fue declarado pandemia Resulta importante conocer predictores de mala evolución para optimizar estrategias de cuidados El índice neutrófilo-linfocito (INL) constituye un novedoso marcador pronóstico en enfermedades cardiovasculares, oncológicas e infecciosas Este trabajo analiza su valor pronóstico en COVID-19 Se evaluó una cohorte retrospectiva de 131 pacientes con COVID-19 confirmado, entre marzo y mayo de 2020 Se analizaron las características basales de la población, la asociación del INL ≥3 con COVID-19 grave y la tasa de mortalidad de la enfermedad La mediana de edad fue de 52 años, 54% fueron hombres En 21 pacientes se encontraron criterios de gravedad, 9 de ellos requirieron ventilación mecánica Presentó INL ≥3 el 81% (18/21) de los pacientes graves y el 33% (36/110) de los pacientes leves (OR = 8 74 IC del 95%: 2 74-2...
Telemedicine is an increasingly used strategy for providing care to patients. The prevention and ... more Telemedicine is an increasingly used strategy for providing care to patients. The prevention and treatment of Upper Respiratory Tract Infections (URTIs) during outbreaks still require new management approaches. We aimed to describe patients' characteristics and the care process after the creation and implementation of a virtual care program for patients with URTI during the epidemiological outbreak. We studied all consultations that took place between May, 21st, and September, 14th 2018 at Hospital Italiano de Buenos Aires (HIBA). After applying exclusion criteria 218 consultations were left for the analysis. Most patients did not need a referral to a care center for a face-to-face assessment. The consultation rate to the Emergency Department (ED) within 7 days was 11.92% (26/218) with a 95% CI of 7.94-16.99%. This new approach in patient care has a great potential for relieving the overcrowding in EDs, decreasing waiting times and preventing the infection spread in waiting rooms.
The objective of this study was to reveal how the COVID-19 pandemic process affected the number o... more The objective of this study was to reveal how the COVID-19 pandemic process affected the number of visits to an emergency department of a highly complex hospital located in the Ciudad Autónoma de Buenos Aires, to explore the characteristics and reasons for consultation. The monthly number of visits between January 2019 and December 2020 was analyzed. The data showed a strong decrease in the number of visits (176 370 in 2019 and 95 421 in 2020), with an abrupt drop after the lockdown disposal (In aprilshowed the maximum reduction: 77.1%), and the different stages are reflected in the evolution (a consequence of quarantine), yielding a global annual reduction of 45.9%. The number of patients admitted by ambulances increased (5.1% in 2019 to 10.4% in 2020; p < 0.05), and consequently, the number of patients in the more complex sector (area B 2019: 5.3%, 2020: 11.5%; p < 0.01), as well as unscheduled hospitalizations from 6.8% (95% CI 6.7-6.9) to 12.1% in 2020 (95%CI11.8-12.3), p < 0.01. The five most frequent reasons for consultation in 2020 were: fever (5.1%), odynophagia (4.7%), abdominal pain (2.6%), cough (1.8%) and headache (1.8%), probably all related to COVID-19. In conclusion, the number of emergency department visits decreased by half compared to the previous year.
The aim of this study was to analyze whether the coronavirus disease 2019 (COVID‐19) vaccine redu... more The aim of this study was to analyze whether the coronavirus disease 2019 (COVID‐19) vaccine reduces mortality in patients with moderate or severe COVID‐19 disease requiring oxygen therapy. A retrospective cohort study, with data from 148 hospitals in both Spain (111 hospitals) and Argentina (37 hospitals), was conducted. We evaluated hospitalized patients for COVID‐19 older than 18 years with oxygen requirements. Vaccine protection against death was assessed through a multivariable logistic regression and propensity score matching. We also performed a subgroup analysis according to vaccine type. The adjusted model was used to determine the population attributable risk. Between January 2020 and May 2022, we evaluated 21,479 COVID‐19 hospitalized patients with oxygen requirements. Of these, 338 (1.5%) patients received a single dose of the COVID‐19 vaccine and 379 (1.8%) were fully vaccinated. In vaccinated patients, mortality was 20.9% (95% confidence interval [CI]: 17.9–24), compar...
Cardiovascular diseases (CVD), mainly ischemic heart disease and stroke, is the main cause of dea... more Cardiovascular diseases (CVD), mainly ischemic heart disease and stroke, is the main cause of death worldwide and each year more people die from CVD than from any other cause. These data call for a paradigm shift, where health promotion and cardiovascular prevention will acquire a central role in health policies. From this perspective, dedicating time during the consultation to promoting the acquisition of heart-healthy habits would be indicated in all individuals, regardless of cardiovascular risk classification, the role of the internist being fundamental. This position document from the International Forum of Internal Medicine (FIMI) presents the main indications regarding changes in lifestyle and acquisition of healthy habits to prevent CVD. The different sections will address topics including: nutrition, physical activity, sedentary lifestyle, obesity, smoking, alcohol consumption, sleep, stress, environmental problems related to CVD and specific conditions in women. A section is included about starting CVD promotion and prevention measures at an early age, childhood and adolescence, also mentioning epigenetic aspects related to CVD. Social determinants in CVD are also taken into account, since some of these aspects, such as low socioeconomic level, modify cardiovascular risk and should be taken into account.
MEDINFO 2021: One World, One Health – Global Partnership for Digital Innovation
For immunosuppressed or transplanted patients, appropriate triage is a timely topic, especially i... more For immunosuppressed or transplanted patients, appropriate triage is a timely topic, especially in the Emergency Department (ED) of a high-volume referral center. We implemented a new Program called Rapid Clinical Care by Internal Medicine Specialists, as a preferential care route for these patients, which combines the proposed informatics framework in the field of total quality management in the healthcare units, as an example of digital technologies that can improve processes in the clinical routine. Our study aimed to describe waiting-time and attention-time in ED and to explore the effect on patients’ clinical outcomes after discharge. Findings were: shortened waiting time (median of 8 minutes versus 21, p<0.001), improved ED on-call time (median of 2 hours compared to 4, p<0.001), and greater follow-up after discharge, measured as 1-week scheduled-visits rate (69% with 95%CI 63-75; compared to 43% with 95%CI 35-51; p<0.001).
MEDINFO 2021: One World, One Health – Global Partnership for Digital Innovation
Since Argentina’s government declared a national emergency to combat the COVID-19 pandemic with a... more Since Argentina’s government declared a national emergency to combat the COVID-19 pandemic with a lockdown status, it has produced consequences on the healthcare system. We aimed to quantify the effect on the Emergency Department (ED) visits at Hospital Italiano de Buenos Aires. Our electronic health data showed that ED in-person visits declined 46% during the COVID-19 pandemic, from an overall of 176,370 visits during 2019 to 95,421 visits during 2020. Simultaneously, there was a telehealth visits boom when mandatory quarantine began (March 20, 2020): from a median of 12 daily in February 2020 to a median of 338 daily in April 2020; reaching a maximum daily peak of 1,132 on March 26 2020. For a while, teleconsultations replaced ED visits. Then, when face-to-face visits began to increase, teleconsultations began to decrease slowly, as the phenomenon reversed.
The main objective was to estimate the prevalence of diabetes mellitus (DM) among patients with C... more The main objective was to estimate the prevalence of diabetes mellitus (DM) among patients with COVID-19, to explore associ-ated factors;and to describe clinical evolution of hospitalized patients. A cross-sectional study was conducted, which included adults confirmed with COVID-19 between 03/12/2020 and 10/15/2020, at Hospital Italiano de Buenos Aires. From 6009 people with COVID-19, 408 had previous diagnosis of DM, yielding a prevalence of 6% (95%CI 6-7), higher prevalence was associated with age (12% in ≥ 60 years and 3% in < 60 years;p = 0.01). In-hospital mortality was 6% (95%CI 6-7), being 15% in DM and 6% compared in non-diabetics (p < 0.01). Associated factors with DM were cardiovascular variables such as male sex, hypertension, smoking, chronic renal failure, heart failure, previous coronary disease;and clinical variables proxy of frailty such as: age, dementia and previous institutionalization (all with p < 0.01). Only 23% (96/408) of DM had an HbA1c measurement ...
En diciembre de 2019 un nuevo coronavirus se identificó como causa de un brote de neumonía y dist... more En diciembre de 2019 un nuevo coronavirus se identificó como causa de un brote de neumonía y distrés respiratorio en Wuhan, China En marzo de 2020 fue declarado pandemia Resulta importante conocer predictores de mala evolución para optimizar estrategias de cuidados El índice neutrófilo-linfocito (INL) constituye un novedoso marcador pronóstico en enfermedades cardiovasculares, oncológicas e infecciosas Este trabajo analiza su valor pronóstico en COVID-19 Se evaluó una cohorte retrospectiva de 131 pacientes con COVID-19 confirmado, entre marzo y mayo de 2020 Se analizaron las características basales de la población, la asociación del INL ≥3 con COVID-19 grave y la tasa de mortalidad de la enfermedad La mediana de edad fue de 52 años, 54% fueron hombres En 21 pacientes se encontraron criterios de gravedad, 9 de ellos requirieron ventilación mecánica Presentó INL ≥3 el 81% (18/21) de los pacientes graves y el 33% (36/110) de los pacientes leves (OR = 8 74 IC del 95%: 2 74-2...
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