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1.
Mayo Clin Proc ; 96(5): 1250-1261, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33958056

RESUMO

The administration of spike monoclonal antibody treatment to patients with mild to moderate COVID-19 is very challenging. This article summarizes essential components and processes in establishing an effective spike monoclonal antibody infusion program. Rapid identification of a dedicated physical infrastructure was essential to circumvent the logistical challenges of caring for infectious patients while maintaining compliance with regulations and ensuring the safety of our personnel and other patients. Our partnerships and collaborations among multiple different specialties and disciplines enabled contributions from personnel with specific expertise in medicine, nursing, pharmacy, infection prevention and control, electronic health record (EHR) informatics, compliance, legal, medical ethics, engineering, administration, and other critical areas. Clear communication and a culture in which all roles are welcomed at the planning and operational tables are critical to the rapid development and refinement needed to adapt and thrive in providing this time-sensitive beneficial therapy. Our partnerships with leaders and providers outside our institutions, including those who care for underserved populations, have promoted equity in the access of monoclonal antibodies in our regions. Strong support from institutional leadership facilitated expedited action when needed, from a physical, personnel, and system infrastructure standpoint. Our ongoing real-time assessment and monitoring of our clinical program allowed us to improve and optimize our processes to ensure that the needs of our patients with COVID-19 in the outpatient setting are met.


Assuntos
Antivirais/administração & dosagem , COVID-19 , Procedimentos Clínicos , Terapia por Infusões no Domicílio , SARS-CoV-2 , Glicoproteína da Espícula de Coronavírus , Anticorpos Monoclonais/administração & dosagem , COVID-19/epidemiologia , COVID-19/terapia , Protocolos Clínicos , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Eficiência Organizacional , Terapia por Infusões no Domicílio/métodos , Terapia por Infusões no Domicílio/normas , Humanos , Colaboração Intersetorial , Cultura Organizacional , Desenvolvimento de Programas/métodos , SARS-CoV-2/imunologia , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Glicoproteína da Espícula de Coronavírus/antagonistas & inibidores , Glicoproteína da Espícula de Coronavírus/imunologia , Estados Unidos/epidemiologia
2.
Pediatr Dermatol ; 37(2): 347-349, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31967343

RESUMO

A 15-year-old boy presented with painful ulcerations affecting the oral mucosa that were eventually attributed to marijuana vaping. In this case report, we highlight cannabis vaping as a potential cause of oral erosions due to injury and chronic inflammation of the oral mucosa.


Assuntos
Fumar Maconha/efeitos adversos , Úlceras Orais/etiologia , Úlceras Orais/patologia , Vaping/efeitos adversos , Adolescente , Humanos , Masculino
3.
J Clin Psychiatry ; 79(4)2018 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-30153403

RESUMO

OBJECTIVE: Collaborative care models for treatment of adolescent depression are rapidly evolving. However, a dearth of information exists regarding patient characteristics associated with positive outcomes. We explored the association between baseline scores on routine screening tools for substance abuse, mood disorders, and anxiety with depression remission and graduation from a collaborative care program in an outpatient pediatric practice. METHODS: Adolescents (aged 12-17 years) with Patient Health Questionnaire-9 Modified for Adolescents (PHQ-9A) score ≥ 10 and a diagnosis of depressive disorder based on DSM-IV criteria between July 2011 and August 2015 were eligible for enrollment in a collaborative care model and inclusion in this study. Remission was defined as a single PHQ-9A score < 5; the criterion for graduation was 3 consecutive months with PHQ-9A score < 5. Analyses compared baseline assessment scores with those at remission and graduation. RESULTS: Of the 182 patients included in the analysis, the overall remission rate was 55%; program graduation rate was 27%. There was no association between scores on baseline screening tools and remission. Graduation was associated with lower scores on a screening tool for substance abuse (unit odds ratio [OR] = 1.62; P = .01) and anxiety (unit OR = 1.03; P = .02). When the scores were examined as categorical variables, graduation was associated with negative assessments on screening tools for substance abuse (OR = 3.21; P = .003) and anxiety (OR = 2.35; P = .02). CONCLUSIONS: Baseline substance abuse and anxiety assessments may have utility in identifying depressed adolescents who are less likely to maintain remission and graduate from a collaborative care program, suggesting that these patients may need additional intervention to achieve sustained remission.


Assuntos
Comportamento do Adolescente/psicologia , Ansiedade/diagnóstico , Transtorno Depressivo/complicações , Transtorno Depressivo/terapia , Transtornos do Humor/diagnóstico , Atenção Primária à Saúde/métodos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adolescente , Ansiedade/complicações , Criança , Feminino , Humanos , Masculino , Transtornos do Humor/complicações , Indução de Remissão , Transtornos Relacionados ao Uso de Substâncias/complicações , Resultado do Tratamento
4.
Psychiatr Serv ; 69(5): 536-541, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29446330

RESUMO

OBJECTIVE: Depression is common among adolescents, but many lack ready access to mental health services. Integrated models of care for depression are needed, along with evidence to support their use in regular practice. The authors examined the effectiveness of an ongoing collaborative care program for depressed adolescents embedded in a busy primary care practice. METHODS: This retrospective cohort study assessed EMERALD (Early Management and Evidence-based Recognition of Adolescents Living with Depression), a collaborative care program. All patients ages 12-17 and age 18 and still in high school with a score of ≥10 on the nine-item Patient Health Questionnaire for Adolescents (PHQ-9A) and without a diagnosis of bipolar disorder were eligible. The sample included 162 EMERALD participants and 499 similarly eligible non-EMERALD patients. Outcomes were six-month remission of depression (score <5) and six-month treatment response (>50% reduction from baseline) as measured by the PHQ-9A. Analyses included logistic regression and propensity score matching to adjust for differences in demographic factors and number of contacts-observations. RESULTS: After propensity score matching, EMERALD patients had better adjusted rates of depression remission (11 percentage points higher, p=.035) and treatment response (14 percentage points higher, p<.001) than comparison patients. Results from primary analyses were as conservative as or more conservative than results from all sensitivity analyses tested. CONCLUSIONS: Collaborative care for adolescents in regular practice led to better remission and treatment response than usual care. Future studies could examine which groups might benefit most and flexible payment models to support these services.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Transtorno Depressivo/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde , Atenção Primária à Saúde/métodos , Adolescente , Criança , Feminino , Humanos , Masculino , Indução de Remissão , Estudos Retrospectivos
5.
Am J Prev Med ; 41(4 Suppl 3): S314-6, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21961685

RESUMO

This is one of six short papers that describe additional innovations to help integrate public health into medical education; these were featured in the "Patients and Populations: Public Health in Medical Education" conference. They represent relatively new endeavors or curricular components that had not been explored in prior publications. Although evaluation data are lacking, it was considered to be of value to medical educators to share a brief description of the collaboration between the Division of Preventive, Occupational, and Aerospace Medicine and the Department of Pediatrics at Mayo Clinic to integrate a preventive medicine-public health curriculum into the pediatric residency.


Assuntos
Internato e Residência/organização & administração , Pediatria/educação , Medicina Preventiva/educação , Saúde Pública/educação , Comportamento Cooperativo , Currículo , Educação de Pós-Graduação em Medicina/organização & administração , Humanos , Minnesota , Desenvolvimento de Programas
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