RESUMO
Assisted teleconsultation, one of the components of telemedicine, is a form of medical practice set to further develop in the coming years. Interprofessional relationships are being adapted, and the triad patient-care provider-physician is experiencing new challenges. In this article we focus on the competencies and skills required and suggest some clinical practice guidelines for this new form of medical practice based on the pilot phase of our project.
La téléconsultation assistée, une des composantes de la télémédecine, est un type de pratique médicale amené à se développer dans les prochaines années. Dans cette nouvelle forme de relation interprofessionnelle, la triade patient-soignant-médecin connaît de nouveaux enjeux. À travers cet article, nous nous intéressons aux compétences requises pour cette nouvelle pratique et tentons de proposer quelques bonnes pratiques à partir de notre expérience pilote.
Assuntos
Médicos , Consulta Remota , Humanos , Guias de Prática Clínica como AssuntoRESUMO
Chronic obstructive pulmonary disease (COPD) out-patient clinic is for stable patients but it requires patient's adherence to medicine and medical checkups. Our study aimed to assess COPD out-patient clinics management efficacy with respect to medication adherence and treatment costs at 3 out-patient clinics. Data were collected through 514 patient interviews and from medical records for statistical analysis. The most common comorbidity was hypertension (28.8%), and 52.9% of patients had experienced exacerbations in the past year requiring 75.7% of them to be hospitalized. According to the Morisky scale, 78.8% had high adherence and 82.9% were using inhaled corticosteroids regimens. The mean cost per year among different cohorts varied, with the out-patient cohort at $305.93, the acute exacerbations of COPD non-hospital cohort at $247.39, the standard admission cohort at $1275.3, and the emergency department cohort at $2132.5. Patients with low medication adherence had significantly lower annual costs ($238.25 vs $325.04, P = .001). In Vietnam, economic constraints have made Inhaled corticosteroids/ Long-acting ß-2 agonists the main mode of treatment. However, the exclusion of Long-acting ß-2 agonists/Long-acting anti-muscarinic antagonists drugs from health insurance coverage poses a challenge to Global Initiative for Chronic Obstructive Lung Disease-based prescription practices and increases the importance of monitoring medication adherence, particularly in patients with higher COPD Assessment Test scores.
RESUMO
The current coronavirus disease 2019 (COVID-19) outbreak is alarmingly escalating and raises challenges in finding efficient compounds for treatment. Repurposing phytochemicals in herbs is an ideal and economical approach for screening potential herbal components against COVID-19. Andrographis paniculata, also known as Chuan Xin Lian, has traditionally been used as an anti-inflammatory and antibacterial herb for centuries and has recently been classified as a promising herbal remedy for adjuvant therapy in treating respiratory diseases. This study aimed to screen Chuan Xin Lian's bioactive components and elicit the potential pharmacological mechanisms and plausible pathways for treating COVID-19 using network pharmacology combined with molecular docking. The results found terpenoid (andrographolide) and flavonoid (luteolin, quercetin, kaempferol, and wogonin) derivatives had remarkable potential against COVID-19 and sequelae owing to their high degrees in the component-target-pathway network and strong binding capacities in docking scores. In addition, the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis showed that the PI3K-AKT signaling pathway might be the most vital molecular pathway in the pathophysiology of COVID-19 and long-term sequelae whereby therapeutic strategies can intervene.