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1.
Appl Clin Inform ; 11(5): 802-806, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33264802

RESUMEN

BACKGROUND AND SIGNIFICANCE: When hospitals are subject to prolonged surges in patients, such as during the coronavirus disease 2019 (COVID-19) pandemic, additional clinicians may be needed to care for the rapid increase of acutely ill patients. How might we quickly prepare a large number of ambulatory-based clinicians to care for hospitalized patients using the inpatient workflow of the electronic health record (EHR)? OBJECTIVES: The aim of the study is to create a successful training intervention which prepares ambulatory-based clinicians as they transition to inpatient services. METHODS: We created a training guide with embedded videos that describes the workflow of an inpatient clinician. We delivered this intervention via an e-mail hyperlink, a static hyperlink inside of the EHR, and an on-demand hyperlink within the EHR. RESULTS: In anticipation of the first peak of inpatients with COVID-19 in April 2020, the training manual was accessed 261 times by 167 unique users as clinicians anticipated being called into service. As our institution has not yet needed to deploy ambulatory-based clinicians for inpatient service, usage data of the training document is still pending. CONCLUSION: We intend that our novel implementation of a multimedia, highly accessible onboarding document with access from points inside and outside of the EHR will improve clinician performance and serve as a helpful example to other organizations during the COVID-19 pandemic and beyond.


Asunto(s)
Instituciones de Atención Ambulatoria , Personal de Salud/educación , Pacientes Internos , Invenciones , Pandemias , Guías de Práctica Clínica como Asunto , Competencia Clínica , Registros Electrónicos de Salud , Humanos , Factores de Tiempo , Interfaz Usuario-Computador
2.
World J Gastroenterol ; 26(40): 6270-6278, 2020 Oct 28.
Artículo en Inglés | MEDLINE | ID: mdl-33177799

RESUMEN

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, mostly causing respiratory symptoms, is also known to affect the gastrointestinal tract. Several case reports hypothesize that SARS-CoV-2 could be an etiological factor in acute pancreatitis (AP). AIM: To assess all the available evidence in the literature relating to coronavirus disease 2019 (COVID-19) and AP. METHODS: We performed a systematic review of the available literature on the topic. The systematic search was conducted on 15 May 2020 on MEDLINE, EMBASE, CENTRAL, Web of Science and Scopus with a search key using the terms "amylase," "lipase," "pancr*," "COVID-19" and synonyms. Due to the low quality and poor comparability of the studies, a meta-analysis was not performed. RESULTS: Six case reports and two retrospective cohorts were included, containing data on eleven COVID-19 patients with AP. Five patients had AP according to the Atlanta classification. Other publications did not provide sufficient information on the diagnostic criteria. Most cases were considered SARS-CoV-2-induced, while several established etiological factors were not investigated. We were able to identify other possible causes in most of them. CONCLUSION: We strongly highlight the need for adherence to the guidelines during a diagnostic and etiological workup, which could alter therapy.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Pancreatitis/virología , Neumonía Viral/diagnóstico , Enfermedad Aguda , Técnicas de Laboratorio Clínico/normas , Infecciones por Coronavirus/complicaciones , Adhesión a Directriz , Humanos , Pandemias , Neumonía Viral/complicaciones , Guías de Práctica Clínica como Asunto
3.
Cardiol Young ; 30(11): 1588-1594, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33140715

RESUMEN

The COVID-19 pandemic is currently ravaging the globe and the African continent is not left out. While the direct effects of the pandemic in regard to morbidity and mortality appear to be more significant in the developed world, the indirect harmful effects on already insufficient healthcare infrastructure on the African continent would in the long term be more detrimental to the populace. Women and children form a significant vulnerable population in underserved areas such as the sub-Saharan region, and expectedly will experience the disadvantages of limited healthcare coverage which is a major fall out of the pandemic. Paediatric cardiac services that are already sparse in various sub-Saharan countries are not left out of this downsizing. Restrictions on international travel for patients out of the continent to seek medical care and for international experts into the continent for regular mission programmes leave few options for children with cardiac defects to get the much-needed care.There is a need for a region-adapted guideline to scale-up services to cater for more children with congenital heart disease (CHD) while providing a safe environment for healthcare workers, patients, and their caregivers. This article outlines measures adapted to maintain paediatric cardiac care in a sub-Saharan tertiary centre in Nigeria during the COVID-19 pandemic and will serve as a guide for other institutions in the region who will inadvertently need to provide these services as the demand increases.


Asunto(s)
/prevención & control , Cardiología , Prestación de Atención de Salud , Cardiopatías Congénitas/terapia , Pediatría , Cirugía Torácica , Atención Ambulatoria/métodos , /epidemiología , Cateterismo Cardíaco/métodos , Procedimientos Quirúrgicos Cardíacos/métodos , Países en Desarrollo , Ecocardiografía/métodos , Ecocardiografía Transesofágica/métodos , Servicio de Urgencia en Hospital , Cardiopatías Congénitas/diagnóstico , Humanos , Control de Infecciones/métodos , Tamizaje Masivo , Nigeria , Equipo de Protección Personal , Sistemas de Atención de Punto , Guías de Práctica Clínica como Asunto , Telemedicina/métodos , Triaje/métodos
4.
BMC Nephrol ; 21(1): 470, 2020 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-33172405

RESUMEN

BACKGROUND: Coronavirus Disease 2019 (COVID-19) has substantially impacted the provision of medical services. During the pandemic, many medical services, including facilities providing care to patients with end stage renal disease faced challenges in safeguarding patients and staff while providing clinical care. This study aims to identify the extent, range, and nature of articles related to COVID-19 and maintenance hemodialysis to understand the research gaps and propose recommendations for future research. METHODS: Using the terms: "Dialysis" OR "RRT" OR "Renal replacement therapy" AND "SARS-COV-2" OR "COVID-19" OR "novel coronavirus" OR "2019-nCov", we performed a multi-step systematic search of the literature in the English language in Pubmed, Scopus, Embase, and Web of Science published from December 1, 2019, to May 13, 2020. Two authors separately screened the title and abstracts of the documents and ruled out irrelevant articles. We obtained a full report of the papers that met our inclusion criteria and screened the full texts. We conducted a descriptive analysis of the characteristics of the included articles and performed a narrative synthesis of the results. We conducted this scoping review in accordance with the PRISMA-ScR Checklist. RESULTS: We included 22 articles in this scoping review. Perspectives (n = 9), editorials (n = 4), and case series (n = 5) were the most common types of articles. Most articles were from Italy and the United States. Seventeen (77.3%) of the articles focused on the topic of recommendation for outpatient hemodialysis units. While many of the recommendations overlapped in several articles, there were also many unique recommendations. CONCLUSIONS: most of the articles are based on single-center experience, which spontaneously developed best practices. Many of these practices have formed the basis for policies and guidelines that will guide future prevention of infection and management of patients with End Stage Renal Disease (ESRD) and COVID-19.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Fallo Renal Crónico/terapia , Neumonía Viral/epidemiología , Guías de Práctica Clínica como Asunto , Diálisis Renal/normas , Adulto , Temperatura Corporal , Niño , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Amigos , Personal de Salud/educación , Hemodiálisis en el Domicilio , Humanos , Pandemias/prevención & control , Educación del Paciente como Asunto , Equipo de Protección Personal , Neumonía Viral/diagnóstico , Neumonía Viral/prevención & control , Cuarentena/métodos , Terapia de Reemplazo Renal , Evaluación de Síntomas
5.
Clin Lab ; 66(11)2020 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-33180450

RESUMEN

BACKGROUND: On January 30, 2020, WHO declared COVID-19 a pandemic. In this article we describe our experience at Richmond University Medical Center with Chembio serological IgM, IgG testing. METHODS: In this prospective cohort study of patients and hospital employees, we utilized Chembio COVID-19 IgM/IgG serological testing in addition to Cepheid RT-PCR analysis. RESULTS: We evaluated the performance of Chembio serological test for IgM and IgG as an employee screening tool in a community hospital setting. The total number of currently asymptomatic employees screened was 1,866 from the Richmond University Medical Center. The non-exposed group included 1,253 (67.1%) employees with no significant clinical history and non-reactive IgM and IgG antibodies. The convalescent group included 255 (13.7%) of the employees with elevation of IgG only, 18 (1%) employees with past history of positive PCR and COVID-19 who currently have non-reactive IgM and IgG antibodies or demonstrate elevated IgG only, followed by 3 employees (< 1%) with no past clinical history who demonstrated reactive IgM and IgG antibodies and negative follow up by PCR. The reported 14.9% exposure/convalescent rate is lower than the reported 20% by the Department of Health and Governor Andrew Cuomo and may represent a better utilization of personal protective equipment, better hand washing techniques, and better disinfection procedures combined with strict social distancing. CONCLUSIONS: Chembio's performance is satisfactory; however, hospitals must design their own policies addressing: who needs to be screened and who will interpret the results as well as constructing management algorithms for employees with no previous history and current double positive antibodies.


Asunto(s)
Técnicas de Laboratorio Clínico/métodos , Inmunoglobulina G/análisis , Inmunoglobulina M/análisis , Tamizaje Masivo/métodos , Pruebas Serológicas/estadística & datos numéricos , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/diagnóstico , Guías como Asunto , Humanos , Pandemias , Neumonía Viral/sangre , Neumonía Viral/diagnóstico
7.
Artículo en Inglés | MEDLINE | ID: mdl-33147715

RESUMEN

The increasing number of COVID-19 patients has increased health care professionals' workloads, making the management of dynamic patient information in a timely and comprehensive manner difficult and sometimes impossible. Compounding this problem is a lack of health care professionals and trained medical staff to handle the increased number of patients. Although Saudi Arabia has recently improved the quality of its health services, there is still no suitable intelligent system that can help health practitioners follow the clinical guidelines and automated risk assessment and treatment plan remotely, which would allow for the effective follow-up of patients of COVID-19. The proposed system includes five sub-systems: an information management system, a knowledge-based expert system, adaptive learning, a notification and follow-up system, and a mobile tracker system. This study shows that, to control epidemics, there is a method to overcome the shortage of specialists in the management of infections in Saudi Arabia, both today and in the future. The availability of computerized clinical guidance and an up-to-date knowledge base play a role in Saudi health organizations, which may not have to constantly train their physician staff and may no longer have to rely on international experts, since the expert system can offer clinicians all the information necessary to treat their patients.


Asunto(s)
Técnicas de Laboratorio Clínico/métodos , Sistemas Especialistas , Guías de Práctica Clínica como Asunto , Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Humanos , Pandemias , Neumonía Viral , Arabia Saudita
8.
Biomedica ; 40(Supl. 2): 180-187, 2020 10 30.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33152202

RESUMEN

The pandemic caused by COVID19 is associated with an increase in the number of cases of cardiorespiratory arrest, which has resulted in ethical concerns regarding the enforceability of cardiopulmonary resuscitation, as well as the conditions to carry it out. The risk of aerosol transmission and the clinical uncertainties about the efficacy, the potential sequelae, and the circumstances that could justify limiting this procedure during the pandemic have multiplied the ethical doubts on how to proceed in these cases. Based on ethical and legal grounds, this paper offers a practical guide on how to proceed in the clinical setting in cases of cardiopulmonary arrest during the pandemic. The criteria of justice, benefit, no harm, respect for autonomy, precaution, integrity, and transparency are asserted in an organized and practical framework for decision-making regarding cardiopulmonary resuscitation.


Asunto(s)
Betacoronavirus , Reanimación Cardiopulmonar/ética , Infecciones por Coronavirus/complicaciones , Paro Cardíaco/terapia , Pandemias , Neumonía Viral/complicaciones , Guías de Práctica Clínica como Asunto , Directivas Anticipadas , Aerosoles , Microbiología del Aire , Reanimación Cardiopulmonar/métodos , Toma de Decisiones Clínicas , Colombia/epidemiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Paro Cardíaco/etiología , Humanos , Control de Infecciones/métodos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Inutilidad Médica , Exposición Profesional , Pandemias/prevención & control , Autonomía Personal , Equipo de Protección Personal , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Justicia Social
9.
Rev Mal Respir ; 37(10): 811-822, 2020 Dec.
Artículo en Francés | MEDLINE | ID: mdl-33067078

RESUMEN

INTRODUCTION: The new coronavirus disease 2019 (COVID-19) is responsible for a global pandemic and many deaths. This context requires an adaptation of health systems as well as the role of each healthcare professional, including physiotherapists. STATE OF THE ART: In order to optimize the management of people with COVID-19, many savant societies published guidelines about physiotherapy interventions within the crisis but none offered a global overview from the intensive care unit to home care. Therefore, the aim of this review is to offer an overview of recommended physiotherapy interventions in order to facilitate the management of these patients, whatever the stage of the disease. PERSPECTIVES: Owing to the emergent character of the COVID-19, actual guidelines will have to be adjusted according to the evolution of the pandemic and the resources of the hospital and liberal sectors, in particular for the long-term follow-up of these patients. Current and future research will aim to assess the effectiveness of physiotherapy interventions for people with COVID-19. CONCLUSION: The emergence of COVID-19 required a very rapid adaptation of the health system. The role of physiotherapists is justified at every stage of patients care in order to limit the functional consequences of the disease.


Asunto(s)
/terapia , Servicios de Atención de Salud a Domicilio/normas , Unidades de Cuidados Intensivos/normas , Modalidades de Fisioterapia/normas , Guías de Práctica Clínica como Asunto , /epidemiología , Vías Clínicas/organización & administración , Vías Clínicas/normas , Humanos , Internacionalidad , Pandemias , Modalidades de Fisioterapia/estadística & datos numéricos , Modalidades de Fisioterapia/tendencias , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Pautas de la Práctica en Medicina/tendencias , /fisiología
10.
Cancer Cell ; 38(5): 602-604, 2020 11 09.
Artículo en Inglés | MEDLINE | ID: mdl-33091381

RESUMEN

To understand the real impact of COVID-19 on cancer patients, an entirely new data collection effort was initiated within the Thoracic Cancers International COVID-19 Collaboration (TERAVOLT). TERAVOLT reported high mortality related to COVID-19 infection in thoracic cancer patients and identified several negative prognostic factors. In this commentary, we discuss the importance and limits of patient registries to support decision-making in thoracic cancer during the SARS-CoV-2 pandemic.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Toma de Decisiones Clínicas , Infecciones por Coronavirus/complicaciones , Carga Global de Enfermedades/normas , Neumonía Viral/complicaciones , Guías de Práctica Clínica como Asunto/normas , Neoplasias Torácicas/terapia , Infecciones por Coronavirus/virología , Humanos , Cooperación Internacional , Pandemias , Neumonía Viral/virología , Sistema de Registros , Neoplasias Torácicas/epidemiología , Neoplasias Torácicas/virología
11.
Actas Urol Esp ; 44(10): 644-652, 2020 12.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33012592

RESUMEN

INTRODUCTION: Telemedicine provides remote clinical support through technology tools. It can facilitate medical care delivery while reducing unnecessary office visits. The COVID-19 outbreak has caused an abrupt change in our daily urological practice, where teleconsultations play a crucial role. OBJECTIVE: To provide practical recommendations for the effective use of technological tools in telemedicine. MATERIALS AND METHODS: A literature search was conducted on Medline until April 2020. We selected the most relevant articles related to «telemedicine¼ and «smart working¼ that could provide valuable information. RESULTS: Telemedicine refers to the use of electronic information and telecommunication tools to provide remote clinical health care support. Smart working is a working approach that uses new or existing technologies to improve performance. Telemedicine is becoming a useful and fundamental tool during the COVID-19 pandemic and will be even more in the future. It is time for us to officially give telemedicine the place it deserves in clinical practice, and it is our responsibility to adapt and familiarize with all the tools and possible strategies for its optimal implementation. We must guarantee that the quality of care received by patients and perceived by them and their families is of the highest standard. CONCLUSIONS: Telemedicine facilitates remote specialized urological clinical support and solves problems caused by limited patient mobility or transfer, reduces unnecessary visits to clinics and is useful to reduce the risk of COVID-19 viral transmission.


Asunto(s)
/epidemiología , Pandemias , Telemedicina , Urología/métodos , Contaminación del Aire/prevención & control , Citas y Horarios , Confidencialidad , Técnicas de Diagnóstico Urológico , Registros Electrónicos de Salud , Europa (Continente)/epidemiología , Humanos , Consentimiento Informado , Guías de Práctica Clínica como Asunto , Calidad de la Atención de Salud , Sociedades Médicas , Telemedicina/organización & administración , Telemedicina/normas , Triaje/métodos , Urología/organización & administración , Urología/normas
13.
Int J Chron Obstruct Pulmon Dis ; 15: 2275-2287, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33061345

RESUMEN

Background: Supplemental oxygen is commonly administered to patients in acute care. It may cause harm when used inappropriately. Guidelines recommend prescription of acute oxygen, yet adherence is poor. We aimed to identify barriers and facilitators to practicing in accordance with the evidence-based Thoracic Society of Australia and New Zealand (TSANZ) oxygen guideline, and to determine the beliefs and attitudes relating to acute oxygen therapy. Methods: A national cross-sectional survey was conducted. The survey consisted of 3 sections: (1) introduction and participant characteristics; (2) opinion/beliefs, knowledge and actions about oxygen therapy and other drugs; and (3) barriers and facilitators to use of the TSANZ guideline. Convenience sampling was employed. A paper-based survey was distributed at the TSANZ Annual Scientific Meeting. An online survey was emailed to the TSANZ membership and to John Hunter Hospital's clinical staff. Results: Responses were received from 133 clinicians: 52.6% nurses, 30.1% doctors, and 17.3% other clinicians. Over a third (37.7%) were unaware/unsure of the oxygen guideline's existence. Most (79.8%) believe that oxygen is a drug and should be treated as one. Most (92.4%) stated they only administered it based on clinical need. For four hypothetical cases, there was only one where the majority of participants identified the optimal oxygen saturation. A number of barriers and facilitators were identified when asked about practicing in accordance with the TSANZ guideline. Lack of oxygen equipment, getting doctors to prescribe oxygen and oxygen being treated differently to other drugs were seen as barriers. The guideline itself and multiple clinician characteristics were considered facilitators. Conclusion: There is discordance between clinicians' beliefs and actions regarding the administration of oxygen therapy and knowledge gaps about optimal oxygen therapy in acute care. Identified barriers and facilitators should be considered when developing evidence-based guidelines to improve dissemination and knowledge exchange.


Asunto(s)
Barreras de Comunicación , Adhesión a Directriz , Terapia por Inhalación de Oxígeno , Guías de Práctica Clínica como Asunto , Enfermedad Pulmonar Obstructiva Crónica/terapia , Facilitación Social , Adulto , Actitud del Personal de Salud , Australia , Estudios Transversales , Conocimientos, Actitudes y Práctica en Salud , Humanos , Nueva Zelanda , Enfermeras Clínicas/psicología , Enfermeras Clínicas/estadística & datos numéricos , Terapia por Inhalación de Oxígeno/métodos , Terapia por Inhalación de Oxígeno/psicología , Terapia por Inhalación de Oxígeno/normas , Médicos/psicología , Médicos/estadística & datos numéricos , Pautas de la Práctica en Medicina/normas
14.
Artículo en Español | MEDLINE | ID: mdl-33069629

RESUMEN

We present the adaptation for Spain of the updated European Cardiovascular Prevention Guidelines. In this update, greater stress is laid on the population approach, and especially on the promotion of physical activity and healthy diet through dietary, leisure and active transport policies in Spain. To estimate vascular risk, note should be made of the importance of recalibrating the tables used, by adapting them to population shifts in the prevalence of risk factors and incidence of vascular diseases, with particular attention to the role of chronic kidney disease. At an individual level, the key element is personalised support for changes in behaviour, adherence to medication in high-risk individuals and patients with vascular disease, the fostering of physical activity, and cessation of smoking habit. Furthermore, recent clinical trials with PCSK9 inhibitors are reviewed, along with the need to simplify pharmacological treatment of arterial hypertension to improve control and adherence to treatment. In the case of patients with type 2 diabetes mellitus and vascular disease or high vascular disease risk, when lifestyle changes and metformin are inadequate, the use of drugs with proven vascular benefit should be prioritised. Lastly, guidelines on peripheral arterial disease and other specific diseases are included, as is a recommendation against prescribing antiaggregants in primary prevention.

15.
BMC Infect Dis ; 20(1): 734, 2020 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-33028245

RESUMEN

BACKGROUND: HIV continues to be the main determinant morbidity with high mortality rates in Sub-Saharan Africa, with a high number of patients being late presenters with advanced HIV. Clinical management of advanced HIV patients is thus complex and requires strict adherence to updated, empirical and simplified guidelines. The current study investigated the impact of the implementation of a new clinical guideline on the management of advanced HIV in Kinshasa, Democratic Republic of Congo (DRC). METHODS: A retrospective analysis of routine clinical data of advanced HIV patients was conducted for the periods; February 2016 to March 2017, before implementation of new guidelines, and November 2017 to July 2018, after the implementation of new guidelines. Eligible patients were patients with CD4 < 200 cell/µl and presenting with at least 1 of 4 opportunistic infections. Patient files were reviewed by a medical doctor and a committee of 3 other doctors for congruence. Statistical significance was set at 0.05%. RESULTS: Two hundred four and Two hundred thirty-one patients were eligible for inclusion before and after the implementation of new guidelines respectively. Sex and age distributions were similar for both periods, and median CD4 were 36 & 52 cell/µl, before and after the new guidelines implementation, respectively. 40.7% of patients had at least 1 missed/incorrect diagnosis before the new guidelines compared to 30% after new guidelines, p < 0.05. Clinical diagnosis for TB and toxoplasmosis were also much improved after the implementation of new guidelines. In addition, only 63% of patients had CD4 count test results before the new guidelines compared to 99% of patients after new guidelines. Death odds after the implementation of new guidelines were significantly lower than before new guidelines in a multivariate regression model that included patients CD4 count and 10 other covariates, p < 0.05. CONCLUSIONS: Simplification and implementation of a new and improved HIV clinical guideline coupled with the installation of laboratory equipment and point of care tests potentially helped reduce incorrect diagnosis and improve clinical outcomes of patients with advanced HIV. Regulating authorities should consider developing simplified versions of guidelines followed by the provision of basic diagnostic equipment to health centers.


Asunto(s)
Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Adolescente , Adulto , Instituciones de Atención Ambulatoria , Recuento de Linfocito CD4 , República Democrática del Congo , Femenino , Guías como Asunto , Infecciones por VIH/complicaciones , Infecciones por VIH/mortalidad , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Toxoplasmosis/complicaciones , Toxoplasmosis/diagnóstico , Tuberculosis/complicaciones , Tuberculosis/diagnóstico , Adulto Joven
16.
Ital J Pediatr ; 46(1): 149, 2020 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-33032650

RESUMEN

The rapid spread of the COVID-19 outbreak in Italy has dramatically impacted the National Healthcare System, causing the sudden congestion of hospitals, especially in Northern Italy, thus imposing drastic restriction of almost all routine medical care. This exceptional adaptation of the Italian National Healthcare System has also been felt by non-frontline settings such as Pediatric Orthopaedic Units, where the limitation or temporary suspension of most routine care activities met with a need to maintain continuity of care and avoid secondary issues due to the delay or suspension of the routine clinical practice. The Italian Society of Pediatric Orthopaedics and Traumatology formulated general and specific recommendations to face the COVID-19 outbreak, aiming to provide essential care for children needing orthopaedic treatments during the pandemic and early post-peak period, ensure safety of children, caregivers and healthcare providers and limit the spread of contagion.


Asunto(s)
Infección Hospitalaria/prevención & control , Prestación de Atención de Salud/organización & administración , Procedimientos Ortopédicos/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Guías de Práctica Clínica como Asunto/normas , Niño , Preescolar , Toma de Decisiones Clínicas , Femenino , Humanos , Italia , Masculino , Salud Laboral/estadística & datos numéricos , Procedimientos Ortopédicos/métodos , Ortopedia/normas , Seguridad del Paciente , Pediatría/normas , Sociedades Médicas/normas , Traumatología/normas
17.
Nutr Metab Cardiovasc Dis ; 30(11): 1945-1953, 2020 10 30.
Artículo en Inglés | MEDLINE | ID: mdl-32998821

RESUMEN

BACKGROUNDS AND AIMS: To investigate relevant indicators of quality of care in a large population-based sample of people with diabetes representative of clinical practice in Italy in 2018. METHODS AND RESULTS: We analyzed data from 11,300,750 subjects. All administrative healthcare claims collected in 2018 were scrutinized to identify subjects with diabetes and investigate several indicators of quality of care. Subjects with diabetes were identified by anti-hyperglycemic drug prescriptions, disease-specific co-payment exemption and hospital discharge codes. Indicators of quality of care pertained to monitoring (HbA1c, creatinine, lipid profile, microalbuminuria, eye examination, ECG, ultrasonography of carotid and lower limb arteries) and diabetes treatment (anti-hyperglycemic agents in subjects with cardiovascular disease, CVD). Subjects attending and nonattending Diabetes Clinics were compared. We identified 697,208 individuals with diabetes. HbA1c was assessed at least once in the year in 62.7%, creatinine in 62.3%, total cholesterol in 59.6%, microalbuminuria in 34.3%. Frequency of eye examination was 8.2%, ECG 23.5%, carotid ultrasonography 14.3%, lower limb ultrasonography 7.6%. Among anti-hyperglycemic drugs, SGLT-2 inhibitors were prescribed to ~5% and GLP-1 receptor agonists to ~5% although the proportion of subjects with CVD was ~45%. Subjects attending Diabetes Clinics had higher figures for all these monitoring and treatment indicators. CONCLUSIONS: The implementation of national and international guidelines regarding disease monitoring and treatment is far from being satisfactory, especially among subjects nonattending Diabetes Clinics. Further efforts and investments are needed for better disseminating guidelines, more efficaciously engaging healthcare professionals and more strongly empowering the healthcare system to improve diabetes care.


Asunto(s)
Instituciones de Atención Ambulatoria/normas , Glucemia/efectos de los fármacos , Diabetes Mellitus/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Indicadores de Calidad de la Atención de Salud/normas , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Glucemia/metabolismo , Diabetes Mellitus/sangre , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Femenino , Hemoglobina A Glucada/metabolismo , Adhesión a Directriz/normas , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto/normas , Pautas de la Práctica en Medicina/normas , Prevalencia , Factores de Tiempo , Resultado del Tratamiento
18.
Anesth Analg ; 131(6): 1911-1922, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33105281

RESUMEN

BACKGROUND: Postoperative delirium is a common and serious problem for older adults. To better align local practices with delirium prevention consensus guidelines, we implemented a 5-component intervention followed by a quality improvement (QI) project at our institution. METHODS: This hybrid implementation-effectiveness study took place at 2 adult hospitals within a tertiary care academic health care system. We implemented a 5-component intervention: preoperative delirium risk stratification, multidisciplinary education, written memory aids, delirium prevention postanesthesia care unit (PACU) orderset, and electronic health record enhancements between December 1, 2017 and June 30, 2018. This was followed by a department-wide QI project to increase uptake of the intervention from July 1, 2018 to June 30, 2019. We tracked process outcomes during the QI period, including frequency of preoperative delirium risk screening, percentage of "high-risk" screens, and frequency of appropriate PACU orderset use. We measured practice change after the interventions using interrupted time series analysis of perioperative medication prescribing practices during baseline (December 1, 2016 to November 30, 2017), intervention (December 1, 2017 to June 30, 2018), and QI (July 1, 2018 to June 30, 2019) periods. Participants were consecutive older patients (≥65 years of age) who underwent surgery during the above timeframes and received care in the PACU, compared to a concurrent control group <65 years of age. The a priori primary outcome was a composite of perioperative American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use (Beers PIM) medications. The secondary outcome, delirium incidence, was measured in the subset of older patients who were admitted to the hospital for at least 1 night. RESULTS: During the 12-month QI period, preoperative delirium risk stratification improved from 67% (714 of 1068 patients) in month 1 to 83% in month 12 (776 of 931 patients). Forty percent of patients were stratified as "high risk" during the 12-month period (4246 of 10,494 patients). Appropriate PACU orderset use in high-risk patients increased from 19% in month 1 to 85% in month 12. We analyzed medication use in 7212, 4416, and 8311 PACU care episodes during the baseline, intervention, and QI periods, respectively. Beers PIM administration decreased from 33% to 27% to 23% during the 3 time periods, with adjusted odds ratio (aOR) 0.97 (95% confidence interval [CI], 0.95-0.998; P = .03) per month during the QI period in comparison to baseline. Delirium incidence was 7.5%, 9.2%, and 8.5% during the 3 time periods with aOR of delirium of 0.98 (95% CI, 0.91-1.05, P = .52) per month during the QI period in comparison to baseline. CONCLUSIONS: A perioperative delirium prevention intervention was associated with reduced administration of Beers PIMs to older adults.


Asunto(s)
Registros Electrónicos de Salud/normas , Delirio del Despertar/prevención & control , Atención Perioperativa/normas , Guías de Práctica Clínica como Asunto/normas , Anciano , Delirio del Despertar/etiología , Femenino , Humanos , Masculino , Atención Perioperativa/métodos , Resultado del Tratamiento
19.
G Ital Nefrol ; 37(5)2020 Oct 05.
Artículo en Italiano | MEDLINE | ID: mdl-33026198

RESUMEN

We report the brief experience of the Nephrology Center located in a "no-COVID" Hospital in Massa Marittima. We describe the actions taken to prevent the transmission of the virus SARS-CoV-2 among hemodialysis patients and healthcare workers and the methods for diagnosing COVID-19, with particular attention to serological tests and nasopharyngeal swabs in asymptomatic subjects. The detection of IgM and IgG antibodies through the serological test performed on 34 patients, all negative for nasopharyngeal swabs, showed positivity in 41,18% of cases. These have been classified as false positives following repeated negative nasopharyngeal swabs, the evaluation of clinical and epidemiological history and of clinical manifestations and, finally, a second serological test performed after 18 days, which resulted negative for all patients. Interpreting serological tests is not easy; the strategies for diagnosis should include clinical and epidemiological history and clinical manifestations, as well as the results of confirmation tests and the evaluation over a precise observation period. Otherwise, there is a risk of considering as protected by antibodies subjects that are in fact false positives.


Asunto(s)
Anticuerpos Antivirales/sangre , Betacoronavirus/inmunología , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Unidades de Hemodiálisis en Hospital/estadística & datos numéricos , Pandemias , Neumonía Viral/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Asintomáticas , Betacoronavirus/aislamiento & purificación , Reacciones Falso Positivas , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Inmunoglobulina M/sangre , Inmunoglobulina M/inmunología , Italia , Masculino , Persona de Mediana Edad , Nasofaringe/virología , Guías de Práctica Clínica como Asunto , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad
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