Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.550
Filtrar
1.
Praxis (Bern 1994) ; 109(11): 879-887, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32873165

RESUMO

CME: Pituitary Incidentaloma in Adults: Key Knowledge for the General Practice Abstract. Incidentally detected pituitary masses, so-called pituitary incidentalomas, are increasing in frequency as the frequency of performing imaging increases. Evaluation of the imaging from a trained neuroradiologist as well as additional endocrinological and, if necessary, neuroophtalmological studies are part of the initial assessment that drives the treatment decision: in the case of benign small lesions with unremarkable assessment results, follow-up is indicated, whereas potentially malignant lesions or lesions with endocrinological or neuroophtalmological irregularities are usually treated. In borderline cases, interdisciplinary work is beneficial for the determination of the case-specific treatment procedure.


Assuntos
Medicina Geral , Neoplasias Hipofisárias , Adulto , Humanos , Achados Incidentais , Neoplasias Hipofisárias/diagnóstico
2.
Clin Interv Aging ; 15: 1427-1437, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32884251

RESUMO

Purpose: Demographic change and lack of specialized workforces are challenging. Likewise, home visits by general practitioners (GPs) become rarer. If a nursing home resident develops acute symptoms, nurses are often inclined to call the rescue service. Besides patient-related consequences, this might lead to unnecessary hospitalization and far-reaching health economic costs. Due to legal restrictions of remote treatment in Germany, which were recently loosened, telemedicine is still in the early stages. The aim of this study was to employ a holistic telemedical system for nursing homes which facilitates the connection to a GP and thus avoids unnecessary hospitalizations in the case of ambulatory-sensitive illnesses. Materials and Methods: After an inter-professional requirement analysis, the iterative development was started. In addition to an audio-video connection, several point of care measurements were integrated. Finally, first field tests were performed in a nursing home in a rural area in Germany. Results: One nursing home was equipped with telemedical system based on the results of the requirement analysis and tele-medically connected to a GP. Over a period of seven months, 56 routine and emergency teleconsultations took place. Only one of those required a hospital admission. In addition to video telephony, electrocardiography and assessment of vitals such as pulse, blood pressure, oxygen saturation and auscultation of heart and lungs were applied frequently. Conclusion: A telemedical system including integrated medical devices was successfully developed and has turned out to be helpful and even necessary for careful and reliable decision-making by the GP. First test results show high acceptance for elderly care. Involved patients, nurses, and the GP itemize various specific benefits, including economic, personal, and altruistic issues. Another issue that the current COVID-19 crisis brought to light is lowering the risk of contagion; GPs can replace their home visits by using telepresence combined with point of care measures.


Assuntos
Infecções por Coronavirus , Medicina Geral/métodos , Casas de Saúde , Pandemias , Pneumonia Viral , Consulta Remota/métodos , Consulta Remota/organização & administração , Idoso , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Feminino , Alemanha , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Consulta Remota/instrumentação , Software , Inquéritos e Questionários
5.
BMJ Case Rep ; 13(8)2020 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-32859618

RESUMO

During the previous months, we have seen the rapid pandemic spread of SARS-CoV-2. Despite being considered a respiratory virus, it has become clear that other clinical presentations are possible and some of these are quite frequent. In this paper, a case of a man in his late 70s showing atypical symptoms in general practice is presented. Apart from fever, the patient complained of diarrhoea, borborygmus, loss of appetite and nausea. He developed no respiratory symptoms during his disease. Due to his symptoms, malignant disease was suspected, and he was referred for further testing which revealed typical COVID-19 findings on a chest CT scan. The occurrence of atypical symptoms is discussed, including the importance of recognising these in an ongoing pandemic.


Assuntos
Anorexia/fisiopatologia , Infecções por Coronavirus/fisiopatologia , Diarreia/fisiopatologia , Hipóxia/fisiopatologia , Pulmão/diagnóstico por imagem , Náusea/fisiopatologia , Pneumonia Viral/fisiopatologia , Idoso , Betacoronavirus , Proteína C-Reativa/metabolismo , Infecções por Coronavirus/diagnóstico , Medicina Geral , Humanos , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Tomografia Computadorizada por Raios X
6.
BMC Infect Dis ; 20(1): 586, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32767968

RESUMO

BACKGROUND: Inappropriate and excessive antimicrobial prescribing can lead to antimicrobial resistance. Antimicrobial Stewardship (AMS) principles are not well established in general practice in Australia despite the relatively high rate of community antimicrobial prescribing. Few interventions have been implemented that have resulted in a significant reduction or improvement in antimicrobial prescribing by General Practitioners (GPs). This study was therefore conducted to assess the impact of a novel GP educational intervention on the appropriateness of antimicrobial prescriptions as well as GP compliance with antimicrobial prescription guidelines. METHODS: In 2018, a simple GP educational intervention was rolled out in a large clinic with the aim of improving antimicrobial prescribing. It included face-to-face education sessions with GPs on AMS principles, antimicrobial resistance, current prescribing guidelines and microbiological testing. An antibiotic appropriateness audit on prescribing practice before and after the educational intervention was conducted. Data were summarised using percentages and compared across time points using Chi-squared tests and Poisson regression (results reported as risk ratios (RR) with 95% confidence intervals (CI)). RESULTS: Data from 376 and 369 prescriptions in July 2016 and July 2018, respectively, were extracted. There were significant improvements in appropriate antimicrobial selection (73.9% vs 92.8%, RR = 1.26; 95% CI = 1.18-1.34), appropriate duration (53.1% vs 87.7%, RR = 1.65; 95% CI = 1.49-1.83) and compliance with guidelines (42.2% vs 58.5%, RR = 1.39, 95% CI = 1.19-1.61) post- intervention. Documentation of antimicrobial duration directions, patient follow-up as well as patient weight significantly increased after the intervention (p < 0.001). There was significant reduction in; prescriptions without a listed indication for antimicrobial therapy, prescriptions without appropriate accompanying microbiological tests and the provision of unnecessary repeat prescriptions (p < 0.001). Inappropriate antimicrobial prescriptions observed pre-intervention for medical termination of pregnancy ceased post-intervention. CONCLUSIONS: Auditing GP antimicrobial prescriptions identified prescribing practices inconsistent with Australian guidelines. However, implementation of a simple education program led to significantly improved antimicrobial prescribing by GPs. These findings indicate the important role of AMS and continued antimicrobial education within general practice.


Assuntos
Anti-Infecciosos/uso terapêutico , Gestão de Antimicrobianos , Medicina Geral/educação , Clínicos Gerais/psicologia , Austrália , Humanos , Prescrição Inadequada/prevenção & controle , Projetos Piloto , Guias de Prática Clínica como Assunto , Prescrições
7.
PLoS One ; 15(8): e0237629, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790804

RESUMO

BACKGROUND: During the COVID-19 pandemic, general practitioners worldwide re-organise care in very different ways because of the lack of evidence-based protocols. OBJECTIVE: This paper describes the organisation and the characteristics of consultations in Belgian out-of-hours primary care during five weekends at the peak of a COVID-19 outbreak and compares it to a similar period in 2019. METHODS: Real-time observational study using pseudonymised routine clinical data extracted out of reports from home visits, telephone- and physical consultations (iCAREdata). Nine general practice cooperatives (GPCs) participated covering a population of 1 513 523. RESULTS: All GPCs rapidly re-organised care in order to handle the outbreak and provide a safe working environment. The average consultation rate was 222 per 100 000 citizens per weekend. These consultations were handled by telephone alone in 40% (N = 6293). A diagnosis at risk of COVID-19 was registered in 6692 (43%) consultations,. Out of 5311 physical consultations, 1460 were at risk of COVID-19 of which 443 (30%) did not receive prior telephone consultation to estimate this risk. Compared to 2019, the workload initially increased due to telephone consultations but afterwards declined drastically. The physical consultation rate declined by 45% with a marked decline in diagnoses unrelated to COVID-19. CONCLUSIONS: General practitioners can rapidly re-organise out-of-hours care to handle patient flows during a COVID-19 outbreak. Forty percent of the out-of-hours primary care contacts are handled by telephone consultations alone. We recommend to give a telephone consultation to all patients and not to rely on call takers to differentiate between infectious and regular care. The demand for physical consultations declined drastically provoking questions about patient's safety for care unrelated to COVID-19.


Assuntos
Plantão Médico/organização & administração , Betacoronavirus , Infecções por Coronavirus/terapia , Medicina Geral/organização & administração , Pneumonia Viral/terapia , Atenção Primária à Saúde/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bélgica/epidemiologia , Criança , Infecções por Coronavirus/virologia , Feminino , Clínicos Gerais , Visita Domiciliar , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Segurança do Paciente , Pneumonia Viral/virologia , Consulta Remota/métodos , Carga de Trabalho , Adulto Jovem
8.
Semergen ; 46 Suppl 1: 35-39, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32646731

RESUMO

OBJECTIVE: To evaluate the prevalence of and factors associated with SARS-CoV-2 infection in general practitioners and nurses from primary care centers and nursing homes in the Healthcare Area of León (Spain). MATERIALS AND METHODS: Cross-sectional study in a convenience sample of professionals from 30 health centers and 30 nursing homes from the primary care management division of the Healthcare Area of Leon. The work center, type of profession, COVID-19 infection, level of exposure, compliance with preventive measures, isolation (if required) and diagnostic tests carried out were collected. The determination of infection was made by differentiated rapid diagnostic test (dRDT), using a finger-stick whole-blood sample. The association of variables with infection was assessed by multivariable non-conditional logistic regression. The true prevalence of SARS-CoV-2 infection was calculated according to two scenarios for RDT (Sensitivity=0.6 and Specificity=0.985; Sensitivity=0.8 and Specificity=1). RESULTS: The true prevalence of SARS-CoV-2 infection was between 4.9% and 11.0%. The observed prevalence was 5.9% and was higher in nursing homes than in primary care centers (9.5% vs. 5.5%). No statistically significant differences were observed by sex, type of professional, level of exposure or compliance with preventive measures. CONCLUSIONS: The prevalence of SARS-CoV-2 infection in this group is low. A high number of professionals remain susceptible to SARS-CoV-2 infection and therefore protective measures should be taken, especially for professionals working in nursing homes.


Assuntos
Infecções por Coronavirus/epidemiologia , Medicina Geral , Casas de Saúde , Enfermagem , Doenças Profissionais/epidemiologia , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde , Adulto , Área Programática de Saúde , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Prevalência , Espanha/epidemiologia
9.
Acta Med Hist Adriat ; 18(1): 3149-164, 2020 06.
Artigo em Servo-Croata (Latino) | MEDLINE | ID: mdl-32638605

RESUMO

Medicine and physicians in Dubrovnik during the last two centuries, i.e. in the period after the dissolution of the Republic of Dubrovnik by Napoleon's Army, have attracted less interest among medical historians. In this paper, the lives and medical careers of two physicians from Dubrovnik, father and son, Baldo and Ante Bibica, have been reconstructed from the end of the nineteenth and the first half of the twentieth century by searching through the contemporary medical journals and newspapers as well as private archives of the members of family Bibica. Baldo Bibica graduated medicine in Vienna and spent the whole professional life as a municipal physician, at first, in the places in the vicinity of Dubrovnik and from 1903 in Gruz. Ante Bibica studied medicine in Graz and in Zagreb to become the first person from Dubrovnik promoted at the School of Medicine, Zagreb University. He specialized in dermatovenereology in Vienna and worked, as a specialist, in Dubrovnik. They both were active in the professional medical societies (at local and national levels) and were influential in the social life in Dubrovnik.


Assuntos
Médicos/história , Áustria-Hungria , Croácia , Dermatologia/história , Medicina Geral/história , História do Século XIX , História do Século XX , Humanos , Sociedades Médicas/história , Venereologia/história
10.
Dtsch Med Wochenschr ; 145(15): 1080-1085, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32731283

RESUMO

COVID-19 challenges GP practice and emergency rooms across Germany. In addition to hygiene, the correct assignment of patients to outpatient, inpatient or intensive care management is difficult. This article provides an overview of aspects of initial care, management and risk assessment in COVID-19 patients. The care of corona infected patients can be improved at the interface between outpatient and inpatient care. There can be no "business as usual" after the crisis! Age, male sex and overweight are among the most important risk factors for serious corona disease. Poor oxygen saturation (< 88 %) and increased signs of inflammation (CRP > 97 mg/l and/or IL-6 > 80 pg/ml) indicate a critical course and should be determined in symptomatic patients. Only through regular dialogue between hospital and practice can meaningful decisions be made to slowly move from individual cases to a basic care structure.


Assuntos
Infecções por Coronavirus , Serviço Hospitalar de Emergência , Medicina Geral , Pandemias , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Feminino , Alemanha , Humanos , Masculino , Oxigênio/sangue , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Medição de Risco , Fatores de Risco
11.
Rev Med Suisse ; 16(700): 1380-1387, 2020 Jul 15.
Artigo em Francês | MEDLINE | ID: mdl-32672018

RESUMO

The management of many traumatic conditions of the hand and wrist can be done or at least initiated by the primary care physician, often the first actor of the scenario. To do so, he must first have performed a correct reading of X-rays made with specific incidences to the suspected pathology. This article reviews the radiological diagnosis of the most common pathologies in hand and wrist traumatology to facilitate interpretation by general practitioners.


Assuntos
Articulação do Punho , Punho , Medicina Geral , Mãos , Humanos , Masculino , Radiografia , Radiologia , Punho/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem
12.
Recenti Prog Med ; 111(7): 454-460, 2020.
Artigo em Italiano | MEDLINE | ID: mdl-32658884

RESUMO

The lockdown of Italy, the re-orientation of many hospital departments into CoViD-19 patient care wards, the need to prevent the general practitioners from being infected has been arising the need of access to medical care in patients isolated at their homes. The specialists of the De Martinis Telemedicine Panel, addressing e-health issues, have been responding to the requests of general practitioners in 14 municipalities of Marche region, by implementing the televideoconsultation to 98 patients, 68 of whom with, certain, probable or supposed to be CoViD-19 infection. The patients were managed from remote until the symptoms were over. Sixty-five patients adhere the televideoconsultation completely and were cured, also with home oxygen therapy and other treatments additional to the standard anti-inflammatory and antibiotic drugs. However, they got stuck to full isolation while making use of no external human resources for health and relying entirely on the electronic prescription of their general practitioner and the help of the cohabiting family members. Two patients abandoned, including one owing to the lack of support from the cohabiting family member, and addressed themselves to the hospital care. However, they required no mechanical ventilation and were discharged being recovered within shortly. One over 90 years' old patient was hospitalised in agreement with the general practitioner for management problems. The results are discussed in relationship to the procedures put in practice, to the perspectives in the use of clinical televideoconsultation in the Italian health system, mainly in support to the primary health care, and to the limitations due to the poor development of other e-health tools such as the citizen's electronic health record.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Medicina Geral/métodos , Serviços de Assistência Domiciliar/organização & administração , Pandemias , Pneumonia Viral/terapia , Telemedicina/métodos , Comunicação por Videoconferência , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Terapia Combinada , Comorbidade , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/prevenção & controle , Registros Eletrônicos de Saúde , Prescrição Eletrônica , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Oxigenoterapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto Jovem
13.
BMJ Open ; 10(6): e039674, 2020 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-32554730

RESUMO

OBJECTIVES: The current COVID-19 pandemic, as well as the measures taken to control it, have a profound impact on healthcare. This study was set up to gain insights into the consequences of the COVID-19 outbreak on the core competencies of general practice, as they are experienced by general practitioners (GPs) on the frontline. DESIGN, SETTING, PARTICIPANTS: We performed a descriptive study using semistructured interviews with 132 GPs in Flanders, using a topic list based on the WONCA definition of core competencies in general practice. Data were analysed qualitatively using framework analysis. RESULTS: Changes in practice management and in consultation strategies were quickly adopted. There was a major switch towards telephone triage and consults, for covid-related as well as for non-covid related problems. Patient-centred care is still a major objective. Clinical decision-making is largely focused on respiratory assessment and triage, and GPs feel that acute care is compromised, both by their own changed focus and by the fact that patients consult less frequently for non-covid problems. Chronic care is mostly postponed, and this will have consequences that will extend and become visible after the corona crisis. Through the holistic eyes of primary care, the current outbreak-as well as the measures taken to control it-will have a profound impact on psychological and socioeconomic well-being. This impact is already visible in vulnerable people and will continue to become clear in the medium and long terms. GPs think that they are at high risk of getting infected. Dropping out and being unable to contribute their part or becoming virus transmitters are reported to be greater concerns than getting ill themselves. CONCLUSIONS: The current times have a profound impact on the core competences of primary care. Although the vast increase in patients soliciting medical help and the necessary separate covid and non-covid flows have been dealt with, GPs are worried about the continuity of regular care and the consequences of the anticovid measures. These may become a threat for the general health of the population and for the provision of primary healthcare in the near and distant future.


Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/terapia , Clínicos Gerais/psicologia , Pneumonia Viral/terapia , Atenção Primária à Saúde/organização & administração , Adulto , Bélgica , Infecções por Coronavirus/psicologia , Gerenciamento Clínico , Feminino , Medicina Geral/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/psicologia , Padrões de Prática Médica/normas , Pesquisa Qualitativa
14.
N Z Med J ; 133(1517): 32-55, 2020 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-32595220

RESUMO

AIMS: To investigate how well the New Zealand PREDICT-CVD risk equations, derived in people aged 30-74 years and US Pooled Cohort Equations (PCEs) derived in people aged 40-79 years, perform for older people. METHODS: The PREDICT cohort study automatically recruits participants when clinicians use PREDICT software to conduct a CVD risk assessment. We identified patients aged 70 years and over, without prior CVD, renal disease or heart failure who had been risk assessed between 2004 and 2016. Equation performance was assessed in five-year age bands using calibration graphs and standard discrimination metrics. RESULTS: 40,161 patients (median 73 years; IQR 71-77) experienced 5,948 CVD events during 185,150 person-years follow-up. PREDICT-CVD equations were well calibrated in 70-74 year olds but underestimated events for women from 75 years and men from 80 years. Discrimination metrics were also poor for these age groups. Recalibrated PCEs overestimated CVD risk in both sexes and had poor discrimination from age 70 years for men and from age 75 years for women. CONCLUSIONS: While PREDICT-CVD equations performed better than PCEs, neither performed well. Multimorbidity and competing risks are likely to contribute to the poor performance and new CVD risk equations need to include these factors.


Assuntos
Doenças Cardiovasculares/epidemiologia , Medicina Geral/métodos , Medição de Risco/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Nova Zelândia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências
15.
Arch Cardiovasc Dis ; 113(6-7): 401-419, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32473996

RESUMO

BACKGROUND: Guidelines have been published concerning patient management after hospitalization for heart failure. The French national healthcare database (Systèmenationaldesdonnéesdesanté; SNDS) can be used to compare these guidelines with real-life practice. AIMS: To study healthcare utilization 30 days before and after hospitalization for heart failure, and the variations induced by the exclusion of institutionalized patients, who are less exposed to outpatient healthcare utilization. METHODS: We identified the first hospitalization for heart failure in 2015 of adult beneficiaries of the health insurance schemes covering 88% of the French population, who were alive 30 days after hospitalization. Outpatient healthcare utilization rates during the 30 days after hospitalization and the median times to outpatient care, together with their interquartile ranges, were described for all patients, and for a subgroup excluding institutionalized patients. RESULTS: Among the 104,984 patients included (mean age 79 years; 52% women), 74% were non-institutionalized (mean age 78 years; 47% women). The frequencies of at least one consultation after hospitalization and the median times to consultation were 69% (total sample) vs. 78% (subgroup excluding institutionalized patients) and 8 days (interquartile range 3; 16) vs. 7 days (3; 15) for general practitioners, 20% vs. 21% and 14 days (7; 23) vs. 16 days (9; 24) for cardiologists and 58% vs. 69% and 3 days (1; 9) vs. 2 days (1; 7) for nurses, with reimbursement of diuretics in 77% vs. 86%, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in 48% vs. 55% and beta-blockers in 55% vs. 63%. Departmental variations, excluding institutionalized patients, were large: general practice consultations (interquartile range 74%; 83%), cardiology consultations (11%; 23%) and nursing care (68%; 77%). CONCLUSIONS: Low outpatient healthcare utilization rates, long intervals to first healthcare utilization and departmental variations indicate a mismatch between guidelines and real-life practice, which is accentuated when including institutionalized patients.


Assuntos
Assistência Ambulatorial/tendências , Recursos em Saúde/tendências , Disparidades em Assistência à Saúde/tendências , Insuficiência Cardíaca/terapia , Programas Nacionais de Saúde , Admissão do Paciente , Alta do Paciente , Padrões de Prática Médica/tendências , Idoso , Idoso de 80 Anos ou mais , Cardiologistas/tendências , Bases de Dados Factuais , Uso de Medicamentos/tendências , Feminino , França , Medicina Geral/tendências , Fidelidade a Diretrizes/tendências , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Serviços de Enfermagem/tendências , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/tendências , Fatores de Tempo
18.
J Med Internet Res ; 22(6): e19786, 2020 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-32540845

RESUMO

BACKGROUND: The coronavirus disease (COVID-19) has become an urgent and serious global public health crisis. Community engagement is the first line of defense in the fight against infectious diseases, and general practitioners (GPs) play an important role in it. GPs are facing unique challenges from disasters and pandemics in delivering health care. However, there is still no suitable mobile management system that can help GPs collect data, dynamically assess risks, and effectively triage or follow-up with patients with COVID-19. OBJECTIVE: The aim of this study is to design, develop, and deploy a mobile-based decision support system for COVID-19 (DDC19) to assist GPs in collecting data, assessing risk, triaging, managing, and following up with patients during the COVID-19 outbreak. METHODS: Based on the actual scenarios and the process of patients using health care, we analyzed the key issues that need to be solved and designed the main business flowchart of DDC19. We then constructed a COVID-19 dynamic risk stratification model with high recall and clinical interpretability, which was based on a multiclass logistic regression algorithm. Finally, through a 10-fold cross-validation to quantitatively evaluate the risk stratification ability of the model, a total of 2243 clinical data consisting of 36 dimension clinical features from fever clinics were used for training and evaluation of the model. RESULTS: DDC19 is composed of three parts: mobile terminal apps for the patient-end and GP-end, and the database system. All mobile terminal devices were wirelessly connected to the back end data center to implement request sending and data transmission. We used low risk, moderate risk, and high risk as labels, and adopted a 10-fold cross-validation method to evaluate and test the COVID-19 dynamic risk stratification model in different scenarios (different dimensions of personal clinical data accessible at an earlier stage). The data set dimensions were (2243, 15) when only using the data of patients' demographic information, clinical symptoms, and contact history; (2243, 35) when the results of blood tests were added; and (2243, 36) after obtaining the computed tomography imaging results of the patient. The average value of the three classification results of the macro-area under the curve were all above 0.71 in each scenario. CONCLUSIONS: DCC19 is a mobile decision support system designed and developed to assist GPs in providing dynamic risk assessments for patients with suspected COVID-19 during the outbreak, and the model had a good ability to predict risk levels in any scenario it covered.


Assuntos
Infecções por Coronavirus/diagnóstico , Sistemas de Apoio a Decisões Clínicas , Medicina Geral/métodos , Clínicos Gerais , Aplicativos Móveis , Pneumonia Viral/diagnóstico , Medição de Risco/métodos , Triagem/métodos , Betacoronavirus , Assistência à Saúde/métodos , Surtos de Doenças , Feminino , Humanos , Masculino , Pandemias , Prognóstico , Saúde Pública/métodos
20.
JMIR Public Health Surveill ; 6(3): e19773, 2020 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-32484782

RESUMO

BACKGROUND: Routinely recorded primary care data have been used for many years by sentinel networks for surveillance. More recently, real world data have been used for a wider range of research projects to support rapid, inexpensive clinical trials. Because the partial national lockdown in the United Kingdom due to the coronavirus disease (COVID-19) pandemic has resulted in decreasing community disease incidence, much larger numbers of general practices are needed to deliver effective COVID-19 surveillance and contribute to in-pandemic clinical trials. OBJECTIVE: The aim of this protocol is to describe the rapid design and development of the Oxford Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID) and its first two platforms. The Surveillance Platform will provide extended primary care surveillance, while the Trials Platform is a streamlined clinical trials platform that will be integrated into routine primary care practice. METHODS: We will apply the FAIR (Findable, Accessible, Interoperable, and Reusable) metadata principles to a new, integrated digital health hub that will extract routinely collected general practice electronic health data for use in clinical trials and provide enhanced communicable disease surveillance. The hub will be findable through membership in Health Data Research UK and European metadata repositories. Accessibility through an online application system will provide access to study-ready data sets or developed custom data sets. Interoperability will be facilitated by fixed linkage to other key sources such as Hospital Episodes Statistics and the Office of National Statistics using pseudonymized data. All semantic descriptors (ie, ontologies) and code used for analysis will be made available to accelerate analyses. We will also make data available using common data models, starting with the US Food and Drug Administration Sentinel and Observational Medical Outcomes Partnership approaches, to facilitate international studies. The Surveillance Platform will provide access to data for health protection and promotion work as authorized through agreements between Oxford, the Royal College of General Practitioners, and Public Health England. All studies using the Trials Platform will go through appropriate ethical and other regulatory approval processes. RESULTS: The hub will be a bottom-up, professionally led network that will provide benefits for member practices, our health service, and the population served. Data will only be used for SQUIRE (surveillance, quality improvement, research, and education) purposes. We have already received positive responses from practices, and the number of practices in the network has doubled to over 1150 since February 2020. COVID-19 surveillance has resulted in tripling of the number of virology sites to 293 (target 300), which has aided the collection of the largest ever weekly total of surveillance swabs in the United Kingdom as well as over 3000 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology samples. Practices are recruiting to the PRINCIPLE (Platform Randomised trial of INterventions against COVID-19 In older PeopLE) trial, and these participants will be followed up through ORCHID. These initial outputs demonstrate the feasibility of ORCHID to provide an extended national digital health hub. CONCLUSIONS: ORCHID will provide equitable and innovative use of big data through a professionally led national primary care network and the application of FAIR principles. The secure data hub will host routinely collected general practice data linked to other key health care repositories for clinical trials and support enhanced in situ surveillance without always requiring large volume data extracts. ORCHID will support rapid data extraction, analysis, and dissemination with the aim of improving future research and development in general practice to positively impact patient care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/19773.


Assuntos
Ensaios Clínicos como Assunto , Infecções por Coronavirus/epidemiologia , Medicina Geral/organização & administração , Sistemas Computadorizados de Registros Médicos , Pneumonia Viral/epidemiologia , Vigilância em Saúde Pública , Humanos , Pandemias , Atenção Primária à Saúde/organização & administração , Sociedades Médicas , Reino Unido/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA