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2.
J Int Med Res ; 48(7): 300060520939337, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32674650

RESUMO

OBJECTIVE: This study aimed to describe the emergency responses to coronavirus disease 2019 (COVID-19) for pregnant patients at our hospital and their effect on hospital operations and patients' outcomes. METHODS: We developed strategies to prevent hospital-associated transmission of COVID-19 in obstetric care. Infrastructure, including the fever clinic and wards, were modified. Outpatient volume was controlled and screening processes were strictly performed. Verification of the virus was compulsory for non-surgery and non-emergency patients. Emergency operations were performed in a negative pressure theater with surgeons fully protected. Outcomes were analyzed and the patients' characteristics were evaluated. The effect of intervention on depressed and anxious patients was assessed. Data from the first 2 months of 2019 and 2020 were compared. RESULTS: No in-hospital COVID-19 infections occurred in our unit. During the epidemic, patient volume significantly decreased. While major characteristics of patients were similar, a higher prevalence of gestational hypertension was found in 2020 than in 2019. Psychological interventions showed optimistic effects in ameliorating depression and anxiety at the beginning of the COVID-19 pandemic. CONCLUSIONS: Our strategies were effective in preventing in-hospital infection of COVID-19 and reassuring women about the safety of pregnancy. Monitoring and managing psychological issues were necessary during this critical period.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Controle de Infecções , Obstetrícia/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Adulto , Ansiedade/complicações , Temperatura Corporal , China/epidemiologia , Infecções por Coronavirus/psicologia , Depressão/complicações , Feminino , Hospitais , Humanos , Recém-Nascido , Obstetrícia/tendências , Avaliação de Resultados em Cuidados de Saúde , Pacientes Ambulatoriais , Pneumonia Viral/psicologia , Gravidez , Complicações Infecciosas na Gravidez/psicologia , Telemedicina/tendências , Adulto Jovem
3.
J Am Med Dir Assoc ; 21(7): 943-947, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32674824

RESUMO

Residents in long-term care settings are particularly vulnerable to COVID-19 infections and, compared to younger adults, are at higher risk of poor outcomes and death. Given the poor prognosis of resuscitation outcomes for COVID-19 in general, the specter of COVID-19 in long-term care residents should prompt revisiting goals of care. Visitor restriction policies enacted to reduce the risk of transmission of COVID-19 to long-term care residents requires advance care planning discussions to be conducted remotely. A structured approach can help guide discussions regarding the diagnosis, expected course, and care of individuals with COVID-19 in long-term care settings. Information should be shared in a transparent and comprehensive manner to allay the increased anxiety that families may feel during this time. To achieve this, we propose an evidence-based COVID-19 Communication and Care Planning Tool that allows for an informed consent process and shared decision making between the clinician, resident, and their family.


Assuntos
Infecções por Coronavirus/prevenção & controle , Tomada de Decisão Compartilhada , Planejamento em Saúde/organização & administração , Assistência de Longa Duração/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Adulto , Planejamento Antecipado de Cuidados/organização & administração , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Controle de Infecções/organização & administração , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Pandemias/estatística & dados numéricos , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/epidemiologia , Desenvolvimento de Programas , Análise de Sobrevida , Estados Unidos
4.
J Am Med Dir Assoc ; 21(7): 900-904, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32674816

RESUMO

OBJECTIVES: To prevent and control COVID-19 infections, nursing homes across the world have taken very restrictive measures, including a ban for visitors. These restrictive measures have an enormous impact on residents' well-being and pose dilemmas for staff, although primary data are lacking. A Dutch guideline was developed to cautiously open nursing homes for visitors during the COVID-19 pandemic. This study reports the first findings on how the guideline was applied in the local context; the compliance to local protocols; and the impact on well-being of residents, their family caregivers, and staff. DESIGN: A mixed-methods cross-sectional study was conducted. SETTING AND PARTICIPANTS: In total, 26 nursing homes were permitted to enlarge their possibilities for allowing visitors in their facility. These nursing homes were proportionally representative of the Netherlands as they were selected by their local Area Health Authority for participation. At each nursing home, a contact person was selected for participation in the current study. METHODS: A mixed-methods cross-sectional study was conducted, consisting of questionnaire, telephone interviews, analyses of documentation (ie, local visiting protocols), and a WhatsApp group. RESULTS: Variation in local protocols was observed, for example, related to the use of personal protective equipment, location, and supervision of visits. In general, experiences were very positive. All nursing homes recognized the added value of real and personal contact between residents and their loved ones and indicated a positive impact on well-being. Compliance with local guidelines was sufficient to good. No new COVID-19 infections were reported during this time. CONCLUSIONS AND IMPLICATIONS: These results indicate the value of family visitation in nursing homes and positive impact of visits. Based on these results, the Dutch government has decided to allow all nursing homes in the Netherlands to cautiously open their homes using the guidelines. More research is needed on impact and long-term compliance.


Assuntos
Infecções por Coronavirus/prevenção & controle , Guias como Assunto , Controle de Infecções/organização & administração , Casas de Saúde/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Visitas a Pacientes/legislação & jurisprudência , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Avaliação Geriátrica , Fidelidade a Diretrizes , Instituição de Longa Permanência para Idosos/organização & administração , Humanos , Masculino , Países Baixos , Pandemias/estatística & dados numéricos , Segurança do Paciente , Pneumonia Viral/epidemiologia
5.
J Am Med Dir Assoc ; 21(7): 905-908, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32674817

RESUMO

OBJECTIVES: During the Coronavirus disease 2019 (COVID-19) outbreak in the United States, nursing homes became the hotbed for the spread of COVID-19. States developed different policies to mitigate the COVID-19 risks at nursing homes, including limiting nursing home visitation and mandating staff screening. The purpose of this study is to examine whether COVID-19 cases and deaths are related to the nursing home reported quality. DESIGN: We combined the COVID-19 data reported by the California Department of Public Health, quality ratings provided by Nursing Home Compare, and patient racial information from Long-Term Care Focus to examine the association between nursing home reported quality and COVID-19 cases and deaths. SETTINGS AND PARTICIPANTS: Cross-sectional data from 1223 California skilled nursing facilities with reported quality and longitudinal data of COVID-19 cases were used. METHODS: The dependent variable is COVID-19 residents' cases and deaths. The main independent variable is nursing home reported quality. Nursing home ownership, size, years of operation, and patient race composition are also included. RESULTS: Nursing home star ratings and greater percentage of residents from different racial and ethnicity groups were significantly (P < .01) related to increased probability of having a COVID-19 residents' case or death. CONCLUSIONS AND IMPLICATIONS: Nursing homes with 5-star ratings were less likely to have COVID-19 cases and deaths after adjusting for nursing home size and patient race proportion.


Assuntos
Causas de Morte , Infecções por Coronavirus/epidemiologia , Controle de Infecções/organização & administração , Casas de Saúde/organização & administração , Pneumonia Viral/epidemiologia , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Idoso , Idoso de 80 Anos ou mais , California , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Feminino , Humanos , Incidência , Assistência de Longa Duração , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Qualidade da Assistência à Saúde , Medição de Risco , Análise de Sobrevida
6.
J Am Med Dir Assoc ; 21(7): 924-927, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32674820

RESUMO

OBJECTIVES: In the United States, home health agencies (HHAs) provide essential services for patients recovering from post-acute care and older adults who are aging in place. During the COVID-19 pandemic, HHAs may face additional challenges caring for these vulnerable patients. Our objective was to explore COVID-19 preparedness of US HHAs and compare results by urban/rural location. DESIGN: Cross-sectional study. SETTING/PARTICIPANTS: Using a stratified random sample of 978 HHAs, we conducted a 22-item online survey from April 10 to 17, 2020. METHODS: Summary statistics were computed; open-ended narrative responses were synthesized using qualitative methods. RESULTS: Similar to national data, most responding HHAs (n = 121, 12% response rate) were for-profit and located in the South. Most HHAs had infectious disease outbreaks included in their emergency preparedness plan (76%), a staff member in charge of outbreak/disaster preparedness (84%), and had provided their staff with COVID-19 education and training (97%). More urban HHAs had cared for confirmed and recovered COVID-19 patients than rural HHAs, but urban HHAs had less capacity to test for COVID-19 than rural HHAs (9% vs 21%). Most (69%) experienced patient census declines and had a current and/or anticipated supply shortage. Rural agencies were affected less than urban agencies. HHAs have already rationed (69%) or implemented extended use (55%) or limited reuse (61%) of personal protective equipment (PPE). Many HHAs reported accessing supplemental PPE from state/local resources, donations, and do-it-yourself efforts; more rural HHAs had accessed these additional resources compared with urban HHAs. CONCLUSIONS/IMPLICATIONS: This survey reveals challenges that HHAs are having in responding to the COVID-19 pandemic, particularly among urban agencies. Of greatest concern are the declines in patient census, which drastically affect agency revenue, and the shortages of PPE and disinfectants. Without proper protection, HHA clinicians are at risk of self-exposure and viral transmission to patients and vulnerable family members.


Assuntos
Defesa Civil/organização & administração , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças/prevenção & controle , Agências de Assistência Domiciliar/organização & administração , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Humanos , Controle de Infecções , Masculino , Pandemias/estatística & dados numéricos , Equipamento de Proteção Individual/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Medição de Risco , População Rural , Estados Unidos , População Urbana , Populações Vulneráveis/estatística & dados numéricos
7.
J Am Med Dir Assoc ; 21(7): 937-938, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32674823

RESUMO

On February 20, 2020, a man living in the north of Italy was admitted to the emergency room with an atypical pneumonia that later proved to be COVID-19. This was the trigger of one of the most serious clusters of COVID-19 in the world, outside of China. Despite aggressive restraint and inhibition efforts, COVID-19 continues to increase, and the total number of infected patients in Italy is growing daily. After 6 weeks, the total number of patients reached 128,948 cases (April 5, 2020), with the higher case-fatality rate (15,887 deaths) dominated by old and very old patients. This sudden health emergency severely challenged the Italian Health System, in particular acute care hospitals and intensive care units. In 1 hospital, geriatric observation units were created, the experience of which can be extremely useful for European countries, the United States, and all countries that in the coming days will face a similar situation.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Surtos de Doenças/estatística & dados numéricos , Avaliação Geriátrica/métodos , Geriatras/estatística & dados numéricos , Controle de Infecções/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Idoso , Idoso de 80 Anos ou mais , Surtos de Doenças/prevenção & controle , Serviço Hospitalar de Emergência/organização & administração , Feminino , Serviços de Saúde para Idosos/organização & administração , Hospitalização/estatística & dados numéricos , Hospitais de Ensino , Humanos , Unidades de Terapia Intensiva/organização & administração , Itália/epidemiologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Papel do Médico , Medicina de Precisão/métodos , Medição de Risco
8.
Am Surg ; 86(6): 599-601, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32683962

RESUMO

The chief of surgery of a 264-bed acute care facility and clinic system in Topeka, KS, USA, gives a chronology that illustrates the rapid and profound clinical, economic, and emotional impact of the SARS-CoV-2 outbreak on his hospital and community. In his view, the pandemic has laid bare the weaknesses of several factors basic to the modern US health care system and the resulting economic crisis: just-in-time supply chain technology; foreign sourcing of masks, gowns, and critical equipment, all at critical shortages during the crisis; rural hospital closings; lack of excess capacity through maximization of utilization for efficiency; and an overreliance on high revenue elective procedures and tests. His team was tested by an emergency operation for bowel obstruction that put all the isolation protocols into action. Despite their readiness and the success of the operation and the potential for telemedicine as an alternative to in-person evaluations and outpatient visits, the forced cancellation of all elective operations have led to the loss of revenue for both hospital system and providers, furlough and termination of workers, and financial hardship and uncertainty.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Hospitais Comunitários/economia , Corpo Clínico Hospitalar/psicologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Betacoronavirus , Protocolos Clínicos , Procedimentos Cirúrgicos Eletivos/economia , Fechamento de Instituições de Saúde/economia , Humanos , Controle de Infecções/métodos , Obstrução Intestinal/cirurgia , Kansas/epidemiologia , Isolamento de Pacientes , Equipamento de Proteção Individual/provisão & distribução , Downsizing Organizacional/economia , Telemedicina
9.
Artigo em Inglês | MEDLINE | ID: mdl-32690631

RESUMO

The COVID-19 pandemic is considered a mass casualty incident of the most severe nature leading to unearthed uncertainties around management, prevention, and care. As of July 2020, more than twelve million people have tested positive for COVID-19 globally and more than 500 000 people have died. Patients with diabetes are among the most severely affected during this pandemic. Healthcare systems have made emergent changes to adapt to this public health crisis, including changes in diabetes care. Adaptations in diabetes care in the hospital (ie, changes in treatment protocols according to clinical status, diabetes technology implementation) and outpatient setting (telemedicine, mail delivery, patient education, risk stratification, monitoring) have been improvised to address this challenge. We describe how to respond to the current public health crisis focused on diabetes care in the USA. We present strategies to address and evaluate transitions in diabetes care occurring in the immediate short-term (ie, response and mitigation), as well as phases to adapt and enhance diabetes care during the months and years to come while also preparing for future pandemics (ie, recovery, surveillance, and preparedness). Implementing multidimensional frameworks may help identify gaps in care, alleviate initial demands, mitigate potential harms, and improve implementation strategies and outcomes in the future.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/normas , Diabetes Mellitus/terapia , Surtos de Doenças/prevenção & controle , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/métodos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Diabetes Mellitus/virologia , Humanos , Controle de Infecções/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Saúde Pública
10.
J Biol Dyn ; 14(1): 590-607, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32696723

RESUMO

In this paper, we apply optimal control theory to a novel coronavirus (COVID-19) transmission model given by a system of non-linear ordinary differential equations. Optimal control strategies are obtained by minimizing the number of exposed and infected population considering the cost of implementation. The existence of optimal controls and characterization is established using Pontryagin's Maximum Principle. An expression for the basic reproduction number is derived in terms of control variables. Then the sensitivity of basic reproduction number with respect to model parameters is also analysed. Numerical simulation results demonstrated good agreement with our analytical results. Finally, the findings of this study shows that comprehensive impacts of prevention, intensive medical care and surface disinfection strategies outperform in reducing the disease epidemic with optimum implementation cost.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Modelos Biológicos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Número Básico de Reprodução/estatística & dados numéricos , Simulação por Computador , Infecções por Coronavirus/epidemiologia , Epidemias/prevenção & controle , Epidemias/estatística & dados numéricos , Humanos , Controle de Infecções , Conceitos Matemáticos , Dinâmica não Linear , Pneumonia Viral/epidemiologia , Fatores de Risco , Biologia de Sistemas
11.
BMC Res Notes ; 13(1): 352, 2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32703315

RESUMO

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is a pandemic respiratory illness spreading from person-to-person caused by a novel coronavirus and poses a serious public health risk. The goal of this study was to apply a modified susceptible-exposed-infectious-recovered (SEIR) compartmental mathematical model for prediction of COVID-19 epidemic dynamics incorporating pathogen in the environment and interventions. The next generation matrix approach was used to determine the basic reproduction number [Formula: see text]. The model equations are solved numerically using fourth and fifth order Runge-Kutta methods. RESULTS: We found an [Formula: see text] of 2.03, implying that the pandemic will persist in the human population in the absence of strong control measures. Results after simulating various scenarios indicate that disregarding social distancing and hygiene measures can have devastating effects on the human population. The model shows that quarantine of contacts and isolation of cases can help halt the spread on novel coronavirus.


Assuntos
Betacoronavirus , Infecções por Coronavirus/transmissão , Exposição Ambiental , Fidelidade a Diretrizes , Controle de Infecções/métodos , Modelos Teóricos , Pandemias , Pneumonia Viral/transmissão , Busca de Comunicante , Convalescença , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Suscetibilidade a Doenças , Previsões , Higiene das Mãos , Humanos , Controle de Infecções/estatística & dados numéricos , Máscaras , Pandemias/prevenção & controle , Cooperação do Paciente , Isolamento de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Quarentena , Fatores de Tempo , Viagem
13.
Geriatr Gerontol Int ; 20(7): 715-719, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32634849

RESUMO

AIM: To clarify the association of cluster number and size of coronavirus disease 2019 (COVID-19) in long-term care (LTC) hospitals/facilities, general medical/welfare facilities and non-medical/welfare facilities with morbidity and mortality in 47 prefectures during 16 January to 9 May 2020 in Japan. METHODS: Information on COVID-19 clusters (n ≥2), and morbidity and mortality of COVID-19 was collected. RESULTS: A total of 381 clusters with 3786 infected cases were collected, accounting for 23.9% of 15 852 cumulated cases on 9 May 2020. Although the cluster number (/107 subjects) in LTC hospitals/facilities was significantly smaller compared with those in the other two groups, the cluster size in LTC hospitals/facilities was significantly larger than that in non-medical/welfare facilities. Cluster numbers in general medical/welfare facilities and in non-medical/welfare facilities were significantly positively correlated with morbidity (/105 ), indicating relatively early identification of clusters in these facilities. Unlike in these facilities, cluster size in LTC hospitals/facilities was significantly positively correlated with morbidity, indicating that clusters in LTC hospitals/facilities were finally identified after already having grown to a large size in areas where infection was prevalent. Multivariate logistic regression analysis showed that both cluster number and cluster size only in LTC hospitals/facilities were independently associated with higher mortality (≥median 0.64/105 subjects) after adjustment. CONCLUSIONS: Preventive efforts against COVID-19 outbreaks even at the early phase of the epidemic are critically important in LTC hospitals/facilities, as both the larger number and size of clusters only in LTC hospitals/facilities were independently linked to higher mortality in prefectures in Japan. Geriatr Gerontol Int 2020; 20: 715-719.


Assuntos
Infecções por Coronavirus , Hospitais de Doenças Crônicas/estatística & dados numéricos , Assistência de Longa Duração , Pandemias , Pneumonia Viral , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Idoso , Betacoronavirus/isolamento & purificação , Análise por Conglomerados , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Controle de Infecções/organização & administração , Japão/epidemiologia , Assistência de Longa Duração/métodos , Assistência de Longa Duração/organização & administração , Assistência de Longa Duração/tendências , Masculino , Mortalidade , Pandemias/prevenção & controle , Pneumonia Viral/mortalidade , Pneumonia Viral/prevenção & controle
15.
Oncology (Williston Park) ; 34(7): 265-269, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32674214

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has rapidly spread all over the world in the past several months. No effective treatment for COVID-19 has been established. High transmissibility and considerable mortality rates have forced many national governments to implement quarantine measures. Many patients with cancer rely on clinical trials to receive their oncologic care, but the routine conduct of clinical trials has substantially changed because of the COVID-19 pandemic. The oncology research community should implement formal policies based on the guidance given from regulatory agencies, with the goal of minimizing the risks of COVID-19 infection while maintaining appropriate oncologic treatments for patients during this pandemic.


Assuntos
Infecções por Coronavirus , Controle de Infecções/organização & administração , Oncologia , Neoplasias/terapia , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral , Betacoronavirus , Gestão de Mudança , Ensaios Clínicos como Assunto/métodos , Ensaios Clínicos como Assunto/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Oncologia/métodos , Oncologia/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gestão da Segurança
16.
Oncology (Williston Park) ; 34(7): 280-282, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32674217

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has rapidly spread all over the world in the past several months. No effective treatment for COVID-19 has been established. High transmissibility and considerable mortality rates have forced many national governments to implement quarantine measures. Many patients with cancer rely on clinical trials to receive their oncologic care, but the routine conduct of clinical trials has substantially changed because of the COVID-19 pandemic. The oncology research community should implement formal policies based on the guidance given from regulatory agencies, with the goal of minimizing the risks of COVID-19 infection while maintaining appropriate oncologic treatments for patients during this pandemic.


Assuntos
Ensaios Clínicos como Assunto/organização & administração , Infecções por Coronavirus , Oncologia , Neoplasias/terapia , Pandemias , Pneumonia Viral , Telemedicina , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Controle de Infecções , Oncologia/métodos , Oncologia/tendências , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Quarentena , Telemedicina/métodos , Telemedicina/tendências
17.
J Am Med Dir Assoc ; 21(7): 895-899.e1, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32674815

RESUMO

OBJECTIVES: Many nursing home residents infected with SARS-CoV-2 fail to be identified with standard screening for the associated COVID-19 syndrome. Current nursing home COVID-19 screening guidance includes assessment for fever, defined as a temperature of at least 38.0°C. The objective of this study was to describe the temperature changes before and after universal testing for SARS-CoV-2 in nursing home residents. DESIGN: Cohort study. SETTING AND PARTICIPANTS: The Veterans Administration (VA) operates 134 Community Living Centers (CLC), similar to nursing homes, that house residents who cannot live independently. VA guidance to CLCs directed daily clinical screening for COVID-19 that included temperature assessment. MEASURES: All CLC residents (n = 7325) underwent SARS-CoV-2 testing. We report the temperature in the window of 14 days before and after universal SARS-CoV-2 testing among CLC residents. Baseline temperature was calculated for 5 days before the study window. RESULTS: SARS-CoV-2 was identified in 443 (6.0%) residents. The average maximum temperature in SARS-CoV-2-positive residents was 37.66 (0.69) compared with 37.11 (0.36) (P = .001) in SARS-CoV-2-negative residents. Temperatures in those with SARS-CoV-2 began rising 7 days before testing and remained elevated during the 14-day follow-up. Among SARS-CoV-2-positive residents, only 26.6% (n = 118) met the fever threshold of 38.0°C during the survey period. Most residents (62.5%, n = 277) with confirmed SARS-CoV-2 did experience 2 or more 0.5°C elevations above their baseline values. One cohort of SARS-CoV-2 residents' (20.3%, n = 90) temperatures never deviated >0.5°C from baseline. CONCLUSIONS AND IMPLICATIONS: A single screening for temperature is unlikely to detect nursing home residents with SARS-CoV-2. Repeated temperature measurement with a patient-derived baseline can increase sensitivity. The current fever threshold as a screening criteria for SARS-CoV-2 infection should be reconsidered.


Assuntos
Infecções por Coronavirus/diagnóstico , Febre/diagnóstico , Programas de Rastreamento/métodos , Casas de Saúde/organização & administração , Pneumonia Viral/diagnóstico , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Idoso , Idoso de 80 Anos ou mais , Temperatura Corporal/fisiologia , Técnicas de Laboratório Clínico/métodos , Estudos de Coortes , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças/prevenção & controle , Diagnóstico Precoce , Feminino , Febre/epidemiologia , Humanos , Controle de Infecções , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Termômetros/estatística & dados numéricos , Estados Unidos , Veteranos
18.
J Pediatr Ophthalmol Strabismus ; 57(4): 213-216, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32687204

RESUMO

The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for coronavirus disease 2019 (COVID-19), which represents a public health threat and has been declared a pandemic by the World Health Organization. The authors describe the treatment of pediatric patients with ophthalmological problems during the COVID-19 pandemic in an Italian tertiary eye center. [J Pediatr Ophthalmol Strabismus. 2020;57(4):213-216.].


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças , Oftalmopatias/terapia , Controle de Infecções/métodos , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto/normas , Criança , Pré-Escolar , Higiene das Mãos , Humanos , Lactente , Recém-Nascido , Itália , Pandemias , Equipamento de Proteção Individual , Centros de Atenção Terciária
19.
Radiology ; 296(2): E26-E31, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32687455

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic initially manifested in the United States in the greater Seattle area and has rapidly progressed across the nation in the past 2 months, with the United States having the highest number of cases in the world. Radiology departments play a critical role in policy and guideline development both for the department and for the institutions, specifically in planning diagnostic screening, triage, and management of patients. In addition, radiology workflows, volumes, and access must be optimized in preparation for the expected surges in the number of patients with COVID-19. In this article, the authors discuss the processes that have been implemented at the University of Washington in managing the COVID-19 pandemic as well in preparing for patient surges, which may provide important guidance for other radiology departments who are in the early stages of preparation and management.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico por imagem , Controle de Infecções/organização & administração , Pneumonia Viral/diagnóstico por imagem , Serviço Hospitalar de Radiologia/organização & administração , Poluentes Ocupacionais do Ar/análise , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Política de Saúde , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Programas de Rastreamento/métodos , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , Washington
20.
Air Med J ; 39(4): 251-256, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32690299

RESUMO

Recent coronavirus disease 2019 (COVID-19) events have presented challenges to health care systems worldwide. Air medical movement of individuals with potential infectious disease poses unique challenges and threats to crews and receiving personnel. The US Department of Health and Human Services air medical evacuation teams of the National Disaster Medical System directly supported 39 flights, moving over 2,000 individuals. Infection control precautions focused on source and engineering controls, personal protective equipment, safe work practices to limit contamination, and containment of the area of potential contamination. Source control to limit transmission distance was used by requiring all passengers to wear masks (surgical masks for persons under investigation and N95 for known positives). Engineering controls used plastic sheeting to segregate and treat patients who developed symptoms while airborne. Crews used Tyvek (Dupont Richmond, VA) suits with booties and a hood, a double layer of gloves, and either a powered air-purifying respirator or an N95 mask with a face shield. For those outside the 6-ft range, an N95 mask and gloves were worn. Safe work practices were used, which included mandatory aircraft surface decontamination, airflow exchanges, and designated lavatories. Although most patients transported were stable, to the best of our knowledge, this represents the largest repatriation of potentially contagious patients in history without infection of any transporting US Department of Health and Human Services air medical evacuation crews.


Assuntos
Medicina Aeroespacial , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Transporte de Pacientes/métodos , Betacoronavirus , China , Infecções por Coronavirus/terapia , Medicina de Desastres , Desinfecção , Equipamentos e Provisões , Governo Federal , Pessoal de Saúde , Humanos , Eliminação de Resíduos de Serviços de Saúde , Isolamento de Pacientes/métodos , Equipamento de Proteção Individual , Admissão e Escalonamento de Pessoal , Pneumonia Viral/terapia , Quarentena/métodos , Navios , Estados Unidos , United States Dept. of Health and Human Services
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