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1.
Support Care Cancer ; 2021 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-34114098

RESUMEN

PURPOSE: Cancer-related biopsychosocial distress is highly prevalent across the cancer care continuum. The implementation of screening patients for biopsychosocial distress has become a standard of practice in cancer care. With the presence of COVID-19, clinical care has shifted from in-person care to virtual care in many instances. One of the realities of COVID-19 is the significant decrease in screening patients for biopsychosocial symptom burden. METHODS: Given that screening for distress has become an accreditation standard in many cancer programs, in the province of Alberta, Canada, all patients are screened for distress with every visit to the cancer centre. Given the presence of COVID-19, much of cancer care has shifted to being delivered virtually (through mediums such as Zoom). In this paper, we present pre- and post-COVID data on the frequency of distress screening and its impact on patient care. RESULTS: A review of pre- and post-COVID-19 screening for distress questionnaires revealed that patients who received virtual care were less satisfied in the areas of emotional support and received less resources and referrals to supportive care. CONCLUSION: The rapid integration of virtual care without the inclusion of a standardized distress screening tool was akin to a natural experiment, as two groups (virtual and in-person clinic patients) received different levels of care and interventions. Without the inclusion of distress screening, the clinical conversation around symptoms is less likely to occur and results in fewer referrals to best practices in supportive care services. Lessons learned about virtual cancer care without distress screening in the time of COVID-19 demonstrates significantly fewer patients being screened for distress and subsequently has resulted in less supportive care referrals. Going forward, we must find ways to ensure that virtual cancer care continues to support distress screening and best patient-centric care.

2.
J Health Care Poor Underserved ; 32(2): 598-606, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34120960

RESUMEN

In response to the COVID-19 pandemic, the Herbert Wertheim College of Medicine's Neighborhood Health Education Learning Program (NeighborhoodHELP) initiated a longitudinal assessment and mitigation of social and health care challenges for a population of approximately 850 underserved households. Here, we describe the needs assessment, ensuing interventions, and lessons learned during this pandemic.

4.
J Drug Deliv Sci Technol ; : 102634, 2021 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-34127930

RESUMEN

Viral diseases have recently become a threat to human health and rapidly become a significant cause of mortality with a continually exacerbated unfavorable socio-economic impact. Coronaviruses, including severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome (MERS-CoV), and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), have threatened human life, with immense accompanying morbidity rates; the COVID-19 (caused by SARS-CoV-2) epidemic has become a severe threat to global public health. In addition, the design process of antiviral medications usually takes years before the treatments can be made readily available. Hence, it is necessary to invest scientifically and financially in a technology platform that can then be quickly repurposed on demand to be adequately positioned for this kind of pandemic situation through lessons learned from the previous pandemics. Nanomaterials/nanoformulations provide such platform technologies, and a proper investigation into their basic science and biological interactions would be of great benefit for potential vaccine and therapeutic development. In this respect, intelligent and advanced nano-based technologies provide specific physico-chemical properties, which can help fix the key issues related to the treatments of viral infections. This review aims to provide an overview of the latest research on the effective use of nanomaterials in the treatment of coronaviruses. Also raised are the problems, perspectives of antiviral nanoformulations, and the possibility of using nanomaterials effectively against current pandemic situations.

5.
J Infect Public Health ; 14(7): 967-977, 2021 Apr 24.
Artículo en Inglés | MEDLINE | ID: mdl-34130121

RESUMEN

The two genetically similar severe acute respiratory syndrome coronaviruses, SARS-CoV-1 and SARS-CoV-2, have each been responsible for global epidemics of vastly different scales. Although both viruses arose from similar origins, they quickly diverged due to differences in their transmission dynamics and spectrum of clinical presentations. The potential involvement of multiple organs systems, including the respiratory, cardiac, gastrointestinal and neurological, during infection necessitates a comprehensive understanding of the clinical pathogenesis of each virus. The management of COVID-19, initially modelled after SARS and other respiratory illnesses, has continued to evolve as we accumulate more knowledge and experience during the pandemic, as well as develop new therapeutics and vaccines. The impact of these two coronaviruses has been profound for our health care and public health systems, and we hope that the lessons learned will not only bring the current pandemic under control, but also prevent and reduce the impact of future pandemics.

6.
Artículo en Inglés | MEDLINE | ID: mdl-34130913

RESUMEN

BACKGROUND: Ramifications of coronavirus disease 2019 (COVID-19) on the re-structuring of healthcare are widespread, including delivery of surgical services across all specialties, including plastic surgery. Re-deployment of personnel and cessation of elective services are commonplace. However, there is a continued need for both emergency and oncological surgery. A national review of practice was conducted during the COVID-19 pandemic, to assess impact on services, staffing and training. METHODS: Key aspects of current plastic surgery practice in the United Kingdom were examined in this cross-sectional study; operating capacity, location of theatre lists (national health service or outsourced private institutions (PIs)), differences across sub-specialties, change in anaesthesia practices, staffing, re-deployment, on-call provision and impact on training. RESULTS: Three-hundred and forty-four plastic surgeons in the United Kingdom provided practice data across 51 units. Theatre capacity and outpatient services were markedly reduced. Outsourcing of operating lists to PIs was widely utilised. Increased use of local anaesthetic hand procedures, the prioritisation of shorter operations with reduced microsurgery in both head and neck/lower limb and almost complete cessation of breast reconstruction were noted, together with marked regional variations. Re-deployment occurred at all staffing levels, whilst telemedicine played a critical role in both patient management and training. CONCLUSIONS: COVID-19 has enforced unprecedented changes to surgical care delivery and training, as identified by examination of plastic surgery nationally in the United Kingdom. Novel means to support continued elective and emergency services, including oncology have been identified. Lessons learned will allow phased return of services and improved preparation for the future.

8.
Muscle Nerve ; 2021 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-34131929

RESUMEN

INTRODUCTION: The initial surge of the Coronavirus Disease 2019 (COVID-19) pandemic in early 2020 led to widespread cancelation of elective medical procedures in the United States, including non-urgent outpatient and inpatient electrodiagnostic (EDX) studies. As certain regions later saw a downtrend in daily new cases, EDX laboratories have reopened under the guidance of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). In our reopening experience guided by the AANEM, we measured relevant outcomes to determine further workflow adaptations. We aimed to detail our experience and share lessons learned. METHODS: We reviewed the clinical volumes, billing data, diagnosis distributions, and rates of COVID-19 exposure and transmission among patients and staff in our EDX laboratory during the first six months of reopening, starting on June 1, 2020. For context, we detailed the recent AANEM guidelines we adopted at our laboratory, supplemented by other consensus statements. RESULTS: We completed 816 outpatient studies from June 1 to December 1, 2020, reaching 97% of the total volume and 97% of total billing compared to the same time period in 2019. The average Relative Value Units per study were similar. There were no major shifts in diagnosis distributions. We completed 10 out of 12 requested inpatient studies during this period. There were no known COVID-19 transmissions between patients and staff. DISCUSSION: Our experience suggests that it is possible to safely operate an EDX laboratory under the guidance of the AANEM and other experts, with clinical volume and billing rates comparable to pre-pandemic baselines.

9.
Curr Treat Options Oncol ; 22(7): 58, 2021 06 07.
Artículo en Inglés | MEDLINE | ID: mdl-34097148

RESUMEN

OPINION STATEMENT: Cardio-oncology is a field dedicated to the prevention, diagnosis, and management of cardiovascular disease in cancer patients before, during, and after cancer therapy. It is an emerging field with limited opportunities for structured education and training. In the year 2021, we cannot define the requirements of cardio-oncology training without acknowledging the impact of the global coronavirus disease 19 (COVID-19) pandemic. While this pandemic poses significant health risks to patients with cancer and cardiovascular disease as well as the providers who care for them, it also allows novel opportunities for the nascent field of cardio-oncology to readily adapt. In this article, we detail how the COVID-19 pandemic has impacted all aspects of cardio-oncology training, how programs and trainees can adapt to these challenges, and how lessons learned from the COVID-19 era can continue to positively impact cardio-oncology training for the foreseeable future.


Asunto(s)
COVID-19/complicaciones , Enfermedades Cardiovasculares/prevención & control , Neoplasias/tratamiento farmacológico , COVID-19/virología , Enfermedades Cardiovasculares/inducido químicamente , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/virología , Humanos , Oncología Médica/tendencias , Neoplasias/complicaciones , Neoplasias/patología , Neoplasias/virología , SARS-CoV-2/patogenicidad
10.
Ann Intern Med ; 2021 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-34125574

RESUMEN

The development of the National Institutes of Health (NIH) COVID-19 Treatment Guidelines began in March 2020 in response to a request from the White House Coronavirus Task Force. Within 4 days of the request, the NIH COVID-19 Treatment Guidelines Panel was established and the first meeting took place (virtually-as did subsequent meetings). The Panel comprises 57 individuals representing 6 governmental agencies, 11 professional societies, and 33 medical centers, plus 2 community members, who have worked together to create and frequently update the guidelines on the basis of evidence from the most recent clinical studies available. The initial version of the guidelines was completed within 2 weeks and posted online on 21 April 2020. Initially, sparse evidence was available to guide COVID-19 treatment recommendations. However, treatment data rapidly accrued based on results from clinical studies that used various study designs and evaluated different therapeutic agents and approaches. Data have continued to evolve at a rapid pace, leading to 24 revisions and updates of the guidelines in the first year. This process has provided important lessons for responding to an unprecedented public health emergency: Providers and stakeholders are eager to access credible, current treatment guidelines; governmental agencies, professional societies, and health care leaders can work together effectively and expeditiously; panelists from various disciplines, including biostatistics, are important for quickly developing well-informed recommendations; well-powered randomized clinical trials continue to provide the most compelling evidence to guide treatment recommendations; treatment recommendations need to be developed in a confidential setting free from external pressures; development of a user-friendly, web-based format for communicating with health care providers requires substantial administrative support; and frequent updates are necessary as clinical evidence rapidly emerges.

11.
Int J Health Serv ; : 207314211024900, 2021 Jun 14.
Artículo en Inglés | MEDLINE | ID: mdl-34125625

RESUMEN

Hospitals play a critical role in providing essential care during emergencies; however, this essential care can overwhelm the functional capacity of health systems. In Italy, substantial cuts in funding have drastically reduced the resources of the National Health Service (NHS) and contributed to the expansion of the private health sector which, unlike the public health system, does not have the capacity to deal with a health emergency such as coronavirus disease 2019 (COVID-19). The purpose of this article is to show how the privatization of the NHS contributed to making Italy more vulnerable and unprepared to tackle the COVID-19 pandemic. The available capacity and resources in the public and private emergency services systems in Italy are compared, including a focus on the numbers of hospital staff, hospitals, and hospital beds. The reduced funding and subsequent shortfalls in services in the NHS are reasons why extreme measures were needed to increase these resources during the COVID-19 pandemic. A public NHS in Italy would be better prepared for future health emergencies. The lessons learned from the COVID-19 pandemic can help to inform future health systems strategies, to halt the current financial decline and performance loss of national health systems, and to enable better preparation for future health emergencies.

12.
Nurs Adm Q ; 45(3): 234-242, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34060506

RESUMEN

The COVID-19 pandemic hit southeast Michigan hard and a rapid influx of patients forced Beaumont Health to shift rapidly into an emergency management model with a laser focus on transforming clinical care and administrative processes to meet complex patient care needs. Navigating this landscape required agility, surge planning, strong interprofessional teams, transformational leadership, nurse-led innovations, support, and transparency to manage the ever-changing environment. This article explains nursing's response and nurse-led innovations that were implemented to meet the needs of the community, patients, and staff, as well as lessons learned to ensure preparedness for any potential future surge.

13.
Disaster Med Public Health Prep ; : 1-19, 2021 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-34099088

RESUMEN

One of the lessons learned from the COVID-19 pandemic is the utility of an early, flexible and rapidly deployable disease screening and detection response. The largely uncontrolled spread of the pandemic in the United States exposed a range of planning and implementation shortcomings, which if they had been in place before the pandemic emerged, may have changed the trajectory. Disease screening by detection dogs show great promise as a non-invasive, efficient, and cost-effective screening method for COVID-19 infection. We explore evidence of their use in infectious and chronic diseases, the training, oversight, resources required for implementation, and potential uses in various settings. Disease detection dogs may contribute to the current and future public health pandemics; however, further research is needed to extend our knowledge and measurement of their effectiveness and feasibility as a public health intervention tool and efforts are needed ensure public and political support.

14.
Therapie ; 2021 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-34119319

RESUMEN

The marketing authorization granted to SARS-Cov-2 vaccines was accompanied by reinforced safety monitoring plans. These plans' implementation was part of the usual logic of post-marketing surveillance of new and innovative health products. It was especially adapted to the context of post-marketing monitoring of drugs developed according to the usual scientific quality standards but in an accelerated schedule. In Europe, the reinforced surveillance system relies on the complementary strengths of pharmacovigilance and pharmacoepidemiology. If the performances of pharmacovigilance monitoring are incomparable for the detection of safety signals relating to rare events of atypical presentation, it needs to be completed with pharmacoepidemiology activities for more common events, either multifactorial or frequently classified as idiopathic. The pharmacoepidemiological monitoring developed in Europe was elaborated before the first SARS-Cov-2 vaccines where marketed, taking into account the lessons learned from the vaccination campaign against 2009 A (H1N1) influenza. It includes numerous academic studies as well as studies performed within vaccines risk management plans. In terms of safety, those defined a priori mostly concerns a list of pre-established health events of specific interest. Aside of these planned activities, ad-hoc studies will be latter developed on purpose to investigate safety signals or potential signals that could be identified as the result of pharmacovigilance activities. Aside of these regulated activities, as for today, very few studies have been published regarding SARS-Cov-2 vaccines; most of the existing consist in preprints that should be considered with caution. Pharmacoepidemiology of vaccines is thought to allow near-real time monitoring that needs sufficient time to provide with valid results. In the constant urge for information that accompanies COVID-related science, it is important not to make haste the enemy of speed and to let pharmacoepidemiology provides with what it is expected to do: rock-solid scientific information contributing to evidence-based decision-making.

16.
Int J Infect Dis ; 2021 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-34119676

RESUMEN

OBJETIVES: To describe the impact of the COVID-19 pandemic on the diagnosis of HIV and opportunistic infections mortality in Guatemala. METHODS: A retrospective study was conducted to describe the impact of COVID-19 pandemic on people living with HIV in a referral HIV clinic as well as the disruption of the services of a diagnostic laboratory hub (DLH), which provides diagnosis for opportunistic infections to a network of 13 HIV health care facilities. March to August months from two different time periods were used for comparative analysis. These periods included months from March to August: : (i) the pre COVID-19 (2017-2019) and (ii) the COVID-19 period (2020). RESULTS: In the COVID-19 period 7,360 HIV tests were performed at CFLAG in comparison with 16,218 tests performed on average in the pre COVID-19 period, a 54.7% reduction (95% CI, 53.8%-55.4%). OI mortality at 90 days was 10.7% higher in 2020 than observed in 2019 (27.3% vs 16.6%, P = 0.05). Clinical samples for opportunistic infections diagnosis sent to the DLH decreased by 43.7% (95% CI, 41%-46.2%). CONCLUSION: The COVID-19 pandemic is having a substantial impact on HIV care in Guatemala. Diagnostic services for HIV were severely affected and OI mortality increased. Lessons learned must guide the introduction of strategies to reduce the impact of the pandemic.

17.
J Telemed Telecare ; : 1357633X211015547, 2021 Jun 13.
Artículo en Inglés | MEDLINE | ID: mdl-34120506

RESUMEN

INTRODUCTION: The increased use of telehealth to maintain ambulatory care during the COVID-19 pandemic had potential to exacerbate or diminish disparities in access to care. OBJECTIVE: The purpose of this study was to describe patient characteristics associated with successful transition from in-person to virtual care, and video vs audio-only participation. METHODS: This was a retrospective analysis of electronic health record data from all patients with ambulatory visits from 1 October 2019-30 September 2020 in a large integrated health system in the Northeast USA. The outcome of interest was receipt of virtual care, and video vs audio-only participation. We matched home addresses with census-tract level area social vulnerability index (SVI) and Internet access. Among ambulatory care patients, we used logistic regression to identify characteristics associated with virtual participation. Among virtual participants, we identified characteristics associated with video vs audio-only visits. RESULTS: Among 1,241,313 patients, 528,542 (42.6%) were virtual participants. Relative to in-person only, virtual participants were older, more often English-proficient and with activated patient portal. Characteristics associated with virtual participation included patients with: only behavioural health visits, COVID patients, highest quartile of visit frequency, and multiple visit types. Characteristics associated with video participation (relative to audio-only) included being younger and patients with: only behavioural health visits, highest quartile of visit frequency, non-Hispanic black race, limited English proficiency and inactivated portal account. DISCUSSION: In our regional healthcare system, the transition to virtual care during COVID was vital for continued access to care, but substantial inequity remained. Without audio-only visits, access to care would have been even more limited for our most vulnerable patients.

18.
Int J Cogn Ther ; : 1, 2021 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-34122687

RESUMEN

[This corrects the article DOI: 10.1007/s41811-021-00109-7.].

19.
Viruses ; 13(6)2021 05 22.
Artículo en Inglés | MEDLINE | ID: mdl-34067381

RESUMEN

After more than one year of the COVID-19 pandemic, antiviral treatment options against SARS-CoV-2 are still severely limited. High hopes that had initially been placed on antiviral drugs like remdesivir have so far not been fulfilled. While individual case reports provide striking evidence for the clinical efficacy of remdesivir in the right clinical settings, major trials failed to demonstrate this. Here, we highlight and discuss the key findings of these studies and underlying reasons for their failure. We elaborate on how such shortcomings should be prevented in future clinical trials and pandemics. We suggest in conclusion that any novel antiviral agent that enters human trials should first be tested in a post-exposure setting to provide rapid and solid evidence for its clinical efficacy before initiating further time-consuming and costly clinical trials for more advanced disease. In the COVID-19 pandemic this might have established remdesivir early on as an efficient antiviral agent at a more suitable disease stage which would have saved many lives, in particular in large outbreaks within residential care homes.


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , Antivirales/uso terapéutico , COVID-19/tratamiento farmacológico , Adenosina Monofosfato/uso terapéutico , Alanina/uso terapéutico , COVID-19/epidemiología , Humanos , SARS-CoV-2/efectos de los fármacos , SARS-CoV-2/fisiología , Resultado del Tratamiento , Replicación Viral/efectos de los fármacos
20.
J Public Health Policy ; 42(2): 211-221, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34088978

RESUMEN

In order to effectively control spread of coronavirus 2019 (COVID-19), it is essential that jurisdictions have the capacity to rapidly trace close contacts of each and every case. Best practice guidance on how to implement such programs is urgently needed. We describe the early experience in the City and County of San Francisco (CCSF), where the City's Department of Health expanded contact tracing capability in anticipation of changes in San Francisco's 'shelter in place' order between April and June 2020. Important prerequisites to successful scale-up included a rapid expansion of the COVID-19 response workforce, expansion of testing capability, and other containment resources. San Francisco's scale-up offers a model for how other jurisdictions can rapidly mobilize a workforce. We underscore the importance of an efficient digital case management system, effective training, and expansion of supportive service programs for those in quarantine or isolation, and metrics to ensure continuous performance improvement.

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