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1.
J. optom. (Internet) ; 13(4): 257-261, oct.-dic. 2020.
Artículo en Inglés | IBECS | ID: ibc-193462

RESUMEN

The pandemic of the severe acute respiratory syndrome disease caused by the new coronavirus SARS-CoV-2 (COVID-19), had profound impact in many countries and their health care systems. Regarding Portugal, a suppression strategy with social distancing was adopted, attempting to break the transmission chains, bending the epidemy curve and reducing mortality. These measures seek to prevent an eventual National Health Service over-running, enforcing the suspension of all elective and non-urgent health care. Despite the success in so far, there is a consensus on the need to recover the previous level of health care provision and further enhance it. The Portuguese National Health Service, as a public, universal access, health care system funded by the State proved, in this context, its importance and relevance to the Portuguese population. However, long standing issues, such as the pre pandemic over long waiting lists for hospital ophthalmology attendance, whose determinants are fully identified but still unmet, emerge amplified from this pandemic. The lack of primary eye care in the National Health Service is a significant bottleneck, placing a huge stress on hospital-based care. An exclusive ophthalmologist's center care was over-runned before pandemic and will be even more so. The optometrist's exclusion from differentiated, multisectoral and multidisciplinary eye care teams remains the main hurdle to overcome and insure universal eye care in Portugal. National Health Service highlights the consequences of an overcome model. Universal eye care more than ever demands an evidence-based, integrated approach with primary eye care, in the community, on time and of proximity


La pandemia del síndrome respiratorio agudo grave causado por el nuevo coronavirus SARS-CoV-2 (COVID-19) ha tenido amplias repercusiones en muchos países y en sus sistemas sanitarios. En Portugal, se ha adoptado una estrategia de contención basada en el distanciamiento social, con la cual se ha intentado cortar las cadenas de transmisión, frenar la curva de la epidemia y reducir la mortalidad. Con estas medidas se trataba de evitar un eventual desbordamiento del Servicio Nacional de Salud y se imponía la suspensión de toda la atención médica programada, que no fuera urgente. A pesar del éxito logrado hasta este momento, existe consenso sobre la necesidad de recuperar el nivel anterior de atención médica y fomentar su mejora. El Servicio Nacional de Salud de Portugal, como sistema sanitario público y de acceso universal, a cargo del Estado, ha demostrado, en este contexto, su importancia y pertinencia para la población portuguesa. Sin embargo, los problemas que acarrea desde hace mucho tiempo, como las largas listas de espera, anteriores a la pandemia, en la asistencia oftalmológica hospitalaria, cuyos factores determinantes están completamente identificados, pero que continúan sin solución, se han visto agravados a resultas de esta pandemia. La falta de atención primaria oftalmológica en el Servicio Nacional de Salud es un importante cuello de botella, que ejerce una enorme presión en la atención hospitalaria. La atención de un centro exclusivamente oftalmológico estaba desbordada antes de la pandemia y lo estará aún más después de esta. La exclusión de los optómetras de los equipos de atención oftalmológica diferenciados, multisectoriales y multidisciplinarios continúa siendo el principal obstáculo que debe superar y asegurar la atención oftalmológica universal en Portugal. El Servicio Nacional de Salud hace hincapié en las consecuencias de un modelo superado. La atención oftalmológica universal exige, más que nunca, un enfoque integral basado en la evidencia para abordar la atención primaria oftalmológica en la comunidad, puntual y de proximidad


Asunto(s)
Humanos , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Pandemias , Sistemas de Salud , Servicios de Salud Ocular , Atención al Paciente/normas , Portugal/epidemiología
2.
Rev. bioét. derecho ; (50): 189-203, nov. 2020.
Artículo en Español | IBECS | ID: ibc-191353

RESUMEN

La actual pandemia por la COVID-19 está ocasionado serias amenazas para la salud pública a nivel mundial, especialmente para los grupos de población más vulnerables. Los casos más graves de la enfermedad han sido primeramente atendidos por los profesionales de urgencias y emergencias, los cuales han tenido que tomar decisiones en contextos altamente complejos donde la priorización en la asignación de los recursos sanitarios disponibles les ha generado situaciones éticamente conflictivas. El objetivo del presente artículo es analizar la importancia de implantar la PDA en los servicios de urgencias y emergencias como herramienta de consulta en la resolución de los problemas éticos surgidos durante la pandemia por COVID-19, concretamente, en la atención al paciente crónico complejo o con enfermedad crónica avanzada


The events of the present CoVID-19 pandemic are causing serious threats to Public Health worldwide, specifically at the most vulnerable population groups. Emergency professionals have served as the first responders for the most serious cases of this disease. At the same time, they have made decisions in highly complex contexts where the prioritization of allocated care resources has generated ethically conflictive situations. The aim of this article is to analyze the importance of implementing the ACP as a tool in the emergency services to solve ethical problems that have arisen during the COVID-19 pandemic, particularly in the care of complex chronic patients or those with advanced chronic disease


L'actual pandèmia per la COVID-19 està ocasionat serioses amenaces a la salut pública a nivell mundial, especialment als grups de població més vulnerables. Els casos més greus de la malaltia han estat primerament atesos pels professionals d'urgències I emergències, els quals han hagut de prendre decisions en contextos altament complexos on la priorització en l'assignació dels recursos sanitaris disponibles els ha generat situacions èticament conflictives. L'objectiu d'aquest article va ser analitzar la importància d'implantar la PDA en els serveis d'urgències I emergències com a eina de consulta a la resolució dels problemes ètics sorgits durant la pandèmia per COVID-19, concretament, en l'atenció al pacient crònic complex o amb malaltia crònica avançada


Asunto(s)
Humanos , Prioridades en Salud/ética , Prioridades en Salud/organización & administración , Planificación de Atención al Paciente , Toma de Decisiones/ética , Conflicto de Intereses , Servicios Médicos de Urgencia/ética , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Pandemias , Enfermedad Crónica
3.
Spinal Cord Ser Cases ; 6(1): 92, 2020 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-32999271

RESUMEN

INTRODUCTION: We observed individuals affected by spinal cord dysfunction (SCD) after coronavirus disease 2019 (COVID-19). The aim of our report is to provide our initial experience with individuals experiencing SCD after COVID-19 in a referral center in Northern Italy, from February 21 to July 15, 2020. CASE PRESENTATION: We report on three men with SCD after COVID-19. Case 1, aged 69 years, experienced T10 AIS B paraplegia upon awakening due to spinal cord ischemia from T8 to conus medullaris, besides diffuse thromboses, 27 days after the onset of COVID-19 symptoms. Case 2, aged 56 years, reported progressive cervicalgia 29 days after COVID-19 onset associated with C3 AIS C tetraplegia. Magnetic resonance imaging (MRI) revealed a C4-C6 spinal epidural abscess (SEA) requiring a C3-C4 left hemilaminectomy. Case 3, aged 48 years, reported backache together with lower limb muscle weakness on day 16 after being diagnosed with COVID-19. Exam revealed T2 AIS A paraplegia and an MRI showed a T1-T7 SEA. He underwent a T3-T4 laminectomy. Prior to SCD, all three individuals suffered from respiratory failure due to COVID-19, required mechanical ventilation, had cardiovascular risk factors, experienced lymphopenia, and received tocilizumab (TCZ). DISCUSSION: To our knowledge, this is the first report of SCD after COVID-19. Based on our experience, we did not observe a direct viral infection, but there were two different etiologies. In Case 1, the individual developed spinal cord ischemia, whereas in Cases 2 and 3 SEAs were likely related to the use of TCZ used to treat COVID-19.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Enfermedades de la Médula Espinal/diagnóstico por imagen , Médula Espinal/diagnóstico por imagen , Anciano , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/cirugía , Humanos , Laminectomía , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/cirugía , Médula Espinal/cirugía , Enfermedades de la Médula Espinal/etiología , Enfermedades de la Médula Espinal/cirugía
6.
Microorganisms ; 8(10)2020 Oct 13.
Artículo en Inglés | MEDLINE | ID: mdl-33066057

RESUMEN

Kinetics of neutralizing antibodies and immunoglobulin G (IgG) against the nucleo (N) or spike (S) proteins of severe acute respiratory syndrome coronavirus type2 (SARS-CoV-2) were studied in patients up to 165 days after PCR diagnosis of infection. Two immunoassays were selected out of eight IgG or total antibody tests by comparing their specificities and sensitivities. Sensitivities were calculated with convalescent sera from 26 PCR-confirmed cases, of which 76.9% had neutralizing antibodies (>1:10). Stored sera collected during the summer 2018 (N = 50) and winter seasons 2018/2019 (N = 50) were included to demonstrate the test specificities. IgG kinetics, avidities, and virus-neutralizing capacities were recorded over up to 165 days in eleven patients and five individuals from routine diagnostics. Sensitivities, specificities, and diagnostic accuracies ranged between 80.8-96.3%, 96.0-100%, and 93.7-99.2%, respectively. Nearly all results were confirmed with two different SARS-CoV-2-specific immunoblots. Six (54.4%) patients exhibited stable N-specific IgG indices over 120 days and longer; three of them developed IgG of high avidity. The S-specific IgG response was stable in ten (91.0%) patients, and eight (72.7%) had neutralizing antibodies. However, the titers were relatively low, suggesting that sustained humoral immunity is uncertain, especially after outpatient SARS-CoV-2 infection.

9.
CNS Neurosci Ther ; 2020 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-33058536

RESUMEN

BACKGROUND: In this brief report, we investigated the impact of COVID-19 on outpatient stroke clinics and inpatient services and their recovery process. METHODS: We sent a survey to physicians worldwide through the network of the World Stroke Organization to investigate the impact of COVID-19 on stroke clinics. To farther along in recovering from the outbreak, we reviewed stroke and other neurology outpatient clinic visits (approximately 50% were stroke related) and the number of inpatient services from December 2019 to July 2020 in a large neurology department in Shanghai, China, where there was no official city lockdown. RESULTS: We received 112 valid survey responses from 46 countries, representing all continents except for Antarctica. Only seven of the survey responders (7/112, 6.3%) reported that they have kept their outpatient clinics open as usual, but they did exercise increased precautions for COVID-19 by following recent guidelines regarding use of personal protective equipment and isolation techniques. The remainder of the respondents have either reduced outpatient clinic services or suspended outpatient clinics completely. Telephone consultation or telemedicine with video capability was used for new patients or follow-ups, with limited in-person evaluations when necessary. Outpatient clinic visits and inpatient services from a large tertiary hospital in China decreased dramatically during the peak period of the outbreak, but then rebounded back quickly following the partial or full recovery from the outbreak. Compared with the recovery process of inpatient services, outpatient clinic visits decreased faster and recovered much slower. This is consistent with our global survey data which indicates that some outpatient clinics have rescheduled their outpatient visits for 3 to 6 months. CONCLUSIONS: The COVID-19 pandemic caused a significant drop of in-person outpatient visits and inpatient services. Clinic visits recovered slower than inpatient services in stroke and other neurological diseases after the pandemic.

11.
Hum Reprod ; 2020 Oct 05.
Artículo en Inglés | MEDLINE | ID: mdl-33017461

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic created a significant impact on medically assisted reproduction (MAR) services. ESHRE decided to mobilize resources in order to collect, analyse, monitor, prepare and disseminate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) knowledge specifically related to ART and early pregnancy. This paper presents the impact of the SARS-CoV-2 pandemic focusing on reproductive healthcare. It details the rationale behind the guidance prepared to support MAR services in organizing and managing the re-start of treatments or in case of any future wave of COVID-19 disease. The guidance includes information on patient selection and informed consent, staff and patient triage and testing, adaptation of ART services, treatment planning and code of conduct. The initiatives detailed in this manuscript are not necessarily COVID-specific and such action plans could be applied effectively to manage similar emergency situations in different areas of medicine, in the future.

13.
Early Hum Dev ; : 105207, 2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-33039258

RESUMEN

Social distancing mandated by COVID-19 so as to slow viral spread has resulted in school closures. It is now the end of summer 2020 and schools are starting. Reopening schools could be safe if accompanied by precautionary measures. This paper describes the events leading up to school closures in Malta with reference to San Andrea Independent School, and the measures and contingency plans created by the school during Malta's soft lockdown and summer holidays for safe school reopening. As cases rise in the global second wave, all should be done to ensure that clusters and hotspots of COVID-19 are avoided or minimised in schools - whilst children may not generally be severely affected, they may be in contact with vulnerable members of society on whom COVID-19 inflicts significant morbidity and mortality.

14.
Am J Transplant ; 2020 Oct 12.
Artículo en Inglés | MEDLINE | ID: mdl-33047475

RESUMEN

To date, little is known about the duration and effectiveness of immunity as well as possible adverse late effects after an infection with SARS-CoV-2. Thus it is unclear, when and if liver transplantation can be safely offered to patients that suffered from COVID-19. Here, we report on a successful liver transplantation shortly after convalescence from COVID-19 with subsequent partial seroreversion as well as recurrence and prolonged shedding of viral RNA.

17.
NASN Sch Nurse ; : 1942602X20962213, 2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-33000685

RESUMEN

The emergence of coronavirus disease 2019 (COVID-19) has highlighted the need for strong partnerships between educators and healthcare professionals to facilitate the reopening of schools. School nurses are uniquely positioned to bridge this gap because of their role as a healthcare professional in the educational setting. Past research identifies the effectiveness of collaborative efforts to serve students by community partners, school system personnel, and school nurses. However, partnerships have been episodic and reactive rather than ongoing and proactive. The circumstances of COVID-19 present an opportunity for school nurses to promote collaboration and planning as an ongoing practice. Recommendations for school nurses to form ongoing public health and school system partnerships, as well as with teachers, parents, and school nursing colleagues, are presented.

18.
Cancer Control ; 27(1): 1073274820964800, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33023342

RESUMEN

Emergence of the COVID-19 crisis has catalyzed rapid paradigm shifts throughout medicine. Even after the initial wave of the virus subsides, a wholesale return to the prior status quo is not prudent. As a specialty that values the proper application of new technology, radiation oncology should strive to be at the forefront of harnessing telehealth as an important tool to further optimize patient care. We remain cognizant that telehealth cannot and should not be a comprehensive replacement for in-person patient visits because it is not a one for one replacement, dependent on the intention of the visit and patient preference. However, we envision the opportunity for the virtual patient "room" where multidisciplinary care may take place from every specialty. How we adapt is not an inevitability, but instead, an opportunity to shape the ideal image of our new normal through the choices that we make. We have made great strides toward genuine multidisciplinary patient-centered care, but the continued use of telehealth and virtual visits can bring us closer to optimally arranging the spokes of the provider team members around the central hub of the patient as we progress down the road through treatment.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Neoplasias/diagnóstico , Aceptación de la Atención de Salud , Habitaciones de Pacientes/organización & administración , Neumonía Viral/epidemiología , Telemedicina/métodos , Realidad Virtual , Comorbilidad , Humanos , Neoplasias/epidemiología , Pandemias , Satisfacción del Paciente
19.
Ophthalmic Epidemiol ; : 1-3, 2020 Oct 13.
Artículo en Inglés | MEDLINE | ID: mdl-33050755

RESUMEN

Purpose: As ophthalmic elective surgeries resume amidst the COVID-19 pandemic, protocols for testing patients for SARS-CoV-2 is important due to the transmissibility of the virus. Here, we describe the protocol our institution has implemented for screening asymptomatic patients before proceeding to elective ophthalmic surgery. Methods: A retrospective chart review analyzed the number of elective surgeries, results of SARS-CoV-2 testing, and the effect of a positive result on surgery scheduling. Results: We display the screening protocol our institution used to test for SARS-CoV-2. Through its implementation, we found 2 asymptomatic patients who were positive for SARS-CoV-2 resulting in cancellation of their surgeries.  Conclusion: Because of the possibility of positive COVID-19 status in asymptomatic patients and the risk this poses to patients and staff, we recommend testing all asymptomatic patients for SARS-CoV-2 prior to elective surgeries.

20.
Appl Energy ; 280: 115966, 2020 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-33052166

RESUMEN

Emission benefits of transit buses depend on ridership. Declines in ridership caused by COVID-19 leads uncertainty about the emission reduction capacity of buses. This paper provides a method framework for analyzing spatio-temporal emission patterns of buses in combination with real-time ridership and potential emission changes in the post-COVID-19 future. Based on GPS trajectory and Smart Card data of 2056 buses from 278 routes covering 1.5 million ridership in Qingdao, China, spatio-temporal emissions characteristics of buses are studied. 7589 taxis with 0.2 million passengers' trips are used for acquiring private cars' emissions to evaluate the emissions difference between buses and cars. Empirical results show that the average difference between buses and cars with 2 persons can reach up to 117 g/km-person during 7:00-8:59 and 115 g/km-person during 17:00-18:59. However, buses have various emission benefits around the city at different periods. A double increase in emissions during non-rush hours can be observed compared with rush hours. 224 online survey data are used to study the potential ridership reduction trend in post-COVID-19. Results show that 56.3% of respondents would decrease the usage of buses in the post-COVID-19 future. Based on this figure, our analysis shows that per kilometer-person emissions of buses are higher than cars during non-rush hours, however, still lower than cars during rush hours. We conclude that when ridership reduces by more than 40%, buses cannot be "greener" travel modal than cars as before. Finally, several feasible policies are suggested for this potential challenge. Our study provides convincing evidence for understanding the emission patterns of buses, to support better buses investment decisions and promotion on eco-friendly public transport service in the post-COVID-19 future.

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