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1.
J Med Internet Res ; 23(3): e26516, 2021 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-33656440

RESUMEN

BACKGROUND: The COVID-19 pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring programs in addition to usual care has demonstrated improved effectiveness in managing patients with heart failure (HF). OBJECTIVE: We aimed to examine the potential clinical and health economic outcomes of a telemonitoring program for management of patients with HF during the COVID-19 pandemic from the perspective of health care providers in Hong Kong. METHODS: A Markov model was designed to compare the outcomes of a care under COVID-19 (CUC) group and a telemonitoring plus CUC group (telemonitoring group) in a hypothetical cohort of older patients with HF in Hong Kong. The model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the model assumptions and the robustness of the base-case results. RESULTS: In the base-case analysis, the telemonitoring group showed a higher QALY gain (1.9007) at a higher cost (US $15,888) compared to the CUC group (1.8345 QALYs at US $15,603). Adopting US $48,937/QALY (1 × the gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, telemonitoring was accepted as a highly cost-effective strategy, with an incremental cost-effective ratio of US $4292/QALY. No threshold value was identified in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, telemonitoring was accepted as cost-effective in 99.22% of 10,000 Monte Carlo simulations. CONCLUSIONS: Compared to the current outpatient care alone under the COVID-19 pandemic, the addition of telemonitoring-mediated management to the current care for patients with HF appears to be a highly cost-effective strategy from the perspective of health care providers in Hong Kong.


Asunto(s)
Atención Ambulatoria , Análisis de Datos , Insuficiencia Cardíaca/epidemiología , Método de Montecarlo , Telemedicina/economía , Telemedicina/métodos , Atención Ambulatoria/economía , Atención Ambulatoria/métodos , Estudios de Cohortes , Análisis Costo-Beneficio , Hong Kong/epidemiología , Humanos , Cadenas de Markov , Pandemias , Años de Vida Ajustados por Calidad de Vida
2.
Trials ; 22(1): 193, 2021 Mar 08.
Artículo en Inglés | MEDLINE | ID: mdl-33685502

RESUMEN

OBJECTIVES: The objective of this trial is to assess whether early antiviral therapy in outpatients with COVID-19 with either favipiravir plus lopinavir/ritonavir, lopinavir/ritonavir alone, or favipiravir alone, is associated with a decrease in viral load of SARS-CoV-2 compared with placebo. TRIAL DESIGN: FLARE is a phase IIA randomised, double-blind, 2x2 factorial placebo-controlled, interventional trial. PARTICIPANTS: This trial is being conducted in the United Kingdom, with Royal Free Hospital, London as the lead site. Participants are non-hospitalised adults with highly suspected COVID-19 within the first 5 days of symptom onset, or who have tested positive with SARS-CoV-2 causing COVID-19 within the first 7 days of symptom onset, or who are asymptomatic but tested positive for SARS-CoV-2 for the first time within the last 48 hours. Inclusion criteria are as follows: 1. Any adult with the following: Symptoms compatible with COVID-19 disease (Fever >37.8°C on at least one occasion AND either cough and/ or anosmia) within the first 5 days of symptom onset (date/time of enrolment must be within the first 5 days of symptom onset) OR ANY symptoms compatible with COVID-19 disease (may include, but are not limited to fever, cough, shortness of breath, malaise, myalgia, headache, coryza) and tested positive for SARS-CoV-2 within the first 7 days of symptom onset) (date/time of enrolment must be within the first 7 days of symptom onset) OR no symptoms but tested positive for SARS-CoV-2 within the last 48 hours (date/time of test must be within 48 hours of enrolment) 2. Male or female aged 18 years to 70 years old inclusive at screening 3. Willing and able to take daily saliva samples 4. Able to provide full informed consent and willing to comply with trial-related procedures Exclusion criteria are as follows: 1. Known hypersensitivity to any of the active ingredients or excipients in favipiravir and matched placebo, and in lopinavir/ritonavir and matched placebo (See Appendix 2) 2. Chronic liver disease at screening (known cirrhosis of any aetiology, chronic hepatitis (e.g. autoimmune, viral, steatohepatitis), cholangitis or any known elevation of liver aminotransferases with AST or ALT > 3 X ULN)* 3. Chronic kidney disease (stage 3 or beyond) at screening: eGFR < 60 ml/min/1.73m2 * 4. HIV infection, if untreated, detectable viral load or on protease inhibitor therapy 5. Any clinical condition which the investigator considers would make the participant unsuitable for the trial 6. Concomitant medications known to interact with favipiravir and matched placebo, and with lopinavir/ritonavir and matched placebo, and carry risk of toxicity for the participant 7. Current severe illness requiring hospitalisation 8. Pregnancy and/ or breastfeeding 9. Eligible female participants of childbearing potential and male participants with a partner of childbearing potential not willing to use highly effective contraceptive measures during the trial and within the time point specified following last trial treatment dose. 10. Participants enrolled in any other interventional drug or vaccine trial (co-enrolment in observational studies is acceptable) 11. Participants who have received the COVID-19 vaccine *Considering the importance of early treatment of COVID-19 to impact viral load, the absence of known chronic liver/ kidney disease will be confirmed verbally by the participant during pre-screening and Screening/Baseline visit. Safety blood samples will be collected at Screening/Baseline visit (Day 1) and test results will be examined as soon as they become available and within 24 hours. INTERVENTION AND COMPARATOR: Participants will be randomised 1:1:1:1 using a concealed online minimisation process into one of the following four arms: Arm 1: Favipiravir + Lopinavir/ritonavir Oral favipiravir at 1800mg twice daily on Day 1, followed by 400mg four (4) times daily from Day 2 to Day 7 PLUS lopinavir/ritonavir at 400mg/100mg twice daily on Day 1, followed by 200mg/50mg four (4) times daily from Day 2 to Day 7. Arm 2: Favipiravir + Lopinavir/ritonavir placebo Oral favipiravir at 1800mg twice daily on Day 1, followed by 400mg four (4) times daily from Day 2 to Day 7 PLUS lopinavir/ritonavir matched placebo at 400mg/100mg twice daily on Day 1, followed by 200mg/50mg four (4) times daily from Day 2 to Day 7. Arm 3: Favipiravir placebo + Lopinavir/ritonavir Oral favipiravir matched placebo at 1800mg twice daily on Day 1, followed by 400mg four (4) times daily from Day 2 to Day 7 PLUS lopinavir/ritonavir at 400mg/100mg twice daily on Day 1, followed by 200mg/50mg four (4) times daily from Day 2 to Day 7. Arm 4: Favipiravir placebo + Lopinavir/ritonavir placebo Oral favipiravir matched placebo at 1800mg twice daily on Day 1, followed by 400mg four (4) times daily from Day 2 to Day 7 PLUS lopinavir/ritonavir matched placebo at 400mg/100mg twice daily on Day 1, followed by 200mg/50mg four (4) times daily from Day 2 to Day 7. MAIN OUTCOMES: The primary outcome is upper respiratory tract viral load at Day 5. SECONDARY OUTCOMES: Percentage of participants with undetectable upper respiratory tract viral load after 5 days of therapy Proportion of participants with undetectable stool viral load after 7 days of therapy Rate of decrease in upper respiratory tract viral load during 7 days of therapy Duration of fever following commencement of trial medications Proportion of participants with hepatotoxicity after 7 days of therapy Proportion of participants with other medication-related toxicity after 7 days of therapy and 14 days post-randomisation Proportion of participants admitted to hospital with COVID-19 related illness Proportion of participants admitted to ICU with COVID-19 related illness Proportion of participants who have died with COVID-19 related illness Pharmacokinetic and pharmacodynamic analysis of favipiravir Exploratory: Proportion of participants with deleterious or resistance-conferring mutations in SARS-CoV-2 RANDOMISATION: Participants will be randomised 1:1:1:1 using a concealed online minimisation process, with the following factors: trial site, age (≤ 55 vs > 55 years old), gender, obesity (BMI <30 vs ≥30), symptomatic or asymptomatic, current smoking status (Yes = current smoker, No = ex-smoker, never smoker), ethnicity (Caucasian, other) and presence or absence of comorbidity (defined as diabetes, hypertension, ischaemic heart disease (including previous myocardial infarction), other heart disease (arrhythmia and valvular heart disease), asthma, COPD, other chronic respiratory disease). BLINDING (MASKING): Participants and investigators will both be blinded to treatment allocation (double-blind). NUMBERS TO BE RANDOMISED (SAMPLE SIZE): 240 participants, 60 in each arm. TRIAL STATUS: Protocol version 4.0 dated 7th January 2021. Date of first enrolment: October 2020. Recruitment is ongoing, with anticipated finish date of 31st March 2021. TRIAL REGISTRATION: The FLARE trial is registered with Clinicaltrials.gov, trial identifying number NCT04499677 , date of registration 4th August 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Asunto(s)
Amidas/uso terapéutico , Antivirales/uso terapéutico , Lopinavir/uso terapéutico , Pirazinas/uso terapéutico , Ritonavir/uso terapéutico , Carga Viral , Atención Ambulatoria , Ensayos Clínicos Fase II como Asunto , Método Doble Ciego , Combinación de Medicamentos , Quimioterapia Combinada , Intervención Médica Temprana , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Reino Unido
3.
World J Gastroenterol ; 27(11): 1022-1042, 2021 Mar 21.
Artículo en Inglés | MEDLINE | ID: mdl-33776370

RESUMEN

Managing inflammatory bowel disease (IBD) during the coronavirus disease 2019 (COVID-19) pandemic has been a challenge faced by clinicians and their patients, especially concerning whether to proceed with biologics and immunosuppressive agents in the background of a global outbreak of a highly contagious new coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2). The knowledge about the impact of this virus on patients with IBD, although it is still scarce, is rapidly evolving. In particular, concerns surrounding medications' impact for IBD on the risk of acquiring SARS-CoV-2 infection or developing COVID-19, and potentially exacerbate viral replication and the COVID-19 course, are a current thinking of both practicing clinicians and providers caring for patients with IBD. Managing patients with IBD infected with SARS-CoV-2 depends on both the clinical activity of the IBD and the occasional development and severity of COVID-19. In this review, we summarize the current data regarding gastrointestinal involvement by SARS-CoV-2 and pharmacologic and surgical management for IBD concerning this infection, and the COVID-19 impact on both the patient's psychological functioning and endoscopy services, and we concisely summarize the telemedicine roles during the COVID-19 pandemic.


Asunto(s)
Productos Biológicos/uso terapéutico , Glucocorticoides/uso terapéutico , Inmunosupresores/uso terapéutico , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Telemedicina , Atención Ambulatoria , Portador Sano , Deprescripciones , Manejo de la Enfermedad , Endoscopía Gastrointestinal , Hospitalización , Humanos , Factores Inmunológicos/uso terapéutico , Enfermedades Inflamatorias del Intestino/complicaciones , Guías de Práctica Clínica como Asunto , Factores de Riesgo , Índice de Severidad de la Enfermedad
5.
Med J (Ft Sam Houst Tex) ; (PB 8-21-01/02/03): 70-78, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33666915

RESUMEN

COVID-19 is a novel disease with complex primary and secondary health effects that may significantly impact the functional independence and quality of life of patients and their families. While the term "rehabilitation" is often associated with exercise, the interventions employed by rehabilitation professionals in both the inpatient and outpatient setting are much more complex and very relevant in caring for individuals hospitalized with respiratory infections. Since the start of the pandemic, the Department of Rehabilitation at Walter Reed National Military Medical Center has cared for over 85% of the military beneficiaries admitted to the hospital for COVID-19. In addition to providing acute inpatient occupational, physical, and recreational therapy to help maximize each patient's functional independence, the rehabilitation team has also developed a novel program to help facilitate the safe discharge and successful recovery and social reintegration for all patients with COVID-19. Using a holistic approach, a team led by Occupational Therapy has applied a needs-based assessment of each patient and developed an individualized treatment plan, which employs home monitoring, virtual health interventions, peer support, and augmentation to case management and behavioral health care. The overall acceptance and satisfaction of this program by the patients and staff has been excellent, with early evidence to suggest improved quality of life and possible mitigation of long-term complications. This article describes the development and essential elements of this unique rehabilitation program so that other military treatment facilities may consider implementing.


Asunto(s)
/rehabilitación , Personal Militar , Terapia Ocupacional , Modalidades de Fisioterapia , Adulto , Anciano , Anciano de 80 o más Años , Atención Ambulatoria , /psicología , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Recuperación de la Función , Integración Social , Adulto Joven
7.
BMC Ophthalmol ; 21(1): 139, 2021 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-33743634

RESUMEN

BACKGROUND: To minimize the risk of viral transmission, ophthalmology practices limited face-to-face encounters to only patients with urgent and emergent ophthalmic conditions in the weeks after the start of the COVID-19 epidemic in the United States. The impact of this is unknown. METHODS: We did a retrospective analysis of the change in the frequency of ICD-10 code use and patient volumes in the 6 weeks before and after the changes in clinical practice associated with COVID-19. RESULTS: The total number of encounters decreased four-fold after the implementation of clinic changes associated with COVID-19. The low vision, pediatric ophthalmology, general ophthalmology, and cornea divisions had the largest total decrease of in-person visits. Conversely, the number of telemedicine visits increased sixty-fold. The number of diagnostic codes associated with ocular malignancies, most ocular inflammatory disorders, and retinal conditions requiring intravitreal injections increased. ICD-10 codes associated with ocular screening exams for systemic disorders decreased during the weeks post COVID-19. CONCLUSION: Ophthalmology practices need to be prepared to experience changes in practice patterns, implementation of telemedicine, and decreased patient volumes during a pandemic. Knowing the changes specific to each subspecialty clinic is vital to redistribute available resources correctly.


Asunto(s)
Centros Médicos Académicos/tendencias , Atención Ambulatoria/tendencias , Oftalmopatías/diagnóstico , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Oftalmología/tendencias , Pautas de la Práctica en Medicina/tendencias , /transmisión , Control de Enfermedades Transmisibles , Humanos , Clasificación Internacional de Enfermedades , Oftalmología/métodos , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Telemedicina/métodos , Estados Unidos
9.
Ned Tijdschr Geneeskd ; 1642021 01 04.
Artículo en Holandés | MEDLINE | ID: mdl-33651521

RESUMEN

METHOD: Registration system initiated by General Practice Research Consortium Netherlands (GPRC-NL). AIM: To obtain national estimates on clinically suspected Covid-19 mortality in general practice and on intensive and palliative covid-19 care provided by general practitioners (GPs) outside hospital, including palliative medication, availability of personal protective equipment, and reasons for not referring to hospital of vulnerable patients during the first three months of the Covid-19 pandemic in The Netherlands. DESIGN: Nationwide registration study, in which 2.331 GP practices in The Netherlands participated from March-June 2020. METHOD: Registration system initiated by General Practice Research Consortium Netherlands (GPRC-NL) through existing digital referral platform ZorgDomein, in which GPs could report PCR-proven and clinically suspected Covid-19 deceased patients to estimate the impact of the Covid-19 pandemic in primary care. RESULTS: GPs reported 1,566 Covid-19 deceased patients, of which 61% (949/1,566) were clinically suspected but not PCR-tested, with large regional differences, and most deaths being reported in the provinces of Brabant and Limburg. Patients had a median duration from onset of symptoms to death of 8 days and a median age of 87 years. GPs reported 1,030 patients for which they delivered intensive or palliative care, of which 56% had a Clinical Frailty Score higher or equal to six. Most mentioned reason for GPs and patients in the decision not going to hospital were the explicit wish of the patient (59%) and somatic vulnerability (52%). CONCLUSION: GPs provided palliative care to a large number of clinically suspected Covid-19 vulnerable patients with large regional differences across The Netherlands. Reported GPs' and patients' considerations to refrain from hospital care can be used to guide future primary care for vulnerable Covid-19 patients.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Cuidados Críticos , Medicina General , Cuidados Paliativos , Anciano de 80 o más Años , /mortalidad , Toma de Decisiones Clínicas , Cuidados Críticos/métodos , Cuidados Críticos/estadística & datos numéricos , Femenino , Medicina General/métodos , Medicina General/estadística & datos numéricos , Humanos , Masculino , Países Bajos/epidemiología , Cuidados Paliativos/métodos , Cuidados Paliativos/estadística & datos numéricos , Prioridad del Paciente , Derivación y Consulta/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , /aislamiento & purificación
11.
Ann R Coll Surg Engl ; 103(3): 167-172, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33645286

RESUMEN

INTRODUCTION: We describe a new service model, the Orthopaedic Assessment Unit (OAU), designed to provide care for trauma patients during the COVID-19 pandemic. Patients without COVID-19 symptoms and isolated musculoskeletal injuries were redirected to the OAU. METHODS: We prospectively reviewed patients throughput during the peak of the global pandemic (7 May 2020 to 7 June 2020) and compared with our historic service provision (7 May 2019 to 7 June 2019). The Mann-Whitney and Fisher Exact tests were used to test the statistical significance of data. RESULTS: A total of 1,147 patients were seen, with peak attendances between 11am and 2pm; 96% of all referrals were seen within 4h. The majority of patients were seen by orthopaedic registrars (52%) and nurse practitioners (44%). The majority of patients suffered from sprains and strains (39%), followed by fractures (22%) and wounds (20%); 73% of patients were discharged on the same day, 15% given follow up, 8% underwent surgery and 3% were admitted but did not undergo surgery. Our volume of trauma admissions and theatre cases decreased by 22% and 17%, respectively (p=0.058; 0.139). There was a significant reduction of virtual fracture clinic referrals after reconfiguration of services (p<0.001). CONCLUSIONS: Rapid implementation of a specialist OAU during a pandemic can provide early definitive trauma care while exceeding national waiting time standards. The fall in trauma attendances was lower than anticipated. The retention of orthopaedic staff in the department to staff the unit and maintain a high standard of care is imperative.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Fracturas Óseas/terapia , Ortopedia/organización & administración , Esguinces y Distensiones/terapia , Adulto , Anciano , Atención Ambulatoria/estadística & datos numéricos , Servicio de Urgencia en Hospital , Planificación Ambiental , Femenino , Fracturas Óseas/diagnóstico , Fracturas Óseas/epidemiología , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Enfermeras Practicantes , Procedimientos Ortopédicos , Cirujanos Ortopédicos , Escocia/epidemiología , Esguinces y Distensiones/diagnóstico , Esguinces y Distensiones/epidemiología , Centros Traumatológicos , Triaje , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/epidemiología , Heridas y Traumatismos/terapia
12.
PLoS One ; 16(3): e0247774, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33662012

RESUMEN

BACKGROUND: Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2), the novel coronavirus that causes coronavirus disease (COVID-19), is creating an unprecedented burden on health care systems across the world due to its high rate of pneumonia-related hospitalizations. This study presents recommendations for the outpatient management of moderate SARS-CoV-2 pneumonia implemented at the Geneva University Hospital, Switzerland, from April 4 to June 30, 2020 and evaluated the impact of these recommendations on patient safety, patient satisfaction, and overall hospital capacity. METHODS: Recommendations for the outpatient management of moderate pneumonia implemented in the Geneva University Hospital (PneumoCoV-Ambu) between April 4 and June 30, 2020, were evaluated prospectively. The primary endpoint was hospitalization. Secondary endpoints were: severity of COVID-19 disease based on a 7-points ordinal scale assessed at 1 and 2 months following SARS-CoV-2 infection; patient satisfaction using a satisfaction survey and the analysis of number of beds and costs potentially averted. RESULTS: A total of 36 patients with COVID-19-related pneumonia were followed between April 4 and May 5, 2020. Five patients (14%) were hospitalized and none died over a median of 30 days follow-up. The majority of patients (n = 31; 86%) were satisfied with the ambulatory care they received. These novel recommendations for outpatient management resulted in sparing an estimated potential 124 hospital bed-nights and CHF 6'826 per capita averted hospitalization costs over the three months period. CONCLUSIONS: Recommendations developed for the outpatient management of COVID-19-related pneumonia were able to spare hospital capacity without increasing adverse patient outcomes. Widely implementing such recommendations is crucial in preserving hospital capacity during this pandemic.


Asunto(s)
Atención Ambulatoria , /terapia , Adulto , Anciano , Atención Ambulatoria/métodos , /epidemiología , Manejo de la Enfermedad , Femenino , Hospitalización , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Índice de Severidad de la Enfermedad , Suiza/epidemiología
13.
JAMA Netw Open ; 4(3): e212618, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33755167

RESUMEN

Importance: This study assesses the role of telehealth in the delivery of care at the start of the COVID-19 pandemic. Objectives: To document patterns and costs of ambulatory care in the US before and during the initial stage of the pandemic and to assess how patient, practitioner, community, and COVID-19-related factors are associated with telehealth adoption. Design, Setting, and Participants: This is a cohort study of working-age persons continuously enrolled in private health plans from March 2019 through June 2020. The comparison periods were March to June in 2019 and 2020. Claims data files were provided by Blue Health Intelligence, an independent licensee of the Blue Cross and Blue Shield Association. Data analysis was performed from June to October 2020. Main Outcomes and Measures: Ambulatory encounters (in-person and telehealth) and allowed charges, stratified by characteristics derived from enrollment files, practitioner claims, and community characteristics linked to the enrollee's zip code. Results: A total of 36 568 010 individuals (mean [SD] age, 35.71 [18.77] years; 18 466 557 female individuals [50.5%]) were included in the analysis. In-person contacts decreased by 37% (from 1.63 to 1.02 contacts per enrollee) from 2019 to 2020. During 2020, telehealth visits (0.32 visit per person) accounted for 23.6% of all interactions compared with 0.3% of contacts in 2019. When these virtual contacts were added, the overall COVID-19 era patient and practitioner visit rate was 18% lower than that in 2019 (1.34 vs 1.64 visits per person). Behavioral health encounters were far more likely than medical contacts to take place virtually (46.1% vs 22.1%). COVID-19 prevalence in an area was associated with higher use of telehealth; patients from areas within the top quintile of COVID-19 prevalence during the week of their encounter were 1.34 times more likely to have a telehealth visit compared with those in the lowest quintile (the reference category). Persons living in areas with limited social resources were less likely to use telehealth (most vs least socially advantaged neighborhoods, 27.4% vs 19.9% usage rates). Per enrollee medical care costs decreased by 15% between 2019 and 2020 (from $358.32 to $306.04 per person per month). During 2020, those with 1 or more COVID-19-related service (1 470 721 members) had more than 3 times the medical costs ($1701 vs $544 per member per month) than those without COVID-19-related services. Persons with 1 or more telehealth visits in 2020 had considerably higher costs than persons having only in-person ambulatory contacts ($2214.10 vs $1337.78 for the COVID-19-related subgroup and $735.87 vs $456.41 for the non-COVID-19 subgroup). Conclusions and Relevance: This study of a large cohort of patients enrolled in US health plans documented patterns of care at the onset of COVID-19. The findings are relevant to policy makers, payers, and practitioners as they manage the use of telehealth during the pandemic and afterward.


Asunto(s)
Atención Ambulatoria , Pautas de la Práctica en Medicina , Telemedicina , Adulto , Atención Ambulatoria/economía , Atención Ambulatoria/métodos , Atención Ambulatoria/estadística & datos numéricos , /prevención & control , Estudios de Cohortes , Costos y Análisis de Costo , Femenino , Humanos , Control de Infecciones/métodos , Seguro de Salud/estadística & datos numéricos , Masculino , Innovación Organizacional/economía , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/organización & administración , Pautas de la Práctica en Medicina/estadística & datos numéricos , Telemedicina/economía , Telemedicina/organización & administración , Telemedicina/estadística & datos numéricos , Estados Unidos/epidemiología
14.
Medicine (Baltimore) ; 100(9): e24163, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655909

RESUMEN

ABSTRACT: No national epidemiological investigations have been conducted recently regarding facial lacerations. The study was performed using the data of 3,634,229 people during the 5-year period from 2014 to 2018 archived by the National Health Information Database (NHID) of the Health Insurance Review and Assessment Service. Preschool and children under 10 years old accounted for about one-third of patients. Facial lacerations were concentrated in the "T-shaped" area, which comprised forehead, nose, lips, and the perioral area. The male to female ratio for all study subjects was 2.16:1. Age and gender are significantly related with each other (P < .001). Mean hospital stays decreased, and numbers of outpatient department visits per patient were highest for hospitals and lowest for health agencies. Over the study period, hospital costs per patient in tertiary and general hospitals increased gradually. Preschool and school-aged children are vulnerable to trauma. Male patients outnumbered female patients by a factor of more than 2. The "T-shaped'" area around forehead is vulnerable to injury. Total cost of medical care benefits per patient in tertiary hospitals was about 7 times on average than in health agencies. Regarding functional, behavioral, and aesthetic outcomes, more attention should be paid to epidemiologic data and hospital costs for facial lacerations.


Asunto(s)
Traumatismos Faciales/epidemiología , Laceraciones/epidemiología , Adolescente , Adulto , Distribución por Edad , Atención Ambulatoria/estadística & datos numéricos , Niño , Preescolar , Bases de Datos Factuales , Traumatismos Faciales/economía , Femenino , Costos de Hospital/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Humanos , Laceraciones/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Programas Nacionales de Salud/estadística & datos numéricos , República de Corea/epidemiología , Distribución por Sexo , Adulto Joven
15.
G Ital Cardiol (Rome) ; 22(3): 188-192, 2021 Mar.
Artículo en Italiano | MEDLINE | ID: mdl-33687369

RESUMEN

The dramatic impact of the COVID-19 pandemic extends beyond the risk of deaths related to virus infection. Excess deaths from other causes, particularly cardiovascular deaths, have been reported worldwide. Our study based on administrative databases of the Emilia-Romagna region demonstrates a 17% excess of out-of-hospital cardiac deaths in the first 2020 semester with a peak of +62% on April. The excess of cardiac deaths may be explained by the indirect consequences of the response to the COVID-19 pandemic. These include a dramatic reduction of hospital admissions during the pandemic, particularly for acute coronary syndromes; an increase of out-of-hospital cardiac arrests; a reduction of outpatient clinic activities and cardiac procedures; long-term cardiovascular effects of COVID-19; and unfavorable cardiac effects of the lockdown imposed by the spread of COVID-19 infection. The knowledge of the indirect consequences of COVID-19 pandemic is important for planning cardiologic strategies.


Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Hospitalización/estadística & datos numéricos , Síndrome Coronario Agudo/epidemiología , Atención Ambulatoria/estadística & datos numéricos , Enfermedades Cardiovasculares/epidemiología , Humanos , Paro Cardíaco Extrahospitalario/epidemiología
16.
BMC Med Educ ; 21(1): 174, 2021 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-33743676

RESUMEN

BACKGROUND: In response to the COVID-19 pandemic, medical schools suspended clinical rotations. This displacement of medical students from wards has limited experiential learning. Concurrently, outpatient practices are experiencing reduced volumes of in-person visits and are shifting towards virtual healthcare, a transition that comes with its own logistical challenges. This article describes a workflow that enabled medical students to engage in meaningful clinical education while helping an institution's outpatient practices implement remote telemedicine visits. METHODS: A 4-week virtual elective was designed to allow clinical learners to participate in virtual telemedicine patient encounters. Students were prepared with EMR training and introduced to a novel workflow that supported healthcare providers in the outpatient setting. Patients were consented to telehealth services before encounters with medical students. All collected clinical information was documented in the EMR, after which students transitioned patients to a virtual Doxy.me video appointment. Surveys were used to evaluate clinical and educational outcomes of students' participation. Elective evaluations and student reflections were also collected. RESULTS: Survey results showed students felt well-prepared to initiate patient encounters. They expressed comfort while engaging with patients virtually during telemedicine appointments. Students identified clinical educational value, citing opportunities to develop patient management plans consistent with in-person experiences. A significant healthcare burden was also alleviated by student involvement. Over 1000 total scheduled appointments were serviced by students who transitioned more than 80 % of patients into virtual attending provider waiting rooms. CONCLUSIONS: After piloting this elective with fourth-year students, pre-clerkship students were also recruited to act in a role normally associated with clinical learners (e.g., elicit patient histories, conduct a review of systems, etc.). Furthermore, additional telemedicine electives are being designed so medical students can contribute to patient care without risk of exposure to COVID-19. These efforts will allow students to continue with their clinical education during the pandemic. Medical educators can adopt a similar workflow to suit evolving remote learning needs.


Asunto(s)
Atención Ambulatoria/métodos , Competencia Clínica , Curriculum , Educación de Pregrado en Medicina/métodos , Pandemias , Telemedicina , Educación a Distancia/métodos , Humanos , Proyectos Piloto , Flujo de Trabajo
17.
Fam Med ; 53(3): 207-210, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33723819

RESUMEN

BACKGROUND AND OBJECTIVES: With the emergence of COVID-19, telemedicine use has increased dramatically as clinicians and patients have looked for alternatives to face-to-face care. Prior research has shown high levels of patient satisfaction and comparable quality of care. Video visits have been hypothesized to be one way to reduce burnout among clinicians, but there has been minimal research on physician views of virtual care. We sought to measure family physician experience with video visits at the start of the COVID-19 pandemic. METHODS: We identified all faculty and resident physicians at a large academic department of family medicine who had conducted a video visit in the prior month and conducted an anonymous online 12-question survey about their experiences, satisfaction, and barriers with care. RESULTS: Most eligible physicians responded (102/109, 94%), of whom half (52%) reported this was their first month trying a video visit. There was very high satisfaction (91% very or somewhat satisfied). The majority of respondents felt that video visits were shorter (54%) or took the same amount of time (38%) as in-person visits. There was concern that many physicians had experienced a visit in which they felt video was not the appropriate platform given patient concerns. CONCLUSIONS: This study is among the first to assess physician experience with video visits. As the visits are perceived as shorter, they may offer a unique opportunity to address clinician burnout. There was a high level of satisfaction at our institution despite multiple technical challenges.


Asunto(s)
Actitud del Personal de Salud , Médicos de Familia/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Atención Ambulatoria/estadística & datos numéricos , Humanos , Satisfacción del Paciente/estadística & datos numéricos , Médicos de Familia/psicología , Estados Unidos
18.
San Salvador; Biblioteca Virtual en Salud de El Salvador; Primera edición; 19.02.2021. 31 p.
No convencional en Español | LILACS, BISSAL | ID: biblio-1147752

RESUMEN

La Organización Mundial de la Salud (OMS), el pasado 11 de marzo de 2020 emitió alerta mundial debido a la propagación del SARS-CoV-2, un virus altamente contagioso que se presentó por primera vez en diciembre de 2019 en Hubei, Wuhan, República Popular de China. Con el propósito de proteger la salud de la población, el gobierno de El Salvador implementó "Medidas Extraordinarias de Prevención y Contención para declarar al territorio Nacional como zona sujeta a Control Sanitario, con el fin de Contener la Pandemia de COVID-19". El Órgano Ejecutivo en el Ramo de Salud anunció dichas medidas el 21 de marzo de 2020 a través del decreto No.12, lo que indica la suspensión de las consultas odontológicas privadas y públicas que no sean emergencia1,2. En el Decreto Ejecutivo No. 12, Artículo 3, literal h2, se hace mención a las excepciones y casos de emergencias y otros relacionados estrictamente con la salud. El decreto custodia por la vida e integridad de la población y en todo su contenido expresa el cuido de las poblaciones vulnerables y que ameritan seguimiento a necesidades prioritarias en salud; tal es el caso de las Emergencias en Odontología, las cuales si no son atendidas de forma oportuna pueden derivar en complicaciones sistémicas en detrimento del sistema inmunológico aumentando el riesgo de letalidad de las personas, independientemente al grupo etario al que pertenezca. En concordancia con el decreto ejecutivo, la Junta de Vigilancia de la Profesión Odontológica (JVPO) a través del Consejo Superior de Salud Pública (CSSP), emite un comunicado de prensa el 24 de marzo en el cual hace una aclaración a los profesionales de la odontología y al público en general, indicando que durante la cuarentena domiciliar se podrán realizar procedimeintos odontológicos exclusivamente de emergencias3.


Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Odontalgia , Atención Ambulatoria , Enfermedades de la Boca
19.
J Am Board Fam Med ; 34(Suppl): S162-S169, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33622832

RESUMEN

The Coronavirus disease 2019 (COVID 19) pandemic has resulted in a rapid shift to telehealth and many services that need in-person care have been avoided. Yet, as practices and payment policies return to a new normal, there will be many questions about what proportion of visits should be done in-person vs telehealth. Using the 2016 National Ambulatory Medical Survey (NAMCS), we estimated what proportion of visits were amenable to telehealth before COVID-19 as a guide. We divided services into those that needed in-person care and those that could be done via telehealth. Any visit that included at least 1 service where in-person care was needed was counted as an in-person only visit. We then calculated what proportion of reported visits and services in 2016 could have been provided via telehealth, as well as what proportion of in-person only services were done by primary care. We found that 66% of all primary care visits reported in NAMCS in 2016 required an in-person service. 90% of all wellness visits and immunizations were done in primary care offices, as were a quarter of all Papanicolaou smears. As practices reopen, patients will need to catch up on many of the in-person only visits that were postponed such as Papanicolaou smears and wellness visits. At the same time, patients and clinicians now accustomed to telehealth may have reservations about returning to in-person only visits. Our estimates may provide a guide to practices as they navigate how to deliver care in a post-COVID-19 environment.


Asunto(s)
Visita a Consultorio Médico/estadística & datos numéricos , Atención Primaria de Salud/métodos , Telemedicina/estadística & datos numéricos , Atención Ambulatoria/estadística & datos numéricos , Humanos , Pandemias , Telemedicina/tendencias
20.
PLoS One ; 16(2): e0247951, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33635926

RESUMEN

BACKGROUND: The SARS-COV-2 pandemic rapidly shifted dynamics around hospitalization for many communities. This study aimed to evaluate how the pandemic altered the experience of healthcare, acute illness, and care transitions among hospitalized patients with substance use disorder (SUD). METHODS: We performed a qualitative study at an academic medical center in Portland, Oregon, in Spring 2020. We conducted semi-structured interviews, and conducted a thematic analysis, using an inductive approach, at a semantic level. RESULTS: We enrolled 27 participants, and identified four main themes: 1) shuttered community resources threatened patients' basic survival adaptations; 2) changes in outpatient care increased reliance on hospitals as safety nets; 3) hospital policy changes made staying in the hospital harder than usual; and, 4) care transitions out of the hospital were highly uncertain. DISCUSSION: Hospitalized adults with SUD were further marginalized during the SARS-COV-2 pandemic. Systems must address the needs of marginalized patients in future disruptive events.


Asunto(s)
Hospitalización , Trastornos Relacionados con Sustancias/terapia , Adulto , Atención Ambulatoria/legislación & jurisprudencia , Manejo de la Enfermedad , Femenino , Hospitalización/legislación & jurisprudencia , Humanos , Tiempo de Internación/legislación & jurisprudencia , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Trastornos Relacionados con Sustancias/epidemiología
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