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1.
Biomed Environ Sci ; 34(5): 395-399, 2021 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-34059177

RESUMEN

Climate change has been referred to as one of the greatest threats to human health, with reports citing likely increases in extreme meteorological events. In this study, we estimated the relationships between temperature and outpatients at a major hospital in Qingdao, China, during 2015-2017, and assessed the morbidity burden. The results showed that both low and high temperatures were associated with an increased risk of outpatient visits. High temperatures were responsible for more morbidity than low temperatures, with an attributed fraction (AF) of 16.86%. Most temperature-related burdens were attributed to moderate cold and hot temperatures, with AFs of 5.99% and 14.44%, respectively, with the young (0-17) and male showing greater susceptibility. The results suggest that governments should implement intervention measures to reduce the adverse effects of non-optimal temperatures on public health-especially in vulnerable groups.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Enfermedades Cardiovasculares/etiología , Frío/efectos adversos , Enfermedades del Sistema Digestivo/etiología , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Calor/efectos adversos , Enfermedades Respiratorias/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/terapia , Niño , Preescolar , China/epidemiología , Costo de Enfermedad , Enfermedades del Sistema Digestivo/epidemiología , Enfermedades del Sistema Digestivo/terapia , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Distribución de Poisson , Enfermedades Respiratorias/epidemiología , Enfermedades Respiratorias/terapia , Factores de Riesgo , Adulto Joven
3.
S Afr Med J ; 111(3): 240-244, 2021 03 02.
Artículo en Inglés | MEDLINE | ID: mdl-33944745

RESUMEN

BACKGROUND: The COVID-19 pandemic has impacted on the global surgery landscape. OBJECTIVES: To analyse and describe the initial impact of the COVID-19 pandemic on orthopaedic surgery at Groote Schuur Hospital, a tertiary academic hospital in South Africa. METHODS: The number of orthopaedic surgical cases, emergency theatre patient waiting times, and numbers of outpatient clinic visits, ward admissions, bed occupancies and total inpatient days for January - April 2019 (pre-COVID-19) were compared with the same time frame in 2020 (COVID-19). The COVID-19 timeframe included initiation of a national 'hard lockdown' from 26 March 2020, in preparation for an increasing volume of COVID-19 cases. RESULTS: April 2020, the time of the imposed hard lockdown, was the most affected month, although the number of surgical cases had started to decrease slowly during the 3 preceding months. The total number of surgeries, outpatient visits and ward admissions decreased significantly during April 2020 (55.2%, 69.1% and 60.6%, respectively) compared with April 2019 (p<0.05). Trauma cases were reduced by 40% in April 2020. Overall emergency theatre patient waiting time was 30% lower for April 2020 compared with 2019. CONCLUSIONS: COVID-19 and the associated lockdown has heavily impacted on both orthopaedic inpatient and outpatient services. Lockdown led to a larger reduction in the orthopaedic trauma burden than in international centres, but the overall reduction in surgeries, outpatient visits and hospital admissions was less. This lesser reduction was probably due to local factors, but also to a conscious decision to avoid total collapse of our surgical services.


Asunto(s)
COVID-19/epidemiología , Procedimientos Ortopédicos/estadística & datos numéricos , Neumonía Viral/epidemiología , Atención Ambulatoria/estadística & datos numéricos , Ocupación de Camas/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Hospitales Urbanos , Humanos , Tiempo de Internación/estadística & datos numéricos , Pandemias , SARS-CoV-2 , Sudáfrica/epidemiología , Centros de Atención Terciaria , Listas de Espera
4.
Epilepsia Open ; 6(2): 437-442, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34033234

RESUMEN

OBJECTIVE: Hyperventilation (HV) is one of the main and basic activation methods during ambulatory electroencephalogram (EEG), unless medical reasons contraindicate it. During the COVID-19 pandemic, with the high risk of human-to-human infection, local guidelines and recommendations have been developed that suggest not to perform the HV maneuver routinely. Our objective was to characterize patients who present positive HV in an epilepsy center. METHODS: We analyzed retrospectively all the ambulatory EEGs performed during one year in our specialized ambulatory child and adolescent epilepsy center, and describe patients with positive maneuver. RESULTS: A total of 305 EEGs were performed. Patients under 3 years and 11 months were excluded as well as all patients that did not fill up the criteria for epilepsy diagnosis. From the 252 EEGs that were included in the study, 194 EEGs (77%) were classified as abnormal and 58 (23%) as normal. From these same 252 EEGs, 150 EEG finished correctly the HV maneuver. Physiological slowing response was found in 54 EEGs (36%), no changes (negative) in 83 (55%), and abnormal response (positive) in 13 EEGs (9%). The 13 HV-positive EEGs showed 4 patients with an increase of epileptiform activity, 3 patients experienced an increase of basal preregistered abnormal slowing, and 6 EEGs showed trigger of bilaterally synchronous and symmetric 2-4 Hz spike-and-slow wave discharges and absences. None of these last 6 patients needed more than 3 minutes to elicit the paroxysmal discharge. SIGNIFICANCE: Based on these findings and according with other studies, the low positivity and high specificity of the HV maneuver support the idea that HV could be excluded during the COVID-19 pandemic situation, and also reevaluate whether it could be changed to a complementary maneuver, restricted only for cases where absence epilepsy is suspected. Larger studies will be needed to reaffirm this proposal.


Asunto(s)
Atención Ambulatoria , COVID-19 , Electroencefalografía/métodos , Epilepsia Tipo Ausencia , Adolescente , Atención Ambulatoria/métodos , Atención Ambulatoria/estadística & datos numéricos , COVID-19/epidemiología , COVID-19/prevención & control , Niño , Chile/epidemiología , Técnicas de Diagnóstico Neurológico/normas , Técnicas de Diagnóstico Neurológico/tendencias , Epilepsia Tipo Ausencia/diagnóstico , Epilepsia Tipo Ausencia/epidemiología , Epilepsia Tipo Ausencia/fisiopatología , Femenino , Humanos , Hiperventilación , Masculino , Estudios Retrospectivos , SARS-CoV-2 , Convulsiones/diagnóstico , Convulsiones/fisiopatología , Sensibilidad y Especificidad
5.
J Prim Care Community Health ; 12: 21501327211017016, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33985374

RESUMEN

BACKGROUND: Coronavirus infection (COVID) presents with flu-like symptoms and can cause serious complications. Here, we discuss the presentation and outcomes of COVID in an ambulatory setting along with distribution of positive cases amongst healthcare workers (HCWs). METHOD: Patients who visited the COVID clinic between 03/11/2020 and 06/14/2020 were tested based on the CDC guidelines at the time using PCR-detection methods. Medical records were reviewed and captured on a RedCap database. Statistical analysis was performed using both univariate and bivariate analysis using Fischer's exact test with 2-sided P values. RESULTS: Of the 2471 evaluated patients, 846 (34.2%) tested positive for COVID. Mean age of positivity was 43.4 years (SD ± 15.4), 60.1% were female and 49% were Black. 58.7% of people tested had a known exposure, and amongst those with exposure, 57.3% tested positive. Ninety-four patients were hospitalized (11.1%), of which 22 patients (23.4%) required ICU admission and 10 patients died. The overall death rate of patients presenting to clinic was 0.4%, or 1.2% amongst positive patients. Median length of hospital stay was 6 days (range 1-51). Symptoms significantly associated with COVID included: anosmia, fever, change in taste, anorexia, myalgias, cough, chills, and fatigue. Increased risk of COVID occurred with diabetes, whereas individuals with lung disease or malignancy were not associated with increased risk of COVID. Amongst COVID positive HCWs, the majority were registered nurses (23.4%), most working in general medicine (39.8%) followed by critical care units (14.3%). DISCUSSION/CONCLUSION: Blacks and females had the highest infection rates. There was a broad range in presentation from those who are very ill and require hospitalization and those who remain ambulatory. The above data could assist health care professionals perform a targeted review of systems and co-morbidities, allowing for appropriate patient triage.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , COVID-19/diagnóstico , Guías como Asunto , Personal de Salud/estadística & datos numéricos , Pacientes Ambulatorios/estadística & datos numéricos , Triaje , Adulto , Anciano , COVID-19/epidemiología , Prueba de COVID-19 , Infección Hospitalaria , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos , SARS-CoV-2 , Población Urbana
6.
BMC Cancer ; 21(1): 578, 2021 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-34016086

RESUMEN

BACKGROUND: The viral pandemic coronavirus disease 2019 (COVID-19) has disrupted cancer patient management around the world. Most reported data relate to incidence, risk factors, and outcome of severe COVID-19. The safety of systemic anti-cancer therapy in oncology patients with non-severe COVID-19 is an important matter in daily practice. METHODS: ONCOSARS-1 was a single-center, academic observational study. Adult patients with solid tumors treated in the oncology day unit with systemic anti-cancer therapy during the initial phase of the COVID-19 pandemic in Belgium were prospectively included. All patients (n = 363) underwent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) serological testing after the first peak of the pandemic in Belgium. Additionally, 141 of these patients also had a SARS-CoV-2 RT-PCR test during the pandemic. The main objective was to retrospectively determine the safety of systemic cancer treatment, measured by the rate of adverse events according to the Common Terminology Criteria for Adverse Events, in SARS-CoV-2-positive patients compared with SARS-CoV-2-negative patients. RESULTS: Twenty-two (6%) of the 363 eligible patients were positive for SARS-CoV-2 by RT-PCR and/or serology. Of these, three required transient oxygen supplementation, but none required admission to the intensive care unit. Hematotoxicity was the only adverse event more frequently observed in SARS-CoV-2 -positive patients than in SARS-CoV-2-negative patients: 73% vs 35% (P < 0.001). This association remained significant (odds ratio (OR) 4.1, P = 0.009) even after adjusting for performance status and type of systemic treatment. Hematological adverse events led to more treatment delays for the SARS-CoV-2-positive group: 55% vs 20% (P < 0.001). Median duration of treatment interruption was similar between the two groups: 14 and 11 days, respectively. Febrile neutropenia, infections unrelated to COVID-19, and bleeding events occurred at a low rate in the SARS-CoV-2-positive patients. CONCLUSION: Systemic anti-cancer therapy appeared safe in ambulatory oncology patients treated during the COVID-19 pandemic. There were, however, more treatment delays in the SARS-CoV-2-positive population, mainly due to a higher rate of hematological adverse events.


Asunto(s)
COVID-19/diagnóstico , COVID-19/epidemiología , Neoplasias/terapia , Anciano , Atención Ambulatoria/estadística & datos numéricos , Bélgica/epidemiología , COVID-19/complicaciones , Instituciones Oncológicas , Estudios de Cohortes , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Factores de Riesgo , SARS-CoV-2
7.
Orthop Clin North Am ; 52(3): 209-214, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34053566

RESUMEN

This study compares anterior supine intermuscular total hip arthroplasty performed at an ambulatory surgery center with the same procedure performed in a hospital setting in regard to complications and costs. The ambulatory surgery center had significantly shorter postoperative stays and superior visual analog pain scores at 3 months. No differences were noted in operative time, blood loss, or complications. Costs were significantly different between groups, with significant cost savings noted in the ambulatory surgery center group.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Artroplastia de Reemplazo de Cadera , Hospitalización , Complicaciones Posoperatorias/epidemiología , Atención Ambulatoria/economía , Atención Ambulatoria/métodos , Atención Ambulatoria/estadística & datos numéricos , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Procedimientos Quirúrgicos Ambulatorios/economía , Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/economía , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Persona de Mediana Edad
8.
J Clin Psychiatry ; 82(3)2021 04 06.
Artículo en Inglés | MEDLINE | ID: mdl-33989466

RESUMEN

OBJECTIVE: By forcing closure of schools, curtailing outpatient services, and imposing strict social distancing, the COVID-19 pandemic has abruptly affected the daily life of millions worldwide, with still unclear consequences for mental health. This study aimed to evaluate if and how child and adolescent psychiatric visits to hospital emergency departments (EDs) changed during the pandemic lockdown, which started in Italy on February 24, 2020. METHODS: We examined all ED visits by patients under 18 years of age in the 7 weeks prior to February 24, 2020, and in the subsequent 8 weeks of COVID-19 lockdown at two urban university hospitals, in Turin and Rome, Italy. ED visits during the corresponding periods of 2019 served as a comparison using Poisson regression modeling. The clinician's decision to hospitalize or discharge home the patient after the ED visit was examined as an index of clinical severity. RESULTS: During the COVID-19 lockdown, there was a 72.0% decrease in the number of all pediatric ED visits (3,395) compared with the corresponding period in 2019 (12,128), with a 46.2% decrease in psychiatric visits (50 vs 93). The mean age of psychiatric patients was higher in the COVID-19 period (15.7 vs 14.1 years). No significant changes were found in hospitalization rate or in the prevalence distribution of the primary reason for the psychiatric ED visit (suicidality, anxiety/mood disorders, agitation). CONCLUSIONS: In the first 8 weeks of the COVID-19-induced social lockdown, the number of child and adolescent psychiatric ED visits significantly decreased, with an increase in patient age. This decrease does not appear to be explained by severity-driven self-selection and might be due to a reduction in psychiatric emergencies or to the implementation of alternative ways of managing acute psychopathology.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , COVID-19 , Urgencias Médicas/epidemiología , Servicios de Urgencia Psiquiátrica , Hospitalización/estadística & datos numéricos , Trastornos Mentales , Distanciamiento Físico , Adolescente , Factores de Edad , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/psicología , Niño , Control de Enfermedades Transmisibles/métodos , Educación a Distancia , Servicios de Urgencia Psiquiátrica/organización & administración , Servicios de Urgencia Psiquiátrica/estadística & datos numéricos , Femenino , Humanos , Italia/epidemiología , Masculino , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Salud Mental/estadística & datos numéricos , Innovación Organizacional , SARS-CoV-2
9.
J Psychosoc Oncol ; 39(3): 416-427, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33792503

RESUMEN

BACKGROUND: The novel coronavirus (COVID-19) rapidly shifted psychosocial services to telepsychology, including psychosocial oncology (PSO) practices. PSO providers work with patients undergoing treatment, experiencing treatment delays and/or immuno-suppression in the context of a global pandemic. There is evidence to support the acceptability of telepsychology among cancer patients and an emerging need for data to inform the design and provision of telepsychology PSO care during the pandemic and beyond. RESEARCH OBJECTIVES: This study examined engagement in telepsychology PSO care at an outpatient community cancer center. METHODS: The current study analyzed practice data from a PSO department from March 2020 through September 2020. The sample included 354 patients (91 established; 263 newly referred). Descriptive, correlational, and comparative analyses were conducted. RESULTS: Among established patients, 93% continued with telepsychology PSO care after the pandemic and 94% completed at least one telepsychology appointment. Among newly referred patients, 50.6% scheduled a telepsychology appointment, consistent with the scheduling rate for the proceeding calendar year (50%). Across patients scheduling telepsychology PSO appointments (N = 194), 68 initially engaged in phone-based services with 20 converting to video, for a total of 127 (76.5%) patients utilizing video-based PSO services. Common reasons for phone-based services included 'patient preference' (N = 14), 'lack of access' (N = 9), and 'technology barriers' (N = 8). During this timeframe, 18% had at least one no-show, which is significantly less than the preceding year (23%). Phone-based patients were significantly older (p =.007). A greater proportion of males engaged in phone-based services compared to females (p = .006). CONCLUSIONS: Telepsychology PSO engages new and existing patients during the COVID-19 pandemic. There may be an increased demand for services and increased utilization in the context of the pandemic and the availability of telepsychology. There are disparities and access issues that should be considered and addressed.


Asunto(s)
COVID-19 , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Neoplasias/psicología , Neoplasias/rehabilitación , Intervención Psicosocial/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Atención Ambulatoria/estadística & datos numéricos , Servicios de Salud Comunitaria/estadística & datos numéricos , Femenino , Humanos , Intervención basada en la Internet/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Psicooncología/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Teléfono/estadística & datos numéricos
10.
JAMA Netw Open ; 4(4): e215854, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33852002

RESUMEN

Importance: Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in vulnerable populations, given the regulatory requirements for video visit technology. Objective: To explore the association of audio-only virtual prenatal care with perinatal outcomes. Design, Setting, and Participants: This cohort study compared perinatal outcomes of women who delivered between May 1 and October 31, 2019 (n = 6559), and received in-person prenatal visits only with those who delivered between May 1 and October 31, 2020 (n = 6048), when audio-only virtual visits were integrated into prenatal care during the COVID-19 pandemic, as feasible based on pregnancy complications. Parkland Health and Hospital System in Dallas, Texas, provides care to the vulnerable obstetric population of the county via a high-volume prenatal clinic system and public maternity hospital. All deliveries of infants weighing more than 500 g, whether live or stillborn, were included. Exposures: Prenatal care incorporating audio-only prenatal care visits. Main Outcomes and Measures: The primary outcome was a composite of placental abruption, stillbirth, neonatal intensive care unit admission in a full-term (≥37 weeks) infant, and umbilical cord blood pH less than 7.0. Visit data, maternal characteristics, and other perinatal outcomes were also examined. Results: The mean (SD) age of the 6559 women who delivered in 2019 was 27.8 (6.4) years, and the age of the 6048 women who delivered in 2020 was 27.7 (6.5) years (P = .38). Of women delivering in 2020, 1090 (18.0%) were non-Hispanic Black compared with 1067 (16.3%) in 2019 (P = .04). In the 2020 cohort, 4067 women (67.2%) attended at least 1 and 1216 women (20.1%) attended at least 3 audio-only virtual prenatal visits. Women who delivered in 2020 attended a greater mean (SD) number of prenatal visits compared with women who delivered in 2019 (9.8 [3.4] vs 9.4 [3.8] visits; P < .001). In the 2020 cohort, 173 women (2.9%) experienced the composite outcome, which was not significantly different than the 195 women (3.0%) in 2019 (P = .71). In addition, the rate of the composite outcome did not differ substantially when examined according to the number of audio-only virtual visits attended. Conclusions and Relevance: Implementation of audio-only virtual prenatal visits was not associated with changes in perinatal outcomes and increased prenatal visit attendance in a vulnerable population during the COVID-19 pandemic when used in a risk-appropriate model.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , COVID-19 , Parto Obstétrico/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Adulto , Femenino , Humanos , Embarazo , Complicaciones del Embarazo/epidemiología , Resultado del Embarazo , Atención Prenatal/métodos , SARS-CoV-2 , Texas/epidemiología
11.
Medicine (Baltimore) ; 100(15): e25435, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847644

RESUMEN

BACKGROUND: While this reduced-visit prenatal care model during the COVID-19 pandemic is well-intentioned, there is still a lack of relevant evidence to prove its effectiveness. Therefore, in order to provide new evidence-based medical evidence for clinical treatment, we undertook a systematic review and meta-analysis to assess the efficacy of reduced-visit prenatal care model during the COVID-19 pandemic. METHODS: The online literature will be searched using the following combination of medical subject heading terms: "prenatal care" OR "prenatal nursing" AND "reduced-visit" OR "reduce visit" OR "virtual visit." MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science will be searched without any language restrictions. A standard data extraction form is used independently by 2 reviewers to retrieve the relevant data from the articles. The outcome measures are as following: pregnancy-related stress, satisfaction with care, quality of care. The present study will be performed by Review Manager Software (RevMan Version 5.3, The Cochrane Collaboration, Copenhagen, Denmark). P < .05 is set as the significance level. RESULTS: It is hypothesized that reduced-visit prenatal care model will provide similar outcomes compared with traditional care model. CONCLUSIONS: The results of our review will be reported strictly following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria and the review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/WYMB7.


Asunto(s)
Atención Ambulatoria , COVID-19 , Práctica Clínica Basada en la Evidencia , Atención Prenatal/organización & administración , Atención Ambulatoria/métodos , Atención Ambulatoria/estadística & datos numéricos , COVID-19/epidemiología , COVID-19/prevención & control , Práctica Clínica Basada en la Evidencia/métodos , Práctica Clínica Basada en la Evidencia/normas , Práctica Clínica Basada en la Evidencia/tendencias , Femenino , Humanos , Control de Infecciones/métodos , Metaanálisis como Asunto , Embarazo , Proyectos de Investigación , SARS-CoV-2 , Revisiones Sistemáticas como Asunto
12.
Medicine (Baltimore) ; 100(15): e25495, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847662

RESUMEN

ABSTRACT: While the new Coronavirus Disease 2019 (COVID-19) pandemic rapidly spread across the world, South America was reached later in relation to Asia, Europe and the United States of America (USA). Brazil concentrates now the largest number of cases in the continent and, as the disease speedily progressed throughout the country, prompt and challenging operational strategies had to be taken by institutions caring for COVID-19 and non-COVID-19 patients in order to assure optimal workflows, triage, and management. Although hospitals in the USA, Europe and Asia have shared their experience on this subject, little has been discussed about such strategies in South America or by the perspective of outpatient centers, which are paramount in the radiology field. This article shares the guidelines adopted early in the pandemic by a nationwide outpatient healthcare center composed by a network of more than 200 patient service centers and nearly 2,000 radiologists in Brazil, discussing operational and patient management strategies, staff protection, changes adopted in the fellowship program, and the effectiveness of such measures.


Asunto(s)
Atención Ambulatoria , COVID-19 , Gestión del Cambio , Defensa Civil , Vías Clínicas , Planificación Estratégica , Tecnología Radiológica , Atención Ambulatoria/métodos , Atención Ambulatoria/organización & administración , Atención Ambulatoria/estadística & datos numéricos , Brasil/epidemiología , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/prevención & control , Defensa Civil/organización & administración , Defensa Civil/estadística & datos numéricos , Vías Clínicas/organización & administración , Vías Clínicas/tendencias , Humanos , Innovación Organizacional , Guías de Práctica Clínica como Asunto , SARS-CoV-2 , Planificación Estratégica/normas , Planificación Estratégica/estadística & datos numéricos , Tecnología Radiológica/métodos , Tecnología Radiológica/organización & administración , Tecnología Radiológica/estadística & datos numéricos
13.
MMWR Morb Mortal Wkly Rep ; 70(17): 644-650, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33914727

RESUMEN

As of April 19, 2021, 21.6 million COVID-19 cases had been reported among U.S. adults, most of whom had mild or moderate disease that did not require hospitalization (1). Health care needs in the months after COVID-19 diagnosis among nonhospitalized adults have not been well studied. To better understand longer-term health care utilization and clinical characteristics of nonhospitalized adults after COVID-19 diagnosis, CDC and Kaiser Permanente Georgia (KPGA) analyzed electronic health record (EHR) data from health care visits in the 28-180 days after a diagnosis of COVID-19 at an integrated health care system. Among 3,171 nonhospitalized adults who had COVID-19, 69% had one or more outpatient visits during the follow-up period of 28-180-days. Compared with patients without an outpatient visit, a higher percentage of those who did have an outpatient visit were aged ≥50 years, were women, were non-Hispanic Black, and had underlying health conditions. Among adults with outpatient visits, 68% had a visit for a new primary diagnosis, and 38% had a new specialist visit. Active COVID-19 diagnoses* (10%) and symptoms potentially related to COVID-19 (3%-7%) were among the top 20 new visit diagnoses; rates of visits for these diagnoses declined from 2-24 visits per 10,000 person-days 28-59 days after COVID-19 diagnosis to 1-4 visits per 10,000 person-days 120-180 days after diagnosis. The presence of diagnoses of COVID-19 and related symptoms in the 28-180 days following acute illness suggests that some nonhospitalized adults, including those with asymptomatic or mild acute illness, likely have continued health care needs months after diagnosis. Clinicians and health systems should be aware of post-COVID conditions among patients who are not initially hospitalized for acute COVID-19 disease.


Asunto(s)
COVID-19/complicaciones , COVID-19/terapia , Prestación Integrada de Atención de Salud , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Atención Ambulatoria/estadística & datos numéricos , COVID-19/diagnóstico , COVID-19/epidemiología , Femenino , Georgia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Adulto Joven
14.
Int J Pediatr Otorhinolaryngol ; 145: 110712, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33887549

RESUMEN

OBJECTIVE: The objective of this study was to evaluate the feasibility of telehealth visits and compare office-based visits for pediatric patients undergoing evaluation of recurrent acute otitis media or sleep-disordered breathing. METHODS: A retrospective cohort study compared telehealth patients with matched controls seen in the office. The feasibility of a thorough patient evaluation in a single telehealth visit without a follow-up office visit was assessed. Both groups were also compared for completeness of physical exam, management, follow-up recommendations, and correlation of physical exam findings with intraoperative findings. RESULTS: 100 children [mean age (SD) = 20.7 (15.6) months] with a chief complaint of recurrent acute otitis media and 128 children [5.4 (3.2) years] with a chief complaint of sleep-disordered breathing were evaluated. Recommendations for surgery, additional studies, or routine follow-up were similar between telehealth and office-based groups. Physical exam feasibility was significantly different for the nasal cavity, oropharynx, and middle ear (P < .001). Patients who underwent office-based consultation were much more likely to have findings of middle ear fluid at the time of tympanostomy tube placement (79.3% vs 39.3%, P = .002). There was no significant difference between preoperative and intraoperative tonsil size discrepancies (P = .749). CONCLUSION: Telehealth can be used successfully for the evaluation of pediatric patients with sleep-disordered breathing; however, reliance on history alone may result in unnecessary tympanostomy tube placement in patients with recurrent acute otitis media. Physical examination of the oropharynx, nasal cavity, and middle ear via telehealth presents a unique challenge in pediatric otolaryngology.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Visita a Consultorio Médico/estadística & datos numéricos , Otolaringología , Telemedicina/estadística & datos numéricos , Preescolar , Humanos , Lactante , Ventilación del Oído Medio , Estudios Retrospectivos
15.
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 , COVID-19/epidemiología , 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
16.
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
17.
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 , COVID-19 , Pautas de la Práctica en Medicina , Telemedicina , Adulto , Atención Ambulatoria/economía , Atención Ambulatoria/métodos , Atención Ambulatoria/estadística & datos numéricos , COVID-19/epidemiología , COVID-19/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 , SARS-CoV-2 , Telemedicina/economía , Telemedicina/organización & administración , Telemedicina/estadística & datos numéricos , Estados Unidos/epidemiología
18.
BMC Cancer ; 21(1): 311, 2021 Mar 24.
Artículo en Inglés | MEDLINE | ID: mdl-33761916

RESUMEN

BACKGROUND: Breast cancer (BC) presents important physical and psychological challenges that should be appropriately addressed through continuous, integrated and individualized rehabilitation programs after treatment. In this study, we aimed to collect more information on the rehabilitation patterns and utilization of healthcare services by women with BC. METHODS: We retrospectively analyzed data from two archives of the Lazio Regional Health System Database to assess rehabilitation patterns in women diagnosed with BC in the Lazio region (Italy) in 2008. RESULTS: A total of 5538 women diagnosed with BC were considered in the present study. Most patients (81.7%) received outpatient rehabilitative care, consisting mainly of pathology-related interventions and, more rarely, disability-related interventions (mainly motor rehabilitation and rarely cognitive or psychological therapy). Few patients followed an inpatient (1.3%) or an intensive outpatient rehabilitation program (1.0%). CONCLUSION: Most patients do not receive adequate rehabilitation care during the first year after diagnosis. More information and better rehabilitation services should be provided to help patients with BC access rehabilitation programs. The study also suggests the importance of psychosocial and cognitive interventions, which is a major unmet need in women with BC.


Asunto(s)
Neoplasias de la Mama/rehabilitación , Vías Clínicas/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Anciano , Atención Ambulatoria/estadística & datos numéricos , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Italia , Persona de Mediana Edad , Calidad de Vida , Estudios Retrospectivos
19.
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)
Atención a la Salud/organización & administración , Fracturas Óseas/terapia , Ortopedia/organización & administración , Esguinces y Distensiones/terapia , Adulto , Anciano , Atención Ambulatoria/estadística & datos numéricos , COVID-19 , 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 , SARS-CoV-2 , Escocia/epidemiología , Esguinces y Distensiones/diagnóstico , Esguinces y Distensiones/epidemiología , Centros Traumatológicos , Triaje , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/epidemiología , Heridas y Lesiones/terapia
20.
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 , Prueba de Ácido Nucleico para COVID-19/estadística & datos numéricos , COVID-19 , Cuidados Críticos , Medicina General , Cuidados Paliativos , Anciano de 80 o más Años , COVID-19/diagnóstico , COVID-19/mortalidad , COVID-19/terapia , 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 , SARS-CoV-2/aislamiento & purificación
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