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1.
Actas Esp Psiquiatr ; 49(4): 155-179, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34195971

RESUMEN

The COVID-19 pandemic has the potential to significant- ly affect the mental health of healthcare workers, who stand in the frontline of this crisis. Insomnia is often related to exposure to stressful situations, such as the current health crisis, as well as other mental disorders, physical conditions and work-related problems. The objectives of this systematic review were: 1) to examine the impact of the current health pandemic produced by COVID-19 on insomnia and sleep quality of health professionals, and 2) to identify risk factors associated with insomnia. After a literature search in MEDLINE, EMBASE, and PsycINFO, 18 relevant studies were identified. The prevalence of insomnia estimated by random effects meta-analysis was 38% (95%CI= 37 to 39%), being slightly higher in women (29%, 95%CI= 27% to 30%) than in men (24%, 95%CI= 21 to 27%). The main risk factor associated with insomnia was working in a high-risk environment, followed by female sex and having a lower educational level. The high figures of self-reported insomnia and poor sleep quality observed indicate the need to develop interventions aimed at mitigating and caring for the mental health of healthcare workers fighting against this pandemic.


Asunto(s)
COVID-19/psicología , COVID-19/terapia , Personal de Salud/psicología , SARS-CoV-2 , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Personal de Salud/estadística & datos numéricos , Humanos
2.
Emerg Med Clin North Am ; 39(3): 453-465, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34215396

RESUMEN

The role of the emergency provider lies at the forefront of recognition and treatment of novel and re-emerging infectious diseases in children. Familiarity with disease presentations that might be considered rare, such as vaccine-preventable and non-endemic illnesses, is essential in identifying and controlling outbreaks. As we have seen thus far in the novel coronavirus pandemic, susceptibility, severity, transmission, and disease presentation can all have unique patterns in children. Emergency providers also have the potential to play a public health role by using lessons learned from the phenomena of vaccine hesitancy and refusal.


Asunto(s)
Enfermedades Transmisibles Emergentes/epidemiología , Pediatría , COVID-19/diagnóstico , COVID-19/terapia , COVID-19/transmisión , Varicela/diagnóstico , Varicela/terapia , Varicela/transmisión , Fiebre Chikungunya/diagnóstico , Fiebre Chikungunya/terapia , Fiebre Chikungunya/transmisión , Niño , Enfermedades Transmisibles Emergentes/inmunología , Árboles de Decisión , Dengue/diagnóstico , Dengue/terapia , Dengue/transmisión , Medicina de Emergencia , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/terapia , Fiebre Hemorrágica Ebola/transmisión , Humanos , Incidencia , Malaria/diagnóstico , Malaria/terapia , Malaria/transmisión , Sarampión/diagnóstico , Sarampión/terapia , Sarampión/transmisión , Rol del Médico , Salud Pública , SARS-CoV-2 , Síndrome de Respuesta Inflamatoria Sistémica , Enfermedad Relacionada con los Viajes , Vacunación , Negativa a la Vacunación , Tos Ferina/diagnóstico , Tos Ferina/terapia , Tos Ferina/transmisión , Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/terapia , Infección por el Virus Zika/transmisión
4.
BMC Cardiovasc Disord ; 21(1): 327, 2021 07 03.
Artículo en Inglés | MEDLINE | ID: mdl-34217220

RESUMEN

BACKGROUND: The relative association between cardiovascular (CV) risk factors, such as diabetes and hypertension, established CV disease (CVD), and susceptibility to CV complications or mortality in COVID-19 remains unclear. METHODS: We conducted a cohort study of consecutive adults hospitalised for severe COVID-19 between 1st March and 30th June 2020. Pre-existing CVD, CV risk factors and associations with mortality and CV complications were ascertained. RESULTS: Among 1721 patients (median age 71 years, 57% male), 349 (20.3%) had pre-existing CVD (CVD), 888 (51.6%) had CV risk factors without CVD (RF-CVD), 484 (28.1%) had neither. Patients with CVD were older with a higher burden of non-CV comorbidities. During follow-up, 438 (25.5%) patients died: 37% with CVD, 25.7% with RF-CVD and 16.5% with neither. CVD was independently associated with in-hospital mortality among patients < 70 years of age (adjusted HR 2.43 [95% CI 1.16-5.07]), but not in those ≥ 70 years (aHR 1.14 [95% CI 0.77-1.69]). RF-CVD were not independently associated with mortality in either age group (< 70 y aHR 1.21 [95% CI 0.72-2.01], ≥ 70 y aHR 1.07 [95% CI 0.76-1.52]). Most CV complications occurred in patients with CVD (66%) versus RF-CVD (17%) or neither (11%; p < 0.001). 213 [12.4%] patients developed venous thromboembolism (VTE). CVD was not an independent predictor of VTE. CONCLUSIONS: In patients hospitalised with COVID-19, pre-existing established CVD appears to be a more important contributor to mortality than CV risk factors in the absence of CVD. CVD-related hazard may be mediated, in part, by new CV complications. Optimal care and vigilance for destabilised CVD are essential in this patient group. Trial registration n/a.


Asunto(s)
COVID-19 , Enfermedades Cardiovasculares , Diabetes Mellitus/epidemiología , Mortalidad Hospitalaria , Hipertensión/epidemiología , Tromboembolia Venosa , Factores de Edad , Anciano , COVID-19/mortalidad , COVID-19/fisiopatología , COVID-19/terapia , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Estudios de Cohortes , Femenino , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Masculino , Mortalidad , Evaluación de Procesos y Resultados en Atención de Salud , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , SARS-CoV-2/aislamiento & purificación , Reino Unido/epidemiología , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etiología
5.
Adv Respir Med ; 89(3): 299-310, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34196383

RESUMEN

Methods for assessing diaphragmatic function can be useful in determining the functional status of the respiratory system and can contribute to determining an individual's prognosis, depending on their pathology. They can also be a useful tool for making objective decisions regarding mechanical ventilation weaning and extubation. Esophageal and transdiaphragmatic pressure measurement, diaphragm ultrasound, diaphragmatic excursion, surface electromyography (sEMG) and some serum biomarkers are of increasing interest and use in clinical and intensive care settings to offer a more objective process for withdrawing mechanical ventilation; especially in the situation that we are experiencing with the increased demand for mechanical ventilation to treat patients with Covid-19-associated viral pneumonia. In this literature review, we updated the clinical and physiological indicators with more evidence to improve ventilator withdrawal techniques. We concluded that, to ensure successful extubation in a way that is useful, cost-effective, practical for health personnel and non-invasive for the patient, further studies of novel techniques such as surface electromyography should be implemented.


Asunto(s)
Extubación Traqueal/métodos , COVID-19/terapia , Diafragma/diagnóstico por imagen , Diafragma/fisiopatología , Desconexión del Ventilador/métodos , COVID-19/diagnóstico por imagen , Humanos , Unidades de Cuidados Intensivos , Respiración Artificial/métodos , Pruebas de Función Respiratoria
6.
J Infus Nurs ; 44(4): 199-202, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34197349

RESUMEN

The emergence of the coronavirus disease 2019 (COVID-19) virus has increased in patients with acute respiratory distress syndrome (ARDS). The use of prone positioning during COVID-19-associated ARDS has led to improved oxygenation and decreased mortality. Extended hours of proning may delay or prevent traditional approaches to central vascular access, such as jugular, subclavian, or femoral cannulation. A peripherally inserted central catheter (PICC) is a viable option for prone patients. This article presents a PICC placement in a 56-year-old man with COVID-19 ARDS who required 20- to 24-hour prone positioning during his care in the intensive care unit. Insertion of a PICC while the patient is prone expedites lifesaving medications and infusions without waiting for the patient to be stable enough to be turned to the supine position.


Asunto(s)
COVID-19 , Enfermería Cardiovascular , Cateterismo Periférico , Posición Prona , COVID-19/complicaciones , COVID-19/terapia , Prueba de COVID-19 , Estudios de Factibilidad , Fiebre/etiología , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Síndrome de Dificultad Respiratoria/complicaciones , Síndrome de Dificultad Respiratoria/terapia
7.
Int J Circumpolar Health ; 80(1): 1935133, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34210240

RESUMEN

Mental health providers have rapidly pivoted their in-person practices to teletherapy and telehealth interventions to address the increased demand for mental health services during the COVID-19 crisis. The change to service delivery has emphasised challenges for mental health service providers, particularly in regions that rely on fly-in and fly-out (FIFO) mental health service providers who are no longer able to travel to their places of work. In this qualitative study, we examined the impact of COVID-19 on the delivery of mental health services in Inuit Nunangat. Using a participatory action research methodology, we conducted semi-structured interviews with eight FIFO mental health service providers to understand their experiences and implement strategies to effectively deliver mental health services in a pandemic. We identified three themes through thematic analysis: 1) Service providers identify the challenges in adapting their practices to meet individual and community needs; 2) Service providers recognise the opportunities for enhancements to service delivery; 3) Service providers identify telemental health services as a potentially effective adjunct to in-person sessions. The findings support reconceptualising post-pandemic mental health service delivery to include both face-to-face and telemental health services.


Asunto(s)
COVID-19/epidemiología , Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Salud Mental/estadística & datos numéricos , Telemedicina/organización & administración , COVID-19/terapia , Consejo/organización & administración , Humanos , Investigación Cualitativa , Apoyo Social
8.
Medwave ; 21(4): e8198, 2021 May 25.
Artículo en Español, Inglés | MEDLINE | ID: mdl-34213514

RESUMEN

Coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus discovered in December 2019 in Wuhan, China, has had an enormous impact on public health worldwide due to its rapid spread and pandemic behavior, challenges in its control and mitigation, and few therapeutic alternatives. In this review, we summarize the pathophysiological mechanisms, clinical presentation, and diagnostic techniques. In addition, the main lineages and the different strategies for disease prevention are reviewed, with emphasis on the development of vaccines and their different platforms. Finally, some of the currently available therapeutic strategies are summarized. Throughout the article, we point out the current knowns and unknowns at the time of writing this article.


Asunto(s)
COVID-19 , SARS-CoV-2 , COVID-19/diagnóstico , COVID-19/fisiopatología , COVID-19/terapia , Humanos , SARS-CoV-2/fisiología
9.
Medwave ; 21(5): e8206, 2021 Jun 14.
Artículo en Español, Inglés | MEDLINE | ID: mdl-34214071

RESUMEN

Background: The 2019 coronavirus disease outbreak (COVID-19) spread rapidly around the world. The extent and ultimate effect are still unclear, as it is an ongoing and constantly evolving pandemic. Aims: To compile the literature and synthesize in Spanish-Latin American language the available international information describing the etiological, pathophysiological, epidemiological and management aspects of COVID-19. Methods: Narrative review, using specific sections created in the databases. The criteria for selecting studies depended on the specific area addressed: etiological, pathophysiological, epidemiological aspects, treatment alternatives, etc. References in Spanish and English were included. Results: The World Health Organization reports that COVID-19 is a disease of zoonotic origin that was transmitted to a human host. The first cases were identified in late 2019 and January 2020, in Wuhan city, China. It was categorized as highly contagious and transmissible between humans, which is attributed to the structural features of this novel coronavirus. The clinical presentation is variable and nonspecific, as well as its severity. With a clear tropism for the respiratory system, the most severe cases may develop pneumonia, respiratory failure, multiorgan failure and thus death. It occurs in all age groups, with a lower percentage in children under 19 years of age (2.4%). Mortality varies between countries and regions (between 1.5 to 9.3% over the total of reported cases). Associated risk factors are the presence of comorbidities, advanced age, and immunosuppression. Conclusions: To date there have been thousands of scientific articles that attempt to explain the onset, progression, possible treatment options and global impact of the disease. There is still no certainty about the level or quality of this evidence. It is essential to generate documents synthesized and translated into Spanish or other languages that can bring this information to all the places and countries that are being impacted by this disease.


Asunto(s)
COVID-19 , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/fisiopatología , COVID-19/terapia , Humanos
10.
Sci Rep ; 11(1): 13733, 2021 07 02.
Artículo en Inglés | MEDLINE | ID: mdl-34215803

RESUMEN

To determine the proportion of patients with COVID-19 who were readmitted to the hospital and the most common causes and the factors associated with readmission. Multicenter nationwide cohort study in Spain. Patients included in the study were admitted to 147 hospitals from March 1 to April 30, 2020. Readmission was defined as a new hospital admission during the 30 days after discharge. Emergency department visits after discharge were not considered readmission. During the study period 8392 patients were admitted to hospitals participating in the SEMI-COVID-19 network. 298 patients (4.2%) out of 7137 patients were readmitted after being discharged. 1541 (17.7%) died during the index admission and 35 died during hospital readmission (11.7%, p = 0.007). The median time from discharge to readmission was 7 days (IQR 3-15 days). The most frequent causes of hospital readmission were worsening of previous pneumonia (54%), bacterial infection (13%), venous thromboembolism (5%), and heart failure (5%). Age [odds ratio (OR): 1.02; 95% confident interval (95% CI): 1.01-1.03], age-adjusted Charlson comorbidity index score (OR: 1.13; 95% CI: 1.06-1.21), chronic obstructive pulmonary disease (OR: 1.84; 95% CI: 1.26-2.69), asthma (OR: 1.52; 95% CI: 1.04-2.22), hemoglobin level at admission (OR: 0.92; 95% CI: 0.86-0.99), ground-glass opacification at admission (OR: 0.86; 95% CI:0.76-0.98) and glucocorticoid treatment (OR: 1.29; 95% CI: 1.00-1.66) were independently associated with hospital readmission. The rate of readmission after hospital discharge for COVID-19 was low. Advanced age and comorbidity were associated with increased risk of readmission.


Asunto(s)
COVID-19/terapia , Readmisión del Paciente , Factores de Edad , Anciano , Anciano de 80 o más Años , COVID-19/complicaciones , COVID-19/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Alta del Paciente , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2/aislamiento & purificación
12.
Br J Community Nurs ; 26(7): 318-323, 2021 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-34232713

RESUMEN

The COVID-19 pandemic has required rapid adaptation of the community nursing service, including the introduction of online communication platforms to prevent COVID-19 transmission among staff. Remote working has protected the workforce in the community from being decimated through team sickness, but has resulted in nurses who are feeling anxious and isolated from their colleagues while experiencing increased workloads, with complex and often emotionally challenging situations. The pressures of community nursing and the associated impact on sickness absence relating to mental health are well documented. The resources made available to support staff wellbeing were increased during the pandemic, but there remains some disparity of access to these resources. There is much that can be done by the district nurse as a leader of a team to ensure that the pressures are managed in a way that promotes team cohesion and mutual respect, while ensuring that open communication about wellbeing is encouraged.


Asunto(s)
COVID-19/epidemiología , Comunicación , Enfermería en Salud Comunitaria , Rol de la Enfermera , Grupo de Atención al Paciente/organización & administración , Medicina Estatal , COVID-19/terapia , Humanos , Reino Unido , Carga de Trabajo
13.
Swiss Med Wkly ; 151: w20529, 2021 06 21.
Artículo en Inglés | MEDLINE | ID: mdl-34233009

RESUMEN

AIM: Mortality rates of COVID-19 patients hospitalised in intensive care units (ICUs) are generally high. Availability of ICU resources might influence clinical outcomes. The aim of this study was to examine the clinical course of the 42 patients treated during the first epidemic wave between 2 March and 20 May 2020 at the tertiary ICU of the Bern University Hospital, where staffing, equipment and drugs were not limited. METHODS: For this descriptive study, retrospective data of the first COVID-19 wave in an interdisciplinary adult ICU of a Swiss University hospital was used. The study included data regarding healthcare staffing and COVID-19 patients. The primary outcome was the ICU mortality in COVID-19 patients. RESULTS: Patients’ median age was 61 years (range 32–86), simplified acute physiology score (SAPS-II) was 46 (13–90), 81% of the patients were males, 79% were mechanically ventilated (3 of them on extracorporeal membrane oxygenation), 31% were under renal replacement therapy and 21% received steroids. All patients were fully anticoagulated from the time of admission. No off-label experimental antiviral or anti-inflammatory drugs were used with the exception of one patient, and antibiotic prescription was restrictive. Nurse-to-patient ratio was 1:1 during all shifts, and the physician-to-patient ratio was 1:4 (day shift) and 1:10 (night shift). Infectious disease specialists and physiotherapists were present every day. The median ICU length of stay was 10 days (1–38) days, and ICU and hospital mortality rates were 7% and 12%, respectively. CONCLUSION: Careful intensive care treatment, without off-label drug use but including steroids in selected cases, combined with an interdisciplinary approach and provision of sufficient human resources, were associated with low ICU and hospital mortality rates despite high disease severity. Availability of qualified human resources may have an important impact on the outcome of COVID-19.


Asunto(s)
COVID-19/mortalidad , Cuidados Críticos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Recursos Humanos , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/epidemiología , COVID-19/terapia , Epidemias , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , SARS-CoV-2 , Suiza/epidemiología
14.
Signal Transduct Target Ther ; 6(1): 255, 2021 07 07.
Artículo en Inglés | MEDLINE | ID: mdl-34234112

RESUMEN

The Coronavirus Disease 2019 (COVID-19) pandemic has become a global crisis and is more devastating than any other previous infectious disease. It has affected a significant proportion of the global population both physically and mentally, and destroyed businesses and societies. Current evidence suggested that immunopathology may be responsible for COVID-19 pathogenesis, including lymphopenia, neutrophilia, dysregulation of monocytes and macrophages, reduced or delayed type I interferon (IFN-I) response, antibody-dependent enhancement, and especially, cytokine storm (CS). The CS is characterized by hyperproduction of an array of pro-inflammatory cytokines and is closely associated with poor prognosis. These excessively secreted pro-inflammatory cytokines initiate different inflammatory signaling pathways via their receptors on immune and tissue cells, resulting in complicated medical symptoms including fever, capillary leak syndrome, disseminated intravascular coagulation, acute respiratory distress syndrome, and multiorgan failure, ultimately leading to death in the most severe cases. Therefore, it is clinically important to understand the initiation and signaling pathways of CS to develop more effective treatment strategies for COVID-19. Herein, we discuss the latest developments in the immunopathological characteristics of COVID-19 and focus on CS including the current research status of the different cytokines involved. We also discuss the induction, function, downstream signaling, and existing and potential interventions for targeting these cytokines or related signal pathways. We believe that a comprehensive understanding of CS in COVID-19 will help to develop better strategies to effectively control immunopathology in this disease and other infectious and inflammatory diseases.


Asunto(s)
COVID-19/terapia , Síndrome de Liberación de Citoquinas/terapia , Transducción de Señal , Síndrome de Liberación de Citoquinas/virología , Citocinas , Humanos , Síndrome de Dificultad Respiratoria/terapia , Síndrome de Dificultad Respiratoria/virología
15.
Behav Neurol ; 2021: 6655103, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34257741

RESUMEN

This study is aimed at assessing differences in basic attentional functioning between substantial and minimal work-related exposure to COVID-19 patients in professionals working in a tertiary referral hospital in Rio de Janeiro, Brazil. Therefore, hospital employees performed a Continuous Visual Attention Test. This test consisted of a 90-second Go/No-Go task with 72 (80%) targets and 18 (20%) nontargets. For each participant, reaction time and intraindividual variability of reaction times of all correct target responses, as well as the number of omission and commission errors, were evaluated. Participants were divided into 2 groups based on their exposure to COVID-19 patients (substantial versus minimal exposure). The substantial exposure group consisted of participants with 24 hours/week or more direct contact with COVID-19 patients. This cut-off was based on the clear division between professionals working and not working with COVID-19 patients and considered that 12-hour and 24-hour daily shifts are common for hospital employees in Brazil. A MANCOVA was performed to examine between-group differences, using age, sleep quality, sex, education level, previous COVID-19 infection, and profession as covariates. Of 124 participants, 80 had substantial exposure and 44 had minimal exposure to COVID-19. The overall MANCOVA reached statistical significance (P = 0.048). Post hoc ANCOVA analysis showed that the substantial exposure group had a statistically significantly higher intraindividual variability of reaction time of all correct target responses (P = 0.017, Cohen's δ = -0.55). This result remained after removing those with a previous COVID-19 infection (P = 0.010, Cohen's δ = -0.64) and after matching groups for sample size (P = 0.004, Cohen's δ = -0.81). No other variables reached statistical significance. Concluding, hospital professionals with a substantial level of exposure to patients with COVID-19 show a significant attention decrement and, thus, may be at a higher risk of accidental SARS-CoV-2 infection.


Asunto(s)
Atención , COVID-19/terapia , COVID-19/transmisión , Personal de Salud/psicología , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Centros de Atención Terciaria , Adulto , Brasil/epidemiología , COVID-19/epidemiología , Femenino , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Tiempo de Reacción , SARS-CoV-2 , Tolerancia al Trabajo Programado , Adulto Joven
16.
Emerg Med Clin North Am ; 39(3): 493-508, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34215399

RESUMEN

Anatomically, the airway is ever changing in size, anteroposterior alignment, and point of most narrow dimension. Special considerations regarding obesity, chronic and acute illness, underlying developmental abnormalities, and age can all affect preparation and intervention toward securing a definitive airway. Mechanical ventilation strategies should focus on limiting peak inspiratory pressures and optimizing lung protective tidal volumes. Emergency physicians should work toward minimizing risk of peri-intubation hypoxemia and arrest. With review of anatomic and physiologic principles in the setting of a practical approach toward evaluating and managing distress and failure, emergency physicians can successfully manage critical pediatric airway encounters.


Asunto(s)
Síndrome de Dificultad Respiratoria/terapia , Insuficiencia Respiratoria/terapia , Manejo de la Vía Aérea , COVID-19/terapia , Niño , Anomalías Craneofaciales/complicaciones , Cuidados Críticos , Diseño de Equipo , Capacidad Residual Funcional , Paro Cardíaco/terapia , Humanos , Hipnóticos y Sedantes/uso terapéutico , Intubación Intratraqueal/métodos , Laringoscopios , Laringoscopía/métodos , Laringe/anatomía & histología , Enfermedades Neuromusculares/terapia , Ventilación no Invasiva , Terapia por Inhalación de Oxígeno , Medicina de Urgencia Pediátrica , Obesidad Pediátrica/complicaciones , Respiración con Presión Positiva , Grabación en Video
17.
BMC Fam Pract ; 22(1): 146, 2021 07 03.
Artículo en Inglés | MEDLINE | ID: mdl-34217208

RESUMEN

BACKGROUND: Early in the COVID-19 pandemic, general practices were asked to expand triage and to reduce unnecessary face-to-face contact by prioritizing other consultation modes, e.g., online messaging, video, or telephone. The current study explores the potential barriers and facilitators general practitioners experienced to expanding triage systems and their attitudes towards triage during the COVID-19 pandemic. METHOD: A mixed-method study design was used in which a quantitative online survey was conducted along with qualitative interviews to gain a more nuanced appreciation for practitioners' experiences in the United Kingdom. The survey items were informed by the Theoretical Domains Framework so they would capture 14 behavioral factors that may influence whether practitioners use triage systems. Items were responded to using seven-point Likert scales. A median score was calculated for each item. The responses of participants identifying as part-owners and non-owners (i.e., "partner" vs. "non-partner" practitioners) were compared. The semi-structured interviews were conducted remotely and examined using Braun and Clark's thematic analysis. RESULTS: The survey was completed by 204 participants (66% Female). Most participants (83%) reported triaging patients. The items with the highest median scores captured the 'Knowledge,' 'Skills,' 'Social/Professional role and identity,' and 'Beliefs about capabilities' domains. The items with the lowest median scores captured the 'Beliefs about consequences,' 'Goals,' and 'Emotions' domains. For 14 of the 17 items, partner scores were higher than non-partner scores. All the qualitative interview participants relied on a phone triage system. Six broad themes were discovered: patient accessibility, confusions around what triage is, uncertainty and risk, relationships between service providers, job satisfaction, and the potential for total digital triage. Suggestions arose to optimize triage, such as ensuring there is sufficient time to conduct triage accurately and providing practical training to use triage efficiently. CONCLUSIONS: Many general practitioners are engaging with expanded triage systems, though more support is needed to achieve total triage across practices. Non-partner practitioners likely require more support to use the triage systems that practices take up. Additionally, practical support should be made available to help all practitioners manage the new risks and uncertainties they are likely to experience during non-face-to-face consultations.


Asunto(s)
COVID-19 , Medicina General , Médicos Generales , Consulta Remota , Triaje , Actitud del Personal de Salud , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/terapia , Competencia Clínica , Inglaterra/epidemiología , Femenino , Medicina General/organización & administración , Medicina General/normas , Medicina General/tendencias , Médicos Generales/psicología , Médicos Generales/normas , Conocimientos, Actitudes y Práctica en Salud , Humanos , Control de Infecciones/métodos , Control de Infecciones/normas , Masculino , Pautas de la Práctica en Medicina/ética , Pautas de la Práctica en Medicina/tendencias , Consulta Remota/ética , Consulta Remota/métodos , Gestión de Riesgos/tendencias , SARS-CoV-2 , Triaje/ética , Triaje/métodos , Triaje/organización & administración , Triaje/normas
18.
Molecules ; 26(12)2021 Jun 09.
Artículo en Inglés | MEDLINE | ID: mdl-34207756

RESUMEN

Since December 2019, humanity has faced an important global threat. Many studies have been published on the origin, structure, and mechanism of action of the SARS-CoV-2 virus and the treatment of its disease. The priority of scientists all over the world has been to direct their time to research this subject. In this review, we highlight chemical studies and therapeutic approaches to overcome COVID-19 with seven different sections. These sections are the structure and mechanism of action of SARS-CoV-2, immunotherapy and vaccine, computer-aided drug design, repurposing therapeutics for COVID-19, synthesis of new molecular structures against COVID-19, food safety/security and functional food components, and potential natural products against COVID-19. In this work, we aimed to screen all the newly synthesized compounds, repurposing chemicals covering antiviral, anti-inflammatory, antibacterial, antiparasitic, anticancer, antipsychotic, and antihistamine compounds against COVID-19. We also highlight computer-aided approaches to develop an anti-COVID-19 molecule. We explain that some phytochemicals and dietary supplements have been identified as antiviral bioproducts, which have almost been successfully tested against COVID-19. In addition, we present immunotherapy types, targets, immunotherapy and inflammation/mutations of the virus, immune response, and vaccine issues.


Asunto(s)
COVID-19/prevención & control , Antivirales/química , Antivirales/uso terapéutico , Productos Biológicos/uso terapéutico , COVID-19/patología , COVID-19/terapia , COVID-19/virología , Vacunas contra la COVID-19/administración & dosificación , Vacunas contra la COVID-19/inmunología , Síndrome de Liberación de Citoquinas/prevención & control , Diseño de Fármacos , Reposicionamiento de Medicamentos , Humanos , Inmunoterapia , SARS-CoV-2/genética , SARS-CoV-2/aislamiento & purificación , SARS-CoV-2/fisiología
19.
Int J Mol Sci ; 22(12)2021 Jun 16.
Artículo en Inglés | MEDLINE | ID: mdl-34208755

RESUMEN

Although the approved vaccines are proving to be of utmost importance in containing the Coronavirus disease 2019 (COVID-19) threat, they will hardly be resolutive as new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, a single-stranded RNA virus) variants might be insensitive to the immune response they induce. In this scenario, developing an effective therapy is still a dire need. Different targets for therapeutic antibodies and diagnostics have been identified, among which the SARS-CoV-2 spike (S) glycoprotein, particularly its receptor-binding domain, has been defined as crucial. In this context, we aim to focus attention also on the role played by the S N-terminal domain (S1-NTD) in the virus attachment, already recognized as a valuable target for neutralizing antibodies, in particular, building on a cavity mapping indicating the presence of two druggable pockets and on the recent literature hypothesizing the presence of a ganglioside-binding domain. In this perspective, we aim at proposing S1-NTD as a putative target for designing small molecules hopefully able to hamper the SARS-CoV-2 attachment to host cells.


Asunto(s)
SARS-CoV-2/metabolismo , Glicoproteína de la Espiga del Coronavirus/metabolismo , Sitios de Unión , COVID-19/patología , COVID-19/terapia , COVID-19/virología , Reposicionamiento de Medicamentos , Humanos , Simulación de Dinámica Molecular , Ácido N-Acetilneuramínico/análogos & derivados , Ácido N-Acetilneuramínico/metabolismo , Ácido N-Acetilneuramínico/farmacología , Ácido N-Acetilneuramínico/uso terapéutico , Unión Proteica , Dominios Proteicos , SARS-CoV-2/aislamiento & purificación , Bibliotecas de Moléculas Pequeñas/química , Bibliotecas de Moléculas Pequeñas/metabolismo , Bibliotecas de Moléculas Pequeñas/farmacología , Bibliotecas de Moléculas Pequeñas/uso terapéutico , Glicoproteína de la Espiga del Coronavirus/química , Acoplamiento Viral/efectos de los fármacos
20.
Arch Iran Med ; 24(5): 405-408, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-34196206

RESUMEN

The coronavirus epidemic first broke out in China in 2019 and spread around the world. Not only the signs, symptoms, and outcomes of the coronavirus in neonates, but also its vertical transmission risks are still unknown. This case series presents eight neonates born to mothers with COVID-19 and two neonates with this infection.


Asunto(s)
COVID-19/diagnóstico , COVID-19/transmisión , Transmisión Vertical de Enfermedad Infecciosa , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/terapia , Adulto , COVID-19/terapia , Femenino , Humanos , Recién Nacido , Irán , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo/virología
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