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1.
PLoS One ; 15(10): e0236503, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33031375

RESUMEN

BACKGROUND: The treatment for stage III non-small cell lung cancer (NSCLC) often involves multi-modality treatment. This retrospective study aimed to evaluate whether multidisciplinary team (MDT) discussion results in better patient survival. MATERIALS AND METHODS: MDT discussion was optional before February 2016 and was actively encouraged by the MDT committee beginning February 2016. We reviewed the medical charts and computer records of patients with stage III NSCLC between January 2013 and December 2018. RESULTS: A total of 515 patients were included. The median survival of all the patients was 33.9 months (M). The median survival of patients who were treated after MDT discussion was 41.2 M and that of patients treated without MDT discussion was 25.7 M (p = 0.018). The median survival of patients treated before February 2016 was 25.7 M and that of patients treated after February 2016 was 33.9 M (p = 0.003). The median survival of patients with stage IIIA tumors and those with stage IIIB tumors was 39.4 M and 25.7 M, respectively (p = 0.141). Multivariate analysis showed that MDT or not (p<0.001), T staging (p = 0.009), performance status (p<0.001), and surgery (p = 0.016) to be significant prognostic factors. CONCLUSION: The results of the study show that MDT discussion results in survival benefit in patients with stage III NSCLC. The MDT discussion, performance status, and if surgery was performed were independent prognostic factors for patients with stage III NSCLC.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Comunicación Interdisciplinaria , Neoplasias Pulmonares/mortalidad , Grupo de Atención al Paciente/estadística & datos numéricos , Calidad de Vida , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/terapia , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/terapia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Tasa de Supervivencia , Adulto Joven
2.
Rev Esp Anestesiol Reanim ; 67(9): 487-495, 2020 11.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33036762

RESUMEN

INTRODUCTION: The current SARS-CoV-2 pandemic has been the world's largest socio-health crisis experienced in the last century. Each healthcare center has been compelled to adapt the treatment guidelines established by the different scientific societies. OBJECTIVES: Analyze the impact of the methodology based on simulation as a tool to improve our clinical practice: work dynamics, effectiveness and safety of all the physicians involved in the management of labor in COVID pregnant women and its usefulness to facilitate the adaptation of protocols to a specific clinical context. METHOD: Descriptive observational study that includes the C-sections and deliveries of COVID pregnant women performed in our hospital. The actions carried out in each procedure were analyzed using the simulation multidisciplinary briefing and debriefing tools, before and after each case. RESULTS: A total of 5 clinical cases were analyzed. Difficulties were found in the execution of the protocols established for the care of the COVID pregnant. Organizational, structural, material resources and human factors obstacles were the most common. CONCLUSIONS: Our results showed that the analysis example using simulation methodology was a tool of great value in three aspects: teamwork improvement, actions consent and improvement proposals for the adaptation and implementation of protocols.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Parto Obstétrico/métodos , Grupo de Atención al Paciente/organización & administración , Neumonía Viral/terapia , Complicaciones Infecciosas del Embarazo/terapia , Entrenamiento Simulado/métodos , Adulto , Cesárea , Toma de Decisiones Clínicas , Técnicas de Laboratorio Clínico/métodos , Protocolos Clínicos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Delegación Profesional , Urgencias Médicas , Femenino , Humanos , Comunicación Interdisciplinaria , Pandemias , Admisión y Programación de Personal , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Adulto Joven
3.
Ann Pharm Fr ; 78(6): 464-468, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33038310

RESUMEN

On January 4 2020, the World Health Organization (WHO) reported the emergence of a cluster of pneumonia cases in Wuhan, China due to a new coronavirus, the SARS-CoV-2. A few weeks later, hospitals had to put in place a series of drastic measures to deal with the massive influx of suspected COVID-19 (COronaroVIrus Disease) patients while securing regular patient care, in particular in the intensive care units (ICU). Since March 12th, 77 of the 685 COVID-19 patients admitted to our hospital required hospitalization in the ICU. What are the roles and the added-value of the critical care pharmacist during this period? His missions have evolved although they have remained focused on providing health services for the patients. Indeed, integrated into a steering committee created to organize the crisis in the intensive care units, the role of the clinical pharmacist was focused on the organization and coordination between ICU and the pharmacy, the implementation of actions to secure practices, to train new professionals and the adaptation of therapeutic strategies. He participated to literature monitoring and increased his involvement in the clinical research team. He provided a link between the ICU and the pharmacy thanks to his knowledges of practices and needs.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Cuidados Críticos , Pandemias , Farmacéuticos , Neumonía Viral/epidemiología , Ensayos Clínicos como Asunto/organización & administración , Miembro de Comité , Equipos y Suministros de Hospitales/provisión & distribución , Francia , Humanos , Servicios de Información , Almacenamiento y Recuperación de la Información , Comunicación Interdisciplinaria , Perfil Laboral , Administración de Materiales de Hospital , Seguridad del Paciente , Preparaciones Farmacéuticas/provisión & distribución , Servicio de Farmacia en Hospital/organización & administración , Rol
4.
Lancet Oncol ; 21(10): e488-e494, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33002444

RESUMEN

Patient-reported outcome (PRO) measures describe how a patient feels or functions and are increasingly being used in benefit-risk assessments in the development of cancer drugs. However, PRO research objectives are often ill-defined in clinical cancer trials, which can lead to misleading conclusions about patient experiences. The estimand framework is a structured approach to aligning a clinical trial objective with the study design, including endpoints and analysis. The estimand framework uses a multidisciplinary approach and can improve design, analysis, and interpretation of PRO results. On the basis of the International Council for Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use E9(R1) addendum, we provide an overview of the estimand framework intended for a multistakeholder audience. We apply the estimand framework to a hypothetical trial for breast cancer, using physical function to develop specific PRO research objectives. This Policy Review is not an endorsement of a specific study design or outcome; rather, it is meant to show the application of principles of the estimand framework to research study design and add to ongoing discussion. Use of the estimand framework to review medical products and label PROs in oncology can improve communication between stakeholders and ultimately provide a clearer interpretation of patient experience in the development of oncological drugs.


Asunto(s)
Protocolos de Ensayos Clínicos como Asunto , Oncología Médica/normas , Medición de Resultados Informados por el Paciente , Antineoplásicos/uso terapéutico , Interpretación Estadística de Datos , Desarrollo de Medicamentos/legislación & jurisprudencia , Desarrollo de Medicamentos/normas , Humanos , Comunicación Interdisciplinaria , Oncología Médica/estadística & datos numéricos , Neoplasias/tratamiento farmacológico , Proyectos de Investigación/normas
5.
G Ital Nefrol ; 37(5)2020 Oct 05.
Artículo en Italiano | MEDLINE | ID: mdl-33026202

RESUMEN

We report the case of a 68-year-old patient who arrived at the hospital with a fever and a cough for 7 days, a history of high blood pressure and chronic kidney failure stage 2 according to CKD-EPI (GFR: 62 ml/minute with creatinine: 1.2 mg/dl). Home therapy included lercanidipine and clonidine. A chest radiograph performed in the emergency department immediately showed images suggestive of pneumonia from COVID-19, confirmed in the following days by a positive swab for coronavirus. Kidney function parameters progressively deteriorated towards a severe acute kidney failure on the 15th day, with creatinine values of 6.6 mg/dl and urea of 210 mg/dl. The situation was managed first in the intensive care unit with CRRT cycles (continuous renal replacement therapy) and then in a "yellow area" devoted to COVID patients, where the patient was dialyzed by us nephrologists through short cycles of CRRT. In our short experience we have used continuous techniques (CRRT) in positive patients hemodynamically unstable and intermittent dialysis (IRRT) in our stable chronic patients with asymptomatic COVID -19. We found CRRT to be superior in hemodynamically unstable patients hospitalized in resuscitation and in the "yellow area". Dialysis continued with high cut-off filters until the normalization of kidney function; the supportive medical therapy has also improved the course of the pathology and contributed to the favorable outcome for our patient. During the COVID-19 pandemic, our Nephrology Group at Savona's San Paul Hospital has reorganized the department to better manage both chronic dialyzed patients and acute patients affected by the new coronavirus.


Asunto(s)
Lesión Renal Aguda/terapia , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Pandemias , Neumonía Viral/complicaciones , Lesión Renal Aguda/diagnóstico por imagen , Lesión Renal Aguda/etiología , Lesión Renal Aguda/fisiopatología , Anciano , Antihipertensivos/uso terapéutico , Antivirales/uso terapéutico , Betacoronavirus/fisiología , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Creatinina/sangre , Cuidados Críticos/métodos , Manejo de la Enfermedad , Hemodinámica , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Comunicación Interdisciplinaria , Fallo Renal Crónico/complicaciones , Masculino , Grupo de Atención al Paciente , Aislamiento de Pacientes , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Diálisis Renal/métodos , Respiración Artificial , Urea/sangre
7.
BMC Infect Dis ; 20(1): 737, 2020 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-33028228

RESUMEN

BACKGROUND: Chronic hepatitis C virus (HCV), which is a concern in many countries, is the leading cause of liver cancer around the world. Since Taiwan launched its national health insurance system in 1995, it has managed to extend health coverage to 99% of the Taiwanese population, providing free but limited antiviral treatment each year since 2017. However, many people in rural areas are unaware that they have chronic HCV; nor do they realize that new drugs with high cure rates could drastically reduce their health burden. The aim of this study is to explore the implementation facilitators of and barriers to inviting potentially infected patients in rural areas to be transferred for HCV ribonucleic acid (RNA) confirmation and new drug treatment. METHODS: A descriptive and prospective study design with an interdisciplinary collaboration approach was implemented. After five elements of referral were developed, telephone counseling was conducted between August 2018 and May 2019 in Yunlin, Taiwan. The elements of referral developed by the research team were: (1) forming and coordinating physicians' schedules, (2) recruiting and training volunteers, (3) training the nursing staff, (4) raising funds or resources, and (5) connecting with village leaders. Thereafter, we collaborated with two district health centers, a private local hospital, and health clinics. Based on the medical records provided by these agencies, community adults that were HCV antibody (anti-HCV) positive were invited to join the program. RESULTS: Of the 1795 adults who were serum anti-HCV positive, 1149 (64%) accepted transfer to a qualified hospital; of these, 623 (54.2%) had an HCV infection. 552 (88.6%) of those infected started receiving direct-acting antivirals (DAAs) treatment. The top four barriers to accepting transfer were: (1) they perceived themselves to be healthy (n = 98, 32.3%); (2) mistrust of treatment/healthcare (n = 60, 20.2%); (3) limited transportation to the hospital (n = 52, 17.5%); and (4) work conflict (n = 30, 10.1%). CONCLUSION: An interdisciplinary collaboration approach significantly contributed to the invitation of CHC patients, as well as their acceptance of HCV RNA confirmation and free DAAs treatment. Using anti-HCV data from previous medical records for case-finding and collaborating with a hospital and health clinics proved to be an efficient strategy.


Asunto(s)
Antivirales/uso terapéutico , Hepacivirus/genética , Hepatitis C Crónica/tratamiento farmacológico , ARN Viral/metabolismo , Adulto , Femenino , Hepacivirus/aislamiento & purificación , Anticuerpos contra la Hepatitis C/sangre , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/psicología , Humanos , Comunicación Interdisciplinaria , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Derivación y Consulta , Población Rural , Taiwán
8.
Clin Dermatol ; 38(4): 467-476, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32972605

RESUMEN

Basal cell nevus syndrome, also known as Gorlin syndrome, is a hereditary cancer syndrome associated with multiple basal cell carcinomas, congenital defects, and nondermatologic tumors. This disease is autosomal dominant with variable expressivity and is caused by abnormalities in the sonic hedgehog signaling pathway. Management requires a multidisciplinary approach and should include the biopsychosocial needs of patients and their families. Genetic testing is necessary to confirm an unclear diagnosis, evaluate at-risk relatives, and assist with family planning.


Asunto(s)
Síndrome del Nevo Basocelular/genética , Síndrome del Nevo Basocelular/terapia , Terapia Molecular Dirigida , Síndromes Neoplásicos Hereditarios/genética , Síndromes Neoplásicos Hereditarios/terapia , Adulto , Síndrome del Nevo Basocelular/diagnóstico , Síndrome del Nevo Basocelular/patología , Femenino , Pruebas Genéticas , Proteínas Hedgehog/genética , Proteínas Hedgehog/metabolismo , Humanos , Comunicación Interdisciplinaria , Síndromes Neoplásicos Hereditarios/diagnóstico , Síndromes Neoplásicos Hereditarios/patología , Receptor Patched-1/genética , Receptor Patched-1/metabolismo , Receptor Patched-2/genética , Receptor Patched-2/metabolismo , Grupo de Atención al Paciente , Proteínas Represoras/genética , Proteínas Represoras/metabolismo , Transducción de Señal/genética , Piel/patología , Adulto Joven
9.
J Interprof Care ; 34(5): 706-710, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32917099

RESUMEN

This report describes the Obstetric and Neonatal Simulation (ONE-Sim) workshop run in a remote learning format for medical and midwifery students in an interprofessional setting during the COVID-19 pandemic. It explores the observation of students as participants in the online learning of using Personal Protective Equipment and simulation-based learning of perinatal emergency management. This was followed by their mutual interaction and reflections. This paper aims to understand the role of synchronous remote learning through simulation and its impact on interprofessional interactions. We describe the experience of medical and midwifery students with the ONE-Sim workshop, facilitated by medical (obstetric and neonatal) and midwifery educators. Formal thematic analysis will be performed as part of the ongoing study; however, initial direct observation demonstrated that students reacted positively to the online ONE-Sim workshop and engaged well with facilitators and peers. Students mutually interacted amongst themselves, shared their previous experiences, knowledge of roles as medical and midwifery practitioners and how they see themselves in those roles in a perinatal emergency setting. The initial observations demonstrate that interprofessional education delivered in an e-learning format can be useful and meaningful, and may be utilized across a number of specialties.


Asunto(s)
Infecciones por Coronavirus , Educación a Distancia , Comunicación Interdisciplinaria , Partería/educación , Pandemias , Neumonía Viral , Entrenamiento Simulado , Estudiantes de Medicina , Betacoronavirus , Cuidados Críticos , Humanos , Obstetricia/educación , Atención Perinatal , Evaluación de Programas y Proyectos de Salud , Grabación en Video
10.
Work ; 67(1): 29-35, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32925151

RESUMEN

BACKGROUND: Prior to the COVID-19 global health emergency, telehealth was an emerging occupational therapy (OT) service delivery model possessing many positive attributes. These include the potential to offset well-documented global occupational therapy practitioner (OTP) shortages. However, wide-spread adoption of telehealth as a delivery model in school-based practice is lacking in the OT evidence literature. While the COVID-19 global health emergency propelled many OTPs into the use of telehealth technologies, in some cases with minimal preparation, an investigation was conducted into the likelihood of telehealth adoption when comprehensive training was provided so that appropriateness of student fit for telehealth could be determined and essential planning could take place. OBJECTIVE: Prior to the COVID-19 global health emergency, a comprehensive training program was developed incorporating detailed perceptions of OTPs experienced in and new to telehealth in school-based practice as measured via surveys with the goal of increasing adoption of telehealth technologies for the delivery of OT services. Following the completion of the online New to Telehealth Pre-training Survey, OTPs new to telehealth were invited to complete the OT Telehealth Primer: School-based Practice training program. Analysis of pre- and post-training surveys yielded information about attitudinal changes experienced post-training. METHODS: Prior to the COVID-19 global health emergency, school-based occupational therapy practitioners (OTP) experienced in telehealth were invited to complete a survey exploring benefits and barriers encountered in the delivery of OT services using telehealth. OTPs new-to-telehealth were invited to complete a different survey intended to explore attitudes about the potential use of telehealth. Data collected from both surveys were used to develop a comprehensive training program, The OT Telehealth Primer for School-based Practice. OTPs new-to-telehealth were invited to complete the training program and a post-training survey. A descriptive data analysis was completed on responses from pre- to post-training surveys and the chi-square test of independence was used to evaluate difference in reported likelihood of adopting telehealth into practice before and after training. RESULTS: Prior to the COVID-19 global health emergency, the top benefits identified by the OTP Experienced Telehealth-User Survey included: 1) service access, 2) collaboration and carry-over with team members, 3) efficiency themes, and4) student engagement and comfort. Top benefits identified by the OTP New to Telehealth Survey identified the same top benefits after participating in the training program. A significant decrease in perceived barriers was noted in scores from pre- to post-training by OTPs new to telehealth. The perceived barriers that did not significantly decrease post-training suggest the need for future education and future protocol development. These included: unreliable internet, lack of hands-on opportunity and e-helpers' (parent, caregiver or support system available to assist the student in person during a telehealth session) decreased comfort with technology. Of the participants who completed the OT Telehealth Primer: School-based Practice, 80% reported being likely to add telehealth as a delivery model for future OT practice. CONCLUSIONS: Prior to the COVID-19 global health emergency, completion of the comprehensive training program OT Telehealth Primer: School-based Practice program yielded improved perceived benefits and an increased likelihood of telehealth adoption into practice by OTPs. However, both OTPs and school administrators require ongoing education for successful widespread adoption to be achieved thus offsetting the global shortage of OTPs and increasing service access. Future research, particularly related to available training and support for the rapid adoption of telehealth technologies during the COVID-19 global health emergency, will yield helpful information about the likelihood of continued use of telehealth in practice.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Fuerza Laboral en Salud , Terapia Ocupacional/organización & administración , Pandemias , Neumonía Viral/epidemiología , Servicios de Salud Escolar/organización & administración , Telemedicina/organización & administración , Betacoronavirus , Eficiencia Organizacional , Salud Global , Accesibilidad a los Servicios de Salud , Humanos , Comunicación Interdisciplinaria , Terapia Ocupacional/estadística & datos numéricos , Grupo de Atención al Paciente
11.
J Interprof Care ; 34(5): 672-678, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32962462

RESUMEN

The COVID-19 pandemic has presented both challenges and opportunities for those working in health and social care in the United Kingdom (UK). With much focus on secondary and acute care at this time, there has been less communication and understanding about the impact on primary care. This discussion paper is based on the experience of one of the authors working as a general practitioner/family doctor during the pandemic and rapid changes are described during this time (April 2020). Two important themes emerged from this experience focusing on the importance of supporting one another and new roles and ways of working. It can be argued that the challenges presented by COVID-19 have expedited positive and potentially sustainable change in UK primary care that has been needed for some time. The authors discuss the implications for future working and make a series of recommendations for primary care relating to the importance of supporting the workforce, remote consultations and communication, regular team meetings, and development of integrated care. It is suggested that many of the challenges highlighted can be addressed by placing a greater emphasis on the use of interprofessional education (IPE) to underpin and support effective collaborative working.


Asunto(s)
Infecciones por Coronavirus , Relaciones Interprofesionales , Pandemias , Neumonía Viral , Atención Primaria de Salud , Betacoronavirus , Prestación Integrada de Atención de Salud , Conducta de Búsqueda de Ayuda , Humanos , Comunicación Interdisciplinaria , Grupo de Atención al Paciente , Pobreza , Rol Profesional , Consulta Remota , Reino Unido
12.
BMC Med Genet ; 21(1): 189, 2020 09 29.
Artículo en Inglés | MEDLINE | ID: mdl-32993552

RESUMEN

BACKGROUND: Acroscyphodysplasia has been described as a phenotypic variant of acrodysostosis type 2 and pseudohypoparathyroidism. In acrodysostosis, skeletal features can include brachydactyly, facial hypoplasia, cone-shaped epiphyses, short stature, and advanced bone age. To date, reports on this disorder have focused on phenotypic findings, endocrine changes, and genetic variation. We present a 14-year overview of a patient, from birth to skeletal maturity, with acroscyphodysplasia, noting the significant orthopaedic challenges and the need for a multidisciplinary team, including specialists in genetics, orthopaedics, endocrinology, and otolaryngology, to optimize long-term outcomes. CASE PRESENTATION: The patient presented as a newborn with dysmorphic facial features, including severe midface hypoplasia, malar flattening, nasal stenosis, and feeding difficulties. Radiologic findings were initially subtle, and a skeletal survey performed at age 7 months was initially considered normal. Genetic evaluation revealed a variant in PDE4D and subsequent pseudohypoparathyroidism. The patient presented to the department of orthopaedics, at age 2 years 9 months with a leg length discrepancy, right knee contracture, and severely crouched gait. Radiographs demonstrated cone-shaped epiphyses of the right distal femur and proximal tibia, but no evidence of growth plate changes in the left leg. The child developed early posterior epiphyseal arrest on the right side and required multiple surgical interventions to achieve neutral extension. Her left distal femur developed late posterior physeal arrest and secondary contracture without evidence of schypho deformity, which improved with anterior screw epiphysiodesis. The child required numerous orthopaedic surgical interventions to achieve full knee extension bilaterally. At age 13 years 11 months, she was an independent ambulator with erect posture. The child underwent numerous otolaryngology procedures and will require significant ongoing care. She has moderate intellectual disability. DISCUSSION AND CONCLUSIONS: Key challenges in the management of this case included the subtle changes on initial skeletal survey and the marked asymmetry of her deformity. While cone-shaped epiphyses are a hallmark of acrodysostosis, posterior tethering/growth arrest of the posterior distal femur has not been previously reported. Correction of the secondary knee contracture was essential to improve ambulation. Children with acroscyphodysplasia require a multidisciplinary approach, including radiology, genetics, orthopaedics, otolaryngology, and endocrinology specialties.


Asunto(s)
Disostosis/terapia , Discapacidad Intelectual/terapia , Comunicación Interdisciplinaria , Osteocondrodisplasias/terapia , Grupo de Atención al Paciente , Seudohipoparatiroidismo/terapia , Huesos/anomalías , Huesos/diagnóstico por imagen , Huesos/metabolismo , Subunidad RIalfa de la Proteína Quinasa Dependiente de AMP Cíclico/genética , Fosfodiesterasas de Nucleótidos Cíclicos Tipo 4/genética , Disostosis/diagnóstico , Disostosis/genética , Estudios de Seguimiento , Predisposición Genética a la Enfermedad/genética , Discapacidad Intelectual/diagnóstico , Discapacidad Intelectual/genética , Osteocondrodisplasias/diagnóstico , Osteocondrodisplasias/genética , Seudohipoparatiroidismo/diagnóstico , Seudohipoparatiroidismo/genética , Radiografía/métodos , Factores de Tiempo
13.
Foot Ankle Spec ; 13(5): 415-419, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32924585

RESUMEN

Skin cancer is the most common cancer within the United States. Reports estimate that 1 in 5 Americans will develop some form of skin cancer. Eccrine porocarcinoma is a rare type of skin cancer of sweat gland origin. Eccrine porocarcinoma is most commonly found on the lower extremities. Clinically it may appear similar to benign skin lesions and it has significant metastatic potential. The authors present a case report with 22 months' follow-up. It describes a multiyear delay in diagnosis involving 3 specialties, including primary care, dermatology, and wound physical therapy. Information is given on techniques when high-risk cutaneous cancers are suspected or encountered. A multispecialty treatment plan is discussed.Levels of Evidence: Level V.


Asunto(s)
Diagnóstico Tardío/prevención & control , Porocarcinoma Ecrino/diagnóstico , Porocarcinoma Ecrino/cirugía , Hallux/cirugía , Procedimientos Ortopédicos/métodos , Neoplasias de las Glándulas Sudoríparas/diagnóstico , Neoplasias de las Glándulas Sudoríparas/cirugía , Anciano , Amputación/métodos , Porocarcinoma Ecrino/diagnóstico por imagen , Porocarcinoma Ecrino/patología , Humanos , Comunicación Interdisciplinaria , Extremidad Inferior , Masculino , Grupo de Atención al Paciente , Enfermedades Raras , Biopsia del Ganglio Linfático Centinela , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Neoplasias de las Glándulas Sudoríparas/diagnóstico por imagen , Neoplasias de las Glándulas Sudoríparas/patología , Resultado del Tratamiento
14.
S Afr Med J ; 110(7): 613-616, 2020 05 21.
Artículo en Inglés | MEDLINE | ID: mdl-32880333

RESUMEN

Faced with a pandemic, doctors around the world are forced to make difficult ethical decisions about clinical, economic and politically charged issues in medicine and healthcare, with little time or resources for support. A decision-making framework is suggested to guide policy and clinical practice to support the needs of healthcare workers, help to allocate scarce resources equitably and promote communication among stakeholders, while drawing on South African doctors' knowledge, culture and experience.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Comunicación Interdisciplinaria , Evaluación de Resultado en la Atención de Salud , Pandemias/prevención & control , Neumonía Viral/prevención & control , Pautas de la Práctica en Medicina/organización & administración , Actitud del Personal de Salud , Toma de Decisiones Clínicas , Infecciones por Coronavirus/epidemiología , Países en Desarrollo , Femenino , Política de Salud , Recursos en Salud , Humanos , Masculino , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Formulación de Políticas , Sudáfrica
16.
Cuad Bioet ; 31(102): 223-229, 2020.
Artículo en Español | MEDLINE | ID: mdl-32910673

RESUMEN

With the arrival of the COVID-19 pandemic, the risk of a possible lack of care for the elderly in nursing homes became evident. We summarize the experience of a multidisciplinary team with volunteer professionals from different specialties who carried out support for healthcare professionals in nursing homes. This team was implemented from both Primary and Specialty Care managements. Its work paradigm was proposed by our home hospitalization team, which included direct care of the most complex patients and general counselling on isolation, hygiene and preventive measures within the nursing homes. Thanks to this support, the elderly population placed there, with suspected or diagnosed COVID-19, received adequate care from an interdisciplinary team, which led part of the pressure to be released from their professional workers, and many family members were aware that there was no neglect of the elderly. Commitment from various levels of care in a coordinated effort has prevented a vulnerable population from being left unattended during the pandemic.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Casas de Salud/ética , Pandemias , Neumonía Viral , Anciano , Continuidad de la Atención al Paciente , Infecciones por Coronavirus/prevención & control , Infección Hospitalaria/prevención & control , Necesidades y Demandas de Servicios de Salud , Humanos , Higiene , Control de Infecciones , Comunicación Interdisciplinaria , Cuidados Paliativos/ética , Pandemias/ética , Pandemias/prevención & control , Grupo de Atención al Paciente , Aislamiento de Pacientes , Transferencia de Pacientes/ética , Neumonía Viral/prevención & control , Relaciones Profesional-Familia , Calidad de Vida , Evaluación de Síntomas , Poblaciones Vulnerables
18.
J Interprof Care ; 34(5): 587-592, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32811213

RESUMEN

Globally, the advent and rapid spread of the COVID-19 virus has created significant disruption to health professions education and practice, and consequently interprofessional education, leading to a model of learning and practicing where much is unknown. Key questions for this ongoing evolution emerge for the global context leading to reflections on future directions for the interprofessional education field and its role in shaping future practice models. Health professions programs around the world have made a dramatic shift to virtual learning platforms in response to closures of academic institutions and restrictions imposed on learners accessing practice settings. Telemedicine, slow to become established in many countries to date, has also revolutionized practice in the current environment. Within the state of disruption and rapid change is the awareness of a silver lining that provides an opportunity for future growth. Key topics explored in this commentary include reflection on the application of existing competency frameworks, consideration of typology of team structures, reconsideration of theoretical underpinnings, revisiting of core dimensions of education, adaptation of interprofessional education activities, and the role in the future pandemic planning. As an international community of educators and researchers, the authors consider current observations relevant to interprofessional education and practice contexts and suggest a response from scholarship voices across the globe. The current pandemic offers a unique opportunity for educators, practitioners, and researchers to retain what has served interprofessional education and practice well in the past, break from what has not worked as well, and begin to imagine the new.


Asunto(s)
Infecciones por Coronavirus , Empleos en Salud/educación , Comunicación Interdisciplinaria , Pandemias , Neumonía Viral , Curriculum , Humanos , Internacionalidad , Aprendizaje Basado en Problemas , Síndrome Respiratorio Agudo Grave
19.
J Interprof Care ; 34(5): 633-646, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32811228

RESUMEN

COVID-19 restrictions necessitated wholescale conversion of curricula to online learning environments globally. We used a mixed-methods study design to evaluate the conversion of a large foundational interprofessional course, at our university, to an asynchronous online learning environment. A survey was used to gauge if students learned interprofessionally and about interprofessional collaborative practice (IPCP). A COVID-19 discussion board was used to assess learner knowledge of their own and other health professions and value for IPCP. Survey results indicated students perceived the online session as effective as it would have been in person. The COVID-19 discussion board presented evidence that students met all Interprofessional Education Collaborative core competencies for IPCP, shared knowledge of their and other health professions, and expressed the value and essentiality of IPCP. Findings support social context as a main requisite for interprofessional education, and within the context of the COVID-19 pandemic, students were able to heighten their connection to the global interprofessional community. Circumstances surrounding COVID-19 highlight the need for increasing IPCP education. One unforeseen positive that has emerged in spite of this global catastrophe is enhanced student awareness of IPCP and interprofessional comradery as evidenced through student discussions in this course.


Asunto(s)
Infecciones por Coronavirus , Educación a Distancia , Personal de Salud/educación , Pandemias , Neumonía Viral , Adulto , Betacoronavirus , Femenino , Humanos , Comunicación Interdisciplinaria , Relaciones Interprofesionales , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto Joven
20.
J Interprof Care ; 34(5): 647-654, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32838599

RESUMEN

In the time of COVID-19, universities have been forced to engage with online learning more than ever before. The facilitator is a key player in the orchestration of online learning and as such, this paper seeks to present a radical reworking of the Garrison and Archer Community of Inquiry model that emphasizes the importance of a therapeutic presence in online interprofessional facilitation. Drawn from a strand of inductive empirical qualitative research based on 15 years' experience of online interprofessional education, this paper employs a therapeutic lens to propose the good enough facilitator as a theoretical construct that emphasizes the importance of the facilitator understanding when to intervene and when to retreat within the online space. Online interprofessional asynchronous discussion groups are explored to illustrate the value of the good enough facilitator in online learning.


Asunto(s)
Infecciones por Coronavirus , Educación a Distancia , Comunicación Interdisciplinaria , Pandemias , Grupo de Atención al Paciente , Neumonía Viral , Betacoronavirus , Conducta Cooperativa , Femenino , Humanos , Masculino
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