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1.
Esc. Anna Nery Rev. Enferm ; 26(spe): e20210179, 2022. ilus
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1292850

RESUMEN

Objetivo: O estudo objetivou compreender as repercussões da pandemia da Covid-19 no cuidado de lactentes prematuros, na perspectiva de mães e profissionais de saúde. Método: Foram realizadas entrevistas semiestruturadas nos meses de junho e julho de 2020, por meio de ligação telefônica, com 14 mães e quatro profissionais de saúde do serviço de follow-up de uma maternidade pública da Paraíba, Brasil. Resultados: A partir da análise temática indutiva, os impactos da pandemia no cuidado ao lactente nascido prematuro, foram: sobrecarga e afastamento dos profissionais dos serviços de saúde, desativação temporária da unidade mãe canguru, descontinuidade da assistência ao prematuro, medo materno de expor a criança à Covid-19 e baixa condição socioeconômica. Foram elencadas estratégias de enfrentamento para o cuidado dos lactentes durante a pandemia, como: maior espaçamento das consultas, acompanhamento por meio telefônico e cumprimento das medidas de biossegurança. Conclusão e implicações para a prática: A pandemia exigi adaptações na assistência, tornando necessárias novas formas de cuidado a essas crianças, como exemplo, as consultas de acompanhamento remotas, a fim de garantir o seu direito à vida e saúde


Objective: The study aimed at understanding the repercussions of the Covid-19 pandemic in the care of premature infants, from the perspective of mothers and health professionals. Method: Semi-structured interviews were conducted in the months of June and July 2020, over the telephone, with 14 mothers and four health professionals from the follow-up service of a public maternity hospital in Paraíba, Brazil. Results: From the inductive thematic analysis, the impacts of the pandemic on the care of premature infants were as follows: overload and distancing of health service professionals, temporary deactivation of the Kangaroo mother unit, discontinuity of care for the premature infant, maternal fear of exposing the child to Covid-19 and low socioeconomic status. Coping strategies for the care of infants during the pandemic were listed, such as: greater spacing between consultations, phone follow-up and compliance with biosafety measures. Conclusion and implications for the practice: The pandemic required adaptations in care, which make new forms of care necessary for these children, such as remote follow-up consultations, in order to guarantee their right to life and health


Objetivo: El estudio tuvo como objetivo comprender las repercusiones de la pandemia de Covid-19 en la atención de bebés prematuros, desde la perspectiva de las madres y los profesionales de la salud. Método: Se realizaron entrevistas semiestructuradas en los meses de junio y julio de 2020, por medio de llamadas telefónicas, a 14 madres y cuatro profesionales de la salud del servicio de seguimiento de una maternidad pública en Paraíba, Brasil. Resultados: A partir del análisis temático inductivo, los efectos de la pandemia en la atención de bebés prematuros fueron los siguientes: sobrecarga y distanciamiento de profesionales de los servicios de salud, inhabilitación temporal de la unidad Madre Canguro, discontinuidad de la atención al bebé prematuro, miedo materno a exponer al niño al Covid-19 y nivel socioeconómico bajo. Se enumeraron estrategias de afrontamiento para la atención infantil durante la pandemia, tales como: mayor intervalo entre consultas, seguimiento telefónico y cumplimiento de medidas de bioseguridad. Conclusión e implicaciones para la práctica: La pandemia requirió adaptaciones en la atención, que hacen necesarias nuevas formas de atención para estos niños, como las consultas de monitoreo remoto, para garantizar su derecho a la vida y a la salud


Asunto(s)
Humanos , Femenino , Lactante , Adulto , Persona de Mediana Edad , Recien Nacido Prematuro/crecimiento & desarrollo , Personal de Salud , Servicios de Salud Materno-Infantil , COVID-19 , Cuidado del Lactante , Madres , Carga de Trabajo/psicología , Consulta Remota , Investigación Cualitativa , Cobertura de Vacunación , Miedo , Método Madre-Canguro , Higiene de las Manos , Distanciamiento Físico , COVID-19/prevención & control
2.
Torture ; 31(1): 37-52, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34606476

RESUMEN

INTRODUCTION: Due to the COVID-19 pandemic, Freedom from Torture developed remote telephone assessments to provide interim medico-legal reports, ensuring people could obtain medical evidence to support their asylum claim. METHOD: To audit this new way of working, feedback was collected from the doctors, interpreters, individuals being assessed, and senior medical and legal staff who reviewed the reports. This paper presents findings from the first 20 assessments. RESULTS: Individuals assessed reported that the doctor developed good rapport, but in 35% of assessments reported that there were some experiences they felt unable to disclose. In 70% of assessments, doctors felt that rapport was not as good compared to face-to-face. In the majority of assessments, doctors were unable to gain a full account of the torture or its impact. They reported feeling cautious about pressing for more information on the telephone, mindful of individuals' vulnerability and the difficulty of providing support remotely. Nevertheless, in 85% of assessments doctors felt able to assess the consistency of the account of torture with the psychological findings, in accordance with the Istanbul Protocol (United Nations, 2004). Factors that hindered the assessment included the inability to observe body language, the person's ill health, and confidentiality concerns. CONCLUSION: This research indicates that psychological medico-legal reports can safely be produced by telephone assessment, but are more likely to be incomplete in terms of both full disclosure of torture experiences and psychological assessment. The limitations underline the need for a follow-up face-to-face assessment to expand the psychological assessment as well as undertake a physical assessment.


Asunto(s)
COVID-19/epidemiología , Relaciones Médico-Paciente/ética , Refugiados/psicología , Consulta Remota/ética , Teléfono , Tortura , Humanos , Anamnesis , Pandemias , Examen Físico , SARS-CoV-2 , Reino Unido/epidemiología
3.
Acta Med Indones ; 53(3): 352-359, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34611077

RESUMEN

BACKGROUND: COVID-19 is an infectious disease that is easily widespread and has clinical manifestations as mild, moderate, or severe disease. COVID-19 patients are required to be isolated during treatment to reduce transmission. This can cause anxiety and depression, which in turn worsens the patient's illness. Providing supportive psychotherapy can help provide a feeling of safety, comfort and calm for patients. The choice of method in providing supportive psychotherapy can be done online/teleconsultation or internet-based. This clinical review aims to determine the effect of online teleconsultation or internet-based psychotherapy on COVID-19 patients. METHODS: A systematic search was performed using online databases, such as PubMed, Cochrane, EBSCO/CINAHL and ProQuest. The identified articles were screened using eligibility criteria. There were 2 studies (Zhou et al, and Wei et al) which were analyzed critically using the Newcastle Ottawa Scale. RESULTS: Both studies showed that management of psychotherapy through teleconsultation or internet-based on COVID-19 patients can help relieve the patient's psychological symptoms. Zhou et al studied 63 suspected COVID-19 with 23.8% (n = 15) having a Hospital Anxiety Depression Scale (HADS) score of 8 or more. There was a significant decrease in HADS-A nxiety (HADS-A) scores (p <0.01) and HADS-Depression (HADS-D) scores (p <0.01) in 15 patients, and from the overall HADS scores (p < 0.01). Wei et al. Showed 17-HAMD and HAMA scores in the online psychological intervention group also showed a significant reduction in symptoms of depression and anxiety compared to controls. CONCLUSION: Psychotherapy through online teleconsultation or internet-based on COVID-19 patients can help relieve symptoms of anxiety and depression and teleconsultation and also effective in dealing with psychological complications in patients with COVID-19.


Asunto(s)
Ansiedad , COVID-19/psicología , Depresión , Intervención basada en la Internet , Psicoterapia/métodos , Consulta Remota/métodos , Ansiedad/etiología , Ansiedad/terapia , COVID-19/epidemiología , COVID-19/prevención & control , Control de Enfermedades Transmisibles/métodos , Depresión/etiología , Depresión/terapia , Humanos , SARS-CoV-2
5.
Dermatol Clin ; 39(4): 599-608, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34556249

RESUMEN

The accelerated implementation and use of teledermatology during the coronavirus disease 2019 pandemic has met with successes and challenges. This review explores how telemedicine was used in dermatology before the pandemic, the regulatory adaptions made in response to the pandemic, and the effectiveness of the rapid implementation of teledermatology during the coronavirus disease 2019 pandemic, and, finally, how teledermatology has expanded in response to the pandemic. This review examines lessons learned and how teledermatology's reliance on digital technologies might paradoxically exacerbate health care disparities, and finally, considers the future outlook.


Asunto(s)
COVID-19/epidemiología , Derivación y Consulta/estadística & datos numéricos , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/terapia , Telemedicina/estadística & datos numéricos , Dermatología/organización & administración , Humanos , Consulta Remota/estadística & datos numéricos , Índice de Severidad de la Enfermedad
6.
PLoS One ; 16(9): e0257458, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34591886

RESUMEN

BACKGROUND: The COVID-19 pandemic has sparked a surge in the use of virtual communication tools for delivering clinical services for many non-urgent medical needs allowing telehealth or telemedicine, to become an almost inevitable part of the patient care. However, most of patients with vascular disease may require face-to-face interaction and are at risk of worse outcomes if not managed in timely manner. OBJECTIVE: We aimed to describe the utilization of telemedicine services in the outpatient vascular surgery clinics in a tertiary hospital. METHODS: A retrospective analysis of data on all vascular outpatient encounters during 2019 and 2020 was conducted and compared to reflect the pattern of practice prior to and during the COVID-19 pandemic. RESULTS: The study showed that 61% of the total patient encounters in 2020 were reported through teleconsultation. Females were the majority of patients who sought the virtual vascular care. Consultations for the new cases decreased from 29% to 26% whereas, the follow-up cases increased from 71% to 74% in 2020 (p = 0.001). The number of procedures performed in the vascular outpatient clinics decreased by 46% in 2020 when compared to 2019. This decrease in procedures was more evident in the duration from February 2020 to April 2020 in which the procedures decreased by 97%. The proportion of procedures represented 22.6% of the total encounters in 2019 and 10.5% of the encounters during 2020, (p = 0.001). CONCLUSIONS: Teleconsultation, along with supporting practice guidelines, can be used to maximize the efficiency of care in vascular surgery patients during the pandemic and beyond. Adoption of the 'hybrid care' which combines both virtual and in-person services as an ongoing practice requires evidence obtained through audits and studies on patients and healthcare providers levels. It is essential to establish a clear practice that ensures patient's needs.


Asunto(s)
Consulta Remota , Procedimientos Quirúrgicos Vasculares , COVID-19/epidemiología , Femenino , Humanos , Masculino , Pacientes Ambulatorios , Qatar/epidemiología , Estudios Retrospectivos , Centros de Atención Terciaria
8.
Int J Med Inform ; 155: 104589, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34592540

RESUMEN

BACKGROUND: During the COVID 19 pandemic, direct-to-consumer telehealth (DTC) services allowed patients real-time virtual access to healthcare providers, especially those with an established relationship. In Colombia, this care modality was implemented between 2019 and 2020, under national considerations, it was implemented for outpatient care in a highly complex university hospital in Cali, Colombia. METHODS: A descriptive study with prospective information collection was used to describe the implementation of the outpatient teleconsultation care model for patients. We constructed the clinical and process indicators with which we evaluated the model. FINDINGS: A total of 56,560 patients from our institution were treated by virtual outpatient consultation during the first nine months of the health emergency declared by COVID 19 in Colombia. The strategy made it possible to achieve coverage more significant than 100% in Cali and the departments of Colombia. Attention by teleconsultation was 19% of the total ambulatory care. The effectiveness in carrying out scheduled teleconsultations had an overall result of 91.5%. The accessibility results demonstrated the need to strengthen connectivity and accessibility to payments and strengthen technology adoption in the institution, health personnel, and patients. INTERPRETATION: Implementing an outpatient teleconsultation model allowed the continuity of the management with comprehensive coverage nationwide from a highly complex hospital in southwestern Colombia. The indicators' analysis should help strengthen the policies of access to telemedicine, especially with the consequences of the pandemic in low- and middle-income countries. Latin American evidence is necessary to establish the safety profile of telemedicine and the costs associated with the provision.


Asunto(s)
COVID-19 , Consulta Remota , Atención Ambulatoria , Colombia/epidemiología , Hospitales , Humanos , Pandemias , Estudios Prospectivos , SARS-CoV-2
9.
Ir Med J ; 114(7): 403, 2021 08 19.
Artículo en Inglés | MEDLINE | ID: mdl-34520346

RESUMEN

Introduction Remote consultation is of growing in importance and gaining popularity in both primary and secondary healthcare settings. Reduced necessity for a physical presence of the patient within the healthcare setting is of particular benefit in the current COVID-19 era. It is also of benefit to a diverse group of patients, for example: those who are geographically distant from the base hospital, those suffering from mobility issues or chronic illness, those who require chaperoning as well as those with limited access to transport. We have developed guidelines for the use of the medical telecommunications platform, Attend Anywhere, which has been utilised across the English and Scottish National Health Services, as well as with the Australian Health service, and is now available in Health Service Executive (HSE) settings. Herein we describe and recommend a process that we have found helpful, and we propose guidelines on how a Health Care Worker (HCW) might consider approaching a virtual consultation when initiating and safely executing a patient encounter on Attend Anywhere, in a secure and efficient manner. The guidelines were created following review of the literature on previous experience by others with this software, as well as recent guidance published by the Irish Medical Council. A proportion of this guidance is transferable to other platforms. Methods We also undertook a short survey of our patients and physicians in Sligo University Hospital, who used Attend Anywhere over a six-week period to gauge their satisfaction levels with the experience., We estimated distance that our patients would have travelled for their appointment had the traditional face-to-face consultation been carried out. We noted whether we considered the medium appropriate for the patient consultations. Results 53 patients took part and satisfaction was rated from satisfied to very satisfied on a 3-point scale for all stakeholders. In addition, we found that remote consultation, when compared to face-to-face consultation, alleviated an average of 144km of unnecessary travel per appointment. Remote consultation was deemed appropriate in all cases and no rescheduled face-to-face appointments were required due to failure of the consultation due to difficulties encountered. Conclusion The authors recommend the implementation of the described guidance, with suggested Checklist, Information leaflet and Consent form, as a means of ensuring the confidentiality of the consultation and to ensure that processes are adhered to that optimise protection for both the patient and the clinician, while reducing the burden of attendance to the healthcare location.


Asunto(s)
COVID-19/epidemiología , Dolor Crónico/diagnóstico , Dolor Crónico/terapia , Consulta Remota/organización & administración , Tecnología de Sensores Remotos/métodos , Australia , Humanos , Programas Nacionales de Salud , Manejo del Dolor , Satisfacción del Paciente , Investigación Cualitativa , Telecomunicaciones/organización & administración , Tecnología Inalámbrica
11.
J Med Internet Res ; 23(9): e19232, 2021 09 17.
Artículo en Inglés | MEDLINE | ID: mdl-34533461

RESUMEN

BACKGROUND: Using technology to reduce the pressure on the National Health Service (NHS) in England and Wales is a key government target, and the NHS Long-Term Plan outlines a strategy for digitally enabled outpatient care to become mainstream by 2024. In 2020, the COVID-19 response saw the widespread introduction of remote consultations for patient follow-up, regardless of individual preferences. Despite this rapid change, there may be enduring barriers to the effective implementation of remote appointments into routine practice once the unique drivers for change during the COVID-19 pandemic no longer apply, to which pre-COVID implementation studies can offer important insights. OBJECTIVE: This study aims to evaluate the feasibility of using real-time remote consultations between patients and secondary care physicians for routine patient follow-up at a large hospital in the United Kingdom and to assess whether patient satisfaction differs between intervention and usual care patients. METHODS: Clinically stable liver transplant patients were randomized to real-time remote consultations in which their hospital physician used secure videoconferencing software (intervention) or standard face-to-face appointments (usual care). Participants were asked to complete postappointment questionnaires over 12 months. Data were analyzed on an intention-to-treat basis. The primary outcome was the difference in scores between baseline and study end by patient group for the three domains of patient satisfaction (assessed using the Visit-Specific Satisfaction Instrument). An embedded qualitative process evaluation used interviews to assess patient and staff experiences. RESULTS: Of the 54 patients who were randomized, 29 (54%) received remote consultations, and 25 (46%) received usual care (recruitment rate: 54/203, 26.6%). The crossover between study arms was high (13/29, 45%). A total of 129 appointments were completed, with 63.6% (82/129) of the questionnaires being returned. Patient satisfaction at 12 months increased in both the intervention (25 points) and usual care (14 points) groups. The within-group analysis showed that the increases were significant for both intervention (P<.001) and usual care (P=.02) patients; however, the between-group difference was not significant after controlling for baseline scores (P=.10). The qualitative process evaluation showed that-according to patients-remote consultations saved time and money, were less burdensome, and caused fewer negative impacts on health. Technical problems with the software were common, and only 17% (5/29) of patients received all appointments over video. Both consultants and patients saw remote consultations as positive and beneficial. CONCLUSIONS: Using technology to conduct routine follow-up appointments remotely may ease some of the resource and infrastructure challenges faced by the UK NHS and free up clinic space for patients who must be seen face-to-face. Our findings regarding the advantages and challenges of using remote consultations for routine follow-ups of liver transplant patients have important implications for service organization and delivery in the postpandemic NHS. TRIAL REGISTRATION: ISRCTN Registry 14093266; https://www.isrctn.com/ISRCTN14093266. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-018-2953-4.


Asunto(s)
COVID-19 , Trasplante de Hígado , Consulta Remota , Estudios de Factibilidad , Hospitales , Humanos , Pandemias , SARS-CoV-2 , Medicina Estatal
12.
S Afr Fam Pract (2004) ; 63(1): e1-e6, 2021 08 26.
Artículo en Inglés | MEDLINE | ID: mdl-34476964

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented international emergency, resulting in a need to adapt the existing healthcare systems, in order to enable ongoing patient care despite the current disruptions. Telemedicine may be a viable option to continue hospital workflow, however there are barriers to its implementation. We set out to establish what barriers might exist and to assess the viability of teleclinics within the province KwaZulu-Natal (KZN), as perceived by doctors. METHODS: This was a quantitative, observational, survey-based study targeted at medical doctors working in both the public as well as the private healthcare sector in University of KwaZulu-Natal (UKZN). RESULTS: One hundred and forty-seven (147) responses were included. The majority (86%) of respondents felt that telemedicine could provide a useful means to continuing hospital workflow, however, only 47% believed that it was a viable option for their unit. The major barrier identified was a feeling that doctors would-be at-increased medico-legal risk. Only 38.4% of doctors were familiar with the Health Professions Council of South Africa (HPCSA) guidelines on telemedicine usage. Other major barriers included: doctors feeling uncomfortable with not seeing a patient in person or not being able to perform a thorough physical examination. Other reasons identified as potential barriers were doctors foreseeing difficulty in accessing patient medical records and the absence of available systems to order investigations without the patient being physically present. CONCLUSION: Telemedicine is currently not widely utilised in KZN; although most doctors were of the opinion that it could be a useful tool in order to continue the workflow during the pandemic. The major barrier identified were issues surrounding medico-legal coverage.


Asunto(s)
Actitud del Personal de Salud , Cuerpo Médico de Hospitales/psicología , Consulta Remota/métodos , Teléfono , COVID-19/epidemiología , Femenino , Encuestas de Atención de la Salud , Humanos , Responsabilidad Legal , Masculino , Registros Médicos , Pandemias , Guías de Práctica Clínica como Asunto , SARS-CoV-2 , Sudáfrica/epidemiología
13.
J Med Internet Res ; 23(10): e31374, 2021 10 07.
Artículo en Inglés | MEDLINE | ID: mdl-34516389

RESUMEN

BACKGROUND: Scotland-a country of 5.5 million people-has a rugged geography with many outlying islands, creating access challenges for many citizens. The government has long sought to mitigate these through a range of measures including an ambitious technology-enabled care program. A strategy to develop a nationwide video consultation service began in 2017. Our mixed methods evaluation was commissioned in mid-2019 and extended to cover the pandemic response in 2020. OBJECTIVE: To draw lessons from a national evaluation of the introduction, spread, and scale-up of Scotland's video consultation services both before and during the pandemic. METHODS: Data sources comprised 223 interviews (with patients, staff, technology providers, and policymakers), 60 hours of ethnographic observation (including in-person visits to remote settings), patient and staff satisfaction surveys (n=20,349), professional and public engagement questionnaires (n=5400), uptake statistics, and local and national documents. Fieldwork during the pandemic was of necessity conducted remotely. Data were analyzed thematically and theorized using the Planning and Evaluating Remote Consultation Services (PERCS) framework which considers multiple influences interacting dynamically and unfolding over time. RESULTS: By the time the pandemic hit, there had been considerable investment in material and technological infrastructure, staff training, and professional and public engagement. Scotland was thus uniquely well placed to expand its video consultation services at pace and scale. Within 4 months (March-June 2020), the number of video consultations increased from about 330 to 17,000 per week nationally. While not everything went smoothly, video was used for a much wider range of clinical problems, vastly extending the prepandemic focus on outpatient monitoring of chronic stable conditions. The technology was generally considered dependable and easy to use. In most cases (14,677/18,817, 78%), patients reported no technical problems during their postconsultation survey. Health care organizations' general innovativeness and digital maturity had a strong bearing on their ability to introduce, routinize, and expand video consultation services. CONCLUSIONS: The national-level groundwork before the pandemic allowed many services to rapidly extend the use of video consultations during the pandemic, supported by a strong strategic vision, a well-resourced quality improvement model, dependable technology, and multiple opportunities for staff to try out the video option. Scotland provides an important national case study from which other countries may learn.


Asunto(s)
COVID-19 , Consulta Remota , Antropología Cultural , Humanos , Pandemias , SARS-CoV-2
14.
Online braz. j. nurs. (Online) ; 20(supl.1): e20216462, 09 setembro 2021. tab
Artículo en Inglés, Español, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1292444

RESUMEN

OBJETIVO: identificar as intervenções de enfermagem realizadas por teleconsulta ao idoso e seu cuidador no Serviço de Atenção Domiciliar (SAD) na pandemia da COVID-19. MÉTODO: estudo transversal das intervenções de enfermagem realizadas com 140 idosos e 106 cuidadores, no município de São Gonçalo-RJ. Para tanto, elaborou-se um instrumento semiestruturado fundamentado nos diagnósticos de enfermagem Síndrome do Idoso Frágil, Risco de contaminação e Tensão do papel do cuidador da Taxonomia da NANDA-I, intervenções e atividades de enfermagem NIC e no Protocolo de Manejo Clínico do Coronavírus (COVID-19), na Atenção Primária à Saúde do Ministério da Saúde. RESULTADOS: em 66,4% dos casos houve mudança na rotina para se adequar ao cuidado do idoso, sem diferença significativa para os idosos com mais de 85 anos; 53,6% tiveram dificuldades em manter o isolamento social e 49,3%, em realizar cuidados de higiene. Em 95,7%, a intervenção realizada foi "ensinar ao idoso e cuidador estratégias de manutenção dos cuidados de saúde para diminuir a contaminação". CONCLUSÃO recomenda-se o uso do telecuidado associado às visitas que se tornaram excepcionalidade na pandemia, dando continuidade ao cuidado no SAD, que auxilia na manutenção da capacidade funcional do idoso, no estresse do cuidador, e na adoção de medidas de isolamento social.


OBJECTIVE: to identify the nursing interventions performed by telenursing to the elderly and their caregivers in the Home Care Service (SAD) during the COVID-19 pandemic. METHOD: cross-sectional study of nursing interventions performed with 140 elderly and 106 caregivers, located in the city of São Gonçalo, in the state of Rio de Janeiro. Therefore, a semi-structured instrument was developed based on the nursing diagnosis of Frailty Syndrome, Risk of contamination, and Caregiver role strain of the NANDA-I Taxonomy, NIC nursing interventions and activities, and on the Coronavirus Clinical Management Protocol (COVID-19) in the Primary Health Care of the Ministry of Health. RESULTS: in 66.4% of the cases, there was a change in the routine to suit the care of the elderly,with no significant difference for the elderly over 85 years old; 53.6% had difficulties in maintaining social isolation, and 49.3% in performing hygiene care. In 95.7%, the intervention performed was "teaching the elderly and caregivers about health caremaintenance strategies to reduce contamination". CONCLUSION: the use of telecare associated with visits that became an exception during the pandemic is recommended, providing continuity of care in the Home Care Service. These strategies help to maintain the functional capacity of the elderly, to control the stress of the caregivers, and to adopt measures of social isolation.


OBJETIVO: identificar as intervenções de enfermagem realizadas por teleconsulta ao idoso e seu cuidador no Serviço de Atenção Domiciliar (SAD) na pandemia da COVID-19. MÉTODO: estudo transversal das intervenções de enfermagem realizadas com 140 idosos e 106 cuidadores, no município de São Gonçalo-RJ. Para tanto, elaborou-se um instrumento semiestruturado fundamentado nos diagnósticos de enfermagem Síndrome do Idoso Frágil, Risco de contaminação e Tensão do papel do cuidador da Taxonomia da NANDA-I, intervenções e atividades de enfermagem NIC e no Protocolo de Manejo Clínico do Coronavírus (COVID-19), na Atenção Primária à Saúde do Ministério da Saúde. RESULTADOS: em 66,4% dos casos houve mudança na rotina para se adequar ao cuidado do idoso, sem diferença significativa para os idosos com mais de 85 anos; 53,6% tiveram dificuldades em manter o isolamento social e 49,3%, em realizar cuidados de higiene. Em 95,7%, a intervenção realizada foi "ensinar ao idoso e cuidador estratégias de manutenção dos cuidados de saúde para diminuir a contaminação". CONCLUSÃO: recomenda-se o uso do telecuidado associado às visitas que se tornaram excepcionalidade na pandemia, dando continuidade ao cuidado no SAD, que auxilia na manutenção da capacidade funcional do idoso, no estresse do cuidador, e na adoção de medidas de isolamento social.


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Salud del Anciano , Cuidadores , Consulta Remota , Teleenfermería , COVID-19 , Servicios de Atención de Salud a Domicilio , Estudios Transversales
15.
Yonsei Med J ; 62(9): 850-857, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34427072

RESUMEN

PURPOSE: During the COVID-19 pandemic, Korea has temporarily expanded coverage of teleconsultation to ensure access to essential health services. As a preliminary study, we investigated service utilization patterns and the characteristics of doctors and patients involved in these temporary teleconsultation services. MATERIALS AND METHODS: Using national health insurance claims data from February 23, 2020 to June 30, 2020 from the Health Insurance Review and Assessment Service, 228269875 cases were identified. Among them, 567390 cases that received teleconsultation services were included in our study. We performed descriptive analyses according to the types of healthcare institutions. RESULTS: In total, 6193 healthcare institutions provided teleconsultation. Of these, 5466 (88.3%) were clinics. Physicians providing teleconsultations were most likely to be doctors of internal medicine (34.0%) or pediatricians (7.0%) and based in the Seoul Metropolitan area (30.4%). In terms of patients undergoing teleconsultation, the most common major disease categories treated were circulatory system diseases (I00-I99). In a detailed analysis, hypertensive diseases (I10-I15) were the most common diagnoses, with a total of 88726 cases (15.6%), followed by diabetes mellitus at 60298 cases (10.6%). The proportion of Medical Aid recipients receiving teleconsultations was higher (9.5%) than other socioeconomic groups. Among all participants, 356622 cases (84.6%) were from a return visit, and 108838 cases (19.2%) received teleconsultation services without being prescribed drugs. CONCLUSION: Temporarily allowed teleconsultation services were provided mostly to the following patients: 1) those scheduled for revisitation, 2) those with chronic diseases, and 3) those living in pandemic hotspots.


Asunto(s)
COVID-19 , Consulta Remota , Humanos , Pandemias , Calidad de la Atención de Salud , SARS-CoV-2
16.
Undersea Hyperb Med ; 48(3): 263-278, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34390631

RESUMEN

Submariners face many challenges. For example, they "live where they work" and can be called to duty anytime. They have limited access to open space, natural settings, fresh air, fresh food, sunlight, privacy, exercise, and outside communication. They support a wider range of missions than occur aboard most other Navy vessels. At sea or on shore, submariners work long hours under conditions with little margin for error. They may traverse remote or disputed areas of the ocean far from rescue assets, and must remain vigilant for potential encounters with hostile forces, onboard fires, anomalies in the breathing atmosphere, leaks, undersea collisions, or radiation exposures. If any of these factors cause casualties, the Independent Duty Corpsman (with intermittent advice from shore-based medical personnel), must be ready to provide aid as long as necessary. The challenges of submarine service led to the growth of the unique field of submarine medicine, which has maintained an excellent record of health and safety. This review introduces the field of submarine medicine as practiced in the U.S. Navy, describing its major concerns, giving an overview of the operation of a submarine medical department, and identifying several medical gaps that researchers are working to fill. Submarine medicine already has a stellar record in terms of radiation and atmospheric safety and has made strides in fatigue management. Ongoing work will deliver improved psychological screening and support tools. This report summarizes developments in these and other areas of submarine medicine.


Asunto(s)
Atención a la Salud , Personal Militar , Navíos , Medicina Submarina , Contaminación del Aire Interior/prevención & control , Atención a la Salud/métodos , Fatiga/complicaciones , Humanos , Salud Mental , Síndrome Metabólico/diagnóstico , Personal Militar/psicología , Enfermedades Profesionales/complicaciones , Enfermedades Profesionales/prevención & control , Enfermedades Profesionales/terapia , Exposición Profesional , Exposición a la Radiación , Consulta Remota , Medicina Submarina/educación , Medicina Submarina/métodos , Transporte de Pacientes/métodos , Estados Unidos , Lugar de Trabajo
17.
Acta Oncol ; 60(10): 1352-1360, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34338113

RESUMEN

BACKGROUND: During the COVID-19 pandemic, teleconsultations (TC) have been increasingly used in cancer care as an alternative to outpatient visits. We aimed to examine patient-related and cancer-specific characteristics associated with experiences with TC among patients with cancer during the COVID-19 pandemic. MATERIAL AND METHODS: This population-based survey included patients with breast, lung, gastrointestinal, urological, and gynaecological cancers with appointments in the outpatient clinics, Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark in March and April 2020. Age- and sex-adjusted logistic regression analyses were used to study associations of sociodemographics, cancer and general health, anxiety, and health literacy with patients' experiences of TC in regards to being comfortable with TC, confident that the doctor could provide information or assess symptoms/side effects and the perceived outcome of TC. RESULTS: Of the 2119 patients with cancer receiving the electronic survey, 1160 (55%) participated. Two thirds of patients (68%) had consultations with a doctor changed to TC. Being male, aged 65-79 years, and having TC for test results were statistically significantly associated with more comfort, confidence, and perceived better outcome of TC. Having breast cancer, anxiety, low health literacy, or TC for a follow-up consultation were statistically significantly associated with less positive experiences with TC. Living alone, short education, disability pension, and comorbidity were statistically significantly associated with anxiety and low health literacy. CONCLUSIONS: Most patients reported positive experiences with TC, but in particular patients with anxiety and low health literacy, who were also the patients with fewest socioeconomic and health resources, felt less comfortable and confident with and were more likely to perceive the outcome negatively from this form of consultation. TC may be suitable for increasing integration into standard cancer care but it should be carefully planned to meet patients' different information needs in order not to increase social inequality in cancer.


Asunto(s)
COVID-19 , Neoplasias , Consulta Remota , Dinamarca/epidemiología , Humanos , Masculino , Neoplasias/epidemiología , Neoplasias/terapia , Pandemias , SARS-CoV-2
18.
BMC Med Inform Decis Mak ; 21(1): 245, 2021 08 21.
Artículo en Inglés | MEDLINE | ID: mdl-34419027

RESUMEN

BACKGROUND: To enhance teleconsultation management, demands can be classified into different patterns, and the service of each pattern demand can be improved. METHODS: For the effective teleconsultation classification, a novel ensemble hierarchical clustering method is proposed in this study. In the proposed method, individual clustering results are first obtained by different hierarchical clustering methods, and then ensembled by one-hot encoding, the calculation and division of cosine similarity, and network graph representation. In the built network graph about the high cosine similarity, the connected demand series can be categorized into one pattern. For verification, 43 teleconsultation demand series are used as sample data, and the efficiency and quality of teleconsultation services are respectively analyzed before and after the demand classification. RESULTS: The teleconsultation demands are classified into three categories, erratic, lumpy, and slow. Under the fixed strategies, the service analysis after demand classification reveals the deficiencies of teleconsultation services, but analysis before demand classification can't. CONCLUSION: The proposed ensemble hierarchical clustering method can effectively category teleconsultation demands, and the effective demand categorization can enhance teleconsultation management.


Asunto(s)
Consulta Remota , Análisis por Conglomerados , Humanos
19.
PLoS One ; 16(8): e0249872, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34347779

RESUMEN

This paper analyzes the application of various telemedicine services in Gansu Province, China during the COVID-19 epidemic, and summarizes the experiences with these services. In addition, the satisfaction levels of patients and doctors with the application of telemedicine in COVID-19 were investigated, the deficiencies of telemedicine in Gansu were determined, and recommendations for modification were proposed. Coronavirus Disease 2019 (COVID-19) has broken out in China, and Gansu Province in Northwest of China has not been spared. To date, there are 91 local COVID-19 cases and 42 imported cases. 109 hospitals were selected as designated hospitals during the COVID-19 outbreak, and most of them were secondary hospitals. However, it was unsatisfactory that the ability of medical services is relatively low in most of secondary hospitals and primary hospitals. Therefore, we helped the secondary hospitals cope with COVID-19 by means of remote consultation, long-distance education, telemedicine question and answer (Q&A). Our practical experience shows that telemedicine can be widely used during the COVID-19 epidemic, especially in developing countries and areas with lagging medical standards.


Asunto(s)
COVID-19/epidemiología , COVID-19/terapia , Telemedicina/organización & administración , China/epidemiología , Brotes de Enfermedades , Educación a Distancia/organización & administración , Educación a Distancia/estadística & datos numéricos , Educación Médica Continua/métodos , Educación Médica Continua/organización & administración , Educación Médica Continua/estadística & datos numéricos , Educación Continua en Enfermería/métodos , Educación Continua en Enfermería/organización & administración , Educación Continua en Enfermería/estadística & datos numéricos , Epidemias , Geografía , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Relaciones Médico-Paciente , Consulta Remota/instrumentación , Consulta Remota/métodos , Consulta Remota/organización & administración , Consulta Remota/estadística & datos numéricos , SARS-CoV-2/fisiología , Programas Informáticos , Telemedicina/instrumentación , Telemedicina/métodos
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