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2.
Ann R Coll Surg Engl ; 103(2): 114-119, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33559558

RESUMEN

INTRODUCTION: Non-injury-related factors have been extensively studied in major trauma and have been shown to have a significant impact on patient outcomes. Mental illness and associated medication use has been proven to have a negative effect on bone health and fracture healing. MATERIALS AND METHODS: We collated data retrospectively from the records of orthopaedic inpatients in a non-COVID and COVID period. We analysed demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient comorbidities, including psychiatric history. RESULTS: There were 824 orthopaedic referrals and 358 admissions (six/day) in the non-COVID period, with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared with 473 referrals and 195 admissions (three/day) in the COVID period, with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) having a fracture. DISCUSSION: There was a reduction in the number of admissions and referrals during the pandemic, but a simultaneous three-fold rise in admissions with a psychiatric diagnosis. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. CONCLUSION: While total numbers using the orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affects those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. It is imperative that adequate support is in place for patients with vulnerable mental health during these periods, particularly as we look towards a potential 'second wave' of COVID-19.


Asunto(s)
Fracturas Óseas/epidemiología , Hospitalización/tendencias , Trastornos Mentales/epidemiología , Derivación y Consulta/tendencias , Intento de Suicidio/tendencias , Adulto , Alcoholismo/epidemiología , Trastornos de Ansiedad/epidemiología , Comorbilidad , Trastorno Depresivo/epidemiología , Femenino , Cuerpos Extraños/epidemiología , Cuerpos Extraños/cirugía , Fracturas Óseas/cirugía , Humanos , Luxaciones Articulares/epidemiología , Luxaciones Articulares/cirugía , Londres/epidemiología , Masculino , Trastornos Mentales/tratamiento farmacológico , Procedimientos Ortopédicos , Psicotrópicos/uso terapéutico , Estudios Retrospectivos , Traumatismos de los Tejidos Blandos/epidemiología , Traumatismos de los Tejidos Blandos/cirugía , Trastornos Relacionados con Sustancias/epidemiología , Heridas y Traumatismos/epidemiología , Heridas y Traumatismos/cirugía
3.
BMC Health Serv Res ; 21(1): 132, 2021 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-33573650

RESUMEN

This study aimed to estimate both direct medical and indirect costs of treating the Coronavirus disease 2019 (COVID-19) from a societal perspective in the patients at a referral hospital in Fars province as well as the economic burden of COVID-19 in Iran in 2020. METHODS: This study is a partial economic evaluation and a cross-sectional cost-description study conducted based on the data of the COVID-19 patients referred to a referral university hospital in Fars province between March and July 2020. The data were collected by examining the patients' records and accounting information systems. The subjects included all the inpatients with COVID-19 (477 individuals) who admitted to the medical centre during the 4 months. Bottom-up costing (also called micro-costing approach), incidence-based and income-based human capital approaches were used as the main methodological features of this study. RESULTS: The direct medical costs were estimated to be 28,240,025,968 Rials ($ 1,791,172) in total with mean cost of 59,203,409 Rials ($ 3755) per person (SD = 4684 $/ 73,855,161 Rials) in which significant part (41%) was that of intensive and general care beds (11,596,217,487 Rials equal to $ 735,510 (M = 24,310,728 Rials or $ 1542, SD = 34,184,949 Rials or $ 2168(. The second to which were the costs of medicines and medical consumables (28%). The mean indirect costs, including income loss due to premature death, economic production loss due to hospitalization and job absenteeism during recovery course were estimated to be 129,870,974 Rials ($ 11,634) per person. Furthermore, the economic burden of the disease in the country for inpatient cases with the definitive diagnosis was 22,688,925,933,095 Rials equal to $ 1,439,083,784. CONCLUSION: The results of this study showed that the severe status of the disease would bring about the extremely high cost of illness in this case. It is estimated that the high prevalence rate of COVID-19 has been imposing a heavy economic burden on the country and health system directly that may result in rationing or painful cost-control approaches.


Asunto(s)
/economía , Costo de Enfermedad , Absentismo , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Hospitales Universitarios/economía , Humanos , Incidencia , Renta/estadística & datos numéricos , Irán/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Derivación y Consulta , Adulto Joven
4.
Respir Res ; 22(1): 50, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33579277

RESUMEN

The importance of vaccinations for COPD patients has been previously described. However, there is still a gap between guideline recommendations and the implementation of preventive care delivery for these patients. Specially, the rise of SARS-CoV-2 pandemic has made the significance of vaccination adherence more critical to address. Our study showed that referral to pulmonary clinic is associated with increased odds of receiving influenza (OR = 1.97, [95% CI 1.07, 3.65]) and pneumococcal vaccinations (PCV13 OR = 3.55, [1.47, 8.54]; PPSV23 OR = 4.92, [1.51, 16.02]). These data suggest that partnerships between primary care physicians and pulmonologists can potentially improve the vaccination rates for patients with COPD.


Asunto(s)
Pautas de la Práctica en Medicina , Atención Primaria de Salud , Enfermedad Pulmonar Obstructiva Crónica/terapia , Neumología , Derivación y Consulta , Vacunación , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Adhesión a Directriz , Humanos , Vacunas contra la Influenza/uso terapéutico , Masculino , Persona de Mediana Edad , Vacunas Neumococicas/uso terapéutico , Guías de Práctica Clínica como Asunto , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Estudios Retrospectivos
5.
J Assoc Physicians India ; 69(2): 62-64, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33527814

RESUMEN

The consult letters can be viewed as a window to the entire consultation process. Suitable drafting of consult letters is a useful but often overlooked skill in training years. It is not uncommon to find the consult notes lacking the relevant context or clinical information. Both the style and content should be kept in mind for an effective written communication. It is also important to supervise and give specific feedback to the trainees to make the consult letters succinct and clear.


Asunto(s)
Comunicación , Derivación y Consulta
7.
Med Clin North Am ; 105(2): 325-339, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33589106

RESUMEN

Spondyloarthritis is a common rheumatologic disease, present in up to 2% of the population, characterized by inflammatory arthritis, often with enthesitis, dactylitis, spondylitis, and skin disease. It has historically been characterized as ankylosing spondylitis, psoriatic arthritis, arthritis associated with inflammatory bowel disease, reactive arthritis, and undifferentiated spondyloarthritis. These subsets are now classified as axial-predominant and peripheral-predominant spondyloarthritis. This article provides an updated understanding of disease classification and practical advice about diagnosis to aid in the determination of which patients should be referred to rheumatology. It is important to provide patients the opportunity to have early and effective therapy.


Asunto(s)
Manejo de Atención al Paciente/métodos , Espondiloartritis , Diagnóstico Diferencial , Intervención Médica Temprana , Humanos , Derivación y Consulta , Reumatología/métodos , Espondiloartritis/diagnóstico , Espondiloartritis/fisiopatología , Espondiloartritis/terapia
8.
Ther Umsch ; 78(2): 83-92, 2021.
Artículo en Alemán | MEDLINE | ID: mdl-33615866

RESUMEN

Update and practical advice for travel vaccinations and consultations in primary care Abstract. Health issues during travels are common. Infections are amongst the most frequent problem besides accidents and cardiovascular events. Prevention is based on avoiding risks, drug prophylaxis and vaccinations. This article focuses on travel vaccinations and aims to provide a general update and practical advice for travel consultations in primary care. Vaccine-preventable infections are systematically summarized, including a specific risk assessment for children, general vaccination indication, vaccination schedule, and information particularities of specific vaccines. Updating the vaccination status is often neglected in regular GP consultations for adult patients. Appointments for travel advice are therefore an ideal and important means of checking and completing the recommended basic and booster immunizations. Travel immunizations typically aim at providing an individual protection from infection. In contrast, basic vaccinations also consider altruistic aspects such as herd immunity. Since ambivalence or skepticism about vaccination is widespread, this discrepancy may result in discussions. Travel consultations may therefore generate opportunities to clarify general ambivalences towards vaccinations. Based on the concept of "Motivational Interviewing", we show communicative possibilities to reduce ambivalence and resistance and ideally to promote the willingness to vaccinate through shared decision-making.


Asunto(s)
Viaje , Vacunación , Adulto , Niño , Humanos , Esquemas de Inmunización , Atención Primaria de Salud , Derivación y Consulta
9.
Ther Umsch ; 78(2): 73-81, 2021.
Artículo en Alemán | MEDLINE | ID: mdl-33615869

RESUMEN

Early recognition or screening of dementia in general practice Abstract. General practitioners play a key role in timely dementia diagnosis. In view that there are currently no drugs to prevent the progression of dementia or are effective in patients with mild cognitive impairment, a general screening of older people to recognize pre-symptomatic stages of dementia is not recommended. Crucial for a timely diagnosis is the GP's perception of warning signs, so-called "red flags". If the patients, family members, authorities or even the GP notice even discreet signs of a possible early dementia, a neuropsychological and medical evaluation should be initiated. Personal history, history by informant, a physical examination, supplemented by a GP's psychiatric evaluation and ideally the careful assessment with the MoCA form the basis of a preliminary clarification in general practice. If dementia is suspected, this clarification should be supplemented by an in-depth laboratory examination and, if applicable, neuroimaging before the patient is referred, depending on the findings, to a memory clinic or a consultant specialist to confirm the diagnosis and if appropriate initiate pharmacological and non-pharmacological therapies.


Asunto(s)
Demencia , Medicina General , Médicos Generales , Anciano , Anciano de 80 o más Años , Demencia/diagnóstico , Humanos , Tamizaje Masivo , Derivación y Consulta
10.
Isr Med Assoc J ; 23(2): 76-81, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33595210

RESUMEN

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic presented a major medical management challenge to ophthalmology departments throughout Israel. OBJECTIVES: To examine the managerial challenges, actions taken, and insights of directors of ophthalmology departments in Israel during the COVID-19 pandemic. METHODS: We conducted a cross sectional survey of directors of ophthalmology departments during the COVID-19 pandemic while the Israeli population was quarantined. RESULTS: All 21 directors answered the survey. The majority of the COVID-19 admissions were located in the center of Israel (53%) and Jerusalem (30%). E-communication took a central role in coping with the pandemic with 80% of the directors satisfied with this form of communication; 75% reported a reduction in clinical and surgery volume of at least 25%, and 40% reported reallocations of manpower. Most of the medical staff used gloves, a face shield, disposable robe, and a mask with no uniformity across departments. Cross satisfaction was noted regarding a hospital's ability to equip the departments. Lack of preparation for post-pandemic era was reported by all directors, but one (95%). Directors sought guidelines and uniformity regarding outpatient referral to the hospital (p = 0.035). CONCLUSIONS: Guidelines via safe digital platforms aid in management decisions and uniformity across departments. Advanced preparation is needed to prevent adverse clinical outcomes and to maintain treatment continuum. Our results can be used to guide and help improve the preparedness of ophthalmology departments during COVID-19 and for future pandemics.


Asunto(s)
Departamentos de Hospitales/organización & administración , Oftalmología/organización & administración , Equipo de Protección Personal/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Adulto , Comunicación , Estudios Transversales , Equipos Desechables/estadística & datos numéricos , Guantes Protectores/estadística & datos numéricos , Departamentos de Hospitales/normas , Humanos , Israel , Máscaras/estadística & datos numéricos , Persona de Mediana Edad , Equipo de Protección Personal/provisión & distribución , Cuarentena , Derivación y Consulta , Encuestas y Cuestionarios
11.
Neurología (Barc., Ed. impr.) ; 36(1): 9-15, ene.-feb. 2021. tab, graf
Artículo en Español | IBECS | ID: ibc-192836

RESUMEN

INTRODUCCIÓN: Varios países del mundo padecen una grave carga en sus sistemas de salud como consecuencia de la pandemia por COVID-19. Esta realidad pone en riesgo el seguimiento de patologías crónicas como las demencias. Asimismo, la atención de las posibles complicaciones neuropsiquiátricas relacionadas con el aislamiento preventivo de la población (cuarentena), que en el caso de Argentina se considera la más prolongada de Latinoamérica. El objetivo del presente trabajo es determinar la frecuencia de las distintas modalidades de consulta médica en relación con la patología neurocognitiva del paciente y las variables predictoras de consulta desde el inicio de la cuarentena. MÉTODOS: Estudio descriptivo observacional y transversal basado en la recolección de datos a través de una encuesta. RESULTADOS: Hubo 324 participantes, 165 (50,9%) de los cuales realizaron al menos una consulta médica. Frecuencia de modalidades de consulta: teléfono, 109 (33,6%); correo electrónico, 62 (19,1%); videoconsulta, 30 (9,3%); servicio de emergencias, 23 (7,1%). Predictores de consulta: Clinical Dementia Rating ≥ 1 (p < 0,001); diagnóstico: Alzheimer (p = 0,017). Se encontraron puntajes más altos del Inventario Neuropsiquiátrico (NPI) en el grupo que ha realizado consultas médicas (p < 0,001). Dicha diferencia no fue observada en el puntaje de la escala de carga del cuidador (Zarit). CONCLUSIÓN: Evidenciamos alta prevalencia de trastornos conductuales en pacientes y de sobrecarga en cuidadores durante la cuarentena. Solamente el 50% accedió a una consulta médica (52,7% por modalidad telefónica y correo electrónico). Es necesario extremar los cuidados en personas con demencia, garantizando el seguimiento de su patología


INTRODUCTION: Health systems in numerous countries around the world are suffering a serious burden as a consequence of the COVID-19 pandemic. As a result of this situation, the follow-up of such chronic diseases as dementia may be at risk. Similarly, neuropsychiatric complications related to lockdown measures may also be neglected; Argentina's lockdown has been the longest implemented in Latin America. This study aims to determine the frequency of the different types of medical consultations for neurocognitive disorders and the predictors for requiring consultation since the beginning of the lockdown. METHODS: We performed a descriptive, observational, cross-sectional study based on data collected through an online survey. RESULTS: Data were collected on 324 participants, with 165 (50.9%) having had at least one medical consultation. Consultations were held by telephone in 109 cases (33.6%), by e-mail in 62 (19.1%), by video conference in 30 (9.3%), and at the emergency department in 23 (7.1%). Predictors of requiring consultation were Clinical Dementia Rating scores ≥1 (P < .001) and diagnosis of Alzheimer disease (P = .017). Higher Neuropsychiatric Inventory scores were found in the group of respondents who did require medical consultation (P < .001), but no significant differences were found between groups for Zarit Burden Interview scores. CONCLUSION: We identified a high prevalence of behavioural disorders and caregiver burden during lockdown. Nevertheless, only 50% of respondents had sought medical consultation (by telephone or email in 52.7% of cases). Care of people with dementia must be emphasised, guaranteeing follow-up of these patients


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Pandemias , Derivación y Consulta/estadística & datos numéricos , Trastornos Neurocognitivos , Cuidadores , Enfermedad de Alzheimer , Demencia , Encuestas y Cuestionarios , Estudios de Seguimiento , Estudios Transversales , Argentina/epidemiología
13.
Trials ; 22(1): 8, 2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33407804

RESUMEN

OBJECTIVES: The primary objective is to determine which of two interventions: 1) an eight week, online, home-based, supervised, group rehabilitation programme (REGAIN); or 2) a single online session of advice (best-practice usual care); is the most clinically and cost-effective treatment for people with ongoing COVID-19 sequelae more than three months after hospital discharge. TRIAL DESIGN: Multi-centre, 2-arm (1:1 ratio) parallel group, randomised controlled trial with embedded process evaluation and health economic evaluation. PARTICIPANTS: Adults with ongoing COVID-19 sequelae more than three months after hospital discharge Inclusion criteria: 1) Adults ≥18 years; 2) ≥ 3 months after any hospital discharge related to COVID-19 infection, regardless of need for critical care or ventilatory support; 3) substantial (as defined by the participant) COVID-19 related physical and/or mental health problems; 4) access to, and able/supported to use email and internet audio/video; 4) able to provide informed consent; 5) able to understand spoken and written English, Bengali, Gujarati, Urdu, Punjabi or Mandarin, themselves or supported by family/friends. EXCLUSION CRITERIA: 1) exercise contraindicated; 2) severe mental health problems preventing engagement; 3) previous randomisation in the present study; 4) already engaged in, or planning to engage in an alternative NHS rehabilitation programme in the next 12 weeks; 5) a member of the same household previously randomised in the present study. INTERVENTION AND COMPARATOR: Intervention 1: The Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN) programme: an eight week, online, home-based, supervised, group rehabilitation programme. Intervention 2: A thirty-minute, on-line, one-to-one consultation with a REGAIN practitioner (best-practice usual care). MAIN OUTCOMES: The primary outcome is health-related quality of life (HRQoL) - PROMIS® 29+2 Profile v2.1 (PROPr) - measured at three months post-randomisation. Secondary outcomes include dyspnoea, cognitive function, health utility, physical activity participation, post-traumatic stress disorder (PTSD) symptom severity, depressive and anxiety symptoms, work status, health and social care resource use, death - measured at three, six and 12 months post-randomisation. RANDOMISATION: Participants will be randomised to best practice usual care or the REGAIN programme on a 1:1.03 basis using a computer-generated randomisation sequence, performed by minimisation and stratified by age, level of hospital care, and case level mental health symptomatology. Once consent and baseline questionnaires have been completed by the participant online at home, randomisation will be performed automatically by a bespoke web-based system. BLINDING (MASKING): To ensure allocation concealment from both participant and REGAIN practitioner at baseline, randomisation will be performed only after the baseline questionnaires have been completed online at home by the participant. After randomisation has been performed, participants and REGAIN practitioners cannot be blind to group allocation. Follow-up outcome assessments will be completed by participants online at home. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): A total of 535 participants will be randomised: 263 to the best-practice usual care arm, and 272 participants to the REGAIN programme arm. TRIAL STATUS: Current protocol: Version 3.0 (27th October 2020) Recruitment will begin in December 2020 and is anticipated to complete by September 2021. TRIAL REGISTRATION: ISRCTN:11466448 , 23rd November 2020 FULL PROTOCOL: The full protocol Version 3.0 (27th October 2020) is attached as an additional file, accessible from the Trials website (Additional file 1). In the interests of expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines.


Asunto(s)
/rehabilitación , Terapia por Ejercicio/métodos , Intervención basada en la Internet/economía , Sistemas de Apoyo Psicosocial , Derivación y Consulta/economía , Adulto , /psicología , Análisis Costo-Beneficio , Terapia por Ejercicio/economía , Femenino , Humanos , Masculino , Estudios Multicéntricos como Asunto , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Reino Unido
15.
Gan To Kagaku Ryoho ; 48(1): 17-21, 2021 Jan.
Artículo en Japonés | MEDLINE | ID: mdl-33468716

RESUMEN

"Counseling on Cancer Genomic Medicine" was added to the list of roles of cancer consultation centers located in Designated Cancer Hospitals under on the Third Cancer Control Act established in 2018. Although cancer consultation centers do not make decisions on whether to conduct genetic testing, it has been revealed that a certain number of such consultations are taking place. Consultations on genetic panel testing are expected to further increase in the future. In order to accommodate this need, individual cancer consultation staff needs to provide services based on the principles of consultation and support. For example, they must have adequate knowledge on the characteristics and limitations of genetic panel testing, understand the true needs of patients and their families, enable such individuals to understand the relevant information, and collaborate with patients and their families to consider the course forward. Furthermore, in order to ensure the quality of individual support, physicians and genetic counselors are expected to contribute by participating in organization-building between genetic counselors, genomic medicine coordinators, and other experts in and outside of hospitals. It is also anticipated that networks will be formed with nearby external institutions and organization, such as Designated Core Hospitals for Cancer Genomic Medicine, Designated Core Hospitals, and Medical Cooperation Hospitals.


Asunto(s)
Pruebas Genéticas , Neoplasias , Instituciones Oncológicas , Genómica , Humanos , Neoplasias/diagnóstico , Neoplasias/genética , Neoplasias/terapia , Derivación y Consulta
16.
J Foot Ankle Res ; 14(1): 4, 2021 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-33413562

RESUMEN

BACKGROUND: Foot health problems are common in the general population, and particularly so in people with rheumatic and musculoskeletal disorders (RMD). Several clinical guidelines state that people with RMDs should have access to foot health services, although service capacity is often limited. The current COVID-19 pandemic has increased the need for alternative ways to provide patient care. The aim of this clinical audit was to review a newly implemented telephone follow-up appointment service conducted within the Rheumatology Podiatry Department in Leeds, UK. METHODS: Fifty-eight patients attending the Rheumatology Podiatry Department at Leeds Teaching Hospitals NHS Trust were contacted by telephone approximately 6-8 weeks following initial intervention. During the telephone consultation, all patients were asked pre-defined questions relating to their symptoms, intervention efficacy, the need for further appointments and their preference for the type of consultation. To assess the cost of the telephone consultation the number of attempts needed in order to make successful contact, the duration of the call and the number of telephone follow-up appointments completed in a working day were also recorded. RESULTS: Twenty-five patients (43%) were successfully contacted within the 6-8 weeks stipulated time frame and were included in the analysis. Of the 25 contacted, twelve (48%) patients were successfully contacted on the first attempt. Ten (40%) were successfully contacted on the second attempt. The remaining three patients (12%) required 3 or more attempts to make successful contact. Telephone consultations were estimated not to last longer than 10 min, including notes screening and documentation. Eleven patients (44%) reported an improvement in their symptoms, thirteen (52%) reported no change and one patient (4%) reported their symptoms to be worse. CONCLUSION: Telephone follow-up consultations may be a potentially cost-effective alternative to face-to-face appointments when implemented in a Rheumatology Podiatry Department, and provide an alternative way of providing care, especially when capacity for face-to-face contact is limited. The potential cost saving and efficiency benefits of this service are likely to be enhanced when telephone consultations are pre-arranged with patients.


Asunto(s)
/epidemiología , Enfermedades Musculoesqueléticas/epidemiología , Pandemias , Podiatría/organización & administración , Derivación y Consulta , Teléfono , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/diagnóstico , Estudios Retrospectivos , Enfermedades Reumáticas/diagnóstico , Enfermedades Reumáticas/epidemiología
17.
BMC Infect Dis ; 21(1): 105, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33482752

RESUMEN

BACKGROUND: Better information on the typical course and management of acute common infections in the community could inform antibiotic stewardship campaigns. We aimed to investigate the incidence, management, and natural history of a range of infection syndromes (respiratory, gastrointestinal, mouth/dental, skin/soft tissue, urinary tract, and eye). METHODS: Bug Watch was an online prospective community cohort study of the general population in England (2018-2019) with weekly symptom reporting for 6 months. We combined symptom reports into infection syndromes, calculated incidence rates, described the proportion leading to healthcare-seeking behaviours and antibiotic use, and estimated duration and severity. RESULTS: The cohort comprised 873 individuals with 23,111 person-weeks follow-up. The mean age was 54 years and 528 (60%) were female. We identified 1422 infection syndromes, comprising 40,590 symptom reports. The incidence of respiratory tract infection syndromes was two per person year; for all other categories it was less than one. 194/1422 (14%) syndromes led to GP (or dentist) consultation and 136/1422 (10%) to antibiotic use. Symptoms usually resolved within a week and the third day was the most severe. CONCLUSIONS: Most people reported managing their symptoms without medical consultation. Interventions encouraging safe self-management across a range of acute infection syndromes could decrease pressure on primary healthcare services and support targets for reducing antibiotic prescribing.


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones/tratamiento farmacológico , Infecciones/patología , Derivación y Consulta/estadística & datos numéricos , Programas de Optimización del Uso de los Antimicrobianos , Estudios de Cohortes , Prestación de Atención de Salud , Inglaterra/epidemiología , Femenino , Humanos , Incidencia , Infecciones/epidemiología , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Síndrome
18.
Ital J Pediatr ; 47(1): 21, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33514391

RESUMEN

BACKGROUND: Italy was the first country in Europe affected by COVID-19: the emergency started on February 20, 2020, culminating with national lockdown on March 11, which terminated on May 4, 2020. We describe how the pandemic affected Emergency Department (ED) accesses in a tertiary children's hospital, composed by two different pediatric centers, one located in Rome's city center and the second, Palidoro (regional COVID-19 center), in its surrounding metropolitan area, both in the Lazio region, analyzing the profile of admitted patients during the pandemic period in terms of their general characteristics (at presentation in the ED's) and urgent hospitalizations compared to prepandemic period. METHODS: The study compare the period between the 21st of February and the 30th of April 2020, covering the three phases of the national responses (this period will be referred to as the pandemic period) with the same period of 2019 (prepandemic period). The study analyzes the number of ED visits and urgent hospitalizations and their distribution according to selected characteristics. RESULTS: The reduction of ED visits was 56 and 62%, respectively in Rome and Palidoro centers. The higher relative decline was encountered for Diseases of Respiratory System, and for Diseases of the Nervous System and Sense Organs. A doubling of the relative frequency of hospitalizations was observed, going from 14.2 to 24.4% in Rome and from 6.4 to 10.3% in Palidoro. In terms of absolute daily numbers the decrease of urgent hospitalizations was less sharp than ED visits. For pathologies such as peritonitis, tumors or other possible life-treathening conditions we did not observe a significative increase due to delayed access. CONCLUSIONS: In the pandemic period there was a general reduction in the number of children referred to ED, such reduction was greater in low-acuity levels. The reduction for respiratory tract infections and other communicable diseases during school closure and the national lockdown must make us reflect on the possible impact that these conditions may have on the health system, in particular the ED, at the reopening of schools. The major problem remains the fear for possible diagnostic delays in life-threatening or crippling diseases; our study doesn't demonstrate an increase in number or significant delay in some serious conditions such as tumors, peritonitis, diabetic ketoacidosis, ileo-colic intussusception and testis/ovary torsion. A continuous, deep re-organizational process step by step of the ED is nececessary in the present and upcoming pandemic situation.


Asunto(s)
/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Hospitalización/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Niño , Femenino , Humanos , Italia/epidemiología , Masculino , Pandemias
19.
BMC Palliat Care ; 20(1): 11, 2021 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-33435954

RESUMEN

BACKGROUND: Palliative care day services provide a safe environment for people with palliative care needs, enabling them to access a range of services while acting as a respite services for family caregivers. Viewed as marginal services, they are often under resourced and under researched. The aim of this study was to understand how palliative day care services contribute to client care from the perspective of management and hospice multidisciplinary teams. METHODS: A descriptive qualitative study, using six focus groups conducted with staff at three United Kingdom hospices in England, Scotland and Northern Ireland. Thirty-five participants were recruited, including management and staff. Discussions were transcribed and analysed thematically. RESULTS: Four key themes emerged: (1) variations of care, beyond heterogeneity of patients; (2) unclear referrals and inconsistent patient population; (3) recognising strengths and challenges and (4) an uncertain future. A major focus of group discussions was the model of care and the benefits of the service, however the importance of demonstrating services' effectiveness and value for money was highlighted. CONCLUSIONS: Management and hospice staff believed day-services to be a helpful introduction to palliative care, providing both social and medical support. Economic pressures and patient demand were influencing them to move from a social model to a hybrid model. Further research is needed to understand the effectiveness of the service.


Asunto(s)
Centros de Día , Personal de Salud , Hospitales para Enfermos Terminales , Cuidados Paliativos , Cuidados Intermitentes , Técnicos Medios en Salud , Cuidadores , Prestación de Atención de Salud , Grupos Focales , Accesibilidad a los Servicios de Salud , Humanos , Enfermeras Administradoras , Enfermeras y Enfermeros , Investigación Cualitativa , Derivación y Consulta , Reino Unido
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