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2.
Br J Nurs ; 30(7): 404-408, 2021 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-33830800

RESUMEN

The coronavirus pandemic has brought about an economic and healthcare crisis. This has resulted in delays in virtually all areas of patient care and has forced clinicians to review and adapt their processes, in order to ensure patients continue to have access to timely and effective services. In the author's local Trust, this manifested in altered protocols, developed in order to maintain patient and staff safety while conducting invasive and potentially virus-spreading investigations. A new (temporary) standard operating procedure was developed in conjunction with Cancer Alliance South West to introduce the quantitative faecal immunochemical test (qFIT) as an indicator for diagnostic testing after the majority of diagnostic services were suspended or drastically reduced. Patients would then have their investigation(s) deferred on the basis of a negative result (<10 mcg Hb/g). This cohort (n=120) were revisited once diagnostic services were resumed and referred for CT examination. Audits carried out on the data showed that nine cancers had been identified in the negative qFIT population (lung, prostate, breast, bladder, small bowel carcinoid, oesophageal and three occurrences of caecal carcinoma. This article provides an overview of the experiences and outcomes of a colorectal 2-week-wait service in response to this global pandemic and how this experience will shape the service in the future.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Sangre Oculta , Derivación y Consulta/organización & administración , Listas de Espera , Estudios de Cohortes , Humanos
3.
Medicine (Baltimore) ; 100(12): e24320, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761631

RESUMEN

ABSTRACT: Palliative care is a central component of the therapy in terminally ill patients. During treatment in non-palliative departments this can be realized by consultation.To analyze the change in symptom burden during palliative care consultation.In this observational study, we enrolled all cancer cases (n = 163) receiving inpatient treatment for 2015 to 2018 at our institution. We used the MDASI-questionnaire (0 = 'not present' and 10 = "as bad as you can imagine") and the FAMCARE-6 (1 = very satisfied, 5 = very dissatisfied) to analyze the treatment effect and patient satisfaction, respectively.We examined the association of symptom burden and patient satisfaction using Spearman-correlation. Comparing mean values, we applied the Wilcoxon-test and one-way ANOVA.An improvement in MDASI-core-items after treatment completion was significant (P < .05) in 14/18 symptoms. The change in perception of pain showed the strongest improvement (median: 5 to 3). Initially the MDASI-items "activity" (median = 8) and emotional distress (median = 5 and 6) were viewed as especially incriminating. There was no evidence for a correlation between patients' age, the type of diagnosis and time since diagnosis.The analysis of FAMCARE-6 patient contentment was lower or equal to two in all of the six items. There was a weak negative association between the change in symptom burden of psycho-emotional items "distress/feeling upset" (P = .006, rSp = -0,226), "sadness" and patient satisfaction in FAMCARE-6.A considerable improvement of the extensive symptom burden particularly of pain relief was achieved by integrating palliative consultation in clinical practice.


Asunto(s)
Dolor en Cáncer/terapia , Neoplasias/terapia , Cuidados Paliativos/psicología , Satisfacción del Paciente/estadística & datos numéricos , Derivación y Consulta/organización & administración , Anciano , Anciano de 80 o más Años , Dolor en Cáncer/diagnóstico , Dolor en Cáncer/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/psicología , Dimensión del Dolor/estadística & datos numéricos , Medición de Resultados Informados por el Paciente , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Enfermo Terminal/psicología , Enfermo Terminal/estadística & datos numéricos , Resultado del Tratamiento
4.
J Laryngol Otol ; 135(3): 241-245, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33648611

RESUMEN

OBJECTIVE: Utilisation of the Head and Neck Cancer Risk Calculator version 2 has been recommended during the coronavirus disease 2019 pandemic for the assessment of head and neck cancer referrals. As limited data were available, this study was conducted to analyse the use of the Head and Neck Cancer Risk Calculator version 2 in clinical practice. METHOD: Patients undergoing telephone triage in a two-week wait referral clinic were included. Data were collected and analysed using appropriate methods. RESULTS: Sixty-four patients in the study were risk-stratified into low-risk (51.6 per cent, 33 of 64), moderate-risk (14.1 per cent, 9 of 64) and high-risk (34.4 per cent, 22 of 64) groups. Of the patients, 53.1 per cent (34 of 64) avoided an urgent hospital visit, and 96.9 per cent (62 of 64) were cancer free, while 3.1 per cent (2 of 64) were found to have a head and neck malignancy. The sensitivity, specificity, negative predictive value and accuracy were 50.00 per cent, 66.13 per cent, 99.92 per cent and 66.11 per cent, respectively. CONCLUSION: It is reasonable to use the calculator for triaging purposes, but it must always be accompanied by a meticulous clinical thought process.


Asunto(s)
/epidemiología , Neoplasias de Cabeza y Cuello/diagnóstico , Otolaringología/organización & administración , Derivación y Consulta/organización & administración , Consulta Remota/organización & administración , Triaje/organización & administración , /prevención & control , Humanos , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Medición de Riesgo , Sensibilidad y Especificidad , Teléfono , Factores de Tiempo , Reino Unido
5.
J Laryngol Otol ; 135(3): 191-195, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33593465

RESUMEN

OBJECTIVES: The global pandemic of coronavirus disease 2019 has necessitated changes to 'usual' ways of practice in otolaryngology, with a view towards out-patient or ambulatory management of appropriate conditions. This paper reviews the available evidence for out-patient management of three of the most common causes for emergency referral to the otolaryngology team: tonsillitis, peri-tonsillar abscess and epistaxis. METHODS: A literature review was performed, searching all available online databases and resources. The Medical Subject Headings 'tonsillitis', 'pharyngotonsillitis', 'quinsy', 'peritonsillar abscess' and 'epistaxis' were used. Papers discussing out-patient management were reviewed by the authors. RESULTS: Out-patient and ambulatory pathways for tonsillitis and peritonsillar abscess are well described for patients meeting appropriate criteria. Safe discharge of select patients is safe and should be encouraged in the current clinical climate. Safe discharge of patients with epistaxis who have bleeding controlled is also well described. CONCLUSION: In select cases, tonsillitis, quinsy and epistaxis patients can be safely managed out of hospital, with low re-admission rates.


Asunto(s)
Atención Ambulatoria/organización & administración , Epistaxis/terapia , Otolaringología/organización & administración , Absceso Peritonsilar/terapia , Tonsilitis/terapia , /prevención & control , Urgencias Médicas , Servicio de Urgencia en Hospital/organización & administración , Humanos , Derivación y Consulta/organización & administración
6.
Public Health ; 192: 49-55, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33631514

RESUMEN

OBJECTIVES: Arts on prescription (AoP) interventions are part of mainstream social prescribing provision in primary health care. Whilst the body of evidence for AoP interventions has been developing, this has primarily focused on well-being. STUDY DESIGN: The present work is an observational longitudinal study on a community-based AoP social prescribing intervention in the South West UK. METHOD: The present study assessed changes in anxiety, depression, and well-being in a cohort of patients participating in up to two eight-week cycles of AoP. The sample consisted of 245 individuals referred into the programme from 2017 to 2019, with a sub-sample of participants (N = 110) with identifiable multimorbidity. Outcomes were measured pre- and post-intervention at both initial and re-referral. RESULTS: Anxiety, depression, and well-being were all significantly improved after initial referral, re-referral, and overall from initial to post re-referral for this intervention in the whole sample and multimorbid sub-sample. Multivariate analyses revealed that no participant variables appeared to account for the variance in outcome change scores. CONCLUSION: The research provides further support for AoP interventions, finding associations with reduced anxiety and depression and increased well-being. Additionally, these outcomes are evidenced in those with multimorbidity, as well as across initial- and re-referral cycles.


Asunto(s)
Trastornos de Ansiedad/terapia , Ansiedad/terapia , Enfermedad Crónica/terapia , Depresión/psicología , Depresión/terapia , Promoción de la Salud/métodos , Prescripciones , Derivación y Consulta/organización & administración , Adulto , Ansiedad/diagnóstico , Ansiedad/psicología , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Depresión/diagnóstico , Femenino , Personal de Salud , Humanos , Estudios Longitudinales , Masculino , Salud Mental , Persona de Mediana Edad , Multimorbilidad , Atención Primaria de Salud , Resultado del Tratamiento
7.
Ophthalmic Physiol Opt ; 41(2): 295-300, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33529405

RESUMEN

PURPOSE: Non-urgent face-to-face outpatient ophthalmology appointments were suspended in the United Kingdom in March 2020, due to the COVID-19 outbreak. In common with other centres, Moorfields Eye Hospital NHS Foundation Trust (London) offered modified telephone consultations to new and follow-up patients in the low vision clinic. Here we assess the success of this telephone service. METHODS: Data were collected for 500 consecutive telephone low vision appointments. Successful completion of the assessment and clinical outcomes (low vision aids prescribed, onward referral) were recorded. RESULTS: Telephone assessments were completed for 364 people (72.8%). The most common reasons for non-completion were either no answer to the telephone call (75 people, 15%), or the patient declining assessment (20 people, 4%). There was no association between age and the likelihood of an assessment being completed. 131 new low vision aids were dispensed, 77 internal referrals were made and 15 people were referred to outside services. More than 80% of the low vision aids prescribed were useful. CONCLUSIONS: Telephone low vision assessments were completed in about three-quarters of cases. About one-quarter of consultations resulted in new low vision aids being dispensed, which were generally found useful. Telephone low vision assessments can be used successfully in a large low vision clinic, but have many limitations when compared to face-to-face assessments.


Asunto(s)
/epidemiología , Transmisión de Enfermedad Infecciosa/prevención & control , Cuarentena , Derivación y Consulta/organización & administración , Telemedicina/métodos , Teléfono , Baja Visión/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Control de Enfermedades Transmisibles/métodos , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reino Unido/epidemiología , Baja Visión/diagnóstico , Adulto Joven
9.
J Am Board Fam Med ; 34(Suppl): S95-S102, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33622824

RESUMEN

BACKGROUND: Severe acute respiratory syndrome coronavirus (SARS-CoV-2) and the associated coronavirus disease of 2019 (COVID-19) have presented immense challenges for health care systems. Many regions have struggled to adapt to disruptions to health care practice and use systems that effectively manage the demand for services. METHODS: This was a cohort study using electronic health records at a health care system in northeast Ohio that examined the effectiveness of the first 5 weeks of a 24/7 physician-staffed COVID-19 hotline including social care referrals for patients required to self-isolate. We describe clinical diagnosis, patient characteristics (age, sex race/ethnicity, smoking status, insurance status), and visit disposition. We use logistic regression to evaluate associations between patient characteristics, visit disposition and subsequent emergency department use, hospitalization, and SARS-Cov-2 PCR testing. PARTICIPANTS: In 5 weeks, 10,112 patients called the hotline (callers). Of these, 4213 (42%) were referred for a physician telehealth visit (telehealth patients). Mean age of callers was 42 years; 67% were female, 51% white, and 46% were on Medicaid/uninsured. RESULTS: Common caller concerns included cough, fever, and shortness of breath. Most telehealth patients (79%) were advised to self-isolate at home, 14% were determined to be unlikely to have COVID-19, 3% were advised to seek emergency care, and 4% had miscellaneous other dispositions. A total of 287 patients (7%) had a subsequent emergency department visit, and 44 (1%) were hospitalized with a COVID-19 diagnosis. Of the callers, 482 (5%) had a COVID-19 test reported, with 69 (14%) testing positive. Among patients advised to stay at home, 83% had no further face-to-face visits. In multivariable results, only a physician recommendation to seek emergency care was associated with emergency department use (odds ratio = 4.73, 95% confidence interval = 1.37-16.39, P = .014). Only older age was associated with having a positive test result. Patients with social needs and interest in receiving help were offered services to meet their needs including food deliveries (n = 92), behavioral health telephone visits (n = 49), and faith-based comfort calls from pastoral care personnel (n = 37). CONCLUSIONS AND RELEVANCE: Robust, physician-directed telehealth services can meet a wide range of clinical and social needs during the acute phase of a pandemic, conserving scarce resources such as personal protective equipment and testing supplies and preventing the spread of infections to patients and health care workers.


Asunto(s)
/epidemiología , Líneas Directas/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Telemedicina/métodos , Adulto , /estadística & datos numéricos , Estudios de Cohortes , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Ohio/epidemiología , Pandemias , Atención Primaria de Salud/organización & administración , Derivación y Consulta/organización & administración , Telemedicina/estadística & datos numéricos
10.
J Fr Ophtalmol ; 44(3): 307-312, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33612327

RESUMEN

PURPOSE: This study aimed to evaluate the ability of a freely accessible internet algorithm to correctly identify the need for emergency ophthalmologic consultation for correct diagnosis and management. METHOD: This retrospective observational cohort study was based on the first 100 patients who requested recommendations on the necessity of breaking the lockdown for emergency ophthalmology consultation during the period from March to May 2020. RESULTS: Ninety-one patients completed questionnaires. Forty-nine were directed to emergency consultation and 42 to differed scheduled visits or telemedicine visits. One patient sent for emergency consultation had an overestimated severity and could have been seen later, while two patients initially recommended for a scheduled visit were considered appropriate for emergency consultation. However, these patients' management did not suffer as a consequence of the delay. The sensitivity of the algorithm, defined as the number of emergency consultations suggested by the algorithm divided by the total number of emergency consultations deemed appropriate by the practitioner's final evaluation, was 96.0%. The specificity of the algorithm, defined as the number of patients recommended for delayed consultation by the algorithm divided by the number of patients deemed clinically appropriate for this approach, was 97.5%. The positive predictive value, defined as the number of appropriate emergency consultations divided by the total number of emergency consultations suggested by the algorithm, was 97.9%. Finally, the negative predictive value, defined as the number of appropriately deferred patients divided by the number of deferred patients recommended by the algorithm, was 95.2%. CONCLUSION: This study demonstrates the reliability of an algorithm based on patients' past medical history and symptoms to classify patients and direct them to either emergency consultation or to a more appropriate deferred, scheduled appointment. This algorithm might allow reduction of walk-in visits by half and thus help control patient flow into ophthalmologic emergency departments.


Asunto(s)
Algoritmos , Citas y Horarios , Urgencias Médicas , Oftalmopatías/terapia , Oftalmología/organización & administración , Cuarentena , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Control de Enfermedades Transmisibles/normas , Urgencias Médicas/epidemiología , Servicios Médicos de Urgencia/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/normas , Oftalmopatías/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paris/epidemiología , Derivación y Consulta/organización & administración , Derivación y Consulta/normas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Encuestas y Cuestionarios , Telemedicina/organización & administración , Telemedicina/normas , Adulto Joven
12.
Ann Hematol ; 100(3): 601-606, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33388859

RESUMEN

While recent medical advances have led to cure, remission, or long-term disease control for patients with hematologic malignancy, many still portend poor prognoses, and frequently are associated with significant symptom and quality of life burden for patients and families. Patients with hematological cancer are referred to palliative care (PC) services less often than those with solid tumors, despite higher inpatient mortality and shorter interval between first consultation and death. The complexity of individual prognostication, ongoing therapeutic goals of cure, the technical nature and complications of treatment, the intensity of medical care even when approaching end of life, and the speed of change to a terminal event all pose difficulties and hinder referral. A modified palliative care model is an unmet need in hemato-oncology, where PC is introduced early from the diagnosis of hematological malignancy, provided alongside care of curative or life-prolonging intent, and subsequently leads to death and bereavement care or cure and survivorship care depending on disease course. From current evidence, the historical prioritization of cancer care at the center of palliative medicine did not guarantee that those diagnosed with a hematological malignancy were assured of referral, timely or otherwise. Hopefully, this article can be a catalyst for debate that will foster a new direction in integration of clinical service and research, and subspecialty development at the interface of hemato-oncology and palliative care.


Asunto(s)
Prestación Integrada de Atención de Salud , Neoplasias Hematológicas/terapia , Oncología Médica , Cuidados Paliativos , Grupo de Atención al Paciente/organización & administración , Continuidad de la Atención al Paciente/organización & administración , Continuidad de la Atención al Paciente/normas , Prestación Integrada de Atención de Salud/métodos , Prestación Integrada de Atención de Salud/organización & administración , Prestación Integrada de Atención de Salud/normas , Humanos , Comunicación Interdisciplinaria , Oncología Médica/métodos , Oncología Médica/organización & administración , Oncología Médica/normas , Cuidados Paliativos/métodos , Cuidados Paliativos/organización & administración , Cuidados Paliativos/normas , Grupo de Atención al Paciente/normas , Derivación y Consulta/organización & administración , Derivación y Consulta/normas
15.
Am J Phys Med Rehabil ; 100(4): 327-330, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33496441

RESUMEN

ABSTRACT: Since March 2020, when COVID-19 pandemic broke out, the world's healthcare systems' main concern has been fighting the pandemic. However, patients with other diseases, also requiring rehabilitation evaluations and treatments, continued to need care. Our rehabilitation unit managed to maintain contact with patients through alternative communication methods even during the lockdown period and in a situation of staff shortage. If face-to-face evaluations and treatments were necessary, preventive measures were followed to avoid hospital-associated contagion. Rehabilitation beds were cleared to leave them to the acute wards, and consultations for the acute care patients were carried out using personal protective equipment. In the future, the lessons from our experience could contribute toward drawing a plan of measures applicable in similar situations and some of these actions could become part of the rehabilitative practice.


Asunto(s)
Necesidades y Demandas de Servicios de Salud/organización & administración , Innovación Organizacional , Derivación y Consulta/organización & administración , Centros de Rehabilitación/organización & administración , Telemedicina/organización & administración , Humanos , Italia , Programas Nacionales de Salud/organización & administración
16.
Ann Hematol ; 100(3): 825-830, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33409623

RESUMEN

Among the different biomarkers predicting response in chronic lymphocytic leukemia (CLL), the most influential parameters are the mutational status of the IGHV genes and the presence of TP53 gene disruptions. Nevertheless, these important assessments are not readily available in most centers dealing with CLL patients. To provide this molecular testing across the country, the Spanish Cooperative Group on CLL (GELLC) established a network of four analytical reference centers. A total of 2153 samples from 256 centers were analyzed over a period of 30 months. In 9% of the patients, we found pathological mutations in the TP53 gene, whereas 48.96% were classified as IGHV unmutated. Results of the satisfaction survey of the program showed a Net Promoter Score of 85.15. Building a national network for molecular testing in CLL allowed the CLL population a broad access to complex biomarkers analysis that should translate into a more accurate and informed therapeutic decision-making.


Asunto(s)
Servicios de Laboratorio Clínico/organización & administración , Análisis Mutacional de ADN , Cadenas Pesadas de Inmunoglobulina/genética , Leucemia Linfocítica Crónica de Células B/genética , Derivación y Consulta/organización & administración , Proteína p53 Supresora de Tumor/genética , Biomarcadores de Tumor/genética , Servicios de Laboratorio Clínico/provisión & distribución , Estudios de Cohortes , Redes Comunitarias/organización & administración , Análisis Mutacional de ADN/métodos , Humanos , Ciencia de la Implementación , Colaboración Intersectorial , Satisfacción en el Trabajo , Leucemia Linfocítica Crónica de Células B/diagnóstico , Leucemia Linfocítica Crónica de Células B/epidemiología , Técnicas de Diagnóstico Molecular/métodos , Mutación , Pronóstico , España/epidemiología , Encuestas y Cuestionarios
17.
J Am Coll Surg ; 232(4): 444-449, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33359232

RESUMEN

BACKGROUND: Maintaining access to kidney transplantation during a pandemic is a challenge, particularly for centers that serve a large rural and minority patient population with an additional burden of travel. The aim of this article was to describe our experience with the rollout and use of a virtual pretransplantation evaluation platform to facilitate ongoing transplant waitlisting during the early peak of the COVID-19 pandemic. STUDY DESIGN: This is a retrospective analysis of the process improvement project implemented to continue the evaluation of potential kidney transplantation candidates and ensure waitlist placement during the COVID-19 pandemic. Operational metrics include transplantation volume per month, referral volume per month, pretransplantation patients halted before completing an evaluation per month, evaluations completed per month, and patients waitlisted per month. RESULTS: Between April and September 2020, a total of 1,258 patients completed an evaluation. Two hundred and forty-seven patients were halted during this time period before completing a full evaluation. One hundred and fifty-two patients were presented at selection and 113 were placed on the waitlist. In addition, the number of patients in the active referral phase was able to be reduced by 46%. More evaluations were completed within the virtual platform (n = 930 vs n = 880), yielding similar additions to the waitlist in 2020 (n = 282) vs 2019 (n = 308) despite the COVID-19 pandemic. CONCLUSIONS: The virtual platform allowed continued maintenance of a large kidney transplantation program despite the inability to have in-person visits. The value of this platform will likely transform our approach to the pretransplantation process and provides an additional valuable method to improve patient equity and access to transplantation.


Asunto(s)
/epidemiología , Accesibilidad a los Servicios de Salud/organización & administración , Trasplante de Riñón , Selección de Paciente , Insuficiencia Renal/cirugía , Telemedicina/organización & administración , Adulto , Anciano , /transmisión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derivación y Consulta/organización & administración , Insuficiencia Renal/diagnóstico , Insuficiencia Renal/etiología , Estudios Retrospectivos , Listas de Espera
18.
Am Fam Physician ; 103(1): 22-32, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33382560

RESUMEN

Eating disorders are potentially life-threatening conditions characterized by disordered eating and weight-control behaviors that impair physical health and psychosocial functioning. Early intervention may decrease the risk of long-term pathology and disability. Clinicians should interpret disordered eating and body image concerns and carefully monitor patients' height, weight, and body mass index trends for subtle changes. After diagnosis, visits should include the sensitive review of psychosocial and clinical factors, physical examination, orthostatic vital signs, and testing (e.g., a metabolic panel with magnesium and phosphate levels, electrocardiography) when indicated. Additional care team members (i.e., dietitian, therapist, and caregivers) should provide a unified, evidence-based therapeutic approach. The escalation of care should be based on health status (e.g., acute food refusal, uncontrollable binge eating or purging, co-occurring conditions, suicidality, test abnormalities), weight patterns, outpatient options, and social support. A healthy weight range is determined by the degree of malnutrition and pre-illness trajectories. Weight gain of 2.2 to 4.4 lb per week stabilizes cardiovascular health. Treatment options may include cognitive behavior interventions that address body image and dietary and physical activity behaviors; family-based therapy, which is a first-line treatment for youths; and pharmacotherapy, which may treat co-occurring conditions, but should not be pursued alone. Evidence supports select antidepressants or topiramate for bulimia nervosa and lisdexamfetamine for binge-eating disorder. Remission is suggested by healthy biopsychosocial functioning, cognitive flexibility with eating, resolution of disordered behaviors and decision-making, and if applicable, restoration of weight and menses. Prevention should emphasize a positive focus on body image instead of a focus on weight or dieting.


Asunto(s)
Imagen Corporal , Trastornos de Alimentación y de la Ingestión de Alimentos/diagnóstico , Trastornos de Alimentación y de la Ingestión de Alimentos/terapia , Anamnesis , Atención Primaria de Salud/organización & administración , Anorexia Nerviosa/diagnóstico , Anorexia Nerviosa/terapia , Trastorno por Atracón/diagnóstico , Trastorno por Atracón/terapia , Bulimia Nerviosa/diagnóstico , Bulimia Nerviosa/terapia , Terapia Cognitivo-Conductual/métodos , Femenino , Humanos , Masculino , Derivación y Consulta/organización & administración , Factores de Riesgo
19.
Fam Community Health ; 44(2): 78-80, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33351516

RESUMEN

The COVID-19 pandemic has highlighted the importance of social determinants of health in affecting health outcomes. Populations with high social risk are disproportionately impacted by the virus and its economic consequences. Primary care practices have a unique opportunity to implement interventions to mitigate their patients' unmet social needs, such as food and income insecurity. In this commentary, we outline key considerations for clinics implementing programs that identify and address patients' social needs in a way that promotes equity, quality, and sustainability. We provide examples from our own experience at a federally qualified health center.


Asunto(s)
Equidad en Salud , Atención Primaria de Salud/métodos , Calidad de la Atención de Salud , Derivación y Consulta/organización & administración , Determinantes Sociales de la Salud , Bienestar Social , Humanos , Evaluación de Necesidades , Pandemias , Pobreza , Evaluación de Programas y Proyectos de Salud
20.
PLoS One ; 15(12): e0243724, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33351810

RESUMEN

BACKGROUND: Government of India and the World Health Organization have guidelines for outpatient management of young infants 0-59 days with signs of Possible Serious Bacterial Infection (PSBI), when referral is not feasible. Implementation research was conducted to identify facilitators and barriers to operationalizing these guidelines. METHODS: Himachal Pradesh government implemented the guidelines in program settings supported by Centre for Health Research and Development, Society for Applied Studies. The strategy included community sensitization, skill enhancement of Accredited Social Health Activists (ASHA), Auxiliary Nurse Midwives (ANMs) and Medical Officers (MOs) to identify PSBI and treat when referral was not feasible. The research team collected information on facilitators and barriers. A technical support unit provided training and oversight. FINDINGS: Among 1997 live births from June 2017 to January 2019, we identified 160 cases of PSBI in young infants resulting in a coverage of 80%, assuming an incidence of 10%. Of these,29(18.1%) had signs of critical illness (CI), 92 (57.5%) had clinical severe infection (CSI), 5 (3.1%)had severe pneumonia (only fast breathing in young infants 0-6 days), while 34 (21%) had pneumonia (only fast breathing in young infants 7-59 days). Hospital referral was accepted by 48/160 (30%), whereas 112/160 (70%) were treated with the simplified treatment regimens at primary level facilities. Of the 29 infants with CI, 18 (62%) accepted referral; 26 (90%) recovered while 3 (10%) who had accepted referral, died. Of the 92 infants who had CSI, 86 (93%) recovered, 65 (71%) received simplified treatment and one infant who had accepted referral, died. All the five infants who had severe pneumonia, recovered; 3 (60%) had received simplified treatment. Of the 34 pneumonia cases, 33 received simplified treatment of which 5 (15%) failed treatment; two out of these 5 died. Overall, 6/160 infants died (case-fatality-rate 3.4%); 2 in the simplified treatment (case-fatality-rate 1.8%) and 4 in the hospital group (case-fatality-rate 8.3%). Delayed identification and care-seeking by families and health system weaknesses like manpower gaps and interrupted supplies were challenges in implementation. CONCLUSIONS: Implementation of the guidelines in program settings is possible and acceptable. Scaling up would require creating community awareness, early identification and appropriate care-seeking, strengthening ASHA home-visitation program, building skills and confidence of MOs and ANMs, uninterrupted supplies and a dependable referral system.


Asunto(s)
Atención Ambulatoria/organización & administración , Infecciones Bacterianas/terapia , Programas de Gobierno/organización & administración , Guías de Práctica Clínica como Asunto , Derivación y Consulta/organización & administración , Atención Ambulatoria/normas , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/mortalidad , Femenino , Programas de Gobierno/normas , Visita Domiciliaria/estadística & datos numéricos , Humanos , Ciencia de la Implementación , India/epidemiología , Lactante , Mortalidad Infantil , Recién Nacido , Aceptación de la Atención de Salud/estadística & datos numéricos , Derivación y Consulta/normas , Derivación y Consulta/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Índice de Severidad de la Enfermedad
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