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1.
Medicine (Baltimore) ; 100(1): e23995, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33429761

RESUMEN

ABSTRACT: The Chinese government is attaching great importance to the development of ambulatory surgery in order to optimize the healthcare system in China. The study aims to examine the complications and quality indicators of patients who underwent gynecological ambulatory surgery at a tertiary hospital in China.This was a retrospective study of patients who underwent ambulatory surgery between July and September 2019 at the Department of Gynecology of the First Affiliated Hospital of Shandong First Medical University. The patients were followed by phone at 30 days after discharge. The postoperative complications, mortality, unplanned re-operation, delayed discharge, unplanned re-hospitalization, and patient satisfaction were collected. The patients who underwent conventional hysteroscopic resection of uterine lesions during the same period were collected as controls for the economics analysis.A total of 392 patients who underwent ambulatory gynecological surgery were included. Fifteen patients had postoperative complications, and the total complication rate was 3.8% (15/392). Eight (8/392, 2.0%) patients had delayed discharge. There were no unplanned re-operations and deaths. There were two (2/392, 0.5%) cases of unplanned re-hospitalization. At 30 days after discharge, two patients were dissatisfied, and 390 cases were satisfied, for an overall satisfaction rate of 99.5%. Compared with conventional hysteroscopic resection of uterine lesions, ambulatory hysteroscopic surgery had a shorter hospital stay and lower total costs (P < .05) but similar surgery-related costs.Ambulatory gynecological surgery is feasible in China, with an acceptable complication profile and obvious economic and social benefits. Nevertheless, hospital management shall be reinforced.


Asunto(s)
Procedimientos Quirúrgicos Ginecológicos/métodos , Adulto , Procedimientos Quirúrgicos Ambulatorios/métodos , Procedimientos Quirúrgicos Ambulatorios/normas , Procedimientos Quirúrgicos Ambulatorios/tendencias , China/epidemiología , Estudios de Factibilidad , Femenino , Procedimientos Quirúrgicos Ginecológicos/normas , Procedimientos Quirúrgicos Ginecológicos/tendencias , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Desarrollo de Programa/métodos , Estudios Retrospectivos
4.
Neurodegener Dis Manag ; 11(1): 83-89, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33172352

RESUMEN

The Covid-19 pandemic forced providers to alter their delivery of care to special populations, including older adults with cognitive impairment. The Montefiore-Einstein Center for the Aging Brain, a specialty multidisciplinary center for the evaluation and management of patients with neurodegenerative disorders, developed a coordinated approach (Coordinated Care At Risk/Remote Elderly program [CCARRE]) to reach our diverse population during the initial Covid-19 crisis in New York City, USA. In the tele-evaluation of the first 85 patients seen with CCARRE, we recognized unique factors that could improve patient care, lessen burden and optimize access to community resources. Lessons learned from the experience are shared.


Asunto(s)
Directivas Anticipadas , Cuidadores/psicología , Disfunción Cognitiva/terapia , Demencia/terapia , Seguridad del Paciente , Desarrollo de Programa , Telemedicina , Comunicación por Videocoferencia , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Disfunción Cognitiva/diagnóstico , Asistencia Sanitaria Culturalmente Competente , Demencia/diagnóstico , Femenino , Humanos , Masculino , Ciudad de Nueva York , Determinantes Sociales de la Salud , Teléfono
6.
Orthop Clin North Am ; 52(1): 27-39, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33222982

RESUMEN

The number of patients undergoing joint replacement and preservation procedures continues to increase worldwide. Globally, there is no standardized educational pathway, training program, or recognized certification program for surgeons in these procedures. Development and implementation of new competency-based curricula to deliver specific educational events and resources may help trainees and practicing surgeons be able to perform these procedures more effectively and therefore improve patient outcomes in their respective countries. Ideally, a curriculum would be globally standardized and professionally designed to interactively meet the needs of surgeons. A competency-based approach with built-in assessment and evaluation processes is today's educational standard.


Asunto(s)
Artroplastia de Reemplazo/educación , Educación Basada en Competencias/organización & administración , Curriculum , Ortopedia/educación , Conservación de Tejido , Humanos , Desarrollo de Programa
7.
J Nurs Adm ; 51(1): 33-37, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33278199

RESUMEN

Mobile supplemental hospitals were an important asset to community response in preparing for the recent pandemic. MED-1 is a Mobile Emergency Department that has adapted and evolved to the changing needs of communities in times of disaster and nondisaster. An overview of the asset (MED-1), the operations, and use is provided to demonstrate how mobile supplemental hospitals can effectively meet a range of healthcare needs. Innovative utilization of MED-1 has secured its future as an effective resource averaging 100 days of deployment per year.


Asunto(s)
Ambulancias , Defensa Civil/métodos , Planificación en Desastres/métodos , Defensa Civil/tendencias , Planificación en Desastres/tendencias , Humanos , Desarrollo de Programa/métodos
8.
Am Psychol ; 75(9): 1376-1388, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33382320

RESUMEN

In today's world of global migration and urbanization, millions of children are separated from parents. Their mental health and future competences as citizens depend on the quality of care from foster parents and group home staff in nonparental care settings. Caregivers are challenged by poor work conditions, too many children, and a lack of knowledge about care for traumatized children. How can our profession match this challenge by upscaling interventions? Digital designs for applications of psychology are growing, recently accelerated by the COVID-19 crisis. From 2008, the author developed a blended learning intervention. In partnerships with nongovernmental organizations and government agencies, care recommendations from an international network of researchers are transformed into start-up seminars for staff, followed by a 6-month online classroom education. Students learn and practice how to train local caregiver groups in attachment-based care, using training sessions developed in local languages, adjusted to culture. At present, the author's Fairstart Foundation educated 500 staff from partners in 26 countries, who have trained the caregivers of some 40,000 children. The theoretical, logistic and technical steps from research to daily caregiver-child practices are described, to inspire discussions of how online designs and international partnerships may benefit underserved populations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Asunto(s)
Cuidadores/educación , Cuidado del Niño , Niño Abandonado , Educación a Distancia , Cuidados en el Hogar de Adopción , Hogares para Grupos , Desarrollo de Programa , Trauma Psicológico/enfermería , Formación del Profesorado , Adulto , Niño , Cuidado del Niño/métodos , Cuidado del Niño/organización & administración , Cuidado del Niño/normas , Cuidado del Niño/estadística & datos numéricos , Niño Abandonado/estadística & datos numéricos , Educación a Distancia/métodos , Educación a Distancia/organización & administración , Educación a Distancia/estadística & datos numéricos , Cuidados en el Hogar de Adopción/métodos , Cuidados en el Hogar de Adopción/organización & administración , Cuidados en el Hogar de Adopción/estadística & datos numéricos , Hogares para Grupos/organización & administración , Hogares para Grupos/estadística & datos numéricos , Humanos , Cooperación Internacional , Colaboración Intersectorial , Desarrollo de Programa/métodos , Desarrollo de Programa/normas , Desarrollo de Programa/estadística & datos numéricos , Formación del Profesorado/métodos , Formación del Profesorado/organización & administración , Formación del Profesorado/estadística & datos numéricos
9.
BMJ ; 371: m4571, 2020 12 29.
Artículo en Inglés | MEDLINE | ID: mdl-33376083

RESUMEN

OBJECTIVES: To investigate whether retrofitting insulation into homes can reduce cold associated hospital admission rates among residents and to identify whether the effect varies between different groups within the population and by type of insulation. DESIGN: A quasi-experimental retrospective cohort study using linked datasets to evaluate a national intervention programme. PARTICIPANTS: 994 317 residents of 204 405 houses who received an insulation subsidy through the Energy Efficiency and Conservation Authority Warm-up New Zealand: Heat Smart retrofit programme between July 2009 and June 2014. MAIN OUTCOME MEASURE: A difference-in-difference approach was used to compare the change in hospital admissions of the study population post-insulation with the change in hospital admissions of the control population that did not receive the intervention over the same two timeframes. Relative rate ratios were used to compare the two groups. RESULTS: 234 873 hospital admissions occurred during the study period. Hospital admission rates after the intervention increased in the intervention and control groups for all population categories and conditions with the exception of acute hospital admissions among Pacific Peoples (rate ratio 0.94, 95% confidence interval 0.90 to 0.98), asthma (0.92, 0.86 to 0.99), cardiovascular disease (0.90, 0.88 to 0.93), and ischaemic heart disease for adults older than 65 years (0.79, 0.74 to 0.84). Post-intervention increases were, however, significantly lower (11%) in the intervention group compared with the control group (relative rate ratio 0.89, 95% confidence interval 0.88 to 0.90), representing 9.26 (95% confidence interval 9.05 to 9.47) fewer hospital admissions per 1000 in the intervention population. Effects were more pronounced for respiratory disease (0.85, 0.81 to 0.90), asthma in all age groups (0.80, 0.70 to 0.90), and ischaemic heart disease in those older than 65 years (0.75, 0.66 to 0.83). CONCLUSION: This study showed that a national home insulation intervention was associated with reduced hospital admissions, supporting previous research, which found an improvement in self-reported health.


Asunto(s)
Enfermedades Cardiovasculares , Calefacción , Hospitalización/estadística & datos numéricos , Vivienda , Enfermedades Respiratorias , Anciano , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/terapia , Eficiencia Organizacional , Ambiente Controlado , Femenino , Calefacción/métodos , Calefacción/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Desarrollo de Programa , Salud Pública/métodos , Salud Pública/estadística & datos numéricos , Enfermedades Respiratorias/epidemiología , Enfermedades Respiratorias/prevención & control , Enfermedades Respiratorias/terapia , Estudios Retrospectivos
10.
BMJ Open ; 10(12): e040213, 2020 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-33268418

RESUMEN

OBJECTIVE: A proportion of those recovering from COVID-19 are likely to have significant and ongoing symptoms, functional impairment and psychological disturbances. There is an immediate need to develop a safe and efficient discharge process and recovery programme. Established rehabilitation programmes are well placed to deliver a programme for this group but will most likely need to be adapted for the post-COVID-19 population. The purpose of this survey was to rapidly identify the components of a post-COVID-19 rehabilitation assessment and elements of a successful rehabilitation programme that would be required to deliver a comprehensive service for those post-COVID-19 to inform service delivery. DESIGN: A survey comprising a series of closed questions and a free-text comment box allowing for a qualitative analysis. SETTING: Online survey. PARTICIPANTS: Multiprofessional clinicians across specialties were invited to take part. RESULTS: 1031 participants responded from a broad range of specialties. There was overwhelming support for an early posthospital discharge recovery programme to advise patients about the management of fatigue (95% agreed/strongly agreed), breathlessness (94%) and mood disturbances (including symptoms of anxiety and depression, 92%). At the time point of 6-8 weeks, an assessment was considered important, focusing on a broad range of possible symptoms and supporting a return to work. Recommendations for the intervention described a holistic programme focusing on symptom management, return of function and return to employment. The free-text comments added depth to the survey and the need 'not to reinvent the wheel' but rather adapt well-established rehabilitation services to individually tailor needs-based care with continued learning for service development. CONCLUSION: The responses indicate a huge interest and the urgent need to establish a programme to support and mitigate the long-term impact of COVID-19 by optimising and individualising existing rehabilitation programmes.


Asunto(s)
/rehabilitación , Desarrollo de Programa , Conducta Cooperativa , Humanos , Pandemias , Recuperación de la Función , Sociedades Médicas , Encuestas y Cuestionarios
12.
Pan Afr Med J ; 36: 323, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33193977

RESUMEN

The Zambia Field Epidemiology Training Program (ZFETP) was established by the Ministry of Health (MoH) during 2014, in order to increase the number of trained field epidemiologists who can investigate outbreaks, strengthen disease surveillance, and support data-driven decision making. We describe the ZFETP´s approach to public health workforce development and health security strengthening, key milestones five years after program launch, and recommendations to ensure program sustainability. Program description: ZFETP was established as a tripartite arrangement between the Zambia MoH, the University of Zambia School of Public Health, and the U.S. Centers for Disease Control and Prevention. The program runs two tiers: Advanced and Frontline. To date, ZFETP has enrolled three FETP-Advanced cohorts (training 24 residents) and four Frontline cohorts (training 71 trainees). In 2016, ZFETP moved organizationally to the newly established Zambia National Public Health Institute (ZNPHI). This re-positioning raised the program´s profile by providing residents with increased opportunities to lead high-profile outbreak investigations and analyze national surveillance data-achievements that were recognized on a national stage. These successes attracted investment from the Government of Republic of Zambia (GRZ) and donors, thus accelerating field epidemiology workforce capacity development in Zambia. In its first five years, ZFETP achieved early success due in part to commitment from GRZ, and organizational positioning within the newly formed ZNPHI, which have catalyzed ZFETP´s institutionalization. During the next five years, ZFETP seeks to sustain this momentum by expanding training of both tiers, in order to accelerate the professional development of field epidemiologists at all levels of the public health system.


Asunto(s)
Brotes de Enfermedades/prevención & control , Epidemiología/educación , Salud Pública/educación , Desarrollo de Personal/organización & administración , Femenino , Humanos , Masculino , Vigilancia de la Población , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Recursos Humanos , Zambia
14.
Med J Aust ; 213 Suppl 10: S3-S31, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33190287

RESUMEN

■The RHD Endgame Strategy: the blueprint to eliminate rheumatic heart disease in Australia by 2031 (the Endgame Strategy) is the blueprint to eliminate rheumatic heart disease (RHD) in Australia by 2031. Aboriginal and Torres Strait Islander people live with one of the highest per capita burdens of RHD in the world. ■The Endgame Strategy synthesises information compiled across the 5-year lifespan of the End Rheumatic Heart Disease Centre of Research Excellence (END RHD CRE). Data and results from priority research projects across several disciplines of research complemented literature reviews, systematic reviews and narrative reviews. Further, the experiences of those working in acute rheumatic fever (ARF) and RHD control and those living with RHD to provide the technical evidence for eliminating RHD in Australia were included. ■The lived experience of RHD is a critical factor in health outcomes. All future strategies to address ARF and RHD must prioritise Aboriginal and Torres Strait Islander people's knowledge, perspectives and experiences and develop co-designed approaches to RHD elimination. The environmental, economic, social and political context of RHD in Australia is inexorably linked to ending the disease. ■Statistical modelling undertaken in 2019 looked at the economic and health impacts of implementing an indicative strategy to eliminate RHD by 2031. Beginning in 2019, the strategy would include: reducing household crowding, improving hygiene infrastructure, strengthening primary health care and improving secondary prophylaxis. It was estimated that the strategy would prevent 663 deaths and save the health care system $188 million. ■The Endgame Strategy provides the evidence for a new approach to RHD elimination. It proposes an implementation framework of five priority action areas. These focus on strategies to prevent new cases of ARF and RHD early in the causal pathway from Streptococcus pyogenes exposure to ARF, and strategies that address the critical systems and structural changes needed to support a comprehensive RHD elimination strategy.


Asunto(s)
Desarrollo de Programa/métodos , Fiebre Reumática/prevención & control , Cardiopatía Reumática/prevención & control , Adolescente , Adulto , Australia/epidemiología , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Sistema de Registros , Fiebre Reumática/complicaciones , Fiebre Reumática/epidemiología , Cardiopatía Reumática/epidemiología , Cardiopatía Reumática/etiología , Prevención Secundaria , Streptococcus pyogenes , Adulto Joven
15.
MMWR Morb Mortal Wkly Rep ; 69(46): 1743-1747, 2020 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-33211678

RESUMEN

On university campuses and in similar congregate environments, surveillance testing of asymptomatic persons is a critical strategy (1,2) for preventing transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). All students at Duke University, a private research university in Durham, North Carolina, signed the Duke Compact (3), agreeing to observe mandatory masking, social distancing, and participation in entry and surveillance testing. The university implemented a five-to-one pooled testing program for SARS-CoV-2 using a quantitative, in-house, laboratory-developed, real-time reverse transcription-polymerase chain reaction (RT-PCR) test (4,5). Pooling of specimens to enable large-scale testing while minimizing use of reagents was pioneered during the human immunodeficiency virus pandemic (6). A similar methodology was adapted for Duke University's asymptomatic testing program. The baseline SARS-CoV-2 testing plan was to distribute tests geospatially and temporally across on- and off-campus student populations. By September 20, 2020, asymptomatic testing was scaled up to testing targets, which include testing for residential undergraduates twice weekly, off-campus undergraduates one to two times per week, and graduate students approximately once weekly. In addition, in response to newly identified positive test results, testing was focused in locations or within cohorts where data suggested an increased risk for transmission. Scale-up over 4 weeks entailed redeploying staff members to prepare 15 campus testing sites for specimen collection, developing information management tools, and repurposing laboratory automation to establish an asymptomatic surveillance system. During August 2-October 11, 68,913 specimens from 10,265 graduate and undergraduate students were tested. Eighty-four specimens were positive for SARS-CoV-2, and 51% were among persons with no symptoms. Testing as a result of contact tracing identified 27.4% of infections. A combination of risk-reduction strategies and frequent surveillance testing likely contributed to a prolonged period of low transmission on campus. These findings highlight the importance of combined testing and contact tracing strategies beyond symptomatic testing, in association with other preventive measures. Pooled testing balances resource availability with supply-chain disruptions, high throughput with high sensitivity, and rapid turnaround with an acceptable workload.


Asunto(s)
Enfermedades Asintomáticas/epidemiología , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Vigilancia en Salud Pública/métodos , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/prevención & control , Humanos , North Carolina/epidemiología , Pandemias/prevención & control , Neumonía Viral/prevención & control , Desarrollo de Programa , Universidades , Carga Viral
16.
Gen Hosp Psychiatry ; 67: 62-69, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33059217

RESUMEN

OBJECTIVE: COVID-19 is an international public health crisis, putting substantial burden on medical centers and increasing the psychological toll on health care workers (HCW). METHODS: This paper describes CopeColumbia, a peer support program developed by faculty in a large urban medical center's Department of Psychiatry to support emotional well-being and enhance the professional resilience of HCW. RESULTS: Grounded in evidence-based clinical practice and research, peer support was offered in three formats: groups, individual sessions, and town halls. Also, psychoeducational resources were centralized on a website. A Facilitator's Guide informed group and individual work by including: (1) emotional themes likely to arise (e.g., stress, anxiety, trauma, grief, and anger) and (2) suggested facilitator responses and interventions, drawing upon evidence-based principles from peer support, stress and coping models, and problem-solving, cognitive behavioral, and acceptance and commitment therapies. Feedback from group sessions was overwhelmingly positive. Approximately 1/3 of individual sessions led to treatment referrals. CONCLUSIONS: Lessons learned include: (1) there is likely an ongoing need for both well-being programs and linkages to mental health services for HCW, (2) the workforce with proper support, will emerge emotionally resilient, and (3) organizational support for programs like CopeColumbia is critical for sustainability.


Asunto(s)
Centros Médicos Académicos , Adaptación Psicológica , Personal de Salud/psicología , Desarrollo de Programa , Servicio de Psiquiatría en Hospital , Psicoterapia , Resiliencia Psicológica , Apoyo Social , Adulto , Humanos , Ciudad de Nueva York , Evaluación de Resultado en la Atención de Salud , Grupo Paritario , Satisfacción Personal
17.
Phys Med ; 80: 10-16, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33070007

RESUMEN

PURPOSE: We present the implementation of e-learning in the Master of Medical Physics programme at the University of Malaya during a partial lockdown from March to June 2020 due to the COVID-19 pandemic. METHODS: Teaching and Learning (T&L) activities were conducted virtually on e-learning platforms. The students' experience and feedback were evaluated after 15 weeks. RESULTS: We found that while students preferred face-to-face, physical teaching, they were able to adapt to the new norm of e-learning. More than 60% of the students agreed that pre-recorded lectures and viewing videos of practical sessions, plus answering short questions, were beneficial. Certain aspects, such as hands-on practical and clinical experience, could never be replaced. The e-learning and study-from-home environment accorded a lot of flexibility. However, students also found it challenging to focus because of distractions, lack of engagement and mental stress. Technical problems, such as poor Internet connectivity and limited data plans, also compounded the problem. CONCLUSION: We expect e-learning to prevail in future. Hybrid learning strategies, which includes face-to-face classes and e-learning, will become common, at least in the medical physics programme of the University of Malaya even after the pandemic.


Asunto(s)
/epidemiología , Instrucción por Computador/métodos , Educación a Distancia/métodos , Tecnología Educacional/métodos , Humanos , Internet , Aprendizaje , Malasia , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud/métodos , Estudiantes de Medicina , Enseñanza , Universidades
20.
PLoS One ; 15(10): e0240407, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33057337

RESUMEN

OBJECTIVES: Unintended (mistimed or unwanted) pregnancies occur frequently in the United States and have negative effects. When designing prevention programs and intervention strategies for the provision of comprehensive birth control methods, it is necessary to identify (1) populations at high risk of unintended pregnancy, and (2) geographic areas with a concentration of need. METHODS: To estimate the proportion and incidence of unintended births and pregnancies for regions in Missouri, two machine-learning prediction models were developed using data from the National Survey of Family Growth and the Missouri Pregnancy Risk Assessment Monitoring System. Each model was applied to Missouri birth certificate data from 2014 to 2016 to estimate the number of unintended births and pregnancies across regions in Missouri. Population sizes from the American Community Survey were incorporated to estimate the incidence of unintended births and pregnancies. RESULTS: About 24,500 (34.0%) of the live births in Missouri each year were estimated to have resulted from unintended pregnancies: about 25 per 1,000 women (ages 15 to 45) annually. Further, 40,000 pregnancies (39.7%) were unintended each year: about 41 per 1,000 women annually. Unintended pregnancy was concentrated in Missouri's largest urban areas, and annual incidence varied substantially across regions. CONCLUSIONS: Our proposed methodology was feasible to implement. Random forest modeling identified factors in the data that best predicted unintended birth and pregnancy and outperformed other approaches. Maternal age, marital status, health insurance status, parity, and month that prenatal care began predict unintended pregnancy among women with a recent live birth. Using this approach to estimate the rates of unintended births and pregnancies across regions within Missouri revealed substantial within-state variation in the proportion and incidence of unintended pregnancy. States and other agencies could use this study's results or methods to better target interventions to reduce unintended pregnancy or address other public health needs.


Asunto(s)
Embarazo no Planeado , Desarrollo de Programa , Adolescente , Adulto , Tasa de Natalidad , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Persona de Mediana Edad , Missouri , Embarazo , Adulto Joven
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