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1.
Arch Argent Pediatr ; 119(2): 76-82, 2021 04.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33749192

RESUMEN

INTRODUCTION: The objective of this study was to analyze available resources, guidelines in use, and preparedness to care for newborn infants at maternity centers in Argentina during the COVID-19 pandemic. METHOD: Cross-sectional study based on a survey administered to medical and nursing staff. In May 2020, Argentine facilities with more than 500 annual births were contacted; 58 % of these were from the public sector. RESULTS: In total, 104/147 facilities answered (71 %). All had guidelines for care during the pandemic, and 93 % indicated they had been trained on how to use them. A companion was not allowed during childbirth in 26 % of private facilities and in 60 % of public ones (p < 0.01). Deferred cord clamping was recommended in 87 %; rooming-in with asymptomatic newborns was promoted in 62 %; breastfeeding using protective measures was recommended in 70 %; and breast milk using a bottle, in 23 %. In 94 %, family visiting in the Neonatology Unit was restricted. Difficulties included the unavailability of individual rooms for symptomatic newborn infants and a potential shortage of health care staff and personal protective equipment. CONCLUSIONS: All facilities are aware of the national guidelines to fight the pandemic. Most have the resources to comply with the recommended protective measures. There is uncertainty as to whether personal protective equipment, staff, and physical space available at the different facilities would be enough if cases increased significantly.


Asunto(s)
/prevención & control , Recursos en Salud/provisión & distribución , Cuidado del Lactante/organización & administración , Control de Infecciones/organización & administración , Servicios de Salud Materna/organización & administración , Argentina/epidemiología , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Política de Salud , Humanos , Cuidado del Lactante/estadística & datos numéricos , Recién Nacido , Control de Infecciones/instrumentación , Control de Infecciones/métodos , Control de Infecciones/estadística & datos numéricos , Masculino , Servicios de Salud Materna/estadística & datos numéricos , Pandemias , Equipo de Protección Personal/provisión & distribución , Guías de Práctica Clínica como Asunto , Embarazo
2.
Medicine (Baltimore) ; 100(12): e25211, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761706

RESUMEN

ABSTRACT: Measuring patient satisfaction scores and interpreting factors that impact their variation is of importance as scores influence various aspects of health care administration. Our objective was to evaluate if Press Ganey scores differ between medical specialties.New patient visits between January 2014 and December 2016 at a single tertiary academic center were included in this study. Press Ganey scores were compared between specialties using a multivariable logistic mixed effects model. Secondary outcomes included a comparison between surgical versus non-surgical specialties, and pediatric versus adult specialties. Due to the survey's high ceiling effect, satisfaction was defined as a perfect total score.Forty four thousand four hundred ninety six patients met inclusion criteria. Compared to internal medicine, plastic surgery, general surgery, dermatology, and family medicine were more likely to achieve a perfect overall score, as, with odds ratios of 1.46 (P = .02), 1.29 (P = .002), 1.22 (P = .004), and 1.16 (P = .02) respectively. Orthopaedics, pediatric medicine, pediatric neurology, neurology, and pain management were less likely to achieve satisfaction with odds ratios of 0.85 (P = .047), 0.71 (P < .001), 0.63 (P = .005), 0.57 (P < .001), and 0.51 (P = .006), respectively. Compared to pediatric specialties, adult specialties were more likely to achieve satisfaction (OR 1.73; P < .001). There were no significant differences between surgical versus non-surgical specialties.Press Ganey scores systematically differ between specialties within the studied institution. These differences should be considered by healthcare systems that use patient satisfaction data to modify provider reimbursement.


Asunto(s)
Medicina , Pacientes Ambulatorios/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Recolección de Datos , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Medicina/clasificación , Medicina/estadística & datos numéricos , Medición de Resultados Informados por el Paciente , Calidad de la Atención de Salud/normas , Proyectos de Investigación , Estados Unidos
5.
Transplant Cell Ther ; 27(3): 270.e1-270.e6, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33781537

RESUMEN

SARS-CoV-2 has spread rapidly worldwide, but the full impact of the COVID-19 pandemic on the field of hematopoietic cell transplantation (HCT) remains unknown. To understand this better, an 18-item online survey was disseminated by the Worldwide Network for Blood & Marrow Transplantation with questions exploring SARS-CoV-2 testing algorithms, mobilization, and cryopreservation strategies and COVID-19 infections in allogeneic related and autologous hematopoietic progenitor cell (HPC) donors. The aim of this survey was to assess the impact of the outbreak on policies relating to HPC mobilization, collection, and processing with respect to changes in daily routine. A total of 91 individual responses from distinct centers in 6 continents were available for analysis. In these centers, the majority (72%) of allogeneic related and autologous donors are routinely tested for SARS-CoV-2 before HPC collection, and 80% of centers implement cryopreservation of allogeneic HPC grafts before commencing conditioning regimens in patients. Five related and 14 autologous donors who tested positive for COVID-19 did not experience any unexpected adverse events or reactions during growth factor administration (eg, hyperinflammatory syndrome). These data are limited by the small number of survey respondents but nonetheless suggest that centers are following the recommendations of appropriate scientific organizations and provide some preliminary data to suggest areas of further study.


Asunto(s)
Trasplante de Médula Ósea/estadística & datos numéricos , Trasplante de Células Madre Hematopoyéticas/estadística & datos numéricos , Pandemias , Algoritmos , Aloinjertos , Trasplante de Médula Ósea/tendencias , /prevención & control , /estadística & datos numéricos , Criopreservación/métodos , Selección de Donante/normas , Salud Global , Encuestas de Atención de la Salud , Movilización de Célula Madre Hematopoyética/estadística & datos numéricos , Trasplante de Células Madre Hematopoyéticas/tendencias , Pautas de la Práctica en Medicina/estadística & datos numéricos , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Conservación de Tejido/métodos , Trasplante Autólogo , Donante no Emparentado/estadística & datos numéricos
7.
Medicine (Baltimore) ; 100(11): e25133, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725994

RESUMEN

ABSTRACT: The purpose of this research was to identify whether a certain set of drivers of satisfaction/perceived quality of healthcare (PQHC) could indirectly affect patients' confidence/trust in the emergency department (ED).Patients were seen at an ED in the public hospital in Lisbon, Portugal between January and December 2016. Data were collected between May and November 2017, using a questionnaire, by mail or e-mail. The total sample size comprised 382 patients. The data analysis included structural equation modeling to test the conceptual model with specific drivers of satisfaction/PQHC (privacy; accessibility and availability; doctors; meeting expectations; waiting time for triage [perception]; waiting time to be called back by the doctor following examinations and/or tests [perception]; information about possible delays in receiving treatment/waiting times) and with the main outcome (confidence/trust in the ED) using path analysis.The analysis of the coefficients revealed that all the mediated paths are statistically significant (P ≤ .05). Although, altogether, the direct paths did not prove statistically significant (P > .05), the overall satisfaction with doctors (P ≤ .01) and meeting expectations (P = .01) can still directly explain the confidence/trust in the ED without the mediating role of satisfaction and PQHC. Hence, overall satisfaction with doctors and meeting expectations can influence, both directly and indirectly, confidence/trust in the ED. All other variables can only indirectly affect confidence/trust in the ED, either through PQHC or through satisfaction.Even though there are more variables that influence confidence/trust in the ED through PQHC (1)waiting time to be called back by the doctor following examinations and/or tests [perception]; 2) privacy; 3) accessibility and availability; 4) doctors; 5) meeting expectations than through satisfaction (1)waiting time for triage [perception]; 2) information about possible delays in receiving treatment/waiting times; 3) doctors; 4) meeting expectations), we observe the strongest contribution in the mediation model through satisfaction, which reveals its dominant role over PQHC.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Servicio de Urgencia en Hospital/normas , Aceptación de la Atención de Salud/psicología , Satisfacción del Paciente/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Encuestas de Atención de la Salud , Hospitales Públicos , Humanos , Masculino , Persona de Mediana Edad , Percepción , Portugal , Factores de Tiempo , Triaje/normas , Triaje/estadística & datos numéricos , Listas de Espera , Adulto Joven
8.
Infect Dis Poverty ; 10(1): 30, 2021 Mar 17.
Artículo en Inglés | MEDLINE | ID: mdl-33731226

RESUMEN

The ongoing coronavirus disease 2019 (COVID-19) pandemic has put a strain on health systems globally. Although Africa is the least affected region to date, it has the weakest health systems and an exponential rise in cases as has been observed in other regions, is bound to overwhelm its health systems. Early detection and isolation of suspected and confirmed COVID-19 cases are pivotal to the prevention and control of the pandemic. The World Health Organization (WHO) recommends that all laboratory-confirmed cases should be isolated and treated in a health care facility; however, where this is not possible due to the health system capacity, patients can be isolated in re-purposed facilities or at home. An already very apparent future challenge for Africa is facility-based isolation of COVID-19 cases, given the already limited health infrastructure and health workforce, and the risk of nosocomial transmission. Use of repurposed facilities requires additional resources, including health workers. Home isolation, on the other hand, would be a challenge given the poor housing, overcrowding, inadequate access to water and sanitation, and stigma related to infectious disease that is prevalent in many African societies. Conflict settings on the continent pose an additional challenge to the prevention and control of COVID-19 with the resultant population displacements in overcrowded camps where access to social services is limited. These unique cultural, social, economic and developmental differences on the continent, call for a tailored approach to COVID-19 case management strategies. This article proposes three broad case management strategies based on the transmission scenarios defined by WHO, and the criteria and package of care for each option, for consideration by policy makers and governments in African countries. Moving forward, African countries should generate local evidence to guide the development of realistic home-grown strategies, protocol and equipment for the management of COVID-19 cases on the continent .


Asunto(s)
/epidemiología , Manejo de Caso , África/epidemiología , Américas/epidemiología , Asia/epidemiología , /terapia , Prestación de Atención de Salud , Manejo de la Enfermedad , Europa (Continente)/epidemiología , Encuestas de Atención de la Salud , Humanos
9.
Medicine (Baltimore) ; 100(12): e24942, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761650

RESUMEN

BACKGROUND: Hemodialysis is a common treatment for patients with end-stage renal failure. Long-term hemodialysis will lead to a series of complications and reduce the quality of life of patients. At present, routine nursing is only limited to in-hospital patients, whereas continuous nursing is an extension of hospital nursing work, which can solve the follow-up health problems of some patients and meet the health needs of patients in their daily life. A number of clinical studies have shown that continuous nursing can improve the quality of life of hemodialysis patients, but there is a lack of evidence-based medicine. Therefore, the purpose of this study is to explore the effect of continuous nursing on the quality of life of hemodialysis patients through systematic evaluation. METHOD: The Cochrance Library, PubMed, Embase, Web of Science, CNKI, VP Information Chinese Journal Service Platform (VIP), and Wanfang will be searched by computer. In addition, Baidu academic and Google academic are searched manually, and all randomized controlled trials on the effects of continuous nursing on the quality of life of hemodialysis patients are collected. The retrieval time is of the establishment of the database to January 31, 2021. Two evaluators screens, extract and evaluate the literature, and the data are analyzed by RevMan5.3 software. RESULT: The purpose of this study is to evaluate the effect of continuous nursing on the quality of life of hemodialysis patients by the MOS item short from health survey, exercise of self-care agency, and the incidence of complications. CONCLUSION: This study will provide reliable evidence for the application of continuous nursing in hemodialysis patients. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/HZKUA.


Asunto(s)
Continuidad de la Atención al Paciente , Metaanálisis como Asunto , Calidad de Vida , Diálisis Renal/enfermería , Revisiones Sistemáticas como Asunto , Encuestas de Atención de la Salud , Humanos , Fallo Renal Crónico/enfermería , Fallo Renal Crónico/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación
10.
Recenti Prog Med ; 112(3): 207-215, 2021 03.
Artículo en Italiano | MEDLINE | ID: mdl-33687359

RESUMEN

OBJECTIVES: The recent lockdown, resulting from the SARS-CoV-2 pandemic, has had a strong social and psychological impact on the most fragile individuals and family structures. In the present work we investigated the experience of families without specific elements of social or health vulnerability during the quarantine period that occurred in the spring of 2020. MATERIALS AND METHODS: Between May and July 2020, 22 primary care pediatricians belonging to AUSL Romagna administered to a number of families a questionnaire to detect changes that occurred, during the lockdown, in family environment, school attendance and personal attitudes. RESULTS: A total of 721 questionnaires were collected, analyzing the associations between variables relating to home environment, daily rhythms, school and warning signs in relation to the age of children. As a result of the lockdown, family habits changed in 31% of cases, with a greater presence of the reference figure in 68% of these. Three out of four families reported they had sufficient domestic spaces, and nine out of ten had access to an outdoor, private or condominium space. Daily rhythms were preserved in 56.7% of cases; mood disorders appeared in 30% of adolescent children, followed by sleep, appetite and psychosomatic disorders. One in three children has made progress in terms of evolution and behavior, and one in 5 children has seen their relationships improve. The overall resilience of families during the lockdown period was considered good in 66.3%, sufficient in 31.3% and not satisfactory in only 2.4% of cases. CONCLUSIONS: Our data show that, in the interviewed families, the simultaneous presence of adults and children at home has generally intensified. Families refer, on the whole, a positive and resilient behavior in the lockdown period, even if initial emotional problems are reported in one out of three children-adolescents. The ability to maintain a family organized structure seems to be partially compromised. Forced cohabitation leads to competition for the same resources of time and space and affects the entire family unit. The school institution emerges as a protective factor for children, young people and also for the well-being of families themselves.


Asunto(s)
/prevención & control , Medicina Comunitaria , Relaciones Familiares/psicología , Pandemias , Pediatras , Psicología del Adolescente , Psicología Infantil , Cuarentena/psicología , Adolescente , Adulto , Actitud , Niño , Preescolar , Aglomeración/psicología , Emigrantes e Inmigrantes/psicología , Trastornos de Alimentación y de la Ingestión de Alimentos/epidemiología , Trastornos de Alimentación y de la Ingestión de Alimentos/etiología , Femenino , Encuestas de Atención de la Salud , Vivienda , Humanos , Lactante , Recién Nacido , Masculino , Trastornos del Humor/epidemiología , Trastornos del Humor/etiología , Padres/psicología , Trastornos Psicofisiológicos/epidemiología , Trastornos Psicofisiológicos/etiología , Instituciones Académicas , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/etiología
11.
MMWR Morb Mortal Wkly Rep ; 70(10): 342-345, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33705366

RESUMEN

The World Health Organization and national guidelines recommend HIV testing and counseling at tuberculosis (TB) clinics for all patients, regardless of TB diagnosis (1). Population-based HIV Impact Assessment (PHIA) survey data for 2015-2016 in Malawi, Zambia, and Zimbabwe were analyzed to assess HIV screening at TB clinics among persons who had positive HIV test results in the survey. The analysis was stratified by history of TB diagnosis* (presumptive versus confirmed†), awareness§ of HIV-positive status, antiretroviral therapy (ART)¶ status, and viral load suppression among HIV-positive adults, by history of TB clinic visit. The percentage of adults who reported having ever visited a TB clinic ranged from 4.7% to 9.7%. Among all TB clinic attendees, the percentage who reported that they had received HIV testing during a TB clinic visit ranged from 48.0% to 62.1% across the three countries. Among adults who received a positive HIV test result during PHIA and who did not receive a test for HIV at a previous TB clinic visit, 29.4% (Malawi), 21.9% (Zambia), and 16.2% (Zimbabwe) reported that they did not know their HIV status at the time of the TB clinic visit. These findings represent missed opportunities for HIV screening and linkage to HIV care. In all three countries, viral load suppression rates were significantly higher among those who reported ever visiting a TB clinic than among those who had not (p<0.001). National programs could strengthen HIV screening at TB clinics and leverage them as entry points into the HIV diagnosis and treatment cascade (i.e., testing, initiation of treatment, and viral load suppression).


Asunto(s)
Infecciones por VIH/diagnóstico , Instituciones de Salud , Tamizaje Masivo/estadística & datos numéricos , Tuberculosis/terapia , Adolescente , Adulto , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Encuestas de Atención de la Salud , Humanos , Malaui/epidemiología , Masculino , Persona de Mediana Edad , Tuberculosis/epidemiología , Adulto Joven , Zambia/epidemiología , Zimbabwe/epidemiología
12.
BMC Musculoskelet Disord ; 22(1): 245, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33673844

RESUMEN

OBJECTIVE: To explore orthopaedic and musculoskeletal clinicians' views and experiences of legal, safety, safeguarding and security issues regarding the use of virtual consultations (VC) during the COVID-19 pandemic. A secondary objective was to suggest ways to overcome these issues. METHODS: A mixed method cross-sectional survey was conducted, seeking the views and experiences of orthopaedic and musculoskeletal medically qualified and Allied Health Professionals in the United Kingdom. Descriptive statistical analysis was employed for quantitative data and a qualitative content analysis undertaken for qualitative data. Findings were presented in accordance with the four key issues. RESULTS: Two hundred and ninety professionals (206 physiotherapists, 78 medically qualified professionals, 6 'other' therapists) participated in the survey. Of the 290 participants, 260 (90%) were not using VC prior to the COVID-19 pandemic, 248 respondents (86%) were unsure whether their professional indemnity insurance covered VC, 136 (47%) had considered how they would handle an issue of safeguarding whilst the remainder had not, 126 (43%) had considered what they would do if, during a virtual consultation, a patient suffered an injury (e.g. bang on their head) or a fall (e.g. mechanical or a medical event like syncope) and 158 (54%) reported they felt the current technological solutions are secure in terms of patient data. Qualitative data provided additional context to support the quantitative findings such as validity of indemnification, accuracy of diagnosis and consent using VC, safeguarding issues; and security and sharing of data. Potential changes to practice have been proposed to address these issues. CONCLUSIONS: VC have been rapidly deployed since the onset of the COVID-19 pandemic often without clear guidance or consensus on many important issues. This study identified legal, safeguarding, safety and security issues. There is an urgent need to address these and develop local and national guidance and frameworks to facilitate ongoing safe virtual orthopaedic practice beyond the COVID-19 pandemic.


Asunto(s)
/epidemiología , Encuestas de Atención de la Salud , Pandemias , Seguridad del Paciente , Telemedicina/legislación & jurisprudencia , Telemedicina/normas , Técnicos Medios en Salud , Seguridad Computacional , Confidencialidad , Estudios Transversales , Femenino , Humanos , Masculino , Ortopedia
13.
N Z Med J ; 134(1530): 48-56, 2021 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-33651777

RESUMEN

AIM: To ensure that staff at North Shore Hospital are competent and confident in the roles that they are performing during a 777 call, and to improve leadership and teamwork within the resuscitation team. METHODS: We introduced two 777 Planner meetings each day at 4pm and 10pm at North Shore Hospital, with a 777 Planner template to guide the meeting. The 777 Planner enabled members of the team to meet, introduce themselves and allocate roles in preparation for resuscitative events prior to later calls. We conducted pre- and post-implementation surveys to evaluate the experience of 777 calls prior to and after implementation of the 777 Planner. RESULTS: 68% of respondents felt that the 777 Planner improved their experience of 777 calls, and 78% found it a useful part of the handover. 50% of pre-implementation survey respondents were not clear what other team members roles were in emergency calls, and 53% were not aware who was leading the emergency call. Following the implementation of the intervention, this improved to 74% reporting clarity on roles and 79% stating they knew who was leading the 777 call. CONCLUSION: The 777 Planner ultimately improved members of the resuscitation teams experience of 777 calls at North Shore Hospital, particularly concerning leadership, communication and clarity of roles.


Asunto(s)
Sistemas de Comunicación entre Servicios de Urgencia , Servicios Médicos de Urgencia/normas , Hospitales , Líneas Directas/provisión & distribución , Encuestas de Atención de la Salud , Líneas Directas/organización & administración , Humanos , Liderazgo , Nueva Zelanda , Grupo de Atención al Paciente
14.
High Blood Press Cardiovasc Prev ; 28(2): 151-157, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33544372

RESUMEN

The approach to hypertensive emergiencies (HE) and urgencies (HU) may be different according to local clinical practice, despite recent guidelines and position papers recommendations. The Italian Society of Hypertension (Società Italiana della Ipertensione Arteriosa, SIIA) developed an online survey, in order to explore the awareness, management and treatment of HU in Italy, sending by e mail a 12 items questionnaire to the members of the SIIA. The results show that the definition of HU was correctly identified by 62% of the responders. Most physicians identified the role of pharmacological therapy or legal/illegal substances abuse as possible cause of BP elevation; the use of a benzodiazepine drugs was considered worthwhile by 65% of responders. The prescription of diagnostic test and drug administration significantly differed from guidelines recommendations and only 57% of the physicians reported to treat HU with oral drug administration. Sub-lingual nifedipine was prescribed by 13% or responders. This survey shows the need to further spread the updated scientific information on the management and treatment of HE and HU, along with the improvement of the interrelationship with the general practitioner health system in Italy.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Medicina General/tendencias , Hipertensión/tratamiento farmacológico , Pautas de la Práctica en Medicina/tendencias , Adolescente , Adulto , Anciano , Utilización de Medicamentos/tendencias , Urgencias Médicas , Femenino , Adhesión a Directriz/tendencias , Encuestas de Atención de la Salud , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertensión/fisiopatología , Italia/epidemiología , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Factores de Riesgo , Resultado del Tratamiento , Adulto Joven
15.
High Blood Press Cardiovasc Prev ; 28(2): 177-184, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33625694

RESUMEN

INTRODUCTION: Patients with chronic kidney disease (CKD) are vulnerable to adverse-drug events from cardiovascular drugs. AIM: To evaluate awareness and knowledge for appropriate dose adjustment of cardiovascular drugs in CKD patients among Internal Medicine house-staff (IMHS). METHODS: Cross-sectional convenience sample survey in Fall 2015 among 341 IMHS from multiple academic institutions in the suburban New York City metropolitan area. Awareness was whether drug dose adjustment was needed. Knowledge was correct GFR level for drug dose adjustment. Multivariate logistic regression was conducted. RESULTS: We found overall high percentages and high odds for all cardiovascular drugs for incorrect awareness and knowledge. Postgraduate year (PGY)-1 had greater odds than PGY-3 for Carvedilol (OR: 5.56, 95% CI: 2.19-14.12, p < 0.001) and Digoxin (OR: 3.87, 95% CI: 1.37-10.95, p < 0.05), and lesser odds than PGY3 for Atenolol (OR: 0.31, 95% CI: 0.10-0.91, p < 0.05). Nephrology exposure during medical school rotation, renal clinic, or family history had lesser odds for Carvedilol (OR: 0.45, 95% CI: 0.21-0.97, p < 0.05), Simvastatin (OR: 0.40, 95% CI: 0.16-0.97, p < 0.05), and Hydralazine (OR: 0.31, 95% CI: 0.12-0.81, p < 0.05). Nephrology exposure during residency (OR: 1.96, 95% CI: 1.10-3.50, p < 0.05) and US osteopathic graduates (OR: 2.40, 95% CI: 1.04-5.50, p < 0.05) each had greater odds for Enalapril (OR: 2.40, 95% CI: 1.04-5.50, p < 0.05). International medical graduates had lesser odds than US graduates for Amlodipine (OR: 0.30, 95% CI: 0.11-0.82, p < 0.05). CONCLUSIONS: IMHS had overall poor awareness and knowledge for dose adjustment for common cardiovascular drugs in patients with CKD. As the majority of CKD patients are managed by their primary care providers, training programs should ensure that IMHS have adequate education in Nephrology during their residency training.


Asunto(s)
Fármacos Cardiovasculares/administración & dosificación , Enfermedades Cardiovasculares/tratamiento farmacológico , Tasa de Filtración Glomerular , Conocimientos, Actitudes y Práctica en Salud , Medicina Interna , Riñón/fisiopatología , Cuerpo Médico de Hospitales , Insuficiencia Renal Crónica/fisiopatología , Adulto , Fármacos Cardiovasculares/efectos adversos , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/fisiopatología , Estudios Transversales , Cálculo de Dosificación de Drogas , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/diagnóstico , Medición de Riesgo , Factores de Riesgo
16.
Circ Arrhythm Electrophysiol ; 14(3): e009458, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33554620
17.
Seizure ; 86: 60-67, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33550135

RESUMEN

OBJECTIVE: To assess the impact of ongoing COVID-19 pandemic on epilepsy care in India. METHODS: We conducted a three-part survey comprising neurologists, people with epilepsy (PWE), and 11 specialized epilepsy centers across India. We sent two separate online survey questionnaires to Indian neurologists and PWE to assess the epilepsy practice, seizures control, and access to care during the COVID-19 pandemic. We collected and compared the data concerning the number of PWE cared for and epilepsy procedures performed during the 6 months periods preceding and following COVID-19 lockdown from epilepsy centers. RESULTS: The survey was completed by 453 neurologists and 325 PWE. One third of the neurologist reported >50 % decline in outdoor visits by PWE and EEG recordings. The cumulative data from 11 centers showed 65-70 % decline in the number of outdoor patients, video-EEG monitoring, and epilepsy surgery. Working in a hospital admitting COVID-19 patients and use of teleconsultation correlated with this decline. Half of PWE had postponed their planned outpatient visits and EEG. Less than 10 % of PWE missed their antiseizure medicines (ASM) or had seizures due to the nonavailability of ASM. Seizure control remained unchanged or improved in 92 % PWE. Half of the neurologists started using teleconsultation during the pandemic. Only 4% of PWE were afflicted with COVID-19 infection. CONCLUSIONS: Despite significant decline in the number of PWE visiting hospitals, their seizure control and access to ASMs were not affected during the COVID-19 pandemic in India. Risk of COVID-19 infection in PWE is similar to general population.


Asunto(s)
Anticonvulsivantes/administración & dosificación , Epilepsia/terapia , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hospitales Especializados/estadística & datos numéricos , Neurólogos/estadística & datos numéricos , Pacientes Ambulatorios/estadística & datos numéricos , Consulta Remota/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Electroencefalografía/estadística & datos numéricos , Epilepsia/epidemiología , Femenino , Encuestas de Atención de la Salud , Humanos , India/epidemiología , Lactante , Masculino , Persona de Mediana Edad , Adulto Joven
18.
Dig Surg ; 38(2): 158-165, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33640885

RESUMEN

BACKGROUND: This survey aimed to register changes determined by the COVID-19 pandemic on pancreatic surgery in a specific geographic area (Germany, Austria, and Switzerland) to evaluate the impact of the pandemic and obtain interesting cues for the future. METHODS: An online survey was designed using Google Forms focusing on the local impact of the pandemic on pancreatic surgery. The survey was conducted at 2 different time points, during and after the lockdown. RESULTS: Twenty-five respondents (25/56) completed the survey. Many aspects of oncological care have been affected with restrictions and delays: staging, tumor board, treatment selection, postoperative course, adjuvant treatments, outpatient care, and follow-up. Overall, 60% of respondents have prioritized pancreatic cancer patients according to stage, age, and comorbidities, and 40% opted not to operate high-risk patients. However, for 96% of participants, the standards of care were guaranteed. DISCUSSION/CONCLUSIONS: The first wave of the COVID-19 pandemic had an important impact on pancreatic cancer surgery in central Europe. Guidelines for prompt interventions and prevention of the spread of viral infections in the surgical environment are needed to avoid a deterioration of care in cancer patients in the event of a second wave or a new pandemic. High-volume centers for pancreatic surgery should be preferred and their activity maintained. Virtual conferences have proven to be efficient during this pandemic and should be implemented in the near future.


Asunto(s)
/prevención & control , Accesibilidad a los Servicios de Salud/tendencias , Pancreatectomía/tendencias , Neoplasias Pancreáticas/cirugía , Pautas de la Práctica en Medicina/tendencias , Cuidados Posteriores/métodos , Cuidados Posteriores/normas , Cuidados Posteriores/tendencias , Actitud del Personal de Salud , Europa (Continente)/epidemiología , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud/normas , Humanos , Control de Infecciones/métodos , Control de Infecciones/tendencias , Estadificación de Neoplasias , Pancreatectomía/normas , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patología , Pandemias , Aceptación de la Atención de Salud , Atención Perioperativa/métodos , Atención Perioperativa/normas , Atención Perioperativa/tendencias , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Tiempo de Tratamiento/normas , Tiempo de Tratamiento/tendencias
19.
Gynecol Oncol ; 161(1): 236-243, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33526258

RESUMEN

OBJECTIVE: International guidelines recommend pneumococcal pneumonia and influenza vaccination for all patients with solid organ malignancies prior to initiating chemotherapy. Baseline vaccination rates (March 2019) for pneumococcal pneumonia and influenza at our tertiary cancer centre were 8% and 40%, respectively. The aim of this study was to increase the number of gynecologic chemotherapy patients receiving pneumococcal and influenza vaccinations to 80% by March 2020. METHODS: We performed an interrupted time series study using structured quality improvement methodology. Three interventions were introduced to address vaccination barriers: an in-house vaccination program, a staff education campaign, and a patient care bundle (pre-printed prescription, information brochure, vaccine record booklet). Process and outcome data were collected by patient survey and pharmacy audit and analyzed on statistical process control charts. RESULTS: We identified 195 eligible patients. Pneumococcal and influenza vaccination rates rose significantly from 5% to a monthly mean of 61% and from 36% to a monthly mean of 67%, respectively. The 80% target was reached for both vaccines during one or more months of study. The in-house vaccination and staff education programs were major contributors to the improvement, whereas the information brochure and record booklet were minor contributors. CONCLUSIONS: Three interventions to promote pneumococcal and influenza vaccination among chemotherapy patients resulted in significantly improved vaccination rates. Lessons learned about promoting vaccine uptake may be generalizable to different populations and vaccine types. In response to the global COVID-19 pandemic, initiatives to expand the program to all chemotherapy patients at our centre are underway.


Asunto(s)
Neoplasias de los Genitales Femeninos/complicaciones , Programas de Inmunización/organización & administración , Vacunas contra la Influenza , Gripe Humana/prevención & control , Vacunas Neumococicas , Neumonía Neumocócica/prevención & control , Mejoramiento de la Calidad/organización & administración , Instituciones Oncológicas/organización & administración , Femenino , Neoplasias de los Genitales Femeninos/tratamiento farmacológico , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Gripe Humana/etiología , Ontario , Aceptación de la Atención de Salud/estadística & datos numéricos , Neumonía Neumocócica/etiología , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Relaciones Profesional-Paciente , Centros de Atención Terciaria/organización & administración
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