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1.
Phys Med Rehabil Clin N Am ; 32(2): 223-238, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33814054

RESUMEN

With the rapid shift to telemedicine brought on by the COVID-19 pandemic, physiatrists must get accustomed to the new technology and learn how to optimize their evaluations. For those practitioners managing patients with acquired brain injuries, which include stroke and traumatic brain injury, this can seem a daunting task given potential physical and cognitive barriers. However, as the authors discuss techniques to optimize visits, the aim is to illustrate how telehealth appointments can not only be comparable to in-person examinations but also may help increase outreach, compliance, and even satisfaction among this unique population.


Asunto(s)
Lesiones Encefálicas/fisiopatología , Lesiones Encefálicas/terapia , Telemedicina/métodos , /epidemiología , Accesibilidad a los Servicios de Salud , Humanos , Pandemias , Cooperación del Paciente , Satisfacción del Paciente , Examen Físico
2.
Phys Med Rehabil Clin N Am ; 32(2): 239-251, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33814055

RESUMEN

Amyotrophic lateral sclerosis and multiple sclerosis are neurodegenerative diseases requiring interdisciplinary rehabilitation services to maximize function, manage symptoms, prevent complications, and promote higher quality of life. Distance and disability may pose barriers to access of subspecialized care. Telehealth is one solution to facilitate access and was rapidly expanded during the COVID-19 pandemic. This article details the utility of telehealth services across the disease spectrum-including to establish a diagnosis, monitor progression for ongoing management, and identify and manage symptoms and provide therapy interventions. The challenges and promise of telehealth services for clinical care and research will be explored.


Asunto(s)
Esclerosis Amiotrófica Lateral/fisiopatología , Esclerosis Amiotrófica Lateral/terapia , Esclerosis Múltiple/fisiopatología , Esclerosis Múltiple/terapia , Telemedicina/métodos , /epidemiología , Accesibilidad a los Servicios de Salud , Humanos , Pandemias , Grupo de Atención al Paciente , Examen Físico
3.
Phys Med Rehabil Clin N Am ; 32(2): 319-353, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33814061

RESUMEN

Telehealth visits result in high-quality care, with high patient and provider satisfaction. Strong evidence suggests that virtual physical therapy is noninferior to conventional face-to-face physical therapy for a variety of musculoskeletal disorders. Postoperative telerehabilitation has a strong positive effect on clinical outcomes, and the increased intensity telerehabilitation programs offer is a promising option for patients. Studies demonstrate effective virtual postoperative management. The novel coronavirus disease 2019 pandemic has led to improved reimbursement for telehealth visits and accelerated widespread implementation of telemedicine. This article establishes experience and evidence-based practice guidelines for conducting telemedicine visits, with emphasis on the virtual physical examination.


Asunto(s)
Enfermedades Musculoesqueléticas/terapia , Dolor Musculoesquelético/terapia , Examen Físico/métodos , Cuidados Posoperatorios/métodos , Telemedicina/métodos , /epidemiología , Accesibilidad a los Servicios de Salud , Humanos , Enfermedades Musculoesqueléticas/fisiopatología , Dolor Musculoesquelético/fisiopatología , Terapia Ocupacional , Pandemias , Satisfacción del Paciente , Modalidades de Fisioterapia
4.
Phys Med Rehabil Clin N Am ; 32(2): 355-372, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33814062

RESUMEN

Telerehabilitation for pain management uses communication technology to minimize geographic barriers. Access to such technology has proven critically important during the coronavirus disease-2019 pandemic and has been useful for patients with chronic pain disorders unable to travel. The evaluation and treatment of such disorders requires a whole health approach that individualizes treatment options and delivers care through a biopsychosocial approach. The goals of care are unchanged from an in-person patient-provider experience. Telerehabilitation can be successfully implemented in pain management with appropriate consideration for staging an evaluation, a structured approach to the visit, and application of standard clinical metrics.


Asunto(s)
Dolor Crónico/tratamiento farmacológico , Dolor Crónico/rehabilitación , Manejo del Dolor/métodos , Telemedicina/métodos , /epidemiología , Terapia Cognitivo-Conductual , Accesibilidad a los Servicios de Salud , Humanos , Dimensión del Dolor , Pandemias , Examen Físico , Modalidades de Fisioterapia
5.
Emerg Med Clin North Am ; 39(2): 287-305, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33863460

RESUMEN

Delirium is common in older emergency department (ED) patients. Although associated with significant morbidity and mortality, it often goes unrecognized. A consistent approach to evaluation of mental status, including use of validated tools, is key to diagnosing delirium. Identification of the precipitating event requires thorough evaluation, including detailed history, medication reconciliation, physical examination, and medical work-up, for causes of delirium. Management is aimed at identifying and treating the underlying cause. Meaningful improvements in delirium care can be achieved when prevention, identification, and management of older delirious ED patients is integrated by physicians and corresponding frameworks implemented at the health system level.


Asunto(s)
Delirio/diagnóstico , Delirio/terapia , Anciano , Antipsicóticos/uso terapéutico , Benzodiazepinas/uso terapéutico , Causalidad , Delirio/etiología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Servicio de Urgencia en Hospital , Humanos , Anamnesis , Conciliación de Medicamentos , Pruebas Neuropsicológicas , Examen Físico , Agitación Psicomotora , Restricción Física
6.
Emerg Med Clin North Am ; 39(2): 361-378, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33863465

RESUMEN

Older adults are frequently seen in the emergency department for genitourinary complaints, necessitating that emergency physicians are adept at managing a myriad of genitourinary emergencies. Geriatric patients may present with acute kidney injury, hematuria, or a urinary infection and aspects of how managing these presentations differs from their younger counterparts is emphasized. Older adults may also present with acute urinary retention or urinary incontinence as a result of genitourinary pathology or other systemic etiologies. Finally, genital complaints as they pertain to older adults are briefly highlighted with emphasis on emergent management and appropriate referrals.


Asunto(s)
Enfermedades Urogenitales Femeninas/diagnóstico , Enfermedades Urogenitales Masculinas/diagnóstico , Anciano , Antibacterianos/uso terapéutico , Enfermedades Asintomáticas , Maltrato al Anciano/diagnóstico , Urgencias Médicas , Femenino , Enfermedades Urogenitales Femeninas/etiología , Enfermedades Urogenitales Femeninas/terapia , Humanos , Masculino , Enfermedades Urogenitales Masculinas/etiología , Enfermedades Urogenitales Masculinas/terapia , Anamnesis , Conciliación de Medicamentos , Examen Físico , Urinálisis
7.
Artículo en Inglés | MEDLINE | ID: mdl-33807413

RESUMEN

This systematic review aimed to identify thematic elements within definitions of physical and chemical restraint, compare explicit and implicit definitions, and synthesize reliability and validity of studies examining physical and/or chemical restraint use in long-term care. Studies were included that measured prevalence of physical and/or chemical restraint use, or evaluated an intervention to reduce restraint use in long-term care. 86 papers were included in this review, all discussed physical restraint use and 20 also discussed chemical restraint use. Seven themes were generated from definitions including: restraint method, setting resident is restrained in, stated intent, resident capacity to remove/control, caveats and exclusions, duration, frequency or number, and consent and resistance. None of the studies reported validity of measurement approaches. Inter-rater reliability was reported in 27 studies examining physical restraint use, and only one study of chemical restraint. Results were compared to an existing consensus definition of physical restraint, which was found to encompass many of the thematic domains found within explicit definitions. However, studies rarely applied measurement approaches that reflected all of the identified themes of definitions. It is necessary for a consensus definition of chemical restraint to be established and for measurement approaches to reflect the elements of definitions.


Asunto(s)
Cuidados a Largo Plazo , Restricción Física , Consenso , Humanos , Examen Físico , Reproducibilidad de los Resultados
8.
BMC Oral Health ; 21(1): 168, 2021 03 31.
Artículo en Inglés | MEDLINE | ID: mdl-33789655

RESUMEN

BACKGROUND: To evaluate the clinical course and interventions required during two years of follow-up of dental surfaces of deciduous molars diagnosed, and consequently treated, by two different strategies: diagnosis made by clinical examination alone or associated with radiographs. METHODS: This is a secondary analysis of a two-arm randomized clinical trial with parallel groups related to the diagnostic strategy for caries detection in preschool children. 216 children (3-6 years old) were followed-up for two years. All dental surfaces were diagnosed by visual inspection and later, through radiographic assessment. Baseline treatment was made in accordance with the results obtained by visual inspection performed alone or combined with radiographic method, considering the allocated group. Dental surfaces with no restoration needs, or those restored at the beginning of the study were followed-up for two years. The treatment decision was made according to the allocated group. The outcome was the occurrence of failure (a new caries lesion or a restoration replacement) during the follow-up. RESULTS: 4383 proximal and occlusal surfaces of deciduous molars in 216 preschool children were diagnosed and treated according to the abovementioned diagnostic strategies and followed-up for 24 months. The assessment of radiographs made change the initial decision reached by visual inspection in about 30% of the surfaces when all types of interventions were considered. However, most disagreements occurred for initial lesions, where radiographs tended to underestimate them. Discordances between methods occurred in less than 5% of all surfaces when considered lesions requiring operative treatment. For discrepancy cases, the placed interventions guided by following the radiographic results did not present less failures against those made following only visual inspection. As a matter of fact, the use of radiographs in the diagnostic strategy for caries detection in children brought more harms than benefits due to the occurrence of false-positives, overdiagnosis and lead-time bias. CONCLUSIONS: Simultaneous association of visual inspection and radiographic assessment for caries detection in preschool children causes more harms than benefits, and therefore, visual inspection should be conducted alone in the regular clinical practice. Trial registration Clinicaltrials.gov platform: NCT02078453, registered on 5th March 2014.


Asunto(s)
Susceptibilidad a Caries Dentarias , Caries Dental , Niño , Preescolar , Caries Dental/diagnóstico por imagen , Humanos , Uso Excesivo de los Servicios de Salud , Examen Físico , Radiografía , Diente Primario
9.
Asia Pac J Ophthalmol (Phila) ; 10(2): 142-145, 2021 Mar 23.
Artículo en Inglés | MEDLINE | ID: mdl-33793439

RESUMEN

ABSTRACT: Ophthalmologists and patients have an inherent increased risk for transmission of SARS-CoV-2. The human ocular surface expresses receptors and enzymes facilitating transmission of SARS-CoV-2. Personal protective equipment alone provides incomplete protection. Adjunctive topical ocular, nasal, and oral antisepsis with povidone iodine bolsters personal protective equipment in prevention of provider-patient transmission of SARS-CoV-2 in ophthalmology.


Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Desinfección/métodos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Povidona Yodada/uso terapéutico , Administración Oftálmica , Humanos , Soluciones Oftálmicas , Equipo de Protección Personal , Examen Físico
10.
Praxis (Bern 1994) ; 110(5): 237-246, 2021 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-33849294

RESUMEN

CME Sonography 97: Ultrasound Pathologies of the Hip Abstract. Hip pain has a broad differential diagnosis. A clinical examination is not enough to determine the underlying cause. In most cases, sonography helps to narrow the differential diagnosis or to make a specific diagnosis. Furthermore, ultrasound allows a targeted and anatomically precise diagnostic aspiration or therapeutic infiltration. Examples are used to illustrate different pathologies by region.


Asunto(s)
Cadera , Examen Físico , Diagnóstico Diferencial , Cadera/diagnóstico por imagen , Articulación de la Cadera/diagnóstico por imagen , Humanos , Dolor , Ultrasonografía
11.
Vasc Health Risk Manag ; 17: 111-121, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33854321

RESUMEN

Autogenous radial-cephalic direct wrist arteriovenous fistula (RC-AVF) in the non-dominant arm is the gold standard for dialysis vascular access. However, the RC-AVF non-maturation rate is significant (≃ 40%) due to an increasingly elderly and comorbid population incidence. A detailed identification of the biological cascade underlying arteriovenous fistula (AVF) maturation could be the key to clinical research aimed at identify the group of patients at risk of primary AVF failure. Currently, careful post-operative monitoring remains the most crucial aspect to overcome the problem of impaired maturation. Up to 80% of patients with immature RC-AVF have problems potentially solvable with early endovascular or surgical correction. Physical examination by experienced practitioners in conjunction with duplex ultrasound examination (DUS) can identify physical signs of non-maturation, understand the underlying cause, and drive for a tailored early planning to treat the complication. New approaches for the early assessment of AVF maturation are under study. Techniques to promote RC-AVF maturation performed through the administration of pre-or peri-operative drugs have missed up to now to prove an efficacy in improving fistula success. The new techniques tested after surgery appear to hold future promise for improving fistula maturation.


Asunto(s)
Derivación Arteriovenosa Quirúrgica , Oclusión de Injerto Vascular/diagnóstico , Examen Físico , Arteria Radial/cirugía , Ultrasonografía Doppler Dúplex , Grado de Desobstrucción Vascular , Venas/cirugía , Muñeca/irrigación sanguínea , Derivación Arteriovenosa Quirúrgica/efectos adversos , Diagnóstico Precoz , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/fisiopatología , Humanos , Valor Predictivo de las Pruebas , Arteria Radial/diagnóstico por imagen , Arteria Radial/fisiopatología , Diálisis Renal , Factores de Riesgo , Factores de Tiempo , Insuficiencia del Tratamiento , Venas/diagnóstico por imagen , Venas/fisiopatología
12.
Arthroscopy ; 37(4): 1179-1181, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33812521

RESUMEN

As one of the many causes of groin pain, iliopsoas tendinitis can be hard to identify and even harder to treat. It occurs in the setting of both the native hip joint and following total hip arthroplasty. Internal snapping, or coxa saltans, can result from the iliopsoas snapping over the anterior hip capsule or iliopectineal eminence and can be a source of labral pathology. The snapping can be painful or painless. Iliopsoas impingement over total hip components either from the cup or collar of a femoral stem are causes of anterior groin pain. However, there are multiple other causes of groin pain, both intra- and extra-articular, that can make finding the source of the pain difficult. Referred pain from the spine, gynecologic, and gastrointestinal systems can all cause pain in the groin. Core muscle injuries and athletic pubalgia can all cause groin pain and frequently mimic intra-articular hip pathology or iliopsoas tendinopathy. Ultrasound-guided diagnostic injection into the iliopsoas bursa or the juxtaposed hip joint (intra-articular injection) can be helpful in differentiating the source of the pain. Combining a clear history, detailed physical, basic and advanced imaging, as well as diagnostic injection is essential in diagnosing this elusive entity and guiding appropriate treatment.


Asunto(s)
Cadera , Tendinopatía , Femenino , Ingle , Articulación de la Cadera , Humanos , Dolor , Examen Físico , Reproducibilidad de los Resultados
13.
Praxis (Bern 1994) ; 110(6): 301-302, 2021 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-33906437

RESUMEN

CME Sonography 97/Answers: Ultrasound Pathologies of the Hip Abstract. Abstract: Hip pain has a broad differential diagnosis. A clinical examination is not enough to determine the underlying cause. In most cases, sonography helps to narrow the differential diagnosis or to make a specific diagnosis. Furthermore, ultrasound allows a targeted and anatomically precise diagnostic aspiration or therapeutic infiltration. Examples are used to illustrate different pathologies by region.


Asunto(s)
Cadera , Examen Físico , Diagnóstico Diferencial , Cadera/diagnóstico por imagen , Articulación de la Cadera/diagnóstico por imagen , Humanos , Dolor , Ultrasonografía
14.
J Int Med Res ; 49(4): 3000605211006542, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33823638

RESUMEN

Neuralgic amyotrophy (NA) is markedly underdiagnosed in clinical practice, and its actual incidence rate is about 1 per 1000 per year. In the current article, we provide an overview of essential information about NA, including the etiology, clinical manifestations, diagnostic investigations, differential diagnosis, treatment, and prognosis. The causes of NA are multifactorial and include immunological, mechanical, or genetic factors. Typical clinical findings are a sudden onset of pain in the shoulder region, followed by patchy flaccid paralysis of muscles in the shoulder and/or arm. A diagnosis of NA is based on a patient's clinical history and physical examination. Gadolinium-enhanced magnetic resonance imaging and high-resolution magnetic resonance neurography are useful for confirming the diagnosis and choosing the appropriate treatment. However, before a diagnosis of NA is confirmed, other disorders with similar symptoms, such as cervical radiculopathy or rotator cuff tear, need to be ruled out. The prognosis of NA depends on the degree of axonal damage. In conclusion, many patients with motor weakness and pain are encountered in clinical practice, and some of these patients will exhibit NA. It is important that clinicians understand the key features of this disorder to avoid misdiagnosis.


Asunto(s)
Neuritis del Plexo Braquial , Radiculopatía , Neuritis del Plexo Braquial/diagnóstico , Humanos , Imagen por Resonancia Magnética , Examen Físico , Hombro
15.
Artículo en Chino | MEDLINE | ID: mdl-33781044

RESUMEN

To project the basis of occupational health examination quality assessment, and put forward advices for cheking: the quality and safety of occupational health examination, assessment requirements, the key points on-site, utilization of the quality assessment results. Total quality control (TQC) contains basic quality, link quality, final quality and front, middle, back of the quality in occupational health examination.


Asunto(s)
Salud Laboral , Examen Físico , Control de Calidad
17.
JAMA Netw Open ; 4(3): e210667, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33662134

RESUMEN

Importance: Before the widespread implementation of robotic systems to provide patient care during the COVID-19 pandemic occurs, it is important to understand the acceptability of these systems among patients and the economic consequences associated with the adoption of robotics in health care settings. Objective: To assess the acceptability and feasibility of using a mobile robotic system to facilitate health care tasks. Design, Setting, and Participants: This study included 2 components: a national survey to examine the acceptability of using robotic systems to perform health care tasks in a hospital setting and a single-site cohort study of patient experiences and satisfaction with the use of a mobile robotic system to facilitate triage and telehealth tasks in the emergency department (ED). The national survey comprised individuals living in the US who participated in a sampling-based survey via an online analytic platform. Participants completed the national survey between August 18 and August 21, 2020. The single-site cohort study included patients living in the US who presented to the ED of a large urban academic hospital providing quaternary care in Boston, Massachusetts between April and August 2020. All data were analyzed from August to October 2020. Exposures: Participants in the national survey completed an online survey to measure the acceptability of using a mobile robotic system to perform health care tasks (facilitating telehealth interviews, acquiring vital signs, obtaining nasal or oral swabs, placing an intravenous catheter, performing phlebotomy, and turning a patient in bed) in a hospital setting in the contexts of general interaction and interaction during the COVID-19 pandemic. Patients in the cohort study were exposed to a mobile robotic system, which was controlled by an ED clinician and used to facilitate a triage interview. After exposure, patients completed an assessment to measure their satisfaction with the robotic system. Main Outcomes and Measures: Acceptability of the use of a mobile robotic system to facilitate health care tasks in a hospital setting (national survey) and feasibility and patient satisfaction regarding the use of a mobile robotic system in the ED (cohort study). Results: For the national survey, 1154 participants completed all acceptability questions, representing a participation rate of 35%. After sample matching, a nationally representative sample of 1000 participants (mean [SD] age, 48.7 [17.0] years; 535 women [53.5%]) was included in the analysis. With regard to the usefulness of a robotic system to perform specific health care tasks, the response of "somewhat useful" was selected by 373 participants (37.3%) for facilitating telehealth interviews, 350 participants (35.0%) for acquiring vital signs, 307 participants (30.7%) for obtaining nasal or oral swabs, 228 participants (22.8%) for placing an intravenous catheter, 249 participants (24.9%) for performing phlebotomy, and 371 participants (37.1%) for turning a patient in bed. The response of "extremely useful" was selected by 287 participants (28.7%) for facilitating telehealth interviews, 413 participants (41.3%) for acquiring vital signs, 192 participants (19.2%) for obtaining nasal or oral swabs, 159 participants (15.9%) for placing an intravenous catheter, 167 participants (16.7%) for performing phlebotomy, and 371 participants (37.1%) for turning a patient in bed. In the context of the COVID-19 pandemic, the median number of individuals who perceived the application of robotic systems to be acceptable for completing telehealth interviews, obtaining nasal and oral swabs, placing an intravenous catheter, and performing phlebotomy increased. For the ED cohort study, 51 individuals were invited to participate, and 41 participants (80.4%) enrolled. One participant was unable to complete the study procedures because of a signaling malfunction in the robotic system. Forty patients (mean [SD] age, 45.8 [2.7] years; 29 women [72.5%]) completed the mobile robotic system-facilitated triage interview, and 37 patients (92.5%) reported that the interaction was satisfactory. A total of 33 participants (82.5%) reported that their experience of receiving an interview facilitated by a mobile robotic system was as satisfactory as receiving an in-person interview from a clinician. Conclusions and Relevance: In this study, a mobile robotic system was perceived to be acceptable for use in a broad set of health care tasks among survey respondents across the US. The use of a mobile robotic system enabled the facilitation of contactless triage interviews of patients in the ED and was considered acceptable among participants. Most patients in the ED rated the quality of mobile robotic system-facilitated interaction to be equivalent to in-person interaction with a clinician.


Asunto(s)
Prestación de Atención de Salud/métodos , Servicio de Urgencia en Hospital , Hospitales , Atención al Paciente/métodos , Satisfacción del Paciente , Robótica/métodos , Triaje , Adulto , Anciano , Boston , Cateterismo , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Flebotomía , Examen Físico , Encuestas y Cuestionarios , Telemedicina
18.
Artículo en Inglés | MEDLINE | ID: mdl-33671417

RESUMEN

BACKGROUND: Guidelines recommend limiting melanoma screening in a population with known risk factors, but none indicates methods for efficient recruitment. The purpose of this study is to compare three different methods of recruiting subjects to be screened for melanoma to detect which, if any, is the most efficient. METHODS: From 2010 to 2019, subjects were recruited as follows: (1) regular skin examinations (RS), mainly conducted through the Associazione Contro il Melanoma network; (2) occasional melanoma screening (OS), during annual public campaigns; (3) and selective screening (SS), where people were invited to undergo a skin check after filling in a risk evaluation questionnaire, in cases where the assigned outcome was intermediate/high risk. Melanoma risk factors were compared across different screening methods. Generalized Linear Mixed Models were used for multivariable analysis. RESULTS: A total of 2238 subjects (62.7% women) were recruited, median age 44 years (2-85), and 1094 (48.9 %) records were collected through RS, 826 (36.9 %) through OS, and 318 (14.2 %) through SS. A total of 131 suspicious non-melanoma skin cancers were clinically diagnosed, 20 pathologically confirmed, and 2 melanomas detected. SS performed significantly better at selecting subjects with a family history of melanoma and I-II phototypes compared to OS. CONCLUSIONS: Prior evaluation of melanoma known risk factors allowed for effective selection of a population to screen at higher risk of developing a melanoma.


Asunto(s)
Melanoma , Neoplasias Cutáneas , Adulto , Femenino , Humanos , Masculino , Tamizaje Masivo , Melanoma/diagnóstico , Melanoma/epidemiología , Melanoma/prevención & control , Examen Físico , Factores de Riesgo , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/prevención & control
19.
Artículo en Inglés | MEDLINE | ID: mdl-33672158

RESUMEN

(1) Background: Follow-up management of workers' general health examination (WGHE) is important, but it is not currently well done. Chatbot, a type of digital healthcare tool, is used in various medical fields but has never been developed for follow-up management of WGHE in Korea. (2) Methods: The database containing results and explanations related to WGHE was constructed. Then, the channel, which connects users with the database was created. A user survey regarding effectiveness was administered to 23 healthcare providers. Additionally, interviews on applicability for occupational health services were conducted with six nurses in the agency of occupational health management. (3) Results: Chatbot was implemented on a small scale on the Amazon cloud service (AWS) EC2 using KaKaoTalk and Web Chat as user channels. Regarding the effectiveness, 21 (91.30%) rated the need for chatbots as very high; however, 11 (47.83%) rated the usability as not high. Of the 23 participants, 14 (60.87%) expressed overall satisfaction. Nurses appreciated the chatbot program as a method for resolving accessibility and as an aid for explaining examination results and follow-up management. (4) Conclusions: The effectiveness of WGHE and the applicability in the occupational health service of the chatbot program for follow-up management can be confirmed.


Asunto(s)
Salud Laboral , Estudios de Seguimiento , Humanos , Examen Físico , Proyectos Piloto , República de Corea
20.
JAMA Netw Open ; 4(3): e211974, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33764423

RESUMEN

Importance: Breast cancer screening, surveillance, and diagnostic imaging services were profoundly limited during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic. Objective: To develop a risk-based strategy for triaging mammograms during periods of decreased capacity. Design, Setting, and Participants: This population-based cohort study used data collected prospectively from mammography examinations performed in 2014 to 2019 at 92 radiology facilities in the Breast Cancer Surveillance Consortium. Participants included individuals undergoing mammography. Data were analyzed from August 10 to November 3, 2020. Exposures: Clinical indication for screening, breast symptoms, personal history of breast cancer, age, time since last mammogram/screening interval, family history of breast cancer, breast density, and history of high-risk breast lesion. Main Outcomes and Measures: Combinations of clinical indication, clinical history, and breast cancer risk factors that subdivided mammograms into risk groups according to their cancer detection rate were identified using classification and regression trees. Results: The cohort included 898 415 individuals contributing 1 878 924 mammograms (mean [SD] age at mammogram, 58.6 [11.2] years) interpreted by 448 radiologists, with 1 722 820 mammograms in individuals without a personal history of breast cancer and 156 104 mammograms in individuals with a history of breast cancer. Most individuals were aged 50 to 69 years at imaging (1 113 174 mammograms [59.2%]), and 204 305 (11.2%) were Black, 206 087 (11.3%) were Asian or Pacific Islander, 126 677 (7.0%) were Hispanic or Latina, and 40 021 (2.2%) were another race/ethnicity or mixed race/ethnicity. Cancer detection rates varied widely based on clinical indication, breast symptoms, personal history of breast cancer, and age. The 12% of mammograms with very high (89.6 [95% CI, 82.3-97.5] to 122.3 [95% CI, 108.1-138.0] cancers detected per 1000 mammograms) or high (36.1 [95% CI, 33.1-39.3] to 47.5 [95% CI, 42.4-53.3] cancers detected per 1000 mammograms) cancer detection rates accounted for 55% of all detected cancers and included mammograms to evaluate an abnormal mammogram or breast lump in individuals of all ages regardless of breast cancer history, to evaluate breast symptoms other than lump in individuals with a breast cancer history or without a history but aged 60 years or older, and for short-interval follow-up in individuals aged 60 years or older without a breast cancer history. The 44.2% of mammograms with very low cancer detection rates accounted for 13.1% of detected cancers and included annual screening mammograms in individuals aged 50 to 69 years (3.8 [95% CI, 3.5-4.1] cancers detected per 1000 mammograms) and all screening mammograms in individuals younger than 50 years regardless of screening interval (2.8 [95% CI, 2.6-3.1] cancers detected per 1000 mammograms). Conclusions and Relevance: In this population-based cohort study, clinical indication and individual risk factors were associated with cancer detection and may be useful for prioritizing mammography in times and settings of decreased capacity.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Asignación de Recursos para la Atención de Salud/métodos , Mamografía , Tamizaje Masivo/métodos , Pandemias , Triaje/métodos , Anciano , Mama/diagnóstico por imagen , Mama/patología , Estudios de Cohortes , Detección Precoz del Cáncer , Femenino , Humanos , Anamnesis , Persona de Mediana Edad , Examen Físico , Radiología , Factores de Riesgo
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