Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 43.021
Filtrar
1.
Proc Natl Acad Sci U S A ; 118(37)2021 09 14.
Artículo en Inglés | MEDLINE | ID: mdl-34465564

RESUMEN

After the Spanish flu pandemic, it was apparent that airborne transmission was crucial to spreading virus contagion, and research responded by producing several fundamental works like the experiments of Duguid [J. P. Duguid, J. Hyg. 44, 6 (1946)] and the model of Wells [W. F. Wells, Am. J. Hyg. 20, 611-618 (1934)]. These seminal works have been pillars of past and current guidelines published by health organizations. However, in about one century, understanding of turbulent aerosol transport by jets and plumes has enormously progressed, and it is now time to use this body of developed knowledge. In this work, we use detailed experiments and accurate computationally intensive numerical simulations of droplet-laden turbulent puffs emitted during sneezes in a wide range of environmental conditions. We consider the same emission-number of drops, drop size distribution, and initial velocity-and we change environmental parameters such as temperature and humidity, and we observe strong variation in droplets' evaporation or condensation in accordance with their local temperature and humidity microenvironment. We assume that 3% of the initial droplet volume is made of nonvolatile matter. Our systematic analysis confirms that droplets' lifetime is always about one order of magnitude larger compared to previous predictions, in some cases up to 200 times. Finally, we have been able to produce original virus exposure maps, which can be a useful instrument for health scientists and practitioners to calibrate new guidelines to prevent short-range airborne disease transmission.


Asunto(s)
COVID-19/transmisión , Guías como Asunto , Aerosoles , Biología Computacional , Simulación por Computador , Humanos , Exposición por Inhalación , Medición de Riesgo , Estornudo
2.
Bull World Health Organ ; 99(9): 640-652E, 2021 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-34475601

RESUMEN

Objective: To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and middle-income countries. Methods: We systematically searched medical databases and websites of medical societies and contacted international organizations. Country-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation). We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of guidelines and plans for dissemination to target audiences. Findings: We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries. Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development; breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines encompassed detailed implementation plans and socioeconomic considerations. Conclusion: Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions.


Asunto(s)
Guías como Asunto , Accidente Cerebrovascular/terapia , Australia , Isquemia Encefálica , Canadá , Humanos , Accidente Cerebrovascular/prevención & control
3.
BMC Infect Dis ; 21(1): 822, 2021 Aug 16.
Artículo en Inglés | MEDLINE | ID: mdl-34399706

RESUMEN

BACKGROUND: We aimed to determine how emerging evidence over the past decade informed how Ugandan HIV clinicians prescribed protease inhibitors (PIs) in HIV patients on rifampicin-based tuberculosis (TB) treatment and how this affected HIV treatment outcomes. METHODS: We reviewed clinical records of HIV patients aged 13 years and above, treated with rifampicin-based TB treatment while on PIs between1st-January -2013 and 30th-September-2018 from twelve public HIV clinics in Uganda. Appropriate PI prescription during rifampicin-based TB treatment was defined as; prescribing doubled dose lopinavir/ritonavir- (LPV/r 800/200 mg twice daily) and inappropriate PI prescription as prescribing standard dose LPV/r or atazanavir/ritonavir (ATV/r). RESULTS: Of the 602 patients who were on both PIs and rifampicin, 103 patients (17.1% (95% CI: 14.3-20.34)) received an appropriate PI prescription. There were no significant differences in the two-year mortality (4.8 vs. 5.7%, P = 0.318), loss to follow up (23.8 vs. 18.9%, P = 0.318) and one-year post TB treatment virologic failure rates (31.6 vs. 30.7%, P = 0.471) between patients that had an appropriate PI prescription and those that did not. However, more patients on double dose LPV/r had missed anti-retroviral therapy (ART) days (35.9 vs 21%, P = 0.001). CONCLUSION: We conclude that despite availability of clinical evidence, double dosing LPV/r in patients receiving rifampicin-based TB treatment is low in Uganda's public HIV clinics but this does not seem to affect patient survival and viral suppression.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Coinfección/tratamiento farmacológico , Guías como Asunto , Infecciones por VIH/tratamiento farmacológico , Prescripción Inadecuada/prevención & control , Inhibidores de Proteasas/uso terapéutico , Rifampin/uso terapéutico , Tuberculosis/tratamiento farmacológico , Adolescente , Adulto , Anciano , Quimioterapia Combinada , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Inhibidores de la Proteasa del VIH/uso terapéutico , Humanos , Lopinavir/uso terapéutico , Persona de Mediana Edad , Ritonavir/uso terapéutico , Resultado del Tratamiento , Tuberculosis/complicaciones , Tuberculosis/epidemiología , Uganda/epidemiología , Adulto Joven
4.
J Forensic Leg Med ; 82: 102206, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34333249

RESUMEN

Forensic pathologists are not as inclined as their peers in medicine and in the subspecialties of pathology, to use social media for professional reasons. Their reservations generally stem from concerns about respecting their rightful obligations to protect both the decedent's privacy and the integrity of judicial processes. While these are legitimate concerns, they should by no means be considered absolute barriers to participation on social media. The purpose of this paper is to provide clear guidelines on how forensic pathologists should navigate social media and how they could interact with colleagues and members of the public on social media platforms without comprising their integrity, decedent confidentiality or judicial processes.


Asunto(s)
Patologia Forense , Guías como Asunto , Práctica Profesional , Medios de Comunicación Sociales , Humanos
5.
Med Sci Monit ; 27: e934514, 2021 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-34456331

RESUMEN

During 2020 and 2021, the COVID-19 pandemic has resulted in interruptions and cancellations of clinical trials and has delayed drug development in all areas except SARS-CoV-2 vaccine development. A further concern is the need to rapidly share anonymized datasets and improve opportunities to conduct randomized clinical trials (RCTs) in low-resource developing countries, particularly for oncology trials and for other infectious diseases. The Consolidated Standards of Reporting Trials (CONSORT) 2010 and the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 currently guide the reporting of trial protocols and completed RCTs, respectively. Extenuating circumstances or unavoidable situations may occur that are beyond the control of study sponsors and investigators. On June 21, 2021, the CONSORT and SPIRIT Extension for RCTs Revised in Extenuating Circumstance (CONSERVE) was published. The scope of CONSERVE 2021 includes modifications that have substantive implications for the feasibility, ethical conduct, scientific content, and study analysis. This Editorial aims to provide the background to CONSERVE 2021 and show how these guidelines may reduce the number of clinical trials currently being paused or discontinued due to the COVID-19 pandemic, particularly in poorly resourced and developing countries.


Asunto(s)
COVID-19/epidemiología , Protocolos Clínicos/normas , Guías como Asunto , Edición/normas , Ensayos Clínicos Controlados Aleatorios como Asunto/normas , Informe de Investigación/normas , SARS-CoV-2/fisiología , COVID-19/virología , Humanos , Estados Unidos/epidemiología
6.
Am J Nurs ; 121(9): 66-69, 2021 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-34438436

RESUMEN

ABSTRACT: It's important to be aware of the signs and symptoms of mental illness and to take action to ensure people experiencing mental health problems receive the assistance and treatment they need. For nurses, this is as true at home as it is at work, particularly so when a person is exhibiting aggressive tendencies or other behaviors that could potentially lead to harm. With the COVID-19 crisis leading many family members to live more closely together for extended periods, nurses should be able to identify concerning behaviors and know what to do if they observe these in their loved ones.


Asunto(s)
Trastornos Mentales/prevención & control , Salud Mental , Diagnóstico Precoz , Familia , Guías como Asunto , Conocimientos, Actitudes y Práctica en Salud , Humanos
7.
AANA J ; 89(4): 281-282, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34342564

RESUMEN

In a series of commentaries in recent issues of the New England Journal of Medicine, potential bias in pulse oximetry has been questioned.


Asunto(s)
Técnicas de Laboratorio Clínico/normas , Guías como Asunto , Oximetría/normas , Racismo , Humanos , Estados Unidos
8.
Prof Case Manag ; 26(5): 250-254, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34397654

RESUMEN

PURPOSE: To review current literature on texting as a sustainable intervention of case management in the outpatient setting. FINDINGS: Texting, as a case management intervention, provides the medically complex client with a pathway to achieve care plan goals. Texting increases adherence, communication, and self-management. It can increase client enrollment in disease management programs, while providing support, flexibility, convenience, cost savings, and increased participation. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: In current practice, such as management of the coronavirus (COVID-19), other pandemics, or natural/environmental disasters, texting is a solution-focused intervention that can deliver and retrieve real-time information to a medically complex population. It can link patients to resources and increase outreach, efficiency, quality, and coordination of care. Texting can promote adherence to appointments, increase medication compliance and disease management interventions, and provide motivational change messages. However, there are legal and regulatory concerns that carry potential consequences and implications that should be approached judiciously (Mellette, 2015). Texting is not one size fits all; it can cause HIPAA breeches, hinder communication with certain populations, confuse health messaging, and replace human communication, thereby reducing staffing in practice.


Asunto(s)
Atención Ambulatoria/normas , Manejo de Caso/normas , Comunicación , Guías como Asunto , Health Insurance Portability and Accountability Act/normas , Telemedicina/normas , Envío de Mensajes de Texto/normas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos
11.
Cochrane Database Syst Rev ; 7: CD012944, 2021 07 27.
Artículo en Inglés | MEDLINE | ID: mdl-34314020

RESUMEN

BACKGROUND: The ubiquity of mobile devices has made it possible for clinical decision-support systems (CDSS) to become available to healthcare providers on handheld devices at the point-of-care, including in low- and middle-income countries. The use of CDSS by providers can potentially improve adherence to treatment protocols and patient outcomes. However, the evidence on the effect of the use of CDSS on mobile devices needs to be synthesized. This review was carried out to support a World Health Organization (WHO) guideline that aimed to inform investments on the use of decision-support tools on digital devices to strengthen primary healthcare. OBJECTIVES: To assess the effects of digital clinical decision-support systems (CDSS) accessible via mobile devices by primary healthcare providers in the context of primary care settings. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, Global Index Medicus, POPLINE, and two trial registries from 1 January 2000 to 9 October 2020. We conducted a grey literature search using mHealthevidence.org and issued a call for papers through popular digital health communities of practice. Finally, we conducted citation searches of included studies. SELECTION CRITERIA: Study design: we included randomized trials, including full-text studies, conference abstracts, and unpublished data irrespective of publication status or language of publication.  Types of participants: we included studies of all cadres of healthcare providers, including lay health workers and other individuals (administrative, managerial, and supervisory staff) involved in the delivery of primary healthcare services using clinical decision-support tools; and studies of clients or patients receiving care from primary healthcare providers using digital decision-support tools. Types of interventions: we included studies comparing digital CDSS accessible via mobile devices with non-digital CDSS or no intervention, in the context of primary care. CDSS could include clinical protocols, checklists, and other job-aids which supported risk prioritization of patients. Mobile devices included mobile phones of any type (but not analogue landline telephones), as well as tablets, personal digital assistants, and smartphones. We excluded studies where digital CDSS were used on laptops or integrated with electronic medical records or other types of longitudinal tracking of clients. DATA COLLECTION AND ANALYSIS: A machine learning classifier that gave each record a probability score of being a randomized trial screened all search results. Two review authors screened titles and abstracts of studies with more than 10% probability of being a randomized trial, and one review author screened those with less than 10% probability of being a randomized trial. We followed standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care group. We used the GRADE approach to assess the certainty of the evidence for the most important outcomes. MAIN RESULTS: Eight randomized trials across varying healthcare contexts in the USA,. India, China, Guatemala, Ghana, and Kenya, met our inclusion criteria. A range of healthcare providers (facility and community-based, formally trained, and lay workers) used digital CDSS. Care was provided for the management of specific conditions such as cardiovascular disease, gastrointestinal risk assessment, and maternal and child health. The certainty of evidence ranged from very low to moderate, and we often downgraded evidence for risk of bias and imprecision. We are uncertain of the effect of this intervention on providers' adherence to recommended practice due to the very low certainty evidence (2 studies, 185 participants). The effect of the intervention on patients' and clients' health behaviours such as smoking and treatment adherence is mixed, with substantial variation across outcomes for similar types of behaviour (2 studies, 2262 participants). The intervention probably makes little or no difference to smoking rates among people at risk of cardiovascular disease but probably increases other types of desired behaviour among patients, such as adherence to treatment. The effect of the intervention on patients'/clients' health status and well-being  is also mixed (5 studies, 69,767 participants). It probably makes little or no difference to some types of health outcomes, but we are uncertain about other health outcomes, including maternal and neonatal deaths, due to very low-certainty evidence. The intervention may slightly improve patient or client acceptability and satisfaction (1 study, 187 participants). We found no studies that reported the time between the presentation of an illness and appropriate management, provider acceptability or satisfaction, resource use, or unintended consequences. AUTHORS' CONCLUSIONS: We are uncertain about the effectiveness of mobile phone-based decision-support tools on several outcomes, including adherence to recommended practice. None of the studies had a quality of care framework and focused only on specific health areas.   We need well-designed research that takes a systems lens to assess these issues.


Asunto(s)
Teléfono Celular , Sistemas de Apoyo a Decisiones Clínicas , Atención Primaria de Salud , Mejoramiento de la Calidad , Calidad de la Atención de Salud , Sesgo , Adhesión a Directriz , Guías como Asunto , Conductas Relacionadas con la Salud , Personal de Salud , Estado de Salud , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto
12.
Lancet Infect Dis ; 21(8): e209-e221, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34331890

RESUMEN

Health-care-associated infections are the most prevalent adverse events of hospital care, posing a substantial threat to patient safety and burden on society. Hand hygiene with alcohol-based hand rub is the most effective preventive strategy to reduce health-care-associated infections. Over the past two decades, various interventions have been introduced and studied to improve hand hygiene compliance among health-care workers. The global implementation of the WHO multimodal hand hygiene improvement strategy and constant efforts to replace the use of soap and water with alcohol-based hand rub have led to a faster and more efficient hand cleaning method. These strategies have strongly contributed to the success of behaviour change and a subsequent decrease in health-care-associated infections and cross-transmission of multidrug-resistant organisms worldwide. The WHO multimodal behaviour change strategy requires a series of elements including system change as a prerequisite for behaviour, change, education, monitoring and performance feedback, reminders in the workplace, and an institutional safety climate. Successful adoption of the promotion strategy requires adaptation to available resources and sociocultural contexts. This Review focuses on the major advances and challenges in hand hygiene research and practices in the past 20 years and sets out various ways forward for improving this lifesaving action.


Asunto(s)
COVID-19/prevención & control , Infección Hospitalaria/prevención & control , Higiene de las Manos/historia , Personal de Salud , Publicaciones/estadística & datos numéricos , Adhesión a Directriz , Guías como Asunto , Desinfección de las Manos/métodos , Higiene de las Manos/tendencias , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Control de Infecciones/métodos , Investigación/tendencias
13.
BMJ Health Care Inform ; 28(1)2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34301725

RESUMEN

OBJECTIVES: Patients with COVID-19 can present to the emergency department (ED) without immediate indication for admission, but with concern for decompensation. Clinical experience has demonstrated that critical illness may present later in the disease course and hypoxia is often the first indication of disease progression. The objectives of this study are to (a) assess feasibility and describe a protocol for ED-based outpatient pulse-oximetry monitoring with structured follow-up and (b) determine rates of ED return, hospitalisation and hypoxia among participants. METHODS: Prospective observational study of patients presenting to a single academic ED in Boston with suspected COVID-19. Eligible patients were adults being discharged from the ED with presumed COVID-19. Exclusion criteria included resting oxygen saturation <92%, ambulatory oxygen saturation <90%, heart rate >110 beats per minute or inability to use the device. Study personnel made scripted phone calls on postdischarge days 1, 3 and 7 to review the pulse-oximetry readings and to evaluate for decompensation. Return visit and admission information were collected via medical record and 28-day follow-up calls. RESULTS: 81 patients were enrolled of which 10 (12%) developed hypoxia after their initial discharge from the ED. Overall, 23 (28%) of the 81 patients returned to the ED at least once and 10 of those who returned (43%) were admitted. We successfully contacted 76/81 (94%) of subjects via phone at least once for follow-up assessment. DISCUSSION: Patients are eager and willing to participate in home monitoring systems and are comfortable with using technology, which will allow providers and health systems to extend our hospitals capabilities for tracking patient populations in times of crisis. CONCLUSIONS: It is feasible to implement an outpatient pulse-oximetry monitoring protocol to monitor patients discharged from the ED with confirmed or suspected COVID-19.


Asunto(s)
COVID-19/terapia , Servicio de Urgencia en Hospital , Guías como Asunto , Monitoreo Fisiológico , Oximetría , Alta del Paciente , Cuidados Posteriores , Boston , Femenino , Hospitalización , Humanos , Hipoxia/etiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Telemedicina
15.
Methods Mol Biol ; 2341: 103-116, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34264466

RESUMEN

Developments in mass spectrometry have made it possible to identify individual biomolecules in complex samples. This has led to advances in the detection and quantification of both extracellular and intracellular metabolites, such as amino acids, organic acids, fatty acids, nucleotides, and CoA-esters from growth media and cellular extracts. However, the reproducibility of metabolite data can be problematic if the concentrations and/or stability of metabolites fluctuate during culture harvesting and processing. Herein we describe a standardized and efficient collection protocol and best practices for preservation and harvesting of Staphylococcus aureus cellular and supernatant samples to improve reproducibility, reliability, and consistency in mass-spectrometry-based metabolite data sets.


Asunto(s)
Metabolómica/métodos , Staphylococcus aureus/crecimiento & desarrollo , Aerobiosis , Guías como Asunto , Espectrometría de Masas , Staphylococcus aureus/metabolismo
16.
GMS J Med Educ ; 38(5): Doc88, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34286068

RESUMEN

Introduction: In Germany, foreign physicians are a fixed component of the medical profession. According to the German Medical Licensure Act, physicians having completed their qualification in another country are required to pass a knowledge examination which falls within the competence of examination offices or the regional governments. Project outline: The preparatory course consists of 10 modules. On Fridays, individual cases are discussed in small groups and specific examination techniques are trained. On Saturdays, illnesses are simulated by simulated patients. After each encounter, faculty experts, psychologists and peer group members provide the participants with 360° feedback. Due to the COVID-19 pandemic, the course which had been established 2 years beforehand has now been switched to an online class within one week. Friday units were visualized in power-point presentations and tutorial videos were discussed. On Saturdays, the cases were simulated by simulated patients and transmitted via a telemedicine platform. Results: The course could be conducted without interruptions (75 hours of in-class tuition and 75 hours of online tuition). In the oral evaluation the participants criticized telemedicine as a medium for imparting of practical skills. 7/22 (32%) of the participants underwent the knowledge examination and 6/7 (86%) of them passed it (versus 18/19 of the participants of in-class tuition (95%)). Discussion: There was a clear preference for in-class tuition. It was noted that the telemedical setting entailed some restrictions. However, the switch to online classes did not affect the pass rate. Conclusion: The switch from in-class to online units was feasible. The gained insights were taken into account when conceiving the online semester at our faculty and especially the tuition with the support of simulated patients.


Asunto(s)
COVID-19 , Curriculum , Educación Médica , Médicos Graduados Extranjeros , Internet , Licencia Médica , Pandemias , Competencia Clínica , Evaluación Educacional , Alemania , Guías como Asunto , Humanos , Distanciamiento Físico , Facultades de Medicina , Estaciones del Año
17.
Int J Equity Health ; 20(1): 166, 2021 07 16.
Artículo en Inglés | MEDLINE | ID: mdl-34271933

RESUMEN

BACKGROUND: The COVID-19 pandemic has uncovered the ways in which disabled people are made more vulnerable due to structural inequalities. These vulnerabilities are the result of the interaction between individual and structural factors that shape how risk is experienced by disabled people. In Australia, these vulnerabilities are influenced by the way disability services and care for disabled people are delivered through a consumer-directed approach. We analysed the policies and documentation made by the Australian Government and state and territory governments during the pandemic to explore whether these were disability-inclusive. We aimed to unpack how these policies shaped disabled people as vulnerable citizens. METHODS: Guided by documentary research, we used framework analysis to examine the policies of the Australian Government and state and territory governments. We analysed legislation that was given royal assent by the federal, state and territory governments, and documents (reports, fact sheets, guidance documents, etc.) published by the federal government and the state of Victoria (given that this state experienced the brunt of the epidemic in Australia) between February 2020 to August of 2020. RESULTS: We found that most of the resources were not aimed at disabled people, but at carers and workers within disability services. In addition, most policies formulated by the Australian Government were related to the expansion of welfare services and the creation of economic stimulus schemes. However, while the stimulus included unemployed people, the expansion of benefits explicitly excluded disabled people who were not employed. Most of the legislation and documents offered accessibility options, though most of these options were only available in English. Disability oriented agencies offered more extensive accessibility options. CONCLUSIONS: The findings indicate a large number of documents addressing the needs of disabled people. However, disability-inclusiveness appeared to be inconsistent and not fully considered, leaving disabled people exposed to greater risk of COVID-19. Neoliberal policies in the health and welfare sector in Australia have led to an individualisation of the responsibility to remain healthy and a reliance on people as independent consumers. Governments need to take a clear stance towards the emergence of such a discourse that actively disvalues disabled people.


Asunto(s)
COVID-19/epidemiología , Personas con Discapacidad , Gobierno , Pandemias , Políticas , Australia/epidemiología , Guías como Asunto , Humanos , Medición de Riesgo , Poblaciones Vulnerables
18.
JAMA Netw Open ; 4(7): e2116543, 2021 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-34287634

RESUMEN

Importance: Detailed analysis of infection rates paired with behavioral and employee-reported risk factors is vital to understanding how transmission of SARS-CoV-2 infection may be exacerbated or mitigated in the workplace. Institutions of higher education are heterogeneous work units that supported continued in-person employment during the COVID-19 pandemic, providing a test site for occupational health evaluation. Objective: To evaluate the association between self-reported protective behaviors and prevalence of SARS-CoV-2 infection among essential in-person employees during the first 6 months of the COVID-19 pandemic in the US. Design, Setting, and Participants: This cross-sectional study was conducted from July 13 to September 2, 2020, at an institution of higher education in Fort Collins, Colorado. Employees 18 years or older without symptoms of COVID-19 who identified as essential in-person workers during the first 6 months of the pandemic were included. Participants completed a survey, and blood and nasal swab samples were collected to assess active SARS-CoV-2 infection via quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) and past infection by serologic testing. Exposure: Self-reported practice of protective behaviors against COVID-19 according to public health guidelines provided to employees. Main Outcomes and Measures: Prevalence of current SARS-CoV-2 infection detected by qRT-PCR or previous SARS-CoV-2 infection detected by an IgG SARS-CoV-2 testing platform. The frequency of protective behavior practices and essential workers' concerns regarding contracting COVID-19 and exposing others were measured based on survey responses. Results: Among 508 participants (305 [60.0%] women, 451 [88.8%] non-Hispanic White individuals; mean [SD] age, 41.1 [12.5] years), there were no qRT-PCR positive test results, and only 2 participants (0.4%) had seroreactive IgG antibodies. Handwashing and mask wearing were reported frequently both at work (480 [94.7%] and 496 [97.8%] participants, respectively) and outside work (465 [91.5%] and 481 [94.7%] participants, respectively). Social distancing was reported less frequently at work (403 [79.5%]) than outside work (465 [91.5%]) (P < .001). Participants were more highly motivated to avoid exposures because of concern about spreading the infection to others (419 [83.0%]) than for personal protection (319 [63.2%]) (P < .001). Conclusions and Relevance: In this cross-sectional study of essential workers at an institution of higher education, when employees reported compliance with public health practices both at and outside work, they were able to operate safely in their work environment during the COVID-19 pandemic.


Asunto(s)
COVID-19 , Pandemias , Salud Pública , SARS-CoV-2 , Conducta Social , Universidades , Lugar de Trabajo , Adulto , COVID-19/sangre , COVID-19/prevención & control , COVID-19/transmisión , COVID-19/virología , Prueba de COVID-19 , Colorado , Control de Enfermedades Transmisibles , Estudios Transversales , Femenino , Guías como Asunto , Humanos , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Salud Laboral , Reacción en Cadena de la Polimerasa , SARS-CoV-2/crecimiento & desarrollo , SARS-CoV-2/inmunología , Autoinforme
19.
Mayo Clin Proc ; 96(8): 2205-2217, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34226025

RESUMEN

Clinicians regularly have to trade benefits and harms to choose between testing and treatment strategies. This process is often done by making global and implicit judgments. A decision analysis is an analytic method that makes this process more explicit, reproducible, and evidence-based. While clinicians are unlikely to conduct their own decision analysis, they will read publications of such analyses or use guidelines based on them. This review outlines the anatomy of a decision tree and provides clinicians with the tools to critically appraise a decision analysis and apply its results to medical decision making. Clinicians reading about a decision analysis can make two judgments. The first judgment is about the credibility of the methods, such as whether the decision analysis addressed a relevant clinical question, included all important outcomes, used the current best evidence to derive variables in the model, and adopted the appropriate time horizon. The second judgment is about rating confidence in the preferred course of action by determining the certainty in the model variables, whether the results are robust in sensitivity analyses and if the results are applicable to a specific patient. Results from a valid and robust decision analysis can inform both guideline panels and the patient-clinician dyad engaged in shared decision-making.


Asunto(s)
Toma de Decisiones Clínicas/métodos , Medicina Basada en la Evidencia/métodos , Guías como Asunto , Participación del Paciente/métodos , Humanos
20.
Gac Med Mex ; 157(2): 201-206, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34270538

RESUMEN

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is the cause of the coronavirus disease 2019 (COVID-19) pandemic, which has a high case fatality rate. Most severely ill patients develop a special type of coagulopathy that had not been described before and that is now considered the main cause of death. For this reason, anticoagulant treatment has become one of the cornerstones of the treatment of this infection. However, the rate at which the evidence regarding the use of anticoagulants is generated is quite fast, and sometimes it is difficult to interpret and conflicting. After having performed an extensive review of the published literature, this proposal for the use of anticoagulant treatment is made, taking into account available resources in Mexico.


Asunto(s)
Anticoagulantes/uso terapéutico , Trastornos de la Coagulación Sanguínea/etiología , Trastornos de la Coagulación Sanguínea/terapia , COVID-19/complicaciones , Adulto , Algoritmos , Trastornos de la Coagulación Sanguínea/prevención & control , Guías como Asunto , Humanos , México
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...