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1.
Medicine (Baltimore) ; 100(22): e25833, 2021 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-34087826

RESUMEN

ABSTRACT: The current status of the diagnosis and management of poststroke aphasia (PSA) in China is unknown.To analyze the physicians' strategy and knowledge about the management of PSA in clinical practice and the needs for standardization of diagnosis and treatment.This survey was conducted in March-August 2019 at 32 tertiary hospitals in 16 provinces/municipalities in China. The attending physicians from the Neurology and Neuro-rehabilitation/Rehabilitation Departments were included. The online questionnaire inquired about patient information, physicians' diagnosis and treatment behavior for PSA, and physicians' understanding of PSA.A total of 236 physicians completed the survey. Regarding PSA assessment, 99.2% of the physicians reported using medical history and physical examination, 93.2% reported using neuroimaging, and 76.3% reported using dedicated scales. Most physicians used a combination of drug and non-drug treatment. Neuro-regenerators/cerebral activators and anti-dementia drugs were the most common pharmacotherapies; butylphthalide, edaravone, and memantine were most frequently prescribed. Six months poststroke was rendered as a spontaneous language recovery period, and a ≥6-month treatment for PSA was suggested by many physicians. The lack of standardized treatment regimen/clinical guidelines and the limited number of approved drugs for PSA were the primary challenges encountered by physicians during practice. The majority of the physicians agreed with the necessity of guidelines or consensus for the diagnosis and treatment of PSA.The knowledge gaps exist among physicians in China regarding the assessment and management of PSA. The improved awareness of the available guidelines/consensus could improve the performance of the physicians.


Asunto(s)
Afasia/etiología , Afasia/terapia , Conocimientos, Actitudes y Práctica en Salud , Médicos/estadística & datos numéricos , Accidente Cerebrovascular/complicaciones , Afasia/diagnóstico , Afasia/rehabilitación , China , Inhibidores de la Colinesterasa/uso terapéutico , Humanos , Fármacos Neuroprotectores/uso terapéutico , Médicos/psicología , Pautas de la Práctica en Medicina
2.
Isr J Health Policy Res ; 10(1): 34, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-34074319

RESUMEN

BACKGROUND: Telemedicine has become an integral part of health care delivery in recent years. One of the leading applications for this use is WhatsApp - a free smartphone application that allows instant messaging with pictures and videos. This study analyzed the emerging role of WhatsApp on reducing the need for referrals to medical specialists and to compare the views of physicians regarding WhatsApp consultations. METHODS: A cross-sectional study based on an anonymous web-survey was conducted among PCPs and medical specialists working in the Israel Defense Forces Medical-Corps during September and October, 2019. RESULTS: Of 201 participants, 153 were PCPs and 48 were medical specialists. 86.9 % of PCPs and 86.5 % of specialists used WhatsApp every day in professional settings. Added workload, potential breaching of patient confidentiality and lack of full documentation of consultations were the main concerns among physicians using the application. 60.7 % of PCPs and 95.7 % of specialists stated that these consultations have reduced the need for in-person appointments at least once a week. CONCLUSIONS: In times of COVID-19 that require social distancing, WhatsApp provides a simple, readily available platform for consultations between healthcare providers, even to the extent of rendering some in-person appointments unnecessary. Healthcare organizations should address the matters troubling healthcare providers, mainly patient confidentiality and lack of documentation in patients' medical records, while providing adequate compensation for those providing the service during and after work hours.


Asunto(s)
COVID-19 , Aplicaciones Móviles , Médicos/estadística & datos numéricos , Telemedicina/métodos , Adulto , Estudios Transversales , Atención a la Salud/métodos , Femenino , Humanos , Israel , Masculino , Persona de Mediana Edad , Derivación y Consulta/estadística & datos numéricos , Teléfono Inteligente , Encuestas y Cuestionarios
3.
Curr Opin Psychiatry ; 34(4): 413-419, 2021 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-34001698

RESUMEN

PURPOSE OF REVIEW: The COVID-19 outbreak has had major impact on individual's psychological health and overall well being worldwide. Evidence shows that these psychological challenges are especially prominent in healthcare workers (HCW); especially in nurses. Indeed, several studies report that nurses suffer more psychologically because of the consequences of the pandemic compared with medical doctors. To further look into this, we systematically review the recent literature to see whether the psychological impact of the COVID-19 pandemic differs between medical doctors and nurses across studies and which aspects of mental health are especially affected in nurses. RECENT FINDINGS: Across studies, there is solid evidence that nurses show poorer mental health outcomes compared with medical doctors during the COVID-19 pandemic. This is especially true for symptoms of depression, anxiety and posttraumatic stress disorder (PTSD). Here, prevalence rates in nurses are often higher than 50%. In contrast, general stress levels and burnout seem to be comparable between nurses and medical doctors. SUMMARY: Given that nurses suffer more from depression, anxiety and PTSD symptoms during the COVID-19 pandemic, special programs addressing their needs are required.


Asunto(s)
COVID-19/psicología , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Enfermeras y Enfermeros/psicología , Médicos/psicología , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Humanos , Enfermeras y Enfermeros/estadística & datos numéricos , Pandemias , Médicos/estadística & datos numéricos , Prevalencia , SARS-CoV-2
4.
Int J Occup Med Environ Health ; 34(2): 189-201, 2021 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-33843941

RESUMEN

OBJECTIVES: The aim of the study was to evaluate the clinical presentation and burden of SARS-CoV-2 infections among medical school physicians and residents, mainly young medical doctors. The awareness of COVID­19 clinical manifestations can improve the early detection of mild cases, possibly reducing further transmission to colleagues and patients. MATERIAL AND METHODS: The study was carried out in March-May 2020, involving medical school physicians in a teaching hospital in northern Italy, with a working population of 881 medical doctors. Data collection was performed using a structured form investigating clinical and epidemiological information. RESULTS: One hundred sixty-two medical doctors contacted the Occupational Health Service reporting acute respiratory symptoms or close contact exposure to a confirmed COVID­19 case. Among the confirmed COVID­19 cases, most were male doctors during residency, and 85% presented a mild clinical picture. Fever (70.3%) and cough (51.4%) represented the most prevalent symptoms of COVID­19. As revealed by the univariate analysis, the prevalence of real-time reverse transcriptase-polymerase chain reaction (RT-PCR) positivity increased with age (OR = 1.08, 95% CI: 1.02-1.14, p = 0.012), working in a COVID­19 ward (OR = 3.33, 95% CI: 1.09-10.21, p = 0.031), presenting alteration or loss of smell/taste (OR = 10.00, 95%CI: 2.80-35.69, p < 0.001) and myalgia (OR = 3.20, 95% CI: 1.00-10.26, p = 0.046), while being a resident (OR = 0.20, 95% CI: 0.05-0.80, p = 0.030) was associated with reduced odds of being infected, compared to staff physicians. Age and loss of smell/taste were the only factors independently associated with RT-PCR positivity. CONCLUSIONS: The majority of COVID­19 cases showed a mild clinical syndrome, ranging from absence or paucity of symptoms to common cold or influenza-like symptoms. The findings of the present study increase the accuracy of the clinical diagnosis for the prompt identification and management of suspected COVID­19 cases, being particularly useful during resurges of the SARS-CoV-2 pandemic. Int J Occup Med Environ Health. 2021;34(2):189-201.


Asunto(s)
COVID-19/epidemiología , Hospitales de Enseñanza/estadística & datos numéricos , Internado y Residencia/estadística & datos numéricos , Pandemias , Médicos/estadística & datos numéricos , SARS-CoV-2 , Facultades de Medicina/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Italia/epidemiología , Masculino , Adulto Joven
5.
BMC Pregnancy Childbirth ; 21(1): 302, 2021 Apr 14.
Artículo en Inglés | MEDLINE | ID: mdl-33853540

RESUMEN

BACKGROUND: Vacuum-assisted birth is not widely practiced in Tanzania but efforts to re-introduce the procedure suggest some success. Few studies have targeted childbirth attendants to learn how their perceptions of and training experiences with the procedure affect practice. This study explores a largely rural cohort of health providers to determine associations between recent practice of the procedure and training, individual and contextual factors. METHODS: A cross-sectional knowledge, attitudes and practice survey of 297 providers was conducted in 2019 at 3 hospitals and 12 health centers that provided comprehensive emergency obstetric care. We used descriptive statistics and binary logistic regression to model the probability of having performed a vacuum extraction in the last 3 months. RESULTS: Providers were roughly split between working in maternity units in hospitals and health centers. They included: medical doctors, assistant medical officers (14%); clinical officers (10%); nurse officers, assistant nurse officers, registered nurses (32%); and enrolled nurses (44%). Eighty percent reported either pre-service, in-service vacuum extraction training or both, but only 31% reported conducting a vacuum-assisted birth in the last 3 months. Based on 11 training and enabling factors, a positive association with recent practice was observed; the single most promising factor was hands-on solo practice during in-service training (66% of providers with this experience had conducted vacuum extraction in the last 3 months). The logistic regression model showed that providers exposed to 7-9 training modalities were 7.8 times more likely to have performed vacuum extraction than those exposed to fewer training opportunities (AOR = 7.78, 95% CI: 4.169-14.524). Providers who worked in administrative councils other than Kigoma Municipality were 2.7 times more likely to have conducted vacuum extraction than their colleagues in Kigoma Municipality (AOR = 2.67, 95% CI: 1.023-6.976). Similarly, providers posted in a health center compared to those in a hospital were twice as likely to have conducted a recent vacuum extraction (AOR = 2.11, 95% CI: 1.153-3.850), and finally, male providers were twice as likely as their female colleagues to have performed this procedure recently (AOR = 1.95, 95% CI: 1.072-3.55). CONCLUSIONS: Training and location of posting were associated with recent practice of vacuum extraction. Multiple training modalities appear to predict recent practice but hands-on experience during training may be the most critical component. We recommend a low-dose high frequency strategy to skills building with simulation and e-learning. A gender integrated approach to training may help ensure female trainees are exposed to critical training components.


Asunto(s)
Competencia Clínica/estadística & datos numéricos , Partería/estadística & datos numéricos , Médicos/estadística & datos numéricos , Extracción Obstétrica por Aspiración/estadística & datos numéricos , Adulto , Instrucción por Computador , Estudios Transversales , Educación Médica Continua , Femenino , Humanos , Masculino , Persona de Mediana Edad , Partería/educación , Embarazo , Entrenamiento Simulado , Tanzanía , Extracción Obstétrica por Aspiración/educación , Adulto Joven
6.
Emerg Med J ; 38(6): 450-459, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33832926

RESUMEN

OBJECTIVE: To quantify psychological distress experienced by emergency, anaesthetic and intensive care doctors during the acceleration phase of COVID-19 in the UK and Ireland. METHODS: Initial cross-sectional electronic survey distributed during acceleration phase of the first pandemic wave of COVID-19 in the UK and Ireland (UK: 18 March 2020-26 March 2020 and Ireland: 25 March 2020-2 April 2020). Surveys were distributed via established specialty research networks, within a three-part longitudinal study. Participants were doctors working in emergency, anaesthetic and intensive medicine during the first pandemic wave of COVID-19 in acute hospitals across the UK and Ireland. Primary outcome measures were the General Health Questionnaire-12 (GHQ-12). Additional questions examined personal and professional characteristics, experiences of COVID-19 to date, risk to self and others and self-reported perceptions of health and well-being. RESULTS: 5440 responses were obtained, 54.3% (n=2955) from emergency medicine and 36.9% (n=2005) from anaesthetics. All levels of doctor seniority were represented. For the primary outcome of GHQ-12 score, 44.2% (n=2405) of respondents scored >3, meeting the criteria for psychological distress. 57.3% (n=3045) had never previously provided clinical care during an infectious disease outbreak but over half of respondents felt somewhat prepared (48.6%, n=2653) or very prepared (7.6%, n=416) to provide clinical care to patients with COVID-19. However, 81.1% (n=4414) either agreed (31.1%, n=2709) or strongly agreed (31.1%, n=1705) that their personal health was at risk due to their clinical role. CONCLUSIONS: Findings indicate that during the acceleration phase of the COVID-19 pandemic, almost half of frontline doctors working in acute care reported psychological distress as measured by the GHQ-12. Findings from this study should inform strategies to optimise preparedness and explore modifiable factors associated with increased psychological distress in the short and long term. TRIAL REGISTRATION NUMBER: ISRCTN10666798.


Asunto(s)
COVID-19/epidemiología , Medicina de Emergencia/estadística & datos numéricos , Estrés Laboral/epidemiología , Médicos/estadística & datos numéricos , Adulto , Anciano , Anestesia/estadística & datos numéricos , COVID-19/psicología , Cuidados Críticos/estadística & datos numéricos , Estudios Transversales , Femenino , Humanos , Irlanda/epidemiología , Masculino , Persona de Mediana Edad , Estrés Laboral/etiología , Médicos/psicología , Distrés Psicológico , Encuestas y Cuestionarios , Reino Unido/epidemiología , Adulto Joven
7.
JCO Clin Cancer Inform ; 5: 394-400, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33822651

RESUMEN

PURPOSE: COVID-19 has infected more than 94 million people worldwide and caused more than 2 million deaths. Patients with cancer are at significantly increased risk compared with the general population. Telemedicine represents a common strategy to prevent viral spread. We sought to evaluate patient with cancer and physician perceptions of telemedicine during the COVID-19 pandemic. METHODS: A 16-question survey was e-mailed to 1,843 active e-mails of patients presenting to one of the six cancer clinics at a comprehensive cancer care center from January 1, 2020, to June 1, 2020. A six-question survey was e-mailed to attending physicians of those clinics. Specialties included Medical Oncology, Hematology-Oncology, Surgical Oncology, Urological Oncology, and Gynecologic Oncology. RESULTS: Three hundred seventy-four patients (20.3%) and 14 physicians (66.7%) responded. Most (68.2%) currently prefer in-person visits, and 80.4% prefer in-person visits following pandemic resolution. More than half (52.2%) of patients preferring virtual visits do so because of convenience. Most (63.1%) patients with cancer are comfortable with a complete physical examination. Surgical patients are more likely to prefer a complete examination (P = .0476). Physicians prefer in-person visits (64.2%) and believe that virtual visits maybe or probably do not provide comparable care (64.2%). 71.4% believe that virtual visits help prevent the spread of infectious disease. CONCLUSION: Given preferences for in-person visits, cancer care teams should be prepared to continue providing in-person visits for many of their patients. The discrepancy between patient and provider concern for spread of infectious disease represents an area where patients may benefit from increased education. Providers should feel comfortable performing physical examinations at their own discretion.


Asunto(s)
Actitud , COVID-19/prevención & control , Oncología Médica/métodos , Neoplasias/terapia , Telemedicina/métodos , Anciano , COVID-19/epidemiología , COVID-19/virología , Humanos , Internet , Persona de Mediana Edad , Neoplasias/diagnóstico , Pandemias , Pacientes/psicología , Pacientes/estadística & datos numéricos , Médicos/psicología , Médicos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , SARS-CoV-2/fisiología , Encuestas y Cuestionarios
8.
Rev Esp Salud Publica ; 952021 Apr 19.
Artículo en Español | MEDLINE | ID: mdl-33867521

RESUMEN

OBJECTIVE: Giving the absence of specialized training to work as a physician in the Emergency Department in Spain, the aim of the study was to describe the variability of specialties in these departments nationally, by regions and hospital complexity. METHODS: A descriptive cross-sectional study was carried out through a survey addressed to Emergency Chiefs of Spanish public hospitals, 65 of whom answered between January 2018 and September 2019. Descriptive and correlative analyzes of the variables were performed, assuming those with p<0.05 as statistically significant. RESULTS: 1,706 emergency physicians of 29 different specialties were described, of which 1,336 (78.31%) were Family and Community Medicine specialists. Different number of specialties among regions and hospitals of different complexities were described. 98.46% of surveyed chiefs demanded specialized formation on Emergency Medicine. Direct correlations were found between the complexity of the hospital and the number of specialties in the Emergency Department (r=0.2921, CI: 0.04445-0.5059; p<0.05); the complexity of the hospital and the number of emergency physicians (r=0.69, CI: 0.5310-0.8020; p<0.0001), as well as between the number of emergency physicians and the number of different specialties in the Emergency Department (r=0.3901, CI: 0.1543-0.5838; p<0.005). CONCLUSIONS: Physicians of 29 different specialties were described working in the Emergency Departments. The variability of specialties changed among regions and hospitals of different complexities. Heads of Emergency Departments agreed on the need for specialized formation on Emergency Medicine.


Asunto(s)
Medicina de Emergencia/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Médicos/estadística & datos numéricos , Especialización/estadística & datos numéricos , Estudios Transversales , Hospitales Públicos , Humanos , España
11.
BMC Cancer ; 21(1): 236, 2021 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-33676431

RESUMEN

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) negatively affects physical function and chemotherapy dosing, yet, clinicians infrequently document CIPN assessment and/or adhere to evidence-based CIPN management in practice. The primary aims of this two-phase, pre-posttest study were to explore the impact of a CIPN clinician decision support algorithm on clinicians' frequency of CIPN assessment documentation and adherence to evidence-based management. METHODS: One hundred sixty-two patients receiving neurotoxic chemotherapy (e.g., taxanes, platinums, or bortezomib) answered patient-reported outcome measures on CIPN severity and interference prior to three clinic visits at breast, gastrointestinal, or multiple myeloma outpatient clinics (n = 81 usual care phase [UCP], n = 81 algorithm phase [AP]). During the AP, study staff delivered a copy of the CIPN assessment and management algorithm to clinicians (N = 53) prior to each clinic visit. Changes in clinicians' CIPN assessment documentation (i.e., index of numbness, tingling, and/or CIPN pain documentation) and adherence to evidence-based management at the third clinic visit were compared between the AP and UCP using Pearson's chi-squared test. RESULTS: Clinicians' frequency of adherence to evidence-based CIPN management was higher in the AP (29/52 [56%]) than the UCP (20/46 [43%]), but the change was not statistically significant (p = 0.31). There were no improvements in clinicians' CIPN assessment frequency during the AP (assessment index = 0.5440) in comparison to during the UCP (assessment index = 0.6468). CONCLUSIONS: Implementation of a clinician-decision support algorithm did not significantly improve clinicians' CIPN assessment documentation or adherence to evidence-based management. Further research is needed to develop theory-based implementation interventions to bolster the frequency of CIPN assessment and use of evidence-based management strategies in practice. TRIAL REGISTRATION: ClinicalTrials.Gov, NCT03514680 . Registered 21 April 2018.


Asunto(s)
Antineoplásicos/efectos adversos , Toma de Decisiones Clínicas/métodos , Técnicas de Apoyo para la Decisión , Neoplasias/tratamiento farmacológico , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Adulto , Anciano , Algoritmos , Medicina Basada en la Evidencia/normas , Estudios de Factibilidad , Femenino , Adhesión a Directriz/estadística & datos numéricos , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Enfermeras Practicantes/estadística & datos numéricos , Medición de Resultados Informados por el Paciente , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/terapia , Asistentes Médicos/estadística & datos numéricos , Médicos/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Calidad de Vida , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios/estadística & datos numéricos
12.
Acad Med ; 96(3): 375-380, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33661849

RESUMEN

A critical shortage of physicians is looming in the United States. The situation in Kentucky is especially dire, especially in rural areas. Class size constraints have resulted in the University of Kentucky College of Medicine (UK COM) unable to admit over 100 qualified Kentuckians each year. This article describes how leadership at University of Kentucky committed to addressing the state physician shortage while simultaneously strengthening relationships with critical partners through the establishment of two 4-year UK COM regional medical campuses. Based on criteria (such as a commitment to educating physicians, ample patients, sufficient willing physician preceptors, etc.), partners selected were Med Center Health, the leading health care system in southwestern Kentucky, and St. Elizabeth Healthcare, the predominant health care system in northern Kentucky. These regional campuses allow UK COM to expand its class size to 201 and total enrollment to 804, increasing from historically 70 to currently 120 graduates per year expected to practice in Kentucky. Critical to the success of this expansion is the buy-in of leadership and the Admissions Committee to consider students with a wider range of Medical College Admission Test scores. The regional clinical partners have substantially increased their teaching opportunities, with a greater ability to attract physicians. Both partners have made substantial financial contributions in support of the regional campuses. These relationships have energized UK COM engagement with its area alumni and have resulted in fewer Kentuckians referred out of state for advanced specialty care. Partnerships are also occurring with UK COM to increase graduate medical education offerings at the regional sites, fulfilling the vision of "training Kentuckians in Kentucky to practice in Kentucky."


Asunto(s)
Centros Médicos Académicos/organización & administración , Fuerza Laboral en Salud/estadística & datos numéricos , Médicos/estadística & datos numéricos , Política Pública/legislación & jurisprudencia , Centros Médicos Académicos/provisión & distribución , Redes Comunitarias , Educación de Postgrado en Medicina/organización & administración , Humanos , Kentucky/epidemiología , Médicos/provisión & distribución , Derivación y Consulta/estadística & datos numéricos , Derivación y Consulta/tendencias , Población Rural/estadística & datos numéricos , Especialización/estadística & datos numéricos , Planificación Estratégica/normas , Estados Unidos/epidemiología
13.
N Z Med J ; 134(1530): 12-20, 2021 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-33651773

RESUMEN

AIM: Burnout has a damaging effect on both the wellbeing of medical professionals and patients alike. Empathy is an important part of the therapeutic relationship and could be damaged by burnout. We aimed to describe the prevalence of burnout, assess levels of empathy and explore the relationship between burnout and empathy among senior medical officers (SMOs). We hypothesised that there would be a negative correlation between empathy and burnout. METHOD: This was a cross-sectional observational study involving SMOs from a variety of specialities. The focus is on SMOs with relatively prolonged contact times with patients. Email invitations were sent out requesting participation in an electronic survey on the QuestionPro platform. The survey comprised 42 questions enquiring about demographics, empathy (Jefferson Scale of Physician Empathy) and burnout (Copenhagen Burnout Inventory). Correlational analyses were performed. RESULTS: Three hundred and fourteen invitations were sent out and 178 responses were received (56.7% response rate). Forty-five percent of SMOs surveyed were experiencing high levels of personal burnout. There was a statistically significant negative correlation between empathy and patient-related burnout (p=0.018). CONCLUSIONS: The results show high levels of personal burnout among SMOs and suggest that empathy reduces as patient-related burnout increases. The nature of this relationship is a complex one, and other contributing variables should be considered.


Asunto(s)
Agotamiento Profesional/epidemiología , Empatía , Relaciones Médico-Paciente , Médicos/estadística & datos numéricos , Adulto , Agotamiento Profesional/psicología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Médicos/psicología , Encuestas y Cuestionarios
15.
Acta Diabetol ; 58(6): 789-796, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33586058

RESUMEN

AIMS: The Italian Titration Approach Study (ITAS) demonstrated comparable HbA1c reductions and similarly low hypoglycaemia risk at 6 months in poorly controlled, insulin-naïve adults with T2DM who initiated self- or physician-titrated insulin glargine 300 U/mL (Gla-300) in the absence of sulphonylurea/glinide. The association of patient characteristics with glycaemic and hypoglycaemic outcomes was assessed. METHODS: This post hoc analysis investigated whether baseline patient characteristics and previous antihyperglycaemic drugs were associated with HbA1c change and hypoglycaemia risk in patient- versus physician-managed Gla-300 titration. RESULTS: HbA1c change, incidence of hypoglycaemia (any type) and nocturnal rates were comparable between patient- and physician-managed arms in all subgroups. Hypoglycaemia rates across subgroups (0.03 to 3.52 events per patient-year) were generally as low as observed in the full ITAS population. Small increases in rates of 00:00-pre-breakfast and anytime hypoglycaemia were observed in the ≤ 10-year diabetes duration subgroup in the patient- versus physician-managed arm (heterogeneity of effect; p < 0.05). CONCLUSIONS: Comparably fair glycaemic control and similarly low hypoglycaemia risk were achieved in almost all patient subgroups with patient- versus physician-led Gla-300 titration. These results reinforce efficacy and safety of Gla-300 self-titration across a range of phenotypes of insulin-naïve people with T2DM. CLINICAL TRIAL REGISTRATION: EudraCT 2015-001167-39.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Cálculo de Dosificación de Drogas , Insulina Glargina/administración & dosificación , Médicos , Automanejo , Adulto , Anciano , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Estudios de Seguimiento , Control Glucémico/métodos , Control Glucémico/normas , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/epidemiología , Incidencia , Insulina Glargina/efectos adversos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Relaciones Médico-Paciente , Médicos/normas , Médicos/estadística & datos numéricos , Estudios Retrospectivos , Automanejo/estadística & datos numéricos , Titulometría/métodos , Titulometría/normas
16.
J Foot Ankle Res ; 14(1): 11, 2021 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-33536046

RESUMEN

BACKGROUND: On the 19th of January, 2020, the Chief Medical Officer of Australia issued a statement about a novel coronavirus, or SARS-CoV-2. Since this date, there have been variable jurisdictional responses, including lockdowns, and restrictions on podiatry practice. This study aimed to describe impacts of the SARS-CoV-2 pandemic on the podiatry profession in Australia. METHODS: This was a cross sectional study of Australian podiatrists using demographic data collected between 2017 and 2020, and pandemic-related question responses collected between 30th March and 31st August, 2020. Data were collected online and participants described their work settings, patient funding types, business decisions and impacts, and information sources used to guide practice decisions during this time-period. Inductive thematic analysis was used to analyse open-ended questions about their practice impact of SARS-CoV-2. RESULTS: There were 732 survey responses, with 465 Australian podiatrists or podiatric surgeons providing responses describing pandemic impact. From these responses, 223 (49% of 453) podiatrists reported no supply issues, or having adequate supplies for the foreseeable future with personal protective equipment (PPE) or consumables to support effective infection prevention and control. The most frequent responses about employment, or hours of work, impact were reported in the various categories of "business as usual" (n = 312, 67%). Participants described most frequently using the local state and territory Department of Health websites (n = 347, 75%), and the Australian Podiatry Association (n = 334, 72%) to make decisions about their business. Overarching themes which resounded through open-ended comments was that working through the pandemic was likened to a marathon, and not a sprint. Themes were: (i) commitment to do this, (ii) it's all in the plan, but not everything goes to plan, (iii) my support team must be part of getting through it, (iv) road blocks happen, and (v) nothing is easy, what's next? CONCLUSION: Podiatrists in Australia reported variable pandemic impact on their business decisions, PPE stores, and their valued sources of information. Podiatrists also described their "marathon" journey through the pandemic to date, with quotes describing their challenges and highlights. Describing these experiences should provide key learnings for future workforce challenges, should further restrictions come into place.


Asunto(s)
COVID-19/prevención & control , Control de Infecciones/tendencias , Médicos/psicología , Podiatría/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Anciano , Australia , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Médicos/estadística & datos numéricos , SARS-CoV-2
17.
Spinal Cord Ser Cases ; 7(1): 13, 2021 02 12.
Artículo en Inglés | MEDLINE | ID: mdl-33579904

RESUMEN

STUDY DESIGN: An online survey. OBJECTIVES: To follow-up with and re-query the international spinal cord community's response to the Coronavirus Disease 2019 (COVID-19) pandemic by revisiting questions posed in a previous survey and investigating new lines of inquiry. SETTING: An international collaboration of authors and participants. METHODS: Two identical surveys (one in English and one in Spanish) were distributed via the internet. Responses from both surveys were pooled and analyzed for demographic and response data. RESULTS: Three hundred and sixty-six respondents were gathered from multiple continents and regions. The majority (63.1%) were rehabilitation physicians and only 12.1% had patients with spinal cord injury/disease (SCI/D) that they knew had COVID-19. Participants reported that the COVID-19 pandemic had caused limited access to clinician and support services and worsening medical complications. Nearly 40% of inpatient clinicians reported that "some or all" of their facilities' beds were being used by medical and surgical patients, rather than by individuals requiring inpatient rehabilitation. Respondents reported a 25.1% increase in use of telemedicine during the pandemic (35% used it before; 60.1% during), though over 60% felt the technology incompletely met their patients' needs. CONCLUSION: The COVID-19 pandemic has negatively impacted the ability of individuals with SCI/D to obtain their "usual level of care." Moving forward into a potential "second wave" of COVID-19, patient advocacy and efforts to secure access to thorough and accessible care are essential.


Asunto(s)
Actitud del Personal de Salud , COVID-19 , Personal de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Rehabilitación Neurológica/estadística & datos numéricos , Traumatismos de la Médula Espinal/rehabilitación , Telemedicina/estadística & datos numéricos , Adulto , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Médicos/estadística & datos numéricos
18.
Med Ref Serv Q ; 40(1): 48-55, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33625330

RESUMEN

An ongoing collaboration between physicians and librarians provided critical information during the COVID-19 pandemic. A development team, which consisted of the hospital and medical school disaster preparedness medical director, the medical library director, professional librarians, and the Departments of IT and Marketing in a multi-state healthcare system worked together to develop a shared website to distribute and curate timely resources during COVID-19. The initial impacts of this collaboration and the website show the benefits of this novel partnership.


Asunto(s)
COVID-19 , Relaciones Interprofesionales , Bibliotecólogos/psicología , Bibliotecas Digitales/organización & administración , Bibliotecas Médicas/organización & administración , Bibliotecas Médicas/estadística & datos numéricos , Médicos/psicología , Adulto , Femenino , Humanos , Bibliotecólogos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pandemias , Médicos/estadística & datos numéricos , SARS-CoV-2
19.
J Am Board Fam Med ; 34(Suppl): S244-S246, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33622846

RESUMEN

OBJECTIVES: As of May 13, 2020, 1004 health care worker (HCW) deaths due to coronavirus disease 2019 (COVID-19) have been reported globally. This study seeks to organize deaths by demographic group, including age, gender, country, and occupation. METHODS: We collected data from a crowdsourced list of global HCW COVID-19 deaths published by Medscape, including age, gender, country, occupation, and physician specialty. RESULTS: As of May 13, 2020, of 1004 HCW deaths, 550 were physicians. The average age of physician death is 62.49, skewed right, and nonphysician is 52.62, approximately symmetrical. The majority of U.S. HCW deaths are male (64.1%). General practitioners and family medicine and primary care physicians account for 26.9% of physician deaths. Anesthesiologists and emergency medicine and critical care physicians account for 7.4%. The United States has the highest number of HCW deaths but a similar number as a fraction of national cases and deaths compared with other developed countries. CONCLUSIONS: Among HCWs globally, in the United States there have been more reported deaths of physicians, primary care physicians, males, and HCWs versus opposing groups. Further research is needed to understand relative risks of death due to COVID-19 in each of these demographic groups.


Asunto(s)
COVID-19/mortalidad , Médicos/estadística & datos numéricos , Distribución por Edad , Anciano , Anciano de 80 o más Años , Colaboración de las Masas , Femenino , Salud Global , Humanos , Masculino , Persona de Mediana Edad , Pandemias , SARS-CoV-2
20.
PLoS One ; 16(2): e0247967, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33635918

RESUMEN

While several areas in the United States have asked nurses and physicians who are not in the labor force to return to help with the COVID-19 pandemic, little is known about the characteristics of these clinicians that may present barriers to returning. We studied age, disability, and household composition of clinicians not in the workforce using the American Community Survey from 2014 to 2018, a nationally-representative survey of US households administered by the US Census. Overall, we found that, for nurses and physicians not in the labor force, over three-quarters were 55 and over and about 15 percent had a disability. For female nurses and physicians not in the labor force, over half of those ages 20-54 had a child under 15 at home and over half of those ages 65+ had another adult 65 and over at home. These characteristics may present challenges and risks to returning.


Asunto(s)
Enfermeras y Enfermeros , Médicos , Reinserción al Trabajo , Adulto , Anciano , COVID-19/epidemiología , Personas con Discapacidad , Empleo/estadística & datos numéricos , Composición Familiar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermeras y Enfermeros/estadística & datos numéricos , Médicos/estadística & datos numéricos , Reinserción al Trabajo/estadística & datos numéricos , Adulto Joven
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