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1.
Arab J Gastroenterol ; 21(3): 156-161, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32912748

RESUMEN

BACKGROUND & STUDY AIMS: Corona virus disease-19 (COVID-19) pandemic has markedly impacted routine medical services including gastrointestinal (GI) endoscopy. We aim to report the real-life performance in high volume GI endoscopy units during the pandemic. PATIENTS AND METHODS: A web-based survey covering all aspects of daily performance in GI endoscopy units was sent to endoscopy units worldwide. Responses were collected and data were analyzed to reveal the effect of COVID-19 pandemic on endoscopy practice. RESULTS: Participants from 48 countries (n = 163) responded to the survey with response rate of 67.35%. The majority (85%) decreased procedure volume by over 50%, and four endoscopy units (2.45%) completely stopped. The top three indications for procedures included upper GI bleeding (89.6%), lower GI bleeding (65.6%) and cholangitis (62.6%). The majority (93.9%) triaged patients for COVID-19 prior to procedure. N95 masks were used in (57.1%), isolation gowns in (74.2%) and head covers in (78.5%). Most centers (65%) did not extend use of N95 masks, however 50.9% of centers reused N95 masks. Almost all (91.4%) centers used standard endoscopic decontamination and most (69%) had no negative pressure rooms. Forty-two centers (25.8%) reported positive cases of SARS-CoV-2 infection among patients and 50 (30.7%) centers reported positive cases of SARS-CoV-2 infection among their healthcare workers. CONCLUSIONS: Most GI endoscopy centers had a significant reduction in their volume and most procedures performed were urgent. Most centers used the recommended personal protective equipment (PPE) by GI societies however there is still a possibility of transmission of SARS-CoV-2 infection in GI endoscopy units.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Endoscopía Gastrointestinal/estadística & datos numéricos , Control de Infecciones/organización & administración , Neumonía Viral/epidemiología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Utilización de Instalaciones y Servicios , Humanos , Pandemias/prevención & control , Selección de Paciente , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Encuestas y Cuestionarios
2.
West J Emerg Med ; 21(5): 1095-1101, 2020 Aug 17.
Artículo en Inglés | MEDLINE | ID: mdl-32970560

RESUMEN

The unprecedented COVID-19 pandemic has resulted in rapidly evolving best practices for transmission reduction, diagnosis, and treatment. A regular influx of new information has upended traditionally static hospital protocols, adding additional stress and potential for error to an already overextended system. To help equip frontline emergency clinicians with up-to-date protocols throughout the evolving COVID-19 crisis, our team set out to create a dynamic digital tool that centralized and standardized resources from a broad range of platforms across our hospital. Using a design thinking approach, we rapidly built, tested, and deployed a solution using simple, out-of-the-box web technology that enables clinicians to access the specific information they seek within moments. This platform has been rapidly adopted throughout the emergency department, with up to 70% of clinicians using the digital tool on any given shift and 78.6% of users reporting that they "agree" or "strongly agree" that the platform has affected their management of COVID-19 patients. The tool has also proven easily adaptable, with multiple protocols being updated nearly 20 times over two months without issue. This paper describes our development process, challenges, and results to enable other institutions to replicate this process to ensure consistent, high-quality care for patients as the COVID-19 pandemic continues its unpredictable course.


Asunto(s)
Betacoronavirus , Toma de Decisiones Clínicas/métodos , Infecciones por Coronavirus/terapia , Sistemas de Apoyo a Decisiones Clínicas , Servicios Médicos de Urgencia/métodos , Neumonía Viral/terapia , Actitud del Personal de Salud , Protocolos Clínicos , Árboles de Decisión , Eficiencia , Urgencias Médicas , Humanos , Internet , Pandemias , Pautas de la Práctica en Enfermería/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Desarrollo de Programa , San Francisco
3.
West J Emerg Med ; 21(5): 1283-1286, 2020 Aug 07.
Artículo en Inglés | MEDLINE | ID: mdl-32970587

RESUMEN

While current research efforts focus primarily on identifying patient level interventions that mitigate the direct impact of COVID-19, it is important to consider the collateral effects of COVID-19 on antimicrobial resistance. Early reports suggest high rates of antibiotic utilization in COVID-19 patients despite their lack of direct activity against viral pathogens. The ongoing pandemic is exacerbating known barriers to optimal antibiotic stewardship in the ED, representing an additional direct threat to patient safety and public health. There is an urgent need for research analyzing overall and COVID-19 specific antibiotic prescribing trends in the ED. Optimizing ED stewardship during COVID-19 will likely require a combination of traditional stewardship approaches (e.g. academic detailing, provider education, care pathways) and effective implementation of host response biomarkers and rapid COVID-19 diagnostics. Antibiotic stewardship interventions with demonstrated efficacy in mitigating the impact of COVID-19 on ED prescribing should be widely disseminated and inform the ongoing pandemic response.


Asunto(s)
Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/métodos , Betacoronavirus , Infecciones por Coronavirus/tratamiento farmacológico , Servicio de Urgencia en Hospital , Prescripción Inadecuada/prevención & control , Neumonía Viral/tratamiento farmacológico , Pautas de la Práctica en Medicina , Programas de Optimización del Uso de los Antimicrobianos/organización & administración , Programas de Optimización del Uso de los Antimicrobianos/estadística & datos numéricos , Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Diagnóstico Diferencial , Servicio de Urgencia en Hospital/organización & administración , Humanos , Prescripción Inadecuada/estadística & datos numéricos , Pandemias , Neumonía Viral/diagnóstico , Pautas de la Práctica en Medicina/estadística & datos numéricos
5.
Am Surg ; 86(8): 916-925, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32926795

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic dramatically altered the delivery of surgical care. METHODS: Members of the Southeastern Surgical Congress were surveyed regarding system adjustments, personal impact, and productivity losses. Subgroups were analyzed for disproportionate impact across practice models (academic/employed/private), practice communities (urban, suburban, rural), and practice case-mix categories (broad general surgery, narrow general surgery, specialty practice, hospital-based practice). RESULTS: 135 respondents reported that 98.5% of surgeons and 97% of hospitals canceled elective cases. Practices and hospitals reduced staffing dramatically. Telemedicine was utilized by most respondents. Hospitals variably implemented system changes, developed tests, and set up diagnostic centers. Most surgeons anticipated resumption of practice and hospital activity by July 1, 2020. More than one-quarter reported worsened financial status and personal well-being. Interestingly, family/personal relationships were improved in more than one-third. Most surgeons anticipate reduced year-end case volumes, clinical productivity, and salary. In subgroup analyses, academic surgeons were more likely than employed and private-practice surgeons to use telemedicine and to work in hospitals with in-house COVID-19 testing. Private-practice surgeons expected decreased financial status, case volumes, relative value units (RVUs), and salary. More rural surgeons anticipate reduced salary than urban and suburban surgeons. Surgeons in narrow general surgery practice reported more furlough of employees than specialty surgeons, hospital-based surgeons, and broad-based general surgeons. Narrow-practice surgeons and specialists were more likely to report RVU reductions and improved family/personal relationships. DISCUSSION: The COVID-19 slowdown affected surgeons throughout the southeastern United States. Variations between different practice models, communities, and case-mix categories may help inform surgeons in the future.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Cirujanos , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , Femenino , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Sudeste de Estados Unidos , Encuestas y Cuestionarios , Telemedicina
6.
MMWR Morb Mortal Wkly Rep ; 69(35): 1210-1215, 2020 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-32881845

RESUMEN

Hydroxychloroquine and chloroquine, primarily used to treat autoimmune diseases and to prevent and treat malaria, received national attention in early March 2020, as potential treatment and prophylaxis for coronavirus disease 2019 (COVID-19) (1). On March 20, the Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for chloroquine phosphate and hydroxychloroquine sulfate in the Strategic National Stockpile to be used by licensed health care providers to treat patients hospitalized with COVID-19 when the providers determine the potential benefit outweighs the potential risk to the patient.* Following reports of cardiac and other adverse events in patients receiving hydroxychloroquine for COVID-19 (2), on April 24, 2020, FDA issued a caution against its use† and on June 15, rescinded its EUA for hydroxychloroquine from the Strategic National Stockpile.§ Following the FDA's issuance of caution and EUA rescindment, on May 12 and June 16, the federal COVID-19 Treatment Guidelines Panel issued recommendations against the use of hydroxychloroquine or chloroquine to treat COVID-19; the panel also noted that at that time no medication could be recommended for COVID-19 pre- or postexposure prophylaxis outside the setting of a clinical trial (3). However, public discussion concerning the effectiveness of these drugs on outcomes of COVID-19 (4,5), and clinical trials of hydroxychloroquine for prophylaxis of COVID-19 continue.¶ In response to recent reports of notable increases in prescriptions for hydroxychloroquine or chloroquine (6), CDC analyzed outpatient retail pharmacy transaction data to identify potential differences in prescriptions dispensed by provider type during January-June 2020 compared with the same period in 2019. Before 2020, primary care providers and specialists who routinely prescribed hydroxychloroquine, such as rheumatologists and dermatologists, accounted for approximately 97% of new prescriptions. New prescriptions by specialists who did not typically prescribe these medications (defined as specialties accounting for ≤2% of new prescriptions before 2020) increased from 1,143 prescriptions in February 2020 to 75,569 in March 2020, an 80-fold increase from March 2019. Although dispensing trends are returning to prepandemic levels, continued adherence to current clinical guidelines for the indicated use of these medications will ensure their availability and benefit to patients for whom their use is indicated (3,4), because current data on treatment and pre- or postexposure prophylaxis for COVID-19 indicate that the potential benefits of these drugs do not appear to outweigh their risks.


Asunto(s)
Cloroquina/uso terapéutico , Hidroxicloroquina/uso terapéutico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Especialización/estadística & datos numéricos , Infecciones por Coronavirus/tratamiento farmacológico , Femenino , Humanos , Masculino , Resultado del Tratamiento , Estados Unidos
7.
Medicine (Baltimore) ; 99(37): e21896, 2020 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-32925724

RESUMEN

This study aimed to determine the differences in antibiotic usage patterns in the treatment of acute pyelonephritis according to hospital type and region in Korea.The claims database of the Health Insurance Review and Assessment Service in Korea was used to select patients with the International Classification of Diseases, Tenth Revision code N10 (acute tubulo-interstitial nephritis) or N12 (tubulo-interstitial nephritis, neither acute nor chronic) as the primary discharge diagnosis in 2010-2014. Usage of each class of antibiotics was expressed as the defined daily dose (DDD)/event.The average antibiotic usage per inpatient event was 11.3 DDD. The average antibiotic usage was the highest among patients admitted to tertiary hospitals (13.8 DDD), followed by those admitted to secondary hospitals (11.5 DDD), clinics (10.0 DDD), and primary hospitals (9.8 DDD). According to the geographic analyses, third-generation cephalosporins were highly prescribed in some southern regions; fluoroquinolones and aminoglycosides were highly prescribed in some centrally located regions of the Korean peninsula. The hotspots for carbapenem usage included Seoul and Gyeonggi province cluster and Busan cluster: these regions include the capital city and the second biggest city in Korea, respectively.In conclusion, the antibiotic usage patterns for acute pyelonephritis in Korea differ according to the hospital type and region.


Asunto(s)
Antibacterianos/uso terapéutico , Utilización de Medicamentos/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Pielonefritis/tratamiento farmacológico , Enfermedad Aguda , Adolescente , Adulto , Aminoglicósidos/uso terapéutico , Cefalosporinas/uso terapéutico , Bases de Datos Factuales , Femenino , Fluoroquinolonas/uso terapéutico , Geografía , Humanos , Masculino , Persona de Mediana Edad , República de Corea , Centros de Atención Secundaria/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Adulto Joven
10.
Am Surg ; 86(8): 1010-1014, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32997952

RESUMEN

INTRODUCTION: Failure to perform adequate fasciotomy for a presumed or diagnosed compartment syndrome after revascularization of an acutely ischemic limb is a potential cause of preventable limb loss. When required, outcomes are best when fasciotomy is conducted with the initial vascular repair. Despite over 100 years of experience with fasciotomy, the actual indications for its performance among acute care and trauma surgeons performing vascular repairs are unclear. The hypothesis of this study was that there are many principles of fasciotomy that are uniformly accepted by surgeons and that consensus guidelines could be developed. METHODS: A 20-question survey on fasciotomy practice patterns was distributed to trauma and acute care surgeons of a major surgical society which had approved distribution. RESULTS: The response to the survey was 160/1066 (15 %). 92.5% of respondents were fellowship trained in trauma and acute care surgery, and 74.9% had been in practice for fewer than 10 years. Most respondents (71.9%) stated that they would be influenced to perform a preliminary fasciotomy (fasciotomy conducted prior to planned exploration and arterial repair) based upon specific signs and symptoms consistent with compartment syndrome-including massive swelling (55.6%), elevated compartment pressures (52.5%), delay in transfer >6 hours (47.5%), or obvious distal ischemia (33.1%). 20.6% responded that they would conduct exploration and repair first, regardless of these considerations. Prophylactic fasciotomies (fasciotomy without overt signs of compartment syndrome) would be performed by respondents in the setting of the tense compartment (87.5%), ischemic time >6 hours (88.1%), measurement of elevated compartment pressures (66.9%), and in the setting of large volume resuscitation requirements (31.3%). 69.4% of respondents selectively measure compartment pressures, with nearly three-fourths utilizing a Stryker needle device (72.5%). The most common sequence of repairs following superficial femoral artery injury with a >6-hour limb ischemia was cited as the initial insertion of a shunt, followed by fasciotomy, then vein harvest, and finally interposition repair. CONCLUSIONS: While there is some general consensus on indications for fasciotomy, there is marked heterogeneity in surgeons' opinions on the precise indications in selected scenarios. This is particularly surprising in light of the long history with fasciotomy in association with major arterial repairs and strongly suggests the need for a consensus conference and/or meta-analysis to guide further care.


Asunto(s)
Arterias/lesiones , Síndromes Compartimentales/cirugía , Fasciotomía/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Cirujanos/estadística & datos numéricos , Procedimientos Quirúrgicos Vasculares , Lesiones del Sistema Vascular/complicaciones , Arterias/cirugía , Síndromes Compartimentales/etiología , Síndromes Compartimentales/prevención & control , Fasciotomía/métodos , Humanos , Encuestas y Cuestionarios , Traumatología , Estados Unidos , Lesiones del Sistema Vascular/cirugía
11.
PLoS One ; 15(8): e0237509, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32810157

RESUMEN

Limited data are available regarding treatment patterns, healthcare resource utilization (HCRU), treatment costs and clinical outcomes for patients with diffuse large B-cell lymphoma (DLBCL) in Japan. This retrospective database study analyzed the Medical Data Vision database for DLBCL patients who received treatment during the identification period from October 1 2008 to December 31 2017. Among 6,965 eligible DLBCL patients, 5,541 patients (79.6%) received first-line (1L) rituximab (R)-based therapy, and then were gradually switched to chemotherapy without R in subsequent lines of therapy. In each treatment regimen, 1L treatment cost was the highest among all lines of therapy. The major cost drivers i.e. total direct medical costs until death or censoring across all regimens and lines of therapy were from the 1L regimen and inpatient costs. During the follow-up period, DLBCL patients who received a 1L R-CHOP regimen achieved the highest survival rate and longest time-to-next-treatment, with a relatively low mean treatment cost due to lower inpatient healthcare resource utilization and fewer lines of therapy compared to other 1L regimens. Our retrospective analysis of clinical practices in Japanese DLBCL patients demonstrated that 1L treatment and inpatient costs were major cost contributors and that the use of 1L R-CHOP was associated with better clinical outcomes at a relatively low mean treatment cost.


Asunto(s)
Costos de la Atención en Salud , Linfoma de Células B Grandes Difuso , Pautas de la Práctica en Medicina , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/economía , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Niño , Preescolar , Análisis Costo-Beneficio , Ciclofosfamida/economía , Ciclofosfamida/uso terapéutico , Bases de Datos Factuales , Doxorrubicina/economía , Doxorrubicina/uso terapéutico , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Formulario de Reclamación de Seguro/estadística & datos numéricos , Japón/epidemiología , Linfoma de Células B Grandes Difuso/economía , Linfoma de Células B Grandes Difuso/mortalidad , Linfoma de Células B Grandes Difuso/terapia , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante/economía , Terapia Neoadyuvante/estadística & datos numéricos , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/estadística & datos numéricos , Prednisona/economía , Prednisona/uso terapéutico , Estudios Retrospectivos , Rituximab/administración & dosificación , Rituximab/economía , Rituximab/uso terapéutico , Análisis de Supervivencia , Vincristina/economía , Vincristina/uso terapéutico , Adulto Joven
12.
JCO Glob Oncol ; 6: 1248-1257, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32755479

RESUMEN

PURPOSE: To understand readiness measures taken by oncologists to protect patients and health care workers from the novel coronavirus (COVID-19) and how their clinical decision making was influenced by the pandemic. METHODS: An online survey was conducted between March 24 and April 29, 2020. RESULTS: A total of 343 oncologists from 28 countries participated. The median age was 43 years (range, 29-68 years), and the majority were male (62%). At the time of the survey, nearly all participants self-reported an outbreak in their country (99.7%). Personal protective equipment was available to all participants, of which surgical mask was the most common (n = 308; 90%). Telemedicine, in the form of phone or video encounters, was common and implemented by 80% (n = 273). Testing patients with cancer for COVID-19 via reverse transcriptase polymerase chain reaction before systemic treatment was not routinely implemented: 58% reported no routine testing, 39% performed testing in selected patients, and 3% performed systematic testing in all patients. The most significant factors influencing an oncologist's decision making regarding choice of systemic therapy included patient age and comorbidities (81% and 92%, respectively). Although hormonal treatments and tyrosine kinase inhibitors were considered to be relatively safe, cytotoxic chemotherapy and immune therapies were perceived as being less safe or unsafe by participants. The vast majority of participants stated that during the pandemic they would use less chemotherapy, immune checkpoint inhibitors, and steroids. Although treatment in neoadjuvant, adjuvant, and first-line metastatic disease was less affected, most of the participants stated that they would be more hesitant to recommend second- or third-line therapies in metastatic disease. CONCLUSION: Decision making by oncologists has been significantly influenced by the ongoing COVID-19 pandemic.


Asunto(s)
Betacoronavirus/patogenicidad , Toma de Decisiones Clínicas , Infecciones por Coronavirus/prevención & control , Control de Infecciones/estadística & datos numéricos , Neoplasias/terapia , Pandemias/prevención & control , Neumonía Viral/prevención & control , Adulto , Anciano , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Femenino , Humanos , Control de Infecciones/métodos , Control de Infecciones/normas , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Masculino , Oncología Médica/métodos , Oncología Médica/normas , Oncología Médica/estadística & datos numéricos , Persona de Mediana Edad , Neoplasias/diagnóstico , Oncólogos/estadística & datos numéricos , Equipo de Protección Personal/normas , Equipo de Protección Personal/estadística & datos numéricos , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Neumonía Viral/virología , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Encuestas y Cuestionarios/estadística & datos numéricos , Telemedicina/estadística & datos numéricos
13.
BMC Infect Dis ; 20(1): 616, 2020 Aug 20.
Artículo en Inglés | MEDLINE | ID: mdl-32819280

RESUMEN

BACKGROUND: The rise in antibiotic resistance is a global public health concern, and antibiotic overuse needs to be reduced. Earlier studies of out-of-hours care have indicated that antibiotic prescribing is less appropriate than that of in-hours care. However, no study has compared the out-of-hours treatment of infections to in-hours treatment within the same population. METHODS: This retrospective, descriptive study was based on data retrieved from the Kronoberg Infection Database in Primary Care (KIDPC), which consists of all visits to primary care with an infection diagnosis or prescription of antibiotics during 2006-2014. The purpose was to study the trends in antibiotic prescribing and to compare consultations and prescriptions between in-hours and out-of-hours. RESULTS: The visit rate for all infections was 434 visits per 1000 inhabitants per year. The visit rate was stable during the study period, but the antibiotic prescribing rate decreased from 266 prescriptions per 1000 inhabitants in 2006 to 194 prescriptions in 2014 (mean annual change - 8.5 [95% CI - 11.9 to - 5.2]). For the out-of-hours visits (12% of the total visits), a similar reduction in antibiotic prescribing was seen. The decrease was most apparent among children and in respiratory tract infections. When antibiotic prescribing during out-of-hours was compared to in-hours, the unadjusted relative risk of antibiotic prescribing was 1.37 (95% CI 1.36 to 1.38), but when adjusted for age, sex, and diagnosis, the relative risk of antibiotic prescribing was 1.09 (95% CI 1.08 to 1.10). The reduction after adjustment was largely explained by a higher visit rate during out-of-hours for infections requiring antibiotics (acute otitis media, pharyngotonsillitis, and lower urinary tract infection). The choices of antibiotics used for common diagnoses were similar. CONCLUSIONS: Although the infection visit rate was unchanged over the study period, there was a significant reduction in antibiotic prescribing, especially to children and for respiratory tract infections. The higher antibiotic prescribing rate during out-of-hours was small when adjusted for age, sex, and diagnosis. No excess prescription of broad-spectrum antibiotics was seen. Therefore, interventions selectively aiming at out-of-hours centres seem to be unmotivated in a low-prescribing context.


Asunto(s)
Atención Posterior/estadística & datos numéricos , Antibacterianos/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Infecciones/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Bases de Datos Factuales , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Suecia/epidemiología
15.
Spine (Phila Pa 1976) ; 45(18): 1285-1292, 2020 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-32756270

RESUMEN

STUDY DESIGN: Cross-sectional survey. OBJECTIVE: The aim of this study was to investigate the impact of COVID-19 pandemic on the clinical practices of spine surgeons within the Asia Pacific region. SUMMARY OF BACKGROUND DATA: COVID-19 pandemic had changed spine surgeons' clinical practices and their concerns toward personal and family risk of infection. METHODS: This cross-sectional survey was carried out from May 4, 2020 to June 4, 2020. The questionnaire was administered using REDCAP. The online questionnaire includes four sections. First section includes surgeon's demographics, background, type of clinical practice, and status of pandemic in their country. Second section includes volume and the type of spine surgery practice before the COVID pandemic. Third section includes changes of clinical practice during the pandemic and the last section was regarding their concern on COVID transmission. RESULTS: Total of 222 respondents from 19 countries completed the questionnaire. During the pandemic, 92.3% of the respondents felt their clinical practice was affected. 58.5% respondents reported reduced outpatient clinic hours and 74.6% respondents reported reduced operation theatre hours due to the enforcement by the hospital administration. The mean reduction of clinic volume for all countries was 48.1%. There was a significant reduction in the number of surgeries performed in Japan, Malaysia, India, Philippines, and South Korea. This was due to reduced patient load. More than 60% of respondents were worried being infected by COVID-19 virus and >68% were worried of transmission to their family members. CONCLUSION: COVID-19 pandemic has significantly affected the clinical and surgical practice of spine surgeons in the Asia Pacific region. Clinics were closed or the practice hours reduced. Similarly, surgical theaters were closed, reduced, or limited to semi-emergency and emergency surgeries. Spine surgeons were moderately concerned of contracting COVID-19 during their clinical practice but were extremely concerned to transmit this disease to their family members. LEVEL OF EVIDENCE: 4.


Asunto(s)
Infecciones por Coronavirus , Pandemias , Neumonía Viral , Columna Vertebral/cirugía , Cirujanos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Asia , Betacoronavirus , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/psicología , Estudios Transversales , Humanos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Neumonía Viral/psicología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Cirujanos/psicología , Cirujanos/estadística & datos numéricos
16.
N Z Med J ; 133(1519): 55-61, 2020 07 31.
Artículo en Inglés | MEDLINE | ID: mdl-32777795

RESUMEN

AIMS: Hip abductor tendon tears are a common cause of chronic hip pain and a difficult problem to manage. The aim of this survey is to establish the level of recognition by New Zealand orthopaedic surgeons and identify the challenges in treating abductor tendon repairs. METHODS: An online survey was sent to 215 consultant orthopaedic surgeons in New Zealand with a registered interest in hip surgery. The survey consisted of five questions regarding the diagnosis, management and clinical challenges related to hip abductor tendon tears. RESULTS: Eighty-six of 204 eligible surgeons (42.2%) completed the survey. Almost all (90%) of respondents have diagnosed abductor tendon tears and over half (59%) have performed hip abductor tendon tears in their practice. The most common indication for repair was pain (35%), followed by functional weakness (29%), and the most common repair technique involved transosseous repair through the greater trochanter (41%), closely followed by suture anchors (37%). The majority of surgeons identified a need for novel biologics and tissue augments for improving repair. CONCLUSIONS: Hip abductor tendon tears were identified as a pertinent clinical problem in this survey. An improvement in the fundamental pathological understanding of disease and greater availability of proven biologics and tissue augments are required.


Asunto(s)
Cadera/cirugía , Cirujanos Ortopédicos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Traumatismos de los Tendones/cirugía , Artroplastia/estadística & datos numéricos , Humanos , Nueva Zelanda , Dolor/etiología , Dolor/cirugía , Encuestas y Cuestionarios , Traumatismos de los Tendones/complicaciones , Tendones/cirugía
17.
Am Surg ; 86(8): 933-936, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32856933

RESUMEN

BACKGROUND: Several studies have described the population of adult trauma patients who undergo withdrawal of life-sustaining treatments (WLST); however, no study has looked specifically at trauma patients who undergo WLST following surgery. METHODS: This was a retrospective chart review of all trauma patients who underwent surgery at our trauma center between January 1 and December 31, 2017. Demographics were collected along with injury patterns and advance directives. Charts of all patients who died or who were discharged to hospice were analyzed to determine whether WLST occurred. Statistics included Fisher's exact test and Mann-Whitney U test. RESULTS: Three thousand and twenty-five adult trauma patients received care and 1495 (49.4%) had operations. Thirty (2.0%) patients underwent WLST, 15 (50.0%) of whom died in the hospital and 15 (50.0%) of whom were discharged to hospice. Twenty-six (86.7%) patients had a palliative care consult and 12 (40.0%) had prior advance directives. The most common injuries were femur fractures and subdural hematomas. Adjusting for age, white race, and age-adjusted CCI, femur fracture patients had, on average, 8.8 more hours between presentation and surgery (95% CI 2.1-15.4, P = .01) and 39 fewer hours between surgery and WLST (95% CI -107-29, P = .26) than traumatic brain injury patients. DISCUSSION: The short time between surgery and WLST in this cohort of patients may demonstrate that surgery was not aligned with patients' goals of care. A patient-centered approach that includes surgeon-driven palliative care discussions may help avoid nonbeneficial surgery in the last few days of life.


Asunto(s)
Cuidados Paliativos/estadística & datos numéricos , Comodidad del Paciente/estadística & datos numéricos , Atención Dirigida al Paciente/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos , Privación de Tratamiento/estadística & datos numéricos , Heridas y Traumatismos/terapia , Adulto , Directivas Anticipadas/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Cuidados Paliativos al Final de la Vida/estadística & datos numéricos , Humanos , Masculino , Inutilidad Médica , Persona de Mediana Edad , Planificación de Atención al Paciente , Estudios Retrospectivos , Heridas y Traumatismos/mortalidad
18.
Plast Reconstr Surg ; 146(2): 371-379, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32740590

RESUMEN

BACKGROUND: As a component of the Maintenance of Certification process from 2003 to 2019, the American Board of Plastic Surgery tracked 20 common plastic surgery operations. By evaluating the data collected over 16 years, the authors are able to examine the practice patterns of pediatric/craniofacial surgeons in the United States. METHODS: Cumulative tracer data for cleft palate repair was reviewed as of April of 2014 and September of 2019. Evidence-based medicine articles were reviewed. Results were tabulated in three categories: pearls, or topics that were covered in both the tracer data and evidence-based medicine articles; topics that were covered by evidence-based medicine articles but not collected in the tracer data; and topics that were covered in tracer data but not addressed in evidence-based medicine articles. RESULTS: Two thousand eight hundred fifty cases had been entered as of September of 2019. With respect to pearls, pushback, von Langenbeck, and Furlow repairs all declined in use, whereas intravelar veloplasty increased. For items not in the tracer, the quality of studies relating to analgesia is among the highest of all areas of study regarding cleft palate repair. In terms of variables collected by the tracer but not studied, in 2019, 41 percent of patients received more than 1 day of antibiotics. CONCLUSIONS: This article provides a review of cleft palate tracer data and summarizes the research in the field. Review of the tracer data enables cleft surgeons to compare their outcomes to national norms and provides an opportunity for them to consider modifications that may enhance their practice.


Asunto(s)
Fisura del Paladar/cirugía , Medicina Basada en la Evidencia/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Procedimientos Quirúrgicos Reconstructivos/métodos , Adolescente , Adulto , Anciano , Niño , Preescolar , Medicina Basada en la Evidencia/métodos , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Reconstructivos/estadística & datos numéricos , Cirujanos/legislación & jurisprudencia , Cirujanos/estadística & datos numéricos , Cirugía Plástica/legislación & jurisprudencia , Cirugía Plástica/estadística & datos numéricos , Resultado del Tratamiento , Estados Unidos , Adulto Joven
19.
Crit Care ; 24(1): 486, 2020 08 05.
Artículo en Inglés | MEDLINE | ID: mdl-32758266

RESUMEN

BACKGROUND: There is little evidence to support the management of severe COVID-19 patients. METHODS: To document this variation in practices, we performed an online survey (April 30-May 25, 2020) on behalf of the European Society of Intensive Care Medicine (ESICM). A case vignette was sent to ESICM members. Questions investigated practices for a previously healthy 39-year-old patient presenting with severe hypoxemia from COVID-19 infection. RESULTS: A total of 1132 ICU specialists (response rate 20%) from 85 countries (12 regions) responded to the survey. The survey provides information on the heterogeneity in patient's management, more particularly regarding the timing of ICU admission, the first line oxygenation strategy, optimization of management, and ventilatory settings in case of refractory hypoxemia. Practices related to antibacterial, antiviral, and anti-inflammatory therapies are also investigated. CONCLUSIONS: There are important practice variations in the management of severe COVID-19 patients, including differences at regional and individual levels. Large outcome studies based on multinational registries are warranted.


Asunto(s)
Infecciones por Coronavirus/terapia , Cuidados Críticos , Internacionalidad , Neumonía Viral/terapia , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Encuestas de Atención de la Salud , Humanos , Pandemias , Índice de Severidad de la Enfermedad
20.
Curr Opin Ophthalmol ; 31(5): 427-434, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32740067

RESUMEN

PURPOSE OF REVIEW: The COVID-19 pandemic has posed an unprecedented challenge to the healthcare community. To reduce disease transmission, national regulatory agencies temporarily recommended curtailment of all nonurgent office visits and elective surgeries in March 2020, including vitreoretinal outpatient care in the USA. The effect of these guidelines on utilization of vitreoretinal care has not been explored to date. RECENT FINDINGS: Retinal outpatient visits, new patient visits, intravitreal antivascular endothelial growth factor injections and in-office multimodal retinal imaging has seen a significant decline in utilization in the early phase of the pandemic. Intravitreal injections were performed at a comparatively higher rate than office visits. Utilization appeared to steadily increase in April 2020. Telemedicine visits, enabled by new national legislation for all areas of medicine, have been adopted to a modest degree by the retina community. SUMMARY: In-office retinal care declined in response to the COVID-19 pandemic and national regulatory guidelines limiting nonurgent care. These trends in practice patterns and care utilization may be of interest to vitreoretinal providers and all ophthalmologists at large.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Pandemias/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Neumonía Viral/epidemiología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Enfermedades de la Retina , Cuerpo Vítreo/patología , Atención Ambulatoria/estadística & datos numéricos , Bases de Datos Factuales , Prestación de Atención de Salud/estadística & datos numéricos , Registros Electrónicos de Salud/estadística & datos numéricos , Investigación sobre Servicios de Salud , Humanos , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/terapia , Telemedicina/estadística & datos numéricos , Estados Unidos/epidemiología
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