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2.
BMC Fam Pract ; 21(1): 271, 2020 12 18.
Artículo en Inglés | MEDLINE | ID: mdl-33339508

RESUMEN

BACKGROUND: The new coronavirus pneumonia (NCP) caused by COVID-19 has affected more than 46 million people worldwide. In China, primary care has played a vital role during the COVID-19 outbreak, and it is important to examine the challenges faced by general practitioners (GPs). This study investigated the roles, preparedness and training needs of GPs in China in managing the NCP outbreak. Based on the outcomes of the study, we hope to take lessons and identify how GPs could be supported in delivering their gatekeeping roles and clinical duties in times of infectious disease outbreak. METHODS: An online survey on the official website of Shenzhen Continuing Education Center. It included questions on GPs' demographics, their awareness of COVID-19 and their preparedness in managing suspected cases of NCP, as well as referrals and their training needs. Conditional multi-variate logistic models were used to investigate the relationships between GPs' preparedness, situational confidence and anxiety. RESULTS: GPs' clinical practice was significantly affected. GPs endeavoured to answer a flood of COVID-19-related enquiries, while undertaking community preventive tasks. In addition to in-person consultations, GP promoted COVID-19 awareness and education through telephone consultations, physical posters and social media. Overall GPs in Shenzhen felt well supported with adequate Personal Protective Equipment (PPE) and resources from secondary care services. Higher levels of self-perceived preparedness (OR = 2.19; 95%CI, 1.04-4.61), lower level of anxiety (OR = 0.56; 95%CI, 0.29-1.09) and fewer perceived family worries (OR = 0.37; 95%CI, 0.12-1.12) were associated with better confidence in coping at work. CONCLUSIONS: Training and supporting GPs while reducing their (and their families') anxiety increase their confidence in delivering the important roles of gatekeeping in face of major disease outbreaks.


Asunto(s)
/prevención & control , Planificación en Desastres/organización & administración , Brotes de Enfermedades/prevención & control , Pautas de la Práctica en Medicina/organización & administración , Atención Primaria de Salud/organización & administración , /epidemiología , China , Sistemas de Apoyo a Decisiones Clínicas , Humanos , Difusión de la Información , Equipo de Protección Personal/estadística & datos numéricos , Salud Pública
3.
Can J Surg ; 63(5): E435-E441, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33009902

RESUMEN

BACKGROUND: Most of the literature on emergency general surgery (EGS) has investigated appendiceal and biliary disease; however, EGS surgeons manage many other complex conditions. This study aimed to describe the operative burden of these conditions throughout Canada. METHODS: This multicentre retrospective cohort study evaluated EGS patients at 7 centres across Canada in 2014. Adult patients (aged ≥ 18 yr) undergoing nonelective operative interventions for nonbiliary, nonappendiceal diseases were included. Data collected included information on patients' demographic characteristics, diagnosis, procedure details, complications and hospital length of stay. Logistic regression was used to identify predictors of morbidity and mortality. RESULTS: A total of 2595 patients were included, with a median age of 60 years (interquartile range 46-73 yr). The most common principal diagnoses were small bowel obstruction (16%), hernia (15%), malignancy (11%) and perianal disease (9%). The most commonly performed procedures were bowel resection (30%), hernia repair (15%), adhesiolysis (11%) and débridement of skin and soft tissue infections (10%). A total of 47% of cases were completed overnight (between 5 pm and 8 am). The overall inhospital mortality rate was 8%. Thirty-three percent of patients had a complication, with independent predictors including increasing age (p = 0.001), increasing American Society of Anesthesiologists score (p = 0.02) and transfer from another centre (p = 0.001). CONCLUSION: This study characterizes the epidemiology of nonbiliary, nonappendiceal EGS operative interventions across Canada. Canadian surgeons are performing a large volume of EGS, and conditions treated by EGS services are associated with a substantial risk of morbidity and mortality. Results of this study will be used to guide future research efforts and set benchmarks for quality improvement.


Asunto(s)
Tratamiento de Urgencia/estadística & datos numéricos , Cirugía General/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Anciano , Benchmarking , Canadá , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Tratamiento de Urgencia/efectos adversos , Femenino , Cirugía General/organización & administración , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Pautas de la Práctica en Medicina/organización & administración , Mejoramiento de la Calidad , Estudios Retrospectivos , Procedimientos Quirúrgicos Operativos/efectos adversos , Resultado del Tratamiento
4.
Australas Psychiatry ; 28(6): 639-643, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33016772

RESUMEN

OBJECTIVE: To analyse the smaller Australian state/territory service impact of the introduction of new COVID-19 psychiatrist video and telephone telehealth Medicare Benefits Schedule (MBS) items. METHOD: MBS item service data were extracted for COVID-19 psychiatrist video and telephone telehealth item numbers corresponding to the pre-existing in-person consultations for the Australian Capital Territory (ACT), Northern Territory (NT), South Australia (SA) and Tasmania. RESULTS: The overall rate of consultations (face-to-face and telehealth) increased during March and April 2020, compared to the monthly face-to-face consultation average, excepting Tasmania. Compared to an annual monthly average of in-person consultations for July 2018-June 2019, total telepsychiatry consultations were higher for April than May. For total video and telephone telehealth consultations combined, video consultations were lower in April and higher in May. As a percentage of combined telehealth and in-person consultations, telehealth was greater for April and lower for May compared to the monthly face-to-face consultation average. CONCLUSIONS: In the smaller states/territories, the private practice workforce rapidly adopted COVID-19 MBS telehealth items, with the majority of psychiatric consultation shifting to telehealth initially, and then returning to face-to-face. With a second wave of COVID-19 in Australia, telehealth is likely to remain a vital part of the national mental health strategy.


Asunto(s)
Infecciones por Coronavirus , Servicios de Salud Mental , Pandemias , Neumonía Viral , Pautas de la Práctica en Medicina , Práctica Privada , Consulta Remota/métodos , Comunicación por Videocoferencia , Adulto , Australia/epidemiología , Betacoronavirus , Control de Enfermedades Transmisibles/métodos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/psicología , Femenino , Humanos , Revisión de Utilización de Seguros , Masculino , Servicios de Salud Mental/organización & administración , Servicios de Salud Mental/tendencias , Innovación Organizacional , Neumonía Viral/epidemiología , Neumonía Viral/psicología , Pautas de la Práctica en Medicina/organización & administración , Pautas de la Práctica en Medicina/tendencias , Práctica Privada/organización & administración , Práctica Privada/tendencias , Telemedicina/métodos
5.
Am J Geriatr Psychiatry ; 28(11): 1133-1145, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32863137

RESUMEN

The ubiquitous coronavirus 2019 (COVID-19) pandemic has required healthcare providers across all disciplines to rapidly adapt to public health guidelines to reduce risk while maintaining quality of care. Electroconvulsive therapy (ECT), which involves an aerosol-generating procedure from manual ventilation with a bag mask valve while under anesthesia, has undergone drastic practice changes in order to minimize disruption of treatment in the midst of COVID-19. In this paper, we provide a consensus statement on the clinical practice changes in ECT specific to older adults based on expert group discussions of ECT practitioners across the country and a systematic review of the literature. There is a universal consensus that ECT is an essential treatment of severe mental illness. In addition, there is a clear consensus on what modifications are imperative to ensure continued delivery of ECT in a manner that is safe for patients and staff, while maintaining the viability of ECT services. Approaches to modifications in ECT to address infection control, altered ECT procedures, and adjusting ECT operations are almost uniform across the globe. With modified ECT procedures, it is possible to continue to meet the needs of older patients while mitigating risk of transmission to this vulnerable population.


Asunto(s)
Infecciones por Coronavirus , Terapia Electroconvulsiva , Control de Infecciones/métodos , Trastornos Mentales , Innovación Organizacional , Pandemias , Neumonía Viral , Pautas de la Práctica en Medicina/organización & administración , Anciano , Betacoronavirus , Consenso , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Terapia Electroconvulsiva/efectos adversos , Terapia Electroconvulsiva/métodos , Terapia Electroconvulsiva/normas , Testimonio de Experto , Humanos , Control de Infecciones/organización & administración , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Guías de Práctica Clínica como Asunto , Revisiones Sistemáticas como Asunto
6.
Tex Med ; 116(8): 20-25, 2020 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-32866271

RESUMEN

Ricardo Garza, MD, was still walking the tightrope: standing, but unable to withstand another gust of wind. COVID-19 swept away about 35% of the San Antonio solo cardiologist's practice revenue, and that was just what he could calculate as he waited for insurers to process straggling claims. But he had returned to in-office operations without any layoffs. While some practices are surviving - and trying their best to prepare for future threats - others weren't so lucky. On-the-ground experiences align with the Texas Medical Association's Practice Viability Survey in showing COVID-19 was, and still is, a disruptor unlike any other - challenging or torpedoing the viability of various practice types.


Asunto(s)
Control de Enfermedades Transmisibles/métodos , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Práctica Profesional , Telemedicina , Betacoronavirus , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/epidemiología , Toma de Decisiones en la Organización , Transmisión de Enfermedad Infecciosa/prevención & control , Humanos , Innovación Organizacional , Pandemias/economía , Neumonía Viral/economía , Neumonía Viral/epidemiología , Pautas de la Práctica en Medicina/organización & administración , Pautas de la Práctica en Medicina/tendencias , Práctica Profesional/economía , Práctica Profesional/tendencias , Texas/epidemiología
7.
S Afr Med J ; 110(7): 613-616, 2020 05 21.
Artículo en Inglés | MEDLINE | ID: mdl-32880333

RESUMEN

Faced with a pandemic, doctors around the world are forced to make difficult ethical decisions about clinical, economic and politically charged issues in medicine and healthcare, with little time or resources for support. A decision-making framework is suggested to guide policy and clinical practice to support the needs of healthcare workers, help to allocate scarce resources equitably and promote communication among stakeholders, while drawing on South African doctors' knowledge, culture and experience.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Comunicación Interdisciplinaria , Evaluación de Resultado en la Atención de Salud , Pandemias/prevención & control , Neumonía Viral/prevención & control , Pautas de la Práctica en Medicina/organización & administración , Actitud del Personal de Salud , Toma de Decisiones Clínicas , Infecciones por Coronavirus/epidemiología , Países en Desarrollo , Femenino , Política de Salud , Recursos en Salud , Humanos , Masculino , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Formulación de Políticas , Sudáfrica
8.
Eur Urol ; 78(5): 731-742, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32893062

RESUMEN

CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid changes in medical practice. Many of these changes may add value to care, creating opportunities going forward. OBJECTIVE: To provide an evidence-informed, expert-derived review of genitourinary cancer care moving forward following the initial COVID-19 pandemic. EVIDENCE ACQUISITION: A collaborative narrative review was conducted using literature published through May 2020 (PubMed), which comprised three main topics: reduced in-person interactions arguing for increasing virtual and image-based care, optimisation of the delivery of care, and the effect of COVID-19 in health care facilities on decision-making by patients and their families. EVIDENCE SYNTHESIS: Patterns of care will evolve following the COVID-19 pandemic. Telemedicine, virtual care, and telemonitoring will increase and could offer broader access to multidisciplinary expertise without increasing costs. Comprehensive and integrative telehealth solutions will be necessary, and should consider patients' mental health and access differences due to socioeconomic status. Investigations and treatments will need to maximise efficiency and minimise health care interactions. Solutions such as one stop clinics, day case surgery, hypofractionated radiotherapy, and oral or less frequent drug dosing will be preferred. The pandemic necessitated a triage of those patients whose treatment should be expedited, delayed, or avoided, and may persist with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in circulation. Patients whose demographic characteristics are at the highest risk of complications from COVID-19 may re-evaluate the benefit of intervention for less aggressive cancers. Clinical research will need to accommodate virtual care and trial participation. Research dissemination and medical education will increasingly utilise virtual platforms, limiting in-person professional engagement; ensure data dissemination; and aim to enhance patient engagement. CONCLUSIONS: The COVID-19 pandemic will have lasting effects on the delivery of health care. These changes offer opportunities to improve access, delivery, and the value of care for patients with genitourinary cancers but raise concerns that physicians and health administrators must consider in order to ensure equitable access to care. PATIENT SUMMARY: The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the care provided to many patients with genitourinary cancers. This has necessitated a transition to telemedicine, changes in threshold or delays in many treatments, and an opportunity to reimagine patient care to maintain safety and improve value moving forward.


Asunto(s)
Infecciones por Coronavirus , Prestación de Atención de Salud , Pandemias , Neumonía Viral , Pautas de la Práctica en Medicina , Telemedicina/métodos , Neoplasias Urogenitales , Control de Enfermedades Transmisibles/métodos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Prestación de Atención de Salud/ética , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/normas , Prestación de Atención de Salud/tendencias , Humanos , Salud Mental/normas , Innovación Organizacional , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Pautas de la Práctica en Medicina/organización & administración , Pautas de la Práctica en Medicina/tendencias , Neoplasias Urogenitales/psicología , Neoplasias Urogenitales/terapia
10.
Phys Ther ; 100(10): 1759-1770, 2020 09 28.
Artículo en Inglés | MEDLINE | ID: mdl-32737503

RESUMEN

OBJECTIVES: Motion analysis is performed by physical therapists to assess and improve movement. Two-dimensional video-based motion analysis (VBMA) is available for smartphones/tablets and requires little to no equipment or cost. Research on VBMA use in clinical practice is limited. The purpose of this study was to examine the current use of VBMA in orthopedic physical therapist practice. METHODS: Members of the Academy of Orthopaedic Physical Therapy completed an online survey. Questions examined frequency of VBMA use, reasons for use, facilitators/barriers, device/apps used, practice patterns, other certificates/degrees, and demographic information. RESULTS: Among the final analysis sample of 477 respondents, 228 (47.8%) use VBMA. Of 228 VBMA users, 91.2% reported using it for ≤25% of their caseload, and 57.9% reported using their personal device to capture movement. Reasons for using VBMA included visual feedback for patient education (91.7%), analysis of movement (91.2%), and assessment of progress (51.8%). Barriers to use included lack of device/equipment (48.8%), lack of space (48.6%), and time restraint (32.1%). Those with ≤20 years of clinical experience (odds ratio [OR] = 1.83, 95% CI = 1.21-2.76), residency training (OR = 2.49, 95% CI = 1.14-5.43), and fellowship training (OR = 2.97, 95% CI = 1.32-6.66), and those from the West region of the United States (OR = 1.66, 95% CI = 1.07-2.56) were more likely to use VBMA. CONCLUSIONS: More than 50% of surveyed orthopedic physical therapists do not use VBMA in clinical practice. Future research should be directed toward assessing reliability and validity of VBMA use by smartphones, tablets, and apps and examining whether VBMA use enhances treatment outcomes. Data security, patient confidentiality, and integration into the electronic medical record should be addressed. IMPACT: This study is the first to our knowledge to describe the use of VBMA in orthopedic physical therapist practice in the United States. It is the first step in understanding how VBMA is used and might be used to enhance clinical assessment and treatment outcomes.


Asunto(s)
Actitud del Personal de Salud , Fisioterapeutas/normas , Modalidades de Fisioterapia/organización & administración , Pautas de la Práctica en Medicina/organización & administración , Grabación de Videodisco/métodos , Adulto , Femenino , Humanos , Masculino , Estados Unidos
11.
Health Aff (Millwood) ; 39(8): 1405-1411, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32744939

RESUMEN

Clinical care in the United States has been transformed during the coronavirus disease 2019 (COVID-19) pandemic. To support these changes, regulators and payers have temporarily modified long-standing policies, recognizing the need for a trade-off between the costs and benefits of oversight during times of crisis. Specifically, there has been a heightened receptivity to the importance of preserving physicians' and other health care professionals' time, cognitive bandwidth, and emotional reserve for the direct care of patients, instead of squandering these resources on low-value tasks and frustrating technology. Instead of reflexively reverting to past practices and policies, there is now an opportunity to take advantage of the lessons of COVID-19 for the further transformation of health care to achieve Quadruple Aim outcomes (better care for individuals, better health for the population, better experience for clinicians, and lower costs). We outline some of the policy and practice changes that we believe should endure after the crisis has passed, and we recommend using similar logic during noncrisis times to make additional changes to further reduce administrative burden, and thus improve patient care.


Asunto(s)
Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud/organización & administración , Política de Salud/legislación & jurisprudencia , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Infecciones por Coronavirus/terapia , Manejo de la Enfermedad , Femenino , Humanos , Masculino , Innovación Organizacional , Pandemias/prevención & control , Neumonía Viral/terapia , Formulación de Políticas , Administración de la Práctica Médica , Pautas de la Práctica en Medicina/organización & administración , Desarrollo de Programa , Estados Unidos
13.
Ren Fail ; 42(1): 710-725, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32713282

RESUMEN

Coronavirus disease 19 (COVID-19) became a nightmare for the world since December 2019. Although the disease affects people at any age; elderly patients and those with comorbidities were more affected. Everyday nephrologists see patients with hypertension, chronic kidney disease, maintenance dialysis treatment or kidney transplant who are also high-risk groups for the COVID-19. Beyond that, COVID-19 or severe acute respiratory syndrome (SARS) due to infection may directly affect kidney functions. This broad spectrum of COVID-19 influence on kidney patients and kidney functions obviously necessitate an up to date management policy for nephrological care. This review overviews and purifies recently published literature in a question to answer format for the practicing nephrologists that will often encounter COVID-19 and kidney related cases during the pandemic times.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Control de Infecciones/organización & administración , Nefrólogos/organización & administración , Pandemias/prevención & control , Neumonía Viral/prevención & control , Diálisis Renal/métodos , Administración de la Seguridad/organización & administración , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/terapia , Adulto , Anciano , Infecciones por Coronavirus/epidemiología , Femenino , Salud Global , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Nefrología/organización & administración , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Pautas de la Práctica en Medicina/organización & administración , Diálisis Renal/estadística & datos numéricos
14.
Afr J Prim Health Care Fam Med ; 12(1): e1-e4, 2020 Jun 09.
Artículo en Inglés | MEDLINE | ID: mdl-32634002

RESUMEN

Ten family physicians and family medicine registrars in a South African semi-rural training complex reflected on the coronavirus disease 2019 (COVID-19) crisis during their quarterly training complex meeting. The crisis has become the disruptor that is placing pressure on the traditional roles of the family physician. The importance of preventative and promotive care in a community-oriented approach, being a capacity builder and leading the health team as a consultant have assumed new meanings.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Medicina Familiar y Comunitaria/organización & administración , Neumonía Viral/terapia , Pautas de la Práctica en Medicina/organización & administración , Atención Primaria de Salud/organización & administración , Actitud del Personal de Salud , Creación de Capacidad/organización & administración , Competencia Clínica , Medicina Familiar y Comunitaria/educación , Humanos , Pandemias , Médicos de Familia/organización & administración , Sudáfrica
15.
PLoS One ; 15(7): e0235363, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32628732

RESUMEN

OBJECTIVE: There are differences in the adoption rates of less invasive surfactant administration (LISA) worldwide. We aimed to describe and analyze the process of LISA introduction at the country level. METHODS: A standardized training program (33 courses covering >500 neonatologists) was followed by a cohort study. Data regarding consecutive LISA procedures were acquired over 12 months in 31 tertiary neonatal centers, using a dedicated on-line platform. RESULTS: Of 500 LISA procedures, 75% were performed by specialists and 25% by residents. The mean percentage share of LISA in all surfactant therapies was 24%, which represents a 6-fold increase compared to previous years. After 12 months, 76% of the procedures were rated "easy/very easy" vs 59% at baseline (p<0.05). Surfactant re-treatment rate was 15%. Twenty-three percent of infants required mechanical ventilation within 72 hours of life. Oxygen desaturation and surfactant reflux were the most frequent complications. Unlike previous reports describing exclusive use of nasal continuous positive airway pressure (nCPAP) during LISA, majority of procedures (63%) were carried out using nasal intermittent positive pressure ventilation (NIPPV) or Bilevel Positive Airway Pressure (BiPAP). Efficacy of LISA with NIPPV or BiPAP was not significantly different from that with nCPAP (22.4% vs 24.5% of cases requiring intubation). Ventilation was provided with nasal cannulas or nasal masks (90%) and rarely with "RAM" cannulas or nasopharyngeal tubes. Rigid catheters were preferred (88.4%); tracheal insertion was successful at first attempt in 87% of cases. Majority of infants (79%) received no premedication prior to the procedure and almost all were given caffeine citrate. Median time of instillation was 1.5 minutes. CONCLUSIONS: The LISA procedure does not appear to be technically difficult to master. Training combining theory with practical exercises is an efficient implementation strategy. Variations in adoption rates indicate the need for additional, more personalized teachings in some centers.


Asunto(s)
Implementación de Plan de Salud/estadística & datos numéricos , Respiración con Presión Positiva/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Surfactantes Pulmonares/administración & dosificación , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Internado y Residencia/organización & administración , Internado y Residencia/estadística & datos numéricos , Masculino , Neonatólogos/educación , Neonatólogos/estadística & datos numéricos , Polonia , Respiración con Presión Positiva/efectos adversos , Respiración con Presión Positiva/métodos , Pautas de la Práctica en Medicina/organización & administración , Estudios Prospectivos
17.
Head Neck ; 42(7): 1482-1490, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32557972

RESUMEN

BACKGROUND: Management of head and neck cancers (HNC) in radiation oncology in the coronavirus disease 2019 (COVID-19) era is challenging. Aim of our work is to report organization strategies at a radiation therapy (RT) department in the first European area experiencing the COVID-19 pandemic. METHODS: We focused on (a) dedicated procedures for HNC, (b) RT scheduling, and (c) health care professionals' protection applied during the COVID-19 breakdown (from March 1, 2020 to April 30, 2020). RESULTS: Applied procedures are reported and discussed. Forty-three patients were treated. Image-guided, intensity modulated RT was performed in all cases. Median overall treatment time was 50 (interquartile range: 47-54.25) days. RT was interrupted/delayed in seven patients (16%) for suspected COVID-19 infection. Two health professionals managing HNC patients were proven as COVID-19 positive. CONCLUSION: Adequate and well-timed organization allowed for the optimization of HNC patients balancing at the best of our possibilities patients' care and personnel's safety.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Neoplasias de Cabeza y Cuello/radioterapia , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Anciano , Femenino , Humanos , Control de Infecciones/organización & administración , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Italia/epidemiología , Masculino , Persona de Mediana Edad , Salud Laboral , Seguridad del Paciente , Equipo de Protección Personal , Pautas de la Práctica en Medicina/organización & administración , Radioterapia Guiada por Imagen , Radioterapia de Intensidad Modulada , Flujo de Trabajo
18.
Plast Reconstr Surg ; 146(5): 1197-1206, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32541534

RESUMEN

The worldwide outbreak of coronavirus disease 2019 (COVID-19) has forced health care systems across the United States to undertake broad restructuring to address the ongoing crisis. The framework of crisis management can assist plastic surgeons navigate the dynamic environment of the COVID-19 pandemic. This article outlines crisis management tools at a number of different levels, from hospital-wide to plastic surgeon-specific, and it offers a practical discussion of the coronavirus situation as it affects plastic surgeons. Although there are innumerable ways that this virus is currently changing plastic surgeons' practices, it is crucial to remember that these changes are temporary, and they will be best met by being confronted head-on.


Asunto(s)
Infecciones por Coronavirus , Pandemias , Neumonía Viral , Administración de la Práctica Médica/organización & administración , Pautas de la Práctica en Medicina/organización & administración , Cirujanos/organización & administración , Cirugía Plástica/organización & administración , Asignación de Recursos para la Atención de Salud/organización & administración , Humanos , Liderazgo , Estados Unidos
19.
PLoS One ; 15(6): e0234425, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32542028

RESUMEN

BACKGROUND: Amid the ongoing U.S. opioid crisis, achieving safe and effective chronic pain management while reducing opioid-related morbidity and mortality is likely to require multi-level efforts across health systems, including the Military Health System (MHS), Department of Veterans Affairs (VA), and civilian sectors. OBJECTIVE: We conducted a series of qualitative panel discussions with national experts to identify core challenges and elicit recommendations toward improving the safety of opioid prescribing in the U.S. DESIGN: We invited national experts to participate in qualitative panel discussions regarding challenges in opioid risk mitigation and how best to support providers in delivery of safe and effective opioid prescribing across MHS, VA, and civilian health systems. PARTICIPANTS: Eighteen experts representing primary care, emergency medicine, psychology, pharmacy, and public health/policy participated. APPROACH: Six qualitative panel discussions were conducted via teleconference with experts. Transcripts were coded using team-based qualitative content analysis to identify key challenges and recommendations in opioid risk mitigation. KEY RESULTS: Panelists provided insight into challenges across multiple levels of the U.S. health system, including the technical complexity of treating chronic pain, the fraught national climate around opioids, the need to integrate surveillance data across a fragmented U.S. health system, a lack of access to non-pharmacological options for chronic pain care, and difficulties in provider and patient communication. Participating experts identified recommendations for multi-level change efforts spanning policy, research, education, and the organization of healthcare delivery. CONCLUSIONS: Reducing opioid risk while ensuring safe and effective pain management, according to participating experts, is likely to require multi-level efforts spanning military, veteran, and civilian health systems. Efforts to implement risk mitigation strategies at the patient level should be accompanied by efforts to increase education for patients and providers, increase access to non-pharmacological pain care, and support use of existing clinical decision support, including state-level prescription drug monitoring programs.


Asunto(s)
Analgésicos Opioides/efectos adversos , Dolor Crónico/terapia , Manejo del Dolor/métodos , Pautas de la Práctica en Medicina/organización & administración , Programas de Monitoreo de Medicamentos Recetados/organización & administración , Analgésicos Opioides/normas , Sistemas de Apoyo a Decisiones Clínicas/organización & administración , Prescripciones de Medicamentos/normas , Femenino , Humanos , Colaboración Intersectorial , Masculino , Servicios de Salud Militares/normas , Epidemia de Opioides , Educación del Paciente como Asunto/organización & administración , Pautas de la Práctica en Medicina/normas , Mal Uso de Medicamentos de Venta con Receta/prevención & control , Programas de Monitoreo de Medicamentos Recetados/normas , Atención Primaria de Salud/organización & administración , Atención Primaria de Salud/normas , Investigación Cualitativa , Estados Unidos/epidemiología , United States Department of Veterans Affairs/organización & administración , United States Department of Veterans Affairs/normas
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