Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.857
Filtrar
2.
Ann Fam Med ; 19(1): 44-47, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33431391

RESUMEN

We studied the changes in presented health problems and demand for primary care since the outbreak of coronavirus disease 2019 (COVID-19) in the Netherlands. We analyzed prominent symptom features of COVID-19, and COVID-19 itself as the reason for encounter. Also, we analyzed the number and type of encounters for common important health problems. Respiratory tract symptoms related to COVID-19 were presented more often in 2020 than in 2019. We observed a dramatic increase of telephone/e-mail/Internet consultations in the months after the outbreak. Contacts for other health problems such as prevention and acute and chronic conditions plummeted substantially (P <0.001); mental health problems stabilized.


Asunto(s)
/terapia , Medicina Familiar y Comunitaria/tendencias , Necesidades y Demandas de Servicios de Salud/tendencias , Pautas de la Práctica en Medicina/tendencias , Atención Primaria de Salud/tendencias , Humanos , Países Bajos/epidemiología , Derivación y Consulta/tendencias , Telemedicina/tendencias
4.
Medicina (Kaunas) ; 57(2)2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33499251

RESUMEN

Throughout 2020, the COVID-19 pandemic has had a major impact on the care of non-communicable diseases across the world and diabetes is no exception. Whereas many branches of medicine have adapted to telemedicine, this is difficult and challenging for the diabetic foot which often requires "hands on" treatment. This review covers the challenges that have faced clinicians across the world in the management of complex diabetic foot problems and also includes some illustrative case vignettes which show how it is possible to manage foot ulcers without the usual access to laboratory and radiological testing. There is no doubt that the COVID-19 experience when handling diabetic foot problems will likely transform our approach to the management of diabetic foot disease especially in the areas of digital health and smart technology.


Asunto(s)
Pie Diabético/terapia , Salud Global/tendencias , Pautas de la Práctica en Medicina/tendencias , Telemedicina/métodos , Humanos
5.
J Dermatolog Treat ; 32(1): 70-72, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31122085

RESUMEN

Objectives: Antibiotics are commonly used in dermatology for infectious and inflammatory diseases, and dermatologists prescribe the most antibiotics per physician of any specialist in the United States (US). While oral antibiotics are effective for many conditions, adverse effects and increase in resistance are important public health issues. The purpose of this study is to examine trends in oral antibiotic prescription by US dermatologists using Medicare claims.Materials and Methods: Retrospective review using publicly available Medicare Part D prescriber public use files from 2013 to 2016.Results: The number of dermatologists within the Medicare system increased from 10,210 to 10,749. The proportion of prescriptions by dermatologists that were oral antibiotics increased from 10.0% to 10.7% (p = .023). The use of oral antibiotics increased 10.1% (2.9 claims per 1,000 beneficiaries) from 28.7 to 31.6 claims per 1,000 beneficiaries. There were more oral antibiotic prescriptions in the South than in other regions. Doxycycline was the most commonly prescribed antibiotic each year in all regions.Conclusions: Between 2013 and 2016, the number of oral antibiotics prescribed by dermatologists has increased among Medicare patients. Dermatologists must continue to reevaluate antibiotic prescription practices, particularly among the elderly population, in order to provide optimal care to patients.


Asunto(s)
Antibacterianos/administración & dosificación , Pautas de la Práctica en Medicina/tendencias , Administración Oral , Bases de Datos Factuales , Dermatólogos , Prescripciones de Medicamentos/estadística & datos numéricos , Humanos , Medicare , Estudios Retrospectivos , Estados Unidos
6.
Med Care ; 59(1): 58-61, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33136711

RESUMEN

BACKGROUND: During the COVID-19 pandemic, there is concern that social distancing, fear of contagion, quarantining of providers, cancellation of elective procedures, media coverage about the pandemic, and other factors drastically reduced physician visits, putting severe financial strain on outpatient providers, and having unknown ramifications for health outcomes. OBJECTIVES: We estimate the effect of the pandemic on utilization of outpatient services. RESEARCH DESIGN: Using 2010-2020 data from a national dataset, the Outpatient Influenza-like Illness Surveillance Network, we estimate the difference in outpatient care utilization during the time period of the COVID-19 pandemic versus the same weeks in prior years. RESULTS: Our findings indicate that the pandemic started to reduce visits during the week of March 15-21. The effect on visits grew until reaching a peak during the week of April 5-11, 2020, when the pandemic reduced the total number of outpatient visits per provider by 70% relative to the same week in prior years. We find negative effects of the pandemic on visits for non-flu symptoms as well as on visits for flu symptoms, but the magnitudes of these latter effects tended to be larger in magnitude. The pandemic's impact declined over time, and by the week of June 28 to July 4, 2020, there was no longer any difference in total visits per provider relative to the same week in prior years. Despite the resurgence of COVID-19 in June and July, we still find no effects on total visits when our data end in July 26 to August 1, 2020. CONCLUSIONS: Our findings show that one by-product of the COVID-19 pandemic in the United States is a large decline in the use of outpatient care which peaked around the week of April 5-11. Total outpatient visits rebounded completely and remain stable as of July 26 to August 1, 2020.


Asunto(s)
Atención Ambulatoria/tendencias , Utilización de Instalaciones y Servicios/tendencias , Pautas de la Práctica en Medicina/tendencias , Humanos , Estados Unidos
7.
JAMA Netw Open ; 3(12): e2029669, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33320265

RESUMEN

Importance: Optic nerve sheath fenestration (ONSF) and cerebrospinal fluid shunting are sometimes used to treat pseudotumor cerebri syndrome (PTCS), but their use patterns are unknown. Objectives: To investigate the frequency of surgical PTCS treatment in the United States and to compare patients undergoing ONSF with those treated with shunting. Design, Setting, and Participants: This was a retrospective longitudinal cross-sectional study. Inpatient data were obtained from the National Inpatient Sample (NIS), and outpatient surgical center data were obtained from the National Survey of Ambulatory Surgery (NSAS) and National Hospital Ambulatory Medical Care Survey (NHAMCS). Included in the analysis were 10 720 patients aged 18 to 65 years with a diagnosis code for PTCS, excluding venous thrombosis and other causes of intracranial hypertension. Time trends were explored and logistic regression was used to measure differences according to age, race/ethnicity, sex, Elixhauser comorbidity index, and other patient and hospital characteristics. Data analysis was performed from March 31 to October 7, 2020. Exposure: Treatment for PTCS, excluding venous thrombosis and other causes of intracranial hypertension. Main Outcomes and Measures: Annual number of PTCS-related admissions, ONSFs, and shunt procedures from 2002-2016. Patient and hospital-level characteristics of patients with PTCS undergoing ONSF or shunting were compared. Results: Between 2010 and 2016, 297 ONSFs were performed and 10 423 shunts were placed as treatment for PTCS. The procedures were most commonly performed in individuals aged 26 to 35 years (39.4%), and 9920 (92.4%) of the surgically treated patients were women. ONSF was more common among younger patients (eg, adjusted odds ratio [AOR] for patients ≥46 years vs those 18-25 years, 0.22; 95% CI, 0.08-0.61) and in Black, Hispanic, or other minority populations (AOR, 2.37; 95% CI, 1.31-4.30) and less common in the South (AOR, 0.34; 95% CI, 0.13-0.88) and West (AOR, 0.15; 95% CI, 0.04-0.58) compared with the Northeast. Total PTCS-related hospitalizations increased from 6081 (95% CI, 5137-7025) in 2002 to 18 020 (95% CI, 16 607-19 433) in 2016. Shunting increased from 2002 to 2011 and subsequently plateaued and declined. ONSF was used much less frequently, and use has not increased. No instances of outpatient ONSF or shunting for PTCS were recorded in the NSAS or NHAMCS databases. Conclusions and Relevance: This study's findings suggest that shunting is more common than ONSF and that the use gap has widened as shunting has increased. However, because overall PTCS-related hospitalizations have increased even more rapidly, the percentage of inpatients with PTCS undergoing surgery has decreased. These trends may reflect changes in medical treatment practices and outcomes or growing limitations in access to ophthalmic surgical expertise.


Asunto(s)
Derivaciones del Líquido Cefalorraquídeo , Hipertensión Intracraneal , Procedimientos Quirúrgicos Oftalmológicos , Nervio Óptico/cirugía , Seudotumor Cerebral/cirugía , Adulto , Derivaciones del Líquido Cefalorraquídeo/métodos , Derivaciones del Líquido Cefalorraquídeo/estadística & datos numéricos , Estudios Transversales , Femenino , Hospitalización/estadística & datos numéricos , Hospitalización/tendencias , Humanos , Hipertensión Intracraneal/etiología , Hipertensión Intracraneal/cirugía , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Oftalmológicos/métodos , Procedimientos Quirúrgicos Oftalmológicos/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Pautas de la Práctica en Medicina/tendencias , Seudotumor Cerebral/diagnóstico , Seudotumor Cerebral/epidemiología , Seudotumor Cerebral/fisiopatología , Estados Unidos/epidemiología
8.
Rev Gastroenterol Peru ; 40(3): 219-223, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33181807

RESUMEN

INTRODUCTION: During the COVID-19 pandemic, endoscopic procedures are associated with a high risk of SARS-CoV-2 infection. However, in cases of upper gastrointestinal bleeding (UGIB), priority should be given to an early endoscopy. OBJECTIVE: The main objective was to compare the time since arrival at the hospital and the performance of the endoscopy between both groups. MATERIALS AND METHODS: We performed a retrospective study. Data contains information of patients who attended to the hospital with UGIB and underwent an endoscopy between October 19th, 2019 and June 6th, 2020. Patients were divided into 2 phases: pre-pandemic and pandemic. The time between arrival at the hospital and the performance of the endoscopy in both phases were compared as well as other indicators such hospital stay and in-hospital mortality. RESULTS: With information from 219 patients, the median age was 69 years. 154 and 65 endoscopies were performed in pre-pandemic and pandemic phase, respectively. The time between arrival at the hospital and the performance of the endoscopy was significantly longer during the pandemic (10.00 vs. 13.08 hours, p-value = 0.019). Nevertheless, there were no significant differences in hospital stay or mortality. CONCLUSION: The management of patients with UGIB during the COVID-19 pandemic is complex and requires the application of clinical judgment to decide the best timing to perform an endoscopy without affecting patient care.


Asunto(s)
Infecciones por Coronavirus , Endoscopía Gastrointestinal/tendencias , Hemorragia Gastrointestinal/diagnóstico por imagen , Pandemias , Neumonía Viral , Pautas de la Práctica en Medicina/tendencias , Tiempo de Tratamiento/tendencias , Tracto Gastrointestinal Superior/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Toma de Decisiones Clínicas , Infecciones por Coronavirus/prevención & control , Femenino , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/mortalidad , Hemorragia Gastrointestinal/terapia , Mortalidad Hospitalaria/tendencias , Humanos , Control de Infecciones/métodos , Tiempo de Internación/tendencias , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Perú , Neumonía Viral/prevención & control , Estudios Retrospectivos
9.
Rev. esp. cardiol. (Ed. impr.) ; 73(11): 910-918, nov. 2020. tab
Artículo en Español | IBECS | ID: ibc-192006

RESUMEN

La pandemia producida por la infección por el coronavirus SARS-CoV-2 (COVID-19) ha cambiado la forma de entender nuestras consultas. Para reducir el riesgo de contagio de los pacientes más vulnerables (aquellos con cardiopatías) y del personal sanitario, se han suspendido la mayoría de las consultas presenciales y se han puesto en marcha las consultas telemáticas. Este cambio se ha implementado en muy poco tiempo, pero parece que ha venido para quedarse. No obstante, hay grandes dudas sobre aspectos organizativos, legales, posibilidades de mejora, etc. En este documento de consenso de la Sociedad Española de Cardiología, tratamos de dar las claves para mejorar la calidad asistencial en nuestras nuevas consultas telemáticas, revisando las afecciones que el cardiólogo clínico atiende con más frecuencia en su consulta ambulatoria y proponiendo unos mínimos en ese proceso asistencial. Estas enfermedades son la cardiopatía isquémica, la insuficiencia cardiaca y las arritmias. En los 3 escenarios tratamos de clarificar los aspectos fundamentales que hay que revisar en la entrevista telefónica, a qué pacientes habrá que atender en una consulta presencial y cuáles serán los criterios para su seguimiento en atención primaria. El documento también recoge distintas mejoras que pueden introducirse en la consulta telemática para mejorar la asistencia de nuestros pacientes


The coronavirus disease 2019 (COVID-19) pandemic has changed how we view our consultations. To reduce the risk of spread in the most vulnerable patients (those with heart disease) and health personnel, most face-to-face consultations have been replaced by telemedicine consultations. Although this change has been rapidly introduced, it will most likely become a permanent feature of clinical practice. Nevertheless, there remain serious doubts about organizational and legal issues, as well as the possibilities for improvement etc. In this consensus document of the Spanish Society of Cardiology, we attempt to provide some keys to improve the quality of care in this new way of working, reviewing the most frequent heart diseases attended in the cardiology outpatient clinic and proposing some minimal conditions for this health care process. These heart diseases are ischemic heart disease, heart failure, and arrhythmias. In these 3 scenarios, we attempt to clarify the basic issues that must be checked during the telephone interview, describe the patients who should attend in person, and identify the criteria to refer patients for follow-up in primary care. This document also describes some improvements that can be introduced in telemedicine consultations to improve patient care


Asunto(s)
Humanos , Telecardiología , Consulta Remota/métodos , Infecciones por Coronavirus/epidemiología , Isquemia Miocárdica/epidemiología , Insuficiencia Cardíaca/epidemiología , Arritmias Cardíacas/epidemiología , Pautas de la Práctica en Medicina/tendencias , Pandemias/estadística & datos numéricos , Cuarentena/estadística & datos numéricos , Distancia Social , Infecciones por Coronavirus/transmisión , Mejoramiento de la Calidad/tendencias
10.
Facial Plast Surg Aesthet Med ; 22(6): 464-470, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33054375

RESUMEN

Introduction: The objectives of this study among facial plastic and reconstructive surgeons (FPRS), include (1) quantifying the use of telemedicine, (2) examining the impact of novel coronavirus-19 (COVID-19) on telemedicine practices, (3) highlighting the types of telemedicine employed, (4) anticipating how telemedicine will be utilized in the future, and (5) describing FPRS' attitudes and understanding of telemedicine technologies. Study Type: Cross-sectional survey. Methods: A 6-13 question survey was sent to the American Academy of Facial Plastic and Reconstructive Surgery membership. Descriptive analyses were performed, along with a Fisher's exact test. Results: We received 100 responses from a diverse group of surgeons across the United States. Overall, 91% of responders utilize telemedicine, of which 76.9% began during the COVID-19 pandemic. 33.3% of responders thought that their platforms were not Health Insurance Portability and Accountability Act compliant or were unsure. Of those that utilize telemedicine, the two biggest concerns were difficulties with physical examination (69.2%) and lack of human connection (44%). 75.8% of telemedicine utilizers plan to incorporate telemedicine into their practice moving forward. Of all responders, 71% believed that telemedicine will have a positive effect on the field of FPRS, although on univariate analysis those in practice >20 years were more likely to believe that there will be no effect or a negative effect (p = 0.014). Conclusions: The COVID-19 pandemic has accelerated the adoption of telemedicine among FPRS in the United States. The great majority of responders plan to incorporate telemedicine into their practice even after the pandemic subsides and believe that telemedicine will have a net positive effect on the field of FPRS.


Asunto(s)
Actitud del Personal de Salud , Infecciones por Coronavirus , Pandemias , Atención Perioperativa/tendencias , Neumonía Viral , Pautas de la Práctica en Medicina/tendencias , Procedimientos Quirúrgicos Reconstructivos , Cirugía Plástica/tendencias , Telemedicina/tendencias , Estudios Transversales , Humanos , Atención Perioperativa/métodos , Cirujanos , Cirugía Plástica/métodos , Encuestas y Cuestionarios , Telemedicina/métodos , Estados Unidos
11.
J Crohns Colitis ; 14(Supplement_3): S780-S784, 2020 Oct 21.
Artículo en Inglés | MEDLINE | ID: mdl-33085971

RESUMEN

Before the onset of the COVID-19 pandemic, the majority of care for inflammatory bowel disease patients was provided in-person. The practice of gastroenterology care has since rapidly transformed, with telemedicine emerging as an essential tool to provide medical care to patients while maintaining social distancing and conserving personal protective equipment. This article provides insight into past and current practices among inflammatory bowel disease specialists and shares regulatory, financial and practical considerations for incorporating telemedicine into clinical practice. Continued government and other payer support for telemedicine and ongoing innovation to provide remote objective patient data will help to sustain the use of telemedicine long after the current pandemic subsides.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Gastroenterología/métodos , Enfermedades Inflamatorias del Intestino/terapia , Pandemias/prevención & control , Neumonía Viral/prevención & control , Pautas de la Práctica en Medicina/tendencias , Telemedicina/métodos , Gastroenterología/organización & administración , Gastroenterología/tendencias , Salud Global , Humanos , Enfermedades Inflamatorias del Intestino/complicaciones , Pautas de la Práctica en Medicina/normas , Telemedicina/organización & administración , Telemedicina/tendencias
12.
Can J Surg ; 63(5): E396-E408, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33009899

RESUMEN

BACKGROUND: The scope of practice of general surgeons in Canada is highly variable. The objective of this study was to examine the demographic characteristics of general surgeons in Canada and compare surgical procedures performed across community sizes and specialties. METHODS: Data from the Canadian Institute for Health Information's National Physician Database were used to analyze fee-for-service (FFS) care provided by general surgeons and other providers across Canada in 2015/16. RESULTS: Across 8 Canadian provinces, 1669 general surgeons provided FFS care. The majority of the surgeons worked in communities with more than 100 000 residents (71%), were male (78%), were aged 35-54 years (56%) and were Canadian medical graduates (76%). Only 7% of general surgeons practised in rural areas and 14% in communities with between 10 000 and 50 000 residents. Rural communities were significantly more likely to have surgeons who were international medical graduates or who were older than 65 years. The surgical procedures most commonly performed by general surgeons were hernia repairs, gallbladder and biliary tree surgery, excision of skin tumours, colon and intestine resections and breast surgery. Many general surgeons performed procedures not listed in their Royal College of Physicians and Surgeons of Canada training objectives. CONCLUSION: Canadian general surgeons provide a wide array of surgical services, and practice patterns vary by community size. Surgeons practising in rural and small communities require proficiency in skills not routinely taught in general surgery residency. Opportunities to acquire these skills should be available in training to prepare surgeons to meet the care needs of Canadians.


Asunto(s)
Cirugía General/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/tendencias , Pautas de la Práctica en Medicina/estadística & datos numéricos , Alcance de la Práctica/tendencias , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Adulto , Canadá , Competencia Clínica/estadística & datos numéricos , Planes de Aranceles por Servicios/estadística & datos numéricos , Femenino , Cirugía General/economía , Cirugía General/educación , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Internado y Residencia/tendencias , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/tendencias , Servicios de Salud Rural/estadística & datos numéricos , Servicios de Salud Rural/tendencias , Cirujanos/economía , Cirujanos/educación , Cirujanos/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/economía , Procedimientos Quirúrgicos Operativos/educación
13.
J Stroke Cerebrovasc Dis ; 29(11): 105228, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33066882

RESUMEN

BACKGROUND: This report aims to describe changes that centres providing transient ischaemic attack (TIA) pathway services have made to stay operational in response to the SARS-CoV-2 pandemic. METHODS: An international cross-sectional description of the adaptions of TIA pathways between 30th March and 6th May 2020. Experience was reported from 18 centres with rapid TIA pathways in seven countries (Australia, France, UK, Canada, USA, New Zealand, Italy, Canada) from three continents. RESULTS: All pathways remained active (n = 18). Sixteen (89%) had TIA clinics. Six of these clinics (38%) continued to provide in-person assessment while the majority (63%) used telehealth exclusively. Of these, three reported PPE use and three did not. Five centres with clinics (31%) had adopted a different vascular imaging strategy. CONCLUSION: The COVID pandemic has led TIA clinics around the world to adapt and move to the use of telemedicine for outpatient clinic review and modified investigation pathways. Despite the pandemic, all have remained operational.


Asunto(s)
Infecciones por Coronavirus/terapia , Vías Clínicas/tendencias , Prestación Integrada de Atención de Salud/tendencias , Equipo Hospitalario de Respuesta Rápida/tendencias , Ataque Isquémico Transitorio/terapia , Neumonía Viral/terapia , Pautas de la Práctica en Medicina/tendencias , Telemedicina/tendencias , Australia , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/virología , Estudios Transversales , Diagnóstico por Imagen/tendencias , Europa (Continente) , Humanos , Ataque Isquémico Transitorio/diagnóstico , Nueva Zelanda , América del Norte , Pandemias , Equipo de Protección Personal/tendencias , Neumonía Viral/diagnóstico , Neumonía Viral/virología , Factores de Tiempo
14.
J Stroke Cerebrovasc Dis ; 29(11): 105209, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33066926

RESUMEN

BACKGROUND AND PURPOSE: Testing for thrombophilic disorders is often performed in patients after cryptogenic ischemic stroke in an attempt to identify a hematologic explanation for the event. However, the role of commonly tested thrombophilias in ischemic stroke is poorly defined. There is limited evidence to quantify how these disorders affect ischemic stroke risk and testing practices are highly variable. METHODS: Retrospective evaluation of thrombophilia testing practices and clinical outcomes was performed in hospitalized patients with acute ischemic stroke (n = 1898) at a large academic hospital over a two-year period. Variables assessed included testing components, timing of testing, number of abnormal results, and frequency of change in clinical management prompted by abnormal results. A provider survey was also performed to assess perceptions of current testing practices and provider understanding of testing indications. RESULTS: Thrombophilia testing was performed in 190 (10%) patients admitted for acute ischemic stroke. Of those tested, 137 (72.1%) had at least one abnormal result, but this decreased to 37.4% when elevated factor VIII activity was excluded. An abnormal result prompted initiation of anticoagulation in only 4 patients (2%). The provider survey indicated that all providers (100%) were selecting thrombophilia tests using a pre-existing order set and were interested in additional education on testing indications and interpretation. Comparison to similar studies at other institutions revealed significant variation in testing practices, and a small proportion of patients in which testing prompted a change in management (1-8%). CONCLUSIONS: Thrombophilia testing is frequently obtained in hospitalized patients with acute ischemic stroke, yet testing only changed management in 2% of patients. Efforts to improve provider education and the stewardship of testing are needed to ensure appropriate evaluation and treatment of patients with acute ischemic stroke.


Asunto(s)
Pruebas de Coagulación Sanguínea/tendencias , Coagulación Sanguínea , Isquemia Encefálica/etiología , Hospitalización , Pautas de la Práctica en Medicina/tendencias , Accidente Cerebrovascular/etiología , Trombofilia/diagnóstico , Adulto , Anciano , Anticoagulantes/uso terapéutico , Coagulación Sanguínea/efectos de los fármacos , Isquemia Encefálica/diagnóstico , Toma de Decisiones Clínicas , Femenino , Disparidades en Atención de Salud/tendencias , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico , Trombofilia/sangre , Trombofilia/complicaciones , Trombofilia/tratamiento farmacológico
15.
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
16.
Arch Pediatr ; 27(8): 423-427, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33011025

RESUMEN

BACKGROUND: The outbreak of COVID-19 has imposed many challenges on health systems. The purpose of this study was to describe the impact of the COVID-19 pandemic on the clinical activity of pediatricians. METHODS: We conducted a cross-sectional and descriptive online survey among pediatricians practicing in Cameroon. Data were collected through an anonymous pre-tested Google Form®. RESULTS: Among the 118 pediatricians eligible for the survey, 101 responded (85.6%), of whom 61.2% were women. The pediatric outpatient consultations dropped significantly from 60.4% of pediatricians seeing more than 30 patients per week before the pandemic to 9.9% during the pandemic (P<0.000). According to the occupancy rate of hospitalisation beds, 45.5% of pediatricians reported having 76-100% of pediatric hospitalisation beds occupied per week before the pandemic but no pediatrician reported a similar rate during the pandemic (P<0.000). There was a significant increase in the use of telehealth, ranging from no pediatrician using telehealth "very frequently" before the pandemic to 23.8% using it during the pandemic (P<0.000). Most of the pediatricians had at their disposal surgical masks (96%), care gloves (80.2%), hydroalcoholic gel (99.0%), and soap and water (86.1%). For the management of children, 90.1% and 71.3% of pediatricians experienced difficulties accessing COVID-19 PCR and chloroquine, respectively, and 74.3% declared difficulties for proper isolation of patients. More than half (65.3%) of the pediatricians interviewed were "very afraid" or "extremely afraid" of being infected with SARS-Cov-2, respectively 45.5% and 19.8%. The most frequent reasons included fear of infecting their relatives (85.1%) and of developing a severe form of the disease (43.6%). The reluctance to consult health services expressed by the parents was due to: fear of being infected when leaving their home and especially in the health facility (96%), strict compliance with confinement (30.7%), and financial difficulties of families (13.9%). CONCLUSION: This work highlights the impact of the coronavirus pandemic on the clinical activity of Cameroonian pediatricians. Since the beginning of the pandemic, there has been a significant drop in the use of health facilities, which probably has a negative impact on children's overall level of health. Although the preventive measures explain this drop in attendance at health facilities, the parents' fear of being infected when leaving the house was the predominant reason likely to explain this drop in attendance at health facilities. This could constitute an axis for developing messages to parents to encourage a gradual return to child health services.


Asunto(s)
Actitud del Personal de Salud , Infecciones por Coronavirus , Pandemias , Pediatras/psicología , Pediatría/tendencias , Neumonía Viral , Pautas de la Práctica en Medicina/tendencias , Adulto , Camerún , Niño , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/psicología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/transmisión , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Control de Infecciones/métodos , Control de Infecciones/estadística & datos numéricos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Neumonía Viral/psicología , Neumonía Viral/terapia , Neumonía Viral/transmisión , Relaciones Profesional-Familia , Telemedicina
17.
J Med Vasc ; 45(5): 288-293, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32862987

RESUMEN

BACKGROUND: The incidence of upper extremity deep vein thrombosis (UEDVT) is increasing. Its management is sometimes complex and difficult due to its complications and the lack of strong recommendations. The aim was to describe the practice of vascular physicians in Occitanie region in the management of upper extremity deep vein thrombosis. MATERIAL AND METHODS: We used a descriptive observational study in the form of a declarative survey by means of a questionnaire from April to May 2019 among vascular physicians. RESULTS: Of the 142 physicians contacted, 84 responded, with a reply rate of 59.1%. The majority of physicians introduced low-molecular-weight heparin treatment (60.71%) and 29.76% direct oral anticoagulation after a diagnosis of UEDVT. Three months of anticoagulation was chosen by 69% of physicians against 27.4% for a duration of 6 months. Diagnostic work-up included biological risk factors, chest and/or cervical radiography and ultrasonography with dynamic maneuvers. Three quarters of doctors recommended venous compression. A control ultrasonography was performed for 67.86% of patients at one month and at the end of treatment. After the acute phase, 63% of physicians introduced direct oral anticoagulation and 11% recommended venous revascularization. DISCUSSION AND CONCLUSIONS: The mobilization of vascular physicians reflects their interest for this pathology. The management of UEDVT requires specific studies to address therapeutic modalities, the duration of anticoagulation or the place of venous compression in the acute phase.


Asunto(s)
Anticoagulantes/administración & dosificación , Vendajes de Compresión/tendencias , Heparina de Bajo-Peso-Molecular/administración & dosificación , Pautas de la Práctica en Medicina/tendencias , Trombosis Venosa Profunda de la Extremidad Superior/terapia , Procedimientos Quirúrgicos Vasculares/tendencias , Administración Oral , Adulto , Esquema de Medicación , Inhibidores del Factor Xa/administración & dosificación , Francia/epidemiología , Encuestas de Atención de la Salud , Disparidades en Atención de Salud/tendencias , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento , Trombosis Venosa Profunda de la Extremidad Superior/diagnóstico por imagen , Trombosis Venosa Profunda de la Extremidad Superior/epidemiología
19.
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
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA