Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.040
Filtrar
1.
BMC Med Inform Decis Mak ; 21(1): 34, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33522934

RESUMEN

BACKGROUND AND OBJECTIVES: Internet-based technologies play an increasingly important role in the management and outcome of patients with chronic kidney disease (CKD). The healthcare system is currently flooded with digital innovations and internet-based technologies as a consequence of the coronavirus disease 2019 (COVID-19) pandemic. However, information about the attitude of German CKD-patients with access to online tools towards the use of remote, internet-based interactions such as video conferencing, email, electronic medical records and apps in general and for health issues in particular, are missing. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: To address the use, habits and willingness of CKD patients in handling internet-based technologies we conducted a nationwide cross-sectional questionnaire survey in adults with CKD. RESULTS: We used 380 questionnaires from adult CKD patients (47.6% on dialysis, 43.7% transplanted and 8.7% CKD before renal replacement therapy) for analysis. Of these 18.9% denied using the internet at all (nonusers). Nonusers were significantly older (74.4 years, SD 11.4) than users (54.5 years, SD 14.5, p < 0.001), had a lower educational level than users (≥ 12 years: 6.9% versus 47.1%, p < 0.001) and were more often on dialysis. Within the group of internet users only a minority (2.6%) was using video conferencing with their physician, only 11.7% stated that they were using email to report symptoms and 26.6% were using the internet to schedule appointments. Slightly more than one-third of internet users (35.1%) are concerned that their personal medical data are not safe when submitted via the internet. CONCLUSIONS: Within our group of German CKD-patients we found that almost one out of five patients, especially older patients and patients with a lower educational level, did not use the internet at all. The majority of internet users reported in our survey that they have not used internet-based technologies within a medical context so far, but are willing to consider it. Therefore, it seems to be important to introduce and teach motivated CKD-patients the use and benefits of simple and safe internet-based health care technologies.


Asunto(s)
Prioridad del Paciente , Insuficiencia Renal Crónica , Telemedicina , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Alemania/epidemiología , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Prioridad del Paciente/estadística & datos numéricos , Insuficiencia Renal Crónica/terapia , Telemedicina/estadística & datos numéricos , Adulto Joven
3.
São Paulo; s.n; 20210219. 100 p.
Tesis en Portugués | LILACS, BBO - Odontología | ID: biblio-1147709

RESUMEN

O objetivo desta revisão sistemática foi avaliar se o fluxo digital rende melhores resultados do que o fluxo convencional na construção de coroas unitárias sobre implantes quando são avaliadas as variáveis tempo de moldagem, a preferência do paciente, a eficiência do tempo e tempo de ajuste da peça. As bases de dados MEDLINE, Embase e Cochrane foram eletronicamente pesquisadas até dia 19 de junho de 2019, juntamente com a busca manual. Apenas estudos clínicos avaliando o fluxo de trabalho digital versus o convencional em coroas unitárias sobre implantes foram incluídos. O tempo de moldagem foi avaliado por meio de meta-análise, enquanto os demais fatores foram reportados pela análise descritiva. Entre as 1334 publicações inicialmente identificadas,10 estudos foram incluídos. O modelo de efeito misto revelou uma redução estatisticamente significante no tempo de moldagem digital quando comparado ao tempo de moldagem convencional na meta-análise principal. (DP: 8.22 [95%IC:5.48,10.96]). As análises comparando o tempo de moldagem digital imediata versus o convencional (DP:3.84 [95%IC:3.30,4.39]) e comparando o tempo de moldagem digital regular versus convencional (DP:10.67 [95%IC:5.70,15.65]) também mostraram uma redução estatisticamente significante no tempo de moldagem quando empregada a moldagem digital. A média do tempo de moldagem no fluxo digital variou entre 6min e 39 segundos e 20min, enquanto no fluxo convencional variou entre 11.7min e 28.47min. Os pacientes demonstraram maior preferência pela moldagem digital. O tempo médio de ajuste da peça utilizando o fluxo de trabalho digital variou entre 1.96min e 14min, enquanto no fluxo convencional variou entre 3.02min e 12min. A eficiência do tempo no fluxo digital de trabalho variou entre 36.8min e 185.4min, enquanto no fluxo convencional variou entre 55.6 min e 332min. Considerando o tempo de moldagem, a preferência do paciente e a eficiência do tempo, o fluxo de trabalho digital demonstrou melhor eficiência clínica. Considerando o tempo de ajuste da peça protética, dois trabalhos demonstraram que o ajuste protético foi mais rápido no fluxo digital e três trabalhos demonstraram que o ajuste protético foi mais rápido no fluxo convencional.


Asunto(s)
Eficiencia , Prioridad del Paciente
6.
Eur J Endocrinol ; 184(2): 253-265, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33513125

RESUMEN

Background: Adrenal insufficiency (AI) is associated with increased cardiovascular morbidity and mortality and reduced quality of life (QoL). Optimum glucocorticoid (GC) dosing and timing are crucial in the treatment of AI, yet the natural circadian secretion of cortisol is difficult to mimic. The once-daily dual-release hydrocortisone (DR-HC) preparation (Plenadren®), offers a more physiological cortisol profile and may address unmet needs. Methods: An investigator-initiated, prospective, cross-over study in patients with AI. Following baseline assessment of cardiometabolic risk factors and QoL, patients switched from their usual hydrocortisone regimen to a once-daily dose equivalent of DR-HC and were reassessed after 12 weeks of treatment. Results: Fifty-one patients (21 PAI/30 SAI) completed the study. Mean age was 41.6 years (s.d. 13), and 58% (n = 30) were male. The median daily HC dose before study entry was 20 mg (IQR 15-20 mg). After 3 months on DR-HC, the mean SBP decreased by 5.7 mmHg, P = 0.0019 and DBP decreased by 4.5 mmHg, P = 0.0011. There was also a significant reduction in mean body weight (-1.23 kg, P = 0.006) and BMI (-0.3 kg/m2, P = 0.003). In a sub-analysis, there was a greater reduction in SBP observed in patients with SAI when compared to PAI post-DR-HC. Patients reported significant improvements in QoL using three validated QoL questionnaires, with a greater improvement in PAI. Conclusion: Dual-release hydrocortisone decreases BP, weight and BMI compared with conventional HC treatment, even at physiological GC replacement doses. Additionally, DR-HC confers significant improvements in QoL compared to immediate-release HC, particularly in patients with PAI, which is also reflected in the patient preference for DR-HC.


Asunto(s)
Insuficiencia Suprarrenal/tratamiento farmacológico , Sistema Cardiovascular/efectos de los fármacos , Terapia de Reemplazo de Hormonas/métodos , Hidrocortisona/administración & dosificación , Calidad de Vida , Insuficiencia Suprarrenal/epidemiología , Insuficiencia Suprarrenal/fisiopatología , Insuficiencia Suprarrenal/psicología , Adulto , Peso Corporal/efectos de los fármacos , Enfermedades Cardiovasculares/epidemiología , Estudios Cruzados , Preparaciones de Acción Retardada , Formas de Dosificación , Esquema de Medicación , Femenino , Humanos , Hidrocortisona/farmacocinética , Irlanda , Masculino , Persona de Mediana Edad , Prioridad del Paciente/estadística & datos numéricos , Calidad de Vida/psicología
7.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-33495179

RESUMEN

We present an unusual case of an acutely unwell patient with an upper gastrointestinal bleed whose resuscitation efforts were delayed by the discovery of his, similarly, acutely unwell pet on the medical high dependency unit. We highlight the challenges this provided the clinical team and focus on the issues relating to patient safety, consent and multidisciplinary action which may be more relevant to daily clinical practice.


Asunto(s)
Transfusión Sanguínea , Hemorragia Gastrointestinal/terapia , Gastroscopía , Pesar , Mascotas , Animales , Pollos , Humanos , Masculino , Competencia Mental , Persona de Mediana Edad , Prioridad del Paciente , Atención Dirigida al Paciente
8.
Vaccine ; 39(3): 473-479, 2021 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-33358265

RESUMEN

In absence of a COVID-19 vaccine, testing, contact tracing and social restrictions are among the most powerful strategies adopted around the world to slow down the spread of the pandemic. Citizens of most countries are suffering major physical, psychological and economic distress. At this stage, a safe and effective COVID-19 vaccine is the most sustainable option to manage the current pandemic. However, vaccine hesitancy by even a small subset of the population can undermine the success of this strategy. The objective of this research is to investigate the vaccine characteristics that matter the most to Australian citizens and to explore the potential uptake of a COVID-19 vaccine in Australia. Through a stated preference experiment, preferences towards a COVID-19 vaccine of 2136 residents of the Australian states and territories were collected and analysed via a latent class model. Results show that preferences for mild adverse cases, mode of administration, location of administration, price and effectiveness are heterogeneous. Conversely, preferences for immediacy and severe reactions are homogeneous, with respondents preferring a shorter period until vaccine is available and lower instances of severe side effects. The expected uptake of the vaccine is estimated under three different scenarios, with the value of 86% obtained for an average scenario. By calculating individual preferences, the willingness to pay is estimated for immediacy, effectiveness, mild and severe side effects.


Asunto(s)
/administración & dosificación , Aceptación de la Atención de Salud/psicología , Prioridad del Paciente/psicología , Vacunación/psicología , Adulto , Anciano , Australia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Aceptación de la Atención de Salud/estadística & datos numéricos , Prioridad del Paciente/estadística & datos numéricos , Encuestas y Cuestionarios
9.
Med Clin North Am ; 105(1): 199-212, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33246520

RESUMEN

Upper respiratory tract infections are one of the most common challenges in ambulatory medicine. Effective evaluation involves identification, primarily through the history, of the dominant set of patient symptoms leading to accurate diagnosis. Certain more morbid illnesses that mimic common upper respiratory symptoms can also be excluded with this approach. Treatment should address patient preferences through an understanding of the limited utility of antibiotics and through tailored advisement of the numerous pharmacologic options for symptom relief.


Asunto(s)
Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Humanos , Anamnesis , Prioridad del Paciente , Examen Físico
10.
J Urol ; 205(1): 52-59, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32856984

RESUMEN

PURPOSE: Adrenal incidentalomas are being discovered with increasing frequency, and their discovery poses a challenge to clinicians. Despite the 2002 National Institutes of Health consensus statement, there are still discrepancies in the most recent guidelines from organizations representing endocrinology, endocrine surgery, urology and radiology. We review recent guidelines across the specialties involved in diagnosing and treating adrenal incidentalomas, and discuss points of agreement as well as controversy among guidelines. MATERIALS AND METHODS: PubMed®, Scopus®, Embase™ and Web of Science™ databases were searched systematically in November 2019 in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement to identify the most recently updated committee produced clinical guidelines in each of the 4 specialties. Five articles met the inclusion criteria. RESULTS: There is little debate among the reviewed guidelines as to the initial evaluation of an adrenal incidentaloma. All patients with a newly discovered adrenal incidentaloma should receive an unenhanced computerized tomogram and hormone screen. The most significant points of divergence among the guidelines regard reimaging an initially benign appearing mass, repeat hormone testing and management of an adrenal incidentaloma that is not easily characterized as benign or malignant on computerized tomography. The guidelines range from actively recommending against any repeat imaging and hormone screening to recommending a repeat scan as early as in 3 to 6 months and annual hormonal screening for several years. CONCLUSIONS: After reviewing the guidelines and the evidence used to support them we posit that best practices lie at their convergence and have presented our management recommendations on how to navigate the guidelines when they are discrepant.


Asunto(s)
Adenoma/terapia , Neoplasias de las Glándulas Suprarrenales/terapia , Oncología Médica/normas , Feocromocitoma/terapia , Guías de Práctica Clínica como Asunto , Adenoma/sangre , Adenoma/diagnóstico , Adenoma/patología , Corticoesteroides/sangre , Neoplasias de las Glándulas Suprarrenales/sangre , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/patología , Glándulas Suprarrenales/diagnóstico por imagen , Glándulas Suprarrenales/patología , Adrenalectomía/normas , Antagonistas Adrenérgicos alfa/uso terapéutico , Biopsia , Endocrinología/métodos , Endocrinología/normas , Humanos , Imagen por Resonancia Magnética , Oncología Médica/métodos , Prioridad del Paciente , Feocromocitoma/sangre , Feocromocitoma/diagnóstico , Feocromocitoma/patología , Tomografía de Emisión de Positrones , Radiología/métodos , Radiología/normas , Tomografía Computarizada por Rayos X , Urología/métodos , Urología/normas , Espera Vigilante/normas
12.
N Z Med J ; 133(1526): 55-66, 2020 12 04.
Artículo en Inglés | MEDLINE | ID: mdl-33332340

RESUMEN

AIM: This retrospective review examined the influence of age and severity of comorbidities on goals-of-care in advance care plans (ACPlans) and concordance between these wishes and care received during hospital admission. METHODS: The medical records of 149 people with an ACPlan admitted to a public hospital were reviewed to evaluate concordance with treatment. The associations between age and comorbidities and goals-of-care were determined using contingency tables and logistic regression analyses. RESULTS: The majority of the review cohort were Caucasian and elderly, with people from minority ethnic groups under-represented compared to census data. Increasing age had a measurable influence on the choice of goal-of-care, whereas comorbidity severity had less influence on this decision. In 60 of the 411 hospital admissions the patient was classified as incompetent, with the goal-of-care adhered to in 59 of these cases and treatment preferences adhered to in six of seven cases. Fifty-five people had died since writing their ACPlan, with 63% dying at their preferred place or with no preference stated. CONCLUSIONS: Age and to a lesser extent the severity of comorbidities influence the choice of goal-of-care in an ACPlan. Our review also showed that end-of-life care appeared to adhere to the instructions in the plan.


Asunto(s)
Planificación Anticipada de Atención/organización & administración , Hospitalización/tendencias , Hospitales Públicos/estadística & datos numéricos , Registros Médicos/estadística & datos numéricos , Prioridad del Paciente , Cuidado Terminal/organización & administración , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Nueva Zelanda , Estudios Retrospectivos
13.
Arq Gastroenterol ; 57(4): 491-497, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33331482

RESUMEN

OBJECTIVE: This study aims to evaluate patient's preferences in the choice of their therapy and the factors that influence this choice. METHODS: This cross-sectional study enrolled 101 outpatients with Crohn's disease or ulcerative colitis. The inclusion criteria were age ≥18 years and no previous exposure to biological therapy. Patients' preferences were assessed through questions that addressed the preferred mode of administration (oral, subcutaneous, or intravenous) and the factors that determined the choice of medication (efficacy, medical indication, fear of medication, convenience, mode of application, and personal doctors' indication). RESULTS: The mean age was 43.6±13.5 years, 75.3% were female, and 81.2% were cases of ulcerative colitis. Regarding the mode of administration, the majority of patients preferred oral (87.1%), followed by intravenous (6.93%) and subcutaneous (5.94%) medications. The reasons were "I prefer to take it at home" (42.57%), "I have more freedom" (36.63%), "I don't like self-application" (29.70%), and "I believe it works better" (19.80%). Younger patients and patients in clinical disease activity preferred intravenous mode compared to the oral route (P<0.05). Doctor's opinion (98%) was an important factor associated with the medication choice. CONCLUSION: Oral route was the preferred mode of administration and most patients took their physician's opinion into account in their choice of medication.


Asunto(s)
Administración Oral , Colitis Ulcerosa/tratamiento farmacológico , Fármacos Gastrointestinales/administración & dosificación , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Inyecciones Subcutáneas/estadística & datos numéricos , Prioridad del Paciente , Satisfacción del Paciente , Adulto , Anciano , Terapia Biológica , Brasil , Estudios Transversales , Femenino , Fármacos Gastrointestinales/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
14.
PLoS One ; 15(12): e0242007, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33370307

RESUMEN

PURPOSE: Progressive Tinnitus Management (PTM) is an evidence-based interdisciplinary stepped-care approach to improving quality of life for patients with tinnitus. PTM was endorsed by Department of Veterans Affairs (VA) Audiology leadership in 2009. Factors affecting implementation of PTM are unknown. We conducted a study to: 1) estimate levels of PTM program implementation in VA Audiology and Mental Health clinics across the country; and 2) identify barriers and facilitators to PTM implementation based on the experiences of VA audiologists and mental health providers. METHOD: We conducted an anonymous, web-based survey targeting Audiology and Mental Health leaders at 144 major VA facilities. Quantitative analyses summarized respondents' facility characteristics and levels of program implementation (full PTM, partial PTM, or no PTM). Qualitative analyses identified themes in factors influencing the implementation of PTM across VA sites. RESULTS: Surveys from 87 audiologists and 66 mental health clinicians revealed that few facilities offered full PTM; the majority offered partial or no PTM. Inductive analysis of the open-ended survey responses identified seven factors influencing implementation of PTM: 1) available resources, 2) service collaboration, 3) prioritization, 4) Veterans' preferences and needs, 5) clinician training, 6) awareness of (evidence-based) options, and 7) perceptions of scope of practice. CONCLUSION: Results suggest wide variation in services provided, a need for greater engagement of mental health providers in tinnitus care, and an interest among both audiologists and mental health providers in receiving tinnitus-related training. Future research should address barriers to PTM implementation, including methods to: 1) improve understanding among mental health providers of their potential role in tinnitus management; 2) enhance coordination of tinnitus-related care between health care disciplines; and 3) collect empirical data on Veterans' need for and interest in PTM, including delivery by telehealth modalities.


Asunto(s)
Medicina Basada en la Evidencia/organización & administración , Implementación de Plan de Salud/organización & administración , Hospitales de Veteranos/organización & administración , Acúfeno/terapia , Audiología/organización & administración , Progresión de la Enfermedad , Medicina Basada en la Evidencia/estadística & datos numéricos , Implementación de Plan de Salud/estadística & datos numéricos , Hospitales de Veteranos/estadística & datos numéricos , Humanos , Comunicación Interdisciplinaria , Servicios de Salud Mental/organización & administración , Prioridad del Paciente/psicología , Prioridad del Paciente/estadística & datos numéricos , Médicos/estadística & datos numéricos , Investigación Cualitativa , Calidad de Vida , Encuestas y Cuestionarios/estadística & datos numéricos , Telemedicina/organización & administración , Telemedicina/estadística & datos numéricos , Acúfeno/psicología , Estados Unidos , United States Department of Veterans Affairs/organización & administración , Veteranos/psicología
15.
Artículo en Inglés | MEDLINE | ID: mdl-33379316

RESUMEN

Spinal exoskeletons have been suggested as an approach for the prevention and rehabilitation of occupational low back pain (LBP). While the state-of-the-art exoskeletons were shown to substantially unload the back, user acceptance is still limited. Perceived discomfort and restriction of freedom of movement are commonly reported. In this pilot study, we explored the differences in subjective responses and user impressions to using passive spinal exoskeleton during a set of simple lifting tasks between LBP patients (n = 12) and asymptomatic individuals (n = 10). Visual analog scales (0-10) were used for all assessments. Overall, the results showed mostly similar responses or slightly more positive responses to the exoskeleton from LBP patients. Most notably, the LBP patients reported a statistically significant (p = 0.048) higher willingness to use the device daily (5.36 ± 4.05) compared to the control group (2.00 ± 1.85) and also gave the device a higher overall grade (6.58 ± 1.98 vs. 4.30 ± 2.26; p = 0.021). This study has demonstrated that individuals with current LBP responded more favorably to the use of the spinal exoskeleton for simple lifting tasks. This implies that current exoskeletons could be appropriate for LBP rehabilitation, but not preventions, as pain-free individuals are less willing to use such devices. Future studies should explore whether different exoskeleton designs could be more appropriate for people with no LBP issues.


Asunto(s)
Dispositivo Exoesqueleto , Elevación , Dolor de la Región Lumbar/rehabilitación , Prioridad del Paciente , Humanos , Proyectos Piloto , Columna Vertebral
16.
Niger J Clin Pract ; 23(12): 1629-1638, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33355813

RESUMEN

Dentists are often confronted with challenges concerning the determination of the treatment type for questionable teeth (retention or extraction) in their routine dental practice. The objective of this review was to explore the available literature pertaining to the factors influencing clinical decision-making and treatment strategies of dentists regarding tooth retention or extraction. Explorative analysis of the literature was conducted based on its relevance to the subjected study area and scope. Primarily, the papers were extracted from sources such as ERIC, PubMed, Scopus, and Medline. The keywords used for searching articles include Clinical Decision-Making, Treatment Strategies, Tooth Extraction, and Tooth Retention. Papers published up to 2018 were extracted and evaluated. The analyzed studies highlighted that a successful treatment plan is based on the practitioner's knowledge, abilities, and skills as well as patients' preference, which is also a determinant of treatment success in restorative dentistry. Multidisciplinary dental treatment is generally adopted for decision making in dental clinics. Overall, the treatment plan should be based on the extensive learning and keen observation of the disease and the associated factors which enable long-term success of the treatment.


Asunto(s)
Toma de Decisiones Clínicas , Extracción Dental , Toma de Decisiones , Humanos , Prioridad del Paciente , Resultado del Tratamiento
17.
BMC Fam Pract ; 21(1): 269, 2020 12 13.
Artículo en Inglés | MEDLINE | ID: mdl-33308161

RESUMEN

BACKGROUND: During the first COVID-19 pandemic 'lockdown' in Aotearoa/New Zealand (March-May 2020, in which strict 'stay at home' measures were introduced), general practices were advised to use telephone and video consultations (telehealth) wherever possible instead of the usual in-person visits. This was a sudden change for most practices and patients. This research aimed to explore how patients accessed general practice during lockdown and evaluate their experiences with telehealth, to inform how telehealth could be most effectively used in the future. METHODS: Using a mixed-method approach, we undertook an online survey and in-depth interviews with adults (> 18 years) who had contact with practices during lockdown, recruited through social media and email lists. We present descriptive statistics from the survey data (n = 1010) and qualitative analysis of interview data (n = 38) and open-ended survey questions, using a framework of access to health care, from the patient's perspective. RESULTS: In general, patients reported high satisfaction with telehealth in general practice during lockdown. Telehealth was convenient and allowed patients to safely access health care without having to weigh-up the fear of COVID-19 infection against the need to be seen. Telehealth worked best for routine and familiar health issues and when rapport was established between patients and clinicians. This was easier with a pre-existing clinical relationship, but not impossible without one. Telehealth was less suitable when a physical examination was needed, when the diagnosis was unknown or for patients who had a strong preference to be seen in-person. CONCLUSIONS: Even in this disruptive lockdown period, that prompted an unexpected and rapid implementation of telehealth services in general practices, most patients had positive experiences with telehealth. In the future, patients want the choice of consultation type to match their needs, circumstances, and preferences. Technological issues and funding barriers may need to be addressed, and clear communication for both patients and clinicians is needed about key aspects of telehealth (e.g. cost, appropriateness, privacy). Maintaining telehealth as an option post-lockdown has the potential to increase timely and safe access to primary health care for many patients.


Asunto(s)
Medicina General , Prioridad del Paciente , Satisfacción del Paciente , Telemedicina , Adolescente , Adulto , Anciano , Grupo de Ascendencia Continental Asiática , Control de Enfermedades Transmisibles , Prestación de Atención de Salud , Grupo de Ascendencia Continental Europea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Grupo de Ascendencia Oceánica , Investigación Cualitativa , Encuestas y Cuestionarios , Adulto Joven
18.
PLoS One ; 15(12): e0244432, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33338078

RESUMEN

Antibiotic resistance is a global health concern. Although numerous strategies have tried to reduce inadequate antibiotic prescribing, antibiotics are still prescribed in 60% of acute lower respiratory tract infections (ALRTIs) cases in Catalonia (Spain). This study aims to explore service users' experiences of ALRTIs, the quality and access to healthcare services, and health education. Selective purposive sampling was carried out, based on a prior definition of participant characteristics. These were sex, age, ethnicity, date of the last ALRTI, number of ALRTIs in the last year, and treatments received. Participants with a previous diagnosis of ALRTIs were recruited from three primary health care centres in Barcelona and one in Tarragona. Twenty-nine interviews were conducted between April and June 2019. A content thematic analysis was performed. Three themes were identified: 1) risk perceptions and help-seeking; 2) treatment preferences and antibiotic use; and 3) relationship dynamics and communication with healthcare professionals. Accounts of service users' sense of autonomy towards their health and power dynamics within the healthcare system were apparent. Supporting service users to become reliable, subjective and agentic experts of their health and bodies could help them to voice their healthcare agendas. Power structures embedded within healthcare, political and economic institutions should be challenged so that healthcare services can be co-developed (with service users) and based on service users' autonomy and horizontal relationships. Special consideration should be paid to the intersection of social vulnerabilities. A concordance approach to prescribing could be key to improve the responsible use of antibiotics and to contribute to the prevention of AMR in primary healthcare. The marketisation of health, and the increased demands of private healthcare in Spain due to the financial pressures on public healthcare as a consequence of the financial crisis of 2008 and the COVID-19 pandemic, are a risk for promoting adequate antibiotic prescribing and use. Trial registration The ISAAC-CAT study has been registered in the NCT registry, ID: NCT03931577.


Asunto(s)
Farmacorresistencia Microbiana , Autonomía Personal , Poder Psicológico , Atención Primaria de Salud/organización & administración , Infecciones del Sistema Respiratorio/epidemiología , Adulto , Anciano , Antibacterianos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prioridad del Paciente , Atención Primaria de Salud/métodos , Investigación Cualitativa , Riesgo , España/epidemiología , Poblaciones Vulnerables
19.
Artículo en Inglés | MEDLINE | ID: mdl-33374611

RESUMEN

BACKGROUND: The rate of cesarean section (CS) is growing in the United Arab Emirates (UAE). Pregnant women's knowledge on the mode of delivery, factors associated with lack of adequate knowledge, and preference towards CS delivery were investigated. METHODS: Baseline cross-sectional data from 1617 pregnant women who participated in the Mutaba'ah Study between September 2018 and March 2020 were analyzed. A self-administered questionnaire inquiring about demographic and maternal characteristics, ten knowledge-based statements about mode of delivery, and one question about preference towards mode of delivery was used. Knowledge on the mode of delivery was categorized into "adequate (total score 6-10)" or "lack of adequate (total score 0-5)" knowledge. Crude and multivariable models were used to identify factors associated with "lack of adequate" knowledge on the mode of delivery and factors associated with CS preference. RESULTS: A total of 1303 (80.6%) pregnant women (mean age 30.6 ± 5.8 years) completed the questionnaire. The majority (57.1%) were ≥30 years old, in their third trimester (54.5%), and had at least one child (76.6%). In total, 20.8% underwent CS delivery in the previous pregnancy, and 9.4% preferred CS delivery for the current pregnancy. A total of 78.4% of pregnant women lacked adequate knowledge on the mode of delivery. The level of those who lacked adequate knowledge was similar across women in different pregnancy trimesters. Young women (18-24 years) (adjusted odds ratios (aOR), 3.07, 95% confidence interval (CI), 1.07-8.86) and women who had CS delivery in the previous pregnancy (aOR, 1.90, 95% CI, 1.06-3.40) were more likely to be classified with a lack of adequate knowledge. Age (aOR, 1.08, 95% CI, 1.02-1.14), employment (aOR, 1.96, 95% CI, 1.13-3.40), or previous CS delivery (aOR, 31.10, 95% CI, 17.71-55.73) were associated with a preference towards CS delivery. CONCLUSION: This study showed that pregnant women may not fully appreciate the health risks associated with different modes of delivery. Therefore, antenatal care appointments should include a balanced discussion on the potential benefits and harms associated with different delivery modes.


Asunto(s)
Parto Obstétrico/métodos , Conocimientos, Actitudes y Práctica en Salud , Prioridad del Paciente , Mujeres Embarazadas/psicología , Adolescente , Adulto , Cesárea , Estudios Transversales , Femenino , Humanos , Embarazo , Emiratos Árabes Unidos , Adulto Joven
20.
J Drugs Dermatol ; 19(11): 1101-1108, 2020 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-33196750

RESUMEN

BACKGROUND: Clinical and economic comparisons of therapies for plaque psoriasis are regularly updated following each new devel- opment in the field. With the recent availability of a novel accessory (Multi Micro DoseTM [MMD®] tip) for the 308nm excimer laser (XTRAC®, Strata Skin Sciences, Horsham, PA), which can determine and deliver an optimal therapeutic dose (OTDTM) of ultraviolet-B light in an improved protocol, the need for comparative health-economic assessment recurs. To this end, a comprehensive evaluation of treatment-related costs was undertaken from the payer perspective. Results show that outcomes are influenced by many factors; most importantly, the severity and extent of disease, treatment selection, and patient preference, as well as compliance, adherence, and persistence with care. Among study comparators, the 308nm excimer laser – XTRAC – with its latest MMD enhancement, is safe and delivers incremental clinical benefits with the potential for significant cost savings. These benefits are particularly relevant today in the context of SARS-CoV-2 virus and the COVid-19 pandemic. J Drugs Dermatol. 2020;19(11):1101-1108. doi:10.36849/JDD.2020.5510.


Asunto(s)
Infecciones por Coronavirus , Costos de la Atención en Salud/estadística & datos numéricos , Pandemias , Neumonía Viral , Psoriasis/terapia , Análisis Costo-Beneficio , Humanos , Láseres de Excímeros/uso terapéutico , Cooperación del Paciente , Prioridad del Paciente , Psoriasis/economía , Psoriasis/patología , Índice de Severidad de la Enfermedad , Terapia Ultravioleta/economía , Terapia Ultravioleta/métodos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA