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2.
Artículo en Inglés | MEDLINE | ID: mdl-33808769

RESUMEN

Racial and ethnic disparities exist in diabetes prevalence, health services utilization, and outcomes including disabling and life-threatening complications among patients with diabetes. Home health care may especially benefit older adults with diabetes through individualized education, advocacy, care coordination, and psychosocial support for patients and their caregivers. The purpose of this study was to examine the association between race/ethnicity and hospital discharge to home health care and subsequent utilization of home health care among a cohort of adults (age 50 and older) who experienced a diabetes-related hospitalization. The study was limited to patients who were continuously enrolled in Medicare for at least 12 months and in the United States. The cohort (n = 786,758) was followed for 14 days after their diabetes-related index hospitalization, using linked Medicare administrative, claims, and assessment data (2014-2016). Multivariate logistic regression models included patient demographics, comorbidities, hospital length of stay, geographic region, neighborhood deprivation, and rural/urban setting. In fully adjusted models, hospital discharge to home health care was significantly less likely among Hispanic (OR 0.8, 95% CI 0.8-0.8) and American Indian (OR 0.8, CI 0.8-0.8) patients compared to White patients. Among those discharged to home health care, all non-white racial/ethnic minority patients were less likely to receive services within 14-days. Future efforts to reduce racial/ethnic disparities in post-acute care outcomes among patients with a diabetes-related hospitalization should include policies and practice guidelines that address structural racism and systemic barriers to accessing home health care services.


Asunto(s)
Diabetes Mellitus , Servicios de Atención de Salud a Domicilio , Anciano , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Grupos Étnicos , Disparidades en Atención de Salud , Humanos , Medicare , Persona de Mediana Edad , Grupos Minoritarios , Derivación y Consulta , Atención Subaguda , Estados Unidos/epidemiología
3.
Eur Rev Med Pharmacol Sci ; 25(8): 3338-3341, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33928621

RESUMEN

Demographic changes in the Western world linked to the increase in the elderly population, life expectancy and above all cancer patients and chronically ill patients, often entrusted to home care or in healthcare residences, highlight an exponential increase in requests for diagnostic tests at home. Conventional radiographic examinations, such as thoracic, musculoskeletal and abdominal images are the most requested and are important first level diagnostic tests. To date and, in particular, in times of COVID-19 emergency, these patients need to be transferred to the hospital to perform radiological examinations which involve an increase in costs for the health system and an increased risk for the health of these patients, already often debilitated and immunocompromised. This article discussed the benefits of taking conventional chest x-rays directly at the patient's home.


Asunto(s)
/prevención & control , Servicios de Atención de Salud a Domicilio/organización & administración , Radiografía/métodos , Prestación de Atención de Salud , Humanos , Unidades Móviles de Salud
4.
BMC Geriatr ; 21(1): 262, 2021 04 20.
Artículo en Inglés | MEDLINE | ID: mdl-33879078

RESUMEN

BACKGROUND: During the first pandemic wave, Sweden experienced a high mortality rate. Home healthcare reflects a group of people especially vulnerable to coronavirus disease 2019 (COVID-19). We aimed to evaluate the pattern of comorbidity and frailty in a group of individuals having fatal outcomes in home healthcare during the COVID-19 pandemic March to September 2020, and to assess the contribution of COVID-19 in the fatal outcomes. METHODS: A cohort of adults with confirmed COVID-19 diagnosis that deceased in home healthcare between March and September 2020 were analysed in a retrospective study comprising home healthcare in 136 facilities in one Swedish county. Main outcome measures were comorbidity and frailty. RESULTS: One hundred fifty-five individuals (88 women, 67 men) aged 57-106 (median 88) years were included in the analysis. Nine had considerable frailty (ability to perform various activities of daily living but confined to bed or chair on occasion) and the remaining 146 had severe frailty (unable to perform activities of daily living and/or confined to bed or chair; dementia necessitating care). Three or more diagnoses besides COVID-19 were present in 142 individuals and another eight had two diagnoses in addition to COVID-19. In 20 (13%) individuals, COVID-19 was assessed as the principal cause of death, in 100 (64.5%) a contributing cause, and for the remaining 35 (22.5%) death was probably caused by another comorbidity. This seemed to change over the course of the COVID - 19 pandemic, with its contributing role decreasing from the middle of the summer. CONCLUSIONS: Death in home healthcare during the first wave of the pandemic mostly affected individuals with severe frailty and comorbidity at very advanced ages. One fifth of the individuals who died in home health care had another cause than Covid-19. TRIAL REGISTRATION: Clinical Trials.gov NCT04642196 date 24/11/2020.


Asunto(s)
Servicios de Atención de Salud a Domicilio , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Causas de Muerte , Prestación de Atención de Salud , Femenino , Anciano Frágil , Humanos , Masculino , Pandemias , Estudios Retrospectivos , Suecia/epidemiología
6.
BMC Geriatr ; 21(1): 220, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33794791

RESUMEN

BACKGROUND: While the Resident Assessment Instrument-Home Care (RAI-HC) tool was designed to support comprehensive geriatric assessment in home care, it is more often used for service allocation and little is known about how point-of-care providers collect the information they need to plan and provide care. The purpose of this pilot study was to develop and test a survey to explore the geriatric care assessment practices of nurses, occupational therapists (OTs) and physiotherapists (PTs) in home care. METHODS: Literature review and expert consultation informed the development of the Geriatric Care Assessment Practices (G-CAP) survey-a 33 question, online, self-report tool exploring assessment and information-sharing methods, attitudes, knowledge, experience and demographic information. The survey was pilot tested at a single home care agency in Ontario, Canada (N = 27). Test-retest reliability (N = 20) and construct validity were explored. RESULTS: The subscales of the G-CAP survey showed fair to good test-retest reliability within a population of interdisciplinary home care providers [ICC2 (A,1) (M ICC = 0.58) for continuous items; weighted kappa (M kappa = 0.63) for categorical items]. Statistically significant differences between OT, PT and nurse responses [M t = 3.0; M p = 0.01] and moderate correlations between predicted related items [M r = |0.39|] provide preliminary support for our hypotheses around survey construct validity in this population. Pilot participants indicated that they use their clinical judgment far more often than standardized assessment tools. Client input was indicated to be the most important source of information for goal-setting. Most pilot participants had heard of the RAI-HC; however, few used it. Pilot participants agreed they could use assessment information from others but also said they must conduct their own assessments and only sometimes share and rarely receive information from other providers. CONCLUSIONS: The G-CAP survey shows promise as a measure of the geriatric care assessment practices of interdisciplinary home care providers. Findings from the survey have the potential to inform improvements to integrated care planning. Next steps include making adaptations to the G-CAP survey to further improve the reliability and validity of the tool and a broad administration of the survey in Ontario home care.


Asunto(s)
Evaluación Geriátrica , Servicios de Atención de Salud a Domicilio , Anciano , Humanos , Ontario , Proyectos Piloto , Reproducibilidad de los Resultados
7.
BMC Geriatr ; 21(1): 235, 2021 04 08.
Artículo en Inglés | MEDLINE | ID: mdl-33832424

RESUMEN

BACKGROUND: During a disaster, home-based care fills the critical need for continuation of health care. Home-based care is intended to function using existing care delivery models, continuing to provide care for patients wherever they are located, including in shelters and hotels. Home-based care providers are often the closest in contact with their patients -seeing them in place, even throughout a disaster- through which they develop a unique insight into aging in place during a disaster. The purpose of this study was to identify individual and community-level support needs of older adults after a disaster through the lens of home-based care providers. METHODS: Using qualitative inquiry, five focus groups were conducted with home-based care providers (n = 25) who provided in-home care during Hurricane Irma and Hurricane Harvey. Participants were identified by contacting home health agencies listed in an open-source database of agencies participating in Centers for Medicare and Medicaid Services programs. Data were coded using an abductive analytic approach, and larger themes were generated in light of existing theory. RESULTS: The results were distilled into eight themes that related to the importance of community and family, informal and formal supports throughout the disaster management cycle, maintaining autonomy during a disaster, and institutional and systemic barriers to obtaining assistance. CONCLUSIONS: In this study, home-based care providers described the challenges aging adults face in the response and recovery period after a large-scale disaster including maintaining continuity of care, encouraging individual preparedness, and accessing complex governmental support. Listening to home-based care providers offers new and important insights for developing interventions to address social and health needs for older adults aging in place after a large-scale disaster.


Asunto(s)
Planificación en Desastres , Desastres , Servicios de Atención de Salud a Domicilio , Anciano , Humanos , Vida Independiente , Medicare , Estados Unidos
8.
Artículo en Inglés | MEDLINE | ID: mdl-33806436

RESUMEN

Despite the importance of patient safety in home-care nursing provided by licensed nurses in patients' homes, little is known about the nationwide incidence of adverse events in Japan. This article describes the incidence of adverse events among home-care nursing agencies in Japan and investigates the characteristics of agencies that were associated with adverse events. A cross-sectional nationwide self-administrative questionnaire survey was conducted in March 2020. The questionnaire included the number of adverse event occurrences in three months, the process of care for patient safety, and other agency characteristics. Of 9979 agencies, 580 questionnaires were returned and 400 were included in the analysis. The number of adverse events in each agency ranged from 0 to 47, and 26.5% of the agencies did not report any adverse event cases. The median occurrence of adverse events was three. In total, 1937 adverse events occurred over three months, of which pressure ulcers were the most frequent (80.5%). Adjusting for the number of patients in a month, the percentage of patients with care-need level 3 or higher was statistically significant. Adverse events occurring in home-care nursing agencies were rare and varied widely across agencies. The patients' higher care-need levels affected the higher number of adverse events in home-care nursing agencies.


Asunto(s)
Agencias de Atención a Domicilio , Servicios de Atención de Salud a Domicilio , Estudios Transversales , Humanos , Japón/epidemiología , Encuestas y Cuestionarios
9.
JAMA Netw Open ; 4(4): e213990, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33792728

RESUMEN

Importance: To optimize patient outcomes and preserve critical acute care access during the COVID-19 pandemic, the Los Angeles County Department of Health Services developed the SAFE @ HOME O2 Expected Practice (expected practice), enabling ambulatory oxygen management for COVID-19. Objective: To assess outcomes of patients with COVID-19 pneumonia discharged via the expected practice approach to home or quarantine housing with supplemental home oxygen. Design, Setting, and Participants: This retrospective cohort study included 621 adult patients with COVID-19 pneumonia who were discharged from 2 large urban public hospitals caring primarily for patients receiving Medicaid from March 20 to August 19, 2020. Patients were included in the analysis cohort if they received emergency or inpatient care for COVID-19 and were discharged with home oxygen. Interventions: Patients receiving at least 3 L per minute of oxygen, stable without other indication for inpatient care, were discharged from either emergency or inpatient encounters with home oxygen equipment, educational resources, and nursing telephone follow-up within 12 to 18 hours of discharge. Nurses provided continued telephone follow up as indicated, always with physician back-up. Main Outcomes and Measures: All-cause mortality and all-cause 30-day return admission. Results: A total of 621 patients with COVID-19 pneumonia (404 male [65.1%] and 217 female [34.9%]) were discharged with home oxygen. Median age of these patients was 51 years (interquartile range, 45-61 years), with 149 (24.0%) discharged from the emergency department and 472 (76%) discharged from inpatient encounters. The all-cause mortality rate was 1.3% (95% CI, 0.6%-2.5%) and the 30-day return hospital admission rate was 8.5% (95% CI, 6.2%-10.7%) with a median follow-up time of 26 days (interquartile range, 15-55 days). No deaths occurred in the ambulatory setting. Conclusions and Relevance: In this cohort study, patients with COVID-19 pneumonia discharged on home oxygen had low rates of mortality and return admission within 30 days of discharge. Ambulatory management of COVID-19 with home oxygen has an acceptable safety profile, and the expected practice approach may help optimize outcomes, by ensuring right care in the right place at the right time and preserving access to acute care during the COVID-19 pandemic.


Asunto(s)
/mortalidad , Servicios de Atención de Salud a Domicilio , Oxígeno/uso terapéutico , Pandemias , Alta del Paciente , Readmisión del Paciente , Atención Ambulatoria , Cuidados Críticos , Servicio de Urgencia en Hospital , Femenino , Asignación de Recursos para la Atención de Salud , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno , Cuarentena , Estudios Retrospectivos
10.
Front Cell Infect Microbiol ; 11: 639579, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33796484

RESUMEN

A multidisciplinary group, mainly from Bergamo region - the epicenter of the COVID-19 pandemic crisis in Italy on march 2020- has developed concept of creating intermediate care facilities and proposes a three-tier model of community-based care, with the goal of reducing hospital admissions, contagion and mortality related to hospital overloading and optimizing human resources.


Asunto(s)
/epidemiología , Pandemias , /prevención & control , Servicios de Atención de Salud a Domicilio , Humanos , Italia/epidemiología , Atención al Paciente/clasificación , Atención al Paciente/métodos , Índice de Severidad de la Enfermedad
11.
Saudi Med J ; 42(4): 355-362, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33795490

RESUMEN

Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis and viral pneumonia in pediatrics worldwide. In the Kingdom of Saudi Arabia (KSA), the prevalence of RSV is 23.5% in pediatric patients with acute lower respiratory tract illness. Coronavirus disease (COVID-19) poses critical public health and socioeconomic challenges in KSA. The Saudi Pediatric Pulmonology Association (SPPA), a subsidiary of the Saudi Thoracic Society (STS), developed a task force to determine the potential challenges and barriers to the RSV immunoprophylaxis program during the era of COVID-19 and to compose a practical, nationwide, and multidisciplinary approach to address these challenges. Some of the recommendations to manage these challenges include increasing the number of RSV immunoprophylaxis clinics, drive-thru visits, home-care services, and swift referrals to the RSV immunoprophylaxis program specialists. Additional training is required for healthcare personnel to add RSV immunoprophylaxis to the regular immunization schedule.


Asunto(s)
Antivirales/uso terapéutico , Bronquiolitis Viral/prevención & control , Prestación de Atención de Salud/métodos , Programas de Inmunización/métodos , Palivizumab/uso terapéutico , Infecciones por Virus Sincitial Respiratorio/prevención & control , Comités Consultivos , /prevención & control , Servicios de Atención de Salud a Domicilio , Humanos , Lactante , Recién Nacido , Inyecciones , Neumología , Arabia Saudita , Sociedades Médicas
13.
Sensors (Basel) ; 21(7)2021 Apr 04.
Artículo en Inglés | MEDLINE | ID: mdl-33916549

RESUMEN

Due to the aging population, home care for the elderly has become very important. Currently, there are many studies focusing on the deployment of various sensors in the house to recognize the home activities of the elderly, especially for the elderly living alone. Through these, we can detect the home situation of the single person and ensure his/her living safety. However, the living environment of the elderly includes, not only the person living alone, but also multiple people living together. By applying the traditional methods for a multi-resident environment, the "individual" activities of each person could not be accurately identified. This resulted in an inability to distinguish which person was involved in what activities, and thus, failed to provide personal care. Therefore, this research tries to investigate how to recognize home activities in multi-resident living environments, in order to accurately distinguish the association between residents and home activities. Specifically, we propose to use the special characteristics of historical activity of residents in a multi-person environment, including activity interaction, activity frequency, activity period length, and residential behaviors, and then apply a suite of machine learning methods to train and test. Five traditional models of supervised learning and two deep learning methods are explored to tackle this problem. Through the experiments with real datasets, the proposed methods were found to achieve higher precision, recall and accuracy with less training time. The best accuracy can reach up to 91% and 95%, by J48DT, and LSTM, respectively, in different living environments.


Asunto(s)
Actividades Cotidianas , Servicios de Atención de Salud a Domicilio , Anciano , Envejecimiento , Femenino , Humanos , Aprendizaje Automático , Masculino , Tecnología
14.
J Clin Neurophysiol ; 38(2): 92-100, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33661785

RESUMEN

SUMMARY: Around 50 years after the first EEG acquisition by Hans Berger, its use in ambulatory setting was demonstrated. Ever since, ambulatory EEG has been widely available and routinely used in the United States (and to a lesser extent in Europe) for diagnosis and management of patients with epilepsy. This technology alone cannot help with semiological characterization, and absence of video is one of its main drawbacks. Addition of video to ambulatory EEG potentially improves diagnostic yield and opens new aspects of utility for better characterization of patient's events, including differential diagnosis, classification, and quantification of seizure burden. Studies evaluating quality of ambulatory video EEG (aVEEG) suggest good quality recordings are feasible. In the utilization of aVEEG, to maximize yield, it is important to consider pretest probability. Having clear pretest questions and a strong index of suspicion for focal, generalized convulsive or non-epileptic seizures further increases the usefulness of aVEEG. In this article, which is part of the topical issue "Ambulatory EEG," the authors compare long-term home aVEEG to inpatient video EEG monitoring, discuss aVEEG's use in diagnosis and follow-up of patients, and present the authors' own experience of the utility of aVEEG in a teaching hospital setting.


Asunto(s)
Electroencefalografía/tendencias , Epilepsia/diagnóstico , Servicios de Atención de Salud a Domicilio/tendencias , Monitoreo Ambulatorio/tendencias , Grabación en Video/tendencias , Centros Médicos Académicos/tendencias , Diagnóstico Diferencial , Electroencefalografía/métodos , Epilepsia/epidemiología , Epilepsia/fisiopatología , Humanos , Monitoreo Ambulatorio/métodos , Grabación en Video/métodos
15.
BMC Geriatr ; 21(1): 207, 2021 03 25.
Artículo en Inglés | MEDLINE | ID: mdl-33765937

RESUMEN

BACKGROUND: At present, the provision of informal care to older relatives is an essential pillar of the long-term care system in Germany. However, the impact of demographic and social changes on informal caregiving remains unclear. METHODS: Thirty-three semi-structured interviews were conducted with care consultants, informal caregivers and people without any caregiving experience to explore if people are willing to provide older adult care and how prepared these are with regard to the possibility of becoming care dependent themselves. RESULTS: In total, three main categories (willingness to provide care, willingness to receive care and information as preparation) with several sub-categories were identified during the content analysis. While almost all interviewees were willing to provide care for close family members, most were hesitant to receive informal care. Other factors such as the available housing space, flexible working hours and the proximity of relatives were essential indicators of a person's preparedness to provide informal care. It is, however, unclear if care preferences change over time and generations. Six out of 12 informal caregivers and nine out of 14 care consultants also reported an information gap. Because they do not possess adequate information, informal caregivers do not seek help until it is too late and they experience high physical and mental strain. Despite the increased efforts of care consultants in recent years, trying to inform caregivers earlier was seen as almost impossible. CONCLUSIONS: The very negative perception of caregiving as a burden was a reoccurring theme throughout all interviews and influenced people's willingness to receive care as well as seeking timely information. Despite recent political efforts to strengthen home-based care in Germany, it remains unclear whether political efforts will be effective in changing individuals' perceptions of informal caregiving and their willingness to be better prepared for the highly likely scenario of having to care for a close relative or becoming care dependent at a later stage in life.


Asunto(s)
Cuidadores , Servicios de Atención de Salud a Domicilio , Anciano , Familia , Alemania , Humanos , Atención al Paciente
16.
Nat Commun ; 12(1): 1931, 2021 03 26.
Artículo en Inglés | MEDLINE | ID: mdl-33771993

RESUMEN

The COVID-19 pandemic continues to have an unprecedented impact on societies and economies worldwide. There remains an ongoing need for high-performance SARS-CoV-2 tests which may be broadly deployed for infection monitoring. Here we report a highly sensitive single molecule array (Simoa) immunoassay in development for detection of SARS-CoV-2 nucleocapsid protein (N-protein) in venous and capillary blood and saliva. In all matrices in the studies conducted to date we observe >98% negative percent agreement and >90% positive percent agreement with molecular testing for days 1-7 in symptomatic, asymptomatic, and pre-symptomatic PCR+ individuals. N-protein load decreases as anti-SARS-CoV-2 spike-IgG increases, and N-protein levels correlate with RT-PCR Ct-values in saliva, and between matched saliva and capillary blood samples. This Simoa SARS-CoV-2 N-protein assay effectively detects SARS-CoV-2 infection via measurement of antigen levels in blood or saliva, using non-invasive, swab-independent collection methods, offering potential for at home and point of care sample collection.


Asunto(s)
/métodos , /sangre , Saliva/virología , /epidemiología , /genética , Epidemias , Servicios de Atención de Salud a Domicilio , Humanos , Sistemas de Atención de Punto , Curva ROC , /fisiología , Manejo de Especímenes/métodos
17.
Cochrane Database Syst Rev ; 3: CD009231, 2021 03 16.
Artículo en Inglés | MEDLINE | ID: mdl-33721912

RESUMEN

BACKGROUND: The policy several countries is to provide people with a terminal illness the choice of dying at home; this is supported by surveys that indicate that the general public and people with a terminal illness would prefer to receive end-of-life care at home. This is the fifth update of the original review. OBJECTIVES: To determine if providing home-based end-of-life care reduces the likelihood of dying in hospital and what effect this has on patients' symptoms, quality of life, health service costs and caregivers compared with inpatient hospital or hospice care. SEARCH METHODS: We searched CENTRAL, Ovid MEDLINE(R), Embase, CINAHL, and clinical trials registries to 18 March 2020. We checked the reference lists of systematic reviews. For included studies, we checked the reference lists and performed a forward search using ISI Web of Science. We handsearched palliative care journals indexed by ISI Web of Science for online first references. SELECTION CRITERIA: Randomised controlled trials evaluating the effectiveness of home-based end-of-life care with inpatient hospital or hospice care for people aged 18 years and older. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed study quality. When appropriate, we combined published data for dichotomous outcomes using a fixed-effect Mantel-Haenszel meta-analysis to calculate risk ratios (RR) with 95% confidence intervals (CI). When combining outcome data was not possible, we reported the results from individual studies. MAIN RESULTS: We included four randomised trials and found no new studies from the search in March 2020. Home-based end-of-life care increased the likelihood of dying at home compared with usual care (RR 1.31, 95% CI 1.12 to 1.52; 2 trials, 539 participants; I2 = 25%; high-certainty evidence). Admission to hospital varied among the trials (range of RR 0.62, 95% CI 0.48 to 0.79, to RR 2.61, 95% CI 1.50 to 4.55). The effect on patient outcomes and control of symptoms was uncertain. Home-based end-of-life care may slightly improve patient satisfaction at one-month follow-up, with little or no difference at six-month follow-up (2 trials; low-certainty evidence). The effect on caregivers (2 trials; very low-certainty evidence), staff (1 trial; very low-certainty evidence) and health service costs was uncertain (2 trials, very low-certainty evidence). AUTHORS' CONCLUSIONS: The evidence included in this review supports the use of home-based end-of-life care programmes for increasing the number of people who will die at home. Research that assesses the impact of home-based end-of-life care on caregivers and admissions to hospital would be a useful addition to the evidence base, and might inform the delivery of these services.


Asunto(s)
Actitud Frente a la Muerte , Servicios de Atención de Salud a Domicilio , Cuidados Paliativos al Final de la Vida/psicología , Prioridad del Paciente/psicología , Anciano , Actitud del Personal de Salud , Sesgo , Cuidadores/psicología , Femenino , Accesibilidad a los Servicios de Salud , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Características de la Residencia/estadística & datos numéricos , Factores de Tiempo
19.
Mayo Clin Proc ; 96(4): 952-963, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33714592

RESUMEN

OBJECTIVE: To describe the place and cause of death during the coronavirus disease 2019 (COVID-19) pandemic to assess its impact on excess mortality. METHODS: This national death registry included all adult (aged ≥18 years) deaths in England and Wales between January 1, 2014, and June 30, 2020. Daily deaths during the COVID-19 pandemic were compared against the expected daily deaths, estimated with use of the Farrington surveillance algorithm for daily historical data between 2014 and 2020 by place and cause of death. RESULTS: Between March 2 and June 30, 2020, there was an excess mortality of 57,860 (a proportional increase of 35%) compared with the expected deaths, of which 50,603 (87%) were COVID-19 related. At home, only 14% (2267) of the 16,190 excess deaths were related to COVID-19, with 5963 deaths due to cancer and 2485 deaths due to cardiac disease, few of which involved COVID-19. In care homes or hospices, 61% (15,623) of the 25,611 excess deaths were related to COVID-19, 5539 of which were due to respiratory disease, and most of these (4315 deaths) involved COVID-19. In the hospital, there were 16,174 fewer deaths than expected that did not involve COVID-19, with 4088 fewer deaths due to cancer and 1398 fewer deaths due to cardiac disease than expected. CONCLUSION: The COVID-19 pandemic has resulted in a large excess of deaths in care homes that were poorly characterized and likely to be the result of undiagnosed COVID-19. There was a smaller but important and ongoing excess in deaths at home, particularly from cancer and cardiac disease, suggesting public avoidance of hospital care for non-COVID-19 conditions.


Asunto(s)
Causas de Muerte/tendencias , Cardiopatías/mortalidad , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Neoplasias/mortalidad , Casas de Salud/estadística & datos numéricos , Adulto , Anciano de 80 o más Años , /mortalidad , Errores Diagnósticos/mortalidad , Errores Diagnósticos/estadística & datos numéricos , Inglaterra/epidemiología , Femenino , Cuidados Paliativos al Final de la Vida/estadística & datos numéricos , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Gales/epidemiología
20.
PLoS One ; 16(3): e0247635, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33770093

RESUMEN

BACKGROUND: COVID-19 is characterized by a rapid change in the patient's condition, with major changes occurring over a few days. We aimed to develop and evaluate an emergency system for monitoring patients with COVID-19, which may be useful in hospitals where more severe patients stay in their homes. METHODOLOGY/PRINCIPAL FINDINGS: The system consists of the home-based patient unit, which is set up around the patient and the hospital unit, which enables the medical staff to telemonitor the patient's condition and help to send medical recommendations. The home unit allows the data transmission from the patient to the hospital, which is performed using a cell phone application. The hospital unit includes a virtual instrument developed in LabVIEW® environment that can provide a real-time monitoring of the oxygen saturation (SpO2), beats per minute (BPM), body temperature (BT), and peak expiratory flow (PEF). Abnormal events may be fast and automatically identified. After the design details are described, the system is validated by a 30-day home monitoring study in 12 controls and 12 patients with COVID-19 presenting asymptomatic to mild disease. Patients presented reduced SpO2 (p<0.0001) and increased BPM values (p<0.0001). Three patients (25%) presented PEF values between 50 and 80% of the predicted. Three of the 12 monitored patients presented events of desaturation (SpO2<92%). The experimental results were in close agreement with the involved pathophysiology, providing clear evidence that the proposed system can be a useful tool for the remote monitoring of patients with COVID-19. CONCLUSIONS: An emergency system for home monitoring of patients with COVID-19 was developed in the current study. The proposed system allowed us to quickly respond to early abnormalities in these patients. This system may contribute to conserving hospital resources for those most in need while simultaneously enabling early recognition of patients under acute deterioration, requiring urgent assessment.


Asunto(s)
/patología , Servicios de Atención de Salud a Domicilio , Monitoreo Fisiológico/métodos , Adulto , Enfermedades Asintomáticas/enfermería , Temperatura Corporal , Estudios de Casos y Controles , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Aplicaciones Móviles , Oximetría , Ápice del Flujo Espiratorio/fisiología , /aislamiento & purificación
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