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1.
Bone Joint J ; 103-B(2): 207-212, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33517733

RESUMEN

The management of symptomatic osteochondral lesions of the talus (OLTs) can be challenging. The number of ways of treating these lesions has increased considerably during the last decade, with published studies often providing conflicting, low-level evidence. This paper aims to present an up-to-date concise overview of the best evidence for the surgical treatment of OLTs. Management options are reviewed based on the size of the lesion and include bone marrow stimulation, bone grafting options, drilling techniques, biological preparations, and resurfacing. Although many of these techniques have shown promising results, there remains little high level evidence, and further large scale prospective studies and systematic reviews will be required to identify the optimal form of treatment for these lesions. Cite this article: Bone Joint J 2021;103-B(2):207-212.


Asunto(s)
Fracturas de Tobillo/terapia , Cartílago Articular/lesiones , Procedimientos Ortopédicos/métodos , Traumatismos de los Tejidos Blandos/terapia , Astrágalo/lesiones , Algoritmos , Cartílago Articular/cirugía , Toma de Decisiones Clínicas , Humanos , Guías de Práctica Clínica como Asunto , Astrágalo/cirugía
2.
Medicine (Baltimore) ; 100(4): e23755, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530175

RESUMEN

BACKGROUND: Dental pain can have a detrimental effect on quality of life. Symptomatic apical periodontitis is the most common cause of dental pain and arise from an inflamed or necrotic dental pulp. There is growing evidence to support the effectiveness of probiotics in combination with antibiotics on periodontitis. We therefor will conduct this study to evaluate the clinical therapeutic effects of probiotics in combination with antibiotics on periodontitis. METHODS: We will systematically search the following databases: PubMed, the Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature Database (CBM), and WanFang database. A grey literature search will be conducted using ZETOC Conference Proceedings and Open Grey. Only randomized controlled trials (RCTs) related to research on probiotics in combination with antibiotics to treatment patients with periodontitis will be included. All sources have to be searched from their inception to October 2020. Two authors will independently select studies, extract study data, and evaluate the quality of the included studies. We will use Review Manager Software (RevMan 5.3) to analyze data. RESULTS: This study will systematically evaluate the clinical therapeutic effects of probiotics in combination with antibiotics on periodontitis. CONCLUSIONS: This study will generate evidence for a better clinical decision of patients with periodontitis. REGISTRATION NUMBER: DOI 10.17605/OSF.IO/QZ6SB (https://osf.io/qz6sb/).


Asunto(s)
Antibacterianos/uso terapéutico , Metaanálisis como Asunto , Periodontitis Periapical/tratamiento farmacológico , Probióticos/uso terapéutico , Revisiones Sistemáticas como Asunto , Toma de Decisiones Clínicas , Protocolos Clínicos , Quimioterapia Combinada , Humanos , Dolor/prevención & control , Periodontitis Periapical/complicaciones , Proyectos de Investigación
3.
Eur Respir Rev ; 30(159)2021 Mar 31.
Artículo en Inglés | MEDLINE | ID: mdl-33568526

RESUMEN

PURPOSE: Corticosteroids have been considered in medicine for a long time, and they are broadly prescribed. In infectious diseases, corticosteroids have been regarded as a thread due to their immunosuppressive effects and therefore their anti-inflammatory properties. MAIN: In recent years, there have been several studies published that aimed to determine the role of corticosteroids in patients with community-acquired pneumonia (CAP), because, despite significant advances in new antibiotics and supportive care, deaths of patients with CAP remain unacceptably high. While the 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) CAP guidelines did not mention the use of corticosteroids in the management of CAP, the recently published 2019 IDSA/ATS guidelines recommended their use in patients with septic shock refractory to vasopressors and fluid resuscitation. Regarding viral infection, the use of corticosteroids in patients with influenza has shown to be associated with significantly higher mortality and higher incidence of nosocomial infection, while in patients with coronavirus disease 2019 (COVID-19) there is a good body of evidence of the benefit of corticosteroids in terms of mortality. CONCLUSIONS: The use of corticosteroids has been considered as a potential alternative co-adjuvant treatment in patients with pneumonia. In patients with COVID-19, the evidence is quite strong and there is a clear benefit of the use of corticosteroids in those patients presenting severe forms of disease.


Asunto(s)
Corticoesteroides/uso terapéutico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Gripe Humana/tratamiento farmacológico , Corticoesteroides/efectos adversos , Toma de Decisiones Clínicas , Humanos , Seguridad del Paciente , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento
4.
J Healthc Eng ; 2021: 8864522, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33552457

RESUMEN

Objectives: The outbreak of coronavirus disease 2019 (COVID-19) was first reported in December 2019. Until now, many drugs and methods have been used in the treatment of the disease. However, no effective treatment option has been found and only case-based successes have been achieved so far. This study aims to evaluate COVID-19 treatment options using multicriteria decision-making (MCDM) techniques. Methods: In this study, we evaluated the available COVID-19 treatment options by MCDM techniques, namely, fuzzy PROMETHEE and VIKOR. These techniques are based on the evaluation and comparison of complex and multiple criteria to evaluate the most appropriate alternative. We evaluated current treatment options including favipiravir (FPV), lopinavir/ritonavir, hydroxychloroquine, interleukin-1 blocker, intravenous immunoglobulin (IVIG), and plasma exchange. The criteria used for the analysis include side effects, method of administration of the drug, cost, turnover of plasma, level of fever, age, pregnancy, and kidney function. Results: The results showed that plasma exchange was the most preferred alternative, followed by FPV and IVIG, while hydroxychloroquine was the least favorable one. New alternatives could be considered once they are available, and weights could be assigned based on the opinions of the decision-makers (physicians/clinicians). The treatment methods that we evaluated with MCDM methods will be beneficial for both healthcare users and to rapidly end the global pandemic. The proposed method is applicable for analyzing the alternatives to the selection problem with quantitative and qualitative data. In addition, it allows the decision-maker to define the problem simply under uncertainty. Conclusions: Fuzzy PROMETHEE and VIKOR techniques are applied in aiding decision-makers in choosing the right treatment technique for the management of COVID-19.


Asunto(s)
/tratamiento farmacológico , Toma de Decisiones Clínicas/métodos , Técnicas de Apoyo para la Decisión , Lógica Difusa , Antivirales/administración & dosificación , Antivirales/uso terapéutico , Humanos , Pandemias
5.
Medicine (Baltimore) ; 100(6): e24657, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578594

RESUMEN

BACKGROUND: Alzheimer's disease (AD) occurs in the elderly and the early stage of aging, with early clinical manifestations of memory impairment, cognitive impairment, behavioral change and decline in language function, etc., and eventually loss of the ability to live independently, requiring 24-hour care, and a variety of complications. However, these complications are the direct cause of death in AD patients. With the acceleration of the aging process of society, the incidence of AD is increasing year by year, seriously threatening the physical health and quality of life of the elderly. There are many ways to treat AD, however, moxibustion is especially popular in China. Therefore, our systematic review aims to evaluate the efficacy and safety of moxibustion in the treatment of ADand to provide reliable evidence for clinical decision-makers. METHODS: We will search electronic databases including PubMed, Embase, Cochrane Library, China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database (WF), and China Scientific Journals Database (VIP) from inception to January 2021. Two authors will independently screen the studies, extract data information, and assess methodological quality through the Cochrane risk of bias (ROB) tool. The RevmanV.5.3 software will be used for statistical analysis. RESULTS: The results of this study will evaluate the current status of moxibustion therapy for AD, aiming to prove the effectiveness and safety of moxibustion therapy, and will be published in a peer-reviewed journal. CONCLUSION: This systematic review will provide a credible evidence-based for moxibustion in the treatment of AD. INPLASY REGISTRATION NUMBER: INPLASY202110021.


Asunto(s)
Terapia por Acupuntura/métodos , Enfermedad de Alzheimer/terapia , Moxibustión/métodos , Terapia por Acupuntura/efectos adversos , Anciano , Enfermedad de Alzheimer/epidemiología , Enfermedad de Alzheimer/psicología , China/epidemiología , Toma de Decisiones Clínicas/ética , Manejo de Datos , Femenino , Humanos , Incidencia , Masculino , Moxibustión/efectos adversos , Calidad de Vida , Proyectos de Investigación , Seguridad , Resultado del Tratamiento
6.
Lancet Oncol ; 22(1): e18-e28, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33387500

RESUMEN

Primary systemic therapy is increasingly used in the treatment of patients with early-stage breast cancer, but few guidelines specifically address optimal locoregional therapies. Therefore, we established an international consortium to discuss clinical evidence and to provide expert advice on technical management of patients with early-stage breast cancer. The steering committee prepared six working packages to address all major clinical questions from diagnosis to surgery. During a consensus meeting that included members from European scientific oncology societies, clinical trial groups, and patient advocates, statements were discussed and voted on. A consensus was reached in 42% of statements, a majority in 38%, and no decision in 21%. Based on these findings, the panel developed clinical guidance recommendations and a toolbox to overcome many clinical and technical requirements associated with the diagnosis, response assessment, surgical planning, and surgery of patients with early-stage breast cancer. This guidance could convince clinicians and patients of the major clinical advancements purported by primary systemic therapy, the use of less extensive and more targeted surgery to improve the lives of patients with breast cancer.


Asunto(s)
Antineoplásicos/administración & dosificación , Neoplasias de la Mama/terapia , Mastectomía Segmentaria/normas , Oncología Médica/normas , Terapia Neoadyuvante/normas , Antineoplásicos/efectos adversos , Neoplasias de la Mama/patología , Quimioterapia Adyuvante , Toma de Decisiones Clínicas , Consenso , Técnica Delfos , Femenino , Humanos , Mastectomía Segmentaria/efectos adversos , Terapia Neoadyuvante/efectos adversos , Estadificación de Neoplasias , Resultado del Tratamiento
7.
BMC Musculoskelet Disord ; 22(1): 18, 2021 Jan 05.
Artículo en Inglés | MEDLINE | ID: mdl-33402136

RESUMEN

BACKGROUND: Like with all cancers, multidisciplinary team (MDT) meetings are the norm in bone and soft tissue tumour (BST) management too. Problem in attendance of specialists due to geographical location is the one of the key barriers to effective functioning of MDTs. To overcome this problem, virtual MDTs involving videoconferencing or telemedicine have been proposed, but however this has been seldom used and tested. The COVID-19 pandemic forced the implementation of virtual MDTs in the Oxford sarcoma service in order to maintain normal service provision. We conducted a survey among the participants to evaluate its efficacy. METHODS: An online questionnaire comprising of 24 questions organised into 4 sections was circulated among all participants of the MDT after completion of 8 virtual MDTs. Opinions were sought comparing virtual MDTs to the conventional face-to-face MDTs on various aspects. A total of 36 responses were received and were evaluated. RESULTS: 72.8% were satisfied with the depth of discussion in virtual MDTs and 83.3% felt that the decision-making in diagnosis had not changed following the switch from face-to-face MDTs. About 86% reported to have all essential patient data was available to make decisions and 88.9% were satisfied with the time for discussion of patient issues over virtual platform. Three-fourths of the participants were satisfied (36.1% - highly satisfied; 38.9% - moderately satisfied) with virtual MDTs and 55.6% of them were happy to attend MDTs only by the virtual platform in the future. Regarding future, 77.8% of the participants opined that virtual MDTs would be the future of cancer care and an overwhelming majority (91.7%) felt that the present exercise would serve as a precursor to global MDTs involving specialists from abroad in the future. CONCLUSION: Our study shows that the forced switch to virtual MDTs in sarcoma care following the unprecedented COVID-19 pandemic to be a viable and effective alternative to conventional face-to-face MDTs. With effective and efficient software in place, virtual MDTs would also facilitate in forming extended MDTs in seeking opinions on complex cases from specialists abroad and can expand cancer care globally.


Asunto(s)
Neoplasias Óseas/terapia , Comunicación Interdisciplinaria , Oncología Médica/organización & administración , Neoplasias de los Músculos/terapia , Grupo de Atención al Paciente/organización & administración , Sarcoma/terapia , Telemedicina/organización & administración , Comunicación por Videocoferencia/organización & administración , Actitud del Personal de Salud , Actitud hacia los Computadores , Neoplasias Óseas/diagnóstico , Toma de Decisiones Clínicas , Prestación Integrada de Atención de Salud/organización & administración , Conocimientos, Actitudes y Práctica en Salud , Humanos , Neoplasias de los Músculos/diagnóstico , Sarcoma/diagnóstico , Centros de Atención Terciaria
8.
Crit Care ; 25(1): 22, 2021 01 08.
Artículo en Inglés | MEDLINE | ID: mdl-33419456

RESUMEN

Providing optimal care to patients with acute respiratory illness while preventing hospital transmission of COVID-19 is of paramount importance during the pandemic; the challenge lies in achieving both goals simultaneously. Controversy exists regarding the role of early intubation versus use of non-invasive respiratory support measures to avoid intubation. This review summarizes available evidence and provides a clinical decision algorithm with risk mitigation techniques to guide clinicians in care of the hypoxemic, non-intubated, patient during the COVID-19 pandemic. Although aerosolization of droplets may occur with aerosol-generating medical procedures (AGMP), including high flow nasal oxygen and non-invasive ventilation, the risk of using these AGMP is outweighed by the benefit in carefully selected patients, particularly if care is taken to mitigate risk of viral transmission. Non-invasive support measures should not be denied for conditions where previously proven effective and may be used even while there is suspicion of COVID-19 infection. Patients with de novo acute respiratory illness with suspected/confirmed COVID-19 may also benefit. These techniques may improve oxygenation sufficiently to allow some patients to avoid intubation; however, patients must be carefully monitored for signs of increased work of breathing. Patients showing signs of clinical deterioration or high work of breathing not alleviated by non-invasive support should proceed promptly to intubation and invasive lung protective ventilation strategy. With adherence to these principles, risk of viral spread can be minimized.


Asunto(s)
Toma de Decisiones Clínicas/métodos , Cuidados Críticos/organización & administración , Ventilación no Invasiva , /terapia , Algoritmos , Humanos
9.
Am J Respir Crit Care Med ; 203(1): 14-23, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33385220

RESUMEN

Rationale: Decisions in medicine are made on the basis of knowledge and reasoning, often in shared conversations with patients and families in consideration of clinical practice guideline recommendations, individual preferences, and individual goals. Observational studies can provide valuable knowledge to inform guidelines, decisions, and policy.Objectives: The American Thoracic Society (ATS) created a multidisciplinary ad hoc committee to develop a research statement to clarify the role of observational studies-alongside randomized controlled trials (RCTs)-in informing clinical decisions in pulmonary, critical care, and sleep medicine.Methods: The committee examined the strengths of observational studies assessing causal effects, how they complement RCTs, factors that impact observational study quality, perceptions of observational research, and, finally, the practicalities of incorporating observational research into ATS clinical practice guidelines.Measurements and Main Results: There are strengths and weakness of observational studies as well as RCTs. Observational studies can provide evidence in representative and diverse patient populations. Quality observational studies should be sought in the development of ATS clinical practice guidelines, and medical decision-making in general, when 1) no RCTs are identified or RCTs are appraised as being of low- or very low-quality (replacement); 2) RCTs are of moderate quality because of indirectness, imprecision, or inconsistency, and observational studies mitigate the reason that RCT evidence was downgraded (complementary); or 3) RCTs do not provide evidence for outcomes that a guideline committee considers essential for decision-making (e.g., rare or long-term outcomes; "sequential").Conclusions: Observational studies should be considered in developing clinical practice guidelines and in making clinical decisions.


Asunto(s)
Investigación Biomédica/normas , Toma de Decisiones Clínicas , Cuidados Críticos/normas , Prestación de Atención de Salud/normas , Medicina Basada en la Evidencia/normas , Estudios Observacionales como Asunto/normas , Enfermedades Torácicas/terapia , Humanos , Guías de Práctica Clínica como Asunto , Sociedades Médicas , Estados Unidos
10.
Anticancer Res ; 41(1): 1-7, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33419794

RESUMEN

Chemoradiotherapy (CRT) refers to the combined administration of both chemotherapy and radiotherapy as an anticancer treatment. Over the years, CRT has become an established treatment for a diverse range of locally advanced solid tumours. The rationale for CRT is based on the two concepts of spatial cooperation and in-field cooperation, whereby the end goal is to achieve synergistic antitumour effects from the combination of both treatment modalities. CRT offers notable patient survival benefits and local disease control without significant long-term toxicities. Although the enhancement of cytotoxic effects inevitably increases damage to normal tissues as well as tumour cells, if the damage to normal tissue is lesser than that to tumour cells, CRT is still deemed beneficial. Thus, the search to optimise dose, timings and fractionation of CRT is of particular interest. Considering the recent success achieved with anticancer immunotherapies including immune checkpoint inhibitors, the combination of CRT and immunotherapy has emerged as an exciting field of research with the potential for significant clinical benefit. This report outlines the rationale underlying CRT and discusses its advantages through clinical examples focusing on anal, cervical, non-small-cell lung cancer and bladder cancer.


Asunto(s)
Quimioradioterapia , Neoplasias/terapia , Quimioradioterapia/efectos adversos , Quimioradioterapia/métodos , Toma de Decisiones Clínicas , Terapia Combinada , Manejo de la Enfermedad , Relación Dosis-Respuesta a Droga , Relación Dosis-Respuesta en la Radiación , Humanos , Neoplasias/diagnóstico , Neoplasias/mortalidad , Especificidad de Órganos , Resultado del Tratamiento
11.
Anticancer Res ; 41(2): 1089-1099, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33517320

RESUMEN

BACKGROUND/AIM: Prognosis plays a vital role in head and neck squamous cell carcinoma (HNSCC) patient management and decision-making. This study aimed to identify the role of BP180 as a prognostic factor in HNSCC. PATIENTS AND METHODS: Protein expression of bullous pemphigoid antigen II (BP180) was verified by immunohistochemistry (IHC) in a tissue microarray study of 202 cases. RESULTS: IHC analysis revealed that protein expression of BP180 among HNSCC patients differed significantly in the presence and absence of neural invasion, and according to T status in laryngeal and pharyngeal cancer subgroups. Overall survival and multivariate analysis showed that positive BP180-IHC and advanced clinical stage were significant independent positive predictors of mortality in HNSCC patients. In addition, in the oral cancer subgroup, independent positive predictors were positive BP180-IHC, advanced N status and neural invasion. In laryngeal and pharyngeal cancer subgroups, predictors were positive BP180-IHC and advanced clinical stage. CONCLUSION: BP180 is a prognostic factor in head and neck squamous cell carcinoma.


Asunto(s)
Autoantígenos/metabolismo , Biomarcadores de Tumor/metabolismo , Neoplasias de Cabeza y Cuello/patología , Colágenos no Fibrilares/metabolismo , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Adulto , Anciano , Anciano de 80 o más Años , Toma de Decisiones Clínicas , Femenino , Regulación Neoplásica de la Expresión Génica , Neoplasias de Cabeza y Cuello/metabolismo , Neoplasias de Cabeza y Cuello/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Pronóstico , Carcinoma de Células Escamosas de Cabeza y Cuello/metabolismo , Carcinoma de Células Escamosas de Cabeza y Cuello/mortalidad , Análisis de Supervivencia , Análisis de Matrices Tisulares
13.
Clin Lab ; 67(1)2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33491422

RESUMEN

BACKGROUND: In December 2019, an outbreak of pneumonia of no identifiable cause had been widely spreading in Wuhan, Hubei Province, China. In late December 2019, the pathogen was identified as a new strain of coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and its associated disease, named Coronavirus disease-19 (COVID-19). As of July 3, 2020, 10,906,822 cases have been confirmed worldwide, with 522,112 deaths, as reported by the World Health Organization. Given the developing situation with COVID-19, extensive studies are urgently needed that determine indicators of severity to provide evidence for health policymakers. This study aimed to review the currently available data on hematological parameters to predict disease severity in patients of COVID-19. METHODS: We performed a review using three electronic databases. Fourteen papers are included. In this review, we summarized the latest research highlighting the clinical features, pathogenesis, and diagnosis, with a concentration on hematological parameters that predict severity to help identify patients with severe disease. These indicators will help doctors know earlier which patients may need intensive care unit (ICU) care to manage their patients with an evidence-based protocol. RESULTS: Most reviewed studies report hematological parameters that predict disease severity, including lymphopenia and elevated fibrin fragment D. CONCLUSIONS: We recommend using these indicators in addition to others, like respiratory failure, shock, or multiple organs dysfunction syndrome, for disease classification in situations where there are insufficient ventilators or ICU beds to prioritize advanced medical services accordingly and to ensure the maximum provision of sufficient medical care.


Asunto(s)
Análisis Químico de la Sangre , /diagnóstico , Biomarcadores/sangre , /complicaciones , Toma de Decisiones Clínicas , Humanos , Valor Predictivo de las Pruebas , Pronóstico , Índice de Severidad de la Enfermedad
15.
BMC Palliat Care ; 20(1): 10, 2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-33430850

RESUMEN

BACKGROUND: Observational studies investigating risk factors in coronavirus disease 2019 (COVID-19) have not considered the confounding effects of advanced care planning, such that a valid picture of risk for elderly, frail and multi-morbid patients is unknown. We aimed to report ceiling of care and cardiopulmonary resuscitation (CPR) decisions and their association with demographic and clinical characteristics as well as outcomes during the COVID-19 pandemic. METHODS: Retrospective, observational study conducted between 5th March and 7th May 2020 of all hospitalised patients with COVID-19. Ceiling of care and CPR decisions were documented using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process. Unadjusted and multivariable regression analyses were used to determine factors associated with ceiling of care decisions and death during hospitalisation. RESULTS: A total of 485 patients were included, of whom 409 (84·3%) had a documented ceiling of care; level one for 208 (50·9%), level two for 75 (18·3%) and level three for 126 (30·8%). CPR decisions were documented for 451 (93·0%) of whom 336 (74·5%) were 'not for resuscitation'. Advanced age, frailty, White-European ethnicity, a diagnosis of any co-morbidity and receipt of cardiovascular medications were associated with ceiling of care decisions. In a multivariable model only advanced age (odds 0·89, 0·86-0·93 p < 0·001), frailty (odds 0·48, 0·38-0·60, p < 0·001) and the cumulative number of co-morbidities (odds 0·72, 0·52-1·0, p = 0·048) were independently associated. Death during hospitalisation was independently associated with age, frailty and requirement for level two or three care. CONCLUSION: Ceiling of care decisions were made for the majority of patients during the COVID-19 pandemic, broadly in line with known predictors of poor outcomes in COVID-19, but with a focus on co-morbidities suggesting ICU admission might not be a reliable end-point for observational studies where advanced care planning is routine.


Asunto(s)
Planificación Anticipada de Atención , Toma de Decisiones Clínicas , Adulto , Anciano , Anciano de 80 o más Años , Reanimación Cardiopulmonar , Femenino , Humanos , Cuidados para Prolongación de la Vida , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
16.
Cardiovasc Ther ; 2021: 8886210, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33505518

RESUMEN

Direct oral anticoagulants (DOACs) are widely used for the prevention of stroke in nonvalvular atrial fibrillation, treatment of deep venous thrombosis and pulmonary embolism, and as prophylaxis after hip and knee surgery after approval by the Food and Drug Administration. In the last decade, DOACs were studied for various indications; this review is focused on rivaroxaban, a factor Xa inhibitor, which is used in an expanded evidence-based fashion for coronary artery disease, peripheral artery disease, heart failure, malignancy, and prophylaxis of deep venous thrombosis in acute medical illnesses.


Asunto(s)
Enfermedades Cardiovasculares/tratamiento farmacológico , Inhibidores del Factor Xa/administración & dosificación , Rivaroxabán/administración & dosificación , Enfermedades Cardiovasculares/diagnóstico , Toma de Decisiones Clínicas , Inhibidores del Factor Xa/efectos adversos , Hemorragia/inducido químicamente , Humanos , Selección de Paciente , Factores de Riesgo , Rivaroxabán/efectos adversos , Resultado del Tratamiento
17.
Emerg Infect Dis ; 27(2): 632-635, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33496233

RESUMEN

We developed an assay that detects minus-strand RNA as a surrogate for actively replicating severe acute respiratory syndrome coronavirus 2. We detected minus-strand RNA in 41 persons with coronavirus disease up to 30 days after symptom onset. This assay might inform clinical decision-making about patient infectiousness.


Asunto(s)
/normas , ARN Viral/análisis , Replicación Viral/genética , Adulto , /métodos , Toma de Decisiones Clínicas , Transmisión de Enfermedad Infecciosa , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , ARN Viral/fisiología , Estudios Retrospectivos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , /fisiología
18.
Phys Ther ; 101(1)2021 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-33508856

RESUMEN

OBJECTIVE: The purpose of this case report is to describe the acute rehabilitation of an individual with severe COVID-19 complicated by myocarditis, focusing on both facility-wide and patient-specific strategies. METHODS: A 50-year-old male presented to the emergency department with progressive dyspnea and confirmed COVID-19. He developed hypoxic respiratory failure and heart failure requiring prolonged mechanical ventilation. Mobility was limited by severe impairments in strength, endurance, balance, and cognition. The referral, screening, and rehabilitation of this patient were guided by a COVID-19 Service Delivery Plan designed to maximize the effectiveness and efficiency of care delivery while minimizing staff exposure to the virus. Coordinated physical and occupational therapy sessions focused on progressive mobility and cognitive retraining. Progress was monitored using a series of standardized outcome measures, including the Activity Measure for Post-Acute Care, Timed Up and Go test, and the Saint Louis University Mental Status examination. RESULTS: Rehabilitation was initiated on day 18, and the patient participated in 19 treatment sessions, each approximately 30 minutes, over the remaining 30 days of his hospital stay. His Activity Measure for Post-Acute Care mobility and function scores both improved from 100% to 0% disability, he experienced substantial improvements in both Timed Up and Go (Δ = 4.2 seconds) and Saint Louis University Mental Status (discharge score = 25). There were no adverse events. He was discharged to home with his family and home rehabilitation services. CONCLUSION: COVID-19 contributed to severe declines in mobility and function in this middle-aged man. He experienced substantial gains in his function, mobility, and cognition during his in-hospital rehabilitation, which was guided by a facility-wide plan to prevent virus transmission. IMPACT: The rehabilitation of individuals with severe COVID-19 presents significant challenges, both at the level of the individual patient and the whole facility. This report describes clinical decision-making required to manage these individuals in the setting of a global pandemic.


Asunto(s)
/rehabilitación , Miocarditis/rehabilitación , /complicaciones , Toma de Decisiones Clínicas , Cognición , Humanos , Masculino , Persona de Mediana Edad , Miocarditis/virología , Prueba de Paso , Caminata
19.
PLoS One ; 16(1): e0237202, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33471809

RESUMEN

BACKGROUND: The novel coronavirus (SARS-CoV-2) pandemic spread rapidly worldwide increasing exponentially in Italy. To date, there is lack of studies describing clinical characteristics of the people at high risk of infection. Hence, we aimed (i) to identify clinical predictors of SARS-CoV-2 infection risk, (ii) to develop and validate a score predicting SARS-CoV-2 infection risk, and (iii) to compare it with unspecific scores. METHODS: Retrospective case-control study using administrative health-related database was carried out in Southern Italy (Campania region) among beneficiaries of Regional Health Service aged over than 30 years. For each person with SARS-CoV-2 confirmed infection (case), up to five controls were randomly matched for gender, age and municipality of residence. Odds ratios and 90% confidence intervals for associations between candidate predictors and risk of infection were estimated by means of conditional logistic regression. SARS-CoV-2 Infection Score (SIS) was developed by generating a total aggregate score obtained from assignment of a weight at each selected covariate using coefficients estimated from the model. Finally, the score was categorized by assigning increasing values from 1 to 4. Discriminant power was used to compare SIS performance with that of other comorbidity scores. RESULTS: Subjects suffering from diabetes, anaemias, Parkinson's disease, mental disorders, cardiovascular and inflammatory bowel and kidney diseases showed increased risk of SARS-CoV-2 infection. Similar estimates were recorded for men and women and younger and older than 65 years. Fifteen conditions significantly contributed to the SIS. As SIS value increases, risk progressively increases, being odds of SARS-CoV-2 infection among people with the highest SIS value (SIS = 4) 1.74 times higher than those unaffected by any SIS contributing conditions (SIS = 1). CONCLUSION: Conditions and diseases making people more vulnerable to SARS-CoV-2 infection were identified by the current study. Our results support decision-makers in identifying high-risk people and adopting of preventive measures to minimize the spread of further epidemic waves.


Asunto(s)
/epidemiología , Adulto , Anciano , Toma de Decisiones Clínicas , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Italia/epidemiología , Masculino , Factores de Riesgo
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