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1.
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
2.
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
3.
J Urol ; 205(1): 137-144, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32856980

RESUMEN

PURPOSE: Current serum tumor markers for testicular germ cell tumor are limited by low sensitivity. Growing evidence supports the use of circulating miR-371a-3p as a superior marker for malignant (viable) germ cell tumor management. We evaluated the real-world application of serum miR-371a-3p levels in detecting viable germ cell tumor among patients undergoing partial or radical orchiectomy. MATERIALS AND METHODS: Serum samples were collected from 69 consecutive patients before orchiectomy. Performance characteristics of serum miR-371a-3p were compared with conventional serum tumor markers (⍺-fetoprotein/ß-human chorionic gonadotropin/lactate dehydrogenase) between patients with viable germ cell tumor and those without viable germ cell tumor on orchiectomy pathology. Relative miR-371a-3p levels were correlated with clinical course. The Kruskal-Wallis test and linear and ordinal regression models were used for analysis. RESULTS: For detecting viable germ cell tumor, combined conventional serum tumor markers had a specificity of 100%, sensitivity of 58% and AUC of 0.79. The miR-371a-3p test showed a specificity of 100%, sensitivity of 93% and AUC of 0.978. Median relative expression of miR-371a-3p in viable germ cell tumor cases was more than 6,800-fold higher than in those lacking viable germ cell tumor. miR-371a-3p levels correlated with composite stage (p=0.006) and, among composite stage I cases, independently associated with embryonal carcinoma percentage (p=0.0012) and tumor diameter (p <0.0001). Six patients underwent orchiectomy after chemotherapy and were correctly predicted to have presence or absence of viable germ cell tumor by the miR-371a-3p test. CONCLUSIONS: If validated, the miR-371a-3p test can be used in conjunction with conventional serum tumor markers to aid clinical decision making. A positive miR-371a-3p test in patients after preoperative chemotherapy or with solitary testes could potentially guide subsequent orchiectomy or observation.


Asunto(s)
Biomarcadores de Tumor/sangre , MicroARN Circulante/sangre , MicroARNs/sangre , Neoplasias de Células Germinales y Embrionarias/diagnóstico , Orquiectomía , Neoplasias Testiculares/diagnóstico , Adulto , Estudios de Casos y Controles , Quimioterapia Adyuvante , Toma de Decisiones Clínicas/métodos , Estudios de Factibilidad , Humanos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante/métodos , Estadificación de Neoplasias , Neoplasias de Células Germinales y Embrionarias/sangre , Neoplasias de Células Germinales y Embrionarias/patología , Neoplasias de Células Germinales y Embrionarias/terapia , Periodo Preoperatorio , Neoplasias Testiculares/sangre , Neoplasias Testiculares/patología , Neoplasias Testiculares/terapia , Testículo/patología , Testículo/cirugía , Espera Vigilante
4.
Anaesthesia ; 76(3): 336-345, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33338259

RESUMEN

Postoperative critical care is a finite resource that is recommended for high-risk patients. Despite national recommendations specifying that such patients should receive postoperative critical care, there is evidence that these recommendations are not universally followed. We performed a national survey aiming to better understand how patients are risk-stratified in practice; elucidate clinicians' opinions about how patients should be selected for critical care; and determine factors which affect the actual provision of postoperative critical care. As part of the second Sprint National Anaesthesia Project, epidemiology of critical care after surgery study, we distributed a paper survey to anaesthetists, surgeons and intensivists providing peri-operative care during a single week in March 2017. We collected data on respondent characteristics, and their opinions of postoperative critical care provision, potential benefits and real-world challenges. We undertook both quantitative and qualitative analyses to interpret the responses. We received 10,383 survey responses from 237 hospitals across the UK. Consultants used a lower threshold for critical care admission than other career grades, indicating potentially more risk-averse behaviour. The majority of respondents reported that critical care provision was inadequate, and cited the value of critical care as being predominantly due to higher nurse: patient ratios. Use of objective risk assessment tools was poor, and patients were commonly selected for critical care based on procedure-specific pathways rather than individualised risk assessment. Challenges were highlighted in the delivery of peri-operative critical care services, such as an overall lack of capacity, competition for beds with non-surgical cases and poor flow through the hospital leading to bed 'blockages'. Critical care is perceived to provide benefit to high-risk surgical patients, but there is variation in practice about the definition and determination of risk, how patients are referred and how to deal with the lack of critical care resources. Future work should focus on evaluating 'enhanced care' units for postoperative patients, how to better implement individualised risk assessment in practice, and how to improve patient flow through hospitals.


Asunto(s)
Actitud del Personal de Salud , Toma de Decisiones Clínicas/métodos , Cuidados Críticos/métodos , Encuestas de Atención de la Salud/métodos , Cuidados Posoperatorios/métodos , Anestesistas/estadística & datos numéricos , Cuidados Críticos/estadística & datos numéricos , Encuestas de Atención de la Salud/estadística & datos numéricos , Humanos , Selección de Paciente , Médicos/estadística & datos numéricos , Cuidados Posoperatorios/estadística & datos numéricos , Cirujanos/estadística & datos numéricos , Reino Unido
6.
Arch. bronconeumol. (Ed. impr.) ; 57: 0-0, 2021. tab, graf, mapas
Artículo en Español | IBECS | ID: ibc-196727

RESUMEN

INTRODUCCIÓN: La pandemia por SARS-CoV-2 es el mayor desafío sanitario en los últimos 100 años, ocasionando el mayor exceso de mortalidad no bélico en este período en el mundo occidental. Ante una enfermedad de elevada contagiosidad y asintomática en un tercio de los casos, es fundamental disponer de modelos que predigan su evolución. Pretendemos desarrollar un modelo de predicción de infección por COVID19 en provincias españolas. MÉTODO: Análisis de componentes principales funcional a datos epidemiológicos de las provincias españolas en función de su curva epidémica entre el 24 de febrero y el 8 de junio. Con este método se han clasificado las provincias en función de su evolución (peor, intermedia y mejor). Se han empleado los datos del Centro Nacional de Epidemiología. RESULTADOS: Se identificaron dos componentes que explican el 99% de la variabilidad de las 52 curvas. La primera componente es la tendencia global de la tasa de incidencia, y la segunda componente es la velocidad de crecimiento o decrecimiento de la incidencia durante el período. Se identificaron 10 provincias en el grupo de peor evolución y 17 en el de evolución intermedia. Los valores umbrales de la tasa de incidencia a 7 días fueron 134 casos/100.000 habitantes para un nivel de alerta 1 (medio) y 167 para el nivel 2 (alto), consiguiendo un elevado poder de discriminación entre provincias. CONCLUSIONES: Estos niveles de alerta podrían ser de utilidad para decidir medidas que puedan afectar a la movilidad de la población, siempre y cuando haya una situación de transmisión comunitaria de SARS-CoV-2. Esta información sería intercomparable entre áreas sanitarias o CCAA


INTRODUCTION: The SARS-CoV-2 pandemic is the most important health challenge encountered in 100 years, and since its emergence has generated the highest excess of non-war-related deaths in the western world. Since this disease is highly contagious and 33% of cases are asymptomatic, it is crucial to develop methods to predict its course. We developed a predictive model for Covid-19 infection in Spanish provinces. METHODS: We applied main components analysis to epidemiological data for Spanish provinces obtained from the National Centre of Epidemiology, based on the epidemiological curve between 24 February and 8 June 2020. Using this method, we classified provinces according to their epidemiological progress (worst, intermediate, and good). RESULTS: We identified two components that explained 99% of variability in the 52 epidemiological curves. The first component can be interpreted as the crude incidence rate trend and the second component as the speed of increase or decrease in the incidence rate during the period analysed. We identified 10 provinces in the group with the worst progress and 17 in the intermediate group. The threshold values for the 7-day incidence rate for an alert 1 (intermediate) were 134 cases/100,000 inhabitants, and 167 for alert 2 (high), respectively, showing a high discriminative power between provinces. CONCLUSIONS: These alert levels might be useful for deciding which measures may affect population mobility and other public health decisions when considering community transmission of SARS-CoV-2 in a given geographical area. This information would also facilitate intercomparison between healthcare areas and Autonomous Communities


Asunto(s)
Humanos , Pandemias , Neumonía Viral/epidemiología , Infecciones por Coronavirus/epidemiología , Toma de Decisiones Clínicas/métodos , Alerta en Emergencia , Incidencia , Prevalencia , Prestación de Atención de Salud , Características de la Residencia , España/epidemiología
7.
GMS J Med Educ ; 37(7): Doc99, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33364378

RESUMEN

Objective: COVID-19 challenges curriculum managers worldwide to create digital substitutes for classroom teaching. Case-based teaching formats under expert supervision can be used as a substitute for practical bedside teaching, where the focus is on teaching clinical reasoning skills. Methods: For medical students of LMU and TU Munich, the interactive, case-based, and supervised teaching format of Clinical Case Discussion (CCD) was digitised and implemented as dCCD in their respective curricula. Case discussions were realised as videoconferences, led by a student moderator, and took place under the supervision of a board-certified clinician. To prevent passive participation, additional cognitive activations were implemented. Acceptance, usability, and subjective learning outcomes were assessed in dCCDs by means of a special evaluation concept. Results: With regard to acceptance, students were of the opinion that they had learned effectively by participating in dCCDs (M=4.31; SD=1.37). The majority of students also stated that they would recommend the course to others (M=4.23; SD=1.62). The technical implementation of the teaching format was judged positively overall, but findings for usability were heterogeneous. Students rated their clinical reasoning skills at the end of the dCCDs (M=4.43; SD=0.66) as being significantly higher than at the beginning (M=4.33; SD=0.69), with low effect size, t(181)=-2.352, p=.020, d=0.15. Conclusion: Our evaluation data shows that the dCCD format is well-accepted by students as a substitute for face-to-face teaching. In the next step, we plan to examine the extent to which participation in dCCDs leads to an increase in objectively measured clinical reasoning skills, analogous to a face-to-face CCD with on-site attendance.


Asunto(s)
/epidemiología , Toma de Decisiones Clínicas/métodos , Educación a Distancia/organización & administración , Educación Médica/organización & administración , Comunicación por Videocoferencia/organización & administración , Competencia Clínica , Educación a Distancia/normas , Educación Médica/normas , Evaluación Educacional , Humanos , Pandemias , Estudiantes de Medicina/psicología , Comunicación por Videocoferencia/normas
8.
Medicine (Baltimore) ; 99(50): e23419, 2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33327269

RESUMEN

BACKGROUND: This study will evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) to investigate tumor resectability at primary debulking surgery among women experiencing advanced-stage ovarian cancer. METHODS: We will systematically search the randomized controlled trials (RCTs) for potentially eligible studies from electronic databases, including 4 English databases (PubMed, EMBASE, Web of Science, and Cochrane Library) and 3 Chinese databases (China National Knowledge Infrastructure, WanFang, and China Biomedical Database). The study language will be restricted to English and Chinese. Also, 2 independent authors will collect and carry out data extraction as well as quality assessment. Data will be synthesized using appropriate statistical methods. RESULTS: We will summarize present study's evidence to assess the diagnostic accuracy of MRI for evaluating tumor resectability at primary debulking surgery in women experiencing advanced-stage ovarian cancer. CONCLUSION: The present study will put forward the latest high-quality evidence for MRI's clinical application for evaluating tumor resectability in women experiencing advanced ovarian cancer. ETHICS AND DISSEMINATION: Since the present study is a systematic review and meta-analysis based on the published literature, ethical approval will not be necessary. PROTOCOL REGISTRATION NUMBER: DOI 10.17605/OSF.IO/UWDRF (https://osf.io/uwdrf/).


Asunto(s)
Toma de Decisiones Clínicas/métodos , Procedimientos Quirúrgicos de Citorreducción , Imagen por Resonancia Magnética/métodos , Neoplasias Ováricas/diagnóstico por imagen , Ovario/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Metaanálisis como Asunto , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Ováricas/cirugía , Ovario/cirugía , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto
9.
Genome Med ; 12(1): 95, 2020 11 09.
Artículo en Inglés | MEDLINE | ID: mdl-33168072

RESUMEN

Genomic studies of patients with COVID-19, or exposed to it, are underway to delineate host factors associated with variability in susceptibility, infectivity, and disease severity. Here, we highlight the ethical implications-both potential benefits and harms-of genomics for clinical practice and public health in the era of COVID-19.


Asunto(s)
Infecciones por Coronavirus/patología , Predisposición Genética a la Enfermedad/genética , Pruebas Genéticas/ética , Genómica/ética , Neumonía Viral/patología , Salud Pública/ética , Betacoronavirus , Toma de Decisiones Clínicas/métodos , Infecciones por Coronavirus/terapia , Genómica/métodos , Humanos , Pandemias , Neumonía Viral/terapia , Salud Pública/métodos
10.
Rev Med Suisse ; 16(714): 2177-2182, 2020 Nov 11.
Artículo en Francés | MEDLINE | ID: mdl-33174701

RESUMEN

Late 2019 a new coronavirus appeared, creating a pandemic, with the first case in Switzerland detected on the 25th of February 2020. Considering the rapid increase in the number of cases, with the fear of an over-burdening of the sanitary network, the Canton of Vaud created a surveillance system (SICOVID). The objective of the SICOVID was to produce a set of indicators, covering the breadth of the epidemiological impact and response as the epidemic progressed. These indicators where used for monitoring purposes, orienting strategies, operational decision-making, communication and research. The challenges encountered throughout this process underline the importance of anticipation and considering the function of a crisis information system, ideally integrating these elements into pandemic preparedness plans.


Asunto(s)
Toma de Decisiones Clínicas/métodos , Infecciones por Coronavirus , Toma de Decisiones Asistida por Computador , Pandemias , Neumonía Viral , Salud Pública/métodos , Infecciones por Coronavirus/epidemiología , Humanos , Neumonía Viral/epidemiología , Suiza/epidemiología
11.
Radiol Clin North Am ; 58(6): 1147-1159, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33040854

RESUMEN

Neuroendocrine tumors are rare solid tumors with an estimated 12,000 people in the United States diagnosed each year. Neuroendocrine tumors can occur in any part of the body. There is a wide spectrum of disease, ranging from slow-growing and indolent tumors found incidentally to highly aggressive malignancies with a poor prognosis. Knowledge of neuroendocrine tumor pathology is essential in the diagnostic workup of these patients. This article focuses on the evaluation, detection, and staging of common neuroendocrine tumors with multiple imaging modalities; the information gained with a multimodality approach is often complementary and leads to image-guided treatment decision making.


Asunto(s)
Toma de Decisiones Clínicas/métodos , Imagen Multimodal/métodos , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/cirugía , Cirugía Asistida por Computador/métodos , Supervivencia sin Enfermedad , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Tumores Neuroendocrinos/mortalidad , Tumores Neuroendocrinos/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Análisis de Supervivencia , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Estados Unidos
13.
Angiol. (Barcelona) ; 72(5): 240-252, sept.-oct. 2020. graf
Artículo en Español | IBECS | ID: ibc-195494

RESUMEN

La rotura de un aneurisma aórtico abdominal (AAA) es un evento altamente letal que continúa asociada a una alta mortalidad, a pesar de su disminución en las últimas dos décadas, asociada a la adopción de la cirugía endovascular como primera línea de tratamiento y a avances en el manejo anestésico y perioperatorio. La actuación frente a un AAA roto (AAAr) puede dividirse en cuatro etapas: diagnóstico, manejo perioperatorio, cirugía y posoperatorio. En el marco de las guías americana y europea sobre manejo de AAAr y de la Guía NICE, se expone una actualización de los puntos críticos en cada etapa: desde el papel diagnóstico clave del angio-TAC hasta el manejo de complicaciones posoperatorias, como el síndrome compartimental abdominal. La creación de protocolos y algoritmos basada en la evidencia ayuda en la toma de decisiones y disminuye el tiempo desde el diagnóstico hasta el control hemorrágico, esencial para la supervivencia


A ruptured abdominal aortic aneurysm (rAAA) is a highly lethal event remaining associated with a high overall mortality, in spite of the reduction in the mortality from rAAA over the last two decades linked with the adoption of an endovascular aneurysm repair (EVAR) as the forefront strategy, as well as the advances in perioperative critical care practices. Management of a rAAA can be divided into four stages: diagnosis, perioperative management, surgical repair and postoperative period. Within the framework of American and European clinical practice guidelines on the management of abdominal aortic aneurysms and NICE guideline, all of them recently published, updated critical issues for each stage are shown. From the key role of CT angiogram for the diagnosis to the postoperative complications, such as abdominal compartment syndrome The creation of evidence-based protocols and algorithms for rapid diagnosis and treatment aids to make decisions and at the same time it will reduce the time since diagnosis to control of hemorrhage, which is essential for survival


Asunto(s)
Humanos , Aneurisma de la Aorta Abdominal/terapia , Rotura de la Aorta/terapia , Toma de Decisiones Clínicas/métodos , Algoritmos , Guías de Práctica Clínica como Asunto , Aneurisma de la Aorta Abdominal/diagnóstico , Rotura de la Aorta/diagnóstico , Protocolos Clínicos/normas
15.
West J Emerg Med ; 21(5): 1042-1045, 2020 Aug 17.
Artículo en Inglés | MEDLINE | ID: mdl-32970551

RESUMEN

The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality, as well as large numbers of patients requiring endotracheal intubation. While much of the literature has focused on the intubation technique, there is scant discussion of intubation confirmation. Herein, we discuss the limitations of traditional confirmatory approaches, summarize the literature supporting a role for point-of-care ultrasound in this application, and propose an algorithm for intubation confirmation among COVID-19 patients.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Intubación Intratraqueal/métodos , Neumonía Viral/terapia , Sistemas de Atención de Punto , Ultrasonografía Intervencional/métodos , Algoritmos , Toma de Decisiones Clínicas/métodos , Infecciones por Coronavirus/diagnóstico por imagen , Humanos , Pandemias , Neumonía Viral/diagnóstico por imagen
16.
West J Emerg Med ; 21(5): 1076-1079, 2020 Aug 17.
Artículo en Inglés | MEDLINE | ID: mdl-32970557

RESUMEN

The current global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has magnified the risk to healthcare providers when inititiating airway management, and safe tracheal intubation has become of paramount importance. Mitigation of risk to frontline providers requires airway management to be an orchestrated exercise based on training and purposeful simulation. Role allocation and closed-loop communication form the foundation of this exercise. We describe a methodical, 10-step approach from decision-making and meticulous drug and equipment choices to donning of personal protective equipment, and procedural concerns. This bundled approach will help reduce unplanned actions, which in turn may reduce the risk of aerosol transmission during airway management in resource-limited settings.


Asunto(s)
Manejo de la Vía Aérea/métodos , Betacoronavirus , Toma de Decisiones Clínicas/métodos , Infecciones por Coronavirus/transmisión , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Paquetes de Atención al Paciente/métodos , Neumonía Viral/transmisión , Aerosoles , Manejo de la Vía Aérea/instrumentación , Manejo de la Vía Aérea/normas , Infecciones por Coronavirus/terapia , Países en Desarrollo , Humanos , Relaciones Interprofesionales , Pandemias , Paquetes de Atención al Paciente/instrumentación , Paquetes de Atención al Paciente/normas , Grupo de Atención al Paciente/organización & administración , Equipo de Protección Personal , Neumonía Viral/terapia
17.
West J Emerg Med ; 21(5): 1095-1101, 2020 Aug 17.
Artículo en Inglés | MEDLINE | ID: mdl-32970560

RESUMEN

The unprecedented COVID-19 pandemic has resulted in rapidly evolving best practices for transmission reduction, diagnosis, and treatment. A regular influx of new information has upended traditionally static hospital protocols, adding additional stress and potential for error to an already overextended system. To help equip frontline emergency clinicians with up-to-date protocols throughout the evolving COVID-19 crisis, our team set out to create a dynamic digital tool that centralized and standardized resources from a broad range of platforms across our hospital. Using a design thinking approach, we rapidly built, tested, and deployed a solution using simple, out-of-the-box web technology that enables clinicians to access the specific information they seek within moments. This platform has been rapidly adopted throughout the emergency department, with up to 70% of clinicians using the digital tool on any given shift and 78.6% of users reporting that they "agree" or "strongly agree" that the platform has affected their management of COVID-19 patients. The tool has also proven easily adaptable, with multiple protocols being updated nearly 20 times over two months without issue. This paper describes our development process, challenges, and results to enable other institutions to replicate this process to ensure consistent, high-quality care for patients as the COVID-19 pandemic continues its unpredictable course.


Asunto(s)
Betacoronavirus , Toma de Decisiones Clínicas/métodos , Infecciones por Coronavirus/terapia , Sistemas de Apoyo a Decisiones Clínicas , Servicios Médicos de Urgencia/métodos , Neumonía Viral/terapia , Actitud del Personal de Salud , Protocolos Clínicos , Árboles de Decisión , Eficiencia , Urgencias Médicas , Humanos , Internet , Pandemias , Pautas de la Práctica en Enfermería/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Desarrollo de Programa , San Francisco
18.
BMJ Open Qual ; 9(3)2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32988831

RESUMEN

The COVID-19 pandemic has led to significant morbidity and mortality globally. As health systems grapple with caring for patients affected with COVID-19, cardiovascular procedures that are deemed 'elective' have been postponed. Guidelines concerning which cardiac procedures should be performed during the pandemic vary by specialty and geography in the USA. We propose a clinical heuristic to guide individual physicians and governing bodies in their decision making regarding which cardiac procedures should be performed during the COVID-19 pandemic using the behavioural economics concept of heuristics and ecological rationality.


Asunto(s)
Procedimientos Quirúrgicos Cardiovasculares/psicología , Toma de Decisiones Clínicas/métodos , Infecciones por Coronavirus/prevención & control , Economía del Comportamiento , Procedimientos Quirúrgicos Electivos/psicología , Heurística , Pandemias/prevención & control , Neumonía Viral/prevención & control , Betacoronavirus , Contraindicaciones de los Procedimientos , Humanos , Estados Unidos
19.
Curr Med Res Opin ; 36(11): 1753-1759, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32945707

RESUMEN

BACKGROUND: Since December 2019, the cumulative number of coronavirus disease 2019 (COVID-19) deaths worldwide has reached 1,013,100 and continues to increase as of writing. Of these deaths, more than 90% are people aged 60 and older. Therefore, there is a need for an easy-to-use clinically predictive tool for predicting mortality risk in older individuals with COVID-19. OBJECTIVE: To explore an easy-to-use clinically predictive tool that may be utilized in predicting mortality risk in older patients with COVID-19. METHODS: A retrospective analysis of 118 older patients with COVID-19 admitted to the Union Dongxihu Hospital, Huazhong University of Science and Technology, Wuhan, China from 12 January to 26 February 2020. The main results of epidemiological, demographic, clinical and laboratory tests on admission were collected and compared between dying and discharged patients. RESULTS: No difference in major symptoms was observed between dying and discharged patients. Among the results of laboratory tests, neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase, albumin, urea nitrogen and D-dimer (NLAUD) show greater differences and have better regression coefficients (ß) when using hierarchical comparisons in a multivariate logistic regression model. Predictors of mortality based on better regression coefficients (ß) included NLR (OR = 31.2, 95% CI 6.7-144.5, p < .0001), lactate dehydrogenase (OR = 73.4, 95% CI 11.8-456.8, p < .0001), albumin (OR < 0.1, 95% CI <0.1-0.2, p < .0001), urea nitrogen (OR = 12.0, 95% CI 3.0-48.4, p = .0005), and D-dimer (OR = 13.6, 95% CI 3.4-54.9, p = .0003). According to the above indicators, a predictive NLAUD score was calculated on the basis of a multivariate logistic regression model to predict mortality. This model showed a sensitivity of 0.889, specificity of 0.984 and a better predictive ability than CURB-65 (AUROC = 0.955 vs. 0.703, p < .001). Bootstrap validation generated the similar sensitivity and specificity. CONCLUSIONS: We designed an easy-to-use clinically predictive tool for early identification and stratified treatment of older patients with severe COVID-19.


Asunto(s)
Betacoronavirus , Reglas de Decisión Clínica , Toma de Decisiones Clínicas/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Factores de Edad , Anciano , Anciano de 80 o más Años , China/epidemiología , Infecciones por Coronavirus/terapia , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/terapia , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y Especificidad
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