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1.
Curr Oncol ; 28(3): 1867-1878, 2021 05 13.
Artículo en Inglés | MEDLINE | ID: mdl-34068441

RESUMEN

Cancer causes substantial emotional and psychosocial distress, which may be exacerbated by delays in treatment. The COVID-19 pandemic has resulted in increased wait times for many patients with cancer. In this study, the psychosocial distress associated with waiting for cancer surgery during the pandemic was investigated. This cross-sectional, convergent mixed-methods study included patients with lower priority disease during the first wave of COVID-19 at an academic, tertiary care hospital in eastern Canada. Participants underwent semi-structured interviews and completed two questionnaires: Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS). Qualitative analysis was completed through a thematic analysis approach, with integration achieved through triangulation. Fourteen participants were recruited, with cancer sites including thyroid, kidney, breast, prostate, and a gynecological disorder. Increased anxiety symptoms were found in 36% of patients and depressive symptoms in 14%. Similarly, 64% of patients experienced moderate or high stress. Six key themes were identified, including uncertainty, life changes, coping strategies, communication, experience, and health services. Participants discussed substantial distress associated with lifestyle changes and uncertain treatment timelines. Participants identified quality communication with their healthcare team and individualized coping strategies as being partially protective against such symptoms. Delays in surgery for patients with cancer during the COVID-19 pandemic resulted in extensive psychosocial distress. Patients may be able to mitigate these symptoms partially through various coping mechanisms and improved communication with their healthcare teams.


Asunto(s)
Ansiedad/epidemiología , 59585/prevención & control , Depresión/epidemiología , Neoplasias/cirugía , Tiempo de Tratamiento , Adaptación Psicológica , Adulto , Anciano , Ansiedad/diagnóstico , Ansiedad/etiología , Ansiedad/psicología , 59585/epidemiología , 59585/transmisión , Control de Enfermedades Transmisibles/normas , Estudios Transversales , Depresión/diagnóstico , Depresión/etiología , Depresión/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/psicología , Nueva Escocia/epidemiología , Pandemias/prevención & control , Distrés Psicológico , Psicometría/estadística & datos numéricos , Investigación Cualitativa , Autoinforme/estadística & datos numéricos , Triaje/normas , Incertidumbre
2.
Artículo en Inglés | MEDLINE | ID: mdl-34072435

RESUMEN

BACKGROUND: During the first COVID-19 pandemic outbreak, a new triage concept had to be implemented for patients with retinal diseases having a scheduled appointment at the medical retina clinic. In this study, we aimed to assess patients' confidence in this triage concept and patients' satisfaction regarding the received treatment during the outbreak. METHODS: This retrospective study included all patients with a diagnosed retinal disease, triaged into three priority groups based on their condition's urgency during lockdown. After restrictions were eased, a subset of previously triaged patients was interviewed to assess their confidence in the triage and their satisfaction regarding the received treatment during the pandemic. RESULTS: In total, 743 patients were triaged during the lockdown. Over 80% received an urgent appointment (priority 1). Among all priority 1 patients, over 84% attended their appointment and 77% received an intravitreal injection (IVI), while 7% cancelled their appointment due to COVID-19. In post-lockdown interviews of 254 patients, 90% trusted the emergency regimen and received treatment. CONCLUSIONS: Our triage seemed to be useful in optimizing access to treatment for patients with retinal diseases. An excellent rating of patients' confidence in the triage and satisfaction regarding the received treatment during the first COVID-19 outbreak could be achieved.


Asunto(s)
Triaje , Control de Enfermedades Transmisibles , Brotes de Enfermedades , Humanos , Pandemias , Retina , Estudios Retrospectivos
4.
PLoS One ; 16(5): e0251143, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33956847

RESUMEN

AIMS: Limb and patient outcomes in people with diabetic foot complications including diabetic foot ulcer (DFU) provided virtual triage and personalized video consultations during COVID-19 pandemic are not known. METHODS: Patients with foot complications attending the diabetic foot clinic prior to lockdown who sought teleconsultations during COVID-19 lockdown underwent virtual triage to include clinical history, visual inspection of feet, domiciliary wound care (community nurse assisted dressings) and offloading instructions. The subsequent ulcer, limb and mortality outcomes during the following 24 weeks of COVID-19 lockdown (April-September 2020, group 1) were assessed and compared with those who attended foot clinic during the same period in 2019 (April-September, group 2). RESULTS: Group 1 included 561 participants with foot complications provided with teleconsultations, median age 57 (51 to 63) years and diabetes duration of 10 (5 to 16) years. Twelve patients with severe DFU were excluded and 549 patients [357 (65%) neuropathic foot, 104 (18.9%) ischemic foot and 88 (16%) chronic Charcot foot with deformities] were evaluated. There were 227 (41.3%) participants with active DFU at start of lockdown, 32 (5.8%) with new onset ulcer during lockdown (47.1%) and 290 patients without ulcers. Group 2 included 650 participants; active foot ulcer was present in 366 patients. Wound closed or reduced in area in 78.4% of participants of group 1 compared to 76.0% (p = 0.318) in group 2. Fourteen (5.4%) patients required amputations [3 major and 11 minor] in group 1 during the study period compared to 6.8% in group 2 (p = 0.191). Twenty-one (3.8%) and 28 (4.3%) patients died (p = 0.532) during 24 weeks of follow up in group 1 and 2, respectively. CONCLUSIONS: Targeted foot-care service through virtual triage and teleconsultations during COVID-19 pandemic for people with foot complications have similar ulcer and limb outcomes compared to face-to-face foot care delivery.


Asunto(s)
Pie Diabético/terapia , Telemedicina , /epidemiología , Control de Enfermedades Transmisibles , Diabetes Mellitus/epidemiología , Pie Diabético/epidemiología , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Resultado del Tratamiento , Triaje
6.
Fam Med ; 53(5): 328-330, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-34019677
7.
Isr Med Assoc J ; 23(5): 274-278, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-34024042

RESUMEN

BACKGROUND: This focus article is a theoretical reflection on the ethics of allocating respirators to patients in circumstances of shortage, especially during the coronavirus disease-2019 (COVID-19) outbreak in Israel. In this article, respirators are placeholders for similar life-saving modalities in short supply, such as extracorporeal membrane oxygenation machines and intensive care unit beds. In the article, I propose a system of triage for circumstances of scarcity of respirators. The system separates the hopeless from the curable, granting every treatable person a real chance of cure. The scarcity situation eliminates excesses of medicine, and then allocates respirators by a single scale, combining an evidence-based scoring system with risk-proportionate lottery. The triage proposed embodies continuity and consistency with the healthcare practices in ordinary times. Yet, I suggest two regulatory modifications: one in relation to expediting review of novel and makeshift solutions and the second in relation to mandatory retrospective research on all relevant medical data and standard (as opposed to experimental) interventions that are influenced by the triage.


Asunto(s)
/terapia , Asignación de Recursos/ética , Triaje/métodos , Ventiladores Mecánicos/provisión & distribución , /epidemiología , Brotes de Enfermedades , Análisis Ético , Oxigenación por Membrana Extracorpórea/instrumentación , Humanos , Unidades de Cuidados Intensivos/ética , Unidades de Cuidados Intensivos/provisión & distribución , Israel , Triaje/ética , Ventiladores Mecánicos/ética
8.
Stud Health Technol Inform ; 281: 525-529, 2021 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-34042631

RESUMEN

During spring 2020, SARS-CoV-2 pandemic induced shortage of medical equipment, hospital capacity and staff. To tackle this issue, medical students have been strongly involved in early patient triage through medical phone call regulation. Here, we present an intelligent web-based decision support system for COVID-19 phone call regulation, developed by and for, medical students to help them during this difficult but crucial task. The system is divided into 5 tabs. The first tab displays administrative information, clinical data related to life-threatening emergency, and personalized recommendations for patient management. The second tab displays a PDF report summarizing the clinical situation; the third tab displays the guidelines used for establishing the recommendations, and the fourth tab displays the overall algorithm in the form of a decision tree. The fifth tab provided a short user guide. The system was assessed by 21 medical staff. More than 90% of them appreciated the navigation and the interface, and found the content relevant. 90,5% of them would like to use it during the medical regulation. In the future, we plan to use this system during simulation-based medical learning for the initial medical training of medical students.


Asunto(s)
Estudiantes de Medicina , Humanos , Pandemias , Triaje
9.
Stud Health Technol Inform ; 281: 1097-1099, 2021 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-34042855

RESUMEN

Emergency Department (ED) overcrowding is a major issue for the efficient management of patients. To this end, triage algorithms have been developed to support the task of patient prioritization. In this paper an ontology was designed to represent the knowledge about patient triage procedure in EDs.


Asunto(s)
Semántica , Triaje , Servicio de Urgencia en Hospital , Humanos
10.
BMC Infect Dis ; 21(1): 470, 2021 May 24.
Artículo en Inglés | MEDLINE | ID: mdl-34030658

RESUMEN

BACKGROUND: In 2017, New Caledonia experienced an outbreak of severe dengue causing high hospital burden (4379 cases, 416 hospital admissions, 15 deaths). We decided to build a local operational model predictive of dengue severity, which was needed to ease the healthcare circuit. METHODS: We retrospectively analyzed clinical and biological parameters associated with severe dengue in the cohort of patients hospitalized at the Territorial Hospital between January and July 2017 with confirmed dengue, in order to elaborate a comprehensive patient's score. Patients were compared in univariate and multivariate analyses. Predictive models for severity were built using a descending step-wise method. RESULTS: Out of 383 included patients, 130 (34%) developed severe dengue and 13 (3.4%) died. Major risk factors identified in univariate analysis were: age, comorbidities, presence of at least one alert sign, platelets count < 30 × 109/L, prothrombin time < 60%, AST and/or ALT > 10 N, and previous dengue infection. Severity was not influenced by the infecting dengue serotype nor by previous Zika infection. Two models to predict dengue severity were built according to sex. Best models for females and males had respectively a median Area Under the Curve = 0.80 and 0.88, a sensitivity = 84.5 and 84.5%, a specificity = 78.6 and 95.5%, a positive predictive value = 63.3 and 92.9%, a negative predictive value = 92.8 and 91.3%. Models were secondarily validated on 130 patients hospitalized for dengue in 2018. CONCLUSION: We built robust and efficient models to calculate a bedside score able to predict dengue severity in our setting. We propose the spreadsheet for dengue severity score calculations to health practitioners facing dengue outbreaks of enhanced severity in order to improve patients' medical management and hospitalization flow.


Asunto(s)
Dengue/clasificación , Dengue/diagnóstico , Dengue/epidemiología , Dengue/patología , Femenino , Hospitalización , Humanos , Masculino , Modelos Teóricos , Nueva Caledonia/epidemiología , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Triaje
11.
Front Public Health ; 9: 610280, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34046384

RESUMEN

Background: The COVID-19 global pandemic has posed unprecedented challenges to health care systems all over the world. The speed of the viral spread results in a tsunami of patients, which begs for a reliable screening tool using readily available data to predict disease progression. Methods: Multicenter retrospective cohort study was performed to develop and validate a triage model. Patient demographic and non-laboratory clinical data were recorded. Using only the data from Zhongnan Hospital, step-wise multivariable logistic regression was performed, and a prognostic nomogram was constructed based on the independent variables identifies. The discrimination and calibration of the model were validated. External independent validation was performed to further address the utility of this model using data from Jinyintan Hospital. Results: A total of 716 confirmed COVID-19 cases from Zhongnan Hospital were included for model construction. Men, increased age, fever, hypertension, cardio-cerebrovascular disease, dyspnea, cough, and myalgia are independent risk factors for disease progression. External independent validation was carried out in a cohort with 201 cases from Jinyintan Hospital. The area under the curve (AUC) was 0.787 (95% confidence interval [CI]: 0.747-0.827) in the training group and 0.704 (95% CI: 0.632-0.777) in the validation group. Conclusions: We developed a novel triage model based on basic and clinical data. Our model could be used as a pragmatic screening aid to allow for cost efficient screening to be carried out such as over the phone, which may reduce disease propagation through limiting unnecessary contact. This may help allocation of limited medical resources.


Asunto(s)
Humanos , Modelos Logísticos , Masculino , Estudios Retrospectivos , Triaje
12.
BMJ Open Qual ; 10(2)2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33958354

RESUMEN

BACKGROUND: Often the first opportunity for clinicians to assess risk of preterm birth is when women present with threatened preterm labour symptoms (such as period-like pain, tightening's or back ache). However, threatened preterm labour symptoms are not a strong predictor of imminent birth. Clinicians are then faced with a complex clinical dilemma, the need to ameliorate the consequences of preterm birth requires consideration with the side-effects and costs. The QUiPP app is a validated app which can aid clinicians when they triage a women who is in threatened preterm labour. AIM: Our aim was to produce a toolkit to promote a best practice pathway for women who arrive in threatened preterm labour. METHODS: We worked with two hospitals in South London. This included the aid of a toolkit midwife at each hospital. We also undertook stakeholder focus groups and worked with two Maternity Voice Partnership groups to ensure a diverse range of voices was heard in the toolkit development. While we aimed to produce the toolkit in September 2020, we rapidly rolled out and produced the first version of the toolkit in April 2020 due to COVID-19. As the QUiPP app can reduce admissions and hospital transfers, there was a need to enable all hospitals in England to have access to the toolkit as soon as possible. RESULTS: While the rapid rollout of The QUiPP App Toolkit due to COVID-19 was not planned, it has demonstrated that toolkits to improve clinical practice can be produced promptly. Through actively welcoming continued feedback meant the initial version of the toolkit could be continually and iteratively refined. The toolkit has been recommended nationally, with National Health Service England recommending the app and toolkit in their COVID-19 update to the Saving Babies Lives Care Bundle and in the British Association of Perinatal Medicine Antenatal Optimisation Toolkit.


Asunto(s)
Servicios de Salud Materna , Aplicaciones Móviles , Trabajo de Parto Prematuro/diagnóstico , Triaje/métodos , Femenino , Implementación de Plan de Salud , Humanos , Control de Infecciones/métodos , Londres , Embarazo , Medición de Riesgo/métodos , Medicina Estatal
13.
J Emerg Manag ; 19(2): 173-188, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33954966

RESUMEN

BACKGROUND: Armed forces hospitals are often called upon to provide medical aid to civilians during natural calamities. Though children are often the most vulnerable segment of population in these events, research that addresses their unique needs and the role of armed forces hospitals remains sparse. OBJECTIVES: We examined pediatric morbidity and mortality at a flooded armed forces hospital. Factors that affected outcomes were identified. METHODS: 158 patients were evacuated en masse from a children's hospital in northern India that was submerged by flood to an adjacent partially inundated armed forces hospital specializing in military medicine and adult trauma. The children were provided case-based clinical care as per existing disaster management protocol. Geoclimatic vulnerability factors, morbidity/mortality, and medical and logistical challenges for future intervention were investigated. RESULTS: One pediatrician who provided initial triage was joined by two others after 48 hours. A limited load of adult patients permitted more resources for the children, majority (49 percent) of whom were neonates. Intensive care was necessitated for 32 (20.2 percent) cases, with half managed in adult ICU. Overall in-hospital mortality was 5.7 percent. Experienced staff, cross-specialty multitasking, and innovative and noncensorious leadership were identified as assets amidst resources compromised by flooding. Clear delineation of primary caregiver role of pediatrician at outset, pediatric emergency care training, pediatric triage, resource allocation for thermoregulation, oxygen therapy and ventilation, earmarking centers for transfer of cases, and safe transportation to the centers were identified as areas meriting further attention. CONCLUSION: Armed forces hospitals in vulnerable geoclimatic zones must address pediatric concerns in disaster management plans.


Asunto(s)
Planificación en Desastres , Desastres , Personal Militar , Niño , Inundaciones , Humanos , Recién Nacido , Triaje
14.
J Med Internet Res ; 23(5): e22959, 2021 05 25.
Artículo en Inglés | MEDLINE | ID: mdl-33999834

RESUMEN

Artificial intelligence-driven voice technology deployed on mobile phones and smart speakers has the potential to improve patient management and organizational workflow. Voice chatbots have been already implemented in health care-leveraging innovative telehealth solutions during the COVID-19 pandemic. They allow for automatic acute care triaging and chronic disease management, including remote monitoring, preventive care, patient intake, and referral assistance. This paper focuses on the current clinical needs and applications of artificial intelligence-driven voice chatbots to drive operational effectiveness and improve patient experience and outcomes.


Asunto(s)
Inteligencia Artificial , Comunicación , Prestación de Atención de Salud/métodos , Software de Reconocimiento del Habla , Telemedicina/métodos , Voz , Teléfono Celular , Enfermedad Crónica/terapia , Cuidados Críticos/métodos , Humanos , Pandemias , Derivación y Consulta , Triaje
15.
Washington, D.C.; OPS; 2021-05-10. (OPS-W/FPL/IM/COVID-19/21-0026).
en Francés | PAHO-IRIS | ID: phr-53917

RESUMEN

Cet outil est destiné à être imprimé et distribué dans les cliniques de vaccination pour aider les agents de santé à communiquer avec les patients qui se font vacciner contre la COVID-19. Le ministère de la Santé doit adapter cet outil avant de sa distribution et inclure l’information concernant les vaccins qui sont utilisés dans votre pays, selon votre plan d’introduction. Cet outil de travail doit être utilisé en consultation avec un médecin de l’établissement, et il doit être fourni aux agents de santé dans la langue appropriée. Veuillez noter qu’il s’agit d’un document évolutif. En tant que telles, les informations et les recommandations qu’il contient sont susceptibles d’être modifiées à mesure que de nouvelles données sur la vaccination contre la COVID-19 deviennent disponibles.


Asunto(s)
Infecciones por Coronavirus , Infecciones por Coronavirus , Triaje , Tamizaje Masivo , Vacunación , Vacunas , Programas de Inmunización , Inmunización
17.
BMJ Open ; 11(5): e048613, 2021 05 10.
Artículo en Inglés | MEDLINE | ID: mdl-33972344

RESUMEN

OBJECTIVES: To conduct a scoping review to identify and summarise the existing literature on interventions involving primary healthcare professionals to manage emergency department (ED) overcrowding. DESIGN: A scoping review. DATA SOURCES: A comprehensive database search of Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley) and CINAHL (EBSCO) databases was conducted (inception until January 2020) using peer-reviewed search strategies, complemented by a search of grey literature sources. ELIGIBILITY CRITERIA: Interventions and strategies involving primary healthcare professionals (PHCPs: general practitioners (GPs), nurse practitioners (NPs) or nurses with expanded role) to manage ED overcrowding. METHODS: We engaged and collaborated, with 13 patient partners during the design and conduct stages of this review. We conducted this review using the JBI guidelines. Two reviewers independently selected studies and extracted data. We conducted descriptive analysis of the included studies (frequencies and percentages). RESULTS: From 23 947 records identified, we included 268 studies published between 1981 and 2020. The majority (58%) of studies were conducted in North America and were predominantly cohort studies (42%). The reported interventions were either 'within ED' (48%) interventions (eg, PHCP-led ED triage or fast track) or 'outside ED' interventions (52%) (eg, after-hours GP clinic and GP cooperatives). PHCPs involved in the interventions were: GP (32%), NP (26%), nurses with expanded role (16%) and combinations of the PHCPs (42%). The 'within ED' and 'outside ED' interventions reported outcomes on patient flow and ED utilisation, respectively. CONCLUSIONS: We identified many interventions involving PHCPs that predominantly reported a positive impact on ED utilisation/patient flow metrics. Future research needs to focus on conducting well-designed randomized controlled trials (RCTs) and systematic reviews to evaluate the effectiveness of specific interventions involving PHCPs to critically appraise and summarise evidence on this topic.


Asunto(s)
Servicio de Urgencia en Hospital , Enfermeras Practicantes , Humanos , América del Norte , Atención Primaria de Salud , Triaje
18.
J Prim Care Community Health ; 12: 21501327211017016, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33985374

RESUMEN

BACKGROUND: Coronavirus infection (COVID) presents with flu-like symptoms and can cause serious complications. Here, we discuss the presentation and outcomes of COVID in an ambulatory setting along with distribution of positive cases amongst healthcare workers (HCWs). METHOD: Patients who visited the COVID clinic between 03/11/2020 and 06/14/2020 were tested based on the CDC guidelines at the time using PCR-detection methods. Medical records were reviewed and captured on a RedCap database. Statistical analysis was performed using both univariate and bivariate analysis using Fischer's exact test with 2-sided P values. RESULTS: Of the 2471 evaluated patients, 846 (34.2%) tested positive for COVID. Mean age of positivity was 43.4 years (SD ± 15.4), 60.1% were female and 49% were Black. 58.7% of people tested had a known exposure, and amongst those with exposure, 57.3% tested positive. Ninety-four patients were hospitalized (11.1%), of which 22 patients (23.4%) required ICU admission and 10 patients died. The overall death rate of patients presenting to clinic was 0.4%, or 1.2% amongst positive patients. Median length of hospital stay was 6 days (range 1-51). Symptoms significantly associated with COVID included: anosmia, fever, change in taste, anorexia, myalgias, cough, chills, and fatigue. Increased risk of COVID occurred with diabetes, whereas individuals with lung disease or malignancy were not associated with increased risk of COVID. Amongst COVID positive HCWs, the majority were registered nurses (23.4%), most working in general medicine (39.8%) followed by critical care units (14.3%). DISCUSSION/CONCLUSION: Blacks and females had the highest infection rates. There was a broad range in presentation from those who are very ill and require hospitalization and those who remain ambulatory. The above data could assist health care professionals perform a targeted review of systems and co-morbidities, allowing for appropriate patient triage.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Guías como Asunto , Personal de Salud/estadística & datos numéricos , Pacientes Ambulatorios/estadística & datos numéricos , Triaje , Adulto , Anciano , Infección Hospitalaria , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos , Población Urbana
19.
J Ambul Care Manage ; 44(3): 197-206, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34016847

RESUMEN

In response to the coronavirus disease-2019 (COVID-19) pandemic, we developed and launched a student-led telemedicine program in Chelsea. From April to November 2020, over 200 student volunteers contacted over 1000 patients to assess COVID-19 symptoms, provide counseling, and triage patients. Through a retrospective cohort study, we determined that student triage decision was associated with patient outcomes, including hospitalization status, COVID-19 test administration, and COVID-19 test result. These results quantify the outcomes of a student-led telemedicine clinic to combat the ongoing pandemic and may serve as a model for implementation of similar clinics to alleviate mounting health care system burden.


Asunto(s)
/diagnóstico , Neumonía Viral/diagnóstico , Clínica Administrada por Estudiantes , Telemedicina/organización & administración , /epidemiología , Consejo , Inglaterra/epidemiología , Humanos , Pandemias , Neumonía Viral/epidemiología , Estudios Retrospectivos , Triaje
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