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2.
Curr Drug Saf ; 2021 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-34636306

RESUMO

BACKGROUND: Various cutaneous manifestations have been observed in patients with COVID-19 infection. However, the skin side effects of the medications used for COVID-19, such as famotidine, have not been studied.

Objective: This case series aim to present our challenge to define cutaneous manifestations between famotidine and COVID-19.

Methods: We identified patients from Imam Khomeini hospital complex who were admitted to the ward with confirmed infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) taking famotidine and having cutaneous rash. Clinical data were obtained through observation and intervention.

Results: We found 4 SARS-COV-2 patients with cutaneous manifestations. The mean (±SD) age of the patients was 57±2 years, 3 patients were men, and COVID-19 symptoms began 10±3 days before admission. The most common symptoms were cough and shortness of breath. All the patients were admitted for hypoxemic respiratory failure. Patients received famotidine for gastrointestinal prophylaxis, and all 4 patients developed Acral macular mountainous skin lesion in the upper and lower extremities, then we discontinued famotidine and lesions were recovered completely in all patients.

Conclusion: These cases prompted us to inform clinicians about cutaneous complications of famotidine in COVID-19 patients.

3.
Daru ; 2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34463929

RESUMO

BACKGROUND: Recent studies have shown an increased risk of acute kidney injury (AKI) induced by vancomycin + piperacillin-tazobactam (VPT) combination. In this study, the efficacy of intravenous magnesium sulfate in prevention of VPT induced AKI in critically ill patients admitted to the ICU has been evaluated. METHODS: In an open-label, placebo-controlled, randomized clinical trial, 72 adults (≥ 18 years old) who had indications to receive VPT as empiric therapy were assigned to the magnesium or control group in 1:1 ratio. Concomitant with VPT, intravenous infusion of magnesium sulfate was started for patients in the magnesium group. The target serum level of magnesium was defined 3 mg/dl. Patients in the control group received normal saline as placebo. The target serum level of magnesium was defined 1.9 mg/dl in this group. The study's primary outcome was incidence of AKI during and up to 48 h after the treatment course. Escalation and de-escalation of VPT regimen, duration of hospitalization, length of ICU stay and 28-day mortality were secondary outcomes. RESULTS: Thirty patients in each group completed the examination. Five patients in the magnesium group and 11 patients in the control group experienced AKI (p = 0.072). De-escalation of VPT regimen was done approximately in 60% of patients. Duration of hospitalization and length of ICU stay were not statistically different between the groups. Finally, 28-day mortality was 23.33% in each group. Although the incidence of AKI was not statistically different between the groups in unadjusted logistic regression model, it became significant after adjusting for confounding factors [unadjusted model (OR = 0.34; 95% CI: 0.10-1.16, p = 0.084), adjusted model: (OR = 0.26; 95% CI: 0.07-0.96, p = 0.04)]. CONCLUSIONS: Administration of magnesium sulfate with the target serum levels around 3 mg/dL reduced the incidence of AKI in critically ill patients who were receiving VPT as empric therapy.

4.
J Interprof Care ; : 1-6, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34139953

RESUMO

Healthcare systems are at times still viewed as siloed performances of single professions, wherein some groups hold hierarchical positions based on their expertise and prestige, rather than a collective functioning of interprofessional teams. Current policies, procedures, and regulations in healthcare education and practice seem to contribute to this context in which the various health and social care professions are set in opposition to one another. The historical, and still prominent, uniprofessional education and socialization practices position health and social care professions to view each as rivals and threats toward achieving their profession/al advancement and growth. The transformation from uniprofessionality to interprofessionality in healthcare requires the application of interprofessional socialization not just at the individual level, but also at the professional and system levels. In this process of interprofessional socialization, we need to embrace the uniqueness of each profession while cultivating an interprofessional collaboration culture in the system (dual identity). In so doing, we can facilitate a shifting mind-set, culture, operations, and policies in healthcare to recognize and foster the contribution and accountability of each profession toward achieving the quadruple aim of better care, better health, better value, and better work experience.

5.
Eur J Clin Pharmacol ; 77(10): 1465-1471, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33963877

RESUMO

PURPOSE: There are limited data regarding the safety of direct oral anticoagulants (DOACs) during breastfeeding. The aim of the present study is to investigate the extent of excretion of DOACs into human milk according to the available clinical and experimental studies. METHODS: On 16th January 2021, we systematically searched PubMed, Scopus, Embase, and Web of Science for all studies which investigated DOACs in breastfeeding without any time frame and language limitation. Search keywords were [breastfeeding, breast feeding, breastfed, lactation, milk secretion OR milk] AND [apixaban OR Eliquist OR rivaroxaban OR Xarelto OR edoxaban OR Savaysa OR dabigatran OR Pradaxa OR dabigatran etexilate OR dabigatran etexilate mesylate OR direct oral anticoagulant OR DOAC OR new oral anticoagulant OR NOAC]. Finally, we identified six articles which reported DOAC use during breastfeeding or lactation. RESULTS AND CONCLUSION: According to the available limited data, dabigatran has the least excretion in human breast milk. Rivaroxaban and dabigatran both have acceptable milk excretion cutoffs, whereas apixaban milk excretion is greater than the maximum allowed range. Further well-designed studies with larger sample sizes are required to generate consistent comparable data and clarify benefits and risks of each DOAC during breastfeeding.

6.
Int Immunopharmacol ; 96: 107636, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34015598

RESUMO

The role of hydroxychloroquine (HCQ) in early outpatient management of mild coronavirus disease 2019 (COVID-19) needs further investigation. This study was a multicenter, population-based national retrospective-cohort investigation of 28,759 adults with mild COVID-19 seen at the network of Comprehensive Healthcare Centers (CHC) between March and September 2020 throughout Iran. The baseline characteristics and outcome variables were extracted from the national integrated health system database. A total of 7295 (25.37%) patients who presented with mild COVID-19 within 3-7 days of symptoms onset received HCQ (400 mg twice daily on day 1 followed by 200 mg twice daily for the next four days and were then followed for 14 days). The main outcome measures were hospitalization or death for six months follow-up. COVID-19-related hospitalizations or deaths occurred in 523 (7.17%) and 27 (0.37%) respectively, in HCQ recipients and 2382 (11.10%) and 287 (1.34%) respectively, in non-recipients. The odds of hospitalization or death was reduced by 38% (odds ratio [OR] = 0.62; 95% confidence interval [CI]: 0.56-0.68, p = < 0.001) and 73% (OR = 0.27; 95% CI: 0.18-0.41, p = < 0.001) in HCQ recipients and non-recipients. These effects were maintained after adjusting for age, comorbidities, and diagnostic modality. No serious HCQ-related adverse drug reactions were reported. In our large outpatient national cohort of adults with mild COVID-19 disease who were given HCQ early in the course of the disease, the odds of hospitalization or death was reduced significantly regardless of age or comorbidities.


Assuntos
Antivirais/uso terapêutico , COVID-19/tratamento farmacológico , Hidroxicloroquina/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Estudos Retrospectivos , SARS-CoV-2 , Resultado do Tratamento
7.
Eur J Med Res ; 26(1): 41, 2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-33957992

RESUMO

BACKGROUND: The clinical course of COVID-19 may vary significantly. The presence of comorbidities prolongs the recovery time. The recovery in patients with mild-to-moderate symptoms might take 10 days, while in those with a critical illness or immunocompromised status could take 15 days. Considering the lack of data about predictors that could affect the recovery time, we conducted this study to identify them. METHODS: This cross-sectional study was implemented in the COVID-19 clinic of a teaching and referral university hospital in Tehran. Patients with the highly suggestive symptoms who had computed tomography (CT) imaging results with typical findings of COVID-19 or positive results of reverse transcriptase-polymerase chain reaction (RT-PCR) were enrolled in the study. Inpatient and outpatient COVID-19 participants were followed up by regular visits or phone calls, and the recovery period was recorded. RESULTS: A total of 478 patients were enrolled. The mean age of patients was 54.11 ± 5.65 years, and 44.2% were female. The median time to recovery was 13.5 days (IQR: 9). Although in the bivariate analysis, multiple factors, including hypertension, fever, diabetes mellitus, gender, and admission location, significantly contributed to prolonging the recovery period, in multivariate analysis, only dyspnea had a significant association with this variable (p = 0.02, the adjusted OR of 2.05; 95% CI 1.12-3.75). CONCLUSION: This study supports that dyspnea is a predictor of recovery time. It seems like optimal management of the comorbidities plays the most crucial role in recovery from COVID-19.


Assuntos
COVID-19/epidemiologia , Hospitalização/estatística & dados numéricos , Recuperação de Função Fisiológica , SARS-CoV-2/isolamento & purificação , COVID-19/virologia , Comorbidade , Estudos Transversais , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
8.
J Comp Eff Res ; 10(8): 673-683, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33860672

RESUMO

Background: The effect of midodrine on lactate clearance has not been assessed in critically ill patients yet. Objective: The goal of this study was to assess the effect of adjunctive midodrine therapy on lactate clearance in patients with septic shock. Materials & methods: Patients with septic shock were assigned to receive either adjunctive midodrine 10 mg three-times a day for 5 days (midodrine group = 15 patients) or not (control group = 13 patients). Results: The lactate clearance was significantly faster in the midodrine group than the control group (p = 0.049) with a large effect size (ηp2 = 0.141). Conclusion: When midodrine was added to intravenous vasopressors, it significantly accelerated lactate clearance in patients with septic shock. Trial registration number: IRCT20100228003449N25 (Clinicaltrials.gov).


Assuntos
Midodrina , Choque Séptico , Humanos , Ácido Láctico , Midodrina/uso terapêutico , Projetos Piloto , Choque Séptico/tratamento farmacológico , Vasoconstritores/uso terapêutico
9.
Thromb Haemost ; 2021 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-33865239

RESUMO

BACKGROUND: Thrombotic complications are considered among the main extrapulmonary manifestations of coronavirus disease 2019 (COVID-19). The optimal type and duration of prophylactic antithrombotic therapy in these patients remain unknown. METHODS: This article reports the final (90-day) results of the Intermediate versus Standard-dose Prophylactic anticoagulation In cRitically-ill pATIents with COVID-19: An opeN label randomized controlled trial (INSPIRATION) study. Patients with COVID-19 admitted to intensive care were randomized to intermediate-dose versus standard-dose prophylactic anticoagulation for 30 days, irrespective of hospital discharge status. The primary efficacy outcome was a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation (ECMO), or all-cause death. The main safety outcome was major bleeding. RESULTS: Of 600 randomized patients, 562 entered the modified intention-to-treat analysis (median age [Q1, Q3]: 62 [50, 71] years; 237 [42.2%] women), of whom 336 (59.8%) survived to hospital discharge. The primary outcome occurred in 132 (47.8%) of patients assigned to intermediate dose and 130 (45.4%) patients assigned to standard-dose prophylactic anticoagulation (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.95-1.55, p = 0.11). Findings were similar for other efficacy outcomes, and in the landmark analysis from days 31 to 90 (HR: 1.59, 95% CI: 0.45-5.06). There were 7 (2.5%) major bleeding events in the intermediate-dose group (including 3 fatal events) and 4 (1.4%) major bleeding events in the standard-dose group (none fatal) (HR: 1.82, 95% CI: 0.53-6.24). CONCLUSION: Intermediate-dose compared with standard-dose prophylactic anticoagulation did not reduce a composite of death, treatment with ECMO, or venous or arterial thrombosis at 90-day follow-up.

10.
Artigo em Inglês | MEDLINE | ID: mdl-33797371

RESUMO

PURPOSE: Clinical and preclinical evidences regarding new strategies for prevention of vancomycin-induced nephrotoxicity are reviewed. METHODS: Evidence from 2014 to end of 2019 was included. Finally, twelve animal studies and one clinical trial were evaluated. RESULTS: Although incidence of vancomycin-induced nephrotoxicity was not reduced significantly in the clinical trial, antioxidants reduced incidence of vancomycin-induced nephrotoxicity in preclinical studies. CONCLUSIONS: Antioxidants including vitamin C, vitamin E, cilastatin, melatonin, zingerone, rutin, naringenin, saffron, silymarin and dexmedetomidine were nephroprotective against vancomycin-induced nephrotoxicity in preclinical studies. The nephroprotective effects of these antioxidants must be confirmed before routine use in the clinical practice.

11.
JAMA ; 325(16): 1620-1630, 2021 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-33734299

RESUMO

Importance: Thrombotic events are commonly reported in critically ill patients with COVID-19. Limited data exist to guide the intensity of antithrombotic prophylaxis. Objective: To evaluate the effects of intermediate-dose vs standard-dose prophylactic anticoagulation among patients with COVID-19 admitted to the intensive care unit (ICU). Design, Setting, and Participants: Multicenter randomized trial with a 2 × 2 factorial design performed in 10 academic centers in Iran comparing intermediate-dose vs standard-dose prophylactic anticoagulation (first hypothesis) and statin therapy vs matching placebo (second hypothesis; not reported in this article) among adult patients admitted to the ICU with COVID-19. Patients were recruited between July 29, 2020, and November 19, 2020. The final follow-up date for the 30-day primary outcome was December 19, 2020. Interventions: Intermediate-dose (enoxaparin, 1 mg/kg daily) (n = 276) vs standard prophylactic anticoagulation (enoxaparin, 40 mg daily) (n = 286), with modification according to body weight and creatinine clearance. The assigned treatments were planned to be continued until completion of 30-day follow-up. Main Outcomes and Measures: The primary efficacy outcome was a composite of venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days, assessed in randomized patients who met the eligibility criteria and received at least 1 dose of the assigned treatment. Prespecified safety outcomes included major bleeding according to the Bleeding Academic Research Consortium (type 3 or 5 definition), powered for noninferiority (a noninferiority margin of 1.8 based on odds ratio), and severe thrombocytopenia (platelet count <20 ×103/µL). All outcomes were blindly adjudicated. Results: Among 600 randomized patients, 562 (93.7%) were included in the primary analysis (median [interquartile range] age, 62 [50-71] years; 237 [42.2%] women). The primary efficacy outcome occurred in 126 patients (45.7%) in the intermediate-dose group and 126 patients (44.1%) in the standard-dose prophylaxis group (absolute risk difference, 1.5% [95% CI, -6.6% to 9.8%]; odds ratio, 1.06 [95% CI, 0.76-1.48]; P = .70). Major bleeding occurred in 7 patients (2.5%) in the intermediate-dose group and 4 patients (1.4%) in the standard-dose prophylaxis group (risk difference, 1.1% [1-sided 97.5% CI, -∞ to 3.4%]; odds ratio, 1.83 [1-sided 97.5% CI, 0.00-5.93]), not meeting the noninferiority criteria (P for noninferiority >.99). Severe thrombocytopenia occurred only in patients assigned to the intermediate-dose group (6 vs 0 patients; risk difference, 2.2% [95% CI, 0.4%-3.8%]; P = .01). Conclusions and Relevance: Among patients admitted to the ICU with COVID-19, intermediate-dose prophylactic anticoagulation, compared with standard-dose prophylactic anticoagulation, did not result in a significant difference in the primary outcome of a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days. These results do not support the routine empirical use of intermediate-dose prophylactic anticoagulation in unselected patients admitted to the ICU with COVID-19. Trial Registration: ClinicalTrials.gov Identifier: NCT04486508.


Assuntos
Anticoagulantes/administração & dosagem , COVID-19/complicações , Enoxaparina/administração & dosagem , Oxigenação por Membrana Extracorpórea , Oxigenoterapia/métodos , Trombose/prevenção & controle , Idoso , Anticoagulantes/efeitos adversos , COVID-19/mortalidade , Esquema de Medicação , Enoxaparina/efeitos adversos , Feminino , Hemorragia/induzido quimicamente , Hospitalização , Humanos , Unidades de Terapia Intensiva , Irã (Geográfico) , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Avaliação de Resultados em Cuidados de Saúde , Embolia Pulmonar/epidemiologia , Trombocitopenia/induzido quimicamente , Trombose/etiologia , Trombose/mortalidade , Resultado do Tratamento , Trombose Venosa/epidemiologia , Trombose Venosa/mortalidade
12.
J Allied Health ; 50(1): e1-e7, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33646254

RESUMO

The challenge of measuring collaborative teamwork among interprofessional students has been reported in the literature. Emphasis in evaluating teamwork has been on socialization and attitudes towards wanting to work with others and not on other aspects of teamwork such as collaboration in teamwork. To date, while the Assessment of the Interprofessional Team Collaboration Scale (AITCS) has been used generically to measure collaboration in both practitioner and student 'teams,' it has been suggested that there may be a need for a student-specific version of this measure. The purpose of this paper is to report on the psychometric properties of the AITCS-II for students. Data sets from 316 student respondents completing pretest assessments of team collaboration were used for a descriptive analysis of the ATICS. Both exploratory (EFA) and confirmatory factor analyses (CFA) were carried out. Factors from the EFA were then used in the CFA to obtain a good model fit. The result was a 16-item AITCS-II for students that demonstrated a reasonable model fit related to four latent variables: partnership (3 items), cooperation (6 items), team working (4 items) and coordination (3 items). In conclusion, the student version of the AITCS-II provides some evidence for its validity and reliability that can be used to assess collaboration in interprofessional student groups.

13.
Expert Opin Pharmacother ; 22(9): 1179-1192, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33586560

RESUMO

Introduction: The coexistence of depression and HIV infection affects more than 9 million people worldwide. A literature review revealed a large gap regarding the pharmacotherapy of depression among patients dually diagnosed with HIV and depression.Areas covered:In this review, the authors covered the various dimensions of deploying integrated pharmacological treatment of HIV/AIDS and depression. This topic was addressed in two ways; first, the direct results of integrated pharmacotherapy in syndemic patients; second, the indirect effects of the integrated model on other outcomes of HIV care.Expert opinion: An integrated pharmacological response to the treatment of HIV and depression can bring substantial benefits to HIV outcomes and reduce the burden of both diseases. The direct advantages regarding pharmacological response to the treatment of depression along with HIV care are improving adherence to antiretroviral therapy, optimizing pharmacotherapy, minimizing drug interaction, and prevention of additive adverse drug reactions. Furthermore, in some cases, medication can target both depression and other neuropsychiatric or somatic comorbidities among people living with HIV/AIDS. The integrated pharmacotherapy also has some potential indirect advantages on HIV care outcomes like minimizing loss of care, reducing ongoing HIV transmission, and improving the outcomes of both diseases.


Assuntos
Síndrome de Imunodeficiência Adquirida , Infecções por HIV , Comorbidade , Depressão/tratamento farmacológico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Adesão à Medicação
15.
Physiother Theory Pract ; 37(5): 594-607, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-31293200

RESUMO

Background: This paper arises from a larger study exploring early professional socialization across five professions: physiotherapy, nursing; dentistry; pharmacy; and medicine. Purpose: To explore the process of physiotherapy student professional identity development and the evolution of expectations and views of interprofessional practice in the first year of their program. Methods: One-on-one interviews at three time points: after being accepted into the physiotherapy program and before classes began (T1; n = 12); after term one (T2; n=9) and on completion of year one (T3; n = 7). Analyses employed narrative methodology, guided by anticipatory socialization and professional identity theories. Results: At T1, participants described their path towards physiotherapy, indicating career satisfaction as the core of their choice. Expectations of practice aligned with the normative social positioning of the profession. T2 and T3 interviews revealed that their pre-entry conceptualization of practice was both challenged and positively reinforced, leading them either to being satisfied with, or questioning their choice. Clinical placements created the most meaningful opportunities to understand their roles both as individual professionals and members of a collaborative team. Conclusion: Findings revealed the complex process of professional socialization in physiotherapy students with implications for admissions and formal and IPE curricula.


Assuntos
Escolha da Profissão , Relações Interprofissionais , Especialidade de Fisioterapia/educação , Estudantes de Ciências da Saúde , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
16.
Am J Ther ; 28(1): e41-e51, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-31241491

RESUMO

BACKGROUND: Effect of nifedipine on pressure ulcer (PU) healing has not been evaluated in the human subjects yet. STUDY QUESTION: In this study, the effect of topical application of nifedipine 3% ointment on PU healing in critically ill patients was investigated. STUDY DESIGN: This was a randomized, double-blind, placebo-controlled clinical. MEASURES AND OUTCOMES: In this study, 200 patients with stage I or II PU according to 2-digit Stirling Pressure Ulcer Severity Scale were randomized to receive topical nifedipine 3% ointment or placebo twice daily for 14 days. Changes in the size and stage of the ulcers were considered as primary outcome of the study. The stage of the ulcers at baseline and on day 7 and day 14 of study was determined by using 2-digit stirling scale. In addition, the surface area of the wounds was estimated by multiplying width by length. RESULTS: In total, 83 patients in each group completed the study. The groups were matched for the baseline stage and size of PUs. Mean decrease in the stage of PU in the nifedipine group was significantly higher than the placebo group on day 7 (-1.71 vs. -0.16, respectively, P < 0.001) and day 14 (-0.78 vs. -0.09, respectively, P < 0.001). Furthermore, the mean decrease in the surface area of PU was significantly higher in the nifedipine group compared with the placebo group on day 7 (-1.44 vs. -0.32, respectively, P < 0.001) and day 14 (-2.51 vs. -0.24, respectively, P < 0.001) of study. CONCLUSIONS: Topical application of nifedipine 3% ointment for 14 days significantly improved the healing process of stage I or II PUs in critically ill patients.

17.
J Interprof Care ; 35(1): 83-91, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-31865829

RESUMO

Dysfunctional interprofessional teams are a threat to health system performance and the delivery of quality patient outcomes. Implementing strategies that prepare future health professionals to be effective collaborators requires a comprehensive understanding of how early professional socialization and professional identity formation occur. We present findings from a qualitative study, grounded in narrative methodology, examining early professional socialization among students across five health professional programs (dentistry, medicine, nursing, pharmacy, physiotherapy) in the first year of health professional training. Between April and September 2015, students (n = 49) entering programs at an Atlantic Canadian University participated in one-on-one, audiotaped interviews starting before formal program orientation. Pre-entry interviews focused on factors influencing students' career choice and expectations of future profession and interprofessional collaboration (IPC). Findings revealed that many different experiences influenced participants' career choice and framed the social positioning of their future career (e.g., leadership, prestige, autonomy). Participant narratives revealed the existence of stereotypes pertaining to their chosen and other health professions. Study findings provided insights that may help strengthen initiatives to promote positive professional identity formation within the context of IPC. Implications of this research highlight the need for the early introduction of IPC including pre-entry recruitment messaging for prospective health professionals.

18.
Med Educ ; 55(4): 478-485, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33332659

RESUMO

PURPOSE: Interprofessional collaboration (IPC) among health professionals is well-recognised to enhance care delivery and patient outcomes. Emerging evidence suggests that the early socialisation of students in health professional programmes to teamwork may have a positive impact on their future as collaborative practitioners. With a purpose of contributing to growing evidence on the processes of professional identity construction, and to explore how early expectations and perceptions of IPC develop during professional socialisation and pre-licensure education, our study examined the early professional socialisation experiences among five groups of health professional students. METHOD: A qualitative, narrative approach was used to examine early professional socialisation among five programmes of health professional students (dentistry, medicine, nursing, pharmacy, physiotherapy) at an Atlantic Canadian University. In March and October 2016, students participated in interviews after first term (n = 44) and first year of study (n = 39). Interviews focused on participants' professional identify formation, as well as their perceptions and experiences of IPC. The authors analysed interview transcripts using narrative analysis. RESULTS: Findings identify that despite the espoused importance of IPC within health professional training, students have a limited understanding of their professional roles and are largely focused on developing a uniprofessional, vs. interprofessional identity. Clinical experiences, role models and exposure to teamwork are critical to contextualise collaborative practice and enhance the development of an interprofessional identity. CONCLUSIONS: Findings can be used to guide the development of curricula that promote interprofessional identity development and IPC during early professional socialisation.


Assuntos
Relações Interprofissionais , Socialização , Atitude do Pessoal de Saúde , Canadá , Comportamento Cooperativo , Pessoal de Saúde/educação , Humanos , Estudantes
19.
Thromb Res ; 196: 382-394, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32992075

RESUMO

BACKGROUND: Microvascular and macrovascular thrombotic events are among the hallmarks of coronavirus disease 2019 (COVID-19). Furthermore, the exuberant immune response is considered an important driver of pulmonary and extrapulmonary manifestations of COVID-19. The optimal management strategy to prevent thrombosis in critically-ill patients with COVID-19 remains unknown. METHODS: The Intermediate versus Standard-dose Prophylactic anticoagulation In cRitically-ill pATIents with COVID-19: An opeN label randomized controlled trial (INSPIRATION) and INSPIRATION-statin (INSPIRATION-S) studies test two independent hypotheses within a randomized controlled trial with 2 × 2 factorial design. Hospitalized critically-ill patients with reverse transcription polymerase chain reaction confirmed COVID-19 will be randomized to intermediate-dose versus standard dose prophylactic anticoagulation. The 600 patients undergoing this randomization will be screened and if meeting the eligibility criteria, will undergo an additional double-blind stratified randomization to atorvastatin 20 mg daily versus matching placebo. The primary endpoint, for both hypotheses will be tested for superiority and includes a composite of adjudicated acute arterial thrombosis, venous thromboembolism (VTE), use of extracorporeal membrane oxygenation, or all-cause death within 30 days from enrollment. Key secondary endpoints include all-cause mortality, adjudicated VTE, and ventilator-free days. Key safety endpoints include major bleeding according to the Bleeding Academic Research Consortium definition and severe thrombocytopenia (platelet count <20,000/fL) for the anticoagulation hypothesis. In a prespecified secondary analysis for non-inferiority, the study will test for the non-inferiority of intermediate intensity versus standard dose anticoagulation for major bleeding, considering a non-inferiority margin of 1.8 based on odds ratio. Key safety endpoints for the statin hypothesis include rise in liver enzymes >3 times upper normal limit and clinically-diagnosed myopathy. The primary analyses will be performed in the modified intention-to-treat population. Results will be tested in exploratory analyses across key subgroups and in the intention-to-treat and per-protocol cohorts. CONCLUSIONS: INSPIRATION and INSPIRATON-S studies will help address clinically-relevant questions for antithrombotic therapy and thromboinflammatory therapy in critically-ill patients with COVID-19.


Assuntos
Anticoagulantes/administração & dosagem , Atorvastatina/administração & dosagem , COVID-19/tratamento farmacológico , Enoxaparina/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Trombose/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Anticoagulantes/efeitos adversos , Atorvastatina/efeitos adversos , COVID-19/complicações , COVID-19/diagnóstico , Estado Terminal , Método Duplo-Cego , Enoxaparina/efeitos adversos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Irã (Geográfico) , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Trombose/diagnóstico , Trombose/etiologia , Fatores de Tempo , Resultado do Tratamento , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia
20.
J Interprof Care ; 34(5): 587-592, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32811213

RESUMO

Globally, the advent and rapid spread of the COVID-19 virus has created significant disruption to health professions education and practice, and consequently interprofessional education, leading to a model of learning and practicing where much is unknown. Key questions for this ongoing evolution emerge for the global context leading to reflections on future directions for the interprofessional education field and its role in shaping future practice models. Health professions programs around the world have made a dramatic shift to virtual learning platforms in response to closures of academic institutions and restrictions imposed on learners accessing practice settings. Telemedicine, slow to become established in many countries to date, has also revolutionized practice in the current environment. Within the state of disruption and rapid change is the awareness of a silver lining that provides an opportunity for future growth. Key topics explored in this commentary include reflection on the application of existing competency frameworks, consideration of typology of team structures, reconsideration of theoretical underpinnings, revisiting of core dimensions of education, adaptation of interprofessional education activities, and the role in the future pandemic planning. As an international community of educators and researchers, the authors consider current observations relevant to interprofessional education and practice contexts and suggest a response from scholarship voices across the globe. The current pandemic offers a unique opportunity for educators, practitioners, and researchers to retain what has served interprofessional education and practice well in the past, break from what has not worked as well, and begin to imagine the new.


Assuntos
Infecções por Coronavirus , Ocupações em Saúde/educação , Comunicação Interdisciplinar , Pandemias , Pneumonia Viral , COVID-19 , Currículo , Humanos , Internacionalidade , Aprendizagem Baseada em Problemas , Síndrome Respiratória Aguda Grave
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