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2.
J Vasc Surg ; 73(1): 4-11.e2, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32891807

RESUMO

BACKGROUND: We sought to understand the effects of coronavirus disease-2019 (COVID-19) on vascular surgery practices as related to the Vascular Activity Condition (VASCON) scale. METHODS: All members of the Vascular and Endovascular Surgery Society were surveyed on the effects of COVID-19 in their practices, educational programs, and self-reported grading of their surgical acuity level using the VASCON scale. RESULTS: Total response rate was 28% (206/731). Most respondents (99.5%) reported an effect of COVID-19 on their practice, and most were VASCON3 or lower level. Most reported a decrease in clinic referrals, inpatient/emergency room consults, and case volume (P < .00001). Twelve percent of respondents have been deployed to provide critical care and 11% medical care for COVID-19 patients. More than one-quarter (28%) face decreased compensation or salary. The majority of respondents feel vascular education is affected; however, most feel graduates will finish with the necessary experiences. There were significant differences in answers in lower VASCON levels respondents, with this group demonstrating a statistically significant decreased operative volume, vascular surgery referrals, and increased hospital and procedure limitations. CONCLUSIONS: Nearly all vascular surgeons studied are affected by the COVID-19 pandemic with decreased clinical and operative volume, educational opportunities for trainees, and compensation issues. The VASCON level may be helpful in determining surgical readiness.


Assuntos
Administração da Prática Médica/tendências , Cirurgiões/tendências , Procedimentos Cirúrgicos Vasculares/tendências , Carga de Trabalho , Agendamento de Consultas , Educação de Pós-Graduação em Medicina/tendências , Pesquisas sobre Serviços de Saúde , Humanos , Administração da Prática Médica/economia , Encaminhamento e Consulta/tendências , Salários e Benefícios/tendências , Cirurgiões/economia , Cirurgiões/educação , Fatores de Tempo , Procedimentos Cirúrgicos Vasculares/economia , Procedimentos Cirúrgicos Vasculares/educação , Carga de Trabalho/economia
3.
Br J Hosp Med (Lond) ; 81(12): 1-8, 2020 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-33377847

RESUMO

BACKGROUND/AIMS: Maintaining emergency eye services is crucial during the COVID-19 pandemic. This article describes the introduction of a new restructured referral pathway to reduce the burden on healthcare providers and create a safe environment. METHODS: During January and February 2020 (group 1), all appointments were face-to-face with a walk-in eye casualty. The first audit cycle comprised all patients in group 1. The primary audit criteria were discharge rates, referral to subspeciality and reattendance. In April 2020, a remodelled system was implemented in which walk-in attendance ceased and was replaced with telephone triage coupled with digital imaging via NHS email for remote clinical review. Patients requiring further assessment following this triage were invited in for face-to-face appointments. A reaudit was conducted during April-July 2020 (group 2) following implementation of these COVID-19 protocol changes. RESULTS: In group 1, 2868 appointments (100.0%) were face-to-face and in group 2 4870 (100.0%) appointments were telephone consults that resulted in 2639 (54.2%) face-to-face appointments. The rate of discharge in the first cycle and second cycle were 55.3% and 76.9% respectively (P<0.0001). Furthermore 2298 (47.2%) patients were able to be discharged following telephone consultation in group 2. CONCLUSIONS: Using this telephone and digital imaging review triage system, the authors have demonstrated a significant reduction in the need for face-to-face reviews. The reduction in avoidable patient face-to-face reviews allows the system to move from saturated to sustainable while increasing accessibility to services for patients who may not be able to present for face-to-face review. This complete audit cycle successfully charts interventions that maximise accessibility, reduce unnecessary hospital visits and deliver safe and prompt management during the pandemic.


Assuntos
/epidemiologia , Assistência à Saúde/organização & administração , Emergências , Traumatismos Oculares/terapia , Telemedicina/métodos , Triagem , Agendamento de Consultas , Humanos , Auditoria Médica , Pandemias , Encaminhamento e Consulta , Reino Unido
4.
Actas urol. esp ; 44(10): 644-652, dic. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-195507

RESUMO

INTRODUCCIÓN: La telemedicina ofrece un soporte clínico remoto utilizando herramientas tecnológicas. Puede facilitar la atención médica al tiempo que reduce las visitas innecesarias a la consulta. La pandemia COVID-19 ha provocado un cambio brusco en nuestra práctica urológica diaria convirtiéndose en algo muy necesario el acto de la teleconsulta. OBJETIVO: Proporcionar recomendaciones prácticas para el uso efectivo de herramientas tecnológicas en telemedicina. MATERIALES Y MÉTODOS: Se realizó una búsqueda en la literatura en la plataforma Medline hasta abril de 2020; seleccionamos los artículos más relevantes relacionados con «telemedicina» y «trabajo inteligente» que podrían proporcionar información útil. RESULTADOS: La telemedicina se refiere al uso de la información electrónica y a las herramientas de telecomunicaciones para proporcionar apoyo clínico remoto a la atención médica. El trabajo inteligente es un modelo de trabajo que utiliza tecnologías nuevas o existentes para mejorar el rendimiento. La telemedicina se está convirtiendo en una herramienta útil y necesaria durante la pandemia COVID-19 e incluso más allá de la misma. Es hora de que formalicemos y demos el lugar que se merece a la telemedicina en nuestra práctica clínica y es nuestra responsabilidad adaptar y conocer todas las herramientas y posibles estrategias para su implementación de una manera óptima, garantizar una atención de calidad a los pacientes y que dicha atención sea percibida por pacientes y familiares como de alto nivel. CONCLUSIONES: La telemedicina facilita la atención clínica urológica especializada a distancia y resuelve problemas como las limitaciones en la movilidad o el traslado de los pacientes, reduce las visitas innecesarias a las clínicas y es útil para reducir el riesgo de transmisión viral de la COVID-19


INTRODUCTION: Telemedicine provides remote clinical support through technology tools. It can facilitate medical care delivery while reducing unnecessary office visits. The COVID-19 outbreak has caused an abrupt change in our daily urological practice, where teleconsultations play a crucial role. OBJECTIVE: To provide practical recommendations for the effective use of technological tools in telemedicine. MATERIALS AND METHODS: A literature search was conducted on Medline until April 2020. We selected the most relevant articles related to «telemedicine» and «smart working» that could provide valuable information. RESULTS: Telemedicine refers to the use of electronic information and telecommunication tools to provide remote clinical health care support. Smart working is a working approach that uses new or existing technologies to improve performance. Telemedicine is becoming a useful and fundamental tool during the COVID-19 pandemic and will be even more in the future. It is time for us to officially give telemedicine the place it deserves in clinical practice, and it is our responsibility to adapt and familiarize with all the tools and possible strategies for its optimal implementation. We must guarantee that the quality of care received by patients and perceived by them and their families is of the highest standard. CONCLUSIONS: Telemedicine facilitates remote specialized urological clinical support and solves problems caused by limited patient mobility or transfer, reduces unnecessary visits to clinics and is useful to reduce the risk of COVID-19 viral transmission


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Pandemias , Betacoronavirus , Telemedicina/organização & administração , Telemedicina/normas , Urologia/métodos , Poluição do Ar/prevenção & controle , Agendamento de Consultas , Confidencialidade , Técnicas de Diagnóstico Urológico , Registros Eletrônicos de Saúde , Urologia/organização & administração , Urologia/normas , Consentimento Livre e Esclarecido , Guias de Prática Clínica como Assunto , Qualidade da Assistência à Saúde , Sociedades Médicas , Triagem/métodos , Europa (Continente)/epidemiologia
5.
Rev. SPAGESP ; 21(2): 66-82, jul.-dez. 2020.
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-1125732

RESUMO

Este artigo se propõe a discutir os desafios na formação para o trabalho com grupos e o papel dos coordenadores, com base na experiência de coordenação de grupos de sala de espera realizado em uma Unidade Básica de Saúde, a partir de um estágio de graduação em Psicologia. Através de recortes do diário de campo, buscamos discutir a mediação grupal nesse contexto de intervenção, ressaltando possibilidades, expectativas e dificuldades vivenciadas. Considerando a escassez de trabalhos publicados com relação à temática de grupos em sala de espera e ênfase em grupos informativos, o presente trabalho buscou ampliar a discussão para grupo enquanto processo, expondo reflexões sobre nossa postura e intervenções, discussões ampliadas para pensar coordenação de grupos e formação profissional.


This article proposes to discuss the challenges in training for group work and the role of coordinators, based on the experience of coordinating groups in a waiting room held in a Basic Health Unit, from a graduation internship in Psychology. Through field diary clippings, we sought to discuss group mediation in this context of intervention, highlighting possibilities, expectations, and difficulties experienced. Considering the scarcity of studies regarding the theme of groups in the waiting room, besides an emphasis on informative groups, this study aimed to expand the discussion to the group as a process, exposing reflections on our posture and interventions, extended discussions to think coordinating groups and professional qualification.


Este artículo se propone discutir los desafíos en la formación para el trabajo con grupos y el papel de los coordinadores, con base en la experiencia de coordinación de grupos de sala de espera realizado en una Unidad Básica de Salud, a partir de una etapa de graduación en Psicología. A través de recortes del diario de campo, buscamos discutir la mediación grupal en ese contexto de intervención, resaltando posibilidades, expectativas y dificultades vivenciadas. Considerando la escasez de trabajos publicados con relación a la temática de grupos en sala de espera y énfasis en grupos informativos, el presente trabajo buscó ampliar la discusión para grupo en cuanto proceso, exponiendo reflexiones sobre nuestra postura e intervenciones, discusiones ampliadas para pensar coordinación de grupos y formación profesional.


Assuntos
Humanos , Agendamento de Consultas , Postura , Papel (figurativo) , Apoio ao Desenvolvimento de Recursos Humanos , Centros de Saúde , Negociação , Cuidados Médicos , Capacitação Profissional , Internato e Residência
6.
Pediatr Dent ; 42(6): 464-469, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-33369558

RESUMO

Purpose: This pilot study aimed to evaluate the association between women's depression risk and their children's return for dental treatment. Methods: A total of 175 female caregivers of children presenting for an initial dental examination between May and October 2019 at a university clinic answered demographic questions and a validated survey on depression risk. An analysis of caregiver's depression risk relative to children's attendance at the next treatment appointment was made. Results: One hundred and eight female caregivers were included in the analysis. Average age was 33 years (standard deviation ± 6.5 years), and 52 percent were Hispanic. The rate of risk for depression was 17.5 percent. Most women at risk lived at least 20 miles away, had an income of less than $29,999, were unemployed or employed part-time, and had no help with childcare. White caregivers were more likely to fail to attend their child's appointment (chi-square [X²] = 7.80, P=0.02) while Hispanic women were more likely to return (X² = 4.10, P=0.04). Caregivers with low depression risk were more likely to return for the child's scheduled appointment (X² = 13.37, P<0.001). Thus, there was a positive association between high depression risk and failed appointments (r=0.474, P<0.01). Conclusion: Children of women at risk for depression are more likely to fail to attend their dental appointment.


Assuntos
Cuidadores , Depressão , Adulto , Agendamento de Consultas , Criança , Feminino , Humanos , Projetos Piloto , Inquéritos e Questionários
7.
Ned Tijdschr Tandheelkd ; 127(12): 719-726, 2020 Dec.
Artigo em Holandês | MEDLINE | ID: mdl-33367300

RESUMO

The aim of orthodontic retention is to counteract post-treatment changes and thereby to preserve the result of active treatment. For active orthodontic treatment, a certain level of patient compliance is necessary and the same applies for the retention phase. Ideally, the retainer will never fail or get lost, the patient will adhere to all recommendations and will wear the retainer in accordance with the instructions, necessary precautions with the fixed retainer are followed, the patient reports a problem immediately, and appointments for retention check-ups will always be met. Unfortunately, the reality is often different. This article considers the need to provide the patient with information about retention before treatment and the problems that may arise during the retention phase. Recommendations are made on how to avoid these problems as much as possible, and solutions are offered for problems that do arise. Finally, it is made clear how the orthodontist, patient and dentist can be jointly responsible for the retention phase.


Assuntos
Contenções Ortodônticas , Ortodontistas , Agendamento de Consultas , Humanos , Desenho de Aparelho Ortodôntico , Cooperação do Paciente
8.
BMC Nephrol ; 21(1): 532, 2020 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-33287730

RESUMO

BACKGROUND: Patients undergoing haemodialysis (HD) are at higher risk of developing worse outcomes if they contract COVID-19. In our renal service we reduced HD frequency from thrice to twice-weekly in selected patients with the primary aim of reducing COVID 19 exposure and transmission between HD patients. METHODS: Dialysis unit nephrologists identified 166 suitable patients (38.4% of our HD population) to temporarily convert to twice-weekly haemodialysis immediately prior to the peak of the COVID-19 pandemic in our area. Changes in pre-dialysis weight, systolic blood pressure (SBP) and biochemistry were recorded weekly throughout the 4-week project. Hyperkalaemic patients (serum potassium > 6.0 mmol/L) were treated with a potassium binder, sodium bicarbonate and received responsive dietary advice. RESULTS: There were 12 deaths (5 due to COVID-19) in the HD population, 6 of which were in the twice weekly HD group; no deaths were definitively associated with change of dialysis protocol. A further 19 patients were either hospitalised and/or developed COVID-19 and thus transferred back to thrice weekly dialysis as per protocol. 113 (68.1%) were still receiving twice-weekly HD by the end of the 4-week project. Indications for transfer back to thrice weekly were; fluid overload (19), persistent hyperkalaemia (4), patient request (4) and compliance (1). There were statistically significant increases in SBP and pre-dialysis potassium during the project. CONCLUSIONS: Short term conversion of a large but selected HD population to twice-weekly dialysis sessions was possible and safe. This approach could help mitigate COVID-19 transmission amongst dialysis patients in centres with similar organisational pressures.


Assuntos
Agendamento de Consultas , Pandemias , Diálise Renal/estatística & dados numéricos , Idoso , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Pressão Sanguínea , Peso Corporal , Comorbidade , Inglaterra/epidemiologia , Feminino , Humanos , Hiperpotassemia/etiologia , Falência Renal Crônica/sangue , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Diálise Renal/efeitos adversos
9.
Paediatr Respir Rev ; 36: 106-108, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33160838

RESUMO

The COVID pandemic has passed its first peak for now in many countries while some are still on the rise, with some facing a second wave of cases. Precautions and infection control measures for both pediatric and adult pulmonary function testing (PFT) have been a topic of debate during the pandemic. Many centers had to close their PFT laboratories during the initial periods of the pandemic and are reopening as the numbers of new cases are decreasing. This review aims to summarize different practices of PFT laboratory management in different countries, including patient appointments, personal protective equipment, testing room requirements and telemedicine during and immediately following the COVID pandemic.


Assuntos
/prevenção & controle , Assistência à Saúde/métodos , Ambiente Controlado , Equipamento de Proteção Individual , Testes de Função Respiratória/métodos , Filtros de Ar , Agendamento de Consultas , Criança , Assistência à Saúde/organização & administração , Humanos , Internacionalidade , Pais , Pediatria , Pneumologia , Telemedicina , Ventilação
11.
J World Fed Orthod ; 9(4): 159-163, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33221177

RESUMO

BACKGROUND: The spread of Coronavirus Disease 2019 (COVID-19) has led to a major public health issue; most dental clinics were closed and millions of orthodontic patients were unable to complete their treatment. This study aimed to assess the challenges faced by patients receiving orthodontic treatment and their preferred solutions to overcoming these challenges during this pandemic. METHODS: An online questionnaire was developed and sent to patients receiving orthodontic treatment at a public or private clinic. RESULTS: A total of 388 responses were analyzed: mean age 20.4 ± 4 years, 75% (291) female, and 58% (226) received their treatment at a public clinic. Of all participants, 27.3% (106) were still unable to attend their appointments and 69% (244) stated that closing of the clinic was the main reason for missing their appointments. Depending on their type of appliance, the patients faced different problems and chose multiple ways to deal with them. Most participants had fixed appliances, 84% (327), and only 21% (64) of them stated that they had no problem compared with 39% (11) and 36% (8) for removable appliance and clear aligner groups, respectively. CONCLUSION: The COVID-19 pandemic has had a significant impact on orthodontic treatments. Almost every orthodontic patient had to stop attending their appointments, which put them in complicated situations and in fear of delayed treatment. Patients from a public clinic and patients with fixed appliances reported more problems than others. More attention should be giving to teleorthodontics; also orthodontists should prepare their patients to deal with some of the problems related to their appliances when possible.


Assuntos
/epidemiologia , Acesso aos Serviços de Saúde , Ortodontia , Agendamento de Consultas , Estudos Transversais , Feminino , Humanos , Masculino , Pandemias , Inquéritos e Questionários , Telemedicina , Adulto Jovem
12.
Artigo em Inglês | MEDLINE | ID: mdl-33182388

RESUMO

To avoid spreading the Corona Virus Disease 2019 (COVID-19), health authorities have forced people to reorganize their working and private lives and to avoid open and public spaces as much as possible. This has also been the case for women both during pregnancy and after delivery. Here, we investigated the associations between subjective beliefs in risk of infections and health anxiety, depression, stress, and other perinatal dimensions. To this end, we assessed 103 women (mean age: 28.57 years) during pregnancy and after delivery. They completed a series of questionnaires covering sociodemographic information, perinatal information, health anxiety, post-partum depression, and stress. Sixty-six participants (64.1%) were in the pre-partum stage, and 37 (35.9%) were post-partum. Health anxiety was unrelated to depression or stress. Knowing and being close to infected people was associated with higher health anxiety. Strict following of the safety recommendations was associated with greater health anxiety, depression, and stress. Postponing or cancelling routine medical check appointments was observed among participants with high health anxiety scores. Higher illness severity, overall health anxiety scores, and lower stress scores predicted those participants who postponed or cancelled their routine medical check appointments. Post-partum stage and a larger number of children were associated with higher stress scores, but not with depression or stress. The results are of practical and clinical importance; it appears that health anxiety, which is to say fear of getting infected with COVID-19 during pregnancy or at the post-partum stage, was associated with postponing or cancelling routine medical check appointments, but not with stress or depression.


Assuntos
Ansiedade/epidemiologia , Agendamento de Consultas , Infecções por Coronavirus/psicologia , Pacientes não Comparecentes/estatística & dados numéricos , Pneumonia Viral/psicologia , Gestantes/psicologia , Adulto , Betacoronavirus , Criança , Depressão/epidemiologia , Feminino , Humanos , Pandemias , Gravidez , Estresse Psicológico/epidemiologia
13.
J Am Acad Orthop Surg ; 28(22): e1006-e1013, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-33156587

RESUMO

BACKGROUND: Patient physical health and provider financial health are both affected when patients are unable to attend scheduled clinic appointments. The purpose of this study is to identify risk factors for patients missing appointments to better target interventions to improve appointment attendance. METHODS: We reviewed scheduled arthroplasty appointments at an urban academic orthopaedic clinic over a 3-year period. We collected information including sex, race, distance to clinic, language, insurance, median income of home zip code, appointment day, time, precipitation, and temperature. Mixed-level multiple logistic regression was used to model the odds of missing appointments in Stata v14. RESULTS: Overall, 8,185 visits for 3,081 unique patients were reviewed and 90.7% of appointments were attended. After controlling for time and day of appointment, distance from the clinic, and the primary language spoken, patients with government insurance were two times as likely to miss an appointment compared with privately insured patients. White patients were two times as likely to attend scheduled appointments compared with black/Hispanic patients. Younger patients (<50 years) and older patients (>73 years) were 2.7 times and 1.8 times, respectively, more likely to miss appointments compared with those aged between 65 and 72 years. Appointments on the most temperate days were more likely to be missed, and those on the coldest days (14°F to 36°F) and warmest days (69°F to 89°F) were less likely to be missed. DISCUSSION: Appointment no shows are associated with sociodemographic and environmental factors. This information is valuable to help better delineate novel ways to better serve these patient populations.


Assuntos
Agendamento de Consultas , Artroplastia , Assistência à Saúde , Pacientes não Comparecentes/estatística & dados numéricos , Medição de Risco/métodos , Serviços Urbanos de Saúde/estatística & dados numéricos , Fatores Etários , Grupos de Populações Continentais , Feminino , Acesso aos Serviços de Saúde , Humanos , Seguro Saúde , Idioma , Modelos Logísticos , Masculino , Modelos Estatísticos , Fatores de Risco , Fatores Sexuais , Temperatura , Tempo , Fatores de Tempo
14.
Epilepsy Behav ; 112: 107483, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33181898

RESUMO

INTRODUCTION: When the SARS-CoV-2 pandemic reached Europe in 2020, a German governmental order forced clinics to immediately suspend elective care, causing a problem for patients with chronic illnesses such as epilepsy. Here, we report the experience of one clinic that converted its outpatient care from personal appointments to telemedicine services. METHODS: Documentations of telephone contacts and telemedicine consultations at the Epilepsy Center Frankfurt Rhine-Main were recorded in detail between March and May 2020 and analyzed for acceptance, feasibility, and satisfaction of the conversion from personal to telemedicine appointments from both patients' and medical professionals' perspectives. RESULTS: Telephone contacts for 272 patients (mean age: 38.7 years, range: 17-79 years, 55.5% female) were analyzed. Patient-rated medical needs were either very urgent (6.6%, n = 18), urgent (23.5%, n = 64), less urgent (29.8%, n = 81), or nonurgent (39.3%, n = 107). Outpatient service cancelations resulted in a lack of understanding (9.6%, n = 26) or anger and aggression (2.9%, n = 8) in a minority of patients, while 88.6% (n = 241) reacted with understanding, or relief (3.3%, n = 9). Telemedicine consultations rather than a postponed face-to-face visit were requested by 109 patients (40.1%), and these requests were significantly associated with subjective threat by SARS-CoV-2 (p = 0.004), urgent or very urgent medical needs (p = 0.004), and female gender (p = 0.024). Telemedicine satisfaction by patients and physicians was high. Overall, 9.2% (n = 10) of patients reported general supply problems due to SARS-CoV-2, and 28.4% (n = 31) reported epilepsy-specific problems, most frequently related to prescriptions, or supply problems for antiseizure drugs (ASDs; 22.9%, n = 25). CONCLUSION: Understanding and acceptance of elective ambulatory visit cancelations and the conversion to telemedicine consultations was high during the coronavirus disease 2019 (COVID-19) lockdown. Patients who engaged in telemedicine consultations were highly satisfied, supporting the feasibility and potential of telemedicine during the COVID-19 pandemic and beyond.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/organização & administração , Infecções por Coronavirus/prevenção & controle , Epilepsia/terapia , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/organização & administração , Adolescente , Adulto , Idoso , Assistência Ambulatorial/métodos , Agendamento de Consultas , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Encaminhamento e Consulta , Telefone , Adulto Jovem
15.
Can J Surg ; 63(6): E527-E529, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33180692

RESUMO

SUMMARY: The cancellation of large numbers of surgical procedures because of the coronavirus disease 2019 (COVID-19) pandemic has drastically extended wait lists and negatively affected patient care and experience. As many facilities resume clinical work owing to the currently low burden of disease in our community, we are faced with operative booking protocols and procedures that are not mathematically designed to optimize efficiency. Using a subset of artificial intelligence called "machine learning," we have shown how the use of operating time can be optimized with a custom Python (a high-level programming language) script and an open source machine-learning algorithm, the ORTools software suite from the Google AI division of Alphabet Inc. This allowed the creation of customized models to optimize the efficiency of operating room booking times, which resulted in a reduction in nursing overtime of 21% - a theoretical cost savings of $469 000 over 3 years.


Assuntos
Agendamento de Consultas , Infecções por Coronavirus/prevenção & controle , Eficiência Organizacional/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Aprendizado de Máquina , Salas Cirúrgicas/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Ontário , Duração da Cirurgia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia
16.
Strahlenther Onkol ; 196(12): 1080-1085, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33123776

RESUMO

PURPOSE: The described work aimed to avoid cancellations of indispensable treatments by implementing active patient flow management practices and optimizing infrastructure utilization in the radiation oncology department of a large university hospital and regional COVID-19 treatment center close to the first German SARS-CoV­2 hotspot region Heinsberg in order to prevent nosocomial infections in patients and personnel during the pandemic. PATIENTS AND METHODS: The study comprised year-to-date intervention analyses of in- and outpatient key procedures, machine occupancy, and no-show rates in calendar weeks 12 to 19 of 2019 and 2020 to evaluate effects of active patient flow management while monitoring nosocomial COVID-19 infections. RESULTS: Active patient flow management helped to maintain first-visit appointment compliance above 85.5%. A slight appointment reduction of 10.3% daily (p = 0.004) could still significantly increase downstream planning CT scheduling (p = 0.00001) and performance (p = 0.0001), resulting in an absolute 20.1% (p = 0.009) increment of CT performance while avoiding overbooking practices. Daily treatment start was significantly increased by an absolute value of 18.5% (p = 0.026). Hypofractionation and acceleration were significantly increased (p = 0.0043). Integrating strict testing guidelines, a distancing regimen for staff and patients, hygiene regulations, and precise appointment scheduling, no SARS-CoV­2 infection in 164 tested radiation oncology service inpatients was observed. CONCLUSION: In times of reduced medical infrastructure capacities and resources, controlling infrastructural time per patient as well as optimizing facility utilization and personnel workload during treatment evaluation, planning, and irradiation can help to improve appointment compliance and quality management. Avoiding recurrent and preventable exposure to healthcare infrastructure has potential health benefits and might avert cross infections during the pandemic. Active patient flow management in high-risk COVID-19 regions can help Radiation Oncologists to continue and initiate treatments safely, instead of cancelling and deferring indicated therapies.


Assuntos
Agendamento de Consultas , Infecção Hospitalar/prevenção & controle , Hospitais Universitários/organização & administração , Controle de Infecções/organização & administração , Neoplasias/radioterapia , Ambulatório Hospitalar/organização & administração , Pandemias , Radioterapia (Especialidade)/organização & administração , Serviço Hospitalar de Radiologia/organização & administração , Fluxo de Trabalho , /diagnóstico , /transmissão , Infecção Hospitalar/epidemiologia , Fracionamento da Dose de Radiação , Alemanha/epidemiologia , Hospitais Universitários/estatística & dados numéricos , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Neoplasias/cirurgia , Ambulatório Hospitalar/estatística & dados numéricos , Equipamento de Proteção Individual , Utilização de Procedimentos e Técnicas , Serviço Hospitalar de Radiologia/estatística & dados numéricos , Radiocirurgia/estatística & dados numéricos , Radioterapia/estatística & dados numéricos , Triagem/métodos , Triagem/normas
17.
Strahlenther Onkol ; 196(12): 1096-1102, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33125504

RESUMO

PURPOSE: The coronavirus pandemic is affecting global health systems, endangering daily patient care. Hemato-oncological patients are particularly vulnerable to infection, requiring decisive recommendations on treatment and triage. The aim of this survey amongst experts on radiation therapy (RT) for lymphoma and leukemia is to delineate typical clinical scenarios and to provide counsel for high-quality care. METHODS: A multi-item questionnaire containing multiple-choice and free-text questions was developed in a peer-reviewed process and sent to members of the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance. Answers were assessed online and analyzed centrally. RESULTS: Omission of RT was only considered in a minority of cases if alternative treatment options were available. Hypofractionated regimens and reduced dosages may be used for indolent lymphoma and fractures due to multiple myeloma. Overall, there was a tendency to shorten RT rather than to postpone or omit it. Even in case of critical resource shortage, panelists agreed to start emergency RT for typical indications (intracranial pressure, spinal compression, superior vena cava syndrome) within 24 h. Possible criteria to consider for patient triage are the availability of (systemic) options, the underlying disease dynamic, and the treatment rationale (curative/palliative). CONCLUSION: RT for hemato-oncological patients receives high-priority and should be maintained even in later stages of the pandemic. Hypofractionation and shortened treatment schedules are feasible options for well-defined constellations, but have to be discussed in the clinical context.


Assuntos
/epidemiologia , Linfoma/radioterapia , Mieloma Múltiplo/radioterapia , Pandemias , Radioterapia (Especialidade)/normas , Triagem/normas , Agendamento de Consultas , /diagnóstico , Infecção Hospitalar/prevenção & controle , Diagnóstico Diferencial , Fracionamento da Dose de Radiação , Humanos , Higiene/normas , Controle de Infecções/métodos , Controle de Infecções/normas , Linfoma/complicações , Linfoma/tratamento farmacológico , Mieloma Múltiplo/complicações , Osteólise/etiologia , Osteólise/radioterapia , Equipamento de Proteção Individual , Radioterapia (Especialidade)/métodos , Pneumonite por Radiação/diagnóstico , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/radioterapia , Inquéritos e Questionários , Tempo para o Tratamento , Irradiação Corporal Total
18.
Actas Urol Esp ; 44(10): 644-652, 2020 12.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33012592

RESUMO

INTRODUCTION: Telemedicine provides remote clinical support through technology tools. It can facilitate medical care delivery while reducing unnecessary office visits. The COVID-19 outbreak has caused an abrupt change in our daily urological practice, where teleconsultations play a crucial role. OBJECTIVE: To provide practical recommendations for the effective use of technological tools in telemedicine. MATERIALS AND METHODS: A literature search was conducted on Medline until April 2020. We selected the most relevant articles related to «telemedicine¼ and «smart working¼ that could provide valuable information. RESULTS: Telemedicine refers to the use of electronic information and telecommunication tools to provide remote clinical health care support. Smart working is a working approach that uses new or existing technologies to improve performance. Telemedicine is becoming a useful and fundamental tool during the COVID-19 pandemic and will be even more in the future. It is time for us to officially give telemedicine the place it deserves in clinical practice, and it is our responsibility to adapt and familiarize with all the tools and possible strategies for its optimal implementation. We must guarantee that the quality of care received by patients and perceived by them and their families is of the highest standard. CONCLUSIONS: Telemedicine facilitates remote specialized urological clinical support and solves problems caused by limited patient mobility or transfer, reduces unnecessary visits to clinics and is useful to reduce the risk of COVID-19 viral transmission.


Assuntos
/epidemiologia , Pandemias , Telemedicina , Urologia/métodos , Poluição do Ar/prevenção & controle , Agendamento de Consultas , Confidencialidade , Técnicas de Diagnóstico Urológico , Registros Eletrônicos de Saúde , Europa (Continente)/epidemiologia , Humanos , Consentimento Livre e Esclarecido , Guias de Prática Clínica como Assunto , Qualidade da Assistência à Saúde , Sociedades Médicas , Telemedicina/organização & administração , Telemedicina/normas , Triagem/métodos , Urologia/organização & administração , Urologia/normas
19.
Rev. esp. enferm. dig ; 112(10): 748-755, oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194290

RESUMO

INTRODUCCIÓN: la pandemia mundial por SARS-CoV-2 obligó a paralizar las unidades de endoscopia. Previamente a la reanudación de la actividad endoscópica diseñamos un protocolo de valoración de gastroscopias y colonoscopias, desprogramadas durante la pandemia, denegando las no indicadas y priorizando las indicadas. MÉTODOS: establecimos dos tipos de denegación: a) contexto covid-19 en ≤ 50 años sin síntomas de alarma y baja probabilidad de hallazgos endoscópicos relevantes; y b) contexto inadecuado por no ser acordes con las guías o protocolos clínicos. Las denegaciones se archivaron en la historia clínica del paciente. Clasificamos las adecuadas en preferentes, convencionales y seguimiento. Comparamos las denegadas por especialidad. Valoramos los hallazgos de las preferentes. RESULTADOS: valoramos 1.658 peticiones (44 % gastroscopias, 56 % colonoscopias) entre el 16 marzo y el 30 junio de 2020. Se consideraron adecuadas 1.164 (70 %), de ellas preferentes el 8,5 %, convencionales el 48 %, seguimiento el 43 % y no valorables el 0,5 %. Se denegaron 494 (30 %): 20 % "contexto covid-19" y 80 % "contexto inadecuado". Los motivos de denegación en las gastroscopias fueron: seguimiento de lesiones (33 %), síntomas insuficientemente estudiados (20 %) y síntomas recidivantes con gastroscopia previa (18 %). Los motivos de denegación en las colonoscopias fueron: vigilancia pospolipectomía (25 %), cáncer colorrectal intervenido (21 %) y antecedentes familiares de cáncer (13 %). Encontramos diferencias significativas en la denegación según la especialidad: Cirugía General (52 %), Hematología (37 %) y Atención Primaria (29 %). Un 31 % de las preferentes mostraron hallazgos relevantes. CONCLUSIONES: un 24 % de nuestras endoscopias son discordantes con las recomendaciones científicas. Su denegación y la priorización de las adecuadas optimizan la utilización de recursos


No disponible


Assuntos
Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Prioridades em Saúde , Endoscopia Gastrointestinal/estatística & dados numéricos , Colonoscopia/estatística & dados numéricos , Infecções por Coronavirus , Pneumonia Viral , Pandemias , Agendamento de Consultas
20.
J Vasc Interv Radiol ; 31(11): 1857-1863, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33041175

RESUMO

PURPOSE: To assess changes in operational utilization following conversion of a single IR suite to a hybrid CT/angiography (Angio-CT) system at an academic tertiary care center. MATERIALS AND METHODS: The total number of interventional procedures and diagnostic CT examinations performed in 29 rooms (20 diagnostic radiology, 7 IR, 2 shared between divisions) was calculated in the 24 months before conversion of an IR suite to Angio-CT and 12 months after conversion. The total number of IR procedures (global IR/month) and diagnostic CT scans per month (global CT/month) in both before and after conversion periods was calculated and defined as baseline institutional growth. This was compared against the change in the number of IR procedures performed in the before and after periods in the converted room (Angio-CT/month) as well as the number of diagnostic CT scans performed in the shared rooms (shared CT/month). RESULTS: The percent change in global CT and global IR from the before to the after periods was 39.2% and 3.1%, respectively. Shared CT per month and Angio-CT per month increased by 46.7% and 12.0% across the same time periods, respectively. The ratio of the percent increase in Angio-CT per month to percent increase in global IR per month was 3.87. The ratio of the percent increase in shared CT per month to percent increase in global CT per month was 1.19. CONCLUSIONS: Operational utilization improved in both diagnostic radiology and IR sections following conversion of a conventional fluoroscopic IR suite to an Angio-CT room.


Assuntos
Agendamento de Consultas , Angiografia por Tomografia Computadorizada , Unidades Hospitalares/organização & administração , Radiografia Intervencionista , Serviço Hospitalar de Radiologia/organização & administração , Sistemas de Informação em Radiologia/organização & administração , Eficiência Organizacional , Fluoroscopia , Humanos , Estudos Retrospectivos , Fluxo de Trabalho , Carga de Trabalho
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