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1.
Medwave ; 21(4): e8192, 2021 May 24.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-34086668

RESUMO

Introduction: On March 19, 2020, a mandatory lockdown was imposed in Argentina due to the global pandemic caused by SARS-CoV-2. Objectives: To explore the elderlys healthcare experiences during the lockdown and the problems that may have arisen regarding accessibility to the healthcare system and emerging adaptations to medical care. Methods: We coded the data using Atlas.ti 8 software and then triangled the analysis among researchers from different backgrounds. Finally, concept maps were developed and themes arising from these were described. Results: Thirty-nine participants were interviewed from the metropolitan area in Buenos Aires from April to July of 2020. The main emerging themes were: 1) access to regularly scheduled consults, 2) access to chronic medication, 3) emergency consultations, and 4) the role of information and communication technologies. Accessibility to the healthcare system was compromised due to reduced outpatient consultations, affecting health checkups, diagnosis, and treatment. However, participants tried to keep their immunizations up to date. Information and communication technologies were used to fill digital prescriptions and online medical consultations. While this was a solution to many, others did not have access to these technologies or had trouble using them. Conclusions: The global pandemic caused a reduction in outpatient medical consultations. Emerging needs originated new ways of carrying out medical consultations, mainly through information and communication technologies, which was a solution for many but led to the exclusion of others because of the preexisting technology gap.


Assuntos
COVID-19/prevenção & controle , Acesso aos Serviços de Saúde , Serviços de Saúde para Idosos , Quarentena , Idoso , Assistência Ambulatorial , Agendamento de Consultas , Argentina/epidemiologia , COVID-19/epidemiologia , COVID-19/psicologia , Prescrição Eletrônica , Serviços Médicos de Emergência , Feminino , Humanos , Tecnologia da Informação , Masculino , Pessoa de Meia-Idade , Preparações Farmacêuticas/provisão & distribuição , Pesquisa Qualitativa , Telemedicina , Vacinação
2.
Biomed Environ Sci ; 34(5): 395-399, 2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34059177

RESUMO

Climate change has been referred to as one of the greatest threats to human health, with reports citing likely increases in extreme meteorological events. In this study, we estimated the relationships between temperature and outpatients at a major hospital in Qingdao, China, during 2015-2017, and assessed the morbidity burden. The results showed that both low and high temperatures were associated with an increased risk of outpatient visits. High temperatures were responsible for more morbidity than low temperatures, with an attributed fraction (AF) of 16.86%. Most temperature-related burdens were attributed to moderate cold and hot temperatures, with AFs of 5.99% and 14.44%, respectively, with the young (0-17) and male showing greater susceptibility. The results suggest that governments should implement intervention measures to reduce the adverse effects of non-optimal temperatures on public health-especially in vulnerable groups.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Doenças Cardiovasculares/etiologia , Temperatura Baixa/efeitos adversos , Doenças do Sistema Digestório/etiologia , Utilização de Instalações e Serviços/estatística & dados numéricos , Temperatura Alta/efeitos adversos , Doenças Respiratórias/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Criança , Pré-Escolar , China/epidemiologia , Efeitos Psicossociais da Doença , Doenças do Sistema Digestório/epidemiologia , Doenças do Sistema Digestório/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/terapia , Fatores de Risco , Adulto Jovem
3.
Artigo em Inglês | MEDLINE | ID: mdl-34081044

RESUMO

INTRODUCTION: In response to the SARS-CoV-2 pandemic, physician attire has evolved to incorporate personal protective equipment (PPE). Although PPE is mandated for all healthcare workers, variability exists in choice and availability. The purpose of this study was to determine patient perception of physician attire during the COVID-19 pandemic in an outpatient setting. METHODS: Three hundred sixty-eight patients who presented to our outpatient orthopaedic clinics completed an anonymous survey. In addition to demographic characteristics, patient preferences for attire, PPE, and social distancing were obtained. RESULTS: Scrubs (81%, 298/368) were found to be the most acceptable physician attire. Eye protection (34.2%, 126/368) and gloves (32.6%, 120/368), however, were deemed much less acceptable; 93.5% (344/368) of patients reported that no mask was unacceptable, with 41.0% (151/368) preferring a surgical mask. Predilection for a surgical mask and N95 rose with increasing patient education level. Interestingly, 55.2% (203/368) responded that physicians should stop wearing PPE only when the Center for Disease Control recommends. CONCLUSION: During the COVID-19 pandemic, most of the patients found scrubs to be the most acceptable attire in an office-based outpatient setting. Patients also found physician mask-wearing to be important but are less accepting of providers wearing eye and hand protection.


Assuntos
Assistência Ambulatorial , Atitude Frente a Saúde , COVID-19/prevenção & controle , Vestuário , Dispositivos de Proteção dos Olhos , Luvas Cirúrgicas , Respiradores N95 , Satisfação do Paciente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Escolaridade , Feminino , Humanos , Masculino , Máscaras , Pessoa de Meia-Idade , Equipamento de Proteção Individual , Roupa de Proteção , SARS-CoV-2 , Inquéritos e Questionários , Adulto Jovem
5.
Rev Bras Epidemiol ; 24: e210037, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34133703

RESUMO

AIM: To investigate the geographical variability and factors associated with hospitalizations for ambulatory care sensitive conditions (ACSC) among older adults living in the state of Minas Gerais. METHODOLOGY: This is an ecological study, based on data from the National Hospital Information System (SIH-SUS). Municipal rates of hospitalization for ACSC were compared to the state's average rate, and analysis of associated factors included sociodemographic characteristics, supply of health services and primary health care (PHC) activities. Data analysis was based on Bayesian spatial modeling. RESULTS: Most municipalities in Minas Gerais (479 or 56.2%) had a rate of hospitalization for ACSC below the state average. After multivariate analysis, income (ß = -0,0008; 95%CI: -0.0014 - -0,0002) and the Family Health Strategy coverage (ß = -0.4269; 95%CI: -0.7988 - -0.1116) were negatively associated with the risk of hospitalization for ACSC, while the availability of hospital beds (ß = 0.0271; 95%CI 0.0211 - 0.0331) was positively associated. The characteristics of PHC did not show any association with the rate of hospitalization for ACSC. CONCLUSION: the rates of hospitalization for ACSC in the elderly population were influenced by the PHC coverage, but also by external factors such as income and structure and provision of health services, indicating that the meeting of population health demands passes through actions that go beyond the health sector, including investment in the reduction of poverty and inequality and expansion of access to PHC.


Assuntos
Assistência Ambulatorial , Hospitalização , Idoso , Teorema de Bayes , Brasil/epidemiologia , Humanos , Análise Espacial
6.
BMC Cancer ; 21(1): 578, 2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34016086

RESUMO

BACKGROUND: The viral pandemic coronavirus disease 2019 (COVID-19) has disrupted cancer patient management around the world. Most reported data relate to incidence, risk factors, and outcome of severe COVID-19. The safety of systemic anti-cancer therapy in oncology patients with non-severe COVID-19 is an important matter in daily practice. METHODS: ONCOSARS-1 was a single-center, academic observational study. Adult patients with solid tumors treated in the oncology day unit with systemic anti-cancer therapy during the initial phase of the COVID-19 pandemic in Belgium were prospectively included. All patients (n = 363) underwent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) serological testing after the first peak of the pandemic in Belgium. Additionally, 141 of these patients also had a SARS-CoV-2 RT-PCR test during the pandemic. The main objective was to retrospectively determine the safety of systemic cancer treatment, measured by the rate of adverse events according to the Common Terminology Criteria for Adverse Events, in SARS-CoV-2-positive patients compared with SARS-CoV-2-negative patients. RESULTS: Twenty-two (6%) of the 363 eligible patients were positive for SARS-CoV-2 by RT-PCR and/or serology. Of these, three required transient oxygen supplementation, but none required admission to the intensive care unit. Hematotoxicity was the only adverse event more frequently observed in SARS-CoV-2 -positive patients than in SARS-CoV-2-negative patients: 73% vs 35% (P < 0.001). This association remained significant (odds ratio (OR) 4.1, P = 0.009) even after adjusting for performance status and type of systemic treatment. Hematological adverse events led to more treatment delays for the SARS-CoV-2-positive group: 55% vs 20% (P < 0.001). Median duration of treatment interruption was similar between the two groups: 14 and 11 days, respectively. Febrile neutropenia, infections unrelated to COVID-19, and bleeding events occurred at a low rate in the SARS-CoV-2-positive patients. CONCLUSION: Systemic anti-cancer therapy appeared safe in ambulatory oncology patients treated during the COVID-19 pandemic. There were, however, more treatment delays in the SARS-CoV-2-positive population, mainly due to a higher rate of hematological adverse events.


Assuntos
COVID-19/diagnóstico , COVID-19/epidemiologia , Neoplasias/terapia , Idoso , Assistência Ambulatorial/estatística & dados numéricos , Bélgica/epidemiologia , COVID-19/complicações , Institutos de Câncer , Estudos de Coortes , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Fatores de Risco , SARS-CoV-2
8.
Medicine (Baltimore) ; 100(21): e26099, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032747

RESUMO

BACKGROUND: Although home-based pulmonary rehabilitation programs have been shown in some studies to be an alternative and effective model, there is a lack of consensus in the medical literature due to different study designs and lack of standardization among procedures. Therefore, the purpose of this study was to compare the efficacy of a home-based versus outpatient pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD). METHODS: Five electronic databases including Embase, PubMed, Scopus, Science Direct, and Cochrane Library will be searched in May 2021 by 2 independent reviewers. The reference lists of the included studies will be also checked for additional studies that are not identified with the database search. There is no restriction on the dates of publication or language in the search. The randomized controlled trials focusing on comparing home-based and outpatient pulmonary rehabilitation for COPD patients will be included in our meta-analysis. The following outcomes should have been measured: functional exercise capacity, disease-specific health-related quality of life, and cost-effectiveness measures. Risk ratio with a 95% confidence interval or standardized mean difference with 95% CI is assessed for dichotomous outcomes or continuous outcomes, respectively. RESULTS: It was hypothesized that these 2 methods would provide similar therapeutic benefits. REGISTRATION NUMBER: 10.17605/OSF.IO/5CV48.


Assuntos
Assistência Ambulatorial/organização & administração , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Doença Pulmonar Obstrutiva Crônica/reabilitação , Qualidade de Vida , Assistência Ambulatorial/economia , Assistência Ambulatorial/métodos , Análise Custo-Benefício , Tolerância ao Exercício , Serviços Hospitalares de Assistência Domiciliar/economia , Humanos , Metanálise como Assunto , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/economia , Doença Pulmonar Obstrutiva Crônica/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Resultado do Tratamento
9.
Urologe A ; 60(6): 760-768, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-34047813

RESUMO

The topic of routine medical care data and healthcare science has gained in relevance and provides an important basis for both healthcare policymakers and those providing care. Access to relevant data and the ability to analyze these is highly competitive as it yields the most compelling arguments and strong facts in any discourse on the ultimately limited resources of the entire healthcare sector. All randomized clinical trials and prospective data collections harbor the inherent similarity that they contain data within a predefined frame of data elements in order to control for any confounding factors. In addition, analyses using retrospective data collections use a predefined evaluation matrix and filter the existing data according to these established data elements. However, an unfiltered and un(pre)specified view to all data would be ideal. An approximation to this goal as part of this project could be the unfiltered collection of as much data as possible and their collection in a data pool, which then could be processed, in a constantly improving analyses algorithm. The automated self-extraction of data from the private-practice information technology (IT) system to UROscience will create a data pool which could be used to answer many different questions related to the reality of healthcare. The preliminary analyses presented here demonstrate that, on basis of the existing data, this versatile sample is available to provide insight into the treatment reality of urologic outpatient care.


Assuntos
Atenção à Saúde , Urologistas , Assistência Ambulatorial , Humanos , Estudos Prospectivos , Estudos Retrospectivos
10.
Am Fam Physician ; 103(10): 590-596, 2021 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-33983005

RESUMO

More than 5 million patients in the United States are admitted to intensive care units (ICUs) annually, and an increasing percentage of patients treated in the ICU survive to hospital discharge. Because these patients require follow-up in the outpatient setting, family physicians should be prepared to provide ongoing care and screening for post-ICU complications. Risk factors for complications after ICU discharge include previous ICU admissions, preexisting mental illness, greater number of comorbidities, and prolonged mechanical ventilation or higher opioid exposure while in the ICU. Early nutritional support and mobilization in the ICU decrease the risk of complications. After ICU discharge, patients should be screened for depression, anxiety, insomnia, and cognitive impairment using standardized screening tools. Physicians should also inquire about weakness, fatigue, neuropathy, and functional impairment and perform a targeted physical examination and laboratory evaluation as indicated; treatment depends on the underlying cause. Exercise regimens are beneficial for reducing several post-ICU complications. Patients who were treated for COVID-19 in the ICU may require additional instruction on reducing the risk of virus transmission. Telemedicine and telerehabilitation allow patients with COVID-19 to receive effective care without increasing exposure risk in communities, hospitals, and medical offices.


Assuntos
Assistência ao Convalescente , Assistência Ambulatorial , COVID-19/terapia , Continuidade da Assistência ao Paciente , Assistência ao Convalescente/métodos , Assistência ao Convalescente/psicologia , Assistência Ambulatorial/métodos , Assistência Ambulatorial/normas , COVID-19/epidemiologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/reabilitação , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Cuidados Críticos/métodos , Necessidades e Demandas de Serviços de Saúde , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Alta do Paciente , Desempenho Físico Funcional , Melhoria de Qualidade , SARS-CoV-2 , Estados Unidos
11.
J Clin Psychiatry ; 82(3)2021 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-33989466

RESUMO

OBJECTIVE: By forcing closure of schools, curtailing outpatient services, and imposing strict social distancing, the COVID-19 pandemic has abruptly affected the daily life of millions worldwide, with still unclear consequences for mental health. This study aimed to evaluate if and how child and adolescent psychiatric visits to hospital emergency departments (EDs) changed during the pandemic lockdown, which started in Italy on February 24, 2020. METHODS: We examined all ED visits by patients under 18 years of age in the 7 weeks prior to February 24, 2020, and in the subsequent 8 weeks of COVID-19 lockdown at two urban university hospitals, in Turin and Rome, Italy. ED visits during the corresponding periods of 2019 served as a comparison using Poisson regression modeling. The clinician's decision to hospitalize or discharge home the patient after the ED visit was examined as an index of clinical severity. RESULTS: During the COVID-19 lockdown, there was a 72.0% decrease in the number of all pediatric ED visits (3,395) compared with the corresponding period in 2019 (12,128), with a 46.2% decrease in psychiatric visits (50 vs 93). The mean age of psychiatric patients was higher in the COVID-19 period (15.7 vs 14.1 years). No significant changes were found in hospitalization rate or in the prevalence distribution of the primary reason for the psychiatric ED visit (suicidality, anxiety/mood disorders, agitation). CONCLUSIONS: In the first 8 weeks of the COVID-19-induced social lockdown, the number of child and adolescent psychiatric ED visits significantly decreased, with an increase in patient age. This decrease does not appear to be explained by severity-driven self-selection and might be due to a reduction in psychiatric emergencies or to the implementation of alternative ways of managing acute psychopathology.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , COVID-19 , Emergências/epidemiologia , Serviços de Emergência Psiquiátrica , Hospitalização/estatística & dados numéricos , Transtornos Mentais , Distanciamento Físico , Adolescente , Fatores Etários , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/psicologia , Criança , Controle de Doenças Transmissíveis/métodos , Educação à Distância , Serviços de Emergência Psiquiátrica/organização & administração , Serviços de Emergência Psiquiátrica/estatística & dados numéricos , Feminino , Humanos , Itália/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Saúde Mental/estatística & dados numéricos , Inovação Organizacional , SARS-CoV-2
12.
BMC Public Health ; 21(1): 957, 2021 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-34016075

RESUMO

BACKGROUND: Studies of consequences of sickness absence such as health and well-being have been rare whereas risk factors for sickness absence have been studied extensively. This study assumed the consequences of sickness absence would differ by diagnostic group or by patient care type. The aim was to investigate sickness absence due to various diagnosis groups as a predictor for subsequent inpatient- and specialized outpatient care while controlling for familial confounding. METHODS: We utilized the register data of 69,552 twin individuals between 16 and 80 years of age (48% women). The first incident sickness absence spell, from baseline year 2005, including diagnosis of sickness absence was our primary exposure of interest and we followed them until the first incident inpatient- and specialized outpatient care episode with main diagnosis code or until 31.12.2013. RESULTS: A total of 7464 incident sickness absence spells took place (11%), 42% had inpatient care and 83% specialized outpatient care (mean follow-up time 3.2 years, SD 3.1 years). All the main sickness absence diagnosis groups were associated with increased risk of future care in comparison to no sickness absence. Controlling for confounders attenuated the associations in magnitude but with retaining direction, and we could not confirm an effect of familial factors. CONCLUSIONS: Sickness absence predicts both inpatient- and specialized outpatient care and the association is universal across diagnosis groups. The lower survival time and incidence rates of inpatient than specialized outpatient care point towards severity of diseases assumption. This finding was also universal across sickness absence diagnosis groups.


Assuntos
Pacientes Internados , Licença Médica , Assistência Ambulatorial , Feminino , Humanos , Masculino , Pacientes Ambulatoriais , Suécia/epidemiologia
13.
Orthop Clin North Am ; 52(3): 209-214, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34053566

RESUMO

This study compares anterior supine intermuscular total hip arthroplasty performed at an ambulatory surgery center with the same procedure performed in a hospital setting in regard to complications and costs. The ambulatory surgery center had significantly shorter postoperative stays and superior visual analog pain scores at 3 months. No differences were noted in operative time, blood loss, or complications. Costs were significantly different between groups, with significant cost savings noted in the ambulatory surgery center group.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Artroplastia de Quadril , Hospitalização , Complicações Pós-Operatórias/epidemiologia , Assistência Ambulatorial/economia , Assistência Ambulatorial/métodos , Assistência Ambulatorial/estatística & dados numéricos , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/economia , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/economia , Artroplastia de Quadril/métodos , Artroplastia de Quadril/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade
14.
BMJ Open ; 11(5): e042779, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952537

RESUMO

OBJECTIVE: Ambulatory care sensitive (ACS) conditions are those for which intensified primary care management could potentially prevent emergency admissions. This study aimed to quantify geographical variation in emergency admissions with ACS conditions in older adults and explore factors influencing variation. DESIGN: Repeated cross-sectional study. SETTING: 34 public hospitals in the Ireland. PARTICIPANTS: Adults aged ≥65 years hospitalised for seven ACS conditions between 2012 and 2016 (chronic obstructive pulmonary disease, congestive heart failure (CHF), diabetes, angina, pyelonephritis/urinary tract infections (UTIs), dehydration and pneumonia). PRIMARY OUTCOME MEASURE: Age and sex standardised emergency admission rates (SARs) per 1000 older adults. ANALYSIS: Age and sex SARs were calculated for 21 geographical areas. Extremal quotients and systematic components of variance (SCV) quantified variation. Spatial regression analyses was conducted for SARs with unemployment, urban population proportion, hospital turnover, supply of general practitioners (GPs), and supply of hospital-based specialists as explanatory variables. RESULTS: Over time, an increase in UTI/pyelonephritis SARs was seen while SARs for angina and CHF decreased. Geographic variation was moderate overall and high for dehydration and angina (SCV=11.7-50.0). For all conditions combined, multivariable analysis showed lower urban population (adjusted coefficient: -2.2 (-3.4 to -0.9, p<0.01)), lower GP supply (adjusted coefficient: -5.5 (-8.2 to -2.9, p<0.01)) and higher geriatrician supply (adjusted coefficient: 3.7 (0.5 to 6.9, p=0.02)) were associated with higher SARs. CONCLUSIONS: Future research should evaluate methods of preventing admissions for ACS conditions among older adults, including how resources are allocated at a local level.


Assuntos
Hospitalização , Doença Pulmonar Obstrutiva Crônica , Idoso , Assistência Ambulatorial , Estudos Transversais , Humanos , Irlanda/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia
15.
J Prim Care Community Health ; 12: 21501327211017016, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33985374

RESUMO

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.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , COVID-19/diagnóstico , Guias como Assunto , Pessoal de Saúde/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Triagem , Adulto , Idoso , COVID-19/epidemiologia , Teste para COVID-19 , Infecção Hospitalar , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , População Urbana
16.
Stud Health Technol Inform ; 279: 10-17, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33965912

RESUMO

Practice efficiency is influenced by its operations management. We aim at studying implementation of operations management in Swiss medical practices and we develop a dashboard that allows controlling and managing resources. To study operations management and relevant indicators in ambulant care, we distributed questionnaires by e-mail and conducted 6 interviews. In collaboration with a group practice, we collected requirements regarding a dashboard for operations management, developed a mockup and finally a prototype. This prototype was deployed and implemented in daily routine. From the assessments we learned that practice information systems (PIS) are not sufficiently supporting production planning and control. Relevant indicators include processing time per patient or waiting time for quantifying efficiency and identify potential improvements in production. Within 5 weeks of implementation of our dashboard in a group practice, we learned that calculating indicators and support of operations management by means of a dashboard is well appreciated by practice employees. Indicators are considered extremely useful for operations management.


Assuntos
Assistência Ambulatorial , Eficiência , Humanos , Suíça
17.
Medwave ; 21(3): e8147, 2021 Apr 07.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-33955972

RESUMO

Introduction: The COVID-19 pandemic was declared in early 2020, requiring different prevention and intervention measures on a large scale. In the case of Colombia, a series of measures focused on isolation and remote services provision were introduced in a context marked by health inequities. This article reviews the theoretical and normative references on primary care interventions in the Colombian response to the COVID-19 pandemic. Methods: A literature review was conducted in PubMed, LILACS, MEDLINE, and official documents and regulations issued in Colombia, the World Health Organization, and the Pan American Health Organization. A narrative synthesis was done of 33 documents based on their contribution to the implementation of primary care in Colombia and their role in the pandemic. Results: The information was organized into two categories: Actions taken in Colombia in response to COVID-19 and Opportunities in primary care in response to COVID-19. Colombias actions were contrasted with world experience. Better pandemic control was found in countries that adopted primary care as a response. Primary care has strengthened the handling of the pandemic through community action, the provision of coordinated services, mental health inclusion, and the adoption of telemedicine processes. Conclusions: In Colombia, primary care is presented as an opportunity to respond to the COVID-19 pandemic and the problems and needs derived from this situation. However, despite the above, there is resistance in the country to adopt this type of approach and complement the hospital-centric model to face the pandemic.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Pandemias/prevenção & controle , Atenção Primária à Saúde/organização & administração , Assistência Ambulatorial , COVID-19/diagnóstico , Colômbia/epidemiologia , Atenção à Saúde/organização & administração , Humanos , Disseminação de Informação , Saúde Mental , Distanciamento Físico , Quarentena/organização & administração , Telemedicina
18.
S Afr Med J ; 111(3): 240-244, 2021 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-33944745

RESUMO

BACKGROUND: The COVID-19 pandemic has impacted on the global surgery landscape. OBJECTIVES: To analyse and describe the initial impact of the COVID-19 pandemic on orthopaedic surgery at Groote Schuur Hospital, a tertiary academic hospital in South Africa. METHODS: The number of orthopaedic surgical cases, emergency theatre patient waiting times, and numbers of outpatient clinic visits, ward admissions, bed occupancies and total inpatient days for January - April 2019 (pre-COVID-19) were compared with the same time frame in 2020 (COVID-19). The COVID-19 timeframe included initiation of a national 'hard lockdown' from 26 March 2020, in preparation for an increasing volume of COVID-19 cases. RESULTS: April 2020, the time of the imposed hard lockdown, was the most affected month, although the number of surgical cases had started to decrease slowly during the 3 preceding months. The total number of surgeries, outpatient visits and ward admissions decreased significantly during April 2020 (55.2%, 69.1% and 60.6%, respectively) compared with April 2019 (p<0.05). Trauma cases were reduced by 40% in April 2020. Overall emergency theatre patient waiting time was 30% lower for April 2020 compared with 2019. CONCLUSIONS: COVID-19 and the associated lockdown has heavily impacted on both orthopaedic inpatient and outpatient services. Lockdown led to a larger reduction in the orthopaedic trauma burden than in international centres, but the overall reduction in surgeries, outpatient visits and hospital admissions was less. This lesser reduction was probably due to local factors, but also to a conscious decision to avoid total collapse of our surgical services.


Assuntos
COVID-19/epidemiologia , Procedimentos Ortopédicos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Assistência Ambulatorial/estatística & dados numéricos , Ocupação de Leitos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais Urbanos , Humanos , Tempo de Internação/estatística & dados numéricos , Pandemias , SARS-CoV-2 , África do Sul/epidemiologia , Centros de Atenção Terciária , Listas de Espera
20.
Epilepsia Open ; 6(2): 437-442, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34033234

RESUMO

OBJECTIVE: Hyperventilation (HV) is one of the main and basic activation methods during ambulatory electroencephalogram (EEG), unless medical reasons contraindicate it. During the COVID-19 pandemic, with the high risk of human-to-human infection, local guidelines and recommendations have been developed that suggest not to perform the HV maneuver routinely. Our objective was to characterize patients who present positive HV in an epilepsy center. METHODS: We analyzed retrospectively all the ambulatory EEGs performed during one year in our specialized ambulatory child and adolescent epilepsy center, and describe patients with positive maneuver. RESULTS: A total of 305 EEGs were performed. Patients under 3 years and 11 months were excluded as well as all patients that did not fill up the criteria for epilepsy diagnosis. From the 252 EEGs that were included in the study, 194 EEGs (77%) were classified as abnormal and 58 (23%) as normal. From these same 252 EEGs, 150 EEG finished correctly the HV maneuver. Physiological slowing response was found in 54 EEGs (36%), no changes (negative) in 83 (55%), and abnormal response (positive) in 13 EEGs (9%). The 13 HV-positive EEGs showed 4 patients with an increase of epileptiform activity, 3 patients experienced an increase of basal preregistered abnormal slowing, and 6 EEGs showed trigger of bilaterally synchronous and symmetric 2-4 Hz spike-and-slow wave discharges and absences. None of these last 6 patients needed more than 3 minutes to elicit the paroxysmal discharge. SIGNIFICANCE: Based on these findings and according with other studies, the low positivity and high specificity of the HV maneuver support the idea that HV could be excluded during the COVID-19 pandemic situation, and also reevaluate whether it could be changed to a complementary maneuver, restricted only for cases where absence epilepsy is suspected. Larger studies will be needed to reaffirm this proposal.


Assuntos
Assistência Ambulatorial , COVID-19 , Eletroencefalografia/métodos , Epilepsia Tipo Ausência , Adolescente , Assistência Ambulatorial/métodos , Assistência Ambulatorial/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Chile/epidemiologia , Técnicas de Diagnóstico Neurológico/normas , Técnicas de Diagnóstico Neurológico/tendências , Epilepsia Tipo Ausência/diagnóstico , Epilepsia Tipo Ausência/epidemiologia , Epilepsia Tipo Ausência/fisiopatologia , Feminino , Humanos , Hiperventilação , Masculino , Estudos Retrospectivos , SARS-CoV-2 , Convulsões/diagnóstico , Convulsões/fisiopatologia , Sensibilidade e Especificidade
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