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2.
Soins Psychiatr ; 41(328): 19-22, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33039086

RESUMO

The act of 5 July 2011 pertaining to the rights and the protection of persons under psychiatric care presents the possibility for compulsory care, without the need for full hospitalisation. Patients can be cared for through partial hospitalisation (day hospital and part-time therapeutic clinic) or in a medical-psychological centre. Treatments and all care are detailed in a care programme. This programme is sent, like all certificates, to the regional health agency and the prefecture in the case of psychiatric care by decision of the State representative, or to the hospital director for psychiatric care at the request of a third party. We propose two clinical vignettes.


Assuntos
Assistência Ambulatorial , Transtornos Mentais/terapia , Hospital Dia , Humanos , Direitos do Paciente/legislação & jurisprudência
3.
Ital J Pediatr ; 46(1): 142, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008445

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) is currently rare in children and they seem to have a milder disease course and better prognosis than adults. However, SARS-Cov-2 pandemic has indirectly caused problems in pediatric medical assistance. In view of this we wanted to draw a picture of what happened during health emergency and analyze future prospects for restarting. METHODS: We involved the Italian pediatric scientific societies institutionally collected in the Italian Federation of Associations and Scientific Societies of the Pediatric Area (FIARPED); We sent a questionnaire to all scientific societies about the pediatric care activity during the COVID-19 emergency and future perspectives for the phase of post-containment. RESULTS: The analysis of the questionnaires showed significant decrease of:admission, outpatient visits and specialist consultancy activities during the COVID-19 emergency, primarily linked to the fear of infection. Instead it was increased the serious degree of diseases admitted. Most of scientific societies maintained the relationship with chronic patients through some form of telemedicine, reporting a strong positive opinion about this modality. Finally showed the need to give life a new approach for hospitalizations and outpatient visits through a greater use of telemedicine, educational programs on families and a more decisive role of family pediatricians. CONCLUSIONS: Our study highlighted many aspects that can be improved in pediatric care. We think that It will be necessary a new shared strategy to improve the management and continuity of care for pediatric patients, primarily developing a network of collaboration between families, family pediatrician and hospitals and by enhancing the use of new methods of telecommunications.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena/organização & administração , Inquéritos e Questionários , Telemedicina/estatística & dados numéricos , Adulto , Assistência Ambulatorial/estatística & dados numéricos , Criança , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Itália , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Planejamento de Assistência ao Paciente/organização & administração , Pediatria/métodos , Pneumonia Viral/epidemiologia , Sociedades Médicas
4.
BMJ Open ; 10(10): e043763, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-33020109

RESUMO

OBJECTIVES: We evaluated whether implementation of lockdown orders in South Africa affected ambulatory clinic visitation in rural Kwa-Zulu Natal (KZN). DESIGN: Observational cohort SETTING: Data were analysed from 11 primary healthcare clinics in northern KZN. PARTICIPANTS: A total of 46 523 individuals made 89 476 clinic visits during the observation period. EXPOSURE OF INTEREST: We conducted an interrupted time series analysis to estimate changes in clinic visitation with a focus on transitions from the prelockdown to the level 5, 4 and 3 lockdown periods. OUTCOME MEASURES: Daily clinic visitation at ambulatory clinics. In stratified analyses, we assessed visitation for the following subcategories: child health, perinatal care and family planning, HIV services, non-communicable diseases and by age and sex strata. RESULTS: We found no change in total clinic visits/clinic/day at the time of implementation of the level 5 lockdown (change from 90.3 to 84.6 mean visits/clinic/day, 95% CI -16.5 to 3.1), or at the transitions to less stringent level 4 and 3 lockdown levels. We did detect a >50% reduction in child healthcare visits at the start of the level 5 lockdown from 11.9 to 4.7 visits/day (-7.1 visits/clinic/day, 95% CI -8.9 to 5.3), both for children aged <1 year and 1-5 years, with a gradual return to prelockdown within 3 months after the first lockdown measure. In contrast, we found no drop in clinic visitation in adults at the start of the level 5 lockdown, or related to HIV care (from 37.5 to 45.6, 8.0 visits/clinic/day, 95% CI 2.1 to 13.8). CONCLUSIONS: In rural KZN, we identified a significant, although temporary, reduction in child healthcare visitation but general resilience of adult ambulatory care provision during the first 4 months of the lockdown. Future work should explore the impacts of the circulating epidemic on primary care provision and long-term impacts of reduced child visitation on outcomes in the region.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/tendências , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde , Saúde Pública , Adulto , Fatores Etários , Betacoronavirus , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pandemias , Pediatria/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , População Rural
5.
BMC Public Health ; 20(1): 1524, 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33032561

RESUMO

BACKGROUND: Arrhythmia is a common cardiovascular event that is associated with increased cardiovascular health risks. Previous studies that have explored the association between air pollution and arrhythmia have obtained inconsistent results, and the association between the two in China is unclear. METHODS: We collected daily data on air pollutants and meteorological factors from 1st January 2014 to 31st December 2016, along with daily outpatient visits for arrhythmia in Hangzhou, China. We used a quasi-Poisson regression along with a distributed lag nonlinear model to study the association between air pollution and arrhythmia morbidity. RESULTS: The results of the single-pollutant model showed that each increase of 10 µg/m3 of Fine particulate matter (PM2.5), Coarse particulate matter (PM10), Sulphur dioxide (SO2), Nitrogen dioxide (NO2), and Ozone (O3) resulted in increases of 0.6% (- 0.9, 2.2%), 0.7% (- 0.4, 1.7%), 11.9% (4.5, 19.9%), 6.7% (3.6, 9.9%), and - 0.9% (- 2.9, 1.2%), respectively, in outpatient visits for arrhythmia; each increase of 1 mg/m3 increase of carbon monoxide (CO) resulted in increase of 11.3% (- 5.9, 31.6%) in arrhythmia. The short-term effects of air pollution on arrhythmia lasted 3 days, and the most harmful effects were observed on the same day that the pollution occurred. Results of the subgroup analyses showed that SO2 and NO2 affected both men and women, but differences between the sexes were not statistically significant. The effect of SO2 on the middle-aged population was statistically significant. The effect of NO2 was significant in both the young and middle-aged population, and no significant difference was found between them. Significant effects of air pollution on arrhythmia were only detected in the cold season. The results of the two-pollutants model and the single-pollutant model were similar. CONCLUSIONS: SO2 and NO2 may induce arrhythmia, and the harmful effects are primarily observed in the cold season. There is no evidence of PM2.5, PM10, CO and O3 increasing arrhythmia risk. Special attention should be given to sensitive populations during the high-risk period.


Assuntos
Poluição do Ar/efeitos adversos , Assistência Ambulatorial/estatística & dados numéricos , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/terapia , Poluentes Atmosféricos/análise , Poluição do Ar/análise , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estações do Ano
6.
JAMA ; 324(13): 1352-1353, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-33021663
7.
Ital J Pediatr ; 46(1): 142, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: covidwho-810384

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) is currently rare in children and they seem to have a milder disease course and better prognosis than adults. However, SARS-Cov-2 pandemic has indirectly caused problems in pediatric medical assistance. In view of this we wanted to draw a picture of what happened during health emergency and analyze future prospects for restarting. METHODS: We involved the Italian pediatric scientific societies institutionally collected in the Italian Federation of Associations and Scientific Societies of the Pediatric Area (FIARPED); We sent a questionnaire to all scientific societies about the pediatric care activity during the COVID-19 emergency and future perspectives for the phase of post-containment. RESULTS: The analysis of the questionnaires showed significant decrease of:admission, outpatient visits and specialist consultancy activities during the COVID-19 emergency, primarily linked to the fear of infection. Instead it was increased the serious degree of diseases admitted. Most of scientific societies maintained the relationship with chronic patients through some form of telemedicine, reporting a strong positive opinion about this modality. Finally showed the need to give life a new approach for hospitalizations and outpatient visits through a greater use of telemedicine, educational programs on families and a more decisive role of family pediatricians. CONCLUSIONS: Our study highlighted many aspects that can be improved in pediatric care. We think that It will be necessary a new shared strategy to improve the management and continuity of care for pediatric patients, primarily developing a network of collaboration between families, family pediatrician and hospitals and by enhancing the use of new methods of telecommunications.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena/organização & administração , Inquéritos e Questionários , Telemedicina/estatística & dados numéricos , Adulto , Assistência Ambulatorial/estatística & dados numéricos , Criança , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Itália , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Planejamento de Assistência ao Paciente/organização & administração , Pediatria/métodos , Pneumonia Viral/epidemiologia , Sociedades Médicas
8.
BMJ Open ; 10(10): e043763, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: covidwho-835490

RESUMO

OBJECTIVES: We evaluated whether implementation of lockdown orders in South Africa affected ambulatory clinic visitation in rural Kwa-Zulu Natal (KZN). DESIGN: Observational cohort SETTING: Data were analysed from 11 primary healthcare clinics in northern KZN. PARTICIPANTS: A total of 46 523 individuals made 89 476 clinic visits during the observation period. EXPOSURE OF INTEREST: We conducted an interrupted time series analysis to estimate changes in clinic visitation with a focus on transitions from the prelockdown to the level 5, 4 and 3 lockdown periods. OUTCOME MEASURES: Daily clinic visitation at ambulatory clinics. In stratified analyses, we assessed visitation for the following subcategories: child health, perinatal care and family planning, HIV services, non-communicable diseases and by age and sex strata. RESULTS: We found no change in total clinic visits/clinic/day at the time of implementation of the level 5 lockdown (change from 90.3 to 84.6 mean visits/clinic/day, 95% CI -16.5 to 3.1), or at the transitions to less stringent level 4 and 3 lockdown levels. We did detect a >50% reduction in child healthcare visits at the start of the level 5 lockdown from 11.9 to 4.7 visits/day (-7.1 visits/clinic/day, 95% CI -8.9 to 5.3), both for children aged <1 year and 1-5 years, with a gradual return to prelockdown within 3 months after the first lockdown measure. In contrast, we found no drop in clinic visitation in adults at the start of the level 5 lockdown, or related to HIV care (from 37.5 to 45.6, 8.0 visits/clinic/day, 95% CI 2.1 to 13.8). CONCLUSIONS: In rural KZN, we identified a significant, although temporary, reduction in child healthcare visitation but general resilience of adult ambulatory care provision during the first 4 months of the lockdown. Future work should explore the impacts of the circulating epidemic on primary care provision and long-term impacts of reduced child visitation on outcomes in the region.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/tendências , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde , Saúde Pública , Adulto , Fatores Etários , Betacoronavirus , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pandemias , Pediatria/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , População Rural
10.
Pharm. pract. (Granada, Internet) ; 18(3): 0-0, jul.-sept. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194193

RESUMO

The practice of community pharmacy in low and middle-income countries, including in Indonesia, is often described as in the state of infancy with several intractable barriers that have been substantially and continuously hampering the practice. Such description might be valid in highlighting how pharmacy is practiced and the conditions within and beyond community pharmacy organizations. Therefore, it is not surprising that the concept of integrating community pharmacy into the primary care system may not be considered in the contemporary discourse despite the fact that community pharmacy has been operating within communities for years. However, in the case of Indonesia, we argue that changes in the health care system within the past decade particularly with the introduction of the universal health coverage (UHC) in 2014, may have significantly amplified the role of pharmacists. There is good evidence which highlights the contribution of pharmacist as a substantial health care element in primary care practice. The initiative for employing pharmacist, identified in this article as primary care pharmacist, in the setting of community health center [puskesmas] and the introduction of affiliated or contracted community pharmacy under the UHC have enabled pharmacist to work together with other primary care providers. Moreover, government agenda under the "Smart Use of Medicines" program [Gema Cermat] recognizes pharmacists as the agent of change for improving the rational use of medicines in the community. Community pharmacy is developing, albeit slowly, and is able to grasp a novel position to deliver pharmacy-related primary care services to the general public through new services, for example drug monitoring and home care. Nevertheless, integrating community pharmacy into primary care is relatively a new notion in the Indonesian setting, and is a challenging process given the presence of barriers in the macro, meso- and micro-level of practice


No disponible


Assuntos
Humanos , Atenção Primária à Saúde , Farmácias/normas , Farmacêuticos/normas , Prática Profissional , Farmácias/organização & administração , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Indonésia , Integração Comunitária
11.
Pharm. pract. (Granada, Internet) ; 18(3): 0-0, jul.-sept. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-194204

RESUMO

With a primary care physician shortage, utilization of pharmacists in the ambulatory care setting has proven to have positive economic and clinical outcomes for the practice and for patients. To extend the reach of the pharmacists, students may assist with patient care activities, such as medication reconciliation, point-of-care testing, and counseling. Evidence has shown that students benefit in building confidence, as well as improved perceptions of interprofessional care, while positive patient outcomes are maintained. There are many methods for schools to integrate these experiences early into their curriculum, as well as for students to explore opportunities on their own


No disponible


Assuntos
Humanos , Estudantes de Farmácia/estatística & dados numéricos , Educação em Farmácia/métodos , Papel Profissional , Assistência Ambulatorial , Assistência Farmacêutica/organização & administração , Assistência Farmacêutica/normas
12.
Vestn Otorinolaringol ; 85(4): 51-57, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32885638

RESUMO

Acute rhinosinusitis is one of the most common outpatient diseases. The duration of antibiotic therapy in practice can be a cause of disagreement. The latest European guideline for rhinosinusitis EPOS 2020 does not specify clear terms for antibacterial therapy for acute bacterial rhinosinusitis, which suggests that they are determined by the attending physician based on the rate of regression of clinical manifestations in each specific clinical case. OBJECTIVE: To analyze the treatment regimens of adult patients with acute rhinosinusitis in the system of the outpatient service of Administrative Directorate of the President of the Russian Federation in Moscow and compare these schemes with guidelines. MATERIAL AND METHODS: A retrospective analysis of 2267 outpatient disease histories of patients who were on outpatient treatment with a diagnosis of acute rhinosinusitis treated by otorhinolaryngologists from 7 ambulance clinics for the period from January 2016 to May 2018 was performed. Diagnostic methods and treatment regimens of these patients were evaluated. RESULTS: At the diagnostic stage, X-ray methods were recommended in 87% of cases, and ultrasound examination of the paranasal sinuses was performed in 4% of cases. Elimination and irrigation therapy was prescribed in 88.05% of cases (1996 people), maxillary sinus punctures were performed in 9.82% of cases, the average number of procedures was 2±1.3, treatment by displacement was performed in 31.8% of patients, the average number of procedures was 3±1.2. Antibiotic therapy was recommended in 77.4% of cases (1755 people), penicillin group drugs were prescribed in 41.5% of cases, macrolides in 30.5% of cases, cephalosporins in 20.7% of cases, and fluoroquinolones in 7.3% of cases. Intranasal glucocorticosteroids were submitted by 67.7% of patients (1535 people), mucolytics and mucoregulatory drugs - 41% of patients, decongestants for acute rhinosinusitis were recommended in 60.9% of cases, antihistamines - in 36.8% of cases. An average course of antibacterial therapy was 5.9±1.34 days, the recovery of the patients was observed on the background of complex treatment. CONCLUSIONS: In general, in the system of the outpatient service of Administrative Directorate of the President of the Russian Federation, diagnostic and therapeutic measures are carried out in accordance with current clinical recommendations. There is a fairly high percentage of prescribing macrolides (30.5%) and fluoroquinolones (7.3%) in starting therapy, which is a violation of the principles of starting antibacterial therapy.


Assuntos
Rinite/tratamento farmacológico , Doença Aguda , Adulto , Assistência Ambulatorial , Antibacterianos/uso terapêutico , Humanos , Moscou , Estudos Retrospectivos , Federação Russa
13.
Infez Med ; 28(3): 351-356, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32920570

RESUMO

The rapidly increased number of patients with COVID-19 resulted in the shortage of hospital beds. An outpatient follow-up plan was developed for COVID-19 patients with stable clinical condition and no concomitant diseases. The records of COVID-19 first admission clinic were retrospectively reviewed to identify the COVID-19 patients who were followed on home isolation as outpatients between March 17, 2020 and April 18, 2020 in Ankara, Turkey. Demographic and clinical characteristics of the patients, compliance with isolation rules, re-admission rates, and outcomes were investigated. A total of 41 patients with COVID-19 were followed on home isolation without hospitalization. The median age of the patients was 36 years. Twenty-four (58.5%) of 41 patients were female. Twenty-nine (70.7%) patients were healthcare workers. The most common symptoms at admission were cough, myalgia/arthralgia, and loss of smell and/or taste. Fourteen (34.1%) patients were asymptomatic on the first admission. Anti-viral treatment was given to 27 (65.8%) of 41 patients. Four of 41 patients were readmitted to the outpatient clinic and hospitalized. Three patients had worsening respiratory symptoms and pneumonia was detected in CT scans. One patient was hospitalized because of disseminated herpes zoster infection. Two patients who jeopardized the isolation rules were isolated and monitored at another hospital by provincial health directorate teams. If adequate conditions are provided, follow-up on home isolation seems to be a feasible method in carefully selected patients. However, these patients should be monitored closely by an experienced team during the isolation period.


Assuntos
Assistência Ambulatorial/métodos , Antivirais/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Isolamento de Pacientes/métodos , Pneumonia Viral/tratamento farmacológico , Adulto , Ocupação de Leitos , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Doenças Profissionais/diagnóstico , Doenças Profissionais/tratamento farmacológico , Doenças Profissionais/epidemiologia , Pacientes Ambulatoriais , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Estudos Retrospectivos , Avaliação de Sintomas , Turquia/epidemiologia
14.
J UOEH ; 42(3): 267-274, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32879191

RESUMO

International immigration into Japan is increasing. It would make sense that investigating the health status of immigrants would be associated with improvements in their health and would be beneficial in building a complete social security system in which minorities can live safely and securely. The objective of this study is to describe the health status of immigrants in Japan and to explore the association between self-rated health status and employment status. As a result, half of those surveyed had some health problem, particularly a lot of mental stress. We did not find a significant relationship between self-rated health status and employment status, but it seems that people who stay in Japan 5 years or more tend to have poor self-rated health status. The factors associated with poor self-rated mental health status were being a non-employee, and having visited a hospital 1 time or more during the past 12 months. A system of mental stress care would be the most necessary health care for international students in Japan.


Assuntos
Emigrantes e Imigrantes/psicologia , Emprego , Nível de Saúde , Saúde do Trabalhador , Autoavaliação , Adulto , Assistência Ambulatorial/estatística & dados numéricos , Feminino , Humanos , Japão , Masculino , Saúde Mental , Serviços de Saúde Mental , Pessoa de Meia-Idade , Estresse Fisiológico , Adulto Jovem
15.
Medicine (Baltimore) ; 99(33): e21266, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871985

RESUMO

Chronic spontaneous urticaria (CSU) is a common dermatologic disease that seriously affects patient quality of life. The choice of therapy to control the disease and prevent its recurrence has always presented a difficult clinical issue. Previous studies have shown that traditional Chinese medicine is a safe and effective treatment for CSU. Recently, the temporal rhythms of CSU, a disease characterized by intermittent flares of active disease and periods of little or no disease, have attracted the attention of traditional Chinese medicine researchers. We designed a multicenter, randomized, controlled study to evaluate the efficacy and safety of combining a Chinese herbal formulation with acupuncture using shu-stream acupoints applied on the corresponding time meridians during disease exacerbations. We plan to recruit 111 outpatients with CSU aged 18 to 65 years. Participants will be randomized to 1 of the 3 groups: group A, which will be given basic acupuncture and the herbal formulation dangui yinzi; group B, which will be given danggui yinzi and shu-stream acupuncture; and a control group, which will be given danggui yinzi alone. Patients will be treated for 4 weeks and followed for 8 additional weeks. Investigators will evaluate the following parameters: the symptoms and side effects of treatment, quality of life (using the chronic urticaria quality of life questionnaire), and overall patient condition. Each week, patients will also complete the measurement of 7-day urticarial activity score. This is the first use of a combination of shu-stream acupoints and Chinese herbal medicine in the treatment of CSU. If successful, it will prove to be a simple, inexpensive, treatment strategy for solving a difficult clinical problem.


Assuntos
Terapia por Acupuntura , Urticária Crônica/terapia , Fármacos Dermatológicos/uso terapêutico , Medicamentos de Ervas Chinesas/uso terapêutico , Medicina Tradicional Chinesa , Ensaios Clínicos Controlados Aleatórios como Assunto , Pontos de Acupuntura , Terapia por Acupuntura/efeitos adversos , Terapia por Acupuntura/métodos , Adolescente , Adulto , Idoso , Assistência Ambulatorial , Terapia Combinada , Fármacos Dermatológicos/efeitos adversos , Medicamentos de Ervas Chinesas/efeitos adversos , Humanos , Medicina Tradicional Chinesa/efeitos adversos , Medicina Tradicional Chinesa/métodos , Pessoa de Meia-Idade , Seleção de Pacientes , Resultado do Tratamento , Adulto Jovem
16.
J Bras Nefrol ; 42(2 suppl 1): 32-35, 2020 Aug 26.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32877496

RESUMO

INTRODUCTION: The impact of the new coronavirus (SARS-COV-2) and its worldwide clinical manifestations (COVID-19) imposed specific regional recommendations for populations in need of specialized care, such as children and adolescents with kidney diseases, particularly in renal replacement therapies (RRT). We present the recommendations of the Brazilian Society of Nephrology regarding the treatment of pediatric patients with kidney diseases during the COVID-19 pandemic. METHODS: Articles and documents from medical societies and government agencies on specific recommendations for children on RRT in relation to COVID-19 as well as those focused on epidemiological aspects of this condition in Brazil Were evaluated and analyzed. RESULTS: We present recommendations on outpatient care, transportation to dialysis centers, peritoneal dialysis, hemodialysis, and kidney transplantation in children and adolescents during the COVID-19 pandemic in Brazil. DISCUSSION: Despite initial observations of higher mortality rates in specific age groups (the elderly) and with comorbidities (obese, diabetics, and those with cardiovascular diseases), patients with chronic kidney disease (CKD) on RRT are particularly prone to develop COVID-19. Specific measures must be taken to reduce the risk of contracting SARS-CoV-2 and developing COVID-19, especially during transport to dialysis facilities, as well as on arrival and in contact with other patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Nefropatias/terapia , Pneumonia Viral/epidemiologia , Terapia de Substituição Renal/normas , Adolescente , Assistência Ambulatorial , Brasil/epidemiologia , Criança , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Higiene/normas , Transplante de Rim , Máscaras , Nefrologia/normas , Doenças Profissionais/prevenção & controle , Pandemias/prevenção & controle , Isolamento de Pacientes , Pediatria , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Terapia de Substituição Renal/métodos , Sociedades Médicas , Avaliação de Sintomas , Transporte de Pacientes
17.
S Afr Med J ; 110(9): 916-919, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32880278

RESUMO

BACKGROUND: In preparation for the COVID-19 pandemic, South Africa (SA) began a national lockdown on 27 March 2020, and many hospitals implemented measures to prepare for a potential COVID-19 surge. OBJECTIVES: To report changes in SA hospital surgical practices in response to COVID-19 preparedness. METHODS: In this cross-sectional study, surgeons working in SA hospitals were recruited through surgical professional associations via an online survey. The main outcome measures were changes in hospital practice around surgical decision-making, operating theatres, surgical services and surgical trainees, and the potential long-term effect of these changes. RESULTS: A total of 133 surgeons from 85 hospitals representing public and private hospitals nationwide responded. In 59 hospitals (69.4%), surgeons were involved in the decision to de-escalate surgical care. Access was cancelled or reduced for non-cancer elective (n=84; 99.0%), cancer (n=24; 28.1%) and emergency operations (n=46; 54.1%), and 26 hospitals (30.6%) repurposed at least one operating room as a ventilated critical care bed. Routine postoperative visits were cancelled in 33 hospitals (36.5%) and conducted by telephone or video in 15 (16.6%), 74 hospitals (87.1%) cancelled or reduced new outpatient visits, 64 (75.3%) reallocated some surgical inpatient beds to COVID-19 cases, and 29 (34.1%) deployed some surgical staff (including trainees) to other hospital services such as COVID-19 testing, medical/COVID-19 wards, the emergency department and the intensive care unit. CONCLUSIONS: Hospital surgical de-escalation in response to COVID-19 has greatly reduced access to surgical care in SA, which could result in a backlog of surgical needs and an excess of morbidity and mortality.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Cirurgia Geral/educação , Admissão e Escalonamento de Pessoal , Pneumonia Viral/epidemiologia , Centro Cirúrgico Hospitalar , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Betacoronavirus , Tomada de Decisão Clínica , Estudos Transversais , Educação de Pós-Graduação em Medicina , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Emergências , Hospitais Privados , Hospitais Públicos , Humanos , Salas Cirúrgicas , Pandemias , Seleção de Pacientes , África do Sul/epidemiologia , Inquéritos e Questionários , Telefone , Comunicação por Videoconferência
18.
Ther Adv Cardiovasc Dis ; 14: 1753944720948651, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32885724

RESUMO

BACKGROUND: We aimed to investigate the safety of endovascular procedures undertaken in a single outpatient center located in a rural, underserved area. Endovascular procedures for Peripheral Arterial Disease (PAD) have become increasingly common in outpatient settings; their safety is yet to be determined in a rural, underserved area with no stand-by vascular surgeon on site. METHODS: We undertook a retrospective case review of endovascular procedures for the investigation and management of lower extremity PAD between December 2012 and August 2015. Patients were classified by Rutherford score, degree of stenosis and length of lesions. Complications were major (requiring hospitalization) or minor, including perforation, distal embolization, hematoma, and allergic reactions, which could be treated immediately in the catheterization laboratory with no sequelae. Patients were monitored in the facility and followed up using clinical, biochemical and radiological parameters at 24 h and 1 month. RESULTS: A total of 692 patients underwent endovascular procedures for the investigation and/or treatment of PAD, of which 608 were interventional. Of these patients, 10.20% experienced procedural complications, of which 0.66% were classified as major, including wire retention and retroperitoneal hemorrhage. In total, 99.34% were discharged safely on the same day as the procedure. No adverse events were reported at follow up. CONCLUSION: Endovascular procedures for PAD can be performed safely in a rural outpatient setting with low complication rates. Most complications are minor and do not require hospitalization. Outpatient procedures for PAD are safe and may widen access to specialist procedures in areas of socio-economic deprivation.


Assuntos
Assistência Ambulatorial , Procedimentos Endovasculares , Tempo de Internação , Área Carente de Assistência Médica , Alta do Paciente , Doença Arterial Periférica/terapia , Serviços de Saúde Rural , Idoso , Idoso de 80 Anos ou mais , California , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Doença Arterial Periférica/diagnóstico por imagem , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
19.
Heart Fail Clin ; 16(4): 433-440, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32888638

RESUMO

Despite steady progress over the past 3 decades in advancing drug and device therapies to reduce morbidity and mortality in heart failure with reduced ejection fraction, large registries of usual care demonstrate incomplete use of these evidence-based therapies in clinical practice. Potential strategies to improve guideline-directed medical therapy include leveraging non-physician clinicians, solidifying transitions of care, incorporating telehealth solutions, and engaging in comprehensive comorbid disease management via multidisciplinary team structures. These approaches may be particularly relevant in an era of Coronavirus Disease 2019 and associated need for social distancing, further limiting contact with traditional ambulatory clinic settings.


Assuntos
Assistência Ambulatorial , Infecções por Coronavirus , Insuficiência Cardíaca/terapia , Pandemias , Pneumonia Viral , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Insuficiência Cardíaca/epidemiologia , Humanos , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
20.
Acta Myol ; 39(2): 57-66, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32904925

RESUMO

Introduction: Since February 2020, the outbreak of COVID-19 in Italy has forced the health care system to undergo profound rearrangements in its services and facilities, especially in the worst-hit areas in Northern Italy. In this setting, inpatient and outpatient services had to rethink and reorganize their activities to meet the needs of patients during the "lockdown". The Italian Association of Myology developed a survey to estimate the impact of these changes on patients affected by neuromuscular disorders and on specialized neuromuscular centers during the acute phase of COVID-19 pandemic. Methods: We developed an electronic survey that was sent to neuromuscular centers affiliated with the Italian Association of Myology, assessing changes in pharmacological therapies provision, outpatient clinical and instrumental services, support services (physiotherapy, nursing care, psychological support) and clinical trials. Results: 40% of surveyed neuromuscular centers reported a reduction in outpatient visit and examinations (44.5% of centers in Northern regions; 25% of centers in Central regions; 50% of centers in Southern regions). Twenty-two% of centers postponed in-hospital administration of therapies for neuromuscular diseases (23.4% in Northern regions; 13.0% in Central regions; 20% in Southern regions). Diagnostic and support services (physiotherapy, nursing care, psychological support) were suspended in 57% of centers (66/43/44% in Northern, Central and Southern centers respectively) Overall, the most affected services were rehabilitative services and on-site outpatient visits, which were suspended in 93% of centers. Strategies adopted by neuromuscular centers to overcome these changes included maintaining urgent on-site visits, addressing patients to available services and promoting remote contact and telemedicine. Conclusions: Overall, COVID-19 pandemic resulted in a significant disruption of clinical and support services for patients with neuromuscular diseases. Despite the efforts to provide telemedicine consults to patients, this option could be promoted and improved further. A close collaboration between the different neuromuscular centers and service providers as well as further implementation of telehealth platforms are necessary to ensure quality care to NMD patients in the near future and in case of recurrent pandemic waves.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Acesso aos Serviços de Saúde/organização & administração , Doenças Neuromusculares/terapia , Pneumonia Viral/epidemiologia , Encaminhamento e Consulta/organização & administração , Telemedicina/organização & administração , Assistência Ambulatorial , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Hospitalização , Humanos , Itália/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Inquéritos e Questionários
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