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1.
CMAJ Open ; 9(2): E693-E702, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1278708

RESUMO

BACKGROUND: Identification of therapies to prevent severe COVID-19 remains a priority. We sought to determine whether hydroxychloroquine treatment for outpatients with SARS-CoV-2 infection could prevent hospitalization, mechanical ventilation or death. METHODS: This randomized controlled trial was conducted in Alberta during the first wave of the COVID-19 pandemic without direct contact with participants. Community-dwelling individuals with confirmed SARS-CoV-2 infection (by reverse transcription polymerase chain reaction [RT-PCR] viral ribonucleic acid test) within the previous 4 days, and symptom onset within the previous 12 days, were randomly assigned to oral hydroxychloroquine or matching placebo for 5 days. Enrolment began Apr. 15, 2020. The primary outcome was the composite of hospitalization, invasive mechanical ventilation or death within 30 days. Secondary outcomes included symptom duration and disposition at 30 days. Safety outcomes, such as serious adverse events and mortality, were also ascertained. Outcomes were determined by telephone follow-up and administrative data. RESULTS: Among 4919 individuals with a positive RT-PCR test, 148 (10.2% of a planned 1446 patients) were randomly assigned, 111 to hydroxychloroquine and 37 to placebo. Of the 148 participants, 24 (16.2%) did not start the study drug. Four participants in the hydroxychloroquine group met the primary outcome (4 hospitalizations, 0 mechanical ventilation, 4 survived to 30 days) and none in the placebo group. Hydroxychloroquine did not reduce symptom duration (hazard ratio 0.77, 95% confidence interval 0.49-1.21). Recruitment was paused on May 22, 2020, when a since-retracted publication raised concerns about the safety of hydroxychloroquine for hospitalized patients with COVID-19. Although we had not identified concerns in a safety review, enrolment was slower than expected among those eligible for the study, and cases within the community were decreasing. Recruitment goals were deemed to be unattainable and the trial was not resumed, resulting in a study underpowered to assess the effect of treatment with hydroxychloroquine and safety. INTERPRETATION: There was no evidence that hydroxychloroquine reduced symptom duration or prevented severe outcomes among outpatients with proven COVID-19, but the early termination of our study meant that it was underpowered. TRIAL REGISTRATION: ClinicalTrials.gov, no. NCT04329611.


Assuntos
Assistência Ambulatorial , COVID-19 , Hospitalização/estatística & dados numéricos , Hidroxicloroquina , Respiração Artificial/estatística & dados numéricos , Assistência Ambulatorial/métodos , Assistência Ambulatorial/estatística & dados numéricos , Antivirais/administração & dosagem , Antivirais/efeitos adversos , COVID-19/diagnóstico , COVID-19/tratamento farmacológico , COVID-19/mortalidade , Término Precoce de Ensaios Clínicos , Feminino , Humanos , Hidroxicloroquina/administração & dosagem , Hidroxicloroquina/efeitos adversos , Vida Independente/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Mortalidade , Avaliação de Resultados em Cuidados de Saúde , Serviços Preventivos de Saúde/métodos , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença
2.
CMAJ Open ; 9(2): E693-E702, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34145052

RESUMO

BACKGROUND: Identification of therapies to prevent severe COVID-19 remains a priority. We sought to determine whether hydroxychloroquine treatment for outpatients with SARS-CoV-2 infection could prevent hospitalization, mechanical ventilation or death. METHODS: This randomized controlled trial was conducted in Alberta during the first wave of the COVID-19 pandemic without direct contact with participants. Community-dwelling individuals with confirmed SARS-CoV-2 infection (by reverse transcription polymerase chain reaction [RT-PCR] viral ribonucleic acid test) within the previous 4 days, and symptom onset within the previous 12 days, were randomly assigned to oral hydroxychloroquine or matching placebo for 5 days. Enrolment began Apr. 15, 2020. The primary outcome was the composite of hospitalization, invasive mechanical ventilation or death within 30 days. Secondary outcomes included symptom duration and disposition at 30 days. Safety outcomes, such as serious adverse events and mortality, were also ascertained. Outcomes were determined by telephone follow-up and administrative data. RESULTS: Among 4919 individuals with a positive RT-PCR test, 148 (10.2% of a planned 1446 patients) were randomly assigned, 111 to hydroxychloroquine and 37 to placebo. Of the 148 participants, 24 (16.2%) did not start the study drug. Four participants in the hydroxychloroquine group met the primary outcome (4 hospitalizations, 0 mechanical ventilation, 4 survived to 30 days) and none in the placebo group. Hydroxychloroquine did not reduce symptom duration (hazard ratio 0.77, 95% confidence interval 0.49-1.21). Recruitment was paused on May 22, 2020, when a since-retracted publication raised concerns about the safety of hydroxychloroquine for hospitalized patients with COVID-19. Although we had not identified concerns in a safety review, enrolment was slower than expected among those eligible for the study, and cases within the community were decreasing. Recruitment goals were deemed to be unattainable and the trial was not resumed, resulting in a study underpowered to assess the effect of treatment with hydroxychloroquine and safety. INTERPRETATION: There was no evidence that hydroxychloroquine reduced symptom duration or prevented severe outcomes among outpatients with proven COVID-19, but the early termination of our study meant that it was underpowered. TRIAL REGISTRATION: ClinicalTrials.gov, no. NCT04329611.


Assuntos
Assistência Ambulatorial , COVID-19 , Hospitalização/estatística & dados numéricos , Hidroxicloroquina , Respiração Artificial/estatística & dados numéricos , Assistência Ambulatorial/métodos , Assistência Ambulatorial/estatística & dados numéricos , Antivirais/administração & dosagem , Antivirais/efeitos adversos , COVID-19/diagnóstico , COVID-19/tratamento farmacológico , COVID-19/mortalidade , Término Precoce de Ensaios Clínicos , Feminino , Humanos , Hidroxicloroquina/administração & dosagem , Hidroxicloroquina/efeitos adversos , Vida Independente/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Mortalidade , Avaliação de Resultados em Cuidados de Saúde , Serviços Preventivos de Saúde/métodos , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença
3.
Epilepsia Open ; 6(2): 437-442, 2021 06.
Artigo em Inglês | MEDLINE | ID: covidwho-1222614

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
4.
NeuroRehabilitation ; 48(4): 469-480, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1226969

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) patients present long-lasting physical and neuropsychological impairment, which may require rehabilitation. OBJECTIVES: The current cross-sectional study characterizes post COVID-19 sequelae and persistent symptoms in patients in an outpatient rehabilitation program. METHODS: Thirty patients [16 post-ICU and 14 non-ICU; median age = 54(43.8-62) years; 19 men] presenting sequelae and/or persistent symptoms (>3 months after acute COVID-19) were selected of 41 patients referred for neurorehabilitation. Patients underwent physical, neuropsychological and respiratory evaluation and assessment of impact of fatigue and quality of life. RESULTS: The main reasons for referral to rehabilitation were: fatigue (86.6%), dyspnea (66.7%), subjective cognitive impairment (46.7%) and neurological sequelae (33.3%). Post-ICU patient presented sequelae of critical illness myopathy and polyneuropathy, stroke and encephalopathy and lower forced vital capacity compared to non-ICU patients. Cognitive impairment was found in 63.3% of patients, with a similar profile in both sub-groups. Increased physical fatigue, anxiety and depression and low quality of life were prevalent irrespective of acute COVID-19 severity. CONCLUSIONS: The variability of post COVID-19 physical and neuropsychological impairment requires a complex screening process both in ICU and non-ICU patients. The high impact of persistent symptoms on daily life activities and quality of life, regardless of acute infection severity, indicate need for rehabilitation.


Assuntos
Assistência Ambulatorial/métodos , COVID-19/reabilitação , Disfunção Cognitiva/reabilitação , Fadiga/reabilitação , Ambulatório Hospitalar , Adulto , COVID-19/complicações , COVID-19/psicologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/psicologia , Estudos Transversais , Fadiga/etiologia , Fadiga/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Qualidade de Vida/psicologia , SARS-CoV-2
5.
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
6.
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
7.
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
8.
Medicine (Baltimore) ; 100(20): e25920, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011061

RESUMO

ABSTRACT: Anxiety and depression are often symptoms present in people who suffer from chronic pain, compromising the quality of life of these individuals. The objective of this study was to assess whether a pulsed radiofrequency (PRF) treatment, in addition to psychological support intervention, can decrease chronic pain, thereby improving quality of life and restoring psychological well-being.Fifty outpatients with a diagnosis of chronic pain, without any benefit from traditional drug therapies, were selected to perform a PRF treatment in combination with a psychological intervention. They were evaluated before and after the intervention through the Hamilton Anxiety Rating Scale and the Beck Depression Inventory-II for anxiety and depression symptomatology, respectively, the Short Form Health Survey 36 (SF-36) was used to assess the subject's quality of life, and the Numerical Rating Scale was used for pain assessment.The Wilcoxon signed-rank test showed a significant difference in Beck Depression Inventory-II (P < .001), Hamilton Anxiety Rating Scale (P < .01), and Numerical Rating Scale (P = .004). In the SF-36 scores, we observed a significant difference between T0 and T1 in both mental (P < .001) and physical (P < .001) dimensions.This study shows that a chronic pain reduction leads to a decrease of anxiety-depressive symptoms and an improvement in quality of life. PRF seems to be an appropriate method to reduce the chronic pain that influences psychological well-being and quality of life.


Assuntos
Dor Crônica/terapia , Terapia Cognitivo-Comportamental/métodos , Tratamento por Radiofrequência Pulsada/métodos , Qualidade de Vida , Idoso , Assistência Ambulatorial/métodos , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/prevenção & controle , Dor Crônica/complicações , Dor Crônica/diagnóstico , Dor Crônica/psicologia , Terapia Combinada/métodos , Depressão/diagnóstico , Depressão/prevenção & controle , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Psicometria/estatística & dados numéricos , Estudos Retrospectivos , Autorrelato/estatística & dados numéricos , Resultado do Tratamento
9.
NeuroRehabilitation ; 48(4): 469-480, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33998551

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) patients present long-lasting physical and neuropsychological impairment, which may require rehabilitation. OBJECTIVES: The current cross-sectional study characterizes post COVID-19 sequelae and persistent symptoms in patients in an outpatient rehabilitation program. METHODS: Thirty patients [16 post-ICU and 14 non-ICU; median age = 54(43.8-62) years; 19 men] presenting sequelae and/or persistent symptoms (>3 months after acute COVID-19) were selected of 41 patients referred for neurorehabilitation. Patients underwent physical, neuropsychological and respiratory evaluation and assessment of impact of fatigue and quality of life. RESULTS: The main reasons for referral to rehabilitation were: fatigue (86.6%), dyspnea (66.7%), subjective cognitive impairment (46.7%) and neurological sequelae (33.3%). Post-ICU patient presented sequelae of critical illness myopathy and polyneuropathy, stroke and encephalopathy and lower forced vital capacity compared to non-ICU patients. Cognitive impairment was found in 63.3% of patients, with a similar profile in both sub-groups. Increased physical fatigue, anxiety and depression and low quality of life were prevalent irrespective of acute COVID-19 severity. CONCLUSIONS: The variability of post COVID-19 physical and neuropsychological impairment requires a complex screening process both in ICU and non-ICU patients. The high impact of persistent symptoms on daily life activities and quality of life, regardless of acute infection severity, indicate need for rehabilitation.


Assuntos
Assistência Ambulatorial/métodos , COVID-19/reabilitação , Disfunção Cognitiva/reabilitação , Fadiga/reabilitação , Ambulatório Hospitalar , Adulto , COVID-19/complicações , COVID-19/psicologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/psicologia , Estudos Transversais , Fadiga/etiologia , Fadiga/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Qualidade de Vida/psicologia , SARS-CoV-2
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.
Medicine (Baltimore) ; 100(15): e25435, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: covidwho-1284945

RESUMO

BACKGROUND: While this reduced-visit prenatal care model during the COVID-19 pandemic is well-intentioned, there is still a lack of relevant evidence to prove its effectiveness. Therefore, in order to provide new evidence-based medical evidence for clinical treatment, we undertook a systematic review and meta-analysis to assess the efficacy of reduced-visit prenatal care model during the COVID-19 pandemic. METHODS: The online literature will be searched using the following combination of medical subject heading terms: "prenatal care" OR "prenatal nursing" AND "reduced-visit" OR "reduce visit" OR "virtual visit." MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science will be searched without any language restrictions. A standard data extraction form is used independently by 2 reviewers to retrieve the relevant data from the articles. The outcome measures are as following: pregnancy-related stress, satisfaction with care, quality of care. The present study will be performed by Review Manager Software (RevMan Version 5.3, The Cochrane Collaboration, Copenhagen, Denmark). P < .05 is set as the significance level. RESULTS: It is hypothesized that reduced-visit prenatal care model will provide similar outcomes compared with traditional care model. CONCLUSIONS: The results of our review will be reported strictly following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria and the review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/WYMB7.


Assuntos
Assistência Ambulatorial , COVID-19 , Prática Clínica Baseada em Evidências , Cuidado Pré-Natal/organização & administração , Assistência Ambulatorial/métodos , Assistência Ambulatorial/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/normas , Prática Clínica Baseada em Evidências/tendências , Feminino , Humanos , Controle de Infecções/métodos , Metanálise como Assunto , Gravidez , Projetos de Pesquisa , SARS-CoV-2 , Revisões Sistemáticas como Assunto
12.
Medicine (Baltimore) ; 100(15): e25495, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: covidwho-1180673

RESUMO

ABSTRACT: While the new Coronavirus Disease 2019 (COVID-19) pandemic rapidly spread across the world, South America was reached later in relation to Asia, Europe and the United States of America (USA). Brazil concentrates now the largest number of cases in the continent and, as the disease speedily progressed throughout the country, prompt and challenging operational strategies had to be taken by institutions caring for COVID-19 and non-COVID-19 patients in order to assure optimal workflows, triage, and management. Although hospitals in the USA, Europe and Asia have shared their experience on this subject, little has been discussed about such strategies in South America or by the perspective of outpatient centers, which are paramount in the radiology field. This article shares the guidelines adopted early in the pandemic by a nationwide outpatient healthcare center composed by a network of more than 200 patient service centers and nearly 2,000 radiologists in Brazil, discussing operational and patient management strategies, staff protection, changes adopted in the fellowship program, and the effectiveness of such measures.


Assuntos
Assistência Ambulatorial , COVID-19 , Gestão de Mudança , Defesa Civil , Procedimentos Clínicos , Planejamento Estratégico , Tecnologia Radiológica , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Brasil/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Defesa Civil/organização & administração , Defesa Civil/estatística & dados numéricos , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Humanos , Inovação Organizacional , Guias de Prática Clínica como Assunto , SARS-CoV-2 , Planejamento Estratégico/normas , Planejamento Estratégico/estatística & dados numéricos , Tecnologia Radiológica/métodos , Tecnologia Radiológica/organização & administração , Tecnologia Radiológica/estatística & dados numéricos
13.
J R Coll Physicians Edinb ; 51(1): 85-90, 2021 03.
Artigo em Inglês | MEDLINE | ID: covidwho-1194768

RESUMO

Telemedicine use has expanded rapidly to cope with increasing demand on services by delivering remote clinical review and monitoring of long-term conditions. Triaging individual patients to determine their suitability for telephone, video or face-to-face consultations is necessary. This is crucial in the context of COVID-19 to ensure doctor-patient safety. Telemedicine was shown to be safe and feasible in managing certain chronic diseases and providing patient education. When reviewing newly referred or long-term patients, different specialty clinics have different requirements for physical examination. Clinicians prefer face-to-face consultations at the initial visit to establish a doctor-patient relationship; telephone or video consultations are reasonable options for long-term patients where physical examination may not be needed. Video consultations, often aided by sophisticated devices and apps or medical assistants, are useful to facilitate remote physical examination. Most patients prefer telemedicine as it saves time and travel cost and provides better access to appointments.


Assuntos
Assistência Ambulatorial , COVID-19 , Doença Crônica/terapia , Exame Físico/métodos , Consulta Remota , Telemedicina , Assistência Ambulatorial/métodos , Assistência Ambulatorial/normas , Assistência Ambulatorial/tendências , COVID-19/epidemiologia , COVID-19/prevenção & controle , Previsões , Humanos , Assistência de Longa Duração/tendências , Relações Médico-Paciente , Consulta Remota/métodos , Consulta Remota/normas , SARS-CoV-2 , Telemedicina/métodos , Telemedicina/normas
14.
BMC Pregnancy Childbirth ; 21(1): 310, 2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: covidwho-1191317

RESUMO

BACKGROUND: Induction of labour (IOL) is one of the most commonly performed interventions in maternity care, with outpatient cervical ripening increasingly offered as an option for women undergoing IOL. The COVID-19 pandemic has changed the context of practice and the option of returning home for cervical ripening may now assume greater significance. This work aimed to examine whether and how the COVID-19 pandemic has changed practice around IOL in the UK. METHOD: We used an online questionnaire to survey senior obstetricians and midwives at all 156 UK NHS Trusts and Boards that currently offer maternity services. Responses were analysed to produce descriptive statistics, with free text responses analysed using a conventional content analysis approach. FINDINGS: Responses were received from 92 of 156 UK Trusts and Boards, a 59% response rate. Many Trusts and Boards reported no change to their IOL practice, however 23% reported change in methods used for cervical ripening; 28% a change in criteria for home cervical ripening; 28% stated that more women were returning home during cervical ripening; and 24% noted changes to women's response to recommendations for IOL. Much of the change was reported as happening in response to attempts to minimise hospital attendance and restrictions on birth partners accompanying women. CONCLUSIONS: The pandemic has changed practice around induction of labour, although this varied significantly between NHS Trusts and Boards. There is a lack of formal evidence to support decision-making around outpatient cervical ripening: the basis on which changes were implemented and what evidence was used to inform decisions is not clear.


Assuntos
Atitude do Pessoal de Saúde , COVID-19 , Maturidade Cervical , Procedimentos Clínicos , Trabalho de Parto Induzido , Adulto , Assistência Ambulatorial/métodos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Tomada de Decisão Clínica , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Feminino , Humanos , Controle de Infecções/métodos , Trabalho de Parto Induzido/métodos , Trabalho de Parto Induzido/tendências , Serviços de Saúde Materna/tendências , Inovação Organizacional , Formulação de Políticas , Gravidez , Inquéritos e Questionários , Reino Unido
15.
Nutrients ; 13(4)2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33924294

RESUMO

Approximately one-fifth to one-third of patients with adolescent anorexia nervosa (AN) need intensive care in the course of their illness. This article provides an update and discussion on different levels of intensive care (inpatient treatment (IP), day patient treatment (DP) and home treatment (HoT)) in different health care systems based on recently published literature. Important issues discussed in this article are new recommendations for the refeeding process and the definition of target weight as well as principles of medical stabilization and psychotherapeutic approaches. The pros and cons of longer or shorter hospitalization times are discussed, and the advantages of stepped care and day patient treatment are described. A new promising intensive treatment method involving the patient, their caregivers and the direct home environment is introduced. Parents and caregivers should be included in treatment research to foster collaborative work with the attending clinicians. There is an urgent need to evaluate the mid- to long-term outcomes of various intensive treatment programs to compare their effectiveness and costs across different health care systems. This could help policy makers and other stakeholders, such as public and private insurances, to enhance the quality of eating disorder care.


Assuntos
Serviços de Saúde do Adolescente/organização & administração , Anorexia Nervosa/terapia , Cuidados Críticos/métodos , Apoio Nutricional/métodos , Psicoterapia/métodos , Adolescente , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Anorexia Nervosa/mortalidade , Anorexia Nervosa/psicologia , Índice de Massa Corporal , Cuidadores , Cuidados Críticos/organização & administração , Política de Saúde , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Hospitalização , Humanos , Pais , Qualidade da Assistência à Saúde , Participação dos Interessados , Resultado do Tratamento
16.
West J Emerg Med ; 22(2): 333-338, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33856320

RESUMO

INTRODUCTION: This study reviews malpractice, also called medical professional liability (MPL), claims involving adult patients cared for in emergency departments (ED) and urgent care settings. METHODS: We conducted a retrospective review of closed MPL claims of adults over 18 years, from the Medical Professional Liability Association's Data Sharing Project database from 2001-2015, identifying 6,779 closed claims. Data included the total amount, origin, top medical specialties named, chief medical factors, top medical conditions, severity of injury, resolution, average indemnity, and defense costs of closed claims. RESULTS: Of 6,779 closed claims, 65.9% were dropped, withdrawn, or dismissed. Another 22.8% of claims settled for an average indemnity of $297,709. Of the 515 (7.6%) cases that went to trial, juries returned verdicts for the defendant in 92.6% of cases (477/515). The remaining 7.4% of cases (38/515) were jury verdicts for the plaintiff, with an average indemnity of $816,909. The most common resulting medical condition cited in paid claims was cardiac or cardiorespiratory arrest (10.4%). Error in diagnosis was the most common chief medical error cited in closed claims. Death was the most common level of severity listed in closed (38.5%) and paid (42.8%) claims. Claims reporting major permanent injury had the highest paid-to-closed ratio, and those reporting grave injury had the highest average indemnity of $686,239. CONCLUSION: This retrospective review updates the body of knowledge surrounding medical professional liability and represents the most recent analysis of claims in emergency medicine. As the majority of emergency providers will be named in a MPL claim during their career, it is essential to have a better understanding of the most common factors resulting in MPL claims.


Assuntos
Assistência Ambulatorial , Serviços Médicos de Emergência , Medicina de Emergência , Serviço Hospitalar de Emergência , Imperícia , Adulto , Assistência Ambulatorial/legislação & jurisprudência , Assistência Ambulatorial/métodos , Serviços Médicos de Emergência/legislação & jurisprudência , Serviços Médicos de Emergência/métodos , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Revisão da Utilização de Seguros , Responsabilidade Legal/economia , Masculino , Imperícia/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Imperícia/tendências , Estudos Retrospectivos , Estados Unidos
17.
J R Coll Physicians Edinb ; 51(1): 85-90, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33877145

RESUMO

Telemedicine use has expanded rapidly to cope with increasing demand on services by delivering remote clinical review and monitoring of long-term conditions. Triaging individual patients to determine their suitability for telephone, video or face-to-face consultations is necessary. This is crucial in the context of COVID-19 to ensure doctor-patient safety. Telemedicine was shown to be safe and feasible in managing certain chronic diseases and providing patient education. When reviewing newly referred or long-term patients, different specialty clinics have different requirements for physical examination. Clinicians prefer face-to-face consultations at the initial visit to establish a doctor-patient relationship; telephone or video consultations are reasonable options for long-term patients where physical examination may not be needed. Video consultations, often aided by sophisticated devices and apps or medical assistants, are useful to facilitate remote physical examination. Most patients prefer telemedicine as it saves time and travel cost and provides better access to appointments.


Assuntos
Assistência Ambulatorial , COVID-19 , Doença Crônica/terapia , Exame Físico/métodos , Consulta Remota , Telemedicina , Assistência Ambulatorial/métodos , Assistência Ambulatorial/normas , Assistência Ambulatorial/tendências , COVID-19/epidemiologia , COVID-19/prevenção & controle , Previsões , Humanos , Assistência de Longa Duração/tendências , Relações Médico-Paciente , Consulta Remota/métodos , Consulta Remota/normas , SARS-CoV-2 , Telemedicina/métodos , Telemedicina/normas
18.
Medicine (Baltimore) ; 100(15): e25435, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33847644

RESUMO

BACKGROUND: While this reduced-visit prenatal care model during the COVID-19 pandemic is well-intentioned, there is still a lack of relevant evidence to prove its effectiveness. Therefore, in order to provide new evidence-based medical evidence for clinical treatment, we undertook a systematic review and meta-analysis to assess the efficacy of reduced-visit prenatal care model during the COVID-19 pandemic. METHODS: The online literature will be searched using the following combination of medical subject heading terms: "prenatal care" OR "prenatal nursing" AND "reduced-visit" OR "reduce visit" OR "virtual visit." MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science will be searched without any language restrictions. A standard data extraction form is used independently by 2 reviewers to retrieve the relevant data from the articles. The outcome measures are as following: pregnancy-related stress, satisfaction with care, quality of care. The present study will be performed by Review Manager Software (RevMan Version 5.3, The Cochrane Collaboration, Copenhagen, Denmark). P < .05 is set as the significance level. RESULTS: It is hypothesized that reduced-visit prenatal care model will provide similar outcomes compared with traditional care model. CONCLUSIONS: The results of our review will be reported strictly following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria and the review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/WYMB7.


Assuntos
Assistência Ambulatorial , COVID-19 , Prática Clínica Baseada em Evidências , Cuidado Pré-Natal/organização & administração , Assistência Ambulatorial/métodos , Assistência Ambulatorial/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/normas , Prática Clínica Baseada em Evidências/tendências , Feminino , Humanos , Controle de Infecções/métodos , Metanálise como Assunto , Gravidez , Projetos de Pesquisa , SARS-CoV-2 , Revisões Sistemáticas como Assunto
19.
Medicine (Baltimore) ; 100(15): e25495, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33847662

RESUMO

ABSTRACT: While the new Coronavirus Disease 2019 (COVID-19) pandemic rapidly spread across the world, South America was reached later in relation to Asia, Europe and the United States of America (USA). Brazil concentrates now the largest number of cases in the continent and, as the disease speedily progressed throughout the country, prompt and challenging operational strategies had to be taken by institutions caring for COVID-19 and non-COVID-19 patients in order to assure optimal workflows, triage, and management. Although hospitals in the USA, Europe and Asia have shared their experience on this subject, little has been discussed about such strategies in South America or by the perspective of outpatient centers, which are paramount in the radiology field. This article shares the guidelines adopted early in the pandemic by a nationwide outpatient healthcare center composed by a network of more than 200 patient service centers and nearly 2,000 radiologists in Brazil, discussing operational and patient management strategies, staff protection, changes adopted in the fellowship program, and the effectiveness of such measures.


Assuntos
Assistência Ambulatorial , COVID-19 , Gestão de Mudança , Defesa Civil , Procedimentos Clínicos , Planejamento Estratégico , Tecnologia Radiológica , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Brasil/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Defesa Civil/organização & administração , Defesa Civil/estatística & dados numéricos , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Humanos , Inovação Organizacional , Guias de Prática Clínica como Assunto , SARS-CoV-2 , Planejamento Estratégico/normas , Planejamento Estratégico/estatística & dados numéricos , Tecnologia Radiológica/métodos , Tecnologia Radiológica/organização & administração , Tecnologia Radiológica/estatística & dados numéricos
20.
BMC Pregnancy Childbirth ; 21(1): 310, 2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33874913

RESUMO

BACKGROUND: Induction of labour (IOL) is one of the most commonly performed interventions in maternity care, with outpatient cervical ripening increasingly offered as an option for women undergoing IOL. The COVID-19 pandemic has changed the context of practice and the option of returning home for cervical ripening may now assume greater significance. This work aimed to examine whether and how the COVID-19 pandemic has changed practice around IOL in the UK. METHOD: We used an online questionnaire to survey senior obstetricians and midwives at all 156 UK NHS Trusts and Boards that currently offer maternity services. Responses were analysed to produce descriptive statistics, with free text responses analysed using a conventional content analysis approach. FINDINGS: Responses were received from 92 of 156 UK Trusts and Boards, a 59% response rate. Many Trusts and Boards reported no change to their IOL practice, however 23% reported change in methods used for cervical ripening; 28% a change in criteria for home cervical ripening; 28% stated that more women were returning home during cervical ripening; and 24% noted changes to women's response to recommendations for IOL. Much of the change was reported as happening in response to attempts to minimise hospital attendance and restrictions on birth partners accompanying women. CONCLUSIONS: The pandemic has changed practice around induction of labour, although this varied significantly between NHS Trusts and Boards. There is a lack of formal evidence to support decision-making around outpatient cervical ripening: the basis on which changes were implemented and what evidence was used to inform decisions is not clear.


Assuntos
Atitude do Pessoal de Saúde , COVID-19 , Maturidade Cervical , Procedimentos Clínicos , Trabalho de Parto Induzido , Adulto , Assistência Ambulatorial/métodos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Tomada de Decisão Clínica , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Feminino , Humanos , Controle de Infecções/métodos , Trabalho de Parto Induzido/métodos , Trabalho de Parto Induzido/tendências , Serviços de Saúde Materna/tendências , Inovação Organizacional , Formulação de Políticas , Gravidez , Inquéritos e Questionários , Reino Unido
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