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1.
Medicine (Baltimore) ; 100(5): e23928, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592846

RESUMO

ABSTRACT: Care maps (CMs), which are innovative, comprehensive, educational, and simple medical tools, were developed for 6 common diseases, including heart failure, stroke, hyperglycemia, urinary tract infection, dengue infection, and upper gastrointestinal bleeding, were implemented in a short-stay ambulatory ward. This study aimed to investigate the effectiveness of and level of clinician satisfaction with CMs in an ambulatory care setting.A retrospective chart review study comparing the quality of care between before and after CM implementation was conducted. The medical records of patients who were admitted to a short-stay ambulatory ward in a tertiary referral center were reviewed. Demographic data, severity of disease, quality of care, length of stay (LOS), admission cost, and CM user satisfaction were collected and recorded.The medical records of 1116 patients were evaluated. Of those, 589 and 527 patients were from before (non-CM group) and after CM (CM group) implementation, respectively. There were no significant differences between groups for age, gender, or disease-specific severity the median (interquartile range) total and essential quality scores were significantly higher in the CM group than in the non-CM group [total quality score 85.3 (75.0-92.9) vs 61.1 (50.0-75.0); P < .001, and essential quality scores 90.0 (75.0-100.0) vs 60.0 (40.6-80.0); P < .0001, respectively]. All aspects of quality of care were significantly improved between before and after CM implementation. Overall median LOS was significantly decreased from 3.8 (2.5-5.7) to 3.0 (2.0-4.9) days, but there was no significant decrease for admission cost. However, CMs were able to significantly reduce both LOS and admission cost in the infectious disease-related subgroup. Most CM users reported satisfaction with CMs.CMs were shown to be an effective tool for improving the quality of care in patients with ambulatory infectious diseases. In that patient subgroup, LOS and admission cost were both significantly reduced compared to pre-CM implementation.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/organização & administração , Doenças Transmissíveis/terapia , Procedimentos Clínicos/normas , Qualidade da Assistência à Saúde/organização & administração , Idoso , Assistência Ambulatorial/normas , Instituições de Assistência Ambulatorial/normas , Feminino , Implementação de Plano de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos
2.
Clin J Oncol Nurs ; 25(1): 48-55, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33480874

RESUMO

BACKGROUND: The COVID-19 pandemic has required healthcare systems to transform the delivery of care. Although the core principles of care for patients with cancer have not changed, this pandemic has led to heightened awareness concerning the fragility of patients with cancer and how healthcare systems can protect them. OBJECTIVES: The aims were to identify and implement inpatient and ambulatory care clinical practice changes during the COVID-19 pandemic, based on defining moments and coping strategies from clinical oncology nurses, advanced practice RNs, nurse leaders, and researchers. METHODS: This article presents a Lean Six Sigma framework, accompanied by numerous rapid cycle tests of change. FINDINGS: The COVID-19 pandemic required clinical healthcare providers at the authors' institution to focus on seven priority areas. Nurses tested and implemented practice changes.


Assuntos
Adaptação Psicológica , Assistência Ambulatorial/normas , Pessoal de Saúde/psicologia , Neoplasias/enfermagem , Enfermagem Oncológica/normas , Medicina Preventiva/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Guias de Prática Clínica como Assunto , Estresse Psicológico
3.
Clin J Oncol Nurs ; 25(1): 41-47, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33480885

RESUMO

BACKGROUND: The COVID-19 pandemic generated challenges to the delivery of safe, efficient, and high-quality cancer care. In ambulatory oncology, where most cancer care is delivered, these challenges required the rapid development of infrastructure. OBJECTIVES: This article describes challenges to the design and implementation of ambulatory oncology infrastructures that support clinical oncology care during a pandemic. METHODS: This article reviews clinical experiences in interprofessional, multicenter, academic, and community settings during the COVID-19 pandemic. Cohesive and efficient services, collaborative processes, and workflows; patient triage and symptom management; technology and equipment; and communication strategies are discussed. National ambulatory care guidelines and practice recommendations are included as applicable and available. FINDINGS: Continued treatment delivery and support for patients with cancer, as well as infrastructure to minimize viral exposure to patients and oncology healthcare workers, are essential when caring for this high-risk population.


Assuntos
Assistência Ambulatorial/normas , Oncologia/normas , Neoplasias/enfermagem , Enfermagem Oncológica/normas , Guias de Prática Clínica como Assunto , Telemedicina/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Estados Unidos/epidemiologia
5.
Jt Comm J Qual Patient Saf ; 47(2): 86-98, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33358323

RESUMO

BACKGROUND: Telemedicine use rapidly increased during the COVID-19 pandemic. This study assessed quality aspects of rapid expansion of a virtual urgent care (VUC) telehealth system and the effects of a secondary telephonic screening initiative during the pandemic. METHODS: A retrospective cohort analysis was performed in a single health care network of VUC patients from March 1, 2020, through April 20, 2020. Researchers abstracted demographic data, comorbidities, VUC return visits, emergency department (ED) referrals and ED visits, dispositions, intubations, and deaths. The team also reviewed incomplete visits. For comparison, the study evaluated outcomes of non-admission dispositions from the ED: return visits with and without admission and deaths. We separately analyzed the effects of enhanced callback system targeting higher-risk patients with COVID-like illness during the last two weeks of the study period. RESULTS: A total of 18,278 unique adult patients completed 22,413 VUC visits. Separately, 718 patient-scheduled visits were incomplete; the majority were no-shows. The study found that 50.9% of all patients and 74.1% of patients aged 60 years or older had comorbidities. Of VUC visits, 6.8% had a subsequent VUC encounter within 72 hours; 1.8% had a subsequent ED visit. Of patients with enhanced follow-up, 4.3% were referred for ED evaluation. Mortality was 0.20% overall; 0.21% initially and 0.16% with enhanced follow-up (p = 0.59). Males and black patients were significantly overrepresented in decedents. CONCLUSION: Appropriately deployed VUC services can provide a pragmatic strategy to care for large numbers of patients. Ongoing surveillance of operational, technical, and clinical factors is critical for patient quality and safety with this modality.


Assuntos
Assistência Ambulatorial/normas , Assistência Ambulatorial/tendências , Segurança do Paciente , Qualidade da Assistência à Saúde , Telemedicina/normas , Telemedicina/tendências , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Pandemias , Estudos Retrospectivos
7.
PLoS One ; 15(12): e0243724, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33351810

RESUMO

BACKGROUND: Government of India and the World Health Organization have guidelines for outpatient management of young infants 0-59 days with signs of Possible Serious Bacterial Infection (PSBI), when referral is not feasible. Implementation research was conducted to identify facilitators and barriers to operationalizing these guidelines. METHODS: Himachal Pradesh government implemented the guidelines in program settings supported by Centre for Health Research and Development, Society for Applied Studies. The strategy included community sensitization, skill enhancement of Accredited Social Health Activists (ASHA), Auxiliary Nurse Midwives (ANMs) and Medical Officers (MOs) to identify PSBI and treat when referral was not feasible. The research team collected information on facilitators and barriers. A technical support unit provided training and oversight. FINDINGS: Among 1997 live births from June 2017 to January 2019, we identified 160 cases of PSBI in young infants resulting in a coverage of 80%, assuming an incidence of 10%. Of these,29(18.1%) had signs of critical illness (CI), 92 (57.5%) had clinical severe infection (CSI), 5 (3.1%)had severe pneumonia (only fast breathing in young infants 0-6 days), while 34 (21%) had pneumonia (only fast breathing in young infants 7-59 days). Hospital referral was accepted by 48/160 (30%), whereas 112/160 (70%) were treated with the simplified treatment regimens at primary level facilities. Of the 29 infants with CI, 18 (62%) accepted referral; 26 (90%) recovered while 3 (10%) who had accepted referral, died. Of the 92 infants who had CSI, 86 (93%) recovered, 65 (71%) received simplified treatment and one infant who had accepted referral, died. All the five infants who had severe pneumonia, recovered; 3 (60%) had received simplified treatment. Of the 34 pneumonia cases, 33 received simplified treatment of which 5 (15%) failed treatment; two out of these 5 died. Overall, 6/160 infants died (case-fatality-rate 3.4%); 2 in the simplified treatment (case-fatality-rate 1.8%) and 4 in the hospital group (case-fatality-rate 8.3%). Delayed identification and care-seeking by families and health system weaknesses like manpower gaps and interrupted supplies were challenges in implementation. CONCLUSIONS: Implementation of the guidelines in program settings is possible and acceptable. Scaling up would require creating community awareness, early identification and appropriate care-seeking, strengthening ASHA home-visitation program, building skills and confidence of MOs and ANMs, uninterrupted supplies and a dependable referral system.


Assuntos
Assistência Ambulatorial/organização & administração , Infecções Bacterianas/terapia , Programas Governamentais/organização & administração , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/organização & administração , Assistência Ambulatorial/normas , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/mortalidade , Feminino , Programas Governamentais/normas , Visita Domiciliar/estatística & dados numéricos , Humanos , Ciência da Implementação , Índia/epidemiologia , Lactente , Mortalidade Infantil , Recém-Nascido , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , População Rural/estatística & dados numéricos , Índice de Gravidade de Doença
8.
Rev. esp. cardiol. Supl. (Ed. impresa) ; 20(supl.E): 40-42, dic. 2020.
Artigo em Espanhol | IBECS | ID: ibc-195346

RESUMO

En diciembre de 2019, se detectaron en China los primeros casos de una neumonía cuyo agente causante se identificó como un nuevo coronavirus, el SARS-CoV-2. Dicho virus causa la enfermedad COVID-19, cuyas virulencia y capacidad de transmision, junto con la ausencia de vacuna o de un tratamiento especifico, han condicionado un impacto sin precedentes en los sistemas sanitarios. La COVID-19 puede producir una afección grave en el sistema cardiovascular. Los pacientes con factores de riesgo cardiovascular o con una enfermedad cardiovascular subyacente son poblaciones particularmente vulnerables, con un riesgo muy elevado de sufrir complicaciones y muerte. Sin embargo, se ha tenido que asistir a dichos pacientes con una evidencia científica inexistente o muy escasa. En este suplemento se analizan la Fisiopatología de la COVID-19, los mecanismos directos e indirectos de la afección cardiovascular y los diversos tipos de complicaciones cardiovasculares. Asimismo se resumen los documentos que la SEC elaboro para dar una respuesta practica a la compleja situación asistencial generada. También se describen las futuras formas de la reorganizacion ambulatoria, principalmente mediante telemedicina, para dar continuidad asistencial. Para terminar, se analizan los diferentes tipos de tratamientos farmacológicos utilizados y sus posibles interacciones. El presente suplemento, con una serie de artículos elaborados por autores de prestigio, resume el conocimiento actual sobre dicha enfermedad y aporta datos e Información de gran valor práctico


In December 2019, clinicians in China first observed cases of pneumonia whose cause was identified as a new coronavirus, SARS-CoV-2. This virus causes COVID-19 disease, which has a virulence and transmission rate that, coupled with the absence of a vaccine or specific treatment, has had an unprecedented impact on health systems. COVID-19 can cause serious cardiovascular disease. Patients with cardiovascular risk factors or with an underlying cardiovascular condition form a particularly vulnerable population with a very high risk of complications and death. However, these patients had to be treated on the basis of very limited or nonexistent scientific evidence. This supplement discusses the pathophysiology of COVID-19, the direct and indirect mechanisms of associated cardiovascular disease, and the different types of cardiovascular complications that can occur. It also summarizes Spanish Society of Cardiology publications that have been produced to provide a practical response to the resulting complex health-care situation. In addition, the supplement describes how outpatient care can be reorganized in the future to ensure continuity of care, principally through telemedicine. Finally, the different types of pharmacological treatment available are discussed, along with their potential interactions. This supplement, which contains a series of articles prepared by influential authors, summarizes current knowledge about this disease and provides data and Información of great practical value


Assuntos
Humanos , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/virologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pandemias , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Assistência Ambulatorial/normas , Sociedades Médicas
9.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(8): 500-508, oct. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-196882

RESUMO

INTRODUCCIÓN: Las herramientas para analizar la casuística en consultas externas son escasas e insatisfactorias. El objetivo de este trabajo de la Sociedad Castellano Manchega de Endocrinología, Nutrición y Diabetes (SCAMEND) fue el desarrollo de una herramienta que permita analizar la casuística de las consultas externas de Endocrinología y Nutrición teniendo en cuenta la complejidad de la patología atendida. MATERIAL Y MÉTODOS: Se definió el Índice SCAMEND de Complejidad en Consultas Externas de Endocrinología y Nutrición (ISCCE-EyN) mediante método Delphi con dos rondas entre especialistas en Endocrinología y Nutrición, comparando la complejidad de cada patología con la de una revisión de hipotiroidismo primario. RESULTADOS: Las primeras visitas fueron consideradas más complejas que las visitas sucesivas. La patología tiroidea no neoplásica y el sobrepeso/obesidad sin complicaciones fueron consideradas las patologías menos complejas, mientras que las metabolopatías, los síndromes de neoplasias endocrinas múltiples y el carcinoma suprarrenal fueron consideradas las más complejas. El grado de consenso fue elevado en la mayoría de las patologías analizadas. CONCLUSIONES: Presentamos una herramienta que permite analizar la casuística de las consultas externas de Endocrinología y Nutrición teniendo en cuenta la complejidad inherente a la patología del paciente atendido. Esta herramienta puede servir para realizar comparaciones entre centros, para asignar mejores recursos dentro de un determinado servicio o para la autoevaluación


INTRODUCTION: The tools for analyzing the case-mix in outpatient clinics are scarce few and unsatisfactory. The objective of this study conducted by Sociedad Castellano Manchega de Endocrinología, Nutrición y Diabetes (SCAMEND) was to develop a tool that allows for analyzing the case-mix in outpatient endocrinology and nutrition clinics, considering bearing in mind the complexity of the conditions seen. MATERIAL AND METHODS: Using the Delphi method, the SCAMEND index of complexity in outpatient endocrinology and nutrition clinics (ISCCE-EyN) was developed by endocrinologists in two rounds, comparing the complexity of each condition being compared with that of a review visit of primary hypothyroidism. RESULTS: The first visits were considered more complex than the subsequent visits. Non-neoplastic thyroid disease and uncomplicated overweight/obesity were considered as the least complex diseases, while metabolic diseases, multiple endocrine neoplasia syndromes, and adrenal carcinoma were considered as the most complex. The degree of agreement was high in most of the diseases analyzed. CONCLUSIONS: This tool allows for analyzing the case-mix in outpatient endocrinology and nutrition clinics, based on the inherent complexity of the disease of the patient is reported. This tool may be used for comparisons between centers, to better allocate resources within a given service, or for self-evaluation


Assuntos
Humanos , Masculino , Feminino , Grupos Diagnósticos Relacionados/classificação , Ambulatório Hospitalar , Sociedades Médicas/normas , Hipotireoidismo/epidemiologia , Ciências da Nutrição/organização & administração , Endocrinologia/normas , Técnica Delfos , Técnicas de Diagnóstico Endócrino/normas , Doenças do Sistema Endócrino/epidemiologia , Assistência Ambulatorial/normas
10.
J Crohns Colitis ; 14(Supplement_3): S785-S790, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-32959882

RESUMO

Infusion centres are a central part in the management of patients with inflammatory bowel disease [IBD] and could be a source of transmission of SARS-COV-2. Here we aimed to develop global guidance for best practices of infusion centres for IBD patients and to determine the impact of the COVID-19 pandemic on these centres. Under the auspices of the International Organization for the Study of Inflammatory Bowel Disease [IOIBD], a task force [TF] was formed, an online survey was developed to query infusion centre protocols during COVID-19, and recommendations were made, based on TF experience and opinion. Recommendations focus mainly on patients screening, infusion centres re-organization, personnel protection, and protocol modifications such as shortening infusion duration or replacing it with subcutaneous alternatives. Implementing these recommendations will hopefully reduce exposure of both IBD patients and care givers to SARS-COV-2 and improve the function and safety of infusion centres during the COVID-19 pandemic as well as potential future threats.


Assuntos
Instituições de Assistência Ambulatorial/normas , Assistência Ambulatorial/normas , Anti-Inflamatórios/administração & dosagem , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/normas , Doenças Inflamatórias Intestinais/tratamento farmacológico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto , Comitês Consultivos , Assistência Ambulatorial/métodos , Anti-Inflamatórios/uso terapêutico , Protocolos Clínicos , Infecções por Coronavirus/complicações , Esquema de Medicação , Fármacos Gastrointestinais/administração & dosagem , Fármacos Gastrointestinais/uso terapêutico , Saúde Global , Pesquisas sobre Serviços de Saúde , Humanos , Controle de Infecções/métodos , Doenças Inflamatórias Intestinais/complicações , Infusões Intravenosas , Quimioterapia de Manutenção/métodos , Quimioterapia de Manutenção/normas , Pneumonia Viral/complicações
12.
Neurología (Barc., Ed. impr.) ; 35(6): 363-371, jul.-ago. 2020. graf
Artigo em Espanhol | IBECS | ID: ibc-188626

RESUMO

INTRODUCCIÓN: La infección por SARS-CoV-2 ha tenido un enorme impacto en los sistemas sanitarios. España, donde la cefalea constituye el motivo principal de consulta ambulatoria en Neurología, es uno de los países con más casos notificados. OBJETIVO: Conocer el impacto de la pandemia COVID-19 en las Unidades de Cefaleas en España y evaluar cómo imaginan el futuro de estas estructuras los neurólogos responsables. MÉTODOS: estudio transversal mediante encuesta online distribuida a los responsables de las Unidades, realizada durante la sexta semana del Estado de Alarma. RESULTADOS: La tasa de respuesta fue del 74%, con participación de centros de diferentes características y de todas las Comunidades Autónomas. El 95,8% describió limitaciones en la actividad presencial, un 60,4% mantuvo la consulta presencial preferente y el 45,8% los procedimientos urgentes. En el 91,7% de los centros la actividad presencial cancelada se sustituyó por consulta telefónica. El 95,8% de los encuestados afirmó que empleará material de protección personal en el futuro y el 86% pretende incorporar en mayor medida la telemedicina. La mayoría prevé un incremento en las listas de espera (93,8% en primeras visitas, 89,6% en revisiones y 89,4% en procedimientos) y una peor situación clínica de los pacientes, pero sólo un 15% cree que su estructura asistencial se verá debilitada. CONCLUSIONES: Como consecuencia de la pandemia, la actividad asistencial e investigadora en cefaleas se ha reducido de manera notable. Esto pone de manifiesto la necesidad de un incremento de la oferta de telemedicina en nuestros centros en un futuro cercano


INTRODUCTION:The COVID-19 pandemic has had a great impact on healthcare systems. Spain, where headache is the main reason for outpatient neurology consultation, is one of the countries with the most reported cases of the disease.Objectives.This study aimed to analyse the impact of the COVID-19 pandemic on headache units in Spain and to evaluate how neurologists see the future of these units. METHODS: We conducted a cross-sectional online survey of headache units during the sixth week of the state of alarm declared in Spain in response to the pandemic. RESULTS:The response rate was 74%, with the participation of centres with different characteristics and from all Autonomous Communities of Spain. Limitations in face-to-face activity were reported by 95.8% of centres, with preferential face-to-face consultation being maintained in 60.4%, and urgent procedures in 45.8%. In 91.7% of centres, the cancelled face-to-face activity was replaced by telephone consultation 95.8% of respondents stated that they woulduse personal protection equipment in the future, and 86% intendedto increase the use of telemedicine. The majority foresaw an increase in waiting lists (93.8% for initial consultations, 89.6% for follow-up, and 89.4% for procedures) and a worse clinical situation for patients, but only 15% believed that their healthcare structures would be negatively affected in the future.Conclusions.As a consequence of the pandemic, headache care and research activity has reduced considerably. This demonstrates the need for an increase in the availability of telemedicine in our centres in the near future


Assuntos
Humanos , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/tendências , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Assistência Ambulatorial/normas , Assistência Ambulatorial/tendências , Cefaleia/terapia , Teleneurologia , Inquéritos e Questionários , Estudos Transversais
13.
J Int AIDS Soc ; 23(7): e25573, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32657527

RESUMO

INTRODUCTION: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has infected >6 million people worldwide since December 2019. Global reports of HIV/SARS-CoV-2 coinfection are limited. To better understand the impact of the coronavirus disease 2019 (COVID-19) pandemic on persons with HIV and improve their care, we present an outpatient and inpatient clinical experience of HIV/SARS-CoV-2 coinfection from Rhode Island, US. METHODS: We describe outpatient and inpatient preparedness for the COVID-19 pandemic, and present a case series of all known patients with HIV/SARS-CoV-2 coinfection at The Miriam Hospital and Rhode Island Hospital, and The Miriam Hospital Infectious Diseases and Immunology Center, in Providence, Rhode Island, US. RESULTS AND DISCUSSION: The Infectious Diseases and Immunology Center rapidly prepared for outpatient and inpatient care of persons with HIV and SARS-CoV-2. Between 30 March and 20 May 2020, 27 patients with HIV were diagnosed with SARS-CoV-2. Twenty were male, six female and one transgender female; average age was 49 years; 13/27 were Hispanic and 6/27 were African American. All had HIV viral load <200 copies/mL and were on antiretroviral therapy with CD4 count range 87 to 1441 cells/µL. Twenty-six of the 27 had common COVID-19 symptoms for one to twenty-eight days and most had other co-morbidities and/or risk factors. Nine of the 27 were hospitalized for one to thirteen days; of those, three lived in a nursing home, six received remdesivir through a clinical trial or emergency use authorization and tolerated it well; eight recovered and one died. Overall, 17% of known Center people had HIV/SARS-CoV-2 coinfection, whereas the comparable state-wide prevalence was 9%. CONCLUSIONS: We highlight challenges of outpatient and inpatient HIV care in the setting of the COVID-19 pandemic and present the largest detailed case series to date from the United States on HIV/SARS-CoV-2 coinfection, adding to limited global reports. The aggregated clinical findings suggest that the clinical presentation and outcomes of COVID-19 appear consistent with those without HIV. Whether SARS-CoV-2 infection is more frequent among persons with HIV remains to be determined. More data are needed as we develop our understanding of how HIV and antiretroviral therapy are affected by or have an impact on this pandemic.


Assuntos
Infecções por Coronavirus/complicações , Infecções por HIV/complicações , Pacientes Internados , Pacientes Ambulatoriais , Pneumonia Viral/complicações , Telemedicina , Adulto , Idoso , Assistência Ambulatorial/normas , Betacoronavirus , Coinfecção/epidemiologia , Infecções por Coronavirus/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Rhode Island/epidemiologia , Fatores de Risco , Estados Unidos
14.
Arch Cardiovasc Dis ; 113(10): 660-670, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32660835

RESUMO

Renal function is often affected in patients with chronic heart failure with reduced ejection fraction (HFrEF). The complex interplay between heart and renal dysfunction makes renal function and potassium monitoring mandatory. Renin-angiotensin-aldosterone system (RAAS) blockers are a life-saving treatment for patients with HFrEF, regardless of worsening renal function. Uptitration to the maximum-tolerated dose should be a constant goal. This simple fact is all too often forgotten (only 30% of patients with heart failure receive the target dosage of RAAS blockers), and the RAAS blocker effect on renal function is sometimes misunderstood. RAAS blockers are not nephrotoxic drugs as they only have a functional effect on renal function. In many routine clinical cases, RAAS blockers are withheld or stopped because of this misunderstanding, combined with suboptimal assessment of the clinical situation and underestimation of the life-saving effect of RAAS blockers despite worsening renal function. In this expert panel, which includes heart failure specialists, geriatricians and nephrologists, we propose therapeutic management algorithms for worsening renal function for physicians in charge of outpatients with chronic heart failure. Firstly, the essential variables to take into consideration before changing treatment are the presence of concomitant disorders that could alter renal function status (e.g. infection, diarrhoea, hyperthermia), congestion/dehydration status, blood pressure and intake of nephrotoxic drugs. Secondly, physicians are invited to adapt medication according to four clinical scenarios (patient with congestion, dehydration, hypotension or hyperkalaemia). Close biological monitoring after treatment modification is mandatory. We believe that this practical clinically minded management algorithm can help to optimize HFrEF treatment in routine clinical practice.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Síndrome Cardiorrenal/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Nefropatias/tratamento farmacológico , Rim/efeitos dos fármacos , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Volume Sistólico/efeitos dos fármacos , Função Ventricular Esquerda/efeitos dos fármacos , Assistência Ambulatorial/normas , Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Síndrome Cardiorrenal/diagnóstico , Síndrome Cardiorrenal/fisiopatologia , Cardiologia/normas , Doença Crônica , Consenso , Progressão da Doença , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Rim/fisiopatologia , Nefropatias/diagnóstico , Nefropatias/fisiopatologia , Antagonistas de Receptores de Mineralocorticoides/efeitos adversos , Nefrologia/normas , Recuperação de Função Fisiológica , Sistema Renina-Angiotensina/efeitos dos fármacos , Resultado do Tratamento
15.
J Med Internet Res ; 22(8): e19493, 2020 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-32721925

RESUMO

During the recent coronavirus disease (COVID-19) pandemic, telehealth has received greater attention due to its role in reducing hospital visits from patients with COVID-19 or other conditions, while supporting home isolation in patients with mild symptoms. The needs of patients with chronic diseases tend to be overlooked during the pandemic. With reduced opportunities for routine clinic visits, these patients are adopting various telehealth services such as video consultation and remote monitoring. We advocate for more innovative designs to be considered to enhance patients' feelings of "copresence"-a sense of connection with another interactant via digital technology-with their health care providers during this time. The copresence-enhanced design has been shown to reduce patients' anxiety and increase their confidence in managing their chronic disease condition. It has the potential to reduce the patient's need to reach out to their health care provider during a time when health care resources are being stretched.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina , Assistência Ambulatorial/normas , Doença Crônica , Infecções por Coronavirus/transmissão , Pessoal de Saúde , Hospitais , Humanos , Pneumonia Viral/transmissão , Encaminhamento e Consulta
16.
J Pak Med Assoc ; 70(Suppl 3)(5): S52-S55, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32515378

RESUMO

In a brief span of a few months, coronavirus disease (COVID-19) pandemic has brought a major paradigm shift in operation of clinical services around the world. Infection may be mild, moderate or severe; many remain asymptomatic. High burden of non-communicable and communicable diseases theoretically puts Pakistani population at increased risk of severe COVID-19 infection. Considering the universal risk of infection, the outpatient services in Pakistan need to be redesigned. Starting with risk assessment of the facility and provision of a dedicated telephone connection, structure and workflow need to be redesigned in order to minimise risk of exposure to healthcare professionals, staff and patients. Patients with COVID-19 patients should be identified before they arrive in the facility and should be served expeditiously, in an environment which prevents cross-transmission of infection. Tele-consultation is assuming an important role. Changes which are taking place in response to Covid-19 pandemic will have far reaching effects on clinical services in Pakistan.


Assuntos
Assistência Ambulatorial , Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Assistência Ambulatorial/métodos , Assistência Ambulatorial/normas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Assistência à Saúde/métodos , Assistência à Saúde/normas , Humanos , Paquistão , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Consulta Remota , Medição de Risco
17.
Artigo em Inglês | MEDLINE | ID: mdl-32549227

RESUMO

This study aimed to examine the association between health insurance, city of residence, and outpatient visits among older adults living alone in China. A sample of 3173 individuals was derived from "Survey on Older Adults Aged 70 and Above Living Alone in Urban China" in five different cities. Logistic regression models indicated that older adults living alone who had urban employee basic medical insurance, urban resident basic medical insurance, and public medical insurance were more likely to have outpatient visits than those without any health insurance. After controlling the number of chronic diseases, only those with public medical insurance were more likely to have outpatient visits than uninsured older adults. Additionally, older adults who resided in Shanghai and Guangzhou were more likely to have outpatient visits than those in Chengdu, whereas older adults who were in Dalian and Hohhot were less likely to have outpatient visits. To improve the equity of outpatient visits among older adults living alone in China, policy efforts should be made to reduce fragmentation of different health insurance plans, expand the health insurance coverage for older adults, provide programs that consider the needs of this special group of older adults, and reduce the inequality in health resources and health insurance policies across cities.


Assuntos
Assistência Ambulatorial , Seguro Saúde , Pessoas sem Cobertura de Seguro de Saúde , Pacientes Ambulatoriais , Idoso , Assistência Ambulatorial/normas , Criança , China , Cidades , Feminino , Humanos , Masculino , Características de Residência , Isolamento Social
19.
Head Neck ; 42(7): 1507-1515, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32584447

RESUMO

INTRODUCTION: The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has altered the health care environment for the management of head and neck cancers. The purpose of these guidelines is to provide direction during the pandemic for rational Head and Neck Cancer management in order to achieve a medically and ethically appropriate balance of risks and benefits. METHODS: Creation of consensus document. RESULTS: The process yielded a consensus statement among a wide range of practitioners involved in the management of patients with head and neck cancer in a multihospital tertiary care health system. CONCLUSIONS: These guidelines support an ethical approach for the management of head and neck cancers during the COVID-19 epidemic consistent with both the local standard of care as well as the head and neck oncological literature.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Neoplasias de Cabeça e Pescoço/terapia , Controle de Infecções/normas , Oncologia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Assistência Ambulatorial/normas , Terapia Combinada , Continuidade da Assistência ao Paciente/normas , Infecções por Coronavirus/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Sistemas Multi-Institucionais , Procedimentos Cirúrgicos Otorrinolaringológicos/normas , Cuidados Paliativos/normas , Segurança do Paciente , Pennsylvania , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Assistência Terminal/normas , Centros de Atenção Terciária
20.
J Clin Nurs ; 29(17-18): 3435-3444, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32562579

RESUMO

AIMS AND OBJECTIVES: To identify and describe nursing interventions in patient documentation in adult psychiatric outpatient setting and to explore the potential for using the Nursing Interventions Classification in documentation in this setting. BACKGROUND: Documentation is an important part of nurses' work, and in the psychiatric outpatient care setting, it can be time-consuming. Only very few research reports are available on nursing documentation in this care setting. METHODS: A qualitative analysis of secondary data consisting of nursing documentation for 79 patients in four outpatient units (years 2016-2017). The data consisted of 1,150 free-text entries describing a contact or an attempted contact with 79 patients, their family members or supporting networks and 17 nursing care summaries. Deductive and inductive content analysis was used. SRQR guideline was used for reporting. RESULTS: We identified 71 different nursing interventions, 64 of which are described in the Nursing Interventions Classification. Surveillance and Care Coordination were the most common interventions. The analysis revealed two perspectives which challenge the use of the classification: the problem of overlapping interventions and the difficulty of naming group-based interventions. CONCLUSION: There is an urgent need to improve patient documentation in the adult psychiatric outpatient care setting, and standardised nursing terminologies such as the Nursing Interventions Classification could be a solution to this. However, the problems of overlapping interventions and naming group-based interventions suggest that the classification needs to be further developed before it can fully support the systematic documentation of nursing interventions in the psychiatric outpatient care setting. RELEVANCE TO CLINICAL PRACTICE: This study describes possibilities of using a systematic nursing language to describe the interventions nurses use in the adult psychiatric outpatient setting. It also describes problems in the current free text-based documentation.


Assuntos
Documentação/normas , Registros de Enfermagem/normas , Terminologia Padronizada em Enfermagem , Adulto , Assistência Ambulatorial/normas , Humanos , Enfermagem Psiquiátrica/métodos , Pesquisa Qualitativa
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