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1.
J Laryngol Otol ; 135(3): 191-195, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33593465

RESUMO

OBJECTIVES: The global pandemic of coronavirus disease 2019 has necessitated changes to 'usual' ways of practice in otolaryngology, with a view towards out-patient or ambulatory management of appropriate conditions. This paper reviews the available evidence for out-patient management of three of the most common causes for emergency referral to the otolaryngology team: tonsillitis, peri-tonsillar abscess and epistaxis. METHODS: A literature review was performed, searching all available online databases and resources. The Medical Subject Headings 'tonsillitis', 'pharyngotonsillitis', 'quinsy', 'peritonsillar abscess' and 'epistaxis' were used. Papers discussing out-patient management were reviewed by the authors. RESULTS: Out-patient and ambulatory pathways for tonsillitis and peritonsillar abscess are well described for patients meeting appropriate criteria. Safe discharge of select patients is safe and should be encouraged in the current clinical climate. Safe discharge of patients with epistaxis who have bleeding controlled is also well described. CONCLUSION: In select cases, tonsillitis, quinsy and epistaxis patients can be safely managed out of hospital, with low re-admission rates.


Assuntos
Assistência Ambulatorial/organização & administração , Epistaxe/terapia , Otolaringologia/organização & administração , Abscesso Peritonsilar/terapia , Tonsilite/terapia , /prevenção & controle , Emergências , Serviço Hospitalar de Emergência/organização & administração , Humanos , Encaminhamento e Consulta/organização & administração
2.
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
3.
Rev Bras Enferm ; 74Suppl 1(Suppl 1): e20200571, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33533804

RESUMO

OBJECTIVE: to report the experience of a health team in restructuring service at a mastology outpatient clinic. METHODS: an experience report in a public university service mastology outpatient in Ceará between March and April 2020. Service in this outpatient clinic is exclusively for women and who have breast changes for surgical treatments ranging from nodulectomies to mastectomies with oncoplastic. RESULTS: increased COVID-19 cases brought the need to restructure healthcare services. The following steps were followed: identification of scheduled patients, reading of clinical developments in electronic medical records, individual assessment to define whether or not appointment would remain, telephone contact to inform about unscheduling. Among the 555 consultations scheduled for March and April 2020, 316 (56.9%) were maintained. FINAL CONSIDERATIONS: restructuring consultations at a mastology outpatient clinic optimized the waiting time for consultations and avoided crowds at service, providing patient safety.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/organização & administração , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , /terapia , Reestruturação Hospitalar/organização & administração , Serviços de Saúde da Mulher/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias
4.
J Am Board Fam Med ; 34(Suppl): S26-S28, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33622813

RESUMO

COVID-19 is primarily a respiratory illness. Historically, upper and lower respiratory illness has been cared for at home or in the ambulatory primary care setting. It is likely that patients experiencing COVID-19-like symptoms may first contact their primary care provider. The Medical Expenditure Panel Survey (MEPS) is a representative sample of patients from the United States that regularly assesses their use of medical care services. We analyzed 2017 MEPS data to determine the number and proportion of patients who were seen in primary care or family medicine ambulatory settings or hospitalized for upper or lower respiratory illness or pneumonia. In a given year, 19.5 million patients are seen by primary care for an upper respiratory illness, 10.7 million patients for bronchitis, and 9 million for pneumonia. In contrast, 890,000 patients are hospitalized with pneumonia. Given that a primary etiology for respiratory illness in early 2020 was SARS CoV-2 (COVID-19), primary care practices likely were the site of first contact for most patients with COVID-19 illness. Unfortunately, there has been inadequate support for in-person and telehealth visits. Primary care clinicians reported serious shortages of personal protective equipment (PPE) and testing capacity. Inadequate reimbursement for telehealth visits coupled with decreased in-person visits put primary care practices at risk of layoffs and closure. Policies related to primary care payment, federal relief efforts, PPE access, testing and follow-up capacity, and telehealth technical support are essential so primary care can provide first contact and continuity for their patients and communities throughout the COVID-19 pandemic response and recovery.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Medicina de Família e Comunidade/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Assistência Ambulatorial/organização & administração , Medicina de Família e Comunidade/organização & administração , Pesquisas sobre Serviços de Saúde , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Equipamento de Proteção Individual/provisão & distribução , Atenção Primária à Saúde/organização & administração , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Estados Unidos
6.
Med Care ; 59(4): 319-323, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33480660

RESUMO

BACKGROUND: Since coronavirus disease 2019 (COVID-19) has caused dramatic changes in everyday life, a major concern is whether patients have adequate access to mental health care despite shelter-in-place ordinances, school closures, and social distancing practices. OBJECTIVES: The aim was to examine the availability of telehealth services at outpatient mental health treatment facilities in the United States at the outset of the COVID-19 pandemic, and to identify facility-level characteristics and state-level policies associated with the availability. RESEARCH DESIGN: Observational cross-sectional study. SUBJECTS: All outpatient mental health treatment facilities (N=8860) listed in the Behavioral Health Treatment Services Locator of the Substance Abuse and Mental Health Services Administration on April 16, 2020. MEASURES: Primary outcome is whether an outpatient mental health treatment facility reported offering telehealth services. RESULTS: Approximately 43% of outpatient mental health facilities in the United States reported telehealth availability at the outset of the pandemic. Facilities located in the United States South and nonmetropolitan counties were more likely to offer services, as were facilities with public sector ownership, those providing care for both children and adults, and those accepting Medicaid as a form of payment. Outpatient mental health treatment facilities located in states with state-wide shelter-in-place laws were less likely to offer telehealth, as well as facilities in counties with more COVID-19 cases per 10,000 population. CONCLUSIONS: At the onset of the COVID-19 pandemic, fewer than half of outpatient mental health treatment facilities were providing telehealth services. Our results suggest that additional policies to promote telehealth may be warranted to increase availability over the course of the COVID-19 pandemic.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Assistência Ambulatorial/organização & administração , /transmissão , Estudos Transversais , Geografia , Acesso aos Serviços de Saúde/organização & administração , Humanos , Serviços de Saúde Mental/organização & administração , Pandemias/prevenção & controle , Telemedicina/organização & administração , Estados Unidos/epidemiologia
7.
JCO Oncol Pract ; 17(3): e343-e354, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33439694

RESUMO

PURPOSE: We present the strategy of a comprehensive cancer center organized to make operations pandemic proof and achieve continuity of cancer care during the COVID-19 pandemic. METHODS: Disease Outbreak Response (DORS) measures implemented at our center and its satellite clinics included strict infection prevention, manpower preservation, prudent resource allocation, and adaptation of standard-of-care treatments. Critical day-to-day clinical operations, number of persons screened before entry, staff temperature monitoring, and personal protection equipment stockpile were reviewed as a dashboard at daily DORS taskforce huddles. Polymerase chain reaction swab tests performed for patients and staff who met defined criteria for testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were tracked. Descriptive statistics of outpatient attendances and treatment caseloads from February 3 to May 23, 2020, were compared with the corresponding period in 2019. RESULTS: We performed COVID-19 swabs for 80 patients and 93 staff, detecting three cancer patients with community-acquired COVID-19 infections with no nosocomial transmission. Patients who required chemotherapy, radiotherapy, or surgery and patients who are on maintenance treatment continued to receive timely treatment without disruption. The number of intravenous chemotherapy treatments was maintained at 97.8% compared with 2019, whereas that of weekly radiotherapy treatments remained stable since December 2019. All cancer-related surgeries proceeded without delay, with a 0.3% increase in workload. Surveillance follow-ups were conducted via teleconsultation, accounting for a 30.7% decrease in total face-to-face clinic consultations. CONCLUSION: Through the coordinated efforts of a DORS taskforce, it is possible to avoid nosocomial SARS-CoV-2 transmissions among patients and staff without compromising on care delivery at a national cancer center.


Assuntos
Comitês Consultivos , Institutos de Câncer/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Controle de Infecções/organização & administração , Assistência Ambulatorial/organização & administração , /transmissão , Infecções Comunitárias Adquiridas/epidemiologia , Infecção Hospitalar/epidemiologia , Alocação de Recursos para a Atenção à Saúde , Pessoal de Saúde , Hospitalização , Humanos , Programas de Rastreamento , Equipamento de Proteção Individual/provisão & distribução , Singapura/epidemiologia
8.
Res Social Adm Pharm ; 17(1): 1838-1844, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33317762

RESUMO

BACKGROUND: The newly emerged coronavirus pandemic (COVID-19) has collapsed the entire global health care system. Due to these settings, a lot of strategic changes are adopted by healthcare facilities to ensure continuity in patient-centered services. OBJECTIVE: This study aims to evaluate the effectiveness of structural and operational changes made in ambulatory care pharmacy services during the COVID-19 pandemic. METHODS: A retrospective comparative study was conducted to evaluate the impact and effectiveness of patient-centered interventions and consequent access to medication management care within Johns Hopkins Aramco Health Care ambulatory care pharmacy services during the COVID-19 pandemic by comparing patient-centered key performance indicators before and during COVID-19 pandemic for a total of 4 months. RESULTS: As a result of the structural and operational changes made in patient-centered ambulatory care pharmacy services during the COVID-19 pandemic, a 48% prescriptions requests and 90% prescriptions fills are increased through online health portal application. A three-fold increase in the pharmacy call center utilization resulted in around 10% abandoned calls. In the number of physical visits to ambulatory care pharmacies, a 37% reduction was also noted. The decrease in staff schedule efficiency and an increase in average prescription waiting time were also noticed. The prescription collection through remote area pick up locations, and medication home delivery services were successful during COVID-19 pandemic as supported by statistical data. CONCLUSION: The access to ambulatory care pharmacy services during COVID-19 pandemic has been successfully maintained via medication home delivery, remote area pickup locations, pharmacy call-center consultations and refill requests, online health portal application services, and other measures, while reducing the number of physical visits to the JHAH hospital/clinic to ensure compliance with infection control and prevention measures.


Assuntos
Assistência Ambulatorial/organização & administração , Assistência Centrada no Paciente/organização & administração , Assistência Farmacêutica/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Instituições de Assistência Ambulatorial/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Assistência Centrada no Paciente/estatística & dados numéricos , Assistência Farmacêutica/estatística & dados numéricos , Estudos Retrospectivos
9.
Support Care Cancer ; 29(1): 11-15, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32856215

RESUMO

During the current pandemic scenario, maxillofacial rehabilitation specialists involved with supportive care in cancer must transform its practice to cope with COVID-19 and improve protocols that could quickly return the oral function of complex cancer patients who cannot wait for surgical complex rehabilitation. This includes the role of the maxillofacial prosthodontist for the rehabilitation of surgically treated patients with maxillary cancers by the means of filling obturator prostheses that are considered an optimal scientific-based strategy to reduce hospital stay with excellent pain control, oral function (speech, swallowing, mastication, and facial esthetics), psychologic and quality of life outcomes for the patients following intraoral cancer resection. Therefore, the aim of this commentary was to bring new lights to the strategic use of obturator prostheses for the rehabilitation of oral cancer patients during the COVID-19 pandemic as well as to present a protocol for managing such cases.


Assuntos
/epidemiologia , Procedimentos Clínicos/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Prótese Maxilofacial , Neoplasias Bucais/reabilitação , Obturadores Palatinos , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Procedimentos Clínicos/normas , Planejamento de Prótese Dentária/normas , Estética , Humanos , Reconstrução Mandibular/instrumentação , Reconstrução Mandibular/métodos , Reconstrução Mandibular/normas , Prótese Maxilofacial/estatística & dados numéricos , Neoplasias Bucais/cirurgia , Ortodontia/métodos , Ortodontia/organização & administração , Ortodontia/normas , Obturadores Palatinos/estatística & dados numéricos , Pandemias , Patologia Bucal/organização & administração , Patologia Bucal/normas , Qualidade de Vida , Fluxo de Trabalho
10.
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
12.
Epilepsy Behav ; 112: 107483, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33181898

RESUMO

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


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/organização & administração , Infecções por Coronavirus/prevenção & controle , Epilepsia/terapia , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/organização & administração , Adolescente , Adulto , Idoso , Assistência Ambulatorial/métodos , Agendamento de Consultas , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Encaminhamento e Consulta , Telefone , Adulto Jovem
14.
Nephrol Nurs J ; 47(5): 423-427, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107714

RESUMO

In March 2020, the COVID-19 pandemic became an increasingly urgent issue of public health concern in the United States. Patients on dialysis are considered to be at increased risk for infection due to their medical comorbidities and need for continued face-to-face encounters in dialysis units. In our outpatient dialysis practice, 42 out of 269 patients (15.6%) were infected with COVID-19 during the first wave of the pandemic. In this retrospective report, we review issues of infection control, access to interventional procedures, and communication encountered in our practice. We discuss lessons learned in patient outcomes and the importance of transitioning patients to home modalities. Further planning for a potential second wave of COVID-19 may help ensure improved quality of care for patients in the dialysis program.


Assuntos
Assistência Ambulatorial/organização & administração , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Diálise Renal , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia
15.
Bull Cancer ; 107(11): 1118-1128, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33059871

RESUMO

INTRODUCTION: Patients with hematological malignancies have less access to palliative care than other cancer patients, and benefit from it later in the course of their disease, though symptom burden is just as heavy. METHODS: We created a specialized outpatient palliative care consultation in the hematology department to improve the quality of patient management and enhance cooperation with hematologists. RESULTS: We found that though patient characteristics and survival were extremely variable, they all had in common a need for symptom management and care coordination. As a result of the consultation, hematology teams called upon a specialized palliative care multidisciplinary team more often to meet patients hospitalized within their departments, and more patients with hematological malignancies hemopathies were hospitalized in palliative care units. DISCUSSION: We describe the benefits that can be anticipated when collaboration increases between hematology and palliative care, including early on in the course of disease. It is now up to policy-makers to establish priorities regarding the allocation of health resources, in particular regarding end-of-life. This requires identifying patient needs, optimizing patient access to specialized palliative care, and improving the pertinence of palliative care interventions as they cannot be generalized.


Assuntos
Assistência Ambulatorial/organização & administração , Neoplasias Hematológicas/terapia , Hematologia/organização & administração , Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Encaminhamento e Consulta , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , França , Acesso aos Serviços de Saúde , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
16.
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
18.
Am Heart J ; 229: 121-126, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32957030

RESUMO

Myocarditis Disease Unit (MDU) is a functional multidisciplinary network designed to offer multidisciplinary assistance to patients with myocarditis. More than 300 patients coming from the whole Country are currently followed up at a specialized multidisciplinary outpatient clinic. Following the pandemic outbreak of the SARS-CoV-2 infection in Italy, we present how the MDU rapidly evolved to a "tele-MDU", via a dedicated multitasking digital health platform.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Unidades Hospitalares/organização & administração , Comunicação Interdisciplinar , Miocardite/terapia , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/epidemiologia , Telemedicina/organização & administração , Adulto , Assistência Ambulatorial/organização & administração , Arritmias Cardíacas/terapia , Feminino , Sistemas de Informação Hospitalar , Humanos , Pacientes Internados , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Centros de Atenção Terciária/organização & administração , Navegador
19.
ANZ J Surg ; 90(11): 2237-2241, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32940413

RESUMO

BACKGROUND: The coronavirus disease outbreak in December 2019 rapidly spread around the world with profound effects on healthcare systems. In March 2020, all elective surgery and elective outpatient clinics were cancelled in our institution, a regional hospital in Northern New South Wales, Australia. With regard to orthopaedic fracture clinics, a telehealth system was implemented on an emergency basis for patient and staff safety to prevent disease transmission. The aim of our study was to investigate whether rapid implementation of telehealth for orthopaedic fracture clinics resulted in an increase in complications. METHODS: A retrospective cohort study of all patients with orthopaedic fracture clinic appointments at a regional New South Wales hospital between 17 March and 8 May 2020 was undertaken. There were 191 patients, including 390 appointments of which 23.1% were conducted via telehealth, namely by phone call. Complications requiring phone calls to the orthopaedic team, presentations to the emergency department, admission to hospital or return to theatre, were recorded. RESULTS: There was no increase in complications following emergent implementation of telehealth for orthopaedic fracture clinic follow-up in our institution. Patients in the telehealth group were significantly older than those in the clinic group. CONCLUSION: The study demonstrates that application of telehealth fracture clinics in a regional Australian setting can be achieved without increasing complication rates and can be used to formulate a rapid telehealth implementation plan if a similar scenario occurs in the future.


Assuntos
Assistência Ambulatorial/organização & administração , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Fraturas Ósseas/terapia , Pneumonia Viral/epidemiologia , Telemedicina/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Criança , Pré-Escolar , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Feminino , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/etiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , New South Wales , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Estudos Retrospectivos , Adulto Jovem
20.
Neurology ; 95(17): 782-788, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-32934166

RESUMO

OBJECTIVE: To describe some current models of outpatient neuropalliative care (NPC) available to patients with amyotrophic lateral sclerosis at different institutions within the United States. METHODS: Six NPC physicians were asked to contribute written descriptions about the PC available in their ALS clinics. Descriptions were then compiled and assessed for similarities and differences. RESULTS: All clinics are multidisciplinary, with regular appointments every 3 months and similar appointment times for new visits (60-120 minutes) and follow-up visits (20-45 minutes). Four clinics have an NPC specialist embedded within the ALS clinic, 1 institution has a separate clinic for NPC, and 1 institution has both. The NPC physician at 5 institutions is a neurologist with formal palliative care training and at 1 institution is an internist with formal palliative care training. NPC is part of routine care for all patients at 2 institutions, and the primary reasons for consultation are goals of care (GOC) and severe symptom management. CONCLUSION: NPC is provided to patients with ALS heterogeneously throughout the United States with some variation in services and delivery, but all clinics are addressing similar core needs. Given the poor prognosis and high PC needs, those with ALS are the ideal patients to receive NPC. Future studies are necessary given the paucity of data available to determine best practices and to better define meaningful outcomes.


Assuntos
Assistência Ambulatorial/organização & administração , Esclerose Amiotrófica Lateral/terapia , Modelos Organizacionais , Cuidados Paliativos/organização & administração , Instituições de Assistência Ambulatorial , Humanos , Neurologistas/educação , Ambulatório Hospitalar/organização & administração , Planejamento de Assistência ao Paciente , Serviços de Saúde para Estudantes/organização & administração , Estados Unidos
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