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1.
BMC Health Serv Res ; 21(1): 651, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34225705

RESUMO

OBJECTIVE: Standardised cancer patient pathways (CPP) are implemented within cancer care with an aim to ensure standardised waiting times for diagnosis and treatment. This article investigates how patients in Norway experience waiting times within a CPP. METHODS: Qualitative semi-structured interviews with 19 patients who had been through CPP for breast cancer, prostate cancer or malignant melanoma in Norway. RESULTS: Few patients knew about the term CPP but trusted that waiting times were standardised to decrease mortality. Their experiences of waiting depended on their expectations as much as the period they waited. Patients generally felt safe about the timing of treatment, but not all expectations of a rapid response from health services were met. Short waiting times were interpreted as a sign of urgency, and a change of pace between urgent action and prolonged periods of waiting were disturbing. CONCLUSIONS: Patients are comforted by knowing they are within a structured CPP that ensures rapid diagnosis and start of treatment. CPPs still need to be improved to avoid delays, allow for adaptions to patient needs, and include more information to avoid stress.


Assuntos
Neoplasias da Mama , Listas de Espera , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Humanos , Masculino , Noruega , Avaliação de Resultados da Assistência ao Paciente , Pesquisa Qualitativa
2.
Int J Mol Sci ; 22(12)2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34207126

RESUMO

Although immune checkpoint inhibitors have changed the treatment paradigm of a variety of cancers, including non-small-cell lung cancer, not all patients respond to immunotherapy in the same way. Predictive biomarkers for patient selection are thus needed. Tumor mutation burden (TMB), defined as the total number of somatic/acquired mutations per coding area of a tumor genome (Mut/Mb), has emerged as a potential predictive biomarker of response to immune checkpoint inhibitors. We found that the limited use of TMB in clinical practice is due to the difficulty in its detection and compounded by several different biological, methodological and economic issues. The incorporation of both TMB and PD-L1 expression or other biomarkers into multivariable predictive models could result in greater predictive power.


Assuntos
Biomarcadores Tumorais , Carcinoma Pulmonar de Células não Pequenas/genética , Predisposição Genética para Doença , Neoplasias Pulmonares/genética , Mutação , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/terapia , Ensaios Clínicos como Assunto , Gerenciamento Clínico , Estudos de Associação Genética , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Terapia de Alvo Molecular , Avaliação de Resultados da Assistência ao Paciente
3.
BMJ Open ; 11(5): e049873, 2021 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059517

RESUMO

INTRODUCTION: Hospitals commonly examine patient safety culture and other quality indicators to evaluate and improve performance in relation to quality and safety. A growing body of research has separately examined relationships between patient safety culture and patient experience on clinical outcomes and other quality indicators. However, there is a knowledge gap regarding the relationship between these two important domains. This article describes the protocol for a scoping review of published literature examining the relationship between patient safety culture and patient experience in hospital settings. The scoping review will provide an overview of research into the relationship between patient safety culture and patient experience in hospital contexts, map key concepts underpinning these domains and identify research gaps for further study. METHODS AND ANALYSIS: The scoping review will be conducted using the five stages of Arksey and O'Malley's framework: identify the research question; identify relevant studies; study selection; chart data; and collate, summarise and report the results. The inclusion criteria will be applied using the Population, Concept and Context Framework. Searches will be conducted in the CINAHL, Cochrane Library, ProQuest, MEDLINE, PsycINFO, Scopus and SciELO databases, without applying date range limits. Hand-searching of grey literature will also be performed to find relevant, non-indexed literature. Data will be extracted using a standardised data extraction form developed by the Joanna Briggs Institute. Both descriptive and thematic analyses will be undertaken to scope key concepts within the body of reviewed literature. ETHICS AND DISSEMINATION: This type of study does not require an ethics review. The results will be submitted for publication in a peer-reviewed journal and presented at conferences.


Assuntos
Segurança do Paciente , Projetos de Pesquisa , Hospitais , Humanos , Avaliação de Resultados da Assistência ao Paciente , Literatura de Revisão como Assunto , Gestão da Segurança , Revisões Sistemáticas como Assunto
4.
J Clin Neurosci ; 89: 26-32, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119278

RESUMO

OBJECTIVE: To evaluate the results of Type II odontoid fractures management in the elderly, according to the Grauer classification. METHODS: Consecutive patients with type II odontoid fracture, age > 65 years and follow-up longer than 3 months were included. Fracture management was proposed according to Grauer classification. Peri-surgical risk factors, NDI, VAS and rate of fusion were evaluated according to the treatment modality and compared between conservative and surgical groups. RESULTS: Thirty-four patients were considered eligible for the study; 2 patients showed a Type IIa fracture, 30 patients a type IIb, and 2 patients a type IIc. Type IIa patients underwent conservative treatment that resulted in failure. A conservative management was adopted in 9 cases with type IIb due to patient preference or anaesthesiologic reasons with a treatment success at 6 months of 11%. Trans-odontoid stabilization was adopted in 21 type IIb cases with an evidence of bony or fibrous union at 6 months of 95% and a median NDI of 20%. A posterior approach was reserved for 2 type IIc fracture patients and in 6 cases as rescue surgery (bony union at 6 months of 100%; median NDI 37%). Higher Lakshmanan grade, gap and displacement of the fracture were found as significant risk factor for fracture non-union (p < 0.05). CONCLUSIONS: The surgical group presented better clinical and radiological outcome and the anterior approach proved to achieve the best results in type IIb fractures. The presence of osteoporosis and fracture spatial features should be duly considered in the decision-making process.


Assuntos
Gerenciamento Clínico , Processo Odontoide/lesões , Processo Odontoide/cirurgia , Avaliação de Resultados da Assistência ao Paciente , Fraturas da Coluna Vertebral/classificação , Fraturas da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Tratamento Conservador/métodos , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Processo Odontoide/diagnóstico por imagem , Prognóstico , Fatores de Risco , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
5.
BMJ Open ; 11(6): e048926, 2021 06 18.
Artigo em Inglês | MEDLINE | ID: covidwho-1276965

RESUMO

OBJECTIVE: People with chronic conditions are known to be vulnerable to the COVID-19 pandemic. This study aims to describe patients' lived experiences, challenges faced by people with chronic conditions, their coping strategies, and the social and economic impacts of the COVID-19 pandemic. DESIGN, SETTING AND PARTICIPANTS: We conducted a qualitative study using a syndemic framework to understand the patients' experiences of chronic disease care, challenges faced during the lockdown, their coping strategies and mitigators during the COVID-19 pandemic in the context of socioecological and biological factors. A diverse sample of 41 participants with chronic conditions (hypertension, diabetes, stroke and cardiovascular diseases) from four sites (Delhi, Haryana, Vizag and Chennai) in India participated in semistructured interviews. All interviews were audio recorded, transcribed, translated, anonymised and coded using MAXQDA software. We used the framework method to qualitatively analyse the COVID-19 pandemic impacts on health, social and economic well-being. RESULTS: Participant experiences during the COVID-19 pandemic were categorised into four themes: challenges faced during the lockdown, experiences of the participants diagnosed with COVID-19, preventive measures taken and lessons learnt during the COVID-19 pandemic. A subgroup of participants faced difficulties in accessing healthcare while a few reported using teleconsultations. Most participants reported adverse economic impact of the pandemic which led to higher reporting of anxiety and stress. Participants who tested COVID-19 positive reported experiencing discrimination and stigma from neighbours. All participants reported taking essential preventive measures. CONCLUSION: People with chronic conditions experienced a confluence (reciprocal effect) of COVID-19 pandemic and chronic diseases in the context of difficulty in accessing healthcare, sedentary lifestyle and increased stress and anxiety. Patients' lived experiences during the pandemic provide important insights to inform effective transition to a mixed realm of online consultations and 'distanced' physical clinic visits.


Assuntos
COVID-19 , Pandemias , Doença Crônica , Controle de Doenças Transmissíveis , Humanos , Índia/epidemiologia , Avaliação de Resultados da Assistência ao Paciente , Percepção , Pesquisa Qualitativa , SARS-CoV-2
7.
BMJ Open ; 11(6): e048926, 2021 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-34145019

RESUMO

OBJECTIVE: People with chronic conditions are known to be vulnerable to the COVID-19 pandemic. This study aims to describe patients' lived experiences, challenges faced by people with chronic conditions, their coping strategies, and the social and economic impacts of the COVID-19 pandemic. DESIGN, SETTING AND PARTICIPANTS: We conducted a qualitative study using a syndemic framework to understand the patients' experiences of chronic disease care, challenges faced during the lockdown, their coping strategies and mitigators during the COVID-19 pandemic in the context of socioecological and biological factors. A diverse sample of 41 participants with chronic conditions (hypertension, diabetes, stroke and cardiovascular diseases) from four sites (Delhi, Haryana, Vizag and Chennai) in India participated in semistructured interviews. All interviews were audio recorded, transcribed, translated, anonymised and coded using MAXQDA software. We used the framework method to qualitatively analyse the COVID-19 pandemic impacts on health, social and economic well-being. RESULTS: Participant experiences during the COVID-19 pandemic were categorised into four themes: challenges faced during the lockdown, experiences of the participants diagnosed with COVID-19, preventive measures taken and lessons learnt during the COVID-19 pandemic. A subgroup of participants faced difficulties in accessing healthcare while a few reported using teleconsultations. Most participants reported adverse economic impact of the pandemic which led to higher reporting of anxiety and stress. Participants who tested COVID-19 positive reported experiencing discrimination and stigma from neighbours. All participants reported taking essential preventive measures. CONCLUSION: People with chronic conditions experienced a confluence (reciprocal effect) of COVID-19 pandemic and chronic diseases in the context of difficulty in accessing healthcare, sedentary lifestyle and increased stress and anxiety. Patients' lived experiences during the pandemic provide important insights to inform effective transition to a mixed realm of online consultations and 'distanced' physical clinic visits.


Assuntos
COVID-19 , Pandemias , Doença Crônica , Controle de Doenças Transmissíveis , Humanos , Índia/epidemiologia , Avaliação de Resultados da Assistência ao Paciente , Percepção , Pesquisa Qualitativa , SARS-CoV-2
8.
Más Vita ; 3(2): 15-22, jun 2021. tab
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1253889

RESUMO

La Atención Prehospitalaria (APH) es uno de los pilares fundamentales de los Sistemas de Emergencias Médicas que intenta brindar la mejor asistencia, en el menor tiempo y al menor costo. Para eso requiere componentes principales como recursos humanos y recursos físicos. Objetivo: Determinar si las competencias profesionales del personal del Instituto Ecuatoriano de Seguridad Social (IESS) de la Ciudad de Guayaquil responden al Servicio de Atención Prehospitalaria de acuerdo con los perfiles legales de contratación. Materiales y métodos: La investigación es de enfoque cuantitativo, de diseño observacional, prospectivo y de corte transversal. El tipo de estudio es descriptivo; gracias a que permitió recoger información y medir de manera individual o grupal la variable estudiada. La población de este estudio se constituyó por los profesionales con cargo de paramédicos del Instituto Ecuatoriano de Seguridad Social de la Ciudad de Guayaquil, los cuales son un total de 32 profesionales. Resultados: Una vez obtenido los datos se reflejó que, el 56,3% de los profesionales son de sexo femenino. Con respecto al título de los profesionales registrado en el Senescyt, solo el 56,3% lo posee de manera incompleto. El 56,3% de los profesionales tienen el puesto de paramédico 1. El 81,3% cumple con su tiempo de experiencia en el trabajo equivalente. En el aseguramiento de la escena el 46,9% cumple lo requerido. Los procedimientos en la atención Prehospitalaria del IESS es uno de los puntos de suma importancia en este estudio, ya que se identificó que el 65,6% cumple de manera parcial este procedimiento de atención. Conclusión: En la revisión de las competencias deducimos que no todo el personal fue contratado de acuerdo al perfil de contratación emitido por el MDT. Se Pudo observar una clara diferencia entre los perfiles de contratación entre paramédico 1 al paramédico 5, lo cuales tienen diferentes tipos de relevancia, lo que nos demuestra que hay una falta de formación a todos los niveles(AU)


Prehospital Care (PHC) is one of the fundamental pillars of Emergency Medical Systems that attempts to provide the best assistance, in the shortest time and at the lowest cost. For this purpose, it requires main components such as human resources and physical resources. Objective: To determine if the professional competencies of the personnel of the Ecuadorian Institute of Social Security (IESS) in the city of Guayaquil respond to the Prehospital Care Service in accordance with the legal hiring profiles. Materials and methods: The research has a quantitative approach, observational, prospective and cross-sectional design. The type of study is descriptive, since it allowed the collection of information and the individual or group measurement of the studied variable. The population of this study consisted of 32 professionals working as paramedics at the Ecuadorian Institute of Social Security in the city of Guayaquil. The results: Once the data were obtained, 56.3% of the professionals were female. With respect to the degree of the professionals registered in Senescyt, only 56.3% of them have incomplete degrees. For the professionals, 56.3% have the position of paramedic 1. 81.3% have the equivalent amount of work experience. In securing the scene, 46.9% meet the requirements. Pre-hospital care procedures at the IESS is one of the most important points in this study, since 65.6% of the patients were found to be partially compliant with these care procedures. Conclusion: In the review of competencies, we deduced that not all personnel were hired according to the hiring profile issued by the MDT. We could observe a clear difference between the hiring profiles between paramedic 1 to paramedic 5, which have different types of relevance, which shows that there is a lack of training at all levels(AU)


Assuntos
Humanos , Masculino , Feminino , Competência Profissional , Pessoal de Saúde , Assistência Pré-Hospitalar/ética , Assistência Hospitalar , Descrição de Cargo , Bioética , Serviços Médicos de Emergência , Avaliação de Resultados da Assistência ao Paciente
9.
BMC Health Serv Res ; 21(1): 564, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098944

RESUMO

BACKGROUND: Cancer diagnosis, treatment and survivorship is multifaceted, and the cancer patient experience can serve as a key indicator of healthcare performance and quality. The purpose of this paper was to analyse free-text responses from the second Northern Ireland Cancer Patient Experience Survey (NICPES) in 2018, to understand experiences of care, emerging themes and identify areas for improvement. METHODS: A 72-item questionnaire (relating to clinical care experience, socio-demographics and 3 free-text questions) was distributed to all Health & Social Care Northern Ireland patients that met the inclusion criteria (≥ 16 years old; confirmed primary diagnosis of cancer and discharged between 1st May and 31st October 2017) in June 2018. Participants could complete the questionnaire online or access a free telephone support line if required. Open-ended free text responses were analysed thematically to identify common themes. Free text responses were divided into positive or negative comments. RESULTS: In total, 3,748 people responded to the survey, with 2,416 leaving at least one free text comment (69 %). Women aged 55-74 years were most likely to comment. Overall, 3,644 comments were left across the three comments boxes, which were categorised as either positive (2,462 comments; 68 %) or negative / area for improvement (1,182 comments; 32 %). Analysis of free text responses identified six common themes (staff; speed [diagnosis and treatment]; safety; system; support services and specific concerns), which were all related to the overarching theme of survival. Staff was the largest single theme (1,458 responses) with overwhelmingly positive comments (1,322 responses; 91 %), whilst safety (296 negative comments; 70 %) and system (340 negative comments; 81 %) were predominantly negative. Negative comments relating to primary care, aftercare and the cancer system were reported. CONCLUSIONS: The high response rate to the free text comments indicates patients were motivated to engage. Analysis indicates most comments provided were positive in nature. Most survey respondents reported a positive experience in relation to staff. However, there were a number of areas for improvement including the aftercare experience, and a perceived disconnect between primary care and cancer services. These results can help inform the effective delivery of cancer services in Northern Ireland.


Assuntos
Neoplasias , Envio de Mensagens de Texto , Adolescente , Feminino , Humanos , Neoplasias/terapia , Irlanda do Norte/epidemiologia , Avaliação de Resultados da Assistência ao Paciente , Satisfação do Paciente , Inquéritos e Questionários
10.
Front Public Health ; 9: 606188, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34169053

RESUMO

Objective: Primary care in China is facing mounting challenges with multimorbidity as the aging population grows. Knowing how patients experience primary care may highlight the deficiencies of the care system and guide health system reform. The purpose of this study was to compare the quality of primary care experienced by patients with and without multimorbidity at community health centers (CHCs) in Shanghai, China and to examine the factors influencing these experiences. Methods: A cross-sectional survey was conducted from August to December 2019 using the validated Chinese Primary Care Assessment Tool-Adult Edition (PCAT-AE). ANOVA was performed to compare the overall and domain-specific quality of primary care for patients with and without multimorbidity. Multivariate linear regressions were used to assess the factors associated with primary care quality while controlling for patients' sociodemographic and healthcare characteristics. Results: From 2,404 completed questionnaires, patients with multimorbidity reported higher PCAT scores in the domains of first contact-utilization (3.54 ± 0.55 vs. 3.48 ± 0.56, P < 0.01), accessibility (2.93 ± 0.49 vs. 2.86 ± 0.47, P < 0.001), and ongoing care (3.20 ± 0.39 vs. 3.14 ± 0.43, P < 0.001), while reporting lower scores in coordination (information system) (2.72 ± 0.41 vs. 2.79 ± 0.35, P < 0.001) and family-centeredness (3.23 ± 0.63 vs. 3.30 ± 0.64, P < 0.01). Multimorbidity (ß = 0.355, P < 0.01), education level (ß = 0.826, P < 0.01), district (suburb: ß = 1.475, P < 0.001), and self-perceived good health status (ß = 0.337, P < 0.05) were associated with better patient experiences in primary care. Patients between the age 61 and 70 (ß = -0.623, P < 0.001; >70 years: ß = -0.573, P < 0.01), with a monthly household income ≥6,000 RMB (ß = -1.385, P < 0.001) and with more than 20 outpatient visits the previous year (ß = -1.883, P < 0.001) reported lower total PCAT scores. Conclusion: The findings of our study suggest that CHCs in China have contributed to better primary care experiences for patients with multimorbidity in certain quality domains, including first contact-utilization, accessibility, and ongoing care. However, there is still room for improvement in care coordination and family-centeredness.


Assuntos
Centros Comunitários de Saúde , Multimorbidade , Adulto , Idoso , China/epidemiologia , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Atenção Primária à Saúde
11.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(3): 560-565, 2021 Jun 18.
Artigo em Chinês | MEDLINE | ID: mdl-34145861

RESUMO

OBJECTIVE: To understand the relationship between health literacy and patient experience of outpatients in China, and to explore its mechanism. METHODS: The conceptual framework was developed based on Andersen's behavioral model of health services use and health literacy skills framework. An online cross-sectional survey was conducted with snowball sampling method, while the health literacy was measured by self-designed patient health literacy scale, and the patient experience was measured by the Chinese patient experience questionnaire for ambulatory care developed by Peking Union Medical College. And a structural equation model was built to explore the relationship between them and test the mechanism of health literacy influencing patient experience. RESULTS: A total of 2 773 subjects were investigated. The average score of health literacy was (90.72±12.90) points, accounting for 78.89% of the full score, and the dimension of seeking social support had the lowest score. The average score of overall rating of patient experience was (3.71±0.74) points, and the scores of each dimension of patient experience were between 3.56 and 3.80. The model fit indices of structural equation model for overall rating of patient experience among the outpatients were χ2/df=9.29 (χ2=4 107.27, df=442), root mean square error of approximation (RMSEA)=0.055 (< 0.06), comparative fit index (CFI)=0.926 (>0.90), Tucker-Lewis index (TLI)=0.918 (>0.90), standardized root mean square residual (SRMR)=0.061 (< 0.08), the model was acceptable. The variance in patient experience explained by the model was 0.108. The structural equation model analysis results showed that the overall rating of outpatient experience was directly affected by health literacy (ß=0.263, P < 0.001), also indirectly affected by health literacy (ß=0.012, P < 0.001). In other words, the overall rating increased by 0.275 units for each standard deviation increase of health literacy. Self-evaluated health status mediated the relationship between health literacy and the overall rating of outpatient experience. In terms of diffe-rent dimensions of patient experience, the standardized path coefficient of the total effect of health literacy on patient experience was as follows: Information guidance 0.337, humanistic care 0.319, communication with doctors 0.294, service efficiency 0.240, and hospital environment 0.173. CONCLUSION: The patients with higher level of health literacy were more likely to have a better outpatient experience in China, and the information guidance experience and humanistic care experience were most affected by health literacy. And the communication and information utilization ability had the greatest influence on patient experience.


Assuntos
Letramento em Saúde , Pacientes Ambulatoriais , China , Estudos Transversais , Humanos , Avaliação de Resultados da Assistência ao Paciente , Inquéritos e Questionários
12.
Ann R Coll Surg Engl ; 103(7): 530-535, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192483

RESUMO

INTRODUCTION: The purpose of this study was to analyse SRS-22 outcomes measures recorded on the British Spine Registry (BSR) for adolescent idiopathic scoliosis (AIS) surgery in the UK. METHODS: All cases having completed an SRS-22 outcome score and labelled with a diagnosis code of 'AIS' on the BSR were analysed. The SRS-22 score for primary cases was analysed by both individual domains and as a total score over time following surgery. RESULTS: A total of 3,860 cases were labelled as AIS recorded from 3,481 individuals. For primary cases, surgery improved the SRS-22 scores in every domain and as a total score, and this was maintained over time. There was no significant change in the scores recorded between 1 and 2 years of follow up apart from in function (and thus total score) for primary cases. CONCLUSIONS: Surgery for AIS in the UK improves quality of life assessed using SRS-22. Mandatory follow up to 2 years postoperatively adds little information not already known at 1 year. We recommend that the Best Practice Tariff incorporates the collection of outcomes data as this is likely to reduce missing data.


Assuntos
Avaliação de Resultados da Assistência ao Paciente , Qualidade de Vida , Escoliose/cirurgia , Fusão Vertebral/estatística & dados numéricos , Adolescente , Criança , Seguimentos , Humanos , Reoperação/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Reino Unido , Adulto Jovem
13.
Arch Virol ; 166(8): 2089-2108, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33934196

RESUMO

The SARS-CoV-2 pandemic has become one of the most serious health concerns globally. Although multiple vaccines have recently been approved for the prevention of coronavirus disease 2019 (COVID-19), an effective treatment is still lacking. Our knowledge of the pathogenicity of this virus is still incomplete. Studies have revealed that viral factors such as the viral load, duration of exposure to the virus, and viral mutations are important variables in COVID-19 outcome. Furthermore, host factors, including age, health condition, co-morbidities, and genetic background, might also be involved in clinical manifestations and infection outcome. This review focuses on the importance of variations in the host genetic background and pathogenesis of SARS-CoV-2. We will discuss the significance of polymorphisms in the ACE-2, TMPRSS2, vitamin D receptor, vitamin D binding protein, CD147, glucose-regulated protein 78 kDa, dipeptidyl peptidase-4 (DPP4), neuropilin-1, heme oxygenase, apolipoprotein L1, vitamin K epoxide reductase complex 1 (VKORC1), and immune system genes for the clinical outcome of COVID-19.


Assuntos
COVID-19/genética , Sistema ABO de Grupos Sanguíneos/genética , Enzima de Conversão de Angiotensina 2/genética , Apolipoproteína L1/genética , Basigina/genética , COVID-19/epidemiologia , COVID-19/terapia , Dipeptidil Peptidase 4/genética , Proteínas de Choque Térmico/genética , Heme Oxigenase-1/genética , Humanos , Imunidade/genética , Neuropilina-1/genética , Avaliação de Resultados da Assistência ao Paciente , Polimorfismo Genético , Receptores de Calcitriol/genética , SARS-CoV-2 , Serina Endopeptidases/genética , Proteína de Ligação a Vitamina D/genética , Vitamina K Epóxido Redutases/genética
14.
Curr Opin Psychiatry ; 34(4): 386-392, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1232246

RESUMO

PURPOSE OF REVIEW: Severe acute respiratory syndrome coronavirus (SARS-CoV2) infection rates are currently occurring at alarmingly accelerated rates. There is also a long-standing and concurrent rise in the prevalence and severity of substance use disorders (SUD). Therefore, the intersection between these two conditions needs to be carefully considered to ensure a more effective delivery of healthcare. RECENT FINDINGS: Generally, those with SUDs are more likely to have higher risk social determinants of health factors. Therefore, these patients are more likely to have barriers that can create difficulties in following appropriate infection control measures which in turn increases the risk of exposure to SARS-CoV2. In addition, these individuals have higher rates of medical comorbidities which increases the risk of all adverse outcomes, including mortality, from SARS-CoV2 infection. SUMMARY: Individuals with SUDs are at increased risk of both contracting SARS-CoV2 infection and suffering from worse outcomes afterwards. Though these risks of adverse outcomes are specific of SARS-CoV2 infection, the risk of exposure to other infectious diseases is increased in this population too. Healthcare providers and policymakers should then consider how to better protect this at-risk population and alleviate this increased disease burden.


Assuntos
COVID-19/complicações , COVID-19/terapia , Avaliação de Resultados da Assistência ao Paciente , Transtornos Relacionados ao Uso de Substâncias/complicações , COVID-19/patologia , Humanos , RNA Viral , Risco , Fatores de Risco , SARS-CoV-2 , Transtornos Relacionados ao Uso de Substâncias/patologia
15.
JAMA Netw Open ; 4(5): e218828, 2021 05 03.
Artigo em Inglês | MEDLINE | ID: covidwho-1210568

RESUMO

Importance: In-hospital mortality rates from COVID-19 are high but appear to be decreasing for selected locations in the United States. It is not known whether this is because of changes in the characteristics of patients being admitted. Objective: To describe changing in-hospital mortality rates over time after accounting for individual patient characteristics. Design, Setting, and Participants: This was a retrospective cohort study of 20 736 adults with a diagnosis of COVID-19 who were included in the US American Heart Association COVID-19 Cardiovascular Disease Registry and admitted to 107 acute care hospitals in 31 states from March through November 2020. A multiple mixed-effects logistic regression was then used to estimate the odds of in-hospital death adjusted for patient age, sex, body mass index, and medical history as well as vital signs, use of supplemental oxygen, presence of pulmonary infiltrates at admission, and hospital site. Main Outcomes and Measures: In-hospital death adjusted for exposures for 4 periods in 2020. Results: The registry included 20 736 patients hospitalized with COVID-19 from March through November 2020 (9524 women [45.9%]; mean [SD] age, 61.2 [17.9] years); 3271 patients (15.8%) died in the hospital. Mortality rates were 19.1% in March and April, 11.9% in May and June, 11.0% in July and August, and 10.8% in September through November. Compared with March and April, the adjusted odds ratios for in-hospital death were significantly lower in May and June (odds ratio, 0.66; 95% CI, 0.58-0.76; P < .001), July and August (odds ratio, 0.58; 95% CI, 0.49-0.69; P < .001), and September through November (odds ratio, 0.59; 95% CI, 0.47-0.73). Conclusions and Relevance: In this cohort study, high rates of in-hospital COVID-19 mortality among registry patients in March and April 2020 decreased by more than one-third by June and remained near that rate through November. This difference in mortality rates between the months of March and April and later months persisted even after adjusting for age, sex, medical history, and COVID-19 disease severity and did not appear to be associated with changes in the characteristics of patients being admitted.


Assuntos
COVID-19 , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Pneumonia Viral/diagnóstico por imagem , Fatores de Tempo , Fatores Etários , COVID-19/mortalidade , COVID-19/terapia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Pneumonia Viral/etiologia , Sistema de Registros , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Fatores Sexuais , Estados Unidos/epidemiologia , Sinais Vitais
16.
JCO Oncol Pract ; 17(5): e645-e653, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33974829

RESUMO

PURPOSE: Black patients with cancer report worse experiences with health care compared with White patients; however, little is known about what influences these ratings. The objective of this study is to explore the multilevel factors that influence global ratings of care for Black cancer survivors. METHODS: We conducted semistructured in-depth interviews with 18 Black cancer survivors. We assessed the global ratings of their personal doctor, specialist, health plan, prescription drug plan, and overall health care, and asked patients to elaborate on their rating. We analyzed the interviews with a deductive grounded theory approach using the socioecologic model to identify the individual, interpersonal, organizational, and environmental influences on Black cancer patient experiences with global ratings of care. We used an inductive constant comparison approach to identify additional themes that emerged. Two coauthors separately coded a set of transcripts and met to refine the codebook. RESULTS: On average, participants reported the highest mean rating for their specialist (9.39/10) and the lowest mean rating for their personal doctor (7.33/10). Emerging themes that influenced patient ratings were perceptions about their interaction with medical providers, physician communication, the doctor's expertise, and aspects of the physical facilities. Global ratings of care measures were widely influenced by patient interactions with their providers that were empathetic, nondiscriminatory, and where the doctors addressed all concerns. CONCLUSION: This grounded theory study identifies multiple aspects of health care that intervention researchers, health care administrators, and providers may target to improve Black cancer patient experiences with care.


Assuntos
Afro-Americanos , Neoplasias , Comunicação , Grupo com Ancestrais do Continente Europeu , Humanos , Neoplasias/terapia , Avaliação de Resultados da Assistência ao Paciente
18.
Eur J Haematol ; 107(2): 173-180, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33987882

RESUMO

Very rare cases of thrombosis associated with thrombocytopenia have occurred following the vaccination with AstraZeneca COVID-19 vaccine. The aim of this concise review is to summarize the current knowledge on the epidemiologic and pathogenic mechanisms of this syndrome named vaccine-associated immune thrombosis and thrombocytopenia (VITT). A practical patient management section will also be dealt with using information available from national and international scientific societies as well as expert panels. A literature search on the VITT syndrome was carried out in PubMed using appropriate MeSH headings. Overall, 40 VITT cases have been reported. Continuous pharmacovigilance monitoring is needed to collect more data on the real incidence and the pathogenesis of VITT syndrome. Such information will also help us to optimize the management this rare but often clinically severe thrombotic condition associated with COVID-19 vaccination.


Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19/complicações , SARS-CoV-2 , Trombocitopenia/etiologia , Trombose/etiologia , Biomarcadores , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/imunologia , Efeitos Psicossociais da Doença , Gerenciamento Clínico , Suscetibilidade a Doenças , Humanos , Avaliação de Resultados da Assistência ao Paciente , Medição de Risco , Fatores de Risco , SARS-CoV-2/imunologia , Índice de Gravidade de Doença , Síndrome , Trombocitopenia/diagnóstico , Trombocitopenia/epidemiologia , Trombocitopenia/terapia , Trombose/diagnóstico , Trombose/epidemiologia , Trombose/terapia
19.
BMC Health Serv Res ; 21(1): 409, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33933095

RESUMO

BACKGROUND: Health optimisation programmes are an increasingly popular policy intervention that aim to support patients to lose weight or stop smoking ahead of surgery. There is little evidence about their impact and the experience of their use. The aim of this study was to investigate the experiences and perspectives of commissioners, clinicians and patients involved in a locality's health optimisation programme in the United Kingdom. The programme alters access to elective orthopaedic surgery for patients who smoke or are obese (body mass index ≥ 30 kg/m2), diverting them to a 12-week programme of behavioural change interventions prior to assessment for surgical referral. METHODS: A thematic analysis of semi-structured interviews (n = 20) with National Health Service and Local Authority commissioners and planners, healthcare professionals, and patients using the pathway. RESULTS: Health optimisation was broadly acceptable to professionals and patients in our sample and offered a chance to trigger both short term pre-surgical weight loss/smoking cessation and longer-term sustained changes to lifestyle intentions post-surgery. Communicating the nature and purpose of the programme to patients was challenging and consequently the quality of the explanation received and understanding gained by patients was generally low. Insight into the successful implementation of health optimisation for the hip and knee pathway, but failure in roll-out to other surgical specialities, suggests placement of health optimisation interventions into the 'usual waiting time' for surgical referral may be of greatest acceptability to professionals and patients. CONCLUSIONS: Patients and professionals supported the continuation of health optimisation in this context and recognised likely health and wellbeing benefits for a majority of patients. However, the clinicians' communication to patients about health optimisation needs to improve to prepare patients and optimise their engagement.


Assuntos
Estilo de Vida , Medicina Estatal , Humanos , Avaliação de Resultados da Assistência ao Paciente , Pesquisa Qualitativa , Reino Unido
20.
BMJ Open ; 11(3): e043689, 2021 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-34006028

RESUMO

OBJECTIVE: Physiotherapists commonly provide non-surgical care for people with knee osteoarthritis (OA). It is unknown if patients are receiving high-quality physiotherapy care for their knee OA. This study aimed to explore the experiences of people who had recently received physiotherapy care for their knee OA in Australia and how these experiences aligned with the national Clinical Care Standard for knee OA. DESIGN: Qualitative study using semistructured individual telephone interviews and thematic analysis, where themes/subthemes were inductively derived. Questions were informed by seven quality statements of the OA of the Knee Clinical Care Standard. Interview data were also deductively analysed according to the Standard. SETTING: Participants were recruited from around Australia via Facebook and our research volunteer database. PARTICIPANTS: Interviews were conducted with 24 people with recent experience receiving physiotherapy care for their knee OA. They were required to be aged 45 years or above, had activity-related knee pain and any knee-related morning stiffness lasted no longer than 30 min. Participants were excluded if they had self-reported inflammatory arthritis and/or had undergone knee replacement surgery for the affected knee. RESULTS: Six themes emerged: (1) presented with a pre-existing OA diagnosis (prior OA care from other health professionals; perception of adequate OA knowledge); (2) wide variation in access and provision of physiotherapy care (referral pathways; funding models; individual vs group sessions); (3) seeking physiotherapy care for pain and functional limitations (knee symptoms; functional problems); (4) physiotherapy management focused on function and exercise (assessment of function; various types of exercises prescribed; surgery, medications and injections are for doctors; adjunctive treatments); (5) professional and personalised care (trust and/or confidence; personalised care) and (6) physiotherapy to postpone or prepare for surgery. CONCLUSION: Patients' experiences with receiving physiotherapy care for their knee OA were partly aligned with the standard, particularly regarding comprehensive assessment, self-management, and exercise.


Assuntos
Osteoartrite do Joelho , Fisioterapeutas , Austrália , Terapia por Exercício , Humanos , Osteoartrite do Joelho/terapia , Avaliação de Resultados da Assistência ao Paciente , Modalidades de Fisioterapia , Pesquisa Qualitativa
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