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1.
Isr Med Assoc J ; 23(3): 153-159, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33734627

RESUMO

BACKGROUND: Immune cell counts in blood in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection may be useful prognostic biomarkers of disease severity, mortality, and response to treatment. OBJECTIVES: To analyze sub-populations of lymphocytes at hospital admission in survivors and deceased from severe pneumonia due to coronavirus disease-2019 (COVID-19). METHODS: We conducted a cross-sectional study of healthcare workers confirmed with SARS-CoV-2 in convalescents (control group) and healthy controls (HC) diagnosed with severe COVID-19. Serum samples were taken at hospital admission and after recovery. Serum samples ≥ 25 days after onset of symptoms were analyzed for lymphocyte subpopulations through flow cytometry. Descriptive statistics, Kruskall-Wallis test, receiver operating characteristic curve, calculation of sensitivity, specificity, predictive values, and Kaplan-Meier analysis were performed. RESULTS: We included 337 patients: 120 HC, 127 convalescents, and 90 severe COVID-19 disease patients (50 survivors, 40 deceased). For T cells, total lymphocytes ≥ 800/µL, CD3+ ≥ 400/µL, CD4+ ≥ 180/µL, CD8+ ≥ 150/µL, B cells CD19+ ≥ 80/µL, and NK ≥ 34/µL subsets were associated with survival in severe COVID-19 disease patients. All subtypes of lymphocytes had higher concentrations in survivors than deceased, but similar between HC and convalescents. Leukocytes ≥ 10.150/µL or neutrophils ≥ 10,000/µL were associated with increased mortality. The neutrophil-to-lymphocyte ratio (NLR) ≥ 8.5 increased the probability of death in severe COVID-19 (odds ratio 11.68). CONCLUSIONS: Total lymphocytes; NLR; and levels of CD3+, CD4+, CD8+, and NK cells are useful as biomarkers of survival or mortality in severe COVID-19 disease and commonly reach normal levels in convalescents.


Assuntos
Linfócitos T CD4-Positivos/patologia , Linfócitos T CD8-Positivos/patologia , Linfopenia , Neutrófilos/patologia , Biomarcadores/sangue , /diagnóstico , /terapia , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Estimativa de Kaplan-Meier , Células Matadoras Naturais/patologia , Contagem de Leucócitos/métodos , Linfopenia/sangue , Linfopenia/diagnóstico , Linfopenia/etiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Mortalidade , Valor Preditivo dos Testes , Avaliação de Sintomas/métodos
2.
Bull Cancer ; 108(3): 242-249, 2021 Mar.
Artigo em Francês | MEDLINE | ID: mdl-33648719

RESUMO

INTRODUCTION: To promote the early diagnosis of pediatric cancers in Ivory Coast, we have initiated a program to train local physicians in the warning signs and to raise public awareness. The aim of this work was to compare the times, stages and survival of patients before and three years after the initiation of the program. METHODS: This retrospective study involved children 0-17 years of age admitted from January to December 2014 and from May 2018 to April 2019. The Mann-Whitney non-parametric test and the Fisher's exact test were used to compare time limits, stages and survival. RESULTS: One hundred and fifty-nine doctors were trained and 1020 people were sensitized. The median age of the 216 children included was 7 years, sex ratio 1.4. For both periods, the median consultation times were 75 and 30 days (P=0.003) and the median diagnostic times were 120 and 105 days (P=0.033). High-risk lymphomas accounted for 60.5% and 58.5% (P=0.99) respectively and nephroblastoma 46.1% and 56.2% (P=0.51). The overall survival was 31% and 30.2% (P=0.92). DISCUSSION: The early diagnosis program had no impact. The diagnosis times and the proportion of cancer classified as high risk are comparable to the data reported in sub-Saharan Africa, which vary respectively from 7 to 15.8 weeks and from 60 to 71%. This program must be intensified, extended to all health workers and include improving access to care.


Assuntos
Detecção Precoce de Câncer , Educação Médica , Neoplasias/diagnóstico , Desenvolvimento de Programas , Avaliação de Sintomas/métodos , Adolescente , Criança , Pré-Escolar , Costa do Marfim , Diagnóstico Tardio , Feminino , Humanos , Lactente , Recém-Nascido , Neoplasias Renais/diagnóstico , Neoplasias Renais/mortalidade , Linfoma/diagnóstico , Linfoma/mortalidade , Masculino , Neoplasias/mortalidade , Neoplasias/patologia , Médicos , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Tempo , Tumor de Wilms/diagnóstico , Tumor de Wilms/mortalidade
3.
BMJ Health Care Inform ; 28(1)2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33685943

RESUMO

OBJECTIVES: Identifying those individuals requiring medical care is a basic tenet of the pandemic response. Here, we examine the COVID-19 community triage pathways employed by four nations, specifically comparing the safety and efficacy of national online 'symptom checkers' used within the triage pathway. METHODS: A simulation study was conducted on current, nationwide, patient-led symptom checkers from four countries (Singapore, Japan, USA and UK). 52 cases were simulated to approximate typical COVID-19 presentations (mild, moderate, severe and critical) and COVID-19 mimickers (eg, sepsis and bacterial pneumonia). The same simulations were applied to each of the four country's symptom checkers, and the recommendations to refer on for medical care or to stay home were recorded and compared. RESULTS: The symptom checkers from Singapore and Japan advised onward healthcare contact for the majority of simulations (88% and 77%, respectively). The USA and UK symptom checkers triaged 38% and 44% of cases to healthcare contact, respectively. Both the US and UK symptom checkers consistently failed to identify severe COVID-19, bacterial pneumonia and sepsis, triaging such cases to stay home. CONCLUSION: Our results suggest that whilst 'symptom checkers' may be of use to the healthcare COVID-19 response, there is the potential for such patient-led assessment tools to worsen outcomes by delaying appropriate clinical assessment. The key features of the well-performing symptom checkers are discussed.


Assuntos
/diagnóstico , Informática em Saúde Pública/organização & administração , Avaliação de Sintomas/métodos , Triagem/organização & administração , Autoavaliação Diagnóstica , Letramento em Saúde/estatística & dados numéricos , Humanos , Japão , Singapura
4.
Medicina (Kaunas) ; 57(2)2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33672384

RESUMO

The global pandemic of the coronavirus disease 2019 is a known consequence of infection of severe respiratory syndrome coronavirus-2 (SARS-CoV-2). It has affected nations worldwide with soaring number of cases daily. Symptoms such as fever, cough, and shortness of breath, diarrhea, nausea and vomiting are commonly presented in COVID-19 patients. This focused review aims to discuss these uncommon and atypical COVID-19 symptoms that may be presented which might affect neurological, cardiovascular, cutaneous and ocular systems and their possible mode of actions. Nonetheless, there are some cases of reported uncommon or atypical symptoms which may warrant healthcare professionals to be aware of, especially when in contact with patients. The knowledge and information concerning these symptoms might be able to provide additional cues for healthcare professional by subjecting patients to COVID-19 screening. Meanwhile, it might be able to further enhance the alertness and additional precautions being taken by healthcare personnel, which eventually lead to reduced risk of infections.


Assuntos
/métodos , Programas de Rastreamento/métodos , Avaliação de Sintomas/métodos , Humanos
6.
BMJ Open ; 11(3): e044154, 2021 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-33674374

RESUMO

OBJECTIVE: Describe the disease course in a cohort of outpatients with COVID-19 and evaluate factors predicting duration of symptoms. DESIGN: Retrospective cohort study. SETTING: Telemedicine clinic at a large medical system in Atlanta, Georgia. PARTICIPANTS: 337 patients with acute COVID-19. Exclusion criteria included intake visit more than 10 days after symptom onset and hospitalisation prior to intake visit. MAIN OUTCOME MEASURES: Symptom duration in days. RESULTS: Common symptoms at intake visit are upper respiratory (73% cough, 55% loss of smell or taste, 57% sinus congestion, 32% sore throat) and systemic (66% headache, 64% body aches, 53% chills, 30% dizziness, 36% fever). Day of symptom onset was earliest for systemic and upper respiratory symptoms (median onset day 1 for both), followed by lower respiratory symptoms (day 3, 95% CI 2 to 4), with later onset of gastrointestinal symptoms (day 4, 95% CI 3 to 5), when present. Cough had the longest duration when present with median 17 days (95% CI 15 to 21), with 42% not resolved at final visit. Loss of smell or taste had the second longest duration with 14 days (95% CI 12 to 17), with 38% not resolved at final visit. Initial symptom severity is a significant predictor of symptom duration (p<0.01 for multiple symptoms). CONCLUSIONS: COVID-19 illness in outpatients follows a pattern of progression from systemic symptoms to lower respiratory symptoms and persistent symptoms are common across categories. Initial symptom severity is a significant predictor of disease duration for most considered symptoms.


Assuntos
/diagnóstico , Avaliação de Sintomas/métodos , Telemedicina , Adulto , Idoso , Feminino , Georgia , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos
7.
Infez Med ; 29(1): 20-36, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33664170

RESUMO

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), the causative pathogen for the COVID-19, first emerged in Wuhan, China, in December 2019 and by March 2020, it was declared a pandemic. COVID-19 pandemic has overburdened healthcare systems in most countries and has led to massive economic losses. SARS-CoV-2 transmission typically occurs by respiratory droplets. The average incubation period is 6.4 days and presenting symptoms typically include fever, cough, dyspnea, myalgia or fatigue. While the majority of patients tend to have a mild illness, a minority of patients develop severe hypoxia requiring hospitalization and mechanical ventilation. Management is mostly supportive. However, several direct anti-viral agents, and immunomodulatory therapy with steroids and various cytokine blockers seem promising in early results. However, an effective vaccine has been established, which will help curb the pandemic.


Assuntos
Saúde Global/estatística & dados numéricos , Pandemias , /patogenicidade , Corticosteroides/uso terapêutico , Microbiologia do Ar , Antivirais/uso terapêutico , /diagnóstico , /terapia , /uso terapêutico , Transmissão de Doença Infecciosa , Hospitalização , Humanos , Hipóxia/etiologia , Hipóxia/terapia , Imunização Passiva , Fatores Imunológicos/uso terapêutico , Período de Incubação de Doenças Infecciosas , Prevenção Primária/métodos , Respiração Artificial , /genética , Esteroides/uso terapêutico , Avaliação de Sintomas/métodos
8.
Medicine (Baltimore) ; 100(9): e24604, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655925

RESUMO

ABSTRACT: Mortality of critically ill patients with coronavirus disease 2019 (COVID-19) was high. Aims to examine whether time from symptoms onset to intensive care unit (ICU) admission affects incidence of extra-pulmonary complications and prognosis in order to provide a new insight for reducing the mortality. A single-centered, retrospective, observational study investigated 45 critically ill patients with COVID-19 hospitalized in ICU of The Third People's Hospital of Yichang from January 17 to March 29, 2020. Patients were divided into 2 groups according to time from symptoms onset to ICU admission (>7 and ≤7 days) and into 2 groups according to prognosis (survivors and non-survivors). Epidemiological, clinical, laboratory, radiological characteristics and treatment data were studied. Compared with patients who admitted to the ICU since symptoms onset ≤7 days (55.6%), patients who admitted to the ICU since symptoms onset >7 days (44.4%) were more likely to have extra-pulmonary complications (19 [95.0%] vs 16 [64.0%], P = .034), including acute kidney injury, cardiac injury, acute heart failure, liver dysfunction, gastrointestinal hemorrhage, hyperamylasemia, and hypernatremia. The incidence rates of acute respiratory distress syndrome, pneumothorax, and hospital-acquired pneumonia had no difference between the 2 groups. Except activated partial thromboplastin and Na+ concentration, the laboratory findings were worse in group of time from symptoms onset to ICU admission >7 days. There was no difference in mortality between the 2 groups. Of the 45 cases in the ICU, 19 (42.2%) were non-survivors, and 16 (35.6%) were with hospital-acquired pneumonia. Among these non-survivors, hospital-acquired pneumonia was up to 12 (63.2%) besides higher incidence of extra-pulmonary complications. However, hospital-acquired pneumonia occurred in only 4 (15.4%) survivors. Critically ill patients with COVID-19 who admitted to ICU at once might get benefit from intensive care via lower rate of extra-pulmonary complications.


Assuntos
Cuidados Críticos , Estado Terminal , Avaliação de Sintomas , Tempo para o Tratamento/estatística & dados numéricos , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , /diagnóstico , /fisiopatologia , China/epidemiologia , Cuidados Críticos/métodos , Cuidados Críticos/estatística & dados numéricos , Estado Terminal/mortalidade , Estado Terminal/terapia , Doenças do Sistema Digestório/diagnóstico , Doenças do Sistema Digestório/etiologia , Feminino , Pneumonia Associada a Assistência à Saúde/diagnóstico , Pneumonia Associada a Assistência à Saúde/mortalidade , Cardiopatias/diagnóstico , Humanos , Hiperamilassemia/diagnóstico , Hiperamilassemia/etiologia , Hipernatremia/diagnóstico , Hipernatremia/etiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Prognóstico , Análise de Sobrevida , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos
9.
Emerg Infect Dis ; 27(4)2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33567247

RESUMO

Multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with higher transmission potential have been emerging globally, including SARS-CoV-2 variants from the United Kingdom and South Africa. We report 4 travelers from Brazil to Japan in January 2021 infected with a novel SARS-CoV-2 variant with an additional set of mutations.


Assuntos
/tratamento farmacológico , Doenças Transmissíveis Importadas , Adulto , Número Básico de Reprodução , Brasil/epidemiologia , /terapia , /virologia , Doenças Transmissíveis Importadas/epidemiologia , Doenças Transmissíveis Importadas/fisiopatologia , Doenças Transmissíveis Importadas/terapia , Doenças Transmissíveis Importadas/virologia , Hospitalização , Humanos , Japão/epidemiologia , Masculino , Mutação , Quarentena/métodos , /isolamento & purificação , Avaliação de Sintomas/métodos , Doença Relacionada a Viagens , Resultado do Tratamento
10.
Emerg Infect Dis ; 27(4)2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33600301

RESUMO

We determined secondary attack rates (SAR) among close contacts of 59 asymptomatic and symptomatic coronavirus disease case-patients by presymptomatic and symptomatic exposure. We observed no transmission from asymptomatic case-patients and highest SAR through presymptomatic exposure. Rapid quarantine of close contacts with or without symptoms is needed to prevent presymptomatic transmission.


Assuntos
Busca de Comunicante , Transmissão de Doença Infecciosa , Quarentena , /isolamento & purificação , Adulto , Doenças Assintomáticas/epidemiologia , /epidemiologia , /transmissão , Busca de Comunicante/métodos , Busca de Comunicante/estatística & dados numéricos , Transmissão de Doença Infecciosa/prevenção & controle , Transmissão de Doença Infecciosa/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Quarentena/métodos , Quarentena/organização & administração , Risco Ajustado , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos
11.
Aging (Albany NY) ; 13(3): 3176-3189, 2021 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-33561834

RESUMO

To establish an effective nomogram for predicting in-hospital mortality of COVID-19, a retrospective cohort study was conducted in two hospitals in Wuhan, China, with a total of 4,086 hospitalized COVID-19 cases. All patients have reached therapeutic endpoint (death or discharge). First, a total of 3,022 COVID-19 cases in Wuhan Huoshenshan hospital were divided chronologically into two sets, one (1,780 cases, including 47 died) for nomogram modeling and the other (1,242 cases, including 22 died) for internal validation. We then enrolled 1,064 COVID-19 cases (29 died) in Wuhan Taikang-Tongji hospital for external validation. Independent factors included age (HR for per year increment: 1.05), severity at admission (HR for per rank increment: 2.91), dyspnea (HR: 2.18), cardiovascular disease (HR: 3.25), and levels of lactate dehydrogenase (HR: 4.53), total bilirubin (HR: 2.56), blood glucose (HR: 2.56), and urea (HR: 2.14), which were finally selected into the nomogram. The C-index for the internal resampling (0.97, 95% CI: 0.95-0.98), the internal validation (0.96, 95% CI: 0.94-0.98), and the external validation (0.92, 95% CI: 0.86-0.98) demonstrated the fair discrimination ability. The calibration plots showed optimal agreement between nomogram prediction and actual observation. We established and validated a novel prognostic nomogram that could predict in-hospital mortality of COVID-19 patients.


Assuntos
Mortalidade Hospitalar , Nomogramas , Fatores Etários , Idoso , Análise Química do Sangue/métodos , Análise Química do Sangue/estatística & dados numéricos , /diagnóstico , /fisiopatologia , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos
13.
BMC Neurol ; 21(1): 2, 2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33397315

RESUMO

BACKGROUND: Nocturnal symptoms in Parkinson's disease are often treated after management of daytime manifestations. In order to better understand the unmet needs of nocturnal symptoms management, we analyzed the characteristics and burden of nocturnal symptoms from patients' perspectives and explored their changes over time. Overall symptoms (occurring at day or night) were collected to compare whether the unmet needs related to nocturnal symptoms and to overall symptoms are different. METHODS: We used a Social Listening big-data technique to analyze large amounts of Parkinson's disease symptoms in dialogues available from social media platforms in 2016 to 2018. These symptoms were classified as either overall symptoms or nocturnal symptoms. We used share of voice (SOV) of symptoms as a proportion of total dialogues per year to reflect the characteristics of symptoms. Negative sentiment score of symptoms was analyzed to find out their related burden. RESULTS: We found the SOV for overall motor symptoms was 79% and had not increased between 2016 and 2018 (79%, p = 0.5). The SOV for non-motor symptoms was 69% and had grown by 7% in 2018 (p <  0.01). The SOV for motor complications was 9% and had increased by 6% in 2018 (p <  0.01). The SOV of motor symptoms was larger than non-motor symptoms and motor complications (p <  0.01). The SOV of non-motor symptoms was larger than motor complications (p <  0.01). For nocturnal symptoms, 45% of the analyzed PD population reported nocturnal symptoms in 2018, growing by 6% (p <  0.01). The SOV for nocturnal-occurring motor symptoms was higher than most non-motor symptoms. However, non-motor symptoms had the higher increases and evoked higher negative sentiment regardless of whether they occurred during the day or night. For symptoms that can occur at either day or night, each nocturnal symptom was rated with a higher negative sentiment score than the same symptom during the day. CONCLUSIONS: The growing SOV and the greater negative sentiment of nocturnal symptoms suggest management of nocturnal symptoms is an unmet need of patients. A greater emphasis on detecting and treating nocturnal symptoms with 24-h care is encouraged.


Assuntos
Mineração de Dados/métodos , Doença de Parkinson/complicações , Avaliação de Sintomas/métodos , Idoso , Big Data , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia , Mídias Sociais , Fatores de Tempo
14.
Artigo em Inglês | MEDLINE | ID: mdl-33445452

RESUMO

The coronavirus disease (COVID-19) pandemic in 2020 resulted in widespread interruption of team sports training and competitions. Our aim was to review the recommendations and best practices in return to play in non-professional football after activity lockdown. The authors searched two electronic databases (PubMed, Web of Science) to extract studies published before September 15 2020. Twenty studies explained recommendations, considerations, or best practices in return to play in football, and all of them were clustered into three groups: (1) training load management (n = 10), (2) medical recommendations (n = 9), and (3) recovery related issues (n = 5). The way to establish a progression in training process should be based on training load management and managing the number of stimuli per time. Following the studies, this training process should be divided into three phases: phase 1-physical distancing should be maintained; phases 2 and 3-group training should start. Medical considerations were clustered into different groups: general, pre- and post- training, during training, education, planning to return to competition, and suggestions for post confinement weeks. In particular, social issues, strict hygiene questions, and continuous PCR testing should be considered in return to play over football season. Finally, since a correlation has been found between high-intensive training loads and immunoglobulin A, nutritional and lifestyle recovery strategies should be performed. Moreover, since immunosuppression has been related to congested schedules (<72 h between matches), football federations should avoid this situation.


Assuntos
/diagnóstico , Futebol Americano/estatística & dados numéricos , Volta ao Esporte , Segurança , Futebol/estatística & dados numéricos , /epidemiologia , Controle de Doenças Transmissíveis , Alemanha/epidemiologia , Humanos , Masculino , Guias de Prática Clínica como Assunto , Avaliação de Sintomas/métodos
16.
Indian Pediatr ; 58(2): 126-128, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33340072

RESUMO

OBJECTIVE: To describe the broader clinical spectrum of COVID-19 in children. METHODS: In this descriptive, prospective study, we included confirmed pediatric patients with COVID-19 who presented to the emergency department of a pediatric tertiary care center from April to July, 2020. All patients were confirmed by the SARS-CoV-2 RT-PCR test, and we analyzed 24 symptoms and 25 signs. RESULTS: Among the 50 patients with COVID-19, the most common symptoms were fever, excessive cry and dry cough; digestive symptoms were frequently found (24%). The most common signs were pharyngeal erythema and irritability. CONCLUSIONS: Clinicians should recognize that the clinical spectrum of COVID-19 in children is wider than previously described, often with nonspecific signs and symptoms, and digestive symptoms should raise suspicion.


Assuntos
Doenças do Sistema Digestório , Avaliação de Sintomas , /epidemiologia , /psicologia , /estatística & dados numéricos , Criança , Pré-Escolar , Tosse/diagnóstico , Tosse/etiologia , Doenças do Sistema Digestório/diagnóstico , Doenças do Sistema Digestório/virologia , Feminino , Febre/diagnóstico , Febre/etiologia , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Humor Irritável/fisiologia , Masculino , México/epidemiologia , Estudos Prospectivos , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos
17.
Support Care Cancer ; 29(1): 301-310, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32358779

RESUMO

BACKGROUND: Children with cancer have difficulty identifying and describing the multiple symptoms they experience during hospitalization and between clinical encounters. Mobile health resources, including apps, are potential solutions to support child-centric symptom reporting. This study evaluated the feasibility and acceptability of a newly developed game-based symptom-reporting app for school-age children with cancer. PROCEDURE: Nineteen school-age children (6-12 years of age) receiving treatment for cancer at a COG institution in the Intermountain West of the United States used a game-based symptom-reporting app between clinical visits. Feasibility was evaluated through a summary of actual days of app use and interaction with each of the app's features. Children and their parents participated in interviews regarding the app's acceptability. RESULTS: Children used the app a median of 4 days (range 1-12) and interacted most frequently with the symptom reporting and the drawing features. Children enjoyed aspects of the app that supported their creativity and provided choices. Parents endorsed the interactive nature of the app and the value of the child providing his/her own report. Both children and parents identified additional opportunities to enhance the child's user experience. CONCLUSION: Study results support the preliminary feasibility and acceptability of the app. Children's and parents' responses supported the developmental relevance of the app and its role in enhancing the child's autonomy and serving as an outlet for creativity. Future directions include optimizing the child user's experience and investigating the app's role as a resource to enhance shared decision-making for symptom management.


Assuntos
Aplicativos Móveis , Neoplasias/diagnóstico , Avaliação de Sintomas/métodos , Jogos de Vídeo/estatística & dados numéricos , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pais , Telemedicina/métodos
18.
Support Care Cancer ; 29(1): 485-490, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32405963

RESUMO

AIM: To assess financial distress (FD) and its impact on symptom expression and other quality of life issues PATIENTS AND METHODS: Advanced cancer patients admitted to inpatient and outpatient clinics were selected. Standard epidemiological data including age, gender, primary cancer diagnosis, and Karnofsky level were recorded. Data regarding marital status, number of cohabitants, religious belief, educational level, and family income (< 1000, 1000-3.000, > 3000 euros), as well as extra costs not covered by health care system, were collected. Symptom burden including FD was measured by Edmonton Symptom Assessment Scale (ESAS), FACT-G (Functional Assessment of Cancer Therapy-General), and HADS (Hospital Anxiety Depression scale) were measured. RESULTS: Two hundred thirty-six patients were evaluated. The mean FD was 3.55 (SD 3.1). One hundred patients (42%) had a FD of ≥ 4. There was an inverse correlation between FD and income (P = 0.032). Most patients incurred in extra-costs, the most frequent being for drugs (n, 114). FD was inversely associated with age (P = 0.024), marital status (divorced or separated, P = 0.005), ESAS anxiety (P = 0.006), total ESAS (P = 0.019), physical well-being (P = 0.033), poor social family well-being (P = 0.004), emotional well-being (P = 0.045), poor functional well-being (P = 0.019), HADS-A (P = 0.003), and global HADS (P = 0.034). Family income was inversely related to age (P = 0.023), education level (P < 0.0005), less number of hospital admissions in the last month (P = 0.020), physical well-being (P = 0.039), social/family well-being (P = 0.020), and total well-being (P = 0.001). CONCLUSION: FD is very common in advanced cancer patients. FD was associated with anxiety, depression, and poor quality of life. The screening of FD may allow to develop effective interventions of social support.


Assuntos
Neoplasias/economia , Qualidade de Vida/psicologia , Avaliação de Sintomas/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Neoplasias/psicologia
19.
Support Care Cancer ; 29(1): 515-524, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32415385

RESUMO

BACKGROUND: Patients with metastatic gastric cancer have poor survival outcomes and may experience high symptom burden. We evaluated symptom trajectory and risk factors for increased symptom severity among metastatic gastric cancer patients during the last 6 months of life. METHODS: We conducted a retrospective cohort study among patients ≥ 18 years diagnosed with metastatic gastric cancer from January 2007 to December 2014 in the province of Ontario, Canada. We included patients who died during the study period and who reported at least one Edmonton Symptom Assessment System (ESAS) score during the last 6 months of life. We described the proportion of patients who reported moderate-to-severe symptom scores (≥ 4) by month. Multivariable logistic regression models were created to identify risk factors for moderate-to-severe symptom scores. RESULTS: Seven hundred eighty-eight eligible patients with 3286 unique symptom scores completed during their last 6 months of life were identified. The highest prevalence of moderate-to-severe scores was observed for tiredness and lack of appetite, while nausea and depression had the lowest prevalence of elevated scores. The prevalence of moderate-to-severe was consistently high for all symptoms, particularly approaching end-of-life. Timing of ESAS scores, receipt of cancer-directed therapy, urban residence, and female sex were associated with increased odds of reporting moderate-to-severe symptom scores. CONCLUSION: Patients with metastatic gastric cancer experience significant symptom burden at the end-of-life. Routine screening with patient-reported outcome tools may assist in shared decision-making and effective palliative care by ensuring patients' health status and supportive care needs are identified promptly at the time of clinical encounters.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Neoplasias Gástricas/complicações , Avaliação de Sintomas/métodos , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
20.
Internist (Berl) ; 62(1): 34-46, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33355682

RESUMO

Back pain is a common reason for consulting a general practitioner. For 80% of patients, the back pain is nonspecific. Specific back pain has a determinable cause that needs to be rapidly identified. The diagnostic work-up to clarify spinal pain involves a detailed patient history taking into account the "red flags", a clinical examination and further stepwise diagnostics. In addition to laboratory diagnostics, structured morphological imaging is necessary. Causes of specific back pain include: fractures, infections, radiculopathy, tumors, axial spondylarthritis, as well as extravertebral causes. The diagnosis, treatment and continuous follow-up of the patient with specific back pain is interdisciplinary and requires close communication with the relevant specialists.


Assuntos
Dor nas Costas/etiologia , Exame Físico , Atenção Primária à Saúde/métodos , Doenças da Coluna Vertebral/diagnóstico por imagem , Dor nas Costas/diagnóstico , Dor nas Costas/terapia , Diagnóstico por Imagem/métodos , Humanos , Dor Lombar/etiologia , Anamnese , Fatores de Risco , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/terapia , Avaliação de Sintomas/métodos
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