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1.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 541-544, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018046

RESUMO

Epileptic seizure prediction explores the probability of forecasting the onset of epileptic seizure, which aids to timely treatment for patients. It provides a time lead compared to traditional seizure detection. In this paper, a spectral feature extraction is developed and the seizure prediction is performed based on uncorrelated multilinear discriminant analysis (UMLDA) and Support Vector Machine (SVM). To make best use of information in different dimension, we construct a three-order tensor in temporal, spectral and spatial domain by wavelet transform. And UMLDA implements the tensor-to-vector projection (TVP) with the minimum redundancy. The proposed solution employed 23 subjects' Electroencephalogram (EEG) data from Boston Children's Hospital-MIT scalp EEG dataset, each subject contains 40 minutes EEG signal. For the classification task of ictal state and preictal state, it exhibits an overall accuracy of 95%.


Assuntos
Algoritmos , Epilepsia , Boston , Criança , Análise Discriminante , Epilepsia/diagnóstico , Humanos , Convulsões/diagnóstico
2.
JAMA Netw Open ; 3(9): e2020498, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32902653

RESUMO

Importance: Some patients are avoiding essential care for fear of contracting coronavirus disease 2019 (COVID-19) in hospitals. There are few data, however, on the risk of acquiring COVID-19 in US hospitals. Objective: To assess the incidence of COVID-19 among patients hospitalized at a large US academic medical center in the 12 weeks after the first inpatient case was identified. Design, Setting, and Participants: This cohort study included all patients admitted to Brigham and Women's Hospital (Boston, Massachusetts) between March 7 and May 30, 2020. Follow-up occurred through June 17, 2020. Medical records for all patients who first tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction (RT-PCR) on hospital day 3 or later or within 14 days of discharge were reviewed. Exposures: A comprehensive infection control program was implemented that included dedicated COVID-19 units with airborne infection isolation rooms, personal protective equipment in accordance with US Centers for Disease Control and Prevention recommendations, personal protective equipment donning and doffing monitors, universal masking, restriction of visitors, and liberal RT-PCR testing of symptomatic and asymptomatic patients. Main Outcomes and Measures: Whether infection was community or hospital acquired based on timing of tests, clinical course, and exposures. Results: Over the 12-week period, 9149 patients (mean [SD] age, 46.1 [26.4] years; median [IQR] age, 51 years [30-67 years]; 5243 female [57.3%]) were admitted to the hospital, for whom 7394 SARS-CoV-2 RT-PCR tests were performed; 697 COVID-19 cases were confirmed, translating into 8656 days of COVID-19-related care. Twelve of the 697 hospitalized patients with COVID-19 (1.7%) first tested positive on hospital day 3 or later (median, 4 days; range, 3-15 days). Of these, only 1 case was deemed to be hospital acquired, most likely from a presymptomatic spouse who was visiting daily and diagnosed with COVID-19 before visitor restrictions and masking were implemented. Among 8370 patients with non-COVID-19-related hospitalizations discharged through June 17, 11 (0.1%) tested positive within 14 days (median time to diagnosis, 6 days; range, 1-14 days). Only 1 case was deemed likely to be hospital acquired, albeit with no known exposures. Conclusions and Relevance: In this cohort study of patients in a large academic medical center with rigorous infection control measures, nosocomial COVID-19 was rare during the height of the pandemic in the region. These findings may inform practices in other institutions and provide reassurance to patients concerned about contracting COVID-19 in hospitals.


Assuntos
Centros Médicos Acadêmicos , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/epidemiologia , Hospitalização , Pandemias , Pneumonia Viral/epidemiologia , Adulto , Idoso , Betacoronavirus , Boston/epidemiologia , Coronavirus , Infecções por Coronavirus/etiologia , Infecções por Coronavirus/virologia , Infecção Hospitalar/virologia , Feminino , Humanos , Incidência , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/etiologia , Pneumonia Viral/virologia , Medição de Risco , Síndrome Respiratória Aguda Grave , Visitas a Pacientes , Adulto Jovem
3.
J Anesth Hist ; 6(3): 151-155, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32921485

RESUMO

BACKGROUND: Regional and general anesthesia were widely available in the United States in the late 1960s. The risk of permanent neurological sequelae resulting from spinal anesthesia had largely been dismissed. Although many academic departments of anesthesiology had gained independent status, a significant number operated as divisions within the department of surgery. We present a case report from Peter Bent Brigham Hospital to illustrate the state of anesthetic techniques in use during the late 1960s, and the power dynamics vis-à-vis physician anesthesiologists and surgeons. SOURCES: Hospital records and interviews with individuals familiar with the case. FINDINGS: An otherwise healthy patient underwent inguinal hernia repair. The resident anesthesiologist conducted a preoperative assessment the evening prior to surgery with the patient consenting to the spinal anesthesia, a plan agreeable to the faculty anesthesiologist. The attending surgeon was one of the most prominent surgeons in America and the chairman of their department. He disapproved of the planned anesthetic. Subsequent modifications to the anesthetic plans are discussed, as is the fallout from those actions. CONCLUSION: Spinal anesthesia remained a popular anesthetic option during the late 1960s. General anesthesia with ether, halothane, and other agents an alternative. This case highlights various aspects of perioperative management during a period when many American academic departments of anesthesiology existed as divisions within the department of surgery. It also touches upon the careers of two prominent American physicians.


Assuntos
Anestesia Geral/história , Raquianestesia/história , Anestesiologia/história , Anestesiologistas/história , Anestesiologia/métodos , Boston , História do Século XX , Hospitais de Ensino/história , Humanos , Relações Interprofissionais , Publicações Periódicas como Assunto/história , Cirurgiões/história
4.
J Anesth Hist ; 6(3): 133-142, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32921483

RESUMO

After a brief "golden age" in the late 1800s, the patriarchal establishment fought back and women faced increasing restrictions in practicing medicine. In 1900, 18.2% of all physicians in the city of Boston were women, but this number decreased to 8.7% by 1930. The relatively young field of anesthesiology was one of the more welcoming specialties for women during this time. History has been unkind to these early female trailblazers who have often been overlooked in favor of the men in their fields. Julia Gordon Arrowood (1900-1984) was a forerunner for women in medicine and a prominent anesthesiologist in Boston from the 1930s until the 1950s. Her work included not only clinical medicine, but also research and teaching. She attended Boston University School of Medicine, graduating as valedictorian in the class of 1933. She interned at Belmont Hospital in Worcester, MA where she decided on a career in anesthesiology. She was accepted as a resident at Massachusetts General Hospital (MGH) by chief-anesthetist Henry Beecher in 1935, thereby becoming the first woman anesthesiology resident in Massachusetts. She remained at MGH and was named Acting Chief of Anesthesia in 1943. In 1944, she became president of the New England Society of Anesthesiologists, another first for a woman. In 1946, she joined Reginald Smithwick's team as Chief of Anesthesia at Massachusetts Memorial Hospital, Boston, and concurrently held the position of Professor of Anesthesiology at Boston University School of Medicine. Arrowood led many of the earliest studies on spinal anesthesia, muscle relaxants, and spinal headaches. In 1957, she moved to Kentucky and joined the United Mine Workers hospital system where she worked until her retirement in 1970. Women such as Julia Arrowood remain underrepresented in the annals of the history of medicine. Much work is needed to recognize the many contributions made by women physicians and to provide equal opportunities, pay, and status.


Assuntos
Anestesiologistas/história , Médicas/história , Anestesiologia/história , Boston , História do Século XX , Internato e Residência/história , Faculdades de Medicina/história , Sexismo/história , Estados Unidos
6.
JAMA Netw Open ; 3(9): e2022058, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32965501

RESUMO

Importance: Coronavirus disease 2019 (COVID-19) is an acute respiratory illness with a high rate of hospitalization and mortality. Biomarkers are urgently needed for patient risk stratification. Red blood cell distribution width (RDW), a component of complete blood counts that reflects cellular volume variation, has been shown to be associated with elevated risk for morbidity and mortality in a wide range of diseases. Objective: To investigate whether an association between mortality risk and elevated RDW at hospital admission and during hospitalization exists in patients with COVID-19. Design, Setting, and Participants: This cohort study included adults diagnosed with SARS-CoV-2 infection and admitted to 1 of 4 hospitals in the Boston, Massachusetts area (Massachusetts General Hospital, Brigham and Women's Hospital, North Shore Medical Center, and Newton-Wellesley Hospital) between March 4, 2020, and April 28, 2020. Main Outcomes and Measures: The main outcome was patient survival during hospitalization. Measures included RDW at admission and during hospitalization, with an elevated RDW defined as greater than 14.5%. Relative risk (RR) of mortality was estimated by dividing the mortality of those with an elevated RDW by the mortality of those without an elevated RDW. Mortality hazard ratios (HRs) and 95% CIs were estimated using a Cox proportional hazards model. Results: A total of 1641 patients were included in the study (mean [SD] age, 62[18] years; 886 men [54%]; 740 White individuals [45%] and 497 Hispanic individuals [30%]; 276 nonsurvivors [17%]). Elevated RDW (>14.5%) was associated with an increased mortality risk in patients of all ages. The RR for the entire cohort was 2.73, with a mortality rate of 11% in patients with normal RDW (1173) and 31% in those with an elevated RDW (468). The RR in patients younger than 50 years was 5.25 (normal RDW, 1% [n = 341]; elevated RDW, 8% [n = 65]); 2.90 in the 50- to 59-year age group (normal RDW, 8% [n = 256]; elevated RDW, 24% [n = 63]); 3.96 in the 60- to 69-year age group (normal RDW, 8% [n = 226]; elevated RDW, 30% [104]); 1.45 in the 70- to 79-year age group (normal RDW, 23% [n = 182]; elevated RDW, 33% [n = 113]); and 1.59 in those ≥80 years (normal RDW, 29% [n = 168]; elevated RDW, 46% [n = 123]). RDW was associated with mortality risk in Cox proportional hazards models adjusted for age, D-dimer (dimerized plasmin fragment D) level, absolute lymphocyte count, and common comorbidities such as diabetes and hypertension (hazard ratio of 1.09 per 0.5% RDW increase and 2.01 for an RDW >14.5% vs ≤14.5%; P < .001). Patients whose RDW increased during hospitalization had higher mortality compared with those whose RDW did not change; for those with normal RDW, mortality increased from 6% to 24%, and for those with an elevated RDW at admission, mortality increased from 22% to 40%. Conclusions and Relevance: Elevated RDW at the time of hospital admission and an increase in RDW during hospitalization were associated with increased mortality risk for patients with COVID-19 who received treatment at 4 hospitals in a large academic medical center network.


Assuntos
Infecções por Coronavirus/mortalidade , Índices de Eritrócitos , Eritrócitos , Hospitalização , Pneumonia Viral/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Biomarcadores/sangue , Boston/epidemiologia , Coronavirus , Infecções por Coronavirus/sangue , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Admissão do Paciente , Pneumonia Viral/sangue , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Síndrome Respiratória Aguda Grave
7.
PLoS One ; 15(8): e0237651, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817684

RESUMO

Body dysmorphic disorder (BDD) is associated with severe comorbidity and impairment. Muscle dysmorphia (MD) is a subtype of BDD which has rarely been assessed outside of undergraduate student samples. Further, there are limited data comparing MD to other psychiatric disorders, including BDD. Thus, the aim of the current study is to explore differences in symptom severity and conformity to masculine norms in men diagnosed with BDD or MD. Men from the greater Boston, Massachusetts area completed a one-time assessment, which included clinician-based structured interviews and self-report questionnaires assessing MD symptom severity, BDD symptom severity, and conformity to traditional masculine norms. The sample was N = 30 men (MD: n = 15; BDD: n = 15). Statistically significant medium to large effects emerged with the MD group experiencing greater MD and BDD symptom severity, and positive attitudes towards the use of violence to solve problems. Although not reaching statistical significance, additional medium-to-large effects also emerged with the MD group reporting greater emotional restriction/suppression, heterosexual self-presentation, and desired sexual promiscuity compared to the BDD group. Findings suggest that men diagnosed with MD may experience greater MD/BDD symptom severity and endorsement of some components of 'traditional' masculine norms, compared to men diagnosed with BDD. Results may suggest that addressing some forms of rigid masculine norms (e.g., use of violence) in therapy could be useful in treating MD; however, additional research comparing clinical samples of men with MD and BDD are needed to guide the nosology, assessment, and treatment of MD.


Assuntos
Transtornos Dismórficos Corporais/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Músculo Esquelético/fisiopatologia , Adulto , Transtornos Dismórficos Corporais/epidemiologia , Transtornos Dismórficos Corporais/fisiopatologia , Boston , Comorbidade , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Humanos , Masculino , Massachusetts , Autorrelato , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto Jovem
8.
Public Health Rep ; 135(5): 700-707, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735497

RESUMO

Clear writing is a critical component of public health research and practice. The ability to convey information in a concise, engaging, and insightful manner influences stakeholder engagement and is the backbone of program and policy development, organization, and implementation. To help master of public health (MPH) students adapt their writing skills to these specialized demands, Boston University School of Public Health launched the Peer Writing Coach Program in 2010 staffed by MPH students. The service is open to all students enrolled in public health classes. They can schedule up to 2 appointments per assignment for both individual and team papers. Student use increased from 55 appointments in academic year 2010-2011 (the first year of the program) to 767 appointments in academic year 2017-2018. For the 2016-2017, 2017-2018, and 2018-2019 academic years, 1128 (74%) of 1530 appointment requests asked for assistance "writing clearly and concisely," 886 (58%) for assistance "organizing and synthesizing main points of argument," and 529 (35%) for assistance "tailoring writing for a specific audience." This case study describes the rationale for creating the program, outlines the chronology of its development since 2010, and provides an overview of peer coach training, student use, and lessons learned as we addressed logistical challenges.


Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Currículo , Educação Médica/organização & administração , Guias como Assunto , Saúde Pública/educação , Estudantes/estatística & dados numéricos , Redação/normas , Adulto , Boston , Feminino , Humanos , Masculino , Grupo Associado , Adulto Jovem
10.
Nat Hum Behav ; 4(9): 964-971, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32759985

RESUMO

While severe social-distancing measures have proven effective in slowing the coronavirus disease 2019 (COVID-19) pandemic, second-wave scenarios are likely to emerge as restrictions are lifted. Here we integrate anonymized, geolocalized mobility data with census and demographic data to build a detailed agent-based model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in the Boston metropolitan area. We find that a period of strict social distancing followed by a robust level of testing, contact-tracing and household quarantine could keep the disease within the capacity of the healthcare system while enabling the reopening of economic activities. Our results show that a response system based on enhanced testing and contact tracing can have a major role in relaxing social-distancing interventions in the absence of herd immunity against SARS-CoV-2.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/estatística & dados numéricos , Busca de Comunicante/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Controle de Infecções/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Boston/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Características da Família , Hospitalização/estatística & dados numéricos , Humanos , Controle de Infecções/métodos , Modelos Estatísticos , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle
13.
J Stroke Cerebrovasc Dis ; 29(8): 104903, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689580

RESUMO

PURPOSE: Evaluate reversal strategies in atrial fibrillation (AF) patients with warfarin-associated intracranial hemorrhage (ICH) in clinical care. MATERIALS AND METHODS: Observational cohort of AF patients with warfarin-associated ICH at two referral hospitals (2007-2010), with patient features, reversal agents, and outcomes collected from medical records. RESULTS: Among 498 ICH patients 403 received fresh frozen plasma (FFP) without 3-factor prothrombin complex concentrates (PCCs) or recombinant factor VIIa (rFVIIa), 65 received PCCs or rFVIIa, mostly with FFP, and 30 received no acute reversal agents. Median time from presentation to reversal agent administration was 3.4 h (IQR 2.3-5.3). INR was reversed to ≤1.4 by 6 h post-presentation in 46% of patients receiving PCCs/rFVIIa versus 15% receiving FFP alone (p<0.0001). Among PCCs/rFVIIa recipients, 31% died in-hospital vs. 24% receiving FFP alone (p=0.27). Adjusted OR for death accounting for age and Glasgow Coma Score was 0.78 (0.36-1.69) for PCCs/rFVIIa vs FFP only and 1.16 (0.59-2.27) comparing those reaching vs. not reaching INR ≤ 1.4 at 6 h. CONCLUSIONS: Treatment with PCCs/rFVIIa led to faster INR reversal than treatment with FFP alone. Neither treatment with PCCs/rFVIIa nor rapid INR reversal was associated with improved survival. Delays receiving PCCs may largely eliminate the benefit of treatment.


Assuntos
Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Fatores de Coagulação Sanguínea/uso terapêutico , Coagulação Sanguínea/efeitos dos fármacos , Coagulantes/uso terapêutico , Fator VIIa/uso terapêutico , Hemorragias Intracranianas/terapia , Plasma , Varfarina/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fatores de Coagulação Sanguínea/efeitos adversos , Boston , Coagulantes/efeitos adversos , Fator VIIa/efeitos adversos , Feminino , Humanos , Coeficiente Internacional Normatizado , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/diagnóstico , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
14.
PLoS Med ; 17(7): e1003219, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32692747

RESUMO

BACKGROUND: The influence of genetic risk for obesity on food choice behaviors is unknown and may be in the causal pathway between genetic risk and weight gain. The aim of this study was to examine associations between genetic risk for obesity and food choice behaviors using objectively assessed workplace food purchases. METHODS AND FINDINGS: This study is a secondary analysis of baseline data collected prior to the start of the "ChooseWell 365" health-promotion intervention randomized control trial. Participants were employees of a large hospital in Boston, MA, who enrolled in the study between September 2016 and February 2018. Cafeteria sales data, collected retrospectively for 3 months prior to enrollment, were used to track the quantity (number of items per 3 months) and timing (median time of day) of purchases, and participant surveys provided self-reported behaviors, including skipping meals and preparing meals at home. A previously validated Healthy Purchasing Score was calculated using the cafeteria traffic-light labeling system (i.e., green = healthy, yellow = less healthy, red = unhealthy) to estimate the healthfulness (quality) of employees' purchases (range, 0%-100% healthy). DNA was extracted and genotyped from blood samples. A body mass index (BMI) genome-wide polygenic score (BMIGPS) was generated by summing BMI-increasing risk alleles across the genome. Additionally, 3 polygenic risk scores (PRSs) were generated with 97 BMI variants previously identified at the genome-wide significance level (P < 5 × 10-8): (1) BMI97 (97 loci), (2) BMICNS (54 loci near genes related to central nervous system [CNS]), and (3) BMInon-CNS (43 loci not related to CNS). Multivariable linear and logistic regression tested associations of genetic risk score quartiles with workplace purchases, adjusted for age, sex, seasonality, and population structure. Associations were considered significant at P < 0.05. In 397 participants, mean age was 44.9 years, and 80.9% were female. Higher genetic risk scores were associated with higher BMI. The highest quartile of BMIGPS was associated with lower Healthy Purchasing Score (-4.8 percentage points [95% CI -8.6 to -1.0]; P = 0.02), higher quantity of food purchases (14.4 more items [95% CI -0.1 to 29.0]; P = 0.03), later time of breakfast purchases (15.0 minutes later [95% CI 1.5-28.5]; P = 0.03), and lower likelihood of preparing dinner at home (Q4 odds ratio [OR] = 0.3 [95% CI 0.1-0.9]; P = 0.03) relative to the lowest BMIGPS quartile. Compared with the lowest quartile, the highest BMICNS quartile was associated with fewer items purchased (P = 0.04), and the highest BMInon-CNS quartile was associated with purchasing breakfast at a later time (P = 0.01), skipping breakfast (P = 0.03), and not preparing breakfast (P = 0.04) or lunch (P = 0.01) at home. A limitation of this study is our data come from a relatively small sample of healthy working adults of European ancestry who volunteered to enroll in a health-promotion study, which may limit generalizability. CONCLUSIONS: In this study, genetic risk for obesity was associated with the quality, quantity, and timing of objectively measured workplace food purchases. These findings suggest that genetic risk for obesity may influence eating behaviors that contribute to weight and could be targeted in personalized workplace wellness programs in the future. TRIAL REGISTRATION: Clinicaltrials.gov NCT02660086.


Assuntos
Preferências Alimentares , Obesidade/etiologia , Obesidade/genética , Adulto , Índice de Massa Corporal , Boston , Comportamento do Consumidor , Feminino , Qualidade dos Alimentos , Predisposição Genética para Doença , Promoção da Saúde/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Local de Trabalho
15.
J Stroke Cerebrovasc Dis ; 29(8): 104980, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689645

RESUMO

BACKGROUND: The COVID-19 pandemic has presented unprecedented challenges to healthcare organizations worldwide. A steadily rising number of patients requiring intensive care, a large proportion from racial and ethnic minorities, demands creative solutions to provide high-quality care while ensuring healthcare worker safety in the face of limited resources. Boston Medical Center has been particularly affected due to the underserved patient population we care for and the increased risk of ischemic stroke in patients with COVID-19 infection. METHODS: We present protocol modifications developed to manage patients with acute ischemic stroke in a safe and effective manner while prioritizing judicious use of personal protective equipment and intensive care unit resources. CONCLUSION: We feel this information will benefit other organizations facing similar obstacles in caring for the most vulnerable patient populations during this ongoing public health crisis.


Assuntos
Betacoronavirus/patogenicidade , Isquemia Encefálica/virologia , Infecções por Coronavirus/terapia , Procedimentos Endovasculares , Necessidades e Demandas de Serviços de Saúde/organização & administração , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Pneumonia Viral/terapia , Radiografia Intervencionista , Acidente Vascular Cerebral/terapia , Terapia Trombolítica , Boston , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Tomada de Decisão Clínica , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Procedimentos Clínicos/organização & administração , Procedimentos Endovasculares/efeitos adversos , Interações entre Hospedeiro e Microrganismos , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Radiografia Intervencionista/efeitos adversos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Terapia Trombolítica/efeitos adversos , Resultado do Tratamento , Triagem/organização & administração
16.
Surgery ; 168(2): 222-225, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32600881

RESUMO

BACKGROUND: The coronavirus disease 2019 pandemic has negatively affected the training of general surgery chief residents during the last trimester of their residency. Our goal was to evaluate the educational concerns of graduating general surgery chief residents during the coronavirus disease 2019 pandemic. METHODS: An anonymous web-based survey was distributed between March 31 and April 7, 2020 to all current general surgery chief residents from 6 academic medical centers in Boston, Massachusetts. Interviews were also conducted with attending surgeons from participating institutions. RESULTS: A total of 24 of 39 general surgery chief residents participated in our survey (61.5% response rate). General surgery chief residents were most concerned about the potential delay in the date of board examinations, followed by not feeling adequately prepared for the board examinations and a possible delay in the graduation date. Whereas not having enough cases to feel ready for fellowship or job and not achieving a sufficient number of cases to meet the requirements for graduation were only moderately concerning to chief residents, attending surgeons stressed a greater importance on the loss of the operative experience as nearly all (93.3%) of them suggested a personalized approach for additional general surgery training during fellowship or job onboarding. CONCLUSION: In addition to the dramatic impact on public health, the coronavirus disease 2019 outbreak has also caused unprecedented changes to surgical education. Therefore, creative interventions are needed to help general surgery chief residents successfully transition into the next phase of their surgical career.


Assuntos
Betacoronavirus , Competência Clínica , Infecções por Coronavirus/epidemiologia , Educação de Pós-Graduação em Medicina , Internato e Residência , Pneumonia Viral/epidemiologia , Cirurgiões , Centros Médicos Acadêmicos , Adulto , Atitude do Pessoal de Saúde , Boston/epidemiologia , Avaliação Educacional , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Conselhos de Especialidade Profissional , Inquéritos e Questionários
17.
MMWR Morb Mortal Wkly Rep ; 69(27): 864-869, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32644981

RESUMO

As of July 5, 2020, approximately 2.8 million coronavirus disease 2019 (COVID-19) cases and 130,000 COVID-19-associated deaths had been reported in the United States (1). Populations historically affected by health disparities, including certain racial and ethnic minority populations, have been disproportionally affected by and hospitalized with COVID-19 (2-4). Data also suggest a higher prevalence of infection with SARS-CoV-2, the virus that causes COVID-19, among persons experiencing homelessness (5). Safety-net hospitals,† such as Boston Medical Center (BMC), which provide health care to persons regardless of their insurance status or ability to pay, treat higher proportions of these populations and might experience challenges during the COVID-19 pandemic. This report describes the characteristics and clinical outcomes of adult patients with laboratory-confirmed COVID-19 treated at BMC during March 1-May 18, 2020. During this time, 2,729 patients with SARS-CoV-2 infection were treated at BMC and categorized into one of the following mutually exclusive clinical severity designations: exclusive outpatient management (1,543; 56.5%), non-intensive care unit (ICU) hospitalization (900; 33.0%), ICU hospitalization without invasive mechanical ventilation (69; 2.5%), ICU hospitalization with mechanical ventilation (119; 4.4%), and death (98; 3.6%). The cohort comprised 44.6% non-Hispanic black (black) patients and 30.1% Hispanic or Latino (Hispanic) patients. Persons experiencing homelessness accounted for 16.4% of patients. Most patients who died were aged ≥60 years (81.6%). Clinical severity differed by age, race/ethnicity, underlying medical conditions, and homelessness. A higher proportion of Hispanic patients were hospitalized (46.5%) than were black (39.5%) or non-Hispanic white (white) (34.4%) patients, a finding most pronounced among those aged <60 years. A higher proportion of non-ICU inpatients were experiencing homelessness (24.3%), compared with homeless patients who were admitted to the ICU without mechanical ventilation (15.9%), with mechanical ventilation (15.1%), or who died (15.3%). Patient characteristics associated with illness and clinical severity, such as age, race/ethnicity, homelessness, and underlying medical conditions can inform tailored strategies that might improve outcomes and mitigate strain on the health care system from COVID-19.


Assuntos
Doença Crônica/epidemiologia , Grupos de Populações Continentais/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Grupos Étnicos/estatística & dados numéricos , Pessoas em Situação de Rua/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Boston/epidemiologia , Infecções por Coronavirus/etnologia , Feminino , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/etnologia , Provedores de Redes de Segurança , Adulto Jovem
18.
Int J Cardiovasc Imaging ; 36(10): 2027-2038, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32533279

RESUMO

In patients with heart failure with preserved ejection fraction (HFpEF), diabetes mellitus (DM) and obesity are important comorbidities as well as major risk factors. Their conjoint impact on the myocardium provides insight into the HFpEF aetiology. We sought to investigate the association between obesity, DM, and their combined effect on alterations in the myocardial tissue in HFpEF patients. One hundred and sixty-two HFpEF patients (55 ± 12 years, 95 men) and 45 healthy subjects (53 ± 12 years, 27 men) were included. Patients were classified according to comorbidity prevalence (36 obese patients without DM, 53 diabetic patients without obesity, and 73 patients with both). Myocardial remodeling, fibrosis, and longitudinal contractility were quantified with cardiovascular magnetic resonance imaging using cine and myocardial native T1 images. Patients with DM and obesity had impaired global longitudinal strain (GLS) and increased myocardial native T1 compared to patients with only one comorbidity (DM + Obesity vs. DM and Obesity; GLS, - 15 ± 2.1 vs - 16.5 ± 2.4 and - 16.7 ± 2.2%; native T1, 1162 ± 37 vs 1129 ± 25 and 1069 ± 29 ms; P < 0.0001 for all). A negative synergistic effect of combined obesity and DM prevalence was observed for native T1 (np2 = 0.273, p = 0.002) and GLS (np2 = 0.288, p < 0.0001). Additionally, severity of insulin resistance was associated with GLS (R = 0.590, P < 0.0001), and native T1 (R = 0.349, P < 0.0001). The conjoint effect of obesity and DM in HFpEF patients is associated with diffuse myocardial fibrosis and deterioration in GLS. The negative synergistic effects observed on the myocardium may be related to severity of insulin resistance.


Assuntos
Diabetes Mellitus/fisiopatologia , Insuficiência Cardíaca/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Miocárdio/patologia , Obesidade/fisiopatologia , Volume Sistólico , Função Ventricular Esquerda , Adulto , Idoso , Boston/epidemiologia , Comorbidade , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Fibrose , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Contração Miocárdica , Obesidade/diagnóstico , Obesidade/epidemiologia , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Fatores de Risco , Remodelação Ventricular
20.
Public Health Rep ; 135(4): 435-441, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32516035

RESUMO

People experiencing homelessness are at high risk for coronavirus disease 2019 (COVID-19). In March 2020, Boston Health Care for the Homeless Program, in partnership with city and state public health agencies, municipal leaders, and homeless service providers, developed and implemented a citywide COVID-19 care model for this vulnerable population. Components included symptom screening at shelter front doors, expedited testing at pop-up sites, isolation and management venues for symptomatic people under investigation and for people with confirmed disease, quarantine venues for asymptomatic exposed people, and contact investigation and tracing. Real-time disease surveillance efforts in a large shelter outbreak of COVID-19 during the third week of operations illustrated the need for several adaptations to the care model to better respond to the local epidemiology of illness among people experiencing homelessness. Symptom screening was de-emphasized given the high number of asymptomatic or minimally symptomatic infections discovered during mass testing; contact tracing and quarantining were phased out under the assumption of universal exposure among the sheltered population; and isolation and management venues were rapidly expanded to accommodate a surge in people with newly diagnosed COVID-19. During the first 6 weeks of operation, 429 of 1297 (33.1%) tested people were positive for COVID-19; of these, 395 people were experiencing homelessness at the time of testing, representing about 10% of the homeless adult population in Boston. Universal testing, as resources permit, is a focal point of ongoing efforts to mitigate the effect of COVID-19 on this vulnerable group of people.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pessoas em Situação de Rua , Pandemias , Pneumonia Viral , Vigilância da População/métodos , Prática de Saúde Pública , Adulto , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Boston/epidemiologia , Técnicas de Laboratório Clínico , Doenças Transmissíveis Emergentes/prevenção & controle , Busca de Comunicante , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , Unidades Móveis de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Reação em Cadeia da Polimerase , Quarentena
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