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1.
Best Pract Res Clin Anaesthesiol ; 35(3): 425-435, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34511230

RESUMO

The novel SARS-CoV-2 pandemic starting in 2019 profoundly changed the world, and thousands of residents of New York City were affected, leading to one of the most acute surges in regional hospital capacity. As the largest academic medical center in the Bronx, Montefiore Medical Center was immediately impacted, and the entire hospital was mobilized to address the needs of its community. In this article, we describe our experiences as a large academic anesthesiology department during this pandemic. Our goals were to maximize our staff's expertise, maintain our commitment to wellness and safety, and preserve the quality of patient care. Lessons learned include the importance of critical care training presence and leadership, the challenges of converting an ambulatory surgery center to an intensive care unit (ICU), and the management of effective communication. Lastly, we provide suggestions for institutions facing an acute surge, or subsequent waves of COVID-19, based on a single center's experiences.


Assuntos
Centros Médicos Acadêmicos/tendências , Anestesiologia/tendências , COVID-19/epidemiologia , Cuidados Críticos/tendências , Reestruturação Hospitalar/tendências , Admissão e Escalonamento de Pessoal/tendências , Centros Médicos Acadêmicos/normas , Anestesiologia/normas , COVID-19/terapia , Cuidados Críticos/normas , Pessoal de Saúde/normas , Pessoal de Saúde/tendências , Reestruturação Hospitalar/normas , Humanos , Cidade de Nova Iorque , Pandemias , Admissão e Escalonamento de Pessoal/normas
2.
BMC Health Serv Res ; 21(1): 930, 2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493261

RESUMO

BACKGROUND: There are plenty of studies investigating the disparity of payer status in accessing to care. However, most studies are either disease-specific or cohort-specific. Quantifying the disparity from the level of facility through a large controlled study are rare. This study aims to examine how the payer status affects patient hospitalization from the perspective of a facility. METHODS: We extracted all patients with visiting record in a medical center between 5/1/2009-4/30/2014, and then linked the outpatient and inpatient records three year before target admission time to patients. We conduct a retrospective observational study using a conditional logistic regression methodology. To control the illness of patients with different diseases in training the model, we construct a three-dimension variable with data stratification technology. The model is validated on a dataset distinct from the one used for training. RESULTS: Patients covered by private insurance or uninsured are less likely to be hospitalized than patients insured by government. For uninsured patients, inequity in access to hospitalization is observed. The value of standardized coefficients indicates that government-sponsored insurance has the greatest impact on improving patients' hospitalization. CONCLUSION: Attention is needed on improving the access to care for uninsured patients. Also, basic preventive care services should be enhanced, especially for people insured by government. The findings can serve as a baseline from which to measure the anticipated effect of measures to reduce disparity of payer status in hospitalization.


Assuntos
Seguro Saúde , Pessoas sem Cobertura de Seguro de Saúde , Centros Médicos Acadêmicos , Hospitalização , Hospitais , Humanos , Estados Unidos
3.
BMC Med Educ ; 21(1): 468, 2021 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-34474670

RESUMO

BACKGROUND: Academic medical centers invest considerably in faculty development efforts to support the career success and promotion of their faculty, and to minimize faculty attrition. This study evaluated the impact of a faculty development program called the Leadership in Academic Medicine Program (LAMP) on participants' (1) self-ratings of efficacy, (2) promotion in academic rank, and (3) institutional retention. METHOD: Participants from the 2013-2020 LAMP cohorts were surveyed pre and post program to assess their level of agreement with statements that spanned domains of self-awareness, self-efficacy, satisfaction with work and work environment. Pre and post responses were compared using McNemar's tests. Changes in scores across gender were compared using Wilcoxon Rank Sum/Mann-Whitney tests. LAMP participants were matched to nonparticipant controls by gender, rank, department, and time of hire to compare promotions in academic rank and departures from the organization. Kaplan Meier curves and Cox proportional hazards models were used to examine differences. RESULTS: There were significant improvements in almost all self-ratings on program surveys (p < 0.05). Greatest improvements were seen in "understand the promotions process" (36% vs. 94%), "comfortable negotiating" (35% vs. 74%), and "time management" (55% vs. 92%). There were no statistically significant differences in improvements by gender, however women faculty rated themselves lower on all pre-program items compared to men. There was significant difference found in time-to-next promotion (p = 0.003) between LAMP participants and controls. Kaplan-Meier analysis demonstrated that LAMP faculty achieved next promotion more often and faster than controls. Cox-proportional-hazards analyses found that LAMP faculty were 61% more likely to be promoted than controls (hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.16-2.23, p-value = 0.004). There was significant difference found in time-to-departure (p < 0.0001) with LAMP faculty retained more often and for longer periods. LAMP faculty were 77% less likely to leave compared to controls (HR 0.23, 95% CI 0.16-0.34, p < 0.0001). CONCLUSIONS: LAMP is an effective faculty development program as measured subjectively by participant self-ratings and objectively through comparative improvements in academic promotions and institutional retention.


Assuntos
Liderança , Autoeficácia , Centros Médicos Acadêmicos , Mobilidade Ocupacional , Docentes de Medicina , Feminino , Humanos , Masculino
4.
Am J Infect Control ; 49(9): 1158-1161, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34454683

RESUMO

BACKGROUND: The purpose of this study was to assess the occupational SARS-CoV-2 infection risk among health care workers (HCW) at University of Kentucky HealthCare (UKHC) by evaluating the prevalence of SARS-CoV-2 antibodies. METHODS: This is a prospective cohort study of HCW at UKHC. SARS-CoV-2 IgG antibody seropositivity was measured in a CLIA-certified laboratory utilizing the Abbott Architect SARS-CoV-2 IgG antibody assay. Demographics and work type were self-reported by study participants via an emailed survey. RESULTS: The overall antibody positivity rate of HCW was 1.55% (5/322; 95% confidence interval: 0.65%-3.71%) at cohort entry. There were no differences in antibody positivity between those that worked directly with SARS-CoV-2 infected patients and those that did not. The antibody rate of positivity of patients during the same time period was similar, 1.8% (9/499; 95% confidence interval 0.94%-3.45%). CONCLUSIONS: Antibody positivity was low and similar between HCW and patients tested during a similar time period. HCW positivity rates did not appear to be impacted by caring for known SARS-CoV-2 infected patients suggesting that appropriate use of personal protective equipment is effective in protecting individuals from transmission.


Assuntos
COVID-19 , SARS-CoV-2 , Centros Médicos Acadêmicos , Pessoal de Saúde , Humanos , Imunoglobulina G , Prevalência , Estudos Prospectivos , Atenção Terciária à Saúde
5.
Oncology (Williston Park) ; 35(8): 462-470, 2021 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34398590

RESUMO

Objectives: COVID-19 created unexpected delays in oncologic treatment. This study sought to assess the volume of missed cancer-related services due to the pandemic. Methods: This case-controlled trial evaluated more than 345,000 oncologic clinic, lab, and radiation appointments from January 1, 2019, through December 31, 2020, and surgery appointments from January 1, 2019, through October 31, 2020. All patients at the Seidman Cancer Center with a cancer diagnosis based on a comprehensive list of 2178 International Classification of Diseases, Ninth Edition (ICD-9) and ICD-10 codes were included in the analysis. Subgroup analyses based on age, race, and sex were also performed. Results: Clinic, lab, and surgical visit cancellations increased by 4.20% (P <.001), 4.84% (P <.001), and 5.22% (P <.001), respectively. In the first 10 months of 2020, there were 703 (9.2%) fewer surgeries compared with the same time period in 2019. The following cancellation rates peaked in March 2020: clinic visits (26.53%), labs (43.66%), surgery (34.00%). Radiation oncology (12.53%) cancellations peaked in April 2020. Prior to the emergence of COVID-19, the group aged 0 to 39 years had the highest clinic cancellation rate (17.85%) compared with patients aged 40 to 64 years (15.95%) and 65 years and older (14.52%; P <.001). Men cancelled (15.63%) significantly more often than women (14.93%; P <.001) in 2019. This reversed during the pandemic: Women (19.56%) cancelled more frequently than men (19.20%; P <.036). Conclusions: There was a large increase in cancelled oncologic care in 2020, which has implications for delayed diagnosis and treatment. This was especially true for patients older than 65 years and for women. These delays could result in patients presenting with more advanced disease, complicating morbidities, and ultimately worse long-term outcomes.


Assuntos
Agendamento de Consultas , COVID-19/epidemiologia , Oncologia/tendências , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Tempo para o Tratamento/tendências , Centros Médicos Acadêmicos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/tendências
6.
Am J Nurs ; 121(9): 46-55, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34438429

RESUMO

ABSTRACT: The coronavirus disease 2019 (COVID-19) pandemic that emerged in early 2020 put unprecedented physical, mental, and emotional strain on the staff of health care organizations, who have been caring for a critically ill patient population for more than a year and a half. Amid the ongoing pandemic, health care workers have struggled to keep up with new information about the disease, while also coping with the anxiety associated with caring for affected patients. It has also been a continual challenge for nurse leaders to provide adequate support for staff members and keep them informed about frequently changing practices and protocols. In this article, nursing leaders at an academic medical center in Boston reflect on the initial COVID-19 patient surge, which occurred from March to June 2020, and identify key actions taken to provide clinical and emotional support to frontline staff who cared for these patients. Lessons learned in this period provide insight into the management of redeployed staff, use of emotional support and debriefing, and relationship between access to information and staff morale. The knowledge gained through these initial experiences has been a vital resource as health care workers continue to face challenges associated with the ongoing pandemic.


Assuntos
Centros Médicos Acadêmicos/organização & administração , COVID-19/enfermagem , Recursos Humanos de Enfermagem no Hospital/organização & administração , Recursos Humanos de Enfermagem no Hospital/psicologia , Boston/epidemiologia , Humanos , SARS-CoV-2
7.
Artigo em Alemão | MEDLINE | ID: mdl-34374799

RESUMO

BACKGROUND: Healthcare workers are among the most exposed and potentially most threatened populations of the ongoing COVID-19 pandemic. Despite some reports on numbers of infections with SARS-CoV­2 in German healthcare workers, the courses of their clinical presentation when affected by COVID-19 are not well described. OBJECTIVE: In this contribution, characteristics and progressions of infected cases among healthcare workers at the University Medical Center Hamburg-Eppendorf during the first wave of the COVID-19 pandemic will be presented. METHODS: Between 1 July and 28 July 2020, 67 healthcare workers, who previously tested positive for SARS-CoV­2 via PCR, were invited via E­mail to participate in an anonymous online questionnaire; 39 persons participated. RESULTS: Participants (58%) were mostly ≤ 39 years old (64%) and female (70%). Most healthcare workers were involved in direct patient management (85%), including contact with SARS-CoV­2 positive patients (62%). All participants reported acute symptoms with a median duration of 19 days. The most frequent symptoms were fatigue (85%), anosmia (67%), cough (64%), headache (62%), and shortness of breath (51%). The disease course was mostly mild with low admission rates (5%). Ongoing symptoms lasting more than four weeks post-symptom-onset, particularly anosmia, fatigue, and shortness of breath, were reported by 38%. This group more frequently had pre-existing conditions (53% vs. 12%, p = 0.010), specifically hypertension (27% vs. 4%, p = 0.062). DISCUSSION: Healthcare workers reported mostly mild courses of COVID-19 despite increased contact with SARS-CoV-2 patients. However, some reported persistent symptoms months after infection.


Assuntos
COVID-19 , Pessoal de Saúde/estatística & dados numéricos , Pandemias , Centros Médicos Acadêmicos , Adulto , COVID-19/epidemiologia , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Universidades
8.
JAMA Netw Open ; 4(8): e2120456, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34379123

RESUMO

Importance: Prior studies on COVID-19 and pregnancy have reported higher rates of cesarean delivery and preterm birth and increased morbidity and mortality. Additional data encompassing a longer time period are needed. Objective: To examine characteristics and outcomes of a large US cohort of women who underwent childbirth with vs without COVID-19. Design, Setting, and Participants: This cohort study compared characteristics and outcomes of women (age ≥18 years) who underwent childbirth with vs without COVID-19 between March 1, 2020, and February 28, 2021, at 499 US academic medical centers or community affiliates. Follow-up was limited to in-hospital course and discharge destination. Childbirth was defined by clinical classification software procedural codes of 134-137. A diagnosis of COVID-19 was identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis of U07.1. Data were analyzed from April 1 to April 30, 2021. Exposures: The presence of a COVID-19 diagnosis using ICD-10. Main Outcomes and Measures: Analyses compared demographic characteristics, gestational age, and comorbidities. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, intensive care unit (ICU) admission, mechanical ventilation, and discharge status. Continuous variables were analyzed using t test, and categorical variables were analyzed using χ2. Results: Among 869 079 women, 18 715 (2.2%) had COVID-19, and 850 364 (97.8%) did not. Most women were aged 18 to 30 years (11 550 women with COVID-19 [61.7%]; 447 534 women without COVID-19 [52.6%]) and were White (8060 White women [43.1%] in the COVID-19 cohort; 499 501 White women (58.7%) in the non-COVID-19 cohort). There was no significant increase in cesarean delivery among women with COVID-19 (6088 women [32.5%] vs 273 810 women [32.3%]; P = .57). Women with COVID-19 were more likely to have preterm birth (3072 women [16.4%] vs 97 967 women [11.5%]; P < .001). Women giving birth with COVID-19, compared with women without COVID-19, had significantly higher rates of ICU admission (977 women [5.2%] vs 7943 women [0.9%]; odds ratio [OR], 5.84 [95% CI, 5.46-6.25]; P < .001), respiratory intubation and mechanical ventilation (275 women [1.5%] vs 884 women [0.1%]; OR, 14.33 [95% CI, 12.50-16.42]; P < .001), and in-hospital mortality (24 women [0.1%] vs 71 [<0.01%]; OR, 15.38 [95% CI, 9.68-24.43]; P < .001). Conclusions and Relevance: This retrospective cohort study found that women with COVID-19 giving birth had higher rates of mortality, intubation, ICU admission, and preterm birth than women without COVID-19.


Assuntos
COVID-19/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Centros Médicos Acadêmicos/estatística & dados numéricos , Adolescente , Adulto , COVID-19/terapia , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Intubação Intratraqueal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias , Gravidez , Complicações Infecciosas na Gravidez/mortalidade , Complicações Infecciosas na Gravidez/terapia , Estudos Retrospectivos , SARS-CoV-2 , Estados Unidos/epidemiologia , Adulto Jovem
10.
J Nurs Adm ; 51(7-8): 395-400, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34405978

RESUMO

OBJECTIVE: The aim of this study was to examine the short-term and sustained effect on well-being, burnout, and mindful awareness of an abbreviated mindfulness practice course designed for nurses and other healthcare professionals. BACKGROUND: Most mindfulness programs are impractical for frontline healthcare providers because of the intensive, off-site initial training and prolonged practice commitment. A psychiatric nurse educator developed a brief training program tailored for healthcare providers. METHODS: Two institutional review board-approved studies examined the abbreviated mindfulness practice course for healthcare providers: the first, a single-group pretest-posttest design with 25 nursing employees in an academic medical center, and the second, a randomized controlled trial with 83 healthcare professionals. RESULTS: Significant improvement in mindful awareness and at least 1 indicator of burnout were demonstrated. Improvements in quality of life were noted with nurses. CONCLUSIONS: Findings support the short-term and sustained impact of this brief mindfulness curriculum on mindful awareness, quality of life, and aspects of burnout for healthcare professionals.


Assuntos
Atitude do Pessoal de Saúde , Esgotamento Profissional/prevenção & controle , Pessoal de Saúde/psicologia , Atenção Plena/educação , Centros Médicos Acadêmicos , Esgotamento Profissional/psicologia , Humanos , Enfermeiras e Enfermeiros/psicologia , Estresse Ocupacional/psicologia , Qualidade de Vida
11.
Prev Med ; 151: 106569, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34217411

RESUMO

The expeditious diagnosis and treatment of high-grade cervical precancers are fundamental to cervical cancer prevention. However, during the COVID-19 pandemic healthcare systems have at times restricted in-person visits to those deemed urgent. Professional societies provided some guidance to clinicians regarding ways in which traditional cervical cancer screening might be modified, but many gaps remained. To address these gaps, leaders of screening programs at an academic medical center and an urban safety net hospital in California formed a rapid-action committee to provide guidance to its practitioners. Patients were divided into 6 categories corresponding to various stages in the screening process and ranked by risk of underlying high-grade cervical precancer and cancer. Tiers corresponding to the intensity of the local pandemic were constructed, and clinical delays were lengthened for the lowest-risk patients as tiers escalated. The final product was a management grid designed to escalate and de-escalate with changes in the local epidemiology of the COVID-19 pandemic. While this effort resulted in substantial delays in clinical screening services as mandated by the healthcare systems, the population effects of delaying on both cervical cancer outcomes as well as the beneficial effects related to decreasing transmission of severe acute respiratory coronavirus 2 have yet to be elucidated.


Assuntos
COVID-19 , Neoplasias do Colo do Útero , Centros Médicos Acadêmicos , California , Detecção Precoce de Câncer , Feminino , Humanos , Pandemias , SARS-CoV-2 , Provedores de Redes de Segurança , Neoplasias do Colo do Útero/diagnóstico
12.
Am J Cardiol ; 156: 114-122, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34325878

RESUMO

We studied the explanted hearts of 519 patients having Orthotopic Heart Transplant (OHT) at Baylor University Medical Center from 2013 to 2020 and compared the morphologic diagnoses to the clinical diagnoses before OHT. We then combined these findings with the findings from 314 patients who had been studied in the laboratory from 1993 to 2012. Thus, the total number of patients included in the overall study were 833. Among the 833 patients the morphologic and clinical diagnoses were congruent in 760 (91%) and incongruent in 73 (9%) cases. Most of the incongruity occurred among the patients with cardiac sarcoidosis (27/36 [75%]), arrhythmogenic right ventricular cardiomyopathy (11/19 [58%]), and hypertrophic cardiomyopathy (8/25 [32%]). The frequency of incongruence among 833 patients having OHT in an 27 year period was 9%, with no significant difference between the 314 patients studied from 1998 to 2012, and the 519 studied from 2013 to 2020.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Previsões , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Miocárdio/patologia , Adulto , Idoso , Feminino , Seguimentos , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
13.
Am J Cardiol ; 153: 43-50, 2021 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-34210501

RESUMO

Lipoprotein (a) [Lp(a)] is associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). As directed therapy for Lp(a) emerges, it is important to understand patterns of Lp(a) testing in routine clinical practice. We set out to characterize Lp(a) testing across a large academic health system. Using electronic health record (EHR) data from 2014 to 2019, we compared patients who underwent Lp(a) testing to date-matched peers who had low density lipoprotein (LDL-C) assessment alone. We analyzed ordering provider characteristics and rates of initiation of new lipid lowering therapy (LLT) within 12 months after testing. Of 1,296 adults with Lp(a) test results, 629 (48.5%) had prior history of ASCVD and 667 (51.4%) did not. Compared with those with LDL-C testing alone, individuals who underwent Lp(a) testing were more like to have a myocardial infarction or ischemic stroke at a young age and multiple prior cardiovascular events. Though the majority of Lp(a) tests were ordered in outpatient encounters, a higher proportion of Lp(a) tests compared with LDL-C tests were performed in the inpatient setting. Neurology and psychiatry were the most common specialty to order Lp(a) tests in our cohort. There was a significantly increased initiation of LLT after Lp(a) testing compared with LDL-C testing across all medication types. Consistent with guidelines, Lp(a) testing is used in those with early onset ASCVD, and among those with multiple cardiovascular events. Lp(a) testing is associated with more aggressive LLT in following year. Further research is needed to characterize Lp(a) testing across larger populations.


Assuntos
Aterosclerose/sangue , Doenças Cardiovasculares/sangue , LDL-Colesterol/sangue , Hiperlipidemias/diagnóstico , Hipolipemiantes/uso terapêutico , Lipoproteína(a)/sangue , Padrões de Prática Médica/estatística & dados numéricos , Centros Médicos Acadêmicos , Idoso , Assistência Ambulatorial/estatística & dados numéricos , Aterosclerose/epidemiologia , Análise Química do Sangue/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Feminino , Fatores de Risco de Doenças Cardíacas , Hospitalização , Humanos , Hiperlipidemias/sangue , Hiperlipidemias/tratamento farmacológico , AVC Isquêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia
14.
Nurs Leadersh (Tor Ont) ; 34(2): 39-44, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34197293

RESUMO

The rapid cadence of change and the fear of acquiring and spreading COVID-19 - coupled with moral distress exacerbated by fulfilling one's duty to care under extremely challenging conditions - continue to impact nurses' coping ability, resilience and psychological safety globally (McDougall et al. 2020). This paper provides an overview of how an academic health sciences centre (AHSC) has responded to the evolving waves of the COVID-19 pandemic. Specifically, we share our context and the strategies we used to build and enhance nurse resilience and psychological safety at the organizational, clinical team and individual levels. This is followed by a description of our nurses' achievements amid the pandemic.


Assuntos
Adaptação Psicológica , COVID-19/enfermagem , Recursos Humanos de Enfermagem no Hospital/organização & administração , Resiliência Psicológica , Centros Médicos Acadêmicos/organização & administração , COVID-19/epidemiologia , Humanos , Liderança , Recursos Humanos de Enfermagem no Hospital/psicologia , Pandemias , Equipe de Assistência ao Paciente/organização & administração , SARS-CoV-2
15.
Mayo Clin Proc ; 96(7): 1782-1791, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34218857

RESUMO

OBJECTIVE: To describe characteristics of a series of patients reporting prolonged symptoms after an infection with coronavirus disease 2019 (COVID-19). PATIENTS AND METHODS: This study describes the multidisciplinary COVID-19 Activity Rehabilitation Program, established at Mayo Clinic to evaluate and treat patients with post-COVID syndrome, and reports the clinical characteristics of the first 100 patients receiving evaluation and management during the timeframe of June 1, 2020, and December 31, 2020. RESULTS: The cohort consisted of 100 patients (mean age, 45.4±14.2 years; 68% women; mean body mass index, 30.2 kg/m2; presenting a mean of 93 days after infection). Common preexisting conditions were respiratory (23%) and mental health, including depression and/or anxiety (34%). Most (75%) had not been hospitalized for COVID-19. Common presenting symptoms ware fatigue (80%), respiratory complaints (59%), and neurological complaints (59%) followed by subjective cognitive impairment, sleep disturbance, and mental health symptoms. More than one-third of patients (34%) reported difficulties in performing basic activities of daily living. Only 1 in 3 patients had returned to unrestricted work duty at the time of the analysis. For most patients, laboratory and imaging tests showed no abnormalities or were nondiagnostic despite debilitating symptoms. Most patients required physical therapy, occupational therapy, or brain rehabilitation. Face-to-face and virtual care delivery modalities were feasible. CONCLUSION: Most of the patients did not have COVID-19-related symptoms that were severe enough to require hospitalization, were younger than 65 years, and were more likely to be female, and most had no preexisting comorbidities before severe acute respiratory syndrome coronavirus 2 infection. Symptoms including mood disorders, fatigue, and perceived cognitive impairment resulted in severe negative impacts on resumption of functional and occupational activities in patients experiencing prolonged effects.


Assuntos
COVID-19/complicações , Centros Médicos Acadêmicos , Adulto , COVID-19/diagnóstico , COVID-19/reabilitação , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota
16.
PLoS One ; 16(7): e0254994, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34288954

RESUMO

Since the onset of the COVID-19 pandemic, it has been unclear how vulnerable people with HIV (PwH) are to SARS-CoV-2 infection. We sought to determine if PwH are more likely to test positive for SARS-CoV-2 than people without HIV, and to identify risk factors associated with SARS-CoV-2 positivity among PwH. We conducted a cross-sectional study in which we collected electronic medical record data for all patients who underwent SARS-CoV-2 PCR testing at an academic medical center. Presence of HIV and other chronic diseases were based on the presence of ICD-10 diagnosis codes. We calculated the percent positivity for SARS-CoV-2 among PwH and among people without HIV. Among PwH, we compared demographic factors, comorbidities, HIV viral load, CD4 T-cell count, and antiretroviral therapy (ART) regimens between those who tested positive for SARS-CoV-2 and those who tested negative. Comparisons were made using chi squared tests or Wilcoxon rank sum tests. Multivariate models were created using logistic regression. Among 69,763 people tested for SARS-CoV-2, 0.6% (431) were PwH. PwH were not significantly more likely to test positive for SARS-CoV-2 than people without HIV (7.2% (31/431) vs 8.4% (5820/69763), p = 0.35), but were more likely to be younger, Black, and male (p-values < .0001). There were no significant differences in HIV clinical factors, chronic diseases, or ART regimens among PwH testing positive for SARS-CoV-2 versus those testing negative. In our sample, PwH were not more likely to contract SARS-CoV-2, despite being more likely to be members of demographic groups known to be at higher risk for infection. Differences between PwH who tested positive for SARS-CoV-2 and those who tested negative were only seen in Hispanic/Latino ethnicity (non-Hispanic or Latino vs unknown Hispanic or Latino ethnicity (OR 0.2 95% CI (0.6, 0.9)) and site of testing(inpatient vs outpatient OR 3.1 95% CI (1.3, 7.4)).


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Infecções por HIV/virologia , SARS-CoV-2/isolamento & purificação , Adulto , Idoso , Fármacos Anti-HIV/uso terapêutico , COVID-19/complicações , COVID-19/epidemiologia , Cidades/estatística & dados numéricos , Comorbidade , Estudos Transversais , Demografia , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Fatores de Risco , SARS-CoV-2/fisiologia
17.
Sci Rep ; 11(1): 13580, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193945

RESUMO

In the DECODE project, data were collected from 3,114 surveys filled by symptomatic patients RT-qPCR tested for SARS-CoV-2 in a single university centre in March-September 2020. The population demonstrated balanced sex and age with 759 SARS-CoV-2( +) patients. The most discriminative symptoms in SARS-CoV-2( +) patients at early infection stage were loss of taste/smell (OR = 3.33, p < 0.0001), body temperature above 38℃ (OR = 1.67, p < 0.0001), muscle aches (OR = 1.30, p = 0.0242), headache (OR = 1.27, p = 0.0405), cough (OR = 1.26, p = 0.0477). Dyspnea was more often reported among SARS-CoV-2(-) (OR = 0.55, p < 0.0001). Cough and dyspnea were 3.5 times more frequent among SARS-CoV-2(-) (OR = 0.28, p < 0.0001). Co-occurrence of cough, muscle aches, headache, loss of taste/smell (OR = 4.72, p = 0.0015) appeared significant, although co-occurrence of two symptoms only, cough and loss of smell or taste, means OR = 2.49 (p < 0.0001). Temperature > 38℃ with cough was most frequent in men (20%), while loss of taste/smell with cough in women (17%). For younger people, taste/smell impairment is sufficient to characterise infection, whereas in older patients co-occurrence of fever and cough is necessary. The presented study objectifies the single symptoms and interactions significance in COVID-19 diagnoses and demonstrates diverse symptomatology in patient groups.


Assuntos
COVID-19/diagnóstico , COVID-19/epidemiologia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , SARS-CoV-2 , Avaliação de Sintomas/estatística & dados numéricos , Centros Médicos Acadêmicos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ageusia/etiologia , COVID-19/complicações , Criança , Pré-Escolar , Tosse/etiologia , Diagnóstico Diferencial , Dispneia/etiologia , Feminino , Febre/etiologia , Cefaleia/etiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Razão de Chances , Transtornos do Olfato/etiologia , Projetos Piloto , Polônia/epidemiologia , Infecções Respiratórias/complicações , Infecções Respiratórias/microbiologia , Inquéritos e Questionários , Avaliação de Sintomas/classificação , Adulto Jovem
18.
West J Emerg Med ; 22(3): 696-701, 2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-34125049

RESUMO

INTRODUCTION: Burnout is a major threat to patient care quality and physician career longevity in emergency medicine. We sought to develop and implement a quality improvement process to engage emergency department (ED) faculty in identifying sources of burnout and generating interventions targeted at improving the work environment. METHODS: In this prospective interventional study conducted at a large, urban, academic medical center, we surveyed a 60-person faculty group using the Professional Fulfilment Index (PFI), as well as burnout-relevant questions from the American Medical Association's Mini-Z survey and the Maslach-Leiter framework for organizational burnout, in order to identify organizational sources of burnout. We assessed the relationship between burnout scores and responses to the Maslach-Leiter framework using univariate regression analysis. In a two-hour facilitated session, we shared survey results and led the group in a process using the six Maslach-Leiter domains to develop a rank-ordered list of interventions to reduce burnout in each domain. RESULTS: In total, 47 of 60 faculty (78.3%) completed the survey and 45 faculty (75%) attended the discussion session. Of the 47 survey respondents, 14 (30%) met criteria for moderate to severe burnout. The respondents' answers to the Maslach-Leiter organizational burnout domain questions were significantly correlated with their burnout scores (P <0.001). Session attendees generated 31 potential interventions for process improvement, which were analyzed and thematically organized. Common intervention themes included reducing documentation burden, receiving more positive feedback on patient care, improving ease of obtaining consults, decreasing ED crowding, and increasing intrafaculty social connection. Interventions were subsequently reviewed and scored based on relative importance and feasibility to create a departmental action plan for process improvement. CONCLUSION: Using the Maslach-Leiter organizational burnout framework, in conjunction with a facilitated solution-oriented faculty discussion, led to the creation of a departmental agenda focused on organizational solutions for augmenting professional fulfillment and reducing burnout. We propose that this process can be used by healthcare organizations to engage physicians and others in efforts to improve their work experiences, which in turn is likely also to support the provision of higher quality of care.


Assuntos
Esgotamento Profissional/prevenção & controle , Medicina de Emergência , Médicos/psicologia , Engajamento no Trabalho , Centros Médicos Acadêmicos , Humanos , Satisfação no Emprego , Estudos Prospectivos , Melhoria de Qualidade , Inquéritos e Questionários , Local de Trabalho/psicologia
20.
J Biomed Inform ; 120: 103851, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34174396

RESUMO

Social determinants of health (SDoH) are increasingly important factors for population health, healthcare outcomes, and care delivery. However, many of these factors are not reliably captured within structured electronic health record (EHR) data. In this work, we evaluated and adapted a previously published NLP tool to include additional social risk factors for deployment at Vanderbilt University Medical Center in an Acute Myocardial Infarction cohort. We developed a transformation of the SDoH outputs of the tool into the OMOP common data model (CDM) for re-use across many potential use cases, yielding performance measures across 8 SDoH classes of precision 0.83 recall 0.74 and F-measure of 0.78.


Assuntos
Registros Eletrônicos de Saúde , Determinantes Sociais da Saúde , Centros Médicos Acadêmicos , Estudos de Coortes , Atenção à Saúde , Humanos
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