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1.
BMC Ophthalmol ; 21(1): 139, 2021 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-33743634

RESUMO

BACKGROUND: To minimize the risk of viral transmission, ophthalmology practices limited face-to-face encounters to only patients with urgent and emergent ophthalmic conditions in the weeks after the start of the COVID-19 epidemic in the United States. The impact of this is unknown. METHODS: We did a retrospective analysis of the change in the frequency of ICD-10 code use and patient volumes in the 6 weeks before and after the changes in clinical practice associated with COVID-19. RESULTS: The total number of encounters decreased four-fold after the implementation of clinic changes associated with COVID-19. The low vision, pediatric ophthalmology, general ophthalmology, and cornea divisions had the largest total decrease of in-person visits. Conversely, the number of telemedicine visits increased sixty-fold. The number of diagnostic codes associated with ocular malignancies, most ocular inflammatory disorders, and retinal conditions requiring intravitreal injections increased. ICD-10 codes associated with ocular screening exams for systemic disorders decreased during the weeks post COVID-19. CONCLUSION: Ophthalmology practices need to be prepared to experience changes in practice patterns, implementation of telemedicine, and decreased patient volumes during a pandemic. Knowing the changes specific to each subspecialty clinic is vital to redistribute available resources correctly.


Assuntos
Centros Médicos Acadêmicos/tendências , Assistência Ambulatorial/tendências , COVID-19/epidemiologia , Oftalmopatias/diagnóstico , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Oftalmologia/tendências , Padrões de Prática Médica/tendências , SARS-CoV-2 , COVID-19/transmissão , Controle de Doenças Transmissíveis , Humanos , Classificação Internacional de Doenças , Oftalmologia/métodos , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Telemedicina/métodos , Estados Unidos
2.
J Clin Neurophysiol ; 38(2): 92-100, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33661785

RESUMO

SUMMARY: Around 50 years after the first EEG acquisition by Hans Berger, its use in ambulatory setting was demonstrated. Ever since, ambulatory EEG has been widely available and routinely used in the United States (and to a lesser extent in Europe) for diagnosis and management of patients with epilepsy. This technology alone cannot help with semiological characterization, and absence of video is one of its main drawbacks. Addition of video to ambulatory EEG potentially improves diagnostic yield and opens new aspects of utility for better characterization of patient's events, including differential diagnosis, classification, and quantification of seizure burden. Studies evaluating quality of ambulatory video EEG (aVEEG) suggest good quality recordings are feasible. In the utilization of aVEEG, to maximize yield, it is important to consider pretest probability. Having clear pretest questions and a strong index of suspicion for focal, generalized convulsive or non-epileptic seizures further increases the usefulness of aVEEG. In this article, which is part of the topical issue "Ambulatory EEG," the authors compare long-term home aVEEG to inpatient video EEG monitoring, discuss aVEEG's use in diagnosis and follow-up of patients, and present the authors' own experience of the utility of aVEEG in a teaching hospital setting.


Assuntos
Eletroencefalografia/tendências , Epilepsia/diagnóstico , Serviços de Assistência Domiciliar/tendências , Monitorização Ambulatorial/tendências , Gravação em Vídeo/tendências , Centros Médicos Acadêmicos/tendências , Diagnóstico Diferencial , Eletroencefalografia/métodos , Epilepsia/epidemiologia , Epilepsia/fisiopatologia , Humanos , Monitorização Ambulatorial/métodos , Gravação em Vídeo/métodos
3.
J Nurs Adm ; 51(1): 19-25, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33278197

RESUMO

BACKGROUND: Hospital flow disruptions have been linked to treatment delays, longer length of stay (LOS), poor patient outcomes, and overburdened staff leading to disengagement. OBJECTIVE: This project was designed to evaluate and determine if the bed reaggregation was successful at meeting its goals. METHODS: Donabedian's framework guided the following evaluation points: 1) patient placement accuracy, 2) LOS variance, 3) emergency department (ED) boarding times, 4) hospital bypass hours, 5) operational declination rates, 6) patient satisfaction, and 7) RN engagement. Data were analyzed using pre-post percent change and χ analysis. RESULTS: Primary placement of patients, LOS variance, and operational declinations improved. Hours on bypass and ED boarding times were not reduced. RN engagement scores varied widely with significant decreases on 2 of the reaggregated units. Patient satisfaction scores varied, but overall did not decrease. CONCLUSION: Further consideration is needed for improving hospital bypass, ED boarding times, and RN engagement.


Assuntos
Centros Médicos Acadêmicos/tendências , Admissão do Paciente/normas , Centros Médicos Acadêmicos/organização & administração , Humanos , Tempo de Internação/tendências , Admissão do Paciente/tendências , Fatores de Tempo , População Urbana
4.
Diabetes Metab Syndr ; 15(1): 149-157, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33352454

RESUMO

BACKGROUND AND AIMS: We describe the characteristics and short-term prognosis of in-patients with diabetes and COVID-19 admitted to a Belgian academic care center. METHODS: We retrospectively reviewed the data on admission from patients with known or newly-diagnosed diabetes and confirmed COVID-19. First, survivors were compared to non-survivors to study the predictive factors of in-hospital death in patients with diabetes. Secondly, diabetic patients with SARS-CoV-2 pneumonia were matched for age and sex with non-diabetic patients with SARS-CoV-2 pneumonia, to study the prognosis and predictive factors of in-hospital death related to diabetes. RESULTS: Seventy-three diabetic patients were included. Mean age was 69 (±14) years. Women accounted for 52%. Most patients had type 2 diabetes (89.0%), long-term complications of hyperglycemia (59.1%), and hypertension (80.8%). The case-fatality rate (CFR) was 15%. Non-survivors had more severe pneumonia based on imaging (p 0.029) and were less often treated with metformin (p 0.036). In patients with SARS-CoV-2 pneumonia, CFR was 15.6% in diabetic (n = 64) and 25.0% in non-diabetic patients (n = 128), the difference being non-significant (p 0.194). Predictive factors of in-hospital death were elevated white blood cells count (HR 9.4, CI 1.50-58.8, p 0.016) and severe pneumonia on imaging (HR 25.0, CI 1.34-466, p 0.031) in diabetic patients, and cognitive impairment (HR 5.80, CI 1.61-20.9, p 0.007) and cardiovascular disease (HR 5.63, CI 1.54-20.6, p 0.009) in non-diabetic patients. CONCLUSION: In this monocentric cohort from Belgium, diabetic in-patients with COVID-19 had mostly type 2 diabetes, prevalent hyperglycemia-related vascular complications and comorbidities including hypertension. In this cohort, the CFR was not statistically different between patients with and without diabetes.


Assuntos
Centros Médicos Acadêmicos/tendências , COVID-19/diagnóstico por imagem , COVID-19/epidemiologia , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Diabetes Mellitus Tipo 2/epidemiologia , Hospitalização/tendências , Idoso , Idoso de 80 Anos ou mais , Bélgica/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Tempo
7.
Clin Neuropsychol ; 34(7-8): 1352-1366, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32660335

RESUMO

Objectives: Emory University has modified its clinical practices across specialties in response to the 2020 COVID-19 pandemic to provide service delivery while maintaining patient, staff, and faculty safety. This report shares current solutions and workarounds associated with telehealth neuropsychology (teleNP) while also recognizing teleNP opportunities.Results: We modified many measures from our traditional assessment protocols so they could be administered through Zoom. To maximize quality control, formal how-to coversheets and manuals were developed for both training and task administration (i.e. navigating Zoom assessment interfaces, practicing adapted test instructions, and troubleshooting).Conclusions: TeleNP has been successfully used to answer referral questions regarding deep brain stimulation (DBS) candidacy in Parkinson's disease patients and presence of mild neurocognitive impairment in patients with subjective memory decline. Our current protocols will continue to evolve with greater experience and are not considered to be a finished product. Nevertheless, development of robust teleNP protocols should expand availability of neuropsychology in both clinical and research applications while simultaneously decreasing assessment burden associated with traveling - sometimes long distances - for diagnostic neuropsychological evaluation.


Assuntos
Centros Médicos Acadêmicos/tendências , Betacoronavirus , Infecções por Coronavirus/terapia , Neuropsicologia/tendências , Pandemias , Pneumonia Viral/terapia , Telemedicina/tendências , Centros Médicos Acadêmicos/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Humanos , Testes Neuropsicológicos , Neuropsicologia/métodos , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Desenvolvimento de Programas/métodos , Telemedicina/métodos
10.
World Neurosurg ; 139: e872-e876, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32450314

RESUMO

BACKGROUND: Neurosurgical services have been affected by the 2019 novel coronavirus disease (COVID-19) pandemic, and several departments have reported their experiences and responses to the COVID-19 crisis in an attempt to provide insights from which other impacted departments can benefit. The goals of this study were to report the load and variety of emergent/urgent neurosurgical cases after implementing the "Battle Plan" at an academic tertiary referral center during the COVID-19 pandemic and to compare these variables with previous practice at the same institution. METHODS: The clinical data of all patients who underwent a neurosurgical intervention between March 23, 2020, and April 20, 2020, were obtained from a prospectively maintained database. Data of the control group were retrospectively collected from the medical records to compare the types of surgeries/interventions performed by the same neurosurgical service before the COVID-19 pandemic started. RESULTS: Over a 4-week period during the COVID-19 pandemic, 91 patients underwent emergent, urgent, and essential neurosurgical interventions. Patient screening at teleclinics identified 11 urgent surgical cases. The implementation of the Battle Plan led to a significant decrease in the caseload, and the variation of cases by subspecialty was evident when compared with a control group comprising 214 patients. CONCLUSIONS: Delivery of optimal care and safe practice and education at an academic neurosurgical department can be well maintained with proper execution of crisis protocols. Teleclinics proved to be efficient in screening patients for urgent neurosurgical conditions, but in-person clinic visits may still be necessary for some cases in the immediate postoperative period.


Assuntos
Centros Médicos Acadêmicos/tendências , Betacoronavirus , Infecções por Coronavirus/cirurgia , Procedimentos Neurocirúrgicos/tendências , Pandemias , Pneumonia Viral/cirurgia , Centros de Atenção Terciária/tendências , Centros Médicos Acadêmicos/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/normas , Pneumonia Viral/epidemiologia , Estudos Prospectivos , Centros de Atenção Terciária/normas , Adulto Jovem
11.
Clin Pharmacol Ther ; 108(4): 730-733, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32407539

RESUMO

The scientific community has risen to the coronavirus disease 2019 (COVID-19) challenge, coming up with an impressive list of candidate drugs and vaccines targeting an array of pharmacological and immunological mechanisms. Yet, generating clinical evidence of efficacy and safety of these candidate treatments may be frustrated by the absence of comprehensive trial coordination mechanisms. Many small stand-alone trials and observational studies of single-agent interventions are currently running or in planning; many of these will likely not deliver robust results that could support regulatory and patient-level treatment decisions. In this paper, we discuss actions that all stakeholders in the clinical trial ecosystem need to take to ensure that the window of opportunity during this pandemic will not shut, both for patients in need of treatment and for researchers to conduct decision-relevant clinical trials.


Assuntos
Betacoronavirus , Pesquisa Biomédica/métodos , Ensaios Clínicos como Assunto/métodos , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Centros Médicos Acadêmicos/métodos , Centros Médicos Acadêmicos/tendências , Pesquisa Biomédica/tendências , Infecções por Coronavirus/epidemiologia , Indústria Farmacêutica/métodos , Indústria Farmacêutica/tendências , Controle de Medicamentos e Entorpecentes/tendências , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Fatores de Tempo
13.
World Neurosurg ; 139: e877-e884, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32461176

RESUMO

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is a disruptive pandemic that has continued to test the limits of health care system capacities. It is important to highlight the specific challenges facing US neurosurgery during these difficult circumstances. In the present study, we have described our neurosurgery department's unique experience during the COVID-19 pandemic. METHODS: We analyzed the following data points both before and during the first months of the COVID-19 pandemic: the number of patients infected with COVID-19 at our institution, changes in neurosurgical operative workflow, changes in neurosurgical outpatient and inpatient clinic workflows, resident redeployment statistics and changes in call schedules, and changes in neurosurgical education. RESULTS: At our institution, the adult surgery numbers decreased from 120 during the week of March 4-11, 2020 (before the World Health Organization had classified the COVID-19 outbreak as a pandemic) to 17 during the week of April 13-17, 2020. The number of pediatric surgeries decreased from 15 to 3 during the same period. Significantly more surgeries were cancelled than were delayed (P < 0.0001). A drastic decline occurred in the number of in-person neurosurgery clinic visits (97.12%) between March and April 2020 (P = 0.0020). The inpatient census declined from mid-March to mid-April 2020 by 44.68% compared with a 4.26% decline during the same period in 2019 (P < 0.0001). Finally, neurosurgery education has largely shifted toward video-conferencing sessions rather than in-person sessions. CONCLUSION: By detailing our experience during the COVID-19 pandemic, we hope to have provided a detailed picture of the challenges facing neurosurgery within an academic medical center.


Assuntos
Centros Médicos Acadêmicos/tendências , Betacoronavirus , Infecções por Coronavirus/cirurgia , Neurocirurgia/tendências , Procedimentos Neurocirúrgicos/tendências , Pneumonia Viral/cirurgia , Centros Médicos Acadêmicos/métodos , Adulto , Assistência Ambulatorial/métodos , Assistência Ambulatorial/tendências , Criança , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Neurocirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Pandemias , Pneumonia Viral/epidemiologia , Fluxo de Trabalho
16.
Acad Med ; 95(8): 1140-1142, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32282372

RESUMO

The COVID-19 pandemic has disrupted all aspects of academic medical center missions. The number and rapidity of innovative responses to the crisis are extraordinary. When the pandemic has subsided, the world of academic medicine will have changed. The author of this Invited Commentary anticipates that at least some of these innovations will become part of academic medicine's everyday clinical and educational operations. Here, he considers the implications of exemplary innovations-virtual care, hospital at home, advances in diagnosis and therapy, virtual learning, and virtual clinical learning-for regulators, academic medical centers, faculty, and students.


Assuntos
Centros Médicos Acadêmicos/tendências , Betacoronavirus , Infecções por Coronavirus , Educação Médica/tendências , Inovação Organizacional , Pandemias , Pneumonia Viral , Humanos
17.
Circ Cardiovasc Qual Outcomes ; 13(3): e005903, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32126805

RESUMO

BACKGROUND: Telestroke provides access to vascular neurology expertise for hospitals lacking stroke coverage, and its use has risen rapidly in the past decade. We aim to characterize consultations, spoke behavior, and the relationship between spoke telestroke utilization (number of telestroke consults per year) and spoke alteplase treatment metrics in an academic telestroke network. METHODS AND RESULTS: We analyzed prospectively collected data on all telestroke consults from 2003 to 2018. Trends in network performance and spoke characteristics were analyzed using generalized estimating equations and Kendall τß nonparametric tests as appropriate. Unadjusted and adjusted linear regression models determined associations between telestroke utilization and treatment metrics. The network included 2 hubs and 43 spokes with 12 803 consults performed during the study period. Network growth overall was +1.8 spokes per year, and median duration of spoke participation was 7.9 years. The numbers of consults and alteplase-treated patients increased annually, even after adjusting for the number of spokes in the network (P<0.01 for both). Although times from last seen well to spoke emergency department arrival and to consult request increased, door-to-needle time, time from teleconsult request to callback, and time from teleconsult to alteplase administration all decreased (all P<0.01). With time, the network included more spokes without a Primary Stroke Center designation. In adjusted analyses, for every 10 telestroke consults requested by a spoke, the spoke door-to-needle decreased by 1.8 minutes (P=0.02), number of patients treated with alteplase was an additional 1.7 (P<0.01), and the percent of eligible patients treated with alteplase increased by 8% (P=0.03). CONCLUSIONS: Telestroke network size and utilization increased over time. Increased use of teleconsults was associated with increased and timely use of alteplase. Over time, the delivery of timely emergency care has improved significantly among emergency departments participating in this telestroke network. Replication of these findings in other networks is warranted.


Assuntos
Centros Médicos Acadêmicos/tendências , Prestação Integrada de Cuidados de Saúde/tendências , Fibrinolíticos/administração & dosagem , Avaliação de Processos e Resultados em Cuidados de Saúde/tendências , Consulta Remota/tendências , Acidente Vascular Cerebral/tratamento farmacológico , Ativador de Plasminogênio Tecidual/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Comportamento Cooperativo , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , New England , Avaliação de Programas e Projetos de Saúde , Estudo de Prova de Conceito , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/tendências , Fatores de Tempo , Tempo para o Tratamento/tendências , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento , Fluxo de Trabalho
18.
BMJ Open Qual ; 9(1)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32213548

RESUMO

The goal of the University of California Davis Health Blood Pressure (BP) Quality Improvement Initiative was to improve the diagnosis, management and control of high BP. Patients aged 18-85 years were included in the initiative. Lean A3 problem solving was used to implement the following evidence-based interventions based on stakeholder interviews, value stream mapping and the Centers for Disease Control and Prevention's Million Hearts Initiative: staff training on accurate BP measurement, visual cues and reminders for BP screening, virtual case-based videoconferences, standardised clinical management algorithm, academic detailing visits, clinical decision support tools, access to pharmacists for medication comanagement, clinician workflow modification, patient education and access to home BP monitors. Following implementation of interventions, accurate screening of BP increased from 14% to 87% and BP control increased from 62% to 75%. Strategies that contributed the most to improvements were using a team-based approach, adjusting clinic workflow and frequent communication of results to staff.


Assuntos
Determinação da Pressão Arterial/normas , Programas de Rastreamento/normas , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Centros Médicos Acadêmicos/tendências , Adolescente , Adulto , Idoso , Determinação da Pressão Arterial/tendências , California , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Melhoria de Qualidade
19.
J Couns Psychol ; 67(2): 222-231, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32105128

RESUMO

To examine process of changes in two distinct psychotherapies-cognitive-behavioral therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP). Two hypothesized processes of change-misinterpretation of bodily sensations and Panic Specific Reflective Function (PSRF)-were tested in the CBT and PFPP arms of the Cornell-Penn Study of Psychotherapies for Panic Disorder. The Brief Bodily Sensations Interpretation Questionnaire (BBSIQ) measures misinterpretation of bodily sensations-a focus of CBT interventions. PSRF, a target of PFPP, assesses the capacity to reflect on the underlying meaning of panic symptoms. A sample of 138 patients (37.7% men, 72.56% Whites, and 16.7% Latinx) with primary Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) panic disorder were included in the present analyses. Mixed effects models tested the effects of early change in BBSIQ and PSRF (intake through Week 5) on subsequent change in the Panic Disorder Severity Scale (PDSS; Week 5 through termination). Early change on both PSRF and BBSIQ predicted subsequent change in panic severity across the two treatments. As predicted, PSRF changed more in PFPP than in CBT, but, contrary to expectation, BBSIQ showed comparable changes in both groups. Counterintuitively, CBT patients benefited more in terms of panic symptom improvement when their PSRF improved than did PFPP patients. This is the first demonstration of general processes of change (PSRF and BBSIQ) across psychotherapies for panic disorder, suggesting that to the extent patients change their beliefs about the meaning of panic, their panic symptoms improve in time-limited, panic-focused psychotherapies. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Assuntos
Centros Médicos Acadêmicos/métodos , Terapia Cognitivo-Comportamental/métodos , Transtorno de Pânico/psicologia , Transtorno de Pânico/terapia , Psicoterapia Psicodinâmica/métodos , Centros Médicos Acadêmicos/tendências , Adulto , Terapia Cognitivo-Comportamental/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/diagnóstico , Psicoterapia Psicodinâmica/tendências , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
20.
Br J Anaesth ; 124(3): e63-e69, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31980155

RESUMO

The under-representation of women in academic leadership roles, including in anaesthesiology, is a well-documented phenomenon that has persisted for decades despite more women attending medical school, participating in anaesthesiology residencies, and joining academic faculties. The percentage of female anaesthesiologists who hold senior academic ranks or leadership roles, such as chair, lags behind the percentage of female anaesthesiologists overall. Trends towards increasing the numbers of women serving in educational leadership roles, specifically residency programme directors, suggest that there are areas in which academic anaesthesiology has been, and can continue, improving gender imbalance. Continued institutional efforts to recruit women into anaesthesiology, reduce gender bias, and promote interventions that foster gender equity in hiring and promotion will continue to benefit women, academic anaesthesiology departments, and the healthcare system overall.


Assuntos
Anestesiologia/tendências , Internato e Residência/tendências , Médicas/tendências , Sexismo/tendências , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/tendências , Anestesiologia/educação , Anestesiologia/organização & administração , Escolha da Profissão , Mobilidade Ocupacional , Educação de Pós-Graduação em Medicina/organização & administração , Educação de Pós-Graduação em Medicina/tendências , Feminino , Humanos , Internato e Residência/organização & administração , Liderança , Médicas/estatística & dados numéricos , Faculdades de Medicina/organização & administração , Faculdades de Medicina/tendências , Sexismo/prevenção & controle , Estados Unidos
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