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1.
BMJ Open ; 11(2): e043837, 2021 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-33619195

RESUMO

OBJECTIVES: Healthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty. SETTING: Our tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless. PARTICIPANTS: We recruited willing low-risk HCP, aged <50 years, with no comorbidities to work in COVID-19 zones. Social distancing, hand hygiene and universal masking were advocated in the low-risk zone. RESULTS: Between 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (<1%), ensured satisfaction with training (92%), PPE (90.8%), medical and psychosocial support (79%) and improved acceptance of COVID-19 duty with 54.7% volunteering for re-deployment. CONCLUSION: A multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.


Assuntos
Transmissão de Doença Infecciosa do Paciente para o Profissional , Corpo Clínico Hospitalar , Doenças Profissionais , Adulto , /prevenção & controle , /transmissão , Países em Desenvolvimento , Feminino , Hospitais Universitários/organização & administração , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Modelos Organizacionais , Doenças Profissionais/epidemiologia , Doenças Profissionais/prevenção & controle , Política Organizacional , Equipamento de Proteção Individual , Estudos Prospectivos , Medição de Risco , Centros de Atenção Terciária/organização & administração
2.
JMIR Public Health Surveill ; 7(1): e21327, 2021 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-33400680

RESUMO

BACKGROUND: The COVID-19 pandemic, caused by SARS-CoV-2, has forced the health care delivery structure to change rapidly. The pandemic has further widened the disparities in health care and exposed vulnerable populations. Health care services caring for such populations must not only continue to operate but create innovative methods of care delivery without compromising safety. We present our experience of incorporating telemedicine in our university hospital-based outpatient clinic in one of the worst-hit areas in the world. OBJECTIVE: Our goal is to assess the adoption of a telemedicine service in the first month of its implementation in outpatient practice during the COVID-19 pandemic. We also want to assess the need for transitioning to telemedicine, the benefits and challenges in doing so, and ongoing solutions during the initial phase of the implementation of telemedicine services for our patients. METHODS: We conducted a prospective review of clinic operations data from the first month of a telemedicine rollout in the outpatient adult ambulatory clinic from April 1, 2020, to April 30, 2020. A telemedicine visit was defined as synchronous audio-video communication between the provider and patient for clinical care longer than 5 minutes or if the video visit converted to a telephone visit after 5 minutes due to technical problems. We recorded the number of telemedicine visits scheduled, visits completed, and the time for each visit. We also noted the most frequent billing codes used based on the time spent in the patient care and the number of clinical tasks (eg, activity suggested through diagnosis or procedural code) that were addressed remotely by the physicians. RESULTS: During the study period, we had 110 telemedicine visits scheduled, of which 94 (85.4%) visits were completed. The average duration of the video visit was 35 minutes, with the most prolonged visit lasting 120 minutes. Of 94 patients, 24 (25.54%) patients were recently discharged from the hospital, and 70 (74.46%) patients were seen for urgent care needs. There was a 50% increase from the baseline in the number of clinical tasks that were addressed by the physicians during the pandemic. CONCLUSIONS: There was a high acceptance of telemedicine services by the patients, which was evident by a high show rate during the COVID-19 pandemic in Detroit. With limited staffing, restricted outpatient work hours, a shortage of providers, and increased outpatient needs, telemedicine was successfully implemented in our practice.


Assuntos
Pandemias/prevenção & controle , Telemedicina/métodos , Assistência Ambulatorial/métodos , /transmissão , Humanos , Michigan , Pandemias/estatística & dados numéricos , Satisfação do Paciente , Estudos Prospectivos , Estudos Retrospectivos , Telemedicina/tendências , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/tendências
4.
Medicine (Baltimore) ; 100(1): e23835, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429744

RESUMO

ABSTRACT: Immune check-point inhibitors (ICIs) have changed our view on how to treat cancer. Despite their approval in treatment of many different cancers, efficacy of immune check-point inhibitors (ICI) in neuroendocrine neoplasia is limited and poorly understood. Established treatment options of neuroendocrine tumors (NET) and neuroendocrine carcinomas (NECs) are based on surgery, tumor-targeted medical treatments, Peptide Receptor Radionuclide Therapy (PRRT), and locoregional therapies. However, in many patients these treatments lose efficacy over time, and novel therapies are urgently needed. We report on 8 patients diagnosed with neuroendocrine neoplasms (NEN) that were treated with ICI (pembrolizumab, avelumab, nivolumab plus ipilimumab) as salvage therapy. In this cohort, we observed tumor response with partial remission in 3 patients and stable disease in 1 patient. Four patients showed progressive disease. Of note, responses were observed both in PD-L1 positive and PD-L1 negative patients. Here, we discuss clinical courses of these patients in the context of available literature to highlight limitations and drawbacks currently preventing the use of ICI in routine management of patients with NEN.


Assuntos
Carcinoma Neuroendócrino/tratamento farmacológico , /farmacologia , Adulto , Anticorpos Monoclonais Humanizados/farmacologia , Anticorpos Monoclonais Humanizados/uso terapêutico , Carcinoma Neuroendócrino/patologia , Feminino , Humanos , Ipilimumab/farmacologia , Ipilimumab/uso terapêutico , Masculino , Pessoa de Meia-Idade , Nivolumabe/farmacologia , Nivolumabe/uso terapêutico , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/tendências
5.
S Afr Fam Pract (2004) ; 62(1): e1-e6, 2020 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-33314945

RESUMO

The ongoing coronavirus disease 2019 (COVID-19) pandemic presented a huge challenge to the health systems across the world. When the virus hit South Africa, and the state of national disaster was announced by the president, the healthcare system had to work on its COVID-19 response preparedness. Initially, a few hospitals were then designated facilities for managing COVID-19 patients. Kalafong Hospital, which was not amongst a list of designated facilities for COVID-19 was forced to evaluate its level of preparedness after an intern doctor tested positive. The objectives of this report are to illustrate the hospital's response around the management of the index case to share our facility's general response to the pandemic.


Assuntos
/transmissão , Infecção Hospitalar/prevenção & controle , Controle de Infecções/organização & administração , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Centros de Atenção Terciária/organização & administração , /diagnóstico , /terapia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/terapia , Humanos , Internato e Residência , Pandemias , África do Sul/epidemiologia
6.
Eur Rev Med Pharmacol Sci ; 24(21): 11440-11444, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33215467

RESUMO

OBJECTIVE: A computerized system of telephone consultation has been experimented at the Pediatric Emergency Department (ED) of Policlinico Gemelli Hospital in Rome during the outbreak of Coronavirus Disease 2019 (COVID-19). MATERIALS AND METHODS: Twenty monothematic items with a series of questions to evaluate child's clinical conditions have been set up in order to evaluate the different situations according to their severity. All items were highlighted according to conventional scores corresponding to the different answers (yes/no) given by the child's parents. This system has been implemented with large diffusion of computer programs and applications by the availability of a computer station in every ED room. RESULTS: The system allows healthcare workers to establish the medical check-up urgency which may be immediate, within the next 24 hours or scheduled in the pediatric ward. Therefore, it has been implemented a telephone triage consultation with a standardized method. CONCLUSIONS: Telephone consultation during outbreaks, considering the risks of contagion, allows healthcare workers to decrease the concern of families and to reduce indiscriminate access to ED. The remote approach will not solve logistic and setting problems related to COVID-19 outbreak17, but it would be a valid tool to improve medical evaluation without deep change in infrastructure and clinical organization.


Assuntos
Infecções por Coronavirus/prevenção & controle , Serviço Hospitalar de Emergência/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Encaminhamento e Consulta/organização & administração , Telefone , Triagem/organização & administração , Betacoronavirus/patogenicidade , Criança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Implementação de Plano de Saúde , Acesso aos Serviços de Saúde/organização & administração , Humanos , Itália/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Avaliação de Programas e Projetos de Saúde , Centros de Atenção Terciária/organização & administração , Fatores de Tempo
7.
S Afr Med J ; 110(10): 964-967, 2020 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-33205721

RESUMO

SARS-CoV-2 has resulted in a global pandemic within months following its initial detection. South Africa (SA), like many other countries, was not prepared for the impact this novel infection would have on the healthcare system. In this paper, the authors discuss the challenges experienced while facing COVID-19 at a tertiary-level institution in Gauteng province, SA, and the dynamic strategies implemented to deal with the epidemic.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Melhoria de Qualidade , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/normas , Betacoronavirus , Protocolos Clínicos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Administração Hospitalar/normas , Humanos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , África do Sul/epidemiologia
8.
S Afr Med J ; 110(10): 968-972, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-33205722

RESUMO

The SARS-CoV-2 pandemic has challenged the provision of healthcare in ways that are unprecedented in our lifetime. Planning for the sheer numbers expected during the surge has required public hospitals to de-escalate all non-essential clinical services to focus on COVID-19. Western Cape Province was the initial epicentre of the COVID-19 epidemic in South Africa (SA), and the Cape Town metro was its hardest-hit geographical region. We describe how we constructed our COVID-19 hospital-wide clinical service at Groote Schuur Hospital, the University of Cape Town's tertiary-level teaching hospital. By describing the barriers and enablers, we hope to provide guidance rather than a blueprint for hospitals elsewhere in SA and in low-resource countries that face similar challenges now or during subsequent waves.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Hospitais Universitários/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Centros de Atenção Terciária/organização & administração , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Registros Eletrônicos de Saúde/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Humanos , Unidades de Terapia Intensiva/organização & administração , Administração de Materiais no Hospital , Pandemias , Equipe de Assistência ao Paciente , Pneumonia Viral/epidemiologia , Centros de Cuidados de Saúde Secundários , África do Sul/epidemiologia
9.
S Afr Med J ; 110(10): 973-981, 2020 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-33205723

RESUMO

The SARS-CoV-2 pandemic has presented clinicians with an enormous challenge in managing a respiratory virus that is not only capable of causing severe pneumonia and acute respiratory distress syndrome, but also multisystem disease. The extraordinary pace of clinical research, and particularly the surge in adaptive trials of new and repurposed treatments, have provided rapid answers to questions of whether such treatments work, and has resulted in corticosteroids taking centre stage in the management of hospitalised patients requiring oxygen support. Some treatment modalities, such as the role of anticoagulation to prevent and treat potential thromboembolic complications, remain controversial, as does the use of high-level oxygen support, outside of an intensive care unit setting. In this paper, we describe the clinical management of COVID-19 patients admitted to Groote Schuur Hospital, a major tertiary level hospital at the epicentre of South Africa's SARS-CoV-2 epidemic during its first 4 months.


Assuntos
Infecções por Coronavirus/terapia , Hospitais Universitários/organização & administração , Pneumonia Viral/terapia , Centros de Atenção Terciária/organização & administração , Corticosteroides/uso terapêutico , Anticoagulantes/uso terapêutico , Gestão de Antimicrobianos , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/psicologia , Cuidados Críticos/organização & administração , Complicações do Diabetes , Humanos , Intubação Intratraqueal , Corpo Clínico Hospitalar/psicologia , Oxigenoterapia , Cuidados Paliativos , Pandemias , Equipe de Assistência ao Paciente , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/psicologia , Respiração Artificial , Fatores de Risco , Apoio Social , África do Sul/epidemiologia
10.
J Surg Oncol ; 122(5): 839-843, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33052593

RESUMO

BACKGROUND: The COVID-19 pandemic has caused a global health emergency and affected the resources in both the public and private health sectors significantly. The present study aims to assess the impact of the pandemic on the services by the department in the first 3 months since the first COVID case in the region. METHODS: The study period was from 16 March to 15 June 2020. We queried the database for data on site of the tumor, diagnosis, stage, tumor board decisions and planning, surgical procedures, adjuvant treatment, and follow-up details. The change in tumor board decision and actual treatment taken by the patient were all recorded, taking into consideration the COVID-19 pandemic. RESULTS: Among the 1567 patient contacts, 1306 were out-patient visits and 261 teleconsultations. Fifty-four patients underwent surgery from the 87 admitted to the hospital. Ten preoperative patients and two postoperative patients were tested for COVID and reported to be negative. CONCLUSIONS: The dilemma of providing cancer surgery services to the patients in this pandemic has been global. Strict measures and guidelines can help to overcome the COVID pandemic time, keeping in mind the locoregional logistics.


Assuntos
Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Oncologia Cirúrgica/organização & administração , Centros de Atenção Terciária/organização & administração , Humanos , Índia/epidemiologia
11.
Can J Surg ; 63(5): E468-E474, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107816

RESUMO

BACKGROUND: The implementation of quality-of-care indicators aiming to improve colorectal cancer (CRC) outcomes has been previously described by Cancer Care Ontario. The aim of this study was to assess the quality-of-care indicators in CRC at a referral centre in a developing country and to determine whether improvement occurred over time. METHODS: We performed a retrospective study of our prospectively collected database of patients after CRC surgery from 2001 to 2016. We excluded patients who underwent local transanal excision, pelvic exenteration or palliative procedures. We evaluated trends over time using the Cochran-Armitage test for trend. RESULTS: A total of 343 patients underwent surgical resection of CRC over the study period. There was improvement of the following indicators over time: the proportion of patients detected by screening (p = 0.03), the proportion of patients with preoperative liver imaging (p = 0.001), the proportion of patients with stage II or III rectal cancer who received neoadjuvant chemotherapy (p = 0.03), the proportion of patients with pathology reports that indicated the number of lymph nodes examined and the number of positive nodes (p = 0.001), and the proportion of patients with pathology reports describing the details on margin status (p = 0.001). CONCLUSION: This study showed the feasibility of applying the Cancer Care Ontario indicators for evaluating outcomes in CRC treatment at a single centre in a developing country. Although there was an improvement of some of the quality-of-care indicators over time, policies and interventions must be implemented to improve the fulfillment of all indicators.


Assuntos
Neoplasias Colorretais/cirurgia , Países em Desenvolvimento , Recidiva Local de Neoplasia/epidemiologia , Avaliação de Resultados em Cuidados de Saúde/métodos , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/mortalidade , Estudos de Viabilidade , Feminino , Seguimentos , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Masculino , México , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
12.
Nurs Leadersh (Tor Ont) ; 33(3): 9-14, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33097100

RESUMO

During my career, I have had many mantras, including "I love to wonder what will happen tomorrow" and "It's all about relationships." Well, I have been rewarded in spades because nothing has been predictable or stable about our professional practice environments since COVID-19 infiltrated our organizations. I have been challenged to develop and implement changes at The Hospital for Sick Children - a 300-bed tertiary pediatric academic health sciences centre in Toronto, ON - that we had never contemplated before. I believe that staying true to my leadership values and core principles has been essential when taking on such challenges and staying afloat during these tumultuous times.


Assuntos
Infecções por Coronavirus/enfermagem , Hospitais Pediátricos/organização & administração , Relações Interprofissionais , Enfermeiras Administradoras/psicologia , Pandemias , Pneumonia Viral/enfermagem , Centros Médicos Acadêmicos/organização & administração , Criança , Infecções por Coronavirus/epidemiologia , Humanos , Liderança , Ontário/epidemiologia , Pneumonia Viral/epidemiologia , Centros de Atenção Terciária/organização & administração
13.
Can J Surg ; 63(5): E442-E448, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33026310

RESUMO

BACKGROUND: The role of physician assistants (PAs) in surgical care in Canada is expanding. Similarly, the acute care surgery (ACS) model continues to evolve, and PAs are increasingly being considered as members of ACS teams. However, their exact impact and contribution has not been well studied. Our study describes the contribution of a PA who worked full time on weekdays on an ACS team in a Canadian academic tertiary hospital. METHODS: To quantify the PA's contributions, an ACS database was created in September 2016. Data on the number of ACS patient encounters, the number of ACS surgical consults, the number of ACS admissions, the PA's involvement in the operating room, the number of PA patient encounters and the number of multidisciplinary meetings were prospectively collected. We report data for 365 consecutive days from Dec. 30, 2016, to Dec. 29, 2017. RESULTS: The ACS team had 11 651 patient encounters during the year, with a mean of 31.92 per day. The mean number of surgical consults per day was 5.89, and a mean of 2.08 surgical procedures were performed per day. The PA was involved in 53.5% of all patient encounters, despite working only during daytime hours on weekdays. Multidisciplinary meetings were conducted by the PA 94.9% of the time. Alternate level of care patients were seen by the PA 96.2% of the time. The PA was directly involved in 2.0% of the operating room procedures during the study period. CONCLUSION: Integrating a PA on an ACS team adds value to patient care by providing consistency and efficient management of ward issues and patient care plans, including multidisciplinary discharge planning, timely emergency department consultations and effective organization of the ACS team members.


Assuntos
Cuidados Críticos/organização & administração , Salas Cirúrgicas/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Assistentes Médicos/organização & administração , Papel Profissional , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Canadá , Cuidados Críticos/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Salas Cirúrgicas/estatística & dados numéricos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos
14.
Can J Surg ; 63(5): E449-E450, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33026313

RESUMO

SUMMARY: With the closure of most operating rooms (ORs) during the coronavirus disease 2019 (COVID-19) pandemic, the traditional allocation of block OR time needed to be redesigned. An important factor permitting the treatment of patients in a prioritized fashion was our pre-existing centralized OR booking (CORB) framework, which already required surgeons to categorize the priority level for each patient. The CORB, in conjunction with the multidisciplinary OR oversight committee that was formed during COVID-19 to review and triage the urgent cases, allowed for prioritization of cases among surgical services. Centralized OR booking provided opportunities that were essential in OR planning during the pandemic, including the ability to plan surgeries to maximize OR efficiency, minimize the number of admissions on any given day to the wards and the intensive care unit, flatten the number of admissions over the week and provide the flexibility to ramp up or down the number of ORs as the crisis changed.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Salas Cirúrgicas/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Centros de Atenção Terciária/organização & administração , Humanos
15.
J Occup Health ; 62(1): e12172, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33058404

RESUMO

With coronavirus disease 2019 declared a Public Health Emergency of International Concern on 30 January 2020, occupational health services in a tertiary hospital in Singapore stepped up via a three-pronged approach, namely, protection of individual staff, protection of staff workforce, and prevention of nosocomial spread so as to support business continuity plans. Despite the multiple new challenges brought by the COVID-19 pandemic, the hospital's occupational health services were able to adapt and keep all employees and patients safe with strong support from senior management and close collaboration with various departments.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Serviços de Saúde do Trabalhador/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Centros de Atenção Terciária/organização & administração , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecção Hospitalar/virologia , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Singapura/epidemiologia
16.
Crit Care Med ; 48(11): 1553-1555, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33045150

RESUMO

OBJECTIVES: To describe the unique perspective of pediatric intensivists caring for critically ill adults during the coronavirus disease 2019 pandemic. DESIGN: Observational study. SETTING: Academic medical center in New York City. PATIENTS: Coronavirus disease 2019 positive adults requiring admission to an ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In late March 2020, New York Presbyterian Hospital centralized all of its inpatient pediatric units (n = 4) from across the network to a single center, in order to create space to accommodate the increasing number of critically ill adults with coronavirus disease 2019. Within 1 week, the PICU at New York Presbyterian Hospital-Weill Cornell Medicine transferred or discharged all inpatients, underwent a transformation of the physical space, and began admitting adults of all ages with coronavirus disease 2019 related acute respiratory failure. The New York Presbyterian Hospital-Weill Cornell Medicine PICU physician group continued to lead this unit. PICU nurses, respiratory therapists, social workers, and child life specialists joined their PICU physician colleagues to care for these critically ill adults. CONCLUSIONS: In the coronavirus disease 2019 pandemic, PICU physicians are well poised to care for adult patients in a surge capacity, and bring a unique perspective to the experience.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Estado Terminal/terapia , Unidades de Terapia Intensiva Pediátrica/organização & administração , Pneumonia Viral/terapia , Centros de Atenção Terciária/organização & administração , Adulto , Infecções por Coronavirus/epidemiologia , Estado Terminal/epidemiologia , Feminino , Humanos , Masculino , Cidade de Nova Iorque , Pandemias , Pneumonia Viral/epidemiologia , Índice de Gravidade de Doença
17.
Circ Heart Fail ; 13(9): e007516, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32894988

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic imposed severe restrictions on traditional methods of patient care. During the pandemic, the heart failure program at New York-Presbyterian Hospital in New York, NY rapidly and comprehensively transitioned its care delivery model and administrative organization to conform to a new healthcare environment while still providing high-quality care to a large cohort of patients with heart failure, heart transplantation, and left ventricular assist device. In addition to the widespread adoption of telehealth, our program restructured outpatient care, initiating a shared clinic model and introducing a comprehensive remote monitoring program to manage patients with heart failure and heart transplant. All conferences, including administrative meetings, support groups, and educational seminars were converted to teleconferencing platforms. Following the peak of COVID-19, many of the new changes have been maintained, and the program structure will be permanently altered as a lasting effect of this pandemic. In this article, we review the details of our program's transition in the face of COVID-19 and highlight the programmatic changes that will endure.


Assuntos
Cardiologia/organização & administração , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Insuficiência Cardíaca/terapia , Pneumonia Viral/epidemiologia , Telemedicina/organização & administração , Planejamento Antecipado de Cuidados , Assistência Ambulatorial/organização & administração , Betacoronavirus , Transplante de Coração , Coração Auxiliar , Humanos , Cidade de Nova Iorque/epidemiologia , Profissionais de Enfermagem , Pandemias , Médicos , Papel Profissional , Grupos de Autoajuda , Telecomunicações , Centros de Atenção Terciária/organização & administração , Comunicação por Videoconferência
18.
Am Heart J ; 229: 121-126, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32957030

RESUMO

Myocarditis Disease Unit (MDU) is a functional multidisciplinary network designed to offer multidisciplinary assistance to patients with myocarditis. More than 300 patients coming from the whole Country are currently followed up at a specialized multidisciplinary outpatient clinic. Following the pandemic outbreak of the SARS-CoV-2 infection in Italy, we present how the MDU rapidly evolved to a "tele-MDU", via a dedicated multitasking digital health platform.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Unidades Hospitalares/organização & administração , Comunicação Interdisciplinar , Miocardite/terapia , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/epidemiologia , Telemedicina/organização & administração , Adulto , Assistência Ambulatorial/organização & administração , Arritmias Cardíacas/terapia , Feminino , Sistemas de Informação Hospitalar , Humanos , Pacientes Internados , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Centros de Atenção Terciária/organização & administração , Navegador
19.
J Cancer Res Ther ; 16(4): 888-899, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32930136

RESUMO

Context: Stereotactic body radiotherapy (SBRT) is increasingly being used for early-stage lung cancer and lung oligometastases. Aims: To report our experience of setting up lung SBRT and early clinical outcomes. Settings and Design: This was a retrospective, interventional, cohort study. Subjects and Methods: Patients were identified from multidisciplinary tumor board meetings. They underwent four-dimensional computed tomography-based planning. The ROSEL trial protocol, the Radiation Therapy Oncology Group (RTOG) 0236, and the UK-Stereotactic Ablative Body Radiotherapy Consortium guidelines were used for target volume and organs-at-risks (OARs) delineation, dosimetry, and plan quality assessment. Each SBRT plan underwent patient-specific quality assurance (QA). Daily online image guidance using KVCT or MVCT was done to ensure accurate treatment delivery. Statistical Analysis Used: Microsoft Excel 2010 was used for data analysis. Results: Fifteen patients were treated to one or more lung tumors. One patient received helical tomotherapy in view of bilateral lung oligometastases at similar axial levels. All the remaining patients received volumetric modulated arc therapy (VMAT)-based treatment. The prescription dose varied from 40 to 60 Gy in 5-8 fractions with alternate-day treatment. The mean and median lung V20 was 5.24% and 5.16%, respectively (range, 1.66%-9.10%). The mean and median conformity indexes were 1.02 and 1.06, respectively (range, 0.70-1.18). After a median follow-up of 17 months, the locoregional control rate was 93.3%. Conclusions: SBRT was implemented using careful evaluation of OAR dose constraints, dosimetric accuracy and plan quality, patient-specific QA, and online image guidance for accurate treatment delivery. It was safe and effective for early-stage nonsmall cell lung cancer and lung metastases. Prospective data were collected to audit our outcomes.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Radiocirurgia/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Tomografia Computadorizada Quadridimensional/métodos , Humanos , Índia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Órgãos em Risco/diagnóstico por imagem , Órgãos em Risco/efeitos da radiação , Garantia da Qualidade dos Cuidados de Saúde , Radiocirurgia/normas , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos , Centros de Atenção Terciária/organização & administração , Resultado do Tratamento
20.
Intern Emerg Med ; 15(8): 1457-1465, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32960429

RESUMO

The correlation between myocardial injury and clinical outcome in COVID-19 patients is gaining attention in the literature. The aim of the present study was to evaluate the role of cardiac involvement and of respiratory failure in a cohort of COVID-19 patients hospitalized in an academic hospital in Lombardy, one of the most affected Italian (and worldwide) regions by the epidemic. The study included 405 consecutive patients with confirmed COVID-19 admitted to a medical ward from February 25th to March 31st, 2020. Follow-up of surviving patients ended either at hospital discharge or by July 30th, 2020. Myocardial injury was defined on the basis of the presence of blood levels of hs-TnI above the 99th percentile upper reference limit. Respiratory function was assessed as PaO2/FiO2 (P/F) ratio. The primary end-point was death for any cause. During hospitalization, 124 patients died. Death rate increased from 7.9% in patients with normal hs-TnI plasma levels and no cardiac comorbidity to 61.5% in patients with elevated hs-TnI and cardiac involvement (p < 0.001). At multivariable analysis, older age, P/F ratio < 200 (both p < 0.001) and hs-TnI plasma levels were independent predictors of death. However, it must be emphasized that the median values of hs-TnI were within normal range in non-survivors. Cardiac involvement at presentation was associated with poor prognosis in COVID-19 patients, but, even in a population of COVID-19 patients who did not require invasive ventilation at hospital admission, mortality was mainly driven by older age and respiratory failure.


Assuntos
Doenças Cardiovasculares/etiologia , Infecções por Coronavirus/complicações , Avaliação de Resultados em Cuidados de Saúde/normas , Pneumonia Viral/complicações , Centros de Atenção Terciária/estatística & dados numéricos , Idoso , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Biomarcadores/análise , Biomarcadores/sangue , Doenças Cardiovasculares/epidemiologia , Infecções por Coronavirus/epidemiologia , Eletrocardiografia/métodos , Eletrocardiografia/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Reação em Cadeia da Polimerase/métodos , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/normas , Troponina I/análise , Troponina I/sangue
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