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1.
Texto & contexto enferm ; 29: e20180104, Jan.-Dec. 2020. graf
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1101981

RESUMO

ABSTRACT Objective: To identify work aspects that generate satisfaction for the professionals who work in the Family Health Strategy. Method: This was a qualitative, descriptive study that involved five geographical regions of Brazil, and 27 Family Health Teams from six municipalities. The data were collected from 76 health professionals using semi-structured interviews, and were analyzed articulating the three phases of content analysis using Atlas.ti software resources. Results: The findings showed 129 statement excerpts, with 14 codes, grouped into three categories related to satisfaction. The category, Job Identification and Family Health Strategy Principles, represented 40.3%, with the codes: team work, job affinity, health model, completeness of care, and longitudinality of care. The category, Relationship with Family Health Strategy patients, represented 32.6%, with the following codes: bonding with patient, resoluteness of care, patient satisfaction, and patient care. Finally, the category, Professional and Working Aspects related to the Family Health Strategy, represented 27.1%, with the following codes: relationship with professionals, work recognition, enjoying the profession, team organization, and employment relationship. Conclusion: Professional satisfaction is associated with the work principles of the Family Health Strategy, and with the relationships that are established between patients, professionals and health management. It also has a subjective dimension, with a strong relationship with characteristics of the work process, how it is organized, and under what conditions and relationships this work occurs.


RESUMEN Objetivo: Identificar los aspectos del trabajo, que generan satisfacción en los profesionales de salud que actúan en la estrategia de salud familiar. Método: Estudio cualitativo que incluye 5 regiones geográficas del Brasil, 27 equipos de salud familiar de 6 municipios. Los datos fueron obtenidos, a través de 76 profesionales de salud por medio de entrevistas semi estructuradas y analizados, articulando las tres frases de Análisis del Contenido y los recursos del software Atlas ti. Resultados: Seleccionaron 129 extractos de conversaciones, 14 códigos agrupados en 3 categorías relacionadas a la satisfacción. La categoría Identificación con el trabajo y principios de la Estrategia salud de la familia, representó 40,3%; tuvo los códigos: trabajo en equipo, afinidad con el trabajo, modelo de salud, integralidad de la asistencia, longitudinalidad del cuidado. La categoría, Relación con los Usuarios en la Estrategia salud de la familia, representó el 32,6% con los siguientes códigos: vinculo con el usuario, resolutividad de la asistencia, satisfacción del usuario y asistencia al usuario. Finalmente, la categoría Aspectos Profesionales y de Trabajo, relacionados con la estrategia salud de la familia, representó 27,1% con los siguientes códigos: Relación con los profesionales, reconocimiento del trabajo, gusto por la profesión, organización del equipo, vinculo del trabajo. Conclusión: La satisfacción del profesional está asociada a los principios del trabajo en la Estrategia Salud de la Familia, a las relaciones que se establecen entre usuarios, profesionales y gestión de la salud. También posee una dimensión subjetiva, fuertemente relacionada con las características del proceso de trabajo, como se encuentra organizado, sus condiciones y relaciones.


RESUMO Objetivo: Identificar os aspectos do trabalho que são geradores de satisfação para os profissionais que atuam na Estratégia Saúde da Família. Método: Estudo qualitativo do tipo descritivo que envolveu 5 regiões geográficas do Brasil, 27 equipes de Saúde da Família de 6 municípios. Os dados foram coletados com 76 profissionais de saúde por meio de entrevistas semiestruturadas e analisados articulando as três fases da Análise de Conteúdo e dos recursos do software Atlas.ti. Resultados: Indicaram 129 trechos de falas e 14 códigos agrupados em 3 categorias relacionadas à satisfação. A categoria Identificação com o trabalho e princípios da Estratégia Saúde da Família representou 40,3% e teve os códigos: trabalho em equipe, afinidade com o trabalho, modelo de saúde, integralidade da assistência, longitudinalidade do cuidado. A categoria relações com os usuários na Estratégia Saúde da Família representou 32,6% com os seguintes códigos: vínculo com o usuário, resolutividade da assistência, satisfação do usuário, assistência ao usuário. Por fim, a categoria aspectos profissionais e trabalhistas relacionados à Estratégia Saúde da Família, representou 27,1% com os seguintes códigos: relação com os profissionais, reconhecimento do trabalho, gostar da profissão, organização da equipe, vínculo de trabalho. Conclusão: A satisfação profissional está associada aos princípios do trabalho na Estratégia Saúde da Família, as conexões que se estabelecem entre usuários, profissionais e gestão em saúde. Possui ainda uma dimensão subjetiva, possuindo forte vínculo com características do processo de trabalho, como esse é organizado e sob que condições e relações o trabalho acontece


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Atenção Primária à Saúde , Condições de Trabalho , Estratégia Saúde da Família , Pesquisa Qualitativa , Satisfação no Emprego , Equipe de Assistência ao Paciente , Trabalho , Sistema Único de Saúde , Saúde da Família , Pessoal de Saúde , Continuidade da Assistência ao Paciente , Gestão em Saúde , Assistência ao Paciente , Recursos em Saúde
3.
AIDS Res Ther ; 17(1): 59, 2020 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-33012282

RESUMO

INTRODUCTION: During the COVID-19 pandemic, hospitals faced increasing pressure, where people living with HIV risked to either acquire SARS-CoV-2 and to interrupt the HIV continuum of care. METHODS: This is a retrospective, observational study. We compared the numbers of medical visits performed, antiretroviral drugs dispensed and the number of new HIV diagnosis and of hospitalizations in a cohort of people living with HIV (PLWH) followed by the Spedali Civili of Brescia between the bimester of the COVID-19 pandemic peak and the bimester of October-November 2019. Data were retrieved from administrative files and from paper and electronic clinical charts. Categorical variables were described using frequencies and percentages, while continuous variables were described using mean, median, and interquartile range (IQR) values. Means for continuous variables were compared using Student's t-tests and the Mann-Whitney test. Proportions for categorical variables were compared using the χ2 test. RESULTS: As of December 31st, 2019, a total of 3875 PLWH were followed in our clinic. Mean age was 51.4 ± 13 years old, where 28% were females and 18.8% non-Italian. Overall, 98.9% were on ART (n = 3834), 93% were viro-suppressed. A total of 1217 and 1162 patients had their visit scheduled at our out-patient HIV clinic during the two bimesters of 2019 and 2020, respectively. Comparing the two periods, we observed a raise of missed visits from 5 to 8% (p < 0.01), a reduction in the number of new HIV diagnosis from 6.4 in 2019 to 2.5 per month in 2020 (p = 0.01), a drop in ART dispensation and an increase of hospitalized HIV patients due to COVID-19. ART regimens including protease inhibitors (PIs) had a smaller average drop than ART not including PIs (16.6 vs 21.6%, p < 0.05). Whether this may be due to the perception of a possible efficacy of PIs on COVID19 is not known. CONCLUSIONS: Our experience highlights the importance of a resilient healthcare system and the need to implement new strategies in order to guarantee the continuum of HIV care even in the context of emergency.


Assuntos
Infecções por Coronavirus/virologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Pneumonia Viral/virologia , Adulto , Fármacos Anti-HIV/administração & dosagem , Antirretrovirais/administração & dosagem , Betacoronavirus/isolamento & purificação , Estudos de Coortes , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Hospitalização , Humanos , Itália/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Saúde Pública , Estudos Retrospectivos , Estatísticas não Paramétricas
4.
Soins Psychiatr ; 41(328): 12-15, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33039084

RESUMO

We need to go back to the time of alienist doctors to understand the interest of the care programme established in 2011. In fact, the psychiatric clinic requires professionals to accompany the patient over time, while accepting the variability of suffering. In this context, this system proposes an alternative to full in-patient care while preserving the aspect of compulsory treatments. Caring for the patient, acquiring their consent while preserving their rights is a real challenge for the psychiatrist and their team.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Consentimento Livre e Esclarecido , Transtornos Mentais/terapia , Psiquiatria , Humanos
5.
MMWR Morb Mortal Wkly Rep ; 69(38): 1337-1342, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32970045

RESUMO

During 2018, gay, bisexual, and other men who have sex with men (MSM) accounted for 69.4% of all diagnoses of human immunodeficiency virus (HIV) infection in the United States (1). Moreover, in all 42 jurisdictions with complete laboratory reporting of CD4 and viral load results,* percentages of MSM linked to care within 1 month (80.8%) and virally suppressed (viral load <200 copies of HIV RNA/mL or interpreted as undetected) within 6 months (68.3%) of diagnosis were below target during 2018 (2). African American/Black (Black), Hispanic/Latino (Hispanic), and younger MSM disproportionately experience HIV diagnosis, not being linked to care, and not being virally suppressed. To characterize trends in these outcomes, CDC analyzed National HIV Surveillance System† data from 2014 to 2018. The number of diagnoses of HIV infection among all MSM decreased 2.3% per year (95% confidence interval [CI] = 1.9-2.8). However, diagnoses did not significantly change among either Hispanic MSM or any MSM aged 13-19 years; increased 2.2% (95% CI = 1.0-3.4) and 2.0% (95% CI = 0.6-3.3) per year among Black and Hispanic MSM aged 25-34 years, respectively; and were highest in absolute count among Black MSM. Annual percentages of linkage to care within 1 month and viral suppression within 6 months of diagnosis among all MSM increased (2.9% [95% CI = 2.4-3.5] and 6.8% [95% CI = 6.2-7.4] per year, respectively). These findings, albeit promising, warrant intensified prevention efforts for Black, Hispanic, and younger MSM.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Infecções por HIV/etnologia , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Distribuição por Idade , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/terapia , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Carga Viral/estatística & dados numéricos , Adulto Jovem
6.
Radiat Oncol ; 15(1): 226, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993690

RESUMO

BACKGROUND: COVID-19 in Italy has led to the need to reorganize hospital protocols with a significant risk of interruption to cancer treatment programs. In this report, we will focus on a management model covering the two phases of the COVID-19 emergency, namely lockdown-phase I and post-lockdown-phase II. METHODS: The following steps were taken in the two phases: workload during visits and radiotherapy planning, use of dedicated routes, measures for triage areas, management of suspected and positive COVID-19 cases, personal protective equipment, hospital environments and intra-institutional meetings and tumor board management. Due to the guidelines set out by the Ministry of Health, oncological follow-up visits were interrupted during the lockdown-phase I; consequently, we set about contacting patients by telephone, with laboratory and instrumental exams being viewed via telematics. During the post-lockdown-phase II, the oncological follow-up clinic reopened, with two shifts operating daily. RESULTS: By comparing our radiotherapy activity from March 9 to May 4 2019 with the same period in 2020 during full phase I of the COVID-19 emergency, similar results were achieved. First radiotherapy visits, Simulation Computed Tomography and Linear Accelerator treatments amounted to 123, 137 and 151 in 2019 compared with 121, 135 and 170 in 2020 respectively. There were no cases of COVID-19 positivity recorded either in patients or in healthcare professionals, who were all negative to the swab tests performed. CONCLUSION: During both phases of the COVID-19 emergency, the planned model used in our own experience guaranteed both continuity in radiotherapy treatments whilst neither reducing workload nor interrupting treatment and, as such, it ensured the safety of cancer patients, hospital environments and staff.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/métodos , Neoplasias/radioterapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Radioterapia (Especialidade)/estatística & dados numéricos , Betacoronavirus , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Hospitais , Humanos , Itália/epidemiologia , Pneumonia Viral/epidemiologia , Radioterapia (Especialidade)/organização & administração , Carga de Trabalho/estatística & dados numéricos
7.
Rev Alerg Mex ; 67(2): 199-201, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32892535
8.
Rev Med Suisse ; 16(706): 1695-1698, 2020 Sep 16.
Artigo em Francês | MEDLINE | ID: mdl-32936552

RESUMO

The COVID-19 pandemic has imposed a reorganization of our health care system leading to an unhoped-for boom in telemedicine, particularly in Geneva. The deployment of HUG@home at the Geneva University Hospitals and of docteur@home in the doctors' offices has allowed health professionals to come together around a single solution thus ensuring continuity of care for patients with chronic diseases but also the triage and follow-up of patients with COVID-19 in compliance with security and confidentiality rules. The ease of use of remote consultation tools is essential for the sustainable anchoring of telemedicine in practice. The supervision of practices, training and the financial valorization of telemedicine are also necessary for the development of quality care.


Assuntos
Infecções por Coronavirus/epidemiologia , Hospitais Universitários/organização & administração , Pneumonia Viral/epidemiologia , Telemedicina , Betacoronavirus , Continuidade da Assistência ao Paciente , Humanos , Pandemias , Suíça
9.
Cuad Bioet ; 31(102): 223-229, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32910673

RESUMO

With the arrival of the COVID-19 pandemic, the risk of a possible lack of care for the elderly in nursing homes became evident. We summarize the experience of a multidisciplinary team with volunteer professionals from different specialties who carried out support for healthcare professionals in nursing homes. This team was implemented from both Primary and Specialty Care managements. Its work paradigm was proposed by our home hospitalization team, which included direct care of the most complex patients and general counselling on isolation, hygiene and preventive measures within the nursing homes. Thanks to this support, the elderly population placed there, with suspected or diagnosed COVID-19, received adequate care from an interdisciplinary team, which led part of the pressure to be released from their professional workers, and many family members were aware that there was no neglect of the elderly. Commitment from various levels of care in a coordinated effort has prevented a vulnerable population from being left unattended during the pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Casas de Saúde/ética , Pandemias , Pneumonia Viral , Idoso , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Necessidades e Demandas de Serviços de Saúde , Humanos , Higiene , Controle de Infecções , Comunicação Interdisciplinar , Cuidados Paliativos/ética , Pandemias/ética , Pandemias/prevenção & controle , Equipe de Assistência ao Paciente , Isolamento de Pacientes , Transferência de Pacientes/ética , Pneumonia Viral/prevenção & controle , Relações Profissional-Família , Qualidade de Vida , Avaliação de Sintomas , Populações Vulneráveis
10.
Pain Physician ; 23(4S): S161-S182, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32942784

RESUMO

BACKGROUND: Chronic pain patients require continuity of care even during the COVID-19 pandemic, which has drastically changed healthcare and other societal practices. The American Society of Interventional Pain Physicians (ASIPP) has created the COVID-ASIPP Risk Mitigation & Stratification (COVID-ARMS) Return to Practice Task Force in order to provide guidance for safe and strategic reopening. OBJECTIVES: The aims are to provide education and guidance for interventional pain specialists and their patients during the COVID-19 pandemic that minimizes COVID-related morbidity while allowing a return to interventional pain care. METHODS: The methodology utilized included the development of objectives and key questions with utilization of trustworthy standards, appropriate disclosures of conflicts of interest, as well as a panel of experts from various regions, specialities, and groups. The literature pertaining to all aspects of COVID-19, specifically related to epidemiology, risk factors, complications, morbidity and mortality, and literature related to risk mitigation and stratification were reviewed. The principles of best evidence synthesis of available literature and grading for recommendations as described by the Agency for Healthcare Research and Quality (AHRQ) typically utilized in ASIPP guideline preparation was not utilized in these guidelines due to limitations because of their lack of available literature on COVID-19, risk mitigation and stratification. These guidelines are considered evidence -- informed with incorporation of best available research and practice knowledge. Consequently, these guidelines are considered evidence-informed with incorporation of best available research and practice knowledge. RESULTS: Numerous risk factors have emerged that predispose patients to contracting COVID-19 and/or having a more severe course of the infection. COVID-19 may have mild symptoms, even be asymptomatic, or may be severe and life threatening. Older age and certain comorbidities, such as underlying pulmonary or cardiovascular disease, have been associated with worse outcomes. In pain care, COVID-19 patients are a heterogeneous group with some individuals relatively healthy and having only a short course of manageable symptoms while others become critically ill. It is necessary to assess patients on a case-by-case basis and craft individualized care recommendations. A COVID-ARMS risk stratification tool was created to quickly and objectively assess patients. Interventional pain specialists and their patients may derive important benefits from evidence-informed risk stratification, protective strategies to prevent infection, and the gradual resumption of treatments and procedures to manage pain. LIMITATIONS: COVID-19 was an ongoing pandemic at the time during which these recommendations were developed. The pandemic has created a fluid situation in terms of evidence-informed guidance. As more and better evidence is gathered, these recommendations may be modified. CONCLUSIONS: Chronic pain patients require continuity of care but during the time of the COVID-19 pandemic, steps must be taken to stratify risks and protect patients from possible infection to safeguard them from COVID-19-related illness and transmitting the disease to others. Pain specialists should optimize telemedicine encounters with their pain patients, be cognizant of risks of COVID-19 morbidity, and take steps to evaluate risk-benefit on a case-by-case basis. Pain specialists may return to practice with lower-risk patients and appropriate safeguards.


Assuntos
Dor Crônica/terapia , Continuidade da Assistência ao Paciente , Infecções por Coronavirus , Manejo da Dor/métodos , Pandemias , Pneumonia Viral , Idoso , Betacoronavirus , Humanos , Fatores de Risco , Estados Unidos
13.
J Korean Med Sci ; 35(36): e329, 2020 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-32924344

RESUMO

BACKGROUND: The number of clinical trials conducted in Korea continues to increase and an increasing proportion focus on severe and rare incurable diseases. After the start of the severe acute respiratory syndrome, coronavirus disease 2019 (COVID-19), Korea Centers for Disease Control and Prevention (KCDC) developed guidelines to prevent the spread of infection. This study evaluated the impact of COVID-19 and the KCDC guideline on the conduct of clinical research in Korea. The purpose was to develop recommendations on how to minimize the risk of infection while enabling subjects to take part in the trials if no better alternative treatment options were available. METHODS: The impact on subject's scheduled visits and major milestones of clinical trials in Korea were measured by conducting a survey among clinical project manager (CPMs) working at global clinical research organization. The policy on monitor's access to hospital and site initiation meetings was investigated through correspondence with clinical trial center of 39 hospitals. The Top 25 pharmaceutical companies' official press and public clinical trial registry database were used to analyze companies' trial strategy during the pandemic and COVID-19 clinical research status, respectively. RESULTS: Of 85 CPMs, 12% reported that trial subjects' scheduled visits had been affected in their project. Monitors' access to hospital for source data verification was restricted at all sites in February 2020. Accordingly, 43% of 105 CPMs reported that the COVID-19 epidemic had an effect on study major milestones and data cleaning and database lock accounted for > 60% of milestones affected. In addition, 87% sites advised not to have site initiation meetings and 52% pharmaceutical companies suspended recruitment or new study start-up due to the pandemic. On the other hands, the number of COVID-19 related clinical trials increased rapidly in Korea and worldwide, with investigator-initiated trials accounting for 47% and 63% of all trials locally and globally, respectively. Most trials were phase 2 and were in the recruitment stage. CONCLUSION: The COVID-19 and the KCDC guideline influenced all parties involved in clinical trials in Korea. In order to ensure the safety and well-being of trial subjects during the pandemic, new approaches are required for clinical trials to respond to the impact actively. Method of non-contact is developed to replace and supplement the face-to-face contact and alternatives to reduce the travel is introduced to decrease the risk of infection for all trial participants in whole trial process. The relevant regulations should be developed and the guidelines for foreign countries need to be adopted in accordance with the situation in Korea. COVID-19 trial is rapidly increasing worldwide and continuous support of health authorities, regulation, and facilities is required for developing the treatments with protecting all trial participants.


Assuntos
Betacoronavirus , Ensaios Clínicos como Assunto/métodos , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/epidemiologia , Indústria Farmacêutica , Comitês de Ética em Pesquisa , Fidelidade a Diretrizes , Humanos , Controle de Infecções , Consentimento Livre e Esclarecido , Estudos Multicêntricos como Assunto , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , República da Coreia/epidemiologia , Projetos de Pesquisa , Pesquisadores , Viagem
14.
G Ital Cardiol (Rome) ; 21(10): 750-756, 2020 Oct.
Artigo em Italiano | MEDLINE | ID: mdl-32968307

RESUMO

BACKGROUND: During the COVID-19 pandemic, non-urgent outpatient activities were temporarily suspended. The aim of this study was to assess the impact of this measure on the management of the heart failure outpatient clinic at our institution. METHODS: We analyzed the clinical outcome of 110 chronic heart failure patients (mean age 73 ± 9 years) whose follow-up visit had been delayed. RESULTS: At their last visit before the lockdown, 80.9% was in NYHA class II, had an ejection fraction of 37 ± 7%, and B-type natriuretic peptide level was moderately elevated (266 ± 138 pg/ml). All patients received loop diuretics, 97.2% beta-blockers, 64.9% an aldosterone antagonist, 60.9% sacubitril/valsartan (S/V), and 72.2% of the remaining patients were on angiotensin-converting enzyme inhibitor or valsartan therapy. Patients were contacted by phone during and at the end of the lockdown period to fix a new appointment and underwent a structured interview to assess their clinical conditions and ongoing therapy and to verify whether they had contracted SARS-CoV-2 infection. Twelve patients (13.2%) contracted COVID-19. None was hospitalized for worsening heart failure or reported defibrillator shocks and none changed autonomously the prescribed therapy. Overall, 75% of patients reported stable or improved general well-being from the last in-person visit, while 25% described subjective worsening due to the social effect of the pandemic. Unchanged body weight and blood pressure values were reported by 86% and 78.4% of patients, respectively. Lower blood pressure values compared to baseline were recorded in 15.2% of patients on conventional renin-angiotensin system inhibition vs 21% of those on S/V, one of whom had to down-titrate S/V for persistent but asymptomatic hypotension; 4 patients up-titrated S/V to 200 mg/day following phone indications. CONCLUSIONS: Cancellation of scheduled follow-up visits during 3 months did not have significant negative effects in a cohort of stable patients with chronic heart failure on optimized medical therapy. Telephone support was effective in keeping connections with the patients during the lockdown, allowing appropriate management and implementation of drug therapy. In particular, patients who received S/V were not affected by delays in scheduled visits, confirming the tolerability and safety of this novel therapy in terms of both clinical and biohumoral parameters.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Insuficiência Cardíaca/tratamento farmacológico , Pneumonia Viral/epidemiologia , Quarentena , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Instituições de Assistência Ambulatorial , Aminobutiratos/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Doença Crônica , Continuidade da Assistência ao Paciente/organização & administração , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/psicologia , Assistência à Saúde , Progressão da Doença , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/psicologia , Humanos , Itália/epidemiologia , Masculino , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Peptídeo Natriurético Encefálico/sangue , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/psicologia , Recidiva , Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico , Volume Sistólico , Telefone , Tetrazóis/uso terapêutico , Suspensão de Tratamento
15.
Rehabilitacion (Madr) ; 54(4): 276-283, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32863012

RESUMO

The COVID-19 pandemic poses a challenge to the management of non-COVID pathologies such as lymphatic diseases and lipoedema. The use of telemedicine can prevent the spread of the disease. A system is needed to help determine the clinical priority and selection of face-to-face or telemedicine options for each patient and how to carry them out during the pandemic. The Spanish Lymphology Group has drafted a consensus document with recommendations based on the literature and clinical experience, as clinical practice guidelines for the management of lymphatic abnormalities and lipoedema during the COVID-19 pandemic. These recommendations must be adapted to the characteristics of each patient, the local conditions of the centres, and the decisions of health care professionals. The document contains minimum criteria, subject to modifications according to the evolution of the pandemic, scientific knowledge and instructions from health authorities.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Lipedema/terapia , Doenças Linfáticas/terapia , Pandemias , Pneumonia Viral , Telemedicina , Comorbidade , Bandagens Compressivas , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Gerenciamento Clínico , Emergências , Desenho de Equipamento , Necessidades e Demandas de Serviços de Saúde , Humanos , Lipedema/complicações , Lipedema/reabilitação , Doenças Linfáticas/complicações , Doenças Linfáticas/reabilitação , Drenagem Linfática Manual , Visita a Consultório Médico , Pandemias/prevenção & controle , Educação de Pacientes como Assunto , Participação do Paciente , Modalidades de Fisioterapia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Medicina de Precisão , Telefone , Triagem , Comunicação por Videoconferência
16.
Front Health Serv Manage ; 37(1): 20-26, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842085

RESUMO

COVID-19 will remain a threat to millions of older adults for the foreseeable future, challenging healthcare providers to find successful ways to address this population's special needs. Thanks to well-defined core values and an experienced and innovative team of colleagues, Trinity Health's Continuing Care division has been able to adroitly support thousands of older adults throughout the COVID-19 pandemic. Our response has also included working to maintain the safety and well-being of thousands of staff who serve in this space every day. The pandemic is less than a year old, yet we have learned lessons that an organization typically takes many years to learn, and we are pleased to share them here. One of the greatest lessons is that, to best respond to a pandemic, everyone in an organization should have a clear understanding of purpose and strategy. In other words, know why you exist and what you need to do to weather the unknown until a vaccine or cure is available for all.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Infecções por Coronavirus/terapia , Assistência à Saúde/organização & administração , Assistência de Longa Duração/organização & administração , Pneumonia Viral/terapia , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Feminino , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Pandemias/prevenção & controle
17.
Medicine (Baltimore) ; 99(32): e21495, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769885

RESUMO

The aim of this study was to clarify the relationship between doctor-shopping behavior and clinical conditions, and to clearly outline the effects of both the number of clinic visits and the number of doctor changes on patients' health conditions. Data from January 1, 2000 to December 31, 2004 was collected from the National Health Insurance Research Database in Taiwan. After randomly selecting one million people, we extracted 5-year longitudinal data, about the number of clinic visits, number of doctor changes, and changes in self-health status for each patient with diabetes over the age of 18. We developed a relationship among the variables by using the generalized estimating equation. The results revealed that the number of clinic visits on the change of health status is a U curve, suggesting that health condition could be optimal with an appropriate number of clinic visits. The effect of the number of doctor changes is linearly correlated with health deterioration. The results suggest that disease conditions can only be controlled with an adequate number of clinic visits. Excessively frequent clinic visits are not only unfavorable to patients' health status but are also wasteful of limited medical resources. For diabetic mellitus patients, the more they change doctors, the worse their health status. All of these results are important for patients to stay healthy and to save medical resources.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Diabetes Mellitus/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Médicos/estatística & dados numéricos , Adulto , Assistência Ambulatorial/psicologia , Bases de Dados Factuais , Diabetes Mellitus/psicologia , Feminino , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Estudos Retrospectivos , Taiwan
19.
J Stroke Cerebrovasc Dis ; 29(9): 105009, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807424

RESUMO

BACKGROUND: Acute stroke unit (ASU) care is proven to reduce mortality and morbidity. During the COVID-19 crisis, established physical units and care practices within existing physical units are likely to be disrupted. Stroke patients with possible suspected COVID-19 infection may be isolated in other wards outside the ASU. METHODS: Our hospital developed an adapted ASU protocol which includes key elements for stroke unit care, can be utilized by staff not familiar with stroke care with minimal training and can be implemented in various settings. RESULTS: The adapted protocol has 3 categories of Acute monitoring (neurological observations, blood pressure and input-output monitoring, investigations and specific post-reperfusion issues), Stroke complications (focusing on 5 common complications) and Unified team (describing daily check-ins, patient education, communication, discharge planning and post-discharge support). CONCLUSIONS: Details are presented in the article in a format that it can be adopted by other centers facing similar issues in order to ensure ASU care is not compromised.


Assuntos
Protocolos Clínicos , Continuidade da Assistência ao Paciente/organização & administração , Infecções por Coronavirus/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/terapia , Acidente Vascular Cerebral/terapia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Saúde do Trabalhador , Pandemias , Segurança do Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Fatores de Risco , Singapura , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia
20.
Med Care ; 58(9): 785-792, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32732787

RESUMO

BACKGROUND: Telephone call programs are a common intervention used to improve patients' transition to outpatient care after hospital discharge. OBJECTIVE: To examine the impact of a follow-up telephone call program as a readmission reduction initiative. RESEARCH DESIGN: Pragmatic randomized controlled real-world effectiveness trial. SUBJECTS: We enrolled and randomized all patients discharged home from a hospital general medicine service to a follow-up telephone call program or usual care discharge. Patients discharged against medical advice were excluded. The intervention was a hospital program, delivering a semistructured follow-up telephone call from a nurse within 3-7 days of discharge, designed to assess understanding and provide education, and assistance to support discharge plan implementation. MEASURES: Our primary endpoint was hospital inpatient readmission within 30 days identified by the electronic health record. Secondary endpoints included observation readmission, emergency department revisit, and mortality within 30 days, and patient experience ratings. RESULTS: All 3054 patients discharged home were enrolled and randomized to the telephone call program (n=1534) or usual care discharge (n=1520). Using a prespecified intention-to-treat analysis, we found no evidence supporting differences in 30-day inpatient readmissions [14.9% vs. 15.3%; difference -0.4 (95% confidence interval, 95% CI), -2.9 to 2.1; P=0.76], observation readmissions [3.8% vs. 3.6%; difference 0.2 (95% CI, -1.1 to 1.6); P=0.74], emergency department revisits [6.1% vs. 5.4%; difference 0.7 (95% CI, -1.0 to 2.3); P=0.43], or mortality [4.4% vs. 4.9%; difference -0.5 (95% CI, -2.0 to 1.0); P=0.51] between telephone call and usual care groups. CONCLUSIONS: We found no evidence of an impact on 30-day readmissions or mortality due to the postdischarge telephone call program.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Readmissão do Paciente/estatística & dados numéricos , Telefone/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Recursos Humanos de Enfermagem no Hospital/organização & administração , Satisfação do Paciente , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Fatores de Tempo
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