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4.
Rehabilitación (Madr., Ed. impr.) ; 54(4): 269-274, oct.-dic. 2020.
Artigo em Espanhol | IBECS | ID: ibc-192488

RESUMO

El sistema sanitario se encuentra ante una pandemia mundial en relación con la enfermedad por coronavirus 2019 (COVID-19). Los planes de preparación para emergencias a menudo no consideran cuestiones específicas de rehabilitación para pacientes hospitalizados ni para ambulatorios, aunque la Organización Mundial de la Salud aconseja incluir a profesionales de rehabilitación lo antes posible. Los planes de contingencia de los Servicios de Rehabilitación deben realizarse en coordinación con las otras áreas asistenciales. En esta revisión, se ha resumido y analizado la información disponible basada en una búsqueda cuidadosa de la literatura científica de COVID-19 y en la experiencia de un entorno concreto, para planificar la continuidad asistencial de rehabilitación para todos los pacientes y para ayudar a los equipos de rehabilitación en este periodo de confinamiento /desconfinamiento incierto


The health system is facing a global pandemic due to coronavirus disease 2019 (COVID-19). Emergency plans often fail to consider specific rehabilitation issues, whether inpatient or outpatient, although the World Health Organisation advises the inclusion of rehabilitation professionals as soon as possible. The contingency plans of rehabilitation services must be carried out in coordination with the other healthcare areas. This review was prepared with the current available evidence on COVID-19 and was based on the experience of a specific environment, to plan the continuity of rehabilitation care for all patients and to help rehabilitation teams in this period of lockdown and uncertain lifting of restrictions


Assuntos
Humanos , Quarentena/psicologia , Infecções por Coronavirus/reabilitação , Vírus da SARS/patogenicidade , Pandemias , Centros de Reabilitação/organização & administração , Terapia por Exercício/métodos , Continuidade da Assistência ao Paciente/organização & administração , Planos de Contingência
7.
Rehabilitación (Madr., Ed. impr.) ; 54(4): 276-283, oct.-dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192491

RESUMO

La pandemia de COVID-19 es un desafío para el manejo de las patologías no COVID como la enfermedad linfática y el lipedema. La telemedicina puede evitar la propagación del coronavirus. Se necesita un sistema que nos ayude a determinar la prioridad clínica y la selección de la asistencia presencial o telemática para cada paciente y la forma de realizarlas durante la pandemia. El Grupo Español de Linfología ha realizado un documento de consenso con recomendaciones basadas en la bibliografía y experiencia clínica, como guía de práctica clínica en el manejo de anomalías linfáticas y lipedema durante la pandemia de COVID-19. Estas recomendaciones deben adaptarse a las características del paciente, las condiciones locales de los centros y las decisiones de los profesionales de la salud. Es un documento de criterios mínimos, sujeto a modificaciones según evolucione la pandemia, los conocimientos científicos y las instrucciones de las autoridades sanitarias


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
Humanos , Infecções por Coronavirus/reabilitação , Lipedema/reabilitação , Anormalidades Linfáticas/reabilitação , Linfedema/reabilitação , Malformações Vasculares/reabilitação , Telerreabilitação/organização & administração , Pandemias , Centros de Reabilitação/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Prioridades em Saúde/tendências
8.
Rev Saude Publica ; 54: 100, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33146323

RESUMO

OBJECTIVE: To estimate the adequacy of health care during pregnancy and the postpartum period in puerperal women and newborn users of the Unified Health System and verify the factors associated with greater adequacy. METHODS: We used data obtained in the hospital interview, the prenatal card and the first telephone interview of 12,646 women participating in the study Nascer no Brasil (Birth in Brazil), conducted in 2011 and 2012. In the first stage of the analysis, the sociodemographic and obstetric characteristics of women and the estimation of adequacy of prenatal and postpartum care indicators are described. In the second stage, the cascade of care for actions related to puerperal women and their newborns is presented. Finally, maternal factors associated with the adequacy of the line of care are verified by means of multiple logistic regression. RESULTS: Only two of the four prenatal indicators were considered satisfactory: initiation up to the 16th week of pregnancy and adequate number of appointments. The guidance on which maternity to go for delivery, as well as the guidance to perform the puerperal appointment and the performance of the heel prick test have reached partial level of adequacy. The puerperal appointment, the first routine appointment of the newborn and the obtaining of the heel prick test results presented unsatisfactory adequacy. In the joint analysis of indicators regarding the effective use of services, only 1.5% of mothers and their babies received all recommended health care. Multiparous women living in the North, Northeast and Midwest, with lower schooling, presented the lowest chances of continuity of care. CONCLUSIONS: The indicators evaluated indicate that almost all women and their children presented partial and disjointed care, showing that the coordination of care is still a challenge in the health care of women and children in the puerperal pregnancy period.


Assuntos
Continuidade da Assistência ao Paciente , Serviços de Saúde Materna , Período Pós-Parto , Cuidado Pré-Natal , Adolescente , Adulto , Brasil , Criança , Continuidade da Assistência ao Paciente/organização & administração , Feminino , Humanos , Recém-Nascido , Serviços de Saúde Materna/organização & administração , Gravidez , Cuidado Pré-Natal/organização & administração , Adulto Jovem
10.
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
11.
J Clin Psychiatry ; 81(5)2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32936543

RESUMO

OBJECTIVE: This study examined a cohort of 15,520 inpatient psychiatric discharges to determine associations between scheduling an outpatient mental health appointment as part of discharge planning and attending outpatient care following discharge after control for patient, hospital, and system characteristics. METHODS: 2012-2013 New York State Medicaid and other administrative databases were used to examine patients who were aged under 65 years, admitted to an inpatient psychiatric unit, and discharged to the community. Outcomes included attending an outpatient mental health service within 7 and 30 days following inpatient discharge. Scheduling a mental health outpatient appointment as part of the discharge plan was the primary predictor variable, and potentially confounding covariates were addressed by adjusting for propensity scores estimating the likelihood of having an outpatient appointment scheduled. RESULTS: Among 15,520 discharged patients, 11,945 (77%) had an outpatient appointment scheduled with a mental health provider as part of their discharge planning. After adjustment for propensity scores, patients who had an outpatient appointment scheduled were significantly more likely to attend an outpatient mental health service within 7 (OR = 1.69; 95% CI, 1.48-1.94) and 30 days (OR = 1.65; 95% CI, 1.42-1.93) compared to patients who did not have an appointment scheduled. Even among those with a low propensity to have an appointment scheduled, scheduling an outpatient appointment was associated with attending outpatient services. CONCLUSIONS: Scheduling an outpatient mental health appointment is an effective and low-resource discharge planning practice that should be an important target for inpatient psychiatric clinical quality measurement and improvement.


Assuntos
Assistência Ambulatorial , Continuidade da Assistência ao Paciente , Transtornos Mentais/terapia , Alta do Paciente , Adolescente , Adulto , Assistência Ambulatorial/métodos , Agendamento de Consultas , Criança , Pré-Escolar , Serviços Comunitários de Saúde Mental/métodos , Serviços Comunitários de Saúde Mental/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New York , Pontuação de Propensão , Adulto Jovem
12.
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
13.
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
14.
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
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.
Clin J Oncol Nurs ; 24(4): 444-447, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32678371

RESUMO

To plan for a proactive approach to support patients traveling for their treatment during the COVID-19 pandemic, a network of oncology hospitals worked within existing collaborative agreements to define policies and procedures to transition care for patients living in communities in close proximity to a member institution. Nurse leaders were instrumental in collaborating with and leading interprofessional partners to achieve these outcomes. These efforts led to patients' abilities to continue treatment in their local community, ensuring continuity of cancer care.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Neoplasias/terapia , Pandemias , Pneumonia Viral/epidemiologia , Continuidade da Assistência ao Paciente/organização & administração , Comportamento Cooperativo , Prática Clínica Baseada em Evidências , Humanos , Enfermagem Oncológica
18.
Rehabilitacion (Madr) ; 54(4): 269-275, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32560965

RESUMO

The health system is facing a global pandemic due to coronavirus disease 2019. Emergency plans often fail to consider specific rehabilitation issues, whether inpatient or outpatient, although the World Health Organization advises the inclusion of rehabilitation professionals as soon as possible. The contingency plans of rehabilitation services must be carried out in coordination with the other healthcare areas. This review was prepared with the current available evidence on coronavirus disease 2019 and was based on the experience of a specific environment, to plan the continuity of rehabilitation care for all patients and to help rehabilitation teams in this period of lockdown and uncertain lifting of restrictions.


Assuntos
Betacoronavirus , Infecções por Coronavirus/reabilitação , Pandemias , Pneumonia Viral/reabilitação , Quarentena , Assistência Ambulatorial/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Cuidados Críticos/métodos , Pessoas com Deficiência , Recursos em Saúde , Acesso aos Serviços de Saúde , Departamentos Hospitalares/organização & administração , Humanos , Alocação de Recursos , Gestão de Riscos , Organização Mundial da Saúde
19.
Arch Osteoporos ; 15(1): 92, 2020 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-32562001

RESUMO

This qualitative study identified the barriers to the implementation of a multidisciplinary co-management program for older hip fracture patients and provided evidence for future intervention improvement and scale-up. INTRODUCTION: Multidisciplinary co-management has been recommended as an effective intervention for hip fracture management in older people. This study is a process evaluation of a multidisciplinary co-management program in an orthopaedic hospital in Beijing, China, to better understand the barriers to implementation. METHODS: Data collection involved semi-structured interviews with key implementers of the co-management intervention (surgeon, geriatrician, physician, nurse, physiotherapist and anaesthetist) and observations of patients' journey to map the care processes were conducted in Beijing Jishuitan Hospital. Data were transcribed, qualitatively coded and analysed using normalization process theory to understand the intervention process from four constructs: coherence, cognitive participation, collective action and reflexive monitoring. RESULTS: Ten stakeholder interviews were conducted. Despite multidisciplinary co-management intervention was meaningful and valued by participants, barriers to its implementation were identified. These included unmatched investment and benefit (cognitive participation), challenges of facing increased workload (collective action), deficient training and supervision system (collective action), limited accommodating capacity of hospital (collective action) and difficulties in accessing information about the effect of the intervention (reflexive monitoring). CONCLUSIONS: Multiple barriers to the effective implementation of the multidisciplinary co-management program in China were identified. The process evaluation highlights key aspects in less willingness to fully invest in the program, inappropriate workload allocation and lack of training and supervision which need to be addressed before scaling up.


Assuntos
Envelhecimento , Continuidade da Assistência ao Paciente/organização & administração , Comportamento Cooperativo , Fraturas do Quadril/prevenção & controle , Modelos Teóricos , Equipe de Assistência ao Paciente/organização & administração , Prevenção Secundária/organização & administração , Idoso , Idoso de 80 Anos ou mais , China , Pessoal de Saúde , Humanos , Entrevistas como Assunto , Osteoporose/terapia , Fraturas por Osteoporose/prevenção & controle , Pesquisa Qualitativa
20.
Mol Genet Metab ; 130(4): 227-229, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32561366

RESUMO

Fabry disease is an X-linked disease due to a deficiency of the lysosomal enzyme alpha-galactosidase A. Clinical symptoms in classically affected males include acroparesthesia, anhydrosis and angiokeratoma, which may present during childhood followed by cardiac, cerebral and renal complications. Even though pulmonary involvement is not widely appreciated by clinicians, an obstructive lung disease is another recognized component of Fabry disease. Coronavirus Disease-19 (COVID-19), caused by the SARS-CoV-2 virus was labeled as a global pandemic and patients with Fabry disease can be considered at high risk of developing severe complications. The impact of COVID-19 on patients with Fabry disease receiving enzyme replacement therapy is still unknown. Many patients who receive treatment in the hospital experienced infusion disruptions due to fear of infection. Effects of temporary treatment interruption was described in more detail in other lysosomal storage diseases, but the recommencement of therapy does not fully reverse clinical decline due to the temporary discontinuation. When possible, home-therapy seems to be the most efficient way to maintain enzyme replacement therapy access during pandemic. Sentence take-home message: Home-therapy, when possible, seems to be the most efficient way to maintain enzyme replacement therapy access during pandemic in patients with Fabry disease.


Assuntos
Betacoronavirus/patogenicidade , Continuidade da Assistência ao Paciente/normas , Infecções por Coronavirus/prevenção & controle , Terapia de Reposição de Enzimas/normas , Doença de Fabry/terapia , Terapia por Infusões no Domicílio/normas , Pneumopatias Obstrutivas/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Terapia de Reposição de Enzimas/estatística & dados numéricos , Doença de Fabry/complicações , Doença de Fabry/diagnóstico , Feminino , Terapia por Infusões no Domicílio/estatística & dados numéricos , Humanos , Controle de Infecções/normas , Infusões Intravenosas , Isoenzimas/administração & dosagem , Pneumopatias Obstrutivas/diagnóstico , Pneumopatias Obstrutivas/etiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Proteínas Recombinantes/administração & dosagem , Índice de Gravidade de Doença , Fatores de Tempo , alfa-Galactosidase/administração & dosagem
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