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1.
BMJ ; 371: m3434, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028575

RESUMO

OBJECTIVE: To characterize the therapeutic value of new drugs approved by the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) and the association between these ratings and regulatory approval through expedited programs. DESIGN: Retrospective cohort study. SETTING: New drugs approved by the FDA and EMA between 2007 and 2017, with follow-up through 1 April 2020. DATA SOURCES: Therapeutic value was measured using ratings of new drugs by five independent organizations (Prescrire and health authorities of Canada, France, Germany, and Italy). MAIN OUTCOME MEASURES: Proportion of new drugs rated as having high therapeutic value; association between high therapeutic value rating and expedited status. RESULTS: From 2007 through 2017, the FDA and EMA approved 320 and 268 new drugs, respectively, of which 181 (57%) and 39 (15%) qualified for least one expedited program. Among 267 new drugs with a therapeutic value rating, 84 (31%) were rated as having high therapeutic value by at least one organization. Compared with non-expedited drugs, a greater proportion of expedited drugs were rated as having high therapeutic value among both FDA approvals (45% (69/153) v 13% (15/114); P<0.001) and EMA approvals (67% (18/27) v 27% (65/240); P<0.001). The sensitivity and specificity of expedited program for a drug being independently rated as having high therapeutic value were 82% (95% confidence interval 72% to 90%) and 54% (47% to 62%), respectively, for the FDA, compared with 25.3% (16.4% to 36.0%) and 90.2% (85.0% to 94.1%) for the EMA. CONCLUSIONS: Less than a third of new drugs approved by the FDA and EMA over the past decade were rated as having high therapeutic value by at least one of five independent organizations. Although expedited drugs were more likely than non-expedited drugs to be highly rated, most expedited drugs approved by the FDA but not the EMA were rated as having low therapeutic value.


Assuntos
Aprovação de Drogas , Avaliação de Medicamentos , Serviços de Informação sobre Medicamentos , Disseminação de Informação , Vigilância de Produtos Comercializados , Aprovação de Drogas/métodos , Aprovação de Drogas/estatística & dados numéricos , Avaliação de Medicamentos/métodos , Avaliação de Medicamentos/estatística & dados numéricos , Serviços de Informação sobre Medicamentos/organização & administração , Serviços de Informação sobre Medicamentos/normas , Serviços de Informação sobre Medicamentos/estatística & dados numéricos , Europa (Continente) , Humanos , Vigilância de Produtos Comercializados/métodos , Vigilância de Produtos Comercializados/estatística & dados numéricos , Desenvolvimento de Programas , Melhoria de Qualidade , Estudos Retrospectivos , Estados Unidos
2.
MMWR Morb Mortal Wkly Rep ; 69(42): 1549-1551, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33090979

RESUMO

Namibia is an upper-middle income country in southern Africa, with a population of approximately 2.5 million (1). On March 13, 2020, the first two cases of coronavirus disease 2019 (COVID-19) in Namibia were identified among recently arrived international travelers. On March 17, Namibia's president declared a state of emergency, which introduced measures such as closing of all international borders, enactment of regional travel restrictions, closing of schools, suspension of gatherings, and implementation of physical distancing measures across the country. As of October 19, 2020, Namibia had reported 12,326 laboratory-confirmed COVID-19 cases and 131 COVID-19-associated deaths. CDC, through its Namibia country office, as part of ongoing assistance from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) provided technical assistance to the Ministry of Health and Social Services (MoHSS) for rapid coordination of the national human immunodeficiency virus (HIV) treatment program with the national COVID-19 response.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por HIV/tratamento farmacológico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Desenvolvimento de Programas , Fármacos Anti-HIV/uso terapêutico , Serviços de Saúde Comunitária/organização & administração , Infecções por Coronavirus/epidemiologia , Humanos , Namíbia/epidemiologia , Pneumonia Viral/epidemiologia
3.
Value Health ; 23(9): 1128-1136, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940229

RESUMO

Real-world data (RWD) and the derivations of these data into real-world evidence (RWE) are rapidly expanding from informing healthcare decisions at the patient and health system level to influencing major health policy decisions, including regulatory approvals and coverage. Recent examples include the approval of palbociclib in combination with endocrine therapy for male breast cancer and the inclusion of RWE in the label of paliperidone palmitate for schizophrenia. This interest has created an urgency to develop processes that promote trust in the evidence-generation process. Key stakeholders and decision-makers include patients and their healthcare providers; learning health systems; health technology assessment bodies and payers; pharmacoepidemiologists and other clinical reseachers, and policy makers interested in bioethical and regulatory issues. A key to optimal uptake of RWE is transparency of the research process to enable decision-makers to evaluate the quality of the methods used and the applicability of the evidence that results from the RWE studies. Registration of RWE studies-particularly for hypothesis evaluating treatment effectiveness (HETE) studies-has been proposed to improve transparency, trust, and research replicability. Although registration would not guarantee better RWE studies would be conducted, it would encourage the prospective disclosure of study plans, timing, and rationale for modifications. A joint task force of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the International Society for Pharmacoepidemiology (ISPE) recommended that investigators preregister their RWE studies and post their study protocols in a publicly available forum before starting studies to reduce publication bias and improve the transparency of research methods. Recognizing that published recommendations alone are insufficient, especially without accessible registration options and with no incentives, a group of experts gathered on February 25 and 26, 2019, in National Harbor, Maryland, to explore the structural and practical challenges to the successful implementation of the recommendations of the ISPOR/ISPE task force for preregistration. This positioning article describes a plan for making registration of HETE RWE studies routine. The plan includes specifying the rationale for registering HETE RWE studies, the studies that should be registered, where and when these studies should be registered, how and when analytic deviations from protocols should be reported, how and when to publish results, and incentives to encourage registration. Table 1 summarizes the rationale, goals, and potential solutions that increase transparency, in addition to unique concerns about secondary data studies. Definitions of terms used throughout this report are provided in Table 2.


Assuntos
Medicina Baseada em Evidências , Avaliação de Resultados em Cuidados de Saúde/organização & administração , Pesquisa/tendências , Humanos , Ensaios Clínicos Pragmáticos como Assunto , Desenvolvimento de Programas , Sistema de Registros
4.
West J Emerg Med ; 21(5): 1095-1101, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32970560

RESUMO

The unprecedented COVID-19 pandemic has resulted in rapidly evolving best practices for transmission reduction, diagnosis, and treatment. A regular influx of new information has upended traditionally static hospital protocols, adding additional stress and potential for error to an already overextended system. To help equip frontline emergency clinicians with up-to-date protocols throughout the evolving COVID-19 crisis, our team set out to create a dynamic digital tool that centralized and standardized resources from a broad range of platforms across our hospital. Using a design thinking approach, we rapidly built, tested, and deployed a solution using simple, out-of-the-box web technology that enables clinicians to access the specific information they seek within moments. This platform has been rapidly adopted throughout the emergency department, with up to 70% of clinicians using the digital tool on any given shift and 78.6% of users reporting that they "agree" or "strongly agree" that the platform has affected their management of COVID-19 patients. The tool has also proven easily adaptable, with multiple protocols being updated nearly 20 times over two months without issue. This paper describes our development process, challenges, and results to enable other institutions to replicate this process to ensure consistent, high-quality care for patients as the COVID-19 pandemic continues its unpredictable course.


Assuntos
Betacoronavirus , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/terapia , Sistemas de Apoio a Decisões Clínicas , Serviços Médicos de Emergência/métodos , Pneumonia Viral/terapia , Atitude do Pessoal de Saúde , Protocolos Clínicos , Árvores de Decisões , Eficiência , Emergências , Humanos , Internet , Pandemias , Padrões de Prática em Enfermagem/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Desenvolvimento de Programas , São Francisco
5.
West J Emerg Med ; 21(5): 1114-1117, 2020 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-32970563

RESUMO

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has seriously impacted clinical research operations in academic medical centers due to social distancing measures and stay-at-home orders. The purpose of this paper is to describe the implementation of a program to continue clinical research based out of an emergency department (ED) using remote research associates (RA). METHODS: Remote RAs were trained and granted remote access to the electronic health record (EHR) by the health system's core information technology team. Upon gaining access, remote RAs used a dual-authentication process to gain access to a host-based, firewall-protected virtual network where the EHR could be accessed to continue screening and enrollment for ongoing studies. Study training for screening and enrollment was also provided to ensure study continuity. RESULTS: With constant support and guidance available to establish this EHR access pathway, the remote RAs were able to gain access relatively independently and without major technical troubleshooting. Each remote RA was granted access and trained on studies within one week and self-reported a high degree of program satisfaction, EHR access ease, and study protocol comfort through informal evaluation surveys. CONCLUSIONS: In response to the COVID-19 pandemic, we virtualized a clinical research program to continue important ED-based studies.


Assuntos
Betacoronavirus , Pesquisa Biomédica/organização & administração , Infecções por Coronavirus/prevenção & controle , Registros Eletrônicos de Saúde , Serviço Hospitalar de Emergência/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pesquisadores/organização & administração , Centros Médicos Acadêmicos/organização & administração , California , Humanos , Informática Médica , Desenvolvimento de Programas
8.
J Med Internet Res ; 22(10): e21211, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-32997642

RESUMO

The physical and social distancing measures that have been adopted worldwide because of COVID-19 will probably remain in place for a long time, especially for senior adults, people with chronic conditions, and other at-risk populations. Teleconsultations can be useful in ensuring that patients continue to receive clinical care while reducing physical crowding and avoiding unnecessary exposure of health care staff. Implementation processes that typically take months of planning, budgeting, pilot testing, and education were compressed into days. However, in the urgency to deal with the present crisis, we may be forgetting that the introduction of digital health is not exclusively a technological issue, but part of a complex organizational change problem. This viewpoint offers insight regarding issues that rapidly adopted teleconsultation systems may face in a post-COVID-19 world.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Consulta Remota/tendências , Telemedicina/tendências , Centros Médicos Acadêmicos , Betacoronavirus , Humanos , Países Baixos/epidemiologia , Pandemias , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Consulta Remota/organização & administração , Software , Telemedicina/organização & administração , Interface Usuário-Computador
9.
PLoS Comput Biol ; 16(9): e1007833, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32881872

RESUMO

Since 2015, we have run a free 9-week summer program that provides non-computer science (CS) undergraduates at San Francisco State University (SFSU) with experience in coding and doing research. Undergraduate research experiences remain very limited at SFSU and elsewhere, so the summer program provides opportunities for many more students beyond the mentoring capacity of our university laboratories. In addition, we were concerned that many students from historically underrepresented (HU) groups may be unable to take advantage of traditional summer research programs because these programs require students to relocate or be available full time, which is not feasible for students who have family, work, or housing commitments. Our program, which is local and part-time, serves about 5 times as many students as a typical National Science Foundation (NSF) Research Experiences for Undergraduates (REU) program, on a smaller budget. Based on our experiences, we present 10 simple rules for busy faculty who want to create similar programs to engage non-CS HU undergraduates in computational research. Note that while some of the strategies we implement are based on evidence-based publications in the social sciences or education research literature, the original suggestions we make here are based on our trial-and-error experiences, rather than formal hypothesis testing.


Assuntos
Metodologias Computacionais , Educação/métodos , Universidades , Humanos , Ciência da Informação/educação , Ciência da Informação/organização & administração , Internet , Desenvolvimento de Programas , São Francisco , Estudantes
12.
Cad Saude Publica ; 36(9): e00132120, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32965375

RESUMO

Brazil is the country of the world with the second most COVID-19 cases and deaths, and the pandemic's impacts pose multiple challenges for mental health. This paper reports on experience with the emergency organization of the volunteer and collaborative Working Group (GT, in Portuguese) on mental health and psychosocial care aimed at producing rapid responses for health services in the context of COVID-19. The study involved the identification and systematization of current evidence in the scientific literature on mental health and psychosocial care in public health emergencies and pandemics, with the establishment of a network involving 117 researchers and 25 institutions, and the organization of themes for the elaboration of materials, referenced on the response phases in public health emergencies and pandemics. In less than 60 days, 18 technical documents were produced, ranging from services organization and management for different vulnerable groups. The materials became references in health institutions and services. A national course on mental health and psychosocial care in COVID-19 was also organized, with more than 60,000 people registered. The experience provides food for thought and a contribution for future experiences involving knowledge translation in the current pandemic and in future public health emergencies and pandemics, with the following: (1) combination of volunteer and collaborative work involving professionals with experience in the organization of services and care in past events; (2) reliance on institutional support and resources; (3) speed and credibility of work involving the establishment of networks of professionals and institutions; and (4) responses to the urgent needs with the capacity to shape paths for care in mental health and psychosocial care.


Assuntos
Comportamento Cooperativo , Infecções por Coronavirus/psicologia , Pessoal de Saúde/psicologia , Saúde Mental , Pandemias , Pneumonia Viral/psicologia , Sistemas de Apoio Psicossocial , Voluntários/estatística & dados numéricos , Betacoronavirus , Brasil/epidemiologia , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , Desenvolvimento de Programas
13.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32747473

RESUMO

BACKGROUND: One-third of outpatient antibiotic prescriptions for pediatric acute respiratory tract infections (ARTIs) are inappropriate. We evaluated a distance learning program's effectiveness for reducing outpatient antibiotic prescribing for ARTI visits. METHODS: In this stepped-wedge clinical trial run from November 2015 to June 2018, we randomly assigned 19 pediatric practices belonging to the Pediatric Research in Office Settings Network or the NorthShore University HealthSystem to 4 wedges. Visits for acute otitis media, bronchitis, pharyngitis, sinusitis, and upper respiratory infection for children 6 months to <11 years old without recent antibiotic use were included. Clinicians received the intervention as 3 program modules containing online tutorials and webinars on evidence-based communication strategies and antibioti c prescribing, booster video vignettes, and individualized antibiotic prescribing feedback reports over 11 months. The primary outcome was overall antibiotic prescribing rates for all ARTI visits. Mixed-effects logistic regression compared prescribing rates during each program module and a postintervention period to a baseline control period. Odds ratios were converted to adjusted rate ratios (aRRs) for interpretability. RESULTS: Among 72 723 ARTI visits by 29 762 patients, intention-to-treat analyses revealed a 7% decrease in the probability of antibiotic prescribing for ARTI overall between the baseline and postintervention periods (aRR 0.93; 95% confidence interval [CI], 0.90-0.96). Second-line antibiotic prescribing decreased for streptococcal pharyngitis (aRR 0.66; 95% CI, 0.50-0.87) and sinusitis (aRR 0.59; 95% CI, 0.44-0.77) but not for acute otitis media (aRR 0.93; 95% CI, 0.83-1.03). Any antibiotic prescribing decreased for viral ARTIs (aRR 0.60; 95% CI, 0.51-0.70). CONCLUSIONS: This program reduced antibiotic prescribing during outpatient ARTI visits; broader dissemination may be beneficial.


Assuntos
Antibacterianos/uso terapêutico , Educação a Distância/organização & administração , Prescrição Inadequada/prevenção & controle , Atenção Primária à Saúde , Infecções Respiratórias/tratamento farmacológico , Doença Aguda , Bronquite/tratamento farmacológico , Bronquite/virologia , Chicago , Criança , Pré-Escolar , Comunicação , Intervalos de Confiança , Educação a Distância/métodos , Feminino , Humanos , Lactente , Análise de Intenção de Tratamento , Modelos Logísticos , Masculino , Razão de Chances , Otite Média/tratamento farmacológico , Pacientes Ambulatoriais , Enfermagem Pediátrica/educação , Enfermagem Pediátrica/estatística & dados numéricos , Pediatras/educação , Pediatras/estatística & dados numéricos , Faringite/tratamento farmacológico , Faringite/microbiologia , Faringite/virologia , Desenvolvimento de Programas , Melhoria de Qualidade , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/virologia , Sinusite/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico
14.
Health Aff (Millwood) ; 39(8): 1405-1411, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32744939

RESUMO

Clinical care in the United States has been transformed during the coronavirus disease 2019 (COVID-19) pandemic. To support these changes, regulators and payers have temporarily modified long-standing policies, recognizing the need for a trade-off between the costs and benefits of oversight during times of crisis. Specifically, there has been a heightened receptivity to the importance of preserving physicians' and other health care professionals' time, cognitive bandwidth, and emotional reserve for the direct care of patients, instead of squandering these resources on low-value tasks and frustrating technology. Instead of reflexively reverting to past practices and policies, there is now an opportunity to take advantage of the lessons of COVID-19 for the further transformation of health care to achieve Quadruple Aim outcomes (better care for individuals, better health for the population, better experience for clinicians, and lower costs). We outline some of the policy and practice changes that we believe should endure after the crisis has passed, and we recommend using similar logic during noncrisis times to make additional changes to further reduce administrative burden, and thus improve patient care.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Política de Saúde/legislação & jurisprudência , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/terapia , Gerenciamento Clínico , Feminino , Humanos , Masculino , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/terapia , Formulação de Políticas , Administração da Prática Médica , Padrões de Prática Médica/organização & administração , Desenvolvimento de Programas , Estados Unidos
15.
CBE Life Sci Educ ; 19(3): es7, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32822277

RESUMO

Experiential learning is an effective educational tool across many academic disciplines, including career development. Nine different institutions bridged by the National Institutes of Health Broadening Experiences in Scientific Training Consortium compared their experiments in rethinking and expanding training of predoctoral graduate students and postdoctoral scholars in the biomedical sciences to include experiential learning opportunities. In this article, we provide an overview of the four types of experiential learning approaches our institutions offer and compare the learning objectives and evaluation strategies employed for each type. We also discuss key factors for shaping experiential learning activities on an institutional level. The framework we provide can help organizations determine which form of experiential learning for career training might best suit their institutions and goals and aid in the successful design and delivery of such training.


Assuntos
Pesquisa Biomédica/educação , Escolha da Profissão , Aprendizagem Baseada em Problemas , Desenvolvimento de Programas , Pesquisadores/educação , Estudantes , Emprego , Docentes , Geografia , Humanos , Internato e Residência
17.
Public Health Rep ; 135(1_suppl): 57S-64S, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735188

RESUMO

OBJECTIVES: California is experiencing a syphilis and congenital syphilis epidemic, and many persons diagnosed with syphilis report a history of recent incarceration or sexual contact with a person who has recently been incarcerated. Fresno County's local health department and jail collaborated to implement a routine syphilis screening policy for male adults aged 18-30 and female adults aged 18-35 booked into the facility. We evaluated syphilis screening, case finding, and treatment rates after implementation of the new policy. METHODS: We linked jail census and laboratory data to syphilis surveillance data to assess screening coverage, positivity, and treatment rates for age-eligible persons who were booked into Fresno County Jail from April 1, 2016, through December 31, 2017. RESULTS: Of 24 045 age-eligible persons who were booked into the jail during the study period, 5897 (24.5%) were female and 18 148 (75.5%) were male. Of 7144 (29.7%) persons who were screened for syphilis, 611 (8.6%) had a reactive rapid plasma reagin blood test result (16.4% [253 of 1546] of female adults; 6.4% [358 of 5598] of male adults) and 238 (3.3%) were newly diagnosed with syphilis, as confirmed by matching to the surveillance system (6.9% [106 of 1546] of female adults; 2.4% [132 of 5598] of male adults). Of persons identified with syphilis, 51.7% (n = 123 of 238) received adequate recommended treatment (59.4% [63 of 106] of female adults; 45.5% [60 of 132] of male adults). CONCLUSIONS: The age-based syphilis screening policy adopted in this jail yielded high positivity, including newly identified syphilis infections among female adults of childbearing age. The targeted screening policy was formalized in the county-negotiated contract with the jail's private correctional health care company in 2018-a strategy that can be replicated.


Assuntos
Programas de Rastreamento/organização & administração , Prisões/organização & administração , Sífilis/diagnóstico , Sífilis/epidemiologia , Adolescente , Adulto , California/epidemiologia , Feminino , Humanos , Incidência , Masculino , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Fatores de Risco , Adulto Jovem
18.
Public Health Rep ; 135(1_suppl): 50S-56S, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735197

RESUMO

In 2014, California passed Assembly Bill 966, which required condom access for persons incarcerated in all 35 California state prisons (33 men's and 2 women's prisons). The California Correctional Health Care Services and the Sexually Transmitted Disease Control Branch and the Office of AIDS of the California Department of Public Health collaborated in a prison administration-led multidisciplinary implementation workgroup. Our workgroup, representing public health, correctional health, legal and legislative affairs, labor relations, and prison staff members, participated in 4 planning meetings during May-September 2015. We surveyed prison staff members and incarcerated men to identify and address potential challenges; conceptualized a tamper-resistant condom dispenser; developed educational materials, frequently asked questions for staff members, and fact sheets for the public; and conducted forums for custody and medical staff members at each prison. Key lessons learned included the need for high-level custody support, engagement of labor unions early in the decision-making process, and flexibility within defined parameters for sites to determine best practices given their unique institutional population, culture, and physical layout. Condom access was initiated at 4 prisons in July 2015 and expanded incrementally to the remaining 29 men's prisons through July 2016. A total of 243 563 condoms were accessed in the men's prisons, for an average of 354 condoms per 1000 population per month. The start-up dispenser cost was $69 825 (735 dispensers at $95 each). We estimated an annual condom cost of $0.60 per person. Although staff members and incarcerated men expressed concern that this legislation would condone sex and provide repositories for contraband, no serious adverse incidents involving condoms were reported. California demonstrated that condom access is a safe, low-cost intervention with high uptake for a large correctional system and provided a replicable implementation model for other states. Prison condom programs have the potential to decrease transmission of sexually transmitted infections (STIs) among incarcerated persons and their communities, which are often disproportionately affected by STIs, HIV, and other chronic diseases.


Assuntos
Preservativos/provisão & distribução , Prisões/organização & administração , Saúde Pública , Doenças Sexualmente Transmissíveis/prevenção & controle , California/epidemiologia , Técnicas de Apoio para a Decisão , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Educação em Saúde/organização & administração , Humanos , Capacitação em Serviço/organização & administração , Sindicatos/organização & administração , Masculino , Prisões/economia , Prisões/normas , Desenvolvimento de Programas , Doenças Sexualmente Transmissíveis/epidemiologia
19.
Emerg Med J ; 37(10): 637-638, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32753392

RESUMO

Telehealth or using technology for a remote medical encounter has become an efficient solution for safe patient care during the severe acute respiratory syndrome coronavirus 2 or COVID-19 pandemic. This medium allows patient immediate healthcare access without the need for an in-person visit. We designed a time-sensitive, practical, effective and innovative scale-up of telehealth services as a response to the demand for COVID-19 evaluation and testing. As more patients made appointments through the institution's telehealth programme, we increased the number of clinicians available. JeffConnect, the acute care telehealth programme, was expanded to increase staffing from a standing staff of 37-187 doctors within 72 hours. Telehealth care clinicians primarily trained in emergency medicine, internal medicine and family medicine followed a patient decision pathway to risk stratify patients into three groups: home quarantine no testing, home quarantine with outpatient COVID-19 testing and referral for in-person evaluation in the ED, for symptomatic and potentially unstable patients.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Síndrome Respiratória Aguda Grave/diagnóstico , Telemedicina/organização & administração , Infecções por Coronavirus/epidemiologia , Delaware , Feminino , Hospitais Universitários , Humanos , Controle de Infecções/métodos , Masculino , New Jersey , Pennsylvania , Pneumonia Viral/epidemiologia , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/terapia
20.
Emerg Med J ; 37(10): 642-643, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32753393

RESUMO

The COVID-19 pandemic has taken the world by storm and overwhelmed healthcare institutions even in developed countries. In response, clinical staff and resources have been redeployed to the areas of greatest need, that is, intensive care units and emergency rooms (ER), to reinforce front-line manpower. We introduce the concept of close air support (CAS) to augment ER operations in an efficient, safe and scalable manner. Teams of five comprising two on-site junior ER physicians would be paired with two CAS doctors, who would be off-site but be in constant communication via teleconferencing to render real-time administrative support. They would be supervised by an ER attending. This reduces direct viral exposure to doctors, conserves precious personal protective equipment and allows ER physicians to focus on patient care. Medical students can also be involved in a safe and supervised manner. After 1 month, the average time to patient disposition was halved. General feedback was also positive. CAS improves efficiency and is safe, scalable and sustainable. It has also empowered a previously untapped group of junior clinicians to support front-line medical operations, while simultaneously protecting them from viral exposure. Institutions can consider adopting our novel approach, with modifications made according to their local context.


Assuntos
Resgate Aéreo/organização & administração , Infecções por Coronavirus/prevenção & controle , Serviços Médicos de Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Recursos Humanos/organização & administração , Infecções por Coronavirus/epidemiologia , Medicina de Emergência/organização & administração , Feminino , Humanos , Masculino , Inovação Organizacional , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Projetos Piloto , Pneumonia Viral/epidemiologia , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade
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