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3.
Medicine (Baltimore) ; 99(51): e23708, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371117

RESUMO

ABSTRACT: Despite the increased morbidity and mortality associated with psychiatric illnesses, there remains a substantial level of inaccuracy of the initial psychiatric diagnoses given by nonpsychiatric physicians. This study examines the accuracy of initial psychiatric diagnoses by non-psychiatric physicians at the McGill University Health Center (MUHC).We conducted a retrospective chart review for all consultations requested from the consultation-liaison psychiatry service at MUHC. We included all the consultations from January 1, 2018, to December 30, 2018, and excluded patient data with established psychiatric diagnoses. In all requested consults, each diagnosis of a referring physician was compared with the final diagnosis given by the C-L psychiatry team. Conformity between the 2 was validated as accurate.Of the 980 referred inpatients, 875 were enrolled. Patients ranged in age and those older than 70 years constituted the largest group: 54.4% were male. For 467 patients (55.20%), the initial diagnostic impression given by the referring physicians agreed with the final diagnosis made by the C-L psychiatry team, while in 379 patients (44.80%), the initial diagnostic impression was not consistent with the final diagnosis made by the C-L team.Diagnostic impressions of neurocognitive and substance use disorders were highly accurate, but this was not the case when the referring physicians suspected depression or bipolar, personality, or psychotic disorders. This study shows that around half of the referrals were accurately diagnosed, which evinces that nonpsychiatric physicians' knowledge regarding psychiatric conditions is not optimal and that might negatively impact screening and treating these conditions.


Assuntos
Transtornos Mentais/diagnóstico , Psiquiatria/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Psiquiatria/normas , Encaminhamento e Consulta/normas , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adulto Jovem
4.
PLoS One ; 15(12): e0243724, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33351810

RESUMO

BACKGROUND: Government of India and the World Health Organization have guidelines for outpatient management of young infants 0-59 days with signs of Possible Serious Bacterial Infection (PSBI), when referral is not feasible. Implementation research was conducted to identify facilitators and barriers to operationalizing these guidelines. METHODS: Himachal Pradesh government implemented the guidelines in program settings supported by Centre for Health Research and Development, Society for Applied Studies. The strategy included community sensitization, skill enhancement of Accredited Social Health Activists (ASHA), Auxiliary Nurse Midwives (ANMs) and Medical Officers (MOs) to identify PSBI and treat when referral was not feasible. The research team collected information on facilitators and barriers. A technical support unit provided training and oversight. FINDINGS: Among 1997 live births from June 2017 to January 2019, we identified 160 cases of PSBI in young infants resulting in a coverage of 80%, assuming an incidence of 10%. Of these,29(18.1%) had signs of critical illness (CI), 92 (57.5%) had clinical severe infection (CSI), 5 (3.1%)had severe pneumonia (only fast breathing in young infants 0-6 days), while 34 (21%) had pneumonia (only fast breathing in young infants 7-59 days). Hospital referral was accepted by 48/160 (30%), whereas 112/160 (70%) were treated with the simplified treatment regimens at primary level facilities. Of the 29 infants with CI, 18 (62%) accepted referral; 26 (90%) recovered while 3 (10%) who had accepted referral, died. Of the 92 infants who had CSI, 86 (93%) recovered, 65 (71%) received simplified treatment and one infant who had accepted referral, died. All the five infants who had severe pneumonia, recovered; 3 (60%) had received simplified treatment. Of the 34 pneumonia cases, 33 received simplified treatment of which 5 (15%) failed treatment; two out of these 5 died. Overall, 6/160 infants died (case-fatality-rate 3.4%); 2 in the simplified treatment (case-fatality-rate 1.8%) and 4 in the hospital group (case-fatality-rate 8.3%). Delayed identification and care-seeking by families and health system weaknesses like manpower gaps and interrupted supplies were challenges in implementation. CONCLUSIONS: Implementation of the guidelines in program settings is possible and acceptable. Scaling up would require creating community awareness, early identification and appropriate care-seeking, strengthening ASHA home-visitation program, building skills and confidence of MOs and ANMs, uninterrupted supplies and a dependable referral system.


Assuntos
Assistência Ambulatorial/organização & administração , Infecções Bacterianas/terapia , Programas Governamentais/organização & administração , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/organização & administração , Assistência Ambulatorial/normas , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/mortalidade , Feminino , Programas Governamentais/normas , Visita Domiciliar/estatística & dados numéricos , Humanos , Ciência da Implementação , Índia/epidemiologia , Lactente , Mortalidade Infantil , Recém-Nascido , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , População Rural/estatística & dados numéricos , Índice de Gravidade de Doença
6.
Eur Rev Med Pharmacol Sci ; 24(21): 11402-11408, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33215462

RESUMO

OBJECTIVE: The study aimed to explore the best follow-up management strategy for patients undergoing peritoneal dialysis (PD) during the novel coronavirus pneumonia (NCP) epidemic. PATIENTS AND METHODS: Patients undergoing PD who were followed up during the NCP epidemic by our hospital were enrolled in this study. Because of the need to control the epidemic, a follow-up system was established during the epidemic period, with WeChat, QQ, and the telephone as the main methods of communication. Outpatient and emergency follow-ups were carried out to ensure the safety of dialysis and the prevention and control of the epidemic. The follow-up strategy included response measures related to the epidemic situation, prevention of peritonitis related to PD, water and salt control, exercise guidance, and psychological care. According to the patient's condition, the appointment system was implemented, with one consulting room and one process for each patient. The emergency patients were isolated in accordance with the epidemic situation. RESULTS: Since January 2020, among the 580 patients undergoing PD who were followed up in our department and their families, none had NCP infection. During the epidemic period, the standard hemoglobin level and the inpatient rate decreased. Complications related to PD, such as peritonitis, cardiovascular complications caused by volume overload, and pulmonary infection, did not significantly increase, and the withdrawal rate and mortality rate decreased compared with those in the same period last year. CONCLUSIONS: The patient follow-up strategy during the epidemic period had a significant positive effect on preventing and controlling the epidemic. Furthermore, during the epidemic period, encouraging patients and caregivers to pay attention to protection at home, avoid going out, strengthen self-management, and other measures were beneficial to the control of kidney disease itself, which is worth promoting. The close relationship between doctors and patients during the epidemic had a positive effect on the occurrence of complications related to patients undergoing PD.


Assuntos
Assistência ao Convalescente/métodos , Infecções por Coronavirus/prevenção & controle , Hemodiálise no Domicílio/normas , Falência Renal Crônica/terapia , Pandemias/prevenção & controle , Diálise Peritoneal/normas , Pneumonia Viral/prevenção & controle , Assistência ao Convalescente/normas , Betacoronavirus/patogenicidade , Cuidadores/psicologia , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Seguimentos , Hemodiálise no Domicílio/efeitos adversos , Hemodiálise no Domicílio/psicologia , Humanos , Educação de Pacientes como Assunto , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/psicologia , Peritonite/epidemiologia , Peritonite/etiologia , Relações Médico-Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/normas , Autogestão/psicologia , Telemedicina/normas , Resultado do Tratamento
7.
Arch. esp. urol. (Ed. impr.) ; 73(7): 573-581, sept. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195955

RESUMO

OBJETIVO: Los médicos de Atención Primaria (MAP) son fundamentales en la regulación del flujo de pacientes desde Atención Primaria (AP), por tanto, es esencial buscar métodos de adecuada gestión de la demanda asistencial y así optimizar recursos. En la hipertrofia benigna de próstata (HBP) se estima que 2/3 de los pacientes pueden ser manejados íntegramente desde AP a lo largo de todo el proceso de la HBP. MATERIAL Y MÉTODOS: Hemos realizado un estudio pre experimental en dos períodos, antes (pre-test) y después (post-test) de la creación de un protocolo de manejo y derivación de pacientes con HBP. Analizamos la adecuación a los criterios de derivación y el uso de los estudios complementarios para llevar a cabo el diagnóstico, realizando un análisis estadístico (descriptivo, bivariante, multivariante y cálculo de tasas) utilizando SPSS (versión 21). RESULTADOS: La tasa de derivación disminuyó tras la aplicación del protocolo, pero no logró mejorar la adecuación. Los pacientes derivados por los MAP que asistieron al programa educativo fueron más jóvenes. Se remitieron menos pacientes con PSA elevado y más pacientes con progresión clínica. Se utilizaron menos estudios complementarios. Los MAP que no acudieron a la formación eran más jóvenes, principalmente mujeres, sin formación especifica en HBP y con contrato temporal. CONCLUSIONES: A pesar de reducir la tasa de derivación no se consiguió mejorar la adecuación de la derivación de los pacientes. Consideramos necesario analizar la problemática de los MAP y valorar otras intervenciones que podrían mejorar la calidad en la transferencia de responsabilidades


OBJECTIVE: In the Spanish health system, General Practitioners (GPs) play a key role in regulating the flow of patients to hospital care. Most of patients with BPH can be managed throughout the evolution of the disease exclusively by the GPs. METHODS: A pre-experimental study was carried out in two periods, before (pre-test) and after (post-test) of the dissemination of a management protocol for patients with BPH. The protocol was trialled in the health area of Villarrobledo and included all referrals to the urology clinic for BPH from Primary Care. We analyzed the appropriate referrals according with the criteria set forth in the protocol and compared the complementary tests through statistical study (descriptive, a bivariate, multivariate analysis and rate calculation) using version 21 of the SPSS. RESULTS: Referral rate decreased after the application of the protocol but did not increase the rate of appropriated referrals. Patients referred after setting forth protocol by GPs that assisted to the education program were younger. There were referred less patients with elevated PSA and more patients with clinical progression. These GPs used less test to achieve diagnosis. The GPs who did not attend were significantly younger, mainly women, with no previous specific training in BPH and without a full time GP position. CONCLUSIONS: The implementation of a protocol has reduced the referral rate, but it has not improved the appropriate referrals. More research is required to understand the determinants of inequalities in referral from primary care


Assuntos
Humanos , Masculino , Idoso , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde , Hiperplasia Prostática/terapia , Sintomas do Trato Urinário Inferior/terapia , Encaminhamento e Consulta/normas , Fatores de Tempo , Algoritmos , Encaminhamento e Consulta/estatística & dados numéricos , Reprodutibilidade dos Testes , Clínicos Gerais , Análise Multivariada , Espanha
8.
Br J Dermatol ; 182(6): e195, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32745237

RESUMO

Since cases first emerged in December 2019, COVID-19 (a type of coronavirus) has rapidly become pandemic. This fast-tracked paper (published quickly) from China on COVID-19 is written by dermatologists at the epicentre of the outbreak in Wuhan. Dermatology clinic staff may be at risk because protective equipment is not routinely available, and skin lesions might possibly transmit the virus indirectly. These authors suggest preventive measures based on experience in this and previous coronavirus outbreaks. Online consultation for non-urgent patients reduces the numbers of patients attending clinics. Nurse-led triage, to identify patients with possible COVID-19, at the entrances of hospital and skin clinics directs patients with a cough or fever to a specific COVID-19 area and a dermatologist is consulted if the fever might be related to skin disease. Clinic staff wear N95 masks and observe hand hygiene during consultations. Patients are admitted to a ward only if routine blood tests and chest CT scans exclude COVID-19. Triage will not detect patients who are showing no symptoms but who are developing the disease, so the hospital should provide an on-call expert team to discuss inpatients suspected or diagnosed with COVID-19 and refer them to radiology, respiratory or intensive care colleagues as required. Confirmed cases are managed following local policies. Skin disorders in COVID-19 inpatients can usually be managed remotely using photographs, email and teleconferencing. If necessary a multidisciplinary team (a team of medical staff from different specialties) can meet in the clean area of the isolation ward. If the dermatologist must see the patient, all records should be provided in advance to minimise exposure time. With these precautions, as of 20th February 2020 no infected patients were detected in the Wuhan Dermatology Department. This is a summary of the study: Emergency management for preventing and controlling nosocomial infection of 2019 novel coronavirus: implications for the dermatology department.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Dermatologia/normas , Emergências , Controle de Infecções/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , China/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Higiene das Mãos/normas , Hospitais/normas , Humanos , Controle de Infecções/instrumentação , Equipamento de Proteção Individual/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Encaminhamento e Consulta/normas , Triagem/normas
9.
Pract Neurol ; 20(5): 396-403, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32862137

RESUMO

Tele-neurology is a neurological consultation at a distance, or not in person, using various technologies to achieve connectivity, including the telephone and the internet. The telephone is ubiquitous and is a standard part of how we manage patients. Video consulting has been used for a long time in some centres, particularly in those where the geography means that patients have to travel long distances. Various technologies can be used, and with the development of various internet-based video-calling platforms, real-time video consulting has become much more accessible. We have provided a tele-neurology service in the North East of Scotland since 2006 using video conferencing with far-end camera control. More recently, we have complemented this using an internet-based platform (NHS Near Me). Here we outline the practicalities of video consulting in 'ordinary' times and comment on its use in the 'extraordinary' times of the coronavirus pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Exame Neurológico/tendências , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Encaminhamento e Consulta/tendências , Telemedicina/tendências , Comunicação por Videoconferência/tendências , Infecções por Coronavirus/epidemiologia , Humanos , Exame Neurológico/métodos , Exame Neurológico/normas , Neurologia/métodos , Neurologia/normas , Neurologia/tendências , Pneumonia Viral/epidemiologia , Encaminhamento e Consulta/normas , Escócia/epidemiologia , Telemedicina/métodos , Telemedicina/normas , Comunicação por Videoconferência/normas
10.
Emergencias (Sant Vicenç dels Horts) ; 32(4): 258-268, ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193946

RESUMO

El presente documento de consenso se ha desarrollado con el fin de proporcionar una herramienta útil para el manejo del paciente asmático que acude al servicio de urgencias (SU) con una crisis asmática. Incluye recomendaciones para tomar la decisión de alta o ingreso, así como indicaciones de derivación para el posterior seguimiento. Un equipo multidisciplinar, constituido por tres especialistas en medicina de urgencias, tres especialistas en neumología y tres especialistas en alergología, se encargó de elaborar una lista de preguntas clínicas que respondieron mediante la ayuda tanto de guías de práctica clínica, como de literatura disponible. Los contenidos y el reparto de tareas en diferentes grupos de trabajo se consensuaron en una reunión presencial. Los materiales resultantes se pusieron en común y sirvieron para la preparación del manuscrito final. Las recomendaciones y los algoritmos incluidos en el mismo van dirigidos a identificar y diagnosticar correctamente las exacerbaciones asmáticas en el SU y a establecer los criterios de hospitalización o alta. Se incluyen también las pautas para el tratamiento de los pacientes y para su derivación al ámbito de atención especializada en caso de alta, incluyendo los criterios de priorización para dicha derivación. El documento ha sido avalado por la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Sociedad Española de Alergología e Inmunología Clínica (SEAIC), y la Sociedad Española de Urgencias y Emergencias (SEMES)


This consensus paper's purpose is to provide a tool for managing emergency asthma exacerbations that require a decision to admit or discharge the patient. The paper also addresses where to refer the discharged patient for follow up. A multidisciplinary team of 3 emergency physicians, 3 specialists in respiratory medicine, and 3 allergy specialists were charged with drafting a list of clinical questions to answer by consulting practice guidelines and other resources in the literature. The specialists held a face-to-face meeting to distribute tasks and topics to working groups. The groups shared their reports, which provided the basis for drafting the final paper. The recommendations and flow charts included in the paper provide guidance for identifying and correctly diagnosing asthma exacerbations in the emergency department. Criteria for admission or discharge are incorporated. Treatment protocols and recommendations for referring discharged patients to specialists are addressed, along with criteria for priority referrals. The final consensus paper has been endorsed by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), the Spanish Society of Allergology and Clinical Immunology (SEAIC), and the Spanish Society of Emergency Medicine (SEMES)


Assuntos
Humanos , Asma/epidemiologia , Serviços Médicos de Emergência/métodos , Encaminhamento e Consulta/normas , Índice de Gravidade de Doença , Indicadores de Qualidade em Assistência à Saúde/normas , Encaminhamento e Consulta/organização & administração , Exacerbação dos Sintomas , Hospitalização , Anamnese , Comunicação Interdisciplinar , Fatores de Risco
11.
Pediatr Clin North Am ; 67(4): 735-757, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32650870

RESUMO

Doctors need to acquire telehealth consultation skills to thrive in the increasingly pressurized health system of delivering high-quality, high-volume health care with a shrinking health care workforce. Telehealth consultations require the same degree of thoroughness and careful clinical judgment as face-to-face consultations. The distinct differences between telehealth and face-to-face consultations warrant training in telehealth, which should be incorporated into core curricula of medical schools and continuing medical education. We describe competency-based training for telehealth piloted with medical residents. The use of competency-based training for telehealth operationalized as an entrustable professional activity will facilitate high-quality, safe, and effective telehealth consultations.


Assuntos
Competência Clínica , Encaminhamento e Consulta/normas , Telemedicina , Currículo/tendências , Educação Médica/tendências , Humanos , Garantia da Qualidade dos Cuidados de Saúde , Estados Unidos
13.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(6): 357-363, jun.-jul. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193360

RESUMO

INTRODUCCIÓN: El HPTP frecuentemente permanece sin diagnosticar en pacientes con hipercalcemia, lo que podría ocasionar un aumento de la morbilidad en estos sujetos. OBJETIVO: Identificar la presencia de hipercalcemia y de criterios de tratamiento quirúrgico (CTQ) no identificados desde al menos un año antes de su remisión a endocrinología en pacientes operados de HPTP. Valorar si este retraso terapéutico se asocia a mayor morbilidad. MÉTODOS: Estudio observacional en 116 pacientes consecutivos. Mediante la revisión de los registros anteriores a 12 meses previos a su derivación a endocrinología se dividieron en 4 grupos: hipercalcemia con CTQ (grupo 1, n = 43), hipercalcemia sin CTQ (grupo 2, n = 23), calcemias normales (grupo 3, n = 18) o ausencia de calcemias en dichos registros (grupo 4, n = 32). RESULTADOS: En 84 pacientes (72,4%) había calcemias previas, 66 (56,9%) con hipercalcemia, de ellos 43 (37%) con CTQ no valorados. La demora media hasta su remisión fue de 57 meses. Casi la mitad de las calcemias del grupo 1 procedían de urgencias. Respecto al grupo 4 los pacientes del grupo 1 tenían menor edad, mayor incidencia de nefrolitiasis e insuficiencia renal al remitírseles. Las calcemias en el momento de su derivación eran similares, superiores a las de los grupos 2 y 3. DISCUSIÓN: Los pacientes con HPTP y CTQ se remiten a endocrinología con un retraso medio de 5 años. La inadvertencia de la hipercalcemia y/o el desconocimiento de los CTQ retrasan esta derivación, determinada por hipercalcemias superiores, y se asocian a una afectación renal más severa. Son precisas medidas correctoras para evitar este retraso en el diagnóstico y curación del HPTP


INTRODUCTION: Primary hyperparathyroidism (PHPT) remains underdiagnosed among patients with hypercalcemia, potentially causing increased morbidity. OBJECTIVE: To identify in surgically operated patients the presence of overlooked hypercalcemia and patients with criteria for surgery (CFS) for PHPT at least one year prior to referral to Endocrinology, and to determine whether this diagnostic delay leads to increased morbidity. METHODS: An observational study was carried out in 116 consecutive patients. We evaluated electronic medical records registered at least 12 months prior to referral and divided them in four groups: hypercalcemia with CFS (group 1), hypercalcemia without CFS (group 2), normocalcemia (group 3), and cases without previous biochemical evaluation (group 4). RESULTS: A total of 84 patients (72.4%) had a previous measurement of serum calcium at a time interval of ≥ 12 months. Sixty-six (56.9%) had hypercalcemia and 43 of them (37%) had ≥ 1 CFS, with an average delay of 57 months in receiving proper evaluation. Almost half of the calcemia measurements in group 1 had been made in the emergency room. Patients from group 1 were younger, and had a greater frequency of nephrolithiasis and renal impairment than patients in group 4. The serum calcium values at referral were similar in both groups and higher than the values found in patients from the other two groups. DISCUSSION: In patients with PHPT and CFS, referral to an endocrinologist is made with an average delay of almost 5 years. The identified causes of this delay, which conditions more kidney disease, are unrecognized hypercalcemia and/or unawareness of the surgical criteria, while calcium elevations promote referral. Interventions are needed to avoid this delay in the diagnosis and resolution of PHPT


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/cirurgia , Tempo para o Tratamento , Diagnóstico Tardio , Indicadores de Morbimortalidade , Hipercalcemia/diagnóstico , Hipercalcemia/classificação , Estudos Retrospectivos , Fosfatase Alcalina/análise , Insuficiência Renal , Paratireoidectomia/normas , Encaminhamento e Consulta/normas
15.
Z Psychosom Med Psychother ; 66(2): 178-192, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32552587

RESUMO

Level of personality functioning and attachment style as predictors of the successful referral to outpatient psychotherapy Objectives: Outpatient psychotherapy is a key element in the effective treatment of mental health problems. First results suggest that interpersonal problems lead to difficulties in receiving outpatient psychotherapeutic treatment. The relationship between these difficulties, attachment style, and the level of personality functioning is still unclear. Methods: We invited 1011 patients of a psychosomatic-psychotherapeutic university outpatient clinic to participate in the study. The clinical diagnoses according to ICD-10, as well as symptoms of depression (PHQ-D), and quality of life (SF-36) were recorded. Hypothesized predictors for the successful referral to outpatient therapy were patient age, availability of local outpatient treatment, number of ICD-10 diagnoses, the motivation for psychotherapy (FPTM), fear of stigmatization (Stig-9), level of personality functioning (OPD-SQ), and attachment style (ECR-RD). Results: We were able to catamnestically reassess n = 300 patients (67.3 % of patients initially referred to outpatient therapy). A smaller number of clinical diagnoses, greater availability of psychotherapeutic care and higher therapy motivation, as well as a lower level of personality functioning predicted the successful referral to outpatient psychotherapy, while the combination of impaired personality functioning and avoidant attachment style was a negative predictor. Conclusions: Contrary to expectations, patients with a lower level of personality functioning are more successful in receiving outpatient psychotherapy. However, patients with a combination of impaired personality functioning and a high degree of attachment avoidance run the risk of not asserting their need for treatment.


Assuntos
Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Apego ao Objeto , Pacientes Ambulatoriais/psicologia , Personalidade , Psicoterapia , Qualidade de Vida , Encaminhamento e Consulta/normas , Humanos , Prognóstico , Resultado do Tratamento
16.
Diabetes Metab Syndr ; 14(5): 797-799, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32534432

RESUMO

BACKGROUND AND AIMS: With restrictions on face to face clinical consultations in the COVID-19 pandemic, Telemedicine has become an essential tool in providing continuity of care to patients. We explore the common pitfalls in remote consultations and strategies that can be adopted to avoid them. METHODS: We have done a comprehensive review of the literature using suitable keywords on the search engines of PubMed, SCOPUS, Google Scholar and Research Gate in the first week of May 2020 including 'COVID-19', 'telemedicine' and 'remote consultations'. RESULTS: Telemedicine has become an integral part to support patient's clinical care in the current COVID-19 pandemic now and will be in the future for both primary and secondary care. Common pitfalls can be identified and steps can be taken to prevent them. CONCLUSION: Telemedicine it is going to play a key role in future of health medicine, however, telemedicine technology should be applied in appropriate settings and situations. Suitable training, enhanced documentations, communication and observing information governance guidelines will go a long way in avoiding pitfalls associated with remote consultations.


Assuntos
Infecções por Coronavirus/epidemiologia , Necessidades e Demandas de Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Pneumonia Viral/epidemiologia , Encaminhamento e Consulta/organização & administração , Telemedicina/organização & administração , Betacoronavirus/fisiologia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/normas , Humanos , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Quarentena/organização & administração , Quarentena/normas , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/tendências , Telemedicina/métodos , Telemedicina/normas , Telemedicina/tendências
17.
J Surg Res ; 255: 106-110, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32543374

RESUMO

BACKGROUND: Pediatric brain injuries are common, but current management of patients with mild traumatic intracranial hemorrhage (T-ICH) is suboptimal, often including unnecessary repeat head CT (RHCT) and neurosurgical consultation (NSC). Brain Injury Guidelines (BIG) have been developed to standardize the management of TBI, and recent work suggests they may be applied to children. The aim of this study was to apply BIG to a low-risk pediatric TBI population to further determine whether the framework can be safely applied to children in a way that reduces overutilization of RHCTs and NSC. METHODS: A retrospective chart review of a Level I Adult and Pediatric Trauma Center's pediatric registry over 4 y was performed. BIG was applied to these patients to evaluate the utility of RHCT and need for neurosurgical intervention (NSG-I) in those meeting BIG-1 criteria. Those with minor skull fracture (mSFx) who otherwise met BIG-1 criteria were also included. RESULTS: Twenty-eight patients with low-risk T-ICH met criteria for review. RHCT was performed in seven patients, with only two being prompted by clinical neurologic change/deterioration. NSC occurred in 21 of the cases. Ultimately, no patient identified by BIG-1 ± mSFx required NSG-I. CONCLUSIONS: Application of BIG criteria to children with mild T-ICH appears capable of reducing RHCT and NSC safely. Additionally, those with mSFx that otherwise fulfill BIG-1 criteria can be managed similarly by acute care surgeons. Further prospective studies should evaluate the application of BIG-1 in larger patient populations to support the generalizability of these findings.


Assuntos
Tomada de Decisão Clínica/métodos , Hemorragia Intracraniana Traumática/cirurgia , Procedimentos Neurocirúrgicos/normas , Provedores de Redes de Segurança/normas , Centros de Traumatologia/normas , Adolescente , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Hemorragia Intracraniana Traumática/diagnóstico , Masculino , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Provedores de Redes de Segurança/estatística & dados numéricos , Tomografia Computadorizada por Raios X/normas , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento
19.
Workplace Health Saf ; 68(6): 257-262, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32421472

RESUMO

Background: Smoking is the leading cause of preventable deaths in the United States. The rates of smoking remain elevated in rural, low income populations in comparison with the rest of the United States. Thus, prompting the process improvement project of implementing the Ask-Advise-Connect (AAC) method to the national quitline in a nurse practitioner-managed clinic for an automotive manufacturing plant in rural Tennessee. Methods: Ask-Advise-Connect method was added to the current smoking cessation program. The employees who utilized the clinic were assessed for smoking status at each visit and subsequently counseled on cessation. Individuals interested in cessation were connected to the national quitline with the AAC method. Pharmaceutical options and nicotine replacement therapy was also offered at no cost to the employee. Findings: In the 4-month period, the clinic provided 102 tobacco cessation counseling visits to workers who smoke. Twenty-four employees enrolled in the cessation program. The participants reported a cessation rate of 12.5% and 21% had a significant decrease in the number of cigarettes smoked. Of the participants, 12.5% (n = 3) engaged in behavioral counseling with the quitline. Conclusion/application to practice: The addition of the AAC method as part of the smoking cessation program had limited success. As smoking cessation is difficult to achieve, any success greater than 7% can be considered an achievement. The 12.5% cessation rate of the participants was above the national average. Thus, demonstrating the benefit of having a workplace cessation program and incorporating the AAC method to the current smoking cessation program.


Assuntos
Linhas Diretas/estatística & dados numéricos , Encaminhamento e Consulta/normas , Abandono do Uso de Tabaco/métodos , Adulto , Feminino , Linhas Diretas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/estatística & dados numéricos , População Rural , Tennessee , Abandono do Uso de Tabaco/psicologia , Abandono do Uso de Tabaco/estatística & dados numéricos
20.
J Med Vasc ; 45(3): 125-129, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32402426

RESUMO

OBJECTIVE: The clinical relevance of hereditary thrombophilia (HT) testing in venous thromboembolic disease (VTE) is limited to specific guidelines. The present study aimed to evaluate the consistency of HT prescriptions in clinical practice according to the current French guidelines. METHODS: This study was conducted from April 2017 to February 2018 in a specialized haemostasis centre and included 58 consecutive patients referred by their clinicians for thrombophilia screening (56 patients following a personal VTE event and 2 asymptomatic relatives of a first-degree patient who had had VTE). One experienced clinician met every patient and assessed a pre-test prediction for the presence or absence of HT based on the clinical characteristics of VTE which was compared to the HT biological results. RESULTS: Among the 58 patients referred to our specialized haemostasis centre, 60% were outside the scope of recommendations for thrombophilia screening. Eight patients were diagnosed with HT. Six out of 8 (75%) patients with diagnosed HT had a history of unprovoked VTE event. Familial history with VTE was a poor predictor for positive HT testing among relatives. The positive and negative predictive values of the clinical prediction were respectively of 19% and 89%. CONCLUSION: The present results underline that screening for HT remains too largely prescribed. Pre-test physician's feeling for the presence of HT was neither sensitive nor specific. Increasing physicians' awareness on this issue and current recommendations should limit prescriptions of HT tests while providing the best possible care for patients with VTE.


Assuntos
Testes de Coagulação Sanguínea/normas , Coagulação Sanguínea , Fidelidade a Diretrizes/normas , Técnicas de Diagnóstico Molecular/normas , Guias de Prática Clínica como Assunto/normas , Encaminhamento e Consulta/normas , Trombofilia/diagnóstico , Tromboembolia Venosa/diagnóstico , Adolescente , Adulto , Idoso , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Trombofilia/sangue , Trombofilia/genética , Tromboembolia Venosa/sangue , Tromboembolia Venosa/genética , Adulto Jovem
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