Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.313
Filtrar
1.
N Z Med J ; 133(1523): 65-75, 2020 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-33032304

RESUMO

AIMS: To investigate changes in general practice consultation patterns in response to reduced face-to-face patient contact during the COVID-19 pandemic. METHODS: A retrospective before and after case notes review study of one urban general practice to investigate patient contact in the first two weeks of New Zealand general practices' COVID-19 response in 2020, compared to the same period in 2019. RESULTS: Twenty percent of patients had contact with the practice in both samples, with similar proportions by age, gender, ethnicity, deprivation and presence of multimorbidity or mental health diagnoses. Similar numbers of acute illness, accident-related and prevention patient contacts occurred in both samples, with more long-term condition-related contact in 2020. While 70% of patient contacts were face-to-face in 2019, 21% were face-to-face in 2020. Most acute illness, accident-related and long-term condition-related contacts were able to be provided through virtual means, but most prevention-related contacts were face-to-face. CONCLUSIONS: This single practice study showed total patient contact was similar over both sample periods, but most contact in 2020 was virtual. Further longitudinal multi-practice studies to confirm these findings and describe future consultation patterns are needed to inform general practice service delivery post-COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Medicina Geral/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Encaminhamento e Consulta/organização & administração , População Urbana/estatística & dados numéricos , Adulto , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Nova Zelândia , Satisfação do Paciente , Pneumonia Viral/epidemiologia , Estudos Retrospectivos
2.
Acta Myol ; 39(2): 57-66, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32904925

RESUMO

Introduction: Since February 2020, the outbreak of COVID-19 in Italy has forced the health care system to undergo profound rearrangements in its services and facilities, especially in the worst-hit areas in Northern Italy. In this setting, inpatient and outpatient services had to rethink and reorganize their activities to meet the needs of patients during the "lockdown". The Italian Association of Myology developed a survey to estimate the impact of these changes on patients affected by neuromuscular disorders and on specialized neuromuscular centers during the acute phase of COVID-19 pandemic. Methods: We developed an electronic survey that was sent to neuromuscular centers affiliated with the Italian Association of Myology, assessing changes in pharmacological therapies provision, outpatient clinical and instrumental services, support services (physiotherapy, nursing care, psychological support) and clinical trials. Results: 40% of surveyed neuromuscular centers reported a reduction in outpatient visit and examinations (44.5% of centers in Northern regions; 25% of centers in Central regions; 50% of centers in Southern regions). Twenty-two% of centers postponed in-hospital administration of therapies for neuromuscular diseases (23.4% in Northern regions; 13.0% in Central regions; 20% in Southern regions). Diagnostic and support services (physiotherapy, nursing care, psychological support) were suspended in 57% of centers (66/43/44% in Northern, Central and Southern centers respectively) Overall, the most affected services were rehabilitative services and on-site outpatient visits, which were suspended in 93% of centers. Strategies adopted by neuromuscular centers to overcome these changes included maintaining urgent on-site visits, addressing patients to available services and promoting remote contact and telemedicine. Conclusions: Overall, COVID-19 pandemic resulted in a significant disruption of clinical and support services for patients with neuromuscular diseases. Despite the efforts to provide telemedicine consults to patients, this option could be promoted and improved further. A close collaboration between the different neuromuscular centers and service providers as well as further implementation of telehealth platforms are necessary to ensure quality care to NMD patients in the near future and in case of recurrent pandemic waves.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Acesso aos Serviços de Saúde/organização & administração , Doenças Neuromusculares/terapia , Pneumonia Viral/epidemiologia , Encaminhamento e Consulta/organização & administração , Telemedicina/organização & administração , Assistência Ambulatorial , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Hospitalização , Humanos , Itália/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Inquéritos e Questionários
3.
S Afr Med J ; 110(8): 807-811, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880311

RESUMO

BACKGROUND: The National Institute for Health and Clinical Excellence (NICE) guidelines state that patients with dyspepsia as well as alarm symptoms, or those that are 55 years and older with new onset dyspepsia, urgently require an upper endoscopy within two weeks. The 'Be Clear on Cancer Campaign' launched by Public Health England estimated that 9% of deaths due to gastric and oesophageal cancers could have been avoided if the diagnosis was made at an earlier stage. Worcester Provincial Hospital (WPH) is a regional hospital in the Western Cape, South Africa, that due to resource constraints was unable to comply with these guidelines. An electronic endoscopy booking system was implemented in June 2014 to assist referring clinicians. OBJECTIVES: To evaluate the ability of the booking system to appropriately prioritise and accommodate clinically appropriate patients for an urgent gastroscopy within 2 weeks at WPH. METHODS: Retrospective analysis of patients booked for urgent gastroscopies using the online booking system at WPH from July 2014 to June 2017. RESULTS: A total of 1 589 gastroscopies were performed, with 1 085 (65%) categorised as urgent by the booking system algorithm, during the study period. The median (interquartile range) waiting time for urgent gastroscopies was 19 (8 - 31) days and 437 (40%) patients underwent a gastroscopy within the recommended 2-week period. Of the patients undergoing gastroscopy within 2 weeks, 87 (20%) were diagnosed with upper gastrointestinal malignancies and 73 (17%) had significant benign pathology (stricture or ulcer). A total of 150 malignancies were diagnosed in the urgent patients of whom 87 (58%) were scoped within 2 weeks. CONCLUSIONS: The volume of patients requiring urgent gastroscopy at WPH outstrips the available resources. The introduction of the online algorithm-based booking system was effective in prioritising patients. The use of this system facilitated a malignancy diagnosis rate which compares favourably with similar fast track endoscopy services in more developed countries.


Assuntos
Agendamento de Consultas , Endoscopia Gastrointestinal , Sistemas Computadorizados de Registros Médicos , Encaminhamento e Consulta/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Criança , Dispepsia/complicações , Endoscopia Gastrointestinal/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Programas Médicos Regionais , Estudos Retrospectivos , África do Sul , Listas de Espera , Adulto Jovem
4.
PLoS One ; 15(9): e0239163, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32946528

RESUMO

BACKGROUND: Trained community workers (CWs) successfully deliver health and social services, especially due to greater community acceptance. Orphans and vulnerable children (OVC) and their caregivers (CG) often need support from several sectors. We identified CW, program and referral characteristics that were associated with success of referrals provided to OVC and their CG in Tanzania in a cross-sectoral bi-directional referral system. METHODS: Data for this secondary analysis come from the first two years (2017-2018) of the USAID funded Kizazi Kipya project. Referral success was defined as feedback and service received within 90 days post-referral provision. We analyzed factors that are associated with the referral success of HIV related, education, nutrition, parenting, household economic strengthening, and child protection services among OVC and CG, using generalized estimating equations. RESULTS: During the study period, 19,502 CWs in 68 councils provided 146,996 referrals to 132,640 beneficiaries. OVC had much lower referral success for HIV related services (48.1%) than CG (81.2%). Adjusted for other covariates, CW age (26-49 versus 18-25 years, for OVC aOR = 0.83, 95%CI (0.78, 0.87) and CW gender (males versus females, for OVC aOR = 1.12, 95%CI (1.08, 1.16); CG aOR = 0.84, 95%CI (0.78, 0.90)) were associated with referral success. CWs who had worked > 1 year in the project (aOR = 1.52, 95%CI 1.46, 1.58) and those with previous work experience as CW (aOR = 1.57, 95%CI (1.42, 1.74) more successfully referred OVC. Referrals provided to OVC for all other services were more successful compared to HIV referrals, with aORs ranging from 2.99 to 7.22. Longer project duration in the district council was associated with increased referral success for OVC (aOR = 1.16 per month 95%CI 1.15,1.17), but decreased for CG (aOR = 0.96, 95%CI 0.94, 0.97). Referral success was higher for OVC and CGs with multiple (versus single) referrals provided within the past 30 days (aOR = 1.28 95%CI 1.21, 1.36) and (aOR = 1.17, 95%CI (1.06, 1.30)) respectively. CONCLUSION: CW characteristics, referral type and project maturity had different and often contrasting associations with referral success for OVC versus for CG. These findings could help policymakers decide on the recruitment and allocation of CWs in community based multi-sectoral intervention programs to improve referral successes especially for OVC.


Assuntos
Bem-Estar da Criança , Crianças Órfãs/estatística & dados numéricos , Agentes Comunitários de Saúde/organização & administração , Encaminhamento e Consulta/organização & administração , Serviço Social/organização & administração , Populações Vulneráveis/estatística & dados numéricos , Adolescente , Adulto , Cuidadores , Criança , Pré-Escolar , Agentes Comunitários de Saúde/estatística & dados numéricos , Feminino , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Estado Nutricional , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Tanzânia , Adulto Jovem
5.
J Rehabil Med ; 52(8): jrm00089, 2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32830284

RESUMO

OBJECTIVE: COVID-19 is a multisystem illness that has considerable long-term physical, psychological, cognitive, social and vocational sequelae in survivors. Given the scale of this burden and lockdown measures in most countries, there is a need for an integrated rehabilitation pathway using a tele-medicine approach to screen and manage these sequelae in a systematic and efficient way. METHODS: A multidisciplinary team of professionals in the UK developed a comprehensive pragmatic telephone screening tool, the COVID-19 Yorkshire Rehabilitation Screen (C19-YRS), and an integrated rehabilitation pathway, which spans the acute hospital trust, community trust and primary care service within the National Health Service (NHS) service model. RESULTS: The C19-YRS telephone screening tool, developed previously, was used to screen symptoms and grade their severity. Referral criteria thresholds were applied to the output of C19-YRS to inform the decision-making process in the rehabilitation pathway. A dedicated multidisciplinary COVID-19 rehabilitation team is the core troubleshooting forum for managing complex cases with needs spanning multiple domains of the health condition. CONCLUSION: The authors recommend that health services dealing with the COVID-19 pandemic adopt a comprehensive telephone screening system and an integrated rehabilitation pathway to manage the large number of survivors in a timely and effective manner and to enable the provision of targeted interventions.


Assuntos
Betacoronavirus , Serviços de Saúde Comunitária/organização & administração , Infecções por Coronavirus/reabilitação , Procedimentos Clínicos/organização & administração , Assistência à Saúde/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/reabilitação , Telemedicina/organização & administração , Serviços de Saúde Comunitária/métodos , Assistência à Saúde/métodos , Humanos , Pandemias , Encaminhamento e Consulta/organização & administração , Medicina Estatal/organização & administração , Sobreviventes , Telemedicina/métodos , Reino Unido
7.
PLoS One ; 15(8): e0237772, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853246

RESUMO

BACKGROUND: Substance use is common among people living with HIV and has been associated with suboptimal HIV treatment outcomes. Integrating substance use services into HIV care is a promising strategy to improve patient outcomes. METHODS: We report on substance use education, screening, and referral practices from two surveys of HIV care and treatment sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. HIV care and treatment sites participating in IeDEA are primarily public-sector health facilities and include both academic and community-based hospitals and health facilities. A total of 286 sites in 45 countries participated in the 2014-2015 survey and 237 sites in 44 countries participated in the 2017 survey. We compared changes over time for 147 sites that participated in both surveys. RESULTS: In 2014-2015, most sites (75%) reported providing substance use-related education on-site (i.e., at the HIV clinic or the same health facility). Approximately half reported on-site screening for substance use (52%) or referrals for substance use treatment (51%). In 2017, the proportion of sites providing on-site substance use-related education, screening, or referrals increased by 9%, 16%, and 8%, respectively. In 2017, on-site substance use screening and referral were most commonly reported at sites serving only adults (compared to only children/adolescents or adults and children/adolescents; screening: 86%, 37%, and 59%, respectively; referral: 76%, 47%, and 46%, respectively) and at sites in high-income countries (compared to upper middle income, lower middle income or low-income countries; screening: 89%, 76%, 68%, and 45%, respectively; referral: 82%, 71%, 57%, and 34%, respectively). CONCLUSION: Although there have been increases in the proportion of sites reporting substance use education, screening, and referral services across IeDEA sites, gaps persist in the integration of substance use services into HIV care, particularly in relation to screening and referral practices, with reduced availability for children/adolescents and those receiving care within resource-constrained settings.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Infecções por HIV/terapia , Acesso aos Serviços de Saúde/organização & administração , Centros de Tratamento de Abuso de Substâncias/organização & administração , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adolescente , Adulto , Fatores Etários , Criança , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Saúde Global , Infecções por HIV/complicações , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Programas de Rastreamento/organização & administração , Programas de Rastreamento/estatística & dados numéricos , Educação de Pacientes como Assunto , Lacunas da Prática Profissional/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
8.
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
9.
Am J Public Health ; 110(S2): S211-S214, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32663088

RESUMO

Many health care providers and systems are developing and implementing processes to screen patients for social determinants of health and to refer patients to appropriate nonclinical and community-based resources. The largest public health care system in the United States, New York City Health + Hospitals, piloted such a program in 2017. A qualitative evaluation yielded insights into the implementation and feasibility of such screening and referral programs in health care systems serving low-income, minority, immigrant, and underserved populations.


Assuntos
Programas de Rastreamento/organização & administração , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Encaminhamento e Consulta/organização & administração , Determinantes Sociais da Saúde , Emigrantes e Imigrantes , Hospitais Públicos , Humanos , Grupos Minoritários , Cidade de Nova Iorque , Ambulatório Hospitalar , Pobreza , Populações Vulneráveis
11.
J Thromb Thrombolysis ; 50(3): 596-603, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32661758

RESUMO

The Coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving and affecting healthcare systems across the world. Singapore has escalated its alert level to Disease Outbreak Response System Condition (DORSCON) Orange, signifying severe disease with community spread. We aimed to study the overall volume of AIS cases and the delivery of hyperacute stroke services during DORSCON Orange. This was a single-centre, observational cohort study performed at a comprehensive stroke centre responsible for AIS cases in the western region of Singapore, as well as providing care for COVID-19 patients. All AIS patients reviewed as an acute stroke activation in the Emergency Department (ED) from November 2019 to April 2020 were included. System processes timings, treatment and clinical outcome variables were collected. We studied 350 AIS activation patients admitted through the ED, 206 (58.9%) pre- and 144 during DORSCON Orange. Across the study period, number of stroke activations showed significant decline (p = 0.004, 95% CI 6.513 to - 2.287), as the number of COVID-19 cases increased exponentially, whilst proportion of activations receiving acute recanalization therapy remained stable (p = 0.519, 95% CI - 1.605 to 2.702). Amongst AIS patients that received acute recanalization therapy, early neurological outcomes in terms of change in median NIHSS at 24 h (-4 versus -4, p = 0.685) were largely similar between the pre- and during DORSCON orange periods. The number of stroke activations decreased while the proportion receiving acute recanalization therapy remained stable in the current COVID-19 pandemic in Singapore.


Assuntos
Assistência Integral à Saúde/organização & administração , Infecções por Coronavirus/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Pneumonia Viral/terapia , Acidente Vascular Cerebral/terapia , Idoso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Recuperação de Função Fisiológica , Encaminhamento e Consulta/organização & administração , Singapura/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Tempo para o Tratamento/organização & administração , Resultado do Tratamento , Fluxo de Trabalho
13.
Ann Vasc Surg ; 68: 76-82, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32562832

RESUMO

BACKGROUND: The aim of this pilot study was to evaluate the effectiveness and patients satisfaction of using telemedicine virtual communications to provide remote health care to vascular patients during the coronavirus disease 2019 (COVID-19) period in China. METHODS: Video calls using WeChat software (Tencent, Shenzhen, China) between patients and vascular surgeons were conducted in a period when there were restrictions and limitations for people' travels in China. At the end of each video call, a short questionnaire was used to evaluate the patient satisfaction level. RESULTS: During the COVID-19 period from 19 February to March 16, 2020, a sample of 114 from 165 (69%) patients was reached after one phone call attempt. One hundred forty-two telemedicine remote communications were made between the two vascular surgeons and 114 patients. The mean age of this cohort of patients were 60 ± 15.2 (range 25 to 90) years old, and 74 (65%) were men. Twenty-five patients (22%) were outside of our province when they received the video call. The mean duration of the video call was 11.0 ± 8.9 minutes. All of the patients thought telemedicine was a good substitute for coming to hospital, and 95% (108/114) of them preferred to have remote telemedicine rather than postpone the appointment. All the patients agreed with the advantages of telemedicine including no infection risks, no need to travel, and no need to wait for long time. All the patients were "satisfied" or "highly satisfied" with the video call and they would like to use telemedicine for follow-up in the future. CONCLUSIONS: Telemedicine virtual communications was effective to provide remote health care with a high patient satisfaction during the COVID-19 period. Telemedicine offers support to vulnerable vascular patients without the need for travel and face-to-face hospital consultation, and so avoided transmission and infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Satisfação do Paciente , Pneumonia Viral/epidemiologia , Encaminhamento e Consulta/organização & administração , Telemedicina/métodos , Doenças Vasculares/diagnóstico , Gravação em Vídeo/métodos , China/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Pneumonia Viral/diagnóstico , Inquéritos e Questionários , Doenças Vasculares/epidemiologia , Doenças Vasculares/terapia
14.
Transplantation ; 104(7): 1305-1307, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32568998
15.
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
16.
J Aging Soc Policy ; 32(4-5): 432-438, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32515297

RESUMO

Millions of older Americans depend on services provided by Area Agencies on Aging to support their nutritional, social, and health needs. Social distancing requirements and the closure of congregate activities due to COVID-19 resulted in a rapid and dramatic shift in service delivery modes. Area Agencies on Aging were able to quickly pivot due to their long-standing expertise in community needs assessment and cross-sectoral partnerships. The federal Coronavirus relief measures also infused one billion dollars into the Aging Network. As the pandemic response evolves, Area Agencies on Aging are poised to be key partners in a transformed health system.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Serviço Social/organização & administração , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Betacoronavirus , Fortalecimento Institucional/organização & administração , Serviços de Saúde Comunitária/organização & administração , Abastecimento de Alimentos , Humanos , Relações Interinstitucionais , Pessoa de Meia-Idade , Pandemias , Encaminhamento e Consulta/organização & administração , Estados Unidos/epidemiologia
18.
Pediatr Crit Care Med ; 21(7): 607-619, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32420720

RESUMO

OBJECTIVE: In the midst of the severe acute respiratory syndrome coronavirus 2 pandemic, which causes coronavirus disease 2019, there is a recognized need to expand critical care services and beds beyond the traditional boundaries. There is considerable concern that widespread infection will result in a surge of critically ill patients that will overwhelm our present adult ICU capacity. In this setting, one proposal to add "surge capacity" has been the use of PICU beds and physicians to care for these critically ill adults. DESIGN: Narrative review/perspective. SETTING: Not applicable. PATIENTS: Not applicable. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The virus's high infectivity and prolonged asymptomatic shedding have resulted in an exponential growth in the number of cases in the United States within the past weeks with many (up to 6%) developing acute respiratory distress syndrome mandating critical care services. Coronavirus disease 2019 critical illness appears to be primarily occurring in adults. Although pediatric intensivists are well versed in the care of acute respiratory distress syndrome from viral pneumonia, the care of differing aged adult populations presents some unique challenges. In this statement, a team of adult and pediatric-trained critical care physicians provides guidance on common "adult" issues that may be encountered in the care of these patients and how they can best be managed in a PICU. CONCLUSIONS: This concise scientific statement includes references to the most recent and relevant guidelines and clinical trials that shape management decisions. The intention is to assist PICUs and intensivists in rapidly preparing for care of adult coronavirus disease 2019 patients should the need arise.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Unidades de Terapia Intensiva Pediátrica/organização & administração , Pediatras/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Capacidade de Resposta ante Emergências/organização & administração , Suporte Vital Cardíaco Avançado/instrumentação , Betacoronavirus , Competência Clínica , Comorbidade , Estado Terminal/terapia , Equipamentos e Provisões Hospitalares , Humanos , Unidades de Terapia Intensiva Pediátrica/normas , Pandemias , Posicionamento do Paciente/normas , Medicamentos sob Prescrição/administração & dosagem , Medicamentos sob Prescrição/provisão & distribução , Encaminhamento e Consulta/organização & administração , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Estados Unidos/epidemiologia
19.
J Vasc Surg ; 72(2): 396-402, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32361072

RESUMO

OBJECTIVE: Ever since the first positive test was identified on January 21, 2020, Washington State has been on the frontlines of the coronavirus disease 2019 (COVID-19) pandemic. Using information obtained from Italian surgeons in Milan and given the concerns regarding the increasing case numbers in Washington State, we implemented new vascular surgery guidelines, which canceled all nonemergent surgical procedures and involved significant changes to our inpatient and outpatient workflow. The consequences of these decisions are not yet understood. METHODS: The vascular surgery division at Harborview Medical Center immediately instituted new vascular surgery COVID-19 practice guidelines on March 17, 2020. Subsequent clinic, operative, and consultation volume data were collected for the next 4 weeks and compared with the historical averages. The Washington State case and death numbers and University of Washington Medical Center (UW Medicine) hospital case volumes were collected from publicly available sources. RESULTS: Since March 10, 2020, the number of confirmed positive COVID-19 cases within the UW Medicine system has increased 1867%, with floor and intensive care unit bed usage increasing by 120% and 215%, respectively. After instituting our new COVID-19 guidelines, our average weekly clinical volume decreased by 96.5% (from 43.1 patients to 1.5 patients per week), our average weekly surgical volume decreased by 71.7% (from 15 cases to 4.25 cases per week), and our inpatient consultation volume decreased to 1.81 consultations daily; 60% of the consultations were completed as telemedicine "e-consults" in which the patient was never evaluated in-person. The trainee surgical volume has also decreased by 86.4% for the vascular surgery fellow and 84.8% for the integrated resident. CONCLUSIONS: The COVID-19 pandemic has changed every aspect of "normal" vascular surgical practice in a large academic institution. New practice guidelines effectively reduced operating room usage and decreased staff and trainee exposure to potential infection, with the changes to clinic volume not resulting in an immediate increase in emergency department or inpatient consultations or acute surgical emergencies. These changes, although preserving resources, have also reduced trainee exposure and operative volume significantly, which requires new modes of education delivery. The lessons learned during the COVID-19 pandemic, if analyzed, will help us prepare for the next crisis.


Assuntos
Centros Médicos Acadêmicos/normas , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Procedimentos Cirúrgicos Vasculares/normas , Betacoronavirus/isolamento & purificação , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Serviço Hospitalar de Emergência/normas , Humanos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Salas Cirúrgicas/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Padrões de Prática Médica/organização & administração , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/normas , Telemedicina/organização & administração , Telemedicina/normas , Universidades/normas , Procedimentos Cirúrgicos Vasculares/organização & administração , Washington/epidemiologia
20.
BJU Int ; 126(3): 339-341, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32469096

RESUMO

The sudden and unanticipated coronavirus disease 2019 (COVID-19) viral pandemic of 2020 and its profound impact on the NHS prompted an almost overnight change in the services we are able to offer our patients to fulfil clinical demands. From March 2020, we have changed outpatient appointments from face-to-face to telephone-led consultations. We have performed an early review of this service to ensure its sustainability during the unknown duration of this current crisis and to establish its potential utility when normal services resume in the future. Our present results show a patient satisfaction of 93%, with 83% happy to have telephone follow-up in the future, and a clinician satisfaction of 82% in the adequacy of the telephone consultation for making a clinical decision. Telephone clinics are a safe and efficient alternative to face-to-face outpatient consultations for many patients, particularly non-complex benign follow-ups.


Assuntos
Assistência Ambulatorial/organização & administração , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Encaminhamento e Consulta/organização & administração , Telemedicina/organização & administração , Unidade Hospitalar de Urologia/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Satisfação do Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Telefone
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA