Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.293
Filtrar
1.
Spine (Phila Pa 1976) ; 45(19): 1386-1394, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32756271

RESUMO

STUDY DESIGN: Case series. OBJECTIVE: For each of the most frequent clinical scenarios, the authors reached a consensus on how should be timing and indications be optimized to reduce risk while maintaining the expected outcomes under the Covid-19 pandemics. SUMMARY OF BACKGROUND DATA: The organization of health care has been changed by the Covid-19 pandemic with a direct impact on Spine Oncology Surgery. Emergency surgery is still a priority, but in case of spinal tumors it should be better defined which conditions require emergency treatment. METHODS: An expert panel with general spine surgeons, oncological spine surgeons, and radiation oncologists was formed to analyze the most frequent scenarios in spinal musculoskeletal oncology during Covid-19 pandemics. RESULTS: Spine metastases can be found incidentally during follow-up or can clinically occur by increasing pain, pathologic fracture, and/or neurological symptoms. Primary spine tumors are much more rare and very rarely present with acute onset. The first step is to suspect this rare condition, to avoid to treat a primary tumor as it were a metastasis. Most complex surgery, like en bloc resection, associated with high morbidity and mortality rate for the treatment of low grade malignancy like chordoma or chondrosarcomas, if intensive care unit availability is reduced, can be best delayed some weeks, as not impacting on prognosis, due to the slow growth rate of these conditions. The currently accepted protocols for Ewing sarcoma (ES) and osteogenic sarcoma must be performed for local and systemic disease control. For ES, after the first courses of chemotherapy, radiotherapy can be selected instead of surgery, during Covid-19, to the end of the full course of chemotherapy. In immunocompromised patients, (treated by chemotherapy), it is necessary to avoid contact with affected or exposed people. CONCLUSION: Even more than during normal times, a multidisciplinary approach is mandatory to share the decision to modify a treatment strategy. LEVEL OF EVIDENCE: 5.


Assuntos
Betacoronavirus , Infecções por Coronavirus/cirurgia , Oncologia/normas , Pandemias , Pneumonia Viral/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Cirurgiões/normas , Adulto , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Oncologia/métodos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Equipe de Assistência ao Paciente/normas , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/normas , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/epidemiologia , Cirurgiões/psicologia
2.
J Am Acad Dermatol ; 83(4): 1222-1224, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32682031
3.
Am J Gastroenterol ; 115(9): 1532-1533, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32694291

RESUMO

INTRODUCTION: To characterize the clinical pharmacists' impact on caring for patients with inflammatory bowel disease during COVID-19. METHODS: A clinical pharmacist's encounters between March 17 and April 14, 2020, were audited to determine encounter frequency and indication. RESULTS: The clinical pharmacist addressed COVID-19 and inflammatory bowel disease treatment concerns with 140 patients, conducted 34 medication education and monitoring visits, reviewed 141 patients' charts and helped rescheduled 18 patients who missed their biologic infusion, transitioned 12 patients to home infusions, and assisted 5 patients with medication access. DISCUSSION: Clinical pharmacists embedded in gastroenterology practices permit for continued optimal patient care during a pandemic.


Assuntos
Betacoronavirus , Auditoria Clínica , Infecções por Coronavirus/complicações , Doenças Inflamatórias Intestinais/tratamento farmacológico , Equipe de Assistência ao Paciente/normas , Assistência ao Paciente/métodos , Farmacêuticos/normas , Pneumonia Viral/complicações , Infecções por Coronavirus/epidemiologia , Humanos , Doenças Inflamatórias Intestinais/complicações , Pandemias , Pneumonia Viral/epidemiologia , Papel Profissional , Estudos Retrospectivos
4.
PLoS One ; 15(7): e0236085, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730277

RESUMO

Developing professional identity is a vital part of health professionals' education. In Auckland four tertiary institutions have partnered to run an interprofessional simulation training course called Urgent and Immediate Patient Care Week (UIPCW) which is compulsory for Year Five medical, Year Four pharmacy, Year Three paramedicine and Year Three nursing students. We sought to understand student experiences of UIPCW and how those experiences informed student ideas about professional identity and their emergent practice as health professionals within multidisciplinary teams. In 2018, we commenced ethnographic research involving participant observation, field notes, interviews, photography and observational ethnographic film. A total of 115 students participated in this research. The emergent findings concern the potentially transformative learning opportunity presented within high fidelity multi-disciplinary simulations for students to develop their professional identity in relation to peers from other professions. Our work also exposes the heightened anxiety and stress which can be experienced by students in such interdisciplinary simulations. Student experience suggests this is due to a range of factors including students having to perform in front of peers and staff in such simulation scenarios when their own professional identity and capabilities are still in emergent stages. Staff-led simulation debriefs form a critical success factor for transformative learning to be able to occur in any such simulations so that students can reflect on, and move beyond, the emotion and uncertainty of such experiences to develop future-focused concepts of professional identity and strategies to support effective interprofessional teamwork.


Assuntos
Competência Clínica , Assistência à Saúde/normas , Pessoal de Saúde/psicologia , Relações Interprofissionais , Equipe de Assistência ao Paciente/normas , Profissionalismo/educação , Treinamento por Simulação/métodos , Antropologia Cultural , Pessoal de Saúde/estatística & dados numéricos , Humanos , Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricos , Estudantes de Enfermagem/psicologia , Estudantes de Enfermagem/estatística & dados numéricos , Estudantes de Farmácia/psicologia , Estudantes de Farmácia/estatística & dados numéricos
6.
Med Care ; 58(7): 643-650, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32520838

RESUMO

BACKGROUND: Investigating primary care provider (PCP)-team communication can provide insight into how colleagues work together to become high-functioning teams more able to address an increasingly complex set of tasks associated with chronic disease management. OBJECTIVE: To assess how PCP communication with their care team relates to patients' health. RESEARCH DESIGN: Longitudinal study of how 3 aspects of PCP-care team communication-participation, time spent listening, and uninterrupted speaking length-relate to disease management of patients with hypertension or diabetes, and the effect of these team communication behaviors on PCP-patient communication as a pathway by which this relationship might exist. We used multilevel regression models. SUBJECTS: Twenty-seven PCPs and 98 team members, and 18,067 patients with hypertension and 8354 patients with diabetes affiliated with a federally qualified health center with 12 practice sites. MEASURES: Primary data on communication collected using sociometric sensors worn by PCPs and team members, patient-PCP communication data collected with surveys, and patient health, PCP and patient characteristics extracted from electronic records. RESULTS: PCPs participated in 75% of care team conversations, spent 56% of conversation time listening, and had an average uninterrupted speaking length of 2.42 seconds. PCP participation, listening, and length of uninterrupted speaking time were associated with significantly higher odds that their patients had controlled hypertension and diabetes and improvements in disease control over time. PCP-patient communication mediates this relationship. CONCLUSIONS: PCP-team communication is associated with patient health management. How team members speak with one another may be as important as the content of their communication.


Assuntos
Gerenciamento Clínico , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente/normas , Atenção Primária à Saúde/métodos , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/estatística & dados numéricos , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Inquéritos e Questionários
7.
Pituitary ; 23(4): 327-337, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32556793

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the viral strain that has caused the coronavirus disease 2019 (COVID-19) pandemic, has presented healthcare systems around the world with an unprecedented challenge. In locations with significant rates of viral transmission, social distancing measures and enforced 'lockdowns' are the new 'norm' as governments try to prevent healthcare services from being overwhelmed. However, with these measures have come important challenges for the delivery of existing services for other diseases and conditions. The clinical care of patients with pituitary disorders typically involves a multidisciplinary team, working in concert to deliver timely, often complex, disease investigation and management, including pituitary surgery. COVID-19 has brought about major disruption to such services, limiting access to care and opportunities for testing (both laboratory and radiological), and dramatically reducing the ability to safely undertake transsphenoidal surgery. In the absence of clinical trials to guide management of patients with pituitary disease during the COVID-19 pandemic, herein the Professional Education Committee of the Pituitary Society proposes guidance for continued safe management and care of this population.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/terapia , Prestação Integrada de Cuidados de Saúde/normas , Acesso aos Serviços de Saúde/normas , Doenças da Hipófise/terapia , Pneumonia Viral/terapia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Nível de Saúde , Interações Hospedeiro-Patógeno , Humanos , Pandemias , Equipe de Assistência ao Paciente/normas , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico , Fatores de Risco
8.
Eur Geriatr Med ; 11(4): 645-650, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32557250

RESUMO

The nursing home sector has seen a disproportionately high number of deaths as part of the COVID-19 pandemic. This reflects, in part, the frailty and vulnerability of older people living in care homes but has also, in part, been a consequence of the failure to include care homes in the systematic planning of a response to COVID, as well as a measure of neglect of standards and quality improvement in the sector. In response, the EUGMS published a set of medical standards of care developed in consultation with experts across its member national societies in 2015. The standards consisted of seven core principles of medical care for physicians working in nursing homes as a first step in developing a programme of clinical, academic and policy engagement in improving medical care for older people who are living and frequently also dying as residents in nursing homes. The gravity of the concerns arising for nursing home care from the COVID-19 pandemic, as well as emerging insights on care improvement in nursing homes indicate that an update of these medical standards is timely. This was performed by the writing group from the original 2015 guidelines and is intended as an interim measure pending a more formal review incorporating a systematic review of emerging literature and a Delphi process.


Assuntos
Infecções por Coronavirus/terapia , Assistência à Saúde/normas , Instituição de Longa Permanência para Idosos/organização & administração , Casas de Saúde/organização & administração , Médicos/normas , Pneumonia Viral/terapia , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Infecções por Coronavirus/epidemiologia , Técnica Delfos , Europa (Continente) , Feminino , Avaliação Geriátrica/métodos , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pandemias , Equipe de Assistência ao Paciente/normas , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/normas , Análise de Sobrevida
9.
PLoS One ; 15(6): e0234416, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32520943

RESUMO

AIM: Describe brief (less than half a day) interventions aimed at improving healthcare team functioning. METHODS: A systematic review on brief team interventions aimed at role clarification and team functioning (PROSPERO Registration Number: CRD42018088922). Experimental or quasi-experimental studies were included. Database searches included CINAHL, Medline, EMBASE, PUBMED, Cochrane, RCT Registry-1990 to April 2020 and grey literature. Articles were screened independently by teams of two reviewers. Risk of bias was assessed. Data from the retained articles were extracted by one reviewer and checked by a second reviewer independently. A narrative synthesis was undertaken. RESULTS: Searches yielded 1928 unique records. Final sample contained twenty papers describing 19 studies, published between 2009 and 2020. Studies described brief training interventions conducted in acute care in-patient settings and included a total of 6338 participants. Participants' socio-demographic information was not routinely reported. Studies met between two to six of the eight risk of bias criteria. Interventions included simulations for technical skills, structured communications and speaking up for non-technical skills and debriefing. Debriefing sessions generally lasted between five to 10 minutes. Debriefing sessions reflected key content areas but it was not always possible to determine the influence of the debriefing session on participants' learning because of the limited information reported. DISCUSSION: Interest in short team interventions is recent. Single two-hour sessions appear to improve technical skills. Three to four 30- to 60-minute training sessions spread out over several weeks with structured facilitation and debriefing appear to improve non-technical skills. Monthly meetings appear to sustain change over time. CONCLUSION: Short team interventions show promise to improve team functioning. Effectiveness of interventions in primary care and the inclusion of patients and families needs to be examined. Primary care teams are structured differently than teams in acute care and they may have different priorities.


Assuntos
Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Equipe de Assistência ao Paciente/tendências , Assistência à Saúde/métodos , Educação Continuada/métodos , Humanos , Aprendizagem , Equipe de Assistência ao Paciente/normas
10.
Am J Gastroenterol ; 115(6): 801-804, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-330592
11.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(2): 209-214, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: covidwho-241763

RESUMO

OBJECTIVE: To analyze the roles of multidisciplinary team (MDT) in the diagnosis and treatment of suspected cases of coronavirus disease 2019 (COVID-19). METHODS: The clinical data of 48 patients with suspected COVID-19 admitted in Jinhua Municipal Central Hospital from January 21, 2020 to March 20, 2020 were retrospectively analyzed. RESULTS: In the 48 suspected cases, 18 were diagnosed with COVID-19, and 30 were excluded. Each of the confirmed cases were discussed among MDT for 2 to 12 times with an average of (4.7±3.2) times; while for non-COVID-19 patients were discussed for 2 to 4 times with an average of (2.3±0.6) times. With the guidance of MDT, one COVID-19 patient was transferred to designated provincial hospital after effective treatment; one patient complicated with acute cholecystitis underwent gallbladder puncture and drainage; and COVID-19 was excluded in a highly suspected patient after alveolar lavage fluid examination. Except one transferred patient, all 17 confirmed COVID-19 patients were cured and discharged. There was no cross-infection occurred in suspected patients during the hospitalization. There were no deaths and no medical staff infections. CONCLUSIONS: The efficiency of diagnosis and treatment for suspected COVID-19 patients can be improved with MDT, particularly for complicated cases.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Comunicação Interdisciplinar , Pandemias , Equipe de Assistência ao Paciente , Pneumonia Viral , Betacoronavirus/isolamento & purificação , China , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Humanos , Equipe de Assistência ao Paciente/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Estudos Retrospectivos , Resultado do Tratamento
12.
Can J Surg ; 63(3): E229-E230, 2020 05 08.
Artigo em Inglês | MEDLINE | ID: covidwho-226013

RESUMO

Summary: The coronavirus disease 2019 (COVID-19) pandemic has accentuated the importance of leadership training for health care professionals, particularly surgeons. Surgeons are expected to lead and thrive in multidisciplinary teams. There is, however, a critical gap in teaching residents about fundamental leadership principles, such as developing productive and vision-driven teams, conflict resolution and emotional intelligence. We discuss the merits of leadership training for surgical residents and future directions for implementing a leadership curriculum for Canadian residency programs in the competency by design era.


Assuntos
Infecções por Coronavirus , Cirurgia Geral/educação , Internato e Residência/organização & administração , Liderança , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral , Canadá , Competência Clínica , Currículo , Cirurgia Geral/normas , Internato e Residência/métodos , Internato e Residência/normas , Equipe de Assistência ao Paciente/normas , Ensino
13.
Am J Gastroenterol ; 115(6): 801-804, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32427684
14.
Can J Surg ; 63(3): E229-E230, 2020 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-32386472

RESUMO

Summary: The coronavirus disease 2019 (COVID-19) pandemic has accentuated the importance of leadership training for health care professionals, particularly surgeons. Surgeons are expected to lead and thrive in multidisciplinary teams. There is, however, a critical gap in teaching residents about fundamental leadership principles, such as developing productive and vision-driven teams, conflict resolution and emotional intelligence. We discuss the merits of leadership training for surgical residents and future directions for implementing a leadership curriculum for Canadian residency programs in the competency by design era.


Assuntos
Infecções por Coronavirus , Cirurgia Geral/educação , Internato e Residência/organização & administração , Liderança , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral , Canadá , Competência Clínica , Currículo , Cirurgia Geral/normas , Internato e Residência/métodos , Internato e Residência/normas , Equipe de Assistência ao Paciente/normas , Ensino
15.
J Vasc Surg ; 72(2): 408-413, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32360374
18.
Can J Aging ; 39(3): 333-343, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32408910

RESUMO

The COVID-19 pandemic and subsequent state of public emergency have significantly affected older adults in Canada and worldwide. It is imperative that the gerontological response be efficient and effective. In this statement, the board members of the Canadian Association on Gerontology/L'Association canadienne de gérontologie (CAG/ACG) and the Canadian Journal on Aging/La revue canadienne du vieillissement (CJA/RCV) acknowledge the contributions of CAG/ACG members and CJA/RCV readers. We also profile the complex ways that COVID-19 is affecting older adults, from individual to population levels, and advocate for the adoption of multidisciplinary collaborative teams to bring together different perspectives, areas of expertise, and methods of evaluation in the COVID-19 response.


Assuntos
Envelhecimento , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus , Serviços de Saúde para Idosos/organização & administração , Pandemias , Administração dos Cuidados ao Paciente , Equipe de Assistência ao Paciente , Pneumonia Viral , Idoso , Envelhecimento/fisiologia , Envelhecimento/psicologia , Betacoronavirus/isolamento & purificação , Canadá/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde , Humanos , Comunicação Interdisciplinar , Saúde Mental , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Administração dos Cuidados ao Paciente/tendências , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Melhoria de Qualidade
20.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(2): 209-214, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32391666

RESUMO

OBJECTIVE: To analyze the roles of multidisciplinary team (MDT) in the diagnosis and treatment of suspected cases of coronavirus disease 2019 (COVID-19). METHODS: The clinical data of 48 patients with suspected COVID-19 admitted in Jinhua Municipal Central Hospital from January 21, 2020 to March 20, 2020 were retrospectively analyzed. RESULTS: In the 48 suspected cases, 18 were diagnosed with COVID-19, and 30 were excluded. Each of the confirmed cases were discussed among MDT for 2 to 12 times with an average of (4.7±3.2) times; while for non-COVID-19 patients were discussed for 2 to 4 times with an average of (2.3±0.6) times. With the guidance of MDT, one COVID-19 patient was transferred to designated provincial hospital after effective treatment; one patient complicated with acute cholecystitis underwent gallbladder puncture and drainage; and COVID-19 was excluded in a highly suspected patient after alveolar lavage fluid examination. Except one transferred patient, all 17 confirmed COVID-19 patients were cured and discharged. There was no cross-infection occurred in suspected patients during the hospitalization. There were no deaths and no medical staff infections. CONCLUSIONS: The efficiency of diagnosis and treatment for suspected COVID-19 patients can be improved with MDT, particularly for complicated cases.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Comunicação Interdisciplinar , Pandemias , Equipe de Assistência ao Paciente , Pneumonia Viral , Betacoronavirus/isolamento & purificação , China , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Humanos , Equipe de Assistência ao Paciente/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Estudos Retrospectivos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA