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1.
JACC Cardiovasc Interv ; 13(16): 1949-1950, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32819484

RESUMO

The coronavirus disease-19 (COVID-19) period have dictated a different approach to cardiac interventions at our medical institution. We prioritize emergent care geared toward lesser invasive approaches while minimizing hospitalization duration. This reflects upon coronary and structural/valvular cases altogether. Despite potential criticism of this approach, we believe it is the most appropriate therapeutic strategy for this unique period. Further investigation is needed to examine the external validity of our approach in other medical centers worldwide.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos/normas , Doenças Cardiovasculares/cirurgia , Infecções por Coronavirus/complicações , Gerenciamento Clínico , Fidelidade a Diretrizes , Pandemias , Pneumonia Viral/complicações , Doenças Cardiovasculares/complicações , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
2.
Public Health Rep ; 135(1_suppl): 172S-181S, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735191

RESUMO

OBJECTIVE: Targeted testing and treatment of persons with latent tuberculosis infection (LTBI) is a critical component of the US tuberculosis (TB) elimination strategy. In January 2016, the California Department of Public Health issued a tool and user guide for TB risk assessment (California tool) and guidance for LTBI testing, and in September 2016, the US Preventive Services Task Force (USPSTF) issued recommendations for LTBI testing in primary care settings. We estimated the epidemiologic effect of adherence to both recommendations in California. METHODS: We used an individual-based Markov micro-simulation model to estimate the number of cases of TB disease expected through 2026 with baseline LTBI strategies compared with implementation of the USPSTF or California tool guidance. We estimated the risk of LTBI by age and country of origin, the probability of being in a targeted population, and the probability of presenting for primary care based on available data. We assumed 100% adherence to testing guidance but imperfect adherence to treatment. RESULTS: Implementation of USPSTF and California tool guidance would result in nearly identical numbers of tests administered and cases of TB disease prevented. Perfect adherence to either recommendation would result in approximately 7000 cases of TB disease averted (40% reduction compared with baseline) by 2026. Almost all of this decline would be driven by a reduction in the number of cases among non-US-born persons. CONCLUSIONS: By focusing on the non-US-born population, adherence to LTBI testing strategies recommended by the USPSTF and the California tool could substantially reduce the burden of TB disease in California in the next decade.


Assuntos
Tuberculose Latente/diagnóstico , Atenção Primária à Saúde/organização & administração , Adulto , Fatores Etários , Antituberculosos/uso terapêutico , California , Emigrantes e Imigrantes , Fidelidade a Diretrizes , Humanos , Hospedeiro Imunocomprometido , Tuberculose Latente/tratamento farmacológico , Tuberculose Latente/etnologia , Cadeias de Markov , Programas de Rastreamento , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Instituições Residenciais , Medição de Risco , Tuberculose/etnologia
3.
Rev Saude Publica ; 54: 80, 2020.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-32813868

RESUMO

OBJECTIVE To evaluate the effectiveness of adherence to a multidisciplinary renal health program in reducing mortality and progression to hemodialysis. METHODS We used a database that included patient monitoring (2013-2017), dialysis admissions and all cause of mortality in Peru. Adherence to the program was established by meeting minimum visits during the first year of monitoring. The outcome of interest was hemodialysis admissions or all cause-mortality. Kaplan-Meier curves, Log-Rank test and competing survival analysis methods were used to estimate the differential risk between adherent and non-adherent patients. RESULTS A total of 20,354 participants was evaluated; 54.1% were male, 72.1 years old in average, 2.2 years average follow-up, and 15,279 (75.1%) belonged to the early stages (1 to 3a) of Chronic Kidney Disease. Adherence decreased the risk of renal replacement therapy in 41.0% (HR = 0.59, 95%CI 0.41-0.85) in the low-risk group and mortality in the high-risk group was 31.0% (HR = 0.69, 95%CI 0.57-0.83). CONCLUSIONS The multidisciplinary care strategy with standardized assessments by stage is effective in reducing admission to .0when the patient is identified in early stages and in reducing mortality in advanced stages.


Assuntos
Fidelidade a Diretrizes , Falência Renal Crônica/terapia , Insuficiência Renal Crônica/terapia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/epidemiologia , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Peru/epidemiologia , Avaliação de Programas e Projetos de Saúde , Diálise Renal , Terapia de Substituição Renal , Fatores de Risco , Análise de Sobrevida
4.
MMWR Morb Mortal Wkly Rep ; 69(33): 1109-1116, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32817598

RESUMO

Three vaccines are recommended by the Advisory Committee on Immunization Practices (ACIP) for routine vaccination of adolescents aged 11-12 years to protect against 1) pertussis; 2) meningococcal disease caused by types A, C, W, and Y; and 3) human papillomavirus (HPV)-associated cancers (1). At age 16 years, a booster dose of quadrivalent meningococcal conjugate vaccine (MenACWY) is recommended. Persons aged 16-23 years can receive serogroup B meningococcal vaccine (MenB), if determined to be appropriate through shared clinical decision-making. CDC analyzed data from the 2019 National Immunization Survey-Teen (NIS-Teen) to estimate vaccination coverage among adolescents aged 13-17 years in the United States.* Coverage with ≥1 dose of HPV vaccine increased from 68.1% in 2018 to 71.5% in 2019, and the percentage of adolescents who were up to date† with the HPV vaccination series (HPV UTD) increased from 51.1% in 2018 to 54.2% in 2019. Both HPV vaccination coverage measures improved among females and males. An increase in adolescent coverage with ≥1 dose of MenACWY (from 86.6% in 2018 to 88.9% in 2019) also was observed. Among adolescents aged 17 years, 53.7% received the booster dose of MenACWY in 2019, not statistically different from 50.8% in 2018; 21.8% received ≥1 dose of MenB, a 4.6 percentage point increase from 17.2% in 2018. Among adolescents living at or above the poverty level,§ those living outside a metropolitan statistical area (MSA)¶ had lower coverage with ≥1 dose of MenACWY and with ≥1 HPV vaccine dose, and a lower percentage were HPV UTD, compared with those living in MSA principal cities. In early 2020, the coronavirus disease 2019 (COVID-19) pandemic changed the way health care providers operate and provide routine and essential services. An examination of Vaccines for Children (VFC) provider ordering data showed that vaccine orders for HPV vaccine; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap); and MenACWY decreased in mid-March when COVID-19 was declared a national emergency (Supplementary Figure 1, https://stacks.cdc.gov/view/cdc/91795). Ensuring that routine immunization services for adolescents are maintained or reinitiated is essential to continuing progress in protecting persons and communities from vaccine-preventable diseases and outbreaks.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Vacinas Meningocócicas/administração & dosagem , Vacinas contra Papillomavirus/administração & dosagem , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Humanos , Esquemas de Imunização , Masculino , Estados Unidos , Vacinas Conjugadas/administração & dosagem
5.
Ann Behav Med ; 54(9): 619-625, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32856691

RESUMO

BACKGROUND: The Centers for Disease Control and Prevention (CDC) offer behavioral guidance to prevent the spread of infectious diseases like COVID-19. Cleaning (e.g., cleaning surfaces, washing and sanitizing hands) and containing (e.g., covering coughs, keeping distance from others, especially sick people) behaviors are recommended. PURPOSE: To develop the Clean and Contain Measure, a brief measure of compliance with CDC recommendations for prevention of infectious disease, and validate the measure in individuals experiencing the COVID-19 pandemic. METHODS: Participants were recruited from Amazon Mechanical Turk and social media. RESULTS: In Study 1 (N = 97), exploratory factor analysis revealed two scales: (a) five items assessing cleaning behaviors and (b) four items assessing containing behaviors. Simple structure was obtained and alpha coefficients for both scales were >.83. In Studies 2 (N = 204) and 3 (N = 527), confirmatory factor analysis verified the identical factor structure found in Study 1. All loadings were statistically significant at p < .001. Alpha coefficients for both scales were >.84 for Studies 2 and 3. CONCLUSIONS: Our measure is a reliable and valid indicator of compliance with cleaning and containing health behaviors that help to prevent the spread of diseases like COVID-19. Future research should replicate construct validity in more diverse samples and continue to refine items, examine construct validity, including predictive and discriminant validity, and improve the measure for future use. With continued use and refinement, this measure could allow health officials and researchers to accurately assess compliance with important infection prevention behavior guidelines.


Assuntos
Infecções por Coronavirus/prevenção & controle , Fidelidade a Diretrizes , Comportamentos Relacionados com a Saúde , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto , Betacoronavirus , Centers for Disease Control and Prevention, U.S. , Desinfecção , Análise Fatorial , Feminino , Guias como Assunto , Desinfecção das Mãos , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos
6.
MMWR Morb Mortal Wkly Rep ; 69(34): 1170-1172, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32853185

RESUMO

On June 1, 2020, with declines in coronavirus disease 2019 (COVID-19) cases and hospitalizations in Rhode Island,* child care programs in the state reopened after a nearly 3-month closure implemented as part of mitigation efforts. To reopen safely, the Rhode Island Department of Human Services (RIDHS) required licensed center- and home-based child care programs to reduce enrollment, initially to a maximum of 12 persons, including staff members, in stable groups (i.e., staff members and students not switching between groups) in physically separated spaces, increasing to a maximum of 20 persons on June 29. Additional requirements included universal use of masks for adults, daily symptom screening of adults and children, and enhanced cleaning and disinfection according to CDC guidelines.† As of July 31, 666 of 891 (75%) programs were approved to reopen, with capacity for 18,945 children, representing 74% of the state's January 2020 child care program population (25,749 children).


Assuntos
Cuidado da Criança , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Adulto , Betacoronavirus/isolamento & purificação , Criança , Cuidado da Criança/organização & administração , Pré-Escolar , Técnicas de Laboratório Clínico , Busca de Comunicante , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Rhode Island/epidemiologia , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-32784414

RESUMO

SARS-CoV-2, and several other microorganisms, may be present in nasopharyngeal and salivary secretions in patients treated in dental practices, so an appropriate clinical behavior is required in order to avoid the dangerous spread of infections. COVID-19 could also be spread when patients touches a contaminated surface with infected droplets and then touch their nose, mouth, or eyes. It is time to consider a dental practice quite similar to a hospital surgery room, where particular attention should be addressed to problems related to the spreading of infections due to air and surface contamination. The effectiveness of conventional cleaning and disinfection procedures may be limited by several factors; first of all, human operator dependence seems to be the weak aspect of all procedures. The improvement of these conventional methods requires the modification of human behavior, which is difficult to achieve and sustain. As alternative sterilization methods, there are some that do not depend on the operator, because they are based on devices that perform the entire procedure on their own, with minimal human intervention. In conclusion, continued efforts to improve the traditional manual disinfection of surfaces are needed, so dentists should consider combining the use of proper disinfectants and no-touch decontamination technologies to improve sterilization procedures.


Assuntos
Infecções por Coronavirus/epidemiologia , Consultórios Odontológicos/métodos , Pneumonia Viral/epidemiologia , Esterilização/métodos , Betacoronavirus , Consultórios Odontológicos/normas , Desinfecção/métodos , Desinfecção/normas , Fidelidade a Diretrizes , Humanos , Pandemias , Guias de Prática Clínica como Assunto , Esterilização/normas
8.
Artigo em Inglês | MEDLINE | ID: mdl-32785004

RESUMO

During the coronavirus-19 disease (COVID-19) pandemic, the basic strategy that is recommended to reduce the spread of the disease is to practice proper hand hygiene and personal protective behaviors, but among adolescents, low adherence is common. The present study aimed to assess the gender-dependent hand hygiene and personal protective behaviors in a national sample of Polish adolescents. The Polish Adolescents' COVID-19 Experience (PLACE-19) Study was conducted in a group of 2323 secondary school students (814 males, 1509 females). Schools were chosen based on the random quota sampling procedure. The participants were surveyed to assess their knowledge and beliefs associated with hand hygiene and personal protection, as well as their actual behaviors during the COVID-19 pandemic. The majority of respondents gave proper answers when asked about their knowledge. However, females displayed a higher level of knowledge (p < 0.05). Most of the respondents declared not leaving home, handwashing, using alcohol-based hand rub, avoiding contact with those who may be sick, and avoiding public places as their personal protective behaviors. They declared using face masks and gloves after the legal regulation requiring people to cover their nose and mouth in public places was enacted in Poland. Regarding the use of face masks and not touching the face, no gender-dependent differences were observed, while for all the other behaviors, females declared more adherence than males (p < 0.05). Females also declared a higher daily frequency of handwashing (p < 0.0001) and washing their hands always when necessary more often than males (68.2% vs. 54.1%; p < 0.0001). Males more often indicated various reasons for not handwashing, including that there is no need to do it, they do not feel like doing it, they have no time to do it, or they forget about it (p < 0.0001), while females pointed out side effects (e.g., skin problems) as the reason (p = 0.0278). Females more often declared handwashing in circumstances associated with socializing, being exposed to contact with other people and health (p < 0.05), and declared always including the recommended steps in their handwashing procedure (p < 0.05). The results showed that female secondary school students exhibited a higher level of knowledge on hand hygiene and personal protection, as well as better behaviors, compared to males. However, irrespective of gender, some false beliefs and improper behaviors were observed, which suggests that education is necessary, especially in the period of the COVID-19 pandemic.


Assuntos
Comportamento do Adolescente , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Higiene das Mãos/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Pneumonia Viral/epidemiologia , Adolescente , Betacoronavirus , Coronavirus , Infecções por Coronavirus/prevenção & controle , Feminino , Fidelidade a Diretrizes , Guias como Assunto , Desinfecção das Mãos , Humanos , Masculino , Máscaras , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Polônia/epidemiologia , Fatores Sexuais
9.
J Hosp Med ; 15(8): 483-488, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32804610

RESUMO

IMPORTANCE: Although intensive care unit (ICU) adaptations to the coronavirus disease of 2019 (COVID-19) pandemic have received substantial attention , most patients hospitalized with COVID-19 have been in general medical units. OBJECTIVE: To characterize inpatient adaptations to care for non-ICU COVID-19 patients. DESIGN: Cross-sectional survey. SETTING: A network of 72 hospital medicine groups at US academic centers. MAIN OUTCOME MEASURES: COVID-19 testing, approaches to personal protective equipment (PPE), and features of respiratory isolation units (RIUs). RESULTS: Fifty-one of 72 sites responded (71%) between April 3 and April 5, 2020. At the time of our survey, only 15 (30%) reported COVID-19 test results being available in less than 6 hours. Half of sites with PPE data available reported PPE stockpiles of 2 weeks or less. Nearly all sites (90%) reported implementation of RIUs. RIUs primarily utilized attending physicians, with few incorporating residents and none incorporating students. Isolation and room-entry policies focused on grouping care activities and utilizing technology (such as video visits) to communicate with and evaluate patients. The vast majority of sites reported decreases in frequency of in-room encounters across provider or team types. Forty-six percent of respondents reported initially unrecognized non-COVID-19 diagnoses in patients admitted for COVID-19 evaluation; a similar number reported delayed identification of COVID-19 in patients admitted for other reasons. CONCLUSION: The COVID-19 pandemic has required medical wards to rapidly adapt with expanding use of RIUs and use of technology emerging as critical approaches. Reports of unrecognized or delayed diagnoses highlight how such adaptations may produce potential adverse effects on care.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/epidemiologia , Controle de Infecções/organização & administração , Pneumonia Viral/epidemiologia , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Estudos Transversais , Fidelidade a Diretrizes , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Estados Unidos/epidemiologia
10.
PLoS One ; 15(8): e0237630, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32813692

RESUMO

BACKGROUND: Dental offices are among the highest risk for transmission of the COVID-19, having the potential to transmit the virus via routine dental procedures. This cross-sectional study assessed the preparedness and perception of infection control measures against the COVID-19 pandemic by dentists in Saudi Arabia. MATERIALS AND METHODS: This online survey addressed the impact and perception of the COVID-19 pandemic on dental practice in Saudi Arabia. The questionnaire comprised 26 closed-ended questions. Descriptive statistics included frequency distributions with percentages. In addition, the significance between the different demographic variables and questions about dentists' perception of the COVID-19 pandemic was tested using the Chi-square test. RESULTS: COVID-19 management in dental clinics varied in terms of adherence to the Ministry of Health (MOH) guidelines. Dental clinics' screening questionnaire for patients showed good adherence (67%), while the lowest agreement was detected with the question on the existence of an airborne infection in the isolation room (15%). Almost two-thirds of the respondents agreed that the dental reception area adopted the proper COVID-19 preventive measures. Greatest accord was observed in their answers on questions about dentists' perception of the COVID-19 pandemic, ranging from 64%-89%. In addition, there were statistically significant differences in questions about the perception of dentists towards the COVID-19 pandemic by different demographic variables such as age and years of work experience (p < 0.05). CONCLUSION: The response of most dentists regarding the preparedness and perception of infection control measures against the COVID-19 pandemic was positive. Dental clinics need to adhere more to the MOH recommendations in preparedness of their facilities or by educating their dentists and staff.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Assistência Odontológica/organização & administração , Odontólogos/psicologia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Padrões de Prática Odontológica/organização & administração , Adulto , Atitude do Pessoal de Saúde , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Estudos Transversais , Clínicas Odontológicas , Feminino , Fidelidade a Diretrizes , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Controle de Infecções , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Arábia Saudita/epidemiologia , Inquéritos e Questionários , Adulto Jovem
11.
BMJ ; 370: m2924, 2020 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-32732352

RESUMO

CLINICAL QUESTION: What is the role of remdesivir in the treatment of severe covid-19? This guideline was triggered by the ACTT-1 trial published in the New England Journal of Medicine on 22 May 2020. CURRENT PRACTICE: Remdesivir has received worldwide attention as a potentially effective treatment for severe covid-19. After rapid market approval in the US, remdesivir is already being used in clinical practice. RECOMMENDATIONS: The guideline panel makes a weak recommendation for the use of remdesivir in severe covid-19 while recommending continuation of active enrolment of patients into ongoing randomised controlled trials examining remdesivir. HOW THIS GUIDELINE WAS CREATED: An international panel of patients, clinicians, and methodologists produced these recommendations in adherence with standards for trustworthy guidelines using the GRADE approach. The recommendations are based on a linked systematic review and network meta-analysis. The panel considered an individual patient perspective and allowed contextual factors (such as resources) to be taken into account for countries and healthcare systems. THE EVIDENCE: The linked systematic review (published 31 Jul 2020) identified two randomised trials with 1300 participants, showing low certainty evidence that remdesivir may be effective in reducing time to clinical improvement and may decrease mortality in patients with severe covid-19. Remdesivir probably has no important effect on need for invasive mechanical ventilation. Remdesivir may have little or no effect on hospital length of stay. UNDERSTANDING THE RECOMMENDATION: Most patients with severe covid-19 would likely choose treatment with remdesivir given the potential reduction in time to clinical improvement. However, given the low certainty evidence for critical outcomes and the fact that different perspectives, values, and preferences may alter decisions regarding remdesivir, the panel issued a weak recommendation with strong support for continued recruitment in randomised trials.


Assuntos
Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Antivirais/uso terapêutico , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Monofosfato de Adenosina/uso terapêutico , Alanina/uso terapêutico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Fidelidade a Diretrizes , Humanos , Tempo de Internação/estatística & dados numéricos , Metanálise em Rede , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial/estatística & dados numéricos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
12.
J Prim Care Community Health ; 11: 2150132720943331, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32686571

RESUMO

The experiences of these recent months have left us with as many new questions as they have given us new solutions. The main question that infection prevention and control department is having these days is "Why have hospital-associated infections (HAIs) reduced during COVID-19 pandemic?" What is the one unique strategy that has brought decline in increasing HAIs? Would it be appropriate to say that rigorous hand hygiene practices among health care workers (HCWs) have reduced HAIs in a tertiary care hospital of Pakistan? This commentary is written to understand the effect of rigorous hand hygiene among HCWs on number of HAIs during COVID-19 pandemic. Given the seriousness of this outbreak, it was observed that the hand hygiene has occupied a new place of importance in the minds of HCWs. We observed 4 times increase in the consumption of hand sanitizers after COVID-19 outbreak. The increased consumption of hand sanitizers was reflected in improved hand hygiene practices. A reduction was observed in the number of HAIs after the COVID-19 outbreak, and we assume that the dip in HAIs is associated with the improvement in hand hygiene practices in the recent months. In the wake of COVID-19 pandemic, these trends reassure us that hand hygiene compliance by HCWs alone can be effective in reducing HAIs in a hospital setting.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/prevenção & controle , Higiene das Mãos , Pessoal de Saúde/psicologia , Pandemias , Pneumonia Viral/epidemiologia , Fidelidade a Diretrizes , Humanos , Paquistão/epidemiologia , Guias de Prática Clínica como Assunto , Centros de Atenção Terciária
13.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32616629

RESUMO

OBJECTIVES: To compare the frequency of opioid and corticosteroid prescriptions dispensed for children with pneumonia or sinusitis visits on the basis of location of care. METHODS: We evaluated 2016 South Carolina Medicaid claims data for 5 to 18 years olds with pneumonia or sinusitis. Visits were associated with 1 of 3 locations: the emergency department (ED), urgent care, or the ambulatory setting. RESULTS: Inclusion criteria were met by 31 838 children. Pneumonia visits were more often linked to an opioid prescription in the ED (34 of 542 [6.3%]) than in ambulatory settings (24 of 1590 [1.5%]; P ≤ .0001) and were more frequently linked to a steroid prescription in the ED (106 of 542 [19.6%]) than in ambulatory settings (196 of 1590 [12.3%]; P ≤ .0001). Sinusitis visits were more often linked to an opioid prescription in the ED (202 of 2705 [7.5%]) than in ambulatory settings (568 of 26 866 [2.1%]; P ≤ .0001) and were more frequently linked to a steroid prescription in the ED (510 of 2705 [18.9%]) than in ambulatory settings (1922 of 26 866 [7.2%]; P ≤ .0001). In logistic regression for children with pneumonia, the ED setting was associated with increased odds of receiving an opioid (adjusted odds ratio [aOR] 4.69) or steroid (aOR 1.67). Similarly, patients with sinusitis were more likely to be prescribed opioids (aOR 4.02) or steroids (aOR 3.05) in the ED than in ambulatory sites. CONCLUSIONS: School-aged children received opioid and steroid prescriptions for pneumonia or sinusitis at a higher frequency in the ED versus the ambulatory setting.


Assuntos
Corticosteroides/uso terapêutico , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Analgésicos Opioides/uso terapêutico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Ambulatório Hospitalar/estatística & dados numéricos , Pneumonia/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Sinusite/tratamento farmacológico , Adolescente , Assistência Ambulatorial , Criança , Pré-Escolar , Serviços Médicos de Emergência , Feminino , Fidelidade a Diretrizes , Humanos , Modelos Logísticos , Masculino , Medicaid , Guias de Prática Clínica como Assunto , South Carolina , Estados Unidos
14.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641358

RESUMO

BACKGROUND: Currently, car seat tolerance screens (CSTSs) are recommended for all infants born prematurely in the United States. Although many late-preterm infants are cared for exclusively in newborn nurseries (NBNs), data on implementation of CSTS in nurseries are limited. Our objective for this study was to determine management strategies and potential variation in practice of CSTS in NBNs across the nation. METHODS: We surveyed NBNs across 35 states using the Better Outcomes through Research for Newborns (BORN) network to determine what percentage perform CSTSs, inclusion and failure criteria, performance characteristics, follow-up of failed CSTSs including use of car beds, and provider attitudes toward CSTS. RESULTS: Of the 84 NBNs surveyed, 90.5% performed predischarge CSTSs. The most common failure criteria were saturation <90%, bradycardia <80 beats per minute, and apnea >20 seconds. More than 55% noted hypotonia as an additional inclusion criterion for testing, and >34% tested any infant who had ever required supplemental oxygen. After an initial failed CSTS, >93% of NBNs retested in a car seat at a future time point, whereas only ∼1% automatically discharged infants in a car bed. When asked which infants should undergo predischarge CSTS, the most common recommendations by survey respondents included infants with hypotonia (83%), airway malformations (78%), hemodynamically significant congenital heart disease (63%), and prematurity (61%). CONCLUSIONS: There is a large degree of variability in implementation of CSTS in NBNs across the United States. Further guidance on screening practices and failure criteria is needed to inform future practice and policy.


Assuntos
Apneia/etiologia , Automóveis , Bradicardia/etiologia , Sistemas de Proteção para Crianças/efeitos adversos , Hipóxia/etiologia , Equipamentos para Lactente/efeitos adversos , Recém-Nascido Prematuro/fisiologia , Programas de Rastreamento , Berçários para Lactentes , Atitude do Pessoal de Saúde , Tamanho Corporal , Feminino , Fidelidade a Diretrizes , Pesquisas sobre Serviços de Saúde , Hemodinâmica , Humanos , Hipóxia/diagnóstico , Lactente , Recém-Nascido , Masculino , Programas de Rastreamento/enfermagem , Programas de Rastreamento/estatística & dados numéricos , Oximetria , Oxigênio/sangue , Pressão Parcial , Postura , Utilização de Procedimentos e Técnicas , Estados Unidos
16.
S Afr Med J ; 110(3): 235-242, 2020 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-32657702

RESUMO

BACKGROUND: Venous thromboembolism (VTE) complicates a significant proportion of medical admissions. As well as increasing patient morbidity, pulmonary embolism is one of the commonest preventable causes of in-hospital death. An increase in the use of pharmacological preventive measures has been advocated in recent years. South African (SA) and international guidelines have been published in an effort to promote the safe use of VTE prophylaxis. OBJECTIVES: To describe adherence to both local and international recommendations for VTE prophylaxis in an SA hospital with regard to appropriateness of the decision to prescribe or withhold low-molecular-weight heparin (LMWH), and to observe the practice of dose adjustment in special population groups. METHODS: This was a prospective, observational study, and data were collected from consenting adults admitted to the medical wards. We assessed the patients' VTE risk, bleeding risk and the presence of contraindications at the time of LMWH prescription as well as the dose prescribed, specifically taking into consideration adjustment for renal dysfunction and obesity. RESULTS: Three hundred and fifty-two patients were enrolled, of whom 51.4% were male and 58.5% received LMWH. Primary outcomes. The appropriate overall decision according to both SA and international guidelines was made in 254 cases (72.2%). The inappropriate decision according to both guidelines was made in 79 cases (22.4%) and the appropriate decision according to one guideline only was made in 18 cases (5.1%), while 1 case (0.3%) was not categorised. Contraindications to VTE prophylaxis were present in 35 patients (9.9%), but 9 of these patients nevertheless received LMWH. An incorrect dose was prescribed in 36 cases (17.5%), the most common reason being an inappropriate reduction in the dose in mild renal dysfunction. SECONDARY OUTCOMES: Other medications that may have increased bleeding risk were prescribed in 46 patients who received LMWH (22.3%). Mechanical prophylaxis was indicated in 25 (7.1%) of the total sample; however, none received this. CONCLUSIONS: Overall adherence to published guidelines for VTE prophylaxis has improved compared with other published reviews on the topic, but documentation of patients' VTE risk in files is poor. Overuse in low-risk patients may be an unintended consequence of the widespread advocacy of LMWH use in hospital, highlighting the importance of adequate VTE risk stratification. Incorrect dosing in special population groups is an issue that needs to be addressed, as is non-utilisation of mechanical prophylaxis methods.


Assuntos
Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Tromboembolia Venosa/prevenção & controle , Adulto , Idoso , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
17.
J Am Med Dir Assoc ; 21(7): 900-904, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32674816

RESUMO

OBJECTIVES: To prevent and control COVID-19 infections, nursing homes across the world have taken very restrictive measures, including a ban for visitors. These restrictive measures have an enormous impact on residents' well-being and pose dilemmas for staff, although primary data are lacking. A Dutch guideline was developed to cautiously open nursing homes for visitors during the COVID-19 pandemic. This study reports the first findings on how the guideline was applied in the local context; the compliance to local protocols; and the impact on well-being of residents, their family caregivers, and staff. DESIGN: A mixed-methods cross-sectional study was conducted. SETTING AND PARTICIPANTS: In total, 26 nursing homes were permitted to enlarge their possibilities for allowing visitors in their facility. These nursing homes were proportionally representative of the Netherlands as they were selected by their local Area Health Authority for participation. At each nursing home, a contact person was selected for participation in the current study. METHODS: A mixed-methods cross-sectional study was conducted, consisting of questionnaire, telephone interviews, analyses of documentation (ie, local visiting protocols), and a WhatsApp group. RESULTS: Variation in local protocols was observed, for example, related to the use of personal protective equipment, location, and supervision of visits. In general, experiences were very positive. All nursing homes recognized the added value of real and personal contact between residents and their loved ones and indicated a positive impact on well-being. Compliance with local guidelines was sufficient to good. No new COVID-19 infections were reported during this time. CONCLUSIONS AND IMPLICATIONS: These results indicate the value of family visitation in nursing homes and positive impact of visits. Based on these results, the Dutch government has decided to allow all nursing homes in the Netherlands to cautiously open their homes using the guidelines. More research is needed on impact and long-term compliance.


Assuntos
Infecções por Coronavirus/prevenção & controle , Guias como Assunto , Controle de Infecções/organização & administração , Casas de Saúde/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Visitas a Pacientes/legislação & jurisprudência , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Avaliação Geriátrica , Fidelidade a Diretrizes , Instituição de Longa Permanência para Idosos/organização & administração , Humanos , Masculino , Países Baixos , Pandemias/estatística & dados numéricos , Segurança do Paciente , Pneumonia Viral/epidemiologia
18.
BMC Res Notes ; 13(1): 352, 2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32703315

RESUMO

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is a pandemic respiratory illness spreading from person-to-person caused by a novel coronavirus and poses a serious public health risk. The goal of this study was to apply a modified susceptible-exposed-infectious-recovered (SEIR) compartmental mathematical model for prediction of COVID-19 epidemic dynamics incorporating pathogen in the environment and interventions. The next generation matrix approach was used to determine the basic reproduction number [Formula: see text]. The model equations are solved numerically using fourth and fifth order Runge-Kutta methods. RESULTS: We found an [Formula: see text] of 2.03, implying that the pandemic will persist in the human population in the absence of strong control measures. Results after simulating various scenarios indicate that disregarding social distancing and hygiene measures can have devastating effects on the human population. The model shows that quarantine of contacts and isolation of cases can help halt the spread on novel coronavirus.


Assuntos
Betacoronavirus , Infecções por Coronavirus/transmissão , Exposição Ambiental , Fidelidade a Diretrizes , Controle de Infecções/métodos , Modelos Teóricos , Pandemias , Pneumonia Viral/transmissão , Busca de Comunicante , Convalescença , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Suscetibilidade a Doenças , Previsões , Higiene das Mãos , Humanos , Controle de Infecções/estatística & dados numéricos , Máscaras , Pandemias/prevenção & controle , Cooperação do Paciente , Isolamento de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Quarentena , Fatores de Tempo , Viagem
19.
Rev Bras Enferm ; 73Suppl 2(Suppl 2): e20200316, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32609253

RESUMO

OBJECTIVE: to perform a situational diagnosis of the behavior of health professionals concerning hand hygiene practices in highly-complex sectors. METHODS: this quantitative and retrospective study was based on reports (2016 and 2017) of Adult and Pediatric ICUs of a Federal hospital in Rio de Janeiro. RESULTS: one thousand two hundred fifty-eight opportunities for hand hygiene were analysed. The chance of professionals sanitizing hands in Pediatric ICUs is 41.61% higher than in Adult ICUs. Concerning proper hand hygiene, the medical team had a 39.44% lower chance than the nursing team. Others had a 30.62% lower chance when compared to the nursing team. The moment "after contact with the patient" presented 4.5275 times the chance in relation "before contact with the patient". CONCLUSION: in front of hand hygiene recommendations to control COVID-19, diagnostic assessment and previous analysis of the behavior of professionals proved to be positive.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Desinfecção das Mãos/normas , Pessoal de Saúde/educação , Unidades de Terapia Intensiva/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Adulto , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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