Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.213
Filtrar
1.
Ann Glob Health ; 87(1): 23, 2021 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-33665145

RESUMO

Introduction: Rwanda has made significant advancements in medical and economic development over the last 20 years and has emerged as a leader in healthcare in the East African region. The COVID-19 pandemic, which reached Rwanda in March 2020, presented new and unique challenges for infectious disease control. The objective of this paper is to characterize Rwanda's domestic response to the first year of the COVID-19 pandemic and highlight effective strategies so that other countries, including high and middle-income countries, can learn from its innovative initiatives. Methods: Government publications describing Rwanda's healthcare capacity were first consulted to obtain the country's baseline context. Next, official government and healthcare system communications, including case counts, prevention and screening protocols, treatment facility practices, and behavioral guidelines for the public, were read thoroughly to understand the course of the pandemic in Rwanda and the specific measures in the response. Results: As of 31 December 2020, Rwanda has recorded 8,383 cumulative COVID-19 cases, 6,542 recoveries, and 92 deaths since the first case on 14 March 2020. The Ministry of Health, Rwanda Biomedical Centre, and the Epidemic and Surveillance Response division have collaborated on preparative measures since the pandemic began in January 2020. The formation of a Joint Task Force in early March led to the Coronavirus National Preparedness and Response Plan, an extensive six-month plan that established a national incident management system and detailed four phases of a comprehensive national response. Notable strategies have included disseminating public information through drones, robots for screening and inpatient care, and official communications through social media platforms to combat misinformation and mobilize a cohesive response from the population. Conclusion: Rwanda's government and healthcare system has responded to the COVID-19 pandemic with innovative interventions to prevent and contain the virus. Importantly, the response has utilized adaptive and innovative technology and robust risk communication and community engagement to deliver an effective response to the COVID-19 pandemic.


Assuntos
COVID-19 , Controle de Doenças Transmissíveis , Atenção à Saúde , Regulamentação Governamental , Gestão de Riscos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Gestão de Mudança , Controle de Doenças Transmissíveis/legislação & jurisprudência , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Comunicação , Atenção à Saúde/organização & administração , Atenção à Saúde/tendências , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , Inovação Organizacional , Gestão de Riscos/métodos , Gestão de Riscos/organização & administração , Ruanda/epidemiologia , SARS-CoV-2
2.
Soins ; 66(852): 50-52, 2021.
Artigo em Francês | MEDLINE | ID: mdl-33750561

RESUMO

The presence of nurses within occupational health care teams is now mandatory. Their role, centred on prevention, health protection and employees' safety, is practised under the authority and in close collaboration with the occupational health doctor, within a multidisciplinary team. Over recent years, their scope of practice has been expanded to include the individual monitoring of employees' health. It could be further expanded in future.


Assuntos
Enfermagem do Trabalho , Serviços de Saúde do Trabalhador , Humanos , Papel do Profissional de Enfermagem , Serviços de Saúde do Trabalhador/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Gestão de Riscos/organização & administração
3.
Adv Med Sci ; 66(1): 221-230, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33744516

RESUMO

Transnasal endoscopic skull base surgery (eSBS) has been adopted in recent years, in great part to replace the extended procedures required by external approaches. Though sometimes perceived as "minimally invasive", eSBS still necessitates extensive manipulations within the nose/paranasal sinuses. Furthermore, exposure of susceptible cerebral structures to light and heat emanated by the telescope should be considered to comprehensively evaluate the safety of the method. While the number of studies specifically targeting eSBS safety still remains scarce, the problem has recently expanded with the SARS-CoV-2 pandemic, which also has implications for the safety of the surgical personnel. It must be stressed that eSBS may directly expose the surgeon to potentially high volumes of virus-contaminated aerosol. Thus, the anxiety of both the patient and the surgeon must be taken into account. Consequently, safety requirements must follow the highest standards. This paper summarizes current knowledge on SARS-CoV-2 biology and the peculiarities of human immunology in respect of the host-virus relationship, taking into account the latest information concerning the SARS-CoV-2 worrisome affinity for the nervous system. Based on this information, a workflow proposal is offered for consideration. This could be useful not only for the duration of the pandemic, but also during the unpredictable timeline involving our coexistence with the virus. Recommendations include technical modifications to the operating theatre, personal protective equipment, standards of testing for SARS-CoV-2 infection, prophylactic pretreatment with interferon, anti-IL6 treatment and, last but not least, psychological support for the patient.


Assuntos
COVID-19 , Cirurgia Endoscópica por Orifício Natural , Procedimentos Neurocirúrgicos , Exposição Ocupacional/prevenção & controle , Base do Crânio/cirurgia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Humanos , Controle de Infecções/métodos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Gestão de Riscos/organização & administração , SARS-CoV-2/isolamento & purificação , SARS-CoV-2/patogenicidade
5.
Clin Ter ; 171(1): e63-e66, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33346331

RESUMO

Having regard to the increasing attention to the issue of safety and health of patients and workers by low, the hypothesis that this topic will be the growing trend in the next years does not seem to be manifestly unfounded. For this reason, it is wise for healthcare professionals to already be aware that any violation of the interests underlying the legislation in question entails a ruling on civil and/or criminal liability. It is therefore necessary to identify the most suitable means to prevent undue harm occurring, partly to exempt healthcare professionals and hospitals from compensation costs, thereby providing them with recourse to insurance coverage. Healthcare facility organisations must adopt Risk Management techniques as a tool to simultaneously guarantee the effectiveness of health services (in this case), the efficiency of the management economy, and finally compliance with all legally required precautions. This will relegate the occurrence of an adverse event to remote and unpredictable hypotheses, thus guaranteeing useful recourse to insurance coverage to compensate any harm that does occur.


Assuntos
Atenção à Saúde/organização & administração , Responsabilidade Legal , Gestão de Riscos/organização & administração , Compensação e Reparação , Atenção à Saúde/legislação & jurisprudência , Atenção à Saúde/normas , Pessoal de Saúde , Humanos , Gestão de Riscos/legislação & jurisprudência
7.
Vaccimonitor (La Habana, Print) ; 29(3)sept.-dic. 2020. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1139852

RESUMO

La vacunación continúa siendo una de las vías más sostenibles y utilizadas en el control de enfermedades infectocontagiosas en medicina veterinaria, dado por su mayor factibilidad económica y por el problema que representa el residuo de antibióticos en productos animales de consumo humano. El surgimiento de vacunas de nuevas generaciones ha motivado la instrumentación de medidas de bioseguridad y la necesidad de realizar estudios de evaluaciones de los riesgos que acometemos en la obtención y producción de vacunas, existiendo puntos críticos importantes en el proceso de obtención de las mismas. El área de vacunas inactivadas que se encuentra ubicada en la Empresa Productora de Vacunas Virales y Bacterianas UP-7, perteneciente al grupo empresarial LABIOFAM de La Habana, Cuba, se encarga de la producción y control de la calidad de las vacunas y los medios diagnósticos. Las inspecciones previas realizadas a dicha área mostraron, en el personal involucrado, desconocimiento y baja percepción del riesgo biológico existente en los procesos productivos que allí se llevan a cabo, lo que sugirió la realización de la presente investigación. Se identificaron y caracterizaron los peligros y se realizó una evaluación del riesgo, utilizando una matriz de estimación del riesgo; mediante un método cualitativo de posibilidad de ocurrencia del peligro y se evaluó de bajo, moderado o alto. Se identificaron las vulnerabilidades presentes empleando para ello una lista de chequeo, detectándose, entre otras, aquellas relacionadas con el diseño del área, con el tratamiento de los desechos y la organización de la bioseguridad, lo que confirmó puntos críticos dentro del proceso productivo con riesgo alto y moderado(AU)


Vaccination continues being one of the most sustainable and used ways in the control of infectious and contagious diseases in veterinary medicine because of both its greater economic feasibility and thwarting animal products from having antibiotics residues, a big-time issue for human ingestion. The appearance of new generation vaccines has motivated the application of biosafety measures and the need to carry out studies of risk assessments that we undertake to obtaining and producing vaccines, being important critical points in the process of acquiring them. The inactivated vaccines' area is located in the UP-7 Viral and Bacterial Vaccine Production Company, belonging to LABIOFAM business group in Havana, Cuba; this area is responsible for vaccines, diagnostic means production and quality control. Previous checkups carried out showed that the personnel involved had lack of knowledge and low perception of the existing biological risk in the productive processes carried out there; leading to suggest the investigation. Hazards were identified and characterized and a risk assessment was carried out, using a qualitative estimate risk matrix. Such hazards were assessed as low, moderate or high. Vulnerabilities were identified using a checklist to this purpose, detecting those related to area design, treatment of waste and the biosafety organization, which established the existence of critical points within the production process with high and moderate risk(AU)


Assuntos
Animais , Gestão de Riscos/organização & administração , Riscos Ocupacionais , Contenção de Riscos Biológicos , Vacinas , Cuba
8.
Aust J Gen Pract ; 49(11): 745-751, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33123716

RESUMO

METHOD: A national cross-sectional online survey of Australian general practitioners was conducted in April and May 2020, with 572 respondents. RESULTS: The COVID-19 pandemic in Australia has resulted in major changes to general practice business models. Most practices have experienced increased workload and reduced income. DISCUSSION: Australian general practices have undertaken major innovation and realignment to respond to staff safety and patient care challenges during the COVID-19 pandemic. Increased administration, reduced billable time, managing staffing and pivoting to telehealth service provision have negatively affected practice viability. Major sources of information for general practice are primary care-specific, but many practices turn to colleagues for support and resources.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus , Medicina Geral , Pandemias , Pneumonia Viral , Gestão de Riscos , Atitude do Pessoal de Saúde , Austrália/epidemiologia , Betacoronavirus , Defesa Civil/normas , Defesa Civil/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Medicina Geral/organização & administração , Medicina Geral/tendências , Clínicos Gerais , Pesquisas sobre Serviços de Saúde , Humanos , Mortalidade , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gestão de Riscos/organização & administração , Gestão de Riscos/tendências , Telemedicina/estatística & dados numéricos
9.
BMJ Open ; 10(9): e041370, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32988953

RESUMO

OBJECTIVES: To use Population Health Management (PHM) methods to identify and characterise individuals at high-risk of severe COVID-19 for which shielding is required, for the purposes of managing ongoing health needs and mitigating potential shielding-induced harm. DESIGN: Individuals at 'high risk' of COVID-19 were identified using the published national 'Shielded Patient List' criteria. Individual-level information, including current chronic conditions, historical healthcare utilisation and demographic and socioeconomic status, was used for descriptive analyses of this group using PHM methods. Segmentation used k-prototypes cluster analysis. SETTING: A major healthcare system in the South West of England, for which linked primary, secondary, community and mental health data are available in a system-wide dataset. The study was performed at a time considered to be relatively early in the COVID-19 pandemic in the UK. PARTICIPANTS: 1 013 940 individuals from 78 contributing general practices. RESULTS: Compared with the groups considered at 'low' and 'moderate' risk (ie, eligible for the annual influenza vaccination), individuals at high risk were older (median age: 68 years (IQR: 55-77 years), cf 30 years (18-44 years) and 63 years (38-73 years), respectively), with more primary care/community contacts in the previous year (median contacts: 5 (2-10), cf 0 (0-2) and 2 (0-5)) and had a higher burden of comorbidity (median Charlson Score: 4 (3-6), cf 0 (0-0) and 2 (1-4)). Geospatial analyses revealed that 3.3% of rural and semi-rural residents were in the high-risk group compared with 2.91% of urban and inner-city residents (p<0.001). Segmentation uncovered six distinct clusters comprising the high-risk population, with key differentiation based on age and the presence of cancer, respiratory, and mental health conditions. CONCLUSIONS: PHM methods are useful in characterising the needs of individuals requiring shielding. Segmentation of the high-risk population identified groups with distinct characteristics that may benefit from a more tailored response from health and care providers and policy-makers.


Assuntos
Infecções por Coronavirus , Sistemas de Informação em Saúde/estatística & dados numéricos , Pandemias , Pneumonia Viral , Gestão da Saúde da População , Medição de Risco/métodos , Gestão de Riscos , Idoso , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Demografia , Inglaterra/epidemiologia , Feminino , Medicina Geral/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Fatores de Risco , Gestão de Riscos/métodos , Gestão de Riscos/organização & administração , Índice de Gravidade de Doença
10.
Br J Hosp Med (Lond) ; 81(9): 1-9, 2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32990080

RESUMO

Guidance regarding appropriate use of personal protective equipment in hospitals is in constant flux as research into SARS-COV-2 transmission continues to develop our understanding of the virus. The risk associated with procedures classed as 'aerosol generating' is under constant debate. Current guidance is largely based on pragmatic and cautious logic, as there is little scientific evidence of aerosolization and transmission of respiratory viruses associated with procedures. The physical properties of aerosol particles which may contain viable virus have implications for the safe use of personal protective equipment and infection control protocols. As elective work in the NHS is reinstated, it is important that the implications of the possibility of airborne transmission of the virus in hospitals are more widely understood. This will facilitate appropriate use of personal protective equipment and help direct further research into the true risks of aerosolization during these procedures to allow safe streamlining of services for staff and patients.


Assuntos
Microbiologia do Ar , Infecções por Coronavirus , Cuidados Críticos , Fidelidade a Diretrizes/normas , Controle de Infecções , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral , Gestão de Riscos/organização & administração , Aerossóis , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Cuidados Críticos/métodos , Cuidados Críticos/tendências , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Reino Unido/epidemiologia
11.
Artigo em Inglês | MEDLINE | ID: mdl-32872189

RESUMO

Clinical risk management constitutes a central element in the healthcare systems in relation to the reverberation that it establishes, and as regards the optimization of clinical outcomes for the patient. The starting point for a right clinical risk management is represented by the identification of non-conforming results. The aim of the study is to carry out a systematic analysis of all data received in the first three years of adoption of a reporting system, revealing the strengths and weaknesses. The results emerged showed an increasing trend in the number of total records. Notably, 86.0% of the records came from the medical category. Moreover, 41.0% of the records reported the possible preventive measures that could have averted the event and in 30% of the reports are hints to be put in place to avoid the repetition of the events. The second experimental phase is categorizing the events reported. Implementing the reporting system, it would guarantee a virtuous cycle of learning, training and reallocation of resources. By sensitizing health workers to a correct use of the incident reporting system, it could become a virtuous error learning system. All this would lead to a reduction in litigation and an implementation of the therapeutic doctor-patient alliance.


Assuntos
Coleta de Dados/métodos , Erros Médicos/prevenção & controle , Segurança do Paciente , Qualidade da Assistência à Saúde/estatística & dados numéricos , Gestão de Riscos/organização & administração , Gestão da Segurança/estatística & dados numéricos , Hospitais Universitários , Humanos , Itália , Auditoria Administrativa , Erros Médicos/estatística & dados numéricos , Sistemas Computadorizados de Registros Médicos , Gestão da Segurança/organização & administração , Gestão da Qualidade Total/organização & administração
13.
Actas Dermosifiliogr ; 111(8): 650-654, 2020 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32622869

RESUMO

As the COVID-19 pandemic gradually comes under control, the members of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) have drawn up a proposed list of the requirements, limitations, and conditioning factors affecting the resumption of work in contact dermatitis units. The assumption is that the severe acute respiratory syndrome coronavirus2 is still circulating and that occasional or seasonal outbreaks will occur. They recommend that the first step should be to assess how many patch tests each clinic can handle and review the waiting list to prioritize cases according to disease severity and urgency. Digital technologies can, where possible, be used to send and receive the documentation necessary for the patch test (information, instructions, informed consent, etc.). If the necessary infrastructure is available, patients can be offered the option of a remote initial consultation. Likewise, in selected cases, the patch test results can be read in a virtual visit using photographs taken by the patient or a video visit can be scheduled to allow the physician to evaluate the site of application remotely. These measures will reduce the number of face-to-face visits required, but will not affect the time spent on each case, which must be scheduled in the normal manner. All of these recommendations are suggestions and should be adapted to the needs and possibilities of each health centre.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Dermatologia/organização & administração , Testes do Emplastro/normas , Pneumonia Viral/epidemiologia , Telemedicina/organização & administração , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Dermatite Alérgica de Contato/diagnóstico , Inquéritos Epidemiológicos/normas , Humanos , Hipersensibilidade/diagnóstico , Visita a Consultório Médico , Pandemias/prevenção & controle , Acesso dos Pacientes aos Registros , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Gestão de Riscos/organização & administração , Espanha/epidemiologia , Avaliação de Sintomas/métodos , Telepatologia , Triagem/organização & administração , Listas de Espera
14.
BMC Med Inform Decis Mak ; 20(1): 106, 2020 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-32522216

RESUMO

BACKGROUND: Infectious diseases that can cause epidemics, such as COVID-19, SARS-CoV, and MERS-CoV, constitute a major social issue, with healthcare providers fearing secondary, tertiary, and even quaternary infections. To alleviate this problem, telemedicine is increasingly being viewed as an effective means through which patients can be diagnosed and medications prescribed by doctors via untact Thus, concomitant with developments in information and communication technology (ICT), medical institutions have actively analyzed and applied ICT to medical systems to provide optimal medical services. However, with the convergence of these diverse technologies, various risks and security threats have emerged. To protect patients and improve telemedicine quality for patient safety, it is necessary to analyze these risks and security threats comprehensively and institute appropriate countermeasures. METHODS: The security threats likely to be encountered in each of seven telemedicine service areas were analyzed, and related data were collected directly through on-site surveys by a medical institution. Subsequently, an attack tree, the most popular reliability and risk modeling approach for systematically characterizing the potential risks of telemedicine systems, was examined and utilized with the attack occurrence probability and attack success probability as variables to provide a comprehensive risk assessment method. RESULTS: In this study, the most popular modelling method, an attack tree, was applied to the telemedicine environment, and the security concerns for telemedicine systems were found to be very large. Risk management and evaluation methods suitable for the telemedicine environment were identified, and their benefits and potential limitations were assessed. CONCLUSION: This research should be beneficial to security experts who wish to investigate the impacts of cybersecurity threats on remote healthcare and researchers who wish to identify new modeling opportunities to apply security risk modeling techniques.


Assuntos
Segurança Computacional , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Gestão de Riscos/organização & administração , Telemedicina/organização & administração , Betacoronavirus , Confidencialidade , Atenção à Saúde , Humanos , Modelos Organizacionais , Segurança do Paciente , Reprodutibilidade dos Testes
16.
Can J Urol ; 27(3): 10205-10212, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32544042

RESUMO

INTRODUCTION: The novel coronavirus disease 2019 (COVID-19), pandemic has afflicted > 3.3 million people around the world since December 2019. Though, more than 1000 publications have appeared in scientific journals addressing a plethora of questions, there is a considerable hiatus in understanding of the behavior and natural history of the virus and its impact on urology. Also, a modified approach is the need of hour in taking care of patients as urologists should safeguard their teams, families, and patients. MATERIAL AND METHODS: The authors have used guidelines from USA, Canada, UK, Europe and India for making recommendations to help urologist define their own policies that may have to be fine-tuned on the basis of continued and evolving challenges they would encounter and the local resources at their disposal. RESULTS: COVID-19 do effect genitourinary system from kidney to testis. The authors provide scientific basis to urologists to help identify patients by remote consultation who are likely to be harmed by coming to the hospital, and not to miss those who need hospitalization for diagnostic or therapeutic interventions. There is uncompromised need of specific precautions during surgery to safe guard the surgeon and his team along with the patient. CONCLUSIONS: Urological operations during COVID-19 pandemic should be limited to emergency cases during the acute phase with an exit strategy planned in a staggered manner, based on the scientific risk stratification. Telemedicine (e-clinics or virtual clinics) would help achieve the goal of risk stratification.


Assuntos
Infecções por Coronavirus , Controle de Infecções/organização & administração , Pandemias , Pneumonia Viral , Doenças Urológicas , Procedimentos Cirúrgicos Urológicos , Betacoronavirus/isolamento & purificação , Betacoronavirus/fisiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Cooperação Internacional , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , Receptores Androgênicos/metabolismo , Saúde Reprodutiva , Gestão de Riscos/métodos , Gestão de Riscos/organização & administração , Doenças Urológicas/etiologia , Doenças Urológicas/metabolismo , Doenças Urológicas/fisiopatologia , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Procedimentos Cirúrgicos Urológicos/normas
17.
Am J Perinatol ; 37(8): 837-844, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32396947

RESUMO

Hypertensive disorders are the most common medical complications of pregnancy and a major cause of maternal and perinatal morbidity and death. The detection of elevated blood pressure during pregnancy is one of the cardinal aspects of optimal antenatal care. With the outbreak of novel coronavirus disease 2019 (COVID-19) and the risk for person-to-person spread of the virus, there is a desire to minimize unnecessary visits to health care facilities. Women should be classified as low risk or high risk for hypertensive disorders of pregnancy and adjustments can be accordingly made in the frequency of maternal and fetal surveillance. During this pandemic, all pregnant women should be encouraged to obtain a sphygmomanometer. Patients monitored for hypertension as an outpatient should receive written instructions on the important signs and symptoms of disease progression and provided contact information to report the development of any concern for change in status. As the clinical management of gestational hypertension and preeclampsia is the same, assessment of urinary protein is unnecessary in the management once a diagnosis of a hypertensive disorder of pregnancy is made. Pregnant women with suspected hypertensive disorders of pregnancy and signs and symptoms associated with the severe end of the disease spectrum (e.g., headaches, visual symptoms, epigastric pain, and pulmonary edema) should have an evaluation including complete blood count, serum creatinine level, and liver transaminases (aspartate aminotransferase and alanine aminotransferase). Further, if there is any evidence of disease progression or if acute severe hypertension develops, prompt hospitalization is suggested. Current guidelines from the American College of Obstetricians and Gynecologists (ACOG) and The Society for Maternal-Fetal Medicine (SMFM) for management of preeclampsia with severe features suggest delivery after 34 0/7 weeks of gestation. With the outbreak of COVID-19, however, adjustments to this algorithm should be considered including delivery by 30 0/7 weeks of gestation in the setting of preeclampsia with severe features. KEY POINTS: · Outbreak of novel coronavirus disease 2019 (COVID-19) warrants fewer office visits.. · Women should be classified for hypertension risk in pregnancy.. · Earlier delivery suggested with COVID-19 and hypertensive disorder..


Assuntos
Infecções por Coronavirus , Hipertensão Induzida pela Gravidez , Controle de Infecções , Pandemias , Pneumonia Viral , Pré-Eclâmpsia/prevenção & controle , Complicações Infecciosas na Gravidez , Cuidado Pré-Natal , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Parto Obstétrico/métodos , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/terapia , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/organização & administração , Fatores de Risco , Gestão de Riscos/organização & administração , Fatores de Tempo
19.
J Thorac Oncol ; 15(7): 1137-1146, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360578

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic is currently accelerating. Patients with locally advanced NSCLC (LA-NSCLC) may require treatment in locations where resources are limited, and the prevalence of infection is high. Patients with LA-NSCLC frequently present with comorbidities that increase the risk of severe morbidity and mortality from COVID-19. These risks may be further increased by treatments for LA-NSCLC. Although guiding data is scarce, we present an expert thoracic oncology multidisciplinary (radiation oncology, medical oncology, surgical oncology) consensus of alternative strategies for the treatment of LA-NSCLC during a pandemic. The overarching goals of these approaches are the following: (1) reduce the number of visits to a health care facility, (2) reduce the risk of exposure to severe acute respiratory syndrome-coronavirus-2, (3) attenuate the immunocompromising effects of lung cancer therapies, and (4) provide effective oncologic therapy. Patients with resectable disease can be treated with definitive nonoperative management if surgical resources are limited or the risks of perioperative care are high. Nonoperative options include chemotherapy, chemoimmunotherapy, and radiation therapy with sequential schedules that may or may not affect long-term outcomes in an era in which immunotherapy is available. The order of treatments may be on the basis of patient factors and clinical resources. Whenever radiation therapy is delivered without concurrent chemotherapy, hypofractionated schedules are appropriate. For patients who are confirmed to have COVID-19, usually, cancer therapies may be withheld until symptoms have resolved with negative viral test results. The risk of severe treatment-related morbidity and mortality is increased for patients undergoing treatment for LA-NSCLC during the COVID-19 pandemic. Adapting alternative treatment strategies as quickly as possible may save lives and should be implemented through communication with the multidisciplinary cancer team.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Infecções por Coronavirus , Procedimentos Clínicos , Pandemias , Administração dos Cuidados ao Paciente/métodos , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/terapia , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Humanos , Controle de Infecções/métodos , Comunicação Interdisciplinar , Estadiamento de Neoplasias , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Medição de Risco , Gestão de Riscos/organização & administração
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...