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3.
West Afr J Med ; 38(3): 206-212, 2021 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-33764716

RESUMO

BACKGROUND: There have been calls for privatisation of public health facilities to improve quality of care received. The study compared antenatal and delivery services received in public and private health facilities in Nigeria. METHODS: The study was based on 2018 Nigeria Demographic and Health Survey data collected from women aged 15-49 years, concerning their pregnancy and delivery. Data on those that attended antenatal clinic (ANC) in public or private facilities and had live births in the preceding five years was analysed. Simple logistic regression was used to test for association between type of facility for ANC and delivery and the care received. RESULTS: A total of 15,811 women attended ANC in public (12,921, 81.7%) and private (2,890, 18.3%) facilities, and 12,399 delivered in public (8,583, 69.2%) and private (3,817, 30.8%) facilities. Type of facility attended was associated with number of ANC visits (OR=3.89; p<0.001), blood sample taken (OR=1.16; p=0.029), iron supplementation (OR=0.49; p<0.001), deworming (OR=0.74; p<0.001), receiving all the components of ANC service (OR=0.79; p<0.001), and skilled birth attendance (OR=3.81; p<0.001). However, it was not associated with blood pressure measurement (OR=1.07; p=0.459), urine sample taken (OR=1.05; p=0.486), postnatal check (OR=0.94; p=0.171) and timing of postnatal check (OR=0.73; p=0.185). CONCLUSION: While private facilities had more ANC visits and skilled birth attendance, overall provision of ANC services was better in the public facilities. Therefore, antenatal and delivery services were not necessarily better in private facilities. Beyond availability, further studies are needed to compare the quality of antenatal and delivery services in public and private facilities.


Assuntos
Cuidado Pré-Natal , Instalações Privadas , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Demografia , Feminino , Humanos , Pessoa de Meia-Idade , Nigéria , Gravidez , Adulto Jovem
4.
J Prim Care Community Health ; 12: 21501327211000235, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33729044

RESUMO

BACKGROUND: To characterize the experience of converting a geriatrics clinic to telehealth visits in early stages of a pandemic. DESIGN: An organizational case study with mixed methods evaluation from the first 8 weeks of converting a geriatrics clinic from in-person visits to video and telephone visits. SETTING: Veteran's Health Administration in Northern California Participants Community-dwelling older Veterans receiving care at VA Palo Alto Geriatrics clinic. Veterans had a mean age of 85.7 (SD = 6.8) and 72.1% had cognitive impairment. INTERVENTION: Veterans with face-to-face appointments were converted to video or telephone visits to mitigate exposure to community spread of COVID-19. MEASUREMENTS: Thirty-two patient evaluations and 80 clinician feedback evaluations were completed. This provided information on satisfaction, care access during pandemic, and travel and time savings. RESULTS: Of the 62 scheduled appointments, 43 virtual visits (69.4%) were conducted. Twenty-six (60.5%) visits were conducted via video, 17 (39.5%) by telephone. Virtual visits saved patients an average of 118.6 minutes each. Patients and providers had similar, positive perceptions about telehealth to in-person visit comparison, limiting exposure, and visit satisfaction. After the telehealth appointment, patients indicated greater comfort with using virtual visits in the future. Thirty-one evaluations included comments for qualitative analysis. We identified 3 main themes of technology set-up and usability, satisfaction with visit, and clinical assessment and communication. CONCLUSION: During a pandemic that has limited the ability to safely conduct inperson services, virtual formats offer a feasible and acceptable alternative for clinically-complex older patients. Despite potential barriers and additional effort required for telehealth visits, patients expressed willingness to utilize this format. Patients and providers reported high satisfaction, particularly with the ability to access care similar to in-person while staying safe. Investing in telehealth services during a pandemic ensures that vulnerable older patients can access care while maintaining social distancing, an important safety measure.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Geriatria/organização & administração , Telemedicina/organização & administração , Serviços de Saúde para Veteranos Militares/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , California/epidemiologia , Demência/terapia , Acesso aos Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Estudos de Casos Organizacionais , Atenção Primária à Saúde/organização & administração , Pesquisa Qualitativa , Telefone , Comunicação por Videoconferência
5.
PLoS One ; 16(3): e0249043, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33755715

RESUMO

BACKGROUND: We sought to investigate the impact of the COVID-19 pandemic and the Tele-HF Clinic (Tele-HFC) program on cardiovascular death, heart failure (HF) rehospitalization, and heart transplantation rates in a cohort of ambulatory HF patients during and after the peak of the pandemic. METHODS: Using the HF clinic database, we compared data of patients with HF before, during, and after the peak of the pandemic (January 1 to March 17 [pre-COVID], March 17 to May 31 [peak-COVID], and June 1 to October 1 [post-COVID]). During peak-COVID, all patients were managed by Tele-HFC or hospitalization. After June 1, patients chose either a face-to-face clinic visit or a continuous tele-clinic visit. RESULTS: Cardiovascular death and medical titration rates were similar in peak-COVID compared with all other periods. HF readmission rates were significantly lower in peak-COVID (8.7% vs. 2.5%, p<0.001) and slightly increased (3.5%) post-COVID. Heart transplant rates were substantially increased in post-COVID (4.5% vs. peak-COVID [0%], p = 0.002). After June 1, 38% of patients continued with the Tele-HFC program. Patients managed by the Tele-HFC program for <6 months were less likely to have HF with reduced ejection fraction (73% vs. 54%, p = 0.005) and stage-D HF (33% vs. 14%, p = 0.001), and more likely to achieve the target neurohormonal blockade dose (p<0.01), compared with the ≥6-month Tele-HFC group. CONCLUSIONS: HF rehospitalization and transplant rates significantly declined during the pandemic in ambulatory care of HF. However, reduction in these rates did not affect subsequent 5-month hospitalization and cardiovascular mortality in the setting of Tele-HFC program and continuum of advanced HF therapies.


Assuntos
/patologia , Doenças Cardiovasculares/diagnóstico , Insuficiência Cardíaca/diagnóstico , Hospitalização/estatística & dados numéricos , Adulto , Idoso , Instituições de Assistência Ambulatorial , Doenças Cardiovasculares/mortalidade , Bases de Dados Factuais , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Transplante de Coração , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Índice de Gravidade de Doença , Taxa de Sobrevida
6.
Nephrol Nurs J ; 48(1): 49-55, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33683843

RESUMO

This article describes the impact of a 12-week workplace wellness program on staff (n = 14) of an outpatient hemodialysis center. The program focused on decreasing dietary sodium and increasing habitual physical activity. The average systolic and diastolic blood pressure of participants decreased by 16.9±21.6 mmHg (p < 0.05) and 4.1±14.0 mmHg (p < 0.05), and body weight decreased by 2.7±1.9kg (p < 0.05). The mean step count at baseline was 7,052±3,278 but increased to 10,388±2,882 (p < 0.05) during a walking challenge. There was a reduction in self-reported barriers to making healthy nutritional changes (p < 0.05) and engaging in habitual physical activity (p < 0.05). Our pilot findings suggest that workplace wellness programs in hemodialysis centers are feasible and effective.


Assuntos
Instituições de Assistência Ambulatorial , Saúde do Trabalhador , Diálise Renal , Dieta Hipossódica , Exercício Físico/psicologia , Humanos , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Autorrelato
7.
Med J (Ft Sam Houst Tex) ; (PB 8-21-01/02/03): 122-127, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33666924

RESUMO

The United States declared a national emergency on March 13, 2020, in response to the rapidly spreading COVID-19 pandemic after all 50 states reported laboratory-confirmed cases.1 The demand for ambulatory medical care in the US fell by almost 60% and immunization encounters at Walter Reed National Military Medical Center decreased by 76% as patients became concerned about the risk of coronavirus exposure within a clinic or hospital setting.2 Our vaccination initiatives aimed to increase our pediatric and adult immunization rates through offering two alternative immunization platforms aimed to reduce patient concerns about COVID exposure.


Assuntos
Instituições de Assistência Ambulatorial , Acesso aos Serviços de Saúde/organização & administração , Vacinação em Massa/organização & administração , /epidemiologia , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Estados Unidos
8.
BMC Nephrol ; 22(1): 81, 2021 03 06.
Artigo em Inglês | MEDLINE | ID: mdl-33676397

RESUMO

BACKGROUND: Emory Dialysis serves an urban and predominantly African American population at its four outpatient dialysis facilities. We describe COVID-19 infection control measures implemented and clinical characteristics of patients with COVID-19 in the Emory Dialysis facilities. METHODS: Implementation of COVID-19 infection procedures commenced in February 2020. Subsequently, COVID-19 preparedness assessments were conducted at each facility. Patients with COVID-19 from March 1-May 31, 2020 were included; with a follow-up period spanning March-June 30, 2020. Percentages of patients diagnosed with COVID-19 were calculated, and characteristics of COVID-19 patients were summarized as medians or percentage. Baseline characteristics of all patients receiving care at Emory Dialysis (i.e. Emory general dialysis population) were presented as medians and percentages. RESULTS: Of 751 dialysis patients, 23 (3.1%) were diagnosed with COVID-19. The median age was 67.0 years and 13 patients (56.6%) were female. Eleven patients (47.8%) were residents of nursing homes. Nineteen patients (82.6%) required hospitalization and 6 patients (26.1%) died; the average number of days from a positive SARS-CoV-2 (COVID) test to death was 16.8 days (range 1-34). Two patients dialyzing at adjacent dialysis stations and a dialysis staff who cared for them, were diagnosed with COVID-19 in a time frame that may suggest transmission in the dialysis facility. In response, universal masking in the facility was implemented (prior to national guidelines recommending universal masking), infection control audits and re-trainings of PPE were also done to bolster infection control practices. CONCLUSION: We successfully implemented recommended COVID-19 infection control measures aimed at mitigating the spread of SARS-CoV-2. Most of the patients with COVID-19 required hospitalizations. Dialysis facilities should remain vigilant and monitor for possible transmission of COVID-19 in the facility.


Assuntos
Afro-Americanos , Instituições de Assistência Ambulatorial/normas , Controle de Infecções/métodos , Diálise Renal/normas , Populações Vulneráveis/etnologia , Idoso , /etnologia , Suscetibilidade a Doenças , Feminino , Georgia , Humanos , Masculino , Pessoa de Meia-Idade , Telemedicina , População Urbana
9.
N Z Med J ; 134(1530): 30-37, 2021 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-33651775

RESUMO

AIM: To investigate the outcomes and effect of a multidisciplinary 'see and treat' pigmented lesion clinic, run jointly by dermatology and general surgery, on the diagnosis and treatment of melanoma at Auckland District Health Board (DHB). METHOD: All patients attending the newly established Pigmented Lesion Clinic (PLC) between 1 March 2019 and 31 August 2019 were included in the study. They were compared against a retrospective cohort of patients seen for suspected or biopsy-proven melanomas during the same corresponding period in 2016. RESULTS: 251 new patients attended the PLC, compared to 148 new patients seen at Auckland DHB in 2016. There was a significant reduction in proportion of pigmented lesions requiring biopsy (35.2% vs 64.3%, p<0.001), with a benign-to-malignant ratio of 2.4:1. Fifty-three melanomas were treated through the PLC, with a significant reduction in mean waiting time from referral to first specialist assessment (22.6 vs 35.1 days, p=0.038), and from referral to wide local excision (50.6 vs 99.1 days, p<0.001). 86.5% of patients received full skin check, from which additional skin malignancies were detected in 1-per-5.3 patients. CONCLUSION: The novel PLC model has led to reduction in unnecessary excisional biopsies of benign pigmented lesions, while streamlining and improving timely access to specialist review and surgical treatment for patients with melanomas.


Assuntos
Melanoma/diagnóstico , Melanoma/patologia , Nevo Pigmentado/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Dermatologia/métodos , Erros de Diagnóstico , Feminino , Humanos , Masculino , Melanoma/cirurgia , Pessoa de Meia-Idade , Modelos Estatísticos , Invasividade Neoplásica , Nova Zelândia , Valor Preditivo dos Testes , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Neoplasias Cutâneas/cirurgia , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-33572718

RESUMO

Reaching the recommendation on physical activity (PA) for health is highly important to effectively manage blood glucose in patients with type 2 diabetes (T2D). The aims of this study were to assess the level and pattern of PA among T2D outpatients and to relate PA levels to glucose control. A cross-sectional study was conducted in outpatient clinics in Hanoi, Vietnam. PA levels were reported using the Global Physical Activity Questionnaire (GPAQ) version 2.0. Participants meeting the WHO recommendations on PA for health or not were respectively categorized as "sufficiently active" and "insufficiently active". FPG < 7.2 mmol/L was defined as controlled plasma glucose. In total, 407 participants with T2D (55% women, mean (SD) age 61.6 (9.7) years) were included. The fraction of T2D outpatients reporting as insufficiently active was 21%. The lowest amount of energy expenditure was from transport activities (travel from and to places). On multivariate logistic regression, being sufficiently active was associated with a two-fold increased likelihood of having better glycemic control. The findings warrant action plans to increase physical activity in general and in specific active transport for T2D patients in Vietnam.


Assuntos
Glicemia , Diabetes Mellitus Tipo 2 , Instituições de Assistência Ambulatorial , Estudos Transversais , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Plasma , Fatores de Risco , Inquéritos e Questionários , Vietnã
12.
BMC Infect Dis ; 21(1): 178, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33588804

RESUMO

BACKGROUND: Tuberculosis (TB) control relies on early diagnosis and treatment. International guidelines recommend systematic TB screening at health facilities, but implementation is challenging. We investigated completion of recommended TB screening steps in Blantyre, Malawi. METHODS: A prospective cohort recruited adult outpatients attending Bangwe primary clinic. Entry interviews were linked to exit interviews. The proportion of participants progressing through each step of the diagnostic pathway were estimated. Factors associated with request for sputum were investigated using multivariable logistic regression. RESULTS: Of 5442 clinic attendances 2397 (44%) had exit interviews. In clinically indicated participants (n = 445) 256 (57.5%) were asked about cough, 36 (8.1%) were asked for sputum, 21 (4.7%) gave sputum and 1 (0.2%) received same-day results. Significant associations with request for sputum were: any TB symptom (aOR:3.20, 95%CI:2.02-5.06), increasing age (aOR:1.02, 95%CI:1.01-1.04 per year) and for HIV-negative participants only, a history of previous TB (aOR:3.37, 95%CI:1.45-7.81). Numbers requiring sputum tests (26/day) outnumbered diagnostic capacity (8-12/day). CONCLUSIONS: Patients were lost at every stage of the TB care cascade, with same day sputum submission following all steps of the diagnosis cascade achieved in only 4.7% if clinically indicated. Infection control strategies should be implemented, with reporting on early steps of the TB care cascade formalised. High-throughput screening interventions, such as digital CXR, that can achieve same-day TB diagnosis are urgently needed to meet WHO End TB goals.


Assuntos
Programas de Rastreamento/estatística & dados numéricos , Tuberculose/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Feminino , Humanos , Entrevistas como Assunto/estatística & dados numéricos , Modelos Logísticos , Malaui/epidemiologia , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Estudos Prospectivos , Escarro/microbiologia , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Adulto Jovem
13.
Epilepsy Behav ; 116: 107740, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33545652

RESUMO

OBJECTIVE: To assess feasibility, patient satisfaction, and financial advantages of telemedicine for epilepsy ambulatory care during the current COVID-19 pandemic. METHODS: The demographic and clinical characteristics of all consecutive patients evaluated via telemedicine at a level 4 epilepsy center between March 20 and April 20, 2020 were obtained retrospectively from electronic medical records. A telephone survey to assess patient satisfaction and preferences was conducted within one month following the initial visit. RESULTS: Among 223 telehealth patients, 85.7% used both synchronous audio and video technology. During the visits, 39% of patients had their anticonvulsants adjusted while 18.8% and 11.2% were referred to laboratory/diagnostic testing and specialty consults, respectively. In a post-visit survey, the highest degree of satisfaction with care was expressed by 76.9% of patients. The degree of satisfaction tended to increase the further a patient lived from the clinic (p = 0.05). Beyond the pandemic, 89% of patients reported a preference for continuing telemedicine if their epilepsy symptoms remained stable, while only 44.4% chose telemedicine should their symptoms worsen. Inclement weather and lack of transportation were factors favoring continued use of telemedicine. An estimated cost saving to patient attributed to telemedicine was $30.20 ±â€¯3.8 per visit. SIGNIFICANCE: Our findings suggest that epilepsy care via telemedicine provided high satisfaction and economic benefit, without compromising patients' quality of care, thereby supporting the use of virtual care during current and future epidemiological fallouts. Beyond the current pandemic, patients with stable seizure symptoms may prefer to use telemedicine for their epilepsy care.


Assuntos
Instituições de Assistência Ambulatorial , Assistência Ambulatorial/métodos , Epilepsia/epidemiologia , Epilepsia/terapia , Telemedicina/métodos , Adulto , Assistência Ambulatorial/tendências , Instituições de Assistência Ambulatorial/tendências , Registros Eletrônicos de Saúde/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Satisfação do Paciente , Encaminhamento e Consulta/tendências , Estudos Retrospectivos , Inquéritos e Questionários , Telemedicina/tendências
14.
BMC Infect Dis ; 21(1): 172, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33579200

RESUMO

BACKGROUND: Swingers are members of a heterosexual couple who, as a couple, have sex with others. They constitute a hidden subpopulation that is at risk for sexually transmitted infections (STIs). This study aimed to determine swingers' level of awareness about the STI risk (indicators: bisexual behaviour, number of sex partners, and STI status) of their swing sex partners (i.e. alters). METHODS: In this cross-sectional study, data were collected from a convenience sample of swingers who visited our STI clinic. The sample consisted of 70 participants (i.e. egos) and their 299 swing sex partners (i.e. alters) who had undergone an STI test at our clinic. We compared network data (i.e. information that egos provided about alters) and data stored in the electronic patient record (EPR) in our clinic (i.e. information provided by alters themselves). We assessed the agreement (correct estimation, overestimation and underestimation) between the network data and EPR data using chi-squared tests. RESULTS: Egos underestimated the bisexual behaviours of 37% of their male alters and overestimated the number of sex partners of 54 and 68% of their male and female alters, respectively. Egos correctly estimated the STI statuses of only 22% of the alters who had an STI during the past six months. CONCLUSIONS: The participating swingers underestimated the bisexual behaviours of their male swing sex partners, overestimated their number of sex partners, and underestimated their positive STI status. Underestimating their alters' STI statuses can cause swingers to underestimate their own STI risk and fail to implement preventive measures. The latter finding has implications for STI prevention. Therefore, more attention should be paid to swingers in general and the promotion of actual partner notification and STI testing among swingers in specific.


Assuntos
Assunção de Riscos , Comportamento Sexual , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto , Instituições de Assistência Ambulatorial , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sexualidade , Doenças Sexualmente Transmissíveis/prevenção & controle
15.
Medicine (Baltimore) ; 100(5): e23928, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592846

RESUMO

ABSTRACT: Care maps (CMs), which are innovative, comprehensive, educational, and simple medical tools, were developed for 6 common diseases, including heart failure, stroke, hyperglycemia, urinary tract infection, dengue infection, and upper gastrointestinal bleeding, were implemented in a short-stay ambulatory ward. This study aimed to investigate the effectiveness of and level of clinician satisfaction with CMs in an ambulatory care setting.A retrospective chart review study comparing the quality of care between before and after CM implementation was conducted. The medical records of patients who were admitted to a short-stay ambulatory ward in a tertiary referral center were reviewed. Demographic data, severity of disease, quality of care, length of stay (LOS), admission cost, and CM user satisfaction were collected and recorded.The medical records of 1116 patients were evaluated. Of those, 589 and 527 patients were from before (non-CM group) and after CM (CM group) implementation, respectively. There were no significant differences between groups for age, gender, or disease-specific severity the median (interquartile range) total and essential quality scores were significantly higher in the CM group than in the non-CM group [total quality score 85.3 (75.0-92.9) vs 61.1 (50.0-75.0); P < .001, and essential quality scores 90.0 (75.0-100.0) vs 60.0 (40.6-80.0); P < .0001, respectively]. All aspects of quality of care were significantly improved between before and after CM implementation. Overall median LOS was significantly decreased from 3.8 (2.5-5.7) to 3.0 (2.0-4.9) days, but there was no significant decrease for admission cost. However, CMs were able to significantly reduce both LOS and admission cost in the infectious disease-related subgroup. Most CM users reported satisfaction with CMs.CMs were shown to be an effective tool for improving the quality of care in patients with ambulatory infectious diseases. In that patient subgroup, LOS and admission cost were both significantly reduced compared to pre-CM implementation.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/organização & administração , Doenças Transmissíveis/terapia , Procedimentos Clínicos/normas , Qualidade da Assistência à Saúde/organização & administração , Idoso , Assistência Ambulatorial/normas , Instituições de Assistência Ambulatorial/normas , Feminino , Implementação de Plano de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos
16.
Toxins (Basel) ; 13(2)2021 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-33573065

RESUMO

Botulinum neurotoxin type A (BoNT/A) injections have to be administered repeatedly to achieve a rather stable, high level of improvement. This study aimed to take a look at changes in the daily routine of a BoNT/A outpatient clinic due to the SARS-CoV-2 pandemic lockdown, analyze the impact of SARS-CoV-2-induced re-injection delay on outcomes in patients with cervical dystonia (CD) (n = 36) and four other disease entities (n = 58), and study the influence of covariables, including previous injections and doses. For the present observational study, the first 100 patients who were scheduled to have an appointment between April 20 and May 18 during the partial lockdown and also had been treated regularly before the lockdown were recruited. Clinical and demographical characteristics and treatment-related data from the previous visits were extracted from charts. Time delay, symptom severity assessment, and TSUI score (if applicable) were gathered at the first coronavirus pandemic lockdown emergency visit for each patient. Of the 94 patients who could come to the clinic, 48 reported a delay and 44 reported worsening during the delay. Delays ranged from 1 to 63 days, the mean delay was 23 days, and the mean worsening was 26% compared to the previous visit. A significant correlation was found between the duration of the delay and the patient's rating of worsening (PwP). In CD patients, the physician´s rating of CD worsening by the TSUI score (ATUSI-PTSUI) was significantly correlated with general worsening (DwP) and the TSUI at the last visit (PTSUI). A small delay of a few weeks led to a similar worsening of symptoms in CD and all other disease entities and to relapse on a higher level of severity. This relapse can only be compensated by continuous treatment up to at least 1 year until patients reach the same level of treatment efficacy as that before the SARS-CoV-2 pandemic.


Assuntos
Instituições de Assistência Ambulatorial/tendências , Assistência à Saúde/tendências , Pandemias , Quarentena , Toxinas Botulínicas Tipo A/administração & dosagem , Toxinas Botulínicas Tipo A/uso terapêutico , Continuidade da Assistência ao Paciente/tendências , Alemanha , Humanos , Fármacos Neuromusculares/administração & dosagem , Fármacos Neuromusculares/uso terapêutico , Tempo para o Tratamento
17.
J Prim Care Community Health ; 12: 2150132721996278, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33615884

RESUMO

INTRODUCTION: Many of the potential barriers to providing telehealth services already disproportionately impact vulnerable populations. The purpose of this study was to assess the incorporation of synchronous ophthalmology telemedicine visits in a tertiary university-based ophthalmology clinic for low-income and uninsured patients in the COVID-19 era. METHODS: The records of 18 patients who were due for an in-person visit in the medically underserved patient clinic at our institute were reviewed. Patients considered high risk of ocular morbidity progression were approved to proceed with an in-person visit. Patients with non-urgent visit indications were attempted to be contacted by telephone to be offered a telemedicine telephone visit as an alternative to a postponed in-person office visit. RESULTS: Clinical triage by an attending ophthalmologist determined that 17 patients (94.4%, n = 18) had visit indications appropriate for evaluation by telemedicine. Six patients (35.3%, n = 17) were successfully contacted and offered a telemedicine visit as an alternative to a postponed in-person office visit. All 6 patients accepted, scheduled, and completed a telemedicine visit. Eleven patients (64.7%, n = 17) were not able to be successfully contacted to offer and schedule either a telemedicine visit or a postponed in-person office visit. Patients who were not able to be successfully contacted were on average younger in age and more likely to be female, Hispanic/Latino, from Latin America, with a preferred language of Spanish. CONCLUSIONS: Synchronous ophthalmology telemedicine visits can be successfully incorporated in a tertiary university-based setting for low-income and uninsured patients. The primary barrier to providing telemedicine visits in this population was the ability to successfully contact patients to offer and schedule these visits.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Área Carente de Assistência Médica , Oftalmologia , Telemedicina/organização & administração , Centros Médicos Acadêmicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ohio/epidemiologia , Estudos Retrospectivos , Centros de Atenção Terciária
18.
Rev Bras Enferm ; 74Suppl 1(Suppl 1): e20200571, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33533804

RESUMO

OBJECTIVE: to report the experience of a health team in restructuring service at a mastology outpatient clinic. METHODS: an experience report in a public university service mastology outpatient in Ceará between March and April 2020. Service in this outpatient clinic is exclusively for women and who have breast changes for surgical treatments ranging from nodulectomies to mastectomies with oncoplastic. RESULTS: increased COVID-19 cases brought the need to restructure healthcare services. The following steps were followed: identification of scheduled patients, reading of clinical developments in electronic medical records, individual assessment to define whether or not appointment would remain, telephone contact to inform about unscheduling. Among the 555 consultations scheduled for March and April 2020, 316 (56.9%) were maintained. FINAL CONSIDERATIONS: restructuring consultations at a mastology outpatient clinic optimized the waiting time for consultations and avoided crowds at service, providing patient safety.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/organização & administração , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , /terapia , Reestruturação Hospitalar/organização & administração , Serviços de Saúde da Mulher/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias
19.
JAMA Netw Open ; 4(2): e2035234, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33555331

RESUMO

Importance: Data from seroepidemiologic surveys measuring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure in diverse communities and ascertaining risk factors associated with infection are important to guide future prevention strategies. Objective: To assess the prevalence of previous SARS-CoV-2 infection across Virginia and the risk factors associated with infection after the first wave of coronavirus disease 2019 (COVID-19) infections in the US. Design, Setting, and Participants: In this statewide cross-sectional surveillance study, 4675 adult outpatients presenting for health care not associated with COVID-19 in Virginia between June 1 and August 14, 2020, were recruited to participate in a questionnaire and receive venipuncture to assess SARS-CoV-2 serology. Eligibility was stratified to meet age, race, and ethnicity quotas that matched regional demographic profiles. Main Outcomes and Measures: The main outcome was SARS-CoV-2 seropositivity, as measured by the Abbott SARS-CoV-2 immunoglobulin G assay. Results: Among 4675 adult outpatients (mean [SD] age, 48.8 [16.9] years; 3119 women [66.7%]; 3098 White [66.3%] and 4279 non-Hispanic [91.5%] individuals) presenting for non-COVID-19-associated health care across Virginia, the weighted seroprevalence was 2.4% (95% CI, 1.8%-3.1%) and ranged from 0% to 20% by zip code. Seroprevalence was notably higher among participants who were Hispanic (10.2%; 95% CI, 6.1%-14.3%), residing in the northern region (4.4%; 95% CI, 2.8%-6.1%), aged 40 to 49 years (4.4%; 95% CI, 1.8%-7.1%), and uninsured (5.9%; 95% CI, 1.5%-10.3%). Higher seroprevalence was associated with Hispanic ethnicity (adjusted odds ratio [aOR], 3.56; 95% CI, 1.76-7.21), residence in a multifamily unit (aOR, 2.55; 95% CI, 1.25-5.22), and contact with an individual with confirmed COVID-19 infection (aOR, 4.33; 95% CI, 1.77-10.58). The sensitivity of serology results was 94% (95% CI, 70%-100%) among those who reported receiving a previous polymerase chain reaction test for COVID-19 infection. Among 101 participants with seropositive results, 67 individuals (66.3%) were estimated to have asymptomatic infection. These data suggested a total estimated COVID-19 burden that was 2.8-fold higher than that ascertained by PCR-positive case counts. Conclusions and Relevance: This large statewide serologic study estimated that 2.4% of adults in Virginia had exposure to SARS-CoV-2, which was 2.8-fold higher than confirmed case counts. Hispanic ethnicity, residence in a multifamily unit, and contact with an individual with confirmed COVID-19 infection were significant risk factors associated with exposure. Most infections were asymptomatic. As of August 2020, the population in Virginia remained largely immunologically naive to the virus.


Assuntos
/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Prevalência , Fatores de Risco , Estudos Soroepidemiológicos , Virginia/epidemiologia , Adulto Jovem
20.
BMC Infect Dis ; 21(1): 203, 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33622262

RESUMO

BACKGROUND: Quality of life (QOL) is one of the major factors to assessing the health and wellbeing of People living with HIV (PLWH). Likewise, improved QOL is among the prominent goals of patient treatment. This study was conducted to investigate the QOL of PLWH in Kermanshah, Iran. METHODS: This cross-sectional study was conducted on 364 PLWH of Kermanshah between 2016 and 2017. Outpatients were selected as the sample through the convenience sampling method from HIV Positive Clients of Kermanshah Behavioral Diseases Counseling Center. The reasons for the selection of outpatients include: (a) some patients were substance users, homeless or did not have a fixed address to follow-up; (b) addresses and personal details that were registered on the first admission were incorrect or incomplete; (c) due to financial issues, some were forced to relocate frequently and were difficult to track; (d) some patients were convicts or prisoners, making it hard to find them after their release; (e) some of them were from other provinces, where managing access was not easy/possible. Data was collected using WHOQOL-HIV BREF questionnaire (Persian Version). Data also analyzed with STATA 14, and SPSS 23 using T-test and multiple regression. RESULTS: This study showed that mean (SD) age of PLWH was 40.21 (10.45) years. Females had better QOL than males except for spirituality, religion and personal beliefs. The gender differences disappeared in multivariate results. A significant association was observed between education and the independence, environment, and spirituality domains of QOL. In addition, being married was correlated with overall QOL, psychological and social relationships domains of QOL of PLWH. Drug use was a behavioral factor with negative influence on the QOL. CONCLUSION: This study found that marital status and drug use were the main predictors of various domains of QOL. Drug use was a behavioral factor with a negative influence on the QOL. Hence, it is recommended that health professionals, planners, and policymakers take effective measures to improve the status quo.


Assuntos
Infecções por HIV/psicologia , Qualidade de Vida/psicologia , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Psicometria
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