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1.
Plast Reconstr Surg ; 147(5): 1087-1095, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33835086

RESUMO

BACKGROUND: The coronavirus disease of 2019 (COVID-19) pandemic has widely affected rhinosurgery, given the high risk of contagion and the elective nature of the aesthetic procedure, generating many questions on how to ensure safety. The Science and Research Committee of the Rhinoplasty Society of Europe aimed at preparing consensus recommendations on safe rhinosurgery in general during the COVID-19 pandemic by appointing an international panel of experts also including delegates of The Rhinoplasty Society. METHODS: A Zoom meeting was performed with a panel of 14 international leading experts in rhinosurgery. During 3.5 hours, four categories of questions on preoperative safety measures in private practice and outpatient clinics, patient assessment before and during surgery, and legal issues were presented by four chairs and discussed by the expert group. Afterward, the panelists were requested to express an online, electronic vote on each category and question. The panel's recommendations were based on current evidence and expert opinions. The resulting report was circulated in an iterative open e-mail process until consensus was obtained. RESULTS: Consensus was obtained in several important points on how to safely restart performing rhinosurgery in general. Preliminary recommendations with different levels of agreement were prepared and condensed in a bundle of safety measures. CONCLUSION: The implementation of the panel's recommendations may improve safety of rhinoplasty by avoiding operating on nondetected COVID-19 patients and minimizing severe acute respiratory syndrome coronavirus 2 virus spread in outpatient clinics and operating rooms.


Assuntos
COVID-19/prevenção & controle , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Cuidados Pré-Operatórios/normas , Rinoplastia/normas , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/normas , Procedimentos Cirúrgicos Ambulatórios/normas , COVID-19/epidemiologia , COVID-19/transmissão , Congressos como Assunto , Consenso , Procedimentos Cirúrgicos Eletivos/normas , Humanos , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Cirurgiões , Comunicação por Videoconferência
2.
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 , COVID-19/prevenção & controle , Controle de Infecções/métodos , Diálise Renal/normas , Populações Vulneráveis/etnologia , Idoso , COVID-19/diagnóstico , COVID-19/etnologia , Teste de Ácido Nucleico para COVID-19 , Suscetibilidade a Doenças , Feminino , Georgia , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Telemedicina , População Urbana
3.
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
5.
Support Care Cancer ; 29(1): 499-507, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32405964

RESUMO

OBJECTIVE: To evaluate the implementation of a cervix cancer-specific patient-reported outcome measure, the European Organization for Research and Treatment of Cancer Quality of Life Cervical Cancer module (EORTC QLQ-CX24), into gynecologic oncology clinics. METHODS: This was a prospective, multi-institutional, cross-sectional study involving cervix cancer patients previously treated with curative intent radiotherapy who were attending routine follow-up appointments. Between January 2017 and August 2018, eligible patients were approached to complete the EORTC QLQ-CX24 prior to their clinical encounter and then review it with their oncologist. Patient and oncologist experience was evaluated using Feedback Questionnaires following the encounter. Descriptive statistics were used to summarize the results of the EORTC QLQ-CX24 and Feedback Questionnaires. Open-ended questions within the Feedback Questionnaires were analyzed to identify themes. RESULTS: Eighty-four patients consented to participate in the study. Of these, 80 (95.2%) completed the EORTC QLQ-CX24 and 76 (90.4%) completed both the EORTC QLQ-CX24 and the Feedback Questionnaires. There were high rates of completion for most items within the EORTC QLQ-CX24 (93-98%), except for items pertaining to vaginal symptoms and sexual health (34-35%). All eligible oncologists participated (n = 9). Overall, patients and oncologists positively endorsed use of the questionnaire during clinical encounters. The majority of patients (80%) and oncologists (89%) reported use of the questionnaire improved communication, including discussion of sensitive topics. Interestingly, only a minority of patients and oncologists stated a perceived preference for electronic completion (18% and 44%, respectively). CONCLUSION: Implementation of the EORTC QLQ-CX24 in gynecologic oncology clinics was feasible and acceptable according to patients and oncologists.


Assuntos
Instituições de Assistência Ambulatorial/normas , Medidas de Resultados Relatados pelo Paciente , Psicometria/métodos , Qualidade de Vida/psicologia , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Inquéritos e Questionários
6.
J Pediatr Orthop ; 41(1): e85-e89, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32852367

RESUMO

BACKGROUND: The purpose of this study was to determine the intraoperative and 30-day postoperative complication rates in a large consecutive cohort of pediatric patients who had orthopaedic surgery at a freestanding ambulatory surgery center (ASC). The authors also wanted to identify the rates of same-day, urgent hospital transfers, and 30-day hospital admissions. The authors hypothesized that pediatric orthopaedic procedures at a freestanding ASC can be done safely with a low rate of complications. METHODS: A retrospective review identified patients aged 17 years or younger who had surgery at a freestanding ASC over a 9-year period. Adverse outcomes were divided into intraoperative complications, postoperative complications, need for the secondary procedure, unexpected hospital admission on the same day of the procedure, and unexpected hospital admission within 30 days of the index procedure. Complications were graded as grade 1, the complication could be treated without additional surgery or hospitalization; grade 2, the complication resulted in an unplanned return to the operating room (OR) or hospital admission; or grade 3, the complication resulted in an unplanned return to the OR or hospitalization with a change in the overall treatment plan. RESULTS: Adequate follow-up was available for 3780 (86.1%) surgical procedures. Overall, there were 9 (0.24%) intraoperative complications, 2 (0.08%) urgent hospital transfers, 114 (3%) complications, and 16 (0.42%) readmissions. Seven of the 9 intraoperative complications resolved before leaving the OR, and 2 required return to the OR.Neither complications nor hospitalizations correlated with age, race, gender, or length or type of surgery. There was no correlation between the presence of medical comorbidities, body mass index, or American Society of Anesthesiologists score and complication or hospitalization. CONCLUSIONS: Pediatric orthopaedic surgical procedures can be performed safely in an ASC because of multiple factors that include dedicated surgical teams, single-purpose ORs, and strict preoperative screening criteria. The rates of an emergency hospital transfer, surgical complications, and 30-day readmission, even by stringent criteria, are lower than those reported for outpatient procedures performed in the hospital setting. LEVEL OF EVIDENCE: Level IV-case series.


Assuntos
Instituições de Assistência Ambulatorial , Procedimentos Cirúrgicos Ambulatórios , Procedimentos Ortopédicos , Complicações Pós-Operatórias , Adolescente , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/normas , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/métodos , Procedimentos Cirúrgicos Ambulatórios/normas , Estudos de Coortes , Feminino , Humanos , Masculino , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/normas , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia
7.
Medicine (Baltimore) ; 99(52): e23763, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350760

RESUMO

ABSTRACT: Emergency departments receive an increasing amount of musculoskeletal injuries, with the majority referred to a fracture clinic (FCs). A literature review revealed certain orthopaedic injuries can be safely managed away from the FC pathway by general practitioners (GPs) or allied health professionals (AHPs). The present study aims to review all paediatric presentations to FCs at 2 Queensland hospitals, identifying low risk injuries that could potentially be managed by GPs or AHPs. This study is a continuation from Cleary et al in which a primary care pathway (PCP) was proposed for the management of low risk adult orthopaedic injuries. A PCP has the potential to have significant savings to the health system.A retrospective study was conducted looking at paediatric patients (<16 years) referrals to 2 FCs over 8 weeks. Injuries were categorised into those requiring FC care supervised by an orthopaedic surgeon, and those that can be safely managed by GPs or AHPs via a PCP.Four hundred ninety (57.7%) of the 849 patients referred to FC were assessed as suitable for PCP care. The most common upper limb injury deemed suitable was radius and ulna buckle fractures (18.4%), while the most common lower limb injury is ankle sprains (8%). Total failure to attend rate in the PCP group was 6.7%.Adopting the PCP has the potential to significantly reduce FC referrals. With proven success of similar pathways abroad, the PCP may generate significant time and financial savings for both the health care system and patient.


Assuntos
Instituições de Assistência Ambulatorial/normas , Serviço Hospitalar de Emergência/normas , Fraturas Ósseas/terapia , Atenção Primária à Saúde , Criança , Serviços de Saúde da Criança/normas , Humanos , Melhoria de Qualidade , Queensland , Encaminhamento e Consulta , Estudos Retrospectivos
8.
Medicine (Baltimore) ; 99(52): e23942, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350799

RESUMO

ABSTRACT: The levels of indoor air pollutants are increasing. However, the indoor air quality of only operating rooms, intensive care units, and radiology departments is usually monitored in hospitals. Hence, we aimed to evaluate the indoor air quality of an otorhinolaryngology outpatient clinic and compare air quality indices among different areas in a hospital.We prospectively measured indoor air quality using air quality sensors in different areas of a hospital from February 1, 2019 to January 31, 2020. Carbon dioxide (CO2), total volatile organic compounds (VOCs), particulate matter with diameter of <2.5 µm (PM2.5), and nitrogen dioxide concentrations were measured in the otorhinolaryngology clinic, orthopedic clinic, and reception area. The intervention efficacy was compared between otorhinolaryngology clinics employing and not employing air-cleaners.The overall concentrations of CO2, VOCs, and PM2.5 in the otorhinolaryngology clinic were significantly higher than those in the orthopedic clinic or reception area. The indoor air quality was the worst in winter. The intervention effect was observed only in PM2.5 concentrations in otorhinolaryngology clinics employing an air-cleaner.Medical practitioners and patients are frequently exposed to ambient indoor air pollution in otorhinolaryngology clinics. Hence, health-related strategies to protect against ambient indoor air pollution in otorhinolaryngology clinics are warranted.


Assuntos
Poluição do Ar em Ambientes Fechados/análise , Poluição do Ar/análise , Instituições de Assistência Ambulatorial , Dióxido de Carbono/análise , Hospitais , Dióxido de Nitrogênio/análise , Otolaringologia , Compostos Orgânicos Voláteis/análise , Poluentes Atmosféricos , Instituições de Assistência Ambulatorial/normas , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Monitoramento Ambiental/métodos , Hospitais/normas , Hospitais/estatística & dados numéricos , Humanos , Determinação de Necessidades de Cuidados de Saúde , Estações do Ano
10.
J Crohns Colitis ; 14(Supplement_3): S785-S790, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-32959882

RESUMO

Infusion centres are a central part in the management of patients with inflammatory bowel disease [IBD] and could be a source of transmission of SARS-COV-2. Here we aimed to develop global guidance for best practices of infusion centres for IBD patients and to determine the impact of the COVID-19 pandemic on these centres. Under the auspices of the International Organization for the Study of Inflammatory Bowel Disease [IOIBD], a task force [TF] was formed, an online survey was developed to query infusion centre protocols during COVID-19, and recommendations were made, based on TF experience and opinion. Recommendations focus mainly on patients screening, infusion centres re-organization, personnel protection, and protocol modifications such as shortening infusion duration or replacing it with subcutaneous alternatives. Implementing these recommendations will hopefully reduce exposure of both IBD patients and care givers to SARS-COV-2 and improve the function and safety of infusion centres during the COVID-19 pandemic as well as potential future threats.


Assuntos
Instituições de Assistência Ambulatorial/normas , Assistência Ambulatorial/normas , Anti-Inflamatórios/administração & dosagem , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/normas , Doenças Inflamatórias Intestinais/tratamento farmacológico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto , Comitês Consultivos , Assistência Ambulatorial/métodos , Anti-Inflamatórios/uso terapêutico , Protocolos Clínicos , Infecções por Coronavirus/complicações , Esquema de Medicação , Fármacos Gastrointestinais/administração & dosagem , Fármacos Gastrointestinais/uso terapêutico , Saúde Global , Pesquisas sobre Serviços de Saúde , Humanos , Controle de Infecções/métodos , Doenças Inflamatórias Intestinais/complicações , Infusões Intravenosas , Quimioterapia de Manutenção/métodos , Quimioterapia de Manutenção/normas , Pneumonia Viral/complicações
11.
Medicina (B Aires) ; 80 Suppl 4: 1-26, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32897867

RESUMO

Treating an anticoagulated patient with vitamin K antagonists (VKA) remains a challenge, especially in areas where dicoumarins are still the first drug of choice due to the cost of other oral anticoagulants. Anticoagulation clinics have proven to be the most efficient and safe way to avoid thrombotic and hemorrhagic complications and to keep patients in optimal treatment range. However, they require adequate infrastructure and trained personnel to work properly. In this Argentine consensus we propose a series of guidelines for the effective management of the anticoagulation clinics. The goal is to achieve the excellence in both the clinical healthcare and the hemostasis laboratory for the anticoagulated patient. The criteria developed in the document were agreed upon by a large group of expert specialists in hematology and biochemistry from all over the country. The criteria presented here must always be considered when indicating VKA although they had to be adapted to the unequal reality of each center. Taking these premises into consideration will allow us to optimize the management of the anticoagulated patient with VKA and thus minimize thrombotic and hemorrhagic intercurrences, in order to honor our promise not to harm the patient.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Anticoagulantes/uso terapêutico , Fibrinolíticos/uso terapêutico , Guias de Prática Clínica como Assunto , Vitamina K/antagonistas & inibidores , Administração Oral , Instituições de Assistência Ambulatorial/normas , Consenso , Humanos , Coeficiente Internacional Normatizado
12.
J Am Acad Dermatol ; 83(5): 1538-1539, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32682892
13.
PLoS One ; 15(6): e0234651, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32544174

RESUMO

BACKGROUND: Imipenem, an intravenous antibiotic is recommended for use in drug resistant tuberculosis (DR-TB) when an effective regimen with combination of other second line drugs is not possible. Though the treatment success rates with carbapenems are promising, the twice daily injection of Imipenem usually requires patients to be hospitalized. The Médecins Sans Frontières independent clinic in Mumbai, India implemented ambulatory and home based management of patients receiving Imipenem through the use of port-a-cath. OBJECTIVE: We aimed to describe the adverse events and treatment outcomes of ambulatory pre- and XDR-TB patients initiated on imipenem through port-a-cath between January 2015 and June 2018 and to explore the challenges with this regimen as perceived by healthcare providers and patients. METHODS: A convergent mixed methods study with quantitative (longitudinal descriptive study using the routine data) and qualitative (descriptive study) part conducted concurrently. For the quantitative component, all XDR-TB and pre-XDR-TB initiated on imipenem containing regimen during January 2015-June 2018 were included. For qualitative component, interviews were carried out including patients who initiated on imipenem (n = 5) and healthcare providers (n = 7) involved in providing treatment. Treatment outcomes, culture conversion and adverse events during treatment were described. Thematic analysis was carried out for qualitative component. RESULTS: Of the 70 patients included, the mean age was 28.1 (standard deviation: 11.2) years and 36 (51.4%) were females. Fifty one (72.9%) had XDR-TB. All patients were resistant to fluoroquinilone, levofloxacin. Vomiting was reported by 55 (78.6%) patients and at least one episode of QTC prolongation (more than 500 msec by Fredrecia method) was detected in 25 (35.7%). Port-a-cath block and infection was seen in 11 (15.7%) and 20 (28.6%) patients respectively. Favourable outcomes were seen in 43 (61.4%) patients. Mortality was seen in 22 (31.4%) patients, 2 (2.9%) were lost-to-follow-up and 3 (4.3%) were declared as treatment failure. The overarching theme of the qualitative analysis was: Challenges in delivering Imipenem via port-a-cath device in ambulatory care. Major challenges identified were difficulties in adhering to drug dose timelines, vomiting, restricted mobility due to port-a-cath, paucity of infection control and space constraints at patients' home for optimal care. CONCLUSION: Administration of imipenem was feasible through port-a-cath. Though outcomes with ambulatory based imipenem containing regimens were promising, there were several challenges in providing care. The feasibility of infusion at day care facilities needs to explored to overcome challenges in infusion at patients home.


Assuntos
Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico , Imipenem/administração & dosagem , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adolescente , Adulto , Instituições de Assistência Ambulatorial/normas , Antituberculosos/efeitos adversos , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Tuberculose Extensivamente Resistente a Medicamentos/complicações , Feminino , Serviços de Assistência Domiciliar/normas , Humanos , Imipenem/efeitos adversos , Imipenem/normas , Índia , Controle de Infecções/normas , Masculino , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/complicações , Dispositivos de Acesso Vascular , Vômito/induzido quimicamente
15.
Sociol Health Illn ; 42(5): 972-986, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32406081

RESUMO

With significant relevance to the Covid-19 pandemic, this paper contributes to emerging 'aerographic' research on the socio-materialities of air and breath, based on an in-depth empirical study of three hospital-based lung infection clinics treating people with cystic fibrosis. We begin by outlining the changing place of atmosphere in hospital design from the pre-antibiotic period and into the present. We then turn to the first of three aerographic themes where air becomes a matter of grasping and visualising otherwise invisible airborne infections. This includes imagining patients located within bodily spheres or 'cloud bodies', conceptually anchored in Irigaray's thoughts on the 'forgetting of the air' and Sloterdijk's immunitary 'spherology' of the body. Our second theme explores the material politics of air, air conditioning, window design and the way competing 'air regimes' come into conflict with each other at the interface of buildings, bodies and the biotic. Our final theme attends to the 'cost of air', the aero-economic problem of atmospheric scarcity within modern high-rise, deep-density healthcare architectures.


Assuntos
Ar , Instituições de Assistência Ambulatorial/organização & administração , Fibrose Cística/epidemiologia , Respiração , Infecções Respiratórias/epidemiologia , Microbiologia do Ar , Instituições de Assistência Ambulatorial/normas , Antibacterianos/uso terapêutico , Arquitetura de Instituições de Saúde , Comportamentos Relacionados com a Saúde , Humanos , Infecções Respiratórias/tratamento farmacológico
16.
BMC Health Serv Res ; 20(1): 404, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393224

RESUMO

BACKGROUND: While HIV Testing Services (HTS) have increased, many South Africans have not been tested. Non-communicable diseases (NCDs) are the top cause of death worldwide. Integrated NCD-HTS could be a strategy to control both epidemics. Healthcare service strategies depends partially on positive user experience. We investigated client satisfaction of services and clinic flow time of an integrated NCD-HTS clinic. METHODS: This prospective, cross-sectional study evaluated HTS client satisfaction with an HTS clinic at two phases. Phase 1 (February-June 2018) utilised standard HTS services: counsellor-led height/weight/blood pressure measurements, HIV rapid testing, and symptoms screening for sexually transmitted infections/Tuberculosis. Phase 2 (June 2018-March 2019) further integrated counsellor-led obesity screening (body mass index/abdominal circumference measurements), rapid cholesterol/glucose testing; and nurse-led Chlamydia and human papilloma virus (HPV)/cervical cancer screening. Socio-demographics, proportion of repeat clients, clinic flow time, and client survey data (open/closed-ended questions using five-point Likert scale) are reported. Fisher's exact test, chi-square analysis, and Kruskal Wallis test conducted comparisons. Multiple linear regression determined predictors associated with clinic time. Content thematic analysis was conducted for free response data. RESULTS: Two hundred eighty-four and three hundred thirty-three participants were from Phase 1 and 2, respectively (N = 617). Phase 1 participants were significantly older (median age 36.5 (28.0-43.0) years vs. 31.0 (25.0-40.0) years; p = 0.0003), divorced/widowed (6.7%, [n = 19/282] vs. 2.4%, [n = 8/332]; p = 0.0091); had tertiary education (27.9%, [n = 79/283] vs. 20.1%, [n = 67/333]; p = 0.0234); and less female (53.9%, [n = 153/284] vs 67.6%, [n = 225/333]; p = 0.0005), compared to Phase 2. Phase 2 had 10.2% repeat clients (n = 34/333), and 97.9% (n = 320/327) were 'very satisfied' with integrated NCD-HTS, despite standard HTS having significantly shorter median time for counsellor-led HTS (36.5, interquartile range [IQR]: 31.0-45.0 vs. 41.5, IQR: 35.0-51.0; p < 0.0001). Phase 2 associations with longer clinic time were clients living together/married (est = 6.548; p = 0.0467), more tests conducted (est = 3.922; p < 0.0001), higher overall satisfaction score (est = 1.210; p = 0.0201). Those who matriculated experienced less clinic time (est = - 7.250; p = 0.0253). CONCLUSIONS: It is possible to integrate counsellor-led NCD rapid testing into standard HTS within historical HTS timeframes, yielding client satisfaction. Rapid cholesterol/glucose testing should be integrated into standard HTS. Research is required on the impact of cervical cancer/HPV screenings to HTS clinic flow to determine if it could be scaled up within the public sector.


Assuntos
Instituições de Assistência Ambulatorial/normas , Infecções por HIV/diagnóstico , Satisfação do Paciente/estatística & dados numéricos , Adolescente , Adulto , Aconselhamento , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Doenças não Transmissíveis , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Prospectivos , Setor Público , África do Sul , Adulto Jovem
17.
Int J Gynaecol Obstet ; 149(3): 377-378, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32267531

RESUMO

From February 24, 2020, a COVID-19 obstetric task force was structured to deliver management recommendations for obstetric care. From March 1, 2020, six COVID-19 hubs and their spokes were designated. An interim analysis of cases occurring in or transferred to these hubs was performed on March 20, 2020 and recommendations were released on March 24, 2020. The vision of this strict organization was to centralize patients in high-risk maternity centers in order to concentrate human resources and personal protective equipment (PPE), dedicate protected areas of these major hospitals, and centralize clinical multidisciplinary experience with this disease. All maternity hospitals were informed to provide a protected labor and delivery room for nontransferable patients in advanced labor. A pre-triage based on temperature and 14 other items was developed in order to screen suspected patients in all hospitals to be tested with nasopharyngeal swabs. Obstetric outpatient facilities were instructed to maintain scheduled pregnancy screening as per Italian guidelines, and to provide pre-triage screening and surgical masks for personnel and patients for pre-triage-negative patients. Forty-two cases were recorded in the first 20 days of hub and spoke organization. The clinical presentation was interstitial pneumonia in 20 women. Of these, seven required respiratory support and eventually recovered. Two premature labors occurred.


Assuntos
Instituições de Assistência Ambulatorial/normas , Infecções por Coronavirus , Alocação de Recursos para a Atenção à Saúde , Maternidades/normas , Obstetrícia/normas , Pandemias , Assistência ao Paciente/normas , Pneumonia Viral , Instituições de Assistência Ambulatorial/organização & administração , Feminino , Alocação de Recursos para a Atenção à Saúde/organização & administração , Alocação de Recursos para a Atenção à Saúde/normas , Maternidades/organização & administração , Hospitais Especializados/organização & administração , Hospitais Especializados/normas , Humanos , Itália , Equipamento de Proteção Individual/provisão & distribuição , Gravidez
18.
Knee Surg Sports Traumatol Arthrosc ; 28(6): 1699-1704, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32342140

RESUMO

PURPOSE: The aim of this manuscript is to review the available strategies in the international literature to efficiently and safely return to both normal orthopaedic surgical activities and to normal outpatient clinical activities in the aftermath of a large epidemic or pandemic. This information would be beneficial to adequately reorganize outpatient clinics and hospitals to provide the highest possible level of orthopaedic care to our patients in a safe and efficient manner. METHODS: A literature search was performed for relevant research articles. In addition, the World Health Organisation (WHO), the US Centers for Disease Control (CDC), American Association of Orthopaedic Surgeons (AAOS), the EU CDC and other government health agency websites were searched for any relevant information. In particular, interest was paid to strategies and advise on managing the orthopaedic patient flow during outpatient clinics as well as surgical procedures including the necessary safety measures, while still providing a high-quality patient experience. The obtained information is provided as a narrative review. RESULTS: There was not any specific literature concerning the organization of an outpatient clinic and surgical activities and the particular challenges in dealing with a high-volume practice, in the afterwave of a pandemic. CONCLUSION: As the COVID-19 crisis has abruptly halted most of the orthopaedic activities both in the outpatient clinic and the operating room, a progressive start-up scenario needs to be planned. The exact timing largely depends on factors outside of our control. After restrictions will be lifted, clinical and surgical volume will progressively increase. This paper offers key points and possible strategies to provide the highest level of safety to both the orthopaedic patient and the orthopaedic team including administrative staff and nurses, during the start-up phase. LEVEL OF EVIDENCE: Review, Level V.


Assuntos
Instituições de Assistência Ambulatorial/normas , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Procedimentos Ortopédicos/normas , Ortopedia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Instituições de Assistência Ambulatorial/organização & administração , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Eficiência Organizacional , Humanos , Controle de Infecções/normas , Ortopedia/organização & administração , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , Segurança
20.
BMC Health Serv Res ; 20(1): 297, 2020 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-32290836

RESUMO

BACKGROUND: Evaluation of renal replacement therapy with haemodialysis is essential for its improvement. Remarkably, outcomes vary across centres. In addition, the methods used have important epistemological limitations, such as ignoring significant features (e.g., quality of life) or no relevance given to the patient's perspective in the indicator's selection. The present study aimed to determine the opinions and preferences of stakeholders (patients, clinicians, and managers) and establish their relative importance, considering the complexity of their interactions, to facilitate a comprehensive evaluation of haemodialysis centres. METHODS: Successive working groups (WGs) were established using a multicriteria methodology. WG1 created a draft of criteria and sub-criteria, WG2 agreed, using a qualitative structured analysis with pre-established criteria, and WG3 was composed of three face-to-face subgroups (WG3-A, WG3-B, and WG3-C) that weighted them using two methodologies: weighted sum (WS) and analytic hierarchy process (AHP). Subsequently, they determined a preference for the WS or AHP results. Finally, via the Internet, WG4 weighted the criteria and sub-criteria by the method preferred by WG3, and WG5 analysed the results. RESULTS: WG1 and WG2 identified and agreed on the following evaluation criteria: evidence-based variables (EBVs), annual morbidity, annual mortality, patient-reported outcome measures (PROMs), and patient-reported experience measures (PREMs). The EBVs consisted of five sub-criteria: type of vascular access, dialysis dose, haemoglobin concentration, ratio of catheter bacteraemia, and bone mineral disease. The patients rated the PROMs with greater weight than the other stakeholders in both face-to-face WG3 (WS and AHP) and WG4 via the Internet. The type of vascular access was the most valued sub-criterion. A performance matrix of each criterion and sub-criterion is presented as a reference for assessing the results based on the preferences of the stakeholders. CONCLUSIONS: The use of a multicriteria methodology allows the relative importance of the indicators to be determined, reflecting the values of the different stakeholders. In a performance matrix, the inclusion of values and intangible aspects in the evaluation could help in making clinical and organizational decisions.


Assuntos
Instituições de Assistência Ambulatorial/normas , Atitude do Pessoal de Saúde , Garantia da Qualidade dos Cuidados de Saúde/métodos , Diálise Renal , Participação dos Interessados , Consenso , Tomada de Decisões , Humanos , Qualidade de Vida , Valores Sociais
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