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1.
Cancer Rep (Hoboken) ; 4(1): e1309, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33439546

RESUMO

BACKGROUND: The COVID-19 pandemic has created a need to prioritize care because of limitation of resources. Owing to the heterogeneity and high prevalence of breast cancers, the need to prioritize care in this vulnerable population is essential. While various medical societies have published recommendations to manage breast disease during the COVID-19 pandemic, most are focused on the Western world and do not necessarily address the challenges of a resource-limited setting. AIM: In this article, we describe our institutional approach for prioritizing care for patients presenting with breast disease. METHODS AND RESULTS: The breast disease management guidelines were developed and approved with the expertise of the Multidisciplinary Breast Program Leadership Committee (BPLC) of the Aga Khan University, Karachi, Pakistan. These guidelines were inspired, adapted, and modified keeping in view the needs of our resource-limited healthcare system. These recommendations are also congruent with the ethical guidelines developed by the Center of Biomedical Ethics and Culture (CBEC) at the Sindh Institute of Urology and Transplantation (SIUT), Karachi. Our institutional recommendations outline a framework to triage patients based on the urgency of care, scheduling conflicts, and tumor board recommendations, optimizing healthcare workers' schedules, operating room reallocation, and protocols. We also describe the "Virtual Blended Clinics", a resource-friendly means of conducting virtual clinics and a comprehensive plan for transitioning back into the post-COVID routine. CONCLUSION: Our institutional experience may be considered as a guide during the COVID-19 pandemic, particularly for triaging care in a resource-limited setting; however, these are not meant to be universally applicable, and individual cases must be tailored based on physicians' clinical judgment to provide the best quality care.


Assuntos
Doenças Mamárias/terapia , Comunicação Interdisciplinar , Médicos/normas , Guias de Prática Clínica como Assunto/normas , Triagem/estatística & dados numéricos , Doenças Mamárias/virologia , /virologia , Países em Desenvolvimento , Feminino , Humanos , Centros de Atenção Terciária
2.
N Z Med J ; 134(1528): 46-56, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33444306

RESUMO

AIM: To investigate the knowledge and practice of health professionals when advising persons on driving restrictions after a transient ischaemic attack (TIA) or stroke in a tertiary hospital in New Zealand. METHODS: Health professionals working in the area of stroke care across the acute and rehabilitation services in a large tertiary hospital were invited to complete an electronic survey around knowledge of driving restrictions based on the New Zealand Transport Agency (NZTA) guidelines. Knowledge was assessed for both private and commercial vehicle use. The other information gathered included participant profession, level of seniority and experience working in stroke care, previous education around medical-related driving restrictions and how and what driving recommendations were discussed with patients. Knowledge of driving restrictions was established by the number and percentage of correct responses for each condition (single TIA, multiple TIA and stroke with full recovery) relating to the recommended restrictions in both private and commercial vehicle use. RESULTS: Forty-nine participants' surveys were analysed with representation from across all the health professions (24.5% [12/49] doctors, 38.8% [19/49] nurses and 36.7% [18/49] allied health). Only 38.8% reported having had received training around post-stroke driving restrictions. Knowledge around driving restrictions was highest for a single episode TIA for private vehicle use (73.5% [36/49]). For all other categories, fewer than 50% of participants answered correctly, with knowledge of commercial vehicle restrictions being the least accurate. CONCLUSIONS: Many health professionals have discussions with people about driving restrictions following a TIA or stroke. However, there appears to be limited knowledge of all the restrictions for each condition as they relate to either private or commercial vehicle use. Insufficient training and education for clinicians might explain this gap.


Assuntos
Atenção/fisiologia , Condução de Veículo , Conhecimentos, Atitudes e Prática em Saúde , Médicos/normas , Acidente Vascular Cerebral/psicologia , Feminino , Humanos , Masculino , Nova Zelândia , Inquéritos e Questionários
3.
J Occup Environ Med ; 63(3): 199-220, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33350662

RESUMO

OBJECTIVE: Higher probability of developing severe COVID-19 has been associated with health risk factors and medical conditions which are common among workers globally. For at risk workers, return to work may require additional protective policies and procedures. METHODS: A review of the medical literature was conducted on health risk factors and medical conditions associated with increased COVID-19 morbidity and mortality, standardized measures for community COVID transmission, and occupation-specific risk. RESULTS: The relative risk of acquiring and the severity of COVID-19 for workers is associated with three pillars: individual risk, workplace risk, and community risk. Matrices were developed to determine a worker's individual risk based on these three pillars. CONCLUSIONS: A practical decision tool is proposed for physicians evaluating and managing individual worker COVID-19 risk in the context of returning to work.


Assuntos
/epidemiologia , Controle de Doenças Transmissíveis/normas , Médicos/normas , Retorno ao Trabalho , /prevenção & controle , Controle de Doenças Transmissíveis/métodos , Guias como Assunto , Humanos , Saúde do Trabalhador , Literatura de Revisão como Assunto , Medição de Risco , Fatores de Risco , Local de Trabalho/normas
5.
J Med Internet Res ; 22(12): e23955, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-33346735

RESUMO

BACKGROUND: The use of mobile devices in hospital care constantly increases. However, smartphones and tablets have not yet widely become official working equipment in medical care. Meanwhile, the parallel use of private and official devices in hospitals is common. Medical staff use smartphones and tablets in a growing number of ways. This mixture of devices and how they can be used is a challenge to persons in charge of defining strategies and rules for the usage of mobile devices in hospital care. OBJECTIVE: Therefore, we aimed to examine the status quo of physicians' mobile device usage and concrete requirements and their future expectations of how mobile devices can be used. METHODS: We performed a web-based survey among physicians in 8 German university hospitals from June to October 2019. The online survey was forwarded by hospital management personnel to physicians from all departments involved in patient care at the local sites. RESULTS: A total of 303 physicians from almost all medical fields and work experience levels completed the web-based survey. The majority regarded a tablet (211/303, 69.6%) and a smartphone (177/303, 58.4%) as the ideal devices for their operational area. In practice, physicians are still predominantly using desktop computers during their worktime (mean percentage of worktime spent on a desktop computer: 56.8%; smartphone: 12.8%; tablet: 3.6%). Today, physicians use mobile devices for basic tasks such as oral (171/303, 56.4%) and written (118/303, 38.9%) communication and to look up dosages, diagnoses, and guidelines (194/303, 64.0%). Respondents are also willing to use mobile devices for more advanced applications such as an early warning system (224/303, 73.9%) and mobile electronic health records (211/303, 69.6%). We found a significant association between the technical affinity and the preference of device in medical care (χs2=53.84, P<.001) showing that with increasing self-reported technical affinity, the preference for smartphones and tablets increases compared to desktop computers. CONCLUSIONS: Physicians in German university hospitals have a high technical affinity and positive attitude toward the widespread implementation of mobile devices in clinical care. They are willing to use official mobile devices in clinical practice for basic and advanced mobile health uses. Thus, the reason for the low usage is not a lack of willingness of the potential users. Challenges that hinder the wider adoption of mobile devices might be regulatory, financial and organizational issues, and missing interoperability standards of clinical information systems, but also a shortage of areas of application in which workflows are adapted for (small) mobile devices.


Assuntos
Computadores de Mão/normas , Internet/normas , Aplicativos Móveis/estatística & dados numéricos , Médicos/normas , Alemanha , Hospitais Universitários , Humanos , Inquéritos e Questionários
6.
Intern Med J ; 50(12): 1578-1583, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33354885

RESUMO

The COVID-19 pandemic has led to many physicians working from home whenever possible. Although the concept of 'remote' patient care has been around for decades, present circumstances have provided a grand impetus in that direction with a view to protecting both patient and caregiver. In this article, we discuss some of the various challenges to moving forward with telemedicine, drawing in part on our own experiences in dealing with the COVID-19 pandemic. Clinical, technical, financial and cultural barriers to telemedicine are identified, along with a discussion concerning anticipated benefits. We conclude that the COVID-19 pandemic will likely forever change how healthcare is conducted as telemedicine figures increasingly prominently in the clinical landscape.


Assuntos
/epidemiologia , Médicos/tendências , Telemedicina/métodos , Telemedicina/tendências , Humanos , Médicos/normas , Smartphone/normas , Smartphone/tendências , Telemedicina/normas , Dispositivos Eletrônicos Vestíveis/normas , Dispositivos Eletrônicos Vestíveis/tendências
8.
PLoS One ; 15(8): e0237632, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817679

RESUMO

BACKGROUND: Licensure and registration are the traditional approaches to ensure minimally acceptable standards of care for practice. However, due to advances in medical technology and changes in clinical practice, the knowledge and skills obtained from basic education and training may rapidly become out of date. There is no mandated, structured and ongoing mechanism to assess all doctors' competence in Hong Kong. This paper assessed doctors' perceived needs for continuous professional development, and to identify facilitators and barriers that are likely to influence the implementation of compulsory continuous professional development for maintaining professional competence and ensuring patient safety. METHODS: An explanatory sequential mixed method design with two distinct interactive phases was adopted comprising a postal self-administered questionnaire survey among a random sample of 2,459 of doctors (Phase 1), followed by individual interviews of a stratified sample of 30 questionnaire respondents for the subsequent qualitative analysis (Phase 2). RESULTS: The majority of doctors (over 90%) agreed the importance of continuous professional development to update knowledge and skills. However, just 30.7% of non-specialists compared with 65.4% of specialists agreed it would be desirable for continuous professional development to be a requirement for renewal of licenses. A relatively higher percentage of non-specialists compared with specialists reported barriers to participation such as accessibility, availability and relevance of the content of the programmes. Facilitators for uptake included more convenient schedule and location, relevant content, and incentives for participation such as making this a pre-condition for enrolling in government-funded services. CONCLUSIONS: To address the needs of individual doctors, the spheres of practice, personal preferences and learning styles should be considered in deciding the content and processes of continuous professional development. Flexibility is also an important principle. A learning model, incentives for participation and a compliance strategy (instead of deterrence) could be effective strategy for continuous professional development.


Assuntos
Educação Médica Continuada/normas , Conhecimentos, Atitudes e Prática em Saúde , Determinação de Necessidades de Cuidados de Saúde/normas , Médicos/normas , Competência Profissional/normas , Especialização/normas , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Inquéritos e Questionários , Adulto Jovem
9.
PLoS One ; 15(8): e0235826, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760142

RESUMO

BACKGROUND: Thrombophilia-screen tests are specialised haemostasis tests that are affected by numerous unique patient variables including the presence of acute thrombosis, the concomitant use of medication and patient demographics. Complete information on the request form is therefore crucial for the haematological pathologist to make patient-specific interpretation of patients' results. OBJECTIVES: To assess the completeness of thrombophilia-screen test request forms and determine the impact of provision of incomplete information, on the interpretive comments generated by reporting haematological pathologists. To assess the impact of an educational session given to clinicians on the importance of providing all the relevant information on the request forms. METHOD: Two retrospective audits, each covering 3 months, were performed to evaluate the completeness of demographic and clinical information on thrombophilia-screen request forms and its impact on the quality of the interpretive comments before and after an educational intervention. RESULTS: One hundred and seventy-one request forms were included in the first audit and 146 in the second audit. The first audit revealed that all 171 thrombophilia-screen request forms had complete patient demographic information but none had clinical information. Haematological pathologists only made generic comments which could not be applied to a specific patient. The second audit, conducted after a physician educational session, did not reveal any improvement in the clinical information provision by the test-ordering physicians. This was reportedly due to the lack of space on the request form. The interpretive comments therefore remained generic and not patient-specific. CONCLUSION: Physicians' failure to provide relevant clinical information made it impossible for pathologists to make patient-specific interpretation of the results. A single physician education session did not change the practice, reportedly due to the inappropriate design of the test request form. Further studies are required to investigate the impact of an improved request form and the planned electronic test requesting.


Assuntos
Educação Médica Continuada , Programas de Rastreamento/normas , Registros Médicos/normas , Médicos/normas , Trombofilia/diagnóstico , Controle de Formulários e Registros/estatística & dados numéricos , Humanos , Programas de Rastreamento/estatística & dados numéricos , Auditoria Médica/estatística & dados numéricos , Registros Médicos/estatística & dados numéricos , Médicos/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , África do Sul
11.
BMC Infect Dis ; 20(1): 515, 2020 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-32677903

RESUMO

BACKGROUND: Procalcitonin is an inflammatory biomarker that is sensitive for bacterial infections and a promising clinical decision aid in antimicrobial stewardship programs. However, there are few studies of physicians' experiences concerning the use of PCT. The objective of this study was to investigate whether hospital physicians' experience with procalcitonin after 18 months of use can inform the PCT implementation in antimicrobial stewardship programs. MATERIALS/METHODS: We deployed a qualitative approach using semi-structured interviews with 14 hospital physicians who had experience with procalcitonin in clinical practice. Interviews were audio-taped, transcribed verbatim and analysed using thematic analysis. RESULTS: Physicians reported a knowledge gap, which made them uncertain about the appropriate procalcitonin use, interpretation, and trustworthiness. Simultaneously, the physicians experienced procalcitonin as a useful clinical decision aid but emphasised that their clinical evaluation of the patient was the most important factor when deciding on antibiotic treatment. CONCLUSIONS: Procalcitonin was regarded a helpful clinical tool, but the physicians called for more knowledge about its appropriate uses. Active implementation of unambiguous procalcitonin algorithms and physician education may enhance the utility of the test as an antimicrobial stewardship adjunct.


Assuntos
Gestão de Antimicrobianos , Infecções Bacterianas/diagnóstico , Biomarcadores/sangue , Hospitais/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Pró-Calcitonina/sangue , Adulto , Idoso , Algoritmos , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Gestão de Antimicrobianos/normas , Infecções Bacterianas/sangue , Infecções Bacterianas/tratamento farmacológico , Bioensaio/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Médicos/normas , Médicos/estatística & dados numéricos , Padrões de Prática Médica/normas , Pró-Calcitonina/análise , Pesquisa Qualitativa , Inquéritos e Questionários
12.
Pain Physician ; 23(4): E335-E342, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709179

RESUMO

BACKGROUND: More patients with cardiac implantable electrical devices (CIEDs) are presenting to spine and pain practices for radiofrequency ablation (RFA) procedures for chronic pain. Although the potential for electromagnetic interference (EMI) affecting CIED function is known with RFA procedures, available guidelines do not specifically address CIED management for percutaneous RFA for zygapophyseal (z-joint) joint pain, and thus physician practice may vary. OBJECTIVES: To better understand current practices of physicians who perform RFA for chronic z-joint pain with respect to management of CIEDs. Perioperative CIED management guidelines are also reviewed to specifically address risk mitigation strategies for potential EMI created by ambulatory percutaneous spine RFA procedures. STUDY DESIGN: Web-based provider survey and narrative review. SETTING: Multispecialty pain clinic, academic medical center. METHODS: A web-based survey was created using Research Electronic Data Capture (REDCap). A survey link was provided via e-mail to active members of the Spine Intervention Society (SIS), American Society of Regional Anesthesia and Pain Medicine, as well as distributed freely to community Pain Physicians and any receptive academic departments of PM&R or Anesthesiology. The narrative review summarizes pertinent case series, review articles, a SIS recommendation statement, and multi-specialty peri-operative guidelines as they relate specifically to spine RFA procedures. RESULTS: A total of 197 clinicians participated in the survey from diverse clinical backgrounds, including anesthesiology, physical medicine and rehabilitation, radiology, neurosurgery, and neurology, with 81% reporting fellowship training. Survey responses indicate wide variability in provider management of CIEDs before, during, and after RFA for z-joint pain. Respondents indicated they would like more specific guidelines to aid in management and decision-making around CIEDs and spine RFA procedures. Literature review yielded several practice guidelines related to perioperative management of CIEDs, but no specific guideline for percutaneous spine RFA procedures. However, combining the risk mitigation strategies provided in these guidelines, with interventional pain physician clinical experience allows for reasonable management recommendations to aid in decision-making. LIMITATIONS: Although this manuscript can serve as a review of CIEDs and aid in management decisions in patients with CIEDs, it is not a clinical practice guideline. CONCLUSIONS: Practice patterns vary regarding CIED management in ambulatory spine RFA procedures. CIED presence is not a contraindication for spine RFA but does increase the complexity of a spine RFA procedure and necessitates some added precautions. KEY WORDS: Radiofrequency ablation, neurotomy, cardiac implantable electrical device, zygapophyseal joint, spondylosis, neck pain, low back pain, chronic pain.


Assuntos
Dor nas Costas/cirurgia , Ablação por Cateter/normas , Desfibriladores Implantáveis/normas , Médicos/normas , Guias de Prática Clínica como Assunto/normas , Inquéritos e Questionários , Anestesia por Condução/métodos , Anestesia por Condução/normas , Anestesiologia/métodos , Anestesiologia/normas , Ablação por Cateter/métodos , Dor Crônica/cirurgia , Humanos , Articulação Zigapofisária/cirurgia
13.
J Nutr Health Aging ; 24(6): 634-641, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32510117

RESUMO

OBJECTIVES: Frailty in older people associates with poor outcomes. Screening by ED physicians would greatly facilitate detection of frail older patients but our previous attempt to introduce routine ED-physician screening with Short Emergency Geriatric Assessment (SEGA), a 13-item frailty tool that French geriatricians use to identify frail patients, failed due to its length and complexity. A national committee recently generated a new version of the fast and simple 5-item Triage Risk Screening Tool (TRST) in which a subjective item ('nurse concern') was replaced by an item assessing basic activities of daily living. The ability of ED physicians using this French-TRST to accurately detect frail patients who require comprehensive geriatric assessment was assessed. DESIGN: Prospective cross-sectional study on diagnostic accuracy relative to the gold standard, namely, geriatrician-administered SEGA. SETTING: Tertiary-care hospital, France. SUBJECTS AND MEASUREMENTS: The participants were 498 ≥75-year-old patients who visited the ED in 2018-2019 and were administered French-TRSTs by first ED physicians and then geriatricians, followed by SEGA, all within 24 hours. Diagnostic accuracy variables were calculated. Geriatrician-TRST was used to identify TRST items that associated with ED physician misclassification of frail patients. RESULTS: Emergency-TRST was significantly less sensitive than Geriatrician-TRST (88% vs. 93%; p=0.04) and tended to have lower negative predictive value (66% vs. 77%; p=0.09). Emergency-TRSTs rated four French-TRST items less well than Geriatrician-TRSTs. CONCLUSIONS: As a substitute for SEGA in the ED, the French-TRST performed quite well overall but the ED physicians detected frail patients less well than the geriatricians. Modifications of the French-TRST that may improve the diagnostic performance of ED physicians are discussed.


Assuntos
Serviço Hospitalar de Emergência/normas , Idoso Fragilizado/estatística & dados numéricos , Avaliação Geriátrica/métodos , Médicos/normas , Medição de Risco/métodos , Triagem/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento , Autonomia Profissional , Estudos Prospectivos , Encaminhamento e Consulta
14.
Eur Geriatr Med ; 11(4): 645-650, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32557250

RESUMO

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


Assuntos
Infecções por Coronavirus/terapia , Assistência à Saúde/normas , Instituição de Longa Permanência para Idosos/organização & administração , Casas de Saúde/organização & administração , Médicos/normas , Pneumonia Viral/terapia , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Infecções por Coronavirus/epidemiologia , Técnica Delfos , Europa (Continente) , Feminino , Avaliação Geriátrica/métodos , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pandemias , Equipe de Assistência ao Paciente/normas , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/normas , Análise de Sobrevida
16.
PM R ; 12(9): 926-932, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32424977

RESUMO

INTRODUCTION: The global pandemic due to SARS-CoV-2 has resulted in an expansion of telemedicine. Measures of quality and barriers for rapid use by patients and physicians are not well described. OBJECTIVE: To describe results from a quality improvement initiative during a rapid adoptive phase of telemedicine during the pandemic. DESIGN: Patient and physician satisfaction with synchronous audiovisual telemedicine visits was measured during the early adoptive phase (6 April 2020-17 April 2020) within the division of sports medicine in an academic Physical Medicine and Rehabilitation (PM&R) department. Patients were invited to participate in a quality improvement initiative by completing an online survey at the end of a telemedicine visit. Physicians completed a separate survey. PRIMARY OUTCOME MEASURES: Patient measures included visit type, duration of encounter, quality, and satisfaction. Physicians reported on experiences performed telemedicine. RESULTS: Surveys were completed by 119 patients (293 telemedicine encounters, response rate 40.6%) and 14 physiatrists. Telemedicine was utilized primarily for follow-up visits (n = 74, 70.6%), and the most common duration was 15 to 29 minutes. Patients rated their telemedicine visit as "excellent" or "very good" across measures (91.6%-95.0%) including addressing concerns, communication, developing a treatment plan, convenience, and satisfaction. Value of completing a future telemedicine visit was measured at 84.9%. Most reported estimated travel time saved was in excess of 30 minutes. Rate of no-show was 2.7%. Most physicians (57.1%) had no prior experience with telemedicine visits, and most were comfortable performing these visits after completing 1 to 4 sessions (71%). Nearly all physicians (92.9%) rated their telemedicine experience as very good or excellent. The key barrier identified for telemedicine was technical issues. All physicians reported plans to perform telemedicine visits if reimbursement continues. CONCLUSIONS: In summary, rapid expansion of telemedicine during the COVID-19 pandemic was well-received by a majority of patients and physicians. This suggests feasibility in rapid expansion of telemedicine for other outpatient sports medicine practices.


Assuntos
Betacoronavirus , Infecções por Coronavirus/reabilitação , Pandemias , Satisfação do Paciente/estatística & dados numéricos , Medicina Física e Reabilitação/métodos , Médicos/normas , Pneumonia Viral/reabilitação , Telemedicina/métodos , Adolescente , Adulto , Idoso , Criança , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Pneumonia Viral/epidemiologia , Adulto Jovem
18.
Can J Anaesth ; 67(10): 1417-1423, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32394338

RESUMO

Symptom management and end-of-life care are core skills for all physicians, although in ordinary times many anesthesiologists have fewer occasions to use these skills. The current coronavirus disease (COVID-19) pandemic has caused significant mortality over a short time and has necessitated an increase in provision of both critical care and palliative care. For anesthesiologists deployed to units caring for patients with COVID-19, this narrative review provides guidance on conducting goals of care discussions, withdrawing life-sustaining measures, and managing distressing symptoms.


Assuntos
Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Pneumonia Viral/terapia , Assistência Terminal/organização & administração , Anestesiologistas/organização & administração , Anestesiologistas/normas , Competência Clínica , Infecções por Coronavirus/mortalidade , Cuidados Críticos/normas , Humanos , Cuidados Paliativos/organização & administração , Pandemias , Médicos/organização & administração , Médicos/normas , Pneumonia Viral/mortalidade , Assistência Terminal/normas , Suspensão de Tratamento
19.
Asian J Psychiatr ; 51: 102085, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32413616

RESUMO

The emergence of mental health (MH) problems during a pandemic is extremely common, though difficult to address due to the complexities of pandemics and the scarcity of evidence about the epidemiology of pandemic-related MH problems and the potential interventions to tackle them. Little attention has been devoted so far to this topic from policymakers, stakeholders and researchers, resulting in a lack of replicable, scalable and applicable frameworks to help plan, develop and deliver MH care during pandemics. As a response, we have attempted to develop a conceptual framework (CF) that could guide the development, implementation, and evaluation of MH interventions during the ongoing COVID-19 pandemic. This CF was developed by early career psychiatrists from 16 countries that cover all the WHO regions. Their opinions were elicited via a semi-structured questionnaire. They were asked to provide their views about the current MH situation in their countries and to elaborate on existing 'myths' and misinformation. They were also asked to name the resources available and to propose solutions and approaches to provide accessible and affordable care. The CF was prepared based on the extant literature and the views discussed in this group; it illustrates the epidemiology of MH problems, preparedness plans, stage-specific plans or innovative solutions, opportunities to integrate those plans and possible outcomes at policy level. This CF can serve as a technical guide for future research regarding pandemics. It can be used to monitor trends and to optimize efforts, and to develop evidence based MH interventions. Still, further research focusing on the individual components of this framework is needed.


Assuntos
Infecções por Coronavirus , Acesso aos Serviços de Saúde , Transtornos Mentais/terapia , Serviços de Saúde Mental , Pandemias , Médicos , Pneumonia Viral , Guias de Prática Clínica como Assunto , Psiquiatria , Adulto , Feminino , Acesso aos Serviços de Saúde/normas , Humanos , Masculino , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/normas , Médicos/normas , Psiquiatria/métodos , Psiquiatria/organização & administração , Psiquiatria/normas , Organização Mundial da Saúde
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