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2.
Metas enferm ; 23(9): 62-68, nov. 2020. graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-195353

RESUMO

La pandemia por COVID-19 ha mostrado la capacidad de adaptación del sistema sanitario español, poniendo en marcha medidas excepcionales e innovadoras como la creación de hoteles medicalizados. El objetivo a alcanzar consistía en liberar camas de hospital y garantizar el aislamiento de personas que o bien no disponían en sus domicilios de infraestructura para poder realizarlo tras el alta hospitalaria, o bien porque compartían hogar con personas vulnerables o frágiles, evitando de esta forma el contagio de los convivientes. El objetivo del presente trabajo es presentar la experiencia de haber medicalizado un hotel en la ciudad de Madrid vinculado al Hospital Universitario Gregorio Marañón (HGUGM) durante la primera ola pandémica de la COVID-19, desde el 19 de marzo hasta el 31 de mayo de 2020. Se aborda la puesta en marcha, contemplando los recursos materiales y humanos que se necesitaron, la organización, el desarrollo de la actividad y la humanización; así como los resultados de la experiencia. Fueron atendidos un total de 465 pacientes, con una estancia media de 10 días. La progresión de la ocupación se correspondió con la curva de contagios (pico máximo primera semana de abril: 146 pacientes). El personal de Enfermería realizó una media de 10 PCR por día, con un total de 817 pruebas. La participación en el estudio de seroprevalencia (Servicio de Microbiología del HGUGM) fue superior al 89% del personal de Enfermería, con un resultado de tres PCR positivas. En el contexto de la pandemia COVID-19, las enfermeras de la Comunidad de Madrid han demostrado estar capacitadas para habilitar espacios y lugares de atención a los pacientes en márgenes de tiempo de 48 h. Se formaron equipos multidisciplinares que funcionaron de forma eficiente, resolutiva y sin ningún conflicto


The COVID-19 pandemic has shown the adaptation ability of the Spanish Health System, through the implementation of exceptional and innovative measures such as the creation of medicalized hotels. The objective to be reached was the release of hospital beds, and ensuring isolation for people who had no infrastructure at home to be isolated after hospital discharge, or shared their home with vulnerable or fragile persons, thus preventing contagion among those living together. The objective of the present article is to present the experience of medicalizing a hotel in the city of Madrid, linked to the Hospital Universitario Gregorio Marañón (HGUGM), during the first wave of the COVID-19 pandemic, from March, 19th to May, 31st, 2020. Its implementation is addressed, considering the material and human resources required, its organization, the development of the activity and humanization, as well as the outcomes of the experience. In total, 465 patients were managed, with a mean 10-day stay. The occupation progression corresponded with the contagion curve (maximum peak during the first week of April: 146 patients). The Nursing staff performed a mean 10 PCR tests per day, with 817 tests in total. There was a >89% participation in the Seroprevalence Study (Microbiology Unit of the HGUGM) by the Nursing staff, with three positive PCR tests as outcome. In the context of the COVID-19 pandemic, the Community of Madrid nurses have demonstrated being qualified to provide spaces and places for patient care within a 48-hour margin. Multidisciplinary teams were formed, which worked in an efficient and operative way and without any conflicts


Assuntos
Humanos , Saneamento de Hotéis , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Betacoronavirus , Pandemias/prevenção & controle , Sistemas de Saúde/organização & administração , Isolamento de Pacientes/organização & administração , Recursos Humanos de Enfermagem/organização & administração , Humanização da Assistência , Espanha , Registros Eletrônicos de Saúde , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/normas
3.
J Transl Med ; 18(1): 390, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33059719

RESUMO

While the COVID-19 pandemic has spurred intense research and collaborative discovery worldwide, the development of a safe, effective, and targeted antiviral from the ground up is time intensive. Therefore, most antiviral discovery efforts are focused on the re-purposing of clinical stage or approved drugs. While emerging data on drugs undergoing COVID-19 repurpose are intriguing, there is an undeniable need to develop broad-spectrum antivirals to prevent future viral pandemics of unknown origin. The ideal drug to curtail rapid viral spread would be a broad-acting agent with activity against a wide range of viruses. Such a drug would work by modulating host-proteins that are often shared by multiple virus families thereby enabling preemptive drug development and therefore rapid deployment at the onset of an outbreak. Targeting host-pathways and cellular proteins that are hijacked by viruses can potentially offer broad-spectrum targets for the development of future antiviral drugs. Such host-directed antivirals are also likely to offer a higher barrier to the development and selection of drug resistant mutations. Given that most approved antivirals do not target host-proteins, we reinforce the need for the development of such antivirals that can be used in pre- and post-exposure populations.


Assuntos
Antivirais , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Descoberta de Drogas , Necessidades e Demandas de Serviços de Saúde , Interações Hospedeiro-Patógeno/efeitos dos fármacos , Pneumonia Viral/tratamento farmacológico , Anti-Inflamatórios/farmacologia , Anti-Inflamatórios/uso terapêutico , Antivirais/classificação , Antivirais/farmacologia , Antivirais/uso terapêutico , Betacoronavirus/genética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Sistemas de Liberação de Medicamentos/métodos , Sistemas de Liberação de Medicamentos/normas , Descoberta de Drogas/organização & administração , Descoberta de Drogas/normas , Descoberta de Drogas/tendências , Saúde Global , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Mutagênese/efeitos dos fármacos , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Determinação de Necessidades de Cuidados de Saúde/normas , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Internalização do Vírus/efeitos dos fármacos
4.
Phlebology ; 35(8): 550-555, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32639862

RESUMO

The coronavirus disease 2019 (COVID-19) global pandemic has resulted in diversion of healthcare resources to the management of patients infected with SARS-CoV-2 virus. Elective interventions and surgical procedures in most countries have been postponed and operating room resources have been diverted to manage the pandemic. The Venous and Lymphatic Triage and Acuity Scale was developed to provide an international standard to rationalise and harmonise the management of patients with venous and lymphatic disorders or vascular anomalies. Triage urgency was determined based on clinical assessment of urgency with which a patient would require medical treatment or surgical intervention. Clinical conditions were classified into six categories of: (1) venous thromboembolism (VTE), (2) chronic venous disease, (3) vascular anomalies, (4) venous trauma, (5) venous compression and (6) lymphatic disease. Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included (1) medical emergencies (requiring immediate attendance), example massive pulmonary embolism; (2) urgent (to be seen as soon as possible), example deep vein thrombosis; (3) semi-urgent (to be attended to within 30-90 days), example highly symptomatic chronic venous disease, and (4) discretionary/non-urgent- (to be seen within 6-12 months), example chronic lymphoedema. Venous and Lymphatic Triage and Acuity Scale aims to standardise the triage of patients with venous and lymphatic disease or vascular anomalies by providing an international consensus-based classification of clinical categories and triage urgency. The scale may be used during pandemics such as the current COVID-19 crisis but may also be used as a general framework to classify urgency of the listed conditions.


Assuntos
Infecções por Coronavirus/terapia , Sistemas de Apoio a Decisões Clínicas/normas , Técnicas de Apoio para a Decisão , Serviço Hospitalar de Emergência/normas , Doenças Linfáticas/terapia , Pneumonia Viral/terapia , Triagem/normas , Doenças Vasculares/terapia , Tomada de Decisão Clínica , Consenso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Necessidades e Demandas de Serviços de Saúde/normas , Humanos , Doenças Linfáticas/diagnóstico , Doenças Linfáticas/epidemiologia , Pandemias , Seleção de Pacientes , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Doenças Vasculares/diagnóstico , Doenças Vasculares/epidemiologia
5.
Nat Med ; 26(7): 1005-1008, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32528155
6.
Diabetes Metab Syndr ; 14(5): 797-799, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32534432

RESUMO

BACKGROUND AND AIMS: With restrictions on face to face clinical consultations in the COVID-19 pandemic, Telemedicine has become an essential tool in providing continuity of care to patients. We explore the common pitfalls in remote consultations and strategies that can be adopted to avoid them. METHODS: We have done a comprehensive review of the literature using suitable keywords on the search engines of PubMed, SCOPUS, Google Scholar and Research Gate in the first week of May 2020 including 'COVID-19', 'telemedicine' and 'remote consultations'. RESULTS: Telemedicine has become an integral part to support patient's clinical care in the current COVID-19 pandemic now and will be in the future for both primary and secondary care. Common pitfalls can be identified and steps can be taken to prevent them. CONCLUSION: Telemedicine it is going to play a key role in future of health medicine, however, telemedicine technology should be applied in appropriate settings and situations. Suitable training, enhanced documentations, communication and observing information governance guidelines will go a long way in avoiding pitfalls associated with remote consultations.


Assuntos
Infecções por Coronavirus/epidemiologia , Necessidades e Demandas de Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Pneumonia Viral/epidemiologia , Encaminhamento e Consulta/organização & administração , Telemedicina/organização & administração , Betacoronavirus/fisiologia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/normas , Humanos , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Quarentena/organização & administração , Quarentena/normas , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/tendências , Telemedicina/métodos , Telemedicina/normas , Telemedicina/tendências
8.
Braz Oral Res ; 34: e047, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32401828

RESUMO

The emergence of severe acute respiratory coronavirus 2 (SARS-CoV-2) and its association with severe pneumonia and deaths has exposed gaps in the health systems of several countries worldwide. Although the necessary focus has been to care for hospitalized patients, the strengthening of Primary Health Care (PHC) actions is necessary. PHC is the gateway to the health system in several countries, including Brazil and it plays a role in preventing, protecting, promoting, and treating individuals and communities. Brazil, like other countries, has faced the SARS-CoV-2 pandemic. As Brazil has a universal and decentralized health system, in which PHC has been the model of health re-organizing the health system; here we reflected the importance of strengthening PHC in Brazil in the times of coronavirus disease 2019 pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Necessidades e Demandas de Serviços de Saúde/normas , Programas Nacionais de Saúde/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Atenção Primária à Saúde/normas , Brasil , Necessidades e Demandas de Serviços de Saúde/organização & administração , Hospitalização/estatística & dados numéricos , Humanos , Programas Nacionais de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração
9.
Anesth Analg ; 131(2): 403-409, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32459667
12.
Arch Med Res ; 51(1): 95-101, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32113785

RESUMO

OBJECTIVE: Describe and analyze the mental health service and medical needs of a group of transgender men from the point when they changed their gender identity to male. MATERIAL AND METHOD: Transgender men volunteers who attended a specialized care center in Mexico City answered a qualitative semi-structured interview to explore their needs as well as the adversities they unnecessarily face due to the lack of information and care for their condition. Interviews were audio-recorded and transcribed for thematic analysis. RESULTS: Respondents began to develop their transgender identity in childhood; however, during that time, almost none of them had any helpful contact with a health professional. Those who did receive some form of care received mistreatment rather than positive feedback. It was not until adulthood that they obtained facts about a specialized care center. CONCLUSION: It is necessary for health professionals to have information about sexual diversity and be trained to meet the needs of transgender children, in order to have information on places and professionals who accompany them and advise on available treatments such as hormone blockers or treatments. The study includes a small but important sample. However, the currently hostile, discriminatory environment, significantly exposes transgender people to developing mental health problems.


Assuntos
Identidade de Gênero , Necessidades e Demandas de Serviços de Saúde , Desenvolvimento da Personalidade , Procedimentos de Readequação Sexual , Pessoas Transgênero , Adulto , Atitude do Pessoal de Saúde , Criança , Estudos de Avaliação como Assunto , Feminino , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/normas , Hospitais Especializados , Humanos , Identificação Psicológica , Entrevistas como Assunto , Masculino , México/epidemiologia , Pesquisa Qualitativa , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Procedimentos de Readequação Sexual/métodos , Procedimentos de Readequação Sexual/psicologia , Procedimentos de Readequação Sexual/normas , Procedimentos de Readequação Sexual/estatística & dados numéricos , Inquéritos e Questionários , Pessoas Transgênero/psicologia , Pessoas Transgênero/estatística & dados numéricos , Adulto Jovem
13.
Support Care Cancer ; 28(11): 5299-5306, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32112352

RESUMO

AIMS: Adjuvant chemotherapy is recommended for patients with curatively resected colorectal cancer. The aim of this study is to evaluate the impact of unmet supportive care needs and anxiety on the initiation of postoperative adjuvant chemotherapy in colorectal cancer patients. METHODS: This is a retrospective study from a single tertiary referral hospital. Patients diagnosed with colorectal cancer who met the inclusion criteria were included. The Hospital Anxiety and Depression Scale (HADS) and modified 34-item Supportive Care Needs Survey (SCNS-SF34) were applied to assess patient's anxiety level and unmet needs. The time intervals between initiation of adjuvant chemotherapy and operation were recorded. Factors associated with delayed initiation of chemotherapy were investigated in univariate and multivariate analysis. RESULTS: A total of 135 patients with colorectal cancer were included. In total, 16.3% (22/135) and 5.2% (7/135) reported symptoms of anxiety and depression. In multivariate analysis, low to moderate income status, postoperative complications, anxiety, and high level of unmet needs are independent risk factors for late initiation of chemotherapy. CONCLUSIONS: Our findings showed that psychological problems such as anxiety and high unmet supportive needs are correlated with delayed initiation of adjuvant chemotherapy in colorectal cancer patients.


Assuntos
Ansiedade/epidemiologia , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/epidemiologia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Idoso , Ansiedade/complicações , Quimioterapia Adjuvante , Neoplasias Colorretais/patologia , Neoplasias Colorretais/psicologia , Depressão/complicações , Depressão/epidemiologia , Feminino , Necessidades e Demandas de Serviços de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Prevalência , Estudos Retrospectivos , Inquéritos e Questionários
14.
Support Care Cancer ; 28(11): 5419-5427, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32146546

RESUMO

PURPOSE: International and national studies have shown unmet information needs regarding nutrition in breast cancer patients. An intervention study has examined the question of the extent to which a fact sheet on the topic of nutrition is suitable to cover the need for information of breast cancer patients. METHOD: The fact sheet with basic information on nutrition was distributed in 21 intervention breast care centres in 2017. The use of the fact sheets was evaluated in a quasi-experimental design as part of the annual breast cancer patients' survey of the University of Cologne. The breast cancer patients considered were being treated with primary breast carcinoma in a hospital in North Rhine-Westphalia. A multilevel analysis was carried out in order to quantify the effect of the intervention. RESULTS: Unmet information needs are experienced more by younger and non-native German-speaking patients. With regard to education, patients without a graduation and a high grade of education express more unmet information needs. The multilevel analysis showed that patients who were treated at an intervention site and therefore possibly received the fact sheet have a significantly higher chance of their information needs being met (OR = 1.45; p ≤ 0.05). CONCLUSION: The intervention study showed that a fact sheet with basic information on nutrition is a possible instrument to satisfy the information needs of breast cancer patients and therefore reduce unmet information needs regarding nutrition. This intervention study is a pragmatic example on how to reduce unmet information needs among breast cancer patients in Germany.


Assuntos
Neoplasias da Mama/terapia , Dieta , Necessidades e Demandas de Serviços de Saúde , Folhetos , Educação de Pacientes como Assunto , Acesso à Informação , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/dietoterapia , Neoplasias da Mama/epidemiologia , Feminino , Alemanha/epidemiologia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitais , Humanos , Pessoa de Meia-Idade , Estado Nutricional , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/organização & administração , Educação de Pacientes como Assunto/normas , Avaliação de Programas e Projetos de Saúde , Recomendações Nutricionais , Inquéritos e Questionários , Adulto Jovem
15.
Ann Emerg Med ; 75(6): 691-703, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32200999

RESUMO

STUDY OBJECTIVE: Brief, easily administered, and valid health literacy assessment tools are needed to optimize health care delivery in the emergency medicine setting. Three health literacy screening items have been proposed to assess health literacy in outpatient settings. We investigated their ability to identify English- and Spanish-speaking adult emergency department (ED) patients with lower health literacy. METHODS: Participants were Spanish- or English-speaking adult patients randomly selected from 4 geographically spread, US, urban, safety-net EDs. Participants completed the 3 health literacy screening items, as well as the Short Assessment of Health Literacy-Spanish and English (SAHL-S&E). Test performance characteristics, including receiver operating characteristics area under the curve, of the 3 health literacy screening items were estimated, as compared with the SAHL-S&E. RESULTS: According to the SAHL-S&E, 36% of the 1,165 English speakers and 35% of the 1,605 Spanish speakers had lower health literacy. Areas under the curve for each health literacy screening item individually were: needing others to help read materials (English 0.59, 95% confidence interval [CI] 0.56 to 0.62; Spanish 0.58, 95% CI 0.56 to 0.61), problems learning because of difficulty reading (English 0.63, 95% CI 0.60 to 0.66; Spanish 0.59, 95% CI 0.56 to 0.62), and confidence with completing forms (English 0.62, 95% CI 0.59 to 0.65; Spanish 0.60, 95% CI 0.57 to 0.63). Areas under the curve for the 3 screening items combined were: English 0.66 (95% CI 0.63 to 0.70) and Spanish 0.62 (95% CI 0.59 to 0.64). CONCLUSION: The 3 health literacy screening items performed poorly in identifying adult ED patients with lower health literacy. Higher-validity screening measures are needed to better serve the health care needs of this vulnerable population in the ED setting.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Letramento em Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Programas de Rastreamento/normas , Desempenho Acadêmico , Adulto , Assistência à Saúde/organização & administração , Serviço Hospitalar de Emergência/tendências , Feminino , Letramento em Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hispano-Americanos/educação , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Inquéritos e Questionários , Estados Unidos/epidemiologia , Estados Unidos/etnologia
16.
PLoS One ; 15(2): e0229235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32069318

RESUMO

Life Cycle Assessment typically focuses on the footprint of products and services, expressed on three Areas of Protection (AoP): Human Health, Ecosystems and Resources. While the handprint is often expressed qualitatively, quantified handprints have recently been compared directly to the footprint concerning one AoP: Human Health. We propose to take this one step further by simultaneously comparing the quantified handprint and footprint on all AoPs through normalization and weighting of the results towards a single score. We discuss two example cases of a pharmaceutical treatment: mebendazole to treat soil-transmitted helminthiases and paliperidone palmitate to treat schizophrenia. Each time, treatment is compared to 'no treatment'. The footprint of health care is compared to the handprint of improved patient health. The handprint and footprint were normalized separately. To include sensitivity in the normalization step we applied four sets of external normalization factors for both handprint (Global Burden of Disease) and footprint (ReCiPe and PROSUITE). At the weighting step we applied 26 sets of panel weighting factors from three sources. We propose the Relative Sustainability Benefit Rate (RSBR) as a new metric to quantify the relative difference in combined handprint and footprint single score between two alternatives. When only considering the footprint, the first case study is associated with an increased single score burden of treatment compared to 'no treatment', while in the second case study treatment reduces the single score burden by 41.1% compared to 'no treatment'. Also including the handprint provided new insights for the first case study, now showing a decrease of 56.4% in single score burden for treatment compared to 'no treatment'. For the second case study the reduction of single score burden was confirmed as the handprint burden was also decreased because of treatment by 9.9%, reinforcing the findings.


Assuntos
Assistência à Saúde/normas , Setor de Assistência à Saúde/normas , Necessidades e Demandas de Serviços de Saúde/normas , Helmintíase/tratamento farmacológico , Modelos Estatísticos , Preparações Farmacêuticas/administração & dosagem , Esquizofrenia/tratamento farmacológico , Nível de Saúde , Helmintíase/epidemiologia , Humanos , Esquizofrenia/epidemiologia
20.
Pediatrics ; 145(1)2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31888959

RESUMO

CONTEXT: Integrated care models may improve health care for children and young people (CYP) with ongoing conditions. OBJECTIVE: To assess the effects of integrated care on child health, health service use, health care quality, school absenteeism, and costs for CYP with ongoing conditions. DATA SOURCES: Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library databases (1996-2018). STUDY SELECTION: Inclusion criteria consisted of (1) randomized controlled trials, (2) evaluating an integrated care intervention, (3) for CYP (0-18 years) with an ongoing health condition, and (4) including at least 1 health-related outcome. DATA EXTRACTION: Descriptive data were synthesized. Data for quality of life (QoL) and emergency department (ED) visits allowed meta-analyses to explore the effects of integrated care compared to usual care. RESULTS: Twenty-three trials were identified, describing 18 interventions. Compared with usual care, integrated care reported greater cost savings (3/4 studies). Meta-analyses found that integrated care improved QoL over usual care (standard mean difference = 0.24; 95% confidence interval = 0.03-0.44; P = .02), but no significant difference was found between groups for ED visits (odds ratio = 0.88; 95% confidence interval = 0.57-1.37; P = .57). LIMITATIONS: Included studies had variable quality of intervention, trial design, and reporting. Randomized controlled trials only were included, but valuable data from other study designs may exist. CONCLUSIONS: Integrated care for CYP with ongoing conditions may deliver improved QoL and cost savings. The effects of integrated care on outcomes including ED visits is unclear.


Assuntos
Serviços de Saúde do Adolescente , Serviços de Saúde da Criança , Prestação Integrada de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde , Qualidade da Assistência à Saúde , Absenteísmo , Adolescente , Serviços de Saúde do Adolescente/economia , Serviços de Saúde do Adolescente/normas , Serviços de Saúde do Adolescente/estatística & dados numéricos , Asma/terapia , Criança , Saúde da Criança , Serviços de Saúde da Criança/economia , Serviços de Saúde da Criança/normas , Serviços de Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Intervalos de Confiança , Redução de Custos , Análise Custo-Benefício , Prestação Integrada de Cuidados de Saúde/economia , Prestação Integrada de Cuidados de Saúde/normas , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Custos de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
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