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2.
Clin Lab ; 67(1)2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33491426

RESUMO

BACKGROUND: The COVID-19 outbreak, which began in late 2019, continues to ravage the globe and has become the greatest threat to human health. As nucleic acid test is the primary means of screening for COVID-19, this makes the laboratory the most important node in the epidemic prevention and control system. METHODS: As a small laboratory in the hospital, we can meet a large number of demands for nucleic acid test by optimizing staff process, strictly disinfecting experimental batches and changing experimental methods. RESULTS: Through the improvement of the above aspects, our daily maximum detection quantity has been increased from 256/day to 1,012/day. Besides, none of the medical staff has been infected. And there have been no nosocomial infections. CONCLUSIONS: Nucleic acid laboratories, especially small laboratories, should promptly adjust their strategies in the face of unexpected outbreaks and conduct risk assessment in accordance with laboratory activities.


Assuntos
/diagnóstico , Necessidades e Demandas de Serviços de Saúde/organização & administração , Programas de Rastreamento/organização & administração , Manejo de Espécimes , Fluxo de Trabalho , Carga de Trabalho , Humanos , Controle de Infecções/organização & administração , Saúde do Trabalhador , Valor Preditivo dos Testes
5.
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
6.
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
7.
S Afr Med J ; 110(7): 621-624, 2020 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-32880335

RESUMO

Infectious diseases pandemics have devastating health, social and economic consequences, especially in developing countries such as South Africa. Scarce medical resources must often be rationed effectively to contain the disease outbreak. In the case of COVID-19, even the best-resourced countries will have inadequate intensive care facilities for the large number of patients needing admission and ventilation. The scarcity of medical resources creates the need for national governments to establish admission criteria that are evidence-based and fair. Questions have been raised whether infection with HIV or tuberculosis (TB) may amplify the risk of adverse COVID-19 outcomes and therefore whether these conditions should be factored in when deciding on the rationing of intensive care facilities. In light of these questions, clinical evidence regarding inclusion of these infections as comorbidities relevant to intensive care unit admission triage criteria is investigated in the first of a two-part series of articles. There is currently no evidence to indicate that HIV or TB infection on their own predispose to an increased risk of infection with SARS-CoV-2 or worse outcomes for COVID-19. It is recommended that, as for other medical conditions, validated scoring systems for poor prognostic factors should be applied. A subsequent article examines the ethicolegal implications of limiting intensive care access of persons living with HIV or TB.


Assuntos
Infecções por Coronavirus , Infecções por HIV/epidemiologia , Alocação de Recursos para a Atenção à Saúde/métodos , Unidades de Terapia Intensiva , Pandemias , Pneumonia Viral , Triagem/organização & administração , Tuberculose/epidemiologia , Betacoronavirus/isolamento & purificação , Coinfecção , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/normas , Pandemias/economia , Seleção de Pacientes , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Prognóstico , Medição de Risco , África do Sul/epidemiologia
8.
S Afr Med J ; 110(7): 625-628, 2020 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-32880336

RESUMO

The COVID-19 pandemic has brought discussions around the appropriate and fair rationing of scare resources to the forefront. This is of special importance in a country such as South Africa (SA), where scarce resources interface with high levels of need. A large proportion of the SA population has risk factors associated with worse COVID-19 outcomes. Many people are also potentially medically and socially vulnerable secondary to the high levels of infection with HIV and tuberculosis (TB) in the country. This is the second of two articles. The first examined the clinical evidence regarding the inclusion of HIV and TB as comorbidities relevant to intensive care unit (ICU) admission triage criteria. Given the fact that patients with HIV or TB may potentially be excluded from admission to an ICU on the basis of an assumption of lack of clinical suitability for critical care, in this article we explore the ethicolegal implications of limiting ICU access of persons living with HIV or TB. We argue that all allocation and rationing decisions must be in terms of SA law, which prohibits unfair discrimination. In addition, ethical decision-making demands accurate and evidence-based strategies for the fair distribution of limited resources. Rationing decisions and processes should be fair and based on visible and consistent criteria that can be subjected to objective scrutiny, with the ultimate aim of ensuring accountability, equity and fairness.


Assuntos
Infecções por Coronavirus , Infecções por HIV/epidemiologia , Alocação de Recursos para a Atenção à Saúde/métodos , Unidades de Terapia Intensiva , Pandemias , Seleção de Pacientes/ética , Pneumonia Viral , Alocação de Recursos , Triagem , Tuberculose/epidemiologia , Betacoronavirus/isolamento & purificação , Coinfecção , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/normas , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Alocação de Recursos/ética , Alocação de Recursos/legislação & jurisprudência , África do Sul/epidemiologia , Triagem/economia , Triagem/ética , Triagem/legislação & jurisprudência
9.
Ethn Dis ; 30(4): 695-700, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32989370

RESUMO

The coronavirus pandemic of 2019 (COVID-19) has created unprecedented changes to everyday life for millions of Americans due to job loss, school closures, stay-at-home orders and health and mortality consequences. In turn, physicians, academics, and policymakers have turned their attention to the public mental health toll of COVID-19. This commentary reporting from the field integrates perceptions of academic, community, health system, and policy leaders from state, county, and local levels in commenting on community mental health needs in the COVID-19 pandemic. Stakeholders noted the broad public health scope of mental health challenges while expressing concern about exacerbation of existing disparities in access and adverse social determinants, including for communities with high COVID-19 infection rates, such as African Americans and Latinos. They noted rapid changes toward telehealth and remote care, and the importance of understanding impacts of changes, including who may benefit or have limited access, with implications for future services delivery. Needs for expanded workforce and training in mental health were noted, as well as potential public health value of expanding digital resources tailored to local populations for enhancing resilience to stressors. The COVID-19 pandemic has led to changes in delivery of health care services across populations and systems. Concerns over the mental health impact of COVID-19 has enhanced interest in remote mental care delivery and preventive services, while being mindful of potential for enhanced disparities and needs to address social determinants of health. Ongoing quality improvement across systems can integrate lessons learned to enhance a public mental well-being.


Assuntos
Infecções por Coronavirus , Assistência à Saúde , Necessidades e Demandas de Serviços de Saúde/organização & administração , Saúde Mental/tendências , Pandemias , Pneumonia Viral , Saúde Pública , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Assistência à Saúde/organização & administração , Assistência à Saúde/tendências , Humanos , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Saúde Pública/métodos , Saúde Pública/tendências , Melhoria de Qualidade , Estados Unidos/epidemiologia
12.
Drug Discov Ther ; 14(4): 153-160, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32908070

RESUMO

The COVID-19 infection has been a matter of urgency to tackle around the world today, there exist 200 countries around the world and 54 countries in Africa that the COVID-19 infection cases have been confirmed. This situation prompted us to look into the challenges African laboratories are facing in the diagnosis of novel COVID-19 infection. A limited supply of essential laboratory equipment and test kits are some of the challenges faced in combatting the novel virus in Africa. Also, there is inadequate skilled personnel, which might pose a significant danger in case there is a surge in COVID-19 infection cases. The choice of diagnostic method in Africa is limited as there are only two available diagnostic methods being used out of the six methods used globally, thereby reducing the opportunity of supplementary diagnosis, which will further lead to inappropriate diagnosis and affect the accuracy of diagnostic reports. Furthermore, challenges like inadequate power supply, the method used in sample collection, storage and transportation of specimens are also significant as they also pose their respective implication. From the observations, there is an urgent need for more investment into the laboratories for proper, timely, and accurate diagnosis of COVID-19.


Assuntos
Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Acesso aos Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Pneumonia Viral/diagnóstico , Virologia/organização & administração , Betacoronavirus/patogenicidade , Orçamentos , Técnicas de Laboratório Clínico/economia , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Custos de Cuidados de Saúde , Acesso aos Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Nigéria/epidemiologia , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Carga Viral , Virologia/economia , Fluxo de Trabalho
13.
Med. paliat ; 27(3): 217-225, jul.-sept. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-197375

RESUMO

OBJETIVO: Este artículo pretende revisar la narrativa de la literatura existente en referencia al Trabajo Social Sanitario (TSS) durante la pandemia de COVID-19, aportando la literatura escrita hasta el momento y dar a conocer tres experiencias en población y servicios de atención paliativa diferentes, mostrando el impacto sanitario y social para las personas afectadas, sus familias y para el resto de la comunidad. Metología: Revisión de la literatura publicada sobre la intervención del TSS en tiempos de COVID-19 en el ámbito de los cuidados paliativos. RESULTADOS: Destacar la dificultad en encontrar publicaciones con respecto a experiencias del TSS ante la pandemia, más allá de las recomendaciones de intervención desde los consejos generales de trabajo social y los propios colegios oficiales. Compartir tres experiencias de intervención del TSS, en el ámbito de los cuidados paliativos en tiempos de COVID-19, que pongan en relevancia la efectividad de los planes de contingencia elaborados, que fueron clave para poder dar cobertura a las necesidades detectadas en población adulta e infantil desde experiencias concretas, así como compartir propuestas de futuro tras el análisis de los resultados obtenidos


OBJECTIVE: This article aims to review the narrative of the existing literature in reference to Social Health Work (TSS) during the COVID-19 pandemic, providing the literature written so far and publicizing three different experiences in population and palliative care services, showing the health and social impact for the affected people, their families and for the rest of the community. METHODOLOGY: Review of the published literature on the intervention of the TSS in times of COVID-19 in the field of palliative care. RESULTS: Highlight the difficulty in finding publications regarding TSS experiences in the face of the pandemic, beyond the recommendations for intervention from the general councils of Social Work and the official schools themselves. Share three experiences of intervention by the TSS, in the field of palliative care during the time of COVID19, that highlight the effectiveness of the contingency plans developed, which were key to being able to cover the needs detected in the adult and child population since concrete experiences, as well as sharing future proposals after analyzing the results obtained


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Serviço Social/organização & administração , Cuidados Paliativos/métodos , Planos de Contingência , Pandemias , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Serviço Social/métodos , Necessidades e Demandas de Serviços de Saúde/organização & administração , Serviços de Saúde Mental , Saúde da Criança , Apoio Social
14.
Rev. neurol. (Ed. impr.) ; 71(6): 199-204, 16 sept., 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-195512

RESUMO

INTRODUCCIÓN: Las consultas por cefalea son el motivo más frecuente de demanda de atención de causa neurológica en la atención primaria y en los servicios de neurología. Las unidades de cefalea mejoran la calidad asistencial, reducen las listas de espera, facilitan el acceso a nuevos tratamientos de eficacia contrastada y optimizan el gasto sanitario. No obstante, la implantación de estas unidades no está extendida en España debido a la relativa importancia atribuida a la patología y a la suposición de que su coste es elevado. OBJETIVO: Definir la estructura y los requerimientos mínimos de una unidad de cefalea con la intención de contribuir a su extensión en los hospitales de España. SUJETOS Y MÉTODOS: Estudio de consenso entre profesionales tras la revisión de la bibliografía sobre la estructura, las funciones y los recursos de una unidad de cefalea para un área de 350.000 habitantes. RESULTADOS: Se tomaron como referencia ocho publicaciones para la identificación de recursos mínimos necesarios de una unidad de cefalea. El panel de expertos estuvo integrado por 12 profesionales de diferentes especialidades. El principal recurso para la implementación de estas unidades son profesionales (superiores y técnicos), lo que puede suponer un coste adicional para el primer año de alrededor de 107.287,19 euros. CONCLUSIONES: Si consideramos los costes directos e indirectos debidos a las pérdidas por productividad laboral por paciente y los comparamos con los costes estimados de implantación de estas unidades y su expectativa de resultados, todo apunta a que es necesaria la generalización de unidades de cefalea en España


INTRODUCTION: Visits due to headaches are the most frequent cause of demand for neurological treatment in primary care and neurology services. Headache units improve the quality of care, reduce waiting lists, facilitate access to new treatments of proven efficacy and optimise healthcare expenditure. However, these units have not been implemented on a widespread basis in Spain due to the relatively low importance attributed to the condition and also the assumption that such units have a high cost. AIM: To define the structure and minimum requirements of a headache unit with the intention of contributing to their expansion in hospitals in Spain. SUBJECTS AND METHODS: We conducted a consensus study among professionals after reviewing the literature on the structure, functions and resources required by a headache unit designed to serve an area with 350,000 inhabitants. RESULTS: Eight publications were taken as a reference for identifying the minimum resources needed for a headache unit. The panel of experts was made up of 12 professionals from different specialties. The main resource required to be able to implement these units is the professional staff (both supervisory and technical), which can mean an additional cost for the first year of around 107,287.19 euros. CONCLUSIONS: If we bear in mind the direct and indirect costs due to losses in labour productivity per patient and compare them with the estimated costs involved in implementing these units and their expected results, everything points to the need for headache units to become generalised in Spain


Assuntos
Humanos , Cefaleia/epidemiologia , Unidades Hospitalares/organização & administração , Neurologia/organização & administração , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Unidades Hospitalares/economia , Espanha/epidemiologia , Neurologia/economia , Consenso , Pesquisa Qualitativa
16.
PLoS One ; 15(8): e0237720, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32834011

RESUMO

BACKGROUND: Underweight, overweight, and obesity are major public health challenges among reproductive-age women of lower- and middle-income countries (including Tanzania). In those settings, obesogenic factors (attributes that promote excessive body weight gain) are increasing in the context of an existing high burden of undernutrition. The present study investigated factors associated with underweight, overweight, and obesity among reproductive age women in Tanzania. METHODS: This study used 2015-16 Tanzania Demographic and Health Survey data (n = 11735). To account for the hierarchical nature of the data (i.e., reproductive age women nested within clusters), multilevel multinomial logistic regression models were used to investigate the association between individual-level (socioeconomic, demographic and behavioural) and community-level factors with underweight, overweight, and obesity. RESULTS: Reproductive age women who were informally employed (relative risk ratio [RRR] = 0.79; 95% confidence interval [CI]: 0.64, 0.96), those who were currently married (RRR = 0.59; 95% CI: 0.43, 0.82) and those who used contraceptives (RRR = 0.70; 95% CI: 0.54, 0.90) were less likely to be underweight. Reproductive age women who attained secondary or higher education (RRR = 1.48; 95% CI: 1.11, 1.96), those who resided in wealthier households (RRR = 2.31; 95% CI: 1.78, 3.03) and those who watched the television (RRR = 1.26; 95% CI: 1.06, 1.50) were more likely to be overweight. The risk of experiencing obesity was higher among reproductive age women who attained secondary or higher education (RRR = 1.79; 95% CI: 1.23, 2.61), those who were formally employed (RRR = 1.50; 95% CI: 1.14, 1.98), those who resided in wealthier households (RRR = 4.77; 95% CI: 3.03, 7.50), those who used alcohol (RRR = 1.43; 95% CI: 1.12, 1.82) and/or watched the television (RRR = 1.70; 95% CI: 1.35, 2.13). CONCLUSION: Our study suggests that relevant government jurisdictions need to identify, promote, and implement evidence-based interventions that can simultaneously address underweight and overweight/obesity among reproductive age women in Tanzania.


Assuntos
Necessidades e Demandas de Serviços de Saúde/organização & administração , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Saúde Reprodutiva/estatística & dados numéricos , Magreza/epidemiologia , Adolescente , Adulto , Estudos Transversais , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Obesidade/fisiopatologia , Obesidade/prevenção & controle , Sobrepeso/fisiopatologia , Sobrepeso/prevenção & controle , Prevalência , Serviços Preventivos de Saúde/organização & administração , Serviços Preventivos de Saúde/estatística & dados numéricos , Reprodução/fisiologia , Fatores de Risco , Fatores Socioeconômicos , Tanzânia/epidemiologia , Magreza/fisiopatologia , Magreza/prevenção & controle , Adulto Jovem
18.
Am J Kidney Dis ; 76(5): 696-709.e1, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32730812

RESUMO

RATIONALE & OBJECTIVE: During the coronavirus disease 2019 (COVID-19) pandemic, New York encountered shortages in continuous kidney replacement therapy (CKRT) capacity for critically ill patients with acute kidney injury stage 3 requiring dialysis. To inform planning for current and future crises, we estimated CKRT demand and capacity during the initial wave of the US COVID-19 pandemic. STUDY DESIGN: We developed mathematical models to project nationwide and statewide CKRT demand and capacity. Data sources included the Institute for Health Metrics and Evaluation model, the Harvard Global Health Institute model, and published literature. SETTING & POPULATION: US patients hospitalized during the initial wave of the COVID-19 pandemic (February 6, 2020, to August 4, 2020). INTERVENTION: CKRT. OUTCOMES: CKRT demand and capacity at peak resource use; number of states projected to encounter CKRT shortages. MODEL, PERSPECTIVE, & TIMEFRAME: Health sector perspective with a 6-month time horizon. RESULTS: Under base-case model assumptions, there was a nationwide CKRT capacity of 7,032 machines, an estimated shortage of 1,088 (95% uncertainty interval, 910-1,568) machines, and shortages in 6 states at peak resource use. In sensitivity analyses, varying assumptions around: (1) the number of pre-COVID-19 surplus CKRT machines available and (2) the incidence of acute kidney injury stage 3 requiring dialysis requiring CKRT among hospitalized patients with COVID-19 resulted in projected shortages in 3 to 8 states (933-1,282 machines) and 4 to 8 states (945-1,723 machines), respectively. In the best- and worst-case scenarios, there were shortages in 3 and 26 states (614 and 4,540 machines). LIMITATIONS: Parameter estimates are influenced by assumptions made in the absence of published data for CKRT capacity and by the Institute for Health Metrics and Evaluation model's limitations. CONCLUSIONS: Several US states are projected to encounter CKRT shortages during the COVID-19 pandemic. These findings, although based on limited data for CKRT demand and capacity, suggest there being value during health care crises such as the COVID-19 pandemic in establishing an inpatient kidney replacement therapy national registry and maintaining a national stockpile of CKRT equipment.


Assuntos
Lesão Renal Aguda , Defesa Civil , Terapia de Substituição Renal Contínua/métodos , Infecções por Coronavirus , Estado Terminal , Necessidades e Demandas de Serviços de Saúde/organização & administração , Unidades de Terapia Intensiva/provisão & distribução , Pandemias , Pneumonia Viral , Estoque Estratégico/métodos , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Betacoronavirus , Defesa Civil/métodos , Defesa Civil/organização & administração , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Estado Terminal/epidemiologia , Estado Terminal/terapia , Humanos , Modelos Teóricos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Medição de Risco/métodos , Estados Unidos/epidemiologia
19.
J Thromb Thrombolysis ; 50(3): 596-603, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32661758

RESUMO

The Coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving and affecting healthcare systems across the world. Singapore has escalated its alert level to Disease Outbreak Response System Condition (DORSCON) Orange, signifying severe disease with community spread. We aimed to study the overall volume of AIS cases and the delivery of hyperacute stroke services during DORSCON Orange. This was a single-centre, observational cohort study performed at a comprehensive stroke centre responsible for AIS cases in the western region of Singapore, as well as providing care for COVID-19 patients. All AIS patients reviewed as an acute stroke activation in the Emergency Department (ED) from November 2019 to April 2020 were included. System processes timings, treatment and clinical outcome variables were collected. We studied 350 AIS activation patients admitted through the ED, 206 (58.9%) pre- and 144 during DORSCON Orange. Across the study period, number of stroke activations showed significant decline (p = 0.004, 95% CI 6.513 to - 2.287), as the number of COVID-19 cases increased exponentially, whilst proportion of activations receiving acute recanalization therapy remained stable (p = 0.519, 95% CI - 1.605 to 2.702). Amongst AIS patients that received acute recanalization therapy, early neurological outcomes in terms of change in median NIHSS at 24 h (-4 versus -4, p = 0.685) were largely similar between the pre- and during DORSCON orange periods. The number of stroke activations decreased while the proportion receiving acute recanalization therapy remained stable in the current COVID-19 pandemic in Singapore.


Assuntos
Assistência Integral à Saúde/organização & administração , Infecções por Coronavirus/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Pneumonia Viral/terapia , Acidente Vascular Cerebral/terapia , Idoso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Recuperação de Função Fisiológica , Encaminhamento e Consulta/organização & administração , Singapura/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Tempo para o Tratamento/organização & administração , Resultado do Tratamento , Fluxo de Trabalho
20.
N C Med J ; 81(4): 261-265, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32641464

RESUMO

North Carolina's providers and payers increasingly recognize the unique needs of people and their caregivers burdened from the pain, symptoms, and stress of serious illness. This article lays out five actions for expanding access to medical and social supports outside the hospital setting.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Cuidados Críticos/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Serviços de Assistência Domiciliar/organização & administração , Humanos , North Carolina
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