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1.
Cancer Cytopathol ; 128(10): 679-680, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33006815
2.
Intern Med J ; 50(8): 918-923, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32881275

RESUMO

The novel Coronavirus disease 2019 (COVID-19) outbreak has led to rapid and profound changes in healthcare system delivery and society more broadly. Older adults, and those living with chronic or life-limiting conditions, are at increased risk of experiencing severe or critical symptoms associated with COVID-19 infection and are more likely to die. They may also experience non-COVID-19 related deterioration in their health status during this period. Advance care planning (ACP) is critical for this cohort, yet there is no coordinated strategy for increasing the low rates of ACP uptake in these groups, or more broadly. This paper outlines a number of key reasons why ACP is an urgent priority, and should form a part of the health system's COVID-19 response strategy. These include reducing the need for rationing, planning for surges in healthcare demand, respecting human rights, enabling proactive care coordination and leveraging societal change. We conclude with key recommendations for policy and practice in the system-wide implementation of ACP, to enable a more ethical, coordinated and person-centred response in the COVID-19 context.


Assuntos
Planejamento Antecipado de Cuidados , Infecções por Coronavirus , Assistência à Saúde , Pandemias , Pneumonia Viral , Planejamento Antecipado de Cuidados/ética , Planejamento Antecipado de Cuidados/organização & administração , Fatores Etários , Austrália/epidemiologia , Betacoronavirus , Deterioração Clínica , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Estado Terminal/terapia , Assistência à Saúde/organização & administração , Assistência à Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Direitos Humanos , Humanos , Inovação Organizacional , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia
3.
Ethn Dis ; 30(4): 693-694, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32989369

RESUMO

As of May 2020, the global COVID-19 pandemic had reached 187 countries with more than 3.7 million confirmed cases and 263,000 deaths. While sub-Saharan Africa (SSA) has not been spared, the extent of disease is currently far less than in Europe or North America leading some to posit that climatic, genetic or other conditions will self-limit disease in this location. Nonetheless, infections in tropical Africa continue to rise at an alarming pace with the potential to soon exceed health resource availability and to exhaust a health care workforce that is already grossly under supported and ill-equipped. This perspective outlines the context of COVID-19 disease in Africa with a focus on the distinctive challenges faced by African nations and a potential best path forward.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus , Alocação de Recursos para a Atenção à Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/tendências , Pandemias , Pneumonia Viral , Alocação de Recursos , África ao Sul do Saara/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Mão de Obra em Saúde , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
4.
Epileptic Disord ; 22(4): 439-442, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32759092

RESUMO

The COVID-19 pandemic shook European healthcare systems, with unavoidable gaps in the management of patients with chronic diseases. We describe the impact of the pandemic on epilepsy care in three tertiary epilepsy centres from Spain and Italy, the most affected European countries. The three epilepsy centres, members of the European EpiCARE network, manage more than 5,700 people with epilepsy. In Bologna and Barcelona, the hospitals housing the epilepsy centres were fully converted into COVID-19 units. We describe the reorganization of the clinics and report on the frequency of SARS-CoV-2 in people with epilepsy as well as the frequency of seizures in patients admitted to the COVID units. Finally, we elaborate on critical issues regarding the second phase of the pandemic. The activities related to epilepsy care were reduced to less than 10% and were deprioritized. Discharges were expedited and elective epilepsy surgeries, including vagal nerve stimulator implantations, cancelled. Hospitalizations and EEG examinations were limited to emergencies. The outpatient visits for new patients were postponed, and follow-up visits mostly managed by telehealth. Antiseizure medication weaning plans and changes in vagal nerve stimulator settings were halted. Among the 5,700 people with epilepsy managed in our centres, only 14 tested positive for SARS-CoV-2, without obvious impact on their epilepsy. None of the 2,122 patients admitted to COVID units experienced seizures among the early symptoms. Epilepsy care was negatively impacted by the pandemic, irrespective of COVID-19 epidemiology or conversion of the hospital into a COVID-19 centre. The pandemic did not silence the needs of people with epilepsy, and this must be considered in the planning of the second phase.


Assuntos
Infecções por Coronavirus , Epilepsia/terapia , Necessidades e Demandas de Serviços de Saúde/tendências , Pandemias , Pneumonia Viral , Infecções por Coronavirus/complicações , Eletroencefalografia/estatística & dados numéricos , Epilepsia/complicações , Epilepsia/cirurgia , Europa (Continente) , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Unidades Hospitalares/organização & administração , Hospitalização/estatística & dados numéricos , Humanos , Itália , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Pneumonia Viral/complicações , Convulsões/epidemiologia , Convulsões/etiologia , Espanha , Telemedicina
7.
S Afr Med J ; 110(5): 355-359, 2020 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-32657716

RESUMO

Since the World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern, COVID-19 infection and the associated mortality have increased exponentially, globally. South Africa (SA) is no exception. Concerns abound over whether SA's healthcare system can withstand a demand for care that is disproportionate to current resources, both in the state and private health sectors. While healthcare professionals in SA have become resilient and adept at making difficult decisions in the face of resource limitations, a surge in COVID-19 cases could place a severe strain on the country's critical care services and necessitate unprecedented rationing decisions. This could occur at two critical points: access to ventilation, and withdrawal of intensive care in non- responsive or deteriorating cases. The ethical dimensions of decision-making at both junctures merit urgent consideration.


Assuntos
Infecções por Coronavirus , Cuidados Críticos , Serviço Hospitalar de Emergência/organização & administração , Alocação de Recursos para a Atenção à Saúde/tendências , Pandemias , Pneumonia Viral , Alocação de Recursos , Triagem , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Cuidados Críticos/ética , Cuidados Críticos/métodos , Cuidados Críticos/organização & administração , Emergências/epidemiologia , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Alocação de Recursos/ética , Alocação de Recursos/organização & administração , África do Sul/epidemiologia , Triagem/ética , Triagem/organização & administração , Ventiladores Mecânicos/provisão & distribução
8.
J Stroke Cerebrovasc Dis ; 29(8): 104988, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689650

RESUMO

BACKGROUND: The COVID-19 pandemic's impact on stroke care is two-fold direct impact of the infection and indirect impact on non-COVID-19 diseases. Anecdotal evidence and clinical observation suggest that there is a decrease in the number of patients presenting with stroke during the pandemic. We aim to understand the impact of the COVID-19 pandemic on the utilization of stroke emergency services on a single comprehensive stroke center (CSC). METHODS: We performed a retrospective analysis of a prospectively maintained database and compared all emergency department (ED) encounters, acute stroke admissions (including TIA), and thrombectomy cases admitted in March 2017-2019 to patients admitted in March 2020 at a comprehensive stroke center. RESULTS: Number of total ED encounters (22%, p=0.005), acute ischemic strokes (40%, p=0.001), and TIAs (60%, p=0.163) decreased between March of 2017-2019 compared to March of 2020. The number of patients undergoing EVT in March 2020 was comparable to March 2017-2019 (p=0.430). CONCLUSION: A pandemic-related stay-at-home policy reduces the utilization of stroke emergency services at a CSC. This effect appears to be more prominent for ED encounters, all stroke admissions and TIAs, and less impactful for severe strokes. Given the relatively low prevalence of COVID-19 cases in our region, this decrement is likely related to healthcare seeking behavior rather than capacity saturation.


Assuntos
Infecções por Coronavirus/terapia , Serviços Médicos de Emergência/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Determinação de Necessidades de Cuidados de Saúde/tendências , Neurologia/tendências , Pneumonia Viral/terapia , Acidente Vascular Cerebral/terapia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Bases de Dados Factuais , Interações entre Hospedeiro e Microrganismos , Humanos , Pandemias , Pennsylvania/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo
9.
Rev. psiquiatr. salud ment. (Barc., Ed. impr.) ; 13(2): 105-110, abr.-jun. 2020.
Artigo em Inglês | IBECS | ID: ibc-188004

RESUMO

The COVID-19 pandemic has forced mental health professionals to substantially change the way they work and may have a delayed impact on patients. The aftermath of COVID-19 will shine a light on certain aspects of psychiatry addressed in this article: psychiatry as a medical specialty, the psychological aspects of medical practice, liaison and consultative psychiatry, home hospitalization, and virtual or telemedicine outpatient care. The consequences of population lockdown, complicated grief over solitary deaths, and the impact of the health crisis on mental health professionals - from hospitals to community services, rehabilitation facilities, and primary care - will be the focus of our efforts during the period of lockdown easing and in the medium term. There will be a foreseeable increase in demand for psychiatric care in the medium and long term along with an impact on mental health education and research


La pandemia por COVID-19 ha obligado a modificar sustancialmente la forma de trabajar de los profesionales de la salud mental, y puede tener un impacto diferido sobre los pacientes. La psiquiatría post-COVID-19 pondrá en valor la especialidad como parte de la medicina, los aspectos psicológicos de la práctica médica, la psiquiatría de enlace e interconsulta hospitalaria, la atención domiciliaria y la atención ambulatoria virtual o telemática. Las consecuencias del confinamiento poblacional, el duelo por las muertes solitarias y el impacto de la crisis sanitaria sobre los profesionales de la salud mental, desde los dispositivos hospitalarios hasta los comunitarios, de rehabilitación y la atención primaria, centrarán nuestros esfuerzos durante el desescalado y el medio plazo. Es previsible un aumento de la demanda de atención psiquiátrica a medio y largo plazo, y un impacto en la docencia e investigación en salud mental


Assuntos
Humanos , Transtornos Mentais/epidemiologia , Infecções por Coronavirus/psicologia , Quarentena/psicologia , Isolamento Social/psicologia , Telepsiquiatria , Impactos na Saúde/análise , Análise de Consequências , Pandemias/estatística & dados numéricos , Vírus da SARS/patogenicidade , Teleterapia , Necessidades e Demandas de Serviços de Saúde/tendências , Capacidade de Resposta ante Emergências/organização & administração , Tele-Emergência , Previsões
10.
BMC Med ; 18(1): 190, 2020 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-32586391

RESUMO

BACKGROUND: Major infectious disease outbreaks are a constant threat to human health. Clinical research responses to outbreaks generate evidence to improve outcomes and outbreak control. Experiences from previous epidemics have identified multiple challenges to undertaking timely clinical research responses. This scoping review is a systematic appraisal of political, economic, administrative, regulatory, logistical, ethical and social (PEARLES) challenges to clinical research responses to emergency epidemics and solutions identified to address these. METHODS: A scoping review. We searched six databases (MEDLINE, Embase, Global Health, PsycINFO, Scopus and Epistemonikos) for articles published from 2008 to July 2018. We included publications reporting PEARLES challenges to clinical research responses to emerging epidemics and pandemics and solutions identified to address these. Two reviewers screened articles for inclusion, extracted and analysed the data. RESULTS: Of 2678 articles screened, 76 were included. Most presented data relating to the 2014-2016 Ebola virus outbreak or the H1N1 outbreak in 2009. The articles related to clinical research responses in Africa (n = 37), Europe (n = 8), North America (n = 5), Latin America and the Caribbean (n = 3) and Asia (n = 1) and/or globally (n = 22). A wide range of solutions to PEARLES challenges was presented, including a need to strengthen global collaborations and coordination at all levels and develop pre-approved protocols and equitable frameworks, protocols and standards for emergencies. Clinical trial networks and expedited funding and approvals were some solutions implemented. National ownership and community engagement from the outset were a key enabler for delivery. Despite the wide range of recommended solutions, none had been formally evaluated. CONCLUSIONS: To strengthen global preparedness and response to the COVID-19 pandemic and future epidemics, identified solutions for rapid clinical research deployment, delivery, and dissemination must be implemented. Improvements are urgently needed to strengthen collaborations, funding mechanisms, global and national research capacity and capability, targeting regions vulnerable to epidemics and pandemics. Solutions need to be flexible to allow timely adaptations to context, and research led by governments of affected regions. Research communities globally need to evaluate their activities and incorporate lessons learnt to refine and rehearse collaborative outbreak response plans in between epidemics.


Assuntos
Pesquisa Biomédica , Surtos de Doenças , Epidemias , Necessidades e Demandas de Serviços de Saúde/tendências , Pandemias , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Ebolavirus , Saúde Global , Humanos , Vírus da Influenza A Subtipo H1N1 , Pneumonia Viral/epidemiologia
11.
Transplantation ; 104(7): 1305-1307, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32568998
12.
Am J Kidney Dis ; 76(3): 392-400, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32505811

RESUMO

With the exponential surge in patients with coronavirus disease 2019 (COVID-19) worldwide, the resources needed to provide continuous kidney replacement therapy (CKRT) for patients with acute kidney injury or kidney failure may be threatened. This article summarizes subsisting strategies that can be implemented immediately. Pre-emptive weekly multicenter projections of CKRT demand based on evolving COVID-19 epidemiology and routine workload should be made. Corresponding consumables should be quantified and acquired, with diversification of sources from multiple vendors. Supply procurement should be stepped up accordingly so that a several-week stock is amassed, with administrative oversight to prevent disproportionate hoarding by institutions. Consumption of CKRT resources can be made more efficient by optimizing circuit anticoagulation to preserve filters, extending use of each vascular access, lowering blood flows to reduce citrate consumption, moderating the CKRT intensity to conserve fluids, or running accelerated KRT at higher clearance to treat more patients per machine. If logistically feasible, earlier transition to intermittent hemodialysis with online-generated dialysate, or urgent peritoneal dialysis in selected patients, may help reduce CKRT dependency. These measures, coupled to multicenter collaboration and a corresponding increase in trained medical and nursing staffing levels, may avoid downstream rationing of care and save lives during the peak of the pandemic.


Assuntos
Betacoronavirus , Terapia de Substituição Renal Contínua/tendências , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde/tendências , Pandemias , Pneumonia Viral/terapia , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/terapia , Anticoagulantes/administração & dosagem , Anticoagulantes/provisão & distribução , Terapia de Substituição Renal Contínua/instrumentação , Infecções por Coronavirus/epidemiologia , Soluções para Diálise/administração & dosagem , Soluções para Diálise/provisão & distribução , Humanos , Pneumonia Viral/epidemiologia , Insuficiência Renal/epidemiologia , Insuficiência Renal/terapia
13.
Am J Kidney Dis ; 76(3): 401-406, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32534129

RESUMO

At Montefiore Medical Center in The Bronx, NY, the first case of coronavirus disease 2019 (COVID-19) was admitted on March 11, 2020. At the height of the pandemic, there were 855 patients with COVID-19 admitted on April 13, 2020. Due to high demand for dialysis and shortages of staff and supplies, we started an urgent peritoneal dialysis (PD) program. From April 1 to April 22, a total of 30 patients were started on PD. Of those 30 patients, 14 died during their hospitalization, 8 were discharged, and 8 were still hospitalized as of May 14, 2020. Although the PD program was successful in its ability to provide much-needed kidney replacement therapy when hemodialysis was not available, challenges to delivering adequate PD dosage included difficulties providing nurse training and availability of supplies. Providing adequate clearance and ultrafiltration for patients in intensive care units was especially difficult due to the high prevalence of a hypercatabolic state, volume overload, and prone positioning. PD was more easily performed in non-critically ill patients outside the intensive care unit. Despite these challenges, we demonstrate that urgent PD is a feasible alternative to hemodialysis in situations with critical resource shortages.


Assuntos
Lesão Renal Aguda/terapia , Betacoronavirus , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde , Diálise Peritoneal/métodos , Pneumonia Viral/terapia , Lesão Renal Aguda/epidemiologia , Infecções por Coronavirus/epidemiologia , Soluções para Diálise/provisão & distribução , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Unidades de Terapia Intensiva/provisão & distribução , Unidades de Terapia Intensiva/tendências , Pandemias , Diálise Peritoneal/tendências , Pneumonia Viral/epidemiologia , Estados Unidos/epidemiologia
14.
Neurol Sci ; 41(6): 1373-1375, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-155217

RESUMO

Because of COVID-19 outbreak, regular clinical services for Parkinson's disease (PD) patients have been suddenly suspended, causing worries, confusion and unexpected needs in such frail population. Here, we reviewed the messages spontaneously sent by patients to an Italian PD clinic during the first two weeks of COVID-19 lockdown (9-21 March 2020), in order to highlight their main needs and then outline appropriate strategies of care for this critical period. One hundred sixty-two messages were analysed. Forty-six percent queried about clinical services; 28% communicated an acute clinical worsening for which a therapeutic change was done in 52% of cases; 17% (those patients with younger age and milder disease) asked about the relationship between PD and COVID-19; 8% informed about an intercurrent event. Our analysis suggests that PD patients' needs during COVID-19 emergency include appropriate and complete information, a timely update on changes in clinical services, and the continuity of care, even in a remote mode. By addressing these issues, acute clinical worsening, complications and subsequent therapeutic changes could be prevented. In this perspective, telecommunication systems and virtual medicine should be implemented.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Doença de Parkinson/epidemiologia , Pneumonia Viral/epidemiologia , Autorrelato , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Pandemias , Doença de Parkinson/diagnóstico , Doença de Parkinson/terapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Telemedicina/métodos , Telemedicina/tendências
19.
Neurol Sci ; 41(6): 1373-1375, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32363506

RESUMO

Because of COVID-19 outbreak, regular clinical services for Parkinson's disease (PD) patients have been suddenly suspended, causing worries, confusion and unexpected needs in such frail population. Here, we reviewed the messages spontaneously sent by patients to an Italian PD clinic during the first two weeks of COVID-19 lockdown (9-21 March 2020), in order to highlight their main needs and then outline appropriate strategies of care for this critical period. One hundred sixty-two messages were analysed. Forty-six percent queried about clinical services; 28% communicated an acute clinical worsening for which a therapeutic change was done in 52% of cases; 17% (those patients with younger age and milder disease) asked about the relationship between PD and COVID-19; 8% informed about an intercurrent event. Our analysis suggests that PD patients' needs during COVID-19 emergency include appropriate and complete information, a timely update on changes in clinical services, and the continuity of care, even in a remote mode. By addressing these issues, acute clinical worsening, complications and subsequent therapeutic changes could be prevented. In this perspective, telecommunication systems and virtual medicine should be implemented.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Doença de Parkinson/epidemiologia , Pneumonia Viral/epidemiologia , Autorrelato , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Pandemias , Doença de Parkinson/diagnóstico , Doença de Parkinson/terapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Telemedicina/métodos , Telemedicina/tendências
20.
Childs Nerv Syst ; 36(7): 1347-1355, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32435890

RESUMO

SARS-CoV-2 COVID-19, coronavirus, has created unique challenges for the medical community after national guidelines called for the cancellation of all elective surgery. While there are clear cases of elective surgery (benign cranial cosmetic defect) and emergency surgery (hemorrhage, fracture, trauma, etc.), there is an unchartered middle ground in pediatric neurosurgery. Children, unlike adults, have dynamic anatomy and are still developing neural networks. Delaying seemingly elective surgery can affect a child's already vulnerable health state by further impacting their neurocognitive development, neurologic functioning, and potential long-term health states. The purpose of this paper is to demonstrate that "elective" pediatric neurosurgery should be risk-stratified, and multi-institutional informed guidelines established.


Assuntos
Betacoronavirus , Infecções por Coronavirus/cirurgia , Procedimentos Cirúrgicos Eletivos/tendências , Incidentes com Feridos em Massa , Procedimentos Neurocirúrgicos/tendências , Pneumonia Viral/cirurgia , Tempo para o Tratamento/tendências , Criança , Infecções por Coronavirus/epidemiologia , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Incidentes com Feridos em Massa/prevenção & controle , Pandemias , Pneumonia Viral/epidemiologia
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