Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.645
Filtrar
1.
J Hosp Palliat Nurs ; 23(2): 128-134, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33633092

RESUMO

Northern New Jersey was inside one of the worst initial coronavirus disease 2019 pandemic epicenters in the United States. At the peak of the pandemic surge in mid-April 2020, New Jersey saw 8045 hospitalized patients with severe coronavirus disease 2019 symptoms, of which 2002 were in intensive care unit beds (86.3% of statewide capacity), including 1705 requiring mechanical ventilation. Because of the severity of pulmonary dysfunction/hypoxia, the unprecedented numbers of critically ill patients, the national opioid shortage, and transmission prevention measures for standard palliative care treatment protocols in place for refractory and/or end-of-life dyspnea were found to be ineffective in providing adequate symptom relief. The aim of the following Notes From the Field is to provide concise, pragmatic, and experiential reflection by 3 palliative care advanced practice nurses from 3 different hospital systems within the pandemic epicenter. The novel methods and opioid strategies implemented by their respective palliative care teams to ensure continued effective and appropriate treatment for end-of-life dyspnea are described. These accounts include Lessons Learned in order to assist others who may need to quickly implement changes in the future due to pandemic resurgence or second-wave events.


Assuntos
/enfermagem , Surtos de Doenças , Dispneia/enfermagem , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , /epidemiologia , Hospitalização , Humanos , New Jersey/epidemiologia
2.
BMC Infect Dis ; 21(1): 72, 2021 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-33446136

RESUMO

BACKGROUND: Hydroxychloroquine has not been associated with improved survival among hospitalized COVID-19 patients in the majority of observational studies and similarly was not identified as an effective prophylaxis following exposure in a prospective randomized trial. We aimed to explore the role of hydroxychloroquine therapy in mildly symptomatic patients diagnosed in the outpatient setting. METHODS: We examined the association between outpatient hydroxychloroquine exposure and the subsequent progression of disease among mildly symptomatic non-hospitalized patients with documented SARS-CoV-2 infection. The primary outcome assessed was requirement of hospitalization. Data was obtained from a retrospective review of electronic health records within a New Jersey USA multi-hospital network. We compared outcomes in patients who received hydroxychloroquine with those who did not applying a multivariable logistic model with propensity matching. RESULTS: Among 1274 outpatients with documented SARS-CoV-2 infection 7.6% were prescribed hydroxychloroquine. In a 1067 patient propensity matched cohort, 21.6% with outpatient exposure to hydroxychloroquine were hospitalized, and 31.4% without exposure were hospitalized. In the primary multivariable logistic regression analysis with propensity matching there was an association between exposure to hydroxychloroquine and a decreased rate of hospitalization from COVID-19 (OR 0.53; 95% CI, 0.29, 0.95). Sensitivity analyses revealed similar associations. QTc prolongation events occurred in 2% of patients prescribed hydroxychloroquine with no reported arrhythmia events among those with data available. CONCLUSIONS: In this retrospective observational study of SARS-CoV-2 infected non-hospitalized patients hydroxychloroquine exposure was associated with a decreased rate of subsequent hospitalization. Additional exploration of hydroxychloroquine in this mildly symptomatic outpatient population is warranted.


Assuntos
/tratamento farmacológico , Hidroxicloroquina/administração & dosagem , Adulto , Idoso , Feminino , Hospitalização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , New Jersey , Pacientes Ambulatoriais/estatística & dados numéricos , Estudos Retrospectivos , /genética , Índice de Gravidade de Doença
3.
Hosp Pediatr ; 11(1): 79-87, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33386296

RESUMO

OBJECTIVES: Understanding the risk factors, predictors, and clinical presentation of coronavirus disease 2019 (COVID-19) in pediatric patients with severe disease. METHODS: We conducted a retrospective chart review of pediatric patients admitted between March 1, 2020, and May 31, 2020, to a large health network in New Jersey with positive test results for severe acute respiratory syndrome coronavirus 2 on reverse transcriptase polymerase chain reaction, rapid testing, or serum immunoglobulin G testing; we included demographic characteristics, clinical features, and outcomes. RESULTS: A total of 81 patients ≤21 years old were admitted with positive test results for severe acute respiratory syndrome coronavirus 2 on reverse transcriptase polymerase chain reaction and/or serum immunoglobulin testing. Sixty-seven patients (82.7%) were admitted for management of acute COVID-19 infection, whereas 14 (17.3%) were admitted for management of multisystem inflammatory syndrome in children (MIS-C). Of the 81 hospitalized patients, 28 (34.6%) required intensive care. A majority of patients (42 [51.9%]) admitted for both acute COVID-19 infection and MIS-C were Hispanic. Underlying chronic health conditions were not present in most patients. Obesity (mean BMI of 41.1) was noted in the patients with MIS-C requiring ICU care, although not statistically significant. Absolute lymphopenia and elevated levels of inflammatory markers were statistically significant in the patients with MIS-C treated in the ICU. CONCLUSIONS: This study adds to the growing literature of potential risk factors for severe disease in pediatric patients due to COVID-19 infection and MIS-C. Patients of Hispanic ethnicity represented the majority of patients with both acute COVID-19 infection and MIS-C, despite only representing 10% to 20% of the population our hospitals serve. Infants and patients with chronic health conditions were not at increased risk for severe disease. Absolute lymphopenia and elevated levels of inflammatory markers were associated with more severe disease.


Assuntos
/diagnóstico , /terapia , Adolescente , Criança , Pré-Escolar , Feminino , Hospitalização , Humanos , Lactente , Masculino , New Jersey , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
8.
9.
MD Advis ; 13(2): 24-26, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33352020
10.
MD Advis ; 13(2): 30-31, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33352022
12.
MD Advis ; 13(2): 38-44, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33352024
15.
J Insect Sci ; 20(6)2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-33367729

RESUMO

Due to changes in pest management practices, farmers' reports of severe feeding injury to cranberries, Vaccinium macrocarpon Aiton Ericales: Ericaceae, caused by the cranberry toad-bug, Phylloscelis rubra Ball, have increased in recent years in New Jersey (United States). Currently, however, limited information is available on the effects of P. rubra feeding or density of individuals needed to cause injury to cranberry vines and fruit. In 2015‒2017, we conducted studies to characterize injury to cranberry at a range of P. rubra densities by using cages in a screen-house and field, to establish a correlation between P. rubra density and crop injury in an open field experiment, and to measure the effects of P. rubra injury on the nutritional content (i.e., amounts of macro- and microelements) of cranberry vines. Phylloscelis rubra feeding on cranberry vines produced typical injury symptoms at relatively low densities (i.e., 2 individuals per vine in field cages or <10 individuals per sweep net sample in open fields), which included discolored (yellowish or reddish) or dead (brown) vines. This vine injury could lead to reductions in fruit mass and total fruit number. However, P. rubra injury to cranberry vines did not alter their nutritional composition. In general, this study highlights the ability of P. rubra to cause substantial injury to cranberry vines even when population densities were relatively low, which could result in declines in fruit production (quality and quantity). Therefore, infestations by P. rubra in cranberries must be considered when making pest management decisions in regions where this insect is present.


Assuntos
Hemípteros , Vaccinium macrocarpon , Animais , Controle de Insetos , New Jersey , Controle de Pragas
16.
Water Sci Technol ; 82(11): 2389-2399, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33339793

RESUMO

More than 2 million tons of chromium ore processing residue (COPR) waste was disposed of in Hudson County of New Jersey, which was known as the center of the production of chromate in the 20th century. The Cr(VI) removal experiments were conducted with the hyporheic zone (HZ) sediments collected along the shore of an urbanized estuary located in and near Hudson County to investigate the natural remediation of Cr(VI). Fine-grained and organic-rich Passaic River sediments showed the highest removal capacity for Cr(VI), whereas the lowest removal of Cr(VI) occurred in coarse-grained and organic-poor sediments from Newark Bay. In general, Cr(VI) removal increased with higher amounts of sediment organic matter, sulfur, and silt and clay fractions, as well as lower pH conditions. The removal of hexavalent chromium in organic-rich sediments is attributed mainly to the reduction of Cr(VI) to Cr(III), resulting in less reversible immobilization of Cr(VI), while reversible adsorption could also remove Cr(VI). The results suggest that the organic-rich, fine-grained HZ sediments can act as a natural reactive barrier for the remediation of Cr(VI) transport from subsurface to surface water in the estuary. Further research is needed to understand the long-term mobility of Cr along the urban estuary.


Assuntos
Cromo , Estuários , Cromo/análise , New Jersey , Rios
17.
Artigo em Inglês | MEDLINE | ID: mdl-33352953

RESUMO

This study investigated the geographic variation and the clustering of lung cancer incidence rates in Philadelphia and the surrounding areas using addresses at the time of diagnosis. Using 60,844 cases from Pennsylvania Cancer Registry, we calculated and mapped the age-adjusted incidence rates for five Pennsylvania (PA) counties near Philadelphia between 1998-2007 and 2008-2017. We identified ZIP codes with significantly higher incidence rates than the state rates and examined their demographic and exposure characteristics. Further, we tested for spatial autocorrelation and identified spatial clusters using Moran's I statistic. Our results showed that approximately one in four ZIP codes had an incidence rate that was significantly higher than the PA state rate in each period studied. Clusters of higher incidences were detected in the southeastern part of PA bordering New Jersey. These areas tended to be more populated, of lower socioeconomic status, and closer to manufacturing facilities and major highways. Possibly driven by the community and environmental factors, the observed differences in disease incidence suggest the importance of including residential location in risk assessment tools for lung cancer.


Assuntos
Neoplasias Pulmonares , Análise por Conglomerados , Humanos , Incidência , Neoplasias Pulmonares/epidemiologia , New Jersey/epidemiologia , Philadelphia/epidemiologia
18.
BMC Infect Dis ; 20(1): 853, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33198725

RESUMO

BACKGROUND: Healthcare workers (HCW) are presumed to be at increased risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection due to occupational exposure to infected patients. However, there has been little epidemiological research to assess these risks. METHODS: We conducted a prospective cohort study of HCW (n = 546) and non-healthcare workers (NHCW; n = 283) with no known prior SARS-CoV-2 infection who were recruited from a large U.S. university and two affiliated university hospitals. In this cross-sectional analysis of data collected at baseline, we examined SARS-CoV-2 infection status (as determined by presence of SARS-CoV-2 RNA in oropharyngeal swabs) by healthcare worker status and role. RESULTS: At baseline, 41 (5.0%) of the participants tested positive for SARS-CoV-2 infection, of whom 14 (34.2%) reported symptoms. The prevalence of SARS-CoV-2 infection was higher among HCW (7.3%) than in NHCW (0.4%), representing a 7.0% greater absolute risk (95% confidence interval for risk difference 4.7, 9.3%). The majority of infected HCW (62.5%) were nurses. Positive tests increased across the two weeks of cohort recruitment in line with rising confirmed cases in the hospitals and surrounding counties. CONCLUSIONS: Overall, our results demonstrate that HCW had a higher prevalence of SARS-CoV-2 infection than NHCW. Continued follow-up of this cohort will enable us to monitor infection rates and examine risk factors for transmission.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pessoal de Saúde , Doenças Profissionais/epidemiologia , Exposição Ocupacional , Pneumonia Viral/epidemiologia , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Jersey/epidemiologia , Doenças Profissionais/virologia , Exposição Ocupacional/efeitos adversos , Pandemias , Prevalência , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Adulto Jovem
19.
J Emerg Manag ; 18(5): 373-382, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33174191

RESUMO

Senior care facilities house populations that are highly vulnerable to impacts from natural hazard events. Recent events in Florida and Texas highlight the need for senior care facilities to prepare to shelter-in-place during and immediately after a natural hazard event occurs and be self-sufficient for extended periods afterward. Interviews with emergency managers and senior facility administrators in New Jersey emphasize how regional planning efforts can be used successfully to improve preparedness at senior facilities and coordination with the emergency response community. While preparedness efforts vary across New Jersey, the southern region has shown success through focused connections between facilities and emergency managers that have led to successful coordination of emergency evacuation of facilities.


Assuntos
Planejamento em Desastres , Emergências , Florida , Humanos , New Jersey , Texas
20.
JMIR Mhealth Uhealth ; 8(10): e20419, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-33006942

RESUMO

BACKGROUND: Telehealth has emerged as a crucial component of the SARS-CoV-2 pandemic emergency response. Simply stated, telehealth is a tool to provide health care from a distance. Jefferson Health has leveraged its acute care telehealth platform to screen, order testing, and manage patients with COVID-19-related concerns. OBJECTIVE: This study aims to describe the expansion and results of using a telehealth program to increase access to care while minimizing additional potential exposures during the early period of the COVID-19 pandemic. METHODS: Screening algorithms for patients with SARS-CoV-2-related complaints were created, and 150 new clinicians were trained within 72 hours to address increased patient demand. Simultaneously, Jefferson Health created mobile testing sites throughout eastern Pennsylvania and the southern New Jersey region. Visit volume, the number of SARS-CoV-2 tests ordered, and the number of positive tests were evaluated, and the volume was compared with preceding time periods. RESULTS: From March 8, 2020, to April 11, 2020, 4663 patients were screened using telehealth, representing a surge in visit volume. There were 1521 patients sent to mobile testing sites, and they received a telephone call from a centralized call center for results. Of the patients who were tested, nearly 20% (n=301) had a positive result. CONCLUSIONS: Our model demonstrates how using telehealth for a referral to central testing sites can increase access to community-based care, decrease clinician exposure, and minimize the demand for personal protective equipment. The scaling of this innovation may allow health care systems to focus on preparing for and delivering hospital-based care needs.


Assuntos
Técnicas de Laboratório Clínico/métodos , Serviços de Saúde Comunitária/organização & administração , Telemedicina , Infecções por Coronavirus/diagnóstico , Humanos , New Jersey/epidemiologia , Pennsylvania/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...