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1.
Front Immunol ; 12: 709861, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34475873

RESUMO

Background: Immune hyperactivity is an important contributing factor to the morbidity and mortality of COVID-19 infection. Nasal administration of anti-CD3 monoclonal antibody downregulates hyperactive immune responses in animal models of autoimmunity through its immunomodulatory properties. We performed a randomized pilot study of fully-human nasal anti-CD3 (Foralumab) in patients with mild to moderate COVID-19 to determine if its immunomodulatory properties had ameliorating effects on disease. Methods: Thirty-nine outpatients with mild to moderate COVID-19 were recruited at Santa Casa de Misericordia de Santos in Sao Paulo State, Brazil. Patients were randomized to three cohorts: 1) Control, no Foralumab (n=16); 2) Nasal Foralumab (100ug/day) given for 10 consecutive days with 6 mg dexamethasone given on days 1-3 (n=11); and 3) Nasal Foralumab alone (100ug/day) given for 10 consecutive days (n=12). Patients continued standard of care medication. Results: We observed reduction of serum IL-6 and C-reactive protein in Foralumab alone vs. untreated or Foralumab/Dexa treated patients. More rapid clearance of lung infiltrates as measured by chest CT was observed in Foralumab and Foralumab/Dexa treated subjects vs. those that did not receive Foralumab. Foralumab treatment was well-tolerated with no severe adverse events. Conclusions: This pilot study suggests that nasal Foralumab is well tolerated and may be of benefit in treatment of immune hyperactivity and lung involvement in COVID-19 disease and that further studies are warranted.


Assuntos
Anticorpos Monoclonais/uso terapêutico , COVID-19/imunologia , COVID-19/prevenção & controle , Pneumonia/terapia , Administração Intranasal , Adolescente , Adulto , Anticorpos Monoclonais/administração & dosagem , Biomarcadores , Proteína C-Reativa/análise , COVID-19/fisiopatologia , COVID-19/terapia , Estudos de Coortes , Feminino , Humanos , Imunidade/efeitos dos fármacos , Interleucina-6/sangue , Pulmão/efeitos dos fármacos , Pulmão/imunologia , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Projetos Piloto , Pneumonia/prevenção & controle , Adulto Jovem
2.
BMJ Open ; 11(9): e043253, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34489262

RESUMO

OBJECTIVE: Transient ischaemic attacks (TIA) and minor strokes are important risk factors for further vascular events. We explored the role of albumin creatinine ratio (ACR) in improving risk prediction after a first event. SETTING: Rapid access stroke clinics in the UK. PARTICIPANTS: 2202 patients attending with TIA or minor stroke diagnosed by the attending stroke physician, able to provide a urine sample to evaluate ACR using a near-patient testing device. PRIMARY AND SECONDARY OUTCOMES: Primary outcome was major adverse cardiac events (MACE: recurrent stroke, myocardial infarction or cardiovascular death) at 90 days. The key secondary outcome was to determine whether urinary ACR could contribute to a risk prediction tool for use in a clinic setting. RESULTS: 151 MACE occurred in 144 participants within 90 days. Participants with MACE had higher ACR than those without. A composite score awarding a point each for age >80 years, previous stroke/TIA and presence of microalbuminuria identified those at low risk and high risk. 90% of patients were at low risk (scoring 0 or 1). Their 90-day risk of MACE was 5.7%. Of the remaining 'high-risk' population (scoring 2 or 3) 12.4% experienced MACE over 90 days (p<0.001 compared with the low-risk population). The need for acute admission in the first 7 days was twofold elevated in the high-risk group compared with the low-risk group (3.23% vs 1.43%; p=0.05). These findings were validated in an independent historic sample. CONCLUSION: A risk score comprising age, previous stroke/TIA and microalbuminuria predicts future MACE while identifying those at low risk of a recurrent event. This tool shows promise in the risk stratification of patients to avoid the admission of low-risk patients.


Assuntos
Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Idoso de 80 Anos ou mais , Humanos , Ataque Isquêmico Transitório/epidemiologia , Pacientes Ambulatoriais , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
3.
Am J Case Rep ; 22: e931974, 2021 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-34480792

RESUMO

BACKGROUND Treacher Collins syndrome is a rare autosomal dominant disorder characterized by micrognathia and abnormal development of the zygomatic arch, which may result in significant upper airway obstruction. As patients who have it age, their upper airway obstruction may worsen. Therefore, they typically require several surgeries throughout their lives to correct specific facial abnormalities. Anesthetic and airway management of patients with Treacher Collins syndrome can be challenging for anesthesia providers, especially in ambulatory settings. CASE REPORT A 15-year-old patient with Treacher Collins syndrome presented to our outpatient surgery center for midface fat grafting. He had undergone multiple surgical procedures at Nationwide Children's Hospital, which is affiliated with The Ohio State University Wexner Medical Center. A decision was made to proceed with the grafting surgery after: (1) the literature was thoroughly reviewed; (2) multidisciplinary planning had been done utilizing our comprehensive preoperative screening and assessment process; (3) the scope of care at our ambulatory surgery center, the patient's medical history, and relevant airway notes had been reviewed; (4) the case was discussed with the surgeon; and (5) relevant images of the patient had been gathered. Evaluation of the patient's airway on the day of surgery was reassuring and a plan for managing a potentially difficult airway had been developed. After anesthetic induction, mask ventilation without adjuvants was successful. Video and direct laryngoscopy (for purposes of education) revealed grade 1 views. Supraglottic airway device placement resulted in an effective seal and the remainder of the surgery and the patient's subsequent course were uneventful. CONCLUSIONS Improved airway approaches, combined with thorough preoperative screening and multidisciplinary planning and communication, may make it possible to perform ambulatory surgery on patients with Treacher Collins syndrome, whose condition typically represents a significant challenge to anesthesia providers.


Assuntos
Anestésicos , Disostose Mandibulofacial , Adolescente , Criança , Face , Humanos , Laringoscopia , Masculino , Disostose Mandibulofacial/cirurgia , Pacientes Ambulatoriais
4.
Artigo em Russo | MEDLINE | ID: mdl-34486850

RESUMO

The article presents results of comparative analysis of morbidity and mortality of diseases of circulatory system in the Republic of Buryatia in 2003-2018. The population mortality depends on identification of risk factors for cardiovascular diseases, diseases of circulatory system and subsequent coverage of population with medical care, including dispensary monitoring. The analysis was based on data from State statistical reporting forms and official data of the Territorial Board of the Federal State Statistics Service in the Republic of Buryatia, including the form № 12 "The information on number of diseases registered in patients residing in area of medical organization servicing activity"; the form № 025-12/s "The Out-Patient Registration Card"; the form № 25-2/y "The Statistical Coupon for Final (updated) Diagnosis Registration". The study was carried out using statistical, analytical and comparative analysis methods. Currently, in the Republic of Buryatia, diseases of circular system occupying second place in the structure of total morbidity (15.7%) and primary disability of adult population (28.6%) are among leading cause of total population mortality (41.6%).


Assuntos
Doenças Cardiovasculares , Sistema Cardiovascular , Adulto , Doenças Cardiovasculares/epidemiologia , Humanos , Morbidade , Pacientes Ambulatoriais , Fatores de Risco
5.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(4): 521-530, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34494521

RESUMO

Objective To quantitatively evaluate the associations of PM2.5,PM10,NO2,and SO2 concentrations with the outpatient visits for atopic dermatitis in Lanzhou. Methods The data of outpatient visits,together with meteorological data and air pollutant data,from January 2013 to December 2017 were collected.The generalized additive model based on Poisson distribution was employed to study the lag effects of PM2.5,PM10,NO2,and SO2 concentrations on the visits of outpatients,with the seasonal and long-term trends and day-of-the-week effect controlled. Results The results of the single pollutant model showed that PM2.5 and PM10 had the most obvious while still insignificant impact on the outpatient visits for atopic dermatitis on the current day(lag0).NO2 also had the most obvious impact in the case of lag0 and showed a lag effect.For each 10 µg/m3 increase in NO2 concentration,the excess risk(ER)of outpatient visits for atopic dermatitis was 1.95%(95% CI=1.09%-2.82%,P=0.01).SO2 had the most significant effect on lag6,and the outpatient visits increased by 1.55%(95% CI=0.48%-2.54%)for every 10 µg/m3 rise in SO2 concentration(P=0.02).Females were more sensitive to PM10 and SO2 than males.For every 10 µg/m3 increase in PM10 and SO2,the female outpatient visits increased by 0.02% and 2.47%,respectively.Males were sensitive to PM2.5 and NO2,and the every 10 µg/m3 rise in PM2.5 and NO2 increased male outpatient visits by 0.47% and 1.78%,respectively.Gaseous pollutants(NO2 and SO2)had more significant effect on people ≤2 years old than on those of other ages.Every 10 µg/m3 rise in NO2 and SO2 would increase the ≤2-year-old outpatient visits by 2.35% and 1.57%,respectively(P=0.02).People of 13-59 years old were sensitive to NO2 concentration,and every 10 µg/m3 rise in NO2 concentration increased their visits by 1.39%.NO2 affected the outpatient visits during the cold and warm seasons,with the ER values of 2.35% and 1.89%,respectively(P=0.01).Particulate matter(PM2.5 and PM10)had the most obvious yet insignificant association with the outpatient visits in winter.The interactions between PM2.5 and NO2,between PM10 and NO2,and between SO2 and NO2 affected the total outpatient visits for atopic dermatitis.The results of double pollutant model showed that in the presence of PM2.5,PM10,or SO2,the effect of NO2 on the outpatient visits for atopic dermatitis enhanced compared with that predicted by single pollutant model(P=0.01). Conclusion The air pollutants(PM2.5,PM10,NO2,and SO2)in Lanzhou were closely related to the outpatient visits for atopic dermatitis,and the increased concentrations of NO2 and SO2 was more likely to increase the risk of atopic dermatitis.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Dermatite Atópica , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Pré-Escolar , China , Dermatite Atópica/epidemiologia , Feminino , Humanos , Masculino , Pacientes Ambulatoriais , Material Particulado/efeitos adversos , Material Particulado/análise
6.
PLoS One ; 16(9): e0257018, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34473782

RESUMO

BACKGROUND: The COVID-19 pandemic has presented emergency medical services (EMS) worldwide with the difficult task of identifying patients with COVID-19 and predicting the severity of their illness. The aim of this study was to investigate whether physiological respiratory parameters in pre-hospital patients with COVID-19 differed from those without COVID-19 and if they could be used to aid EMS personnel in the prediction of illness severity. METHODS: Patients with suspected COVID-19 were included by EMS personnel in Uppsala, Sweden. A portable respiratory monitor based on pneumotachography was used to sample the included patient's physiological respiratory parameters. A questionnaire with information about present symptoms and background data was completed. COVID-19 diagnoses and hospital admissions were gathered from the electronic medical record system. The physiological respiratory parameters of patients with and without COVID-19 were then analyzed using descriptive statistical analysis and logistic regression. RESULTS: Between May 2020 and January 2021, 95 patients were included, and their physiological respiratory parameters analyzed. Of these patients, 53 had COVID-19. Using adjusted logistic regression, the odds of having COVID-19 increased with respiratory rate (95% CI 1.000-1.118), tidal volume (95% CI 0.996-0.999) and negative inspiratory pressure (95% CI 1.017-1.152). Patients admitted to hospital had higher respiratory rates (p<0.001) and lower tidal volume (p = 0.010) compared to the patients who were not admitted. Using adjusted logistic regression, the odds of hospital admission increased with respiratory rate (95% CI 1.081-1.324), rapid shallow breathing index (95% CI 1.006-1.040) and dead space percentage of tidal volume (95% CI 1.027-1.159). CONCLUSION: Patients taking smaller, faster breaths with less pressure had higher odds of having COVID-19 in this study. Smaller, faster breaths and higher dead space percentage also increased the odds of hospital admission. Physiological respiratory parameters could be a useful tool in detecting COVID-19 and predicting hospital admissions, although more research is needed.


Assuntos
COVID-19/diagnóstico , Serviços Médicos de Emergência/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Infecções Respiratórias/diagnóstico , Inquéritos e Questionários , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/virologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Prospectivos , Infecções Respiratórias/fisiopatologia , SARS-CoV-2/fisiologia , Suécia
7.
Neurology ; 97(10): e988-e995, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34489348

RESUMO

OBJECTIVE: Health care delivery systems transformed rapidly at the beginning of the coronavirus disease 2019 (COVID-19) pandemic to slow the spread of the virus while identifying novel methods for providing care. In many ways, the pandemic affected both persons with neurologic illness and neurologists. This study describes the perspectives and experiences of community neurologists providing care for patients with neurodegenerative illnesses during the COVID-19 pandemic. METHODS: We conducted a qualitative study with 20 community neurologists from a multisite comparative-effectiveness trial of outpatient palliative care from July 23, 2020, to November 11, 2020. Participants were interviewed individually about the impact of the coronavirus disease 2019 (COVID-19) pandemic on their professional and personal lives. Interviews were analyzed with matrix analysis to identify key themes. RESULTS: Four main themes illustrated the impact of the pandemic on community neurologists: (1) challenges of the current political climate, (2) lack of support for new models of care, (3) being on the frontline of suffering, and (4) clinician self-care. Taken together, the themes capture the unusual environment in which community neurologists practice, the lack of clinician trust among some patients, patient and professional isolation, and opportunities to support quality care delivery. CONCLUSIONS: The COVID-19 pandemic and pandemic politics created an environment that made care provision challenging for community neurologists. Efforts to improve care delivery should proactively work to reduce clinician burnout while incorporating support for new models of care adopted due to the pandemic. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov identifier: NCT03076671.


Assuntos
COVID-19 , Doenças Neurodegenerativas , Neurologistas , Humanos , Doenças Neurodegenerativas/complicações , Pacientes Ambulatoriais , Pesquisa Qualitativa , SARS-CoV-2
8.
Swiss Med Wkly ; 151: w30021, 2021 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-34495604

RESUMO

BACKGROUND: Healthcare workers are more frequently exposed to SARS-CoV-2 than the general population. Little is known about healthcare settings outside of hospitals. We studied the seroprevalence of SARS-CoV-2 among healthcare workers in outpatient facilities and retirement or nursing homes in the Canton of Solothurn, Switzerland in the first wave of the COVID-19 pandemic. METHODS: Longitudinal seroprevalence study among healthcare workers with examinations at baseline and 2 months between June and September 2020. The Abbott SARS-CoV-2 IgG and Liaison/Diasorin SARS-CoV-2 S1/S2 IgG assay were used to detect antibodies against SARS-CoV-2. All participants provided demographic information. We report descriptive statistics and calculated the seroprevalence with 95% confidence intervals. RESULTS: We included 357 healthcare workers; their median age was 43 years (interquartile range 29-54), and 315 (88.2%) were female. Forty-nine (13.7%) were physicians, 87 (24.4%) practice assistants and 221 (61.9%) nurses. Overall seroprevalence among healthcare workers in outpatient facilities and retirement or nursing homes was 3.4% (12/357). The 12 seropositive healthcare workers were all nurses (12/221, 5.5%); 11 worked at retirement or nursing homes and one at the hospital's outpatient clinic. Symptoms such as loss of smell or taste, shortness of breath, and fever were more prevalent among seropositive healthcare workers than seronegative healthcare workers. No close contact had detectable antibodies against SARS-CoV-2. CONCLUSIONS: Seroprevalence among healthcare workers was low, but higher among nursing staff of retirement or nursing homes. Healthcare workers at private practices were able to protect themselves well during the first wave of the COVID-19 pandemic.


Assuntos
COVID-19 , SARS-CoV-2 , Adulto , Anticorpos Antivirais , Feminino , Pessoal de Saúde , Humanos , Casas de Saúde , Pacientes Ambulatoriais , Pandemias , Aposentadoria , Estudos Soroepidemiológicos , Suíça/epidemiologia
9.
Praxis (Bern 1994) ; 110(11): 625-628, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34465191

RESUMO

Outpatient Management of Primary Spontaneous Pneumothorax Abstract. Pneumothorax (PT) is defined as a collapse of the lung due to the collection of air in the pleural space. In primary spontaneous pneumothorax (PSP) there is no underlying pulmonary pathology. Treatment, either conservative or invasive, depends on the size of the PT, the patient's clinical situation and the patient's setting/environment. According to the actual literature, the uncomplicated PSP can at best be treated conservatively and on an outpatient basis. Management with intervention (needle aspiration or chest drainage) is historically carried out on an inpatient basis, but outpatient management (without comorbidities and without symptoms) is also possible. In these cases, the patient compliance (motivation, cognition, support, housing situation …) has to be proven. For outpatient management with intervention, a small-caliber chest tube (<14 F) with a Heimlich valve should be used.


Assuntos
Pneumotórax , Tubos Torácicos , Drenagem , Humanos , Pacientes Ambulatoriais , Pneumotórax/diagnóstico , Pneumotórax/terapia
10.
JNMA J Nepal Med Assoc ; 59(238): 564-570, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34508405

RESUMO

INTRODUCTION: Adolescence is the time when most mental illness begins most of the time these problems are overlooked leading to increased morbidity and mortality. The study is undertaken to find out the prevalence of psychiatric disorders in adolescents attending psychiatry outpatient department in a tertiary hospital. METHODS: A descriptive cross-sectional study was done from 1st December 2019 to 29th November 2020 at a tertiary care centre of Kathmandu. Ethical approval (Ref No.: 012-076/077) was taken from the Institution Review Committee. A semi-structured proforma was used for the socio-demographic profile of patients and International Classification of Diseases-10 was used to make the diagnosis. Data were analyzed using Statistical Package for the Social Sciences version 16. RESULTS: A total of 174 adolescents were included in the study. Out of the total cases 141 (81.03%) (75.1-86.8 at 95% Confidence Interval) were diagnosed with psychiatric disorders, among them 73 (51.77%) were males and 68 (48.23%) were females. The common diagnoses were anxiety disorders 63 (36.20%), mood disorders 34 (19.54%), psychotic disorders 26 (14.94%), substance use disorders 8 (4.59%), non-organic sleep disorders 5 (2.87%), behavioral and emotional disorders 3 (1.72%) and mental retardation 2 (1.149%). CONCLUSIONS: Prevalence of psychiatric illnesses is high in the adolescent population compared to the similar studies.


Assuntos
Transtornos Mentais , Psiquiatria , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pacientes Ambulatoriais , Centros de Atenção Terciária
11.
JNMA J Nepal Med Assoc ; 59(237): 432-436, 2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34508420

RESUMO

INTRODUCTION: The nose is the central most part of the face, so any nasal deformities may cause a high level of psychological distress on one's quality of life. Septorhinoplasty is a surgical procedure used to correct both functional as well as aesthetic problems of the nose. It enhances facial harmony and increases self-confidence. The objective of this study is to find out the prevalence of out-patients who underwent septorhinoplasty in a tertiary care centre in Nepal. METHODS: A descriptive cross-sectional study among 5,760 patients who visited the outpatient department of Otolaryngology-Head and Neck Surgery of Kathmandu Medical College from April 2019 to September 2020. Ethical approval was taken from the Institutional Committee of Kathmandu Medical College. A convenient sampling technique was used. The preoperative and postoperative assessment was done with the help of a rhinoplasty outcome evaluation questionnaire. Statistical Package for the Social Sciences is used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: The prevalence of septorhinoplasty was 117 (2.03%) during the study period (95% Confidence Interval= 1.66-2.40). Among 117 patients, 67 (57.3%) were males and 50 (42.7%) were females. Among 117 patients, 85 (72.6%) patients underwent an open approach, while 32 (27.4%) patients underwent closed approach rhinoplasty for the correction of both aesthetic and functional problems. CONCLUSIONS: This study concludes the prevalence of septorhinoplasty is low which may be due to the COVID-19 pandemic during the study period.


Assuntos
COVID-19 , Otolaringologia , Rinoplastia , Estudos Transversais , Feminino , Humanos , Masculino , Pacientes Ambulatoriais , Pandemias , Qualidade de Vida , SARS-CoV-2 , Centros de Atenção Terciária
12.
JNMA J Nepal Med Assoc ; 59(237): 450-453, 2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34508426

RESUMO

INTRODUCTION: Onychomycosis is a fungal disease of the nail apparatus caused by dermatophytes, non-dermatophytes and yeasts. Although onychomycosis is rarely life threatening, its high incidence and the associated morbidity makes it an important public health problem. This study was aimed to find the prevalence of onychomycosis among clinically suspected patients attending the outpatient department of Dermatology and Venereology. METHODS: A descriptive cross-sectional study was done in a total of 200 clinically suspected cases of onychomycosis attending the Dermatology outpatient department of a tertiary care hospital within the period of one year from 1st September 2019 to 31st August 2020. Ethical approval (Reference: 150320196) was taken and convenience sampling was done. Data were analyzed using Statistical Package for Social Sciences version 19. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 200 clinically suspected cases prevalence of onychomycosis was found to be 40 (20%) (Confidence Interval = 19.94-20.06) by both direct microscopy and culture. Onychomycosis was commonest among age group of 21-40 years and more predominant among male patients 60 (65.21%). The fingernails were frequently involved i.e., 58 (63%) cases followed by toenails 34 (21%). Dermatophytes were the most common type of fungal infection accounting for 25 (62.5%). CONCLUSIONS: The study highlighted dermatophytes as the most common clinical pattern of onychomycosis and Trichophyton rubrum as the most common aetiological agent causing onychomycosis.


Assuntos
Dermatologia , Onicomicose , Adulto , Arthrodermataceae , Estudos Transversais , Humanos , Masculino , Onicomicose/diagnóstico , Onicomicose/epidemiologia , Pacientes Ambulatoriais , Centros de Atenção Terciária , Adulto Jovem
13.
Int J Chron Obstruct Pulmon Dis ; 16: 2397-2406, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34465987

RESUMO

Background: Beta-blockers have been proposed to improve COPD-related outcomes, yet studies report conflicting results. We aimed to investigate the effect of beta blockers on time-to-first exacerbation and all-cause mortality in high-risk COPD outpatients. Methods: All COPD outpatients managed at the Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Denmark in 2016 were followed for 3.5 years in this retrospective, registry-based cohort study. Outcomes were time-to-first acute exacerbation of COPD (AECOPD) or death. The association was estimated using time-varying crude and multivariable Cox proportional hazard regression adjusted for age, sex, BMI, use of COPD medication, smoking status, cardiovascular disease and COPD severity. Results: The cohort comprised 950 COPD outpatients, mean age 71 (SD 11) years, and FEV1 44% predicted (IQR 33%; 57%). The annual exacerbation rate was 0.88 (SD 1.68) and 211 patients (22%) had a history of hospitalization requiring AECOPD within 12 months. Of the enrolled patients, 247 (26%) were prescribed beta blockers. Beta-blocker use was associated, although with borderline significance, with increased all-cause mortality (HR 1.37 (95% CI, 0.99 to 1.89, p = 0.059)). On the other hand, beta blocker use did not reduce the risk of AECOPD (HR = 0.89 (95% CI 0.71 to 1.10; p = 0.270)), which remained non-significant after stratifying for severity of exacerbations. Conclusion: We found an association between beta blocker use and all-cause mortality in high-risk COPD outpatients. No association was found between beta blocker use and risk of AECOPD.


Assuntos
Pacientes Ambulatoriais , Doença Pulmonar Obstrutiva Crônica , Idoso , Estudos de Coortes , Progressão da Doença , Humanos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Estudos Retrospectivos
14.
J Opioid Manag ; 17(7): 167-170, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34520038

RESUMO

Buprenorphine (BPN), FDA approved for opioid use disorder (OUD), requires an induction protocol for the patient in mild to moderate withdrawal. This can be problematic in outpatient practice due to complicated medical management. An emerging technique in literature uses a novel approach, called microinduction. In this method, escalating microdoses of BPN are administered, without requiring the patient to stop the opioid agonist. Our addiction treatment center used a microdosing technique to transit patients from methadone to BPN, without requiring opioid abstinence. Our case series is novel as it was outpatient microinduction from methadone to BPN in 7 days or less.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Buprenorfina/uso terapêutico , Humanos , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Pacientes Ambulatoriais
15.
Z Kinder Jugendpsychiatr Psychother ; 49(5): 334-348, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34503362

RESUMO

Diagnostic work with the conflict axis of the OPD-CA: Empirical results on inpatients and outpatients Abstract. In recent years, the Operationalized Psychodynamic Diagnostics (OPD-CA) is increasingly being used in child and adolescent psychiatry and psychotherapy. This article presents the conflict axis of the OPD-CA, which contains an operationalization of seven psychodynamic conflicts and the processing modes assigned to them. It describes empirical comparisons of the conflict axis ratings and the structure rating in a group of outpatient and inpatient children and adolescents (total N = 186, 12.7 years, 54 % female). The findings in the total sample show that diagnosis-specific gender differences are disappearing, and that male and female patients have largely similar intrapsychic development-impairing conflicts. Patients in inpatient treatment in a child and adolescent psychiatry institution, however, more often show a self-conflict and, as expected, have a lower structural level than patients of the same age in outpatient psychotherapy. The number of highly stressful events before the start of therapy is also significantly higher in this group, which may have contributed to the structural deficits. For outpatients, there is a strikingly higher level of guilt and identity conflicts. In both samples, the mode of processing the conflicts is largely passive. Based on these findings, possible implications for therapeutic practice are discussed.


Assuntos
Pacientes Internados , Terapia Psicanalítica , Adolescente , Psiquiatria do Adolescente , Criança , Feminino , Hospitalização , Humanos , Masculino , Pacientes Ambulatoriais , Psicoterapia
16.
BMJ Open ; 11(9): e049570, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493518

RESUMO

OBJECTIVES: Patient satisfaction is an important indicator of hospital healthcare quality. Little up-to-date information of patient satisfaction in China is available. This study attempts to gain a holistic understanding of patient satisfaction in China and identify the key antecedents of patient satisfaction. DESIGN: A cross-sectional national survey was conducted in 2018. SETTING: Hospitals in 27 provinces and 4 municipalities in 4 regions of China. PARTICIPANTS: A random sample of 15 699 patients who visited 1304 hospitals were surveyed, with around 500 from each of the 27 provinces and 4 municipalities. PRIMARY AND SECONDARY OUTCOME MEASURES: The Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire was used to measure patients' overall satisfaction and willingness to recommend the hospital. RESULTS: We found significant variation in overall patient satisfaction but little variation in hospital recommendation across the four broad regions. Moreover, we examined determinants of patient satisfaction and their likelihood to recommend the hospital. The overall satisfaction for inpatients and outpatients is commonly influenced by communication with doctors (inpatient: ß=0.524, p<0.001; outpatient: ß=0.541, p<0.001), hospital cleanness (inpatient: ß=0.165, p<0.05; outpatient: ß=0.144, p<0.001) and acceptable charges (inpatient: ß=1.481, p<0.001; outpatient: ß=1.045, p<0.001). Both inpatients and outpatients are more likely to recommend the hospital if there are communication with doctors (inpatient: OR=1.743, p<0.001; outpatient: OR=1.647, p<0.001), acceptable charges (inpatient: OR=2.660, p<0.001; outpatient: OR=2.433, p<0.001). Outpatient satisfaction and hospital recommendation are also influenced by time spent with doctors (satisfaction: ß=0.301, p<0.001; recommend: OR=1.430, p<0.001) and waiting time (satisfaction: ß=-0.318, p<0.001; recommend: OR=0.844, p<0.001). CONCLUSIONS: There are regional differences of patient satisfaction in China. Patient satisfaction is influenced by a variety of hospital factors and province/municipality factors. The influencing factors of patient satisfaction may not motivate patients to recommend the hospital.


Assuntos
Pacientes Ambulatoriais , Satisfação do Paciente , China , Estudos Transversais , Humanos , Pacientes Internados , Inquéritos e Questionários
17.
BMJ Open ; 11(9): e051107, 2021 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-34497085

RESUMO

INTRODUCTION: Multimorbidity refers to the presence of two or more chronic non-communicable diseases (NCDs) in a given individual. It is associated with premature mortality, lower quality of life (QoL) and greater use of healthcare resources. The burden of multimorbidity could be huge in the low and middle-income countries (LMICs), including Ethiopia. However, there is limited evidence on the magnitude of multimorbidity, associated risk factors and its effect on QoL and functionality. In addition, the evidence base on the way health systems are organised to manage patients with multimorbidity is sparse. The knowledge gleaned from this study could have a timely and significant impact on the prevention, management and survival of patients with NCD multimorbidity in Ethiopia and in LMICs at large. METHODS AND ANALYSIS: This study has three phases: (1) a cross-sectional quantitative study to determine the magnitude of NCD multimorbidity and its effect on QoL and functionality, (2) a qualitative study to explore organisation of care for patients with multimorbidity, and (3) a longitudinal quantitative study to investigate disease progression and patient outcomes over time. A total of 1440 patients (≥40 years) on chronic care follow-up will be enrolled from different facilities for the quantitative studies. The quantitative data will be collected from multiple sources using the KoBo Toolbox software and analysed by STATA V.16. Multiple case study designs will be employed to collect the qualitative data. The qualitative data will be coded and analysed by Open Code software thematically. ETHICS AND DISSEMINATION: Ethical clearance has been obtained from the College of Medicine and Health Sciences, Bahir Dar University (protocol number 003/2021). Subjects who provide written consent will be recruited in the study. Confidentiality of data will be strictly maintained. Findings will be disseminated through publications in peer-reviewed journals and conference presentations.


Assuntos
Doenças não Transmissíveis , Assistência Ambulatorial , Estudos Transversais , Etiópia/epidemiologia , Humanos , Multimorbidade , Doenças não Transmissíveis/epidemiologia , Doenças não Transmissíveis/terapia , Pacientes Ambulatoriais , Qualidade de Vida
18.
J Oral Rehabil ; 48(10): 1173-1182, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34346106

RESUMO

BACKGROUND: Oral hypofunction is defined as the reversible stage preceding oral dysfunction. However, its assessment and management need further examination and consideration. OBJECTIVE: The present study aimed to examine the current state of oral hypofunction among outpatients at the university hospital. METHODS: New outpatients underwent medical interviews and detailed assessment of oral hypofunction at their initial visit to our dental department. Oral hypofunction was diagnosed if the results of three of the following seven assessment items were below cut-off values: poor oral hygiene, oral dryness, reduced occlusal force, decreased tongue-lip motor function, decreased tongue pressure, decreased masticatory function and deterioration of swallowing function. The relationships between factors used to diagnose oral hypofunction as well as the distributions of assessment values were clarified. RESULTS: Seventy-five of 209 patients (35.9%) were finally diagnosed with oral hypofunction. Diagnosis of oral hypofunction was significantly related to patient age, Eichner index, a chief complaint of dental or periodontal disease or ill-fitting dentures and a history of neurodegenerative disease. The lowest quintile values for poor oral hygiene, oral dryness and decreased masticatory performance were all above current cut-off values. Reduced occlusal force contributed strongly to the diagnosis of oral hypofunction. CONCLUSION: Oral hypofunction in dental outpatients at a university hospital was associated with patient age, medical history and chief complaint at presentation. Diagnosis of oral hypofunction can be closely related to reduced occlusal force. The validity of cut-off values for assessments of oral hypofunction needs further consideration.


Assuntos
Doenças Neurodegenerativas , Pacientes Ambulatoriais , Idoso , Estudos Transversais , Hospitais , Humanos , Pressão , Língua
19.
Stomatologiia (Mosk) ; 100(4): 88-97, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34357735

RESUMO

BACKGROUND: In the article presented data about organization of the medical care over a period of 10 months at the Municipal Public Dental clinic in the metropolitan city such as Saint-Petersburg to the patients diagnosed with new coronavirus infection. AIM: Organization of the medical ambulatory care to the patients diagnosed with new coronavirus infection. MATERIALS AND METHODS: Layout decisions were utilized that enabled to organize the reception of patients infected with SARS-CoV-2 without disrupting the scheduled mode of treatment of the dental patients. Saint Petersburg Budgetary Healthcare Facility «Municipal Dental Clinic N 33¼ provided dental service to 191 patients with COVID-19. RESULTS: Whereas 159 patients were admitted for treatment at the contagious isolation ward, 89 patients were consulted via the use of telehealth technology and among them 39 received telemedical assistance service. Mean age of the patients treated in the isolated ward: children 8.6±3.6, adults 39.1±13.8 years. People of active working age comprised 72% of all adult patients. Males filed for dental assistance more than females (54%). ICD K04.5 was established diagnosis in 52% of cases. CONCLUSIONS: We managed to demonstrate high efficiency in utilizing telehealth technology. An issue of organizing medical dental care at the II level healthcare institution for adult population and for children diagnosed with new coronavirus infection COVID-19 in the heavy populated metropolis was solved.


Assuntos
COVID-19 , SARS-CoV-2 , Adulto , Criança , Assistência Odontológica , Clínicas Odontológicas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais
20.
Artigo em Inglês | MEDLINE | ID: mdl-34360505

RESUMO

The COVID-19 pandemic has affected outpatient caregivers in a particular way. While the German population becomes increasingly older, the number of people in need of care has also increased. The health and, thus, the health behaviour of employees in the outpatient care become relevant to maintain working capacity and performance in the long term. The aims of the study were (1) to examine the health behaviour and (2) to explore pandemic-related perceived change of health behaviour among outpatient caregivers during the COVID-19 pandemic. In a mixed-methods study, 15 problem-centred interviews and a web-based cross-sectional survey (N = 171) were conducted with outpatient caregivers working in Northern Germany. Interviewees reported partially poorer eating behaviour, higher coffee consumption, lower physical activity, skipping breaks more often and less sleep duration and quality during the pandemic. Some quantitative findings indicate the same tendencies. A majority of participants were smokers and reported higher stress perception due to the pandemic. Preventive behaviour, such as wearing PPE or hand hygiene, was increased among interviewees compared to the pre-pandemic period. Our findings indicate that the COVID-19 pandemic could negatively affect outpatient caregivers' health behaviour, e.g., eating/drinking behaviour and physical activity. Therefore, employers in outpatient care should develop workplace health promotion measures to support their employees in conducting more health-promoting behaviours during the COVID-19 pandemic.


Assuntos
COVID-19 , Pandemias , Cuidadores , Estudos Transversais , Comportamentos Relacionados com a Saúde , Humanos , Pacientes Ambulatoriais , SARS-CoV-2 , Inquéritos e Questionários
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