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1.
BMC Surg ; 20(1): 222, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008379

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been declared a global pandemic by the World Health Organization. Patients with cancer are more likely to incur poor clinical outcomes. Due to the prevailing pandemic, we propose some surgical strategies for gastric cancer patients. METHODS: The 'COVID-19' period was defined as occurring between 2020 and 01-20 and 2020-03-20. The enrolled patients were divided into two groups, pre-COVID-19 group (PCG) and COVID-19 group (CG). A total of 109 patients with gastric cancer were enrolled in this study. RESULTS: The waiting time before admission increased by 4 days in the CG (PCG: 4.5 [IQR: 2, 7.8] vs. CG: 8.0 [IQR: 2,20]; p = 0.006). More patients had performed chest CT scans besides abdominal CT before admission during the COVID-19 period (PCG: 22 [32%] vs. CG: 30 [73%], p = 0.001). After admission during the COVID period, the waiting time before surgery was longer (PCG: 3[IQR: 2,5] vs. CG: 7[IQR: 5,9]; p < 0.001), more laparoscopic surgeries were performed (PCG: 51[75%] vs. CG: 38[92%], p = 0.021), and hospital stay period after surgery was longer (7[IQR: 6,8] vs.9[IQR:7,11]; p < 0.001). In addition, the total cost of hospitalization increased during this period, (PCG: 9.22[IQR:7.82,10.97] vs. CG: 10.42[IQR:8.99,12.57]; p = 0.006). CONCLUSION: This study provides an opportunity for our surgical colleagues to reflect on their own services and any contingency plans they may have to tackle the COVID-19 crisis.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Seleção de Pacientes , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Padrões de Prática Médica , Utilização de Procedimentos e Técnicas , Estudos Retrospectivos
2.
J Cancer Res Ther ; 16(5): 974-978, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33004737

RESUMO

The pandemic of coronavirus disease 2019 (COVID-19) has become a major public health threat to the whole world. Although the control of COVID-19 has been in the forefront of interventional practice, most interventional radiologists (IRs) are not equipped adequately to cope with such a crisis. In this review, we share our experience from Chinese IRs' perspective, report on the acute measures instituted within interventional radiology (IR) units, and give recommendations to the prevention and control of COVID-19.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/normas , Pandemias/prevenção & controle , Equipamento de Proteção Individual/normas , Pneumonia Viral/prevenção & controle , Padrões de Prática Médica/normas , Radiologia Intervencionista/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Radiologia Intervencionista/instrumentação
3.
Vet Rec ; 187(7): 278, 2020 10 03.
Artigo em Inglês | MEDLINE | ID: mdl-33008985
5.
Am Surg ; 86(8): 916-925, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32926795

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic dramatically altered the delivery of surgical care. METHODS: Members of the Southeastern Surgical Congress were surveyed regarding system adjustments, personal impact, and productivity losses. Subgroups were analyzed for disproportionate impact across practice models (academic/employed/private), practice communities (urban, suburban, rural), and practice case-mix categories (broad general surgery, narrow general surgery, specialty practice, hospital-based practice). RESULTS: 135 respondents reported that 98.5% of surgeons and 97% of hospitals canceled elective cases. Practices and hospitals reduced staffing dramatically. Telemedicine was utilized by most respondents. Hospitals variably implemented system changes, developed tests, and set up diagnostic centers. Most surgeons anticipated resumption of practice and hospital activity by July 1, 2020. More than one-quarter reported worsened financial status and personal well-being. Interestingly, family/personal relationships were improved in more than one-third. Most surgeons anticipate reduced year-end case volumes, clinical productivity, and salary. In subgroup analyses, academic surgeons were more likely than employed and private-practice surgeons to use telemedicine and to work in hospitals with in-house COVID-19 testing. Private-practice surgeons expected decreased financial status, case volumes, relative value units (RVUs), and salary. More rural surgeons anticipate reduced salary than urban and suburban surgeons. Surgeons in narrow general surgery practice reported more furlough of employees than specialty surgeons, hospital-based surgeons, and broad-based general surgeons. Narrow-practice surgeons and specialists were more likely to report RVU reductions and improved family/personal relationships. DISCUSSION: The COVID-19 slowdown affected surgeons throughout the southeastern United States. Variations between different practice models, communities, and case-mix categories may help inform surgeons in the future.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Sudeste dos Estados Unidos , Inquéritos e Questionários , Telemedicina
6.
Artigo em Alemão | MEDLINE | ID: mdl-32940747

RESUMO

BACKGROUND: Pediatric outpatients with respiratory tract infections (RTIs) comprise an important target population for antibiotic stewardship (ABS) intervention. OBJECTIVES: The aim of this qualitative study was to determine which clinical and contextual factors have a significant impact on antibiotic therapy (ABT) in pediatric patients with RTIs. MATERIALS AND METHODS: An online survey was developed and carried out in Germany in cooperation with the Federal Association of Pediatricians and the German Society for Pediatric Infectious Diseases. Pediatricians and general practitioners were invited to participate. RESULTS: The survey yielded 555 complete response data sets. Diagnostic uncertainty, time constraints for repeated consultations, and fear of complications were identified by 50% of both medical specialties as contextual factors fostering ABT. The risk of serious complications (e.g., mastoiditis) was overestimated by the majority of participants. More than 40% of respondents lacked knowledge concerning official guidelines, and RTIs with fever lasting longer than three days appeared to be an important criterion for ABT for 30-40%. Fewer than 60% of physicians were using a point-of-care device to determine C­reactive protein. CONCLUSION: Although most participants acknowledged the growing prevalence of antibiotic-resistant pathogens as an important problem, this survey identifies targets for ABS in pediatric outpatients with RTIs. Ongoing education and training (e.g., better communication strategies in response to parental concerns) should become mandatory for those who prescribe ABT for children with RTIs.


Assuntos
Clínicos Gerais , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Antibacterianos/uso terapêutico , Criança , Alemanha , Humanos , Pacientes Ambulatoriais , Pediatras , Padrões de Prática Médica , Inquéritos e Questionários
8.
Am Surg ; 86(8): 1010-1014, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32997952

RESUMO

INTRODUCTION: Failure to perform adequate fasciotomy for a presumed or diagnosed compartment syndrome after revascularization of an acutely ischemic limb is a potential cause of preventable limb loss. When required, outcomes are best when fasciotomy is conducted with the initial vascular repair. Despite over 100 years of experience with fasciotomy, the actual indications for its performance among acute care and trauma surgeons performing vascular repairs are unclear. The hypothesis of this study was that there are many principles of fasciotomy that are uniformly accepted by surgeons and that consensus guidelines could be developed. METHODS: A 20-question survey on fasciotomy practice patterns was distributed to trauma and acute care surgeons of a major surgical society which had approved distribution. RESULTS: The response to the survey was 160/1066 (15 %). 92.5% of respondents were fellowship trained in trauma and acute care surgery, and 74.9% had been in practice for fewer than 10 years. Most respondents (71.9%) stated that they would be influenced to perform a preliminary fasciotomy (fasciotomy conducted prior to planned exploration and arterial repair) based upon specific signs and symptoms consistent with compartment syndrome-including massive swelling (55.6%), elevated compartment pressures (52.5%), delay in transfer >6 hours (47.5%), or obvious distal ischemia (33.1%). 20.6% responded that they would conduct exploration and repair first, regardless of these considerations. Prophylactic fasciotomies (fasciotomy without overt signs of compartment syndrome) would be performed by respondents in the setting of the tense compartment (87.5%), ischemic time >6 hours (88.1%), measurement of elevated compartment pressures (66.9%), and in the setting of large volume resuscitation requirements (31.3%). 69.4% of respondents selectively measure compartment pressures, with nearly three-fourths utilizing a Stryker needle device (72.5%). The most common sequence of repairs following superficial femoral artery injury with a >6-hour limb ischemia was cited as the initial insertion of a shunt, followed by fasciotomy, then vein harvest, and finally interposition repair. CONCLUSIONS: While there is some general consensus on indications for fasciotomy, there is marked heterogeneity in surgeons' opinions on the precise indications in selected scenarios. This is particularly surprising in light of the long history with fasciotomy in association with major arterial repairs and strongly suggests the need for a consensus conference and/or meta-analysis to guide further care.


Assuntos
Artérias/lesões , Síndromes Compartimentais/cirurgia , Fasciotomia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/complicações , Artérias/cirurgia , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/prevenção & controle , Fasciotomia/métodos , Humanos , Inquéritos e Questionários , Traumatologia , Estados Unidos , Lesões do Sistema Vascular/cirurgia
9.
West J Emerg Med ; 21(5): 1095-1101, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32970560

RESUMO

The unprecedented COVID-19 pandemic has resulted in rapidly evolving best practices for transmission reduction, diagnosis, and treatment. A regular influx of new information has upended traditionally static hospital protocols, adding additional stress and potential for error to an already overextended system. To help equip frontline emergency clinicians with up-to-date protocols throughout the evolving COVID-19 crisis, our team set out to create a dynamic digital tool that centralized and standardized resources from a broad range of platforms across our hospital. Using a design thinking approach, we rapidly built, tested, and deployed a solution using simple, out-of-the-box web technology that enables clinicians to access the specific information they seek within moments. This platform has been rapidly adopted throughout the emergency department, with up to 70% of clinicians using the digital tool on any given shift and 78.6% of users reporting that they "agree" or "strongly agree" that the platform has affected their management of COVID-19 patients. The tool has also proven easily adaptable, with multiple protocols being updated nearly 20 times over two months without issue. This paper describes our development process, challenges, and results to enable other institutions to replicate this process to ensure consistent, high-quality care for patients as the COVID-19 pandemic continues its unpredictable course.


Assuntos
Betacoronavirus , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/terapia , Sistemas de Apoio a Decisões Clínicas , Serviços Médicos de Emergência/métodos , Pneumonia Viral/terapia , Atitude do Pessoal de Saúde , Protocolos Clínicos , Árvores de Decisões , Eficiência , Emergências , Humanos , Internet , Pandemias , Padrões de Prática em Enfermagem/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Desenvolvimento de Programas , São Francisco
10.
West J Emerg Med ; 21(5): 1283-1286, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32970587

RESUMO

While current research efforts focus primarily on identifying patient level interventions that mitigate the direct impact of COVID-19, it is important to consider the collateral effects of COVID-19 on antimicrobial resistance. Early reports suggest high rates of antibiotic utilization in COVID-19 patients despite their lack of direct activity against viral pathogens. The ongoing pandemic is exacerbating known barriers to optimal antibiotic stewardship in the ED, representing an additional direct threat to patient safety and public health. There is an urgent need for research analyzing overall and COVID-19 specific antibiotic prescribing trends in the ED. Optimizing ED stewardship during COVID-19 will likely require a combination of traditional stewardship approaches (e.g. academic detailing, provider education, care pathways) and effective implementation of host response biomarkers and rapid COVID-19 diagnostics. Antibiotic stewardship interventions with demonstrated efficacy in mitigating the impact of COVID-19 on ED prescribing should be widely disseminated and inform the ongoing pandemic response.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/métodos , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Serviço Hospitalar de Emergência , Prescrição Inadequada/prevenção & controle , Pneumonia Viral/tratamento farmacológico , Padrões de Prática Médica , Gestão de Antimicrobianos/organização & administração , Gestão de Antimicrobianos/estatística & dados numéricos , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Diagnóstico Diferencial , Serviço Hospitalar de Emergência/organização & administração , Humanos , Prescrição Inadequada/estatística & dados numéricos , Pandemias , Pneumonia Viral/diagnóstico , Padrões de Prática Médica/estatística & dados numéricos
11.
PLoS Med ; 17(9): e1003336, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32956399

RESUMO

BACKGROUND: Research has questioned the safety of delaying or withholding antibiotics for suspected urinary tract infection (UTI) in older patients. We evaluated the association between antibiotic treatment for lower UTI and risk of bloodstream infection (BSI) in adults aged ≥65 years in primary care. METHODS AND FINDINGS: We analyzed primary care records from patients aged ≥65 years in England with community-onset UTI using the Clinical Practice Research Datalink (2007-2015) linked to Hospital Episode Statistics and census data. The primary outcome was BSI within 60 days, comparing patients treated immediately with antibiotics and those not treated immediately. Crude and adjusted associations between exposure and outcome were estimated using generalized estimating equations. A total of 147,334 patients were included representing 280,462 episodes of lower UTI. BSI occurred in 0.4% (1,025/244,963) of UTI episodes with immediate antibiotics versus 0.6% (228/35,499) of episodes without immediate antibiotics. After adjusting for patient demographics, year of consultation, comorbidities, smoking status, recent hospitalizations, recent accident and emergency (A&E) attendances, recent antibiotic prescribing, and home visits, the odds of BSI were equivalent in patients who were not treated with antibiotics immediately and those who were treated on the date of their UTI consultation (adjusted odds ratio [aOR] 1.13, 95% CI 0.97-1.32, p-value = 0.105). Delaying or withholding antibiotics was associated with increased odds of death in the subsequent 60 days (aOR 1.17, 95% CI 1.09-1.26, p-value < 0.001), but there was limited evidence that increased deaths were attributable to urinary-source BSI. Limitations include overlap between the categories of immediate and delayed antibiotic prescribing, residual confounding underlying differences between patients who were/were not treated with antibiotics, and lack of microbiological diagnosis for BSI. CONCLUSIONS: In this study, we observed that delaying or withholding antibiotics in older adults with suspected UTI did not increase patients' risk of BSI, in contrast with a previous study that analyzed the same dataset, but mortality was increased. Our findings highlight uncertainty around the risks of delaying or withholding antibiotic treatment, which is exacerbated by systematic differences between patients who were and were not treated immediately with antibiotics. Overall, our findings emphasize the need for improved diagnostic/risk prediction strategies to guide antibiotic prescribing for suspected UTI in older adults.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/etiologia , Infecções Urinárias/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Registros Eletrônicos de Saúde , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pacientes , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Fatores de Risco
12.
Tex Med ; 116(8): 43-44, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32866277

RESUMO

First, the bad news: Physicians need to take some serious time between now and Jan 1, 2021, to study changes that are coming to Medicare outpatient evaluation and management (E&M) codes - changes most private insurers likely will follow. Now the good news: The changes should reduce the amount of documentation needed with each patient.


Assuntos
Medicare/normas , Pacientes Ambulatoriais , Padrões de Prática Médica/economia , Avaliação de Sintomas/normas , Documentação , Controle de Formulários e Registros , Humanos , Seguro Saúde , Visita a Consultório Médico/economia , Reembolso de Incentivo , Estados Unidos
14.
Arab J Gastroenterol ; 21(3): 156-161, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32912748

RESUMO

BACKGROUND & STUDY AIMS: Corona virus disease-19 (COVID-19) pandemic has markedly impacted routine medical services including gastrointestinal (GI) endoscopy. We aim to report the real-life performance in high volume GI endoscopy units during the pandemic. PATIENTS AND METHODS: A web-based survey covering all aspects of daily performance in GI endoscopy units was sent to endoscopy units worldwide. Responses were collected and data were analyzed to reveal the effect of COVID-19 pandemic on endoscopy practice. RESULTS: Participants from 48 countries (n = 163) responded to the survey with response rate of 67.35%. The majority (85%) decreased procedure volume by over 50%, and four endoscopy units (2.45%) completely stopped. The top three indications for procedures included upper GI bleeding (89.6%), lower GI bleeding (65.6%) and cholangitis (62.6%). The majority (93.9%) triaged patients for COVID-19 prior to procedure. N95 masks were used in (57.1%), isolation gowns in (74.2%) and head covers in (78.5%). Most centers (65%) did not extend use of N95 masks, however 50.9% of centers reused N95 masks. Almost all (91.4%) centers used standard endoscopic decontamination and most (69%) had no negative pressure rooms. Forty-two centers (25.8%) reported positive cases of SARS-CoV-2 infection among patients and 50 (30.7%) centers reported positive cases of SARS-CoV-2 infection among their healthcare workers. CONCLUSIONS: Most GI endoscopy centers had a significant reduction in their volume and most procedures performed were urgent. Most centers used the recommended personal protective equipment (PPE) by GI societies however there is still a possibility of transmission of SARS-CoV-2 infection in GI endoscopy units.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Endoscopia Gastrointestinal/estatística & dados numéricos , Controle de Infecções/organização & administração , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Utilização de Instalações e Serviços , Humanos , Pandemias/prevenção & controle , Seleção de Pacientes , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Inquéritos e Questionários
15.
Tex Med ; 116(8): 20-25, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32866271

RESUMO

Ricardo Garza, MD, was still walking the tightrope: standing, but unable to withstand another gust of wind. COVID-19 swept away about 35% of the San Antonio solo cardiologist's practice revenue, and that was just what he could calculate as he waited for insurers to process straggling claims. But he had returned to in-office operations without any layoffs. While some practices are surviving - and trying their best to prepare for future threats - others weren't so lucky. On-the-ground experiences align with the Texas Medical Association's Practice Viability Survey in showing COVID-19 was, and still is, a disruptor unlike any other - challenging or torpedoing the viability of various practice types.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Prática Profissional , Telemedicina , Betacoronavirus , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Tomada de Decisões Gerenciais , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , Inovação Organizacional , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/tendências , Prática Profissional/economia , Prática Profissional/tendências , Texas/epidemiologia
16.
Cien Saude Colet ; 25(9): 3413-3419, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32876249

RESUMO

When Covid-19 emerged in December last year, there was no vaccine nor was there specific effective treatment for this fast-spreading and life-threatening viral respiratory infection. Clinical trials were planned and are in progress to investigate whether drugs used for influenza, HIV and other viruses, and also anthelmintics (ivermectin, nitazoxanide, niclosamide), and antimalarials (chloroquine, hydroxychloroquine) showing antiviral activity in in vitro assays, are effective and safe for Covid-19. So far there is no convincing evidence that these antiviral and antiparasitic drugs are of any benefit for Covid-19. Notwithsanding the absence of evidence of clinical efficacy, these drugs are widely used outside of clinical trials (off label) for prophylaxis and treatment of this viral infection. The rationale behind the prescription of macrolide antibiotics (azithromycin) for Covid-19 is obscure as well. The widespread prescription and use of drugs of unproven efficacy and safety for Covid-19 is at odds with the rational use of medicines, a cornerstone principle of pharmacotherapy advanced by WHO in 1985. This irrational use of drugs is cause for concern because some of them are associated with serious heart disorders and deaths.


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Uso Off-Label , Pneumonia Viral/tratamento farmacológico , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Infecções por Coronavirus/virologia , Humanos , Prescrição Inadequada/estatística & dados numéricos , Pandemias , Pneumonia Viral/virologia , Padrões de Prática Médica/normas
17.
J Med Vasc ; 45(5): 288-293, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862987

RESUMO

BACKGROUND: The incidence of upper extremity deep vein thrombosis (UEDVT) is increasing. Its management is sometimes complex and difficult due to its complications and the lack of strong recommendations. The aim was to describe the practice of vascular physicians in Occitanie region in the management of upper extremity deep vein thrombosis. MATERIAL AND METHODS: We used a descriptive observational study in the form of a declarative survey by means of a questionnaire from April to May 2019 among vascular physicians. RESULTS: Of the 142 physicians contacted, 84 responded, with a reply rate of 59.1%. The majority of physicians introduced low-molecular-weight heparin treatment (60.71%) and 29.76% direct oral anticoagulation after a diagnosis of UEDVT. Three months of anticoagulation was chosen by 69% of physicians against 27.4% for a duration of 6 months. Diagnostic work-up included biological risk factors, chest and/or cervical radiography and ultrasonography with dynamic maneuvers. Three quarters of doctors recommended venous compression. A control ultrasonography was performed for 67.86% of patients at one month and at the end of treatment. After the acute phase, 63% of physicians introduced direct oral anticoagulation and 11% recommended venous revascularization. DISCUSSION AND CONCLUSIONS: The mobilization of vascular physicians reflects their interest for this pathology. The management of UEDVT requires specific studies to address therapeutic modalities, the duration of anticoagulation or the place of venous compression in the acute phase.


Assuntos
Anticoagulantes/administração & dosagem , Bandagens Compressivas/tendências , Heparina de Baixo Peso Molecular/administração & dosagem , Padrões de Prática Médica/tendências , Trombose Venosa Profunda de Membros Superiores/terapia , Procedimentos Cirúrgicos Vasculares/tendências , Administração Oral , Adulto , Esquema de Medicação , Inibidores do Fator Xa/administração & dosagem , França/epidemiologia , Pesquisas sobre Serviços de Saúde , Disparidades em Assistência à Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa Profunda de Membros Superiores/diagnóstico por imagem , Trombose Venosa Profunda de Membros Superiores/epidemiologia
20.
S Afr Med J ; 110(7): 613-616, 2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32880333

RESUMO

Faced with a pandemic, doctors around the world are forced to make difficult ethical decisions about clinical, economic and politically charged issues in medicine and healthcare, with little time or resources for support. A decision-making framework is suggested to guide policy and clinical practice to support the needs of healthcare workers, help to allocate scarce resources equitably and promote communication among stakeholders, while drawing on South African doctors' knowledge, culture and experience.


Assuntos
Infecções por Coronavirus/prevenção & controle , Comunicação Interdisciplinar , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Padrões de Prática Médica/organização & administração , Atitude do Pessoal de Saúde , Tomada de Decisão Clínica , Infecções por Coronavirus/epidemiologia , Países em Desenvolvimento , Feminino , Política de Saúde , Recursos em Saúde , Humanos , Masculino , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Formulação de Políticas , África do Sul
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