Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 65.699
Filtrar
1.
Best Pract Res Clin Anaesthesiol ; 35(3): 307-319, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34511221

RESUMO

Telemedicine is the medical practice of caring for and treating patients remotely. With the spread of the coronavirus disease-2019 (COVID-19) pandemic, telemedicine has become increasingly prevalent. Although telemedicine was already in practice before the 2020 pandemic, the internet, smartphones, computers, and video-conferencing tools have made telemedicine easily accessible and available to almost everyone. However, there are also new challenges that health care providers may not be prepared for, including treating and diagnosing patients without physical contact. Physician adoption also depends upon reimbursement and education to improve the telemedicine visits. We review current trends involving telemedicine, how pandemics such as COVID-19 affect the remote treatment of patients, and key concepts important to healthcare providers who practice telemedicine.


Assuntos
COVID-19/prevenção & controle , Pessoal de Saúde/tendências , Padrões de Prática Médica/tendências , Telemedicina/tendências , COVID-19/diagnóstico , COVID-19/epidemiologia , Humanos , Manejo da Dor/métodos , Manejo da Dor/tendências , Pandemias/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Telemedicina/métodos
2.
Rural Remote Health ; 21(3): 5865, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34469693

RESUMO

INTRODUCTION: In various countries, a shortage of general practitioners (GPs) and worrying health statistics on risk factors, morbidity and mortality have been observed in rural areas. However, few comparative data are available on GP activities according to their location. The aim of this study was to analyse French GP activities according to their rural or urban practice location. METHODS: This study was ancillary to the Eléments de la COnsultation en médecine GENérale (ECOGEN) study, which was a cross-sectional, multicentre, national study conducted in 128 French general practices in 2012. Data were collected by 54 interns in training during a period of 20 working days from December 2011 to April 2012. GP practice location was classified as rural area, urban cluster or urban area. The International Classification of Primary Care (ICPC-2) was used to classify reasons for encounter, health problem assessments, and processes of care. Univariate analyses were performed for all dependent variables, then multivariable analyses for key variables, using hierarchical mixed-effect models. RESULTS: The database included 20 613 consultations. The mean yearly number of consultations per GP was higher in rural areas (p<0.0001), with a shorter consultation length (p<0.0001). No difference was found for GP sex (p=0.41), age (p=0.87), type of fees agreement (p=0.43), and type of practice (p=0.19) according to their practice location. Urban patients were younger, and there was a lower percentage of patients over 75 years (p<0.001). GPs more frequently consulted at patients' homes in rural areas (p<0.0001). The mean number of chronic conditions managed was higher in rural areas and urban clusters than in urban areas (p<0001). Hypertension (p<0.0001), type 2 diabetes (p=0.003), and acute bronchitis/bronchiolitis (p=0.01) were more frequently managed in rural areas than in urban clusters and areas. Health maintenance/prevention (p<0.0001) and no disease situations (p<0.0001) were less frequent in rural areas. Drug prescription was more frequent in rural areas than in urban clusters and areas (p<0.0001). Multivariable analysis confirmed the influence of a GP's rural practice location on the consultation length (p<0.0001), the number of chronic conditions per consultation (p<0.0001) and the number of health maintenance/prevention situations (p<0.0001), and a trend towards a higher yearly number of consultations per GP (p=0.09). CONCLUSION: French rural GPs tend to have a higher workload than urban GPs. Rural patients have more chronic conditions to be managed but are offered fewer preventive services during consultations. It is necessary to increase the GP workforce and develop cooperation with allied health professionals in rural areas.


Assuntos
Medicina Geral/estatística & dados numéricos , Clínicos Gerais/psicologia , Encaminhamento e Consulta/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Serviços Urbanos de Saúde/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Adulto , Idoso , Doença Crônica , Estudos Transversais , Diabetes Mellitus Tipo 2 , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Prevenção Primária/organização & administração , População Rural , Fatores de Tempo , População Urbana
3.
JNMA J Nepal Med Assoc ; 59(240): 745-748, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34508487

RESUMO

INTRODUCTION: To establish appropriate health care services in developing countries, rationalization of drug use holds utmost importance. Drug use patterns can be found out using Core Indicators of the World Health Organisation in collaboration with the International Network of Rational Use of Drugs. With the help of the indicators, this study aimed to find out the way the drugs were prescribed in the Medicine out-patient department of a tertiary care hospital. METHODS: A descriptive cross-sectional survey was conducted from October 2019 to March 2020 in a tertiary care hospital. The ethical approval was taken from the Institutional Review Committee of the Dhulikhel hospital (reference number 198/19). Convenient sampling was done. After taking consent from the patient, data was collected from prescriptions written on the patient's card. The data were analysed using Statistical Package for the Social Sciences Version 25. Descriptive statistics were applied and the results were expressed as frequency and percentage, mean and standard deviation. RESULTS: A total of 559 prescriptions were analysed, of which a total of 1427 medicines were found to be prescribed with an average number of medicines per the prescription of 2.55±1.388. Drugs prescribed by generic name were 820 (57.5%), antibiotics were 138 (9.7%) and injections were 8 (0.6%). Drugs prescribed from the Essential Drug List of Nepal was 939 (65.8%). CONCLUSIONS: Our study revealed that despite some results being up to the mark, there is a requisite for the proper regulation of prescribing and dispensing drugs in order to promote rationalisation.


Assuntos
Medicamentos Essenciais , Padrões de Prática Médica , Estudos Transversais , Prescrições de Medicamentos , Humanos , Centros de Atenção Terciária , Organização Mundial da Saúde
5.
J Opioid Manag ; 17(4): 284-288, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34533822

RESUMO

OBJECTIVE: Guidelines for opioid prescription post-operatively exist; however, the majority of these are for adults. Nevertheless, opioid risks are present for pediatric patients also. This study investigates the effect of a single institution's guidelines on post-operative opioid prescribing for pediatric orthopedic patients undergoing knee surgery. We hypothesized that a standardized set of prescribing guidelines would result in a decrease in opioids prescribed at discharge home after these surgeries. DESIGN: Retrospective observational. SETTING: Urban, tertiary care, academic orthopedic hospital. PATIENTS: Pediatric, sports knee surgery, 23-month period. INTERVENTIONS: Guidelines were implemented institutionally for post-operative opioid prescribing practices. We reviewed all post-operative opioid prescriptions for pediatric patients undergoing sports knee surgery with two pediatric sports surgeons for the 11 months prior to the guidelines and 12 months afterwards, totaling 316 surgeries. MAIN OUTCOME MEASURE: Oral morphine equivalents (OMEs) prescribed on discharge from the hospital before and after implementation of guidelines. RESULTS: There was a significant reduction in OMEs from 229 OMEs to 175 OMEs before and after opioid prescribing guidelines (p < 0.001). This is a decrease in approximately seven 5 mg oxycodone tablets per patient. CONCLUSIONS: This study demonstrates that at our institution, with a pediatric patient population having sports knee surgery, prescribing guidelines reduced the number of opioids prescribed at discharge.


Assuntos
Analgésicos Opioides , Medicina Esportiva , Adulto , Analgésicos Opioides/uso terapêutico , Criança , Prescrições de Medicamentos , Humanos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica , Estudos Retrospectivos
6.
J Opioid Manag ; 17(4): 321-325, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34533826

RESUMO

OBJECTIVE: We sought to determine prescribing patterns for opioid analgesia following anterior cruciate ligament (ACL) reconstruction among age- and gender-stratified adolescents in a nationally representative database. DESIGN: A retrospective study. SETTING: PearlDiver Patient Records. PATIENTS, PARTICIPANTS: Outpatient opioid claims within 30 days of surgery were extracted. The patients were defined into age groups 10-14 ("younger") and 15-19 ("older"). A total of 1,139 patients were included in this study (536 female and 603 males) with 108 patients in the 10-14 age category and 1,034 patients in the 15-19 category. MAIN OUTCOME MEASURE(S): The primary study outcome measures the average number of opioid pills administered, average total morphine milligram equivalents (MMEs) prescribed, and the average prescription strength (MMEs/pill). RESULTS: No difference was found in the average number of pills (p = 0.26) or normalized total MMEs (p = 0.312) prescribed by age group. Normalized total morphine equivalents per prescription was significantly lower in females than males (p = 0.005). Multivariate linear regression analysis demonstrated that increasing patient age was predictive of fewer total pills (p = 0.017), after accounting for gender. CONCLUSIONS: There are age- and gender-based disparities in prescription patterns for adolescent ACL reconstruction. Our findings indicate that patients in the older age group on average received fewer pills than the younger age group, which consequently trended toward receiving higher total MMEs prescribed. This suggests that surgeons may be inadvertently overprescribing in the younger cohort. Additional studies that account for concurrent factors should be conducted to observe potentially similar trends.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Alcaloides Opiáceos , Adolescente , Idoso , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Masculino , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica , Estudos Retrospectivos
7.
J Opioid Manag ; 17(4): 311-320, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34533825

RESUMO

OBJECTIVE: To determine the number of opioid pills remaining after pediatric ambulatory knee surgery to provide insight into how many pills are actually used. DESIGN: Prospective observational cohort study. Participants who were expected to be prescribed 20 (Group 1) versus 40 (Group 2) opioid pills according to the institutional policy (based on the type of surgery) were studied. Patient's reported pain, medication use, and number of opioid pills remaining at post-operative days (PODs) 7 and 14. Participants were not randomly assigned to groups and no intervention was applied. SETTING: An urban tertiary care musculoskeletal institution. PARTICIPANTS: Sixty adolescents between the ages of 12 and 19 undergoing ambulatory knee surgery. INTERVENTIONS: Observational study, no experimental study intervention. MAIN OUTCOME MEASURE: The total number of opioid pills remaining. RESULTS: By POD7, more than 70 percent of patients had stopped taking their prescribed opioid medication mainly because their knee pain was tolerable either without the opioid or by using other medications. By POD14, the mean number of pills taken was 6.3 ± 5.3 for Group 1 and 18.4 ± 13.9 for Group 2. The mean number of unused opioids was 13.5 ± 7.2 for Group 1 and 17.9 ± 13.7 for Group 2. CONCLUSIONS: Even with prescribing practice guidelines in place, opioids may be overprescribed and could be given in a smaller quantity without affecting the quality of acute postoperative pain control in adolescents undergoing ambulatory knee surgery. However, one needs to consider that some patients may need a larger than average amount in order to be appropriately treated for their level of pain and thus prescription amounts-preferably after reevaluation-should be individualized.


Assuntos
Analgésicos Opioides , Procedimentos Ortopédicos , Adolescente , Adulto , Analgésicos Opioides/efeitos adversos , Criança , Humanos , Procedimentos Ortopédicos/efeitos adversos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica , Estudos Prospectivos , Adulto Jovem
8.
J Opioid Manag ; 17(4): 337-342, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34533828

RESUMO

OBJECTIVE: Florida-mandated Prescription Drug Monitoring Program (PDMP) use and restricted Schedule II opioid dispensing for acute pain to 3-day supply in 2018. This study assessed physician perception of these policies. DESIGN: A cross-sectional study design. SETTING: Large academic medical center. PATIENTS/PARTICIPANTS: Physicians in inpatient and outpatient practice, as stratified by physician specialty for psychiatry or addiction medicine (Psych/AM), primary care, and others. INTERVENTIONS: A survey was administered electronically from July to September 2019, with survey items adapted from published opioid policy evaluations. MAIN OUTCOME MEASURE: Assessment of physician reason for the use of PDMP and perception of PDMP clinical utility. Responses by specialty were compared via chi square testing. RESULTS: There were N = 214 responses (response rate ~10.9 percent), representing n = 15 from Psych/AM, n = 58 primary care, and n = 143 from other specialties. The most frequently reported reason for PDMP use across specialties was to examine prescribing history for patients currently using opioid analgesics (6.7 percent Psych/AM; 50.1 percent primary care; 38.6 percent others; p = 0.027). Fewer Psych/AM physicians agreed that the policy hinders the clinical work day as compared with primary care physicians (46.7 percent vs. 58.6 percent). More primary care agreed the policy was a good idea relative to Psych/AM (62.1 percent vs. 53.3 percent). More primary care than Psych/AMs agreed that the policy made it more challenging for chronic pain patients to access opioid therapies (77.6 percent vs. 53.3 percent). CONCLUSIONS: The perceived workflow burden and unintended consequence of decreased chronic pain patient access to opioid pharmacotherapies suggest further opportunities for pharmacist-physician collaboration in managing affected patients.


Assuntos
Analgésicos Opioides , Médicos de Atenção Primária , Estudos Transversais , Humanos , Percepção , Políticas , Padrões de Prática Médica
9.
Diagn. tratamento ; 26(3): 118-24, jul-set. 2021. ilus, tab
Artigo em Português | LILACS | ID: biblio-1291202

RESUMO

Os benefícios da prática regular de atividades físicas para a saúde, tanto na prevenção como no auxílio ao tratamento de diversas doenças, estão confirmados por inúmeras publicações científicas. No entanto, o sedentarismo ou a inatividade física na população ainda é muito prevalente. Com a pandemia devido à doença do novo coronavírus (COVID-19) e a necessidade de isolamento social e o fechamento dos locais de prática de atividades físicas, aumentaram as dificuldades para a sua realização. Será que os médicos realizam atividades físicas? Existem poucos estudos sobre este tema. Nosso trabalho foi realizado na Santa Casa de São Paulo, e analisamos se os médicos brasileiros praticam atividades físicas regularmente e se houve algum impacto com a pandemia. Procuramos também analisar se os médicos orientam e prescrevem atividades físicas aos pacientes. Por meio de um questionário distribuído de forma digital, obtivemos 1.215 respostas de médicos de todos os estados brasileiros, que evidenciaram a pouca atividade física praticada pelos médicos brasileiros, com 84% de sedentarismo e que piorou ainda mais com a pandemia. A presença de obesidade, diabetes e hipertensão arterial foram detectadas na nossa amostragem. Contraditoriamente, a maioria dos médicos responderam que costumam orientar os pacientes sobre a importância da prática regular de atividades físicas. Como fatores que podem explicar a alta taxa de sedentarismo, a falta de tempo e de hábito foram os principais fatores, além da falta da capacitação durante a faculdade. A maioria dos médicos brasileiros são sedentários.


Assuntos
Padrões de Prática Médica , Exercício Físico , Cuidados Médicos , Comportamento Sedentário , Anamnese
10.
Open Heart ; 8(2)2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34353958

RESUMO

OBJECTIVES: We aimed to explore the impact of the COVID-19 pandemic on cardiac diagnostic testing and practice and to assess its impact in different regions in Europe. METHODS: The online survey organised by the International Atomic Energy Agency Division of Human Health collected information on changes in cardiac imaging procedural volumes between March 2019 and March/April 2020. Data were collected from 909 centres in 108 countries. RESULTS: Centres in Northern and Southern Europe were more likely to cancel all outpatient activities compared with Western and Eastern Europe. There was a greater reduction in total procedure volumes in Europe compared with the rest of the world in March 2020 (45% vs 41%, p=0.003), with a more marked reduction in Southern Europe (58%), but by April 2020 this was similar in Europe and the rest of the world (69% vs 63%, p=0.261). Regional variations were apparent between imaging modalities, but the largest reductions were in Southern Europe for nearly all modalities. In March 2020, location in Southern Europe was the only independent predictor of the reduction in procedure volume. However, in April 2020, lower gross domestic product and higher COVID-19 deaths were the only independent predictors. CONCLUSION: The first wave of the COVID-19 pandemic had a significant impact on care of patients with cardiac disease, with substantial regional variations in Europe. This has potential long-term implications for patients and plans are required to enable the diagnosis of non-COVID-19 conditions during the ongoing pandemic.


Assuntos
COVID-19 , Técnicas de Imagem Cardíaca/tendências , Cardiologistas/tendências , Disparidades em Assistência à Saúde/tendências , Cardiopatias/diagnóstico por imagem , Padrões de Prática Médica/tendências , Europa (Continente) , Pesquisas sobre Serviços de Saúde , Humanos , Valor Preditivo dos Testes
11.
BMC Public Health ; 21(1): 1518, 2021 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362330

RESUMO

BACKGROUND: Physicians do not prescribe opioid analgesics for pain treatment equally across groups, and such disparities may pose significant public health concerns. Although research suggests that institutional constraints and cultural stereotypes influence doctors' treatment of pain, prior quantitative evidence is mixed. The objective of this secondary analysis is therefore to clarify which institutional constraints and patient demographics bias provider prescribing of opioid analgesics. METHODS: We used electronic medical record data from an emergency department of a large U.S hospital during years 2008-2014. We ran multi-level logistic regression models to estimate factors associated with providing an opioid prescription during a given visit while controlling for ICD-9 diagnosis codes and between-patient heterogeneity. RESULTS: A total of 180,829 patient visits for 63,513 unique patients were recorded during the period of analysis. Overall, providers were significantly less likely to prescribe opioids to the same individual patient when the visit occurred during higher rates of emergency department crowding, later times of day, earlier in the week, later years in our sample, and when the patient had received fewer previous opioid prescriptions. Across all patients, providers were significantly more likely to prescribe opioids to patients who were middle-aged, white, and married. We found no bias towards women and no interaction effects between race and crowding or between race and sex. CONCLUSIONS: Providers tend to prescribe fewer opioids during constrained diagnostic situations and undertreat pain for patients from high-risk and marginalized demographic groups. Potential harms resulting from previous treatment decisions may accumulate by informing future treatment decisions.


Assuntos
Analgésicos Opioides , Registros Eletrônicos de Saúde , Analgésicos Opioides/uso terapêutico , Serviço Hospitalar de Emergência , Feminino , Hospitais , Humanos , Pessoa de Meia-Idade , Padrões de Prática Médica
12.
BMC Health Serv Res ; 21(1): 832, 2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34404405

RESUMO

OBJECTIVES: To identify the patterns of antibiotic use and irrational antibiotic prescriptions in primary healthcare institutions (PHIs) in Dongcheng District of Beijing, China. MATERIALS AND METHODS: All primary healthcare institutions (7 community healthcare centres and 59 community healthcare stations in total) in Dongcheng District were included in the study. Prescription data from January 2015 to December 2018 was derived from the Beijing Prescription Reviewing System of Primary healthcare institutions and analysed retrospectively. The antibiotic prescription rate was calculated and cases of irrational antibiotic prescriptions were identified. RESULTS: We extracted 11,166,905 prescriptions from the database. Only 189,962 prescriptions were included in the study, among which 9167 (4.8%) contained antibiotics. The antibiotic prescription rate fell from 5.2% in 2015 to 4.1% in 2018 while irrational antibiotic prescription rate increased from 10.4 to 11.8%. Acute Bronchitis was the most prevalent diagnosis (17.6%) for antibiotic prescriptions, followed by Unspecified Acute Respiratory Tract Infection (14.4%), Acute Tonsillitis (9.9%), and Urinary Tract Infection (6.4%). Around 10% of the prescriptions for the top 7 diagnoses identified were rated as irrational. Cephalosporins, fluoroquinolones, and macrolides were the most prescribed antibiotics, which accounted for 89.3% of all antibiotic prescriptions. Of all the antibiotic prescriptions, 7531 were reviewed, among which 939 (12.5%) were rated as irrational because of antibiotic use. Among all the irrational prescriptions, prescriptions with inappropriate antibiotic use and dosage accounted for the majority (54.4%). CONCLUSION: Although a relatively low level of antibiotic utilization was found in PHIs in Dongcheng District of Beijing, the utilization patterns differed considerably from developed countries and irrational prescriptions remained. Considering the imbalanced allocation of medical resources between primary healthcare setting and secondary and tertiary hospitals, there need to be more efforts invested in regions with different levels of economic development.


Assuntos
Antibacterianos , Infecções Respiratórias , Antibacterianos/uso terapêutico , Pequim , China/epidemiologia , Prescrições de Medicamentos , Humanos , Padrões de Prática Médica , Atenção Primária à Saúde , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos
13.
Medicina (Kaunas) ; 57(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34441037

RESUMO

Background and Objectives: Primary care physicians frequently prescribe antibiotics for acutely ill children, even though they usually have self-limiting diseases of viral etiology. The aim of this research was to evaluate the routine antibiotic-prescribing habits of primary care in Latvia, in response to children presenting with infections. Materials and Methods: This cross-sectional study included acutely ill children who consulted eighty family physicians (FP) in Latvia, between November 2019 and May 2020. The data regarding patient demographics, diagnoses treated with antibiotics, the choice of antibiotics and the use of diagnostic tests were collected. Results: The study population comprised 2383 patients aged between one month and 17 years, presenting an acute infection episode, who had a face-to-face consultation with an FP. Overall, 29.2% of these patients received an antibiotic prescription. The diagnoses most often treated with antibiotics were otitis (45.8% of all antibiotic prescriptions), acute bronchitis (25.0%) and the common cold (14.8%). The most commonly prescribed antibiotics were amoxicillin (55.9% of prescriptions), amoxicillin/clavulanate (18.1%) and clarithromycin (11.8%). Diagnostic tests were carried out for 59.6% of children presenting with acute infections and preceded 66.4% of antibiotic prescriptions. Conclusion: Our data revealed that a high level of antibiotic prescribing for self-limiting viral infections in children continues to occur. The underuse of narrow-spectrum antibiotics and suboptimal use of diagnostic tests before treatment decision-making were also identified. To achieve a more rational use of antibiotics in primary care for children with a fever, professionals and parents need to be better educated on this subject, and diagnostic tests should be used more extensively, including the implementation of daily point-of-care testing.


Assuntos
Antibacterianos , Padrões de Prática Médica , Antibacterianos/uso terapêutico , Criança , Estudos Transversais , Hábitos , Humanos , Lactente , Atenção Primária à Saúde
14.
Ned Tijdschr Geneeskd ; 1652021 05 06.
Artigo em Holandês | MEDLINE | ID: mdl-34346612

RESUMO

This is a commentary on the article of Van der Spek et al. on the workload, diagnostic work-up and treatment of urinary tract infections in adults during out-of-hours primary care. Despite a well-established Dutch guideline on urinary tract infections, correctly diagnosing and prescribing antibiotics for urinary tract infections is a challenge that needs major improvement, especially during out-of-hours GP care.


Assuntos
Medicina Geral , Infecções Urinárias , Adulto , Antibacterianos/uso terapêutico , Medicina de Família e Comunidade , Humanos , Padrões de Prática Médica , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológico
15.
Ned Tijdschr Geneeskd ; 1652021 07 01.
Artigo em Holandês | MEDLINE | ID: mdl-34346661

RESUMO

When patients are treated with a drug that is not registered for the intended indication the prescriber must inform the patient on the benefits and risks of this off-label prescription. In the patient file the prescriber should make a note that the patient was informed. In daily practice prescribers are reluctant to do this, with the motivation that informing patients on benefits and risks of pharmacotherapy is done for all drug treatments, and that this is not different for off-label prescriptions.


Assuntos
Prescrições de Medicamentos , Uso Off-Label , Humanos , Padrões de Prática Médica , Prescrições , Rotulagem de Produtos
16.
S Afr Med J ; 111(6): 575-581, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-34382570

RESUMO

BACKGROUND: Empirical broad-spectrum antibiotics are frequently prescribed to patients with severe COVID-19, motivated by concern about bacterial coinfection. There is no evidence of benefit from such a strategy, while the dangers of inappropriate antibiotics are well described. OBJECTIVES: To investigate the frequency, profile and related outcomes of infections by bacterial pathogens in patients admitted to an intensive care unit (ICU) with severe COVID-19 pneumonia. METHODS: This was a prospective, descriptive study in a dedicated COVID-19 ICU in Cape Town, South Africa, involving all adult patients admitted to the ICU with confirmed COVID-19 pneumonia between 26 March and 31 August 2020. We collected data on patient comorbidities, laboratory results, antibiotic treatment, duration of admission and in-hospital outcome. RESULTS: We included 363 patients, who collectively had 1 199 blood cultures, 308 tracheal aspirates and 317 urine cultures performed. We found positive cultures for pathogens in 20 patients (5.5%) within the first 48 hours of ICU admission, while 73 additional patients (20.1%) had positive cultures later during their stay. The most frequently isolated pathogens at all sites were Acinetobacter baumannii (n=54), Klebsiella species (n=13) and coagulase-negative staphylococci (n=9). Length of ICU stay (p<0.001) and intubation (p<0.001) were associated with positive cultures on multivariate analysis. Disease severity (p=0.5), early antibiotic use (p=0.5), diabetes mellitus (p=0.1) and HIV (p=0.9) were not associated with positive cultures. Positive cultures, particularly for tracheal aspirates (p<0.05), were associated with longer ICU length of stay and mortality. Early empirical antibiotic use was not associated with mortality (odds ratio 2.5; 95% confidence interval 0.95 - 6.81). CONCLUSIONS: Bacterial coinfection was uncommon in patients at the time of admission to the ICU with severe COVID-19. Avoiding early empirical antibiotic therapy is therefore reasonable. Strategies to avoid coinfection and outbreaks in hospital, such as infection prevention and control, as well as the strict use of personal protective equipment, are important to improve outcomes.


Assuntos
Antibacterianos/administração & dosagem , Infecções Bacterianas/tratamento farmacológico , COVID-19/complicações , Unidades de Terapia Intensiva , Adulto , Bactérias/isolamento & purificação , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Humanos , Prescrição Inadequada , Tempo de Internação , Pessoa de Meia-Idade , Pneumonia Viral , Padrões de Prática Médica , Estudos Prospectivos , África do Sul
17.
J Health Care Poor Underserved ; 32(3): 1225-1235, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34421027

RESUMO

There have been significant advances in the diagnosis and treatment of psychiatric disorders; however, racial disparities continue to create inequity in mental health care. In this commentary, we explore mental health disparities disfavoring African Americans in the psychiatric literature. We discuss how discrimination over time has resulted in a difference of perception, misdiagnoses, and conflicts in patient care. The literature reviewed reveals a pattern wherein African Americans are more likely to be misdiagnosed for all types of mental illness compared with other ethnicities due to fallacies perpetuated throughout the history of African Americans. In addition, the aggregation of current information and research on the current COVID-19 pandemic will justify future research on the epidemic of police brutality and shootings of unarmed African Americans. If we address this issue, we will reduce medical mistrust and ultimately reduce racial health inequities.


Assuntos
Afro-Americanos , Disparidades em Assistência à Saúde , Transtornos Mentais/terapia , Racismo , COVID-19/etnologia , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Transtornos Mentais/etnologia , Padrões de Prática Médica , Psiquiatria/história , Racismo/história
18.
Nutrients ; 13(8)2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34444914

RESUMO

There is little data on the experience of managing pediatric Intestinal Failure (IF) in Latin America. This study aimed to identify and describe the current organization and practices of the IF teams in Latin America and the Caribbean. An online survey was sent to inquire about the existence of IF teams that managed children on home parenteral nutrition (HPN). Our questionnaire was based on a previously published European study with a similar goal. Twenty-four centers with pediatric IF teams in eight countries completed the survey, representing a total number of 316 children on HPN. The median number of children on parenteral nutrition (PN) at home per team was 5.5 (range 1-50). Teams consisted of the following members: pediatric gastroenterologist and a pediatric surgeon in all teams, dietician (95.8%), nurse (91.7%), social worker (79.2%), pharmacist (70.8%), oral therapist (62.5%), psychologist (58.3%), and physiotherapist (45.8%). The majority of the centers followed international standards of care on vascular access, parenteral and enteral nutrition, and IF medical and surgical management, but a significant percentage reported inability to monitor micronutrients, like vitamins A (37.5%), E (41.7%), B1 (66.7%), B2 (62.5%), B6 (62.5%), active B12 (58.3%); and trace elements-including zinc (29.2%), aluminum (75%), copper (37.5%), chromium (58.3%), selenium (58.3%), and manganese (58.3%). Conclusion: There is wide variation in how IF teams are structured in Latin America-while many countries have well-established Intestinal rehabilitation programs, a few do not follow international standards. Many countries did not report having an IF team managing pediatric patients on HPN.


Assuntos
Gastroenterologia/estatística & dados numéricos , Enteropatias/terapia , Equipe de Assistência ao Paciente/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Região do Caribe , Criança , Pré-Escolar , Feminino , Gastroenterologia/métodos , Humanos , Lactente , Recém-Nascido , América Latina , Masculino , Nutrição Parenteral no Domicílio/estatística & dados numéricos , Pediatria/métodos , Inquéritos e Questionários
19.
Int J Rheum Dis ; 24(9): 1106-1111, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34375036

RESUMO

Rheumatoid arthritis (RA) is a major health burden in Asia Pacific affecting the quality of life of patients and consuming healthcare resources. According to recent estimates from the World Health Organization-International League Against Rheumatism-Community Oriented Program for Control of Rheumatic Diseases, prevalence is around 0.3%-0.5%. Management guidelines have helped to improve treatment across this diverse region. To gain better insight into current real-world management applications in view of these guidelines, virtual meetings were conducted in mid-2020 to explore perspectives of rheumatologists and patients, as well as discuss the impact of coronavirus disease 2019 on RA management. Patients and rheumatologists from Hong Kong, Malaysia, Singapore, the Philippines, Thailand, India, Pakistan, and Taiwan were included, representing a diverse mix of healthcare systems, wealth, ethnicity and culture. Despite many countries having prospered in recent years, similar challenges in RA diagnosis and treatment were identified. The daily impact and patient experience of RA were also similar across countries, marked by "silent" pain and disability, and universal misunderstanding of the disease. Late diagnosis and treatment, and barriers to access to appropriate treatment, remain problematic. The experience shared by Taiwan offers a glimmer of hope, however, wherein patient advocacy groups have succeeded in being included in policy-making decisions and securing access to advanced treatment. Real-world solutions that pay heed to the unique local needs and diversity of Asia Pacific are required to improve RA management, which will take time. In the interim, help can be sought from the trained, non-rheumatologist community to reduce some of the disease burden.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , COVID-19 , Manejo da Dor/tendências , Padrões de Prática Médica/tendências , Antirreumáticos/efeitos adversos , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/epidemiologia , Ásia/epidemiologia , Humanos , Resultado do Tratamento
20.
Clin Pediatr (Phila) ; 60(9-10): 418-426, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34342242

RESUMO

Pediatrician Screening, Brief Intervention, and Referral to Treatment (SBIRT) practices vary widely, though little is known about the correlates of SBIRT implementation. Using data from a national sample of US pediatricians who treat adolescents (n = 250), we characterized self-reported utilization rates of SBIRT among US pediatricians and identified provider- and practice-level characteristics and barriers associated with SBIRT utilization. All participants completed an electronic survey querying the demographics, practice patterns, and perceived barriers related to SBIRT practices. Our results showed that 88% of respondents reported screening for substance use annually, but only 26% used structured/validated screening instruments. Furthermore, 40% of respondents provided evidence-based brief interventions, and only 11% implemented all core SBIRT practices. Common barriers (eg, confidentiality and insufficient time) and unique provider- and setting-specific barriers to implementation were identified. These findings indicate that although most pediatricians deliver some SBIRT components in their practice, few implement the full SBIRT model, and barriers persist.


Assuntos
Intervenção na Crise/métodos , Programas de Rastreamento/métodos , Pediatras/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Comportamento do Adolescente , Confidencialidade , Intervenção na Crise/estatística & dados numéricos , Humanos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Tempo , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...