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1.
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
2.
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
3.
Arch. argent. pediatr ; 119(4): 224-229, agosto 2021. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1280889

RESUMO

Introducción. La apendicitis constituye la principal causa de abdomen agudo quirúrgico en pediatría. Durante la pandemia por COVID-19, se replantearon las estrategias de manejo ydisminuyeron las consultas en las guardias, lo que podría asociarse a diagnósticos tardíos y complicaciones. El objetivo de este estudio fue analizar el impacto de la pandemia en los niños con apendicitis aguda. Métodos. Estudio analítico retrospectivocomparativo de pacientes pediátricos conapendicitis aguda durante los cinco meses del confinamiento por COVID-19 versus los meses equivalentes del año previo. Se analizaron la incidencia, la clínica, el estadio, el abordajequirúrgico y las complicaciones. Resultados. Los casos totales de apendicitisse redujeron un 25 % (n = 67 versus n = 50 en 2020). El tiempo medio hasta la consulta fue de 24 horas en ambos períodos (p = 0,989). La incidencia de peritonitis fue del 44 % (n = 22) versus el 37 % (n = 22) (p = 0,22) en 2019. No se evidenció diferencia en los estadios deenfermedad de acuerdo con lo informado en los partes quirúrgicos. En 2019, todas las cirugías se realizaron por vía laparoscópica; en 2020, solo un42 % (n = 21). La incidencia de complicaciones fue del 6 %, contra 7,5 % en el período previo (p = 0,75). Un paciente fue COVID-19 positivo. Conclusión. A pesar de la reducción en el númerode casos de apendicitis, no se evidenció una demora en la consulta en nuestra población. El mayor impacto se asoció a la readecuación del manejo, evitando el abordaje laparoscópico para reducir la diseminación del virus.


Introduction. Appendicitis is the leading cause of surgical acute abdomen in pediatrics. During the COVID-19 pandemic, management strategies were reassessed and the number of visits to the emergency department dropped down, which may be associated with delayed diagnoses and complications. The objective of this study was to analyze the impact of the pandemic on children with acute appendicitis. Methods. Analytical, retrospective, comparative study of pediatric patients with acute appendicitis in the 5 months of COVID-19 lockdown versus the same period in the previous year. Incidence, clinical data, stage, surgical approach, and complications were analyzed. Results. The total number of appendicitis cases went down by 25 % (n = 67 versus n = 50 in 2020). The mean time to consultation was 24 hours in both periods (p = 0.989). The incidence of peritonitis was 44 % (n = 22) versus 37 % (n = 22) (p = 0.22) in 2019. No differences were  observed in terms of appendicitis stage based on surgery reports. In 2019, all surgeries were laparoscopic; while in 2020, only 42 % (n = 21). The incidence of complications was 6 % versus 7.5 % in the previous period (p = 0.75). One patient was COVID-19 positive. Conclusion. Although in our population the number of appendicitis cases dropped down, consultation was not delayed. The greater impact was associated with the reformulation of management strategies, in which the laparoscopic approach is avoided to reduce virus transmission.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Apendicectomia/tendências , Apendicite/cirurgia , Apendicite/diagnóstico , Apendicite/epidemiologia , Padrões de Prática Médica/tendências , Diagnóstico Tardio/tendências , COVID-19/prevenção & controle , Acesso aos Serviços de Saúde/tendências , Apendicectomia/métodos , Argentina/epidemiologia , Doença Aguda , Incidência , Estudos Retrospectivos , Laparoscopia/tendências , Pandemias/prevenção & controle , Centros de Atenção Terciária , COVID-19/diagnóstico , COVID-19/epidemiologia , Hospitais Gerais
4.
J Stroke Cerebrovasc Dis ; 30(9): 105985, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34284323

RESUMO

OBJECTIVES: COVID-19 pandemic has forced important changes in health care worldwide. Stroke care networks have been affected, especially during peak periods. We assessed the impact of the pandemic and lockdowns in stroke admissions and care in Latin America. MATERIALS AND METHODS: A multinational study (7 countries, 18 centers) of patients admitted during the pandemic outbreak (March-June 2020). Comparisons were made with the same period in 2019. Numbers of cases, stroke etiology and severity, acute care and hospitalization outcomes were assessed. RESULTS: Most countries reported mild decreases in stroke admissions compared to the same period of 2019 (1187 vs. 1166, p = 0.03). Among stroke subtypes, there was a reduction in ischemic strokes (IS) admissions (78.3% vs. 73.9%, p = 0.01) compared with 2019, especially in IS with NIHSS 0-5 (50.1% vs. 44.9%, p = 0.03). A substantial increase in the proportion of stroke admissions beyond 48 h from symptoms onset was observed (13.8% vs. 20.5%, p < 0.001). Nevertheless, no differences in total reperfusion treatment rates were observed, with similar door-to-needle, door-to-CT, and door-to-groin times in both periods. Other stroke outcomes, as all-type mortality during hospitalization (4.9% vs. 9.7%, p < 0.001), length of stay (IQR 1-5 days vs. 0-9 days, p < 0.001), and likelihood to be discharged home (91.6% vs. 83.0%, p < 0.001), were compromised during COVID-19 lockdown period. CONCLUSIONS: In this Latin America survey, there was a mild decrease in admissions of IS during the COVID-19 lockdown period, with a significant delay in time to consultations and worse hospitalization outcomes.


Assuntos
COVID-19/prevenção & controle , Procedimentos Endovasculares/tendências , Hospitalização/tendências , Padrões de Prática Médica/tendências , Acidente Vascular Cerebral/terapia , Tempo para o Tratamento/tendências , COVID-19/transmissão , Causas de Morte/tendências , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Pesquisas sobre Serviços de Saúde , Mortalidade Hospitalar/tendências , Humanos , América Latina , Tempo de Internação/tendências , Masculino , Admissão do Paciente/tendências , Alta do Paciente/tendências , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do Tratamento
6.
BMC Fam Pract ; 22(1): 143, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210284

RESUMO

BACKGROUND: Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams' delivery of mental health care. METHODS: A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. RESULTS: We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. CONCLUSIONS: From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care's capacity for mental health care for the duration of the pandemic and beyond.


Assuntos
COVID-19 , Prestação Integrada de Cuidados de Saúde/organização & administração , Serviços de Saúde Mental , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde , Telemedicina , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/psicologia , Feminino , Grupos Focais , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Saúde Mental/tendências , Serviços de Saúde Mental/normas , Serviços de Saúde Mental/provisão & distribuição , Ontário/epidemiologia , Padrões de Prática Médica/tendências , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Melhoria de Qualidade/organização & administração , SARS-CoV-2 , Telemedicina/métodos , Telemedicina/estatística & dados numéricos
7.
BMC Fam Pract ; 22(1): 146, 2021 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217208

RESUMO

BACKGROUND: Early in the COVID-19 pandemic, general practices were asked to expand triage and to reduce unnecessary face-to-face contact by prioritizing other consultation modes, e.g., online messaging, video, or telephone. The current study explores the potential barriers and facilitators general practitioners experienced to expanding triage systems and their attitudes towards triage during the COVID-19 pandemic. METHOD: A mixed-method study design was used in which a quantitative online survey was conducted along with qualitative interviews to gain a more nuanced appreciation for practitioners' experiences in the United Kingdom. The survey items were informed by the Theoretical Domains Framework so they would capture 14 behavioral factors that may influence whether practitioners use triage systems. Items were responded to using seven-point Likert scales. A median score was calculated for each item. The responses of participants identifying as part-owners and non-owners (i.e., "partner" vs. "non-partner" practitioners) were compared. The semi-structured interviews were conducted remotely and examined using Braun and Clark's thematic analysis. RESULTS: The survey was completed by 204 participants (66% Female). Most participants (83%) reported triaging patients. The items with the highest median scores captured the 'Knowledge,' 'Skills,' 'Social/Professional role and identity,' and 'Beliefs about capabilities' domains. The items with the lowest median scores captured the 'Beliefs about consequences,' 'Goals,' and 'Emotions' domains. For 14 of the 17 items, partner scores were higher than non-partner scores. All the qualitative interview participants relied on a phone triage system. Six broad themes were discovered: patient accessibility, confusions around what triage is, uncertainty and risk, relationships between service providers, job satisfaction, and the potential for total digital triage. Suggestions arose to optimize triage, such as ensuring there is sufficient time to conduct triage accurately and providing practical training to use triage efficiently. CONCLUSIONS: Many general practitioners are engaging with expanded triage systems, though more support is needed to achieve total triage across practices. Non-partner practitioners likely require more support to use the triage systems that practices take up. Additionally, practical support should be made available to help all practitioners manage the new risks and uncertainties they are likely to experience during non-face-to-face consultations.


Assuntos
COVID-19 , Medicina Geral , Clínicos Gerais , Consulta Remota , Triagem , Atitude do Pessoal de Saúde , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/terapia , Competência Clínica , Inglaterra/epidemiologia , Feminino , Medicina Geral/organização & administração , Medicina Geral/normas , Medicina Geral/tendências , Clínicos Gerais/psicologia , Clínicos Gerais/normas , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Masculino , Padrões de Prática Médica/ética , Padrões de Prática Médica/tendências , Consulta Remota/ética , Consulta Remota/métodos , Gestão de Riscos/tendências , SARS-CoV-2 , Triagem/ética , Triagem/métodos , Triagem/organização & administração , Triagem/normas
8.
Eur J Endocrinol ; 185(4): G35-G42, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34292875

RESUMO

COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counselling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of postoperative SIAD. They should know hyponatraemia symptoms. Hyponatraemia in COVID-19 is common with a prevalence of 20-30% and is mostly due to SIAD or hypovolaemia. It mirrors disease severity and is an early predictor of mortality. Hypernatraemia may also develop in COVID-19 patients, with a prevalence of 3-5%, especially in ICU, and derives from different multifactorial reasons, for example, due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.


Assuntos
COVID-19/epidemiologia , Diabetes Insípido/terapia , Endocrinologia/normas , Hiponatremia/terapia , Assistência Ambulatorial/métodos , Assistência Ambulatorial/normas , Consenso , Diabetes Insípido/epidemiologia , Diabetes Insípido/patologia , Aconselhamento à Distância/métodos , Aconselhamento à Distância/normas , Endocrinologia/história , Endocrinologia/tendências , Prova Pericial , História do Século XXI , Hospitalização/estatística & dados numéricos , Humanos , Hiponatremia/epidemiologia , Hiponatremia/patologia , Pandemias , Padrões de Prática Médica/história , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , SARS-CoV-2 , Índice de Gravidade de Doença , Telemedicina/história , Telemedicina/métodos , Telemedicina/normas
9.
Arch Argent Pediatr ; 119(4): 224-229, 2021 08.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34309297

RESUMO

INTRODUCTION: Appendicitis is the leading cause of surgical acute abdomen in pediatrics. During the COVID-19 pandemic, management strategies were reassessed and the number of visits to the emergency department dropped down, which may be associated with delayed diagnoses and complications. The objective of this study was to analyze the impact of the pandemic on children with acute appendicitis. METHODS: Analytical, retrospective, comparative study of pediatric patients with acute appendicitis in the 5 months of COVID-19 lockdown versus the same period in the previous year. Incidence, clinical data, stage, surgical approach, and complications were analyzed. RESULTS: The total number of appendicitis cases went down by 25% (n = 67 versus n = 50 in 2020). The mean time to consultation was 24 hours in both periods (p = 0.989). The incidence of peritonitis was 44% (n = 22) versus 37% (n = 22) (p = 0.22) in 2019. No differences were observed in terms of appendicitis stage based on surgery reports. In 2019, all surgeries were laparoscopic; while in 2020, only 42% (n = 21). The incidence of complications was 6% versus 7.5% in the previous period (p = 0.75). One patient was COVID-19 positive. CONCLUSION: Although in our population the number of appendicitis cases dropped down, consultation was not delayed. The greater impact was associated with the reformulation of management strategies, in which the laparoscopic approach is avoided to reduce virus transmission.


Assuntos
Apendicectomia/tendências , Apendicite , COVID-19/prevenção & controle , Diagnóstico Tardio/tendências , Acesso aos Serviços de Saúde/tendências , Padrões de Prática Médica/tendências , Doença Aguda , Adolescente , Apendicectomia/métodos , Apendicite/diagnóstico , Apendicite/epidemiologia , Apendicite/cirurgia , Argentina/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , Criança , Pré-Escolar , Feminino , Hospitais Gerais , Humanos , Incidência , Lactente , Recém-Nascido , Laparoscopia/tendências , Masculino , Pandemias/prevenção & controle , Estudos Retrospectivos , Centros de Atenção Terciária
10.
Cir Esp (Engl Ed) ; 99(6): 450-456, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34092540

RESUMO

INTRODUCTION: The COVID-19 pandemic has had a significant impact on Spanish hospitals, which have had to allocate all available resources to treat these patients, reducing the ability to attend other common pathologies. The aim of this study is to analyze how the treatment of acute appendicitis has been affected. METHOD: A national descriptive study was carried out by an online voluntary specific questionnaire with Google Drive™ distributed by email by the Spanish Association of Surgeons (AEC) to all affiliated surgeons currently working in Spain (5203), opened from April 14th to April 24th. RESULTS: We received 337 responses from 170 centers. During the first month of the pandemic, the incidence of acute appendicitis decreased. Although conservative management increased, the surgical option has been the most used in both simple and complicated appendicitis. Despite the fact that the laparoscopic approach continues to be the most widely used in our services, the open approach has increased during this pandemic period. CONCLUSION: Highlight the contribution of this study in terms of knowledge of the status of the treatment of acute appendicitis during this first month of the pandemic, being able to serve for a better possible organization in future waves of the pandemic and a reorganization of current protocols and management of acute appendicitis in a pandemic situation.


Assuntos
Apendicectomia/tendências , Apendicite/terapia , COVID-19/terapia , Tratamento Conservador/tendências , Alocação de Recursos para a Atenção à Saúde/tendências , Controle de Infecções/tendências , Padrões de Prática Médica/tendências , Doença Aguda , Apendicectomia/métodos , Apendicite/complicações , Apendicite/diagnóstico , Apendicite/epidemiologia , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Incidência , Controle de Infecções/métodos , Laparoscopia/tendências , Pandemias , Espanha/epidemiologia
11.
Eur J Endocrinol ; 185(2): C1-C7, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34132200

RESUMO

Changes that COVID-19 induced in endocrine daily practice as well as the role of endocrine and metabolic comorbidities in COVID-19 outcomes were among the striking features of this last year. The aim of this statement is to illustrate the major characteristics of the response of European endocrinologists to the pandemic including the disclosure of the endocrine phenotype of COVID-19 with diabetes, obesity and hypovitaminosis D playing a key role in this clinical setting with its huge implication for the prevention and management of the disease. The role of the European Society of Endocrinology (ESE) as a reference point of the endocrine community during the pandemic will also be highlighted, including the refocusing of its educational and advocacy activities.


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Endocrinologistas/organização & administração , Endocrinologia/organização & administração , COVID-19/complicações , COVID-19/prevenção & controle , Redes Comunitárias/organização & administração , Redes Comunitárias/tendências , Atenção à Saúde/história , Atenção à Saúde/organização & administração , Atenção à Saúde/tendências , Doenças do Sistema Endócrino/diagnóstico , Doenças do Sistema Endócrino/epidemiologia , Doenças do Sistema Endócrino/etiologia , Doenças do Sistema Endócrino/terapia , Endocrinologistas/história , Endocrinologistas/tendências , Endocrinologia/história , Endocrinologia/tendências , Europa (Continente)/epidemiologia , História do Século XXI , Humanos , Pandemias , Fenótipo , Papel do Médico , Padrões de Prática Médica/história , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/tendências , Sociedades Médicas/história , Sociedades Médicas/organização & administração , Sociedades Médicas/tendências , Telemedicina/história , Telemedicina/organização & administração , Telemedicina/tendências
13.
BMC Fam Pract ; 22(1): 108, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078281

RESUMO

BACKGROUND: Attempts to manage the COVID-19 pandemic have led to radical reorganisations of health care systems worldwide. General practitioners (GPs) provide the vast majority of patient care, and knowledge of their experiences with providing care for regular health issues during a pandemic is scarce. Hence, in a Danish context we explored how GPs experienced reorganising their work in an attempt to uphold sufficient patient care while contributing to minimizing the spread of COVID-19. Further, in relation to this, we examined what guided GPs' choices between telephone, video and face-to-face consultations. METHODS: This study consisted of qualitative interviews with 13 GPs. They were interviewed twice, approximately three months apart in the initial phase of the pandemic, and they took daily notes for 20 days. All interviews were audio recorded, transcribed, and inductively analysed. RESULTS: The GPs re-organised their clinical work profoundly. Most consultations were converted to video or telephone, postponed or cancelled. The use of video first rose, but soon declined, once again replaced by an increased use of face-to-face consultations. When choosing between consultation forms, the GPs took into account the need to minimise the risk of COVID-19, the central guidelines, and their own preference for face-to-face consultations. There were variations over time and between the GPs regarding which health issues were dealt with by using video and/or the telephone. For some health issues, the GPs generally deemed it acceptable to use video or telephone, postpone or cancel appointments for a short term, and in a crisis situation. They experienced relational and technical limitations with video consultation, while diagnostic uncertainty was not regarded as a prominent issue CONCLUSION: This study demonstrates how the GPs experienced telephone and video consultations as being useful in a pandemic situation when face-to-face consultations had to be severely restricted. The GPs did, however, identify several limitations similar to those known in non-pandemic times. The weighing of pros and cons and their willingness to use these alternatives shifted and generally diminished when face-to-face consultations were once again deemed viable. In case of future pandemics, such alternatives seem valuable, at least for a short term.


Assuntos
Atitude do Pessoal de Saúde , COVID-19/prevenção & controle , Medicina Geral/tendências , Padrões de Prática Médica/tendências , Consulta Remota/tendências , COVID-19/epidemiologia , Tomada de Decisão Clínica/métodos , Dinamarca/epidemiologia , Medicina Geral/métodos , Medicina Geral/organização & administração , Humanos , Entrevistas como Assunto , Pandemias , Relações Médico-Paciente , Padrões de Prática Médica/organização & administração , Pesquisa Qualitativa , Consulta Remota/métodos , Consulta Remota/organização & administração , Telefone , Comunicação por Videoconferência
15.
Allergy Asthma Proc ; 42(4): 301-309, 2021 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-34030767

RESUMO

Background: Most U.S. patient and health care provider surveys with regard to nasal allergy treatments were conducted before sublingual immunotherapy (SLIT)-tablets and allergy immunotherapy (AIT) shared decision-making tools were available. Objective: Patient and health care provider surveys with regard to current perceptions of nasal allergy burden, symptoms, and treatments were conducted to compare with previous surveys and provide insight into the use of SLIT-tablets and AIT shared decision-making tools. Methods: From November-December 2019, adults (N = 510) diagnosed with nasal allergies and health care providers (N = 304) who treated nasal allergies in the United States completed surveys with regard to nasal allergy management. Results: Of the patient respondents, 42% reported that their symptoms were only somewhat controlled and 48% had avoided activities because of their nasal allergies. In all, 38% were using only over-the-counter (OTC) medications for treatment, and 42%, 7%, and 8% had ever received subcutaneous immunotherapy (SCIT), sublingual allergy drops, or SLIT-tablets, respectively; 56% and 85% reported that they had never discussed SCIT or SLIT, respectively, with their health care provider. Of the health care provider respondents, 45%, 58%, and 20% were very likely to discuss OTC medications, SCIT, or SLIT, respectively. Allergists were more inclined to discuss SCIT with their patients than other health care providers (82% versus 33%, respectively). Most allergists (67%) and other health care providers (62%) reported that they did not use an AIT shared decision-making tool, primarily because of unawareness. Conclusion: The patients with nasal allergies continued to report inadequate symptom control and activity impairment. SLIT-tablets and AIT shared decision-making tools were underused. In the coronavirus disease 2019 era, social distancing may limit office visits, which impacts SCIT administration and prompts increased use of telemedicine and a possible advantage for at-home-administered SLIT-tablets over SCIT.


Assuntos
Alergia e Imunologia/tendências , COVID-19 , Tomada de Decisão Compartilhada , Técnicas de Apoio para a Decisão , Dessensibilização Imunológica/tendências , Medicamentos sem Prescrição/uso terapêutico , Padrões de Prática Médica/tendências , Rinite Alérgica/terapia , Telemedicina/tendências , Adolescente , Adulto , Idoso , Pesquisas sobre Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Distanciamento Físico , Prognóstico , Rinite Alérgica/diagnóstico , Imunoterapia Sublingual/tendências , Fatores de Tempo , Estados Unidos , Adulto Jovem
16.
J Stroke Cerebrovasc Dis ; 30(8): 105806, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34058701

RESUMO

BACKGROUND: The COVID-19 pandemic has strained the healthcare systems across the world but its impact on acute stroke care is just being elucidated. We hypothesized a major global impact of COVID-19 not only on stroke volumes but also on various aspects of thrombectomy systems. AIMS: We conducted a convenience electronic survey with a 21-item questionnaire aimed to identify the changes in stroke admission volumes and thrombectomy treatment practices seen during a specified time period of the COVID-19 pandemic. METHODS: The survey was designed using Qualtrics software and sent to stroke and neuro-interventional physicians around the world who are part of the Global Executive Committee (GEC) of Mission Thrombectomy 2020, a global coalition under the aegis of Society of Vascular and Interventional Neurology, between April 5th and May 15th, 2020. RESULTS: There were 113 responses to the survey across 25 countries with a response rate of 31% among the GEC members. Globally there was a median 33% decrease in stroke admissions and a 25% decrease in mechanical thrombectomy (MT) procedures during the COVID-19 pandemic period until May 15th, 2020 compared to pre-pandemic months. The intubation policy for MT procedures during the pandemic was highly variable across participating centers: 44% preferred intubating all patients, including 25% of centers that changed their policy to preferred-intubation (PI) from preferred non-intubation (PNI). On the other hand, 56% centers preferred not intubating patients undergoing MT, which included 27% centers that changed their policy from PI to PNI. There was no significant difference in rate of COVID-19 infection between PI versus PNI centers (p=0.60) or if intubation policy was changed in either direction (p=1.00). Low-volume (<10 stroke/month) compared with high-volume stroke centers (>20 strokes/month) were less likely to have neurointerventional suite specific written personal protective equipment protocols (74% vs 88%) and if present, these centers were more likely to report them to be inadequate (58% vs 92%). CONCLUSION: Our data provides a comprehensive snapshot of the impact on acute stroke care observed worldwide during the pandemic. Overall, respondents reported decreased stroke admissions as well as decreased cases of MT with no clear preponderance in intubation policy during MT. DATA ACCESS STATEMENT: The corresponding author will consider requests for sharing survey data. The study was exempt from institutional review board approval as it did not involve patient level data.


Assuntos
COVID-19 , Saúde Global/tendências , Disparidades em Assistência à Saúde/tendências , Padrões de Prática Médica/tendências , Acidente Vascular Cerebral/terapia , Trombectomia/tendências , Estudos Transversais , Pesquisas sobre Serviços de Saúde , Hospitais com Alto Volume de Atendimentos/tendências , Hospitais com Baixo Volume de Atendimentos/tendências , Humanos , Controle de Infecções/tendências , Intubação Intratraqueal/tendências , Admissão do Paciente/tendências , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo
18.
Urol Int ; 105(7-8): 650-656, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33951666

RESUMO

BACKGROUND: There are limited data on the use and concern of telemedicine among German urologists, and thus, there are no established guidelines for telemedical diagnosis, treatment, and prevention of urological indications. METHODS: An anonymized survey was conducted among German private practice urologists during the 2019 coronavirus disease (COVID-19) pandemic. The χ2 test, Mann-Whitney U-test, and Kruskal-Wallis test were used for statistical analysis. RESULTS: 257 urologists were included in the final analysis. Thirty-five (14.0%) of urologists had used telemedicine as part of their consultation, and 221 (86.0%) had not used telemedicine. There was no difference between telemedicine adoption rates between rural and urban settings. Telemedicine users were significantly more satisfied with the information they had received regarding telemedicine issues. Users saw the greatest barrier to telemedicine that patients do not take up the offer of telemedicine. Nonusers were most concerned with unclear indications for telemedicine followed by lesser reimbursements during telemedicine than in-person visitations. Users were significantly more likely to use telemedicine beyond the COVID-19 pandemic. Urologists, who wanted to use the service in the future, wanted an active support by the German society of urology and guidelines for telemedicine. Last, users and nonusers preferred telemedicine for non-acute chronic diseases and follow-up visitations. CONCLUSION: Despite the COVID-19 pandemic, telemedicine remains a rarely used service among German private practice urologists. Ultimately, to overcome the current challenges, urologists require an active support for the service through the German Society of Urology and telemedical guidelines.


Assuntos
COVID-19 , Padrões de Prática Médica/tendências , Prática Privada/tendências , Telemedicina/tendências , Doenças Urológicas/terapia , Urologistas/tendências , Urologia/tendências , Adulto , Idoso , Atitude do Pessoal de Saúde , Atitude Frente aos Computadores , Alemanha , Pesquisas sobre Serviços de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-Idade , Doenças Urológicas/diagnóstico
19.
Contraception ; 104(3): 289-295, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33932400

RESUMO

OBJECTIVE: To explore US provider perspectives about self-sourced medication abortion and how their attitudes and clinic practices changed in the context of the COVID-19 pandemic. STUDY DESIGN: We conducted a multi-method study of survey and interview data. We performed 40 baseline interviews and surveys in spring 2019 and 36 follow-up surveys and ten interviews one year later. We compared pre- and post-Likert scale responses of provider views on the importance of different aspects of standard medication abortion assessment and evaluation (e.g., related to ultrasounds and blood-typing). We performed content analysis of the follow-up interviews using deductive-inductive analysis. RESULTS: Survey results revealed that clinics substantially changed their medication abortion protocols in response to COVID-19, with more than half increasing their gestational age limits and introducing telemedicine for follow-up of a medication abortion. Interview analysis suggested that physicians were more supportive of self-sourced medication abortion in response to changing clinic protocols that decreased in-clinic assessment and evaluation for medication abortion, and as a result of physicians' altered assessments of risk in the context of COVID-19. Having evidence already in place that supported these practice changes made the implementation of new protocols more efficient, while working in a state with restrictive abortion policies thwarted the flexibility of clinics to adapt to changes in standards of care. CONCLUSION: This exploratory study reveals that the COVID-19 pandemic has altered clinical assessment of risk and has shifted practice towards a less medicalized model. Further work to facilitate person-centered abortion information and care can build on initial modifications in response to the pandemic. IMPLICATIONS: COVID-19 has shifted clinician perception of risk and has catalyzed a change in clinical protocols for medication abortion. However, state laws and policies that regulate medication abortion limit physician ability to respond to changes in risk assessment.


Assuntos
Abortivos/uso terapêutico , Aborto Induzido/métodos , Aborto Induzido/tendências , Atitude do Pessoal de Saúde , COVID-19/prevenção & controle , Médicos/psicologia , Padrões de Prática Médica/tendências , Adulto , Assistência ao Convalescente/métodos , Assistência ao Convalescente/tendências , Protocolos Clínicos , Feminino , Política de Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Medição de Risco , Autoadministração , Inquéritos e Questionários , Estados Unidos
20.
J Stroke Cerebrovasc Dis ; 30(8): 105857, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34022581

RESUMO

OBJECTIVE: To characterize differences in disposition arrangement among rehab-eligible stroke patients at a Comprehensive Stroke Center before and during the COVID-19 pandemic. MATERIALS AND METHODS: We retrospectively analyzed a prospective registry for demographics, hospital course, and discharge dispositions of rehab-eligible acute stroke survivors admitted 6 months prior to (10/2019-03/2020) and during (04/2020-09/2020) the COVID-19 pandemic. The primary outcome was discharge to an inpatient rehabilitation facility (IRF) as opposed to other facilities using descriptive statistics, and IRF versus home using unadjusted and adjusted backward stepwise logistic regression. RESULTS: Of the 507 rehab-eligible stroke survivors, there was no difference in age, premorbid disability, or stroke severity between study periods (p>0.05). There was a 9% absolute decrease in discharges to an IRF during the pandemic (32.1% vs. 41.1%, p=0.04), which translated to 38% lower odds of being discharged to IRF versus home in unadjusted regression (OR 0.62, 95%CI 0.42-0.92, p=0.016). The lower odds of discharge to IRF persisted in the multivariable model (aOR 0.16, 95%CI 0.09-0.31, p<0.001) despite a significant increase in discharge disability (median discharge mRS 4 [IQR 2-4] vs. 2 [IQR 1-3], p<0.001) during the pandemic. CONCLUSIONS: Admission for stroke during the COVID-19 pandemic was associated with a significantly lower probability of being discharged to an IRF. This effect persisted despite adjustment for predictors of IRF disposition, including functional disability at discharge. Potential reasons for this disparity are explored.


Assuntos
COVID-19 , Alta do Paciente/tendências , Transferência de Pacientes/tendências , Padrões de Prática Médica/tendências , Reabilitação do Acidente Vascular Cerebral/tendências , Acidente Vascular Cerebral/terapia , Idoso , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Jersey , Recuperação de Função Fisiológica , Sistema de Registros , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo
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