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1.
Nat Commun ; 12(1): 2349, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33859192

RESUMO

Substantial COVID-19 research investment has been allocated to randomized clinical trials (RCTs) on hydroxychloroquine/chloroquine, which currently face recruitment challenges or early discontinuation. We aim to estimate the effects of hydroxychloroquine and chloroquine on survival in COVID-19 from all currently available RCT evidence, published and unpublished. We present a rapid meta-analysis of ongoing, completed, or discontinued RCTs on hydroxychloroquine or chloroquine treatment for any COVID-19 patients (protocol: https://osf.io/QESV4/ ). We systematically identified unpublished RCTs (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Cochrane COVID-registry up to June 11, 2020), and published RCTs (PubMed, medRxiv and bioRxiv up to October 16, 2020). All-cause mortality has been extracted (publications/preprints) or requested from investigators and combined in random-effects meta-analyses, calculating odds ratios (ORs) with 95% confidence intervals (CIs), separately for hydroxychloroquine and chloroquine. Prespecified subgroup analyses include patient setting, diagnostic confirmation, control type, and publication status. Sixty-three trials were potentially eligible. We included 14 unpublished trials (1308 patients) and 14 publications/preprints (9011 patients). Results for hydroxychloroquine are dominated by RECOVERY and WHO SOLIDARITY, two highly pragmatic trials, which employed relatively high doses and included 4716 and 1853 patients, respectively (67% of the total sample size). The combined OR on all-cause mortality for hydroxychloroquine is 1.11 (95% CI: 1.02, 1.20; I² = 0%; 26 trials; 10,012 patients) and for chloroquine 1.77 (95%CI: 0.15, 21.13, I² = 0%; 4 trials; 307 patients). We identified no subgroup effects. We found that treatment with hydroxychloroquine is associated with increased mortality in COVID-19 patients, and there is no benefit of chloroquine. Findings have unclear generalizability to outpatients, children, pregnant women, and people with comorbidities.


Assuntos
/tratamento farmacológico , Cloroquina/efeitos adversos , Hidroxicloroquina/efeitos adversos , Complicações Infecciosas na Gravidez/mortalidade , Adulto , /virologia , Criança , Cloroquina/administração & dosagem , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Comorbidade , Feminino , Humanos , Hidroxicloroquina/administração & dosagem , Cooperação Internacional , Razão de Chances , Participação do Paciente/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologia , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos
2.
Medicine (Baltimore) ; 100(8): e24755, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663091

RESUMO

ABSTRACT: Health information technology (IT) is often proposed as a solution to fragmentation of care, and has been hypothesized to reduce readmission risk through better information flow. However, there are numerous distinct health IT capabilities, and it is unclear which, if any, are associated with lower readmission risk.To identify the specific health IT capabilities adopted by hospitals that are associated with hospital-level risk-standardized readmission rates (RSRRs) through path analyses using structural equation modeling.This STROBE-compliant retrospective cross-sectional study included non-federal U.S. acute care hospitals, based on their adoption of specific types of health IT capabilities self-reported in a 2013 American Hospital Association IT survey as independent variables. The outcome measure included the 2014 RSRRs reported on Hospital Compare website.A 54-indicator 7-factor structure of hospital health IT capabilities was identified by exploratory factor analysis, and corroborated by confirmatory factor analysis. Subsequent path analysis using Structural equation modeling revealed that a one-point increase in the hospital adoption of patient engagement capability latent scores (median path coefficient ß = -0.086; 95% Confidence Interval, -0.162 to -0.008), including functionalities like direct access to the electronic health records, would generally lead to a decrease in RSRRs by 0.086%. However, computerized hospital discharge and information exchange capabilities with other inpatient and outpatient providers were not associated with readmission rates.These findings suggest that improving patient access to and use of their electronic health records may be helpful in improving hospital performance on readmission; however, computerized hospital discharge and information exchange among clinicians did not seem as beneficial - perhaps because of the quality or timeliness of information transmitted. Future research should use more recent data to study, not just adoption of health IT capabilities, but also whether their usage is associated with lower readmission risk. Understanding which capabilities impact readmission risk can help policymakers and clinical stakeholders better focus their scarce resources as they invest in health IT to improve care delivery.


Assuntos
Hospitais/estatística & dados numéricos , Informática Médica/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Estudos Transversais , Registros Eletrônicos de Saúde/estatística & dados numéricos , Número de Leitos em Hospital , Humanos , Acesso dos Pacientes aos Registros/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Características de Residência , Estudos Retrospectivos , Estados Unidos
3.
Cancer Control ; 28: 1073274821989315, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33491475

RESUMO

INTRODUCTION: The ongoing SARS-CoV-2 pandemic is having major effects on cancer research, including major reductions in participant accrual to cancer clinical trials. Existing research has indicated that these steep drops in accrual rates to cancer clinical trials may be disproportionately affecting women. We sought to determine if there were gender differences in a dataset collected to examine participants' concerns about taking part in cancer research during the pandemic. METHODS: Between 5-19 June 2020, we distributed a fully anonymized survey via social media. We contacted 85 UK cancer patient organizations/charities and asked them to share our questionnaire on their platforms, of which 26 obliged. Patients aged 18 with a cancer diagnosis were eligible to participate and asked about their clinical and demographic characteristics, concerns about research participation given the COVID-19 pandemic, anxiety levels measured using the Generalized Anxiety Disorder-7 (GAD-7) scale, amongst other questions. Anxiety levels and concerns about participating were compared between men and women using univariate and multivariate analyses. RESULTS: 93 individuals, comprising n = 37 women and n = 56 men of various cancer types, provided survey responses. Independent t-tests showed that women reported higher anxiety scores, and concerns about participating in cancer research during COVID-19, than men. Linear regression analyses showed that anxiety scores predicted concerns about research participation in women but not men (pinteraction = 0.002). CONCLUSIONS: Cancer patients have concerns about participating in research during the COVID-19 pandemic that range from mild to serious. Furthermore, the relationship between general anxiety and concerns about research participation may be both more relevant and more pronounced in women than in men. Future work should examine the reasons why women are less likely to enrol in cancer trials during the COVID-19 pandemic.


Assuntos
/epidemiologia , Neoplasias/psicologia , Participação do Paciente/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Ansiedade/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/terapia , Participação do Paciente/estatística & dados numéricos , Fatores Sexuais , Inquéritos e Questionários
4.
JAMA Otolaryngol Head Neck Surg ; 147(3): 287-295, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33443539

RESUMO

Importance: The coronavirus disease 2019 (COVID-19) pandemic required the rapid transition to telehealth with the aim of providing patients with medical access and supporting clinicians while abiding by the stay-at-home orders. Objective: To assess demographic and socioeconomic factors associated with patient participation in telehealth during the COVID-19 pandemic. Design, Setting, and Participants: This cohort study included all pediatric and adult patient encounters at the Department of Otolaryngology-Head & Neck Surgery in a tertiary care, academic, multisubspecialty, multisite practice located in an early hot spot for the COVID-19 pandemic from March 17 to May 1, 2020. Encounters included completed synchronous virtual, telephone, and in-person visits as well as visit no-shows. Main Outcomes and Measures: Patient demographic characteristics, insurance status, and 2010 Census block level data as a proxy for socioeconomic status were extracted. Univariate and multivariate logistic regression models were created for patient-level comparisons. Results: Of the 1162 patients (604 females [52.0%]; median age, 55 [range, 0-97] years) included, 990 completed visits; of these, 437 (44.1%) completed a virtual visit. After multivariate adjustment, females (odds ratio [OR], 1.71; 95% CI, 1.11-2.63) and patients with preferred provider organization insurance (OR, 2.70; 95% CI, 1.40-5.20) were more likely to complete a virtual visit compared with a telephone visit. Increasing age (OR per year, 0.98; 95% CI, 0.98-0.99) and being in the lowest median household income quartile (OR, 0.60; 95% CI, 0.42-0.86) were associated with lower odds of completing a virtual visit overall. Those patients within the second (OR, 0.53; 95% CI, 0.28-0.99) and lowest (OR, 0.33; 95% CI, 0.17-0.62) quartiles of median household income by census block and those with Medicaid, no insurance, or other public insurance (OR, 0.47; 95% CI, 0.23-0.94) were more likely to complete a telephone visit. Finally, being within the lower 2 quartiles of proportion being married (OR for third quartile, 0.49 [95% CI, 0.29-0.86]; OR for lowest quartile, 0.39 [95% CI, 0.23-0.67]) was associated with higher likelihood of a no-show visit. Conclusions and Relevance: These findings suggest that age, sex, median household income, insurance status, and marital status are associated with patient participation in telehealth. These findings identify vulnerable patient populations who may not engage with telehealth, yet still require medical care in a changing health care delivery landscape.


Assuntos
/epidemiologia , Disparidades em Assistência à Saúde , Otolaringologia , Participação do Paciente/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Demografia , Feminino , Acesso aos Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Pandemias , Fatores Socioeconômicos , Estados Unidos
5.
BMC Palliat Care ; 20(1): 6, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407388

RESUMO

BACKGROUND: Patient participation is a key foundation of advance care planning (ACP). However, a patient himself/herself may be left out from sensitive conversations such as end-of-life (EOL) care discussions. The objectives of this study were to investigate patients' participation rate in the discussion of Cardiopulmonary Resuscitation (CPR) / Do-Not-Attempt-Resuscitation (DNAR) order, and in the discussion that the patient is at his/her EOL stage (EOL disclosure), and to explore their associated factors. METHODS: This is a retrospective chart review study. The participants were all the patients who were hospitalized and died in a university-affiliated teaching hospital (tertiary medical facility) in central Tokyo, Japan during the period from April 2018 to March 2019. The following patients were excluded: (1) cardiopulmonary arrest on arrival; (2) stillbirth; (3) under 18 years old at the time of death; and (4) refusal by their bereaved family. Presence or absence of CPR/DNAR discussion and EOL disclosure, patients' involvement in those discussions, and their associated factors were investigated. RESULTS: CPR/DNAR discussions were observed in 336 out of the 358 patients (93.9%). However, 224 of these discussions were carried out without a patient (patient participation rate 33.3%). Male gender (odds ratio (OR) = 2.37 [95% confidence interval (CI) 1.32-4.25]), living alone (OR = 2.51 [1.34-4.71]), and 1 year or more from the date of diagnosis (OR = 1.78 [1.03-3.10]) were associated with higher patient's participation in CPR/DNAR discussions. The EOL disclosure was observed in 341 out of the 358 patients (95.3%). However, 170 of the discussions were carried out without the patient (patient participation rate 50.1%). Patients who died of cancer (OR = 2.41[1.45-4.03]) and patients without mental illness (OR=2.41 [1.11-5.25]) were more likely to participate in EOL disclosure. CONCLUSIONS: In this clinical sample, only up to half of the patients participated in CPR/DNAR discussions and EOL disclosure. Female, living with family, a shorter period from the diagnosis, non-cancer, and mental illness presence are risk factors for lack of patients' participation in CPR/DNAR or EOL discussions. Further attempts to facilitate patients' participation, based on their preference, are warranted.


Assuntos
Planejamento Antecipado de Cuidados/estatística & dados numéricos , Revelação/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Neoplasias/mortalidade , Participação do Paciente/estatística & dados numéricos , Ordens quanto à Conduta (Ética Médica) , Assistência Terminal , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/mortalidade , Transtornos Cerebrovasculares/mortalidade , Feminino , Humanos , Hepatopatias/mortalidade , Masculino , Pessoa de Meia-Idade , Razão de Chances , Características de Residência , Doenças Respiratórias/mortalidade , Fatores Sexuais , Fatores de Tempo
8.
PLoS One ; 15(12): e0244490, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33382760

RESUMO

Forty-four percent of Black transgender women are living with HIV, and many face challenges with HIV care engagement. An HIV cure has much to offer this population, however little HIV cure-related research has included them. We conducted 19 face-to-face in-depth interviews with 10 Black transgender women living with HIV. Interviews were audio recorded, transcribed verbatim, coded, and analyzed using content analysis. Our interview guide contained three categories: 1) perceptions of HIV cure-related research and participation, 2) perceptions of HIV treatment and treatment interruptions, and 3) considerations for transgender women and HIV cure-related research. Salient themes included skepticism about HIV cure strategies and limited benefits compared with an undetectable viral load. Willingness to interrupt HIV treatment for research was low and linked to being able to go back on the same HIV treatment without consequence when the study ended. Concerns about being a test subject and perceptions of risks versus benefits of various strategies also affected willingness to take part in HIV cure-related research. Centering the dignity and autonomy of research participants as well as building upon and supporting existing social networks were identified as important facilitators for engaging Black transgender women in HIV cure-related research. Specific to Black transgender women, other concerns included the desire for gender-affirming research staff, community-building among transgender women, and safety issues associated with risk of transphobic violence when traveling to study visits. Participants stressed the importance of HIV cure-related researchers providing accessible and complete information and expressing genuine care and concern for transgender communities.


Assuntos
Afro-Americanos/psicologia , Ensaios Clínicos como Assunto/psicologia , Infecções por HIV/terapia , Participação do Paciente/estatística & dados numéricos , Pessoas Transgênero/psicologia , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Antirreumáticos/uso terapêutico , Ensaios Clínicos como Assunto/estatística & dados numéricos , Vítimas de Crime/psicologia , Vítimas de Crime/estatística & dados numéricos , Feminino , HIV/isolamento & purificação , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Infecções por HIV/virologia , Humanos , Masculino , Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Participação do Paciente/psicologia , Seleção de Pacientes , Pesquisa Qualitativa , Pesquisadores , Autorrelato/estatística & dados numéricos , Procedimentos de Readequação Sexual/psicologia , Estigma Social , Pessoas Transgênero/estatística & dados numéricos , Estados Unidos , Carga Viral
9.
Med Sci (Paris) ; 36(11): 1034-1037, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33151866

RESUMO

Coronavirus disease (COVID)-19 is an emerging pandemic infection whose significant ability to spread in a naïve population is well established. The first response of states to the COVID-19 outbreak was to impose lock-down and social barrier measures, such as wearing a surgical mask or social distancing. One of the consequences of this pandemic in terms of public health was the suspension or slowdown of infant vaccination campaigns, in almost all countries. The indirect effects of COVID-19 may therefore weigh on mortality from measles and polio in developing countries. In this pandemic chaos, the only hope lies in the rapid development of an effective vaccine against severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). However, acceptance of this vaccine has not yet been won, as beyond the many unknowns that will inevitably weigh around such rapid development, skepticism among vaccine hesitants is growing.


Assuntos
Infecções por Coronavirus/epidemiologia , Programas de Imunização/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Saúde Pública/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Betacoronavirus/fisiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças/prevenção & controle , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Programas de Imunização/organização & administração , Programas de Imunização/normas , Programas de Imunização/tendências , Sarampo/epidemiologia , Sarampo/prevenção & controle , Pandemias/prevenção & controle , Participação do Paciente/estatística & dados numéricos , Participação do Paciente/tendências , Pneumonia Viral/imunologia , Pneumonia Viral/prevenção & controle , Poliomielite/epidemiologia , Poliomielite/prevenção & controle , Saúde Pública/normas , Saúde Pública/tendências , Cobertura Vacinal/organização & administração , Cobertura Vacinal/estatística & dados numéricos , Vacinas Virais/uso terapêutico
11.
Niger Postgrad Med J ; 27(3): 196-201, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687119

RESUMO

Background: Waning donor funding and poor country ownership of HIV care programmes are challenges for the sustainability of care for people living with HIV (PLHIV) in Nigeria. Health insurance presents a viable alternative for funding of HIV care services. This study assessed the determinants of willingness to participate in health insurance amongst PLHIV in a tertiary hospital in South-East Nigeria. Methods: Across-sectional survey was conducted amongst 371 PLHIV on treatment at Federal Teaching Hospital, Abakaliki, Nigeria, using a semi-structured, interviewer-administered questionnaire. Chi-square test and logistic regression were conducted with SPSS version 20 at 5% level of significance. Results: Respondents were mostly males (51.8%) with a mean age and monthly income of 45.4 ± 10.3 years and $74.1 ± 42, respectively. Majority were willing to participate (82.5%) and to finance health insurance (65.2%). The major reasons cited by those unwilling to participate were poor understanding of how the system works and lack of regular source of income. The predictors of willingness to participate were female gender (adjusted odds ratio [AOR] = 2.9; 95% confidence interval [CI]: 1.6-5.7), being currently unmarried (AOR = 4.3; 95% CI: 2.3-7.8), being self-employed (AOR = 2.2; 95% CI: 1.2-3.9), having family size >5 (AOR = 3.1; 95% CI: 1.7-5.9) and having less than secondary school education (AOR = 4.3; 95% CI: 2.3-7.8). Conclusion: Majority of the respondents surveyed were willing to participate in, and finance health insurance. Willingness to participate was more amongst vulnerable subgroups (females, unmarried, self-employed, poorly educated and those with large family size). We recommend the inclusion of health insurance in the care package of PLHIV.


Assuntos
Infecções por HIV/tratamento farmacológico , Seguro Saúde/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Aceitação pelo Paciente de Cuidados de Saúde , Participação do Paciente/psicologia , Inquéritos e Questionários , Centros de Atenção Terciária
12.
Nihon Koshu Eisei Zasshi ; 67(6): 369-379, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32612077

RESUMO

Objective This study aims to identify changes in homebound status and related factors in community-dwelling older adults participating in physical checkups over two years in order to help with prevention and recovery from being homebound.Methods A survey on needs in the sphere of daily life was conducted in July 2011 among 6,696 independent older adults in 10 regions of Kameoka City (baseline survey). Of the 6,696 adults, 1,379 responded to the survey and participated in a physical checkup held between March and April 2012. These individuals were then invited to a similar checkup again in September 2013. Of these, 638 consenting individuals were administered a questionnaire survey (follow-up survey). In all, 522 subjects responded to both surveys (baseline and follow-up) regarding being homebound. The responses involved basic attributes, state of daily living, state of health, items of the Kihon Checklist, items concerning daily living activities in the baseline survey, and items concerning being homebound in the follow-up survey. The responses were analyzed, and an evaluation of homebound status was conducted based on whether or not one (or both) of the two items of the Kihon Checklist were applicable. The subjects were classified according to the following: 1) whether non-homebound individuals remained non-homebound (non-homebound group) or whether they became homebound (homebound transition group) and 2) whether individuals who became homebound recovered (recovery group) or remained the same (persisting group). After comparing the characteristics of each group, a logistic regression analysis was employed to analyze the factors related to changes in homebound status after two years.Results Of the 375 non-homebound individuals in the baseline survey, 326 (86.9%) and 49 (13.1%) were classified into non-homebound and homebound transition groups, respectively. Of the 147 subjects who became homebound, 85 (57.8%) and 62 (42.2%) were classified into the recovery and persisting groups, respectively. Among the factors related to change in homebound status after two years, a low score of social role (OR=0.675, CI=0.458-0.997) was an independent factor for being at risk of becoming homebound (P<0.05). Having no diseases under treatment (OR=14.340, CI=1.345-152.944) and a high intellectual activity score (OR=2.643, CI=1.378-5.069) were independent factors of recovery from being homebound (P<0.05).Conclusion The results of the two year longitudinal study suggest the need for support for non-homebound older individuals devoid of social roles to prevent homebound status. Additionally, there is a need for support surrounding the reduction in obtaining a disease and maintaining intellectual activity in order to recover from being homebound.


Assuntos
Pacientes Domiciliares , Vida Independente , Participação do Paciente/estatística & dados numéricos , Exame Físico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Pacientes Domiciliares/psicologia , Pacientes Domiciliares/estatística & dados numéricos , Humanos , Japão/epidemiologia , Modelos Logísticos , Estudos Longitudinais , Masculino , Isolamento Social , Apoio Social , Inquéritos e Questionários , Fatores de Tempo
14.
Rev Assoc Med Bras (1992) ; 66(3): 284-289, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32520146

RESUMO

OBJECTIVE: Children with renal tumors included in clinical trials have significantly better outcomes. In Brasil, the enrollment of patients in clinical trials remains challenging. Here we aimed to describe participation accrual in the Brazilian Wilms Tumor Study Group (BWTSG) and to identify barriers to trial registration of children with renal tumors. METHODS: We determined the numbers of renal tumor diagnoses in 105 hospital-based cancer registries from 2001-2009. We then compared these totals with the numbers of renal tumor cases registered in the BWTSG from the same hospitals during the same time period. We also invited members of the Brazilian Pediatric Oncology Society to complete a 5-point Likert-type scale questionnaire regarding their opinions of the importance of participation in cooperative group trials. RESULTS: The accrual rate of patient participation per hospital varied from 25% to 76%, and was highest in the South region. The accrual rate of hospital participation also varied according to the region (20-31%) and was highest in the Southeast region. For the questionnaire regarding the importance of participation in cooperative groups, the responses showed an agreement of >75% on 10 of the 13 statements. CONCLUSION: Our results demonstrated low accrual of participation in a cooperative group trial in Brasil. We identified variations in registration rates according to geographic region and hospital, which may help targeted efforts to increase registration rates. The survey responses demonstrated that colleagues understand the importance of trial participation.


Assuntos
Participação do Paciente/estatística & dados numéricos , Tumor de Wilms/epidemiologia , Adolescente , Brasil/epidemiologia , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Sistema de Registros/estatística & dados numéricos , Características de Residência , Inquéritos e Questionários , Taxa de Sobrevida
15.
Spine Deform ; 8(5): 957-963, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32495208

RESUMO

STUDY DESIGN: Prospective survey of adolescent idiopathic scoliosis (AIS) patients/parents with surgical magnitude curves. OBJECTIVE: We hypothesized that patients and families considering fusion surgery would be willing to enroll in a randomized controlled trial (RCT) evaluating the effect of number of implants on curve correction. Surgical RCTs are infrequently performed, particularly in a pediatric population. Parental willingness to enroll affects both study design and trial feasibility. The Minimize Implants Maximize Outcomes (MIMO) Clinical Trial proposes to randomize patients to more versus fewer screws (high or low density) for Lenke 1A curve patterns, but it is unclear whether families and patients are willing to enroll in such a trial. METHODS: This study was undertaken at 4 of the 14 sites participating in the MIMO Clinical Trial. AIS patients with Cobb > 45° were included. Implant density is defined as screws per level fused. Patients and families reviewed the MIMO education module describing proposed advantages and disadvantages of high (> 1.8) vs. low (< 1.4) density screw constructs and completed a custom survey regarding their preferences about the trial. RESULTS: 159 individuals were surveyed (78 families), including 82 parents/guardians, and 77 patients. Of those surveyed, 95% mostly or completely understood the trial (range 47-78%), and 63% agreed to enroll. Parents and patients who completely understood the trial were significantly more likely to enroll. CONCLUSION: Randomization in the MIMO Trial was acceptable to the majority (63%) of patients and parents. Clear patient and parent education materials and access to the surgeon may facilitate enrollment in the trial. Parents afforded the child much autonomy when considering enrollment, although most families agree both child and parent should be in agreement before entering the trial. LEVEL OF EVIDENCE: II.


Assuntos
Pais/psicologia , Participação do Paciente/psicologia , Participação do Paciente/estatística & dados numéricos , Preferência do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Escoliose/cirurgia , Fusão Vertebral/métodos , Parafusos Ósseos , Feminino , Humanos , Masculino , Educação de Pacientes como Assunto , Estudos Prospectivos
16.
Postgrad Med ; 132(7): 614-623, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32476532

RESUMO

College students in the United States are at an increased risk for meningococcal serogroup B disease or MenB, which causes the majority of invasive meningococcal disease in the country among adolescents and young adults (62%) and also across all age groups (36%) as of 2018. Approximately one-third of MenB cases among college students occur during campus outbreaks, which trigger substantial public health concern and costs associated with conducting rapid mass vaccination campaigns in an emergency setting. Eleven US college outbreaks of MenB disease have occurred since the initial licensure and recommendation of two MenB vaccines in 2014/2015; both vaccines have been used as part of outbreak responses on campuses, but vaccine coverage and multidose series completion among the general adolescent population are very low (approximately 17% of 17-year-olds in the United States received ≥1 dose in 2018). This review recounts shifts in US meningococcal outbreak epidemiology, lessons from immunogenicity evaluations of MenB vaccines with outbreak strains, and recent college outbreak experiences and mass vaccination responses. The challenges of reactive MenB outbreak containment and potential benefits of preventive immunization of US adolescents are also considered.


Assuntos
Surtos de Doenças/prevenção & controle , Infecções Meningocócicas/prevenção & controle , Vacinas Meningocócicas/administração & dosagem , Vacinação/estatística & dados numéricos , Adolescente , Tomada de Decisões , Feminino , Humanos , Infecções Meningocócicas/epidemiologia , Participação do Paciente/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Estados Unidos , Universidades , Adulto Jovem
17.
Ann Intern Med ; 172(11 Suppl): S123-S129, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32479176

RESUMO

Ninety percent of health care systems now offer patient portals to access electronic health records (EHRs) in the United States, but only 15% to 30% of patients use these platforms. Using PubMed, the authors identified 53 studies published from September 2013 to June 2019 that informed best practices and priorities for future research on patient engagement with EHR data through patient portals, These studies mostly involved outpatient settings and fell into 3 major categories: interventions to increase use of patient portals, usability testing of portal interfaces, and documentation of patient and clinician barriers to portal use. Interventions that used one-on-one patient training were associated with the highest portal use. Patients with limited health or digital literacy faced challenges to portal use. Clinicians reported a lack of workflows to support patient use of portals in routine practice. These studies suggest that achieving higher rates of patient engagement through EHR portals will require paying more attention to the needs of diverse patients and systematically measuring usability as well as scope of content. Future work should incorporate implementation science approaches and directly address the key role of clinicians and staff in promoting portal use.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Letramento em Saúde/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Pesquisa Qualitativa , Humanos , Portais do Paciente/estatística & dados numéricos
18.
Transfusion ; 60(5): 965-973, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32359217

RESUMO

BACKGROUND: Men who have sex with men in Australia are currently ineligible to donate blood (are "deferred") for 12 months since last oral or anal sexual contact with another man. In Australia and overseas, there has been limited research on attitudes and perceptions related to blood donation in this population. STUDY DESIGN AND METHODS: Questions on blood donation histories and attitudes toward the deferral policy were included in the questionnaire of an online prospective cohort of gay and bisexual men (GBM) living in Australia. RESULTS: In 2018, 1595 GBM responded to the survey. In this sample, 28.7% reported previously donating blood. Among the remaining men who had never donated blood, 64.5% expressed an interest in doing so. Nearly all men indicated they were not willing to abstain from sex with another man for 12 months in order to donate, and the vast majority believed the rule was unfair, too strict, and homophobic. Three-quarters (77.7%) said that if the policy changed, they would likely donate blood. Age and openness about one's sexuality were independently associated with one's willingness to donate blood in the absence of the deferral. CONCLUSION: There was a high level of willingness and desire to donate blood among GBM. However, rather than abstaining from sex in order to donate, many men comply with the deferral policy and do not donate. A less conservative deferral policy may increase donations from GBM.


Assuntos
Atitude , Bissexualidade/estatística & dados numéricos , Doadores de Sangue/psicologia , Doadores de Sangue/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Percepção , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adolescente , Adulto , Austrália/epidemiologia , Bissexualidade/psicologia , Estudos Transversais , Seleção do Doador/legislação & jurisprudência , Seleção do Doador/normas , Seleção do Doador/estatística & dados numéricos , Seguimentos , Política de Saúde , Homossexualidade Masculina/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/psicologia , Participação do Paciente/estatística & dados numéricos , Minorias Sexuais e de Gênero/psicologia , Pessoas Transgênero/psicologia , Pessoas Transgênero/estatística & dados numéricos , Volição , Voluntários/estatística & dados numéricos , Adulto Jovem
19.
Artigo em Inglês | MEDLINE | ID: mdl-32429532

RESUMO

BACKGROUND: Chronic diseases are a leading cause of morbidity and mortality worldwide, and preventative screenings are the most effective way to reduce the risk of developing a chronic disease. However, many individuals do not take advantage of preventative screening services for chronic diseases, especially in rural areas. In this study, we investigated (1) the factors that affect people's willingness to participate in chronic disease screenings and (2) reasons why people have not undergone screening for a chronic disease in the past. METHODS: Study participants (aged 30-65 of years age; n = 204) included individuals from four areas in northern of Taiwan that are considered to have a high chronic disease risk. To identify factors that influence willingness to attend health screenings, data were collected by questionnaire. RESULTS: Over 50% of participants (58.33%; n = 119) indicated that they were unaware of community-based screenings for chronic diseases offered by Chang Gung Memorial Hospital, which is one of the top-rated medical centers in Taiwan. Factors that increase willingness to participate in health screenings for chronic diseases include: (1) the convenience of screening site locations; (2) affordability; and (3) other considerations related to healthcare providers and diagnostic facilities (e.g., reputation, degree of modernization, etc.). Conversely, factors that reduce willingness to participate in health screenings include: (1) a belief that one was currently healthy; (2) lack of time; (3) a belief that screening procedures were too complicated to understand; (4) physical pain or negative emotions such as fear, anxiety, embarrassment, pain, and discomfort and, (5) having had a negative experience during a previous health checkup. CONCLUSIONS: Our findings demonstrate that health attitudes, sociodemographic factors, and other motivating and preventative factors affect peoples' willingness to participate in health screenings. The motivating factors and barriers for people to participate in health screening for chronic diseases are very heterogeneous. However, understanding the barriers and motivating factors to health screening would mean that interventions with the purpose of decreasing people's health risks and reducing deaths and disabilities caused by a chronic illness could be implemented.


Assuntos
Doença Crônica/prevenção & controle , Comportamentos Relacionados com a Saúde , Nível de Saúde , Programas de Rastreamento/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Participação do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Taiwan
20.
Rev Esp Salud Publica ; 942020 May 05.
Artigo em Espanhol | MEDLINE | ID: mdl-32382000

RESUMO

OBJECTIVE: Terminal patients and their relatives must know their real situation, and be treated according to the principle of autonomy, to establish therapeutic objectives adapted each one, according to their needs and decisions. The objective of this study is to identify the sufficient existence of records in the Medical Histories of terminal patients, which indicate their situation, such as the information given to the patients, or the LET, No-RCP or Z.51.5 codes, and the statistical relation they have with the sociodemographic and clinical variables. METHODS: Cross-sectional study in a third-level hospital, with patients admitted between January and December 2017, who died with terminal illness criteria. Data were collected from the medical records, and, fundamentally, from the nursing clinical notes. The statistical analysis was performed with the SPSS program, version 22. RESULTS: Participants were 140 people, 54.3% men, of 78.51 (SD=13.5) of middle age. People up to 70 years of age received less information (Odds ratio (OR): 0.077, 95% Confidence interval (CI): 0.015-0.390) and lower sedation (OR: 0.366, 95% CI: 0.149-0.899). Proceeding from city reduced the probability of receiving information (OR: 0.202; IC95%: 0.058-0.705). Presenting dyspnea reduced LTE (OR: 0.44, 95% CI: 0.20-093), No CPR (0.29, 95% CI: 0.12-0.68) and sedation (OR: 0.27; 95% CI: 0.12-060). Fatigue increased the probability of being Non-CPR (OR: 2.77, 95% CI: 1.166-6.627) and of receiving sedation (OR: 2.6, 95% CI: 1.065-6.331). CONCLUSIONS: Efforts to empower the patient in the decision of their process and the management of the information of their diagnosis and prognosis are still lacking. A greater and better clinical records facilitates knowing how actions are developed, allowing to identify and implement ethical and responsible interventions.


Assuntos
Diretivas Antecipadas/ética , Registros Médicos , Participação do Paciente , Autonomia Pessoal , Melhoria de Qualidade/ética , Assistência Terminal/ética , Centros de Atenção Terciária/ética , Adulto , Diretivas Antecipadas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Tomada de Decisões/ética , Feminino , Hospitalização , Humanos , Consentimento Livre e Esclarecido/ética , Consentimento Livre e Esclarecido/normas , Consentimento Livre e Esclarecido/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/métodos , Participação do Paciente/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Estudos Retrospectivos , Espanha , Assistência Terminal/normas , Assistência Terminal/estatística & dados numéricos , Centros de Atenção Terciária/normas , Centros de Atenção Terciária/estatística & dados numéricos
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