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1.
Rev. bioét. derecho ; (50): 189-203, nov. 2020.
Artigo em Espanhol | IBECS | ID: ibc-191353

RESUMO

La actual pandemia por la COVID-19 está ocasionado serias amenazas para la salud pública a nivel mundial, especialmente para los grupos de población más vulnerables. Los casos más graves de la enfermedad han sido primeramente atendidos por los profesionales de urgencias y emergencias, los cuales han tenido que tomar decisiones en contextos altamente complejos donde la priorización en la asignación de los recursos sanitarios disponibles les ha generado situaciones éticamente conflictivas. El objetivo del presente artículo es analizar la importancia de implantar la PDA en los servicios de urgencias y emergencias como herramienta de consulta en la resolución de los problemas éticos surgidos durante la pandemia por COVID-19, concretamente, en la atención al paciente crónico complejo o con enfermedad crónica avanzada


The events of the present CoVID-19 pandemic are causing serious threats to Public Health worldwide, specifically at the most vulnerable population groups. Emergency professionals have served as the first responders for the most serious cases of this disease. At the same time, they have made decisions in highly complex contexts where the prioritization of allocated care resources has generated ethically conflictive situations. The aim of this article is to analyze the importance of implementing the ACP as a tool in the emergency services to solve ethical problems that have arisen during the COVID-19 pandemic, particularly in the care of complex chronic patients or those with advanced chronic disease


L'actual pandèmia per la COVID-19 està ocasionat serioses amenaces a la salut pública a nivell mundial, especialment als grups de població més vulnerables. Els casos més greus de la malaltia han estat primerament atesos pels professionals d'urgències I emergències, els quals han hagut de prendre decisions en contextos altament complexos on la priorització en l'assignació dels recursos sanitaris disponibles els ha generat situacions èticament conflictives. L'objectiu d'aquest article va ser analitzar la importància d'implantar la PDA en els serveis d'urgències I emergències com a eina de consulta a la resolució dels problemes ètics sorgits durant la pandèmia per COVID-19, concretament, en l'atenció al pacient crònic complex o amb malaltia crònica avançada


Assuntos
Humanos , Prioridades em Saúde/ética , Prioridades em Saúde/organização & administração , Planejamento de Assistência ao Paciente , Tomada de Decisões/ética , Conflito de Interesses , Serviços Médicos de Emergência/ética , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Doença Crônica
2.
Ital J Pediatr ; 46(1): 142, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008445

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) is currently rare in children and they seem to have a milder disease course and better prognosis than adults. However, SARS-Cov-2 pandemic has indirectly caused problems in pediatric medical assistance. In view of this we wanted to draw a picture of what happened during health emergency and analyze future prospects for restarting. METHODS: We involved the Italian pediatric scientific societies institutionally collected in the Italian Federation of Associations and Scientific Societies of the Pediatric Area (FIARPED); We sent a questionnaire to all scientific societies about the pediatric care activity during the COVID-19 emergency and future perspectives for the phase of post-containment. RESULTS: The analysis of the questionnaires showed significant decrease of:admission, outpatient visits and specialist consultancy activities during the COVID-19 emergency, primarily linked to the fear of infection. Instead it was increased the serious degree of diseases admitted. Most of scientific societies maintained the relationship with chronic patients through some form of telemedicine, reporting a strong positive opinion about this modality. Finally showed the need to give life a new approach for hospitalizations and outpatient visits through a greater use of telemedicine, educational programs on families and a more decisive role of family pediatricians. CONCLUSIONS: Our study highlighted many aspects that can be improved in pediatric care. We think that It will be necessary a new shared strategy to improve the management and continuity of care for pediatric patients, primarily developing a network of collaboration between families, family pediatrician and hospitals and by enhancing the use of new methods of telecommunications.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena/organização & administração , Inquéritos e Questionários , Telemedicina/estatística & dados numéricos , Adulto , Assistência Ambulatorial/estatística & dados numéricos , Criança , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Itália , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Planejamento de Assistência ao Paciente/organização & administração , Pediatria/métodos , Pneumonia Viral/epidemiologia , Sociedades Médicas
3.
Assist Inferm Ric ; 39(3): 118-121, 2020.
Artigo em Italiano | MEDLINE | ID: mdl-33077980

RESUMO

. Care path for non-deferred elective hospitalizations in cardiology in the Covid-19 period. INTRODUCTION: The novel coronavirus-19 (Covid-19) has rapidly resulted in a global pandemic. Our hospital had to postpone all elective admissions to increase capacity for COVID-19 patients. Therefore, a rearrangement of the elective admissions was necessary to guarantee a restart of ordinary procedures. AIM: To describe the organizational model adopted for elective procedures during the Covid-19 pandemic, to guarantee maximum safety for patients and healthcare workers. METHODS: Patients on waiting list for cardiac procedures were rearranged based on risks prioritization. Procedure of coronary angiography and cardiac devices (PM and ICD) implants or replacement took priority upon other cardiac procedures. Each patient underwent a telephone nurse triage to assess for any covid-19 symptoms. The hospital admissions were organized in accordance with health and safety measures declared by the National Institute of Health, with different paths according to the swab results. RESULTS: A total of 66 patients were contacted and 40 accepted the hospital admission (26 refused it, for fear of infection or covid-19 related family problems). No patient resulted positive to the nasal swab. CONCLUSIONS: In view of the impact on the health care system of this new pandemic, the choice of an appropriate pathway which can preserve patients' safety is essential, while guaranteeing the treatment of problems, such as cardiovascular diseases, with a high mortality rate.


Assuntos
Infecções por Coronavirus/epidemiologia , Hospitalização/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Planejamento de Assistência ao Paciente , Pneumonia Viral/epidemiologia , Cardiologia/estatística & dados numéricos , Hospitais , Humanos , Modelos Organizacionais , Pandemias , Listas de Espera
5.
Oral Maxillofac Surg Clin North Am ; 32(4): 519-559, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32919832

RESUMO

Impacted third molars occur in a significant number of patients and often require treatment because of presence of symptoms and/or disease. Management of these teeth typically involves referral to oral and maxillofacial surgeons for diagnosis, treatment planning, and ultimate removal if indicated. Proper diagnosis and treatment planning helps optimize surgical results at each stage of the procedure, and ultimately patient outcomes. Adherence to proper surgical techniques helps minimize risks and complications associated with the procedure. Multiple alternative surgical techniques also exist for uncommon, but potentially complicated, situations that arise with some impacted third molars.


Assuntos
Dente Serotino/cirurgia , Dente Impactado/cirurgia , Humanos , Planejamento de Assistência ao Paciente , Encaminhamento e Consulta , Extração Dentária
7.
Prim Dent J ; 9(3): 23-28, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32940593

RESUMO

With patients living longer and retaining their natural teeth for longer, dental healthcare professionals are presented with new challenges. This paper outlines considerations for dental health care professionals managing periodontal disease in an ageing population. Although age itself is not considered an independent risk factor for periodontal disease, there may be complicating factors associated with ageing that impact upon the planning and delivery of care. This paper describes current evidence for the management of periodontal disease in the context of health conditions associated with ageing. It identifies aspects to consider and provides advice on how treatment planning for this patient population may be tailored.


Assuntos
Doenças Periodontais , Envelhecimento , Humanos , Planejamento de Assistência ao Paciente , Fatores de Risco
8.
Brasília, D.F.; OPAS; 2020-09-08. (OPAS-W/BRA/COVID-19/20-107).
Não convencional em Português | PAHO-IRIS | ID: phr2-52643

RESUMO

A pandemia da COVID-19 afetou desproporcionalmente os idosos, principalmente aqueles que vivem em instituições de longa permanência. Em muitos países, as evidências mostram que mais de 40% das mortes relacionadas à COVID-19 foram ligadas a instituições de longa permanência, chegando a 80% em alguns países de alta renda. Além disso, nas instituições de longa permanência, a taxa de letalidade de residentes com COVID-19 pode ser maior do que na população da mesma idade que vive fora de instituições de longa permanência. Os residentes de instituições de longa permanência frequentemente enfrentam alto risco, baixas medidas preventivas e recursos inadequados para se recuperar da COVID-19, bem como acesso reduzido a serviços essenciais de saúde em um contexto no qual os sistemas de saúde se deparam com restrições durante o surto da COVID-19... Este sumário de políticas fornece 11 objetivos e pontos de ação importantes para prevenir e gerenciar a COVID-19 na assistência de longa permanência. Seu público-alvo é formado por legisladores e autoridades (nacionais, subnacionais e locais) envolvidos na pandemia da COVID-19. O sumário se baseia em evidências atualmente disponíveis referentes a medidas adotadas para prevenção, preparação e resposta à pandemia da COVID-19 e para mitigar seu impacto nos serviços de assistência de longa permanência, incluindo os prestadores de cuidados. Embora este documento contenha opções de políticas e ações relevantes para todos os ambientes de assistência de longa permanência, as instituições de longa permanência são enfatizadas porque apresentaram incidência, morbidade e mortalidade extremamente altas referentes à COVID-19.


Assuntos
Infecções por Coronavirus , Pandemias , Betacoronavirus , Serviços de Saúde , Tempo de Internação , Planejamento de Assistência ao Paciente
10.
Med Clin North Am ; 104(5): 767-775, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773044

RESUMO

Goals of care conversations are important but complex for clinicians caring for older adults. Although clinicians tend to focus on specific medical interventions, these conversations are more successful if they begin with gaining a shared understanding of the medical conditions and possible outcomes, followed by discussion of values and goals. Although training in the medical setting is incomplete, there are many published and online resources that can help clinicians gain these valuable skills.


Assuntos
Tomada de Decisão Compartilhada , Cuidados Paliativos , Planejamento de Assistência ao Paciente , Idoso , Competência Clínica , Humanos , Cuidados Paliativos/ética , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Planejamento de Assistência ao Paciente/ética , Planejamento de Assistência ao Paciente/normas , Relações Médico-Paciente
11.
J Emerg Manag ; 18(4): 281-293, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804397

RESUMO

OBJECTIVE: This case study elaborates on the theme of crisis planning and addresses the question of the value of crisis plans and for whom. METHOD: This study is based on the data collected during a water pollution incident and consists of interviews, notes, and observations at a Municipal Council, County Administrative Board, and County Council in Sweden. RESULT: Merton's concept of manifest and latent function offers a new understanding in the discussion of crisis plans. The result is then related to how known the place, task, and situation are to them. The manifest function im-plies that preparing crisis plans are supposed to direct officials in how to act when a crisis occurs. However, the plan was not made by or intended for the operative personnel who handled the water pollution crisis. Rather, this study shows that the personnel acted on the basis of their professional knowledge and earlier experiences when handling the crisis, and their knowledge can be related to the context of the crisis, and how known the place, task, and situa-tion are to them. CONCLUSION: This research adds to the knowledge of the use of crisis plans. It shows that the importance of having a crisis plan is related to how known the situation and the place is to those handling the crisis, and if the task to be done is known to them. Knowing the place and task helps the personnel to improvise in an unknown situation, and the crisis plan is not used. The value of a crisis plan arises when the task is unknown.


Assuntos
Intervenção na Crise , Planejamento em Desastres , Planejamento de Assistência ao Paciente , Humanos
12.
Cancer Radiother ; 24(6-7): 667-675, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32828670

RESUMO

The planning target volume is an essential notion in radiotherapy, that requires a new conceptualization. Indeed, the variability and diversity of the uncertainties involved or improved with the development of the new modern technologies and devices in radiotherapy suggest that random and systematic errors cannot be currently generalized. This article attempts to discuss these various uncertainties and tries to demonstrate that a redefinition of the concept of planning target volume toward its personalization for each patient and the robustness notion are likely an improvement basis to take into account the radiotherapy uncertainties.


Assuntos
Neoplasias/radioterapia , Carga Tumoral/efeitos da radiação , Humanos , Neoplasias/patologia , Planejamento de Assistência ao Paciente , Radioterapia/métodos , Dosagem Radioterapêutica , Incerteza
13.
Cancer Radiother ; 24(6-7): 576-585, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32830054

RESUMO

Cancer and cardiovascular disease (CVD) are the leading cause of mortality worldwide, and breast cancer (BC) the most common malignancy affecting women worldwide. Radiotherapy is an important component of BC treatment and participates in CVD occurrence. It seems, therefore, crucial to gather both radiation oncology and cardiology medical fields to improve the follow-up quality of our BC patients. This review aims at updating our knowledge regarding cardiotoxicities risk factors, and consequently, doses constraints in case of 3D-conformal and IMRT treatment planning. Then we will develop how to reduce cardiac exposure and what kind of cardiac follow-up we could recommend to our breast cancer patients.


Assuntos
Neoplasias da Mama/radioterapia , Cardiotoxicidade/etiologia , Cardiotoxicidade/fisiopatologia , Assistência ao Convalescente , Feminino , Humanos , Planejamento de Assistência ao Paciente , Guias de Prática Clínica como Assunto , Doses de Radiação , Radioterapia Conformacional , Fatores de Risco
14.
Am Surg ; 86(8): 933-936, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32856933

RESUMO

BACKGROUND: Several studies have described the population of adult trauma patients who undergo withdrawal of life-sustaining treatments (WLST); however, no study has looked specifically at trauma patients who undergo WLST following surgery. METHODS: This was a retrospective chart review of all trauma patients who underwent surgery at our trauma center between January 1 and December 31, 2017. Demographics were collected along with injury patterns and advance directives. Charts of all patients who died or who were discharged to hospice were analyzed to determine whether WLST occurred. Statistics included Fisher's exact test and Mann-Whitney U test. RESULTS: Three thousand and twenty-five adult trauma patients received care and 1495 (49.4%) had operations. Thirty (2.0%) patients underwent WLST, 15 (50.0%) of whom died in the hospital and 15 (50.0%) of whom were discharged to hospice. Twenty-six (86.7%) patients had a palliative care consult and 12 (40.0%) had prior advance directives. The most common injuries were femur fractures and subdural hematomas. Adjusting for age, white race, and age-adjusted CCI, femur fracture patients had, on average, 8.8 more hours between presentation and surgery (95% CI 2.1-15.4, P = .01) and 39 fewer hours between surgery and WLST (95% CI -107-29, P = .26) than traumatic brain injury patients. DISCUSSION: The short time between surgery and WLST in this cohort of patients may demonstrate that surgery was not aligned with patients' goals of care. A patient-centered approach that includes surgeon-driven palliative care discussions may help avoid nonbeneficial surgery in the last few days of life.


Assuntos
Cuidados Paliativos/estatística & dados numéricos , Conforto do Paciente/estatística & dados numéricos , Assistência Centrada no Paciente/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios , Suspensão de Tratamento/estatística & dados numéricos , Ferimentos e Lesões/terapia , Adulto , Diretivas Antecipadas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Humanos , Masculino , Futilidade Médica , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente , Estudos Retrospectivos , Ferimentos e Lesões/mortalidade
16.
Popul Health Manag ; 23(5): 378-385, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32810418

RESUMO

Several months into the impact of the global COVID-19 pandemic, the authors use the framework of "radical uncertainty" and specific regional health care data to understand current and future health and economic impacts. Four key areas of discussion included are: (1) How did structural health care inequality manifest itself during the closure of all elective surgeries and visits?; (2) How can we really calculate the so-called untold burden that resulted from the closure, with a special emphasis on primary care?; (3) The Pennsylvania experience - using observations from the population of one major delivery ecosystem (Jefferson Health), a major accountable care organization (Delaware Valley ACO), and statewide data from Pennsylvania; and (4) What should be the priorities and focus of the delivery system of the future given the dramatic financial and clinical disruption of COVID-19?


Assuntos
Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/organização & administração , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Atenção Primária à Saúde/estatística & dados numéricos , Saúde Pública , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Efeitos Psicossociais da Doença , Feminino , Planejamento em Saúde/métodos , Humanos , Masculino , Pandemias/estatística & dados numéricos , Planejamento de Assistência ao Paciente/organização & administração , Pennsylvania , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde/métodos , Estados Unidos
17.
Nat Commun ; 11(1): 4308, 2020 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-32855399

RESUMO

Distant metastasis (DM) is the main cause of treatment failure in locally advanced rectal cancer. Adjuvant chemotherapy is usually used for distant control. However, not all patients can benefit from adjuvant chemotherapy, and particularly, some patients may even get worse outcomes after the treatment. We develop and validate an MRI-based radiomic signature (RS) for prediction of DM within a multicenter dataset. The RS is proved to be an independent prognostic factor as it not only demonstrates good accuracy for discriminating patients into high and low risk of DM in all the four cohorts, but also outperforms clinical models. Within the stratified analysis, good chemotherapy efficacy is observed for patients with pN2 disease and low RS, whereas poor chemotherapy efficacy is detected in patients with pT1-2 or pN0 disease and high RS. The RS may help individualized treatment planning to select patients who may benefit from adjuvant chemotherapy for distant control.


Assuntos
Antineoplásicos/uso terapêutico , Nomogramas , Protectomia , Neoplasias Retais/terapia , Reto/diagnóstico por imagem , Adulto , Idoso , Quimioterapia Adjuvante/estatística & dados numéricos , Conjuntos de Dados como Assunto , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/estatística & dados numéricos , Metástase Neoplásica/diagnóstico , Metástase Neoplásica/prevenção & controle , Estadiamento de Neoplasias , Planejamento de Assistência ao Paciente , Seleção de Pacientes , Radioterapia Adjuvante/estatística & dados numéricos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Reto/patologia , Reto/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco/métodos
18.
Rozhl Chir ; 99(6): 249-257, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32736479

RESUMO

Complex anorectal examination including a detailed medical history, physical proctological examination and evaluation of the sensorimotor and structural function of the anorectum is essential for the diagnosis and therapeutic management of functional anorectal dysfunction. The aim of the work is to provide an overview of diagnosing functional anorectal disorders according to the new update and consensus statement of the International Anorectal Physiology Working Group (IAPWG) with a focus on indications, a standardized examination protocol and introduction of the new London classification of anorectal dysfunction. The indications are: fecal incontinence, defecation disorders, functional pelvic (anorectal) pain, evaluation before an anorectal intervention and before planned delivery to assess the function of a previously traumatized anal sphincter. Standardization of the diagnosis and the evaluated data are the basis for multidisciplinary cooperation and determination of a treatment plan for each patient individually.


Assuntos
Incontinência Fecal/diagnóstico , Canal Anal , Defecação , Humanos , Londres , Manometria , Planejamento de Assistência ao Paciente , Reto
19.
Rozhl Chir ; 99(6): 282-288, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32736484

RESUMO

Presented selected case reports are focused on the individual cases of patients suffering from functional anorectal disorders. During the examination algorithm, the emphasis is on 3D high-resolution anorectal manometry, which is a useful diagnostic technique and helps to understand the pathophysiological mechanisms in the field of functional anorectal disorders. Thanks to a comprehensive examination an individualized treatment plan can be determined for each patient.


Assuntos
Incontinência Fecal , Canal Anal , Constipação Intestinal , Defecação , Humanos , Manometria , Planejamento de Assistência ao Paciente , Reto
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