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1.
Curr Opin Otolaryngol Head Neck Surg ; 29(3): 179-186, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33896909

RESUMO

PURPOSE OF REVIEW: Spiralling numbers of patients are being referred on the two-week wait (2WW) head and neck cancer referral pathway. Only a small proportion are found to have cancer. There is a call for change in the management of these referrals, particularly following coronavirus. Allied health professionals (AHPs) are being encouraged by the NHS to extend their clinical practice to address increased demand. Speech and Language Therapists (SLTs) may offer a solution to some of the 2WW pathway's challenges. RECENT FINDINGS: Recent evidence highlights problems with the pathway and reasons for change. Hoarse voice is consistently found to be the most common presenting symptom. Emerging evidence suggests SLTs can extend their scope of practice to manage new hoarse voice referrals. A pilot project is described. Outcomes from this and other ongoing studies explore efficacy and investment required to make this proposal an achievable prospect for the future. SUMMARY: The management of 2WW referrals on the head and neck cancer pathway needs to change. Preliminary findings suggest SLTs working within the context of the multidisciplinary team can safely extended their role to improve management of these patients. Professional role outline, recognition, guidance, and training framework are needed.


Assuntos
Procedimentos Clínicos/organização & administração , Neoplasias de Cabeça e Pescoço/terapia , Terapia da Linguagem/organização & administração , Encaminhamento e Consulta/organização & administração , Fonoterapia/organização & administração , Distúrbios da Voz/etiologia , Adulto , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Masculino , Projetos Piloto , Padrões de Prática Médica , Tempo para o Tratamento , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/terapia
2.
Indian Pediatr ; 58(4): 383-390, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33883314

RESUMO

JUSTIFICATION: The unprecedented COVID-19 pandemic has had a formidable impact on Indian health care. With no sight of its end as yet, various establishments including the smaller clinics and nursing homes are restarting full operations. Hence, there is the need for recommendations to allow safe practice ensuring the safety of both the heath care worker (HCW) and patients. PROCESS: Indian Academy of Pediatrics organized an online meeting of subject experts on 27 July, 2020. A committee was formed comprising of pediatricians, pediatric and neonatal intensivists, and hospital administrators. The committee held deliberations (online and via emails) and a final consensus was reached by November, 2020. OBJECTIVES: To develop recommendations to provide a safe and practical healthcare facility at clinics and small establishments during COVID times. RECOMMENDATIONS: The key recommendation to practise safely in this setting are enumerated. Firstly, organizing the out-patient department (OPD). Secondly, appropriate personal protective equipment (PPE) to provide protection to the individual. Thirdly, decontamination/disinfection of various common surfaces and equipment to prevent transmission of infection from fomites. Next, maintaining the heating ventilation and air conditioning (HVAC) to provide a stress-free, comfortable, and safe environment for patients and HCWs. Finally, steps to effectively manage COVID-19 exposures in a non-COVID-19 facility. All these measures will ensure safe practice during these unprecedent times in clinics and smaller establishments.


Assuntos
Procedimentos Clínicos , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Neonatologia , Pediatria , /epidemiologia , /terapia , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/normas , Procedimentos Clínicos/tendências , Humanos , Índia/epidemiologia , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Colaboração Intersetorial , Neonatologia/organização & administração , Neonatologia/normas , Inovação Organizacional , Pediatria/organização & administração , Pediatria/normas , Sociedades Médicas
3.
Medicine (Baltimore) ; 100(15): e25495, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33847662

RESUMO

ABSTRACT: While the new Coronavirus Disease 2019 (COVID-19) pandemic rapidly spread across the world, South America was reached later in relation to Asia, Europe and the United States of America (USA). Brazil concentrates now the largest number of cases in the continent and, as the disease speedily progressed throughout the country, prompt and challenging operational strategies had to be taken by institutions caring for COVID-19 and non-COVID-19 patients in order to assure optimal workflows, triage, and management. Although hospitals in the USA, Europe and Asia have shared their experience on this subject, little has been discussed about such strategies in South America or by the perspective of outpatient centers, which are paramount in the radiology field. This article shares the guidelines adopted early in the pandemic by a nationwide outpatient healthcare center composed by a network of more than 200 patient service centers and nearly 2,000 radiologists in Brazil, discussing operational and patient management strategies, staff protection, changes adopted in the fellowship program, and the effectiveness of such measures.


Assuntos
Assistência Ambulatorial , Gestão de Mudança , Defesa Civil , Procedimentos Clínicos , Planejamento Estratégico , Tecnologia Radiológica , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Brasil/epidemiologia , /epidemiologia , Defesa Civil/organização & administração , Defesa Civil/estatística & dados numéricos , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Humanos , Inovação Organizacional , Guias de Prática Clínica como Assunto , Planejamento Estratégico/normas , Planejamento Estratégico/estatística & dados numéricos , Tecnologia Radiológica/métodos , Tecnologia Radiológica/organização & administração , Tecnologia Radiológica/estatística & dados numéricos
4.
BMC Pregnancy Childbirth ; 21(1): 310, 2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33874913

RESUMO

BACKGROUND: Induction of labour (IOL) is one of the most commonly performed interventions in maternity care, with outpatient cervical ripening increasingly offered as an option for women undergoing IOL. The COVID-19 pandemic has changed the context of practice and the option of returning home for cervical ripening may now assume greater significance. This work aimed to examine whether and how the COVID-19 pandemic has changed practice around IOL in the UK. METHOD: We used an online questionnaire to survey senior obstetricians and midwives at all 156 UK NHS Trusts and Boards that currently offer maternity services. Responses were analysed to produce descriptive statistics, with free text responses analysed using a conventional content analysis approach. FINDINGS: Responses were received from 92 of 156 UK Trusts and Boards, a 59% response rate. Many Trusts and Boards reported no change to their IOL practice, however 23% reported change in methods used for cervical ripening; 28% a change in criteria for home cervical ripening; 28% stated that more women were returning home during cervical ripening; and 24% noted changes to women's response to recommendations for IOL. Much of the change was reported as happening in response to attempts to minimise hospital attendance and restrictions on birth partners accompanying women. CONCLUSIONS: The pandemic has changed practice around induction of labour, although this varied significantly between NHS Trusts and Boards. There is a lack of formal evidence to support decision-making around outpatient cervical ripening: the basis on which changes were implemented and what evidence was used to inform decisions is not clear.


Assuntos
Atitude do Pessoal de Saúde , Maturidade Cervical , Procedimentos Clínicos , Trabalho de Parto Induzido , Adulto , Assistência Ambulatorial/métodos , /prevenção & controle , Tomada de Decisão Clínica , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Feminino , Humanos , Controle de Infecções/métodos , Trabalho de Parto Induzido/métodos , Trabalho de Parto Induzido/tendências , Serviços de Saúde Materna/tendências , Inovação Organizacional , Formulação de Políticas , Gravidez , Inquéritos e Questionários , Reino Unido
8.
Heart ; 107(9): 734-740, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33685933

RESUMO

OBJECTIVE: There are concerns that healthcare and outcomes of black, Asian and minority ethnic (BAME) communities are disproportionately impacted by the COVID-19 pandemic. We investigated admission rates, treatment and mortality of BAME with acute myocardial infarction (AMI) during COVID-19. METHODS: Using multisource national healthcare records, patients hospitalised with AMI in England during 1 February-27 May 2020 were included in the COVID-19 group, whereas patients admitted during the same period in the previous three consecutive years were included in a pre-COVID-19 group. Multilevel hierarchical regression analyses were used to quantify the changes in-hospital and 7-day mortality in BAME compared with whites. RESULTS: Of 73 746 patients, higher proportions of BAME patients (16.7% vs 10.1%) were hospitalised with AMI during the COVID-19 period compared with pre-COVID-19. BAME patients admitted during the COVID-19 period were younger, male and likely to present with ST-elevation acute myocardial infarction. COVID-19 BAME group admitted with non-ST-elevation acute myocardial infarction less frequently received coronary angiography (86.1% vs 90.0%, p<0.001) and had a longer median delay to reperfusion (4.1 hours vs 3.7 hours, p<0.001) compared with whites. BAME had higher in-hospital (OR 1.68, 95% CI 1.27 to 2.28) and 7-day mortality (OR 1.81 95% CI 1.31 to 2.19) during COVID-19 compared with pre-COVID-19 period. CONCLUSION: In this multisource linked cohort study, compared with whites, BAME patients had proportionally higher hospitalisation rates with AMI, less frequently received guidelines indicated care and had higher early mortality during COVID-19 period compared with pre-COVID-19 period. There is a need to develop clinical pathways to achieve equity in the management of these vulnerable populations.


Assuntos
Procedimentos Clínicos , Disparidades em Assistência à Saúde , Infarto do Miocárdio sem Supradesnível do Segmento ST , Infarto do Miocárdio com Supradesnível do Segmento ST , /mortalidade , Angiografia Coronária/métodos , Angiografia Coronária/estatística & dados numéricos , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/normas , Inglaterra/epidemiologia , Feminino , Necessidades e Demandas de Serviços de Saúde , Disparidades em Assistência à Saúde/normas , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/etnologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde , Fatores Raciais , Infarto do Miocárdio com Supradesnível do Segmento ST/etnologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
10.
J Perioper Pract ; 31(4): 159-162, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33544660

RESUMO

On 20 August 2020, Public Health England released a new version of the 'COVID-19: Guidance for the remobilisation of services within health and care settings: infection prevention and control recommendations', superseding that of 18 June 2020. In this document, the infection prevention and control principles determine that the treatment, care and support of patients are to be managed in three COVID-19 pathways. These are: 'high risk', 'medium risk' and 'low risk'. In the operating theatre, where procedures may be urgent or planned, and where various surgical and anaesthetic procedures generate airborne particles (aerosols), it is crucial to communicate the infection prevention and control recommendations in a way that is easily understood and followed by all healthcare professionals. The theatre team at one hospital in the East of England produced local alternating signage to communicate the COVID-19 pathway risk during cases in theatres. This signage - named the 'COVID-19 Flag' - is placed outside of the individual theatre to ensure that staff are informed of the infection risk with the cases underway. Furthermore, it is a quick visual guide to be used in conjunction with national guidance and local protocols for appropriate decisions regarding the treatment and care of patients in the operating theatres.


Assuntos
/enfermagem , Comunicação , Procedimentos Clínicos/organização & administração , Salas Cirúrgicas/organização & administração , Infecção da Ferida Cirúrgica/enfermagem , Inglaterra , Humanos , Equipe de Assistência ao Paciente/organização & administração , Fatores de Risco , Infecção da Ferida Cirúrgica/prevenção & controle
11.
Elife ; 102021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33588991

RESUMO

Before the coronavirus 2019 (COVID-19) pandemic began, antimicrobial resistance (AMR) was among the top priorities for global public health. Already a complex challenge, AMR now needs to be addressed in a changing healthcare landscape. Here, we analyse how changes due to COVID-19 in terms of antimicrobial usage, infection prevention, and health systems affect the emergence, transmission, and burden of AMR. Increased hand hygiene, decreased international travel, and decreased elective hospital procedures may reduce AMR pathogen selection and spread in the short term. However, the opposite effects may be seen if antibiotics are more widely used as standard healthcare pathways break down. Over 6 months into the COVID-19 pandemic, the dynamics of AMR remain uncertain. We call for the AMR community to keep a global perspective while designing finely tuned surveillance and research to continue to improve our preparedness and response to these intersecting public health challenges.


Assuntos
Antibacterianos , Procedimentos Clínicos , Farmacorresistência Bacteriana/fisiologia , Saúde Global/tendências , Antibacterianos/provisão & distribução , Antibacterianos/uso terapêutico , /epidemiologia , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Humanos
12.
Am J Kidney Dis ; 77(5): 777-785, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33388404

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic required transplant nephrologists, surgeons, and care teams to make decisions about the full spectrum of transplant program operations and clinical practices in the absence of experience or data. Initially, across the country, there was a reduction in kidney transplant procedures and a striking pause in the conduct of living donation and living-donor transplant surgeries. Aspects of candidate evaluation and follow-up rapidly converted to telehealth. Months into the pandemic, much has been learned from experiences worldwide, yet many questions remain. In this Perspective, we reflect on some of the practice decisions made by the transplant community in the initial response to the pandemic and consider lessons learned, including those related to the risks, benefits, and logistical considerations of proceeding with versus delaying deceased-donor transplantation, living donation, and living-donor transplantation during the pandemic. We review the evolution of therapeutic strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their use in transplant recipients, current consensus related to immunosuppression management in infected transplant recipients, and emerging information on vaccination against SARS-CoV-2. We share our thoughts on research priorities, discuss the areas in which we are still practicing with uncertainty, and look ahead to the next phase of the pandemic response.


Assuntos
Procedimentos Clínicos , Imunossupressão/métodos , Falência Renal Crônica , Transplante de Rim/métodos , /epidemiologia , Tomada de Decisão Clínica , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Humanos , Controle de Infecções/métodos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/cirurgia , Telemedicina/métodos , Tempo para o Tratamento , Doadores de Tecidos/estatística & dados numéricos , Transplantados
13.
Support Care Cancer ; 29(1): 11-15, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32856215

RESUMO

During the current pandemic scenario, maxillofacial rehabilitation specialists involved with supportive care in cancer must transform its practice to cope with COVID-19 and improve protocols that could quickly return the oral function of complex cancer patients who cannot wait for surgical complex rehabilitation. This includes the role of the maxillofacial prosthodontist for the rehabilitation of surgically treated patients with maxillary cancers by the means of filling obturator prostheses that are considered an optimal scientific-based strategy to reduce hospital stay with excellent pain control, oral function (speech, swallowing, mastication, and facial esthetics), psychologic and quality of life outcomes for the patients following intraoral cancer resection. Therefore, the aim of this commentary was to bring new lights to the strategic use of obturator prostheses for the rehabilitation of oral cancer patients during the COVID-19 pandemic as well as to present a protocol for managing such cases.


Assuntos
/epidemiologia , Procedimentos Clínicos/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Prótese Maxilofacial , Neoplasias Bucais/reabilitação , Obturadores Palatinos , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Procedimentos Clínicos/normas , Planejamento de Prótese Dentária/normas , Estética , Humanos , Reconstrução Mandibular/instrumentação , Reconstrução Mandibular/métodos , Reconstrução Mandibular/normas , Prótese Maxilofacial/estatística & dados numéricos , Neoplasias Bucais/cirurgia , Ortodontia/métodos , Ortodontia/organização & administração , Ortodontia/normas , Obturadores Palatinos/estatística & dados numéricos , Pandemias , Patologia Bucal/organização & administração , Patologia Bucal/normas , Qualidade de Vida , Fluxo de Trabalho
14.
Anesth Analg ; 132(1): 31-37, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315601

RESUMO

BACKGROUND: Care of the pregnant patient during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic presents many challenges, including creating parallel workflows for infected and noninfected patients, minimizing waste of materials, and ensuring that clinicians can seamlessly transition between types of anesthesia. The exponential community spread of disease limited the time for development and training. METHODS: The goals of our workflow and process development were to maximize safety for staff and patients, minimize the risk of contamination, and reduce the waste of unused supplies and materials. We used a cyclical improvement system and the plus/delta debriefing method to rapidly develop workflows consisting of sequential checklists and procedure-specific packs. RESULTS: We designed independent workflows for labor analgesia, neuraxial anesthesia for cesarean delivery, conversion of labor analgesia to cesarean anesthesia, and general anesthesia. In addition, we created procedure-specific material packs to optimize supplies and prevent wastage. Finally, we generated sequential checklists to allow staff to perform standard operating procedures without extensive training. CONCLUSIONS: Collectively, these workflows and tools allowed our staff to urgently care for patients in high-risk situations without prior experience. Over time, we refined the workflows using a cyclical improvement system. We present our checklists and workflows as well as the system we used for their development, so that others may use them to their benefit.


Assuntos
Serviço Hospitalar de Anestesia/organização & administração , Anestesia Obstétrica , Lista de Checagem , Assistência à Saúde/organização & administração , Controle de Infecções/organização & administração , Fluxo de Trabalho , /transmissão , Procedimentos Clínicos/organização & administração , Feminino , Humanos , Gravidez , Melhoria de Qualidade/organização & administração , Indicadores de Qualidade em Assistência à Saúde/organização & administração
15.
PLoS One ; 15(12): e0244446, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33382762

RESUMO

OBJECTIVES: Oral potentially malignant disorders (OPMDs) encompass histologically benign, dysplastic, and cancerous lesions that are often indistinguishable by appearance and inconsistently managed. We assessed the potential impact of test-and-treat pathways enabled by a point-of-care test for OPMD characterization. MATERIALS AND METHODS: We constructed a decision-analytic model to compare life expectancy of test-treat strategies for 60-year-old patients with OPMDs in the primary dental setting, based on a trial for a point-of-care cytopathology tool (POCOCT). Eight strategies of OPMD detection and evaluation were compared, involving deferred evaluation (no further characterization), prompt OPMD characterization using POCOCT measurements, or the commonly recommended usual care strategy of routine referral for scalpel biopsy. POCOCT pathways differed in threshold for additional intervention, including surgery for any dysplasia or malignancy, or for only moderate or severe dysplasia or cancer. Strategies with initial referral for biopsy also reflected varied treatment thresholds in current practice between surgery and surveillance of mild dysplasia. Sensitivity analysis was performed to assess the impact of variation in parameter values on model results. RESULTS: Requisite referral for scalpel biopsy offered the highest life expectancy of 20.92 life-years compared with deferred evaluation (+0.30 life-years), though this outcome was driven by baseline assumptions of limited patient adherence to surveillance using POCOCT. POCOCT characterization and surveillance offered only 0.02 life-years less than the most biopsy-intensive strategy, while resulting in 27% fewer biopsies. When the probability of adherence to surveillance and confirmatory biopsy was ≥ 0.88, or when metastasis rates were lower than reported, POCOCT characterization extended life-years (+0.04 life-years) than prompt specialist referral. CONCLUSION: Risk-based OPMD management through point-of-care cytology may offer a reasonable alternative to routine referral for specialist evaluation and scalpel biopsy, with far fewer biopsies. In patients who adhere to surveillance protocols, POCOCT surveillance may extend life expectancy beyond biopsy and follow up visual-tactile inspection.


Assuntos
Técnicas de Apoio para a Decisão , Assistência Odontológica/organização & administração , Neoplasias Bucais/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Lesões Pré-Cancerosas/diagnóstico , Biópsia/economia , Biópsia/estatística & dados numéricos , Tomada de Decisão Clínica , Simulação por Computador , Análise Custo-Benefício , Procedimentos Clínicos/economia , Procedimentos Clínicos/organização & administração , Assistência Odontológica/economia , Clínicas Odontológicas/economia , Clínicas Odontológicas/organização & administração , Clínicas Odontológicas/estatística & dados numéricos , Diagnóstico Diferencial , Feminino , Humanos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Neoplasias Bucais/mortalidade , Neoplasias Bucais/patologia , Neoplasias Bucais/prevenção & controle , Sistemas Automatizados de Assistência Junto ao Leito/economia , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/terapia , Encaminhamento e Consulta/economia , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Medição de Risco/métodos
16.
BMC Med ; 18(1): 398, 2020 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-33323116

RESUMO

BACKGROUND: Dementia is caused by a variety of neurodegenerative diseases and is associated with a decline in memory and other cognitive abilities, while inflicting an enormous socioeconomic burden. The complexity of dementia and its associated comorbidities presents immense challenges for dementia research and care, particularly in clinical decision-making. MAIN BODY: Despite the lack of disease-modifying therapies, there is an increasing and urgent need to make timely and accurate clinical decisions in dementia diagnosis and prognosis to allow appropriate care and treatment. However, the dementia care pathway is currently suboptimal. We propose that through computational approaches, understanding of dementia aetiology could be improved, and dementia assessments could be more standardised, objective and efficient. In particular, we suggest that these will involve appropriate data infrastructure, the use of data-driven computational neurology approaches and the development of practical clinical decision support systems. We also discuss the technical, structural, economic, political and policy-making challenges that accompany such implementations. CONCLUSION: The data-driven era for dementia research has arrived with the potential to transform the healthcare system, creating a more efficient, transparent and personalised service for dementia.


Assuntos
Biologia Computacional/tendências , Procedimentos Clínicos , Bases de Dados Factuais/provisão & distribução , Demência/terapia , Neurologia/tendências , Big Data/provisão & distribução , Comorbidade , Biologia Computacional/métodos , Biologia Computacional/organização & administração , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/normas , Procedimentos Clínicos/estatística & dados numéricos , Ciência de Dados/métodos , Ciência de Dados/organização & administração , Ciência de Dados/tendências , Demência/epidemiologia , Humanos , Neurologia/métodos , Neurologia/organização & administração
17.
Adv Respir Med ; 88(5): 424-432, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33169815

RESUMO

The expanding number of chronic respiratory diseases and the new Covid-19 outbreak create an increasing demand for mechanical ventilation (MV). As MV is no longer limited to intensive care units (ICU) and operating rooms (OR), more clinicians should acquaint themselves with the principles of mechanical ventilation. To fully acknowledge contemporary concepts of MV, it is crucial to understand the elemental physiology and respiratory machine nuances. This paper addresses the latter issues and provides insight into ventilation modes and essential monitoring of MV.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Procedimentos Clínicos/organização & administração , Pneumonia Viral/terapia , Respiração Artificial/estatística & dados numéricos , Insuficiência Respiratória/terapia , Infecções por Coronavirus/complicações , Humanos , Unidades de Terapia Intensiva , Intubação Intratraqueal/estatística & dados numéricos , Pandemias , Pneumonia Viral/complicações , Insuficiência Respiratória/etiologia
20.
Open Heart ; 7(2)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33106441

RESUMO

OBJECTIVES: To understand the impact of COVID-19 on delivery and outcomes of primary percutaneous coronary intervention (PPCI). Furthermore, to compare clinical presentation and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with active COVID-19 against those without COVID-19. METHODS: We systematically analysed 348 STEMI cases presenting to the PPCI programme in London during the peak of the pandemic (1 March to 30 April 2020) and compared with 440 cases from the same period in 2019. Outcomes of interest included ambulance response times, timeliness of revascularisation, angiographic and procedural characteristics, and in-hospital clinical outcomes RESULTS: There was a 21% reduction in STEMI admissions and longer ambulance response times (87 (62-118) min in 2020 vs 75 (57-95) min in 2019, p<0.001), but that this was not associated with a delays in achieving revascularisation once in hospital (48 (34-65) min in 2020 vs 48 (35-70) min in 2019, p=0.35) or increased mortality (10.9% (38) in 2020 vs 8.6% (38) in 2019, p=0.28). 46 patients with active COVID-19 were more thrombotic and more likely to have intensive care unit admissions (32.6% (15) vs 9.3% (28), OR 5.74 (95%CI 2.24 to 9.89), p<0.001). They also had increased length of stay (4 (3-9) days vs 3 (2-4) days, p<0.001) and a higher mortality (21.7% (10) vs 9.3% (28), OR 2.72 (95% CI 1.25 to 5.82), p=0.012) compared with patients having PPCI without COVID-19. CONCLUSION: These findings suggest that PPCI pathways can be maintained during unprecedented healthcare emergencies but confirms the high mortality of STEMI in the context of concomitant COVID-19 infection characterised by a heightened state of thrombogenicity.


Assuntos
Infecções por Coronavirus , Procedimentos Clínicos/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Avaliação de Processos e Resultados em Cuidados de Saúde/organização & administração , Pandemias , Intervenção Coronária Percutânea , Pneumonia Viral , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Ambulâncias/organização & administração , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Segurança do Paciente , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Trombose/mortalidade , Trombose/terapia , Fatores de Tempo , Tempo para o Tratamento/organização & administração , Resultado do Tratamento
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