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1.
S Afr Med J ; 110(7): 605-606, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32880330

RESUMO

In the South African public healthcare sector, patient medical records are still written on paper and stored in filing rooms. There has been an attempt to move towards a paperless electronic system in many public healthcare facilities, but owing to lack of funding, this has been a challenge to achieve. During the current COVID-19 pandemic, the virus could be transmitted through the physical manipulation of patient records by various categories of staff who handle the records with or without gloves for protection. We discuss a digital option that has been partially used at Tygerberg Hospital (TBH), Cape Town, to avoid SARS-CoV-2 patient hard-copy record manipulation. It includes assignment of a QR code to every patient admitted as a person under investigation or confirmed COVID-19 case. The QR code is synced to one of the many free online medical notes smartphone applications (apps), which are password-protected with patient information privacy regulations (Trello is used at TBH), for daily medical notes review and editing. Upon discharge, all notes made during the patient's hospital stay, together with the discharge summary, are printed to generate a hard copy of notes for filing to avoid violation of the current national and provincial patient records policy. Doing this means that a patient will have a virtual online file through the designated app until discharge, when a physical file will be made for storage and safekeeping. It will keep physical manipulation of patient records to the minimum, and potentially assist in reducing transmission of the SARS-CoV-2 virus among healthcare workers.


Assuntos
Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Registros Eletrônicos de Saúde/economia , Controle de Infecções/métodos , Saúde do Trabalhador , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Custos e Análise de Custo , Países em Desenvolvimento , Registros Eletrônicos de Saúde/organização & administração , Feminino , Controle de Formulários e Registros , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Registros Médicos/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , África do Sul
2.
Infez Med ; 28(3): 295-301, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32920564

RESUMO

Most studies evaluating chest computed tomography (CT) features in coronavirus disease 2019 (COVID-19) have been small-sized and have presented varied findings. We aim to systematically review these studies and to conduct a meta-analysis of their results to provide a well-powered assessment of chest CT findings in patients with COVID-19. PubMed and EMBASE databases were systematically searched to identify published studies that evaluated chest CT findings in COVID-19 patients. Data regarding study characteristics and CT findings, including distribution of lesions, the lobe of lung involved, lesion densities, and radiological patterns, were extracted. Arcsine transformed proportions from individual studies were pooled using a random-effects model to derive pooled proportions (PPs) and 95% confidence intervals (CIs). A total of fifty-four studies (n=2693 confirmed COVID-19 patients) were included in the final review. Prevalence of different CT findings varied across studies; however, the most common findings were bilateral pulmonary involvement (PP: 74.1% [68.4%, 79.5%]; I2 = 85.76%), ground glass opacification (PP: 64.6% [57.6%, 71.4%]; I2 = 91.52%), involvement of the left lower lobe (PP: 71.2% [58.9%, 82.1%]; I2 = 90.91%), and subpleural distribution of lesions (PP: 57.2% [39.0%, 74.3%]; I2 = 93.08%). Multivariate meta-regression revealed a positive association between prevalence of air bronchograms and average age of the population (p=0.013). Bilateral ground glass opacification, a subpleural distribution of lesions, and involvement of the left lower lobe were the most notable chest CT findings in COVID-19 patients.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Intervalos de Confiança , Infecções por Coronavirus/diagnóstico , Feminino , Hospitalização , Humanos , Masculino , Registros Médicos/estatística & dados numéricos , Pandemias , Radiografia Torácica/métodos , Análise de Regressão , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
3.
Niger J Clin Pract ; 23(8): 1127-1134, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32788491

RESUMO

Background: The Child Welfare Card (CWC) contains the records of a child's immunization and information on the other aspects of the child's health, including growth curves and home treatment of diarrheal disease to mention a few. How easily retrievable these records are and what influence the cards have on parents/caregivers regarding the child's nurture are uncertain in our environment. Aim: The present study was aimed at assessing the parents/caregivers' knowledge and utilization of CWCs as well as the health-providers' accessibility of the card in the hospital. Method: This study was a cross-sectional descriptive one that involved the parents/caregivers of children aged 60 months and below, attending the children's clinics and wards in a tertiary center. We collected the relevant information, including the sociodemographic data of the parents/caregivers, their knowledge, and assessed the utilization of CWC. The analysis of the categorical data was performed with the IBM Statistical Package for Social Sciences (S.P.S.S) version 23.0 for windows. P values < 0.05 were considered significant. Results: Of the 377 parents/caregivers enrolled in the study, good knowledge of the contents of the CWC was demonstrated by 82 (21.8%) while 78 (20.7%) made the cards available to the health care providers. Eighty (21.2%) made adequate use of the cards at home. A greater number of parents/caregivers from the higher social class had good knowledge of the intervention contents of the CWC (P = 0.005). The accessibility of the cards to the health care-providers was significantly higher among the older parents/caregivers (P = 0.010), those with a good knowledge of CWC (P = 0.020) and parents/caregivers from higher social class (P = 0.001). Subjects with good knowledge were 2.4 times (OR = 2.4, 95% CI = 1.4-4.2) more likely to utilize the intervention contents in the CWC. Conclusion: The overall knowledge, utilization, and accessibility of the CWC were poor. Parents/caregivers with good knowledge were more likely to utilize the information on the CWC compared with participants with poor knowledge.


Assuntos
Cuidadores/estatística & dados numéricos , Serviços de Saúde da Criança/estatística & dados numéricos , Bem-Estar da Criança/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Registros Médicos/estatística & dados numéricos , Adulto , Cuidadores/psicologia , Criança , Saúde da Criança , Serviços de Saúde da Criança/organização & administração , Pré-Escolar , Estudos Transversais , Família , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Esquemas de Imunização , Masculino , Pessoa de Meia-Idade , Nigéria , Classe Social , Fatores Socioeconômicos
4.
PLoS One ; 15(8): e0235826, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760142

RESUMO

BACKGROUND: Thrombophilia-screen tests are specialised haemostasis tests that are affected by numerous unique patient variables including the presence of acute thrombosis, the concomitant use of medication and patient demographics. Complete information on the request form is therefore crucial for the haematological pathologist to make patient-specific interpretation of patients' results. OBJECTIVES: To assess the completeness of thrombophilia-screen test request forms and determine the impact of provision of incomplete information, on the interpretive comments generated by reporting haematological pathologists. To assess the impact of an educational session given to clinicians on the importance of providing all the relevant information on the request forms. METHOD: Two retrospective audits, each covering 3 months, were performed to evaluate the completeness of demographic and clinical information on thrombophilia-screen request forms and its impact on the quality of the interpretive comments before and after an educational intervention. RESULTS: One hundred and seventy-one request forms were included in the first audit and 146 in the second audit. The first audit revealed that all 171 thrombophilia-screen request forms had complete patient demographic information but none had clinical information. Haematological pathologists only made generic comments which could not be applied to a specific patient. The second audit, conducted after a physician educational session, did not reveal any improvement in the clinical information provision by the test-ordering physicians. This was reportedly due to the lack of space on the request form. The interpretive comments therefore remained generic and not patient-specific. CONCLUSION: Physicians' failure to provide relevant clinical information made it impossible for pathologists to make patient-specific interpretation of the results. A single physician education session did not change the practice, reportedly due to the inappropriate design of the test request form. Further studies are required to investigate the impact of an improved request form and the planned electronic test requesting.


Assuntos
Educação Médica Continuada , Programas de Rastreamento/normas , Registros Médicos/normas , Médicos/normas , Trombofilia/diagnóstico , Controle de Formulários e Registros/estatística & dados numéricos , Humanos , Programas de Rastreamento/estatística & dados numéricos , Auditoria Médica/estatística & dados numéricos , Registros Médicos/estatística & dados numéricos , Médicos/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , África do Sul
5.
BMJ Open Respir Res ; 7(1)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32624495

RESUMO

The aim of this case series is to describe and evaluate our experience of continuous positive airway pressure (CPAP) to treat type 1 respiratory failure in patients with COVID-19. CPAP was delivered in negative pressure rooms in the newly repurposed infectious disease unit. We report a cohort of 24 patients with type 1 respiratory failure and COVID-19 admitted to the Royal Liverpool Hospital between 1 April and 30 April 2020. Overall, our results were positive; we were able to safely administer CPAP outside the walls of a critical care or high dependency unit environment and over half of patients (58%) avoided mechanical ventilation and a total of 19 out of 24 (79%) have survived and been discharged from our care.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Unidades de Cuidados Respiratórios , Insuficiência Respiratória , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Procedimentos Clínicos/tendências , Feminino , Humanos , Masculino , Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Consumo de Oxigênio , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Unidades de Cuidados Respiratórios/métodos , Unidades de Cuidados Respiratórios/organização & administração , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia , Análise de Sobrevida , Reino Unido/epidemiologia
7.
Medicine (Baltimore) ; 99(26): e20804, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590765

RESUMO

The aim of this study was to evaluate the effect of a novel 4-dimensional similarity filter (4DSF) on quantitative and qualitative parameters of low-dose dynamic myocardial computed tomography perfusion (CTP) images.In this retrospective study, medical records of 32 patients with suspected or known coronary artery disease who underwent dynamic myocardial CTP at 80 kV were included. The 4DSF reduces noise by averaging voxels that have similar dynamic behavior after adaptive iterative dose reduction 3D (AIDR3D) and deformable image registration were applied. Qualitative (artefact, contour sharpness, and myocardial homogeneity [1 = poor; 2 = intermediate; 3 = good]) and quantitative measurement (standard deviation [SD] and signal-to-noise ratio [SNR]) were compared between the 4DSF and AIDR3D. Contrast-to-noise ratio (CNR) between ischemic and normal remote myocardium was also assessed using myocardial perfusion magnetic resonance imaging as the reference standard in seven patients.The 4DSF was successfully applied to all the images. Improvement in subjective image quality yielded by 4DSF was higher than that yielded by AIDR3D (homogeneity, 1.0 [3 vs 2]; artefact, 1.5 [3 vs 1.5]; P < .001) in all patients. The 4DSF significantly decreased the SD by 59% (AIDR3D vs 4DSF: 33.5 ±â€Š0.4 vs 13.8 ±â€Š0.4, P < .001), increased the SNR by 134% (AIDR3D vs 4DSF: 4.4 ±â€Š0.2 vs 10.3 ±â€Š0.2, P < .001), and increased the CNR by 131% (AIDR3D vs 4DSF: 1.6 ±â€Š0.2 vs 3.7 ±â€Š0.2, P < .001).The 4DSF improved the qualitative and quantitative parameters of low-dose dynamic myocardial CTP images.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Imagem de Perfusão do Miocárdio/métodos , Tomografia Computadorizada por Raios X , Feminino , Humanos , Japão , Masculino , Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Melhoria de Qualidade , Intensificação de Imagem Radiográfica/métodos , Saúde Radiológica , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/instrumentação , Tomografia Computadorizada por Raios X/métodos
8.
Tunis Med ; 98(3): 219-224, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32395815

RESUMO

INTRODUCTION: The initial medical certificate (IMC) is the first document delivered to an injured person, or his or her legal representative. The objective of this study was to determine the knowledge and writing habits of Tunisian dental post-graduate students regarding the IMC. METHOD: This was a descriptive study conducted at the Faculty of Dentistry of Monastir (Tunisia) during the period from October 1, 2018 to March 31, 2019. All the post graduate students were included in the survey. For data collection, a questionnaire written in French was used. The platform "Google Forms" was used to perform the questionnaire and the link was sent by mail to all participants. RESULTS: For 19.9% of respondents , the IMC was considered as an expertise and 22% of them declared that even non-graduates can deliver it. In addition, 22% of participants have already given a IMC to a third party and 12.2% have reported photos and X-rays to the IMC. On the other hand, 82.4% of respondents do not indicate total incapacity for work (TIW) when writing the IMC. In fact, 13.7% of them do not know what a TIW is and 52.1% think that it will be determined during the expertise. Finally, 85.6% of respondents estimated that they did not have the necessary information about the IMC and 96.9% of them thought that an information support would be useful to help them in writing it. CONCLUSION: The writing of IMC incurs the criminal, civil and ethical responsibility of the practitioner.


Assuntos
Educação de Pós-Graduação em Odontologia , Conhecimentos, Atitudes e Prática em Saúde , Registros Médicos/normas , Padrões de Prática Médica , Estudantes de Odontologia/estatística & dados numéricos , Odontologia/normas , Odontologia/estatística & dados numéricos , Educação de Pós-Graduação em Odontologia/estatística & dados numéricos , Humanos , Internato e Residência/normas , Internato e Residência/estatística & dados numéricos , Traumatismos Maxilofaciais/terapia , Registros Médicos/estatística & dados numéricos , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Inquéritos e Questionários , Tunísia/epidemiologia , Redação/normas
9.
Oncologist ; 25(6): e982-e985, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-38316

RESUMO

From a large medical center in Wuhan, the epicenter of the 2019 novel coronavirus disease (COVID-19), we report clinical features and prognosis for three women diagnosed with COVID-19 after gynecologic oncology surgery and hospitalized in January 2020. The incidence of COVID-19 was 0.77% (3 of 389) of total hospitalizations and 1.59% (3 of 189) of patients undergoing surgeries in the ward. The infection of severe acute respiratory syndrome coronavirus 2 may be related to the older age, comorbidities, malignant tumor, and surgery in gynecologic hospitalizations. By February 20, 2020, only two of the three patients had met the clinical discharge criteria. Given the long and uncertain incubation period of COVID-19, screening for the virus infection should be carried out for all patients, both preoperatively and postoperatively. Postponement of scheduled gynecologic surgery for patients in the epidemic area should be considered.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Pneumonia Viral/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Adulto , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Programas de Rastreamento/normas , Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/virologia , Estudos Retrospectivos
10.
Oncologist ; 25(6): e982-e985, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32259322

RESUMO

From a large medical center in Wuhan, the epicenter of the 2019 novel coronavirus disease (COVID-19), we report clinical features and prognosis for three women diagnosed with COVID-19 after gynecologic oncology surgery and hospitalized in January 2020. The incidence of COVID-19 was 0.77% (3 of 389) of total hospitalizations and 1.59% (3 of 189) of patients undergoing surgeries in the ward. The infection of severe acute respiratory syndrome coronavirus 2 may be related to the older age, comorbidities, malignant tumor, and surgery in gynecologic hospitalizations. By February 20, 2020, only two of the three patients had met the clinical discharge criteria. Given the long and uncertain incubation period of COVID-19, screening for the virus infection should be carried out for all patients, both preoperatively and postoperatively. Postponement of scheduled gynecologic surgery for patients in the epidemic area should be considered.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Pneumonia Viral/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Adulto , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Programas de Rastreamento/normas , Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/virologia , Estudos Retrospectivos
11.
Radiol Med ; 125(10): 961-970, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32335813

RESUMO

OBJECTIVE: Extraventricular neurocytoma (EVN) was firstly described in 1997. The current literature regarding imaging of EVN is limited to sporadic case reports and case series. EVN is still poorly considered in the differential diagnosis by neuroradiologists, thus diagnosis remains challenging. In this systematic review, we summarize and discuss computed tomography (CT) and magnetic resonance imaging (MRI) features of EVN cases described in the literature, in order to provide useful informations to neuroradiologists. To the best of our knowledge, this is the most extensive review about imaging of EVN. MATERIALS AND METHODS: A systematic review of the literature about imaging of EVN cases was done. Only case reports or case series in which imaging (CT and/or MRI) features were deeply described were included in the revision. Eligibility of studies was assessed independently by two authors and any disagreements resolved by discussion. RESULTS: Our search strategy revealed 224 articles. After implementation of inclusion and exclusion criteria, 35 studies were considered, and a total of 79 cases of EVN were analyzed. CONCLUSION: EVN has not specific characteristics, with a large and variable imaging spectrum. Usually it appears as a large tumor, with diameters superior to 40 mm, frequently involving the frontal lobe. CT density and MRI signal intensity typically mirror the presence of cystic, solid, or calcified elements; contrast enhancement is visible in 87% of cases. Today, diagnosis of EVN with only imaging techniques is not univocal; neuroradiologists can only suspect this type of lesion, while the definitive diagnosis remains histological.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neurocitoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Feminino , Humanos , Masculino , Registros Médicos/estatística & dados numéricos
12.
Acta otorrinolaringol. esp ; 71(1): 16-25, ene.-feb. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-192431

RESUMO

OBJECTIVES: Unilateral sinonasal disease is commonly encountered in practice and represents an issue of major concern since neoplasms may mimic inflammatory conditions. This paper aims to describe the demographic, clinical and radiological patterns of unilateral pathologies and, accordingly, to establish a guiding algorithm for diagnosis and management. MATERIAL AND METHODS: We conducted a retrospective review of medical records of patients with unilateral sinus opacification on CT scan who underwent endoscopic nasal surgery in our department from January 2011 to December 2017. RESULTS: Of the 150 patients included, 97(64.7%) and 53(35.3%) had inflammatory and neoplastic pathology, respectively. In the neoplastic group, malignancy was present in 35% of patients. Neoplastic conditions were more common in males (p = 0.02) and older patients (56 ± 18 years vs. 38 ± 18, p < .01). Nasal mass or polyp was observed in 56.7% patients. Chronic sinusitis was the most prevalent inflammatory condition, whereas inverted papilloma and osteoma were the most frequent neoplasms. Facial neuralgia, paraesthesia, epistaxis and, on CT scan, superior Lund-Mackay scores, bone remodelling and erosion were significantly more common in neoplastic conditions. Excellent agreement between punch biopsy and postoperative histological results was obtained (k = .883, p < .001). CONCLUSION: A sequential and careful management of unilateral lesions is mandatory. Based on our experience, we propose that, as routine, physical examination should be complemented with nasal endoscopy, CT scan and punch biopsy, in case of visible mass. Although clinical and radiological information might raise suspicion of some conditions, final diagnosis can only be established with histological examination of the surgical specimen


OBJETIVOS: La patología nasal unilateral es común en la práctica clínica y causa preocupación ya que las neoplasias pueden mimetizar las condiciones inflamatorias. Este trabajo pretende describir los patrones demográficos, clínicos y radiológicos de las patologías unilaterales y establecer un algoritmo para el diagnóstico y manejo. MATERIAL Y MÉTODOS: Revisión retrospectiva de los registros médicos de pacientes con opacificación sinusal unilateral en la TC sometidos a cirugía nasal endoscópica en nuestro servicio desde enero de 2011 hasta diciembre de 2017. RESULTADOS: De los 150 pacientes incluidos, 97(64,7%) y 53(35,3%) presentaban patología inflamatoria y neoplásica, respectivamente. En el grupo neoplásico, la malignidad estaba presente en el 35% de los pacientes. Las condiciones neoplásicas fueron más comunes en hombres (p = 0,02) y pacientes mayores (56 ± 18 años vs. 38 ± 18, p < 0,01). Se observó masa nasal en el 56,7% de los pacientes. La sinusitis crónica fue la afección inflamatoria más prevalente, mientras que el papiloma invertido y el osteoma fueron las neoplasias más frecuentes. La neuralgia facial, la parestesia, la epistaxis y, en la TC, las puntuaciones superiores de Lund-Mackay, remodelación y erosión ósea fueron significativamente más comunes en los trastornos neoplásicos. Se encontró una excelente concordancia entre la biopsia por punción y los resultados histológicos postoperatorios (k = 0,88, p < 0,01). CONCLUSIÓN: Con base en nuestra experiencia, proponemos que, el examen físico se complemente con endoscopia nasal, TC y biopsia, en caso de una masa visible. A pesar de que la información clínica y radiológica puede generar sospechas de algunas afecciones, el diagnóstico final solo se puede establecer con el examen histológico postoperatorio


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Doenças dos Seios Paranasais/diagnóstico por imagem , Algoritmos , Tomografia Computadorizada por Raios X , Estudos Retrospectivos , Registros Médicos/estatística & dados numéricos , Endoscopia , Doenças dos Seios Paranasais/patologia , Sinusite/epidemiologia , Neuralgia Facial/epidemiologia , Doença Crônica , Pólipos Nasais/complicações , Fatores de Risco
13.
Sci Rep ; 10(1): 2470, 2020 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-32051480

RESUMO

Acute chest syndrome (ACS) is a major complication of sickle cell anaemia (SCA) and a leading cause for hospital admissions and death. We aimed to study the spectrum of clinical and laboratory features of ACS and to assess the predisposing factors and predictors of severity. A retrospective case-control cohort was studied by retrieving patient information from electronic medical records after ethical approval. One hundred adolescents and adults with SCA and hospital admissions for ACS were identified through the discharge summaries, along with 20 additional patients presenting with VOC, but without ACS (controls). Among the patients with ACS, fever (>38.5 °C), reduced oxygen saturation (<95) and asplenia significantly differed when compared to those of controls (p < 0.05, chi-squared test). The degree of severity was reflected in the use of non-invasive ventilation (NIV), simple and exchange transfusions, and the presence of bilateral pleural effusions and multi-lobar atelectasis/consolidation, which were significantly higher in the cases with ACS than in the controls. Lower haemoglobin (Hb) and high WBC counts were also significantly different between the two groups (p < 0.05, Student's t test). Using logistic regression, our study further demonstrated that asplenia, fever, and reduced O2 saturation, along with low Hb and leukocytosis, were important predictors for the development of ACS.


Assuntos
Síndrome Torácica Aguda/sangue , Anemia Falciforme/complicações , Síndrome Torácica Aguda/diagnóstico , Síndrome Torácica Aguda/etiologia , Adulto , Anemia Falciforme/sangue , Biomarcadores/sangue , Feminino , Hemoglobinas/análise , Humanos , Masculino , Registros Médicos/estatística & dados numéricos , Oxigênio/sangue
14.
Epidemiol Psychiatr Sci ; 29: e95, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31987063

RESUMO

AIMS: Children with autism spectrum disorder (ASD) tend to suffer from various medical comorbidities. We studied the comorbidity burden and health services' utilisation of children with ASD to highlight potential aetiologies and to better understand the medical needs of these children. METHODS: In this nested case-control study, ASD cases and controls - matched by age, sex and ethnicity in a 1:5 ratio - were sampled from all children born between 2009 and 2016 at a tertiary medical centre. Data were obtained from the hospital's electronic database. Comorbid diagnoses were classified according to pathophysiological aetiology and anatomical/systemic classification of disease. Standard univariate and multivariate statistics were used to demonstrate comorbidities and health services' utilisation patterns that are significantly associated with ASD. RESULTS: ASD children had higher rates of comorbidities according to both pathophysiological and anatomical/systemic classifications (p < 0.001). The most marked significant differences were observed for: hearing impairments (OR = 4.728; 95% CI 2.207-10.127) and other auricular conditions (OR = 5.040; 95% CI 1.759-14.438); neurological (OR = 8.198; 95% CI 5.690-11.813) and ophthalmological (OR = 3.381; 95% CI 1.617-7.068) conditions; and ADD/ADHD (OR = 3.246; 95% CI 1.811-5.818). A subgroup analysis revealed a more profound case-control difference in anaemia rates among girls than in boys (OR = 3.25; 95% CI 1.04-10.19 v. OR = 0.74; 95% CI 0.33-1.64 respectively) and an opposite trend (larger differences in males than in females in cardiovascular diseases (OR = 1.99; 95% CI 1.23-3.23 v. OR = 0.76; 95% CI 0.17-3.45, respectively)). In addition, larger case-control differences were seen among Bedouin children than in Jewish children in a number of medical comorbidities (Breslow-Day test for homogeneity of odds ratio p-value <0.05). Finally, we found that children with ASD tended to be referred to the emergency department and to be admitted to the hospital more frequently than children without ASD, even after adjusting for their comorbidity burden (aOR = 1.28; 95% CI 1.08-1.50 and aOR = 1.28; 95% CI 1.11-1.47 for >1 referrals and admissions per year, respectively). CONCLUSIONS: The findings of this study contribute to the overall understanding of comorbid conditions and health services' utilisation for children with ASD. The higher prevalences of comorbidities and healthcare services' utilisation for children with ASD highlight the additional medical burden associated with this condition.


Assuntos
Transtorno do Espectro Autista/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Estudos de Casos e Controles , Criança , Comorbidade , Feminino , Humanos , Israel/epidemiologia , Masculino , Registros Médicos/estatística & dados numéricos , Prevalência
16.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e190010.supl.3, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800849

RESUMO

INTRODUCTION: Brazil presented a high proportion of ill-defined causes of death (IDCD) in 2000, compromising accurate cause-of-death analysis. OBJECTIVE: To analyze specific underlying causes for deaths originally assigned as IDCD in the Mortality Information System (SIM - Sistema de Informação sobre Mortalidade), after investigation activities implemented in country between 2006 and 2017. METHOD: For all IDCD identified in the SIM, municipal health professionals collected information about the final disease obtained from hospital records, autopsies, forms of family health teams, and home investigation. Specific causes among reclassified IDCD after investigation were evaluated according to age groups and four calendar periods. RESULTS: Proportions of IDCD reassigned to other causes after review increased over time, reaching 30.1% in 2017. From a total of 257,367 IDCD reclassified in 2006-2017, neonatal-related conditions, injury, ischemic heart disease and stroke were the leading causes detected in the age groups 0-9 years, 10-29 years, 30-69 years, 70 years and over, respectively. DISCUSSION: The similarity and plausibility of cause-specific proportions derived from the reclassification of IDCD by age group over time indicate the accuracy of the investigation data. CONCLUSION: High proportions of IDCD reassigned to more informative causes after review indicate the success of this approach to correct misclassification in the SIM, an initiative that should be maintained. Training physicians on death certification along with better quality of medical care and access to health services would lead to further improvement.


Assuntos
Causas de Morte , Coleta de Dados/métodos , Sistemas de Informação/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Autopsia/estatística & dados numéricos , Brasil/epidemiologia , Criança , Pré-Escolar , Atestado de Óbito , Feminino , Humanos , Lactente , Entrevistas como Assunto/estatística & dados numéricos , Masculino , Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores de Tempo , Adulto Jovem
18.
Rev. bras. cir. plást ; 34(4): 497-503, oct.-dec. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047912

RESUMO

Introdução: A úlcera plantar por hanseníase é uma lesão no pé resultante da falta de sensibilidade plantar. O objetivo é descrever o tratamento realizado em portadores de úlceras plantares por hanseníase. Métodos: Estudo de prontuários de portadores de úlcera plantar atendidos no Hospital Sarah em Brasília, de 2006 a 2016, quanto ao sexo, idade, etiologia, localização e tratamento. Resultados: Foram atendidos 27 pacientes, 17(62,96%) homens e 10 (37,04%) mulheres, procedentes de Goiás e DF, na faixa etária de 41 a 60 anos (40,74%). Todos necessitaram de um ou mais procedimentos cirúrgicos. Conclusão: Observou-se maior frequência no sexo masculino, grau avançado, localizadas no primeiro artelho. Todos necessitaram de procedimentos cirúrgicos e não cirúrgicos, evoluindo com cicatrização completa da ferida, amputação transtibial em um caso e de artelhos em sete casos, e 90% dos casos apresentaram recorrência da úlcera após um ano.


Introduction: Leprosy-induced plantar ulcers result from a lack of plantar sensitivity. Objective: This study aimed to describe the treatment provided to patients with leprosy-induced plantar ulcers. Methods: We retrospectively reviewed the medical records of patients with plantar ulcers treated at Sarah Hospital in Brasilia from 2006 to 2016 and collected information about sex, age, etiology, location, and treatment. Results: A total of 27 patients (17 [62.96%] men, 10 [37.04%] women; 40.74% were aged 41­60 years) were treated from Goiás and the Federal District. All required ≥1 surgical procedure. Conclusion: A higher frequency of advanced grade was observed in men, primarily on the first toe. All needed surgical and non-surgical procedures and achieved complete wound healing. Transtibial amputation was required in 1 case and toe amputation in 7 cases; 90% patients developed ulcer recurrence after 1 year.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Reabilitação , Terapêutica , Tratamento Terciário , Registros Médicos , Úlcera do Pé , Hanseníase , Reabilitação/métodos , Reabilitação/estatística & dados numéricos , Terapêutica/métodos , Terapêutica/estatística & dados numéricos , Tratamento Terciário/métodos , Tratamento Terciário/estatística & dados numéricos , Registros Médicos/normas , Registros Médicos/estatística & dados numéricos , Úlcera do Pé/cirurgia , Úlcera do Pé/complicações , Úlcera do Pé/terapia , Hanseníase/cirurgia , Hanseníase/complicações , Hanseníase/terapia
19.
PLoS One ; 14(10): e0224124, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31639171

RESUMO

OBJECTIVES: The main objective of this study was to evaluate community pharmacists' awareness and perception about medication reconciliation service and to assess the completeness of collecting patients' medication histories in the community pharmacy setting. METHODS: A cross-sectional study was conducted between February to March 2018 in Amman-Jordan. During the study period, 150 community pharmacists were invited to participate in the study. Each pharmacist completed a validated structured questionnaire evaluating their awareness, current practice, perceived attitude and perceived barriers towards the implementation of medication reconciliation and the collection of medication histories at the community pharmacy setting. RESULTS: A total of 121 pharmacists agreed to participate and filled the questionnaire. Our results showed that only 13.2% of the pharmacists were able to define "medication reconciliation" correctly, and around 31% have a misconception that the medication reconciliation process should be performed only at the inpatient setting. Only 19.8% (n = 24) of the participating pharmacists stated that they ask all patients for a complete current medication list of medications when they arrive at the pharmacy site. Medication histories for most patients were lacking information about the dosage, route, frequency, and time of the last refill for each medication listed. "Patients lack of awareness about all the medications they are receiving" was the main barrier discouraging community pharmacists from collecting medication histories and participating in reconciliation service. CONCLUSION: Community pharmacists in Jordan showed a low awareness about the medication reconciliation concept and demonstrated a modest role in obtaining medication histories in community pharmacies. But still, they showed a positive attitude towards their role in implementing the different steps of medication reconciliation. This suggests that educational workshops to increase pharmacists' awareness about their role and responsibilities in collecting a complete and accurate medication history are warrented.


Assuntos
Atitude do Pessoal de Saúde , Serviços Comunitários de Farmácia/organização & administração , Documentação/normas , Registros Médicos/estatística & dados numéricos , Reconciliação de Medicamentos/normas , Farmacêuticos/normas , Medicamentos sob Prescrição/normas , Adulto , Estudos Transversais , Feminino , Humanos , Jordânia , Masculino , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Papel Profissional
20.
Int J Clin Pharm ; 41(6): 1562-1569, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31664686

RESUMO

Background The STOPP/START criteria are an explicit tool to detect potentially inappropriate medications (PIMs). Patient clinical information may not be available in all settings. Objective To identify patient clinical information needed to apply the STOPP/START criteria. Setting: Four nursing homes in Portugal. Methods First, a theoretical analysis was performed to identify the patient information required to apply the STOPP/START criteria (v2), according to the following categories: patients' current medication, medication history (previous medication and duration), medical records (current and past medical conditions), and laboratory test results. A verification of the information requirements was conducted through a cross-sectional study on a nursing home population with patients over 65 years old. Patients' medical records were appraised to extract only demographic data and current medication profiles. Main outcome measure Information requirements of STOPP/START. Results For only 29 of the 81 STOPP criteria and 1 of the 34 START criteria, a judgement could be made with only the information in the patient's medication profile. 52 STOPP and 33 START criteria require additional information, (i.e. duration of therapy, previous medication, current and past medical conditions, and laboratory data). The 208 evaluated persons (87 years; 68.75% female) used 1770 medications, with 989 (55.9%) potentially involved in 1629 STOPP criteria. Sufficient information to judge STOPP criteria was available for only 529 (32.5%) potential STOPP criteria situations, with a positive identification of a STOPP PIM in 397 instances (75.0%). Conclusions Although STOPP/START criteria can be considered a high-level tool to identify PIMs, their use may be compromised in scenarios where access to patients' clinical information is limited.


Assuntos
Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Registros Médicos/estatística & dados numéricos , Portugal
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