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4.
Adv Ther ; 38(3): 1382-1396, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33586006

RESUMO

INTRODUCTION: Widespread misuse of short-acting beta-agonists (SABAs) may contribute to asthma-related morbidity and mortality. Recognizing this, the Global Initiative for Asthma neither recommends SABA monotherapy nor regards this formulation as a preferred reliever. Many health systems and healthcare professionals (HCPs) experience practical issues in implementing guidelines. Clear quality standards can drive improvements in asthma care and encourage implementation of global and national medical guidelines. METHODS: A steering group of global asthma experts came together between May and September 2019 to develop quality statements codifying the minimum elements of good quality asthma care. These statements were either evidence based (when robust evidence was available) or reflected a consensus based on clinical expertise and experience of the group. RESULTS: The quality statements (and associated essential criteria) developed emphasize key elements concerning (1) objective diagnosis specific to individual symptoms, (2) treatment appropriate to the long-term management of asthma as an inflammatory disease, consistent with evidence-based recommendations, (3) controlled dispensing of SABA canisters and monitoring to prevent overuse, (4) regular review of patients after treatment initiation or change, and (5) follow-up of patients in primary care after treatment for an exacerbation in a hospital or an emergency department. CONCLUSIONS: The steering group proposes quality statements that national and local clinical groups can implement as quantitative quality standards that are appropriate to their local circumstances, including during the coronavirus disease 2019 (Covid-19) pandemic. By translating these statements into locally relevant quality standards, primary care physicians and HCPs can encourage optimal management and reduce preventable healthcare interactions. The evidence-based evolution of care encapsulated in these statements will further engender high-quality, patient-centered holistic management that addresses asthma as an inflammatory disease. In particular, the statements empower self-management by patients and encourage health-promoting behaviors, which are essential to reduce exacerbations, the primary goal of asthma management.


Assuntos
Agonistas Adrenérgicos beta/farmacologia , Asma , Uso Indevido de Medicamentos/prevenção & controle , Conduta do Tratamento Medicamentoso/normas , Melhoria de Qualidade/organização & administração , Adulto , Antiasmáticos/farmacologia , Asma/diagnóstico , Asma/tratamento farmacológico , /prevenção & controle , Criança , Feminino , Saúde Global/normas , Fidelidade a Diretrizes , Humanos , Masculino , Inaladores Dosimetrados , Guias de Prática Clínica como Assunto
5.
Ann Glob Health ; 87(1): 17, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33633928

RESUMO

Member States at this year's World Health Assembly 73 (WHA73), held virtually for the first time due to the COVID-19 pandemic, passed multiple resolutions that must be considered when framing efforts to strengthen surgical systems. Surgery has been a relatively neglected field in the global health landscape due to its nature as a cross-cutting treatment rather than focusing on a specific disease or demographic. However, in recent years, access to essential and emergency surgical, obstetric, and anesthesia care has gained increasing recognition as a vital aspect of global health. The WHA73 Resolutions concern specific conditions, as has been characteristic of global health practice, yet proper care for each highlighted disease is inextricably linked to surgical care. Global surgery advocates must recognize how surgical system strengthening aligns with these strategic priorities in order to ensure that surgical care continues to be integrated into efforts to decrease global health disparities.


Assuntos
Anestesia/normas , Cirurgia Geral , Saúde Global , Acesso aos Serviços de Saúde/organização & administração , Disparidades em Assistência à Saúde/organização & administração , Obstetrícia/normas , /epidemiologia , Cirurgia Geral/organização & administração , Cirurgia Geral/normas , Saúde Global/normas , Saúde Global/tendências , Humanos , Melhoria de Qualidade
11.
Drug Saf ; 44(1): 95-105, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33354753

RESUMO

INTRODUCTION: Evidence-based clinical data on coronavirus disease 2019 (COVID-19) pharmacotherapies are scarce. OBJECTIVE: This study documented and characterized COVID-19 cases reported in individuals receiving treatment with Pfizer pharmaceutical products and cases that reported use of Pfizer pharmaceutical products for COVID-19 treatment. METHODS: This retrospective observational review leveraged the Pfizer safety database containing adverse event data collected in association with use of Pfizer products between 1 October, 2019, and 25 June, 2020; the database includes worldwide adverse event data from various sources. Selected Medical Dictionary for Drug Regulatory Activities (MedDRA®) Preferred Terms and subsequent clinical review were used to characterize COVID-19 cases. RESULTS: Over 1500 relevant cases were identified over an 8-month period. In cases that reported COVID-19, immunosuppressant/immunomodulating agents, followed by anticoagulant/antithrombic agents and corticosteroids, were the most frequently reported agents. The frequent reporting of immunosuppressant/immunomodulating agents among cases of COVID-19 suggests increased vulnerability to infection among treated patients, either because of immunosuppressive effects of certain agents or the nature of the underlying treated condition. In cases involving off-label pharmacotherapy use for the treatment of COVID-19-related conditions, the most frequently reported therapeutic classes included antibiotics, antimalarial agents, antivirals/antiretroviral agents, immunosuppressant/immunomodulating agents, corticosteroids, anticoagulants, and immunoglobulin/interferons. The most frequently reported pharmacotherapeutic agents were azithromycin and chloroquine/hydroxychloroquine, followed by lopinavir-ritonavir, ceftriaxone, and tofacitinib. The most frequently reported clinical adverse events associated with azithromycin (as sole therapy or combined with chloroquine/hydroxychloroquine) include electrocardiogram QT prolonged, drug interaction, hepatitis, diarrhea, and hepatitis acute. Regarding cardiac-related events, 19% (120/645) of azithromycin cases reported events associated with QT prolongation/torsade de pointes (which included seven fatal cardiac events). The most frequently reported clinical adverse events associated with other commonly used agents are also presented. CONCLUSIONS: This pharmacovigilance surveillance study provides a unique characterization of cases in which a broad range of pharmaceutical products was reported in relation to COVID-19.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/tendências , Indústria Farmacêutica/tendências , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Saúde Global/tendências , Farmacovigilância , Sistemas de Notificação de Reações Adversas a Medicamentos/normas , Anticoagulantes/efeitos adversos , Antimaláricos/efeitos adversos , Antivirais/efeitos adversos , Bases de Dados Factuais/normas , Bases de Dados Factuais/tendências , Indústria Farmacêutica/normas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Saúde Global/normas , Humanos , Imunossupressores/efeitos adversos , Estudos Retrospectivos
12.
Ann Glob Health ; 86(1): 133, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-33102153

RESUMO

The COVID-19 pandemic has highlighted vast differences across countries in their responses to the emergency and their capacities to implement public health measures that could slow the progression of the disease. As public health systems are the first line of defense during pandemics, it has become clear that sustained investment in strengthening public health infrastructure is a major need in all countries, irrespective of income levels. Drawing on the successful experiences of Switzerland, Georgia, and New Zealand in dealing with COVID-19, we suggest prioritizing core public health capacities with links to the International Health Regulations, improving international cooperation, coordination, and multisectoral action, addressing health inequities by targeting vulnerable groups, and enhancing health literacy, including through sophisticated and sustained communication campaigns to build resilience. These measures will ensure that health systems and communities will be better prepared for the disruptions that future disease outbreaks will inevitably bring.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Assistência à Saúde , Saúde Global/normas , Pandemias/prevenção & controle , Pneumonia Viral , Saúde Pública/métodos , Betacoronavirus , Defesa Civil , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Humanos , Cooperação Internacional , Colaboração Intersetorial , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Melhoria de Qualidade , Fatores Socioeconômicos
15.
QJM ; 113(10): 717-719, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32780855

RESUMO

Societies are organizing themselves to keep the COVID-19 virus at bay for the foreseeable future. The World Health Organization (WHO) has proposed that every country implement a comprehensive set of measures to prevent infection, detect cases, interrupt transmission, control clusters, suppress outbreaks and reduce mortality. Throughout the world, four systems capabilities are emerging that are important for societies to get ahead of the virus and become COVID-19 ready. First: understand the pattern of infection locally and act on it effectively: assess the status of the outbreak; act rapidly and robustly to interrupt transmission. Second: enable people to be active participants in their own responses. Third: focus on the places where people are most at risk of infection. Fourth: assess the performance of responses to COVID-19 infection: detecting cases, interrupting chains of transmission, minimizing adverse consequences, protecting the most vulnerable and ensuring opportunities for sustainable livelihoods and well-being for all, leaving no-one behind. These four capabilities are being woven together within societies: successful weaving can be helped through focusing on three interlinked elements: making information available; assessing and reducing risk; and being able to suppress outbreaks rapidly. This means involving everyone in the response and having strong public health defences. Governments, authorities, public health teams, employers and community organizations make it possible for us to stay safe but, in the end, what happens is up to all of us, individually and collectively. If we are to live well with the threat of COVID-19, solidarity really does matter.


Assuntos
Defesa Civil/organização & administração , Controle de Doenças Transmissíveis , Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Saúde Global , Pandemias , Pneumonia Viral , Saúde Pública , Betacoronavirus/isolamento & purificação , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Participação da Comunidade/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Saúde Global/normas , Saúde Global/tendências , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Saúde Pública/ética , Saúde Pública/métodos , Saúde Pública/tendências , Medição de Risco/métodos , Responsabilidade Social
17.
Ann Biol Clin (Paris) ; 78(4): 363-382, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32753365

RESUMO

The point-of-care tests (POCT) are subject to accreditation. A national inventory survey provides a synthesis of knowledge. The survey distributed 31 questions in 2019. 147 responses were received (75% biologists, 49% CHU, 42% CHG). Only 20.41% are accredited ISO22870, the majority for <50% of the medical departments; 70% say they are going there at the end of 2019 or in 2020. The maps are unknown for 32% (EBMD) and 82% (TROD). Visibility is poor with: medical establishment committee (40%), IT department (31%). Connection is necessary for 87-95% depending on the criterion (QC, authorizations, etc.) and 66% of answers highlight that less than 50% of connexion is effective. The major advantage is the delay of the result (62.5%), then the relationship with the health teams (33.3%). The disadvantages: difficulty of the quality approach (45%), cost of tests (34.3%). Human resource requirements are identified for technicians (82%) and biologists (76%). The multiplicity of sites, devices and operators means that it is difficult to set up and maintain. Biology outside the laboratories, under biological responsibility, must meet a rigorous imperative quality approach.


Assuntos
Técnicas de Laboratório Clínico , Saúde Global , Laboratórios/estatística & dados numéricos , Laboratórios/normas , Testes Imediatos , Acreditação , Serviços de Laboratório Clínico/normas , Serviços de Laboratório Clínico/estatística & dados numéricos , Técnicas de Laboratório Clínico/normas , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , França/epidemiologia , Saúde Global/normas , Saúde Global/estatística & dados numéricos , História do Século XXI , Humanos , Internacionalidade , Ensaio de Proficiência Laboratorial/normas , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Sistemas Automatizados de Assistência Junto ao Leito/normas , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Testes Imediatos/organização & administração , Testes Imediatos/normas , Testes Imediatos/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Inquéritos e Questionários
18.
Lancet Gastroenterol Hepatol ; 5(10): 927-939, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32730786

RESUMO

WHO has set global targets for the elimination of hepatitis B and hepatitis C as a public health threat by 2030. However, investment in elimination programmes remains low. To help drive political commitment and catalyse domestic and international financing, we have developed a global investment framework for the elimination of hepatitis B and hepatitis C. The global investment framework presented in this Health Policy paper outlines national and international activities that will enable reductions in hepatitis C incidence and mortality, and identifies potential sources of funding and tools to help countries build the economic case for investing in national elimination activities. The goal of this framework is to provide a way for countries, particularly those with minimal resources, to gain the substantial economic benefit and cost savings that come from investing in hepatitis C elimination.


Assuntos
Erradicação de Doenças/métodos , Saúde Global/economia , Hepatite B/prevenção & controle , Hepatite C/prevenção & controle , Redução de Custos/economia , Erradicação de Doenças/economia , Feminino , Saúde Global/normas , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Período Periparto , Gravidez , Saúde Pública/economia , Saúde Pública/normas , Vacinação/normas , Organização Mundial da Saúde/organização & administração
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