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1.
Dtsch Med Wochenschr ; 145(20): 1470-1475, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-33022728

RESUMO

Decisions about the initiation, continuation and termination of life-supporting treatments are a permanent challenge in intensive care units (ICUs). Decisions should be based on patient preferences and the medical indication. The medical indication is mainly the result of an assessment of the patient's prognosis and the applicable therapeutic options. Factors influencing the short term prognosis are mostly the severity of the acute leading disease, the number and severity of other organ failures and the response to initial treatment. Long term prognosis is dominated by the severity and number of comorbidities, age and the resulting frailty. Because in many patients all these informations are not available at the time of admission, in these cases a time-limited trial is often justified to gather all this information before a decision is made. These principles of decision making can also applied to situations in which ICU-capacities are limited (e. g. COVID-19 pandemic).


Assuntos
Tomada de Decisão Clínica , Cuidados Críticos , Betacoronavirus , Infecções por Coronavirus , Humanos , Unidades de Terapia Intensiva , Pandemias , Pneumonia Viral , Prognóstico
2.
J Med Case Rep ; 14(1): 191, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028403

RESUMO

BACKGROUND: Determining the infectiousness of patients with coronavirus disease 2019 is crucial for patient management. Medical staff usually refer to the results of reverse transcription polymerase chain reaction tests in conjunction with clinical symptoms and computed tomographic images. CASE PRESENTATION: We report a case of a 62-year-old Japanese man who twice had positive and negative test results by polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 over 48 days of hospitalization, including in intensive care. His respiratory symptoms and computed tomographic imaging findings consistent with coronavirus disease 2019 improved following initial intensive care, and the result of his polymerase chain reaction test became negative 3 days before discharge from the intensive care unit. However, 4 days after this first negative result, his polymerase chain reaction test result was positive again, and another 4 days later, he had a negative result once more. Eight days after the second polymerase chain reaction negative test result, the patient's test result again became positive. Finally, his polymerase chain reaction results were negative 43 days after his first hospitalization. CONCLUSIONS: This case emphasizes the importance of repeat polymerase chain reaction testing and diagnosis based on multiple criteria, including clinical symptoms and computed tomographic imaging findings. Clinical staff should consider that a negative result by polymerase chain reaction does not necessarily certify complete coronavirus disease 2019 recovery.


Assuntos
Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus , Pulmão/diagnóstico por imagem , Pandemias , Pneumonia Viral , Avaliação de Sintomas/métodos , Tomada de Decisão Clínica , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Reações Falso-Negativas , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(40): e22547, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019465

RESUMO

BACKGROUND: chronic low back pain (CLBP) are common symptoms bothering people in daily life. Traditional Chinese medicine (TCM) nonpharmacological interventions are gaining an increasing popularity for CLBP. Nevertheless, the evidence of efficacy and safety of random controlled trials (RCTs) remains controversial. This study aims to evaluate the efficacy and acceptability of different TCM nonpharmacological therapies by systematic review and network meta-analysis. METHODS: According to the strategy, The authors will retrieve a total of 7 electronic databases by September 2020, including PubMed, the Cochrane Library, EMbase, China National Knowledge Infrastructure, China Biological Medicine, Chongqing VIP, and Wan-fang databases After a series of screening, 2 researchers will use Aggregate Data Drug Information System and Stata software to analyze the data extracted from the randomized controlled trials of TCM nonpharmacological interventions for CLBP. The primary outcome will be the improvement of Pain intensity and functional status/disability and the secondary outcomes will include lobal improvement, health-related quality of life, satisfaction with treatment, and adverse events. Both classical meta-analysis and network meta-analysis will be implemented to investigate direct and indirect evidences on this topic. The quality of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation instrument. RESULTS: This study will provide a reliable evidence for the selection of TCM nonpharmacological therapies in the treatment of CLBP. CONCLUSION: This study will generate evidence for different TCM nonpharmacological therapies for CLBP and provide a decision-making reference for clinical research. ETHICS AND DISSEMINATION: This study does not require ethical approval. The results will be disseminated through a peer-reviewed publication. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/4H3Y9.


Assuntos
Dor Lombar/terapia , Medicina Tradicional Chinesa/métodos , Metanálise em Rede , Acupressão/métodos , Terapia por Acupuntura/métodos , Tomada de Decisão Clínica , Ventosaterapia/métodos , Bases de Dados Factuais , Humanos , Dor Lombar/psicologia , Medicina Tradicional Chinesa/efeitos adversos , Medicina Tradicional Chinesa/tendências , Moxibustão/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Tai Ji/métodos , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(40): e22588, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019476

RESUMO

BACKGROUND: The objective of this meta-analysis was to summarize and identify the available evidence from studies to estimate the clinical value of traditional Chinese medicine (TCM) in the treatment of recurrent aphthous stomatitis (RAS) and provides clinicians with evidence on which to base their clinical decision making. METHODS: This review will include all studies comparing clinical efficacy of TCM in the treatment of RAS. The search strategy will be performed in 9 databases. We will not establish any limitations to language and publication status, published from inception to the August 2020. Two reviewers will screen, select studies, extract data, and assess quality independently. Outcome is clinical efficacy, pain relief, duration of wound healing, effect on wound healing, rate of recurrence, adverse events, and safety. The methodological quality including the risk of bias of the included studies will be evaluated. We will carry out statistical analysis using RevMan 5.3 software. RESULTS: This study will summarize current evidence to assess the efficacy and safety of TCM in the treatment of RAS. CONCLUSION: The findings of this study will provide helpful evidence for the clinician, and will promote further studies, as well as studying the value of TCM. REGISTRATION NUMBER: INPLASY202080126 (DOI number: 10.37766/inplasy2020.8.0126).


Assuntos
Medicina Tradicional Chinesa/métodos , Medição da Dor/estatística & dados numéricos , Estomatite Aftosa/terapia , China/epidemiologia , Tomada de Decisão Clínica , Feminino , Humanos , Incidência , Masculino , Medicina Tradicional Chinesa/efeitos adversos , Estudos Observacionais como Assunto , Medição da Dor/efeitos dos fármacos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Segurança , Estomatite Aftosa/epidemiologia , Resultado do Tratamento , Cicatrização/efeitos dos fármacos
6.
Ital J Pediatr ; 46(1): 149, 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33032650

RESUMO

The rapid spread of the COVID-19 outbreak in Italy has dramatically impacted the National Healthcare System, causing the sudden congestion of hospitals, especially in Northern Italy, thus imposing drastic restriction of almost all routine medical care. This exceptional adaptation of the Italian National Healthcare System has also been felt by non-frontline settings such as Pediatric Orthopaedic Units, where the limitation or temporary suspension of most routine care activities met with a need to maintain continuity of care and avoid secondary issues due to the delay or suspension of the routine clinical practice. The Italian Society of Pediatric Orthopaedics and Traumatology formulated general and specific recommendations to face the COVID-19 outbreak, aiming to provide essential care for children needing orthopaedic treatments during the pandemic and early post-peak period, ensure safety of children, caregivers and healthcare providers and limit the spread of contagion.


Assuntos
Infecção Hospitalar/prevenção & controle , Assistência à Saúde/organização & administração , Procedimentos Ortopédicos/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto/normas , Criança , Pré-Escolar , Tomada de Decisão Clínica , Feminino , Humanos , Itália , Masculino , Saúde do Trabalhador/estatística & dados numéricos , Procedimentos Ortopédicos/métodos , Ortopedia/normas , Segurança do Paciente , Pediatria/normas , Sociedades Médicas/normas , Traumatologia/normas
7.
Rev Med Suisse ; 16(709): 1865-1869, 2020 Oct 07.
Artigo em Francês | MEDLINE | ID: mdl-33026729

RESUMO

Obstructive sleep apnea syndrome (OSAS) is a respiratory disorder affecting up to 49 % and 23 % of middle to older aged men and women respectively. CPAP (continuous positive airway pressure) is the gold-standard treatment for severe apneas. In mild and moderate forms of OSAS, mandibular advancement devices (MAD) are equally a first line of treatment. Both CPAP and MAD have their advantages and side effects. Patient tolerance to these two therapies varies according to different patient-parameters. In order to guide physicians and patients in choosing between these two treatments, we present a description of both treatment modalities.


Assuntos
Tomada de Decisão Clínica , Pressão Positiva Contínua nas Vias Aéreas , Avanço Mandibular , Apneia Obstrutiva do Sono/terapia , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Humanos , Avanço Mandibular/efeitos adversos , Placas Oclusais/efeitos adversos
8.
Rev Med Suisse ; 16(707): 1751-1755, 2020 Sep 23.
Artigo em Francês | MEDLINE | ID: mdl-32969612

RESUMO

Acute treatment of agitation in psychiatry is one of the urgent situations for which management recommendations are needed. Various existing international recommendations have been evaluated and adapted to our clinical practice and to the drugs available in Switzerland in order to propose a uniform management strategy in our hospital. This strategy includes a treatment choice algorithm with different options depending on the clinical situation and the possible route of administration. Dose recommendations for the oral and intramuscular routes, certain pharmacokinetic parameters, as well as risks of interactions and important warnings are also included in this clinical recommendation.


Assuntos
Algoritmos , Tomada de Decisão Clínica , Psiquiatria/métodos , Tranquilizantes/administração & dosagem , Tranquilizantes/uso terapêutico , Teoria da Decisão , Vias de Administração de Medicamentos , Humanos , Suíça , Tranquilizantes/farmacocinética
10.
J Thromb Haemost ; 18(9): 2138-2144, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32881336

RESUMO

Hypercoagulability is an increasingly recognized complication of SARS-CoV-2 infection. As such, anticoagulation has become part and parcel of comprehensive COVID-19 management. However, several uncertainties exist in this area, including the appropriate type and dose of heparin. In addition, special patient populations, including those with high body mass index and renal impairment, require special consideration. Although the current evidence is still insufficient, we provide a pragmatic approach to anticoagulation in COVID-19, but stress the need for further trials in this area.


Assuntos
Anticoagulantes/uso terapêutico , Betacoronavirus/patogenicidade , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Coagulação Sanguínea/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/mortalidade , Transtornos da Coagulação Sanguínea/virologia , Tomada de Decisão Clínica , Infecções por Coronavirus/sangue , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Interações Hospedeiro-Patógeno , Humanos , Pandemias , Seleção de Pacientes , Pneumonia Viral/sangue , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Fatores de Risco , Resultado do Tratamento
11.
BMC Infect Dis ; 20(1): 675, 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938422

RESUMO

INTRODUCTION: Person-centred care, an internationally recognised priority, describes the involvement of people in their care and treatment decisions, and the consideration of their needs and priorities within service delivery. Clarity is required regarding how it may be implemented in practice within different contexts. The standard multi-drug resistant tuberculosis (MDR-TB) treatment regimen is lengthy, toxic and insufficiently effective. 2019 World Health Organisation guidelines include a shorter (9-11-month) regimen and recommend that people with MDR-TB be involved in the choice of treatment option. We examine the perspectives and experiences of people with MDR-TB and health-care workers (HCW) regarding person-centred care in an MDR-TB programme in Karakalpakstan, Uzbekistan, run by Médecins Sans Frontières and the Ministry of Health. METHODS: A qualitative study comprising 48 interviews with 24 people with MDR-TB and 20 HCW was conducted in June-July 2019. Participants were recruited purposively to include a range of treatment-taking experiences and professional positions. Interview data were analysed thematically using coding to identify emerging patterns, concepts, and categories relating to person-centred care, with Nvivo12. RESULTS: People with MDR-TB were unfamiliar with shared decision-making and felt uncomfortable taking responsibility for their treatment choice. HCW were viewed as having greater knowledge and expertise, and patients trusted HCW to act in their best interests, deferring the choice of appropriate treatment course to them. HCW had concerns about involving people in treatment choices, preferring that doctors made decisions. People with MDR-TB wanted to be involved in discussions about their treatment, and have their preference sought, and were comfortable choosing whether treatment was ambulatory or hospital-based. Participants felt it important that people with MDR-TB had knowledge and understanding about their treatment and disease, to foster their sense of preparedness and ownership for treatment. Involving people in their care was said to motivate sustained treatment-taking, and it appeared important to have evidence of treatment need and effect. CONCLUSIONS: There is a preference for doctors choosing the treatment regimen, linked to shared decision-making unfamiliarity and practitioner-patient knowledge imbalance. Involving people in their care, through discussions, information, and preference-seeking could foster ownership and self-responsibility, supporting sustained engagement with treatment.


Assuntos
Pessoal de Saúde/psicologia , Assistência Centrada no Paciente , Tuberculose Resistente a Múltiplos Medicamentos/psicologia , Adolescente , Adulto , Antituberculosos/uso terapêutico , Tomada de Decisão Clínica , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Uzbequistão , Adulto Jovem
12.
BMJ Open Qual ; 9(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32988831

RESUMO

The COVID-19 pandemic has led to significant morbidity and mortality globally. As health systems grapple with caring for patients affected with COVID-19, cardiovascular procedures that are deemed 'elective' have been postponed. Guidelines concerning which cardiac procedures should be performed during the pandemic vary by specialty and geography in the USA. We propose a clinical heuristic to guide individual physicians and governing bodies in their decision making regarding which cardiac procedures should be performed during the COVID-19 pandemic using the behavioural economics concept of heuristics and ecological rationality.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/psicologia , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/prevenção & controle , Economia Comportamental , Procedimentos Cirúrgicos Eletivos/psicologia , Heurística , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Contraindicações de Procedimentos , Humanos , Estados Unidos
13.
J Ovarian Res ; 13(1): 105, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32917254

RESUMO

BACKGROUND: The number of cases of novel coronavirus disease 2019 (COVID-19) in Japan have risen since the first case was reported on January 24, 2020, and 6225 infections have been reported as of June 30, 2020. On April 8, 2020, our hospital began screening patients via pre-admission reverse transcriptase-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and chest computed tomography (CT). Although no patients exhibited apparent pneumonia, treatment delay or changes in treatment plans were required for a few patients based on the results of screening tests. During an emerging infectious disease pandemic, the likelihood of being infected, as well as the disease itself, affects clinical decision making in several ways. We summarized and presented our experience. CASE PRESENTATION: After the introduction of pre-admission screening, RT-PCR and CT were performed in 200 and 76 patients, respectively, as of June 30, 2020. The treatment of five patients, including two patients with cervical cancer, two patients with ovarian tumors, and one patient with ovarian cancer, was affected by the results. Two asymptomatic RT-PCR-positive patients did not develop COVID-19, but their treatment was delayed until the confirmation of negative results. The other three patients were RT-PCR-negative, but abnormal CT findings suggested the possibility of COVID-19, which delayed treatment. The patients receiving first-line preoperative chemotherapy for ovarian cancer had clinically evident exacerbations because of the treatment delay. CONCLUSION: During the epidemic phase of an emerging infectious disease, we found that COVID-19 has several other effects besides its incidence. The postponing treatment was the most common, therefore, treatment of ovarian tumors and ovarian cancer was considered to be the most likely to be affected among gynecological diseases. Protocols that allow for easy over-diagnosis can be disadvantageous, mainly because of treatment delays, and therefore, the protocols must be developed in light of the local infection situation.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Neoplasias dos Genitais Femininos/terapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Betacoronavirus/isolamento & purificação , Institutos de Câncer , Tomada de Decisão Clínica , Técnicas de Laboratório Clínico , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Tempo para o Tratamento , Tóquio/epidemiologia , Resultado do Tratamento
14.
Surg Oncol ; 34: 182-185, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32891326

RESUMO

In the midst of the coronavirus disease 2019 (COVID-19) pandemic, governmental agencies, state medical boards, and healthcare organizations have called for restricting "elective" operations to mitigate the risk of transmission of the virus amongst patients and healthcare providers and to preserve essential resources for potential regional surges of COVID patients. While the fear of delaying surgical care for many of our patients is deeply challenging for us as cancer care providers, we must balance our personal commitment to providing timely and appropriate oncologic care to our cancer patients with our societal responsibility to protect our patients (including those on whom we are operating), co-workers, trainees, families, and community, from undue risks of contracting and propagating COVID-19. Herein, we present guidelines for surgical decision-making and case prioritization developed among all adult disease specialties in the MD Anderson Cancer Center Departments of Surgical Oncology and Breast Surgical Oncology in Houston, Texas.


Assuntos
Tomada de Decisão Clínica , Infecções por Coronavirus/epidemiologia , Neoplasias/cirurgia , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Betacoronavirus , Neoplasias da Mama/cirurgia , Neoplasias do Sistema Digestório/cirurgia , Neoplasias das Glândulas Endócrinas/cirurgia , Humanos , Melanoma/cirurgia , Tumores Neuroendócrinos/cirurgia , Pandemias , Equipe de Assistência ao Paciente , Neoplasias Peritoneais/cirurgia , Sarcoma/cirurgia , Oncologia Cirúrgica
15.
S Afr Med J ; 110(7): 613-616, 2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32880333

RESUMO

Faced with a pandemic, doctors around the world are forced to make difficult ethical decisions about clinical, economic and politically charged issues in medicine and healthcare, with little time or resources for support. A decision-making framework is suggested to guide policy and clinical practice to support the needs of healthcare workers, help to allocate scarce resources equitably and promote communication among stakeholders, while drawing on South African doctors' knowledge, culture and experience.


Assuntos
Infecções por Coronavirus/prevenção & controle , Comunicação Interdisciplinar , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Padrões de Prática Médica/organização & administração , Atitude do Pessoal de Saúde , Tomada de Decisão Clínica , Infecções por Coronavirus/epidemiologia , Países em Desenvolvimento , Feminino , Política de Saúde , Recursos em Saúde , Humanos , Masculino , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Formulação de Políticas , África do Sul
17.
Glob Heart ; 15(1): 44, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32923338

RESUMO

In this paper, we provide recommendations on the management of cardiovascular disease (CVD) among patients with confirmed or suspected coronavirus disease (COVID-19) to facilitate the decision making of healthcare professionals in low resource settings. The emergence of novel coronavirus disease, also known as Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has presented an unprecedented global challenge for the healthcare community. The ability of SARS-CoV-2 to get transmitted during the asymptomatic phase and its high infectivity have led to the rapid transmission of COVID-19 beyond geographic regions, leading to a pandemic. There is concern that COVID-19 is cardiotropic, and it interacts with the cardiovascular system on multiple levels. Individuals with established CVD are more susceptible to severe COVID-19. Through a consensus approach involving an international group this WHF statement summarizes the links between cardiovascular disease and COVID-19 and present some practical recommendations for the management of hypertension and diabetes, acute coronary syndrome, heart failure, rheumatic heart disease, Chagas disease, and myocardial injury for patients with COVID-19 in low-resource settings. This document is not a clinical guideline and it is not intended to replace national clinical guidelines or recommendations. Given the rapidly growing burden posed by COVID-19 illness and the associated severe prognostic implication of CVD involvement, further research is required to understand the potential mechanisms linking COVID-19 and CVD, clinical presentation, and outcomes of various cardiovascular manifestations in COVID-19 patients.


Assuntos
Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/terapia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Tomada de Decisão Clínica , Árvores de Decisões , Recursos em Saúde , Humanos , Pandemias , Guias de Prática Clínica como Assunto
18.
Rev Med Suisse ; 16(708): 1790-1795, 2020 Sep 30.
Artigo em Francês | MEDLINE | ID: mdl-32997448

RESUMO

Medical care of adults with disabilities, especially those with intellectual disabilities, can be ethically difficult. Several questions arise frequently. Can we administer a life-saving treatment that could impact negatively the patient's quality of life when the patient isn't able to give consent? During this Covid-19 period, can the use of chemical or physical restraints be considered as mistreatment, whereas the aim is to protect others? These are situations where the ethical question holds a central role. Although each clinical situation is unique, this article highlights, through four clinical cases, the ethical principles that should guide physicians in their decision-making process.


Assuntos
Tomada de Decisão Clínica/ética , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Pessoas com Deficiência , Deficiência Intelectual , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Qualidade de Vida , Adulto , Infecções por Coronavirus/epidemiologia , Humanos , Consentimento Livre e Esclarecido/ética , Pandemias , Pneumonia Viral/epidemiologia , Restrição Física/ética
19.
J Law Med ; 27(4): 981-984, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32880414

RESUMO

Clinical issues involving ethical dilemmas arise daily and confound physicians as they provide medical care. These dilemmas require difficult decisions as physicians must respect patients' values, lifestyles, and freedom of choice while protecting life and promoting health. This is made more challenging as values and lifestyles become more diverse, making third-party support necessary to accommodate the wishes of stakeholders, particularly patients. Collaborative work is important for addressing clinical ethics issues. Government agencies and professional organisations should discuss individual cases as public policy concerns and release guidelines based on their deliberations. Medical institutions should refer to such guidelines in their own discussions on ethically challenging cases. This is not the case today as each organisation creates its own guidelines; there is no consensus on how clinical ethics committees or consultations should be conducted. Support systems that are public in nature are needed to protect patients' rights and freedoms in medical care.


Assuntos
Tomada de Decisão Clínica , Médicos , Ética Médica , Liberdade , Humanos , Japão , Direitos do Paciente
20.
Int J Med Sci ; 17(15): 2257-2263, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32922189

RESUMO

Background: Corona Virus Disease 2019 (COVID-19) has become a global pandemic. This study established prognostic scoring models based on comorbidities and other clinical information for severe and critical patients with COVID-19. Material and Methods: We retrospectively collected data from 51 patients diagnosed as severe or critical COVID-19 who were admitted between January 29, 2020, and February 18, 2020. The Charlson (CCI), Elixhauser (ECI), and age- and smoking-adjusted Charlson (ASCCI) and Elixhauser (ASECI) comorbidity indices were used to evaluate the patient outcomes. Results: The mean hospital length of stay (LOS) of the COVID-19 patients was 22.82 ± 12.32 days; 19 patients (37.3%) were hospitalized for more than 24 days. Multivariate analysis identified older age (OR 1.064, P = 0.018, 95%CI 1.011-1.121) and smoking (OR 3.696, P = 0.080, 95%CI 0.856-15.955) as positive predictors of a long LOS. There were significant trends for increasing hospital LOS with increasing CCI, ASCCI, and ASECI scores (OR 57.500, P = 0.001, 95%CI 5.687-581.399; OR 71.500, P = 0.001, 95%CI 5.689-898.642; and OR 19.556, P = 0.001, 95%CI 3.315-115.372, respectively). The result was similar for the outcome of critical illness (OR 21.333, P = 0.001, 95%CI 3.565-127.672; OR 13.000, P = 0.009, 95%CI 1.921-87.990; OR 11.333, P = 0.008, 95%CI 1.859-69.080, respectively). Conclusions: This study established prognostic scoring models based on comorbidities and clinical information, which may help with the graded management of patients according to prognosis score and remind physicians to pay more attention to patients with high scores.


Assuntos
Comorbidade , Infecções por Coronavirus/mortalidade , Estado Terminal/mortalidade , Modelos Estatísticos , Pneumonia Viral/mortalidade , Índice de Gravidade de Doença , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Betacoronavirus/patogenicidade , Tomada de Decisão Clínica , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos
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