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1.
Rev. bioét. derecho ; (50): 37-61, nov. 2020.
Artigo em Espanhol | IBECS | ID: ibc-191345

RESUMO

Este documento ofrece una propuesta desde la perspectiva de la bioética para la elaboración de un protocolo de triaje en el contexto de la pandemia de COVID-19. Dicha propuesta incluye recomendaciones sobre las normas procedimentales y normas sustantivas que deben regir la asignación y reasignación de recursos terapéuticos en condiciones de escasez extrema


This document offers a proposal for the elaboration of a triage guideline in the context of the COVID-19 pandemic. This proposal includes recommendations on the procedural norms and substantive norms that should govern the allocation and reallocation of therapeutic resources in conditions of extreme scarcity


Aquest document ofereix una proposta des de la perspectiva de la bioètica per a l'elaboració d'un protocol de triatge en el context de la pandèmia de COVID-19. L'esmentada proposta inclou recomanacions sobre les normes procedimentals I normes substantives que han de regir l'assignació I reassignació de recursos terapèutics en condicions d'escassetat extrema


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias/ética , Protocolos Clínicos , Triagem/ética , Tomada de Decisões/ética
2.
Rev. bioét. derecho ; (50): 99-112, nov. 2020.
Artigo em Espanhol | IBECS | ID: ibc-191348

RESUMO

En el marco de una pandemia a escala mundial como la que representa el COVID-19 uno de los mayores dilemas bioéticos que se plantean es el de la gestión de determinados medios asistenciales escasos, tales como los respiradores (ventilación mecánica asistida), pues del acceso a los mismos dependen las posibilidades de supervivencia de numerosos pacientes en estado crítico. El presente trabajo trata de determinar los criterios para la gestión de dichos soportes vitales en un contexto de escasez extrema de los mismos para hacer frente a las necesidades de la totalidad de los pacientes que los requieren, analizando la literatura comparada sobre el particular, así como diferentes informes institucionales y de organismos en la esfera de la bioética


In the context of a worldwide pandemic such as COVID-19, one of the greatest bioethical dilemmas that arise is the management of certain scarce medical devices, such as ventilators (mechanical ventilation), since the survival of many critically ill patients depends on the access to these ventilators. The present paper tries to determine the criteria applicable for the management of these medical devices in a context of extreme scarcity to face the needs of all the patients who require them. To this end, the comparative literature on the subject as well as different institutional and academic reports in the field of bioethics are analysed


En el marc d'una pandèmia a escala mundial com la que representa la COVID-19 un dels majors dilemes bioètics que es plantegen és el de la gestió de determinats mitjans assistencials escassos, com ara els respiradors (ventilació mecànica assistida), ja que de l'accés als mateixos depenen les possibilitats de supervivència de nombrosos pacients en estat crític. El present treball pretén determinar els criteris per a la gestió d'aquests suports vitals en un context d'escassetat extrema dels mateixos per fer front a les necessitats de la totalitat dels pacients que els requereixen, analitzant la literatura comparada sobre el particular, així com diferents informes institucionals I d'organismes en l'esfera de la bioètica


Assuntos
Humanos , Sistemas de Manutenção da Vida/estatística & dados numéricos , Administração dos Cuidados ao Paciente , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Pandemias , Triagem , Respiração Artificial , Ventiladores Mecânicos/provisão & distribução , Unidades de Terapia Intensiva/provisão & distribução
3.
Rev. bioét. derecho ; (50): 1133-131, nov. 2020.
Artigo em Espanhol | IBECS | ID: ibc-191349

RESUMO

Han sucedido tantas cosas, y en tan poco tiempo, que no resulta fácil seleccionar alguna temática sin dejarnos fuera otras igualmente relevantes. Probablemente nos pasaremos los próximos años debatiendo sobre lo acontecido, entre otros motivos, por la escasa información que aun hoy tenemos sobre la apisonadora que ha triturado nuestro estilo de vida. Pues bien, he seleccionado, de entre las innumerables que podríamos estudiar, cuatro narrativas. En concreto, la pandemia como refriega entre neokantianos y utilitaristas; como datificación de rebaño; como ajuste de cuentas epistemológico y como singularidad española. Con este análisis podremos interrelacionar, aunque sea de forma breve, las implicaciones éticas, jurídicas, políticas y científicas de una historia que recién ha comenzado


So many things have happened, and in such a short time, that it is not easy to select some topic without leaving out other equally relevant ones. We will probably spend the next few years debating what happened, among other things, due to the scant information that we still have today about the steamroller that has crushed our lifestyle. Well, I have selected, from the innumerable ones that remain to be studied, four narratives. Specifically, the pandemic as a fray between neo-Kantians and utilitarians; as herd dating; as an epistemological reckoning and as a Spanish singularity. With this analysis we will be able to interrelate, albeit briefly, the ethical, legal, political and scientific implications of a history that has just begun


Han passat tantes coses, I en tan poc temps, que no resulta fàcil seleccionar alguna temàtica sense deixar-nos fora d'altres igualment rellevants. Probablement ens passarem els propers anys debatent sobre els fets, entre altres motius, per l'escassa informació que encara avui tenim sobre la piconadora que ha triturat el nostre estil de vida. Doncs bé, he seleccionat, d'entre els innombrables que podríem estudiar, quatre narratives. En concret, la pandèmia com la batalla entre neokantians I utilitaristes; com datificació de ramat; com venjança epistemològica I com a singularitat espanyola. Amb aquest anàlisi podrem interrelacionar, encara que sigui de forma breu, les implicacions ètiques, jurídiques, polítiques I científiques d'una història que just acaba de començar


Assuntos
Humanos , Triagem , Biotecnologia , Direitos do Paciente , Tomada de Decisões , Infecções por Coronavirus , Pneumonia Viral , Pandemias
4.
Rev. bioét. derecho ; (50): 369-383, nov. 2020.
Artigo em Espanhol | IBECS | ID: ibc-191363

RESUMO

Durante el periodo de estado de alarma del estado español producido por la emergencia sanitaria derivada de la pandemia de la enfermedad por coronavirus 2019-2020 se han puesto de manifiesto amenazas a los derechos de las personas con discapacidad y oportunidades de desarrollo en relación con su autonomía personal. El respeto a los tratados internacionales en materia de derechos humanos obliga a los estados a abordar desde el modelo de la autonomía personal la situación de vulnerabilidad de las personas con discapacidad y a luchar contra las actitudes basadas en modelos anteriores de tratamiento de la discapacidad


Threats to the rights of persons with disabilities and opportunities to develop in relation to their personal autonomy have been revealed during the period of state of alarm of the Spanish state produced by the health emergency derived from the 2019-2020 coronavirus disease pandemic. Respect for international human rights treaties obliges states to approach the vulnerable situation of people with disabilities from personal autonomy model and to fight against attitudes based on previous models of treatment of disability


Durant el període d'estat d'alarma de l'estat espanyol produït per l'emergència sanitària derivada de la pandèmia de la malaltia per coronavirus 2019-2020 s'han posat de manifest amenaces als drets de les persones amb discapacitat I oportunitats de desenvolupament en relació amb la seva autonomia personal. El respecte als tractats internacionals en matèria de drets humans obliga els estats a abordar des del model de l'autonomia personal la situació de vulnerabilitat de les persones amb discapacitat I a lluitar contra les actituds basades en models anteriors de tractament de la discapacitat


Assuntos
Humanos , Análise de Vulnerabilidade , Pessoas com Deficiência/legislação & jurisprudência , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Direitos Humanos , Triagem , Legislação como Assunto
5.
Rev Lat Am Enfermagem ; 28: e3378, 2020.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-33084778

RESUMO

OBJECTIVE: to compare the performance of the rapid triage conducted by nurses at the emergency entrance and of the Manchester Triage System (MTS) in identifying the priority level of care for patients with spontaneous demand and predicting variables related to hospitalization. METHOD: a cross-sectional study carried out in an Emergency Department (ED) of a university hospital in São Paulo. The priority levels established in the rapid triage performed by nurses were high priority (patients of spontaneous demand directed to the emergency room) or low priority (those referred to the institution's usual flow). Diagnostic accuracy measures were calculated to assess the performance of the indexes. RESULTS: of the 173 patients (52.0% female, with mean age of 60.4 ± 21.2 years old) evaluated, it was observed that rapid triage was more inclusive for high priority and had better sensitivity and worse specificity than the MTS. The probability of non-severe patients being admitted to the emergency observation unit was lower due to the rapid triage. For the prediction of the other variables, the systems presented unsatisfactory results. CONCLUSION: the nurses overestimated the classification of patients as high priority, and rapid triage performed better than MTS in predicting admission to the emergency observation unit.


Assuntos
Serviço Hospitalar de Emergência , Triagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Emergências , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade
6.
Aust J Gen Pract ; 49(10): 656-661, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33015681

RESUMO

BACKGROUND: Patients with red eyes frequently present to general practitioners (GPs). Although infrequent, some patients with COVID-19 may present with features typical of viral conjunctivitis. SARS-CoV-2 is expressed at a low rate in tears, which may be a source of infection to GPs caring for patients at high risk of COVID­19. OBJECTIVE: The aims of this article are to outline: 1) ophthalmic complications of SARS-CoV-2 infection, 2) triage and management of patients with potential COVID-19 conjunctivitis, and 3) triage and management of patients with red eyes during the current COVID-19 pandemic. DISCUSSION: It is important that GPs: 1) have a high index of suspicion that patients with apparently typical viral conjunctivitis may have an uncommon presentation of COVID-19 illness, 2) develop appropriate telephone triage systems to reduce patient consultations, and 3) foster relationships with their ophthalmologist and optometrist colleagues who can provide phone advice, guidance on treatment initiation and definitive care when necessary.


Assuntos
Betacoronavirus/isolamento & purificação , Conjuntivite , Infecções por Coronavirus , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias , Pneumonia Viral , Triagem/métodos , Comorbidade , Conjuntivite/diagnóstico , Conjuntivite/epidemiologia , Conjuntivite/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Diagnóstico Diferencial , Técnicas de Diagnóstico Oftalmológico , Clínicos Gerais , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Exposição Ocupacional/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Lágrimas/virologia
7.
J Infect Dev Ctries ; 14(9): 968-970, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-33031082

RESUMO

The COVID-19 pandemic has created new challenges on multiple fronts including a few ethical concerns. Timely and appropriate access to health services and the need to protect vulnerable people are some of them. An important aspect to consider, at the global level, is the frailty of health systems in many developing countries and the constant threat of these collapsing due to shortage of resources and medical supply. Special attention should be placed towards protecting the health of care workers who are highly exposed to SARS-CoV-2 infection. Research and clinical trials involving COVID-19 patients and healthy human volunteers must be done in strict adherence to the fundamental principles of bioethics, even if finding a solution is an urgent need. Shared responsibility must be assumed as we collectively face a common problem and ethical conflicts must be resolved using, as reference, the guidelines developed by the World Health Organization and other relevant international and national organizations. This would allow responsible action in the face of the pandemic without harming human rights, the individual and collective well-being.


Assuntos
Betacoronavirus , Saúde Global/ética , Pandemias/ética , Ensaios Clínicos como Assunto/ética , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Países em Desenvolvimento , Pessoal de Saúde/ética , Disparidades em Assistência à Saúde/ética , Direitos Humanos/ética , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Triagem/ética
8.
Rev Prat ; 70(6): 617-620, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-33058601

RESUMO

Prehospital management of acute stroke patients. In France, prehospital management of patients with suspected acute stroke relies on emergency medical communication centers (Samu), which provides first-line telephone assessment and dispatches the most appropriate emergency vehicle. Such tasks are not straightforward because many clinical symptoms may correspond to stroke and alternative diagnoses - stroke mimics - are common. It is crucial to reduce both prehospital and hospital delays in patients eligible for reperfusion therapies, namely intravenous thrombolysis and/or mechanical thrombectomy. Because mechanical thrombectomy only applies to patients with acute ischemic stroke and large-vessel occlusion, prehospital triage is important. However, clinical prediction of large-vessel occlusion is difficult and whether a specific patient should be sent to the nearest primary stroke center (drip and ship paradigm) or a comprehensive stroke center with thrombectomy capability (mothership paradigm) remains uncertain. Prehospital notification of the hospital-based stroke teams by the emergency medical system crews is crucial in reducing delays to achieve reperfusion.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , França/epidemiologia , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Trombectomia , Triagem
9.
Emergencias ; 32(5): 320-331, 2020 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33006832

RESUMO

OBJECTIVES: To estimate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the organization of Spanish hospital emergency departments (EDs). To explore differences between Spanish autonomous communities or according to hospital size and disease incidence in the area. MATERIAL AND METHODS: Survey of the heads of 283 EDs in hospitals belonging to or affiliated with Spain's public health service. Respondents evaluated the pandemic's impact on organization, resources, and staff absence from work in March and April 2020. Assessments were for 15-day periods. Results were analyzed overall and by autonomous community, hospital size, and local population incidence rates. RESULTS: A total of 246 (87%) responses were received. The majority of the EDs organized a triage system, first aid, and observation wards; areas specifically for patients suspected of having COVID-19 were newly set apart. The nursing staff was increased in 83% of the EDs (with no subgroup differences), and 59% increased the number of physicians (especially in large hospitals and locations where the COVID-19 incidence was high). Diagnostic tests for the severe acute respiratory syndrome coronavirus 2 were the resource the EDs missed most: 55% reported that tests were scarce often or very often. Other resources reported to be scarce were FPP2 and FPP3 masks (38% of the EDs), waterproof protective gowns (34%), and space (32%). More than 5% of the physicians, nurses, or other emergency staff were on sick leave 20%, 19%, and 16% of the time. These deficiencies were greatest during the last half of March, except for tests, which were most scarce in the first 15 days. Large hospital EDs less often reported that diagnostic tests were unavailable. In areas where the COVID-19 incidence was higher, the EDs reported higher rates of staff on sick leave. Resource scarcity differed markedly by autonomous community and was not always associated with the incidence of COVID-19 in the population. CONCLUSION: The COVID-19 pandemic led to organizational changes in EDs. Certain resources became scarce, and marked differences between autonomous communities were detected.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Absenteísmo , Adulto , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Surtos de Doenças , Serviço Hospitalar de Emergência/organização & administração , Recursos em Saúde/provisão & distribução , Necessidades e Demandas de Serviços de Saúde , Mão de Obra em Saúde/estatística & dados numéricos , Número de Leitos em Hospital , Hospitais Públicos/organização & administração , Hospitais Públicos/estatística & dados numéricos , Humanos , Incidência , Recursos Humanos em Hospital/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Alocação de Recursos , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/etiologia , Espanha/epidemiologia , Triagem/organização & administração
10.
G Ital Nefrol ; 37(5)2020 Oct 05.
Artigo em Italiano | MEDLINE | ID: mdl-33026200

RESUMO

The epidemic wave that hit Italy from February 21st, 2020, when the Italian National Institute of Health confirmed the first case of SARS­CoV­2 infection, led to a rapid and efficient reorganization of Dialysis Centers' activities, in order to contain large-scale spread of disease in this clinical setting. We herein report the experience of the Hemodialysis Unit of Parma University Hospital (Azienda Ospedaliero-Universitaria, Parma, Italy) and the Dialysis Centers of Parma territory, in the period from March 1st, 2020 to June 15, 2020. Among patients undergoing chronic haemodialysis, 37/283 (13%) had positive swabs for SARS­CoV­2, 9/37 (24%) died because of COVID-19. Twenty-three patients required hospitalization, while the remaining were managed at home. The primary measures applied to contain the infection were: the strengthening of personal protective equipment use by doctors and nurses, early identification of infected subjects by performing oro-pharyngeal swabs in every patient and in the healthcare personnel, the institution of a triage protocol when entering Dialysis Room, and finally the institution of two separate sections, managed by different doctors and dialysis nurses, to physically separate affected from unaffected patients and to manage "grey" patients. Our experience highlights the importance and effectiveness of afore-mentioned measures in order to contain the spread of the virus; moreover, we observed a higher lethality rate of COVID-19 in dialysis patients as compared to the general population.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Unidades Hospitalares de Hemodiálise/organização & administração , Reestruturação Hospitalar , Falência Renal Crônica/terapia , Pandemias , Pneumonia Viral/epidemiologia , Diálise Renal , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Diagnóstico Precoce , Emergências , Unidades Hospitalares de Hemodiálise/estatística & dados numéricos , Hemodiálise no Domicílio/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais Universitários/estatística & dados numéricos , Humanos , Controle de Infecções/métodos , Itália/epidemiologia , Falência Renal Crônica/epidemiologia , Nasofaringe/virologia , Pandemias/prevenção & controle , Isolamento de Pacientes , Diálise Peritoneal , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Utilização de Procedimentos e Técnicas , Triagem
11.
Gastroenterol Nurs ; 43(5): 375-381, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33003024

RESUMO

Elective surgical and endoscopic procedures were suspended nationwide during the March 2020 COVID-19 pandemic to minimize exposure and healthcare resource utilization. This resulted in an unprecedented backlog of procedures in most clinical practices including pediatrics. Our group developed an internal process toward the rational development of an algorithm prioritizing elective procedures. This was based on patient disease severity defined by the presence of alert symptoms, symptom severity for dysphagia and abdominal pain, and diagnostic investigation findings. The underlying rationale is to prioritize patients in whom suspected disease course would be greatest impacted by endoscopy. We developed a nurse phone call-based process utilizing REDCap®, identifying relevant symptoms categorized by severity, and a validated functional impairment questionnaire for abdominal pain. We abstracted key laboratory and radiological findings also categorized by severity. The order of priority of procedures was established on the basis of a 4-tiered system factoring both presence and severity of symptoms or prior diagnostic testing results. We present the framework that we have adopted toward prioritizing procedures with the assumption that it offers an objective methodology and that can be efficiently and more broadly applied to other similar practice scenarios. Our tool may have wide-ranging implications both in the current COVID-19 pandemic and in other scenarios of limited resource allocation and deserves further investigation.


Assuntos
Agendamento de Consultas , Betacoronavirus , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos do Sistema Digestório , Procedimentos Cirúrgicos Eletivos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adolescente , Algoritmos , Criança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Endoscopia , Feminino , Humanos , Masculino , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Avaliação de Sintomas , Triagem
14.
Med. intensiva (Madr., Ed. impr.) ; 44(6): 351-362, ago.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-186898

RESUMO

El 31 de diciembre de 2019, la Comisión de Salud de la provincia China de Hubei, dio a conocer por primera vez un grupo de casos inexplicables de neumonía, que posteriormente la OMS definió como el nuevo coronavirus de 2019 (SARS-CoV-2). El SARS-CoV-2 ha presentado una transmisión rápida de persona a persona y actualmente es una pandemia mundial. En la mayor serie de casos descrita hasta la fecha de pacientes hospitalizados con enfermedad por SARS-CoV-2 (2019-nCoViD), el 26% requirió atención en una unidad de cuidados intensivos (UCI). Esta pandemia está provocando una movilización de la comunidad científica sin precedentes, lo que lleva asociado un numero exponencialmente creciente de publicaciones en relación con la misma. La presente revisión bibliográfica narrativa, tiene como objetivo reunir las principales aportaciones en el área de los cuidados intensivos hasta la fecha en relación con la epidemiología, clínica, diagnóstico y manejo de 2019-nCoViD


On 31 December 2019, the Health Commission of Hubei Province of China first unveiled a group of unexplained cases of pneumonia, which WHO subsequently defined as the new coronavirus of 2019 (SARS-CoV-2). SARS-CoV-2 has presented rapid person-to-person transmission and is currently a global pandemic. In the largest number of cases described to date of hospitalized patients with SARS-CoV-2 disease (2019-nCoViD), 26% required care in an intensive care unit (ICU). This pandemic is causing an unprecedented mobilization of the scientific community, which has been associated with an exponentially growing number of publications in relation to it. This narrative literature review aims to gather the main contributions in the area of intensive care to date in relation to the epidemiology, clinic, diagnosis and management of 2019-nCoViD


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/métodos , Triagem , Betacoronavirus , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/diagnóstico por imagem , Espanha/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Pandemias , Fatores de Risco
16.
Emerg Med Clin North Am ; 38(4): 919-930, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981626

RESUMO

The geriatric population is growing and is the largest utilizer of emergency and critical care services; the emergency clinician should be comfortable in the management of the acutely ill geriatric patient. There are important physiologic changes in geriatric patients, which alters their clinical presentation and management. Age alone should not determine the prognosis for elderly patients. Premorbid functional status, frailty, and severity of illness should be considered carefully for the geriatric population. Emergency clinicians should have honest conversations about goals of care based not only a patient's clinical presentation but also the patient's values.


Assuntos
Envelhecimento/fisiologia , Estado Terminal , Ressuscitação , Idoso , Cuidados Críticos , Tomada de Decisão Compartilhada , Delírio/induzido quimicamente , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Serviço Hospitalar de Emergência , Fragilidade/classificação , Humanos , Farmacocinética , Polimedicação , Ordens quanto à Conduta (Ética Médica) , Assistência Terminal , Triagem
17.
J Clin Ethics ; 31(4): 303-317, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991327

RESUMO

The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the triage protocol, summarize the protocol itself, and discuss the major ethical challenges encountered, along with our answers to these challenges. These challenges include (1) the role of age and chronic comorbidities; (2) evaluating children and pregnant patients; (3) racial, ethnic, and socioeconomic disparities in health; (4) prioritization of healthcare workers; and (5) balancing clinical judgment versus protocolized assessments. We conclude with a review of the limitations of our protocol and the lessons learned. We hope that a robust public discussion of such protocols and the ethical challenges that they raise will result in the fairest possible processes, less need for triage, and more lives saved during future waves of the COVID-19 pandemic and similar public health emergencies.


Assuntos
Alocação de Recursos para a Atenção à Saúde/ética , Recursos em Saúde/provisão & distribução , Pandemias/ética , Triagem/ética , Betacoronavirus , Criança , Infecções por Coronavirus , Emergências , Feminino , Humanos , Pneumonia Viral , Gravidez , Saúde Pública
19.
Eur J Gen Pract ; 26(1): 129-133, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32985278

RESUMO

The COVID-19 pandemic has modified organisation and processes of primary care. In this paper, we aim to summarise experiences of international primary care systems. We explored personal accounts and findings in reporting on the early experiences from primary care during the pandemic, through the online Global Forum on Universal Health Coverage and Primary Health Care. During the early stage of the pandemic, primary care continued as the first point of contact to the health system but was poorly informed by policy makers on how to fulfil its role and ill equipped to provide care while protecting staff and patients against further spread of the infection. In many countries, the creativity and initiatives of local health professionals led to the introduction or extension of the use of telephone, e-mail and virtual consulting, and introduced triaging to separate 'suspected' COVID-19 from non-COVID-19 care. There were substantial concerns of collateral damage to the health of the population due to abandoned or postponed routine care. The pandemic presents important lessons to strengthen health systems through better connection between public health, primary care, and secondary care to cope better with future waves of this and other pandemics.


Assuntos
Infecções por Coronavirus/epidemiologia , Comportamentos Relacionados com a Saúde , Médicos de Atenção Primária , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde/métodos , Telemedicina , Triagem , Betacoronavirus , Assistência à Saúde , Humanos , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , Atenção Primária à Saúde/organização & administração , Pesquisa Qualitativa , Telefone
20.
PLoS One ; 15(9): e0239173, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32931524

RESUMO

OBJECTIVES: 1. To assess the performance of an extended questionnaire in identifying cases of SARS-CoV-2 infection among obstetric patients. 2. To evaluate the rate of infection among healthcare workers involved in women's care. STUDY DESIGN: A prospective cohort study of obstetric patients admitted to MBBM Foundation and Buzzi Hospital (Lombardy, Northern Italy) from March 16th to May 22nd, 2020. Women were screened on admission by a questionnaire investigating major and minor symptoms of infection and high-risk contacts in the last 14 days. SARS-CoV-2 assessment was performed by RT-PCR on nasopharyngeal swabs. Till April 7th, a targeted SARS-CoV-2 testing triggered by a positive questionnaire was used; from April 8th, a universal testing approach was implemented. RESULTS: There were 1,177 women screened by the questionnaire, which yielded a positive result in 130 (11.0%) cases. SARS-CoV-2 RT-PCR was performed in 865 (73.5%) patients, identifying 51 (5.9%) infections. During the first period, there were 29 infected mothers, 4 (13.8%) of whom had a negative questionnaire. After universal testing implementation, there were 22 (3%, 95% CI 1.94% - 4.04%) infected mothers, 13 (59.1%) of whom had a negative questionnaire; rate of infection among asymptomatic women was 1.9%. Six of the 17 SARS-CoV-2-positive women with a negative questionnaire reported symptoms more than 14 but within 30 days before admission. Isolated olfactory or taste disorders were identified in 15.7% of infected patients. Rate of infection among healthcare workers was 5.8%. CONCLUSIONS: An exhaustive triage questionnaire can effectively discriminate women at low risk of SARS-CoV-2 infection in the context of a targeted and a universal viral testing approach. In 15.7% of infected women, correct classification as a suspected case of infection was due to investigation of olfactory and taste disorders. Extension of the assessed time-frame to 30 days may be worth considering to increase the questionnaire's performance.


Assuntos
Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Adulto , Doenças Assintomáticas/epidemiologia , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Pessoal de Saúde/estatística & dados numéricos , Hospitais de Ensino , Humanos , Itália/epidemiologia , Nasofaringe/virologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Prospectivos , RNA Viral/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Inquéritos e Questionários , Distúrbios do Paladar/diagnóstico , Distúrbios do Paladar/epidemiologia , Distúrbios do Paladar/etiologia , Triagem
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