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1.
Ann Ig ; 33(4): 371-380, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33908602

RESUMO

Study design: A cross-sectional study conducted by an online questionnaire-based survey. Methods: This study was conducted by an anonymous online questionnaire based on a Chinese study during the fifth week from the beginning of outbreak of COVID-19 in Bosnia and Herzegovina. Background: In order to control the spread of COVID-19, prevent the crash of health care system and ensure well-being of its residents, Bosnia and Herzegovina has taken rigorous preventive epidemiological measures in the beginning of the pandemic. Currently the situation has dramatically changed. The aim of this study is to present knowledge, attitudes and practices at the beginning of the outbreak in Bosnia and Herzegovina when the spreading of COVID-19 was well controlled and provide useful information to policymakers at this challenging time. Results: In total 1,201 respondents, predominantly female (943 or 78.5%), with a mean age 30.57±11.26, scored very high on the knowledge test with a mean score 9.13±1.90. Being male (ß: -0.141, p<0.001) and aged >30 (ß: -0.099, p=0.030) were associated with lower knowledge scores, while education level of bachelor's degree and above (ß: 0.092, p=0.003), living in urban environment (ß: 0.062, p=0.044) and being a student (ß: 0.240, p<0.001) were associated with higher knowledge scores. Only 638 (53.1%) of the participants agreed that COVID-19 will be successfully controlled. The vast majority of the participants (1,092 or 90.9%) have not visited any crowded place and 1,043 (86.9%) wore masks when they were going out... Decreased exposure to crowded places [(OR=0.427, p<0.001);(OR=0.805, p<0.001)] and an increase of wearing a mask while leaving home [(OR=1.564, p=0.022);(OR=1.219, p<0.001)] were associated with female sex and higher knowledge scores, respectively. Age group 18-29 (OR=0.616, p=0.007) and living in rural environment (OR=0.600, p<0.025) were associated with not wearing a mask outside the home. Conclusions: Our study suggests that residents of Bosnia and Herzegovina have had good knowledge, a relatively optimistic attitudes and appropriate practices towards COVID-19 during the first period of outbreak.


Assuntos
/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Pandemias , Adolescente , Adulto , Fatores Etários , Idoso , Bósnia e Herzegóvina/epidemiologia , /psicologia , Estudos Transversais , Escolaridade , Feminino , Comportamentos Relacionados com a Saúde , Política de Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Máscaras , Pessoa de Meia-Idade , Utilização de Procedimentos e Técnicas , Adulto Jovem
2.
Transplant Cell Ther ; 27(3): 270.e1-270.e6, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33781537

RESUMO

SARS-CoV-2 has spread rapidly worldwide, but the full impact of the COVID-19 pandemic on the field of hematopoietic cell transplantation (HCT) remains unknown. To understand this better, an 18-item online survey was disseminated by the Worldwide Network for Blood & Marrow Transplantation with questions exploring SARS-CoV-2 testing algorithms, mobilization, and cryopreservation strategies and COVID-19 infections in allogeneic related and autologous hematopoietic progenitor cell (HPC) donors. The aim of this survey was to assess the impact of the outbreak on policies relating to HPC mobilization, collection, and processing with respect to changes in daily routine. A total of 91 individual responses from distinct centers in 6 continents were available for analysis. In these centers, the majority (72%) of allogeneic related and autologous donors are routinely tested for SARS-CoV-2 before HPC collection, and 80% of centers implement cryopreservation of allogeneic HPC grafts before commencing conditioning regimens in patients. Five related and 14 autologous donors who tested positive for COVID-19 did not experience any unexpected adverse events or reactions during growth factor administration (eg, hyperinflammatory syndrome). These data are limited by the small number of survey respondents but nonetheless suggest that centers are following the recommendations of appropriate scientific organizations and provide some preliminary data to suggest areas of further study.


Assuntos
Transplante de Medula Óssea/estatística & dados numéricos , Transplante de Células-Tronco Hematopoéticas/estatística & dados numéricos , Pandemias , Algoritmos , Aloenxertos , Transplante de Medula Óssea/tendências , /prevenção & controle , /estatística & dados numéricos , Criopreservação/métodos , Seleção do Doador/normas , Saúde Global , Pesquisas sobre Serviços de Saúde , Mobilização de Células-Tronco Hematopoéticas/estatística & dados numéricos , Transplante de Células-Tronco Hematopoéticas/tendências , Padrões de Prática Médica/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Preservação de Tecido/métodos , Transplante Autólogo , Doadores não Relacionados/estatística & dados numéricos
3.
Lancet Gastroenterol Hepatol ; 6(5): 381-390, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33713606

RESUMO

BACKGROUND: The COVID-19 pandemic has led to a substantial reduction in gastrointestinal endoscopies, creating a backlog of procedures. We aimed to quantify this backlog nationally for England and assess how various interventions might mitigate the backlog. METHODS: We did a national analysis of data for colonoscopies, flexible sigmoidoscopies, and gastroscopies from National Health Service (NHS) trusts in NHS England's Monthly Diagnostic Waiting Times and Activity dataset. Trusts were excluded if monthly data were incomplete. To estimate the potential backlog, we used linear logistic regression to project the cumulative deficit between actual procedures performed and expected procedures, based on historical pre-pandemic trends. We then made further estimations of the change to the backlog under three scenarios: recovery to a set level of capacity, ranging from 90% to 130%; further disruption to activity (eg, second pandemic wave); or introduction of faecal immunochemical testing (FIT) triaging. FINDINGS: We included data from Jan 1, 2018, to Oct 31, 2020, from 125 NHS trusts. 10 476 endoscopy procedures were done in April, 2020, representing 9·5% of those done in April, 2019 (n=110 584), before recovering to 105 716 by October, 2020 (84·5% of those done in October, 2019 [n=125 072]). Recovering to 100% capacity on the current trajectory would lead to a projected backlog of 162 735 (95% CI 143 775-181 695) colonoscopies, 119 025 (107 398-130 651) flexible sigmoidoscopies, and 194 087 (172 564-215 611) gastroscopies in January, 2021, attributable to the pandemic. Increasing capacity to 130% would still take up to June, 2022, to eliminate the backlog. A further 2-month interruption would add an extra 15·4%, a 4-month interruption would add an extra 43·8%, and a 6-month interruption would add an extra 82·5% to the potential backlog. FIT triaging of cases that are found to have greater than 10 µg haemoglobin per g would reduce colonoscopy referrals to around 75% of usual levels, with the backlog cleared in early 2022. INTERPRETATION: Our work highlights the impact of the pandemic on endoscopy services nationally. Even with mitigation measures, it could take much longer than a year to eliminate the pandemic-related backlog. Urgent action is required by key stakeholders (ie, individual NHS trusts, Clinical Commissioning Groups, British Society of Gastroenterology, and NHS England) to tackle the backlog and prevent delays to patient management. FUNDING: Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) at University College London, National Institute for Health Research University College London Hospitals Biomedical Research Centre, and DATA-CAN, Health Data Research UK.


Assuntos
Fortalecimento Institucional , Endoscopia do Sistema Digestório , Gastroenteropatias , Utilização de Procedimentos e Técnicas , Triagem , /epidemiologia , Fortalecimento Institucional/métodos , Fortalecimento Institucional/organização & administração , Gestão de Mudança , Endoscopia do Sistema Digestório/métodos , Endoscopia do Sistema Digestório/estatística & dados numéricos , Gastroenteropatias/epidemiologia , Gastroenteropatias/terapia , Humanos , Imunoquímica , Controle de Infecções , Avaliação de Processos e Resultados em Cuidados de Saúde , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/tendências , Medicina Estatal/organização & administração , Medicina Estatal/tendências , Triagem/métodos , Triagem/estatística & dados numéricos , Reino Unido/epidemiologia , Listas de Espera
5.
Urologia ; 88(1): 3-8, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33632087

RESUMO

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pandemic has dramatically hit all Europe and Northern Italy in particular. The reallocation of medical resources has caused a sharp reduction in the activity of many medical disciplines, including urology. The restricted availability of resources is expected to cause a delay in the treatment of urological cancers and to negatively influence the clinical history of many cancer patients. In this study, we describe COVID-19 impact on uro-oncological management in Piedmont/Valle d'Aosta, estimating its future impact. METHODS: We performed an online survey in 12 urological centers, belonging to the Oncological Network of Piedmont/Valle d'Aosta, to estimate the impact of COVID-19 emergency on their practice. On this basis, we then estimated the medical working capacity needed to absorb all postponed uro-oncological procedures. RESULTS: Most centers (77%) declared to be "much"/"very much" affected by COVID-19 emergency. If uro-oncological consultations for newly diagnosed cancers were often maintained, follow-up consultations were more than halved or even suspended in around two out of three centers. In-office and day-hospital procedures were generally only mildly reduced, whereas major uro-oncological procedures were more than halved or even suspended in 60% of centers. To clear waiting list backlog, the urological working capacity should dramatically increase in the next months; delays greater than 1 month are expected for more than 50% of uro-oncological procedures. CONCLUSIONS: COVID-19 emergency has dramatically slowed down uro-oncological activity in Piedmont and Valle d'Aosta. Ideally, uro-oncological patients should be referred to COVID-19-free tertiary urological centers to ensure a timely management.


Assuntos
/epidemiologia , Continuidade da Assistência ao Paciente , Acesso aos Serviços de Saúde , Oncologia/estatística & dados numéricos , Pandemias , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologia/estatística & dados numéricos , Agendamento de Consultas , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Itália/epidemiologia , Neoplasias Renais/epidemiologia , Neoplasias Renais/cirurgia , Masculino , Oncologia/organização & administração , Utilização de Procedimentos e Técnicas , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/cirurgia , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/cirurgia , Neoplasias Urológicas/epidemiologia , Neoplasias Urológicas/cirurgia , Urologia/organização & administração
6.
Langenbecks Arch Surg ; 406(2): 367-375, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33550453

RESUMO

PURPOSE: The COVID-19 pandemic has transformed medical care worldwide. General surgery has been affected in elective procedures, yet the implications for emergency surgery are unclear. The current study analyzes the effect of the COVID-19 lockdown in spring 2020 on appendicitis treatment in Germany. METHODS: Hospitals that provided emergency surgical care during the COVID-19 lockdown were invited to participate. All patients diagnosed with appendicitis during the lockdown period (10 weeks) and, as a comparison group, patients from the same period in 2019 were analyzed. Clinical and laboratory parameters, intraoperative and pathological findings, and postoperative outcomes were analyzed. RESULTS: A total of 1915 appendectomies from 41 surgical departments in Germany were included. Compared to 2019 the number of appendectomies decreased by 13.5% (1.027 to 888, p=0.003) during the first 2020 COVID-19 lockdown. The delay between the onset of symptoms and medical consultation was substantially longer in the COVID-19 risk group and for the elderly. The rate of complicated appendicitis increased (58.2 to 64.4%), while the absolute number of complicated appendicitis decreased from 597 to 569, (p=0.012). The rate of negative appendectomies decreased significantly (6.7 to 4.6%; p=0.012). Overall postoperative morbidity and mortality, however, did not change. CONCLUSION: The COVID-19 lockdown had significant effects on abdominal emergency surgery in Germany. These seem to result from a stricter selection and a longer waiting time between the onset of symptoms and medical consultation for risk patients. However, the standard of emergency surgical care in Germany was maintained.


Assuntos
Apendicectomia/estatística & dados numéricos , Apendicite/cirurgia , Controle de Doenças Transmissíveis , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Apendicectomia/efeitos adversos , Apendicite/diagnóstico , Apendicite/etiologia , /epidemiologia , Feminino , Alemanha , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Utilização de Procedimentos e Técnicas , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
7.
Ann Hematol ; 100(4): 941-952, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33560468

RESUMO

Splenectomy is one of the treatments of immune thrombocytopenia (ITP) with a high response rate. However, it is an irreversible procedure that can be associated with morbidity in this setting. Our aim was to study the trends of splenectomy in adults with ITP, and the factors associated with splenectomy and resource utilization during these hospitalizations. We used the National (Nationwide) Inpatient Sample (NIS) to identify hospitalizations for adult patients with a principal diagnosis of ITP between 2007 and 2017. The primary outcome was the splenectomy trend. Secondary outcomes were (1) incidence of ITP trend, (2) in-hospital mortality, length of stay, and total hospitalization costs after splenectomy trend, and (3) independent predictors of splenectomy, length of stay, and total hospitalization costs. A total of 36,141 hospitalizations for ITP were included in the study. The splenectomy rate declined over time (16% in 2007 to 8% in 2017, trend p < 0.01) and so did the in-hospital mortality after splenectomy. Of the independent predictors of splenectomy, the strongest was elective admissions (adjusted odds ratio [aOR]: 22.1, 95% confidence interval [CI]:17.8-27.3, P < 0.01), while recent hospitalization year, older age, and Black (compared to Caucasian) race were associated with lower odds of splenectomy. Splenectomy tends to occur during elective admissions in urban medical centers for patients with private insurance. Despite a stable ITP hospitalization rate over the past decade and despite listing splenectomy as a second-line option for management of ITP in major guidelines, splenectomy rates consistently declined over time.


Assuntos
Púrpura Trombocitopênica Idiopática/cirurgia , Esplenectomia , Adulto , Fatores Etários , Procedimentos Cirúrgicos Eletivos , Seguimentos , Número de Leitos em Hospital , Custos Hospitalares , Mortalidade Hospitalar , Hospitalização , Hospitais de Ensino/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Renda , Tempo de Internação/estatística & dados numéricos , Utilização de Procedimentos e Técnicas , Púrpura Trombocitopênica Idiopática/economia , Estudos Retrospectivos , Esplenectomia/economia , Esplenectomia/métodos , Esplenectomia/estatística & dados numéricos , Esplenectomia/tendências , Resultado do Tratamento , Estados Unidos
9.
Langenbecks Arch Surg ; 406(2): 377-383, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33420517

RESUMO

PURPOSE: Acute appendicitis is one of the most common reasons for emergency medical consultation. While simple appendicitis can be treated with antibiotics or surgery, complex appendicitis including gangrene, abscess, and perforation requires appendectomy. During the COVID-19 pandemic in early 2020, an overall drop in emergency room consultations was observed. We therefore aimed to investigate the incidence and treatment strategies of acute appendicitis during that period. METHODS: Data of insurance holders with the ICD code for "acute appendicitis" or OPS procedure of appendectomy of a major health insurance company in Germany were analyzed retrospectively. Groups were built, containing of the means of March-June of 2017, 2018, and 2019, defined as "pre-COVID group" with the "COVID group," defined as data from March to June of 2020. Data was analyzed by age, sex, comorbidities, length of hospital stay, diagnoses, and treatment. Data of the COVID group was analyzed for simultaneous COVID-19 infection. RESULTS: During the COVID-19 pandemic of early 2020, an overall reduction by 12.9% of patients presenting with acute appendicitis was noticeable. These results were mainly due to decreased rates of uncomplicated appendicitis, while complicated appendicitis was scarcely affected. Especially in the group of females < 40 years, a drastic reduction was visible. Rates of extended surgery did not change. Likewise, the complication rate like appendix stump leakage or need for re-operation did not differ. In March 2020, 4.8% of acute appendicitis patients had concomitant COVID-19 infection. CONCLUSION: In line with the overall drop of emergency room visits during the COVID-19 pandemic of spring 2020 in Germany, a significantly lowered number of patients with uncomplicated appendicitis were noticeable, whereas complicated appendicitis did not differ. Also, treatment and complication rate of acute appendicitis did not change. These findings might be a hint that acute appendicitis is not a progressing disease but caused by different entities for uncomplicated and complicated appendicitis and therefore another clue that uncomplicated appendicitis can be treated with antibiotics or observation. Nevertheless provided data does not cover outpatient treatment; therefore, no statement observation or antibiotics in outpatients can be made.


Assuntos
Apendicectomia/estatística & dados numéricos , Apendicite/epidemiologia , Apendicite/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia/efeitos adversos , Apendicite/diagnóstico , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Laparoscopia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Utilização de Procedimentos e Técnicas , Estudos Retrospectivos
10.
Am J Emerg Med ; 41: 28-34, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33383268

RESUMO

INTRODUCTION: Though point-of-care ultrasound (POCUS) is recognized as a useful diagnostic and prognostic intervention during cardiac arrest (CA), critics advise caution. The purpose of this survey study was to determine the barriers to POCUS during CA in the Emergency Department (ED). METHODS: Two survey instruments were distributed to emergency medicine (EM) attending and resident physicians at three academic centers in the South Florida. The surveys assessed demographics, experience, proficiency, attitudes and barriers. Descriptive and inferential statistics along with Item Response Theory Logistic Model and the Friedman Test with Wilcoxon Signed Rank tests were used to profile responses and rank barriers. RESULTS: 206 EM physicians were invited to participate in the survey, and 187 (91%) responded. 59% of attending physicians and 47% of resident physicians reported that POCUS is performed in all their cases of CA. 5% of attending physicians and 0% of resident physicians reported never performing POCUS during CA. The top-ranked departmental barrier for attending physicians was "No structured curriculum to educate physicians on POCUS." The top-ranked personal barriers were "I do not feel comfortable with my POCUS skills" and "I do not have sufficient time to dedicate to learning POCUS." The top-ranked barriers for resident physicians were "Time to retrieve and operate the machine" and "Chaotic milieu." CONCLUSIONS: While our study demonstrates that most attending and resident physicians utilize POCUS in CA, barriers to high-quality implementation exist. Top attending physician barriers relate to POCUS education, while the top resident physician barriers relate to logistics and the machines. Interventions to overcome these barriers might lead to optimization of POCUS performance during CA in the ED.


Assuntos
Atitude do Pessoal de Saúde , Serviço Hospitalar de Emergência , Parada Cardíaca/diagnóstico por imagem , Testes Imediatos/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Medicina de Emergência , Pesquisas sobre Serviços de Saúde , Humanos , Internato e Residência , Corpo Clínico Hospitalar , Ultrassonografia/estatística & dados numéricos
11.
AJR Am J Roentgenol ; 216(2): 519-525, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33356434

RESUMO

OBJECTIVE. The purpose of our study was to assess potential disparities in the utilization of advanced imaging during emergency department (ED) visits. MATERIALS AND METHODS. This retrospective study was conducting using 5% Research Identifiable Files. All CT and MRI (together defined as "advanced imaging") examinations associated with ED visits in 2015 were identified for continuously enrolled Medicare beneficiaries. Individuals with medical claims 30 days before the index ED event were excluded, and encounters that occurred in hospitals without advanced imaging capabilities were also excluded. Patient characteristics were identified using Medicare files and hospital characteristics using the American Hospital Association Annual Survey of Hospitals. Multivariate logistic regression was used for the analysis. RESULTS. Of 86,976 qualifying ED encounters, 52,833 (60.74%) ED encounters were for female patients; 29.03% (n = 25,245) occurred at rural hospitals and 15.81% (n = 13,750) at critical access hospitals. Race distribution was 83.13% White, 11.05% Black, and 5.82% Other. Compared with ED patients at urban hospitals, those at rural and critical access hospitals were 6.9% less likely (odds ratio [OR] = 0.931, p = 0.015) and 18.0% less likely (OR = 0.820, p < 0.0001), respectively, to undergo advanced imaging. Compared with White patients, Black patients were 31.6% less likely (OR = 0.684, p < 0.0001) to undergo advanced imaging. Relative to their urban counterparts, both White (OR = 0.941, p = 0.05) and Black (OR = 0.808, p = 0.047) rural ED patients were less likely to undergo advanced imaging. CONCLUSION. Among Medicare beneficiaries receiving care in U.S. EDs, significant disparities exist in advanced imaging utilization. Although imaging appropriateness was not investigated, these findings suggest inequity. Further research is necessary to understand why consistent health benefits do not translate into consistent imaging access among risk-adjusted ED patients.


Assuntos
Diagnóstico por Imagem/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Benefícios do Seguro , Medicare , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Logísticos , Masculino , Utilização de Procedimentos e Técnicas , Estudos Retrospectivos , Estados Unidos
14.
Pan Afr Med J ; 35(Suppl 2): 131, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193946

RESUMO

Introduction: Nigeria is the most populous country in the African continent. The aim of this study was to analyze risk factors for COVID-19 prevalence and deaths in all 6 geopolitical regions and 37 States in Nigeria. Methods: we analyzed the data retrieved from various sources, including Nigeria CDC, Nigeria National Bureau of Statistics, Unicef-Nigeria multiple indicator cluster survey and the Institute of Health Metrics and Evaluation, University of Washington. We examined 4 clinical risk factors (prevalence of TB, HIV, smoking and BCG vaccination coverage) and 5 sociodemographic factors (age ≥65, population density, literacy rate, unemployment and GDP per capita). Multivariate modeling was conducted using generalized linear model. Results: our analysis showed that the incidence of confirmed COVID-19 cases differed widely across the 37 States, from 0.09 per 100,000 in Kogi to 83.7 in Lagos. However, more than 70% of confirmed cases were concentrated in just 7 States: Lagos, Abuja, Oyo, Kano, Edo, Rivers and Delta. Case mortality rate (CMR) also varied considerably, with Lagos, Abuja and Edo having CMR above 9 per million population. On bivariate analysis, higher CMR correlated positively with GDP (r=0.53) and to a lesser extent with TB (r=0.36) and population density (r=0.38). On multivariate analysis, which is more definitive, States with higher HIV prevalence and BCG coverage had lower CMR, while high GDP States had a greater CMR. Conclusion: this study indicates that COVID-19 has disproportionately affected certain States in Nigeria. Population susceptibility factors include higher economic development but not literacy or unemployment. Death rates were mildly lower in States with higher HIV prevalence and BCG vaccination coverage.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Pandemias , Pneumonia Viral/mortalidade , Fatores Etários , Idoso , Vacina BCG , Feminino , Geografia Médica , Produto Interno Bruto/estatística & dados numéricos , Infecções por HIV/epidemiologia , Humanos , Alfabetização/estatística & dados numéricos , Masculino , Nigéria/epidemiologia , Densidade Demográfica , Prevalência , Utilização de Procedimentos e Técnicas , Fatores de Risco , Fumar/epidemiologia , Determinantes Sociais da Saúde , Tuberculose/epidemiologia , Desemprego/estatística & dados numéricos , Vacinação/estatística & dados numéricos
15.
Medicine (Baltimore) ; 99(45): e23081, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157975

RESUMO

Few studies have clarified the use of complementary therapies (CTs) in France. The main objective of this preliminary study was to evaluate knowledge of CTs in 4 representative groups of patients: patients suffering from cancer, patients presenting with a chronic noncancerous disease, chronic dialysis patients and nonchronic or cancerous patients needing surgery.A formalized questionnaire was designed by 2 psychologists, an oncologist and an anesthesiologist in charge of the Pain Clinic and Support Care Unit. One-hundred eleven patients were enrolled, and all agreed to complete the questionnaire.Eighty (72%) patients did not know the term "complementary therapies" (patients who were "not aware of CTs"), and 24 (21.6%) patients knew the term "complementary therapies" (patients who were "aware of CTs"), while 7 patients were not sure of the meaning. There were no differences between aware and unaware patients in gender (P = .27), age (P = .24), level of education (p = 0.24) or professional occupation (P = .06). Knowledge about CTs was significantly different among the different categories of patients (P = .03), with the only statistically significant difference between groups being between oncologic patients receiving ambulatory chemotherapy and patients presenting with a chronic noncancerous disease (P = .004).This preliminary study clearly highlights that patients and health caregivers are not aware of CTs and that there is a need for better communication about CTs.


Assuntos
Terapias Complementares/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Idoso , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato
16.
Biomedica ; 40(Supl. 2): 77-79, 2020 10 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33152191

RESUMO

The COVID-19 pandemic has generated a revolution of such magnitude that no aspect of human life will be the same from now on. The provision of health services and health education are not unrelated to this new normality imposed by the disease, and its consequences have been reflected in the need to use protocols and resources based on virtuality that most of us had not valued in their real dimension. Telehealth and telemedicine will be basic tools for professionals and teachers and it is our obligation to know them, apply them, and innovate to adapt to this reality.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Telemedicina/tendências , Colômbia/epidemiologia , Confidencialidade , Infecções por Coronavirus/prevenção & controle , Educação a Distância , Programas Governamentais , Instalações de Saúde , Acesso aos Serviços de Saúde , Humanos , Disseminação de Informação , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Utilização de Procedimentos e Técnicas , Telemedicina/métodos , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Universidades , Recursos Humanos
17.
Biomedica ; 40(Supl. 2): 188-197, 2020 10 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33152203

RESUMO

The COVID-19 pandemic caused by SARS-CoV-2 is a public health problem on a scale unprecedented in the last 100 years, as has been the response focused on the rapid genomic characterization of SARS-CoV-2 in virtually all regions of the planet. This pandemic emerged during the era of genomic epidemiology, a science fueled by continued advances in next-generation sequencing. Since its recent appearance, genomic epidemiology included the precise identification of new lineages or species of pathogens and the reconstruction of their genetic variability in real time, evidenced in past outbreaks of influenza H1N1, MERS, and SARS. However, the global and uncontrolled scale of this pandemic created a scenario where genomic epidemiology was put into practice en masse, from the rapid identification of SARS-CoV-2 to the registration of new lineages and their active surveillance throughout the world. Prior to the COVID-19 pandemic, the availability of genomic data on circulating pathogens in several Latin America and the Caribbean countries was scarce or nil. With the arrival of SARS-CoV-2, this scenario changed significantly, although the amount of available information remains scarce and, in countries such as Colombia, Brazil, Argentina, and Chile, the genomic information of SARS-CoV-2 was obtained mainly by research groups in genomic epidemiology rather than the product of a public health surveillance policy or program. This indicates the need to establish public health policies aimed at implementing genomic epidemiology as a tool to strengthen surveillance and early warning systems against threats to public health in the region.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/epidemiologia , Genoma Viral , Disseminação de Informação , Epidemiologia Molecular/tendências , Pandemias , Pneumonia Viral/epidemiologia , Vigilância da População , RNA Viral/genética , Análise de Sequência de RNA , Sequência de Bases , Região do Caribe , Doenças Transmissíveis Emergentes , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Planejamento em Desastres , Surtos de Doenças , Humanos , América Latina/epidemiologia , Epidemiologia Molecular/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/virologia , Utilização de Procedimentos e Técnicas , Saúde Pública , RNA-Seq , Desenvolvimento Sustentável , Viroses/epidemiologia
18.
BMC Surg ; 20(1): 222, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008379

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been declared a global pandemic by the World Health Organization. Patients with cancer are more likely to incur poor clinical outcomes. Due to the prevailing pandemic, we propose some surgical strategies for gastric cancer patients. METHODS: The 'COVID-19' period was defined as occurring between 2020 and 01-20 and 2020-03-20. The enrolled patients were divided into two groups, pre-COVID-19 group (PCG) and COVID-19 group (CG). A total of 109 patients with gastric cancer were enrolled in this study. RESULTS: The waiting time before admission increased by 4 days in the CG (PCG: 4.5 [IQR: 2, 7.8] vs. CG: 8.0 [IQR: 2,20]; p = 0.006). More patients had performed chest CT scans besides abdominal CT before admission during the COVID-19 period (PCG: 22 [32%] vs. CG: 30 [73%], p = 0.001). After admission during the COVID period, the waiting time before surgery was longer (PCG: 3[IQR: 2,5] vs. CG: 7[IQR: 5,9]; p < 0.001), more laparoscopic surgeries were performed (PCG: 51[75%] vs. CG: 38[92%], p = 0.021), and hospital stay period after surgery was longer (7[IQR: 6,8] vs.9[IQR:7,11]; p < 0.001). In addition, the total cost of hospitalization increased during this period, (PCG: 9.22[IQR:7.82,10.97] vs. CG: 10.42[IQR:8.99,12.57]; p = 0.006). CONCLUSION: This study provides an opportunity for our surgical colleagues to reflect on their own services and any contingency plans they may have to tackle the COVID-19 crisis.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Seleção de Pacientes , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Padrões de Prática Médica , Utilização de Procedimentos e Técnicas , Estudos Retrospectivos
19.
Elife ; 92020 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-33044170

RESUMO

This study examined records of 2566 consecutive COVID-19 patients at five Massachusetts hospitals and sought to predict level-of-care requirements based on clinical and laboratory data. Several classification methods were applied and compared against standard pneumonia severity scores. The need for hospitalization, ICU care, and mechanical ventilation were predicted with a validation accuracy of 88%, 87%, and 86%, respectively. Pneumonia severity scores achieve respective accuracies of 73% and 74% for ICU care and ventilation. When predictions are limited to patients with more complex disease, the accuracy of the ICU and ventilation prediction models achieved accuracy of 83% and 82%, respectively. Vital signs, age, BMI, dyspnea, and comorbidities were the most important predictors of hospitalization. Opacities on chest imaging, age, admission vital signs and symptoms, male gender, admission laboratory results, and diabetes were the most important risk factors for ICU admission and mechanical ventilation. The factors identified collectively form a signature of the novel COVID-19 disease.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde , Pandemias , Pneumonia Viral/terapia , Adulto , Idoso , Área Sob a Curva , Índice de Massa Corporal , Comorbidade , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Unidades de Terapia Intensiva/provisão & distribução , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Dinâmica não Linear , Pneumonia Viral/epidemiologia , Utilização de Procedimentos e Técnicas , Curva ROC , Respiração Artificial/estatística & dados numéricos , Fatores de Risco , Ventiladores Mecânicos/provisão & distribução
20.
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
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