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1.
Orv Hetil ; 162(40): 1591-1600, 2021 10 03.
Artigo em Húngaro | MEDLINE | ID: mdl-34601456

RESUMO

Összefoglaló. Bevezetés: A COVID-19-pandémia okozta nagyfokú betegszám-növekedés ellátásának érdekében az egészségügyi rendszerek gyakran a kórházak teljes átszervezésére kényszerültek. A szakállomány gyors és hatékony felzárkóztatása kulcsfontosságú ilyen körülmények között. A telepített kórházi egységek személyzetének felkészítésére a virtuális valóságban levezetheto csoportos gyakorlatozás ígéretes módszernek mutatkozik. Célkituzés: Célunk egy telepített kórház személyzetének felkészítésére alkalmazott virtuális szimulációs gyakorlatsorozat tapasztalatainak bemutatása, valamint a létrehozott és kipróbált virtuális gyakorlatcsomagok adaptálási lehetoségeinek elméleti bemutatása a COVID-19-kórházak személyzetének gyors felzárkóztatását szolgáló gyakorlatsorozat lehetséges kivitelezése érdekében. Módszer: Három, prototípusként eloállított virtuális gyakorlat került alkalmazásba két próbatanfolyam keretén belül. A virtuális színterek kialakítására az XVR szimulációs szoftvert használtuk. A gyakorlatok alkalmazhatóságának és hasznosságának kiértékelésére anonim kérdoíves felméréseket készítettünk. Az adatok feldolgozásában kereszttábla-elemzést és khi-négyzet-próbát alkalmaztunk. Eredmények: A két próbaképzésen nyolc ország képviseletében összesen 76 gyakornok vett részt. A résztvevok 63,9%-a szerint a módszer alkalmas ilyen jellegu gyakorlatok levezetésére, de további fejlesztéseket igényel. Véleményük, hogy technikai használata "elég könnyen" elsajátítható (59,7%), és interaktív (90,32%), valósághu (45,0%) szimulációs közeget biztosít. Megbeszélés: Eredményeink alapján a virtuális valóság egy alkalmazható módszer a telepített kórházak szakállományának valós bevetésekre való felkészítésére. A létrehozott virtuális gyakorlatcsomagok tartalma és szerkezete könnyen adaptálható egy COVID-19 ideiglenes egészségügyi egység sajátos munkakörülményeihez való gyors személyzeti felzárkóztatást szolgáló muhelygyakorlatok megszervezéséhez. Következtetés: A virtuális valóság ígéretes oktatási eszköz, amely kiegészítheti a nagy költségekkel és bonyolult szervezéssel járó terepgyakorlatokat, megközelítve azok oktatási hatásfokát. A virtuális térben megélt tapasztalatok valós szakmai élményekké alakulnak, és hozzájárulnak egy biztonságos és hatékony munkaközeg gyors kialakításához. Orv Hetil. 2021; 162(40): 1591-1600. INTRODUCTION: COVID-19 pandemic imposed sudden increase in hospital admissions, thus medical systems needed to reorganize entire hospitals quite often. Quick and efficient training is of outmost importance. Virtual reality team training is a promising tool for newly organized hospital units' staff. OBJECTIVE: Our goal was to present the usefulness and applicability of virtual simulation exercises for training of field hospital personnel and to evaluate the adaptability of these created and tested exercise packs for urgent staff training of COVID-19 hospitals. METHOD: Three prototypes of virtual reality exercises were assessed through two test courses. XVR simulation software was used to create virtual environments. Evaluation of exercise applicability and utility was performed by anonymous questionnaires. Statistical data-processing was performed using contingency table and chi-square tests. RESULTS: 76 trainees from eight countries participated in the two pilot courses. 63.9% of the participants stated that the method is suitable for conducting such exercises, but needs further development. Its technical use is "easy enough" to learn (59.7%) and provides an interactive (90.32%) and realistic (45.0%) working environment. DISCUSSION: Virtual reality is applicable to train field hospital staffs for real missions. The created virtual exercise packages are easily adaptable, both in content and structure, to workshops dedicated for quick training of specific COVID-19 temporary medical facility's personnel. CONCLUSION: Virtual reality is a promising educational tool that can complement the expensive and laborious field exercises, with comparable training efficiency. These virtual reality experiences may become real professional memories and create swiftly a secure and efficient professional milieu. Orv Hetil. 2021; 160(40): 1591-1600.


Assuntos
COVID-19 , Realidade Virtual , Hospitais , Humanos , Hungria , Unidades Móveis de Saúde , Pandemias , SARS-CoV-2
2.
N Engl J Med ; 385(11): 971-981, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34496173

RESUMO

BACKGROUND: Mobile stroke units (MSUs) are ambulances with staff and a computed tomographic scanner that may enable faster treatment with tissue plasminogen activator (t-PA) than standard management by emergency medical services (EMS). Whether and how much MSUs alter outcomes has not been extensively studied. METHODS: In an observational, prospective, multicenter, alternating-week trial, we assessed outcomes from MSU or EMS management within 4.5 hours after onset of acute stroke symptoms. The primary outcome was the score on the utility-weighted modified Rankin scale (range, 0 to 1, with higher scores indicating better outcomes according to a patient value system, derived from scores on the modified Rankin scale of 0 to 6, with higher scores indicating more disability). The main analysis involved dichotomized scores on the utility-weighted modified Rankin scale (≥0.91 or <0.91, approximating scores on the modified Rankin scale of ≤1 or >1) at 90 days in patients eligible for t-PA. Analyses were also performed in all enrolled patients. RESULTS: We enrolled 1515 patients, of whom 1047 were eligible to receive t-PA; 617 received care by MSU and 430 by EMS. The median time from onset of stroke to administration of t-PA was 72 minutes in the MSU group and 108 minutes in the EMS group. Of patients eligible for t-PA, 97.1% in the MSU group received t-PA, as compared with 79.5% in the EMS group. The mean score on the utility-weighted modified Rankin scale at 90 days in patients eligible for t-PA was 0.72 in the MSU group and 0.66 in the EMS group (adjusted odds ratio for a score of ≥0.91, 2.43; 95% confidence interval [CI], 1.75 to 3.36; P<0.001). Among the patients eligible for t-PA, 55.0% in the MSU group and 44.4% in the EMS group had a score of 0 or 1 on the modified Rankin scale at 90 days. Among all enrolled patients, the mean score on the utility-weighted modified Rankin scale at discharge was 0.57 in the MSU group and 0.51 in the EMS group (adjusted odds ratio for a score of ≥0.91, 1.82; 95% CI, 1.39 to 2.37; P<0.001). Secondary clinical outcomes generally favored MSUs. Mortality at 90 days was 8.9% in the MSU group and 11.9% in the EMS group. CONCLUSIONS: In patients with acute stroke who were eligible for t-PA, utility-weighted disability outcomes at 90 days were better with MSUs than with EMS. (Funded by the Patient-Centered Outcomes Research Institute; BEST-MSU ClinicalTrials.gov number, NCT02190500.).


Assuntos
Ambulâncias , Serviços Médicos de Emergência , AVC Isquêmico/tratamento farmacológico , Unidades Móveis de Saúde , Tempo para o Tratamento , Ativador de Plasminogênio Tecidual/uso terapêutico , Idoso , Avaliação da Deficiência , Feminino , Humanos , AVC Isquêmico/complicações , AVC Isquêmico/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Razão de Chances , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
3.
BMC Health Serv Res ; 21(1): 972, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34526032

RESUMO

BACKGROUND: The demand for more flexible and person-centered models of oral healthcare delivery is increasing and while mobile and domiciliary dental services have the potential to increase access to oral healthcare among dependent elderly and people with disabilities; the uptake of this service model by dentists remains low. Therefore, the aim of this study was to understand how existing domiciliary dental services operate within a particular context. METHODS: We used a qualitative descriptive multiple case study design. We studied three independent domiciliary dentistry clinics in the province of Quebec, Canada. We completed observations of 27 domiciliary visits, four of which were in private homes and the remaining 23 in LTCFs. We also conducted semi-structured interviews with dental professionals, patients, and caregivers. We performed a qualitative content analysis using a deductive/inductive coding framework. RESULTS: We presented a detailed description of the physical and service features of the studied cases. Physical features included the set-up of the mobile clinics, the portable equipment used, and the domiciliary locations of visits. For service features, we described the roles, attitudes, and interactions among those involved on both the providers' and recipients' sides, as well as, the logistical and financial aspect of the domiciliary dental services. CONCLUSIONS: Despite variations in setup and years of practice, the three mobile clinics had similar physical and service features. They also faced common logistic challenges but were able to provide services and respond to the high demand for domiciliary dental services. Additional research in different contexts would further contribute to building evidence-based models to help increase the uptake of this type of practice by current and future dental professionals.


Assuntos
Atenção à Saúde , Unidades Móveis de Saúde , Idoso , Canadá , Odontologia , Acesso aos Serviços de Saúde , Humanos , Quebeque
5.
Artigo em Russo | MEDLINE | ID: mdl-34486868

RESUMO

The common coding of main diagnosis (so-called "manual coding") is accompanied by quite many errors associated with inobservance of classification algorithm and subjective causes that in statistical morbidity and mortality data corruption. The article presents the results of implementing automated system of diagnosis coding by the ICD-10 in the departments of the Medicosanitary Unit of MVD of Russia in City of Moscow. The functional and time losses and the error rate were studied under manual coding and automated coding system. In case of common coding of complete clinical diagnosis of one discharged patient per day, it takes from 5 to 15 minutes, for coding diagnoses of all discharged patients - about 1 hour. The number of errors in common coding made up to 14.1% (n=2472) and in case of automated coding it made up to 1.5% (n= 63, p>0.05). The application of automated coding system in medical organizations ensures exact correspondence of clinical and statistical diagnosis, unifies wording of clinical diagnosis, minimizes subjective deviations from algorithm of the ICD-10.


Assuntos
Classificação Internacional de Doenças , Unidades Móveis de Saúde , Algoritmos , Humanos , Morbidade , Alta do Paciente
6.
Rev Gaucha Enferm ; 42(spe): e20200378, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34524360

RESUMO

OBJECTIVE: To understand the role of nurses in field hospitals aimed at patients with Covid-19. METHODS: Qualitative research based on Alfred Schütz's social phenomenology. Twenty nurses working in São Paulo were interviewed between May and June 2020. The testimonies were organized and analyzed based on the theoretical-methodological and thematic framework. RESULTS: The following categories emerged: "Nurses' challenges in field hospital care", "Visibility of nursing in the Covid-19 pandemic scenario" and "Covid-19 post-pandemic professional valorization". FINAL CONSIDERATIONS: The reflection on the results that emerged in this study may contribute to support improvements in training, working conditions and valuing nurses, considering the importance of this professional category in the scope of health services. New investigations may increase knowledge in the area, providing subsidies for professional role in this and other health situations that require nursing intensity and excellence.


Assuntos
COVID-19/enfermagem , Unidades Móveis de Saúde/organização & administração , Papel do Profissional de Enfermagem/psicologia , Enfermeiras e Enfermeiros/psicologia , Enfermagem/normas , Adulto , Brasil , COVID-19/epidemiologia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Teoria de Enfermagem , Pandemias , Prática Profissional , Pesquisa Qualitativa , SARS-CoV-2
7.
Am J Phys Med Rehabil ; 100(11): 1027-1030, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34508061

RESUMO

ABSTRACT: Rehabilitation experts play an important role in preventing hospital-acquired debility, increasing patients' abilities to safely perform activities of daily living, and facilitating discharge to the home setting for patients with COVID-19. Surges in COVID-19 hospitalization rates combined with increases in length of hospital stay and decreases in postacute care placements have necessitated the opening of COVID-19 field hospitals around the country. Most field hospitals lack the resources to offer a full suite of rehabilitation services, but there are opportunities for small teams of rehabilitation experts to increase their reach by using innovative strategies. This article describes the implementation of a small team of rehabilitation experts in a COVID-19 field hospital and strategies used by this team to maximize patient activity and mobility, facilitate timely discharge, and maximize the number of patients discharged to the home setting. Strategies include training nonclinical staff to assist with activity and mobility promotion and using a rehabilitation triage system to determine needs of individual patients and facilitate efficient resource utilization. The authors reflect on successful aspects of these strategies, as well as barriers to rehabilitation implementation, and make recommendations for other field hospitals seeking to implement rehabilitation during the COVID-19 pandemic or future health crises.


Assuntos
COVID-19/reabilitação , Unidades Móveis de Saúde/organização & administração , Atividades Cotidianas , Baltimore , Feminino , Humanos , Tempo de Internação , Masculino , Pandemias , Alta do Paciente , Recuperação de Função Fisiológica , SARS-CoV-2 , Cuidados Semi-Intensivos
8.
J Infect Public Health ; 14(9): 1206-1211, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34419704

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) has affected over 145 million infected people and 3 million deaths worldwide. There has been limited data to recommend either for or against use of antiviral regimens in mild COVID-19 patients. This study aimed to compare clinical outcomes between mild COVID-19 patients receiving antiviral drugs and those without. METHOD: Thai patients diagnosed with COVID-19 at field hospital affiliated to Thammasat University Hospital, Thailand were evaluated between January 1, 2020 and April 13, 2021. Patients' data, clinical presentation, past medical history, laboratory results, and treatment outcomes were extensively reviewed. RESULTS: Five hundred patients with positive tests were included in the study. The mean age was 35.9 years; 46% males. There were 225 (45%), 207 (41.4%), 44 (8.8%), 18 (3.6%), 6 (1.2%) patients with asymptomatic, mild, moderate, severe, and critical COVID-19, respectively. Of 207 mild COVID-19 patients, 9 (4.3%) received lopinavir/ritonavir or darunavir/ritonavir, 17 (8.2%) received favipiravir, while 175 (84.5%) had only supportive care. Mild COVID-19 patients receiving antiviral treatment had longer median length of hospital stay [13 days (IQR 11-14) vs. 10 days (IQR 8-12), p < 0.001] than patients having only supportive treatment. Antiviral drug use was significantly associated with longer hospital stay (>10 days) in mild COVID-19 patients (OR 5.52; 95%CI 2.12-14.40, p < 0.001). Adverse drug reactions such as diarrhea, abdominal pain, and hepatitis were also demonstrated in our COVID-19 patients with antiviral treatments. Majority of patients (97.6%) recovered without any complications and were discharged home. Two deaths were caused by acute respiratory distress syndrome from severe COVID-19 pneumonia. CONCLUSION: Antiviral treatment could not provide superior clinical outcomes to supportive care in mild COVID-19 patients. Mild COVID-19 patients receiving antiviral medication had longer length of hospital stay than those without. Standard supportive care and regular monitoring of disease progression might be keys for successful management of mild COVID-19.


Assuntos
Antivirais , COVID-19 , Adulto , Antivirais/uso terapêutico , Feminino , Humanos , Masculino , Unidades Móveis de Saúde , Estudos Retrospectivos , SARS-CoV-2 , Resultado do Tratamento
9.
BMC Health Serv Res ; 21(1): 888, 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34454505

RESUMO

BACKGROUND: Daily doses of pre-exposure prophylaxis (PrEP) can reduce the risk of acquiring HIV by more than 95 %. In sub-Saharan Africa, adolescent girls and young women (AGYW) are at disproportionately high risk of acquiring HIV, accounting for 25 % of new infections. There are limited data available on implementation approaches to effectively reach and deliver PrEP to AGYW in high HIV burden communities. METHODS: We explored the feasibility and acceptability of providing PrEP to AGYW (aged 16-25 years) via a community-based mobile health clinic (CMHC) known as the Tutu Teen Truck (TTT) in Cape Town, South Africa. The TTT integrated PrEP delivery into its provision of comprehensive sexual and reproductive health services (SRHS). We analyzed data from community meetings and in-depth interviews with 30 AGYW PrEP users to understand the benefits and challenges of PrEP delivery in this context. RESULTS: A total of 585 young women started PrEP at the TTT between July 2017 - October 2019. During in-depth interviews a subset of 30 AGYW described the CMHC intervention for PrEP delivery as acceptable and accessible. The TTT provided services at times and in neighborhood locations where AGYW organically congregate, thus facilitating service access and generating peer demand for PrEP uptake. The community-based nature of the CMHC, in addition to its adolescent friendly health providers, fostered a trusting provider-community-client relationship and strengthened AGYW HIV prevention self-efficacy. The integration of PrEP and SRHS service delivery was highly valued by AGYW. While the TTT's integration in the community facilitated acceptability of the PrEP delivery model, challenges faced by the broader community (community riots, violence and severe weather conditions) also at times interrupted PrEP delivery. CONCLUSIONS: PrEP delivery from a CMHC is feasible and acceptable to young women in South Africa. However, to effectively scale-up PrEP it will be necessary to develop diverse PrEP delivery locations and modalities to meet AGYW HIV prevention needs.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Adolescente , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Humanos , Unidades Móveis de Saúde , África do Sul
10.
Psychiatriki ; 32(3): 199-207, 2021 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-34390558

RESUMO

In Greece, the provision of mental health shows inefficiencies in remote and inaccessible areas due to the lack of appropriate structures and access to healthcare. The purpose of this study was to assess the effectiveness of the Mobile Mental Health Units (MMHUs) in Cyclades with and without MMHUs' operation based on Real-World Evidence (RWE). The study population consisted of 724 people who visited the MMHUs of the western and northeastern Cyclades in 2015. The data derived from the patients' medical records of EPAPSY classified by International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) and the Global Assessment of Functioning (GAF) scale. The analysis revealed that 60.9% of the participants were women and the average age was 50.1. 50.4% of the people who visited MMHUs without referral from primary health care professionals and 18.8% with referral. The calculation of effectiveness was based on DALYs (Disability-Adjusted Life Years) and was performed according to the World Health Organization methodology. In the specific population, there are no recorded deaths caused by mental disorders and thus DALYs are equal to Years Lost due to Disability (YLDs) with MMHUs' operation. 18% of the population was diagnosed with mood disorders (F30-F39) and morbidity burden 9.49 (YLDs), while 17.5% of the patients were diagnosed with neurotic, stress-related and somatoform disorders (F40-F48) and corresponding morbidity burden 4.53 (YLDs). Our results revealed that the effectiveness of MMHUs corresponds to 17.98 Disability-Adjusted Life Years (DALYs) averted in 2015. The mood disorders and the neurotic, stress-related disorders have shown a high morbidity burden. Advanced age, non-permanent employment, existence of psychopathology in the family and referral on patients' own will were found to significantly affect the mental health status of the participants. The implementation and expansion of flexible and alternative community-based interventions, such as MMHUs, constitute a best practice both for obtaining higher clinical outcomes and for facing regional inefficiencies related to population's access to healthcare.


Assuntos
Transtornos Mentais , Saúde Mental , Feminino , Humanos , Ilhas , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Unidades Móveis de Saúde , Anos de Vida Ajustados por Qualidade de Vida
12.
BMC Med ; 19(1): 160, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34238298

RESUMO

BACKGROUND: East Africa is home to 170 million people and prone to frequent outbreaks of viral haemorrhagic fevers and various bacterial diseases. A major challenge is that epidemics mostly happen in remote areas, where infrastructure for Biosecurity Level (BSL) 3/4 laboratory capacity is not available. As samples have to be transported from the outbreak area to the National Public Health Laboratories (NPHL) in the capitals or even flown to international reference centres, diagnosis is significantly delayed and epidemics emerge. MAIN TEXT: The East African Community (EAC), an intergovernmental body of Burundi, Rwanda, Tanzania, Kenya, Uganda, and South Sudan, received 10 million € funding from the German Development Bank (KfW) to establish BSL3/4 capacity in the region. Between 2017 and 2020, the EAC in collaboration with the Bernhard-Nocht-Institute for Tropical Medicine (Germany) and the Partner Countries' Ministries of Health and their respective NPHLs, established a regional network of nine mobile BSL3/4 laboratories. These rapidly deployable laboratories allowed the region to reduce sample turn-around-time (from days to an average of 8h) at the centre of the outbreak and rapidly respond to epidemics. In the present article, the approach for implementing such a regional project is outlined and five major aspects (including recommendations) are described: (i) the overall project coordination activities through the EAC Secretariat and the Partner States, (ii) procurement of equipment, (iii) the established laboratory setup and diagnostic panels, (iv) regional training activities and capacity building of various stakeholders and (v) completed and ongoing field missions. The latter includes an EAC/WHO field simulation exercise that was conducted on the border between Tanzania and Kenya in June 2019, the support in molecular diagnosis during the Tanzanian Dengue outbreak in 2019, the participation in the Ugandan National Ebola response activities in Kisoro district along the Uganda/DRC border in Oct/Nov 2019 and the deployments of the laboratories to assist in SARS-CoV-2 diagnostics throughout the region since early 2020. CONCLUSIONS: The established EAC mobile laboratory network allows accurate and timely diagnosis of BSL3/4 pathogens in all East African countries, important for individual patient management and to effectively contain the spread of epidemic-prone diseases.


Assuntos
COVID-19/prevenção & controle , Redes Comunitárias , Dengue/epidemiologia , Doença pelo Vírus Ebola/epidemiologia , Laboratórios , Unidades Móveis de Saúde , Burundi/epidemiologia , COVID-19/terapia , Dengue/prevenção & controle , Epidemias , Doença pelo Vírus Ebola/prevenção & controle , Doença pelo Vírus Ebola/terapia , Humanos , Quênia/epidemiologia , Unidades Móveis de Saúde/economia , Saúde Pública , Ruanda/epidemiologia , SARS-CoV-2 , Sudão do Sul/epidemiologia , Tanzânia/epidemiologia , Uganda/epidemiologia
13.
Artigo em Inglês | MEDLINE | ID: mdl-34198917

RESUMO

BACKGROUND: Given the current COVID-19 pandemic situation, now more than ever, remote solutions for assessing and monitoring individuals with cognitive impairment are urgently needed. Older adults in particular, living in isolated rural areas or so-called 'medical deserts', are facing major difficulties in getting access to diagnosis and care. Telemedical approaches to assessments are promising and seem well accepted, reducing the burden of bringing patients to specialized clinics. However, many older adults are not yet adequately equipped to allow for proper implementation of this technology. A potential solution could be a mobile unit in the form of a van, equipped with the telemedical system which comes to the patients' home. The aim of this proof-of-concept study is to evaluate the feasibility and reliability of such mobile unit settings for remote cognitive testing. Methods and analysis: eight participants (aged between 69 and 86 years old) from the city of Digne-Les-Bains volunteered for this study. A basic neuropsychological assessment, including a short clinical interview, is administered in two conditions, by telemedicine in a mobile clinic (equipped van) at a participants' home and face to face in a specialized clinic. The administration procedure order is randomized, and the results are compared with each other. Acceptability and user experience are assessed among participants and clinicians in a qualitative and quantitative manner. Measurements of stress indicators were collected for comparison. RESULTS: The analysis revealed no significant differences in test results between the two administration procedures. Participants were, overall, very satisfied with the mobile clinic experience and found the use of the telemedical system relatively easy. CONCLUSION: A mobile unit equipped with a telemedical service could represent a solution for remote cognitive testing overcoming barriers in rural areas to access specialized diagnosis and care.


Assuntos
COVID-19 , Telemedicina , Idoso , Idoso de 80 Anos ou mais , Cognição , Estudos de Viabilidade , Humanos , Unidades Móveis de Saúde , Pandemias , Projetos Piloto , Reprodutibilidade dos Testes , SARS-CoV-2
14.
BMC Infect Dis ; 21(1): 626, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210269

RESUMO

OBJECTIVE: To quantitatively evaluate the effectiveness of Fangcang shelter hospitals, designated hospitals, and the time interval from illness onset to diagnosis toward the prevention and control of the COVID-19 epidemic. METHODS: We used SEIAR and SEIA-CQFH warehouse models to simulate the two-period epidemic in Wuhan and calculate the time dependent basic reproduction numbers (BRNs) of symptomatic infected individuals, asymptomatic infected individuals, exposed individuals, and community-isolated infected individuals. Scenarios that varied in terms of the maximum numbers of open beds in Fangcang shelter hospitals and designated hospitals, and the time intervals from illness onset to hospitals visit and diagnosis were considered to quantitatively assess the optimal measures. RESULTS: The BRN decreased from 4.50 on Jan 22, 2020 to 0.18 on March 18, 2020. Without Fangcang shelter hospitals, the cumulative numbers of cases and deaths would increase by 18.58 and 51.73%, respectively. If the number of beds in the designated hospitals decreased by 1/2 and 1/4, the number of cumulative cases would increase by 178.04 and 92.1%, respectively. If the time interval from illness onset to hospital visit was 4 days, the number of cumulative cases and deaths would increase by 2.79 and 6.19%, respectively. If Fangcang shelter hospitals were not established, the number of beds in designated hospitals reduced 1/4, and the time interval from visiting hospitals to diagnosis became 4 days, the cumulative number of cases would increase by 268.97%. CONCLUSION: The declining BRNs indicate the high effectiveness of the joint measures. The joint measures led by Fangcang shelter hospitals are crucial and need to be rolled out globally, especially when medical resources are limited.


Assuntos
COVID-19/prevenção & controle , COVID-19/terapia , Simulação por Computador , Unidades Móveis de Saúde , SARS-CoV-2 , COVID-19/epidemiologia , COVID-19/mortalidade , China/epidemiologia , Hospitais Especializados , Humanos , Modelos Biológicos , Saúde Pública
18.
J Neurosci Nurs ; 53(4): 166-169, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34091516

RESUMO

ABSTRACT: BACKGROUND: Prehospital tissue plasminogen activator dosing in a mobile stroke unit (MSU) is estimated by the paramedic and nurse. We aimed to determine the accuracy of the estimated weight method compared with the actual weight of patients treated with tissue plasminogen activator on the MSU. METHODS: We prospectively collected the estimated weight used on the MSU for treatment and the first-documented hospital-measured weight (bed scale) within 24 hours of hospital arrival. Median absolute and percent difference in weights were calculated; less than 10% of difference in weights was considered acceptable. To compare the estimated and measured weights, we conducted a Wilcoxon signed rank test and Fisher exact test to explore the association between weight difference of greater than 10% and patient outcomes. RESULTS: Among 337 patients, median estimated and hospital-measured weights were 79.0 kg (interquartile range [IQR], 66.0-94.5) and 78.5 kg (IQR, 65.0-91.7), respectively. The median of the absolute value of the difference in estimated versus measured weight was 2.7 kg (IQR, 0.6-7.6; P < .0001). The median percent difference in weight was 3.6% (IQR, 0.8%-9.4%). The median difference between the tissue plasminogen activator dosage administered on the MSU and the recommended dose based on the actual weight was 1.3 mg (IQR, 0.06-4.8) in absolute value. In 56 patients (16.6% of the entire sample) with overestimation of weight by greater than 10%, there were no symptomatic intracerebral hemorrhages. There was no association between weight difference and discharge modified Rankin score (P = .59). CONCLUSION: Weight estimation on an MSU can lead to similar tissue plasminogen activator dosing for 83.4% of subjects compared with if dosing were determined based on actual weight. Weight overestimation or underestimation had no detected impact on tissue plasminogen activator outcomes.


Assuntos
Isquemia Encefálica , Unidades Móveis de Saúde , Acidente Vascular Cerebral , Peso Corporal , Isquemia Encefálica/tratamento farmacológico , Fibrinolíticos/uso terapêutico , Hospitais , Humanos , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento
19.
Bull World Health Organ ; 99(6): 422-428, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34108752

RESUMO

Objective: To assess the implementation of a mobile dispensing service to improve opioid users' access to methadone maintenance therapy. Methods: In March 2019, we started mobile methadone dispensing in an urban underprivileged locality in Delhi, India. The doctor was available only at the main community drug treatment clinic for clinical services, while the nurse dispensed methadone from a converted ambulance. We involved patients in identifying community leaders for sensitization and in deciding the location and timings for dispensing. We conducted a retrospective chart review of the programme data collected during delivery of clinical services. We compared the numbers of patients registered for methadone therapy and their retention and adherence to therapy in the 12-month periods before and after implementation of the mobile service. Findings: The number of patients registered for therapy at the clinic increased from 167 in the year before implementation to 671 in the year after. A significantly higher proportion of patients were retained in therapy at 3, 6 and 9 months after enrolment; 9-month retention rates were 19% (32/167 patients) and 45% (44/97 patients) in the year before and after implementation, respectively. There was no significant difference in patients' adherence to therapy between the two periods. Challenges included providing suitable dispensing hours for patients in employment and concerns of local community near to the dispensing sites. Conclusion: It is feasible to dispense methadone by a mobile team in an urban setting, with better retention rates in therapy compared with dispensing through a stationary clinic.


Assuntos
Analgésicos Opioides/uso terapêutico , Implementação de Plano de Saúde , Metadona/uso terapêutico , Unidades Móveis de Saúde/organização & administração , Transtornos Relacionados ao Uso de Opioides/reabilitação , Adulto , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Resultado do Tratamento
20.
Artif Organs ; 45(10): 1168-1172, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34181752

RESUMO

ECMO support is particularly resource-intensive and should be provided in highly specialized centers. Occasionally, ECMO needs to be initiated in non-ECMO centers by mobile ECMO retrieval teams. Subsequently, patients must be transferred on ECMO to the ECMO center. We report single-center data from out-of-center initiations of ECMO during the COVID-19 pandemic. From March 2020 through February 2021, nine patients were connected to ECMO before transfer to our center. Median travel distance (IQR) from the referring hospital to our center was 66 km (20-92), median land travel time (IQR) was 51 minutes (26-92). Personal protective equipment was available for all team members and used throughout the missions. No infections of team members with SARS-CoV-2 occurred. Three patients survived until hospital discharge. Median duration of ECMO (IQR) was 18 days (2-78) in survivors and 19 days (9-42) in non-survivors, respectively. Out-of-center initiation of ECMO during the COVID-19 pandemic was feasible and safe for patients and staff.


Assuntos
COVID-19/terapia , Oxigenação por Membrana Extracorpórea , Unidades Móveis de Saúde , Transporte de Pacientes , Idoso , COVID-19/diagnóstico , COVID-19/mortalidade , COVID-19/transmissão , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/prevenção & controle , Equipamento de Proteção Individual , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
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