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1.
Pan Afr Med J ; 39: 222, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34630834

RESUMEN

Introduction: irrational or inappropriate prescribing of antibiotics is a major problem in healthcare and leads to antibiotic resistance. There is the need to understand the prescribing patterns and antibiotic stewardship in health facilities to support appropriate antibiotic use. A study was carried out to evaluate prescribing pattern of antibiotics at the Ghana Police Hospital using National Standard Treatment Guidelines (STG) and World Health Organization (WHO) prescribing indicators. Methods: a cross-sectional descriptive study was conducted at the Ghana Police Hospital. Data on prescriptions of antibiotics for both out-patients and in-patients was collected between December 2019 and March 2020. A pretested self-designed tool was used for data collection. All sampled prescriptions were assessed for appropriateness using the STG of 2017 and WHO "AWaRe" classification. The criteria used in assessment included dose, frequency, duration of treatment and choice of antibiotic prescribed for disease condition. Descriptive statistics were used in data analysis. Results: a total of 184 patient prescriptions (286 antibiotics) were included in this study. Results showed that antibiotics were mostly prescribed for dental and dental-related conditions (20.7%) and obstetric post-delivery prophylaxis (18.1%). Appropriateness of indicators for antibiotics prescribed assessed ranged between 89.2% to 97.6%. The most frequently prescribed antibiotics were metronidazole (25.9%), amoxicillin with clavulanic acid (22.0%), amoxicillin (16.4%) and ciprofloxacin (10.1%). Based on WHO "AWaRe" classification, the "access" group of antibiotics (74%) was the most prescribed, followed by "watch" group (24%). There were no antibiotics prescribed from the "reserve" group of antibiotics and another 2% that was not part of AwaRe classification. Conclusion: study revealed that the level of appropriateness for prescribing indicators assessed was relatively high and majority of prescribed antibiotics were from the "access" and "watch" group. These observations suggest responsible prescribing of antibiotics at the Ghana Police Hospital and effective antibiotic stewardship should be sustained and improved.


Asunto(s)
Antibacterianos/administración & dosificación , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Adulto , Anciano , Programas de Optimización del Uso de los Antimicrobianos , Niño , Preescolar , Estudios Transversales , Femenino , Ghana , Hospitales , Humanos , Prescripción Inadecuada/estadística & datos numéricos , Lactante , Masculino , Persona de Mediana Edad , Proyectos Piloto , Pautas de la Práctica en Medicina/normas , Indicadores de Calidad de la Atención de Salud , Adulto Joven
2.
BMC Cancer ; 21(1): 1094, 2021 Oct 11.
Artículo en Inglés | MEDLINE | ID: mdl-34635061

RESUMEN

BACKGROUND: To ensure safe delivery of oncologic care during the COVID-19 pandemic, telemedicine has been rapidly adopted. However, little data exist on the impact of telemedicine on quality and accessibility of oncologic care. This study assessed whether conducting an office visit for thoracic oncology patients via telemedicine affected time to treatment initiation and accessibility. METHODS: This was a retrospective cohort study of patients with thoracic malignancies seen by a multidisciplinary team during the first surge of COVID-19 cases in Philadelphia (March 1 to June 30, 2020). Patients with an index visit for a new phase of care, defined as a new diagnosis, local recurrence, or newly discovered metastatic disease, were included. RESULTS: 240 distinct patients with thoracic malignancies were seen: 132 patients (55.0%) were seen initially in-person vs 108 (45.0%) via telemedicine. The majority of visits were for a diagnosis of a new thoracic cancer (87.5%). Among newly diagnosed patients referred to the thoracic oncology team, the median time from referral to initial visit was significantly shorter amongst the patients seen via telemedicine vs. in-person (median 5.0 vs. 6.5 days, p < 0.001). Patients received surgery (32.5%), radiation (24.2%), or systemic therapy (30.4%). Time from initial visit to treatment initiation by modality did not differ by telemedicine vs in-person: surgery (22 vs 16 days, p = 0.47), radiation (27.5 vs 27.5 days, p = 0.86, systemic therapy (15 vs 13 days, p = 0.45). CONCLUSIONS: Rapid adoption of telemedicine allowed timely delivery of oncologic care during the initial surge of the COVID19 pandemic by a thoracic oncology multi-disciplinary clinic.


Asunto(s)
COVID-19/epidemiología , Accesibilidad a los Servicios de Salud , Pandemias , Telemedicina/organización & administración , Neoplasias Torácicas/terapia , Tiempo de Tratamiento , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Grupo de Atención al Paciente , Philadelphia/epidemiología , Calidad de la Atención de Salud , Derivación y Consulta , Estudios Retrospectivos , Telemedicina/normas , Telemedicina/estadística & datos numéricos , Neoplasias Torácicas/epidemiología , Neoplasias Torácicas/patología , Factores de Tiempo
3.
BMC Health Serv Res ; 21(1): 1065, 2021 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-34625080

RESUMEN

BACKGROUND: Neglected Tropical Diseases (NTDs) such as podoconiosis, lymphatic filariasis (LF) and leprosy mainly affect communities in low resource settings. These diseases are associated with physical disability due to lymphoedema as well as poor mental health and psychosocial outcomes. Integration of care across these NTDs at primary health care level, which includes mental health and psychosocial care alongside physical health care, is increasingly recommended. METHODS: A holistic integrated care package was developed and piloted as part of the EnDPoINT project in Gusha district, Awi zone, Ethiopia. The intervention was conducted at the health care organization, health facility and community levels. To assess the impact of the care package in terms of acceptability, scalability, sustainability and barriers to implementation, a qualitative study was conducted in January 2020. This included four focus group discussions (29 participants) and ten key informant interviews with decision makers, health professionals, patients, and community representatives. RESULTS: The integrated lymphoedema care package was found to be efficient compared to vertical programs in saving time and resources. It also resulted in improved awareness of the causes, treatment and prevention of lymphoedema, in marked improvements in the lymphoedema, and in reduced stigma and discrimination. The care package was found to be acceptable to patients, health professionals and decision makers. The barriers to integrated care were unrealistic patient expectations, inadequate dissemination across health workers, and poor transportation access. Health professionals, decision makers and patients believed the integrated lymphoedema care package to be scalable and sustainable. CONCLUSION: The integrated holistic care package was found to be acceptable to patients, health professionals and decision makers. We recommend its scale-up to other endemic districts.


Asunto(s)
Elefantiasis , Linfedema , Atención a la Salud , Etiopía , Humanos , Linfedema/terapia , Proyectos Piloto
4.
J Orthop Traumatol ; 22(1): 39, 2021 Oct 06.
Artículo en Inglés | MEDLINE | ID: mdl-34613499

RESUMEN

BACKGROUND: The present systematic review analysed the available literature to assess reliability of the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score in the evaluation of knee and ankle osteochondral lesions. METHODS: All the studies using the MOCART score for knee and/or talus chondral defects were accessed in March 2021. A multivariate analysis was performed to assess associations between the MOCART score at last follow-up and data of patients at baseline, clinical scores and complications. A multiple linear model regression analysis was used. RESULTS: The MOCART score evidenced no association with patient age (P = 0.6), sex (P = 0.1), body mass index (P = 0.06), defect size (P = 0.9), prior length of symptoms (P = 0.9) or visual analogue scale (P = 0.07). For chondral defects of the knee, no statistically significant association was found between the MOCART score and the International Knee Documentation Committee (P = 0.9) and with the Lysholm Knee Scoring Scales (P = 0.2), Tegner Activity Scale (P = 0.2), visual analogue scale P = 0.07), rate of failure (P = 0.2) and revision (P = 0.9). For chondral defect of the talus, no statistically significant associations were found between the MOCART score and the American Orthopedic Foot and Ankle Score (P = 0.3), Tegner Activity Scale (P = 0.4), visual analogue scale (P = 0.1), rate of failure (P = 0.1) and revision (P = 0.7). CONCLUSION: The MOCART score demonstrated no association with patient characteristics and with the surgical outcome in patients who underwent surgical management for knee and talus chondral defects. LEVEL OF EVIDENCE: Level IV.


Asunto(s)
Revisiones Sistemáticas como Asunto/normas , Humanos , Reproducibilidad de los Resultados , Proyectos de Investigación
5.
Artículo en Inglés | MEDLINE | ID: mdl-34639587

RESUMEN

Mental health care is shifting towards more person-centered and community-based health care. Although integrating eHealth within a transforming healthcare setting may help accomplishing the shift, research studying this is lacking. This study aims to improve our understanding of the value of eHealth within a transforming mental healthcare setting and to define the challenges and prerequisites for implementing eHealth in particular within this transforming context. In this article, we present the results of 29 interviews with clients, social network members, and professionals of an ambulatory team in transition within a Dutch mental health care institute. The main finding is that eHealth can support a transforming practice shifting towards more recovery-oriented, person-centered, and community-based service in which shared-decision making is self-evident. The main challenge revealed is how to deal with clients' voices, when professionals see the value of eHealth but clients do not want to start using eHealth. The shift towards client-centered and network-oriented care models and towards blended care models are both high-impact changes in themselves. Acknowledging the complexity of combining these high-impact changes might be the first step towards creating blended client-centered and network-oriented care. Future research should examine whether and how these substantial shifts could be mutually supportive.


Asunto(s)
Servicios de Salud Mental , Telemedicina , Atención a la Salud , Humanos , Investigación Cualitativa
6.
Artículo en Inglés | MEDLINE | ID: mdl-34639623

RESUMEN

For patients with coronary heart disease (CHD) lifestyle changes and disease management are key aspects of treatment that could be facilitated by mobile health applications (MHA). However, the quality and functions of MHA for CHD are largely unknown, since reviews are missing. Therefore, this study assessed the general characteristics, quality, and functions of MHA for CHD. Hereby, the Google Play and Apple App stores were systematically searched using a web crawler. The general characteristics and quality of MHA were rated with the Mobile Application Rating Scale (MARS) by two independent raters. From 3078 identified MHA, 38 met the pre-defined criteria and were included in the assessment. Most MHA were affiliated with commercial companies (52.63%) and lacked an evidence-base. An overall average quality of MHA (M = 3.38, SD = 0.36) was found with deficiencies in information quality and engagement. The most common functions were provision of information and CHD risk score calculators. Further functions included reminders (e.g., for medication or exercises), feedback, and health management support. Most MHA (81.58%) had one or two functions and MHA with more features had mostly higher MARS ratings. In summary, this review demonstrated that a number of potentially helpful MHA for patients with CHD are commercially available. However, there is a lack of scientific evidence documenting their usability and clinical potential. Since it is difficult for patients and healthcare providers to find suitable and high-quality MHA, databases with professionally reviewed MHA are required.


Asunto(s)
Enfermedad Coronaria , Aplicaciones Móviles , Telemedicina , Atención a la Salud , Frecuencia Cardíaca , Humanos
7.
Medicine (Baltimore) ; 100(37): e27191, 2021 Sep 17.
Artículo en Inglés | MEDLINE | ID: mdl-34664845

RESUMEN

INTRODUCTION: : When using portable oxygen, a demand oxygen delivery system (DODS), which senses the beginning of inhalation and delivers a bolus of oxygen, is often used. However, conventional DODS may not supply sufficient oxygen when reduced tidal flow fails to trigger the flow sensor. Recently, "auto-DODS," which detects the negative pressure of inhalation and switches among 3 trigger sensitivity levels (standard, high, and extra high), has been developed to improve the efficacy of oxygenation. An auto-DODS can also supply pulsed-flow oxygen when it detects apnea, whereas a conventional DODS has only standard sensitivity. This randomized, open-label, crossover pilot study compared the performance of an auto-DODS with that of a conventional DODS. METHODS: : We recruited patients with chronic obstructive pulmonary disease (COPD) or interstitial pneumonia receiving long-term oxygen therapy. Interventions were performed on 2 different days for each participant. On each day, an auto-DODS or a conventional DODS were tested at rest for 30 minutes and during the 6-minute walk test. The primary outcome was mean oxygen saturation (SpO2). Secondary outcomes were the ratios of time for each sensitivity level and pulsed-flow oxygen when using the auto-DODS, total time desaturated below SpO2 90%, percentage of time desaturated below SpO2 90%, minimum SpO2, mean and maximum pulse rate, six-minute walk distance, recovery time after 6-minute walk test, modified Borg scale, comfort, and discomfort index. RESULTS: : When using the auto-DODS at rest, a high or extra high sensitivity level was observed in addition to standard sensitivity in 6 of 8 participants. During the 6-minute walk test, only standard sensitivity was observed in 6 participants. Mean SpO2 differences between the auto-DODS and conventional DODS at rest and during the 6-minute walk test were -0.6 [-4.5, 3.4] and 0.0 [-2.5, 2.5] ([95% confidence interval]), respectively, neither of which were significant (P = .73 and P = .99). There were no significant differences in secondary outcomes. There were no adverse events when using the auto-DODS. CONCLUSIONS: : This study showed that the auto-DODS did not show superiority in oxygenation either at rest or during exercise compared to a conventional DODS. The auto-DODS was shown to supply oxygen safely and detect inhalations with various trigger sensitivities.


Asunto(s)
Diseño de Equipo/normas , Terapia por Inhalación de Oxígeno/instrumentación , Insuficiencia Respiratoria/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Estudios Cruzados , Diseño de Equipo/estadística & datos numéricos , Femenino , Humanos , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Oxígeno/administración & dosificación , Terapia por Inhalación de Oxígeno/métodos , Terapia por Inhalación de Oxígeno/normas , Proyectos Piloto , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Factores de Tiempo
8.
Medicine (Baltimore) ; 100(37): e27218, 2021 Sep 17.
Artículo en Inglés | MEDLINE | ID: mdl-34664858

RESUMEN

BACKGROUND: Mild neurocognitive disorder (MND) is an intermediate state that can progress to dementia, and the cognitive reserve of MND is an important task in preventing dementia. Acupuncture and neurofeedback (NF) training have been used to improve cognitive function and treat MND or dementia, but their effectiveness remains controversial. In this trial, we will evaluate the efficacy and safety of combined NF-acupuncture treatment in comparison with single acupuncture treatment. METHODS AND DESIGN: This study is a randomized, assessor-blind, pilot trial. It is designed in accordance with the Standards for Reporting Interventions in Controlled Trials of Acupuncture. A total of 44 MND participants who meet the inclusion and exclusion criteria will be enrolled, and each will be randomly assigned to 1 of 2 groups of 22 subjects. Each subject will visit 24 times over 12 weeks and receive either acupuncture or NF-acupuncture combined treatment. At visit 25 (week 13), a follow-up evaluation will be performed, and then the investigator will analyze the results. The primary outcome is defined by the Korean version of the Montreal Cognitive Assessment score from screening to visit 25. The secondary outcome includes the following: change in Alzheimer Disease Assessment Scale-Cognitive, the Korean version of the Beck Depression Inventory, Body Awareness Questionnaire, delayed matching to sample task scores, and functional near-infrared spectroscopy values, from visit 1 to visit 25; heart rate variability values from visit 1 to visit 5, visit 9, visit 13, visit 21, visit 25; breath per minute values from visit 1 to visit 1 to 25. DISCUSSION: We will evaluate the effectiveness and safety of combined NF-acupuncture therapy, and expect that it will serve as the basis for the use of NF together with acupuncture in the clinical setting. TRIAL REGISTRATION NUMBER: KCT0004972 (registered in Clinical Research Information Service of the Republic of Korea, https://cris.nih.go.kr/cris/search/detailSearch.do/16239).


Asunto(s)
Terapia por Acupuntura/métodos , Cognición/efectos de los fármacos , Disfunción Cognitiva/terapia , Terapia Combinada/normas , Neurorretroalimentación/métodos , Terapia por Acupuntura/normas , Terapia por Acupuntura/estadística & datos numéricos , Anciano , Disfunción Cognitiva/fisiopatología , Terapia Combinada/métodos , Terapia Combinada/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , República de Corea
9.
Medicine (Baltimore) ; 100(37): e27256, 2021 Sep 17.
Artículo en Inglés | MEDLINE | ID: mdl-34664874

RESUMEN

ABSTRACT: International evidence-based guidelines recommend self-management support for stroke survivors to improve their health outcomes. We developed a 4-week nurse-led stroke self-management programme (SSMP) and conducted a randomised controlled trial to assess its effects. This paper reports the findings of a qualitative study nested within the randomised controlled trial to explore stroke survivors' experiences of SSMP participation. Semi-structured interviews were conducted with all adult participants who were clinically diagnosed with a first or recurrent ischaemic or haemorrhagic stroke, residing at home, communicable in Cantonese, had a Montreal Cognitive Assessment score below the second percentile, and participated in at least 1 SSMP session. All interviews were conducted in Cantonese, lasted approximately 45 minutes, and were audio-recorded. Interview data were transcribed verbatim and analysed thematically. Sixty-four stroke survivors (mean age 66.33 years, SD 12.34) were recruited, and 59 were interviewed via phone immediately after completion of SSMP. Three themes were derived. Overall, participants were satisfied with the SSMP. Their understanding of self-management was improved, and they recognised its importance in recovery. Their confidence in self-management was also enhanced through the use of multifaceted strategies. Suggestions were made to enhance their participation experiences, including increased home visits and group sessions, making group session attendance optional and arranging them more accessibly, meeting the survivors who shared their survival experiences in the videos, and access to the videos online. This study concurred that the SSMP enhanced stroke survivors' self-efficacy in self-management. Rearrangement of the programme format and enhancements in accessibility could be further examined to enable more effective stroke self-management.


Asunto(s)
Vida Independiente/psicología , Automanejo/psicología , Accidente Cerebrovascular/enfermería , Sobrevivientes/psicología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Vida Independiente/lesiones , Entrevistas como Asunto/métodos , Masculino , Persona de Mediana Edad , Teoría de Enfermería , Evaluación de Programas y Proyectos de Salud/métodos , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Investigación Cualitativa , Automanejo/métodos , Automanejo/estadística & datos numéricos , Accidente Cerebrovascular/psicología , Rehabilitación de Accidente Cerebrovascular/enfermería , Rehabilitación de Accidente Cerebrovascular/psicología , Rehabilitación de Accidente Cerebrovascular/normas , Sobrevivientes/estadística & datos numéricos
10.
BMC Health Serv Res ; 21(1): 1108, 2021 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-34656126

RESUMEN

BACKGROUND: There is a long-standing debate in implementation research on whether adaptations to evidence-based interventions (EBIs) are desirable in health care. If an intervention is adapted and not delivered as conceived and planned, it is said to have low fidelity. The WALK-Cph project was developed based on the assumption that involving stakeholders in co-design processes would facilitate the fidelity of an intervention to increase the mobility of acutely admitted older medical patients and its implementation in two hospitals in Denmark. The purpose of this study is to describe and analyse adaptations and modifications that were made to the co-designed WALK-Cph intervention and its implementation. METHODS: This study used a qualitative design. An ethnographic field study was performed using participant observations, workshops and semi-structured interviews. Data were analysed twice using the Framework Method. The first analysis was based on the frameworks from Stirman, Moore and Proctor. The second analysis, a retrospective modifications analysis, was based on the Adaptation-Impact Framework. RESULTS: Many different types of adaptations and modifications were made to the WALK-Cph intervention and its implementation plan. Most of the modifications were made on the contents of the intervention. In total, 44 adaptations and modifications were made, of which 21 were planned (adaptations) and 23 were made haphazardly (modifications). Most of the content and context adaptations and modifications made on the intervention had a mixed result regarding enhanced fidelity. The retrospective modifications analysis showed that modifications were ongoing and both situationally and contextually shaped. CONCLUSIONS: Although an extensive co-design process was carried out to facilitate the fidelity of the WALK-Cph intervention, this study showed that many adaptations and modifications were still made to both the intervention and its implementation plan. It could indicate that the co-design process had a small effect or that adaptations and modifications are ongoing and both situationally and contextually shaped, which challenge the assumption and the desire to be able to plan and control changes.


Asunto(s)
Atención a la Salud , Proyectos de Investigación , Dinamarca , Humanos , Investigación Cualitativa , Estudios Retrospectivos
12.
Dermatol Clin ; 39(4): 587-597, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34556248

RESUMEN

The impact of the COVID-19 pandemic on dermatology practice cannot be overstated. At its peak, the pandemic resulted in the temporary closure of ambulatory sites as resources were reallocated towards pandemic response efforts. Many outpatient clinics have since reopened and are beginning to experience a semblance of pre-pandemic routine, albeit with restrictions in place. We provide an overview of how COVID-19 has affected dermatology practice globally beginning with the rise of teledermatology. A summary of expert recommendations that shape the "new normal" in various domains of dermatology practice, namely, dermatology consultation, procedural dermatology, and phototherapy, is also provided.


Asunto(s)
Instituciones de Atención Ambulatoria/tendencias , Dermatología/normas , Atención Primaria de Salud/tendencias , Enfermedades de la Piel/terapia , Telemedicina/tendencias , COVID-19/epidemiología , Dermatología/tendencias , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Visita a Consultorio Médico/tendencias , Enfermedades de la Piel/epidemiología
13.
J Foot Ankle Res ; 14(1): 53, 2021 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-34470650

RESUMEN

BACKGROUND: Occupational musculoskeletal injuries are prevalent in healthcare workers and are reported to be profession-specific. There is, however, a paucity of information around the injuries sustained from working as a podiatrist. This paper looks at the incidence of injury from working as a podiatrist, the aggravating factors to sustain these injuries and whether the changes in workload due to the COVID-19 pandemic altered the incidence. METHODS: A modified work based musculoskeletal injury questionnaire was distributed in the UK via podiatry led social media platforms. Open and Closed questions explored the demographics of the sample, perceived injury 12 months prior to the COVID-19 pandemic and then 6 months into the lockdown. Pre and post COVID-19 data were analysed for differences and thematic analysis was included to categorise reported experiences. RESULTS: 148 podiatrists representing 3 % of HCPC registered practitioners responded to the questionnaire. Employment status altered as a result of the COVID-19 pandemic with a 13 % reduction in those working full time. Environments also changed with domiciliary and telehealth significantly increasing (p > 0.00) and non-clinical roles being extended (p > 0.002). Pain frequency and intensity significantly (p > 0.04) increased as a result of the pandemic with shoulder pain being most frequent before lockdown altering to the neck during the lockdown. Two main themes were identified that were attributed to the causes of pain including physical demands and working in awkward spaces. CONCLUSIONS: Work-related musculoskeletal pain in podiatrists is common with the shoulder and neck being the most frequently affected. Changes in work practices due to the restrictions enforced from the COVID-19 pandemic increased the frequency and intensity of pain mostly associated with increased domiciliary and telehealth working environments.


Asunto(s)
Accidentes de Trabajo , COVID-19 , Dolor de Cuello , Enfermedades Profesionales , Podiatría , Dolor de Hombro , Accidentes de Trabajo/prevención & control , Accidentes de Trabajo/estadística & datos numéricos , COVID-19/epidemiología , COVID-19/prevención & control , Control de Enfermedades Transmisibles/métodos , Encuestas de Atención de la Salud/métodos , Encuestas de Atención de la Salud/estadística & datos numéricos , Humanos , Dolor de Cuello/epidemiología , Dolor de Cuello/etiología , Enfermedades Profesionales/clasificación , Enfermedades Profesionales/epidemiología , Podiatría/métodos , Podiatría/tendencias , Prevalencia , SARS-CoV-2 , Dolor de Hombro/epidemiología , Dolor de Hombro/etiología , Telemedicina/métodos , Reino Unido/epidemiología , Carga de Trabajo/estadística & datos numéricos , Lugar de Trabajo/normas
15.
World J Emerg Surg ; 16(1): 46, 2021 09 10.
Artículo en Inglés | MEDLINE | ID: mdl-34507603

RESUMEN

On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.


Asunto(s)
COVID-19/epidemiología , Salud Global , Pandemias , Investigación Biomédica , COVID-19/diagnóstico , COVID-19/terapia , Vacunas contra la COVID-19 , Atención a la Salud/organización & administración , Política de Salud , Accesibilidad a los Servicios de Salud , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Humanos , Cooperación Internacional , Vacunación Masiva/organización & administración , Pandemias/prevención & control , Política , Atención Primaria de Salud/organización & administración , Telemedicina/organización & administración
16.
Best Pract Res Clin Anaesthesiol ; 35(3): 307-319, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34511221

RESUMEN

Telemedicine is the medical practice of caring for and treating patients remotely. With the spread of the coronavirus disease-2019 (COVID-19) pandemic, telemedicine has become increasingly prevalent. Although telemedicine was already in practice before the 2020 pandemic, the internet, smartphones, computers, and video-conferencing tools have made telemedicine easily accessible and available to almost everyone. However, there are also new challenges that health care providers may not be prepared for, including treating and diagnosing patients without physical contact. Physician adoption also depends upon reimbursement and education to improve the telemedicine visits. We review current trends involving telemedicine, how pandemics such as COVID-19 affect the remote treatment of patients, and key concepts important to healthcare providers who practice telemedicine.


Asunto(s)
COVID-19/prevención & control , Personal de Salud/tendencias , Pautas de la Práctica en Medicina/tendencias , Telemedicina/tendencias , COVID-19/diagnóstico , COVID-19/epidemiología , Humanos , Manejo del Dolor/métodos , Manejo del Dolor/tendencias , Pandemias/prevención & control , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapia , Telemedicina/métodos
17.
Healthc Policy ; 17(1): 17-24, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34543172

RESUMEN

The unequal social and economic burden of the COVID-19 pandemic is evident in racialized and low-income communities across Canada. Importantly, social inequities have not been adequately addressed and current public policies are not reflective of the needs of diverse populations. Public participation in decision-making is crucial and there is, therefore, a pressing need to increase diversity of representation in patient partnerships in order to prevent the further exclusion of socially marginalized groups from research and policy making. Deliberate effort and affirmative action are needed to meaningfully engage and nurture diverse patient partnerships by broadening the scope of the patient community to include excluded or underrepresented individuals or groups. This will help us co-develop ways to enhance access and equity in healthcare and prevent the systematic reproduction of structural inequalities that have already been heightened by the COVID-19 pandemic.


Asunto(s)
Investigación Biomédica/normas , COVID-19/terapia , Atención a la Salud/normas , Equidad en Salud/normas , Política de Salud , Selección de Paciente , Proyectos de Investigación/normas , Adulto , Anciano , Anciano de 80 o más Años , Canadá , Femenino , Guías como Asunto , Humanos , Masculino , Persona de Mediana Edad , Pandemias , SARS-CoV-2
18.
Ann Fam Med ; 19(5): 457-459, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34546953

RESUMEN

Health care organizations in the United States have transformed at an unprecedented rate since March 2020 due to COVID-19, most notably with a shift to telemedicine. Despite rapidly adapting health care delivery in light of new safety considerations and a shifting insurance landscape, primary care offices across the country are facing drastic decreases in revenue and potential bankruptcy. To survive, primary care's adaptations will need to go beyond virtual versions of traditional office visits. Primary care is faced with a chance to redefine what it means to care for and support patients wherever they are. This opportunity to shape the "new normal" is a critical step for primary care to meet its full potential to lead a paradigm shift to patient-centered health care reform in America during this time when we need it most.


Asunto(s)
COVID-19/psicología , Atención a la Salud/organización & administración , Atención Primaria de Salud/métodos , Telemedicina , Atención a la Salud/tendencias , Humanos , Pandemias/prevención & control , Atención Primaria de Salud/tendencias , SARS-CoV-2 , Estados Unidos
19.
J Med Internet Res ; 23(9): e23539, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-34468333

RESUMEN

BACKGROUND: Telemedicine has been increasingly used in many health care fields, including home care, where patients receive medical care at home. Owing to the current COVID-19 crisis, the value of telemedicine via videoconferencing is more recognized, particularly in allowing immobile patients to continue receiving care. However, the efficacy of telemedicine in home care settings in Japan remains to be fully appraised. OBJECTIVE: This study aims to identify the use and impact of telemedicine in a singular home care delivery setting in Japan. METHODS: A retrospective observational study was conducted using patient and other administrative records from a home care clinic. We considered patients who were involved in videoconferencing with home care physicians and telepresenters serving patients during 2018 and 2019. We extracted sociodemographic data of the patients and details of the videoconferencing and descriptively illustrated some specific cases. RESULTS: In a home care clinic in Japan, videoconferencing was conducted in 17 cases (involving 14 patients) over a 2-year period. Of all the cases, 12% (2/17) required emergency transfers and were hospitalized. A total of 88% (15/17) of cases remained; 71% (12/17) of cases were found to need extra medication or to go to a medical facility for consultation, whereas 18% (3/17) of cases were found not to be in need of urgent attention and were asked to rest. Problematic symptoms subsequently improved in 82% (14/17) of cases, and only 6% (1/17) of cases were later hospitalized. CONCLUSIONS: Telemedicine was deemed effective for assessing patients' conditions in the home care setting in situations where home visits by a physician cannot be carried out. Our findings indicate that consultations via videoconferencing are safe and effective, suggesting more active use of videoconferencing in other clinical contexts.


Asunto(s)
COVID-19 , Servicios de Atención de Salud a Domicilio , Telemedicina , Atención a la Salud , Humanos , Japón , SARS-CoV-2 , Comunicación por Videocoferencia
20.
BMJ Open ; 11(9): e048921, 2021 09 07.
Artículo en Inglés | MEDLINE | ID: mdl-34493515

RESUMEN

INTRODUCTION: Consideration of the preferences for everyday living of older people with various care needs is a prerequisite for person-centred and evidence-based nursing care. Knowledge of and respect for these preferences by nursing staff are associated with better care outcomes for older people with various care needs. To assess preferences in a structured way, instruments focusing on different topics of everyday living appear to be useful. It is unclear which instruments exist for assessing preferences for everyday living. The aim of this planned review is to identify relevant instruments for assessing the preferences for everyday living of older people with various care needs in the form of an evidence map. Additionally, gaps requiring further research will be presented. METHODS AND ANALYSIS: To identify the different instruments, we will conduct a systematic search in the electronic databases MEDLINE (via PubMed), CINAHL and PsycINFO (via EBSCO). In addition, we will perform backward and forward citation tracking via reference lists and Google Scholar. The identified records will be independently screened (title/abstract and full text) by two reviewers. Data from the included studies will be extracted independently by the same two reviewers. In all three steps, the results will be checked for deviations, and if there are any deviations, they will be discussed. If no consensus can be achieved through discussion, a third reviewer will be engaged. All study designs will be included, and there will be no limitations regarding the publication status or time period. We will include all studies published in English and German that use instruments focusing on the assessment of preferences for everyday living in people older than 60 years of age with various care needs. For data charting, we will extract the number, categories and types of preferences, the care setting for which the instrument was developed and, if available, psychometric properties. Finally, the various extracted results will be presented in the form of tables and a bubble plot. ETHICS AND DISSEMINATION: There are no ethical concerns related to the construction of an evidence map, and ethical approval was given by the Witten/Herdecke University (application number 226/2020). We will discuss our results with practitioners in the field of nursing care and persons with various care needs. We will also make our results available to practitioners in an upcoming Project (PELI-D II) and to the public at (inter)national conferences and in the form of practice and peer-reviewed articles.


Asunto(s)
Atención a la Salud , Proyectos de Investigación , Anciano , Humanos , Psicometría
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