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2.
JMIR Form Res ; 6(2): e29012, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1662500

ABSTRACT

BACKGROUND: To demonstrate the value of implementation of an artificial intelligence solution in health care service, a winning project of the Massachusetts Institute of Technology Hacking Medicine Brazil competition was implemented in an urgent care service for health care professionals at Hospital das Clínicas of the Faculdade de Medicina da Universidade de São Paulo during the COVID-19 pandemic. OBJECTIVE: The aim of this study was to determine the impact of implementation of the digital solution in the urgent care service, assessing the reduction of nonvalue-added activities and its effect on the nurses' time required for screening and the waiting time for patients to receive medical care. METHODS: This was a single-center, comparative, prospective study designed according to the Public Health England guide "Evaluating Digital Products for Health." A total of 38,042 visits were analyzed over 18 months to determine the impact of implementing the digital solution. Medical care registration, health screening, and waiting time for medical care were compared before and after implementation of the digital solution. RESULTS: The digital solution automated 92% of medical care registrations. The time for health screening increased by approximately 16% during the implementation and in the first 3 months after the implementation. The waiting time for medical care after automation with the digital solution was reduced by approximately 12 minutes compared with that required for visits without automation. The total time savings in the 12 months after implementation was estimated to be 2508 hours. CONCLUSIONS: The digital solution was able to reduce nonvalue-added activities, without a substantial impact on health screening, and further saved waiting time for medical care in an urgent care service in Brazil during the COVID-19 pandemic.

3.
Healthcare (Basel) ; 10(2)2022 Jan 21.
Article in English | MEDLINE | ID: covidwho-1650960

ABSTRACT

BACKGROUND: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the association between intubation day and mortality in COVID-19 patients. METHODS: We performed a unicentric retrospective cohort study considering all COVID-19 patients consecutively admitted between March 2020 and August 2020 requiring invasive mechanical ventilation. The primary outcome was all-cause mortality within 28 days after intubation, and a Cox model was used to evaluate the effect of time from onset of symptoms to intubation in mortality. RESULTS: A total of 592 (20%) patients of 3020 admitted with COVID-19 were intubated during study period, and 310 patients who were intubated deceased 28 days after intubation. Each additional day between the onset of symptoms and intubation was significantly associated with higher in-hospital death (adjusted hazard ratio, 1.018; 95% CI, 1.005-1.03). CONCLUSION: Among patients infected with SARS-CoV-2 who were intubated and mechanically ventilated, delaying intubation in the course of symptoms may be associated with higher mortality. TRIAL REGISTRATION: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068).

4.
Clinics ; 76: e2795, 2021.
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1271045

ABSTRACT

OBJECTIVES: A good health care does not only depend on good medical practice, but also needs great management of its resources, which are generally short. In this sense, PROAHSA has been training new health managers since 1972. With the arrival of the COVID-19 pandemic, it was clear that medicine will go through a new phase, where telehealth will be present in this "Improved Normal". This report is about how a pilot teleconsultation study was carried out for HCFMUSP patients through the Scrum-like framework. It is to deploy a pilot of remote assistance involving a doctor and a patient in the Ambulatory of Hepatology and Liver Transplantation of HCFMUSP. METHODS: We applied the Scrum-like framework to carry out this work with an interdisciplinary multifunctionality team. RESULTS: A full telemedicine service flow was implemented within eight weeks using existing infrastructure and resources implementing the Scrum methodology. Twenty-three teleconsultations were scheduled and eight guides built. CONCLUSION: Scrum framework has a great potential to improve the training of students and to conclude pilot projects.


Subject(s)
Humans , Telemedicine , COVID-19 , Internship and Residency , Outpatients , Pandemics , SARS-CoV-2
8.
Ferreira, Juliana C.; Ho, Yeh-Li, Besen, Bruno A. M. P.; Malbuisson, Luiz M. S.; Taniguchi, Leandro U.; Mendes, Pedro V.; Costa, Eduardo L. V.; Park, Marcelo, Daltro-Oliveira, Renato, Roepke, Roberta M. L.; Silva Jr, João M.; Carmona, Maria José C.; Carvalho, Carlos Roberto Ribeiro, Hirota, Adriana, Kanasiro, Alberto Kendy, Crescenzi, Alessandra, Fernandes, Amanda Coelho, Miethke-Morais, Anna, Bellintani, Arthur Petrillo, Canasiro, Artur Ribeiro, Carneiro, Bárbara Vieira, Zanbon, Beatriz Keiko, Batista, Bernardo Pinheiro De Senna Nogueira, Nicolao, Bianca Ruiz, Besen, Bruno Adler Maccagnan Pinheiro, Biselli, Bruno, Macedo, Bruno Rocha De, Toledo, Caio Machado Gomes De, Pompilio, Carlos Eduardo, Carvalho, Carlos Roberto Ribeiro De, Mol, Caroline Gomes, Stipanich, Cassio, Bueno, Caue Gasparotto, Garzillo, Cibele, Tanaka, Clarice, Forte, Daniel Neves, Joelsons, Daniel, Robira, Daniele, Costa, Eduardo Leite Vieira, Silva Júnior, Elson Mendes Da, Regalio, Fabiane Aliotti, Segura, Gabriela Cardoso, Marcelino, Gustavo Brasil, Louro, Giulia Sefrin, Ho, Yeh-Li, Ferreira, Isabela Argollo, Gois, Jeison de Oliveira, Silva Junior, Joao Manoel Da, Reusing Junior, Jose Otto, Ribeiro, Julia Fray, Ferreira, Juliana Carvalho, Galleti, Karine Vusberg, Silva, Katia Regina, Isensee, Larissa Padrao, Oliveira, Larissa dos Santos, Taniguchi, Leandro Utino, Letaif, Leila Suemi, Lima, Lígia Trombetta, Park, Lucas Yongsoo, Chaves Netto, Lucas, Nobrega, Luciana Cassimiro, Haddad, Luciana, Hajjar, Ludhmila, Malbouisson, Luiz Marcelo, Pandolfi, Manuela Cristina Adsuara, Park, Marcelo, Carmona, Maria José Carvalho, Andrade, Maria Castilho Prandini H. De, Santos, Mariana Moreira, Bateloche, Matheus Pereira, Suiama, Mayra Akimi, Oliveira, Mayron Faria de, Sousa, Mayson Laercio, Louvaes, Michelle, Huemer, Natassja, Mendes, Pedro, Lins, Paulo Ricardo Gessolo, Santos, Pedro Gaspar Dos, Moreira, Pedro Ferreira Paiva, Guazzelli, Renata Mello, Reis, Renato Batista Dos, Oliveira, Renato Daltro De, Roepke, Roberta Muriel Longo, Pedro, Rodolpho Augusto De Moura, Kondo, Rodrigo, Rached, Samia Zahi, Fonseca, Sergio Roberto Silveira Da, Borges, Thais Sousa, Ferreira, Thalissa, Cobello Junior, Vilson, Sales, Vivian Vieira Tenório, Ferreira, Willaby Serafim Cassa, Group, E. PICCoV Study.
Clinics ; 75:e2294-e2294, 2020.
Article in English | LILACS (Americas), Grey literature | ID: grc-742344

ABSTRACT

OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital's electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.

10.
Ferreira, Juliana C; Ho, Yeh-Li; Besen, Bruno A M P; Malbuisson, Luiz M S; Taniguchi, Leandro U; Mendes, Pedro V; Costa, Eduardo L V; Park, Marcelo; Daltro-Oliveira, Renato; Roepke, Roberta M L; Silva Jr, João M; Carmona, Maria José C; Carvalho, Carlos Roberto Ribeiro; Hirota, Adriana; Kanasiro, Alberto Kendy; Crescenzi, Alessandra; Fernandes, Amanda Coelho; Miethke-Morais, Anna; Bellintani, Arthur Petrillo; Canasiro, Artur Ribeiro; Carneiro, Bárbara Vieira; Zanbon, Beatriz Keiko; Batista, Bernardo Pinheiro De Senna Nogueira; Nicolao, Bianca Ruiz; Besen, Bruno Adler Maccagnan Pinheiro; Biselli, Bruno; Macedo, Bruno Rocha De; Toledo, Caio Machado Gomes De; Pompilio, Carlos Eduardo; Carvalho, Carlos Roberto Ribeiro De; Mol, Caroline Gomes; Stipanich, Cassio; Bueno, Caue Gasparotto; Garzillo, Cibele; Tanaka, Clarice; Forte, Daniel Neves; Joelsons, Daniel; Robira, Daniele; Costa, Eduardo Leite Vieira; Silva Júnior, Elson Mendes Da; Regalio, Fabiane Aliotti; Segura, Gabriela Cardoso; Marcelino, Gustavo Brasil; Louro, Giulia Sefrin; Ho, Yeh-Li; Ferreira, Isabela Argollo; Gois, Jeison de Oliveira; Silva Junior, Joao Manoel Da; Reusing Junior, Jose Otto; Ribeiro, Julia Fray; Ferreira, Juliana Carvalho; Galleti, Karine Vusberg; Silva, Katia Regina; Isensee, Larissa Padrao; Oliveira, Larissa dos Santos; Taniguchi, Leandro Utino; Letaif, Leila Suemi; Lima, Lígia Trombetta; Park, Lucas Yongsoo; Chaves Netto, Lucas; Nobrega, Luciana Cassimiro; Haddad, Luciana; Hajjar, Ludhmila; Malbouisson, Luiz Marcelo; Pandolfi, Manuela Cristina Adsuara; Park, Marcelo; Carmona, Maria José Carvalho; Andrade, Maria Castilho Prandini H De; Santos, Mariana Moreira; Bateloche, Matheus Pereira; Suiama, Mayra Akimi; Oliveira, Mayron Faria de; Sousa, Mayson Laercio; Louvaes, Michelle; Huemer, Natassja; Mendes, Pedro; Lins, Paulo Ricardo Gessolo; Santos, Pedro Gaspar Dos; Moreira, Pedro Ferreira Paiva; Guazzelli, Renata Mello; Reis, Renato Batista Dos; Oliveira, Renato Daltro De; Roepke, Roberta Muriel Longo; Pedro, Rodolpho Augusto De Moura; Kondo, Rodrigo; Rached, Samia Zahi; Fonseca, Sergio Roberto Silveira Da; Borges, Thais Sousa; Ferreira, Thalissa; Cobello Junior, Vilson; Sales, Vivian Vieira Tenório; Ferreira, Willaby Serafim Cassa.
Clinics ; 75: e2294, 2020. tab, graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-769762

ABSTRACT

OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital's electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.


Subject(s)
Humans , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Research Design , Brazil , Cohort Studies , Hospital Mortality , Observational Studies as Topic , Pandemics , Betacoronavirus , SARS-CoV-2 , COVID-19 , Hospitals, University , Intensive Care Units
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