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1.
Journal of Clinical Outcomes Management ; 29(1):32-38, 2022.
Article in English | EMBASE | ID: covidwho-1884741

ABSTRACT

Background: The COVID-19 pandemic has placed substantial strain on hospital resources and has been responsible for more than 733 000 deaths in the United States. The US Food and Drug Administration has granted emergency use authorization (EUA) for monoclonal antibody (mAb) therapy for patients with early-stage high-risk COVID-19. Methods: In this retrospective cohort study, we studied the emergency department (ED) during a massive COVID-19 surge in Orange County, California, from December 4, 2020, to January 29, 2021, as a potential setting for efficient mAb delivery by evaluating the impact of bamlanivimab use in high-risk COVID-19 patients. All patients included in this study had positive results on nucleic acid amplification detection from nasopharyngeal or throat swabs, presented with 1 or more mild or moderate symptoms, and met EUA criteria for mAb treatment. The primary outcome analyzed among this cohort of ED patients was overall improvement, which included subsequent ED/hospital visits, inpatient hospitalization, and death related to COVID-19. Results: We identified 1278 ED patients with COVID-19 not treated with bamlanivimab and 73 patients with COVID-19 treated with bamlanivimab during the treatment period. Of these patients, 239 control patients and 63 treatment patients met EUA criteria. Overall, 7.9% (5/63) of patients receiving bamlanivimab had a subsequent ED/hospital visit, hospitalization, or death compared with 19.2% (46/239) in the control group (P= .03). Conclusion: Targeting ED patients for mAb treatment may be an effective strategy to prevent progression to severe COVID-19 illness and substantially reduce the composite end point of repeat ED visits, hospitalizations, and deaths, especially for individuals of underserved populations who may not have access to ambulatory care.

2.
Rev Panam Salud Publica ; 46: e43, 2022.
Article in Spanish | MEDLINE | ID: covidwho-1884926

ABSTRACT

Objective: To describe the clinical features of patients with post-COVID-19 syndrome who have recently been discharged from intensive care units (ICUs) included in a chronic care program in Colombia. Methods: Descriptive case series study of a cohort of patients with post-COVID-19 syndrome who entered the Remeo® chronic care program between July 2020 and May 2021. Clinical features, complications, and treatments are described. Results: Among patients in the program discharged from an ICU, 122 cases of post-COVID-19 syndrome were identified. These patients continued in the program. The mean age was 66.9 years (CI 64-68); 62.29% were men, 88.9% (109) had a tracheostomy, 72.8% (90) had a gastrostomy, and 99% required supplemental oxygen. In the first four months, 9,518 interventions were carried out, including physical therapy (x̄:20.7), occupational therapy (x̄:10.9), respiratory therapy (x̄:41.4), and psychology (x̄:4.8). Conclusions: The chronic care program was an option for patients with post-COVID-19 syndrome recently discharged from an ICU, with a view to minimizing ICU occupation rates and facilitating patients' return to their homes.


Objetivo: Descrever as características clínicas de pacientes com síndrome pós-COVID-19 após internação em unidade de terapia intensiva (UTI), acompanhados em um programa de cuidados prolongados na Colômbia. Métodos: Estudo descritivo de série de casos oriundos de uma coorte de pacientes com síndrome pós-COVID-19 admitidos no programa de cuidados prolongados Remeo® entre julho de 2020 e maio de 2021. Foram descritas as características clínicas desses pacientes, assim como complicações e tratamentos. Resultados: Foram identificados 122 casos de pacientes com síndrome pós-COVID-19 que foram acompanhados no programa após alta da UTI. A média de idade foi 66,9 anos (IC 64­68), 62,29% pertenciam ao sexo masculino, 88,9% (109) haviam sido submetidos a traqueostomia, 72,8% (90) a gastrostomia e 99% precisavam usar oxigênio suplementar. Ao todo, 9.518 intervenções foram realizadas nos 4 meses iniciais de acompanhamento no programa, incluindo fisioterapia (x̄ 20,7), terapia ocupacional (x̄ 10,9), terapia respiratória (x̄ 41,4) e atendimento psicológico (x̄ 4,8). Conclusões: O programa de cuidados prolongados ofereceu uma alternativa aos pacientes com síndrome pós-COVID-19 após internação em UTI e teve o objetivo de reduzir a ocupação das UTIs e facilitar a transição do paciente da UTI para casa.

3.
Int J Med Inform ; 165: 104812, 2022 Jun 08.
Article in English | MEDLINE | ID: covidwho-1882089

ABSTRACT

BACKGROUND: The COVID-19 pandemic and the need for physical distancing has led to rapid uptake of virtual visits to deliver ambulatory health care. Despite widespread adoption, there has been limited evaluation of the quality of care being delivered through virtual modalities for ambulatory care sensitive conditions (ACSCs). OBJECTIVE: To characterize patients' and providers' experiences with the quality and sustainability of virtual care for ACSCs. DESIGN: This was a multi-method study utilizing quantitative and qualitative data from patient surveys, provider surveys, and provider focus groups at a large academic ambulatory care hospital between May 2020 and June 2021. We included patients and providers utilizing telephone or video visits for the following ACSCs: hypertension, angina, heart failure, atrial fibrillation, diabetes, chronic obstructive pulmonary disease, or asthma. MAIN MEASURES: Quantitative and qualitative patient and provider survey responses were mapped to the Six Domains of Healthcare Quality framework. Provider focus groups were coded to identify themes within each quality domain. KEY RESULTS: Surveys were completed by 110/352 (31%) consenting patients and 20/61 (33%) providers. 5 provider focus groups were held with 14 participants. Patients found virtual visits to be generally more convenient than in-person visits for ACSCs. The perceived effectiveness of virtual visits was dependent on the clinical and social complexity of individual encounters. Respondents reported difficulty forming effective patient-provider relationships in the virtual environment. Patients and providers felt that virtual care has potential to both alleviate and exacerbate structural barriers to equitable access to care. CONCLUSIONS: In a large academic ambulatory care hospital, patients and providers experienced the quality of virtual visits for the management of ACSCs to be variable depending on the biopsychosocial complexity of the individual encounter. Our findings in each quality domain highlight key considerations for patients, providers and institutions to uphold the quality of virtual care for ACSCs.

4.
Dialogues in Health ; : 100021, 2022.
Article in English | ScienceDirect | ID: covidwho-1881907

ABSTRACT

Aim of the study The aim of the study was to investigate patient satisfaction, saving of time and the possible reduction of visits to medical practices that use Remote Patient Monitoring (RPM) during treatment compared to usual care. Methods In a randomized controlled trial between October 2020 and May 2021, the participating medical practices were randomized into three groups (two different RPM systems, one control). Doctors were required to enroll patients ≥ 18 years with acute respiratory infection in possession of a web-enabled device, such as a laptop, tablet or computer. After a three-month study phase, doctors were asked to describe the treatment of their patients via online survey. Patients were also questioned. The analysis was carried out descriptively and through group comparisons. Results 51 practices with 121 patients were included. Overall, the results generally show a positive assessment of digital care on the patient side. As for the doctors, handling and integrating the systems into established practice routines seem to be a challenge. Further, the number of patient visits to the medical practice was not reduced by using the systems. Doctors did not save time, but the relationship to the patients was intensified. Conclusion While there was no indication for an increase in efficiency by using RPM systems, participating doctors indicated their potential for an enhanced interaction between doctor and patient. In particular, intensified interaction contact with patients with chronic diseases (e. g. COPD, long-COVID) could be of long-term interest and importance for doctors in ambulatory care. Trial Registration: DRKS00023553

5.
CardioVascular and Interventional Radiology ; 45(SUPPL 1):S57, 2022.
Article in English | EMBASE | ID: covidwho-1881492

ABSTRACT

Purpose: The cyclic nature of active and recovery phases of the COVID-19 pandemic, has demanded fast adaptations and preparation for health care workers world-wide. We aimed to assess how interventional radiologists are handling the pandemic during active and recovery phases with regard to work and team structures, as well as mental health and how the pandemic could have increased the awareness of minimally-invasive therapies as alternatives to postponements of non-urgent procedures. Material and methods: 7125 CIRSE members were invited to participate. For this interim report, responses were collected between 23 November 2021 and 17 December 2021. Results: 114 responses were obtained for this preliminary report, of which 102 were complete. 94% (n=99) of respondents were interventional radiology specialists. Most respondents reported having established a routine to handle different waves of the pandemic (89.5%;n=102). Compared to active phases, fewer respondents indicated at least one pandemic-associated measure in their department during recovery phases (46%-71% vs 13%). 56% reported an increase in ambulatory care patients either during active and/or recovery phases. 54% reported more referrals during active and/or recovery phases. 25% reported increased hours at the hospital during recovery phases, 52% indicated increased sick leave, care leave, quarantine, and burn-out of team members and only 39% reported to get enough time to rest during recovery phases. Conclusion: While the COVID-19 pandemic is continuing to burden IR departments and the mental health of IRs, more than half of respondents reported an increase in referrals for minimally-invasive therapies and ambulatory care.

6.
Fertility and Sterility ; 116(3 SUPPL):e207, 2021.
Article in English | EMBASE | ID: covidwho-1880369

ABSTRACT

OBJECTIVE: The purpose of this study is to determine the positive predictive value (PPV) of diagnosis for endometriosis by the Nezhat Endometriosis Advisor (NEA) mobile application to serve as a screening tool MATERIALS AND METHODS: A retrospective cohort study was conducted at a university-affiliated private practice. Inclusion criteria were women with no previous surgical diagnosis of endometriosis who also completed an endometriosis assessment using the application. Patients with symptoms desiring definitive diagnosis and treatment of endometriosis then underwent laparoscopic surgery once surgeries were once again allowed. The diagnosis of endometriosis was confirmed visually by a surgeon specialized in treating endometriosis and also through biopsy sent to pathology. The primary outcome measured was the PPVof NEA mobile application questionnaire to the surgical diagnoses of endometriosis. RESULTS: A total of 100 patients met the inclusion criteria for this study. 95% of the patients whose score on the app was 90% or above, had a surgical pathology confirmed diagnosis of endometriosis (PPV 95%). CONCLUSIONS: NEA mobile application questionnaire has a high PPVof 95% for diagnosing endometriosis and can help identify a patient population that may require surgical treatment for pelvic pain or unexplained infertility. This will be helpful as it may lead to earlier diagnosis and management of endometriosis. Patients can reduce risk exposure of COVID-19 by avoiding multiple medical office visits. The COVID-19 pandemic has also decreased the availability of healthcare for many, and they may suffer for a long time with pain or infertility before a diagnosis is made. The mobile application is a possible alternative method to assess risk of endometriosis while avoiding risk of COVID-19 exposure. Patients can be medically treated based on symptoms and application results until surgery can be performed. With further research, the application has the potential to be the diagnostic measure of endometriosis. More research is needed to determine the continued accuracy of the application in different patient population and demographics IMPACT STATEMENT: Endometriosis is ectopic uterine lining growing outside the uterus which causes pain and infertility. Currently, definitive diagnosis is with pelvic laparoscopic surgery, as no screening test is widely available or accepted. The Coronavirus Disease 2019 (COVID-19) pandemic due to the infectious pathogen Severe Acute Respiratory Syndrome Coronavirus 2 has altered ambulatory and inpatient health care. For several months commencing March 2020, non-emergent surgeries came to an abrupt hault due to the COVID- 19 pandemic. Many patients who were scheduled to have diagnostic laparoscopies for suspected endometriosis were not able to have their surgeries performed. As an alternative NEA was utilized to determine the likelihood of endometriosis based on self-answered questionnaires about experienced symptoms. The mobile app is free and available for patients worldwide. Patients with a high probability of endometriosis can be treated medically until surgery resume.

7.
BMJ Supportive & Palliative Care ; 12(Suppl 2):A49, 2022.
Article in English | ProQuest Central | ID: covidwho-1874682

ABSTRACT

BackgroundFor patients with chronic, life limiting haematological conditions such as Myelodysplastic syndrome (MDS), regular transfusion for relief of symptoms of anaemia requires frequent attendance to acute hospital. Literature demonstrates MDS is associated with significant impairment and poor prognosis with critical palliative care needs.1 Opportunities to address these needs can be challenging in an acute environment.The Covid-19 pandemic led to a revision of services offered in St. Oswald’s Hospice Day Services with the development of a new Ambulatory Care service for patients requiring blood transfusion. This involves working with specialities to offer services to patients who would benefit from earlier palliative care support.MethodFollowing a successful pilot service we have continued to capture patient experience, patient need to access services available from palliative care MDT whilst working collaboratively with Haematology and Oncology services.Records were kept of MDT services accessed alongside collated patient feedback.ResultsFrom March to October 2021 there have been 13 patients with 86 attendances for blood transfusion:All patients had initial assessment with a senior palliative medicine Doctor5 patients have engaged in Advance Care Planning discussions3 patients reviewed by Physiotherapy6 patients received complementary therapy1 patient reviewed by social worker5 patients had medical review for specific symptom management1 patient assessed by lymphoedema specialist2 patients referred to music therapist1 patient admitted to the inpatient unit for observation overnight1 patient admitted for end of life care after outpatient attendanceFeedback has been very positive from patients and their familiesConclusionPatient feedback has been very positive with patients accessing palliative care services and engaging in ACP. Increasing the number of referrals to the service will continue to widen access to patients not typically referred until later in their disease process, promoting improved quality of life and Advance Care Planning.ReferenceNickolich M, El-Jawahri A, LeBlanc TW. Palliative and end-of-life care in myelodysplastic syndromes. Curr Hematol Malig Rep 2016;11:434–440.

8.
European Journal of Hospital Pharmacy. Science and Practice ; 29(Suppl 1):A28, 2022.
Article in English | ProQuest Central | ID: covidwho-1874577

ABSTRACT

Background and importanceMeasuring health care quality and performance is a major challenge in improving health systems’ efficiency. Patient experience is an important health care quality measure;thus, use of questionnaires reporting patients’ experience and perceptions while receiving care is recommended. The COVID-19 pandemic has accelerated the establishment of proximity dispensation models and ambulatory care redesign, aligned with the Anaesthesia Clinical Services Accreditation (ACSA) accreditation model, implemented in 2019 in the Pharmacy Department.Aim and objectivesEvaluate patient-reported experience regarding outpatient care in a central hospital pharmacy, during the COVID-19 pandemic.Material and methodsSingle-centre cross-sectional study (March–June 2021). Ambulatory outpatients were invited to complete a survey, consisting of 14 questions on: access to care, waiting time, communication and information about medication, pharmaceutical care provider (pharmacist in charge), privacy/confidentiality and unmet needs. The survey was made available to patients in paper or digital format at the pharmacist consultation, teleconsultation, medicines home delivery and pharmadrive delivery.ResultsA total of 9634 outpatients attended our ambulatory care during the study period. We carried out 1939 teleconsultations, 2194 home deliveries and 91 in-person consultations. Outpatients answered 148 surveys (1.5%). Most patients were pleased to continue picking up medication at hospital pharmacy (86%) and rated the service as good/very good. Patients considered that there was availability to listen/sympathy (99%) and privacy (96%) during the service. Information provided about medication was considered useful (89%). Waiting time was rated as appropriate (90%). A large percentage of patients were unaware of the possibility of pharmadrive (76%) and proximity dispensation (45%). Outpatients knew their pharmacist in charge in 37% of the cases and 75% had already contacted their pharmacist, 32% were not aware of the existence of a pharmacist in charge and the remaining (30%) did not have a pharmacist in charge.Conclusion and relevancePharmacists’ effort in pandemic times, implementing strategies to improve patient-centredness of care, ensured outpatients’ continuity of pharmaceutical care and medicines. In order to engage patients and improve their experience, awareness and retention of pharmacists in charge needs to increase. As improvement measures we intend to improve our outpatient care guide with more detailed information, and will also refresh pharmacist training.References and/or acknowledgementsConflict of interestNo conflict of interest

9.
Antibiotics (Basel) ; 11(5)2022 May 11.
Article in English | MEDLINE | ID: covidwho-1869448

ABSTRACT

In France, despite several successive plans to control antimicrobial resistance, antibiotic use remains high in the outpatient setting. This study aims to better understand outpatient antibiotic use and prescription in order to identify tailored targets for future public health actions. Using data from the French National Health Data System, we described and compared the individual characteristics of patients with and without an antibiotic prescription. The prescribed antibiotics (ATC-J01) were detailed and compared between 2019 and 2020. Antibiotic prescribing indicators that take prescriber activity into account were estimated and compared. Patients who were female, advanced age, and the presence of comorbidities were associated with antibiotic prescriptions. The overall prescription rate was estimated at 134 per 1000 consultations and 326 per 1000 patients seen in 2019. General practitioners (GPs), dentists and paediatricians were associated with 78.0%, 12.2% and 2.2% of antibiotic prescriptions, respectively, with high prescription rates (391, 447, and 313 p. 1000 patients seen, respectively). In comparison with 2019, this rate decreased in 2020 for paediatricians (-30.4%) and GPs (-17.9%) whereas it increased among dentists (+17.9%). The reduction was twice as high among the male prescribers than among their female counterparts (-26.6 and -12.0, respectively). The reduction in prescriptions observed in 2020 (-18.2%) was more marked in children (-35.8%) but less so among individuals ≥65 years (-13.1%) and those with comorbidities (-12.5%). The decrease in penicillin prescriptions represents 67.3% of the overall reduction observed in 2020. The heterogeneous decrease in prescriptions by age and antibiotic class could be explained by the impact of COVID-19 control measures on the spread of respiratory viruses; thus, a substantial proportion of the prescriptions avoided in 2020 is likely inappropriate, particularly among children. In order to keep the rate of prescriptions comparable to that observed in 2020, male prescribers, paediatricians and GPs should be encouraged to maintain that level, while a campaign to raise awareness of the appropriate use of antibiotics should be aimed at dentists in particular.

10.
Journal of Investigative Medicine ; 70(4):1163, 2022.
Article in English | EMBASE | ID: covidwho-1868768

ABSTRACT

Purpose of Study To identify factors influencing acceptance or refusal of COVID-19 vaccine by parents of children at a university affiliated community healthcare center. The introduction of the COVID-19 vaccine has been crucial in the mitigation of the COVID-19 pandemic. Initially, the vaccine was targeted at healthcare workers and other high-risk adults. Early in the pandemic, studies in adults on vaccine hesitancy noted concerns about the supposed novelty and efficacy of the vaccine. Studies in China and the UK established that most parents were willing to vaccinate their children with the COVID-19 vaccine even though they expressed concerns about safety and efficacy. This study aims to identify potential barriers and uncertainties that parents express when considering vaccinating their children. Methods Used Cross-sectional study using a self-administered questionnaire completed by English and Spanish-speaking parents/guardians requesting acute or well child care for their children less than 18 years of age at a university-affiliated pediatric ambulatory care center from April 2021 to May 2021. Summary of Results 223 subjects, predominantly mothers (90.1%), participated in the study. 49.8% of children were male and 48.4% female. The mean age of all children was 6.79 ± 5.4 years. 74% of the participants identified themselves as Hispanic, 17.9% as African American/Black, and 5.8% as 'mixed'. Concerning vaccinating their children against COVID-19, 23.8% of the respondents, stated 'Yes definitely' to agreeing to give the vaccine to their child, while 37.7% were 'Unsure but leaning towards yes'. 9.9% had 'No opinion', 13.5% were 'Unsure but leaning towards no', and 14.3% stated, 'No, definitely not'. Reasons for vaccine refusal include;uncertainty about vaccine efficacy (46.2%), concerns about hurried vaccine production (31.4%), belief that the child will get sick after vaccination (23.8%) and, being generally opposed to vaccines (4.5%). Conclusions In a largely Hispanic population, majority of parents/guardians were unsure but leaning towards accepting the COVID-19 vaccine for their children. Common reasons for vaccine refusal were concerns for efficacy and the rapid speed of production. This data suggests that specific vaccine education is needed in this community to address the concerns of efficacy, speedy vaccine production, and reactivity after vaccine administration to increase parental acceptance of COVID- 19 vaccine administration in their children.

11.
Drug Topics ; 166(4):30-32, 2022.
Article in English | EMBASE | ID: covidwho-1865867
12.
Archivos de Neurociencias ; 27(1):39-41, 2022.
Article in English | EMBASE | ID: covidwho-1863654

ABSTRACT

Introduction. The COVID-19 pandemic has affected the delivery of healthcare to people with chronic diseases such as movement disorders. Movement disorders specialists were compelled to adapt to this unprecedented situation. The objective of this study is to assess this impact in terms of the reduction in the number of in-office consultations of a high-specialty fellowship program as a result of the pandemic restrictions, and to evaluate the overall satisfaction with the fellowship. Methods. Out-patient records of the Movement Disorders clinic from March 1st, 2020, to February 28th, 2021, were collected. Data from this period was compared to that from the previous eight years. A satisfaction survey along with a visual analog scale was applied to both the patients and the specialty fellows. Results. During the study period a total of 1,742 consultations were given, which represent a 60% drop in comparison to the previous year. Moreover, 38% of those consultations were carried out by telemedicine. Both fellows’ self-reported satisfaction and patient satisfaction with teleconsultation was high (90% and 96%, respectively. Conclusions. Despite the decrease of in-office visits, fellows reported an acceptable satisfaction regarding the learning objectives of the program and patient satisfaction was not compromised.

13.
Revista Chilena de Infectologia ; 38(3):355-361, 2021.
Article in Spanish | EMBASE | ID: covidwho-1863035

ABSTRACT

In March 2020, the World Health Organization (WHO) recommen-ded that vaccination not be interrupted as long as countries could safely maintain this service in the context of the SARS-CoV-2 pandemic. WHO also warned about the risk of interruption of programmatic vaccination that generates an increase in the number of people sus-ceptible to infections that are sought to be prevented with the use of vaccines and, therefore, an increase in the probability of disease outbreak. Along with increased morbidity and mortality in risk groups, vaccine-preventable disease outbreaks would put additional demand on the health system already burdened by COVID-19. In August 2020, WHO reported the interruption of essential health services in different countries as a result of the SARS-CoV-2 pandemic, which mainly affected routine and extramural vaccination. In Chile, routine vaccination coverage decreased during 2020 compared to the average coverage for the 2015-2019 period. The smallest decline was 0.39% for the hexavalent vaccine at 2 months of age and the largest decrease was 12.02% at 18 months for the same vaccine. The exception to the fall in coverage in 2020 was adult pneumococcal vaccination, which showed an increase of 0.8% compared to 2015-2019.

14.
JMIR Formative Research ; 4(11), 2020.
Article in English | ProQuest Central | ID: covidwho-1857625

ABSTRACT

Background: Rapid and accurate diagnosis of chronic obstructive pulmonary disease (COPD) is problematic in acute care settings, particularly in the presence of infective comorbidities. Objective: The aim of this study was to develop a rapid smartphone-based algorithm for the detection of COPD in the presence or absence of acute respiratory infection and evaluate diagnostic accuracy on an independent validation set. Methods: Participants aged 40 to 75 years with or without symptoms of respiratory disease who had no chronic respiratory condition apart from COPD, chronic bronchitis, or emphysema were recruited into the study. The algorithm analyzed 5 cough sounds and 4 patient-reported clinical symptoms, providing a diagnosis in less than 1 minute. Clinical diagnoses were determined by a specialist physician using all available case notes, including spirometry where available. Results: The algorithm demonstrated high positive percent agreement (PPA) and negative percent agreement (NPA) with clinical diagnosis for COPD in the total cohort (N=252;PPA=93.8%, NPA=77.0%, area under the curve [AUC]=0.95), in participants with pneumonia or infective exacerbations of COPD (n=117;PPA=86.7%, NPA=80.5%, AUC=0.93), and in participants without an infective comorbidity (n=135;PPA=100.0%, NPA=74.0%, AUC=0.97). In those who had their COPD confirmed by spirometry (n=229), PPA was 100.0% and NPA was 77.0%, with an AUC of 0.97. Conclusions: The algorithm demonstrated high agreement with clinical diagnosis and rapidly detected COPD in participants presenting with or without other infective lung illnesses. The algorithm can be installed on a smartphone to provide bedside diagnosis of COPD in acute care settings, inform treatment regimens, and identify those at increased risk of mortality due to seasonal or other respiratory ailments. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001521213;http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375939

16.
Rev. bras. epidemiol ; 24: e210050, 2021.
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1855131

ABSTRACT

ABSTRACT: Objective: Emergency services are essential to the organization of the health care system. Nevertheless, they face different operational difficulties, including overcrowded services, largely explained by their inappropriate use and the repeated visits from users. Although a known situation, information on the theme is scarce in Brazil, particularly regarding longitudinal user monitoring. Thus, this project aims to evaluate the predictive performance of different machine learning algorithms to estimate the inappropriate and repeated use of emergency services and mortality. Methods: To that end, a study will be conducted in the municipality of Pelotas, Rio Grande do Sul, with around five thousand users of the municipal emergency department. Results: If the study is successful, we will provide an algorithm that could be used in clinical practice to assist health professionals in decision-making within hospitals. Different knowledge dissemination strategies will be used to increase the capacity of the study to produce innovations for the organization of the health system and services. Conclusion: A high performance predictive model may be able to help decisionmaking in the emergency services, improving quality of care.


RESUMO: Objetivo: Os serviços de emergência são fundamentais na organização da rede de atenção à saúde. Não obstante, apresentam diferentes dificuldades para seu funcionamento. Entre essas, destaca-se a superlotação dos serviços, a qual, em boa medida, é explicada pelo uso inadequado do serviço e reutilização frequente por parte de usuários. Apesar do conhecimento dessa situação, as informações sobre a temática são escassas no Brasil, ainda mais as relacionadas ao acompanhamento longitudinal dos usuários. Assim, este projeto objetiva avaliar a performance preditiva de diferentes algoritmos de machine learning para estimar o uso inapropriado e a reutilização dos serviços de emergência e a mortalidade. Métodos: Para isso, será realizado um estudo no município de Pelotas, Rio Grande do Sul, com um pouco mais de cinco mil usuários do pronto socorro municipal. Resultados: Caso o estudo seja bem-sucedido, será disponibilizado um algoritmo com potencial para ser usado na prática clínica para auxiliar profissionais de saúde na tomada de decisão no contexto hospitalar. Diferentes estratégias de difusão dos conhecimentos serão utilizadas para aumentar a capacidade do estudo de produzir inovações para a organização do sistema e serviços de saúde. Conclusão: Um modelo preditivo de alto desempenho pode auxiliar na tomada de decisão nos serviços de emergência, melhorando a qualidade do atendimento.


Subject(s)
Humans , Emergency Medical Services , Emergency Service, Hospital , Brazil , Outcome Assessment, Health Care , Machine Learning
17.
Diabetol Metab Syndr ; 14(1): 75, 2022 May 21.
Article in English | MEDLINE | ID: covidwho-1854864

ABSTRACT

BACKGROUND: Optimal glycemic control is the main goal for patients with diabetes. The results of type 1 diabetes patients' neglected demands during the pandemic can determine a long-term negative clinical, social, and economic impact, and result in worse diabetes control and a higher incidence of chronic complications. Therefore, this study aims to evaluate the impact of the COVID-19 outbreak in the quality of care of patients with type 1 diabetes in Southern Brazil. METHODS: Cohort study based on electronic medical records of patients with type 1 diabetes, with scheduled appointments between January 1st 2020, and November 6th 2020, at a university public hospital. The quality indicators used were: assessment of albuminuria and/or serum creatinine, lipid profile, thyroid-stimulating hormone, glycated hemoglobin, retinopathy, and neuropathy. McNemar test was used to analyze categorical variables and the Wilcoxon test for continuous variables. RESULTS: Out of 289 patients, 49.5% were women aged 40 ± 12 years old. During the pandemic, 252 patients had at least one face-to-face appointment canceled. The quality of care indicators showed a significant worsening during the COVID-19 pandemic compared to the previous year (p < 0.001). In 2019, 23.2% of the participants had all the indicators evaluated, while in 2020, during the pandemic, only 3.5% had all of them evaluated. CONCLUSION: The COVID-19 pandemic hindered the offer of comprehensive and quality care to patients with type 1 diabetes.

18.
Epidemiology ; 70(SUPPL 1):S251, 2022.
Article in English | EMBASE | ID: covidwho-1854022

ABSTRACT

Background: Home visits were an essential former practice where a patient is evaluated and treated in their own house. With a growing elderly population in personal care homes, some homebound visits on-site become a more necessary service. During the COVID-19 pandemic the need of healthcare providers on-site has become imperative due to restrictions for leaving the facilities. Telemedicine visits are difficult for elderly in Assisted Living Facilities (ALF) where WiFi and smart phone technology are limited. While the need for medical care remains at higher demand during the pandemic, it is important to provide accessible and high-quality care to patients in these facilities. Surveys are used to assess if on-site visits are favored by patients and families. Design: We built a survey questionnaire that focused on patient/ family satisfaction of having provider visits on-site. The survey was conducted after an on-site visit and was done or via phone call. If the patient was unable to meaningfully answer the survey, the family member or POA was contacted via phone. The patient satisfaction survey was used to translate their satisfaction in measurable and comparable data to classic office visits. Results: Overall, 100% of responders had a favorable opinion of the on-site physician visits and preferred them to in-person office visits. The survey demonstrates that patients are able to recognize the on-site visits as more convenient and less stressful with the same quality as in-office visits. Some families also pointed out that on-site visits are financially more favorable as there is no need for transportation organization and fees. Conclusion: On-site visits by the physician or APP were very favorable in this survey. This service is bringing comprehensive care to patients directly at their facilities in the community. Patients are benefiting from on-site visits with the same high quality of care while having the convenience of remaining in their own home at the ALF.

19.
Canadian Medical Association. Journal ; 194(19):E666-E673, 2022.
Article in English | ProQuest Central | ID: covidwho-1848964

ABSTRACT

Background: The frequency of readmissions after COVID-19 hospitalizations is uncertain, as is whether current readmission prediction equations are useful for discharge risk stratification of COVID-19 survivors or for comparing among hospitals. We sought to determine the frequency and predictors of death or unplanned readmission after a COVID-19 hospital discharge. Methods: We conducted a retrospective cohort study of all adults (> 18 yr) who were discharged alive from hospital after a nonpsychiatric, nonobstetric, acute care admission for COVID-19 between Jan. 1, 2020, and Sept. 30, 2021, in Alberta and Ontario. Results: Of 843 737 individuals who tested positive for SARS-CoV-2 by reverse transcription polymerase chain reaction during the study period, 46 412 (5.5%) were adults admitted to hospital within 14 days of their positive test. Of these, 8496 died in hospital and 34 846 were discharged alive (30 336 discharged after an index admission of < 30 d and 4510 discharged after an admission > 30 d). One in 9 discharged patients died or were readmitted within 30 days after discharge (3173 [10.5%] of those with stay < 30 d and 579 [12.8%] of those with stay > 30 d). The LACE score (length of stay, acuity, Charlson Comorbidity Index and number of emergency visits in previous 6 months) for predicting urgent readmission or death within 30 days had a c-statistic of 0.60 in Alberta and 0.61 in Ontario;inclusion of sex, discharge locale, deprivation index and teaching hospital status in the model improved the c-statistic to 0.73. Interpretation: Death or readmission after discharge from a COVID-19 hospitalization is common and had a similar frequency in Alberta and Ontario. Risk stratification and interinstitutional comparisons of outcomes after hospital admission for COVID-19 should include sex, discharge locale and socioeconomic measures, in addition to the LACE variables.

20.
BMC Med Inform Decis Mak ; 22(1): 132, 2022 05 14.
Article in English | MEDLINE | ID: covidwho-1846831

ABSTRACT

BACKGROUND: The healthcare sector poses many strategic, tactic and operational planning questions. Due to the historically grown structures, planning is often locally confined and much optimization potential is foregone. METHODS: We implemented optimized decision-support systems for ambulatory care for four different real-world case studies that cover a variety of aspects in terms of planning scope and decision support tools. All are based on interactive cartographic representations and are being developed in cooperation with domain experts. The planning problems that we present are the problem of positioning centers for vaccination against Covid-19 (strategical) and emergency doctors (strategical/tactical), the out-of-hours pharmacy planning problem (tactical), and the route planning of patient transport services (operational). For each problem, we describe the planning question, give an overview of the mathematical model and present the implemented decision support application. RESULTS: Mathematical optimization can be used to model and solve these planning problems. However, in order to convince decision-makers of an alternative solution structure, mathematical solutions must be comprehensible and tangible. Appealing and interactive decision-support tools can be used in practice to convince public health experts of the benefits of an alternative solution. The more strategic the problem and the less sensitive the data, the easier it is to put a tool into practice. CONCLUSIONS: Exploring solutions interactively is rarely supported in existing planning tools. However, in order to bring new innovative tools into productive use, many hurdles must be overcome.


Subject(s)
COVID-19 , Pandemics , Ambulatory Care , COVID-19/prevention & control , Humans , Models, Theoretical , Pandemics/prevention & control , Public Health
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