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1.
J Adolesc Health ; 67(3): 453-455, 2020 09.
Article in English | MEDLINE | ID: covidwho-654519

ABSTRACT

Young adults with chronic and complex diseases face systemic barriers, care fragmentation, and increased vulnerabilities. Novel coronavirus pandemic has proven to further complicate care coordination for young adult patients with medical and psychosocial complexities. The BRIDGES Young Adult Program at Boston Children's Hospital has 6 years of experience advocating for and empowering young adults with chronic medical conditions, and their families, through outpatient consults aimed to assist with subspecialty guidance and defragmentation of care during the time of transition from pediatric to adult care. Recently, the BRIDGES consult team developed a pandemic-responsive approach to facilitate individual emergency planning and empowerment of self-management for these high-risk patients. Through the use of a virtual platform, consults were conducted with a multidisciplinary team to support patients and families with system navigation, advance care planning, emergency preparedness, chronic care management, and coping during this time of crisis. BRIDGES aimed to equip patients and families with knowledge and resources, within a rapidly changing environment, to allow for optimal self-care and self-advocacy.


Subject(s)
Chronic Disease/therapy , Coronavirus Infections/epidemiology , Pandemics , Patient Participation/methods , Pneumonia, Viral/epidemiology , Transitional Care/organization & administration , Chronic Disease/epidemiology , Emergencies , Humans , Patient Navigation , Self Care/psychology , Young Adult
3.
Hepatology ; 72(2): 723-728, 2020 08.
Article in English | MEDLINE | ID: covidwho-754841

ABSTRACT

Evidence strongly supports that access to specialty gastroenterology or hepatology care in cirrhosis is associated with higher adherence to guideline-recommended care and improves clinical outcomes. Presently, only about one half of acute care hospitalizations for cirrhosis-related complications result in inpatient specialty care, and the current hepatology workforce cannot meet the demand of patients with liver disease nationwide, particularly in less densely populated areas and in community-based practices not affiliated with academic centers. Telemedicine, defined as the delivery of health care services at a distance using electronic means for diagnosis and treatment, holds tremendous promise to increase access to broadly specialty care. The technology is cheap and easy to use, although it is presently limited in scale by interstate licensing restrictions and reimbursement barriers. The outbreak of severe acute respiratory syndrome coronavirus 2 and coronavirus disease 2019 has, in the short term, accelerated the growth of telemedicine delivery as a public health and social distancing measure. Herein, we examine whether this public health crisis can accelerate the national conversation about broader adoption of telemedicine for routine medical care in non-crisis situations, using a case series from our telehepatology program as a pragmatic example.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Liver Diseases/therapy , Pneumonia, Viral/epidemiology , Telemedicine , Adult , Aged , Emergencies , Female , Humans , Male , Middle Aged , Pandemics , Patient Acceptance of Health Care , Pilot Projects
4.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(5): 489-494, 2020 May 28.
Article in English, Chinese | MEDLINE | ID: covidwho-745338

ABSTRACT

To propose the architectural layout for the big general hospital in the face of public health emergencies, we analyzed the conditions, methods, problems and countermeasures for the reconstruction of the isolation ward from the existing medical building layout of a general hospital. The affected areas met the requirements of isolation ward in the reconstruction, and realized the corresponding partition and separation of people. But the cost of occupying the medical room should be concerned. General hospital should be alerted to potential risks of public health emergencies. The characteristics of different construction types, defects, and the function of the hospital should be considered in the construction, rebuilding, and expansion of the hospital, which shouldnot only meet the needs of the development of the hospital daily usage but also consider dealing with emergent public health events. We can adopt the reasonable layout, including setting up a firewall-like device between the channel and the floor, an ordinary ward at ordinary times, and an independent space for emergency by pulling down the gate. This strategy can not only avoid the problem of low utilization rate of the space occupied by the corresponding area in the ward for diseases spread by air and droplets, maximizing the efficiency of the medical site, but also avoid the problem of emergency response to the temporary reconstruction.


Subject(s)
Emergencies , Facility Design and Construction , Hospitals, General , Public Health , Emergency Service, Hospital , Humans
5.
J Bras Nefrol ; 42(2 suppl 1): 41-43, 2020 Aug 26.
Article in English, Portuguese | MEDLINE | ID: covidwho-740465

ABSTRACT

Vascular accesses for hemodialysis are considered the patient's lifeline and their maintenance is essential for treatment continuity. Following the example of institutions in other countries affected by the Covid-19 pandemic, the Brazilian Society of Nephrology developed these guidelines for healthcare services, elaborating on the importance of carrying out procedures for the preparation and preservation of vascular accesses. Creating definitive accesses for hemodialysis, grafts and arteriovenous fistulas are non-elective procedures, as well as the transition from the use of non-tunneled catheters to tunneled catheters, which cause less morbidity. In the case of patients with suspected or confirmed coronavirus infection, one may postpone the procedures for the quarantine period, to avoid spreading the disease.


Subject(s)
Arteriovenous Shunt, Surgical/methods , Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Renal Dialysis/methods , Vascular Access Devices , Advisory Committees , Arteriovenous Shunt, Surgical/standards , Brazil , Elective Surgical Procedures/methods , Elective Surgical Procedures/standards , Emergencies , Humans , Nephrology/standards , Pandemics , Societies, Medical
6.
Dtsch Arztebl Int ; 117(33-34): 545-552, 2020 08 17.
Article in English | MEDLINE | ID: covidwho-738961

ABSTRACT

BACKGROUND: In this study, we investigate the number of emergency room consultations during the COVID-19 pandemic of 2020 in Germany compared to figures from the previous year. METHODS: Case numbers from calendar weeks 1 through 22 of the two consecutive years 2019 and 2020 were obtained from 29 university hospitals and 7 non-university hospitals in Germany. Information was also obtained on the patients' age, sex, and urgency, along with the type of case (outpatient/inpatient), admitting ward, and a small number of tracer diagnoses (I21, myocardial infarction; J44, COPD; and I61, I63, I64, G45, stroke /TIA), as well as on the number of COVID-19 cases and of tests performed for SARS-CoV-2, as a measure of the number of cases in which COVID-19 was suspected or at least included in the differential diagnoses. RESULTS: A total of 1 022 007 emergency room consultations were analyzed, of which 546 940 took place in 2019 and 475 067 in 2020. The number of consultations with a positive test for the COVID-19 pathogen was 3122. The total number of emergency room consultations in the observation period was 13% lower in 2020 than in 2019, with a maximum drop by 38% coinciding with the highest number of COVID-19 cases (calendar week 14; 572 cases). After the initiation of interpersonal contact restrictions in 2020, there was a marked drop in COVID-19 case numbers, by a mean of -240 cases per week per emergency room (95% confidence interval [-284; -128]). There was a rise in case numbers thereafter, by a mean of 17 patients per week [14; 19], and the number of cases of myocardial infarction returned fully to the level seen in 2019. CONCLUSION: In Germany, the COVID-19 pandemic led to a significant drop in medical emergencies of all kinds presenting to the nation's emergency departments. A recovery effect began to be seen as early as calendar week 15, but the levels seen in 2019 were not yet reached overall by calendar week 22; only the prevalence of myocardial infarction had renormalized by then. The reasons for this require further investigation.


Subject(s)
Coronavirus Infections/epidemiology , Emergencies/epidemiology , Emergency Service, Hospital/statistics & numerical data , Pandemics , Pneumonia, Viral/epidemiology , Germany/epidemiology , Humans
7.
Hepatology ; 72(2): 723-728, 2020 08.
Article in English | MEDLINE | ID: covidwho-734774

ABSTRACT

Evidence strongly supports that access to specialty gastroenterology or hepatology care in cirrhosis is associated with higher adherence to guideline-recommended care and improves clinical outcomes. Presently, only about one half of acute care hospitalizations for cirrhosis-related complications result in inpatient specialty care, and the current hepatology workforce cannot meet the demand of patients with liver disease nationwide, particularly in less densely populated areas and in community-based practices not affiliated with academic centers. Telemedicine, defined as the delivery of health care services at a distance using electronic means for diagnosis and treatment, holds tremendous promise to increase access to broadly specialty care. The technology is cheap and easy to use, although it is presently limited in scale by interstate licensing restrictions and reimbursement barriers. The outbreak of severe acute respiratory syndrome coronavirus 2 and coronavirus disease 2019 has, in the short term, accelerated the growth of telemedicine delivery as a public health and social distancing measure. Herein, we examine whether this public health crisis can accelerate the national conversation about broader adoption of telemedicine for routine medical care in non-crisis situations, using a case series from our telehepatology program as a pragmatic example.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Liver Diseases/therapy , Pneumonia, Viral/epidemiology , Telemedicine , Adult , Aged , Emergencies , Female , Humans , Male , Middle Aged , Pandemics , Patient Acceptance of Health Care , Pilot Projects
8.
BMC Surg ; 20(1): 190, 2020 Aug 26.
Article in English | MEDLINE | ID: covidwho-730210

ABSTRACT

BACKGROUND: Novel coronavirus pneumonia (NCP) outbreak in Wuhan, China in early 2020, resulted in over 80 thousand infections in China. At present, NCP has an explosive growth in the world. Surgeons could refuse selective operation during the outbreak, but they must face the emergency operation. We hope to avoid the spread of NCP while ensuring efficient treatment of emergency cases. METHODS: The data of patients with incarcerated hernia admitted to Beijing Chaoyang Hospital during NCP epidemic were analyzed and compared with those in 2019. All cases were divided into NCP group and 2019 group. The operation data and inpatient protection process of emergency cases were analyzed. Result During the NCP epidemic, 17 cases with incarcerated hernia were treated in our department. A Total of 263 cases of the same disease were admitted in 2019. There was no significant difference in age, gender, BMI and hernia type between two groups. No significant difference was observed between the two groups in operation method and hospital stay. The waiting time for emergency operation of NCP group was significantly longer than that of 2019 group (P = 0.002). A buffer ward was set up by administrator of hospital during NCP outbreak. Hospitals were divided into "Red area, Yellow area and Green area" artificially, and strict screening consultation system was implemented. There was no case of SARS-nCoV-2 infection in medical staff. CONCLUSION: It was safe and effective to carry out emergency operation on the premise of screening, protection and isolation during the NCP epidemic. The increased waiting time for operation due to NCP screening did not threaten medical safety of emergency incarcerated hernia patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Hernia, Abdominal/surgery , Herniorrhaphy , Hospitals, General , Infection Control/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Aged , Aged, 80 and over , China/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Emergencies , Emergency Service, Hospital , Female , Humans , Length of Stay , Male , Middle Aged , Patient Selection , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Retrospective Studies
9.
Ann Intern Med ; 173(4): 297-299, 2020 08 18.
Article in English | MEDLINE | ID: covidwho-729754

ABSTRACT

Coronavirus disease 2019 (COVID-19) has sickened millions, killed hundreds of thousands, and utterly disrupted the daily lives of billions of people around the world. In an effort to ameliorate this devastation, the biomedical research complex has allocated billions of dollars and scientists have initiated hundreds of clinical trials in an expedited effort to understand, prevent, and treat this disease. National emergencies can stimulate significant investment of financial, physical, and intellectual resources that catalyze impressive scientific accomplishments, as evident with the Manhattan Project, penicillin, and the polio vaccines in the 20th century. However, pressurized research has also led to false promises, disastrous consequences, and breaches in ethics. Antiserum in the 1918 flu epidemic, contaminated yellow fever vaccines in World War II, and unethical human experimentation with mustard gas offer just a few cautionary exemplars. It is critical to continue biomedical research efforts to address this pandemic, and it is appropriate that they receive priority in both attention and funding. But history also demonstrates the importance of treating early results-such as those associated with hydroxychloroquine-with caution as we only begin to understand the biology, epidemiology, and potential target points of COVID-19.


Subject(s)
Biomedical Research/history , Biomedical Research/standards , Coronavirus Infections/history , Coronavirus Infections/therapy , Emergencies/history , Pandemics/history , Pneumonia, Viral/history , Pneumonia, Viral/therapy , Betacoronavirus , Coronavirus Infections/drug therapy , History, 20th Century , History, 21st Century , Human Experimentation/history , Humans
10.
Harm Reduct J ; 17(1): 60, 2020 08 24.
Article in English | MEDLINE | ID: covidwho-727277

ABSTRACT

BACKGROUND: Caledonian Stadium, the main mass temporary shelter for homeless people in the City of Tshwane, was created as a local response to the imperatives of the novel coronavirus disease (COVID-19) National State of Disaster lockdown in South Africa. This is a case study of the coordinated emergency healthcare response provided by the University of Pretoria's Department of Family Medicine between 24 March and 6 April 2020. METHODS: This study uses a narrative approach to restory situated, transient, partial and provisional knowledge. Analysis is based on documented data and iteratively triangulated interviews on the operational experiences of selected healthcare first responders directly involved in the shelter. RESULTS: The impending lockdown generated intense interactions by UP-DFM to prepare for the provision of COVID-19 and essential generalist primary with partners involved in the Community Oriented Substance Use Programme (COSUP). With approximately 2000 people at the shelter at its peak, the numbers exceeded expectations. Throughout, while government officials tried to secure bedding, food and toilets, the shelter was poorly equipped and without onsite management. The COSUP clinical team prioritised opioid substitution therapy using methadone and COVID-19 screening over generalist healthcare to manage withdrawal and contain tension and anxiety. COSUP and its partners helped the city plan and implement the safe re-sheltering of all Caledonian residents. CONCLUSION: The Caledonian shelter is an account of organisational resilience in the face of homelessness and substance use emergencies triggered by lockdown. Through community-oriented, bottom-up self-organisation, a clinically led team navigated a response to the immediate needs of people who are homeless and/or use drugs that evolved into a more sustainable intervention. Key lessons learnt were the importance of communicating with people directly affected by emergencies, the value of using methadone to reduce harms during emergencies and the imperative of including OST in essential primary healthcare.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Harm Reduction , Homeless Persons , Opiate Substitution Treatment/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Quarantine/methods , Adolescent , Adult , Emergencies , Female , Humans , Male , Middle Aged , South Africa , Young Adult
11.
Pathog Glob Health ; 114(6): 309-317, 2020 09.
Article in English | MEDLINE | ID: covidwho-727006

ABSTRACT

BACKGROUND: The aim of this study is to describe the successful emergency plan implemented by Padova University Hospital (AOUP) during the COVID-19 pandemic. METHODS: The emergency plan included early implementation of procedures aimed at meeting the increasing demand for testing and care while ensuring safe and timely care of all patients and guaranteeing the safety of healthcare workers. RESULTS: From 21 February to 1 May 2020, there were 3,862 confirmed cases of SARS-CoV-2 infection in the Province of Padua. A total of 485 patients were hospitalized in AOUP, of which 91 were admitted to the ICU; 12 .6% of admitted patients died. The average bed occupancy rate in the ICU was 61.1% (IQR 43.6%:77.4%). Inpatient surgery and inpatient admissions were kept for 76% and 74%, respectively, compared to March 2019. A total of 123,077 swabs were performed, 19.3% of which (23,725 swabs) to screen AOUP workers. The screening of all staff showed that 137 of 7,649 (1.8%) hospital workers were positive. No healthcare worker died. DISCUSSION: AOUP strategy demonstrated effective management of the epidemic thanks to the timely implementation of emergency procedures, a well-coordinated effort shared by all hospital Departments, and their continuous adjustment to the ongoing epidemic. Timely screening of all hospital workers proved to be particularly important to defend the hospital, avoiding epidemic clusters due to unknown positive cases.


Subject(s)
Betacoronavirus/physiology , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Aged , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Emergencies , Female , Health Personnel , Hospitalization , Hospitals, University , Humans , Intensive Care Units , Italy/epidemiology , Male , Mass Screening , Middle Aged , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Tertiary Care Centers
12.
Semergen ; 46 Suppl 1: 65-77, 2020 Aug.
Article in Spanish | MEDLINE | ID: covidwho-725119

ABSTRACT

In late December 2019, some cases of atypical pneumonia, at that time of unknown origin, were reported in Wuhan, China. Days later, the etiologic agent was identified as a new coronavirus. This new coronavirus was called SARS-CoV-2 and the disease it produces was named COVID-19. The origin of this new virus is presumed zoonotic, with bats being its probable vector. Due to the rapid number of infections and deaths that occurred first in China and later around the world, the infection of this virus quickly went from being an isolated outbreak in a Chinese region to becoming a health emergency of international concern and later, a pandemic. The purpose of this review is to study the most relevant and current information on the pathogen, as well as epidemiology, pathology, clinical features, transmission, prevention, and treatment of the disease.


Subject(s)
Coronavirus Infections , Global Health , Pandemics , Pneumonia, Viral , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Coronavirus Infections/virology , Emergencies , Humans , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission , Pneumonia, Viral/virology
15.
Scand J Trauma Resusc Emerg Med ; 28(1): 80, 2020 Aug 14.
Article in English | MEDLINE | ID: covidwho-714033

ABSTRACT

BACKGROUND: Rapid access to emergency medical communication centers (EMCCs) is pivotal to address potentially life-threatening conditions. Maintaining public access to EMCCs without delay is crucial in case of disease outbreak despite the significant increased activity and the difficulties to mobilize extra staff resources. The aim of our study was to assess the impact of two-level filtering on EMCC performance during the COVID-19 outbreak. METHODS: A before-after monocentric prospective study was conducted at the EMCC at the Nantes University Hospital. Using telephone activity data, we compared EMCC performance during 2 periods. In period one (February 27th to March 11th 2020), call takers managed calls as usual, gathering basic information from the caller and giving first aid instructions to a bystander on scene if needed. During period two (March 12th to March 25th 2020), calls were answered by a first-line call taker to identify potentially serious conditions that required immediate dispatch. When a serious condition was excluded, the call was immediately transferred to a second-line call taker who managed the call as usual so the first-line call taker could be rapidly available for other incoming calls. The primary outcome was the quality of service at 20 s (QS20), corresponding to the rate of calls answered within 20 s. We described activity and outcome measures by hourly range. We compared EMCC performance during periods one and two using an interrupted time series analysis. RESULTS: We analyzed 45,451 incoming calls during the two study periods: 21,435 during period 1 and 24,016 during period 2. Between the two study periods, we observed a significant increase in the number of incoming calls per hour, the number of connected call takers and average call duration. A linear regression model, adjusted for these confounding variables, showed a significant increase in the QS20 slope (from - 0.4 to 1.4%, p = 0.01), highlighting the significant impact of two-level filtering on the quality of service. CONCLUSIONS: We found that rapid access to our EMCC was maintained during the COVID-19 pandemic via two-level filtering. This system helped reduce the time gap between call placement and first-line call-taker evaluation of a potentially life-threatening situation. We suggest implementing this system when an EMCC faces significantly increased activity with limited staff resources.


Subject(s)
Betacoronavirus , Communication , Coronavirus Infections/epidemiology , Emergencies , Emergency Medical Service Communication Systems/organization & administration , Emergency Medical Services/methods , Pneumonia, Viral/epidemiology , Triage/methods , Controlled Before-After Studies , Humans , Pandemics , Prospective Studies , Telephone
17.
Eur J Gastroenterol Hepatol ; 32(10): 1301-1304, 2020 10.
Article in English | MEDLINE | ID: covidwho-709228

ABSTRACT

OBJECTIVE: SARS-CoV-2 outbreak is spreading worldwide. As a consequence of the new circumstances, almost all endoscopic units underwent in-depth reorganization involving patients' selection. We analyzed the efficacy of the newly adopted endoscopic triage. METHODS: In March 2020, we monitored endoscopies to evaluate the effects of the novel selective triage aimed to reduce the number of investigations and viral spread/contagions. Clinical-demographic data of the patients, indications, type of endoscopy, endoscopic findings (subtyped in major and minor), finding rates (major and minor) and diagnostic yields (major findings) have been analyzed and compared to the endoscopic procedures performed in March 2019. Furthermore, patients were called at least 21 days after the endoscopy to evaluate the possibility of a Covid-19 onset. RESULTS: Accordingly to the novel triage, the number of procedures dropped from 530 to 91 (-84%). The finding rates and diagnostic yields were 83% (74-89) vs 71% (66-73) (P 0.015) and 56% (46-65) vs 43% (38-47) (P 0.03) on March 2020 and March 2019, respectively. A significant increase of operative procedures has been reported in 2020, 34% vs 22% in March 2019. All the patients were recalled and neither cases of onset of Covid-19 like symptoms nor positive nasopharyngeal swabs PCR have been evidenced. CONCLUSION: The novel endoscopic triage significantly reduced the number of procedures and increased finding rates and diagnostic yields. However, a careful schedule of canceled procedures should be applied to avoid to miss relevant pathologies. No Covid-19 onset or infection has been noted after endoscopies.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Emergencies , Endoscopy/methods , Pandemics , Pneumonia, Viral/epidemiology , Triage/methods , Female , Humans , Male , Middle Aged , Risk Factors
19.
Korean J Anesthesiol ; 73(4): 347-351, 2020 08.
Article in English | MEDLINE | ID: covidwho-705992

ABSTRACT

BACKGROUND: Since the first case of severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) occurred in Wuhan in December 2019, the virus has spread globally. The World Health Organization declared the virus outbreak a pandemic on March 11, 2020. On January 19, 2020, a 35-year-old woman who returned from China was confirmed as the first SARS-CoV-2 infected case in Korea. Since then, it has spread all over Korea. CASE: We report the first case of a SARS-CoV-2 positive woman delivering a baby through cesarean section at 37+6 weeks of pregnancy in the Republic of Korea. CONCLUSIONS: This case suggested that negative pressure operating room, skillful medical team, and enhanced personal protective equipment including N95 masks, surgical cap, double gown, double gloves, shoe covers, and powered air-purifying respirator are required at the hospital for safe delivery in such a case.


Subject(s)
Betacoronavirus , Cesarean Section/methods , Coronavirus Infections/surgery , Infection Control/methods , Pneumonia, Viral/surgery , Pregnancy Complications, Infectious/surgery , Adult , Emergencies , Female , Humans , Infant, Newborn , Pandemics , Personal Protective Equipment , Pregnancy , Republic of Korea
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