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3.
Can J Aging ; 39(3): 333-343, 2020 09.
Article in English | MEDLINE | ID: covidwho-1261985

ABSTRACT

The COVID-19 pandemic and subsequent state of public emergency have significantly affected older adults in Canada and worldwide. It is imperative that the gerontological response be efficient and effective. In this statement, the board members of the Canadian Association on Gerontology/L'Association canadienne de gérontologie (CAG/ACG) and the Canadian Journal on Aging/La revue canadienne du vieillissement (CJA/RCV) acknowledge the contributions of CAG/ACG members and CJA/RCV readers. We also profile the complex ways that COVID-19 is affecting older adults, from individual to population levels, and advocate for the adoption of multidisciplinary collaborative teams to bring together different perspectives, areas of expertise, and methods of evaluation in the COVID-19 response.


Subject(s)
Aging , Communicable Disease Control/methods , Coronavirus Infections , Health Services for the Aged/organization & administration , Pandemics , Patient Care Management , Patient Care Team , Pneumonia, Viral , Aged , Aging/physiology , Aging/psychology , Betacoronavirus/isolation & purification , COVID-19 , Canada/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Health Services Needs and Demand , Humans , Interdisciplinary Communication , Mental Health , Patient Care Management/methods , Patient Care Management/standards , Patient Care Management/trends , Patient Care Team/organization & administration , Patient Care Team/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Quality Improvement , SARS-CoV-2
5.
Emerg Infect Dis ; 27(4): 1164-1168, 2021.
Article in English | MEDLINE | ID: covidwho-1146202

ABSTRACT

We compared the characteristics of hospitalized and nonhospitalized patients who had coronavirus disease in Atlanta, Georgia, USA. We found that risk for hospitalization increased with a patient's age and number of concurrent conditions. We also found a potential association between hospitalization and high hemoglobin A1c levels in persons with diabetes.


Subject(s)
COVID-19 , Diabetes Mellitus , Glycated Hemoglobin A/analysis , Hospitalization/statistics & numerical data , Hypertension , Obesity , Patient Care Management , Age Factors , COVID-19/epidemiology , COVID-19/psychology , COVID-19/therapy , Diabetes Mellitus/blood , Diabetes Mellitus/epidemiology , Disease Progression , Female , Georgia/epidemiology , Humans , Hypertension/drug therapy , Hypertension/epidemiology , Male , Middle Aged , Multimorbidity , Obesity/diagnosis , Obesity/epidemiology , Patient Acceptance of Health Care , Patient Care Management/methods , Patient Care Management/standards , Patient Care Management/statistics & numerical data , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2
6.
Lancet Gastroenterol Hepatol ; 6(3): 199-208, 2021 03.
Article in English | MEDLINE | ID: covidwho-1065697

ABSTRACT

BACKGROUND: There are concerns that the COVID-19 pandemic has had a negative effect on cancer care but there is little direct evidence to quantify any effect. This study aims to investigate the impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England. METHODS: Data were extracted from four population-based datasets spanning NHS England (the National Cancer Cancer Waiting Time Monitoring, Monthly Diagnostic, Secondary Uses Service Admitted Patient Care and the National Radiotherapy datasets) for all referrals, colonoscopies, surgical procedures, and courses of rectal radiotherapy from Jan 1, 2019, to Oct 31, 2020, related to colorectal cancer in England. Differences in patterns of care were investigated between 2019 and 2020. Percentage reductions in monthly numbers and proportions were calculated. FINDINGS: As compared to the monthly average in 2019, in April, 2020, there was a 63% (95% CI 53-71) reduction (from 36 274 to 13 440) in the monthly number of 2-week referrals for suspected cancer and a 92% (95% CI 89-95) reduction in the number of colonoscopies (from 46 441 to 3484). Numbers had just recovered by October, 2020. This resulted in a 22% (95% CI 8-34) relative reduction in the number of cases referred for treatment (from a monthly average of 2781 in 2019 to 2158 referrals in April, 2020). By October, 2020, the monthly rate had returned to 2019 levels but did not exceed it, suggesting that, from April to October, 2020, over 3500 fewer people had been diagnosed and treated for colorectal cancer in England than would have been expected. There was also a 31% (95% CI 19-42) relative reduction in the numbers receiving surgery in April, 2020, and a lower proportion of laparoscopic and a greater proportion of stoma-forming procedures, relative to the monthly average in 2019. By October, 2020, laparoscopic surgery and stoma rates were similar to 2019 levels. For rectal cancer, there was a 44% (95% CI 17-76) relative increase in the use of neoadjuvant radiotherapy in April, 2020, relative to the monthly average in 2019, due to greater use of short-course regimens. Although in June, 2020, there was a drop in the use of short-course regimens, rates remained above 2019 levels until October, 2020. INTERPRETATION: The COVID-19 pandemic has led to a sustained reduction in the number of people referred, diagnosed, and treated for colorectal cancer. By October, 2020, achievement of care pathway targets had returned to 2019 levels, albeit with smaller volumes of patients and with modifications to usual practice. As pressure grows in the NHS due to the second wave of COVID-19, urgent action is needed to address the growing burden of undetected and untreated colorectal cancer in England. FUNDING: Cancer Research UK, the Medical Research Council, Public Health England, Health Data Research UK, NHS Digital, and the National Institute for Health Research Oxford Biomedical Research Centre.


Subject(s)
COVID-19 , Colonoscopy/statistics & numerical data , Colorectal Neoplasms , Colorectal Surgery/statistics & numerical data , Early Detection of Cancer , Patient Care Management , Radiotherapy/statistics & numerical data , COVID-19/epidemiology , COVID-19/prevention & control , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/therapy , Delivery of Health Care/trends , Early Detection of Cancer/methods , Early Detection of Cancer/statistics & numerical data , England/epidemiology , Female , Health Services Needs and Demand , Humans , Male , Middle Aged , Patient Care Management/methods , Patient Care Management/organization & administration , Patient Care Management/standards , Referral and Consultation/statistics & numerical data , SARS-CoV-2 , State Medicine
8.
GMS J Med Educ ; 37(7): Doc94, 2020.
Article in English | MEDLINE | ID: covidwho-972037

ABSTRACT

Background: Focused history taking, knowledge-based clinical reasoning, and adequate case presentation during hand-offs represent important facets of competence of practicing physicians. Based on a validated 360-degree assessment simulating a first day of residency we developed a training for final-year medical students including patient consultation, patient management, and patient hand-off. Due to the COVID-19 pandemic the training was changed to a telemedicine format and evaluated. Methods: In 2019, 103 final-year students participated in a newly designed competence-based training including a consultation hour with simulated patients, a patient management phase with an electronic patient chart, and a case presentation in hand-off format. Due to social distancing regulations, the training was not allowed to take place in this way. Therefore, we changed the training to a telemedicine format. In May 2020, 32 students participated in the telemedicine training. A 5-point Likert scale (1: does not apply to 5: fully applies) was used for the evaluation items. The two formats were compared with t-tests. Results: The students were similarly satisfied with the content of the training independently of its format. Both groups found the patient cases interesting (presence: 4.68 ± 0.49, telemedicine: 4.66 ± 0.48). With respect to the telemedicine format, participants were glad that an option had been found that could be offered throughout the final year (4.94 ± 0.24) despite the COVID-19 pandemic and they regarded it as a very useful training for their final examination (4.94 ± 0.24). Conclusion: The telemedicine format of the competence-based training worked as well as the presence format. In its telemedicine format, the training can be offered to students independently of their location.


Subject(s)
COVID-19/epidemiology , Education, Distance/organization & administration , Education, Medical/organization & administration , Telemedicine/organization & administration , Clinical Competence , Humans , Pandemics , Patient Care Management/standards , Patient Handoff/standards , Patient Simulation , SARS-CoV-2 , Students, Medical/psychology
10.
Chron Respir Dis ; 17: 1479973120961843, 2020.
Article in English | MEDLINE | ID: covidwho-808369

ABSTRACT

The spread of the SARS-CoV-2 infection among population has imposed a re-organization of healthcare services, aiming at stratifying patients and dedicating specific areas where patients with suspected COVID-related respiratory disease could receive the necessary health care assistance while waiting for the confirmation of the diagnosis of COVID-19 disease. In this scenario, the pathway defined as a "grey zone" is strongly advocated. We describe the application of rules and pathways in a regional context with low diffusion of the infection among the general population in the attempt to provide the best care to respiratory patients with suspected COVID-19. To date, this process has avoided the worst-case scenario of intra-hospital epidemic outbreak.


Subject(s)
Coronavirus Infections , Critical Pathways/trends , Infection Control/methods , Pandemics , Patient Care Management , Pneumonia, Viral , Respiratory Tract Diseases/diagnosis , Aged , Betacoronavirus , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Diagnosis, Differential , Female , Humans , Italy/epidemiology , Male , Organizational Innovation , Pandemics/prevention & control , Patient Care Management/organization & administration , Patient Care Management/standards , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , Prevalence , SARS-CoV-2
11.
PLoS One ; 15(9): e0239249, 2020.
Article in English | MEDLINE | ID: covidwho-788880

ABSTRACT

Since the end of February 2020 a severe diffusion of COVID-19 has affected Italy and in particular its northern regions, resulting in a high demand of hospitalizations in particular in the intensive care units (ICUs). Hospitals are suffering the high degree of patients to be treated for respiratory diseases and the majority of the health structures, especially in the north of Italy, are or are at risk of saturation. Therefore, the question whether and to what extent the reduction of hospital beds occurred in the past years has biased the management of the emergency has come to the front in the public debate. In our opinion, to start a robust analysis it is necessary to consider the Italian health system capacity prior to the emergency. Therefore, the aim of this study is to analyse the availability of hospital beds across the country as well as to determine their management in terms of complexity and performance of cases treated at regional level. The results of this study underlines that, despite the reduction of beds for the majority of the hospital wards, ICUs availabilities did not change between 2010 and 2017. Moreover, this study confirms that the majority of the Italian regions have a routinely efficient management of their facilities allowing hospitals to treat patients without the risk of having an overabundance of patients and a scarcity of beds. In fact, this analysis shows that, in normal situations, the management of hospital and ICU beds has no critical levels.


Subject(s)
Coronavirus Infections/therapy , Hospital Bed Capacity/statistics & numerical data , Intensive Care Units/supply & distribution , Pneumonia, Viral/therapy , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Delivery of Health Care/standards , Disease Outbreaks , Hospital Bed Capacity/standards , Humans , Intensive Care Units/statistics & numerical data , Italy/epidemiology , Pandemics , Patient Care Management/standards , Pneumonia, Viral/epidemiology , SARS-CoV-2
12.
Am J Obstet Gynecol MFM ; 2(4): 100210, 2020 11.
Article in English | MEDLINE | ID: covidwho-764099

ABSTRACT

Epidemiologic data available so far suggest that individuals with diabetes, especially when not well controlled, are at a greater risk than the general population for severe acute respiratory syndrome coronavirus 2 morbidity such as acute respiratory distress syndrome, multiorgan failure, and mortality. Given the significant correlation between severity of coronavirus disease 2019 and diabetes mellitus and the lack of pregnancy-specific recommendations, we aim to provide some guidance and practical recommendations for the management of diabetes in pregnant women during the pandemic, especially for general obstetricians-gynecologists and nonobstetricians taking care of these patients.


Subject(s)
COVID-19 , Diabetes Mellitus , Hypoglycemic Agents , Pregnancy Complications, Infectious , Adult , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19/therapy , Diabetes Mellitus/blood , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Female , Glycemic Control/methods , Humans , Hypoglycemic Agents/administration & dosage , Hypoglycemic Agents/adverse effects , Medication Therapy Management/standards , Needs Assessment , Ohio , Patient Care Management/methods , Patient Care Management/standards , Patient Selection , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/physiopathology , Pregnancy Complications, Infectious/therapy , Pregnancy Complications, Infectious/virology , Risk Adjustment/methods , SARS-CoV-2/isolation & purification
13.
Gut ; 70(6): 1044-1052, 2021 06.
Article in English | MEDLINE | ID: covidwho-740292

ABSTRACT

OBJECTIVE: Paediatric acute severe colitis (ASC) management during the novel SARS-CoV-2/COVID-19 pandemic is challenging due to reliance on immunosuppression and the potential for surgery. We aimed to provide COVID-19-specific guidance using the European Crohn's and Colitis Organisation/European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for comparison. DESIGN: We convened a RAND appropriateness panel comprising 14 paediatric gastroenterologists and paediatric experts in surgery, rheumatology, respiratory and infectious diseases. Panellists rated the appropriateness of interventions for ASC in the context of the COVID-19 pandemic. Results were discussed at a moderated meeting prior to a second survey. RESULTS: Panellists recommended patients with ASC have a SARS-CoV-2 swab and expedited biological screening on admission and should be isolated. A positive swab should trigger discussion with a COVID-19 specialist. Sigmoidoscopy was recommended prior to escalation to second-line therapy or colectomy. Methylprednisolone was considered appropriate first-line management in all, including those with symptomatic COVID-19. Thromboprophylaxis was also recommended in all. In patients requiring second-line therapy, infliximab was considered appropriate irrespective of SARS-CoV-2 status. Delaying colectomy due to SARS-CoV-2 infection was considered inappropriate. Corticosteroid tapering over 8-10 weeks was deemed appropriate for all. After successful corticosteroid rescue, thiopurine maintenance was rated appropriate in patients with negative SARS-CoV-2 swab and asymptomatic patients with positive swab but uncertain in symptomatic COVID-19. CONCLUSION: Our COVID-19-specific adaptations to paediatric ASC guidelines using a RAND panel generally support existing recommendations, particularly the use of corticosteroids and escalation to infliximab, irrespective of SARS-CoV-2 status. Consideration of routine prophylactic anticoagulation was recommended.


Subject(s)
Anticoagulants/therapeutic use , COVID-19 , Colectomy/methods , Colitis, Ulcerative , Crohn Disease , Infliximab/therapeutic use , Methylprednisolone/therapeutic use , Adolescent , COVID-19/epidemiology , COVID-19/therapy , Child , Colitis, Ulcerative/epidemiology , Colitis, Ulcerative/therapy , Crohn Disease/epidemiology , Crohn Disease/therapy , Humans , Immunosuppressive Agents/classification , Immunosuppressive Agents/therapeutic use , Patient Care Management/methods , Patient Care Management/standards , Patient Care Management/trends , Practice Guidelines as Topic , Risk Adjustment/methods , SARS-CoV-2/isolation & purification , Severity of Illness Index , Sigmoidoscopy/methods , United Kingdom
14.
Ann Glob Health ; 86(1): 100, 2020 08 13.
Article in English | MEDLINE | ID: covidwho-736810

ABSTRACT

Background: Brazil faces some challenges in the battle against the COVID-19 pandemic, including: the risks for cross-infection (community infection) increase in densely populated areas; low access to health services in areas where the number of beds in intensive care units (ICUs) is scarce and poorly distributed, mainly in states with low population density. Objective: To describe and intercorrelate epidemiology and geographic data from Brazil about the number of intensive care unit (ICU) beds at the onset of COVID-19 pandemic. Methods: The epidemiology and geographic data were correlated with the distribution of ICU beds (public and private health systems) and the number of beneficiaries of private health insurance using Pearson's Correlation Coefficient. The same data were correlated using partial correlation controlled by gross domestic product (GDP) and number of beneficiaries of private health insurance. Findings: Brazil has a large geographical area and diverse demographic and economic aspects. This diversity is also present in the states and the Federal District regarding the number of COVID-19 cases, deaths and case fatality rate. The effective management of severe COVID-19 patients requires ICU services, and the scenario was also dissimilar as for ICU beds and ICU beds/10,000 inhabitants for the public (SUS) and private health systems mainly at the onset of COVID-19 pandemic. The distribution of ICUs was uneven between public and private services, and most patients rely on SUS, which had the lowest number of ICU beds. In only a few states, the number of ICU beds at SUS was above 1 to 3 by 10,000 inhabitants, which is the number recommended by the World Health Organization (WHO). Conclusions: Brazil needed to improve the number of ICU beds units to deal with COVID-19 pandemic, mainly for the SUS showing a late involvement of government and health authorities to deal with the COVID-19 pandemic.


Subject(s)
Coronavirus Infections , Health Services Accessibility/organization & administration , Intensive Care Units/supply & distribution , Pandemics , Patient Care Management , Pneumonia, Viral , Private Sector/statistics & numerical data , Public Sector/statistics & numerical data , Bed Occupancy/statistics & numerical data , Betacoronavirus , Brazil/epidemiology , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Health Services Needs and Demand , Humans , Infection Control/organization & administration , Infection Control/standards , Organizational Innovation , Pandemics/prevention & control , Patient Care Management/organization & administration , Patient Care Management/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , SARS-CoV-2 , Severity of Illness Index
15.
Can J Cardiol ; 36(8): 1313-1316, 2020 08.
Article in English | MEDLINE | ID: covidwho-733905

ABSTRACT

The COVID-19 pandemic has raised ethical questions for the cardiovascular leader and practitioner. Attention has been redirected from a system that focuses on individual patient benefit toward one that focuses on protecting society as a whole. Challenging resource allocation questions highlight the need for a clearly articulated ethics framework that integrates principled decision making into how different cardiovascular care services are prioritized. A practical application of the principles of harm minimisation, fairness, proportionality, respect, reciprocity, flexibility, and procedural justice is provided, and a model for prioritisation of the restoration of cardiovascular services is outlined. The prioritisation model may be used to determine how and when cardiovascular services should be continued or restored. There should be a focus on an iterative and responsive approach to broader health care system needs, such as other disease groups and local outbreaks.


Subject(s)
Cardiology Service, Hospital , Cardiovascular Diseases , Coronavirus Infections , Ethics, Institutional , Infection Control/methods , Pandemics , Patient Care Management , Pneumonia, Viral , Betacoronavirus/isolation & purification , COVID-19 , Canada/epidemiology , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/trends , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Humans , Models, Organizational , Organizational Innovation , Pandemics/prevention & control , Patient Care Management/ethics , Patient Care Management/methods , Patient Care Management/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2
18.
Ginekol Pol ; 91(7): 428-431, 2020.
Article in English | MEDLINE | ID: covidwho-719820

ABSTRACT

The Polish Society of Gynecologists and Obstetricians and Polish Society of Colposcopy and Cervical Pathophysiology Interim Guidelines goal at aiding gynecologists in providing a cervical cancer prevention care during the evolving SARS-CoV-2 pan-demic. Presented guidelines were developed on a review of limited data and updated when new relevant publications were revealed. Timing for deferrals of diagnostic-therapeutic procedures were mostly covered in the guidelines. Also, a support for the existing Polish recommendations on abnormal screening results in a subject of minor and major screening abnor-malities terminology were given. The guidelines are obligatory for the specified COVID-19 pandemic period only and they might be changed depending on the new available evidence.


Subject(s)
Cervical Intraepithelial Neoplasia , Cervix Uteri/pathology , Colposcopy , Coronavirus Infections , Early Detection of Cancer , Pandemics , Pneumonia, Viral , Uterine Cervical Neoplasms , Betacoronavirus , COVID-19 , Cervical Intraepithelial Neoplasia/diagnosis , Cervical Intraepithelial Neoplasia/pathology , Colposcopy/methods , Colposcopy/standards , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Diagnosis, Differential , Early Detection of Cancer/standards , Female , Humans , Pandemics/prevention & control , Patient Care Management/methods , Patient Care Management/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Poland/epidemiology , SARS-CoV-2 , Secondary Prevention/methods , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/prevention & control
19.
Chest ; 158(1): 106-116, 2020 07.
Article in English | MEDLINE | ID: covidwho-634902

ABSTRACT

With more than 900,000 confirmed cases worldwide and nearly 50,000 deaths during the first 3 months of 2020, the coronavirus disease 2019 (COVID-19) pandemic has emerged as an unprecedented health care crisis. The spread of COVID-19 has been heterogeneous, resulting in some regions having sporadic transmission and relatively few hospitalized patients with COVID-19 and others having community transmission that has led to overwhelming numbers of severe cases. For these regions, health care delivery has been disrupted and compromised by critical resource constraints in diagnostic testing, hospital beds, ventilators, and health care workers who have fallen ill to the virus exacerbated by shortages of personal protective equipment. Although mild cases mimic common upper respiratory viral infections, respiratory dysfunction becomes the principal source of morbidity and mortality as the disease advances. Thoracic imaging with chest radiography and CT are key tools for pulmonary disease diagnosis and management, but their role in the management of COVID-19 has not been considered within the multivariable context of the severity of respiratory disease, pretest probability, risk factors for disease progression, and critical resource constraints. To address this deficit, a multidisciplinary panel comprised principally of radiologists and pulmonologists from 10 countries with experience managing patients with COVID-19 across a spectrum of health care environments evaluated the utility of imaging within three scenarios representing varying risk factors, community conditions, and resource constraints. Fourteen key questions, corresponding to 11 decision points within the three scenarios and three additional clinical situations, were rated by the panel based on the anticipated value of the information that thoracic imaging would be expected to provide. The results were aggregated, resulting in five main and three additional recommendations intended to guide medical practitioners in the use of chest radiography and CT in the management of COVID-19.


Subject(s)
Coronavirus Infections , Lung/diagnostic imaging , Pandemics , Patient Care Management , Pneumonia, Viral , Radiography, Thoracic/methods , Respiratory Tract Diseases , Tomography, X-Ray Computed/methods , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Diagnosis, Differential , Disease Progression , Early Diagnosis , Humans , International Cooperation , Patient Care Management/methods , Patient Care Management/standards , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Respiratory Tract Diseases/diagnosis , Respiratory Tract Diseases/virology , SARS-CoV-2
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