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2.
BMC Infect Dis ; 24(1): 186, 2024 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-38347526

RESUMO

OBJECTIVES: In this study, we describe the patterns of antibiotic prescription for neonates based on World Health Organization's (WHO) Essential Medicines List Access, Watch, and Reserve (AWaRe), and the Management of Antibiotic Classification (MAC) Guidelines in China. METHODS: One-day point-prevalence surveys (PPS) on antimicrobial prescriptions were conducted on behalf of hospitalized neonates in China from September 1 and November 30, annually from 2017 to 2019. RESULTS: Data was collected for a total of 2674 neonatal patients from 15 hospitals in 9 provinces across China of which 1520 were newborns who received at least one antibiotic agent. A total of 1943 antibiotic prescriptions were included in the analysis. The most commonly prescribed antibiotic was meropenem (11.8%). The most common reason for prescribing antibiotic to neonates was pneumonia (44.2%). There were 419 (21.6%), 1343 (69.1%) and 6 (0.3%) antibiotic prescriptions in the Access, Watch and Reserve groups, respectively. According to MAC Guidelines in China, there were 1090 (56.1%) antibiotic agents in the Restricted and 414 (21.3%) in the Special group. CONCLUSION: Broad-spectrum antibiotics included in the Watch and Special groups were likely to be overused in Chinese neonates.


Assuntos
Antibacterianos , Prescrições de Medicamentos , Humanos , Recém-Nascido , Prevalência , Pesquisas sobre Atenção à Saúde , Antibacterianos/uso terapêutico , China/epidemiologia
3.
J Glob Antimicrob Resist ; 36: 473-481, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38280720

RESUMO

OBJECTIVES: Point prevalence surveys (PPS) provide valuable data on patterns of hospital antimicrobial administration. To identify quality improvement indicators, we evaluated antimicrobial prescribing patterns in children and neonates admitted to three referral centres in Sanandaj, Western Iran, and compared these with Southeast Asian and European paediatric benchmark data. METHODS: The standardised Global-PPS was performed to assess antimicrobial use in Southeast Asia, including Sanandaj and European hospitals, in 2019. RESULTS: Of the 4118, 2915, and 443 paediatric patients enrolled in Southeast Asian, European and Sanandaj hospitals, 2342 (56.9%), 833 (28.6%) and 332 (74.9%), respectively, received at least one antimicrobial in 2019. The most administered antibiotics in neonates were ampicillin in Southeast Asia (30.3%) and Sanandaj (41.5%, often in combination with cefotaxime (29.0%)), compared with amoxicillin in Europe (20.0%). In children, ceftriaxone was most prescribed in Sanandaj (62.4%) and Southeast Asia (20.5%) as opposed to amoxicillin (11.8%) in Europe. Twice as many Watch antibiotics (83.0%) were prescribed on paediatric wards in Sanandaj compared with European paediatric wards (41.1%). All antimicrobials in Sanandaj hospitals were prescribed empirically, and prolonged surgical prophylaxis was common (75.5%). CONCLUSION: The high prevalence of antibiotic prescribing, high empirical therapies, and poor outcomes for antibiotic quality indicators strongly suggest the urgent need for an antibiotic stewardship program in Sanandaj hospitals, where improved diagnostic laboratory capacity and reconsideration of training may be good targets for intervention in their hospitals.


Assuntos
Anti-Infecciosos , Gestão de Antimicrobianos , Recém-Nascido , Criança , Humanos , Prevalência , Irã (Geográfico) , População do Sudeste Asiático , Pesquisas sobre Atenção à Saúde , Antibacterianos/uso terapêutico , Hospitais , Anti-Infecciosos/uso terapêutico , Amoxicilina
4.
J Gen Intern Med ; 39(2): 214-221, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37698724

RESUMO

BACKGROUND: Despite initiatives to eradicate racial inequalities in pain treatment, there is no clear picture on whether this has translated to changes in clinical practice. OBJECTIVE: To determine whether racial disparities in the receipt of pain medication in the emergency department have diminished over a 22-year period from 1999 to 2020. DESIGN: We used data from the National Hospital Ambulatory Medical Care Survey, an annual, cross-sectional probability sample of visits to emergency departments of non-federal general and short-stay hospitals in the USA. PATIENTS: Pain-related visits to the ED by Black or White patients. MAIN MEASURES: Prescriptions for opioid and non-opioid analgesics. KEY RESULTS: A total of 203,854 of all sampled 625,433 ED visits (35%) by Black or White patients were pain-related, translating to a population-weighted estimate of over 42 million actual visits to US emergency departments for pain annually across 1999-2020. Relative risk regression found visits by White patients were 1.26 (95% CI, 1.22-1.30; p<0.001) times more likely to result in an opioid prescription for pain compared to Black patients (40% vs. 32%). Visits by Black patients were also 1.25 (95% CI, 1.21-1.30; p<0.001) times more likely to result in non-opioid analgesics only being prescribed. Results were not substantively altered after adjusting for insurance status, type and severity of pain, geographical region, and other potential confounders. Spline regression found no evidence of meaningful change in the magnitude of racial disparities in prescribed pain medication over 22 years. CONCLUSIONS: Initiatives to create equitable healthcare do not appear to have resulted in meaningful alleviation of racial disparities in pain treatment in the emergency department.


Assuntos
Analgésicos não Narcóticos , Analgésicos Opioides , Humanos , Estados Unidos/epidemiologia , Analgésicos Opioides/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Estudos Transversais , Padrões de Prática Médica , Dor/tratamento farmacológico , Serviço Hospitalar de Emergência , Pesquisas sobre Atenção à Saúde
5.
J Vasc Interv Radiol ; 35(1): 102-112.e5, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-37696431

RESUMO

PURPOSE: To study the experiences of patients with hepatocellular carcinoma (HCC) contributing to treatment discrepancy in the United States. MATERIALS AND METHODS: Using Surveillance, Epidemiology, and End Results data from National Cancer Institute (NCI), Medicare (2002-2015) beneficiaries with HCC who completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey were included. Six CAHPS items (3 global scores: global care rating [GCR], primary doctor rating [PDR], and specialist rating [SR]; 3 composite scores: getting needed care [GNC], getting care quickly [GCQ], and doctor communication [DC]) assessed patient experience. Covariates assessed between treated and nontreated groups included patient, disease, hospital, and CAHPS items. RESULTS: Among 548 patients with HCC, 211 (39%) received treatment and 337 (61%) did not receive treatment. Forty-two percent (GCR), 29% (PDR), 30% (SR), 36% (GNC), 78% (GCQ), and 35% (DC) of patients reported less-than-excellent experiences on the respective CAHPS items. Chronic liver disease (CLD) was present in 52% and liver decompensation (LD) in 60%. A minority of the hospitals were NCI-designated cancer centers (47%), transplant centers (27%), and referral centers (9%). On univariable analysis, patients with at least a high school degree (odds ratio [OR], 1.9), admittance to a ≥400-bed hospital (OR, 2.7), CLD (OR, 3.0), or LD (OR, 1.7) were more likely to receive treatment, whereas older patients (≥75 years) (OR, 0.5) were less likely to receive treatment. On multivariable, patients with CLD (OR, 6.8) and an excellent experience in GNC with a specialist (OR, 10.6) were more likely to receive treatment. CONCLUSIONS: HCC treatment discrepancy may be associated with patient-related factors, such as lack of specialist care (GNC), and disease-related factors, such as absence of underlying CLD.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Idoso , Estados Unidos/epidemiologia , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/terapia , Medicare , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/terapia , Pessoal de Saúde , Análise de Sistemas , Avaliação de Resultados da Assistência ao Paciente , Satisfação do Paciente , Pesquisas sobre Atenção à Saúde
6.
Vaccine ; 42(3): 418-425, 2024 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-38143201

RESUMO

The National Immunization Survey-Child (NIS-Child) provides annual vaccination coverage estimates in the United States for children aged 19 through 35 months, nationally, for each state, and for select local areas and territories. There is a need for vaccination coverage estimates for smaller geographic areas to support local authority planning and identify counties with potentially low vaccination coverage for possible further intervention. We describe small area estimation methods using 2008-2018 NIS-Child data to generate county-level estimates for children up to two years of age born 2007-2011 and 2012-2016. We applied an empirical best linear unbiased prediction method to combine direct estimates of vaccination coverage with model-based prediction using county-level predictors regarding health and demographic characteristics. We review the predictors commonly selected for the small area models and note multiple predictors related to barriers to vaccination.


Assuntos
Cobertura Vacinal , Vacinação , Humanos , Estados Unidos , Lactente , Pesquisas sobre Atenção à Saúde , Imunização , Programas de Imunização
7.
Health Care Manage Rev ; 49(1): 14-22, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38019460

RESUMO

BACKGROUND: Whereas organizational literature has provided much insight into the conceptual and theoretical underpinnings of organizational leadership and management during emergencies, measures to operationalize related effective practices during crises remain sparse. PURPOSE: To address this need, we developed the Healthcare Emergency Response Optimization survey, which set out to examine the leadership and management practices in health care organizations that support resilience and performance during crisis. METHODOLOGY: We administered an online survey in April to May 2022 to health care administrators and frontline staff intimately involved in their hospital's emergency response during the COVID-19 pandemic, which included a sample of 379 respondents across nine rural and urban hospitals (response rate: 44.4%). We used confirmatory factor analysis and quantile regressions to examine the results. RESULTS: Applying confirmatory factor analysis, we retained 36 items in our survey that comprised eight measures for formal and informal practices to assess crisis leadership and management. To test effectiveness of the specified practices, we regressed self-reported resilience and performance measures on the formality and informality scores. Findings show that informal practices mattered most for resilience, whereas formal practices mattered most for performance. We also identified specific practices (anticipation, transactional and relational interactions, and ad hoc collaborations) for resilience and performance. PRACTICE IMPLICATIONS: These validated measures of organizational practices assess emergency response during crisis, with an emphasis on the actions and decisions of leadership as well as the management of organizational structures and processes. Organizations using these measures may subsequently modify preparedness and planning approaches to better manage future crises.


Assuntos
COVID-19 , Prática de Grupo , Humanos , Liderança , Pandemias , Pesquisas sobre Atenção à Saúde
12.
BMC Public Health ; 23(1): 2039, 2023 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-37853363

RESUMO

BACKGROUND: Growing recognition of racism perpetuated within academic institutions has given rise to anti-racism efforts in these settings. In June 2020, the university-based California Preterm Birth Initiative (PTBi) committed to an Anti-Racism Action Plan outlining an approach to address anti-Blackness. This case study assessed perspectives on PTBi's anti-racism efforts to support continued growth toward racial equity within the initiative. METHODS: This mixed methods case study included an online survey with multiple choice and open-ended survey items (n = 27) and key informant interviews (n = 8) of leadership, faculty, staff, and trainees working within the initiative. Survey and interview questions focused on perspectives about individual and organizational anti-racism competencies, perceived areas of initiative success, and opportunities for improvement. Qualitative interview and survey data were coded and organized into common themes within assessment domains. RESULTS: Most survey respondents reported they felt competent in all the assessed anti-racism skills, including foundational knowledge and responding to workplace racism. They also felt confident in PTBi's commitment to address anti-Blackness. Fewer respondents were clear on strategic plans, resources allocated, and how the anti-racism agenda was being implemented. Suggestions from both data sources included further operationalizing and communicating commitments, integrating an anti-racism lens across all activities, ensuring accountability including staffing and funding consistent with anti-racist approaches, persistence in hiring Black faculty, providing professional development and support for Black staff, and addressing unintentional interpersonal harms to Black individuals. CONCLUSIONS: This case study contributes key lessons which move beyond individual-level and theoretical approaches towards transparency and accountability in academic institutions aiming to address anti-Black racism. Even with PTBi's strong commitment and efforts towards racial equity, these case study findings illustrate that actions must have sustained support by the broader institution and include leadership commitment, capacity-building via ongoing coaching and training, broad incorporation of anti-racism practices and procedures, continuous learning, and ongoing accountability for both short- and longer-term sustainable impact.


Assuntos
Centros Médicos Acadêmicos , Antirracismo , Negro ou Afro-Americano , Equidade em Saúde , Nascimento Prematuro , Racismo Sistêmico , Feminino , Humanos , Recém-Nascido , Nascimento Prematuro/etnologia , Nascimento Prematuro/prevenção & controle , Racismo/etnologia , Racismo/prevenção & controle , Gravidez , Racismo Sistêmico/etnologia , Racismo Sistêmico/prevenção & controle , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/normas , Internet , Pesquisas sobre Atenção à Saúde , Liderança , Responsabilidade Social , Fortalecimento Institucional
13.
NCHS Data Brief ; (481): 1-8, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37847575

RESUMO

Nonfatal injuries are major causes of emergency department (ED) visits in the United States (1). The National Center for Injury Prevention and Control estimated that, in 2020, 22.9 million ED visits related to nonfatal injuries occurred (1). Visits for assault (excluding sexual assault) represented 5.8% of these visits (1). This report uses the most recent data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) to present assault-related ED visit (excluding sexual assault) rates by selected demographic and hospital characteristics.


Assuntos
Assistência Ambulatorial , Serviço Hospitalar de Emergência , Humanos , Estados Unidos/epidemiologia , Pesquisas sobre Atenção à Saúde
14.
Nurs Outlook ; 71(6): 102062, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37866300

RESUMO

BACKGROUND: Physicians see most emergency department (ED) patients, but, recently, nurse practitioners (NPs) and physician assistants (PAs) have provided an increasing amount of ED care. PURPOSE: Compare NP and PA teams' practice patterns to physician teams in EDs. METHODS: Using 12 years of data from the National Hospital Ambulatory Medical Care Survey (2009-2020), we used multivariate regression analysis to separately examine the associations between the ED practice patterns (i.e., number of diagnostic services, number of procedures, waiting time, boarding time, length of visit, and hospital admission) of patients seen by NP or PA teams compared with physician teams. DISCUSSION: Patient visits to NP and PA teams received fewer diagnostic services and procedures, had shorter visits, and were less likely to be hospitalized. CONCLUSION: If the additional diagnostic services, procedures, and hospital admission provided by physician teams were unnecessary for the patients studied, NP and PA team care could be more efficient.


Assuntos
Profissionais de Enfermagem , Assistentes Médicos , Médicos , Humanos , Estados Unidos , Pesquisas sobre Atenção à Saúde , Serviço Hospitalar de Emergência , Padrões de Prática Médica
15.
J Drugs Dermatol ; 22(10): 1040-1045, 2023 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-37801531

RESUMO

BACKGROUND: Onychomycosis represents the highest proportion of nail disorders seen in clinical practice. Onychomycosis management may differ amongst specialties, with impact on patient outcomes and quality of life (QoL). OBJECTIVE: We aimed to characterize onychomycosis treatment across specialties, accounting for patient demographics, to assess for potential onychomycosis practice gaps. MATERIALS/METHODS: We conducted a population based cross-sectional analysis using the National Ambulatory Medical Care Survey (NAMCS) 2007 to 2016 (the most recent years available). RESULTS: Overall, 71.6% of onychomycosis visits were with general practitioners (GPs), 25.8% with dermatologists, and 2.58% with pediatricians. No onychomycosis treatment was prescribed at 82.0% of dermatology visits and 78.9% of GP visits. Dermatologists (Odds Ratio (OR):2.27 [95% Confidence Interval (CI):[2.14-2.41]; P<0.0001) and GPs (OR:2.32 [2.21-2.44]; P<0.0001) were more likely than pediatricians to prescribe treatment vs no treatment. Dermatologists were more likely than GPs to prescribe both no treatment vs treatment and topical vs oral antifungals (OR:1.33 [1.16-1.52]; P<0.0001 and OR:4.20 [3.80-4.65]; P<0.0001), respectively. DISCUSSION: Our study showed that there is a low treatment rate for onychomycosis, with treatment prescribed at only 20% of visits. Untreated onychomycosis might result in secondary infection, pain, and negative QoL impact.1 Although dermatologists are specialists in nail disease management, they saw only about 25% of onychomycosis visits. Future efforts should be directed towards promoting onychomycosis therapy, and educating both patients and referring physicians that dermatologists are primary resources for nail disorder treatment.J Drugs Dermatol. 2023;22(10):1040-1045 doi:10.36849/JDD.6770.


Assuntos
Doenças da Unha , Onicomicose , Humanos , Onicomicose/diagnóstico , Onicomicose/tratamento farmacológico , Onicomicose/epidemiologia , Estudos Transversais , Qualidade de Vida , Antifúngicos/uso terapêutico , Pesquisas sobre Atenção à Saúde , Doenças da Unha/tratamento farmacológico , Assistência Ambulatorial
17.
BMJ Open ; 13(9): e070580, 2023 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-37666549

RESUMO

OBJECTIVES: Assess community perceptions of the Lebanese care model for non-communicable diseases (NCDs) and trust in the health system among others, and test association between them. DESIGN: Cross-sectional study using multistage random sampling and targeting adult community members living with NCDs. SETTING: Households in Greater Beirut-Lebanon. PARTICIPANTS: 941 respondents including 574 Lebanese community members and 367 Syrian refugees. PRIMARY AND SECONDARY OUTCOMES: Three main outcomes (barriers to care seeking, perceptions of the care model and trust in healthcare) were assessed including by multiple linear regressions. RESULTS: Reported NCDs were hypertension (51.3%) and diabetes (34.5%), followed by chronic respiratory conditions (21.9%) and other cardiovascular diseases (20.0%). Communities reported seeking care from different sources. While 78% of Lebanese participants had visited private clinics at least once within the 6 months preceding the survey, 56% of Syrian refugees had done so. Determinants of access to care were health coverage, gender, and employment among Lebanese, and socioeconomic status among Syrian refugees. Lebanese community members had more positive perceptions of the care model compared with Syrian refugees and determinants included sociodemographic characteristics and the type of providers. Trust in the health system was higher among Syrian compared with Lebanese participants and was significantly influenced by the care model score and barriers to care seeking. CONCLUSION: Our study generated evidence about the experience of people living with NCDs with Lebanon's care model and can inform service delivery interventions towards a more inclusive person-centred approach.


Assuntos
Serviços de Saúde Comunitária , Doenças não Transmissíveis , Líbano , Estudos Transversais , Doenças não Transmissíveis/diagnóstico , Doenças não Transmissíveis/terapia , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso
18.
J Gen Intern Med ; 38(16): 3482-3489, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37709993

RESUMO

BACKGROUND: Medication cost conversations occur less frequently than patients prefer, and it is unclear whether patients have positive experiences with them when they do occur. OBJECTIVE: To describe patients' experiences discussing their medication costs with their health care team. DESIGN: Cross-sectional survey. SETTING: Nationally representative survey fielded in the United States in 2022 (response rate = 48.5%). PATIENTS: 1020 adults over age 65. MEASUREMENTS: Primary measures were adapted from Clinician and Group Consumer Assessment of Healthcare Providers Survey visit survey v4.0 and captured patients' experiences of medication cost conversations. Additional measures captured patients' interest in future cost conversations, the type of clinicians with whom they would be comfortable discussing costs, and sociodemographic characteristics. RESULTS: Among 1020 respondents who discussed medication prices with their health care team, 39.3% were 75 or older and 78.6% were non-Hispanic White. Forty-three percent of respondents indicated that their prior medication cost conversation was not easy to understand; 3% indicated their health care team was not respectful and 26% indicated their health care team was somewhat respectful during their last conversation; 48% indicated that there was not enough time. Those reporting that their prior discussion was not easy to understand or that their clinician was not definitely respectful were less likely to be interested in future discussions. Only 6% and 10% of respondents indicated being comfortable discussing medication prices with financial counselors or social workers, respectively. Few differences in responses were observed by survey participant characteristics. LIMITATIONS: This cross-sectional survey of prior experiences may be subject to recall bias. CONCLUSION: Among older adults who engaged in prior medication cost conversations, many report that these conversations are not easy to understand and that almost one-third of clinicians were somewhat or not respectful. Efforts to increase the frequency of medication cost conversations should consider parallel interventions to ensure the discussions are effective at informing prescribing decisions and reducing cost-related medication nonadherence.


Assuntos
Adesão à Medicação , Relações Médico-Paciente , Humanos , Estados Unidos , Idoso , Estudos Transversais , Inquéritos e Questionários , Pesquisas sobre Atenção à Saúde
19.
J Glob Health ; 13: 07005, 2023 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-37616128

RESUMO

Background: Information on the mortality rate and proportional cause-specific mortality is essential for identifying diseases of public health importance, design programmes, and formulating policies, but such data on women of reproductive age in Bangladesh is limited. Methods: We analysed secondary data from the 2001, 2010, and 2016 rounds of the nationally representative Bangladesh Maternal Mortality and Health Care Survey (BMMS) to estimate mortality rates and causes of death among women aged 15-49 years. We collected information on causes of death three years prior to each survey using a country-adapted version of the World Health Organization (WHO) verbal autopsy (VA) questionnaire. Trained physicians independently reviewed the VA questionnaire and assigned a cause of death using the International Classification of Diseases (ICD) codes. The analysis included mortality rates and proportional mortality showing overall and age-specific causes of death. Results: The overall mortality rates for women aged 15-49 years decreased over time, from 190 per 100 000 years of observation in the 2001 BMMS, to 121 per 100 000 in the 2010 BMMS, to 116 per 100 000 in the 2016 BMMS. Age-specific mortality showed a similar downward pattern. The three diseases contributing the most to mortality were maternal causes (13-20%), circulatory system diseases (15-23%), and malignancy (14-24%). The relative position of these three diseases changed between the three surveys. From the 2001 BMMS to the 2010 BMMS and subsequently to the 2016 BMMS, the number of deaths from non-communicable diseases (e.g. cardiovascular diseases and malignancies) increased from 29% to 38% to 48%. Maternal causes led to the highest proportion of deaths among 20-34-year-olds in all three surveys (25-32%), while suicide was the number one cause of death for teenagers (19-22%). Circulatory system diseases and malignancy were the two leading causes of death for older women aged 35-49 years (40%-67%). Conclusions: There was a gradual shift in the causes of death from communicable to non-communicable diseases among women of reproductive age in Bangladesh. Suicide as the primary cause of death among teenage girls demands urgent attention for prevention.


Assuntos
Doenças Cardiovasculares , Doenças não Transmissíveis , Adolescente , Feminino , Humanos , Idoso , Causas de Morte , Bangladesh/epidemiologia , Pesquisas sobre Atenção à Saúde
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