Assuntos
Aborto Induzido , Estruturas Embrionárias , Assistência ao Paciente , Saúde Reprodutiva , Técnicas de Reprodução Assistida , Saúde da Mulher , Humanos , Alabama , Ativismo Político , Estados Unidos , Aborto Legal/legislação & jurisprudência , Aborto Induzido/legislação & jurisprudência , Assistência ao Paciente/normas , Saúde da Mulher/legislação & jurisprudência , Saúde da Mulher/normas , Saúde Reprodutiva/legislação & jurisprudência , Saúde Reprodutiva/normas , Técnicas de Reprodução Assistida/legislação & jurisprudênciaRESUMO
Manual hand-hygiene audit is time-consuming, labour-intensive and inaccurate. Automated hand-hygiene monitoring systems (AHHMSs) offer advantages (generation of standardized data, avoidance of the Hawthorne effect). World Health Organization Guidelines for Hand Hygiene published in 2009 suggest that AHHMSs are a possible alternative. The objective of this review was to assess the current state of the literature for AHHMSs and offer recommendations for use in real-world settings. This was a systematic literature review, and publications included were from the time that PubMed commenced until 19th November 2023. Forty-three publications met the criteria. Using the Medical Research Council's Framework for Developing and Evaluating Complex Interventions, two were categorized as intervention development studies. Thirty-nine were evaluations. Two described implementation in real-world settings. Most were small scale and short duration. AHHMSs in conjunction with additional intervention (visual or auditory cue, performance feedback) could increase hand hygiene compliance in the short term. Impact on infection rates was difficult to determine. In the few publications where costs and resources were considered, time devoted to improving hand hygiene compliance increased when an AHHMS was in use. Health workers' opinions about AHHMSs were mixed. In conclusion, at present too little is known about the longer-term advantages of AHHMSs to recommend uptake in routine patient care. Until more longer-term accounts of implementation (over 12 months) become available, efforts should be made to improve direct observation of hand hygiene compliance to improve its accuracy and credibility. The Medical Research Council Framework could be used to categorize other complex interventions involving use of technology to prevent infection to help establish readiness for implementation.
Assuntos
Higiene das Mãos , Humanos , Higiene das Mãos/métodos , Higiene das Mãos/normas , Controle de Infecções/métodos , Controle de Infecções/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Infecção Hospitalar/prevenção & controle , Assistência ao Paciente/normas , Assistência ao Paciente/métodos , Pessoal de SaúdeRESUMO
National pharmacy associations have increasingly explored regulation according to a "standard of care." In such a model, pharmacists can provide a wide range of clinical services aligned with their education and training. Based on Idaho's experience implementing this model, there are five critical steps states must take to enact a standard of care: 1) Adopt a broad definition of "practice of pharmacy;" 2) Allow elasticity for practice innovation over time; 3) Decide which limited instances still necessitate prescriptive regulation; 4) Eliminate all unnecessary regulations; and 5) Strengthen accountability for deviations from the standard of care. States wishing to adopt a standard of care approach can follow this five-step process to enhance patient care and mitigate the lag that is otherwise constant between laws and practice.
Assuntos
Farmacêuticos , Padrão de Cuidado , Farmacêuticos/legislação & jurisprudência , Farmacêuticos/normas , Humanos , Padrão de Cuidado/legislação & jurisprudência , Assistência Farmacêutica/legislação & jurisprudência , Assistência Farmacêutica/normas , Assistência Farmacêutica/organização & administração , Papel Profissional , Idaho , Sociedades Farmacêuticas/normas , Assistência ao Paciente/normasAssuntos
Cuidadores , Demência , Humanos , Demência/terapia , Apoio Social , Assistência ao Paciente/normas , Modelos TeóricosRESUMO
This article summarizes the 2023 updated ARDS guidelines from the European Society of Intensive Care Medicine, including the guidelines' methods, findings, and implications, along with reflections on next steps.
Assuntos
Guias de Prática Clínica como Assunto , Síndrome do Desconforto Respiratório , Humanos , Cuidados Críticos , Assistência ao Paciente/métodos , Assistência ao Paciente/normas , Respiração Artificial , Síndrome do Desconforto Respiratório/terapiaAssuntos
Demência , Instituição de Longa Permanência para Idosos , Casas de Saúde , Assistência ao Paciente , Idoso , Humanos , Demência/terapia , Instituição de Longa Permanência para Idosos/normas , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/normas , Casas de Saúde/provisão & distribuição , Assistência ao Paciente/normasRESUMO
This article summarizes the recent update of guidelines on health care for transgender and gender diverse people, including primary care, gender-affirming care, mental health care, and education of the clinical workforce.
Assuntos
Atenção à Saúde , Assistência ao Paciente , Minorias Sexuais e de Gênero , Padrão de Cuidado , Humanos , Atenção à Saúde/normas , Identidade de Gênero , Pessoas Transgênero , Assistência ao Paciente/normasRESUMO
This article presents a radical claim: American medical ethics is broken, and it needs love to be healed. Due to a unique set of cultural and economic pressures, American medical ethics has adopted a mechanistic mode of ethical reasoning epitomized by the doctrine of principlism. This mode of reasoning divorces clinicians from both their patients and themselves. This results in clinicians who can ace ethics questions on multiple-choice tests but who fail either to recognize a patient's humanity or to navigate the ethical quandaries into which they are frequently thrown. Drawing on personal experience as well as the philosophical work of Augustine of Hippo, Simone Weil, and Iris Murdoch, we propose a novel ethical approach grounded in a conception of neighbor love, specifically, the virtue of love understood as attention to a sufferer's humanity. We conclude with five practical recommendations for reimagining medical ethics education oriented around the virtue of love.
Assuntos
Ética Médica , Amor , Assistência ao Paciente , Virtudes , Humanos , Ética Médica/educação , Estados Unidos , Assistência ao Paciente/ética , Assistência ao Paciente/métodos , Assistência ao Paciente/normasRESUMO
In this biography, the life of William Hugh Isbister is traced through three continents, where he planted the seeds of academic surgery into a generation of leaders in colorectal surgery. This ultimately improved the care for thousands of patients. His last station in Saudi Arabia made a huge impact on the country. I hope this article inspires others to write about their mentors who were important in their development as surgeons and physicians. Short biographies of these important figures will serve as a valuable historical record for generations to come.
Assuntos
Cirurgia Colorretal , Médicos , Humanos , História do Século XX , Arábia Saudita , Cirurgia Colorretal/educação , Cirurgia Colorretal/história , Liderança , Assistência ao Paciente/história , Assistência ao Paciente/normas , Mentores/históriaRESUMO
In the modern era, evidence-based medicine (EBM) has been embraced as the best approach to practising medicine, providing clinicians with 'objective' evidence from clinical research. However, for presentations with complex pathophysiology or from complex social environments, sometimes there remains no evidence, and no amount of research will obtain it. Yet, health researchers continue to undertake randomised controlled trials (RCT) in complex environments, ignoring the risk that participants' health may be compromised throughout the trial process. This paper examines the role of research that seeks to obtain evidence to support EBM. We provide examples of RCTs on ear disease in Aboriginal populations as a case-in-point. Decades of ear research have failed to yield statistically significant findings, demonstrating that when multiple factors are at play, study designs struggle to balance the known disease process drivers, let alone unknown drivers. This paper asks the reader to consider if the pursuit of research is likely to produce evidence in complex situations; or if perhaps RCTs should not be undertaken in these situations. Instead, clinicians could apply empirical evidence, tailoring treatments to individuals while taking into account the complexities of their life circumstances.
Assuntos
Competência Clínica , Atenção à Saúde , Pesquisa Empírica , Medicina Baseada em Evidências , Assistência ao Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Povos Aborígenes Australianos e Ilhéus do Estreito de Torres , Competência Clínica/normas , Atenção à Saúde/normas , Otopatias , Medicina Baseada em Evidências/normas , Assistência ao Paciente/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Projetos de Pesquisa/normasAssuntos
Identidade de Gênero , Acessibilidade aos Serviços de Saúde , Assistência ao Paciente , Minorias Sexuais e de Gênero , Pessoas Transgênero , Humanos , Pessoas Transgênero/legislação & jurisprudência , Assistência ao Paciente/normas , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/normas , Minorias Sexuais e de Gênero/legislação & jurisprudênciaRESUMO
This JAMA Clinical Guidelines Synopsis summarizes the American Head and Neck Society's 2021 consensus statement on care of survivors of head and neck cancer.