RESUMO
The decision of November 6th, 2006 defining the principles of best practices recommends that posttransfusional red cell alloantibodies research is performed after one to three months after. In the University hospital of Brest, the haemovigilance unit takes charge of sending the medical prescription within the required time and centralizing the results. We wished to estimate if the realization of this research still remains relevant. METHODS: A prospective analysis was performed in 2015. We evaluated the realization rate, the red cell alloantibodies rate and the recipient adverse reactions with the diagnostic category: alloimmunization (delayed serological transfusion reaction, DSTR). RESULTS: In 2015, 2162 prescriptions were sent to the 3271 transfused patients. One thousand and eighteen red cell alloantibodies research were done, i.e. a return rate of 61%. Among them, 12 alloantibodies appeared (0.9%) within an average of 56 days. Thirty-three other alloantibodies appeared and were discovered most frequently before a new transfusion. In 10 cases, a posttransfusional research was done that was negative. A survey was conducted among GHCOH members to describe the practices in these health institutions. Twelve questionnaires were analysed. Ten institutions performed a posttransfusional alloantibodies research by issuing a prescription at the patient's exit with a return rate between 0.14 and 16%; 1 institution has a centralized organization with a return rate of 68.3%; 1566 red cell alloantibodies research were performed and among them, 24 alloantibodies appeared (1.53%). CONCLUSION: These results indicate that to be effective, the management of this biological test must be centralized. Despite this, the red cell alloantibodies rate remains very low (0.9 and 1.53%) and raises the question of the relevance of this systematic testing after transfusion, which is in any case mandatory before a new transfusion of red blood cells.
Assuntos
Segurança do Sangue/métodos , Transfusão de Sangue/legislação & jurisprudência , Isoanticorpos/sangue , Antígenos de Grupos Sanguíneos/imunologia , Segurança do Sangue/economia , Segurança do Sangue/normas , Custos e Análise de Custo , Membrana Eritrocítica/imunologia , França , Hospitais Universitários , Humanos , Imunização , Isoanticorpos/biossíntese , Isoanticorpos/imunologia , Guias de Prática Clínica como Assunto , Prevalência , Estudos Prospectivos , Inquéritos e Questionários , Fatores de Tempo , Reação Transfusional/epidemiologia , Reação Transfusional/imunologia , Reação Transfusional/prevenção & controleRESUMO
BACKGROUND: The Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) and Cutaneous Assessment Tool-Binary Method (CAT-BM) have been shown to be reliable and valid outcome measures to assess cutaneous disease in adult dermatomyositis (DM) and juvenile DM (JDM), respectively. OBJECTIVES: This study compared the CDASI and CAT-BM for use by paediatric dermatologists, paediatric rheumatologists and paediatric neurologists in patients with JDM. METHODS: Five paediatric dermatologists, five paediatric rheumatologists and five paediatric neurologists each evaluated 14 patients with JDM using the CDASI, CAT-BM, and skin Physician Global Assessment (PGA) scales. Inter-rater reliability, intra-rater reliability, construct validity and completion time were compared. RESULTS: Inter-rater reliability for CDASI activity and damage scores was good to moderate for paediatric dermatologists and rheumatologists, but poor for paediatric neurologists. The inter-rater reliability for CAT-BM activity scores was moderate for paediatric dermatologists and rheumatologists, but poor for paediatric neurologists and poor across all specialties for damage scores. Intra-rater reliability for the CDASI and CAT-BM activity and damage scores was moderate to excellent for paediatric dermatologists, rheumatologists and neurologists. Strong associations were found between skin PGA activity and damage scores and CDASI or CAT-BM activity and damage scores, respectively (P < 0·002). The CDASI had a mean completion time of 5·4 min compared with that for the CAT-BM of 3·1 min. CONCLUSIONS: Our data confirm the reliability of the CDASI activity and damage scores and the CAT-BM activity scores when used by paediatric dermatologists and rheumatologists in assessing JDM. Significant variation existed in the paediatric neurologists' scores.
Assuntos
Dermatomiosite/diagnóstico , Índice de Gravidade de Doença , Criança , Dermatologistas , Feminino , Humanos , Masculino , Neurologistas , Variações Dependentes do Observador , Exame Físico/métodos , Reumatologistas , Sensibilidade e EspecificidadeRESUMO
The aim of this study was to evaluate the impact, on a regional scale (Franche-Comté), of 3 National Alzheimer care plans, particularly concerning the development of the offer of care management by clinicians as well as the panel of diagnoses concerned. Data on sociodemographic, neuropsychological and diagnostic characteristics were retrieved from the RAPID regional database between 1st January 2003 and 31st December 2012. These analyses focused exclusively on patients who had an initial consultation (n=12,017) during the same period. The existence of a previously established health network capable of carrying out governmental health plans has produced an effective interface between regional administrative structures responsible for the implementation of these plans and health professionals responsible for carrying out them out. This network study, the use of a battery of tests and a common software database have enabled the development of patient care management throughout the Franche-Comté region. It also showed the diversification of diagnoses mentioned over the past years as well as changes in clinical practices on how to address the issue of cognitive impairment.
Assuntos
Bases de Dados Factuais , Gerenciamento Clínico , Transtornos da Memória/epidemiologia , Programas Nacionais de Saúde/organização & administração , Sistema de Registros , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/psicologia , Doença de Alzheimer/terapia , Lesões Encefálicas/diagnóstico , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/terapia , Diagnóstico Diferencial , Progressão da Doença , Feminino , França/epidemiologia , Implementação de Plano de Saúde , Humanos , Masculino , Transtornos da Memória/diagnóstico , Transtornos da Memória/terapia , Transtornos Mentais/diagnóstico , Programas Nacionais de Saúde/estatística & dados numéricos , Doenças Neurodegenerativas/diagnóstico , Testes Neuropsicológicos , SoftwareRESUMO
BACKGROUND: Poor results after lumbar spinal surgery have been recorded in compensation cases throughout the world medical literature. It seems that psychosocial factors play an important role in the delay in returning to gainful employment but that chronic postoperative lumbar and lower extremity pain is blamed for this state of affairs. The present series of late outcomes is based on actual physical examination by independent neurosurgical and orthopedic experts appointed by the Workman's Compensation Board, providing an impartial opinion as to the discrepancy between objective findings and failure to reintegrate into the work force. METHODS: One thousand workmen's compensation patients who had undergone lumbar spinal surgery were divided into two groups, one of 600 patients with single operations, evaluated on average 51 months after surgery, and the second of 400 with multiple operations, evaluated on average 38 months postoperatively. RESULTS: Seventy-one percent of the single operation group had not returned to work more than 4 years after the operation, and 95% of the multiple operations group. In none of these cases was there a neurological deficit that precluded gainful employment, the failure to return to work being blamed on chronic postoperative pain. CONCLUSIONS: Although motivational (that is, psychosocial) factors undoubtedly play a role in failure to return to work, the role of chronic pain cannot be ignored. Increased attention must be devoted to ascertaining the etiology of this pain and ways to prevent it.
Assuntos
Acidentes de Trabalho , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Doenças Profissionais/cirurgia , Complicações Pós-Operatórias/etiologia , Doenças da Coluna Vertebral/cirurgia , Adulto , Doença Crônica , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Dor Lombar/etiologia , Vértebras Lombares/lesões , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/etiologia , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/reabilitação , Complicações Pós-Operatórias/reabilitação , Reabilitação Vocacional , Reoperação , Doenças da Coluna Vertebral/etiologia , Falha de Tratamento , Indenização aos TrabalhadoresAssuntos
Atenção à Saúde/tendências , Inovação Organizacional , Dinâmica Populacional , Canadá , Atenção à Saúde/organização & administração , Demografia , Alocação de Recursos para a Atenção à Saúde , Gastos em Saúde/tendências , Acessibilidade aos Serviços de Saúde/tendências , Internet , Cultura Organizacional , Qualidade da Assistência à Saúde/tendênciasAssuntos
Hospitais/normas , Serviços de Informação , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Atitude Frente a Saúde , Benchmarking , Canadá , Serviços de Saúde Comunitária , Coleta de Dados , Liberdade , Acessibilidade aos Serviços de Saúde , Programas Nacionais de Saúde/organização & administração , Satisfação do Paciente , Responsabilidade SocialAssuntos
Participação da Comunidade/tendências , Setor de Assistência à Saúde/tendências , Publicidade/tendências , Canadá , Participação da Comunidade/estatística & dados numéricos , Terapias Complementares/estatística & dados numéricos , Indústria Farmacêutica/tendências , Prescrições de Medicamentos/economia , Internet/estatística & dados numéricos , Marketing de Serviços de Saúde/tendências , Poder PsicológicoRESUMO
Organizational change, in the form of work redesign, is widespread in hospitals across the country. How can the resulting patient-focused care models be sustained when "sustaining" means continuously changing and improving? The authors describe one hospital's use of a multidisciplinary shared governance system to provide the structure and process support for the innovative changes initiated by work redesign.
Assuntos
Unidades Hospitalares/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Análise e Desempenho de Tarefas , Custos e Análise de Custo , Unidades Hospitalares/economia , Humanos , Inovação Organizacional , Ortopedia , TennesseeRESUMO
In 1987, six Yale graduate students set out to study the concurrent review methods used in key hospitals across the US. They examined the advantages and disadvantages of concurrent review and the tie-in of medical record concurrent review coding with utilization review activities. The first part of their report appeared in the May issue of JAMRA. The second part appears below.
Assuntos
Indexação e Redação de Resumos , Revisão Concomitante/organização & administração , Grupos Diagnósticos Relacionados , Departamentos Hospitalares/métodos , Serviço Hospitalar de Registros Médicos/métodos , Revisão da Utilização de Recursos de Saúde/organização & administração , Documentação , Estudos de Avaliação como Assunto , Modelos Teóricos , Papel do Médico , Análise de Sistemas , Fatores de Tempo , Estados UnidosRESUMO
Ten years ago the medical profession in Canada was conscripted into a compulsory national health insurance scheme without any prior consultation. Predictions that an open-ended, so-called "free" medical insurance scheme would lead to cost overruns and deterioration of medical services as well as inflationary trends have come true. Federal and provincial governments now attempt to contain costs by closing active treatment beds or filling them up with chronic patients and by attrition of existing facilities. Compulsory national health insurance has not led to lower morbidity nor greater longevity. It has only provoked an insatiable demand from the public for more "free" services, with the result that the system has become a quagmire of cost overruns and unfulfilled and unrealizable promises.
Assuntos
Medicina Estatal , Canadá , Honorários Médicos , Ontário , Política , Quebeque , Medicina Estatal/economia , Medicina Estatal/tendênciasRESUMO
The general principles in the treatment of the disordered, is the change from segregation to social integration. The allocation of financial resources is necessary for the needed conditions, that means, that instead of the traditional institutions but mostly the ambulatory institutions, an early apprehension therapy should be financed. The seriousness in the treatment next to the specific facilities for the disordered, is the individual psychic help needed in regard to the secondary psychic problems, as a result of his disorder, also the socialization of the disordered should be advanced. Social organizations for disordered, as well as the parents of disordered children have a very important task, but the organizations can only fullfill the work in cooperation with a municiple care system.