Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 72
Filtrar
Mais filtros

Bases de dados
País/Região como assunto
Tipo de documento
Intervalo de ano de publicação
1.
Healthc Manage Forum ; 35(4): 213-217, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35603437

RESUMO

The COVID-19 pandemic is now endemic and has taken a terrible toll on the health workforce and its leaders. Stress and burnout are rampant, and health workers are leaving in record numbers. Using data collected during the first four waves of the pandemic, and a longitudinal analysis of these data, the authors identify ongoing challenges to health leadership related to building resilience and psychologically healthy workplaces. The article is organized around three questions: What happened during Waves 1 to 4? What did we learn? And what should be done differently? Eight actions emerged around the theme of "leaders supporting leaders": build personal resilience; practice compassionate leadership; model effective interpersonal leadership behaviour; ensure frequent and authentic communication; participate in networks and communities of practice; balance short- and long-term commitments; apply systems thinking; and contribute to a collaborative, national strategy.


Assuntos
Esgotamento Profissional , COVID-19 , Esgotamento Profissional/prevenção & controle , COVID-19/epidemiologia , Humanos , Liderança , Pandemias , Local de Trabalho
2.
Ann Surg ; 262(2): 403-8, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25423065

RESUMO

OBJECTIVES: To evaluate an intervention for improving antibiotic prophylaxis (AP) guideline compliance to prevent surgical site infections in children. BACKGROUND: Although appropriate AP reduces surgical site infection, and guidelines improve quality of care, changing practice is difficult. To facilitate behavioral change, various barriers need to be addressed. METHODS: A multidisciplinary task force at a pediatric hospital developed an evidence-based AP guideline. Subsequently, the guideline was posted in operating rooms and the online formulary, only recommended antibiotics were available in operating rooms, incoming trainees received orientation, antibiotic verification was included in time-out, computerized alerts were set for inappropriate postoperative prophylaxis, and surgeons received e-mails when guideline was not followed. AP indication and administration were documented for surgical procedures in July 2008 (preintervention), September 2011 (postintervention), and April-May 2013 (follow-up). Compliance was defined as complete--appropriate antibiotic, dose, timing, redosing, and duration when prophylaxis was indicated; partial--appropriate drug and timing when prophylaxis was indicated; and appropriate use--complete compliance when prophylaxis was indicated, no antibiotics when not indicated. Compliance at preintervention and follow-up was compared using χ(2) tests. RESULTS: AP was indicated in 43.9% (187/426) and 62.0% (124/200) of surgical procedures at preintervention and follow-up, respectively. There were significant improvements in appropriate antibiotic use (51.6%-67.0%; P < 0.001), complete (26.2%-53.2%; P < 0.001) and partial compliance (73.3%-88.7%, P = 0.001), correct dosage (77.5%-90.7%; P = 0.003), timing (83.3%-95.8%; P = 0.001), redosing (62.5%-95.8%, P = 0.003), and duration (47.1%-65.3%; P < 0.002). CONCLUSIONS: A multifaceted intervention improved compliance with a pediatric AP guideline.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia , Fidelidade a Diretrizes , Guias de Prática Clínica como Assunto , Infecção da Ferida Cirúrgica/prevenção & controle , Canadá , Criança , Feminino , Humanos , Masculino , Seleção de Pacientes , Padrões de Prática Médica , Avaliação de Programas e Projetos de Saúde
3.
Ann Surg ; 262(2): 397-402, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25243561

RESUMO

OBJECTIVE: To investigate the association between antibiotic prophylaxis (AP) and surgical-site infection in pediatric patients. BACKGROUND: Surgical-site infections (SSIs) are a major cause of postoperative morbidity and mortality. Despite numerous studies in adults, benefit of AP in preventing SSIs in children is uncertain. METHODS: Patients aged 0 to 21 years who underwent surgical procedures at a pediatric acute care hospital from April 1, 2009, to December 31, 2010, were assessed. Antibiotic prophylaxis indication and administration according to an evidence-based guideline were recorded. Complete compliance was defined as AP given, when indicated, within 60 minutes before incision. Surgical-site infections were identified using the Centers for Disease Control and Prevention criteria and documented in the medical records using the International Classification of Diseases, Tenth Revision. Multiple logistic regressions adjusting for age, sex, American Society of Anesthesiologists status, wound classification, admission status, surgical discipline, and surgical duration evaluated association of AP compliance and SSI. RESULTS: Of 5309 patients for whom antibiotics were indicated, 3901 (73.5%) with complete compliance had an infection rate of 3.0%, whereas 1408 (26.5%) who were not compliant had an infection rate of 4.3% (adjusted relative risk: 0.7; 95% confidence interval: 0.5-0.9; P = 0.02). Of 4156 patients for whom antibiotics were not indicated, the 895 (21.5%) who received antibiotics had an infection rate of 1.7% compared with 0.7% in the 3261 (78.5%) who did not receive antibiotics (adjusted relative risk: 1.6; 95% confidence interval: 0.8-3.1; P = 0.18). CONCLUSIONS: In pediatric surgery, complete compliance with AP was associated with 30% decreased risk of SSI.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Fatores Etários , Canadá , Criança , Pré-Escolar , Esquema de Medicação , Feminino , Fidelidade a Diretrizes , Humanos , Lactente , Recém-Nascido , Masculino , Duração da Cirurgia , Estudos Prospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/diagnóstico , Adulto Jovem
4.
Pediatr Radiol ; 45(1): 99-107, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25056229

RESUMO

BACKGROUND: Studies of elective surgical procedures indicate that cancellation is common and preventable. Little is known about cancellation of anesthesia-supported elective diagnostic imaging. OBJECTIVE: To describe the reasons for same-day cancellation of MRI studies performed under sedation or anesthesia and identify patient characteristics associated with cancellations. MATERIALS AND METHODS: This case-control study was carried out in a university-affiliated tertiary care children's hospital. Cases were defined as elective outpatient MRI studies booked under anesthesia that were cancelled after the patient had arrived in the radiology department in 2009. Matched controls were identified by selecting the same day and time 1 week before or after the cancelled case. Main outcome measures included demographics, MRI study characteristics, and social and medical factors. RESULTS: There were 111 outpatient anesthesia-supported MRI studies cancelled on the same day as the assessment (cancellation rate: 4.5%), of which 74.6% were related to family and patient factors, while 22% were related to system factors. Cancelled cases involved patients who lived in lower median income quintile neighborhoods compared to controls (2 vs. 3; P = 0.0007; odds ratio [OR] 3.81; 95% confidence interval [CI] 1.18-12.34). Those who traveled a greater median distance (in kilometers) were less likely to be cancelled (18.8 vs. 27.1, P = 0.0035). Although cancelled patients had a lower mean number of total medical services (2.5 vs. 3.0; P = 0.03; OR = 0.78; 95% CI 0.62-0.98), current medical factors (past 12 months) did not impact cancellations. CONCLUSION: Same-day cancellations of anesthesia-supported MRI studies are not uncommon, and the main predictor of cancellation seems to be socioeconomic rather than medical.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Anestesia/estatística & dados numéricos , Imageamento por Ressonância Magnética/psicologia , Imageamento por Ressonância Magnética/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Viagem/estatística & dados numéricos , Adolescente , Assistência Ambulatorial/psicologia , Anestesia/psicologia , Estudos de Casos e Controles , Pré-Escolar , Economia , Humanos , Lactente , Recém-Nascido , Masculino , Ontário/epidemiologia , Cooperação do Paciente/psicologia , Classe Social
5.
Artigo em Inglês | MEDLINE | ID: mdl-26015790

RESUMO

BACKGROUND: Increasing antimicrobial resistance has been identified as an important global health threat. Antimicrobial use is a major driver of resistance, especially in the hospital sector. Understanding the extent and type of antimicrobial use in Canadian hospitals will aid in developing national antimicrobial stewardship priorities. METHODS: In 2002 and 2009, as part of one-day prevalence surveys to quantify hospital-acquired infections in Canadian Nosocomial Infection Surveillance Program hospitals, data were collected on the use of systemic antimicrobial agents in all patients in participating hospitals. Specific agents in use (other than antiviral and antiparasitic agents) on the survey day and patient demographic information were collected. RESULTS: In 2002, 2460 of 6747 patients (36.5%) in 28 hospitals were receiving antimicrobial therapy. In 2009, 3989 of 9953 (40.1%) patients in 44 hospitals were receiving antimicrobial therapy (P<0.001). Significantly increased use was observed in central Canada (37.4% to 40.8%) and western Canada (36.9% to 41.1%) but not in eastern Canada (32.9% to 34.1%). In 2009, antimicrobial use was most common on solid organ transplant units (71.0% of patients), intensive care units (68.3%) and hematology/oncology units (65.9%). Compared with 2002, there was a significant decrease in use of first-and second-generation cephalosporins, and significant increases in use of carbapenems, antifungal agents and vancomycin in 2009. Piperacillin-tazobactam, as a proportion of all penicillins, increased from 20% in 2002 to 42.8% in 2009 (P<0.001). There was a significant increase in simultaneous use of >1 agent, from 12.0% of patients in 2002 to 37.7% in 2009. CONCLUSION: From 2002 to 2009, the prevalence of antimicrobial agent use in Canadian Nosocomial Infection Surveillance Program hospitals significantly increased; additionally, increased use of broad-spectrum agents and a marked increase in simultaneous use of multiple agents were observed.


HISTORIQUE: La résistance antimicrobienne croissante est une menace importante pour la santé dans le monde. L'utilisation d'antimicrobiens est un moteur de résistance majeur, particulièrement dans le milieu hospitalier. Il faut comprendre la portée et le type d'utilisation des antimicrobiens dans les hôpitaux canadiens pour établir les priorités nationales en matière de gouvernance antimicrobienne. MÉTHODOLOGIE: En 2002 et 2009, dans le cadre de sondages de prévalence d'une journée visant à quantifier les infections nosocomiales dans les hôpitaux du Programme canadien de surveillance des infections nosocomiales, les chercheurs ont colligé des données sur l'utilisation des antimicrobiens systémiques par tous les patients des hôpitaux participants. Le jour du sondage, ils ont recueilli les agents précis utilisés (à part les antiviraux et les antiparasitaires) et l'information démographique relative aux patients. RÉSULTATS: En 2002, 2 460 des 6 747 patients (36,5 %) de 28 hôpitaux recevaient un traitement antimicrobien. En 2009, 3 989 des 9 953 patients (40,1 %) de 44 hôpitaux recevaient un tel traitement (P<0,001). L'utilisation avait beaucoup augmenté au centre du Canada (37,4 % à 40,8 %) et dans l'Ouest canadien (36,9 % à 41,1 %), mais pas dans l'Est canadien (32,9 % à 34,1 %). En 2009, l'utilisation d'antimicrobiens était plus courante dans les unités de transplantation d'organes pleins (71,0 % des patients), les unités de soins intensifs (68,3 %) et les unités d'hématologie-oncologie (65,9 %). Par rapport à 2002, on constatait en 2009 une diminution importante des céphalosporines de première et seconde générations et des augmentations marquées de carbapénèmes, d'antifongiques et de vancomycine. L'utilisation de piperacilline-tazobactam, en proportion de toutes les pénicillines, est passée de 20 % en 2002 à 42,8 % en 2009 (P<0,001). L'utilisation simultanée de plus d'un agent a également connu une hausse importante, passant de 12,0 % des patients en 2002 à 37,7 % en 2009. CONCLUSION: De 2002 à 2009, la prévalence d'utilisation d'antimicrobiens dans les hôpitaux du Programme canadien de surveillance des infections nosocomiales a considérablement augmenté. De plus, les chercheurs ont constaté une augmentation marquée d'agents à large spectre et d'utilisation simultanée de multiples agents.

6.
Healthc Pap ; 13(1): 69-74; discussion 78-82, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23803358

RESUMO

When used in a military context, the term front line refers to the interface between enemies in action on the battlefield. In a non-military context, the front line is the site where the core activity defining a particular industry takes place, and those working there are key to successful operations. In healthcare, the need to improve patient safety has become a global imperative, and an armamentarium of strategies, tools and technological approaches have been adapted or developed for this context. Often neglected, however, have been strategies to engage the healthcare workers, those at the front line, in the cause.In order for healthcare to function error free, we must assume the characteristics of high-reliability organizations. In particular, the ability to bounce back, to be resilient in the face of a catastrophe, is of paramount importance. Those working at the front line may have the answers. We need to create an opportunity for them to be heard.`


Assuntos
Infecção Hospitalar/prevenção & controle , Pessoal de Saúde/normas , Controle de Infecções/normas , Segurança do Paciente/normas , Gestão da Segurança/normas , Humanos
7.
J Clin Microbiol ; 50(11): 3542-7, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22915608

RESUMO

An international multilaboratory collaborative study was conducted to develop standard media and consensus methods for the performance and quality control of antimicrobial susceptibility testing of Mycoplasma pneumoniae, Mycoplasma hominis, and Ureaplasma urealyticum using broth microdilution and agar dilution techniques. A reference strain from the American Type Culture Collection was designated for each species, which was to be used for quality control purposes. Repeat testing of replicate samples of each reference strain by participating laboratories utilizing both methods and different lots of media enabled a 3- to 4-dilution MIC range to be established for drugs in several different classes, including tetracyclines, macrolides, ketolides, lincosamides, and fluoroquinolones. This represents the first multilaboratory collaboration to standardize susceptibility testing methods and to designate quality control parameters to ensure accurate and reliable assay results for mycoplasmas and ureaplasmas that infect humans.


Assuntos
Antibacterianos/farmacologia , Testes de Sensibilidade Microbiana/métodos , Testes de Sensibilidade Microbiana/normas , Mycoplasma hominis/efeitos dos fármacos , Mycoplasma pneumoniae/efeitos dos fármacos , Ureaplasma urealyticum/efeitos dos fármacos , Meios de Cultura/química , Humanos , Cooperação Internacional , Controle de Qualidade , Tenericutes
8.
CMAJ ; 184(13): E709-18, 2012 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-22847964

RESUMO

BACKGROUND: Limited data are available on adverse events among children admitted to hospital. The Canadian Paediatric Adverse Events Study was done to describe the epidemiology of adverse events among children in hospital in Canada. METHODS: We performed a 2-stage medical record review at 8 academic pediatric centres and 14 community hospitals in Canada. We reviewed charts from patients admitted from April 2008 through March 2009, evenly distributed across 4 age groups (0 to 28 d; 29 to 365 d; > 1 to 5 yr and > 5 to 18 yr). In stage 1, nurses and health records personnel who had received training in the use of the Canadian Paediatric Trigger Tool reviewed medical records to detect triggers for possible adverse events. In stage 2, physicians reviewed the charts identified as having triggers and described the adverse events. RESULTS: A total of 3669 children were admitted to hospital during the study period. The weighted rate of adverse events was 9.2%. Adverse events were more frequent in academic pediatric centres than in community hospitals (adjusted odds ratio [OR] 2.98, 95% confidence interval [CI] 1.65-5.39). The incidence of preventable adverse events was not significantly different between types of hospital, but nonpreventable adverse events were more common in academic pediatric centres (adjusted OR 4.39, 95% CI 2.08-9.27). Surgical events predominated overall and occurred more frequently in academic pediatric centres than in community hospitals (37.2% v. 21.5%, relative risk [RR] 1.7, 95% CI 1.0-3.1), whereas events associated with diagnostic errors were significantly less frequent (11.1% v. 23.1%, RR 0.5, 95% CI 0.2-0.9). INTERPRETATION: More children have adverse events in academic pediatric centres than in community hospitals; however, adverse events in the former are less likely to be preventable. There are many opportunities to reduce harm affecting children in hospital in Canada, particularly related to surgery, intensive care and diagnostic error.


Assuntos
Hospitais/estatística & dados numéricos , Erros Médicos/estatística & dados numéricos , Centros Médicos Acadêmicos/estatística & dados numéricos , Adolescente , Fatores Etários , Canadá , Criança , Pré-Escolar , Hospitais Comunitários/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Incidência , Lactente , Recém-Nascido , Modelos Logísticos , Estudos Retrospectivos
9.
J Interprof Care ; 26(2): 158-60, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22316231

RESUMO

The teamwork that is required for interprofessional collaboration in healthcare is not an inherent attribute of the current system, and must be fostered. Education, training, and role modelling are important enablers. From our experience we posit that participating in a quality improvement project can be also be an excellent vehicle to promote interprofessional collaboration.


Assuntos
Atitude do Pessoal de Saúde , Relações Interprofissionais , Equipe de Assistência ao Paciente/organização & administração , Melhoria de Qualidade/organização & administração , Comportamento Cooperativo , Grupos Focais , Humanos , Estudos Interdisciplinares , Modelos Educacionais , Ontário , Equipe de Assistência ao Paciente/normas , Pesquisa Qualitativa , Melhoria de Qualidade/normas , Autorrelato
10.
Clin Infect Dis ; 53(7): 697-710, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21890775

RESUMO

The objective of this review was to determine whether consistent definitions were used in published studies of bloodstream infections due to central venous catheters in patients with cancer (ie, catheter-related or catheter-associated bloodstream infections). Review of 191 studies reporting catheter-related or catheter-associated bloodstream infections in patients with cancer revealed a lack of uniformity in these definitions. We grouped definitions by type, with 39 articles failing to cite or report a definition. Definitions included those of the Centers for Disease Control and Prevention (n = 39) and the Infectious Diseases Society of America (n = 18). The criteria included in the definitions in studies were also tabulated. Clinical manifestations were frequently included. Definitions used have been highly variable; comparability of risk factors, incidence, management, and outcomes of such infections is difficult to achieve across studies. Future research should focus on development of a common definition of catheter-related and catheter-associated bloodstream infections for both adults and children with cancer.


Assuntos
Infecções Relacionadas a Cateter/diagnóstico , Cateterismo Venoso Central/efeitos adversos , Neoplasias/complicações , Sepse/diagnóstico , Terminologia como Assunto , Infecções Relacionadas a Cateter/patologia , Humanos , Neoplasias/terapia , Sepse/patologia
11.
Jt Comm J Qual Patient Saf ; 37(12): 560-7, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22235541

RESUMO

BACKGROUND: Medication errors are common in the pediatric outpatient setting, and children with multiple prescriptions are at increased risk. Little is known about medication reconciliation's application in the ambulatory setting. Caregivers' perceptions of a patient medication list (PML), created for children with complex health needs, were assessed. METHODS: Caregivers of children followed by a tertiary care hospital ambulatory complex care program from February through December 2009 were enrolled in the study. An electronic PML software was nested within a clinical database. At the clinic visit, the medications were updated in the database by a nurse practitioner, and a PML was created and printed for the caregivers. Caregivers were asked to complete a pre-questionnaire before using the PML and a post-questionnaire 12 weeks later. RESULTS: The pre-questionnaire demonstrated that 19 (68%) of 28 caregivers expected the PML to be very helpful. After a mean of 19.3 weeks, on the post-questionnaire, 14 (50%) of the 28 caregivers reported that the PML was very helpful, 10 (40%) of 25 caregivers used the PML at every follow-up clinic visit, and 18 (67%) of 27 caregivers were satisfied with the PML. Five (18%) of 28 caregivers strongly agreed that the PML increased their knowledge of the child's medications, and 3 (11%) of 28 caregivers strongly agreed that the PML helped them remember to give the child's medications at home. CONCLUSIONS: A subset of caregivers in a complex care program reported that a PML was helpful during interactions with their medical team. Yet in general, caregivers did not find the PML helpful in increasing their medication knowledge or reminding them to administer their child's medications.


Assuntos
Cuidadores , Inquéritos e Questionários , Criança , Humanos , Erros de Medicação , Médicos
12.
Am J Phys Med Rehabil ; 100(2S Suppl 1): S7-S11, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32520796

RESUMO

ABSTRACT: Medical trainees are expected to achieve leadership competencies by the end of their training. However, there is a lack of standardized postgraduate leadership education. The aims of this study were to evaluate a pilot program consistent with leadership aims of the medical education body and to assess learners' perceived responses to the curriculum. A pilot workshop was developed using Kern's six-step approach to curriculum development for medical education. Topics included leading teams, managing conflict, feedback, goal setting, and time management, as these gaps were identified during a targeted needs assessment. Learning was assessed by preworkshop and postworkshop self-assessments, and the curriculum was evaluated with a postworkshop survey. The workshop was attended by 14 physical medicine and rehabilitation residents and 1 medical student. There was a statistically significant increase in participants' Likert scale confidence scores for the summative areas of leading teams, managing conflict, feedback, goal setting, and time management (P < 0.001). All participants rated the session as 4 or 5/5 on all evaluation domains. In conclusion, a single session targeting stated needs of trainees was successful in increasing perceived competence in areas relevant to clinical leadership. Expansion to include a longitudinal component, with assessment for behavior change for ongoing improvement would be beneficial.


Assuntos
Competência Clínica/normas , Educação de Pós-Graduação em Medicina/organização & administração , Internato e Residência/organização & administração , Liderança , Medicina Física e Reabilitação/educação , Currículo , Humanos , Avaliação de Programas e Projetos de Saúde , Estados Unidos
13.
Leadersh Health Serv (Bradf Engl) ; ahead-of-print(ahead-of-print)2021 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-34738770

RESUMO

PURPOSE: The purpose of this paper was to determine the complementarity between the Canadian Medical Education Directions for Specialists (CanMEDS) physician competency and LEADS leadership capability frameworks from three perspectives: epistemological, philosophical and pragmatic. Based on those findings, the authors propose how the frameworks collectively layout pathways of lifelong learning for physician leadership. DESIGN/METHODOLOGY/APPROACH: Using a qualitative approach combining critical discourse analysis with a modified Delphi, the authors examined "How complementary the CanMEDS and LEADS frameworks are in guiding physician leadership development and practice" with the following sub-questions: What are the similarities and differences between CanMEDS and LEADS from: An epistemological and philosophical perspective? The perspective of guiding physician leadership training and practice? How can CanMEDS and LEADS guide physician leadership development from medical school to retirement? FINDINGS: Similarities and differences exist between the two frameworks from philosophical and epistemological perspectives with significant complementarity. Both frameworks are founded on a caring ethos and value physician leadership - CanMEDS (for physicians) and LEADS (physicians as one of many professions) define leadership similarly. The frameworks share beliefs in the function of leadership, embrace a belief in distributed leadership, and although having some philosophical differences, have a shared purpose (preparing for changing health systems). Practically, the frameworks are mutually supportive, addressing leadership action in different contexts and where there is overlap, complement one another in intent and purpose. ORIGINALITY/VALUE: To the best of the authors' knowledge, this is the first paper to map the CanMEDS (physician competency) and LEADS (leadership capabilities) frameworks. By determining the complementarity between the two, synergies can be used to influence physician leadership capacity needed for today and the future.


Assuntos
Educação Médica , Medicina , Médicos , Canadá , Educação Continuada , Humanos , Liderança
14.
Antimicrob Agents Chemother ; 54(5): 2265-8, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20231402

RESUMO

We determined the in vitro antimicrobial susceptibilities of 7,942 methicillin-resistant Staphylococcus aureus (MRSA) isolates obtained from patients hospitalized in 48 Canadian hospitals from 1995 to 2008. Regional variations in susceptibilities were identified. The dissemination of community-associated strains in Canada appears to have contributed to increased susceptibility of MRSA to several non-beta-lactam antimicrobial agents in the past decade. Reduced susceptibility to glycopeptides was not identified.


Assuntos
Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Resistência a Meticilina , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Infecções Estafilocócicas/tratamento farmacológico , Canadá/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Infecção Hospitalar/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Saúde Pública/estatística & dados numéricos , Infecções Estafilocócicas/epidemiologia
15.
Antimicrob Agents Chemother ; 54(2): 945-9, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19949062

RESUMO

We describe the epidemiology of heterogeneously resistant Staphylococcus aureus (hVISA) identified in Canadian hospitals between 1995 and 2006. hVISA isolates were confirmed by the population analysis profiling-area under the curve method. Only 25 hVISA isolates (1.3% of all isolates) were detected. hVISA isolates were more likely to have been health care associated (odds ratio [OR], 5.1; 95% confidence interval [CI], 1.9 to 14.2) and to have been recovered from patients hospitalized in central Canada (OR, 3.0; 95% CI, 1.2 to 7.4). There has been no evidence of vancomycin "MIC creep" in Canadian strains of methicillin (meticillin)-resistant S. aureus, and hVISA strains are currently uncommon.


Assuntos
Antibacterianos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Infecções Estafilocócicas/tratamento farmacológico , Resistência a Vancomicina/genética , Vancomicina/uso terapêutico , Canadá/epidemiologia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Staphylococcus aureus Resistente à Meticilina/fisiologia , Testes de Sensibilidade Microbiana , Infecções Estafilocócicas/epidemiologia
16.
Healthc Q ; 13 Spec No: 102-9, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20959738

RESUMO

Handover is defined as the communication of information between individuals and teams of healthcare providers to support the transfer of patient care and maintain professional responsibility and accountability. Poor handovers are increasingly recognized as potentially dangerous for patient safety and are associated with adverse events. One suggested method to improve the timely and efficient exchange of clinical information at handover and to reduce discontinuities in care is through the use of a minimum data set (MDS). The objective of this study was to describe the process of developing a single comprehensive hospital-wide MDS, created through an analysis of current handover processes and customary information tools used to support physician handover (MDHO) at a large quaternary care pediatric academic health sciences centre. A 20-item questionnaire was administered in person to a senior resident or fellow on each of 49 services identified to objectively assess MDHO processes, including frequency, consistency, format, participants and duration, for each service. The presence, type, location, responsibility for updating and security characteristics of MDHO tools used to support MDHO were also analyzed. The MDHO tools currently in use were collected and analyzed to create a comprehensive cross-institutional MDS. The analysis indicates that MDHO is highly consistent in terms of frequency, processes, participants, duration and the use of written tools to guide information exchange across departments. However, many best practice recommendations for MDHO are not being followed. Further, many of the existing MDHO tools in use have a similar content structure and already contain a majority of the components of a comprehensive MDS. Current local consistency in practice will allow for improved acceptance and adoption of an MDHO tool that continues to meet the clinical and administrative needs of physicians but also addresses needs for data accuracy and security. These additional specifications can be met through the use of information communication technologies.


Assuntos
Continuidade da Assistência ao Paciente , Transferência de Pacientes/normas , Desenvolvimento de Programas , Humanos , Transferência de Pacientes/organização & administração , Inquéritos e Questionários
17.
Acad Med ; 95(11): 1643-1646, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32079931

RESUMO

Within graduate medical education, many educators are experiencing a climate of significant change. One transformation, competency-based medical education (CBME), is occurring simultaneously across much of the world, and implementation will require navigating numerous tensions and paradoxes. Successful transformation requires many types of power and is most likely to happen when the medical education community of professionals is engaged in designing, experimenting, acting, and sensemaking together.In this complex climate, the craft of change facilitators and community leaders is needed more than ever. National top-down policies and structures, while important, are not sufficient. The operationalization of new advances is best done when local leaders are afforded room to shape their local context. An evidence-based approach to thinking about the transformative change associated with CBME needs to be adopted. In this age of entrustment, 3 priorities are paramount: (1) engage, entrust, and empower professionals with increasing shared ownership of the innovation; (2) better prepare education professionals in leadership and transformational change techniques in the complex system of medical education; and (3) leverage the wider community of practice to maximize local CBME customization. These recommendations, although based largely on the Canadian experience, are intended to inform CBME transformation in any context.


Assuntos
Educação Baseada em Competências , Educação Médica , Ciência da Implementação , Canadá , Humanos , Liderança , Inovação Organizacional
18.
Healthc Q ; 12 Spec No Patient: 102-9, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19667786

RESUMO

Admission Medication Reconciliation (Med Rec) is an organizational practice designed to ensure patients' pre-admission medications are ordered correctly upon hospital admission. We describe the implementation of admission Med Rec at two academic health sciences centres, each having designed distinctly different processes. Common challenges encountered included the multi-step, inter-professional nature of Med Rec, staffing resource and workload concerns and frequent medical staff turnover in a teaching environment. Both teams found that participation in a national safety collaborative enabled the pilot initially; however, they later found the outcome measures suggested by the collaborative less useful and switched to internal compliance measures for establishing maintenance and spread. Common themes were identified among the critical success factors, with unique variations at each centre. Both teams acknowledged accreditation standards to be a major accelerator of implementation and spread. Using different measures of implementation success at each centre, the majority of patient admissions on the pilot units are complying with admission Med Rec. However, very high levels of compliance remain elusive. At Sunnybrook Health Sciences Centre's pilot unit, 62-77% of patients are being screened by a pharmacist and 65-75% of high-risk patients identified are undergoing Med Rec by a pharmacist. At The Hospital for Sick Children's pilot unit, 72-88% of patients have a physician's primary medication history documented on a Med Rec form and 57-73% of patients are also undergoing Med Rec by a nurse or pharmacist.


Assuntos
Centros Médicos Acadêmicos , Erros de Medicação/prevenção & controle , Admissão do Paciente , Difusão de Inovações , Humanos , Ontário , Estudos de Casos Organizacionais
19.
Infect Control Hosp Epidemiol ; 29(3): 271-4, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18241031

RESUMO

Surveillance for vancomycin-resistant enterococci (VRE) in sentinel Canadian hospitals has been conducted since 1999. From 1999 to 2005, the rate of VRE detection increased from 0.37 to 1.32 cases per 1,000 patients admitted, and the rate of VRE infection increased from 0.02 to 0.05 cases per 1,000 patients admitted. Thirty-three percent of all patients with VRE detected that were reported during 1999-2005 were identified in 2005, with increases seen in all regions of Canada. Although the incidence rate of VRE carriage in Canada is increasing, it remains very low.


Assuntos
Portador Sadio/epidemiologia , Infecção Hospitalar/epidemiologia , Enterococcus , Infecções por Bactérias Gram-Positivas/epidemiologia , Resistência a Vancomicina , Canadá/epidemiologia , Portador Sadio/microbiologia , Infecção Hospitalar/microbiologia , Enterococcus/efeitos dos fármacos , Enterococcus/isolamento & purificação , Infecções por Bactérias Gram-Positivas/microbiologia , Hospitais , Humanos , Incidência , Vigilância de Evento Sentinela
20.
Can J Infect Dis Med Microbiol ; 19(3): 233-6, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-19412380

RESUMO

BACKGROUND: The present study describes a vancomycin-resistant enterococci (VRE) outbreak investigation and a case-control study to identify risk factors for VRE acquisition in a tertiary care pediatric hospital. OBJECTIVE: To report an outbreak investigation and a case-control study to identify risk factors for VRE colonization or infection in hospitalized children. METHODS: Screening for VRE cases was performed by culture or polymerase chain reaction. A case-control study of VRE-colonized patients was undertaken. Environmental screening was performed using standard culture and susceptibility methods, with pulsed-field gel electrophoresis to determine relationships between VRE isolates. Statistical analysis was performed using SAS version 9.0 (SAS Institute Inc, USA). RESULTS: Thirty-four VRE-positive cases were identified on 10 wards between February 28, 2005, and May 27, 2005. Pulsed-field gel electrophoresis analysis confirmed a single outbreak strain that was also isolated from a video game found on one affected ward. Multivariate analysis identified cephalosporin use as the major risk factor for VRE colonization. CONCLUSIONS: In the present study outbreak, VRE colonization was significantly associated with cephalosporin use. Because shared recreational items and environmental surfaces may be colonized by VRE, they warrant particular attention in housekeeping protocols, particularly in pediatric institutions.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA