RESUMO
OBJECTIVE: To compile the lessons learned in the Greater Maghreb, during the first six months of the fight against the COVID-19 pandemic, in the field of "capacity building" of community resilience. METHODS: An expert consultation was conducted during the first week of May 2020, using the "Delphi" technique. An email was sent requesting the formulation of a lesson, in the form of a "Public Health" good practice recommendation. The final text of the lessons was finalized by the group coordinator and validated by the signatories of the manuscript. RESULTS: A list of five lessons of resilience has been deduced and approved : 1. Elaboration of "white plans" for epidemic management; 2. Training in epidemic management; 3. Uniqueness of the health system command; 4. Mobilization of retirees and volunteers; 5. Revision of the map sanitary. CONCLUSION: Based on the evaluation of the performance of the Maghreb fight against COVID-19, characterized by low resilience, this list of lessons could constitute a roadmap for the reform of Maghreb health systems, towards more performance to manage possible waves of COVID-19 or new emerging diseases with epidemic tendency.
Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Atenção à Saúde/organização & administração , Atenção à Saúde/normas , Reforma dos Serviços de Saúde , África do Norte/epidemiologia , Argélia/epidemiologia , Atitude do Pessoal de Saúde , Defesa Civil/métodos , Defesa Civil/organização & administração , Defesa Civil/normas , Participação da Comunidade/métodos , Conflito de Interesses , Atenção à Saúde/estatística & dados numéricos , Técnica Delphi , Prova Pericial , Saúde Global/normas , Reforma dos Serviços de Saúde/organização & administração , Reforma dos Serviços de Saúde/normas , Número de Leitos em Hospital/normas , Número de Leitos em Hospital/estatística & dados numéricos , Humanos , Mauritânia/epidemiologia , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/normas , Pandemias , Saúde Pública/métodos , Saúde Pública/normas , SARS-CoV-2/fisiologia , Tunísia/epidemiologiaAssuntos
Fechamento de Instituições de Saúde , Unidade Hospitalar de Ginecologia e Obstetrícia , Feminino , Número de Leitos em Hospital/normas , Humanos , Tocologia/organização & administração , Tocologia/normas , Enfermagem Neonatal/organização & administração , Enfermagem Neonatal/normas , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia/normas , Gravidez , SuéciaRESUMO
INTRODUCTION: There are little data available regarding compliance with the National Comprehensive Cancer Network (NCCN) guidelines. We investigated variation in the management of pancreatic cancer (PC) among large hospitals in California, USA, specifically to evaluate whether compliance with NCCN guidelines correlates with patient outcomes. METHODS: The California Cancer Registry was used to identify patients treated for PC from 2001 to 2006. Only hospitals with ≥ 400 beds were included to limit evaluation to centres possessing resources to provide multimodality care (n= 50). Risk-adjusted multivariable models evaluated predictors of adherence to stage-specific NCCN guidelines for PC and mortality. RESULTS: In all, 3706 patients were treated for PC in large hospitals during the study period. Compliance with NCCN guidelines was only 34.5%. Patients were less likely to get recommended therapy with advanced age and low socioeconomic status (SES). Using multilevel analysis, controlling for patient factors (including demographics and comorbidities), hospital factors (e.g. size, academic affiliation and case volume), compliance with NCCN guidelines was associated with a reduced risk of mortality [odds ratio (OR) for death 0.64 (0.53-0.77, P < 0.0001)]. CONCLUSIONS: There is relatively poor overall compliance with the NCCN PC guidelines in California's large hospitals. Higher compliance rates are correlated with improved survival. Compliance is an important potential measure of the quality of care.