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CONTEXTE: Les interventions non pharmacologiques demeurent le principal moyen de maîtriser le coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) d'ici à ce que la couverture vaccinale soit suffisante pour donner lieu à une immunité collective. Nous avons utilisé des données de mobilité anonymisées de téléphones intelligents afin de quantifier le niveau de mobilité requis pour maîtriser le SRAS-CoV-2 (c.-à-d., seuil de mobilité), et la différence par rapport au niveau de mobilité observé (c.-à-d., écart de mobilité). MÉTHODES: Nous avons procédé à une analyse de séries chronologiques sur l'incidence hebdomadaire du SRAS-CoV-2 au Canada entre le 15 mars 2020 et le 6 mars 2021. Le paramètre mesuré était le taux de croissance hebdomadaire, défini comme le rapport entre les cas d'une semaine donnée et ceux de la semaine précédente. Nous avons mesuré les effets du temps moyen passé hors domicile au cours des 3 semaines précédentes à l'aide d'un modèle de régression log-normal, en tenant compte de la province, de la semaine et de la température moyenne. Nous avons calculé le seuil de mobilité et l'écart de mobilité pour le SRAS-CoV-2. RÉSULTATS: Au cours des 51 semaines de l'étude, en tout, 888 751 personnes ont contracté le SRAS-CoV-2. Chaque augmentation de 10 % de l'écart de mobilité a été associée à une augmentation de 25 % du taux de croissance des cas hebdomadaires de SRAS-CoV-2 (rapport 1,25, intervalle de confiance à 95 % 1,201,29). Comparativement à la mobilité prépandémique de référence de 100 %, le seuil de mobilité a été plus élevé au cours de l'été (69 %, écart interquartile [EI] 67 %70 %), et a chuté à 54 % pendant l'hiver 2021 (EI 52 %55 %); un écart de mobilité a été observé au Canada entre juillet 2020 et la dernière semaine de décembre 2020. INTERPRÉTATION: La mobilité permet de prédire avec fiabilité et constance la croissance des cas hebdomadaires et il faut maintenir des niveaux faibles de mobilité pour maîtriser le SRAS-CoV-2 jusqu'à la fin du printemps 2021. Les données de mobilité anonymisées des téléphones intelligents peuvent servir à guider le relâchement ou le resserrement des mesures de distanciation physique provinciales et régionales.
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COVID-19/prevención & control , Mapeo Geográfico , Aplicaciones Móviles/normas , Sistemas de Identificación de Pacientes/métodos , COVID-19/epidemiología , COVID-19/transmisión , Canadá/epidemiología , Humanos , Aplicaciones Móviles/estadística & datos numéricos , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Cuarentena/métodos , Cuarentena/normas , Cuarentena/estadística & datos numéricos , Análisis de Regresión , Factores de TiempoRESUMEN
The Joint Commission International (JCI) is a US-based organization that accredits and certifies hospitals worldwide. Among the requirements for accreditation, the JCI emphasizes continuous quality improvement (CQI) with regard to international patient safety goals (IPSGs). Our university hospital treats about 26,000 hospitalized patients and 600,000 outpatients annually, and our goal is patient safety in compliance with IPSGs. The purpose of this study is to examine the activities of orthopedic surgeons in preparation for JCI accreditation, including clear identification of patients, preoperative timeout and marking to ensure correct surgery, timely approval of CT/MRI reports, care with pain management, prevention of infection, setting of quality indicators and daily monitoring, and teamwork. Examiners from the JCI visited our hospital to review medical records and documents, and to interview patients, nurses and doctors. There were 1270 evaluation items covering 16 fields, including reviews of IPSGs, patient evaluation and care, infection prevention and control, and governance and leadership. Most importantly, the efforts of all the medical staff in our hospital in obtaining the first JCI accreditation among national university hospitals in Japan have promoted the safety and quality of medical care from the perspective of the patient.
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Acreditación/normas , Hospitales Universitarios , Cirujanos Ortopédicos/normas , Seguridad del Paciente/normas , Accidentes por Caídas/prevención & control , Infección Hospitalaria/prevención & control , Objetivos , Humanos , Internacionalidad , Japón , Joint Commission on Accreditation of Healthcare Organizations , Procedimientos Ortopédicos/normas , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Relaciones Médico-Paciente , Indicadores de Calidad de la Atención de Salud , Estados UnidosRESUMEN
PURPOSE: Safe delivery of brachytherapy and establishing a safety culture are critical in high-quality brachytherapy. The American Brachytherapy Society (ABS) Quality and Safety Committee surveyed members regarding brachytherapy services offered, safety practices during treatment, quality assurance procedures, and needs to develop safety and training materials. METHODS AND MATERIALS: A 22-item survey was sent to ABS membership in early 2019 to physicians, physicists, therapists, nurses, and administrators. Participation was voluntary. Responses were summarized with descriptive statistics and relative frequency distributions. RESULTS: There were 103 unique responses. Approximately one in three was attending physicians and one in three attending physicists. Most were in practice >10 years. A total of 94% and 50% performed gynecologic and prostate brachytherapy, respectively. Ninety-one percent performed two-identification patient verification before treatment. Eighty-six percent performed a time-out. Ninety-five percent had an incident reporting or learning system, but only 71% regularly reviewed incidents. Half reviewed safety practices within the last year. Twenty percent reported they were somewhat or not satisfied with department safety culture, but 92% of respondents were interested in improving safety culture. Most reported time, communication, and staffing as barriers to improving safety. Most respondents desired safety-oriented webinars, self-assessment modules, learning modules, or checklists endorsed by the ABS to improve safety practice. CONCLUSIONS: Most but not all practices use standards and quality assurance procedures in line with society recommendations. There is a need to heighten safety culture at many departments and to shift resources (e.g., time or staffing) to improve safety practice. There is a desire for society guidance to improve brachytherapy safety practices. This is the first survey to assess safety practice patterns among a national sample of radiation oncologists with expertise in brachytherapy.
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Braquiterapia/estadística & datos numéricos , Neoplasias de los Genitales Femeninos/radioterapia , Seguridad del Paciente , Neoplasias de la Próstata/radioterapia , Garantía de la Calidad de Atención de Salud/estadística & datos numéricos , Oncología por Radiación/organización & administración , Braquiterapia/efectos adversos , Braquiterapia/normas , Lista de Verificación , Comunicación , Femenino , Humanos , Masculino , Cultura Organizacional , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Admisión y Programación de Personal , Mejoramiento de la Calidad , Gestión de Riesgos/estadística & datos numéricos , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
OBJECTIVE: To analyse the effectiveness of corrective measures arising from the analysis of safety incident notifications in the Paediatric Emergency Unit. METHODS: A quasi-experimental, prospective, and single-centre study was carried out between 2015 and 2018. In the first phase, incidents notified throughout one year were analysed. Corrective measures were then implemented for 5 specific kinds of incidents. These incidents were finally compared to those notified within 12 months after the implementation of those measures. Results were expressed as relative risk and relative risk reduction. RESULTS: A total of 1587 safety incidents were notified (0.9% of patients treated) between January 2015 and December 2017. After implementation of corrective measures, there was a decrease in all kinds of incidents notifications analysed. The incidents related to patient identification were reduced by 60.9% (RR 0.39, 95% CI; 0.25-0.60), and those regarding communication between professionals were reduced by 74.5% (RR 0.25, 95% CI; 0.12-0.55). Incidents related to sedation and analgesic procedures totally disappeared. No significant reduction was found in incidents concerning the triage system, or in those related to rapid intravenous rehydration procedures. CONCLUSIONS: The implementation of improvement actions arising from the analysis of voluntary notification of incidents is an effective strategy to improve patient effective strategy to improve.
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Servicio de Urgencia en Hospital , Seguridad del Paciente , Pediatría , Gestión de Riesgos/métodos , Comunicación , Servicio de Urgencia en Hospital/estadística & datos numéricos , Tratamiento de Urgencia/efectos adversos , Tratamiento de Urgencia/estadística & datos numéricos , Fluidoterapia/efectos adversos , Fluidoterapia/estadística & datos numéricos , Reducción del Daño , Humanos , Relaciones Interprofesionales , Errores Médicos/prevención & control , Errores Médicos/estadística & datos numéricos , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Seguridad del Paciente/estadística & datos numéricos , Pediatría/estadística & datos numéricos , Estudios Prospectivos , Riesgo , Gestión de Riesgos/estadística & datos numéricos , Factores de Tiempo , TriajeRESUMEN
BACKGROUND: Health apps on mobile devices provide an unprecedented opportunity for ordinary people to develop social connections revolving around health issues. With increasing penetration of mobile devices and well-recorded behavioral data on such devices, it is desirable to employ digital traces on mobile devices rather than self-reported measures to capture the behavioral patterns underlying the use of mobile health (mHealth) apps in a more direct and valid way. OBJECTIVE: The objectives of this study were to (1) assess the demographic predictors of the adoption of mHealth apps; (2) investigate the temporal pattern underlying the use of mHealth apps; and (3) explore the impacts of demographic variables, temporal features, and app genres on the use of mHealth apps. METHODS: Logfile data of mobile devices were collected from a representative panel of about 2500 users in Hong Kong. Users' mHealth app activities were analyzed. We first conducted a binary logistic regression analysis to uncover demographic predictors of users' adoption status. Then we utilized a multilevel negative binomial regression to examine the impacts of demographic characteristics, temporal features, and app genres on mHealth app use. RESULTS: It was found that 27.5% of mobile device users in Hong Kong adopt at least one genre of mHealth app. Adopters of mHealth apps tend to be female and better educated. However, demographic characteristics did not showcase the predictive powers on the use of mHealth apps, except for the gender effect (Bfemale vs Bmale=-0.18; P=.006). The use of mHealth apps demonstrates a significant temporal pattern, which is found to be moderately active during daytime and intensifying at weekends and at night. Such temporal patterns in mHealth apps use are moderated by individuals' demographic characteristics. Finally, demographic characteristics were also found to condition the use of different genres of mHealth apps. CONCLUSIONS: Our findings suggest the importance of dynamic perspective in understanding users' mHealth app activities. mHealth app developers should consider more the demographic differences in temporal patterns of mHealth apps in the development of mHealth apps. Furthermore, our research also contributes to the promotion of mHealth apps by emphasizing the differences of usage needs for various groups of users.
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Teléfono Celular/estadística & datos numéricos , Sistemas de Identificación de Pacientes/métodos , Adolescente , Adulto , Femenino , Hong Kong , Humanos , Masculino , Persona de Mediana Edad , Aplicaciones Móviles/normas , Aplicaciones Móviles/estadística & datos numéricos , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
Introduction: The primary objective of this study was to describe the demographic, clinical, and attrition characteristics of active duty U.S. military service members who were aeromedically evacuated from Iraq and Afghanistan theaters with a psychiatric condition as the primary diagnosis. The study links the U.S. Transportation Command Regulating and Command and Control Evacuation System (TRAC2ES) data with the Defense Manpower Data Center (DMDC) to conduct an examination of the long-term occupational impact of psychiatric aeromedical evacuations on military separations and discharges. Materials and Methods: Retrospective analyses were conducted on the demographic, clinical, and attrition information of active duty service members (N = 7,023) who received a psychiatric aeromedical evacuation from Iraq or Afghanistan between 2001 and 2013 using TRAC2ES data. Additionally, TRAC2ES database was compared with DMDC data to analyze personal and service demographics, aeromedical evacuation information, and reasons for military separation with the entire 2013 active duty force. Chi-square tests of independence and standardized residuals were used to identify cells with observed frequencies or proportions significantly different than expected by chance. Additionally, OR were calculated to provide context about the nature of any significant relationships. Results: Compared with the active duty comparison sample, those with a psychiatric aeromedical evacuation tended to be younger, female, white, divorced or widowed, and less educated. They were also more likely to be junior enlisted service members in the Army serving in a Combat Arms military occupational specialty. The primary psychiatric conditions related to the aeromedical evacuation were depressive disorders (25%), adjustment disorders (18%), post-traumatic stress disorder (9%), bipolar disorders (6%), and anxiety disorders (6%). Approximately, 3% were evacuated for suicidal ideation and associated behaviors. Individuals who received a psychiatric aeromedical evacuation were almost four times as likely (53%) to have been subsequently separated from active duty at the time of the data analysis compared with other active duty service members (14%). The current study also found that peaks in the number of aeromedical evacuations coincided with significant combat operational events. These peaks almost always preceded or followed a significant operational event. An unexpected finding of the present study was that movement classification code was not predictive of subsequent reasons for separation from the military. Thus, the degree of clinical supervision and restraint of a service member during psychiatric aeromedical evacuation from deployment proved to be unrelated to subsequent service outcome. Conclusions: Psychiatric conditions are one of the leading reasons for the aeromedical evacuation of active duty military personnel from the military combat theater. For many active duty military personnel, a psychiatric aeromedical evacuation from a combat theater is the start of a military career-ending event that results in separation from active duty. This finding has important clinical and operational implications for the evaluation and treatment of psychiatric conditions during military deployments. Whenever possible, deployed military behavioral health providers should attempt to treat psychiatric patients in theater to help them remain in theater to complete their operational deployments. Improved understanding of the factors related to psychiatric aeromedical evacuations will provide important clinical and policy implications for future conflicts.
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Medicina Aeroespacial/estadística & datos numéricos , Trastornos Mentales/terapia , Personal Militar/estadística & datos numéricos , Guerra , Trastornos de Adaptación/epidemiología , Trastornos de Adaptación/terapia , Adulto , Medicina Aeroespacial/métodos , Campaña Afgana 2001- , Ambulancias Aéreas/estadística & datos numéricos , Trastorno Bipolar/epidemiología , Trastorno Bipolar/terapia , Distribución de Chi-Cuadrado , Depresión/epidemiología , Depresión/terapia , Femenino , Humanos , Clasificación Internacional de Enfermedades/tendencias , Guerra de Irak 2003-2011 , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Personal Militar/psicología , Sistemas de Identificación de Pacientes/métodos , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Enfermería Psiquiátrica/métodos , Enfermería Psiquiátrica/estadística & datos numéricos , Estudios Retrospectivos , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/terapia , Viaje/estadística & datos numéricos , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To investigate compliance of national patient safety protocols in Emergency Care Units (UPA) of the Paraná State. METHOD: From April until September 2016, the exploratory stage of the action research was conducted on stratified sampling with 377 patients of eight units, with use of verification instrument of basic safety actions. RESULTS: The absence of systematic identification of patients, fall risk assessment and signaling and development of pressure injuries were evidenced. We observed that 52.8% of parenteral solutions in use were not identified and that, in only 29.4% of the cases, the allergic condition was investigated. In 80.6% of the emergency units there was availability of alcoholic solution to hand hygiene. CONCLUSION: We concluded that the non-compliance of basic actions concerning patient safety exposes users to preventable adverse events and demands systematized actions to comply with government guidelines and promote quality of health assistance.
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Servicio de Urgencia en Hospital , Adhesión a Directriz/estadística & datos numéricos , Seguridad del Paciente/normas , Accidentes por Caídas/prevención & control , Adolescente , Adulto , Brasil , Servicio de Urgencia en Hospital/organización & administración , Femenino , Personal de Salud/normas , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Úlcera por Presión/prevención & control , Medición de Riesgo/estadística & datos numéricos , Recursos HumanosRESUMEN
ABSTRACT Objective: To investigate compliance of national patient safety protocols in Emergency Care Units (UPA) of the Paraná State. Method: From April until September 2016, the exploratory stage of the action research was conducted on stratified sampling with 377 patients of eight units, with use of verification instrument of basic safety actions. Results: The absence of systematic identification of patients, fall risk assessment and signaling and development of pressure injuries were evidenced. We observed that 52.8% of parenteral solutions in use were not identified and that, in only 29.4% of the cases, the allergic condition was investigated. In 80.6% of the emergency units there was availability of alcoholic solution to hand hygiene. Conclusion: We concluded that the non-compliance of basic actions concerning patient safety exposes users to preventable adverse events and demands systematized actions to comply with government guidelines and promote quality of health assistance.
RESUMEN Objetivo: Investigar el cumplimiento de los protocolos nacionales de seguridad del paciente en Unidades de Pronta Atención paranaenses. Método: Entre abril y septiembre de 2016 fue realizada la etapa exploratoria de la investigación acción, en muestra estratificada de 377 pacientes de ocho unidades, utilizándose instrumento de certificación de acciones básicas de seguridad. Resultados: Se evidenció la ausencia de identificación sistematizada de los pacientes y de evaluación y señalización del riesgo para caída y desarrollo de lesión por presión. Se observó que el 52,8% de las soluciones parenterales en uso no estaban identificadas y que, en solamente el 29,4% de los casos, la condición alérgica fue investigada. En el 80,6% de los puntos de asistencia había disponibilidad de solución alcohólica para la higienización de las manos. Conclusión: Se concluye que el no cumplimiento de acciones básicas relativas a la seguridad del paciente expone a los usuarios a eventos adversos prevenibles y demanda acciones sistematizadas para la observancia de las directrices gubernamentales y la promoción de la cualidad de la asistencia en salud.
RESUMO Objetivo: Investigar o cumprimento dos protocolos nacionais de segurança do paciente em Unidades de Pronto Atendimento paranaenses. Método: Entre abril e setembro de 2016 foi realizada etapa exploratória de pesquisa ação, em amostra estratificada de 377 pacientes de oito unidades, utilizando-se instrumento de verificação de ações básicas de segurança. Resultados: Evidenciou-se ausência de identificação sistematizada dos pacientes e de avaliação e sinalização do risco para queda e desenvolvimento de lesão por pressão. Observou-se que 52,8% das soluções parenterais em uso não estavam identificadas e que, em apenas 29,4% dos casos, a condição alérgica foi investigada. Em 80,6% dos pontos de assistência havia a disponibilidade de solução alcoólica para a higienização das mãos. Conclusão: Conclui-se que o não cumprimento de ações básicas relativas à segurança do paciente expõe os usuários a eventos adversos preveníveis e demanda ações sistematizadas para observância das diretrizes governamentais e promoção da qualidade da assistência em saúde.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Adhesión a Directriz/estadística & datos numéricos , Servicio de Urgencia en Hospital/organización & administración , Seguridad del Paciente/normas , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Accidentes por Caídas/prevención & control , Brasil , Personal de Salud/normas , Personal de Salud/estadística & datos numéricos , Medición de Riesgo/estadística & datos numéricos , Úlcera por Presión/prevención & control , Recursos Humanos , Persona de Mediana EdadRESUMEN
INTRODUCTION We present a novel solution to ensure that information and contact details are always available to patients while in cast. An information sticker containing both telephone numbers and a Quick Response (QR) code is applied to the cast. When scanned with a smartphone, the QR code loads the plaster team's webpage. This contains information and videos about cast care, complications and enhancing recovery. METHODS A sticker was designed and applied to all synthetic casts fitted in our fracture clinic. On cast removal, patients completed a questionnaire about the sticker. A total of 101 patients were surveyed between November 2015 and February 2016. The questionnaire comprised ten binary choice questions. RESULTS The vast majority (97%) of patients had the sticker still on their cast when they returned to clinic for cast removal. Eighty-four per cent of all patients felt reassured by the presence of the QR code sticker. Nine per cent used the contact details on the cast to seek advice. Over half (56%) had a smartphone and a third (33%) of these scanned the QR code. Of those who scanned the code, 95% found the information useful. CONCLUSIONS This study indicates that use of a QR code reassures patients and is an effective tool in the proactive management of potential cast problems. The QR code sticker is now applied to all casts across our trust. In line with NHS England's Five Year Forward View calling for enhanced use of smartphone technology, our trust is continuing to expand its portfolio of patient information accessible via QR codes. Other branches of medicine may benefit from incorporating QR codes as portals to access such information.
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Moldes Quirúrgicos/estadística & datos numéricos , Sistemas de Identificación de Pacientes/métodos , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Today, military combat medical care is the best it has ever been. Regulated U.S. Air Force aeromedical evacuation (AE) is one important reason. The Theater Validating Flight Surgeon (TVFS) validates that a patient is ready for flight. Two TVFSs' experiences, successively deployed in 2007, are the focus of this study. A unique operational worksheet used to manage the AE queue was used for approximately 5 months. A descriptive analysis of the worksheet's 1,389 patients found the majority male (94%), median age 30 years, and mostly Army enlisted soldiers (63%). U.S. civilians made up 9%. Battle Injury (55%) surpassed Disease, Non-Battle Injury (45%); most frequently seen were extremity injuries (73%) and cardiac illness (31%), respectively. Common to both Battle Injury and Disease, Nonbattle Injury were several TVFS prescriptions including no "remain overnights" (79%), head of bed elevation (78%), cabin altitude restriction (57%), no stops (44%), Critical Care Air Transport Team (27%), and supplemental oxygen (22%). This study is a first look at the TVFS experience and it offers up an initial accounting of the TVFS clinical and prescriptive practices. It is also a jumping point for future TVFS investigations using the available AE databases.
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Ambulancias Aéreas/estadística & datos numéricos , Medicina Militar/estadística & datos numéricos , Pacientes/estadística & datos numéricos , Guerra , Heridas y Lesiones/epidemiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Sistemas de Identificación de Pacientes/métodos , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Estudios Retrospectivos , Estadísticas no Paramétricas , Transporte de Pacientes/estadística & datos numéricos , Transporte de Pacientes/tendencias , Estados Unidos/epidemiologíaAsunto(s)
Sistemas de Computación/estadística & datos numéricos , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Dispositivo de Identificación por Radiofrecuencia , Accidente Cerebrovascular/diagnóstico por imagen , Estudios de Tiempo y Movimiento , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Flujo de Trabajo , Animales , Eficiencia Organizacional , Humanos , Monitoreo Ambulatorio/métodos , Monitoreo Ambulatorio/estadística & datos numéricos , RadiologíaRESUMEN
Blood transfusion is an important but complex and high-risky clinical procedure. Any error could cause serious injuries to patients. To better assure the procedure safety, we enhancing our home-made blood transfusion platform with new clinic decision support components to assure patient's identity and to inform clinicians of any event in time. So far, our transfusion incidence case has been reduced to 0 from 9 before the system implemented.
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Transfusión Sanguínea/instrumentación , Transfusión Sanguínea/estadística & datos numéricos , Sistemas de Apoyo a Decisiones Clínicas/estadística & datos numéricos , Errores Médicos/prevención & control , Errores Médicos/estadística & datos numéricos , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Transfusión Sanguínea/métodos , Diseño de Equipo , Análisis de Falla de Equipo , Humanos , Seguridad del Paciente , Prevalencia , Taiwán/epidemiología , Resultado del TratamientoRESUMEN
BACKGROUND: Several indirect comparison methods, including network meta-analyses (NMAs), using individual patient data (IPD) have been developed to synthesize evidence from a network of trials. Although IPD indirect comparisons are published with increasing frequency in health care literature, there is no guidance on selecting the appropriate methodology and on reporting the methods and results. METHODS: In this paper we examine the methods and reporting of indirect comparison methods using IPD. We searched MEDLINE, Embase, the Cochrane Library, and CINAHL from inception until October 2014. We included published and unpublished studies reporting a method, application, or review of indirect comparisons using IPD and at least three interventions. RESULTS: We identified 37 papers, including a total of 33 empirical networks. Of these, only 9 (27 %) IPD-NMAs reported the existence of a study protocol, whereas 3 (9 %) studies mentioned that protocols existed without providing a reference. The 33 empirical networks included 24 (73 %) IPD-NMAs and 9 (27 %) matching adjusted indirect comparisons (MAICs). Of the 21 (64 %) networks with at least one closed loop, 19 (90 %) were IPD-NMAs, 13 (68 %) of which evaluated the prerequisite consistency assumption, and only 5 (38 %) of the 13 IPD-NMAs used statistical approaches. The median number of trials included per network was 10 (IQR 4-19) (IPD-NMA: 15 [IQR 8-20]; MAIC: 2 [IQR 3-5]), and the median number of IPD trials included in a network was 3 (IQR 1-9) (IPD-NMA: 6 [IQR 2-11]; MAIC: 2 [IQR 1-2]). Half of the networks (17; 52 %) applied Bayesian hierarchical models (14 one-stage, 1 two-stage, 1 used IPD as an informative prior, 1 unclear-stage), including either IPD alone or with aggregated data (AD). Models for dichotomous and continuous outcomes were available (IPD alone or combined with AD), as were models for time-to-event data (IPD combined with AD). CONCLUSIONS: One in three indirect comparison methods modeling IPD adjusted results from different trials to estimate effects as if they had come from the same, randomized, population. Key methodological and reporting elements (e.g., evaluation of consistency, existence of study protocol) were often missing from an indirect comparison paper.
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Investigación Biomédica/métodos , Registros de Hospitales/estadística & datos numéricos , Difusión de la Información/métodos , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Informe de Investigación , Humanos , Metaanálisis como Asunto , Reproducibilidad de los Resultados , Proyectos de InvestigaciónRESUMEN
Incarceration provides an opportunity to test for HIV, provide treatment such as highly active anti-retroviral therapy, as well as link infected persons to comprehensive HIV care upon their release. A key factor in assessing the success of a program that links released individuals to care is the time from release to receiving care in the community (linkage time). To estimate the linkage time, records from correction systems are linked to Ryan White Clinic data using encrypted Unique Client Identifier (eUCI). Most of the records that were linked using eUCI belong to the same individual; however, in some cases, it may link records incorrectly, or not identify records that should have been linked. We propose a Bayesian procedure that relies on the relationships between variables that appear in either of the data sources, as well as variables that exists in both to identify correctly linked records among all linked records. The procedure generates K datasets in which each pair of linked records is identified as a true link or a false link. The K datasets are analyzed independently, and the results are combined using Rubin's multiple imputation rules. A small validation dataset is used to examine different statistical models and to inform the prior distributions of the parameters. In comparison with previously proposed methods, the proposed method utilizes all of the available data and is both flexible and computationally efficient. In addition, this approach can be applied in other file linking applications.
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Infecciones por VIH/diagnóstico , Registro Médico Coordinado/métodos , Sistemas de Identificación de Pacientes/métodos , Prisioneros , Terapia Antirretroviral Altamente Activa , Teorema de Bayes , Bioestadística/métodos , Servicios de Salud Comunitaria/métodos , Servicios de Salud Comunitaria/estadística & datos numéricos , Simulación por Computador , Confidencialidad , Infecciones por VIH/tratamiento farmacológico , Humanos , Modelos Estadísticos , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricosRESUMEN
INTRODUCTION: Clinic-based tracing efforts and public health surveillance data can provide different information about HIV care status for the same patients. The relative yield and how best to use these sources to identify and reengage out-of-care patients is unknown. METHODS: At a large public HIV clinic in San Francisco, we selected a 10% random sample of active patients who were at least 210 days "late" for an HIV primary care visit as of April 1, 2013, for clinic-based outreach. Patients were considered out of care if they did not have an HIV primary care visit in the 210 days before April 1, 2013. We then matched the sample with the San Francisco Department of Public Health HIV surveillance registry. Patients with a CD4 or viral load result in the 210-day period were classified as in care. We compared results from both sources and estimated the cumulative incidence of disengagement from care for the full cohort of clinic patients. RESULTS: Of 940 patients lost to follow-up, 95 were sampled. Clinic tracing found 60 (63%) in care, 23 (24%) not located, 9 (10%) out of care, 2 (2%) incarcerated, and 1 (1%) had died. Of 42 individuals surveillance classified as out of care, tracing found 22 (52%) were in care. Of 52 patients found to be in care by surveillance, 12 (23%) were out of care by clinic tracing or unable to be located. The naive estimate of the cumulative incidence of disengagement from care at 3 years for the active clinic cohort was 41.1% [95% confidence interval (CI): 37.6 to 44.5]. The use of surveillance data reduced this estimate to 12.7% (95% CI: 18.2 to 25.4), and when further corrected using tracing outcomes, the estimate dropped to only 6.4% (95% CI: 3.4 to 9.4). CONCLUSIONS: Clinic-based tracing and surveillance data together provide a better understanding of care status than either method alone. Using surveillance data to inform clinic-based outreach efforts may be an effective strategy, although tracing efforts are most likely to be successful if conducted in real time.
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Continuidad de la Atención al Paciente , Infecciones por VIH/epidemiología , Aceptación de la Atención de Salud , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Vigilancia en Salud Pública , Adulto , Instituciones de Atención Ambulatoria , Recuento de Linfocito CD4 , Estudios de Cohortes , Registros Electrónicos de Salud , Femenino , Infecciones por VIH/prevención & control , Humanos , Incidencia , Perdida de Seguimiento , Masculino , Persona de Mediana Edad , Salud Pública , Sistema de Registros , San Francisco/epidemiología , Carga ViralRESUMEN
OBJECTIVE: Portable electronic devices play an important role in the management of type 1 diabetes mellitus. Electromagnetic interference from electronic devices has been shown to impair the function of an avalanche transceiver in search mode (but not in transmitting mode). This study investigates the influence of electromagnetic interference from diabetes devices on a searching avalanche beacon. METHODS: The greatest distance at which an avalanche transceiver (in search mode) could accurately indicate the location of a transmitting transceiver was assessed when portable electronic devices (including an insulin pump and commonly used real-time continuous subcutaneous glucose monitoring system [rtCGMS]) were held in close proximity to each transceiver. RESULTS: The searching transceiver could accurately locate a transmitted signal at a distance of 30 m when used alone. This distance was unchanged by the Dexcom G4 rtCGMS, but was reduced to 10 m when the Medtronic Guardian rtCGMS was held close (within 30 cm) to the receiving beacon. Interference from the Animas Vibe insulin pump reduced this distance to 5 m, impairing the searching transceiver in a manner identical to the effect of a cell phone. CONCLUSIONS: Electromagnetic interference produced by some diabetes devices when held within 30 cm of a searching avalanche transceiver can impair the ability to locate a signal. Such interference could significantly compromise the outcome of a companion rescue scenario. Further investigation using other pumps and rtCGMS devices is required to evaluate all available diabetes electronics. Meantime, all electronic diabetes devices including rtCGMS and insulin pumps should not be used within 30 cm of an avalanche transceiver.
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Avalanchas , Diabetes Mellitus Tipo 1 , Equipos y Suministros Eléctricos , Fenómenos Electromagnéticos , Análisis de Falla de Equipo , Humanos , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Radio/instrumentación , Radio/estadística & datos numéricos , Trabajo de RescateRESUMEN
OBJECTIVE: to evaluate the use of identification wristbands among patients hospitalized in inpatient units. METHOD: quantitative, descriptive and transversal research, with a sample of 385 patients. Data collection occurred through the observational method through the filling out of a structured questionnaire which aimed to check the presence of the identification wristband and the identifiers used. Descriptive statistics with absolute and relative frequencies was used for analysis. RESULTS: it was obtained that 83.9% of the patients were found to have the correctly identified wristband, 11.9% had a wristband with errors, and 4.2% of the patients were without a wristband. The main nonconformities found on the identification wristbands were incomplete name, different registration numbers, illegibility of the data and problems with the physical integrity of the wristbands. CONCLUSION: the study demonstrated the professionals' engagement in the process of patient identification, evidencing a high rate of conformity of the wristbands. Furthermore, it contributed to identify elements in the use of wristbands which may be improved for a safe identification process.
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Hospitalización , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Estudios Transversales , Hospitales de Enseñanza , HumanosAsunto(s)
Competencia Clínica/estadística & datos numéricos , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Atención Dirigida al Paciente/estadística & datos numéricos , Fotograbar/estadística & datos numéricos , Sistemas de Información Radiológica/estadística & datos numéricos , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Femenino , Humanos , Aumento de la Imagen/métodos , Masculino , Persona de Mediana Edad , Ontario , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
OBJECTIVES: To assess the coverage of the Swedish Biologics Register (Anti-Rheumatic Therapy in Sweden, ARTIS) across indications, and the accuracy of the registered information on treatment with biologics. METHOD: Through cross-reference of ARTIS to almost complete national health registers on prescriptions (adalimumab and etanercept), outpatient visits, and death/residency during 2008-2010, we assessed: the treatment coverage of ARTIS for each treatment indication, the validity of the registered start and stop dates, ARTIS treatments with no corresponding drug dispensations, and the accuracy of the registered information on concomitant anti-rheumatic therapies. RESULTS: According to the national health registers, 3945 individuals with a spondyloarthropathy (SpA) and 8032 patients with rheumatoid arthritis (RA) had filled at least one adalimumab or etanercept prescription during the study period. Of these, 86% of those with SpAs and 95% of patients with RA were also found in ARTIS with the corresponding treatment. Tumour necrosis factor (TNF) inhibitor prescriptions had been filled by 95% of patients between the ARTIS start and stop dates (allowing a 90-day window). More than 60 days before and more than 60 days after the registered start date in ARTIS, 5% and 4% respectively of patients had filled their first TNF inhibitor prescription. More than 90 days after the registered stop date in ARTIS, 8% of patients had filled one or more TNF inhibitor prescriptions. CONCLUSIONS: We observed a high coverage and accuracy of ARTIS data on biologics exposure, for both SpAs and RA. The combination of data from clinical registers such as ARTIS with data from national health registers offers a high quality measurement of actual treatment.
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Anticuerpos Monoclonales/uso terapéutico , Antirreumáticos/uso terapéutico , Artritis Psoriásica/tratamiento farmacológico , Sistema de Registros/normas , Espondiloartropatías/tratamiento farmacológico , Espondilitis Anquilosante/tratamiento farmacológico , Factores Biológicos/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud , Evaluación de Procesos y Resultados en Atención de Salud , Sistemas de Identificación de Pacientes/normas , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Suecia , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
BACKGROUND: The safety of percutaneous coronary intervention (PCI) at medical facilities without on-site cardiothoracic (CT) surgery has been established in clinical trials. However, the comparative effectiveness of this strategy in real-world practice, including impact on patient access and outcomes, is uncertain. The Veterans Affairs (VA) health care system has used this strategy, with strict quality oversight, since 2005, and can provide insight into this question. METHODS AND RESULTS: Among 24,387 patients receiving PCI at VA facilities between October 2007 and September 2010, 6616 (27.1%) patients underwent PCI at facilities (n=18) without on-site CT surgery. Patient drive time (as a proxy for access), procedural complications, 1-year mortality, myocardial infarction, and rates of subsequent revascularization procedures were compared by facility. Results were stratified by procedural indication (ST-segment-elevation myocardial infarction versus non-ST-segment-elevation myocardial infarction/unstable angina versus elective) and PCI volume. With the inclusion of PCI facilities without on-site CT surgery, median drive time for patients treated at those facilities decreased by 90.8 minutes (P<0.001). Procedural need for emergent coronary artery bypass graft and mortality rates were low and similar between facilities. Adjusted 1-year mortality and myocardial infarction rates were similar between facilities (hazard ratio in PCI facilities without relative to those with on-site CT surgery, 1.02; 95% confidence interval, 0.87-1.2), and not modified by either PCI indication or PCI volume. Subsequent revascularization rates were higher at sites without on-site CT surgery facilities (hazard ratio, 1.21; 95% confidence interval, 1.03-1.42). CONCLUSIONS: This study suggests that providing PCI facilities without on-site CT surgery in an integrated health care system with quality oversight improves patient access without compromising procedural or 1-year outcomes.