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1.
Hastings Cent Rep ; 50(3): 7-8, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32596916

RESUMO

Seeking useful ways to respond to the Covid-19 pandemic, bioethicists have been tempted to claim for themselves what Alasdair MacIntyre characterized in After Virtue as the moral fiction of managerial expertise. They have been eager to offer a wide range of policy prescriptions, presenting themselves as bureaucratic managers and suggesting an expertise that bioethics may not in fact be able to offer. This was evident, for example, in the petition published by The Hastings Center in March 2020. The pandemic could foster a more hopeful future for bioethics if it were to focus attention less on policy decisions that belong to all citizens and more on some of the most basic moral questions that life presents and with which bioethics has always dealt-including, surely, the virtues needed in order to live well in a time of pandemic.


Assuntos
Temas Bioéticos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Betacoronavirus , Equipamentos Médicos Duráveis/provisão & distribução , Humanos , Pandemias , Guias de Prática Clínica como Assunto , Equipamentos de Proteção/provisão & distribução , Valores Sociais
2.
Zhongguo Yi Liao Qi Xie Za Zhi ; 44(2): 141-144, 2020 Feb 08.
Artigo em Chinês | MEDLINE | ID: mdl-32400988

RESUMO

In order to improve the efficiency of medical instrumentation management in hospital, reduce the management cost and save the human cost, this study analyzes the problems in the traditional hospital medical instrumentation management system, and develops a new system based on cloud computing. Through the characters of the SaaS Service Platform, the system improves the flow efficiency of the medical instrumentation in hospital, saves deployment and operating system costs, and improves the people's work efficiency.


Assuntos
Computação em Nuvem , Equipamentos Médicos Duráveis , Administração de Materiais no Hospital , Software
4.
No Shinkei Geka ; 47(8): 845-850, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31477627

RESUMO

PURPOSE: Herein we aimed to investigate the degradation of surgical instruments in our hospital and how water quality affects the rate of metal corrosion. MATERIALS AND METHODS: We observed 279 stainless steel instruments, and determined the presence of damage like metal corrosion or scale formation. We also measured the concentrations of chloride(Cl-)and silicate(SiO44-)ions in the water used for cleaning in our operating rooms, including tap water from the city water supply and reverse-osmosis(RO)filtered water. RESULT: Pitting corrosion was observed on 71% of the instruments we investigated. The concentration of Cl- was 0.7mg/L in tap water and 0.1mg/L in RO water, while the concentration of SiO44- was 0.3mg/L in both the tap and RO water. DISCUSSION: Of the dissolved ions Cl- and SiO44-, Cl- is more of a concern, as it causes pitting corrosion over time, while SiO44- causes scale formation. Considering the typical water quality in the operating-room environment, degradation must be monitored for the general maintenance of metal surgical instruments.


Assuntos
Equipamentos Médicos Duráveis , Controle de Qualidade , Abastecimento de Água , Corrosão , Humanos , Aço Inoxidável , Esterilização/normas , Água
5.
Artigo em Inglês | MEDLINE | ID: mdl-31416229

RESUMO

The aim of the study is to investigate the relationship between the spatial distribution of the selected medical equipment and the preventable mortality rate in the regions of the Slovak Republic. The main analytical approach is carried out through the cluster analysis based on a Euclidean distance technique in order to get similarity of the administrative divisions in form of a district and a pseudot2 approach aimed at the determination of a number of the districts in a cluster. A number of medical equipment had a rising tendency from the year 2008. The most extreme position according to a localisation distribution of the computed tomographs and the magnetic resonance imaging scanners is held by the Kosice IV District at the level of 7.50630. From an angle of view of the preventable mortality, the Piestany District holds the most extreme position peaking at the level of 10.97969 for the female sex and the Kezmarok District with the value of 9.44088. The study has the significant dissemination outputs for health policy interventions, especially to draw up regional health plans for computed tomography and magnetic resonance imaging deployment, mainly in locations with a high preventable mortality rate for both sexes.


Assuntos
Causas de Morte , Equipamentos Médicos Duráveis/provisão & distribução , Equipamentos Médicos Duráveis/estatística & dados numéricos , Geografia , Sistemas de Distribuição no Hospital/estatística & dados numéricos , Mortalidade , Feminino , Humanos , Masculino , Eslováquia
6.
Yakugaku Zasshi ; 139(8): 1093-1095, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31366844

RESUMO

Currently, the role of medical representative (MR) is responsible for providing information to medical doctors from pharmaceutical/medical equipment companies. In recent years, however, the newer role of medical science liaison (MSL) has been established to construct evidence and provide advanced medical and scientific information to health care professionals. This position, independent from the sales division of a pharmaceutical or medical equipment company, has already been established in Europe and the U.S. The MSL helps to combat concerns of conflicts of interest (COI) concerning the sophistication of expert information, and in support of clinical research. I will introduce the role of the MSL in Japan.


Assuntos
Protocolos Clínicos , Indústria Farmacêutica , Equipamentos Médicos Duráveis , Setor de Assistência à Saúde , Pessoal de Saúde , Papel Profissional , Humanos , Japão
7.
Eur J Orthop Surg Traumatol ; 29(8): 1631-1637, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31350650

RESUMO

PURPOSE: Healthcare facilities could minimize the cost of surgical instrument and implant processing by using single-use devices. The main objective was to prospectively compare the total cost of a single-use and reusable device used in short lumbar spine fusion. METHODS: A 1-year, single-centre, prospective study was performed on patients requiring a one- or two-level lumbar arthrodesis. Patients were randomized in two groups treated with either reusable or single-use device. A cost minimization analysis was performed using a micro-costing approach from a hospital perspective. Every step of the preparation process was timed and costed based on hourly wages of hospital employees, cleaning supplies and hospital waste costs. RESULTS: Forty cases were evaluated. No significant difference in operation time was noted (reusable 176.1 ± 68.4 min; single use 190.4 ± 71.7 min; p = 0.569). Mean processing time for single-use devices was lower than for reusable devices (33 min vs. 176 min) representing a cost of 14€ versus 58€ (p < 0.05). Pre-/post-sterilization and spinal set recomposing steps were the most time-consuming in reusable device group. A total cost saving of 181€ per intervention resulted from the use and processing of the single-use device considering an additional sterilization cost of 137€ with the reusable device. The weight of the reusable device was 42 kg for three containers and 1.2 kg for the single-use device. CONCLUSIONS: Owing to the absence of re-sterilization, single-use devices in one- and two-level lumbar fusion allow significant money and time savings. They may also avoid delaying surgery in case of reusable device unavailability.


Assuntos
Equipamentos Descartáveis/economia , Equipamentos Médicos Duráveis/economia , Custos Hospitalares/estatística & dados numéricos , Fusão Vertebral/economia , Fusão Vertebral/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Custos e Análise de Custo/métodos , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Distribuição Aleatória , Esterilização/economia , Estudos de Tempo e Movimento
8.
J Hosp Infect ; 103(2): 217-222, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31301329

RESUMO

BACKGROUND: Appropriate decontamination of breast pump milk collection kits (BPKs) is critical to obtain safe milk for infants and to avoid discarding donor human milk (DHM). AIM: To evaluate two strategies for BPK decontamination by assessing microbial cultures and the proportion of discarded DHM, according to the criteria of the National Institute for Health and Care Excellence for pre-pasteurization cultures. METHODS: Prospective comparative study, allocation ratio 1:1, microbiologist-blind. PARTICIPANTS: 47 new donors in a human milk bank in Madrid. INTERVENTIONS: Study group (N=21): BPKs washed with water and detergent after each use and further steam decontamination within a microwavable bag. Control group (N=26): washing, rinsing and drying only. Five samples: first sample by hand expression and four samples (one per week) collected using the same pump and method. OUTCOMES: Primary: proportion of DHM discarded due to contamination. Secondary: comparison of the microbiota between samples obtained by hand expression and breast pump in both groups. FINDINGS: In total, 217 milk samples were collected: 47 by hand expression and 170 by pump expression (78 from study group). Steam decontamination of BPKs using a microwavable bag after washing resulted in a lower proportion of discarded DHM samples (1.3% vs 18.5%, P<0.001) and samples contaminated with Enterobacteriaceae (1.3% vs 22.8%, P<0.001) and Candida spp. (1.3% vs 14.1%, P<0.05) compared with samples collected with BPKs that were washed but not steam decontaminated. There were no differences in bacterial contamination between samples obtained using steam decontaminated BPKs and those obtained by hand expression. CONCLUSIONS: Steam decontamination of BPKs using a microwavable bag after washing decreases the amount of discarded DHM and the number of samples with potentially pathogenic bacteria.


Assuntos
Descontaminação/métodos , Desinfecção/métodos , Equipamentos Médicos Duráveis , Bancos de Leite , Leite Humano/microbiologia , Adulto , Candida/isolamento & purificação , Enterobacteriaceae/isolamento & purificação , Feminino , Humanos , Estudos Prospectivos
9.
Chest ; 156(3): 619-628, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31265834

RESUMO

This article reviews four key clinician strategies to improve the care of adult patients receiving supplemental oxygen in the outpatient setting in the United States. The current barriers to adequate oxygen services are substantial and complex and include decreased reimbursement to durable medical equipment (DME) companies; a substantially lower number of available DME suppliers; difficult communication with DME suppliers; rigid patient testing, prescription, and documentation requirements; and unclear patient benefit and adherence. Recent data documenting frequent and varied problems reflect the significant impact of supplemental oxygen therapy on patients and caregivers. Areas where clinicians can improve patient oxygen experiences are highlighted in this review and include understanding Centers for Medicare and Medicaid Services oxygen prescription requirements, matching oxygen equipment to patient needs, providing essential patient education, and understanding mechanisms for patients and clinicians to report unresolved oxygen problems.


Assuntos
Acesso aos Serviços de Saúde , Oxigenoterapia , Adulto , Assistência Ambulatorial , Equipamentos Médicos Duráveis , Humanos , Estados Unidos
10.
Diabetes Technol Ther ; 21(7): 371-378, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31149838

RESUMO

Background: Recent studies demonstrate variable results of the accuracy with which patch pumps infuse insulin. Aim of this evaluation was to measure dose accuracies of the patch pump mylife™ OmniPod® (OP) in comparison with the durable insulin pump MiniMed® 640G (MM) simulating real-life clinical situations under laboratory conditions. Methods: Thirty-two OP and 15 MM were tested using insulin aspart at five different boluses (0.5, 1, 5, 10, and 15 international units [IU]) and three basal rates (0.2, 0.6, and 1.8 IU/h) at different time points during a 70 h investigation period. Owing to malfunctions only 22 OP and 11 MM could be analyzed. Dose accuracy was measured by an experimental setting based on IEC 60601-2-24:2012 with determination of weight differences of insulin collection tubes before and after experiments using a precision scale. A maximal tolerance of ±5% for boluses and basal rates was considered adequate according to IEC 60601-2-24:2012. Results: For the five boluses, the percentages of measurement results within the ±5% accuracy threshold were as follows: OP (18.6%, 26.5%, 89.0%, 96.0%, and 96.0%); MM (21.7%, 44.1%, 88.1%, 98.3%, and 100.0%). Both pumps were more accurate at higher bolus volumes (5, 10, and 15 IU), later bolus periods, and if the accuracy threshold was lowered to <10%, <15%, or >15%. For the three basal rates, the percentages within the ±5% accuracy threshold were as follows: OP (66.7%, 22.7%, and 16.7%); MM (14.3%, 0.0%, and 0.0%). Conclusion: This study demonstrates low accuracy for basal rates and single bolus deliveries at low insulin doses for both pump models. Clinicians should be aware of this variability when initiating insulin pump therapy especially in insulin-sensitive patients with low insulin dose requirements.


Assuntos
Equipamentos Médicos Duráveis , Hipoglicemiantes/administração & dosagem , Sistemas de Infusão de Insulina , Insulina/administração & dosagem , Adesivo Transdérmico , Diabetes Mellitus/tratamento farmacológico , Relação Dose-Resposta a Droga , Humanos
11.
Occup Ther Health Care ; 33(3): 233-246, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31074672

RESUMO

This survey study describes practice patterns, knowledge, skills, resources, and needs of occupational therapy practitioners providing services to parents with physical impairments. Participants (n = 51) primarily worked in outpatient rehabilitation (30%), inpatient rehabilitation (21%), and acute care (15%) settings. Participants reported evaluating and providing interventions for nine role-focused parenting activities. All participants agreed addressing the instrumental activities of daily living (IADL) of parenting should be part of occupational therapy practice. Adaptive equipment and techniques were utilized to increase participation of parents with physical impairments in child rearing. Lack of resources for childcare equipment and need for more training were barriers. Ninety-eight percent of participants agreed advancing the role of occupational therapy for parents with physical impairments is needed.


Assuntos
Pessoas com Deficiência/educação , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Terapia Ocupacional/métodos , Poder Familiar , Pais/educação , Adulto , Equipamentos Médicos Duráveis , Feminino , Humanos , Masculino , Projetos Piloto , Inquéritos e Questionários
12.
J Occup Health ; 61(5): 339-348, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31004382

RESUMO

OBJECTIVES: The incidence of occupational low back pain (LBP) is high among caregivers. The use of care equipment and training about care methods could prevent LBP among caregivers. However, in care facilities in Japan, these measures are not adequately employed. Moreover, the care facilities have faced issues regarding poor staffing in recent years. The present study investigated the relationship between LBP and occupational safety and health activities (OSHAs) for preventing LBP among caregivers and aimed to validate the priority approaches of OSHA. METHODS: This cross-sectional study was conducted in care facilities for the elderly in Japan. Questionnaires for administrators and caregivers were distributed to 1,000 facilities and 5,000 caregivers, respectively. Questionnaires completed by 612 facilities and 2,712 caregivers were analyzed. RESULTS: No direct association was observed between severe LBP and OSHA, but indirect association was done. A significant relationship was noted between severe LBP and the care methods. Direct factors causing severe LBP were lifting a resident using human power and taking an unsuitable posture. These care methods were associated with the following OSHAs: promoting the use of care equipment, training about care methods, and consultation regarding the use of care equipment and employing an appropriate care method with the person in charge. CONCLUSIONS: These OSHAs decreased lifting a resident using human power and taking an unsuitable posture, which are the primary risk factors of LBP. Therefore, these OSHAs should be implemented as priority approaches to prevent LBP among caregivers in care facilities for the elderly.


Assuntos
Cuidadores/estatística & dados numéricos , Remoção/efeitos adversos , Dor Lombar/prevenção & controle , Doenças Profissionais/epidemiologia , Doenças Profissionais/prevenção & controle , Saúde do Trabalhador/normas , Adulto , Estudos Transversais , Equipamentos Médicos Duráveis , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
13.
Gerontology ; 65(4): 353-361, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30731470

RESUMO

BACKGROUND: Historically, older adults have been disproportionately affected by disasters. In particular, homebound adults are especially at risk. As one facet of bolstering community resilience, home health agencies have been tasked with improving their patients' disaster preparedness. However, home health practitioners often lack the information necessary to fulfill these requirements. Providing resources about disaster preparedness will allow these practitioners, often seen as trusted advisors, to better prepare their patients. OBJECTIVE: This study explores the utility of implementing a checklist-style assessment tool to guide Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) practitioners in disaster preparedness assessments of their patients. METHODS: The HBPC Patient Assessment Tool for Disaster Planning ("Tool") was fielded by practitioners at 10 VHA HBPC programs with all patients seen over the course of a 3-week period. Descriptive statistics and bivariate analysis of the data collected via the Tool were used to understand the baseline levels of preparedness education provided by practitioners to their patients. Data from a follow-up survey and follow-up interviews with Program Managers were analyzed, the latter using content analysis methods. RESULTS: 754 surveys were returned for analysis. We examined how frequently practitioners reviewed the included preparedness items with their patients. Of those patients on oxygen, adherence ranged from 67 to 94% for practitioners covering a discussion about smoking materials/open flame, despite strong efforts to achieve high compliance on this measure as reported by several program managers. Of those items applicable to the general population, certain items were more frequently discussed than others. How to activate 911 services was most frequently reviewed (87%). Providing information about emergency shelter registration and specialty transport was the item least frequently reviewed (44%). Strengths about the Tool included its ease of use, flow, comprehensiveness, and that it fits on one page. CONCLUSION: Home-based care programs, such as the VHA HBPC program, are tasked with supporting the emergency preparedness of their patients, but often do not have the expertise to do so. This study shows that the checklist-like structure of an assessment tool can assist with this role by encouraging practitioners to cover key points with patients and their caregivers.


Assuntos
Lista de Checagem , Doença Crônica , Planejamento em Desastres/métodos , Pacientes Domiciliares , Atenção Primária à Saúde , Idoso , Equipamentos Médicos Duráveis , Fontes de Energia Elétrica , Feminino , Serviços de Assistência Domiciliar , Humanos , Masculino , Oxigenoterapia , Estados Unidos , United States Department of Veterans Affairs
14.
Simul Healthc ; 14(2): 113-120, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30601468

RESUMO

STATEMENT: Simulation is relatively new in many low-income countries. We describe the challenges encountered, solutions deployed, and the costs incurred while establishing two simulation centers in Uganda. The challenges we experienced included equipment costs, difficulty in procurement, lack of context-appropriate curricula, unreliable power, limited local teaching capacity, and lack of coordination among user groups. Solutions we deployed included improvisation of equipment, customization of low-cost simulation software, creation of context-specific curricula, local administrative support, and creation of a simulation fellowship opportunity for local instructors. Total costs for simulation setups ranged from US $165 to $17,000. For centers in low-income countries trying to establish simulation programs, our experience suggests that careful selection of context-appropriate equipment and curricula, engagement with local and international collaborators, and early emphasis to increase local teaching capacity are essential. Further studies are needed to identify the most cost-effective levels of technological complexity for simulation in similar resource-constrained settings.


Assuntos
Educação Médica/métodos , Treinamento por Simulação/estatística & dados numéricos , Custos e Análise de Custo , Países em Desenvolvimento , Equipamentos Médicos Duráveis/economia , Equipamentos Médicos Duráveis/provisão & distribução , Educação Médica/economia , Fontes de Energia Elétrica/normas , Docentes de Medicina/normas , Humanos , Projetos Piloto , Treinamento por Simulação/economia , Uganda
15.
BMC Infect Dis ; 19(1): 28, 2019 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-30616550

RESUMO

BACKGROUND: Healthcare-associated infections have become a public health problem, creating a new burden on medical care in hospitals. The emergence of multidrug-resistant bacteria poses a difficult task for physicians, who have limited therapeutic options. The dissemination of pathogens depends on "reservoirs", the different transmission pathways of the infectious agents and the factors favouring them. Contaminated environmental surfaces are an important potential reservoir for the transmission of many healthcare-associated pathogens. Pathogens can survive or persist in the environment for months and be a source of infection transmission when appropriate hygiene and disinfection procedures are inefficient. The aim of this study was to identify bacterial species from hospital surfaces in order to effectively prevent healthcare-associated infections. METHODS: Samples were taken from surfaces at the University Hospital of Abomey-Calavi/So-Ava in South Benin (West Africa). To achieve the objective of this study, 160 swab samples of hospital surfaces were taken as recommended by the International Organization for Standardization (ISO 14698-1). These samples were analysed in the bacteriology section of the National Laboratory for Biomedical Analysis. All statistical analyses were performed using SPSS Statistics 21 software. A Chi Square Test was used to test the association between the Results of culture samples and different care units. RESULTS: Of the 160 surface samples, 65% were positive for bacteria. The frequency of isolation was predominant in Paediatrics (87.5%). The positive samples were 64.2% Gram-positive bacteria and 35.8% of Gram-negative bacteria. Staphylococcus aureus predominated (27.3%), followed by Bacillus spp. (23.3%). The proportion of other microorganisms was negligible. S. aureus and Staphylococcus spp. were present in all care units. There was a statistically significant association between the Results of culture samples and different care units (χ2 = 12.732; p = 0.048). CONCLUSION: The bacteria found on the surfaces of the University Hospital of Abomey-Calavi/So-Ava's care environment suggest a risk of healthcare-associated infections. Adequate hospital hygiene measures are required. Patient safety in this environment must become a training priority for all caregivers.


Assuntos
Infecção Hospitalar/microbiologia , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Benin , Equipamentos Médicos Duráveis/microbiologia , Hospitais Universitários , Humanos , Staphylococcus/isolamento & purificação , Staphylococcus aureus/isolamento & purificação
16.
Infect Control Hosp Epidemiol ; 40(2): 158-163, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30698135

RESUMO

OBJECTIVE: To evaluate the efficacy of multiple ultraviolet (UV) light decontamination devices in a radiology procedure room. DESIGN: Laboratory evaluation. METHODS: We compared the efficacy of 8 UV decontamination devices with a 4-minute UV exposure time in reducing recovery of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Clostridium difficile spores on steel disk carriers placed at 5 sites on a computed tomography patient table. Analysis of variance was used to compare reductions for the different devices. A spectrometer was used to obtain irradiance measurements for the devices. RESULTS: Four standard vertical tower low-pressure mercury devices achieved 2 log10CFU or greater reductions in VRE and MRSA and ~1 log10CFU reductions in C. difficile spores, whereas a pulsed-xenon device resulted in less reduction in the pathogens (P<.001). In comparison to the vertical tower low-pressure mercury devices, equal or greater reductions in the pathogens were achieved by 3 nonstandard low-pressure mercury devices that included either adjustable bulbs that could be oriented directly over the exam table, a robotic base allowing movement along the side of the table during operation, or 3 vertical towers operated simultaneously. The low-pressure mercury devices produced primarily UV-C light, whereas the pulsed-xenon device produced primarily UV-A and UV-B light. The time required to move the devices from the corner of the room and set up for operation varied from 18 to 59 seconds. CONCLUSIONS: Many currently available UV devices could provide an effective and efficient adjunct to manual cleaning and disinfection in radiology procedure rooms.


Assuntos
Desinfecção/métodos , Equipamentos Médicos Duráveis , Fômites/microbiologia , Raios Ultravioleta , Clostridium difficile/efeitos da radiação , Contagem de Colônia Microbiana , Infecção Hospitalar/prevenção & controle , Descontaminação/métodos , Contaminação de Equipamentos/prevenção & controle , Staphylococcus aureus Resistente à Meticilina/efeitos da radiação , Esporos Bacterianos/efeitos da radiação , Fatores de Tempo , Enterococos Resistentes à Vancomicina/efeitos da radiação , Xenônio
17.
Health Care Manag Sci ; 22(2): 336-349, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29508164

RESUMO

Most healthcare organizations (HCOs) engage Group Purchasing Organizations (GPOs) as an outsourcing strategy to secure their supplies and materials. When an HCO outsources the procurement function to a GPO, this GPO will directly interact with the HCO's supplier on the HCO's behalf. This study investigates how an HCO's dependence on a GPO affects supply chain relationships and power in the healthcare medical equipment supply chain. Hypotheses are tested through factor analysis and structural equation modeling, using primary survey data from HCO procurement managers. An HCO's dependence on a GPO is found to be positively associated with a GPO's reliance on mediated power, but, surprisingly, negatively associated with a GPO's mediated power. Furthermore, analysis indicates that an HCO's dependence on a GPO is positively associated with an HCO's dependence on a GPO-contracted Original Equipment Manufacturer (OEM). HCO reliance on GPOs may lead to a buyer's dependence trap, where HCOs are increasingly dependent on GPOs and OEMs. Implications for HCO procurement managers and recommended steps for mitigation are offered. Power-dependence relationships in the medical equipment supply chain are not consistent with relationships in other, more traditional, supply chains. While dependence in a supply chain relationship typically leads to an increase in reliance on mediated power, GPO-dependent HCOs instead perceive a decrease in GPO mediated power. Furthermore, HCOs that rely on procurement service from GPOs are increasingly dependent on the OEMs.


Assuntos
Equipamentos e Provisões Hospitalares/provisão & distribução , Compras em Grupo/organização & administração , Equipamentos Médicos Duráveis/economia , Equipamentos Médicos Duráveis/provisão & distribução , Equipamentos e Provisões Hospitalares/economia , Compras em Grupo/economia , Humanos , Modelos Teóricos , Serviços Terceirizados/economia , Serviços Terceirizados/organização & administração
18.
Clin Infect Dis ; 68(7): 1244-1250, 2019 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-30371755

RESUMO

We are in the midst of a global outbreak of Mycobacterium chimaera infections related to a point source contamination of a widely used surgical device, the 3T heater-cooler unit. More than 250000 heart bypass procedures using heater-cooler devices are performed in the United States every year. It is estimated that 60% of these operations use the device associated with this outbreak. Most of the reported cases present with a disseminated infection that is striking in both the latency of presentation and the high mortality. The diagnosis can be elusive due to intermittent bacteremia and normal echocardiography. Therapy includes several months of antibiotics, and surgical intervention appears to be critical for successful outcomes. Here, we review diagnostic methods and treatment options to guide clinicians in the management of this complicated infection.


Assuntos
Gerenciamento Clínico , Surtos de Doenças , Contaminação de Equipamentos , Infecções por Mycobacterium/epidemiologia , Infecções por Mycobacterium/microbiologia , Mycobacterium/isolamento & purificação , Antibacterianos/uso terapêutico , Testes Diagnósticos de Rotina/métodos , Equipamentos Médicos Duráveis , Humanos , Infecções por Mycobacterium/diagnóstico , Infecções por Mycobacterium/tratamento farmacológico , Estados Unidos/epidemiologia
19.
Infect Control Hosp Epidemiol ; 40(2): 214-216, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30522541

RESUMO

A DNA marker inoculated onto portable equipment on a medical ward was disseminated to other wards when equipment was shared and to a physician work room and the hospital cafeteria by personnel. These results demonstrate the plausibility of pathogen transmission in healthcare facilities in the absence of shared ward exposure.


Assuntos
Biomarcadores/análise , Infecção Hospitalar/transmissão , DNA Viral/isolamento & purificação , Equipamentos Médicos Duráveis/virologia , Contaminação de Equipamentos , Microbiologia Ambiental , Fômites/virologia , Humanos , Quartos de Pacientes
20.
Fed Regist ; 83(220): 56922-7073, 2018 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-30457290

RESUMO

This final rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year (CY) 2019. This rule also updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). In addition, it updates and rebases the ESRD market basket for CY 2019. This rule also updates requirements for the ESRD Quality Incentive Program (QIP), and makes technical amendments to correct existing regulations related to the Competitive Bidding Program (CBP) for certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). Finally, this rule finalizes changes to bidding and pricing methodologies under the DMEPOS competitive bidding program; adjustments to DMEPOS fee schedule amounts using information from competitive bidding for items furnished from January 1, 2019 through December 31, 2020; new payment classes for oxygen and oxygen equipment and a new methodology for ensuring that new payment classes for oxygen and oxygen equipment are budget neutral; payment rules for multi- function ventilators or ventilators that perform functions of other durable medical equipment (DME); and revises the payment methodology for mail order items furnished in the Northern Mariana Islands. This rule also includes a summary of the feedback received for the request for information related to establishing fee schedule amounts for new DMEPOS items and services.


Assuntos
Equipamentos Médicos Duráveis/economia , Tabela de Remuneração de Serviços/economia , Tabela de Remuneração de Serviços/legislação & jurisprudência , Medicare/economia , Medicare/legislação & jurisprudência , Sistema de Pagamento Prospectivo/economia , Sistema de Pagamento Prospectivo/legislação & jurisprudência , Diálise Renal/economia , Proposta de Concorrência/economia , Proposta de Concorrência/legislação & jurisprudência , Humanos , Estados Unidos
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