RESUMEN
India has experienced a significant increase in facility-based delivery (FBD) coverage and reduction in maternal mortality. Nevertheless, India continues to have high levels of maternal health inequity. Improving equity requires data collection methods that can produce a better contextual understanding of how vulnerable populations access and interact with the health care system at a local level. While large population-level surveys are valuable, they are resource intensive and often lack the contextual specificity and timeliness to be useful for local health programming. Qualitative methods can be resource intensive and may lack generalizability. We describe an innovative mixed-methods application of Large Country-Lot Quality Assurance Sampling (LC-LQAS) that provides local coverage data and qualitative insights for both FBD and antenatal care (ANC) in a low-cost and timely manner that is useful for health care providers working in specific contexts. LC-LQAS is a version of LQAS that combines LQAS for local level classification with multistage cluster sampling to obtain precise regional or national coverage estimates. We integrated qualitative questions to uncover mothers' experiences accessing maternal health care in the rural district of Sri Ganganagar, Rajasthan, India. We interviewed 313 recently delivered, low-income women in 18 subdistricts. All respondents participated in both qualitative and quantitative components. All subdistricts were classified as having high FBD coverage with the upper threshold set at 85%, suggesting that improved coverage has extended to vulnerable women. However, only two subdistricts were classified as high ANC coverage with the upper threshold set at 40%. Qualitative data revealed a severe lack of agency among respondents and that household norms of care seeking influenced uptake of ANC and FBD. We additionally report on implementation outcomes (acceptability, feasibility, appropriateness, effectiveness, fidelity, and cost) and how study results informed the programs of a local health non-profit.
Asunto(s)
Muestreo para la Garantía de la Calidad de Lotes/métodos , Servicios de Salud Materna/economía , Servicios de Salud Materna/tendencias , Atención a la Salud , Personal de Salud , Política de Salud/economía , Política de Salud/tendencias , Humanos , India/epidemiología , Muestreo para la Garantía de la Calidad de Lotes/tendencias , Salud Materna/estadística & datos numéricos , Servicios de Salud Materna/estadística & datos numéricos , Mortalidad Materna/tendencias , Aceptación de la Atención de Salud , Atención Prenatal/estadística & datos numéricos , Garantía de la Calidad de Atención de Salud/métodos , Garantía de la Calidad de Atención de Salud/tendencias , Población Rural , MuestreoRESUMEN
PROBLEM: The speed and scope of the upheaval that COVID-19 inflicted on medical education made innovation a necessity. While medical students wanted high-quality, consolidated educational resources on COVID-19, the medical school faculty who typically produced such resources were increasingly burdened with clinical, administrative, and personal commitments. However, students eager to contribute to the pandemic response were well suited to create these instructional materials for their peers. APPROACH: In mid-March 2020, a group of students at Harvard Medical School came together to synthesize the key facts and collate the best existing educational materials about the COVID-19 pandemic into a unified learning resource. The materials were faculty reviewed and shared freely online. The curriculum now contains 8 modules that are updated regularly. Throughout this process, the student authors prioritized accessibility, iterative improvement, and effective pedagogy. OUTCOMES: To date, nearly 80,000 users from 132 countries have accessed the curriculum. It has been referenced or incorporated into courses at Harvard Medical School and more than 30 other medical schools across the country. About 40% of all users are from outside the United States, and the materials have been translated into 28 languages. This effort has spurred a number of other educational initiatives led by medical student groups in the United States and abroad. NEXT STEPS: As understanding of the COVID-19 pandemic is constantly changing, the student authors' immediate goal is to keep the curriculum up to date in the months to come. They plan to maintain existing partnerships with medical schools and student groups around the world while pursuing new opportunities to expand the curriculum's reach, provide education, and build community. Students and educators alike should leverage student-driven education efforts to benefit other learners both within and, importantly, beyond their institutions.
Asunto(s)
COVID-19 , Curriculum/tendencias , Educación Médica/organización & administración , Estudiantes de Medicina , Educación a Distancia/organización & administración , Educación a Distancia/tendencias , Humanos , Internet/tendencias , Nepal , Garantía de la Calidad de Atención de Salud/organización & administración , Garantía de la Calidad de Atención de Salud/tendenciasRESUMEN
Conoley, Powers, and Gutkin (2020) have provided an assessment of the progress and lack thereof of school psychology as a profession toward school reformation, especially as related to their various earlier calls for changes in training and practice. Conoley and Gutkin especially (and I have been colleagues of both) have called for decades for an emphasis on working with teachers, other adults in the school system, and the school system itself to alter the delivery of education. In some earlier work, they have characterized this as adult school psychology. In many ways this is a reconceptualization of earlier mental health consultation models of school psychology practice that were not widely adopted for reasons Conoley et al. (2020) explain. School psychology has a long history of wanting to be seen and to practice differently from in a primary role of test and place, and indeed I would characterize the primary organizations that represent the profession (the National Association of Psychologists and the American Psychological Association's Division of School Psychology) as being in many ways antagonistic toward psychological testing. Yet, it is what most school psychologists are in fact hired to do as their primary role, and training in psychological testing and assessment is one of the key skills that sets us apart and distinguishes us from others in the schools. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Asunto(s)
Educación Basada en Competencias/tendencias , Psicología Clínica/tendencias , Psicología Educacional/tendencias , Garantía de la Calidad de Atención de Salud/tendencias , Sociedades Científicas/tendencias , Aniversarios y Eventos Especiales , Curriculum/normas , Curriculum/tendencias , Práctica Clínica Basada en la Evidencia , Humanos , Competencia Profesional/normas , Psicología Clínica/educación , Psicología Educacional/educación , Garantía de la Calidad de Atención de Salud/normasRESUMEN
OBJECTIVE: To reduce extubation failure rate by implementing protocol-driven ventilation and extubation strategies. METHODS: Quality improvement project in a level II neonatal care unit from April 2017 to January 2018. Ventilation and extubation protocols implemented from 1 August, 2017. 18 ventilated newborns in the pre-protocol period, 16 in Plan-do-check-act (PDCA) cycle I and 17 in PDCA cycle II. Primary outcome was extubation failure within the first 72 h of extubation. RESULTS: Extubation failure rate reduced from 41.7% (pre-protocol period) to 23.8% (PDCA 1 and 2, OR 0.44, 95% CI 0.12 to 1.59, P = 0.21). Median time to first extubation attempt significantly decreased (71.5 h to 38 h, P=0.046). CONCLUSIONS: A protocolized approach through quality improvement initiative demonstrated a sustained improvement in successful extubation with a significant reduction in the median time to first extubation attempt in ventilated newborns.
Asunto(s)
Extubación Traqueal/normas , Garantía de la Calidad de Atención de Salud/métodos , Mejoramiento de la Calidad/tendencias , Desconexión del Ventilador/normas , Extubación Traqueal/métodos , Extubación Traqueal/tendencias , Protocolos Clínicos , Femenino , Humanos , Recién Nacido , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Garantía de la Calidad de Atención de Salud/tendencias , Desconexión del Ventilador/métodos , Desconexión del Ventilador/tendenciasRESUMEN
Acromegaly is characterized by increased release of growth hormone (GH) and, consequently, Insulin-Like Growth Factor I (IGF-I), most often by a pituitary adenoma. Prolonged exposure to excess hormone leads to progressive somatic disfigurement and a wide range of systemic manifestations that are associated with increased mortality. Transsphenoidal adenomectomy is the treatment of choice of GH-secreting pituitary tumors but surgical cure is not achieved in around 50% of patients, then adjuvant treatment is necessary. Mortality in acromegaly is normalized with biochemical control and has decreased in the last decade with the increased use of adjuvant therapy. Both GH and IGF-I are currently biomarkers for assessing disease activity in patients with acromegaly. However, discordance between GH and IGF-I results is encountered in a quarter of treated patients. The impacts of such a discrepancy over mortality and morbidity and the risk of biochemical and/or clinical recurrence are unclear. Moreover, despite a good biochemical control, some symptoms persist, leading to a decreased quality of life. Back pain due to vertebral fractures seem to be frequent in these patients and underdiagnosed. In patients with acromegaly, bone mineral density is not a reliable predictor of fracture risk. A more accurate evaluation of bone microstructural alterations associated with GH hypersecretion and vertebral fractures may be provided by new radiological devices analyzing alteration of trabecular microarchitecture, leading to a better prevention. © 2019 Published by Elsevier Masson SAS. All rights reserved. Cet article fait partie du numéro supplément Les Must de l'Endocrinologie 2019 réalisé avec le soutien institutionnel de Ipsen-Pharma.
Asunto(s)
Acromegalia/terapia , Garantía de la Calidad de Atención de Salud , Mejoramiento de la Calidad , Acromegalia/diagnóstico , Acromegalia/epidemiología , Acromegalia/etiología , Adenoma/complicaciones , Adenoma/epidemiología , Adenoma/metabolismo , Adenoma/terapia , Técnicas de Diagnóstico Endocrino/tendencias , Adenoma Hipofisario Secretor de Hormona del Crecimiento/complicaciones , Adenoma Hipofisario Secretor de Hormona del Crecimiento/epidemiología , Adenoma Hipofisario Secretor de Hormona del Crecimiento/metabolismo , Adenoma Hipofisario Secretor de Hormona del Crecimiento/terapia , Hormona de Crecimiento Humana/metabolismo , Humanos , Garantía de la Calidad de Atención de Salud/métodos , Garantía de la Calidad de Atención de Salud/tendenciasRESUMEN
Nurse leaders are dually responsible for resource stewardship and the delivery of high-quality care. However, methods to identify patient risk for hospital-acquired conditions are often outdated and crude. Although hospitals and health systems have begun to use data science and artificial intelligence in physician-led projects, these innovative methods have not seen adoption in nursing. We propose the Petri dish model, a theoretical hybrid model, which combines population ecology theory and human factors theory to explain the cost/benefit dynamics influencing the slow adoption of data science for hospital-based nursing. The proliferation of nurse-led data science in health systems may be facing several barriers: a scarcity of doctorally prepared nurse scientists with expertise in data science; internal structural inertia; an unaligned national "precision health" strategy; and a federal reimbursement landscape, which constrains-but does not negate the hard dollar business case. Nurse executives have several options: deferring adoption, outsourcing services, and investing in internal infrastructure to develop and implement risk models. The latter offers the best performing models. Progress in nurse-led data science work has been sluggish. Balanced partnerships with physician experts and organizational stakeholders are needed, as is a balanced PhD-DNP research-practice collaboration model.
Asunto(s)
Inteligencia Artificial/tendencias , Recolección de Datos/métodos , Atención a la Salud/métodos , Enfermedad Iatrogénica , Inteligencia Artificial/normas , Recolección de Datos/tendencias , Ciencia de los Datos , Humanos , Rol de la Enfermera , Garantía de la Calidad de Atención de Salud/tendenciasAsunto(s)
Servicios de Salud Comunitaria , Participación de la Comunidad , Salud Holística , Pautas de la Práctica en Medicina/ética , Medio Social , Servicios de Salud Comunitaria/ética , Servicios de Salud Comunitaria/tendencias , Vías Clínicas/ética , Humanos , Filosofía Médica , Garantía de la Calidad de Atención de Salud/métodos , Garantía de la Calidad de Atención de Salud/tendenciasAsunto(s)
Medicina General , Pautas de la Práctica en Medicina/tendencias , Garantía de la Calidad de Atención de Salud/tendencias , Indicadores de Calidad de la Atención de Salud/tendencias , Inglaterra , Medicina General/normas , Medicina General/tendencias , Humanos , Dinámica Poblacional , Servicios de Salud RuralRESUMEN
Head and Neck Cancer (HNC) radiation oncologists (ROs) enjoy the immense pleasure of curing patients, working within a large multidisciplinary team to effectively deliver curative intent treatment whilst also aiming to minimise late treatment toxicity. Secondary analyses of large-scale HNC clinical trials have shown the critical impact of the quality of radiotherapy plans, where protocol non-compliant plans have yielded inferior survival rates approximating 20%. The peer review process in routine day-to-day HNC practice shows that even in major academic centers a significant proportion of RT plans may require changes to the radiotherapy planning volume. Optimising the therapeutic ratio in HNC has been dramatically facilitated by intensity modulated radiotherapy (IMRT), but that technology has also increased the complexity of HNC radiotherapy treatment and high-volume centers with experienced clinicians may be best placed to deliver this most accurately. International consensus guidelines to standardise or benchmark best practice with respect to the RT-QA process in HNC are needed. The aim of this paper is to highlight the importance of the RT-QA process in the HNC treatment process and to make some recommendations for its inclusion in both clinical trials and routine clinical practice.
Asunto(s)
Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/terapia , Garantía de la Calidad de Atención de Salud/métodos , Garantía de la Calidad de Atención de Salud/tendencias , Radioterapia de Intensidad Modulada/métodos , Predicción , Humanos , Aprendizaje Automático , Revisión por Expertos de la Atención de Salud/métodos , Revisión por Expertos de la Atención de Salud/tendencias , Oncólogos de Radiación , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador/métodos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Antecedentes. El modelo biopsicosocial propone que la atención de la salud se centre en las necesidades de las personas.Sin embargo, no siempre los profesionales de la salud conocen adecuadamente lo que esperan de los encuentros clínicos sus pacientes. Objetivo. Explorar las expectativas respecto de sus encuentros clínicos de los/as pacientes atendidos por médicos de familia en un Centro de Salud de Atención Primaria del Conurbano Bonaerense (Buenos Aires, Argentina). Métodos. Estudio observacional descriptivo de corte transversal llevado a cabo sobre una muestra consecutiva de pacientes que acudieron a las consultas médicas de un centro de salud. Se les pidió a los pacientes que de un listado de diez potenciales expectativas, valoraran y priorizaran las más importantes para esa consulta. Resultados. Fueron entrevistadas 146 personas (91 % mujeres) con una mediana de edad de 30 años.Las expectativas más mencionadas (94 % de las personas encuestadas) fueron que el médico demuestre interés y escuche a sus pacientes, y que les brinde explicaciones sobre sus problemas y dudas. Conclusiones. Hemos podido documentar que las expectativas de nuestros pacientes respecto de sus entrevistas clínicas están muy vinculadas a su componente actitudinal (predisposición a escuchar con interés sus problemas) y al de las habilidades comunicacionales del profesional de la salud (explicaciones). (AU)
Background. The biopsychosocial model proposes that health care focus on the needs of people. However, health profes-sionals do not always know what their patients expect from clinical meetings. Objective. To explore the expectations regarding their clinical meetings of the patients attended by family doctors in aPrimary Health Care Center of Buenos Aires, Argentina. Methods. Descriptive cross-sectional observational study carried out on a consecutive sample of patients who attendedthe medical consultations of a health center. Patients were asked to rate and prioritize the most important ones for thatconsultation from a list of ten potential expectations. Results. 146 people (91 % women) with a median age of 30 years were interviewed.The most mentioned expectations (94 % of the people surveyed) were for the doctor to show interest and listen to theirpatients, and to give them explanations about their problems and doubts. Conclusions. We have been able to document that our patients' expectations regarding their clinical interviews are closelylinked to their attitudinal component (predisposition to listen with interest to their problems) and to the communication skillsof the healthcare professional (explanations). (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Adulto Joven , Satisfacción del Paciente , Medicina Familiar y Comunitaria/tendencias , Argentina , Relaciones Médico-Paciente , Médicos de Familia/tendencias , Atención Primaria de Salud/tendencias , Garantía de la Calidad de Atención de Salud/tendencias , Calidad de la Atención de Salud/tendencias , Estudios Transversales/estadística & datos numéricos , Competencia Clínica , Atención Dirigida al Paciente/tendencias , Empatía , Prioridad del Paciente/psicología , Comunicación en Salud/métodosRESUMEN
BACKGROUND: The Federal Joint Committee of Germany defined structural and staff requirements for the care of preterm and term infants as a proxy measure for quality. Neonatal outcome has been evaluated as a quality marker for a long time. While Germany has one of the highest preterm birth rates in Europe, no data exist on centre-specific preterm birth rates. METHODS: Over 2 years, all pregnant women admitted to six centres for perinatal medicine in Baden-Württemberg at a gestational age between 22+0 and 31+6 weeks were eligible (n=2972). The preterm birth rate before 32 wks of gestation was evaluated if at least one of the following secondary inclusion criteria was present within 24 h after admission: 1) premature rupture of membranes, 2) cervical length less than 25 mm, or 3) more than 3 contractions of at least 30-s duration within a 30-min period. Neonatal outcome could be documented for 70.6% of infants. RESULTS: Of the women who met at least one secondary inclusion criterion (n=1325), 21.1% (n=279) delivered 344 preterm infants before 32 weeks. The preterm birth rate was between 16.8 and 27.9% (11.1% difference). A lower preterm birth rate was not associated with a worse neonatal outcome. CONCLUSION: Preterm birth rate should become a quality indicator for perinatal care. A reduction of the preterm birth rate of 5% could help to reduce the number of preterm infants by up to 2,400 per year in Germany (about 25%).
Asunto(s)
Centros de Asistencia al Embarazo y al Parto/estadística & datos numéricos , Recién Nacido de muy Bajo Peso , Trabajo de Parto Prematuro/epidemiología , Atención Perinatal/estadística & datos numéricos , Garantía de la Calidad de Atención de Salud/tendencias , Estudios Transversales , Femenino , Predicción , Alemania , Humanos , Recién Nacido , Masculino , Trabajo de Parto Prematuro/prevención & control , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Embarazo , Mejoramiento de la Calidad/tendenciasRESUMEN
Since the publication of the ordinance of January 13th 2010, ratified by the law of May 30th 2013, medical biology in France has undergone a massive restructuration with the emergence of groups of several hundred laboratories. This evolution, which leads to a considerable reduction in the number of structures, causes numerous problems related to increased industrialization and financialization, difficulties of accreditation and disappearance of the proximity link between the biologist and the prescriber or the patient. It also leads to a clear disaffection of students, especially medical students, for this specialty whose medical character has been clearly affirmed by the law. This report takes stock of the current situation of medical biology and makes recommendations to strengthen the role of the medical biologist in the health system and patients' care.
Asunto(s)
Biología/tendencias , Laboratorios/tendencias , Ciencia del Laboratorio Clínico/tendencias , Acreditación/legislación & jurisprudencia , Biología/métodos , Biología/organización & administración , Biología/normas , Francia , Humanos , Laboratorios/legislación & jurisprudencia , Laboratorios/organización & administración , Laboratorios/normas , Ciencia del Laboratorio Clínico/legislación & jurisprudencia , Ciencia del Laboratorio Clínico/organización & administración , Ciencia del Laboratorio Clínico/normas , Garantía de la Calidad de Atención de Salud/legislación & jurisprudencia , Garantía de la Calidad de Atención de Salud/organización & administración , Garantía de la Calidad de Atención de Salud/tendencias , Control de CalidadRESUMEN
No disponible
Asunto(s)
Humanos , Unidades Hospitalarias/tendencias , Eccema/epidemiología , Dermatología/organización & administración , Dermatitis/epidemiología , Calidad de la Atención de Salud/organización & administración , Calidad de la Atención de Salud/tendencias , Dermatología/normas , Pruebas del Parche/tendencias , Garantía de la Calidad de Atención de Salud/tendencias , Instituciones de Atención Ambulatoria/tendenciasRESUMEN
No disponible
Asunto(s)
Humanos , Consulta Remota/tendencias , Dermatología/métodos , Enfermedades de la Piel/diagnóstico , Telemedicina/métodos , Dermatología/educación , Dermatología/organización & administración , Telemedicina/instrumentación , Telemedicina/organización & administración , Garantía de la Calidad de Atención de Salud/tendencias , Calidad de la Atención de SaludRESUMEN
Artificial intelligence (AI) is emerging as a technology with the power to transform established industries, and with applications from automated manufacturing to advertising and facial recognition to fully autonomous transportation. Advances in each of these domains have led some to call AI the "fourth" industrial revolution [1]. In healthcare, AI is emerging as both a productive and disruptive force across many disciplines. This is perhaps most evident in Diagnostic Radiology and Pathology, specialties largely built around the processing and complex interpretation of medical images, where the role of AI is increasingly seen as both a boon and a threat. In Radiation Oncology as well, AI seems poised to reshape the specialty in significant ways, though the impact of AI has been relatively limited at present, and may rightly seem more distant to many, given the predominantly interpersonal and complex interventional nature of the specialty. In this overview, we will explore the current state and anticipated future impact of AI on Radiation Oncology, in detail, focusing on key topics from multiple stakeholder perspectives, as well as the role our specialty may play in helping to shape the future of AI within the larger spectrum of medicine.