Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.199
Filtrar
1.
Lancet Glob Health ; 8(6): e780-e789, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32389195

RESUMEN

BACKGROUND: As coronavirus disease 2019 (COVID-19) spreads, weak health systems must not become a vehicle for transmission through poor infection prevention and control practices. We assessed the compliance of health workers with infection prevention and control practices relevant to COVID-19 in outpatient settings in Tanzania, before the pandemic. METHODS: This study was based on a secondary analysis of cross-sectional data collected as part of a randomised controlled trial in private for-profit dispensaries and health centres and in faith-based dispensaries, health centres, and hospitals, in 18 regions. We observed provider-patient interactions in outpatient consultation rooms, laboratories, and dressing rooms, and categorised infection prevention and control practices into four domains: hand hygiene, glove use, disinfection of reusable equipment, and waste management. We calculated compliance as the proportion of indications (infection risks) in which a health worker performed a correct action, and examined associations between compliance and health worker and facility characteristics using multilevel mixed-effects logistic regression models. FINDINGS: Between Feb 7 and April 5, 2018, we visited 228 health facilities, and observed at least one infection prevention and control indication in 220 facilities (118 [54%] dispensaries, 66 [30%] health centres, and 36 [16%] hospitals). 18 710 indications were observed across 734 health workers (49 [7%] medical doctors, 214 [29%] assistant medical officers or clinical officers, 106 [14%] nurses or midwives, 126 [17%] clinical assistants, and 238 [32%] laboratory technicians or assistants). Compliance was 6·9% for hand hygiene (n=8655 indications), 74·8% for glove use (n=4915), 4·8% for disinfection of reusable equipment (n=841), and 43·3% for waste management (n=4299). Facility location was not associated with compliance in any of the infection prevention and control domains. Facility level and ownership were also not significantly associated with compliance, except for waste management. For hand hygiene, nurses and midwives (odds ratio 5·80 [95% CI 3·91-8·61]) and nursing and medical assistants (2·65 [1·67-4·20]) significantly outperformed the reference category of assistant medical officers or clinical officers. For glove use, nurses and midwives (10·06 [6·68-15·13]) and nursing and medical assistants (5·93 [4·05-8·71]) also significantly outperformed the reference category. Laboratory technicians performed significantly better in glove use (11·95 [8·98-15·89]), but significantly worse in hand hygiene (0·27 [0·17-0·43]) and waste management (0·25 [0·14-0·44] than the reference category. Health worker age was negatively associated with correct glove use and female health workers were more likely to comply with hand hygiene. INTERPRETATION: Health worker infection prevention and control compliance, particularly for hand hygiene and disinfection, was inadequate in these outpatient settings. Improvements in provision of supplies and health worker behaviours are urgently needed in the face of the current pandemic. FUNDING: UK Medical Research Council, Economic and Social Research Council, Department for International Development, Global Challenges Research Fund, Wellcome Trust.


Asunto(s)
Instituciones de Atención Ambulatoria , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Adhesión a Directriz/estadística & datos numéricos , Control de Infecciones/normas , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Guías de Práctica Clínica como Asunto , Estudios Transversales , Humanos , Tanzanía/epidemiología
2.
J Korean Med Sci ; 35(12): e72, 2020 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-32233156

RESUMEN

BACKGROUND: There could be a gap between asthma management guidelines and current practice. We evaluated the awareness of and compliance with asthma management guidelines, and the internal and external barriers to compliance, for the first time in Korea. METHODS: From March to September of 2012, 364 physicians treating asthma patients at primary, secondary, and tertiary teaching hospitals were enrolled. They completed a questionnaire on the awareness of and compliance with asthma management guidelines, and the barriers and alternatives to their implementation. RESULTS: Of the 364 physicians, 79.1% were men and 56.9% were primary care physicians. The mean age was 40.5 ± 11.2 years. Most of them were aware of asthma management guidelines (89.3%). However, only a portion (11.0%) of them complied with the guidelines for asthma. Pulmonary function tests for diagnosis of asthma were performed by 20.1% of all physicians and 9.2% of primary care physicians, and by 9.9% of all physicians and 5.8% of primary care physicians for monitoring. Physicians stated that 'asthma monitoring' was the most difficult part of the guidelines, followed by 'environmental control and risk factors.' Only 39.6% (31.9% of the primary care physicians) prescribed an inhaled corticosteroid (ICS) as the first-line treatment for persistent asthma. The internal barriers were physician's preference for oral medications, difficulty in use even with inhaler training, and concern over ICS side effects. The external barriers were possible rejection of medical reimbursement by health insurance, refusal by the patient, cost, and a poor environment for teaching the patient how to use the inhaler. Alternatives proposed by physicians to implement asthma management guidelines were to improve medical reimbursement policies and the level of awareness of such guidelines. CONCLUSION: Compliance with the asthma management guidelines, including ICS prescription, is low despite the awareness of the guidelines. It is necessary to develop a strategy to overcome the internal and external barriers.


Asunto(s)
Corticoesteroides/administración & dosificación , Asma , Adhesión a Directriz , Administración por Inhalación , Adulto , Asma/diagnóstico , Asma/tratamiento farmacológico , Actitud del Personal de Salud , Manejo de la Enfermedad , Femenino , Adhesión a Directriz/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Médicos , Pautas de la Práctica en Medicina/estadística & datos numéricos , República de Corea , Pruebas de Función Respiratoria
3.
Medicine (Baltimore) ; 99(17): e19873, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32332654

RESUMEN

To measure Primary Health Care physicians' knowledge of and adherence to the Saudi Hypertension Management Guidelines (SHMGs) in Southwest of Saudi Arabia.This study was a cross-sectional investigation where data was collected via a self-administered questionnaire. The demographics of the physicians, data related to the source of the guidelines for hypertension management, knowledge about the SHMGs and physicians' adherence to the SHMG were collected. Student's t test was used to assess the presence of any statistical difference between the level of knowledge and adherence according to the study's measured variables.A total of 316 physicians participated in this investigation, representing 65% of all the PHC physicians in the Jazan region. The number of correct answers measuring knowledge about various topics varied between 18% and 94% with a mean overall score of 7.9/16. The number of reported practices adherent to the guidelines varied between 2% and 97%, and the mean overall score was 7.2/11. Receiving hypertension management guidelines from the Directory of Health was statistically associated with a higher level of knowledge (P value < .05). Undergoing clinical training for hypertension management and seeing fewer numbers of patients on a daily basis was associated with a statistically higher level of adherence to the guidelines (P value < .05).Improper distribution of guidelines, lack of continuous clinical training, negative attitude of physicians toward guidelines and large number of patients seen by physicians are likely to hinder translating guidelines to actual clinical practice.


Asunto(s)
Competencia Clínica/normas , Adhesión a Directriz/normas , Hipertensión/tratamiento farmacológico , Médicos de Atención Primaria/normas , Adulto , Actitud del Personal de Salud , Competencia Clínica/estadística & datos numéricos , Estudios Transversales , Femenino , Adhesión a Directriz/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Médicos de Atención Primaria/estadística & datos numéricos , Arabia Saudita , Autoinforme , Encuestas y Cuestionarios
4.
Rev Saude Publica ; 54: 42, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32321058

RESUMEN

OBJECTIVE: To describe students protected by laws and exposed to soft drinks sales and assess whether forbidding laws are associated with lower availability of these beverages. METHODS: We identified laws forbidding non-government administered cafeterias or sales of soft drinks in schools in the 27 Brazilian state capitals. Data on soft drinks sales were obtained from Pesquisa Nacional de Saúde do Escolar 2015 (PeNSE - National Survey of School Health 2015), for a representative sample of 9th graders from public and private schools. Students were attributed with the status of their school regarding the law and sale of soft drinks. Co-variables were school status (public or private), school size, geographic regions, mother's educational level, score of goods and services. We performed multivariate analyses using Poisson regression. RESULTS: The total of 23 laws forbidding sales of soft drinks covered 63.0% of capitals, comprising 56.9% of students. Law coverage was higher among students from more developed regions (67.6%) and in public schools (60.6%), compared with those from less developed regions (38.0%) and private schools (45.8%). Soft drinks were available for 33.9% of students. Students attending public schools in less developed regions had the lowest availability of soft drinks, regardless of law coverage (14.8%; 12.0%); while students attending private schools in these regions had a high availability, regardless of law coverage (82.1%; 73.4%). Restrictive laws were associated with lower sales of soft drinks in more developed regions, and restrictions had a greater association with the availability of soft drinks in public schools (PR = 0.25; 95%CI = 0.15-0.41), compared with private schools (PR = 0.48; 95%CI = 0.35-0.66). CONCLUSION: Laws restricting soft drinks in schools were associated with fewer sales in more developed regions. Private schools were less compliant with the law than public schools. A broadly enforced national law could reduce the availability of soft drinks in schools.


Asunto(s)
Bebidas Gaseosas/legislación & jurisprudencia , Comercio/legislación & jurisprudencia , Instituciones Académicas/legislación & jurisprudencia , Brasil , Adhesión a Directriz/estadística & datos numéricos , Humanos , Sector Privado/legislación & jurisprudencia , Sector Público/legislación & jurisprudencia , Instituciones Académicas/estadística & datos numéricos , Estudiantes/estadística & datos numéricos , Encuestas y Cuestionarios
5.
BMJ ; 369: m982, 2020 Apr 14.
Artículo en Inglés | MEDLINE | ID: mdl-32291261

RESUMEN

OBJECTIVES: To evaluate the compliance with prospective registration and inclusion of the trial registration number (TRN) in published randomised controlled trials (RCTs), and to analyse the rationale behind, and detect selective registration bias in, retrospective trial registration. DESIGN: Cross sectional analysis. DATA SOURCES: PubMed, the 17 World Health Organization's trial registries, University of Toronto library, International Committee of Medical Journal Editors (ICMJE) list of member journals, and the InCites Journal Citation Reports. STUDY SELECTION CRITERIA: RCTs registered in any WHO trial registry and published in any PubMed indexed journal in 2018. RESULTS: This study included 10 500 manuscripts published in 2105 journals. Overall, 71.2% (7473/10500) reported the TRN and 41.7% (3013/7218) complied with prospective trial registration. The univariable and multivariable analyses reported significant relations (P<0.05) between reporting the TRN and the impact factor and ICMJE membership of the publishing journal. A significant relation (P<0.05) was also observed between prospective trial registration and the registry, region, condition, funding, trial size, interval between paper registration and submission dates, impact factor, and ICMJE membership of the publishing journal. A manuscript published in an ICMJE member journal was 5.8 times more likely to include the TRN (odds ratio 5.8, 95% confidence interval 4.0 to 8.2), and a published trial was 1.8 times more likely to be registered prospectively (1.8, 1.5 to 2.2) when published in an ICMJE member journal compared with other journals. This study detected a new form of bias, selective registration bias, with a higher proportion (85.2% (616/723)) of trials registered retrospectively within a year of submission for publication. Higher rates of retrospective registrations were observed within the first three to eight weeks after enrolment of study participants. Within the 286 RCTs registered retrospectively and published in an ICMJE member journal, only 2.8% (8/286) of the authors included a statement justifying the delayed registration. Reasons included lack of awareness, error of omission, and the registration process taking longer than anticipated. CONCLUSIONS: This study found a high compliance in reporting of the TRN for trial papers published in ICMJE member journals, but prospective trial registration was low.


Asunto(s)
Adhesión a Directriz/estadística & datos numéricos , Declaración de Helsinki , Edición/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Proyectos de Investigación/estadística & datos numéricos , Estudios Transversales , Edición/normas , Ensayos Clínicos Controlados Aleatorios como Asunto/normas , Proyectos de Investigación/normas
6.
Nursing ; 50(4): 63-69, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32195880

RESUMEN

Accurate BP measurements are vital for determining appropriate medication and treatment regimens. This article describes a quality improvement project to increase compliance with the American Heart Association's guidelines for BP measurement.


Asunto(s)
Determinación de la Presión Sanguínea/enfermería , Adhesión a Directriz/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Mejoramiento de la Calidad/organización & administración , American Heart Association , Humanos , Investigación en Evaluación de Enfermería , Personal de Enfermería en Hospital/educación , Reproducibilidad de los Resultados , Estados Unidos
7.
PLoS One ; 15(2): e0229356, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32092100

RESUMEN

Food allergy is an emerging clinical condition in pediatrics, so recommendations on its management have been widely published. Studying pediatricians' adherence to these clinical practice guidelines (CPG) and understanding the reasons for their non-compliance can help to promote better management of this condition. A cross-sectional study was conducted by a survey among Brazilian pediatricians, randomly selected during the 38th Brazilian Congress of Pediatrics, which took place in October, 2017. A validated questionnaire with 16 questions addressing knowledge and practice on food allergy, as well as self-reported adherence to international guidelines was applied. Of the total of 415 pediatricians from all regions of the country who were surveyed, only 69 (16.7%) had a satisfactory adherence rate (≥80%). Adequate adherence to the guidelines was associated with the variables: 'evaluating more than 10 children with suspected cow's milk allergy (CMA) per month'; 'having read the Brazilian consensus'; or 'being aware of any international food allergy guideline'. In 8 of the 10 questions that assessed conscious adherence, a minority of those surveyed (20.3-42.3% variation) stated that they knew that their response was in line with the guidelines. This finding was statistically significant (p<0.05) in 7 of these 8 questions. The self-reported adherence of Brazilian pediatricians to international food allergy guidelines was low. Pediatricians who evaluated a higher number of children with suspected CMA or who were aware of the recommendations, had a higher rate of adherence. The results of the survey found that lack of resource was the major reported barrier to guideline adherence but lack of awareness must be a relevant non perceived barrier. This study shows the pediatricians´ self-reported adherence to food allergy guidelines in a widely overview for the first time in Brazil. More studies are necessary to investigate adherence to guidelines by pediatricians in other countries and to develop strategies to improve adherence.


Asunto(s)
Hipersensibilidad a los Alimentos/terapia , Adhesión a Directriz/estadística & datos numéricos , Pediatras/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Concienciación , Brasil/epidemiología , Estudios Transversales , Femenino , Hipersensibilidad a los Alimentos/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Hipersensibilidad a la Leche/epidemiología , Hipersensibilidad a la Leche/terapia , Pediatras/normas , Pautas de la Práctica en Medicina/normas , Encuestas y Cuestionarios
8.
BMC Public Health ; 20(1): 172, 2020 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-32019508

RESUMEN

BACKGROUND: Policies to improve healthy food retail have been recognized as a potential means of reducing diet-related health disparities. The revised 2014 Minneapolis Staple Foods Ordinance instituted minimum stocking standards for healthy, staple foods. The objective of this study was to examine retailer compliance with the policy, and whether compliance varied by neighborhood and store characteristics. METHODS: In this natural experiment, audits were conducted annually pre- and post-ordinance (2014-2017) in 155 small/nontraditional stores in Minneapolis, MN and a comparison city (St. Paul, MN). Compliance measures for 10 product categories included: (1) met requirements for ≥8 categories; (2) 10-point scale (one point for each requirement met); and (3) carried any item in each category. Store characteristics included store size and ownership status. Neighborhood characteristics included census-tract socioeconomic status and low-income/low-access status. Analyses were conducted in 2018. RESULTS: All compliance measures increased in both Minneapolis and St. Paul from pre- to post-policy; Minneapolis increases were greater only for carrying any item in each category (p < 0.01). In Minneapolis, corporate (vs. independent) stores were generally more compliant. No differences were found by neighborhood characteristics. CONCLUSIONS: Overall trends suggest broad movement among Minneapolis stores towards providing a minimum level of staple foods. Increases were greater in corporate stores. Trends do not suggest neighborhood-level disparities in compliance. STUDY REGISTRATION: ClinicalTrials.gov NCT02774330, retrospectively registered May 17, 2016.


Asunto(s)
Comercio/estadística & datos numéricos , Adhesión a Directriz/estadística & datos numéricos , Política Nutricional , Características de la Residencia/estadística & datos numéricos , Humanos , Minnesota , Factores Socioeconómicos
9.
PLoS One ; 15(2): e0228715, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32045446

RESUMEN

BACKGROUND: Head injuries in children are a common and potentially devastating presentation. The CareTrack Kids (CTK) study assessed care of Australian children aged 0-15 years, in 2012 and 2013, to evaluate the proportion in line with guideline-based indicators for 17 common conditions. Overall adherence to guideline-based recommended practice occurred 59.8% of care encounters (95% CI: 57.5-62.0), and 78.3% (95% CI: 75.1-81.2) for head injury. This paper presents results for head injury, at indicator level. METHODS: A modified version of the RAND-UCLA method of indicator development was used. Indicators, measurable components of a standard or guideline, were developed from international and national guidelines relating to head injury in children and were ratified by clinical experts using a Delphi process. Paediatric nurses extracted data from medical records from general practitioners (GPs), emergency departments (EDs) and inpatient wards in Queensland, New South Wales and South Australia, for children under 15 years receiving care in 2012-13. Our purpose was to estimate the percentage adherent for each indicator. RESULTS: The medical records of 629 children with head injury were examined. Fifty-one percent of children were under 5 years old, with more males (61%) than females. Thirty-eight indicators were assessed. Avoidance of nasotracheal airways (100%; 95% CI: 99.4-100) or nasogastric tubes (99.7%; 95% CI: 98.5-100) for children with a head injury had the highest adherence. Indicators relating to primary and secondary assessment of head injuries were mostly adhered to. However, adherence to other indicators was poor (e.g., documentation of the past history of children (e.g., presence or absence of seizures) before the injury; 29.9% (95% CI: 24.5-35.7)), and for others was difficult to estimate with confidence due to small sample sizes (e.g., Children with a head injury who were intubated had PaO2 above 80mm Hg; 56.0% (95% CI: 28.6-80.9)). Indicators guiding clinical decision making regarding the need for CT scan had insufficient data to justify reporting. CONCLUSION: This study highlights that management of head injury in children mostly follows guidelines, but also flags some specific areas of inconsistency. Individual sites are encouraged to use these results to guide investigation of local practices and inform quality improvement endeavours.


Asunto(s)
Traumatismos Craneocerebrales/terapia , Adhesión a Directriz/estadística & datos numéricos , Adolescente , Australia , Niño , Preescolar , Bases de Datos Factuales , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Indicadores de Calidad de la Atención de Salud , Estudios Retrospectivos
10.
N Z Med J ; 133(1510): 16-22, 2020 02 21.
Artículo en Inglés | MEDLINE | ID: mdl-32078597

RESUMEN

AIM: Previous generation contrast agents were associated with high rates of nausea, vomiting and risk of aspiration leading to recommendations to fast prior to the procedure. However, modern contrast agents are well tolerated with a low risk of aspiration. Our current guidelines recommend fasting four to six hours before elective and semi-urgent cardiac catheterisation despite a lack of evidence to support this. We sought to determine the duration and effects of fasting at our centre. METHODS: A single-centre prospective observational study in patients undergoing elective cardiac catheterisation over a six-month period between 7 August 2017 to 7 February 2018 at Auckland City Hospital, New Zealand. RESULTS: One thousand and thirty patients with a mean age of 66±12 years underwent catheterisation. Sixty-seven percent were male, 26% had diabetes, 72% had hypertension and 23% had stage 3 or worse chronic kidney disease. The mean duration of fasting was 11.6±4.9 hours with 80% fasting longer than recommended. One hundred and eight (48%) patients with documented chronic kidney disease did not receive recommended pre-hydration. The most common symptoms related to fasting were hunger (47 %), nausea (3.9%) and vomiting (0.8%). Hypertension (4.1%) and hyperglycaemia (0.8%) occurred due to missed medication. There were no reports of aspiration. CONCLUSION: Most patients were fasted for significantly longer than recommended and pre-hydration was underutilised in patients at high risk of contrast-induced nephropathy. There were no episodes of aspiration with modern contrast agents. Further studies are required to evaluate the need for fasting prior to non-emergency cardiac catheterisation.


Asunto(s)
Cateterismo Cardíaco , Ayuno/efectos adversos , Adhesión a Directriz/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Cuidados Preoperatorios/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Cuidados Preoperatorios/efectos adversos , Cuidados Preoperatorios/normas , Cuidados Preoperatorios/estadística & datos numéricos , Estudios Prospectivos , Factores de Tiempo
11.
Angiology ; 71(5): 431-437, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32066246

RESUMEN

We describe the characteristics of ambulatory patients with heart failure with reduced ejection fraction (HFrEF) in the Gulf region (Middle East) and the implementation of guideline-recommended treatments. We included 2427 HFrEF outpatients (mean age 59 ± 13 years, 75% males and median left ventricular ejection fraction [LVEF] of 30%). A high proportion of patients received guideline-recommended medications (angiotensin-converting enzyme inhibitor [ACEI]/angiotensin receptor blocker [ARB]/angiotensin receptor-neprilysin inhibitor [ARNI] 87%, ß-blocker 91%, mineralocorticoid antagonist [MRA] 64%). However, only a minority of patients received guideline-recommended target doses (ACEI/ARB/ARNI 13%, ß-blocker 27%, and MRA 4.4%). Old age was a significant independent predictor for not prescribing treatment (P < .001 for ACEI/ARB/ARNI and MRA; and P = .002 for ß-blockers). Other independent predictors were chronic kidney disease (for both ACEI/ARB/ARNI and MRA, P < .001) and higher LVEF (P = .014 for ß-blockers and P < .001 for MRA). Patients with HFrEF managed by heart failure specialists more often received recommended target doses of ACEI/ARB/ARNI (40% vs 11%, P < .001) and ß-blockers (56% vs 26%, P < .001) compared to those treated by general cardiologists. Although the majority of our patients with HFrEF received guideline-recommended medications, the doses they were prescribed were suboptimal. Understanding the reasons behind this is important for improved practice.


Asunto(s)
Adhesión a Directriz/estadística & datos numéricos , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/fisiopatología , Volumen Sistólico , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
12.
Einstein (Sao Paulo) ; 18: eAO4995, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32074221

RESUMEN

OBJECTIVE: To describe antiretroviral treatment regimens prescribed and their compliance with the Clinical Protocol and Therapy Guidelines of the Ministry of Health for the management of HIV infection. METHODS: Observational and descriptive study. Secondary data of the state of Paraná (Brazil) on drugs, treatment regimens, lines of treatment and number of individuals on treatment, from January to June 2018, were accessed at the Antiretroviral Agents Logistic Control System. Combinations of antiretroviral drugs (treatment regimens) were compared according to the current Clinical Protocol and Therapy Guidelines and non-compliances were classified and quantified. RESULTS: In Paraná, 35,127 individuals with HIV were treated with 253 different treatment regimens. Of the prescribed regimens, 19.1% were first-line, 27.4% second-line and 48.5% third-line. Among non-compliances, the most prevalent were absence of association of protease inhibitors and ritonavir (42.8%), low efficacy triple therapy (36.9%), double therapy (26.1%), monotherapy (20.3%), and triple therapy of nucleoside analog reverse transcriptase inhibitors (17.1%). CONCLUSION: Most individuals receiving HIV treatment in the state of Paraná are on treatment regimens established in the current Clinical Protocol and Therapy Guidelines, which contributes to successful therapy. However, associations not provided by the current Clinical Protocol and Therapy Guidelines were identified in the initial treatment lines, which could lead to ineffectiveness, virologic failure and viral resistance.


Asunto(s)
Antirretrovirales/administración & dosificación , Protocolos Clínicos/normas , Adhesión a Directriz/normas , Cumplimiento de la Medicación , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/uso terapéutico , Antirretrovirales/uso terapéutico , Brasil , Quimioterapia Combinada/normas , Quimioterapia Combinada/estadística & datos numéricos , Adhesión a Directriz/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Humanos , Cumplimiento de la Medicación/estadística & datos numéricos
14.
Anesth Analg ; 130(4): 910-916, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31922998

RESUMEN

BACKGROUND: The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend a bundle of different measures for patients at increased risk of acute kidney injury (AKI). Prospective, single-center, randomized controlled trials (RCTs) have shown that management in accordance with the KDIGO recommendations was associated with a significant reduction in the incidence of postoperative AKI in high-risk patients. However, compliance with the KDIGO bundle in routine clinical practice is unknown. METHODS: This observational prevalence study was performed in conjunction with a prospective RCT investigating the role of the KDIGO bundle in high-risk patients undergoing cardiac surgery. A 2-day observational prevalence study was performed in all participating centers before the RCT to explore routine clinical practice. The participating hospitals provided the following data: demographics and surgical characteristics, AKI rates, and compliance rates with the individual components of the bundle. RESULTS: Ninety-five patients were enrolled in 12 participating hospitals. The incidence of AKI within 72 hours after cardiac surgery was 24.2%. In 5.3% of all patients, clinical management was fully compliant with all 6 components of the bundle. Nephrotoxic drugs were discontinued in 52.6% of patients, volume optimization was performed in 70.5%, 52.6% of the patients underwent functional hemodynamic monitoring, close monitoring of serum creatinine and urine output was undertaken in 24.2% of patients, hyperglycemia was avoided in 41.1% of patients, and no patient received radiocontrast agents. The patients received on average 3.4 (standard deviation [SD] ±1.1) of 6 supportive measures as recommended by the KDIGO guidelines. There was no significant difference in the number of applied measures between AKI and non-AKI patients (3.2 [SD ±1.1] vs 3.5 [SD ±1.1]; P = .347). CONCLUSIONS: In patients after cardiac surgery, compliance with the KDIGO recommendations was low in routine clinical practice.


Asunto(s)
Lesión Pulmonar Aguda/prevención & control , Procedimientos Quirúrgicos Cardíacos/métodos , Adhesión a Directriz/estadística & datos numéricos , Enfermedades Renales/terapia , Complicaciones Posoperatorias/prevención & control , Lesión Pulmonar Aguda/epidemiología , Adulto , Anciano , Estudios de Cohortes , Creatinina/sangre , Creatinina/orina , Femenino , Humanos , Incidencia , Enfermedades Renales/complicaciones , Pruebas de Función Renal , Tiempo de Internación , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico , Prevalencia , Estudios Prospectivos
15.
BMC Health Serv Res ; 20(1): 27, 2020 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-31914998

RESUMEN

BACKGROUND: Familial hypercholesterolaemia (FH) is a genetic condition characterised by elevated levels of low-density lipoprotein cholesterol (LDL-C) and an increased risk of cardiovascular disease (CVD). Following dietary and physical activity guidelines could help minimise this risk but adherence is low. Interventions to target these behaviours are therefore required. A comprehensive understanding of the target behaviours and behaviour change theory should drive the process of intervention development to increase intervention effectiveness and scalability. This paper describes the application of a theoretical framework to the findings of a qualitative evidence synthesis (QES) to inform the content and delivery of an intervention to improve adherence to dietary and physical activity guidelines in individuals with FH. METHODS: The Behaviour Change Wheel (BCW) was used to guide intervention development. Factors influencing dietary and physical activity behaviours were identified from an earlier QES and mapped onto factors within the BCW. A comprehensive behavioural diagnosis of these factors was conducted through application of the theoretical domains framework (TDF). Using these data, the most appropriate intervention functions and behaviour change techniques (BCTs) for inclusion in the intervention were identified. Decision making was guided by evaluation criteria recommended by BCW guidance and feedback from individuals with FH. RESULTS: Factors influencing dietary and physical activity behaviours mapped onto twelve of the fourteen TDF domains, with seven intervention functions deemed suitable to target the domains' theoretical constructs. Twenty-six BCTs were identified as being appropriate for delivery within these functions and were included in the intervention. For instance, within the enablement intervention function, the BCT problem solving was incorporated by inclusion of a 'barriers and solutions' section. Guided by evaluation criteria and feedback from individuals with FH, the intervention will be delivered as an hour-long family-based appointment, followed up with four telephone calls. CONCLUSIONS: The novel application of the BCW and TDF to the results of a QES has enabled the development of a theory and evidence informed behaviour change intervention. This systematic approach facilitates evaluation of the intervention as part of an ongoing feasibility trial. The transparent approach taken can be used to guide intervention development by researchers in other fields.


Asunto(s)
Dieta/psicología , Ejercicio Físico/psicología , Adhesión a Directriz/estadística & datos numéricos , Guías como Asunto , Promoción de la Salud/métodos , Promoción de la Salud/organización & administración , Hiperlipoproteinemia Tipo II/terapia , Estudios de Factibilidad , Humanos , Teoría Psicológica , Investigación Cualitativa
16.
BMC Public Health ; 20(1): 1, 2020 Jan 02.
Artículo en Inglés | MEDLINE | ID: mdl-31898494

RESUMEN

BACKGROUND: Primary care patients with prediabetes is a priority group in the clinical, organisational and policy contexts. Engaging in regular physical activity is crucial to prevent diabetes for this group. The objectives of the study were to assess factors associated with meeting the recommendation of at least 150 min of moderate/vigorous physical activity weekly, and to explore facilitators and barriers related to the behaviour among primary care patients with prediabetes in Singapore. METHODS: This was a mixed methods study, consisting of a cross-sectional survey involving 433 participants from 8 polyclinics, and in-depth interviews with 48 of them. Adjusted prevalence ratios (aPR) were obtained by mixed effects Poisson regression model. The socio-ecological model (SEM) was applied, and thematic analysis performed. RESULTS: The prevalence of meeting the recommendation was 65.8%. This was positively associated with being male (aPR 1.21, 95%CI 1.09-1.34), living in 4-5 room public housing (aPR 1.19, 95%CI 1.07-1.31), living in executive flat/private housing (aPR 1.26, 95%CI 1.06-1.50), having family members/friends to exercise with (aPR 1.57, 95%CI 1.38-1.78); and negatively associated with a personal history of osteoarthritis (aPR 0.75, 95%CI 0.59-0.96), as well as time spent sitting or reclining daily (aPR 0.96, 95%CI 0.94-0.98). The recurrent themes for not meeting the recommendation included lacking companionship from family members/friends, medical conditions hindering physical activity (particularly osteoarthritis), lacking knowledge/skills to exercise properly, "no time" to exercise and barriers pertaining to exercise facilities in the neighbourhood. The recurrent themes for meeting the recommendation included family/peer influence, health/well-being concerns and education by healthcare professionals. CONCLUSIONS: Much more remains to be done to promote physical activity among primary care patients with prediabetes in Singapore. Participants reported facilitators and barriers to physical activity at different levels of the SEM. Apart from the individual and interpersonal levels, practitioners and policy makers need to work together to address the organisational, community and policy barriers to physical activity.


Asunto(s)
Ejercicio Físico/psicología , Adhesión a Directriz/estadística & datos numéricos , Estado Prediabético/terapia , Atención Primaria de Salud , Anciano , Estudios Transversales , Ejercicio Físico/fisiología , Femenino , Guías como Asunto , Humanos , Masculino , Persona de Mediana Edad , Estado Prediabético/epidemiología , Investigación Cualitativa , Singapur/epidemiología , Factores Socioeconómicos
17.
Br J Nurs ; 29(2): S10-S16, 2020 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-31972115

RESUMEN

Latest clinical guidelines for peripheral vascular catheters (PVC) recommend that they should be removed only when clinically indicated and not routinely removed and replaced. In 2017, the authors' hospital policy was changed to align with the new recommendations and, between March and July 2019, 500 PVCs were audited at two main sites to evaluate the efficacy of the change. Of the 500 PVCs, 31% (n=155) were in situ for more than 3 days (range 4-22 days). Analysis of the combined data showed an overall prevalence of phlebitis at 8%, but variation in trends looking at each individual site (7% and 9% respectively) with a wide variation for PVCs in situ for more than 7 days. Implementing clinically indicated removal of PVCs has resulted in better patient experience with fewer PVCs for a course of treatment. Implementation has also resulted in cost savings for the Trust with a notable decrease in number of PVCs used.


Asunto(s)
Cateterismo Periférico/instrumentación , Remoción de Dispositivos/normas , Adhesión a Directriz/estadística & datos numéricos , Humanos , Guías de Práctica Clínica como Asunto , Factores de Tiempo
18.
Urology ; 135: 44-49, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31586570

RESUMEN

OBJECTIVE: To examine the use of in-hospital pharmacologic thromboprophylaxis (PTP) in patients undergoing radical cystectomy between 2004 and 2014 and to assess the risk of venous thromboembolism (VTE) across the study period. MATERIAL AND METHODS: We identified 8322 patients without contraindications to PTP undergoing radical cystectomy in the US using the Premier Healthcare Database. Nonparametric Wilcoxon type test for trend was employed to examine the trend of PTP utilization across the study period. Ensuing, we employed multivariable logistic regression and generalized linear regression models to examine the odds of receiving PTP and the risk of being diagnosed with VTE, respectively. RESULTS: Based on VTE risk-stratification, the majority of patients (87.8%) qualified as "high-risk." Across the study period the use of PTP increased (Odds ratio 1.02, 95% confidence interval (CI) 1.00-1.03, P = .044), but remained underutilized as the maximum percentage of patients receiving in-hospital PTP did not exceed 58.6%. The risk of VTE did not vary across the study period (risk ratio 0.97, 95%CI 0.92-1.02, P = .178). CONCLUSION: Utilization of PTP increased throughout the study period, while the risk of VTE did not change. Future studies are necessary to improve implementation of guideline-driven care, as PTP remained underutilized throughout the study period.


Asunto(s)
Anticoagulantes/administración & dosificación , Cistectomía/efectos adversos , Adhesión a Directriz/tendencias , Complicaciones Posoperatorias/prevención & control , Tromboembolia Venosa/prevención & control , Adolescente , Adulto , Anciano , Femenino , Adhesión a Directriz/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Neoplasias de la Vejiga Urinaria/cirugía , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etiología , Adulto Joven
19.
Int J Clin Pharmacol Ther ; 58(2): 82-88, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31724529

RESUMEN

OBJECTIVE: The main objective of this study was to evaluate therapeutic drug monitoring (TDM) services for antibiotics and investigate the association between non-adherence to TDM guidelines and development of nephrotoxicity. MATERIALS AND METHODS: This retrospective study was conducted using electronic health records of hospitalized patients who received antibiotics for which TDM was requested over a 1-year period. Adherence to TDM guidelines was measured by reviewing appropriate indications, sampling times, result reporting, and clinical pharmacist interventions. RESULTS: A total of 1,179 patients (65% males), for whom TDM was requested during 2017 were included. Upon an assessment of the appropriateness of sampling times, we found that ~ 15% of samples were drawn at the wrong time, and in over 46% of the cases, TDM service was inconsistent with guidelines. Further, although physicians accepted the majority of pharmacists' interventions related to the TDM service, the pharmacist did not provide any recommendation in more than one-third of the cases. Nephrotoxicity was the most common adverse reaction and was observed in 19.5% of the patients. Furthermore, we found a significant correlation between nephrotoxicity and non-adherence to TDM guidelines (OR = 1.47; p = 0.014). Our study shows that adherence to the guidelines and implementation of an appropriate and effective TDM service for antibiotics increases the number of patients with adequate plasma levels, optimizes clinical outcomes, and minimizes toxicities. Moreover, there was a strong association between non-adherence to the TDM guidelines and development of nephrotoxicity. CONCLUSION: The findings suggest that adherence to TDM guidelines not only improves clinical practice but also contributes to the reduction of the cost associated with the development of nephrotoxicity.


Asunto(s)
Antibacterianos/uso terapéutico , Monitoreo de Drogas , Adhesión a Directriz/estadística & datos numéricos , Insuficiencia Renal/prevención & control , Antibacterianos/efectos adversos , Registros Electrónicos de Salud , Femenino , Humanos , Masculino , Farmacéuticos , Insuficiencia Renal/inducido químicamente , Estudios Retrospectivos
20.
Radiol Med ; 125(3): 329-335, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31832987

RESUMEN

INTRODUCTION: The management of patients bearing a cardiac implantable electronic device and needing a radiotherapy treatment is an important clinical scenario. The aim of this survey was to evaluate the level of awareness within the Italian Radiation Oncologist community on this topic. MATERIALS AND METHODS: A survey was promoted by the Young Group of Italian Association of Radiotherapy and Clinical Oncology (AIRO) with a questionnaire made up of 22 questions allowing for multiple answers, which was administered, both online and on paper version. It was addressed to Radiation Oncologists, AIRO members, participating in the National Congress held in 2015. RESULTS: A total of 113 questionnaires were collected back and analyzed (survey online: 50 respondents; paper version: 63). The answers showed a good level of awareness on the issue, but with a nonhomogeneous adherence to the different published guidelines (GL). There is a general low rate of referral for a preliminary cardiological evaluation in patients bearing PM/ICDs, in line with some published surveys; nevertheless, a focused attention to certain specific treatment factors and patient-centered point of view emerged. CONCLUSIONS: A generally good awareness of this topic was shown but homogeneous application of GL was not observed, possibly due to the multiplicity of available GL. A prospective data collection could help to better clarify the shadows on this topics.


Asunto(s)
Desfibriladores Implantables , Adhesión a Directriz , Marcapaso Artificial , Oncología por Radiación , Radioterapia , Adulto , Desfibriladores Implantables/estadística & datos numéricos , Adhesión a Directriz/estadística & datos numéricos , Encuestas de Atención de la Salud/estadística & datos numéricos , Humanos , Italia , Marcapaso Artificial/estadística & datos numéricos , Dosis de Radiación , Oncología por Radiación/estadística & datos numéricos , Sociedades Médicas
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA