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1.
BMJ ; 367: l5887, 2019 11 05.
Artículo en Inglés | MEDLINE | ID: mdl-31690574

RESUMEN

Diabetes is a major and costly health concern worldwide, with high morbidity, disability, mortality, and impaired quality of life. The vast majority of people living with diabetes have type 2 diabetes. Historically, the main strategy to reduce complications of type 2 diabetes has been intensive glycemic control. However, the body of evidence shows no meaningful benefit of intensive (compared with moderate) glycemic control for microvascular and macrovascular outcomes important to patients, with the exception of reduced rates of non-fatal myocardial infarction. Intensive glycemic control does, however, increase the risk of severe hypoglycemia and incurs additional burden by way of polypharmacy, side effects, and cost. Additionally, data from cardiovascular outcomes trials showed that cardiovascular, kidney, and mortality outcomes may be improved with use of specific classes of glucose lowering drugs largely independently of their glycemic effects. Therefore, delivering evidence based, patient centered care to people with type 2 diabetes requires a paradigm shift and departure from the predominantly glucocentric view of diabetes management. Instead of prioritizing intensive glycemic control, the focus needs to be on ensuring access to adequate diabetes care, aligning glycemic targets to patients' goals and situations, minimizing short term and long term complications, reducing the burden of treatment, and improving quality of life.


Asunto(s)
Complicaciones de la Diabetes/prevención & control , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemia/epidemiología , Hipoglucemiantes/administración & dosificación , Calidad de Vida , Glucemia/análisis , Glucemia/efectos de los fármacos , Complicaciones de la Diabetes/sangre , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Medicina Basada en la Evidencia/métodos , Medicina Basada en la Evidencia/normas , Humanos , Hiperglucemia/sangre , Hiperglucemia/tratamiento farmacológico , Hipoglucemia/inducido químicamente , Hipoglucemiantes/efectos adversos , Incidencia , Metaanálisis como Asunto , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/normas , Guías de Práctica Clínica como Asunto , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
2.
Am J Occup Ther ; 73(5): 7305185010p1-7305185010p10, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31484020

RESUMEN

IMPORTANCE: Leaders in the occupational therapy profession have called for occupational therapy's inclusion in primary care, but little is known about the occupational needs of patients in this setting. OBJECTIVE: To explore the need for and potential role of occupational therapy in a team-based primary care clinic. DESIGN: A qualitative descriptive study using a convenience sample of clinicians and patients. Meetings and semistructured interviews were recorded, transcribed, and coded by multiple coders using a general immersion-crystallization approach to identify relevant themes. SETTING: Outpatient complex care clinic of an urban academic medical center. PARTICIPANTS: The study included a voluntary sample of clinicians and patients from the complex care clinic. Patients were recruited from a staff-provided list; eligible patients had attended the clinic for at least 1 yr. All patients had multiple chronic conditions and were uninsured or received Medicaid. RESULTS: Researchers attended 10 clinician team meetings and conducted 13 patient interviews and 10 clinician interviews. Four domains of patient need were identified by both patients and clinicians: complex medical management, patients' limited resources, mental health needs, and challenges to occupation. Clinicians also identified cognitive-behavioral challenges affecting care, including lack of engagement and poor problem solving. CONCLUSIONS AND RELEVANCE: The makeup of the clinic team reflected their intent to address medical, socioeconomic, and mental health domains. However, cognitive-behavioral challenges and patients' occupational limitations were not consistently addressed. Thus, patients had unmet needs that occupational therapy practitioners were qualified to address. WHAT THIS ARTICLE ADDS: This study adds to the available literature examining patient needs and clinician challenges in a primary care clinic. Patients have occupational needs that are not being addressed in primary care, indicating a need for occupational therapy in this setting.


Asunto(s)
Terapia Ocupacional , Atención Ambulatoria , Humanos , Grupo de Atención al Paciente/normas , Atención Dirigida al Paciente/normas , Atención Primaria de Salud/normas , Investigación Cualitativa
3.
Bull World Health Organ ; 97(8): 563-569, 2019 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-31384074

RESUMEN

In 2018, three independent reports were published, emphasizing the need for attention to, and improvements in, quality of care to achieve effective universal health coverage. A key aspect of high quality health care and health systems is that they are person-centred, a characteristic that is at the same time intrinsically important (all individuals have the right to be treated with dignity and respect) and instrumentally important (person-centred care is associated with improved health-care utilization and health outcomes). Following calls to make 2019 a year of action, we provide guidance to policy-makers, researchers and implementers on how they can take on the task of measuring person-centred care. Theoretically, measures of person-centred care allow quality improvement efforts to be evaluated and ensure that health systems are accountable to those they aim to serve. However, in practice, the utility of these measures is limited by lack of clarity and precision in designing and by using measures for different aspects of person-centeredness. We discuss the distinction between two broad categories of measures of patient-centred care: patient experience and patient satisfaction. We frame our discussion of these measures around three key questions: (i) how will the results of this measure be used?; (ii) how will patient subjectivity be accounted for?; and (iii) is this measure validated or tested? By addressing these issues during the design phase, researchers will increase the usability of their measures.


Asunto(s)
Satisfacción del Paciente , Atención Dirigida al Paciente/organización & administración , Indicadores de Calidad de la Atención de Salud/normas , Calidad de la Atención de Salud/organización & administración , Proyectos de Investigación , Humanos , Atención Dirigida al Paciente/normas , Mejoramiento de la Calidad , Calidad de la Atención de Salud/normas , Reproducibilidad de los Resultados
4.
Plast Reconstr Surg ; 144(3): 560-568, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31461002

RESUMEN

BACKGROUND: New York State passed the Breast Cancer Provider Discussion Law in 2010, mandating discussion of insurance coverage for reconstruction and expedient plastic surgical referral, two significant factors found to affect reconstruction rates. This study examines the impact of this law. METHODS: A retrospective cohort study of the New York State Planning and Research Cooperative System database to examine breast reconstruction rates 3 years before and 3 years after law enactment was performed. Difference-interrupted time series models were used to compare trends in the reconstruction rates by sociodemographic factors and provider types. RESULTS: The study included 32,452 patients. The number of mastectomies decreased from 6479 in 2008 to 5235 in 2013; the rate of reconstruction increased from 49 percent in 2008 to 62 percent in 2013. This rise was seen across all median income brackets, races, and age groups. When comparing before to after law enactment, the increase in risk-adjusted reconstruction rates was significantly higher for African Americans and elderly patients, but the disparity in reconstruction rates did not change for other races, different income levels, or insurance types. Reconstruction rates were also not significantly different between those treated in various hospital settings. CONCLUSIONS: The aim of the Breast Cancer Provider Discussion Law is to improve reconstruction rates through provider-driven patient education. The authors' data show significant change following law passage in African American and elderly populations, suggesting effectiveness of the law. The New York State Provider Discussion Law may provide a template for other states to model legislation geared toward patient-centered improvement of health outcomes.


Asunto(s)
Neoplasias de la Mama/cirugía , Disparidades en Atención de Salud , Cobertura del Seguro , Seguro de Salud , Mamoplastia , Mastectomía/estadística & datos numéricos , Adulto , Anciano , Femenino , Disparidades en Atención de Salud/legislación & jurisprudencia , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Seguro de Salud/legislación & jurisprudencia , Mamoplastia/legislación & jurisprudencia , Mamoplastia/estadística & datos numéricos , Persona de Mediana Edad , New York , Atención Dirigida al Paciente/normas , Estudios Retrospectivos
5.
J Clin Nurs ; 28(23-24): 4250-4263, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31429996

RESUMEN

AIMS AND OBJECTIVES: To synthesise the available body of qualitative evidence relating to nurses' perceptions and experiences of care provision in adult critical care environments. METHODS: The study adhered to ENTREQ (Confidence in Evidence of Reviews of Qualitative Research) guidelines. See Appendix S1. A systematic search of the literature in nine databases was undertaken: CINAHL, Web of Science, MEDLINE, EMBASE, PsycINFO, Campbell Collaboration, ProQuest A & I, DART and Lenus. Blind screening to select relevant studies was undertaken, and each selected study was assessed for quality using the Critical Appraisal Skills Programme framework. Guided by Thomas and Harden's three-stage approach to thematic analysis, line-by-line coding of participants' verbatim accounts and the researchers' interpretations in the selected studies' findings was undertaken and then organised into higher order analytical themes. Confidence in the findings was reviewed using GRADE-CERQual. RESULTS: Twelve studies reported in thirteen papers, including 122 nurses, were selected in the final sample for synthesis. Three analytical themes were identified: (a) sometimes machines get all the attention, (b) with experience the patient becomes the focus and (c) technology can't save everybody. CONCLUSIONS: Providing care for adult patients in a highly technological environment is challenging particularly for novice nurses, who face the potential of technology drawing all their attention. Experienced critical care nurses learn to keep technology in abeyance and deliver person-centred care within the bounds of a technological environment. RELEVANCE TO CLINICAL PRACTICE: The review supports Locsin's theory of technological competence and highlights that providing care in critical care requires nurses to actively balance attention for the person while managing machines. Experienced nurses achieve this balance and can offer support to novice nurses. Critical care nurse orientation programmes should be underpinned by a holistic approach which addresses the dualism of technology and care.


Asunto(s)
Tecnología Biomédica , Enfermería de Cuidados Críticos/métodos , Adulto , Humanos , Atención Dirigida al Paciente/normas , Investigación Cualitativa
7.
BMC Health Serv Res ; 19(1): 606, 2019 Aug 29.
Artículo en Inglés | MEDLINE | ID: mdl-31464615

RESUMEN

BACKGROUND: There is a disparity in the burden of gynaecological cancer for Indigenous women compared with non-Indigenous women in Australia. Understanding how Indigenous women currently experience gynaecological cancer care services and factors that impact on their engagement with care is critical. This study explored Indigenous Australian women's experience of gynaecological cancer care at a major metropolitan hospital in Queensland. METHODS: Indigenous women receiving care at a major metropolitan Queensland hospital for investigation or diagnosis of gynaecological cancer were invited to participate in a larger longitudinal study exploring women's experiences of gynaecological cancer care. This component was an in-depth, qualitative interview exploring the women's experiences of hospital care at approximately three-month post initial referral. A peer-approach was used to interview women. Hospital-based care providers involved in the care of Indigenous gynaecological cancer patients were invited to be interviewed. Interviews were transcribed and thematically analysed using an interpretative phenomenological approach enabling a multi-layered, contextualised understanding of the patients' experience and their interaction with tertiary cancer services. RESULTS: Eight Indigenous patients and 18 care providers were interviewed. Analysis of all interviews revealed four broad issues affecting Indigenous patients' early experiences of care: (1) navigating the system, impacted by timely diagnosis, access to support services and follow up; (2) communication and decision-making, patients' decision-making, efficacy of doctor-patient communication, and patients' knowledge about cancer; (3) coping with treatment demands, was impacted by emotional stress, access to services and support by hospital staff; and (4) feeling welcome and safe in the hospital, impacted by patients' relationship with care providers and their access to culturally-safe services. The combination of factors impacting these women's' experience of gynaecological care commonly left these women at breaking point, often with limited access to information, resources or support. CONCLUSIONS: Our findings revealed that experiences of cancer care for Indigenous women are overlain by challenges associated with late referral, misdiagnosis, miscommunication, lack of information, logistics in accessing treatment and services and system cultural insensitivities. Our findings offer insights that can inform cancer care provision to more effectively support Indigenous women accessing gynaecological cancer services.


Asunto(s)
Neoplasias de los Genitales Femeninos/terapia , Evaluación de Necesidades , Grupo de Ascendencia Oceánica/etnología , Adolescente , Adulto , Anciano , Actitud del Personal de Salud , Cuidadores/psicología , Comunicación , Toma de Decisiones , Detección Precóz del Cáncer , Femenino , Neoplasias de los Genitales Femeninos/etnología , Hospitales Urbanos , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Grupo de Ascendencia Oceánica/psicología , Satisfacción del Paciente , Atención Dirigida al Paciente/normas , Investigación Cualitativa , Queensland/epidemiología , Queensland/etnología , Adulto Joven
9.
Rev Lat Am Enfermagem ; 27: e3151, 2019 Jul 18.
Artículo en Portugués, Inglés, Español | MEDLINE | ID: mdl-31340342

RESUMEN

OBJECTIVE: to adapt the Consultation and Relational Empathy Measure (Brazilian version) for nurses; to evaluate the concurrence between empathy self-reported by nurses and that perceived by patients; To correlate self-compassion to the empathy self-reported by nurses and perceived by patients. METHOD: seven specialists validated the Consultation and Relational Empathy Measure Nurses (Brazilian version)' adaptation by original author's authorization. A sample with 15 triage nurses and 93 patients they admitted to the Emergency Department of a philanthropic private hospital were interviewed according to the following instruments: Consultation and Relational Empathy Measure - Nurses (Brazilian version) and the Self-Compassion Scale (Brazilian version). RESULTS: the psychometrics properties of Consultation and Relational Empathy Measure - Nurses (Brazilian version) showed appropriate internal consistency (Cronbach's alpha=0,799). The evaluation of empathy provided by the patients was better than that self-reported by the nurses (p<0,001). The nurses with higher level of self-compassion also showed higher empathy scores (p=0,002). CONCLUSION: our results confirmed the psychometrics properties' adequacy of Consultation and Relational Empathy Measure - Nurses (Brazilian version), allowing to compare empathy scores embased at same parameters. Self-compassion showed to influence self-reported empathy.


Asunto(s)
Empatía , Relaciones Enfermero-Paciente , Atención Dirigida al Paciente/normas , Autoinforme , Adolescente , Adulto , Anciano , Brasil , Femenino , Humanos , Masculino , Persona de Mediana Edad , Triaje , Adulto Joven
11.
Nurs Outlook ; 67(4): 311-330, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31277895

RESUMEN

BACKGROUND: Precision health calls for collecting and analyzing large amounts of data to capture an individual's unique behavior, lifestyle, genetics, and environmental context. The diffusion of digital tools has led to a significant growth of patient generated health data (PGHD), defined as health-related data created, gathered or inferred by or from patients and for which the patient controls data collection and data sharing. PURPOSE: We assessed the current evidence of the impact of PGHD use in clinical practice and provide recommendations for the formal integration of PGHD in clinical care. METHODS: We searched PubMed, Ovid, Embase, CINAHL, Web of Science, and Scopus up to May 2018. Inclusion criteria were applied and four reviewers screened titles and abstracts and consequently full articles. FINDINGS: Our systematic literature review identified 21 studies that examined the use of PGHD in clinical settings. Integration of PGHD into electronic records was extremely limited, and decision support capabilities were for the most part basic. DISCUSSION: PGHD and other types of patient-reported data will be part of the health care system narrative and we must continue efforts to understand its impact on health outcomes, costs, and patient satisfaction. Nursing scientists need to lead the process of defining the role of PGHD in the era of precision health.


Asunto(s)
Guías como Asunto , Registros de Salud Personal , Datos de Salud Generados por el Paciente/normas , Atención Dirigida al Paciente/normas , Medicina de Precisión/normas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad
12.
Rev Bras Enferm ; 72(3): 825-829, 2019 Jun 07.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31269152

RESUMEN

OBJECTIVE: To describe the experience in the implementation of the Humanitude Care Methodology (MCH) in the humanization of care for the elderly. METHODOLOGY: This is an experience report about the implementation of the MCH, in a Health Service in Portugal, with capacity for 30 elderly people, most of them having cognitive alterations. RESULTS: The implementation of the MCH has shown positive results in the humanization of care for the elderly, namely in the reduction of agitation behaviors and better acceptance of care. There was a change in organizational culture, more focused on the person and on the humanization of care. CONCLUSION: The results reflect the need to introduce innovative care methodologies in the training of health professionals, with a focus on interaction, for a professionalized relational care that dignifies the person cared for and the care giver.


Asunto(s)
Prestación de Atención de Salud/normas , Geriatría/normas , Humanismo , Prestación de Atención de Salud/métodos , Geriatría/métodos , Humanos , Cuidados a Largo Plazo/métodos , Cuidados a Largo Plazo/normas , Cultura Organizacional , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/normas
13.
Dev Period Med ; 23(2): 125-130, 2019.
Artículo en Polaco | MEDLINE | ID: mdl-31280249

RESUMEN

The progress that has been made in neonatology is associated with an increasing number of painful procedures constantly being performed on the neonate. Additionally, prolonged hospitalization of premature neonates in NICUs isolates the family from their child. Parents may state that they do not have any parental feelings and cannot communicate with their newborns. The FCC (Family-Centered Care) initiative responded to emerging reports about the adverse consequences ensuing from the lack of parental access to hospitalized children. The FCC should be understood as care based on partner relations between families and health professionals, which is supposed to lead to health and well-being for both the children and their parents. The FCC should become standard practice in all neonatal intensive care units.


Asunto(s)
Unidades de Cuidado Intensivo Neonatal/normas , Padres , Atención Dirigida al Paciente/normas , Femenino , Humanos , Recién Nacido , Masculino , Polonia , Estrés Psicológico
14.
Eur J Oncol Nurs ; 41: 33-40, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31358255

RESUMEN

PURPOSE: To assess patients' diagnosed with cancer perceptions on individualized nursing care and quality of oncology nursing care in Cyprus. METHODS: This was a descriptive correlational research with 150 patients diagnosed with cancer and receiving treatment as in-patients at three different urban hospitals of Cyprus, based on predetermined inclusion and exclusion criteria. Data were collected with the Individualized Care Scale-ICS and the Quality Oncology Nursing Care Scale-QONCS. Statistical significance was set at the 0.05 level. RESULTS: Data showed that a medium level of support of patients' individuality was provided by nurses (ICS-A mean = 3.41, SD = 0.98) and a high level of realization of perceived individuality in the provided care. Quality of oncology nursing care was found high on three dimensions of care, i.e. being supported and confirmed, being respected and having a sense of belonging. A statistically significant positive correla-tion was observed between the two scales of ICS, i.e. ICS-A and ΙCS-B (r = 0.80), and four of the dimensions of QONCS, i.e. "Being supported and confirmed", "Being cared for religiously and spiritually", "Sense of Belonging" and "Being respected" and all the subscales, i.e. Clinical Situation (r = 0.45, 0.27, 0.41, 0.42), Personal life sit-uation (r = 0.30, 0.51, 0.44, 0.35) and Decision control (r = 0.35, 0.46, 0.35, 0.40). CONCLUSION: The correlations found between individualized care and quality of oncology nursing care, highlight the need to provide a more personalized nursing care as a means to achieve a high level of quality nursing care.


Asunto(s)
Neoplasias/enfermería , Enfermería Oncológica/normas , Atención Dirigida al Paciente/normas , Calidad de la Atención de Salud/normas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Chipre , Toma de Decisiones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
15.
Reprod Health ; 16(1): 91, 2019 Jun 28.
Artículo en Inglés | MEDLINE | ID: mdl-31253198

RESUMEN

In a global culture that is increasingly interested in ecological interventions, probiotics, 'friendly bacteria', microbiome preservation/restoration and long-term health, there is growing awareness of the idea of seeding the vaginal microbiome in the new born after caesarean section. It is postulated as a way of restoring helpful missing microbes and preventing long term non-communicable diseases of babies delivered by caesarean section. Currently, there is a deluge of evidence being published on the human microbiome, which can be challenging to digest and absorb by scientists, clinicians and patients. The specific evidence base around this technique is at its early stages. This commentary discusses what advice is currently available from a feminist and a person-centred care perspective. ABSTRAKT: Det er en voksende interesse internasjonalt for økologiske intervensjoner, probiotika, 'snille bakterier', bevaring/gjenoppretting av. mikrobiomet og helse i et langtidsperspektiv. I denne sammenhengen er det en økende interesse for tanken om å så det vaginale mikrobiomet (vaginal seeding) på den nyfødte etter et keisersnitt. Dette er postulert som en måte å gjenopprette manglende normalflora/mikrobiom og forebygge langvarige ikke-smittsomme sykdommer hos barn født med keisersnitt. For tiden publiseres det mye forskning om menneskets mikrobiom, noe som kan være utfordrende å fordøye og ta til seg for forskere, klinikere og pasienter. Forskningen på denne spesifikke metoden er i sin begynnelse. Denne kommentaren drøfter hvilke råd som for øyeblikket er tilgjengelige, fra et feministisk og personsentrert omsorgsperspektiv. POPULARISERT SAMMENDRAG På NORSK: Det menneskelige mikrobiomet er summen av alle bakteriene som dekker den menneskelige kroppen og det hjelper kroppen i å fungere optimalt. Når mikrobiomet forstyrres, vil kroppen kunne få betennelsesreaksjoner og allergier. I fødsel finnes de «gode¼ bakteriene i kvinnens vagina. (det vaginale mikrobiomet) som man tror vil være fordelaktig for babyens evne til å utvikle et sunt immunsystem. Babyer som er født med keisersnitt vil ikke bli eksponert for disse «gode¼ bakteriene og det kan påvirke barnets immunforsvar negativt og potensielt øke sjansen for allergier og betennelsesreaksjoner i kroppen på lang sikt. Vaginal seeding (et forsøk på å gjenopprette balansen og noen av de gode bakterier i spedbarnet gjennom å tilføre mors vaginale bakterier via en kompress som strykes over spedbarnets ansikt) Vaginal seeding er en metode som noen forskere sier muligens delvis gjenoppretter de manglende «gode¼ bakteriene etter et keisersnitt. Forskningen er på et tidlig stadium. Det har vært avisartikler og en film om emnet og mødre har funnet ut om vaginal seeding som en måte å gjenopprette denne delen av babyens mikrobiom. Foreldre ønsker å diskutere vaginal seeding, men på nåværende tidspunkt er helsevesenet avventende og helsepersonell er ikke godt nok informert. Denne artikkelen vil se på den pågående diskusjonen. RéSUMé: Dans une culture mondiale qui s'intéresse de plus en plus aux interventions écologiques, aux probiotiques, aux «bactéries amicales¼, à la préservation / restauration du microbiome et à la santé à long terme, on commence à prendre conscience de l'idée d'ensemencer le microbiome vaginal chez le nouveau-né après une césarienne. Il est postulé comme un moyen de restaurer les microbes manquants et d'aider à prévenir les maladies non transmissibles à long terme des bébés mis au monde par césarienne. Il existe actuellement un déluge de preuves sur le microbiome humain, qui peuvent être difficiles à digérer et à absorber par les scientifiques, les cliniciens et les patients. La base de preuves spécifique autour de cette technique en est à ses débuts. Ce commentaire discute des conseils actuellement disponibles dans une perspective de soins féministe et centrée sur la personne. RéSUMé SIMPLIFIé: Le microbiome humain est constitué de tous les microbes qui recouvrent le corps humain et qui aident le corps à bien fonctionner. Lorsque le microbiome est perturbé, le corps devient plus inflammatoire et est sujet aux allergies. Lors de l'accouchement, le vagin d'une mère (le microbiome vaginal) contient des "bactéries amicales" qui pourraient être bénéfiques pour l'enfant et aider le bébé à développer un système immunitaire en bonne santé. Les bébés nés par césarienne ne sont généralement pas exposés à ces «bactéries bénéfiques¼, ce qui pourrait affecter négativement le système immunitaire du bébé et potentiellement augmenter le risque d'allergies et d'inflammation à long terme. Selon certains scientifiques, l'ensemencement vaginal pourrait partiellement restaurer les «bactéries amies¼ manquantes après la césarienne. La recherche en est à ses débuts. Il y a eu des articles de journaux et un film à ce sujet, et les mères ont découvert l'existence d'un ensemencement vaginal (où une compresse placée dans le vagin de la mère pourrait être appliquée sur l'enfant après la césarienne) afin de restaurer une partie du microbiome du bébé. Les parents souhaitent discuter de l'ensemencement vaginal, mais à l'heure actuelle, les organisations médicales sont prudentes et les praticiens ne sont pas suffisamment informés. Cet article examine le débat en cours. RESUMO: Numa cultura global que está cada vez mais interessada em intervenções ecológicas, probióticos, "bactérias amigáveis", preservação/restauração do microbioma e saúde a longo prazo, há uma crescente consciência sobre a ideia de semear o microbioma vaginal no recém-nascido após uma cirurgia cesariana. Isso está sendo postulado como uma forma de restaurar micróbios úteis que lhe faltariam e prevenir doenças não transmissíveis em longo prazo para bebês que nasceram pela via cirúrgica. Atualmente, há um aumento massivo de evidências sendo publicadas sobre o microbioma humano cuja absorção e digestão pode ser desafiadora para cientistas, clínicos e pacientes. A base específica da evidência que cerca essa técnica ainda está em estágios preliminares. Este comentário discute o aconselhamento atualmente disponível numa perspectiva feminista e centrada na pessoa. SíNTESE SIMPLIFICADA: O microbioma humano está composto por todos os micróbios que cobrem o corpo humano e que ajudam o corpo a funcionar bem. Quando o microbioma é perturbado, o corpo tem mais inflamações e maior propensão a desenvolver alergias. Ao nascimento, há "bactérias amigáveis" na vagina materna (o microbioma vaginal) que podem ser benéficas à criança e ajudar o bebê a desenvolver um sistema imunológico saudável. Bebês que nascem por cesariana usualmente não são expostos a essas "bactérias amigáveis" e isso poderá afetar negativamente o sistema imunológico do bebê, aumentando potencialmente a probabilidade de alegrias e inflamações no longo prazo. A semeadura de bactéria vaginais é um método que alguns cientistas afirmam que poderá restaurar parcialmente as "bactérias amigáveis" faltantes depois de uma cesariana. Essa pesquisa está em fase preliminar. Houve alguns artigos em jornais e um filme sobre isso, e as mães descobriram a possibilidade da semeadura vaginal (quando é feito um swab da vagina materna que é esfregado no bebê após a cesárea) para restaurar parte do microbioma do bebê. Pais desejam discutir a semeadura vaginal, mas, no momento, as organizações médicas têm sido cautelosas e os profissionais não estão adequadamente informados. Este artigo aborda o debate em andamento. RESUMEN: En una cultura global que está cada vez más interesada en las intervenciones ecológicas, los probióticos, las "bacterias amigables", la conservación/restauración de microbiomas y la salud a largo plazo, hay una creciente conciencia de la idea de sembrar el microbioma vaginal en el recién nacido después de la cesárea. Se postula como una forma de restaurar los microbios útiles faltantes y prevenir las enfermedades no transmisibles a largo plazo de los bebés nacidos por cesárea. Actualmente, se está publicando una gran cantidad de pruebas sobre el microbioma humano, que pueden ser difíciles de digerir y absorber por parte de científicos, clínicos y pacientes. La base de la evidencia específica en torno a esta técnica se encuentra en sus primeras etapas. Este artículo analiza qué consejos están disponibles actualmente desde una perspectiva feminista y de atención centrada en la persona. RESUMEN EN LENGUAJE SENCILLO: El microbioma humano está hecho de todos las bacterias que cubren el cuerpo humano y que ayudan al cuerpo a funcionar bien. Cuando se altera el microbioma, el cuerpo se inflama más y es propenso a las alergias. En el parto, hay "bacterias amigables" en la vagina de la madre (el microbioma vaginal) que podrían ser beneficiosas para el niño y ayudar al bebé a desarrollar un sistema inmunológico saludable. Los bebés que nacen por cesárea generalmente no se exponen a estas "bacterias amigables" y esto podría afectar negativamente el sistema inmunológico del bebé, lo que podría aumentar la probabilidad de alergias e inflamación a largo plazo. La siembra vaginal es un método que algunos científicos dicen que podría restaurar parcialmente las "bacterias amigables" que faltan después de la cesárea. La investigación se encuentra en sus primeras etapas. Han habido artículos periodísticos y una película sobre esto, y las madres se han enterado de la siembra vaginal (donde se puede frotar el niño con una torunda de la vagina de la madre después de la cesárea) para restaurar la parte del microbioma del bebé. Los padres quieren hablar sobre la siembra vaginal, pero en la actualidad las organizaciones médicas son cautelosas y los profesionales no están informados adecuadamente. Este artículo analiza el debate en curso.


Asunto(s)
Cesárea/normas , Microbiota , Atención Dirigida al Paciente/normas , Vagina/microbiología , Femenino , Humanos , Recién Nacido , Embarazo
17.
BMC Palliat Care ; 18(1): 44, 2019 May 31.
Artículo en Inglés | MEDLINE | ID: mdl-31151438

RESUMEN

BACKGROUND: The needs of care based on palliative principles are stressed for all people with progressive and/or life-limiting conditions, regardless of age and the place in which care is provided. Person-centred palliative care strives to make the whole person visible and prioritizes the satisfaction of spiritual, existential, social, and psychological needs to the same extent as physical needs. However, person-centred palliative care for older persons in nursing homes seems to be sparse, possibly because staff in nursing homes do not have sufficient knowledge, skills, and training in managing symptoms and other aspects of palliative care. METHODS: This study aimed to evaluate whether an educational intervention had any effect on the staff's perception of providing person-centred palliative care for older persons in nursing homes. METHODS: A knowledge-based palliative care intervention consisting of five 2-h seminars during a 6-month period was implemented at 20 nursing homes in Sweden. In total, 365 staff members were participated, 167 in the intervention group and 198 in the control group. Data were collected using two questionnaires, the Person-centred Care Assessment Tool (P-CAT) and the Person-Centred Climate Questionnaire (PCQ-S), answered before (baseline) and 3 months after (follow-up) the educational intervention was completed. Descriptive, comparative, and univariate logistical regression analyses were performed. RESULTS: Both the intervention group and the control group revealed high median scores in all subscales at baseline, except for the subscale amount of organizational and environmental support in the P-CAT. The staff's high rating level of person-centred care before the intervention provides limited space for further improvements at follow-up. CONCLUSION: This study shows that staff perceived that managers' and the organization's amount of support to them in their everyday work was the only area for improvement in order to maintain person-centred care. The experiences among staff are crucial knowledge in understanding how palliative care can be made person-centred in spite of often limited resources in nursing homes. The dose and intensity of education activities of the intervention model need to be tested in future research to develop the most effective implementation model. TRIAL REGISTRATION: NCT02708498 . Date of registration 26 February 2016.


Asunto(s)
Atención Dirigida al Paciente/normas , Enseñanza/normas , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Casas de Salud/organización & administración , Casas de Salud/estadística & datos numéricos , Cuidados Paliativos/métodos , Cuidados Paliativos/psicología , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/estadística & datos numéricos , Encuestas y Cuestionarios , Suecia , Enseñanza/psicología
18.
Eur J Pediatr ; 178(9): 1449-1467, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31240389

RESUMEN

Between 2015 and 2017, an estimated 200,000 to 400,000 children were seeking asylum each year in EU/EEA countries. As access to high-quality health care is important, we collected and compared current recommendations across Europe for a consensus recommendation on medical care for migrant (asylum-seeking and refugee) children. Existing recommendations were collected from published literature and identified through national representatives from paediatric societies of 31 EU/EEA countries through the European Academy of Paediatrics (EAP). Recommendations were systematically extracted and collected in a database. Those mentioned in at least one recommendation were evaluated for inclusion, and evidence on recommendations was specifically identified in literature searches focused on recent evidence from Europe. For eight EU/EEA countries, a national recommendation was identified. Growth and development, vision and hearing impairment, skin and dental problems, immunisations, anaemia, micronutrient deficiency, helminths, hepatitis B and C, human immunodeficiency virus, malaria, schistosomiasis, syphilis, tuberculosis, mental health disorder and sexual health were most frequently mentioned and therefore selected for inclusion in the recommendation.Conclusion: The current document includes general recommendations on ethical standards, use of interpreters and specific recommendations for prevention or early detection of communicable and non-communicable diseases. It may serve as a tool to ensure the fundamental right that migrant children in Europe receive a comprehensive, patient-centred health care.


Asunto(s)
Servicios de Salud del Niño/normas , Atención Dirigida al Paciente/normas , Pediatría/normas , Refugiados , Adolescente , Cuidados Posteriores/métodos , Cuidados Posteriores/normas , Niño , Preescolar , Europa (Continente) , Accesibilidad a los Servicios de Salud/normas , Humanos , Lactante , Recién Nacido , Atención Dirigida al Paciente/métodos , Pediatría/métodos , Sociedades Médicas
19.
J Perinat Med ; 47(6): 656-664, 2019 Aug 27.
Artículo en Inglés | MEDLINE | ID: mdl-31211690

RESUMEN

Objective To identify socio-cultural and clinician determinants in the decision-making process in the choice for trial of labor after cesarean (TOLAC) or elective repeat cesarean section (ERCS) in delivering women. Methods A tailored questionnaire focused on epidemiological, socio-cultural and obstetric data was administered to 133 patients; of these, 95 were admitted for assistance at birth at Fondazione Policlinico Universitario "A. Gemelli" (FPG) IRCCS, Rome, and 38 at S. Chiara Hospital (SCH), Trento, Italy. Descriptive analysis and logistic regression modeling were performed. Results Vaginal birth after cesarean (VBAC) rates were higher at SCH than at FPG (68.4% vs. 23.2%; P < 0.05). Maternal age in the TOLAC/VBAC group was significantly higher at SCH than at FPG (37.1 vs. 34.9 years, P < 0.05). High levels of education and no-working condition corresponded to a lower rate of VBAC. Proposal on delivery mode after a previous CS was missed in the majority of cases. Participation in prenatal course was significantly less among women in the ERCS groups. Using logistic regression, the following determinants were found to be statistically significant in the decision-making process: maternal age [odds ratio (OR) = 0.968 (95% confidence interval [CI] 0.941-0.999); P = 0.019], education level [OR = 0.618 (95% CI 0.419-0.995); P = 0.043], information received after the previous CS [OR = 0.401 (95% CI 0.195-1.252); P = 0.029], participation in antenatal courses [OR = 0.534 (95% CI 0.407-1.223); P = 0.045] and self-determination in attempting TOLAC [OR = 0.756 (95% CI 0.522-1.077); P = 0.037]. Conclusion In the attempt to promote person-centered care, increases in TOLAC/VBAC rates could be achieved by focusing on individual maternal needs. An ad hoc strategy for making birth safer should begin from accurate information at the time of the previous CS.


Asunto(s)
Cesárea Repetida , Cesárea , Esfuerzo de Parto , Parto Vaginal Después de Cesárea , Adulto , Cesárea/psicología , Cesárea/estadística & datos numéricos , Cesárea Repetida/psicología , Cesárea Repetida/estadística & datos numéricos , Cultura , Toma de Decisiones , Femenino , Humanos , Italia/epidemiología , Edad Materna , Anamnesis/métodos , Prioridad del Paciente , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/normas , Embarazo , Investigación Cualitativa , Historia Reproductiva , Factores Sociológicos , Parto Vaginal Después de Cesárea/psicología , Parto Vaginal Después de Cesárea/estadística & datos numéricos
20.
Pediatr Clin North Am ; 66(4): 775-789, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31230622

RESUMEN

This article aims to broaden pediatric hospital medicine providers' understanding of patient- and family-centered care (PFCC) and equip them to both implement and advance PFCC. The article discusses the origins and history of PFCC and reviews selected relevant literature. The article shares an overview of several existing frameworks for patient-centeredness, emphasizing an emerging concept called coproduction. The article reviews several attitudes, skills, and infrastructure components that are considered essential prerequisites for effective coproduction. The article then highlights several strategies for promoting coproduction in Hospital Medicine, organized around 4 key tenets of coproduction (cocommissioning, codesign, codelivery, and coassessment).


Asunto(s)
Niño Hospitalizado , Atención Dirigida al Paciente/normas , Relaciones Profesional-Familia , Mejoramiento de la Calidad , Actitud del Personal de Salud , Niño , Humanos
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