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2.
Rev Med Chil ; 147(5): 589-601, 2019 May.
Artículo en Español | MEDLINE | ID: mdl-31859891

RESUMEN

BACKGROUND: The Family and Community Health Model (MAIS) establishes the continuity of care as an essential principle. The Family Study, as a clinical strategy, allows to have sufficient and timely information and knowledge about users of health care services, facilitates their accompaniment and is a source of information to improve the quality of care and the management of health centers. AIM: To develop a tool to conduct family studies, devised by experts in Primary Health Care. MATERIAL AND METHODS: Using a qualitative method, an electronic Delphi was conducted on 24 experts on primary health care. Afterwards, the content validation was carried out with the participation of judges. RESULTS: The resulting tool considers two levels of family assessment. It allows to distinguish those families that would benefit from interventions of greater complexity than those derived from the usual care of health centers. CONCLUSIONS: The tool to perform family studies responds to the informational and continuity component of Continuity of Patient Care principle. It may be a proposal for the continuous improvement of Chilean primary care.


Asunto(s)
Técnica Delfos , Salud de la Familia/normas , Atención Primaria de Salud/normas , Encuestas y Cuestionarios/normas , Adulto , Chile , Continuidad de la Atención al Paciente/normas , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Calidad de la Atención de Salud/normas , Reproducibilidad de los Resultados , Factores Socioeconómicos
3.
Medicine (Baltimore) ; 98(52): e18537, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31876751

RESUMEN

Thyroid disorders are associated with blood glucose abnormalities. For rendering the patients euthyroid, routine screening and care are essential. Therefore, the aim of this study was to investigate the association between continuity of care (COC) and type 2 diabetes onset among patients with thyroid disorders.We used the national claim data. Our study population was 4099 patients with hyperthyroidism or hypothyroidism. For calculating COC, the Most Frequent Provider Continuity Index (MFPCI), Modified Modified Continuity Index (MMCI), and COC Index (COCI) were used. The dependent variable was type 2 diabetes onset. The Cox proportional hazard regression model was used.Among 4099 patients with thyroid disorders, 25.3% experienced onset of type 2 diabetes. Thyroid patients who had MFPCI and COCI below the median were more likely to experience onset of type 2 diabetes than who had these indices above the median (MFPCI: hazard ratio [HR] = 1.26, 95% confidence interval [CI] = 1.09-1.46; COCI: HR = 1.22, 95% CI = 1.06-1.41). Our subgroup analysis showed that female patients and those 20 to 34 years of age showed a significant association between COC and onset of type 2 diabetes.Patients with thyroid disorders with low COC showed an increased risk of developing type 2 diabetes. Therefore, efforts to enhance COC among patients with thyroid disorders needs to be encouraged.


Asunto(s)
Continuidad de la Atención al Paciente , Diabetes Mellitus Tipo 2/etiología , Enfermedades de la Tiroides/complicaciones , Adulto , Factores de Edad , Anciano , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , Hipertiroidismo/complicaciones , Hipertiroidismo/terapia , Hipotiroidismo/complicaciones , Hipotiroidismo/terapia , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , República de Corea/epidemiología , Factores de Riesgo , Factores Sexuales , Enfermedades de la Tiroides/terapia , Adulto Joven
4.
Revista Espaço para a Saúde ; 20(2): [90-107], dez.2019. tab, ilus
Artículo en Portugués | LILACS | ID: biblio-1046436

RESUMEN

Objetivo: Conhecer os principais riscos relacionados à segurança do paciente no transporte intra-hospitalar. Método: Trata-se de uma revisão integrativa, que utilizou os descritores: segurança do paciente, Cuidados críticos e transporte intra-hospitalar. Resultados: Analisaramse 12 artigos, todos na língua portuguesa, selecionados nas bases de dados BVS, CAPES e Google Acadêmico, delimitados ao período de 2010 a 2019. Conclusão: A alta incidência de eventos adversos em pacientes críticos durante o transporte intra-hospitalar torna imperativa a criação de protocolos institucionais para auxiliar e padronizar o transporte, minimizando erros e favorecendo uma prática segura.


Asunto(s)
Administración de la Seguridad , Continuidad de la Atención al Paciente , Prevención de Accidentes , Instituciones de Salud
5.
N C Med J ; 80(6): 339-343, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31685566

RESUMEN

AJ was a 34-year-old African American male who was incarcerated for eight years for drug-related convictions. He suffered from diabetes, hypertension, chronic kidney failure, depression, and substance use disorder. Upon release from prison he was not connected with health services and he was uninsured, which was an additional barrier to accessing medical care. His own perceived need for care was limited as he had significant cognitive deficits with extremely low health literacy. Two years following his release from prison, an aunt concerned about his health brought him to clinic. His clinical course was fraught with complications that would likely have been preventable if he had been connected to care upon release. With treatment, his depression eventually improved and his substance use disorder was under better control. However, he endured multiple amputations from diabetic foot infections, partial vision loss, severe pain from diabetic neuropathy, temporary dialysis for end stage kidney disease, and two months of a feeding tube for severe gastroparesis. AJ's story is not unique, and it highlights the terrible personal costs of inadequately addressing the health needs of people during periods of incarceration and following their release.


Asunto(s)
Continuidad de la Atención al Paciente , Necesidades y Demandas de Servicios de Salud , Prisioneros , Adulto , Humanos , Masculino , North Carolina
6.
BMJ ; 367: l6109, 2019 11 13.
Artículo en Inglés | MEDLINE | ID: mdl-31722884

RESUMEN

OBJECTIVE: To review and summarise the evidence on the prevalence of colorectal adenomas and cancers at a follow-up screening colonoscopy after negative index colonoscopy, stratified by interval between examinations and by sex. DESIGN: Systematic review and meta-analysis of all available studies. DATA SOURCES: PubMed, Web of Science, and Embase. Two investigators independently extracted characteristics and results of identified studies and performed standardised quality ratings. ELIGIBILITY CRITERIA: Studies assessing the outcome of a follow-up colonoscopy among participants at average risk for colorectal cancer with a negative previous colonoscopy (no adenomas). RESULTS: 28 studies were identified, including 22 cohort studies, five cross sectional studies, and one case-control study. Findings for an interval between colonoscopies of one to five, five to 10, and more than 10 years were reported by 17, 16, and three studies, respectively. Summary estimates of prevalences of any neoplasm were 20.7% (95% confidence interval 15.8% to 25.5%), 23.0% (18.0% to 28.0%), and 21.9% (14.9% to 29.0%) for one to five, five to 10, and more than 10 years between colonoscopies. Corresponding summary estimates of prevalences of any advanced neoplasm were 2.8% (2.0% to 3.7%), 3.2% (2.2% to 4.1%), and 7.0% (5.3% to 8.7%). Seven studies also reported findings stratified by sex. Summary estimates stratified by interval and sex were consistently higher for men than for women. CONCLUSIONS: Although detection of any neoplasms was observed in more than 20% of participants within five years of a negative screening colonoscopy, detection of advanced neoplasms within 10 years was rare. Our findings suggest that 10 year intervals for colonoscopy screening after a negative colonoscopy, as currently recommended, may be adequate, but more studies are needed to strengthen the empirical basis for pertinent recommendations and to investigate even longer intervals. STUDY REGISTRATION: Prospero CRD42019127842.


Asunto(s)
Colonoscopía/métodos , Neoplasias Colorrectales , Detección Precóz del Cáncer , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/patología , Continuidad de la Atención al Paciente/normas , Detección Precóz del Cáncer/métodos , Detección Precóz del Cáncer/normas , Humanos , Prevalencia , Medición de Riesgo/estadística & datos numéricos
7.
Lakartidningen ; 1162019 Oct 07.
Artículo en Sueco | MEDLINE | ID: mdl-31593289

RESUMEN

The medical and nursing care of preterm infants has improved over the last decades, including the involvement of parents in the daily care. Previously parents could only visit a few scheduled hours per day but today most neonatal units in Sweden strive to let the parents be the primary caregivers, with the right to stay at the unit during the entire hospitalization period. Despite this development, there is still need for a number of improvements, not only in the neonatal care but also during the complicated pregnancy.


Asunto(s)
Cuidado Intensivo Neonatal/organización & administración , Responsabilidad Parental , Nacimiento Prematuro , Rol , Lactancia Materna , Continuidad de la Atención al Paciente , Padre , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Servicios de Salud Materna/organización & administración , Madres , Alta del Paciente , Educación del Paciente como Asunto , Embarazo , Apoyo Social , Suecia
8.
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190010, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31576986

RESUMEN

INTRODUCTION: Care continuum models have supported recent strategies against sexually transmitted diseases, such as HIV and Hepatitis C (HCV). METHODS: HIV, HCV, and congenital syphilis care continuum models were developed, including all stages of care, from promotion/prevention to clinical control/cure. The models supported the intervention QualiRede, developed by a University-Brazilian National Health System (SUS) partnership focused on managers and other professionals from six priority health regions in São Paulo and Santa Catarina. Indicators were selected for each stage of the care continuum from the SUS information systems and from the Qualiaids and QualiAB facility's process evaluation questionnaires. The indicators acted as the technical basis of two workshops with professionals and managers in each region: the first one to identify problems and to create a Regional Technical Group; and the second one to design action plans for improving regional performance. RESULTS: The indicators are available at www.qualirede.org. The workshops took place in the regions of Alto Tietê, Baixada Santista, Grande ABC, and Registro (São Paulo) and of Foz do Rio Itajaí (Santa Catarina), which resulted in regional action plans in São Paulo, but not in Santa Catarina. A lack of awareness was observed regarding the new HIV and HCV protocols, as well as an incipient use of indicators in routine practices. CONCLUSION: Improving the performance of the care continuum requires appropriation of performance indicators and coordination of care flows at local, regional, and state levels of management.


Asunto(s)
Continuidad de la Atención al Paciente/estadística & datos numéricos , Infecciones por VIH/terapia , Investigación sobre Servicios de Salud/estadística & datos numéricos , Hepatitis C/terapia , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Sífilis Congénita/terapia , Brasil , Infecciones por VIH/epidemiología , Promoción de la Salud/métodos , Promoción de la Salud/estadística & datos numéricos , Hepatitis C/epidemiología , Humanos , Programas Nacionales de Salud , Encuestas y Cuestionarios , Sífilis Congénita/epidemiología
10.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1202-1207, out.-dez. 2019. tab
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1022269

RESUMEN

Objetivo: Avaliar as características clínicas e imunológica dos receptores de transplante renal. Métodos: estudo documental e retrospectivo, realizado em um Ambulatório do Hospital Geral de Fortaleza, Fortaleza, Ceará, Brasil, com pacientes internados no período de junho de 2012 a junho de 2014. A amostra foi composta por 300 pacientes submetidos ao transplante renal. As variáveis preditoras de interesse, foram subdivididas em: características prétransplante, características pós-transplante e características imunológicas. Utilizou-se testes de Pearson e Spearman para avaliar correlação entre variáveis. Resultados: Houve predomínio de pacientes do sexo masculino (65%), com faixa etária entre 44 e 56 anos (31,4%). Demonstrou-se relação estatisticamente significante entre o DSA e a disfunção do enxerto (p<0,04), Rejeição celular o Painel Reativo classe I (p< 0,05), o tempo de internação e a disfunção do enxerto (p<0,001) e entre o entre o HLA e o MISMATCH. Conclusão: Aponta-se a necessidade de um acompanhamento crítico e individualizado do paciente transplantado por parte dos profissionais para garantir o sucesso do transplante a longo prazo


Objective: The study's purpose has been to assess both clinical and immunological characteristics of renal transplant recipients. Methods: It is a documentary and retrospective study that was performed at the renal transplantation ambulatory from the Hospital Geral de Fortaleza (HGF), Fortaleza city, Ceará State, with patients hospitalized from June 2012 to June 2014. The sample consisted of 300 patients submitted to renal transplantation. The predictive variables of interest were subdivided in the following categories: pre-transplant characteristics, post-transplant characteristics and immunological characteristics. Pearson and Spearman tests were used to evaluate the correlation between variables. Results: There was a predominance of male patients (65%), with ages ranging from 44 to 56 years (31.4%). A statistically significant relationship was found between the Donor-Specific Antibody and Delayed Graft Function (p<0.04), Cellular Rejection and PanelReactive Antibody class I (p<0.05), duration of hospitalization and Delayed Graft Function (p<0.001) and also between the Human Leukocyte Antigen and MISMATCH. Conclusion: It is pointed out the need for a critical and individualized follow-up of the transplanted patient by the professionals to guarantee the long-term transplantation success


Objetivo: Evaluar las características clínicas e inmunológicas de lós receptores de trasplante renal. Métodos: estudio documental y retrospectivo realizado en una clínica del Hospital General de Fortaleza, Fortaleza, Ceará, Brasil, con pacientes ingresados desde junio de 2012 a junio de 2014. La muestra fue de 300 pacientes sometidos a trasplante de riñón. Las variables predictoras de interés, fueron subdivididas en: características pretrasplante, características post-transplante y características inmunológicas. Se utilizaron pruebas de Pearson y Spearman para evaluar la correlación entre variables. Resultados: Hubo un predominio de pacientes del sexo masculino (65%), con edades comprendidas entre 44 y 56 años (31,4%). Se demostró una relación estadísticamente significativa entre el DSA y la disfunción del injerto (p <0,04), el rechazo celular del panel reactivo clase I (p <0,05), el tiempo de internación y la disfunción del injerto (p <0,001) y entre el HLA y el MISMATCH. Conclusión: Se apunta la necesidad de un acompañamiento crítico e individualizado del paciente trasplantado por parte de los profesionales para garantizar el éxito del trasplante a largo plazo


Asunto(s)
Humanos , Masculino , Femenino , Inmunología del Trasplante , Trasplante de Riñón/estadística & datos numéricos , Continuidad de la Atención al Paciente/estadística & datos numéricos , Brasil , Rechazo de Injerto/epidemiología
11.
Psychiatr Danub ; 31(Suppl 3): 622-625, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31488803

RESUMEN

Doctors play an important role in a multidisciplinary team, however therapeutic relationships are not limited to between a doctor and a patient. In Community Mental Health Teams, patients are allocated a care coordinator - usually a community psychiatric nurse or a social worker - and they usually become the healthcare provider the patient is most regularly in contact with. Similarly, a practice nurse in General Practice may be the healthcare professional a patient is most familiar with. In these instances, the patient-provider relationship may be stronger than the doctor-patient relationship. Non-doctor and patient relationships play an increasingly important role in improving the patient experience and contributing to information gathering, shared-decision making, and establishment and adherence to treatment plans. Care coordinators may be in a more superior position than doctors to accurately recognise the ongoing and changing needs of a person with mental illness. Patients value continuity of care, compassion, and mutual trust and respect: these qualities can potentially all be provided by any trained healthcare professional. In this paper, we will review the literature on the emerging role of the care coordinator and other healthcare professionals in the management of chronic mental illness in the community.


Asunto(s)
Servicios Comunitarios de Salud Mental/organización & administración , Trastornos Mentales/terapia , Médicos , Enfermedad Crónica/terapia , Continuidad de la Atención al Paciente , Empatía , Humanos , Relaciones Médico-Paciente
12.
AIDS Behav ; 23(Suppl 3): 287-295, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31520241

RESUMEN

Test and Rapid Response Treatment (TRRT) linkage programs have demonstrated improved HIV suppression rates. This paper describes the design and implementation of the Miami TRRT initiative and its clinical impact. Assisted by a dedicated care navigator, patients receiving a reactive HIV rapid test at the Florida Department of Health STD Clinic were offered same-day HIV care at the University of Miami/Jackson Memorial Medical Center Adult HIV Outpatient Clinic. Patient retention and labs were tracked for 12 months. Of the 2337 individuals tested, 46 had a reactive HIV test; 41 (89%) consented to participate. For the 36 patients in continued care for a year, 33 (91.7%) achieved virological suppression (< 200 copies/mL) within 70 days of their reactive HIV rapid test; at 12 months, 35 (97.2%) remained suppressed, and mean CD4 T cell counts increased from 452 ± 266 to 597 ± 322 cells/mm3. The Miami TRRT initiative demonstrated that immediate linkage to care is feasible and improves retention and suppression in a public/academic medical center in the U.S. South.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Tamizaje Masivo/métodos , Navegación de Pacientes , Cumplimiento y Adherencia al Tratamiento/psicología , Centros Médicos Académicos , Adulto , Instituciones de Atención Ambulatoria , Recuento de Linfocito CD4 , Continuidad de la Atención al Paciente , Femenino , Florida , Infecciones por VIH/virología , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud , Resultado del Tratamiento , Carga Viral
13.
Bull Cancer ; 106(10): 847-859, 2019 Oct.
Artículo en Francés | MEDLINE | ID: mdl-31521255

RESUMEN

INTRODUCTION: The Cancer Observatory, from the OMEDITs (Observatory for Medicines and Medical Devices and Treatment Innovations) of Bretagne and Pays de la Loire areas has conducted a survey aiming to know and map the current practices of management of patients by Oral Anti-cancer Drug (OAD) in inter-region. METHODS: Forty eight cancer centers received by e-mail in July and October 2016 a questionnaire concerning the management of OADs : from prescription by the specialist of oncology, to the intervention of the pharmacist (analysis and pharmaceutical consulting), to follow-up by nurse, as well as the financing of this activity and the feelings of the actors about this organizational set up. RESULTS: Fifty-seven professionals from 31 centers, including the most important ones, responded to the survey. As a result, half of the establishments carry out a pharmaceutical analysis for some or all of the OAD prescriptions and only 30% carry out a pharmaceutical consulting. The nurse consultation is, on the other hand, more largely implanted (74% of the centers) as well as the telephone follow-up (6%). More than 90% of professionals believe that the organizational set up could be improved and more secure by, at least, the stronger involvement of pharmacists, the development of tools for nurse (for monitoring, therapeutic education…) and by improving the city-hospital link. CONCLUSION: This survey shows the variability in the management of patients under OAD because of the lack of resources to ensure the fairness and sustainability of the organizational set up. The hospital/city link could still be optimized to secure patient care.


Asunto(s)
Antineoplásicos/administración & dosificación , Encuestas de Atención de la Salud/estadística & datos numéricos , Neoplasias/tratamiento farmacológico , Administración Oral , Instituciones Oncológicas/estadística & datos numéricos , Continuidad de la Atención al Paciente/estadística & datos numéricos , Prescripciones de Medicamentos , Francia , Humanos , Rol de la Enfermera , Objetivos Organizacionales , Satisfacción del Paciente , Farmacéuticos , Pautas de la Práctica en Enfermería/estadística & datos numéricos , Teléfono
14.
Bone Joint J ; 101-B(9): 1087-1092, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31474144

RESUMEN

AIMS: The aim of this study was to assess the effects of transferring patients to a specialized arthroplasty centre between the first and second stages (interstage) of prosthetic joint infection (PJI) of the knee. PATIENTS AND METHODS: A search of our institutional database was performed to identify patients having undergone two-stage revision total knee arthroplasty (TKA) for PJI. Two cohorts were created: continuous care (CC) and transferred care (TC). Baseline characteristics and outcomes were collected and compared between cohorts. RESULTS: A total of 137 patients were identified: 105 in the CC cohort (56 men, 49 women; mean age 67.9) and 32 in the TC cohort (17 men, 15 women; mean age 67.8 years). PJI organism virulence was greater in the CC cohort (36.2% vs 15.6%; p = 0.030). TC patients had a higher rate of persisting or recurrent infection (53.6% vs 13.4%; p < 0.001), soft-tissue complications (31.3 vs 14.3%; p = 0.030), and reduced requirement for porous metal augments (78.1% vs 94.3%; p = 0.006). Repeat first stage debridement after transfer led to greater need for plastic surgical procedures (58.3% vs 0.0%; p < 0.001). CONCLUSION: Patient transfer during the interstage of treatment for infected TKA leads to poorer outcomes compared with patients receiving all their treatment at a specialized arthroplasty centre. Cite this article: Bone Joint J 2019;101-B:1087-1092.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Hospitales Especializados/estadística & datos numéricos , Transferencia de Pacientes/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Infecciones Relacionadas con Prótesis/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Continuidad de la Atención al Paciente/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Infecciones Relacionadas con Prótesis/etiología , Reoperación/estadística & datos numéricos , Resultado del Tratamiento
15.
Z Orthop Unfall ; 157(5): 510-514, 2019 Oct.
Artículo en Inglés, Alemán | MEDLINE | ID: mdl-31387123

RESUMEN

BACKGROUND: A key factor in the successful treatment of periprosthetic joint infection is the consistent antimicrobial therapy. Depending on the pathogen antimicrobial susceptibility, intravenous (i. v.) antibiotics may not be switched to oral medication at patient discharge, without risking a treatment failure. The implementation of an outpatient i. v. therapy using peripherally inserted central catheters (PICCs) allows for early discharge with continuation of adequate antimicrobial therapy. METHODS: We prospectively evaluated the systematic use of PICC in 11 patients with periprosthetic joint infection. Inclusion criterion was the detection of a pathogen that cannot be optimally treated with oral antibiotics according to the current treatment concept (Trampuz et al.). RESULTS: A total of 12 PICCs in 11 patients were analysed. An error or mechanical nerve irritation was not observed. The occurrence of a catheter-related bloodstream infection (CRBSI) was not recorded. None of our patients had PICC-associated infections, thrombophlebitis or thrombosis. One patient stopped therapy due to a lack of compliance. Ten patients successfully completed their treatment. At a mean follow-up of 29 months, successful infection eradication as measured by the Delphi criteria was achieved in 100%. CONCLUSION: Although the number of patients included in the study was small, our short-term results suggest a good applicability of PICCs in the outpatient i. v. antimicrobial therapy for treatment of periprosthetic joint infection. Catheter-associated complications could not be observed in our collective. The successful infection control in all cases despite proven difficult-to-treat infection is promising.


Asunto(s)
Antibacterianos/administración & dosificación , Cateterismo Periférico , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Administración Intravenosa , Anciano , Atención Ambulatoria , Continuidad de la Atención al Paciente , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/microbiología
16.
BMC Infect Dis ; 19(1): 703, 2019 Aug 08.
Artículo en Inglés | MEDLINE | ID: mdl-31395019

RESUMEN

BACKGROUND: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. METHODS: We conducted a single arm clinical trial of a combined transitional care coordination (TCC) and patient navigation intervention and assessed the linkage rate and factors associated with linkage to HCV care after incarceration. RESULTS: During the intervention, 84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years. Of those who returned to the community, 26 (31%) linked to HCV care within a median of 20.5 days; 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, 9 (11%) had a follow-up lab drawn to confirm sustained virologic response (SVR), and 7 (8%) had a documented SVR. Among those with follow-up labs the known SVR rate was (7/9) 78%. Expressing a preference to be linked to the participant's existing health system, being on methadone prior to incarceration, and feeling that family or a loved one were concerned about the participant's wellbeing were associated with linkage to HCV care. Reporting drinking alcohol to intoxication prior to incarceration was negatively associated with linkage to HCV care. CONCLUSION: We demonstrate that an integrated strategy with combined TCC and patient navigation may be effective in achieving timely linkage to HCV care. Additional multicomponent interventions aimed at treatment of substance use disorders and increasing social support could lead to further improvement. TRIAL REGISTRATION: Clinicaltrials.gov NCT04036760 July 30th, 2019 (retrospectively registered).


Asunto(s)
Continuidad de la Atención al Paciente , Hepatitis C/tratamiento farmacológico , Prisioneros/estadística & datos numéricos , Adulto , Servicios de Salud Comunitaria , Femenino , Hepatitis C/virología , Hispanoamericanos , Humanos , Masculino , Metadona/uso terapéutico , Persona de Mediana Edad , New York , Navegación de Pacientes , Prisiones , Estudios Prospectivos , Trastornos Relacionados con Sustancias/terapia , Respuesta Virológica Sostenida
17.
AIDS Behav ; 23(10): 2654-2673, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31463711

RESUMEN

Pre-exposure prophylaxis (PrEP) has demonstrated high efficacy to reduce HIV infections, however, racial/ethnic HIV disparities continue among black MSM. The purpose of this review was to assess available data to inform interventions to increase PrEP awareness, uptake, and adherence among black MSM. Of the 3024 studies retrieved, 36 met final inclusion criteria and were categorized into the PrEP care continuum: (1) awareness (n = 16), (2) uptake (n = 9), and (3) adherence (n = 12). Only 26 of the studies presented analytical findings by race/ethnicity. Key barrier themes included cost, HIV-related stigma, and fear of potential side effects. A key facilitator theme identified by black MSM included gaining PrEP awareness from social and sexual networks. There are significant gaps in research on black MSM and PrEP utilization, especially regarding PrEP uptake and adherence. These data are needed to inform interventions to address current inequities in PrEP services, to help improve care outcomes for black MSM.


Asunto(s)
Afroamericanos/psicología , Fármacos Anti-VIH/administración & dosificación , Continuidad de la Atención al Paciente , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Aceptación de la Atención de Salud/psicología , Profilaxis Pre-Exposición/estadística & datos numéricos , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Fármacos Anti-VIH/uso terapéutico , Concienciación , Infecciones por VIH/tratamiento farmacológico , Homosexualidad Masculina/etnología , Homosexualidad Masculina/psicología , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Retención en el Cuidado , Conducta Sexual , Estigma Social
18.
19.
Presse Med ; 48(7-8 Pt 1): e209-e215, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31421945

RESUMEN

AIM: Identified Palliative Care Beds (Lits Identifiés Soins Palliatifs - LISPs) is a French specificity. Primarily created to integrate palliative care culture into conventional hospital units, the relevance of this measure became a controversial issue. Nowadays, hospital teams continue to frequently encounter complex situations regarding medical care for palliative patients. To the best of our knowledge, there is only one study, a quantitative one, bridging the gap about that subject. It showed failure in practicing palliative care work around LISP. Our study is based on a qualitative method that complements the quantitative study. It aimed to describe difficulties that limit palliative care practices in managing adult patients in LISP. METHOD: This qualitative exploratory survey was conducted with a sample of health service professionals (n=20), from senior physicians to caregivers. Each semi-structured interview included open questions regarding their experiences, feelings and difficulties with palliative care practices on LISP. It also included closed questions concerning interviewee's demographics and career course. The data for this research were submitted to a two-stage analysis: first, a global review of each interview was performed to identify trends. Then, a detailed breakdown, question by question, was implemented. RESULTS: From a quantitative perspective, the interviews revealed 305 difficulties, indicating the gaps and barriers limiting the implementation of a palliative approach in these services. From a qualitative perspective, five topics raised our attention by their recurrence in discourses: (1) partial knowledge about palliative care definition and legislation mostly due to a lack of training; (2) need for time; (3) need for human resources; (4) need for communication; (5) hard time in transitioning from curative to palliative care. PERSPECTIVE: This survey gives the opportunity to understand health service professionals' difficulties in practicing palliative care in conventional medical services. It raises the central issue of the pricing reform on the health institutes activity. It also provides angles of inquiry to improve LISP effectiveness. This qualitative and descriptive study was designed to explore difficulties in practicing palliative care around LISP. Nevertheless, according to the size of the sample, results will need to be confirmed by a more extensive qualitative survey.


Asunto(s)
Continuidad de la Atención al Paciente , Unidades Hospitalarias/organización & administración , Cuidados Paliativos/organización & administración , Grupo de Atención al Paciente/organización & administración , Pautas de la Práctica en Medicina , Calidad de la Atención de Salud/organización & administración , Adulto , Actitud del Personal de Salud , Cuidadores/organización & administración , Cuidadores/normas , Barreras de Comunicación , Continuidad de la Atención al Paciente/organización & administración , Continuidad de la Atención al Paciente/normas , Prestación de Atención de Salud/métodos , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/normas , Arquitectura y Construcción de Instituciones de Salud/normas , Francia , Conocimientos, Actitudes y Práctica en Salud , Capacidad de Camas en Hospitales , Unidades Hospitalarias/normas , Humanos , Entrevistas como Asunto , Satisfacción en el Trabajo , Cuidados Paliativos/psicología , Cuidados Paliativos/normas , Grupo de Atención al Paciente/normas , Pautas de la Práctica en Medicina/organización & administración , Pautas de la Práctica en Medicina/normas , Investigación Cualitativa , Calidad de la Atención de Salud/normas , Estudios Retrospectivos , Encuestas y Cuestionarios
20.
Rev Lat Am Enfermagem ; 27: e3162, 2019 Aug 19.
Artículo en Portugués, Inglés, Español | MEDLINE | ID: mdl-31432917

RESUMEN

OBJECTIVE: to describe the activities developed by the liaison nurses for the continuity of care after hospital discharge. METHOD: descriptive, qualitative study, based on the theoretical reference. Strength Based Care. The sample comprised 23 liaison nurses. The data was collected through a semi-structured questionnaire via Survey Monkey electronic platform and analyzed through the content analysis technique, with pre-defined categories. RESULTS: among the liaison nurses, nine (39.14%), between 35 and 44 years of age; 17 (73.91%) were female; 15 (65.22%) were working eleven years or more nurse and 11 (47.82%), were between six and ten years old as a liaison nurse. The professionals participate in the identification of the patients who need care after hospital discharge, coordinate the planning of the hospital discharge and transfer the patient's information to an extra-hospital service. CONCLUSION: the activities developed by the liaison nurses focus on the needs of the patient and the articulation with the extra-hospital services, and can be adapted to the Brazilian context as a strategy to minimize the discontinuity of care at the time of hospital discharge.


Asunto(s)
Continuidad de la Atención al Paciente/normas , Rol de la Enfermera , Personal de Enfermería en Hospital/normas , Alta del Paciente/estadística & datos numéricos , Adulto , Brasil , Canadá , Femenino , Hospitales Universitarios , Humanos , Masculino , Transferencia de Pacientes , Investigación Cualitativa , Encuestas y Cuestionarios
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