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1.
Pediatrics ; 144(2)2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31363070

RESUMEN

Physician-scientists represent a critical component of the biomedical and health research workforce. However, the proportion of physicians who spend a significant amount of effort on scientific research has declined over the past 40 years. This trend has been particularly noticeable in pediatrics despite recent scientific work revealing that early life influences, exposures, and health status play a significant role in lifelong health and disease. To address this problem, the Duke University Department of Pediatrics developed the Duke Pediatric Research Scholars Program for Physician-Scientist Development (DPRS). The DPRS is focused on research training during pediatric residency and fellowship. We aim to provide sufficient research exposure and support to help scholars develop a research niche and scholarly products as well as identify the career pathways that will enable them to achieve their research goals. Herein, we describe the DPRS's organizational structure, core components, recruitment strategies, and initial results, and we discuss implementation challenges and solutions. Additionally, we detail the program's integration with the department's residency and fellowship training programs (with particular reference to the challenges of integrating research into small- to medium-sized residency programs) and describe the development and integration of related initiatives across Duke University School of Medicine. The program served as the basis for 2 successful National Institutes of Health Stimulating Access to Research in Residency (R38) applications, and we hope it will serve as a model to integrate formalized research training for residents and fellows who wish to pursue research careers in academic medicine.


Asunto(s)
Investigación Biomédica/educación , Investigación Biomédica/métodos , Personal de Laboratorio Clínico/educación , Pediatras/educación , Desarrollo de Programa/métodos , Investigación Biomédica/tendencias , Selección de Profesión , Competencia Clínica , Humanos , Internado y Residencia/métodos , Internado y Residencia/tendencias , Personal de Laboratorio Clínico/tendencias , Tutoría/métodos , Tutoría/tendencias , Pediatras/tendencias
2.
BMC Health Serv Res ; 19(1): 515, 2019 Jul 23.
Artículo en Inglés | MEDLINE | ID: mdl-31337391

RESUMEN

BACKGROUND: Many international health policies recognise the World Health Organization's (2008) vision that communities should be involved in shaping primary healthcare services. However, researchers continue to debate definitions, models, and operational challenges to community participation. Furthermore, there has been no use of implementation theory to study how community participation is introduced and embedded in primary healthcare in order to generate insights and transferrable lessons for making this so. Using Normalisation Process Theory (NPT) as a conceptual framework, this qualitative study was designed to explore the levers and barriers to the implementation of community participation in primary healthcare as a routine way of working. METHODS: We conducted two qualitative studies based on a national Initiative designed to support community participation in primary care in Ireland. We had a combined multi-stakeholder purposeful sample (n = 72), utilising documentary evidence (study 1), semi-structured interviews (studies 1 and 2) and focus groups (study 2). Data generation and analysis were informed by Participatory Learning and Action (PLA) Research Methodology and NPT. RESULTS: For many stakeholders, community participation in primary healthcare was a new way of working. Stakeholders did not always have a clear, shared understanding of the aims, objectives and benefits of this way of working and getting involved in a specific project sometimes provided this clarity. Drivers/champions, and strong working partnerships, were considered integral to its initiation and implementation. Participants emphasised the benefits of funding, organisational support, training and networking to enact relevant activities. Health-promoting activities and healthcare consultation/information events were generally successful, but community representation on interdisciplinary Primary Care Teams proved more challenging. Overall, participants were broadly positive about the impacts of community participation, but were concerned about the scope to sustain the work without the 'protected' space and resources that the national Initiative afforded. CONCLUSIONS: Despite the success of specific activities undertaken as part of a community process in Irish primary healthcare, the likelihood of this becoming a routine way of working in Ireland is low. Analysing the learning from this process using NPT provides theoretically informed recommendations that are transferrable to other settings and can be used to prospectively design and formatively evaluate community participation processes.


Asunto(s)
Participación de la Comunidad , Atención Primaria de Salud , Desarrollo de Programa/métodos , Grupos Focales , Política de Salud , Humanos , Irlanda , Modelos Teóricos , Investigación Cualitativa , Derivación y Consulta
3.
Int J Evid Based Healthc ; 17 Suppl 1: S68-S71, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31283587

RESUMEN

In 2016, the Belgian Minister for Social Affairs and Public Health decided to set up a central governance structure for evidence-based practice (EBP). The underlying model, consisting of six EBP life cycle cells (prioritization, development, validation, dissemination, implementation and evaluation) and a bipolar governance layer was developed in 2017. Based on the characteristics of the Belgian EBP landscape, a network administrative organization was chosen to coordinate and facilitate the operational processes in the EBP life cycle and act as intermediate between the two forces: stakeholders and funders/policy makers. Scientific processes remain the responsibility of the EBP experts in the cells. As organizational change can result in resistance, building trust and consensus is a very important success factor for the setup of the network. The process is now in an advanced stage and in 2019 the EBP governance structure will be operationalized.


Asunto(s)
Práctica Clínica Basada en la Evidencia/organización & administración , Bélgica , Guías como Asunto/normas , Humanos , Innovación Organizacional , Desarrollo de Programa/métodos
4.
Pediatrics ; 143(6)2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31160512

RESUMEN

OBJECTIVES: To develop a nationwide, evidence-based framework to support prenatal counseling in extreme prematurity, focusing on organization, decision-making, content, and style aspects. METHODS: A nationwide multicenter RAND-modified Delphi method study was performed between November 2016 and December 2017 in the Netherlands. Firstly, recommendations were extracted from literature and previous studies. Secondly, an expert panel (n = 21) with experienced parents, obstetricians, and neonatologists rated the recommendations on importance for inclusion in the framework. Thirdly, ratings were discussed in a consensus meeting. The final set of recommendations was approved and transformed into a framework. RESULTS: A total of 101 recommendations on organization, decision-making, content, and style were included in the framework, including tools to support personalization. The most important recommendations regarding organization were to have both parents involved in the counseling with both the neonatologist and obstetrician. The shared decision-making model was recommended for deciding between active support and comfort care. Main recommendations regarding content of conversation were explanation of treatment options, information on survival, risk of permanent consequences, impossibility to predict an individual course, possibility for multiple future decision moments, and a discussion on parental values and standards. It was considered important to avoid jargon, check understanding, and provide a summary. The expert panel, patient organization, and national professional associations (gynecology and pediatrics) approved the framework. CONCLUSIONS: A nationwide, evidence-based framework for prenatal counseling in extreme prematurity was developed. It contains recommendations and tools for personalization in the domains of organization, decision-making, content, and style of prenatal counseling.


Asunto(s)
Consejo/normas , Personal de Salud/normas , Recien Nacido Extremadamente Prematuro , Enfermedades del Prematuro/diagnóstico , Atención Prenatal/normas , Desarrollo de Programa/normas , Actitud del Personal de Salud , Toma de Decisiones Clínicas/métodos , Consejo/métodos , Técnica Delfos , Femenino , Humanos , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/terapia , Países Bajos/epidemiología , Embarazo , Atención Prenatal/métodos , Desarrollo de Programa/métodos , Encuestas y Cuestionarios
8.
Nurs Womens Health ; 23(3): 253-264, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31059674

RESUMEN

Choosing Wisely is a national health care improvement campaign promoting conversations between women and their health care professionals about selecting high-value health care practices. It disseminates lists of recommendations and downloadable educational materials from professional societies on its website. In November 2018, we searched for and categorized Choosing Wisely recommendations pertinent to women's health care. Of 78 recommendations, 28 (36%) were related to perinatal care, 22 (28%) were related to gynecologic care, and 28 (36%) were related to women's health and general care. Twelve recommendations (17.6%) were related to antenatal care, 10 (14.7%) to intrapartum and postpartum care, and 10 (14.7%) to cervical cancer screening. These free resources can help frame the shared decision-making process in clinical practice.


Asunto(s)
Toma de Decisiones , Mejoramiento de la Calidad/tendencias , Servicios de Salud para Mujeres/normas , Femenino , Humanos , Embarazo , Desarrollo de Programa/métodos , Calidad de la Atención de Salud/normas , Servicios de Salud para Mujeres/tendencias
9.
Intensive Crit Care Nurs ; 53: 79-83, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31056235

RESUMEN

OBJECTIVES: To assess the potential impact of introducing an already established and effective programme of rehabilitation within a critical care unit in a different organisation. DESIGN: Fifteen-month prospective before/after quality improvement project. SETTING: Seven-bed mixed dependency critical care unit. PARTICIPANTS: 209 patients admitted to critical care for ≥4 days. INTERVENTION: A multi-faceted quality improvement project focussed on changing structure and overcoming local barriers to increase levels of rehabilitation within critical care. MAIN OUTCOME MEASURE: Proportion of patients mobilised within critical care, time to first mobilise and highest level of mobility achieved within critical care. RESULTS: Compared to before the quality improvement project, significantly more patients mobilised within critical care (92% vs 73%, p = 0.003). This resulted in a significant reduction in time to 1st mobilisation (2 vs 3.5 days, P < 0.001), particularly for those patients ventilated ≥4 days (3 vs 14 days) and higher mobility scores at the point of critical care discharge (Manchester mobility score 5 vs 4, p = 0.019). CONCLUSION: The results from this quality improvement project demonstrate the positive impact of introducing a programme of early and structured rehabilitation to a critical care unit within a different organisation. This could provide a framework for introducing similar programmes to other critical care units nationally.


Asunto(s)
Rehabilitación/métodos , APACHE , Anciano , Cuidados Críticos/métodos , Cuidados Críticos/tendencias , Femenino , Humanos , Unidades de Cuidados Intensivos/organización & administración , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Innovación Organizacional , Desarrollo de Programa/métodos , Estudios Prospectivos , Mejoramiento de la Calidad , Rehabilitación/tendencias , Medicina Estatal/organización & administración , Medicina Estatal/estadística & datos numéricos , Estadísticas no Paramétricas
10.
Nurs Womens Health ; 23(3): 224-233, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31077639

RESUMEN

OBJECTIVE: To design and implement group prenatal care (GPC) for Somali women and to evaluate participants' satisfaction, knowledge, and care engagement. DESIGN: Quality improvement project. SETTING/LOCAL PROBLEM: A federally qualified health center in an urban Midwestern setting, which serves a largely East African immigrant and refugee population. PARTICIPANTS: Pregnant Somali women at more than 20 weeks gestation receiving prenatal care at the project site. Many participants were non-English speaking. INTERVENTION/MEASUREMENTS: While honoring the 13 essential elements of CenteringPregnancy, the model was adapted to the East African population at the project site and offered to all eligible women receiving individual prenatal care at the clinic. Women attended biweekly sessions, including individual assessment and education, exposure to integrative health therapies, and group discussion. Pre- and postintervention data were collected in surveys and in-depth interviews from March through August 2017. RESULTS: Seventeen Somali women attended a median of two sessions (range = 1-7). Self-reported results for knowledge of safe exercise in pregnancy (p = .02), exclusive breastfeeding (p = .04), what happens in the hospital (p = .02), and stress management (p = .03) increased after GPC participation. Ninety-three percent of women preferred GPC to individual care. CONCLUSION: When adapted to meet the needs of Somali women, GPC has the potential to improve care satisfaction, increase knowledge, and reduce stress during pregnancy and the postpartum period. This model may interest women and care providers in similar community health care settings.


Asunto(s)
Instituciones de Atención Ambulatoria/tendencias , Atención Prenatal/métodos , Desarrollo de Programa/métodos , Adulto , Instituciones de Atención Ambulatoria/organización & administración , Emigrantes e Inmigrantes/psicología , Femenino , Humanos , Medio Oeste de Estados Unidos , Áreas de Pobreza , Embarazo , Mejoramiento de la Calidad , Somalia/etnología , Encuestas y Cuestionarios
11.
JMIR Mhealth Uhealth ; 7(5): e12542, 2019 05 29.
Artículo en Inglés | MEDLINE | ID: mdl-31144672

RESUMEN

BACKGROUND: The incidence of cancer pain increases in discharged patients because of discontinued standard treatments and reductions in medication adherence. Motivated by the need for better pain management in discharged patients, we developed a mobile phone app (Pain Guard) to provide continuous treatment information and feedback to discharged cancer patients suffering from pain. OBJECTIVE: The aim was to design, construct, and test the Pain Guard app in patients managing cancer pain, evaluate the total remission rate of pain and the improvement in quality of life (QoL) to improve pain management for cancer pain patients, and assess patient acceptance of the app. METHODS: This randomized controlled double-arm study involved 58 patients with cancer pain symptoms. Participants were randomly assigned to a group receiving care through the Pain Guard app (n=31) or to a control group (n=27) who received only traditional pharmaceutical care. In a pretest, participants were rated using a baseline cancer pain assessment and QoL evaluation. During treatment, the consumption levels of analgesic drugs were recorded every week. After a 4-week study period, another round of cancer pain assessment and QoL evaluation was conducted. The system's usability, feasibility, app compliance, and satisfaction were also assessed. Our primary outcome was remission rate of pain, and secondary outcomes were medication adherence, improvements in QoL, frequency of breakthrough cancer pain (BTcP), incidence of adverse reactions, and satisfaction of patients. RESULTS: All participants (N=58) successfully completed the study. There were no significant differences in baseline pain scores or baseline QoL scores between groups. At the end of the study, the rate of pain remission in the trial group was significantly higher than that in the control group (P<.001). The frequency of BTcP in the app group was considerably lower than that in the control group (P<.001). The rate of medication adherence in the trial group was considerably higher than that in the control group (P<.001). Improvements in global QoL scores in the trial group were also significantly higher than those in the control group (P<.001). The incidence of adverse reactions in the trial group (7/31) was lower than that in the control group (12/27), especially constipation, with significant differences (P=.01). The 31 participants in the trial group completed a satisfaction survey regarding Pain Guard: 23 (74%) indicated that they were satisfied with receiving pharmaceutical care by Pain Guard, 5 (16%) indicated that they were somewhat satisfied, 2 (6%) indicated neutral feelings, and 1 (3%) indicated that they were somewhat dissatisfied; no participants indicated that they were very dissatisfied. CONCLUSIONS: Pain Guard was effective for the management of pain in discharged patients with cancer pain, and its operability was effective and easily accepted by patients. TRIAL REGISTRATION: Chinese Clinical Trials Registry ChiCTR1800016066; http://www.chictr.org.cn/showproj.aspx?proj=27153.


Asunto(s)
Dolor en Cáncer/terapia , Aplicaciones Móviles/normas , Manejo del Dolor/normas , Adulto , Dolor en Cáncer/psicología , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aplicaciones Móviles/estadística & datos numéricos , Neoplasias/complicaciones , Neoplasias/psicología , Manejo del Dolor/instrumentación , Manejo del Dolor/estadística & datos numéricos , Desarrollo de Programa/métodos , Calidad de Vida/psicología , Derivación y Consulta , Encuestas y Cuestionarios
12.
J Med Syst ; 43(7): 182, 2019 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-31093803

RESUMEN

Today, despite the advantages of the PACS system, its implementation in some healthcare organizations faces many challenges. One of the important factors in the successful implementation of a PACS system is identifying and prioritizing the challenges from the perspectives of involved staff and user of this system. Therefore, the aim of this study was to determine and compare the challenges of implementing PACS from perspectives these users in educational hospitals. This study was conducted on all IT and medical equipment staff, and radiology residents (n = 140) in Kerman University of Medical Sciences (KUMS) and Shiraz University of Medical Sciences (SUMS) in 2016. The data were collected through two researcher-made questionnaires. Their validity was approved by radiologists, IT staff, and medical informatics specialists and their reliability through calculation of Cronbach's Alpha (0.969 and 0.795). We used Multivariate Analysis of Variance (MANOVA) to compare the scores given by three groups of participants in the challenges and Univariate Analysis of Variance (ANOVA) to compare the scores in two universities. The participants believed that technical challenges were more important than other challenges (x̄=3.74, SD = 0.7). IT experts (x̄=3.87, SD = 1) and radiology residents (x̄=3.95, SD = 0.9) gave the higher scores to the "shortage of high quality monitors" factor and medical equipment experts (x̄=4.26, SD = 0.87) to the "low speed of communication networks" factor among all technical challenges. The mean scores given to technical (x̄=76.1, SD = 13.5) and managerial (x̄=16, SD = 5.9) challenges in SUMS were more than the scores of the same challenges in KUMS (x̄=69.9, SD = 15.7) and (x̄=11.9, SD = 6.4) (p < 0.05). The technical challenges are the most common challenges to PACS implementation, and different universities experience different levels of technical challenges. Eliminating implementation challenges can reduce the risk of failure in the utilization process. Based on the results of this study, providing necessary infrastructures such as appropriate monitors and upgraded IT equipment can prevent many of the PACS implementation challenges.


Asunto(s)
Sistemas de Información en Hospital , Desarrollo de Programa/métodos , Sistemas de Información Radiológica/organización & administración , Adulto , Actitud del Personal de Salud , Femenino , Humanos , Irán , Masculino , Persona de Mediana Edad , Estudios de Casos Organizacionales , Encuestas y Cuestionarios
13.
Clinics (Sao Paulo) ; 74: e435, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30994702

RESUMEN

OBJECTIVES: Minimally invasive paracentetic suprapubic cystostomy is a technique that should be learned by all surgical trainees and residents. This study aimed to develop a self-made training model for paracentetic suprapubic cystostomy and placement of the suprapubic catheter and then to evaluate its effectiveness in training fourth-year medical students. METHODS: Medical students were divided into an experimental group receiving comprehensive training involving literature, video, and model use and a control group receiving all the same training protocols as the experimental group except without hands-on practice using the model. Each student's performance was video-recorded, followed by subjective and objective evaluations by urology experts and statistical analysis. RESULTS: All students completed the surgical procedures successfully. The experimental group's performance scores were significantly higher than those of the control group (median final performance scores of 91.0 vs. 86.8, respectively). Excellent scores were achieved by more students in the experimental group than in the control group (55% vs. 20%), and fewer poor scores were observed in the experimental group than in the control group (5% vs. 30%). CONCLUSIONS: Based on its cost-effectiveness, reusability, and training effectiveness, this paracentetic suprapubic cystostomy training model is able to achieve goals in teaching practice quickly and easily. Use of the model should be encouraged for training senior medical students and resident physicians who may be expected to perform emergent suprapubic catheter insertion at some time.


Asunto(s)
Cistostomía/educación , Evaluación Educacional , Modelos Anatómicos , Desarrollo de Programa/métodos , Entrenamiento Simulado/métodos , Análisis Costo-Beneficio , Cistostomía/instrumentación , Cistostomía/métodos , Educación de Pregrado en Medicina/métodos , Femenino , Humanos , Masculino , Paracentesis/educación , Paracentesis/instrumentación , Paracentesis/métodos , Estudios Prospectivos , Distribución Aleatoria , Cateterismo Urinario/instrumentación , Cateterismo Urinario/métodos , Grabación en Video/métodos
14.
JMIR Mhealth Uhealth ; 7(4): e11664, 2019 04 11.
Artículo en Inglés | MEDLINE | ID: mdl-30973345

RESUMEN

BACKGROUND: In 2011, we launched the Smarter Pregnancy mobile health (mHealth) coaching program, which has shown to effectively improve inadequate nutrition and lifestyle behaviors in women before and during pregnancy. It is known that in deprived neighborhoods, risk factors for adverse pregnancy outcomes like inadequate nutrition and lifestyle behaviors accumulate. However, it has not yet been investigated whether the Smarter Pregnancy program is equally effective in women living in deprived neighborhoods. OBJECTIVE: This paper aimed to study the associations between neighborhood deprivation and improvement of inadequate nutrition and lifestyle behaviors of women who were either contemplating pregnancy or already pregnant and subscribed to the Smarter Pregnancy program. METHODS: We performed an additional analysis on data from women who used the Smarter Pregnancy program from 2011 to 2016. The program comprised 24 weeks of coaching on 5 nutrition and lifestyle behaviors, of which adequate intakes or lifestyle behaviors were defined as an intake of 200 grams or above of vegetables, 2 pieces of fruit, daily folic acid supplement use of 400 µg per day, and no smoking or alcohol consumption. Neighborhood deprivation was determined according to the status scores of the Netherlands Institute for Social Research. Logistic regression analyses and generalized estimating equation models were used to assess the associations between the neighborhood status score (NSS) and the improvement of inadequate nutrition and lifestyle behaviors, taking into account the behaviors at baseline. We adjusted the analyses for maternal age, body mass index, geographic origin, pregnancy status, and participation as a couple. RESULTS: Of the 2554 women included, 521 participated with their male partner. Overall, daily vegetable intake was most frequently inadequate at the start of the program (77.72, 1985/2554). Women with a higher NSS (ie, nondeprived neighborhood) smoked less often (adjusted odds ratio [OR] 0.85; 95% CI 0.77-0.93), consumed alcohol more often (adjusted OR 1.14, 95% CI 1.04-1.24), and were less likely to complete the 24 weeks of coaching (OR 0.91, 95% CI 0.88-0.95) compared with women who lived in a neighborhood with a low NSS (ie, deprived). In the total group, the relative improvement of inadequate nutrition and lifestyle behaviors after 24 weeks of coaching was between 26% and 64%. NSS was negatively associated with this improvement, indicating that women with a higher NSS were less likely to improve inadequate nutrition and lifestyle behaviors, especially vegetable intake (adjusted OR 0.89, 95% CI 0.82-0.97). CONCLUSIONS: The Smarter Pregnancy mHealth coaching program empowers women to improve inadequate nutrition and lifestyle behaviors. Unexpectedly, the program seemed more effective in women living in deprived neighborhoods. It is important to unravel differences in needs and behaviors of specific target groups to further tailor the mHealth program on the basis of demographic characteristics like neighborhood deprivation.


Asunto(s)
Tutoría/normas , Ciencias Nutricionales/educación , Atención Preconceptiva/métodos , Telemedicina/normas , Adulto , Femenino , Humanos , Tutoría/métodos , Países Bajos , Ciencias Nutricionales/métodos , Oportunidad Relativa , Atención Preconceptiva/normas , Embarazo , Desarrollo de Programa/métodos , Características de la Residencia/estadística & datos numéricos , Encuestas y Cuestionarios , Telemedicina/métodos , Población Urbana/estadística & datos numéricos
15.
World J Surg ; 43(7): 1628-1635, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31004208

RESUMEN

BACKGROUND: Mozambique has had no policy-driven trauma system and no hospital-based trauma registries, and injury was not a public health priority. In other low-income countries, trauma system implementation and trauma registries have helped to reduce mortality from injury by up to 35%. In 2014, we introduced a trauma registry in four hospitals in Maputo serving 18,000 patients yearly. The project has since expanded nationally. This study summarizes the challenges, results, and lessons learned from this large national undertaking. METHODS: Between October 2014-September 2015, we implemented a trauma registry at four hospitals in Maputo. In October 2015, the project began to be expanded nationally. Physicians and allied health professionals at each hospital were trained to implement the registry, and each identified and trained data collectors. We conducted semi-structured interviews with the key stakeholders of this project to identify the challenges, results, and creative solutions implemented for the success of this project. RESULTS: Most participants identified the importance of having a trauma registry and its usefulness in identifying gaps in trauma care. The registry identified that less than 5% of injured patients arrived by ambulance, which served as evidence for the need for a prehospital system, which the Ministry of Health had already begun implementing. Participants also highlighted how the registry has allowed for a structured clinical approach to patients, ensuring that severely injured patients are identified early. Challenges reported included the high rates of missing data, the difficulty in establishing a streamlined flow of trauma patients within each hospital, and the bureaucratic challenges faced when attempting to improve capacity for trauma care at each hospital by introducing a trauma bay and new technologies. Participants identified the need to improve data completeness, to disseminate the results of the project nationally and internationally, to improve inter-divisional cooperation, and to continue educating health providers on the importance of registries. Participants also identified political instabilities in the region as a potential source of challenge in expanding the project nationally; they also identified the lack of uniform resource allocation and low personnel in many areas, especially rural, as a major burden that would need to be overcome. CONCLUSION: Introduction of a trauma registry system in Mozambique is feasible and necessary. Initial findings provide insight into the nature of traumas seen in Maputo hospitals, but also underscore future challenges, especially in minimizing missing data, utilizing data to develop evidence-based trauma prevention policies, and ensuring the sustainability of these efforts by ensuring continued governmental support, education, and resource allocation. Many of these measures are being undertaken.


Asunto(s)
Desarrollo de Programa/métodos , Vigilancia en Salud Pública/métodos , Sistema de Registros , Heridas y Traumatismos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Recolección de Datos/métodos , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Hospitales , Humanos , Lactante , Masculino , Persona de Mediana Edad , Mozambique/epidemiología , Evaluación de Programas y Proyectos de Salud , Mejoramiento de la Calidad , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/epidemiología , Heridas y Traumatismos/terapia , Adulto Joven
16.
Int J Gynaecol Obstet ; 144 Suppl 1: 7-12, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30815866

RESUMEN

The Expanding Maternal and Neonatal Survival (EMAS) program was implemented from September 2011 to March 2017 to support the Indonesian Ministry of Health to improve the quality of emergency obstetric and newborn care, increase the efficiency and effectiveness of emergency referrals, and increase accountability through local government and civic engagement. EMAS worked in over 400 public and private referral hospitals and community health centers (puskesmas) in six provinces where over 50% of all maternal deaths were occurring. Mentoring was the main method used to improve performance at facilities and within referral systems. The use of data for prospective assessment of indicators of improved quality of care and referral efficiency was strengthened. Case reviews were used to examine contextual factors contributing to maternal deaths in EMAS-target hospitals and external evaluations were used in retrospective assessments of effectiveness of approaches. The vision of sustainability was infused into EMAS approaches from the outset. Collaboration and advocacy with district health offices in EMAS-supported districts enabled self-funding of selected interventions within 23 of 30 EMAS districts and 35 non-EMAS districts. Articles in this Supplement describe outcomes and impact of EMAS approaches over the term of the program.


Asunto(s)
Mortalidad Infantil , Mortalidad Materna , Desarrollo de Programa/métodos , Mejoramiento de la Calidad/organización & administración , Femenino , Humanos , Indonesia/epidemiología , Lactante , Recién Nacido , Servicios de Salud Materno-Infantil/legislación & jurisprudencia , Servicios de Salud Materno-Infantil/normas , Embarazo , Estudios Prospectivos , Derivación y Consulta/normas , Estudios Retrospectivos
17.
JMIR Mhealth Uhealth ; 7(3): e11568, 2019 03 29.
Artículo en Inglés | MEDLINE | ID: mdl-30924789

RESUMEN

BACKGROUND: Schizophrenia relapses are common, have profound, adverse consequences for patients and are costly to health services. Early signs interventions aim to use warning signs of deterioration to prevent full relapse. Such interventions show promise but could be further developed. This study addresses 2 developments: adding basic symptoms to checklists of conventional early signs and using a mobile phone app ExPRESS to aid early signs monitoring. OBJECTIVE: This study aimed to (1) design a pool of self-report items assessing basic symptoms (Basic Symptoms Checklist, BSC); (2) develop and beta test a mobile phone app (ExPRESS) for monitoring early signs, basic symptoms, and psychotic symptoms; and (3) evaluate the long-term acceptability of ExPRESS via qualitative feedback from participants in a 6-month feasibility study. METHODS: The BSC items and ExPRESS were developed and then adjusted following feedback from beta testers (n=5) with a schizophrenia diagnosis. Individuals (n=18) experiencing a relapse of schizophrenia within the past year were asked to use ExPRESS for 6 months to answer weekly questions about experiences of early signs, basic symptoms, and psychotic symptoms. At the end of follow-up, face-to-face qualitative interviews (n=16; 2 were uncontactable) explored experiences of using ExPRESS. The topic guide sought participants' views on the following a priori themes regarding app acceptability: item content, layout, and wording; app appearance; length and frequency of assessments; worries about app use; how app use fitted with participants' routines; and the app's extra features. Interview transcripts were analyzed using the framework method, which allows examination of both a priori and a posteriori themes, enabling unanticipated aspects of app use experiences to be explored. RESULTS: Participants' mean age was 38 years (range 22-57 years). Responses to a priori topics indicated that long-term use of ExPRESS was acceptable; small changes for future versions of ExPRESS were suggested. A posteriori themes gave further insight into individuals' experiences of using ExPRESS. Some reported finding it more accessible than visits from a clinician, as assessments were more frequent, more anonymous, and did not require the individual to explain their feelings in their own words. Nevertheless, barriers to app use (eg, unfamiliarity with smartphones) were also reported. Despite ExPRESS containing no overtly therapeutic components, some participants found that answering the weekly questions prompted self-reflection, which had therapeutic value for them. CONCLUSIONS: This study suggests that apps are acceptable for long-term symptom monitoring by individuals with a schizophrenia diagnosis across a wide age range. If the potential benefits are understood, patients are generally willing and motivated to use a weekly symptom-monitoring app; most participants in this study were prepared to do so for more than 6 months. TRIAL REGISTRATION: ClinicalTrials.gov NCT03558529; https://clinicaltrials.gov/ct2/show/NCT03558529 (Archived by WebCite at http://www.webcitation.org/70qvtRmZY).


Asunto(s)
Aplicaciones Móviles/normas , Trastornos Psicóticos/diagnóstico , Prevención Secundaria/instrumentación , Síndrome , Factores de Tiempo , Adulto , Estudios de Factibilidad , Femenino , Humanos , Entrevistas como Asunto/métodos , Masculino , Persona de Mediana Edad , Aplicaciones Móviles/estadística & datos numéricos , Desarrollo de Programa/métodos , Trastornos Psicóticos/complicaciones , Investigación Cualitativa , Prevención Secundaria/métodos , Prevención Secundaria/normas , Autoinforme/estadística & datos numéricos , Teléfono Inteligente/instrumentación
18.
JMIR Mhealth Uhealth ; 7(3): e11157, 2019 03 25.
Artículo en Inglés | MEDLINE | ID: mdl-30907738

RESUMEN

BACKGROUND: There are disadvantages-largely related to cost, participant burden, and missing data-associated with traditional electronic methods of assessing drinking behavior in real time. This potentially diminishes some of the advantages-namely, enhanced sample size and diversity-typically attributed to these methods. Download of smartphone apps to participants' own phones might preserve these advantages. However, to date, few researchers have detailed the process involved in developing custom-built apps for use in the experimental arena or explored methodological concerns regarding compliance and reactivity. OBJECTIVE: The aim of this study was to describe the process used to guide the development of a custom-built smartphone app designed to capture alcohol intake behavior in the healthy population. Methodological issues related to compliance with and reactivity to app study protocols were examined. Specifically, we sought to investigate whether hazard and nonhazard drinkers would be equally compliant. We also explored whether reactivity in the form of a decrease in drinking or reduced responding ("yes") to drinking behavior would emerge as a function of hazard or nonhazard group status. METHODS: An iterative development process that included elements typical of agile software design guided the creation of the CNLab-A app. Healthy individuals used the app to record alcohol consumption behavior each day for 21 days. Submissions were either event- or notification-contingent. We considered the size and diversity of the sample, and assessed the data for evidence of app protocol compliance and reactivity as a function of hazard and nonhazard drinker status. RESULTS: CNLab-A yielded a large and diverse sample (N=671, mean age 23.12). On average, participants submitted data on 20.27 (SD 1.88) out of 21 days (96.5%, 20.27/21). Both hazard and nonhazard drinkers were highly compliant with app protocols. There were no differences between groups in terms of number of days of app use (P=.49) or average number of app responses (P=.54). Linear growth analyses revealed hazardous drinkers decreased their alcohol intake by 0.80 standard drinks over the 21-day experimental period. There was no change to the drinking of nonhazard individuals. Both hazard and nonhazard drinkers showed a slight decrease in responding ("yes") to drinking behavior over the same period. CONCLUSIONS: Smartphone apps participants download to their own phones are effective and methodologically sound means of obtaining alcohol consumption information for research purposes. Although further investigation is required, such apps might, in future, allow for a more thorough examination of the antecedents and consequences of drinking behavior.


Asunto(s)
Consumo de Bebidas Alcohólicas/tendencias , Aplicaciones Móviles/normas , Cumplimiento y Adherencia al Tratamiento/psicología , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aplicaciones Móviles/estadística & datos numéricos , Desarrollo de Programa/métodos , Teléfono Inteligente/normas , Teléfono Inteligente/estadística & datos numéricos , Diseño de Programas Informáticos , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos
19.
Fam Syst Health ; 37(1): 10-29, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30920260

RESUMEN

INTRODUCTION: Youth with type 1 diabetes (T1D) experiencing self-management difficulties are at risk of irreversible long-term health problems and consume a disproportionate amount of health care resources. Behavioral health interventions for this population have shown limited long-term effects, perhaps because of limited research on and intervention in relevant environments. To effectively intervene, providers must first thoroughly understand how risk factors interact with various contexts (e.g., school, home, hospital) to determine opportunities for the development of relevant interventions. METHOD: This review utilized an ecological systems framework to examine the state of the literature with regard to risk factors for poor T1D outcomes and associated intervention. RESULTS: This review identified that, whereas risk factors in some systems (e.g., individual, family) have received disproportionate scrutiny, other environments and contexts (e.g., school, medical system) have been relatively neglected by researchers. Similarly, interventions that target understudied environments are lacking, and the majority of rigorously studied interventions only target a single context. Perhaps this accounts for the lack of interventions shown to have a long-term impact on glycemic control. DISCUSSION: Our review demonstrates that researchers and funding agencies should prioritize efforts that (a) examine the influence of underexamined environments (e.g., primary care clinics, schools) and interactions (e.g., health care provider to parent, school nurse to youth) on T1D outcomes, (b) place increased emphasis on inclusion of understudied populations (e.g., families of minority racial/ethnic backgrounds), and (c) develop and evaluate interventions that specifically are tailored for these settings, interactions, and populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Medicina de la Conducta/métodos , Diabetes Mellitus Tipo 1/terapia , Automanejo/métodos , Adolescente , Terapia Conductista/instrumentación , Terapia Conductista/métodos , Medicina de la Conducta/tendencias , Niño , Diabetes Mellitus Tipo 1/psicología , Relaciones Familiares/psicología , Femenino , Humanos , Masculino , Pediatría/métodos , Desarrollo de Programa/métodos , Factores de Riesgo , Automanejo/psicología
20.
JMIR Mhealth Uhealth ; 7(3): e10921, 2019 03 18.
Artículo en Inglés | MEDLINE | ID: mdl-30882352

RESUMEN

BACKGROUND: Approximately 70,000 adolescents and young adults (AYA) are diagnosed with cancer each year in the United States. Sarcomas carry a particularly high symptom burden and are some of the most common cancers among AYA. Recent work has documented significant levels of unmet needs among AYA with cancer, particularly the need for psychosocial support. Mobile technology may be a cost-effective and efficient way to deliver a psychosocial intervention to AYA with cancer and cancer survivors. OBJECTIVE: The two aims of this study were to (1) develop a pilot version of a mobile-based mindfulness and social support program and (2) evaluate program usage and acceptability. An exploratory aim was to examine change in psychosocial outcomes. METHODS: Thirty-seven AYA with sarcoma or sarcoma survivors, parents, and health care providers participated in the study. Semistructured interviews were conducted with 10 AYA, parents of five of the adolescents, and six health care providers. Themes from the interviews helped to inform the development of a mobile-based mindfulness pilot program and a companion Facebook-based social support group. Twenty AYA consented to participate in a single-arm pre-post evaluation of the program; 17 downloaded the app and joined the Facebook group. Seven of these participants had participated in the semistructured interviews. Six additional health care providers consented to participate in the evaluation stage. RESULTS: On average, participants completed 16.9 of the 28 unique sessions and used the mindfulness app for a mean 10.2 (SD 8.2) days during the 28-day evaluation period. The majority of participants (16/17) engaged in the social group and posted at least one reply to the moderator's prompts. The mean number of responses per person to the moderator of the social group was 15.2 of 31 (49%, range 0%-97%). Both AYA and health care providers responded positively to the Mindfulness for Resilience in Illness program and offered useful recommendations for improvements. Exploratory psychosocial analyses indicated there were no significant differences from pretest to posttest on measures of perceived social support, mindfulness, body image, or psychological functioning. CONCLUSIONS: This study offers preliminary support for the feasibility and acceptability of a mobile-based mindfulness and Facebook-based social support program for AYA with sarcoma. The feedback from AYA and health care providers will assist in creating a fully developed intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT03130751; https://clinicaltrials.gov/ct2/show/NCT03130751.


Asunto(s)
Atención Plena/instrumentación , Aplicaciones Móviles/normas , Sarcoma/psicología , Apoyo Social , Adolescente , Supervivientes de Cáncer/psicología , Supervivientes de Cáncer/estadística & datos numéricos , Femenino , Humanos , Masculino , Atención Plena/métodos , Aplicaciones Móviles/tendencias , Desarrollo de Programa/métodos , Desarrollo de Programa/estadística & datos numéricos , Sarcoma/complicaciones
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