Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 58.597
Filtrar
1.
Z Psychosom Med Psychother ; 66(1): 20-31, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32066348

RESUMEN

Objectives: Intercultural opening of the health care system is supposed to optimize health services for migrants. It is part of the National Integration Plan and promoted by medical societies in Germany. This study examines its state of implementation at hospitals and rehabilitation centres for psychosomatic medicine and psychotherapy in Bavaria. Methods: A written survey was conducted using a modified version of the questionnaire for the implementation of intercultural opening in the mental health care system IKÖ-P (Penka et al. 2012a). Results: Altogether 18 institutions responded. Migrants were underrepresented among patients and employees excluding physicians. Specialized psychotherapeutic interventions for migrants were rarely available, but frequently used when offered. Conclusions: Intercultural opening was poorly implemented in a structural level. Due to the low response-rate of 21.7 % the survey is not representative. Participation of institutions interested in intercultural opening could have led to biased results. To provide adequate psychosomatic medical care for migrants, intercultural opening should be further developed.


Asunto(s)
Competencia Cultural/organización & administración , Hospitales , Trastornos Psicofisiológicos/terapia , Medicina Psicosomática/organización & administración , Psicoterapia/organización & administración , Centros de Rehabilitación/organización & administración , Alemania , Humanos , Trastornos Psicofisiológicos/etnología , Migrantes/psicología
2.
Rev Med Liege ; 75(2): 125-129, 2020 Feb.
Artículo en Francés | MEDLINE | ID: mdl-32030939

RESUMEN

Cybersecurity is a real threat in almost all human activity domains. The health sector is a particular vulnerable target for cybercriminals. The first reason is obviously the financial incentive: the value of the content of a personal electronic health record, sold on the darknet, easily exceeds 1000 US dollars. The second reason is the aging Information Technology (IT) infrastructure we are dealing with, both in the hospital sector as well as in the vast majority of private medical practices. There is also an astonishing lack of environmental consciousness and an absence of a real safety culture in the medical profession. Very often there is neither an institutional basic training, nor a continuous and mandatory education in institutional cybersecurity. There is no single magic bullet to solve the problem, but various mechanisms can be put in place to mitigate the risks and limit the hazards as much as possible.


Asunto(s)
Seguridad Computacional , Sector de Atención de Salud , Registros Electrónicos de Salud , Hospitales , Humanos
3.
Medicine (Baltimore) ; 99(2): e18714, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914082

RESUMEN

To investigate the situation of antibiotic consumption and to assess the inappropriate use on pediatric inpatients of different types hospitals in Sichuan, China.A cross-sectional survey of antibiotic prescriptions among hospitalized children aged 1month -14years were conducted from April 2018 to June 2018 in southwestern China. Antibiotic prescriptions were extracted from electronic records during hospitalization of each inpatient in five different types hospitals.In this study, the antibiotic prescription rate of hospitalized children was 66.9% (1176/1758). Compared with tertiary children hospital (TC) (46.1%), general hospitals and non-tertiary children hospitals has higher rate of antibiotic prescription (almost 85%) (P < .001). 93.4% of inpatients received parenteral antibiotic. Overall, the most common antibiotics were Cefoperazone and enzyme inhibitor, Cefixime and Azithromycin. Lower respiratory tract infection (LRTI) was the leading reason for antibiotic consumption in pediatric wards (56.8%), followed by upper respiratory tract infection (URTI) (22.2%). For children with LRTI, Cephalosporins were heavy prescribed, especially broad-spectrum third-generation Cephalosporins (60.3%). The antibiotic prescription proportion of URTI in general hospitals and non-tertiary children hospitals (more than 18%) was higher than TC (8.1%) (P < .001).There was inappropriate use of antibiotic in hospitalized children including overuse of parenteral administration, overprescribing of antibiotic on URTI and misuse of third-generation Cephalosporins in pediatric inpatients with LRTI. Compared with tertiary freestanding children hospital, the irrational antibiotic prescription of general hospitals and non-tertiary children hospitals were more serious. Management strategy should be implementer on quality improvement of antibiotic use.


Asunto(s)
Antibacterianos/uso terapéutico , Utilización de Medicamentos/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Prescripción Inadecuada/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Antibacterianos/administración & dosificación , Niño , Niño Hospitalizado , Preescolar , China , Estudios Transversales , Femenino , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Masculino , Infecciones del Sistema Respiratorio/tratamiento farmacológico
4.
N Engl J Med ; 382(1): 51-59, 2020 01 02.
Artículo en Inglés | MEDLINE | ID: mdl-31893515

RESUMEN

BACKGROUND: The hospital industry has consolidated substantially during the past two decades and at an accelerated pace since 2010. Multiple studies have shown that hospital mergers have led to higher prices for commercially insured patients, but research about effects on quality of care is limited. METHODS: Using Medicare claims and Hospital Compare data from 2007 through 2016 on performance on four measures of quality of care (a composite of clinical-process measures, a composite of patient-experience measures, mortality, and the rate of readmission after discharge) and data on hospital mergers and acquisitions occurring from 2009 through 2013, we conducted difference-in-differences analyses comparing changes in the performance of acquired hospitals from the time before acquisition to the time after acquisition with concurrent changes for control hospitals that did not have a change in ownership. RESULTS: The study sample included 246 acquired hospitals and 1986 control hospitals. Being acquired was associated with a modest differential decline in performance on the patient-experience measure (adjusted differential change, -0.17 SD; 95% confidence interval [CI], -0.26 to -0.07; P = 0.002; the change was analogous to a fall from the 50th to the 41st percentile) and no significant differential change in 30-day readmission rates (-0.10 percentage points; 95% CI, -0.53 to 0.34; P = 0.72) or in 30-day mortality (-0.03 percentage points; 95% CI, -0.20 to 0.14; P = 0.72). Acquired hospitals had a significant differential improvement in performance on the clinical-process measure (0.22 SD; 95% CI, 0.05 to 0.38; P = 0.03), but this could not be attributed conclusively to a change in ownership because differential improvement occurred before acquisition. CONCLUSIONS: Hospital acquisition by another hospital or hospital system was associated with modestly worse patient experiences and no significant changes in readmission or mortality rates. Effects on process measures of quality were inconclusive. (Funded by the Agency for Healthcare Research and Quality.).


Asunto(s)
Instituciones Asociadas de Salud , Hospitales , Calidad de la Atención de Salud , Anciano , Femenino , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Medicare , Readmisión del Paciente/estadística & datos numéricos , Readmisión del Paciente/tendencias , Medición de Resultados Informados por el Paciente , Indicadores de Calidad de la Atención de Salud , Estados Unidos
5.
Lancet ; 395(10219): 177-178, 2020 01 18.
Artículo en Inglés | MEDLINE | ID: mdl-31954450
7.
J Nurs Adm ; 50(2): 72-77, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31929345

RESUMEN

OBJECTIVE: To examine whether end-of-life care quality is superior in Magnet hospitals, a recognition designating nursing excellence. BACKGROUND: Considerable research shows better patient outcomes in hospitals with excellent nurse work environments, but end-of-life care quality has not been studied in Magnet hospitals. METHODS: An analysis of cross-sectional data was completed using surveys of nurses and hospitals. Multivariate logistic regression models were used to determine the association between Magnet hospitals and measures of end-of-life care quality. RESULTS: Overall, nurses report poor quality of end-of-life care in US hospitals. In Magnet hospitals, nurses were significantly less likely to give their hospital an unfavorable rating on end-of-life care. CONCLUSIONS: Hospital Magnet status may signal better quality in end-of-life care. Administrators looking to improve the quality of end-of-life care may consider improving aspects of nursing that distinguish Magnet hospitals.


Asunto(s)
Hospitales/estadística & datos numéricos , Personal de Enfermería en Hospital/psicología , Personal de Enfermería en Hospital/normas , Calidad de la Atención de Salud/estadística & datos numéricos , Calidad de la Atención de Salud/normas , Cuidado Terminal/psicología , Cuidado Terminal/normas , Adulto , Actitud del Personal de Salud , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Humanos , Satisfacción en el Trabajo , Masculino , Persona de Mediana Edad , Cultura Organizacional , Cuidado Terminal/estadística & datos numéricos , Estados Unidos
11.
Br J Anaesth ; 124(1): 73-83, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31860444

RESUMEN

BACKGROUND: Socioeconomic circumstances can influence access to healthcare, the standard of care provided, and a variety of outcomes. This study aimed to determine the association between crude and risk-adjusted 30-day mortality and socioeconomic group after emergency laparotomy, measure differences in meeting relevant perioperative standards of care, and investigate whether variation in hospital structure or process could explain any difference in mortality between socioeconomic groups. METHODS: This was an observational study of 58 790 patients, with data prospectively collected for the National Emergency Laparotomy Audit in 178 National Health Service hospitals in England between December 1, 2013 and November 31, 2016, linked with national administrative databases. The socioeconomic group was determined according to the Index of Multiple Deprivation quintile of each patient's usual place of residence. RESULTS: Overall, the crude 30-day mortality was 10.3%, with differences between the most-deprived (11.2%) and least-deprived (9.8%) quintiles (P<0.001). The more-deprived patients were more likely to have multiple comorbidities, were more acutely unwell at the time of surgery, and required a more-urgent surgery. After risk adjustment, the patients in the most-deprived quintile were at significantly higher risk of death compared with all other quintiles (adjusted odds ratio [95% confidence interval]: Q1 [most deprived]: reference; Q2: 0.83 [0.76-0.92]; Q3: 0.84 [0.76-0.92]; Q4: 0.87 [0.79-0.96]; Q5 [least deprived]: 0.77 [0.70-0.86]). We found no evidence that differences in hospital-level structure or patient-level performance in standards of care explained this association. CONCLUSIONS: More-deprived patients have higher crude and risk-adjusted 30-day mortality after emergency laparotomy, but this is not explained by differences in the standards of care recorded within the National Emergency Laparotomy Audit.


Asunto(s)
Servicios Médicos de Urgencia , Laparotomía/mortalidad , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/mortalidad , Factores Socioeconómicos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Inglaterra/epidemiología , Femenino , Hospitales/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Atención Perioperativa/economía , Atención Perioperativa/normas , Pobreza , Ajuste de Riesgo , Medicina Estatal , Adulto Joven
13.
Anaesthesia ; 75(1): 131-132, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31794642
14.
Anaesthesia ; 75(1): 129-130, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31794644
16.
Sci Total Environ ; 700: 134469, 2020 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-31693961

RESUMEN

The presence of contaminants of emerging concern (CECs), such as antibiotics, antimicrobial disinfectants, nonprescription drugs, personal care products, pharmaceuticals, and steroids, in water resources can impact aquatic and human health. A large portion of the CECs entering regional wastewater treatment plants originate from hospitals. The purposes of this study were to conduct exploratory analytical work to characterize two hospital wastewaters and to evaluate treatment of CECs at hospitals before dilution with domestic wastewater. A 24-h batch reaction with biogenic manganese oxides coated onto coir fiber was used to treat the wastewaters. Organic contaminants in the wastewaters were concentrated by both liquid-liquid extraction (LLE) and solid-phase extraction (SPE). LLE extracts were analyzed by Comprehensive Two-Dimensional Gas Chromatography/Time-of-Flight Mass Spectrometry (GC × GC-TOFMS) while SPE extracts were analyzedby UltraHigh Performance Liquid Chromatography/Time-of-Flight Mass Spectrometry (UHPLC-TOFMS). Fifty-two organic micropollutants were detected (26 by GC × GC-TOFMS, 25 by UHPLC-TOFMS, 1 by both) in the wastewaters, while 29 were removed by >90% and six were degraded by <50% after treatment. Control experiments revealed that sorption to coir fiber and oxidation by manganese oxides were the primary contaminant removal mechanisms. Both the LLE and SPE extracts were used to evaluate potential human toxicity of the hospital wastewaters before and after treatment. Twenty-eight human cell-based bioreceptor assays were used to screen the wastewaters, and secondary tests were run to quantify toxicity equivalents to activated receptors. The wastewaters initially contained organic micropollutants that strongly activated the Androgen Receptor, Estrogen Receptor ß, and the Mineralocorticoid Receptor but no bioactive compounds were detected after treatment. Point-of-entry treatment of hospital wastewater should reduce bioactive compounds from entering the environment.


Asunto(s)
Monitoreo del Ambiente , Eliminación de Residuos Líquidos/métodos , Contaminantes Químicos del Agua/análisis , Cromatografía Líquida de Alta Presión , Cromatografía Liquida , Cromatografía de Gases y Espectrometría de Masas , Hospitales , Extracción Líquido-Líquido , Extracción en Fase Sólida , Espectrometría de Masas en Tándem , Aguas Residuales
18.
J Clin Nurs ; 29(1-2): 53-59, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31241794

RESUMEN

AIMS AND OBJECTIVES: To examine the association between registered nurses' (referred to as "nurses" for brevity) shifts of 12 hr or more and presence of continuing educational programmes; ability to discuss patient care with other nurses; assignments that foster continuity of care; and patient care information being lost during handovers. BACKGROUND: The introduction of long shifts (i.e., shifts of 12 hr or more) remains controversial. While there are claims of efficiency, studies have shown long shifts to be associated with adverse effects on quality of care. Efficiency claims are predicated on the assumption that long shifts reduce overlaps between shifts; these overlaps are believed to be unproductive and dangerous. However, there are potentially valuable educational and communication activities that occur during these overlaps. DESIGN: Cross-sectional survey of 31,627 nurses within 487 hospitals in 12 European countries. METHODS: The associations were measured through generalised linear mixed models. The study methods were compliant with the STROBE checklist. RESULTS: When nurses worked shifts of 12 hr or more, they were less likely to report having continuing educational programmes; and time to discuss patient care with other nurses, compared to nurses working 8 hr or less. Nurses working shifts of 12 hr or more were less likely to report assignments that foster continuity of care, albeit the association was not significant. Similarly, working long shifts was associated with reports of patient care information being lost during handovers, although association was not significant. CONCLUSION: Working shifts of 12 hr or more is associated with reduced educational activities and fewer opportunities to discuss patient care, with potential negative consequences for safe and effective care. RELEVANCE TO CLINICAL PRACTICE: Implementation of long shifts should be questioned, as reduced opportunity to discuss care or participate in educational activities may jeopardise the quality and safety of care for patients.


Asunto(s)
Continuidad de la Atención al Paciente/normas , Personal de Enfermería en Hospital/estadística & datos numéricos , Horario de Trabajo por Turnos/estadística & datos numéricos , Estudios Transversales , Educación Continua/estadística & datos numéricos , Europa (Continente) , Femenino , Hospitales , Humanos , Relaciones Interprofesionales , Masculino , Personal de Enfermería en Hospital/organización & administración , Personal de Enfermería en Hospital/psicología , Horario de Trabajo por Turnos/psicología , Encuestas y Cuestionarios
19.
Talanta ; 206: 120224, 2020 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-31514858

RESUMEN

This paper presents a fast and automatic flow-based method to extract 131I from biological samples and hospital waste, previous to liquid scintillation detection. 131I is a radionuclide extensively used in Nuclear Medicine due to their beta and gamma disintegrations, whereby hospitals have to manage the associated waste generation. The automatic developed system is based on Lab-On-Valve (LOV) flow-technique exploiting Cl-resin (135 mg per extraction). This methodology allows performing sample extractions and measurements on the same day, since the extraction frequency takes 1.4-4 h-1, depending on the analysed sample volume, plus up to 2 h of measurement for each vial. 131I is retained as iodine ion and eluted with sodium sulphide 0.2 mol L-1. The maximum sample volume that can be preconcentrated is 20 mL, reaching an extraction efficiency of 85 ±â€¯5%. The minimum detectable activity (MDA) is 0.05 Bq, showing a precision of 7% RSD (n = 5). Both, biological samples (urine and saliva) and hospital waste samples can be satisfactorily analysed by the proposed system, obtaining recoveries between 90 and 110%. The developed method is then suitable to implement in hospitals, improving the surveillance of the 131I environmental release.


Asunto(s)
Análisis de Inyección de Flujo/métodos , Hospitales/provisión & distribución , Radioisótopos de Yodo/análisis , Residuos Sanitarios/análisis , Conteo por Cintilación/métodos , Humanos , Radioisótopos de Yodo/orina , Saliva/química
20.
Soins ; 64(839): 27-29, 2019 Oct.
Artículo en Francés | MEDLINE | ID: mdl-31783944

RESUMEN

The interview with the relatives of a deceased for a post-mortem and cardiac death multi-tissues donation is a complex and delicate act of care performed by hospital coordination nurses for organ and tissue donation. The desirable exercise in face to face can also be done by telephone.


Asunto(s)
Paro Cardíaco , Obtención de Tejidos y Órganos , Muerte , Ejercicio , Familia , Hospitales , Humanos , Donantes de Tejidos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA