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2.
Artículo en Inglés | MEDLINE | ID: mdl-33578949

RESUMEN

Introduction: The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) is delivering an exercise programme for people with dementia. The Lincolnshire partnership National Health Service (NHS) foundation Trust successfully delivered PrAISED through a video-calling platform during the Coronavirus Disease 2019 (COVID-19) pandemic. METHODS: This qualitative case-study aimed to identify participants that video delivery worked for, to highlight its benefits and its challenges. Interviews were conducted between May and August 2020 with five participants with dementia and their caregivers (n = 10), as well as five therapists from the Lincolnshire partnership NHS foundation Trust. The interviews were analysed through thematic analysis. RESULTS: Video delivery worked best when participants had a supporting caregiver and when therapists showed enthusiasm and had an established rapport with the client. Benefits included time efficiency of sessions, enhancing participants' motivation, caregivers' dementia awareness, and therapists' creativity. Limitations included users' poor IT skills and resources. DISCUSSION: The COVID-19 pandemic required innovative ways of delivering rehabilitation. This study supports that people with dementia can use tele-rehabilitation, but success is reliant on having a caregiver and an enthusiastic and known therapist.


Asunto(s)
Demencia/rehabilitación , Telerrehabilitación , Cuidadores , Inglaterra/epidemiología , Humanos , Pandemias , Medicina Estatal
5.
Ann R Coll Surg Engl ; 103(2): 88-95, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33559552

RESUMEN

INTRODUCTION: COVID-19 remains a threat for a fear of a second pandemic. Emergency orthopaedic operations are still among the most commonly performed procedures with increased risk of transmission of SARS CoV-2 to the patients and the healthcare workers. The aim of this study was to present the evidence available into best practices limiting the spread of COVID-19 in healthcare setting during current and future pandemics. METHODS: A review of the literature was performed in multiple databases (PubMed, the Cochrane Library, Google Scholar, World Health Organization and Centers for Disease Control), using 'COVID-19' with other relevant keywords in different combinations. Owing to the limited and heterogenous evidence available, data were presented in a narrative manner. FINDINGS: From the evidence gathered it was noted that a multimodal approach to minimising pathogen transmission is required. This primarily comprises the wider engineering and administrative controls to reduce the concentration of the pathogen and to separate staff and patients from it. Theatre isolation and traffic control bundling, theatre flow and logistics, ventilation and waste management form a pivotal role in the environmental/engineering controls. Administrative measures include policies for both patients and staff. For patients, isolation and preoperative screening are of utmost value. For staff, testing for COVID-19, risk assessment, redeployment and provision of persona; protective equipment, together with the necessary training are important administrative controls. CONCLUSION: We believe these measures are likely to improve the sustainability of resources and can be carried to elective settings in order to return to some form of normality and help to mitigate the effects of future pandemics.


Asunto(s)
/prevención & control , Servicio de Limpieza en Hospital , Control de Infecciones/métodos , Quirófanos , Equipo de Protección Personal , Ventilación , Administración de Residuos , Flujo de Trabajo , Filtros de Aire , Humanos , Capacitación en Servicio , Admisión y Programación de Personal , Medición de Riesgo , Medicina Estatal , Reino Unido
6.
Artículo en Ruso | MEDLINE | ID: mdl-33591676

RESUMEN

The article considers the circumstances of the beginning of teaching medical police at St.Vladimir Imperial University in Kiev that was investigated for the first time. It was established that the medical police were taught as one of academic disciplines at the Department of State Medicine Studies. It found out that the given Department began its activities in 1843 when it was organized and headed by professor Ivan Fedorovich Leonov (1809-1854). The adjunct assistant professor Ch.Ya. von Hübbenet and associate professor A. I. Slobodzinsky worked at this Department in 1847-1850 and in 1851-1856 correspondingly. In 1852, the Charter and Staff of the St. Vladimir University provided setting apart medical jurisprudence from medical police subject and teaching it as an independent faculty discipline. It is demonstrated that hereinafter the given practice didn't become widespread in the Universities of the Russian Empire. In 1853, the Department of State Medicine Studies in Kiev was headed by F. F. Mering (1822-1887).


Asunto(s)
Docentes Médicos , Policia , Historia del Siglo XX , Humanos , Federación de Rusia , Medicina Estatal , Universidades
13.
Lancet Oncol ; 22(1): 98-106, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33387498

RESUMEN

BACKGROUND: Stereotactic ablative body radiotherapy (SABR) is increasingly being used to treat oligometastatic cancers, but high-level evidence to provide a basis for policy making is scarce. Additional evidence from a real-world setting is required. We present the results of a national study of patients with extracranial oligometastases undergoing SABR, representing the largest dataset, to our knowledge, on outcomes in this population so far. METHODS: In 2015, National Health Service (NHS) England launched a Commissioning through Evaluation scheme that funded a prospective, registry-based, single-arm, observational, evaluation study of patients with solid cancer and extracranial oligometastases treated with SABR. Prescribed doses ranged from 24-60 Gy administered in three to eight fractions. The study was done at 17 NHS radiotherapy centres in England. Patients were eligible for the scheme if aged 18 years or older with confirmed primary carcinoma (excluding haematological malignancies), one to three extracranial metastatic lesions, a disease-free interval from primary tumour development to metastases of longer than 6 months (with the exception of synchronous colorectal liver metastases), a WHO performance status of 2 or lower, and a life expectancy of at least 6 months. The primary outcome was overall survival at 1 year and 2 years from the start of SABR treatment. The study is now completed. FINDINGS: Between June 15, 2015, and Jan 30, 2019, 1422 patients were recruited from 17 hospitals in England. The median age of the patients was 69 years (IQR 62-76), and the most common primary tumour was prostate cancer (406 [28·6%] patients). Median follow-up was 13 months (IQR 6-23). Overall survival was 92·3% (95% CI 90·5-93·9) at 1 year and 79·2% (76·0-82·1) at 2 years. The most common grade 3 adverse event was fatigue (28 [2·0%] of 1422 patients) and the most common serious (grade 4) event was increased liver enzymes (nine [0·6%]). Notreatment-related deaths were reported. INTERPRETATION: In patients with extracranial oligometastatic cancer, use of SABR was associated with high overall survival and low toxicity. 'The study findings complement existing evidence from a randomised, phase 2 trial, and represent high-level, real-world evidence supporting the use of SABR in this patient cohort, with a phase 3 randomised, controlled trial to confirm these findings underway. Based on the selection criteria in this study, SABR was commissioned by NHS England in March, 2020, as a treatment option for patients with oligometastatic disease. FUNDING: NHS England Commissioning through Evaluation scheme.


Asunto(s)
Carcinoma/radioterapia , Radiocirugia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/mortalidad , Carcinoma/secundario , Inglaterra , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiocirugia/efectos adversos , Radiocirugia/mortalidad , Sistema de Registros , Medicina Estatal , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
14.
BMC Fam Pract ; 22(1): 20, 2021 01 14.
Artículo en Inglés | MEDLINE | ID: mdl-33446099

RESUMEN

BACKGROUND: The purpose of this study is to forward the implementation of an operational evidence-based state screening program of common diseases in Ukraine, where currently no state-based and evidence-based screening (EBS) exists. EBS should be performed by Family Doctors in a primary care setting and concern prevalent diseases in adults, such as: obesity (BMI), hypertension (BP measurement), diabetes (glycaemia), dyslipidemia (cholesterol/lipids), colon cancer (FOBT/colonoscopy), breast cancer (mammography), STIs (chlamydia, syphilis), HIV, HBV, HCV (i.e. serology or other rapid tests), HPV (swabs), cervical cancer (test Pap). depression (i.e., PHQ-9), and smoking (i.e., Fagerstrom). METHODS: Four needs-based research actions were led among citizens and healthcare professionals, based on multidimensional empowerment. Internal Strengths and Weaknesses of the ongoing implementation process were identified through these studies, whereas external Opportunities and Threats were determined by the present socio-cultural and political context. This SWOT analysis is likely to guide future state-based initiatives to accomplish EBS implementation in Ukraine. RESULTS: Internal Strengths are the bottom-up multidimensional empowerment approach, teaching of EBS and the development of an internet-based platform "Screening adviser" to assist shared decision making for person-centred EBS programs. Internal Weaknesses identified for the Family Doctors are a heterogeneous screening and the risk of decreasing motivation to screen. External Opportunities include the ongoing PHC reform, the existent WONCA and WHO support, and the existence of EBS programs in Europe. External Threats are the lack of national guidelines, not fully introduced gate keeping system, the vulnerable socio-economic situation, the war situation in the East of Ukraine and the Covid-19 pandemic. CONCLUSIONS: We started EBS implementation through research actions, based on a multidimensional empowerment of citizens, HCP and in EBS pathways involved stakeholder teams, to foster a sustainable operational human resource to get involved in that new EBS pathway to implement. The presented SWOT-analysis of this ongoing implementation process allows to plan and optimize future steps towards a state based and supports EBS program in Ukraine.


Asunto(s)
Medicina Basada en la Evidencia , Medicina Familiar y Comunitaria , Tamizaje Masivo/organización & administración , Medicina Estatal , Conflictos Armados , Femenino , Humanos , Masculino , Ucrania/epidemiología
20.
Midwifery ; 94: 102915, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33450714

RESUMEN

The context of healthcare and of healthcare education has radically changed as a result of the Covid-19 pandemic. To identify positive strategies for midwifery education in this context, five case studies from the UK and beyond were conducted using an appreciative enquiry approach, from the perspectives of students, the maternity services, cross-university collaboration, and digital learning. A health system analysis was used to identify strategies to cope, adapt, and transform for the future, at the levels of individuals, teams, and the whole system. Findings showed that the implementation of effective responses was possible. Responding effectively and rapidly to a shock as profound as this pandemic requires courageous, respectful, evidence-based, innovative, collaborative, cross-sectoral working and leadership across education institutions, practice settings, the regulator, government, and with students themselves. Pre-existing trusting relationships and collaborative systems supported rapid responses. Effective digital learning requires a pro-active, student-centred approach, and addressing the problems of inequitable access to equipment and space. Joint problem-solving and focussing on the key outcomes that matter contribute to developing successful strategies and robust processes. The pandemic provides an opportunity for student midwives to be re-imagined as essential members of midwifery teams and not 'just students'. Transformative actions identified include whole-system working, tackling longstanding problems including racism, poverty, prejudice, and systemic discrimination, and keeping students at the heart of the education system.


Asunto(s)
Adaptación Psicológica , Fuerza Laboral en Salud , Partería/educación , Estudiantes de Enfermería/psicología , Bachillerato en Enfermería , Femenino , Humanos , Embarazo , Medicina Estatal , Reino Unido
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