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2.
Artículo en Inglés | MEDLINE | ID: mdl-33799752

RESUMEN

Companies operate in a competitive and changing environment requiring increasingly effective and efficient management strategies. Lean is a proven philosophy in the industrial sector having helped companies to adapt to rapid market changes; to economic, technical, and social complexities; and to customer needs. For this reason, companies in the service sector are adopting Lean to improve their service management and to achieve economic, social, and environmental sustainability. This paper presents a model which uses Lean tools to facilitate the introduction of Lean in the management of primary care centers. The results show the implementation of Lean improved primary care center management, achieved stated objectives, and demonstrated faster adaptation to environmental needs and changes. The Lean philosophy developed and applied in the primary care center proved useful at a professional level facilitating developmental changes and prompting lasting improvements by developing a sustainable work culture.


Asunto(s)
Prestación de Atención de Salud , Mejoramiento de la Calidad , Eficiencia Organizacional , Instituciones de Salud , Atención Primaria de Salud
3.
BMJ Glob Health ; 6(3)2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33758014

RESUMEN

We have worked to develop a Clinical Information Network (CIN) in Kenya as an early form of learning health systems (LHS) focused on paediatric and neonatal care that now spans 22 hospitals. CIN's aim was to examine important outcomes of hospitalisation at scale, identify and ultimately solve practical problems of service delivery, drive improvements in quality and test interventions. By including multiple routine settings in research, we aimed to promote generalisability of findings and demonstrate potential efficiencies derived from LHS. We illustrate the nature and range of research CIN has supported over the past 7 years as a form of LHS. Clinically, this has largely focused on common, serious paediatric illnesses such as pneumonia, malaria and diarrhoea with dehydration with recent extensions to neonatal illnesses. CIN also enables examination of the quality of care, for example that provided to children with severe malnutrition and the challenges encountered in routine settings in adopting simple technologies (pulse oximetry) and more advanced diagnostics (eg, Xpert MTB/RIF). Although regular feedback to hospitals has been associated with some improvements in quality data continue to highlight system challenges that undermine provision of basic, quality care (eg, poor access to blood glucose testing and routine microbiology). These challenges include those associated with increased mortality risk (eg, delays in blood transfusion). Using the same data the CIN platform has enabled conduct of randomised trials and supports malaria vaccine and most recently COVID-19 surveillance. Employing LHS principles has meant engaging front-line workers, clinical managers and national stakeholders throughout. Our experience suggests LHS can be developed in low and middle-income countries that efficiently enable contextually appropriate research and contribute to strengthening of health services and research systems.


Asunto(s)
Servicios de Salud del Niño/normas , Prestación de Atención de Salud/normas , Accesibilidad a los Servicios de Salud/normas , Investigación sobre Servicios de Salud , Mejoramiento de la Calidad , /epidemiología , Niño , Preescolar , Países en Desarrollo , Diarrea/epidemiología , Diarrea/prevención & control , Humanos , Lactante , Recién Nacido , Kenia/epidemiología , Malaria/epidemiología , Malaria/prevención & control , Pandemias , Neumonía/epidemiología , Neumonía/prevención & control
8.
Anesth Analg ; 132(4): e61-e63, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33723200
9.
Lancet Gastroenterol Hepatol ; 6(4): 327-334, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33714370

RESUMEN

Anal squamous cell carcinoma is the most common type of anal cancer and is largely associated with anal human papillomavirus infection. The incidence of anal squamous cell carcinoma is increasing, and although still uncommon in the general population, a high incidence has been noted in specific population groups (eg, patients with HIV, men who have sex with men [MSM], recipients of solid organ transplants, women with genital neoplasia, and patients with systemic lupus erythematosus or inflammatory bowel disease). The higher incidence among individuals who are HIV-positive makes anal squamous cell carcinoma one of the most common non-AIDS-defining cancers among HIV-positive individuals. Anal cancer screening in high-risk groups aims to detect high-grade squamous intraepithelial lesions, which are considered anal precancerous lesions, and for which identification can provide an opportunity for prevention. A blind anal cytology is normally the first screening method, and for patients with abnormal results, this approach can be followed by an examination of the anal canal and perianal area under magnification, along with staining-a technique known as high-resolution anoscopy. Digital anorectal examination can enable early anal cancer detection. Several societies are in favour of screening for HIV-positive MSM and recipients of transplants. There are no current recommendations for screening of anal precancerous lesions via endoscopy, but in high-risk groups, a careful observation of the squamocolumnar junction should be attempted. Several treatments can be used to treat high-grade squamous intraepithelial lesions, including argon plasma coagulation or radiofrequency ablation, which are largely limited by high recurrence rates. Gastroenterologists need to be aware of anal squamous cell carcinoma and anal precancerous lesions, given that patients at high risk are frequently encountered in the gastroenterology department. We summarise simple procedures that can help in early anal squamous cell carcinoma detection.


Asunto(s)
Neoplasias del Ano/prevención & control , Carcinoma de Células Escamosas/prevención & control , Lesiones Precancerosas/prevención & control , Neoplasias del Ano/diagnóstico , Neoplasias del Ano/terapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Humanos , Lesiones Precancerosas/diagnóstico , Lesiones Precancerosas/terapia , Proctoscopía , Mejoramiento de la Calidad
10.
Prev Chronic Dis ; 18: E19, 2021 03 04.
Artículo en Inglés | MEDLINE | ID: mdl-33661727

RESUMEN

INTRODUCTION: Communication networks among professionals can be pathways for accelerating the diffusion of innovations if some local health departments (LHDs) drive the spread of knowledge. Such a network could prove valuable during public health emergencies such as the novel coronavirus disease 2019 (COVID-19) pandemic. Our objective was to determine whether LHDs in the United States were tied together in an informal network to share information and advice about innovative community health practices, programs, and policies. METHODS: In January and February 2020, we conducted an online survey of 2,303 senior LHD leaders to ask several questions about their sources of advice. We asked respondents to rank up to 3 other LHDs whose practices informed their work on new public health programs, evidence-based practices, and policies intended to improve community health. We used a social network analysis program to assess answers. RESULTS: A total of 329 LHDs responded. An emergent network appeared to operate nationally among 740 LHDs. Eleven LHDs were repeatedly nominated by peers as sources of advice or examples (ie, opinion leaders), and 24 acted as relational bridges to hold these emergent networks together (ie, boundary spanners). Although 2 LHDs played both roles, most LHDs we surveyed performed neither of these roles. CONCLUSION: Opinion leading and boundary spanning health departments can be accessed to increase the likelihood of affecting the rate of interest in and adoption of innovations. Decision makers involved in disseminating new public health practices, programs, or policies may find our results useful both for emergencies and for practice-as-usual.


Asunto(s)
Práctica Clínica Basada en la Evidencia/normas , Sistemas de Información en Salud , Difusión de la Información/métodos , Sistemas de Información/organización & administración , /epidemiología , Comunicación , Difusión de Innovaciones , Sistemas de Información en Salud/organización & administración , Sistemas de Información en Salud/tendencias , Conocimientos, Actitudes y Práctica en Salud , Humanos , Bases del Conocimiento , Mejoramiento de la Calidad , Estados Unidos/epidemiología
11.
Post Reprod Health ; 27(1): 10-18, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33673758

RESUMEN

Menopause is a major life event affecting all women in a variety of ways, both short and long term. All women should have access to accurate information, available in all forms and through all recognised sources. All healthcare professionals should have a basic understanding of the menopause and know where to signpost women for advice, support and treatment whenever appropriate. Every primary care team should have at least one nominated healthcare professional with a special interest and knowledge in menopause. All healthcare professionals with a special interest in menopause should have access to British Menopause Society Menopause Specialists for advice, support, onward referral and leadership of multidisciplinary education. With the introduction of the comprehensive British Menopause Society Principles and Practice of Menopause Care programme, the society is recognised throughout the UK as the leading provider of certificated menopause and post reproductive health education and training for healthcare professionals. Restrictions imposed by the coronavirus pandemic have been a springboard for the British Menopause Society to bring innovations to the services provided for our membership and for healthcare professionals throughout the UK.


Asunto(s)
Menopausia , Programas Nacionales de Salud , Grupo de Atención al Paciente , Calidad de Vida , /epidemiología , Femenino , Disparidades en el Estado de Salud , Humanos , Comunicación Interdisciplinaria , Menopausia/fisiología , Menopausia/psicología , Salud Mental/normas , Programas Nacionales de Salud/organización & administración , Programas Nacionales de Salud/tendencias , Innovación Organizacional , Atención al Paciente/métodos , Atención al Paciente/normas , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/tendencias , Mejoramiento de la Calidad , Conducta de Reducción del Riesgo , Reino Unido/epidemiología
12.
Artículo en Inglés | MEDLINE | ID: mdl-33642858

RESUMEN

Pulmonary rehabilitation (PR) is effective in reducing symptoms and improving health status, and exercise tolerance of patients with chronic obstructive pulmonary disease (COPD). The coronavirus disease 19 (COVID-19) pandemic has greatly impacted PR programs and their delivery to patients. Owing to fears of viral transmission and resultant outbreaks of COVID-19, institution-based PR programs have been forced to significantly reduce enrolment or in some cases completely shut down during the pandemic. As a majority of COPD patients are elderly and have multiple co-morbidities including cardiovascular disease and diabetes, they are notably susceptible to severe complications of COVID-19. As such, patients have been advised to stay at home and avoid social contact to the maximum extent possible. This has increased patients' vulnerability to physical deconditioning, depression, and social isolation. To address this major gap in care, some traditional hospital or clinic-centered PR programs have converted some or all of their learning contents to home-based telerehabilitation during the pandemic. There are, however, some significant barriers to this approach that have impeded its implementation in the community. These include variable access and use of technology (by patients), a lack of standardization of methods and tools for evaluation of the program, and inadequate training and resources for health professionals in optimally delivering telerehabilitation to patients. There is a pressing need for high-quality studies on these modalities of PR to enable the successful implementation of PR at home and via teleconferencing technologies. Here, we highlight the importance of telerehabilitation of patients with COPD in the post-COVID world and discuss various strategies for clinical implementation.


Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Telerrehabilitación , /epidemiología , Control de Enfermedades Transmisibles/métodos , Humanos , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Mejoramiento de la Calidad , Telerrehabilitación/métodos , Telerrehabilitación/organización & administración , Telerrehabilitación/normas
14.
Medicine (Baltimore) ; 100(9): e24760, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655939

RESUMEN

ABSTRACT: Radiation overexposure is common in chest X-ray (CXRs) of pediatric patients. However, overexposure may reveal incidental findings that can help to guide patient management or warrant quality improvement.To assess the prevalence of overexposure in CXRs in pediatric intensive care unit (PICU); and identify the incidental findings within overexposed areas, we conducted a retrospective cohort study of children who were admitted to PICU. Two independent evaluators reviewed patient's charts and digital CXRs according to the American College of Radiology standards; to evaluate overexposure of the anatomical parameters and incidental findings.A total of 400 CXRs of 85 patients were reviewed. The mean number of CXRs per patient was 4.7. Almost all (99.75%) CXRs met the criteria for overexposure, with the most common being upper abdomen (99.2%), upper limbs (97%) and neck (95.7%). In addition, 43% of these X-rays were cropped by the radiology technician to appear within the requested perimeter. There was a significant association between field cropping and overexposure (t-test: t = 9.8, P < .001). Incidental findings were seen in 41.5% of the radiographs; with the most common being gaseous abdominal distension (73.1%), low-positioned nasogastric tube (24.6%), and constipation (10.3%).Anatomical overexposure in routine CXRs remains high and raises a concern in PICU practice. Appropriate collimation of the X-ray beam, rather than electronically cropping the image, is highly recommended to minimize hiding incidental findings in the cropped-out areas. Redefining the anatomic boundaries of CXR in critically ill infants and children may need further studies and consideration. Quality improvement initiatives to minimize radiation overexposure in PICU are recommended, especially in younger children and those with more severe illness upon PICU admission.


Asunto(s)
Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Errores Médicos/estadística & datos numéricos , Exposición a la Radiación/análisis , Traumatismos por Radiación/epidemiología , Radiografía Torácica/efectos adversos , Adolescente , Niño , Preescolar , Femenino , Humanos , Hallazgos Incidentales , Lactante , Recién Nacido , Masculino , Prevalencia , Mejoramiento de la Calidad , Estudios Retrospectivos , Tórax/diagnóstico por imagen
15.
J Vis Exp ; (168)2021 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-33682861

RESUMEN

"Implementation" of new initiatives in healthcare settings typically encompasses two distinct components: a "clinical intervention" plus accompanying "implementation strategies" that support putting the clinical intervention into day-to-day practice. A novel clinical intervention, for example, might consist of a new medication, a new protocol, a new device, or a new program. As clinical interventions are not self-implementing, however, they nearly always require effective implementation strategies in order to succeed. Implementation strategies set out to engage healthcare providers, staff and patients in ways that increase the likelihood of the new initiative being successfully adopted, a process that often involves behavior change and new ways of thinking by participants. One of the challenges in studying implementation is that it can be difficult to collect data about the status and progress of implementation, including participants' own perspectives and experiences concerning implementation to date. This protocol describes a novel method for collecting and analyzing data related to ongoing implementation called the Participant-Reported Implementation Update and Score, or PRIUS. The PRIUS method allows for the efficient and systematic capture of qualitative and quantitative data that can provide a detailed and nuanced account of implementation over time and from multiple viewpoints. This longitudinal method can enable researchers, as well as implementation leaders and organizational stakeholders, to monitor implementation progress more closely, conduct formative evaluation, identify improvement opportunities, and gauge the effect of any implementation changes on a rolling basis.


Asunto(s)
Implementación de Plan de Salud , Personal de Salud , Humanos , Mejoramiento de la Calidad , Factores de Tiempo
16.
Bone Joint J ; 103-B(4): 672-680, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33752468

RESUMEN

AIMS: The aim of this study was to assess the quality of life of patients on the waiting list for a total hip (THA) or knee arthroplasty (KA) during the COVID-19 pandemic. Secondary aims were to assess whether length of time on the waiting list influenced quality of life and rate of deferral of surgery. METHODS: During the study period (August and September 2020) 843 patients (THA n = 394, KA n = 449) from ten centres in the UK reported their EuroQol five dimension (EQ-5D) scores and completed a waiting list questionnaire (2020 group). Patient demographic details, procedure, and date when listed were recorded. Patients scoring less than zero for their EQ-5D score were defined to be in a health state "worse than death" (WTD). Data from a retrospective cohort (January 2014 to September 2017) were used as the control group. RESULTS: The 2020 group had a significantly worse EQ-5D score compared to the control group for both THA (p < 0.001) and KA (p < 0.001). Over one-third (35.0%, n = 138/394) of patients waiting for a THA and nearly a quarter (22.3%, n = 100/449) for KA were in a health state WTD, which was significantly greater than the control group (odds ratio 2.30 (95% confidence interval (CI) 1.83 to 2.93) and 2.08 (95% CI 1.61 to 2.70), respectively; p < 0.001). Over 80% (n = 680/843) of the 2020 group felt that their quality of life had deteriorated while waiting. Each additional month spent on the waiting list was independently associated with a decrease in quality of life (EQ-5D: -0.0135, p = 0.004). There were 117 (13.9%) patients who wished to defer their surgery and the main reason for this was health concerns for themselves and or their family (99.1%, n = 116/117). CONCLUSION: Over one-third of patients waiting for THA and nearly one-quarter waiting for a KA were in a state WTD, which was approaching double that observed prior to the pandemic. Increasing length of time on the waiting list was associated with decreasing quality of life. Level of evidence: Level III retrospective case control study Cite this article: Bone Joint J 2021;103-B(4):672-680.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Accesibilidad a los Servicios de Salud , Indicadores de Salud , Calidad de Vida/psicología , Listas de Espera , Adulto , Anciano , Anciano de 80 o más Años , /prevención & control , Estudios Transversales , Femenino , Humanos , Modelos Lineales , Masculino , Auditoría Médica , Persona de Mediana Edad , Análisis Multivariante , Pandemias , Aceptación de la Atención de Salud , Mejoramiento de la Calidad , Factores de Tiempo , Reino Unido/epidemiología
17.
Adv Ther ; 38(3): 1382-1396, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33586006

RESUMEN

INTRODUCTION: Widespread misuse of short-acting beta-agonists (SABAs) may contribute to asthma-related morbidity and mortality. Recognizing this, the Global Initiative for Asthma neither recommends SABA monotherapy nor regards this formulation as a preferred reliever. Many health systems and healthcare professionals (HCPs) experience practical issues in implementing guidelines. Clear quality standards can drive improvements in asthma care and encourage implementation of global and national medical guidelines. METHODS: A steering group of global asthma experts came together between May and September 2019 to develop quality statements codifying the minimum elements of good quality asthma care. These statements were either evidence based (when robust evidence was available) or reflected a consensus based on clinical expertise and experience of the group. RESULTS: The quality statements (and associated essential criteria) developed emphasize key elements concerning (1) objective diagnosis specific to individual symptoms, (2) treatment appropriate to the long-term management of asthma as an inflammatory disease, consistent with evidence-based recommendations, (3) controlled dispensing of SABA canisters and monitoring to prevent overuse, (4) regular review of patients after treatment initiation or change, and (5) follow-up of patients in primary care after treatment for an exacerbation in a hospital or an emergency department. CONCLUSIONS: The steering group proposes quality statements that national and local clinical groups can implement as quantitative quality standards that are appropriate to their local circumstances, including during the coronavirus disease 2019 (Covid-19) pandemic. By translating these statements into locally relevant quality standards, primary care physicians and HCPs can encourage optimal management and reduce preventable healthcare interactions. The evidence-based evolution of care encapsulated in these statements will further engender high-quality, patient-centered holistic management that addresses asthma as an inflammatory disease. In particular, the statements empower self-management by patients and encourage health-promoting behaviors, which are essential to reduce exacerbations, the primary goal of asthma management.


Asunto(s)
Agonistas Adrenérgicos beta/farmacología , Asma , Abuso de Medicamentos/prevención & control , Administración del Tratamiento Farmacológico/normas , Mejoramiento de la Calidad/organización & administración , Adulto , Antiasmáticos/farmacología , Asma/diagnóstico , Asma/tratamiento farmacológico , /prevención & control , Niño , Femenino , Salud Global/normas , Adhesión a Directriz , Humanos , Masculino , Inhaladores de Dosis Medida , Guías de Práctica Clínica como Asunto
18.
Nurs Adm Q ; 45(2): 152-158, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33570882

RESUMEN

This article describes the implementation of an evidence-based mentoring program for new registered nurses (RNs) hired into medical-surgical units in a small community-based hospital during the unfolding of the SARS-Cov2 (COVID-19) pandemic. The hospital's nursing leadership supported the program implementation during the COVID-19 pandemic to provide a broader support system to new RNs to improve nurse retention. During a response to the pandemic, the medical-surgical units faced numerous process changes in a short time, which further reinforced the urgency of an additional support system for the newly hired RNs.


Asunto(s)
/enfermería , Liderazgo , Tutoría/organización & administración , Personal de Enfermería en Hospital/psicología , /epidemiología , Enfermería Basada en la Evidencia/organización & administración , Hospitales Comunitarios/organización & administración , Humanos , Satisfacción en el Trabajo , Personal de Enfermería en Hospital/educación , Pandemias , Desarrollo de Programa/métodos , Mejoramiento de la Calidad
19.
Nurs Adm Q ; 45(2): 142-151, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33587412

RESUMEN

Whether natural or human-induced, disasters are a global issue that impact health care systems' operations, especially in the acute care setting. The current COVID-19 pandemic is a recent illustration of how health care systems and providers, especially nurses, respond to a rapidly evolving crisis. Nurse leaders in the acute care setting are pivotal in responding to the multifactorial challenges caused by a disaster. A quality improvement project was developed to increase nurse leaders' knowledge and confidence in disaster management during the COVID-19 pandemic at 2 Magnet-designated acute care hospitals within the John Muir Health system in Northern California. A total of 50 nurse leaders initially participated in this project, with 33 participants completing the postintervention survey. Results indicated significant improvement in perceived knowledge and confidence in disaster management after the intervention. Qualitative responses from project participants highlighted the need to annualize educational opportunities to sustain knowledge and consistently review emergency management operations plans. This quality improvement project provided an approach to educating nurse leaders in disaster management to promote resilience, support of employees, and optimal patient outcomes during disasters.


Asunto(s)
/enfermería , Medicina de Desastres/educación , Conocimientos, Actitudes y Práctica en Salud , Liderazgo , Adulto , Medicina de Desastres/organización & administración , Femenino , Humanos , Masculino , Persona de Mediana Edad , Personal de Enfermería en Hospital/educación , Pandemias , Mejoramiento de la Calidad , Encuestas y Cuestionarios
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