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1.
Bull World Health Organ ; 98(3): 161-169, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32132750

RESUMEN

Objective: To evaluate the effect of a disease management programme in Kazakhstan on quality indicators for patients with hypertension, diabetes and chronic heart failure. Methods: A supportive, interdisciplinary, quality improvement programme was implemented between November 2014 and November 2015 at seven polyclinics in Pavlodar and Petropavlovsk. Quality improvement teams were established at each clinic and quality improvement tools were introduced, including patient flowsheets, decision support tools, patient registries, a patient recall process, support for patient self-management and patient follow-up with intensity adjusted for level of disease control. Clinic teams met for four 3-day interactive learning sessions within 1 year, with additional coaching visits. Implementation was managed by five local coordinators and consultants trained by international consultants. National and regional steering committees monitored progress. Findings: Between July and October 2015, the proportion of hypertensive patients with the recommended blood pressure increased from 24% (101/424) to 56% (228/409). Among patients with diabetes, the proportion who recently underwent eye examinations increased from 26% (101/391) to 71% (308/433); the proportion who had their low-density lipoprotein cholesterol measured increased from 57% (221/391) to 85% (369/433); and the proportion who had their albumin : creatinine ratio measured increased from 11% (44/391) to 49% (212/433). The proportion of chronic heart failure patients who underwent echocardiography rose from 91% (128/140) to 99% (157/158). All patients set themselves self-management goals. Conclusion: This intensive, supportive, multifaceted programme was associated with significant improvements in quality of care for patients with chronic disease. Further investment in coaching capacity is needed to extend the programme nationally.


Asunto(s)
Diabetes Mellitus/terapia , Insuficiencia Cardíaca/terapia , Hipertensión/terapia , Calidad de la Atención de Salud , Autocuidado/normas , Enfermedad Crónica , Femenino , Humanos , Kazajstán , Masculino , Tutoría , Mejoramiento de la Calidad , Autocuidado/métodos
2.
Medicine (Baltimore) ; 99(10): e19032, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150050

RESUMEN

Rapid response teams have been adopted to prevent unexpected in-ward cardiac arrest. However, there is no convincing evidence of optimal operation with rapid response team. Our aim was to address the impact of focused rapid response team on the safety of patients in wards. Comparison of focused with extended rapid response teams was performed in single center. The extended team operated on adult patients in whole ward (both medical and nonmedical ward) 24 hours per day, 7 days per week during 2012. In 2015, the operational time of the focused team was office hours from Monday to Friday and study population were limited to adult patients in the nonmedical ward. Unexpected in-ward cardiac arrests were compared between the extended team and focused team periods. During the focused team period, there was significant reduction in cardiac arrest per 1000 admissions in whole ward compared to the before the rapid response team period (1.09 vs 1.67, P < .001). Compared to that of the extended team period (1.42), there was also a significant reduction in cardiac arrest rate (P = .04). The cardiac arrest rate of nonmedical ward patients was also significantly decreased in the focused team period compared to that before the rapid response team period (0.43 vs 0.95, P < .001). Compared to the extended team period (0.64), there was a marginally significant reduction in cardiac arrest of nonmedical ward patients (P = .05). The focused rapid response team was associated with a reduced incidence of unexpected in-ward cardiac arrest. Further research on the optimal composition and operational time is needed.


Asunto(s)
Paro Cardíaco/prevención & control , Equipo Hospitalario de Respuesta Rápida/normas , Adulto , China , Femenino , Paro Cardíaco/mortalidad , Mortalidad Hospitalaria , Hospitalización , Humanos , Incidencia , Unidades de Cuidados Intensivos , Masculino , Habitaciones de Pacientes , Estudios Prospectivos , Mejoramiento de la Calidad
3.
Bull Cancer ; 107(2): 254-261, 2020 Feb.
Artículo en Francés | MEDLINE | ID: mdl-32035652

RESUMEN

The context and constraints of modern medicine (hospital beds and caregivers' reductions, ambulatory shift, new therapeutic approaches, integration of supportive care…) combined with new societal and Health system changes (ageing population, chronic diseases, new requirements of the patients…) redefine the orientations of care and question professional practices. The participative approach (PA) as a model of team organization proposes solutions involving the skills of the various interacting caregivers and experimental knowledge and consideration of patient needs. The multi-professional staff (MPS) is a collaborative tool of this participative approach that federates a team around a health or care project personalized from the crosschecked eyes of care professionals and from a shared decision-making process. Its objective is to combine the improvement of quality of care with quality of life at work. It requires a transversal mindset of teams, intrinsic values and specific characteristics. Its organization is simple but requires some rules and we will develop the main steps to success. This article, which is the result of a joint reflection and experience of health professionals, shows the principles and wants to demonstrate the weakness of MPS. The interest of the French National Cancer Institute for this collaborative tool is an asset for further work in the perspective of generalization of MPS for all patients with chronic disease and not only for patients at palliative phase.


Asunto(s)
Guías como Asunto , Sector de Atención de Salud/organización & administración , Personal de Salud/organización & administración , Neoplasias/terapia , Admisión y Programación de Personal/organización & administración , Humanos , Grupo de Atención al Paciente/organización & administración , Mejoramiento de la Calidad , Calidad de Vida
5.
Urology ; 136: 68-69, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32033685
6.
Can Assoc Radiol J ; 71(1): 48-57, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32066281

RESUMEN

PURPOSE: Quality improvement is vital to ensure health-care providers meet optimal patient care standards. Within our jurisdiction, accreditation requires image peer review as part of the quality assurance program. We propose a method to improve quality assurance in radiography by implementing a novel software-based peer review system for radiography technologists. METHODS: This is a retrospective study. A peer review tool was developed in Microsoft Excel and Visual Basic. The tool has 14 image quality criteria, which were selected based on national and international criteria, each containing standardized answers ensuring a common scoring regime. The tool provides data analysis and storage of all peer reviews performed. Radiography supervisors utilized the tool to evaluate image quality of various body parts at 28 hospitals. The tool enabled each Medical Imaging Department to objectively score images at their own hospital. Approximately 2% of all radiographs were randomly chosen for peer review. Additionally, the tool allowed for regional analysis based on hospital, body part, and quality criterion. RESULTS: Initial findings exposed equipment-related issues such as worn imaging plates, artifacts, and poor exposures, which prompted increased preventative maintenance. Other documented issues included foreign objects, inadequate collimation and centering, and inconsistent usage of lead markers. After identifying quality assurance-related issues, hospitals implemented education, resulting in improved overall image quality scores in subsequent audits. CONCLUSION: The peer review tool helped identify and correct various issues affecting image quality and ensures our program meets required accreditation standards. Furthermore, staff found utilizing the tool to identify areas for improvement improved collaboration, ongoing education, and support between staff.


Asunto(s)
Revisión por Expertos/métodos , Garantía de la Calidad de Atención de Salud/métodos , Mejoramiento de la Calidad , Radiografía/normas , Humanos , Estudios Retrospectivos
8.
Medicine (Baltimore) ; 99(7): e19194, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049856

RESUMEN

The incidence of invasive fungal infections (IFIs) has recently increased, and early and accurate diagnosis of IFIs is important for the rational selection of antifungal drugs with high efficacy. We developed a method for rapid and accurate clinical diagnosis of IFIs and provide a reference for personalized drug treatment.We designed and screened fungal internal transcribed spacer regions with universal primers and designed 8 TaqMan detection probes to establish a multi-channel real-time fluorescent polymerase chain reaction (PCR) melting curve analysis (MCA) method. The sensitivity, specificity, and reproducibility of this method were investigated using standard fungal strains and clinical isolates. Candidemia was detected using the MCA method.The limit of detection and assay cut-off (melting temperature [Tm]) for Candida albicans were 0.05 pg/µL and 66.50 °C; Candida glabrata were 0.1 pg/µL and 66.25 °C; Candida tropicalis were 0.1 pg/µL and 60.15 °C; Candida krusei were 0.1 pg/µL and 72.15 °C; Candida parapsilosis were 0.2 pg/µL and 63.10 °C; Candida guilliermondii were 0.1 pg/µL and 61.84 °C; Cryptococcus neoformans were 0.1 pg/µL and 65.50 °C; Aspergillus flavus were 0.05 pg/µL and 71.50 °C; Aspergillus terreus, Aspergillus fumigatus, and Aspergillus niger were 0.05 pg/µL and 76.80 °C. Analytical specificity was evaluated using 13 clinical pathogens including Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae, etc. No false-positive results were obtained for any of these samples. The MCA method can detect and identify different candidemia simulations. The limit detection concentration of C albicans was 44 cfu/mL, C glabrata was 73 cfu/mL, C tropicalis was 29 cfu/mL, C parapsilosis was 21 cfu/mL, C krusei was 71 cfu/mL, and C guilliermondii was 53 cfu/mL.The multi-channel real-time fluorescence PCR melting curve analysis displayed high sensitivity and specificity in detecting various clinically invasive fungi. Furthermore, it simultaneously detected the genera Candida, Cryptococcus, and Aspergillus and identified Candida at the species level. Our method can facilitate early and accurate clinical diagnosis and personalized medication regimens.


Asunto(s)
Aspergillus/aislamiento & purificación , Candida/aislamiento & purificación , Cryptococcus/aislamiento & purificación , Infecciones Fúngicas Invasoras/diagnóstico , Aspergillus/clasificación , Candida/clasificación , Cryptococcus/clasificación , Colorantes Fluorescentes , Humanos , Infecciones Fúngicas Invasoras/microbiología , Mejoramiento de la Calidad , Reacción en Cadena en Tiempo Real de la Polimerasa
9.
Vasc Health Risk Manag ; 16: 11-25, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32021224

RESUMEN

Familial hypercholesterolemia (FH) is a frequent disorder associated with premature atherosclerotic cardiovascular disease. Different clinical diagnosis criteria are available, and cost of genetic testing has been reduced in the last years; however, most cases are not diagnosed worldwide. Patients with FH are at high cardiovascular risk and the risk can be reduced with lifelong lifestyle and pharmacological treatment. Statins and ezetimibe are available as generic drugs in most countries reducing the cost of treatment. However, the use of high-intensity statins combined with ezetimibe and PCSK9 inhibitors, if necessary, is low for different reasons that contribute to a high number of patients not reaching LDL-C targets according to guidelines. On the other hand, cardiovascular risk varies greatly in families with FH; therefore, risk stratification strategies including cardiovascular imaging is another element to consider for improving care and management of FH. There are numerous barriers depending on the awareness, knowledge, perception of risk, management and care of patients living with FH that impact in the diagnosis and treatment of the disorder. In this contemporary review, we analyze different barriers in the diagnosis and care of patients to improve patients' care and prevention of atherosclerotic cardiovascular disease and describe recent advances and strategies to improve the gaps in the care of FH, including global collaboration and advocacy.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Colesterol/sangre , Prestación Integrada de Atención de Salud , Hiperlipoproteinemia Tipo II/diagnóstico , Hiperlipoproteinemia Tipo II/terapia , Tamizaje Masivo , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud , Biomarcadores/sangre , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/etiología , Diagnóstico Precoz , Predisposición Genética a la Enfermedad , Pruebas Genéticas , Humanos , Hiperlipoproteinemia Tipo II/sangre , Hiperlipoproteinemia Tipo II/genética , Fenotipo , Valor Predictivo de las Pruebas , Pronóstico , Medición de Riesgo , Factores de Riesgo
10.
J Nurs Adm ; 50(3): 174-181, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32068626

RESUMEN

OBJECTIVE: Rush University Medical Center nursing leadership undertook a process improvement project to revamp nursing handoff during unit transfer with the goal of improving patient throughput. The aim was to decrease assign-to-occupy time, the duration from bed assignment to bed occupancy. BACKGROUND: There was a lengthy lag time in admitting/transferring patients, leading to delays in patient throughput and potential threats to patient safety. In fiscal year 2016, assign-to-occupy time averaged 97 minutes. The goal was to decrease that time to 60 minutes or less. METHODS: Process improvement leaders held a rapid improvement event to determine viable solutions. A team then standardized handoff workflow; created an electronic tool, virtually eliminating verbal report; and implemented a new handoff process. RESULTS: Assign-to-occupy time at 1 year after go-live averaged 55 minutes, and it has been staying less than 60 minutes since the implementation. CONCLUSIONS: Key success strategies included engaging stakeholders during the rapid improvement event, imploring frontline nurses to create and promote the revised process to facilitate staff engagement, and leveraging electronic health records.


Asunto(s)
Eficiencia Organizacional/normas , Registros Electrónicos de Salud/organización & administración , Pase de Guardia/organización & administración , Transferencia de Pacientes/organización & administración , Centros Médicos Académicos/organización & administración , Humanos , Seguridad del Paciente/normas , Mejoramiento de la Calidad , Flujo de Trabajo
13.
14.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(1): 26-32, 2020 Jan 25.
Artículo en Chino | MEDLINE | ID: mdl-31958927

RESUMEN

Since the China Gastrointestinal Cancer Surgery Union was established, it has continuously collected the annual reports of 95 gastrointestinal surgery centers nationwide from 2014 to 2017, and collected data on more than 130 000 cases of gastric cancer. This article combines the experience of associated databases at home and abroad to analyze the construction of the China Gastrointestinal Cancer Surgery Union Database, and explore the role of multi-center cooperation and big data analysis in the promotion of gastrointestinal surgery. For a complete database to successfully achieve its ultimate goal, it needs clear goals, continuous funding, a qualified management team, consensus on data content, a high completion rate, and the support and cooperation of an advanced processing system. As a high-quality database with clear construction goals and database project construction based on the goals, while promoting the level of clinical diagnosis and treatment, it is also widely used in risk prediction model development, audit supervision, epidemiological research, health service research, and clinical hypothesis testing, etc. How to build a high-quality database to give a full promotion in clinical diagnosis and treatment is a huge challenge. Although the construction of medical databases in China has just started, we believe that with the further improvement in understanding, management and analysis capabilities for surgical databases, more databases including the China Gastrointestinal Cancer Surgery Union Database will make greater contributions in promoting the development of diagnosis and treatment of gastrointestinal cancer in China and the world.


Asunto(s)
Bases de Datos Factuales , Neoplasias Gastrointestinales/diagnóstico , Neoplasias Gastrointestinales/terapia , Mejoramiento de la Calidad , China , Humanos
15.
Medicine (Baltimore) ; 99(4): e18974, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31977914

RESUMEN

We aimed to develop a nomogram based on a population-based cohort to estimate the individualized overall survival (OS) for patients with nasopharyngeal carcinoma (NPC) and compare its predictive value with that of the traditional staging system.Data for 3693 patients with NPC were extracted from the Surveillance, Epidemiology, and End Results dataset and randomly divided into two sets: training (n = 2585) and validation (n = 1108). On the basis of multivariate Cox regression analysis, a nomogram was constructed to predict the 3-, 5-, and 10-year survival probability for a patient. The performance of the nomogram was quantified with respect to discrimination, calibration, and clinical utility.In the training set, age, sex, race, marital status, histological type, T stage, N stage, M stage, radiotherapy, and chemotherapy were selected to develop a nomogram for predicting the OS probability based on the multivariate Cox regression model. The nomogram was generally more discriminative compared with the American Joint Committee on Cancer 7th staging system. Calibration plots exhibited an excellent consistency between the observed probability and the nomogram's prediction. Categorical net classification improvement and integrated discrimination improvement suggested that the predictive accuracy of the nomogram exceeded that of the classic staging system. With respect to decision curve analyses, the nomogram exhibited preferable net benefit gains than the staging system across a wide range of threshold probabilities.This proposed nomogram exhibits an excellent performance with regard to its predictive accuracy, discrimination capability, and clinical utility, and thus can be used as a convenient and reliable tool for prognosis prediction in patients with NPC.


Asunto(s)
Carcinoma Nasofaríngeo/mortalidad , Nomogramas , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Mejoramiento de la Calidad , Programa de VERF/estadística & datos numéricos , Adulto Joven
16.
Int J Radiat Oncol Biol Phys ; 106(3): 639-647, 2020 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-31983560

RESUMEN

PURPOSE: We sought to develop a quality surveillance program for approximately 15,000 US veterans treated at the 40 radiation oncology facilities at the Veterans Affairs (VA) hospitals each year. METHODS AND MATERIALS: State-of-the-art technologies were used with the goal to improve clinical outcomes while providing the best possible care to veterans. To measure quality of care and service rendered to veterans, the Veterans Health Administration established the VA Radiation Oncology Quality Surveillance program. The program carries forward the American College of Radiology Quality Research in Radiation Oncology project methodology of assessing the wide variation in practice pattern and quality of care in radiation therapy by developing clinical quality measures (QM) used as quality indices. These QM data provide feedback to physicians by identifying areas for improvement in the process of care and identifying the adoption of evidence-based recommendations for radiation therapy. RESULTS: Disease-site expert panels organized by the American Society for Radiation Oncology (ASTRO) defined quality measures and established scoring criteria for prostate cancer (intermediate and high risk), non-small cell lung cancer (IIIA/B stage), and small cell lung cancer (limited stage) case presentations. Data elements for 1567 patients from the 40 VA radiation oncology practices were abstracted from the electronic medical records and treatment management and planning systems. Overall, the 1567 assessed cases passed 82.4% of all QM. Pass rates for QM for the 773 lung and 794 prostate cases were 78.0% and 87.2%, respectively. Marked variations, however, were noted in the pass rates for QM when tumor site, clinical pathway, or performing centers were separately examined. CONCLUSIONS: The peer-review protected VA-Radiation Oncology Surveillance program based on clinical quality measures allows providers to compare their clinical practice to peers and to make meaningful adjustments in their personal patterns of care unobtrusively.


Asunto(s)
Instituciones Oncológicas/normas , Hospitales de Veteranos/normas , Desarrollo de Programa , Garantía de la Calidad de Atención de Salud/normas , Oncología por Radiación/normas , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Medicina Basada en la Evidencia/normas , Humanos , Neoplasias Pulmonares/radioterapia , Masculino , Revisión por Expertos , Evaluación de Programas y Proyectos de Salud/normas , Neoplasias de la Próstata/radioterapia , Garantía de la Calidad de Atención de Salud/métodos , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/normas , Carcinoma Pulmonar de Células Pequeñas/radioterapia , Sociedades Médicas/normas , Estados Unidos , Veteranos
19.
CMAJ ; 192(4): E81-E91, 2020 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-31988152

RESUMEN

BACKGROUND: Preterm birth is the leading cause of morbidity and mortality in children younger than 5 years. We report the changes in neonatal outcomes and care practices among very preterm infants in Canada over 14 years within a national, collaborative, continuous quality-improvement program. METHODS: We retrospectively studied infants born at 23-32 weeks' gestation who were admitted to tertiary neonatal intensive care units that participated in the Evidence-based Practice for Improving Quality program in the Canadian Neonatal Network from 2004 to 2017. The primary outcome was survival without major morbidity during the initial hospital admission. We quantified changes using process-control charts in 6-month intervals to identify special-cause variations, adjusted regression models for yearly changes, and interrupted time series analyses. RESULTS: The final study population included 50 831 infants. As a result of practice changes, survival without major morbidity increased significantly (56.6% [669/1183] to 70.9% [1424/2009]; adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.06-1.10, per year) across all gestational ages. Survival of infants born at 23-25 weeks' gestation increased (70.8% [97/137] to 74.5% [219/294]; adjusted OR 1.03, 95% CI 1.02-1.05, per year). Changes in care practices included increased use of antenatal steroids (83.6% [904/1081] to 88.1% [1747/1983]), increased rates of normothermia at admission (44.8% [520/1160] to 67.5% [1316/1951]) and reduced use of pulmonary surfactant (52.8% [625/1183] to 42.7% [857/2009]). INTERPRETATION: Network-wide quality-improvement activities that include better implementation of optimal care practices can yield sustained improvement in survival without morbidity in very preterm infants.


Asunto(s)
Cuidado Intensivo Neonatal/métodos , Cuidado Intensivo Neonatal/normas , Mejoramiento de la Calidad , Canadá , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Masculino , Evaluación de Programas y Proyectos de Salud , Indicadores de Calidad de la Atención de Salud , Estudios Retrospectivos , Análisis de Supervivencia
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