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1.
Lancet ; 395(10222): 463-466, 2020 02 08.
Artículo en Inglés | MEDLINE | ID: mdl-31924402
3.
PLoS Med ; 16(7): e1002860, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31335869

RESUMEN

BACKGROUND: The Indian government supports both public- and private-sector provision of hospital care for neonates: neonatal intensive care is offered in public facilities alongside a rising number of private-for-profit providers. However, there are few published reports about mortality levels and care practices in these facilities. We aimed to assess care practices, causes of admission, and outcomes from neonatal intensive care units (NICUs) in public secondary and private tertiary hospitals and both public and private medical colleges enrolled in a quality improvement collaborative in Telangana and Andhra Pradesh-2 Indian states with a respective population of 35 and 50 million. METHODS AND FINDINGS: We conducted a cross-sectional study between 30 May and 26 August 2016 as part of a baseline evaluation in 52 consenting hospitals (26 public secondary hospitals, 5 public medical colleges, 15 private tertiary hospitals, and 6 private medical colleges) offering neonatal intensive care. We assessed the availability of staff and services, adherence to evidence-based practices at admission, and case fatality after admission to the NICU using a range of tools, including facility assessment, observations of admission, and abstraction of registers and telephone interviews after discharge. Our analysis is adjusted for clustering and weighted for caseload at the hospital level and presents findings stratified by type and ownership of hospitals. In total, the NICUs included just over 3,000 admissions per month. Staffing and infrastructure provision were largely according to government guidelines, except that only a mean of 1 but not the recommended 4 paediatricians were working in public secondary NICUs per 10 beds. On admission, all neonates admitted to private hospitals had auscultation (100%, 19 of 19 observations) but only 42% (95% confidence interval [CI] 25%-62%, p-value for difference is 0.361) in public secondary hospitals. The most common single cause of admission was preterm birth (25%) followed by jaundice (23%). Case-fatality rates at age 28 days after admission to a NICU were 4% (95% CI 2%-8%), 15% (9%-24%), 4% (2%-8%) and 2% (1%-5%) (Chi-squared p = 0.001) in public secondary hospitals, public medical colleges, private tertiary hospitals, and private medical colleges, respectively, according to facility registers. Case fatality according to postdischarge telephone interviews found rates of 12% (95% CI 7%-18%) for public secondary hospitals. Roughly 6% of admitted neonates were referred to another facility. Outcome data were missing for 27% and 8% of admissions to private tertiary hospitals and private medical colleges. Our study faced the limitation of missing data due to incomplete documentation. Further generalizability was limited due to the small sample size among private facilities. CONCLUSIONS: Our findings suggest differences in quality of neonatal intensive care and 28-day survival between the different types of hospitals, although comparison of outcomes is complicated by differences in the case mix and referral practices between hospitals. Uniform reporting of outcomes and risk factors across the private and public sectors is required to assess the benefits for the population of mixed-care provision.


Asunto(s)
Prestación Integrada de Atención de Salud/tendencias , Mortalidad Hospitalaria/tendencias , Hospitales Privados/tendencias , Hospitales Públicos/tendencias , Mortalidad Infantil/tendencias , Unidades de Cuidado Intensivo Neonatal/tendencias , Cuidado Intensivo Neonatal/tendencias , Indicadores de Calidad de la Atención de Salud/tendencias , Estudios Transversales , Adhesión a Directriz/tendencias , Disparidades en Atención de Salud/tendencias , Humanos , India , Lactante , Admisión del Paciente/tendencias , Admisión y Programación de Personal/tendencias , Guías de Práctica Clínica como Asunto , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
5.
J Holist Nurs ; 37(3): 260-272, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31257971

RESUMEN

Background: Nurses and others have used various terms to describe our caring/healing approach to practice. Because terms used can influence our image of ourselves and the image others have of us, we sought to clarify their meanings. Questions: How are the terms holistic nursing, integrative health care, and integrative nursing defined or described? Do we identify with these definitions/descriptions? Are the various terms the same or are they distinct? Method: We conducted an integrated review of peer-reviewed literature following the process described by Whittemore and Knafl. Using standard search methods, we reviewed full texts of 94 published papers and extracted data from 58 articles. Findings: Holistic describes "whole person care" often acknowledging body-mind-spirit. Holistic nursing defines a disciplinary practice specialty. The term integrative refers to practice that includes two or more disciplines or distinct approaches to care. Both terms, integrative and holistic, are associated with alternative/complementary modalities and have similar philosophical and/or theoretical underpinnings. Conclusions: There is considerable overlap between holistic nursing and integrative nursing. The relationship of integrative nursing to integrative health care is unclear based solely on definitions. Consideration of terms used provides opportunities for reflection, collaboration, and growth.


Asunto(s)
Prestación Integrada de Atención de Salud/clasificación , Enfermería Holística/clasificación , Prestación Integrada de Atención de Salud/métodos , Prestación Integrada de Atención de Salud/tendencias , Enfermería Holística/métodos , Enfermería Holística/tendencias , Humanos
6.
J Cardiovasc Med (Hagerstown) ; 20(9): 597-605, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31318839

RESUMEN

METHODS: We performed a nationwide survey on the current practice of ventricular tachycardia catheter ablation in Italy during the year 2016. RESULTS: Among 145 operators participating in the survey, 58 (40.0%) did not perform any ventricular tachycardia ablation in 2016. Among those performing ventricular tachycardia ablation, 9 operators (6.2%) performed only right ventricular endocardial catheter ablation, 52 (35.9%) performed endocardial catheter ablation both in the right and left ventricle (LV) and 26 (17.9%) performed both endocardial and epicardial LV catheter ablations. Seventy operators (89.7%) among the 78 performing LV and epicardial ablations treated patients with ischemic cardiomyopathy; ablations in the setting of other causes were less frequently performed. The following were considered as minimum requirements for ventricular tachycardia ablation: presence of a three-dimensional mapping system (120 operators, 82.8%), ICU in the hospital (118 operators, 81.4%), operator's training in high volume centers (93 operators, 64.1%). Twenty-eight operators (19.3%) performed catheter ablation in patients with electrical storm only after hemodynamic stabilization, 41 operators (28.3%) also during the acute phase and 9 operators (6.2%) never performed catheter ablation in electrical storm patients; the remaining 67 operators did not perform ventricular tachycardia ablation at all, or performed ablations only in the right ventricle. CONCLUSION: The present survey provides a snapshot of the current invasive treatment of ventricular tachycardia by catheter ablation. The procedure, especially in the setting of ischemic cardiomyopathy, is performed nationwide. Complex cases, including those with electrical storm, should be managed within a preestablished integrated network of regional referral centers able to transfer patients as soon as possible.


Asunto(s)
Ablación por Catéter/tendencias , Prestación Integrada de Atención de Salud/tendencias , Pautas de la Práctica en Medicina/tendencias , Taquicardia Ventricular/cirugía , Ablación por Catéter/efectos adversos , Encuestas de Atención de la Salud , Disparidades en Atención de Salud/tendencias , Humanos , Italia/epidemiología , Transferencia de Pacientes/tendencias , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/terapia , Regionalización/tendencias , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/epidemiología , Taquicardia Ventricular/fisiopatología , Resultado del Tratamiento
7.
Fam Syst Health ; 37(2): 173-175, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31180709

RESUMEN

In addition to providing critical behavioral health services for those with mental health issues and substance use disorders, some Community Mental Health Centers (CMHCs) in the United States have begun integrating primary care services, referred to as "reverse integration". Representing the interests of CMHCs across the United States, the National Council for Behavioral Health (NCBH) represents over 3,000 member organizations delivering mental health and/or addictions treatment and services to roughly 10 million patients and families. This article reflects a recent wide-ranging conversation with Linda Rosenberg, the president and CEO of NCBH. Trained as a social worker, Rosenberg was senior deputy commissioner of the New York State Office of Mental Health prior to joining the NCBH and is a dynamic and high-energy strategist and thought leader in the field of community mental health and integrated care. We discussed issues impacting payment for integrated care, including private equity investment, capitated payment, and the role of risk, and how these market dynamics impact vulnerable populations. For the sake of brevity, we summarize our conversation with Ms. Rosenberg and offer her perspective to integrated care practitioners and researchers who largely operate outside of this world of business built on calculated risks and rewards. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Gestión del Cambio , Centros Comunitarios de Salud Mental/tendencias , Prestación Integrada de Atención de Salud/tendencias , Centros Comunitarios de Salud Mental/organización & administración , Prestación Integrada de Atención de Salud/métodos , Prestación Integrada de Atención de Salud/organización & administración , Femenino , Humanos , Liderazgo , Trastornos Mentales/psicología , Trastornos Mentales/terapia , New York , Atención Primaria de Salud/métodos , Atención Primaria de Salud/tendencias , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/terapia , Estados Unidos
9.
Pediatrics ; 143(5)2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31018988

RESUMEN

BACKGROUND: Most studies on adolescent screening, brief intervention, and referral to treatment (SBIRT) have examined substance use outcomes. However, it may also impact service use and comorbidity-an understudied topic. We address this gap by examining effects of SBIRT on health care use and comorbidities. METHODS: In a randomized trial sample, we assessed 3 SBIRT care modalities: (1) pediatrician-delivered, (2) behavioral clinician-delivered, and (3) usual. Medical comorbidity and health care use were compared between a brief-intervention group with access to SBIRT for behavioral health (combined pediatrician and behavioral clinician arms) and a group without (usual care) over 1 and 3 years. RESULTS: Among a sample of eligible adolescents (n = 1871), the SBIRT group had fewer psychiatry visits at 1 year (incidence rate ratio [iRR] = 0.76; P = .05) and 3 years (iRR = 0.65; P < .05). Total outpatient visits did not differ in year 1. The SBIRT group was less likely to have mental health diagnoses (odds ratio [OR] = 0.69; 95% confidence interval [CI] = 0.48-1.01) or chronic conditions (OR = 0.66; 95% CI = 0.45-0.98) at 1 year compared with those in usual care. At 3 years, the SBIRT group had fewer total outpatient visits (iRR = 0.85; P < .05) and was less likely to have substance use diagnoses (OR = 0.64; 95% CI = 0.45-0.91) and more likely to have substance use treatment visits (iRR = 2.04; P < .01). CONCLUSIONS: Providing SBIRT in pediatric primary care may improve health care use and health, mental health, and substance use outcomes. We recommend further exploring the effects of SBIRT on these outcomes.


Asunto(s)
Terapia Conductista/tendencias , Conductas Relacionadas con la Salud , Aceptación de la Atención de Salud , Pediatras/tendencias , Atención Primaria de Salud/tendencias , Trastornos Relacionados con Sustancias/terapia , Adolescente , Niño , Prestación Integrada de Atención de Salud/tendencias , Registros Electrónicos de Salud/tendencias , Femenino , Humanos , Masculino , Aceptación de la Atención de Salud/psicología , Trastornos Relacionados con Sustancias/psicología , Factores de Tiempo
10.
Fam Syst Health ; 37(1): 95-97, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30920270

RESUMEN

Provides John S. Rolland's acceptance speech for the 2018 CFHA Don Bloch Award. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Distinciones y Premios , Habla , Prestación Integrada de Atención de Salud/tendencias , Medicina Familiar y Comunitaria/métodos , Medicina Familiar y Comunitaria/tendencias , Humanos , Mentores/psicología
12.
Curationis ; 42(1): e1-e6, 2019 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-30843402

RESUMEN

BACKGROUND:  Integration of human immunodeficiency virus and acquired immune deficiency syndrome (HIV and AIDS) services into primary healthcare (PHC) is a key public health approach to achieving universal access to antiretroviral therapy (ART). Despite the government's efforts of integrating HIV services into PHC, an insufficient number of PHC staff and inadequate infrastructure are challenging when integrating HIV and AIDS services into PHC. This study explored the challenges of PHC nurses regarding the integration of HIV and AIDS services into PHC. OBJECTIVES:  The aim of the study was to explore the challenges of PHC nurses regarding the integration of HIV and AIDS services into PHC. METHOD:  An exploratory, descriptive and contextual qualitative research design utilising face-to-face semi-structured interviews was conducted with 12 PHC nurses from selected clinics and health centres in the Vhembe district of Limpopo province. RESULTS:  Two main themes emerged from data analysis which included challenges related to healthcare recipients and challenges related to healthcare providers. CONCLUSION:  Clear policies on the integration of HIV and AIDS services into PHC should be available and should include strategies to promote HIV testing and counselling, adherence to ART and scheduled appointments, disclosure of HIV status as well as revising the human resource policy to reduce workload.


Asunto(s)
Infecciones por VIH/enfermería , Enfermería de Atención Primaria/métodos , Adulto , Instituciones de Atención Ambulatoria/organización & administración , Prestación Integrada de Atención de Salud/tendencias , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Accesibilidad a los Servicios de Salud/normas , Humanos , Entrevistas como Asunto/métodos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Sudáfrica
13.
J Stroke Cerebrovasc Dis ; 28(4): 980-987, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30630752

RESUMEN

OBJECTIVE: Stroke care in the US is increasingly regionalized. Many patients undergo interhospital transfer to access specialized, time-sensitive interventions such as mechanical thrombectomy. METHODS: Using a stratified survey design of the US Nationwide Inpatient Sample (2009-2014) we examined trends in interhospital transfers for ischemic stroke resulting in mechanical thrombectomy. International Classification of Disease-Ninth Revision (ICD-9) codes were used to identify stroke admissions and inpatient procedures within endovascular-capable hospitals. Regression analysis was used to identify factors associated with patient outcomes. RESULTS: From 2009-2014, 772,437 ischemic stroke admissions were identified. Stroke admissions that arrived via interhospital transfer increased from 12.5% to 16.8%, 2009-2014 (P-trend < .001). Transfers receiving thrombectomy increased from 4.0% to 5.2%, 2009-2014 (P-trend = .016), while those receiving tissue plasminogen activator increased from 16.0% to 20.0%, 2009-2014 (P-trend < .001). One in 4 patients receiving thrombectomy were transferred from another acute care facility (n = 6,014 of 24,861). Compared to patients arriving via the hospital "front door" receiving mechanical thrombectomy, those arriving via transfer were more often from rural areas and received by teaching hospitals with greater frequency of thrombectomy. Those arriving via interhospital transfer undergoing thrombectomy had greater odds of symptomatic intracranial hemorrhage (adjusted odds ratio [AOR] 1.19, 95% CI: 1.01-1.42) versus "front door" arrivals. There were no differences in inpatient mortality (AOR 1.11, 95% CI: .93-1.33). CONCLUSIONS: From 2009 to 2014, interhospital stroke transfers to endovascular-capable hospitals increased by one-third. For every ∼15 additional transfers over the time period one additional patient received thrombectomy. Optimization of transfers presents an opportunity to increase access to thrombectomy.


Asunto(s)
Isquemia Encefálica/terapia , Procedimientos Endovasculares/tendencias , Pacientes Internos , Transferencia de Pacientes/tendencias , Accidente Cerebrovascular/terapia , Trombectomía/tendencias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiología , Bases de Datos Factuales , Prestación Integrada de Atención de Salud/tendencias , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/métodos , Femenino , Disparidades en Atención de Salud/tendencias , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Trombectomía/efectos adversos , Trombectomía/métodos , Factores de Tiempo , Tiempo de Tratamiento/tendencias , Resultado del Tratamiento , Estados Unidos/epidemiología , Adulto Joven
14.
J R Soc Med ; 112(1): 22-28, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30507284

RESUMEN

In recent years, there has been massive progress in artificial intelligence (AI) with the development of deep neural networks, natural language processing, computer vision and robotics. These techniques are now actively being applied in healthcare with many of the health service activities currently being delivered by clinicians and administrators predicted to be taken over by AI in the coming years. However, there has also been exceptional hype about the abilities of AI with a mistaken notion that AI will replace human clinicians altogether. These perspectives are inaccurate, and if a balanced perspective of the limitations and promise of AI is taken, one can gauge which parts of the health system AI can be integrated to make a meaningful impact. The four main areas where AI would have the most influence would be: patient administration, clinical decision support, patient monitoring and healthcare interventions. This health system where AI plays a central role could be termed an AI-enabled or AI-augmented health system. In this article, we discuss how this system can be developed based on a realistic assessment of current AI technologies and predicted developments.


Asunto(s)
Inteligencia Artificial , Prestación Integrada de Atención de Salud , Vías Clínicas/organización & administración , Vías Clínicas/tendencias , Prestación Integrada de Atención de Salud/métodos , Prestación Integrada de Atención de Salud/tendencias , Predicción , Heurística , Humanos , Evaluación de la Tecnología Biomédica
15.
J Psychosoc Nurs Ment Health Serv ; 57(5): 38-43, 2019 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-30508461

RESUMEN

The purpose of the current article is to highlight the potential of a care coordination model in promoting interagency collaboration when designing recovery-oriented services. The authors argue the case using exemplars from the literature and lessons learned from Australia's Partners in Recovery initiative. Interagency collaboration is paramount when designing a recovery-oriented service system. A care coordination model has the potential to overcome most challenges that preclude implementation of service system integration. Although the care coordination model is relatively new in recovery-oriented services and effectiveness studies of this model have yet to be undertaken, the model has the potential to be a viable alternative to service system integration. [Journal of Psychosocial Nursing and Mental Health Services, 57(5), 38-43.].


Asunto(s)
Continuidad de la Atención al Paciente , Conducta Cooperativa , Prestación Integrada de Atención de Salud/métodos , Trastornos Mentales/rehabilitación , Servicios de Salud Mental/tendencias , Australia , Prestación Integrada de Atención de Salud/tendencias , Humanos , Trastornos Mentales/psicología , Apoyo Social
16.
J Stroke Cerebrovasc Dis ; 28(2): 295-304, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30389376

RESUMEN

BACKGROUND: Little is known about how hospitals are connected in the transfer of ischemic stroke (IS) patients. We aimed to describe differences in characteristics of transferred versus nontransferred patients and between transferring and receiving hospitals in the Northeastern United States, and to describe changes over time. METHODS: We used Medicare claims data, and a subset linked with the Get with the Guidelines-Stroke registry from 2007 to 2011. Receiving hospitals were those with annual IS volume greater than or equal to 120 and greater than or equal to 15% received as transfers, and transferring hospitals were nonaccepting hospitals that transferred greater than or equal to 15% of their total (ED plus inpatient) IS patient discharges. A transferring-to-receiving hospital connection was identified if greater than or equal to 5 patients per year were shared. ArcGIS 10.3.1 was used for network visualization. RESULTS: Among 177,270 admissions to 402 Northeast hospitals, 6906 (3.9%) patients were transferred. Transferred patients were younger with more severe strokes (78 versus 81 years, P < .001; National Institutes of Health Stroke Severity 7 versus 5, P < .001), and were as likely to receive tissue plasminogen activator as nontransferred (P = .29). From 2007 to 2011, there were more patients transferred (960 [3%] to 1777 [6%], P < .001), and more transferring hospitals (46 [12%] to 91 [24%], P < .001), and receiving hospitals (6 [2%] to 16 [4%], P < .001). Most transferring hospitals were exclusively connected to a single receiving hospital. CONCLUSIONS: From 2007 to 2011, hospitals in the United States Northeast became more connected in the care of IS patients, with increasing patient transfers and hospital connections. Yet most hospitals remained unconnected. Further characterization of this transfer network will be important for understanding and improving regional stroke systems of care.


Asunto(s)
Isquemia Encefálica/terapia , Prestación Integrada de Atención de Salud/tendencias , Transferencia de Pacientes/tendencias , Regionalización/organización & administración , Accidente Cerebrovascular/terapia , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiología , Femenino , Humanos , Masculino , New England/epidemiología , Sistema de Registros , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Factores de Tiempo , Resultado del Tratamiento
17.
Eur Urol ; 75(4): 543-545, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30377007
19.
Am J Phys Med Rehabil ; 98(4): 311-318, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30211715

RESUMEN

Because health care is being moved to a higher level of accountability, there has been a focus on improving outcomes through improving postacute care. The issues of cost and readmissions to acute care settings are very important, but the focus on patient function has not been foremost. Because of the fact that most postacute care needs are based on functional limitations and that physiatrists are well versed in transitions of care, rehabilitation of patients back to community settings, team building, and leadership, it is appropriate for rehabilitation medicine to take a leadership role in the planning and development of postacute care services in the new integrated healthcare systems that are becoming prevalent in healthcare. This review discusses some of the issues in postacute care, the growth of the integrated health system model, and how there are opportunities and challenges for physiatric leadership to help develop these new models of care.


Asunto(s)
Prestación Integrada de Atención de Salud/tendencias , Medicina Física y Rehabilitación/tendencias , Atención Subaguda/tendencias , Prestación Integrada de Atención de Salud/métodos , Humanos , Liderazgo , Medicina Física y Rehabilitación/métodos , Atención Subaguda/métodos
20.
Anesth Analg ; 128(1): 123-127, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30198933

RESUMEN

The Gerard W. Ostheimer lecture is given each year at the Society for Obstetric Anesthesia and Perinatology annual meeting and is intended to summarize important new scientific literature relevant to practicing obstetric anesthesiologists. This review highlights some of the most consequential papers covered in this lecture. It discusses landmark clinical trials that are likely to change the practice of obstetrics and obstetric anesthesia. It summarizes several articles that focus on how to optimize the provision of neuraxial anesthesia and postoperative pain control. Finally, it reviews studies aimed at identifying systems-based interventions that can improve obstetrical outcomes. A proposed "to-do" list focused on quality improvement initiatives that can be implemented on labor and delivery units is provided.


Asunto(s)
Analgesia Obstétrica/tendencias , Anestesia Obstétrica/tendencias , Bloqueo Nervioso/tendencias , Congresos como Asunto , Prestación Integrada de Atención de Salud/tendencias , Difusión de Innovaciones , Medicina Basada en la Evidencia , Femenino , Predicción , Humanos , Grupo de Atención al Paciente/tendencias , Seguridad del Paciente , Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto
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