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1.
Instr Course Lect ; 69: 167-182, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32017727

RESUMEN

Joint arthroplasty is increasingly being performed in ambulatory surgery centers (ASCs). Enabled by enhanced recovery protocols and multimodal pain management, and incentivized by the implementation of value-based payment models, this trend is projected to continue, with more than half of total joint replacements predicted to be outpatient by 2026.1 Like any advance in healthcare, this transition offers both new advantages and new challenges. ASCs provide opportunities to improve patient satisfaction and outcomes while lowering costs, but realizing these advantages requires a new level of presurgery preparation for both surgeons and patients. This chapter outlines key considerations for success when transitioning to performing joint arthroplasty at ASCs. Paramount among these are patient selection and preparation. Additional considerations include protocol optimization through data tracking and iterative refinement. A clear understanding of the differences in performing joints at an ASC versus a hospital outpatient setting enables surgeons to make the transition smoothly, maintain a high-quality patient experience, and deliver optimum outcomes.


Asunto(s)
Artroplastia de Reemplazo , Pacientes Ambulatorios , Guías de Práctica Clínica como Asunto , Procedimientos Quirúrgicos Ambulatorios , Prestación de Atención de Salud , Humanos , Manejo del Dolor
2.
Sr Care Pharm ; 35(2): 56-67, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32019640

RESUMEN

Increasingly, public policy makers, professional organizations, and academics are discussing social determinants of health-the conditions in which people live, work, and age. The impetus for the discussion is a growing awareness that medication and any type of health care is a poor substitute for improving a patient's living conditions. Health care is a necessary but insufficient intervention when people develop chronic disease. Addressing the social determinants of health that include poverty, food insecurity, health literacy, neighborhoods, and the environment is essential if we are to improve an individual's overall health. This is the focus of population health, and to address social determinants of health adequately, the medical team needs to expand to give all team members overlapping duties. It also needs to include social workers and legal representatives. Pharmacists may wonder how the theories associated with social determinants of health can be incorporated into their practices. This article discusses a number of different approaches.


Asunto(s)
Alfabetización en Salud , Determinantes Sociales de la Salud , Prestación de Atención de Salud , Abastecimiento de Alimentos , Humanos , Política Pública
4.
Lancet ; 395(10219): 165, 2020 01 18.
Artículo en Inglés | MEDLINE | ID: mdl-31954441
5.
Epidemiol Psychiatr Sci ; 29: e87, 2020 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-31915090

RESUMEN

Increasing numbers of young adults need continued support for their attention deficit hyperactivity disorder (ADHD) beyond the age-boundary for children's services. The sparse literature on transition in general suggests patchy provision and huge gaps in transitional care, but also that young people with ADHD and other neurodevelopmental disorders fair particularly badly. Transition in health care coincides with many other important life-transitions while the difficulties associated with ADHD may make these challenges particularly hard to cope with. Parents or other advocates therefore often need to be involved, which can present problems in adult mental health services given that they tend to be less family oriented than children's services. Importantly, young people need help negotiating the transition from passive recipient of care to active self-management, and in building relationships with the adult team.In addition to patchy provision of adult ADHD services, transition is currently hampered by poor understanding of ADHD as a long term condition and uncertain knowledge of what services are available among young people and parents as well as the clinicians working with them. Guidelines recommend, and more importantly young people want, access to psycho-social interventions as well as medication. However, available evidence suggests poor quality transitional care and adult services that are highly focused on medication.Adult ADHD services need to undergo similar development to that experienced by Child and Adolescent Mental Health Services and community paediatrics over the last few decades. While we debate the relative merits of dedicated or specialist v. generic adult mental health services, for young adults with ADHD the training, experience and availability of professionals are more important than their qualifications or setting.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Accesibilidad a los Servicios de Salud , Servicios de Salud Mental/organización & administración , Transición a la Atención de Adultos , Adolescente , Niño , Progresión de la Enfermedad , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Cuidado de Transición , Adulto Joven
6.
Epidemiol Psychiatr Sci ; 29: e90, 2020 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-31915102

RESUMEN

For young people with autism spectrum disorder (ASD), the transition from childhood to adulthood especially for those with additional mental health problems can be challenging. Increasing numbers of young people attending child and adolescent mental health services (CAMHS) have a recognised diagnosis of ASD. What are the outcomes of these young people when they are discharged from CAMHS and how best can services support their needs? In this editorial we consider the emerging literature on transition for young people with long-term conditions and in particular those with ASD. Longer term studies suggest that the outcomes for individuals with ASD across the ability range is mostly poor and that healthcare transfer has generally not been managed well, with service users often reporting a lack of appropriate types of support. Encouragingly there is an increasing awareness of the need to support young people with long-term conditions as they negotiate the many developmental tasks of transition to adulthood. However, less is known about the experiences and aspirations of autistic individuals of all abilities as they transition to adulthood. This knowledge can inform a more nuanced approach to identifying developmentally appropriate outcomes. Recent studies with cognitively able young people with ASD, highlight some features in common with young people with long-term conditions but also the importance of identifying ways to foster underlying skills and the ability of young people with ASD to develop and maintain relationships. Child-focussed and adult-orientated healthcare services need to work directly with autistic individuals and their support networks to facilitate successful engagement with services and enable adults to manage their mental health needs. There is an urgent need to investigate the implementation and effectiveness of research and clinical guideline recommendations that aim to increase wellbeing, health self-efficacy and improve the mental health outcomes for autistic adults.


Asunto(s)
Trastorno del Espectro Autista/terapia , Prestación de Atención de Salud , Servicios de Salud Mental , Transición a la Atención de Adultos , Adolescente , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Salud Mental , Adulto Joven
11.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 6-7, 2020 Jan 06.
Artículo en Chino | MEDLINE | ID: mdl-31914561

RESUMEN

This article illustrates that health management, as one of the tools of health service, plays an important role in the control and treatment of chronic diseases as well as the history of health management development in China. It was pointed out that currently the concept of health management is not well established in China and the practice of health management in the Chinese market is quite in a mess. Therefore, there is an urgent need for the standardization of health management practice. The China Health Management Association released an organizational standard entitled "Standard for Chronic Disease Health Management" in November, 2019. It is comprehensive, science-based, easy to use and fit into the Chinese situation and it is expected that it will facilitate the development of health management in China.


Asunto(s)
Prestación de Atención de Salud/organización & administración , China , Enfermedad Crónica/prevención & control , Prestación de Atención de Salud/normas , Humanos , Estándares de Referencia
12.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 39-41, 2020 Jan 06.
Artículo en Chino | MEDLINE | ID: mdl-31914567

RESUMEN

This standard specifies the terms and definitions, processes, components, information systems and information summary, analysis and utilization of health management of major chronic and non-communicable diseases (chronic diseases). It is suitable for medical and health service institutions, health examination institutions and health management-related enterprises to carry out health management services for individuals with major chronic diseases such as cardiovascular diseases, diabetes, cancer, chronic respiratory diseases and so on.


Asunto(s)
Enfermedad Crónica/prevención & control , Prestación de Atención de Salud/organización & administración , Humanos
16.
MMWR Morb Mortal Wkly Rep ; 69(2): 35-39, 2020 Jan 17.
Artículo en Inglés | MEDLINE | ID: mdl-31945033

RESUMEN

Transgender women* in the United States are disproportionately affected by human immunodeficiency virus (HIV) infection because of multiple factors, including stigma related to gender identity, unstable housing, limited employment options, and high-risk behaviors, such as sex work, unprotected receptive anal intercourse, and injection drug use, that tend to increase their vulnerability to becoming infected with HIV (1,2). In a recent meta-analysis of 88 U.S. studies conducted during 2006-2017, the mean estimated laboratory-confirmed prevalence of HIV infection among transgender women was 14.2%, and the mean self-reported prevalence estimate was 21.0% (3). The Ending the HIV Epidemic initiative calls for accelerating the implementation of evidence-based strategies in the right geographic areas targeted to the right persons to end the HIV epidemic in the United States (4). HIV partner services are effective strategies offered by public health workers to persons with a diagnosis of HIV infection (index persons) and their sex or needle-sharing partners (partners), who are notified of potential HIV exposure and offered HIV testing and related services. CDC analyzed HIV partner services data submitted by 61 health departments† during 2013-2017. Among 208,304 index persons, 1,727 (0.8%) were transgender women. Overall, 71.5% of index transgender women were interviewed for partner services, which was lower than that for all index persons combined (81.1%). Among 1,089 transgender women named as partners by index persons, 71.2% were notified of potential HIV exposure, which was lower than that for all partners combined (77.1%). Fewer than half (46.5%) of notified transgender women partners were tested for HIV, and approximately one in five (18.6%) of those who were tested received a new diagnosis of HIV infection, slightly higher than for all partners combined (17.6%). Additional efforts are needed to effectively implement partner services among transgender women and identify those whose infection with HIV is undiagnosed, provide timely prevention and care services, reduce HIV transmission, and contribute to ending the HIV epidemic.


Asunto(s)
Prestación de Atención de Salud , Infecciones por VIH/terapia , Parejas Sexuales , Personas Transgénero , Adolescente , Adulto , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Estados Unidos/epidemiología , Adulto Joven
17.
Plast Reconstr Surg ; 145(2): 471-481, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985644

RESUMEN

BACKGROUND: Hand surgeons can alleviate the burden associated with various congenital anomalies, burn sequelae, and trauma that debilitate individuals in low- and middle-income countries. Because few surgeons in these areas have the necessary resources to perform complex hand surgery, surgical trips provide essential surgical care. The authors aimed to determine the economic benefit of hand surgical trips to low- and middle-income countries to comprehensively determine the economic implications of hand surgery trips in low-resource settings. METHODS: The authors collected data from two major global hand surgery organizations to analyze the economic benefit of hand surgery trips in low- and middle-income countries. The authors used both the human capital approach and the value of a statistical life-year approach to conduct this cost-benefit analysis. To demonstrate the economic gain, the authors subtracted the budgeted cost of each trip from the economic benefit. RESULTS: The authors analyzed a total of 15 trips to low- and middle-income countries. The costs of the trips ranged from $3453 to $87,434 (average, $24,869). The total cost for all the surgical trips was $373,040. The authors calculated a net economic benefit of $3,576,845 using the human capital approach and $8,650,745 using the value of a statistical life-year approach. CONCLUSIONS: The authors found a substantial return on investment using both the human capital approach and the value of a statistical life-year approach. In addition, the authors found that trips emphasizing education had a net economic benefit. Cost-benefit analyses have substantial financial implications and will aid policy makers in developing cost-reduction strategies to promote surgery in low- and middle-income countries.


Asunto(s)
Países en Desarrollo/economía , Deformidades Congénitas de la Mano/economía , Traumatismos de la Mano/economía , Mano/cirugía , Adolescente , Adulto , Anciano , Niño , Preescolar , Análisis Costo-Beneficio , Prestación de Atención de Salud/economía , Femenino , Deformidades Congénitas de la Mano/cirugía , Traumatismos de la Mano/cirugía , Humanos , Masculino , Turismo Médico/economía , Área sin Atención Médica , Persona de Mediana Edad , Embarazo , Años de Vida Ajustados por Calidad de Vida , Estudios Retrospectivos , Viaje/economía , Viaje/estadística & datos numéricos , Adulto Joven
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