RESUMO
Heart and circulatory diseases affect more than seven million people in the UK. Non-invasive cardiac imaging is a critical element of contemporary cardiology practice. Progressive improvements in technology over the last 20 years have increased diagnostic accuracy in all modalities and led to the incorporation of non-invasive imaging into many standard cardiac clinical care pathways. Cardiac imaging tests are requested by a variety of healthcare practitioners and performed in a range of settings from the most advanced hospitals to local health centres. Imaging is used to detect the presence and consequences of cardiovascular disease, as well as to monitor the response to therapies. The previous UK national imaging strategy statement which brought together all of the non-invasive imaging modalities was published in 2010. The purpose of this document is to collate contemporary standards developed by the modality-specific professional organisations which make up the British Cardiovascular Society Imaging Council, bringing together common and essential recommendations. The development process has been inclusive and iterative. Imaging societies (representing both cardiology and radiology) reviewed and agreed on the initial structure. The final document therefore represents a position, which has been generated inclusively, presents rigorous standards, is applicable to clinical practice and deliverable. This document will be of value to a variety of healthcare professionals including imaging departments, the National Health Service or other organisations, regulatory bodies, commissioners and other purchasers of services, and service users, i.e., patients, and their relatives.
Assuntos
Cardiologia , Doenças Cardiovasculares , Doenças Cardiovasculares/diagnóstico por imagem , Diagnóstico por Imagem , Humanos , Sociedades , Medicina Estatal , Reino UnidoRESUMO
The success of cardiac surgery has transformed the prospects of children with congenital heart disease with over 90% now surviving to adulthood. The early pioneering surgeons took on significant risk, whilst current surgical practice emphasises safety and consistency. In this article we review important British contributions to the field and consider challenges for the future, specifically how to better manage and reduce the adverse sequelae of congenital cardiac surgery by continuing to innovate safely.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas , Cirurgiões , Adulto , Criança , Cardiopatias Congênitas/cirurgia , HumanosAssuntos
Mortalidade Hospitalar , Admissão do Paciente/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Hospitais/normas , Hospitais/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Fatores de Risco , Índice de Gravidade de Doença , Medicina Estatal/organização & administração , Medicina Estatal/normas , Fatores de Tempo , Reino Unido/epidemiologiaAssuntos
Atenção à Saúde , Emigração e Imigração , Saúde Global , Cooperação Internacional , Enfermeiros Obstétricos/provisão & distribuição , Organizações , Cirurgiões/provisão & distribuição , Países Desenvolvidos , Países em Desenvolvimento , Feminino , Serviços de Saúde , Humanos , Enfermeiros Obstétricos/educação , Pobreza , Gravidez , Cirurgiões/educação , Recursos HumanosAssuntos
Reforma dos Serviços de Saúde/organização & administração , Medicina Estatal/tendências , Prestação Integrada de Cuidados de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/tendências , Humanos , Inovação Organizacional , Medicina Estatal/organização & administração , Reino UnidoAssuntos
Reforma dos Serviços de Saúde/organização & administração , Medicina Preventiva/organização & administração , Qualidade da Assistência à Saúde/normas , Medicina Estatal/organização & administração , Reforma dos Serviços de Saúde/tendências , Prioridades em Saúde , Humanos , Medicina Preventiva/tendências , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/tendências , Saúde Pública , Medicina Estatal/tendências , Reino UnidoRESUMO
The Five Year Forward View is a look at what the NHS could achieve, given the range of resources that may be available. It sets out how the health service needs to change, arguing for a more engaged relationship with patients, carers, and citizens to promote wellbeing and prevent ill health. Here, we outline how the Forward View supports clinicians to provide better, higher quality and more integrated care.New models of care are presented, including multispecialty providers, primary and acute care systems, urgent and emergency care networks, viable smaller hospitals, specialised services, modern maternity services, and enhanced care homes. The commitments to support clinicians are discussed, including specific proposals for primary care, initiatives to improve the health of NHS staff, dealing with gaps in the NHS workforce, and the use of technology and innovation to further enable clinicians.
Assuntos
Reforma dos Serviços de Saúde/organização & administração , Medicina Estatal/organização & administração , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/tendências , Previsões , Reforma dos Serviços de Saúde/tendências , Pessoal de Saúde/organização & administração , Pessoal de Saúde/tendências , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/tendências , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/tendências , Medicina Estatal/tendências , Reino UnidoAssuntos
Revelação , Qualidade da Assistência à Saúde , Medicina Estatal/organização & administração , Revelação/ética , Humanos , Qualidade da Assistência à Saúde/ética , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/estatística & dados numéricos , Medicina Estatal/legislação & jurisprudência , Reino UnidoRESUMO
OBJECTIVES: Continuous monitoring of surgical outcomes through benchmarking and the identification of best practices has become increasingly important. A structured approach to data collection, coupled with validation, analysis and reporting, is a powerful tool in these endeavours. However, inconsistencies in standards and practices have made comparisons within and between European countries cumbersome. The European Association for Cardio-Thoracic Surgery (EACTS) has established a large international database with the goals of (i) working with other organizations towards universal data collection and creating a European-wide repository of information on the practice of cardio-thoracic surgery, and (ii) disseminating that information in scientific, peer-reviewed articles. We report on the process of data collection, as well as on an overview of the data in the database. METHODS: The EACTS Database Committee met for the first time in Monaco, September 2002, to establish the ground rules for the process of setting up the database. Subsequently, data have been collected and merged by Dendrite Clinical Systems Ltd. RESULTS: As of December 2008, the database included 1,074,168 patient records from 366 hospitals located in 29 countries. The latest submission from the years 2006-08 included 404,721 records. The largest contributors were the UK (32.0%), Germany (20.9%) and Belgium (7.3%). Isolated coronary bypass surgery was the most frequently performed operation; the proportion of surgical workload that comprised isolated coronary artery bypass grafting varied from country to country: 30% in Spain and almost 70% in Denmark. Isolated valve procedures constituted 12% of all procedures in Norway and 32% in Spain. Baseline demographics showed an increase in the mean age and the percentage of patients that were female over time. Remarkably, the mortality rates for all procedures declined over the period analysed, to 2.2% (95% confidence interval [CI] 2.2-2.3%) for isolated coronary bypass, 3.4% (95% CI 3.3-3.5%) for isolated valve and 6.2% (95% CI 6.0-6.5%) for bypass + valve procedures. CONCLUSION: The EACTS database has proven to be an important step forward in providing opportunities for monitoring cardiac surgical care across Europe. As the database continues to expand, it will facilitate research projects, establish benchmarking standards and identify potential areas for quality improvements.
Assuntos
Bases de Dados Factuais , Sistema de Registros , Sociedades Médicas , Procedimentos Cirúrgicos Torácicos , Europa (Continente) , HumanosRESUMO
OBJECTIVE: To develop a tool for identifying and quantifying morbidity following cardiac surgery (cardiac postoperative morbidity score [C-POMS]). STUDY DESIGN AND SETTING: Morbidity was prospectively assessed in 450 cardiac surgery patients on postoperative days 1, 3, 5, 8, and 15 using POMS criteria (nine postoperative morbidity domains in general surgical patients) and cardiac-specific variables (from expert panel). Other morbidities were noted as free text and included if prevalence was more than 5%, missingness less than 5%, and mean expert-rated severity-importance index score more than 8. Construct validity was assessed by expert panel review, Cronbach's alpha (internal consistency), and linear regression (predictive ability of C-POMS for length of stay [LOS]). RESULTS: A 13-domain model was derived. Internal consistency (>0.7) on D3-D15 permits use as a summative score of total morbidity burden. Mean C-POMS scores were 3.4 (D3), 2.6 (D5), 3.4 (D8), and 3.8 (D15). Patient LOS was 4.6 days (P=0.012), 5.3 days (P=0.001), and 7.6 days (P=0.135) longer in patients with C-POMS-defined morbidity on D3, D5, D8, and D15, respectively, than in those without. For every unit increase in C-POMS summary score, subsequent LOS increased by 1.7 (D3), 2.2 (D5), 4.5 (D8), and 6.2 (D15) days (all P=0.000). CONCLUSION: C-POMS is the first validated tool for identifying total morbidity burden after cardiac surgery. However, further external validation is warranted.