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1.
Front Pediatr ; 9: 772529, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34869125

RESUMO

Variations in the visceral vasculature are often encountered, but rarely cause clinical symptoms. We report a 12-year-old girl with portal hypertension caused by congenital variations in visceral vessels. The clinical manifestations included gastrointestinal hemorrhage and ascites. The common hepatic artery and splenic artery stem shared the same trunk from the aorta, and the common hepatic artery was directly connected with the main portal vein to form an arteriovenous fistula. In addition, the left hepatic artery and the left gastric artery shared a common trunk termed the "hepatic-gastric trunk" which originated from the anterior wall of the aorta, while the right hepatic artery originated from the superior mesenteric artery and supplied the right liver. The patient was treated with interventional embolization and remained in good condition throughout the follow-up and at the time of publication.

2.
Cardiovasc Intervent Radiol ; 44(9): 1394-1402, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33948697

RESUMO

PURPOSE: The survival benefits of patients with inoperable hepatocellular carcinoma (HCC) who undergo transarterial chemoembolization (TACE) and receive sorafenib therapy remain controversial. We aimed to identify clinical predictors in patients with inoperable HCC undergoing TACE and receiving sorafenib. METHODS: Between January 2014 and December 2017, 148 consecutive patients with inoperable HCC who were treated with TACE plus sorafenib were retrospectively analyzed. Critical clinical factors associated with overall survival (OS) were identified by Cox regression model analysis. Kaplan-Meier methods were used to calculate the survival times, which were compared with the log-rank test. RESULTS: Macrovascular invasion (MVI), radiologic response and sorafenib-related dermatologic toxicities were identified as independent factors associated with OS. MVI is a known prognostic factor before treatment. The median OS of patients with either radiologic response or dermatologic toxicities was significantly improved compared with that of patients without it (both 23.0 vs. 7.0 months, P < 0.001). The median OS of patients with a combination of radiologic response and dermatologic toxicities was significantly longer than that of patients with either radiologic response or dermatologic toxicities, as well as no response (25.0 vs. 14.0 vs. 6.0 months, respectively, P < 0.001), and the predictive value was confirmed across patients with different baseline characteristics in terms of MVI, α-fetoprotein level, performance status and liver function. CONCLUSION: The combination of radiologic response and sorafenib-related dermatologic toxicities is the most robust predictor of survival benefits for HCC patients after TACE plus sorafenib therapy. LEVEL OF EVIDENCE: Level 3.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Adulto , Antineoplásicos/efeitos adversos , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/terapia , Terapia Combinada , Feminino , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sorafenibe/uso terapêutico , Resultado do Tratamento
3.
Front Public Health ; 9: 647230, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33898380

RESUMO

Productive aging, or older adults engaging in paid or unpaid activities that produce socially valued goods or services, has been suggested to have the beneficial impact on older adults' health and well-being. We performed a cross-sectional study to examine the influence of health literacy on the relationship between socioeconomic status (SES) and productive aging among older Chinese adults in a newly urbanized community. Data was collected from 995 older adults from a newly urbanized community between June and August 2013 in Chengdu, China. We used structural equation modeling (SEM) to test the hypothesized relationship among SES, health literacy and productive aging. Results showed that education attainment and income had a direct positive effect on health literacy (ß = 0.47and ß = 0.15, respectively). Education had a partial indirect effect on productive aging through health literacy (ß = 0.27). And health literacy was an important factor in improving the productive aging of the elderly. Interventions targeting health education and health promotion should be taken to improve health literacy of older adults under the background of urbanization, especially for those with lower SES.


Assuntos
Letramento em Saúde , Idoso , Envelhecimento , China/epidemiologia , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Classe Social
5.
Adv Healthc Mater ; 9(1): e1900948, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31746549

RESUMO

Prussian blue nanoprobes are widely studied and applied in tumor photothermal therapy (PTT) and magnetic resonance imaging (MRI), due to their low toxicity and excellent in vivo performance. However, the sizes of hitherto reported Prussian blue nanoprobes are generally larger than 50 nm, which greatly influence cell phagocytosis, in vivo circulation, and biodistribution. In this work, a novel method of doping zinc ions is used to control the size of Prussian blue nanoprobes. Consequently, the performances of the nanoprobes in PTT and MRI are both significantly improved. The results show that the minimum size of Prussian blue nanoprobes achieved by doping 10% zinc ions (abbreviated as SPBZn(10%)) is 3.8 ± 0.90 nm, and the maximum specific absorption coefficient, photothermal conversion efficiency, and longitudinal relaxation rates are 1.78 L g-1 cm-1 , 47.33%, and 18.40 mm-1 s-1 , respectively. In addition, the SPBZn(10%) nanoprobes provide excellent PTT efficacy on 4T1 tumor cells (killing rate: 90.3%) and breast cancer model (tumor inhibition rate: 69.4%). Toxicological experiment results show that the SPBZn(n%) nanoprobes exhibit no obvious in vitro cytotoxicity and they can be used safely in mice at doses below 100 mg kg-1 . Therefore, SPBZn(10%) nanoprobes can potentially be used for effective cancer theranostics.


Assuntos
Neoplasias da Mama/terapia , Ferrocianetos/química , Nanoestruturas/química , Fármacos Fotossensibilizantes/química , Terapia Fototérmica/métodos , Zinco/química , Animais , Neoplasias da Mama/diagnóstico por imagem , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Feminino , Humanos , Hipertermia Induzida , Raios Infravermelhos , Imageamento por Ressonância Magnética , Camundongos , Camundongos Endogâmicos BALB C , Tamanho da Partícula , Fármacos Fotossensibilizantes/metabolismo , Fármacos Fotossensibilizantes/farmacologia , Fármacos Fotossensibilizantes/uso terapêutico , Nanomedicina Teranóstica , Distribuição Tecidual , Ensaios Antitumorais Modelo de Xenoenxerto
6.
J Toxicol Sci ; 44(9): 621-632, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31474743

RESUMO

In the past few decades, upconversion nanoparticles (abbreviated as UCNPs) have been more widely applied in the biomedical fields, such as in vitro and in vivo upconversion fluorescent bioimaging, photodynamic therapy, biological macromolecular detection, imaging mediated drug delivery and so on. But meanwhile, there is still not much research on the acute toxicity of upconversion nanoparticles in vivo, such as acute hepatotoxicity. In this work, we studied the in vivo biodistribution and acute hepatotoxicity of multimodal targeted contrast agent NaLuF4:Gd,Yb,Er-PEG/PEI-FA nanoprobe, which were synthesized by the solvothermal method and modified with Polyethylene glycol (PEG), Polyetherimide (PEI), folic acid (FA) on the surface. The acute hepatotoxicity in mice was systematically assessed after tail vein injection of different concentration of UCNPs. The results showed that NaLuF4:Gd,Yb,Er-PEG/PEI-FA nanoparticles with an average diameter of 44.5 ± 10.4 nm, and three typical upconversion fluorescence emission bands at 520 nm, 540 nm and 660 nm under the excitation of 980 nm laser. In vivo distribution experiments results demonstrated that approximately 87% of UCNPs injected through the tail vein accumulate in the liver. In the acute hepatotoxicity test, the intravenously injection dose of UCNPs was 10, 40, 70 and 100 mg/kg, respectively. The body weight, blood routine, serum biochemistry, histomorphology and liver oxidative stress were detected and observed no significant acute hepatotoxicity damage under the injection dose of 100 mg/kg. In conclusion, NaLuF4:Gd,Yb,Er-PEG/PEI-FA nanoprobes are safe and reliable, and have potential applications in the field of tumor targeted multimodal imaging.


Assuntos
Meios de Contraste/toxicidade , Corantes Fluorescentes/toxicidade , Gadolínio/toxicidade , Fígado/efeitos dos fármacos , Fígado/diagnóstico por imagem , Imagem Multimodal/métodos , Nanopartículas/efeitos adversos , Animais , Meios de Contraste/administração & dosagem , Meios de Contraste/metabolismo , Relação Dose-Resposta a Droga , Feminino , Corantes Fluorescentes/administração & dosagem , Corantes Fluorescentes/metabolismo , Gadolínio/administração & dosagem , Gadolínio/metabolismo , Injeções Intravenosas , Camundongos Endogâmicos ICR , Nanopartículas/administração & dosagem , Nanopartículas/metabolismo , Tamanho da Partícula , Segurança , Distribuição Tecidual
7.
PLoS One ; 14(2): e0211984, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30730967

RESUMO

OBJECTIVE: To explore influential factors contributing to the choice of primary care facilities (PCFs) for the initial treatment among rural and urban residents in Southwestern China. METHODS: A face-to-face survey was conducted on a multistage stratified random sample of 456 rural and 459 urban residents in Sichuan Province from January to August in 2014. A structured questionnaire was used to collect data on residents' characteristics, provider of initial treatment and principal reason for the choice. Multivariate logistic regression was performed to identify factors associated with choosing PCFs for the initial treatment. RESULTS: The result showed that 65.4% of the rural residents and 50.5% of the urban residents chose PCFs as their initial contact for medical care. Among both rural and urban residents, the principal reason for choosing medical institutions for the initial treatment was convenience (42.3% versus 40.5%, respectively), followed by high quality of medical care (26.5% versus 29.4%, respectively). Compared to rural residents, urban residents were more likely to value trust in doctors and high quality of medical care but were less likely to value the insurance designation status of the facilities. Logistic regression analysis showed that both rural and urban residents were less likely to choose PCFs for the initial treatment if they lived more than 15 minutes (by walk) from the nearest facilities (rural: OR = 0.15, 95%CI = 0.09-0.26; urban: OR = 0.19, 95%CI = 0.10-0.36), had fair (rural: OR = 0.49, 95%CI = 0.26-0.92; urban: OR = 0.31, 95%CI = 0.15-0.64) or poor (rural: OR = 0.14, 95%CI = 0.07-0.30; urban: OR = 0.22, 95%CI = 0.11-0.44) self-reported health status. Among rural residents, attending college or higher education (OR = 0.21, 95%CI = 0.08-0.59), being retired (OR = 0.90, 95%CI = 0.44-1.84) and earning a per capita annual income of household of 10,000-29,999 (OR = 0.24, 95%CI = 0.11-0.52) and 30,000-49,999 (OR = 0.26, 95%CI = 0.07-0.92) were associated with lower rates of seeking care at PCFs. CONCLUSION: Efforts should be made to improve the accessibility of PCFs and to upgrade the services capability of PCFs both in rural and urban areas in China. At the same time, resources should be prioritized to residents with poorer self-reported health status, and rural residents who retire or have better education and higher income levels should be taken into account.


Assuntos
Tomada de Decisões , Atenção Primária à Saúde/normas , Adulto , Idoso , Instituições de Assistência Ambulatorial , China , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde , Serviços de Saúde Rural/normas , Inquéritos e Questionários , Serviços Urbanos de Saúde/normas , Adulto Jovem
8.
J Minim Invasive Gynecol ; 26(6): 1187-1192, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30611975

RESUMO

Retroperitoneal ectopic pregnancy (REP) is an extremely rare type of ectopic pregnancy. Currently, surgery is the most widely used treatment method although it involves a high likelihood of intraoperative hemorrhage. In this case report, we describe a safe and effective alternative method for managing epigastric REP. We conducted a retrospective analysis of the clinical data of 2 patients with REP in the epigastrium who were treated at our hospital using our nonsurgical method. The treatment involved conservative management by computed tomographic-guided methotrexate injection in the gestational sac. We also present a literature review of 26 case reports and discuss the clinical features and various methods for treating REP. Our experience with the successful treatment of 2 patients suggests that the novel approach of computed tomographic-guided methotrexate injection in the gestational sac may be a safe and effective approach to manage REP. Further studies are warranted to confirm our findings.


Assuntos
Metotrexato/administração & dosagem , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/tratamento farmacológico , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X , Abortivos não Esteroides/administração & dosagem , Adulto , Perda Sanguínea Cirúrgica , China , Tratamento Conservador/métodos , Feminino , Saco Gestacional , Humanos , Injeções Intraperitoneais/métodos , Gravidez , Espaço Retroperitoneal/diagnóstico por imagem , Espaço Retroperitoneal/patologia
10.
J Thorac Dis ; 9(3): E249-E252, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28449512

RESUMO

The rarity and non-specific symptoms of benign primary tracheal tumors always leaded to misdiagnosis and delayed treatment, and also undefined the optimal treatment. In this case, a 45-year-old woman had a history of progressive shortness of breath and dry cough for several years, CT scan revealed an intra-luminal tracheal mass invaded the left side of tracheal wall. After being located by bronchoscope preoperatively, the tumor was removed by surgical resection. The tumor was 1.5 cm in diameter with intact capsule. The pathological result confirmed the diagnosis of schwannoma.

11.
Contemp Clin Trials ; 56: 1-8, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28315478

RESUMO

BACKGROUND: The 2014 Institute of Medicine report recommended that healthcare providers caring for individuals with advanced illness have basic palliative care competencies in communication, inter-professional collaboration, and symptom management. Nursing homes, where one in three American decedents live and die, have fallen short of these competency goals. We implemented an intervention study to examine the efficacy of nursing home-based integrated palliative care teams in improving the quality of care processes and outcomes for residents at the end of life. METHODS/DESIGN: This paper describes the design, rationale, and challenges of a two-arm randomized controlled trial of nursing home-based palliative care teams in 31 facilities. The impact of the intervention on residents' outcomes is measured with four risk-adjusted quality indicators: place of death (nursing home or hospital), number of hospitalizations, and self-reported pain and depression in the last 90-days of life. The effect of the intervention is also evaluated with regard to staff satisfaction and impact on care processes (e.g. palliative care competency, communication, coordination). Both secondary (e.g. the Minimum Data Set) and primary (e.g. staff surveys) data are employed to examine the effect of the intervention. DISCUSSION: Several challenges in conducting a complex, nursing home-based intervention have been identified. While sustainability of the intervention without research funding is not clear, we surmise that without changes to the payment model that put palliative care services in this care setting on par with the more "skilled" care, it will not be reasonable to expect any widespread efforts to implement facility-based palliative care services.


Assuntos
Instituição de Longa Permanência para Idosos/organização & administração , Casas de Saúde/organização & administração , Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Assistência Terminal/organização & administração , Idoso , Idoso de 80 Anos ou mais , Depressão/epidemiologia , Feminino , Hospitalização , Humanos , Capacitação em Serviço/organização & administração , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Dor/epidemiologia , Qualidade da Assistência à Saúde/organização & administração , Projetos de Pesquisa , Características de Residência , Fatores Socioeconômicos
12.
Nurs Outlook ; 64(1): 71-85, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26475528

RESUMO

BACKGROUND: One proposed strategy to expand primary care capacity is to use nurse practitioners (NPs) more effectively in health care delivery. However, the ability of NPs to provide care to the fullest extent of their education is moderated by state scope-of-practice (SOP) regulations. PURPOSE: The purpose of this study was to examine the impact of state SOP regulations on the following three key issues: (a) NP workforce, (b) access to care and health care utilization, and (c) health care costs. METHODS: Systematic review. RESULTS/DISCUSSION: States granting NPs greater SOP authority tend to exhibit an increase in the number and growth of NPs, greater care provision by NPs, and expanded health care utilization, especially among rural and vulnerable populations. Our review indicates that expanded NP practice regulation can impact health care delivery by increasing the number of NPs in combination with easing restrictions on their SOP. CONCLUSIONS: Findings show promise that removing restrictions on NP SOP regulations could be a viable and effective strategy to increase primary care capacity.


Assuntos
Competência Clínica/legislação & jurisprudência , Competência Clínica/normas , Atenção à Saúde/legislação & jurisprudência , Atenção à Saúde/normas , Profissionais de Enfermagem/legislação & jurisprudência , Profissionais de Enfermagem/normas , Atenção Primária à Saúde/normas , Feminino , Humanos , Masculino , Atenção Primária à Saúde/legislação & jurisprudência , Estados Unidos
13.
Med Care ; 53(8): 713-9, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26125418

RESUMO

BACKGROUND: Quality report cards have been shown to be effective in influencing patients' referrals and promoting quality improvement in some instances and not others. In this study, we investigate one of the mechanisms that may detract from their effectiveness: voluntary versus mandatory participation of nursing homes in public quality reporting. OBJECTIVES: To answer 2 questions: (1) Were the nursing homes choosing not to participate low-quality performers relative to those who chose to participate? (2) Once participation became mandatory, did those that did not voluntarily participate initially, improve more than those that participated voluntarily? RESEARCH DESIGN: Massachusetts published the Massachusetts Satisfaction Survey report card for nursing homes for the years 2005, 2007, and 2009. Nursing homes' participation was voluntary in 2005 and mandatory in 2007 and 2009. We performed a retrospective statistical analysis of the relationship between nursing homes' decision to participate in quality reporting and 12 quality outcomes: deficiency citations, staffing, and 8 survey domains. SUBJECTS: A total of 424 Massachusetts nursing homes. RESULTS: Sixty-seven percent of nursing homes participated in reporting voluntarily. Volunteer nursing homes had better quality for all measures (significant at the 0.05 level or trending toward significance at the 0.10 level for all but 2). Once reporting became mandatory, nonvolunteers improved more than volunteers in all but 2 staffing measures (trending toward significance at the 0.10 level in 5). CONCLUSIONS: Report cards are more effective if nursing homes' participation is mandated. Nonmandatory reporting systems, as those implemented by some states and professional associations, lead to missed opportunities for quality improvements.


Assuntos
Benchmarking/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/organização & administração , Notificação de Abuso , Casas de Saúde/organização & administração , Melhoria de Qualidade/estatística & dados numéricos , Humanos , Programas Obrigatórios/estatística & dados numéricos , Massachusetts , Avaliação de Resultados em Cuidados de Saúde , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Gestão da Qualidade Total/organização & administração
14.
Infect Control Hosp Epidemiol ; 36(7): 759-66, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25797334

RESUMO

OBJECTIVE To examine the prevalence of healthcare-associated pathogens and the infection control policies and practices in a national sample of nursing homes (NHs). METHODS In 2012, we conducted a national survey about the extent to which NHs follow suggested infection control practices with regard to 3 common healthcare-associated pathogens: methicillin-resistant Staphylococcus aureus, Clostridium difficile, and extended-spectrum ß-lactamase producers, and their prevalence in NHs. We adapted a previously used and validated NH infection control survey, including questions on prevalence, admission and screening policies, contact precautions, decolonization, and cleaning practices. RESULTS A total of 1,002 surveys were returned. Of the responding NHs, 14.2% were less likely to accept residents with methicillin-resistant Staphylococcus aureus, with the principal reason being lack of single or cohort rooms. NHs do not routinely perform admission screening (96.4%) because it is not required by regulation (56.2%) and would not change care provision (30.7%). Isolation strategies vary substantially, with gloves being most commonly used. Most NHs (75.1%) do not decolonize carriers of methicillin-resistant Staphylococcus aureus, but some (10.6%) decolonize more than 90% of residents. Despite no guidance on how resident rooms on contact precautions should be cleaned, 59.3% of NHs report enhanced cleaning for such rooms. CONCLUSION Overall, NHs tend to follow voluntary infection control guidelines only if doing so does not require substantial financial investment in new or dedicated staff or infrastructure.


Assuntos
Clostridioides difficile , Enterocolite Pseudomembranosa/prevenção & controle , Controle de Infecções/organização & administração , Staphylococcus aureus Resistente à Meticilina , Casas de Saúde/organização & administração , Política Organizacional , Infecções Estafilocócicas/prevenção & controle , Portador Sadio/tratamento farmacológico , Desinfecção/organização & administração , Desinfecção/normas , Enterocolite Pseudomembranosa/microbiologia , Luvas Protetoras , Humanos , Casas de Saúde/estatística & dados numéricos , Admissão do Paciente , Isolamento de Pacientes/métodos , Quartos de Pacientes/normas , Infecções Estafilocócicas/microbiologia , Inquéritos e Questionários , Estados Unidos , Resistência beta-Lactâmica , beta-Lactamases/biossíntese
15.
Med Care ; 52(7): 641-8, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24926712

RESUMO

BACKGROUND: Providing equitable and patient-centered care is critical to ensuring high quality of care. Although racial/ethnic disparities in quality are widely reported for nursing facilities, it is unknown whether disparities exist in consumer experiences with care and how public reporting of consumer experiences affects facility performance and potential racial disparities. METHODS: We analyzed trends of consumer ratings publicly reported for Maryland nursing homes during 2007-2010, and determined whether racial/ethnic disparities in experiences with care changed during this period. Multivariate longitudinal regression models controlled for important facility and county characteristics and tested changes overall and by facility groups (defined based on concentrations of black residents). Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food and meals; physical environment; and autonomy and personal rights. RESULTS: Overall ratings on care experience remained relatively high (mean=8.3 on a 1-10 scale) during 2007-2010. Ninety percent of survey respondents each year would recommend the facility to someone who needs nursing home care. Ratings on individual domains of care improved among all nursing homes in Maryland (P<0.01), except for food and meals (P=0.827 for trend). However, site-of-care disparities existed in each year for overall ratings, recommendation rate, and ratings on all domains of care (P<0.01 in all cases), with facilities more predominated by black residents having lower scores; such disparities persisted over time (P>0.2 for trends in disparities). CONCLUSIONS: Although Maryland nursing homes showed maintained or improved consumer ratings during the first 4 years of public reporting, gaps persisted between facilities with high versus low concentrations of minority residents.


Assuntos
Comportamento do Consumidor , Família/psicologia , Disparidades em Assistência à Saúde/etnologia , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Serviços de Alimentação , Instituição de Longa Permanência para Idosos/organização & administração , Humanos , Maryland , Casas de Saúde/organização & administração , Assistência Centrada no Paciente/organização & administração , Autonomia Pessoal , Admissão e Escalonamento de Pessoal , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/estatística & dados numéricos , Características de Residência
16.
Health Aff (Millwood) ; 32(8): 1416-25, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23918486

RESUMO

Since 2005 Massachusetts has publicly reported results from biennial surveys of satisfaction with nursing homes, completed by responsible parties for residents, to promote consumer-centered care. Our analysis of the results from 2005, 2007, and 2009 revealed generally high satisfaction with care, which remained stable over time. On a scale of 1 to 5 (from very dissatisfied to very satisfied), average satisfaction with overall care was 4.22-4.31, and satisfaction that overall residents' needs were met was 4.09-4.16. Around 90 percent of respondents would recommend the facility. Satisfaction ratings varied considerably across facilities, with higher scores associated with higher nursing staffing levels, fewer deficiency citations, and nonprofit or government ownership. Scores for six domains of care were, in general, closely associated with satisfaction scores. However, family members seemed less satisfied with the physical and social activities available to residents and with the food and meals served than with such attributes as the physical environment. Our findings suggest that including the consumer's perspective would improve the Centers for Medicare and Medicaid Services' current nursing home reporting efforts. However, refinements may be necessary to detect the impact of consumer reporting on the quality of patient-centered care.


Assuntos
Instituição de Longa Permanência para Idosos , Casas de Saúde , Satisfação do Paciente/estatística & dados numéricos , Idoso , Cuidadores/psicologia , Comportamento do Consumidor , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Massachusetts , Pessoa de Meia-Idade , Assistência Centrada no Paciente , Inquéritos e Questionários
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