Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 655
Filtrar
1.
Reprod Health ; 18(1): 49, 2021 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-33627155

RESUMO

INTRODUCTION: Both inpatient and outpatient providers may be at increased risk of stress, anxiety and depression from their roles as health providers during the COVID-19 epidemic. This study explores how the US COVID-19 epidemic has increased feelings of stress, anxiety and depression among outpatient reproductive health providers. METHODS: We conducted a survey with open-ended responses among outpatient reproductive health providers across the U.S. engaged in contraceptive care to collect data on their experiences with stress, anxiety and depression during the COVID-19 epidemic. The study population included physicians, nurses, social workers, and other health professions [n = 288]. Data were collected from April 21st-June 24th 2020. We used content analysis of free text responses among providers reporting increased stress, anxiety or depression. RESULTS: Two-thirds (184) of providers reported increased stress and one-third (96) reported increased anxiety or depression related to care provision during the COVID-19 epidemic. The major sources of stress, anxiety and depression were due to patient care, worry about becoming infected or infecting family members, work- and home-related concerns, experiencing provider burnout, and fear of the unknown. Concerns about quality of patient care, providers' changing responsibilities, lack of personal protective equipment, and difficulty coping with co-worker illness and absence all contributed to provider stress and anxiety. Worries about unemployment and childcare responsibilities were also highlighted. Providers attributed their stress, anxiety or depression to feeling overwhelmed, being unable to focus, lacking sleep, and worrying about the unknown. CONCLUSIONS: US outpatient providers are experiencing significant stress, anxiety, and depression during the US COVID-19 epidemic. Policy and programmatic responses are urgently needed to address the widespread adverse mental health consequences of this epidemic on outpatient providers, including reproductive health providers, across the US. Both inpatient and outpatient providers may be at increased risk of stress, anxiety and depression from their roles as health providers during the COVID-19 epidemic. This study explores how the US COVID-19 epidemic has increased feelings of stress, anxiety and depression among outpatient reproductive health providers across the US. We conducted a survey from April 21st to June 24th, 2020 among outpatient reproductive health providers, including physicians, nurses, social workers and other health professions. We asked open-ended questions to understand why providers reported increased stress, anxiety and/or depression. Two-thirds (184) of providers reported increased stress and one-third (96) reported increased anxiety or depression from care provision during the COVID-19 epidemic. Major sources of stress, anxiety and depression were due to patient care, worry about becoming infected or infecting family members, work- and home-related concerns, experiencing provider burnout, and fear of the unknown. Concerns about quality of patient care, providers' changing responsibilities, lack of personal protective equipment, and difficulty coping with co-worker illness and absence all contributed to provider stress and anxiety. Worries about unemployment and childcare responsibilities were also highlighted. Providers attributed their stress, anxiety or depression to feeling overwhelmed, being unable to focus, lacking sleep, and worrying about the unknown. This study highlights that US outpatient reproductive health providers are experiencing significant stress, anxiety, and depression during the US COVID-19 epidemic. Policy and programmatic responses are urgently needed to address the widespread adverse mental health consequences of this epidemic on outpatient providers, including reproductive health providers, across the US.


Assuntos
/psicologia , Pessoal de Saúde/psicologia , Saúde Mental/estatística & dados numéricos , Saúde Reprodutiva , Adulto , Assistência Ambulatorial/psicologia , Ansiedade/epidemiologia , Depressão/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/epidemiologia , Inquéritos e Questionários , Estados Unidos/epidemiologia
2.
PLoS One ; 15(7): e0235165, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735588

RESUMO

INTRODUCTION: Patient-reported experience measures (PREMs) are central to inform on the responsiveness of health systems to citizens' health care needs and expectations. At their current form, PREMs do not reflect the weights that patients assign to varying aspects of the care experience. We aimed to investigate patients' preferences and willingness to pay (WTP) for attributes of the care experience in outpatient settings. METHODS: A discrete choice experiment was conducted among a representative sample of the general adult population of Hungary (n = 1000). Choice set attributes and levels were defined based on OECD's standardized PREMs (e.g. a doctor spending enough time in consultation, providing easy to understand explanations, giving opportunity to ask questions, and involving in decision making) and a price attribute. Conditional and mixed logit analyses were conducted. WTP estimates were computed in preference and WTP space. RESULTS: The respondents most preferred attribute was that of a doctor spending enough time in consultation, followed by involvement in decision making. Moreover, waiting times had a less important effect on respondents' choice preference compared with aspects of the doctor-patient relationship. Estimates in the WTP space varied from €4.38 (2.85-5.90) for waiting an hour less at a doctor's office to €36.13 (32.07-40.18) for a consultation where a doctor spends enough time with a patient relative to a consultation where a doctor does not. CONCLUSIONS: A preference-based PREMs approach provide insight on the value patients assign to different aspects of their care experience. This can inform the decisions of policy-makers and other stakeholders to coordinate efforts and resource allocation in a more targeted manner, by acting on attributes of the care experience that have a greater impact on the implementation of patient-centered care.


Assuntos
Assistência Ambulatorial/psicologia , Preferência do Paciente/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Relações Médico-Paciente , Adolescente , Adulto , Idoso , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Tomada de Decisão Compartilhada , Feminino , Política de Saúde , Humanos , Hungria , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente/organização & administração , Alocação de Recursos/organização & administração , Adulto Jovem
3.
Medicine (Baltimore) ; 99(32): e21495, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769885

RESUMO

The aim of this study was to clarify the relationship between doctor-shopping behavior and clinical conditions, and to clearly outline the effects of both the number of clinic visits and the number of doctor changes on patients' health conditions. Data from January 1, 2000 to December 31, 2004 was collected from the National Health Insurance Research Database in Taiwan. After randomly selecting one million people, we extracted 5-year longitudinal data, about the number of clinic visits, number of doctor changes, and changes in self-health status for each patient with diabetes over the age of 18. We developed a relationship among the variables by using the generalized estimating equation. The results revealed that the number of clinic visits on the change of health status is a U curve, suggesting that health condition could be optimal with an appropriate number of clinic visits. The effect of the number of doctor changes is linearly correlated with health deterioration. The results suggest that disease conditions can only be controlled with an adequate number of clinic visits. Excessively frequent clinic visits are not only unfavorable to patients' health status but are also wasteful of limited medical resources. For diabetic mellitus patients, the more they change doctors, the worse their health status. All of these results are important for patients to stay healthy and to save medical resources.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Diabetes Mellitus/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Médicos/estatística & dados numéricos , Adulto , Assistência Ambulatorial/psicologia , Bases de Dados Factuais , Diabetes Mellitus/psicologia , Feminino , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Estudos Retrospectivos , Taiwan
4.
J Couns Psychol ; 67(4): 449-461, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32614226

RESUMO

Early change is an increasing area of investigation in psychotherapy research. In this study, we analyzed patterns of early change in interpersonal problems and their relationship to nonverbal synchrony and multiple outcome measures for the first time. We used growth mixture modeling to identify different latent classes of early change in interpersonal problems with 212 patients who underwent cognitive-behavioral treatment including interpersonal and emotion-focused elements. Furthermore, videotaped sessions were analyzed using motion energy analysis, providing values for the calculation of nonverbal synchrony to predict early change in interpersonal problems. The relationship between early change patterns and symptoms as well as overall change in interpersonal problems was also investigated. Three latent subgroups were identified: 1 class with slow improvement (n = 145), 1 class with fast improvement (n = 12), and 1 early deterioration class (n = 55). Lower levels of early nonverbal synchrony were significantly related to fast improvement in interpersonal change patterns. Furthermore, such patterns predicted treatment outcome in symptoms and interpersonal problems. The results suggest that nonverbal synchrony is associated with early change patterns in interpersonal problems, which are also predictive of treatment outcome. Limitations of the applied methods as well as possible applications in routine care are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Assistência Ambulatorial/métodos , Assistência Ambulatorial/psicologia , Terapia Cognitivo-Comportamental/métodos , Relações Interpessoais , Comunicação não Verbal/psicologia , Adolescente , Adulto , Assistência Ambulatorial/tendências , Terapia Cognitivo-Comportamental/tendências , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Psicoterapia/métodos , Psicoterapia/tendências , Resultado do Tratamento , Adulto Jovem
5.
Enferm. intensiva (Ed. impr.) ; 31(2): 71-81, abr.-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-190923

RESUMO

OBJETIVO: Conocer el significado que atribuyen pacientes adultos y sus familias a la ausencia familiar durante la atención de urgencia. MÉTODO: Estudio cualitativo siguiendo la propuesta de la teoría fundamentada con recogida de datos en 2 unidades públicas de urgencias hospitalarias, localizadas en el sur de Brasil. Se llevaron a cabo 15 entrevistas con pacientes y 15 entrevistas con familiares durante los meses de octubre de 2016 a febrero de 2017. Los datos fueron analizados siguiendo el método comparativo contante. RESULTADOS: Los pacientes y familiares vivencian la ausencia familiar en la atención de urgencia como un proceso de sufrimiento causado por la separación del binomio familia-paciente; por la falta de entendimiento acerca de los motivos que justifican la exclusión familiar, y por enfrentarse a la situación con resignación. CONCLUSIÓN: La urgencia per se conlleva un sufrimiento en el paciente y sus familiares; este sufrimiento se intensifica cuando la familia es apartada y no puede acompañar al paciente durante la atención de urgencia. En vista de estos resultados, es necesario desarrollar estrategias y políticas sanitarias que contribuyan a la atención integral de pacientes y familias en unidades de urgencias hospitalarias


AIM: To understand what the absence of the family during emergency care means to adult patients and their families to. METHOD: A grounded theory study was conducted in two emergency units of two public hospitals in southern Brazil. From October 2016 to February 2017, 15 interviews with patients and 15 with family members were carried out. The data were analyzed following the comparative method. RESULTS: The patients and families experienced the absence of the family in emergency care as a process of suffering caused by the separation of patient and family; they did not understand the reasons for family exclusion, and were resigned to the situation. CONCLUSIÓN: Urgent care per se entails suffering in patients and their relatives; this suffering intensifies when the family is separated and cannot accompany the patient during emergency care. These results show the need to develop health strategies and policies that contribute to the comprehensive care of patients and families in hospital emergency units


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Assistência Ambulatorial/psicologia , Estresse Psicológico/psicologia , Pacientes/psicologia , Família/psicologia , Relações Familiares/psicologia , Enfermagem Familiar , Serviços Médicos de Emergência , Visitas a Pacientes/psicologia
7.
Muscle Nerve ; 61(6): 682-691, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32297678

RESUMO

Telehealth has the potential to improve the efficiency of healthcare while reducing the burden on patients and caregivers. Encounters can be synchronous or asynchronous. When used for care of those with amyotrophic lateral sclerosis (ALS) by individual health care providers or by a multidisciplinary team, synchronous telehealth is feasible, acceptable, may produce outcomes comparable to those of in-person care, and is cost effective. Individuals with ALS who use telehealth tend to have lower physical and respiratory function and to live farther from an ALS clinic than those who exclusively attend in-person clinic visits. Asynchronous telehealth can be used as a substitute full multidisciplinary visits, or for remote monitoring of pulmonary function, gait/falls, and speech. Barriers to implementing telehealth on a wider scale include disparities in access to technology and challenges surrounding medical licensure and billing, but these are being addressed.


Assuntos
Assistência Ambulatorial/tendências , Esclerose Amiotrófica Lateral/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Telemedicina/tendências , Assistência Ambulatorial/métodos , Assistência Ambulatorial/psicologia , Esclerose Amiotrófica Lateral/diagnóstico , Esclerose Amiotrófica Lateral/psicologia , Humanos , Doenças Neuromusculares/diagnóstico , Doenças Neuromusculares/psicologia , Doenças Neuromusculares/terapia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Satisfação do Paciente , Telemedicina/métodos
8.
Hawaii J Health Soc Welf ; 79(3): 91-97, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32190842

RESUMO

Ambulatory care sensitive conditions (ACSCs) are conditions that can generally be managed in community-based healthcare settings, and, if managed well, should not require hospital admission. A 5-year, mixed methods study was recently concluded that (1) documented disparities in hospitalizations for ACSCs in Hawai'i through quantitative analysis of state-wide hospital discharge data; and (2) identified contributing factors for these hospitalizations through patient interviews. This Public Health Insights article provides deeper context for, and consideration of, a striking study finding: the differences between typical measures of access to care and the quality of patient/provider interactions as reported by study participants. The themes that emerged from the patients' stories of their own potentially preventable hospital admissions shed light on the importance of being heard, trust, communication, and health knowledge in their relationships with their providers. We conclude that improving the quality of the relationship and level of engagement between the patient and community/outpatient providers may help reduce hospitalizations for ACSCs in Hawai'i and beyond. These interpersonal-level goals should be supported by systems-level efforts to improve health care delivery and address health disparities.


Assuntos
Atitude do Pessoal de Saúde , Disparidades nos Níveis de Saúde , Relações Médico-Paciente , Adulto , Idoso , Assistência Ambulatorial/psicologia , Doenças Cardiovasculares/terapia , Continuidade da Assistência ao Paciente/normas , Diabetes Mellitus/terapia , Hawaii , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
9.
Psychiatry Res ; 285: 112780, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31954541

RESUMO

Poor medication adherence remains frequent in schizophrenia. The present study examined the efficacy of two month-long pilot interventions using the Medication Event Monitoring System (MEMS®). Thirty-three outpatients at high risk for relapse were randomized to receive a smartphone-based intervention, a nurse-based intervention, or treatment as usual. All patients then used the MEMS® to objectively measure medication adherence over six months. No differences were observed in adherence measures or relapse rates across the three groups. When using electronic medication monitoring as an objective measure of adherence, easily-implemented interventions may not significantly improve adherence in patients at high risk for relapse.


Assuntos
Assistência Ambulatorial/psicologia , Monitoramento de Medicamentos/psicologia , Adesão à Medicação/psicologia , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Smartphone , Adulto , Assistência Ambulatorial/métodos , Doença Crônica , Monitoramento de Medicamentos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/psicologia , Projetos Piloto
10.
PLoS One ; 15(1): e0228148, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31990930

RESUMO

INTRODUCTION: Zimbabwe is scaling up HIV differentiated service delivery (DSD) to improve treatment outcomes and health system efficiencies. Shifting stable patients into less-intensive DSD models is a high priority in order to accommodate the large numbers of newly-diagnosed people living with HIV (PLHIV) needing treatment and to provide healthcare workers with the time and space needed to treat people with advanced HIV disease. DSD is also seen as a way to improve service quality and enhance retention in care. National guidelines support five differentiated antiretroviral treatment models (DART) for stable HIV-positive adults, but little is known about patient preferences, a critical element needed to guide DART scale-up and ensure person-centered care. We designed a mixed-methods study to explore treatment preferences of PLHIV in urban Zimbabwe. METHODS: The study was conducted in Harare, and included 35 health care worker (HCW) key informant interviews (KII); 8 focus group discussions (FGD) with 54 PLHIV; a discrete choice experiment (DCE) in which 500 adult DART-eligible PLHIV selected their preferences for health facility (HF) vs. community location, individual vs. group meetings, provider cadre and attitude, clinic operation times, visit frequency, visit duration and cost to patient; and a survey with the 500 DCE participants exploring DART knowledge and preferences. RESULTS: Patient preferences were consistent in the FGDs, DCE and survey. Participants strongly preferred respectful HCWs, HF-based services, individual DART models, and less costly services. Patients also preferred less frequent visits and shorter wait times. They were indifferent to variations in HCW cadre and distances from home to HF. These preferences were mostly homogenous, with only minor differences between male vs. female and older vs. younger patients. HCWs in the KII correctly characterized facility-based individual models as the one most favored by patients; HCWs also preferred this model, which they felt decongested HFs and reduced their workload. CONCLUSIONS: DART-eligible PLHIV in Harare found it relatively easy to access HFs, and preferred attributes associated with facility-based individual models. Prioritizing these for scale-up in urban areas may be the most efficient way to sustain positive patient outcomes and increase health system performance.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Assistência Ambulatorial/psicologia , Assistência Ambulatorial/estatística & dados numéricos , Comportamento de Escolha , Confidencialidade , Feminino , Grupos Focais , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Masculino , Inquéritos e Questionários , Adulto Jovem , Zimbábue/epidemiologia
11.
Psychooncology ; 29(1): 132-138, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31707735

RESUMO

CONTEXT: Palliative care encompasses an interdisciplinary team, including mental health care professionals, to address psychological distress of cancer patients. OBJECTIVES: To present the implementation of an outreach counseling program via videoconferencing or telephone to patients receiving care in an outpatient palliative care clinic and to compare patients using this service to those who only received psychological counseling in our outpatient clinic. METHODS: We conducted a retrospective chart review of cancer patients seen for psychology counseling services in an outpatient supportive care center between June 2015 and March 2017. RESULTS: We reviewed 2072 unique patients (52% of the total patients seen at the outpatient Supportive Care Center), who had 4567 total counseling encounters across outreach and outpatient settings. A total of 452 (22%) patients participated in a combination of outpatient and outreach counseling services. Patients who participated in outreach services had significantly more encounters (311 [69%] had two to five sessions) compared with those who had outpatient services only (1137 [70%] had one session only) (P < .001). Outreach patients also had shorter times between the initial and follow-up encounters (median 14 days) compared with those who had outpatient services only (median 30 days) (P < .0001). CONCLUSIONS: Outreach telehealth counseling services was found to enhance palliative care patient access to psychological counseling. These services represent an additional modality for providing continuous psychological care.


Assuntos
Assistência Ambulatorial/psicologia , Aconselhamento/métodos , Cuidados Paliativos/psicologia , Qualidade de Vida/psicologia , Telemedicina/métodos , Assistência Ambulatorial/métodos , Tomada de Decisões , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Cuidados Paliativos/métodos , Estudos Retrospectivos , Comunicação por Videoconferência
12.
Gynecol Oncol ; 156(2): 482-487, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31831167

RESUMO

OBJECTIVES: A randomized control trial (RCT) to estimate the effect of an interventional video on improving palliative care knowledge, acceptability and attendance to outpatient services in gynecologic oncology patients. METHODS: Women receiving treatment for gynecologic malignancy recruited at an academic tertiary care center were randomized to: palliative care educational video or non-directive cancer center video. The primary outcome was referral to palliative care. Function and knowledge were assessed using the Functional Assessment of Cancer Therapy and the Palliative Care Knowledge Scale. Data analyses were performed using t-tests, Wilcoxon rank sum or Fisher's exact tests with significance level of α = 0.05. RESULTS: 111 women were enrolled. Demographic characteristics were equally distributed between groups with respect to age, race, cancer, and stage. There was no statistical difference in knowledge scores or in referral to palliative care between the patients that watched the educational versus control video (29% vs. 27%; p = .79). Secondary analysis showed a statistically significant increase in utilization of palliative care services compared to historic institutional data (8.8% to 31.5%; p ≤.001). Further, those referred had significantly worse baseline functional scores. CONCLUSIONS: Use of a palliative care educational video did not increase knowledge or acceptability of palliative services within this RCT. However, the rate of patients referred to palliative care tripled compared to historic rates. Further studies should investigate whether discussion regarding palliative care services alone may increase desire for referral, and if use of Fact-G scores may identify patients in greatest need of services.


Assuntos
Assistência Ambulatorial/psicologia , Neoplasias dos Genitais Femininos/psicologia , Neoplasias dos Genitais Femininos/terapia , Cuidados Paliativos/psicologia , Educação de Pacientes como Assunto/métodos , Idoso , Assistência Ambulatorial/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Cuidados Paliativos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde
13.
Rev Bras Enferm ; 72(suppl 3): 178-183, 2019 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31851251

RESUMO

OBJECTIVE: to characterize the sociodemographic and psychiatric profile of women users of psychoactive substances in treatment for drug addiction. METHOD: descriptive study of quantitative approach performed with women attended at a Psychosocial Care Center for Users of Alcohol and Other Drugs (CAPS ad) from the interior of São Paulo State. RESULTS: the sample consisted of 349 adult women, single, low educational level and unemployed, users of alcohol, cocaine, crack and tranquillizers. Among the consequences of use include withdrawal syndrome, overdose, depressive and suicidal symptoms. Most were referred for treatment by the family or health services. Almost 20% of these women had previously started treatments. CONCLUSION: The results suggest marked morbidity and high levels of psychosocial vulnerability, which require thorough investigation at the patient's admission, as well as damage associated with use, withdrawal symptoms and depressive symptoms.


Assuntos
Psicotrópicos/normas , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Adolescente , Adulto , Idoso , Alcoolismo/tratamento farmacológico , Alcoolismo/psicologia , Assistência Ambulatorial/métodos , Assistência Ambulatorial/psicologia , Assistência Ambulatorial/normas , Transtornos Relacionados ao Uso de Cocaína/tratamento farmacológico , Transtornos Relacionados ao Uso de Cocaína/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Psicotrópicos/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/psicologia
14.
Rev Esp Enferm Dig ; 111(12): 899-902, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31793322

RESUMO

Colorectal cancer (CRC) is one of the most relevant diseases worldwide because of its incidence, prevalence and mortalitye. It is the third most common tumor in men, after lung and prostate cancer, and the second most common tumor in women, after breast cancer. A recent systematic analysis showed global data referring to age-standardized incidence rates for CRC, which increased by 9.5% from 1990 to 2017, whereas mortality rates decreased by 13.5%. This might be due to the introduction of CRC prevention programs, which facilitate early identification and higher survival chances.


Assuntos
Neoplasias Colorretais/diagnóstico , Serviços Hospitalares de Assistência Domiciliar , Satisfação do Paciente , Qualidade de Vida , Assistência Ambulatorial/psicologia , Neoplasias Colorretais/psicologia , Hospitalização , Humanos , Indicadores de Qualidade em Assistência à Saúde , Espanha , Inquéritos e Questionários
15.
Medicina (Kaunas) ; 55(12)2019 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-31817931

RESUMO

Invasive dental procedures can be performed only with local anesthesia; in some cases, it may be useful to combine the administration of drugs to obtain anxiolysis with local anesthesia. Sedation required level should be individually adjusted to achieve a proper balance between the needs of the patient, the operator, and the safety of the procedure. Surgical time is an important factor for post-operative phases, and this could be greatly increased by whether the patient interrupts the surgeon or if it is not collaborative. In this manuscript some dentistry-used methods to practice conscious sedation have been evaluated. This manuscript could be a useful reading on the current state of conscious sedation in dentistry and an important starting point for future perspectives. Surely the search for safer drugs for our patients could have beneficial effects for them and for the clinicians.


Assuntos
Anestesia Local/psicologia , Sedação Consciente/métodos , Assistência Odontológica/métodos , Odontologia/normas , Administração Oral , Adulto , Assistência Ambulatorial/psicologia , Assistência Ambulatorial/normas , Anestesia Dentária/tendências , Anestesia Local/efeitos adversos , Anestésicos Inalatórios/administração & dosagem , Ansiolíticos , Benzodiazepinas/administração & dosagem , Benzodiazepinas/farmacocinética , Sistema Nervoso Central/efeitos dos fármacos , Criança , Ansiedade ao Tratamento Odontológico/tratamento farmacológico , Ansiedade ao Tratamento Odontológico/epidemiologia , Ansiedade ao Tratamento Odontológico/prevenção & controle , Assistência Odontológica/psicologia , Humanos , Óxido Nitroso/administração & dosagem , Duração da Cirurgia , Período Pós-Operatório , Segurança/normas
16.
Can J Urol ; 26(6): 10022-10025, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860418

RESUMO

INTRODUCTION: The American Academy of Pediatrics views Certified Child Life Specialists (CCLS) as "an important component of pediatric hospital based care to address the psychosocial concerns that accompany hospitalization." CCLSs help patients and parents navigate the complex medical system in order to minimize psychosocial and emotional stress by implementing age appropriate coping skills. This survey explores the perceptions towards CCLS and their utilization with pediatric urology. MATERIALS AND METHODS: A Survey Monkey questionnaire was developed and distributed to Society for Pediatric Urology members (SPU) (n = 314). Providers were queried about CCLS implementation and their perception regarding CCLS's role in improving health related quality of life (HRQOL). RESULTS: There was a 34.1% response rate (n = 107). Ninety-four providers (87.9%) reported CCLS interaction with their patients and greater than 95% of providers felt CCLS imparted some degree of benefit to their patients' HRQOL. Only 4.7% felt CCLS offered no benefit to the patients. CCLS were consistently used in a minority of inpatient and outpatient settings and never in the radiological setting. They were used at least 50% of the time by the most responders in inpatient and radiological setting and nearly the same in the ambulatory surgery setting. CONCLUSIONS: This survey illuminates that the majority of providers interact with CCLS in clinical settings and believe their involvement is beneficial. However, CCLSs are under-utilized during invasive urological procedures where patient anxiety is high. By understanding perceptions of providers and their practice patterns we can overcome barriers to CCLS use and improve their quality of life.


Assuntos
Atitude do Pessoal de Saúde , Criança Hospitalizada , Diagnóstico por Imagem , Pessoal de Saúde , Urologia/estatística & dados numéricos , Assistência Ambulatorial/psicologia , Assistência Ambulatorial/estatística & dados numéricos , Procedimentos Cirúrgicos Ambulatórios/psicologia , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Criança , Criança Hospitalizada/psicologia , Criança Hospitalizada/estatística & dados numéricos , Diagnóstico por Imagem/psicologia , Diagnóstico por Imagem/estatística & dados numéricos , Família , Pesquisas sobre Serviços de Saúde , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Qualidade de Vida
17.
Arq. ciências saúde UNIPAR ; 23(3): 215-220, set-dez. 2019.
Artigo em Português | LILACS | ID: biblio-1046189

RESUMO

A assistência à emergência psiquiátrica é encarada como um dos tópicos mais difíceis e estratégicos no processo da Reforma Psiquiátrica. Essa assistência psicossocial requer buscar formas de atuação que, além de perceber o indivíduo em situação de emergência como ser singular, complexo e entrelaçado por uma rede familiar e social, valorize também a subjetividade. O objetivo desse estudo é reconhecer os obstáculos descritos no acervo literário sobre o atendimento nas situações de urgências e emergências psiquiátricas. Adotou-se a da literatura que se refere à análise sistemática e ampla de estudos científicos, proporcionando uma síntese do conhecimento contemplando o tema escolhido. De uma maneira geral os estudos e pesquisas analisadas relataram que as dificuldades encontradas no cuidado à pessoa em sofrimento psíquico, devem-se à falta de conhecimentos específicos da área de saúde mental, pois a formação profissional não é frequente nessa área de atuação. Observou-se que em muitas situações o profissional não se sente capacitado a atender a esse público. Com isso, sugere-se o fortalecimento da educação continuada para os profissionais atuantes, como também para os acadêmicos, uma vez que estes serão inseridos no mercado de trabalho.


Psychiatric emergency care is seen as one of the most difficult and strategic topics in the Psychiatric Reform process. This psychosocial assistance requires looking for ways of acting that, in addition to perceiving the individual in an emergency situation as being singular, complex and intertwined by a family and social network, also values subjectivity. The purpose of this study is to recognize the obstacles described in the literature on care in psychiatric emergency situations. A literature review was developed on the systematic and extensive analysis of scientific studies, providing a synthesis of the knowledge about the chosen topic. In general, the studies and research analyzed reported that the difficulties faced in caring for the person suffering from mental diseases are due to the lack of specific knowledge in the area of mental health, since professionals are not frequently trained on that field. It could be observed that in many situations the professional does not feel able to care for this kind of patient. Therefore, this study suggests the strengthening of continuing education for working professionals as well as for graduation students, since they will soon be inserted in the job.


Assuntos
Serviços de Emergência Psiquiátrica , Assistência à Saúde Mental , Identificação da Emergência , Educação Continuada , Serviços Médicos de Emergência , Capacitação de Recursos Humanos em Saúde , Capacitação Profissional , Assistência Ambulatorial/psicologia
18.
BMC Complement Altern Med ; 19(1): 305, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711478

RESUMO

BACKGROUND: Patient-centered culturally sensitive health care (PC-CSHC) has emerged as a primary approach to health care. This care focuses on the cultural diversity of the patients rather than the views of the health care professionals. PC-CSHC enables the patient to feel comfortable, respected, and trusted in the health care delivery process. As users of traditional and complementary medicine (T&CM) rarely inform their conventional health care providers of such use, the providers need to identify the users of T&CM themselves to avoid negative interaction with conventional medicine and to be able to provide them with PC-CSHC. Since the patterns of traditional medicine (TM) use are different to those of complementary medicine (CM), the aim of this study was to investigate the prevalence, and the health- and sociodemographic associations for visits to TM- and CM providers in an urban population. METHOD: The data were collected through two self-administrated questionnaires from the seventh survey of the Tromsø Study, a population-based cohort study conducted in 2015-2016. All inhabitants of Tromsø aged 40 or above were invited (n = 32,591) and n = 21,083 accepted the invitation (response rate 65%). Pearson chi-square tests and one-way ANOVA tests were used to describe differences between the groups whereas binary logistic regressions were used for adjusted values. RESULTS: The results revealed that 2.5% of the participants had seen a TM provider, 8.5% had seen a CM provider whereas 1% had visited both a TM and a CM provider during a 12-month period. TM users tended to be older, claim that religion was more important to them, have poorer economy and health, and have lower education compared to CM users. We found that more than 90% of the participants visiting T&CM providers also used conventional medicine. CONCLUSION: A considerable number of the participants in this study employed parallel health care modalities including visits to conventional, traditional, and complementary medicine providers. To offer patient-centered culturally sensitive health care that is tailored to the patients' treatment philosophy and spiritual needs, conventional health care providers need knowledge about, and respect for their patients' use of parallel health care systems.


Assuntos
Terapias Complementares/psicologia , Medicina Tradicional/psicologia , Pacientes/psicologia , Adulto , Idoso , Assistência Ambulatorial/psicologia , Assistência Ambulatorial/estatística & dados numéricos , Estudos de Coortes , Terapias Complementares/estatística & dados numéricos , Demografia , Feminino , Pessoal de Saúde/psicologia , Humanos , Masculino , Medicina Tradicional/estatística & dados numéricos , Pessoa de Meia-Idade , Noruega , Pacientes/estatística & dados numéricos , Prevalência , Religião , Confiança
19.
Rev Esp Enferm Dig ; 111(12): 903-908, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31729234

RESUMO

BACKGROUND: satisfaction with healthcare is focused on the patient and is known as "patient-centered care". However, user satisfaction is not always synonymous with good care. Healthcare practitioners should determine and understand what patients need and expect in order to improve the quality of care. AIMS: the main objective of this study was to determine the perceived quality of care of patients diagnosed with colorectal cancer in our unit. METHODS: a cross-sectional study was performed in all patients diagnosed with colorectal cancer (CRC) that underwent staging studies and were hospitalized in the Gastroenterology Department from May 2013 to October 2013. Furthermore, outpatients with rapid consultations for CRC staging from November 2013 to November 2014 were also included. Two questionnaires were administered: a) a survey of 20 questions with closed responses regarding the competence of treating physicians and nurses, the information received and the waiting time; b) the European Organization for Research and Treatment of Cancer (EORTC) QLQ-INFO25: information on the disease, medical tests, treatment and other services, with eight single items. RESULTS: there were no differences in the perceived healthcare quality, delays in starting treatment, the tumor stage, symptoms (performance status) or the time spent studying the disease. In-patients and those with advanced disease started treatment earlier than outpatients and those with disease stage I or II. Likewise, outpatients perceived a better psychological support. CONCLUSIONS: outpatient study did not reduce the quality of care and did not delay treatment.


Assuntos
Assistência Ambulatorial/normas , Neoplasias Colorretais/terapia , Hospitalização , Satisfação do Paciente , Qualidade da Assistência à Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/psicologia , Cuidadores/psicologia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Qualidade de Vida , Inquéritos e Questionários , Fatores de Tempo , Listas de Espera
20.
BMC Complement Altern Med ; 19(1): 300, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694613

RESUMO

BACKGROUND: Both doctors' and patients' opinions are important in the process of treatment and healthcare of Chinese medicine. This study is to compare patients' and doctors' treatment satisfaction over the course of two visits in a Chinese medicine outpatient setting, and to explain their respective views. METHODS: Patients' chief complaints were collected prior to the outpatient encounter. The doctor was then asked (through a questionnaire) to state what complaints he or she was prioritizing during the process of diagnosing disease and making a prescription for herbal medicine or acupuncture treatment. On the next visit, both the patient and the doctor completed a questionnaire assessing satisfaction with the treatment of Chinese medicine prescribed in the first visit and administered by the patient at home. A 5-point Likert scales was used to assess the patients' and doctors' satisfaction with treatment. The timing of the follow-up appointment was determined by the doctor. One chief specialist, one associate chief specialist and one attending practitioner in Chinese medicine, and 60 patients having a follow-up appointment with one of the doctors, participated in the study. RESULTS: For 11 patients, their most urgent complaint was different from what the doctor's choose to focus on in his or her treatment. And only one patient refused to comply due to his or her dissatisfaction with the treatment focus of the doctor. Overall, 59 patients completed the satisfaction assessment, and 53 patients visited their doctors for a follow-up appointment. Patients' total satisfaction was higher than their doctors' (mean 3.55 vs. 3.45), and correlation of patients' and doctors' treatment satisfaction was moderate (r = 0.63, P < 0.01). Both of the patients' and doctors' satisfaction ratings were correlated with treatment adherence (P < 0.001). The predictors of their treatment satisfaction were different. Doctors' satisfaction with treatment was a significant factor in the process of making further clinical decisions. CONCLUSION: Patients and doctors form their opinion about the treatment effects in different ways. When evaluating treatment satisfaction, doctor's opinions are also an important indicator of positive or negative clinical effects and affect the subsequent decisions-making.


Assuntos
Assistência Ambulatorial/psicologia , Medicina Tradicional Chinesa/psicologia , Pacientes Ambulatoriais/psicologia , Satisfação do Paciente , Médicos/psicologia , Adulto , Idoso , Tomada de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...