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2.
Nurs Educ Perspect ; 41(5): 280-284, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32732817

RESUMO

AIM: The purpose of the study was to evaluate the validity of the Clinical Simulation Competency Assessment Tool (ClinSimCAT). BACKGROUND: The 2011 Future of Nursing report encouraged nursing programs to move toward a competency-based approach to education. As no tool was found to holistically evaluate nursing student competency in clinical and simulation settings, we developed the ClinSimCAT based on the Institute of Medicine recommended competencies. METHOD: A Delphi study with three rounds was conducted. A national sample of nursing education and simulation leaders was used to achieve consensus about the competencies. RESULTS: The process resulted in a set of 20 competencies across eight domains (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, informatics, professionalism, and systems-based practice). CONCLUSION: The ClinSimCAT has demonstrated evidence of content validity and can be used for evaluation of clinical and simulation across a variety of undergraduate nursing courses.


Assuntos
Competência Clínica , Bacharelado em Enfermagem , Educação em Enfermagem , Estudantes de Enfermagem , Humanos , Assistência Centrada no Paciente , Melhoria de Qualidade
4.
J Gerontol Nurs ; 46(9): 9-13, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32845343

RESUMO

With the onset of the COVID-19 pandemic, telehealth was thrust to the forefront, becoming one of the most predominant forms of care almost overnight. Despite years of research, practice, and policymaking, tenets for providing telehealth in an interdisciplinary, family- and person-centered fashion, and across a wide breadth of settings remain underdeveloped. In addition, although telehealth has the potential to increase equity in care, it can also further exacerbate disparities. The current article discusses the opening created by the pandemic and provides recommendations for how to make permanent changes in telehealth policy and practice to allow for interdisciplinary, person- and family-centered care while also taking care to address issues of equity and ethics and privacy issues related to telehealth and remote monitoring. [Journal of Gerontological Nursing, 46(9), 9-13.].


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Enfermagem Geriátrica/organização & administração , Política de Saúde , Assistência Centrada no Paciente/organização & administração , Pneumonia Viral/epidemiologia , Telemedicina/organização & administração , Infecções por Coronavirus/prevenção & controle , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle
5.
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
6.
Gac Med Mex ; 156(4): 311-316, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32831322

RESUMO

Medical schools play a central role in the compilation and development of professional knowledge, which is why they have privileges and resources that are justified only to the extent that they use them to serve the community, particularly those who are most in need. Medical schools social accountability focuses on the training, healthcare provision and research services they offer. The principles of medical education and the structure proposed by the Flexner Report are in crisis due to the COVID-19 pandemic, and redefinition of the social contract is required. This document offers a proposal for medical schools social accountability that includes anticipation of the needs of the community, patient-centered inter-professional care, training of people in the area of health and collaboration between institutions. It highlights the need for a conscious institution that finds new training spaces other than hospitals, where each patient is cared for in a personalized way, with inter-professional training models that consider the student as a person who takes care of him/herself in open collaboration with organizations. Leaders must act now because it is their social accountability and because it is the right thing to do.


Assuntos
Infecções por Coronavirus/terapia , Educação Médica/métodos , Pneumonia Viral/terapia , Responsabilidade Social , Comportamento Cooperativo , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Humanos , Pandemias , Assistência Centrada no Paciente/métodos , Pneumonia Viral/epidemiologia , Faculdades de Medicina , Estudantes de Medicina
7.
J Nurs Adm ; 50(9): 456-461, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32826514

RESUMO

OBJECTIVE: The aim of this study was to understand the experiences of nurses making the role transition from clinical nurse specialists (CNSs) (hospital based) into transitional care nurse (TCN) roles (community based). BACKGROUND: The shift from fee-for-service to value-based care has led to the development of transitional care programs. However, little is known about the perceptions of nurses transitioning from a hospital- to a community-based position. Their perceptions can inform training and future recommendations for the TCN role. METHODS: Five of 6 eligible TCNs from a community rural hospital in Vermont who transitioned from a CNS role to a TCN role participated in individual, face-to-face interviews using a semistructured interview guide. Data were audio recorded, transcribed verbatim, and analyzed using the constant comparative method. RESULTS: Seven major themes were identified: enhanced patient-centered care, collaboration among the other TCNs, transitioning from expert to novice, recommendations for navigating and negotiating systems, discomfort with the role transition, a level of altruism and autonomy, and recommendations for improving the TCN role. Minor themes supported the major themes. CONCLUSIONS: Our findings provide implications to improve the transitions of CNSs into a TCN role. Transitional care nurse programs are essential in transitioning individuals from hospital to home. To achieve maximum benefit from TCN programs and ensure their sustainability, nursing leaders must address gaps in both community resources and TCN training.


Assuntos
Enfermagem em Saúde Comunitária , Enfermeiras Clínicas , Papel do Profissional de Enfermagem/psicologia , População Rural , Cuidado Transicional/tendências , Adulto , Feminino , Humanos , Entrevistas como Assunto , Enfermeiras Clínicas/psicologia , Enfermeiras Clínicas/estatística & dados numéricos , Assistência Centrada no Paciente , Pesquisa Qualitativa , Vermont
8.
J Nurs Adm ; 50(7-8): 419-425, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32701647

RESUMO

Evaluation of the professional practice model is an expectation in Magnet-designated facilities. Few evaluations of practice models are theory driven. A multisite, theory-driven model evaluation was conducted that included input from a variety of sources resulting in a comprehensive revision of the model.


Assuntos
Modelos de Enfermagem , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Teoria de Enfermagem , Prática Profissional , Técnica Delfos , Humanos , Papel do Profissional de Enfermagem , Objetivos Organizacionais , Assistência Centrada no Paciente/estatística & dados numéricos , Estudos Prospectivos
9.
Washington; Organización Panamericana de la Salud; 2020; 20200729. 115 p.
Monografia em Inglês, Espanhol | BIGG | ID: biblio-1116760

RESUMO

Esta guía de práctica clínica provee recomendaciones informadas por la evidencia para la identificación de marcadores y factores de riesgo de mortalidad de los pacientes críticos, control de la infección, recolección de muestras, cuidado de soporte (ventilatorio y hemodinámico), tratamiento farmacológico, rehabilitación temprana, uso de imágenes diagnósticas, prevención de complicaciones y criterios de egreso. Las recomendaciones están dirigidas a todo el personal de salud que atiende a los pacientes en el servicio de urgencias y de emergencias y la unidad de cuidados intensivos (médicos especialistas en medicina de urgencias, neumología, medicina intensiva, medicina interna, anestesiología, infectología, terapistas respiratorios, terapistas físicos, enfermeras y químicos farmacéuticos). La guía está elaborada para su uso por tomadores de decisiones y miembros de entidades gubernamentales relacionados con el manejo de pacientes con COVID-19 en las UCI de la Región de las Américas.


These clinical practice guidelines (short version) were developed in order to provide recommendations for the management of critically ill adult patients with COVID-19 treated in intensive care units (ICUs). These clinical practice guidelines provide evidence-informed recommendations for identifying markers and mortality risk factors in critically ill patients, as well as infection control, sample collection, supportive care (respiratory and hemodynamic), pharmacological treatment, early rehabilitation, diagnostic imaging use, prevention of complications, and discharge requirements. The recommendations are for all healthcare staff who deal with patients in emergency departments and ICUs. These guidelines are also intended for use by decision-makers and government entities involved in the management of patients with COVID-19 in ICUs in the Region of the Americas. This document is the result of a rapid guideline adaptation process. The information presented reflects published evidence as of the date of inclusion in the document. The recommendations are based on the evidence available and the quality thereof (GRADE methodology) at the time the guidelines were published. However, PAHO recognizes that there are numerous research projects under way and will periodically update these reviews and the applicable recommendations.


Assuntos
Humanos , Adulto , Antivirais/uso terapêutico , Plasma/imunologia , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Administração dos Cuidados ao Paciente/organização & administração , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Assistência Centrada no Paciente/organização & administração , Prática Clínica Baseada em Evidências/organização & administração , Gravidade do Paciente , Betacoronavirus , Fatores Imunológicos/uso terapêutico , Unidades de Terapia Intensiva/organização & administração , Antibacterianos/uso terapêutico , América/epidemiologia
10.
Clin Nutr ESPEN ; 38: 196-200, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32690158

RESUMO

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a worldwide rapidly spreading illness, Coronavirus Disease 2019 (COVID-19). Patients fed enterally and parenterally at home are exposed to the same risk of infection as the general population, but more prone to complications than others. Therefore the guidance for care-givers and care-takers of these patients is needed. METHODS: The literature search identified no relevant systematic reviews or studies on the subject. Therefore a panel of 21 experts from 13 home medical nutrition (HMN) centres in Poland was formed. Twenty-three key issues relevant to the management of SARS-CoV-2 infection or COVID-19 in the HMN settings were identified and discussed. Some statements diverge from the available nutrition, surgical or ICU guidelines, some are based on the best available experience. Each topic was discussed and assessed during two Delphi rounds subsequently. Statements were graded strong or weak based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. RESULTS: the panel issued 23 statements, all of them were graded strong. Two scored 85.71% agreement, eleven 95.23%, and ten 100%. The topics were: infection control, enrolment to HMN, logistics and patient information. CONCLUSIONS: the position paper present pragmatic statements for HMN to be implemented in places without existing protocols for SARS-CoV-2 pandemic. They represent the state of knowledge available at the moment and may change should new evidence occurs.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Nutrição Enteral/métodos , Serviços de Assistência Domiciliar , Nutrição Parenteral/métodos , Pneumonia Viral/complicações , Cuidadores/educação , Técnicas de Laboratório Clínico , Consenso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Equipe de Assistência ao Paciente , Isolamento de Pacientes , Assistência Centrada no Paciente/métodos , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Fatores de Risco
11.
N C Med J ; 81(4): 257-258, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32641462

RESUMO

Our population is rapidly aging and increasingly identifying as transgender or non-binary (TNB). Are our health care and long-term care systems prepared to provide person-centered care to aging TNB people?


Assuntos
Envelhecimento , Equidade em Saúde , Pessoas Transgênero , Assistência à Saúde/organização & administração , Feminino , Humanos , Assistência de Longa Duração/organização & administração , Masculino , North Carolina , Assistência Centrada no Paciente
12.
Oncology (Williston Park) ; 34(5): 156-162, 2020 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-32644174

RESUMO

The coronavirus disease 2019 pandemic has rapidly placed tremendous stress on health systems around the world. In response, multiple health systems have postponed elective surgeries in order to conserve hospital beds and personal protective equipment, minimize patient traffic, and prevent unnecessary utilization and exposure of healthcare workers. The American College of Surgeons released the following statement on March 13, 2020: "Each hospital, health system and surgeon should thoughtfully review all scheduled elective procedures with a plan to minimize, postpone, or cancel electively scheduled operations, endoscopes, or other invasive procedures until we have passed the predicted inflection point in the exposure graph and can be confident that our health care infrastructure can support a potentially rapid and overwhelming uptick in critical patient care needs." In our state, North Carolina, Governor Roy Cooper requested that all hospitals postpone elective and non-urgent procedures and surgeries effective March 23, 2020.


Assuntos
Infecções por Coronavirus , Procedimentos Cirúrgicos Eletivos/métodos , Excisão de Linfonodo/métodos , Serviço Hospitalar de Oncologia , Pandemias , Pneumonia Viral , Prostatectomia/métodos , Neoplasias da Próstata , Risco Ajustado/métodos , Gestão de Riscos , Betacoronavirus , Gestão de Mudança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , North Carolina , Serviço Hospitalar de Oncologia/organização & administração , Serviço Hospitalar de Oncologia/tendências , Pandemias/prevenção & controle , Seleção de Pacientes , Assistência Centrada no Paciente/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Gestão de Riscos/métodos , Gestão de Riscos/tendências
14.
PLoS One ; 15(7): e0235091, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32609733

RESUMO

Genital psoriasis affects 2-5% of psoriasis patients; generalised plaque or intertriginous psoriasis also affects the genital area in 29-40% of cases. Anogenital psoriasis has been associated with significant quality of life impairments, but little is known about specific patient needs/treatment goals. This study aimed to examine the overall and sex-related disease burden, patient needs and treatment benefits in patients with anogenital psoriasis, compared to patients with psoriasis not affecting the anal/genital areas. Within the cross-sectional nationwide survey, 2,009 participants were consecutively recruited in 157 randomly assigned German dermatology practices and clinics, according to the following inclusion criteria aged 18 years or over; diagnosis of psoriasis vulgaris; ability to answer the questionnaires; and written informed consent. Based on a high-resolution grid on the topical distribution of psoriasis, two groups were formed: anogenital psoriasis (n = 622) and comparison group (n = 1,303). Clinical severity was assessed by the Psoriasis Area and Severity Index (PASI). Patients completed the EuroQoL visual analogue scale (EQ VAS), the Dermatology Life Quality Index (DLQI), and the Patient Benefit Index (PBI). Patients with anogenital psoriasis had higher PASI (13.0±10.6 vs. 8.9±7.6, P < 0.001) and more DLQI impairments (8.9±6.9 vs. 7.0±6.2, P = 0.002) than controls. At the item-level, they also reported more sex-related DLQI impairments (DLQI-i9: 0.5±0.8 vs. 0.3±0.7, P < 0.001) and treatment needs (PBI-i17: 2.2±1.8 vs. 1.9±1.8, P = 0.001). A great percentage of missing/not-relevant responses was found for sex-related items (23.3-41.9%). These results suggest that the assessment of sex-related impairments and treatment needs should be prioritised in patients with anogenital psoriasis. Questionnaires may be used as a less uncomfortable way for patients to discuss their genital lesions and sexual function during healthcare visits. However, the great percentage of missing/not-relevant responses to sex-related items calls for in-depth assessments and effective patient-physician communication regarding these sensitive topics.


Assuntos
Assistência Centrada no Paciente , Psoríase/patologia , Adolescente , Adulto , Idoso , Canal Anal/patologia , Estudos Transversais , Feminino , Genitália/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Psoríase/epidemiologia , Qualidade de Vida , Índice de Gravidade de Doença , Fatores Sexuais , Adulto Jovem
16.
Int J Oral Maxillofac Implants ; 35(4): 833-840, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32724938

RESUMO

PURPOSE: A prospective cohort multicenter study was undertaken to identify risk factors for implant survival, complications, and patient-centered outcomes following single-tooth immediate implant placement and loading in esthetic areas. MATERIALS AND METHODS: Consecutive immediate implants placed in incisors, canines, and premolar sites were included. Variables recorded as possible risk factors included smoking habit, systemic conditions or therapies, previous assumption of bisphosphonates, inability to take amoxicillin, untreated periodontitis, thin periodontium, parafunctional habits, suppuration, bone dehiscences, and buccal bone fracture during implant insertion. Outcome variables included implant survival, recession, other complications, and patient satisfaction. RESULTS: Data of 215 implants in 215 patients were collected in 15 centers in 2 years. One implant was seated with a torque < 30 Ncm and was not immediately loaded. It was successfully loaded 10 weeks after placement and was healthy 2 years later. This implant was excluded from subsequent analysis. Potential risk factors were identified in 116 patients (54.21%). There were 11 dropouts after 1 year and 37 after 2 years. Failures were relatively frequent (14.6%) before the delivery of the definitive prosthesis. No significant association was observed between early failures and risk factors. One failure and six recessions were observed after the definitive prosthesis. High satisfaction scores (mean score of 9.47/10 and 9.55/10 for esthetics and function, respectively) were recorded at 2 years. No recession occurred in the no-risk group. Five mucositis cases and one peri-implantitis case were observed in the 2-year follow-up. CONCLUSION: Failures were frequent before the definitive restoration and could not be explained by specific risk factors. Tissues appeared stable after the definitive restoration. Patients were very satisfied during the follow-up.


Assuntos
Perda do Osso Alveolar , Implantes Dentários para Um Único Dente , Carga Imediata em Implante Dentário , Coroas , Implantação Dentária Endo-Óssea , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Estética Dentária , Humanos , Assistência Centrada no Paciente , Estudos Prospectivos , Resultado do Tratamento
17.
Croat Med J ; 61(3): 252-259, 2020 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-32643342

RESUMO

AIM: To develop pragmatic recommendations for Central and Eastern European (CEE) policymakers about transferability assessment of integrated care models established in higher income European Union (EU) countries. METHODS: Draft recommendations were developed based on Horizon 2020-funded SELFIE project deliverables related to 17 promising integrated care models for multimorbid patients throughout Europe, as well as on an online survey among CEE stakeholders on the relevance of implementation barriers. Draft recommendations were discussed at the SELFIE transferability workshop and finalized together with 22 experts from 12 CEE countries. RESULTS: Thirteen transferability recommendations are provided in three areas. Feasibility of local implementation covers the identification and prioritization of implementation barriers and proposals for potential solutions. Performance measurement of potentially transferable models focuses on the selection of models with proven benefits and assurance of performance monitoring. Transferability of financing methods for integrated care explores the relevance of financing methodologies and planning of adequate initial and long-term financing. CONCLUSIONS: Implementation of international integrated care models cannot be recommended without evidence on its local feasibility or scientifically sound and locally relevant performance assessment in the country of origin. However, if the original financing method is not transferable to the target region, development of a locally relevant alternative financing method can be considered.


Assuntos
Prestação Integrada de Cuidados de Saúde/normas , Guias de Prática Clínica como Assunto/normas , Garantia da Qualidade dos Cuidados de Saúde , Mecanismo de Reembolso , Alocação de Recursos , Europa (Continente) , Europa Oriental , União Europeia , Medicina Baseada em Evidências , Humanos , Assistência Centrada no Paciente
18.
Stud Health Technol Inform ; 272: 292-295, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32604659

RESUMO

To keep healthcare effective, accessible and affordable to all we need a fundamental paradigm shift. Self-management for prevention and care with the help of healthcare professionals, having a shared view of the state of well-being, will play a significant role in this transition. The problem list is widely adopted as centerpiece of electronic health records and is although often patient oriented, but mostly limited to the institutional level. The requirements for this paradigm shift has been discussed in a series of workshops. Truly person-centered care requires to move towards a holistic problem list with an assessment and planning process resulting in an overarching care plan. The change process towards a real person-centered problem list, integrated in an overarching care plan, should be focused on the transition of health services delivery and requires a transition based on the "Quadruple Aim" principles.


Assuntos
Registros Eletrônicos de Saúde , Autocuidado , Assistência à Saúde , Humanos , Assistência Centrada no Paciente
19.
Stud Health Technol Inform ; 272: 338-341, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32604671

RESUMO

Person-centred care is known as a novel approach which contributes to wellbeing, prevention, care and support of patients. There is little evidence about practising PCC in stroke rehabilitation. In this paper, we develop a novel framework for creation of person-centred services for stroke rehabilitation which supports service configuration adapted to the requirements of each patient. The framework is elaborated over evidence from neurology department of Clinical Centre in Montenegro.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Humanos , Montenegro , Assistência Centrada no Paciente , Autocuidado
20.
Pediatr Clin North Am ; 67(4): 629-634, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32650859

RESUMO

A team of providers, researchers, patients, and families created a novel telehealth tool to improve communication across a variety of systems involved in pediatric epilepsy care. This tool facilitates in-home telemedicine appointments and saves costs for patients and hospital systems alike within the context of a population highly affected by health care disparities.


Assuntos
Epilepsia/terapia , Telemedicina/métodos , Adolescente , Criança , Comunicação , Epilepsia/economia , Disparidades em Assistência à Saúde , Humanos , Assistência Centrada no Paciente , Telemedicina/economia , Comunicação por Videoconferência
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