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2.
J Alzheimers Dis ; 76(1): 33-40, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32538856

RESUMO

BACKGROUND: Fundació ACE is a non-profit organization providing care based on a holistic model to persons with cognitive disorders and their families for 25 years in Barcelona, Spain. Delivering care to this vulnerable population amidst the COVID-19 pandemic has represented a major challenge to our institution. OBJECTIVE: To share our experience in adapting our model of care to the new situation to ensure continuity of care. METHODS: We detail the sequence of events and the actions taken within Fundació ACE to swiftly adapt our face-to-face model of care to one based on telemedicine consultations. We characterize individuals under follow-up by the Memory Unit from 2017 to 2019 and compare the number of weekly visits in 2020 performed before and after the lockdown was imposed. RESULTS: The total number of individuals being actively followed by Fundació ACE Memory Unit grew from 6,928 in 2017 to 8,147 in 2019. Among those newly diagnosed in 2019, most patients had mild cognitive impairment or mild dementia (42% and 25%, respectively). Weekly visits dropped by 60% following the suspension of face-to-face activity. However, by April 24 we were able to perform 78% of the visits we averaged in the weeks before confinement began. DISCUSSION: We have shown that Fundació ACE model of care has been able to successfully adapt to a health and social critical situation as COVID-19 pandemic. Overall, we were able to guarantee the continuity of care while preserving the safety of patients, families, and professionals. We also seized the opportunity to improve our model of care.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Demência/terapia , Saúde Holística , Assistência Centrada no Paciente/métodos , Pneumonia Viral/terapia , Telemedicina/métodos , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Demência/epidemiologia , Demência/psicologia , Feminino , Seguimentos , Saúde Holística/tendências , Humanos , Masculino , Pandemias , Assistência Centrada no Paciente/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Espanha/epidemiologia , Telemedicina/tendências
3.
PLoS One ; 15(4): e0230340, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32236118

RESUMO

CONTEXT: The person-centred approach (PCA) is a promising avenue for care improvement. However, health professionals in Burkina Faso (hereafter referred to as caregivers) seem unprepared for taking into consideration patients' preferences and values in the context of healthcare provision. OBJECTIVE: To understand the meaning attributed to PCA in the Burkina Faso context of care and to identify the challenges related to its adoption from the perspective of caregivers and women service users (hereafter referred to as patients). METHODS: An ethnographic qualitative research design was used in this study. We conducted 31 semi-directed interviews with caregivers and patients from Koudougou (Burkina Faso) healthcare facilities. We also carried out direct observation of consultations. Data thematic analyses are based on the person-centred approach analysis framework. RESULTS: According to the caregivers and patients interviewed, the PCA in maternal and child healthcare in Burkina Faso includes the following five components used in our analytical framework: i) pregnancy follow-up consultations extend beyond examining physical health issues (biopsychosocial component), ii) healthcare professionals' mood affects the caregiver-patient relationship as well as care delivery (the healthcare professional as a person), iii) patients expect to be well received, listened to, and respected (the patient as a person), iv) healthcare professionals first acknowledge that both themselves and patients have power, rights but also responsibilities (sharing power, rights and responsibilities of professionals and patients), and v) healthcare professionals who are open to involving patients in decision-making about their care and patients asking to have a say in the organization of services (therapeutic alliance). Implementing each of these themes comes with challenges, such as i) talking about health problems in the presence of other women, especially those related to sexuality, even though they are common to parturient women (biopsychosocial component); ii) offering psychotherapy to healthcare professionals (healthcare professional as a person); iii) taking into consideration patients' cultural and linguistic differences (the patient as a person); iv) raising awareness among patients about their right to ask questions and healthcare professionals' duty to answer them (sharing power, and rights and responsibilities of professionals and patients); v) accepting the presence of birth attendants while avoiding traditional practices that are contrary to scientific recommendations (therapeutic alliance). CONCLUSION: Despite some context-specific particularities, the PCA is not new in the context of health care in Burkina Faso. However, its implementation can pose a number of challenges. There is a need to train healthcare professionals with a view to being sensitive to these particularities. This may also require organizational adjustments so as to create the physical and sociocultural environments that are conducive to taking into account the patient's perspective.


Assuntos
Pessoal de Saúde/psicologia , Serviços de Saúde Materno-Infantil/tendências , Assistência Centrada no Paciente/tendências , Relações Profissional-Paciente , Burkina Faso , Pessoal de Saúde/educação , Humanos , Pesquisa Qualitativa , Encaminhamento e Consulta
4.
Pediatr Cardiol ; 41(3): 486-502, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32198592

RESUMO

There is no better representation of the need for personalization of care than the breadth and complexity of congenital heart disease. Advanced imaging modalities are now standard of care in the field, and the advancements being made to three-dimensional visualization technologies are growing as a means of pre-procedural preparation. Incorporating emerging modeling approaches, such as computational fluid dynamics, will push the limits of our ability to predict outcomes, and this information may be both obtained and utilized during a single procedure in the future. Artificial intelligence and customized devices may soon surface as realistic tools for the care of patients with congenital heart disease, as they are showing growing evidence of feasibility within other fields. This review illustrates the great strides that have been made and the persistent challenges that exist within the field of congenital interventional cardiology, a field which must continue to innovate and push the limits to achieve personalization of the interventions it provides.


Assuntos
Cardiologia/tendências , Cardiopatias Congênitas/cirurgia , Inteligência Artificial , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Assistência Centrada no Paciente/tendências
5.
Pediatr Clin North Am ; 67(2): 247-258, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32122558

RESUMO

Pediatricians need to adopt a strengths-based approach within their practices to better address their patients' health-related social needs. This approach becomes even more important as the pediatric population in the United States becomes increasingly diverse. Pediatricians must be cognizant of and address biases within their practices to maximize effectiveness of a strengths-based approach. With evidence mounting about their significance to health, a paradigm shift is needed to address health-related social needs by focusing on assets, not deficits. This shift will hopefully improve pediatric health outcomes which have languished in the United States, despite outspending other wealthy nations for decades.


Assuntos
Bem-Estar da Criança/tendências , Assistência Centrada no Paciente/tendências , Pediatria/tendências , Determinantes Sociais da Saúde/tendências , Criança , Necessidades e Demandas de Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Pobreza , Estigma Social , Estados Unidos , Populações Vulneráveis
8.
Cardiovasc Ther ; 2020: 9241081, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31969934

RESUMO

Introduction: Including healthcare professionals dealing with cardiovascular diseases, Heart Team is a concept/structure designed for selecting diagnostic strategies, facilitating therapeutic decisions, and improving cardiovascular outcomes in patients with complex heart pathologies, requiring input from different subspecialties and the necessity of a multidisciplinary approach. The aim of this narrative review is to search for and to summarize current evidence regarding Heart Team and to underline the future directions for the development of this concept. Methods: We searched the electronic database of PubMed, SCOPUS, and Cochrane CENTRAL for studies including Heart Team. Forty-eight studies were included, if reference was made to Heart Team structure and functionality. Results: We depicted the structure and the timeline of Heart Team, along with actual evidence-based recommendations from European Guidelines. We underlined the importance of quality of knowledge-sharing and decision-making inside the Team, analyzing bad decisions which did not reflect members' true beliefs due to "uniformity pressure, closed mindedness, and illusion of invulnerability." The observation that Guidelines' indications regarding Heart Team carry a level C indication underlines the very future of this Team: randomized controlled trials proving solid benefits in an evidence-based world. Conclusions: Envisioned as a tool for optimizing the management of various complex cardiovascular pathologies, Heart Team should simplify and facilitate the activity in the cardiovascular ward. Finally, these facts should be translated into better cardiovascular outcomes and a lower psychological distress among Team participants. Despite all future changes, there must always be a constant part: the patient should remain at the very center of the Team.


Assuntos
Doenças Cardiovasculares/terapia , Prestação Integrada de Cuidados de Saúde/tendências , Medicina Baseada em Evidências/tendências , Equipe de Assistência ao Paciente/tendências , Assistência Centrada no Paciente/tendências , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/história , Doenças Cardiovasculares/fisiopatologia , Comportamento Cooperativo , Prestação Integrada de Cuidados de Saúde/história , Difusão de Inovações , Medicina Baseada em Evidências/história , Previsões , História do Século XXI , Humanos , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente/história , Assistência Centrada no Paciente/história
9.
Obesity (Silver Spring) ; 28(1): 9-17, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31858735

RESUMO

Eliciting a weight history can provide clinically important information to aid in treatment decision-making. This view is consistent with the life course perspective of obesity and the aim of patient-centered care, one of six domains of health care quality. However, thus far, the value and practicality of including a weight history in the clinical assessment and treatment of patients with obesity have not been systematically explored. For these reasons, the Clinical Committee of The Obesity Society established a task force to review and assess the available evidence to address five key questions. It is concluded that weight history is an essential component of the medical history for patients presenting with overweight or obesity, and there are strong and emerging data that demonstrate the importance of life stage, duration of exposure to obesity, maximum BMI, and group-based trajectory modeling in predicting risk for increased morbidity and mortality. Consideration of these and other patient-specific factors may improve risk stratification and clinical decision-making for screening, counseling, and management. Recommendations are provided for the key elements that should be included in a weight history, and several needs for future clinical research are outlined.


Assuntos
Peso Corporal/fisiologia , Trajetória do Peso do Corpo , Anamnese , Obesidade/terapia , Assistência Centrada no Paciente/tendências , Aconselhamento , Tomada de Decisões , Humanos , Anamnese/métodos , Anamnese/normas , Morbidade , Mortalidade , Obesidade/epidemiologia , Obesidade/patologia , Sobrepeso/epidemiologia , Sobrepeso/patologia , Sobrepeso/terapia , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/normas , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências
10.
Rev Bras Enferm ; 72(suppl 3): 235-242, 2019 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31851259

RESUMO

OBJECTIVE: to evaluate the association of Obstetric Nursing in the best practices of delivery and birth care in maternity hospitals. METHOD: a cross-sectional study, with 666 women selected for delivery. Parturition obstetric practices performed by professionals were categorized into: clearly useful practices that should be encouraged, practices that are clearly harmful or ineffective and that should be eliminated and practices used inappropriately at the time of parturition. RESULTS: clearly useful practices were used in greater proportions in the hospitals that had Obstetric Nursing working, while clearly harmful practices and those used inappropriately were practiced in smaller proportions in hospitals that had Obstetric Nursing, both with statistical difference. CONCLUSION: institutions with Obstetric Nursing adopt better practices of delivery and birth care, based on scientific evidence, when compared to those that do not act.


Assuntos
Enfermagem Obstétrica/normas , Assistência Centrada no Paciente/tendências , Guias de Prática Clínica como Assunto , Adulto , Estudos Transversais , Feminino , Humanos , Enfermagem Obstétrica/tendências , Assistência Centrada no Paciente/normas , Assistência Perinatal/métodos , Gravidez
13.
Urologiia ; (4 ()): 19-24, 2019 Sep.
Artigo em Russo | MEDLINE | ID: mdl-31535793

RESUMO

A multidisciplinary approach is currently a necessary and standard approach in treatment of cancer patients. The main goals of the multidisciplinary approach include coordinated highly effective interaction of medical specialists to timely identify, prescribe and conduct planned treatment, as well as prevention and correction of adverse events of treatment to achieve most lasting effect of treatment. The article discusses role of multidisciplinary team, including an oncologist, urologist, pathomorphologist, molecular genetics, radiologist, medical oncologist, radiation therapist, neurosurgeon, orthopedic surgeon, endovascular, thoracic and abdominal surgeons for effective treatment of oncourological patients. To solve existing problems, it is necessary to create common standards for the treatment of oncological diseases, develop and improve an oncological care system, improve logistics and improve skills of specialists or train specialists in the required profile.


Assuntos
Equipe de Assistência ao Paciente/organização & administração , Assistência Centrada no Paciente/organização & administração , Neoplasias Urológicas/terapia , Humanos , Equipe de Assistência ao Paciente/tendências , Assistência Centrada no Paciente/tendências , Médicos , Cirurgiões , Resultado do Tratamento
14.
Nat Rev Endocrinol ; 15(11): 666-682, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31488888

RESUMO

Endometriosis is a chronic inflammatory disease defined as the presence of endometrial tissue outside the uterus, which causes pelvic pain and infertility. This disease should be viewed as a public health problem with a major effect on the quality of life of women as well as being a substantial economic burden. In light of the considerable progress with diagnostic imaging (for example, transvaginal ultrasound and MRI), exploratory laparoscopy should no longer be used to diagnose endometriotic lesions. Instead, diagnosis of endometriosis should be based on a structured process involving the combination of patient interviews, clinical examination and imaging. Notably, a diagnosis of endometriosis often leads to immediate surgery. Therefore, rethinking the diagnosis and management of endometriosis is warranted. Instead of assessing endometriosis on the day of the diagnosis, gynaecologists should consider the patient's 'endometriosis life'. Medical treatment is the first-line therapeutic option for patients with pelvic pain and no desire for immediate pregnancy. In women with infertility, careful consideration should be made regarding whether to provide assisted reproductive technologies prior to performing endometriosis surgery. Modern endometriosis management should be individualized with a patient-centred, multi-modal and interdisciplinary integrated approach.


Assuntos
Gerenciamento Clínico , Endometriose/diagnóstico , Endometriose/terapia , Assistência Centrada no Paciente/métodos , Endometriose/psicologia , Feminino , Pessoal de Saúde/psicologia , Humanos , Assistência Centrada no Paciente/tendências
15.
Healthc Q ; 22(2): 27-31, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31556376

RESUMO

Canada's universal healthcare program, medicare, continues to evolve. An area of care that has gained increasing attention over the past several years is the general concept and specific components of patient centricity in healthcare delivery. This paper compares key measures of patient-centred care practices recorded in the 2013 and 2016 Health Care in Canada (HCIC) surveys, with the most recent preferences of the public and health professionals obtained in the 2018 HCIC survey, including priorities for improved future care. Timely access and caring care were the public's top-supported components of patient-centred care in the 2013 and 2016 HCIC surveys. In the 2018 HCIC survey, the Canadian public's overwhelming choice as the top-priority component of patient-centred care continued to be care readily and timely accessed, provided in a caring and respectful environment and based on need versus the ability to pay. In contrast, the public's lesser-supported option in all surveys was measurement and stakeholder feedback of actual care and outcomes. Among professionals in 2018, timely access and caring care were also rated as the top characteristics of patient-centred care, followed by care supported by research and expert opinion. Also similar to the public, Canadian healthcare professionals in 2018 rated measurement and feedback of delivered care and outcomes at the bottom of their support list. When the public and professionals were asked in the 2018 survey to prioritize their implementation choices for enhanced patient-centred care going forward, both stakeholder groups chose timely access as their first priority. Measurements and feedback of care and outcomes were rated at the lower end of choices in both groups in 2018. In summary, among key stakeholders, healthcare that is not readily and timely accessed remains the perceived greatest impediment to achievement of patient-centred care in contemporary Canadian medicare. The continued reality of undue delay in accessing healthcare in Canada is disturbing. A companion risk going forward is that all other components of patient-centred care will retreat to a level of irrelevance. Measurement and feedback of care, particularly its timeliness of access and outcomes, are necessary to monitor progress, stimulate innovation and ensure the success of Canadian medicare. Things can be better.


Assuntos
Acesso aos Serviços de Saúde , Programas Nacionais de Saúde/estatística & dados numéricos , Assistência Centrada no Paciente/tendências , Canadá , Pessoal de Saúde/psicologia , Humanos , Opinião Pública , Inquéritos e Questionários
16.
Rev. esp. cardiol. (Ed. impr.) ; 72(8): 658-663, ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-189037

RESUMO

El tratamiento percutáneo de la enfermedad coronaria y determinadas enfermedades cardiovasculares estructurales ha experimentado un desarrollo espectacular. Cada vez se trata a un mayor número de pacientes con diferentes tipos de cardiopatías mediante intervenciones percutáneas o transcatéter, mientras que este incremento no se observa en los pacientes sometidos a cirugía cardiaca. Esta situación ha motivado diferentes posicionamientos que requieren un análisis objetivo que considere todos los aspectos que pueden influir en esta evolución. En este documento se evalúan las 2 situaciones en que el problema es más manifiesto: la revascularización coronaria y el tratamiento de la estenosis aórtica. El artículo analiza la situación de la revascularización coronaria en España y las causas que pueden explicar las diferencias existentes entre el número de pacientes que actualmente se someten a revascularización percutánea respecto a los que se someten a cirugía coronaria. Por otra parte, el implante percutáneo de válvula aórtica mediante catéter en el tratamiento de la estenosis aórtica condicionará una previsible reducción del número de pacientes candidatos a tratamiento mediante recambio quirúrgico. Diferentes sociedades científicas internacionales han publicado los requisitos de formación y experiencia y los volúmenes exigidos a los operadores y centros para desarrollar un programa de implante percutáneo de válvula aórtica, condiciones que la Sociedad Española de Cardiología, situando al paciente en el centro del proceso asistencial, considera como absolutamente imprescindibles. Teniendo en cuenta que ambas formas de intervención (percutánea y quirúrgica) son procedimientos complementarios, la valoración multidisciplinaria de los pacientes (Heart Team) sigue siendo de extrema necesidad para poder ofrecerles la mejor opción de tratamiento. En este escenario de aproximaciones diversas, la figura del cardiólogo clínico adquiere una relevancia clave. Por último, la evolución que está experimentando el tratamiento de la enfermedad estructural obligará en el futuro a realizar procedimientos en los que se requiera la actuación conjunta de profesionales de ambas especialidades. Este acercamiento exigirá un rediseño de los programas de formación actualmente existentes


The percutaneous treatment of coronary artery disease and some structural cardiovascular diseases has undergone spectacular changes. More and more patients with different types of heart disease are being treated by percutaneous or transcatheter interventions, with no such increase in patients undergoing cardiac surgery. This situation has led to different types of approach, requiring an objective analysis that includes all the factors possibly influencing these changes. This document assesses the 2 scenarios where this problem is most evident: coronary revascularization and the treatment of aortic stenosis. The document analyzes the situation of coronary revascularization in Spain, and the causes that may explain the differences between the number of patients who currently undergo percutaneous revascularization and those who undergo coronary surgery. In contrast, treatment of aortic stenosis through transcatheter aortic valve implantation will lead to a foreseeable reduction in the number of candidates for surgical replacement. Several international scientific societies have published the requirements on training and experience and the necessary operator and center volumes to implement a transcatheter aortic valve implantation program, conditions that the Spanish Society of Cardiology, adopting a patient-centered approach, considers absolutely essential. Given that the 2 forms of intervention (percutaneous and surgical) are complementary, multidisciplinary patient assessment (Heart Team) remains crucial to offer the best treatment option. In this scenario of diverse approaches, a key figure is the clinical cardiologist. Finally, the changes currently occurring in the treatment of structural heart disease will, in future, lead to the performance of procedures requiring the participation of professionals from both specialties. This approach will require a redesign of current training programs


Assuntos
Humanos , Intervenção Coronária Percutânea/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Doenças Cardiovasculares/cirurgia , Doença das Coronárias/cirurgia , Estenose da Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , Consenso , Assistência Centrada no Paciente/tendências , Padrões de Prática Médica
19.
Fam Syst Health ; 37(2): 107-119, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31045385

RESUMO

Children with medical complexity (CMC) are a medically fragile pediatric population that experience severe chronic illnesses resulting in significant health care needs, functional limitations, and health care utilization, and are at the highest risk for morbidity and mortality among all children. Furthermore, families and parents of CMC experience significant caregiver hardships and diminished quality of life. The field of pediatric palliative care has grown in recent years, in part to address the physical and psychosocial issues inherent to the care of these chronically ill children. However, as the prevalence and long-term survival of CMC increases with medical advancements, the demand for pediatric palliative care will likely exceed the capacity of current and future pediatric palliative care specialists. Therefore, alternative strategies to ensure access to essential aspects of palliative care must be considered. This article focuses on why and how high-quality palliative care should be integrated into the patient- and family-centered medical home, the ideal care delivery model for CMC and their families. We first discuss how palliative care principles naturally align with and complement the goals of the CMC medical home. Next, we detail what actions pediatric palliative care specialists can take to best support the CMC medical home as "medical neighbors." Lastly, we describe the fundamental aspects of pediatric palliative care that all clinicians caring for CMC should be able to provide, referred to as "primary pediatric palliative care." (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Doença Crônica/enfermagem , Cuidados Paliativos/métodos , Características de Residência , Criança , Pré-Escolar , Doença Crônica/psicologia , Crianças com Deficiência/psicologia , Feminino , Humanos , Masculino , Cuidados Paliativos/tendências , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/tendências , Pediatria/métodos
20.
Am J Kidney Dis ; 74(3): 407-416, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30982551

RESUMO

This Core Curriculum article models a person-centered approach to care for older adults with kidney disease. We provide background information on the principles of person-centered care and outline ways in which this approach contrasts with the more disease-based approaches that dominate current medical education and practice. Using hypothetical cases, we discuss 3 clinical scenarios that arise commonly when caring for older adults with kidney disease: (1) a moderate reduction in estimated glomerular filtration rate, (2) new-onset nephrotic-range proteinuria, and (3) the prospect of starting dialysis. For each scenario, we summarize relevant available evidence and model what a person-centered approach might look like. In discussing each scenario, we highlight: (1) the considerable heterogeneity in clinical presentation, circumstances, priorities, and values that exist among older adults with kidney disease; (2) the importance of interpreting available evidence and clinical practice guidelines in the context of what is relevant to each patient; (3) methods for grounding discussions about care and treatment options in the realities of each patient's situation and what is most meaningful to them; and (4) the importance of setting aside one's own biases and practice style to ensure that patients' own values and goals guide their care.


Assuntos
Geriatria , Nefrologia , Assistência Centrada no Paciente , Insuficiência Renal Crônica/terapia , Idoso , Currículo , Geriatria/educação , Geriatria/métodos , Humanos , Nefrologia/educação , Nefrologia/métodos , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/tendências
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