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1.
Eur Arch Otorhinolaryngol ; 276(11): 3173-3177, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31489494

RESUMO

PURPOSE: In acute epiglottitis (AE) or acute supraglottitis (AS), the management of the airway is crucial. We hypothesized that tracheotomized patients recover faster than intubated patients do. METHODS: We retrospectively reviewed all adult AE and AS patients, who underwent intubation or tracheotomy between 2007 and 2018 in a tertiary care center. Patient demographics, treatment, and complications were analyzed. RESULTS: The cohort comprised 42 patients. The airway was secured with intubation in 50% and with tracheotomy in 50%. All intubated patients (n = 21) and three tracheotomized patients were treated in the intensive care unit (p < 0.0001). Procedure-related complications were encountered in three intubated and eight tracheotomized patients (p = 0.892). Median overall treatment cost was 11.547 € and 5.856 € in the intubated and tracheotomized patient groups, respectively (p < 0.001). The median duration of sick leave after discharge from hospital was 13 days in the tracheotomy group and 7 days in the intubation group (p = 0.097). CONCLUSION: Tracheotomy resulted in a less expensive management in securing the airway in AE or AS, but tracheotomized patients had a trend towards more complications and longer sick leaves compared to intubated patients. LEVEL OF EVIDENCE: 2b.


Assuntos
Epiglotite , Intubação Intratraqueal , Assistência ao Paciente , Complicações Pós-Operatórias , Supraglotite , Traqueotomia , Doença Aguda , Adulto , Custos e Análise de Custo , Epiglotite/fisiopatologia , Epiglotite/cirurgia , Feminino , Finlândia , Humanos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/economia , Intubação Intratraqueal/métodos , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/economia , Assistência ao Paciente/métodos , Assistência ao Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Supraglotite/fisiopatologia , Supraglotite/cirurgia , Traqueotomia/efeitos adversos , Traqueotomia/economia , Traqueotomia/métodos , Resultado do Tratamento
2.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(7): 425-433, ago.-sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182862

RESUMO

Objetivos: Elaborar un registro de situación de los Servicios y Unidades de Endocrinología y Nutrición (S°EyN) del Sistema Nacional de Salud (SNS) y valorar sus recursos asistenciales para desarrollar, a partir de los resultados obtenidos, propuestas de políticas de mejora en los S°EyN. Material y métodos: Estudio descriptivo transversal de los pacientes atendidos en los S°EyN en hospitales generales de agudos del SNS en 2016. Se utilizaron datos obtenidos mediante RECALSEEN 2017, una encuesta «ad hoc» diseñada específicamente para este fin y de las altas dadas por los S°EyN registradas en el CMBD del SNS (2015). Resultados: De un total de 125 hospitales generales de agudos de más de 200 camas instaladas del SNS español, se han obtenido 88 respuestas de los S°EyN, que representan el 70%. El 47% de los S°EyN que respondieron eran servicios y el 31% secciones. El promedio de endocrinólogos por S°EyN era de 7,4±4,4, siendo la tasa media de endocrinólogos por cada 100.000 habitantes de 2,3±1. Las actividades asistenciales más relevantes eran la consulta (promedio de 12,3 primeras consultas por mil habitantes y año), hospital de día (mediana de 2.000 sesiones/año) e interconsulta hospitalaria (mediana de 900 interconsultas/año). El 83% de los S°EyN incorporaban una Unidad de Nutrición Clínica. La dotación de dietistas, técnicos en nutrición y bromatólogos en las Unidades de Nutrición Clínica era baja. En relación con la gestión de la calidad se detectó un amplio margen de mejora; solamente un 35% de los S°EyN tenían responsable de calidad y el 38% había implantado una gestión por procesos para aquellos más frecuentemente atendidos por la unidad. Existen notables diferencias en estructura, recursos y actividad de los S°EyN entre Comunidades Autónomas. Conclusiones: La encuesta RECALSEEN 2017 es útil para el análisis de los S°EyN. La notable variabilidad hallada en los indicadores de estructura, actividad y gestión probablemente indica relevantes diferencias y, por tanto, un amplio margen de mejora


Objectives: To elaborate a diagnosis of the situation regarding the assistance in the Services and Units of Endocrinology and Nutrition (S°EyN) of the National Health System of Spain (SNHS) and to develop, based on the results obtained, proposals for improvement policies in the S°EyN. Material and methods: Cross-sectional descriptive study of the patients treated in the S°EyN departments of acute general hospitals of the SNHS in 2016. Data were obtained through RECALSEEN 2017, an "ad hoc" survey designed specifically for this purpose, and the Minimum Basic Data Set of discharges given by the S°EN of the SNHS (2015). Results: 88 responses of S°EyN have been obtained forma total of 125 acute general hospitals of more than 200 beds installed in the SNHS (70% answers). 47% of the S°EyN respondents were services and 31% sections. The average of endocrinologists by S°EyN was 7.4±4.4, and the average rate of endocrinologists per 100,000 inhabitants was 2.3±1. The most relevant care activities were the consultation (average of 12.3 first consultations per thousand inhabitants and year), day hospital (median of 2,000 sessions/year) and in-hospital consultations (median of 900 in-hospital consultations/year). 83% of S°EyNhad a Clinical Nutrition Unit. The number of dietitians, nutrition technicians and nutritionists in the Clinical Nutrition Unit was low. In relation to quality management, a large margin for improvement was detected; only 35% of S°EyN had a responsible of quality and 38% had implemented process management for those most frequent processes in the unit. There were notable differences in structure, resources and activity of S°EyN between Autonomous Communities. Conclusions: RECALSEEN 2017 survey is a useful tool for the analysis of S°EyN. The remarkable variability found in the structure, activity and management indicators probably indicates significant differences and, therefore, a wide margin for improvement


Assuntos
Humanos , Unidades Hospitalares , Assistência ao Paciente/estatística & dados numéricos , Sistemas Nacionais de Saúde/organização & administração , Sistema de Registros/normas , Endocrinologistas/estatística & dados numéricos , Política de Saúde , Estudos Transversais , Gestão da Qualidade , Análise Estatística , Serviço Hospitalar de Nutrição/organização & administração , Serviço Hospitalar de Nutrição/normas , Endocrinologistas/organização & administração , Endocrinologistas/provisão & distribução
3.
Am J Med Sci ; 358(2): 134-142, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31331451

RESUMO

BACKGROUND: Human body temperature is believed to be linked to clinical diagnoses. However, most of the available data stems from healthy individuals, with no large-scale studies addressing body temperature in the inpatient setting, which is the focus of our study. MATERIALS AND METHODS: This is a retrospective analysis of a total of 695,107 temperature readings from 16,245 patients hospitalized over a 1-year period at a tertiary medical center, ages 0-105 years, 50% female, with rectal, monotherm, axillary, oral, temporal and tympanic measurement sites. The average temperature (Tave) per patient and per measurement site was used in all calculations. Descriptive statistics, Student's t-test, and Pearson's correlation were used, where appropriate, with statistical significance set at P < 0.05. RESULTS: Tave from all measurement sites was 98.13 ± 0.48(SD)F(36.74 ± 0.27°C). Tave varied by the site of measurement, in decreasing order highest-to-lowest being rectal, monotherm, axillary, oral, temporal, and tympanic, all of which were higher than the available reported averages for healthy subjects. Tave decreased as patients' age increased. There was only slight and likely clinically insignificant difference between the sexes. There were differences in Tave between the intensive care units (ICUs), listed from highest-to-lowest: Neuro ICU, Pediatric ICU, Surgical ICU, Cardiac ICU and Medical ICU. However, there was no difference between all ICU and non-ICU patients. CONCLUSIONS: Our inpatient data demonstrate that previously identified body temperature trends among healthy subjects are preserved, to an extent, in the inpatient setting. To our knowledge, ours is the first study that evaluates the temperatures of all hospitalized patients at a large tertiary medical center.


Assuntos
Temperatura Corporal , Hospitalização , Assistência ao Paciente/métodos , Termometria/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Pacientes Internados , Masculino , Pessoa de Meia-Idade , New York , Assistência ao Paciente/estatística & dados numéricos , Estudos Retrospectivos , Termômetros , Termometria/estatística & dados numéricos , Adulto Jovem
4.
Med Care ; 57(9): 680-687, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31295166

RESUMO

BACKGROUND: Properties of social networks and shared patient networks of physicians are associated with important outcomes, including costs, quality, information exchange, and organizational effectiveness. OBJECTIVES: To determine whether practice consolidation affects size, strength, and stability of US practice-based physician shared patient networks. RESEARCH DESIGN: We used a dynamic difference-in-differences (event study) design to determine how 2 types of vertical consolidation (hospital and health system practice acquisition) and 2 types of horizontal consolidation (medical group membership and practice-practice mergers) affect individual shared patient network characteristics, controlling for physician fixed effects and geographic market (metropolitan statistical area). SUBJECTS: Practice-based US physicians whose practices consolidated 2009-2014 are identified via health system, hospital, and medical group affiliation information and appearance/disappearance of listed practice affiliations in the SK&A Physician Database. MEASURES: Outcomes measured were network size (number of individual physicians with whom a physician shares patients within 30 d), strength (average number of shared patients within those relationships), and stability (percent of shared patient relationships that persist in the current and prior year), all generated from Medicare Shared Patient Patterns (30-d) data. RESULTS: Shared patient network stability increases significantly after acquisition of practices by horizontal practice-practice mergers [ßt=1=0.041 (P<0.001), ßt=2=0.047 (P<0.001), ßt=3=0.041 (P<0.001), ßt=4=0.031 (P<0.05), where t is the number of years after the consolidation event]. These effects were robust to sensitivity analyses. Shared patient network size and strength are not observably associated with practice consolidation events. CONCLUSIONS: Practice consolidation can increase the stability of physician networks, which may have positive implications for organizational effectiveness.


Assuntos
Redes Comunitárias/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Prática Profissional/organização & administração , Redes Comunitárias/organização & administração , Humanos , Médicos/organização & administração , Padrões de Prática Médica/organização & administração , Atenção Primária à Saúde/organização & administração , Estados Unidos
5.
PLoS One ; 14(6): e0216936, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31166957

RESUMO

BACKGROUND: The Joint United Nations Programme on HIV/AIDS (UNAIDS) Fast-Track initiative seeks to eliminate AIDS as a health threat by 2030, with its focus on UNAIDS 90-90-90 targets. Effective policies and programs, if scaled nationally, have the potential to generate a greater impact on HIV control, yet a synthesis of successful HIV policies/programs aligned to the targets is currently unavailable. To fill this gap, we conducted a systematic review to evaluate successful HIV policies and programs to direct future interventions. METHODS: For the period 2007-2018, we searched 8 databases and classified eligible studies by country income level, UNAIDS targets, intervention type, and reported outcomes. Study outcomes were classified as per UNAIDS targets; proportionally: 90% target 1, 81% target 2, and 73% target 3. RESULTS: We retrieved 5201 citations and a final set of eight studies on policies. Break up by income: three (38%) from high income, one (12%) from middle income and four (50%) from low income. Break up by outcomes reported: 36% (4/11) focused on HIV testing, 46% (5/11) on antiretroviral therapy initiation, and 18% (2/11) on viral suppression. Across studies, UNAIDS targets were met in high-income countries, where policies and guidelines were adhered to, whereas in low and middle-income countries, non-adherence led to failure to reach the targets. Targets were also met when country infrastructure supported a targeted program and stakeholders were actively engaged. CONCLUSIONS: From the studies identified, we deduced a clear, positive correlation between implementation of policies and programs that resulted in an increase in patient awareness and an increase in partner notification with services that encouraged them, and together these resulted in increasing testing rates, and deployment of linkage/retention programs that improved retention in care. An analysis of these studies also suggests that policies, combined with the scale-up incentives, are needed to change the status quo. Incentives to improve the targets must exist; performance incentives at the health care worker level and country level incentives that could transform the nature of care. Given the complexity in reporting of targets, a one size fits all model is not a feasible option. However, the policies created a strong framework to shape future interventions.


Assuntos
Síndrome de Imunodeficiência Adquirida/diagnóstico , Metas , Política de Saúde , Programas de Rastreamento/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos , Nações Unidas , Humanos
6.
BMC Health Serv Res ; 19(1): 323, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31118012

RESUMO

BACKGROUND: The substitute or complementary effect of formal care on informal care service used by the elderly has been tested in Western countries. However, this effect is excluded from the discussion in the Chinese context. The identification of the relationship between informal care and formal care may imply different directions in policy-making. Thus, this study contributes to understanding the relationship between informal care and formal care among Chinese older adults. METHODS: Using the dataset from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2014, this study uses regression models and instrumental variable (IV) method to examine the impact of formal care on informal care. RESULTS: The results primarily show that formal care does not substitute informal care among Chinese older adults. In fact, formal care is a supplement to informal care in China. CONCLUSION: It is expected that informal care will become less available in the future in China. Thus, policymakers should be concerned about the underdevelopment of formal care for the elderly in China.


Assuntos
Cuidadores/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Serviços de Assistência Domiciliar/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , China , Utilização de Instalações e Serviços , Feminino , Assistência Domiciliar/estatística & dados numéricos , Humanos , Longevidade , Estudos Longitudinais , Masculino
7.
Breast Cancer Res Treat ; 176(3): 657-667, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31076954

RESUMO

PURPOSE: Randomized trials studying endocrine therapy (ET) with and without radiation therapy (RT) following breast-conserving surgery (BCS) have detected differences in local recurrence (LR) but not survival among elderly women with hormone receptor positive stage I breast cancer (BC). We assembled a population-based cohort of such women to examine the use and outcomes associated with or without the administration of adjuvant radiotherapy (RT) or ET. METHODS: Women aged ≥ 65 years with stage I BC treated with BCS in Ontario between 2010 and 2016, their treatments and outcomes were ascertained using deterministic linkages of administrative databases. Multivariable Cox regression models were used to evaluate risks of ipsilateral LR and of any first in-breast event, categorizing women by their treatment. RESULTS: 5076 women were treated with BCS followed by RT + ET (n = 1964), RT alone (n = 1325), ET alone (n = 719), or no adjuvant treatment (n = 1068). Median follow-up was 5 years. LR occurred in 0.9% after adjuvant RT + ET, 1.4% after RT alone, 3.1% after ET alone, and 9.4% after BCS alone (p < 0.001). The adjusted risk of LR was increased in those who received no adjuvant therapy (HR = 13.43, CI: 7.89, 22.85), or ET alone (HR = 4.03, CI: 2.14, 7.59). The adjusted risk of any first in-breast event was greatest among those without any adjuvant therapy (HR = 7.61, 95%CI: 5.21, 11.11, p < 0.0001). Absolute and adjusted risks of any first in-breast event were comparable between those with ET alone (HR = 2.09, 95%CI: 1.27, 3.43, p = 0.0038) and those with RT alone (HR = 1.91, 95% CI: 1.25, 2.91, p = 0.0028). CONCLUSIONS: Older women with stage I BC who receive no adjuvant therapy have a significant absolute risk of LR and any first in-breast event, whereas the absolute risk of these events among those with either RT alone or ET alone is only slightly higher than among those treated with both.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/terapia , Assistência ao Paciente , Cuidados Pós-Operatórios , Padrões de Prática Médica , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais , Neoplasias da Mama/etiologia , Neoplasias da Mama/patologia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Feminino , Humanos , Mastectomia Segmentar , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Assistência ao Paciente/métodos , Assistência ao Paciente/estatística & dados numéricos , Vigilância da População , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Prognóstico , Cooperação e Adesão ao Tratamento , Resultado do Tratamento
8.
Malar J ; 18(1): 170, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088466

RESUMO

BACKGROUND: The present study aimed to evaluate the management of severe malaria at Gezira State hospitals in Sudan by assessing hospital readiness, health care provider knowledge and the care received by severe malaria patients. METHODS: A cross-sectional descriptive study was performed to assess the severe malaria management practices at hospitals level in Gezira State. The study population included hospitals, health care providers and patients. Data was collected using checklists and structured questionnaires. RESULTS: A total of 20 hospitals, 158 health care providers and 370 patients were included in the study. Out of the total hospitals, 95% (19/20) were providing 24 h outpatient services, 65% (13/20) had ICU units, while triage system was found in only 35% (7/20) of hospitals. From all hospitals evaluated, 90% (18/20) were suffering from shortage of staff, especially doctors. About half of the health care providers (46.7%) did not receive severe malaria management training. The average knowledge score among health care providers was 55.4%. Microscopy was available in all hospitals (100%), while rapid diagnostic test, complete blood count and renal function test were available in 15 hospitals (75%). Fever was the most presenting symptom (97.8%) followed by repeated vomiting (51.4%), convulsion in children (24.3%) and prostration in adult (57.9%). Correctly diagnosed patients were 68.9%. Essential tests were done for only 11.1% of patients. Majority of patients (91.7%) were treated with quinine, 5.9% received artemether, while 2.4% were treated with artemether-lumefantrine. Those who received both the correct dose and dosing regimen were 53.8%. The overall compliance to guidelines was 2.2%. CONCLUSION: This study highlights the fact that management of severe malaria at hospital level was suboptimal with serious shortcomings in the different aspects of care particularly in specialized hospitals. Technical staff was inadequate, hospitals were anguish from defective emergency services, and most patients were not treated according to the national guidelines.


Assuntos
Gerenciamento Clínico , Hospitais/estatística & dados numéricos , Malária/epidemiologia , Malária/prevenção & controle , Antimaláricos/uso terapêutico , Artemisininas/uso terapêutico , Estudos Transversais , Testes Diagnósticos de Rotina , Feminino , Pessoal de Saúde , Humanos , Malária/tratamento farmacológico , Masculino , Assistência ao Paciente/estatística & dados numéricos , Sudão/epidemiologia , Inquéritos e Questionários
9.
J Grad Med Educ ; 11(2): 202-206, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31024654

RESUMO

Background: Improving continuity is challenging in residency training practices. Studies have shown that empanelment enables high-performing primary care and is foundational to improve accountability and continuity. Objective: An empanelment process was created in a large, urban, residency training practice as an effective approach to enhancing continuity among residents and their patients. Methods: In 2016, we formed an empanelment committee that included stakeholders from the department of medicine, the internal medicine residency program, and hospital and IT leadership. This committee set goal panel sizes, selected an empanelment algorithm, determined which patients needed re-empanelment, and facilitated medical record integration. Empanelment was followed and reassessed quarterly for 2 years. We measured anticipated visit demand using visits in the prior year and continuity using the continuity for physician formula. Results: Of 18 495 active patients in July 2016, 8411 (45%) were assigned a new PCP in the empanelment process. At baseline, panel sizes and expected visit demand were highly variable among residents (from 40 to 107 and 120 to 480, respectively). Empanelment led to more equivalent panel sizes and expected visit demand across same year residents (eg, PGY-3: 80-100 and 320-440, respectively). Continuity for all PCPs in the practice improved from 63% before empanelment to over 80% after empanelment, and improved from 55% to 72% for individual residents. Conclusions: In a large and complex practice environment, we were able to empanel resident clinic patients to improve continuity and maintain it over 2 years.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Medicina Interna/educação , Internato e Residência/organização & administração , Instituições de Assistência Ambulatorial , Educação de Pós-Graduação em Medicina , Humanos , Medicina Interna/organização & administração , Cidade de Nova Iorque , Pacientes Ambulatoriais/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos
10.
J Rehabil Med ; 51(6): 397-404, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-30873564

RESUMO

OBJECTIVES: To systematically identify literature reporting on assessment instruments relevant for incipient hospital-acquired deconditioning during acute hospital admissions; evaluate their psychometric properties; and identify individual assessment items to form the basis of a comprehensive acute hospital test battery for hospital-acquired deconditioning. DESIGN AND DATA SOURCES: Systematic evidence scan of MEDLINE, CINAHL, PubMed and Google Scholar from database inception to January 2018. STUDY SELECTION: Papers reporting psychometric properties of assessment instruments to detect change in body function and structure, relevant to hospital-acquired deconditioning were selected. Included instruments should assess one or more elements of hospital-acquired deconditioning, reflect the short time-frame constraints of acute hospital admissions, and be able to be applied by any healthcare provider. Quality evaluation: Evidence of psychometric properties and utility were assessed using a validated instrument. DATA EXTRACTION: Hospital-acquired deconditioning assessment items. RESULTS: Eight potentially-relevant instruments were identified, with moderate-to-good validity and utility, but limited evidence of reliability. These instruments reported a total of 53 hospital-acquired deconditioning assessment items. Seventeen items with measurement periods greater than 3 days were excluded. The remaining items measured anthropometrics, gait, balance, mobility, activities of daily living, and skin integrity. CONCLUSION: These assessment items provide the basis of a multifaceted evidence-based test battery to comprehensively and repeatedly assess acute hospital inpatient function for incipient hospital-acquired deconditioning.


Assuntos
Avaliação da Deficiência , Hospitais/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos , Atividades Cotidianas , Hospitalização , Humanos , Pacientes Internados/psicologia , Assistência ao Paciente/métodos , Assistência ao Paciente/psicologia , Psicometria , Recuperação de Função Fisiológica , Pesquisa de Reabilitação , Reprodutibilidade dos Testes
11.
JAMA Surg ; 154(1): 74-79, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30422256

RESUMO

Importance: The Fragility Index (FI) is the minimum number of participants in a randomized clinical trial (RCT) whose status would have to change from a nonevent (not experiencing the primary end point) to an event (experiencing the primary end point) required to turn a statistically significant result to a nonsignificant result. The FI measures the robustness (or fragility) of the results of an RCT and is an important aid to the clinician's interpretation of RCT results. It has now been recognized that RCTs, which provide the foundation for treatment guideline recommendations, may not be robust. Observations: Most RCTs in surgery and general medicine are fragile (with a low FI score), in contrast to those in cardiac disease and heart failure, where most RCTs are robust (with high FI scores). For clinical trials of trauma, we identified that the median (interquartile range) FI score was 3 (1-8), which means that adding 3 events to the opposite treatment arm in a given RCT eliminated statistical significance. The median Fragility Quotient (the FI score divided by the total study sample size) was 0.016 (0.0043-0.0408). Conclusions and Relevance: The provision of high-quality, evidence-based clinical care in surgery for optimal patient outcomes requires a foundation of robust clinical research evidence, and knowledge of the FI will assist in future surgical RCT design. We strongly recommend the routine reporting of FI scores for all future trauma and surgical RCTs to assist in appropriate and optimal decision making in the care of patients who have experienced trauma and/or need surgery. We also recommend the routine inclusion of the FI score in the development of clinical guidelines to assist the clinician in ascertaining whether guideline recommendations are robust. Surgeons should be aware to particularly exercise caution when considering a potential change in clinical practice based on RCTs with a low FI score.


Assuntos
Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Humanos , Assistência ao Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Tamanho da Amostra , Ferimentos e Lesões/terapia
12.
Eur J Health Econ ; 20(2): 303-316, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30121870

RESUMO

Informal care is a substantial source of support for people with cancer. However, various studies have predicted its disappearance in the near future. The aim of this study is to analyse the catastrophic effect resulting from the substitution of informal care with formal care in patients with blood cancer throughout the different stages of treatment. A total of 139 haematological neoplasm patients who underwent stem cell transplantation in Spain, completed a longitudinal questionnaire according to the three phases of treatment between 2012 and 2013. The economic value of informal care was estimated using proxy good, opportunity cost, and contingent valuation methods. Catastrophic health expenditure measures with thresholds ranging from 5 to 100% were used to value the financial burden derived from substitution. A total of 88.5% of patients reported having received informal care. In 85.37%, 80.49%, and 33.33% of households, more than 40% of their monthly income would have to be devoted to the replacement with formal care, with monthly amounts of €2105.22, €1790.86, and €1221.94 added to the 40% in the short, medium, and long-term, respectively (proxy good method, value = 9 €/h). Informal caregivers are a structural support for patients with blood cancer, assuming significant care time and societal costs. The substitution of informal care with formal care would be financially unaffordable by the families of people with blood cancer.


Assuntos
Cuidadores/economia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Neoplasias Hematológicas/economia , Assistência ao Paciente/economia , Assistência ao Paciente/métodos , Adolescente , Adulto , Idoso , Cuidadores/estatística & dados numéricos , Análise Custo-Benefício , Feminino , Neoplasias Hematológicas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econométricos , Assistência ao Paciente/estatística & dados numéricos , Espanha , Transplante de Células-Tronco/economia , Inquéritos e Questionários , Adulto Jovem
13.
AIDS Care ; 31(2): 243-249, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30146895

RESUMO

With the increase in the US of the number of older adults living with HIV, more research is needed to understand the caregiving and advance care planning needs of this population. This descriptive study examined the relationship between social support and caregiving preferences and advance care planning. Older adults living with HIV were recruited from clinics in Los Angeles, CA and New Orleans, LA to complete cross-sectional surveys (n = 154). Logistic regression analyses were modeled to determine the characteristics associated with 1) preference for formal short-term term care, 2) preference for formal long-term care, 3) having at least one contact for emergency care, 4) having an advance directive or living will, and 5) having a healthcare proxy or agent. The mean age was 56.8 years. The majority of participants indicated a preference for informal support for both short-term (73.4%) and long-term care (66.2%), 13.2% had no one they could call for emergency care, 26.0% had an advance directive/living will, and 30.5% had a healthcare proxy/agent. In adjusted models, greater social support was associated with preference for informal short-term care and with having at least one emergency contact. Findings suggest that older adults living with HIV prefer informal sources of support for their caregiving needs despite having small social networks and individuals with limited social networks are particularly vulnerable due to lack of access to caregivers in sudden or unexpected health situations.


Assuntos
Infecções por HIV/enfermagem , Testamentos Quanto à Vida/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Procurador/estatística & dados numéricos , Idoso , Estudos Transversais , Emergências , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Assistência de Longa Duração , Los Angeles , Masculino , Pessoa de Meia-Idade , Apoio Social
14.
Emerg Med Australas ; 31(1): 138-140, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30565419

RESUMO

Trauma and other disease registries have been used to improve patient care and outcomes at the system level. Paradoxically, registries have had little role in informing the care of any individual patient while that care is being determined and delivered. The lack of timeliness of useful data is a major barrier to the value of registries in improving individual patient care real-time. What do trauma and emergency care providers require from their trauma registries to inform real-time patient-tailored improvements in trauma care? Research is urgently needed to improve the usefulness of disease registries, and to develop innovative processes and applications using patient data to inform patient care real-time, thereby improving patient outcomes.


Assuntos
Assistência ao Paciente/métodos , Sistema de Registros/estatística & dados numéricos , Fatores de Tempo , Ferimentos e Lesões/epidemiologia , Austrália/epidemiologia , Humanos , Assistência ao Paciente/estatística & dados numéricos
15.
Ir Med J ; 111(9): 819, 2018 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-30556667

RESUMO

Aim To describe the healthcare needs of adolescent patients inhabiting the 'seventh age of childhood' in our region with a view towards future workforce and infrastructure planning. Methods This is a retrospective descriptive study of patients aged between 14 and 16 years presenting to each of the six hospitals in our hospital group over a 10 year period (01.07.2006-1.07.2016) using electronic databases. Results There were 10,992 hospital admissions, 41,456 outpatient appointments and an average of 1,847 attendances per year at our Emergency Department in this age group. Seventeen percent (n=1,873) of patients were admitted to age appropriate wards. Only 11.3% (n=1,242) of our cohort were admitted under the care of a Paediatrician. Conclusion The Irish healthcare agenda needs to be advanced to ensure the optimal health for this valuable, yet vulnerable generation. Further investment will help shape the fledgling discipline of 'adolescent health' in Ireland.


Assuntos
Saúde do Adolescente , Assistência Ambulatorial/estatística & dados numéricos , Assistência à Saúde , Necessidades e Demandas de Serviços de Saúde , Pacientes Ambulatoriais/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos , Adolescente , Fatores Etários , Estudos de Coortes , Bases de Dados Factuais , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Irlanda/epidemiologia , Masculino , Pediatras , Estudos Retrospectivos , Fatores de Tempo
16.
Sci Rep ; 8(1): 17965, 2018 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-30568180

RESUMO

Data on post stroke outcomes in developing countries are scarce due to uncoordinated healthcare delivery systems. In Malaysia, the national stroke clinical practice guideline does not address transfer of care and longer term post stroke care beyond tertiary care. Hence, post stroke care delivery may be delivered at either tertiary or primary care facilities. This study aimed at describing patients' characteristics and outcomes of post stroke care delivered by the primary care teams at public primary care healthcentres across Peninsular Malaysia. Multi staged sampling was done to select public primary care health centres to recruit post stroke patients. At each health centre, convenience sampling was done to recruit adult patients (≥18 years) who received post stroke care between July-December 2012. Baseline measurements were recorded at recruitment and retrospective medical record review was done simultaneously, for details on medical and / or rehabilitation treatment at health centre. Changes in the measurements for post stroke care were compared using paired t-tests and Wilcoxon Rank test where appropriate. Total of 151 patients were recruited from ten public primary care healthcentres. The mean age at stroke presentation was 55.8 ± 9.8 years. Median duration of follow up was 2.3 (IQR 5.1) years. Majority co-resided with a relative (80.8%), and a family member was primary caregiver (75.%). Eleven percent were current smokers. Almost 71.0% of patients achieved BP ≤ 140/90 mmHg. Only 68.9% of the patients had been referred for neurorehabilitation. Percentage of recorded data was highest for blood pressure (88.1%) while lowest was HbA1c (43.0%). For clinical outcomes, systolic and diastolic blood pressure, triglyceride level and calculated GFR (eGFR) showed statistically significant changes during follow up (p < 0.05). Post stroke care at public primary care healthcentres showed benefits in stroke risk factors control (i.e. hypertension and dyslipidaemia) but deterioration in renal function. A more structured coordination is needed to optimise post stroke care beyond acute phase management for patients who reside at home in the community.


Assuntos
Assistência ao Paciente , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/métodos , Assistência ao Paciente/estatística & dados numéricos , Atenção Primária à Saúde , Vigilância em Saúde Pública , Estudos Retrospectivos
17.
PLoS One ; 13(10): e0206448, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30379946

RESUMO

BACKGROUND: In the context of the national Cancer Plans of France that have changed the healthcare landscape, it has become necessary to better document and assess the related actions, and to promote research and understanding. The national cancer cohort, an exhaustive population-based cohort, was set up on the basis of the National Health Data System (SNDS) by the French National Cancer Institute. OBJECTIVES: The aim is to describe the French national cancer cohort. METHODS: All people living in France (67 million population) with universal insurance coverage and diagnosed, treated or followed up for a cancer, such as survivors, are included and will be followed up for 25 years. It contains all healthcare consumptions and reimbursements (i.e. hospitalization, outpatient care, medication…) since 2010. Every year, around 650 000 new cases are included. RESULTS: From 2010 to 2015, 6.2 million subjects have been included. Most subjects were entered in 2010, in 2015 it concerned 0.6 million. In 2015, the median age was 65 [54-76]; 51% were women. The primary cancer organ could be attributed with certitude to 87% of the people. The most frequent locations were skin (16%), breast (15%), prostate (12%), colon-rectum (11%) and lung (9%). In 2015, 40% of included subjects underwent surgery for cancer, 16% chemotherapy at hospital and 11% at least one session of radiotherapy. CONCLUSION: Based on SNDS, the cancer cohort has been designed to study cancer care use in the short-, medium- and long-term, and evaluate healthcare and public health policies.


Assuntos
Política de Saúde , Neoplasias , Assistência ao Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/economia , Sistema de Registros/estatística & dados numéricos , Adulto Jovem
18.
JAAPA ; 31(12): 1-12, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30489397

RESUMO

PURPOSE: Advanced practice providers (APPs, which include NPs and physician assistants [PAs]) are integral members of oncology teams. This study aims first to identify all APPs in oncology and, second, to understand personal and practice characteristics (including compensation) of those APPs. METHODS: We identified APPs who practice oncology from membership and claims data. We surveyed 3,055 APPs about their roles in clinical care. RESULTS: We identified at least 5,350 APPs in oncology and an additional 5,400 who might practice oncology. Survey respondents totaled 577 out of 3,055, which provided a 19% response rate. Results focused on 540 NPs and PAs. Greater than 90% reported satisfaction with career choice. Respondents identified predominately as white (89%) and female (94%). NPs and PAs spent the majority (80%) of time in direct patient care. The top four patient care activities were patient counseling (NPs, 94%; PAs, 98%), prescribing (NPs, 93%; PAs, 97%), treatment management (NPs, 89%; PAs, 93%), and follow-up visits (NPs, 81%; PAs, 86%). A majority of all APPs reported both independent and shared visits (65% hematology/oncology/survivorship/prevention/pediatric hematology/oncology; 85% surgical/gynecologic oncology; 78% radiation oncology). A minority of APPs reported that they conducted only shared visits. Average annual compensation was between $113,000 and $115,000, which is about $10,000 higher than average pay for APPs not in oncology. CONCLUSION: We identified 5,350 APPs in oncology and conclude that number may be as high as 7,000. Survey results suggest that practices that incorporate APPs routinely rely on them for patient care. Given the increasing number of patients with and survivors of cancer, APPs are important to ensure access to quality cancer care now and in the future.


Assuntos
Pessoal de Saúde , Oncologia , Profissionais de Enfermagem , Oncologistas , Equipe de Assistência ao Paciente , Assistência ao Paciente/estatística & dados numéricos , Assistentes Médicos , Papel Profissional , Compensação e Reparação , Feminino , Pessoal de Saúde/economia , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Profissionais de Enfermagem/economia , Profissionais de Enfermagem/estatística & dados numéricos , Oncologistas/estatística & dados numéricos , Assistentes Médicos/economia , Assistentes Médicos/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos
19.
Actas dermo-sifiliogr. (Ed. impr.) ; 109(9): 807-812, nov. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-175743

RESUMO

Introducción y objetivos: Recientemente se han consensuado unos indicadores de calidad de la atención del cáncer de piel no melanoma y melanoma promovidos por la Fundación Piel Sana AEDV. El objetivo de este estudio es conocer la adherencia a estos criterios de calidad asistencial. Material y métodos: En noviembre de 2016 se realizó una encuesta anónima que constaba de 32 preguntas, dirigida a los responsables de los servicios de dermatología y venereología españoles incluidos en la base de datos de la AEDV. Las preguntas de la encuesta hacían referencia a los diferentes indicadores consensuados previamente. Resultados: Fueron respondidas 104 de las 150 encuestas enviadas (69,3% de porcentaje de respuesta). El menor porcentaje conseguido de respuesta a una pregunta fue del 56% (n=84). Más del 85% de los encuestados contestaron a 29 (91%) o más preguntas. Los indicadores con mayor implantación fueron la disponibilidad de TAC o RMN para el estudio de carcinoma espinocelular (98%), seguidos de la existencia de un modelo estandarizado para la realización del informe anatomopatológico de melanoma (90%). Los indicadores con menor implantación se relacionaron con el acceso a electroquimioterapia (25%) y el acceso a otras terapias invasivas para el melanoma locorregionalmente avanzado (20%). Conclusiones: Se ha encontrado variabilidad en la adherencia de estos criterios en los diferentes centros. Con los datos obtenidos se pueden identificar posibilidades de mejora en los centros. Futuras investigaciones deberían centrarse en la medición de indicadores de proceso y resultado


Introduction and objectives: A series of quality indicators for melanoma and nonmelanoma skin cancer were recently approved within a project promoted by the Healthy Skin Foundation of the Spanish AEDV. The aim of this study was to evaluate adherence to these indicators. Material and methods: In November 2016, an anonymous questionnaire consisting of 32 items was sent to the heads of Spanish dermatology and venereology departments listed in the AEDV's database. The questions referred to the above-mentioned quality of care indicators. Results: The questionnaire was completed by 104 of the 150 people contacted (response rate, 69.3%). The lowest response rate for any given question was 56% (84 respondents). Over 85% of respondents answered 29 questions or more (91%). The most widely used indicators were those related to the use of computed tomography or magnetic resonance imaging for squamous cell carcinoma (98%), followed by the availability of a standardized melanoma pathology report (90%). The least widely used indicators were related to availability of electrochemotherapy (25%) and other invasive therapies for locoregionally advanced melanoma (20%). Conclusions: Adherence to quality of cancer care criteria at the different hospitals evaluated varied. Our findings could be useful for identifying areas for improvement at different hospitals. Future studies should focus on measuring both process and outcome indicators


Assuntos
Humanos , Assistência ao Paciente/estatística & dados numéricos , Neoplasias Cutâneas/epidemiologia , Serviços Hospitalares , Indicadores de Serviços/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Dermatologia/estatística & dados numéricos , Inquéritos e Questionários
20.
J Infect ; 77(6): 516-525, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30179645

RESUMO

BACKGROUND: Staphylococcus aureus bloodstream infection (SAB) is a common, life-threatening infection with a high mortality. Survival can be improved by implementing quality of care bundles in hospitals. We previously observed marked differences in mortality between hospitals and now assessed whether mortality could serve as a valid and easy to implement quality of care outcome measure. METHODS: We conducted a prospective observational study between January 2013 and April 2015 on consecutive, adult patients with SAB from 11 tertiary care centers in Germany, South Korea, Spain, Taiwan, and the United Kingdom. Factors associated with mortality at 90 days were analyzed by Cox proportional hazards regression and flexible parametric models. RESULTS: 1851 patients with a median age of 66 years (64% male) were analyzed. Crude 90-day mortality differed significantly between hospitals (range 23-39%). Significant variation between centers was observed for methicillin-resistant S. aureus, community-acquisition, infective foci, as well as measures of comorbidities, and severity of disease. In multivariable analysis, factors independently associated with mortality at 90 days were age, nosocomial acquisition, unknown infective focus, pneumonia, Charlson comorbidity index, SOFA score, and study center. The risk of death varied over time differently for each infective focus. Crude mortality differed markedly from adjusted mortality. DISCUSSION: We observed significant differences in adjusted mortality between hospitals, suggesting differences in quality of care. However, mortality is strongly influenced by patient mix and thus, crude mortality is not a suitable quality indicator.


Assuntos
Bacteriemia/tratamento farmacológico , Bacteriemia/mortalidade , Assistência ao Paciente/estatística & dados numéricos , Infecções Estafilocócicas/mortalidade , Centros de Atenção Terciária/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/epidemiologia , Comorbidade , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Feminino , Alemanha , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , República da Coreia , Fatores de Risco , Espanha , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/efeitos dos fármacos , Análise de Sobrevida , Taiwan , Reino Unido
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