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3.
Rev. bras. cir. plást ; 34(4): 517-523, oct.-dec. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1047918

RESUMO

A atenção e zelo do médico no período pré e pós-operatório é de extrema importância para a manutenção da boa relação médico/paciente. A organização e o adequado registro documental, contribui para a obtenção de um bom vínculo e assegura importante ferramenta jurídica ao médico. Hoje, com os avanços tecnológicos, o prontuário eletrônico é uma forma segura e democrática de lidar com estas informações. Nas instituições públicas o governo tem buscado implementar este sistema, mas os resultados são ainda discretos, talvez pela falta principalmente de recursos para investimento nesta área. Diante deste cenário e da grande relevância de um prontuário médico prático, informativo e dinâmico, objetivamos apresentar a nossa experiência com o uso complementar de um recurso digital sem custos. Associado ao prontuário médico de uso habitual dos serviços, descreve-se um sistema complementar, utilizando-se uma plataforma digital de armazenamento de dados na "nuvem". Por meio desse sistema é possível fornecer informações adicionais sobre cada paciente, incluindo o seguimento ambulatorial, assim como o registro fotográfico do pré, intra e pós-operatório, além de viabilizar um acesso rápido, sincronizado e remoto por meio da internet. O sistema gera economia de recursos, planejamento cirúrgico e melhora na relação médico/paciente. Favorece maior integração da equipe médica, discussão dos casos e distribuição das cirurgias por preceptor e residente. Assim, é um recurso alternativo para incrementar os prontuários médicos com dados importantes para a atuação das equipes médicas, com especial atenção às peculiaridades da cirurgia plástica.


The attention and enthusiasm of doctors in the pre- and postoperative period is of extreme importance in maintaining good doctor/patient relationships. An adequate organization and documentary record contributes to achieving a good relationship and ensures an important legal tool for physicians. With current technological advances, the electronic medical record is a secure and democratic way to deal with this information. The government has sought to implement this system in public institutions; however, results are still modest, perhaps mainly due to the lack of resources for investment in this area. In light of this, and given the relevance of practical, informative, and dynamic medical records, we aim to present our experience with the use of a complementary digital resource that is commonly associated with medical records and uses a free of cost digital platform for storing data in the "cloud". This system can provide additional information about each patient, including outpatient follow-up, as well as photographic records of the pre-, intra-, and post-operative periods, and also facilitates quick, synchronized, and remote access through the internet. The system generates optimization of resources, surgical planning, and improvement in patient/ doctor relationships. It also leads to greater integration of the medical team, particularly in the discussion of cases and distribution of surgeries by preceptors and residents. Thus, it is an alternative resource to improve medical charts with important data regarding the performance of medical teams, paying special attention to the peculiarities of plastic surgery.


Assuntos
Humanos , História do Século XXI , Cirurgia Plástica , Administração de Serviços de Saúde , Registros Médicos , Inovação , Assistência ao Paciente , Cirurgia Plástica/organização & administração , Administração de Serviços de Saúde/normas , Registros Médicos/normas , Assistência ao Paciente/métodos , Assistência ao Paciente/normas
4.
Medicine (Baltimore) ; 98(48): e18168, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770265

RESUMO

RATIONALE: Recent years have witnessed a marked improvement in the safety and accuracy of nerve blocks with the help of ultrasound and other visualization technologies. This study reports a challenging case of a severe complication during the ultrasound-guided stellate ganglion block. PATIENT CONCERNS: A 28-year-old male patient with refractory migraine complained episodic pulsatile pain with photophobia, haphalgesia of the scalp for 3 years. INTERVENTIONS: Ultrasound-guided stellate ganglion block with 4 ml of 1% lidocaine was administrated. OUTCOMES: A sudden loss of consciousness and tonic-clonic seizure was occurred after negative aspiration and test dose. Further sonographic examination revealed a variation in the left vertebral artery, which remained unrecognized during the needle insertion because of its sliding ability under the differential pressure applied by the probe. LESSONS: Inadvertent intra-arterial injection of a local anesthetic agent could be minimized under the ultrasound guidance with various protective strategies, including the determination of any prior variation, optimizing the block route, maintaining a constant probe pressure, and using saline for the test dosage. This case resulted in the implementation of new protocols of the ultrasound-guided stellate ganglion block in our department.


Assuntos
Bloqueio Nervoso Autônomo , Complicações Intraoperatórias , Lidocaína , Convulsões , Gânglio Estrelado , Inconsciência , Artéria Vertebral , Adulto , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Bloqueio Nervoso Autônomo/efeitos adversos , Bloqueio Nervoso Autônomo/métodos , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Masculino , Erros Médicos/prevenção & controle , Transtornos de Enxaqueca/cirurgia , Assistência ao Paciente/métodos , Convulsões/etiologia , Convulsões/terapia , Gânglio Estrelado/diagnóstico por imagem , Gânglio Estrelado/cirurgia , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos , Inconsciência/etiologia , Inconsciência/terapia , Artéria Vertebral/anatomia & histologia , Artéria Vertebral/lesões
5.
Dis Colon Rectum ; 62(11): 1294-1304, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31567919

RESUMO

BACKGROUND: Despite the increasing number of younger individuals diagnosed with colon and rectal cancer, research on the long-term disease-specific health-related quality of life of younger (<50 years) survivors of colon and rectal cancer is scarce. OBJECTIVE: Our study aimed to compare disease-specific functional deficits and symptoms of survivors of colon and rectal cancer 5 to 16 years postdiagnosis, stratified by age at diagnosis and by sex. DESIGN: This is a cross-sectional study. SETTING: We used data from the population-based CAncEr Survivorship-A multi-Regional study in collaboration with 5 population-based German cancer registries. PATIENTS: Survivors of colon and rectal cancer were included in the study. MAIN OUTCOME MEASURES: Respondents completed the disease-specific European Organization for Research and Treatment of Cancer Quality of Life colorectal cancer module. Age at diagnosis categories were <50, 50 to 59, 60 to 69, and ≥70 years. Least square mean health-related quality of life scores, derived from linear regression, were adjusted for sex, education, time since diagnosis, cancer site, cancer stage, and treatment, where appropriate. RESULTS: The sample comprised 697 survivors of colon cancer and 479 survivors of rectal cancer. In general, survivors of colon and rectal cancer diagnosed at <50 years of age reported lower functioning and higher symptom burden in comparison with survivors diagnosed at an older age. When stratified by sex, female survivors of colon cancer tended to report more concerns with hair loss but fewer sexual problems when compared with male survivors of colon cancer of the same age. Female survivors of rectal cancer in all age groups tended to report lower levels of sexual interest than male survivors of rectal cancer of the same age. LIMITATIONS: This was a cross-sectional study with findings that could be biased toward healthier long-term survivors. The generalizability of results is limited to survivors diagnosed before 2005. CONCLUSIONS: Our results suggest that supportive care for survivors of colon and rectal cancer to improve their self-management of symptoms should be adapted according to cancer type, age at diagnosis, and sex. See Video Abstract at http://links.lww.com/DCR/B29. LA EDAD AL DIAGNÓSTICO Y EL GÉNERO ESTÁN ASOCIADOS CON DÉFICITS A LARGO PLAZO EN LA CALIDAD DE VIDA RELACIONADA CON LA SALUD ESPECíFICA DE LA ENFERMEDAD DE LOS SOBREVIVIENTES DE CÁNCER DE COLON Y RECTO: UN ESTUDIO BASADO EN LA POBLACIÓN:: A pesar del creciente número de individuos jóvenes diagnosticados con cáncer de colon y recto, la investigación sobre la calidad de vida relacionada con la salud específica de la enfermedad a largo plazo de los sobrevivientes de cáncer de colon y recto jóvenes (<50 años) es escasa.Nuestro estudio tuvo como objetivo comparar los déficits funcionales específicos de la enfermedad y los síntomas de los sobrevivientes de cáncer de colon y recto 5-16 años después del diagnóstico, estratificados por edad al momento del diagnóstico y por género.Transversal.Utilizamos datos del estudio Supervivencia de CAncEr basada en la población: Un estudio multirregional en colaboración con cinco bases de datos alemanas de cáncer basados en la población.Sobrevivientes de cáncer de colon y recto.Los encuestados respondieron el módulo de calidad de vida específica para la enfermedad en cáncer colorrectal de la Organización Europea para la Investigación y Tratamiento del Cáncer. Las categorías de edad al diagnóstico fueron <50, 50-59, 60-69 y ≥70 años. Los puntajes de CVRS (calidad de vida relacionada a la salud) medios mínimos cuadrados, derivados de la regresión lineal, se ajustaron por género, educación, tiempo desde el diagnóstico, sitio del cáncer, etapa del cáncer y tratamiento, cuando apropiado.La muestra comprendió 697 y 479 sobrevivientes de cáncer de colon y de recto, respectivamente. En general, los sobrevivientes de cáncer de colon y recto diagnosticados con <50 años de edad reportaron una menor funcionalidad y una mayor carga de síntomas en comparación con los sobrevivientes diagnosticados a una edad más avanzada. Cuando se estratificaron por género, las mujeres sobrevivientes de cáncer de colon tendieron a informar más preocupaciones sobre la pérdida de cabello pero menos problemas sexuales en comparación con los hombres sobrevivientes de colon de la misma edad. Las mujeres sobrevivientes de cáncer rectal en todos los grupos de edad tendieron a informar niveles más bajos de interés sexual que los hombres sobrevivientes de cáncer rectal de la misma edad.Estudio transversal con hallazgos que podrían estar sesgados hacia sobrevivientes a largo plazo más saludables. La generalización de los resultados se limitó a los sobrevivientes diagnosticados antes de 2005.Nuestros resultados sugieren que los cuidados de soporte para los sobrevivientes de cáncer de colon y recto para mejorar su automanejo de síntomas deben adaptarse según el tipo de cáncer, la edad en el momento del diagnóstico y el género. Vea el resumen en video en http://links.lww.com/DCR/B29.


Assuntos
Neoplasias Colorretais , Efeitos Psicossociais da Doença , Desempenho Físico Funcional , Qualidade de Vida , Sobreviventes , Tempo , Idoso , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/psicologia , Neoplasias Colorretais/terapia , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/métodos , Fatores Sexuais , Sobreviventes/psicologia , Sobreviventes/estatística & dados numéricos
6.
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
7.
BMC Womens Health ; 19(1): 112, 2019 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477083

RESUMO

BACKGROUND: Internationally, women with cervical intraepithelial neoplasia (CIN) lack knowledge about their disease, which limits their ability to take responsibility for self-care and creates negative psychosocial effects, including marital problems. Normally, screening is performed in primary care, and in case of abnormal results, the patient is referred to specialized care for follow-up and treatment. Given the lack of international literature regarding patients' experiences in primary and specialized healthcare, our study aims to: (a) investigate how women with CIN perceive the communication and management of information by healthcare providers at different moments of their healthcare and (b) identify these women's informational needs. METHODS: A qualitative exploratory study was carried out in a gynecology unit of a public hospital of the Galician Health Care Service (Spain). Participants were selected through purposive sampling. The sample consisted of 21 women aged 21 to 52 years old with a confirmed diagnosis of CIN. Semistructured interviews were recorded and transcribed. A thematic analysis was carried out, including triangulation of researchers for analysis verification. RESULTS: Two analytical themes were identified. The first was communication gaps in the diagnosis and management of information in primary and specialized healthcare. These gaps occurred in the following moments of the healthcare process: (a) cervical cancer screening in primary care, (b) waiting time until referral to specialized care, (c) first consultation in specialized care, and (d) after consultation in specialized care. The second theme was participants' unmatched informational needs. The doubts and informational needs of women during their healthcare process related to the following subthemes: (a) HPV transmission, (b) HPV infection symptoms and consequences, and (c) CIN treatment and follow-up. CONCLUSIONS: This study shows that women who have a diagnosis of CIN experience important healthcare informational challenges when accessing primary and specialized care that have several implications for their wellbeing. The information given is limited, which makes it difficult for women to understand and participate in the decision making regarding the prevention and treatment of CIN. Service coordination among different levels of care and the availability of educational materials at any given time would improve the patients' healthcare experience.


Assuntos
Neoplasia Intraepitelial Cervical , Detecção Precoce de Câncer , Assistência ao Paciente , Navegação de Pacientes/organização & administração , Neoplasias do Colo do Útero , Adulto , Neoplasia Intraepitelial Cervical/patologia , Neoplasia Intraepitelial Cervical/psicologia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/psicologia , Feminino , Humanos , Competência em Informação , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Assistência ao Paciente/métodos , Assistência ao Paciente/normas , Pesquisa Qualitativa , Espanha , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/psicologia
8.
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
9.
Appl Ergon ; 80: 9-16, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31280815

RESUMO

Care coordination is important for chronically ill patients who need assistance from a variety of healthcare professionals especially when they transition through different care settings. There has not been a clear definition of care coordination and its associated activities. This paper provides a two-dimension framework of care coordination for chronically ill patients: 1) coordination activities (i.e. communication and monitoring) and 2) interdependencies (i.e. flow, shared resources, simultaneity). We used this framework in a qualitative content analysis of 12 interviews with healthcare professionals involved in coordinating care of chronically ill patients. We identified a total of 258 care coordination activities and developed categories and sub-categories using the constant comparative method. The first category of care coordination activities involves communication with flow or shared resources interdependencies or both. This category includes arranging services and equipment for the patient, exchanging information about patient transition to different care settings, reporting errors and resolving them, and helping the patient with appointments and transportation. The second category involves monitoring, sometimes combined with communication, with flow or shared resources interdependencies or both. This category includes reviewing medications and services and detecting errors, reviewing patient symptoms and following up if needed, and scheduling follow-up to review patient status. The last category involves communication with simultaneity interdependency. This category involves talking in the same location and developing a plan of care, people exchanging information at the same time, and scheduling delivery of medications/services to correspond with patient arrival home. Finally, we identified characteristics of health information technology that can support these various care coordination activities.


Assuntos
Doença Crônica/enfermagem , Pessoal de Saúde/psicologia , Planejamento de Assistência ao Paciente/organização & administração , Assistência ao Paciente/psicologia , Comunicação , Humanos , Assistência ao Paciente/métodos , Pesquisa Qualitativa
11.
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
12.
Recenti Prog Med ; 110(5): 212-214, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31140452

RESUMO

Recently, John Mandrola et al. established the tenets of medical conservativism. We endorse this approach to patient care, and we believe that, in order to have this perspective incorporated into medical reasoning, the foundations for being medical conservatives should be taught since medical school. In this Perspective, through an analogy between medicine's and criminal law's approaches to uncertainty, we suggest that the precautionary principle of in dubio pro reo could be adapted to medicine as a decisional strategy for medical conservatives. This principle would represent a cognitive and decisional filter that allows physicians to counterbalance the currently widespread propensity toward interventions with a conservative and precautionary attitude.


Assuntos
Assistência à Saúde/métodos , Assistência ao Paciente/métodos , Médicos/organização & administração , Atitude do Pessoal de Saúde , Tomada de Decisões , Humanos
13.
Am Soc Clin Oncol Educ Book ; 39: e212-e218, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31099651

RESUMO

Emerging modalities of communication have transformed the landscape of information dissemination particularly in the context of health care. Within oncology, stakeholders in all roles have formed both role-specific and multidisciplinary communities within the modalities of social media. Two platforms with particularly high adoption and penetration within oncologic practice for clinicians and general oncologic care as well as for patients and the community have been Facebook and Twitter. On both platforms, patients have come together to form disease-specific (or even mutation-specific) groups ripe with discussion on all aspects of their cancer, including disease and treatment symptoms, novel therapeutics, and clinical trial participation. Similarly, clinicians have united within professional communities to facilitate collaboration and community building in this rapidly changing medical practice landscape. Here, we investigate the current state of stakeholder engagement within social media and review strategies and platforms to maximize the impact of social media for patients and clinicians.


Assuntos
Oncologia , Assistência ao Paciente , Mídias Sociais , Cuidadores , Comunicação , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Humanos , Comportamento de Busca de Informação , Oncologia/métodos , Oncologia/normas , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/terapia , Prática Associada , Assistência ao Paciente/métodos , Assistência ao Paciente/normas , Participação do Paciente , Relações Médico-Paciente , Estados Unidos
14.
Am Soc Clin Oncol Educ Book ; 39: e167-e175, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31099675

RESUMO

The concept of "big data" research-the aggregation and analysis of biologic, clinical, administrative, and other data sources to drive new advances in biomedical knowledge-has been embraced by the cancer research enterprise. Although much of the conversation has concentrated on the amalgamation of basic biologic data (e.g., genomics, metabolomics, tumor tissue), new opportunities to extend potential contributions of big data to clinical practice and policy abound. This article examines these opportunities through discussion of three major data sources: aggregated clinical trial data, administrative data (including insurance claims data), and data from electronic health records. We will discuss the benefits of data use to answer key oncology practice and policy research questions, along with limitations inherent in these complex data sources. Finally, the article will discuss overarching themes across data types and offer next steps for the research, practice, and policy communities. The use of multiple sources of big data has the promise of improving knowledge and providing more accurate data for clinicians and policy decision makers. In the future, optimization of machine learning may allow for current limitations of big data analyses to be attenuated, thereby resulting in improved patient care and outcomes.


Assuntos
Big Data , Oncologia , Neoplasias/epidemiologia , Assistência ao Paciente , Administração da Prática Médica , Pesquisa , Ensaios Clínicos como Assunto , Assistência à Saúde , Política de Saúde , Humanos , Oncologia/legislação & jurisprudência , Oncologia/métodos , Assistência ao Paciente/métodos
15.
Maturitas ; 124: 39-42, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31097177

RESUMO

OBJECTIVE: We previously conducted an audit of the care provided for survivors of sexual violence seen at our emergency department and observed that 90% of them did not receive optimal care. This study analysed whether the implementation of a new protocol and educational sessions for staff increased the proportion of such patients who received optimal medical care. METHODS: A computerized chart detailing a new care protocol was developed specifically for rape survivors. Educational sessions focusing on the use of the new protocol were organized for healthcare providers. We then conducted another audit that reviewed retrospectively the charts of all survivors of sexual violence who were cared for at a public university hospital. MAIN OUTCOME MEASURE: Optimal medical care was defined as including systematic investigations for sexually transmitted diseases, and the provision of prophylactic antibiotics, a pregnancy test, emergency contraception, and psychological and medical follow-up. RESULTS: We analysed the charts of 362 survivors of sexual violence and observed that all of the required procedures were completed for 337 patients (93%) and the required preventive measures were provided to 325 patients (90%). CONCLUSION: After the implementation of the new protocol and educational sessions, the proportion of survivors who received optimal medical care increased from 10% to 90%. Nevertheless, optimal management also implies social, psychological and legal support. We hope that the establishment of specialist sexual assault centres will further improve management.


Assuntos
Pessoal de Saúde/educação , Assistência ao Paciente/métodos , Estupro , Sobreviventes , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Protocolos Clínicos , Anticoncepção Pós-Coito , Serviço Hospitalar de Emergência , Feminino , Humanos , Pessoa de Meia-Idade , Assistência ao Paciente/normas , Testes de Gravidez , Estudos Retrospectivos , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/prevenção & controle , Adulto Jovem
16.
Haemophilia ; 25(4): 626-632, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31144379

RESUMO

INTRODUCTION: Multidisciplinary clinics in academic settings are often inefficient and can lead to lengthy clinic visits for patients and staff. AIM: We aimed to use quality improvement (QI) methodology and a multidisciplinary approach to optimize outpatient comprehensive haemophilia clinic flow. METHODS: At baseline, a multidisciplinary QI team created a key driver diagram to identify drivers of haemophilia clinic flow. Identified drivers included patient needs/scheduling, provider flow and laboratory/research requirements. From December 2016 to August 2017, value stream mapping (VSM) was used to identify barriers to clinic flow, and plan-do-study-act cycles were used to address these barriers. Interventions included (a) standardizing the order in which providers saw patients to enable time-sensitive laboratories, (b) improving HTC team meeting functionality, (c) optimizing a visual management board and implementing a flow coordinator, (d) initiating a team huddle prior to clinic start and (e) modifying the clinic appointment template. Timely laboratory draw was used as a surrogate marker of clinic flow, and VSM utilization percentage was used as an objective measure of efficiency. RESULTS: We did not demonstrate a statistically significant improvement in timed laboratory draws; however, clinic utilization percentage increased by 30%, which resulted in adding point-of-care musculoskeletal ultrasound services without lengthening clinic duration. CONCLUSION: Quality improvement methodology is an effective means of improving clinic utilization in a multidisciplinary clinic.


Assuntos
Instituições de Assistência Ambulatorial , Hemofilia A , Assistência ao Paciente/métodos , Melhoria de Qualidade , Fluxo de Trabalho , Humanos , Laboratórios , Admissão e Escalonamento de Pessoal , Fatores de Tempo
17.
J Athl Train ; 54(4): 449-458, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30933607

RESUMO

CONTEXT: Current evidence suggests that a low percentage of athletic trainers (ATs) routinely use patient-reported outcome measures (PROMs). An understanding of the perceptions of ATs who use (AT-USE) and who do not use (AT-NON) PROMs as well as any differences due to demographic characteristics (eg, use for patient care or research, job setting, highest education level) may help facilitate the use of PROMs in athletic training. OBJECTIVE: To describe commonly used PROMs by AT-USE, the criteria by which AT-USE select PROMs, and reasons for non-use by AT-NON. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: A convenience sample of 1784 ATs (response rate = 10.7% [1784/17972]; completion rate = 92.2% [1784/1935]) who worked in a variety of settings. MAIN OUTCOME MEASURE(S): Participants completed an anonymous electronic online survey. Descriptive statistics were used to describe commonly used PROMs, PROM selection criteria, and reasons for PROM non-use. RESULTS: Participants were classified as AT-USE (n = 370, 20.7%) or AT-NON (n = 1414, 79.3%). For the AT-USE group, the most common type of PROMs used were specific (eg, region, joint; n = 328, 88.6%), followed by single-item (n = 258, 69.7%) and generic (n = 232, 62.7%). Overall, the PROMs most frequently endorsed by the AT-USE group were the Numeric Pain Rating Scale (n = 128, 34.6%); Lower Extremity Functional Scale (n = 108, 29.2%); Disability of the Arm, Shoulder and Hand (n = 96, 25.9%); Owestry Disability Index (n = 80, 21.6%); and Foot and Ankle Ability Measure (n = 78, 21.1%). The most important criteria reported by AT-USE for selecting PROMs were that the measure was valid and reliable, easy for patients to understand, and easy for clinicians to understand and interpret. Common reasons for non-use were that PROMs were too time consuming for the clinician, too time consuming for the patient, and more effort than they were worth. CONCLUSIONS: The Numeric Pain Rating Scale; Lower Extremity Functional Scale; Disability of the Arm, Shoulder and Hand; Owestry Disability Index; and Foot and Ankle Ability Measure were the PROMs most commonly endorsed by AT-USE and should be considered for athletic training use. To further facilitate the use of PROMs in athletic training, future authors should identify strategies to address organizational and time-constraint obstacles. Interpretation of our study findings may require caution due to a relatively low response rate and because "routine use" was not operationalized.


Assuntos
Atletas/educação , Traumatismos em Atletas/prevenção & controle , Assistência ao Paciente/métodos , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Medicina Esportiva/métodos , Esportes , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e Questionários
19.
Int J Clin Pharm ; 41(3): 667-671, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30953272

RESUMO

Background Emergency medicine (EM) pharmacists are increasingly recognized as integral team members in the care of emergency department (ED) patients but there is variability in the scope of direct patient care services. Objectives The primary objective was to categorize direct patient care activities and drug therapy recommendations. The secondary objectives were to categorize recommendations based on drug class and to determine the proportion of recommendations associated with Institute for Safe Medication Practices (ISMP) high-alert medications. Methods This retrospective, single-center, chart review was conducted in an academic ED with 65,000 annual visits. EM pharmacists documented direct patient care activities in the electronic health record. Documented activities from 1/1/2015 through 3/31/2015 were abstracted electronically for analysis by a trained reviewer. Results There were 3567 interventions and direct patient care activities documented. The most common activities were facilitation of medication histories (n = 1300) and drug therapy recommendations (n = 1165). Of 1165 drug therapy recommendations, 986 were linked to a drug class such as antimicrobial agents (31.9%), cardiovascular agents (16.6%), and analgesic agents (13.2%) and 20% of these interventions were associated with ISMP high-alert medications. Conclusion EM pharmacists documented several types of direct patient care activities with the majority being drug therapy recommendations and medication histories.


Assuntos
Medicina de Emergência/métodos , Erros de Medicação/prevenção & controle , Assistência ao Paciente/métodos , Farmacêuticos , Serviço de Farmácia Hospitalar/métodos , Papel Profissional , Medicina de Emergência/normas , Humanos , Assistência ao Paciente/normas , Farmacêuticos/normas , Serviço de Farmácia Hospitalar/normas , Estudos Retrospectivos
20.
J Card Surg ; 34(5): 274-278, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30924558

RESUMO

BACKGROUND: Surgical site infections after cardiac surgery are associated with severe outcomes, including reoperation and death. We aimed to describe the effect of a standardized clinical-care protocol for preventing mediastinitis in patients who underwent coronary artery bypass graft surgery (CABG). METHODS: In a hospital certified by Joint Commission International, all patients who underwent CABG from January 2011 to December 2016 were compared in two periods according to the moment of implementation of a standardized clinical-care protocol for prevention of mediastinitis (CCPPM): pre-protocol (January 2011-December 2012) and post-protocol (January 2013-December 2016). The CCPPM consisted of the patient using a kit containing chlorhexidine 2% for bathing, mupirocin 20 mg/g for nasal topical use and chlorhexidine 0.12% for oral hygiene for 5 days before surgery, in addition to prophylaxis with a glycopeptide antimicrobial and strict glucose control (110-140 mg/dL) during surgery and immediate postoperative. RESULTS: We evaluated 1760 patients who underwent CABG in both periods. The occurrence of mediastinitis before protocol implementation was 1.44% (10 of 692 CABG). After the implementation of the protocol, there was an important reduction in the incidence of mediastinitis to 0.09% (1 of 1068 CABG) (P = 0.002). Although we did not observe a significant difference in mortality between the groups (2.3% vs 1%, P = 0.77), there was fewer in-hospital mortality due to mediastinitis after the CCPPM (0.2% vs 0%, P < 0.001). CONCLUSION: Implementation of a standardized CCPPM was associated with a significant reduction in the incidence of mediastinitis after CABG and reduction of mortality in the group of patients with mediastinitis.


Assuntos
Clorexidina/administração & dosagem , Ponte de Artéria Coronária , Hospitais Privados , Mediastinite/prevenção & controle , Assistência ao Paciente/métodos , Assistência ao Paciente/normas , Complicações Pós-Operatórias/prevenção & controle , Qualidade da Assistência à Saúde , Administração Tópica , Idoso , Antibioticoprofilaxia , Banhos , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Mediastinite/epidemiologia , Mediastinite/mortalidade , Pessoa de Meia-Idade , Mupirocina/administração & dosagem , Higiene Bucal , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Fatores de Tempo
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