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4.
Pneumologie ; 73(11): 670-676, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31715635

RESUMO

BACKGROUND: Home mechanical ventilation is dramatically evolving in Germany. Patients with non-invasive and invasive ventilation are increasingly treated at home. In-hospital treatment of these patients is also necessary either for control visits or the management of acute medical problems. However, the development of in-hospital patient care, morbidity and mortality of these patients is unknown. METHODS: All patients with long-term dependence on mechanical ventilation for more than three months requiring hospitalisation between 2006 and 2016 were analysed (data obtained from the Federal Statistical Office of Germany). RESULTS: There was an exponential increase in the number of in-patients with long-term dependence of mechanical ventilation. While 24 845 patients were treated in-hospital in 2006, 86 117 patients were treated in 2016. Correspondingly, mortality decreased from 13.2 % (2006) to 5.7 % (2016). In addition, in 2016 47 % of all patients were treated on the intensive care or high dependency care unit. Overall, patients had been severely ill, as there were plenty of medical and neurological co-morbidities. The most common diagnosis was COPD with 58 % of all cases, followed by several cardiology diagnosis. A high number of patients had an impairment of renal function (24 %), in part requiring dialysis. CONCLUSIONS: The rapid development of home mechanical ventilation substantially impacts on the development of the hospital landscape in Germany. The exponential increase of these care-intensive patients is challenging for the health care system and requires a discussion about its limits.


Assuntos
Cuidados Críticos , Serviços de Assistência Domiciliar , Assistência ao Paciente/tendências , Respiração Artificial , Cuidados Críticos/métodos , Cuidados Críticos/tendências , Alemanha , Serviços de Assistência Domiciliar/estatística & dados numéricos , Serviços de Assistência Domiciliar/tendências , Hospitalização , Humanos , Unidades de Terapia Intensiva , Respiração Artificial/métodos , Respiração Artificial/estatística & dados numéricos
6.
Expert Rev Clin Pharmacol ; 12(5): 481-489, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30961406

RESUMO

INTRODUCTION: The potentials of Africa for growth and economic transformation through science remains challenging because of existing gaps in knowledge and infrastructure. The Africa Pharmacological Science Gateway project and the Medicines Utilization Research in Africa Group seek to meet the research needs of African pharmacologists. This study aimed at identifying priority needs that might be met by access to information and tools through e-infrastructure. METHODS: A web-based cross-sectional study among 472 members of pharmacological societies in Africa to obtain information on their research interests and skills, available resources, needs, and knowledge gaps. Descriptive analyses were done. RESULTS: A total of 118 responses from 13 countries were received, mostly from Nigeria (48.3%) and South Africa (21.3%). Respondents had wide ranges of research interests predominantly in drug utilization research. The desired resources included drug utilization research training and tools, pharmacokinetics and pharmacometrics modeling training and tools, drug-drug interaction and medicine prices resources, statistical analysis resources, access to journals, training in specific laboratory techniques, equipment and funding for research-related activities. CONCLUSIONS: Key areas of needs not currently provided by the African Pharmacological Science Gateway e-infrastructure were identified to guide the further provision of resources on the e-infrastructure and potentially enhance research capacity within the continent.


Assuntos
Acesso à Informação , Conhecimentos, Atitudes e Prática em Saúde , Farmacologia/organização & administração , Pesquisa/organização & administração , África , Estudos Transversais , Assistência à Saúde/tendências , Humanos , Internet , Assistência ao Paciente/tendências , Projetos Piloto , Competência Profissional , Inquéritos e Questionários
7.
Orv Hetil ; 160(4): 131-137, 2019 Jan.
Artigo em Húngaro | MEDLINE | ID: mdl-30661382

RESUMO

INTRODUCTION: Data during routine patient care are created in multiple digital and paper-based hardcopy systems, therefore their retrieval is cumbersome in the follow-up of patients. Multiple sclerosis is the most prevalent neurological disorder in the young age, with major consequences on health and socio-economic status. AIM: We set forth to create a user-friendly, detailed local database where it is easy to access, register and analyze data. Based on our experiences during building this registry, we develop the model of a modern type of database. METHOD: First we established a local registry in Excel, then data were transferred to the worldwide used iMed system. Separate pages were used to register basic data, follow-up visits, relapses, accompanying diseases, results of neuroimaging, cerebrospinal fluid, evoked response and other tests, pharmacological and non-pharmacological treatments. RESULTS: The database currently contains data of 316 patients. MRI was performed in 96%, cerebrospinal fluid examination in 45% of the patients. The rate of primary progressive disease at disease onset is 9%. Disease modifying treatments were applied in 82% of the patients. CONCLUSION: The traditional manual data entry and data export in PDF format is obsolete and time-consuming. The development of local disease-specific databases appropriate for clinical and research purposes requires continuous and mostly automatic data entry. In future local registries the establishment of uniform documentational language and structure, and automatic transfer of information among different digital systems are required. We present the model of such a registry, which is based on a healthcare data lake. Orv Hetil. 2019; 160(4): 131-137.


Assuntos
Coleta de Dados/normas , Bases de Dados como Assunto/normas , Bases de Dados Factuais , Esclerose Múltipla , Assistência ao Paciente/tendências , Sistema de Registros , Coleta de Dados/métodos , Bases de Dados Factuais/tendências , Previsões , Humanos , Hungria
8.
J Evid Based Med ; 12(1): 22-28, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30398014

RESUMO

BACKGROUND: This study aimed to assess the nationwide trends in optimal diabetic care and complications of elderly type 2 diabetes mellitus (T2DM) patients over a 6-year period in Thailand. METHODS: T2DM patients aged 65 years or older who received medical care at public hospitals in Thailand from 2010 to 2015 were included. The optimal T2DM care in elderly patients was defined as (1) blood pressure (BP) < 140/90, (2) hemoglobin A1C (HbA1c) < 7%, (3) low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL, (4) use of antiplatelet medications, and (5) use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) in hypertensive patients. T2DM treatment-related complications included hospital admissions due to dysglycemia. RESULTS: A total of 54 295 elderly T2DM patients were enrolled in this study. From 2010 to 2015, there was an increasing trend in the achievement of BP control and use of antiplatelet medications (P for trend < 0.01), whereas there was a decreasing trend in the achievement of HbA1c and LDL-C control among elderly T2DM patients (P for trend < 0.001). There was an increasing trend in the use of ACEI/ARB among elderly T2DM patients with hypertension (P for trend < 0.001). Hospital admissions due to dysglycemia decreased over the study period (P for trend < 0.001). CONCLUSION: There has been a trend change for diabetic care among elderly T2DM patients in Thailand. Further studies are needed to assess the impact on patient outcomes.


Assuntos
Complicações do Diabetes/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Hipertensão/tratamento farmacológico , Assistência ao Paciente/tendências , Idoso , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Pressão Sanguínea , LDL-Colesterol/sangue , Complicações do Diabetes/etiologia , Diabetes Mellitus Tipo 2/sangue , Feminino , Hemoglobina A Glicada/metabolismo , Hospitalização/tendências , Hospitais Públicos , Humanos , Hipertensão/complicações , Masculino , Inibidores da Agregação de Plaquetas/uso terapêutico , Prevalência , Tailândia/epidemiologia , Fatores de Tempo
11.
PLoS One ; 13(10): e0205433, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30304052

RESUMO

BACKGROUND: Patient support during tuberculosis treatment is expected to be more often available and more customized in low tuberculosis incidence, high-resource settings than in lower-resource settings. The aim of this systematic review is to provide an overview of tuberculosis patient support interventions implemented in low-incidence countries and an evaluation of their effects on treatment-related outcomes as well as their acceptability by patients and providers. METHODS: PubMed, Social Science Citation Index and Cumulative Index to Nursing and Allied Health and Literature were searched for the period 01.2006-05.2016 on publications describing tuberculosis patient support interventions in low-incidence countries (<20 patients per 100,000 population). RESULTS: Through our search strategy, 1875 unique publications were identified. Forty publications were included: 17 evaluated patient support quantitatively, 9 qualitatively and 14 only described the patient support. Nineteen publications assessed treatment supervision options only, 21 assessed (combinations of) treatment supervision, socio-economic, psycho-emotional, health-educational and other support. Of eight studies quantitatively evaluating the effects of support with a control group, four showed positive effects: two out of three that used combinations of patient support and two out of five that compared treatment supervision options. Heterogeneity of interventions precluded pooling of results. Qualitative and descriptive studies showed that patients appreciated individualized support including treatment supervision, psycho-emotional and socio-economic support; and digital health interventions. CONCLUSION: Our review shows that a variety of patient support interventions is implemented in low-incidence countries. Although only a few interventions were evaluated quantitatively, we identified potential best practices. The scarcity of evidence on effectiveness, however, indicates the need for further research to evaluate potential best practices.


Assuntos
Assistência ao Paciente/tendências , Pacientes , Tuberculose/epidemiologia , Canadá/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Incidência , Japão/epidemiologia , Psicologia , Fatores Socioeconômicos , Resultado do Tratamento , Estados Unidos/epidemiologia
12.
Rev Bras Enferm ; 71(5): 2461-2468, 2018.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30304177

RESUMO

OBJECTIVE: To investigate the forms of coping used to relieve tensions by elderly caregivers of elderly relatives and to know the type of support they receive from the Primary Health Care service at home. METHOD: A qualitative study with a theoretical-methodological contribution of Grounded Theory, carried out with 10 elderly caregivers interviewed between August 2014 and January 2015. RESULTS: Participants use primarily religious coping to deal with adverse situations that arise in their lives; they attribute to the sacred the strength to continue to age and care for another elderly person at home. Religiousness was the main coping strategy used by the participants, but little recognized by the health service. FINAL CONSIDERATIONS: It is recommended that the Primary Health Care service provide greater support to these caregivers and be attentive to the spiritual dimension as an auxiliary element in the process of comprehensive and inclusive health care of these elderly caregivers.


Assuntos
Cuidadores/psicologia , Assistência ao Paciente/métodos , Espiritualidade , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Feminino , Teoria Fundamentada , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/tendências , Pesquisa Qualitativa , Inquéritos e Questionários
14.
J Alzheimers Dis ; 66(1): 281-288, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30248051

RESUMO

BACKGROUND: Hip fracture is a major health problem and a patient's biological age, comorbidity, and cognitive vulnerability have an impact on its related outcomes. Length of stay (LOS) for these highly vulnerable patients is rather long and the possible causes have not been clearly identified yet. OBJECTIVE: We aimed to assess the main clinical factors associated with protracted LOS, focusing on delirium with or without dementia in older age hip fractured patients. METHODS: 218 subjects (mean age 86.70±6.18 years), admitted to the Orthogeriatric Unit of the Ospedale Policlinico San Martino (Italy), were recruited. All patients received physical and comprehensive geriatric assessment. Days to surgery, days from surgery to rehabilitation, and LOS were recorded. In-hospital and three months' mortality were reported. RESULTS: Prevalent delirium at hospital admission was of 3.1%. 35% of patients developed incident delirium. 56.4% were affected by dementia of Alzheimer-type. In addition, 52% of patients developed delirium superimposed to dementia. Mean LOS was 13.5±4.99 days. Namely, delirium, time to surgery, and complication rate disproportionally affected LOS. The analysis with 3 months mortality, based on cognitive vulnerability profiles, showed how delirium mainly affect short-term mortality in patients with dementia. CONCLUSION: Our exploratory study originally pointed out the high incidence of delirium superimposed to dementia in orthogeriatric wards and how delirium turns to be a moderator of LOS. The results meet the need for additional research by virtue of a deeper understanding of the impact of delirium and dementia on orthogeriatric clinical management and outcomes.


Assuntos
Delírio/terapia , Demência/terapia , Fraturas do Quadril/terapia , Tempo de Internação/tendências , Assistência ao Paciente/tendências , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Delírio/diagnóstico , Delírio/mortalidade , Demência/diagnóstico , Demência/mortalidade , Feminino , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/mortalidade , Hospitalização/tendências , Humanos , Masculino , Mortalidade/tendências , Assistência ao Paciente/mortalidade , Estudos Prospectivos
15.
J Alzheimers Dis ; 66(1): 185-194, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30248059

RESUMO

BACKGROUND: Previous studies have shown that patients with dementia receive less testing and treatment for stroke. OBJECTIVES: Our aim was to investigate hospital management of acute ischemic stroke in patients with and without dementia. METHODS: Retrospective analysis of prospectively collected data 2010-2014 from the Swedish national dementia registry (SveDem) and the Swedish national stroke registry (Riksstroke). Patients with dementia who suffered an acute ischemic stroke (AIS) (n = 1,356) were compared with matched non-dementia AIS patients (n = 6,755). Outcomes included length of stay in a stroke unit, total length of hospitalization, and utilization of diagnostic tests and assessments. RESULTS: The median age at stroke onset was 83 years. While patients with dementia were equally likely to be directly admitted to a stroke unit as their non-dementia counterparts, their stroke unit and total hospitalization length were shorter (10.5 versus 11.2 days and 11.6 versus 13.5, respectively, p < 0.001). Dementia patients were less likely to receive carotid ultrasound (OR 0.36, 95% CI [0.30-0.42]) or undergo assessments by the interdisciplinary team members (physiotherapists, speech therapists, occupational therapists; p < 0.05 for all adjusted models). However, a similar proportion of patients received CT imaging (97.4% versus 98.6%, p = 0.001) and a swallowing assessment (90.7% versus 91.8%, p = 0.218). CONCLUSIONS: Patients with dementia who suffer an ischemic stroke have equal access to direct stroke unit care compared to non-dementia patients; however, on average, their stay in a stroke unit and total hospitalization are shorter. Dementia patients are also less likely to receive specific diagnostic tests and assessments by the interdisciplinary stroke team.


Assuntos
Demência/diagnóstico por imagem , Demência/terapia , Assistência ao Paciente/métodos , Sistema de Registros , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/terapia , Estudos de Coortes , Demência/epidemiologia , Eletrocardiografia/métodos , Eletrocardiografia/tendências , Feminino , Humanos , Masculino , Neuroimagem/métodos , Neuroimagem/tendências , Assistência ao Paciente/tendências , Estudos Prospectivos , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Suécia/epidemiologia
16.
Am Soc Clin Oncol Educ Book ; 38: 838-849, 2018 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-30231412

RESUMO

This paper aims to review literature published on the support of cancer caregivers with health technology. Eighteen articles were reviewed to better understand cancer caregiving and categorized into four different themes: (1) design guidelines, (2) information facilitation, (3) social support, and (4) multicomponent interventions. Analysis of the current articles revealed that there are substantial gaps in knowledge regarding a range of health technologies that facilitate family caregiver support and its distribution to health institutions. Further research is needed in this area, as family caregivers are primary providers of essential elements of care to patients. Future studies should unpack existing barriers that interfere with the development of health technology interventions in cancer care.


Assuntos
Cuidadores , Oncologia , Assistência ao Paciente , Apoio Social , Humanos , Oncologia/métodos , Oncologia/normas , Oncologia/tendências , Assistência ao Paciente/métodos , Assistência ao Paciente/normas , Assistência ao Paciente/tendências , Guias de Prática Clínica como Assunto , Tecnologia , Telemedicina/métodos
18.
Urologe A ; 57(9): 1031-1039, 2018 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-30088025

RESUMO

Digitalization cannot be understood as an off-the-shelf product, bought as a one-time purchase in a warehouse. It rather requires a constantly developing vision, which comes with a continuous transformation process, hand in hand with strategic innovation management. Thus, digitalization means understanding the digital maturity level of an enterprise and the digital skills of the employees. Besides an investment in products, a successful digitalization process also necessitates consideration of the cost to release employees from their obligations in order to contribute to the process as well as for a dedicated and continuing staff training and education program. While digitalization in Germany is underdeveloped regarding both the national health infrastructure and the level of digitalization in hospitals, German clinics are recognizing more and more the importance of digitalization and are initiating digitalization strategies. In this regard, we can learn from our European partners, who have partially established advanced and innovative solutions. Looking into these flagship projects can help to see potentials and to identify valuable building blocks for our own strategy.


Assuntos
Assistência à Saúde , Registros Eletrônicos de Saúde , Troca de Informação em Saúde , Hospitais/tendências , Assistência ao Paciente/tendências , Registros Eletrônicos de Saúde/tendências , Previsões , Alemanha , Humanos
19.
BMC Palliat Care ; 17(1): 96, 2018 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-30037346

RESUMO

BACKGROUND: This systematic review aimed to identify the unmet care needs and their associated variables in patients with advanced cancer and informal caregivers, alongside summarizing the tools used for needs assessment. METHODS: Ten electronic databases were searched systematically from inception of each database to December 2016 to determine eligible studies. Studies that considered the unmet care needs of either adult patients with advanced cancer or informal caregivers, regardless of the study design, were included. The Mixed Methods Appraisal Tool was utilized for quality appraisal of the included studies. Content analysis was used to identify unmet needs, and descriptive analysis was adopted to synthesize other outcomes. RESULTS: Fifty studies were included, and their methodological quality was generally robust. The prevalence of unmet needs varied across studies. Twelve unmet need domains were identified in patients with advanced cancer, and seven among informal caregivers. The three most commonly reported domains for patients were psychological, physical, and healthcare service and information. The most prominent unmet items of these domains were emotional support (10.1-84.4%), fatigue (18-76.3%), and "being informed about benefits and side-effects of treatment" (4-66.7%). The most commonly identified  unmet needs for informal caregivers were information needs, including illness and treatment information (26-100%) and care-related information (21-100%). Unmet needs of patients with advanced cancer were associated with their physical symptoms, anxiety, and quality of life. The most commonly used instruments for needs assessment among patients with advanced cancer were the Supportive Care Needs Survey (N = 8) and Problems and Needs in Palliative Care questionnaire (N = 5). The majority of the included studies investigated unmet needs from the perspectives of either patients or caregivers with a cross-sectional study design using single time-point assessments. Moreover, significant heterogeneity, including differences in study contexts, assessment methods, instruments for measurement, need classifications, and reporting methods, were identified across studies. CONCLUSION: Both advanced cancer patients and informal caregivers reported a wide range of context-bound unmet needs. Examining their unmet needs on the basis of viewing patients and their informal caregivers as a whole unit will be highly optimal. Unmet care needs should be comprehensively evaluated  from the perspectives of all stakeholders and interpreted by using rigorously designed mixed methods research and longitudinal studies within a given context.


Assuntos
Cuidadores/psicologia , Determinação de Necessidades de Cuidados de Saúde/normas , Neoplasias/terapia , Humanos , Neoplasias/psicologia , Assistência ao Paciente/métodos , Assistência ao Paciente/tendências , Prevalência , Inquéritos e Questionários
20.
Best Pract Res Clin Anaesthesiol ; 32(1): 47-55, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30049338

RESUMO

Changed employment models, an ageing workforce and demands of new generations are challenging healthcare facilities to go down new paths. Never before have well-qualified staff been as highly sought after within the medical and nursing care sector as they are today. For many years, the Geriatric Health Care Centres of the city of Graz (GGZ)-a large regional health care provider with more than 650 staff across five locations-has focused a lot on the topic of competence management, facilitation of specialist and management careers in nursing and medicine as well as the optimal mix of skills and grades in staffing. In addition to competence management, quality management is another prerequisite for systematic staff development. The consistent path of quality management at GGZ has demonstrated for more than 15 years that the regular consideration of quality management systems supports the constant development of human resource management; additionally, it has also demonstrated that it leads to important certifications and prestigious prices: these include the KTQ award for Cooperation for Transparency and Quality in Health Care (Kooperation für Transparenz und Qualität im Gesundheitswesen) in 2010 and 2013, the Austrian Quality Award (Staatspreis Unternehmensqualität) in 2014, the European Quality Award from EFQM (European Foundation for Quality Management) in 2015 and runner-up for the Austrian award for the most family-friendly company (Staatspreis Familienfreundlichster Betrieb Österreichs) in 2014. Furthermore, the competitive edge is sustainably ensured. However, to remain competitive in the labour market and to satisfy the aforementioned requirements, skill-based teamwork and consideration of life-phase-orientation are keys to increase the job and life satisfaction of staff, especially for the mentally and physically draining work with elderly, chronically ill and dying patients. The facilitation of specialist and management careers and age-appropriate workplaces are in turn part of workplace health management of the company. Incorporating workplace health management into the corporate strategy allows health-related management decisions to be made. The integration of health-relevant agendas as strategic management instruments (e.g. the so-called balanced scorecard) is supported by the processes of quality management systems (e.g. EFQM). The strategic corporate objective of GGZ is to increase the health literacy of the population-and by doing so, also increases the health literacy of patients and residents. This kind of patient empowerment can be substantially supported by specially qualified, empathic staff with good social skills and a genuine interest in the elderly; this reinforces the high significance of professional human resource management.


Assuntos
Competência Clínica , Assistência à Saúde/tendências , Geriatria/tendências , Alocação de Recursos para a Atenção à Saúde/tendências , Pessoal de Saúde/tendências , Recursos Humanos/tendências , Competência Clínica/normas , Assistência à Saúde/normas , Geriatria/normas , Alocação de Recursos para a Atenção à Saúde/normas , Pessoal de Saúde/normas , Humanos , Assistência ao Paciente/normas , Assistência ao Paciente/tendências , Recursos Humanos/normas
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