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1.
Anaesthesia ; 76(1): 19-26, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32406071

RESUMO

Over 30,000 adult cardiac operations are carried out in the UK annually. A small number of these patients need to return to theatre in the first few days after the initial surgery, but the exact proportion is unknown. The majority of these resternotomies are for bleeding or cardiac tamponade. The Association of Cardiothoracic Anaesthesia and Critical Care carried out a 1-year national audit of resternotomy in 2018. Twenty-three of the 35 centres that were eligible participated. The overall resternotomy rate (95%CI) within the period of admission for the initial operation in these centres was 3.6% (3.37-3.85). The rate varied between centres from 0.69% to 7.6%. Of the 849 patients who required resternotomy, 127 subsequently died, giving a mortality rate (95%CI) of 15.0% (12.7-17.5). In patients who underwent resternotomy, the median (IQR [range]) length of stay on ICU was 5 (2-10 [0-335]) days, and time to tracheal extubation was 20 (12-48 [0-2880]) hours. A total of 89.3% of patients who underwent resternotomy were transfused red cells, with a median (IQR [range]) of 4 (2-7 [1-1144]) units of red blood cells. The rate (95%CI) of needing renal replacement therapy was 23.4% (20.6-26.5). This UK-wide audit has demonstrated that resternotomy after cardiac surgery is associated with prolonged intensive care stay, high rates of blood transfusion, renal replacement therapy and very high mortality. Further research into this area is required to try to improve patient care and outcomes in patients who require resternotomy in the first 24 h after cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Reoperação/mortalidade , Reoperação/estatística & dados numéricos , Esternotomia/mortalidade , Esternotomia/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Extubação , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Cuidados Críticos/estatística & dados numéricos , Transfusão de Eritrócitos/mortalidade , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Humanos , Incidência , Tempo de Internação , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/cirurgia , Terapia de Substituição Renal/mortalidade , Terapia de Substituição Renal/estatística & dados numéricos , Reino Unido/epidemiologia
2.
Radiol Clin North Am ; 59(1): 41-55, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33222999

RESUMO

Screening mammography aims to identify small, node-negative breast cancers when they are still curable while maintaining an acceptable range of false-positive recalls and biopsies. The mammography audit is a powerful tool to help radiologists understand their performance with respect to that goal. This article defines audit terms and describes how to use collected and derived data to perform a mammography audit. Accepted benchmarks are discussed as well as their applicability to radiologists and breast imaging practices in the United States. Special considerations regarding volumes and radiologist characteristics are explored, because these factors may affect audit results.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mamografia/normas , Auditoria Médica/métodos , Controle de Qualidade , Detecção Precoce de Câncer/normas , Feminino , Humanos , Programas de Rastreamento/normas , Estados Unidos , United States Food and Drug Administration
3.
Radiol Clin North Am ; 59(1): 57-65, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33223000

RESUMO

Breast magnetic resonance (MR) imaging is the most sensitive imaging modality for breast cancer detection and guidelines recommend its use, in addition to screening mammography, for high-risk women. The most recent American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) manual coordinated cross-modality BI-RADS terminology and established an outcome monitoring section that helps guide a medical imaging outcomes audit. This article provides a framework for performing a breast MR imaging audit in clinical practice, incorporating ACR BI-RADS guidance and more recently published data, clarifies common pitfalls, and discusses audit challenges related to evolving clinical practice.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Auditoria Médica/métodos , Mama/diagnóstico por imagem , Detecção Precoce de Câncer/tendências , Feminino , Humanos , Imagem por Ressonância Magnética/tendências
4.
Recenti Prog Med ; 111(12): 714-716, 2020 12.
Artigo em Italiano | MEDLINE | ID: mdl-33362167

RESUMO

The first of a series of four online meetings entitled "A&F CONNECTIONS. In practice and in response to Covid-19", as part of the EASY-NET network program on the topic of Audit & Feedback (A&F), was an opportunity to present and discuss the first results of a survey carried out by the area working on A&F, to describe the characteristics of A&F interventions in the EASY-NET context. A reflection on the preliminary results of the investigation and on the cultural dimension of the importance of creating a bridge between the world of clinicians and the world of epidemiology, for a real and virtuous exchange of information.


Assuntos
/terapia , Epidemiologistas , Pesquisas sobre Serviços de Saúde , Troca de Informação em Saúde , Comunicação Interdisciplinar , Médicos , Telecomunicações , Feedback Formativo , Humanos , Internet , Itália , Auditoria Médica
5.
Br J Hosp Med (Lond) ; 81(12): 1-8, 2020 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-33377847

RESUMO

BACKGROUND/AIMS: Maintaining emergency eye services is crucial during the COVID-19 pandemic. This article describes the introduction of a new restructured referral pathway to reduce the burden on healthcare providers and create a safe environment. METHODS: During January and February 2020 (group 1), all appointments were face-to-face with a walk-in eye casualty. The first audit cycle comprised all patients in group 1. The primary audit criteria were discharge rates, referral to subspeciality and reattendance. In April 2020, a remodelled system was implemented in which walk-in attendance ceased and was replaced with telephone triage coupled with digital imaging via NHS email for remote clinical review. Patients requiring further assessment following this triage were invited in for face-to-face appointments. A reaudit was conducted during April-July 2020 (group 2) following implementation of these COVID-19 protocol changes. RESULTS: In group 1, 2868 appointments (100.0%) were face-to-face and in group 2 4870 (100.0%) appointments were telephone consults that resulted in 2639 (54.2%) face-to-face appointments. The rate of discharge in the first cycle and second cycle were 55.3% and 76.9% respectively (P<0.0001). Furthermore 2298 (47.2%) patients were able to be discharged following telephone consultation in group 2. CONCLUSIONS: Using this telephone and digital imaging review triage system, the authors have demonstrated a significant reduction in the need for face-to-face reviews. The reduction in avoidable patient face-to-face reviews allows the system to move from saturated to sustainable while increasing accessibility to services for patients who may not be able to present for face-to-face review. This complete audit cycle successfully charts interventions that maximise accessibility, reduce unnecessary hospital visits and deliver safe and prompt management during the pandemic.


Assuntos
/epidemiologia , Assistência à Saúde/organização & administração , Emergências , Traumatismos Oculares/terapia , Telemedicina/métodos , Triagem , Agendamento de Consultas , Humanos , Auditoria Médica , Pandemias , Encaminhamento e Consulta , Reino Unido
6.
N Z Med J ; 133(1526): 18-30, 2020 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-33332337

RESUMO

AIM: To describe stroke services currently offered in New Zealand hospitals and compare service provision in urban and non-urban settings. METHOD: An online questionnaire was sent to stroke lead clinicians at all New Zealand District Health Boards (DHBs). Questions covered number and location of stroke inpatients, stroke service configuration, use of guidelines/protocols, staffing mix, access to staff education, and culture appropriate care. RESULTS: There were responses from all 20 DHBs. Differences between urban and non-urban hospitals included: access to acute stroke units (55.6% non-urban vs 100% urban; p=0.013), stroke clinical nurse specialists (50% vs 90%; p=0.034), stroke clot retrieval (38.9% vs 80%; p=0.037) and Pacific support services (55.6% vs 100%; p=0.030). There were also differences in carer training (66.7% non-urban vs 100% urban; p=0.039) and goal-specific rehabilitation plans in the community (61.1% vs 100%; p=0.023). Access to TIA services, stroke rehabilitation units, early supported discharge, psychologists, continuing staff education, and culturally responsive stroke care were suboptimal irrespective of hospital location. CONCLUSION: Hospital location is associated with differences in stroke services provision across New Zealand and ongoing work is required to optimise consistent access to best practice care. These results, in conjunction with an ongoing (REGIONS Care) study, will be used to determine whether this affects patient outcomes.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Auditoria Médica/métodos , Qualidade da Assistência à Saúde , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/prevenção & controle , Humanos , Morbidade/tendências , Nova Zelândia/epidemiologia , Acidente Vascular Cerebral/epidemiologia
7.
N Z Med J ; 133(1526): 67-75, 2020 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-33332341

RESUMO

AIM: The Systematised Nomenclature of Medicine - Clinical Terms (SNOMED-CT) coding system has been introduced to emergency departments in New Zealand, starting with the patient's chief presenting complaint (CPC). However, it is not known how accurate CPC coding at triage is, or whether coding accuracy varies by patient characteristics. The aim of this study was to determine the accuracy of CPC coding. METHOD: We compared the real-time triage recorded CPC with the presenting complaints recorded in medical notes by the treating clinician. Agreement was determined by exact CPC matches and the kappa statistic. RESULTS: From 1,000 consecutive presentations 852 were eligible (89 CPCs). Real-time CPC agreed with clinical notes in 514/852 (60.3%) cases. When real-time free text comments were included, agreement was 732/852 (85.9%). There were no differences by age, sex or ethnicity. Agreement for the common CPCs: 'trauma' (21%); 'abdominal pain' (11%), 'chest pain' 87 (10%) and 'shortness of breath' (8%) was substantial, k=0.66 (95% CI: 0.61, 0.70). Use of non-specific CPC such as 'referral for investigation' (5%) and 'general weakness/fatigue/unwell' (2%) was uncommon but associated with poor agreement. CONCLUSION: The accuracy of real-time coding for CPC using SNOMED-CT was reasonable, except for non-specific CPCs, which should be avoided where possible.


Assuntos
Emergências/classificação , Serviço Hospitalar de Emergência , Auditoria Médica/estatística & dados numéricos , Triagem/normas , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
Chirurgia (Bucur) ; 115(5): 595-599, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33138896

RESUMO

Introduction: Recent evidence suggests the need to proceed with a surveillance colonoscopy in patients above the age of 40 years who undergo appendicectomy for acute appendicitis, given the higher risk of an underlying colonic tumor. After anecdotally observing a substantial variability in terms of adaptation of these recommendations by the on-call surgical teams, we performed a clinical audit regarding our relevant endoscopic follow-up compliance rates to identify areas for improvement of our practise. Materials Methods: We performed a retrospective review of the electronic records of all patients above 40 years who had appendicectomy for acute appendicitis within a 3-year period in our institution, assessing as primary outcome the actual performance of a follow-up colonoscopy and the detected endoscopic findings. Results: Our results demonstrated that more than 80% of our patients did not have an endoscopic follow-up, as suggested by the current evidence. In addition, with respect to the subspecialisation of the parent surgical team, it seems that non-colorectal teams had lower compliance regarding the arrangement of endoscopic surveillance, when compared to specialist colorectal team. Conclusions: Emergency surgical teams need to be further educated with respect to the current practise recommendations concerning the appropriate endoscopic follow-up after the performance of appendicectomy for acute appendicitis. Establishment of dedicated bundles of postoperative care, as well as clear relevant guidance from the gastrointestinal/emergency surgery societies would be of great value in this direction.


Assuntos
Apendicectomia , Apendicite , Neoplasias do Colo/diagnóstico , Colonoscopia , Vigilância da População , Doença Aguda , Fatores Etários , Apendicite/complicações , Apendicite/cirurgia , Neoplasias do Colo/complicações , Detecção Precoce de Câncer , Humanos , Auditoria Médica , Estudos Retrospectivos
9.
Acute Med ; 19(4): 209-219, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33215174

RESUMO

INTRODUCTION: The eighth Society for Acute Medicine Benchmarking Audit (SAMBA19) took place on Thursday 27th June 2019. SAMBA gives a broad picture of acute medical care in the UK and allows individual units to compare their performance against their peers. METHOD: All UK hospitals were invited to participate. Unit and patient level were collected. Data were analysed against published Clinical Quality indicators (CQI) and standards. This was the biggest SAMBA to date, with data from 7170 patients across 142 units in 140 hospitals. RESULTS: 84.5% of patients had an Early Warning Score measured within 30 minutes of arrival in hospital (SAMBA18 84.1%), 90.4% of patients were seen by a competent clinical decision maker within four hours of arrival in hospital (SAMBA18 91.4 %) and 68.6% of patients were seen by a consultant within the timeframe standard (SAMBA18 62.7%). Ambulatory Emergency Care is provided in 99.3% of hospitals. 61.8% of patients are initially seen in the Emergency Department (ED). Since SAMBA18 death rates and planned discharge rates, while the use of NEWS2 increased from 2.5% to 59.2% of hospitals. CONCLUSION: SAMBA19 highlighted the evolving complexity of acute medical pathways for patients. The challenge now is to increase sample frequency, assess the impact of SAMBA open a broader debate to define optimal CQIs.


Assuntos
Benchmarking , Auditoria Médica , Cuidados Críticos , Emergências , Serviço Hospitalar de Emergência , Humanos
10.
Acute Med ; 19(4): 220-229, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33215175

RESUMO

The Winter Society for Acute Medicine Benchmarking Audit (SAMBA) provides the first comparison of performance within acute medicine against clinical quality indicators during winter, a time of increased pressure and demand on acute services. 105 hospitals participated in Winter SAMBA, collecting data over 24-hours on 30th January 2020. 5626 patients were included. Participating units saw a median of 48 patients (range 13-131). Comparison between Winter SAMBA and SAMBA19 found less patients had an early warning score within 30 minutes during winter (74.3% vs 78.9%) and less were seen by a clinical decision maker within four hours (84.9% vs 87.9%). Unplanned admissions represented a higher proportion of workload (92.5% vs 90.1%). Patients were more likely to have a NEWS2 score of 3 or higher (30.1% vs 25.7%). Performance is poorer in winter, and patients are more unwell, needing prompt treatment. Services should ensure high quality care can be maintained through times of increased pressure, including winter.


Assuntos
Benchmarking , Auditoria Médica , Cuidados Críticos , Hospitalização , Hospitais , Humanos
12.
Igaku Butsuri ; 40(3): 88-96, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32999255

RESUMO

The quality assurance (QA) of the output constancy of linear accelerators (linacs) is one of the most basic items for radiation therapy. The necessity and demand of the dosimetric audit is on the rise. We aimed at establishing an on-site dosimetric audit program with a plastic phantom in order to enrich the availability of dosimetric audit in Japan. By this, we developed and evaluated an on-site audit program in multiple institutions in 120 cases for photon and electron standard dosimetry and intensity modulated radiation therapy (IMRT) condition. For photon standard dosimetry, we evaluated the accuracies of institutional measured absorbed dose in 50 cases by this on-site audit program. For the electron standard dosimetry, we evaluated the accuracies of institutional measured absorbed dose in 25 cases. For IMRT condition, we evaluated the accuracies of the institutional calculated dose in radiation treatment planning systems in 45 cases. The agreements of the measured absorbed dose between our audit and the institutions were within±1.1% for photon standard dosimetry. The agreements of the measured absorbed dose between our audit and the institutions were within±2.1% for electron standard dosimetry. The agreements between the measured absorbed dose of our audit and the institutional calculated dose were within±2.1% for IMRT condition. We established an on-site dosimetric audit program with a plastic phantom and this program is suitable with tight criteria similar to criteria required for clinical QA.


Assuntos
Auditoria Médica/métodos , Garantia da Qualidade dos Cuidados de Saúde , Radiometria/métodos , Radioterapia de Intensidade Modulada/métodos , Radioterapia de Intensidade Modulada/normas , Humanos , Japão , Auditoria Médica/normas , Órgãos em Risco , Imagens de Fantasmas , Plásticos , Radiometria/normas , Dosagem Radioterapêutica , Risco , Sensibilidade e Especificidade
13.
PLoS One ; 15(10): e0240719, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33057427

RESUMO

How much can we rely on whether what was reported in a study was actually done? Systematic and independent examination of records, documents and processes through audits are a central element of quality management systems. In the context of current concerns about the robustness and reproducibility of experimental biomedical research audits have been suggested as a remedy a number of times. However, audits are resource intense and time consuming, and due to their very nature may be perceived as inquisition. Consequently, there is very little experience or literature on auditing and assessments in the complex preclinical biomedical research environment. To gain some insight into which audit approaches might best suit biomedical research in academia, in this study we have applied a number of them in a typical academic neuroscience environment consisting of twelve research groups with about 100 researchers, students and technicians, utilizing the full gamut of state-of-the-art methodology. Several types of assessments and internal as well as external audits (including the novel format of a peer audit) were systematically explored by a team of quality management specialists. An experimental design template was developed (and is provided here) that takes into account and mitigates difficulties, risks and systematic errors that may occur during the course of a study. All audits were performed according to a pre-defined workflow developed by us. Outcomes were assessed qualitatively. We asked for feedback from participating employees in every final discussion of an audit and documented this in the audit reports. Based on these reports follow-up audits were improved. We conclude that several realistic options for auditing exist which have the potential to improve preclinical biomedical research in academia, and have listed specific recommendations regarding their benefits and provided practical resources for their implementation (e.g. study design and audit templates, audit workflow).


Assuntos
Pesquisa Biomédica/normas , Auditoria Médica/normas , Estudos de Viabilidade , Humanos , Neurologia , Autoavaliação
15.
Clin Med (Lond) ; 20(6): e234-e237, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33067188

RESUMO

The British Thoracic Society have published SPACES (Sharing Patient Assessments Cuts Exposure for Staff) guidance recommending the use of telecommunications as a means of inpatient clinical assessment during the COVID-19 pandemic. The aim of this audit was to reduce face-to-face exposure time during inpatient care of patients with suspected/confirmed COVID-19 using a telecommunications-based approach. 76 patients were included in the audit. 46 patients were included in cycle 1, which measured the average face-to-face time for clinical consultation per patient. 30 patients were included in cycle 2, whereby history-taking was conductedusing telecommunications and, if required, face-to-face physical examination.Average face-to-face exposure time was reduced to a median of 0 seconds (IQR 0-146.3 seconds) in the telecommunications group, from a median of 312.5 seconds (IQR 178.8-442.3 seconds) in the comparator group (p<0.0001). Patient satisfaction was high with individuals' responses revealing a perception of improved safety by maintaining social distancing. No adverse events were noted.The audit confirms telecommunications can be integrated successfully into the daily inpatient ward round structure, reducing face-to-face exposure time while maintaining patient satisfaction and safety.


Assuntos
Infecções por Coronavirus , Hospitais , Exposição Ocupacional , Pandemias , Satisfação do Paciente/estatística & dados numéricos , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Inglaterra , Humanos , Auditoria Médica , Exposição Ocupacional/prevenção & controle , Exposição Ocupacional/estatística & dados numéricos , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Telemedicina
16.
J Am Heart Assoc ; 9(22): e018379, 2020 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-33023348

RESUMO

Background Studies have reported significant reduction in acute myocardial infarction-related hospitalizations during the coronavirus disease 2019 (COVID-19) pandemic. However, whether these trends are associated with increased incidence of out-of-hospital cardiac arrest (OHCA) in this population is unknown. Methods and Results Acute myocardial infarction hospitalizations with OHCA during the COVID-19 period (February 1-May 14, 2020) from the Myocardial Ischaemia National Audit Project and British Cardiovascular Intervention Society data sets were analyzed. Temporal trends were assessed using Poisson models with equivalent pre-COVID-19 period (February 1-May 14, 2019) as reference. Acute myocardial infarction hospitalizations during COVID-19 period were reduced by >50% (n=20 310 versus n=9325). OHCA was more prevalent during the COVID-19 period compared with the pre-COVID-19 period (5.6% versus 3.6%), with a 56% increase in the incidence of OHCA (incidence rate ratio, 1.56; 95% CI, 1.39-1.74). Patients experiencing OHCA during COVID-19 period were likely to be older, likely to be women, likely to be of Asian ethnicity, and more likely to present with ST-segment-elevation myocardial infarction. The overall rates of invasive coronary angiography (58.4% versus 71.6%; P<0.001) were significantly lower among the OHCA group during COVID-19 period with increased time to reperfusion (mean, 2.1 versus 1.1 hours; P=0.05) in those with ST-segment-elevation myocardial infarction. The adjusted in-hospital mortality probability increased from 27.7% in February 2020 to 35.8% in May 2020 in the COVID-19 group (P<.001). Conclusions In this national cohort of hospitalized patients with acute myocardial infarction, we observed a significant increase in incidence of OHCA during COVID-19 period paralleled with reduced access to guideline-recommended care and increased in-hospital mortality.


Assuntos
/epidemiologia , Hospitalização/tendências , Parada Cardíaca Extra-Hospitalar/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , /mortalidade , Feminino , Humanos , Incidência , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Reperfusão Miocárdica/tendências , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/terapia , Prevalência , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Fatores de Tempo , Tempo para o Tratamento/tendências , Reino Unido/epidemiologia , Adulto Jovem
17.
Injury ; 51(12): 2822-2826, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32951919

RESUMO

COVID-19 has had profound management implications for orthopaedic management due to balancing patient outcomes with clinical safety and limited resources. The BOAST guidelines on outpatient orthopaedic fracture management took a pragmatic approach. At Great Western Hospital, Swindon, a closed loop audit was performed looking at a selection of these guidelines, to assess if our initial changes were sufficient and what could be improved. METHOD: An audit was designed around fracture immobilisation, type of initial fracture clinic assessment, default virtual follow up clinic and late imaging. Interventions were implemented and re-audited. RESULTS: Initially 223 patients were identified over 4 weeks. Of these, 100% had removable casts and 99% did not have late imaging. 96% of patients were initially assessed virtually or had initial orthopaedic approval to be seen in face to face clinic. 97% had virtual follow up or had documented reasons why not. The 26 patients who were initially seen face to face were put through a simulated virtual fracture clinic. 22 appointments and 13 Xray attendances could have been avoided. We implemented a change of requiring all patients to be assessed at consultant level before having a face to face appointment. The re-audit showed over 99% achievement in all areas. CONCLUSION: Virtual fracture clinics, both triaging new patients and follow-up clinics have dramatically changed our outpatient management, helping the most appropriate patients to be seen face to face. Despite their limitations, they have been well tolerated by patients and improved patient safety and treatment.


Assuntos
/prevenção & controle , Fraturas Ósseas/terapia , Ortopedia/organização & administração , Ambulatório Hospitalar/organização & administração , Telemedicina/organização & administração , Assistência ao Convalescente/organização & administração , Assistência ao Convalescente/normas , Assistência ao Convalescente/estatística & dados numéricos , Controle de Doenças Transmissíveis/normas , Inglaterra , Fixação de Fratura , Fraturas Ósseas/diagnóstico , Fidelidade a Diretrizes/estatística & dados numéricos , Implementação de Plano de Saúde , Humanos , Auditoria Médica/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Ortopedia/normas , Ortopedia/estatística & dados numéricos , Ambulatório Hospitalar/normas , Ambulatório Hospitalar/estatística & dados numéricos , Pandemias/prevenção & controle , Segurança do Paciente , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Sociedades Médicas/normas , Telemedicina/normas , Telemedicina/estatística & dados numéricos , Resultado do Tratamento
18.
Recenti Prog Med ; 111(9): 487-491, 2020 09.
Artigo em Italiano | MEDLINE | ID: mdl-32914776

RESUMO

CoViD-19 pandemic heavily impacted most on-going research activities, causing delays and need of re-programming. EASY-NET (NET-2016-02364191) is a network project, started in April 2019, co-funded by the Italian Ministry of Health and the participating regions. Within the general project, centred on the evaluation of Audit and Feedback (A&F) strategies in improving quality and equity in different health care contexts, the Piedmont region is responsible of the work package 3 (WP3) on specific oncology pathways and procedures. After a thorough evaluation of the impact of the CoViD-19 emergency on the WP3 activities, at the beginning of March 2020, the decision was to continue, with some adaptations, the audits already started, and to delay those in the early planning phase. The provisional availability of part of the time-persons involved in EASY-NET on one side, and the urgency of acquiring data on the management of the large number of CoViD-19 patients admitted to the study coordinator hospital on the other side, determined the personnel responsible of the WP3, in accordance with the hospital management, to invest these resources in monitoring the CoViD-19 hospitalized patients with both A&F activity and research objectives. Besides periodic reports, a web site, with restricted access to the involved health care personnel, was developed to allow a direct and timely consultation of graphics describing the flow of the patients, their management, and outcomes. This experience was made possible thanks to a favourable combination of different factors: the presence within the hospital of a group of experienced epidemiologists in A&F, the availability of extra resources, the strong support and collaboration by the hospital management and the readiness for authorisation by the Ethics Committee. We underline the need to provide a certain degree of flexibility in the long-term projects funded by the Ministry of Health, the extraordinary adaptability of the A&F approach also to emergency situations and the possibility of combining audit activities and research objectives in the same project.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Hospitalização/estatística & dados numéricos , Auditoria Médica/organização & administração , Pneumonia Viral/epidemiologia , Pesquisa Biomédica/organização & administração , Assistência à Saúde/normas , Humanos , Itália/epidemiologia , Pandemias , Qualidade da Assistência à Saúde
19.
PLoS One ; 15(8): e0235826, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760142

RESUMO

BACKGROUND: Thrombophilia-screen tests are specialised haemostasis tests that are affected by numerous unique patient variables including the presence of acute thrombosis, the concomitant use of medication and patient demographics. Complete information on the request form is therefore crucial for the haematological pathologist to make patient-specific interpretation of patients' results. OBJECTIVES: To assess the completeness of thrombophilia-screen test request forms and determine the impact of provision of incomplete information, on the interpretive comments generated by reporting haematological pathologists. To assess the impact of an educational session given to clinicians on the importance of providing all the relevant information on the request forms. METHOD: Two retrospective audits, each covering 3 months, were performed to evaluate the completeness of demographic and clinical information on thrombophilia-screen request forms and its impact on the quality of the interpretive comments before and after an educational intervention. RESULTS: One hundred and seventy-one request forms were included in the first audit and 146 in the second audit. The first audit revealed that all 171 thrombophilia-screen request forms had complete patient demographic information but none had clinical information. Haematological pathologists only made generic comments which could not be applied to a specific patient. The second audit, conducted after a physician educational session, did not reveal any improvement in the clinical information provision by the test-ordering physicians. This was reportedly due to the lack of space on the request form. The interpretive comments therefore remained generic and not patient-specific. CONCLUSION: Physicians' failure to provide relevant clinical information made it impossible for pathologists to make patient-specific interpretation of the results. A single physician education session did not change the practice, reportedly due to the inappropriate design of the test request form. Further studies are required to investigate the impact of an improved request form and the planned electronic test requesting.


Assuntos
Educação Médica Continuada , Programas de Rastreamento/normas , Registros Médicos/normas , Médicos/normas , Trombofilia/diagnóstico , Controle de Formulários e Registros/estatística & dados numéricos , Humanos , Programas de Rastreamento/estatística & dados numéricos , Auditoria Médica/estatística & dados numéricos , Registros Médicos/estatística & dados numéricos , Médicos/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , África do Sul
20.
N Z Med J ; 133(1519): 62-69, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32777796

RESUMO

AIM: To assess whether trimethoprim remains an appropriate empiric treatment for uncomplicated cystitis in women 15-55 years old. METHODS: General practitioners in Auckland, Nelson-Marlborough, Otago and Southland were invited to participate in this audit of current practice. Participating general practitioners were asked to submit urine to the laboratory for microscopy and culture from any woman aged 15-55 years presenting with uncomplicated cystitis. Urine samples submitted as part of the audit were identified by a "copy to" code. Data on laboratory results were extracted from the laboratory information system. RESULTS: Data were collected from June 2016 to August 2018. Four hundred and eighty-one samples were submitted, of which 340 (70.7%) met the inclusion criteria of the audit. A urinary pathogen was identified in 181 (53.2%) specimens, of which 148 (81.8%) were E. coli, 13 (7.2%) other coliforms and 20 (11.0%) Staphylococcus saprophyticus. Of the E. coli isolates, 109 of 148 (73.6%, 95% CI 66.6-80.7) were susceptible to trimethoprim, 144 of 144 (100%, 95% CI 100-100) to nitrofurantoin and 143 of 148 (96.6%, 95% CI 93.7-99.5) to cefalexin. Of the urinary pathogens, 139 of 185 (75.1%, 95% CI 68.9-81.4) were susceptible to trimethoprim, 164 of 177 tested (92.7%, 95% CI 88.8-96.5) to nitrofurantoin and 166 of 178 tested (93.3%, 95% CI 89.6-96.9) to cefalexin. Overall, a uropathogen resistant to trimethoprim was detected in 13.5%, to nitrofurantoin in 3.8%, and to cefalexin in 3.5% of samples tested. CONCLUSION: Similar rates of resistance to trimethoprim were seen in women 15-55 years old presenting with cystitis compared with unselected samples submitted from the general community. Given the high rates of resistance, trimethoprim is no longer appropriate as an empiric treatment option for cystitis in this group. Nitrofurantoin or cefalexin are appropriate alternative empiric treatment options. Given the current recommendation that a urine sample should not be submitted to the laboratory from women with uncomplicated cystitis, ongoing audits will be required to ensure that empiric treatment recommendations remain appropriate.


Assuntos
Antibacterianos/uso terapêutico , Cistite , Farmacorresistência Bacteriana/efeitos dos fármacos , Prescrição Inadequada/estatística & dados numéricos , Trimetoprima/uso terapêutico , Adolescente , Adulto , Antibacterianos/farmacologia , Cistite/tratamento farmacológico , Cistite/microbiologia , Escherichia coli , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Feminino , Clínicos Gerais , Humanos , Auditoria Médica , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Nova Zelândia , Trimetoprima/farmacologia , Adulto Jovem
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