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2.
Medicine (Baltimore) ; 99(51): e23776, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371146

RESUMO

ABSTRACT: Whereas handover of pertinent information between hospital and primary care is necessary to ensure continuity of care and patient safety, both quality of content and timeliness of discharge summary need to be improved. This study aims to assess the impact of a quality improvement program on the quality and timeliness of the discharge summary/letter (DS/DL) in a University hospital with approximatively 40 clinical units using an Electronic medical record (EMR).A discharge documents (DD) quality improvement program including revision of the EMR, educational program, audit (using scoring of DD) and feedback with a ranking of clinical units, was conducted in our hospital between October 2016 and November 2018. Main outcome measures were the proportion of the DD given to the patient at discharge and the mean of the national score assessing the quality of the discharge documents (QDD score) with 95% confidence interval.Intermediate evaluation (2017) showed a significant improvement as the proportion of DD given to patients increased from 63% to 85% (P < .001) and mean QDD score rose from 41 (95%CI [36-46]) to 74/100 (95%CI [71-77]). In the final evaluation (2018), the proportion of DD given to the patient has reached 95% and the mean QDD score was 82/100 (95% CI [80-85]). The areas of the data for admission and discharge treatments remained the lowest level of compliance (44%).The involvement of doctors in the program and the challenge of participating units have fostered the improvement in the quality of the DD. However, the level of appropriation varied widely among clinical units and completeness of important information, such as discharge medications, remains in need of improvement.


Assuntos
Documentação/normas , Alta do Paciente/normas , Avaliação de Programas e Projetos de Saúde/métodos , Fatores de Tempo , Estudos Controlados Antes e Depois , Documentação/métodos , Documentação/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Paris , Alta do Paciente/estatística & dados numéricos , Melhoria de Qualidade
3.
Artigo em Inglês | MEDLINE | ID: mdl-33348556

RESUMO

The teaching personal and social responsibility (TPSR) model has been extensively used in a vast array of settings. However, few TPSR studies have focused on preschool settings. The purpose of this action research study was to analyze the experiences of a program leader, her preschool children, and their parents throughout a TPSR program focused on transference of responsibility model goals. The participants were 25 preschool children, six parents, and a program leader involved in a preschool setting located in the north of Portugal. Data were collected through reflexive journaling, participant observations, semi-structured interviews, and focus group interviews. Findings suggest the TPSR model could be a useful instructional model for preschool teachers focused on providing social and emotional learning opportunities to their students. In order to foster transference, parents played a pivotal role in this process and were included in the intervention, which appeared to enhance life skill transfer.


Assuntos
Objetivos , Avaliação de Programas e Projetos de Saúde/métodos , Professores Escolares/psicologia , Responsabilidade Social , Estudantes/psicologia , Ensino , Pré-Escolar , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Educação Física e Treinamento , Portugal
4.
PLoS One ; 15(10): e0233948, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33104731

RESUMO

The US budget for global health funding, which was by far the largest of similar funding in the world, increased from US $1.3 billion in 2001 to more than US $10 billion in recent years. More than 54% of this funding was allocated to the Global Fund to Fight HIV/AIDS through the US President's Emergency Plan for AIDS Relief (PEPFAR) in Africa. However, recent studies indicate contradictory results regarding the effectiveness of PEPFAR. One by Bendavid, Holmes, Bhattacharya, and Miller shows positive effects of PEPFAR in reducing adult mortality in Africa, while another by Duber, Coates, Szekeras, Kaji, and Lewis finds that there are no significant differences in reducing adult mortality in countries that received PEPFAR funding vs countries that did not. Due to their potential impact on policy decisions regarding critical global health funding, we wanted to assess why the results are discrepant. To do this, we replicated the Bendavid study. The replication provides verification that the study replicable and that the analytic choices of the authors are robust to different assumptions or restrictions. This allows us to assess the different choices and data available to the two research groups and draw some conclusions about why the results may be different. Then, focusing on two of the prominently discrepant studies, i.e., the Bendavid study (1998-2008) and the Duber study (2000-2006), we establish why the two studies are in disagreement. We apply appropriate individual-level and country-level analytical methodology as used by Bendavid over the analytical time period used for the Duber study (2000-2006), which originally focused on nationally aggregated data and differed in some key focus countries. For our first objective, we replicated the original Bendavid study findings and our findings support their conclusion that between 1998-2008 all-cause mortality decreased significantly more (OR = 0.84, CI, 0.72-0.99) in countries that implemented PEPFAR. For our second objective (Bendavid's data and methodology applied to Duber's study period), we found reduction in all cause adult mortality to be borderline insignificant (OR = 0.87 CI, 0.75-1.01, p = 0.06), most possibly reflecting the abbreviated fewer number of events and sample size over a shorter period. Therefore, our overall analyses are consistent with the conclusion of positive impact of the PEPFAR program in reducing adult mortality. We believe that the discrepancy observed in the original studies mainly a reflection of shortcomings in the analytical approach necessitated by the Duber study's nationally aggregated dataset or "may reflect a lack of data quality" in the Duber study (Duber, et al. 2010).


Assuntos
Saúde Global/legislação & jurisprudência , Infecções por HIV/mortalidade , Avaliação de Programas e Projetos de Saúde/métodos , Adulto , África ao Sul do Saara/epidemiologia , Países em Desenvolvimento , Feminino , Saúde Global/economia , Infecções por HIV/economia , Promoção da Saúde/economia , Promoção da Saúde/legislação & jurisprudência , Humanos , Cooperação Internacional/legislação & jurisprudência , Avaliação de Resultados da Assistência ao Paciente , Estados Unidos
5.
Glob Health Sci Pract ; 8(3): 396-412, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33008854

RESUMO

This article assesses the CORE Group Polio Project (CGPP) experience over a 20-year period in 5 countries. It examines how a program designed to provide social mobilization to eradicate one disease, and which did so effectively, functioned within the general framework of community health workers (CHWs). Vertical health programs often have limited impact on broader community health. CGPP has a 20-year history of social mobilization and effective program interventions. This history provided an opportunity to assess how CGPP community mobilizers (CMs) functioned in polio and maternal and child health. The Updated Program Functionality Matrix for Optimizing Community Health Programs tool of the CHW Assessment and Improvement Matrix (AIM) was used to examine CGPP CM roles across different contexts. The analysis determined that CGPP CMs met the basic level of functioning (level 3) for 6 of the 10 components of the AIM tool. This cross-country descriptive analysis of the CGPP demonstrates the importance of embracing the full range of CHW AIM components, even in a vertical program. Use of data, community involvement, local adaptation, and linkage with the health system are especially critical for success. This general lesson could be applied to other community mobilization and disease/epidemic control initiatives, especially as we face the issues of the COVID-19 pandemic.


Assuntos
Agentes Comunitários de Saúde , Erradicação de Doenças/métodos , Poliomielite/prevenção & controle , Avaliação de Programas e Projetos de Saúde/métodos , Serviços de Saúde Rural , África , Ásia , Humanos , População Rural
6.
BMC Public Health ; 20(1): 1463, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993607

RESUMO

BACKGROUND: Healthcare facilities are notorious for occupational health and safety problems. Multi-level interventions are needed to address interacting exposures and their overlapping origins in work organization features. Worker participation in problem identification and resolution is essential. This study evaluates the CPH-NEW Healthy Workplace Participatory Program (HWPP), a Total Worker Health® protocol to develop effective employee teams for worker safety, health, and wellbeing. METHODS: Six public sector, unionized healthcare facilities are enrolled, in three pairs, matched by agency. The unit of intervention is a workplace health and safety committee, adapted here to a joint labor-management "Design Team" (DT). The DT conducts root cause analyses, prioritizes problems, identifies feasible interventions in light of the constraints and needs of the specific setting, makes business-case presentations to facility leadership, and assists in evaluation. Following a stepped-wedge (cross-over) design, one site in each pair is randomly assigned to "immediate intervention" status, receiving the full coached intervention at baseline; in the "lagged intervention" site, coaching begins about half-way through the study. Program effectiveness and cost-effectiveness outcomes are assessed at both organizational (e.g., workers' compensation claim and absenteeism rates, perceived management support of safety) and individual levels (e.g., self-rated health, sleep quality, leisure-time exercise). Targeted pre-post analyses will also examine specific outcomes appropriate to the topics selected for intervention. Process evaluation outcomes include fidelity of the HWPP intervention, extent of individual DT member activity, expansion of committee scope to include employee well-being, program obstacles and opportunities in each setting, and sustainability (within the available time frame). DISCUSSION: This study aims for a quantitative evaluation of the HWPP over a time period long enough to accomplish multiple intervention cycles in each facility. The design seeks to achieve comparable study engagement and data quality between groups. We will also assess whether the HWPP might be further improved to meet the needs of U.S. public sector healthcare institutions. Potential challenges include difficulty in pooling data across study sites if Design Teams select different intervention topics, and follow-up periods too short for change to be observed. TRIAL REGISTRATION: ClinicalTrials.gov NCT04251429 (retrospectively registered January 29, 2020), protocol version 1.


Assuntos
Promoção da Saúde/métodos , Saúde do Trabalhador/estatística & dados numéricos , Engajamento no Trabalho , Local de Trabalho/organização & administração , Análise Custo-Benefício , Exercício Físico , Humanos , Grupos Populacionais , Avaliação de Programas e Projetos de Saúde/métodos , Estudos Prospectivos , Indenização aos Trabalhadores
7.
Epidemiol Psychiatr Sci ; 29: e169, 2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-32996442

RESUMO

AIMS: Many people who are homeless with severe mental illnesses are high users of healthcare services and social services, without reducing widen health inequalities in this vulnerable population. This study aimed to determine whether independent housing with mental health support teams with a recovery-oriented approach (Housing First (HF) program) for people who are homeless with severe mental disorders improves hospital and emergency department use. METHODS: We did a randomised controlled trial in four French cities: Lille, Marseille, Paris and Toulouse. Participants were eligible if they were 18 years or older, being absolutely homeless or precariously housed, with a diagnosis of schizophrenia (SCZ) or bipolar disorder (BD) and were required to have a high level of needs (moderate-to-severe disability and past hospitalisations over the last 5 years or comorbid alcohol or substance use disorder). Participants were randomly assigned (1:1) to immediate access to independent housing and support from the Assertive Community Treatment team (social worker, nurse, doctor, psychiatrist and peer worker) (HF group) or treatment as usual (TAU group) namely pre-existing dedicated homeless-targeted programs and services. Participants and interviewers were unmasked to assignment. The primary outcomes were the number of emergency department (ED) visits, hospitalisation admissions and inpatient days at 24 months. Secondary outcomes were recovery (Recovery Assessment Scale), quality of life (SQOL and SF36), mental health symptoms, addiction issues, stably housed days and cost savings from a societal perspective. Intention-to-treat analysis was performed. RESULTS: Eligible patients were randomly assigned to the HF group (n = 353) or TAU group (n = 350). No differences were found in the number of hospital admissions (relative risk (95% CI), 0.96 (0.76-1.21)) or ED visits (0.89 (0.66-1.21)). Significantly less inpatient days were found for HF v. TAU (0.62 (0.48-0.80)). The HF group exhibited higher housing stability (difference in slope, 116 (103-128)) and higher scores for sub-dimensions of S-QOL scale (psychological well-being and autonomy). No differences were found for physical composite score SF36, mental health symptoms and rates of alcohol or substance dependence. Mean difference in costs was €-217 per patient over 24 months in favour of the HF group. HF was associated with cost savings in healthcare costs (RR 0.62(0.48-0.78)) and residential costs (0.07 (0.05-0.11)). CONCLUSION: An immediate access to independent housing and support from a mental health team resulted in decreased inpatient days, higher housing stability and cost savings in homeless persons with SCZ or BP disorders.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pessoas em Situação de Rua/psicologia , Habitação/estatística & dados numéricos , Adulto , Alcoolismo/complicações , Alcoolismo/epidemiologia , Transtorno Bipolar/complicações , Transtorno Bipolar/epidemiologia , Comorbidade , Feminino , França/epidemiologia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde/métodos , Qualidade de Vida , Esquizofrenia/complicações , Esquizofrenia/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
8.
Matern Child Health J ; 24(Suppl 2): 141-151, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32748287

RESUMO

OBJECTIVES: With funding from the Pregnancy Assistance Fund, the Maternal, Child, and Adolescent Health Division (MCAH) of California redesigned its existing Adolescent Family Life Program (AFLP) for expectant and parenting young women into a more intensive and structured intervention, AFLP with positive youth development (PYD). This paper presents key findings from a federally funded, rigorous implementation study of the two programs. METHODS: This implementation study collected data from 13 agencies from January 2016 through December 2017, including interviews with 69 case managers and 18 supervisors; focus groups with 130 program participants; surveys of 66 case managers and 1330 young women; and observations of 42 visits with program participants. The study combined qualitative and quantitative analysis methods. RESULTS: As designed, PYD was a much more structured and intensive program than AFLP. Case managers and supervisors saw value in the PYD model and new approach but needed more support and guidance than expected in order to deliver it with fidelity. MCAH provided additional trainings and technical assistance to address challenges. In practice, although staff noted differences in approach and content, the youth experience with the two programs was similar. CONCLUSIONS FOR PRACTICE: Integrating the PYD framework into case management systems may foster youth self-sufficiency and resiliency. However, the rigid structure of the program was often challenging to implement in practice. Organizations interested in implementing prescribed case management approaches should consider allowing opportunities for flexibility in implementation and providing more detailed preservice training to prepare staff for real-world implementation.


Assuntos
Mães/educação , Poder Familiar , Gravidez na Adolescência , Avaliação de Programas e Projetos de Saúde/métodos , Adolescente , California , Administração de Caso , Feminino , Humanos , Mães/psicologia , Gravidez
9.
Artigo em Inglês | MEDLINE | ID: mdl-32858885

RESUMO

Strokes are a time-dependent medical emergency. The training of emergency medical service (EMS) professionals is essential to ensure the activation of stroke codes with pre-notification, as well as a rapid transfer to achieve early therapy. New assessment scales for the detection of patients with suspected large vessel occlusion ensures earlier access to endovascular therapy. The aim of this study was to evaluate the impact on an online training intervention focused on the Rapid Arterial oCclusion Evaluation (RACE) scoring of EMS professionals based on the prehospital stroke code in Catalonia from 2014 to 2018 in a pre-post intervention study. All Catalonian EMS professionals and the clinical records from primary stroke patients were included. The Kirkpatrick model guided the evaluation of the intervention. Data were collected on the knowledge on stroke recognition and management, pre-notification compliance, activated stroke codes and time performance of EMS professionals. Knowledge improved significatively in most items and across all categories, reaching a global achievement of 82%. Pre-notification compliance also improved significantly and remained high in the long-term. Increasingly higher notification of RACE scores were recorded from 60% at baseline to 96.3% in 2018, and increased on-site clinical care time and global time were also observed. Therefore, the online training intervention was effective for increasing EMS professionals' knowledge and pre-notification compliance upon stroke code activation, and the wide adoption of a new prehospital scale for the assessment of stroke severity (i.e., the RACE scale) was achieved.


Assuntos
Educação a Distância/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Socorristas/educação , Conhecimentos, Atitudes e Prática em Saúde , Avaliação de Programas e Projetos de Saúde/métodos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Adulto , Arteriopatias Oclusivas , Avaliação Educacional , Feminino , Humanos , Internet , Masculino , Estudos Retrospectivos , Espanha , Tempo para o Tratamento
10.
PLoS One ; 15(8): e0237533, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804941

RESUMO

BACKGROUND: Switzerland lacks future general practitioners (GPs). Residents who wished to specialize as general practitioners were formerly trained solely in hospital settings. To better prepare and also attract more young doctors to become GPs, the canton of Bern (equivalent to a state) has implemented a partly state-funded vocational training program in GP practices. Our study examines the efficacy of this 10-year program, identifies factors that positively influence residents in their decision to become a GP and the distribution of new GPs in the canton of Bern, who had taken part in the traineeship. METHODS: This cross-sectional survey among all residents, who participated in a traineeship in general practice from 2008 to 2017 in the canton of Bern asked if residents had taken a subsequent career choice as a GP and if so in which region. Residents scored the importance of their traineeship and their mentor's influence on becoming a GP. By using zip codes of work area of respondents already working as GPs and matching it with population census data, we could obtain the distribution of GPs on a per capita basis. RESULTS: Out of 165 residents who participated in a traineeship, 151 (92%) completed our survey. 81% had chosen a career as a GP or were on track to become a GP. Almost half of the participants became GPs in the offices of their mentors or in the area. Our respondents emphasized the importance of their mentors' influence as well as the training program in their decision-making to become a GP. Most mentioned benefits of being a GP were broad field of medical care (37%) and a fulfilling doctor-patient relationship (34%). We could show an increase in GP practices in the canton of Bern, not only in urban but also accordingly in rural areas. CONCLUSIONS: Most residents continued subsequent careers as general practitioners after having completed a GP traineeship, with almost half of them in the region of their training. A vocational training program helped motivating young doctors to become GPs and underserved regions of the canton of Bern to gain new GPs.


Assuntos
Clínicos Gerais/estatística & dados numéricos , Internato e Residência/organização & administração , Avaliação de Programas e Projetos de Saúde/métodos , Educação Vocacional/organização & administração , Adulto , Estudos Transversais , Educação Médica/organização & administração , Feminino , Clínicos Gerais/educação , Humanos , Masculino , Medicina Estatal , Suíça
11.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32769198

RESUMO

CONTEXT: An updated synthesis of research on substance abuse prevention programs can promote enhanced uptake of programs with proven effectiveness, particularly when paired with information relevant to practitioners and policy makers. OBJECTIVE: To assess the strength of the scientific evidence for psychoactive substance abuse prevention programs for school-aged children and youth. DATA SOURCES: A systematic review was conducted of studies published up until March 31, 2020. STUDY SELECTION: Articles on substance abuse prevention programs for school-aged children and youth were independently screened and included if they met eligibility criteria: (1) the program was designed for a general population of children and youth (ie, not designed for particular target groups), (2) the program was delivered to a general population, (3) the program only targeted children and youth, and (4) the study included a control group. DATA EXTRACTION: Two reviewers independently evaluated study quality and extracted outcome data. RESULTS: Ninety studies met eligibility criteria, representing 16 programs. Programs evaluated with the largest combined sample sizes were Drug Abuse Resistance Education, Project Adolescent Learning Experiences Resistance Training, Life Skills Training (LST), the Adolescent Alcohol Prevention Trial, and Project Choice. LIMITATIONS: Given the heterogeneity of outcomes measured in the included studies, it was not possible to conduct a statistical meta-analysis of program effectiveness. CONCLUSIONS: The most research has been conducted on the LST program. However, as with other programs included in this review, studies of LST effectiveness varied in quality. With this review, we provide an updated summary of evidence for primary prevention program effectiveness.


Assuntos
Prevenção Primária/normas , Avaliação de Programas e Projetos de Saúde/normas , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Criança , Humanos , Prevenção Primária/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/psicologia
12.
J Gen Intern Med ; 35(9): 2675-2679, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32642929

RESUMO

INTRODUCTION: Hospital and ambulatory care systems are rapidly building their virtual care capacity in response to the novel coronavirus (COVID-19) pandemic. The use of resident trainees in telemedicine is one area of potential development and expansion. To date, however, training opportunities in this field have been limited, and residents may not be adequately prepared to provide high-quality telemedicine care. AIM: This study evaluates the impact of an adapted telemedicine Objective Structured Clinical Examination (OSCE) on telemedicine-specific training competencies of residents. SETTING: Primary Care Internal Medicine residents at a large urban academic hospital. PROGRAM DESCRIPTION: In March 2020, the New York University Grossman School of Medicine Primary Care program adapted its annual comprehensive OSCE to a telemedicine-based platform, to comply with distance learning and social distancing policies during the COVID-19 pandemic. A previously deployed in-person OSCE on the subject of a medical error was adapted to a telemedicine environment and deployed to 23 primary care residents. Both case-specific and core learning competencies were assessed, and additional observations were conducted on the impact of the telemedicine context on the encounter. PROGRAM EVALUATION: Three areas of telemedicine competency need were identified in the OSCE case: technical proficiency; virtual information gathering, including history, collateral information collection, and physical exam; and interpersonal communication skills, both verbal and nonverbal. Residents expressed enthusiasm for telemedicine training, but had concerns about their preparedness for telemedicine practice and the need for further competency and curricular development. DISCUSSION: Programs interested in building capacity among residents to perform telemedicine, particularly during the COVID-19 pandemic, can make significant impact in their trainees' comfort and preparedness by addressing key issues in technical proficiency, history and exam skills, and communication. Further research and curricular development in digital professionalism and digital empathy for trainees may also be beneficial.


Assuntos
Betacoronavirus , Fortalecimento Institucional/métodos , Competência Clínica , Infecções por Coronavirus/terapia , Internato e Residência/métodos , Pneumonia Viral/terapia , Telemedicina/métodos , Fortalecimento Institucional/tendências , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/prevenção & controle , Humanos , Internato e Residência/tendências , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Avaliação de Programas e Projetos de Saúde/métodos , Telemedicina/tendências
13.
J Cardiothorac Vasc Anesth ; 34(10): 2581-2585, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32665178

RESUMO

This article discusses the impact of the COVID-19 pandemic on the EACTA fellowship program. The authors present three points that in their view are important and give cause for concern because they could make it difficult or impossible to achieve the original goals of the fellowship program. Corresponding points are discussed and possible solutions are presented. An implementation in the fellowship curriculum is planned.


Assuntos
Anestesia em Procedimentos Cardíacos/tendências , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Bolsas de Estudo/tendências , Pandemias , Pneumonia Viral/epidemiologia , Avaliação de Programas e Projetos de Saúde/tendências , Anestesia em Procedimentos Cardíacos/métodos , Anestesiologistas/educação , Anestesiologistas/tendências , Europa (Continente)/epidemiologia , Bolsas de Estudo/métodos , Humanos , Avaliação de Programas e Projetos de Saúde/métodos
14.
BMJ Open ; 10(7): e040999, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32665394

RESUMO

INTRODUCTION: Advance care planning (ACP) is associated with improved health outcomes for patients with cancer, and its absence is associated with unfavourable outcomes for patients and their caregivers. However, older adults do not complete ACP at expected rates due to patient and clinician barriers. We present the original design, methods and rationale for a trial aimed at improving ACP for older patients with advanced cancer and the modified protocol in response to changes brought by the COVID-19 pandemic. METHODS AND ANALYSIS: The Advance Care Planning: Promoting Effective and Aligned Communication in the Elderly study is a pragmatic, stepped-wedge cluster randomised trial examining a Comprehensive ACP Program. The programme combines two complementary evidence-based interventions: clinician communication skills training (VitalTalk) and patient video decision aids (ACP Decisions). We will implement the programme at 36 oncology clinics across three unique US health systems. Our primary outcome is the proportion of eligible patients with ACP documentation completed in the electronic health record. Our secondary outcomes include resuscitation preferences, palliative care consultations, death, hospice use and final cancer-directed therapy. From a subset of our patient population, we will collect surveys and video-based declarations of goals and preferences. We estimate 11 000 patients from the three sites will be enrolled in the study. ETHICS AND DISSEMINATION: Regulatory and ethical aspects of this trial include Institutional Review Board (IRB) approval via single IRB of record mechanism at Dana-Farber Cancer Institute, Data Use Agreements among partners and a Data Safety and Monitoring Board. We plan to present findings at national meetings and publish the results. TRIAL REGISTRATION NUMBER: NCT03609177; Pre-results.


Assuntos
Planejamento Antecipado de Cuidados , Betacoronavirus , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/prevenção & controle , Comunicação em Saúde/métodos , Neoplasias/terapia , Pandemias/prevenção & controle , Participação do Paciente/métodos , Pneumonia Viral/prevenção & controle , Idoso , Análise por Conglomerados , Humanos , Avaliação de Programas e Projetos de Saúde/métodos , Projetos de Pesquisa , Estados Unidos
15.
Am J Geriatr Psychiatry ; 28(9): 1004-1008, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32624338

RESUMO

OBJECTIVE: One effect of the COVID-19 pandemic is the disruption of in-person clinical experiences within geriatric psychiatry residency education. Online resources for trainees are needed to fill resultant gaps. METHODS: The American Association of Geriatric Psychiatry (AAGP) Teaching and Training Committee leadership collaborated with geriatric psychiatry experts to develop a web-based geriatric psychiatry curriculum for psychiatry residents and other learners. In addition, we planned to obtain initial self-report outcomes of the curricular modules. RESULTS: The COVID-19 AAGP Online Trainee Curriculum (aagponline.org/covidcurriculum) consists of approximately 30 video-recorded lectures provided by AAGP member experts. A demographic survey and pre-/postsurvey attached to each module allow us to obtain learner characteristics and feedback on each module. CONCLUSIONS: The Curriculum has the potential to supplement psychiatry residency education during the pandemic and potentially raise the profile of AAGP, with the goal of inspiring interest within geriatric psychiatry. Results of the initial self-report evaluation should be available in 1 year.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Currículo , Psiquiatria Geriátrica/educação , Internato e Residência/métodos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde/métodos , Betacoronavirus , Humanos , Internet , Autorrelato
16.
AIDS Educ Prev ; 32(2): 137-S5, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32539479

RESUMO

In 2015, the Centers for Disease Control and Prevention (CDC) funded Project PrIDE, a national initiative to implement and evaluate demonstration projects to increase PrEP uptake among HIV-negative individuals and to re-engage HIV-positive individuals in HIV care. Our team served as the Evaluation Center for Project PrIDE organizations in Chicago and used an empowerment evaluation (EE) approach to enhance evaluation capacity at these organizations. To evaluate our approach, we assessed organizations' evaluation capacity and engagement in technical assistance and capacity building activities in 2016 and 2018. Respondents who self-reported higher engagement with the Evaluation Center and who spent a greater number of hours engaged with our evaluators experienced greater increases in evaluation capacity tied to implementation of evaluation activities and technical assistance utilization. These findings demonstrate that multisite EE can be successfully applied to increase the evaluation capacity of organizations providing both HIV prevention and care services.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Fortalecimento Institucional/organização & administração , Empoderamento , Infecções por HIV/prevenção & controle , Promoção da Saúde/organização & administração , Poder Psicológico , Profilaxia Pré-Exposição/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/métodos , Adulto , Chicago , Feminino , Infecções por HIV/psicologia , Humanos , Masculino , Encaminhamento e Consulta/estatística & dados numéricos , Autorrelato , Inquéritos e Questionários , Pessoas Transgênero , Estados Unidos
17.
PLoS One ; 15(6): e0234345, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32544185

RESUMO

BACKGROUND: Mentorship plays an essential role in enhancing the success of junior faculty. Previous evaluation tools focused on specific types of mentors or mentees. The main objective was to develop and provide validity evidence for a Mentor Evaluation Tool (MET) to assess the effectiveness of one-on-one mentoring for faculty in the academic health sciences. METHODS: Evidence was collected for the validity domains of content, internal structure and relationship to other variables. The 13 item MET was tested for internal structure evidence with 185 junior faculty from Schools of Dentistry, Medicine, Nursing, and Pharmacy. Finally, the MET was studied for additional validity evidence by prospectively enrolling mentees of three different groups of faculty (faculty nominated for, or winners of, a lifetime achievement in mentoring award; faculty graduates of a mentor training program; and faculty mentors not in either of the other two groups) at the University of California San Francisco (UCSF) and asking them to rate their mentors using the MET. Mentors and mentees were clinicians, educators and/or researchers. RESULTS: The 13 MET items mapped well to the five mentoring domains and six competencies described in the literature. The standardized Cronbach's coefficient alpha was 0.96. Confirmatory factor analysis supported a single factor (CFI = 0.89, SRMR = 0.05). The three mentor groups did not differ in the single overall assessment item (P = 0.054) or mean MET score (P = 0.288), before or after adjusting for years of mentoring. The mentorship score means were relatively high for all three groups. CONCLUSIONS: The Mentor Evaluation Tool demonstrates evidence of validity for research, clinical, educational or career mentors in academic health science careers. However, MET did not distinguish individuals nominated as outstanding mentors from other mentors. MET validity evidence can be studied further with mentor-mentee pairs and to follow prospectively the rating of mentors before and after a mentorship training program.


Assuntos
Tutoria/métodos , Mentores/psicologia , Avaliação de Programas e Projetos de Saúde/métodos , Adulto , Docentes de Medicina/classificação , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Pesquisadores/educação , São Francisco
18.
Br J Anaesth ; 125(1): e119-e129, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32493580

RESUMO

BACKGROUND: Inconsistent and poorly coordinated systems of tracheostomy care commonly result in frustrations, delays, and harm. Quality improvement strategies described by exemplar hospitals of the Global Tracheostomy Collaborative have potential to mitigate such problems. This 3 yr guided implementation programme investigated interventions designed to improve the quality and safety of tracheostomy care. METHODS: The programme management team guided the implementation of 18 interventions over three phases (baseline/implementation/evaluation). Mixed-methods interviews, focus groups, and Hospital Anxiety and Depression Scale questionnaires defined outcome measures, with patient-level databases tracking and benchmarking process metrics. Appreciative inquiry, interviews, and Normalisation Measure Development questionnaires explored change barriers and enablers. RESULTS: All sites implemented at least 16/18 interventions, with the magnitude of some improvements linked to staff engagement (1536 questionnaires from 1019 staff), and 2405 admissions (1868 ICU/high-dependency unit; 7.3% children) were prospectively captured. Median stay was 50 hospital days, 23 ICU days, and 28 tracheostomy days. Incident severity score reduced significantly (n=606; P<0.01). There were significant reductions in ICU (-;0.25 days month-1), ventilator (-;0.11 days month-1), tracheostomy (-;0.35 days month-1), and hospital (-;0.78 days month-1) days (all P<0.01). Time to first vocalisation and first oral intake both decreased by 7 days (n=733; P<0.01). Anxiety decreased by 44% (from 35.9% to 20.0%), and depression decreased by 55% (from 38.7% to 18.3%) (n=385; both P<0.01). Independent economic analysis demonstrated £33 251 savings per patient, with projected annual UK National Health Service savings of £275 million. CONCLUSIONS: This guided improvement programme for tracheostomy patients significantly improved the quality and safety of care, contributing rich qualitative improvement data. Patient-centred outcomes were improved along with significant efficiency and cost savings across diverse UK hospitals. CLINICAL TRIAL REGISTRATION: IRAS-ID-206955; REC-Ref-16/LO/1196; NIHR Portfolio CPMS ID 31544.


Assuntos
Avaliação de Programas e Projetos de Saúde/métodos , Melhoria de Qualidade/estatística & dados numéricos , Traqueostomia/métodos , Traqueostomia/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Hospitais , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Reino Unido , Adulto Jovem
19.
Pan Afr Med J ; 35(Suppl 1): 4, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32373255

RESUMO

Introduction: Immunization program monitoring includes numerous activities, some of which include monitoring of vaccination coverage, surveillance performance and epidemiological patterns. The provision of timely, high quality and actionable feedback is an essential component of strengthening health systems. Within the African region of the WHO, various bulletins are produced and disseminated regularly to provide feedback on the performance of immunization programs and vaccine preventable disease control initiatives. Methods: The 2019 annual national immunization program managers' meeting for countries in the eastern and southern African subregion was held in Asmara from 18 - 20 March 2019. A survey questionnaire was administered to the participants representing the national programs and in-country partners across the 20 countries. Results: On average, the 75 respondents receive 1.8 e-mailed feedback bulletins monthly. Twenty-three (31%) respondents receive 3 or more written feedback bulletins per month, and 72% receive the bulletins regularly. On a scale of 1 - 5 (from lowest to highest), 87% participants rated the relevance of the bulletins they receive at 4 - 5. Only 19% of the respondents responded that the results are discussed within the national immunization program, and 14% stated that action points are generated based on the feedback received. Fifty-nine (79%) respondents want to receive more frequent feedback on routine immunization performance. Among the EPI program managers and the EPI program data managers, the access to these feedback bulletins was quite limited. Even though the primary objective of the bulletins is to initiate discussions and action based on the provided feedback, such discussions do not happen regularly at country level. The programmatic use and advocacy value of the bulletins is not optimal. Conclusion: We recommend integrating program feedback, regularly updating the distribution lists, the additional use of instant messaging platforms for distribution, as well as online posting of the bulletins for wider availability.


Assuntos
Retroalimentação , Programas de Imunização/organização & administração , Avaliação de Programas e Projetos de Saúde/métodos , Inquéritos e Questionários , Cobertura Vacinal , África Oriental/epidemiologia , África Austral/epidemiologia , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Assistência à Saúde/estatística & dados numéricos , Países em Desenvolvimento , Humanos , Programas de Imunização/normas , Disseminação de Informação/métodos , Vigilância da População/métodos , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Inquéritos e Questionários/normas , Nações Unidas , Vacinação/estatística & dados numéricos , Cobertura Vacinal/métodos , Cobertura Vacinal/organização & administração , Cobertura Vacinal/estatística & dados numéricos , Organização Mundial da Saúde
20.
Infant Ment Health J ; 41(3): 393-410, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32281127

RESUMO

This study sought to understand how practitioners perceive and experience the Circle of Security-Parenting (COS-P) training, and further, how they integrate and implement it into practice, and how these experiences influence their use and understanding of the program and its underlying model. A thematic analysis of semistructured interviews at two time points (shortly after training and 3-6 months after training) was used to explore 12 practitioners' experiences of COS-P training and subsequent implementation. Three main themes were identified; clinical salience, personal salience, and partial use of the program. The findings reflected participants' common perception that the model is relevant and generalizable to a wide variety of contexts. It also highlighted potential barriers to implementation, particularly practitioners' experiences using only components of the COS-P program in isolation. The results suggest practitioners' assumptions about client complexities, vulnerabilities, and/or incapacities, can prompt practitioners to withhold the use of COS-P (in part or whole), thereby potentially neglecting key components required for client change. The only participants who implemented the COS-P training in full had additional training in Circle of Security.


Assuntos
Atitude do Pessoal de Saúde , Educação não Profissionalizante/métodos , Relações Pais-Filho , Poder Familiar/psicologia , Adulto , Educação/métodos , Feminino , Humanos , Masculino , Apego ao Objeto , Avaliação de Programas e Projetos de Saúde/métodos
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