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3.
Mayo Clin Proc ; 95(1): 35-43, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31902427

RESUMO

OBJECTIVE: To assess adherence to and individual or systematic deviations from predicted physician compensation by gender or race/ethnicity at a large academic medical center that uses a salary-only structured compensation model incorporating national benchmarks and clear standardized pay steps and increments. PARTICIPANTS AND METHODS: All permanent staff physicians employed at Mayo Clinic medical practices in Minnesota, Arizona, and Florida who served in clinical roles as of January 2017. Each physician's pay, demographics, specialty, full-time equivalent status, benchmark pay for the specialty, leadership role(s), and other factors that may influence compensation within the plan were collected and analyzed. For each individual, the natural log of pay was used to determine predicted pay and 95% CI based on the structured compensation plan, compared with their actual salary. RESULTS: Among 2845 physicians (861 women, 722 nonwhites), pay equity was affirmed in 96% (n=2730). Of the 80 physicians (2.8%) with higher and 35 (1.2%) with lower than predicted pay, there was no interaction with gender or race/ethnicity. More men (31.4%; 623 of 1984) than women (15.9%; 137 of 861) held or had held a compensable leadership position. More men (34.7%; 688 of 1984) than women (20.5%; 177 of 861) were represented in the most highly compensated specialties. CONCLUSION: A structured compensation model was successfully applied to all physicians at a multisite large academic medical system and resulted in pay equity. However, achieving overall gender pay equality will only be fully realized when women achieve parity in the ranks of the most highly compensated specialties and in leadership roles.


Assuntos
Planos de Incentivos Médicos/estatística & dados numéricos , Médicos , Salários e Benefícios , Fatores Sexuais , Centros Médicos Acadêmicos/economia , Centros Médicos Acadêmicos/estatística & dados numéricos , Competência Clínica/economia , Grupos Étnicos , Feminino , Humanos , Liderança , Masculino , Modelos Econométricos , Médicos/classificação , Médicos/economia , Médicos/estatística & dados numéricos , Médicas/economia , Médicas/normas , Salários e Benefícios/classificação , Salários e Benefícios/estatística & dados numéricos , Estados Unidos
4.
Urology ; 136: 100-104, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31751623

RESUMO

OBJECTIVE: To examine urologic transfers and rate of tertiary center interventions from 4 geographically distinct academic medical centers. METHODS: Four academic medical centers were selected for this study including Baylor College of Medicine, University of Alabama at Birmingham, University of Kentucky, and University of Pennsylvania Hospital (Penn). Baylor College of Medicine and Penn primarily service large metropolitan city centers and University of Kentucky and University of Alabama at Birmingham primarily service large rural populations. Transfer logs were pulled for each institution over a 2-year period, and a retrospective chart review was performed to evaluate transfer diagnosis and need for procedural management upon admission. Date of transfer, transfer diagnosis, and interventions performed during tertiary center admission were extracted from the transfer log data sets. The transfer diagnosis was categorized into 1 of 11 mutually exclusive categories. RESULTS: Overall, 984 urologic transfers were included. Sixty-nine percent (682/984) of patients were transferred to the 2 rural centers, and 30.7% (302/984) were transferred to the 2 metropolitan centers. The most common reason for transfer was nephrolithiasis at 26% (256 of 984 transfers). The overall surgical intervention rate for all urologic transfers in this study was 44.4% (437 of 984 total transfers). Rural center transfers had a lower rate of surgical intervention than metropolitan centers (42.7% vs 48.3%) as well as a markedly higher number of total transfers during the study period (682 vs 302). CONCLUSION: Given that a majority of patients did not require surgical intervention, methods for avoiding unnecessary urologic transfers are warranted.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Doenças Urológicas , Humanos , Estudos Retrospectivos , Estados Unidos , Doenças Urológicas/diagnóstico , Doenças Urológicas/terapia
5.
J Surg Res ; 245: 265-272, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31421372

RESUMO

BACKGROUND: Although insurance and race-based survival disparities in colon cancer are well studied, little is known regarding how these survival disparities are impacted by type of treating facility. MATERIALS AND METHODS: This is a retrospective cohort study of 433,997 patients diagnosed with colon adenocarcinoma using the National Cancer Database (NCDB). Using Cox proportional hazard analyses, we assessed overall survival (OS) as a function of race, insurance status, and treating facility, after adjusting for demographic and clinical factors. We also assessed differences in OS according to race and insurance status stratified by treating facility type. RESULTS: OS was significantly diminished for blacks (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.07-1.10; P < 0.001) and increased for patients of other race (primarily Asians; HR, 0.76; 95% CI, 0.74-0.78) compared with whites. Patients with private insurance had improved OS compared with uninsured (HR, 1.28; 95% CI, 1.25-1.31; P < 0.001), Medicaid (HR, 1.35; 95% CI, 1.33-1.38; P < 0.001) and Medicare (HR, 1.13, 95% CI, 1.12-1.15; P < 0.001) patients. Compared with patients treated at comprehensive community programs, patients treated at academic centers (ACs) had improved OS (HR, 0.86; 95% CI, 0.85-0.88; P < 0.001). When stratified by type of treating facility, racial disparities were not mitigated for patients treated at ACs compared with other facilities (P = 0.266 for interaction). At ACs, patients with Medicaid had persistent OS disparities compared with patients with private insurance (HR, 1.12; 95% CI, 1.09-1.15; P < 0.001), although these disparities were significantly diminished compared with patients treated at other facilities (HR, 1.41; 95% CI, 1.38-1.45; P < 0.001). CONCLUSIONS: Other race, private insurance, and treatment at AC were independently associated with improved OS in patients with colon cancer. Medicaid-based, but not race-based, survival disparities are reduced at ACs compared with other facilities.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Neoplasias do Colo/terapia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Afro-Americanos/estatística & dados numéricos , Idoso , Neoplasias do Colo/mortalidade , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Estados Unidos/epidemiologia
6.
Clin Nucl Med ; 45(1): 44-45, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31789909

RESUMO

Very few medical schools offer a nuclear medicine elective. I will share our experience with the nuclear medicine elective rotation which has been well received by our fourth-year medical students. This may be of interest to nuclear medicine physicians who work in an academic setting.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Educação de Graduação em Medicina/estatística & dados numéricos , Medicina Nuclear/educação , Faculdades de Medicina/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Humanos
7.
BMJ ; 367: l6322, 2019 12 09.
Artigo em Inglês | MEDLINE | ID: mdl-31818913

RESUMO

OBJECTIVE: To study the effects of recent political events on mood among young physicians. DESIGN: Prospective cohort study. SETTING: United States medical centres. PARTICIPANTS: 2345 medical interns provided longitudinal mood data as part of the Intern Health Study between 2016 and 2018. MAIN OUTCOME MEASURES: Mean mood score during the week following influential political and non-political events as compared with mean mood during the preceding four week control period. RESULTS: We identified nine political events and eight non-political events for analysis. With the start of internship duties in July, the mean decline in mood for interns was -0.30 (95% confidence interval -0.33 to -0.27, t=-17.45, P<0.001). The decline in mood was of similar magnitude following the 2016 presidential election (mean mood change -0.32, 95% confidence interval -0.45 to -0.19, t=-4.73, P<0.001) and subsequent inauguration (mean mood change -0.25, 95% confidence interval -0.37 to -0.12, t=-3.93, P<0.001). Further, compared with men, women reported greater mood declines after both the 2016 election (mean gender difference 0.31, 95% confidence interval 0.05 to 0.58, t=2.33, P=0.02) and the inauguration (mean gender difference 0.25, 95% confidence interval 0.01 to 0.49, t=2.05, P=0.04). Overall, there were statistically significant changes in mood following 66.7% (6/9) of political events assessed. In contrast, none of the non-political events included in the analysis were statistically significantly associated with a change in mood. CONCLUSIONS: Macro level factors such as politics may be correlated with the mood of young doctors. This finding signals the need for further evaluation of the consequences of increasing entanglement between politics and medicine moving forward for young physicians and their patients.


Assuntos
Afeto , Corpo Clínico Hospitalar/psicologia , Política , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Estudos de Coortes , Correlação de Dados , Feminino , Humanos , Internato e Residência , Masculino , Saúde Mental , Pesquisa Qualitativa , Fatores Sexuais , Estados Unidos
8.
Am J Health Syst Pharm ; 76(1): 34-43, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31603982

RESUMO

PURPOSE: The development of an inpatient antimicrobial stewardship program (ASP) in an integrated healthcare system is described. SUMMARY: With increasing national focus on reducing inappropriate antimicrobial use, state and national regulatory mandates require hospitals to develop ASPs. In 2015, BJC HealthCare, a multihospital health system, developed a system-level, multidisciplinary ASP team to assist member hospitals with ASP implementation. A comprehensive gap analysis was performed to assess current stewardship resources, activities and compliance with CDC core elements at each facility. BJC system clinical leads facilitated the development of hospital-specific leadership support statements, identification of hospital pharmacy and medical leaders, and led development of staff and patient educational components. An antimicrobial-use data dashboard was created for reporting and tracking the impact of improvement activities. Hospital-level interventions were individualized based on the needs and resources at each facility. Hospital learnings were shared at bimonthly system ASP meetings to disseminate best practices. The initial gap analysis revealed that BJC hospitals were compliant in a median of 6 ASP elements (range, 4-8) required by regulatory mandates. By leveraging system resources, all hospitals were fully compliant with regulatory requirements by January 2017. CONCLUSION: BJC's ASP model facilitated the development of broad-based stewardship activities, including education modules for patients and providers and clinical decision support, while allowing hospitals to implement activities based on local needs and resource availability.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Desenvolvimento de Programas , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Gestão de Antimicrobianos/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Illinois , Missouri , Modelos Organizacionais , Equipe de Assistência ao Paciente/organização & administração , Educação de Pacientes como Assunto/organização & administração , Educação de Pacientes como Assunto/estatística & dados numéricos , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Lacunas da Prática Profissional/organização & administração , Lacunas da Prática Profissional/estatística & dados numéricos
9.
S Afr J Surg ; 57(3): 50-53, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392865

RESUMO

BACKGROUND: Colorectal surgery has developed into an established surgical subspecialty in South Africa, however there is a paucity of data regarding the epidemiology and surgical outcomes of patients with colorectal disease in this country. The objective is to present the findings of a one-year audit of the Wits Donald Gordon Medical Centre (WDGMC) Colorectal Unit with specific reference to indications, surgical procedures and patient outcomes. METHOD: Patient files from December 2016 to November 2017 were included in a retrospective analysis. The Mann-Whitney U test was used to analyse continuous variables and the Chi-squared test was used to compare categorical variables. RESULTS: During the audit period, 1264 patients were admitted to the Colorectal Unit and a further 564 outpatient endoscopic procedures were performed. There were 306 emergency admissions. 139 elective colorectal resections took place, with a 16% major complication rate, a 12% anastomotic leak rate and no deaths. Rectal resections constituted 66% of the operations and 34% were colonic resections. The median length of stay for all patients undergoing resection was 9 days and there was no statistically significant difference in length of stay between open and laparoscopic cases. CONCLUSION: The WDGMC Colorectal Unit manages a high volume of patients presenting with the full spectrum of colorectal disease.


Assuntos
Colectomia/estatística & dados numéricos , Doenças do Colo/cirurgia , Complicações Pós-Operatórias/etiologia , Protectomia/estatística & dados numéricos , Doenças Retais/cirurgia , Centros Médicos Acadêmicos/estatística & dados numéricos , Fístula Anastomótica/etiologia , Colectomia/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/estatística & dados numéricos , Unidades Hospitalares/estatística & dados numéricos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/estatística & dados numéricos , Tempo de Internação , Auditoria Médica , Readmissão do Paciente/estatística & dados numéricos , Protectomia/efeitos adversos , Estudos Retrospectivos
10.
Am J Health Syst Pharm ; 76(1): 50-56, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31381099

RESUMO

PURPOSE: Results of a study to evaluate medication storage, distribution, and safety outcomes after addition of 23.4% sodium chloride to a hospital formulary and development of a novel distribution process incorporating safeguards allowing for urgent medication removal from an automated dispensing cabinet (ADC) are reported. SUMMARY: A retrospective review of 23.4% sodium chloride injection doses dispensed during a 38-month period was performed at an academic medical center to evaluate times from order entry to pharmacist verification, dispensing, and administration; adverse events related to dispensing or administration; and other outcomes. Seventy doses of 23.4% sodium chloride injection were administered to 60 patients during the study period. The mean times from order entry to pharmacist verification, medication removal from an ADC, and administration were 8, 25, and 43 minutes, respectively, when the ADC override function was not used. After 23.4% sodium chloride injection's addition to the ADC override list, 16 of 30 doses were removed "on override," with order entry performed retrospectively for 9 of these doses. There were no documented adverse events related to medication distribution and 2 adverse effects possibly related to medication administration. CONCLUSION: Novel storage and distribution processes for 23.4% sodium chloride injection were implemented at a large academic medical center to optimize safety related to the medication-use process. A retrospective review of 70 administered doses found the process of maintaining this medication in ADCs to be a safe and efficient method of storing and dispensing a high-alert medication.


Assuntos
Uso de Medicamentos/estatística & dados numéricos , Tratamento de Emergência/métodos , Erros de Medicação/prevenção & controle , Sistemas de Medicação no Hospital/organização & administração , Solução Salina Hipertônica/administração & dosagem , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Armazenamento de Medicamentos/estatística & dados numéricos , Tratamento de Emergência/efeitos adversos , Feminino , Humanos , Injeções Intravenosas/efeitos adversos , Masculino , Sistemas de Registro de Ordens Médicas/organização & administração , Sistemas de Registro de Ordens Médicas/estatística & dados numéricos , Sistemas de Medicação no Hospital/estatística & dados numéricos , Pessoa de Meia-Idade , Serviço de Farmácia Hospitalar/normas , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Estudos Retrospectivos , Solução Salina Hipertônica/efeitos adversos
11.
J Surg Res ; 244: 174-180, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299433

RESUMO

BACKGROUND: The exchange of health information between primary care providers (PCPs) and surgeons is critical during transitions of care for older patients with multiple comorbidities; however, it is unknown to what extent this process occurs. This study was designed to characterize the extent to which factors associated with older patient's recovery, such as functional status, cognitive status, social status, and emotional factors, are shared among PCPs and surgical providers during care transitions. MATERIALS AND METHODS: We prospectively identified 15 patients aged over 60 y with ≥3 comorbidities referred for general and vascular surgery procedures at a Veterans Administrative and academic medical center. Semistructured Critical Decision Method interviews were conducted with patients along with their surgical providers and referring PCPs. Thematic content analysis was performed independently by five reviewers on the cognitive processes associated with functional status, cognitive status, social status, and emotional factors. Interrater reliability between providers and patients was assessed using Cohen's kappa. RESULTS: Forty-seven Critical Decision Method interviews were conducted, which included 20 paired interviews between a PCP and a surgeon and 16 paired interviews that involved a patient and a provider. The majority of patients reported experiencing poor information exchange between their PCP and surgeon (58%) and feeling they were primarily responsible for communicating their own health information during care transitions (67%). In paired interviews between PCPs and surgeons, there was nearly perfect agreement for the shared knowledge of cognitive (kappa: 0.83) and emotional (kappa 1) factors. In contrast, there was only minimal agreement for shared knowledge of functional status (kappa 0.38) and social status (kappa: 0.34). CONCLUSIONS: Information exchange between PCPs and surgical providers is often discordant during transitions of surgical care for medically complex older patients, particularly when it pertains to communicating their functional or social status.


Assuntos
Troca de Informação em Saúde/estatística & dados numéricos , Transferência de Pacientes/organização & administração , Médicos de Atenção Primária/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Centros Médicos Acadêmicos/estatística & dados numéricos , Fatores Etários , Idoso , Tomada de Decisão Clínica , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente/organização & administração , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Estudos Prospectivos , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos , United States Department of Veterans Affairs/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos
12.
Med Care ; 57(10): 753-756, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31295164

RESUMO

BACKGROUND: Length of stay (LOS) remains a primary focus for hospitals, and patients with prolonged LOS disproportionately affect hospital capacity and costs. We recently showed that long LOS patients are increasingly hospitalized at academic centers, but their effect on the distribution of LOS is unknown. METHODS: Using the Vizient Clinical Data Base/Resource Manager (CDB/RM), which includes over 90% of the academic medical centers in the United States, we examined trends in the distributions of LOS for acute medical/surgical hospitalizations from 2007 to 2016 in 117 hospitals. We excluded patients under 18 years and those with primary psychiatry, obstetric or rehabilitation diagnoses. RESULTS: Two separate trends were evident during this time period. Mean LOS decreased steadily from 2007 to 2010, but then rose steadily from 2011 and reached its maximum in 2016. Median LOS remained consistent at 3 days from 2007 to 2013 but it too rose from 2014 to 2016. As expected from the difference between the mean and median values, LOS at the 99th percentile dropped from 2007 to 2010 but then rose back by 2016. Gini coefficient values, used to measure inequalities in distribution, declined modestly from 2007 to 2010 but then remained unchanged through 2016. Results were similar in analyses adjusted for age, sex, and case-mix index. CONCLUSIONS: The beginning of the study period was characterized by a reduction in mean LOS, driven largely by decreases of the longest hospitalizations and greater uniformity in LOS. The latter portion saw steady increases in LOS that were similar across the entire distribution of hospitalizations. If the nadir in LOS has truly been reached, these trends will complicate the long-term health of academic medical centers and their staff, faculty, and trainees.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Hospitalização/tendências , Tempo de Internação/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
13.
Otolaryngol Head Neck Surg ; 161(4): 629-634, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31307271

RESUMO

OBJECTIVES: (1) To evaluate whether admission volume and case complexity are associated with mortality rates and (2) evaluate whether admission volume and case complexity are associated with cost per admission. STUDY DESIGN: Retrospective case series. SETTING: Tertiary academic hospital. SUBJECTS AND METHODS: The Vizient database was queried for inpatient admissions between July 2015 and March 2017 to an otolaryngology-head and neck surgery service. Data collected included admission volume, length of stay, intensive care unit (ICU) status, complication rates, case mix index (CMI), and cost data. Regression analysis was performed to evaluate the relationship between cost, CMI, admission volume, and mortality rate. RESULTS: In total, 338 hospitals provided data for analysis. Mean hospital admission volume was 182 (range, 1-1284), and mean CMI was 1.69 (range, 0.66-6.0). A 1-point increase in hospital average CMI was associated with a 40% increase in odds for high mortality. Admission volume was associated with lower mortality, with 1% lower odds for each additional case. A 1-point increase in CMI produces a $4624 higher total cost per case (95% confidence interval, $4550-$4700), and for each additional case, total cost per case increased by $6. CONCLUSION: For otolaryngology inpatient services at US academic medical centers, increasing admission volume is associated with decreased mortality rates, even after controlling for CMI and complication rates. Increasing CMI levels have an anticipated correlation with higher total costs per case, but admission volume is unexpectedly associated with a significant increase in average cost per case.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Grupos Diagnósticos Relacionados , Custos de Cuidados de Saúde , Hospitalização/estatística & dados numéricos , Procedimentos Cirúrgicos Otorrinolaringológicos/economia , Procedimentos Cirúrgicos Otorrinolaringológicos/mortalidade , Centros Médicos Acadêmicos/economia , Economia Hospitalar , Cabeça/cirurgia , Mortalidade Hospitalar , Hospitais com Alto Volume de Atendimentos , Humanos , Tempo de Internação , Pescoço/cirurgia , Análise de Regressão , Estudos Retrospectivos , Estados Unidos
14.
Am J Health Syst Pharm ; 76(6): 360-365, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-31361840

RESUMO

PURPOSE: This study evaluated employee perceptions of safety culture in 9 health-system-owned community pharmacies using a safety culture survey before and after implementation of a Pharmacy Services Call Center (PSCC) designed to reduce distractions through reduction of phone volume related to refills and prescription readiness. METHODS: The Agency for Healthcare Research and Quality (AHRQ) Community Pharmacy Survey on Patient Safety Culture (CPSPSC) was used to collect employee safety culture perceptions pre-post PSCC implementation. A percent positive score (PPS) was calculated for each of 11 CPSPSC composite questions and for 1 overall rating of patient safety question based on AHRQ-suggested analytic procedures. Pre-post PSCC implementation, PPSs were compared using a chi-square test. RESULTS: Overall, the lowest composite PPS (Staffing, Work Pressure, and Pace) and the highest composite PPS (Patient Counseling) ranked the same in both survey periods. Of the nine PSCC pharmacies, statistically significant (p < 0.05) PPS improvements occurred in 4 composites including Teamwork (11.9%), Communication About Mistakes (18%), Staff Training and Skills (20.6%), and Staffing, Work Pressure, and Pace (11.8%). PSCC pharmacies also reported a 9.3% (NS) improvement in overall rating of pharmacy patient safety post PSCC implementation. Separate analysis of pharmacist responses was consistent with pharmacy level results, but technician results differed slightly in overall rating of safety perceptions. CONCLUSION: Presence of the PSCC appeared to increase pharmacy employees' perceptions of safety culture in the community pharmacies, an integral part of overall patient safety.


Assuntos
Atitude do Pessoal de Saúde , Call Centers/organização & administração , Serviços Comunitários de Farmácia/organização & administração , Segurança do Paciente , Gestão da Segurança , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Serviços Comunitários de Farmácia/estatística & dados numéricos , Aconselhamento/organização & administração , Implementação de Plano de Saúde , Humanos , Erros de Medicação/prevenção & controle , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Técnicos em Farmácia/psicologia , Técnicos em Farmácia/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos , United States Agency for Healthcare Research and Quality , Carga de Trabalho/psicologia , Carga de Trabalho/estatística & dados numéricos
15.
Am J Health Syst Pharm ; 76(6): 353-359, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-31361842

RESUMO

PURPOSE: The process and methods used in an impact assessment of a centralized pharmacy call center on community pharmacy employee patient safety climate perceptions, telephone distractions/interruptions, and prescription filling efficiency are described. SUMMARY: A broad-based team designed a multi-faceted, pre-post call center implementation analysis that included multiple change assessment measures. First, yearly administration of the Agency for Healthcare Research and Quality Community Pharmacy Survey on Patient Safety Culture was used to assess patient safety climate based on employee perceptions of a safe working environment and potential for errors due to interruptions and distractions. Evaluative measures of staff workload that assessed telephone interference with prescription filling activities pre and 3 months post implementation included (1) the NASA Task Load Index, (2) multi-tasking observations through shadowing of pharmacists and technicians to count number of interruptions/distractions per prescription "touched," and (3) self-reported work sampling to assess proportional time estimates of clinical, professional, and technical activities. Finally, pharmacy efficiency and prescription filling capacity were assessed using operational measures (prescriptions filled, patients served, phone call volume changes, prescription rework counting). Data analysis included summary statistics, Student's t-test, and chi-square analysis, as appropriate, in addition to assessing convergence and agreement among measures. Every evaluative method showed a positive outcome from call center implementation, although individual pharmacies may have accrued greater benefit from call reduction than others. CONCLUSION: Multiple analysis methods can be used to evaluate the impact of workflow changes.


Assuntos
Call Centers/organização & administração , Serviços Comunitários de Farmácia/organização & administração , Erros de Medicação/prevenção & controle , Segurança do Paciente , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Serviços Comunitários de Farmácia/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Eficiência Organizacional/estatística & dados numéricos , Implementação de Plano de Saúde , Humanos , Auditoria Administrativa/estatística & dados numéricos , Comportamento Multitarefa , Farmacêuticos/organização & administração , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Técnicos em Farmácia/organização & administração , Técnicos em Farmácia/psicologia , Técnicos em Farmácia/estatística & dados numéricos , Papel Profissional/psicologia , Avaliação de Programas e Projetos de Saúde , Gestão da Segurança/organização & administração , Inquéritos e Questionários/estatística & dados numéricos , Telefone , Estados Unidos , United States Agency for Healthcare Research and Quality , Carga de Trabalho/psicologia , Carga de Trabalho/estatística & dados numéricos
16.
BMC Med Educ ; 19(1): 193, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185960

RESUMO

BACKGROUND: Several studies correlate medical residency with the occurrence of mental health disorders, Burnout Syndrome and quality of life impairment. It has been demonstrated that mental health disorders increase medical errors and lead to less effective patient care. Considering such context, this study aimed to evaluate the prevalence of anxiety, depression, stress and to identify its correlates with Burnout Syndrome and quality of life in a sample of medical residents and fellow physicians of the largest Brazilian academic health system. METHODS: In 2017, 1648 participants were voluntarily and anonymously surveyed online about demographic characteristics, Burnout Syndrome, mental symptoms, and quality of life measured by validated questionnaires. Responses were captured through REDCap platform and multivariate statistical analyses were performed with STATA 15. RESULTS: A total of 606 (36.8%) residents/fellows physicians completed the survey. Depression symptoms were present in 19%, anxiety symptoms in 16% and stress symptoms in 17.7% of the sample. Burnout Syndrome was present in 63% of the sample. Multivariate analysis showed a statistical significant positive correlation between Burnout Syndrome and depression, anxiety and stress symptoms and a negative correlation between mental symptoms and quality of life scores. CONCLUSIONS: Mental health symptoms prevalence in this study is similar to other studies and their occurrence is positively correlated with Burnout Syndrome among medical residents/fellow physicians of the largest Brazilian academic health system. These results are relevant and must be confirmed by multicentric longitudinal studies. This study reinforces the importance of debating interventions to improve mental health among doctors in training.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Internato e Residência/estatística & dados numéricos , Estresse Psicológico/epidemiologia , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Ansiedade/etiologia , Brasil/epidemiologia , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/etiologia , Depressão/etiologia , Humanos , Prevalência , Escalas de Graduação Psiquiátrica , Qualidade de Vida/psicologia , Estresse Psicológico/etiologia
19.
Prog Neurol Surg ; 34: 9-18, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31096232

RESUMO

A decision to develop a stereotactic radiosurgery center and install the first 201 cobalt-60 Gamma Knife in Pittsburgh was made in 1981 after gathering regional and leadership support. This was part of a 7-year quest that required overcoming barriers to a new technology unfamiliar to US regulatory authorities and insurance companies. The first patient was treated in August 1987. Since that time our center has installed each succeeding Gamma Knife device developed. During an initial 30-year experience we performed more than 14,750 patient procedures. In addition to patient care our Center's goal was to develop a major teaching and clinical research program that eventually led to the training of more than 2,500 physicians and medical physicists, the publication of more than 600 peer-reviewed clinical outcome research studies, and 4 books. This report summarizes the rationale for acquisition, the challenges and the early years, and then the evolution of our center which installed the first US 201 source Gamma Knife.


Assuntos
Centros Médicos Acadêmicos , Radioisótopos de Cobalto , Radiocirurgia , Centros Médicos Acadêmicos/história , Centros Médicos Acadêmicos/estatística & dados numéricos , História do Século XX , História do Século XXI , Humanos , América do Norte , Radiocirurgia/educação , Radiocirurgia/história , Radiocirurgia/instrumentação , Radiocirurgia/estatística & dados numéricos
20.
Intensive Crit Care Nurs ; 53: 8-14, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31023516

RESUMO

OBJECTIVE: To determine perceptions of Jordanian critical care staff about obstacles and facilitators to end-of-life care. RESEARCH METHODOLOGY: The "National Survey of Critical Care Nurses' Perceptions of End-of-Life Care" was adapted and distributed to 143 critical care nurses (n = 110) and physicians (n = 33) in two Jordanian hospitals. Nurses and physicians completed items about perceived obstacles to end-of-life care. Nurses only completed items about facilitators to end-of-life care. RESULTS: The overall response rate was 72.7% (n = 104/143). Seventy-six nurses (69.1%) and 28 physicians (84.5%) responded. Nurses and physicians agreed that the highest scoring obstacles were: 'family members who do not understand what life-saving measures mean' and the 'poor design of critical care units'. Other highly scoring obstacles related to clinicians' behaviours, characteristics and attitudes. Nurses perceived the highest scoring facilitator was 'family members who accepted that the patient was dying'. CONCLUSION: There is a need to further explore the issues underlying perceptions about clinicians' behaviours, which were perceived to be key barriers to quality end-of-life care and to find acceptable solutions that fit with Islamic culture. It is the first time that the survey has been used to gather perceptions of doctors and nurses in a non-western culture.


Assuntos
Pessoal de Saúde/psicologia , Assistência Terminal/métodos , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Relações Interprofissionais , Jordânia , Masculino , Pessoa de Meia-Idade , Percepção , Inquéritos e Questionários , Assistência Terminal/normas , Assistência Terminal/estatística & dados numéricos
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