Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 236
Filtrar
1.
J Oncol Pharm Pract ; 26(1): 116-123, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31096855

RESUMO

PURPOSE: Nurse practitioners, physician assistants, and pharmacists are advanced practice providers who are highly trained and qualified healthcare professionals that can help support traditional demands on oncologists' increased time in direct patient care. The purpose of this study was to detail and assess the creation of a privileging process for this group of medical professionals within an academic medical center. Obtaining the designation of limited oncology practice provider (LOPP) gives the right to modify chemotherapy orders and to order supportive care medications. METHODS: An interdisciplinary team developed a comprehensive training process inclusive of required educational domains, knowledge goals, and educational activities to become an LOPP. In 2018, five years after the implementation of the privileging process, a survey was distributed to assess perceptions of the training process and integration of LOPPs within oncology practice. RESULTS: Most oncologists noted that working with LOPPs is beneficial to oncology practice (94%) and that they make modifying chemotherapy orders more efficient (87%). Greater than 82% of LOPPs also reported that their privileges streamline the chemotherapy process and make them feel valuable. CONCLUSION: The creation of the LOPP designation is an effective way to integrate nurse practitioners, physician assistants, and pharmacists within oncology practice. The inclusion of a focused privileging process ensures the safety of cancer care provided and has created a streamlined process for chemotherapy modifications and supportive care.


Assuntos
Centros Médicos Acadêmicos/normas , Prática Avançada de Enfermagem/normas , Oncologia/normas , Profissionais de Enfermagem/normas , Farmacêuticos/normas , Assistentes Médicos/normas , Centros Médicos Acadêmicos/métodos , Prática Avançada de Enfermagem/métodos , Antineoplásicos/administração & dosagem , Feminino , Humanos , Masculino , Oncologia/métodos , Inquéritos e Questionários
3.
Anesth Analg ; 129(3): e83-e85, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31425214

RESUMO

While significant literature exists on hospital-based "code calls," there is a lack of research on calls for help in the operating room (OR). The purpose of this study was to quantify the rate and nature of calls for help in the OR of a tertiary care hospital. For a 1-year period, all calls were recorded in the main OR at The University of California, Irvine Medical Center. The average rate of calls per 1000 anesthesia hours was 1.4 (95% CI, 1.1-1.8), corresponding to a rate of 5.0 (3.8-6.5) calls per 1000 cases. Airway (44%), cardiac (32%), and hemorrhagic (11%) emergencies were the most common etiologies. Thirty-day mortality approached 11% for patients who required a call for help in the OR.


Assuntos
Centros Médicos Acadêmicos/tendências , Serviços Médicos de Emergência/tendências , Salas Cirúrgicas/tendências , Centros de Atenção Terciária/tendências , Centros Médicos Acadêmicos/métodos , Estudos de Coortes , Serviços Médicos de Emergência/métodos , Feminino , Humanos , Masculino , Salas Cirúrgicas/métodos , Estudos Prospectivos
4.
Anesth Analg ; 129(3): 794-803, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31425222

RESUMO

BACKGROUND: Noise in the operating room may cause distractions during critical periods and impair reliable communication between staff. Even momentary inefficiency while administering anesthesia can lead to errors and serious consequences for the patient. Distractions to an anesthesia provider during critical periods such as induction and emergence are a patient safety issue. Because of concerns regarding unacceptable noise levels and distractions during induction of general anesthesia, our institution developed a quality improvement initiative, the "Distraction-Free Induction Zone." The specific aim of this project was to decrease the percentage of cases with a distraction, described as music, unnecessary conversations, or loud noises, occurring during induction of general anesthesia in pediatric otolaryngology operating rooms from 61% to 15%. METHODS: To complete this quality improvement initiative, a multidisciplinary team used improvement science methods, including The Model for Improvement with interventions tested via Plan-Do-Study-Act cycles. We used tools such as the Key Driver Diagram, Pareto Charts, Process Flow Chart, and Plan-Do-Study-Act worksheets. Data were manually collected and entered weekly in an Excel spreadsheet. Statistical process control methods, including a run chart and a P-control chart, were used for data analysis. Our measure was a composite measure in which observation of 1 of the 3 distractions during induction of general anesthesia categorized the case as a case with a distraction. RESULTS: We tested and implemented several interventions via Plan-Do-Study-Act cycles in which 3 main interventions collectively were associated with an observed decrease in distractions during induction of general anesthesia. These included educating the perioperative staff present in the operating room to help them understand that distractions to anesthesia providers represent a patient safety issue, the operating room circulating nurse taking responsibility to pause any music on arrival to the operating room, and the anesthesiologist reminding the staff in the operating room of induction time and/or asking for quiet during induction if a distraction occurs. The percentage of cases with a distraction during induction of general anesthesia in our pediatric otolaryngology operating rooms decreased from 61% to 15% by April 15, 2017 and to 10% by June 5, 2017. CONCLUSIONS: Using improvement science methods, we observed a decrease in distractions during induction of general anesthesia, improved a process, and encouraged change in culture at a large academic children's hospital to enhance the quality and safety of the anesthetic care we provide our patients.


Assuntos
Centros Médicos Acadêmicos/normas , Anestesia Geral/normas , Pessoal de Saúde/normas , Hospitais Pediátricos/normas , Cuidados Pré-Operatórios/normas , Melhoria de Qualidade/normas , Centros Médicos Acadêmicos/métodos , Anestesia Geral/métodos , Anestésicos/administração & dosagem , Humanos , Cuidados Pré-Operatórios/métodos , Inquéritos e Questionários
5.
J Grad Med Educ ; 11(3): 295-300, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31210860

RESUMO

Background: Identification of surrogate decision makers (SDMs) is an important part of advance care planning for hospitalized patients. Despite its importance, the best methods for engaging residents to sustainably improve SDM documentation have not been identified. Objective: We implemented a hospital-wide quality improvement initiative to increase identification and documentation of SDMs in the electronic health record (EHR) for hospitalized patients, utilizing a Housestaff Quality and Safety Council (HQSC). Methods: EHR documentation of SDMs for all adult patients admitted to a tertiary academic hospital, excluding psychiatry, were tracked and grouped by specialty in a weekly run chart during the intervention period (July 2015 through April 2016). This also continued postintervention. Interventions included educational outreach for residents, monthly plan-do-study-act cycles based on performance feedback, and a financial incentive of a one-time payment of 0.75% of a resident's salary put into the retirement account of each resident, contingent on meeting an SDM documentation target. Comparisons were made using statistical process control and chi-square tests. Results: At baseline, SDMs were documented for 11.1% of hospitalized adults. The intervention period included 9146 eligible admissions. Hospital-wide SDM documentation increased significantly and peaked near the financial incentive deadline at 48% (196 of 407 admissions, P < 001). Postintervention, hospital-wide SDM documentation declined to 30% (134 of 446 admissions, P < .001), but remained stable. Conclusions: This resident-led intervention sustainably increased documentation of SDMs, despite a decline from peak rates after the financial incentive period and notable differences in performance patterns by specialty admitting service.


Assuntos
Planejamento Antecipado de Cuidados/organização & administração , Documentação/métodos , Internato e Residência/normas , Centros Médicos Acadêmicos/métodos , Centros Médicos Acadêmicos/organização & administração , Adulto , Tomada de Decisões , Registros Eletrônicos de Saúde , Planos para Motivação de Pessoal , Humanos , Oregon , Melhoria de Qualidade/organização & administração
6.
Bull Hosp Jt Dis (2013) ; 77(2): 122-127, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31128581

RESUMO

OBJECTIVE: An important part of clinical training is learning how to identify and prevent hospital-acquired conditions or injuries. Despite this, there are few standardized methods in graduate medical education (GME) for teaching and assessing resident patient safety skills. Residents often do not report safety events, and increasing resident engagement can positively impact patient safety. In the current study, we sought to apply such a tool in gauging the capacity of orthopedic surgery interns at a large academic medical center to identify patient safety hazards and begin a discussion regarding the management of potential patient safety issues. METHODS: A total of 27 orthopedic surgery interns at a single large academic medical center participated in the current observational study divided into two distinct groups in the summers of 2016 and 2017. A patient room was simulated with a training mannequin lying supine in a hospital bed. A mock patient chart and handoff were created in the electronic medical record (EMR) on the bedside computer. Patient safety hazards and errors of care were placed around the room and in the EMR, including several derived from the Joint Commission's National Patient Safety Goals. Each intern was given a maximum of 20 minutes to identify as many of the simulated patient safety hazards as possible. A debrief was conducted at the end of the exercise to discuss their responsibility to speak up when hazards are identified in a non-simulated patient room. For analysis, the hazards were distributed into four categories: room organization, EMR, patient care, and white board. Each intern's individual score (number of complete identifications/total number of hazards) and the group's performance as a whole in each category were calculated. RESULTS: The mean individual score was 51.54% (26.67% to 70.00%) in group A and 40.41% (25.71% to 54.29%) in group B. In group A, room organization hazards were identified more than any other category (74.62%), followed by patient care errors (40.38%), EMR hazards (40.17%), and white board errors (38.46%). In group B, room organization was identified the most (57.74%), followed by EMR (50%), and patient care and white board hazards (28.57% each). Certain critical safety hazards were identified by a small number of interns. For example, the inadequate handoff was only identified by four interns in each group. CONCLUSIONS: Hazards related to room cleanliness were easier to identify than hazards related to specific errors in patient care. A wide variation in the identification of critical safety issues was observed among the trainees assessed. This type of simulated educational experience provides important opportunities for resident-specific education in the realm of patient safety and health care quality.


Assuntos
Competência Clínica , Internato e Residência/métodos , Procedimentos Ortopédicos , Assistência ao Paciente , Segurança do Paciente , Centros Médicos Acadêmicos/métodos , Currículo , Educação , Avaliação Educacional , Humanos , Manequins , Procedimentos Ortopédicos/educação , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/normas , Assistência ao Paciente/efeitos adversos , Quartos de Pacientes/normas , Treinamento por Simulação/métodos
7.
Arthritis Care Res (Hoboken) ; 71(3): 343-351, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30724039

RESUMO

OBJECTIVE: Recent studies have suggested that fibromyalgia is inaccurately diagnosed in the community, and that ~75% of persons reporting a physician diagnosis of fibromyalgia would not satisfy published criteria. To investigate possible diagnostic misclassification, we compared expert physician diagnosis with published criteria. METHODS: In a university rheumatology clinic, 497 patients completed the Multidimensional Health Assessment Questionnaire (MD-HAQ) and the 2010 American College of Rheumatology preliminary diagnostic criteria modified for self-administration during their ordinary medical visits. Patients were evaluated and diagnosed by university rheumatology staff. RESULTS: Of the 497 patients, 121 (24.3%) satisfied the fibromyalgia criteria, while 104 (20.9%) received a clinician International Classification of Diseases (ICD) diagnosis of fibromyalgia. The agreement between clinicians and criteria was 79.2%. However, agreement beyond chance was only fair (κ = 0.41). Physicians failed to identify 60 criteria-positive patients (49.6%) and incorrectly identified 43 criteria-negative patients (11.4%). In a subset of 88 patients with rheumatoid arthritis (RA), the kappa value was 0.32, indicating slight to fair agreement. Universally, higher polysymptomatic distress scores and criteria-based diagnosis were associated with more abnormal MD-HAQ clinical scores. Women and patients with more symptoms but fewer pain areas were more likely to receive a clinician's diagnosis than to satisfy fibromyalgia criteria. CONCLUSION: There is considerable disagreement between ICD clinical diagnosis and criteria-based diagnosis of fibromyalgia, calling into question ICD-based studies. Fibromyalgia criteria were easy to use, but problems regarding clinician bias, meaning of a fibromyalgia diagnosis, and the validity of physician diagnosis were substantial.


Assuntos
Centros Médicos Acadêmicos/normas , Instituições de Assistência Ambulatorial/normas , Erros de Diagnóstico , Fibromialgia/diagnóstico , Papel do Médico , Centros Médicos Acadêmicos/métodos , Adulto , Idoso , Erros de Diagnóstico/psicologia , Feminino , Fibromialgia/epidemiologia , Fibromialgia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Medição da Dor/normas , Papel do Médico/psicologia
8.
J Cardiothorac Vasc Anesth ; 33(4): 1037-1043, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30638919

RESUMO

OBJECTIVE: Comprehensive educational initiatives in ultrasound for practicing physicians are lacking. We developed a perioperative ultrasound training program for faculty to offer a broad orientation to the principles and clinical applications of ultrasound. DESIGN AND SETTING: The program consisted of two phases. Phase one, which introduced ultrasound via didactic and hands-on components, had six live sessions. At the end of each, participants completed a knowledge quiz. During the sixth session, faculty participated in an objective structured clinical examination (OSCE). For phase two, faculty attended two to three sessions (8-10 hours each) of in-depth individualized training and demonstrated supervised performance of ultrasound-related procedures of their choice. PARTICIPANTS: Participants included Anesthesia faculty at Beth Israel Deaconess Medical Center. MEASUREMENTS AND MAIN RESULTS: On average 30 faculty members attended each live session for phase one; 12 completed phase two. There was a significant difference in quiz scores across the six sessions (p < 0.001) with scores for Session 6 being significantly higher than for Session 1 (p < 0.001). The average mean and median scores on the three OSCE stations were 95.63% and 98.33%, respectively. For phase two, the 8 participants who received training in regional anesthesia each performed > 10 blocks on patients over two days; 5 of the 7 participants who received training in transthoracic echocardiography each completed more than 15 examinations on simulators and 10 examinations on patients. CONCLUSION: It is possible to implement a departmental educational program for ultrasound to improve ultrasound knowledge and skills in practicing anesthesiologists.


Assuntos
Anestesiologia/educação , Anestesiologia/normas , Competência Clínica/normas , Avaliação Educacional/normas , Docentes de Medicina/educação , Docentes de Medicina/normas , Centros Médicos Acadêmicos/métodos , Centros Médicos Acadêmicos/normas , Anestesiologia/métodos , Avaliação Educacional/métodos , Humanos , Internato e Residência/métodos , Internato e Residência/normas
9.
J Med Libr Assoc ; 107(1): 89-97, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30598653

RESUMO

Background: Librarians and researchers alike have long identified research data management (RDM) training as a need in biomedical research. Despite the wealth of libraries offering RDM education to their communities, clinical research is an area that has not been targeted. Clinical RDM (CRDM) is seen by its community as an essential part of the research process where established guidelines exist, yet educational initiatives in this area are unknown. Case Presentation: Leveraging my academic library's experience supporting CRDM through informationist grants and REDCap training in our medical center, I developed a 1.5 hour CRDM workshop. This workshop was designed to use established CRDM guidelines in clinical research and address common questions asked by our community through the library's existing data support program. The workshop was offered to the entire medical center 4 times between November 2017 and July 2018. This case study describes the development, implementation, and evaluation of this workshop. Conclusions: The 4 workshops were well attended and well received by the medical center community, with 99% stating that they would recommend the class to others and 98% stating that they would use what they learned in their work. Attendees also articulated how they would implement the main competencies they learned from the workshop into their work. For the library, the effort to support CRDM has led to the coordination of a larger institutional collaborative training series to educate researchers on best practices with data, as well as the formation of institution-wide policy groups to address researcher challenges with CRDM, data transfer, and data sharing.


Assuntos
Centros Médicos Acadêmicos/métodos , Pesquisa Biomédica/métodos , Análise de Dados , Educação/organização & administração , Pesquisadores/educação , Adulto , Feminino , Humanos , Bibliotecas Médicas , Masculino , Pessoa de Meia-Idade , New York , Adulto Jovem
10.
J Cardiothorac Vasc Anesth ; 33(4): 993-1000, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30149982

RESUMO

OBJECTIVE: Cerebrospinal fluid drainage catheter-related complications can be reduced by following strict guidelines during their introduction, maintenance, and removal. The authors therefore aimed to determine whether simulation-based learning would improve senior anesthesiology residents' patient care performance during the insertion and management of these catheters compared to interactive problem-based learning (PBL) using the Anaesthetists' Non-Technical Skills global rating scale (ANTS). DESIGN: Prospective randomized trial. SETTING: Vascular or hybrid operating rooms in a large academic tertiary care center. PARTICIPANTS: Senior anesthesia (categorical anesthesia-3) residents rotating through the vascular rotation at the Cleveland Clinic main campus in the period between December 2014 and June 2017. INTERVENTION: Simulation-based learning versus PBL. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the composite score (ANTS global rating scale) achieved by participating residents as evaluated by their supervising anesthesiologists. Out of 28 residents who completed the study, N = 13 were randomized to simulation-based learning and N = 15 residents to the PBL approach. The median (first quartile, third quartile) composite score was 16 (14, 16) and 16 (13, 16) for the simulation-based learning and PBL groups, respectively. There was no significant difference in staff evaluation of the 2 study groups (p = 0.48) with an estimated odds (95% confidence interval) of getting a better staff evaluation score of 1.9 (0.3-10.6) times higher comparing simulation versus traditional training groups. CONCLUSION: Compared to interactive PBL, simulation-based learning does not result in a statistically significant improvement in anesthesia resident performance during insertion and management of cerebrospinal fluid drainage catheters.


Assuntos
Centros Médicos Acadêmicos/métodos , Anestesiologia/métodos , Cateterismo/métodos , Internato e Residência/métodos , Aprendizagem Baseada em Problemas/métodos , Treinamento por Simulação/métodos , Centros Médicos Acadêmicos/normas , Anestesiologia/educação , Anestesiologia/normas , Cateterismo/normas , Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Competência Clínica/normas , Avaliação Educacional/métodos , Avaliação Educacional/normas , Feminino , Humanos , Internato e Residência/normas , Masculino , Aprendizagem Baseada em Problemas/normas , Estudos Prospectivos , Treinamento por Simulação/normas
11.
World Neurosurg ; 121: e892-e897, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30315984

RESUMO

BACKGROUND: Factors affecting academic productivity of neurosurgeons are increasingly being studied. In the current investigation, we retrospectively reviewed a cohort of early career neurosurgeons to determine if their medical education, residency training, or academic employer had the most influence on a young academician's productivity. METHODS: We studied early career neurosurgeons who completed residency in U.S.-based neurosurgical training programs between 2010 and 2014. The ranking of an individual subject's medical school, residency, and current academic employer were analyzed for correlation with his or her current h-index. RESULTS: The neurosurgeons with the highest h-indexes are more likely to have attended elite medical schools, have trained in high-ranking residency programs, and work for prestigious university departments (P < 0.0001). Furthermore, we identified a positive correlation between the subjects' academic productivity and the ranking of all the institutions throughout their medical education, training, and current employment. The strongest correlation was with the rank of their residency program (ρ = 0.52). CONCLUSIONS: There is a correlation between the early career academic neurosurgeons' h-indexes and the ranking of all the institutions throughout their education, training, and current employment, but the strongest correlation was with the academic productivity of their residency program.


Assuntos
Centros Médicos Acadêmicos/métodos , Escolha da Profissão , Educação de Pós-Graduação em Medicina/tendências , Neurocirurgia/educação , Centros Médicos Acadêmicos/estatística & dados numéricos , Centros Médicos Acadêmicos/tendências , Estudos de Coortes , Feminino , Humanos , Masculino , Estatísticas não Paramétricas , Estados Unidos
12.
Crit Care Med ; 47(2): 159-166, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30407951

RESUMO

OBJECTIVES: Antimicrobial stewardship is advocated to reduce antimicrobial resistance in ICUs by reducing unnecessary antimicrobial consumption. Evidence has been limited to short, single-center studies. We evaluated whether antimicrobial stewardship in ICUs could reduce antimicrobial consumption and costs. DESIGN: We conducted a phased, multisite cohort study of a quality improvement initiative. SETTING: Antimicrobial stewardship was implemented in four academic ICUs in Toronto, Canada beginning in February 2009 and ending in July 2012. PATIENTS: All patients admitted to each ICU from January 1, 2007, to December 31, 2015, were included. INTERVENTIONS: Antimicrobial stewardship was delivered using in-person coaching by pharmacists and physicians three to five times weekly, and supplemented with unit-based performance reports. Total monthly antimicrobial consumption (measured by defined daily doses/100 patient-days) and costs (Canadian dollars/100 patient-days) before and after antimicrobial stewardship implementation were measured. MEASUREMENTS AND MAIN RESULTS: A total of 239,123 patient-days (57,195 patients) were analyzed, with 148,832 patient-days following introduction of antimicrobial stewardship. Antibacterial use decreased from 120.90 to 110.50 defined daily dose/100 patient-days following introduction of antimicrobial stewardship (adjusted intervention effect -12.12 defined daily dose/100 patient-days; 95% CI, -16.75 to -7.49; p < 0.001) and total antifungal use decreased from 30.53 to 27.37 defined daily doses/100 patient-days (adjusted intervention effect -3.16 defined daily dose/100 patient-days; 95% CI, -8.33 to 0.04; p = 0.05). Monthly antimicrobial costs decreased from $3195.56 to $1998.59 (adjusted intervention effect -$642.35; 95% CI, -$905.85 to -$378.84; p < 0.001) and total antifungal costs were unchanged from $1771.86 to $2027.54 (adjusted intervention effect -$355.27; 95% CI, -$837.88 to $127.33; p = 0.15). Mortality remained unchanged, with no consistent effects on antimicrobial resistance and candidemia. CONCLUSIONS: Antimicrobial stewardship in ICUs with coaching plus audit and feedback is associated with sustained improvements in antimicrobial consumption and cost. ICUs with high antimicrobial consumption or expenditure should consider implementing antimicrobial stewardship programs.


Assuntos
Centros Médicos Acadêmicos , Gestão de Antimicrobianos/métodos , Unidades de Terapia Intensiva , Centros Médicos Acadêmicos/métodos , Centros Médicos Acadêmicos/estatística & dados numéricos , Idoso , Anti-Infecciosos/economia , Anti-Infecciosos/uso terapêutico , Gestão de Antimicrobianos/economia , Gestão de Antimicrobianos/organização & administração , Análise Custo-Benefício , Custos de Medicamentos , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Desenvolvimento de Programas , Melhoria de Qualidade
13.
Appl Nurs Res ; 44: 1-5, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30389052

RESUMO

BACKGROUND: Alphanumeric paging is underutilized, despite being the standard mode of communication between physicians and nurses at many hospitals across the United States. OBJECTIVE: We hypothesized that an educational program designed to teach optimal alphanumeric paging behavior in conjunction with providing nurses with alphanumeric pagers would improve the quality and efficiency of nurse pages. METHODS: We implemented an educational program to teach nurses about optimal alphanumeric paging, defined as including four important components-patient identification, clinical scenario, sender identification, and callback number. We also provided each nurse with their own unique pager. Alphanumeric paging logs were reviewed prior to the intervention (baseline study period), and again following implementation of the intervention (intervention study period). Questionnaires were also completed by resident-physicians and nurses before and after implementation. RESULTS: During the intervention period, the percentage of ideal pages increased, and the percentage of suboptimal pages decreased. Compared to baseline, pages during the intervention period more often included patient identity, clinical scenario, and page-sender. Resident-physicians rated the paging-system's impact on patient care and job satisfaction more highly, and reported that disruptions and nurse accessibility were less of a problem during the intervention period compared to baseline. Nurses reported less problems with disruptions, ignored pages, miscommunication, and contentious relationships with resident-physicians. CONCLUSIONS: This study underscores the importance of two-way communication, which can be achieved without expensive technology. Creative use of old technology, such as providing nurses with traditional pagers, can improve communication and workflow, and potentially quality of care and patient safety.


Assuntos
Comunicação , Sistemas de Comunicação no Hospital , Internato e Residência/métodos , Invenções , Recursos Humanos de Enfermagem no Hospital/educação , Assistência ao Paciente/métodos , Segurança do Paciente , Centros Médicos Acadêmicos/métodos , Adulto , Educação Médica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos , Estados Unidos
14.
J Alzheimers Dis ; 66(1): 249-261, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30282355

RESUMO

BACKGROUND: There is a lack of research on the effects of physical activity (PA) on the progression of Alzheimer's disease (AD). OBJECTIVES: We investigated whether PA is associated with progression of dementia and mortality in AD. METHODS: In the present study, 934 patients with mild-to-moderate AD were included. PA was evaluated using a questionnaire written by the caregiver. The outcome measures were the Clinical Dementia Rating-Sum of Boxes (CDR-SB), Seoul-Instrumental Activities of Daily Living (S-IADL), Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI), a global composite score of neuropsychological subtests, and mortality. They were evaluated annually and received a maximum of three follow-up examinations. RESULTS: Between-group differences compared with the no PA group in the change of CDR-SB scores were -0.431 (95% CI = -0.824∼-0.039; p = 0.031) for the moderate PA group (150-750 minutes per week of moderate intensity PA), and -1.148 (-1.656∼-0.639; p < 0.001) for the high PA group (>750 minutes per week). As PA increased, there was a significant trend to slow the rate of increase in the CDR-SB, S-IADL, and CGA-NPI scores. The patients with ≥150 minutes per week for each of non-recreational and recreational PAs had a lower risk of mortality compared to those with <150 minutes per week for each of the PAs (hazard ratio 0.22, 95% CI = 0.05∼0.88; p = 0.033). CONCLUSION: More PA is associated with slower progression of dementia severity, functional decline, and abnormal behavior, and with a lower risk of mortality in AD.


Assuntos
Centros Médicos Acadêmicos/tendências , Doença de Alzheimer/psicologia , Doença de Alzheimer/terapia , Progressão da Doença , Exercício/fisiologia , Exercício/psicologia , Centros Médicos Acadêmicos/métodos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Testes Neuropsicológicos , Sistema de Registros , República da Coreia/epidemiologia
15.
Nurs Adm Q ; 42(4): 331-342, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30180079

RESUMO

Schools of nursing located within academic health centers have embraced expanded opportunities to lead in this era of rapid change and considerable uncertainty in US health care. These schools bear a unique responsibility to work with their clinical nursing partners to advance the care of patients, improve the health of communities and populations, and help steward the nation's health care resources. This article describes how the Emory University Nell Hodgson Woodruff School of Nursing has formed and sustained academic-practice partnerships in response to these imperatives. The structures and processes that have supported the partnerships are shared, as are the keys to success in a true partnership. The authors describe the work required to achieve mutually agreed-upon goals, along with the challenges that faculty and health care leaders have faced in their journey to system partnerships.


Assuntos
Centros Médicos Acadêmicos/métodos , Comportamento Cooperativo , Gerenciamento da Prática Profissional/tendências , Escolas de Enfermagem/tendências , Centros Médicos Acadêmicos/organização & administração , Humanos
17.
Am J Health Syst Pharm ; 75(22): 1812-1820, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30076167

RESUMO

PURPOSE: An interprofessional initiative to operationalize outpatient naloxone prescribing at a large academic medical center is described. SUMMARY: The initiative was carried out by a work group of clinical pharmacists and pharmacy administrators in collaboration with physicians and nursing staff leaders from multiple practice settings. An opioid overdose risk-assessment guide was developed on the basis of literature review and expert opinion. An institutional policy to guide identification of high-risk patient populations and facilitate naloxone prescribing and dispensing was developed and vetted by multiple expert committees. Patient education materials were created, and patients at high risk for opioid overdose were educated about overdose risk factors and naloxone use by a pharmacist and/or nurse before discharge or, in some cases, by outpatient pharmacists; when feasible, patients' friends, family members, and/or caregivers were included in education sessions. Interventions included distribution of a pamphlet emphasizing the importance of contacting emergency medical services personnel immediately in the event of an overdose, depicting the process for administration of injectable and nasal spray formulations of naloxone, and providing information on other first-response steps. Collaboration with outpatient pharmacies allowed for successful dispensing of naloxone prescriptions. CONCLUSION: The implementation of an outpatient naloxone prescribing policy at a large academic medical center created a streamlined approach for the interprofessional healthcare team to use in providing naloxone education and improved naloxone access to patients at high risk for opioid overdose.


Assuntos
Centros Médicos Acadêmicos , Prescrições de Medicamentos , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Centros Médicos Acadêmicos/métodos , Centros Médicos Acadêmicos/organização & administração , Overdose de Drogas/prevenção & controle , Humanos , Naloxona/administração & dosagem , Naloxona/envenenamento , Antagonistas de Entorpecentes/administração & dosagem , Antagonistas de Entorpecentes/envenenamento , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Política Organizacional , Equipe de Assistência ao Paciente/organização & administração , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/organização & administração , Serviço de Farmácia Hospitalar , Desenvolvimento de Programas
19.
J Perinat Neonatal Nurs ; 32(2): 136-143, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29689014

RESUMO

In 2012, the state of South Carolina lacked any Baby-Friendly designated hospitals. The Medical University of South Carolina had a strong lactation service since 2002 but continued to struggle with improving breastfeeding rates. The Baby-Friendly Hospital Initiative was the catalyst to increase breastfeeding rates at this academic medical center. In 2012, membership in the Best Fed Beginnings Learning Collaborative heightened awareness of the importance of interdisciplinary collaboration. Participation in the regional collaborative provided evidence-based breastfeeding education and best clinical practices that supported the maternal-infant dyad. These improved practices are achieved by implementation of the Ten Steps to Successful Breastfeeding. The collaborative model accelerated change, and the goals to reach 80% of each metric were met. The exclusive breastfeeding rate increased by 30%. As a result of swiftly achieving designation, the institution was then able to focus on sustainability issues and efforts to expand breastfeeding support into the community. The purpose of this article is to review one hospital's journey while providing guidance to other organizations undergoing the process of becoming Baby-Friendly. The invaluable membership in the Best Fed Beginnings Learning Collaborative quality improvement initiative proved to be a major incentive and source of support in efficiently achieving Baby-Friendly status.


Assuntos
Centros Médicos Acadêmicos , Aleitamento Materno , Educação em Saúde , Mães/educação , Centros Médicos Acadêmicos/métodos , Centros Médicos Acadêmicos/normas , Aleitamento Materno/métodos , Aleitamento Materno/estatística & dados numéricos , Feminino , Educação em Saúde/métodos , Educação em Saúde/organização & administração , Humanos , Recém-Nascido , Comunicação Interdisciplinar , Modelos Educacionais , Melhoria de Qualidade , South Carolina
20.
Am J Med ; 131(8): 967-971, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29660352

RESUMO

BACKGROUND: The purpose of this study was to test the hypothesis that a community-based intensive cardiac rehabilitation program could produce positive changes in risk factor profile and outcomes in an at-risk population. METHODS: Participants seeking either primary or secondary coronary artery disease prevention voluntarily enrolled in the 12-week intensive cardiac rehabilitation program. Data were obtained at baseline and 6-12 months after completion of the program. RESULTS: A total of 142 individuals, mean age 69 years, completed the Heart Series between 2012 and 2016. Follow-up data were available in 105 participants (74%). Participants showed statistically significant improvements in mean weight (165 to 162 lbs, P = .0005), body mass index (26 to 25 kg/m2, P = .001), systolic blood pressure (126 to 122 mm Hg, P = .01), diastolic blood pressure (73 to 70 mm Hg, P = .0005), total cholesterol (175 to 168 mg/dL, P = .03), low-density lipoprotein cholesterol (LDL-C) (100 to 93 mg/dL, P = .005), LDL-C/high-density lipoprotein cholesterol (HDL-C) ratio (1.8 to 1.6, P = .005), and cholesterol/HDL-C ratio (3.2 to 3.0, P = .003). Changes in HDL-C, triglycerides, and fasting blood glucose did not reach statistical significance, but all trended in favorable directions. Adverse cardiovascular disease outcomes were rare (one stent placement, no deaths). CONCLUSIONS: A total of 105 participants completed our 12-week community-based intensive cardiac rehabilitation program and showed significant positive changes in several measures of cardiac risk, with only 1 adverse event. These results compare favorably with those of hospital-based and academic institutional programs.


Assuntos
Assistência Ambulatorial/métodos , Reabilitação Cardíaca/métodos , Serviços de Saúde Comunitária/métodos , Centros Médicos Acadêmicos/métodos , Idoso , Glicemia/análise , Pressão Sanguínea , Índice de Massa Corporal , Peso Corporal , Doenças Cardiovasculares/prevenção & controle , Colesterol/sangue , LDL-Colesterol/sangue , Humanos , Comportamento de Redução do Risco , Resultado do Tratamento , Triglicerídeos/sangue
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA