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1.
BMJ Open ; 11(9): e046111, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34475150

RESUMO

OBJECTIVE: Communication failures between clinicians lead to poor patient outcomes. Critically injured patients have multiple injured organ systems and require complex multidisciplinary care from a wide range of healthcare professionals and communication failures are abundantly common. This study sought to determine barriers and facilitators to interdisciplinary communication between the consulting trauma, intensive care unit (ICU) team and specialty consultants for critically injured patients at an urban, safety-net, level 1 trauma centre. DESIGN: An observational qualitative study of barriers and facilitators to interdisciplinary communication. SETTING: We conducted observations of daily rounds in two trauma surgical ICUs and recorded the most frequently consulted teams. PARTICIPANTS: Key informant interviews after presenting clinical vignettes as discussion prompts were conducted with a broad range of clinicians from the ICUs and physicians and nurse practitioners from the consultant teams who were identified during the observations. Interviews were recorded and transcribed verbatim. Data of these 10 interviews were combined with primary transcript data from prior study (25 interviews) and analysed together because of the same setting with same themes. Independent coding of the transcripts, with iterative reconciliation, was performed by two coders. OUTCOMES MEASURES: Facilitators and barriers of interdisciplinary communication were identified. RESULTS: A total of 35 interview transcripts were analysed. Cardiology and interventional radiology were the most frequently consulted teams. Consulting and consultant clinicians reported that perceived accessibility from the team seeking a consultation and the consultant team impacted interdisciplinary communication. Accessibility had a physical dimension as well as a psychological dimension. Accessibility was demonstrated by responsiveness between clinicians of different disciplines and in turn facilitated interdisciplinary communication. Social norms, cognitive biases, hierarchy and relationships were reported as both facilitators and barriers to accessibility, and therefore, interdisciplinary communication. CONCLUSION: Accessibility impacted interdisciplinary communication between the consulting and the consultant team. ARTICLE SUMMARY: Elucidates barriers and facilitators to interdisciplinary communication between consulting and consultant teams.


Assuntos
Comunicação Interdisciplinar , Encaminhamento e Consulta , Comunicação , Barreiras de Comunicação , Pessoal de Saúde , Humanos , Unidades de Terapia Intensiva , Pesquisa Qualitativa
3.
Adv Emerg Nurs J ; 43(3): 237-246, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34397502

RESUMO

Patients suffering from mental illness are often less likely to engage in treatment at an outpatient level. Lack of communication and coordination of care between providers has negative results for the health system and the patient. Improved communication has shown improved satisfaction of providers in health care. Using prior research, an electronic reminder and standardized documentation of communication was added to the health system's electronic health record. The aim of this quality improvement (QI) project was to compare pre-/postintervention communication and satisfaction between emergency department and outpatient psychiatric providers. The QI project was conducted on a convenience sample of 13 outpatient psychiatric providers at a large academic medical center. Using a pre-/postintervention design, QI project data were collected via chart reviews and pre-/postsurveys. The chart review results revealed the communication rate increased significantly from pre (22%) to post (85%), p < .001. The survey results revealed overall satisfaction had statistically significant increase from pre- (Mdn = 3, neutral) to postintervention (Mdn = 5, very satisfied), Z = -2.21, p =.027. The survey results revealed a statistically significant increase in frequency of direct communication from pre- (21%-40%) to postintervention (81%-100%), Z = -2.06, p = .039. The QI project documents an increase in both provider satisfaction and communication post-intervention.


Assuntos
Registros Eletrônicos de Saúde , Serviço Hospitalar de Emergência , Comunicação Interdisciplinar , Psiquiatria , Melhoria de Qualidade , Humanos , Pacientes Ambulatoriais , Inquéritos e Questionários
4.
Am J Public Health ; 111(7): 1227-1230, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34370535

RESUMO

Cook County Health partnered with the Chicago Departments of Public Health and Family & Support Services and several dozen community-based organizations to rapidly establish a temporary medical respite shelter during the spring 2020 COVID-19 peak for individuals experiencing homelessness in Chicago and Cook County, Illinois. This program provided low-barrier isolation housing to medically complex adults until their safe return to congregate settings. We describe strategies used by the health care agency, which is not a Health Resource and Services Administration Health Care for the Homeless grantee, to provide medical services and care coordination.


Assuntos
COVID-19/reabilitação , Redes Comunitárias/organização & administração , Pessoas em Situação de Rua/estatística & dados numéricos , Relações Interinstitucionais , Serviço Social/organização & administração , COVID-19/epidemiologia , Chicago , Doenças Transmissíveis Emergentes/prevenção & controle , Humanos , Illinois , Comunicação Interdisciplinar , Habitação Popular/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos
5.
Nutrients ; 13(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34371897

RESUMO

Traditionally, patients with end-stage heart failure (HF) have rarely been involved in end-of-life care (EOLC) discussions in Japan. The purpose of this study was to examine the impact of HF-specific palliative care team (HF-PCT) activities on EOLC discussions with patients, HF therapy and care, and food intake at the end of life. We retrospectively analyzed 52 consecutive patients with HF (mean age, 70 ± 15 years; 42% female) who died at our hospital between May 2013 and July 2020 and divided them into two groups: before (Era 1, n = 19) and after (Era 2, n = 33) the initiation of HF-PCT activities in June 2015. Compared to Era 1, Era 2 showed a decrease in invasive procedures, an increase in opioid and non-intubating sedative use for symptom relief, improved quality of meals at the end of life, and an increase in participation in EOLC discussions. The administration of artificial nutrition in the final three days was associated with non-ischemic cardiomyopathy etiology, the number of previous hospitalizations for HF, and multidisciplinary EOLC discussion support. HF-PCT activities may provide an opportunity to discuss EOLC with patients, reduce the burden of physical and psychological symptoms, and shift the goals of end-of-life nutritional intake to ensure comfort and quality of life.


Assuntos
Ingestão de Alimentos , Insuficiência Cardíaca/terapia , Estado Nutricional , Apoio Nutricional , Cuidados Paliativos , Assistência Terminal , Idoso , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Comunicação Interdisciplinar , Japão , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
6.
Isr J Health Policy Res ; 10(1): 48, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34407864

RESUMO

Among the challenges presented by the SARS-CoV2 pandemic are those related to balancing societal priorities with averting threats to population health. In this exceptional context a group of Israeli physicians and public health scholars (multidisciplinary academic group on children and coronavirus [MACC]) coalesced, examining the role of children in viral transmission and assessing the necessity and consequences of restricted in-class education. Combining critical appraisal and analytical skills with public health experience, MACC advocated for safe and monitored school re-opening, stressing the importance of education as a determinant of health, continuously weighing this stance against evolving COVID-19-risk data. MACC's activities included offering research-based advice to government agencies including Ministries of Health, Finance, and Education. In a setting where government bodies were faced with providing practical solutions to both decreasing disease transmission and maintaining society's vital activities, and various advisors presented decision-makers with disparate views, MACC contributed epidemiological, clinical and health policy expertise to the debate regarding school closure as a pandemic control measure, and adaptations required for safe re-opening. In this paper, we describe the evolution, activities, policy inputs and media profile of MACC, and discuss the role of academics in advocacy and activism in the midst of an unprecedented public health crisis. A general lesson learned is that academics, based on the rigor of their scientific work and their perceived objectivity, can and should be mobilized to pursue and promote policies based on shared societal values as well as empiric data, even when considerable uncertainty exists about the appropriate course of action. Mechanisms should be in place to open channels to multidisciplinary academic groups and bring their input to bear on decision-making.


Assuntos
COVID-19/prevenção & controle , Comunicação Interdisciplinar , Pandemias/prevenção & controle , Instituições Acadêmicas/organização & administração , COVID-19/epidemiologia , COVID-19/transmissão , Criança , Humanos , Israel/epidemiologia , Médicos/psicologia , Saúde Pública
8.
Br J Anaesth ; 127(3): 470-478, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34238547

RESUMO

BACKGROUND: Communication amongst team members is critical to providing safe, effective medical care. We investigated the role of communication failures in patient injury using the Anesthesia Closed Claims Project database. METHODS: Claims associated with surgical/procedural and obstetric anaesthesia and postoperative pain management for adverse events from 2004 or later were included. Communication was defined as transfer of information between two or more parties. Failure was defined as communication that was incomplete, inaccurate, absent, or not timely. We classified root causes of failures as content, audience, purpose, or occasion with inter-rater reliability assessed by kappa. Claims with communication failures contributing to injury (injury-related communication failures; n=389) were compared with claims without any communication failures (n=521) using Fisher's exact test, t-test, or Mann-Whitney U-tests. RESULTS: At least one communication failure contributing to patient injury occurred in 43% (n=389) out of 910 claims (κ=0.885). Patients in claims with injury-related communication failures were similar to patients in claims without failures, except that failures were more common in outpatient settings (34% vs 26%; P=0.004). Fifty-two claims had multiple communication failures for a total of 446 injury-related failures, and 47% of failures occurred during surgery, 28% preoperatively, and 23% postoperatively. Content failures (insufficient, inaccurate, or no information transmitted) accounted for 60% of the 446 communication failures. CONCLUSIONS: Communication failure contributed to patient injury in 43% of anaesthesia malpractice claims. Patient/case characteristics in claims with communication failures were similar to those without failures, except that failures were more common in outpatient settings.


Assuntos
Analgesia/efeitos adversos , Anestesia/efeitos adversos , Comunicação Interdisciplinar , Imperícia , Erros Médicos , Equipe de Assistência ao Paciente , Relações Médico-Paciente , Relações Profissional-Família , Adulto , Idoso , Anestesia Obstétrica/efeitos adversos , Bases de Dados Factuais , Feminino , Humanos , Seguro de Responsabilidade Civil , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Medição de Risco , Fatores de Risco , Análise de Causa Fundamental
13.
Turk Neurosurg ; 31(4): 481-483, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34270082

RESUMO

In the past decade or perhaps a little earlier than that the concept of teamwork evolved among the circles of surgeons especially among those involved in complicated and time consuming surgeries. Skull base surgeries were one of those surgeries where the role of teamwork was acutely felt owing to innumerable specialties involved in the consummation of such surgeries. Although teamwork in this specialty is the need of the hour but, achieving the spirit of teamwork is not that easy and perhaps a challenging task. This manuscript tackles the much needed demand of teamwork in this arena of surgery and unveils whether such a teamwork is achievable or is just an utopian dream.


Assuntos
Procedimentos Neurocirúrgicos , Equipe de Assistência ao Paciente/organização & administração , Base do Crânio/cirurgia , Comportamento Cooperativo , Tomada de Decisão Compartilhada , Estudos de Viabilidade , Mortalidade Hospitalar , Humanos , Comunicação Interdisciplinar , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/mortalidade , Procedimentos Neurocirúrgicos/normas , Equipe de Assistência ao Paciente/normas , Estudos Retrospectivos , Resultado do Tratamento , Utopias
14.
Isr Med Assoc J ; 23(7): 437-440, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34251127

RESUMO

BACKGROUND: Pregnant women with Marfan syndrome (MS) have a high risk of aortic dissection around delivery and their optimal management requires a multi-disciplinary approach, including proper cardio-obstetric care and adequate pain management during labor, which may be difficult due to the high prevalence of dural ectasia (DE) in these patients. OBJECTIVES: To evaluate the multidisciplinary management of MS patients during labor. METHODS: Nineteen pregnant women (31 pregnancies) with MS were followed by a multi-disciplinary team (cardiologist, obstetrician, anesthesiologist) prior to delivery. RESULTS: Two patients had kyphoscoliosis; none had previous spine surgery nor complaints compatible with DE. In eight pregnancies (7 patients), aortic root diameter (ARd) before pregnancy was 40 to 46 mm. In this high-risk group, one patient underwent elective termination, two underwent an urgent cesarean section (CS) under general anesthesia, and five had elective CS; two under general anesthesia (GA), and three under spinal anesthesia. In 23 pregnancies (12 patients), ARd was < 40 mm. In this non-high-risk group three pregnancies (1 patient) were electively terminated. Of the remaining 20 deliveries (11 patients), 14 were vaginal deliveries, 9 with epidural analgesia and 5 without. Six patients had a CS; four under GA and two2 under spinal anesthesia. There were no epidural placement failures and no failed responses. There were 2 cases of aortic dissection, unrelated to the anesthetic management. CONCLUSIONS: The optimal anesthetic strategy during labor in MS patients should be decided by a multi-disciplinary team. Anesthetic complications due to DE were not encountered during neuraxial block.


Assuntos
Anestesia Obstétrica , Aneurisma Dissecante , Doenças da Aorta , Parto Obstétrico , Síndrome de Marfan , Complicações do Trabalho de Parto , Complicações na Gravidez , Adulto , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/métodos , Anestesia Obstétrica/estatística & dados numéricos , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/prevenção & controle , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico , Doenças da Aorta/etiologia , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Comunicação Interdisciplinar , Israel/epidemiologia , Síndrome de Marfan/complicações , Síndrome de Marfan/epidemiologia , Síndrome de Marfan/fisiopatologia , Monitorização Fisiológica/métodos , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/prevenção & controle , Avaliação de Processos e Resultados em Cuidados de Saúde , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/fisiopatologia , Complicações na Gravidez/terapia , Resultado da Gravidez/epidemiologia , Gravidez de Alto Risco
16.
Postgrad Med ; 133(6): 592-598, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34171981

RESUMO

OBJECTIVES: COVID19 pandemic has forced physicians from different specialties to assist cases overload. Our aim is to assess gastroenterologist's assistance in COVID-19 by assessing mortality, ICU admission, and length of stay, and seek for risk factors for in-hospital mortality and longer hospital stay. METHODS: A total of 41 COVID-19 patients assisted by gastroenterologist (GI cohort) and 137 assisted by pulmonologist, internal medicine practitioners, and infectious disease specialists (COVID expert cohort) during October-November 2020 were prospectively collected. Clinical, demographic, imaging, and laboratory markers were collected and compared between both cohorts. Bivariate analysis and logistic regression were performed to search for risk factors of mortality and longer hospital stays. RESULTS: A total of 27 patients died (15.1%), 11 were admitted to ICU (6.1%). There were no differences between cohorts in mortality (14.6% vs 15.4%;p = 0.90), ICU admission (12.1% vs 4%;p = 0.13), and length of stay (6.67 ± 4 vs 7.15 ± 4.5 days; p = 0.58). PaO2/FiO2 on admission (OR 0.991;CI95% 0.984-0.998) and age > 70 (OR 17.54;CI95% 3.93-78.22) were independently related to mortality. Age > 70, history of malignancy, diabetes, and cardiovascular disease were related to longer hospital stays (p < 0.001, p = 0.03, p = 0.04, p = 0.02 respectively). CONCLUSIONS: COVID-19 assistance was similar between gastroenterologist and COVID experts when assessing mortality, ICU admission, and length of stay. Age>70 and decreased PaO2/FiO2 on admission were independent risk factors of mortality. Age and several comorbidities were related to longer hospital stay.


Assuntos
COVID-19 , Prova Pericial , Gastroenterologistas/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Fatores Etários , Idoso , COVID-19/diagnóstico , COVID-19/mortalidade , COVID-19/fisiopatologia , Comorbidade , Prova Pericial/métodos , Prova Pericial/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Comunicação Interdisciplinar , Masculino , Prognóstico , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Espanha/epidemiologia
18.
Tech Vasc Interv Radiol ; 24(1): 100729, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34147197

RESUMO

Since the introduction of uterine artery embolization as a treatment option for symptomatic leiomyomas, there has been a growing interest in expanding the role of interventional radiology (IR) in the evaluation and treatment of obstetrics and gynecology (OBGYN) patients. This review provides an overview of opportunities for collaboration between IR and OBGYN. This can include medically and/or surgically complex patients, efforts to reduce quantitative blood loss, obstetrical emergencies, and consideration of fertility or uterine preservation. Increased collaborative efforts between IR and OBGYN would allow for patients to be fully informed regarding the complete spectrum of surgical and nonsurgical treatment options available to them. The purpose of this review is to foster opportunities to improve outcomes and respect patient values.


Assuntos
Leiomioma/terapia , Equipe de Assistência ao Paciente , Hemorragia Pós-Parto/terapia , Radiografia Intervencionista , Embolização da Artéria Uterina , Neoplasias Uterinas/terapia , Adulto , Comportamento Cooperativo , Feminino , Preservação da Fertilidade , Humanos , Comunicação Interdisciplinar , Leiomioma/diagnóstico por imagem , Leiomioma/patologia , Hemorragia Pós-Parto/diagnóstico por imagem , Radiografia Intervencionista/efeitos adversos , Resultado do Tratamento , Embolização da Artéria Uterina/efeitos adversos , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/patologia
20.
Med Clin North Am ; 105(4): 757-782, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34059249

RESUMO

Connective tissue diseases (CTDs) encompass a broad spectrum of clinical presentations that involve multidisciplinary management. Cutaneous findings are common in CTD and careful examination of these features aids in appropriate diagnosis and subsequent evaluation. Thorough work-up of CTD is crucial to properly identify disease subtypes and systemic involvement. Management plans can be developed based on diagnosis and systemic manifestations of disease. Disease management often requires treatment with pharmacotherapies with potential for toxicities, further underscoring the importance of diagnostic accuracy in this patient population. Evolving research strives to better elucidate the pathogenic mechanisms of CTDs allowing for more targeted treatment modalities.


Assuntos
Doenças do Tecido Conjuntivo/complicações , Doenças do Tecido Conjuntivo/tratamento farmacológico , Doenças do Tecido Conjuntivo/patologia , Tratamento Farmacológico/métodos , Adulto , Comorbidade , Doenças do Tecido Conjuntivo/diagnóstico , Dermatomiosite/diagnóstico , Dermatomiosite/etiologia , Dermatomiosite/patologia , Diagnóstico Diferencial , Tratamento Farmacológico/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Diagnóstico Precoce , Feminino , Humanos , Comunicação Interdisciplinar , Lúpus Eritematoso Cutâneo/diagnóstico , Lúpus Eritematoso Cutâneo/etiologia , Lúpus Eritematoso Cutâneo/patologia , Lúpus Eritematoso Discoide/diagnóstico , Lúpus Eritematoso Discoide/etiologia , Lúpus Eritematoso Discoide/patologia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/etiologia , Lúpus Eritematoso Sistêmico/patologia , Masculino , Administração dos Cuidados ao Paciente/métodos , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/etiologia , Escleroderma Sistêmico/patologia , Vasculite/diagnóstico , Vasculite/etiologia , Vasculite/patologia
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