Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 18.603
Filtrar
1.
Bone Joint J ; 101-B(9): 1087-1092, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474144

RESUMO

AIMS: The aim of this study was to assess the effects of transferring patients to a specialized arthroplasty centre between the first and second stages (interstage) of prosthetic joint infection (PJI) of the knee. PATIENTS AND METHODS: A search of our institutional database was performed to identify patients having undergone two-stage revision total knee arthroplasty (TKA) for PJI. Two cohorts were created: continuous care (CC) and transferred care (TC). Baseline characteristics and outcomes were collected and compared between cohorts. RESULTS: A total of 137 patients were identified: 105 in the CC cohort (56 men, 49 women; mean age 67.9) and 32 in the TC cohort (17 men, 15 women; mean age 67.8 years). PJI organism virulence was greater in the CC cohort (36.2% vs 15.6%; p = 0.030). TC patients had a higher rate of persisting or recurrent infection (53.6% vs 13.4%; p < 0.001), soft-tissue complications (31.3 vs 14.3%; p = 0.030), and reduced requirement for porous metal augments (78.1% vs 94.3%; p = 0.006). Repeat first stage debridement after transfer led to greater need for plastic surgical procedures (58.3% vs 0.0%; p < 0.001). CONCLUSION: Patient transfer during the interstage of treatment for infected TKA leads to poorer outcomes compared with patients receiving all their treatment at a specialized arthroplasty centre. Cite this article: Bone Joint J 2019;101-B:1087-1092.


Assuntos
Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/estatística & dados numéricos , Hospitais Especializados/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Infecções Relacionadas à Prótese/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Infecções Relacionadas à Prótese/etiologia , Reoperação/estatística & dados numéricos , Resultado do Tratamento
3.
Rev Lat Am Enfermagem ; 27: e3162, 2019 Aug 19.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31432917

RESUMO

OBJECTIVE: to describe the activities developed by the liaison nurses for the continuity of care after hospital discharge. METHOD: descriptive, qualitative study, based on the theoretical reference. Strength Based Care. The sample comprised 23 liaison nurses. The data was collected through a semi-structured questionnaire via Survey Monkey electronic platform and analyzed through the content analysis technique, with pre-defined categories. RESULTS: among the liaison nurses, nine (39.14%), between 35 and 44 years of age; 17 (73.91%) were female; 15 (65.22%) were working eleven years or more nurse and 11 (47.82%), were between six and ten years old as a liaison nurse. The professionals participate in the identification of the patients who need care after hospital discharge, coordinate the planning of the hospital discharge and transfer the patient's information to an extra-hospital service. CONCLUSION: the activities developed by the liaison nurses focus on the needs of the patient and the articulation with the extra-hospital services, and can be adapted to the Brazilian context as a strategy to minimize the discontinuity of care at the time of hospital discharge.


Assuntos
Continuidade da Assistência ao Paciente/normas , Papel do Profissional de Enfermagem , Recursos Humanos de Enfermagem no Hospital/normas , Alta do Paciente/estatística & dados numéricos , Adulto , Brasil , Canadá , Feminino , Hospitais Universitários , Humanos , Masculino , Transferência de Pacientes , Pesquisa Qualitativa , Inquéritos e Questionários
5.
Stud Health Technol Inform ; 264: 664-668, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438007

RESUMO

This article describes development of the multi-professional discharge checklist and its implementation into the nursing documentation system (NDS) as part of the patient's overall care plan. The aim was to harmonize patient's admission and care period documentation and to improve the quality of electronic nursing discharge summaries. The ultimate goal was to ensure continuity of care. The multidisciplinary discharge checklist was developed in two phases to support the discharge of elderly patients (over 65 years). First, the information content of the checklist was defined, and second, it was integrated into the NDS. Focus groups of social and healthcare professionals (n = 82) in specialist health care, primary health care and social services defined the information content and participated in the feedback and checking rounds. The development work should continue. Particular attention should be given to the technical performance of discharge checklists in the NDS.


Assuntos
Continuidade da Assistência ao Paciente , Alta do Paciente , Lista de Checagem , Assistência à Saúde , Hospitais , Humanos
6.
Stud Health Technol Inform ; 264: 669-673, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438008

RESUMO

Continuity of patient care (COC) is considered an essential feature of good quality care, but the ambiguity of the concept has given rise to methodological challenges in scientific studies. This study has a strong link to the functional definitions of electronic health records (EHR). In order to evaluate how COC is achieved, through a discharge summary, for example, the contents of COC should be defined. Conceptual consensus on COC as a multidimensional concept has increased. This study was conducted to provide an overview of the dimensions and descriptions of informational and management continuity of care. A scoping review was conducted. We found that informational continuity of care refers to data tool, data content, data structures or information quality related processes. Management continuity of care refers to information flow, co-operation, co-ordination, multiprofessionality or management processes. We identified the need to define next the contents of relational and cross-border continuities.


Assuntos
Continuidade da Assistência ao Paciente , Assistência à Saúde , Registros Eletrônicos de Saúde , Humanos , Qualidade da Assistência à Saúde
7.
Presse Med ; 48(7-8 Pt 1): e209-e215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31421945

RESUMO

AIM: Identified Palliative Care Beds (Lits Identifiés Soins Palliatifs - LISPs) is a French specificity. Primarily created to integrate palliative care culture into conventional hospital units, the relevance of this measure became a controversial issue. Nowadays, hospital teams continue to frequently encounter complex situations regarding medical care for palliative patients. To the best of our knowledge, there is only one study, a quantitative one, bridging the gap about that subject. It showed failure in practicing palliative care work around LISP. Our study is based on a qualitative method that complements the quantitative study. It aimed to describe difficulties that limit palliative care practices in managing adult patients in LISP. METHOD: This qualitative exploratory survey was conducted with a sample of health service professionals (n=20), from senior physicians to caregivers. Each semi-structured interview included open questions regarding their experiences, feelings and difficulties with palliative care practices on LISP. It also included closed questions concerning interviewee's demographics and career course. The data for this research were submitted to a two-stage analysis: first, a global review of each interview was performed to identify trends. Then, a detailed breakdown, question by question, was implemented. RESULTS: From a quantitative perspective, the interviews revealed 305 difficulties, indicating the gaps and barriers limiting the implementation of a palliative approach in these services. From a qualitative perspective, five topics raised our attention by their recurrence in discourses: (1) partial knowledge about palliative care definition and legislation mostly due to a lack of training; (2) need for time; (3) need for human resources; (4) need for communication; (5) hard time in transitioning from curative to palliative care. PERSPECTIVE: This survey gives the opportunity to understand health service professionals' difficulties in practicing palliative care in conventional medical services. It raises the central issue of the pricing reform on the health institutes activity. It also provides angles of inquiry to improve LISP effectiveness. This qualitative and descriptive study was designed to explore difficulties in practicing palliative care around LISP. Nevertheless, according to the size of the sample, results will need to be confirmed by a more extensive qualitative survey.


Assuntos
Continuidade da Assistência ao Paciente , Unidades Hospitalares/organização & administração , Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Padrões de Prática Médica , Qualidade da Assistência à Saúde/organização & administração , Adulto , Atitude do Pessoal de Saúde , Cuidadores/organização & administração , Cuidadores/normas , Barreiras de Comunicação , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Arquitetura de Instituições de Saúde/normas , França , Conhecimentos, Atitudes e Prática em Saúde , Número de Leitos em Hospital , Unidades Hospitalares/normas , Humanos , Entrevistas como Assunto , Satisfação no Emprego , Cuidados Paliativos/psicologia , Cuidados Paliativos/normas , Equipe de Assistência ao Paciente/normas , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/normas , Estudos Retrospectivos , Inquéritos e Questionários
8.
Rev Bras Enferm ; 72(3): 680-686, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269132

RESUMO

OBJECTIVE: to develop a software that allows the nurse of the surgical center to plan intraoperative nursing care through electronic access to the work routines of his/her team. METHOD: the methodological course was carried out according to systems development theory, which guides five basic activities: communication, planning, modeling, developing and delivery of the product. RESULTS: the activities and functions of the software were arranged in five modules, containing information regarding the inputs and the step-by-step involving the assembly, circulation and disassembly of the operating room to perform the various anesthetic and surgical procedures. FINAL CONSIDERATIONS: The developed software will allow the surgical center's nursing team to access its intraoperative routines in a fast and systematic way, since this allowed to concentrate all the routines of assembly, circulation and disassembly of operating room in a safe space and accessible.


Assuntos
Cuidados Intraoperatórios/enfermagem , Equipe de Assistência ao Paciente/tendências , Desenho de Programas de Computador , Comunicação , Continuidade da Assistência ao Paciente/normas , Humanos , Cuidados Intraoperatórios/tendências , Teoria de Sistemas , Interface Usuário-Computador
9.
Women Birth ; 32(5): 427-436, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31326382

RESUMO

BACKGROUND: The urban-based Malabar Community Midwifery Link Service integrates multidisciplinary wrap-around services along-side continuity of midwifery care for Aboriginal and Torres Strait Islander mothers and babies. AIM: To evaluate the Malabar Service from 1 January 2007 to 31 December 2014. METHODS: A mixed method design. Outcomes for mothers of Aboriginal and/or Torres Strait Islander babies cared for at an urban Australian referral hospital by the Malabar Service were compared to mainstream. Primary outcomes are rates of low birth weight; smoking >20 weeks gestation; preterm birth; and breastfeeding at discharge. Malabar outcomes are also compared to national and state perinatal outcomes. RESULTS: The Malabar Service (n = 505) demonstrated similar rates of preterm birth (aOR 2.2, 95% CI 0.96-4.97); breastfeeding at discharge (aOR 1.1, 95% CI 0.61-1.86); and a higher rate of low birth weight babies (aOR 3.6, 95% CI 1.02-12.9) than the comparison group (n = 201). There was a 25% reduction in smoking rates from 38.9% to 29.1%. Compared to national and state populations, Malabar outcomes were better. Women experienced greater psychosocial complexity but were well supported. Malabar Mothers (n = 9) experienced: accessibility, preparedness for birth and cultural safety. Staff (n = 13) identified going 'above and beyond' and teamwork to provide culturally safe care counterbalanced with concerns around funding and cultural support. CONCLUSIONS: Dedicated integrated continuity of midwifery care with wrap-around services for Aboriginal and/or Torres Strait Islander mothers is highly valued and is culturally safe. The service is as safe as main stream services and promotes better clinical outcomes compared to national and state outcomes.


Assuntos
Continuidade da Assistência ao Paciente , Serviços de Saúde do Indígena , Serviços de Saúde Materna/organização & administração , Bem-Estar Materno/etnologia , Tocologia/organização & administração , Grupo com Ancestrais Oceânicos/psicologia , Parto/etnologia , Adulto , Austrália , Características Culturais , Feminino , Humanos , Obstetrícia , Gravidez , Fumar
10.
Women Birth ; 32(5): 449-459, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31345659

RESUMO

PROBLEM: It is not well known how to prepare new multidisciplinary teams aiming to provide culturally safe maternity care for Aboriginal and Torres Strait Islander families in an urban setting. BACKGROUND: National policies recommend increasing the Aboriginal and Torres Strait Islander workforce and cultural competencies of the non-Indigenous workforce as key drivers of culturally safe care. QUESTION: What are the key learnings from staff experiences establishing multidisciplinary teams aiming to provide culturally safe maternity care that aims to privilege Indigenous ways of knowing, being and doing? METHODS: As part of a larger participatory action research project, semi-structured qualitative interviews were conducted December 2014-April 2015 with 21 Aboriginal and Torres Strait Islander and non-Indigenous healthcare staff. Thematic analysis was used to identify learnings for practice. FINDINGS: Four key learnings were identified for forming new teams aiming to provide culturally safe care: (a) having a shared understanding of what characterises cultural safety in the local program context; (b) understanding and valuing different roles and knowledges people bring to the team; (c) acknowledging the influence of race and culture on staff behaviour; and (d) acting on individual and organisational responsibilities for continuous improvement towards cultural safety. DISCUSSION: We present recommendations from our participatory action research approach to respond to these learnings in practice. CONCLUSION: A deliberate workforce investment at the early stages of team development is crucial when aiming to provide culturally safe maternity care that can respond to the unique needs of Aboriginal and Torres Strait Islander women and families.


Assuntos
Continuidade da Assistência ao Paciente , Competência Cultural , Assistência à Saúde Culturalmente Competente , Pesquisa sobre Serviços de Saúde/organização & administração , Serviços de Saúde Materna/organização & administração , Bem-Estar Materno/etnologia , Equipe de Assistência ao Paciente/organização & administração , Adulto , Pesquisa Participativa Baseada na Comunidade , Feminino , Serviços de Saúde do Indígena , Disparidades em Assistência à Saúde , Humanos , Entrevistas como Assunto , Obstetrícia , Grupo com Ancestrais Oceânicos , Pesquisa Qualitativa
11.
Women Birth ; 32(5): 383-390, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31257181

RESUMO

BACKGROUND: This case study explores the four pregnancy and birthing journeys of Wiradjuri & Ngemba-Wayilwan woman, Fleur Magick Dennis. Fleur provides a personal account of her journeys and relates them to socio-cultural issues surrounding her life during these times. Fleur experienced her first birth in hospital and her three next births at different locations out of hospital on Wiradjuri Country. Fleur is able to show that her personal wellbeing & healing and that of her family & community is linked to her having been able to birth according to her spiritual & cultural beliefs. The midwife for Fleur's third and fourth pregnancy, Hazel Keedle, then provides a brief account of her experiences supporting Fleur in her choices and explores the impact of these births on her midwifery and personal life.


Assuntos
Continuidade da Assistência ao Paciente , Parto Domiciliar , Tocologia , Mães/psicologia , Grupo com Ancestrais Oceânicos/psicologia , Parto/psicologia , Satisfação Pessoal , Austrália , Centros de Assistência à Gravidez e ao Parto , Feminino , Hospitais , Humanos , Gravidez
12.
Rev. enferm. UFSM ; 9: 17, jul. 15, 2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1009362

RESUMO

"\"\\\"[{\\\\\\\"text\\\\\\\": \\\\\\\"Objetivo: analisar a acessibilidade organizacional de uma Unidade de Saúde da Família. Método: pesquisa qualitativa na modalidade de estudo de caso, realizada em uma Unidade de Saúde da Família de um\\\\\\\\r\\\\\\\\nmunicípio do Rio Grande do Sul, no período de fevereiro a julho de 2012. Resultados: a equipe não se\\\\\\\\r\\\\\\\\nresponsabiliza pela recepção dos usuários, interferindo na acessibilidade; as falhas de comunicação entre equipe e usuários, com ausência de acolhimento, prejudicam a resolutividade das necessidades dos usuários; identificou-se que o absenteísmo está relacionado à falta de escuta e singularização; os trabalhadores não se comprometem com a condução de casos. Contudo, linhas de cuidado estão em construção. Conclusões: é necessário qualificar a recepção e a oferta de serviços, fortalecer a organização interna da Unidade e investir na comunicação entre equipe e usuários e com outros pontos de atenção, estabelecendo fluxos assistenciais e redes articuladas.\\\\\\\", \\\\\\\"_i\\\\\\\": \\\\\\\"pt\\\\\\\"}, {\\\\\\\"text\\\\\\\": \\\\\\\"Objective to analyze accessibility to a Family Health Center. Method: qualitative research in the form\\\\\\\\r\\\\\\\\nof case study, carried out in a Family Health Center from a township in the State of Rio Grande do Sul, from\\\\\\\\r\\\\\\\\nFebruary to July 2012. Results: the team does not take responsibility for the users' reception, which interferes in accessibility; miscommunication between staff and users, and the fact that professionals do not welcome the users undermines the staff's ability to solve the users' needs; it was identified that absenteeism was related to a lack of listening and to the absence of personalized care; professionals do not commit to handling the cases. However, lines of care are being created. Conclusions: it is necessary to qualify the reception and service offer, to strengthen the internal organization of the Unit and to invest in the communication between staff and users and with other units, establishing care flows and articulated networks.\\\\\\\", \\\\\\\"_i\\\\\\\": \\\\\\\"en\\\\\\\"}, {\\\\\\\"text\\\\\\\": \\\\\\\"Objetivo: analizar la accesibilidad organizacional de una Unidad de Salud de la Familia. Método:\\\\\\\\r\\\\\\\\ninvestigación cualitativa, en la modalidad estudio de casos, realizada en una Unidad de Salud de la Familia, en un municipio de Rio Grande do Sul, en el período de febrero a julio de 2012. Resultados: el equipo no se responsabiliza por la recepción de los usuarios, lo que interfiere en la accesibilidad; hay fallas de comunicación entre el equipo y los usuarios y ausencia de recepción, lo que perjudica la resolución de las necesidades de los usuarios; se identificó que el ausentismo está relacionado con la falta de atención y personalización; el equipo no se compromete con el manejo de los casos. Sin embargo, se están elaborando líneas de atención. Conclusiones: es necesario calificar la recepción y la prestación de servicios, fortalecer la organización interna de la Unidad e invertir en la comunicación entre el equipo y los usuarios y con otros puntos de atención, estableciendo flujos asistenciales y redes articuladas.\\\\\\\", \\\\\\\"_i\\\\\\\": \\\\\\\"es\\\\\\\"}]\\\"\""


Assuntos
Humanos , Atenção Primária à Saúde , Sistema Único de Saúde , Continuidade da Assistência ao Paciente , Assistência à Saúde
13.
J Surg Oncol ; 120(3): 348-358, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31197851

RESUMO

BACKGROUND: We describe a multidisciplinary approach for comprehensive care of amputees with concurrent targeted muscle reinnervation (TMR) at the time of amputation. METHODS: Our TMR cohort was compared to a cross-sectional sample of unselected oncologic amputees not treated at our institution (N = 58). Patient-Reported Outcomes Measurement Information System (NRS, PROMIS) were used to assess postamputation pain. RESULTS: Thirty-one patients underwent amputation with concurrent TMR during the study; 27 patients completed pain surveys; 15 had greater than 1 year follow-up (mean follow-up 14.7 months). Neuroma symptoms occurred significantly less frequently and with less intensity among the TMR cohort. Mean differences for PROMIS pain intensity, behavior, and interference for phantom limb pain (PLP) were 5.855 (95%CI 1.159-10.55; P = .015), 5.896 (95%CI 0.492-11.30; P = .033), and 7.435 (95%CI 1.797-13.07; P = .011) respectively, with lower scores for TMR cohort. For residual limb pain, PROMIS pain intensity, behavior, and interference mean differences were 5.477 (95%CI 0.528-10.42; P = .031), 6.195 (95%CI 0.705-11.69; P = .028), and 6.816 (95%CI 1.438-12.2; P = .014), respectively. Fifty-six percent took opioids before amputation compared to 22% at 1 year postoperatively. CONCLUSIONS: Multidisciplinary care of amputees including concurrent amputation and TMR, multimodal postoperative pain management, amputee-centered rehabilitation, and peer support demonstrates reduced incidence and severity of neuroma and PLP.


Assuntos
Cotos de Amputação/inervação , Amputação/métodos , Amputação/reabilitação , Músculo Esquelético/inervação , Neoplasias/cirurgia , Transferência de Nervo/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/reabilitação , Neoplasias Ósseas/cirurgia , Estudos de Coortes , Continuidade da Assistência ao Paciente , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/reabilitação , Osteossarcoma/reabilitação , Osteossarcoma/cirurgia , Equipe de Assistência ao Paciente , Membro Fantasma/prevenção & controle , Sarcoma/reabilitação , Sarcoma/cirurgia , Adulto Jovem
14.
Rech Soins Infirm ; (136): 80-89, 2019 03.
Artigo em Francês | MEDLINE | ID: mdl-31210504

RESUMO

BACKGROUND: Type 1 diabetes in children in Switzerland is becoming increasingly prevalent. The coordination of care seems to be a determining element and is essential for effective and efficient care. OBJECTIVE: Identify the difficulties and the levers of coordination faced by healthcare workers and families during the discovery of type 1 diabetes in children aged from birth to fifteen. METHOD: Qualitative analysis using semi-directed interviews. RESULTS: Three families and five healthcare workers participated in the study. Confirmation of the diagnosis was received badly and was a shock for the families. Nurses specializing in pediatric diabetes are recognized for being experts in diabetes care and education. Non-specialist nurses consider diabetes care to be stressful and complex. Collaboration between units is described as compartmentalized. ICT tools are not shared between units. Psychological support is considered to be unsatisfactory by the families. DISCUSSION: Interdisciplinary nurses need to work together and with a structured coordination of care.


Assuntos
Prática Avançada de Enfermagem , Continuidade da Assistência ao Paciente/organização & administração , Diabetes Mellitus Tipo 1/enfermagem , Família/psicologia , Papel do Profissional de Enfermagem , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Pesquisa Qualitativa , Suíça
15.
Soins Psychiatr ; 40(322): 12-17, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31229140

RESUMO

The terms 'admission, solution and continuity' are the condensation of useful notions for describing the phenomenon of the referral of patients receiving psychiatric care to nursing homes. The extent of this trend and the concern for quality of life means that, in terms of the institutional, legal and ethical issues involved, the psychotic elderly patient must not remain marginal or invisible.


Assuntos
Continuidade da Assistência ao Paciente , Casas de Saúde , Admissão do Paciente , Transtornos Psicóticos/enfermagem , Idoso , Humanos , Qualidade de Vida
16.
Med. infant ; 26(2): 130-139, Junio 2019. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1015635

RESUMO

Introducción: Los grandes avances en el diagnóstico y tratamiento de los pacientes con cardiopatías congénitas en las últimas décadas han permitido que mas del 90% lleguen a la adolescencia y edad adulta. Sin embargo, muchos de ellos requirieran seguimiento e intervenciones de por vida, por lo que necesitaran ser transferidos desde el hospital pediátrico al de adultos. Material y Métodos: Se incluyeron los pacientes mayores de 15 años que consultaron en el área ambulatoria del servicio de cardiología del Hospital Garrahan durante el periodo agosto 2017 - agosto 2018. Las variables analizadas fueron: procedencia, cardiopatía de base y variedad pronostica ,procedimientos intervencionistas factores asociados como síndrome genéticos y otras comorbilidades, cobertura social, nivel educativo, terapéutica medicamentosa, clase funcional, embarazos, prevalencia de cardiopatías en la descendencia y transición-transferencia al hospital de adultos. Resultados: Registramos 704 consultas de 309 pacientes con una edad media de 19,17 años (DS +- 4,62; (rango 15- 49,4 años). Fueron 112 mujeres y 197 varones. El 51,1 % provenían de Buenos Aires,40 % de las provincias del interior y 8,1% CABA. El 92% de los pacientes tenía cardiopatías de moderada y severa complejidad, y el 93,5% eran operadas. El 13,2 % eran síndromes genéticos. El 48.5% tenían comorbilidades, siendo los trastornos electrofisiológicos los más frecuentes en el 72,66% de los casos. El 63% tenía cobertura social pero solo el 2,6% prepagos con cobertura en centros alta complejidad. El 23.6% recibía terapia combinada con 2 o más drogas. El 48,78% ya presentaban antecedente de algún tipo de reintervención, 98,5% de estas se vincularon a las cardiopatías moderadas a complejas. Registramos 15 embarazos con 14 recién nacidos vivos, 1 con cardiopatía congénita. El proceso de transición ­ transferencia en el 55% (170 p) se había iniciado, siendo efectiva (8p), frustra (9p), compartida (49 p), y en proceso (103 p). Hubo un solo fallecimiento durante el periodo de estudio, vinculado a cardiopatía compleja, múltiples reintervenciones y endocarditis. Conclusiones: El 92% de los pacientes en nuestro estudio, tienen cardiopatías operadas de moderada y severa complejidad. Los trastornos electrofisiológicos y la necesidad de reintervenciones durante el seguimiento alejado han sido las complicaciones más frecuentes de esta población. El proceso de transición y transferencia desde el hospital pediátrico al de adultos es deficitario, principalmente por falta de cobertura y experiencia sobre todo para la atención continua de las cardiopatías moderadas y complejas (AU)


Introduction: In recent decades, important advances in the diagnosis and treatment of patients with congenital heart defects have allowed more than 90% of them to reach adolescence and adulthood. However, many patients required lifelong follow-up and interventions, and therefore the need to be transitioned from pediatric to adult care. Material and Methods: Patients older than 15 years who consulted at the outpatient clinic of the department of cardiology at Garrahan Hospital from August 2017 to August 2018 were included. The variables analyzed were place of origin, underlying heart disease, and diagnosis, interventions, associated factors, such as genetic syndromes and other comorbidities, insurance coverage, educational level, pharmacological treatment, functional class, pregnancies, prevalence of heart disease in offspring, and transition-transfer to adult hospital. Results: We recorded 704 consultations from 309 patients with an average age of 19.17 years (SD +- 4.62; range 15-49.4 years); 112 patients were female and 197 male. Overall, 51.1% came from the province of Buenos Aires, 40% from the other provinces, and 8.1% from the city of Buenos Aires. Of the patients, 92% had moderate and severe heart disease, and 93.5% had undergone surgery. Genetic syndromes were identified in 13.2%. Overall, 48.5% had comorbidities, of which electrophysiological disorders were the most common in 72.66% of cases. 63% had social insurance coverage but only 2.6% had a prepaid insurance with coverage in tertiary-level centers. Overall, 23.6% received combination therapy with 2 or more drugs. 48.78% had undergone some type of previous reintervention, 98.5% of whom had moderate-to-severe heart disease. We recorded 15 pregnancies with 14 live neonates, one of whom had congenital heart defects. The transition - transfer had been initiated in 55% (170 p) and was effective (8p), frustrated (9p), shared (49 p), or in progress (103 p). There was only one death during the study period, related to severe heart disease, multiple reinterventions, and endocarditis. Conclusions: 92% of patients in our study have moderate or severe operated heart disease. Electrophysiological disorders and the need for reintervention during the long-term follow-up were the most common complications of this population. The process of transition and transfer from pediatric to adult care is deficient, mainly due to lack of insurance coverage and experience especially for the ongoing care of moderate-to-severe heart disease


Assuntos
Humanos , Adolescente , Ambulatório Hospitalar/estatística & dados numéricos , Planejamento de Assistência ao Paciente , Transferência de Pacientes/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Transição para Assistência do Adulto/organização & administração , Cardiopatias Congênitas/terapia , Estudos Retrospectivos , Estudo Observacional
17.
BMC Public Health ; 19(1): 706, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174506

RESUMO

BACKGROUND: Whilst people with intellectual disability grow older, evidence has emerged internationally about the largely unmet health needs of this specific ageing population. Health checks have been implemented in some countries to address those health inequalities. Evaluations have focused on measuring process outcomes due to challenges measuring quality of life outcomes. In addition, the cost-effectiveness is currently unknown. As part of a national guideline for this population we sought to explore the likely cost-effectiveness of annual health checks in England. METHODS: Decision-analytical Markov modelling was used to estimate the cost-effectiveness of a strategy, in which health checks were provided for older people with intellectual disability, when compared with standard care. The approach we took was explorative. Individual models were developed for a selected range of health conditions, which had an expected high economic impact and for which sufficient evidence was available for the modelling. In each of the models, hypothetical cohorts were followed from 40 yrs. of age until death. The outcome measure was cost per quality-adjusted life-year (QALY) gained. Incremental cost-effectiveness ratios (ICER) were calculated. Costs were assessed from a health provider perspective and expressed in 2016 GBP. Costs and QALYs were discounted at 3.5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinion informed parameters. RESULTS: Health checks led to a mean QALY gain of 0.074 (95% CI 0.072 to 0.119); and mean incremental costs of £4787 (CI 95% 4773 to 5017). For a threshold of £30,000 per QALY, health checks were not cost-effective (mean ICER £85,632; 95% CI 82,762 to 131,944). Costs of intervention needed to reduce from £258 to under £100 per year in order for health checks to be cost-effective. CONCLUSION: Whilst findings need to be considered with caution as the model was exploratory in that it was based on assumptions to overcome evidence gaps, they suggest that the way health systems deliver care for vulnerable populations might need to be re-examined. The work was carried out as part of a national guideline and informed recommendations about system changes to achieve more equal health care provisions.


Assuntos
Continuidade da Assistência ao Paciente/economia , Acesso aos Serviços de Saúde/economia , Deficiência Intelectual/economia , Pessoas com Deficiência Mental/estatística & dados numéricos , Adulto , Idoso , Análise Custo-Benefício , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida
18.
Mo Med ; 116(2): 134-139, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31040500

RESUMO

Children with medical complexity (CMC) have warranted substantial individual provider commitment for pediatric management. New drivers have prompted program creation that focuses even greater care on this small, increasingly influential population. These drivers include enhancing care coordination, aligning value-based reimbursement strategies and managing higher patient acuity in non-hospital environments. This article will review management of CMC and highlight the Complex Medical Care Program at SSM Health Cardinal Glennon Children's Hospital in St. Louis, Missouri.


Assuntos
Cuidadores , Administração de Caso/normas , Doença Crônica/terapia , Assistência à Saúde/organização & administração , Hospitais Pediátricos/organização & administração , Cuidadores/educação , Cuidadores/psicologia , Criança , Doença Crônica/psicologia , Continuidade da Assistência ao Paciente , Assistência à Saúde/métodos , Humanos , Missouri
19.
Top Antivir Med ; 27(1): 50-68, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31137003

RESUMO

The 2019 Conference on Retroviruses and Opportunistic Infections included many exciting advances in antiretroviral therapy (ART). Investigators presented a case report of a second patient possibly cured of HIV through an allogeneic hematopoietic stem cell transplant from a CC chemokine receptor 5-delta 32 donor. Two clinical trials of long-acting injectable cabotegravir and rilpivirine showed promising safety, efficacy, and tolerability as maintenance ART. Test-and-treat and rapid-ART-start strategies show promise in advancing progress toward the HIV care cascade 90-90-90 Joint United Nations Programme on HIV/AIDS/World Health Organization targets. However, late diagnosis and mortality after ART initiation remain high, even in the context of HIV service scale-up, and mortality from unintentional opioid overdose in people living with HIV in the United States is on the rise. In vitro studies were presented that identified and evaluated the effect of resistance-associated mutations on ART susceptibility and elucidated mechanisms of resistance. Epidemiologic data were reported on the prevalence, impact, regional variation, and changes over time of resistance-associated mutations. Decreasing regional and national rates of resistance may be a benefit of increasing use of integrase strand transfer inhibitors (InSTIs). New findings were presented on maternal and fetal health outcomes in women of reproductive potential, drug-drug interactions between hormonal contraception and ART, and further exploration of the association between InSTIs and birth defects.


Assuntos
Antirretrovirais/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/terapia , Transplante de Células-Tronco Hematopoéticas/métodos , Antirretrovirais/farmacocinética , Continuidade da Assistência ao Paciente , Anticoncepcionais Orais Hormonais/farmacocinética , Anticoncepcionais Orais Hormonais/farmacologia , Gerenciamento Clínico , Interações de Medicamentos , Farmacorresistência Viral , HIV/efeitos dos fármacos , HIV/genética , Infecções por HIV/diagnóstico , Humanos , Mutação , Resultado do Tratamento , Estados Unidos
20.
Crit Care Nurs Clin North Am ; 31(2): 133-139, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31047088

RESUMO

Stroke can cause severe disability and death in the adult population. Many stroke patients do not have access to resources required to provide a timely diagnosis and treatment. Telestroke can provide these patients the accurate diagnosis and appropriate treatment they require. Telestroke has been linked to improved functional outcomes in the treatment of acute ischemic strokes. There are several barriers to providing a telestroke service, such as licensure and liability, reimbursement, technology, and financial issues. It is important to recognize these barriers and begin to implement strategies to overcome them. Telestroke use is cost-effective by reducing stroke complications and disabilities.


Assuntos
Análise Custo-Benefício , Gerenciamento Clínico , Avaliação de Resultados (Cuidados de Saúde) , Acidente Vascular Cerebral/diagnóstico , Telemedicina/métodos , Continuidade da Assistência ao Paciente , Humanos , Controle de Qualidade , Acidente Vascular Cerebral/tratamento farmacológico , Fatores de Tempo , Ativador de Plasminogênio Tecidual/uso terapêutico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA