Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 569
Filtrar
1.
BMC Palliat Care ; 18(1): 60, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331302

RESUMO

BACKGROUND: Incurable oesophageal cancer patients are often affected by existential distress and deterioration of quality of life. Knowledge about the life situation of this patient group is important to provide relevant palliative care and support. The purpose of this study is to illuminate the ways in which incurable oesophageal cancer disrupts the patients' lives and how the patients experience and adapt to life with the disease. METHODS: Seventeen patients receiving palliative care for oesophageal cancer were interviewed 1-23 months after diagnosis. The epistemological approach was inspired by phenomenology and hermeneutics, and the method of data collection, analysis and interpretation consisted of individual qualitative interviews and meaning condensation, inspired by Kvale and Brinkmann. RESULTS: The study reveals how patients with incurable oesophageal cancer experience metaphorically to end up at a "table in the corner". The patients experience loss of dignity, identity and community. The study illuminated how illness and symptoms impact and control daily life and social relations, described under these subheadings: "sense of isolation"; "being in a zombie-like state"; "one day at a time"; and "at sea". Patients feel alone with the threat to their lives and everyday existence; they feel isolated due to the inhibiting symptoms of their illness, anxiety, worry and daily losses and challenges. CONCLUSIONS: The patients' lives are turned upside down, and they experience loss of health, function and familiar, daily habits. The prominent issues for the patients are loneliness and lack of continuity. As far as their normal everyday lives, social networks and the health system are concerned, patients feel they have been banished to a "table in the corner". These patients have a particular need for healthcare professionals who are dedicated to identifying what can be done to support the patients in their everyday lives, preserve dignity and provide additional palliative care.


Assuntos
Neoplasias Esofágicas/psicologia , Cuidados Paliativos/normas , Percepção , Qualidade de Vida/psicologia , Adaptação Psicológica , Adulto , Continuidade da Assistência ao Paciente/tendências , Neoplasias Esofágicas/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Satisfação do Paciente , Pesquisa Qualitativa , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia
2.
Enferm. glob ; 18(55): 157-169, jul. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-186239

RESUMO

Objetivo: describir la caracterización sociodemográfica y clínica de los pacientes portadores de hepatitis C crónica acompañados en el ambulatorio de un hospital de referencia en infectología. Método: estudio transversal, descriptivo, cuantitativo, con usuarios portadores de hepatitis C crónica asistidos en el ambulatorio de un hospital de referencia durante noviembre de 2015 a abril de 2016 con una muestra de 47 usuarios. Resultados: los participantes son de sexo masculino (76,6%) con rango de edad superior a 57 años (57,5%), pardo (38,3%), casado (55,3%), con grado de escolaridad (31,9%), y residente en la capital (61,7%), con tiempo de descubrimiento de hasta 6 años (68,1%), desconociendo la forma de contaminación (57,5%), inmunizado contra la hepatitis B (65,9%), realizando tratamiento medicamentoso (85,1%) con Ribavirina (55,6%); Y el 70,2% presentó efectos adversos. Conclusión: la caracterización sociodemográfica y clínica auxilian en la práctica clínica del equipo multiprofesional con los portadores de hepatitis C crónica


Objetivo: descrever a caracterização sociodemográfica e clínica dos pacientes portadores de hepatite C crônica acompanhados no ambulatório de um hospital referência em infectologia. Método: estudo transversal, descritivo, quantitativo, com usuários portadores de hepatite C crônica assistidos no ambulatório de um hospital referência durante Novembro 2015 a Abril de 2016 com uma amostra de 47 usuários. Resultados: os participantes encontram-se no sexo masculino (76,6%) com faixa etária acima de 57 anos (57,5%), pardo (38,3%), casado (55,3%), com grau de escolaridade fundamental incompleto (31,9%), e residente na capital (61,7%), com tempo de descoberta de até 6 anos (68,1%), desconhecendo a forma de contaminação (57,5%), realizando tratamento medicamentoso (85,1%) com Ribavirina (55,6%); e 70,2% apresentaram efeitos adversos. Conclusões: a caracterização sociodemográfica e clínica auxiliam na prática clínica da equipe multiprofissional com os portadores de hepatite C crônica


Objective: to describe the sociodemographic and clinical characterization of patients with chronic hepatitis C followed at the outpatient clinic of a reference hospital in infectology. Method: a cross-sectional, descriptive, quantitative study with chronic hepatitis C patients attended at a referral hospital during November 2015 to April 2016 with a sample of 47 users. Results: the participants were male (76.6%), 57 years old (57.5%), brown (38.3%), married (55.3%), (61.7%), with a discovery time of up to 6 years (68.1%), not knowing the form of contamination (57.5%), immunized against hepatitis B (65.9%), undergoing drug therapy (85.1%) with Ribavirin (55.6%); And 70.2% had adverse effects. Conclusion: sociodemographic and clinical characterization assist the clinical practice of the multiprofessional team with patients with chronic hepatitis C


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Hepatite C Crônica/epidemiologia , Hepacivirus/patogenicidade , Ribavirina/uso terapêutico , Estimativas de População , Continuidade da Assistência ao Paciente/tendências , Hepatite C Crônica/tratamento farmacológico
3.
Enferm. glob ; 18(55): 554-566, jul. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-186250

RESUMO

Introducción: el nacimiento prematuro lleva implícito una situación de inmadurez que afecta a todos los sistemas anatómicos y funcionales del recién nacido, condición de especial vulnerabilidad, con una frecuente asociación con otras patologías y/o alteraciones del desarrollo infantil. Objetivo: conocer las dificultades en la escuela que pueden presentar los niños y niñas nacidos muy prematuros. Material y Métodos: revisión bibliográfica en bases de datos como Pubmed, Medline, Scielo, Cochrane; seleccionando artículos científicos tanto en español como en inglés de los últimos 10 años. Resultados: los niños y las niñas que nacen muy prematuros y/o con bajo peso al nacer, tienen un mayor riesgo de presentar dificultades que pueden perjudicar su correcto desarrollo en la infancia y la adolescencia. Algunas de las necesidades evidenciadas a nivel motor son el retraso motor simple y la parálisis cerebral; a nivel sensorio-cognitivo, fueron los problemas de aprendizaje y alteraciones sensoriales mayores; y a nivel socioemocional, se evidencian trastornos comportamentales como es la hiperactividad y trastornos emocionales como son la depresión, quejas somáticas, temores y fobias. Conclusiones: los profesionales de salud, de la educación y las familias, deben conocer el riesgo que presentan los grandes prematuros de presentar dificultades y/o alteraciones que pueden interferir en la vida escolar, con el fin de trabajar conjuntamente en la prevención de dichas dificultades con una intervención temprana. El cuidado de enfermería debe ir mucho más allá de la situación aguda del recién nacido, siendo agente promotor de salud en todas las etapas de la vida del niño/a


Introduction: premature birth implicitly involves a situation of immaturity that affects all the anatomical and functional systems of the newborn, a condition of special vulnerability, with a frequent association with other pathologies and / or alterations in child development. Objetive:: to know the difficulties in school that children born very premature can present. Material and Methods: bibliographic review in databases such as Pubmed, Medline, Scielo, Cochrane; selecting scientific articles in both Spanish and English for the last 10 years. Results: children born very premature and / or with low birth weight, have a higher risk of presenting difficulties that may impair their proper development in childhood and adolescence. Some of the needs evidenced at the motor level are simple motor delay and cerebral palsy; at sensory-cognitive level, there were learning problems and major sensory alterations; and at a social-emotional level, there are behavioral disorders such as hyperactivity and emotional disorders such as depression, somatic complaints, fears and phobias. Conclusions: health professionals, education and families must know the risk presented by large premature children to present difficulties and / or alterations that may interfere with school life, in order to work together in the prevention of such difficulties with a early intervention. Nursing care must go far beyond the acute situation of the newborn, being a promoter of health in all stages of the child's life


Assuntos
Humanos , Masculino , Feminino , Criança , Transtornos de Aprendizagem/epidemiologia , Recém-Nascido Prematuro/crescimento & desenvolvimento , Transtornos do Neurodesenvolvimento/epidemiologia , Continuidade da Assistência ao Paciente/tendências , Cuidados de Enfermagem/métodos , Desenvolvimento Infantil/classificação
4.
Crit Care ; 23(Suppl 1): 122, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200740

RESUMO

Until relatively recently, critical illness was considered as a separate entity and the intensive care unit (ICU), often a little cut-off from other areas of the hospital, was in many cases used as a last resort for patients so severely ill that it was no longer possible to care for them on the general ward. However, we are increasingly realizing that critical illness should be seen as just one part of the patient's disease trajectory and how the patient is managed before and after ICU admission has an important role to play in optimizing outcomes. Identifying critical illness early, before it reaches a stage where it is life-threatening, is a challenge and requires a combination of improved and more frequent or continuous monitoring of at-risk patients, staff training to recognize when a patient is deteriorating, a system to "call for help," and an effective response to that call. Critical care doctors are now widely available 24 h a day for consultation, and many hospitals have rapid response or medical emergency teams composed of staff trained in intensive care and with resuscitation skills who can attend patients on the ward who have been identified to be deteriorating, assess them to determine the need for ICU admission, and initiate further tests and/or initial therapy. Early intensivist input may also be important for patients undergoing interventions that are likely to result in ICU admission, e.g., transplantation or cardiac surgery. The patient's continuum after ICU discharge must also be taken into account during their ICU stay, with attempts made to limit the longer-term physical and psychological consequences of critical illness as much as possible. Minimal sedation, good communication, and early mobilization are three factors that can help patients survive their ICU stay with minimal sequelae.


Assuntos
Continuidade da Assistência ao Paciente/tendências , Cuidados Críticos/métodos , Estado Terminal/terapia , Humanos , Unidades de Terapia Intensiva/organização & administração
5.
Int J Rheum Dis ; 22(5): 880-889, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30950207

RESUMO

AIM: This study aims to measure current situation with regard to access and financial protection towards healthcare for rheumatic diseases (RDs) in India. METHOD: The first part of this study is quantitative, and uses the data generated by the 71st Round of National Sample Survey 2014, which measured self-reported morbidity, choice of provider and utilization of services and out of pocket expenditure (OOPE) incurred on healthcare services in a sample of 65 932 households and 333 104 individuals from all across India. The second qualitative part of the study was done in one sample district to understand the barriers to access and financial protection. RESULTS: 3.5% of all hospitalizations in the preceding one year and 9.9% of all ambulatory care in the preceding 15 days of this study period were due to RDs. Cost of care for RDs was three times higher in private sector. Cost on medicines comprised the largest share in both sectors. 54% of the households faced catastrophic health expenditure at 10% threshold (CHE-10) and this was nine times higher in private provisioning (OR: 8.8, CI: 6.8-11.4). 24% of the households had to borrow or sell household assets to meet the hospitalization expenditure. Insurance had marginal impact and it did not help in preventing household from facing CHE-10 for the lowermost three economic quintiles. There was significant unmet health care needs and lack of continuity of care of RDs in India. CONCLUSION: Addressing the gaps in access and financial protection for patients with RDs need greater emphasis in policy as well as implementation, if the country has to achieve Universal Health Coverage.


Assuntos
Custos de Cuidados de Saúde , Gastos em Saúde , Acesso aos Serviços de Saúde/economia , Doenças Reumáticas/economia , Doenças Reumáticas/terapia , Reumatologia/economia , Cobertura Universal do Seguro de Saúde/economia , Adolescente , Adulto , Criança , Pré-Escolar , Continuidade da Assistência ao Paciente/economia , Continuidade da Assistência ao Paciente/tendências , Feminino , Custos de Cuidados de Saúde/tendências , Pesquisas sobre Serviços de Saúde , Gastos em Saúde/tendências , Acesso aos Serviços de Saúde/tendências , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/tendências , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Doenças Reumáticas/epidemiologia , Reumatologia/tendências , Cobertura Universal do Seguro de Saúde/tendências , Adulto Jovem
6.
Vet Clin North Am Small Anim Pract ; 49(3): 325-338, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30846384

RESUMO

This article provides a brief review of important foundational concepts and an overview of major milestones in the history of animal hospice and palliative care. This article also presents a view of future goals and challenges that lie ahead of the veterinary profession as the field of animal hospice and palliative care evolves. Some examples of topics reviewed and explored in the article include current "state of-the-art" of animal hospice, future research goals, improved veterinary college curricula, collaboration among medical disciplines, and support of the veterinary staff.


Assuntos
Continuidade da Assistência ao Paciente/tendências , Cuidados Paliativos na Terminalidade da Vida/tendências , Dor/veterinária , Cuidados Paliativos/tendências , Medicina Veterinária/tendências , Animais , América do Norte , Dor/prevenção & controle
9.
Drug Alcohol Depend ; 195: 114-120, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30611979

RESUMO

BACKGROUND: To describe the "continuum of care" for hepatitis C virus (HCV) and related health service utilization among persons who inject drugs (PWID) in the Seattle metropolitan area. METHODS: The study analyzed data from the 2015 National HIV Behavioral Surveillance system focused on PWID, which included local questions on HCV treatment and testing. We calculated respondent driven sampling (RDS)-adjusted percentages of participants who had completed each step of the care continuum and compared healthcare harm reduction services among participants who were HCV + vs. HCV- using bivariate analyses. RESULTS: 513 PWID were screened for HCV antibodies (Ab). Of those, 59.7% were HCV Ab+. Among those HCV Ab+, 86.4% had been tested for HCV at least once; 69.9% reported a previous diagnosis. Of those diagnosed, 55.9% had received a confirmatory test, 17.2% had ever received any medications for HCV, and 7.2% had completed treatment. The majority of HCV Ab + participants had seen a health care provider in the past 12 months (85.6%). CONCLUSIONS: There is a large gap between HCV screening and treatment among Seattle area PWID.


Assuntos
Continuidade da Assistência ao Paciente/tendências , Redução do Dano , Hepatite C/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Feminino , Hepatite C/diagnóstico , Hepatite C/terapia , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Abuso de Substâncias por Via Intravenosa/diagnóstico , Abuso de Substâncias por Via Intravenosa/terapia , Inquéritos e Questionários , Washington/epidemiologia , Adulto Jovem
10.
Soc Psychiatry Psychiatr Epidemiol ; 54(7): 861-870, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30603806

RESUMO

PURPOSE: This study has the objective of assessing the psychiatric rehospitalization experience of a large cohort of persons with schizophrenia and modeling the effects of personal and systemic conditions on rehospitalization risk. METHODS: The study employs a secondary analysis of US data from Massachusetts' casemix database of all patients discharged from acute general hospital units. It focuses on 11,291 patients during 1994-2000 who were discharged from acute adult psychiatric units. Predictors used include basic demographics, length of stay, continuity of care with doctors and facilities, diagnoses, discharge referral, type of insurance, and distance to and selected socioeconomic characteristics of the patient's home zip code. Data are analyzed with descriptive statistics and modeled with the Cox proportional hazard model. The model was assessed through split-half reliability testing, the generalized R2, and Harrell's Concordance Index. RESULTS: Overall, 13.4% of patients were rehospitalized within 1 month; 38.9% within 1 year; and 64.1% within 5 years. Predictors that are most strongly associated with lower rehospitalization rates include continuity of care, discharge to a chronic hospital, and density of home zipcode, whereas discharge to another acute psychiatric unit had the greatest effect on increasing risk of rehospitalization. Overall the Cox model has generalized R2 of 0.343 and a Concordance Index of 0.734. CONCLUSIONS: The results highlight the need to enhance the continuity of the relationships with providers, whether these are with the assigned psychiatrists or other therapists and case managers, as well as workplace issues involving staff turnover and hospital assignment and admitting policies.


Assuntos
Hospitais Psiquiátricos/tendências , Readmissão do Paciente/tendências , Unidade Hospitalar de Psiquiatria/tendências , Esquizofrenia/epidemiologia , Adulto , Estudos de Coortes , Continuidade da Assistência ao Paciente/tendências , Feminino , Humanos , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Alta do Paciente/tendências , Modelos de Riscos Proporcionais , Encaminhamento e Consulta/tendências , Reprodutibilidade dos Testes
11.
J Cancer Educ ; 34(1): 154-160, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-28932992

RESUMO

Survivorship care plans (SCPs) have been recommended as tools to improve care coordination and outcomes for cancer survivors. SCPs are increasingly being provided to survivors and their primary care providers. However, most primary care providers remain unaware of SCPs, limiting their potential benefit. Best practices for educating primary care providers regarding SCP existence and content are needed. We developed an education program to inform primary care providers of the existence, content, and potential uses for SCPs. The education program consisted of a 15-min presentation highlighting SCP basics presented at mandatory primary care faculty meetings. An anonymous survey was electronically administered via email (n = 287 addresses) to evaluate experience with and basic knowledge of SCPs pre- and post-education. A total of 101 primary care advanced practice providers (APPs) and physicians (35% response rate) completed the baseline survey with only 23% reporting prior receipt of a SCP. Only 9% could identify the SCP location within the electronic health record (EHR). Following the education program, primary care physicians and APPs demonstrated a significant improvement in SCP knowledge, including improvement in their ability to locate one within the EHR (9 vs 59%, p < 0.0001). A brief educational program containing information about SCP existence, content, and location in the EHR increased primary care physician and APP knowledge in these areas, which are prerequisites for using SCP in clinical practice.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Continuidade da Assistência ao Paciente/tendências , Oncologia/educação , Neoplasias/terapia , Planejamento de Assistência ao Paciente/normas , Médicos de Atenção Primária/educação , Padrões de Prática Médica/normas , Humanos , Inquéritos e Questionários , Sobrevivência
12.
Int J Cardiol ; 279: 57-61, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30413300

RESUMO

As a result of advances in pediatric care, the majority of patients born with congenital heart disease (CHD) survive into adulthood [1]. Effective transfer and transition programs assure that patients with CHD remain in follow-up and receive continuous holistic care. Unfortunately, adult patients with CHD carry residual lesions and sequelae putting them at risk for premature death related to re-interventions or complications; most commonly heart failure and arrhythmia [2]. The scientific adult CHD (ACHD) community has been working hard to identify variables related to worse outcomes, modifying those where possible in order to improve survival. Indeed, survival in adults with CHD has increased, but consequently, on top of CHD-related complications, patients are increasingly exposed to the standard cardiovascular risk factors. Therefore, a program for lifelong coaching on health behavior and life style management becomes indispensable. More emerging is that a substantial number of patients, in particular those with complex heart defects, will eventually end up in a stage with hardly any medical or interventional options left. Our healthcare provision has to be prepared to organize care for this specific group of patients who will die prematurely and require the timely development and establishment of advanced care planning. Advanced care planning should preferentially be set-up in expert CHD centers. The long-lasting relationship in ACHD care with healthcare providers offers an excellent basis with regards to prognosis, advanced care planning and end-of-life issues.


Assuntos
Continuidade da Assistência ao Paciente , Cardiopatias Congênitas/terapia , Cuidados Paliativos/métodos , Assistência Terminal/métodos , Adulto , Continuidade da Assistência ao Paciente/tendências , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/epidemiologia , Humanos , Cuidados Paliativos/tendências , Assistência Terminal/tendências , Cuidado Transicional/tendências
13.
PLoS One ; 13(12): e0207511, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30517130

RESUMO

OBJECTIVES: Research concentrating on continuity of care for chronic, non-communicable disease (NCD) patients in resource-constrained settings is currently limited and focusses on inpatients. Outpatient care requires attention as this is where NCD patients often seek treatment and optimal handover of information is essential. We investigated handover, healthcare communication and barriers to continuity of care for chronic NCD outpatients in India. We also explored potential interventions for improving storage and exchange of healthcare information. METHODS: A mixed-methods design was used across five healthcare facilities in Kerala and Himachal Pradesh states. Questionnaires from 513 outpatients with cardiovascular disease, chronic respiratory disease, or diabetes covered the form and comprehensiveness of information exchange between healthcare professionals (HCPs) and between HCPs and patients. Semi-structured interviews with outpatients and HCPs explored handover, healthcare communication and intervention ideas. Barriers to continuity of care were identified through triangulation of all data sources. RESULTS: Almost half (46%) of patients self-referred to hospital outpatient clinics (OPCs). Patient-held healthcare information was often poorly recorded on unstructured sheets of paper; 24% of OPC documents contained the following: diagnosis, medication, long-term care and follow-up information. Just 55% of patients recalled receiving verbal follow-up and medication instructions during OPC appointments. Qualitative themes included patient preference for hospital visits, system factors, inconsistent doctor-patient communication and attitudes towards medical documents. Barriers were hospital time constraints, inconsistent referral practices and absences of OPC medical record-keeping, structured patient-held medical documents and clinical handover training. Patients and HCPs were in favour of the introduction of patient-held booklets for storing and transporting medical documents. CONCLUSIONS: Deficiencies in communicative practices are compromising the continuity of chronic NCD outpatient care. Targeted systems-based interventions are urgently required to improve information provision and exchange. Our findings indicate that well-designed patient-held booklets are likely to be an acceptable, affordable and effective part of the solution.


Assuntos
Assistência Ambulatorial/métodos , Continuidade da Assistência ao Paciente/tendências , Transferência da Responsabilidade pelo Paciente/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/psicologia , Atitude do Pessoal de Saúde , Doença Crônica/terapia , Doença Crônica/tendências , Comunicação , Feminino , Pessoal de Saúde/educação , Humanos , Índia , Relações Interprofissionais , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/educação , Pacientes Ambulatoriais/psicologia , Relações Médico-Paciente , Inquéritos e Questionários
14.
Rev Bras Enferm ; 71(suppl 5): 2264-2271, 2018.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30365793

RESUMO

OBJECTIVE: To define the safe transition process from hospital to community of patients with chronic mental disorders and their families. METHOD: This was an action research study included in the constructivist paradigm. The participants in the study were nurses from a psychiatry service and from primary healthcare services. RESULTS: After the identification of causes of continuity fragmentation, the following items emerged from the participants' speeches: a) two criteria categories for safe transition (those associated with health status, dependence level, and self-care capacity of patients, and those associated with knowledge and competence level of informal caregivers); b) the design of an algorithm to facilitate clinical decision-making. FINAL CONSIDERATIONS: In order to promote adherence to therapeutic treatment in the hospital-community transition, treatment plans must include patients and their families, and improve communication networks and support among care levels.


Assuntos
Transtornos Mentais/terapia , Transferência de Pacientes/métodos , Ensino/normas , Continuidade da Assistência ao Paciente/tendências , Bacharelado em Enfermagem/métodos , Família/psicologia , Humanos , Transtornos Mentais/psicologia , Transferência de Pacientes/normas , Portugal , Atenção Primária à Saúde/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Enfermagem Psiquiátrica/métodos , Pesquisa Qualitativa
17.
Drug Alcohol Depend ; 192: 125-128, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30248558

RESUMO

BACKGROUND: HIV-positive persons who use stimulants such as methamphetamine experience greater difficulties in navigating the HIV care continuum. In the era of HIV treatment as prevention (TasP), little is known about the prevalence and correlates of success along the HIV care continuum among people who use stimulants. SETTING: San Francisco, California USA METHODS: Cross-sectional study that enrolled 129 HIV-positive men who have sex with men (MSM) from 2013 through 2017 who had biologically confirmed, recent methamphetamine use. Multivariable logistic regressions were built to identify correlates of success across the HIV care continuum. RESULTS: Although two-thirds (87/129) of participants had undetectable HIV viral load (<40 copies/mL), only one-in-four (32/129) reported taking at least 90% of their antiretroviral therapy (ART). Those who were homeless in the past year (adjusted odds ratio [aOR] = 0.20; 95% CI = 0.06-0.65) had 80% lower odds of being undetectable and adherent to ART. Substance use disorder treatment was associated with 77% lower odds of being engaged in HIV care (aOR = 0.23; 95% CI = 0.06-0.84) but also close to 3-fold greater odds of being adherent to ART (aOR = 2.91; 95% CI = 1.12-7.60). CONCLUSION: Despite the fact that many HIV-positive, methamphetamine-using MSM are able to achieve undetectable viral load in this sample, difficulties with ART adherence threaten to undermine the clinical and public health benefits of TasP. Expanded efforts to boost the effectiveness of TasP in this population should focus on meeting the unique needs of homeless individuals, optimizing ART adherence, and facilitating the integration of HIV care with substance use disorder treatment.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/terapia , Continuidade da Assistência ao Paciente/tendências , Infecções por HIV/terapia , Homossexualidade Masculina , Metanfetamina/efeitos adversos , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/diagnóstico , Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Estimulantes do Sistema Nervoso Central/uso terapêutico , Estudos Transversais , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , São Francisco/epidemiologia , Carga Viral/tendências
18.
Mil Med ; 183(suppl_2): 15-23, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30189080

RESUMO

The National Academies of Sciences, Engineering, and Medicine Report on Zero Preventable Deaths highlighted the need for a military and civilian partnership to take lessons learned from the wars in Iraq and Afghanistan and incorporate them into a national learning trauma care system. One of the specific objectives in the report was to establish military preventable death metrics. Upon further inspection, it became apparent that the Department of Defense did not have an established methodology to reliably estimate and report preventable death metrics and opportunities to improve the military trauma care system. Over the last year, clinical and non-clinical subject matter experts from the Joint Trauma System and Armed Forces Medical Examiners System began the process of establishing a standard military preventable death review process to meet the objective outlined in the report. Based on an assessment to understand methodological best practices for preventable death reviews, this manuscript presents the conceptual framework that is guiding our effort to establish the first ever battle-related mortality surveillance system with preventable death metrics and opportunities to improve the trauma care system.


Assuntos
Militares/estatística & dados numéricos , Mortalidade/tendências , Guerra/estatística & dados numéricos , Continuidade da Assistência ao Paciente/normas , Continuidade da Assistência ao Paciente/tendências , Humanos , Medicina Militar/normas , Estados Unidos
19.
BMC Geriatr ; 18(1): 177, 2018 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-30103688

RESUMO

BACKGROUND: The period after hospitalization due to deteriorated heart failure (HF) is characterized as a time of high generalized risk. The transition from hospital to home is often problematic due to insufficient coordination of care, leading to a fragmentation of care rather than a seamless continuum of care. The aim was to describe health and community care utilization prior to and 30 days after hospitalization, and the continuity of care in patients hospitalized due to de novo or deteriorated HF from the patients' perspective and from a medical chart review. METHODS: This was a cross-sectional study with consecutive inclusion of patients hospitalized at a county hospital in Sweden due to deteriorated HF during 2014. Data were collected by structured telephone interviews and medical chart review and analyzed with the Spearman's rank correlation coefficient and Chi square. A P value of 0.05 was considered significant. RESULTS: A total of 121 patients were included in the study, mean age 82.5 (±6.8) and 49% were women. Half of the patients had not visited any health care facility during the month prior to the index hospital admission, and 79% of the patients visited the emergency room (ER) without a referral. Among these elderly patients, a total of 40% received assistance at home prior to hospitalization and 52% after discharge. A total of 86% received written discharge information, one third felt insecure after hospitalization and lacked knowledge of which health care provider to consult with and contact in the event of deterioration or complications. Health care utilization increased significantly after hospitalization. CONCLUSION: Most patients had not visited any health care facility within 30 days before hospitalization. Health care utilization increased significantly after hospitalization. Flaws in the continuity of care were found; even though most patients received written information at discharge, one third of the patients lacked knowledge about which health care provider to contact in the event of deterioration and felt insecure at home after discharge.


Assuntos
Serviços de Saúde Comunitária/tendências , Continuidade da Assistência ao Paciente/tendências , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Hospitalização/tendências , Aceitação pelo Paciente de Cuidados de Saúde , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Serviço Hospitalar de Emergência/tendências , Feminino , Humanos , Masculino , Alta do Paciente/tendências , Suécia/epidemiologia
20.
Drug Alcohol Depend ; 190: 246-254, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30071457

RESUMO

BACKGROUND: New highly effective medications are available to treat the hepatitis C virus (HCV). However, little is known about HCV treatment knowledge and readiness among young people who inject drugs (PWID), or factors that may contribute to treatment uptake and adherence in this treatment era. PURPOSE: Using a framework for understanding healthcare utilization, we examined perspectives and experiences of young PWID tied to the HCV care continuum in Boston, Massachusetts, to inform future strategies. METHODS: We conducted 24 in-depth interviews with active and recent PWID aged 22-30 years living with HCV in Boston, February-August 2016. At the time of the interviews, no participants had been prescribed or had taken the new direct acting antivirals. We developed a codebook deductively from the interview guide and coded and analyzed the data into themes using a consensus-based process. RESULTS: The following five themes emerged, which captured PWID's knowledge of and experiences with HCV along the care continuum through social determinants of engagement in care, as well as illness level: (1) deservingness of HCV treatment and stigma, (2) dissatisfaction with provider interactions, (3) perceived lack of referral to treatment and care continuity, (4) disincentives around HCV treatment for PWID; and (5) perceived need for treatment. Young PWID living with HCV face unique barriers to HCV testing, counseling, and treatment. CONCLUSION: Breakdowns in the HCV care continuum may have adverse effects on HCV-treatment readiness and willingness. Improved public health and practice approaches are needed to address these barriers to effectively engage young PWID in care.


Assuntos
Antivirais/uso terapêutico , Continuidade da Assistência ao Paciente/tendências , Conhecimentos, Atitudes e Prática em Saúde , Hepatite C/tratamento farmacológico , Aceitação pelo Paciente de Cuidados de Saúde , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico , Adulto , Antivirais/farmacologia , Boston/epidemiologia , Resfriado Comum , Feminino , Hepacivirus/efeitos dos fármacos , Hepatite C/epidemiologia , Hepatite C/psicologia , Humanos , Masculino , Massachusetts/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/psicologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA