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1.
Nephrol Nurs J ; 47(3): 239-265, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32639125

RESUMO

Vitamin D deficiency is prevalent among patients with chronic kidney disease (CKD) and even more pronounced in patients with kidney failure who are undergoing peritoneal dialysis and hemodialysis. This project was a nurse practitioner-led quality improvement project conducted in an outpatient hemodialysis unit that focused on determining if educating providers and hemodialysis unit clinical staff on vitamin D guidelines increased the awareness and monitoring of patients on hemodialysis. The number of patients screened for vitamin D levels increased from 29% to 100%, and 70% of patients tested were deficient in vitamin D. While the follow-up monitoring yielded a result of only 32%, we recommend processes and structures for long-term sustainability, such as periodic re-education, reminders and prompts for conducting needed follow-up, continued outcome monitoring, and champions to support the ongoing processes and structures.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Medicina Baseada em Evidências/organização & administração , Corpo Clínico/educação , Diálise Renal , Insuficiência Renal Crônica/terapia , Deficiência de Vitamina D/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Programas de Rastreamento/estatística & dados numéricos , Profissionais de Enfermagem , Guias de Prática Clínica como Assunto , Melhoria de Qualidade/organização & administração , Insuficiência Renal Crônica/epidemiologia , Deficiência de Vitamina D/epidemiologia
2.
Yakugaku Zasshi ; 140(5): 657-661, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32378667

RESUMO

The development of specialized training programs for medical personnel, particularly nurses, clinical laboratory technicians, and pharmacists, is considered critical for the promotion of genomic medicine throughout Japan. Specifically, medical personnel skilled at analyzing and understanding high-throughput genomic data are in high demand. In this symposium, we will introduce the basic knowledge and skills necessary for processing genomic data.


Assuntos
Ciência de Dados/educação , Terapia Genética/métodos , Genoma Humano , Genômica , Corpo Clínico/educação , Neoplasias/genética , Neoplasias/terapia , Equipe de Assistência ao Paciente , Competência Clínica , Análise Mutacional de DNA/métodos , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Japão , Mutação
3.
Clin Biochem ; 74: 1-11, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31473202

RESUMO

Dietary biotin intake does not typically result in blood biotin concentrations that exceed interference thresholds for in vitro diagnostic tests. However, recent trends of high-dose biotin supplements and clinical trials of very high biotin doses for patients with multiple sclerosis have increased concerns about biotin interference with immunoassays. Estimates of the prevalence of high biotin intake vary, and patients may be unaware that they are taking biotin. Since 2016, 92 cases of suspected biotin interference have been reported to the US Food and Drug Administration. Immunoassays at greatest risk from biotin interference include thyroid and reproductive hormones, cardiac, and immunosuppressive drug tests. Several case studies have highlighted the challenge of biotin interference with thyroid hormone assays and the potential misdiagnosis of Graves' disease. Biotin interference should be suspected when immunoassay test results are inconsistent with clinical information; a clinically relevant biotin interference happens when the blood biotin concentration is high and the assay is sensitive to biotin. We propose a best practice workflow for laboratory scientists to evaluate discrepant immunoassay results, comprising: (1) serial dilution; (2) retesting after biotin clearance and/or repeat testing on an alternate platform; and (3) confirmation of the presence of biotin using depletion protocols or direct measurement of biotin concentrations. Efforts to increase awareness and avoid patient misdiagnosis should focus on improving guidance from manufacturers and educating patients, healthcare professionals, and laboratory staff. Best practice guidance for laboratory staff and healthcare professionals would also provide much-needed information on the prevention, detection, and management of biotin interference.


Assuntos
Biotina/administração & dosagem , Biotina/sangue , Suplementos Nutricionais , Doença de Graves/diagnóstico , Imunoensaio/normas , Guias de Prática Clínica como Assunto , Testes de Função Tireóidea/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Conscientização , Criança , Pré-Escolar , Erros de Diagnóstico , Feminino , Doença de Graves/sangue , Humanos , Lactente , Recém-Nascido , Laboratórios , Masculino , Pessoal de Laboratório Médico/educação , Corpo Clínico/educação , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Tireotropina/sangue , Tiroxina/sangue
4.
J Pediatr Endocrinol Metab ; 32(8): 821-826, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31287798

RESUMO

Background The purpose of this study was to assess the benefit of a short workshop addressing knowledge and confidence of inpatient caregivers (physicians and nurses) treating pediatric type 1 diabetes mellitus (T1DM) patients. Methods Questionnaires to determine familiarity with T1DM management and confidence in care were distributed at three university-affiliated medical centers. A 5-h practical-skills workshop was conducted at one center. Same questionnaires were filled out immediately after the workshop and 3 months later. Evaluation of knowledge was based on 16 multiple-choice questions, and confidence based on 10 categorical questions. Results Nurses and physicians (total 135, 106 women, 85 nurses) completed the questionnaires. The median knowledge score was 53.33 (40-66) and 46.7 (26.7-66.7) for nurses and physicians, respectively (p = 0.76). The confidence scores were 1.44 (1.1-1.9) and 1.56 (1.2-1.8), respectively (p = 0.7). More experience among nurses (>10 years) was associated with higher confidence scores (p = 0.04). Twenty-one physicians and 52 nurses, 66 women, attended the workshop. The median knowledge grade improved from 60 (47-67) to 81 (69-81), p < 0.001, immediately after, and to 69 (63-81), p < 0.001, 3 months post-workshop. The median confidence score improved from 1.8 (1.6-2) to 2.4 (2.1-2.6), p < 0.001, and to 2.2 (2-2.6), p < 0.001, respectively. There was no association with profession or seniority. Conclusions Knowledge and confidence in care of medical staff treating inpatient T1DM pediatric patients are lacking. Both improved significantly after the workshop, independent of seniority or profession.


Assuntos
Competência Clínica/normas , Diabetes Mellitus Tipo 1/terapia , Conhecimentos, Atitudes e Prática em Saúde , Hospitalização/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Corpo Clínico/educação , Administração dos Cuidados ao Paciente/normas , Criança , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Inquéritos e Questionários
5.
J Clin Psychopharmacol ; 39(4): 357-361, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31205186

RESUMO

PURPOSE/BACKGROUND: The present study was conducted to investigate the difference in attitudes toward psychiatric drugs, long-term medication, and depot formulations between psychiatric patients and patient-related groups and the German general public. METHODS/PROCEDURES: Different groups (n = 50 patients, n = 34 relatives of patients, n = 42 psychiatrists, n = 70 medical students, and n = 58 psychiatric nursing professionals) were surveyed using a questionnaire to investigate their attitude toward depot medication and compared with matched participants from the German general public. FINDINGS/RESULTS: Patients did not differ from their matched controls regarding their attitude toward potential reasons to reject a depot, whereas psychiatrists (P = 0.002) and nursing staff (P = 0.003) were more concerned about patients fearing an injection than their matched controls. IMPLICATIONS/CONCLUSIONS: Psychiatrists and psychiatric nurses were significantly more concerned about giving an (intragluteal) injection because of concerns about patients' fears of this administration method than their matched controls. In contrast, patients' concerns about receiving an injection did not differ from their matched controls. Furthermore, we found that psychiatrists tended to believe that giving an injection might be time-consuming than giving oral medication. These results may emphasize the fact that the low rate of depot medication use is derived from subjective reservations of medical staff rather than actual negative attitudes or fears of patients.


Assuntos
Antipsicóticos/administração & dosagem , Preparações de Ação Retardada/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Corpo Clínico/psicologia , Adulto , Idoso , Família/psicologia , Feminino , Alemanha , Humanos , Masculino , Corpo Clínico/educação , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Pacientes/psicologia , Enfermagem Psiquiátrica/educação , Psiquiatria/educação , Esquizofrenia/tratamento farmacológico , Estudantes de Medicina/psicologia , Inquéritos e Questionários , Adulto Jovem
6.
BMC Health Serv Res ; 19(1): 332, 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31126277

RESUMO

BACKGROUND: Deficits in general and specialized on-site medical care are a common problem in nursing homes and can lead to unnecessary, costly and burdensome hospitalizations for residents. Reasons for this are often organizational obstacles (such as lack of infrastructure or communication channels) and unfavorable compensation structures, which impede the implementation of adequate medical care. The purpose of this study is to evaluate a complex intervention aiming to improve the coordination of medical care in long-term care nursing homes in Germany. The project aims to optimize the collaboration of nurses and physicians in order to reduce avoidable hospital admissions and ambulance transportations. METHODS/DESIGN: In a prospective controlled trial, nursing home residents receiving a complex on-site intervention are compared to residents receiving care/treatment as usual. The study will include a total of around 4000 residents in approximately 80 nursing homes split equally between the intervention group and the control group. Recruitment will take place in all administrative districts of Baden-Wuerttemberg, Germany. The control group focuses on the administrative district of Tuebingen. The intervention includes on-site visits by physicians joined by nursing staff, the formation of teams of physicians, a computerized documentation system (CoCare Cockpit), joint trainings and audits, the introduction of structured treatment paths and after-hours availability of medical care. The project evaluation will be comprised of both a formative process evaluation and a summative evaluation. DISCUSSION: This study will provide evidence regarding the efficacy of a complex intervention to positively influence the quality of medical care and supply efficiency as well as provide cost-saving effects. Its feasibility will be evaluated in a controlled inter-regional design. TRIAL REGISTRATION: WHO UTN: U1111-1196-6611 ; DRKS-ID: DRKS00012703 (Date of Registration in DRKS: 2017/08/23).


Assuntos
Assistência de Longa Duração/normas , Casas de Saúde/normas , Melhoria de Qualidade , Adulto , Idoso , Coleta de Dados/métodos , Alemanha , Pesquisa sobre Serviços de Saúde , Instituição de Longa Permanência para Idosos/normas , Humanos , Capacitação em Serviço , Corpo Clínico/educação , Recursos Humanos de Enfermagem/educação , Estudos Prospectivos
7.
Therapie ; 74(4): 487-494, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-30904318

RESUMO

In 2006, because of the chloroquine-resistance and following the World Health Organization (WHO) recommendations, Côte d'Ivoire adopted a new policy for the prevention of malaria during pregnancy by intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). However, its implementation remains limited. Objectives of this study were to evaluate the knowledge of the TPIp-SP regimen and prescribers opinion concerning this protocol. It was a knowledge attitude and pratices (KAP) cross-sectional descriptive study. We used a two-stage stratified sounding. The study took place in 12 health facilities in the health region of Abidjan 2 from march to august 2016 and involved 187 health professionals. We performed descriptive analysis, univariate and bivariate comparative analysis. The study found that half of the prescribers surveyed actually knew the ITPp program (SP - 3 doses - 2nd and 3rd trimesters). Knowledge was better among practitioners with more than 5 years of exercise (P=0.011) and at the level of first contact of health institution (P=0.001). Half of the prescribers were in favor of applying the protocol. The level of knowledge of prescribers has changed little in 2016 compared to 2008 for physicians (Pr (|Z|<|z|)=0.4861) or midwives Pr (|Z|<|z|)=0.4786). Prescribers remained faithful to the old 2-dose protocol. The opinion on the protocol was better in 2016 compared to 2008 Pr (Z

Assuntos
Antimaláricos/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Malária/tratamento farmacológico , Complicações Parasitárias na Gravidez/tratamento farmacológico , Pirimetamina/administração & dosagem , Sulfadoxina/administração & dosagem , Adulto , Competência Clínica/estatística & dados numéricos , Costa do Marfim/epidemiologia , Estudos Transversais , Esquema de Medicação , Combinação de Medicamentos , Escolaridade , Feminino , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Malária/epidemiologia , Masculino , Corpo Clínico/educação , Corpo Clínico/normas , Corpo Clínico/estatística & dados numéricos , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Gravidez , Complicações Parasitárias na Gravidez/epidemiologia , Medicina Preventiva/educação , Medicina Preventiva/métodos , Medicina Preventiva/estatística & dados numéricos , Adulto Jovem
8.
J Robot Surg ; 13(3): 511-514, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30835043

RESUMO

Establishing a new robotics program presents a unique set of challenges that differ from routine operative procedures. These include training robotic staff, operating room logistics, and surgeon training. As the surgeon moves away from the patient bedside, the responsibilities of the bedside team and circulating staff must increase to fill that void. Therefore, a critical element of robotic thoracic surgery is the training of the robotic team to facilitate fluid movement of the patient through the surgical process. We report our process in establishing a thoracic robotics program with an emphasis on the training personnel.


Assuntos
Corpo Clínico/educação , Equipe de Assistência ao Paciente , Sistemas Automatizados de Assistência Junto ao Leito , Procedimentos Cirúrgicos Robóticos/educação , Procedimentos Cirúrgicos Torácicos/educação , Humanos
10.
BMC Med Educ ; 18(1): 170, 2018 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-30041635

RESUMO

BACKGROUND: Multisource feedback (MSF), involves the collection of feedback from multiple groups of assessors, including those without a traditional hierarchal responsibility to evaluate doctors. Allied healthcare professionals (AHCPs), administrative staff, peers, patients and their families may all contribute to the formative assessment of physicians. Theoretically, this feedback provides a thorough view of physician performance; however, the ability of MSF programs to consistently impact physician behavior remains in question. Therefore, the objective of this study was to explore perceptions and prerequisites to an effective MSF program in postgraduate medical education from the perspectives of both pediatric residents and AHCPs. METHODS: This exploratory study was conducted in a pediatric inpatient unit prior to implementation of a MSF program. Focus groups were conducted with purposefully recruited participants from three distinct groups: junior pediatric residents, senior pediatric residents, and AHCPs. Discussions were audio recorded, transcribed verbatim and analyzed using thematic analysis. RESULTS: Both residents and AHCPs expressed a strong interest in the concept of MSF. However, more in depth discussions identified barriers to residents' acceptance of, and AHCPs' provision of feedback. Roles and responsibilities, perceptions of expertise, hospital culture/interprofessionalism and power dynamics were identified as barriers to the acceptance and provision of feedback. All groups expressed interest in opportunities to engage in bi-directional feedback. CONCLUSIONS: The identified barriers and prerequisites to providing and accepting MSF suggest limits to the efficacy of the MSF process. Our findings suggest that these factors should be considered in the design and implementation of MSF programs.


Assuntos
Competência Clínica , Feedback Formativo , Internato e Residência , Corpo Clínico/educação , Humanos , Pesquisa Qualitativa
11.
BMC Med Educ ; 18(1): 135, 2018 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-29895284

RESUMO

BACKGROUND: The German quality assurance programme for evaluating work capacity is based on peer review that evaluates the quality of medical experts' reports. Low reliability is thought to be due to systematic differences among peers. For this purpose, we developed a curriculum for a standardized peer-training (SPT). This study investigates, whether the SPT increases the inter-rater reliability of social medical physicians participating in a cross-institutional peer review. METHODS: Forty physicians from 16 regional German Pension Insurances were subjected to SPT. The three-day training course consist of nine educational objectives recorded in a training manual. The SPT is split into a basic module providing basic information about the peer review and an advanced module for small groups of up to 12 peers training peer review using medical reports. Feasibility was tested by assessing selection, comprehensibility and subjective use of contents delivered, the trainers' delivery and design of training materials. The effectiveness of SPT was determined by evaluating peer concordance using three anonymised medical reports assessed by each peer. Percentage agreement and Fleiss' kappa (κm) were calculated. Concordance was compared with review results from a previous unstructured, non-standardized peer-training programme (control condition) performed by 19 peers from 12 German Pension Insurances departments. The control condition focused exclusively on the application of peer review in small groups. No specifically training materials, methods and trainer instructions were used. RESULTS: Peer-training was shown to be feasible. The level of subjective confidence in handling the peer review instrument varied between 70 and 90%. Average percentage agreement for the main outcome criterion was 60.2%, resulting in a κm of 0.39. By comparison, the average percentage concordance was 40.2% and the κm was 0.12 for the control condition. CONCLUSION: Concordance with the main criterion was relevant but not significant (p = 0.2) higher for SPT than for the control condition. Fleiss' kappa coefficient showed that peer concordance was higher for SPT than randomly expected. Nevertheless, a score of 0.39 for the main criterion indicated only fair inter-rater reliability, considerably lower than the conventional standard of 0.7 for adequate reliability.


Assuntos
Corpo Clínico/educação , Grupo Associado , Revisão por Pares/normas , Garantia da Qualidade dos Cuidados de Saúde , Currículo , Estudos de Viabilidade , Alemanha , Humanos , Variações Dependentes do Observador , Médicos de Família/educação , Médicos de Família/normas , Reprodutibilidade dos Testes , Avaliação da Capacidade de Trabalho
12.
BMC Med Educ ; 18(1): 111, 2018 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-29769059

RESUMO

BACKGROUND: In September 2013, two cases of cholera were reported in Mexico; 1 week later, a new outbreak was reported in the Huasteca region of Hidalgo. Upon the determination that the diagnostic and therapeutic interventions implemented by health personnel overlooked predefined procedures, the National Institute of Public Health, in coordination with the Ministry of Health, immediately designed the massive open online course "Proper cholera containment and management measures" to strengthen and standardize basic prevention and control practices. METHODS: During the first 5 months, 35,968 participants from across the country finished the course: medical and nursing personnel, health promoters, and hospital staff. To understand the magnitude of the data, an analysis was performed to calculate the MOOC coverage, and multiple linear regression models were generated to relate the score earned in the course to the characteristics of the participants. In addition, a qualitative analysis was performed to identify the dissemination of information, technological barriers, and feedback on course design. A total of 17% of participants were from the state where the outbreak originated, and 33.5% were from its neighboring states. RESULTS: This study shows that the need for information is greater when an emergency occurs, and the involvement of the authorities increased the extent of the training response. CONCLUSION: A MOOC can be a useful training strategy to prepare personnel for emergency situations.


Assuntos
Cólera/prevenção & controle , Surtos de Doenças/prevenção & controle , Pessoal de Saúde/educação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cólera/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Emergências , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Modelos Lineares , Masculino , Corpo Clínico/educação , Corpo Clínico/estatística & dados numéricos , México/epidemiologia , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem/educação , Recursos Humanos de Enfermagem/estatística & dados numéricos , Recursos Humanos em Hospital/educação , Recursos Humanos em Hospital/estatística & dados numéricos , Pesquisa Qualitativa , Adulto Jovem
13.
PLoS One ; 13(5): e0197172, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29750798

RESUMO

OBJECTIVE: To review the scientific literature related to the safe handling of hazardous drugs (HDs). METHOD: Critical analysis of works retrieved from MEDLINE, the Cochrane Library, Scopus, CINHAL, Web of Science and LILACS using the terms "Hazardous Substances", "Antineoplastic Agents" and "Cytostatic Agents", applying "Humans" and "Guidelines" as filters. Date of search: January 2017. RESULTS: In total, 1100 references were retrieved, and from those, 61 documents were selected based on the inclusion and exclusion criteria: 24 (39.3%) documents related to recommendations about HDs; 27 (44.3%) about antineoplastic agents, and 10 (33.3%) about other types of substances (monoclonal antibodies, gene medicine and other chemical and biological agents). In 14 (23.3%) guides, all the stages in the manipulation process involving a risk due to exposure were considered. Only one guide addressed all stages of the handling process of HDs (including stages with and without the risk of exposure). The most described stages were drug preparation (41 guides, 67.2%), staff training and/or patient education (38 guides, 62.3%), and administration (37 guides, 60.7%). No standardized informatics system was found that ensured quality management, traceability and minimization of the risks associated with these drugs. CONCLUSIONS: Most of the analysed guidelines limit their recommendations to the manipulation of antineoplastics. The most frequently described activities were preparation, training, and administration. It would be convenient to apply ICTs (Information and Communications Technologies) to manage processes involving HDs in a more complete and simpler fashion.


Assuntos
Antineoplásicos/efeitos adversos , Educação Médica Continuada , Corpo Clínico/educação , Educação de Pacientes como Assunto , Humanos , Guias de Prática Clínica como Assunto
14.
Soc Psychiatry Psychiatr Epidemiol ; 52(11): 1435-1445, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28667486

RESUMO

PURPOSE: This study aimed to assess the efficacy of a staff-training intervention to improve service users' engagement in activities and quality of care, by means of a cluster randomised controlled trial. METHOD: All residential units with at least 12-h a day staff support (n = 23) were invited to participate. Quality of care was assessed with the Quality Indicator for Rehabilitative Care (QuIRC) filled online by the unit's manager. Half the units (n = 12) were randomly assigned to continue providing treatment as usual, and half (n = 11) received a staff-training intervention that focused on skills for engaging service users in activities, with trainers working alongside staff to embed this learning in the service. The primary outcome was service users' level of activity (measured with the Time Use Diary), reassessed at 4 and 8 months. Secondary outcomes were the quality of care provided (QuIRC), and service users' quality of life (Manchester Short Assessment of Quality of Life) reassessed at 8 months. Generalized linear mixed effect models were used to assess the difference in outcomes between units in the two trial arms. The trial was registered with Current Controlled Trials (Ref NCT02366117). RESULTS: Knowledge acquired by the staff during the initial workshops increased significantly (p ≤ 0.01). However, the intervention and comparison units did not differ significantly in primary and secondary outcomes at either follow-up. CONCLUSIONS: The intervention increased the level of knowledge of staff without leading to an improvement in service users' engagement in activities, quality of life, or quality of care in the units.


Assuntos
Capacitação em Serviço , Corpo Clínico/educação , Transtornos Mentais/terapia , Instituições Residenciais , Adulto , Competência Clínica , Análise por Conglomerados , Feminino , Seguimentos , Humanos , Masculino , Corpo Clínico/psicologia , Corpo Clínico/estatística & dados numéricos , Pessoa de Meia-Idade , Portugal , Qualidade da Assistência à Saúde , Qualidade de Vida
15.
Artigo em Inglês | MEDLINE | ID: mdl-28566135

RESUMO

The use of computers to assist surgeons in the operating room has been an inevitable evolution in the modern practice of surgery. Robotic-assisted surgery has been evolving now for over two decades and has finally matured into a technology that has caused a monumental shift in the way gynecologic surgeries are performed. Prior to robotics, the only minimally invasive options for most Gynecologic (GYN) procedures including hysterectomies were either vaginal or laparoscopic approaches. However, even with over 100 years of vaginal surgery experience and more than 20 years of laparoscopic advancements, most gynecologic surgeries in the United States were still performed through an open incision. However, this changed in 2005 when the FDA approved the da Vinci Surgical Robotic Systemtm for use in gynecologic surgery. Over the last decade, the trend for gynecologic surgeries has now dramatically shifted to less open and more minimally invasive procedures. Robotic-assisted surgeries now include not only hysterectomy but also most all other commonly performed gynecologic procedures including myomectomies, pelvic support procedures, and reproductive surgeries. This success, however, has not been without controversies, particularly around costs and complications. The evolution of computers to assist surgeons and make minimally invasive procedures more common is clearly a trend that is not going away. It is now incumbent on surgeons, hospitals, and medical societies to determine the most cost-efficient and productive use for this technology. This process is best accomplished by developing a Robotics Program in each hospital that utilizes robotic surgery.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/educação , Laparoscopia/educação , Corpo Clínico/educação , Procedimentos Cirúrgicos Robóticos/educação , Centros Cirúrgicos/organização & administração , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Laparoscopia/métodos , Corpo Clínico/organização & administração , Procedimentos Cirúrgicos Robóticos/métodos
16.
JAMA Intern Med ; 177(6): 846-853, 2017 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-28418449

RESUMO

Importance: Off-label antipsychotic prescribing in nursing homes (NHs) is common and is associated with increased risk of mortality in older adults. Prior large-scale, controlled trials in the NH setting failed to show meaningful reductions in antipsychotic use. Objective: To quantify the influence of a large-scale communication training program on NH antipsychotic use called OASIS. Design, Setting, and Participants: This investigation was a quasi-experimental longitudinal study of NHs in Massachusetts enrolled in the OASIS intervention. Participants were residents living in NHs between March 1, 2011, and August 31, 2013. The data were analyzed from December 2015, to March 2016, and from November through December 2016. Exposures: The OASIS educational program targets all NH staff (direct care and nondirect care) using a train-the-trainer model. The program goals were to reframe challenging behaviors of residents with cognitive impairment as the communication of unmet needs, to train staff to anticipate resident needs, and to integrate resident strengths into daily care plans. Main Outcomes and Measures: This study used an interrupted time series model of facility-level prevalence of antipsychotic medication use, other psychotropic medication use (antidepressants, anxiolytics, and hypnotics), and behavioral disturbances to evaluate the intervention's effectiveness in participating facilities compared with control NHs in Massachusetts and New York. The 18-month preintervention (baseline) period was compared with a 3-month training period, a 6-month implementation period, and a 3-month maintenance period. Results: This study included 93 NHs enrolled in the OASIS intervention (27 of which had a high prevalence of antipsychotic use) compared with 831 nonintervention NHs. Among OASIS facilities, prevalences of atypical antipsychotic prescribing were 34.1% at baseline and 26.5% at the study end (absolute reduction of 7.6% and relative reduction of 22.3%) compared with a drop of 22.7% to 18.8% in the comparison facilities (absolute reduction of 3.9% and relative reduction of 17.2%). In the OASIS implementation phase, NHs experienced a reduction in antipsychotic use prevalence among OASIS facilities (-1.20%; 95% CI, -1.85% to -0.09% per quarter) greater than that among non-OASIS facilities (-0.23%; 95% CI, -0.47% to 0.01% per quarter), resulting in a net OASIS influence of -0.97% (95% CI, -1.85% to -0.09%; P = .03). A difference in trend was not sustained in the maintenance phase (difference of 0.93%; 95% CI, -0.66% to 2.54%; P = .48). No increases in other psychotropic medication use or behavioral disturbances were observed. Conclusions and Relevance: Antipsychotic use prevalence declined during OASIS implementation of the intervention, but the decreases did not continue in the maintenance phase. Other psychotropic medication use and behavioral disturbances did not increase. This study adds evidence for nonpharmacological programs to treat behavioral and psychological symptoms of dementia.


Assuntos
Competência Clínica , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Capacitação em Serviço/normas , Corpo Clínico/educação , Casas de Saúde/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Antipsicóticos/uso terapêutico , Transtornos Cognitivos , Comunicação , Demência/tratamento farmacológico , Feminino , Humanos , Estudos Longitudinais , Masculino , Massachusetts , Pessoa de Meia-Idade , Agitação Psicomotora/tratamento farmacológico
17.
Pediatr Emerg Care ; 33(9): e43-e45, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26599465

RESUMO

There is a growing body of literature that supports the use of ultrasound for vascular access. Advanced simulation has become a widely applied technique for training medical staff in vascular access. Nevertheless, advanced simulators are expensive and of limited usage. We describe both a step-wise systematic approach and an experimental cadaveric model of vascular access using a simple piece of chicken that can be easily used for trainees.


Assuntos
Simulação por Computador/economia , Corpo Clínico/educação , Ultrassonografia de Intervenção/economia , Dispositivos de Acesso Vascular/economia , Animais , Cadáver , Galinhas , Simulação por Computador/estatística & dados numéricos , Desenho de Equipamento , Humanos , Modelos Animais , Ultrassonografia de Intervenção/instrumentação
18.
Masui ; 66(4): 463-469, 2017 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-30382653

RESUMO

We report the development of a multi-center/multi- specialist perioperative team development training program about respiratory surgery. Participants were members of the team, including anesthesiologists, respiratory surgeons, and operation nurses. A ques- tionnaire survey was conducted prior to course partici- pation to clarify any questions team members had. The courses included a lecture and simulation training with scenario-based discussions or the use of a simulator. Scenarios included massive bleeding during pulmonary artery damage, intractable hypoxia during one lung ventilation, and severe hypotension accompanied with hypoxia after tracheal extubation. We also discussed the best method for preoperative smoking cessation for better surgery outcome. After each course, participants discussed problems associated with perioperative medi- cal safety of respiratory surgery in the context of each theme. Simulation-based perioperative team training with anesthesiologists, respiratory surgeons, and opera- tion nurses may serve as a vehicle to promote periop- erative obstetrics safety.


Assuntos
Corpo Clínico/educação , Equipe de Assistência ao Paciente , Assistência Perioperatória/educação , Humanos , Transtornos Respiratórios/cirurgia , Inquéritos e Questionários
19.
BMC Med Educ ; 16(1): 207, 2016 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-27530343

RESUMO

BACKGROUND: Smartphones are ubiquitous and commonly used as a learning and information resource. They have potential to revolutionize medical education and medical practice. The iDoc project provides a medical textbook smartphone app to newly-qualified doctors working in Wales. The project was designed to assist doctors in their transition from medical school to workplace, a period associated with high levels of cognitive demand and stress. METHODS: Newly qualified doctors submitted case reports (n = 293) which detail specific instances of how the textbook app was used. Case reports were submitted via a structured online form (using Bristol Online Surveys - BOS) which gave participants headings to elicit a description of: the setting/context; the problem/issue addressed; what happened; any obstacles involved; and their reflections on the event. Case reports were categorised by the purpose of use, and by elements of the quality improvement framework (IoM 2001). They were then analysed thematically to identify challenges of use. RESULTS: Analysis of the case reports revealed how smartphones are a viable tool to address clinical questions and support mobile learning. They contribute to novice doctors' provision of safe, effective, timely, efficient and patient-centred care. The case reports also revealed considerable challenges for doctors using mobile technology within the workplace. Participants reported concern that using a mobile phone in front of patients and staff might appear unprofessional. CONCLUSION: Mobile phones blur boundaries between the public and private, and the personal and professional. In contrast to using a mobile as a communication device, using a smartphone as an information resource in the workplace requires different rituals. Uncertain etiquette of mobile use may reduce the capacity of smartphone technology to improve the learning experience of newly qualified doctors.


Assuntos
Telefone Celular , Educação Médica Continuada/métodos , Corpo Clínico/educação , Aplicativos Móveis , Obras Médicas de Referência , Competência Clínica , Humanos , Disseminação de Informação , Comportamento de Busca de Informação , Capacitação em Serviço , Assistência ao Paciente/normas , Segurança do Paciente , País de Gales
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