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1.
Aust J Gen Pract ; 50(6): 388-393, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34059849

RESUMO

BACKGROUND AND OBJECTIVES: Immunisation uptake in Australian older adults is suboptimal. General practice registrars are responsible for a significant proportion of immunisations in this age group and are also in the process of developing patterns of practice. Despite their role, little is known about general practice registrars' attitudes towards immunisation of older adults, the barriers faced, and the role supervisors play in developing adult immunisation skills. METHOD: This was a qualitative study involving semi-structured interviews with general practice registrars and supervisors purposively sampled from around Australia. Data were analysed using thematic analysis. RESULTS: The five key themes were grouped in terms of perceptions of registrars' role in immunisation of older adults, consultation barriers, health system barriers, managing vaccine hesitancy, and a team approach to vaccination. DISCUSSION: Vaccine positivity is an important attitude to cultivate within the general practice environment as it has an impact on registrar behaviour. Immunisation-skilled nurses could play a role in training general practice registrars in immunisation. Findings from the present study may be useful in improving vaccine uptake in the elderly in the context of the COVID-19 vaccine rollout.


Assuntos
Atitude do Pessoal de Saúde , Vacinas contra COVID-19 , COVID-19/prevenção & controle , Clínicos Gerais/psicologia , Papel do Médico , Idoso , Austrália/epidemiologia , Competência Clínica , Barreiras de Comunicação , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Papel do Profissional de Enfermagem , Aceitação pelo Paciente de Cuidados de Saúde , Equipe de Assistência ao Paciente , Relações Médico-Paciente , Pesquisa Qualitativa , SARS-CoV-2
2.
BMJ Open ; 11(6): e046845, 2021 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-34135050

RESUMO

OBJECTIVES: This study investigated the costs of 2-hour multiprofessional in situ hospital trauma team simulation training and its effects on teams' non-technical skills using the T-NOTECHS instrument. BACKGROUND: Simulation is a feasible and effective teaching and learning method. Calculating the costs of simulated trauma team training in medical emergency situations can yield valuable information for improving its overall cost-effectiveness. DESIGN: A prospective cohort study. SETTING: Trauma resuscitation room in Central Finland Hospital, Finland. PARTICIPANTS: 475 medical professionals in 81 consecutive, simulated trauma teams. PRIMARY AND SECONDARY OUTCOME MEASURES: Team simulation training costs in 2017 and 2018 were analysed in the following two phases: (1) start-up costs and (2) costs of education. Primary outcome measures were training costs per participant and training costs per team. Secondary outcome measures were non-technical skills, which were measured on a 5-25-point scale using the T-NOTECHS instrument. RESULTS: The annual mean total costs of trauma team simulation training were €58 000 for 40 training sessions and 238 professionals. Mean cost per participant was €203. Mean cost per team was €1220. The annual costs of simulation training markedly decreased when at least 70-80 teams participated in the training. Mean change in T-NOTECHS score after simulation training was +2.86 points (95% CI 1.97 to 3.75;+14.5%). CONCLUSIONS: The greater the number of teams trained per year, the lower the costs per trauma team. In this study, we developed an activity-based costing method to calculate the costs of trauma team simulation training to help stakeholders make decisions about whether to initiate or increase existing trauma team simulation training or to obtain these services elsewhere.


Assuntos
Equipe de Assistência ao Paciente , Treinamento por Simulação , Competência Clínica , Finlândia , Hospitais , Humanos , Estudos Prospectivos
6.
Surg Clin North Am ; 101(3): 489-497, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34048768

RESUMO

Esophageal cancer commonly presents in advanced stage, and many patients will require palliative intervention. Endoscopic stenting remains an excellent first-line therapy; however, this should be discussed in a multidisciplinary setting, considering expectations for long-term survival.


Assuntos
Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/terapia , Cuidados Paliativos/métodos , Equipe de Assistência ao Paciente , Papel do Médico , Cirurgiões , Humanos , Cuidados Paliativos/organização & administração
7.
Nurse Educ Pract ; 53: 103075, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33991967

RESUMO

Children with chronic illnesses have improved physiological and psychosocial outcomes when they are able to identify and converse with others who experience the same challenges. Support groups are one way to enhance this interaction. To facilitate this process, student nurses worked with an interprofessional healthcare team, thalassemia patients, and their families to determine their support needs. The purpose of this article is to describe the innovative development and outcomes of the Thalassemia Patient Support Project, a community engagement partnership. This partnership provided a unique educational clinical experience for nursing students where they had an opportunity to help develop a support group and a pediatric to adult transitional care program. The outcomes could be used as a guide for community nursing education, in US and international settings.


Assuntos
Educação em Enfermagem , Estudantes de Enfermagem , Talassemia , Adulto , Criança , Relações Comunidade-Instituição , Humanos , Relações Interprofissionais , Equipe de Assistência ao Paciente
8.
Nurse Educ Pract ; 53: 103073, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33991968

RESUMO

To bridge the gap between university and the clinical environment, the university where this study was conducted incorporated interprofessional simulation sessions into the curricula for pre-registration nursing and occupational therapy students. The purpose of the study was to evaluate the effectiveness of simulation training to support the development of students' interprofessional communication and teamwork skills. Study participants were first-year students. A mixed methods study design was used that included: (1) a cross-sectional survey, (using the Interprofessional Education Collaborative Competency Self-Assessment tool), before and after the simulation session; and (2) two focus groups with students and one with academic staff. A total of 91 students and 5 staff participated. All students increased their self-perceived skills in interprofessional interactions. Two major themes were identified: 'Communication and Teamwork', with four sub-themes, (1) 'Significance of Communication in teamwork'; (2) 'Learning about, from and with each other'; (3) 'Professional role identification and collaborative practice'; and (4) 'Clinical leadership facilitated collaboration' and 'Lessons learnt from the simulation session', with three subthemes: (1) 'enhanced preparation for clinical placement'; (2) 'the experience of interacting with a simulated patient'; and (3) 'holistic patient care'. The results from the study demonstrated that interprofessional simulation sessions are an effective approach to introducing and developing collaborative clinical practice.


Assuntos
Terapia Ocupacional , Treinamento por Simulação , Estudantes de Enfermagem , Atitude do Pessoal de Saúde , Comunicação , Comportamento Cooperativo , Estudos Transversais , Humanos , Relações Interprofissionais , Equipe de Assistência ao Paciente , Estudantes
9.
J Oncol Pharm Pract ; 27(4): 785-801, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34024179

RESUMO

The Oncology Pharmacy Team (OPT), consisting of specialty-trained pharmacists and/or pharmacy technicians, is an integral component of the multidisciplinary healthcare team (MHT) involved with all aspects of cancer patient care. The OPT fosters quality patient care, safety, and local regulatory compliance. The International Society of Oncology Pharmacy Practitioners (ISOPP) developed this position statement to provide guidance on five key areas: 1) oncology pharmacy practice as a pharmacy specialty; 2) contributions to patient care; 3) oncology pharmacy practice management; 4) education and training; and 5) contributions to oncology research and quality initiatives to involve the OPT. This position statement advocates that: 1) the OPT be fully incorporated into the MHT to optimize patient care; 2) educational and healthcare institutions develop programs to continually educate OPT members; and 3) regulatory authorities develop certification programs to recognize the unique contributions of the OPT in cancer patient care.


Assuntos
Oncologia/normas , Neoplasias/terapia , Equipe de Assistência ao Paciente/organização & administração , Sociedades Farmacêuticas , Antineoplásicos/uso terapêutico , Educação em Farmácia , Fidelidade a Diretrizes , Humanos , Assistência ao Paciente , Segurança do Paciente , Assistência Farmacêutica , Farmacêuticos , Técnicos em Farmácia , Pesquisa , Especialização
10.
BMC Public Health ; 21(1): 922, 2021 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-33990190

RESUMO

BACKGROUND: Community Health Workers (CHWs) have long been integrated in the delivery of HIV care in middle- and low-income countries. However, less is known about CHW integration into HIV care teams in the United States (US). To date, US-based CHW integration studies have studies explored integration in the context of primary care and patient-centered medical homes. There is a need for research related to strategies that promote the successful integration of CHWs into HIV care delivery systems. In 2016, the Health Resources and Services Administration HIV/AIDS Bureau launched a three-year initiative to provide training, technical assistance and evaluation for Ryan White HIV/AIDS Program (RWHAP) recipient sites to integrate CHWs into their multidisciplinary care teams, and in turn strengthen their capacity to reach communities of color and reduce HIV inequities. METHODS: Ten RWHAP sites were selected from across eight states. The multi-site program evaluation included a process evaluation guided by RE-AIM to understand how the organizations integrated CHWs into their care teams. Site team members participated in group interviews to walk-the-process during early implementation and following the program period. Directed content analysis was employed to examine program implementation. Codes developed using implementation strategies outlined in the Expert Recommendations for Implementing Change project were applied to group interviews (n = 20). FINDINGS: Implementation strategies most frequently described by sites were associated with organizational-level adaptations in order to integrate the CHW into the HIV care team. These included revising, defining, and differentiating professional roles and changing organizational policies. Strategies used for implementation, such as network weaving, supervision, and promoting adaptability, were second most commonly cited strategies, followed by training and Technical Assistance strategies. CONCLUSIONS: Wrapped up in the implementation experience of the sites there were some underlying issues that pose challenges for healthcare organizations. Organizational policies and the ability to adapt proved significant in facilitating CHW program implementation. The integration of the CHWs in the delivery of HIV care requires clearly distinguishing their role from the roles of other members of the healthcare delivery team.


Assuntos
Agentes Comunitários de Saúde , Infecções por HIV , Atenção à Saúde , Infecções por HIV/terapia , Humanos , Equipe de Assistência ao Paciente , Avaliação de Programas e Projetos de Saúde , Estados Unidos
11.
Rev Gaucha Enferm ; 42(spe): e20200331, 2021.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34037186

RESUMO

OBJECTIVE: Describe the experience lived in an interdisciplinary follow-up care center for mastectomized women at a public university in São Paulo during the beginning of the COVID-19 pandemic. METHOD: Experience report on the health care provided in the health center for mastectomized women. RESULTS: The care was provided three times a week by an interdisciplinary health team. The mentioned areas that cover the women care in the center: Physical, Psychological, Social Support and Health Education. CONCLUSIONS: The attention by an interdisciplinary team becomes prevalent in the care of mastectomized women, since cancer and its treatment produce various changes in women's lives in the short and long term, so follow-up and support must be biopsychosocial, covering all areas that may be affected, especially during the pandemic.


Assuntos
Linfedema Relacionado a Câncer de Mama/reabilitação , COVID-19/epidemiologia , Mastectomia/reabilitação , Pandemias , Equipe de Assistência ao Paciente , Centros de Reabilitação , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Linfedema Relacionado a Câncer de Mama/etiologia , Linfedema Relacionado a Câncer de Mama/psicologia , Terapia Focada em Emoções , Terapia por Exercício , Feminino , Educação em Saúde , Humanos , Mastectomia/efeitos adversos , Mastectomia/psicologia , Pessoa de Meia-Idade , Apoio Social
13.
J Korean Med Sci ; 36(17): e103, 2021 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-33942575

RESUMO

Due to the coronavirus disease 2019 (COVID-19) outbreak, consultation and prescription via telemedicine were temporarily allowed in the Korean population. However, at this point, it is difficult to determine whether telemedicine fulfills its role as a health care strategy. Arguably, if we had enough previous experience with telemedicine or sufficient preparation for its application, telemedicine could be more smoothly and flexibly adopted in the medical field. As it is still not possible to predict when the COVID-19 pandemic will end, phone consultation and prescription are likely to continue for some time. Hence, it is expected that telemedicine will naturally settle in the medical field in the near future. However, as we have noticed during this outbreak, improvised telemedicine without adequate guidance can be confusing to both patients and health professionals, thus reducing the benefit to patients. Medical staff requires preparation on how to appropriately use telemedicine. Thus, here we present some suggestions on implementing and preparing for telemedicine in the medical community.


Assuntos
COVID-19/epidemiologia , Guias de Prática Clínica como Assunto , SARS-CoV-2 , Telemedicina , Continuidade da Assistência ao Paciente , Procedimentos Clínicos , Equipamentos e Provisões , Humanos , Colaboração Intersetorial , Equipe de Assistência ao Paciente , Médicos , República da Coreia/epidemiologia
14.
BMC Health Serv Res ; 21(1): 461, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-33990198

RESUMO

BACKGROUND: Multidisciplinary team meeting (MDM) processes differ according to clinical setting and tumour site. This can impact on decision making. This study aimed to evaluate the translation of MDM recommendations into clinical practice across solid tumour MDMs at an academic centre. METHODS: A retrospective audit of oncology records was performed for nine oncology MDMs held at Liverpool Hospital, NSW, Australia from 1/2/17-31/7/17. Information was collected on patient factors (age, gender, country of birth, language, postcode, performance status, comorbidities), tumour factors (diagnosis, stage) and MDM factors (number of MDMs, MDM recommendation). Management was audited up to a year post MDM to record management and identify reasons if discordant with MDM recommendations. Univariate and multivariable regression analyses were performed to assess for factors associated with concordant management. RESULTS: Eight hundred thirty-five patients were discussed, median age was 65 years and 51.4% were males. 70.8% of patients were presented at first diagnosis, 77% discussed once and treatment recommended in 73.2%. Of 771 patients assessable for concordance, management was fully concordant in 79.4%, partially concordant in 12.8% and discordant in 7.8%. Concordance varied from 84.5% for lung MDM to 97.6% for breast MDMs. On multivariable analysis, breast and upper GI MDMs and discussion at multiple MDMs were significantly associated with concordant management. The most common reason for discordant management was patient/guardian decision (28.3%). CONCLUSION: There was variability in translation of MDM recommendations into clinical practice by tumour site. Routine measurement of implementation of MDM recommendations should be considered as a quality indicator of MDM practice.


Assuntos
Comunicação Interdisciplinar , Equipe de Assistência ao Paciente , Idoso , Austrália/epidemiologia , Feminino , Humanos , Masculino , Oncologia , Estudos Retrospectivos
15.
Nursing ; 51(2): 24-34, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33953095

RESUMO

ABSTRACT: The role of nurses in managing patients with cirrhosis is increasing due to the growing prevalence of the disease. This article reviews the pathophysiology, diagnosis, complications, and management of patients with cirrhosis, with an emphasis on interdisciplinary collaboration and evidence-based practice.


Assuntos
Enfermagem Baseada em Evidências , Fibrose/enfermagem , Comportamento Cooperativo , Fibrose/complicações , Fibrose/epidemiologia , Fibrose/fisiopatologia , Humanos , Diagnóstico de Enfermagem , Equipe de Assistência ao Paciente
16.
Adv Skin Wound Care ; 34(6): 293-300, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33979817

RESUMO

GENERAL PURPOSE: To introduce the 15 recommendations of the International Ostomy Guideline (IOG) 2020, covering the four key arenas of education, holistic aspects, and pre- and postoperative care; and to summarize key concepts for clinicians to customize for translation into their practice. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Analyze supporting evidence for the education recommendations in the IOG 2020.2. Identify a benefit of the International Charter of Ostomate Rights.3. Distinguish concepts related to pre- and postoperative ostomy-related care.4. Select a potential barrier to IOG 2020 guideline implementation.


Assuntos
Pessoal de Saúde/educação , Estomia/reabilitação , Guias de Prática Clínica como Assunto/normas , Humanos , Equipe de Assistência ao Paciente/organização & administração , Higiene da Pele/métodos , Cicatrização
17.
BMC Health Serv Res ; 21(1): 453, 2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980224

RESUMO

BACKGROUND: The Protocol-guided Rapid Evaluation of Veterans Experiencing New Transient Neurologic Symptoms (PREVENT) program was a complex quality improvement (QI) intervention targeting transient ischemic attack (TIA) evidence-based care. The aim of this study was to evaluate program acceptability among the QI teams and factors associated with degrees of acceptability. METHODS: QI teams from six Veterans Administration facilities participated in active implementation for a one-year period. We employed a mixed methods study to evaluate program acceptability. Multiple data sources were collected over implementation phases and triangulated for this evaluation. First, we conducted 30 onsite, semi-structured interviews during active implementation with 35 participants at 6 months; 27 interviews with 28 participants at 12 months; and 19 participants during program sustainment. Second, we conducted debriefing meetings after onsite visits and monthly virtual collaborative calls. All interviews and debriefings were audiotaped, transcribed, and de-identified. De-identified files were qualitatively coded and analyzed for common themes and acceptability patterns. We conducted mixed-methods matrix analyses comparing acceptability by satisfaction ratings and by the Theoretical Framework of Acceptability (TFA). RESULTS: Overall, the QI teams reported the PREVENT program was acceptable. The clinical champions reported high acceptability of the PREVENT program. At pre-implementation phase, reviewing quality data, team brainstorming solutions and development of action plans were rated as most useful during the team kickoff meetings. Program acceptability perceptions varied over time across active implementation and after teams accomplished actions plans and moved into sustainment. We observed team acceptability growth over a year of active implementation in concert with the QI team's self-efficacy to improve quality of care. Guided by the TFA, the QI teams' acceptability was represented by the respective seven components of the multifaceted acceptability construct. CONCLUSIONS: Program acceptability varied by time, by champion role on QI team, by team self-efficacy, and by perceived effectiveness to improve quality of care aligned with the TFA. A complex quality improvement program that fostered flexibility in local adaptation and supported users with access to data, resources, and implementation strategies was deemed acceptable and appropriate by front-line clinicians implementing practice changes in a large, national healthcare organization. TRIAL REGISTRATION: clinicaltrials.gov : NCT02769338 .


Assuntos
Ataque Isquêmico Transitório , Veteranos , Humanos , Ataque Isquêmico Transitório/terapia , Equipe de Assistência ao Paciente , Melhoria de Qualidade
18.
Pan Afr Med J ; 38: 223, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34046128

RESUMO

Introduction: quality improvement teams facilitate improvement in the performance of the health facilities and simultaneously improving the quality of health services. There is scanty information on the factors associated with performance of quality improvement teams. This study aimed to assess the perceptions of members of the quality improvement teams on the factors influencing the performance of quality improvement teams in regional referral hospitals in Tanzania. Methods: a cross-sectional study was conducted in four regional referral hospitals in Tanzania. We used self-administered questionnaires to collect data from 61 members of quality improvement teams. Descriptive statistics were used to assess the perceived factors influencing team performance. Bivariate and multivariate logistic regression was used to test the association between perceptions of the team members and factors associated with team performance. Results: the overall mean perception score on team performance was high at 27.51 ± 4.62. Five factors namely: training (83.6%); communication (75.1%); team cohesiveness (71.5%); clarity of roles and responsibility (70.2%); team size and composition (65.5%); and self-assessment and learning (56.2%) were considered as the main drivers of team performance. Inadequate management support obtained the lowest score (36.1%). Multivariable regression analysis established a significant association between training, communication, clarity of roles and responsibilities, team size and composition, self-assessment and learning, management support and team performance. Conclusion: inadequate management support to the team was found to be a barrier to team performance. Managerial interventions should focus on provision of coaching and mentoring to the team while addressing resource challenges affecting the team performance.


Assuntos
Hospitais Públicos/normas , Equipe de Assistência ao Paciente/organização & administração , Melhoria de Qualidade/organização & administração , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Mentores , Pessoa de Meia-Idade , Inquéritos e Questionários , Tanzânia
19.
Clin Interv Aging ; 16: 767-779, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33981140

RESUMO

Purpose: To conduct a systematic review of the economic impact of interventions intended at optimizing medication use in older adults with multimorbidity and polypharmacy. Methods: We searched Ovid-Medline, Embase, CINAHL, Ageline, Cochrane, and Web of Science, for articles published between 2004 and 2020 that studied older adults with multimorbidity and polypharmacy. The intervention studied had to be aimed at optimizing medication use and present results on costs. Results: Out of 3,871 studies identified by the search strategy, eleven studies were included. The interventions involved different provider types, with a majority described as a multidisciplinary team involving a pharmacist and a general practitioner, in the decision-making process. Interventions were generally associated with a reduction in medication expenditure. The benefits of the intervention in terms of clinical outcomes remain limited. Five studies were cost-benefit analyses, which had a net benefit that was either null or positive. Cost-utility and cost-effectiveness analyses resulted in incremental cost-effectiveness ratios that were generally within the willingness-to-pay thresholds of the countries in which the studies were conducted. However, the quality of the studies was generally low. Omission of key cost elements of economic evaluations, including intervention cost and payer perspective, limited interpretability. Conclusion: Interventions to optimize medication use may provide benefits that outweigh their implementation costs, but the evidence remains limited. There is a need to identify and address barriers to the scaling-up of such interventions, starting with the current incentive structures for pharmacists, physicians, and patients.


Assuntos
Múltiplas Afecções Crônicas/tratamento farmacológico , Múltiplas Afecções Crônicas/economia , Polimedicação , Idoso , Análise Custo-Benefício , Humanos , Equipe de Assistência ao Paciente , Farmacêuticos/organização & administração
20.
Compend Contin Educ Dent ; 42(5): 256-257, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33980024

RESUMO

Dental therapists (DTs) have been treating patients in the United States since 2004, and the evidence is unequivocal. DTs provide safe, high-quality, cost-effective care to thousands of patients.1-3 Presently, 12 states have authorized DTs, and an additional eight states are pursuing legislation to bring these professionals to the oral healthcare team.4,5.


Assuntos
Equidade em Saúde , Assistência Odontológica , Acesso aos Serviços de Saúde , Humanos , Saúde Bucal , Equipe de Assistência ao Paciente , Qualidade da Assistência à Saúde , Estados Unidos
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