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2.
J Stroke Cerebrovasc Dis ; 29(2): 104552, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31839545

RESUMO

BACKGROUND AND AIM: Performance measures have been extensively studied for acute ischemic stroke, leading to guideline-established benchmarks. Factors influencing care efficiency for intracerebral hemorrhage (ICH) are not well delineated. We sought to identify factors associated with early recognition of ICH and to assess the association between early recognition and completion of emergency care tasks. METHODS: Consecutive patients with spontaneous ICH were enrolled in an observational cohort study conducted from 2009 to 2017 at an urban comprehensive stroke center, excluding patient transferred from other hospitals. We used stroke team activation as the indicator of early recognition and measured completion times for multiple ICH-relevant performance metrics including door to computed tomography (CT) acquisition and door to hemostatic medication initiation. RESULTS: We studied 204 cases. All stroke-related performance times were faster in patients managed with stroke team activation compared to no activation, including quicker door to CT acquisition (median 24 versus 48 minutes, P < .001) and door to hemostatic medication initiation (63 versus 99 minutes, P = .005). These associations were confirmed in adjusted models. Stroke codes were activated in 43% of cases and were more likely in patients with shorter onset-to-arrival times, higher National Institutes of Health Stroke Scale scores, and higher Glasgow Coma Scale scores. CONCLUSIONS: Stroke team activation was associated with more rapid diagnostic and therapeutic interventions for patients with ICH, but activation did not occur in the majority of cases, implying absence of early recognition. A stroke team activation process improves care performance, but leveraging the advantages of existing systems will require improved triage tools to identify ICH in the acute setting.


Assuntos
Hemorragia Cerebral/tratamento farmacológico , Serviço Hospitalar de Emergência/normas , Hemostáticos/administração & dosagem , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Tempo para o Tratamento/normas , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/diagnóstico por imagem , Procedimentos Clínicos/normas , Esquema de Medicação , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/normas , Estudos Prospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X/normas , Resultado do Tratamento
3.
J Trauma Acute Care Surg ; 88(2): 266-278, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31464870

RESUMO

BACKGROUND: Elderly patients commonly suffer isolated hip fractures, causing significant morbidity and mortality. The use of orthogeriatrics (OG) management services, in which geriatric specialists primarily manage or co-manage patients after admission, may improve outcomes. We sought to provide recommendations regarding the role of OG services. METHODS: Using GRADE methodology with meta-analyses, the Practice Management Guidelines Committee of the Eastern Association for the Surgery of Trauma conducted a systematic review of the literature from January 1, 1900, to August 31, 2017. A single Population, Intervention, Comparator and Outcome (PICO) question was generated with multiple outcomes: Should geriatric trauma patients 65 years or older with isolated hip fracture receive routine OG management, compared with no-routine OG management, to decrease mortality, improve discharge disposition, improve functional outcomes, decrease in-hospital medical complications, and decrease hospital length of stay? RESULTS: Forty-five articles were evaluated. Six randomized controlled trials and seven retrospective case-control studies met the criteria for quantitative analysis. For critical outcomes, retrospective case-control studies demonstrated a 30-day mortality benefit with OG (OR, 0.78 [0.67, 0.90]), but this was not demonstrated prospectively or at 1 year. Functional outcomes were superior with OG, specifically improved score on the Short Physical Performance Battery at 4 months (mean difference [MD], 0.78 [0.28, 1.29]), and improved score on the Mini Mental Status Examination with OG at 12 months (MD, 1.57 [0.40, 2.73]). Execution of activities of daily living was improved with OG as measured by two separate tests at 4 and 12 months. There was no difference in discharge disposition. Among important outcomes, the OG group had fewer hospital-acquired pressure ulcers (OR, 0.30 [0.15, 0.60]). There was no difference in other complications or length of stay. Overall quality of evidence was low. CONCLUSION: In geriatric patients with isolated hip fracture, we conditionally recommend an OG care model to improve patient outcomes. LEVEL OF EVIDENCE: Systematic review/meta-analysis, level III.


Assuntos
Geriatria/normas , Fraturas do Quadril/terapia , Ortopedia/normas , Equipe de Assistência ao Paciente/normas , Guias de Prática Clínica como Assunto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Avaliação Geriátrica , Geriatria/métodos , Fraturas do Quadril/mortalidade , Humanos , Ortopedia/métodos , Sociedades Médicas/normas , Padrão de Cuidado , Traumatologia/normas , Resultado do Tratamento
4.
J Surg Res ; 246: 614-622, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30528925

RESUMO

BACKGROUND: The World Health Organization's (WHO) surgical safety checklist is meant to be customized to facilitate local implementation, encourage full-team participation, and promote a culture of safety. Although it has been globally adopted, little is known about the extent of checklist modification and the type of changes made. METHODS: Nonsubspecialty surgical checklists were obtained through online search and targeted hospital requests. A detailed coding scheme was created to capture modifications to checklist content and formatting. Descriptive statistics were performed. RESULTS: Of 155 checklists analyzed, all were modified. Compared with the WHO checklist, those in our sample contained more lines of text (median: 63 [interquartile range: 50-73] versus 56) and items (36 [interquartile range: 30-43] versus 28). A median of 13 new items were added. Items most frequently added included implants/special equipment (added by 84%), deep vein thrombosis prophylaxis/anticoagulation (added by 75%), and positioning (added by 63%). Checklists removed a median of 5 WHO items. The most frequently removed item was the pulse oximeter check (removed in 75%), followed by 4 items (each removed in 39%-48%) that comprise part of the WHO Checklist's "Anticipated Critical Events" section, which is intended for exchanging critical information. The surgeon was not explicitly mentioned in the checklist in 12%; the anesthesiologist/certified registered nurse anesthetist in 14%, the circulator in 10%, and the surgical tech/scrub in 79%. CONCLUSIONS: Checklists are highly modified but often enlarged with items that may not prompt discussion or teamwork. Of concern is the frequent removal of items from the WHO's "Anticipated Critical Events" section.


Assuntos
Lista de Checagem/normas , Relações Interprofissionais , Salas Cirúrgicas/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Segurança do Paciente/normas , Erros Médicos/prevenção & controle , Salas Cirúrgicas/normas , Equipe de Assistência ao Paciente/normas , Organização Mundial da Saúde
5.
J Nurs Adm ; 50(1): 5-8, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31809450

RESUMO

OBJECTIVE: To describe the impact of a standardized rounding process on rounding time and multidisciplinary member attendance. BACKGROUND: Rounding efficiency and effectiveness are often compromised by lack of standardization of important elements including start time and location, the attendance of multidisciplinary representatives, patient presentation highlights, and physician workflow. In 2017, the study authors noted inefficiencies and process failures in multidisciplinary rounds within our ICU. METHODS: We conducted a retrospective review of rounding data before and after the implementation of a simplified and streamlined rounding template for ICU nurses and measures to standardize rounding processes and attendance. RESULTS: Rounding time was decreased by 25% in postimplementation phase. Additionally, attendance of respiratory therapists, clinical dietitians, and case managers improved. CONCLUSIONS: We suggest the piloting of these strategies in other ICUs that experience similar inefficiencies and process failures during multidisciplinary rounds.


Assuntos
Estado Terminal , Enfermeiras Administradoras , Equipe de Assistência ao Paciente/normas , Visitas com Preceptor/normas , Fluxo de Trabalho , Humanos , Unidades de Terapia Intensiva , Estudos Retrospectivos
6.
Thorac Surg Clin ; 30(1): 111-120, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761279

RESUMO

Nonintubated thoracic surgery arose as supplemental evolution of minimally invasive surgery and is gaining popularity. A proper nonintubated thoracic surgery unit is mandatory and should involve surgeons, anesthesiologists, intensive care physicians, physiotherapists, psychologists, and scrub and ward nurses. Surgical training should involve experienced and young surgeons. It deserves a step-by-step approach and consolidated experience on video-assisted thoracic surgery. Due to difficulty in reproducing lung and diaphragm movements, training with simulation systems may be of scant value; instead, preceptorships and invited proctorships are useful. Preoperatively, patients must be fully informed. Effective intraoperative communication with patients and among the surgical team is pivotal.


Assuntos
Equipe de Assistência ao Paciente , Preceptoria , Cirurgia Torácica Vídeoassistida , Humanos , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Preceptoria/métodos , Preceptoria/organização & administração , Cirurgia Torácica Vídeoassistida/educação , Cirurgia Torácica Vídeoassistida/métodos
7.
Medicine (Baltimore) ; 98(49): e18201, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804343

RESUMO

BACKGROUND: Leadership and teamwork are important contributory factors in determining cardiac resuscitation performance and clinical outcome. We aimed to determine whether fixed positioning of the resuscitation team leader (RTL) relative to the patient influences leadership qualities during cardiac resuscitation using simulation. METHODS: A cross-sectional randomized intervention study over 12 months' duration was conducted in university hospital simulation lab. ACLS-certified medical doctors were assigned to run 2 standardized simulated resuscitation code as RTL from a head-end position (HEP) and leg-end position (LEP). They were evaluated on leadership qualities including situational attentiveness (SA), errors detection (ED), and decision making (DM) using a standardized validated resuscitation-code-checklist (RCC). Performance was assessed live by 2 independent raters and was simultaneously recorded. RTL self-perceived performance was compared to measured performance. RESULTS: Thirty-four participants completed the study. Mean marks for SA were 3.74 (SD ±â€Š0.96) at HEP and 3.54 (SD ±â€Š0.92) at LEP, P = .48. Mean marks for ED were 2.43 (SD ±â€Š1.24) at HEP and 2.21 (SD ±â€Š1.14) at LEP, P = .40. Mean marks for DM were 4.53 (SD ±â€Š0.98) at HEP and 4.47 (SD ±â€Š0.73) at LEP, P = .70. The mean total marks were 10.69 (SD ±â€Š1.82) versus 10.22 (SD ±â€Š1.93) at HEP and LEP respectively, P = .29 which shows no significance difference in all parameters. Twenty-four participants (71%) preferred LEP for the following reasons, better visualization (75% of participants); more room for movement (12.5% of participants); and better communication (12.5% of participants). RTL's perceived performance did not correlate with actual performance CONCLUSION:: The physical position either HEP or LEP appears to have no influence on performance of RTL in simulated cardiac resuscitation. RTL should be aware of the advantages and limitations of each position.


Assuntos
Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/normas , Liderança , Equipe de Assistência ao Paciente/normas , Postura , Melhoria de Qualidade , Adulto , Lista de Checagem , Estudos Transversais , Tomada de Decisões , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Malásia , Masculino , Projetos Piloto , Treinamento por Simulação , Inquéritos e Questionários , Gravação em Vídeo
8.
Rozhl Chir ; 98(10): 414-417, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31842572

RESUMO

INTRODUCTION: Multidisciplinary teams (MDTs) have become a standard part of treating oncological patients. Based on the available data, they have lead to significantly higher survival rates in the treatment of colorectal cancer (CRC). Reported negatives include potentially longer times between diagnoses and the start of appropriate treatment, and the lack of quality controls over the MTDs actions. This report aims to assess the benefits of MDTs using our own data set for 2017. METHODS: Year 2010 saw the institution of an MDT at the Central Military University Hospital in Prague, with the obligation to refer CRC patients to the MDT before the start of treatment. Having standardized the registration, we have implemented a simple procedure to track the quality of our MDTs involvement and its patient benefits: number of patients, number of referrals with proposed diagnostic and therapeutic procedure, frequency and reason of changes to original strategies, and the frequency of variations from the MDTs conclusions. RESULTS: 405 CRC patients were referred to the MDT in 2017; we have found 499 referrals in this group. The data set was formed predominantly by men (61%), with the mean age of 63 (21-91), and the median age of 64.5 years. Surgical treatment was the most commonly proposed procedure (59%), followed by systemic treatment or, as the case may be, radiotherapy. In 24% of the cases, the conclusion did not match the originally proposed procedure. The decision not to go through with the proposed surgical treatment was the most common change (66 %). We have found a difference in the quality of referral in patients examined specifically by the referring doctor, as opposed to patients whose medical records have just been sent in. We have found therapeutic variation in the MTDs conclusions in less than 5% of patients. CONCLUSION: Having analyzed our data for CRC patients referred to the MDT in 2017, we have found out that in 24% of the patients, the MDT referral leads to a change in the originally proposed diagnostic and therapeutic procedure. Consensus among the MDTs members on the CRC patients treatment guarantees an optimum procedure. What is fundamental is that the referring doctor knows the patient. Constant tracking of the MDTs outputs forms a condition for sustaining the quality of its work and a base for assessing its benefits to the patients.


Assuntos
Neoplasias Colorretais/terapia , Equipe de Assistência ao Paciente/normas , Qualidade da Assistência à Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
BMC Health Serv Res ; 19(1): 819, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703670

RESUMO

BACKGROUND: The Transmural Trauma Care Model (TTCM) is a refined post-clinical rehabilitation approach, in which a multidisciplinary hospital-based team guides a network of primary care physical therapists in the treatment of trauma patients. The objective of this study was to assess the effectiveness of the TTCM compared to regular care. METHODS: A controlled-before-and-after study was performed in a level 1 trauma center. The TTCM includes four elements: 1) a multidisciplinary team at the outpatient clinic, 2) coordination and individual goal setting for each patient by this team, 3) a network of primary care physical therapists, 4) E-health support for transmural communication. Intervention group patients were prospectively followed (3, 6 and 9 months). The control group consisted of 4 clusters of patients who either had their first consultation at the outpatient clinic 0, 3, 6 or 9 months ago. Outcomes included generic- and disease-specific health-related quality of life (HR-QOL), pain, functional status, patient satisfaction, and perceived recovery. Between-group comparisons were made using linear regression analyses. The recovery pattern of intervention group patients was identified using longitudinal data analysis methods. RESULTS: A total of 83 participants were included in the intervention group. In the control group, 202 participants were included (68 in the baseline cluster, 26 in the 3-month cluster, 51 in the 6-month cluster, 57 in the 9-month cluster). Between-group differences were statistically significant in favor of the intervention group for disease-specific HR-QOL at 9 months, pain at 6 and 9 months, functional status at 6 and 9 months, patient satisfaction at 3, 6 and 9 months, and perceived recovery at 6 months. No significant differences were found between groups for generic HR-QOL at any time point. Generic HR-QOL, disease-specific HR-QOL, pain, and functional status significantly improved in a linear fashion among intervention group patients during the nine-month follow-up period. CONCLUSIONS: This study provides preliminary evidence that the TTCM is effective in improving patient related outcome measures, such as disease-specific HR-QOL, pain and functional status. A multicenter, and ideally randomized controlled trial, is required to confirm these results. TRIAL REGISTRATION: The trial is registered at the Dutch Trial Register (NTR5474). Registered 12 October 2015. Retrospectively registered.


Assuntos
Satisfação do Paciente , Modalidades de Fisioterapia/normas , Ferimentos e Lesões/reabilitação , Adulto , Estudos Controlados Antes e Depois , Feminino , Metas , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Medidas de Resultados Relatados pelo Paciente , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Prospectivos , Melhoria de Qualidade , Qualidade de Vida , Estudos Retrospectivos , Centros de Traumatologia/normas
10.
Spine (Phila Pa 1976) ; 44(23): E1396-E1400, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31725688

RESUMO

STUDY DESIGN: Observational simulation study. OBJECTIVE: The goal of this study was to investigate the relationship between technical and nontechnical skills (NTS) in a simulated surgical procedure. SUMMARY OF BACKGROUND DATA: Although surgeons' technical and NTS during surgery are crucial determinants for clinical outcomes, little literature is available in spine surgery. Moreover, evidence regarding how surgeons' technical and NTS are related is limited. METHODS: A mixed-reality and full-scale simulated operating room environment was employed for the surgical team. Eleven surgeons performed the vertebroplasty procedure (VP). Technical skills (TS) were assessed using Objective Structured Assessment of Technical Skill scores and senior expert-evaluated VP outcome assessment. NTS were assessed with the Observational Teamwork Assessment for Surgery. Kendall-Tau-b tests were performed for correlations. We further controlled the influence of surgeons' experience (based on professional tenure and number of previous VPs performed). RESULT: Surgeons' NTS correlated significantly with their technical performance (τ = 0.63; P = 0.006) and surgical outcome scores (τ = 0.60; P = 0.007). This association was attenuated when controlling for surgeons' experience. CONCLUSION: Our results suggest that spine surgeons with higher levels of TS also apply better communication, leadership, and coordination behaviors during the procedure. Yet, the role of surgeons' experience needs further investigation for improving surgeons' intraoperative performance during spine surgery. LEVEL OF EVIDENCE: 3.


Assuntos
Competência Clínica/normas , Salas Cirúrgicas/métodos , Salas Cirúrgicas/normas , Cirurgiões/normas , Comunicação , Humanos , Liderança , Equipe de Assistência ao Paciente/normas , Projetos Piloto
11.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31740501

RESUMO

This technical report reviews education, training, competency requirements, and scopes of practice of the different neonatal care providers who work to meet the special needs of neonatal patients and their families in the NICU. Additionally, this report examines the current workforce issues of NICU providers, offers suggestions for establishing and monitoring quality and safety of care, and suggests potential solutions to the NICU provider workforce shortages now and in the future.


Assuntos
Competência Clínica/normas , Pessoal de Saúde/normas , Mão de Obra em Saúde/normas , Unidades de Terapia Intensiva Neonatal/normas , Equipe de Assistência ao Paciente/normas , Feminino , Pessoal de Saúde/educação , Humanos , Recém-Nascido , Doenças do Recém-Nascido/terapia , Masculino
12.
J Cardiovasc Med (Hagerstown) ; 20(7): 414-418, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31593558

RESUMO

: The 2015 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis recommend the use of a multidisciplinary team in the care of patients with infective endocarditis. A standardized collaborative approach should be implemented in centres with immediate access to different imaging techniques, cardiac surgery and health professionals from several specialties. This position paper has been produced by the Task Force for Management of Infective Endocarditis of Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) with the aim of providing recommendations for the implementation of the Endocarditis Team within the Italian hospital network. On the basis of the Italian hospital network with many cardiology facilities encompassing a total of 405 intensive cardiac care units (ICCUs) across the country, 224 (3.68 per million inhabitants) of which have on-site 24-h PCI capability, but with relatively few centres equipped with cardiac surgery and nuclear medicine, in the present article, the SIECVI Task Force for Management of Infective Endocarditis develops the idea of a network where 'functional' reference centres act as a link with the periphery and with 'structural' reference centres. A number of minimum characteristics are provided for these 'functional' reference centres. Outcome and cost analysis of implementing an Endocarditis Team with functional referral is expected to be derived from ongoing Italian and European registries.


Assuntos
Técnicas de Imagem Cardíaca/normas , Serviço Hospitalar de Cardiologia/normas , Prestação Integrada de Cuidados de Saúde/normas , Endocardite/diagnóstico por imagem , Endocardite/terapia , Equipe de Assistência ao Paciente/normas , Regionalização/normas , Consenso , Humanos , Comunicação Interdisciplinar , Valor Preditivo dos Testes , Resultado do Tratamento
13.
N Z Med J ; 132(1502): 11-15, 2019 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-31563923

RESUMO

AIM: To define the range and severity of cardiac disease in pregnant women in New Zealand, as well as the maternal and neonatal morbidity and mortality compared with the background obstetric population. METHODS: We retrospectively audited pregnant women with cardiac comorbidity seen by a multidisciplinary team at a tertiary referral centre consisting of midwives, cardiologists, obstetricians and anaesthetists in 2016-2017. RESULTS: Seventy-two women were referred to the multidisciplinary team. The most common referral reasons were arrhythmia (n=20, 27.8%), congenital anomalies (n=19, 26.4%) and palpitations (n=10, 13.9%). Fifty-two of these women were found to be at increased risk of morbidity or mortality. A specific delivery plan was devised for 37 of these women (69.8%). There was no serious maternal morbidity or mortality. Instrumental delivery rates were higher for women with cardiac comorbidity than the background obstetric population (19.2% vs 10.8%, p=0.049), however, neonatal admissions were not increased (11.5% compared with 16.5%). CONCLUSION: Multidisciplinary review of obstetric patients with cardiac disease provides an important service to ensure risk modification prior to conception and throughout pregnancy and the puerperium.


Assuntos
Efeitos Psicossociais da Doença , Parto Obstétrico , Planejamento de Assistência ao Paciente/normas , Equipe de Assistência ao Paciente/normas , Complicações Cardiovasculares na Gravidez , Adulto , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Nova Zelândia/epidemiologia , Gravidez , Complicações Cardiovasculares na Gravidez/classificação , Complicações Cardiovasculares na Gravidez/etnologia , Complicações Cardiovasculares na Gravidez/terapia , Resultado da Gravidez/epidemiologia , Melhoria de Qualidade , Estudos Retrospectivos , Fatores de Risco , Atenção Terciária à Saúde/métodos , Atenção Terciária à Saúde/organização & administração
14.
Curr Urol Rep ; 20(10): 59, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31478111

RESUMO

PURPOSE OF REVIEW: The purpose of this review is to summarize the most current literature regarding the most important aspects to consider when developing a center of excellence for prostate imaging and biopsy. RECENT FINDINGS: Multiparametric MRI (mp-MRI) has changed the way we diagnose and treat prostate cancer. This imaging modality allows for more precise identification of areas suspicious in terms of harboring prostate cancer, enabling performance of targeted mp-MRI-guided biopsies that have been demonstrated to yield superior cancer detection rates. Centers worldwide are increasingly adopting this technology. However, obtaining results comparable with those findings published in the literature can be challenging. The imaging and biopsy process entails the need for a multidisciplinary team including a dedicated radiologist, urologist, and pathologist. Adequate mp-MRI interpretation for accurate lesion identification, acquaintance with the biopsy technique selected, and precise characterization of Gleason Score/Grade Groupings are equal determinants of accurate biopsy results. Furthermore, all specialists are required to attain appropriate learning curves to ensure optimal results. In this review, we characterize crucial aspects to consider when developing a center of excellence for prostate imaging and biopsy as well as insights regarding how to implement them.


Assuntos
Instalações de Saúde/normas , Biópsia Guiada por Imagem/normas , Imagem por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico por imagem , Biópsia/métodos , Biópsia/normas , Humanos , Biópsia Guiada por Imagem/métodos , Curva de Aprendizado , Masculino , Gradação de Tumores , Equipe de Assistência ao Paciente/normas , Desenvolvimento de Programas/normas , Neoplasias da Próstata/patologia , Estados Unidos
15.
BMC Health Serv Res ; 19(1): 613, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470853

RESUMO

BACKGROUND: The aim was to determine the feasibility of implementing a patient safety survey which measures patients' experiences of their own safety relating to a care transition. This included limited-efficacy testing, determining acceptability (to patients and staff), and investigating integration with existing systems and practices from the staff perspective. METHODS: Mixed methods study in 16 wards across four hospitals, from two English NHS Trusts and four clinical areas; cardiology, care of older people, orthopaedics, stroke. Limited-efficacy testing of a previously validated survey was conducted through collection of patient reports of safety experiences, and thematic comparison with staff safety incident reports. Patient acceptability was determined through analysis of survey response rates and semi-structured interviews. Staff acceptability and integration were investigated through analysis of survey distribution rates, semi-structured interviews and focus groups. RESULTS: Patients returned 366 valid surveys (16.4% response rate) from 2824 distributed surveys (25.1% distribution rate). Older age was a contributing factor to lower responses. Delays were the largest safety concern for patients. Staff incident report themes included five not present in the safety survey data (documentation, pressure ulcers, devices or equipment, staffing shortages, and patient actions). Patient interviews (n = 28) identified that providing feedback was acceptable, subject to certain conditions being met; cognitive-cultural (patient understanding and prioritisation of safety), structural-procedural (opportunities, means and ease of providing feedback without fear of reprisals), and learning and change (closure of the feedback loop). Staff (n = 21) valued patient feedback but barriers to collecting and using the feedback included resource limitations, staff turnover and reluctance to over-burden patients. CONCLUSIONS: Patients can provide meaningful feedback on their experiences and perceptions of safety in the context of care transitions. Providing this feedback was acceptable to some patients, subject to certain conditions being met. Safety experience feedback from patients was also acceptable to staff; quantitative data was perceived as useful to identify potential risks, and qualitative data informed types of changes required to improve care. However, patient feedback was not integrated into any quality improvement initiatives, suggesting there are still significant challenges to healthcare teams or organisations utilising patient feedback, particularly in relation to care transitions.


Assuntos
Segurança do Paciente/normas , Transferência de Pacientes/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Inglaterra , Estudos de Viabilidade , Retroalimentação , Feminino , Grupos Focais , Hospitais/normas , Humanos , Aprendizagem , Masculino , Pessoa de Meia-Idade , Cultura Organizacional , Equipe de Assistência ao Paciente/normas , Participação do Paciente , Pacientes , Melhoria de Qualidade , Gestão de Riscos , Medicina Estatal/normas , Inquéritos e Questionários , Adulto Jovem
16.
Am J Occup Ther ; 73(5): 7305185010p1-7305185010p10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484020

RESUMO

IMPORTANCE: Leaders in the occupational therapy profession have called for occupational therapy's inclusion in primary care, but little is known about the occupational needs of patients in this setting. OBJECTIVE: To explore the need for and potential role of occupational therapy in a team-based primary care clinic. DESIGN: A qualitative descriptive study using a convenience sample of clinicians and patients. Meetings and semistructured interviews were recorded, transcribed, and coded by multiple coders using a general immersion-crystallization approach to identify relevant themes. SETTING: Outpatient complex care clinic of an urban academic medical center. PARTICIPANTS: The study included a voluntary sample of clinicians and patients from the complex care clinic. Patients were recruited from a staff-provided list; eligible patients had attended the clinic for at least 1 yr. All patients had multiple chronic conditions and were uninsured or received Medicaid. RESULTS: Researchers attended 10 clinician team meetings and conducted 13 patient interviews and 10 clinician interviews. Four domains of patient need were identified by both patients and clinicians: complex medical management, patients' limited resources, mental health needs, and challenges to occupation. Clinicians also identified cognitive-behavioral challenges affecting care, including lack of engagement and poor problem solving. CONCLUSIONS AND RELEVANCE: The makeup of the clinic team reflected their intent to address medical, socioeconomic, and mental health domains. However, cognitive-behavioral challenges and patients' occupational limitations were not consistently addressed. Thus, patients had unmet needs that occupational therapy practitioners were qualified to address. WHAT THIS ARTICLE ADDS: This study adds to the available literature examining patient needs and clinician challenges in a primary care clinic. Patients have occupational needs that are not being addressed in primary care, indicating a need for occupational therapy in this setting.


Assuntos
Terapia Ocupacional , Assistência Ambulatorial , Humanos , Equipe de Assistência ao Paciente/normas , Assistência Centrada no Paciente/normas , Atenção Primária à Saúde/normas , Pesquisa Qualitativa
17.
Am J Health Syst Pharm ; 76(18): 1403-1412, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31505561

RESUMO

PURPOSE: Millions of Americans who undergo surgical procedures receive opioid prescriptions as they return home. While some derive great benefit from these medicines, others experience adverse events, convert to chronic opioid use, or have unused medicines that serve as a reservoir for potential nonmedical use. Our aim was to investigate concepts and methods relevant to optimal opioid prescribing and pain treatment in the perioperative period. METHODS: We reviewed existing literature for trials on factors that influence opioid prescribing and optimization of pain treatment for surgical procedures and generated a conceptual framework to guide future quality, safety, and research efforts. RESULTS: Opioid prescribing and pain treatment after discharge from surgery broadly consist of 3 key interacting perspectives, including those of the patient, the perioperative team, and, serving in an essential role for all patients, the pharmacist. Systems-based factors, ranging from the organizational environment's ability to provide multimodal analgesia and participation in enhanced recovery after surgery programs to other healthcare system and macro-level trends, shape these interactions and influence opioid-related safety outcomes. CONCLUSIONS: The severity and persistence of the opioid crisis underscore the urgent need for interventions to improve postoperative prescription opioid use in the United States. Such interventions are likely to be most effective, with the fewest unintended consequences, if based on sound evidence and built on multidisciplinary efforts that include pharmacists, nurses, surgeons, anesthesiologists, and the patient. Future studies have the potential to identify the optimal amount to prescribe, improve patient-focused safety and quality outcomes, and help curb the oversupply of opioids that contributes to the most pressing public health crisis of our time.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/normas , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Procedimentos Cirúrgicos Operatórios/efeitos adversos , /normas , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Humanos , Conduta do Tratamento Medicamentoso/organização & administração , Conduta do Tratamento Medicamentoso/normas , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Manejo da Dor/normas , Dor Pós-Operatória/etiologia , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Alta do Paciente , Segurança do Paciente , Assistência Perioperatória/métodos , Assistência Perioperatória/normas , Farmacêuticos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Estados Unidos/epidemiologia
18.
Presse Med ; 48(7-8 Pt 1): 780-787, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31383383

RESUMO

Interprofessional simulation-based education is effective for learning non-technical critical care skills and strengthening interprofessional team collaboration to optimize quality of care and patient outcome. Implementation of interprofessional simulation sessions in initial and continuing education is facilitated by a team of "champions" from each discipline/profession to ensure educational quality and logistics. Interprofessional simulation training must be integrated into a broader interprofessional curriculum supported by managers, administrators and clinical colleagues from different professional programs. When conducting interprofessional simulation training, it is essential to account for sociological factors (hierarchy, power, authority, interprofessional conflicts, gender, access to information, professional identity) both in scenario design and debriefing. Teamwork assessment tools in interprofessional simulation training may be used to guide debriefing. The interprofessional simulation setting (in-situ or simulation centre) will be chosen according to the learning objectives and the logistics.


Assuntos
Cuidados Críticos/métodos , Educação Médica/métodos , Relações Interprofissionais , Equipe de Assistência ao Paciente , Treinamento por Simulação , Competência Clínica , Cuidados Críticos/normas , Currículo/normas , Educação Médica/normas , Avaliação Educacional/métodos , Humanos , Ciência da Implementação , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Treinamento por Simulação/métodos , Treinamento por Simulação/organização & administração , Treinamento por Simulação/normas
19.
Rev Lat Am Enfermagem ; 27: e3167, 2019 Aug 19.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31432920

RESUMO

OBJECTIVE: analyze the safety culture of multidisciplinary teams from three neonatal intensive care units of public hospitals in Minas Gerais, Brazil. METHOD: a cross-sectional survey conducted with 514 health professionals, using the Hospital Survey on Patient Safety Culture; data were subjected to a descriptive statistical analysis in software R-3.3.2. RESULTS: the findings showed that none of the dimensions had a positive response score above 75% to be considered as a strength area. The dimension 'Nonpunitive response to error' was classified as a critical area of the patient safety culture, present in 55.45% of the responses. However, areas with potential for improvements were identified, such as 'Teamwork within units' (59.44%) and 'Supervisor/manager's expectations and actions to promote patient safety' (49.90%). CONCLUSION: none of the dimensions was considered as a strength area, which indicates safety culture has not been fully implemented in the evaluated units. A critical look at the weaknesses of the patient safety process is recommended in order to seek strategies for the adoption of a positive safety culture to benefit patients, family members and health professionals.


Assuntos
Hospitais Públicos/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Gestão da Segurança/estatística & dados numéricos , Adulto , Brasil , Estudos Transversais , Feminino , Hospitais Públicos/normas , Humanos , Unidades de Terapia Intensiva Neonatal/normas , Masculino , Cultura Organizacional , Equipe de Assistência ao Paciente/normas , Segurança do Paciente/normas , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Gestão da Segurança/normas , Estatísticas não Paramétricas , Inquéritos e Questionários , Fatores de Tempo , Carga de Trabalho/estatística & dados numéricos , Adulto Jovem
20.
World J Gastroenterol ; 25(27): 3484-3502, 2019 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-31367152

RESUMO

The peritoneum is a common site of dissemination for colorrectal cancer, with a poorer prognosis than other sites of metastases. In the last two decades, it has been considered as a locoregional disease progression and treated as such with curative intention treatments. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the actual reference treatment for these patients as better survival results have been reached as compared to systemic chemotherapy alone, but its therapeutic efficacy is still under debate. Actual guidelines recommend that the management of colorectal cancer with peritoneal metastases should be led by a multidisciplinary team carried out in experienced centers and consider CRS + HIPEC for selected patients. Accumulative evidence in the last three years suggests that this is a curative treatment that may improve patients disease-free survival, decrease the risk of recurrence, and does not increase the risk of treatment-related mortality. In this review we aim to gather the latest results from referral centers and opinions from experts about the effectiveness and feasibility of CRS + HIPEC for treating peritoneal disease from colorectal malignancies.


Assuntos
Quimioterapia do Câncer por Perfusão Regional/normas , Neoplasias Colorretais/terapia , Procedimentos Cirúrgicos de Citorredução/normas , Hipertermia Induzida/normas , Neoplasias Peritoneais/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/normas , Quimioterapia Adjuvante/métodos , Quimioterapia Adjuvante/normas , Quimioterapia do Câncer por Perfusão Regional/métodos , Ensaios Clínicos como Assunto , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Intervalo Livre de Doença , Estudos de Viabilidade , Humanos , Hipertermia Induzida/métodos , Metanálise como Assunto , Equipe de Assistência ao Paciente/normas , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/secundário , Peritônio/patologia , Peritônio/cirurgia , Guias de Prática Clínica como Assunto , Prognóstico
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