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1.
PLoS One ; 16(6): e0252892, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34086823

RESUMO

The magnitude and nature of the COVID-19 pandemic prevents public health policies from relying on coercive enforcement. Practicing social distancing, wearing masks and staying at home becomes voluntary and conditional on the behavior of others. We present the results of a large-scale survey experiment in nine countries with representative samples of the population. We find that both empirical expectations (what others do) and normative expectations (what others approve of) play a significant role in compliance, beyond the effect of any other individual or group characteristic. In our vignette experiment, respondents evaluate the likelihood of compliance with social distancing and staying at home of someone similar to them in a hypothetical scenario. When empirical and normative expectations of individuals are high, respondents' evaluation of the vignette's character's compliance likelihood goes up by 55% (relative to the low expectations condition). Similar results are obtained when looking at self-reported compliance among those with high expectations. Our results are moderated by individuals' trust in government and trust in science. Holding expectations high, the effect of trusting science is substantial and significant in our vignette experiment (22% increase in compliance likelihood), and even larger in self-reported compliance (76% and 127% increase before and after the lockdown). By contrast, trusting the government only generates modest effects. At the aggregate level, the country-level trust in science, and not in government, becomes a strong predictor of compliance.


Assuntos
Pesquisa Biomédica , COVID-19/epidemiologia , Fidelidade a Diretrizes , Motivação , Pandemias , Política Pública , Quarentena , SARS-CoV-2 , Confiança , Adulto , COVID-19/prevenção & controle , Feminino , Governo , Humanos , Masculino
2.
BMC Musculoskelet Disord ; 22(1): 507, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34074285

RESUMO

CONTEXT: Many clinical practice guidelines have been developed for the management of musculoskeletal disorders (MSDs). However, there is a gap between evidence-based knowledge and clinical practice, and reasons are poorly understood. Understanding why healthcare providers use clinical practice guidelines is essential to improve their implementation, dissemination, and adherence. AIM: To identify determinants of clinical practice guidelines' utilization by health care providers involved in the assessment and management of MSDs. METHOD: A scoping review of the literature was conducted. Three databases were searched from inception to March 2021. Article identification, study design, methodological quality, type of healthcare providers, MSDs, barriers and facilitators associated with guidelines' utilization were extracted from selected articles. RESULTS: 8671 citations were retrieved, and 43 articles were selected. 51% of studies were from Europe, and most were quantitative studies (64%) following a cross-sectional design (88%). Almost 80% of articles dealt with low back pain guidelines, and the most studied healthcare providers were general practitioners or physiotherapists. Five main barriers to guideline utilization were expressed by providers: 1) disagreement between recommendations and patient expectations; 2) guidelines not specific to individual patients; 3) unfamiliarity with "non-specific" term, or with the bio psychosocial model of MSDs; 4) time consuming; and 5) heterogeneity in guideline methods. Four main facilitators to guideline utilization were cited: 1) clinician's interest in evidence-based practice; 2) perception from clinicians that the guideline will improve triage, diagnosis and management; 3) time efficiency; and 4) standardized language. CONCLUSION: Identifying modifiable determinants is the first step in developing implementation strategies to improve guideline utilization in clinical practice.


Assuntos
Clínicos Gerais , Doenças Musculoesqueléticas , Estudos Transversais , Europa (Continente) , Fidelidade a Diretrizes , Humanos , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/epidemiologia , Doenças Musculoesqueléticas/terapia
3.
Int J Prison Health ; ahead-of-print(ahead-of-print)2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-34089577

RESUMO

PURPOSE: This paper examines prison services and how they can be managed to uphold COVID-19 prevention etiquettes, in light of the contemporary rise in COVID-19 cases across the sub-Saharan Africa continent and the world at large. DESIGN/METHODOLOGY/APPROACH: An extensive review of existing literature on COVID-19 was conducted to ascertain the nature of the pandemic in prisons in sub-Saharan Africa. FINDINGS: In line with empirical observations, the paper recommends regular disinfection of prisons and correctional facilities on the sub-continent. Again, there is the need for countries to resort to alternative punitive measures other than imprisonment, to curb the issue of overcrowding in prisons. Furthermore, there is the need for national governments to build ultramodern prison facilities, which would make room for emergency situations, as well as make provision for any future rise in the number of inmates while, at the same time, meeting fundamental needs as peculiar to prisoners. Finally, medical units in prisons need to be well-equipped against contemporary rise in COVID-19 cases. ORIGINALITY/VALUE: The authors hereby declare that this submission is their handmade which has not been submitted to any other journal outlet.


Assuntos
COVID-19 , Pandemias/prevenção & controle , Prisões , África ao Sul do Saara , Fidelidade a Diretrizes , Humanos , SARS-CoV-2
4.
Bone Joint J ; 103-B(5): 881-887, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33934649

RESUMO

AIMS: The aim of this study was to determine whether national standards of best practice are associated with improved health-related quality of life (HRQoL) outcomes in hip fracture patients. METHODS: This was a multicentre cohort study conducted in 20 acute UK NHS hospitals treating hip fracture patients. Patients aged ≥ 60 years treated operatively for a hip fracture were eligible for inclusion. Regression models were fitted to each of the "Best Practice Tariff" indicators and overall attainment. The impact of attainment on HRQoL was assessed by quantifying improvement in EuroQol five-dimension five-level questionnaire (EQ-5D-5L) from estimated regression model coefficients. RESULTS: A total of 6,532 patients provided both baseline and four-month EQ-5D-5L, of whom 1,060 participants had died at follow-up. Best practice was achieved in the care of 57% of participants; there was no difference in age, cognitive ability, and mobility at baseline for the overall attainment and non-attainment groups. Attaining at least 'joint care by surgeon and orthogeriatrician', 'delirium assessment', and 'falls assessment' was associated with a large, clinically relevant increase in four months EQ-5D-5L of 0.094 (bootstrapped 95% confidence interval (CI) 0.046 to 0.146). CONCLUSION: National standards with enhanced remuneration in hip fracture care results in improvement in individual patients' HRQoL. Cite this article: Bone Joint J 2021;103-B(5):881-887.


Assuntos
Fraturas do Quadril/cirurgia , Qualidade de Vida , Reembolso de Incentivo , Idoso , Idoso de 80 Anos ou mais , Feminino , Fidelidade a Diretrizes , Fraturas do Quadril/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Reino Unido/epidemiologia
5.
BMC Infect Dis ; 21(1): 420, 2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-33947338

RESUMO

BACKGROUND: The Hawthorne Effect is the change in behaviour by subjects due to their awareness of being observed and is evident in both research and clinical settings as a result of various forms of observation. When the Hawthorne effect exists, it is short-lived, and likely leads to increased productivity, compliance, or adherence to standard protocols. This study is a qualitative component of an ongoing multicentre study, examining the role of Incisional Negative Pressure Wound Therapy after vascular surgery (INVIPS Trial). Here we examine the factors that influence hygiene and the role of the Hawthorne effect on the adherence of healthcare professionals to standard hygiene precautions. METHODS: This is a qualitative interview study, investigating how healthcare professionals perceive the observation regarding hygiene routines and their compliance with them. Seven semi-structured focus group interviews were conducted, each interview included a different staff category and one individual interview with a nurse from the Department for Communicable Disease Control. Additionally, a structured questionnaire interview was performed with environmental services staff. The results were analysed based on the inductive qualitative content analysis approach. RESULTS: The analysis revealed four themes and 12 subthemes. Communication and hindering hierarchy were found to be crucial. Healthcare professionals sought more personal and direct feedback. All participants believed that there were routines that should be adhered to but did not know where to find information on them. Staff in the operating theatre were most meticulous in adhering to standard hygiene precautions. The need to give observers a clear mandate and support their work was identified. The staff had different opinions concerning the patient's awareness of the importance of hygiene following surgery. The INVIPS Trial had mediated the Hawthorne effect. CONCLUSION: The results of this study indicate that the themes identified, encompassing communication, behaviour, rules and routines, and work environment, influence the adherence of healthcare professionals to standard precautions to a considerable extent of which many factors could be mediated by a Hawthorne effect. It is important that managers within the healthcare system put into place an improved and sustainable hygiene care to reduce the rate of surgical site infections after vascular surgery.


Assuntos
Modificador do Efeito Epidemiológico , Pessoal de Saúde , Controle de Infecções/métodos , Procedimentos Cirúrgicos Vasculares , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Higiene
6.
BMC Infect Dis ; 21(1): 454, 2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011263

RESUMO

BACKGROUND: Globally, Coronavirus disease-19 has created unprecedented challenges to public health. Healthcare workers (HCWs) are at risk of COVID-19 because of their profession. There are limited studies conducted in Ethiopia among HCWs regarding their compliance with COVID-19 preventive measures. Therefore, this study intended to assess HCWs' compliance with measures to prevent COVID-19, and its potential determinants in public hospitals in Western Ethiopia. METHODS: A self-administered, multicenter hospital-based cross-sectional survey was proposed to 422 randomly selected HCWs working in seven public hospitals in Western Ethiopia identified as COVID-19 referral centers. Data were entered into Epi Data version 3.1 and analyzed using SPSS version 24. Binary logistic regression was used to identify potential determinants of outcome variables at p-value < 0.05. RESULTS: Out of 422 completed questionnaires, the overall HCWs' compliance with COVID-19 prevention is 22% (n = 404). In multivariate regression analysis, factors such as spending most of caring time at bedside (AOR = 1.94, 95%CI, 1.06-3.55), receiving training on infection prevention/COVID-19 (AOR = 1.86, 95%CI, 1.04-3.33), reading materials on COVID-19 (AOR = 2.04, 95%CI, 1.14-3.63) and having support from hospital management (AOR = 2.09, 95%CI, 1.20-3.64) were found to be significantly associated with COVID-19 preventive measures. Furthermore, inadequate supplies of appropriate personal protective equipment (83.2%), insufficient supportive medications (78.5%), and lack of provision of adequate ventilation (77.7%) were the barriers to COVID-19 prevention most frequently mentioned by participants. CONCLUSION: Our findings highlight HCWs' poor compliance with COVID-19 preventive measures. Providing information and refreshing training to improve the level of healthcare workers' adherence with COVID-19 prevention is as imperative as increasing staff commitment to supply resources necessary to protect HCWs and to reduce healthcare-associated infections transmission of SARS-COV-2.


Assuntos
COVID-19/prevenção & controle , Infecção Hospitalar/prevenção & controle , Pessoal de Saúde/psicologia , Adulto , COVID-19/patologia , COVID-19/virologia , Estudos Transversais , Etiópia , Feminino , Fidelidade a Diretrizes , Pessoal de Saúde/estatística & dados numéricos , Hospitais Públicos , Humanos , Modelos Logísticos , Masculino , SARS-CoV-2/isolamento & purificação , Autorrelato , Inquéritos e Questionários , Adulto Jovem
7.
Pan Afr Med J ; 38: 199, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33995805

RESUMO

Introduction: the current pandemic of coronavirus disease (COVID-19) caused by a novel strain (SARS-CoV-2) is enormous and continues to pose a threat to the lives of people. In Nigeria, as of 21st April 2020, 668 confirmed cases, 22 deaths and 188 recoveries have been reported. Police officers are at the forefront of enforcing advisories to ensure public compliance. However, there is a paucity of data on knowledge, risk perception, and adherence to COVID-19 advisories issued by the Health authorities particularly among the police officers. We, therefore, assessed the knowledge, risk perceptions and adherence to NCDC recommended advisory on COVID-19. Methods: we conducted a two-stage sampling cross-sectional study among different cadres of police officers in Benue State, Nigeria using a pretested, semi-structured, interviewer-administered questionnaire. The results of the study were presented in frequencies and proportions. Chi-square test was used for an association between variables at p-value < 0.05. Results: the mean age of the 305 participants was 39.1 ± 8.4 years and most, 124 (40.7%) of the participants were within age-group 30-39 years, 19 (64.3%.8) were male, 250 (82.0%) were married and 160 (52.5%) had secondary education as the highest qualification. Majority of the participants, 301 (98.7%) have heard about COVID-19 and the commonest source of information was via television/radio, 230 (76.4%). Most participants demonstrate a good knowledge of COVID-19 infection, 302 (99.0%) and positive risk perception of COVID-19, 303 (99.3%) but few demonstrated good adherences on COVID-19 prevention practices, 133 (43.6%). Participants' academic qualification (X2 = 10.98, p = 0.001) and cadre (X2 = 112.5, p = 0.001) were found to be associated with good adherence. Conclusion: while most participants had a good knowledge of COVID-19 transmission dynamics, and positive risk perception about COVID-19, good adherence to public health advisories were low. We recommended periodic training, provision of adequate PPE and personal hand-sanitizers as a strategy to improve adherence.


Assuntos
COVID-19/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Polícia/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Percepção , Saúde Pública , Inquéritos e Questionários , Adulto Jovem
8.
Biomed Res Int ; 2021: 2873859, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33996995

RESUMO

The diagnosis and management of COVID-19 are much dependent on the adherence to standardized protocols. Healthcare workers play a crucial role in the case management of COVID-19 in many institutions. Globally, the disease burden is increasing, and the mortality has reached over 2 041 426 compared with 323 000 in May 2020. In West Africa, the pandemic has shown a slow but steady rise in many countries. Existing protocols and their utilization are best assessed after the occurrence of the index case. General aim. The study assessed the health worker's response to COVID-19 protocols at three designated areas of the in-hospital management care triaging, holding area, and treatment centers. Method. A qualitative design was used to assess the response of healthcare workers with regards to early case detection, infection prevention, risk communication to clients and compliance to protocols. The study conducted observational visits and purposively selected healthcare workers comprising of clinicians, nurses, emergency medical technicians, and laboratory technicians who perform routine duties at the triaging, holding, and treatment centers. A total of 41 observations were made over two weeks. Results. Participants comprised 23 males and 18 females. At all observed units, the case definition was being used to screen attendants presenting, and appropriate categorization of patients was ensured. The use of temperature in screening for COVID-19 at the units was generally adhered to. Only 50% of participants used the prescribed PPEs. The physical distancing between healthcare workers and client and between clients and caregivers were not enforced; however, hand hygiene was practiced. Disinfection of working surfaces and equipment with 0.5% chlorine or 70% alcohol-based rubs were used most of the time. It was observed however that no psychological counselling was given to suspected cases or their relatives. Conclusion. Healthcare workers showed discordant response to different parts of the protocols for COVID-19 especially appropriate distancing. There was an enhanced awareness among healthcare workers and improvement in infection prevention protocols. The study also observed that as the risk of infection increased from triaging to holding area and to treatment centers, the response of healthcare workers to COVID-19 protocols also improved. Risk communication is an essential part of the COVID-19 management strategy. At the treatment centers, healthcare workers adhered to this protocol, whereas it was a major gap at the triaging and holding areas.


Assuntos
COVID-19/psicologia , Fidelidade a Diretrizes/estatística & dados numéricos , Pessoal de Saúde/psicologia , Adulto , COVID-19/terapia , Administração de Caso/tendências , Feminino , Gana/epidemiologia , Higiene das Mãos , Pessoal de Saúde/estatística & dados numéricos , Hospitais Militares , Humanos , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , Pandemias , Equipamento de Proteção Individual , SARS-CoV-2/isolamento & purificação
9.
Medicine (Baltimore) ; 100(18): e25810, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950984

RESUMO

ABSTRACT: Research that focuses on transfers to and from the intensive care unit (ICU) could highlight important patients' safety issues. This study aims to describe healthcare workers' (HCWs) practices involved in patient transfers to or from the ICU.This cross-sectional study was conducted among HCWs during the Saudi Critical Care Society's annual International Conference, April 2017. Responses were assessed using Likert scales and frequencies. Bivariate analysis was used to evaluate the significance of different indicators.Overall, 312 HCWs participated in this study. Regarding transfer to ICUs, the most frequently reported complications were deterioration in respiratory status (51.4%), followed by deterioration in hemodynamic status (46.5%), and missing clinical information (35.5%). Regarding transfers from ICUs to the general ward, the most commonly reported complications were changes in respiratory status (55.6%), followed by incomplete clinical information (37.9%), and change in hemodynamic conditions (29%). The most-used models for communicating transfers were written documents in electronic health records (69.3%) and verbal communication (62.8%). One-fourth of the respondents were not aware of the Situation, Background, Assessment, Recommendation (SBAR) method of patients' handover. Pearson's test of correlation showed that the HCW's perceived satisfaction with their hospital transfer guidelines showed significant negative correlation with their reported transfer-related complications (r = -0.27, P < .010).Hemodynamic and respiratory status deterioration is representing significant adverse events among patients transferred to or from the ICU. Factors controlling the perceived satisfaction of HCWs involved in patients, transfer to and from the ICU need to be addressed, focusing on their compliance to the hospital-wide transfer and handover policies. Quality improvement initiatives could improve patient safety to transfer patients to and from the ICU and minimize the associated adverse events.


Assuntos
Deterioração Clínica , Cuidados Críticos/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Cuidados Críticos/normas , Estado Terminal/terapia , Estudos Transversais , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Transferência da Responsabilidade pelo Paciente/normas , Transferência da Responsabilidade pelo Paciente/estatística & dados numéricos , Transferência de Pacientes/normas , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Arábia Saudita , Inquéritos e Questionários/estatística & dados numéricos
10.
Subst Abus ; 42(2): 220-226, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34010118

RESUMO

Background: We sought to understand the association between heavy alcohol and frequent drug use and non-adherence to recommended social distancing and personal hygiene guidelines for preventing the spread of COVID-19 early in the US pandemic. Methods: A survey was offered on the crowdsourcing platform, Amazon Mechanical Turk (MTurk) during April 2020 (the early days of strict, social distancing restrictions). The study included 1,521 adults ages 18 years and older who resided in the US and were enrolled as MTurk workers, i.e., workers who are qualified by Amazon to complete a range of human interaction tasks, including surveys through the MTurk worker platform. Main predictors included measures of heavy drinking, marijuana, and polysubstance use. The dependent measures were measures of social distancing and personal hygiene, based on guidelines recommended at the time of the survey by the US Centers for Disease Control to prevent the spread of COVID-19. Results: We found consistent negative associations between heavy drinking and drug use and adherence to social distancing and personal hygiene. Additionally, three control variables, age, gender, and race/ethnicity, were significant correlates of adherence to these measures. Conclusions: The findings here are consistent with previous research exploring links between substance use and other adverse health behaviors. Further, the negative association between heavy drinking (five or more drinks in one sitting) and adherence underscore the public health risks entailed with the unrestricted reopening of public drinking establishments.


Assuntos
Alcoolismo/epidemiologia , COVID-19/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Higiene , Abuso de Maconha/epidemiologia , Distanciamento Físico , Saúde Pública , Política Pública , Adolescente , Adulto , Controle de Doenças Transmissíveis , Feminino , Higiene das Mãos/estatística & dados numéricos , Humanos , Masculino , SARS-CoV-2 , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos , Adulto Jovem
11.
J Pak Med Assoc ; 71(2(B)): 713-717, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33941965

RESUMO

Compliance with standard precautions is very important for healthcare workers because studies have shown that it helps in minimising the transmission of infectious diseases and healthcare-associated infections which is directly proportional to the patient cost and stay of the patient in hospitals. As healthcare associated infections increase, the cost and the stay of the patient will increase. Researchers suggest that all healthcare workers need to follow the standard precautions guideline and it can be possible with the help of health education, training, provision of equipment and supervision by the management. Barriers to the compliance identified are lack of education, heavy workload, unavailability of equipment, lack of resources and lack of access to supplies. The lack of education and heavy workload are the major factors faced by the nurses.


Assuntos
Infecção Hospitalar , Fidelidade a Diretrizes , Infecção Hospitalar/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Controle de Infecções , Cooperação do Paciente
12.
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
13.
BMC Infect Dis ; 21(1): 495, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34049512

RESUMO

BACKGROUND: The literature examining healthcare-associated infections (HAI) points to two main problems in conforming to infection prevention and control (IPC) guidelines among healthcare professionals (HP). One is the discrepancy between HPs' behavioral intentions and their implementation in practice. The other refers to how HPs maintain these practices after the intervention stage ends. The method proposed in this study seeks to address both these issues by using the Positive Peviance (PD) approach to focus on the dissemination stage of interventions. The study seeks to offer a method for disseminating 27 PD practices to 135 HPs, among them nurses, nurse assistants and physicians, so as to help them maintain IPC guidelines, offer feedback on the dissemination process and examine the impact of the dissemination stage on changes in their behavior. METHODS: The theoretical model underlying this qualitative research was the Recognition-Primed dDecision (RPD) model, which we implemented in the field of healthcare-associated infections (HAIs). Moreover, we used the Discovery & Action Dialogue (DAD) and Think Aloud (TA) techniques to describe the methodological development of simulations for HPs. Feedback from the HP demonstrators underwent content analysis, while descriptive statistics were used to characterize behavioral changes. RESULTS: HPs' information processing regarding infection prevention shifts from peripheral/automatic processing to intuition and analytical/central processing, turning PD practices into positive norms. The HPs personally experienced finding a solution and made repeated corrections until they overcame the barriers. Most of the HPs (69.4%) reported that the practices were fully implemented, together with additional practices. CONCLUSIONS: Implementation of the dissemination stage indicates that in order for HPs to integrate and assimilate practices that are not in the official guidelines, merely observing simulations is not sufficient. Rather, each staff member must personally carry out the procedures.


Assuntos
Infecção Hospitalar/prevenção & controle , Fidelidade a Diretrizes , Pessoal de Saúde , Controle de Infecções/métodos , Guias de Prática Clínica como Assunto , Normas Sociais , Adulto , Idoso , Continuidade da Assistência ao Paciente/normas , Atenção à Saúde/normas , Feminino , Humanos , Higiene/normas , Masculino , Pessoa de Meia-Idade , Motivação , Pesquisa Qualitativa , Inquéritos e Questionários , Adulto Jovem
14.
BMJ Open ; 11(5): e046685, 2021 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-33972342

RESUMO

OBJECTIVES: To assess an intervention for surgical antibiotic prophylaxis (SAP) improvement within surgical teams focused on addressing barriers and fostering enablers and ownership of guideline compliance. DESIGN: The Queensland Surgical Antibiotic Prophylaxis (QSAP) study was a multicentre, mixed methods study designed to address barriers and enablers to SAP compliance and facilitate engagement in self-directed audit/feedback and assess the efficacy of the intervention in improving compliance with SAP guidelines. The implementation was assessed using a 24-month interrupted time series design coupled with a qualitative evaluation. SETTING: The study was undertaken at three hospitals (one regional, two metropolitan) in Australia. PARTICIPANTS: SAP-prescribing decisions for 1757 patients undergoing general surgical procedures from three health services were included. Six bimonthly time points, pre-implementation and post implementation of the intervention, were measured. Qualitative interviews were performed with 29 clinical team members. SAP improvements varied across site and time periods. INTERVENTION: QSAP embedded ownership of quality improvement in SAP within surgical teams and used known social influences to address barriers to and enablers of optimal SAP prescribing. RESULTS: The site that reported senior surgeon engagement showed steady and consistent improvement in prescribing over 24 months (prestudy and poststudy). Multiple factors, including resource issues, influenced engagement and sites/time points where these were present had no improvement in guideline compliance. CONCLUSIONS: The barriers-enablers-ownership model shows promise in its ability to facilitate prescribing improvements and could be expanded into other areas of antimicrobial stewardship. Senior ownership was a predictor of success (or failure) of the intervention across sites and time periods. The key role of senior leaders in change leadership indicates the critical need to engage other specialties in the stewardship agenda. The influence of contextual factors in limiting engagement clearly identifies issues of resource distributions/inequalities within health systems as limiting antimicrobial optimisation potential.


Assuntos
Antibacterianos , Propriedade , Antibacterianos/uso terapêutico , Austrália , Fidelidade a Diretrizes , Hospitais , Humanos , Queensland
15.
Intern Med J ; 51(5): 780-783, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34047025

RESUMO

Ample evidence supports an association between acute oxygen over-administration and harm. Australian and international guidelines consistently recommend lower oxygen saturation aims in populations with chronic obstructive pulmonary disease (COPD). We assessed adherence to acute oxygen use guidelines and outcomes in hospitalised patients with COPD at a large Australian metropolitan hospital network.


Assuntos
Oxigênio , Doença Pulmonar Obstrutiva Crônica , Austrália/epidemiologia , Fidelidade a Diretrizes , Humanos , Doença Pulmonar Obstrutiva Crônica/terapia
16.
Mayo Clin Proc ; 96(5): 1135-1146, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33958051

RESUMO

OBJECTIVE: To assess longitudinal prescribing patterns for patients undergoing urologic surgery in the nearly 2-year time frame before and after implementation of an evidence-based opioid prescribing guideline to accurately characterize the impact on postoperative departmental practices. PATIENTS AND METHODS: Historical prescribing data for adults who underwent 21 urologic procedures at 3 academic institutions were used to derive a 4-tiered guideline for postoperative opioid prescribing. The guideline was implemented on January 16, 2018, and prescribing patterns including quantity of opioids prescribed (in oral morphine equivalents [OMEs]) and refill rates were compared for opioid-naïve patients undergoing urologic surgery before (January 1, 2016, through January 15, 2018; N=10,649) and after (January 16, 2018, through September 30, 2019; N=9422) guideline implementation. Univariate analysis was performed using Wilcoxon rank sum and χ2 tests. Cochran-Armitage trend tests and interrupted time series analysis were used to test for significance in the change in OMEs prescribed before vs after guideline implementation. RESULTS: The median quantity of opioids decreased from 150 OMEs (interquartile range, 0-225) before guideline implementation to 0 OMEs (interquartile range, 0-90) after guideline implementation (P<.001). Median OMEs decreased significantly in each tier and each of 21 individual procedures. Overall guideline adherence was 90.7% (n=8547). Despite this decrease in OMEs prescribed, post-guideline implementation patients obtained fewer refills than the pre-guideline implementation group (614 [6.5%] vs 999 [9.4%]; P<.001). CONCLUSION: In a multi-institutional follow-up prospective study of adult urologic surgery-specific evidence-based guidelines for postoperative prescribing, we demonstrate sustained reduction in OMEs prescribed secondary to guideline implementation and adherence by our providers.


Assuntos
Analgésicos Opioides/uso terapêutico , Fidelidade a Diretrizes/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica/tendências , Procedimentos Cirúrgicos Urológicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Análise de Séries Temporais Interrompida , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Adulto Jovem
18.
JMIR Public Health Surveill ; 7(4): e25762, 2021 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-33819910

RESUMO

BACKGROUND: Public health campaigns aimed at curbing the spread of COVID-19 are important in reducing disease transmission, but traditional information-based campaigns have received unexpectedly extreme backlash. OBJECTIVE: This study aimed to investigate whether customizing of public service announcements (PSAs) providing health guidelines to match individuals' identities increases their compliance. METHODS: We conducted a within- and between-subjects, randomized controlled cross-sectional, web-based study in July 2020. Participants viewed two PSAs: one advocating wearing a mask in public settings and one advocating staying at home. The control PSA only provided information, and the treatment PSAs were designed to appeal to the identities held by individuals; that is, either a Christian identity or an economically motivated identity. Participants were asked about their identity and then provided a control PSA and treatment PSA matching their identity, in random order. The PSAs were of approximately 100 words. RESULTS: We recruited 300 social media users from Amazon Mechanical Turk in accordance with usual protocols to ensure data quality. In total, 8 failed the data quality checks, and the remaining 292 were included in the analysis. In the identity-based PSA, the source of the PSA was changed, and a phrase of approximately 12 words relevant to the individual's identity was inserted. A PSA tailored for Christians, when matched with a Christian identity, increased the likelihood of compliance by 12 percentage points. A PSA that focused on economic values, when shown to individuals who identified as economically motivated, increased the likelihood of compliance by 6 points. CONCLUSIONS: Using social media to deliver COVID-19 public health announcements customized to individuals' identities is a promising measure to increase compliance with public health guidelines. TRIAL REGISTRATION: ISRCTN Registry 22331899; https://www.isrctn.com/ISRCTN22331899.


Assuntos
COVID-19/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Comunicação Persuasiva , Anúncios de Utilidade Pública como Assunto , Identificação Social , Adolescente , Adulto , Idoso , COVID-19/epidemiologia , Estudos Transversais , Feminino , Guias como Assunto , Humanos , Masculino , Máscaras , Pessoa de Meia-Idade , Quarentena , Mídias Sociais , Estados Unidos/epidemiologia , Adulto Jovem
19.
Sci Rep ; 11(1): 8979, 2021 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-33903717

RESUMO

The Enhanced Recovery After Surgery (ERAS) protocol affected traditional cardiac surgery processes and COVID-19 is expected to accelerate its scalability. The aim of this study was to assess the impact of an ERAS-based protocol on the length of hospital stay after cardiac surgery. From January 2019 to June 2020, 664 patients underwent consecutive cardiac surgery at a Latin American center. Here, 46 patients were prepared for a rapid recovery through a multidisciplinary institutional protocol based on the ERAS concept, the "TotalCor protocol". After the propensity score matching, 46 patients from the entire population were adjusted for 12 variables. Patients operated on the TotalCor protocol had reduced intensive care unit time (P < 0.025), postoperative stay (P ≤ 0.001) and length of hospital stay (P ≤ 0.001). In addition, there were no significant differences in the occurrence of complications and death between the two groups. Of the 10-central metrics of TotalCor protocol, 6 had > 70% adherences. In conclusion, the TotalCor protocol was safe and effective for a 3-day discharge after cardiac surgery. Postoperative atrial fibrillation and renal failure were predictors of postoperative stay > 5 days.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Tempo de Internação , Alta do Paciente , Segurança do Paciente , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Fidelidade a Diretrizes , Humanos , Equipe de Assistência ao Paciente , Complicações Pós-Operatórias , Pontuação de Propensão
20.
Fertil Steril ; 115(5): 1156-1158, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33823992

RESUMO

The prevalence and ease of electronic communication, specifically email through patient portals associated with electronic medical records or via traditional enterprise email clients (e.g., Outlook) and video, have resulted in increased use for rapid communication between practitioners and their patients. Concerns regarding patient privacy and compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA) remain a barrier to routine incorporation of electronic communication into practice. Furthermore, capital investment, implementation, and maintenance costs may provide additional barriers. These long-standing concerns have been heightened and tested by the COVID-19 pandemic. Best-practice guidelines for the secure and safe use of electronic communication with reproductive care patients are provided.


Assuntos
Confidencialidade/normas , Correio Eletrônico/normas , Medicina Reprodutiva/normas , Telemedicina/normas , Envio de Mensagens de Texto/normas , Gravação em Vídeo/normas , COVID-19/epidemiologia , Registros Eletrônicos de Saúde/normas , Fidelidade a Diretrizes/normas , Humanos , Medicina Reprodutiva/métodos , Telemedicina/métodos , Gravação em Vídeo/métodos
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