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2.
West Afr J Med ; 36(2): 116-121, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385596

RESUMO

BACKGROUND: Hand hygiene (HH) practices are emphasized as the single most important way of reducing HealthCare-Associated Infection (HCAIs). This study was done to assess the compliance with hand hygiene and knowledge about standard HH practices by health care workers as well as to assess the availability of HH materials in the largest tertiary Hospital in Nigeria. METHODS: A cross-sectional, observational study involving consecutive observations during routine patient care in various units of the University College Hospital (UCH), Ibadan; using a checklist and compliance forms adapted from the WHO guidelines was done. HH knowledge scores were categorized as < 4 = poor, 4-6=fair and >7 = good. RESULTS: A total of 559 HH opportunities were identified and overall compliance was 30.4% (170/ 559). Compliance differed by units: Neonatology SCBU (68.2%), Intensive Care Unit (41.8%), Obstetrics & Gynaecology (39.4%), Adult emergency (26.7%), Children emergency (24.6%), Medicine (22.4%), Surgery (14.9%) and Paediatrics (12.8%). Nurses were more likely to practice hand hygiene (33.2%) compared to doctors (29.0%) [c2 = 33.270, CI= 95%, P<0.001]. Female HCWs had higher hand hygiene compliance (30.6% vs. 25.4%) [c2= 2.129, CI= 95%, P= 0.345]. Soap and water were employed more (95.5%) compared to alcohol-based hand rub (4.5%). Only 12.1% had good HH knowledge scores (>7). CONCLUSION: Poor HH compliance is observed at the facility and is attributable to inadequate education, poor knowledge of standard HH practices and unavailability of HH materials in most of the units. A multidimensional approach is advocated to tackle these issues.


Assuntos
Infecção Hospitalar , Fidelidade a Diretrizes , Higiene das Mãos , Adulto , Criança , Estudos Transversais , Feminino , Pessoal de Saúde , Humanos , Nigéria , Centros de Atenção Terciária/normas
4.
Stud Health Technol Inform ; 264: 1714-1715, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438307

RESUMO

openEHR's Guideline Definition Language is designed for standardizing clinical decision support systems. In this study, we use Guideline Definition Language to represent patient safety rules in pre-operation of Percutaneous Coronary Intervention for the dynamic checklist system. After using Guideline Definition Language in this case, we had some results about its expression adaptability to requirements of patient safety rules.


Assuntos
Lista de Checagem , Sistemas de Apoio a Decisões Clínicas , Intervenção Coronária Percutânea , Fidelidade a Diretrizes , Humanos , Linguagem , Segurança do Paciente , Intervenção Coronária Percutânea/normas
5.
J Laryngol Otol ; 133(8): 704-712, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31370911

RESUMO

OBJECTIVES: The National Institute for Health and Care Excellence referral guidelines prompting urgent two-week referrals were updated in 2015. Additional symptoms with a lower threshold of 3 per cent positive predictive values were integrated. This study aimed to examine whether current pan-London urgent referral guidelines for suspected head and neck cancer lead to efficient and accurate referrals by assessing frequency of presenting symptoms and risk factors, and examining their correlation with positive cancer diagnoses. METHODS: The risk factors and symptoms of 984 consecutive patients (over a six-month period in 2016) were collected retrospectively from urgent referral letters to University College London Hospital for suspected head and neck cancer. RESULTS: Only 37 referrals (3.76 per cent) resulted in a head and neck cancer diagnosis. Four of the 23 recommended symptoms demonstrated statistically significant results. Nine of the 23 symptoms had a positive predictive value of over 3 per cent. CONCLUSION: The findings indicate that the current referral guidelines are not effective at detecting patients with cancer. Detection rates have decreased from 10-15 per cent to 3.76 per cent. A review of the current head and neck cancer referral guidelines is recommended, along with further data collection for comparison.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias de Cabeça e Pescoço/diagnóstico , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Adulto Jovem
6.
J Glob Health ; 9(1): 010811, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263554

RESUMO

Background: The use of mobile health (mHealth) technology to improve quality of care (QoC) has increased over the last decade; limited evidence exists to espouse mHealth as a decision support tool, especially at the community level. This study presents evaluation findings of using a mobile application for integrated community case management (iCCM) by Malawi's health surveillance assistants (HSAs) in four pilot districts to deliver lifesaving services for children. Methods: A quasi-experimental study design compared adherence to iCCM guidelines between HSAs using mobile application (n = 137) and paper-based tools (n = 113), supplemented with 47 key informant interviews on perceptions about QoC and sustainability of iCCM mobile application. The first four sick children presenting to each HSA for an initial consultation of an illness episode were observed by a Ministry of Health iCCM trainer for assessment, classification, and treatment. Results were compared using logistic regression, controlling for child-, HSA-, and district-level characteristics, with Holm-Bonferroni-adjusted significance levels for multiple comparison. Results: HSAs using the application tended to assess sick children according to iCCM guidelines more often than HSAs using paper-based tools for cough (adjusted proportion, 98% vs 91%; P < 0.01) and five physical danger signs - chest in-drawing; alertness; palmar pallor; malnourishment; oedema (80% vs 62%; P < 0.01), but not for fever (97% vs 93%; P = 0.06), diarrhoea (94% vs 87%; P = 0.03), and three danger signs - not able to eat or drink; vomits everything; has convulsions (88% vs 79%; P = 0.01). Across illnesses and danger signs, 81% of HSAs using the application correctly classified sick children, compared to 58% of HSAs using paper-based tools (P < 0.01). No differences existed for their treatment (P = 0.27). Interview respondents corroborated these findings that using iCCM mobile application ensures protocol adherence. Respondents noted barriers to its consistent and wide use including hardware problems and limited resources. Conclusion: Generally, the mobile application is a promising tool for improving adherence to the iCCM protocol for assessing sick children and classifying illness by HSAs. Limited effects on treatments and inconsistent use suggest the need for more studies on mHealth to improve QoC at community level.


Assuntos
Administração de Caso/organização & administração , Serviços de Saúde Comunitária/organização & administração , Agentes Comunitários de Saúde/psicologia , Prestação Integrada de Cuidados de Saúde , Fidelidade a Diretrizes/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adulto , Pré-Escolar , Agentes Comunitários de Saúde/estatística & dados numéricos , Diarreia/mortalidade , Diarreia/terapia , Feminino , Humanos , Lactente , Malária/mortalidade , Malária/terapia , Malaui/epidemiologia , Masculino , Pneumonia/mortalidade , Pneumonia/terapia , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa
7.
J Stroke Cerebrovasc Dis ; 28(9): 2434-2441, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31301984

RESUMO

BACKGROUND AND AIM: In recent years, interest in the quality of medical care has rapidly increased worldwide. However, quality indicators that contribute to establishing standard treatment in stroke medicine, especially rehabilitation, are not well-developed in Japan. Japan has established Kaifukuki (convalescent) rehabilitation wards, and the development of quality indicators for stroke rehabilitation in the convalescent phase is an urgent issue. METHODS: We first reviewed the literature regarding quality indicators for stroke rehabilitation. Next, we extracted candidate indicators from identified reports and guidelines and surveyed educational hospitals certified by the Japanese Association of Rehabilitation Medicine. On the basis of the survey results, we reevaluated the suitability of the proposed indicators in discussions with an expert panel. RESULTS: The questionnaire survey highlighted several important items that revealed there is room for improvement in adherence. For stroke rehabilitation in the convalescent phase, we adopted 15 indicators that were feasible as indicators to be used for comparisons between facilities, based on scoring by and opinions of the expert panel. These indicators measured structure (2 indicators), process (5 indicators), and outcome (8 indicators). CONCLUSION: This is the first study to establish quality indicators to standardize stroke rehabilitation in Japan. We developed this set of 15 indicators using an evidence-based approach. However, many tasks remain for continuous quality improvement.


Assuntos
Fidelidade a Diretrizes/normas , Avaliação de Processos e Resultados (Cuidados de Saúde)/normas , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Reabilitação do Acidente Vascular Cerebral/normas , Acidente Vascular Cerebral/terapia , Avaliação da Deficiência , Pesquisas sobre Serviços de Saúde , Nível de Saúde , Humanos , Japão/epidemiologia , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
8.
J Assoc Physicians India ; 67(4): 30-34, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31299835

RESUMO

Introduction: Dengue fever management is guided by WHO guideline, the recent one being 2009; however, compliance to the guideline is difficult to assess and in India there is no data on it. The present study, a longitudinal pre-post interventional quality improvement study, was done to determine the compliance to the guideline on dengue patients before and after resident physicians' training during two peak seasons and their impact on survival. Methods: This study was conducted in a tertiary health care centre in North India over 18 months. Data of hospitalized patients who admitted with dengue fever diagnosis in a peak season was collected in the form of quality indicators as described by the WHO-2009 guideline on dengue. Resident physicians were then given appropriate training about the guideline during the off season. Data of new dengue patients in next peak season after resident training was collected and compared with the baseline by standard statistical tests. Results: The post-intervention compliances of all components increased (total mean score by giving one point to each of the quality indicators reached 7.9 from 6.4). The compliance to individual indicator also increased: the admission criteria (baseline, 44% to post-intervention, 52%, p = 0.37), classification criteria (91.7% to 96%, p = 0.33), correct staging/triage (42.9% to 86%, p <0.001), vitals monitoring (85.7% to 92%, p = 0.28), correct usage of bolus fluids (34.3% to 69.5%, p <0.001), crystalloid as choice of fluid (100% in both groups), proper fluid titration (26.2% to 56%, p <0.001), hematocrit monitoring (95.2% to 98%, p = 0.42), platelet transfusion when indicated (65.5% to 58%, p = 0.39), antibiotic use when required (61.5% to 80%, p = 0.03), and discharge criteria (100% in both groups). The mortality decreased from 7.1% (baseline) to zero (post-intervention). The median duration of hospital stay also reduced by 1 day. Conclusion: The study affirms that the compliance to WHO guideline on dengue management in India can be further improved by regular physician training on the guideline. Simultaneously, this educational intervention not only improves patient outcomes but also direct proper resource utilization especially platelet transfusion and antibiotic use. Furthermore, every hospital/institute should have an internal quality improvement program like this to improve the management of dengue patients. Future studies are needed to understand various barriers to 100% implementation of the guideline.


Assuntos
Dengue/terapia , Cooperação do Paciente , Melhoria de Qualidade , Fidelidade a Diretrizes , Guias como Assunto , Hospitais , Humanos , Índia , Organização Mundial da Saúde
9.
J Infus Nurs ; 42(4): 193-196, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31283661

RESUMO

Central line-associated bloodstream infections (CLABSIs) account for one-third of all hospital-acquired infections and can cost the health care system between $21,000 and $100,000 per infection. A dedicated vascular access team (VAT) can help develop, implement, and standardize policies and procedures for central line usage that address insertion, maintenance, and removal as well as educate nursing staff and physicians. This article presents how 1 hospital developed a VAT and implemented evidence-based guidelines. Central line utilization decreased by 45.2%, and CLABSI incidence decreased by 90%. The results of the study demonstrated that a reduced utilization of central lines minimized the risk of patients developing a CLABSI.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/normas , Controle de Infecções/métodos , Equipe de Assistência ao Paciente/normas , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/métodos , Fidelidade a Diretrizes , Humanos , Estudos Retrospectivos
10.
MMWR Morb Mortal Wkly Rep ; 68(23): 513-518, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31194722

RESUMO

Since the release of the 2008 Physical Activity Guidelines for Americans (https://health.gov/paguidelines/2008/pdf/paguide.pdf), the age-adjusted percentage of adults meeting the combined aerobic and muscle-strengthening guidelines increased from 18.2% to 24.3% in 2017 (1). Trends in urban and rural areas, across demographic subgroups, and among subgroups within urban and rural areas have not been reported. CDC analyzed 2008-2017 National Health Interview Survey (NHIS) data to examine trends in the age-standardized prevalence of meeting physical activity guidelines among adults aged ≥18 years living in urban and rural areas. Among urban and rural residents, prevalence increased from 19.4% to 25.3% and from 13.3% to 19.6%, respectively. Nationally, all demographic subgroups and regions experienced increases over this period; increases for several groups were not consistent year-to-year. Among urban residents, the prevalence was higher during 2016-2017 than during 2008-2009 for all demographic subgroups and regions. During the same period, prevalence was higher across all rural-dwelling subgroups except Hispanics, adults with a college education, and those living in the South U.S. Census region. Urban and rural communities can implement evidence-based approaches, including improved community design, improved access to indoor and outdoor recreation facilities, social support programs, and community-wide campaigns to make physical activity the safe and easy choice for persons of all ages and abilities (2-4). Incorporating culturally appropriate strategies into local programs might help address differences across subgroups.


Assuntos
Exercício , Fidelidade a Diretrizes/tendências , Guias como Assunto , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
11.
Expert Rev Clin Pharmacol ; 12(7): 661-680, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31194593

RESUMO

Introduction: The addition of neurokinin-1 receptor antagonists (NK1RAs) to standard prophylaxis of 5-hydroxytryptamine-3 RA (5-HT3RA) plus dexamethasone more effectively prevents chemotherapy-induced nausea and vomiting (CINV) associated with highly and moderately emetogenic chemotherapy. Areas covered: This review presents the evidence base for the use of oral and intravenous (IV) NK1RAs, focusing on the pharmacologic and clinical properties as a class, and highlighting differences between agents. A PubMed literature search was conducted from 2000 to 2018. Expert opinion: Adherence to international antiemetic guidelines remains a clinical challenge. Strategies to simplify antiemetic regimens and facilitate their administration may improve compliance and treatment outcomes. The use of fixed-combination antiemetics offers clinical utility, in combining an NK1RA with a 5-HT3RA in a single oral dose. The use of long-lasting NK1RAs and administering CINV prophylaxis closer to the time of chemotherapy may also assist with guideline and treatment compliance, diminishing the need for home-based administration, and potentially reducing resource utilization. The availability of IV and oral formulations of NK1RAs and NK1RA-5-HT3RA fixed combinations offers further utility, particularly for those patients unsuited for oral administration. However, safety considerations with respect to injection site toxicity and hypersensitivity reactions of the new NK1RA IV formulations deserve close attention.


Assuntos
Náusea/prevenção & controle , Antagonistas do Receptor de Neuroquinina-1/administração & dosagem , Vômito/prevenção & controle , Adulto , Antieméticos/administração & dosagem , Antieméticos/efeitos adversos , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Dexametasona/administração & dosagem , Quimioterapia Combinada , Fidelidade a Diretrizes , Humanos , Náusea/induzido quimicamente , Antagonistas do Receptor de Neuroquinina-1/efeitos adversos , Guias de Prática Clínica como Assunto , Fatores de Tempo , Vômito/induzido quimicamente
12.
J Surg Oncol ; 120(2): 148-159, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31172534

RESUMO

BACKGROUND: Adherence to evidence-based standards can lead to improved outcomes for patients with breast cancer. However, adherence rates to standards and their effects on patient outcomes are unknown. OBJECTIVES: To examine adherence rates to standards compiled by the American College of Surgeons Clinical Research Program and its effects on patient outcomes. METHODS: Using the National Cancer Database (2004-2015), we identified cohorts of breast cancer patients: clinical T1N0M0 under age of 70 (cT1), clinical T2N0M0 or T3N0M0 (cT2/3), and clinical M0 and pathologic N2 or N3 (pN2/3). Standards included negative margins, any adjuvant therapy, and two or more lymph nodes (LNs) examined (for cT1 or cT2/3 patients) or more than 10 LNs examined (for pN2/3 patients). We performed Kaplan-Meier and Cox proportional hazards analysis. RESULTS: We identified 318 853 (65.0%) cT1, 164 593 (67.3%) cT2/3, and 77 626 (67.7%) pN2/3 patients who met the standards. More than 90% of patients had negative margins and adjuvant therapy, but less than 80% met LN standards. The median overall survival (OS) was significantly longer for patients who met the standards. Individual components of the standards were predictors of improved OS. CONCLUSIONS: One-third of patients did not meet the evidence-based standards in their treatment for breast cancer. Efforts to improve the knowledge of and adherence to these standards should be emphasized.


Assuntos
Neoplasias da Mama/mortalidade , Neoplasias da Mama/terapia , Fidelidade a Diretrizes , Idoso , Antineoplásicos/administração & dosagem , Neoplasias da Mama/patologia , Estudos de Coortes , Terapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Margens de Excisão , Mastectomia , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Modelos de Riscos Proporcionais
13.
Pan Afr Med J ; 32: 79, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31223370

RESUMO

Introduction: This study aims to assess the adherence of private health providers to the use of malaria rapid diagnostic tests (RDTs) and to the prescription of artemisinin-containing combinations (ACT) in patients with uncomplicated malaria. Methods: We conducted an analytical, retrospective and cross-sectional study in 11 Madagascar's health districts divided into four epidemiological strata in September and in October 2015. A total of 43 health providers from 39 private health care facilities (PHF) were interviewed and visited. Results: Health providers declared having read the malaria management manual in 16.3% of cases (4/43). Only one quarter (25.6%) of health providers had RDTs in their office. ACT was reported as "first-line drug" for the treatment of uncomplicated malaria by 83.7% of health providers. In practice, 55.6% of health providers had doubts about the results of the RDTs. The use of antimalarial drugs, despite having had negative RDTs results (38.2%), was more frequent among those who had raised doubts (p = 0.03). Conversely, despite having had positive RDTs results, half of the health providers did not prescribe ACT (50%). The decision to not participate in periodic reviews by the Health District (p = 0.05) negatively influenced the adherence to the policies. Conclusion: The low adherence of private health providers to the national guidelines for the management of uncomplicated malaria raises questions about the importance of exercising more control over health providers activities.


Assuntos
Antimaláricos/administração & dosagem , Artemisininas/administração & dosagem , Fidelidade a Diretrizes , Malária/tratamento farmacológico , Estudos Transversais , Testes Diagnósticos de Rotina , Quimioterapia Combinada , Humanos , Madagáscar , Malária/diagnóstico , Guias de Prática Clínica como Assunto , Setor Privado , Estudos Retrospectivos
14.
BMC Public Health ; 19(1): 743, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196062

RESUMO

BACKGROUND: Smoking remains one of the major preventable causes of chronic diseases. Considering the promising evidence on the effectiveness of mobile technology for health behaviour change, along with the increasing adoption of smartphones, this review aims to systematically assess the adherence of popular mobile apps for smoking cessation to evidence-based guidelines. METHODS: The United Kingdom Android and iOS markets were searched in February 2018 to identify smoking cessation apps. After screening, 125 Android and 15 iOS apps were tested independently by two reviewers for adherence to the National Institute of Care and Excellence (NICE) Smoking Cessation Guidelines for Self-Help Materials and the Five A Guidelines for Smoking Cessation. Pearson chi square tests were run to examine differences between the two operating systems. RESULTS: A majority of apps across both operating systems had low adherence (fulfils 1-2 out of 5 guidelines) to the Five A Guidelines (65.7%) and low adherence (fulfils 1-3 out of 9 guidelines) to the NICE Smoking Cessation Guidelines for Self-Help Materials (63.6%). Only 15% of mobile apps provided information about the benefits of nicotine replacement therapy (NRT), and even fewer provided information regarding types of NRT products (7.1%) or how to use them (2.1%). In addition, only a minority of apps arrange follow-up appointments or provide additional support to help smokers quit. CONCLUSION: Similar to previous mobile app reviews dating back to 2014, our findings show that most mobile apps do not follow existing smoking cessation treatment guidelines, indicating little change regarding the availability of evidence-based mobile apps for smoking cessation in the UK market. Smokers seeking to quit, tobacco control policy makers and software developers need to work together to develop apps that are in line with the latest clinical guidelines and strategies to maximise effectiveness.


Assuntos
Prática Clínica Baseada em Evidências , Fidelidade a Diretrizes/estatística & dados numéricos , Guias como Assunto , Aplicativos Móveis/normas , Abandono do Hábito de Fumar/métodos , Humanos , Reino Unido
15.
Artigo em Alemão | MEDLINE | ID: mdl-31209503

RESUMO

BACKGROUND: Antimicrobial resistance is an increasing problem - a consequence of uncritical use, especially of "last-resort" antibiotics. Approaches towards a more rational use of antibiotics have so far focused on the inpatient sector, whereas the majority of antibiotics are prescribed in the outpatient sector. Therefore, there is demand for innovative approaches for the latter sector. The project Antibiotic Therapy in Bielefeld ("AnTiB"), founded in 2016 by pediatricians active in the outpatient pediatric sector, developed respective structures and measures at the local level. OBJECTIVES: The development of local recommendations, suitable for everyday practice, for antibiotic prescription in frequent infectious conditions, are described. MATERIALS AND METHODS: In order to develop these recommendations, evidence from the literature and practice guidelines was collected. In a structured process, mainly via quality circles, the contents were consented locally and then put under external expert review. Together with the Association of Statutory Health Insurance Physicians of Westphalia-Lippe (KVWL), antibiotic prescription data were collected exemplarily for 2016. RESULTS: The first version of the respective pediatric recommendations was published in January 2017. Meanwhile, comparable recommendations for outpatient gynecologists and adult GPs were released. Antibiotic prescription data from 2016 show an important spread of antibiotic prescription prevalences in general as well as with respect to single agent classes. CONCLUSIONS: Locally consented practical recommendations may contribute to a local "culture" of antibiotic prescription behavior. The pediatric recommendations locally have so far gained good coverage and high acceptance. Transfer to other regions or medical disciplines seems possible and reasonable. In the future, the effects of such projects on the prescription behavior will be measurable by the comparison of prescription data.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Criança , Alemanha , Fidelidade a Diretrizes , Humanos , Pacientes Ambulatoriais
16.
Infect Dis Poverty ; 8(1): 30, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31036087

RESUMO

BACKGROUND: In 2012, the Ugandan Government declared an epidemic of Nodding Syndrome (NS) in the Northern districts of Gulu, Kitgum, Lamwo and Pader. Treatment guidelines were developed and NS treatment centres were established to provide symptomatic control and rehabilitation. However, a wide gap remained between the pre-defined care standards and the quality of routine care provided to those affected. This study is to qualitatively assess adherence to accepted clinical care standards for NS; identify gaps in the care of affected children and offer Clinical Support Supervision (CSS) to Primary Health Care (PHC) staff at the treatment centres; and identify psychosocial challenges faced by affected children and their caregivers. METHODS: This case study was carried out in the districts of Gulu, Kitgum, Lamwo and Pader in Uganda from September to December in 2015. Employing the 5-stage approach of Clinical Audit, data were collected through direct observations and interviews with PHC providers working in public and private-not-for-profit health facilities, as well as with caregivers and political leaders. The qualitative data was analysed using Seidel model of data processing. RESULTS: Clinical Audit and CSS revealed poor adherence to treatment guidelines. Many affected children had sub-optimal NS management resulting in poor seizure control and complications including severe burns. Root causes of these outcomes were frequent antiepileptic drugs stock outs, migration of health workers from their work stations and psychosocial issues. There was hardly any specialized multidisciplinary team (MDT) to provide for the complex rehabilitation needs of the patients and a task shifting model with inadequate support supervision was employed, leading to loss of skills learnt. Reported psychosocial and psychosexual issues associated with NS included early pregnancies, public display of sexual behaviours and child abuse. CONCLUSIONS: Despite involvement of relevant MDT members in the development of multidisciplinary NS guidelines, multidisciplinary care was not implemented in practice. There is urgent need to review the NS clinical guidelines. Quarterly CSS and consistent anticonvulsant medication are needed at health facilities in affected communities. Implementation of the existing policies and programs to deal with the psychosocial and psychosexual issues that affect children with NS and other chronic conditions is needed.


Assuntos
Atitude do Pessoal de Saúde , Fidelidade a Diretrizes , Pessoal de Saúde/psicologia , Acesso aos Serviços de Saúde , Síndrome do Cabeceio/terapia , Adolescente , Anticonvulsivantes/uso terapêutico , Criança , Pré-Escolar , Auditoria Clínica , Epilepsia , Humanos , Lactente , Entrevistas como Assunto , Síndrome do Cabeceio/tratamento farmacológico , Síndrome do Cabeceio/epidemiologia , Pesquisa Qualitativa , Resultado do Tratamento , Uganda
18.
Methodist Debakey Cardiovasc J ; 15(1): 16-22, 2019 Jan-Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31049145

RESUMO

Although lipid guidelines provide updated, practical, and clinically relevant information that may be used in patient care, the continuing publication of new evidence and the inevitable treatment gaps present in all guidelines reinforce the importance of clinical judgment in shared decision making. This article explores the development of the 2013 American College of Cardiology/American Heart Association Blood Cholesterol Guidelines and the evidence base for managing patients with severe hypercholesterolemia, provides more recent high-quality evidence, and identifies existing treatment gaps that should be considered when caring for such patients. Although it was submitted prior to publication of the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol, this review also includes key takeaway messages from the updated guideline.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Dislipidemias/tratamento farmacológico , Hipolipemiantes/uso terapêutico , Lipídeos/sangue , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Adulto , Idoso , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Tomada de Decisão Clínica , Dislipidemias/sangue , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Medicina Baseada em Evidências/normas , Feminino , Fidelidade a Diretrizes/normas , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento
19.
BMC Health Serv Res ; 19(1): 309, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088467

RESUMO

BACKGROUND: Clinical guidelines are systematically proven statements that help physicians to make healthcare decisions for specific medical conditions. Non-adherence to clinical guidelines is believed to contribute significantly to poor delivery of clinical care, and hence poor clinical outcomes. This study aimed at investigating adherence of doctors to hypertension clinical guidelines in Academy Charity Teaching Hospital, Khartoum, Sudan. METHODS: A cross-sectional hospital-based study was conducted during the period from January 2017 to October 2017 on a sample of 150 doctors. Adherence of doctors to hypertension guidelines was measured through the modified JNC7 adherence tool. Descriptive statistics was used to summarize the data (mean, standard deviation, median) and analyzed by frequency tables. Chi square test used to determine association among categorized variables. Logistic regression analysis was conducted to determine the relation between adherence to hypertension guidelines and the explanatory variables. All statistical tests were considered statistically significant when p value < 0.05. RESULTS: Of the 150 participants, 92% (138/150) were aware of the major hypertension treatment guidelines. 71% (98/138) reported the use of guidelines recommendations in their practice. Whereas 52% (78/150) were aware of local Sudanese guidelines. High adherence rate was highly statistically associated with job titles (p = 0.000), and also associated with age of the participants (p = 0.024) and duration of clinical experience (p = 0.012). However, the logistic regression analysis revealed despite all those variables were contributing to adherence to the treatment guidelines, only duration of clinical experience was statistically significant (p = 0.022). CONCLUSION: The overall adherence of doctors to hypertension treatment guidelines was very low. This study highlights how a gap in clinical governance contributes to low adherence to clinical guidelines. Establishing regular clinical audit, issuing regulations to enforce the use of updated guidelines, along with introducing training programs in hospitals and continuous assessment to the practicing doctors are suggested as crucial interventions. Considerable efforts to build clinical governance in Sudan are required.


Assuntos
Atitude do Pessoal de Saúde , Fidelidade a Diretrizes/estatística & dados numéricos , Hipertensão/diagnóstico , Padrões de Prática Médica/estatística & dados numéricos , Academias e Institutos , Adulto , Instituições de Caridade , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hospitais de Ensino , Humanos , Hipertensão/terapia , Masculino , Guias de Prática Clínica como Assunto , Sudão , Resultado do Tratamento
20.
Rev Med Chil ; 147(2): 190-198, 2019 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-31095167

RESUMO

BACKGROUND: Gestational diabetes (GD) impacts maternal and fetal morbidity. In 2012, the World Diabetes Foundation provided financing project in Barranquilla (Colombia), aimed to implement a clinical guide for the diagnosis and treatment of this condition. AIM: To estimate the adherence of the guide in primary care centers. MATERIAL AND METHODS: A Cross-sectional study of pregnant women suspected of having gestational diabetes. Pregnant women were classified according to the week of admission to the prenatal control program: < week 24 or later. Women with a fasting blood glucose over 92 mg/dL and under 126 mg/dL or with some positive result to the oral glucose tolerance test were included. RESULTS: Nine percent (1,887 women) of 21,699 registries of pregnant women, were at risk for gestational diabetes. Of these, 1,880 registries with complete data were analyzed. Sixty nine entered the program at less than 24 weeks of pregnancy and 71% had had a fasting blood glucose measured in the first control. In 69.2% of these women, criteria for gestational diabetes was met. A glucose tolerance test was suggested to women with a blood glucose below 92 mg/dl. Among 72% of the latter, the glucose tolerance test met the criteria for gestational diabetes. Among the 498 women who entered the program after 24 weeks of gestation, 68% met the criteria for gestational diabetes with the fasting blood glucose levels. In 90 women, a glucose tolerance test was performed and 80% met the criteria for gestational diabetes. CONCLUSIONS: An adequate adherence to guidelines favors the detection of pregnant women with gestational diabetes.


Assuntos
Diabetes Gestacional/diagnóstico , Fidelidade a Diretrizes/estatística & dados numéricos , Programas de Rastreamento/normas , Guias de Prática Clínica como Assunto/normas , Atenção Primária à Saúde/normas , Adulto , Glicemia/análise , Colômbia/epidemiologia , Estudos Transversais , Diabetes Gestacional/epidemiologia , Feminino , Idade Gestacional , Fidelidade a Diretrizes/normas , Humanos , Gravidez , Cuidado Pré-Natal/normas , Cuidado Pré-Natal/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos
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