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2.
Rev Med Chil ; 147(5): 602-611, 2019 May.
Artigo em Espanhol | MEDLINE | ID: mdl-31859892

RESUMO

BACKGROUND: Clinical practice guidelines (CPGs) promote better quality and equity in health care and potentially they could improve patients' outcomes. However, their implementation is hindered by a number of factors including some related to health care professionals. AIM: To assess the perceptions and attitudes of primary care physicians regarding CPGs developed by the Chilean Ministry of Health in the context of the Health Sector Reform. MATERIAL AND METHODS: An adaptation of the survey "Knowledge, perceptions and attitudes towards Clinical Practice Guidelines" was sent to 1,264 primary care physicians in Chile and answered completely by 354. The analysis assessed the attitudes towards CPG, their use in primary care and their relationship with socio demographic features of respondents. RESULTS: Eighty two percent of respondents reviewed the flowcharts of the guidelines, 85% consulted their online version. The classification of evidence levels and the strength of recommendations generated a high level of confidence with the guidelines in 70 and 64% of respondents. Eighty five percent considered that CPG could help to standardize clinical practice. The most relevant barrier hindering CPG use was the lack of a brief, simple and easy to access format in 63% of respondents. The three dimensions of the theory of planned behavior (attitude toward behavior, subjective norms, and perceived behavioral control) were associated with a greater frequency of guideline use. A higher age and not being Chilean were associated with a lower frequency of use. CONCLUSIONS: The identified factors associated with CPG use should be considered in future guideline design.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Médicos de Atenção Primária/normas , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Atenção Primária à Saúde/normas , Adulto , Atitude do Pessoal de Saúde , Chile , Estudos Transversais , Feminino , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Médicos de Atenção Primária/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Inquéritos e Questionários
3.
Medicine (Baltimore) ; 98(44): e17737, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689820

RESUMO

The World Health Organization and United Nations Children's Fund's Baby-Friendly Hospital Initiative is aimed at the global promotion, protection and support of breastfeeding. In this study, we compared breastfeeding-related information received, knowledge and behaviours among postpartum women in Baby-Friendly Hospital Initiative accredited and non-accredited hospitals. We selected 10 hospitals: 9 non-accredited hospitals in the Campania region in southern Italy and one accredited hospital in the Piedmont region in northern Italy. In total, 786 women (580 (73.8%) in Campania and 206 (26.2%) in Piedmont) in the hospitals' maternity wards completed a questionnaire comprising 5 sections within 24 to 72hours after giving birth. The questionnaire investigated breastfeeding activities in the days immediately following childbirth, as well as the information provided by health personnel, knowledge about breastfeeding before and during hospitalisation, and participation in antenatal classes. To evaluate the comparison between the 2 regions, we performed at first a bivariate analysis and then a multinomial and a multivariate logistic regression. Compared with Piedmont, in Campania hospitals there was a rate of breastfeeding of 44.3% vs 89.3%, a skin-to-skin contact between mother and child of 74.5% vs 90.7% and first milk feed within 2hours of 15.0% vs 87.2%. The Campania group had fewer problems with child latching. The Campania group reported receiving less information about breastfeeding in general compared with the Piedmont group. In general, both groups showed good basic knowledge about different aspects of breastfeeding. In both regions, about 90% reported that the information received during the antenatal classes simplified the breastfeeding experience. Our study confirms the importance of systematic promotion of breastfeeding and subsequent delivery of adequate support to maternity departments, in accordance with international guidelines.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Promoção da Saúde/normas , Mães/estatística & dados numéricos , Unidade Hospitalar de Ginecologia e Obstetrícia/estatística & dados numéricos , Adulto , Aleitamento Materno/psicologia , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Humanos , Recém-Nascido , Itália , Modelos Logísticos , Mães/psicologia , Análise Multivariada , Unidade Hospitalar de Ginecologia e Obstetrícia/normas , Gravidez , Avaliação de Programas e Projetos de Saúde , Nações Unidas , Organização Mundial da Saúde
5.
BMC Infect Dis ; 19(1): 767, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477055

RESUMO

BACKGROUND: Tuberculosis (TB) is among the world's top public health challenges and the leading killer of people with HIV, yet is a treatable disease. This study aimed to assess, in a real-world setting, the implementation of antiretroviral therapy (ART) and Cotrimoxazole preventive therapy (CPT) policy, specific interventions proven to benefit patients in HIV-associated TB care. METHODS: This retrospective cohort study was conducted in Botswana in the Serowe/Palapye district, a largely urban district with a high burden of HIV-associated TB with a high case fatality, at Segkoma and Palapye hospitals and their feeder clinics. Between 1 January 2013 and 31 December 2013, confirmed HIV-positive patients aged ≥15 years with a confirmed TB diagnosis and medical record available were included in the analysis. The Kaplan-Meier method was used to compare time to death for the group of patients on ART and the group of patients not on ART during TB treatment. Cox proportional hazard regression was undertaken to identify predictors of mortality. RESULTS: Of the 300 patients included in the study, 217 (72%) were ART experienced at TB diagnosis. Of these, 86 (40%) had TB within 3 months following ART initiation. Of the 83 (28%) patients who were ART-naïve at TB diagnosis, 40 (48%) were commenced on ART during TB treatment, with 24 (60%) patients commencing within 4 weeks following TB treatment initiation. The overall ART uptake was 84%, while cotrimoxazole preventive therapy uptake was 100%. There were 45 deaths (15%), ART-experienced patients during TB treatment accounted for 30 deaths (30/257; 14%), while those who were not ART-experienced during TB treatment accounted for 15 deaths (15/43; 35%). There was a significant difference in survival time between patients with no ART use during TB treatment and those with ART use during TB treatment (log rank p < 0.001). Patients with no ART use during TB treatment were more likely to die within the first 2 months. CONCLUSION: The implementation of CPT policy is a substantial success. Strengthening the implementation of ART policy could improve survival among HIV-associated TB patients.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Antirretrovirais/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Tuberculose/tratamento farmacológico , Tuberculose/mortalidade , Adulto , Botsuana/epidemiologia , Coinfecção/tratamento farmacológico , Coinfecção/mortalidade , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , HIV/fisiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Implementação de Plano de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose/complicações , Tuberculose/virologia
6.
Ann R Coll Surg Engl ; 101(8): 584-588, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31537105

RESUMO

INTRODUCTION: The National Institute for Health and Care Excellence published a draft consultation update on abdominal aortic aneurysm, which was expected to be published on 7 November 2018. This article analyses the readiness of NHS hospitals and their workforce to embrace the proposed guidelines. METHODS: The trust and individual surgeon-level anonymised data in the public domain for elective, rupture and complex abdominal aortic aneurysm cases were collected and analysed for all the acute care trusts providing these services from the Vascular Society of Great Briton and Ireland's prospective National Vascular Registry database. RESULTS: Of the 95 acute care trusts providing the service for the year 2017, the annual volume of infrarenal abdominal aortic aneurysm (both endovascular and open repairs) ranged between 0 and 137. Of these, 64 (67.36%) trusts had an annual volume of fewer than 60 cases. A total of 366 (approximately 75% of 490) vascular surgeons have performed 10 or fewer open abdominal aortic aneurysm repairs in three years (2014-2016) with a mean operating volume of 1.452 procedures per surgeon per three years (n = 254, median 0, interquartile range, IQR, 0-3, 0.484 procedures per surgeon per year) and about 51% of the vascular surgeons have only performed five or fewer procedures in those three years with a mean operating volume of 3.455 per surgeon per three years (n = 367, median 3, IQR 0-3, 1.151 per surgeon per year). CONCLUSION: The observations show that most UK acute hospitals lack the optimum case volume necessary to embrace the proposed change in the guideline.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Vasculares/normas , Aneurisma da Aorta Abdominal/epidemiologia , Ruptura Aórtica/epidemiologia , Ruptura Aórtica/cirurgia , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos/normas , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Emergências , Medicina Baseada em Evidências/métodos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Irlanda/epidemiologia , Sistema de Registros , Medicina Estatal/normas , Medicina Estatal/estatística & dados numéricos , Reino Unido/epidemiologia , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos
7.
Presse Med ; 48(9): e257-e266, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31473028

RESUMO

OBJECTIVES: Asthma is the leading chronic disease of the child; control and treatment remain inadequate. Our objective was to assess whether the use of the Childhood Asthma Control Test (C -ACT) in primary care had an impact on adapting therapy. METHODS: The study was quantitative prospective and compared 2 groups of general practioners. All had the same reminders about childhood asthma management. The C-ACT was detailed to one group only. Doctors in the control group had to work as usual without C-ACT. Doctors included asthmatic children aged 6 to 11 years who were consulting for their asthma or any other reason. The primary endpoint was the adaptation of asthma treatment according to the Global Initative for Asthma (GINA). Evaluations of the control group were compared with the after consultation self-administered online C-ACT. RESULTS: From April to October 2014, 61 physicians included 179 patients in two comparable groups. Although not significant statistically, doctors using C-ACT found 45% of uncontrolled asthma (vs. 31%). When the reason for consultation was not related to asthma, the figure was 25% (vs. 15%). Doctors using the C-ACT made twice less therapeutic adaptations not recommended by the GINA: 8% vs. 16%. 25% of evaluations of doctors in the control group were discordant with the internet C-ACT. After correction with the internet C-ACT of these imprecise initial assessments, the figure was 25%: 3 times more than in the C-ACT group (P=0.014). CONCLUSION: The use in primary care of C-ACT should allow a better assessment of asthma control and adaptation of treatment in children.


Assuntos
Asma/terapia , Medicina Geral , Fidelidade a Diretrizes/estatística & dados numéricos , Criança , Feminino , França , Humanos , Masculino , Estudos Prospectivos
8.
J Pediatr Orthop ; 39(8): 394-399, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393292

RESUMO

BACKGROUND: To determine if the AAOS clinical practice guidelines (CPG) for the treatment of pediatric femoral shaft fractures (2009) changed treatment, we analyzed pediatric femoral shaft fractures at 4 high-volume, geographically separated, level-1 pediatric trauma centers over a 10-year period (2004 to 2013). METHODS: Consecutive series of pediatric femoral shaft fractures (ages, birth to 18 y) treated at the 4 centers were reviewed. Treatment methods were analyzed by age and treatment method for each center and in aggregate. RESULTS: Of 2646 fractures, 1476 (55.8%) were treated nonoperatively and 1170 fractures operatively. Of the operative group, flexible intramedullary nails (IMN) were used for 568 patients (21.5%), locked intramedullary nails (LIMNs) for 309 (11.7%), and plating for 188 (7.1%). In total, 105 fractures were treated with external fixation or skeletal traction. Analysis before and after the CPG publication revealed a significant increase in the use of interlocked IMNs in patients younger than 11 years (0.5% before, 3.8% after; P<0.001). Over the same time period there was an increase in surgical management, regardless of technique, for patients younger than 5 years (6.4% before, 8.4% after; P=0.206). There were considerable differences in treatment among centers: 74% of fractures treated with plating were from a single center (center A), which also contributed 68% of patients younger than 5 years treated with plating; center B had the highest rate (41%) of flexible IMN in children younger than 5 years; center C had the highest rate (63%) of LIMN in children younger than 11 years; and center D treated the fewest patients outside the CPG guidelines. CONCLUSIONS: Following publication of the AAOS CPG, there was a significant increase in the use of LIMNs in patients younger than 11 years old and a trend toward surgical treatment in patients younger than 5 years. The considerable variability among centers in treatment methods and adherence to the CPG highlights the need for further outcome studies to better define optimal treatment methods and perhaps update the AAOS CPG guidelines. LEVEL OF EVIDENCE: Level III-therapeutic.


Assuntos
Tratamento Conservador , Fraturas do Fêmur/cirurgia , Fixação de Fratura , Guias de Prática Clínica como Assunto , Pinos Ortopédicos/estatística & dados numéricos , Criança , Pré-Escolar , Tratamento Conservador/métodos , Tratamento Conservador/estatística & dados numéricos , Feminino , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Fixação de Fratura/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Estudos Retrospectivos
9.
J Pediatr Orthop ; 39(8): e578-e585, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393293

RESUMO

OBJECTIVES: The purpose of this study was to characterize management of supracondylar humerus fractures (SCHFs) at a level 1 trauma center and identify factors contributing to divergence in management from American Academy of Orthopedic Surgeons (AAOS) the Appropriate Use Criteria (AUC) recommendations. METHODS: A query revealed 556 patients with diagnoses of SCHF between 2013 and 2015 at a pediatric level 1 trauma center. Patients were excluded if they were younger than 2 years of age, older than 12 years of age, were polytrauma patients, or if there was not sufficient clinical or radiographic documentation, resulting in 449 patients. Urgent/emergent intervention was defined as surgery within 8 hours of presentation. Binomial logistic regression assessed whether various factors predicted operative versus nonoperative management. RESULTS: Operative management was undertaken in 0/208 (0%) type I fractures, 61/106 (57.0%) type II fractures, and 135/135 (100%) type III fractures. Comparison with AUC recommendations revealed disagreement in 31% (138/449) of cases. Among 449 patients, 44 were treated nonoperatively despite AUC recommendations for operative treatment. All 44 of these patients were type II SCHFs managed nonoperatively. There were no definitive cases of malalignment or loss of alignment in these nonoperative cases. Factors predictive of operative management were anterior humeral line not intersecting the capitellum (odds ratio, 200; P<0.001) and increasing age (odds ratio, 1.53; P=0.024). The AUC more frequently recommended urgent/emergent operative intervention (148/449, 33.0%) than was performed at our pediatric level 1 trauma center (50/449, 11.1%). The majority of this disagreement (94/98, 95.9%) consisted of uncomplicated type III SCHF treated operatively in >8 hours. None of these patients developed compartment syndrome or required an open reduction. CONCLUSIONS: The American Academy of Orthopedic Surgeons AUC recommended operative and urgent/emergent intervention more frequently than was performed at a level 1 pediatric trauma center. Patient age and alignment of the anterior humeral line with the capitellum, though not specifically addressed in the AUC, were most predictive of operative versus nonoperative management at our institution.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Fraturas do Úmero/terapia , Criança , Pré-Escolar , Feminino , Humanos , Fraturas do Úmero/complicações , Fraturas do Úmero/diagnóstico por imagem , Masculino , Guias de Prática Clínica como Assunto , Radiografia , Estudos Retrospectivos , Centros de Traumatologia
10.
BMC Public Health ; 19(1): 1188, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464621

RESUMO

BACKGROUND: Water advisories, especially those concerning boiling drinking water, are widely used to reduce risks of infection from contaminants in the water supply. Since the effectiveness of boil water advisories (BWAs) depends on public compliance, monitoring the public response to such advisories is essential for protecting human health. However, assessments of public compliance with BWAs remain sparse. Thus, this study was aimed at investigating awareness and compliance among residents who had received BWAs in Baerum municipality in Norway. METHOD: We conducted a cross-sectional study among 2764 residents who had received water advisories by SMS in the municipality of Baerum between January and September 2017. We analysed data from two focus group discussions and an online survey sent to all residents who had received an advisory. We conducted descriptive analyses and calculated odds ratios (OR) using logistic regression to identify associations of compliance and awareness with demographic characteristics. RESULTS: Of the 611 respondents, 67% reported that they had received a water advisory notification. Effective compliance rate with safe drinking water practices, either by storing clean drinking water or boiling tap water, after a water outage was 72% among those who remembered receiving a notification. Compliance with safe drinking water advisories was lower among men than women (OR 0.53, 95% CI 0.29-0.96), but was independent of age, education and household type. The main reason for respondents' non-compliance with safe water practices was that they perceived the water to be safe to drink after letting it flush through the tap until it became clear. CONCLUSIONS: Awareness of advisories was suboptimal among residents who had received notifications, but compliance was high. The present study highlights the need to improve the distribution, phrasing and content of water advisory notifications to achieve greater awareness and compliance. Future studies should include hard-to-reach groups with adequate data collection approaches and examine the use of BWAs in a national context to inform future policies on BWAs.


Assuntos
Água Potável/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Purificação da Água/estatística & dados numéricos , Abastecimento de Água/estatística & dados numéricos , Adolescente , Adulto , Idoso , Conscientização , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Gravidez , Inquéritos e Questionários , Purificação da Água/métodos , Adulto Jovem
11.
Rech Soins Infirm ; 137(2): 91-98, 2019 06.
Artigo em Francês | MEDLINE | ID: mdl-31453676

RESUMO

Introduction : Nursing care for a venous ulcer includes repairing the dressing and applying the medical compression bandage (MCB). Nurses use the application technique found in the guidelines to achieve the required pressure level. There are wide disparities in the way an MCB is applied.Methodology : An observational study combining quantitative and qualitative components was conducted to evaluate the application of MCBs and to explore the elements that nurses take into account when applying MCBs.Results : Of the 261 patients, 27% had MCBs applied according to the guidelines. The main variation found was that the heel was left out of the bandage for 48% of patients. The private nurses interviewed expressed that the patient's opinion was taken into account in order to promote compliance.Discussion : Regarding the nursing knowledge used to perform the application of an MCB, it appears that the empirical knowledge proposed by Carper is not the only element taken into account. Patient participation in the choice of the application technique, which could be linked with a sense of artistry allows nurses to guide their practice.


Assuntos
Bandagens Compressivas , Úlcera Varicosa/enfermagem , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Pesquisa em Avaliação de Enfermagem , Participação do Paciente , Guias de Prática Clínica como Assunto , Pesquisa Qualitativa
12.
Rev Bras Enferm ; 72(3): 774-779, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269145

RESUMO

OBJECTIVE: To evaluate the compliance of the care process involving insertion of central vascular catheter (CVC) in hemodialysis. METHOD: Cross-sectional quantitative approach developed at the hemodialysis service of a reference hospital in Sergipe, Brazil. Sample consisting of 1,342 actions evaluated, corresponding to 122 forms for monitoring and control of CVC insertion. Data collection was held from July to December 2016. RESULTS: The adherence rate to the use of the insertion form was 54.9%. The procedure evaluated achieved 93% overall compliance. Of the 11 specific actions observed, seven (64%) presented 100% compliance. The density of the overall incidence of primary bloodstream infections reduced from 10.6 to 3.1 infections per 1,000 patients/day. CONCLUSION: Although the observed actions reached specific desired conformities, the use of the checklist was lower than expected. Strategies for monitoring, coaching and educational and organizational actions can contribute to safe care.


Assuntos
Cateteres Venosos Centrais/efeitos adversos , Fidelidade a Diretrizes/normas , Controle de Infecções/normas , Adulto , Brasil , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais/estatística & dados numéricos , Estudos Transversais , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Controle de Infecções/estatística & dados numéricos , Masculino , Garantia da Qualidade dos Cuidados de Saúde/métodos , Diálise Renal/instrumentação , Diálise Renal/métodos
13.
BMC Public Health ; 19(1): 871, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269931

RESUMO

BACKGROUND: High population levels of sitting is contributing to high rates of chronic health problems. Therefore, the aim of this study was to identify the sitting time messages with the greatest potential to reduce sitting behaviour, as well as identify how this may differ according to demographic, behavioural and psychosocial characteristics. METHODS: Australian adults (N = 1460) were asked to report the likelihood that they would adhere to seven messages promoting reduced sitting time and two messages promoting increased physical activity (from 'not at all likely' to 'very likely'). Ordinal regression models were used to compare messages on the likelihood of adherence and whether likelihood of adherence differed as a function of demographic, psychosocial and behavioural characteristics. RESULTS: Likelihood of adherence was highest for the messages, 'Stand and take a break from sitting as frequently as you can' (83% respectively) and 'Avoid sitting for more than 10 hours during the entire day' (82%) and was significantly lower for the message, 'Sit as little as possible on all days of the week' (46%) compared to all other messages. CONCLUSIONS: To increase likelihood of adherence messages should be specific, achievable and promote healthy alternatives to sitting (e.g. standing). Messages promoting standing as a healthy alternative to sitting may be more likely to engage people with high sitting behaviour and messages promoting physical activity may be more likely to engage males and retired adults.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Comunicação em Saúde , Postura Sentada , Posição Ortostática , Adulto , Idoso , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
14.
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
15.
BMC Health Serv Res ; 19(1): 464, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286960

RESUMO

BACKGROUND: The healthcare systems in the western world have in recent years faced major challenges caused by demographic changes and altered patterns of diseases as well as political decisions influencing the organisation of healthcare provisions. General practitioners are encouraged to delegate more clinical tasks to their staff in order to respond to the changing circumstances. Nevertheless, the degree of task delegation varies substantially between general practices, and how these different degrees affect the quality of care for the patients is currently not known. Using chronic obstructive pulmonary disease (COPD) as our case scenario, the aim of the study was to investigate associations between degrees of task delegation in general practice and spirometry testing as a measure of quality of care. METHODS: We carried out a cross-sectional study comprising all general practices in Denmark and patients suffering from chronic obstructive pulmonary disease. General practitioners (GPs) were invited to participate in a survey investigating degrees of task delegation in their clinics. Data were linked to national registers on spirometry testing among patients with COPD. We investigated associations using multilevel mixed-effects logit models and adjusted for practice and patient characteristics. RESULTS: GPs from 895 practices with staff managing COPD-related tasks responded, and 61,223 COPD patients were linked to these practices. Hereof, 24,685 (40.3%) had a spirometry performed within a year. Patients had a statistically significant higher odds ratio (OR) of having an annual spirometry performed in practices with medium or maximal degrees of task delegation compared to practices with a minimal degree (OR = 1.27 and OR = 1.33, respectively). CONCLUSION: Delegating more complex tasks to practice staff implies that COPD-patients are more likely to be treated according to evidence-based recommendations on spirometry testing.


Assuntos
Medicina Geral/organização & administração , Clínicos Gerais/psicologia , Fidelidade a Diretrizes/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Espirometria/normas , Idoso , Estudos Transversais , Dinamarca , Feminino , Clínicos Gerais/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
16.
Eur J Oncol Nurs ; 40: 98-103, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31229212

RESUMO

PURPOSE: Nurses are at risk from handling chemotherapeutic agents. This study aimed to determine adherence to safety guidelines for chemotherapy administration by Korean nurses and to examine the relationship between the hospital safety climate and nurses' adherence to safety guidelines. METHOD: A descriptive, correlational design with a cross-sectional survey using data from the Korea Nurses' Health Study. For this study, participants included 872 female nurses who had administered chemotherapeutic agents to patients in the last 30 days. RESULTS: Only a quarter of the participants had high adherence to the safety guidelines, while the majority had moderate to low adherence. The absence of job hindrances and feedback/training - two sub-factors of the hospital safety climate - enhanced the likeliness for nurses to comply with the safety guidelines by almost 1.3 and 1.7 times, respectively. CONCLUSION: The results imply that the hospital safety climate, particularly feedback/training, and the absence of job hindrances are significantly correlated with adherence to the safety guidelines for chemotherapy administration. Therefore, organisational and policy support is needed to improve the hospital safety climate.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Neoplasias/tratamento farmacológico , Neoplasias/enfermagem , Recursos Humanos de Enfermagem no Hospital/psicologia , Guias de Prática Clínica como Assunto , Adulto , Antineoplásicos/efeitos adversos , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Pesquisa em Avaliação de Enfermagem , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Exposição Ocupacional/prevenção & controle , Saúde do Trabalhador , República da Coreia , Medição de Risco , Gestão da Segurança , Inquéritos e Questionários , Adulto Jovem
17.
Nurse Pract ; 44(7): 37-42, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31211737

RESUMO

Current research on NPs' use of the American Academy of Pediatrics (AAP) Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents is limited. This cross-sectional survey examined 89 NPs in Upstate New York regarding self-reported practice behaviors based on the guideline. Most NPs followed at least 50% of the AAP guideline for diagnosis and treatment. However, use of all criteria was less than optimal.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/enfermagem , Fidelidade a Diretrizes/estatística & dados numéricos , Profissionais de Enfermagem/psicologia , Guias de Prática Clínica como Assunto , Padrões de Prática em Enfermagem/estatística & dados numéricos , Adolescente , Criança , Estudos Transversais , Humanos , New York , Diagnóstico de Enfermagem , Pesquisa em Avaliação de Enfermagem
18.
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
19.
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
20.
Rev Chil Pediatr ; 90(1): 44-51, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31095218

RESUMO

INTRODUCTION: Anaphylaxis is an emergency condition. According to the latest international guide lines, early recognition and treatment with intramuscular epinephrine are associated with increased survival. OBJECTIVE: To determine the level of knowledge of pediatricians in a tertiary Pediatric Hos pital about the diagnostic criteria and treatment of anaphylaxis. MATERIAL AND METHOD: A cross-sec tional descriptive study was conducted, designing, applying, and validating an anonymous survey to physicians with complete residency in pediatrics who are on call at a third level hospital. The statisti cal analysis was made using the SPSS v.21 software, presenting measures of central tendency (median, range, and frequency table) and Chi-square test for comparison. A value of p < 0.05 was considered significant. RESULTS: 71 physicians completed the survey with a median of three years after the end of residency.35% of them identified all clinical criteria, 99% (70) indicated epinephrine, 73% chose the intramuscular route, and 55% indicated the correct dose. Only 48% of responders chose the dose and administration route correctly. In general, 21% recognized anaphylaxis and used epinephrine correctly. Physicians with less than five years of experience performed better in the intramuscular administration of epinephrine (83% vs 52% p = 0.005) and in the detection of gastrointestinal symp toms (60% vs 35% p = 0.043). CONCLUSIONS: There are difficulties in the identification and proper management of anaphylaxis by pediatricians of a tertiary Pediatric Hospital in a theoretical clinical setting. Although most of pediatricians chose epinephrine as a first-line drug, half of them did not indicate it correctly, and only one-third recognized anaphylaxis in all scenarios.


Assuntos
Anafilaxia/diagnóstico , Anafilaxia/tratamento farmacológico , Competência Clínica/estatística & dados numéricos , Epinefrina/uso terapêutico , Fidelidade a Diretrizes/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Simpatomiméticos/uso terapêutico , Argentina , Criança , Estudos Transversais , Emergências , Pesquisas sobre Serviços de Saúde , Hospitais Pediátricos , Humanos , Injeções Intramusculares , Pediatras/normas , Pediatras/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas
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