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1.
Einstein (Sao Paulo) ; 18: eAO4995, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32074221

RESUMO

OBJECTIVE: To describe antiretroviral treatment regimens prescribed and their compliance with the Clinical Protocol and Therapy Guidelines of the Ministry of Health for the management of HIV infection. METHODS: Observational and descriptive study. Secondary data of the state of Paraná (Brazil) on drugs, treatment regimens, lines of treatment and number of individuals on treatment, from January to June 2018, were accessed at the Antiretroviral Agents Logistic Control System. Combinations of antiretroviral drugs (treatment regimens) were compared according to the current Clinical Protocol and Therapy Guidelines and non-compliances were classified and quantified. RESULTS: In Paraná, 35,127 individuals with HIV were treated with 253 different treatment regimens. Of the prescribed regimens, 19.1% were first-line, 27.4% second-line and 48.5% third-line. Among non-compliances, the most prevalent were absence of association of protease inhibitors and ritonavir (42.8%), low efficacy triple therapy (36.9%), double therapy (26.1%), monotherapy (20.3%), and triple therapy of nucleoside analog reverse transcriptase inhibitors (17.1%). CONCLUSION: Most individuals receiving HIV treatment in the state of Paraná are on treatment regimens established in the current Clinical Protocol and Therapy Guidelines, which contributes to successful therapy. However, associations not provided by the current Clinical Protocol and Therapy Guidelines were identified in the initial treatment lines, which could lead to ineffectiveness, virologic failure and viral resistance.


Assuntos
Antirretrovirais/administração & dosagem , Protocolos Clínicos/normas , Fidelidade a Diretrizes/normas , Adesão à Medicação , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Antirretrovirais/uso terapêutico , Brasil , Quimioterapia Combinada/normas , Quimioterapia Combinada/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Humanos , Adesão à Medicação/estatística & dados numéricos
2.
High Blood Press Cardiovasc Prev ; 27(1): 51-59, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31916207

RESUMO

INTRODUCTION: The most recent European guidelines on hypertension redefined office blood pressure (BP) treatment targets according to age strata and cardiovascular (CV) risk profile. AIM: To evaluate proportions of adult outpatients achieving office BP treatment targets recommended by current compared to previous hypertension guidelines. METHODS: We extracted data from medical databases of adult outpatients followed in three excellence centers in hypertension (Rome, Italy; L'Aquila, Italy; Valencia, Spain). Office BP treatment targets were defined according to either 2013 ESH/ESC guidelines (< 140/90 mmHg in non-diabetic individuals aged 18-80 years, < 150/90 mmHg in those aged ≥ 80 years, and < 140/85 mmHg in diabetic individuals), or 2018 ESC/ESH guidelines: (< 130/80 mmHg in individuals aged 18-65 years, < 140/80 mmHg in those aged 65-79 and ≥ 80 years). SCORE risk was assessed in all patients. RESULTS: From an overall sample of 14,229 adult subjects, 4049 (28.5%) resulted normotensive individuals, 3088 (21.7%) were untreated and 7092 (49.8%) treated hypertensive outpatients. Treated hypertensives showed significantly higher ESC score risk (8.3 ± 13.0% vs. 3.9 ± 8.4%; P < 0.001) and lower systolic/diastolic BP (140.6 ± 18.8/83.9 ± 11.5 vs. 148.3 ± 14.2/94.7 ± 10.1 mmHg; P < 0.001) than untreated hypertensives. Compared to previous guidelines, BP control significantly lowered in non-diabetic outpatients (n = 5847) of all age groups [18-65 years: (13.1% vs. 42.9%), 65-79 years (25.8% vs. 42.5%) and ≥ 80 years (29.1% vs. 66.0%); P < 0.001 for all comparisons]; similar reductions were observed in diabetic outpatients (n = 1245) [18-65 years (32.7% vs. 14.8%), 65-79 years (37.3% vs. 24.7%) and ≥ 80 years (47.1% vs. 27.9%); P < 0.001]. CONCLUSIONS: According to the recommended new office BP treatment targets, the proportions of treated uncontrolled hypertensive patients substantially increased. These findings should prompt a tighter application of therapeutic recommendations and, thus, highlight the need for improving hypertension management and control strategies.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Fidelidade a Diretrizes/normas , Hipertensão/tratamento farmacológico , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/efeitos adversos , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Itália , Masculino , Pessoa de Meia-Idade , Espanha , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
3.
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
4.
Ophthalmic Surg Lasers Imaging Retina ; 50(11): e274-e277, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31755978

RESUMO

BACKGROUND AND OBJECTIVE: This study examines the rate of adherence to recommended ophthalmology follow-up after primary care-based telemedicine diabetic retinopathy (DR) screening. PATIENTS AND METHODS: Retrospective observational study of 5,764 insured diabetic patients undergoing telemedicine DR screening between May 2015 and April 2017 in an urban primary care setting. Patients underwent non-mydriatic fundus photography for telemedicine DR screening. The main outcome measure was the "capture rate." RESULTS: Of the patients studied, 31.7% were found to have any retinal pathology, and 20% were found to have DR. In the 11.8% percent of patients with sight-threatening retinopathy who were recommended to have a retinal examination, the capture rate was 81.9%. CONCLUSION: The authors' study demonstrated higher capture rate than has been previously reported, indicating that telemedicine DR screening in an urban, insured population may be a useful method for triaging high-risk patients without losing patients to follow-up. [Ophthalmic Surg Lasers Imaging Retina. 2019;50: e274-e277.].


Assuntos
Retinopatia Diabética/diagnóstico , Técnicas de Diagnóstico Oftalmológico , Programas de Rastreamento/organização & administração , Telemedicina/métodos , Serviços Urbanos de Saúde/organização & administração , Adulto , Feminino , Fundo de Olho , Fidelidade a Diretrizes/normas , Humanos , Masculino , Pessoa de Meia-Idade , Fotografação/métodos , Estudos Retrospectivos
5.
Diabetes Res Clin Pract ; 158: 107898, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31672503

RESUMO

AIM: The aim of this study was to evaluate the adherence to guideline recommended medical therapies in type 2 diabetic patients with chronic critical limb ischemia (CCLI). METHODS: We retrospectively analyzed the data of 1315 admissions performed in our Department, focusing on diabetic foot patients (842-64%) of which 603 consecutive type 2 diabetic patients with CCLI (M/F(%): 73/27; age: 70.3 ±â€¯10.4 yrs; diabetes duration: 17.3 ±â€¯13.7 yrs; BMI: 27.7 ±â€¯5.3 Kg/m2; HbA1c 7.8 ±â€¯1.8%) referred to a third-level Center from 2011 to 2015. We focused on medical therapy of diabetes, dyslipidemia, hypertension, peripheral vascular disease and smoke habits. RESULTS: In total, at admission, 66.6% of patients had HbA1c levels higher than recommended; 65.9% of patients were on statins; 81.4% on anti-hypertensive treatment and 72.4% on antiplatelet drugs. Concerning smoke habits, 27% of patients were no-smokers; 41% former smokers and 32% active smokers. Among all patients, only 24% were prescribed all five guideline recommended therapies while 32% reached four out of five of these. As for patients treated with anti-hypertensive drugs, we observed higher levels of systolic pressure (138.0 ±â€¯29.5 vs 107.7 ±â€¯36.6 p < 0.02) while no differences were observed in diastolic pressure levels. CONCLUSIONS: In conclusion, when it comes to diabetic patients with a severe limb and life threatening clinical condition, we noticed a lower-than-expected application of international guideline-recommended medical therapies. In fact, only one out of four patients was following all the recommended therapies. Nevertheless, these patients did not reach the standard targets requested to prevent cardiovascular disease.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/terapia , Fidelidade a Diretrizes/normas , Isquemia/terapia , Idoso , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco
6.
J Rehabil Med ; 51(11): 834-840, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31583419

RESUMO

OBJECTIVE: To describe a project to develop guideline implementation tools (GItools) for rehabilitation guidelines, and a collaboration between a guideline producer and a healthcare organization to implement guidelines into care pathways. DESIGN: Descriptive case study. METHODS: A national guideline organization in Finland launched a 3-year project in 2015 to implement rehabilitation recommendations. Usability of the GItools was evaluated and improved, based on literature, workshops and surveys. An implementation plan guided the production of the GItools. An implementation plan was developed to integrate the shoulder disorders guideline into a care pathway at Päijät-Häme district rehabilitation unit. The implementation plan was produced in 3 facilitated workshops, which included brainstorming, snowballing, prioritizing and short lectures. RESULTS: Twenty implementation plans and 119 different GItools for 22 guidelines were developed. The GItools, in particular patient material, were perceived as useful for the facilitation of guideline implementation. Four seminars and 14 sessions of continuous medical education were arranged. A plan was developed and executed for the implementation of the shoulder disorders guideline. CONCLUSION: It is feasible for a guideline producer to systematically include GItools into rehabilitation guidelines. This implementation project was an example of a successful collaboration between a guideline producer and a healthcare organization.


Assuntos
Fidelidade a Diretrizes/normas , Reabilitação/métodos , Humanos
7.
J Prev Med Public Health ; 52(5): 277-280, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31588696

RESUMO

The Ministry of Food and Drug Safety of Korea made an official announcement in March 2018 that the total number of inoculations of Hantaan virus vaccine (Hantavax®) would change from 3 to 4. Some aspects of this decision remain controversial. Based on the characteristics of Hantaan virus (HTNV) and its role in the pathogenesis of hemorrhagic fever with renal syndrome, it might be difficult to develop an effective and safe HTNV vaccine through the isolate-inactivate-inject paradigm. With the development of high-throughput 'omics' technologies in the 21st century, vaccinomics has been introduced. While the goal of vaccinomics is to develop equations to describe and predict the immune response, it could also serve as a tool for developing new vaccine candidates and individualized approaches to vaccinology. Thus, the possibility of applying the innovative field of vaccinomics to develop a more effective and safer HTNV vaccine should be considered.


Assuntos
Fidelidade a Diretrizes/normas , Medicina de Precisão , Vacinação , Vacinas , Vírus Hantaan/isolamento & purificação , Humanos , Imunogenética , República da Coreia
8.
BMC Res Notes ; 12(1): 647, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31590689

RESUMO

OBJECTIVE: This study aimed to determine the effect of awareness of subtle control after training on the hand hygiene compliance among nurses in intensive care units (ICUs). The study was conducted in two ICUs of a trauma center in Shiraz, Iran on 48 nurses. The nurses of one ICU were randomly allocated to the intervention and the nurses of the other ICU were allocated to the control group. All nurses were trained on hand hygiene. Then a fake closed camera television (CCTV) was visibly installed in the intervention group's ICU, while the nurses were aware of it. The degree of compliance with hand hygiene was observed in both groups before and after the intervention. Data were gathered using a checklist based on the World Health Organization hand hygiene protocol and analyzed using SPSS 16 and the Chi square, Wilcoxon, Mann-Whitney U, and Independent T-tests, were performed. RESULTS: The mean percentage of hand hygiene compliance in the intervention group after the intervention was significantly higher than before the intervention (p < 0.001). Additionally, the changes in the mean percentage of the intervention group was significantly higher than that for the control group (p = 0.001). The findings showed that a fake CCTV after training, installed in ICUs, can improve hand hygiene compliance.


Assuntos
Higiene das Mãos/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Controle de Infecções/estatística & dados numéricos , Unidades de Terapia Intensiva , Enfermeiras e Enfermeiros/estatística & dados numéricos , Lista de Checagem/normas , Lista de Checagem/estatística & dados numéricos , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/prevenção & controle , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Desinfecção das Mãos/métodos , Desinfecção das Mãos/normas , Higiene das Mãos/métodos , Humanos , Controle de Infecções/métodos , Irã (Geográfico) , Enfermeiras e Enfermeiros/normas
9.
J Stroke Cerebrovasc Dis ; 28(12): 104445, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31627997

RESUMO

BACKGROUND: Stroke is a leading cause of disability worldwide with a great impact on quality of life. Ain Shams University Hospital is a tertiary center for neurology and a pioneer in offering comprehensive stroke service in the region. METHODS: A cross sectional study in which an 8 domains questionnaire was applied to all cerebrovascular stroke patients who were admitted to the stroke unit of the neurology department of Ain Shams University Hospital in the period from January 2016 till May 2017, with the aim to define pitfalls in post discharge. RESULTS: From our study show that 20% of all patients discharged from acute stroke unit did not have further follow up with any stroke doctor. Moreover, 60% of patients were not seen by a physiotherapist after discharge, including almost half of patients with moderate or severe disability on discharge who are expected to have ongoing care needs. Patients who developed stroke complications were more likely to seek follow up. As expected, continuous follow up was associated with increased adherence to secondary preventive medications. CONCLUSIONS: Patient needs should be assessed before patient discharge and patient and care givers should have clear written information on required follow up with stroke doctors, and arrangements made for receiving adequate rehabilitation post discharge.


Assuntos
Continuidade da Assistência ao Paciente/normas , Hospitais Universitários , Sumários de Alta do Paciente Hospitalar/normas , Alta do Paciente/normas , Padrões de Prática Médica/normas , Prevenção Secundária/normas , Acidente Vascular Cerebral/terapia , Idoso , Estudos Transversais , Avaliação da Deficiência , Egito , Feminino , Fidelidade a Diretrizes/normas , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia/normas , Guias de Prática Clínica como Assunto/normas , Prognóstico , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Centros de Atenção Terciária
10.
Dan Med J ; 66(9)2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31495369

RESUMO

INTRODUCTION: The objective of the present study was to validate two questionnaires (the Danish National Tympanostomy Tube Insertion Questionnaires (DANTIQ)) intended for use by the DØNHO database in the investigation of the effect of tympanic tube (TT) insertion on ear-related symptoms and the adherence of ear, nose and throat (ENT) specialists in Danish private practice to the Danish National Clinical Guideline on treatment of otitis media (OM) with TT insertion using electronic patient-reported outcome (ePRO) data. METHODS: The content validity of the questionnaires was assessed through discussion in a group of four active ENT specialists. Face and content validity analyses were conducted using data from semi-structured, single-person interviews with nine subjects. Reliability analysis was conducted as a three-day test/re-test study involving two groups of 117 individuals receiving and answering the same questionnaire twice. RESULTS: The overall face validity of both questionnaires was satisfactory. The reliability of the answers for both questionnaires was considered acceptable with a proportion of agreement ranging from 1.00 to 0.77. The correlation between first and second scores of the total number of symptoms reported in the test/re-test setup was acceptable with results ranging from 0.93 to 0.84. CONCLUSIONS: The DANTIQ are valid and reliable for measuring ear-related symptoms in children with OM undergoing TT insertion and for investigating Danish private ENT specialists' adherence to guidelines concerning TT insertion by use of ePRO data. FUNDING: non. TRIAL REGISTRATION: not relevant.


Assuntos
Fidelidade a Diretrizes/normas , Ventilação da Orelha Média/normas , Inquéritos e Questionários/normas , Criança , Dinamarca , Humanos , Otite Média/fisiopatologia , Otite Média/cirurgia , Otolaringologia/normas , Pais/psicologia , Reprodutibilidade dos Testes
12.
Crit Care Nurs Q ; 42(4): 376-391, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31449148

RESUMO

In this article, we discuss the literature behind the use of paralytics, sedation, and steroids in acute respiratory distress syndrome. We explore the controversies and discuss the recommendations for the use of these agents.


Assuntos
Adjuvantes Anestésicos/uso terapêutico , Corticosteroides/uso terapêutico , Atracúrio/análogos & derivados , Bloqueadores Neuromusculares/uso terapêutico , Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico , Atracúrio/administração & dosagem , Enfermagem de Cuidados Críticos , Fidelidade a Diretrizes/normas , Humanos
13.
J Infus Nurs ; 42(2): 249-253, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464833

RESUMO

Every health care facility aims to achieve and maintain a zero central line-associated bloodstream infection (CLABSI) rate. Infections can be costly for institutions of any size and are often not covered by health insurance. The interventions put in place in this quality improvement project were implemented in 4 phases: (1) develop a new standard of care for central lines and give nurses full responsibility for the care and handling of these lines (including blood sampling); (2) revise policy and provide educational sessions to support nurses; (3) document compliance with the new policy; and (4) document CLABSI rates. The project took place during a 15-month period between January 1, 2016 and March 30, 2017, in 4 critical care units in a university medical center in Lebanon. The results revealed a reduction in CLABSI rates from a maximum rate of more than 17 per 1000 catheter days to zero per 1000 catheter days, which was sustained for 10 months. Nurse compliance with the new policy after 3 months ranged from 95% to 99%.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/normas , Enfermagem de Cuidados Críticos/educação , Fidelidade a Diretrizes/normas , Controle de Infecções/normas , Unidades de Terapia Intensiva , Centros Médicos Acadêmicos , Adulto , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Líbano , Melhoria de Qualidade
14.
Medicina (Kaunas) ; 55(9)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31454896

RESUMO

Background and objectives: Extemporaneous preparations are pharmaceutical preparations individually prepared for a specific patient or patient group, but also high-risk products accompanied by doubts regarding their safety and quality. Legislation regulating the compounding of extemporaneous preparations is not harmonized among European countries. This problem is partially resolved by Resolution CM/Res(2016)1 on quality and safety assurance requirements for medicinal products prepared in pharmacies for the special needs of patients. In order to understand the relevance of extemporaneous compounding in Latvia and the fulfillment of the abovementioned resolution's requirements, it is essential to get information about the volume and breakdown of sales of extemporaneous medicinal products in community pharmacies. The purpose of this survey is to identify the sales volume of extemporaneous preparations in community pharmacies in Latvia in 2017 by analyzing unpublished data of the State Agency of Medicines (SAM), as well as comparing Latvian laws with the requirements of the resolution. Materials and Methods: A separate Microsoft Excel spreadsheet was prepared for each statistical region in order to summarize the unpublished information of SAM on the turnover of extemporaneous preparations in 2017 in all Latvian statistical regions. In order to compare the regulatory framework in Latvia with the resolution, the Latvian Pharmaceutical Law and the Cabinet of Ministers Regulations regulating prescription, compounding and control of extemporaneous preparations in community pharmacies were analyzed. Results: Only 280 of 384 pharmacies submitted a report of sales of extemporaneous preparations for 2017 to the SAM. These pharmacies represented all Latvian statistical regions. Extemporaneous preparations were mostly sold in Riga (78.93%). The Latvian regulation does not include all paragraphs of the resolution. Most of the paragraphs of the resolution are described in Latvian regulatory enactments only partially. Conclusions: The total number of compounding pharmacies evidence that the service is needed. Latvian example highlights a necessity for European Union countries to compare their national legislation with the requirements of the resolution's last version and, if necessary, implement relevant amendments.


Assuntos
Controle de Medicamentos e Entorpecentes/tendências , Preparações Farmacêuticas/economia , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Fidelidade a Diretrizes/normas , Humanos , Letônia , Segurança do Paciente/normas , Segurança do Paciente/estatística & dados numéricos , Preparações Farmacêuticas/normas , Farmácias/economia , Farmácias/normas , Farmácias/estatística & dados numéricos , Inquéritos e Questionários
15.
Int J Radiat Oncol Biol Phys ; 105(2): 329-337, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31299242

RESUMO

PURPOSE: The ongoing phase 2/3 PRODIGE 26/CONCORDE trial compares chemoradiation therapy with and without dose escalation in patients with locally advanced or unresectable esophageal cancer. The results of a benchmark case procedure are reported here to evaluate the protocol compliance of participating centers as part of quality assurance for radiation therapy. METHODS AND MATERIALS: Volume delineation, target coverage, and dose constraints to the organs at risk (OARs) were assessed on treatment plans of a common benchmark case performed by each participating center. The centers were classified in 3 categories: per protocol, minor acceptable deviation (MiD), or major unacceptable deviation (MaD). A plan was rejected if ≥4 MiDs or 1 MaD were found. RESULTS: Thirty-5 centers submitted 43 plans. Among them, 14 (32.6%) were per protocol, 19 (44.2%) presented at least 1 MiD, 2 (4.6%) presented at least 1 MaD, and 8 (18.6%) presented both MiD and MaD. Overall, 11 (25.6%) plans were rejected. Only 1 plan was rejected because gross tumor volume was not correctly delineated. The OAR delineation was respected in all cases. Dose constraints to the OARs were respected in the majority of cases except for the heart, where one-third of the plans presented a deviation. As for the target volume, 3 plans (5.8%) had a major underdosage and 1 plan (1.9%) had a major overdosage. Overall, 58% of all treatments were planned with intensity modulated radiation therapy, whereas 42% were planned with 3-dimensional chemoradiation therapy. Significantly more plans in the intensity modulated radiation therapy group were accepted compared with the 3-dimensional chemoradiation therapy group (P = .03). CONCLUSION: The high frequency of protocol deviations underlines the importance of a quality assurance program in clinical trials. Further work should assess the impact of quality assurance for radiation therapy on patient outcomes.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Quimiorradioterapia/normas , Neoplasias Esofágicas/diagnóstico por imagem , Órgãos em Risco/diagnóstico por imagem , Garantia da Qualidade dos Cuidados de Saúde , Planejamento da Radioterapia Assistida por Computador/normas , Radioterapia de Intensidade Modulada/normas , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Benchmarking , Institutos de Câncer/classificação , Institutos de Câncer/normas , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia/métodos , Cisplatino/administração & dosagem , Esquema de Medicação , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Fluoruracila/administração & dosagem , França , Fidelidade a Diretrizes/classificação , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Coração/efeitos da radiação , Humanos , Rim/diagnóstico por imagem , Leucovorina/administração & dosagem , Fígado/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Irradiação Linfática/métodos , Irradiação Linfática/normas , Masculino , Compostos Organoplatínicos/administração & dosagem , Órgãos em Risco/efeitos da radiação , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/classificação , Planejamento da Radioterapia Assistida por Computador/estatística & dados numéricos , Radioterapia Conformacional/normas , Medula Espinal/diagnóstico por imagem , Carga Tumoral
16.
Nutrients ; 11(7)2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31261665

RESUMO

Sodium intake in Argentina has been estimated to be at least double the dose of 2000 mg/day recommended by WHO, mostly coming from processed foods. Argentina is one of the few countries in the world that have regulated sodium content in certain food products. This study presents an assessment of sodium content in a selection of food groups and categories as reported in the nutrient information panels. We surveyed 3674 food products, and the sodium content of 864 and 1375 of them was compared to the maximum levels according to the Argentinean law and the regional targets, respectively. All food categories presented high variability of sodium content. Over 90% of the products included in the national sodium reduction law were found to be compliant. Food groups with high median sodium, such as condiments, sauces and spreads, and fish and fish products, are not included in the national law. In turn, comparisons with the lower regional targets indicated that almost 50% of the products analyzed had sodium contents above the recommended values. This evidence suggests that enhancing sodium reduction in processed foods may be a necessity for public health objectives and it is also technically feasible in Argentina.


Assuntos
Manipulação de Alimentos/legislação & jurisprudência , Rotulagem de Alimentos/legislação & jurisprudência , Indústria de Processamento de Alimentos/legislação & jurisprudência , Fidelidade a Diretrizes/legislação & jurisprudência , Guias como Assunto , Recomendações Nutricionais/legislação & jurisprudência , Sódio na Dieta/análise , Argentina , Estudos Transversais , Manipulação de Alimentos/normas , Rotulagem de Alimentos/normas , Indústria de Processamento de Alimentos/normas , Fidelidade a Diretrizes/normas , Guias como Assunto/normas , Humanos , Controle de Qualidade , Melhoria de Qualidade , Sódio na Dieta/efeitos adversos , Sódio na Dieta/normas
17.
Nurse Educ Today ; 81: 72-77, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31330405

RESUMO

BACKGROUND: The risk of acquiring and spreading infection must be minimized in nursing students because they are exposed to healthcare-associated infections during clinical training. To achieve this goal, students should be knowledgeable and competent in infection control practice before proceeding to their training hospitals. OBJECTIVES: This study assessed the nursing students' perception of the infection prevention climate in training hospitals in Saudi Arabia. It also examined the predictors of the students' perceptions. DESIGN: A quantitative, cross-sectional design was used. METHODS: This investigation was part of a large study conducted in six Saudi universities. A total of 829 Saudi nursing students were included in this study. Data were collected using the Leading Culture of Quality in Infection Prevention scale and analyzed using descriptive and inferential statistics. Ethical approval was obtained from the King Saud University, and permission was given by the administration of each participating university. RESULTS: The overall perception of nursing students indicated a modest infection prevention climate. Prioritization of quality and improvement orientation was rated as the highest dimensions, whereas psychological safety and supportive environment were the lowest. The nursing students in University F had the poorest perceptions among the six universities. The predictors of nursing student perception of their training hospitals' infection prevention climates were the university where they studied, their age, and participation in infection prevention seminars. CONCLUSIONS: This article describes nursing students' perception of the infection prevention climate of their training hospitals in Saudi Arabia. Results may provide a unique theoretical underpinning on the perception and factors that effect an infection prevention climate. Thereby, previous knowledge and literature may be expanded. Results can be used as a guide in establishing clinical policies in efforts toward improving the infection prevention climate.


Assuntos
Infecção Hospitalar/enfermagem , Infecção Hospitalar/prevenção & controle , Controle de Infecções/normas , Estudantes de Enfermagem/psicologia , Universidades , Estudos Transversais , Currículo , Bacharelado em Enfermagem , Feminino , Fidelidade a Diretrizes/normas , Hospitais , Humanos , Masculino , Arábia Saudita , Estudantes de Enfermagem/estatística & dados numéricos , Inquéritos e Questionários
18.
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 , 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
19.
J Surg Res ; 244: 9-14, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31279266

RESUMO

BACKGROUND: Thyroid nodules are highly prevalent, and owing to their malignant potential, proper evaluation is imperative. The objective of this study was to characterize variation in thyroid nodule evaluations. MATERIALS AND METHODS: This retrospective review included all consecutive surgical referrals for thyroid nodules from October to December 2017 at a single institution. We determined the proportion of evaluations that contained a thyroid-stimulating hormone (TSH) level and a high-quality ultrasound because these components of thyroid nodule evaluations are common to several evidence-based guidelines. RESULTS: The study cohort included 64 patients, with a median age of 51.5 y. Primary care providers referred most patients (51.6%), followed by endocrinologists (40.6%), and other specialists (7.8%). In total, 35.9% of evaluations did not include a TSH value, which is vital to any thyroid nodule evaluation. Most evaluations (95.3%) included a dedicated ultrasound, but only 12.3% of ultrasound reports commented on nodule size in three dimensions, structure, echogenicity, and lymph nodes, which we considered the minimum commentary indicative of a high-quality ultrasound. Only 51.5% of evaluations included both a TSH and a thyroid ultrasound. If patients receiving low-quality ultrasound reports were excluded, 9.4% of the entire cohort received a guideline-concordant, high-quality evaluation. CONCLUSIONS: Great variation exists in the quality of thyroid nodule evaluations before surgical referral. Two necessary components of thyroid nodule evaluations that contribute most to the observed deviation from guidelines are obtaining a TSH value and obtaining an ultrasound with enough information to risk stratify the nodule.


Assuntos
Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde/normas , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco/normas , Medição de Risco/estatística & dados numéricos , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/sangue , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia , Tireotropina/sangue , Ultrassonografia/estatística & dados numéricos
20.
Int J Cardiovasc Imaging ; 35(12): 2157-2166, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31346831

RESUMO

2016 guidelines for the echographic evaluation of left ventricular filling pressure (LVFP) proposed a single algorithm with limited number of criteria (E/A ratio, tricuspid regurgitation velocity, left atrial volume index and average E/e') mainly related to left atrial pressure. Pulmonary venous flow analysis, evaluating more specifically left ventricular end diastolic pressure (LVEDP) has been withdrawn. We aim to evaluate the proportion of patients diagnosed with normal LVFP according to 2016 recommendations, despite an abnormal pulmonary venous flow profile suggesting high LVEDP. We prospectively studied patients with stable ischemic cardiomyopathy and aortic stenosis, before cardiac surgery. Extensive echocardiography was performed including pulmonary and mitral A wave durations. We included 76 patients (mean age 72 ± 10 years, 78% were men), 37 (49%) with aortic stenosis and 22 (29%) with ischemic cardiomyopathy. Mean left ventricular ejection fraction was 67 ± 11%. Applying recommendations, 58 patients had normal LVFP and 15 patients had high LVFP. Among the 58 patients with normal LVFP, 26 patients had Apd-Amd duration > 30 ms highly suggestive of high LVEDP. These patients had higher LV mass (112 ± 30 g/m2 vs. 86 ± 20 g/m2, p = 0.004) and shorter A wave duration (120 ± 13.6 ms vs. 132 ± 16.5 ms, p = 0.006) as compared to the remaining 15 patients with concordant evaluation (normal LVFP and normal Apd-Amd). In the present study, we found that 26/58 patients with low LVFP according to the 2016 recommendations had Apd-Amd suggestive of high LVEDP. Pulmonary venous flow should be added to the algorithm, particularly in patients with unexplained symptom, high LV mass or truncated mitral A wave.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Ecocardiografia Doppler/normas , Fidelidade a Diretrizes/normas , Guias de Prática Clínica como Assunto/normas , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Pressão Ventricular , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/fisiopatologia , Cardiomiopatias/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Disfunção Ventricular Esquerda/fisiopatologia
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