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1.
Medicine (Baltimore) ; 99(43): e22876, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120829

RESUMO

BACKGROUND: Spontaneous intracerebral hemorrhage (sICH) is a serious stroke subtype. The effective therapies for patients with sICH are still unclear, and the role of hemostatic agents in sICH is still unclear. Although some studies have shown that hemostatic agents could benefit patients with sICH, different hemostatic drugs have different effects on patients with sICH, and which hemostatic drug has the best effect on the prevention of hematoma expansion and neurological deterioration in sICH patients remains unclear. To better understand the effects of hemostatic agents in patients with sICH, it is necessary to carry out a network meta-analysis to comprehensively compare the effects of different hemostatic agents. METHODS: This protocol has been designed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. Related studies in the following databases will be searched until September 2020: PubMed, Embase, Scopus, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, VIP and Wanfang. Randomized controlled trials and nonrandomized controlled studies comparing at least 2 different hemostatic agents in sICH patients will be included. A quality assessment will be conducted with the Cochrane Collaboration tool or the Newcastle-Ottawa Scale based on the study design. The primary outcome will be the incidence of hematoma expansion, and the secondary outcome will be the functional outcome. Pairwise and network meta-analyses will be conducted using STATA V.14 (StataCorp, College Station, Texas, USA). Mean ranks and the surface under the cumulative ranking curve will be used to evaluate every agent. Statistical inconsistency assessment, subgroup analysis, sensitivity analysis and publication bias assessment will be performed. RESULTS: According to disseminate through academic conferences, the results of this network meta-analysis are expected to publish in a peer-reviewed journal. CONCLUSION: This study will provide high quality evidence about effects of different hemostatic agents in patients with sICH. REGISTRATION NUMBER: CRD42020196039.


Assuntos
Hemorragia Cerebral/tratamento farmacológico , Hematoma/prevenção & controle , Hemostáticos/uso terapêutico , Doenças do Sistema Nervoso/prevenção & controle , China/epidemiologia , Gerenciamento de Dados , Feminino , Hematoma/epidemiologia , Hemostáticos/administração & dosagem , Humanos , Incidência , Masculino , Metanálise em Rede , Ensaios Clínicos Controlados não Aleatórios como Assunto , Avaliação de Resultados da Assistência ao Paciente , Garantia da Qualidade dos Cuidados de Saúde/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Medicine (Baltimore) ; 99(39): e22284, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991430

RESUMO

BACKGROUND: Plate fixation and intramedullary nail/Knowles pin fixation methods are commonly used to treat displaced midshaft clavicle fractures. However, the differences between these 2 methods are unclear. OBJECTIVE: This meta-analysis aimed to compare plate fixation and intramedullary nail/Knowles pin fixation for displaced midshaft clavicle fractures. METHODS: We searched PubMed, EBM reviews, and Ovid Medline online for studies related to comparison of plate fixation versus intramedullary nail/Knowles pin fixation for displaced midshaft clavicle fracture from inception to June 30, 2019. Relevant literature search, data extraction, and quality assessment will be performed by 2 researchers independently. The methodological quality of all included studies was appraised using the Cochrane system for randomized trials. The RevMan 5.2 software was used for heterogeneity assessment, generating funnel-plots, data synthesis, sensitivity analysis, and determining publication bias. The fixed-effects or random-effects model was used to calculate mean difference (MD)/relative risks (RRs) and 95% confidence intervals (CIs). RESULTS: This meta-analysis included 839 patients from 12 randomized controlled trials. We found that compared to plate fixation, intramedullary nail/Knowles pin fixation yielded a higher shoulder constant score [MD = -2.43, 95% CI (-3.46 to -1.41), P < .00001] and lower disabilities of the arm, shoulder and hand (DASH) score [MD = 2.98, 95% CI (0.16-5.81), P = .04], and lower infection rates [RR = 2.05, 95% CI (1.36-3.09), P = .003], operation time [MD = 20.20, 95% CI (10.80-29.60), P < .0001], incision size [MD = 6.09, 95% CI (4.54-7.65), P < .00001], and hospital stay [MD = 1.10, 95% CI (0.56-1.64), P < .00001] but with a higher removal rate [RR = 0.52, 95% CI (0.41-0.65), P < .00001] compared to plate fixation. There were no significant differences in nonunion, reintervention, or revision and refracture between these two methods. The limitation is that many studies did not demonstrate the random generated details, and only English articles were enrolled in this meta-analysis. CONCLUSIONS: Intramedullary nail/Knowles pin fixation might be an optimum choice for treating displaced midshaft clavicle fractures, with similar performance in terms of the nonunion, reintervention, or revision and refracture, and better shoulder constant and DASH scores, infection rates, and operative parameters.


Assuntos
Placas Ósseas/efeitos adversos , Clavícula/patologia , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , Adulto , Pinos Ortopédicos/efeitos adversos , Avaliação da Deficiência , Feminino , Fixação Intramedular de Fraturas/instrumentação , Fraturas Ósseas/classificação , Fraturas não Consolidadas/epidemiologia , Humanos , Infecções/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Avaliação de Resultados em Cuidados de Saúde , Garantia da Qualidade dos Cuidados de Saúde/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação/estatística & dados numéricos , Risco , Sensibilidade e Especificidade , Ferida Cirúrgica/classificação , Ferida Cirúrgica/epidemiologia
3.
Ann Biol Clin (Paris) ; 78(5): 574-580, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32716002

RESUMO

Laboratories need to set up effective overall management of their internal quality control (IQC) and external quality assessment (EQA) results as key elements in statistical process control. Quality targets need to be defined, with methods to ensure durable control with respect to the relevant specifications. The hemostasis laboratory of the Lyon Hospitals Board (HCL, Lyon, France) uses model 3 from the Milan consensus conference, which is the state of the art in terms of quality targets, and uses a common EQA provider supplying as many real patient samples as possible. Giving priority to adopted methods, the lab optimizes the use of manufacturers' prior data: maximum acceptable inter assay coefficient of variation (CV) and prior IQC target values. Bayesian inference brings the method under control with respect to the manufacturers' prior data without the need for a preliminary phase. It links the IQC and EQA plans by the maximum acceptable CVs defined by the manufacturer.


Assuntos
Testes Hematológicos/estatística & dados numéricos , Testes Hematológicos/normas , Laboratórios Hospitalares/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde , Teorema de Bayes , Testes de Coagulação Sanguínea/instrumentação , Testes de Coagulação Sanguínea/métodos , Testes de Coagulação Sanguínea/normas , Testes de Coagulação Sanguínea/estatística & dados numéricos , Serviços de Laboratório Clínico/organização & administração , Serviços de Laboratório Clínico/normas , Serviços de Laboratório Clínico/estatística & dados numéricos , França/epidemiologia , Testes Hematológicos/instrumentação , Testes Hematológicos/métodos , Hemostasia/fisiologia , Humanos , Laboratórios Hospitalares/organização & administração , Laboratórios Hospitalares/normas , Ensaio de Proficiência Laboratorial/organização & administração , Ensaio de Proficiência Laboratorial/normas , Ensaio de Proficiência Laboratorial/estatística & dados numéricos , Prática Profissional/organização & administração , Prática Profissional/normas , Prática Profissional/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Controle de Qualidade , Estudos Retrospectivos
4.
Medicine (Baltimore) ; 99(29): e20542, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702812

RESUMO

BACKGROUND: This study will investigate the clinical efficacy of Duyiwei capsule (DYWC) for the treatment of gingivitis. METHODS: Relevant studies will be searched in PUBMED, EMBASE, Cochrane Library, WANGFANG, VIP, CBM, and CNKI from inception to the March 31, 2020 without limitations of language and publication time. All potential randomized controlled trials on the clinical efficacy of DYWC for the treatment of gingivitis will be considered. Two authors will independently perform literature selection, data collection, and study quality assessment. Any disagreements will be solved by a third author through discussion. We will utilize RevMan 5.3 software for statistical analysis. RESULTS: This study will summarize present randomized controlled trials on the efficacy and safety of DYWC for the treatment of gingivitis. CONCLUSION: The findings of this study will provide evidence to show whether DYWC is effective and safety for gingivitis.Systematic review registration: INPLASY202040199.


Assuntos
Gengivite/tratamento farmacológico , Gengivite/patologia , Medicina Tradicional Chinesa/métodos , Feminino , Humanos , Masculino , Medicina Tradicional Chinesa/efeitos adversos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Resultado do Tratamento
6.
Ann Palliat Med ; 9(3): 1198-1205, 2020 May.
Artigo em Inglês | MEDLINE | ID: covidwho-530660

RESUMO

BACKGROUND: Nursing quality is an integral part of health care quality and one of key performance indicators (KPIs) for health care management. The Plan-Do-Check-Act (PDCA) cycle is a management tool for continuous improvement of a business's products or processes. It can be applied to standardize nursing management and thus improve the nursing quality and increase the survival rate of patients. This study assessed the value of the PDCA cycle in standardizing nursing management in an intensive care unit (ICU) for patients with severe coronavirus disease 2019 (COVID-19). METHODS: The status quo of the ICU was analyzed, and the relevant issues and countermeasures were proposed. The PDCA cycle was applied to standardize the nursing management in the ICU. RESULTS: Nine measures were proposed and applied to improve the management of the COVID-19 ICU: defining the clean or contaminated areas, use of self-designed shoe storage cabinets, defining staff roles and responsibilities, establishing the staffing structure, staff training, placing items at fixed locations, improving shift handover, use of bulletin boards for listing key points, and use of reserved drugs cabinets. The virus contamination awareness, professional skills, awareness of duties and responsibilities, and quality and performance of nursing were remarkably improved 2 weeks after the implementation of the above countermeasures. CONCLUSIONS: The PDCA cycle helps to standardize nursing management in COVID-19 ICU by developing and applying effective nursing management approaches.


Assuntos
Infecções por Coronavirus/enfermagem , Enfermagem de Cuidados Críticos/organização & administração , Enfermagem de Cuidados Críticos/normas , Unidades de Terapia Intensiva/organização & administração , Pneumonia Viral/enfermagem , Garantia da Qualidade dos Cuidados de Saúde/métodos , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Humanos , Pesquisa em Administração de Enfermagem , Pesquisa em Avaliação de Enfermagem , Pandemias , Pneumonia Viral/epidemiologia
7.
J Infect Public Health ; 13(9): 1322-1329, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32473817

RESUMO

BACKGROUND: The national committee for control of viral hepatitis (NCCVH) in Egypt, settled by the Ministry of health, treated over one million patients in around 60 centers with chronological changes in drug combinations. This research aims to study the health care facilities and services provided by NCCVH treatment centers in Egypt and explore hinders faced. METHODS: A cross-sectional operational research study. Multistage random sampling technique was applied for Egyptian governorates. From each stratum one governorate was chosen from which one center was randomly selected. Quality of recorded data for each center in the central server (Data-oriented parameter), newly designed score to assess the overall performance of the centers was retrieved from computer based recording system. A self-administered questionnaire was completed by the centers head. RESULTS: This study included 24 treatment centers from urban, rural areas, Upper and Lower Egypt. The Upper centers showed the best completeness of follow-up records and the least compliance rates. None of the centers had 100% completeness of follow-up data. Proportion of SVR is minimally less than proportion of patient with known outcome in all treatment centers. A novel indicator standardizing the comparisons of performance of different facilities was introduced: Total number of physicians/total number of SVR patients with completed records. The highest response rate: Monfiya Governorate (Lower Egypt), Aswan (Upper Egypt), Completeness of follow-up records: Kalyoubia (Lower Egypt), Sohag governorate (Upper Egypt). The average administrative score was 64%. CONCLUSION: Challenges of NCCVH program: overcrowdings, resistant sociocultural background among rural patients, limited accessibility for internal migrants and incompleteness of data entry are system lacking points. Strengths include, clear patient pathway, well-established database online application, well-trained physicians and treatment availability.


Assuntos
Instalações de Saúde/normas , Hepatite C Crônica/terapia , Estudos Transversais , Egito , Instalações de Saúde/estatística & dados numéricos , Hepacivirus , Hepatite C Crônica/prevenção & controle , Humanos , Avaliação de Resultados em Cuidados de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Inquéritos e Questionários
8.
Ann Palliat Med ; 9(3): 1198-1205, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32498535

RESUMO

BACKGROUND: Nursing quality is an integral part of health care quality and one of key performance indicators (KPIs) for health care management. The Plan-Do-Check-Act (PDCA) cycle is a management tool for continuous improvement of a business's products or processes. It can be applied to standardize nursing management and thus improve the nursing quality and increase the survival rate of patients. This study assessed the value of the PDCA cycle in standardizing nursing management in an intensive care unit (ICU) for patients with severe coronavirus disease 2019 (COVID-19). METHODS: The status quo of the ICU was analyzed, and the relevant issues and countermeasures were proposed. The PDCA cycle was applied to standardize the nursing management in the ICU. RESULTS: Nine measures were proposed and applied to improve the management of the COVID-19 ICU: defining the clean or contaminated areas, use of self-designed shoe storage cabinets, defining staff roles and responsibilities, establishing the staffing structure, staff training, placing items at fixed locations, improving shift handover, use of bulletin boards for listing key points, and use of reserved drugs cabinets. The virus contamination awareness, professional skills, awareness of duties and responsibilities, and quality and performance of nursing were remarkably improved 2 weeks after the implementation of the above countermeasures. CONCLUSIONS: The PDCA cycle helps to standardize nursing management in COVID-19 ICU by developing and applying effective nursing management approaches.


Assuntos
Infecções por Coronavirus/enfermagem , Enfermagem de Cuidados Críticos/organização & administração , Enfermagem de Cuidados Críticos/normas , Unidades de Terapia Intensiva/organização & administração , Pneumonia Viral/enfermagem , Garantia da Qualidade dos Cuidados de Saúde/métodos , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Humanos , Pesquisa em Administração de Enfermagem , Pesquisa em Avaliação de Enfermagem , Pandemias , Pneumonia Viral/epidemiologia
9.
JAMA Netw Open ; 3(5): e205535, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32459354

RESUMO

Importance: Clinical practice guidelines (CPGs) may lack rigor and suitability to the setting in which they are to be applied. Methods to yield clinical practice guideline recommendations that are credible and implementable remain to be determined. Objective: To describe the development of AGREE-REX (Appraisal of Guidelines Research and Evaluation-Recommendations Excellence), a tool designed to evaluate the quality of clinical practice guideline recommendations. Design, Setting, and Participants: A cross-sectional study of 322 international stakeholders representing CPG developers, users, and researchers was conducted between December 2015 and March 2019. Advertisements to participate were distributed through professional organizations as well as through the AGREE Enterprise social media accounts and their registered users. Exposures: Between 2015 and 2017, participants appraised 1 of 161 CPGs using the Draft AGREE-REX tool and completed the AGREE-REX Usability Survey. Main Outcomes and Measures: Usability and measurement properties of the tool were assessed with 7-point scales (1 indicating strong disagreement and 7 indicating strong agreement). Internal consistency of items was assessed with the Cronbach α, and the Spearman-Brown reliability adjustment was used to calculate reliability for 2 to 5 raters. Results: A total of 322 participants (202 female participants [62.7%]; 83 aged 40-49 years [25.8%]) rated the survey items (on a 7-point scale). All 11 items were rated as easy to understand (with a mean [SD] ranging from 5.2 [1.38] for the alignment of values item to 6.3 [0.87] for the evidence item) and easy to apply (with a mean [SD] ranging from 4.8 [1.49] for the alignment of values item to 6.1 [1.07] for the evidence item). Participants provided favorable feedback on the tool's instructions, which were considered clear (mean [SD], 5.8 [1.06]), helpful (mean [SD], 5.9 [1.00]), and complete (mean [SD], 5.8 [1.11]). Participants considered the tool easy to use (mean [SD], 5.4 [1.32]) and thought that it added value to the guideline enterprise (mean [SD], 5.9 [1.13]). Internal consistency of the items was high (Cronbach α = 0.94). Positive correlations were found between the overall AGREE-REX score and the implementability score (r = 0.81) and the clinical credibility score (r = 0.76). Conclusions and Relevance: This cross-sectional study found that the AGREE-REX tool can be useful in evaluating CPG recommendations, differentiating among them, and identifying those that are clinically credible and implementable for practicing health professionals and decision makers who use recommendations to inform clinical policy.


Assuntos
Guias de Prática Clínica como Assunto/normas , Garantia da Qualidade dos Cuidados de Saúde/métodos , Adulto , Estudos Transversais , Feminino , Política de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Garantia da Qualidade dos Cuidados de Saúde/normas , Reprodutibilidade dos Testes , Participação dos Interessados
10.
PLoS One ; 15(5): e0233538, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469920

RESUMO

INTRODUCTION: Simulation is a powerful tool for training and evaluating clinicians. However, few studies have examined the consistency of actor performances during simulation based medical education (SBME). The Simulated Communication with ICU Proxies trial (ClinicalTrials.gov NCT02721810) used simulation to evaluate the effect of a behavioral intervention on physician communication. The purpose of this secondary analysis of data generated by the quality assurance team during the trial was to assess how quality assurance monitoring procedures impacted rates of actor errors during simulations. METHODS: The trial used rigorous quality assurance to train actors, evaluate performances, and ensure the intervention was delivered within a standardized environment. The quality assurance team evaluated video recordings and documented errors. Actors received both timely, formative feedback and participated in group feedback sessions. RESULTS: Error rates varied significantly across three actors (H(2) = 8.22, p = 0.02). In adjusted analyses, there was a decrease in the incidence of actor error over time, and errors decreased sharply after the first group feedback session (Incidence Rate Ratio = 0.25, 95% confidence interval 0.14-0.42). CONCLUSIONS: Rigorous quality assurance procedures may help ensure consistent actor performances during SBME.


Assuntos
Feedback Formativo , Simulação de Paciente , Garantia da Qualidade dos Cuidados de Saúde/métodos , Idoso de 80 Anos ou mais , Humanos , Masculino
11.
Updates Surg ; 72(3): 573-582, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32415666

RESUMO

Many systematic reviews have been published to evaluate the clinical benefits of robotic surgery for gastric cancer. However, these reviews have investigated various outcomes and differ considerably in quality. In this overview, we summarize the findings and quality of these reviews. A comprehensive literature search was conducted using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials to identify systematic reviews and meta-analyses that compared robotic surgery with laparoscopic surgery for gastric cancer. We summarized the results of the meta-analyses and evaluated the quality of the reviews using the AMSTAR-2 tool. The literature search identified 14 eligible reviews. The reviews showed that estimated blood loss was significantly less and time to resumption of oral intake was significantly shorter in patients who underwent robotic surgery than in those who underwent laparoscopic surgery. However, no significant differences in other outcomes were found between the two types of surgery. The quality of the included reviews was judged to be critically low. In conclusion, the available evidence, albeit of critically low quality, suggests that robotic surgery decreases estimated blood loss and shortens the time to resumption of oral intake in patients with gastric cancer. There is currently no high-quality evidence that robotic surgery has clinical benefits for gastric cancer patients.


Assuntos
Laparoscopia , Garantia da Qualidade dos Cuidados de Saúde/métodos , Qualidade da Assistência à Saúde , Procedimentos Cirúrgicos Robóticos , Neoplasias Gástricas/cirurgia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Ingestão de Alimentos , Humanos , Duração da Cirurgia , Resultado do Tratamento
14.
BMC Infect Dis ; 20(1): 355, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32429860

RESUMO

BACKGROUND: Microscopic examination of peripheral blood smear produces reliable results both about the malaria infection status and level of parasitemia. However, test results are affected by skill of the laboratory personnel, workload, condition of microscopes and quality of laboratory supplies. Therefore, continuous monitoring of the performance of laboratories is of pivotal importance in order to make timely correction. METHODS: A facility based cross-sectional study was conducted from July 2017 to July 2019 to assess malaria microscopy performance among thirty malaria diagnostic laboratories in west Amhara region. Thirty slides were collected from participating laboratories every quarter. Collected slides were taken to Amhara Public Health Institute reference laboratory and re-checked by malaria microscopists who were blind to the results from health facilities. Percentage of test agreement, rates of false positive, false negative and species misdiagnosis were calculated using Excel 2010. RESULTS: Among a total of 6689 slides re-checked, results of 6146 slides were the same with that of participating laboratories. The test agreement was 97.31 and 94.6% for parasite detection and species identification, respectively. Variations in the overall performance of individual laboratories were seen within a range of 81.55 to 97.27% test agreement. Results of 543 (8.12%) slides were discordant, of which 363 (5.4%), 93 (1.4%) and 87 (1.3%) slides were due to species misdiagnosis, false positive and false negative results, respectively. CONCLUSION: There was good test agreement between participated laboratories and Amhara Public Health Institute. More accurate performance is expected as the country is tracking to malaria elimination. Hence, further strengthening the external quality assurance program is recommended.


Assuntos
Instalações de Saúde , Malária/diagnóstico por imagem , Microscopia/métodos , Plasmodium falciparum/isolamento & purificação , Plasmodium vivax/isolamento & purificação , Garantia da Qualidade dos Cuidados de Saúde/métodos , Estudos Transversais , Confiabilidade dos Dados , Testes Diagnósticos de Rotina/métodos , Diagnóstico Precoce , Etiópia , Humanos , Laboratórios/normas , Malária/parasitologia , Parasitemia/diagnóstico por imagem
15.
Medicine (Baltimore) ; 99(20): e20180, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443337

RESUMO

BACKGROUND: Previous clinical studies have reported that clinical value of high-frequency ultrasound combined computed tomography (HFUCT) is used for diagnosis of thyroid tumor (TT). However, no study has investigated this topic systematically. Therefore, this study will evaluate the clinical value of HFUCT for the diagnosis of TT. METHODS: We will search the databases of Cochrane Library, EMBASE, PUBMED, SCOPUS, Web of Science, OpenGrey, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and China National Knowledge Infrastructure from any time period published to the present. We will consider all case-controlled studies that assessed the clinical value of HFUCT for diagnosis of TT. Two authors will independently scan titles and abstracts to check eligible studies, followed by full-text read. We will extract data and assess study quality using Quality Assessment of Diagnostic Accuracy Studies tool. RevMan 5.3 software will be utilized for data pooling and statistical analysis. RESULTS: This study will be performed to assess the clinical value of HFUCT for the diagnosis of TT, and will provide an evidence-based synthesis for clinical application and further study. CONCLUSION: Summary of this study will provide the latest evidence to determine whether HFUCT can be used for TT diagnosis accurately. STUDY REGISTRATION: INPLASY202040022.


Assuntos
Imagem Multimodal/métodos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Estudos de Casos e Controles , China/epidemiologia , Humanos , Imagem Multimodal/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Projetos de Pesquisa , Sensibilidade e Especificidade , Software , Neoplasias da Glândula Tireoide/patologia , Ultrassonografia/tendências
16.
BMC Health Serv Res ; 20(1): 347, 2020 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-32331521

RESUMO

BACKGROUND: Frail older patients are at risk of experiencing a decline in physical and cognitive function unrelated to the reason for admission. The Elder-Friendly Care (EFC) program was designed to improve the care, experiences, and outcomes of frail older adults. The project supported 8 Early Adoption Sites (EAS) in a large Canadian healthcare organization by providing multiple strategies, educational opportunities, and resources. The purpose of this study was to assess the usefulness of EFC educational materials and resources, staff practice changes and perceptions in pilot sites, and readiness for scale and spread. METHODS: The study was conducted from May 2017 to June 2018 using a mixed-methods approach incorporating the Kirkpatrick Model of Training/Evaluation. A total of 76 Direct Care Staff participated in the staff survey, which assessed their awareness of, satisfaction with, and utilization of EFC principles, resources, and practices. Additionally, 12 interviews were conducted with staff who were directly involved in site implementation of EFC. RESULTS: Most survey participants were aware (86%, n = 63) of the EFC program, and 85% (n = 41) indicated they or their site/unit had implemented EFC. Out of these 41 participants, the most common practice changes identified were: incorporating alternatives to restraint (81%, n = 33), decreased use of pharmacological restraint (78%, n = 32), and patient and family care planning (76%, n = 31). Participants that attended all 3 EFC Learning Workshops (LWs) were significantly more likely to recommend the EFC Toolkit to others (87% versus 40%; χ2 = 8.82, p < 0.01) compared to participants attending less than 3 EFC LWs. Interview participants indicated that the program was well structured and flexible as sites/units could adopt changes that suited their individual sites, needs, contexts, and challenges. CONCLUSIONS: The educational materials and resources used for the EFC project are useful and appreciated by the Direct Care Staff. Further, participants perceive the EFC intervention as effective in creating positive practice change and useful in reducing hospital-related complications for older patients. Future implementation will investigate the impact of EFC on system-level outcomes in acute care.


Assuntos
Serviço Hospitalar de Emergência , Idoso Fragilizado , Serviços de Saúde para Idosos/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/métodos , Idoso , Canadá , Pesquisas sobre Serviços de Saúde , Humanos , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa
17.
Am Soc Clin Oncol Educ Book ; 40: 1-10, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32239962

RESUMO

Quality improvement (QI) initiatives and health services research (HSR) are commonly used to target health care quality. These disciplines are increasingly important because of the movement toward value-based health care as alternative payment and care delivery models drive institutions and investigators to focus on reducing unnecessary health care use and improving care coordination. QI efforts frequently target medical error and/or efficiency of care through the Plan-Do-Study-Act methodology. Within the QI framework, strategies for data display (e.g., Pareto charts, run charts, histograms, scatter plots) are leveraged to identify opportunities for intervention and improvement. HSR is a multidisciplinary field of study that seeks to identify the most effective way to organize, deliver, and finance health care to maximize the quality and value of care at both the individual and population levels. HSR uses a diverse set of quantitative and qualitative methodologies, such as case-control studies, cohort studies, randomized control trials, and semistructured interview/focus group evaluations. This manuscript provides examples of methodologic approaches for QI and HSR, discusses potential challenges associated with concurrent quality efforts, and identifies strategies to successfully leverage the strengths of each discipline in care delivery.


Assuntos
Assistência à Saúde/normas , Pesquisa sobre Serviços de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/métodos , Humanos , Erros Médicos , Melhoria de Qualidade , Qualidade da Assistência à Saúde
18.
BMC Health Serv Res ; 20(1): 297, 2020 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-32290836

RESUMO

BACKGROUND: Evaluation of renal replacement therapy with haemodialysis is essential for its improvement. Remarkably, outcomes vary across centres. In addition, the methods used have important epistemological limitations, such as ignoring significant features (e.g., quality of life) or no relevance given to the patient's perspective in the indicator's selection. The present study aimed to determine the opinions and preferences of stakeholders (patients, clinicians, and managers) and establish their relative importance, considering the complexity of their interactions, to facilitate a comprehensive evaluation of haemodialysis centres. METHODS: Successive working groups (WGs) were established using a multicriteria methodology. WG1 created a draft of criteria and sub-criteria, WG2 agreed, using a qualitative structured analysis with pre-established criteria, and WG3 was composed of three face-to-face subgroups (WG3-A, WG3-B, and WG3-C) that weighted them using two methodologies: weighted sum (WS) and analytic hierarchy process (AHP). Subsequently, they determined a preference for the WS or AHP results. Finally, via the Internet, WG4 weighted the criteria and sub-criteria by the method preferred by WG3, and WG5 analysed the results. RESULTS: WG1 and WG2 identified and agreed on the following evaluation criteria: evidence-based variables (EBVs), annual morbidity, annual mortality, patient-reported outcome measures (PROMs), and patient-reported experience measures (PREMs). The EBVs consisted of five sub-criteria: type of vascular access, dialysis dose, haemoglobin concentration, ratio of catheter bacteraemia, and bone mineral disease. The patients rated the PROMs with greater weight than the other stakeholders in both face-to-face WG3 (WS and AHP) and WG4 via the Internet. The type of vascular access was the most valued sub-criterion. A performance matrix of each criterion and sub-criterion is presented as a reference for assessing the results based on the preferences of the stakeholders. CONCLUSIONS: The use of a multicriteria methodology allows the relative importance of the indicators to be determined, reflecting the values of the different stakeholders. In a performance matrix, the inclusion of values and intangible aspects in the evaluation could help in making clinical and organizational decisions.


Assuntos
Instituições de Assistência Ambulatorial/normas , Atitude do Pessoal de Saúde , Garantia da Qualidade dos Cuidados de Saúde/métodos , Diálise Renal , Participação dos Interessados , Consenso , Tomada de Decisões , Humanos , Qualidade de Vida , Valores Sociais
19.
Phys Med Biol ; 65(11): 115006, 2020 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-32235050

RESUMO

Brain stereotactic radiosurgery (SRS) treatments require multiple quality assurance (QA) procedures to ensure accurate and precise treatment delivery. As single-isocenter multitarget SRS treatments become more popular, the quantification of off-axis accuracy of the linear accelerator is crucial. In this study, a novel brain SRS integrated phantom was developed and validated to enable SRS QA with a single phantom to facilitate implementation of a frameless single-isocenter, multitarget SRS program. This phantom combines the independent verification of each positioning system, the Winston-Lutz, off-axis accuracy evaluation (i.e. off-axis Winston-Lutz), and the dosimetric accuracy utilizing both point dose measurements as well as film measurement, without moving the phantom. A novel 3D printed phantom, coined OneIso, was designed with a movable insert which can switch between the Winston-Lutz test target and dose measurement without moving the phantom itself. For dose verification, ten brain SRS clinical treatment plans with 10 MV flattening-filter-free beams were delivered on a Varian TrueBeam with a high-definition multileaf collimator (HD-MLC). Radiochromic film and pinpoint ion chamber comparison measurements were made between the OneIso and solid water (SW) phantom setups. For the off-axis Winston-Lutz measurements, a row of off-axis ball bearings (BBs) was integrated into the OneIso. To quantify the spatial accuracy versus distance from the isocenter, two-dimensional displacements were calculated between the planned and delivered BB locations relative to their respective MLC defined field border. OneIso and the SW phantoms agree within 1%, for both film and point dose measurements. OneIso identified a reduction in spatial accuracy further away from the isocenter. Differences increased as distance from the isocenter increased, exceeding recommended SRS accuracy tolerances at 7 cm away from the isocenter. OneIso provides a streamlined, single-setup workflow for single-isocenter multitarget frameless linac-based SRS QA. Additionally, with the ability to quantify off-axis spatial discrepancies, we can determine limitations on the maximum distance between targets to ensure a single-isocenter multitarget SRS program meets recommended guidelines.


Assuntos
Imagens de Fantasmas/normas , Garantia da Qualidade dos Cuidados de Saúde/métodos , Radiocirurgia/normas , Algoritmos , Humanos , Aceleradores de Partículas , Impressão Tridimensional , Radiocirurgia/instrumentação , Radiocirurgia/métodos , Dosagem Radioterapêutica
20.
Healthc Q ; 23(1): 53-59, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32249740

RESUMO

Over the past 15 years, Cancer Care Ontario has used a robust performance management approach to drive improvements in care. Each year, priority indicators and targets are selected or retained, and performance is reviewed quarterly with each of Ontario's Regional Cancer Programs. Improvement support and encouragement are provided, such as data analysis, program ranking, communities of practice, consultations, action plan requests and certificates. This article analyzes data on 28 indicators prioritized over these years and demonstrates that 25 have shown sustained improvement over time. The performance management approach, lessons learned and gaps in knowledge are described to inform future research and practice.


Assuntos
Neoplasias/diagnóstico , Neoplasias/terapia , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Humanos , Ontário , Garantia da Qualidade dos Cuidados de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/normas
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