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2.
Am J Obstet Gynecol ; 224(4): B24-B28, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33347844

RESUMO

The Society for Maternal-Fetal Medicine Publications Committee first adopted the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system in 2013. This document provides an update on the Society for Maternal-Fetal Medicine Publications Committee process for creating evidence-based practice recommendations and describes the GRADE process as it is currently implemented in the SMFM Consult and Guidelines series.


Assuntos
Medicina Baseada em Evidências/normas , Guias de Prática Clínica como Assunto/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Feminino , Humanos , Perinatologia/normas , Gravidez , Sociedades Médicas
3.
Nefrología (Madrid) ; 40(6): 608-622, nov.-dic. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197197

RESUMO

ANTECEDENTES Y OBJETIVO: Recientemente, se han desarrollado en España las Unidades de Enfermedad Renal Crónica Avanzada (UERCA) con el objetivo de ofrecer una mayor calidad de vida a los pacientes con ERCA, mejorar su supervivencia y disminuir la morbilidad en esta fase de la enfermedad. Al día de hoy, hay poca evidencia en la literatura española e internacional con respecto a la estructura y cómo conseguir estos objetivos en las UERCA. Desde el grupo de trabajo ERCA de la Sociedad Española de Nefrología (SEN) se impulsa este proyecto para mejorar la atención a los pacientes ERCA a través de la definición de estándares de calidad para el funcionamiento de las UERCA. MATERIAL Y MÉTODOS: Se conformó una propuesta inicial de estándares de calidad sobre el funcionamiento de las UERCA a través de la consulta de principales fuentes de referencias y el asesoramiento de un grupo de trabajo de expertos a través de reuniones presenciales y no presenciales. A partir de esta propuesta inicial de estándares, se diseñó y envío una encuesta vía correo electrónico a 121 especialistas de nefrología y profesionales de enfermería con experiencia en UERCA españolas para conocer entre otros, la idoneidad de cada estándar, es decir, su obligatoriedad o recomendación como estándar. Se permitió acceso a la encuesta entre el 16 de julio de 2018, hasta el 26 de septiembre de 2018. RESULTADOS: Participaron un total de 95 (78,5%) profesionales de los 121 que fueron invitados a participar. De éstos, 80 fueron especialistas en nefrología y 15 profesionales de enfermería, obteniéndose una variada representación de profesionales de la geografía española. Tras analizar las opiniones de estos participantes, los estándares quedaron definidos a un total de 68, 37 de ellos (54,4%) obligatorios y 31 de ellos (45,5%) recomendables. Además, se observó que el volumen de pacientes atendidos en las UERCA se sitúa usualmente por encima de los 100 pacientes, y que el criterio de derivación por regla general está por debajo de 25-29 mL/min/1,73 m2 de filtración glomerular. CONCLUSIONES: Este trabajo constituye una primera propuesta de estándares de calidad para el funcionamiento de una UERCA en España. La definición de estos estándares ha permitido establecer las bases para la estandarización de la organización de las UERCA, y trabajar posteriormente en la configuración de un manual de estándares para la acreditación de estas Unidades


BACKGROUND AND OBJECTIVE: Recently, the Advanced Chronic Kidney Disease Units (UERCA, in Spanish) have been developed in Spain to offer a better quality of life to patients with advanced chronic kidney disease (ACKD), improving their survival and reducing morbidity in this phase of the disease. Nowadays, there is not much evidence in the Spanish and international literature regarding the structure and how to achieve these objectives in the UERCA. From the ERCA working group of the Spanish Society of Nephrology (SEN), this project is promoted to improve care for ERCA patients through the definition of quality standards for the operation of the UERCA. MATERIAL AND METHODS: An initial proposal for quality standards concerning the operation of the UERCA was configured through consultation with the main sources of references and the advice of an expert working group through face-to-face and telematic meetings. Base on this initial proposal of standards, a survey was conducted and sent it via email to 121 nephrology specialist and nursing professionals with experience in Spanish UERCA to find out, among others, the suitability of each standards, that is, its mandatory nature or recommendation as standards. The access to the survey was allowed between July 16th, 2018, until September 26th, 2018. RESULTS: A total of 95 (78.5%) professionals participated out of the 121 who were invited to participate. Of these, 80 of the participants were nephrology specialists and 15 nursing professionals, obtaining a varied representation of professionals from the Spanish geography. After analyzing the opinions of these participants, the standards were defined to a total of 68, 37 of them (54.4%) mandatory and 31 of them (45.5%) recommended. Besides, it was observed that the volume of patients attended in the UERCA is usually above 100 patients, and the referral criteria is generally below 25-29 mL/min/1.73 m2 of glomerular filtration. CONCLUSIONS: This work constitutes a first proposal of quality standards for the operation of UERCA in Spain. The definition of these standards has made it possible to establish the bases for the standardization of the organization of UERCA, and to subsequently work on the configuration of a standards manual for the accreditation of ERCA Units


Assuntos
Humanos , Garantia da Qualidade dos Cuidados de Saúde/normas , Insuficiência Renal Crônica/terapia , Hospitais de Doenças Crônicas/normas , Segurança do Paciente/normas , Hospitais de Doenças Crônicas/estatística & dados numéricos , Inquéritos e Questionários , Espanha
4.
J Nurs Adm ; 50(12): e12-e13, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33181603

RESUMO

Innovation has enabled organizations to highlight and engage during the COVID -19 pandemic. The use of virtual site visits to assess the organizations 's culture and sustainability of the Magnet components during initial designation and redesignation allows for ongoing support of nursing excellence.


Assuntos
American Nurses' Association/organização & administração , Credenciamento/organização & administração , Serviço Hospitalar de Enfermagem/normas , Inovação Organizacional , Garantia da Qualidade dos Cuidados de Saúde/normas , Infecções por Coronavirus , Humanos , Recursos Humanos de Enfermagem no Hospital , Pandemias , Pneumonia Viral , Estados Unidos
5.
Plast Reconstr Surg ; 146(2): 127e-136e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740569

RESUMO

BACKGROUND: Reduction mammaplasty is the standard of care for symptomatic macromastia. The process of requesting insurance coverage for reduction mammaplasty is cumbersome and potentially controversial, and insurance policies vary significantly. The goal of our analysis is to identify trends in insurance coverage rates, assess for the presence of disparities, and propose ways to increase chances of successful preauthorization. METHODS: The authors performed a retrospective review of preauthorizations for reduction mammaplasty at a single institution from 2012 to 2017. Insurance company names were deidentified. Preauthorization denial rates were assessed by year, insurance carrier, and reason for denial. Multiple regression analysis was performed to identify predictors for predetermination denial by insurance companies. RESULTS: Among 295 preauthorizations, 212 were approved (72 percent) and 83 were denied (28 percent), among which 18 were appealed, 13 successfully. Rates of insurance denials have been increasing steadily, from 18 percent to 41 percent. Medicaid had the lowest denial rates (9.3 percent), whereas private carriers denials ranged from 21.4 to 62.1 percent. In terms of reason for denial, 30 percent were because of contract exclusion, 39 percent were because of inadequate documentation or not meeting medical criteria, and 12 percent were because of inadequate predicted resection weight. Certain private insurance carriers were the only independent predictors of predetermination denial. CONCLUSIONS: Rate of preauthorization denials is high and has been increasing steadily. Insurance criteria remain arbitrary. A proper documentation and appeal process by the plastic surgeon may improve rates of insurance approval. Although resection weight does not correlate with symptom relief, predicted breast tissue resection weight continues to be critical for insurance approval.


Assuntos
Mama/anormalidades , Hipertrofia/cirurgia , Reembolso de Seguro de Saúde/economia , Mamoplastia/economia , Garantia da Qualidade dos Cuidados de Saúde/normas , Adulto , Mama/cirurgia , Feminino , Seguimentos , Humanos , Cobertura do Seguro/economia , Mamoplastia/métodos , Estudos Retrospectivos , Estados Unidos
6.
J Occup Environ Med ; 62(10): 781-782, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32769798

RESUMO

OBJECTIVE: The proliferation of improvised masks during the COVID-19 pandemic has raised questions regarding filter effectiveness and safety. We sought to compare the effectiveness of commonly used improvised filter materials against N95 industry standards. METHODS: Six different filter materials commonly used in the community were tested using both single- and multi-layer configurations with the TSI 8130 automated filter tester in accordance with National Institute for Occupational Safety and Health (NIOSH) standards for N95 respirators. RESULTS: Only three of the tested filter material configurations met N95 parameters with regard to filtration efficiency and pressure drop across the filter material-the: True-high-efficiency particulate air (HEPA) filter, four-layer MERV 13 and 14 HVAC filters. CONCLUSIONS: Many proposed filter materials for improvised masks do not meet current industry standards and may pose safety and efficacy concerns. Care should be taken when selecting materials for this critical respirator component, particularly for health care workers or others at high risk for pathogen exposure.


Assuntos
Infecções por Coronavirus/prevenção & controle , Exposição por Inalação/prevenção & controle , Máscaras/normas , Exposição Ocupacional/prevenção & controle , Saúde do Trabalhador , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Poluentes Ocupacionais do Ar/análise , Infecções por Coronavirus/epidemiologia , Desenho de Equipamento , Segurança de Equipamentos , Feminino , Saúde Global , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Teste de Materiais , National Institute for Occupational Safety and Health, U.S./normas , Pandemias/estatística & dados numéricos , Tamanho da Partícula , Pneumonia Viral/epidemiologia , Garantia da Qualidade dos Cuidados de Saúde/normas , Estados Unidos
7.
Acta Cytol ; 64(6): 597-606, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32829336

RESUMO

BACKGROUND: The Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP) offers a comprehensive range of External Quality Assurance programs for all disciplines of pathology and is committed to delivering programs to advance outcomes in patient care and promote excellence in laboratory diagnostic and technical proficiency. Proficiency testing in cytopreparatory techniques became available for formal enrolment in 2018. The 2019 technical program focused on the demonstration of a laboratory to troubleshoot problems encountered during staining and processing. The exercise provided a peer comparison of a laboratory's ability to (1) identify the problem viewed from a digital image and (2) describe the troubleshooting steps to rectify the problem using assessment guidelines. METHODS: Ten troubleshooting exercises including whole-slide z-stacked virtual images, a reference slide, and an online Result Entry questionnaire were provided. Common staining and processing problems were demonstrated in these exercises. Multiple-choice responses were made available to participants for each case with 1 response requiring submission. Participants were then allowed free text to describe how they would rectify the problem. RESULTS: Of the 72 participants who participated, 62 participants (86%) achieved a satisfactory assessment, 6 participants (8%) received a borderline assessment, and 4 participants (6%) received an unsatisfactory assessment. The average mark obtained was 32.7 out of a total of 45 marks, which equates to a satisfactory assessment. The highest mark obtained for this survey was 42.5. CONCLUSIONS: Quality cytopathology preparatory techniques are integral to mitigating the risk of diagnostic error. The digital pathology platform allowed homogeneity of samples for all participants and appeared to be a satisfactory mode for demonstrating the technical problems to participants. Laboratories participating in this survey showed good performance in identifying processing and staining problems on virtual images and working through the troubleshooting steps. The exercise also identified a method for troubleshooting formalin vapour-affected slides using citrate buffer which may be useful for laboratories following in-house validation.


Assuntos
Laboratórios/normas , Teste de Papanicolaou/normas , Patologia Clínica/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Testes Diagnósticos de Rotina , Feminino , Humanos , Controle de Qualidade , Coloração e Rotulagem/métodos , Esfregaço Vaginal/métodos
9.
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
10.
Emerg Med Clin North Am ; 38(3): 663-680, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616286

RESUMO

Quality assurance (QA) of care in the emergency department encompasses activities ensuring that the care provided meets applicable standards. Health care delivery is complex and many factors affect quality of care. Thus, quantification of health care quality is challenging, especially with regard to attribution of outcomes to various factors contributing to such care. A critical component of the process of QA is determination of quality health care and the concept of (unjustified) deviation from the reference applicable standard of care.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Serviço Hospitalar de Emergência/normas , Humanos , Garantia da Qualidade dos Cuidados de Saúde/normas , Indicadores de Qualidade em Assistência à Saúde
12.
Phys Med Biol ; 65(19): 195013, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32580170

RESUMO

As automation in radiation oncology becomes more common, it is important to determine which algorithms are equivalent for a given workflow. Often, algorithm comparisons are performed in isolation; however, clinical context can provide valuable insight into the importance of algorithm features and error magnification in subsequent workflow steps. We propose a strategy for deriving workflow-specific algorithm performance requirements. We considered two independent workflows indicating the need for radiotherapy treatment replanning for 15 head and neck cancer patients (15 planning CTs, 105 on-unit CBCTs). Each workflow was based on a different deformable image registration (DIR) algorithm. Differences in DIR output were assessed using three sets of QA metrics: (1) conventional, (2) workflow-specific, (3) a combination of (1) and (2). For a given set of algorithm metrics, lasso logistic regression modeled the probability of discrepant replan indications. Varying the minimum probability needed to predict a workflow discrepancy produced receiver operating characteristic (ROC) curves. ROC curves were compared using sensitivity, specificity, and the area under the curve (AUC). A heuristic then derived simple algorithm performance requirements. Including workflow-specific QA metrics improved AUC from 0.70 to 0.85, compared to the use of conventional metrics alone. Algorithm performance requirements had high sensitivity of 0.80, beneficial for replan assessments, with specificity of 0.57. This was an improvement over a naïve application of conventional QA criteria, which had sensitivity of 0.57 and specificity of 0.68. In addition, the algorithm performance requirements indicated practical refinements of conventional QA tolerances, indicated where auxiliary workflow processes should be standardized, and may be used to prioritize structures for manual review. Our algorithm performance requirements outperformed current comparison recommendations and provided practical means for ensuring workflow equivalence. This strategy may aid in trial credentialing, algorithm development, and streamlining expert adjustment of workflow output.


Assuntos
Algoritmos , Neoplasias de Cabeça e Pescoço/radioterapia , Processamento de Imagem Assistida por Computador/métodos , Garantia da Qualidade dos Cuidados de Saúde/normas , Planejamento da Radioterapia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/normas , Fluxo de Trabalho , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Modelos Logísticos , Dosagem Radioterapêutica , Tomografia Computadorizada por Raios X/métodos
13.
J Aging Soc Policy ; 32(4-5): 316-322, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32497467

RESUMO

As of May 2020, nursing home residents account for a staggering one-third of the more than 80,000 deaths due to COVID-19 in the U.S. This pandemic has resulted in unprecedented threats to achieving and sustaining care quality even in the best nursing homes, requiring active engagement of nursing home leaders in developing solutions responsive to the unprecedented threats to quality standards of care delivery during the pandemic. This perspective offers a framework, designed with the input of nursing home leaders, to facilitate internal and external decision-making and collective action to address these threats. Policy options focus on assuring a shared understanding among nursing home leaders and government agencies of changes in the operational status of nursing homes throughout the crisis, improving access to additional essential resources needed to mitigate the crisis' impact, and promoting shared accountability for consistently achieving accepted standards in core quality domains.


Assuntos
Infecções por Coronavirus/epidemiologia , Instituição de Longa Permanência para Idosos/organização & administração , Casas de Saúde/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Qualidade da Assistência à Saúde/organização & administração , Betacoronavirus , Planejamento em Desastres/organização & administração , Instituição de Longa Permanência para Idosos/normas , Humanos , Liderança , Casas de Saúde/normas , Políticas , Roupa de Proteção/provisão & distribução , Garantia da Qualidade dos Cuidados de Saúde/normas , Qualidade da Assistência à Saúde/normas
14.
Enferm. clín. (Ed. impr.) ; 30(3): 160-167, mayo-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-196681

RESUMO

INTRODUCCIÓN: El ictus es causa importante de morbimortalidad en adultos y supone un elevado coste sociosanitario por las secuelas que provoca. Para minimizarlas es importante aplicar guías de buenas prácticas que aseguren cuidados basados en la evidencia y reduzcan la variabilidad clínica. El objetivo del estudio es evaluar los resultados de implantación de una Guía de buenas prácticas para la atención de pacientes con ictus hospitalizados. MÉTODO: Estudio cuasi-experimental pre/post-intervención. Mayores de 18 años ingresados en el Complejo Hospitalario Universitario de Albacete (CHUA) y Complejo Hospitalario de Navarra (CHN) con diagnóstico de ictus. Variables de proceso: valoración neurológica (Escala canadiense y la National Institute of Health Stroke Scale), valoración de la disfagia (Test del agua y el método de exploración clínica volumen-viscosidad), riesgo de caídas (Escala Downton), detección de dolor (Escala numérica), riesgo de lesiones por presión (Escala Braden) y educación sanitaria. Variables de resultado: neumonía por aspiración, caídas, independencia para las actividades de la vida diaria (índice de Barthel y Rankin modificada), lesiones por presión e intensidad del dolor. RESULTADOS: Se evaluaron 1.270 pacientes en el CHUA y 627 en el CHN, mayoritariamente hombres mayores de 69 años y con alta incidencia de ictus isquémicos. En el CHUA se registraron 16 lesiones por presión, 17 caídas y 20 casos de neumonías por aspiración. En CHN se identificaron 15 casos de lesiones por presión. El aumento de casos podría atribuirse al incremento de pacientes evaluados y a una mayor concienciación para registrar estos eventos. CONCLUSIONES: La aplicación de las recomendaciones de la GBP ha mejorado de manera estadísticamente significativa a lo largo del tiempo, existiendo posibilidades de mejora tanto en la calidad de los cuidados prestados como en los resultados en salud de los pacientes


INTRODUCTION: Stroke is an important cause of morbidity and mortality in adults and implies high social and healthcare costs due to the consequences it causes. To minimize these, it is important to apply best practice guidelines that ensure evidence-based care and reduce clinical variability. The objective of the study is to evaluate the results of implantation of the Ictus Best Practice Guideline for attending in-hospital stroke patients. METHOD: Quasi-experimental pre-post intervention study. Over 18 years of age admitted to the University Hospital Complex of Albacete and Hospital Complex of Navarra with a diagnosis of stroke. Process variables: Neurological assessment (Canadian Scale and the National Institute of Health Stroke Scale), dysphagia assessment (Water Test and the Volume-Viscosity Clinical Exploration Method), risk falls (Downton Scale), pain detection (Numerical Scale), pressure injury risk (Braden Scale), health education. Outcome variables: Aspiration pneumonia, falls, independence of daily life activities (modified Barthel and Rankin index), pressure injuries and pain intensity. RESULTS: 1270 patients were evaluated in CHUA and 627 in CHN, most were men and the average age was over 69 years, with a higher incidence of ischaemic strokes. In CHUA 16 pressure sores, 17 falls and 20 cases of aspiration pneumonia were recorded and 15 cases of pressure sores were identified in CHN. An increase of cases could be attributed to the greater number of patients evaluated and the increased nursing awareness about recording adverse events. CONCLUSIONS: Application of guideline recommendations improved statistically significantly throughout the implementation time. Some possibilities for improvement are detected, so it is necessary to continue working on both the quality of care provided and the health outcomes of patients


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Implementação de Plano de Saúde/normas , Segurança do Paciente/normas , Guias de Prática Clínica como Assunto/normas , Acidente Vascular Cerebral/epidemiologia , Cuidados de Enfermagem/normas , Fidelidade a Diretrizes/normas , Acidente Vascular Cerebral/enfermagem , Avaliação em Enfermagem , Avaliação de Processos em Cuidados de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Hospitalização
15.
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
16.
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
17.
PLoS One ; 15(3): e0229771, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155180

RESUMO

INTRODUCTION: Enhancing the self-management activities of patients improves the quality of care and is an integrated element of current healthcare provision. However, self-management support (SMS) is not yet common in healthcare. The Primary Care Resources and Support for Self-Management (PCRS) is a tool for healthcare professionals to assess the quality of SMS. In this study, we assessed the validity and reliability of the Dutch version of the PCRS. METHOD: The validation of the PCRS was performed in Dutch healthcare centres. Correlations between the PCRS scores and the Assessment of Chronic Illness Care (ACIC) and Clinician Support for Patient Activation Measure (CS-PAM) scores were calculated to assess the convergent and discriminant validity. A confirmatory factor analysis (CFA) was performed to test the factor structure. Lastly, the internal consistency and face validity were assessed. RESULTS: The convergent and discriminant validity were good, with respective correlations of 0.730 (p < 0.001) and 0.030 (p > 0.050) between the PCRS and the ACIC SMS subscale and the PCRS and the CS-PAM. Although 49% of the variance of the PCRS was explained by one factor, the CFA could not confirm a fit between a one-factor model and the data. The reliability was excellent (Cronbach's α = 0.921). CONCLUSION: The PCRS showed good validity and excellent internal consistency. However, the evidence for its validity was inconclusive. We therefore suggest rephrasing specific items.


Assuntos
Atenção Primária à Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/métodos , Autogestão , Adulto , Atitude do Pessoal de Saúde , Feminino , Clínicos Gerais/psicologia , Clínicos Gerais/normas , Recursos em Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Garantia da Qualidade dos Cuidados de Saúde/normas , Apoio Social , Inquéritos e Questionários
18.
Br J Nurs ; 29(6): 378-379, 2020 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-32207641

RESUMO

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses some recent patient safety publications from the World Health Organization and the Care Quality Commission.


Assuntos
Segurança do Paciente/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Medicina Estatal/normas , Inglaterra , Hospitais Públicos/organização & administração , Hospitais Públicos/normas , Hospitais Universitários/normas , Humanos , Medição de Risco , Medicina Estatal/organização & administração , Organização Mundial da Saúde
19.
Strahlenther Onkol ; 196(5): 417-420, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32211940

RESUMO

Stereotactic radiotherapy with its forms of intracranial stereotactic radiosurgery (SRS), intracranial fractionated stereotactic radiotherapy (FSRT) and stereotactic body radiotherapy (SBRT) is today a guideline-recommended treatment for malignant or benign tumors as well as neurological or vascular functional disorders. The working groups for radiosurgery and stereotactic radiotherapy of the German Society for Radiation Oncology (DEGRO) and for physics and technology in stereotactic radiotherapy of the German Society for Medical Physics (DGMP) have established a consensus statement about the definition and minimal quality requirements for stereotactic radiotherapy to achieve best clinical outcome and treatment quality in the implementation into routine clinical practice.


Assuntos
Consenso , Garantia da Qualidade dos Cuidados de Saúde/normas , Radiocirurgia/normas , Alemanha , Humanos , Sociedades Médicas
20.
Strahlenther Onkol ; 196(5): 421-443, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32211939

RESUMO

This review details and discusses the technological quality requirements to ensure the desired quality for stereotactic radiotherapy using photon external beam radiotherapy as defined by the DEGRO Working Group Radiosurgery and Stereotactic Radiotherapy and the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The covered aspects of this review are 1) imaging for target volume definition, 2) patient positioning and target volume localization, 3) motion management, 4) collimation of the irradiation and beam directions, 5) dose calculation, 6) treatment unit accuracy, and 7) dedicated quality assurance measures. For each part, an expert review for current state-of-the-art techniques and their particular technological quality requirement to reach the necessary accuracy for stereotactic radiotherapy divided into intracranial stereotactic radiosurgery in one single fraction (SRS), intracranial fractionated stereotactic radiotherapy (FSRT), and extracranial stereotactic body radiotherapy (SBRT) is presented. All recommendations and suggestions for all mentioned aspects of stereotactic radiotherapy are formulated and related uncertainties and potential sources of error discussed. Additionally, further research and development needs in terms of insufficient data and unsolved problems for stereotactic radiotherapy are identified, which will serve as a basis for the future assignments of the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The review was group peer-reviewed, and consensus was obtained through multiple working group meetings.


Assuntos
Consenso , Garantia da Qualidade dos Cuidados de Saúde/normas , Radiocirurgia/normas , Alemanha , Doses de Radiação , Sociedades Médicas
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