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1.
J Surg Res ; 245: 354-359, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31425875

RESUMO

BACKGROUND: Enhanced recovery pathways (ERPs) can decrease length of stay (LOS) and improve colorectal surgery outcomes in private health care; however, their efficacy in the public realm, comprised largely of underserved and uninsured patients, remains uncertain. MATERIALS AND METHODS: An ERP without social interventions was implemented at a private hospital (PH) and a safety-net hospital (SNH) within a large academic medical center in 2014. Process and outcome metrics from 100 patients in the 18 mo before ERP implementation at each institution were retrospectively compared with a similar group after ERP implementation. Primary outcomes were LOS, 30-d readmission, and reoperation. RESULTS: Post-ERP groups were older than pre-ERP (P = 0.047, 0.034), with no difference in sex or body mass index. Rate of open versus minimally invasive was similar at the SNH (P = 0.067), whereas more post-ERP patients at PH underwent open surgery (P = 0.002). Ninety six percentage of PH patients were funded through private insurance or Medicare, verses 6% at the SNH. LOS at PH decreased from 8.1 to 5.9 d (P = 0.028) and at SNH from 7.0 to 5.1 d (P = 0.004). There was no change in 30-d all-cause readmission (PH P = 0.634; SNH P = 1) or reoperation (PH P = 0.610; SNH P = 0.066). CONCLUSIONS: ERP reduced LOS in both private and safety-net settings without addressing social determinants of health. Readmission and reoperation rates were unchanged. As health care moves toward a bundled payment model, ERP can help optimize outcomes and control costs in the public arena.


Assuntos
Cirurgia Colorretal , Procedimentos Clínicos , Hospitais Privados/estatística & dados numéricos , Provedores de Redes de Segurança/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
Int J Radiat Oncol Biol Phys ; 106(1): 61-66, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31505246

RESUMO

PURPOSE: To evaluate the use of single-fraction palliative radiation therapy (SFRT) for the management of bone metastases (BM) in Victoria, Australia. METHODS AND MATERIALS: This is a population-based cohort of patients with cancer who received radiation therapy for BM between 2012 and 2017 as captured in the Victorian Radiotherapy Minimum Data Set. The primary outcome was proportion of SFRT use. The Cochrane-Armitage test for trend was used to evaluate changes in practice over time. Multivariable logistic regression was used to assess factors associated with SFRT use. RESULTS: Of the 18,158 courses of radiation therapy for BM delivered to a total of 10,956 patients, 17% were SFRT. There was no significant change in SFRT use over time, from 18% in 2012 to 19% in 2017 (P = .07). SFRT was less commonly given to the skull (4%) and spine (14%), compared with the shoulder (37%) and ribs (53%). Patients with lung cancer (21%) were most likely to receive SFRT, followed by those with prostate cancers (18%) and gastrointestinal cancers (16%). Patients from regional/remote areas were more likely to have SFRT compared with those in major cities (22% vs 16%, P < .001). Patients treated in public institutions were more likely to have SFRT compared with those treated in private institutions (22% vs 10%, P < .001). In multivariable analyses, increasing age, lung cancer, higher socioeconomic status, residence in regional/ remote areas, and being treated in public institutions were factors independently associated with increased likelihood of receiving SFRT. CONCLUSIONS: SFRT appears underused for BM in Australia over time, with variation in practice by patient, tumor, sociodemographic, geographical, and institutional provider factors.


Assuntos
Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Cuidados Paliativos/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Austrália , Fracionamento da Dose de Radiação , Feminino , Neoplasias Gastrointestinais , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Neoplasias Pulmonares , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/estatística & dados numéricos , Neoplasias da Próstata , Radioterapia/métodos , Radioterapia/estatística & dados numéricos , Dosagem Radioterapêutica , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Fatores de Tempo , População Urbana/estatística & dados numéricos
3.
Einstein (Sao Paulo) ; 18: eAO4752, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31664323

RESUMO

OBJECTIVE: To evaluate the epidemiological profile of patients seen at a dementia outpatient clinic. METHODS: A retrospective study conducted by medical record review searching data on sex, race, age, schooling level, and diagnosis of patients seen from 2008 to 2015. RESULTS: A total of 760 patients were studied, with a predominance of female (61.3%; p<0.0001). The mean age was 71.2±14.43 years for women and 66.1±16.61 years for men. The most affected age group was 71 to 80 years, accounting for 29.4% of cases. In relation to race, 96.3% of patients were white. Dementia was diagnosed in 68.8% of patients, and Alzheimer's disease confirmed in 48.9%, vascular dementia in 11.3%, and mixed dementia in 7.8% of cases. The prevalence of dementia was 3% at 70 years and 25% at 85 years. Dementia appeared significantly earlier in males (mean age 68.5±15.63 years). As to sex distribution, it was more frequent in women (59.6%) than in men (40.4%; p<0.0001; OR=2.15). People with higher schooling level (more than 9 years) had a significantly younger age at onset of dementia as compared to those with lower schooling level (1 to 4 years; p=0.0007). CONCLUSION: Most patients seen in the period presented dementia, and Alzheimer was the most prevalent disease. Women were more affected, and men presented young onset of the disease. Individuals with higher schooling level were diagnosed earlier than those with lower level.


Assuntos
Disfunção Cognitiva/epidemiologia , Demência/epidemiologia , Pacientes Ambulatoriais/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/epidemiologia , Brasil/epidemiologia , Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Escolaridade , Feminino , Hospitais Privados/estatística & dados numéricos , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Distribuição por Sexo , Adulto Jovem
4.
Isr Med Assoc J ; 21(10): 644-648, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599503

RESUMO

BACKGROUND: Surgery is a core activity in hospitals. Operating rooms have some of the most important and vital functions in medical centers. The operating rooms and their staff are a valuable infrastructure resource and their availability and preparedness affect human life and quality of care. OBJECTIVES: To prepare operational suggestions for improving operating room utilization by mapping current working processes in the operating rooms of a large private medical center. METHODS: Data on 23,585 surgeries performed at our medical center between August 2016 and March 2017 were analyzed by various parameters including utilization, capacity, working hours, and surgery delays. RESULTS: Average operating room utilization was 79%, while 21% was considered lost operating room time. The two major factors that influenced the lost operating room time were the time intervals between planned usage blocks and the partial utilization of operating room time. We calculated that each percent of utilized operating room time translates into 440 surgeries annually, resulting in a potential annual increase in income. CONCLUSIONS: Increasing operating room utilization would result in an improvement of operating room availability and an increased number of procedures. Our analysis shows that operating room utilization in the private healthcare system is efficient compared to the public healthcare system in Israel. Therefore the private healthcare system should be treated as a contributing factor to help lower surgery waiting times and release bottlenecks, rather than being perceived as contributing to inequality.


Assuntos
Hospitais Privados , Salas Cirúrgicas/organização & administração , Salas Cirúrgicas/estatística & dados numéricos , Eficiência Organizacional/estatística & dados numéricos , Humanos , Israel
5.
Hosp Pract (1995) ; 47(5): 254-258, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31661995

RESUMO

Background: The quality of life (QOL) among the end-stage renal disease patients is an essential component for assessing the success of treatment. This study aimed to determine the factors predicted with quality of life among hemodialysis patients in private hospital of Thailand.Method: This cross-sectional study was conducted by interviewing 188 Thai patients with end-stage renal disease (ESRD), who were on hemodialysis (HD) at Sanamchan Hospital Bangkok. Patients with stable hemodynamic status without any history of mental illness were included in this study. However, those who could not properly communicate were excluded. The descriptive statistics and the multiple linear regression were applied to identify the predictive factors of quality of life (QOL) scores in the end-stage renal disease (ESRD) patients on maintenance hemodialysis (HD). The QoL was assessed in three components including kidney disease component score (KDCS) physical component score (PCS) and mental component score (MCS).Findings: More than half of the participants (57%) in this research were male and (44%) were unemployed. The mean average systolic value of the participants was 157 (25.12 SD) mmHg and the diastolic blood pressure was 81 (5.85 SD) mmHg. Average hematocrit (Hct) was 30.95 (4.38 SD), Kt/v was 1.86 (0.96 SD), and average normalized protein catabolic rate (nPCR) was 1.12 (1.09 SD). The age, income, patients with more than three associated diseases, enough expenses for living, frequency of dialysis per week, and duration of treatment was statistically significant with the kidney disease component score (KDCS) (F = 6.28, p < 0.05). Furthermore, the age, income, patients with more than three associated diseases, hematocrit (Hct) and frequency of dialysis per week were the statistically significant with the physical component score (PCS) (F = 4.99, p < 0.05) while patients with more than three associated diseases and enough expenses for living were the statistically significant with the mental component score (MCS) (F = 3.30, p ≤ 0.05).Conclusion: Study concluded that the factors like; age, expenses for living, frequency of dialysis, patients with more than three associated diseases were had a positive impact on the quality of life among the end-stage renal disease patients coming for dialysis in private hospital of Thailand.


Assuntos
Hospitais Privados , Falência Renal Crônica/terapia , Qualidade de Vida , Diálise Renal , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Tailândia
6.
BMC Health Serv Res ; 19(1): 639, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488141

RESUMO

BACKGROUND: The Australian Commission on Safety and Quality in Health Care released a set of national standards which became a mandatory part of accreditation in 2013. Standard 9 focuses on the identification and treatment of deteriorating patients. The objective of the study was to identify changes in the characteristics and perceptions of rapid response systems (RRS) since the implementation of Standard 9. METHODS: Cross-sectional study of Australian hospitals. Baseline data was obtained from a pre-implementation survey in 2010 (220 hospitals). A follow-up survey was distributed in 2015 to staff involved in implementing Standard 9 in public and private hospitals (276 responses) across Australia. RESULTS: Since 2010, the proportion of hospitals with formal RRS had increased from 66 to 85. Only 7% of sites had dedicated funding to operate the RRS. 83% of respondents reported that Standard 9 had improved the recognition of, and response to, deteriorating patients in their health service, with 51% believing it had improved awareness at the executive level and 50% believing it had changed hospital culture. CONCLUSIONS: Implementing a national safety and quality standard for deteriorating patients can change processes to deliver safer care, while raising the profile of safety issues. Despite limited dedicated funding and staffing, respondents reported that Standard 9 had a positive impact on the care for deteriorating patients in their hospitals.


Assuntos
Deterioração Clínica , Equipe de Respostas Rápidas de Hospitais/normas , Acreditação/normas , Austrália , Estudos Transversais , Hospitais Privados/normas , Hospitais Públicos/normas , Humanos , Cultura Organizacional , Padrões de Referência , Inquéritos e Questionários
7.
S Afr J Surg ; 57(3): 24-29, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392861

RESUMO

BACKGROUND: The South African healthcare system has an under-financed public sector serving most of the population and a better resourced private sector serving a small fraction of the population. This study evaluated management and outcome in patients with complex bile duct injuries (BDIs) after laparoscopic cholecystectomy referred from either private or public hospitals. METHOD: The data of patients who underwent hepaticojejunostomy repair were retrieved from a prospectively maintained central departmental BDI database. Patients were treated either in the Surgical Gastroenterology Unit at Groote Schuur Hospital, University of Cape Town (UCT) or the Digestive Diseases Centre, UCT Private Academic Hospital by the same hepatobiliary surgical team. Relevant preoperative clinical data and postoperative complications and outcomes were compared between patients originating either in the public or private sector. RESULTS: One hundred and twenty-five patients were included, 58 from the public and 67 from the private sector. The type of BDI, time to diagnosis, referral and repair were similar. Patients referred from the private sector underwent more percutaneous cholangiograms prior to referral (11.9% vs 1.7%, p = 0.037). Patients referred from the public sector underwent more CT examinations (p = 0.044) and endoscopic retrograde cholangiography (p = 0.038) after admission to our centre. There were no statistically significant differences in 30-day postoperative complications. Primary patency rates were similar for public and private referrals (90% vs 88%, respectively). There were two BDI-related mortalities at 90 days. CONCLUSION: Despite differences in public and private healthcare system resources, patients were referred early and appropriately from both sectors and had similar postoperative outcomes when treated in a specialised unit.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Hospitais Privados , Hospitais Públicos , Ferimentos e Lesões/diagnóstico por imagem , Ferimentos e Lesões/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Estudos Retrospectivos , África do Sul , Centros de Atenção Terciária , Fatores de Tempo , Tempo para o Tratamento , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ferimentos e Lesões/etiologia , Adulto Jovem
8.
BMC Infect Dis ; 19(1): 654, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331280

RESUMO

BACKGROUND: Retaining patients on antiretroviral treatment in care is critical to sustaining the 90:90:90 vision. Nigeria has made some progress in placing HIV-positive patients on treatment. In an effort to increase access to treatment, ART decentralization has been implemented in the country. This is aimed at strengthening lower level health facilities to provide comprehensive antiretroviral treatment. We determined the level of retention and adherence to treatment as well as the associated factors among private and public secondary level hospitals in Anambra State. METHOD: We conducted a cross-sectional study among patients who had taken antiretroviral treatment for at least one complete year. A structured questionnaire and patient record review were used to extract information on patient adherence to treatment, and retention in care. Adherence to treatment was ascertained by patient self-report of missed pills in the 30 days prior to date of interview. Retention in care was ascertained using the 3-month visit constancy method reviewing the period spanning 12 months prior to the study. RESULT: We found a comparable level of retention in care (private 81.1%; public 80.3%; p = 0.722). However, treatment adherence was significantly higher amongst participants in the private hospitals compared to those in the public hospitals (private: 95.3%; public: 90.7%; p = 0.001). Determinants of good retention in the private hospitals included disclosure of one's HIV status (AOR: 1.94, 95% CI: 1.09-3.46), being on first-line regimen (AOR: 3.07, 95% CI: 1.27-7.41), whereas being on once-daily regimen (AOR: 0.58, 95% CI: 0.36-0.92), and being currently married (AOR: 0.54 95% CI: 0.32-0.91) determined poor retention. In the public hospitals, only disclosure (AOR: 3.12 95% CI: 1.81-5.56) determined good retention, whereas, spending less than N1000 on transport (AOR: 0.230 95% CI: 0.07-0.78) and residing in a rural area (AOR: 0.64 95% CI: 0.41-0.99) determined poor retention. None of the factors determined adherence. CONCLUSION: Retention in care was high and comparable among the different hospital types and HIV disclosure status was an important factor relating to retention in care. The other factors that determined retention were however different at public and private hospitals. The HIV program manager should consider these variations in designing programs to improve patient retention in care and adherence to treatment.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Retenção nos Cuidados/estatística & dados numéricos , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Adulto , Estudos Transversais , Feminino , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Nigéria , Cooperação do Paciente/estatística & dados numéricos , Inquéritos e Questionários
9.
Cancer Radiother ; 23(5): 395-400, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31331842

RESUMO

PURPOSE: Lung and some digestive tumours move during a respiratory cycle. Four-dimensional scanography (4D-CT) is commonly used in treatment planning to account for respiratory motion. Although many French radiotherapy centres are now equipped, there are no guidelines on this subject to date. We wanted to draw up a description of the use of the 4D-CT for the treatment planning in France. METHODS AND MATERIAL: We conducted a survey in all French radiotherapy centres between March and April 2017. RESULTS: One hundred and seventy-two were contacted. The participation rate was 88.37%. The use of the 4D-CT seems to be common and concerned planning for 15.28% of kidney and adrenal cancers, 19.72% of pancreatic cancers, 27.78% of oesophageal cancers and 73.24% of lung cancers in case of normofractionated treatments. The use of the 4D-CT was also widespread in the case of stereotactic body radiation therapy: with 61.11% in the case of pulmonary irradiation and 34.72% in the case of hepatic irradiation. Many centres declared they carried out several 4D-CT for treatment planning (29, 55% in case of stereotactic body radiation therapy for lung tumours and 20% for liver tumours). Private centres tend to repeat 4D-CT more. CONCLUSION: Although the use of the 4D-CT appears to be developing, it remains very heterogeneous. To date, the repetition of the 4D-CT has been very poorly studied and could be the subject of clinical studies, allowing to define in which indications and for which populations there is a real benefit.


Assuntos
Tomografia Computadorizada Quadridimensional , Planejamento da Radioterapia Assistida por Computador/métodos , Artefatos , Institutos de Câncer/estatística & dados numéricos , França , Pesquisas sobre Serviços de Saúde , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Imagem Tridimensional/estatística & dados numéricos , Movimento (Física) , Neoplasias/diagnóstico por imagem , Neoplasias/radioterapia , Utilização de Procedimentos e Técnicas , Serviço Hospitalar de Radiologia/estatística & dados numéricos , Radiocirurgia/métodos , Planejamento da Radioterapia Assistida por Computador/estatística & dados numéricos , Planejamento da Radioterapia Assistida por Computador/tendências , Respiração
10.
PLoS Med ; 16(7): e1002860, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31335869

RESUMO

BACKGROUND: The Indian government supports both public- and private-sector provision of hospital care for neonates: neonatal intensive care is offered in public facilities alongside a rising number of private-for-profit providers. However, there are few published reports about mortality levels and care practices in these facilities. We aimed to assess care practices, causes of admission, and outcomes from neonatal intensive care units (NICUs) in public secondary and private tertiary hospitals and both public and private medical colleges enrolled in a quality improvement collaborative in Telangana and Andhra Pradesh-2 Indian states with a respective population of 35 and 50 million. METHODS AND FINDINGS: We conducted a cross-sectional study between 30 May and 26 August 2016 as part of a baseline evaluation in 52 consenting hospitals (26 public secondary hospitals, 5 public medical colleges, 15 private tertiary hospitals, and 6 private medical colleges) offering neonatal intensive care. We assessed the availability of staff and services, adherence to evidence-based practices at admission, and case fatality after admission to the NICU using a range of tools, including facility assessment, observations of admission, and abstraction of registers and telephone interviews after discharge. Our analysis is adjusted for clustering and weighted for caseload at the hospital level and presents findings stratified by type and ownership of hospitals. In total, the NICUs included just over 3,000 admissions per month. Staffing and infrastructure provision were largely according to government guidelines, except that only a mean of 1 but not the recommended 4 paediatricians were working in public secondary NICUs per 10 beds. On admission, all neonates admitted to private hospitals had auscultation (100%, 19 of 19 observations) but only 42% (95% confidence interval [CI] 25%-62%, p-value for difference is 0.361) in public secondary hospitals. The most common single cause of admission was preterm birth (25%) followed by jaundice (23%). Case-fatality rates at age 28 days after admission to a NICU were 4% (95% CI 2%-8%), 15% (9%-24%), 4% (2%-8%) and 2% (1%-5%) (Chi-squared p = 0.001) in public secondary hospitals, public medical colleges, private tertiary hospitals, and private medical colleges, respectively, according to facility registers. Case fatality according to postdischarge telephone interviews found rates of 12% (95% CI 7%-18%) for public secondary hospitals. Roughly 6% of admitted neonates were referred to another facility. Outcome data were missing for 27% and 8% of admissions to private tertiary hospitals and private medical colleges. Our study faced the limitation of missing data due to incomplete documentation. Further generalizability was limited due to the small sample size among private facilities. CONCLUSIONS: Our findings suggest differences in quality of neonatal intensive care and 28-day survival between the different types of hospitals, although comparison of outcomes is complicated by differences in the case mix and referral practices between hospitals. Uniform reporting of outcomes and risk factors across the private and public sectors is required to assess the benefits for the population of mixed-care provision.


Assuntos
Prestação Integrada de Cuidados de Saúde/tendências , Mortalidade Hospitalar/tendências , Hospitais Privados/tendências , Hospitais Públicos/tendências , Mortalidade Infantil/tendências , Unidades de Terapia Intensiva Neonatal/tendências , Terapia Intensiva Neonatal/tendências , Indicadores de Qualidade em Assistência à Saúde/tendências , Estudos Transversais , Fidelidade a Diretrizes/tendências , Disparidades em Assistência à Saúde/tendências , Humanos , Índia , Lactente , Admissão do Paciente/tendências , Admissão e Escalonamento de Pessoal/tendências , Guias de Prática Clínica como Assunto , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
Niger J Clin Pract ; 22(7): 906-912, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31293253

RESUMO

Objective: The aim of this study was to investigate how Queen bee syndrome, which is known as the mobbing behaviors of female employees from other female employees or managers, as perceived by nurses who are predominantly female workers. Materials and Methods: The universe of the qualitative type patterned research was formed by 12 nurses between the ages of 20 and 40 who worked for at least one year in different parts of a private hospital on the Anatolian side of Istanbul province. Maximum diversity sampling method for purposes was used for sample selection. The research data were collected in the form of written recording and voice recording with an unstructured interview form, which includes the structure, gender, competence, support, conflict, and competition themes created by the researchers to evaluate the characteristics of Queen bee syndrome. Focus group interviews were held on 30 April 2018. The results were evaluated using descriptive analysis and indicator methods. Results: In the study, the nurses' responses to interview questions were examined and women managers felt more emotional than men managers, and therefore they were less successful in problem-solving than men managers, but they were more successful in communication among women. The majority of nurses stated that women managers are more suitable for management in healthcare, that they are open to change, but they are not enough for men to solve the problem due to the fact that they are more concerned with the details. In addition, a significant part of the nurses, more than one female managers can cause competition and conflict in the workplace, especially women managers with similar status, said that this situation is seen more. Conclusions: The results of this study indicate that the woman is adapting to the Queen bee syndrome because of her ambition, competition, and emotional approaches, but that she has not been able to produce enough of it due to the environment.


Assuntos
Atitude do Pessoal de Saúde , Recursos Humanos de Enfermagem no Hospital/psicologia , Local de Trabalho/psicologia , Adolescente , Adulto , Animais , Feminino , Grupos Focais , Hospitais Privados , Humanos , Relações Interprofissionais , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Enfermeiras Administradoras/organização & administração , Enfermeiras Administradoras/psicologia , Recursos Humanos de Enfermagem no Hospital/organização & administração , Percepção , Pesquisa Qualitativa , Adulto Jovem
12.
Rev Esc Enferm USP ; 53: e03474, 2019 Jul 04.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31291394

RESUMO

OBJECTIVE: To study the epidemiological profile of Healthcare-associated Infections caused by Enterobacteria which carry the Klebsiella pneumoniae Carbapenemase gene (blaKPC) in the hospital environment. METHOD: A descriptive study was conducted in a private hospital in Belo Horizonte, MG, Brazil, which included all patients with infections caused by Enterobacteriaceae which carry the Klebsiella pneumoniae Carbapenemase gene. The data were collected by the Automated System of Hospital Infection Control and analyzed by descriptive statistics by the Epi Info 7 program. RESULTS: Eighty-two (82) patients participated in the study. Klebsiella pneumoniae was the most frequent species (68%) isolated in blood (30%), bronchoalveolar lavage (22%) and urine (18%), while catheter-associated bloodstream infection (30%) predominated regarding topography. A case fatality rate of 62% is highlighted in evaluating the outcome. CONCLUSION: The resistance genes spread rapidly, limiting the antimicrobial options for treating infectious diseases. The epidemiological profile of Healthcare-Associated Infections found in this study can be prevented by prevention and infection control programs.


Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Infecção Hospitalar/epidemiologia , Infecções por Enterobacteriaceae/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Brasil , Infecção Hospitalar/microbiologia , Infecções por Enterobacteriaceae/microbiologia , Feminino , Hospitais Privados , Humanos , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/isolamento & purificação , Masculino , Pessoa de Meia-Idade
13.
PLoS Negl Trop Dis ; 13(6): e0007438, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31226110

RESUMO

BACKGROUND: Dengue virus infection (DVI) among children is a leading cause of hospitalization in endemic areas. Hospitalized patients are at risk of receiving unnecessary antibiotics. METHODS: A retrospective medical review analysis study was conducted to evaluate the prevalence, indication, and choice of antibiotics given to hospitalized patients less than 15 years of age with DVI in two different hospital settings (teaching and private hospitals) in the Municipality of Bandung. Epidemiological, clinical, and laboratory data were obtained using a pre-tested standardized questionnaire from patients' medical records admitted from January 1 to December 31, 2015. RESULTS: There were 537 (17.5%) out of 3078 cases who received antibiotics. Among 176 cases admitted to the teaching hospitals, presumed bacterial upper respiratory tract infection (URTI) and typhoid fever were found in 1 (0.6%) case and 6 (0.3%) cases. In private hospitals among 2902 cases, presumed bacterial URTI was found in 324 (11.2%) cases, typhoid fever in 188 (6.5%) cases and urinary tract infection (UTI) in 18 (0.6%) cases. The prevalence of URTI and typhoid fever were significantly lower in the teaching hospitals compared to the private hospitals (p<0.0001 and p<0.05 respectively). The diagnosis of URTI in both teaching and private hospitals was merely based on clinical findings. Amoxicillin was given to 1 patient in the teaching hospitals; the 3rd generation of cephalosporins, mostly intravenous, were given in 247 (67%) cases in private hospitals. The diagnosis of typhoid fever in the teaching hospitals was based on culture in 1 (16.7%) and reactive IgM anti-Salmonella in 5 (83.3%) cases while in the private hospitals, they were based on reactive IgM anti-Salmonella in 13 (6.5%) cases, single Widal test in 61 (32.5%), and without laboratory confirmation in 114 (60.6%) cases. Most of the cases in both hospital settings were treated mostly with 3rd generation cephalosporin. The diagnosis of UTI was based on positive leucocyte esterase and nitrite in urine dipstick test in 7 (38.9%) and leucocyturia alone in 11 (61.1%) cases and was treated with 3rd generation in 15 (83.3%) cases, amoxicillin, chloramphenicol and clarithromycin, each in 1 (5.6%) case. CONCLUSION: The use of antibiotics in private hospitals was inappropriate in most cases while the use of antibiotics in the teaching hospital was more accountable. This study indicated that interventions, such as the implementation of the antibiotics stewardship program, are needed especially in private hospitals to reduce inappropriate use of antibiotics.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Dengue/complicações , Uso de Medicamentos/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Adolescente , Infecções Bacterianas/diagnóstico , Criança , Pré-Escolar , Testes Diagnósticos de Rotina/métodos , Feminino , Hospitais Privados , Hospitais de Ensino , Humanos , Indonésia , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
14.
Breast J ; 25(4): 625-630, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31074047

RESUMO

Disparities in breast cancer treatment have been documented in young and underserved women. This study aimed to determine whether surgical disparities exist among young breast cancer patients by comparing cancer treatment at a public safety-net hospital (BH) and private cancer center (PCC) within a single institution. This was a retrospective study of young women (<45) diagnosed with invasive breast cancer (stage I-III) from 2011-2016. Patient information was abstracted from the breast cancer database at BH and PCC. Demographic variables, surgery type, method of presentation, and stage were analyzed using Pearson's chi-square tests and binary logistic regression. A total of 275 patients between ages 25-45 with invasive breast cancer (Stage I-III) were included in the study. There were 69 patients from BH and 206 patients from PCC. At PCC, the majority of patients were Caucasian (68%), followed by Asian (11%), Hispanic (10%), and African American (8.7%). At BH, patients were mostly Hispanic (47.8%), followed by Asian (27.5%), and African American (10.1%). At PCC, 82% had a college/graduate degree versus 18.6% of patients at BH (P < 0.001). All patients at PCC reported English as their primary language versus 30% of patients at BH (P < 0.001). Patients at PCC were more likely to present with lower stage cancer (P = 0.04), and less likely to present with a palpable mass (P = 0.04). Hospital type was not a predictor of receipt of mastectomy (P = 0.5), nor was race, primary language, or education level. Of patients who received a mastectomy, 87% at BH and 76% at PCC had immediate reconstruction. Surgical management of young women with breast cancer in a public hospital versus private hospital setting was equivalent, even after controlling for race, primary language, stage, and education level.


Assuntos
Neoplasias da Mama/cirurgia , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Adulto , Afro-Americanos , Implante Mamário/estatística & dados numéricos , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Grupo com Ancestrais do Continente Europeu , Feminino , Disparidades em Assistência à Saúde , Hispano-Americanos , Humanos , Cobertura do Seguro , Mamoplastia/estatística & dados numéricos , Mastectomia Segmentar/estatística & dados numéricos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Cidade de Nova Iorque , Estudos Retrospectivos , Fatores Socioeconômicos
15.
PLoS One ; 14(5): e0216344, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31059526

RESUMO

BACKGROUND: One of the key strategies for reducing maternal and perinatal morbidities and mortalities is the provision of skilled intrapartum care. While cesarean section is an important emergency obstetric intervention for saving the lives of mothers and newborns, a study comparing the prevalence of cesarean delivery is not sufficiently available in Ethiopia. This study aimed at assessing the prevalence and associated factors of cesarean delivery among women who gave birth at hospitals in Dessie town, Northeast Ethiopia. METHODS: A facility based cross-sectional study was conducted between July and October 2013. A total of 520 women who gave birth in four hospitals (public = 1, private = 3) were interviewed. Face-to-face interviews using a pre-tested and structured questionnaire were conducted for primary data collection. Additionally, patients' charts were reviewed to collect mothers' clinical data. Bivariate and multiple logistic regressions analyses were conducted. Odds ratios and 95% confidence intervals were computed and a P-value of less than 0.05 was taken to declare the level of significance. RESULTS: A total of 512 mothers were included in the final analysis (response rate = 98.4%), the prevalence of cesarean delivery was found to be 47.6% (95% CI: 44.3, 51.1), While 46 (18.2%) of the procedure conducted in public and 198 (76.1%) were in private hospitals. Partograph monitoring [AOR = 3.84 95%CI: 2.24, 6.59], oxytocin administration [AOR = 4. 80 95%CI: 2.87-8.02], previous cesarean delivery [AOR = 2. 86 95%CI: 1.64-5.01] and place of delivery being a private hospital [AOR = 6. 79 95%CI: 4.18-11.01)] were associated with cesarean delivery. CONCLUSION: The prevalence of cesarean delivery was found to be high, and was significantly higher in private hospitals than a public facility. There is a need to conduct cesarean delivery audits to appropriately utilize scarce resources. Further an in-depth exploration of the experiences of women with cesarean delivery is necessary.


Assuntos
Cesárea/estatística & dados numéricos , Hospitais , Adulto , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Etiópia , Feminino , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Mães , Gravidez , Análise de Regressão , Adulto Jovem
16.
J Prev Med Hyg ; 60(1): E18-E24, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31041406

RESUMO

Introduction: Uncompleted visits to emergency departments (UEDC) are a patient safety concern. The purpose of this study was to investigate risk factors for UEDC, describing not only the sociodemographic characteristics of patients who left against medical advice (AMA) and those who left without being seen (LWBS), but also the characteristics of their access to the emergency department (ED) and of the hospital structure. Methods: This was a cross sectional study on anonymized administrative data in a population-based ED database. Results: A total of 9,147,415 patients attended EDs in the Veneto Region from 2011 to 2015. The UEDC rate was 28.7‰, with a slightly higher rate of AMA than of LWBS (15.3‰ vs 13.4‰). Age, sex, citizenship, and residence were sociodemographic factors associated with UEDC, and so were certain characteristics of access, such as mode of admission, type of referral, emergency level, waiting time before being seen, and type of medical issue (trauma or other). Some characteristics of the hospital structure, such as the type of hospital and the volume of patients managed, could also be associated with UEDC. Conclusion: Cases of UEDC, which may involve patients who leave AMA and those who LWBS, differ considerably from other cases managed at the ED. The present findings are important for the purpose of planning and staffing health services. Decision-makers should identify and target the factors associated with UEDC to minimize walkouts from public hospital EDs.


Assuntos
Serviço Hospitalar de Emergência , Qualidade da Assistência à Saúde , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Hospitais com Alto Volume de Atendimentos , Hospitais com Baixo Volume de Atendimentos , Hospitais Privados , Hospitais Públicos , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
17.
East Mediterr Health J ; 25(3): 213-217, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31054232

RESUMO

Background: Developing countries face difficulties in implementing safe healthcare waste management (HWM) practices. It is important to holistically probe the ground situation to meet this challenge. Aims: This study aimed to examine HWM practices in public and private healthcare institutions in Pakistan. Methods: In this study we surveyed 12 public and private hospitals in a major city of Pakistan, Gujranwala. The survey consisted of waste characterization as well as targeted interviews using standardized questionnaires. Results: The results indicated issues including lack of waste segregation, lack of sufficient knowledge and awareness regarding HWM and a high prevalence of Hepatitis C among hospital housekeeping staff. We also discovered that organizational and administrative solutions for effective HWM are as important as preventive monitoring and control. Conclusions: Apart from technical improvement, behavioural changes are vital for a positive change regarding HWM. Overall, this study led to an increased awareness of public health issues related to HWM that had hitherto gone unnoticed by hospital staff as well as relevant public authorities in the city.


Assuntos
Eliminação de Resíduos de Serviços de Saúde , Hospitais Privados , Hospitais Públicos , Humanos , Entrevistas como Assunto , Eliminação de Resíduos de Serviços de Saúde/métodos , Paquistão , Inquéritos e Questionários
18.
Ghana Med J ; 53(1): 8-12, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31138938

RESUMO

Background: Therapeutic drug monitoring (TDM) is essential to ensure that aminoglycoside peak concentrations are high enough for effective antimicrobial treatment and trough levels are low enough to minimise toxicity. Inappropriate utilisation of TDM may lead to suboptimal therapy, toxicity and waste of resources. This study aimed to investigate the standard of aminoglycoside TDM performed in adult hospitalised patients. Design: An observational, descriptive, cross-sectional study. Setting: A 221-bed private hospital. Participants: All patients, older than 18 years, on intravenous aminoglycosides for more than 48 hours were included. Interventions: None, was observational. A computerised database and patient files were used to obtain the information required for this study. Descriptive statistical analysis was used. Main outcomes measures: Aminoglycoside blood levels and estimated glomerular filtration rate (eGFR) in the patients. Results: One hundred and three (103) patients were included: 65 on gentamicin and 38 on amikacin. Blood levels were performed in only 19 gentamicin (29.23%) and 22 amikacin (57.89%) patients. Trough levels were taken more than 2 hours before the next dose in 12 gentamicin (63.16%) and 12 amikacin (54.54%) patients. The majority of patients (96.92% on gentamicin and 84.21% on amikacin) received once daily doses. TDM was performed in all patients with an estimated glomerular filtration rate (eGFR) lower than 60 mL/min/1.73m2 and in 23.31% of gentamicin patients and 56.76% of amikacin patients with an eGFR higher than 60 mg/min/1.73m2. Conclusions: Incorrect sampling times and unnecessary levels taken in patients with normal renal function indicate a need for aminoglycoside treatment guidelines in the private hospital. Funding: None.


Assuntos
Aminoglicosídeos/sangue , Antibacterianos/sangue , Coleta de Amostras Sanguíneas/normas , Monitoramento de Medicamentos/normas , Adulto , Idoso , Amicacina , Aminoglicosídeos/farmacocinética , Antibacterianos/farmacocinética , Estudos Transversais , Feminino , Gentamicinas , Taxa de Filtração Glomerular/efeitos dos fármacos , Hospitais Privados , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , África do Sul , Fatores de Tempo
19.
Rev Peru Med Exp Salud Publica ; 36(1): 87-92, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31116345

RESUMO

The main mechanisms of antimicrobial resistance are described using the Vitek® 2 system in uropathogens isolated in older adults from a private clinic in Lima. Descriptive study conducted between January 2014 and October 2016. Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis obtained a sensitivity greater than 80% against piperacillin/ tazobactam, amikacin, and carbapenems. Moreover, 83.6% of Escherichia coli were nitrofurantoin-sensitive strains. A 41.7% of Escherichia coli, 50.9% of Klebsiella pneumoniae, and 50% of Proteus mirabilis were producers of extended spectrum beta-lactamases (ESBL). Similarly, 60% of Pseudomonas aeruginosa were producers of carbapenemases. Active site modification (PBP) and enzymatic inactivation by penicillinases occurred in 7.8% of Enterococcus faecalis. Resistance to aminoglycosides was presented in Escherichia coli (27.1%), Klebsiella pneumoniae (46.7%), and Proteus mirabilis (84.6%) for the production of modifier enzymes. There is an increase in bacterial resistance in relation to age. Enzymatic inactivation of beta-lactam antibiotics and aminoglycosides is the most common resistance mechanism.


Assuntos
Bactérias/efeitos dos fármacos , Infecções Urinárias/microbiologia , Idoso , Bactérias/isolamento & purificação , Farmacorresistência Bacteriana , Feminino , Hospitais Privados , Humanos , Masculino , Testes de Sensibilidade Microbiana , Peru , Estudos Retrospectivos , Saúde da População Urbana
20.
Med Educ Online ; 24(1): 1593785, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30957686

RESUMO

Burnout syndrome is a psychological condition that commonly affects health professionals, medical students, and others in professions with long shifts. It is defined by a high amount of emotional exhaustion, depersonalization, and low personal job satisfaction. We aimed to determine the prevalence of burnout syndrome in medical interns and establish the relationships between this condition and the time and type of hospital at which students worked during their medical internship. This was a survey study in which we used the Maslach Burnout Inventory, applied to fifth-year medical students on an internship at private and public hospitals in Mexico. The participants were 96 women (54.5%) and 80 men (45.5%), with ages ranging from 21 to 34 years old. We found burnout syndrome in 20% of these medical students 22% of the women and 18.6% of the men in the sample. Second-semester interns suffered burnout at a rate of 29%, in contrast to 15% of first-semester students. Emotional exhaustion and depersonalization scores were higher in second-semester interns who worked in public hospitals. However, the prevalence did not differ between public and private hospitals. Our study reports a higher prevalence of burnout syndrome during the second semester of internship. Students who practiced their internship in a public hospital showed higher scores in emotional exhaustion and depersonalization than those who practiced in a private hospital.


Assuntos
Esgotamento Profissional/epidemiologia , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Estudantes de Medicina/psicologia , Adulto , Esgotamento Profissional/psicologia , Estudos Transversais , Emoções , Feminino , Humanos , Satisfação no Emprego , Masculino , México/epidemiologia , Prevalência , Estresse Psicológico/epidemiologia , Adulto Jovem
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