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1.
Ig Sanita Pubbl ; 76(2): 119-129, 2020.
Artigo em Italiano | MEDLINE | ID: mdl-32877396

RESUMO

The Authors present the results of an experience carried out in a University General Hospital, for the assessment of the sanitation of surfaces and instruments in the context of hospital refection. A specific procedure has been quarterly implemented in order to verify the correct execution of the sanitization procedures. In the time-period September 2016 - March 2020 Petri dishes and tampons were used in order to determine the following microbiological parameters and indicators: total bacterial load at 30 degrees C, Coliforms, Listeria monocytogenes, Salmonella spp, Staphylococcus aureus, Escherichia coli and mycetic load. Only 7 out of 82 sanitized surfaces (8.5% of the total) were found to be not complying, only for total bacterial load at 30 degrees C, mycetic load and Coliforms. The systematic application of this procedure and the results of the survey conducted, comforting as a whole, confirm the attention reserved to the hygienic level of surfaces, tools, equipment and utensils, in the context of the centralized catering service of the hospital, in which the Health Department, sharing with the UOC Hospital Hygiene the specific hygienic procedure, has always been at the forefront of the proposal of interventions, considering the increased susceptibility and vulnerability of the hospitalized patients.


Assuntos
Hospitais Universitários/normas , Higiene/normas , Saneamento/normas , Humanos , Listeria monocytogenes
2.
Clinics (Sao Paulo) ; 75: e1989, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555947

RESUMO

OBJECTIVES: The present coronavirus disease (COVID-19) pandemic has ushered in an unprecedented era of quality control that has necessitated advanced safety precautions and the need to ensure the adequate protection of healthcare professionals (HCPs). Endoscopy units, endoscopists, and other HCP may be at a significant risk for transmission of the virus. Given the immense burden on the healthcare system and surge in the number of patients with COVID-19, well-designed protocols and recommendations are needed. We aimed to systematically characterize our approach to endoscopic procedures in a quaternary university hospital setting and provide summary protocol recommendations. METHOD: This descriptive study details a COVID-19-specific protocol designed to minimize infection risks to patients and healthcare workers in the endoscopy unit. RESULTS: Our institution, located in São Paulo, Brazil, includes a 900-bed hospital, with a 200-bed-specific intensive care unit exclusively designed for patients with moderate and severe COVID-19. We highlighted recommendations for infection prevention and control during endoscopic procedures, including appropriate triage and screening, outpatient management and procedural recommendations, role and usage of personal protective equipment (PPE), and role and procedural logistics involving COVID-19-positive patients. We also detailed hospital protocols for reprocessing endoscopes and cleaning rooms and also provided recommendations to minimize severe acute respiratory syndrome coronavirus 2 transmission. CONCLUSION: This COVID-19-specific administrative and clinical protocol can be replicated or adapted in multiple institutions and endoscopy units worldwide. Furthermore, the recommendations and summary protocol may improve patient and HCP safety in these trying times.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Endoscopia/normas , Hospitais Universitários/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual/normas , Pneumonia Viral/prevenção & controle , Brasil , Infecções por Coronavirus/transmissão , Endoscopia/métodos , Pessoal de Saúde/normas , Humanos , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , Fatores de Risco
5.
J Med Internet Res ; 22(4): e15554, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-32238331

RESUMO

BACKGROUND: Variations in patient demand increase the challenge of balancing high-quality nursing skill mixes against budgetary constraints. Developing staffing guidelines that allow high-quality care at minimal cost requires first exploring the dynamic changes in nursing workload over the course of a day. OBJECTIVE: Accordingly, this longitudinal study analyzed nursing care supply and demand in 30-minute increments over a period of 3 years. We assessed 5 care factors: patient count (care demand), nurse count (care supply), the patient-to-nurse ratio for each nurse group, extreme supply-demand mismatches, and patient turnover (ie, number of admissions, discharges, and transfers). METHODS: Our retrospective analysis of data from the Inselspital University Hospital Bern, Switzerland included all inpatients and nurses working in their units from January 1, 2015 to December 31, 2017. Two data sources were used. The nurse staffing system (tacs) provided information about nurses and all the care they provided to patients, their working time, and admission, discharge, and transfer dates and times. The medical discharge data included patient demographics, further admission and discharge details, and diagnoses. Based on several identifiers, these two data sources were linked. RESULTS: Our final dataset included more than 58 million data points for 128,484 patients and 4633 nurses across 70 units. Compared with patient turnover, fluctuations in the number of nurses were less pronounced. The differences mainly coincided with shifts (night, morning, evening). While the percentage of shifts with extreme staffing fluctuations ranged from fewer than 3% (mornings) to 30% (evenings and nights), the percentage within "normal" ranges ranged from fewer than 50% to more than 80%. Patient turnover occurred throughout the measurement period but was lowest at night. CONCLUSIONS: Based on measurements of patient-to-nurse ratio and patient turnover at 30-minute intervals, our findings indicate that the patient count, which varies considerably throughout the day, is the key driver of changes in the patient-to-nurse ratio. This demand-side variability challenges the supply-side mandate to provide safe and reliable care. Detecting and describing patterns in variability such as these are key to appropriate staffing planning. This descriptive analysis was a first step towards identifying time-related variables to be considered for a predictive nurse staffing model.


Assuntos
Hospitais Universitários/normas , Recursos Humanos de Enfermagem no Hospital/normas , Admissão e Escalonamento de Pessoal/normas , Adulto , Pré-Escolar , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Estudos Retrospectivos , Suíça
6.
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
8.
Ann Biol Clin (Paris) ; 78(1): 79-86, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32108585

RESUMO

This is a prospective study realized at the level of the hematology department and blood transfusion center of the University Hospital Center (CHU) of Dr Ben Badis of Constantine and spread out over a period of one year (from January 1st to December 31st). The work focused on the analytical processes mastery of the NFS needs a compulsory step concerning technical and organizational laboratory skills respecting the ISO 15189 laws going through a mastery of support processes (humain resourses, informatics, materials, documents, management) indispensable for the good function of analytic proceedings, a performance evaluation of the hematology analyzer Advia (2120 I and II and 560) and quality control management (intern, extern). The analytic performance evaluation of Advia gives reliable results reproductible and stable for use of the routine automatisation good inter-machine correlation and laboratory performance in terms of the quality extern evaluation with military hospital laboratory.


Assuntos
Contagem de Células Sanguíneas , Hematologia/normas , Laboratórios Hospitalares/normas , Automação Laboratorial/instrumentação , Automação Laboratorial/métodos , Automação Laboratorial/normas , Contagem de Células Sanguíneas/instrumentação , Contagem de Células Sanguíneas/métodos , Contagem de Células Sanguíneas/normas , Hematologia/métodos , Hospitais Universitários/normas , Humanos , Contagem de Leucócitos/instrumentação , Contagem de Leucócitos/métodos , Contagem de Leucócitos/normas , Fase Pré-Analítica/métodos , Fase Pré-Analítica/normas , Estudos Prospectivos , Controle de Qualidade , Reprodutibilidade dos Testes , Medicina Transfusional/métodos , Medicina Transfusional/normas
10.
Artigo em Inglês | MEDLINE | ID: mdl-31936699

RESUMO

Surgical staff behavior in operating theatres is one of the factors associated with indoor air quality and surgical site infection risk. The aim of this study was to apply an approach including microbiological, particle, and microclimate parameters during two simulated surgical hip arthroplasties to evaluate the influence of staff behavior on indoor air quality. During the first hip arthroplasty, the surgical team behaved correctly, but in the second operation, behavioral recommendations were not respected. Microbiological contamination was evaluated by active and passive methods. The air velocity, humidity, temperature, and CO2 concentration were also monitored. The highest levels of microbial and particle contamination, as well as the highest variation in the microclimate parameter, were recorded during the surgical operation where the surgical team behaved "incorrectly". Turbulent air flow ventilation systems appeared more efficient than in the past and very low air microbial contamination was reached when behavior was correct. Therefore, adherence to behavioral recommendations in operating theatres is essential to not undermine the effectiveness of the heating, ventilation, and air conditioning systems and employed resources.


Assuntos
Poluição do Ar em Ambientes Fechados/análise , Comportamento , Corpo Clínico Hospitalar/estatística & dados numéricos , Salas Cirúrgicas/normas , Ventilação/normas , Microbiologia do Ar , Artroplastia , Hospitais Universitários/normas , Humanos
11.
Rev Epidemiol Sante Publique ; 68(1): 51-56, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-31839377

RESUMO

BACKGROUND: The establishment of a common pragmatic terminology represents the first step in structuring patient engagement initiatives in healthcare facilities. However, none is currently available in French. As part of the deployment of patient engagement within a French University Hospital Center, we propose a terminology of patient engagement. METHODS: We conducted a scoping review of the international literature that aimed at identifying the main conceptual and terminological frameworks for the engagement of patients, users and citizens in the healthcare system until 2019 in the PubMed and Cairn.info databases for English and French language articles. Additionally, we identified concepts and practices in the leading organizations of countries where this approach was implemented (United States, Canada and especially the province of Quebec, United Kingdom) and completed this approach by close exchanges and reflections with the team that developed the Montreal model. RESULTS: In total, 75 references and Internet resources were consulted. Patient, interaction, patient experience, experiential knowledge, patient engagement, patient partner and its variations as a resource patient, peer-supporter, trainer, researcher and coach have been defined. CONCLUSION: This terminology of patient engagement proposes an initial stabilization of the vocabulary, using a pragmatic approach. This contribution is a first step aiming at promoting the development of a new model of care and more broadly of healthcare system management, involving scientific and experiential knowledge.


Assuntos
Hospitais Universitários/organização & administração , Participação do Paciente , Relações Profissional-Paciente , Administração em Saúde Pública/métodos , Terminologia como Assunto , Canadá , França , Hospitais Universitários/normas , Humanos , Idioma , Quebeque , Reino Unido , Estados Unidos , Vocabulário
12.
Dig Dis Sci ; 65(6): 1806-1815, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31732905

RESUMO

BACKGROUND: To prevent colorectal cancer, high-quality colonoscopy is advocated, undertaken by endoscopists with high adenoma detection rates (ADRs). Despite reports that various factors may impact ADRs, the significance of such factors is still unclear. AIMS: The analysis was aimed at quality-oriented interventions for boosting ADRs. METHODS: Study enrollees were adults subjected to screening colonoscopy between September 2013 and August 2016 at the Gangnam Center of Seoul National University Hospital Healthcare System. The investigation entailed six periods (P1-6) of 6 months each, during which serial multidirectional quality improvement efforts were instituted. In particular, we sought to further educate endoscopists, provide feedback on individual ADRs, and introduce a split-dose regimen, gauging results via the Boston Bowel Preparation Score. Changes in polyp detection rates (PDRs) and ADRs were then analyzed. RESULTS: A total of 13,430 colonoscopies were undertaken by 15 experienced endoscopists. Overall, the ADR increased from 45.6% (P1) to 48.2% (P6, p < 0.001). The PDR, ADR, and advanced adenoma detection rate (AdvADR) showed the greatest increases between P3 and P4 [PDR 67.8% → 71.2% (p < 0.001); ADR 44.1% → 47.7% (p = 0.001); AdvADR 2.3% → 3.3% (p = 0.028)] in keeping with the introduction of a split-dose regimen. The sessile serrated adenoma detection rate (SSADR) increased substantially from 2.1% (P1) to 7.9% (P6, p < 0.001), with the largest gain between P1 and P2, just after education (p = 0.023). CONCLUSIONS: Successful quality improvement in colonoscopy was achieved through comprehensive multidirectional efforts in education, feedback, and enhanced bowel preparation. Achieving high-level bowel preparation was paramount in ADR improvement. The SSADR was improved through education.


Assuntos
Colonoscopia/normas , Neoplasias Colorretais/prevenção & controle , Assistência à Saúde/normas , Hospitais Universitários/normas , Melhoria de Qualidade , Idoso , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia
13.
J Minim Invasive Gynecol ; 27(1): 195-199, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30936030

RESUMO

STUDY OBJECTIVE: Our primary goal was to uncover preoperative and intraoperative risk factors that prevented same-day discharge (SDD) after myomectomy in a setting where SDD was the standard of care. Uncovered predictors would serve to enhance patient counseling and medical optimization before surgery. DESIGN: Single-center retrospective cohort study. SETTING: Urban university hospital center, by fellowship-trained minimally invasive gynecologic surgeons. PATIENTS: A total of 315 consecutive patients undergoing minimally invasive myomectomy between March 2012 and May 2018. INTERVENTION: Minimally invasive myomectomy. MEASUREMENTS AND MAIN RESULTS: Preoperative and intraoperative characteristics were collected for analysis as predictors of SDD vs overnight admission. Comparisons of demographic, clinical, imaging, and operative characteristics were made using appropriate statistical methods for normally distributed, skewed, and categorical variables. Length of stay was analyzed as a categorical variable, SDD vs overnight admission. A logistic regression model was used to evaluate SDD vs any overnight stay. Out of the 315 patients undergoing laparoscopic myomectomy, 208 (66.03%) were discharged on the same day, and 107 (33.96%) were admitted for at least 1 day after surgery. The patients were more likely to be admitted overnight if they were of Asian ethnicity (p = .01), or if they had a lower preoperative Hct (36.15 vs 37.57; p < .003). An increase in any myoma characteristic metric was associated with overnight stay after surgery; these included mean myoma weight (512.0 g vs 310.1 g; p < .001), estimated size of the largest myoma on imaging (9.01 cm vs 7.77 cm; p < .001), and number of myomas removed (6.59 vs 5.57; p = .021). Other statistically significant differences between the overnight admission and SDD groups were mean estimated blood loss (599.4 mL vs 221.9 mL; p < .001), operative time (224.4 minutes vs 140.9 minutes; p < .001), and surgery end time (15:02 hours vs 12:43 hours; p < .001). Intraoperative complications associated with overnight admission were estimated blood loss >1 L (p < .001) and any intraoperative transfusion (p < .001). The adjusted logistic regression model identified an increase in operative time (by 60 minutes) and later surgery end time (by 60 minutes) as predictors of an overnight stay, whereas an 5% increase in preoperative hematocrit was associated with a 34% decrease in odds for an overnight stay. CONCLUSION: Perioperative factors, such as preoperative hematocrit, and myoma characteristics, as well as intraoperative factors, such as prolonged operative time and surgery end-time, are independent predictors of overnight hospital admission after minimally invasive myomectomy. Our present data can be used to provide better patient counseling before surgery.


Assuntos
Leiomioma/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Admissão do Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Miomectomia Uterina/efeitos adversos , Neoplasias Uterinas/cirurgia , Adulto , Instituições de Assistência Ambulatorial/normas , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Estudos de Coortes , Feminino , Hospitais com Alto Volume de Atendimentos/normas , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais Universitários/normas , Hospitais Universitários/estatística & dados numéricos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Leiomioma/diagnóstico , Leiomioma/epidemiologia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Miomectomia Uterina/métodos , Miomectomia Uterina/estatística & dados numéricos , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/epidemiologia
14.
Int J Med Inform ; 134: 103927, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31864096

RESUMO

CONTEXT: The Unified Model of Information Systems Continuance (UMISC) is a metamodel for the evaluation of clinical information systems (CISs) that integrates constructs from five models that have previously been published in the literature. UMISC was developed at the Georges Pompidou University Hospital (HEGP) in Paris and was partially validated at the Saint Joseph Hospital Group (HPSJ), another acute care institution using the same CIS as HEGP. OBJECTIVE: The aim of this replication study was twofold: (1) to perform an external validation of UMISC in two different hospitals and country contexts: the Italian Hospital of Buenos Aires (HIBA) in Argentina and the Hospital Sirio Libanes in Sao Paulo, Brazil (HSL); (2) to compare, using the same evaluation model, the determinants of satisfaction, use, and continuance intention observed at HIBA and HSL with those previously observed at HEGP and HPSJ. METHODS: The UMISC evaluation questionnaires were translated from their original languages (English and French) to Brazilian Portuguese and Spanish following the translation/back-translation method. These questionnaires were then applied at each target site. The 21 UMISC-associated hypotheses were tested using structural equation modeling (SEM). RESULTS: A total of 3020 users, 1079 at HIBA and 1941 at the HSL, were included in the analysis. The respondents included 1406 medical staff and 1001 nursing staff. The average profession-adjusted use, overall satisfaction and continuance intention were significantly higher at HIBA than at HSL in the medical and nursing groups. In SEM analysis, UMISC explained 23% and 11% of the CIS use dimension, 72% and 85% of health professionals' satisfaction, and 41% and 60% of continuance intention at HIBA and HSL, respectively. Twenty of the 21 UMISC-related hypotheses were validated in at least one of the four evaluation sites, and 16 were validated in two or more sites. CONCLUSION: The UMISC evaluation metamodel appears to be a robust comparison and explanatory model of satisfaction, use and continuance intention for CISs in late post adoption situations.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde/estatística & dados numéricos , Sistemas de Informação Hospitalar/estatística & dados numéricos , Hospitais Universitários/normas , Modelos Organizacionais , Satisfação Pessoal , Adulto , Argentina , Brasil , Feminino , Humanos , Agências Internacionais , Masculino , Inquéritos e Questionários
15.
Ir J Med Sci ; 189(2): 701-709, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31602574

RESUMO

BACKGROUND: There is an increasing body of research demonstrating stress, burnout, and compassion fatigue among those working in obstetrics and gynaecology. The literature is lacking with respect to targeted interventions aimed at improving staff wellbeing. AIMS: To investigate whether an intervention which increases support for staff is feasible to implement and effective at improving staff wellbeing. METHODS: This study was conducted in a tertiary university teaching maternity hospital. All doctors in training (DITs) (N = 28) and midwives (N = 69) working in the delivery suite were invited to participate. Wellbeing was assessed by measuring burnout, compassion fatigue, and perceived stress using validated questionnaires. These were distributed pre-intervention and 6 months after implementation of the interventions. The support interventions consisted of posters promoting self-care, team bonding sessions, and end of shift meetings. RESULTS: Eighteen (64%) DITs and 22 (31%) midwives returned pre-intervention questionnaires. Thirteen (18%) midwives retuned post-intervention questionnaires, of which five midwives (7%) returned both the pre-intervention questionnaire and the post-intervention questionnaire. Eighty-seven percent of participants were experiencing emotional exhaustion pre-intervention. There was a statistically significant decrease in the Professional Quality of Life burnout score from pre-intervention (M = 25.8) to post-intervention (M = 21.4), p = 0.02. End of shift meetings were discontinued after 5 weeks due to low attendance. End of shift meetings provided an opportunity for support and debriefing; however, the timing of these sessions impaired their long-term feasibility. CONCLUSION: DITs and midwives of this sample are experiencing high levels of burnout and compassion fatigue. End of shift meetings for midwives and team bonding sessions for DITs may positively impact on wellbeing, but in current format, they are not feasible for long-term implementation. The low level of participation highlights a challenge in implementing institution-wide support interventions.


Assuntos
Maternidades/normas , Hospitais Universitários/normas , Tocologia/normas , Obstetrícia/métodos , Feminino , Humanos , Irlanda , Masculino
16.
Acad Psychiatry ; 44(1): 46-52, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31691196

RESUMO

OBJECTIVE: Integrating behavioral health services into the primary care setting is a recognized approach to improving timely access and building capacity for primary care providers. The aim of this study was to examine barriers to family medicine resident learning in a co-located primary care-behavioral health integration program with psychiatrists in an academic hospital. METHODS: The authors used a descriptive qualitative study design to collect data on participants' learning experiences from focus groups and semi-structured interviews with 5 family medicine residents, 3 psychiatry residents, 5 family physicians, 3 psychiatrists, 2 office coordinators, and 2 educational coordinators. Thematic analysis of transcripts was performed. RESULTS: Three themes were identified with respect to barriers to learning in the program from the family medicine perspective. Organizational barriers encompassed lack of clear vision, goals, roles, and responsibilities. Administrative barriers involved complex appointment bookings and scheduling. Communication and engagement barriers included insufficient communication between team members and lack of patient engagement in the program. CONCLUSIONS: The study findings highlight the importance of several factors for the successful implementation of a co-located academic primary care-behavioral health integrated model. This includes the formalization of program structure that encompasses shared vision, goals, roles, and responsibilities; coordinated processes for appointment bookings; team communication and patient engagement; and diverse educational and longitudinal care opportunities. With the growing number of integrated care programs, these results provide guidance for health care leaders involved in the design and management of primary care-behavioral health integration programs.


Assuntos
Medicina de Família e Comunidade , Pessoal de Saúde , Hospitais Universitários , Relações Interprofissionais , Serviços de Saúde Mental , Atenção Primária à Saúde , Adulto , Medicina de Família e Comunidade/educação , Medicina de Família e Comunidade/organização & administração , Medicina de Família e Comunidade/normas , Pessoal de Saúde/educação , Pessoal de Saúde/organização & administração , Pessoal de Saúde/normas , Hospitais Universitários/organização & administração , Hospitais Universitários/normas , Humanos , Capacitação em Serviço , Internato e Residência , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/normas , Médicos de Família/educação , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Psiquiatria/educação , Pesquisa Qualitativa
17.
Rev Chilena Infectol ; 36(3): 253-264, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859743

RESUMO

BACKGROUND: Nowadays about half of antibiotic prescriptions are inadequate, increasing bacterial resistance. Both cephalosporins and fluoroquinolones are associated with this phenomenon: increase of ß-lactamase producing bacteria and Clostridioides difficile infections, which is why regulatory agencies seek to rationalize their use. AIM: To evaluate the effect of use recommendations on the proportion of inadequate prescriptions of ceftriaxone and fluoroquinolones. METHODS: A prospective and interventional study was developed, comparing the quality and quantity of use of ceftriaxone and fluoroquinolones before and after the implementation of use recommendations for treatments of infectious diseases acquired at the community. The outcomes were: proportion of inadequate prescriptions and defined daily dose (DDD). Data were analyzed using the Chi-square test, Fisher's correction and Student's test. RESULTS: A total of 206 patients were evaluated, a 35% decrease in inadequate prescriptions, a decline in the consumption of ceftriaxone and levofloxacin, and a significant increase in the use of ampicillin/ sulbactam was observed. CONCLUSIONS: The implementation of use recommendations based on scientific evidence and local susceptibility allowed to reduce the proportion of inadequate prescriptions and to reduce de consumption of ceftriaxone and fluoroquinolones.


Assuntos
Antibacterianos/administração & dosagem , Gestão de Antimicrobianos/normas , Ceftriaxona/administração & dosagem , Prescrições de Medicamentos/normas , Fluoroquinolonas/administração & dosagem , Hospitais Universitários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Esquema de Medicação , Uso de Medicamentos/normas , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Prescrição Inadequada/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
18.
Rev Esp Salud Publica ; 932019 Nov 06.
Artigo em Espanhol | MEDLINE | ID: mdl-31690715

RESUMO

OBJECTIVE: Protection, promotion and support to the breastfeeding is considered as an area of priority in public health care and as a determining factor of child and maternal health. The use of good practice guides improves health outcomes and patients safety. The aim of study was to assess the impact on breastfeeding of a Guide of Good Clinic Practices about breastfeeding in the Mother and Child Center of the Virgen de las Nieves University Hospital in Granada. METHODS: Cross-sectional descriptive study. Mothers and newborns attended from 2015 to 2018 were studied. Process and outcome variables were considered to perform a descriptive and bivariate analysis for the comparison between years. RESULTS: The rate of exclusive breastfeeding at discharge went from 58.3% to 72.2%. Significant differences were found for the first intake of exclusive breastfeeding in eutocic births and in C-sections, from 90.8% to 93.2% in the first and from 21.7% to 60% in the second. Improvements were detected in the assessment of intake, postnatal education and onset and duration of skin-to-skin contact. CONCLUSIONS: Postnatal protocolized actions carried out by health professionals, such as the assessment of the intake of breastfeeding and postnatal education, were effective for the establishment of breastfeeding. The first moment of skin-to-skin contact and its duration are aspects to be reinforced for effective support.


Assuntos
Aleitamento Materno , Maternidades/normas , Hospitais Universitários/normas , Cuidado Pós-Natal/normas , Adulto , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Cuidado Pós-Natal/métodos , Guias de Prática Clínica como Assunto , Espanha
19.
Arch Pediatr ; 26(7): 400-406, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31611146

RESUMO

OBJECTIVE: To identify the discrepancies between the adverse drug reactions (ADRs) identified by medical records technicians and the ADRs identified by the pharmacovigilance team, and to validate the quality of the information collected by the medical records technicians. To propose improvements to the method for detection of serious ADRs by medical records technicians and the pharmacovigilance team to meet the new requirements of Canada's amended Food and Drug Act (Vanessa's Law) and its regulations. METHODS: This was a descriptive and retrospective study. We included all ADRs identified by medical records technicians in the coding of records after hospitalization, including active ADRs present at admission or identified during hospitalization between 1 April 2017 and 31 October 2017, and all ADRs identified and reported by the pharmacy through its pharmacovigilance program during the same period. We identified the discrepancies between the two identification systems and revised all cases from patient records. In addition, we identified improvements in the method for detecting and reporting serious ADRs. RESULTS: This study identified 343 ADRs, 322 of which were coded by the medical records technicians and 21 identified by the pharmacovigilance team for a period of 7 months in a mother-child university hospital center. Only 1.5% of the ADRs were identified by both medical records technicians and the pharmacovigilance team. The code Y43, which corresponds to the largest number of identified ADRs, mainly includes anticancer drugs and immunosuppressant drugs. Three corrective actions were set up: 1) implementation of a form to explain the addition and coding of an ADR to a patient's file, 2) weekly transmission of a working file between the medical records technicians and the pharmacovigilance team so that the files would be reviewed and a declaration made to the regulatory authority, and 3) creation of a standardized pharmacist's note to add to the patient file. CONCLUSION: It is possible to increase the reporting of ADRs, improve the quality of coding, and reduce discrepancies between the ADRs coded by these two teams through a structured intervention.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/normas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Registros Médicos/normas , Pediatria/normas , Farmacovigilância , Melhoria de Qualidade , Adolescente , Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Canadá , Criança , Pré-Escolar , Codificação Clínica/normas , Codificação Clínica/estatística & dados numéricos , Hospitais Universitários/normas , Hospitais Universitários/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Registros Médicos/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde , Indicadores de Qualidade em Assistência à Saúde/normas , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos
20.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(8): 719-723, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31422608

RESUMO

Department of minimally invasive gastrointestinal surgery in Peking University Cancer Hospital (also named as Department of Gastrointestinal Surgery IV) was established on April 7, 2009. Up to now, ten years have passed since its foundation. As the first department built in specialized cancer hospital, which mainly focuses on laparoscopic surgery, its foundation and development has a very important historical and practical significance in the development of surgical oncology in China. Reviewing the rapid growth of the Department of Minimally Invasive Gastrointestinal Surgery over the past decade, on the one hand, it has benefited from the opportunities of the times and the support of leaders in Peking University Cancer Hospital at that time. More importantly, the progress owes to the pioneering Professor Su Xiangqian, who is brave and innovative, with indomitable spirit and advanced management philosophy. With rigorous training, the ability of the team has been steadily enhanced, the competitiveness has been gradually improved, and the development direction which focuses on laparoscopic gastric cancer surgery and laparoscopic colorectal cancer surgery has been established. Now, the Department of Minimally Invasive Gastrointestinal Surgery has become a well-known domestic gastrointestinal tumor center. In the past ten years, under the leadership of Professor Su Xiangqian, the growth of this team is innovative and comprehensive: (1) Introduce the internationally advanced Baldrige medical service management framework, and propose the "management by principle" concept to improve the core competitiveness of the department; (2) Establish an academic brand by laparoscopic standardized surgery training courses for gastrointestinal tumors, promote cooperation and exchange at home and abroad, and participate in international multi-center clinical research projects; (3) Adhere to the "formation of a research-oriented department, conducting clinical and basic research simultaneously" as the development direction; (4) Stick to the core development concept of team building and cultivate professional talents. Looking forward to the future, our team will not forget the beginning of the heart, and move forward! In the next ten years, we will break through ourselves and continue to pursue the higher level!


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/história , Neoplasias Gastrointestinais/história , Procedimentos Cirúrgicos Minimamente Invasivos/história , Institutos de Câncer/história , Institutos de Câncer/normas , China , Procedimentos Cirúrgicos do Sistema Digestório/educação , Procedimentos Cirúrgicos do Sistema Digestório/normas , Neoplasias Gastrointestinais/cirurgia , História do Século XX , História do Século XXI , Hospitais Universitários/história , Hospitais Universitários/normas , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Desenvolvimento de Programas
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