Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.043
Filtrar
2.
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
3.
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
4.
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
5.
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
6.
BMC Pregnancy Childbirth ; 19(1): 238, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288780

RESUMO

BACKGROUND: There are several international guidelines on oxytocin regimens for induction and augmentation of labour, but no agreement on a standardised regimen in Germany. This study collated and reviewed the oxytocin regimens used for labour augmentation in university hospitals, with the long-term aim of contributing to the development of a national clinical guideline. METHODS: Germany has 34 university hospital compounds, representing 39 maternity units. In this observational study we asked units to provide standard operational procedures on oxytocin augmentation during labour or provide the details in a structured survey. Data were collected on the dosage of oxytocin, type and volume of solutions used, indications and contraindications for use and discontinuation, case-specific administration, and on who developed the procedures. Findings were analysed descriptively. RESULTS: A total of 35 (90%) units participated in this study. Standard operating procedures were available in 24 units (69%), seven units (20%) did not have procedures and information was missing from four units (11%). Midwives participated in the development of standard operating procedures in 15 units (43%). Infusions were most commonly prepared using six units of oxytocin in 500 ml 0.9% normal saline solution (12 mU/ml). The infusions were started at 120 mU/hour and increased by 120 mU/hour at 20-min intervals up to a maximum dosage of 1200 mU/hour. The most common indication for use was delayed progress in labour. Infusions were stopped when uterine contractions became hypertonic and/or the fetal heart rate showed signs of distress. Most of the practices described aligned with international guidance. All units used reduced oxytocin dosages for women with a history of previous caesareans section, as recommended in the international guidelines, and restrictive use was advised in multiparous women. The main difference between units related to combined use of amniotomy and oxytocin, recommended by three guidelines but used in only four maternity units (11%). CONCLUSIONS: While there was considerable variation in the oxytocin augmentation procedures, most but not all practices used in these 35 German maternity units were comparable. Establishing a national guideline on the criteria for and administration of oxytocin for augmentation of labour would eliminate the observed differences and minimise risk of administration and medication error.


Assuntos
Hospitais Universitários/estatística & dados numéricos , Trabalho de Parto Induzido/estatística & dados numéricos , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Adulto , Feminino , Alemanha , Hospitais Universitários/normas , Humanos , Trabalho de Parto Induzido/métodos , Trabalho de Parto Induzido/normas , Ocitócicos/normas , Ocitocina/normas , Guias de Prática Clínica como Assunto , Gravidez , Inquéritos e Questionários
7.
Osteoporos Int ; 30(9): 1779-1788, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31190123

RESUMO

The purpose of this study was to assess the performance of our Fracture Liaison Service (FLS) over a period of 2 years. Osteoporosis medication was prescribed for 243 patients, and zoledronic acid was the main drug prescribed (60.2%). INTRODUCTION: A Fracture Liaison Service (FLS) was implemented at Lille University Hospital in 2016. The main purpose of this study was to assess the performance of the FLS using criteria proposed by the International Osteoporosis Foundation (IOF). METHODS: The criteria used were patient identification, patient evaluation, post-fracture assessment timing, vertebral-fracture identification, blood and bone mineral density (BMD) testing, falls prevention, multifaceted health and lifestyle risk-factor assessment, and medication initiation and review. RESULTS: Between January 2016 and January 2018, 736 patients (≥ 50 years old) with a recent history of fragility fracture (≤ 12 months) were identified. The identification rate for hip fractures was 74.2%. However, patient evaluation for all type of fractures was quite low (30.3%) since many patients failed to attend the FLS unit. The reasons for non-attendance were refusal, agreed but subsequently failed to attend, and still waiting to be seen. In all, 256 patients (76.6% female, mean (SD) age 74.3 (11.0) years) were seen at the FLS. Mean (SD) post-fracture assessment timing was 13.3 (9.3) weeks. Of the 139 patients seen for a non-vertebral fracture, 103 were assessed for vertebral fractures, and at least one new vertebral fracture was found in 45 of them (43.7%). Osteoporosis medication was prescribed for 243 (94.9%) patients. The main osteoporosis drug prescribed was zoledronic acid (60.2%). CONCLUSIONS: Secondary prevention of osteoporotic fractures has improved since the implementation of the FLS. However, patient identification, patient evaluation, and post-fracture assessment timing still need to be improved.


Assuntos
Fraturas por Osteoporose/prevenção & controle , Prevenção Secundária/métodos , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Conservadores da Densidade Óssea/uso terapêutico , Comunicação , Procedimentos Clínicos/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/normas , Feminino , França/epidemiologia , Pesquisa sobre Serviços de Saúde/métodos , Hospitais Universitários/organização & administração , Hospitais Universitários/normas , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Pacientes não Comparecentes/estatística & dados numéricos , Osteoporose/tratamento farmacológico , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Medição de Risco/métodos , Prevenção Secundária/organização & administração , Prevenção Secundária/normas
8.
Clin Biochem ; 70: 24-29, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31153900

RESUMO

BACKGROUND: The clinical laboratory is responsible for reporting accurate and expeditious results. However, the pre-analytical phase is directly related to the procedure of specimen collection and is mostly out of the direct control of the laboratory; further, most pre-analytical errors are related to human factors. Therefore, education and training programs for the phlebotomy teams are considered the most significant and necessary measures to reduce these errors. METHODS: A cross-sectional study was conducted to investigate the types and frequencies of pre-analytical errors in the hospital laboratory. Pre-analytical errors were categorized into four main categories: rejected sample, error related to test ordering, misidentification, and others. Several activities were performed for quality improvement in order to reduce the rates of these errors. The data were analyzed by comparing the pre-intervention and post-intervention results along with the results of questionnaires to assess knowledge to investigate the effects of the activities. RESULTS: The rates of pre-analytical errors decreased from 0.42% in the pre-intervention period to 0.32% in the post-intervention period. The rejected sample category accounted for the highest rates in the pre- and post-intervention periods. In the questionnaires, the overall average score after the intervention was 71.5, which was a significant increase from 46.0 in the pre-intervention period. CONCLUSIONS: Each clinical laboratory has various types of pre-analytical errors due to the complexity of the healthcare environment. Therefore, targeted intervention including a quality improvement program and its continuous maintenance should be conducted to reduce pre-analytical errors and to improve patient safety.


Assuntos
Hospitais Universitários/normas , Laboratórios Hospitalares/normas , Melhoria de Qualidade , Estudos Transversais , República da Coreia
9.
J Med Vasc ; 44(3): 184-193, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31029272

RESUMO

GOAL: Describe the use of diagnostic, prognostic and therapeutic algorithms for venous thromboembolism (VTE), derived from the 2014 European guidelines, in a teaching hospital's emergencies department and compare two groups: the 2015 group "without a care path" and the 2017 group "with a care path". METHOD: Comparative and retrospective study of the characteristics of emergencies department patients admitted for VTE from January to June 2015 for the 2015 group and from January to June 2017 for the 2017 group. RESULTS: Seventy-nine patients were included in the 2015 group and 62 patients in the 2017 group. In 24% of cases a clinical probability rule was calculated in the 2017 group (vs. no score in 2015, P<0.05). In the 2015 group, 10% of patients did not have a D-Dimer measurement in case of low clinical probability (vs. 0% in 2017, P<0.05). For both groups, the severity score sPESI was not noted in the medical record. All patients with pulmonary embolism were hospitalized in both groups. A total of 36% of patients with deep vein thrombosis (DVT) were hospitalized in the 2015 group (vs. none in 2017, P<0.05). A total of 52.5% of patients were treated with direct oral anticoagulants (DOAS) in the 2017 group vs. 32.5% in the 2015 group (P<0.05). In 18% of cases DOAS were prescribed by emergency physicians in the 2017 group vs. 2.5% in the 2015 group (P<0.05). Mean hospital stay was 7.4 days in the 2017 group and 9.4 days in the 2015 group (P<0.05). CONCLUSION: We observed a change in clinical practices and prescriptions after the establishment of an "Emergency Thrombosis" care system. Indeed, improvement in the calculation of the clinical probability score, increase in the outpatient management of DVT, increase in prescribing DOAS and reducing the length of hospital stay were the main revisions. The implementation of standardized digitally calculated clinical and prognostic probability scores would optimize this care path, as well as allow a better distribution of the post-emergency consultations created for outpatients.


Assuntos
Procedimentos Clínicos , Serviço Hospitalar de Emergência , Hospitais Universitários , Embolia Pulmonar/terapia , Tromboembolia/terapia , Trombose Venosa/terapia , Anticoagulantes/administração & dosagem , Biomarcadores/sangue , Procedimentos Clínicos/normas , Técnicas de Apoio para a Decisão , Serviço Hospitalar de Emergência/normas , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hospitais Universitários/normas , Humanos , Tempo de Internação , Admissão do Paciente , Avaliação de Programas e Projetos de Saúde , Embolia Pulmonar/diagnóstico , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Tromboembolia/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa/diagnóstico
10.
World J Surg ; 43(8): 1871-1879, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30944958

RESUMO

BACKGROUND: Surgical conditions represent up to 30% of the global burden of diseases. The aim of this study was to assess the delays in patients transferred to a tertiary referral hospital from district hospitals (DHs) in Rwanda with emergency general surgery (EGS) conditions. METHODS: We performed a prospective review of all EGS patients referred from DH over a 3-month period to assess delays in transfer and accessing care. We then surveyed general practitioners to define their perspective on delays in surgical care. RESULTS: Over a 3-month period, there were 86 patients transferred from DH with EGS conditions. The most common diagnoses were bowel obstruction (n = 22, 26%) and trauma (n = 19, 22%). The most common performed operations were laparotomy (n = 21, 24%) and bowel resection (n = 20, 23%). The mortality rate was 12%, and the intensive care unit admission rate was 4%. In transfer to the referral hospital, 5% patients were delayed for financial reasons and 2% due to lack of insurance. After reaching CHUK, 5% patients were delayed due to laboratory and radiology issues. Other delays included no operating theater available (4%) and no surgeon available (1%). Providers' perceptions for not performing surgeries at DH were predominantly the lack of a competent surgical provider or anesthesia staff. CONCLUSION: EGS patients represent a broad range of diagnoses. Delays were noted at each step in the referral process with multiple areas for potential improvement. Expanding surgical access at the DH has the potential to decrease delays and thereby improves patient outcomes.


Assuntos
Hospitais de Distrito/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adolescente , Adulto , Emergências , Feminino , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais de Distrito/normas , Hospitais Universitários/normas , Humanos , Masculino , Estudos Prospectivos , Encaminhamento e Consulta/normas , Estudos Retrospectivos , Ruanda , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/normas , Centros de Atenção Terciária/normas , Centros de Atenção Terciária/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Adulto Jovem
11.
World J Surg ; 43(9): 2117-2122, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31011820

RESUMO

BACKGROUND: Surgical 'never events' have serious adverse outcomes for patients. A never event can be defined as a serious, avoidable patient safety incident that would not occur if necessary preventative measures are implemented. The literature from South Africa on this topic is limited. This study aims to understand these never events in our setting and to develop a taxonomy to classify these events which facilitates the development of strategies to prevent and reduce the incidence and impact of surgical never events. MATERIALS AND METHODS: A retrospective review was undertaken over a 5-year period (December 2012-December 2017) at the Pietermaritzburg Metropolitan Surgical Service, South Africa. All morbidities and surgical never events recorded on the Hybrid Electronic Medical Registry (HEMR) were retrieved and analyzed. RESULTS: A total of 20,432 patient admissions were captured on HEMR, and total of 7187 morbidities were recorded. Of these morbidities, 61.6% were in males and 38.3% in females. Patients admitted to general surgery accounted for 62.7% of the total, and trauma surgery and pediatric surgery accounted for 33.6% and 3.8%, respectively, of the total number of morbidities. Of these 7187 morbidities, a total of 79 never events were identified: 53 (67.1%) in males and 26 (32.9%) in females. Of all morbidities reported, 1.1% (79/7187) constituted a never event. The rate of never events for all admissions was (79 never events/20,432 admissions) or 0.39%. Among the 79 never events, general surgery patients experienced 47 (59.5%), trauma surgery 25 (31.6%), and pediatric surgery 7 (8.9%). In addition to these 79 never events, a total of 126 near misses were identified, of which 80 (63.5%) occurred in males. CONCLUSION: Surgical morbidity is common and has a substantial impact of both the individual patient and society as a whole. Robust reporting mechanisms are needed to capture data, and these data must feed into evidence-based strategies to reduce the incidence and impact of this morbidity. Our systems ensure that our incidence of surgical never events is relatively low, but ongoing efforts must be made to ensure that we drive this level down even further.


Assuntos
Erros Médicos/prevenção & controle , Erros Médicos/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Universitários/normas , Hospitais Universitários/estatística & dados numéricos , Humanos , Incidência , Masculino , Morbidade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Sistema de Registros , Estudos Retrospectivos , África do Sul/epidemiologia
12.
Clinics (Sao Paulo) ; 74: e941, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30942282

RESUMO

Human immunodeficiency virus (HIV) infection was considered a contraindication for solid organ transplantation (SOT) in the past. However, HIV management has improved since highly active antiretroviral therapy (HAART) became available in 1996, and the long-term survival of patients living with HIV has led many transplant programs to reevaluate their policies regarding the exclusion of patients with HIV infection.Based on the available data in the medical literature and the cumulative experience of transplantation in HIV-positive patients at our hospital, the aim of the present article is to outline the criteria for transplantation in HIV-positive patients as recommended by the Immunocompromised Host Committee of the Hospital das Clínicas of the University of São Paulo.


Assuntos
Infecções por HIV/cirurgia , Hospitais Universitários/normas , Transplante de Órgãos/normas , Brasil , Humanos , Seleção de Pacientes , Transplantados
14.
Z Evid Fortbild Qual Gesundhwes ; 141-142: 11-17, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-30935787

RESUMO

BACKGROUND: Critical Incident Reporting Systems (CIRS) support the analysis of critical incidents and foster quality improvement in healthcare. The analysis of CIRS reports by designated CIRS teams enable organizational learning. To maintain a constructive work flow CIRS teams should be able to self-assess their work. We adapted the checklist used by the Dutch Healthcare Inspectorate to judge the quality of sentinel event analysis reports provided by hospitals. METHOD: The 26 items of the Dutch checklist were translated into German and culturally adapted to be used in a Swiss university hospital. Relevance and comprehensibility were rated by experts applying the Content Validity Index on item level (I-CVI) and on the checklist level (S-CVI). Five CIRS team members tested the usefulness of the revised checklist and provided feedback which we used to further revise the checklist. RESULTS: Comprehensibility of the 19 items ranged from 58.3 % to 100 %, and the I-CVI ranged between 0.17 and 1.0. The S-CVI achieved a good 0.80. For reasons of clarity we modified, deleted and added items. CIRS team members regarded this further adapted 15-item checklist to be of limited utility. DISCUSSION: The adapted checklist for self-assessment of the CIRS teams' work flow received good ratings for content validity but its usefulness for CIRS teams was found to be limited. The checklist may benefit from further development.


Assuntos
Lista de Checagem , Gestão de Riscos , Autoavaliação , Lista de Checagem/normas , Hospitais Universitários/normas , Humanos , Suíça , Tradução
15.
Eur J Clin Pharmacol ; 75(8): 1143-1151, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30972451

RESUMO

BACKGROUND: The hepatotoxicity of acetaminophen is recognised worldwide. Unfavourable prognoses relating to overdose include liver transplantation and/or death. Several hepatotoxicity risk factors (HRFs) should motivate the adjustment of acetaminophen daily intake (to < 4 g/day): advanced age, weight < 50 kg, malnutrition, chronic alcoholism, chronic hepatitis B and C and HIV infection, severe chronic renal failure and hepatocellular insufficiency. METHOD: Over a 7-day period in Rennes University Hospital in December 2017, using DxCare® software, with an odds ratio estimation, we analysed all acetaminophen prescriptions, to assess to what extent the presence of HRFs altered the prescribers' choice of acetaminophen dose (< 4 g/day versus 4 g/day). RESULTS: Among 1842 patients, considering only the first acetaminophen prescription, 73.7% were on 4 g/day. Almost half this population had at least 1 HRF. Whereas around 80% of the prescriptions in the < 4 g/day group were for patients with at least 1 HFR, only 53% of the prescriptions in the 4 g/day group concerned patients without HFRs (p < 0.001). Age > 75 and low weight were associated with the prescriber's choice of dose. Neither chronic alcoholism nor hepatocellular insufficiency influenced the acetaminophen doses prescribed. CONCLUSION: Considering the widespread use of acetaminophen and its favourable safety profile compared with other analgesic drugs, it appears urgent to remind prescribers of the maximum daily dose recommendations for acetaminophen for patients with HRFs, especially those with chronic alcoholism and hepatocellular insufficiency.


Assuntos
Acetaminofen/administração & dosagem , Doença Hepática Induzida por Substâncias e Drogas/prevenção & controle , Overdose de Drogas/prevenção & controle , Prescrições de Medicamentos/normas , Acetaminofen/efeitos adversos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Estudos Transversais , Relação Dose-Resposta a Droga , Overdose de Drogas/epidemiologia , Overdose de Drogas/etiologia , Feminino , França , Hospitais Universitários/normas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
16.
BMC Res Notes ; 12(1): 137, 2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30871605

RESUMO

OBJECTIVE: This study was aimed to assess the prevalence and associated factors of diabetic ketoacidosis among adult patients admitted in emergency department of Hawassa university comprehensive specialized hospital. An institution based retrospective cross-sectional study design was conducted among 195 adult patients aged 16 years and above with known or previously unknown diabetes cases presented in the emergency unit. RESULT: In our study from the total 195 patients medical record reviewed 78 (40%) developed DKA. Out of the total reviewed medical record 55 (28.2%) and 23 (11.8%) were with type-1 and type 2 diabetes mellitus respectively. From acute complication of diabetes, diabetic ketoacidosis was a leading cause 78 (77%) followed by hypoglycemia 14 (14%) and hyperosmolar hyperglycemic state (9%). During multiple logistic regression analysis age and hypertension were found to have significant association with diabetic ketoacidosis.


Assuntos
Diabetes Mellitus/epidemiologia , Cetoacidose Diabética/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Comorbidade , Assistência Integral à Saúde/normas , Estudos Transversais , Etiópia/epidemiologia , Feminino , Hospitais Especializados/normas , Hospitais Especializados/estatística & dados numéricos , Hospitais Universitários/normas , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores Sexuais , Adulto Jovem
17.
Ir J Med Sci ; 188(2): 667-674, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30051165

RESUMO

BACKGROUND AND AIMS: Healthcare professionals are exposed to high levels of stress in the course of their profession and are particularly susceptible to experiencing burnout. In the USA, burnout among physicians is highly prevalent, exceeding that of other workers. Little literature has been published describing burnout prevalence in the context of the Irish emergency healthcare population. We conducted a survey to determine burnout in the Emergency Department hospital staff at Cork University Hospital (CUH). METHODS: This is a prospective inclusive cross-sectional study assessing burnout with the Oldenburg Burnout Inventory (OLBI). Over 90 staff (physicians, nurses, administrators, radiographers, care assistants, and porters) participated. Provider demographic differences were documented and comparisons of burnout were made between this study population and previous international studies. RESULTS: Sixty-three percent of administrators (8), 100% of care assistants (3), 78% of nurses (50), 70% of physicians (23), 67% of porters (3), and 80% of radiographers (10) met the criteria for burnout (75% overall). Burnout was significantly associated with a history of depression (p = 0.030). The burnout rates were not significantly different between professions (p = 0.77), age groups (p = 0.078), years working in the ED (p = 0.16), or gender (p = 0.46). DISCUSSION AND CONCLUSIONS: Burnout is very common in the Emergency Department at CUH. Approximately three out of four staff met the cutoff for burnout. Self-reported depression was also significantly associated with burnout.


Assuntos
Esgotamento Profissional/psicologia , Esgotamento Psicológico/psicologia , Hospitais Universitários/normas , Adulto , Estudos Transversais , Feminino , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Adulto Jovem
18.
J Oncol Pharm Pract ; 25(7): 1665-1674, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30348073

RESUMO

Management and prevention of problems related to oncology drugs are particularly important due to the excessive cost, high toxicity, and narrow therapeutic index of the antineoplastic drugs, in addition to the patients' state of health. Therefore, the presence of the pharmacist as a member of the multidisciplinary team is essential to contribute to patient safety. In this work, the interventions performed were identified, quantified, and classified to characterize the work of the clinical oncology pharmacist. This is a prospective and quantitative study, conducted over a period of six months in the outpatient oncology and chemotherapy clinic of the University Hospital of the University of Campinas, Brazil. A total of 3526 medical prescriptions were evaluated for the 780 patients seen and, among these prescriptions, 220 (6.24%) contained errors, representing 6.24% of the total number. The most common error was dose-related with 79 (22.83%) cases of overdosing. Wrong-patient medication error was the least reported (0.29%). Thirty drugs were involved in the pharmaceutical interventions, Carboplatin and Ondansetron being the most frequent. Thirteen types of potential errors were evaluated according to the method proposed by Cardinal and Fernandes. Two (15.38%) included interventions of indication, contraindication, and therapeutic efficacy of a drug. Five of them (38.46%) are related to the treatment regimen, and two (15.38%) were related to prevention of potential adverse events. Four interventions (30.77%) concerned technical interventions in injectable drugs such as dilution, compatibility, and administration time. Of the 346 interventions performed, 1 (0.29%) was classified as potentially lethal, 114 as serious (32.95%), 140 as significant (40.46%), and 91 as minor (26.30%).


Assuntos
Oncologia/normas , Erros de Medicação/prevenção & controle , Segurança do Paciente/normas , Farmacêuticos/normas , Papel Profissional , Brasil/epidemiologia , Feminino , Hospitais Universitários/normas , Hospitais Universitários/tendências , Humanos , Masculino , Oncologia/tendências , Erros de Medicação/tendências , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/normas , Equipe de Assistência ao Paciente/tendências , Farmacêuticos/tendências , Estudos Prospectivos
19.
J Clin Nurs ; 28(5-6): 912-919, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30357973

RESUMO

AIMS AND OBJECTIVE: To explore whether an iterative process of information and training paired with a feedback system to observed healthcare professionals and the respective management improves hand hygiene (HH) compliance. BACKGROUND: Healthcare-associated infections are a major risk for patient safety, and adherence to the "My five moments" (M5M) for HH varies significantly within organisations as well as within healthcare professional groups. Identified barriers in a baseline survey revealed the need of more information, training, repetitive compliance measurements and feedback to all healthcare professionals. DESIGN: A quality improvement project using the method of direct observation of healthcare professionals in nonsurgical and surgical wards. METHODS: Between 2013 and 2017, 6,009 healthcare professionals were informed and trained, and HH compliance measurements were performed by hygiene experts. Compliance measurement results were documented in an online tool to give an immediate feedback to observed healthcare professionals. Additionally, a report was forwarded to the management of the respective department to raise awareness. Compliance rates per year were descriptively summarised. The research and reporting methodology followed SQUIRE 2.0. RESULTS: In total, 84 compliance measurements with 19,295 "M5M for HH" were observed in 49 wards. Overall, mean HH compliance increased from 81.9 ± 5.2% in 2013 to 94.0 ± 3.6% in 2017. Physicians' HH compliance rate improved from 69.0 ± 16.6% to 89.3 ± 6.6%, that of nurses from 86.0 ± 6.9% to 96.4 ± 3.1%, and that of others from 60.5 ± 27.9% to 83.8 ± 20.2%. All M5M for HH (#1-#5) increased over the study period (#1: +16.9%; #2: +20.5%; #3: +7.6%; #4: +5.9%; #5: +12.7%). CONCLUSIONS: Results demonstrated that an iterative process of information, training, observation and feedback over a period of 5 years can be successful in increasing HH compliance. Positive trends were observed for HH compliance rates across all healthcare professional groups as well as for all M5M for HH.


Assuntos
Infecção Hospitalar/prevenção & controle , Higiene das Mãos/normas , Recursos Humanos em Hospital/educação , Melhoria de Qualidade/organização & administração , Hospitais Universitários/normas , Humanos , Cooperação do Paciente , Recursos Humanos em Hospital/estatística & dados numéricos , Desenvolvimento de Programas/métodos , Centros de Atenção Terciária
20.
Eur J Nucl Med Mol Imaging ; 46(1): 54-64, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30269155

RESUMO

PURPOSE: The purpose of this study was to evaluate the impact of PET/CT on clinical management of cancer patients based on a prospective data registry. The study was developed to inform consultations with public health insurances on PET/CT coverage. METHODS: We evaluated a prospective patient cohort having a clinically indicated PET/CT at a single German University Center from April 2013 to August 2016. The registry collected questionnaire data from requesting physicians on intended patient management before and after PET/CT. A total of 4,504 patients with 5,939 PET/CT examinations were enrolled in the registry, resulting in evaluable data from 3,724 patients receiving 4,754 scans. The impact of PET/CT on patient management was assessed across 22 tumor types, for different indications (diagnosis, staging, suspected recurrence) and different categories of management including treatment (curative or palliative) and non-treatment (watchful waiting, additional imaging, invasive tests). RESULTS: The most frequent PET/CT indication was tumor staging (59.7%). Melanoma, lung cancer, lymphoma, neuroendocrine tumor and prostate cancer accounted for 70% of cases. Overall, the use of PET/CT resulted in a 37.1% change of clinical management (95% CI, 35.7-38.5), most frequently (30.6%) from an intended non-treatment strategy before PET/CT to active treatment after PET/CT. The frequency of changes ranged from 28.3% for head and neck cancers up to 46.0% for melanomas. The impact of PET/CT was greatest in reducing demands for additional imaging which decreased from 66.1% before PET/CT to 6.1% after PET/CT. Pre-PET/CT planned invasive tests could be avoided in 72.7% of cases. The treatment goal changed after PET/CT in 21.7% of cases, in twice as many cases from curative to palliative therapy than vice versa. CONCLUSIONS: The data of this large prospective registry confirm that physicians often change their intended management on the basis of PET/CT by initiating treatment and reducing additional imaging as well as invasive tests. This applies to various cancer types and indications.


Assuntos
Neoplasias/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/estatística & dados numéricos , Sistema de Registros , Idoso , Gerenciamento Clínico , Medicina Baseada em Evidências , Feminino , Alemanha , Hospitais Universitários/normas , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/normas
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA