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1.
Rev Esc Enferm USP ; 53: e03496, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31618312

RESUMO

OBJECTIVE: To apply the standard time parameters of nursing activities proposed by COFEN Resolution No. 543/2017 to determine the number of nursing technicians in the material and sterilization center of a university hospital and compare the projected framework with the existing one in the sector. METHOD: An exploratory and descriptive study with data collection performed on the sterilization control sheets and direct observation of the work process stages in the different sector areas. RESULTS: Only one of the 15 described activities was not conducted in the sector; those most performed which presented more workload and required more personnel were the receiving of contaminated materials and the organization and distribution of sterilized materials; the areas that required the highest number of employees were for materials preparation and cleaning/disinfection. No difference was observed between the number of staff required in the different work shifts, and the calculated staff quantity was similar to that existing in the result of the staff sizing performed using the functional sites. CONCLUSION: The proposals analyzed in this study can be used to calculate staff size in the studied sector and in other institutions.


Assuntos
Hospitais Universitários/organização & administração , Recursos Humanos de Enfermagem no Hospital/organização & administração , Esterilização , Humanos , Fatores de Tempo , Carga de Trabalho
2.
GMS J Med Educ ; 36(4): Doc38, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31544138

RESUMO

Aim: In the final (practical) year (PY), students have the opportunity to become familiar with their potential future place of work. At the same time, university hospitals and teaching hospitals compete to recruit the best junior staff from this pool. The aim of this study is to present students' selection criteria for the location of the final year in detail. Methods: On the formal evaluation of the final year at the Mannheim Medical Faculty, students were asked after each training period which reasons led to the selection of the location. Thirty-one subcategories were formed from the free-text responses, sorted according to their controllability and then grouped into 11 main categories. The Mannheim University Hospital introduced an expense allowance in November 2015. The data from the period before and after its introduction, the reasons given for choosing the location for the compulsory and elective subjects, and the reasons given for choosing a teaching hospital or university hospital were evaluated and compared separately. Results: A total of 1,164 questionnaires were evaluated from the period before the introduction of the expense allowance, and 1,120 questionnaires were evaluated from the period after the introduction. Overall, Proximity (19%), Financial incentives (18%) and Subject (18%) were the most frequently cited reasons. The Financial incentives subcategory was the most frequent in period 1 (32%), but lost relevance in period 2 (6%). In contrast, Recommendation gained in importance (from 8% to 15%). A comparison of the lead categories shows that teaching hospitals benefit more from their public image and university hospitals more from the subjects they offer. Conclusion: Students primarily choose the location for their final year for pragmatic reasons, such as Incentives and Living environment, but the Public image of the hospitals also plays a significant role. The frequency of the reasons given differs between compulsory and elective subjects, as well as between university hospitals and teaching hospitals. The results can help to improve the attractiveness of the location in a targeted manner and to present a specific image to the public.


Assuntos
Escolha da Profissão , Competência Clínica , Motivação , Estudantes de Medicina/psicologia , Educação de Graduação em Medicina , Hospitais de Ensino/organização & administração , Hospitais Universitários/organização & administração , Humanos , Inquéritos e Questionários
3.
Am J Health Syst Pharm ; 76(Supplement_3): S74-S78, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31418772

RESUMO

PURPOSE: The development and implementation of centralized mail-order pharmacy services in an academic healthcare system are described. SUMMARY: The use of mail-order pharmacy services continues to increase, as mail-order services offer patient benefits such as reduced copayments and improved clinical outcomes. Prior to undertaking an initiative to improve its mail-order pharmacy services, the University of Utah Health system's pharmacy department offered decentralized mail-order pharmacy services at all of its retail pharmacies, but there was no standardized process for processing mail-order prescriptions or providing phone support to mail-order patients. Centralized mail-order pharmacy services were developed and implemented by creating (1) a standard process for mail-order pharmacy services, (2) a centralized mail-order prescription filling center, and (3) a call center to support mail-order pharmacy services. Implementation of centralized mail-order pharmacy services resulted in an almost 50% reduction in time spent by pharmacy team members on mail-order prescription filling and packaging tasks. Use of a central call center resulted in a decreased call abandonment rate and contributed to a decreased pharmacy workload resulting from an overall reduction in call volume due to an increased rate of first-call issue resolution. CONCLUSION: Establishment of a centralized mail-order pharmacy service along with operational and infrastructure improvements resulted in improved quality and regulatory compliance and enhanced labor efficiency and patient communication.


Assuntos
Implementação de Plano de Saúde , Farmácias/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Serviços Postais , Call Centers/organização & administração , Hospitais Universitários/organização & administração , Hospitais Universitários/estatística & dados numéricos , Humanos , Farmácias/estatística & dados numéricos , Farmacêuticos/organização & administração , Farmacêuticos/estatística & dados numéricos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Carga de Trabalho/estatística & dados numéricos
4.
Pediatr Blood Cancer ; 66(11): e27959, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31423715

RESUMO

Retinoblastoma is an ocular tumor that occurs in young children, in either heritable or sporadic manner. The relative rarity of retinoblastoma, and the need for expensive equipment, anesthesia, and pediatric ophthalmologic expertise, are barriers for effective treatment in developing countries. Also, with an average age-adjusted incidence of two to five cases per million children, patient number limits development of local expertise in countries with small populations. Lebanon is a small country with a population of approximately 4.5 million. In 2012, a comprehensive retinoblastoma program was formalized at the Children's Cancer Institute (CCI) at the American University of Beirut Medical Center, and resources were allocated for efficient interdisciplinary coordination to attract patients from neighboring countries such as Syria and Iraq, where such specialized therapy is also lacking. Through this program, care was coordinated across hospitals and borders such that patients would receive scheduled chemotherapy at their institution, and monthly retinal examinations and focal laser therapy at the CCI in Lebanon. Our results show the feasibility of successful collaboration across borders, with excellent patient and physician adherence to treatment plans. This was accompanied by an increase in patient referrals, which enables continued expertise development. However, the majority of patients presented with advanced intraocular disease, necessitating enucleation in 90% of eyes in unilateral cases, and more than 50% of eyes in bilateral cases. Future efforts need to focus on expanding the program that reaches to additional hospitals in both countries, and promoting early diagnosis, for further improvement of globe salvage rates.


Assuntos
Institutos de Câncer/organização & administração , Países em Desenvolvimento , Hospitais Universitários/organização & administração , Internacionalidade , Colaboração Intersetorial , Neoplasias da Retina/terapia , Retinoblastoma/terapia , Institutos de Câncer/economia , Terapia Combinada/economia , Terapia Combinada/métodos , Diagnóstico Tardio , Gerenciamento Clínico , Estudos de Viabilidade , Feminino , Aconselhamento Genético , Hospitais Universitários/economia , Humanos , Incidência , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Líbano/epidemiologia , Masculino , Oriente Médio/epidemiologia , Equipe de Assistência ao Paciente , Encaminhamento e Consulta , Neoplasias da Retina/diagnóstico , Neoplasias da Retina/epidemiologia , Retinoblastoma/diagnóstico , Retinoblastoma/economia , Retinoblastoma/epidemiologia , Resultado do Tratamento , Estados Unidos
5.
Rev Bras Enferm ; 72(3): 767-773, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269144

RESUMO

OBJECTIVE: To evaluate nurse safety culture in a teaching hospital, as well as to verify differences in the safety culture dimensions between services. METHOD: cross-sectional, quantitative study, conducted from October to December 2015, in a university hospital. The instrument Hospital Survey on Patient Safety Culture was applied. RESULTS: A total of 195 nurses from four different services participated in the study. Significant difference between services were identified for five dimensions of safety culture: organizational learning (P=0.012); return of information and communication about error (P=0.014); management support for patient safety (P=0.001); general perceptions about patient safety (P=0.005); and frequency of event notification (P=0.003). CONCLUSION: The medical clinic service had the highest statistical difference between the dimensions. These evaluations allow managers to identify the differences between the same hospital's services, serving as a warning and assisting in the services' improvement.


Assuntos
Enfermeiras e Enfermeiros/psicologia , Serviços de Enfermagem/normas , Gestão da Segurança/normas , Adulto , Atitude do Pessoal de Saúde , Brasil , Estudos Transversais , Feminino , Hospitais Universitários/organização & administração , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/normas , Enfermeiras e Enfermeiros/estatística & dados numéricos , Serviços de Enfermagem/estatística & dados numéricos , Cultura Organizacional , Gestão da Segurança/estatística & dados numéricos , Estatísticas não Paramétricas , Inquéritos e Questionários
6.
Pan Afr Med J ; 32: 152, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303923

RESUMO

Introduction: Regional anesthesia is a safe alternative to general anesthesia. Despite benefits for perioperative morbidity and mortality, this technique is underutilized in low-resource settings. In response to an identified need, a regional anesthesia service was established at the University Teaching Hospital of Kigali (CHUK), Rwanda. This qualitative study investigates the factors influencing implementation of this service in a low-resource tertiary-level teaching hospital. Methods: Following service establishment, we recruited 18 local staff at CHUK for in-depth interviews informed by the "Consolidated Framework for Implementation Research" (CFIR). Data were coded using an inductive approach to discover emergent themes. Results: Four themes emerged during data analysis. Patient experience and outcomes: where equipment failure is frequent and medications unavailable, regional anesthesia offered clear advantages including avoidance of airway intervention, improved analgesia and recovery and cost-effective care. Professional satisfaction: morale among healthcare providers suffers when outcomes are poor. Participants were motivated to learn techniques that they believe improve patient care. Human and material shortages: clinical services are challenged by high workload and human resource shortages. Advocacy is required to solve procurement issues for regional anesthesia equipment. Local engagement for sustainability: participants emphasized the need for a locally run, sustainable service. This requires broad engagement through education of staff and long-term strategic planning to expand regional anesthesia in Rwanda. Conclusion: While the establishment of regional anesthesia in Rwanda is challenged by human and resource shortages, collaboration with local stakeholders in an academic institution is pivotal to sustainability.


Assuntos
Anestesia por Condução/métodos , Pessoal de Saúde/organização & administração , Hospitais Universitários/organização & administração , Anestesia por Condução/economia , Anestesia por Condução/instrumentação , Países em Desenvolvimento , Desenho de Equipamento , Humanos , Satisfação no Emprego , Pobreza , Pesquisa Qualitativa , Ruanda , Carga de Trabalho
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.
Hosp Top ; 97(3): 80-86, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31124745

RESUMO

The hospital environment has been suggested as having an important role in the transmission of health care-associated infections. The aim of this work is to clarify the possible role of visitors in environmental contamination at our hospital. The microbial load was determined by Rodac plate contact on flat surfaces and by swabs on uneven surfaces. A total of 137 samples were taken from four different areas of the hospital unit. The results were divided into two groups according to the types of subjects that most often frequented those environments. We found that the transmission of health care-associated infections (HAIs) occurs mainly in areas where visitors are not allowed.


Assuntos
Transmissão de Doença Infecciosa/estatística & dados numéricos , Microbiologia Ambiental , Visitas a Pacientes/estatística & dados numéricos , Carga Bacteriana/métodos , Transmissão de Doença Infecciosa/prevenção & controle , Hospitais Universitários/organização & administração , Hospitais Universitários/estatística & dados numéricos , Humanos , Sicília
9.
Rev Gaucha Enferm ; 40(spe): e20180398, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31038610

RESUMO

OBJECTIVE: Describe the implementation of care transfer flow chart in postoperative, based on a risk classification model. METHOD: Experience report on the implementation of a pilot project between the post-anesthetic recovery room and the surgical hospitalization unit, developed between December/2016 and March/2017, aimed at transferring s the care of patients with low risk of postoperative mortality, in a university hospital in the South of Brazil. RESULTS: The project made it possible to expedite the discharge of the patient from the Post-Anesthetic Recovery Room to the surgical hospitalization unit, to qualify the records regarding nursing care and to optimize the time of nurses in both units for care activities. CONCLUSION: The implementation of a care transfer flow chart from the risk classification for postoperative patients contributed to a more effective communication, culminating in improvements in patient safety.


Assuntos
Transferência de Pacientes , Cuidados Pós-Operatórios , Brasil , Registros Hospitalares , Unidades Hospitalares , Hospitais Universitários/organização & administração , Humanos , Registros de Enfermagem , Transferência de Pacientes/métodos , Projetos Piloto , Cuidados Pós-Operatórios/mortalidade , Cuidados Pós-Operatórios/enfermagem , Sala de Recuperação , Risco , Desenho de Programas de Computador
11.
Glob Health Action ; 12(1): 1597451, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31062663

RESUMO

BACKGROUND: The Ebola epidemic in West Africa caused global fear and stirred up worldwide preparedness activities in countries sharing borders with those affected, and in geographically far-away countries such as Iceland. OBJECTIVE: To describe and analyse Ebola preparedness activities within the Icelandic healthcare system, and to explore the perspectives and experiences of managers and frontline health workers. METHODS: A qualitative case study, based on semi-structured interviews with 21 staff members in the national Ebola Treatment Team, Emergency Room at Landspitali University Hospital, and managers of the response team. RESULTS: Contextual factors such as culture and demography influenced preparedness, and contributed to the positive state of mind of participants, and ingenuity in using available resources for preparedness. While participants believed they were ready to take on the task of Ebola, they also had doubts about the chances of Ebola ever reaching Iceland. Yet, factors such as fear of Ebola and the perceived stigma associated with caring for a potentially infected Ebola patient, influenced the preparation process and resulted in plans for specific precautions by staff to secure the safety of their families. There were also concerns about the teamwork and lack of commitment by some during training. Being a 'tiny' nation was seen as both an asset and a weakness in the preparation process. Honest information sharing and scenario-based training contributed to increased confidence amongst participants in the response plans. CONCLUSIONS: Communication and training were important for preparedness of health staff in Iceland, in order to receive, admit, and treat a patient suspected of having Ebola, while doubts prevailed on staff capacity to properly do so. For optimal preparedness, likely scenarios for future global security health threats need to be repeatedly enacted, and areas plagued by poverty and fragile healthcare systems require global support.


Assuntos
Planejamento em Desastres/organização & administração , Epidemias/prevenção & controle , Pessoal de Saúde/educação , Doença pelo Vírus Ebola/epidemiologia , Hospitais Universitários/organização & administração , África Ocidental/epidemiologia , Comunicação , Serviço Hospitalar de Emergência/organização & administração , Saúde Global , Instalações de Saúde , Humanos , Islândia , Estudos de Casos Organizacionais , Pesquisa Qualitativa
12.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(4): 403-406, 2019 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-31109410

RESUMO

OBJECTIVE: Critical care medicine is an important part of modern medicine and has become an important comprehensive second-level discipline of clinical medicine. The department of critical care medicine of the Affiliated Hospital of Guizhou Medical University was established in 1994. After 24 years of development, there are currently 90 beds, 6 sub-specialties (including comprehensive ICU A, B, C 3 subspecialties, internal ICU, emergency ICU, pediatric ICU) of the third-level intensive medical discipline development model, involve severe nervous system, severe circulatory system, severe environmental disorders, severe trauma, severe digestion, severe kidney, severe immunity, severe endocrine, severe respiratory disease, severe infection, severe obstetric disease, severe poisoning, and there are corresponding talent echelons. The three-level discipline construction model has been explored and operated for more than three years. The hospital's critical care medicine discipline has established a larger professional discipline in southwestern China. The rapid and standardized development of critical care medicine in an all-round way was promoted, so as to lead the rapid development of critical care medicine in hospitals, cities, provinces and even surrounding provinces, and to achieve mutual learning, complementary advantages, resource sharing, win-win cooperation and coordinated development.


Assuntos
Cuidados Críticos/organização & administração , Hospitais Universitários/organização & administração , China , Humanos
13.
Work ; 63(1): 57-67, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31127745

RESUMO

BACKGROUND: Work-related stress is a significant health and safety concern. OBJECTIVES: To assess the prevalence of burnout and occupational stress among emergency department (ED) professionals and to identify associated factors. METHODS: A cross-sectional study included all ED professionals of a French university hospital. Data were collected using the French versions of the Maslach Burnout Inventory and the Karasek Job Content Questionnaire. RESULTS: Of the 166 respondents (75.8%), 19.3% reported burnout and 27.1% job strain. Factors associated with burnout were work-related dissatisfaction, fear of making mistakes, lack of time to perform tasks, and being younger. Those factors associated with job strain were having at least one sick leave in the past year, being affected by hard work, interpersonal conflicts at workplace, and sleep disorders. CONCLUSIONS: Compared to the literature, our results showed a lower prevalence of burnout among physicians but similar among paramedics. The proportion of professionals with job strain was higher than that of the whole French working population. Organizational factors and the work environment were the primary causes of burnout and job strain, while being younger was the only associated sociodemographic factor. The identification of professionals experiencing difficulty is essential to ensure patient safety, particularly in the high-risk field of emergency medicine.


Assuntos
Esgotamento Profissional/etiologia , Serviço Hospitalar de Emergência/normas , Pessoal de Saúde/psicologia , Estresse Psicológico/etiologia , Adulto , Análise de Variância , Esgotamento Profissional/psicologia , Estudos Transversais , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , França , Hospitais Universitários/organização & administração , Hospitais Universitários/estatística & dados numéricos , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Prevalência , Estresse Psicológico/psicologia , Inquéritos e Questionários , Local de Trabalho/psicologia , Local de Trabalho/normas
14.
Farm Hosp ; 43(3): 110-115, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31072289

RESUMO

OBJECTIVE: To classify hospital units into three risk levels in order to define and prioritise  improvement and training measures in each of them. METHOD: The risk map was developed in two phases: First phase involved the setting up of a  multidisciplinary team, a bibliographic search, the identification of medications and of the criteria to  design the map: (1) Location: number of high-alert medications; (2) Staff turnover: the units were  classified in low turnover units = 1, medium turnover units = 2 and high turnover units = 3 according  to data provided by the human resource department; (3) Frequency: quotient between the number of high alert medicactions in each unit and the total of medications used, and (4) Severity: voluntary  survey of professionals. An accumulated risk of severity of each unit was calculated: Σ (severity of the  drug x number of its units). The Neperian logarithm was applied to this value to reduce the  variability of the values. Thus a risk probability index was established = staff turnover x frecuency x  Neperian logarithm of severity. In a  second phase, the units were classified into three groups and the  risk map of high-alert medication was elaborated in the hospital. In it, the units that had a risk  probability index higher than 2.9 were classified as high risk units, those that had between 1-2.9 as  intermediate risk units and those that had less than 1 as low risk units. According to the risk probability index, improvement measures were defined and priorities were set for each of them. RESULTS: A total 447 high-risk medications corresponding to 227 active ingredients were identified  during the study period. The units showing a higher risk were: Intensive Care Medicine (10.51),  Reanimation (4.01), and Palliative Care (3.90). Improvement actions (informative poster, visual  identification, alerts, training and double checks) were defined and prioritised in accordance with the  risk probability index. CONCLUSIONS: Knowing the degree of risk of hospitalization units in the management of high-alert  medications allows for the implementation of improvement plans in relation to the degree of  vulnerability detected.


Assuntos
Tratamento Farmacológico/métodos , Hospitais Universitários/organização & administração , Sistemas de Medicação no Hospital/organização & administração , Medição de Risco/métodos , Algoritmos , Serviço Hospitalar de Anestesia/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Hospitais Universitários/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Sistemas de Medicação no Hospital/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Probabilidade , Desenvolvimento de Pessoal , Inquéritos e Questionários
15.
BMC Res Notes ; 12(1): 239, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023367

RESUMO

OBJECTIVES: This cross-sectional study was conducted on 399 patients at Hawassa University Comprehensive Specialized Hospital from February 15 to March 30/2018 to assess the length of stay (LOS) and its associated factors in emergency departments (EDs). RESULT: About 91.5% patients were stayed in the EDs for greater than 24 h in different reasons. Inadequacy of beds in inpatient wards, overcrowding, absence of different laboratory test profiles and delay in radiological services were showed a significant differences in LOS greater than 24 h when compared to LOS ≤ 24 h in EDs (p < 0.05 for all). In addition, admission beds [adjusted odds ratio: 8.7 (95% CI 3.2-23.2)]; overcrowding [adjusted odds ratio: 3.6 (95% CI 1.6-8.3)]; laboratory test profiles [adjusted odds ratio: 5.1 (95% CI 1.9-14.1)], and radiology services [adjusted odds ratio: 3.7 (95% CI 1.5-9.2)] were significantly and positively associated with LOS greater than 24 h in EDs. Further, a significant proportion of patients were stayed for unnecessary extended length of time in EDs due to different factors. Therefore, the commitment of organization is crucial to provide sufficient number of admission beds, to scale-up laboratory test profiles and to decrease radiology service turn-around time in order to improve LOS in EDs.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Hospitais Universitários/organização & administração , Tempo de Internação/estatística & dados numéricos , Radioterapia (Especialidade)/organização & administração , Adolescente , Adulto , Criança , Estudos Transversais , Aglomeração , Serviço Hospitalar de Emergência/economia , Etiópia , Feminino , Hospitais Universitários/economia , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Radioterapia (Especialidade)/economia , Fatores de Tempo
16.
Int J Clin Pharm ; 41(2): 488-495, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31028599

RESUMO

Background A pharmaceutical care program is necessary to improve the management of direct-acting antivirals in hepatitis C. Objective Describe health outcomes obtained with the implementation of a pharmaceutical care program in Hepatitis C patients treated with direct-acting antivirals. Setting This study was performed in a pharmacy department of a university hospital. Methods Retrospective study between 1st-April 2015 and 28st-February 2016. Hospital pharmacists implemented interventional measures for validation of antivirals prescriptions, detection of drug-interaction, adverse drug events, education and patient´s adherence to antiviral regimen. Main outcome measure Health and quality outcomes of the implementation of the pharmaceutical care program. Results A total 128 patients were enrolled. The overall sustained virologic response at week 12 post-treatment rate was 96.1% (95% CI 92.7-99.5). Adverse drug events occurred in 90.6% of the patients, and the majority were grade 1-2. Pharmacists made 334 pharmaceutical interventions. 35.5% of these interventions were aimed to resolve negative results of drugs. 80.9% of the negative results of drugs improved or were eliminated with the application of the measures proposed by the pharmacists (p ≤ 0.001). Pharmacists carried out 175 preventive interventions to avoid negative results of drugs. 97.3% of these interventions were accepted and managed to prevent the appearance of negative results of drugs (p = 0.453). Conclusion The implementation of a pharmaceutical care program in patients with hepatitis C treated with direct-acting antivirals has improved the safety in the use of these drugs.


Assuntos
Antivirais/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Hepatite C/tratamento farmacológico , Assistência Farmacêutica/estatística & dados numéricos , Desenvolvimento de Programas/estatística & dados numéricos , Antivirais/efeitos adversos , Feminino , Hospitais Universitários/organização & administração , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Garantia da Qualidade dos Cuidados de Saúde , Estudos Retrospectivos , Resultado do Tratamento
17.
J Health Organ Manag ; 33(2): 204-220, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30950308

RESUMO

PURPOSE: The purpose of this paper is to gain a better understanding of the difficulties encountered in the hybrid roles of physician-managers (P-Ms), examine the impact of organizational constraints on the role conflicts experienced by P-Ms and explore the different ways their two roles are integrated. DESIGN/METHODOLOGY/APPROACH: A qualitative approach was adopted, using six focus groups made up of clinical co-managers, medical directors and P-Ms. In all, 43 different people were interviewed to obtain their perceptions of the day-to-day realities of the role of the P-M. The data collected were subsequently validated. FINDINGS: Although the expectations of the different groups involved regarding the role of P-Ms are well understood and shared, there are significant organizational constraints affecting what P-Ms are able to do in their day-to-day activities, and these constraints can result in role conflicts for the people involved. Such constraints also affect the ways P-Ms integrate the two roles. The authors identify three role hybridization profiles. PRACTICAL IMPLICATIONS: The results afford a better understanding of how organizational constraints might be used as levers of organizational change to achieve a better hybridization of the dual roles of P-Ms. ORIGINALITY/VALUE: This paper seeks to reach beyond a simple identification of constraints affecting the dual roles of P-Ms by analyzing how such constraints impact on these professionals' day-to-day activities. Results also enable us to further refine Katz and Kahn's (1966) role model, in addition to identifying hybridization profiles.


Assuntos
Hospitais Universitários/organização & administração , Diretores Médicos/psicologia , Médicos/psicologia , Papel Profissional/psicologia , Canadá , Feminino , Grupos Focais , Humanos , Masculino , Inovação Organizacional , Diretores Médicos/estatística & dados numéricos , Médicos/estatística & dados numéricos , Pesquisa Qualitativa
19.
J Oral Sci ; 61(1): 164-170, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30918213

RESUMO

Needle-stick and sharps injuries (NSIs) can happen even when dental health care workers (DHCWs) act in compliance with standard precautions to prevent transmitting blood-borne infections. The objective of this study was to investigate causes of NSIs that had occurred at a dental specialty university hospital during the past 12 academic years. A total of 215 NSIs were reported during the investigation period, and NSIs ascribed to female DHCWs (n = 148; 68.8%) were significantly (P < 0.05) more common than those ascribed to male DHCWs (n = 67; 31.2%). One hundred twenty-six NSIs (58.6%) were caused by DHCWs with little experience (P < 0.05), and 37 of those (17.2% of the total) were ascribed to undergraduate students during clinical training (P < 0.05). The NSIs occurred both during treatment (n = 119; 55.3%) and during cleaning up used devices (n = 89; 41.4%). The NSIs at the dental hospital occurred with a probability of 0.004% of total therapeutic opportunities. Prevention of NSIs should be the responsibility of dental students and DHCWs, and should be a part of education about infection control to prevent the nosocomial transmission of blood-borne pathogens.


Assuntos
Serviços de Saúde Bucal , Hospitais Especializados/organização & administração , Hospitais Universitários/organização & administração , Ferimentos Penetrantes Produzidos por Agulha , Especialidades Odontológicas , Adulto , Feminino , Humanos , Japão , Masculino , Recursos Humanos em Hospital , Fatores de Risco
20.
Artigo em Inglês | MEDLINE | ID: mdl-30925660

RESUMO

Legionnaires' disease is normally acquired by inhalation of legionellae from a contaminated environmental source. Water systems of large and old buildings, such as hospitals, can be contaminated with legionellae and therefore represent a potential risk for the hospital population. In this study, we demonstrated the constant presence of Legionella in water samples from the water system of a large university hospital in Messina (Sicily, Italy) consisting of 11 separate pavilions during a period of 15 years (2004⁻2018). In total, 1346 hot water samples were collected between January 2004 and December 2018. During this period, to recover Legionella spp. from water samples, the standard procedures reported by the 2000 Italian Guidelines were adopted; from May 2015 to 2018 Italian Guidelines revised in 2015 (ISS, 2015) were used. Most water samples (72%) were positive to L. pneumophila serogroups 2⁻14, whereas L. pneumophila serogroup 1 accounted for 18% and non-Legionella pneumophila spp. Accounted for 15%. Most of the positive samples were found in the buildings where the following critical wards are situated: (Intensive Care Unit) ICU, Neurosurgery, Surgeries, Pneumology, and Neonatal Intensive Unit Care. This study highlights the importance of the continuous monitoring of hospital water samples to prevent the potential risk of nosocomial legionellosis.


Assuntos
Monitoramento Ambiental/métodos , Hospitais Universitários/organização & administração , Legionella/isolamento & purificação , Microbiologia da Água/normas , Abastecimento de Água/normas , Infecção Hospitalar/prevenção & controle , Humanos , Itália/epidemiologia , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/epidemiologia
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