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3.
Palliat Support Care ; 18(4): 400-402, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32576325

RESUMO

The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic has necessitated an interim restructuring of the healthcare system in accordance with public health preventive measures to mitigate spread of the virus while providing essential healthcare services to the public. This article discusses how the Palliative Care Team of the Komfo Anokye Teaching Hospital in Ghana has modified its services in accordance with public health guidelines. It also suggests a strategy to deal with palliative care needs of critically ill patients with COVID-19 and their families.


Assuntos
Infecções por Coronavirus/terapia , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/normas , Hospitais de Ensino/normas , Cuidados Paliativos/normas , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Betacoronavirus , Gana , Humanos , Pandemias
4.
Ann R Coll Surg Engl ; 102(6): 451-456, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32347738

RESUMO

INTRODUCTION: UK and European guidelines recommend consideration of a self-expandable metallic stent (SEMS) as an alternative to emergency surgery in left-sided colonic obstruction. However, there is no clear consensus on stenting owing to concern for complications and long-term outcomes. Our study is the first to explore SEMS provision across England. METHODS: All colorectal surgery department leads in England were contacted in 2018 and invited to complete an objective multiple choice questionnaire pertaining to service provision of colorectal stenting (including referrals, time, location and specialty). RESULTS: Of 182 hospitals contacted, 79 responded (24 teaching hospitals, 55 district general hospitals). All hospitals considered stenting, with 92% performing stenting and the remainder referring. The majority (93%) performed fewer than four stenting procedures per month. Most (96%) stented during normal weekday hours, with only 25% stenting out of hours and 23% at weekends. Compared with district general hospitals, a higher proportion of teaching hospitals stented out of hours and at weekends. Stenting was performed in the radiology department (64%), the endoscopy department (44%) and operating theatres (15%), by surgeons (63%), radiologists (60%) and gastroenterologists (48%). A radiologist was present in 66% of cases. Of 14 hospitals that received referrals, 3 had a protocol, 3 returned patients the same day and 4 returned patients for management in the event of failure. CONCLUSIONS: All responding hospitals in England consider the use of SEMS in colonic obstruction. Nevertheless, there is great variation in stenting practices, and challenges in terms of access and expertise. Centralisation and regional referral networks may help maximise availability and expertise but more work is needed to support this.


Assuntos
Colonoscopia/instrumentação , Neoplasias Colorretais/complicações , Obstrução Intestinal/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Stents Metálicos Autoexpansíveis/estatística & dados numéricos , Plantão Médico/estatística & dados numéricos , Protocolos Clínicos/normas , Colonoscopia/normas , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/cirurgia , Estudos Transversais , Inglaterra , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais de Distrito/normas , Hospitais de Distrito/estatística & dados numéricos , Hospitais Gerais/normas , Hospitais Gerais/estatística & dados numéricos , Hospitais de Ensino/normas , Hospitais de Ensino/estatística & dados numéricos , Humanos , Obstrução Intestinal/etiologia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Stents Metálicos Autoexpansíveis/normas , Inquéritos e Questionários/estatística & dados numéricos
5.
Rev Saude Publica ; 54: 23, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32049212

RESUMO

OBJECTIVE: To describe some characteristics of the 97 teaching hospitals participating in the Projeto de Aprimoramento e Inovação no Cuidado e Ensino em Obstetrícia e Neonatologia (Apice ON-Project for Improvement and Innovation in Care and Teaching in Obstetrics and Neonatology). METHODS: The semester prior to the beginning of the program was adopted as the baseline to evaluate the subsequent structural and processes changes of this project. Secondary data from the first half of 2017 were extracted from the National Registry of Health Establishments (NRHE), the Hospital Information System and the Sistema de Informações sobre Nascidos Vivos (SINASC-Live Birth Information System). RESULTS: Before the implementation of the project, only 66% of the hospitals had a Baby-friendly Hospital Initiative, only 3% offered special accommodations for high-risk pregnant women, mothers and their newborns, and 45.4% hospitals adopted the skin-to-skin contact; 97% hospitals had separate rooms for pre-labor and vaginal delivery (93%), not following the recommendations of the Ministry of Health; nine hospitals (9%) had no rooming-in; there were few obstetrics nurses (less than 1% of professionals enrolled in the NRHE), and in only six hospitals the proportion of births assisted by this professional was above 50% of vaginal deliveries, while in eight this percentage ranged between 15% and 50%; the average cesarean section rate was 42%, ranging between 37.6% (Southeast) and 49.1% (Northeast); ten hospitals did not charge for companions according to inpatient hospital authorization. CONCLUSION: The study strengthens the relevance of the Apice ON project as an inducer of change of the care model in teaching hospitals and, therefore, as a strategy for the implementation of the national public policy represented by the Stork Network.


Assuntos
Maternidades/organização & administração , Hospitais de Ensino/organização & administração , Programas Nacionais de Saúde/organização & administração , Neonatologia/educação , Obstetrícia/educação , Brasil , Cesárea/normas , Parto Obstétrico/normas , Feminino , Maternidades/normas , Hospitais de Ensino/normas , Humanos , Recém-Nascido , Trabalho de Parto , Nascimento Vivo , Programas Nacionais de Saúde/normas , Neonatologia/normas , Obstetrícia/normas , Período Pós-Parto , Gravidez
6.
J Neurooncol ; 146(2): 389-396, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31939029

RESUMO

PURPOSE: Studies have demonstrated that higher surgical volumes correlate with improved neurosurgical outcomes yet none exist evaluating the effects of hospital teaching status on the surgical neuro-oncology patient. We present the first analysis comparing brain tumor surgery perioperative outcomes at academic and non-teaching centers. METHODS: Brain tumor surgeries in the Nationwide Inpatient Sample (NIS) from 1998 to 2014 were identified. A teaching hospital, defined by the NIS, must have ≥ 1 Accreditation Council of Graduate Medical Education (ACGME) approved residency programs, Council of Teaching Hospitals membership, or have a ratio ≥ 0.25 of full-time residents to hospital beds. Annual treatment trends were stratified by hospital teaching status, assessing yearly caseload with linear regression. Multivariable logistic regression determined predictors of inpatient mortality/complications. Hospitals were further divided into quartiles by case volume and teaching status was compared in each. RESULTS: Teaching hospitals (THs) exhibited an average annual increase in brain tumor surgeries (+ 1057/year, p < 0.0001). In multivariable analysis, teaching status was associated with decreased risk of mortality (OR 0.82, p = 0.0003) and increased likelihood of discharge home (OR 1.21, p < 0.0001). In subgroup analysis, within the highest hospital quartile by caseload, higher mortality rates and lower routine discharges were again seen at non-teaching hospitals (NTHs) (p = 0.0002 and p = 0.0016, respectively). CONCLUSION: THs are performing more brain tumor surgeries over time with lower rates of inpatient mortality and perioperative complications even after controlling for hospital case volume. These results suggest a shift in neuro-oncology practice patterns favoring THs to optimize patient outcomes especially at the highest volume centers.


Assuntos
Neoplasias Encefálicas/mortalidade , Mortalidade Hospitalar/tendências , Hospitais de Ensino/normas , Pacientes Internados/estatística & dados numéricos , Procedimentos Neurocirúrgicos/mortalidade , Complicações Pós-Operatórias/mortalidade , Oncologia Cirúrgica/educação , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Feminino , Seguimentos , Humanos , Internato e Residência , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Prognóstico , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Taxa de Sobrevida
7.
Circ J ; 84(4): 584-591, 2020 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-31983725

RESUMO

BACKGROUND: Palliative care is highly relevant for patients with heart failure (HF), and there is a need for quantitative information on quality of care. Accordingly, this study aimed to develop a set of quality indicators (QIs) for palliative care of HF patients, and to conduct a practical pilot measurement of the proposed QIs in clinical practice.Methods and Results:We used a modified Delphi technique, a consensus method that involves a comprehensive literature review, face-to-face multidisciplinary panel meeting, and anonymous rating in 2 rounds. A 15-member multidisciplinary expert panel individually rated each potential indicator on a scale of 1 (lowest) to 9 (highest) for appropriateness. All indicators receiving a median score ≥7 without significant disagreement were included in the final set of QIs. Through the consensus-building process, 35 QIs were proposed for palliative care in HF patients. Practical measurement in HF patients (n=131) from 3 teaching hospitals revealed that all of the proposed QIs could be obtained retrospectively from medical records, and the following QIs had low performance (<10%): "Intervention by multidisciplinary team", "Opioid therapy for patients with refractory dyspnea", and "Screening for psychological symptoms". CONCLUSIONS: The first set of QIs for palliative care of HF patients was developed and could clarify quantitative information and might improve the quality of care.


Assuntos
Insuficiência Cardíaca/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Cuidados Paliativos/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/administração & dosagem , Doença Crônica , Consenso , Técnica Delfos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Hospitais de Ensino/normas , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/normas , Equipe de Assistência ao Paciente/normas , Projetos Piloto , Estudos Retrospectivos , Resultado do Tratamento
8.
J Surg Res ; 247: 469-478, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31668433

RESUMO

BACKGROUND: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted further duty hour restrictions in response to concerns over long work hours and sleep deprivation in trainees and their effects on patient outcomes. The effect of duty hour restrictions on complications after breast reconstruction procedures has not been clarified. MATERIALS AND METHODS: A retrospective cross-sectional analysis was designed. The National Inpatient Sample database was queried in the 2 y before and 2 y after the 2011 duty hour changes. Patients undergoing breast reconstruction, the most common elective admission diagnosis for plastic surgery patients, were selected for analysis. Patient groups were separated by teaching hospitals (THs) and nonteaching hospitals and by pre- and post-ACGME change periods. Surgical complication rates, length of stay, and procedures were analyzed using complex survey-weighted univariate and multivariate logistic regression analysis, with additional sensitivity analysis applied. RESULTS: The number of procedures did not vary significantly in the period after duty hour restrictions in THs (n = 46,188, pre-ACGME versus n = 48,980, post-ACGME). Overall complication rates in teaching (9.54%, pre-ACGME versus 9.04%, post-ACGME; P = 0.561) and nonteaching hospitals (8.54%, pre-ACGME versus 7.70%, post-ACGME; P = 0.319) did not significantly change after the implementation of duty hour changes. On multivariate analysis, surgery performed in resident THs after duty hour changes was not associated with a significant change in overall (odds ratio [OR], 1.03; 95% confidence interval [95% CI], 0.77-1.37; P = 0.857) breast-specific complications (OR, 1.06; 95% CI, 0.77-1.46; P = 0.731) or general complications (OR, 1.11; 95% CI, 0.80-1.54; P = 0.541). CONCLUSIONS: Duty hour restrictions enacted in 2011 were not associated with postoperative complications after breast reconstruction.


Assuntos
Acreditação/normas , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Internato e Residência/normas , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/psicologia , Estudos Transversais , Procedimentos Cirúrgicos Eletivos/educação , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Hospitais de Ensino/normas , Hospitais de Ensino/estatística & dados numéricos , Humanos , Tempo de Internação , Mamoplastia/educação , Mamoplastia/estatística & dados numéricos , Erros Médicos/prevenção & controle , Erros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia Plástica/educação , Tolerância ao Trabalho Programado/psicologia , Carga de Trabalho/normas , Carga de Trabalho/estatística & dados numéricos
9.
Australas Psychiatry ; 28(1): 66-74, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31564108

RESUMO

OBJECTIVE: Consultation-liaison psychiatry (CLP) services are particularly susceptible to heterogeneity, developing haphazardly in response to local interests and perceived need. This hampers the generalisability of comparisons between services in terms of service models, resource requirements and outcome data. The objective of this paper therefore is to chronicle the development of a method to meaningfully describe, map and compare different CLP services. METHOD: A review of the literature was followed by multiple site visits in both New Zealand and England, and an extended process of consultation and feedback. RESULTS: Sixteen dimensions common to CLP services were extracted to create a multi-dimensional matrix (mMAX-LP) which had three broad clusters (structure, coverage and relationship with physical health services). The model was applied and discussed with the previously visited hospitals over the succeeding five years. Additionally, the matrix was tested, and its utility demonstrated during the planned reconfiguration of CLP services at a large teaching hospital in South Auckland, New Zealand by tracking the evolution of CLP services. CONCLUSIONS: mMAX-LP shows promise as a useful model for profiling and comparing CLP services; mapping their evolution over time; and sign-posting future service development.


Assuntos
Hospitais de Ensino , Serviços de Saúde Mental , Modelos Organizacionais , Avaliação de Processos em Cuidados de Saúde/métodos , Psiquiatria , Encaminhamento e Consulta , Inglaterra , Pesquisa sobre Serviços de Saúde , Hospitais de Ensino/organização & administração , Hospitais de Ensino/normas , Humanos , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/normas , Nova Zelândia , Psiquiatria/organização & administração , Psiquiatria/normas , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/normas
10.
Ethiop J Health Sci ; 29(6): 657-668, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31741636

RESUMO

Background: Among different factors, accreditation is being widely used across the world to improve quality and safety in hospitals. Therefore, the purpose of the present study was to develop an accreditation model for teaching hospitals in Iran. Methods: This qualitative study was conducted in four phases from January, 2017 to March, 2018. To this end; firstly, existing accreditation models were extracted and reviewed comparatively. Within the second stage, dimensions and components of the accreditation model were extracted through semi-structured interviews. In the third stage, a new instruction was developed via integrating the findings from the first and the second stages. Finally, the model was validated in two phases of Delphi method and a specialized forum in the fourth step. Qualitative findings were then analyzed using content analysis method. Results: Models of Joint Commission International (JCI) and Word Federation for Medical Education (WFME) in other 6 countries were reviewed and compared with the current Iranian model. Extracted dimensions discovered to complement the present model included learner assessment, continuous reviews and revisions, and educational productivity. The final model was also developed with 12 dimensions and 94 standards. Content validity ratio (CVR) and content validity index (CVI) were also estimated to be 0.40 and 0.80, respectively. As well, the second round of Delphi method could increase the number of model standards to 97. Moreover, Cohen's kappa coefficient was calculated to be at least 0.71. Conclusion: This study led to the development of a comprehensive model for scientific accreditation of teaching hospitals through reviewing documentation, combining and comparing global approaches, as well as integrating them with the views of domestic experts.


Assuntos
Acreditação/estatística & dados numéricos , Acreditação/normas , Guias como Assunto , Hospitais de Ensino/estatística & dados numéricos , Hospitais de Ensino/normas , Qualidade da Assistência à Saúde/normas , Técnica Delfos , Humanos , Irã (Geográfico) , Modelos Teóricos , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/organização & administração
11.
Cardiol Young ; 29(12): 1489-1493, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31749444

RESUMO

BACKGROUND: In any country, the development of open heart surgery programme parallels stable political climate, economic growth, good leadership, and prudent fiscal management. This is lacking in a country like Nigeria without a functional cardiac hospital. OBJECTIVE: To review and compare the various models being adopted towards establishing a sustainable open heart surgery programme in Nigeria. MATERIALS AND METHODS: For ethnic and cultural reasons, Nigeria is divided into six geopolitical regions. Each region has one or more Federal Teaching Hospitals including medical centres. The hospitals have trained cardiothoracic surgeons and cardiologists as well as other auxiliary staff. After attainment of democratic rule in 1999, individual hospitals have devised various models to establish sustainable open heart surgery programme. The number of hospitals in each region, the models devised, and the limitations including the outcome were studied and analysed. RESULTS: Each geopolitical zone has about three to four centres, either public or private, trying to establish the programme. There are six different models. Each centre has been trying the different models since the year 2000. The oldest of the model is cardiac mission and the newest is employment of highly skilled retired expatriate consultant cardiac surgeon to help develop the local team. Inadequate funds, lack of governmental support, and brain drain syndrome have largely affected the programme.


Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/normas , Países em Desenvolvimento , Hospitais de Ensino/normas , Hospitais de Ensino/estatística & dados numéricos , Humanos , Nigéria , Avaliação de Programas e Projetos de Saúde
13.
Pediatr Emerg Care ; 35(10): 716-721, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593981

RESUMO

OBJECTIVES: Length of stay (LOS) and boarding for pediatric psychiatric patients presenting in the emergency department (ED) have been understudied, despite evidence that children with psychiatric disorders experience longer LOS relative to those without. This investigation examined correlates of LOS and boarding among youth with psychiatric disorders presenting to the ED in a large, statewide database. METHODS: Using the 2010 to 2013 Florida ED discharge database, generalized linear mixed models were used to examine for associations between LOS and patient and hospital characteristics among pediatric patients (<18 years) who presented with a primary psychiatric diagnosis (N = 44,328). RESULTS: Patients had an overall mean ± SD ED LOS of 5.96 ± 8.64 hours. Depending on the definition used (ie, 12 or 6 hours), between 23% and 58% of transferred patients were boarded. Patient characteristics associated with a longer LOS included female sex, being 15 to 17 years old, Hispanic ethnicity, having Medicaid or VA/TriCare insurance, having impulse control problems, having mood or psychotic disorders, and exhibiting self-harm behaviors. Patient transfer, large hospital size, and rural designation were associated with longer LOS. Teaching hospital status and profit status were not significantly associated with LOS. CONCLUSIONS: These data suggest that LOS for pediatric psychiatry patients in the ED varies significantly by psychiatric presentation, patient disposition, and hospital factors. Such findings have implications for quality of care, patient safety, and health outcomes.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Transtornos Mentais/diagnóstico , Adolescente , Criança , Feminino , Florida/epidemiologia , Hispano-Americanos/estatística & dados numéricos , Hospitais de Ensino/normas , Humanos , Masculino , Medicaid/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Segurança do Paciente , Transferência de Pacientes/estatística & dados numéricos , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Ideação Suicida , Resultado do Tratamento , Estados Unidos/epidemiologia
14.
JBI Database System Rev Implement Rep ; 17(12): 2559-2569, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31567556

RESUMO

OBJECTIVES: The aim of this project was to implement best practice in pain relief during wound care for patients with deep open wounds in the orthopedic trauma department of a tertiary teaching hospital in China. INTRODUCTION: Patients with deep open wounds often suffer from severe pain during wound care. Inadequate pain relief for these patients calls for evidence-based changes to close the gap between current and best practice. METHODS: The current quality improvement project was carried out over six months using the JBI Practical Application of Clinical Evidence System (JBI PACES). A baseline and two follow-up audits of wound pain management practice were conducted to identify practice gaps and post implementation compliance in pain management in wound care. The sample comprised 20 patients and two dressing nurses. The Getting Research into Practice tool identified barriers to and strategies for improvement in practice. The patients' pain experiences were measured following the implementation of changes. RESULTS: The baseline audit identified poor compliance with best practice. Following implementation of the recommended changes, some significant improvements in practice were made by the dressing nurses; however, these were inadequately maintained at the second post implementation audit. Patients' pain scores improved following the nurses' practice changes (t = 2.272, P > 0.05). CONCLUSION: The implementation of best practice in pain relief during wound care for patients with deep open wounds has led to significant improvement in nurses' performance in the orthopedic trauma department. The most challenging barriers involved interdisciplinary collaborations and organizational structure.


Assuntos
Prática Clínica Baseada em Evidências/métodos , Fidelidade a Diretrizes/estatística & dados numéricos , Manejo da Dor/métodos , Centros de Traumatologia/normas , Ferimentos e Lesões/terapia , China , Prática Clínica Baseada em Evidências/normas , Implementação de Plano de Saúde , Hospitais de Ensino/normas , Humanos , Manejo da Dor/normas , Guias de Prática Clínica como Assunto , Centros de Atenção Terciária/normas
15.
Artigo em Inglês | MEDLINE | ID: mdl-31503542

RESUMO

Background Antihypertensive medications are one among the most highly used drugs across the globe as well as in India, and their prescribing pattern will be erratic despite the various clinical guidelines. Few studies address the pattern and adherence to the standard treatment guidelines in India. This study aimed to review the prescribing pattern of antihypertensive medications in a rural tertiary care teaching Indian hospital and to investigate the adherence to the Joint National Commission-8 (JNC-8) guidelines on prevention, detection, evaluation, and treatment of hypertension in adults. Methods A prospective observational study was conducted among the participants from four different inpatient wards who are aged >18 years, without gender restriction. The prescription pattern was reviewed and adherence to the JNC-8 guidelines was also assessed. A purposive sampling technique was adopted and descriptive statistics were used in Statistical Package for the Social Sciences v16. Results Of the 101 participants included in the study, 62 (61.39%) were female, 23.76% were aged <30 and >60 years, and the other 52.48% belong to the range of 30-60 years. As per JNC-8 guidelines, 4.95%, 17.82%, 44.55%, and 32.67% of patients were classified as normal, pre-hypertensive, stage I, and stage II, respectively. Most of them (31.68%) were free from comorbidities. The most (23.76%) prescribed drug was calcium channel blocker (CCB), and 15.84% of the patients received combination therapy. Treatment was effective in 70.30% of the patients through analyzing their blood pressure even though the adherence to the JNC-8 guidelines was only in 54.46%. Conclusions Our study revealed that CCB was the most prescribed drug, and in spite of the only 50% adherence rate, treatment was effective in the majority of the population. The treatment outcome can be improved if the adherence rate is increased further.


Assuntos
Anti-Hipertensivos/uso terapêutico , Fidelidade a Diretrizes/normas , Hospitais de Ensino/normas , Hipertensão/tratamento farmacológico , Padrões de Prática Médica/normas , Atenção Terciária à Saúde/normas , Adulto , Pressão Sanguínea/efeitos dos fármacos , Bloqueadores dos Canais de Cálcio/uso terapêutico , Comorbidade , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
16.
BMC Health Serv Res ; 19(1): 623, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481058

RESUMO

BACKGROUND: Hospital accreditation is expected to improve health care quality and patient satisfaction. However, little and conflicting evidence is currently available to support its effect on patient outcomes, particularly patient experience. Hong Kong recently launched a pilot programme to test an infrastructure for accreditation of both private and public hospitals with the Australian Council on Healthcare Standards. This study aims to evaluate the longitudinal impact of hospital accreditation on patient experience in a publicly-funded university teaching hospital in Hong Kong. METHODS: Three cross-sectional surveys were conducted at three time points: 9 months pre- accreditation as baseline (T1), three (T2) and fifteen months (T3) post-accreditation. Acute care inpatients aged 18 to 80 were recruited on the second day of hospital admission to complete the Picker Patient Experience Questionnaire-15 (PPE-15). Baseline data was first compared to the 2005 Hong Kong average for public hospitals using t-tests. Data was then analyzed using ANOVA and multiple linear regression to evaluate differences across the three cross-sections and examine the effect of accreditation over time while controlling for covariates. RESULTS: 3083 patients (T1 = 896, T2 = 1093, T3 = 1094) completed the survey for a response rate of 83.5, 86.1, and 83.8%, respectively. The hospital baseline domain and summary patient experience scores differed from the Hong Kong public hospital average obtained from the 2005 Thematic Household Survey. All domain and summary patient experience scores declined (improved) over the study period (T1 to T3). The multiple regression results confirmed the time point score comparisons with declining (improving) parameter estimates for T2 and T3 for all domain and summary scores except the 'continuity and transition' domain, for which the declining coefficient was only significant at T3. CONCLUSIONS: While hospital accreditation has not been shown to improve patient outcomes, this study suggests the accreditation exercise may enhance patient experience. Moreover, it suggests the quality improvement initiatives associated with accreditation may address areas of concern emphasized by Hong Kong patients, such as involvement in care and emotional support from providers.


Assuntos
Acreditação/normas , Hospitais Públicos/normas , Satisfação do Paciente , Qualidade da Assistência à Saúde/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Métodos Epidemiológicos , Feminino , Hong Kong , Hospitalização , Hospitais de Ensino/normas , Humanos , Pacientes Internados/psicologia , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade/normas , Adulto Jovem
17.
Malays J Pathol ; 41(2): 161-167, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31427551

RESUMO

INTRODUCTION: Overnight transfusion (OT) is the blood transfusion taking place from 9pm to 8am. During this period, patients are exposed to increased risk of errors. This cross-sectional study aims to determine the incidence and practice of OT in Universiti Kebangsaan Malaysia Medical Centre. MATERIALS & METHODS: Data from all OT in June and mid-July 2017 were collected from recipients' cards, transfusion request forms and patient's case files, regarding discipline involved, indications, time intervals from request of blood transfusion to the completion of OT on patients, monitoring of patients and adverse reactions. RESULTS: A total of 1285 transfusion cases were identified during the study period. 216 (16.8%) cases were OT while the 1069 (83.2%) cases were non-OT. Surgery discipline has the highest (30.1%) OT. The indications of OT were acute clinical need: 82.9%, less acute clinical need: 13.9% and no clinical need: 3.2%. A huge delay (average: 5 hours 40 minutes) in starting transfusion after grouping and crossmatching (GXM) completion was noted. Besides, 25.9% cases took <4 hours to complete OT; 83.4% cases did not have proper transfusion monitoring and three transfusion reactions were reported. DISCUSSION: Although most of the OT cases had appropriate clinical indications, the transfusion can be commenced earlier at day time rather than overnight. Cases without absolute indication should avoid OT. The poor monitoring of patient during OT had posed risks to patients' life if an adverse transfusion reaction happened. The major reason for OTs was a huge delay in starting transfusion after the GXM completion. The contravention of 4-hour infusion rule increased the patients' risk of developing bacterial sepsis. The practice of OT should be discouraged wherever possible except for clinically indicated cases.


Assuntos
Transfusão de Sangue/métodos , Hospitais de Ensino , Adolescente , Adulto , Idoso , Transfusão de Sangue/normas , Criança , Estudos Transversais , Feminino , Hospitais de Ensino/métodos , Hospitais de Ensino/normas , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Reação Transfusional/epidemiologia , Adulto Jovem
19.
J Chemother ; 31(7-8): 378-387, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31145043

RESUMO

Antimicrobial stewardship (AMS) is a key strategy promoting rational antimicrobial use. In Zambia, information on health professionals' knowledge, attitude, and practice of AMS is limited. This study was undertaken to address this at Zambia's leading specialized teaching hospitals. Descriptive, cross-sectional study involved 137 physicians and 61 pharmacists. AMS knowledge was relatively low among physicians (51%) and pharmacists (39%). Few physicians (9%) and pharmacists (20%) demonstrated sufficient knowledge of the basic principles of AMS. Physicians' and pharmacists' knowledge levels were significantly associated with years of practice, job position or practice rank, and previous AMS training. The majority (95%) perceived AMR as a current problem in their practise. Most physicians (92%) and pharmacists (86%) had not undertaken AMS training before. All indicated the need for context-specific educational interventions to promote AMS in Zambia. Despite positive perceptions, basic knowledge of AMS was relatively low. Context-specific educational interventions and capacity building are needed to address AMS gaps.


Assuntos
Antibacterianos/normas , Gestão de Antimicrobianos/normas , Hospitais de Ensino/normas , Farmacêuticos/normas , Médicos/normas , Centros de Atenção Terciária/normas , Estudos Transversais , Humanos , Conhecimento , Zâmbia
20.
J Surg Res ; 242: 264-269, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31108344

RESUMO

BACKGROUND: Resident work hour restrictions and required protected didactic time limit their ability to perform clinical duties and participate in structured education. Advanced practice providers (APPs) have previoulsy been shown to positively impact patients' outcomes and overall hospital costs. We describe a model in which nurse practitioners (NPs) improve resident education and American Board of Surgery In Training Examination (ABSITE) scores by providing support to our trauma and acute care surgery (ACS) service thereby protecting resident didactic time. MATERIALS AND METHODS: A new educational model aimed to improve ABSITE scores was created, increasing protected resident didactic time. The addition of three full-time NPs to the ACS service allowed implementation of this redesigned academic curriculum to be put into effect without neglecting patient or service-related responsibilities that were previously fulfilled by resident staff. Resident ABSITE results including standard score, percent correct, and percentile were compared before and after the educational changes were instituted. RESULTS: Eleven residents' scores were included. For each ABSITE score, we used a mixed model with time and postgraduate year (PGY) level as fixed effects and subject ID as a random effect. The interaction term between PGY level and time was not significant and removed from the model. A significant main effect of PGY level and of time was then observed. A statistically significant improvement in ABSITE scores after intervention was observed across all the PGY levels. Standard score increased 77.3 points (P-value = 0.001), percent correct increased 5.9% (P-value = 0.002), and percentile increased 23.8 (P-value = 0.02). Following the educational reform, no residents scored below the 35th percentile. CONCLUSIONS: Utilization of NPs on our ACS service provided adequate service coverage, allowing the implementation of an educational reform increasing protected resident education time and improved ABSITE scores.


Assuntos
Cirurgia Geral/educação , Internato e Residência/métodos , Modelos Educacionais , Profissionais de Enfermagem/organização & administração , Carga de Trabalho/normas , Avaliação Educacional/estatística & dados numéricos , Hospitais de Ensino/organização & administração , Hospitais de Ensino/normas , Humanos , Internato e Residência/normas , Internato e Residência/estatística & dados numéricos , Designação de Pessoal/organização & administração , Estudos Retrospectivos , Fatores de Tempo , Centros de Traumatologia/organização & administração , Centros de Traumatologia/normas , Estados Unidos
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