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1.
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
3.
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
4.
Ann Thorac Surg ; 108(3): 929-934, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31353035

RESUMO

BACKGROUND: Recent studies in noncardiac surgery have described worse outcomes in the first month of training. However, the "July effect" in the context of cardiac surgery outcomes is not well understood. We examined whether patient outcomes after cardiac surgery were affected by procedure month or academic year quartile. METHODS: Using the National Inpatient Sample, we isolated all coronary artery bypass grafting (CABG), surgical aortic valve replacement (AVR), mitral valve repair or replacement (MV), and isolated thoracic aortic aneurysm (TAA) replacement procedures between 2012 and 2014. For each procedure, overall trends in in-hospital mortality and hospital complications were compared by academic year quartiles (ie, between the first academic year quartile vs the fourth quartile) and by procedure month. Outcomes between teaching and nonteaching hospitals were also compared. RESULTS: Overall, 301,105 CABG, 111,260 AVR, 54,985 MV, and 2,655 TAA procedures met inclusion criteria. In-hospital mortality for each procedure did not vary by procedure month or academic year quartile, even after risk adjustment (all P > .05). Teaching status did not influence risk-adjusted mortality for CABG and isolated TAA replacement (both P > .05). However, teaching hospitals had significantly lower adjusted mortality than nonteaching hospitals for AVR and MV surgery (both P < .01). CONCLUSIONS: The July effect is not evident for cardiac surgery despite preexisting notions. Teaching hospitals performed at least equivalent, if not better, for major cardiac surgery procedures. These findings highlight the pivotal role of hospital support systems to ensure the safe transition of resident classes without compromising on patient outcomes.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Competência Clínica , Mortalidade Hospitalar , Corpo Clínico Hospitalar/tendências , Qualidade da Assistência à Saúde , Centros Médicos Acadêmicos/organização & administração , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Estudos de Coortes , Bases de Dados Factuais , Educação de Pós-Graduação em Medicina/organização & administração , Feminino , Hospitais de Ensino/organização & administração , Humanos , Pacientes Internados/estatística & dados numéricos , Internato e Residência/organização & administração , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Risco Ajustado , Estações do Ano , Estados Unidos
5.
Surgery ; 166(5): 800-811, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31230839

RESUMO

BACKGROUND: Complex cancer operations performed at high-volume and teaching hospitals have been associated with better outcomes. The purpose of this study was to determine the national trends in the performance of these operations at large teaching hospitals. METHODS: Patients who underwent elective esophagectomies, gastrectomies, pancreatectomies, and hepatectomies for cancer (2003-2015) were identified using the National Inpatient Sample. We determined average annual percent change (AAPC) in the proportion of operations at large teaching hospitals, inpatient complications, length of stay (LOS), and inpatient mortality. RESULTS: Between 2003 and 2015, 38,932 esophageal, 104,941 gastric, 96,098 hepatic, and 137,440 pancreatic cancer resections were performed. The proportion at large teaching hospitals increased with an AAPC of 2.5 for esophagectomies (P < .001), 3.6 for gastrectomies (P < .001), and 1.5 for pancreatectomies (P = .039), but did not change for hepatectomies (AAPC 0.48, P = .50). During the study period, mean LOS and inpatient mortality rates at large teaching hospitals decreased across hospital types. By 2013 to 2015, the operations at large hospitals were associated with decreased mortality only for pancreatectomies (odds ratio, 0.62, 95% confidence interval, 0.43-0.91, P = .015). CONCLUSIONS: Complex cancer operations are performed increasingly at large teaching hospitals, but perioperative outcomes have improved nationally across hospital types. Further studies should identify actionable areas for improvement to ensure accessible quality cancer care.


Assuntos
Procedimentos Cirúrgicos Eletivos/efeitos adversos , Hospitais de Ensino/tendências , Neoplasias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Feminino , Mortalidade Hospitalar/tendências , Hospitais de Ensino/organização & administração , Hospitais de Ensino/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Período Perioperatório , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia
6.
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
7.
Rev Gaucha Enferm ; 40(spe): e20180341, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31038606

RESUMO

OBJECTIVE: To analyze the registry of the Transfer Note (NT) and the emission of the Modified Early Warning Score (MEWS) performed by the nurse in adult patients transferred from the Emergency Service as an effective communication strategy for patient safety. METHOD: A cross-sectional retrospective study developed at a teaching hospital in the South of Brazil that evaluated 8028 electronic medical records in the year 2017. A descriptive analysis was performed. RESULTS: NT reached the institutional target of 95% in January and February, falling below the target in other months. The MEWS measurement was performed in 85.6% (n = 6,870) of the medical records. Of these patients, 96.8% (n = 6,652) had unchanged MEWS. CONCLUSION: NT and MEWS are inserted in the work of the nurse, however, actions are needed to qualify patient safety, improving effective communication and therefore reducing the possibility of occurrence of adverse events.


Assuntos
Sistemas de Comunicação no Hospital , Registros Hospitalares , Avaliação em Enfermagem , Registros de Enfermagem , Segurança do Paciente , Transferência de Pacientes/organização & administração , Gestão de Riscos/métodos , Índice de Gravidade de Doença , Adulto , Brasil , Estudos Transversais , Registros Eletrônicos de Saúde , Serviço Hospitalar de Emergência , Controle de Formulários e Registros , Sistemas de Comunicação no Hospital/organização & administração , Hospitais de Ensino/organização & administração , Humanos , Papel do Profissional de Enfermagem , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Medição de Risco , Gestão de Riscos/organização & administração
8.
East Mediterr Health J ; 25(3): 172-180, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31054227

RESUMO

Background: Antibiotic misuse is a worldwide public health problem and has been associated with increased morbidity, length of hospital stay, mortality, healthcare costs, and most importantly antibiotic resistance. Aims: We aimed to evaluate the compliance of antibiotic prescribing with national guidelines, assess how educational interventions can best be utilized to make impact and fill gaps for optimal antibiotic utilization, and to identify facilitators and barriers to implementing ASPs in Qatar. Methods: Six cross-sectional baseline audits of antibiotic prescribing were conducted over a two-week period at a tertiary care teaching hospital. A sub-analysis of prescriptions with follow up has followed. An educational intervention utilizing the PDSA (Plan-Do-Study-Act) tool was implemented to address gaps identified. A repeated audit was done to assess the impact of change. Lastly, interviews were conducted to recognize perceived facilitators and barriers for ASP implementation, identify strategies to overcome barriers, and evaluate the effectiveness of educational interventions. Results: The most common indication for antibiotic prescribing was febrile neutropenia (20.7%). The most frequently used class of antibiotics was carbapenems (21.4%). Sixty percent of prescriptions complied with guidelines. The rationale behind choosing not to adhere to guidelines was not documented in 37.2% of cases. Suboptimal documentation in records was targeted through our intervention. The audit post intervention showed slight improvement in documentation. Facilitators and barriers included: collaboration and communication among teams, compliance with guidelines, interventions documented by clinical pharmacists, and electronic system errors. Conclusions: Effective communication, continuous documentation in records, and repetitive education promote rational antibiotic prescribing and enhance ASPs.


Assuntos
Gestão de Antimicrobianos/métodos , Hospitais de Ensino , Centros de Atenção Terciária , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Estudos Transversais , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Feedback Formativo , Fidelidade a Diretrizes/estatística & dados numéricos , Hospitais de Ensino/organização & administração , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Catar , Centros de Atenção Terciária/organização & administração
9.
J Surg Res ; 242: 332-335, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31129242

RESUMO

BACKGROUND: Chair of the Department of Surgery, sometimes known as the Chief, holds a title that has significant historical connotations. Our goal was to assess a group of objectively measurable characteristics that unify these individuals as a group. METHODS: Utilizing publicly available data for all US teaching hospitals, demographic information was accumulated for the named chiefs/chairs of surgery. Information collected included location of their program, their medical/surgical training history, their surgical specialty, previous chair/chief titles held, and academic productivity. RESULTS: Of the 259 programs listed, data were available on 244 individuals who were trained in 19 different specialties. The top three specialties of these practitioners are General Surgery (40, 16.3%), Surgical Oncology (38, 15.5%), and Vascular Surgery (33, 13.5%). There were only 14 female chairs (5.7%) and only one chair with a doctor of osteopathic medicine degree. The majority (62.3%) had been a previous chief of a surgical subdivision with only 26% having been a previous chair/chief of the surgical department. The average chair had 72 peer-reviewed manuscripts with 28 published book chapters. Chair's at academic institutions with university affiliation had a significantly higher number of peer-reviewed manuscripts (P < 0.0001) as well as were more likely to be trained at academic institutions (P = 0.013). CONCLUSIONS: There are no set characteristics that define the Chair of a Department of Surgery. By understanding a group of baseline characteristics that unify these surgical leaders, young faculty and trainees with leadership aspirations may begin to understand what is necessary to fill these roles in the future.


Assuntos
Docentes de Medicina/psicologia , Hospitais de Ensino/organização & administração , Liderança , Diretores Médicos/psicologia , Centro Cirúrgico Hospitalar/organização & administração , Docentes de Medicina/estatística & dados numéricos , Feminino , Humanos , Masculino , Diretores Médicos/estatística & dados numéricos , Editoração/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
10.
Rev Bras Enferm ; 72(2): 442-449, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31017208

RESUMO

OBJECTIVE: To describe the social network of adolescents who need special health care. METHOD: A qualitative, descriptive and exploratory study conducted between 2016 and 2017 in the pediatric outpatient clinic of a teaching hospital in southern Brazil. Thirty-five semi-structured interviews were conducted with adolescents between 12 and 18 years of age, followed by the construction of genograms and ecomaps. After transcription, the enunciations were subjected to Pêcheux's method of discourse analysis. RESULTS: The institutional network consists of health services, schools and religious entities, as well as adolescents' families and friends. In the family network, women family members-such as mothers, grandmothers and aunts-have a special role. FINAL CONSIDERATION: The adolescents' social network is composed of institutional and family circles. In the view of adolescents, the tertiary service is more capable of solving their problems, and for this reason used the most. In order to ensure these adolescents access to and continuity of care, the articulation between health policies and health services is suggested.


Assuntos
Comportamento do Adolescente/psicologia , Doença Crônica/psicologia , Rede Social , Adolescente , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Brasil , Criança , Doença Crônica/enfermagem , Doença Crônica/reabilitação , Feminino , Hospitais de Ensino/organização & administração , Hospitais de Ensino/estatística & dados numéricos , Humanos , Entrevistas como Assunto/métodos , Masculino , Relações Profissional-Paciente , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/normas , Apoio Social
11.
J Surg Res ; 241: 264-270, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31035141

RESUMO

Barriers to active participation in clinical research among academic surgeons include insufficient research training and mentorship, increased clinical demands, lack of protected research time, limited access to resources, complex regulatory requirements, and a highly competitive research funding environment. We describe the development and implementation of a novel clinical research infrastructure program designed to attenuate these barriers and increase clinical research engagement and productivity in a large academic surgery department. Interim outcomes show a high utilization of program services across all divisions within the department, a substantial increase in new clinical research protocols, more applications submitted to funding agencies, and a high level of user satisfaction. We discuss how a departmental infrastructure program can simultaneously address barriers faced by surgeon clinical researchers and foster continuation of the longstanding tradition of innovation and discovery in academic surgery.


Assuntos
Pesquisa Biomédica/organização & administração , Hospitais de Ensino/organização & administração , Desenvolvimento de Programas , Centro Cirúrgico Hospitalar/organização & administração , Pesquisa Biomédica/estatística & dados numéricos , Protocolos Clínicos , Eficiência , Hospitais de Ensino/estatística & dados numéricos , Humanos , Satisfação Pessoal , Avaliação de Programas e Projetos de Saúde , Cirurgiões/psicologia , Cirurgiões/estatística & dados numéricos , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos
12.
Nephron ; 142(2): 114-116, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943504

RESUMO

Maintenance haemodialysis is the most common form of renal replacement therapy treatment in Sub-Saharan Africa. In spite of this, there is a general inadequacy for patients receiving this form of therapy due to lack of materials, human resources and funding from the governments. This form of treatment is relatively new in the Gambia compared to many West African countries, but there is also an enormous challenge on the part of the government to ensure that the citizens benefit from this form of therapy. Inadequate finances and human resources are making it difficult for the Gambia government to achieve this objective. It is therefore imperative for the state to invest more efforts on preventive strategies, which until today continue to remain inadequate.


Assuntos
Hospitais de Ensino/organização & administração , Falência Renal Crônica/reabilitação , Diálise Renal , Gâmbia , Humanos
13.
BMC Health Serv Res ; 19(1): 181, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30894150

RESUMO

BACKGROUND: Evidence-based clinical algorithms (EBCA) are knowledge tools to promote evidence use by codifying evidence into action plans to facilitate appropriate care. However, their impact on process and outcomes of care varies considerably across practice settings and providers, highlighting the need for tailoring of both these knowledge tools and their implementation strategies to target end users and the setting in which EBCAs are to be employed. Leadership at the Tikur Anbessa Specialized Hospital emergency department (TASH-ED) in Addis Ababa, Ethiopia identified a need for context-appropriate EBCAs to improve evidence uptake to mitigate care gaps in this high volume, high acuity setting. We aimed to identify barriers and facilitators to utilization of EBCAs in the TASH-ED, to identify priority targets for development of EBCAs tailored for the TASH-ED context and to understand the process of care in the TASH-ED to inform implementation planning. METHODS: We employed a multi-component qualitative design including: semi-structured interviews with TASH-ED clinical, administrative and support services staff, and Toronto EM physicians who had worked in the TASH-ED; direct observation of the process of care in TASH-ED; document review. RESULTS: Although most TASH-ED participants reported an awareness of EBCAs, they noted little or no experience using them, primarily due to the poor fit of many EBCAs to their practice setting. All participants felt that context-appropriate EBCAs were needed to ensure standardized and evidence-based care and improve patient outcomes for common ED presentations. Trauma, sepsis, acute cardiac conditions, hypertensive emergencies, and diabetic keto-acidosis were most commonly identified as priorities for EBCA development. Lack of medication, equipment and human resources were identified as the primary barriers to use of EBCAs in the TASH-ED. Support from leadership and engagement of stakeholders outside the ED where EBCAs were believed to be less well accepted were identified as essential facilitators to implementation of EBCAs in the TASH-ED. CONCLUSIONS: This study found a perceived need for EBCAs tailored to the TASH-ED setting to support uptake of evidence-based care into routine practice for common clinical presentations. Barriers and facilitators provide information essential to development of both context-appropriate EBCAs and plans for their implementation in the TASH-ED.


Assuntos
Algoritmos , Serviço Hospitalar de Emergência/organização & administração , Prática Clínica Baseada em Evidências , Países em Desenvolvimento , Etiópia , Hospitais de Ensino/organização & administração , Humanos , Entrevistas como Assunto , Liderança , Pesquisa Qualitativa , Resultado do Tratamento
14.
Intern Med ; 58(13): 1859-1864, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-30918184

RESUMO

Objective To describe the clinical research support systems in Japanese board certification programs of internal medicine and to assess the relationship between these support systems and the scholarly activities of residents. Methods In 2018, a 26-item web questionnaire was mailed to 542 points of contact of hospitals listed as certified residency programs of internal medicine in order to obtain information about the presence of a research support system and scholarly activity from 2016. We used hospital characteristic data from the Japanese Diagnostic Procedure Combination database, a national inpatient database, and the annual report of the Japanese Society of Internal Medicine. Results A total of 228 hospitals (42%) responded to the survey. There were regular research lectures in 129 hospitals (57%), protected time (time to perform research during working hours) in 53 hospitals (23%), research consultations in 175 hospitals (77%), regular journal clubs in 213 hospitals (77%), regular research conferences in 151 hospitals (66%), data warehouses in 139 hospitals (61%), and financial research support from the hospital budget in 140 hospitals (61%). A multivariate analysis showed that none of the research support systems were related to the number of conference presentations. In contrast, protected time [odds ratio (OR) 3.66, 95% confidence interval (CI) 1.43-9.39] and regular research conferences (OR 2.20, 95% CI 1.14-4.23) were related to the presence of clinical research presentations in scientific conferences hosted by residents. Conclusion Protected time and regular research conferences were related to the scholarly activity of residents in Japanese teaching hospitals.


Assuntos
Pesquisa Biomédica/organização & administração , Educação de Pós-Graduação em Medicina/organização & administração , Escolaridade , Hospitais de Ensino/organização & administração , Medicina Interna/educação , Medicina Interna/organização & administração , Internato e Residência/organização & administração , Adulto , Pesquisa Biomédica/estatística & dados numéricos , Currículo , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Feminino , Humanos , Medicina Interna/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Japão , Masculino , Inquéritos e Questionários , Adulto Jovem
15.
Am J Health Syst Pharm ; 76(Supplement_2): S41-S48, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-30854546

RESUMO

PURPOSE: The results and methods of a pharmacist-driven multifaceted educational intervention on the appropriate management of asymptomatic bacteriuria (ABU) within an emergency department (ED) are reported. METHODS: A retrospective, single-center cohort study was conducted to evaluate the effects of an educational intervention aimed at reducing the rates of mismanaged ABU within an ED at a Level 1 trauma center. The education involved a multifaceted approach directed by pharmacists and involved a handout and algorithm communicated through in-person discussions, emails, and general distribution. In order to evaluate the effectiveness of this education the preintervention and postintervention rates of inappropriate treatments were determined through a retrospective chart review. The primary outcome was the difference in the frequency of inappropriately treated ABU between the preintervention and postintervention periods. RESULTS: A total of 268 patients were included in the study for review (134 in each group). There was a 16.5% reduction in the frequency of patients that had ABU inappropriately treated as a urinary tract infection in the postintervention period compared with the preintervention period (31 [23.1%] versus 53 [39.6%], p = 0.004). CONCLUSION: Pharmacist-driven education was effecitive in reducing the rates of inappropriately used antibiotics for ABU within an ED.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Infecções Assintomáticas/terapia , Bacteriúria/tratamento farmacológico , Farmacêuticos/organização & administração , Adulto , Idoso , Infecções Assintomáticas/epidemiologia , Bacteriúria/diagnóstico , Bacteriúria/epidemiologia , Educação Continuada/organização & administração , Feminino , Hospitais de Ensino/organização & administração , Humanos , Prescrição Inadequada/prevenção & controle , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Médicos , Prevalência , Papel Profissional , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Centros de Traumatologia/organização & administração
16.
J Nurs Manag ; 27(5): 1020-1029, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30848036

RESUMO

AIM: The aim of the present study was to clarify the relationship between perception of job empowerment and organizational commitment and trust among nurses in teaching hospitals of Khorramabad (Iran). BACKGROUND: Lack of power has been widespread among nurses in their workplaces due to uneven distribution of power among hospital staffs. Giving power to only a few individuals at the top of hospital hierarchy may often make nurses feel weak in their workplaces and causes reduction in the patients' quality care. METHODS: This is a descriptive cross-sectional study which included 160 officially employed nurses in four teaching hospitals of Khorramabad (west Iran) selected by stratified random sampling. The instruments used were: The Conditions of Work Effectiveness Questionnaire-II (C.W.E.Q-II), which measures nurses' empowerment, the Pressure Management Indicator, which measures organizational commitment and the Trust in Management Scale, which measures organizational trust. The data were analysed by the SPSS software using the descriptive and analytic statistical tests employing chi-square, Fisher's test and the Spearman-Brown correlation coefficient. RESULTS: The results showed that the nurses had a below moderate score in their perception of job empowerment ( < ! [ C D A T A [ x ¯ ] ] >  = 2.38 ± 0.70), with the highest score in their perception of access to "opportunity" subscale ( < ! [ C D A T A [ x ¯ ] ] >  = 3.11 ± 0.95), and the lowest score in their perception of access to "formal power" ( < ! [ C D A T A [ x ¯ ] ] >  = 2.43 ± 0.95). Additionally, moderate "organizational commitment" and "organizational trust" were reported with < ! [ C D A T A [ x ¯ ] ] >  = 4.5 ± 0.90 and < ! [ C D A T A [ x ¯ ] ] >  = 4.01 ± 1.11, respectively. The highest and the lowest perception scores were found for "continuous commitment" and "affective commitment" with < ! [ C D A T A [ x ¯ ] ] >  = 4.94 ± 0.97 and < ! [ C D A T A [ x ¯ ] ] >  = 4.26 ± 1.21, respectively. There were positive significant relationships between the three major variables of the study (p < 0.001). CONCLUSION: The results showed that there was a positive and significant relationship between nurses' perception of job empowerment, organizational commitment and trust. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers can increase the motivating factors among their nurses through evaluating organizational variables like empowerment and organizational trust. In fact, through recognition of the relationship between empowerment and organizational trust, one can design the interventions of structural empowering for the improvement of professional nursing practice, nurses' workplace well-being and safe quality care.


Assuntos
Hospitais de Ensino/normas , Enfermeiras e Enfermeiros/psicologia , Cultura Organizacional , Percepção , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Hospitais de Ensino/organização & administração , Hospitais de Ensino/estatística & dados numéricos , Humanos , Irã (Geográfico) , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Psicometria/instrumentação , Psicometria/métodos , Inquéritos e Questionários , Confiança/psicologia
18.
Drug Alcohol Rev ; 38(2): 190-197, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30729600

RESUMO

INTRODUCTION AND AIMS: Alcohol-related morbidity is estimated to range from 10-38% of the presentations to hospital emergency departments. This study aims to investigate the actual management process for alcohol-related presentations in a teaching hospital in Australia. DESIGN AND METHODS: Retrospective audit was conducted on the electronic medical records of 210 presentations with a primary or secondary diagnosis of 'alcohol use disorder' at discharge between November 2016 and February 2017. Six key management steps were investigated: identification of alcohol use disorder, documentation, thiamine, alcohol withdrawal assessment, benzodiazepine for alcohol withdrawal and referral to the drug and alcohol consultation liaison service. RESULTS: Of all the 210 presentations, 77.1% (162) were identified with alcohol use disorder in the initial assessments; 64.3% (135) were documented with alcohol use history, 49.5% (104) were prescribed with thiamine, 48.1% (101) were assessed with the alcohol withdrawal scale, 41% (86) were prescribed with benzodiazepine for alcohol withdrawal and only 38.6% (81) were referred to the drug and alcohol consultation liaison service. Only 8.6% (18) of the initial presentations were directly related to alcohol. These presentations had a higher completion rate in each of the six steps than those (91.4%, 192) not directly related to alcohol. Only 6.2% (13) were formally screened for alcohol use. DISCUSSION AND CONCLUSIONS: The findings suggest a need to improve the alcohol management practice in the hospital. Routine use of an alcohol screening tool can enable early identification of the alcohol use disorder and to improve the management of this problem in the hospital.


Assuntos
Consumo de Bebidas Alcoólicas/terapia , Alcoolismo/diagnóstico , Alcoolismo/terapia , Austrália , Serviço Hospitalar de Emergência/organização & administração , Hospitais de Ensino/organização & administração , Humanos , Estudos Retrospectivos
19.
PLoS One ; 14(2): e0210693, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30726297

RESUMO

BACKGROUND: There are many reasons for mothers not receiving modern obstetric care, being dissatisfied by health care deliveries is one of the major factors. There are limited studies about maternal satisfaction with labor and delivery care services in Ethiopia and particularly in the study area. Therefore, the aim of this study was to better understand client satisfaction on existing labor and delivery care service and associated factors among mothers who gave birth in the University of Gondar Teaching Hospital, Ethiopia. METHODS: This institution based cross-sectional study was conducted at the University of Gondar Referral Hospital. 593 mothers who gave birth between July and September 2016 were enrolled. Study participants were selected by systematic random sampling. A standardized, interviewer-administered questionnaire was used to collect data. Descriptive and summary statistics were performed. A linear regression model was fitted and variables having a P value of ≤0.05 in the multivariable model were considered statistically significant. RESULT: Overall, 31.3% of mothers were satisfied by the existing labor and delivery care. Living in rural areas (-2.9%; 95% CI: -5.75,-0.12) and the presence of a co-morbidity (-3.2%; 95%CI:-5.70, -0.72) were the factor which have a negative influence on maternal satisfaction. On the other hand, travel time to reach to the hospital (hours) (0.79%; 95% CI: 0.07, 1.52), birth by episiotomy or assisted vaginal delivery (6.3%; 95%CI: 1.56, 11.04), and receiving cost-free maternal health services (6.66%; 95%CI: 3.31, 10.01) were the factors that had positive influence. CONCLUSION: The level of satisfaction of laboring mothers with the labor and delivery care services was poor. Rural residency and chronic medical co-morbidity were negatively associated with level of satisfaction while travel time, mode of delivery, and payment free delivery service had a statistically significant positive influence on satisfaction.


Assuntos
Hospitais de Ensino/estatística & dados numéricos , Mães/psicologia , Satisfação do Paciente/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Etiópia , Feminino , Hospitais de Ensino/economia , Hospitais de Ensino/organização & administração , Humanos , Mães/estatística & dados numéricos , Satisfação do Paciente/economia , Assistência Perinatal/economia , Assistência Perinatal/organização & administração , Gravidez , População Rural/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
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