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J Theor Biol ; 509: 110501, 2021 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-32980371


We model the COVID-19 coronavirus epidemics in China, South Korea, Italy, France, Germany and the United Kingdom. We identify the early phase of the epidemics, when the number of cases grows exponentially, before government implementation of major control measures. We identify the next phase of the epidemics, when these social measures result in a time-dependent exponentially decreasing number of cases. We use reported case data, both asymptomatic and symptomatic, to model the transmission dynamics. We also incorporate into the transmission dynamics unreported cases. We construct our models with comprehensive consideration of the identification of model parameters. A key feature of our model is the evaluation of the timing and magnitude of implementation of major public policies restricting social movement. We project forward in time the development of the epidemics in these countries based on our model analysis.

/epidemiologia , Epidemias , Previsões/métodos , Modelos Estatísticos , /transmissão , China/epidemiologia , França/epidemiologia , Alemanha/epidemiologia , Implementação de Plano de Saúde/normas , Humanos , Itália/epidemiologia , Pandemias , Política Pública , Quarentena , República da Coreia/epidemiologia , Isolamento Social , Reino Unido/epidemiologia
PLoS One ; 15(9): e0236712, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915798


INTRODUCTION: The Reproductive Life Plan (RLP) is a clinical tool to help clients find strategies to achieve their reproductive goals. Despite much research on the RLP from high-income countries, it has never been studied in low- or middle income countries. Together with health workers called Mentor Mothers (MMs), we used a context-adapted RLP in disadvantaged areas in Eswatini. Our aim was to evaluate the implementation of the RLP in this setting. METHODOLOGY: MMs participated in focus group discussions (FGDs, n = 3 MMs n = 29) in January 2018 and at follow-up in May 2018 (n = 4, MMs n = 24). FGDs covered challenges in using the RLP, how to adapt it, and later experiences from using it. We used a deductive qualitative thematic analysis with the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, creating themes guided by its four constructs: facilitation, innovation, recipients and context. The MMs also answered a questionnaire to assess the implementation process inspired by normalization process theory. RESULTS: The RLP intervention was feasible and acceptable among MMs and fit well with existing practices. The RLP questions were perceived as advantageous since they opened up discussions with clients and enabled reflection. All except one MM (n = 23) agreed or strongly agreed that they valued the effect the RLP has had on their work. Using the RLP, the MMs observed progress in pregnancy planning among their clients and thought it improved the quality of contraceptive counselling. The clients' ability to form and achieve their reproductive goals was hampered by contextual factors such as intimate partner violence and women's limited reproductive health and rights. DISCUSSION: The RLP was easily implemented in these disadvantaged communities and the MMs were key persons in this intervention. The RLP should be further evaluated among clients and suitable approaches to include partners are required.

Implementação de Plano de Saúde/normas , Avaliação de Programas e Projetos de Saúde , Educação Sexual/métodos , Adulto , Essuatíni , Feminino , Implementação de Plano de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Reprodutivo/psicologia , Comportamento Reprodutivo/estatística & dados numéricos , Educação Sexual/normas , Inquéritos e Questionários , Populações Vulneráveis
J Am Acad Dermatol ; 83(3): 958-959, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32531304
Enferm. clín. (Ed. impr.) ; 30(3): 136-144, mayo-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-196678


La aplicación de Guías de Buenas Prácticas es efectiva en la mejora de la práctica clínica y en la disminución de la variabilidad clínica. En España se implantan desde 2012 las Guías de Buenas Prácticas de la Asociación de Enfermeras de Ontario a través del Programa de Centros Comprometidos con la Excelencia en Cuidados®, siguiendo los principios del programa canadiense Best Practice Spotlight Organizations® (BPSO®). La Unidad de Investigación en Cuidados y Servicios de Salud (Investén-isciii) coordina dicho programa en España, tras ser nombrada BPSO Host por la Asociación de Enfermeras de Ontario. Se han seguido 4 estrategias: traducción de las Guías de Buenas Prácticas, difusión de las mismas y del programa, implantación de las GuÍas de Buenas Prácticas y evaluación de los resultados en centros seleccionados de forma competitiva, y, finalmente, desarrollo de mecanismos de sostenibilidad. La implantación se apoya en el modelo teórico Knowledge to Action, que establece un ciclo de 6 fases: identificación del problema y formación a Centros Comprometidos con la Excelencia en Cuidados® seleccionados; adaptación al contexto local; evaluación de los facilitadores y barreras; adaptación e implantación de las intervenciones; monitorización y evaluación de resultados, y sostenibilidad. En cada una de estas fases se incorporan aquellos elementos basados en la evidencia que favorecen la efectividad de la implantación, como son la concurrencia competitiva para ser seleccionado candidato a participar en el programa, la selección por la institución de las guías a implantar, el liderazgo por enfermeras con un enfoque multiprofesional, la planificación del proceso a partir de estructuras de trabajo no verticales, pero con apoyo de la institución, el uso de múltiples estrategias de forma simultánea, la evaluación continuada y la retroalimentación de resultados, todo ello tutorizado y apoyado desde el BPSO Host. Actualmente en España hay 27 instituciones de diferentes características que implantan en total 20 guías clínicas. Recientemente se ha ampliado el alcance y estructura del programa con centros coordinadores BPSO Host regionales, lo que ha ampliado el número de instituciones a 36 y el número de guías clínicas implantadas a 22. El programa ha tenido un impacto positivo a nivel de las organizaciones y el sistema, en los procesos de cuidados y en la salud de los pacientes. Se observa en el enriquecimiento de la práctica profesional basada en la evidencia, el fomento del trabajo colaborativo en red, así como en la mejora en los resultados de salud de los pacientes y en la calidad de los cuidados prestados

The implementation of Best practice guidelines is effective in improving clinical practice and reducing clinical variability. The Best Practice Guidelines of the Ontario Nurses Association have been implemented in Spain since 2012 following the principles of the Canadian programme of the Best Practice Spotlight Organisations® (BPSO®). The Nursing and Healthcare Research Unit (Investén-isciii) coordinates this programme in Spain, having been nominated BPSO Host by the Ontario Nurses Association. Four strategies were followed: translation of the Best Practice Guidelines, dissemination of same and of the programme, implementation of the Best Practice Guidelines and assessment of the results in competitively selected centres, and, finally, the development of sustainability mechanisms. Implementation is based on the theoretical Knowledge to Action model, which establishes a cycle of 6 phases: identification of the problem and training of selected BPSO®; adaptation to the local context; assessment of facilitators and barriers; adaptation and implementation of interventions; monitoring and evaluation of results, and sustainability. Each of these phases incorporate evidence-based elements that promote the effectiveness of implementation, such as the competitive selection of candidates to participate in the programme, selection by the institution of the guidelines to be implemented, leadership by nurses with a multi-professional approach, planning of the process from work structures that are non-vertical but with the support of the institution, the simultaneous use of multiple strategies, ongoing assessment and feedback of results. All of which is mentored and supported by the BPSO Host. There are currently 27 institutions in Spain of different characteristics that implement a total of 20 clinical guidelines. The scope and structure of the programme has recently been extended with regional BPSO Host coordinating centres, which has brought the number of institutions to 36 and the number of implemented clinical guidelines to 22. The programme has had a positive impact on organisations and the system, on care processes and on patient health. This is evidenced by enriched evidence-based professional practice, the promotion of collaborative networking and by improved patient health outcomes and the quality of care provided

Humanos , Guias de Prática Clínica como Assunto/normas , Avaliação de Programas e Projetos de Saúde , Cuidados de Enfermagem/organização & administração , Enfermagem Baseada em Evidências/normas , Implementação de Plano de Saúde/normas , Espanha , Cuidados de Enfermagem/normas , Cuidados de Enfermagem/ética
Enferm. clín. (Ed. impr.) ; 30(3): 145-154, mayo-jun. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-196679


Este artículo describe la experiencia de implantación y consolidación de las Guías de buenas prácticas clínicas (GBP) de la Registered Nurses' Association of Ontario (RNAO) en el ámbito clínico y académico, en Santander (Colombia) y su proyección futura. Para la implantación de las Guías de buenas prácticas en ambos contextos se utilizó la herramienta propuesta por la RNAO. En el ámbito clínico, la implantación de las guías ha permitido iniciar el proceso de estandarización del cuidado de forma transversal en la institución, con seguimiento sistemático de los indicadores, lo cual ha hecho posible la toma de decisiones y la visualización de la calidad del cuidado que prestan las enfermeras en sus diferentes roles. En el ámbito académico, la implantación de las guías ha potenciado la función docente e investigadora, y en menor proporción la función de extensión (entendida como educación continua o proyección social). En la fase de consolidación se han logrado avances en 10 componentes a nivel de docentes, estudiantes, escenarios de práctica clínica en instituciones de salud públicas/privadas, usuarios (paciente/cuidadores), profesionales sanitarios y vinculación a otros programas enfermeros a nivel nacional e internacional con la organización RNAO. Consecuentemente, la implantación de GBP ha favorecido la disminución de la brecha en la relación entre la docencia y los servicios clínicos, mejorando así la colaboración entre la asistencia y la academia, donde se potencia el trabajo colaborativo e interinstitucional en pro de la obtención de los mejores resultados en el paciente usando la evidencia disponible. Por tanto, se ha obtenido una trasformación de práctica enfermera a través del conocimiento, como pretende el programa de implantación de las GPC a través del establecimiento del programa Best Practice Spotlight Organizations (BPSO®) en nuestro entorno

This paper describes the results of the implementation, consolidation and future projection of the Best practice guidelines of the Registered Nurses' Association of Ontario (RNAO) in clinical and academic scenarios in Santander, Colombia. The tool proposed by the RNAO was used for the implementation of the guidelines in both clinical and academic settings. Preliminary results on the implementation of the guidelines are presented in this paper. In the clinical setting, the implementation of the guidelines has made it possible to start the process of standardizing care across the institution, with systematic follow-up based on indicators. This has allowed decision-making and visualization of the quality of nursing care provided by nurses in their different roles. In the academic scenario, implementing the guidelines has strengthened teaching and research functions, and, to a lesser extent, continuing education and social projection processes. In the consolidation phase, advances were achieved in 10 components, relevant to teachers, students, and practice scenarios of public / private health institutions, users (patients/caregivers), health personnel and other nursing programmes at a national and international level. Implementing the clinical practice guidelines has reduced the gap between the clinical and the academic scenarios, where collaborative and inter-institutional work is enhanced to obtain better patient outcomes, based on the available evidence

Humanos , Guias de Prática Clínica como Assunto/normas , Avaliação em Enfermagem/métodos , Implementação de Plano de Saúde/normas , Enfermagem Baseada em Evidências/normas , Segurança do Paciente/normas , Currículo/normas , Avaliação em Enfermagem/normas , Colômbia , Sociedades/normas , Fundações/organização & administração , Fundações/normas , Relações Interinstitucionais
Enferm. clín. (Ed. impr.) ; 30(3): 155-159, mayo-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-196680


OBJETIVO: Conocer la evolución de los cuidados tras la implantación de la Guía de buenas prácticas «Valoración y cuidado de adultos en riesgo de ideación y comportamiento suicida». MÉTODO: Se realizó un estudio descriptivo longitudinal en la Unidad de Hospitalización de Salud Mental del Hospital Universitario Virgen de las Nieves de Granada. Se incluyeron 1.471 pacientes, todos los ingresados entre 2016 y 2018. Se evaluaron el cumplimiento en indicadores del proceso de cuidados y la situación de riesgo suicida, y se obtuvo la tasa de suicidio por 100.000 habitantes. Se calcularon frecuencias absolutas y relativas de los indicadores y su evolución en el tiempo con el test chi-cuadrado de Pearson para p < 0,05. RESULTADOS: Se observó un incremento estadísticamente significativo en todos los procesos. El porcentaje de pacientes con valoración de riesgo suicida aumentó del 16% en 2016 al 45,25% en 2018. La aplicación de medidas de seguridad aumentó hasta el 100% en 2018, y la derivación a otros servicios comunitarios pasó del 70,31% al 90,50%. El porcentaje de pacientes en riesgo de ideación suicida se mantuvo estable. La tasa de suicidios por 100.000 habitantes en la provincia de Granada disminuyó un 24,50%. CONCLUSIONES: La mejora en los procesos de cuidados y la disminución de la tasa de suicidio en Granada desde la implantación son consistentes con los hallazgos de otros estudios y ofrecen una visión esperanzadora. Se deben potenciar las estrategias integrales de prevención y continuar con la evaluación de las iniciativas puestas en marcha

OBJECTIVE: To establish the evolution of the care process after the implementation of the Best Practices Guideline «Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour». METHOD: A descriptive longitudinal study was carried out at the Mental Health Hospitalization Unit in Hospital Universitario Virgen de las Nieves, Granada. All patients admitted to the Unit between 2016 and 2018, 1471 in total, were included. Compliance of care process indicators and suicidal risk were evaluated; in addition, suicide rates per 100,000 inhabitants were obtained. Absolute and relative frequencies of the indicators were calculated, as well as the change during the study period by the chi-square Pearson test, for P<.05. RESULTS: We observed a statistically significant increase in the entire care process. The percentage of patients with suicidal risk assessment improved from 16% in 2016 to 45.25% in 2018. The application of safety measures grew reaching 100% in 2018, and community services referral went from 70.31% to 90.50%. The percentage of patients at risk of suicidal ideation remains stable. Suicide rates per 100,000 inhabitants in Granada decreased by 24.50%. CONCLUSIONS: Improvement in the care process and the decrease in the suicide rate in Granada since the implementation of the guideline are consistent with the results of other research and offer a hopeful vision. Comprehensive strategies for suicide prevention must be promoted, and the evaluation of initiatives undertaken must continue

Humanos , Avaliação em Enfermagem/métodos , Implementação de Plano de Saúde/normas , Segurança do Paciente/normas , Currículo/normas , Fidelidade a Diretrizes/normas , Guias de Prática Clínica como Assunto/normas , Ideação Suicida , Estudos Longitudinais , Medição de Risco/normas , Desenvolvimento de Programas , Suicídio/prevenção & controle , Tentativa de Suicídio/prevenção & controle
Enferm. clín. (Ed. impr.) ; 30(3): 160-167, mayo-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-196681


INTRODUCCIÓN: El ictus es causa importante de morbimortalidad en adultos y supone un elevado coste sociosanitario por las secuelas que provoca. Para minimizarlas es importante aplicar guías de buenas prácticas que aseguren cuidados basados en la evidencia y reduzcan la variabilidad clínica. El objetivo del estudio es evaluar los resultados de implantación de una Guía de buenas prácticas para la atención de pacientes con ictus hospitalizados. MÉTODO: Estudio cuasi-experimental pre/post-intervención. Mayores de 18 años ingresados en el Complejo Hospitalario Universitario de Albacete (CHUA) y Complejo Hospitalario de Navarra (CHN) con diagnóstico de ictus. Variables de proceso: valoración neurológica (Escala canadiense y la National Institute of Health Stroke Scale), valoración de la disfagia (Test del agua y el método de exploración clínica volumen-viscosidad), riesgo de caídas (Escala Downton), detección de dolor (Escala numérica), riesgo de lesiones por presión (Escala Braden) y educación sanitaria. Variables de resultado: neumonía por aspiración, caídas, independencia para las actividades de la vida diaria (índice de Barthel y Rankin modificada), lesiones por presión e intensidad del dolor. RESULTADOS: Se evaluaron 1.270 pacientes en el CHUA y 627 en el CHN, mayoritariamente hombres mayores de 69 años y con alta incidencia de ictus isquémicos. En el CHUA se registraron 16 lesiones por presión, 17 caídas y 20 casos de neumonías por aspiración. En CHN se identificaron 15 casos de lesiones por presión. El aumento de casos podría atribuirse al incremento de pacientes evaluados y a una mayor concienciación para registrar estos eventos. CONCLUSIONES: La aplicación de las recomendaciones de la GBP ha mejorado de manera estadísticamente significativa a lo largo del tiempo, existiendo posibilidades de mejora tanto en la calidad de los cuidados prestados como en los resultados en salud de los pacientes

INTRODUCTION: Stroke is an important cause of morbidity and mortality in adults and implies high social and healthcare costs due to the consequences it causes. To minimize these, it is important to apply best practice guidelines that ensure evidence-based care and reduce clinical variability. The objective of the study is to evaluate the results of implantation of the Ictus Best Practice Guideline for attending in-hospital stroke patients. METHOD: Quasi-experimental pre-post intervention study. Over 18 years of age admitted to the University Hospital Complex of Albacete and Hospital Complex of Navarra with a diagnosis of stroke. Process variables: Neurological assessment (Canadian Scale and the National Institute of Health Stroke Scale), dysphagia assessment (Water Test and the Volume-Viscosity Clinical Exploration Method), risk falls (Downton Scale), pain detection (Numerical Scale), pressure injury risk (Braden Scale), health education. Outcome variables: Aspiration pneumonia, falls, independence of daily life activities (modified Barthel and Rankin index), pressure injuries and pain intensity. RESULTS: 1270 patients were evaluated in CHUA and 627 in CHN, most were men and the average age was over 69 years, with a higher incidence of ischaemic strokes. In CHUA 16 pressure sores, 17 falls and 20 cases of aspiration pneumonia were recorded and 15 cases of pressure sores were identified in CHN. An increase of cases could be attributed to the greater number of patients evaluated and the increased nursing awareness about recording adverse events. CONCLUSIONS: Application of guideline recommendations improved statistically significantly throughout the implementation time. Some possibilities for improvement are detected, so it is necessary to continue working on both the quality of care provided and the health outcomes of patients

Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Implementação de Plano de Saúde/normas , Segurança do Paciente/normas , Guias de Prática Clínica como Assunto/normas , Acidente Vascular Cerebral/epidemiologia , Cuidados de Enfermagem/normas , Fidelidade a Diretrizes/normas , Acidente Vascular Cerebral/enfermagem , Avaliação em Enfermagem , Avaliação de Processos em Cuidados de Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Hospitalização
Enferm. clín. (Ed. impr.) ; 30(3): 176-184, mayo-jun. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-196683


INTRODUCCIÓN: Los cuidados proporcionados a las personas ostomizadas son cruciales para su evolución y rehabilitación. Las Guías de práctica clínica de la Registered Nurses' Association of Ontario recogen las intervenciones enfermeras con mayor evidencia en el cuidado del paciente ostomizado. El objetivo del estudio es analizar el impacto en los cuidados y los resultados de salud de los pacientes tras la implantación de la guía Cuidado y manejo de la ostomía. MÉTODO: Estudio cuasiexperimental pre-post test en todos los pacientes a los que se les realizó una ostomía digestiva o urológica en 8 Centros Comprometidos con la Excelencia en Cuidados® donde se implanta la guía para el cuidado y manejo de la ostomía, desde 2012 hasta 2018. Se analizaron y compararon variables clínicas de proceso y de resultados en salud en 3 períodos de tiempo. Se realizó un análisis descriptivo y se compararon las proporciones entre períodos, mediante Chi cuadrado, aplicando la corrección de Yates, considerando un nivel de confianza del 95%. RESULTADOS: La educación preoperatoria pasó del 36,7 al 47,3% (p < 0,05); el marcaje de la ostomía, del 25,2 al 33,8% (p < 0,05); la evaluación postoperatoria, del 94,8 al 59% (p < 0,05); la educación postoperatoria, del 75,5 al 91,9% (p < 0,05); las complicaciones en la piel periestomal, del 16,6 al 10,9% (p < 0,05), y las complicaciones en la ostomía, del 21,8 al 27,9% (p < 0,05). CONCLUSIONES: La implantación de la guía para el cuidado y manejo de la ostomía produjo mejoras en los cuidados preoperatorios, el marcaje del estoma y en las complicaciones de la piel periestomal

INTRODUCTION: Care provided to ostomized people is crucial in their progress and rehabilitation. The Registered Nurses' Association of Ontario clinical practice guidelines include greatest evidence nursing interventions for ostomized patient care. The aim of the study is to analyze the impact on patients' care and health outcomes after Care and management of ostomy guideline implementation. METHOD: Pre-post quasi-experimental study, carried out in all patients who underwent a digestive or urological ostomy in 8 centres of Best Practices Spotlight Organization® where the ostomy care and management guideline was implanted from 2012 to 2018. Clinical, process and health outcome variables were analyzed and compared in 3 periods of time. Descriptive analysis and comparison of proportions between the periods was performed, using Chi square, applying Yates correction, considering a 95% confidence interval. RESULTS: Preoperative education went from 36.7 to 47.3% (P<.05); stoma site marking from 25.2 to 33.8% (P<.05); postoperative evaluation from 94.8 to 59% (P<.05); postoperative education from 75.5 to 91.9% (P<.05); peristomal skin complications from 16.6 to 10.9% (P<.05), and ostomy complications from 21.8 to 27.9% (P<.05). CONCLUSIONS: The implementation of the ostomy care and management improved preoperative care, stoma site marking and peristomal skin complications

Humanos , Enfermagem no Consultório/normas , Implementação de Plano de Saúde/normas , Estomia/enfermagem , Estomia/normas , Guias de Prática Clínica como Assunto/normas , Resultado do Tratamento , Cuidados de Enfermagem/normas , Intervalos de Confiança , Cuidados Pré-Operatórios/normas , Cuidados Pós-Operatórios/normas , Estomia/estatística & dados numéricos
Enferm. clín. (Ed. impr.) ; 30(3): 185-197, mayo-jun. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-196684


OBJETIVO: Describir la progresión del grado de adherencia a las recomendaciones de la Guía «Prevención de caídas» del Programa Best Practice Spotlight Organization (BPSO®) y resultados en caídas en los Centros Comprometidos con la Excelencia en Cuidados (CCEC®). MÉTODO: Estudio cuasiexperimental pretest-postest con carácter multicéntrico desarrollado entre 2012 y 2018. Se incluye a los pacientes ≥65 años, dados de alta en las unidades de implantación de la Guía, analizando variables sociodemográficas (sexo, edad); estancia hospitalaria; valoración del riesgo de caídas al ingreso y pacientes con riesgo; plan de cuidados para la prevención de caídas e incidencia de caídas. Se han comparado los indicadores del programa CCEC® medidos en los periodos: basal (T1), de candidatura en los 3 primeros años (T2) y de sostenibilidad (T3). Se ha realizado un análisis estadístico descriptivo e inferencial. RESULTADOS: Se ha evaluado a 31.486 pacientes de 7 centros hospitalarios (T1=465; T2=14.255; T3=16.766). El 51,87% fueron hombres, con una edad media de 79,06 años. La estancia hospitalaria fue 8,15 días. La valoración del riesgo al ingreso se realizó en el 81,96% (T1=44,30%; T2=81,11%; T3=83,73%), estando en riesgo un 52,31%. Tenían planificados cuidados para prevenir caídas un 47,75% (T1=24,73%; T2=42,43%; T3=52,90%). De las 423 caídas registradas, el 62,17% no tuvieron lesiones. CONCLUSIONES: A pesar de las diferencias entre hospitales, como las características estructurales, las estrategias, los instrumentos de valoración y el ritmo en la progresión de datos, el grado de adherencia a las recomendaciones está siendo exitoso mejorando de forma generalizada. La implantación de la Guía ha permitido abordar la problemática de las caídas, produciendo cambios positivos en el proceso y favoreciendo la implantación y sostenibilidad de prácticas basadas en la evidencia

AIM: To describe the progress of implementing the «Preventing falls» Guideline of the Best Practice Spotlight Organization (BPSO®) Programme and fall outcomes in Centres Committed to Excellence in Care (CCEC®). METHOD: A Quasi-experimental study pre-post test from a multicentric approach carried out between 2012-2018. The study is focused on patients aged 65 or older, discharged from guideline implementation units, analysing sociodemographic variables (sex, age, hospitalization days; fall risk assessment on admission and patient in risk; fall prevention plan; incidence of falls. Data was compared from CCEC® programme indicators measured over the periods: baseline (T1), candidate during the first three years (T2), and sustainability (T3). Descriptive and inferential analysis was performed. RESULTS: 31,486 patients were evaluated in 7 centres (T1=465; T2=14,255; T3=16,766). Of the patients, 51.87% were men and average age was 79.06 years. Hospitalization was 8.15 days. Fall risk assessment on admission was performed in 81.96% of patients (T1=44.30%, T2=81.11%, T3=83.73%) and 52.31% patients had high risk. A prevention falls plan was registered in 47.75% of patients (T1=24.73%, T2=42.43%, T3=52.90%). Four hundred and twenty-three falls were recorded, 62.17% without injuries. CONCLUSIONS: Despite the differences between hospitals, such as structural characteristics, strategies, assessment tools and data progression pace; adherence to recommendations is proving successful, improving widely. Guideline implementation has allowed fall problems to be addressed, producing positive changes in the process and encouraging the implementation and sustainability of evidence-based nursing practice

Humanos , Masculino , Feminino , Idoso , Implementação de Plano de Saúde/normas , Guias de Prática Clínica como Assunto/normas , Acidentes por Quedas/prevenção & controle , Instituições para Cuidados Intermediários/normas , Fidelidade a Diretrizes/normas , Cuidados de Enfermagem/normas , Enfermagem Baseada em Evidências
Enferm. clín. (Ed. impr.) ; 30(3): 198-211, mayo-jun. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-196685


OBJETIVO: Evaluar el impacto de la implantación de la guía «Valoración del riesgo y prevención de úlceras por presión» sobre la adherencia a las recomendaciones de la guía, la prevalencia de lesiones por presión (LPP) y sostenibilidad de los resultados, así como analizar las estrategias de implantación, la sostenibilidad y las barreras detectadas. MÉTODO: Estudio observacional retrospectivo (de junio del 2015 a diciembre del 2018). Se estudiaron 2periodos (P1: preparación y P2: sostenibilidad). Se analizaron las memorias del programa y los datos de la historia clínica de pacientes dados de alta en los 4hospitales participantes sobre la adherencia de las recomendaciones preventivas y los resultados en salud en términos de presencia de LPP por cada centro. RESULTADOS: Se incluyó a 13.515 pacientes, de los cuales 4.523 tenían riesgo de LPP y 722 tenían LPP. El 82,9% de los pacientes recibieron una valoración del riesgo de LPP al ingreso. Se observó una disminución de esta valoración al ingreso: P1: 89,1% vs. P2: 81%; p < 0,001. El 42,1% de los pacientes de riesgo fueron reevaluados durante el ingreso, observándose un aumento significativo entre los períodos: P1: 30,7% vs. P2: 46%; p < 0,001. El 63,2% contaba con una superficie especial de manejo de presión, con un aumento significativo: P1: 55,3% vs. P2: 65%; p < 0,001. La prevalencia global de LPP fue del 5,5%, observándose una disminución significativa al comparar P1: 6,6% vs. P2: 5,1%; p = 0,003. La prevalencia de LPP nosocomiales fue del 2,1%, manteniéndose constante P1: 2% y P2: 2,1%; p = 0,708. El compromiso institucional, la designación de líderes, elaboración de planes de acción y la formación son estrategias destacables en todos los centros. CONCLUSIONES: El presente estudio muestra la existencia de una adecuada adherencia a las principales recomendaciones de la guía, observándose una mejoría estadísticamente significativa en la adherencia a 2 de las 3 recomendaciones evaluadas. Las estrategias de implantación y sostenibilidad puestas en marcha han contribuido en el mantenimiento o mejora de los resultados en el tiempo

AIM: To assess the impact of implementing the "Risk Assessment and Prevention of Pressure Injuries (PI)" guideline on adherence to its recommendations, the prevalence of PI and the sustainability of results, and to analyse the implementation strategies, sustainability and barriers detected. METHODS: A retrospective observational study (June 2015 to December 2018). Two periods were studied (P1: Preparation and P2: Sustainability). The programme reports and data from the medical records of patients discharged from the 4participating hospitals were analysed with regard to adherence to preventive recommendations and health outcomes in terms of the presence of pressure injuries per centre. RESULTS: A total of 13,515 patients were included, of whom 4,523 were at risk for PI and 722 had PI. Of the patients, 82.9% underwent a risk assessment for PI on admission. A decrease in this assessment on admission was observed between P1:89.1% vs. P2: 81% P<.001. Of the patients at risk, 42.1% were reassessed during their admission and a significant increase was observed between the periods P1: 30.7% vs. P2:46%; P<.001. 63.2% had a special pressure management surface, with a significant increase between P1:55.3% vs. P2: 65%; P<.001. The overall prevalence of PI was 5.5% and a significant decrease was observed on comparing P1: 6.6% vs. P2:5.1%; P=.003. The prevalence of nosocomial PI remained constant at 2.1%, P1:2% and P2:2.1%; P=.708. Institutional commitment, the appointment of leaders, drawing up of action plans, and training are outstanding strategies in all the centres. CONCLUSIONS: This study shows that there is adequate adherence to the main recommendations of the guideline. A statistically significant improvement was observed in adherence to 2 out of the 3 recommendations assessed. The implantation and sustainability strategies implemented have been contributed to maintenance and/or improving results over time

Humanos , Masculino , Feminino , Criança , Adulto , Lesão por Pressão/enfermagem , Lesão por Pressão/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Indicadores de Desenvolvimento Sustentável/prevenção & controle , Implementação de Plano de Saúde/normas , Avaliação de Resultado de Ações Preventivas , Estudos Retrospectivos , Avaliação em Saúde/normas , Medição de Risco/normas
Enferm. clín. (Ed. impr.) ; 30(3): 212-221, mayo-jun. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-196686


OBJETIVO: Analizar la evolución de la implantación de las recomendaciones de proceso de la guía RNAO Valoración y manejo del dolor y de los resultados en salud. MÉTODO: Estudio observacional, longitudinal, retrospectivo, realizado en 3hospitales de tercer nivel de España. Se incluyó a todos los pacientes dados de alta los últimos 5 días de cada mes de las unidades seleccionadas en el proceso de implantación. Se evaluaron datos estructurales, estancia media, estrategia de implantación y grado de implantación de recomendaciones de proceso según la guía RNAO durante los 3primeros años de implantación y resultados. Se realizó un análisis descriptivo mediante el cálculo de medias y frecuencias absolutas y relativas por periodos: basal (T0) y anual durante los 3primeros años de implantación (T1, T2 y T3, respectivamente) e inferencial. RESULTADOS: Se ha incluido a 8.128 pacientes. Se ha realizado contraste de hipótesis entre los diferentes periodos. La valoración inicial del dolor en las primeras 24h de ingreso o poscirugía se incrementó tras el periodo basal en todos los hospitales, especialmente en aquellos en los que no se cumplían los requisitos de la guía al inicio, y continuó creciendo de forma progresiva hasta a los 3 años de implantación (alcanzando un 94,6% en el hospital 2). En cambio, la implantación del plan de cuidados no ha llegado a superar el 37,5 o el 38,5% de los hospitales 1 y 3, respectivamente. Respecto a los indicadores de resultado, la prevalencia de dolor a las 24 h e intenso disminuyó en los 3hospitales de forma general desde T0 o T1 a T3; sin embargo, no se obtuvieron diferencias estadísticamente significativas concluyentes. CONCLUSIONES: La evolución de la implantación de las recomendaciones de proceso ha mejorado desde el inicio, al igual que los resultados sobre los pacientes, consiguiendo una disminución de la prevalencia y la intensidad del dolor, aunque no se obtuvieron datos concluyentes; todo esto conlleva una mejor práctica enfermera con mayores registros, continuidad asistencial y mejora de la gestión del dolor en los pacientes

AIM: to analyse the progress of implementing the process recommendations of the RNAO Assessment and Management of Pain guideline and health outcomes. METHOD: An observational, longitudinal, retrospective study conducted in 3tertiary-level hospitals in Spain. All patients discharged over the last 5 days of each month from the units selected in the implementation process were included. We evaluated structural data, mean hospital stay, implementation strategy and degree of implementation of the process recommendations of the RNAO guideline over the first 3 years of implementation, and outcomes. A descriptive analysis was performed by calculating means and absolute and relative frequencies in periods: baseline (T0), annual, over the 3first years of implementation (T1, T2 and T3 respectively), and inferential. RESULTS: 8128 patients were included in the study. Hypotheses were contrasted between the different periods. The initial pain assessment in the first 24h following admission or post-surgery increased after the baseline period in all the hospitals, especially those that did not meet the guidelines from the outset. It continued to rise progressively up to 3 years following implementation (reaching 94.6% in hospital 2). By contrast, implementation of the care plan did not exceed 37.5% and 38.5% in hospitals 1 and 3 respectively. With regard to the outcome indicators, the prevalence of pain at 24hours and intense pain generally decreased in the 3hospitals from T0 or T1 to T3, however no conclusive statistically significant differences were obtained. CONCLUSIONS: Implementation of the process recommendations improved from the outset, as did patient outcomes. A decrease in the prevalence and intensity of pain was achieved, although no conclusive data were obtained; all of which leads to better nursing practice with more recording, continuity of care and improved pain management for patients

Humanos , Manejo da Dor/normas , Implementação de Plano de Saúde/normas , Cuidados de Enfermagem/normas , Resultado do Tratamento , Espanha , Estudos Longitudinais , Estudos Retrospectivos , Dor/enfermagem , Dor/prevenção & controle
Enferm. clín. (Ed. impr.) ; 30(3): 222-230, mayo-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-196687


OBJETIVO: Identificar elementos favorecedores y barreras de implantación en el Programa de Centros Comprometidos con la Excelencia en Cuidados® que instauran guías de práctica clínica de la Registered Nurse' Association of Ontario, con el fin de que experiencias futuras pudieran beneficiarse de las apreciaciones expuestas. MÉTODO: Estudio de investigación evaluativa del proceso de implantación de guías en instituciones que componen las dos primeras cohortes del programa en España, mediante análisis de contenido de memorias de implantación y proceso inductivo, lectura, interpretación, codificación y categorización según estructura DAFO: debilidades, amenazas, fortalezas y oportunidades. RESULTADOS: Se han analizado memorias e informes de 18 centros de 12 Comunidades Autónomas, entre los cuales implantan 22 guías distintas. Como debilidades, destacan por frecuencia e intensidad, problemas relacionados con sistemas de información y su explotación. Se exponen otros elementos relacionados con difusión de resultados, profesionales, cuidados y factores relativos a la institución. Sobresalen como amenazas, la inestabilidad de plantillas y cambios continuados en la alta dirección o políticas corporativas. Entre las fortalezas, se distinguen la dedicación exclusiva de personal al proyecto y su vinculación a objetivos institucionales. Y por último, se identifica como oportunidades, destacan la posibilidad de comparación estandarizada de resultados propios con ajenos, así como la difusión de resultados. CONCLUSIÓN: Se configura un patrón útil para el abordaje de implantación en otras realidades, donde el cambio en la cultura profesional, su formación, comunicación y liderazgo, así como alinear intereses de gestores y políticos, facilitan unas condiciones ideales para la práctica basada en la evidencia

OBJECTIVE: To identify favourable elements and barriers to implementation in the Program of Best Practice Spotlight Organization® that establish clinical practice guidelines of the Registered Nurse' Association of Ontario, so that future experiences could benefit from the assessments presented here. METHOD: Evaluation research study of the process of implementing guidelines in institutions that make up the first two cohorts of the programme in Spain, through analysis of contents of implantation reports and inductive process, reading, interpretation, coding and categorized according to SWOT structure: Strengths, weaknesses, opportunities and threats. RESULTS: Reports from 18 centres in 12 Autonomous Communities have been analyzed, including 22 different guidelines. As weaknesses, problems related to information systems and their exploitation stand out for frequency and intensity. Other elements related to dissemination of results, to professionals, care and factors related to the institution are presented. Standing out as threats are the instability of staff and continued changes in Senior Management or corporate policies. Among the strengths, the exclusive dedication of personnel to the project and its link to institutional objectives are distinguished. As opportunities, the possibility of standardized comparison of own results with others, as well as the dissemination of results are highlighted. CONCLUSION: A useful pattern is set up to approach implementation in other scenarios, where changes in professional culture, training, communication and leadership, as well as aligning interests of managers and politicians, facilitate ideal conditions for Evidence-Based Practice

Humanos , Planos e Programas de Saúde/normas , Implementação de Plano de Saúde/normas , Cuidados de Enfermagem/normas , Guias de Prática Clínica como Assunto/normas , Pesquisa em Avaliação de Enfermagem/normas , Enfermagem Baseada em Evidências/normas , Espanha
PLoS One ; 15(2): e0228495, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32074113


Our objective was to quantify the impact on the use of zolpidem of the obligation implemented in France in 2017 to use secure prescription pads to prescribe it. We conducted a cohort study within the French SNDS healthcare database. Patients aged over 18 years of age were considered for inclusion. The number of prevalent users and incident episodes of zolpidem use were compared before the change in law (July 1, 2016 to January 1, 2017) and after (July 1, 2017 to January 1, 2018). A prevalent user was a patient who has been reimbursed for zolpidem at least once. An incident episode of zolpidem use was defined by a first administration of zolpidem without any prior administration within the previous six months. Regarding prevalence of zolpidem users, we observed a decrease from 2.79% (CI95%:2.75-2.83) to 1.48% (1.44-1.51), with a number of patients who stopped taking it after the change in law being approximately 4.3 times higher than the number of patients who started. We observed a negative association between the post-law change period (OR = 0.52 (0.51-0.53)) and the probability of receiving zolpidem, adjusting for sex, aging, low income and chronic disease. We observed a decrease from 183 treatment episodes per 100,000 insured months on average to 79 episodes per 100,000 insured months, with an incidence rate ratio (IRR) equal to 0.43 (0.38-0.49). The use of secure prescription pads seems to have reduced the exposure of the French population to zolpidem.

Implementação de Plano de Saúde , Padrões de Prática Médica/estatística & dados numéricos , Programas de Monitoramento de Prescrição de Medicamentos , Medidas de Segurança , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Zolpidem/uso terapêutico , Adulto , Idoso , Estudos de Coortes , Confidencialidade/legislação & jurisprudência , Confidencialidade/normas , Bases de Dados Factuais , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , França/epidemiologia , Implementação de Plano de Saúde/legislação & jurisprudência , Implementação de Plano de Saúde/normas , Humanos , Hipnóticos e Sedativos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/legislação & jurisprudência , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , Programas de Monitoramento de Prescrição de Medicamentos/legislação & jurisprudência , Programas de Monitoramento de Prescrição de Medicamentos/organização & administração , Programas de Monitoramento de Prescrição de Medicamentos/normas , Prescrições/normas , Prescrições/estatística & dados numéricos , Prevalência , Vigilância de Produtos Comercializados/métodos , Vigilância de Produtos Comercializados/normas , Medidas de Segurança/legislação & jurisprudência , Medidas de Segurança/normas , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Fatores de Tempo
Transfusion ; 60(5): 918-921, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32052859


BACKGROUND: A new national donor safety initiative was introduced in Australia in 2018, which aimed to encourage all whole blood donors to water load and to use applied muscle tension. This study evaluated the effect of this initiative on the rate of vasovagal reactions (VVR). STUDY DESIGN AND METHODS: Routinely collected data were used to identify whole blood donations and any associated VVRs before (n = 167,056 donations) and after implementation (n = 215,572 donations). Multivariate logistic regression analyses were performed to evaluate the differences in VVR rates. RESULTS: The total rate of VVRs declined from 22.5 per 1000 donations to 20.6 per 1000 donations after implementation, a reduction of 8% (p < 0.001). The rate of presyncopal reactions decreased by 8% in new donors and 12% in repeat donors. No impact was observed on the rate of syncope in any of the groups. The multivariate logistic regression analysis demonstrated the odds of experiencing a presyncopal reaction was reduced by 13% following implementation, with no significant effects on syncope. CONCLUSION: The findings of this study support the use of water loading and applied muscle tension in routine whole blood collection to reduce the incidence of VVRs.

Doadores de Sangue , Implementação de Plano de Saúde , Tono Muscular/fisiologia , Manipulações Musculoesqueléticas/métodos , Segurança do Paciente/normas , Síncope Vasovagal/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Doadores de Sangue/psicologia , Doadores de Sangue/estatística & dados numéricos , Feminino , Implementação de Plano de Saúde/normas , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Manipulações Musculoesqueléticas/normas , Flebotomia/efeitos adversos , Flebotomia/métodos , Flebotomia/normas , Flebotomia/estatística & dados numéricos , Fatores de Risco , Comportamento de Redução do Risco , Síncope Vasovagal/epidemiologia , Síncope Vasovagal/etiologia , Água , Suporte de Carga/fisiologia , Adulto Jovem
Transpl Infect Dis ; 22(2): e13252, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31997565


BACKGROUND: Cytomegalovirus (CMV) infection is common among solid organ transplant (SOT) recipients and may cause CMV disease. To optimize the implementation of existing prevention strategies, the Management of Post-transplant Infections in Collaborating Hospitals (MATCH) program was developed. Two key performances of MATCH (diagnosing CMV infection at low viral load (VL) and before the onset of CMV disease) were assessed prior to, during and after the implementation of MATCH. METHODS: The MATCH program included a personalized surveillance plan, prophylaxis and preemptive therapy determined by the recipient's risk of CMV infection. The plan was composed through predefined algorithms and implemented through harvesting of real-time data from medical records. Risk of CMV disease was compared for recipients transplanted during and after vs prior to the implementation of MATCH. Lung and non-lung transplants were analyzed separately. RESULTS: A total of 593, 349, 520, and 360 SOT recipients were transplanted before (2007-2010), during (2011-2012), early after (2013-2015), and late after (2016-2017) implementation of MATCH with an observed reduction of diagnostic VL (P < .001) over time. Risk of CMV disease was reduced among non-lung transplant recipients transplanted during (adjusted hazard ratios [95% CI] 0.15 [0.04-0.54], P = .003), early after (aHR 0.27 [0.11-0.63], P = .003), and late after (aHR 0.17 [0.06-0.52], P = .002) compared with prior to MATCH. No significant change was observed among lung transplants. CONCLUSION: Implementation of CMV preventive strategies through MATCH was associated with a reduced risk of CMV disease among non-lung transplant recipients. Furthermore, the limitations of VL as a sole indicator for CMV disease in lung transplants were emphasized.

Infecções por Citomegalovirus/prevenção & controle , Gerenciamento Clínico , Implementação de Plano de Saúde/normas , Transplante de Órgãos/efeitos adversos , Transplantados/estatística & dados numéricos , Adulto , Antivirais/uso terapêutico , Citomegalovirus , Infecções por Citomegalovirus/tratamento farmacológico , Feminino , Implementação de Plano de Saúde/organização & administração , Hospitais/normas , Hospitais/estatística & dados numéricos , Humanos , Transplante de Pulmão/efeitos adversos , Transplante de Pulmão/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/estatística & dados numéricos , Fatores de Risco , Carga Viral
Support Care Cancer ; 28(1): 201-210, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30997595


INTRODUCTION: Fear of cancer recurrence (FCR) in people with breast cancer affects treatment recovery, quality of life, service utilisation and relationships. Our aim was to investigate how specialist breast cancer nurses (SBCN) respond to their patients' fears of cancer recurrence and analyse SBCN's views about embedding a new psychological intervention, the Mini-AFTERc, into their consultations. METHOD: A mixed methods sequential design was used, informed by normalisation process theory. Phase 1: UK SBCNs were emailed a web-based survey to investigate how breast cancer survivors' FCR is currently identified and managed, and their willingness to utilise the Mini-AFTERc. Phase 2: a purposive sample of respondents (n = 20) were interviewed to augment phase 1 responses, and explore views on the importance of addressing FCR, interest in the Mini-AFTERc intervention, its content, skills required and challenges to delivering the intervention. RESULTS: Ninety nurses responded to the survey. When SBCN's were asked to identify the proportion of patients experiencing FCR in their caseload, there was no consensus on the size of the problem or unmet need. They estimated that 20-100% people experience moderate FCR and 10-70% severe FCR. The interviews identified that clinical conversations are focused primarily on giving information about signs and symptoms of recurrence rather than addressing the psychological aspects of fear. CONCLUSION: Findings indicate wide variability in how FCR was identified, assessed and supported by a sample of UK SBCNs. The introduction of a structured intervention into practice was viewed favourably and has implications for nursing and health professional ways of working in all cancer services.

Neoplasias da Mama/enfermagem , Medo , Recidiva Local de Neoplasia/psicologia , Enfermeiras e Enfermeiros/psicologia , Percepção , Transtornos Fóbicos/enfermagem , Adulto , Idoso , Atitude do Pessoal de Saúde , Neoplasias da Mama/complicações , Neoplasias da Mama/patologia , Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Medo/psicologia , Feminino , Implementação de Plano de Saúde/normas , Humanos , Oncologia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/enfermagem , Recidiva Local de Neoplasia/prevenção & controle , Transtornos Fóbicos/etiologia , Padrões de Prática em Enfermagem/normas , Qualidade de Vida , Especialidades de Enfermagem , Inquéritos e Questionários
J Surg Res ; 247: 514-523, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31668605


BACKGROUND: There is increasing need to avoid excess opioid prescribing after surgery. We prospectively assessed overprescription in our hospital system and used these data to design a quality improvement intervention to reduce overprescription. MATERIALS AND METHODS: Beginning in January 2017, an e-mail-based survey to assess the quantity of opioids used postoperatively as well as patient-reported pain control was sent to all surgical patients in a 23-hospital system. In January 2018, as a quality improvement initiative, guidelines were given to surgeons based on patient consumption data. Prescription and consumption were then tracked prospectively. Wilcoxon signed-rank, analysis of variance, and Cuzick trend tests were used to assess for overprescription and changes over time in opioid prescribing and consumption. RESULTS: We included 2239 patients in our cohort. The amount prescribed (median [IQR]: 30 [24-45] versus 18 [12-30], P < 0.001) and consumed (median [IQR]: 12 [7-20] versus 8 [3-15], P < 0.001) each decreased between the first and last quarter studied. Academic hospitals prescribed fewer opioids than nonacademic hospitals (median [IQR]: 24[15-40] versus median [IQR]: 30 [20-45], P < 0.001). There was no difference in the quantity of opioids consumed between patients treated at academic and nonacademic facilities (median [IQR]: 10[3-19] versus 10.5 [4-20], P = 0.08). Patients consumed a median of 42% of the opioids prescribed, and there was no significant trend in the percent consumed over time (P = 0.8). CONCLUSIONS: Patients used far fewer opioids than prescribed after common adult general surgery procedures. When surgeons were provided with patient consumption data, the number of opioids prescribed decreased significantly.

Analgésicos Opioides/administração & dosagem , Implementação de Plano de Saúde/normas , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica/organização & administração , Melhoria de Qualidade , Adulto , Idoso , Analgésicos Opioides/efeitos adversos , Feminino , Humanos , Hidrocodona/administração & dosagem , Hidrocodona/efeitos adversos , Masculino , Sobremedicalização/prevenção & controle , Sobremedicalização/estatística & dados numéricos , Pessoa de Meia-Idade , Epidemia de Opioides/prevenção & controle , Manejo da Dor/métodos , Manejo da Dor/normas , Manejo da Dor/estatística & dados numéricos , Medição da Dor/estatística & dados numéricos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Medidas de Resultados Relatados pelo Paciente , Cuidados Pós-Operatórios/normas , Cuidados Pós-Operatórios/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Estudos Prospectivos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Comprimidos
Gastroenterology ; 158(2): 418-432, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31394083


The incidence of colorectal cancer (CRC) is increasing worldwide. CRC has high mortality when detected at advanced stages, yet it is also highly preventable. Given the difficulties in implementing major lifestyle changes or widespread primary prevention strategies to decrease CRC risk, screening is the most powerful public health tool to reduce mortality. Screening methods are effective but have limitations. Furthermore, many screen-eligible people remain unscreened. We discuss established and emerging screening methods, and potential strategies to address current limitations in CRC screening. A quantum step in CRC prevention might come with the development of new screening strategies, but great gains can be made by deploying the available CRC screening modalities in ways that optimize outcomes while making judicious use of resources.

Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/normas , Carga Global da Doença , Implementação de Plano de Saúde/normas , Programas de Rastreamento/normas , Colonoscopia/normas , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/estatística & dados numéricos , Estilo de Vida Saudável , Humanos , Incidência , Programas de Rastreamento/organização & administração , Programas de Rastreamento/estatística & dados numéricos , Sangue Oculto , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Medição de Risco/normas , Sigmoidoscopia/normas , Sigmoidoscopia/estatística & dados numéricos
Medicina (B Aires) ; 79(6): 468-476, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31829949


The integrated care pathways for the last days of life propose quality standards optimizing the care of patients and families. The Pallium Multidisciplinary Assistance Program (PAMPA ©) was implemented based on standards of the International Collaborative for Best Care for the Dying Person in 4 phases: induction, implementation, dissemination and sustainability, in five health centres in Argentina, between 2008 and 2018. A total of 1237 adult patients in the last days of life were included and cared for by palliative care teams trained in PAMPA©. An audit was conducted before and after the implementation of the Program, which is still going on. The median range of follow up into five centres from the beginning of the pathway until death varied from 16 to 178 hours. Care goals were compared: symptom control, communication, multidimensional needs, hydration and nutrition, documentation of interventions and post-mortem care. The overall analysis showed an improvement in the number of records (p = 0.001). The goal of communication on care plan to the patient showed no difference (p = 0.173). Continuous training, support and permanent teams supervision were carried out and perceptions and impact of the implementation were registered. The main emerging items of the qualitative analysis were: attitudes towards the program, fundamental contributions, strengths, weaknesses and subjective definition of the program, recognition of institutional cultural singularities and its influence on care. PAMPA© demonstrated its feasibility as a model of end of life care for patients and families, based on international quality standards.

Cuidados Paliativos/normas , Avaliação de Programas e Projetos de Saúde , Garantia da Qualidade dos Cuidados de Saúde/normas , Assistência Terminal/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina , Procedimentos Clínicos/normas , Feminino , Implementação de Plano de Saúde/métodos , Implementação de Plano de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Reprodutibilidade dos Testes , Assistência Terminal/métodos , Fatores de Tempo