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2.
BMC Infect Dis ; 19(1): 767, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477055

RESUMO

BACKGROUND: Tuberculosis (TB) is among the world's top public health challenges and the leading killer of people with HIV, yet is a treatable disease. This study aimed to assess, in a real-world setting, the implementation of antiretroviral therapy (ART) and Cotrimoxazole preventive therapy (CPT) policy, specific interventions proven to benefit patients in HIV-associated TB care. METHODS: This retrospective cohort study was conducted in Botswana in the Serowe/Palapye district, a largely urban district with a high burden of HIV-associated TB with a high case fatality, at Segkoma and Palapye hospitals and their feeder clinics. Between 1 January 2013 and 31 December 2013, confirmed HIV-positive patients aged ≥15 years with a confirmed TB diagnosis and medical record available were included in the analysis. The Kaplan-Meier method was used to compare time to death for the group of patients on ART and the group of patients not on ART during TB treatment. Cox proportional hazard regression was undertaken to identify predictors of mortality. RESULTS: Of the 300 patients included in the study, 217 (72%) were ART experienced at TB diagnosis. Of these, 86 (40%) had TB within 3 months following ART initiation. Of the 83 (28%) patients who were ART-naïve at TB diagnosis, 40 (48%) were commenced on ART during TB treatment, with 24 (60%) patients commencing within 4 weeks following TB treatment initiation. The overall ART uptake was 84%, while cotrimoxazole preventive therapy uptake was 100%. There were 45 deaths (15%), ART-experienced patients during TB treatment accounted for 30 deaths (30/257; 14%), while those who were not ART-experienced during TB treatment accounted for 15 deaths (15/43; 35%). There was a significant difference in survival time between patients with no ART use during TB treatment and those with ART use during TB treatment (log rank p < 0.001). Patients with no ART use during TB treatment were more likely to die within the first 2 months. CONCLUSION: The implementation of CPT policy is a substantial success. Strengthening the implementation of ART policy could improve survival among HIV-associated TB patients.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Antirretrovirais/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Tuberculose/tratamento farmacológico , Tuberculose/mortalidade , Adulto , Botsuana/epidemiologia , Coinfecção/tratamento farmacológico , Coinfecção/mortalidade , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , HIV/fisiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Implementação de Plano de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose/complicações , Tuberculose/virologia
3.
Metas enferm ; 22(7): 65-71, sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184101

RESUMO

La función cardiaca y la función renal están íntimamente asociadas, ya que el corazón y los riñones llevan a cabo la regulación hemodinámica del organismo. Cuando se producen alteraciones de forma bidireccional en ambos órganos se activa una serie de mecanismos compensadores que provocan un efecto nocivo de uno de ellos sobre el otro. Es lo que se conoce como síndrome cardiorrenal. Actualmente se dispone de protocolos de Enfermería estandarizados para el manejo de la insuficiencia cardiaca y para la insuficiencia renal; no obstante, es necesario ampliar la información para entender de forma óptima la relación cardiorrenal y aplicar la mejor evidencia científica a los cuidados. Por ello se expone un caso clínico abordado desde Atención Primaria, con el desarrollo de un plan de cuidados elaborado una vez identificados los diagnósticos de Enfermería que se han derivado de la valoración enfermera siguiendo el modelo de las 14 necesidades básicas de Virginia Henderson


Cardiac function and renal function are closely related, because the heart and the kidneys carry out the hemodynamic regulation of the body. When there are bidirectional alterations in both organs, a series of compensating mechanisms are activated, which cause harmful effects of one over the other. This is known as Cardiorenal Syndrome. There are current standard Nursing protocols available for the management of heart failure and renal impairment; however, it is necessary to increase information for an optimal understanding of the cardiorenal interaction, and to apply the best scientific evidence into care. To this aim, we present a case record addressed at Primary Care, with the development of a plan of care prepared after the Nursing diagnoses were identified, derived from nursing assessment following the model of the 14 Basic Needs of Virginia Henderson


Assuntos
Humanos , Feminino , Idoso , Cuidados de Enfermagem , Atenção Primária à Saúde/métodos , Síndrome Cardiorrenal/complicações , Síndrome Cardiorrenal/enfermagem , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/enfermagem , Padrão de Cuidado/normas , Nível de Saúde , Atenção Primária à Saúde , Nefropatias/complicações , Cardiopatias/complicações , Implementação de Plano de Saúde/normas , Insuficiência Cardíaca/enfermagem
4.
Afr J Prim Health Care Fam Med ; 11(1): e1-e8, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31038343

RESUMO

BACKGROUND: Postnatal care (PNC) provides the opportunity for protecting the lives of women infected with human immune deficiency virus (HIV) and their babies. The prevention of mother-to-child transmission of HIV (PMTCT) guidelines provide a framework for implementation of PNC. There has been no empirical evidence on how the nurses at the clinic level implement these guidelines. In addition, there are reports that PNC has been neglected in South Africa. AIM: The study aimed to explore the implementation of PNC for HIV-positive women, by explicating nurses' views regarding their practices. SETTING: The study was conducted in 2015 at three clinics at Mangaung Metro Municipality in the Free State. METHODS: A qualitative, evaluative case study was conducted to provide a detailed account of the implementation of PNC, using 2015 PMTCT guidelines as a framework for evaluation. Eighteen key informants participated in three focus groups. Data were reviewed through direct thematic analysis. RESULTS: Four themes emerged from data analysis, namely, guidelines as an empowering tool, implementation of HIV guidelines, perceived successes and challenges of postnatal HIV care, and measures to strengthen postnatal HIV care services. The study found that nurses interpreted and used guidelines to direct their practice. However, there were challenges and some successes. CONCLUSION: It was concluded that nurses had a good understanding of the guidelines provided for their practices and implemented them with various levels of success. Effective management of HIV-infected women during the postnatal period requires well-designed multidisciplinary collaborations, adequate resources, continuous professional development programmes, a high level of competence and confidence.


Assuntos
Atitude do Pessoal de Saúde , Infecções por HIV/enfermagem , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Enfermeiras e Enfermeiros/psicologia , Cuidado Pós-Natal/psicologia , Complicações Infecciosas na Gravidez/enfermagem , Adulto , Feminino , Grupos Focais , Infecções por HIV/transmissão , Implementação de Plano de Saúde/normas , Humanos , Recém-Nascido , Cuidado Pós-Natal/normas , Guias de Prática Clínica como Assunto , Gravidez , Complicações Infecciosas na Gravidez/virologia , Pesquisa Qualitativa , África do Sul , Adulto Jovem
5.
PLoS Med ; 16(4): e1002788, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31039158

RESUMO

BACKGROUND: Tuberculosis (TB) still represents a major public health problem in Latin America, with low success and high default rates. Poor adherence represents a major threat for TB control and promotes emergence of drug-resistant TB. Expanding social protection programs could have a substantial effect on the global burden of TB; however, there is little evidence to evaluate the outcomes of socioeconomic support interventions. This study evaluated the effect of a conditional cash transfer (CCT) policy on treatment success and default rates in a prospective cohort of socioeconomically disadvantaged patients. METHODS AND FINDINGS: Data were collected on adult patients with first diagnosis of pulmonary TB starting treatment in public healthcare facilities (HCFs) from 16 health departments with high TB burden in Buenos Aires who were followed until treatment completion or abandonment. The main exposure of interest was the registration to receive the CCT. Other covariates, such as sociodemographic and clinical variables and HCFs' characteristics usually associated with treatment adherence and outcomes, were also considered in the analysis. We used hierarchical models, propensity score (PS) matching, and inverse probability weighting (IPW) to estimate treatment effects, adjusting for individual and health system confounders. Of 941 patients with known CCT status, 377 registered for the program showed significantly higher success rates (82% versus 69%) and lower default rates (11% versus 20%). After controlling for individual and system characteristics and modality of treatment, odds ratio (OR) for success was 2.9 (95% CI 2, 4.3, P < 0.001) and default was 0.36 (95% CI 0.23, 0.57, P < 0.001). As this is an observational study evaluating an intervention not randomly assigned, there might be some unmeasured residual confounding. Although it is possible that a small number of patients was not registered into the program because they were deemed not eligible, the majority of patients fulfilled the requirements and were not registered because of different reasons. Since the information on the CCT was collected at the end of the study, we do not know the exact timing for when each patient was registered for the program. CONCLUSIONS: The CCT appears to be a valuable health policy intervention to improve TB treatment outcomes. Incorporating these interventions as established policies may have a considerable effect on the control of TB in similar high-burden areas.


Assuntos
Antituberculosos/uso terapêutico , Política de Saúde , Política Pública , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/economia , Argentina/epidemiologia , Estudos de Coortes , Feminino , Implementação de Plano de Saúde/economia , Implementação de Plano de Saúde/normas , Implementação de Plano de Saúde/estatística & dados numéricos , Política de Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistemas de Apoio Psicossocial , Política Pública/economia , Remuneração , Fatores Socioeconômicos , Resultado do Tratamento , Tuberculose/economia , Tuberculose/epidemiologia , Populações Vulneráveis/estatística & dados numéricos , Adulto Jovem
7.
J Appl Res Intellect Disabil ; 32(4): 913-931, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30950177

RESUMO

BACKGROUND: Due to complex processes of implementation of innovations aimed at persons with intellectual disabilities in healthcare organizations, lifestyle interventions are not used as intended or not used at all. In order to provide insight into determinants influencing this implementation, this study aims to ascertain if the Measurement Instrument for Determinants of Innovations (MIDI) is useful for objectively evaluating implementation. METHOD: With semi-structured interviews, data concerning determinants of implementation of lifestyle interventions were aggregated. These data were compared to the determinants questioned in the MIDI. Adaptations to the MIDI were made in consultation with the author of the MIDI. RESULTS: All determinants of the MIDI, except for that concerning legislation and regulations, were represented in the interview data. Determinants not represented in the MIDI were the level of intellectual disabilities, suitability of materials and physical environment, multi-levelness of interventions and several persons who could be involved in the intervention, such as direct support persons (DSPs), a therapist or family, and the communication between these involved persons. CONCLUSION: The present authors suggested making adjustments to existing questions of the MIDI in order to improve usability for deployment in organizations that provide care to persons with intellectual disabilities. The adjustments need to be tested with other interventions.


Assuntos
Assistência à Saúde , Implementação de Plano de Saúde , Serviços de Saúde para Pessoas com Deficiência , Deficiência Intelectual/reabilitação , Estilo de Vida , Pessoas com Deficiência Mental/reabilitação , Assistência à Saúde/legislação & jurisprudência , Assistência à Saúde/normas , Implementação de Plano de Saúde/legislação & jurisprudência , Implementação de Plano de Saúde/normas , Serviços de Saúde para Pessoas com Deficiência/legislação & jurisprudência , Serviços de Saúde para Pessoas com Deficiência/normas , Humanos , Inovação Organizacional , Pesquisa Qualitativa
8.
An. pediatr. (2003. Ed. impr.) ; 90(3): 180-186, mar. 2019. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-178371

RESUMO

Introducción: La dieta baja en FODMAP (acrónimo en inglés de polioles, monosacáridos, disacáridos y oligosacáridos fermentables) ha demostrado eficacia como tratamiento del síndrome de intestino irritable en adultos, siendo escasos los estudios en niños. Nuestro objetivo es analizar la implantación de esta dieta como tratamiento del dolor abdominal crónico funcional en población pediátrica de un área mediterránea, y su respuesta a esta. Material y métodos: Se elaboró una tabla clasificando los alimentos según su contenido en FODMAP, y se diseñó un "Diario de síntomas y deposiciones" para recoger los datos. Posteriormente se realizó un estudio prospectivo con niños con dolor abdominal crónico funcional de nuestra Unidad de Gastroenterología Pediátrica. Resultados: Se reclutaron 22 pacientes, 20 de los cuales completaron el estudio. Se recogieron durante 3 días datos sobre el dolor abdominal; posteriormente recibieron dieta baja en FODMAP 2 semanas, y al finalizarla recogieron de nuevo dichos datos. Tras la dieta se objetivó disminución en frecuencia diaria de episodios de dolor abdominal (1,16 [RIQ: 0,41-3,33] frente a 2 [RIQ: 1,33-6,33] inicialmente, p = 0,024), menor intensidad del dolor (1,41 cm [RIQ: 0,32-5,23] frente a 4,63 cm [RIQ: 2,51-6,39] inicial, p = 0,035, medido mediante Escala Visual Analógica de 10 cm), menor interferencia con la actividad diaria y menos síntomas acompañantes. Solo un 15% de los pacientes consideraron la dieta difícil. Conclusiones: La implantación de una dieta baja en FODMAP durante 2 semanas en una población pediátrica mediterránea con dolor abdominal crónico funcional es posible utilizando dietas adaptadas, es bien valorada por los pacientes, y su evaluación mediante herramientas objetivas muestra mejoría en los síntomas de dolor abdominal


Introduction: The low FODMAP diet (fermentable oligosaccharides, monosaccharides, disaccharides, and polyols) has shown to be effective in adult patients with irritable bowel syndrome, but there are few studies on paediatric patients. The aim of this study is to assess the implementation and the outcomes of a low FODMAP diet in the treatment of functional abdominal pain in children from a Mediterranean area. Material and methods: A table was designed in which foods were classified according to their FODMAP content, as well as a 'Symptoms and Stools Diary'. A prospective study was conducted on children with functional abdominal pain in our Paediatric Gastroenterology Unit. Results: A total of 22 patients were enrolled in the trial, and 20 completed it. Data were collected of the abdominal pain features over a period of 3 days, and then patients followed a two-week low FODMAP diet. Afterwards, information about abdominal pain features was collected again. After the diet, they showed fewer daily abdominal pain episodes compared to baseline (1.16 [IQR: 0.41-3.33] versus 2 [IQR: 1.33-6.33] daily episodes, P = .024), less pain severity compared to baseline (1.41 cm [IQR: 0.32-5.23] versus 4.63 cm [IQR: 2.51-6.39] measured by 10-cm Visual Analogue Scale, P = .035), less interference with daily activities, and less gastrointestinal symptoms. Only 15% of patients found it difficult to follow the diet. Conclusions: The implementation of a low FODMAP diet for 2 weeks in a Mediterranean paediatric population diagnosed with functional abdominal pain is possible with adapted diets. It was highly valued by patients, and they showed an improvement in abdominal pain symptoms assessed by objective methods


Assuntos
Humanos , Masculino , Feminino , Criança , Dor Abdominal/dietoterapia , Implementação de Plano de Saúde/normas , Desidrogenase do Álcool de Açúcar/uso terapêutico , Monossacarídeos/uso terapêutico , Dissacarídeos/uso terapêutico , Oligossacarídeos/uso terapêutico , Alimentos/classificação , Estudos Prospectivos , Microbioma Gastrointestinal
9.
Implement Sci ; 14(1): 17, 2019 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-30777080

RESUMO

BACKGROUND: While it is recommended that childcare services implement policies and practices to support obesity prevention, there remains limited evidence to inform policy and practice. The aim of this study is to examine the effectiveness of performance review and facilitated feedback in increasing the implementation of healthy eating and physical activity-promoting policies and practices in childcare services. METHODS: The study was conducted with childcare services in the Hunter New England region of New South Wales, Australia. Eligible services were randomised to a wait-list control group or to receive the implementation strategy. The strategy targeted the implementation of written nutrition, physical activity, and small screen recreation policies; providing information to families regarding healthy eating, physical activity, and small screen time; providing twice weekly healthy eating learning experiences to children; providing water and plain milk only to children; providing fundamental movement skills activities for children every day; and limiting the use of electronic screen time for educational purposes and learning experiences. Intervention services received a performance review and facilitated feedback process five times over the 10 months that included an assessment of current practices, goal setting, identification of barriers to implementation, problem-solving, and resource provision. The primary outcome was the proportion of services implementing all six policies and practices, assessed by nominated supervisor completion of a computer-assisted telephone interview at baseline and 12-month follow-up. RESULTS: One hundred and eight services took part. There were no significant differences in the proportion of services implementing all six practices at 12 months (mean difference 0.51; 95% CI 0.16 to 1.58; p = 0.24). There were also no differences between groups in the mean number of policies and practices implemented (mean difference 0.1; 95% CI - 0.4 to 0.6; p = 0.71), or the proportion implementing each of the six individual policies and practices at 12 months (OR range 0.57 to 1.85; p > 0.05). CONCLUSIONS: Further support may be required to assist childcare services to make recommended changes to their policies and practices. TRIAL REGISTRATION: The trial was registered retrospectively on 10 September 2014 with the Australian New Zealand Clinical Trials Registry ACTRN12614000972628 .


Assuntos
Serviços de Saúde da Criança/normas , Exercício , Implementação de Plano de Saúde/normas , Obesidade Pediátrica/prevenção & controle , Saúde da Criança/normas , Pré-Escolar , Avaliação de Desempenho Profissional , Retroalimentação , Política de Saúde , Promoção da Saúde/normas , Humanos , New South Wales , Melhoria de Qualidade
10.
Rev Neurol (Paris) ; 175(6): 390-395, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30736986

RESUMO

INTRODUCTION: Stroke is a public health priority in France. The use of telemedicine for stroke known as telestroke, is a safe and effective practice improving access to acute stroke care including thrombolysis. Telestroke is currently being implemented in France. The objective was to describe the public health policy supporting telestroke implementation in France. METHODS: An external ex-post evaluation of telestroke policy in France was conducted through a retrospective descriptive study from 2003 to 31st December 2016. Process, content, and actors of the health policy were described at a national level. The logical framework of the telestroke policy was described. The stages model of public policy from the 'Institut National de Santé Publique du Quebec' was used. RESULTS: Agenda setting was produced from 2003 to 2007. Policy formulation lasted from 2008 to 2009 with official reports on telemedicine, telehealth and stroke. The decision-making stage included the national stroke plan, the national telemedicine implementation strategy and an administrative document in 2012 that described the organization of telestroke implementation. Implementation in 2011 was initiated with dedicated funding and methodological resources. No dedicated evaluation of policy for telestroke was defined. CONCLUSIONS: Using a health policy model allowed to describe the policies supporting telestroke implementation in France and to highlight the need for better evaluation.


Assuntos
Fibrinolíticos/uso terapêutico , Política de Saúde , Acidente Vascular Cerebral/tratamento farmacológico , Telemedicina , Terapia Trombolítica , Cuidados Críticos/legislação & jurisprudência , Cuidados Críticos/métodos , França , Implementação de Plano de Saúde/legislação & jurisprudência , Implementação de Plano de Saúde/normas , Política de Saúde/legislação & jurisprudência , Humanos , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Telemedicina/legislação & jurisprudência , Telemedicina/métodos , Terapia Trombolítica/métodos , Terapia Trombolítica/normas
11.
Rev Epidemiol Sante Publique ; 67 Suppl 1: S33-S40, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30639052

RESUMO

BACKGROUND: The state of populations' health is linked to their access to quality healthcare. Best achieving this primary condition - a health, social and humanitarian condition - is an ongoing public policy objective. Although significant effort goes into this, do public policies sufficiently take into account the state of health of the most vulnerable populations? In France, reducing the non-take-up (NTU) of healthcare is a priority in current national health insurance policy. Under the local plans to tackle non-take-up, lack of understanding and exit from the system (PLANIR), national health insurance is currently rolling out a regional and partnership-based intervention framework in order to prevent NTU of healthcare by welfare clients. This social investment is unprecedented, yet the impact of the framework on the most vulnerable populations still seems to be limited. METHOD: The study of this example is based on monitoring of the framework's general implementation. This task was entrusted to the research team co-founded by the author, ODENORE (Observatory for the Non-take-up of Social Rights and Public Services). It is organized in four parts: quantitative monitoring of the detection and addressing of non-take-up situations (n=160,000 questionnaires); analysis of the results through qualitative interviews with beneficiaries and individuals who rejected the framework (n=365 interviews); analysis of the framework's implementation, using qualitative interviews and participant observations at the services in charge of the framework's implementation (n=18 collective interviews across three sites), and an analysis of the partnership through collective interviews with all the actors in the areas involved in the framework (three sites). RESULTS: The analysis shows that the integration of the most vulnerable populations' state of health into a common-law framework for intervention is hindered by three limitations: the framework's neutrality regarding public decisions and non-decisions that exacerbate social and regional health inequalities; its organizational design, which does not take into account the need for long-term medical-psycho-social care; and the absence of regulation capable of bringing together and coordinating the actors working towards healthcare access locally but with different populations. CONCLUSION: The difficulties of integrating the most vulnerable populations into a common-law framework such as the one proposed by the national health insurance do not seem insurmountable-provided, that is, that the regulatory authority (the regional health agencies) are willing and able to make it a strategic organizational objective at local level.


Assuntos
Implementação de Plano de Saúde , Política de Saúde , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Populações Vulneráveis , Tomada de Decisões , Emergências , França/epidemiologia , Implementação de Plano de Saúde/legislação & jurisprudência , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/normas , Política de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/legislação & jurisprudência , Disparidades em Assistência à Saúde/organização & administração , Disparidades em Assistência à Saúde/normas , Humanos , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/tendências , Direitos do Paciente/legislação & jurisprudência , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/legislação & jurisprudência , Atenção Primária à Saúde/organização & administração , Fatores Socioeconômicos , Populações Vulneráveis/estatística & dados numéricos
12.
J Autism Dev Disord ; 49(5): 1863-1875, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30627891

RESUMO

Intervention research is increasingly conducted in community settings, however it is not clear how well practices are sustained locally or how children progress once external research support is removed. Two school-year cohorts of toddlers with autism (year 1: n = 55, year 2: n = 63) received Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER) intervention from teaching assistants (TAs) with external support in year 1 and local, internal support in year 2. TAs sustained intervention strategies with more modest maintenance of high-level skills. Children in both years 1 and 2 made similar gains in initiations of joint attention during independent assessment. Year 1 children made significantly greater play gains. JASPER sustained into year 2, however advancing play may require additional supports.


Assuntos
Transtorno Autístico/reabilitação , Serviços Comunitários de Saúde Mental/métodos , /métodos , Atenção , Transtorno Autístico/psicologia , Pré-Escolar , Serviços Comunitários de Saúde Mental/normas , Feminino , Implementação de Plano de Saúde/métodos , Implementação de Plano de Saúde/normas , Humanos , Masculino , Instituições Acadêmicas
13.
Encephale ; 45 Suppl 1: S22-S26, 2019 Jan.
Artigo em Francês | MEDLINE | ID: mdl-30470501

RESUMO

BACKGROUND: The implementation of a surveillance program after a suicide attempt (SA) is a very innovative step in the evolution of our system of care. It was interesting to know if we observe a decline in suicide attempts in the region, in particular of recurrences of SA. METHOD: We measured the evolution of the number of suicide attempts before and after implantation of VigilanS, using two types of analysis: a first from the national medical information systems in Medicine-Surgery-Obstetrics (PMSI-MCO) and a second from the collection of the ER stays for SA in the hospitals involved in the VigilanS program. RESULTS: In 2014 (year before start of VigilanS), a total of 10 119 ER stays for SA was observed (5626 women and4463 men); in 2017, the total was 9.230 stays for SA (5047 women and 3 839 men), representing a decrease of 13.5%. The reduction was balanced between men (-14%) and women (-10%). Based on the figures of PMSI, we see an acceleration of the reduction of stay for SA in the Nord-Pas-de-Calais after 2014 (-16% instead of -6%), instead of the two Picardy departments the most comparable which show a degradation of the phenomenon (+13%), and opposed to the Department of the Oise which shows a stable maintenance of the current decline (-12%). CONCLUSION: These two indicators are imperfect, but evolution over three years since the implementation of VigilanS goes in the same direction. We find a uncoupling of a hospital stay in connection with a SA. The intensity of this decline seems correlated to the penetrance of the program.


Assuntos
Implementação de Plano de Saúde , Vigilância da População/métodos , Psiquiatria Preventiva , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/estatística & dados numéricos , Tentativa de Suicídio/tendências , Adolescente , Adulto , Feminino , França/epidemiologia , Implementação de Plano de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Monitorização Fisiológica/psicologia , Monitorização Fisiológica/estatística & dados numéricos , Dados Preliminares , Psiquiatria Preventiva/métodos , Psiquiatria Preventiva/organização & administração , Psiquiatria Preventiva/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Recidiva , Adulto Jovem
14.
Acta Paediatr ; 107 Suppl 471: 53-62, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30570791

RESUMO

AIM: To evaluate an integrated community case management programme for sick children aged 2 to 59 months in western Kenya using the Research, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. METHODS: This was a prospective observational research project conducted between December 2013 and February 2016. Outcome variables were measured before, during and at end of implementation using a series of surveys as well as by looking at routine service statistics. RESULTS: A total of 2604 community health workers were trained in 245 community units. The average post-training knowledge level (73.5%) and retention rates (89.7) of trained community health workers was high. At the end of study, there was an increase in the proportion of children who received appropriate treatment for diarrhoea (49.2%), pneumonia (19.5%), malaria (16.4%) and vitamin A (51.5%) from baseline. Community health workers were able to assess, classify and treat sick children with a similar quality as that provided by facility-based healthcare workers (>85% concordance). CONCLUSION: Based on the RE-AIM metrics, our results demonstrate promising practical approaches and outcomes of a large-scale implementation of integrated community case management in western Kenya. The findings have important implications for future design and expansion of the programme in Kenya.


Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Agentes Comunitários de Saúde/estatística & dados numéricos , Implementação de Plano de Saúde/estatística & dados numéricos , Serviços de Saúde da Criança/normas , Pré-Escolar , Agentes Comunitários de Saúde/normas , Implementação de Plano de Saúde/normas , Humanos , Ciência da Implementação , Lactente , Quênia , Estudos Prospectivos , Qualidade da Assistência à Saúde
15.
PLoS One ; 13(12): e0208414, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30566494

RESUMO

BACKGROUND: Nucleic acid testing (NAT) for virus detection during blood screening has helped to prevent transfusion-transmitted infections worldwide. In northern Brazil, NAT was implemented in 2012 for HIV and HCV and more recently, in January 2015, the screening for HBV was included and currently used concomitant with serological tests (HBsAg and anti-HBc). This study aims to evaluate the prevalence and the incidence of HBV infection among voluntary blood donors at ten regional blood centers of HEMOPA Foundation in Pará state and to compare the residual risk of transfusion-transmitted HBV infection before and after the Brazilian HBV-NAT implementation. METHODS: The prevalence (restricted to first time donors- FT) and seroconversion rate (restricted to repeat donors- RP) of HBV were calculated based on rates of confirmed positive samples. Residual risk was based on the incidence and window period (WP) model described by Schreiber and coauthors. Logistic and Poisson regression were used in the statistical analysis by SPSS v20.0. A p value <0.05 was considered statistically significant. RESULTS: HBV prevalence in the periods before and after the implementation of HBV-NAT were 247 and 251 per 100,000 donations, respectively. Seroconversion rates were 114 and 122 per 100,000 donations in the two periods, respectively. The residual risk (RR) for HBV decreased significantly in the posterior period to the HBV-NAT implementation, when compared to RR before implementation, with a reduction of 1:144,92 to 1:294,11 donations (p <0,001). CONCLUSIONS: The RR to HBV decreased after the implementation of HBV-NAT, increasing significantly the transfusional security in the North region of Brazil at HEMOPA Foundation.


Assuntos
DNA Viral/análise , Implementação de Plano de Saúde , Vírus da Hepatite B/genética , Hepatite B/epidemiologia , Programas de Rastreamento , Técnicas de Amplificação de Ácido Nucleico , Reação Transfusional/epidemiologia , Adolescente , Adulto , Idoso , Doadores de Sangue/estatística & dados numéricos , Segurança do Sangue/métodos , Segurança do Sangue/normas , Brasil/epidemiologia , DNA Viral/isolamento & purificação , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Implementação de Plano de Saúde/normas , Hepatite B/diagnóstico , Hepatite B/prevenção & controle , Hepatite B/transmissão , Vírus da Hepatite B/isolamento & purificação , Humanos , Incidência , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Técnicas de Amplificação de Ácido Nucleico/normas , Prevalência , Medição de Risco , Testes Sorológicos/métodos , Testes Sorológicos/normas , Reação Transfusional/diagnóstico , Reação Transfusional/prevenção & controle , Reação Transfusional/virologia , Adulto Jovem
16.
Georgian Med News ; (283): 180-183, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30516519

RESUMO

The paper examines the narrative arrangement of the problem-oriented medical record (POMR) as an effective method of registering and assessing clinical data. The aim of the research is to examine the types of narrators and focalization, as well as the hierarchy and interaction of narrative levels in the analyzed discourse. The research has demonstrated the presence of several types of narrators within the analyzed discourse: (1) the omniscient hetero-extradiegetic narrator with transient internal focalization (the third-person narration, represented by the physician) and (2) homo-intradiegetic narration (patient's first-person narration) in the "Subjective Observation" section; (3) the "estranged" heterodiegetic narrator with external focalization (the "Objective Observation" part); (4) the "uncertain" type of narrator (the "Assessment" part); (5) and the imperative mode of narration (the "Plan" section). Each section of POMR is characterized by a specific type of narration, and each of them aims to "intertwine" the events, scattered in time and space, into one coherent narrative to ensure the effective communication between physicians and successful treatment of patients. It is highly important for future physicians to develop narrative competence and master the basic mechanisms of producing an effective POMR, in order to be able to accurately document the encounters with patients, elicit the relevant details from case histories, and select the appropriate strategy of treatment. Therefore, in the process of training future doctors, the analysis of the basic mechanisms of writing POMRs should be an integral part of the curricula in English for Specific Purposes at universities.


Assuntos
Registros Médicos Orientados a Problemas/normas , Narração , Comunicação , Implementação de Plano de Saúde/normas , Humanos , Relações Médico-Paciente , Redação
18.
BMC Infect Dis ; 18(1): 567, 2018 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-30428846

RESUMO

BACKGROUND: Prior to the 2009 pandemic H1N1, and the unprecedented outbreak of Highly Pathogenic Avian Influenza (HPAI) caused by the H5N1 virus, the World Health Organization (WHO) called upon its Member States to develop preparedness plans in response to a new pandemic in humans. The WHO Member States responded to this call by developing national pandemic plans in accordance with the International Health Regulations (IHR) to strengthen the capabilities of Member States to respond to different pandemic scenarios. In this study, we aim to evaluate the quality of the preparedness plans in the WHO African region since their inception in 2005. METHODS: A standard checklist with 61 binary indicators ("yes" or "no") was used to assess the quality of the preparedness plans. The checklist was categorised across seven thematic areas of preparedness: preparation (16 indicators); coordination and partnership (5 indicators); risk communication (8 indicators); surveillance and monitoring (7 indicators); prevention and containment (10 indicators); case investigation and treatment (10 indicators) and ethical consideration (5 indicators). Four assessors independently scored the plans against the checklist. RESULTS: Of the 47 countries in the WHO African region, a total of 35 national pandemic plans were evaluated. The composite score for the completeness of the pandemic plans across the 35 countries was 36%. Country-specific scores on each of the thematic indicators for pandemic plan completeness varied, ranging from 5% in Côte d'Ivoire to 79% in South Africa. On average, preparation and risk communication scored 48%, respectively, while coordination and partnership scored the highest with an aggregate score of 49%. Surveillance and monitoring scored 34%, while prevention and containment scored 35%. Case investigation and treatment scored 25%, and ethical consideration scored the lowest of 14% across 35 countries. Overall, our assessment shows that pandemic preparedness plans across the WHO African region are inadequate. CONCLUSIONS: Moving forward, these plans must address the gaps identified in this study and demonstrate clarity in their goals that are achievable through drills, simulations and tabletop exercises.


Assuntos
Lista de Checagem , Planejamento em Desastres/organização & administração , Surtos de Doenças/prevenção & controle , Influenza Humana/epidemiologia , Pandemias/prevenção & controle , Organização Mundial da Saúde/organização & administração , África/epidemiologia , Lista de Checagem/métodos , Lista de Checagem/normas , Planejamento em Desastres/métodos , Planejamento em Desastres/normas , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/normas , Humanos , Programas de Imunização/organização & administração , Programas de Imunização/normas , Vírus da Influenza A Subtipo H1N1/imunologia , Virus da Influenza A Subtipo H5N1/imunologia , Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Projetos de Pesquisa , Cobertura Vacinal/organização & administração , Cobertura Vacinal/normas
20.
J Natl Compr Canc Netw ; 16(11): 1321-1328, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30442733

RESUMO

Background: Surveillance colonoscopy is required in patients with polyps due to an elevated colorectal cancer (CRC) risk; however, studies suggest substantial overuse and underuse of surveillance colonoscopy. The goal of this study was to characterize guideline adherence of surveillance recommendations after implementation of an electronic medical record (EMR)-based Colonoscopy Pathology Reporting and Clinical Decision Support System (CoRS). Methods: We performed a retrospective cohort study of patients who underwent colonoscopy with polypectomy at a safety-net healthcare system before (n=1,822) and after (n=1,320) implementation of CoRS in December 2013. Recommendations were classified as guideline-adherent or nonadherent according to the US Multi-Society Task Force on CRC. We defined surveillance recommendations shorter and longer than guideline recommendations as potential overuse and underuse, respectively. We used multivariable generalized linear mixed models to identify correlates of guideline-adherent recommendations. Results: The proportion of guideline-adherent surveillance recommendations was significantly higher post-CoRS than pre-CoRS (84.6% vs 77.4%; P<.001), with fewer recommendations for potential overuse and underuse. In the post-CoRS period, CoRS was used for 89.8% of cases and, compared with cases for which it was not used, was associated with a higher proportion of guideline-adherent recommendations (87.0% vs 63.4%; RR, 1.34; 95% CI, 1.23-1.42). In multivariable analysis, surveillance recommendations were also more likely to be guideline-adherent in patients with adenomas but less likely among those with fair bowel preparation and those with family history of CRC. Of 203 nonadherent recommendations, 70.4% were considered potential overuse, 20.2% potential underuse, and 9.4% were not provided surveillance recommendations. Conclusions: An EMR-based CoRS was widely used and significantly improved guideline adherence of surveillance recommendations.


Assuntos
Pólipos do Colo/cirurgia , Colonoscopia/estatística & dados numéricos , Sistemas de Apoio a Decisões Clínicas/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Prevenção Secundária/estatística & dados numéricos , Idoso , Pólipos do Colo/patologia , Colonoscopia/normas , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Detecção Precoce de Câncer/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Implementação de Plano de Saúde/normas , Implementação de Plano de Saúde/estatística & dados numéricos , Mau Uso de Serviços de Saúde/prevenção & controle , Mau Uso de Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Utilização de Procedimentos e Técnicas/normas , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Provedores de Redes de Segurança/normas , Provedores de Redes de Segurança/estatística & dados numéricos , Prevenção Secundária/normas , Fatores de Tempo
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