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1.
BMJ Open ; 10(11): e042626, 2020 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-33184088

RESUMO

BACKGROUND: To develop items for an early warning score (RECAP: REmote COVID-19 Assessment in Primary Care) for patients with suspected COVID-19 who need escalation to next level of care. METHODS: The study was based in UK primary healthcare. The mixed-methods design included rapid review, Delphi panel, interviews, focus groups and software development. Participants were 112 primary care clinicians and 50 patients recovered from COVID-19, recruited through social media, patient groups and snowballing. Using rapid literature review, we identified signs and symptoms which are commoner in severe COVID-19. Building a preliminary set of items from these, we ran four rounds of an online Delphi panel with 72 clinicians, the last incorporating fictional vignettes, collating data on R software. We refined the items iteratively in response to quantitative and qualitative feedback. Items in the penultimate round were checked against narrative interviews with 50 COVID-19 patients. We required, for each item, at least 80% clinician agreement on relevance, wording and cut-off values, and that the item addressed issues and concerns raised by patients. In focus groups, 40 clinicians suggested further refinements and discussed workability of the instrument in relation to local resources and care pathways. This informed design of an electronic template for primary care systems. RESULTS: The prevalidation RECAP-V0 comprises a red flag alert box and 10 assessment items: pulse, shortness of breath or respiratory rate, trajectory of breathlessness, pulse oximeter reading (with brief exercise test if appropriate) or symptoms suggestive of hypoxia, temperature or fever symptoms, duration of symptoms, muscle aches, new confusion, shielded list and known risk factors for poor outcome. It is not yet known how sensitive or specific it is. CONCLUSIONS: Items on RECAP-V0 align strongly with published evidence, clinical judgement and patient experience. The validation phase of this study is ongoing. TRIAL REGISTRATION NUMBER: NCT04435041.


Assuntos
Lista de Checagem , Infecções por Coronavirus/diagnóstico , Escore de Alerta Precoce , Pneumonia Viral/diagnóstico , Telemedicina , Betacoronavirus , Confusão , Infecções por Coronavirus/fisiopatologia , Técnica Delfos , Progressão da Doença , Dispneia , Febre , Frequência Cardíaca , Humanos , Hipóxia , Mialgia , Pandemias , Pneumonia Viral/fisiopatologia , Pesquisa Qualitativa , Medição de Risco , Fatores de Risco , Fatores de Tempo , Reino Unido
2.
Brasília, D.F.; OPAS; 2020-11-05. (OPAS-W/BRA/PHE/COVID-19/20-142).
Não convencional em Português | PAHO-IRIS | ID: phr2-52981

RESUMO

Este documento acompanha a orientação provisória “Fortalecimento da Preparação para a COVID-19 em Cidades e Entornos urbanos”, que complementa o Plano Estratégico de Preparação e Resposta à COVID-19 (SPRP na sigla em inglês) e a atualização de estratégia. Ele detalha e expande as ações recomendadas conforme o listado na orientação provisória e fornece uma ferramenta, a lista de verificação, para as autoridades locais, líderes e formuladores de políticas nas cidades visando melhorar a preparação para a pandemia da COVID-19 e ações posteriores. Não se trata de documento prescritivo e nem exaustivo e deve ser adaptado aos marcos regulatórios nacionais, às competências dos atores subnacionais/estaduais e aos contextos sociais, culturais e econômicos locais. A lista de verificação não pretende substituir outras orientações e planejamentos, mas complementá-los, ajudando as autoridades locais a garantir que as áreas principais tenham sido cobertas.


Assuntos
Infecções por Coronavirus , Coronavirus , Emergências , Lista de Checagem , Fatores de Risco , Infecções por Coronavirus , Saúde Pública , Pandemias , Políticas Públicas de Saúde
3.
Medicine (Baltimore) ; 99(42): e22624, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080697

RESUMO

BACKGROUND: Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder involving hyperandrogenism, menstrual disorder, metabolic problems, infertility, obesity, and acne. The main aim of this study was to assess the reporting quality of clinical practice guidelines (CPGs) in the field of PCOS to provide a reporting specification for this study. METHODS: We evaluated the reporting quality of clinical guidelines of PCOS using the Reporting Items for Practice Guidelines in HealThcare (RIGHT) checklist. Nine databases and 3 medical associations were searched. These included Medline, Embase, PubMed, National Institute for Health and Care Excellence (NICE), Guidelines International Network (GIN), National Guideline Clearinghouse (NGC), China National Knowledge Infrastructure, Wanfang and Chinese Science, and Technology Journal Database (VIP). Three medical associations included the European Society of Human Reproduction and Embryology, the American Society for Reproductive Medicine and the Agency for Healthcare Research and Quality. Two independent authors assessed the reporting quality of PCOS CPGs by the RIGHT checklist, and Spearman's correlation was used to assess inter-rater reliability. RESULTS: Twelve PCOS CPGs were included. On average, 20.0 (57.1%) of the 35 items in the RIGHT checklist were reported. All items were fully reported by one of these CPGs. The number of reported items ranged from 10 (28.6%) to 35 (100%). Overall, 16.7%, 66.7%, and 16.7% of included guidelines were of high, medium, and low quality, respectively. The reporting proportions of the 7 domains (i.e., Basic information, Background, Evidence, Recommendations, Reviewand quality assurance, Funding and declaration and management of interests, and Other information) in the RIGHT checklist were 62.0%, 69.1%, 53.3%, 60.7%, 33.3%, 31.2%, and 69.4%, respectively. CONCLUSIONS: The evaluation of these CPGs by the RIGHT checklist revealed that the reporting quality varied among guidelines. Low quality items were the processes of evidence decision and the declaration of funding in most included CPGs. Guideline developers should pay more attention to these items to disseminate and implement better guidelines in near future. TRIAL REGISTRATION NUMBER: registration at PROSPERO CRD42020163435.


Assuntos
Síndrome do Ovário Policístico , Guias de Prática Clínica como Assunto/normas , Lista de Checagem , Feminino , Humanos
5.
Value Health ; 23(11): 1405-1408, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33127009

RESUMO

OBJECTIVES: To develop a checklist that helps quantify the economic impact associated with fear of contagion and to illustrate how one might use the checklist by presenting a case study featuring China during the coronavirus disease 2019 (COVID-19) outbreak. METHODS: Based on "fearonomic effects," a qualitative framework that conceptualizes the direct and indirect economic effects caused by the fear of contagion, we created a checklist to facilitate empirical estimation. As a case study, we first identified relevant sectors affected by China's lockdown policies implemented just before the Lunar New Year (LNY) week. To quantify the immediate impact, we then estimated the projected spending levels in 2020 in the absence of COVID-19 and compared these projections with actual spending during the LNY week. Data sources used include Chinese and global websites. To characterize uncertainty, we reported upper and lower bound estimates and calculated midpoints for each range. RESULTS: The COVID-19 epidemic is estimated to cost China's economy $283 billion ($196-369 billion), that is, ¥2.0 trillion renminbi (¥1.4-¥2.6 trillion), during the LNY week. Reduced restaurant and movie theater business ($106 [$103-$109] billion, 37.5% [36.4%-38.5%]) and reduced public transportation utilization ($96 [$13-$179] billion dollars, 33.9% [4.6%-63.3%]) explain most of this loss, followed by travel restrictions and the resulting loss of hotel business and tourism ($80.36 billion, 28.4%). CONCLUSION: Our checklist can help quantify the immediate and near-term impact of COVID-19 on a country's economy. It can also help researchers and policy makers consider the broader economic and social consequences when valuing future vaccines and treatments.


Assuntos
Infecções por Coronavirus/economia , Medo , Modelos Econômicos , Pandemias/economia , Pneumonia Viral/economia , Betacoronavirus , Lista de Checagem , China , Bases de Dados Factuais , Política de Saúde , Humanos
6.
Rev Bras Parasitol Vet ; 29(3): e008720, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32935771

RESUMO

This study provides an updated list of parasite species and their respective hosts in the upper Paraná River floodplain. The list of parasites is structured by phylum, class, order and family, followed by a record of each host species. A total of 315 taxa of parasites were reported, of which 201 were identified at the species level. These 201 species comprise 3 Flagellata, 3 Myxozoa, 50 Monogenea, 43 Digenea, 40 Cestoda, 41 Nematoda, 8 Acanthocephala, 6 Copepoda, 5 Branchiura and 2 Pentastomida, arranged in 84 host fish species. This work carried out in the floodplain of the upper Paraná River contributes to the listing of parasite species and host interactions of the local ichthyofauna. Little is known about these communities and its riches are underestimated due to the high density of fish found in this region, highlighting the importance of conducting studies on the local fauna.


Assuntos
Doenças dos Peixes , Parasitos , Doenças Parasitárias em Animais , Animais , Lista de Checagem , Doenças dos Peixes/parasitologia , Peixes/parasitologia , Parasitos/classificação , Parasitos/isolamento & purificação , Doenças Parasitárias em Animais/parasitologia , Rios
7.
J Med Internet Res ; 22(9): e19716, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32975521

RESUMO

BACKGROUND: Most people who experience a potentially traumatic event (PTE) recover on their own. A small group of individuals develops psychological complaints, but this is often not detected in time or guidance to care is suboptimal. To identify these individuals and encourage them to seek help, a web-based self-help test called Mobile Insight in Risk, Resilience, and Online Referral (MIRROR) was developed. MIRROR takes an innovative approach since it integrates both negative and positive outcomes of PTEs and time since the event and provides direct feedback to the user. OBJECTIVE: The goal of this study was to assess MIRROR's use, examine its psychometric properties (factor structure, internal consistency, and convergent and divergent validity), and evaluate how well it classifies respondents into different outcome categories compared with reference measures. METHODS: MIRROR was embedded in the website of Victim Support Netherlands so visitors could use it. We compared MIRROR's outcomes to reference measures of PTSD symptoms (PTSD Checklist for DSM-5), depression, anxiety, stress (Depression Anxiety Stress Scale-21), psychological resilience (Resilience Evaluation Scale), and positive mental health (Mental Health Continuum Short Form). RESULTS: In 6 months, 1112 respondents completed MIRROR, of whom 663 also completed the reference measures. Results showed good internal consistency (interitem correlations range .24 to .55, corrected item-total correlations range .30 to .54, and Cronbach alpha coefficient range .62 to .68), and convergent and divergent validity (Pearson correlations range -.259 to .665). Exploratory and confirmatory factor analyses (EFA+CFA) yielded a 2-factor model with good model fit (CFA model fit indices: χ219=107.8, P<.001, CFI=.965, TLI=.948, RMSEA=.065), conceptual meaning, and parsimony. MIRROR correctly classified respondents into different outcome categories compared with the reference measures. CONCLUSIONS: MIRROR is a valid and reliable self-help test to identify negative (PTSD complaints) and positive outcomes (psychosocial functioning and resilience) of PTEs. MIRROR is an easily accessible online tool that can help people who have experienced a PTE to timely identify psychological complaints and find appropriate support, a tool that might be highly needed in times like the coronavirus pandemic.


Assuntos
Inquéritos Epidemiológicos , Aplicativos Móveis , Encaminhamento e Consulta , Resiliência Psicológica , Autocuidado/métodos , Autocuidado/normas , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Ansiedade/diagnóstico , Lista de Checagem , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Depressão/diagnóstico , Análise Fatorial , Feminino , Humanos , Internet , Masculino , Países Baixos/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Psicometria , Reprodutibilidade dos Testes , Estresse Psicológico/diagnóstico
8.
J Extra Corpor Technol ; 52(3): 227-236, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32981961

RESUMO

As the extracorporeal membrane oxygenation (ECMO) program at our institution has grown and our staffing model has evolved into a multidisciplinary team, our method of ECMO charting has also evolved, using an electronic medical record (EMR) with electronic checklists, progress notes, and remote access. Using our EPIC charting platform, version 1 of our EMR was implemented in 2015. It has been revised three times, and remote access deemed necessary to properly support our staff and patients. Our current, yet still evolving, remotely accessible, ECMO EMR incorporates hourly charting and protocol-based checklists for procedures such as initiation of support, shift handoffs, circuit checks, and patient transport. Perfusionists are required to fill out thrice daily progress notes, notes for bedside/operating room procedures, and patient transport. We present a format for centers looking to implement a comprehensive EMR for ECMO patients. An expanding ECMO program required a change to our staffing model, and an EMR with electronic checklists and remote access facilitated the transition to a multidisciplinary team. Protocol-based checklists ensure consistency during procedures, transports, and shift changes. The remote access and required progress notes create a safer team approach and keep our perfusionists engaged when specialists are sitting ECMO.


Assuntos
Oxigenação por Membrana Extracorpórea , Lista de Checagem , Registros Eletrônicos de Saúde , Humanos , Equipe de Assistência ao Paciente
9.
Perm J ; 242020.
Artigo em Inglês | MEDLINE | ID: mdl-32956034

RESUMO

Coronavirus disease 2019 (COVID-19) is a new, rapidly spreading pandemic that can lead to a life-threatening disease. Accurate and transparent COVID-19 case reports provide systematic clinical observations supporting researchers designing clinical trials and clinicians delivering health care. The checklist described here is designed to systematically and accurately capture data from case reports and case series for documentation on COVID-19. It is aligned with the CARE guidelines, available from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network.


Assuntos
Lista de Checagem , Infecções por Coronavirus/terapia , Documentação , Pneumonia Viral/terapia , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto
10.
Psychiatr Danub ; 32(Suppl 1): 88-92, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890370

RESUMO

BACKGROUND: The present study reports preliminary results from the multicentre project on the approbation of the Russian language version of the "The Communication Checklist-Self Report" (RL-CC-SR) and its first use in schizophrenia (SZ), aiming to evaluate the contribution of language disturbances in the pathogenesis of this heterogeneous disorder. SUBJECTS AND METHODS: The study evaluated patients' clinical state with the Diagnostic Interview for Psychoses (DIP), and assessed language and communication disturbances (LCD) with the RL-CC-SR in all participants (213 healthy controls (HC), 83 SZ patients, 31 SZ first-degree relatives). Data from the current sample of SZ (n=50), and HC (n=213) was analysed to calculate the relationships between LCD, social and clinical variables using descriptive statistics methods, T-test and Pearson's correlations (SPSS-26, 2019). RESULTS: The quotient scores (<6) and raw scores on all three CC-SR subscales demonstrated prominent LCD in SZ: (i) language structure (LS) (SZ:11.92±8.01, HC:7.54±5.91; p<0.001), (ii) pragmatic skills (PS) (SZ:11.30±10.07, HC:8.71±7.39; p=0.040), (iii) social engagement (SE) (SZ:31.94±11.76, HC:19.42±10.35; p<0.001). In SZ, Pearson correlations of LS scores were significant for the DIP-items Odd Speech (p=0.033), and Social Engagement - Blunted Affect (p=0.042). PS was related to early disease onset (p=0.027), poor premorbid work adjustment (p=0.003), along with LS (p=0.005), and was also linked to poor premorbid social adjustment (p=0.005). CONCLUSIONS: SZ patients are aware of their LCD at all levels of language structure, pragmatics, and nonverbal communication, but are unable to compensate. Disturbances of LS and PS in SZ patients relate to their poor social adjustment and functioning, and may prove to be associated with the primary negative symptoms domain of the disorder and its generally poor outcome.


Assuntos
Lista de Checagem , Transtornos do Desenvolvimento da Linguagem , Esquizofrenia , Autorrelato , Humanos , Transtornos do Desenvolvimento da Linguagem/etiologia , Esquizofrenia/complicações , Esquizofrenia/diagnóstico , Ajustamento Social
11.
BMJ ; 370: m3210, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907797

RESUMO

The SPIRIT 2013 (The Standard Protocol Items: Recommendations for Interventional Trials) statement aims to improve the completeness of clinical trial protocol reporting, by providing evidence-based recommendations for the minimum set of items to be addressed. This guidance has been instrumental in promoting transparent evaluation of new interventions. More recently, there is a growing recognition that interventions involving artificial intelligence need to undergo rigorous, prospective evaluation to demonstrate their impact on health outcomes.The SPIRIT-AI extension is a new reporting guideline for clinical trials protocols evaluating interventions with an AI component. It was developed in parallel with its companion statement for trial reports: CONSORT-AI. Both guidelines were developed using a staged consensus process, involving a literature review and expert consultation to generate 26 candidate items, which were consulted on by an international multi-stakeholder group in a 2-stage Delphi survey (103 stakeholders), agreed on in a consensus meeting (31 stakeholders) and refined through a checklist pilot (34 participants).The SPIRIT-AI extension includes 15 new items, which were considered sufficiently important for clinical trial protocols of AI interventions. These new items should be routinely reported in addition to the core SPIRIT 2013 items. SPIRIT-AI recommends that investigators provide clear descriptions of the AI intervention, including instructions and skills required for use, the setting in which the AI intervention will be integrated, considerations around the handling of input and output data, the human-AI interaction and analysis of error cases.SPIRIT-AI will help promote transparency and completeness for clinical trial protocols for AI interventions. Its use will assist editors and peer-reviewers, as well as the general readership, to understand, interpret and critically appraise the design and risk of bias for a planned clinical trial.


Assuntos
Inteligência Artificial , Protocolos Clínicos , Projetos de Pesquisa , Lista de Checagem , Ensaios Clínicos como Assunto , Consenso , Humanos
12.
BMJ ; 370: m3164, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32909959

RESUMO

The CONSORT 2010 (Consolidated Standards of Reporting Trials) statement provides minimum guidelines for reporting randomised trials. Its widespread use has been instrumental in ensuring transparency when evaluating new interventions. More recently, there has been a growing recognition that interventions involving artificial intelligence (AI) need to undergo rigorous, prospective evaluation to demonstrate impact on health outcomes.The CONSORT-AI extension is a new reporting guideline for clinical trials evaluating interventions with an AI component. It was developed in parallel with its companion statement for clinical trial protocols: SPIRIT-AI. Both guidelines were developed through a staged consensus process, involving a literature review and expert consultation to generate 29 candidate items, which were assessed by an international multi-stakeholder group in a two-stage Delphi survey (103 stakeholders), agreed on in a two-day consensus meeting (31 stakeholders) and refined through a checklist pilot (34 participants).The CONSORT-AI extension includes 14 new items, which were considered sufficiently important for AI interventions, that they should be routinely reported in addition to the core CONSORT 2010 items. CONSORT-AI recommends that investigators provide clear descriptions of the AI intervention, including instructions and skills required for use, the setting in which the AI intervention is integrated, the handling of inputs and outputs of the AI intervention, the human-AI interaction and providing analysis of error cases.CONSORT-AI will help promote transparency and completeness in reporting clinical trials for AI interventions. It will assist editors and peer-reviewers, as well as the general readership, to understand, interpret and critically appraise the quality of clinical trial design and risk of bias in the reported outcomes.


Assuntos
Inteligência Artificial , Projetos de Pesquisa , Lista de Checagem , Protocolos Clínicos , Ensaios Clínicos como Assunto , Consenso , Técnica Delfos , Humanos
13.
PLoS Med ; 17(9): e1003294, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32956344

RESUMO

BACKGROUND: Placebo or sham controls are the standard against which the benefits and harms of many active interventions are measured. Whilst the components and the method of their delivery have been shown to affect study outcomes, placebo and sham controls are rarely reported and often not matched to those of the active comparator. This can influence how beneficial or harmful the active intervention appears to be. Without adequate descriptions of placebo or sham controls, it is difficult to interpret results about the benefits and harms of active interventions within placebo-controlled trials. To overcome this problem, we developed a checklist and guide for reporting placebo or sham interventions. METHODS AND FINDINGS: We developed an initial list of items for the checklist by surveying experts in placebo research (n = 14). Because of the diverse contexts in which placebo or sham treatments are used in clinical research, we consulted experts in trials of drugs, surgery, physiotherapy, acupuncture, and psychological interventions. We then used a multistage online Delphi process with 53 participants to determine which items were deemed to be essential. We next convened a group of experts and stakeholders (n = 16). Our main output was a modification of the existing Template for Intervention Description and Replication (TIDieR) checklist; this allows the key features of both active interventions and placebo or sham controls to be concisely summarised by researchers. The main differences between TIDieR-Placebo and the original TIDieR are the explicit requirement to describe the setting (i.e., features of the physical environment that go beyond geographic location), the need to report whether blinding was successful (when this was measured), and the need to present the description of placebo components alongside those of the active comparator. CONCLUSIONS: We encourage TIDieR-Placebo to be used alongside TIDieR to assist the reporting of placebo or sham components and the trials in which they are used.


Assuntos
Lista de Checagem/métodos , Lista de Checagem/normas , Humanos , Placebos/farmacologia , Placebos/normas , Projetos de Pesquisa , Pesquisadores , Relatório de Pesquisa , Inquéritos e Questionários
14.
PLoS Med ; 17(9): e1003344, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32956352

RESUMO

BACKGROUND: Large sample sizes are often required to detect statistically significant associations between pharmacogenetic markers and treatment response. Meta-analysis may be performed to synthesize data from several studies, increasing sample size and, consequently, power to detect significant genetic effects. However, performing robust synthesis of data from pharmacogenetic studies is often challenging because of poor reporting of key data in study reports. There is currently no guideline for the reporting of pharmacogenetic studies that has been developed using a widely accepted robust methodology. The objective of this project was to develop the STrengthening the Reporting Of Pharmacogenetic Studies (STROPS) guideline. METHODS AND FINDINGS: We established a preliminary checklist of reporting items to be considered for inclusion in the guideline. We invited representatives of key stakeholder groups to participate in a 2-round Delphi survey. A total of 52 individuals participated in both rounds of the survey, scoring items with regards to their importance for inclusion in the STROPS guideline. We then held a consensus meeting, at which 8 individuals considered the results of the Delphi survey and voted on whether each item ought to be included in the final guideline. The STROPS guideline consists of 54 items and is accompanied by an explanation and elaboration document. The guideline contains items that are particularly important in the field of pharmacogenetics, such as the drug regimen of interest and whether adherence to treatment was accounted for in the conducted analyses. The guideline also requires that outcomes be clearly defined and justified, because in pharmacogenetic studies, there may be a greater number of possible outcomes than in other types of study (for example, disease-gene association studies). A limitation of this project is that our consensus meeting involved a small number of individuals, the majority of whom are based in the United Kingdom. CONCLUSIONS: Our aim is for the STROPS guideline to improve the transparency of reporting of pharmacogenetic studies and also to facilitate the conduct of high-quality systematic reviews and meta-analyses. We encourage authors to adhere to the STROPS guideline when publishing pharmacogenetic studies.


Assuntos
Farmacogenética/métodos , Testes Farmacogenômicos/normas , Testes Farmacogenômicos/tendências , Adulto , Lista de Checagem , Consenso , Técnica Delfos , Feminino , Estudos de Associação Genética , Objetivos , Humanos , Masculino , Pessoa de Meia-Idade , Farmacogenética/normas , Política , Editoração/normas , Projetos de Pesquisa/normas , Participação dos Interessados , Inquéritos e Questionários , Reino Unido
16.
West J Emerg Med ; 21(5): 1089-1094, 2020 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-32970559

RESUMO

INTRODUCTION: The correct use of personal protective equipment (PPE) limits transmission of serious communicable diseases to healthcare workers, which is critically important in the era of coronavirus disease 2019 (COVID-19). However, prior studies illustrated that healthcare workers frequently err during application and removal of PPE. The goal of this study was to determine whether a simulation-based, mastery learning intervention with deliberate practice improves correct use of PPE by physicians during a simulated clinical encounter with a COVID-19 patient. METHODS: This was a pretest-posttest study performed in the emergency department at a large, academic tertiary care hospital between March 31-April 8, 2020. A total of 117 subjects participated, including 56 faculty members and 61 resident physicians. Prior to the intervention, all participants received institution-mandated education on PPE use via an online video and supplemental materials. Participants completed a pretest skills assessment using a 21-item checklist of steps to correctly don and doff PPE. Participants were expected to meet a minimum passing score (MPS) of 100%, determined by an expert panel using the Mastery Angoff and Patient Safety standard-setting techniques. Participants that met the MPS on pretest were exempt from the educational intervention. Testing occurred before and after an in-person demonstration of proper donning and doffing techniques and 20 minutes of deliberate practice. The primary outcome was a change in assessment scores of correct PPE use following our educational intervention. Secondary outcomes included differences in performance scores between faculty members and resident physicians, and differences in performance during donning vs doffing sequences. RESULTS: All participants had a mean pretest score of 73.1% (95% confidence interval [CI], 70.9-75.3%). Faculty member and resident pretest scores were similar (75.1% vs 71.3%, p = 0.082). Mean pretest doffing scores were lower than donning scores across all participants (65.8% vs 82.8%, p<0.001). Participant scores increased 26.9% (95% CI of the difference 24.7-29.1%, p<0.001) following our educational intervention resulting in all participants meeting the MPS of 100%. CONCLUSION: A mastery learning intervention with deliberate practice ensured the correct use of PPE by physician subjects in a simulated clinical encounter of a COVID-19 patient. Further study of translational outcomes is needed.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Educação Médica Continuada/métodos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Treinamento por Simulação/métodos , California , Lista de Checagem , Competência Clínica/estatística & dados numéricos , Infecções por Coronavirus/transmissão , Serviço Hospitalar de Emergência , Humanos , Controle de Infecções/instrumentação , Pneumonia Viral/transmissão
17.
J Bras Nefrol ; 42(2 suppl 1): 4-8, 2020 Aug 26.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32877490

RESUMO

The Covid-19 pandemic brought several challenges to the healthcare system: diagnosis, treatment and measures to prevent the spread of the disease. With the greater availability and variety of diagnostic tests, it is essential to properly interpret them. This paper intends to help dialysis units concerning the use of clinical criteria and diagnostic tests for decision making regarding the discontinuation of isolation of patients with suspected or confirmed Covid-19, as well as the return to work activities for employees with suspected or confirmed Covid-19.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/diagnóstico , Nefrologia/normas , Pneumonia Viral/diagnóstico , Diálise Renal , Retorno ao Trabalho , Algoritmos , Brasil , Lista de Checagem , Tomada de Decisão Clínica , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/epidemiologia , Humanos , Doenças Profissionais/diagnóstico , Pandemias , Isolamento de Pacientes , Pneumonia Viral/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Reação em Cadeia da Polimerase em Tempo Real/normas , Sociedades Médicas/normas , Unidade Hospitalar de Urologia/normas
18.
Rev. SOBECC ; 25(3): 128-135, 30-09-2020.
Artigo em Inglês | LILACS | ID: biblio-1122400

RESUMO

Objetivo: Analisar o processo de produção e execução do protocolo de cirurgia segura em dois hospitais terciários do município de Manaus. Método: Pesquisa guiada pelo design thinking, com ênfase na técnica do duplo diamante, realizada em dois hospitais públicos no município de Manaus, de julho de 2018 a março de 2019. Foi feita nas etapas: investigativa (observação e questionário) e interventiva (síntese, ideação e entrega). Resultados: Na primeira etapa, com 120 horas de observação, constatou-se que as três fases do protocolo não foram cumpridas; analisando-se as repostas a 63 questionários, reforçou-se a não adesão ao checklist. Com base nesses achados, na etapa de síntese, elegeu-se como foco a aplicação do checklist do protocolo; na etapa de ideação, realizou-se a proposição de solução e a testagem-piloto; a etapa de entrega da solução aos hospitais encerrou o ciclo. Conclusão: A análise do processo de execução do protocolo indicou seu descumprimento, o que sugere o comprometimento da segurança do paciente. A solução testada poderá, após entrega e implementação, contribuir para a execução efetiva do protocolo.


Objective: To analyze the process of elaboration and implementation of the surgical safety checklist in two tertiary hospitals in the city of Manaus. Method: This study was based on design thinking, focusing on the double diamond technique. It was conducted in two public hospitals in Manaus, from July 2018 to March 2019. The following stages were adopted for this research: investigation (observation and questionnaire) and intervention (synthesis, ideation, and delivery). Results: The first stage, consisting of 120 hours of observation, showed the non-fulfillment of the three phases of the process. After analyzing the answers to the 63 questionnaires, we confirmed the non-adherence to the checklist. Based on these findings, the synthesis phase focused on the use of the checklist; the ideation phase involved the proposal of solutions and the pilot testing; the delivery phase concluded the cycle by providing solutions to the hospitals. Conclusion: The analysis of the process of implementation of the checklist indicated non-compliance, suggesting risk to patient safety. After delivery and implementation, the tested solution may contribute to the effective execution of the checklist.


Objetivo: Analizar el proceso de producción y ejecución del Protocolo de Cirugía Segura en dos hospitales terciarios de la ciudad de Manaus. Método: Investigación guiada por Design Thinking, con énfasis en la técnica Double Diamond, llevada a cabo en dos hospitales públicos de la ciudad de Manaus, desde julio de 2018 hasta marzo de 2019. Se realizó por etapas: de investigación (observación y cuestionario) e intervencionista (síntesis, ideación y entrega). Resultados: En la primera etapa, con 120 horas de observación, se encontró que las tres fases del protocolo no se cumplieron; En base a las respuestas a 63 cuestionarios, se reforzó la no adhesión a la lista de verificación. Con base en estos hallazgos, en la etapa de síntesis, la aplicación de la lista de verificación del protocolo fue elegida como el foco; en la etapa de ideación, se llevaron a cabo la propuesta de solución y la prueba piloto;La etapa de entrega de la solución a los hospitales finalizó el ciclo. Conclusión: El análisis del proceso de ejecución del protocolo indicó incumplimiento, lo que sugiere comprometer la seguridad del paciente. La solución probada puede, después de la entrega y la implementación, contribuir a la ejecución efectiva del protocolo.


Assuntos
Humanos , Cirurgia Geral , Lista de Checagem , Segurança do Paciente , Protocolos , Hospitais , Hospitais Públicos
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