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1.
JCO Glob Oncol ; 6: 1455-1460, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32997540

RESUMO

The core pillars of multimodal care of patients with cancer are surgical, radiation, and medical oncology. The global pandemic of coronavirus disease 2019 (COVID-19) has suddenly resurrected a new pillar in oncology care: teleoncology. With oncologists reaching out to patients through telemedicine, it is possible to evaluate and fulfill patients' needs; triage patients for elective procedures; screen them for influenza-like illness; provide them with guidance for hospital visits, if needed; and bridge oral medications and treatments when a hospital visit is not desirable because of any high risk-benefit ratio. Teleoncology can bring great reassurance to patients at times when reaching an oncology center is challenging, and more so in resource-constrained countries. Evidence-based treatment protocols, dispensable by teleoncology, already exist for many sites of cancer and they can provide a bridge to treatment when patients are unable to reach cancer centers for their standard treatment. The young pillar of teleoncology is going to remain much longer than COVID-19.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Oncologia/organização & administração , Neoplasias/diagnóstico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/organização & administração , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/normas , Medicina Baseada em Evidências/tendências , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Oncologia/métodos , Oncologia/normas , Oncologia/tendências , Neoplasias/terapia , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Telemedicina/normas , Telemedicina/tendências , Triagem/métodos , Triagem/organização & administração , Triagem/normas
2.
PLoS One ; 15(8): e0237720, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32834011

RESUMO

BACKGROUND: Underweight, overweight, and obesity are major public health challenges among reproductive-age women of lower- and middle-income countries (including Tanzania). In those settings, obesogenic factors (attributes that promote excessive body weight gain) are increasing in the context of an existing high burden of undernutrition. The present study investigated factors associated with underweight, overweight, and obesity among reproductive age women in Tanzania. METHODS: This study used 2015-16 Tanzania Demographic and Health Survey data (n = 11735). To account for the hierarchical nature of the data (i.e., reproductive age women nested within clusters), multilevel multinomial logistic regression models were used to investigate the association between individual-level (socioeconomic, demographic and behavioural) and community-level factors with underweight, overweight, and obesity. RESULTS: Reproductive age women who were informally employed (relative risk ratio [RRR] = 0.79; 95% confidence interval [CI]: 0.64, 0.96), those who were currently married (RRR = 0.59; 95% CI: 0.43, 0.82) and those who used contraceptives (RRR = 0.70; 95% CI: 0.54, 0.90) were less likely to be underweight. Reproductive age women who attained secondary or higher education (RRR = 1.48; 95% CI: 1.11, 1.96), those who resided in wealthier households (RRR = 2.31; 95% CI: 1.78, 3.03) and those who watched the television (RRR = 1.26; 95% CI: 1.06, 1.50) were more likely to be overweight. The risk of experiencing obesity was higher among reproductive age women who attained secondary or higher education (RRR = 1.79; 95% CI: 1.23, 2.61), those who were formally employed (RRR = 1.50; 95% CI: 1.14, 1.98), those who resided in wealthier households (RRR = 4.77; 95% CI: 3.03, 7.50), those who used alcohol (RRR = 1.43; 95% CI: 1.12, 1.82) and/or watched the television (RRR = 1.70; 95% CI: 1.35, 2.13). CONCLUSION: Our study suggests that relevant government jurisdictions need to identify, promote, and implement evidence-based interventions that can simultaneously address underweight and overweight/obesity among reproductive age women in Tanzania.


Assuntos
Necessidades e Demandas de Serviços de Saúde/organização & administração , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Saúde Reprodutiva/estatística & dados numéricos , Magreza/epidemiologia , Adolescente , Adulto , Estudos Transversais , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Obesidade/fisiopatologia , Obesidade/prevenção & controle , Sobrepeso/fisiopatologia , Sobrepeso/prevenção & controle , Prevalência , Serviços Preventivos de Saúde/organização & administração , Serviços Preventivos de Saúde/estatística & dados numéricos , Reprodução/fisiologia , Fatores de Risco , Fatores Socioeconômicos , Tanzânia/epidemiologia , Magreza/fisiopatologia , Magreza/prevenção & controle , Adulto Jovem
3.
Stroke Vasc Neurol ; 5(3): 260-269, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32641444

RESUMO

AIM: Stroke is characterised by high morbidity, mortality and disability, which seriously affects the health and safety of the people. Stroke has become a serious public health problem in China. Organisational stroke management can significantly reduce the mortality and disability rates of patients with stroke. We provide this evidence-based guideline to present current and comprehensive recommendations for organisational stroke management. METHODS: A formal literature search of MEDLINE (1 January 1997 through 30 September 2019) was performed. Data were synthesised with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The Chinese Stroke Association's Levels of Evidence grading algorithm was used to grade each recommendation. RESULTS: Evidence-based guidelines are presented for the organisational management of patients presenting with stroke. The focus of the guideline was subdivided into prehospital first aid system of stroke, rapid diagnosis and treatment of emergency in stroke centre, organisational management of stroke unit and stroke clinic, construction of regional collaborative network among stroke centres and evaluation and continuous improvement of stroke medical quality. CONCLUSIONS: The guidelines offer an organisational stroke management model for patients with stroke which might help dramatically.


Assuntos
Prestação Integrada de Cuidados de Saúde/normas , Medicina Baseada em Evidências/normas , Neurologia/normas , Reabilitação do Acidente Vascular Cerebral/normas , Acidente Vascular Cerebral/terapia , China/epidemiologia , Consenso , Prestação Integrada de Cuidados de Saúde/organização & administração , Avaliação da Deficiência , Medicina Baseada em Evidências/organização & administração , Humanos , Modelos Organizacionais , Neurologia/organização & administração , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
4.
Emerg Med J ; 37(9): 572-575, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32651176

RESUMO

The COVID-19 pandemic has led to a surge of information being presented to clinicians regarding this novel and deadly disease. There is a clear urgency to collate, review, appraise and act on this information if we are to do the best for clinicians and patients. However, the speed of the pandemic is a threat to traditional models of knowledge translation and practice change. In this concepts paper, we argue that clinicians need to be agile in their thinking and practice in order to find the right time to change. Adoption of new methods should be based on clinical judgement, the weight of evidence and the balance of probabilities that any new technique, test or treatment might work. The pandemic requires all of us to reach a new level of evidence-based medicine characterised by scepticism, thoughtfulness, responsiveness and clinically agility in practice.


Assuntos
Infecções por Coronavirus , Procedimentos Clínicos , Medicina Baseada em Evidências , Pandemias , Pneumonia Viral , Pesquisa Médica Translacional , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Medicina Baseada em Evidências/educação , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/organização & administração , Humanos , Gestão do Conhecimento , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Melhoria de Qualidade , Capacidade de Resposta ante Emergências , Pesquisa Médica Translacional/educação , Pesquisa Médica Translacional/tendências
5.
Nephrol Nurs J ; 47(3): 239-265, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32639125

RESUMO

Vitamin D deficiency is prevalent among patients with chronic kidney disease (CKD) and even more pronounced in patients with kidney failure who are undergoing peritoneal dialysis and hemodialysis. This project was a nurse practitioner-led quality improvement project conducted in an outpatient hemodialysis unit that focused on determining if educating providers and hemodialysis unit clinical staff on vitamin D guidelines increased the awareness and monitoring of patients on hemodialysis. The number of patients screened for vitamin D levels increased from 29% to 100%, and 70% of patients tested were deficient in vitamin D. While the follow-up monitoring yielded a result of only 32%, we recommend processes and structures for long-term sustainability, such as periodic re-education, reminders and prompts for conducting needed follow-up, continued outcome monitoring, and champions to support the ongoing processes and structures.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Medicina Baseada em Evidências/organização & administração , Corpo Clínico/educação , Diálise Renal , Insuficiência Renal Crônica/terapia , Deficiência de Vitamina D/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Programas de Rastreamento/estatística & dados numéricos , Profissionais de Enfermagem , Guias de Prática Clínica como Assunto , Melhoria de Qualidade/organização & administração , Insuficiência Renal Crônica/epidemiologia , Deficiência de Vitamina D/epidemiologia
6.
Ceska Gynekol ; 85(2): 139-143, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32527109

RESUMO

OBJECTIVE: To informed about international surveillance network severe maternal morbidity and mortality - INOSS. DESIGN: Literature review. SETTINGS: 1st Department of Gynaecology and Obstetrics Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic. METHODS: Literate review of articles published till august 2019. RESULTS: The International Network of Obstetric Survey Systems (INOSS) is an international network that connects countries with the same or similar system of surveillance of acute severe maternal morbidity and mortality. The INOSS was established in year 2010 by twelve countries. Nowadays 19 countries are involved in the INOSS. The cooperation between member countries is focused on the acquisition of relevant data about rare severe acute maternal morbidities. INOSS in 2017 year unified definitions of 8 severe acute maternal morbidities according Delphi method: eclampsia, amniotic fluid embolism, peripartum hysterectomy, severe primary postpartum haemorrhage, uterine rupture, abnormally invasive placenta, spontaneous hemoperitoneum in pregnancy, and cardiac arrest in pregnancy. CONCLUSION: The international cooperation allows the acquisition of relevant epidemiologic data and the optimalization of the treatment according the evidence-based medicine.


Assuntos
Coleta de Dados/métodos , Medicina Baseada em Evidências/organização & administração , Mortalidade Materna , Morbidade , Complicações do Trabalho de Parto , Vigilância da População , Complicações na Gravidez , Medicina Baseada em Evidências/métodos , Feminino , Humanos , Cooperação Internacional , Complicações do Trabalho de Parto/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Sistema de Registros , Eslováquia/epidemiologia , Inquéritos e Questionários
7.
BMC Public Health ; 20(1): 993, 2020 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-32580720

RESUMO

BACKGROUND: Universal child health services (UCHS) provide an important pragmatic platform for the delivery of universal and targeted interventions to support families and optimize child health outcomes. We aimed to identify brief, evidence-based interventions for common health and developmental problems that could be potentially implemented in UCHS. METHODS: A restricted evidence assessment (REA) of electronic databases and grey literature was undertaken covering January 2006 to August 2019. Studies were eligible if (i) outcomes related to one or more of four areas: child social and emotional wellbeing (SEWB), infant sleep, home learning environment or parent mental health, (ii) a comparison group was used, (iii) universal or targeted intervention were delivered in non-tertiary settings, (iv) interventions did not last more than 4 sessions, and (v) children were aged between 2 weeks postpartum and 5 years at baseline. RESULTS: Seventeen studies met the eligibility criteria. Of these, three interventions could possibly be implemented at scale within UCHS platforms: (1) a universal child behavioural intervention which did not affect its primary outcome of infant sleep but improved parental mental health, (2) a universal screening programme which improved maternal mental health, and (3) a targeted child behavioural intervention which improved parent-reported infant sleep problems and parental mental health. Key lessons learnt include: (1) Interventions should impart the maximal amount of information within an initial session with future sessions reinforcing key messages, (2) Interventions should see the family as a holistic unit by considering the needs of parents with an emphasis on identification, triage and referral, and (3) Brief interventions may be more acceptable for stigmatized topics, but still entail considerable barriers that deter the most vulnerable. CONCLUSIONS: Delivery and evaluation of brief evidence-based interventions from a UCHS could lead to improved maternal and child health outcomes through a more responsive and equitable service. We recommend three interventions that meet our criteria of "best bet" interventions.


Assuntos
Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/estatística & dados numéricos , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/organização & administração , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
10.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 8-12, 2020 Jan 06.
Artigo em Chinês | MEDLINE | ID: mdl-31914562

RESUMO

With the rapid development of medical practice, evidence-based medicine combines the best evidence, clinical experience and patient value, the role of evidence-based public health in public health has become increasingly prominent. However, only about half of the evidence-based medical evidence can be truly translated into regular health care services, and the conversion process takes a long time. In order to bridge the gap between best evidence and clinical or public health applications, implementation research emerged as a new discipline. This paper introduce the background, development, theory and methods of implementation research, and discusses it's application and challenges of implementing scientific in the field of public health in China.


Assuntos
Ciência da Implementação , Saúde Pública , China , Medicina Baseada em Evidências/organização & administração , Humanos
11.
Clin Pharmacol Ther ; 107(1): 136-139, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31376148

RESUMO

"Regulatory science" (RS) has been defined in various ways, but, nevertheless, the definitions of RS in different parts of the world include many common elements. It seems to be a common view that RS is not basic or applied science but, rather, focuses on the estimation and prediction of safety and efficacy. Thus, we think RS overall should incorporate not only RS specifically for medical product assessment but also RS engineering to provide prediction and estimation tools for those purposes, including guideline/guidance development. It is important as well to consider the potential contribution of RS to rational medicine (i.e., to evidence-based medicine in a broader context), and especially to real-world evidence generation. We will look at how definitions of RS have evolved, and how we believe RS might develop in the future. Taking a patient-centric view, we re-emphasize RS is an ethical science contributing to society and human welfare.


Assuntos
Medicina Baseada em Evidências/organização & administração , Saúde Global/legislação & jurisprudência , Avaliação da Tecnologia Biomédica/métodos , Medicina Baseada em Evidências/legislação & jurisprudência , Regulamentação Governamental , Humanos , Assistência Centrada no Paciente/legislação & jurisprudência , Assistência Centrada no Paciente/organização & administração
12.
J Trauma Acute Care Surg ; 88(1): 106-112, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31490336

RESUMO

BACKGROUND: Unaddressed alcohol use among injured patients may result in recurrent injury or death. Many trauma centers incorporate alcohol screening, brief intervention, and referral to treatment for injured patients with alcohol use disorders, but systematic reviews evaluating the impact of these interventions are lacking. METHODS: An evidence-based systematic review was performed to answer the following population, intervention, comparator, outcomes question: Among adult patients presenting for acute injury, should emergency department, trauma center, or hospital-based alcohol screening with brief intervention and/or referral to treatment be instituted compared with usual care to prevent or decrease reinjury, hospital readmission, alcohol-related offenses, and/or alcohol consumption? A librarian-initiated query of PubMed, MEDLINE, and the Cochrane Library was performed. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the quality of the evidence and create recommendations. The study was registered with PROSPERO (registration number CRD42019122333). RESULTS: Eleven studies met criteria for inclusion, with a total of 1,897 patients who underwent hospital-based alcohol screening, brief intervention, and/or referral to treatment for appropriate patients. There was a relative paucity of data, and studies varied considerably in terms of design, interventions, and outcomes of interest. Overall evidence was assessed as low quality, but a large effect size of intervention was present. CONCLUSION: In adult trauma patients, we conditionally recommend emergency department, trauma center, or hospital-based alcohol screening with brief intervention and referral to treatment for appropriate patients in order to reduce alcohol-related reinjury. LEVEL OF EVIDENCE: Systematic review, Level III.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Programas de Rastreamento/organização & administração , Prevenção Secundária/organização & administração , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/cirurgia , Adulto , Consumo de Bebidas Alcoólicas/terapia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/normas , Medicina Baseada em Evidências/estatística & dados numéricos , Cirurgia Geral/normas , Humanos , Incidência , Programas de Rastreamento/normas , Programas de Rastreamento/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Prevenção Secundária/normas , Prevenção Secundária/estatística & dados numéricos , Sociedades Médicas/normas , Centros de Traumatologia/normas , Centros de Traumatologia/estatística & dados numéricos , Estados Unidos , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia
13.
Ann Pharmacother ; 54(3): 287-289, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31625410

RESUMO

Evidence-based medicine (EBM) has been positively accepted by clinicians; however, there are barriers to practicing EBM that create gaps between EBM and current clinical practice. A pharmacist-led drug information (DI) service initiative was established to overcome common barriers to practicing EBM. The service utilizes technology and a collaborative model among otherwise independent academic DI centers to provide efficient high-quality service to health care professionals. It was piloted at a large health care system with positive user satisfaction. The unique technological collaborative has shown several benefits, including increased efficiency and peer learning among DI pharmacists.


Assuntos
Serviços de Informação sobre Medicamentos/organização & administração , Medicina Baseada em Evidências , Atitude do Pessoal de Saúde , Estudos Transversais , Tomada de Decisões , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/normas , Medicina Baseada em Evidências/tendências , Humanos , Modelos Organizacionais , Equipe de Assistência ao Paciente , Farmacêuticos
14.
J Am Geriatr Soc ; 68(1): 15-22, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31721145

RESUMO

The US population is aging faster than at any other time in our history. This growth, coupled with a slow adaptive health policy framework, is creating an urgent need to reengineer and improve the quality, safety, and cost-effectiveness of health systems to meet the needs of older adults and embrace the success we have achieved with longevity. Without rapid adoption of evidence-based models that are known to improve safety and health outcomes, we significantly jeopardize the lives of thousands of older adults receiving care under our current health systems' processes and models. This article describes an innovation and operations infrastructure that was successfully tested in two independent and geographically distinct community health systems. This operations and implementation framework can be scaled and used to accelerate the changes needed to improve care for older adults in health systems throughout the United States. J Am Geriatr Soc 68:15-22, 2019.


Assuntos
Envelhecimento , Assistência à Saúde/organização & administração , Difusão de Inovações , Medicina Baseada em Evidências/organização & administração , Modelos Organizacionais , Idoso , Política de Saúde , Humanos , Estados Unidos
15.
Health Res Policy Syst ; 17(1): 100, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842886

RESUMO

The importance of linking evidence into practice and policy is recognised as a key pillar of a prudent approach to healthcare; it is of importance to healthcare professionals and decision-makers across the world in every speciality. However, rapid access to evidence to support service redesign, or to change practice at pace, is challenging. This is particularly so in smaller specialties such as Palliative Care, where pressured multidisciplinary clinicians lack time and skill sets to locate and appraise the literature relevant to a particular area. Therefore, we have initiated the Palliative Care Evidence Review Service (PaCERS), a knowledge transfer partnership through which we have developed a clear methodology to conduct evidence reviews to support professionals and other decision-makers working in palliative care.PaCERS methodology utilises modified systematic review methods as there is no agreed definition or an accepted methodology for conducting rapid reviews. This paper describes the stages involved based on our iterative recent experiences and engagement with stakeholders, who are the potential beneficiaries of the research. Uniquely, we emphasise the process and opportunities of engagement with the clinical workforce and policy-makers throughout the review, from developing and refining the review question at the start through to the importance of demonstrating impact. We are faced with the challenge of the trade-off between the timely transfer of evidence against the risk of impacting on rigour. To address this issue, we try to ensure transparency throughout the review process. Our methodology aligns with key principles of knowledge synthesis in defining a process that is transparent, robust and improving the efficiency and timeliness of the review.Our reviews are clinically or policy driven and, although we use modified systematic review methods, one of the key differences between published review processes and our review process is in our relationship with the requester. This streamlining approach to synthesising evidence in a timely manner helps to inform decisions faced by clinicians and decision-makers in healthcare settings, supporting, at pace, knowledge transfer and mobilisation.


Assuntos
Comportamento Cooperativo , Medicina Baseada em Evidências/organização & administração , Cuidados Paliativos/organização & administração , Pesquisa Médica Translacional/organização & administração , Medicina Baseada em Evidências/normas , Humanos , Cuidados Paliativos/normas , Pesquisa Médica Translacional/normas
16.
Eur. j. clin. microbiol. infect. dis ; 39: [483-491], Dec. 10, 2019.
Artigo em Inglês | BIGG - guias GRADE | ID: biblio-1117206

RESUMO

Clinical practice guidelines (CPGs) are intended to support clinical decisions and should be based on high-quality evidence. Theobjective of the study was to evaluate the quality of evidence supporting the recommendations issued in CPGs for therapy,diagnosis, and prevention of hospital-acquired and ventilator-associated pneumonia (HAP/VAP). CPGs released by internationalscientific societies after year 2000, using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE)methodology, were analyzed. Number and strength of recommendations and quality of evidence (high, moderate, low, and verylow) were extracted and indexed in the aforementioned sections. High-quality evidence was based on randomized control trials(RCT) without important limitations and exceptionally on rigorous observational studies. Eighty recommendations wereassessed, with 7 (8.7%), 24 (30.0%), 29 (36.3%), and 20 (25.0%) being supported by high, moderate, low, and very lowquality evidence, respectively. Highest evidence degree was reported for 26 prevention recommendations, with 7 (26.9%)supported by high-quality evidence and no recommendation based on very low-quality evidence. In contrast, among 9 recommendations for diagnosis and 45 for therapy, none was supported by high-quality evidence, in spite of being recommended asstrong in 33.3% and 46.7%, respectively. Among HAP/VAP diagnosis recommendations, the majority of evidence was rated as low or very low-quality (55.6% and 22.2%, respectively) whereas among HAP/VAP therapy recommendations, 4/5 were rated aslow and very low-quality (40% each). In conclusion, among HAP/VAP international guidelines, most recommendations, particularly in therapy, remain supported by observational studies, case reports, and expert opinion. Well-designed RCTs are urgently needed.


Assuntos
Humanos , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Pneumonia Associada a Assistência à Saúde/prevenção & controle , Medicina Baseada em Evidências/organização & administração
17.
J Am Board Fam Med ; 32(6): 818-826, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31704750

RESUMO

BACKGROUND: Team-based care facilitates efficient, evidence-based, patient-centered practice. An outpatient, integrated lactation consultant (LC) and primary care provider (PCP) model improves breastfeeding support, yet practices need assistance with implementation. METHOD: Based on experience with team-based breastfeeding support at a suburban practice serving mainly well-educated and privately insured families, we constructed and piloted a 6-step needs assessment that informed implementation of the model at a federally qualified health center (FQHC). Practice assessment included baseline data collection of practice newborn volume, breastfeeding intent, breastfeeding rates, provider survey, and financial variables. Postimplementation outcome measurements included provider satisfaction and visit volume. RESULTS: Analysis using newborn volume, breastfeeding intent, and average insurance reimbursement enabled business calculation, which estimated additional 400 visits per year and revenue to cover staff training costs. The baseline provider survey (n = 20) assessed knowledge, practice resources, and barriers. The main barriers identified to providing lactation support were "not enough time" (80%) and patients "not receiving adequate help" (80%) with 58% noting "inadequate LC staffing at the clinic." After team-based LC/PCP implementation, monthly lactation visit volume doubled. Provider postintervention assessment surveys (n = 20) demonstrated a positive response with providers reporting a perception of "providing better breastfeeding support" (100%) and that "patients had a positive breastfeeding support experience" (84%). CONCLUSION: Team-based LC and PCP health care is a promising approach for delivering efficient, patient-centered, face-to-face counseling and support. Practice assessment informs financial feasibility and confirms provider interest in change. An integrated LC/PCP model can be implemented in a FQHC while enhancing patient breastfeeding support and provider satisfaction.


Assuntos
Aleitamento Materno , Necessidades e Demandas de Serviços de Saúde/organização & administração , Equipe de Assistência ao Paciente , Cuidado Pós-Natal/organização & administração , Atenção Primária à Saúde/organização & administração , Adolescente , Adulto , Aconselhamento/organização & administração , Medicina Baseada em Evidências/organização & administração , Feminino , Implementação de Plano de Saúde , Promoção da Saúde/organização & administração , Humanos , Lactente , Assistência Centrada no Paciente/organização & administração , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Adulto Jovem
18.
Vet Rec ; 185(20): 636, 2019 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-31757923
20.
Am J Health Syst Pharm ; 76(21): 1753-1761, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31612925

RESUMO

PURPOSE: To assess antibiotic selection, administration, and prescribing practices in emergency departments across a large hospital system using evidence-based practices and susceptibility patterns. METHODS: This retrospective data review was conducted using health system-level electronic data compiled from 145 emergency departments (EDs) across the United States. Data were examined for national generalizability, most common diagnoses of infectious origin seen in nonadmitted patients in the ED, most commonly administered antibiotics in the ED, and geographically defined areas' unique patterns of antibiotic resistance and susceptibility. RESULTS: More than 627,000 unique patient encounters and 780,000 antibiotic administrations were assessed for trends in patient demographics, antibiotics administered for a diagnosis of infectious origin, and corresponding susceptibility patterns. Results indicated that practices in the EDs of this health system aligned with evidence-based practices for streptococcal pharyngitis, otitis media, cellulitis, and uncomplicated urinary tract infections. CONCLUSION: These results provide a representative sample of the current state of practices within many EDs across the United States for nonadmitted patients. A similar data reconstruction can be completed by other health systems to assess their prescribing practices in the ED to improve and elevate care for patients visiting the emergency room and treated as outpatients.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Medicina Baseada em Evidências/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Gestão de Antimicrobianos/organização & administração , Criança , Pré-Escolar , Resistência Microbiana a Medicamentos , Serviço Hospitalar de Emergência/organização & administração , Medicina Baseada em Evidências/organização & administração , Feminino , Implementação de Plano de Saúde , Humanos , Prescrição Inadequada/estatística & dados numéricos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Infecções Respiratórias/tratamento farmacológico , Estudos Retrospectivos , Estados Unidos , Infecções Urinárias/tratamento farmacológico , Adulto Jovem
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