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1.
Rev Soc Bras Med Trop ; 53: e20200167, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32320998

RESUMO

The outbreak of new coronavirus disease 2019 (COVID-19) reported for the first time in Wuhan, China in late December 2019 have rapidly spread to other countries and it was declared on January 30, 2020 as a public health emergency of international concern (PHEIC) by the World Health Organization. Before the first COVID-19 cases were reported in Brazil, several measures have been implemented including the adjustment of legal framework to carry out isolation and quarantine. As the cases increased significantly, new measures, mainly to reduce mortality and severe cases, have also been implemented. Rapid and robust preparedness actions have been undertaken in Brazil while first cases have not yet been identified in Latin-American. The outcome of this early preparation should be analyzed in future studies.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Programas Nacionais de Saúde/tendências , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Medicina Estatal/tendências , Brasil/epidemiologia , Monitoramento Epidemiológico , Humanos , Medição de Risco
5.
Ann R Coll Surg Engl ; 102(4): 271-276, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31918560

RESUMO

INTRODUCTION: There has been regular dialogue regarding the importance of developing clinical networks to compensate for the steady decline in general paediatric surgery performed by adult surgeons. Despite this dialogue, there are no contemporary published data to quantify the issue. This report documents patterns in delivery of general paediatric surgery in England and shows what is being performed where and by whom. MATERIALS AND METHODS: Using the Surgical Workload Outcome Database, we compared hospital-level data between 2009 and 2017. Inclusion criteria were children under 18 years admitted to NHS hospitals in England for elective general paediatric surgery. Data were analysed with an online statistical package performing paired t-tests. RESULTS: There was no real change in the overall number of elective general paediatric surgical marker cases, but the type mix has changed. The number of marker cases performed by adult surgeons fell by 34% (4699 vs 3090 p < 0.05). The number of marker cases performed by specialist paediatric surgeons increased by 21% (8184 vs 9862 p < 0.05). This increase in workload occurred in both tertiary (21% increase) and peripheral (18% increase) centres. When analysing data by operation type it was apparent that 78% of the increased workload was attributable to an increase in orchidopexy rate. CONCLUSION: Best practice is to treat children close to home by staff with the right skills. This study shows significant shifts in the general paediatric surgical workload. It is important to monitor these trends for successful succession planning as well as configuration of services.


Assuntos
Procedimentos Cirúrgicos Eletivos/tendências , Hospitais Gerais/tendências , Hospitais Pediátricos/tendências , Centro Cirúrgico Hospitalar/tendências , Carga de Trabalho/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Inglaterra , Feminino , Planejamento Hospitalar/organização & administração , Hospitais Gerais/estatística & dados numéricos , Hospitais Pediátricos/organização & administração , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Especialização/estatística & dados numéricos , Especialização/tendências , Medicina Estatal/organização & administração , Medicina Estatal/estatística & dados numéricos , Medicina Estatal/tendências , Cirurgiões/estatística & dados numéricos , Cirurgiões/tendências , Centro Cirúrgico Hospitalar/estatística & dados numéricos
7.
Scand Cardiovasc J ; 53(6): 361-372, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31394936

RESUMO

Objective. International guidelines recommend rehabilitation including supervised exercise therapy in patients with Intermittent Claudication (IC), but knowledge of the implementation in clinical practice is limited. This study aims to investigate current practice and opinions on rehabilitation for patients with IC among vascular surgeons and rehabilitation departments in the municipalities and hospitals. Design. Three electronic cross-sectional surveys were distributed nationally to the Danish vascular surgeons (n = 131) and to rehabilitation departments in the municipalities (n = 92) and hospitals (n = 33). Results. The response rates were 70% among the vascular surgeons, 98% among the municipalities and 94% among the hospitals. Vascular surgeons utilize oral advice to exercise by self-administered walking, pharmacological treatment, and revascularization to improve walking distance in patients with IC. Currently, only 12% of the vascular surgeons referred to rehabilitation to improve walking distance, while almost all vascular surgeons (96%) would refer their patients to IC rehabilitation, if it was available. Only 14% of municipalities and none of the hospitals, who treat patients with IC, have a rehabilitation program designed specifically for patients with IC. However, 59% of the rehabilitation departments in the municipalities and 26% in the hospitals included patients with IC in rehabilitation program designed for other patient groups - mostly cardiac patients. There was consensus among the groups of respondents that future IC specific rehabilitation should include an initial conversation, supervised exercise therapy, smoking cessation, and patient education according to guidelines. Conclusion. Vascular surgeons support referral and participation in IC rehabilitation to improve walking distance in patients with IC. Despite some hospitals and municipalities included patients with IC in rehabilitation nearly all services fail to meet current guideline as specific services tailored to patient with IC is almost non-existent in Denmark. Our findings call for action for services to comply with current recommendations of structured, systematic rehabilitation for patients with IC.


Assuntos
Terapia por Exercício/tendências , Claudicação Intermitente/reabilitação , Educação de Pacientes como Assunto/tendências , Padrões de Prática Médica/tendências , Encaminhamento e Consulta/tendências , Abandono do Hábito de Fumar , Medicina Estatal/tendências , Cirurgiões/tendências , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Dinamarca/epidemiologia , Tolerância ao Exercício , Feminino , Pesquisas sobre Serviços de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/epidemiologia , Claudicação Intermitente/fisiopatologia , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Cirurgiões/psicologia , Resultado do Tratamento , Caminhada
9.
Healthc Q ; 21(4): 32-36, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30946652

RESUMO

This issue of Healthcare Quarterly features the third and final instalment in a three-part series developed by Ontario's The Change Foundation featuring international perspectives on health service delivery models that improve system integration and ensure seamless services and better coordination. Part one featured Chris Ham, chief executive of the London-based King's Fund think tank, and part two featured Geoff Huggins, director for health and social care integration in Scotland. In this issue, Helen Bevan, chief transformation officer of England's National Health Service, discusses the radical shifts she'd like to see in how we approach integration.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Medicina Estatal/organização & administração , Prestação Integrada de Cuidados de Saúde/métodos , Inglaterra , Humanos , Liderança , Atenção Primária à Saúde/organização & administração , Medicina Estatal/tendências
12.
Int J Health Care Qual Assur ; 32(1): 21-33, 2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30859878

RESUMO

PURPOSE: The purpose of this paper is to assess failure demand as a lean concept that assists in waste analysis during quality improvement activity. The authors assess whether the concept's limited use is a missed opportunity to help us understand improvement priorities, given that a UK Government requirement for public service managers to report failure demand has been removed. DESIGN/METHODOLOGY/APPROACH: The authors look at the literature across the public sector and then apply the failure demand concept to the UK's primary healthcare system. The UK National Health Service (NHS) demand data are analysed and the impact on patient care is elicited from patient interviews. FINDINGS: The study highlighted the concept's value, showing how primary care systems often generate failure demand partly owing to existing demand and capacity management practices. This demand is deflected to other systems, such as the accident and emergency department, with a considerable detrimental impact on patient experience. RESEARCH LIMITATIONS/IMPLICATIONS: More research is needed to fully understand how best to exploit the failure demand concept within wider healthcare as there are many potential barriers to its appropriate and successful application. PRACTICAL IMPLICATIONS: The authors highlight three practical barriers to using failure demand: first, demand within the healthcare system is poorly understood; second, systems improvement understanding is limited; and third, need to apply the concept for improvement and not just for reporting purposes. ORIGINALITY/VALUE: The authors provide an objective and independent insight into failure demand that has not previously been seen in the academic literature, specifically in relation to primary healthcare.


Assuntos
Atenção Primária à Saúde/normas , Melhoria de Qualidade/organização & administração , Medicina Estatal/normas , Assistência à Saúde/organização & administração , Humanos , Atenção Primária à Saúde/tendências , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde/organização & administração , Medicina Estatal/tendências , Reino Unido
16.
Int J Soc Psychiatry ; 65(2): 107-113, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30654680

RESUMO

BACKGROUND: Mental health can help explain how social inequalities impact on health. Many current public health challenges are shaped by social, economic and environmental conditions that take a mental toll on society. PURPOSE: This article describes a conceptual framework illustrating the psychosocial pathways that link the wider conditions to health behaviours and outcomes. It draws out implications of this framework for mental health practice that aim to support policy and decision-making on future action to reduce health inequalities and presents practical examples of what can be done. METHODS: This article expands on a report commissioned by Public Health England. A narrative review and synthesis of relevant evidence built on existing research by the Institute of Health Equity. A conceptual framework was developed and a consultation exercise with stakeholders helped to revise and illustrate it with practice examples. CONCLUSIONS: The field of mental health has much to contribute to prevention, not just of mental illness but also of physical health conditions and reduction of inequalities in life expectancy and healthy life expectancy, especially through collaborative public health action.


Assuntos
Disparidades nos Níveis de Saúde , Transtornos Mentais/prevenção & controle , Saúde Mental , Administração em Saúde Pública/tendências , Medicina Estatal/organização & administração , Comportamento Cooperativo , Inglaterra , Humanos , Modelos Psicológicos , Pesquisa Qualitativa , Determinantes Sociais da Saúde , Medicina Estatal/tendências
18.
Arch Dis Child Fetal Neonatal Ed ; 104(3): F324-F325, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30355782

RESUMO

BACKGROUND: Previous surveys have demonstrated that neonatal resuscitation practices on the delivery suite vary between UK units, particularly according to the hospital's neonatal unit's level. Our aim was to determine if recent changes to the Resuscitation Council guidelines had influenced clinical practice. METHODS: Surveys of resuscitation practices at UK delivery units carried out in 2012 and 2017 were compared. RESULTS: Comparing 2017 with 2012, initial resuscitation using air was more commonly used in both term (98% vs 75%, p<0.001) and preterm (84% vs 34%, p<0.001) born infants. Exhaled carbon dioxide monitoring was more frequently employed in 2017 (84% vs 19%, p<0.001). There were no statistically significant differences in practices according to the level of neonatal care provided by the hospital. CONCLUSION: There have been significant changes in neonatal resuscitation practices in the delivery suite since 2012 regardless of the different levels of neonatal care offered.


Assuntos
Salas de Parto/tendências , Assistência Perinatal/tendências , Ressuscitação/tendências , Salas de Parto/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal/normas , Unidades de Terapia Intensiva Neonatal/tendências , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Monitorização Fisiológica/tendências , Assistência Perinatal/métodos , Assistência Perinatal/normas , Guias de Prática Clínica como Assunto , Prática Profissional/normas , Prática Profissional/tendências , Ressuscitação/métodos , Ressuscitação/normas , Medicina Estatal/normas , Medicina Estatal/tendências , Reino Unido
19.
Nurs Inq ; 26(1): e12271, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30548117

RESUMO

Compassion in healthcare has received significant attention recently, on an international scale, with concern raised about its absence during clinical interactions. As a concept, compassionate care has been linked to nursing. We examined historical discourse on this topic, to understand and situate current debates on compassionate care as a hallmark of high-quality services. Documents we looked at illustrated how responsibility for delivering compassionate care cannot be consigned to individual nurses. Health professionals must have the right environmental circumstances to be able to provide and engage in compassionate interactions with patients and their relatives. Hence, although compassionate care has been presented as a straightforward solution when crisis faces health services, this discourse, especially in policy documents, has often failed to acknowledge the system-level issues associated with its provision. This has resulted in simplistic presentations of 'compassion' as inexpensive and the responsibility of individual nurses, a misleading proposal that risks devaluing the energy and resources required to deliver compassionate care. It also overlooks the need for organisations, not just individuals, to be charged with upholding its provision.


Assuntos
Empatia , Liderança , Humanos , Medicina Estatal/organização & administração , Medicina Estatal/tendências , Estereotipagem , Reino Unido
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