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1.
BMC Infect Dis ; 19(1): 770, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481020

RESUMO

BACKGROUND: We sought to assess reporting in China's Pneumonia of Unknown Etiology (PUE) passive surveillance system for emerging respiratory infections and to identify ways to improve the PUE surveillance system's detection of respiratory infections of public health significance. METHODS: From February 29-May 29, 2016, we actively identified and enrolled patients in two hospitals with acute respiratory infections (ARI) that met all PUE case criteria. We reviewed medical records for documented exposure history associated with respiratory infectious diseases, collected throat samples that were tested for seasonal and avian influenza, and interviewed clinicians regarding reasons for reporting or not reporting PUE cases. We described and analyzed the proportion of PUE cases reported and clinician awareness of and practices related to the PUE system. RESULTS: Of 2619 ARI admissions in two hospitals, 335(13%) met the PUE case definition; none were reported. Of 311 specimens tested, 18(6%) were seasonal influenza virus-positive; none were avian influenza-positive. < 10% PUE case medical records documented whether or not there were exposures to animals or others with respiratory illness. Most commonly cited reasons for not reporting cases were no awareness of the PUE system (76%) and not understanding the case definition (53%). CONCLUSIONS: Most clinicians have limited awareness of and are not reporting to the PUE system. Exposures related to respiratory infections are rarely documented in medical records. Increasing clinicians' awareness of the PUE system and including relevant exposure items in standard medical records may increase reporting.


Assuntos
Notificação de Doenças , Necessidades e Demandas de Serviços de Saúde , Pneumonia/epidemiologia , Pneumonia/etiologia , Vigilância da População , Adulto , China/epidemiologia , Doenças Transmissíveis Emergentes/diagnóstico , Doenças Transmissíveis Emergentes/epidemiologia , Diagnóstico Diferencial , Notificação de Doenças/métodos , Notificação de Doenças/normas , Feminino , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/normas , Hospitalização , Humanos , Influenza Humana/epidemiologia , Masculino , Notificação de Abuso , Testes Obrigatórios/normas , Pessoa de Meia-Idade , Projetos Piloto , Pneumonia/diagnóstico , Vigilância da População/métodos , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Avaliação de Programas e Projetos de Saúde , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Engajamento no Trabalho
2.
Pediatrics ; 143(5)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31010906

RESUMO

Children with special health care needs should have access to proper resources for safe transportation as do typical children. This policy statement reviews important considerations for transporting children with special health care needs and provides current guidance for the protection of children with specific health care needs, including those with airway obstruction, orthopedic conditions or procedures, developmental delays, muscle tone abnormalities, challenging behaviors, and gastrointestinal disorders.


Assuntos
Serviços de Saúde da Criança/normas , Crianças com Deficiência , Necessidades e Demandas de Serviços de Saúde/normas , Cintos de Segurança/normas , Transporte de Pacientes/normas , Criança , Humanos , Transporte de Pacientes/métodos
3.
Diabetes Care ; 42(5): 705-712, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31010940

RESUMO

Group clinics are becoming popular as a new care model in diabetes care. This evidence synthesis, using realist review methodology, examined the role of group clinics in meeting the complex needs of young people living with diabetes. Following Realist And Meta-narrative Evidence Synthesis-Evolving Standards (RAMESES) quality standards, we conducted a systematic search across 10 databases. A total of 131 articles met inclusion criteria and were analyzed to develop theoretically informed explanations of how and why group clinics could work (or not) for young people with diabetes. Models of group-based care in the literature varied significantly and incorporated different degrees of clinical and educational content. Our analysis identified four overarching principles that can be applied in different contexts to drive sustained engagement of young people in group clinics: 1) emphasizing self-management as practical knowledge; 2) developing a sense of affinity between patients; 3) providing safe, developmentally appropriate care; and 4) balancing group and individual needs. Implementation of group clinics was not always straightforward; numerous adjustments to operational and clinical processes were required to establish and deliver high-quality care. Group clinics for young people with diabetes offer the potential to complement individualized care but are not a panacea and may generate as well as solve problems.


Assuntos
Instituições de Assistência Ambulatorial , Diabetes Mellitus/terapia , Acesso aos Serviços de Saúde , Adolescente , Fatores Etários , Idade de Início , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/normas , Diabetes Mellitus/epidemiologia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/normas , Humanos , Autogestão , Adulto Jovem
4.
Diabetes Res Clin Pract ; 150: 184-193, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30872067

RESUMO

AIMS: This study explored the impact of a care management intervention aiming to improve self-care behavior in multimorbid individuals with Type 2 diabetes mellitus on health-related quality of life (HRQoL). METHODS: A patient-level randomized parallel-group superiority trial with 32 primary care practice teams, 11 care managers and 495 patients was conducted. The intervention was delivered as add-on to an already implemented disease management program and embedded in a network of primary care practices. Hierarchical linear modeling was used to analyze impacts of the care management approach on HRQoL. RESULTS: Small improvements of HRQoL in the intervention arm were found after nine months (r = 0.024; 95%CI = [0.000, 0.047]). However, compared to standard care no significant differences of HRQoL changes were observed (r = 0.022; 95%CI = [-0.011, 0.054]). Subgroup analyses showed effects for female participants favoring the intervention arm (r = 0.059; 95%CI = [0.010, 0.108]). No significant differences between intervention and control arm for several other subgroups were observed, including subgroups defined by comorbidities. CONCLUSION: Additional care management did not influence HRQoL over and above standard disease management. Improving diabetes patients' self-care behavior in the context of structured disease management programs may be difficult to achieve. Women might benefit from additional care management, but this finding needs to be confirmed in future research.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Necessidades e Demandas de Serviços de Saúde/normas , Qualidade de Vida , Autocuidado , Idoso , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Atenção Primária à Saúde
5.
Int J Gynaecol Obstet ; 144 Suppl 1: 4-6, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30815871

RESUMO

Globally, countries have made impressive strides toward achieving targets set by the Millennium Development Goals (MDGs) to reduce maternal mortality. The subsequent Sustainable Development Goals (SDGs) have further challenged countries to accelerate these reductions. While Indonesia invested in several initiatives to improve care for mothers and newborns and made large gains in improving skilled care at birth, the country fell short of its MDG target. This paper outlines some of the remaining challenges and highlights the role of the US Agency for International Development-funded Expanding Maternal and Neonatal Survival (EMAS) program in eliminating the barriers to improved care. Achieving the SDGs by 2030 will require strong cross-sectoral collaboration and innovative approaches, such as the recent launch of Indonesia's national health insurance program, which can accelerate reductions in mortality by reaching women most in need of services.


Assuntos
Mortalidade Infantil , Mortalidade Materna , Feminino , Necessidades e Demandas de Serviços de Saúde/normas , Humanos , Indonésia/epidemiologia , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Mortalidade Materna/tendências , Programas Nacionais de Saúde/organização & administração , Gravidez
7.
J Cancer Surviv ; 13(1): 148-159, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30685822

RESUMO

PURPOSE: To identify the qualitative evidence on the experience of cancer and comorbid illness from the perspective of patients, carers and health care professionals to identify psycho-social support needs, experience of health care, and to highlight areas where more research is needed. METHODS: A qualitative systematic review following PRISMA guidance. Relevant research databases were searched using an exhaustive list of search terms. Two reviewers independently screened titles and abstracts and discussed variations. Included articles were subject to quality appraisal before data extraction of article characteristics and findings. Thomas and Harden's thematic synthesis of extracted findings was undertaken. RESULTS: Thirty-one articles were included in the review, covering a range of cancer types and comorbid conditions; with varying time since cancer diagnosis and apparent severity of disease for both cancer and other conditions. The majority of studies were published after 2010 and in high income countries. Few studies focused exclusively on the experience of living with comorbid conditions alongside cancer; such that evidence was limited. Key themes identified included the interaction between cancer and comorbid conditions, symptom experience, illness identities and ageing, self-management and the role of primary and secondary care. CONCLUSIONS: In addition to a better understanding of the complex experience of cancer and comorbidity, the review will combine with research prioritisation work with consumers to inform an interview study with the defined patient group. IMPLICATIONS FOR CANCER SURVIVORS: Expanding this evidence base will help to illuminate developing models of cancer patient-centred follow-up care for the large proportion of patients with comorbid conditions.


Assuntos
Atividades Cotidianas , Sobreviventes de Câncer , Neoplasias/epidemiologia , Neoplasias/terapia , Apoio Social , Atividades Cotidianas/psicologia , Sobreviventes de Câncer/psicologia , Sobreviventes de Câncer/estatística & dados numéricos , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Comorbidade , Assistência à Saúde/normas , Pessoal de Saúde , Necessidades e Demandas de Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Determinação de Necessidades de Cuidados de Saúde/normas , Neoplasias/complicações , Neoplasias/psicologia , Assistência Centrada no Paciente/métodos , Pesquisa Qualitativa
8.
Cancer ; 125(9): 1518-1526, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30602057

RESUMO

BACKGROUND: High-quality oncology care is marked by skillful communication, yet little is known about patient and family communication perceptions or content preferences. Our study sought to elicit pediatric oncology patient and parent perceptions of early cancer communication to establish whether informational needs were met and identify opportunities for enhanced communication throughout cancer care. METHOD: An original survey instrument was developed, pretested, and administered to 129 patients, age 10-18 years, and their parents at 3 cancer centers between 2011 and 2015. Statistical analysis of survey items about perceived communication, related associations, and patient/parent concordance was performed. RESULTS: A greater percentage of participants reported "a lot" of discussion about the physical impact of cancer (patients, 58.1% [n = 75]; parents, 69.8% [n = 90]) compared with impact on quality of life (QOL) (patients, 44.2% [n = 57]; parents, 55.8% [n = 72]) or emotional impact (patients, 31.8% [n = 41]; parents, 43.4% [n = 56]). One fifth of patients (20.9% [n = 27]) reported they had no up-front discussion about the emotional impact of cancer treatment. Parents indicated a desire for increased discussion regarding impact on family life (27.9% [n = 36]), long-term QOL (27.9% [n = 36]), and daily activities (20.2% [n = 26]). Patients more frequently than parents indicated a desire for increased physician/patient discussion around the impact on daily activities (patients, 40.3% [n = 52]; parents, 21.7% [n = 28]; P < .001), long-term QOL (patients, 34.9% [n = 45]; parents, 16.3% [n = 21]; P < .001), pain management (patients, 23.3% [n = 30]; parents, 7% [n = 9]; P < .001), physical symptom management (patients, 24% [n = 31]; parents, 7.8% [n = 10]; P < .001), short-term QOL (patients, 23.3% [n = 30]; parents, 9.3% [n = 12]; P = .001), and curative potential (patients, 21.7% [n = 28]; parents, 8.5% [n = 11]; P = .002, P values calculated using McNemar's test). CONCLUSION: Oncologists may not be meeting the informational needs of many patients and some parents/caregivers. Communication could be enhanced through increased direct physician-patient communication, as well as proactive discussion of emotional symptoms and impact of cancer on QOL.


Assuntos
Comunicação , Necessidades e Demandas de Serviços de Saúde , Oncologia , Neoplasias/terapia , Pediatria , Adolescente , Adulto , Idoso , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Criança , Família/psicologia , Feminino , Necessidades e Demandas de Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Oncologia/normas , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/psicologia , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/normas , Educação de Pacientes como Assunto/estatística & dados numéricos , Pediatria/normas , Pediatria/estatística & dados numéricos , Relações Médico-Paciente , Médicos/psicologia , Médicos/normas , Médicos/estatística & dados numéricos , Inquéritos e Questionários
9.
J Autism Dev Disord ; 49(2): 556-568, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30145735

RESUMO

With the increasing prevalence of adults with autism spectrum disorder (ASD), research examining the service experiences of this population is greatly needed. The current study investigated service use, unmet needs, and obstacles to service access for a large sample of adults with ASD. After accounting for various demographic factors known to impact service usage and needs, living situation was a significant predictor of service use, needs, and obstacles to services. Adults with ASD living with family reported less service use, higher unmet need, and more obstacles to accessing services. With more than half of this adult sample living with family, results have clear public policy implications to support the increasing population of adults with ASD living with aging caregivers.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Utilização de Instalações e Serviços/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/normas , Adulto , Transtorno do Espectro Autista/reabilitação , Criança , Família , Feminino , Humanos , Masculino , Características de Residência , Condições Sociais
10.
Med Law Rev ; 27(2): 295-317, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30102359

RESUMO

Human rights discourse on the rights of transgender people has to a large extent focused on access to correction of legal gender and medical preconditions for this change. Jurisdictions across the world are now beginning to free legal gender recognition from medical interventions and examinations. State bodies have, however, done little to realise the rights of transgender people to adequate healthcare. A key issue is whether international law obliges states to ensure access to trans-specific healthcare. This article examines the right to healthcare appropriate to transgender persons' needs. Drawing on in-depth interviews with transgender people living in Norway, it investigates how individuals explain their needs for trans-specific healthcare. It shows that Norwegian healthcare practice uses the diagnosis of 'transsexualism' to determine a person's needs for trans-specific healthcare and as such excludes many from receiving the healthcare they need. The article analyses whether trans-specific healthcare falls within the ambit of the right to health under Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), and the right to necessary healthcare under the Norwegian Patients' Rights Act. It concludes that the Norwegian authorities are obliged to provide equal access to adequate trans-specific healthcare to those who need it.


Assuntos
Equidade em Saúde/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Direito à Saúde/legislação & jurisprudência , Pessoas Transgênero/legislação & jurisprudência , Transexualismo/diagnóstico , Feminino , Identidade de Gênero , Equidade em Saúde/normas , Necessidades e Demandas de Serviços de Saúde/normas , Direitos Humanos/legislação & jurisprudência , Direitos Humanos/normas , Humanos , Direito Internacional , Masculino , Noruega , Direito à Saúde/normas , Pessoas Transgênero/psicologia , Transexualismo/psicologia , Transexualismo/terapia
12.
Cancer ; 125(3): 473-481, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30508291

RESUMO

BACKGROUND: Adequate social support for older adults is necessary to maintain quality of life and reduce mortality and morbidity. However, little is known regarding the social support needs of older adults with cancer. The objective of the current study was to examine social support needs, specifically the unmet needs, among older adults with cancer. METHODS: Medicare beneficiaries (those aged ≥65 years) with cancer were identified from the University of Alabama at Birmingham Health System Cancer Community Network. Social support needs were assessed using a modified version of the Medical Outcomes Study Social Support Survey. The authors defined an "unmet need" if participants reported having some/a little/never availability of support and requiring support for that need. RESULTS: Of the 1460 participants in the current study, the average age was 74 years (standard deviation, 5.8 years). Approximately two-thirds of participants (986 participants; 67.5%) reported having at least 1 social support need, with the highest needs noted in the emotional (49.5%) and physical (47.4%) support subdomains. Of those individuals with a support need, approximately 45% had at least 1 unmet need, with the greatest percentages noted in the medical (39%) and informational (36%) subdomains. Multivariable analyses demonstrated that participants who were nonwhite, were divorced or never married, or had a high symptom burden were at greatest risk of having unmet social support needs across subdomains. CONCLUSIONS: In this population of older adults with cancer, the authors found high levels of unmet social support needs, particularly in the medical and informational support subdomains. Participants who were nonwhite, were divorced or never married, or had a high symptom burden were found to be at greatest risk of having unmet needs.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Neoplasias/epidemiologia , Neoplasias/terapia , Apoio Social , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Feminino , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde para Idosos/organização & administração , Serviços de Saúde para Idosos/normas , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Neoplasias/psicologia , Qualidade de Vida , Estados Unidos/epidemiologia
13.
J Crohns Colitis ; 12(11): 1295-1301, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30445450

RESUMO

Background and Aims: Crohn's disease and ulcerative colitis are the most common forms of inflammatory bowel disease [IBD], affecting 1 in 250 of the population in the UK. It is accepted that access to a specialist nurse service improves patient experience and outcome. National Standards for the Healthcare of People Who Have Inflammatory Bowel Disease [2013] defined the number of nurse specialists required at 1.5 full time equivalent per 250000 population. The aim of this study was to determine if these standards were being met and to publish a new, robust, validated standard optimising the UK nursing workforce model. Methods: Existing national data and specific workload and service data were collected from 164 IBD specialist nurses who completed a questionnaire designed to collect information on activity and complexity of work both done and undone. Results: Data were received from all of the UK; 36% of respondents were specialist nurses in the field for 3 years or less. A higher caseload than the recommended level was reported by 63% of respondents. Unpaid overtime was regularly carried out by 84% of respondents. The IBD specialist nurse was involved in all areas of the patient pathway. Areas of work left undone were psychological interventions, prescribing medicines and physical assessments. Conclusions: Compared with other specialties, IBD specialist nurses are less experienced. It is recommended that the current standard be increased to 2.5 full time equivalent specialist nurses per 250000 patients, to mitigate the increasing complexity of the role, care and the 'rookie' factor.


Assuntos
Necessidades e Demandas de Serviços de Saúde/normas , Mão de Obra em Saúde/normas , Doenças Inflamatórias Intestinais/enfermagem , Enfermeiras Especialistas/provisão & distribução , Carga de Trabalho/estatística & dados numéricos , Humanos , Papel do Profissional de Enfermagem , Admissão e Escalonamento de Pessoal , Inquéritos e Questionários , Reino Unido
14.
Cancer J ; 24(6): 315-320, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30480576

RESUMO

Adolescents and young adults (AYAs) with cancer constitute a particular group of patients with unique features, whose needs during and after treatment are poorly met. A standardized model of care for them has yet to be established, as neither the pediatric nor the adult oncology systems seamlessly fit their needs. Regardless of the setting in which they are treated, their health care providers should be aware of the impact that the disease and its treatments have on these especially vulnerable patients. Simple ways of improving the AYA experience should be considered: reducing isolation through connections with peers, adapting the staff's approach to the emotional and developmental needs of this age group, and modifying the hospital environment making it more age appropriate. Commitment of national governments is valuable; building and sharing international experience will accelerate advances in clinical care, education, and research. Further progress in the care of AYA cancer patients is still needed to improve their outcomes.


Assuntos
Assistência à Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/tendências , Oncologia/organização & administração , Neoplasias/terapia , Adolescente , Adulto , Fatores Etários , Austrália , Canadá , Assistência à Saúde/normas , Assistência à Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/normas , Humanos , Cooperação Internacional , Oncologia/normas , Oncologia/tendências , Resultado do Tratamento , Estados Unidos , Adulto Jovem
16.
Health Policy ; 122(10): 1085-1092, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30241796

RESUMO

BACKGROUND: An increasing number of countries are introducing new health professions, such as Nurse Practitioners (NPs) and Physician Assistants (PAs). There is however limited evidence, on whether these new professions are included in countries' workforce planning. METHODS: A cross-country comparison of workforce planning methods. Countries with NPs and/or PAs were identified, workforce planning projections reviewed and differences in outcomes were analysed, based on a review of workforce planning models and a scoping review. Data on multi-professional (physicians/NPs/PAs) vs. physician-only models were extracted and compared descriptively. Analysis of policy implications was based on policy documents and grey literature. RESULTS: Of eight countries with NPs/PAs, three (Canada, the Netherlands, United States) included these professions in their workforce planning. In Canada, NPs were partially included in Ontario's needs-based projection, yet only as one parameter to enhance efficiency. In the United States and the Netherlands, NPs/PAs were covered as one of several scenarios. Compared with physician-only models, multi-professional models resulted in lower physician manpower projections, primarily in primary care. A weakness of the multi-professional models was the accuracy of data on substitution. Impacts on policy were limited, except for the Netherlands. CONCLUSIONS: Few countries have integrated NPs/PAs into workforce planning. Yet, those with multi-professional models reveal considerable differences in projected workforce outcomes. Countries should develop several scenarios with and without NPs/PAs to inform policy.


Assuntos
Planejamento em Saúde , Mão de Obra em Saúde/organização & administração , Profissionais de Enfermagem/provisão & distribução , Assistentes Médicos/provisão & distribução , Médicos/provisão & distribução , Canadá , Política de Saúde , Necessidades e Demandas de Serviços de Saúde/normas , Humanos , Países Baixos , Estados Unidos
17.
Cochrane Database Syst Rev ; 9: CD004538, 2018 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-30188566

RESUMO

BACKGROUND: It is becoming increasingly common to publish information about the quality and performance of healthcare organisations and individual professionals. However, we do not know how this information is used, or the extent to which such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers, and purchasers. OBJECTIVES: To estimate the effects of public release of performance data, from any source, on changing the healthcare utilisation behaviour of healthcare consumers, providers (professionals and organisations), and purchasers of care. In addition, we sought to estimate the effects on healthcare provider performance, patient outcomes, and staff morale. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and two trials registers on 26 June 2017. We checked reference lists of all included studies to identify additional studies. SELECTION CRITERIA: We searched for randomised or non-randomised trials, interrupted time series, and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or professionals. Each study had to report at least one main outcome related to selecting or changing care. DATA COLLECTION AND ANALYSIS: Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers, and healthcare purchasers), performance data, main outcomes (choice of healthcare provider, and improvement by means of changes in care), and other outcomes (awareness, attitude, knowledge of performance data, and costs). Given the substantial degree of clinical and methodological heterogeneity between the studies, we presented the findings for each policy in a structured format, but did not undertake a meta-analysis. MAIN RESULTS: We included 12 studies that analysed data from more than 7570 providers (e.g. professionals and organisations), and a further 3,333,386 clinical encounters (e.g. patient referrals, prescriptions). We included four cluster-randomised trials, one cluster-non-randomised trial, six interrupted time series studies, and one controlled before-after study. Eight studies were undertaken in the USA, and one each in Canada, Korea, China, and The Netherlands. Four studies examined the effect of public release of performance data on consumer healthcare choices, and four on improving quality.There was low-certainty evidence that public release of performance data may make little or no difference to long-term healthcare utilisation by healthcare consumers (3 studies; 18,294 insurance plan beneficiaries), or providers (4 studies; 3,000,000 births, and 67 healthcare providers), or to provider performance (1 study; 82 providers). However, there was also low-certainty evidence to suggest that public release of performance data may slightly improve some patient outcomes (5 studies, 315,092 hospitalisations, and 7502 providers). There was low-certainty evidence from a single study to suggest that public release of performance data may have differential effects on disadvantaged populations. There was no evidence about effects on healthcare utilisation decisions by purchasers, or adverse effects. AUTHORS' CONCLUSIONS: The existing evidence base is inadequate to directly inform policy and practice. Further studies should consider whether public release of performance data can improve patient outcomes, as well as healthcare processes.


Assuntos
Informação de Saúde ao Consumidor/métodos , Hospitais/normas , Disseminação de Informação , Garantia da Qualidade dos Cuidados de Saúde/métodos , Melhoria de Qualidade , Canadá , Tomada de Decisão Clínica , Estudos de Avaliação como Assunto , Sistemas Pré-Pagos de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/normas , Humanos , Medicaid , Inovação Organizacional , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Resultado do Tratamento , Estados Unidos
19.
Asian Pac J Cancer Prev ; 19(8): 2247-2253, 2018 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-30139233

RESUMO

Background: Information needs of Breast Cancer (BC) and its perceived importance has not been adequately assessed in Sri Lanka. The present study aimed to assess cognitive information needs of BC among the adults. Methods: A household survey was conducted among a representative sample (n=1500) of over 18 years of age resident in the district of Colombo not having BC patients in the families. A validated interviewer-administered questionnaire collected information on general and cognitive information needs. Exploratory factor analysis assessed whether any of the aspects of informational needs are redundant and to group the needs. Results: Mean age of the participants was 37.21 (SD = ±9.7) years. Proportion of females was 51.7%, 82.9% were married and 44.1% had been educated up to General Certificate of Education (GCE) Ordinary Level. Exploratory factor analysis revealed all items of the questionnaire to form two groups that were named as "Factual information on BC prevention and early detection (screening and early diagnosis)" and "Factual information on BC diagnosis and treatment". Results indicated that both groups of information needs were considered as highly important and the group "Factual information on BC diagnosis and treatment" (mean score 4.20 ± 0.75) was perceived as more important than the other group. The perceived importance of information needs was shown to be significantly different based on the sex of the adults, marital status, level of education and the employment status of the participants. Conclusion: This study demonstrates that cognitive information needs on BC are viewed as highly important by the general public. The study identified specific informational needs that are perceived as more important and some socio-demographic characteristics that are associated with higher perceived needs. The study recommends taking into account the findings of the study in designing the content and target groups for education on BC.


Assuntos
Neoplasias da Mama/psicologia , Sistemas de Informação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde/normas , Educação de Pacientes como Assunto , Percepção , Acesso à Informação , Adolescente , Adulto , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/prevenção & controle , Características da Família , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
20.
Nutrients ; 10(8)2018 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-30081546

RESUMO

The purpose of this overview is to make the case for the establishment and publication of standards for home enteral nutrition (HEN) therapy in adult patients who require a long-term alternative to oral feeding. Overviews can provide a broad and often comprehensive summation of a topic area and, as such, have value for those coming to a subject for the first time. It will provide a broad summation, background and rationale, review specific considerations unique to HEN (tubes, products and supplies) and we describe a recent audit of seven HEN programs which highlights tube and process related challenges. Based on the overview of the literature and our experience with the audit we propose a way forward for best home enteral nutrition care.


Assuntos
Nutrição Enteral/normas , Serviços de Assistência Domiciliar/normas , Guias de Prática Clínica como Assunto/normas , Padrão de Cuidado/normas , Nutrição Enteral/instrumentação , Necessidades e Demandas de Serviços de Saúde/normas , Humanos , Determinação de Necessidades de Cuidados de Saúde/normas , Indicadores de Qualidade em Assistência à Saúde/normas
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