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1.
BJOG ; 127(3): 416-423, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31677228

RESUMO

OBJECTIVE: To develop a sepsis care bundle for the initial management of maternal sepsis in low resource settings. DESIGN: Modified Delphi process. SETTING: Participants from 34 countries. POPULATION: Healthcare practitioners working in low resource settings (n = 143; 34 countries), members of an expert panel (n = 11) and consultation with the World Health Organization Global Maternal and Neonatal Sepsis Initiative technical working group. METHODS: We reviewed the literature to identify all potential interventions and practices around the initial management of sepsis that could be bundled together. A modified Delphi process, using an online questionnaire and in-person meetings, was then undertaken to gain consensus on bundle items. Participants ranked potential bundle items in terms of perceived importance and feasibility, considering their use in both hospitals and health centres. Findings from the healthcare practitioners were then triangulated with those of the experts. MAIN OUTCOME MEASURE: Consensus on bundle items. RESULTS: Consensus was reached after three consultation rounds, with the same items deemed most important and feasible by both the healthcare practitioners and expert panel. Final bundle items selected were: (1) Fluids, (2) Antibiotics, (3) Source identification and control, (4) Transfer (to appropriate higher-level care) and (5) Monitoring (of both mother and neonate as appropriate). The bundle was given the acronym 'FAST-M'. CONCLUSION: A clinically relevant maternal sepsis bundle for low resource settings has been developed by international consensus. TWEETABLE ABSTRACT: A maternal sepsis bundle for low resource settings has been developed by international consensus.


Assuntos
Pacotes de Assistência ao Paciente/métodos , Administração dos Cuidados ao Paciente , Complicações Infecciosas na Gravidez , Consenso , Técnica Delfos , Feminino , Humanos , Recém-Nascido , Cooperação Internacional , Área Carente de Assistência Médica , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/organização & administração , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Organização Mundial da Saúde
4.
Anaesthesia ; 75(1): 63-71, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31549413

RESUMO

Delirium is a common complication following hip fracture surgery. We introduced a peri-operative care bundle that standardised management in the emergency department, operating theatre and ward. This incorporated: use of fascia iliaca blocks; rationalisation of analgesia; avoidance of drugs known to trigger delirium; a regular education program for staff; and continuous auditing of compliance. The study was conducted between June 2017 and December 2018. We recruited 150 patients before (control group) and 150 patients after (care bundle group) the introduction of the care bundle. In patients having surgery for a hip fracture, there was a lower incidence of delirium on the third postoperative day in the care bundle group compared with the control group (33 patients (22%) vs. 49 patients (33%)), respectively; p = 0.04). Patients in the care bundle group had an adjusted OR of 2.2 (95%CI 1.1-4.4) (p = 0.03) for the avoidance of delirium on the third postoperative day. There was no difference between groups for the secondary outcome measures (measured at 30 days postoperatively) including: all-cause mortality; composite morbidity; institutionalisation; and walking status. During the study period, compliance with elements of the care bundle improved in the emergency department (49 patients (33%) compared with 85 patients (59%); p < 0.001) and anaesthetic department (40 patients (27%) compared with 104 patients (69%); p < 0.001), while orthogeriatrics maintained a high level of compliance (140 patients (93%) compared with 143 patients (95%); p = 0.45). There was a clinically and statistically significant reduction in the incidence of delirium following hip fracture surgery in patients treated with a multidisciplinary care bundle.


Assuntos
Delírio/prevenção & controle , Fraturas do Quadril/cirurgia , Pacotes de Assistência ao Paciente/métodos , Complicações Pós-Operatórias/prevenção & controle , Melhoria de Qualidade , Idoso , Idoso de 80 Anos ou mais , Delírio/induzido quimicamente , Feminino , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/induzido quimicamente , Estudos Prospectivos
5.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1048348

RESUMO

Objetivo: elaborar um bundle de cuidados para a prevenção e o controle das infecções hospitalares em unidade de emergência, com base no conhecimento e prática dos profissionais de saúde e nas evidências científicas disponíveis na literatura. Método: pesquisa convergente assistencial, realizada em um serviço de emergência adulto de um hospital geral universitário localizado em uma capital do Sul do Brasil com aplicação de um Survey para 52 trabalhadores da equipe multiprofissional e posterior discussão em grupos "Aqui e Agora". Foi aprovado pelo CEPSH/UFSC com CAAE: 56390616.0.0000.0121. Resultados: emergiram três aspectos mais significativos que compuseram o bundle de cuidados: higienização das mãos; uso de equipamentos de proteção individual; e assepsia de materiais e equipamentos. Conclusão: a utilização do bundle permite informar, orientar, melhorar hábitos e relembrar a equipe de saúde sobre a necessidade de aderir a atitudes que tornem o cuidado realizado mais qualificado e seguro, tanto para o paciente, quanto para o profissional


Objective: develop a care bundle in order to help preventing and controlling hospital infections in emergency care units, based on the knowledge and practice of health professionals, as well as on scientific evidences available in the literature. Method: The study was carried out through the application of a survey comprising 52 health professionals working in the multi-professional team of the aforementioned hospital. The data from the survey were discussed in "Here-and-Now" groups. It was approved by CEPSH / UFSC with CAAE: 56390616.0.0000.0121. Results: the three most significant aspects composing the care bundle were selected based on data derived from the survey, from the groups and from the literature, namely: hand hygiene; use of personal protection equipment; and asepsis of materials and equipment. Conclusion: using the bundle allows inform, guide, as well as to improve habits and remind health teams about the need to adhere to measures able to make the health care practice more qualified and safer for both the patients and the professionals


Objetivo: elaborar un bundle de cuidados para la prevención y el control de las infecciones hospitalarias en unidad de emergencia, con base en el conocimiento y práctica de los profesionales de salud y en las evidencias científicas disponibles en la literatura. Método: se realizó con aplicación de un Survey de que participaron 52 trabajadores del equipo multiprofesional. Los datos de Survey fueron discutidos posteriormente en grupos "Aquí y Ahora". Fue aprobado por el CEPSH / UFSC con CAAE: 56390616.0.0.0000.0121. Resultados: en base a los datos de Survey, de los grupos y de la literatura se seleccionaron los tres aspectos más significativos que compusieron el bundle de cuidados: higienización de las manos; uso de equipos de protección individual; y asepsia de materiales y equipos. Conclusión: la utilización del bundle permite informar, orientar, mejorar hábitos y recordar el equipo de salud sobre la necesidad de adherir a actitudes que hagan del cuidado realizado más calificado y seguro, tanto para el paciente, como para el profesional


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Infecção Hospitalar/prevenção & controle , Serviços Médicos de Emergência , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários , Grupos Focais , Segurança do Paciente , Pacotes de Assistência ao Paciente
6.
J Surg Orthop Adv ; 28(4): 241-249, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31886758

RESUMO

Financial success in a bundled payment system requires knowledge of the costs of care throughout the period of risk. Understanding the significant cost-drivers of total joint arthroplasty (TJA) is crucial in this effort. This article inspects the basics of reimbursement under Medicare's bundled care programs as well as some common investigative tools used in the literature to measure cost. Additionally, the effects of standardized enhanced recovery clinical pathways on costs are reviewed. Finally, drivers of implant costs and several proven measures for implant cost-reduction are evaluated. This review provides surgeons and hospitals successful measures to reduce the cost of TJA via enhanced recovery pathways and reduced implant pricing. (Journal of Surgical Orthopaedic Advances 28(4):241-249, 2019).


Assuntos
Artroplastia do Joelho , Pacotes de Assistência ao Paciente , Artroplastia de Quadril , Procedimentos Clínicos , Medicare , Estados Unidos
7.
Medicine (Baltimore) ; 98(40): e17459, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577774

RESUMO

To determine the impact of the implementation of a hand-off bundle on medical errors at an inpatient unit of an academic community teaching hospital. Our secondary objective was to determine the research utility of the use of an all-electronic data collection system for medical errors.A retrospective review was conducted of 1290 admissions 6 months before and after implementation of an improved computerized hand-off tool and training bundle. The study took place at an academic community teaching hospital on a Family Medicine inpatient service caring for patients of all ages. The comparison focused on preventable and non-preventable adverse events.A significant decrease in medical errors was noted. Medical error rate dropped from 6.0 (95% CI, 4.2-8.3) to 2.2 (95% CI, 1.2-3.7) per 100 admissions (P < .001). Preventable medical errors dropped from 0.65 (95% CI, 0.18-1.67) to 0.15 (95% CI, 0.03-0.82) per 100 admissions (P = .194). Non-intercepted potential adverse events dropped from 1.30 (95% CI, 0.56-2.57) to 0.44 (95% CI, 0.09-1.30) per 100 admissions (P = .131). Intercepted potential adverse events dropped from 0.98 (95% CI 0.36-2.13) to 0.74 (95% CI 0.24-1.7) per 100 admissions (P = .766) and errors with little potential for harm dropped from 2.77 (95% CI 1.61-4.43) to 0.74 (95% CI 0.24-1.7) per 100 admissions (P = .009).Implementation of a standardized hand-off bundle was associated with a reduction in medical errors despite a low overall event rate. Further studies are warranted to determine the generalizability of this finding, to examine the overall epidemiology of medical errors and the reporting of such events within general medical teaching units.


Assuntos
Medicina de Família e Comunidade , Internato e Residência , Erros Médicos/prevenção & controle , Pacotes de Assistência ao Paciente , Transferência da Responsabilidade pelo Paciente/organização & administração , Centros Médicos Acadêmicos , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos
8.
Br J Nurs ; 28(19): S3, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31647732
9.
Rev Col Bras Cir ; 46(4): e2252, 2019 Sep 09.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31508737

RESUMO

OBJECTIVE: to present a descriptive analysis of the results of a care bundle applied to obese patients submitted to bariatric surgery, regarding infection control. METHODS: a care bundle was designed to control surgical site infection (SSI) rates in patients undergoing bariatric surgery. The bundle included smoking cessation, bathing with 4% chlorhexidine two hours before surgery, cefazolin (2g bolus) in anesthetic induction associated with a continuous infusion of the same drug at a dose of 1g over a two-hour period, appropriate trichotomy, glycemic control, supplemental oxygen, normothermia, intraspinal morphine for the relief of pain, and sterile dressing removal 48 hours after surgery. All patients were followed up for 30 days. RESULTS: among the 1,596 included patients, 334 (20.9%) underwent open surgery and 1,262 (79.1%) underwent videolaparoscopic surgery. SSI rates were 0.5% in the group submitted to laparoscopic surgery and 3% in the one submitted to open surgery. The overall incidence of SSI was 1%. Intra-abdominal, respiratory tract, and urinary tract infections occurred in 0.9%, 1.1%, and 1.5% of the sample, respectively. Higher body mass index was associated with higher incidence of SSI (p=0.001). Among patients with diabetes, 2.2% developed SSI, while the rate of infection among non-diabetics was only 0.6%. CONCLUSION: the established care bundle, structured by core evidence-based strategies, associated with secondary measures, was able to maintain low SSI rates after bariatric surgery.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Pacotes de Assistência ao Paciente , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Brasil/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade/cirurgia , Assistência Perioperatória/métodos , Estudos Prospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Adulto Jovem
10.
Tidsskr Nor Laegeforen ; 139(12)2019 09 10.
Artigo em Norueguês | MEDLINE | ID: mdl-31502798

RESUMO

BACKGROUND: The purpose of introducing the 'cancer patient pathway for breast cancer' was to ensure a coherent treatment pathway without unnecessary delays. Radiologists and pathologists who work with breast diagnostics are involved in both cancer patient pathways and BreastScreen Norway. The extent to which this policy may have affected waiting times has not been analysed previously. This study presents waiting times in BreastScreen Norway before and after introduction of cancer patient pathway. MATERIAL AND METHOD: We analysed waiting times associated with 1 485 240 screening examinations undertaken as part of BreastScreen Norway in the period 01.7.2011-30.6.2018, stratified by breast diagnostic centre. Waiting times were defined as the number of calendar days from the a) screening examination to the dispatch of the negative results letter (dispatch time), b) screening examination to the date on which the follow-up examination was performed (follow-up examination time) and c) follow-up examination to diagnosis (diagnosis time). Data were retrieved from the Cancer Registry of Norway's databases. Use of these is set out in the Cancer Registry Regulations. We calculated median waiting times in addition to 90th percentiles. RESULTS: The median dispatch time was 13 days before the cancer patient pathway was introduced, and 12 days after. The median follow-up examination time increased from 23 to 27 days, while the median diagnosis time was 3 days both before and after introduction of the cancer patient pathway. INTERPRETATION: Dispatch and diagnosis times were unchanged, or slightly changed after introduction of the cancer patient pathway, while follow-up examination time increased somewhat. Introduction of the cancer patient pathway may have led to differential adjustments in priorities, workflows and access to resources between the breast diagnostic centres.


Assuntos
Neoplasias da Mama , Mamografia/normas , Pacotes de Assistência ao Paciente/normas , Listas de Espera , Idoso , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/diagnóstico por imagem , Diagnóstico Tardio , Detecção Precoce de Câncer , Feminino , Humanos , Pessoa de Meia-Idade , Noruega , Sistema de Registros , Fatores de Tempo
11.
Orthop Nurs ; 38(4): 262-269, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343631

RESUMO

BACKGROUND: Standardized approaches to care and care pathways for patients with joint replacement have been shown to decrease length of stay (LOS), improve patient participation in education, decrease patient anxiety while improving perception of care, and lead to overall efficiency and improved care and outcomes. PURPOSE: The purpose of this study was to determine whether implementation of a standardized bundle approach to care influenced the outcomes after total hip or total knee arthroplasty (THA or TKA). METHODS: A retrospective, quasi-experimental before- and after-design study was used to evaluate the impact of the intervention. Two hospitals implemented a standardized bundle of care for patients undergoing THA or TKA that included preoperative patient education, day of surgery mobilization, and a total joint group physical therapy session (Full Bundle). Data analyses were completed on a convenience sample of 2,200 patients who underwent THA or TKA. Outcomes data measured were LOS, discharge disposition, costs, and readmission rate. RESULTS: Patients receiving the Full Bundle had significant reduction in LOS of roughly 1 day (OR = 1.687, 95% CI [1.578, 1.797]) versus group not receiving all elements (OR = 2.706; 95% CI [2.623, 2.789]). Full Bundle patients were 6 times more likely to be discharged home compared with the Partial Bundle group (OR = 6.01, 95% CI [4.01, 9.03]). Full Bundle group had significantly lower total direct costs, F(1) = 4.06, p = .046, partial η = 0.003. There were no differences in readmission rates between the 2 groups. CONCLUSION: Patients who had all elements of the THA/TKA bundle had the best outcomes. By improving efficiencies of care through the use of the bundle, the 2 hospitals positively impacted the care and outcomes of THA and TKA patients.


Assuntos
/normas , Pacotes de Assistência ao Paciente/normas , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Idoso , Artroplastia de Quadril/métodos , Artroplastia de Quadril/normas , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/métodos , Artroplastia do Joelho/normas , Artroplastia do Joelho/estatística & dados numéricos , Distribuição de Qui-Quadrado , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacotes de Assistência ao Paciente/instrumentação , Pacotes de Assistência ao Paciente/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Sudeste dos Estados Unidos/epidemiologia
14.
BMC Health Serv Res ; 19(1): 461, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286954

RESUMO

BACKGROUND: Blunt chest injury can lead to significant morbidity and mortality if not treated appropriately. A blunt chest injury care bundle was to be implemented at two sites to guide care. AIM: To identify facilitators and barriers to the implementation of a blunt chest injury care bundle and design strategies tailored to promote future implementation. METHODS: 1) A mixed-method survey based on the theoretical domains framework (TDF) was used to identify barriers and facilitators to the implementation of a blunt chest injury care bundle. This survey was distributed to 441 staff from 12 departments across two hospitals. Quantitative data were analysed using SPSS and qualitative using inductive content analysis. 2) The quantitative and qualitative results from the survey were integrated and mapped to each of the TDF domains. 3) The facilitators and barriers were evaluated using the Behaviour Change Wheel to extract specific intervention functions, policies, behaviour change techniques and implementation strategies. Each phase was assessed against the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects or safety and Equity (APEASE) criteria. RESULTS: One hundred ninety eight staff completed the survey. All departments surveyed were represented. Nine facilitators and six barriers were identified from eight domains of the TDF. Facilitators (TDF domains) were: understanding evidence-informed patient care and understanding risk factors (Knowledge); patient assessment skills and blunt chest injury management skills (Physical skills); identification with professional role (Professional role and identity); belief of consequences of care bundle (Belief about consequences); provision of training and protocol design (Environmental context and resources); and social supports (Social influences). Barriers were: not understanding the term 'care bundle' (Knowledge); lacking regional analgesia skills (Physical skills); not remembering to follow protocol (Memory, attention, and decision processes); negative emotions relating to new protocols (Emotions); equipment and protocol access (Environmental context and resources). Implementation strategies were videos, education sessions, visual prompt for electronic medical records and change champions. CONCLUSIONS: Multiple facilitators and barriers were identified that may affect the implementation of a blunt chest injury care bundle. Implementation strategies developed through this process have been included in a plan for implementation in the emergency departments of two hospitals. Evaluation of the implementation is underway.


Assuntos
Corpo Clínico Hospitalar/psicologia , Pacotes de Assistência ao Paciente , Traumatismos Torácicos/terapia , Adulto , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Inquéritos e Questionários
15.
Tex Med ; 115(6): 4, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31260543

RESUMO

Former Texas Medical Association President Josie Williams, MD, was tenacious in advocating that organized medicine pay zealous attention to two topics: data and guidelines. In this, she was both sage and prescient. We have done well in following her recommendations on data, but we continue to fall far short of where we need to be on guidelines.


Assuntos
Guias de Prática Clínica como Assunto , Sociedades Médicas/organização & administração , Estudos de Coortes , Feminino , Humanos , Masculino , Pacotes de Assistência ao Paciente , Revisão da Pesquisa por Pares , Ensaios Clínicos Controlados Aleatórios como Assunto , Texas
16.
Rev Bras Enferm ; 72(3): 671-679, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269131

RESUMO

OBJECTIVE: to construct collectively with nursing professionals bundle for best practices of cold chain maintenance of immunobiological agents conservation at the local level. METHOD: a qualitative research of convergent care type. Bundle construction was guided by the Evidence-Based Practice criterion. Data collection was carried out from October to December 2016, through five workshops, with the participation of 21 professionals from 7 vaccination rooms of a municipality of Minas Gerais State. The framework developed by Morse and Field was adopted for data analysis. RESULTS: through bundle, care is taken regarding refrigeration equipment temperature monitoring, contingency plan performance, recyclable ice coil setting and chamber use as refrigeration equipment. FINAL CONSIDERATIONS: the chosen interventions began to guide the practice and promote a care based on safety and quality.


Assuntos
Pacotes de Assistência ao Paciente/métodos , Refrigeração/métodos , Vacinas/uso terapêutico , Adulto , Competência Clínica/normas , Enfermagem Baseada em Evidências/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Pesquisa Qualitativa , Refrigeração/normas
17.
Rev. enferm. Inst. Mex. Seguro Soc ; 27(3): 163-174, Jul-Sep 2019. tab, graf
Artigo em Espanhol | LILACS, BDENF - Enfermagem | ID: biblio-1047308

RESUMO

Introducción: el plan de cuidados de enfermería estandarizado (PLACE) es un protocolo específico de cuidados, apropiado para aquellos pacientes que padecen los problemas normales o previsibles relacionados con un diagnóstico concreto o una enfermedad. Objetivo: diseñar un PLACE de quimioterapia, como una propuesta para el profesional de enfermería en la programación de los cuidados. Desarrollo: se presenta el caso de una paciente adulta de 34 años, con diagnóstico médico de linfoma de Hodgkin y tratamiento de quimioterapia, hospitalizada en el servicio de Quimioterapia Ambulatoria. Para la evaluación del estado de la paciente se utilizó la Guía de valoración para el paciente adulto por dominios y clases de la NANDA (North American Nursing Diagnosis Association); con base en un proceso de razonamiento diagnóstico, se jerarquizaron y determinaron los diagnósticos de enfermería, los resultados esperados y las intervenciones de enfermería. Se diseñó un plan de cuidados basado en la interrelación de las taxonomías NANDA, NOC (Nursing Outcomes Classification) y NIC (Nursing Interventions Classification). Derivado del razonamiento diagnóstico, se priorizó el siguiente diagnóstico de enfermería: insomnio R/C factores del entorno M/P dificultad para conciliar el sueño. Conclusión: el plan de cuidados de enfermería con enfoque educativo puede ayudar a mejorar el patrón y la calidad del sueño al disminuir la dificultad para conciliar el sueño. Asimismo un adecuado manejo de la medicación, manejo de la energía y del ambiente en casa y en el hospital favorece un adecuado control de la enfermedad y la recuperación.


Introduction: The standardized nursing care plan (SNCP) is a specific care protocol, appropriate for those patients who suffer from normal or foreseeable problems related to a specific diagnosis or illness. Objective: To design an SNCP with an educational approach aimed at a female adult patient with insomnia, Hodgkin lymphoma and chemotherapy treatment, as a proposal for the nursing professional in the patient care program. Development: It is presented the case of a 34-year-dd female adult patient with a medical diagnosis of Hodgkin lymphoma and chemotherapy treatment, hospitalized in the Outpatient Chemotherapy Service. The NANDA (North American Nursing Diagnosis Association) Assessment Cuide for the Adult Patient by Domains and Classes was used to assess the patient's condition; based on a process of diagnostic reasoning, the nursing diagnoses, expected results and nursing interventions were hierarchized and determined. A care plan was designed based on the interrelation of the NANDA NOC (Nursing Outcomes Classification) and NIC (Nursing Interventions Classification) taxonomies. Derived from the diagnostic reasoning, the following nursing diagnosis was prioritized: Insomnia R/T environmental factors M/B difficulty falling asleep. Conclusión: The nursing care plan with an educational approach can help to improve the pattern and quality of sleep by decreasing the difficulty in falling asleep. Likewise, proper medication management, energy management and the environment at home and in the hospital favors adequate disease control and recovery.


Assuntos
Humanos , Transtornos do Sono-Vigília , Doença de Hodgkin , Tratamento Farmacológico , Metabolismo Energético , Pacotes de Assistência ao Paciente , Distúrbios do Início e da Manutenção do Sono , Cuidados de Enfermagem , Processo de Enfermagem , México
18.
Lakartidningen ; 1162019 Feb 12.
Artigo em Sueco | MEDLINE | ID: mdl-31192376

RESUMO

The Swedish fast-track diagnostic pathway was applied during 2017 for 146 patients with serious non-specific symptoms including weight loss, fatigue and anemia. Within five days all patients had a physical examination and a decision was made of radiologic investigations. The waiting time was short for e.g. CT-scan of the abdomen and thorax. A diagnosis of a malignant condition was made in 38 patients (26%) with a median age of 75 (48-91) years. There were 24 men and 14 women. Most common diagnoses were lung cancer and colorectal cancer. Hematologic malignancy was diagnosed in 8 patients. Stage IV disease occurred in 17 of the patients with carcinoma (57%). About 60 benign main diagnoses were made in 108 patients without malignant disease. Two of them have developed cancer during 2018 (breast cancer, pancreatic cancer).


Assuntos
Neoplasias/diagnóstico , Pacotes de Assistência ao Paciente , Idoso , Idoso de 80 Anos ou mais , Procedimentos Clínicos , Transtornos de Deglutição/etiologia , Fadiga/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/epidemiologia , Dor/etiologia , Assistência Centrada no Paciente , Qualidade de Vida , Suécia/epidemiologia , Perda de Peso
19.
Lakartidningen ; 1162019 Feb 19.
Artigo em Sueco | MEDLINE | ID: mdl-31192391

RESUMO

Frequency of cancer in the urinary organs was significantly lower in patients with macroscopic hematuria associated with bacteriuria compared to those without bacteriuria. The predictive value of macroscopic hematuria was <1% in patients ≤ 75 years of age with concomitant bacteriuria. CT-urography added no diagnostic value over and above cystoscopy in patients with macroscopic hematuria with bacteriuria.Bacteriuria with other bacteria than E. coli or S. saprophyticus was associated with findings of bladder tumors.


Assuntos
Bacteriúria/diagnóstico , Hematúria/diagnóstico , Neoplasias Urogenitais/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Cistoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacotes de Assistência ao Paciente , Valor Preditivo dos Testes , Garantia da Qualidade dos Cuidados de Saúde , Fatores de Risco , Fumar , Tomografia Computadorizada por Raios X , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/microbiologia , Neoplasias Urogenitais/microbiologia , Urografia
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