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1.
Artigo em Inglês | MEDLINE | ID: mdl-31610771

RESUMO

Immunisation at the earliest appropriate age and high levels of vaccine coverage at milestone ages are important in preventing the spread of vaccine-preventable diseases. At the Central Coast Public Health Unit, the authors sought to determine if follow-up of children said by the Australian Childhood Immunisation Register (ACIR) to be overdue for vaccination improved both of these factors. In a quality improvement activity, monthly ACIR lists of overdue Central Coast children aged 9 to 10 months of age were examined. The study alternated three months of intervention with three months of no intervention. The intervention was designed to find evidence of vaccination, first from the last known provider, and then if this was unsuccessful, from the parent. If no information was available, a letter was sent to the parents. If the child was indeed vaccinated, the register was updated. If the child was missing any vaccinations, the parent(s) were encouraged to complete the schedule. On reviewing routinely-published quarterly ACIR data at three-monthly intervals for 24 months after the intervention (or non-intervention), timeliness of vaccination improved in the intervention cohort. Central Coast fully vaccinated rates diverged from NSW rates during the study. In addition, the ACIR quarters that contained two out of three months of intervention rather than one out of three months of intervention had the highest rates of fully vaccinated children. The authors concluded that the intervention improved both timeliness of vaccination and the proportion of fully vaccinated children.


Assuntos
Programas de Imunização/estatística & dados numéricos , Esquemas de Imunização , Vacinação/estatística & dados numéricos , Vacinas/administração & dosagem , Austrália , Confiabilidade dos Dados , Pesquisas sobre Serviços de Saúde , Humanos , Lactente , Pais , Sistema de Registros
2.
Sante Publique ; Vol. 31(3): 395-404, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31640327

RESUMO

OBJECTIVE: The aim of this research is, on the one hand, to describe the customs and attitudes of Swiss general practitioners (GP) considering cardiovascular risk, and on the other, to put into perspective with the national recommendation Eviprev (summary representations of the primary and secondary preventions recommendations for patients aged between 18 and 70 years old). METHODS: The study was based on an online survey sent to general practitioners belonging to the same research network and who were randomly selected. The sample was made of 200 Swiss GP. This article focuses on the frequency with which GP give advice related to consumption of tobacco and alcohol, exercising and nutrition during a regular meeting with their patient or a first visit. The results were analyzed according to age, sex, linguistic area and the extent to which they lived in a city or in the countryside. RESULTS: Results suggest that the majority (97.6%) of GP show concern about informing patients on cardiovascular risk factors. Nonetheless most of the advice given are usually related to the patient's case and not given in a systematic way. Tobacco addiction is the most systematically discussed theme during a first visit (33.9%), exercise comes second (25.6%), then nutrition (16.1%), and finally alcohol consumption (18.5%). Differences in numbers based on the different languages are little, except dealing with exercise. CONCLUSIONS: Recommendations on prevention are followed by a majority of GP. Improvements could be made considering the training given and the remuneration of these counseling activities.


Assuntos
Atitude do Pessoal de Saúde , Doenças Cardiovasculares/prevenção & controle , Clínicos Gerais/psicologia , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Pesquisas sobre Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Suíça , Adulto Jovem
3.
JAAPA ; 32(2): 52, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31579253

RESUMO

PAs and NPs have broad prescribing authority in the United States, yet little is known about how the quality of their prescribing practices compares with that of physicians. The quality of prescribing practices of physicians, PAs, and NPs was investigated through a serial cross-sectional analysis of the 2006-2012 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS). Ambulatory care services in physician offices, hospital EDs, and outpatient departments were evaluated using a nationally representative sample of patient visits to physicians, PAs, and NPs. Main outcome measures were 13 validated outpatient quality indicators focused on pharmacologic management of chronic diseases and appropriate medication use. The study sampled 701,499 patient visits during the study period, representing about 8.3 billion visits nationwide. Physicians were the primary provider for 96.8% of all outpatient visits examined; PAs and NPs each accounted for 1.6% of these visits. The proportion of eligible visits in which quality standards were met ranged from 34.1% (angiotensin-converting enzyme inhibitor use for patients with heart failure) to 89.5% (avoidance of inappropriate medications in older adults). The median overall performance across all indicators was 58.7%. On unadjusted analyses, differences in quality of care between PAs, NPs, and physicians for each indicator did not consistently favor one practitioner type over others. After adjustment for potentially confounding patient and provider characteristics, the quality of prescribing by PAs and NPs was similar to the care delivered by physicians for 10 of the 13 indicators evaluated, and no consistent directional association was found between provider type and indicator fulfillment for the remaining measures. Although significant shortfalls exist in the quality of ambulatory prescribing across all practitioner types, the quality of care delivered by PAs, NPs, and physicians was generally comparable.1.


Assuntos
Profissionais de Enfermagem , Assistentes Médicos , Médicos , Idoso , Assistência Ambulatorial , Estudos Transversais , Pesquisas sobre Serviços de Saúde , Humanos , Estados Unidos
4.
MMWR Morb Mortal Wkly Rep ; 68(41): 913-918, 2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31622284

RESUMO

The Advisory Committee on Immunization Practices (ACIP) recommends that children be vaccinated against 14 potentially serious illnesses during the first 24 months of life (1). CDC used data from the National Immunization Survey-Child (NIS-Child) to assess vaccination coverage with the recommended number of doses of each vaccine at the national, state, territorial, and selected local levels* among children born in 2015 and 2016. Coverage by age 24 months was at least 90% nationally for ≥3 doses of poliovirus vaccine, ≥1 dose of measles, mumps, and rubella vaccine (MMR), ≥3 doses of hepatitis B vaccine (HepB), and ≥1 dose of varicella vaccine, although MMR coverage was <90% in 20 states. Children were least likely to be up to date by age 24 months with ≥2 doses of influenza vaccine (56.6%). Only 1.3% of children born in 2015 and 2016 had received no vaccinations by the second birthday. Coverage was lower for uninsured children and for children insured by Medicaid than for those with private health insurance. Vaccination coverage can be increased by improving access to vaccine providers and eliminating missed opportunities to vaccinate children during health care visits. Increased use of local vaccination coverage data is needed to identify communities at higher risk for outbreaks of measles and other vaccine-preventable diseases.


Assuntos
Cobertura Vacinal/estatística & dados numéricos , Vacinas/administração & dosagem , Pré-Escolar , Pesquisas sobre Serviços de Saúde , Humanos , Esquemas de Imunização , Lactente , Recém-Nascido , Estados Unidos
5.
Cancer Radiother ; 23(6-7): 517-519, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31471256

RESUMO

Ten years after the beginning of CREX in radiotherapy departments we wanted to know about users' feeling. We sent a survey to 168 centers in the whole country and a hundred of them answer. The time, top management's involvement and professionals' training seem to be the key success factors. Systemic analysis methods and mainly the Orion© one are not identified as an issue. The main challenge for the next years will be the effectiveness check of actions.


Assuntos
Comitês Consultivos/organização & administração , Institutos de Câncer , Pesquisas sobre Serviços de Saúde , Gestão de Riscos/estatística & dados numéricos , França , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Comitê de Profissionais , Gestão de Riscos/métodos
6.
N C Med J ; 80(5): 261-268, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471505

RESUMO

BACKGROUND Successful diabetes care requires patient engagement and health self-management. Diabetes shared medical appointments (SMAs) are an evidence-based approach that enables peer support, diabetes group education, and medication management to improve outcomes. The purpose of this study is to learn how diabetes SMAs are being delivered in North Carolina, including the characteristics of diabetes SMAs across the state.METHOD Twelve health systems in the state of North Carolina were contacted to explore clinical workflow and intervention characteristics with a member of the SMA care delivery team. Surveys were used to assess intervention characteristics and delivery.RESULTS Diabetes SMAs were offered in 10 clinics in 5 of the 12 health systems contacted with considerable heterogeneity across sites. The majority of SMAs were open cohorts (80%), offered monthly (60%) for 1.5 hours (60%). SMAs included a mean of 7.5 ± 3.4 patients with a maximum of 11.2 ± 2.7 patients. Survey data revealed barriers (cost-sharing and provider buy-in) to, and facilitators (leadership support and clinical champions) of, clinical adoption and sustained implementation.LIMITATIONS External validity is limited due to the small sample size and geographic clustering.CONCLUSION There is significant heterogeneity in the delivery and characteristics of diabetes SMAs in North Carolina with only modest uptake across the health systems. Further research to determine best practices and effectiveness in diverse, real-world clinical settings is required to inform implementation and dissemination efforts.


Assuntos
Agendamento de Consultas , Diabetes Mellitus/terapia , Pesquisas sobre Serviços de Saúde , Humanos , North Carolina
7.
Anticancer Res ; 39(9): 5203-5207, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519634

RESUMO

BACKGROUND: A retrospective analysis was performed to investigate the survival outcomes in pediatric acute lymphoblastic leukemia (ALL) based on time period. We hypothesized that improvement has been obtained with the time-dependent therapeutic era and rise in the gross domestic product (GDP) and Human Development Index (HDI). MATERIALS AND METHODS: Data from 710 children who were treated for ALL between 1958 and 2018 at a single pediatric center were analyzed for probability of 5-year overall survival (pOS), event-free survival (pEFS) and relapse risk (pRR). Time periods were defined by the treatment protocols used in seven consecutive therapeutic eras. RESULTS: Over the 60-year period analyzed, pOS increased from 1.2% to 90.7%, pEFS from 1.2% to 86.6%, and pRR decreased from 98.8% to 9.9% for patients treated in the past decade. Risk of mortality for patients who received chemotherapy and hematopoietic cell transplant was reduced to 9.9% in the recent era, however, no statistically significant survival difference was found between patients treated with stem cell transplant and those not. CONCLUSION: The therapeutic era, related to improved GDP and HDI, was a statistically significant predictor of increased OS from ALL.


Assuntos
Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Adolescente , Biomarcadores Tumorais , Biópsia , Criança , Pré-Escolar , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Avaliação de Resultados (Cuidados de Saúde) , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Resultado do Tratamento
8.
Bull Cancer ; 106(10): 847-859, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31521255

RESUMO

INTRODUCTION: The Cancer Observatory, from the OMEDITs (Observatory for Medicines and Medical Devices and Treatment Innovations) of Bretagne and Pays de la Loire areas has conducted a survey aiming to know and map the current practices of management of patients by Oral Anti-cancer Drug (OAD) in inter-region. METHODS: Forty eight cancer centers received by e-mail in July and October 2016 a questionnaire concerning the management of OADs : from prescription by the specialist of oncology, to the intervention of the pharmacist (analysis and pharmaceutical consulting), to follow-up by nurse, as well as the financing of this activity and the feelings of the actors about this organizational set up. RESULTS: Fifty-seven professionals from 31 centers, including the most important ones, responded to the survey. As a result, half of the establishments carry out a pharmaceutical analysis for some or all of the OAD prescriptions and only 30% carry out a pharmaceutical consulting. The nurse consultation is, on the other hand, more largely implanted (74% of the centers) as well as the telephone follow-up (6%). More than 90% of professionals believe that the organizational set up could be improved and more secure by, at least, the stronger involvement of pharmacists, the development of tools for nurse (for monitoring, therapeutic education…) and by improving the city-hospital link. CONCLUSION: This survey shows the variability in the management of patients under OAD because of the lack of resources to ensure the fairness and sustainability of the organizational set up. The hospital/city link could still be optimized to secure patient care.


Assuntos
Antineoplásicos/administração & dosagem , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Neoplasias/tratamento farmacológico , Administração Oral , Institutos de Câncer/estatística & dados numéricos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Prescrições de Medicamentos , França , Humanos , Papel do Profissional de Enfermagem , Objetivos Organizacionais , Satisfação do Paciente , Farmacêuticos , Padrões de Prática em Enfermagem/estatística & dados numéricos , Telefone
9.
Soins ; 64(838): 20-24, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31542113

RESUMO

Peripheral venous catheters are the most commonly used vascular devices in hospitals. The ageing population and the increase in comorbidities makes their insertion more complex. A survey carried out in surgical units describes the factors contributing to failures. It is important to improve the identification of patients with difficult venous access, to offer access to various techniques and devices, as well as to the expertise of a specialised team.


Assuntos
Cateterismo Periférico , Idoso , Comorbidade , Pesquisas sobre Serviços de Saúde , Hospitalização , Humanos , Fatores de Risco , Centro Cirúrgico Hospitalar , Falha de Tratamento
10.
Zhonghua Wai Ke Za Zhi ; 57(8): 616-621, 2019 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-31422632

RESUMO

Objective: To explore the current clinical practice of implant-based breast reconstruction (IBBR) in China. Methods: The current survey was sponsored by Chinese Anti-Cancer Association, Committee of Breast Cancer Society and Chinese Society of Breast Surgeons. A survey was mailed to 110 hospitals in China, which have more than 200 breast cancer operations performed in 2017. The survey mainly included questions on the clinical practice of IBBR, sociodemographic and geographical factors associated with IBBR practice, reasons and concerns for selecting IBBR, type and timing of breast reconstruction, and the complications of IBBR. Data were analyzed using χ(2) test, Fisher's exact test or Kruskal-Wallis rank sum test. Results: IBBR was available in 86.4% (95/110) included hospitals. It was predominantly performed breast reconstruction surgery, the proportion of IBBR in all the breast reconstruction was 65.75% (4 296/6 534). However, the rate of IBBR in all the patients received mastectomy was only 7.06% (4 296/60 877). Among all the included hospitals, the number of implant reconstructions performed in 2017 was 24 (57.5) cases (M(Q(R)), range: 2-565 cases). Factors associated with the performance of IBBR including regional per capita gross domestic product (H=10.47, P=0.005) and annual surgery volume (H=8.30, P=0.016). The main reasons for choosing IBBR were relatively simple surgical procedure, short learning curve and short operation time. The effects of adjuvant radiotherapy on prosthesis, postoperative complications and patient satisfaction were the main concerns for implant reconstruction. Compared with delay reconstruction, a higher proportion of IBBR was observed in immediate reconstruction (83.1% vs. 62.0%, χ(2)=12.522, P=0.000). In all, 10.5% (10/95) hospitals reported more than 10% grade Ⅲ to Ⅳ capsular contracture. The incidence of infections need surgical intervention was reported between 10% and 20% by 4.2% (4/95) hospitals. Hospitals with 6% to 10% implant rupture and 6% to 15% implant removal were 1.1% (1/95) and 4.2% (4/95) respectively. Conclusions: IBBR was the most common used surgery in breast reconstruction after mastectomy. However, the proportion of IBBR in patients after mastectomy was still low. Reginal economy, surgery volume of hospitals, lack of specialty training program and the concern about complications and patient's satisfaction were the factors affecting the development of IBBR.


Assuntos
Implantes de Mama , Neoplasias da Mama/cirurgia , Mamoplastia/métodos , China , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Mastectomia
11.
MMWR Morb Mortal Wkly Rep ; 68(32): 693-697, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31415490

RESUMO

An estimated 45 million U.S. residents enjoy the benefits of contact lens wear, but many of them might be at increased risk for complications stemming from improper wear and care behaviors (1). One of the most serious complications of contact lens wear is a corneal infection known as microbial keratitis, which can sometimes result in reduced vision or blindness (2). In 2014, 50% of contact lens wearers reported ever sleeping in contact lenses, and 55% reported topping off* their contact lens solutions (3), which put them at greater risk for a contact lens-related eye infection (2,4). Data on communication between eye care providers and contact lens wearers on contact lens wear and care recommendations are limited. Two surveys were conducted to better understand and assess contact lens education about nine recommendations: the first assessed contact lens wearer experiences regarding recommendations received from eye care providers during their most recent appointment; the second evaluated provider-reported practices for communicating contact lens wear and care recommendations to their patients. One third (32.9%) of contact lens wearers aged ≥18 years recalled never hearing any lens wear and care recommendations. Fewer than half (47.9%) recalled hearing their provider recommend not sleeping in lenses at their last visit, and 19.8% recalled being told to avoid topping off their contact lens solution. A majority of providers reported sharing recommendations always or most of the time at initial visits, regular checkups, and complication-related visits. Providers reported sharing nearly all recommendations more frequently at initial and complication-related visits than at regular checkups. Of the nine recommendations for safe contact lens wear and care, eye care providers at regular checkups most often recommend complying with the recommended lens replacement schedules (85% of regular visits), not sleeping in lenses (79.0% of regular visits), and not topping off solutions (64.4% of regular visits). Eye care providers play an important role in the health of their contact lens-wearing patients and can share health communication messages with their patients to help educate them about healthy wear and care habits. These findings can assist in the creation of health communication messages to help encourage eye care providers to communicate more effectively with their patients.


Assuntos
Lentes de Contato , Comportamentos Relacionados com a Saúde , Comunicação em Saúde , Rememoração Mental , Oftalmologistas/psicologia , Educação de Pacientes como Assunto/estatística & dados numéricos , Relações Médico-Paciente , Adolescente , Adulto , Idoso , Lentes de Contato/efeitos adversos , Infecções Oculares/epidemiologia , Feminino , Pesquisas sobre Serviços de Saúde , Comportamentos de Risco à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
12.
Pan Afr Med J ; 33: 48, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31448011

RESUMO

Introduction: diagnostic methods and management of iron deficiency and iron deficiency anemia in clinical practice in Algeria is poorly known. Methods: we conducted a cross-sectional survey among doctors in different specialties treating patients with iron deficiency anemia in 2016. Results: data analysis was based on 349 questionnaires which were validated (anesthesia/resuscitation: 39; obstetrics and gynaecology: 111; oncology/Hematology: 71; hepato-gastroenterology: 64; cardiology: 36; internal medicine: 28). All specialties combined, 73% (254/349) of physicians thought that at least 30% of their patients had iron deficiency anemia; 65% of physicians (226/349) thought that at least 30% of their patients had iron deficiency. Iron deficiency was investigated systematically by 57% (63/111) of physicians of the group obstetrics and gynaecology, but only by 11% (26/238) of the remaining doctors; indeed, 82% (195/238) of physicians investigated it only in patients with anemia. The assessment of iron deficiency showed that the hemoglobin (Hb) was almost always determined (89%; 310/349) while laboratory tests to explore iron metabolism were inadequate: 70% (244/349) of physicians performed serum ferritin test and only 37% (128/349) performed transferrin saturation. Patients with iron deficiency (with or without anemia) received oral iron therapy (prescribed by 92% (322/349) of physicians) and iron injections therapy depending on Hb level (prescribed by 36% (127/349) of physicians). Conclusion: this survey shows that iron deficiency is evaluated only in patients with anemia. In particular, laboratory tests to measure iron deficiency are insufficiently prescribed.


Assuntos
Anemia Ferropriva/diagnóstico , Ferro/deficiência , Médicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Argélia , Anemia/diagnóstico , Anemia/terapia , Anemia Ferropriva/terapia , Estudos Transversais , Feminino , Ferritinas/sangue , Pesquisas sobre Serviços de Saúde , Hemoglobinas/análise , Humanos , Ferro/administração & dosagem , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
Am Surg ; 85(7): 747-751, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405421

RESUMO

The ACGME work hour restrictions facilitated increased utilization of service-based advanced practice providers (APPs) to offset reduced general surgery resident work hours. Information regarding attending surgeon perceptions of APP impact is limited. The aim of this survey was to gauge these perceptions with respect to workload, length of stay (LOS), safety, best practice, level of function, and clinical judgment. Attending surgeons on surgical teams that employ service-based APPs at an urban tertiary referral center responded to a survey at the completion of academic year 2016. Perceptions regarding APP impact on workload, LOS, safety, best practice, level of function, and clinical judgment were examined. Twenty-two attending surgeons (40%) responded. Respondents agreed that APPs always/usually decrease their workload (77%), decrease LOS (64%), improve safety (68%), contribute to best practice (82%), and decrease near misses (71%). They also agreed that APPs decrease resident workload (87%), but fewer agreed that APPs contribute to resident education (68%). The majority perceived APPs function at the PGY1/2 (43%) or PGY3 (39%) level and always/usually trust their clinical judgment (72%), and felt there was variability in level of function among APPs (56%). This single-center study illustrates that attending surgeons perceive a positive impact on patient care by service-based APPs.


Assuntos
Atitude do Pessoal de Saúde , Internato e Residência , Admissão e Escalonamento de Pessoal/organização & administração , Adulto , Feminino , Cirurgia Geral/educação , Pesquisas sobre Serviços de Saúde , Humanos , Tempo de Internação , Masculino , Profissionais de Enfermagem , Segurança do Paciente/normas , Qualidade da Assistência à Saúde , Carga de Trabalho
14.
MMWR Morb Mortal Wkly Rep ; 68(33): 718-723, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31437143

RESUMO

The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of persons aged 11-12 years to protect against certain diseases, including human papillomavirus (HPV)-associated cancers, meningococcal disease, and pertussis (1). A booster dose of quadrivalent meningococcal conjugate vaccine (MenACWY) is recommended at age 16 years, and serogroup B meningococcal vaccine (MenB) may be administered to persons aged 16-23 years (1). To estimate vaccination coverage among adolescents in the United States, CDC analyzed data from the 2018 National Immunization Survey-Teen (NIS-Teen) which included 18,700 adolescents aged 13-17 years.* During 2017-2018, coverage with ≥1 dose of HPV vaccine increased from 65.5% to 68.1%, and the percentage of adolescents up-to-date† with the HPV vaccine series increased from 48.6% to 51.1%, although the increases were only observed among males. Vaccination coverage increases were also observed for ≥1 MenACWY dose (from 85.1% to 86.6%) and ≥2 MenACWY doses (from 44.3% to 50.8%). Coverage with tetanus and reduced diphtheria toxoids and acellular pertussis vaccine (Tdap) remained stable at 89%. Disparities in coverage by metropolitan statistical area (MSA)§ and health insurance status identified in previous years persisted (2). Coverage with ≥1 dose of HPV vaccine was higher among adolescents whose parents reported receiving a provider recommendation; however, prevalence of parents reporting receiving a recommendation for adolescent HPV vaccination varied by state (range = 60%-91%). Supporting providers to give strong recommendations and effectively address parental concerns remains a priority, especially in states and rural areas where provider recommendations were less commonly reported.


Assuntos
Cobertura Vacinal/estatística & dados numéricos , Vacinas/administração & dosagem , Adolescente , Comitês Consultivos , Centers for Disease Control and Prevention (U.S.) , Vacina contra Varicela/administração & dosagem , District of Columbia , Feminino , Pesquisas sobre Serviços de Saúde , Vacinas contra Hepatite B/administração & dosagem , Humanos , Esquemas de Imunização , Masculino , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Vacinas Meningocócicas/administração & dosagem , Vacinas contra Papillomavirus/administração & dosagem , Guias de Prática Clínica como Assunto , Estados Unidos , Vacinação/normas , Vacinas Conjugadas/administração & dosagem
15.
Artigo em Alemão | MEDLINE | ID: mdl-31432202

RESUMO

BACKGROUND: Since 2011, German hospitals have been requested to record and evaluate antibiotic use in their institution. In this publication, the use of antibiotics in hospitals belonging to the administrative district Frankfurt/Main between 2012 and 2017 is presented and discussed with regards to the targets set in 2014. These targets are to improve the perioperative prophylaxis, reduce the use of cefuroxime, and increase the penicillin/cephalosporin ratio. METHODS: Since 2012, hospitals in Frankfurt/Main have been transmitting the defined daily doses (DDD) of all antibiotics used, the absolute number of patients, and their days of treatment. Since 2013, the data have also distinguished between intensive care and other units. The Frankfurt health authority calculated the total number of antibiotics and the DDD/100 patient days for all hospitals combined as well as for every hospital compared to each other. RESULTS: From 2012 to 2017, the number of absolute annual patient days increased from 1,592,161 to 1,615,180. Antibiotic use decreased from 1,073,975 DDD to 953,349 DDD, leading to a decrease from 67.5 DDD per 100 patient days to 59.0 DDD per 100 patient days. Cefuroxime was the most frequently used antibiotic in all hospitals. The use of cefuroxime showed a significant decrease between 2012 and 2017 (from 250,398 in 2012 to 165,160 DDD in 2017, a decrease of 34%). The use of ceftriaxone was reduced by 27%, ciprofloxacin by 9%, and levofloxacin by 16%. DISCUSSION: The targets set in 2014 were reached in the entirety of Frankfurt hospitals. However, there were significant differences between the hospitals taking part. The results were given as feedback to the hospitals in order to support their efforts in further improving antibiotic stewardship.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Revisão de Uso de Medicamentos/legislação & jurisprudência , Uso de Medicamentos/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Uso de Medicamentos/tendências , Revisão de Uso de Medicamentos/estatística & dados numéricos , Alemanha/epidemiologia , Regulamentação Governamental , Pesquisas sobre Serviços de Saúde , Humanos , Vigilância da População
16.
J Glob Health ; 9(1): 010807, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263552

RESUMO

Background: Malawi has a mature integrated community case management (iCCM) programme that is led by the Ministry of Health (MOH) but that still relies on donor support. From 2013 until 2017, under the Rapid Access Expansion (RAcE) programme, the World Health Organization supported the MOH to expand and strengthen iCCM services in four districts. This paper examines Malawi's iCCM programme performance and implementation strength in RAcE districts to further strengthen the broader programme. Methods: Baseline and endline household surveys were conducted in iCCM-eligible areas of RAcE districts. Primary caregivers of recently-sick children under five were interviewed to assess changes in care-seeking and treatment over the project period. Health surveillance assistants (HSAs) were surveyed at endline to assess iCCM implementation strength. Results: Care-seeking from HSAs and treatment of fever improved over the project period. At endline, however, less than half of sick children were brought to an HSA, many caregivers reported a preference for providers other than HSAs, and perceptions of HSAs as trusted providers of high-quality, convenient care had decreased. HSA supervision and mentorship were below MOH targets. Stockouts of malaria medicines were associated with decreased care-seeking from HSAs. Thirty percent of clusters had limited or no access to iCCM (no HSA or an HSA providing iCCM services less than 2 days per week); 50% had moderate access (an HSA providing iCCM services 2 to 4 days per week; and 20% had high access (a resident HSA providing iCCM services 5 or more days per week). Moderate access to iCCM was associated with increased care-seeking from HSAs, increased treatment by HSAs, and more positive perceptions of HSAs compared to areas with limited or no access. Areas with high access to iCCM did not show further improvements above areas with moderate access. Conclusions: Availability of well-equipped and supported HSAs is critical to the provision of iCCM services. Additional qualitative research is needed to examine challenges and to inform potential solutions. Malawi's mature iCCM programme has a strong foundation but can be improved to strengthen the continuity of care from communities to facilities and to ultimately improve child health outcomes.


Assuntos
Administração de Caso/organização & administração , Serviços de Saúde Comunitária/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Pré-Escolar , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/organização & administração , Humanos , Lactente , Malaui , Estudos de Casos Organizacionais , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa
18.
J Glob Health ; 9(2): 020406, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31360446

RESUMO

Background: Africa, and sub-Saharan Africa in particular, remains one of the regions with modest improvements to maternal and newborn survival and morbidity. Good quality intrapartum and early postpartum care in a health facility as well as delivery under the supervision of trained personnel is associated with improved maternal and newborn health outcomes and decreased mortality. We describe and contrast recent time trends in the scale and socio-economic inequalities in facility-based and private facility-based childbirth in sub-Saharan Africa. Methods: We used Demographic and Health Surveys in two time periods (2000-2007 and 2008-2016) to analyse levels and time trends in facility-based and private facility-based deliveries for all live births in the five-year survey recall period to women aged 15-49. Household wealth quintiles were used for equity analysis. Absolute numbers of births by facility sector were calculated applying UN Population Division crude birth rates to the total country population. Results: The percentage of all live births occurring in health facilities varied across countries (5%-85%) in 2000-2007. In 2008-2016, this ranged from 22% to 92%. The lowest percentage of all births occurring in private facilities in 2000-2007 period was in Ethiopia (0.3%) and the highest in the Democratic Republic of Congo at 20.5%. By 2008-2016, this ranged from 0.6% in Niger to 22.3% in Gabon. Overall, the growth in the absolute numbers of births in facilities outpaced the growth in the percentage of births in facilities. The largest increases in absolute numbers of births occurred in public sector facilities in all countries. Overall, the percentage of births occurring in facilities was significantly lower for poorest compared to wealthiest women. As the percentage of facility births increased in all countries over time, the extent of wealth-based differences had reduced between the two time periods in most countries (median risk ratio in 2008-2016 was 2.02). The majority of countries saw a narrowing in both the absolute and relative difference in facility-based deliveries between poorest and wealthiest. Conclusions: The growth in facility-based deliveries, which was largely driven by the public sector, calls for increased investments in effective interventions to improve service delivery and quality of life for the mother and newborn. The goal of universal health coverage to provide better quality services can be achieved by deploying interventions that are holistic in managing and regulating the private sector to enhance performance of the health care system in its entirety rather than interventions that only target service delivery in one sector.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Parto Obstétrico/tendências , Instalações de Saúde/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Adolescente , Adulto , África ao Sul do Saara , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Fatores de Tempo , Adulto Jovem
19.
BMC Public Health ; 19(1): 988, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337384

RESUMO

BACKGROUND: Immunization is one of the most cost-effective health intervention to halt the spread of childhood diseases, and improve child health. Yet, there is a substantial disparity in childhood immunization coverage. The overall objective of the study is to investigate the trends of within-country inequalities in childhood immunization coverage among children aged 12-23 months in Kenya, Ghana, and Côte d'Ivoire. The three countries included in this study are countries that are on the verge of entering the accelerated phase of the Gavi, the Vaccine Alliance's co-sharing of costs of vaccine and eventually assuming full costs of vaccines. Côte d'Ivoire is in the Gavi preparatory transition phase, entering the accelerated transition phase in 2020, with an expected transition to full self-financing in 2025. Ghana is expected to enter the accelerated transition phase in 2021 and to full self-financing in 2026 while Kenya will enter in 2022 and fully self-finance in 2027. We examine the pattern of inequality in childhood immunization coverage over time through an equity lens by mainly exploring the direction of inequality in coverage. METHODS: We use data from the Demographic Health Surveys and Multiple Indicator Cluster Surveys. The rate difference, rate ratio, and relative concentration index are used as measures of inequality. RESULTS: Results of the study suggest that in most years inequality in immunization coverage in the three countries persist over time, and it favors the most-advantaged households. However, there is a sharp decrease pattern in inequalities in childhood immunization coverage in Ghana over time. CONCLUSION: Policymakers could be more strategic in addressing pro-rich inequality in immunization coverage by designing health interventions through an equity lens. Using inequality data and putting disadvantaged households at the center of health intervention designs could increase the efficiency of the primary health care system and reduce the incidence of mortality and morbidity as a result of vaccine-preventable disease.


Assuntos
Disparidades em Assistência à Saúde/tendências , Cobertura Vacinal/tendências , Costa do Marfim , Feminino , Gana , Pesquisas sobre Serviços de Saúde , Humanos , Lactente , Quênia , Masculino , Fatores Socioeconômicos
20.
J Stroke Cerebrovasc Dis ; 28(9): 2434-2441, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31301984

RESUMO

BACKGROUND AND AIM: In recent years, interest in the quality of medical care has rapidly increased worldwide. However, quality indicators that contribute to establishing standard treatment in stroke medicine, especially rehabilitation, are not well-developed in Japan. Japan has established Kaifukuki (convalescent) rehabilitation wards, and the development of quality indicators for stroke rehabilitation in the convalescent phase is an urgent issue. METHODS: We first reviewed the literature regarding quality indicators for stroke rehabilitation. Next, we extracted candidate indicators from identified reports and guidelines and surveyed educational hospitals certified by the Japanese Association of Rehabilitation Medicine. On the basis of the survey results, we reevaluated the suitability of the proposed indicators in discussions with an expert panel. RESULTS: The questionnaire survey highlighted several important items that revealed there is room for improvement in adherence. For stroke rehabilitation in the convalescent phase, we adopted 15 indicators that were feasible as indicators to be used for comparisons between facilities, based on scoring by and opinions of the expert panel. These indicators measured structure (2 indicators), process (5 indicators), and outcome (8 indicators). CONCLUSION: This is the first study to establish quality indicators to standardize stroke rehabilitation in Japan. We developed this set of 15 indicators using an evidence-based approach. However, many tasks remain for continuous quality improvement.


Assuntos
Fidelidade a Diretrizes/normas , Avaliação de Processos e Resultados (Cuidados de Saúde)/normas , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Reabilitação do Acidente Vascular Cerebral/normas , Acidente Vascular Cerebral/terapia , Avaliação da Deficiência , Pesquisas sobre Serviços de Saúde , Nível de Saúde , Humanos , Japão/epidemiologia , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
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