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1.
Pediatrics ; 146(Suppl 2): S218-S222, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33004643

RESUMO

Data from the past decade have revealed that neonatal mortality represents a growing burden of the under-5 mortality rate. To further reduce these deaths, the focus must expand to include building capacity of the workforce to provide high-quality obstetric and intrapartum care. Obstetric complications, such as hypertensive disorders and obstructed labor, are significant contributors to neonatal morbidity and mortality. A well-prepared workforce with the necessary knowledge, skills, attitudes, and motivation is required to rapidly detect and manage these complications to save both maternal and newborn lives. Traditional off-site, didactic, and lengthy training approaches have not always yielded the desired results. Helping Mothers Survive training was modeled after Helping Babies Breathe and incorporates further evidence-based methodology to deliver training on-site to the entire team of providers, who continue to practice after training with their peers. Research has revealed that significant gains in health outcomes can be reached by using this approach. In the coronavirus disease 2019 era, we must look to translate the best practices of these training programs into a flexible and sustainable model that can be delivered remotely to maintain quality services to women and their newborns.


Assuntos
Pessoal de Saúde/educação , Capacitação em Serviço/organização & administração , Assistência Perinatal/organização & administração , Fortalecimento Institucional , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Serviços de Saúde Materno-Infantil/organização & administração , Assistência Perinatal/normas , Gravidez , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/terapia
2.
PLoS One ; 15(8): e0236933, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866154

RESUMO

BACKGROUND: Persons living with human immunodeficiency virus (HIV) are at a greater risk of developing tuberculosis (TB) compared to people without HIV and of developing complications due to the complexity of TB/HIV coinfection management. METHODS: During 2013-2017, the Centers for Disease Control and Prevention (CDC) funded 5 TB Regional Training and Medical Consultation Centers (RTMCCs) (now known as TB Centers of Excellence or COEs) to provide medical consultation to providers for TB disease and latent TB infection (LTBI), with data entered into a Medical Consultation Database (MCD). Descriptive analyses of TB/HIV-related consultations were conducted using SAS® software, version [9.4] to determine the distribution of year of consultation, medical setting and provider type, frequency of consultations regarding a pediatric (<18 years) patient, and to categorize key concepts and themes arising within consultation queries and medical consultant responses. RESULTS: Of 14,586 consultations captured by the MCD in 2013-2017, 544 (4%) were categorized as TB/HIV-related, with 100 (18%) received in 2013, 129 (24%) in 2014, 104 (19%) in 2015, 117 (22%) in 2016, and 94 (17%) in 2017. Most TB/HIV consultations came from nurses (54%) or physicians (43%) and from local (65%) or state health departments (10%). Only 17 (3%) of HIV-related consultations involved pediatric cases. Off the 544 TB/HIV consultations, 347 (64%) concerned the appropriate treatment regimen for TB/HIV or LTBI/HIV for a patient on or not on antiretroviral therapy (ART). CONCLUSIONS: The data support a clear and ongoing gap in areas of specialized HIV knowledge by TB experts that could be supplemented with proactive educational outreach. The specific categories of TB/HIV inquiries captured by this analysis are strategically informing future targeted training and educational activities planned by the CDC TB Centers of Excellence, as well as guiding HIV educational efforts at regional and national TB meetings.


Assuntos
Centers for Disease Control and Prevention, U.S./economia , Infecções por HIV/complicações , Pessoal de Saúde/economia , Pessoal de Saúde/educação , Encaminhamento e Consulta/economia , Tuberculose/complicações , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Antituberculosos/efeitos adversos , Antituberculosos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Humanos , Segurança , Tuberculose/tratamento farmacológico , Estados Unidos
3.
Indian J Public Health ; 64(3): 277-284, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32985430

RESUMO

Background: Improving quality of health services and providing safe care require well-trained and skilled workforce. The inclusion of components of patient safety in graduate training curricula, followed by adherence to curricula in teaching programs, can improve the quality of health-care services. Objectives: To review the existing training curricula for five subgroups of health workforce (Allopathic doctors, nurses, laboratory technicians, pharmacists, and nurse midwives) and to document the components and identified variables of patient safety covered. Methods: A mixed-methods study was conducted during July 2017-March 2018. Data were collected through desk review, field visits, in-depth interviews, self-administered questionnaires, and focused group discussions (FGDs). A total of 24 variables were identified by the experts to review the training curricula. Results: Seven states, 28 institutes, and 42 health-care facilities were visited. A total of 516 staff from different health cadres participated in the study through 54 interviews, 156 self-administered questionnaires, and 24 FGDs. Of 24 patient safety variables considered, 16 were covered in the medical and nursing, 9 in laboratory technician and pharmacist, and 5 in midwives' curricula. The teaching material on the patient safety, for most categories of staff, was not available in consolidated form, and there was no standardization. Conclusion: There is a need for the development of comprehensive training material cum operational modules on patient safety, suitably adopted as per the learning needs of different subgroups of health staff. The need for strengthening patient safety has been further underscored as the health workforce is fighting the coronavirus disease 19 (COVID-19) pandemic. The initiatives on patient safety will contribute to improved overall quality of health services, which in turn would advance universal health coverage.


Assuntos
Educação de Pós-Graduação/métodos , Pessoal de Saúde/educação , Segurança do Paciente , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Currículo , Coleta de Dados/métodos , Feminino , Humanos , Índia , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Melhoria de Qualidade
4.
Am J Disaster Med ; 14(4): 247-254, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32803744

RESUMO

OBJECTIVE: The Pandemic and All-Hazards Preparedness Act calls for establishing a competency-based training program to train public health practitioners. To inform such training, the Centers for Disease Control and Prevention and the Association of Schools of Public Health managed groups of experts to produce a competency model which could function as a national standard of behaviorally based, observable skills for the public health workforce to prevent, protect against, respond to, and recover from all hazards. DESIGN: A systematic review of existing competency models generated a competency model of proposed domains and competencies. PARTICIPANTS: National stakeholders were engaged to obtain consensus through a three-stage Delphi-like process. RESULTS: The Delphi-like process achieved 84 percent, 82 percent, and 79 percent response rates in its three stages. Three hundred sixty six unique individuals responded to the three-round process, with 45 percent (n = 166) responding to all three rounds. The resulting competency model features 18 competencies within four core learning domains targeted at midlevel public health workers. CONCLUSIONS: Practitioners and academics have adopted the Public Health Preparedness and Response Core Competency Model, some of whom have formed workgroups to develop curricula based on the model. Efforts will be needed to develop evaluation materials for training and education programs to refine the model as well as for future training and education initiatives.


Assuntos
Planejamento em Desastres/organização & administração , Pessoal de Saúde/educação , Competência Profissional/normas , Saúde Pública/normas , Consenso , Currículo , Técnica Delfos , Humanos
7.
Arch. argent. pediatr ; 118(4): e384-e391, agosto 2020. tab
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1118509

RESUMO

Introducción. El abordaje del desarrollo en la primera infancia (DPI) y las dificultades del desarrollo (DD) en los países de ingresos bajos o medios (PIBM) requiere de programas aplicables y sostenibles. Se evaluó el programa de capacitación para las unidades de pediatría del desarrollo (UPD) en los centros de referencia tras siete años. Población y métodos. Diseño transversal con métodos cualicuantitativos para evaluar los servicios, la capacitación, la investigación y la promoción de las UPD. Resultados. Se mantuvieron los servicios clínicos, la capacitación, investigación y promoción. En total, 23710 niños fueron derivados. La motivación y resistencia del personal, el respaldo de los administradores y la satisfacción del paciente facilitaron el programa, aunque la invisibilidad dentro del sistema de salud fue un obstáculo. Conclusiones. En Turquía, y posiblemente otros PIBM, el programa de capacitación para las UPD es aplicable y sostenible si se abordan los obstáculos del sistema de salud.


Introduction. Addressing early childhood development (ECD) and developmental difficulties (DDs) in low and middle-income countries (LMICs) requires applicable and sustainable programs. Seven years after its implementation in 2010, we evaluated the Developmental Pediatrics Unit (DPU) Training Program in pediatric referral centers in Turkey. Population and methods. We applied crosssectional design and quantitative/qualitative methods to assess services, training, research and advocacy of the DPUs. Results. Five of six established DPUs sustained clinical services, training, research, and advocacy. A total of 23,710 children (9085 new cases in 2017) had been referred mainly for perinatal risks and chronic illness, all centers contributed with similar proportions of children. Staff motivation and endurance, hospital administrator support, and client satisfaction facilitated the program; whereas invisibility within the performance based healthcare system was a barrier. Conclusions. In Turkey and possibly other LMICs, the DPU Training Program is applicable and sustainable if health system barriers are addressed


Assuntos
Humanos , Masculino , Feminino , Desenvolvimento Infantil , Pediatria , Pobreza , Turquia , Estudos Transversais , Pessoal de Saúde/educação , Crianças com Deficiência , Educação , Tutoria
9.
J Contin Educ Nurs ; 51(9): 399-401, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32833029

RESUMO

In light of the COVID-19 pandemic and uncertainties around risk of transmission, urgent hospital resuscitation (also known as "Code Blue") efforts are needed, pivoting to protect health care workers. This article provides teaching tips for "Protected Code Blues." [J Contin Educ Nurs. 2020;51(9):399-401.].


Assuntos
Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/enfermagem , Reanimação Cardiopulmonar/normas , Infecções por Coronavirus/enfermagem , Pessoal de Saúde/educação , Recursos Humanos de Enfermagem no Hospital/educação , Pneumonia Viral/enfermagem , Treinamento por Simulação/organização & administração , Adulto , Betacoronavirus , Currículo , Educação Continuada em Enfermagem/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Guias de Prática Clínica como Assunto
10.
J Contin Educ Nurs ; 51(9): 402-411, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32833030

RESUMO

This article provides the most current guidelines for nurse educators and nurses to use systems thinking to manage COVID-19 in health systems. A working definition of systems thinking is offered, with a review of basic knowledge and care in the context of the system awareness model (SAM). Seven key messages assist nurse educators and nurses in the management of COVID-19 patients culminating in leadership of complex health care systems using systems thinking. [J Contin Educ Nurs. 2020;51(9):402-411.].


Assuntos
Infecções por Coronavirus/terapia , Enfermagem de Cuidados Críticos/educação , Enfermagem de Cuidados Críticos/normas , Assistência à Saúde/organização & administração , Assistência à Saúde/estatística & dados numéricos , Pessoal de Saúde/educação , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Adulto , Betacoronavirus , Currículo , Educação Continuada em Enfermagem/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Análise de Sistemas
11.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32817268

RESUMO

BACKGROUND: Although required for healing, sleep is often disrupted during hospitalization. Blood pressure (BP) monitoring can be especially disruptive for pediatric inpatients and has few clinical indications. Our aim in this pilot study was to reduce unnecessary overnight BP monitoring and improve sleep for pediatric inpatients. METHODS: The intervention in June 2018 involved clinician education sessions and updated electronic health record (EHR) orders that enabled the forgoing of overnight BP checks. The postintervention period from July 2018 to May 2019 examined patient-caregiver surveys as outcome measures. These surveys measured inpatient sleep and overnight disruptions and were adopted from validated surveys: the Patient Sleep Questionnaire, expanded Brief Infant Sleep Questionnaire, and Potential Hospital Sleep Disruptions and Noises Questionnaire. Uptake of new sleep-friendly EHR orders was a process measure. Reported patient care escalations served as a balancing measure. RESULTS: Interrupted time series analysis of EHR orders (npre = 493; npost = 1472) showed an increase in intercept for the proportion of patients forgoing overnight BP postintervention (+50.7%; 95% confidence interval 41.2% to 60.3%; P < .001) and a subsequent decrease in slope each week (-0.16%; 95% confidence interval -0.32% to -0.01%; P = .037). Statistical process control of surveys (npre = 263; npost = 131) showed a significant increase in sleep duration for patients older than 2, and nighttime disruptions by clinicians decreased by 19% (P < .001). Annual estimated cost savings were $15 842.01. No major adverse events in patients forgoing BP were reported. CONCLUSIONS: A pilot study combining EHR changes and clinician education safely decreased overnight BP checks, increased pediatric inpatient sleep duration, and reduced nighttime disruptions by clinicians.


Assuntos
Determinação da Pressão Arterial/normas , Criança Hospitalizada , Pessoal de Saúde/normas , Análise de Séries Temporais Interrompida/normas , Melhoria de Qualidade/normas , Sono/fisiologia , Adolescente , Determinação da Pressão Arterial/psicologia , Determinação da Pressão Arterial/tendências , Cuidadores/educação , Cuidadores/normas , Cuidadores/tendências , Criança , Criança Hospitalizada/psicologia , Pré-Escolar , Registros Eletrônicos de Saúde/normas , Registros Eletrônicos de Saúde/tendências , Feminino , Pessoal de Saúde/educação , Pessoal de Saúde/tendências , Humanos , Lactente , Recém-Nascido , Análise de Séries Temporais Interrompida/tendências , Masculino , Projetos Piloto , Estudos Prospectivos , Melhoria de Qualidade/tendências
12.
PLoS Negl Trop Dis ; 14(8): e0008554, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32810163

RESUMO

BACKGROUND: Scabies is a common contagious skin disease. With the economic growth in South Korea, the incidence of scabies has decreased. However, with the recent advancements in medical facilities, mainly the establishment of long-term care hospitals (LTCHs), scabies is now considered an emerging public health problem. METHODOLOGY/PRINCIPAL FINDINGS: To examine the prevalence and management of scabies in LTCHs in South Korea, we contacted all 1,336 LTCHs registered at the Health Insurance Review and Assessment Service in South Korea in 2018. A total of 110 LTCHs completed a questionnaire, and we analyzed their responses. In the last 5 years, 71.8% (79/110) of LTCHs had a high incidence of scabies (suspected/confirmed cases). Usually, patients aged older than 80 years (45.5%) were diagnosed with the disease, with more women being affected than men. Only 30.0% of the patients were transferred to scabies-restricted rooms, and very few LTCHs (7.0%) had special departments for scabies. Fifty-five (61.1%) of 90 LTCHs reported contact between scabies patients and nurses, nurse aides, caregivers, and other employees (hereinafter, referred to as primary exposure), with 29 (32.2%) LTCHs reporting infections due to primary exposure. The most common challenges in managing scabies were patient isolation (47.8%), diagnosis (31.1%), management of individuals exposed to an individual with scabies (17.8%), lack of staff for managing the patients (16.7%), and treatment (11.1%). CONCLUSIONS: The incidence rate of scabies in LTCHs in South Korea has increased. Regular and enhanced staff training is needed, considering that most hospitals rarely focused on the handling of equipment and furniture used by scabies patients and on educating their healthcare staff. These findings can be used to develop various strategies to reduce the prevalence of scabies.


Assuntos
Hospitais , Assistência de Longa Duração , Escabiose/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Pessoal de Saúde/educação , Humanos , Incidência , Controle de Infecções , Masculino , Pessoa de Meia-Idade , Administração dos Cuidados ao Paciente , Prevalência , República da Coreia/epidemiologia , Estudos Retrospectivos , Adulto Jovem
13.
PLoS One ; 15(8): e0235591, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790671

RESUMO

Adverse drug reactions (ADRs) are associated with morbidity and mortality worldwide. Although national systems for reporting ADRs exist there is a low reporting rate. The aim of the current study was to evaluate an intervention plan for improving ADRs reporting among medical professionals (physicians and nurses). A multicentre intervention study was conducted, in which one medical centre was randomly assigned to the intervention group and two medical centres to the control group. The study consisted of 3 phases: baseline data collection, intervention and follow-up of the reporting rate. The questionnaire that was filled in at base line and at the end of study, contained questions about personal/professional demographic variables, and statements regarding knowledge of and behaviour toward ADRs reporting. The intervention program consisted of posters, lectures, distant electronic learning and reminders. An increase in the number of ADRs reports was noted in the intervention group (74 times higher than in the control group) during the intervention period, which was gradually decreased with as the study progressed (adjusted O.R = 74.1, 95% CI = 21.11-260.1, p<0.001). The changes in the "knowledge related to behaviour" (p = 0.01) and in the "behaviour related to reporting" (p<0.001) score was significantly higher in the intervention group. Specialist physicians and nurses (p<0.001), fulfilling additional positions (p<0.001) and those working in other places (p = 0.05) demonstrated a high rate of report. Lectures were preferable as a method to encourage ADRs reporting. The most convenient reporting tools were telephone and online reporting. Thus, implementation and maintenance of a continuous intervention program, by a pharmacovigilance specialist staff member, will improve ADRs reporting rates.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/normas , Educação Profissional em Saúde Pública/métodos , Pessoal de Saúde/educação , Hospitais Públicos/estatística & dados numéricos , Humanos , Melhoria de Qualidade
14.
Artigo em Russo | MEDLINE | ID: mdl-32827385

RESUMO

The article presents the results of study concerning improving medical care quality in rural areas. The purpose was to investigate the characteristics of medical personnel training in the framework of the "Zemstvo Doctor" program. The activities of the University were analyzed concerning implementation of professional training of medical personnel and including continuing medical education. To achieve this goal, efficiency of educational programs development considering contribution of the "Zemstvo doctor" program implementation was evaluated. The study was carried out in 2013-2019 on the basis of the Medical Institute of Belgorod State National Research University. The structured interview was applied as methodology of collecting primary data. The fact of decreasing of medical profession prestige that occurs against the background of implementation of the state program "Zemstvo Doctor" was established. The overcoming of this situation is necessary to improve medical care quality in rural areas. The focusing on existing regional features of medical care support and taking into account characteristics of health of population are required. In this respect the key factor is the training of rural physicians to employ high-tech technologies, including digital simulation and telecommunications equipment. The relevance of the state program "Zemstvo Doctor" is obvious, but the medical education system has no official instructions concerning the need of correcting educational programs. The efficiency of changes applied to educational programs was determined by subjective assessment of the need and the clinical experience of physicians-lecturers who are involved in resolving scientific and practical problems of health care in rural areas.


Assuntos
Educação Médica , Médicos , Assistência à Saúde , Pessoal de Saúde/educação , Humanos , Qualidade da Assistência à Saúde
15.
Palliat Med ; 34(9): 1220-1227, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32736486

RESUMO

BACKGROUND: Hospital palliative care is an essential part of the COVID-19 response, but relevant data are lacking. The recent literature underscores the need to implement protocols for symptom control and the training of non-specialists by palliative care teams. AIM: The aim of the study was to describe a palliative care unit's consultation and assistance intervention at the request of an Infectious Diseases Unit during the COVID-19 pandemic, determining what changes needed to be made in delivering palliative care. DESIGN: This is a single holistic case study design using data triangulation, for example, audio recordings of team meetings and field notes. SETTING/PARTICIPANTS: This study was conducted in the Palliative Care Unit of the AUSL-IRCCS hospital of Reggio Emilia, which has no designated beds, consulting with the Infectious Diseases Unit of the same hospital. RESULTS: A total of 9 physicians and 22 nurses of the Infectious Diseases Unit and two physicians of the Palliative Care Unit participated in the study.Our Palliative Care Unit developed a feasible 18-day multicomponent consultation intervention. Three macro themes were identified: (1) new answers to new needs, (2) symptom relief and decision-making process, and (3) educational and training issues. CONCLUSION: From the perspective of palliative care, some changes in usual care needed to be made. These included breaking bad news, patients' use of communication devices, the limited time available for the delivery of care, managing death necessarily only inside the hospital, and relationships with families.


Assuntos
Infecções por Coronavirus/terapia , Pessoal de Saúde/educação , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/educação , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/normas , Infectologia/educação , Infectologia/normas , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Adulto , Betacoronavirus , Feminino , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/métodos , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Humanos , Infectologia/métodos , Infectologia/estatística & dados numéricos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pesquisa Qualitativa
16.
Am J Infect Control ; 48(10): 1244-1247, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32763351

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has created many challenges for health care providers. At the forefront is the need to balance optimal patient care with the safety of those providing that care. This is especially true during resuscitations where life-saving procedures cause widespread aerosolization of the virus. Efforts to mitigate this exposure to front-line providers are therefore paramount. We share how we used simulation to prepare our pediatric emergency department for COVID-19 resuscitations.


Assuntos
Infecções por Coronavirus/terapia , Serviço Hospitalar de Emergência , Pessoal de Saúde/educação , Pneumonia Viral/terapia , Ressuscitação/educação , Treinamento por Simulação/métodos , Betacoronavirus , Criança , Humanos , Pandemias , Integração de Sistemas
17.
Eur Rev Med Pharmacol Sci ; 24(15): 8202-8209, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32767350

RESUMO

OBJECTIVE: The recent outbreak of SARS-CoV-2 infection in Italy has resulted in a sudden and massive flow of patients into emergency rooms, and a high number of hospitalizations with the need for respiratory isolation. Massive admission of patients to the Policlinico "Agostino Gemelli" Foundation of Rome, Italy, determined the need for reengineering the entire hospital. MATERIALS AND METHODS: In this article, we consider some of the structural and organizational changes that have been necessary to deal with the emergency, with particular reference to non-intensive medicine wards, and the preventive measures aimed at limiting the spread of SARS-CoV-2 infection among hospital staff and patients themselves. RESULTS: 577 staff members were subjected to molecular tests in 1-month period and 3.8% of the total were positive. 636 patients admitted to the COVID-19 pathway were included and analyzed: 45.4% were identified as SARS-CoV-2 positive. More SARS-CoV-2 negative patients were discharged in comparison to SARS-CoV-2 positive patients (59% vs. 41%, respectively). On the other hand, more SARS-CoV-2 positive patients were transferred to ICUs in comparison to SARS-CoV-2 negative patients (16% vs. 1%, respectively). Occurrence of death was similar between the two groups, 11% vs. 7%, for SARS-CoV-2 negative and positive patients, respectively. 25% of ≥80 years old SARS-CoV-2 positive patients died during the hospitalization, while death rate was lower in other age groups (5% in 70-79 years old patients and 0% in remaining age groups). CONCLUSIONS: Rapid hospital reengineering has probably had an impact on the management of patients with and without SARS-CoV-2 infection, and on in-hospital mortality rates over the reporting period.


Assuntos
Infecções por Coronavirus/epidemiologia , Unidades Hospitalares/organização & administração , Controle de Infecções/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Pneumonia Viral/epidemiologia , Centros de Atenção Terciária/organização & administração , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Feminino , Pessoal de Saúde/educação , Número de Leitos em Hospital , Hospitais Especializados , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Unidades de Terapia Intensiva , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Isolamento de Pacientes , Equipamento de Proteção Individual , Pneumonia Viral/terapia , Pneumonia Viral/transmissão
19.
PLoS One ; 15(7): e0235577, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628714

RESUMO

BACKGROUND: Nigeria is estimated to have 25,000 cases of cryptococcal antigenemia (CrAg) annually. CrAg screening with pre-emptive fluconazole treatment is recommended but not yet implemented in Nigeria. Trainings were conducted to improve health-care provider (HCP) awareness and clinical skills in the management and prevention of cryptococcal meningitis (CM). METHODS: HCPs providing care for people living with HIV were targeted for training at 13 sites from April to November 2018 Course content was adapted from CDC Cryptococcal Screening Program Training Manual and LIFE-website. "Hands-on" training on CrAg testing and lumbar puncture was included. A 14-point pre and post-test assessment instrument was designed to capture the impact of the training and focus group discussions (FGDs) were conducted. RESULTS: A total of 761 HCPs were trained. 519 HCPs completed the pre-test evaluation while 470 (90.6%) took part in the post-test evaluation. Post-training, HCPs were significantly more likely to respond correctly to all 14 assessment items, with the mean percentage score rising to 91.0% from a pre-training value of 60.0%. FGDs revealed that many of the HCPs were not aware of the CrAg screening and pre-emptive treatment recommendations in Nigerian guidelines, and reported not having seen or managed a case of CM. Also, they highlighted challenges with routine CrAg screening due to a lack of access to CD4 testing, CrAg test kits, antifungal drugs, as well as the need for similar trainings across all tiers of care in Nigeria. CONCLUSION: Training significantly improved HCPs' understanding of Nigerian policy on CrAg screening, CM diagnosis and best management practices. This training could be included in routine capacity building efforts for HCPs involved in HIV care in Nigeria.


Assuntos
Pessoal de Saúde/educação , Meningite Criptocócica/prevenção & controle , Meningite Criptocócica/terapia , Assistência ao Paciente/estatística & dados numéricos , Grupos Focais , Humanos , Nigéria
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