Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 335
Filtrar
1.
Prof Case Manag ; 26(2): 62-69, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33507016

RESUMO

PURPOSE: Since the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the disease known as COVID-19, case management has emerged as a critical intervention in the treatment of cases, particularly for patients with severe symptoms and medical complications. In addition, case managers have been on the front lines of the response across the health care spectrum to reduce risks of contagion, including among health care workers. The purpose of this article is to discuss the case management response, highlighting the importance of individual care plans to provide access to the right care and treatment at the right time to address both the consequences of the disease and patient comorbidities. PRIMARY PRACTICE SETTINGS: The COVID-19 response spans the full continuum of health and human services, including acute care, subacute care, workers' compensation (especially catastrophic case management), home health, primary care, and community-based care. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: From the earliest days of the pandemic, case managers have assumed an important role on the front lines of the medical response to COVID-19, ensuring that procedures are in place for managing a range of patients: those who were symptomatic but able to self-isolate and care for themselves at home; those who had serious symptoms and needed to be hospitalized; and those who were asymptomatic and needed to be educated about the importance of self-isolating. Across the care spectrum, individualized responses to the clinical and psychosocial needs of patients with COVID-19 in acute care, subacute care, home health, and other outpatient settings have been guided by the well-established case management process of screening, assessing, planning, implementing, following up, transitioning, and evaluating. In addition, professional case managers are guided by values such as advocacy, ensuring access to the right care and treatment at the right time; autonomy, respecting the right to self-determination; and justice, promoting fairness and equity in access to resources and treatment. The value of justice also addresses the sobering reality that people from racial and ethnic minority groups are at an increased risk of getting sick and dying from COVID-19. Going forward, case management will continue to play a major role in supporting patients with COVID-19, in both inpatient and outpatient settings, with telephonic follow-up and greater use of telehealth.


Assuntos
/enfermagem , Administração de Caso/normas , Enfermagem de Cuidados Críticos/educação , Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Planejamento de Assistência ao Paciente/normas , Assistência Centrada no Paciente/normas , Adulto , Administração de Caso/estatística & dados numéricos , Currículo , Educação Continuada em Enfermagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Assistência Centrada no Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto
2.
PLoS One ; 15(9): e0238562, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881971

RESUMO

BACKGROUND AND OBJECTIVES: A summary indicator for evaluating the breast cancer network has never been measured at the regional level. The aim is to design treemaps providing a summary description of hospitals (including breast units) and Local Health Units (LHUs) in terms of their levels of performance within the breast cancer network of the Lazio region (central Italy). The treemap structure has an intuitive design and displays information from both general and specific analyses. METHODS: Patients admitted to the regional hospitals for malignant breast cancer (MBC) surgery in 2010-2017 were selected in a population-based cohort study. These quality indicators were calculated based on the international guidelines (EUSOMA, ESMO) to assess the performance in terms of volume of activity, surgery procedure, post-surgery assistance and timeliness of medical therapy or radiotherapy beginning. The quality indicators were calculated using administrative health data systematically collected at the regional level and were included in the treemap to represent the surgery or the post-surgery areas of the breast cancer clinical pathway. In order to allow aggregation of scores for different indicators belonging to the same clinical area, up to five evaluation classes were defined using the "Jenks Natural Breaks" algorithm. A score and a colour were assigned to each clinical area based on the ranking of the indicators involved. The analyses were performed on an annual basis, by the LHU of residence and by the hospital which performed the surgical intervention. RESULTS: In 2017, 6218 surgical interventions for MBC were performed in the hospitals of Lazio. The results showed a continuous increase of the level of performance over the years. Hospitals showed higher variability in the levels of performance than the LHUs. 36% of the evaluated hospitals reached a high level of performance. An audit of the S. Filippo Neri breast unit revealed incorrect coding of the input data. For this reason, the score for the indicator for the volume of wards was re-calculated and re-evaluated, with a subsequent improvement of the level of performance. Most LHUs achieved at least an average overall level of performance, with 20% of the LHUs reaching a high level of performance. CONCLUSIONS: This is the first attempt to apply the treemap logic to a single clinical network, in order to obtain a summary indicator for the evaluation of the breast cancer care network. Our results supply decision makers with a transparent instrument of governance for heterogeneous users, directing efforts improving and promoting equity of care. The treemaps could be reproduced and adapted for other local contexts, in order to limit inappropriateness and ensure uniform levels of breast cancer care within local areas. The next step is the evaluation of audit and feedback interventions to improve the quality of care and to guarantee homogeneous levels of care throughout the region.


Assuntos
Neoplasias da Mama/epidemiologia , Hospitais/estatística & dados numéricos , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estudos de Coortes , Redes Comunitárias/estatística & dados numéricos , Feminino , Humanos , Itália/epidemiologia
3.
PLoS One ; 15(6): e0233810, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525888

RESUMO

Limited resources and increased patient flow highlight the importance of optimizing healthcare operational systems to improve patient care. Accurate prediction of exam volumes, workflow surges and, most notably, patient delay and wait times are known to have significant impact on quality of care and patient satisfaction. The main objective of this work was to investigate the choice of different operational features to achieve (1) more accurate and concise process models and (2) more effective interventions. To exclude process modelling bias, data from four different workflows was considered, including a mix of walk-in, scheduled, and hybrid facilities. A total of 84 features were computed, based on previous literature and our independent work, all derivable from a typical Hospital Information System. The features were categorized by five subgroups: congestion, customer, resource, task and time features. Two models were used in the feature selection process: linear regression and random forest. Independent of workflow and the model used for selection, it was determined that congestion feature sets lead to models most predictive for operational processes, with a smaller number of predictors.


Assuntos
Modelos Logísticos , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Fluxo de Trabalho , Agendamento de Consultas , Sistemas de Informação Hospitalar/estatística & dados numéricos , Aprendizado de Máquina , Planejamento de Assistência ao Paciente/organização & administração
4.
JAMA Netw Open ; 3(5): e205424, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32427325

RESUMO

Importance: Lack of pediatric advance care planning has been associated with poor communication, increased hospitalization, poor quality of life, and legal actions. Clinicians presume that families understand adolescents' treatment preferences for end-of-life care. Objective: To examine patient-reported end-of-life values and needs of adolescents with cancer and congruence with their families' understanding of these needs. Design, Setting, and Participants: This cross-sectional survey was conducted among adolescent-family dyads from July 16, 2016, to April 30, 2019, at 4 tertiary care pediatric US hospitals. Participants included 80 adolescent-family dyads (160 participants) within a larger study facilitating pediatric advance care planning. Adolescent eligibility criteria included being aged 14 to 21 years, English speaking, being diagnosed with cancer at any stage, and knowing their diagnosis. Family included legal guardians for minors or chosen surrogate decision-makers for those aged 18 years or older. Data analysis was performed from April 2019 to November 2019. Exposure: Session 1 of the 3-session Family Centered Pediatric Advance Care Planning for Teens With Cancer intervention. Main Outcomes and Measures: The main outcome was congruence between adolescents with cancer and their families regarding adolescents' values, goals, and beliefs about end-of-life care. Prevalence-adjusted and bias-adjusted κ (PABAK) values were used to measure congruence on the Lyon Advance Care Planning Survey-Revised (Patient and Surrogate versions). Results: A total of 80 adolescent-family dyads (160 participants) were randomized to the intervention group in the original trial. Among the adolescents, 44 (55.0%) were female and 60 (75.0%) were white, with a mean (SD) age of 16.9 (1.8) years. Among family members, 66 (82.5%) were female and 65 (81.3%) were white, with a mean (SD) age of 45.3 (8.3) years. Family members' understanding of their adolescent's beliefs about the best time bring up end-of-life decisions was poor: 86% of adolescents wanted early timing (before getting sick, while healthy, when first diagnosed, when first sick from a life-threatening illness, or all of the above), but only 39% of families knew this (PABAK, 0.18). Families' understanding of what was important to their adolescents when dealing with their own dying was excellent for wanting honest answers from their physician (PABAK, 0.95) and understanding treatment choices (PABAK, 0.95) but poor for dying a natural death (PABAK, 0.18) and being off machines that extend life, if dying (PABAK, 0). Conclusions and Relevance: Many families had a poor understanding of their adolescent's values regarding their own end-of-life care, such as when to initiate end-of-life conversations and preference for being off machines that extend life. Pediatric advance care planning could minimize these misunderstandings with the potential for a substantial impact on quality of care.


Assuntos
Família/psicologia , Neoplasias/terapia , Assistência Terminal/psicologia , Adolescente , Adulto , Planejamento Antecipado de Cuidados/estatística & dados numéricos , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Psicologia do Adolescente/estatística & dados numéricos , Estados Unidos , Adulto Jovem
5.
Oncol Nurs Forum ; 46(6): 715-726, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31626609

RESUMO

OBJECTIVES: To determine if patients and providers perceived improved care processes through the delivery of personalized, electronic care plans (CPs) generated from the Carevive Care Planning System™. SAMPLE & SETTING: 121 women (51 with gynecologic cancer from Billings Clinic and 70 with breast cancer from Moffit Cancer Center) completed electronic patient-reported outcome assessments and were given electronically generated, personalized supportive CPs tailored to individual symptoms and local healthcare resources. METHODS & VARIABLES: Quantitative instruments evaluated feasibility, usability, acceptability, and satisfaction of the CPs from patient and provider perspectives. Qualitative interviews described patient perceptions of the CPs. RESULTS: Patients with cancer reported the CPs to be useful. Most perceived that CPs improved team communication, helped find needed resources, and helped manage symptoms. Provider satisfaction was highest with the platform's ability to customize patient recommendations. Interviews indicated that patients with cancer used their CP as a resource, preferred delivery at treatment initiation, and valued information to manage symptoms. IMPLICATIONS FOR NURSING: Nurses play an integral role in patient education and in discussing individual care. Tailored CPs can be used as a teaching tool that patients with cancer can refer to for self-care.


Assuntos
Neoplasias da Mama/enfermagem , Registros Eletrônicos de Saúde/estatística & dados numéricos , Neoplasias dos Genitais Femininos/enfermagem , Fidelidade a Diretrizes/estatística & dados numéricos , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Educação de Pacientes como Assunto/normas , Assistência Centrada no Paciente/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Guias de Prática Clínica como Assunto , Estados Unidos , Adulto Jovem
6.
J Int Assoc Provid AIDS Care ; 18: 2325958219880532, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31607234

RESUMO

Jacksonville, Florida, provides services to persons living with the HIV. A federal call for integrated HIV prevention and treatment was published on June 19, 2015. This study unveils the principles that guided the local response to that call. Service providers have not systematically engaged in strategic planning for system improvement, the absence of which defines the boundaries and properties of the service system. Integration requires a unifying strategy as it draws leaders from their respective silos. Directed leadership, community-based participatory research, and action research provided a science-based framework for integration. Quantitatively, one-third of the planning implementation journey has elapsed, and 46% of the 75 planned activities have either reached fulfillment or are ongoing. Another one-fourth is in progress and slightly more than one-fourth (28%) are pending. Qualitatively, this study recorded 7 system-level changes. Progress to date is a harbinger of future system-level changes.


Assuntos
Prestação Integrada de Cuidados de Saúde , Infecções por HIV/prevenção & controle , Implementação de Plano de Saúde/estatística & dados numéricos , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Saúde Pública/métodos , Adolescente , Feminino , Florida , Humanos , Gravidez , Cuidado Pré-Natal , Saúde Pública/estatística & dados numéricos , Adulto Jovem
7.
Eur J Cancer ; 121: 85-93, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31563730

RESUMO

INTRODUCTION: For optimal oncological care, it is recommended to discuss every patient with cancer in a multidisciplinary team meeting (MDTM). This is a time consuming and expensive practice, leading to a growing demand to change the current workflow. We aimed to investigate the number of patients discussed in MDTMs and to identify characteristics associated with not being discussed. METHODS: Data of patients with a newly diagnosed solid malignant tumour in 2015 and 2016 were analysed through the nationwide population-based Netherlands Cancer Registry (NCR). We clustered tumour types in groups that were frequently discussed within a tumour-specific MDTM. Tumour types without information about MDTMs in the NCR were excluded. Multivariable logistic regression analyses were used to analyse factors associated with not being discussed. RESULTS: Out of 105.305 patients with cancer, 91% were discussed in a MDTM, varying from 74% to 99% between the different tumour groups. Significantly less frequently discussed were patients aged ≥75 years (odds ratio [OR] = 0.7, 95% confidence interval [CI] = 0.6-0.7), patients diagnosed with disease stage I (OR = 0.5, 95% CI = 0.5-0.6), IV (OR = 0.4, 95% CI = 0.4-0.4) or unknown (OR = 0.2, 95% CI = 0.2-0.2) and patients who received no treatment (OR = 0.3, 95% CI = 0.3-0.3). Patients who received a multidisciplinary treatment were more likely to be discussed in contrary to a monodisciplinary treatment (OR = 4.6, 95% CI = 4.2-5.1). CONCLUSION: In general, most patients with cancer were actually discussed in a MDTM, although differences were observed between tumour groups. Factors associated with not being discussed may, at least partially, reflect the absence of a multidisciplinary question. These results form a starting point for debate on a more durable and efficient new MDTM strategy.


Assuntos
Comunicação Interdisciplinar , Neoplasias/epidemiologia , Neoplasias/terapia , Planejamento de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Oncologia/métodos , Oncologia/organização & administração , Oncologia/normas , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias/patologia , Países Baixos/epidemiologia , Planejamento de Assistência ao Paciente/normas , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Equipe de Assistência ao Paciente/normas , Equipe de Assistência ao Paciente/estatística & dados numéricos , Assistência Centrada no Paciente/organização & administração , Assistência Centrada no Paciente/normas , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas
8.
Australas Emerg Care ; 22(4): 229-235, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31501073

RESUMO

OBJECTIVE: To evaluate the use of management plans for people who frequently attend the emergency department (ED). BACKGROUND: Management plans are used to decrease ED utilisation by people who frequently attend. There is limited evidence regarding the use management plans for this population and the perspectives of staff who use them has previously not been considered. DESIGN: A descriptive observational design including before and after measures of attendance (November 2010 to September 2014) and survey of staff perceptions (July to November 2014). The setting was a major metropolitan hospital ED in Australia. METHODS: The date for commencement of each plan was determined. Data were extracted regarding ED attendance 12 months before and after implementation. Staff perspectives were obtained via an online survey. RESULTS: Fifty-seven patients made 1482 ED attendances. Of these 830 occurred in the 12 months before the management plan was implemented and 652 during the 12 months after. The number of attendances per patient decreased from a median of 11 to 4. Staff considered management plans to be beneficial to care planning practices and individual patient outcomes. CONCLUSIONS: Management plans were acceptable to staff, and implementation of management plans was associated with a decrease in ED attendance.


Assuntos
Administração de Caso/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Utilização de Instalações e Serviços , Feminino , Humanos , Masculino , Corpo Clínico Hospitalar/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vitória
9.
J Oncol Pract ; 15(11): e916-e924, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31265350

RESUMO

PURPOSE: The aim of the current study was to assess whether the quality of patient-provider communication on key elements of cancer survivorship care changed between 2011 and 2016. METHODS: Participating survivors completed the 2011 or 2016 Medical Expenditure Panel Survey Experiences with Cancer Surveys (N = 2,266). Participants reported whether any clinician ever discussed different aspects of survivorship care. Responses ranged from "Did not discuss at all" to "Discussed it with me in detail". Distributions of responses were compared among all respondents and only among those who had received cancer-directed treatment within 3 years of the survey. RESULTS: In 2011, the percentage of survivors who did not receive detailed instructions on follow-up care, late or long-term adverse effects, lifestyle recommendations, and emotional or social needs were 35.1% (95% CI, 31.9% to 38.4%), 54.2% (95% CI, 50.7% to 57.6%), 58.9% (95% CI, 55.3% to 62.5%), and 69.2% (95% CI, 65.9% to 72.3%), respectively, and the corresponding proportions for 2016 were 35.4% (95% CI, 31.9% to 37.8%), 55.5% (95% CI, 51.7% to 59.3%), 57.8% (95% CI, 54.2% to 61.2%), and 68.2% (95% CI, 64.3% to 71.8%), respectively. Findings were similar among recently treated respondents. Only 24% in 2011 and 22% in 2016 reported having detailed discussions about all four topics. In 2016, 47.6% of patients (95% CI, 43.8% to 51.4%) reported not having detailed discussions with their providers about a summary of their cancer treatments. CONCLUSION: Clear gaps in the quality of communication between survivors of cancer and providers persist. Our results highlight the need for continued efforts to improve communication between survivors of cancer and providers, including targeted interventions in key survivorship care areas.


Assuntos
Sobreviventes de Câncer/psicologia , Comunicação , Assistência à Saúde/normas , Neoplasias/terapia , Relações Médico-Paciente , Qualidade da Assistência à Saúde/normas , Sobrevivência , Adolescente , Adulto , Assistência ao Convalescente , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Disseminação de Informação , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Planejamento de Assistência ao Paciente/normas , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Prognóstico , Inquéritos e Questionários , Adulto Jovem
10.
J Surg Res ; 244: 174-180, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299433

RESUMO

BACKGROUND: The exchange of health information between primary care providers (PCPs) and surgeons is critical during transitions of care for older patients with multiple comorbidities; however, it is unknown to what extent this process occurs. This study was designed to characterize the extent to which factors associated with older patient's recovery, such as functional status, cognitive status, social status, and emotional factors, are shared among PCPs and surgical providers during care transitions. MATERIALS AND METHODS: We prospectively identified 15 patients aged over 60 y with ≥3 comorbidities referred for general and vascular surgery procedures at a Veterans Administrative and academic medical center. Semistructured Critical Decision Method interviews were conducted with patients along with their surgical providers and referring PCPs. Thematic content analysis was performed independently by five reviewers on the cognitive processes associated with functional status, cognitive status, social status, and emotional factors. Interrater reliability between providers and patients was assessed using Cohen's kappa. RESULTS: Forty-seven Critical Decision Method interviews were conducted, which included 20 paired interviews between a PCP and a surgeon and 16 paired interviews that involved a patient and a provider. The majority of patients reported experiencing poor information exchange between their PCP and surgeon (58%) and feeling they were primarily responsible for communicating their own health information during care transitions (67%). In paired interviews between PCPs and surgeons, there was nearly perfect agreement for the shared knowledge of cognitive (kappa: 0.83) and emotional (kappa 1) factors. In contrast, there was only minimal agreement for shared knowledge of functional status (kappa 0.38) and social status (kappa: 0.34). CONCLUSIONS: Information exchange between PCPs and surgical providers is often discordant during transitions of surgical care for medically complex older patients, particularly when it pertains to communicating their functional or social status.


Assuntos
Troca de Informação em Saúde/estatística & dados numéricos , Transferência de Pacientes/organização & administração , Médicos de Atenção Primária/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Centros Médicos Acadêmicos/estatística & dados numéricos , Fatores Etários , Idoso , Tomada de Decisão Clínica , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente/organização & administração , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Estudos Prospectivos , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos , United States Department of Veterans Affairs/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos
11.
J Am Geriatr Soc ; 67(8): 1713-1717, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31166614

RESUMO

OBJECTIVES: Behavioral health (BH) disorders affect 65% to 90% of nursing home (NH) residents. Access to BH services in NHs has been generally considered inadequate, but the empirical evidence is sparse. We examined the availability of BH services and identified facility-level factors associated with the difficulty of providing BH services in NHs. DESIGN: A national random sample of 3996 NHs was identified. Two structured surveys with questions about BH service availability, quality, satisfaction, staffing, staff education, turnover, and service barriers were mailed to administrators and directors of nursing in each NH between July and December 2017. SETTING/PARTICIPANTS: Completed surveys were obtained from 1079 NHs (27% response rate). Descriptive statistics and multivariable logistic regressions were employed. MEASUREMENTS: Four outcome measures were based on five-point Likert scales: (1) adequacy of BH staff education; (2) ability to meet resident BH service needs; (3) adequacy of coordination/collaboration between NH/community providers; and (4) availability of necessary facility infrastructure. RESULTS: BH service needs were unmet in one third of NHs; almost half lacked appropriate staff BH education. Over 30% reported having inadequate coordination of care between NH and community providers, and 26.2% had inadequate infrastructure for residents' referrals/transport. Staff BH education was less problematic in NHs with Alzheimer disease units (odds ratio [OR] = 0.6; P < .05), lower registered nurse (RN) turnover (OR = 0.7; P < .05), and more psychiatrically trained RNs (OR = 0.5; P < .001) and social workers (OR = 0.6; P < .05). Lower RN turnover (OR = 0.7; P < .05) and more psychiatrically trained RNs (OR = 0.6; P < .05) were associated with fewer NHs reporting being unable to meet BH service needs. Having more psychiatrically trained RNs (OR = 0.6; P < .05) was associated with fewer NHs reporting inadequate coordination with community providers. CONCLUSION: Inadequate BH education and psychiatric training among NH staff were associated with subpar provision of BH services in this care setting. New initiatives that increase access to BH providers and services and improve staff education are urgently needed in NHs. J Am Geriatr Soc 67:1713-1717, 2019.


Assuntos
Medicina do Comportamento/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde para Idosos/provisão & distribução , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Modelos Logísticos , Masculino , Enfermeiras e Enfermeiros/provisão & distribução , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos
12.
Int J Law Psychiatry ; 64: 71-82, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31122642

RESUMO

Both structured and unstructured clinical risk assessments within forensic care aim to prevent violence by informing risk management, but research about their preventive role is inconclusive. The aim of this study was to investigate risk management interventions that were planned and realized during forensic care by analysing patient records. Records from a forensic clinic in Sweden, covering 14 patients and 526 months, were reviewed. Eight main types of risk management interventions were evaluated by content analysis: monitoring, supervision, assessment, treatment, victim protection, acute coercion, security level and police interventions. Most planned risk management interventions were realized, both in structured and clinical risk assessments. However, most realized interventions were not planned, making them more open to subjective decisions. Analysing risk management interventions actually planned and realized in clinical settings can reveal the preventive role of structured risk assessments and how different interventions mediate violence risk.


Assuntos
Psiquiatria Legal/métodos , Transtornos Mentais/terapia , Planejamento de Assistência ao Paciente , Gestão de Riscos , Violência/psicologia , Adulto , Feminino , Psiquiatria Legal/estatística & dados numéricos , Humanos , Masculino , Registros Médicos , Transtornos Mentais/psicologia , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Medição de Risco , Suécia
13.
Ear Nose Throat J ; 98(3): 158-164, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30938238

RESUMO

The objective of our study is to assess the impact of equivocal or positive positron emission tomography combined with low-dose noncontrast computed tomography (PET/CT) findings in the chest on treatment for head and neck cancer (HNC). We reviewed charts of patients presented at Augusta University's Head and Neck Tumor Board (AUTB) between 2013 and 2016 with the following exclusion criteria: <18 years, Veterans Affairs patients, those with incomplete data, and those without a history of head and neck squamous cell carcinoma. The lung/thorax sections of the radiologists' PET/CT reports were graded as "Positive, Equivocal, or Negative" for chest metastases. Patients who underwent workup for suspected chest metastases were assessed for treatment delays, changes in treatment plans, and complications. In addition, we evaluated the time between AUTB presentation and peri-treatment PET/CT to primary treatment initiation were calculated between groups. There was a total of 363 patients with PET/CT prior to treatment, the read was "Negative" in 71.3% (n = 259), "Equivocal" in 20.9% (n = 76), and "Positive" in 5.8% (n = 21). Of 272 patients with complete treatment data, 22 underwent workup for suspected chest metastases. Mean time from PET/CT to treatment initiation was 27.5 days without workup and 64.9 days with workup ( P < .0001), and from AUTB presentation was 29.1 days without workup and 62.5 days with workup ( P < .0001). Five (19.2%) patients experienced a complication from workup. Twenty (76.9%) patients had no changes in their treatment plan after workup. In conclusion, our results for potential chest metastases on PET/CT in patients with HNC are often not clear-cut. Workup of suspected chest metastasis based on PET/CT findings significantly delays primary treatment initiation and may cause serious complications.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Neoplasias Torácicas , Tórax/diagnóstico por imagem , Tempo para o Tratamento/estatística & dados numéricos , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Feminino , Fluordesoxiglucose F18/farmacologia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/diagnóstico por imagem , Estadiamento de Neoplasias , Compostos Radiofarmacêuticos/farmacologia , Neoplasias Torácicas/diagnóstico , Neoplasias Torácicas/secundário , Neoplasias Torácicas/terapia , Estados Unidos
14.
Support Care Cancer ; 27(10): 3785-3792, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30721368

RESUMO

PURPOSE: The purpose of this study was to determine the impact of receiving a survivorship care plan (SCP) on meeting cancer survivors' overall, informational, physical, emotional, and practical needs. Since the recommendation for implementation of SCPs, there have been numerous studies on their effectiveness with mostly inconclusive results. METHODS: All Nova Scotia survivors meeting specific inclusion and exclusion criteria were identified from the Nova Scotia Cancer Registry and sent the 83-item survey to assess experiences and needs across five domains (overall, informational, physical, emotional, and practical). Descriptive statistics (frequencies, percentages) and chi-square analyses were used to examine and report survey findings. RESULTS: The response rate was 44.6%, with 1514 respondents. SCPs were significantly associated (p < 0.00001) with receiving timely help and support to meet survivors' overall, informational, physical, emotional, and practical needs posttreatment. For the most part, survivors' clinical characteristics, such as cancer type, time since treatment, chronic comorbidities, and metastases, did not result in differences among the five outcomes. CONCLUSIONS: Those who received a SCP reported higher agreement on all five outcomes in comparison to those who did not receive a SCP. Further work should evaluate the delivery of SCPs and the components of SCPs that are most likely to contribute to positive survivor outcomes.


Assuntos
Sobreviventes de Câncer/psicologia , Sobreviventes de Câncer/estatística & dados numéricos , Neoplasias/psicologia , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Escócia , Inquéritos e Questionários , Sobrevivência
15.
Diabetes Care ; 42(5): 816-823, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30739885

RESUMO

OBJECTIVE: Precise monthly achievement rates for reaching guideline targets for HbA1c, blood pressure (BP), and lipid levels remain unknown. We evaluated achievement rates on a monthly basis in persons with type 2 diabetes mellitus (T2DM) and explored related factors. RESEARCH DESIGN AND METHODS: This retrospective study initially analyzed data on 104,601 persons with T2DM throughout Japan. Patients whose HbA1c, BP, and LDL cholesterol were measured ≥12 times during a 24-month period were included. We evaluated monthly achievement rates. Achieved targets were defined as HbA1c <7%, BP <130/80 mmHg, and LDL cholesterol <100 mg/dL. Achievement of all targets was expressed as the "all ABC achievement." RESULTS: A total of 4,678 patients were analyzed. The achievement rates of all ABC, HbA1c, BP, and LDL cholesterol were lowest in winter, with those for systolic BP (SBP) being particularly low (all ABC, summer 15.6%, winter 9.6%; HbA1c, 53.1%, 48.9%; SBP, 56.6%, 40.9%; LDL cholesterol, 50.8%, 47.2%). In winter, age ≥65 years (odds ratio 0.47 [95% CI 0.34-0.63]) was independently related to decreased achievement rates for SBP, BMI ≥25 kg/m2 (BMI 25-30 kg/m2, 0.45 [0.29-0.70]; BMI ≥30 kg/m2, 0.35 [0.22-0.57]), and diabetes duration ≥10 years (0.53 [0.37-0.76]) were independently related to lower achievement rates for HbA1c. Insulin use and sulfonylurea use were independently associated with the decreased all ABC achievement rates in both summer and winter. CONCLUSIONS: The all ABC achievement rate for guideline targets changed on a monthly basis. Seasonal variations in the all ABC achievement rate should be considered when managing T2DM in ordinary clinical practices.


Assuntos
Pressão Sanguínea , Colesterol/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Hemoglobina A Glicada/metabolismo , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Idoso , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Hemoglobina A Glicada/análise , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estações do Ano
16.
J Cancer Surviv ; 13(2): 180-186, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30767110

RESUMO

PURPOSE: Our study aims to determine whether receipt of a written survivorship care plan (SCP) is associated with five self-reported health behaviors known to be correlated with positive long-term outcomes for cancer survivors: (1) attending a recent medical appointment, (2) exercise in the past month, (3) non-smoking status, (4) mammography in the past 2 years, and (5) up-to-date colorectal cancer screening. METHODS: In this secondary data analysis, we used data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) cancer survivorship module for 1855 off-treatment cancer survivors. Multivariable logistic regression accounting for complex survey design was used to examine the association between SCP receipt and each of the five preventive health behaviors. RESULTS: Overall, 37% (669/1855) of survivors reported receiving a written survivorship care plan. In the logistic regression models adjusted for sociodemographic and disease-related factors, SCP receipt was associated with having a recent medical appointment (OR (95% CI) 2.81 (1.27-6.22)), exercise in the past month (1.78 (1.20-2.63)), non-smoking status (2.27 (1.26-4.12)), and up-to-date mammography (2.25 (1.30-3.88)). Receipt of a survivorship care plan was not associated with colorectal cancer screening (1.2 (0.73-2.03)). CONCLUSIONS: This study provides preliminary evidence that SCPs may be helpful in promoting health behaviors among cancer survivors, including attending a regular medical appointment, mammography screening, exercise, and abstinence from smoking. Additionally, the low rates of SCP provision highlight an important missed opportunity and area for intervention. IMPLICATIONS FOR CANCER SURVIVORS: Providing survivors with SCPs may help to increase important health behaviors.


Assuntos
Sobreviventes de Câncer , Comportamentos Relacionados com a Saúde/fisiologia , Aceitação pelo Paciente de Cuidados de Saúde , Planejamento de Assistência ao Paciente , Sobrevivência , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Sobreviventes de Câncer/psicologia , Sobreviventes de Câncer/estatística & dados numéricos , Criança , Pré-Escolar , Neoplasias Colorretais/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/reabilitação , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Educação de Pacientes como Assunto/organização & administração , Educação de Pacientes como Assunto/normas , Educação de Pacientes como Assunto/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Autoeficácia , Autorrelato , Adulto Jovem
17.
J Med Imaging Radiat Oncol ; 63(3): 383-389, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30720245

RESUMO

INTRODUCTION: This paper reports the key findings of the first survey of Australian, New Zealand (ANZ) and Singaporean radiation oncology trainees on contouring and planning. METHODS: The survey was conducted from May to July 2018 using a 35-question instrument. It was emailed to all ANZ and Singaporean trainees on the Royal Australian and New Zealand College of Radiologists (RANZCR) database with at least 6 months experience. The questions related to demographics, time spent on contouring, most difficult sites to contour, most useful atlas, feedback on contouring, interaction with radiation therapists, plan reviews, stereotactic radiation therapy (SBRT), brachytherapy and suggested areas of improvement. Respondents were assured that their responses were anonymous. RESULTS: The response rate was 50% (54/108). Most respondents were from New South Wales (31%) with nearly all working full time (96%) and a large majority in public practice (89%). All respondents had at least one other accredited trainee at their site. The large majority (75%) spent at least two hours per week contouring, but nearly 80% had to spend some time out of hours contouring with 10% performing all their contouring out of hours. Two-thirds of respondents indicated there was insufficient time for contouring with over half having no allocated time for this activity. All respondents were allowed to independently contour by their consultants and were allowed to do radical and palliative cases. The most difficult cases to contour were head and neck and the upper gastrointestinal sites with the RTOG atlas the most useful guide. All trainee respondents received feedback on their contouring which was most often face to face. Interaction with radiation therapists was valuable and more interaction was desired. Two-thirds (67%) of respondents had the opportunity to review treatment plans with consultants with one to two cases per week being the most common numbers reviewed, but this was usually not done (87%) on an allocated time in the roster. The large majority (90%) had the opportunity to be involved in brachytherapy, but this dropped to 60% for SBRT. Three quarters (73%) of respondents felt that there was not enough time spent on contouring, planning and evaluation of plans. CONCLUSIONS: This initial detailed survey of ANZ and Singaporean trainees on contouring and planning indicates that dedicated protected time without interruption is required for this integral activity with current hours spent on this activity inadequate. Optimisation and improvement in a number of areas is required. Feedback from this study should be adopted by sites and networks. Feedback could also be considered as the Faculty of Radiation Oncology transitions into programmatic assessment.


Assuntos
Internato e Residência/estatística & dados numéricos , Neoplasias/radioterapia , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Radioterapia (Especialidade)/educação , Radiologistas/estatística & dados numéricos , Austrália , Educação de Pós-Graduação em Medicina , Humanos , Nova Zelândia , Singapura , Inquéritos e Questionários , Carga de Trabalho/estatística & dados numéricos
18.
BMC Cancer ; 19(1): 130, 2019 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-30736754

RESUMO

BACKGROUND: Cancer is the leading cause of death in the developed world, and yet healthcare practitioners infrequently discuss goals of care (GoC) with hospitalized cancer patients. We sought to identify barriers to GoC discussions from the perspectives of staff oncologists, oncology residents, and oncology nurses. METHODS: This was a single center survey of staff oncologists, oncology residents, and inpatient oncology nurses. Barriers to GoC discussions were assessed on a 7-point Likert scale (1 = extremely unimportant; 7 = extremely important). RESULTS: Between July 2013 and May 2014, of 185 eligible oncology clinicians, 30 staff oncologists, 10 oncology residents, and 28 oncology nurses returned surveys (response rate of 37%). The most important barriers to GoC discussions were patient and family factors. They included family members' difficulty accepting poor prognoses (mean score 5.9, 95% CI [5.7, 6.2]), lack of family agreement in the goals of care (mean score 5.8, 95% CI [5.5, 6.1]), difficulty understanding the limitations of life-sustaining treatments (mean score 5.8, 95% CI [5.6, 6.1]), lack of patients' capacity to make goals of care decisions (mean score 5.7, 95% CI [5.5, 6.0]), and language barriers (mean score 5.7, 95% CI [5.4, 5.9]). Participants viewed system factors and healthcare provider factors as less important barriers. CONCLUSIONS: Oncology practitioners perceive patient and family factors as the most limiting barriers to GoC discussions. Our findings underscore the need for oncology clinicians to be equipped with strong communication skills to help patients and families navigate GoC discussions.


Assuntos
Oncologia , Oncologistas , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Comunicação , Estudos Transversais , Tomada de Decisões , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Oncologia/métodos , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Inquéritos e Questionários
19.
Injury ; 50(5): 1064-1067, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30745124

RESUMO

INTRODUCTION: Many injured patients or their families make the difficult decision to withdraw life-sustaining therapies (WLST) following severe injury. While this population has been studied in the setting of severe traumatic brain injury (TBI), little is known about patients who undergo WLST without TBI. We sought to describe patients who may benefit from early involvement of end-of-life resources. METHODS: Trauma Quality Improvement Program (2013-2014) patients who underwent WLST were identified. WLST patients were compared to those who died with full supportive care (FSC). Patients were excluded for death within 24 h of admission, or head AIS > 3. Intergroup comparisons were by student's t tests or Wilcoxon rank sum tests; significance for p < 0.05. RESULTS: We identified 3471 total injured patients without major TBI who died > 24 h after admission. Of these death after WLST occurred in 2301 (66% of total). This group had a mean age of 66.8 years; 35.7% were women, and 95.4% sustained blunt injury. WLST patients had a higher ISS (21.6 vs. 12.5, p = 0.001), more in-hospital complications (71.4% vs. 41.6%, p = < 0.0001), and a longer ICU length of stay (8.9 days vs. 7.5 days, p = <0.0001) compared to patients who died with FSC. CONCLUSION: WLST occurs in two-thirds of injured patients without severe TBI who die in the hospital. In-hospital complications are more frequent in this patient group than those who die with FSC. Early palliative care consultation may improve patient and family satisfaction after acute injury when the timeframe to leverage such services is significantly condensed.


Assuntos
Cuidados Críticos , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Conforto do Paciente , Suspensão de Tratamento , Ferimentos e Lesões/terapia , Diretivas Antecipadas , Idoso , Tomada de Decisão Clínica , Cuidados Críticos/métodos , Cuidados Críticos/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Conforto do Paciente/estatística & dados numéricos , Melhoria de Qualidade , Estudos Retrospectivos , Suspensão de Tratamento/estatística & dados numéricos , Ferimentos e Lesões/mortalidade
20.
J Invasive Cardiol ; 31(5): 133-139, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30643040

RESUMO

BACKGROUND: For patients needing coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI), a planned, staged intervention has been recommended by experts. Ad hoc CTO-PCI, however, occurs in practice. METHODS: Observational, contemporary, multicenter, international registry. Our goals were to determine the frequency, characteristics, procedural techniques, and outcomes of patients who underwent ad hoc vs planned CTO-PCI. RESULTS: Among 2282 patients who underwent CTO-PCI between 2012 and 2017, 318 (14%) were ad hoc. Patients undergoing ad hoc CTO-PCI had lower J-CTO, PROGRESS CTO, and PROGRESS Complications scores. Antegrade-wire escalation was used more often in ad hoc PCI (96% vs 81%; P<.001), whereas antegrade-dissection re-entry (22% vs 32%) and retrograde approaches (14% vs 38%) were more common in planned PCI (P<.001). There was no difference in ad hoc vs planned PCI in technical (85% vs 86%) and procedural success (84% vs 84%). In-hospital major adverse cardiac events (MACE) were more common in patients who underwent planned procedures (0.6% vs 2.9%; P=.02). Multivariable analyses showed that ad hoc CTO-PCI was not associated with technical success or MACE. CONCLUSIONS: Ad hoc CTO-PCI occurs more commonly in less complex lesions and is associated with similarly high success rates as planned CTO-PCI in lower J-CTO score lesions, suggesting that ad hoc CTO-PCI may be an acceptable option for experienced hybrid operators in carefully selected cases. Complex cases, as quantified by the J-CTO score, have a higher in-hospital MACE rate and should preferably be performed following proper planning and preparation.


Assuntos
Oclusão Coronária , Serviços Médicos de Emergência , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Intervenção Coronária Percutânea , Idoso , Angiografia Coronária/métodos , Oclusão Coronária/diagnóstico , Oclusão Coronária/fisiopatologia , Oclusão Coronária/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Sistema de Registros , Risco Ajustado/métodos , Medição de Risco/métodos , Índice de Gravidade de Doença , Tempo para o Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...