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1.
BMJ Open ; 10(10): e042392, 2020 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-33130573

RESUMO

OBJECTIVES: The suspension of elective surgery during the COVID-19 pandemic is unprecedented and has resulted in record volumes of patients waiting for operations. Novel approaches that maximise capacity and efficiency of surgical care are urgently required. This study applies Markov multiscale community detection (MMCD), an unsupervised graph-based clustering framework, to identify new surgical care models based on pooled waiting-lists delivered across an expanded network of surgical providers. DESIGN: Retrospective observational study using Hospital Episode Statistics. SETTING: Public and private hospitals providing surgical care to National Health Service (NHS) patients in England. PARTICIPANTS: All adult patients resident in England undergoing NHS-funded planned surgical procedures between 1 April 2017 and 31 March 2018. MAIN OUTCOME MEASURES: The identification of the most common planned surgical procedures in England (high-volume procedures (HVP)) and proportion of low, medium and high-risk patients undergoing each HVP. The mapping of hospitals providing surgical care onto optimised groupings based on patient usage data. RESULTS: A total of 7 811 891 planned operations were identified in 4 284 925 adults during the 1-year period of our study. The 28 most common surgical procedures accounted for a combined 3 907 474 operations (50.0% of the total). 2 412 613 (61.7%) of these most common procedures involved 'low risk' patients. Patients travelled an average of 11.3 km for these procedures. Based on the data, MMCD partitioned England into 45, 16 and 7 mutually exclusive and collectively exhaustive natural surgical communities of increasing coarseness. The coarser partitions into 16 and seven surgical communities were shown to be associated with balanced supply and demand for surgical care within communities. CONCLUSIONS: Pooled waiting-lists for low-risk elective procedures and patients across integrated, expanded natural surgical community networks have the potential to increase efficiency by innovatively flexing existing supply to better match demand.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Cadeias de Markov , Modelos Organizacionais , Pandemias , Medicina Estatal/organização & administração , Listas de Espera , Adulto , Betacoronavirus , Redes Comunitárias/organização & administração , Infecções por Coronavirus/epidemiologia , Eficiência Organizacional , Procedimentos Cirúrgicos Eletivos/classificação , Inglaterra/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Colaboração Intersetorial , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Medição de Risco , Medicina Estatal/estatística & dados numéricos
2.
Comunidad (Barc., Internet) ; 22(2): 0-0, jul.-oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193596

RESUMO

La soledad y el apoyo social deficiente están reconocidos como predictores de morbimortalidad. Cuando una persona mayor vive sola y no recibe soporte familiar ni social para corregir desviaciones en su autocuidado, se produce una sobreutilización de servicios sanitarios y, posiblemente, un aumento de los ingresos hospitalarios. En 2018, el Consell de Salut del Centro de Salud (CS) República Argentina de Valencia realizó un estudio piloto de detección y abordaje de soledad no deseada en las personas del barrio en el que se estableció que un 45% de las personas que vivían solas y eran mayores de 75 años tendrían un posible diagnóstico de aislamiento social. OBJETIVOS: implementar una red comunitaria de voluntariado de acompañamiento-vigilancia en autocuidados para personas mayores con aislamiento social en el área del CS República Argentina, con el soporte del «Programa de acompañamiento en salud constante» (PASC) de la Cruz Roja, en colaboración con el centro de salud, y estudiar la relación entre soledad y salud. MÉTODOS: mediante un diseño escalado de detección y diagnóstico de aislamiento social, con la participación de técnicos de la Cruz Roja, profesionales del centro de salud y la colaboración de voluntariado de acompañamiento a personas mayores participantes. RESULTADOS: en 7 meses 1.200 personas fueron sensibilizadas de forma directa sobre la soledad y 49 voluntarios del barrio desarrollaron labores de acompañamiento y asistencia a talleres formativos y lúdicos. Los profesionales sanitarios analizaron 216 casos: 149 (69%) no se sintieron solos y 67 (31%) fueron diagnosticados de aislamiento social (código correspondiente a V64.01 según CIE-9). Participaron en el proyecto 54 personas (25%). Existe asociación entre la escala de detección de la soledad existencial (EDSOL) y la participación en el proyecto. La sensación de soledad no deseada presenta correlación positiva con problemas de movilidad, cronicidad y una tendencia de asociación con otras variables de salud (consumo elevado de fármacos, percepción negativa de calidad de vida, etc.). CONCLUSIONES: las intervenciones comunitarias promovidas desde el centro de salud sobre personas que viven solas contribuyen al abordaje del aislamiento no deseado y a su vez generan un barrio más solidario


Loneliness and poor social support are widely recognized as predictors of morbidity and mortality. When an elderly person lives alone and does not receive family or social support to correct minor deviations in basic self-care processes, this leads to overuse of health services and possibly, increased hospital admissions. In 2018, the Consell de Salut of the República Argentina Primary Health Centre in Valencia, began a pilot study to detect and tackle unwanted loneliness in people from the neighbourhood, in which it was established that 45% of people aged over 75 years old who lived alone may be diagnosed with social isolation. OBJECTIVES: To establish a community network of accompanying-surveillance volunteers in self-care for socially isolated elderly people in the area of the República Argentina Primary Care Centre with the support of the Red Cross Constant Health Accompaniment Programme. The specific objective is to study the relationship between loneliness and health. METHODS: Using a scaled design for the detection and diagnosis of social isolation, with the participation of the Red Cross technicians, professionals from the health center, and the collaboration of volunteer support for elderly participants. RESULTS: Over seven months a total of 1200 people have been directly made aware about loneliness and 49 volunteers from the neighbourhood performed accompaniment work and attended training and recreational workshops. Health professionals analyzed 216 cases, of which 149 (69%) did not feel alone and the remaining 67 (31%) were diagnosed with social isolation (code V64.01 according to ICD-9). A total of 54 (25%) agreed to take part in the project. An association was observed between the scale for detection of existential loneliness (EDSOL) and participation in the project. The feeling of unwanted loneliness correlates positively with mobility problems, chronicity and a tendency of association with other health variables such as high consumption of drugs and negative perception of quality of life. CONCLUSIONS: Community interventions promoted by the Primary Health Centre on people who live alone contribute to tackling unwanted isolation, which at the same time generates a more supportive neighbourhood


Assuntos
Humanos , Masculino , Feminino , Idoso , Participação da Comunidade/métodos , Redes Comunitárias , Idoso Fragilizado/psicologia , Programas Voluntários , Agências Voluntárias , Solidão , Argentina , Qualidade de Vida
3.
J Med Microbiol ; 69(10): 1213-1220, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32902373

RESUMO

Antimicrobial resistance (AMR) is a major global health threat that requires an interdisciplinary international approach to address. In response to calls from policymakers and funders alike, a growing number of research networks on AMR have been created with this approach in mind. However, there are many challenges facing researchers in establishing such networks and research projects. In this article, we share our experience of establishing the network 'TACTIC: Tackling AMR Challenges through Translational Interdisciplinary Collaborations'. Although presented with many challenges both scientific and logistical, the network has underpinned productive interaction between biomedical and social scientists from several countries and fostered true collaboration in an educative, stimulating and sustainable way that forms a platform for important research on AMR.


Assuntos
Redes Comunitárias/tendências , Saúde Global/tendências , Antibacterianos/farmacologia , Resistência Microbiana a Medicamentos/efeitos dos fármacos , Colaboração Intersetorial
4.
Sante Publique ; 32(2): 239-246, 2020 09 15.
Artigo em Francês | MEDLINE | ID: mdl-32989953

RESUMO

INTRODUCTION: Professional and Territorial Health Communities aim at organizing the coordination of health professionals of primary and specialty care, in order to better structure care pathways and improve healthcare access. The flow of patients to specialty care outlines territories whose scale and organization can serve as a basis to identify these communities’ territories. METHOD: The analysis of patient flows to specialty care professionals in Centre-Val de Loire region in 2015 (SNIIRAM data) made it possible to classify medical specialties according to their scale of attractiveness (i.e. regional, departmental and sub-departmental specialties). Among sub-departmental specialties, 5 have been merged to identify common poles of attraction. These empirical poles have been compared to health professionals’ perception of territories where they practice in order to refine the territorial subdivision of the region. Patient flows to the General Hospitals (PMSI date) were then defined to compare them with the private practice patient poles. RESULTS: In the region, twenty or so attraction poles can be identified in the six departments of the region. Local areas have been divided into 5 classes, according to their degree of attraction to a pole. Attraction poles seem to be consistent with health professionals’ habits. The concordance with hospital patient poles reinforced the relevance of this division. CONCLUSION: Patients flows respond to a real territorial logic which, confronted to health professionals’ real-life practices, draws territories relevant for a first approach of the Professional and Territorial Health Communities.


Assuntos
Redes Comunitárias/organização & administração , Assistência à Saúde/organização & administração , Pessoal de Saúde/organização & administração , França , Acesso aos Serviços de Saúde , Humanos , Atenção Primária à Saúde/organização & administração , Especialização
5.
Artigo em Inglês | MEDLINE | ID: mdl-32872244

RESUMO

In the last decade, we have seen a growth of Compassionate Communities and Cities (CCC) at the end of life. There has been an evolution of organizations that help construct Community-Based Palliative Care programs. The objective is to analyze the implementation, methodology and effectiveness of the CCC models at the end of life. We conducted a systematic review following PRISMA ScR Guideline. The protocol was registered on PROSPERO (CRD42017068501). Five databases (MEDLINE, EMBASE, Web of Science, CINAHL and Google Scholar) were searched for studies (from 2000 to 2018) using set eligibility criteria. Three reviewers screened full-texts articles and extracted study data. Outcomes were filled in a registration form which included a narrative synthesis of each article. We screened 1975 records. We retrieved 112 articles and included 31 articles for the final analysis: 17 descriptive studies, 4 interventions studies, 4 reviews and 6 qualitative studies. A total of 11 studies regard the development models of CCC at the end of life, 15 studies were about evaluation of compassionate communities' programs and 5 studies were about protocols for the development of CCC programs. There is poor evidence of the implementation and evaluation models of CCC at the end of life. There is little and low-/very low-quality evidence about CCC development and assessment models. We found no data published on care intervention in advance disease and end of life. A global model for the development and evaluation of CCC at the end of life seems to be necessary.


Assuntos
Redes Comunitárias , Empatia , Cuidados Paliativos , Cidades , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/organização & administração , Assistência Terminal/métodos , Assistência Terminal/organização & administração
6.
Am J Trop Med Hyg ; 103(4): 1681-1690, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32876007

RESUMO

The main objective of this study was to assess the management of childhood infections in high-density poorly planned urban areas of Kampala and Wakiso districts in Uganda, to develop a strategy to deliver integrated community case management (iCCM) of childhood illness services. A total of 72 private healthcare facilities were surveyed (36 drug shops, eight pharmacies, 27 private clinics, and one herbal clinic); supplemented by focus group discussions with village health teams (VHTs), drug shops, and private clinic providers. The majority of drug shops (96.4%, 27/28), pharmacies (100%, 8/8), and (68%, private clinics 17/27) were registered; however, supervision was poor. The majority of patients (> 77%) who visited private health facilities were children aged < 5 years. Furthermore, over 80% (29/64) of the children with uncomplicated malaria were reported to have been given artemether-lumefantrine, and 42% with difficulty breathing were given an antibiotic. Although > 72% providers said they referred children with severe illnesses, taking up referral was complicated by poverty, long distances, and the perception that there were inadequate drugs at referral facilities. Less than 38% of all the facilities had malaria treatment guidelines; < 15% had iCCM guidelines; 6% of the drug shops had iCCM guidelines; and < 13% of the facilities had pneumonia and diarrhea treatment guidelines. Village health teams existed in the study areas, although they had little knowledge on causes and prevention of pneumonia. In conclusion, this study found that quality of care was poor and introduction of iCCM delivered through VHTs, drug shops, and private clinics may, with proper training and support, be a feasible intervention to improve care.


Assuntos
Antimaláricos/uso terapêutico , Combinação Arteméter e Lumefantrina/uso terapêutico , Administração de Caso/normas , Pessoal de Saúde/educação , Malária/tratamento farmacológico , Qualidade da Assistência à Saúde , Criança , Redes Comunitárias , Feminino , Humanos , Masculino , Farmácias , Instalações Privadas , Encaminhamento e Consulta , Uganda
7.
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
8.
Sante Publique ; 32(2): 239-246, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32985840

RESUMO

INTRODUCTION: Professional and Territorial Health Communities aim at organizing the coordination of health professionals of primary and specialty care, in order to better structure care pathways and improve healthcare access. The flow of patients to specialty care outlines territories whose scale and organization can serve as a basis to identify these communities’ territories. METHOD: The analysis of patient flows to specialty care professionals in Centre-Val de Loire region in 2015 (SNIIRAM data) made it possible to classify medical specialties according to their scale of attractiveness (i.e. regional, departmental and sub-departmental specialties). Among sub-departmental specialties, 5 have been merged to identify common poles of attraction. These empirical poles have been compared to health professionals’ perception of territories where they practice in order to refine the territorial subdivision of the region. Patient flows to the General Hospitals (PMSI date) were then defined to compare them with the private practice patient poles. RESULTS: In the region, twenty or so attraction poles can be identified in the six departments of the region. Local areas have been divided into 5 classes, according to their degree of attraction to a pole. Attraction poles seem to be consistent with health professionals’ habits. The concordance with hospital patient poles reinforced the relevance of this division. CONCLUSION: Patients flows respond to a real territorial logic which, confronted to health professionals’ real-life practices, draws territories relevant for a first approach of the Professional and Territorial Health Communities.


Assuntos
Redes Comunitárias/organização & administração , Assistência à Saúde/organização & administração , Pessoal de Saúde/organização & administração , França , Acesso aos Serviços de Saúde , Humanos
10.
J Am Board Fam Med ; 33(5): 645-649, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32989057

RESUMO

The COVID-19 outbreak is a stark reminder of the ongoing challenge of emerging and reemerging disease, the human cost of pandemics and the need for robust research.1 For primary care, the advent of COVID-19 has forced an unprecedented wave of practice change. In turn, Practice-Based Research Networks (PBRNs) must rapidly pivot to address the changing environment and the critical challenges faced by primary care. The pandemic has also impacted the ability of PBRNs to deploy traditional research methods such as face-to-face patient and provider interactions, practice facilitation, and stakeholder engagement. Providers need more relevant, patient-centered evidence and the skills to effect change. These skills will become more important than ever as primary care practices evolve in response to the current COVID-19 pandemic and the disparities in health outcomes highlighted by COVID-19 and the global Black Lives Matter social movement for justice. Throughout this issue, authors detail the work conducted by PBRNs that demonstrate many of these evolving concepts. Articles explore how PBRNs can evaluate COVID-19 in primary care, the role of PBRNs in quality improvement, stakeholder engagement, prevention and chronic care management, and patient safety in primary care.


Assuntos
Betacoronavirus , Redes Comunitárias/tendências , Infecções por Coronavirus , Pesquisa sobre Serviços de Saúde/tendências , Pandemias , Pneumonia Viral , Atenção Primária à Saúde/tendências , Redes Comunitárias/organização & administração , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/organização & administração , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Projetos de Pesquisa , Participação dos Interessados , Estados Unidos
11.
J Am Board Fam Med ; 33(5): 774-778, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32989072

RESUMO

BACKGROUND: Primary care practice-based research networks (PBRNs) are critical laboratories for generating evidence from real-world settings, including studying natural experiments. Primary care's response to the novel coronavirus-19 (COVID-19) pandemic is arguably the most impactful natural experiment in our lifetime. EVALUATING THE IMPACT OF COVID-19: We briefly describe the OCHIN PBRN of community health centers (CHCs), its partnership with implementation scientists, and how we are leveraging this infrastructure and expertise to create a rapid research response evaluating how CHCs across the country responded to the COVID-19 pandemic. COVID-19 RESEARCH ROADMAP: Our research agenda focuses on asking: How has care delivery in CHCs changed due to COVID-19? What impact has COVID-19 had on the delivery of preventive services in CHCs? Which PBRN services (e.g., data surveillance, training, evidence synthesis) are most impactful to real-world practices? What decision-making strategies were used in the PBRN and its practices to make real-time changes in response to the pandemic? What critical factors in successfully and sustainably transforming primary care are illuminated by pandemic-driven changes? DISCUSSION AND CONCLUSIONS: PBRNs enable real-world evaluation of practice change and natural experiments, and thus are ideal laboratories for implementation science research. We present a real-time example of how a PBRN Implementation Laboratory activated a response to study a historic natural experiment, to help other PBRNs charting a course through this pandemic.


Assuntos
Betacoronavirus , Centros Comunitários de Saúde/tendências , Redes Comunitárias/tendências , Infecções por Coronavirus , Assistência à Saúde/tendências , Pesquisa sobre Serviços de Saúde/tendências , Pandemias , Pneumonia Viral , Atenção Primária à Saúde/tendências , Centros Comunitários de Saúde/organização & administração , Redes Comunitárias/organização & administração , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Prática Clínica Baseada em Evidências , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/organização & administração , Humanos , Ciência da Implementação , Disseminação de Informação , Inovação Organizacional , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa , Participação dos Interessados , Estados Unidos
14.
PLoS One ; 15(9): e0238841, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32898156

RESUMO

A growing body of literature has documented that community-based early childhood development (ECD) interventions can improve child developmental outcomes in vulnerable communities. One critical element of effective community-based programs is consistent program participation. However, little is known about participation in community-based ECD interventions or factors that may affect participation. This paper examines factors linked to program participation within a community-based ECD program serving 819 infants and their caregivers in 50 rural villages in northwestern China. The results find that more than half of families did not regularly attend the ECD program. Both village-level social ties within the program and proximity to the program significantly predict program participation. Increased distance from the program site is linked with decreased individual program participation, while the number of social ties is positively correlated with participation. The average program participation rates among a family's social ties is also positively correlated with individual participation, indicating strong peer effects. Taken together, our findings suggest that attention should be given to promoting social interactions and reducing geographic barriers among households in order to raise participation in community-based ECD programs.


Assuntos
Cuidadores/psicologia , Desenvolvimento Infantil , Redes Comunitárias/estatística & dados numéricos , Relações Interpessoais , Poder Familiar/psicologia , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , China , Características da Família , Feminino , Humanos , Lactente , Masculino , Grupo Associado , População Rural
15.
Am J Public Health ; 110(10): 1472-1475, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32816543

RESUMO

Following the devastation of the Greater New Orleans, Louisiana, region by Hurricane Katrina, 25 nonprofit health care organizations in partnership with public and private stakeholders worked to build a community-based primary care and behavioral health network. The work was made possible in large part by a $100 million federal award, the Primary Care Access Stabilization Grant, which paved the way for innovative and sustained public health and health care transformation across the Greater New Orleans area and the state of Louisiana.


Assuntos
Redes Comunitárias/tendências , Tempestades Ciclônicas , Reforma dos Serviços de Saúde/organização & administração , Atenção Primária à Saúde , Assistência à Saúde/estatística & dados numéricos , Desastres , Financiamento Governamental/economia , Humanos , Louisiana , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/tendências
16.
J Med Internet Res ; 22(8): e22033, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32750010

RESUMO

BACKGROUND: The coronavirus disease (COVID-19) pandemic has resulted in significant morbidity and mortality; large numbers of patients require intensive care, which is placing strain on health care systems worldwide. There is an urgent need for a COVID-19 disease severity assessment that can assist in patient triage and resource allocation for patients at risk for severe disease. OBJECTIVE: The goal of this study was to develop, validate, and scale a clinical decision support system and mobile app to assist in COVID-19 severity assessment, management, and care. METHODS: Model training data from 701 patients with COVID-19 were collected across practices within the Family Health Centers network at New York University Langone Health. A two-tiered model was developed. Tier 1 uses easily available, nonlaboratory data to help determine whether biomarker-based testing and/or hospitalization is necessary. Tier 2 predicts the probability of mortality using biomarker measurements (C-reactive protein, procalcitonin, D-dimer) and age. Both the Tier 1 and Tier 2 models were validated using two external datasets from hospitals in Wuhan, China, comprising 160 and 375 patients, respectively. RESULTS: All biomarkers were measured at significantly higher levels in patients who died vs those who were not hospitalized or discharged (P<.001). The Tier 1 and Tier 2 internal validations had areas under the curve (AUCs) of 0.79 (95% CI 0.74-0.84) and 0.95 (95% CI 0.92-0.98), respectively. The Tier 1 and Tier 2 external validations had AUCs of 0.79 (95% CI 0.74-0.84) and 0.97 (95% CI 0.95-0.99), respectively. CONCLUSIONS: Our results demonstrate the validity of the clinical decision support system and mobile app, which are now ready to assist health care providers in making evidence-based decisions when managing COVID-19 patient care. The deployment of these new capabilities has potential for immediate impact in community clinics and sites, where application of these tools could lead to improvements in patient outcomes and cost containment.


Assuntos
Betacoronavirus/patogenicidade , Redes Comunitárias/normas , Infecções por Coronavirus/epidemiologia , Coronavirus/patogenicidade , Sistemas de Apoio a Decisões Clínicas/normas , Pneumonia Viral/epidemiologia , Feminino , Humanos , Masculino , Pandemias
17.
PLoS One ; 15(8): e0236721, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32750071

RESUMO

Whereas governments are increasingly considering affirmative action programs to increase corporate board diversity, the effect of such programs can be superficial as they do not address the underlying problem, which is women's access to and inclusion in relevant corporate networks. To address this issue, we study the relationship among affirmative action programs (binding gender quotas and non-binding gender targets), director networks, and the number of board positions individual directors hold given their gender. We use personal, professional, and network characteristics of 25,127 unique directors from 2,435 public firms in 32 European countries over the period of 2000 through 2017. We find that in the absence of affirmative action programs, women directors benefit less from their networks than men directors suggesting the existence of a gender gap in network benefits. After the passage of binding gender quotas, this gender gap in network benefits narrows between women and men directors. Overall, this research suggests that binding gender quotas make director networks a more salient tool for hiring women and may help in leveling the playing field in the way these networks are used for achieving top management positions.


Assuntos
Redes Comunitárias/organização & administração , Ética nos Negócios , Cultura Organizacional , Corporações Profissionais/organização & administração , Política Pública , Mulheres Trabalhadoras , Europa (Continente) , Feminino , Humanos , Masculino
18.
PLoS One ; 15(8): e0237197, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790796

RESUMO

BACKGROUND: Recent concerns have cast doubt over the effectiveness of cardiac rehabilitation [CR] programmes for improving cardiorespiratory fitness [CRF] in patients with a history of cardiac disease in the United Kingdom [UK]. We aimed to characterise the weekly progression of exercise training dose over an 8-week Phase III CR programme as we felt this may be partly responsible for the lack of improvement in CRF reported in previous studies. DESIGN: Observational study. METHODS: We evaluated a community-based Phase III CR programme in the UK. During each training session, patients wore an Apple Watch and the weekly progression of exercise training dose/load was quantified. The analysis was based on 332 individual training sessions. Exercise intensity [% heart rate reserve] during the cardiovascular [CV] exercise training component [%HRR-CV], CV training duration; estimated changes in cardiorespiratory fitness [change in estimated metabolic equivalents (METs)]; session rating of perceived exertion [sRPE], sRPE training load [sRPE-TL], and exercise training impulse [TRIMP] were evaluated. RESULTS: Thirty cardiac patients [83% male; age [SD] 67.0 [10.0] years; body mass index [SD] 28.3 [4.6] kg∙m-2] were recruited to an 8-week programme [16 sessions in total]. Bayesian repeated-measures ANOVA indicated anecdotal evidence for the alternative hypothesis for changes in %HRR-CV (BF10 = 0.61), sRPE (BF10 = 1.1), and change in estimated METs (BF10 = 1.2) during CR. Conversely, Bayesian repeated-measures ANOVA showed extreme evidence for changes in CV training duration (BF10 = 2.438e+26), TRIMP (BF10 = 71436), and sRPE-TL (BF10 = 779570). CONCLUSION: The key exercise training principle of progressive overload was only partially applied. Increases observed in exercise dose were due to increases in the duration of CV training, rather than combined with increases in exercise intensity [%HRR-CV and sRPE]. Accordingly, allied health professionals must ensure that exercise intensity is more consistently progressed to optimise the exercise stimulus and improvements in CRF and patient outcomes.


Assuntos
Reabilitação Cardíaca/métodos , Aptidão Cardiorrespiratória , Terapia por Exercício/métodos , Idoso , Redes Comunitárias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reino Unido
19.
Med Care ; 58(9): 800-804, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32826745

RESUMO

OBJECTIVE: The objective of this study was to evaluate if the networks of diabetic patients sharing physicians are associated with emergency department (ED) visits and hospitalizations. STUDY DESIGN: This is a retrospective cohort study. METHODS: We used administrative data from a large insurer in Hawaii in 2010. Three types of networks were defined based on patient visits: (1) the total number of links from one patient to other patients sharing a physician; (2) the number of other patients connected by sharing the physician seen the most often; and (3) the number of other patients connected by seeing all the same physicians during the year. The networks were characterized into thirds based on their complexity and analyzed using zero-inflated negative binomial regression models on ED visits and hospitalizations. RESULTS: The study included 38,767 diabetes patients with a mean age of 64 years. Patients sharing the most physicians had double the risks of ED visits and hospitalizations. Patients linked by belonging to the largest primary care practices had a 28% reduced odds of ED visits. Patients linked by seeing all of the same physicians during the year had the fewest primary care providers and specialists visits and 25%-50% reductions in ED visits and hospitalizations. CONCLUSIONS: Networks of diabetic patients sharing all the same physicians were associated with decreased ED visits and hospitalizations. Encouraging diabetic patients to find a provider they like and trust and to stay in the provider's care may help reduce the risks of adverse events. Physicians building loyalty among their patients may reduce their patients' risks.


Assuntos
Redes Comunitárias , Diabetes Mellitus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Médicos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Comorbidade , Feminino , Clínicos Gerais/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Características de Residência , Estudos Retrospectivos , Fatores Socioeconômicos , Adulto Jovem
20.
Crit Care Nurs Q ; 43(4): 451-467, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833780

RESUMO

This article provides a road map to swiftly operationalize the structure and process for organizational readiness in response to the COVID-19 pandemic. The pandemic forced network leaders to face an unprecedented public health crisis while navigating circumstances driven by a widely impactful disease with minimal empirical evidence regarding disease spread, containment, and treatment. Key leaders across the enterprise planned, executed, and continually refined a strategy against the pandemic surge. Mission-driven decisions, communication, and actions were critical in connecting and informing the stakeholders about the evolving and uncertain conditions. In partnership with internal and external stakeholders, the use of data, technology, and innovation provided new opportunities to transform existing care and business models into adaptable prototypes for mitigating risks and informing tactical steps. Execution of testing sites, building a command center, and increasing bed capacity infused daily operations. Creating innovative processes, including working with private industry to secure resources and pioneering solutions, is the result of leveraging talented teams to produce solutions. Trustful partnerships among enterprise leaders and their constituents stemmed from a common, shared vision. Utilizing systems thinking led to optimizing a response and preparedness plan for now and for future pandemics.


Assuntos
Redes Comunitárias/organização & administração , Infecções por Coronavirus/epidemiologia , Liderança , Pandemias , Pneumonia Viral/epidemiologia , Humanos , Incerteza
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