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1.
J Surg Res ; 245: 587-592, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31499364

RESUMO

BACKGROUND: Surgical disease increasingly contributes to global mortality and morbidity. The Lancet Commission on Global Surgery found that global cost-effectiveness data are lacking for a wide range of essential surgical procedures. This study helps to address this gap by defining the cost-effectiveness of exploratory laparotomies in a regional referral hospital in Uganda. MATERIALS AND METHODS: A time-and-motion analysis was utilized to calculate operating theater personnel costs per case. Ward personnel, administrative, medication, and supply costs were recorded and calculated using a microcosting approach. The cost in 2018 US Dollars (USD, $) per disability-adjusted life year (DALY) averted was calculated based on age-specific life expectancies for otherwise fatal cases. RESULTS: Data for 103 surgical patients requiring exploratory laparotomy at the Soroti Regional Referral Hospital were collected over 8 mo. The most common cause for laparotomy was small bowel obstruction (32% of total cases). The average cost per patient was $75.50. The postoperative mortality was 11.7%, and 7.8% of patients had complications. The average number of DALYs averted per patient was 18.51. The cost in USD per DALY averted was $4.08. CONCLUSIONS: This investigation provides evidence that exploratory laparotomy is cost-effective compared with other public health interventions. Relative cost-effectiveness includes a comparison with bed nets for malaria prevention ($6.48-22.04/DALY averted), tuberculosis, tetanus, measles, and polio vaccines ($12.96-25.93/DALY averted), and HIV treatment with multidrug antiretroviral therapy ($453.74-648.20/DALY averted). Given that the total burden of surgically treatable conditions in DALYs is more than that of malaria, tuberculosis, and HIV combined, our findings strengthen the argument for greater investment in primary surgical capacity in low- and middle-income countries.


Assuntos
Análise Custo-Benefício , Países em Desenvolvimento/economia , Laparotomia/economia , Centros de Atenção Terciária/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Países em Desenvolvimento/estatística & dados numéricos , Equipamentos e Provisões Hospitalares/economia , Feminino , Mão de Obra em Saúde/economia , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Laparotomia/estatística & dados numéricos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Regionalização/economia , Centros de Atenção Terciária/estatística & dados numéricos , Uganda , Adulto Jovem
2.
J Cardiovasc Med (Hagerstown) ; 20(7): 414-418, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31593558

RESUMO

: The 2015 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis recommend the use of a multidisciplinary team in the care of patients with infective endocarditis. A standardized collaborative approach should be implemented in centres with immediate access to different imaging techniques, cardiac surgery and health professionals from several specialties. This position paper has been produced by the Task Force for Management of Infective Endocarditis of Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) with the aim of providing recommendations for the implementation of the Endocarditis Team within the Italian hospital network. On the basis of the Italian hospital network with many cardiology facilities encompassing a total of 405 intensive cardiac care units (ICCUs) across the country, 224 (3.68 per million inhabitants) of which have on-site 24-h PCI capability, but with relatively few centres equipped with cardiac surgery and nuclear medicine, in the present article, the SIECVI Task Force for Management of Infective Endocarditis develops the idea of a network where 'functional' reference centres act as a link with the periphery and with 'structural' reference centres. A number of minimum characteristics are provided for these 'functional' reference centres. Outcome and cost analysis of implementing an Endocarditis Team with functional referral is expected to be derived from ongoing Italian and European registries.


Assuntos
Técnicas de Imagem Cardíaca/normas , Serviço Hospitalar de Cardiologia/normas , Prestação Integrada de Cuidados de Saúde/normas , Endocardite/diagnóstico por imagem , Endocardite/terapia , Equipe de Assistência ao Paciente/normas , Regionalização/normas , Consenso , Humanos , Comunicação Interdisciplinar , Valor Preditivo dos Testes , Resultado do Tratamento
3.
J Stroke Cerebrovasc Dis ; 28(11): 104368, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31537417

RESUMO

INTRODUCTION: Little is known about the effectiveness of endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) admitted to a primary stroke center (PSC). The aim of this study was to assess EVT effectiveness after transfer from a PSC to a distant (156 km apart; 1.5 hour by car) comprehensive stroke center (CSC), and to discuss perspectives to improve access to EVT, if indicated. PATIENTS AND METHOD: Analysis of the data collected in a 6-year prospective registry of patients admitted to a PSC for AIS due to LVO and selected for transfer to a distant CSC for EVT. The rate of transfer, futile transfer, EVT, reperfusion (thrombolysis in cerebral infarction score ≥2b-3), and relevant time measures were determined. RESULTS: Among the 529 patients eligible, 278 (52.6%) were transferred and 153 received EVT (55% of transferred patients) followed by reperfusion in 115 (overall reperfusion rate: 21.7%). Median times (interquartile range) were: 90 minutes (76-110) for PSC-door-in to PSC-door-out, 88 minutes (65-104) for PSC-door-out to CSC-door-in, 262 minutes (239-316) for PSC-imaging to reperfusion, and 393 minutes (332-454) for symptom onset to reperfusion. At 3 months, rates of favorable outcome (modified Rankin Scale 0-2) were not significantly different between patients eligible for EVT (42.4%), transferred patients (49.1%) and patients who underwent EVT (34.1%). DISCUSSION AND CONCLUSIONS: Our study suggests that transfer to a distant CSC is associated with reduced access to early EVT. These results argue in favor of on-site EVT at high volume PSCs that are distant from the CSC.


Assuntos
Assistência Integral à Saúde , Procedimentos Endovasculares , Acesso aos Serviços de Saúde , Regionalização , Acidente Vascular Cerebral/terapia , Tempo para o Tratamento , Transporte de Pacientes , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função Fisiológica , Sistema de Registros , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
4.
Adv Parasitol ; 105: 1-21, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31530391

RESUMO

This paper introduces the three stages of development of the Regional Network on Asian Schistosomiasis and other Helminthic Zoonoses (RNAS+), namely the preparatory stage, the strengthening stage and the expanding stage. Significant achievements have been made through the help of RNAS+, particularly on research on helminthiases. As scientists, researchers, academics work closer with control authorities, elimination of these diseases is slowly getting nearer and within reach. RNAS+, at present can boast of the following strengths: (i) strong collaboration in the regional research area with support from experts on research and control; (ii) presence of experts in various areas who can improve and promote both research and control; (iii) RNAS+ has been successful in translating research output to field application; (iv) setting up a platform that is capable of advancing the mechanisms of sharing information through its website, databases, publications and meetings; (v) RNAS+ has proved that it is capable of undertaking joint collaborative projects on operational research through multi-country, multi-disease using multi-disciplinary approach and involving different academic and research institutions in the region. Most importantly, experts who are members of RNAS+ are also linked with control programmes of the endemic member countries in the region.


Assuntos
Helmintíase/prevenção & controle , Cooperação Internacional , Zoonoses/prevenção & controle , Animais , Ásia , Humanos , Serviços de Informação , Regionalização , Esquistossomose/prevenção & controle
5.
J Stroke Cerebrovasc Dis ; 28(8): 2292-2301, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31200963

RESUMO

BACKGROUND AND PURPOSE: Although endovascular thrombectomy combined with recombinant tissue-type plasminogen activator is effective for treatment of acute ischemic stroke, regional disparities in implementation rates of those treatments have been reported. Drive and retrieve system, where a qualified neurointerventionist travels to another primary stroke center for endovascular thrombectomy, has been practiced in parts of Hokkaido, Japan. This study aims to simulate the cost effectiveness of the drive and retrieve system, which can be a method to enhance equality and cost effectiveness of treatments for acute ischemic stroke. MATERIALS AND METHODS: The number of patients who had acute ischemic stroke in 2015 is estimated. Those patients are generated according to the population distribution, and thereafter patient transport time is analyzed in the 3 scenarios (1) 60-minute drive scenario, (2) 90-minute drive scenario, in which the drive and retrieve system operates within 60-minute or 90-minute driving distance (3) without the system, using geographic information system. Incremental cost-effectiveness rate, quality-adjusted life years, and medical and nursing care costs are estimated from the analyzed transport time. FINDINGS: The incremental cost-effectiveness rate by implementing the system was dominant. Cost reductions of $213,190 in 60-minute drive scenario, and $247,274 in the 90-minute scenario were expected, respectively. Such benefits are the most significant in Soya, Emmon, Rumoi, and Kamikawahokubu medical areas. CONCLUSIONS: The drive and retrieve system could enhance regional equality and cost effectiveness of ischemic stroke treatments in Hokkaido, which can be achieved using existing resources. Further studies are required to clarify its cost effectiveness from hospital perspective.


Assuntos
Condução de Veículo , Isquemia Encefálica/terapia , Procedimentos Endovasculares/economia , Sistemas de Informação Geográfica/economia , Custos de Cuidados de Saúde , Neurologistas/economia , Regionalização/economia , Acidente Vascular Cerebral/terapia , Trombectomia/economia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Redução de Custos , Análise Custo-Benefício , Prestação Integrada de Cuidados de Saúde/economia , Sistemas de Informação Geográfica/organização & administração , Disparidades em Assistência à Saúde/economia , Humanos , Japão/epidemiologia , Neurologistas/organização & administração , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Regionalização/organização & administração , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Tempo para o Tratamento/economia , Resultado do Tratamento
6.
J Vasc Surg ; 70(3): 921-926, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31147113

RESUMO

OBJECTIVE: The objective of this study was to review our institute's open aortic surgery volume experience and its impact on Accreditation Council for Graduate Medical Education trainees. METHODS: A review was conducted of the vascular surgery department's operative database for all cases that underwent aortic aneurysm repair, whether open aortic repair (OAR), endovascular aneurysm repair (EVAR), or fenestrated EVAR (FEVAR). We also reviewed our graduating trainees' case logs. In the setting of our regionalized referral center, all patients who underwent open or endovascular aortic intervention between 2010 and 2014 at our main campus were included. The total number of aortic procedures performed by our graduation trainees was determined. All aortic aneurysm interventions, both open and endovascular (both EVAR and FEVAR), were included. The main outcome measures were the total number of aortic interventions, any change in trends of intervention, and the total number of open aortic cases that our graduation trainees had. RESULTS: During the 5-year period analyzed, a total of 1389 abdominal aortic aneurysm repair procedures were performed by OAR, EVAR, and FEVAR. Of those, 462 were OARs, representing 33.2% of the total; 440 were EVARs, representing 31.6%; and 487 were FEVARs, representing 35.2%. For all OAR procedures, there was a significant increase in the proportion of these cases over time (P = .014). The total number of EVAR and FEVAR cases performed annually during this time did not change, whereas the number of OAR cases has increased. Of the OARs, 59.3% were performed for juxtarenal aneurysms, whereas 22.9% involved type IV thoracoabdominal aortic aneurysms. On average, graduating vascular surgery trainees performed 23.1 OARs before graduation (range, 19-26). CONCLUSIONS: In contrast to the documented national trend of decreased OAR, our institute continues to see increased OAR relative to EVAR and FEVAR. Moreover, we theorized that the preservation of OAR volume in our program and other similar institutions might offer a practical solution to the challenge of addressing vascular surgery training in aortic surgery by OAR, EVAR, and FEVAR. Inclusive discussions at the national and international levels are needed to reach consensus regarding the future of vascular surgery training and key issues, such as additional, mandatory, subspecialized training in OAR and FEVAR for both residents and fellows who wish to receive certification in OAR; creation of centers of excellence for open aortic surgery that would centralize OAR and direct trainees to those centers for their needed training; and possibly development of new training strategies whereby single cases can be shared among trainees with alternating roles as exposure and closure vs repair.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Serviços Centralizados no Hospital , Educação de Pós-Graduação em Medicina , Procedimentos Endovasculares/educação , Hospitais com Alto Volume de Atendimentos , Regionalização , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Carga de Trabalho , Serviços Centralizados no Hospital/tendências , Competência Clínica , Currículo , Bases de Dados Factuais , Educação de Pós-Graduação em Medicina/tendências , Procedimentos Endovasculares/tendências , Hospitais com Alto Volume de Atendimentos/tendências , Humanos , Ohio , Encaminhamento e Consulta/tendências , Regionalização/tendências , Cirurgiões/tendências , Fatores de Tempo , Procedimentos Cirúrgicos Vasculares/tendências
9.
Am Soc Clin Oncol Educ Book ; 39: e121-e125, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31099669

RESUMO

Incidence and mortality from cancer is increasing in most countries in the world, with the highest burden in developing countries. City Cancer Challenge (C/Can), an initiative launched in 2017, aims to improve access to quality cancer care in metropolitan areas (1 million inhabitants or more) in low- and upper-middle income countries by transforming the way stakeholders at the city, regional, and national levels collectively design, plan, and implement local cancer solutions. The approach is built on the core principle that local leaders in cities define their own needs and craft solutions with the support of a network of global, regional, and local partners that reflect an understanding of the unique local context. C/Can aims to build a collective movement of cities that can together deliver quality, equitable, and sustainable cancer control solutions for all.


Assuntos
Neoplasias/epidemiologia , Cidades , Prioridades em Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Incidência , Prática Associada , Avaliação de Programas e Projetos de Saúde , Vigilância em Saúde Pública , Regionalização , População Urbana
11.
Rev. enferm. UFPE on line ; 13(4): 933-942, abr. 2019. ilus, tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-1017130

RESUMO

Objetivo: avaliar o acesso ao sistema regional de saúde a partir das ações de atenção aos agravos cardiovasculares. Método: trata-se de um estudo misto, descritivo. Coletaram-se dados a partir dos Sistemas de Informação Ambulatorial e Hospitalar do SUS, armazenados em planilhas Microsoft Excel e analisados utilizando-se estatística descritiva. Posteriormente, selecionaram-se 41 participanetes (gestores e reguladores) para responderem um questionário semiestruturado sobre acesso em cardiologia na rede regional. Optou-se pela Análise Temática de Conteúdo para análise dos dados qualitativos. Resultados: registrou-se o incremento da produção de consultas e exames, indicando a ampliação da oferta de serviços, a redução das internações clínicas e o crescimento das internações cirúrgicas em Cardiologia. Revelaram-se, em entrevistas, aspectos da organização da atenção no sistema regional que favorecem o acesso à atenção integral em Cardiologia. Conclusão: conclui-se que houve uma melhoria do acesso à atenção cardiovascular. Aponta-se que a coordenação do cuidado e a melhoria da resolubilidade da Atenção Básica favorecem o acesso à saúde, que também requer a implantação de estruturas sólidas de gestão, envolvendo planejamento, controle, regulação e avaliação.(AU)


Objective: to evaluate the access to the regional health system from the actions of attention to cardiovascular diseases. Method: this is a mixed, descriptive study. Data were collected from UHS Ambulatory and Hospital Information Systems, stored in Microsoft Excel spreadsheets and analyzed using descriptive statistics. Subsequently, 41 participanetes (managers and regulators) were selected to answer a semistructured questionnaire about access in cardiology in the regional network. The Thematic Content Analysis was used to analyze the qualitative data. Results: there was an increase in the production of consultations and examinations, indicating the expansion of the service offer, the reduction of clinical hospitalizations and the increase of surgical hospitalizations in Cardiology. In interviews, aspects of the organization of care in the regional system that favor access to comprehensive care in Cardiology were revealed. Conclusion: it was concluded that there was an improvement in access to cardiovascular care. It is pointed out that the coordination of care and the improvement of the resolubility of Primary Care favor access to health, which also requires the implementation of solid management structures, involving planning, control, regulation and evaluation.(AU)


Objetivo: evaluar el acceso al sistema regional de salud a partir de las acciones de atención a los agravios cardiovasculares. Método: se trata de un estudio mixto, descriptivo. Se recolectó datos a partir de los Sistemas de Información Ambulatoria y Hospitalaria del SUS, almacenados en hojas de cálculo de Microsoft Excel y analizados utilizando estadística descriptiva. Posteriormente, se seleccionaron 41 participantes (gestores y reguladores) para responder un cuestionario semiestructurado sobre acceso en cardiología en la red regional. Se optó por el Análisis Temático de Contenido para el análisis de los datos cualitativos. Resultados: se registró el incremento de la producción de consultas y exámenes, indicando la ampliación de la oferta de servicios, la reducción de las internaciones clínicas y el crecimiento de las internaciones quirúrgicas en Cardiología. Se revelaron, en entrevistas, aspectos de la organización de la atención en el sistema regional que favorecen el acceso a la atención integral en Cardiología. Conclusion: se concluye que hubo una mejora del acceso a la atención cardiovascular. Se señala que la coordinación del cuidado y la mejora de la resolución de la Atención Básica favorecen el acceso a la salud, que también requiere la implantación de estructuras sólidas de gestión, involucrando planificación, control, regulación y evaluación.(AU)


Assuntos
Humanos , Masculino , Feminino , Regionalização , Avaliação em Saúde , Doenças Cardiovasculares , Gestão em Saúde , Atenção à Saúde , Acesso aos Serviços de Saúde , Sistema Único de Saúde , Epidemiologia Descritiva , Sistemas de Informação em Saúde
12.
Eur Respir Rev ; 28(151)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30872399

RESUMO

In 2017, in recognition of the challenges faced by Member States in managing childhood and adolescent tuberculosis (TB) at a country level, the WHO Regional Office for Europe held a Regional Consultation. In total, 35 countries participated in the consultations representing both high- and low-incidence Member States. Here, we provide an overview of the existing World Health Organization (WHO) documents and guidelines on childhood and adolescent TB and describe the outcomes of this regional meeting. National childhood and adolescent TB guidelines are available in 25% of Member States, while 33% reported that no such guidelines are at hand. In the majority of countries (83%), childhood and adolescent TB is part of the National Strategic Plan. The most pressing challenges in managing paediatric TB comprise the lack of adequate drug formulations, the difficult diagnosis, and treatment of presumed latent TB infection. Investments into childhood and adolescent TB need to be further advocated to achieve the End TB goals set by WHO to eliminate TB by 2030.


Assuntos
Antituberculosos/uso terapêutico , Prioridades em Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Regionalização/organização & administração , Tuberculose/tratamento farmacológico , Organização Mundial da Saúde/organização & administração , Adolescente , Distribuição por Idade , Criança , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/microbiologia
13.
N Z Med J ; 132(1491): 38-45, 2019 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-30845127

RESUMO

AIM: As part of a project developing cancer service capability, the National Health Service (NHS) Cancer patient experience survey was used to assess the currently available services at Waitemata District Health Board (WDHB). METHODS: Patients presenting with cancer to WDHB in the previous 12 months were mailed a copy of the survey, to the initial cohort in 2013 and to the second in 2015. Results were compared between survey periods and with the 2015 NHS Cancer Patient Experience Survey. RESULTS: In 2013, 329 patients completed the survey while 319 responded in 2015. Over 90% of patients classed their experience as good or excellent in both survey periods and comparison showed significant overall improvement (p=0.001) in patient experience between 2013 and 2015. Overall, WDHB benchmarked with the NHS experience but the NHS performed better than WDHB in cancer nurse specialist contact for ongoing support and information related to eligibility for financial assistance. CONCLUSION: The results of these confirm that the NHS Cancer Patient Experience Survey provides meaningful data within New Zealand and that WDHB cancer patient experience has improved over the survey period. This data has assisted WDHB in prioritising patient information resources and treatment planning in developing services.


Assuntos
Acesso aos Serviços de Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Neoplasias/terapia , Serviços de Saúde Rural/organização & administração , Feminino , Humanos , Masculino , Neoplasias/epidemiologia , Nova Zelândia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Regionalização/organização & administração
14.
J Clin Pathol ; 72(6): 412-417, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30846480

RESUMO

AIMS: Our laboratory is a centralised centre receiving routine non-small cell lung cancer (NSCLC) samples for programmed death ligand-1 (PD-L1) immunohistochemical (IHC) evaluation. Since literature data are not concordant here we review our clinical records to assess the rate of PD-L1 positive and negative NSCLC cases in real-world practice. METHODS: PD-L1 expression was evaluated by a validated 22C3 IHC laboratory developed test on 211 prospectively collected routine NSCLC samples, received from 10 outside institutions. PD-L1 expression was assessed by the tumour proportion score (TPS) and reported by using a three cut-point system: TPS<1, TPS 1%-49% and TPS≥50%. RESULTS: Overall, 193 out of 211 samples (91.5%) meet the criteria for adequacy (more than 100 viable neoplastic cells). In 62.7% (121/193) of samples TPS was <1%; 17.6% of samples (34/193) expressed PD-L1 with a TPS of 1%-49% and 19.7% (38/193) with a TPS of >50%. There was no significant difference in PD-L1 expression rates between different histotypes and site of sampling. Instead, a statistically significant difference was associated to the type of samples: in fact, cytological samples were more frequently negative for PD-L1 expression (TPS<1%) and less often displayed PD-L1 expression at high levels (TPS>50%) than surgical resections and biopsies. CONCLUSIONS: We present a referral laboratory experience on IHC PD-L1 expression of prospectively collected routine NSCLC samples. Data from the real-world practice can better clarify the percentage of PD-L1 positive and negative cases, to establish benchmarks for good practice standards.


Assuntos
Antígeno B7-H1/análise , Biomarcadores Tumorais/análise , Carcinoma Pulmonar de Células não Pequenas/imunologia , Técnicas de Laboratório Clínico , Imuno-Histoquímica , Neoplasias Pulmonares/imunologia , Patologia Clínica , Regionalização , Carcinoma Pulmonar de Células não Pequenas/patologia , Técnicas de Laboratório Clínico/normas , Feminino , Humanos , Imuno-Histoquímica/normas , Itália , Neoplasias Pulmonares/patologia , Masculino , Patologia Clínica/organização & administração , Patologia Clínica/normas , Valor Preditivo dos Testes , Estudos Prospectivos , Encaminhamento e Consulta , Regionalização/organização & administração , Regionalização/normas , Reprodutibilidade dos Testes
15.
Rev. Hosp. Ital. B. Aires (2004) ; 39(1): 4-11, mar. 2019. ilus., tab., graf.
Artigo em Espanhol | LILACS | ID: biblio-1021445

RESUMO

El sedentarismo está aumentando en la Ciudad Autónoma de Buenos Aires (CABA). Es importante estudiar el ambiente construido que promueve la realización de actividad física (AF). Nuestro objetivo fue analizar la distribución del espacio verde (EV) apto para realizar AF, así como la oferta estatal de actividades deportivas gratuitas en la ciudad. Se realizó un estudio ecológico analizando y mapeando datos según fuentes e informes oficiales de CABA para 2015. Hicimos un análisis por número absoluto, superficie, densidad poblacional y valor promedio del metro cuadrado construido por comuna. Además, realizamos un análisis cualitativo según imágenes satelitales de la ciudad. La mediana de espacio verde apto para AF era de 2,6 m2/habitante (rango intercuartílico de 1,0 a 4,6). La menor cantidad estuvo en las comunas céntricas, más densamente pobladas, así como en la mayoría de las de menor valor del terreno (una de estas tenía buena cantidad de EV, pero con un ambiente construido que podría limitar la realización de AF). En cambio, en cuanto a las actividades deportivas gratuitas, a menor valor del terreno había mayor oferta. Estos resultados deben analizarse junto con condiciones ambientales y de seguridad para la planificación integral de la ciudad. (AU)


Sedentary lifestyle is increasing in Buenos Aires City (CABA). It is important to study the built environment that promotes physical activity (PA). Our objective was to analyze the distribution of the green spaces or urban open spaces (GS) suitable for PA, as well as the state offer of free sports activities in the city. We did an ecological study, analyzing and mapping data according to sources and official reports of CABA for 2015. We performed analyses by absolute number, area, population density and average value of the built squared meter for each district (comuna). In addition, we did a qualitative analysis according to satellite images of the city. The median of green space suitable for PA was 2.6 m2 / inhabitant (interquartile range 1.0 to 4.6). The smallest amount was in the central districts, more densely populated, as well as in most of the lower landvalue ones (one of these had a good amount of GS, but with a built environment that could limit the practice of PA). In contrast, regarding free sports activities, the lower the value of the land, the greater the state offer. These results must be analyzed along with environmental and safety conditions for an integral planning of the city. (AU)


Assuntos
Humanos , Regionalização/organização & administração , Esportes/tendências , Equidade em Saúde/estatística & dados numéricos , Áreas Verdes/estatística & dados numéricos , Doenças não Transmissíveis/prevenção & controle , /estatística & dados numéricos , Argentina , Qualidade de Vida , Regionalização/tendências , Classe Social , Esportes/estatística & dados numéricos , Saúde Pública/estatística & dados numéricos , Equidade em Saúde/organização & administração , Estudos Ecológicos , Comportamento Sedentário , Senso de Coerência , Estilo de Vida Saudável , /provisão & distribução , /tendências , Promoção da Saúde/organização & administração
16.
Pediatr. aten. prim ; 21(81): 87-93, ene.-mar. 2019. tab, mapas
Artigo em Espanhol | IBECS | ID: ibc-184542

RESUMO

Introducción: la Asociación Española de Pediatría de Atención Primaria (AEPap) ha querido conocer las repercusiones que podrían tener en la continuidad de la actividad pediátrica en el primer nivel asistencial algunas propuestas que se están haciendo desde diversas instituciones. Análisis realizado: la Junta directiva de la AEPap y el grupo de trabajo profesional han analizado seis propuestas para ver si fortalecen o debilitan a la Pediatría de Atención Primaria. Las propuestas analizadas han sido: 1) prolongación de la edad pediátrica en Atención Primaria; 2) prolongación de la duración de la especialidad de Pediatría y sus Áreas Específicas; 3) adecuación de las salidas profesionales; 4) adecuación del número de tarjetas individuales sanitarias; 5) aumento de las plazas de médicos internos residentes de Pediatría, y 6) mantenimiento de oposiciones diferenciadas de Pediatría de Atención Primaria y facultativo especialista de área de Pediatría. Conclusiones: la prolongación de la edad pediátrica en Atención Primaria de los 14 a los 18 años y la prolongación de la duración de la especialidad de Pediatría y sus Áreas Específicas serían perjudiciales para la continuidad de la Pediatría de Atención Primaria


Introduction: the Spanish Association of Primary Care Pediatrics (SAPCP) had wanted to know the repercussions that some proposals that are being made from different institutions could have on the continuity of primary care pediatrics. Analysis performed: the SAPCP and the professional working group have analyzed six proposals to see if they strengthen or weaken Primary Care Pediatrics. The proposals that have been analyzed are: 1) prolongation of the pediatric age in primary care; 2) prolongation of the duration of the specialty of Pediatrics and its Specific Areas; 3) adjustment of professional opportunities; 4) adaptation of the number of individual health cards; 5) increase in Internal medical residents of pediatrics, and 6) maintenance of differentiated oppositions of Pediatrics of Primary Care and facultative specialist of Area of Pediatrics. Conclusions: the prolongation of the pediatric age in primary care from 14 to 18 years and the prolongation of the duration of the specialty of Pediatrics and its Specific Areas would be detrimental for the continuity of Primary Care Pediatrics


Assuntos
Humanos , Qualidade da Assistência à Saúde/tendências , Pediatria/tendências , Atenção Primária à Saúde/organização & administração , Regionalização , Administração de Recursos Humanos/tendências
17.
JAAPA ; 32(3): 20-24, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30741850

RESUMO

Women with opioid use disorder who become pregnant are a particularly vulnerable population and require a comprehensive treatment approach for mother and fetus. Research is continuing on opioid use disorder, effects of opioid use on the fetus, and best treatment approaches. This article reviews current recommendations and guidelines for treatment.


Assuntos
Analgésicos Opioides/administração & dosagem , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/terapia , Complicações na Gravidez/cirurgia , Regionalização , Adolescente , Adulto , Buprenorfina/administração & dosagem , Terapia Cognitivo-Comportamental , Feminino , Doenças Fetais/induzido quimicamente , Doenças Fetais/prevenção & controle , Humanos , Metadona/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Assistentes Médicos , Guias de Prática Clínica como Assunto , Gravidez , Complicações na Gravidez/diagnóstico , Papel Profissional , Adulto Jovem
18.
Semin Thorac Cardiovasc Surg ; 31(3): 327-334, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30616006

RESUMO

Utilization of extracorporeal membrane oxygenation (ECMO) has increased dramatically over the last decade. Despite this trend, many medical centers have limited, if any, access to this technology or the resources necessary to manage these complex patients. In an effort to improve the current infrastructure of regional ECMO care, ECMO centers of excellence have an obligation to partner with facilities within their communities and regions to increase access to this potentially life-saving technology. While the need for this infrastructure is widely acknowledged in the ECMO community, few reports describe the actual mechanisms by which a successful interfacility transport program can operate. As such, the purpose of this document is to describe the elements of and methods for providing safe and efficient mobile ECMO services from the perspective of an experienced, high-volume tertiary ECMO center of excellence in the Southeastern United States.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Oxigenação por Membrana Extracorpórea , Transferência de Pacientes/organização & administração , Encaminhamento e Consulta/organização & administração , Regionalização/organização & administração , Insuficiência Respiratória/terapia , Choque Cardiogênico/terapia , Tomada de Decisão Clínica , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/mortalidade , Humanos , Equipe de Assistência ao Paciente/organização & administração , Seleção de Pacientes , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/fisiopatologia , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/mortalidade , Choque Cardiogênico/fisiopatologia , Resultado do Tratamento , Triagem
19.
Health Serv Res ; 54(1): 97-105, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30318592

RESUMO

OBJECTIVE: To estimate and describe factors driving variation in spending for breast cancer patients within geographic region. DATA SOURCE: Surveillance, Epidemiology, and End Results (SEER)-Medicare database from 2009-2013. STUDY DESIGN: The proportion of variation in monthly medical spending within geographic region attributed to patient and physician factors was estimated using multilevel regression models with individual patient and physician random effects. Using sequential models, we estimated the contribution of differences in patient and disease characteristics or use of cancer treatment modalities to patient-level and physician-level variance in spending. Services associated with high spending physicians were estimated using linear regression. DATA EXTRACTION METHOD: A total of 20 818 women with a breast cancer diagnosis in 2010-2011. PRINCIPAL FINDINGS: We observed substantial between-patient and between-provider variation in spending following diagnosis and at the end-of-life. Immediately following diagnosis, 48% of between-patient and 31% of between-physician variation were driven by differences in delivery of cancer treatment modalities to similar patients. At the end-of-life, patients of high spending physicians had twice as many inpatient days, double the chemotherapy spending, and slightly more hospice days. CONCLUSIONS: Similar patients receive very different treatments, which yield significant differences in spending. Efforts to reduce unwanted variation may need to target treatment choices within patient-doctor discussions.


Assuntos
Neoplasias da Mama/economia , Neoplasias da Mama/metabolismo , Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/economia , Neoplasias da Mama/terapia , Feminino , Humanos , Oncologia/economia , Regionalização/economia , Estados Unidos
20.
J Stroke Cerebrovasc Dis ; 28(2): 259-266, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30442556

RESUMO

BACKGROUND: Mechanical thrombectomy (MT) in association with intravenous thrombolysis is recommended for treatment of acute ischemic stroke (AIS), with large vessel occlusion (LVO) in the anterior circulation. Because MT is only available in comprehensive stroke centers (CSC), the challenge of stroke organization is to ensure equitable access to the fastest endovascular suite. Our aim was to evaluate the feasibility, efficacy, and safety of MT in patients initially managed in 1 CSC (mothership), compared with patients first managed in primary stroke center (PSC), and then transferred to the CSC for MT (drip-and-ship). METHODS: We retrospectively analyzed 179 consecutive patients (93 in the mothership group and 86 in the drip-and-ship group), with AIS secondary to LVO in the anterior cerebral circulation and a clinical-radiological mismatch (NIHSS ≥ 8 and DWI-ASPECT score ≥5), up to 6 hours after symptoms onset. We evaluated 3-month functional modified Rankin scale (mRS), periprocedural time management, mortality, and symptomatic intracranial haemorrhage (sICH). RESULTS: Despite significant longer process time in the drip-and-ship group, mRS ≤ 2 at 3 months (39.8% versus 44.1%, P = .562), Thrombolysis in cerebral infarction 2b-3 (85% versus 78%, P = .256), and sICH (7.0% versus 9.7%, P = .515) were similar in both group regardless of baseline clinical or radiological characteristics. After multivariate logistic regression, the predictive factors for favorable outcome were age (odds ratio [OR] -5years= 1.32, P < .001), initial NIHSS (OR -5points = 1.59, P = .010), absence of diabetes (OR = 3.35, P = .075), and the delay magnetic resonance imagining-puncture (OR -30min = 1.16, P = .048). CONCLUSIONS: Our study showed encouraging results from a regional protocol of MT comparing patients transferred from PSC or brought directly in CSC.


Assuntos
Infarto Encefálico/cirurgia , Prestação Integrada de Cuidados de Saúde/organização & administração , Fibrinolíticos/administração & dosagem , Trombólise Mecânica , Transferência de Pacientes/organização & administração , Regionalização/organização & administração , Trombectomia , Tempo para o Tratamento/organização & administração , Idoso , Infarto Encefálico/diagnóstico , Infarto Encefálico/mortalidade , Infarto Encefálico/fisiopatologia , Avaliação da Deficiência , Estudos de Viabilidade , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intravenosas , Masculino , Trombólise Mecânica/efeitos adversos , Trombólise Mecânica/mortalidade , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Trombectomia/efeitos adversos , Trombectomia/mortalidade , Fatores de Tempo , Resultado do Tratamento
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