Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 11.847
Filtrar
1.
World Neurosurg ; 145: e1-e6, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32777401

RESUMO

In December 2019, coronavirus disease 2019 (COVID-19) was discovered in Wuhan, Hubei province, from where it spread rapidly worldwide. COVID-19 characteristics (increased infectivity, rapid spread, and general population susceptibility) pose a great challenge to hospitals. Infectious disease, pulmonology, and intensive care units have been strengthened and expanded. All other specialties have been compelled to suspend or reduce clinical and elective surgical activities. The profound effects on spine surgery call for systematic approaches to optimizing the diagnosis and treatment of spinal diseases. Based on the experience of one Italian region, we draw an archetype for assessing the current and predicted level of stress in the health care system, with the aim of enabling hospitals to make better decisions during the pandemic. Further, we provide a framework that may help guide strategies for adapting surgical spine care to the conditions of epidemic surge.


Assuntos
Cirurgia Geral/estatística & dados numéricos , Pandemias , Coluna Vertebral/cirurgia , /epidemiologia , Tomada de Decisões Gerenciais , Árvores de Decisões , Assistência à Saúde/estatística & dados numéricos , Serviço Hospitalar de Emergência , Humanos , Itália/epidemiologia , Doenças da Coluna Vertebral/cirurgia , Doenças da Coluna Vertebral/terapia , Tempo para o Tratamento
2.
PLoS One ; 15(11): e0239757, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33151954

RESUMO

Innovations in decision-making practice for allocation of funds in health research are emerging; however, it is not clear to what extent these are used. This study aims to better understand current decision-making practices for the allocation of research funding from the perspective of UK and international health funders. An online survey (active March-April 2019) was distributed by email to UK and international health and health-related funding organisations (e.g., biomedical and social), and was publicised on social media. The survey collected information about decision-making approaches for research funding allocation, and covered assessment criteria, current and past practices, and considerations for improvements or future practice. A mixed methods analysis provided descriptive statistics (frequencies and percentages of responses) and an inductive thematic framework of key experiences. Thirty-one responses were analysed, representing government-funded organisations and charities in the health sector from the UK, Europe and Australia. Four themes were extracted and provided a narrative framework. 1. The most reported decision-making approaches were external peer review, triage, and face-to-face committee meetings; 2. Key values underpinned decision-making processes. These included transparency and gaining perspectives from reviewers with different expertise (e.g., scientific, patient and public); 3. Cross-cutting challenges of the decision-making processes faced by funders included bias, burden and external limitations; 4. Evidence of variations and innovations from the most reported decision-making approaches, including proportionate peer review, number of decision-points, virtual committee meetings and sandpits (interactive workshop). Broadly similar decision-making processes were used by all funders in this survey. Findings indicated a preference for funders to adapt current decision-making processes rather than using more innovative approaches: however, there is a need for more flexibility in decision-making and support to applicants. Funders indicated the need for information and empirical evidence on innovations which would help to inform decision-making in research fund allocation.


Assuntos
Pesquisa Biomédica/economia , Tomada de Decisões Gerenciais , Saúde Global/economia , Financiamento da Assistência à Saúde , Alocação de Recursos/estatística & dados numéricos , Austrália , Pesquisa Biomédica/estatística & dados numéricos , Saúde Global/estatística & dados numéricos , Alocação de Recursos/economia , Inquéritos e Questionários/estatística & dados numéricos , Reino Unido
3.
Healthc Q ; 23(3): 15-23, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33243361

RESUMO

The East Toronto Health Partners (ETHP) include more than 50 organizations working collaboratively to create an integrated system of care in the east end of Toronto. This existing partnership proved invaluable as a platform for a rapid, coordinated local response to the COVID-19 pandemic. Months after the first wave of the pandemic began, with the daily numbers of COVID-19 cases finally starting to decline, leaders from ETHP provided preliminary reflections on two critical questions: (1) How were existing integration efforts leveraged to mobilize a response during the COVID-19 crisis? and (2) How can the response to the initial wave of COVID-19 be leveraged to further accelerate integration and better address subsequent waves and system improvements once the pandemic abates?


Assuntos
/terapia , Participação da Comunidade , Prestação Integrada de Cuidados de Saúde/organização & administração , Assistência à Saúde/organização & administração , Política de Saúde , /epidemiologia , Participação da Comunidade/métodos , Tomada de Decisões Gerenciais , Assistência à Saúde/métodos , Prestação Integrada de Cuidados de Saúde/métodos , Saúde Global , Humanos , Ontário , Inovação Organizacional , Atenção Primária à Saúde/organização & administração , Administração em Saúde Pública/métodos , Alocação de Recursos/métodos , Alocação de Recursos/organização & administração
5.
Work ; 66(4): 717-729, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925133

RESUMO

BACKGROUND: COVID-19 is a highly contagious acute respiratory syndrome and has been declared a pandemic in more than 209 countries worldwide. At the time of writing, no preventive vaccine has been developed and tested in the community. This study was conducted to review studies aimed at preventing the spread of the coronavirus worldwide. METHODS: This study was a review of the evidence-based literature and was conducted by searching databases, including Google Scholar, PubMed, and ScienceDirect, until April 2020. The search was performed based on keywords including "coronavirus", "COVID-19", and "prevention". The list of references in the final studies has also been re-reviewed to find articles that might not have been obtained through the search. The guidelines published by trustworthy organizations such as the World Health Organization and Center for Disease Control have been used in this study. CONCLUSION: So far, no vaccine or definitive treatment for COVID-19 has been invented, and the disease has become a pandemic. Therefore, observation of hand hygiene, disinfection of high-touch surfaces, observation of social distance, and lack of presence in public places are recommended as preventive measures. Moreover, to control the situation and to reduce the incidence of the virus, some of the measures taken by the decision-making bodies and the guidelines of the deterrent institutions to strengthen telecommuting of employees and reduce the presence of people in the community and prevent unnecessary activities, are very important.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Local de Trabalho/organização & administração , /epidemiologia , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Tomada de Decisões Gerenciais , Desinfecção/organização & administração , Desinfecção/normas , Guias como Assunto , Higiene das Mãos/organização & administração , Higiene das Mãos/normas , Humanos , Incidência , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Programas de Rastreamento/organização & administração , Programas de Rastreamento/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Telecomunicações/organização & administração , Telecomunicações/normas , Local de Trabalho/normas
6.
Tex Med ; 116(8): 20-25, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32866271

RESUMO

Ricardo Garza, MD, was still walking the tightrope: standing, but unable to withstand another gust of wind. COVID-19 swept away about 35% of the San Antonio solo cardiologist's practice revenue, and that was just what he could calculate as he waited for insurers to process straggling claims. But he had returned to in-office operations without any layoffs. While some practices are surviving - and trying their best to prepare for future threats - others weren't so lucky. On-the-ground experiences align with the Texas Medical Association's Practice Viability Survey in showing COVID-19 was, and still is, a disruptor unlike any other - challenging or torpedoing the viability of various practice types.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Prática Profissional , Telemedicina , Betacoronavirus , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Tomada de Decisões Gerenciais , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , Inovação Organizacional , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/tendências , Prática Profissional/economia , Prática Profissional/tendências , Texas/epidemiologia
7.
PLoS One ; 15(9): e0239141, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32956383

RESUMO

Disruptive behavior by passengers delayed at airport terminals not only affects personal safety but also reduces civil aviation efficiency and passenger satisfaction. This study investigated the causal mechanisms of disruptive behavior by delayed passengers in three aspects: environmental, managerial, and personal. Data on flight delays at Shenzhen Airport in 2018 were collected and analyzed. The main factors leading to disruptive behavior by delayed passengers were identified, and an early warning model for disturbances was developed using multiple logistic regression and a back-propagation(BP) neural network. The results indicated that the proposed model and method were feasible. Compared to the logistic regression model, the BP neural network model had advantages in predicting disturbances by delayed passengers, showing higher prediction accuracy. The BP network weight analysis method was used to obtain the influence weight of each factor on behavior change of delayed passengers. The influence weight of different factors was obtained, providing an assistant decision-making method to address disruption from flight-delayed passengers.


Assuntos
Aviação/organização & administração , Modelos Psicológicos , Comportamento Problema/psicologia , Gestão da Segurança/métodos , Viagem/psicologia , Tomada de Decisões Gerenciais , Humanos , Modelos Logísticos , Redes Neurais de Computação , Satisfação Pessoal , Fatores de Tempo
8.
PLoS One ; 15(9): e0231954, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32898163

RESUMO

To implement ecosystem-based approaches to fisheries management, decision makers need insight on the potential costs and benefits of the policy options available to them. In the Southern Ocean, two such options for addressing trade-offs between krill-dependent predators and the krill fishery include "feedback management" (FBM) strategies and marine protected areas (MPAs); in theory, the first adjusts to change, while the latter is robust to change. We compared two possible FBM options to a proposed MPA in the Antarctic Peninsula and Scotia Sea given a changing climate. One of our feedback options, based on the density of Antarctic krill (Euphasia superba), projected modest increases in the abundances of some populations of krill predators, whereas outcomes from our second FBM option, based on changes in the abundances of penguins, were more mixed, with some areas projecting predator population declines. The MPA resulted in greater increases in some, but not all, predator populations than either feedback strategy. We conclude that these differing outcomes relate to the ways the options separate fishing and predator foraging, either by continually shifting the spatial distribution of fishing away from potentially vulnerable populations (FBM) or by permanently closing areas to fishing (the MPA). For the krill fishery, we show that total catches could be maintained using an FBM approach or slightly increased with the MPA, but the fishery would be forced to adjust fishing locations and sometimes fish in areas of relatively low krill density-both potentially significant costs. Our work demonstrates the potential to shift, rather than avoid, ecological risks and the likely costs of fishing, indicating trade-offs for decision makers to consider.


Assuntos
Conservação dos Recursos Naturais/métodos , Tomada de Decisões Gerenciais , Pesqueiros/organização & administração , Cadeia Alimentar , Animais , Regiões Antárticas , Mudança Climática , Euphausiacea , Retroalimentação , Peixes , Densidade Demográfica , Dinâmica Populacional , Spheniscidae
10.
Am J Public Health ; 110(S2): S197-S203, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32663082

RESUMO

Objectives. To examine spending and resource allocation decision-making to address health and social service integration challenges within and between governments.Methods. We performed a mixed methods case study to examine the integration of health and social services in a large US metropolitan area, including a city and a county government. Analyses incorporated annual budget data from the city and the county from 2009 to 2018 and semistructured interviews with 41 key leaders, including directors, deputies, or finance officers from all health care-, health-, or social service-oriented city and county agencies; lead budget and finance managers; and city and county executive offices.Results. Participants viewed public health and social services as qualitatively important, although together these constituted only $157 or $1250 total per capita spending in 2018, and per capita public health spending has declined since 2009. Funding streams can be siloed and budget approaches can facilitate or impede service integration.Conclusions. Health and social services should be integrated through greater attention to the budgetary, jurisdictional, and programmatic realities of health and social service agencies and to the budget models used for driving the systems-level pursuit of population health.


Assuntos
Assistência à Saúde/economia , Governo Local , Saúde Pública/economia , Serviço Social/economia , Tomada de Decisões Gerenciais , Financiamento Governamental , Gastos em Saúde/estatística & dados numéricos , Humanos , Alocação de Recursos
11.
Diabetes Res Clin Pract ; 166: 108288, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32615277

RESUMO

BACKGROUND: The prevalence and incidence of Type 2 Diabetes mellitus (T2DM) are significantly increasing in Nigeria. Effective management of the condition, in clinical settings, can be achieved with a minimal financial cost, but this is often overlooked. It is crucial to understand organisational factors influencing non-pharmacological management of T2DM in Nigerian public hospitals for effective management of patients diagnosed with the condition. AIM: To examine healthcare delivery services influencing patient management and seek approaches to heighten optimisation of patient health outcomes. METHODS: Adopting a qualitative case study design, we used the Constant Comparative Method and semi-structured questions to interview17 nurses in public hospitals across Lagos. Using the five stages of the Framework Analysis process, the transcribed interviews were thematically analysed. RESULTS: Nurses suggested that a complex, multifaceted system constituted organisational factors influencing T2DM management in public hospitals across Lagos, Nigeria. Specific factors identified were levels of available information and knowledge, relationship, policy and decision-making management. These factors were, in turn, linked to political, infrastructural, health professional and the environments within which patients were given health services. CONCLUSIONS: The study revealed a significant gap in the organisation of care for individuals diagnosed with T2DM in public hospitals across Lagos. Timely and affordable strategies have been highlighted to secure effective care delivery to patients.


Assuntos
Assistência à Saúde/organização & administração , Diabetes Mellitus Tipo 2/terapia , Serviços de Saúde/normas , Hospitais Públicos/organização & administração , Enfermeiras e Enfermeiros , Percepção , Adulto , Atitude do Pessoal de Saúde , Tomada de Decisões Gerenciais , Assistência à Saúde/normas , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/enfermagem , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Públicos/normas , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Enfermeiras e Enfermeiros/organização & administração , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/normas , Enfermeiras e Enfermeiros/estatística & dados numéricos , Padrões de Prática em Enfermagem/organização & administração , Padrões de Prática em Enfermagem/normas , Padrões de Prática em Enfermagem/estatística & dados numéricos , Pesquisa Qualitativa , Fatores Socioeconômicos , Inquéritos e Questionários , Resultado do Tratamento
13.
Sci Rep ; 10(1): 9289, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32518246

RESUMO

The Norwood surgical procedure restores functional systemic circulation in neonatal patients with single ventricle congenital heart defects, but this complex procedure carries a high mortality rate. In this study we address the need to provide an accurate patient specific risk prediction for one-year postoperative mortality or cardiac transplantation and prolonged length of hospital stay with the purpose of assisting clinicians and patients' families in the preoperative decision making process. Currently available risk prediction models either do not provide patient specific risk factors or only predict in-hospital mortality rates. We apply machine learning models to predict and calculate individual patient risk for mortality and prolonged length of stay using the Pediatric Heart Network Single Ventricle Reconstruction trial dataset. We applied a Markov Chain Monte-Carlo simulation method to impute missing data and then fed the selected variables to multiple machine learning models. The individual risk of mortality or cardiac transplantation calculation produced by our deep neural network model demonstrated 89 ± 4% accuracy and 0.95 ± 0.02 area under the receiver operating characteristic curve (AUROC). The C-statistics results for prediction of prolonged length of stay were 85 ± 3% accuracy and AUROC 0.94 ± 0.04. These predictive models and calculator may help to inform clinical and organizational decision making.


Assuntos
Aprendizado Profundo , Mortalidade Hospitalar , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Procedimentos de Norwood/mortalidade , Procedimentos de Norwood/métodos , Tomada de Decisões Gerenciais , Ventrículos do Coração/patologia , Ventrículos do Coração/cirurgia , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Cadeias de Markov , Modelos Estatísticos , Método de Monte Carlo , Redes Neurais de Computação , Risco
16.
Health Policy ; 124(7): 671-673, 2020 07.
Artigo em Inglês | MEDLINE | ID: covidwho-277031

RESUMO

As Corona virus is putting a huge stress on healthcare systems around the world, analysts of health policy will have to respond with starting up research on the consequences of current policies. In this paper, we propose an agenda for research of health policy from a governance perspective, focussing on the consequences of decision-making structures and practices, the mediatisation of the pandemic, the organisation of healthcare systems and the role of expertise.


Assuntos
Infecções por Coronavirus/prevenção & controle , Política de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Tomada de Decisões Gerenciais , Assistência à Saúde , Humanos , Meios de Comunicação de Massa , Competência Profissional
19.
Health Policy ; 124(7): 671-673, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32425282

RESUMO

As Corona virus is putting a huge stress on healthcare systems around the world, analysts of health policy will have to respond with starting up research on the consequences of current policies. In this paper, we propose an agenda for research of health policy from a governance perspective, focussing on the consequences of decision-making structures and practices, the mediatisation of the pandemic, the organisation of healthcare systems and the role of expertise.


Assuntos
Infecções por Coronavirus/prevenção & controle , Política de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Tomada de Decisões Gerenciais , Assistência à Saúde , Humanos , Meios de Comunicação de Massa , Competência Profissional
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA