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1.
Anaesthesia ; 75(2): 234-246, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31788789

RESUMO

The location of care for many brain-injured patients has changed since 2012 following the development of major trauma centres. Advances in management of ischaemic stroke have led to the urgent transfer of many more patients. The basis of care has remained largely unchanged, however, with emphasis on maintaining adequate cerebral perfusion as the key to preventing secondary injury. Organisational aspects and training for transfers are highlighted, and we have included an expanded section on paediatric transfers. We have also provided a table with suggested blood pressure parameters for the common types of brain injury but acknowledge that there is little evidence for many of our recommendations. These guidelines remain a mix of evidence-based and consensus-based statements. We have received assistance from many organisations representing clinicians who care for these patients, and we believe our views represent the best of current thinking and opinion. We encourage departments to review their own practice using our suggestions for audit and quality improvement.


Assuntos
Lesões Encefálicas/terapia , Transferência de Pacientes/métodos , Acidente Vascular Cerebral/terapia , Transporte de Pacientes/métodos , Anestesiologia , Anestesistas , Cuidados Críticos , Humanos , Sociedades Médicas
2.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(9): 1158-1159, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31657344

RESUMO

OBJECTIVE: In daily medical work, most of the critically ill patients who cannot move by themselves are pulled and lifted by manpower, often relying on the cooperation of many doctors and nurses, which not only increases the risk of transfer and patients' discomfort, but also causes certain skeletal and muscle damage to the porters. The emergency department of the First Hospital of Jiaxing City, Zhejiang Province designed a kind of patient transfer device, and obtained the National Utility Model Patent (ZL 2018 2 0579844.X). The transfer device is composed of upper frame, lower frame and base. The upper frame and the lower frame are rectangular and in a horizontal position. The upper frame can slide laterally through the circular tubes which are fixed on the lower frame. The lower part of the base is provided with four universal foot brake wheels. During the usage, the booster frame facilitates the transfer of patients by the rolling and two sliding tracks of the circular tube, which can make patients move smoothly and comfortably, and reduce the working intensity of the transporter. This device has good practical value.


Assuntos
Estado Terminal , Transferência de Pacientes/métodos , Serviço Hospitalar de Emergência , Humanos
3.
Transplant Proc ; 51(9): 3042-3043, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31627913

RESUMO

OBJECTIVE: The objective is to describe the donations made with extracorporeal membrane oxygenation as a method of preservation to meet the characteristics of the donors and the transplants obtained. METHODS: This was a retrospective descriptive study, using the donation registration data made at Virgen de las Nieves Hospital from 2010 to February 2018. RESULTS: A total of 11 transfers occurred: 2 to the province of Jaen (Jaen Hospital, 92 km from Virgen de las Nieves Hospital; San Agustín Hospital, Linares, 136 km), 1 to Santa Ana Hospital, Motril (68 km), 1 to Poniente Hospital, El Ejido, Almeria (137 km), and 7 trips within the city of Granada. From these donations, a total of 21 kidneys, 3 livers, 10 corneal transplants, 4 extractions of osteotendinous tissue, and 1 extraction of vascular tissue were obtained. CONCLUSION: Extracorporeal membrane oxygenation mobile teams can enable donation in controlled donation after circulatory death with normothermic preservation in hospitals without these resources, which increases the donor group and optimizes graft results.


Assuntos
Oxigenação por Membrana Extracorpórea , Transferência de Pacientes/métodos , Obtenção de Tecidos e Órgãos/métodos , Transplantes , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doadores de Tecidos/provisão & distribução
4.
BMJ ; 367: l5678, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619384

RESUMO

OBJECTIVE: To determine if postnatal transfer or birth in a non-tertiary hospital is associated with adverse outcomes. DESIGN: Observational cohort study with propensity score matching. SETTING: National health service neonatal care in England; population data held in the National Neonatal Research Database. PARTICIPANTS: Extremely preterm infants born at less than 28 gestational weeks between 2008 and 2015 (n=17 577) grouped based on birth hospital and transfer within 48 hours of birth: upward transfer (non-tertiary to tertiary hospital, n=2158), non-tertiary care (born in non-tertiary hospital; not transferred, n=2668), and controls (born in tertiary hospital; not transferred, n=10 866). Infants were matched on propensity scores and predefined background variables to form subgroups with near identical distributions of confounders. Infants transferred between tertiary hospitals (horizontal transfer) were separately matched to controls in a 1:5 ratio. MAIN OUTCOME MEASURES: Death, severe brain injury, and survival without severe brain injury. RESULTS: 2181 infants, 727 from each group (upward transfer, non-tertiary care, and control) were well matched. Compared with controls, infants in the upward transfer group had no significant difference in the odds of death before discharge (odds ratio 1.22, 95% confidence interval 0.92 to 1.61) but significantly higher odds of severe brain injury (2.32, 1.78 to 3.06; number needed to treat (NNT) 8) and significantly lower odds of survival without severe brain injury (0.60, 0.47 to 0.76; NNT 9). Compared with controls, infants in the non-tertiary care group had significantly higher odds of death (1.34, 1.02 to 1.77; NNT 20) but no significant difference in the odds of severe brain injury (0.95, 0.70 to 1.30) or survival without severe brain injury (0.82, 0.64 to 1.05). Compared with infants in the upward transfer group, infants in the non-tertiary care group had no significant difference in death before discharge (1.10, 0.84 to 1.44) but significantly lower odds of severe brain injury (0.41, 0.31 to 0.53; NNT 8) and significantly higher odds of survival without severe brain injury (1.37, 1.09 to 1.73; NNT 14). No significant differences were found in outcomes between the horizontal transfer group (n=305) and controls (n=1525). CONCLUSIONS: In extremely preterm infants, birth in a non-tertiary hospital and transfer within 48 hours are associated with poor outcomes when compared with birth in a tertiary setting. We recommend perinatal services promote pathways that facilitate delivery of extremely preterm infants in tertiary hospitals in preference to postnatal transfer.


Assuntos
Lesões Encefálicas , Salas de Parto , Doenças do Prematuro , Transferência de Pacientes , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/etiologia , Lesões Encefálicas/mortalidade , Salas de Parto/classificação , Salas de Parto/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Lactente Extremamente Prematuro , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/etiologia , Doenças do Prematuro/mortalidade , Masculino , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Pontuação de Propensão , Análise de Sobrevida , Centros de Atenção Terciária/estatística & dados numéricos
5.
Ned Tijdschr Geneeskd ; 1632019 10 01.
Artigo em Holandês | MEDLINE | ID: mdl-31580036

RESUMO

Transitions of care pose a risk to medication safety. To reduce patient harm, medication reconciliation is advised. However, implementation of medication reconciliation is difficult due to time constraints. We present two female patients aged 82 and 84 years. In both women, unintentional discrepancies arose, went undetected and led to patient harm. Accurate information transfer is essential for continuity of patient care. Medication reconciliation comprises four steps, i.e. verification (identify discrepancies), clarification (check the collected list), reconciliation (document the reason for medication changes) and transfer (communicate the updated list). This article discusses the steps of medication reconciliation and those medication errors that arise during a patient's transfer from the home setting to hospitalization or a clinic visit. We show that medication reconciliation is not merely an administrative task. As the patient is the only constant factor in health care, patient participation is essential.


Assuntos
Erros de Medicação/prevenção & controle , Reconciliação de Medicamentos/métodos , Transferência de Pacientes/métodos , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Erros de Medicação/efeitos adversos , Participação do Paciente
6.
J Wound Ostomy Continence Nurs ; 46(4): 321-326, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31274863

RESUMO

PURPOSE: The purpose of this study was to evaluate bladder self-management in transition to adult care for patients with spina bifida (SB) in 3 countries with similar clinical practice and different social, cultural, and economic milieu. STUDY DESIGN: Cross-sectional study. SUBJECTS AND SETTING: The sample comprised 90 participants: 27 reside in Brazil, 36 reside in Germany, and 27 reside in the United States. Demographic characteristics of the sample are based on country. The distribution of sex in the Brazilian sample was 18 males and 9 females, the German group had 11 males and 25 females, and the United States group had 8 males and 19 females. The age range of the cumulative sample was 13 to 29 years. The age of the German sample (mean 23.56, standard deviation [SD] 4.60 years) was significantly higher (analysis of variance, F(2, 87) = 13.62, P < .001) than the other 2 groups (Brazil mean 20.56 years, SD 5.24; US mean 19.44 years, SD 4.70). METHODS: Demographic, clinical, and social variable data were collected via an online questionnaire distributed to multiple regions of Germany and a multidisciplinary myelomeningocele clinic at the University of Michigan in the Midwestern United States. In Brazil, participants completed a printed version of the survey. In Germany and the United States, an electronic version of the survey was made available online. German and English versions of the survey, originally developed in Portuguese for persons residing in Brazil, were translated and validated. RESULTS: The majority of participants (94.4%) performed intermittent catheterization (IC), 76.5% performed IC independently, whereas 23.5% required assistance with IC or catheterized with aids (handles, leg spreaders, and penis or labia holder). There were no statistically significant group differences in independent self-catheterization by gender. There were significant national group differences in level of lesion (P = .016), use of shunt (P = .012), and medication for bladder management (P < .001). Among participants 18 years and older, there were significantly higher levels of education in the German and the US samples than in the Brazilian sample (P < .001). CONCLUSIONS: Although there were national group differences in medical characteristics and management of SB, differences in independent self-catheterization were not significant. Findings suggest that support from family/caregivers and health care providers appears to facilitate transition to independent self-care, regardless of national context.


Assuntos
Transferência de Pacientes/métodos , Autogestão/métodos , Disrafismo Espinal/complicações , Bexiga Urinária/fisiopatologia , Adolescente , Adulto , Análise de Variância , Brasil , Estudos Transversais , Feminino , Alemanha , Humanos , Cateterismo Uretral Intermitente/métodos , Cateterismo Uretral Intermitente/tendências , Masculino , Michigan , Transferência de Pacientes/tendências , Autogestão/tendências , Disrafismo Espinal/psicologia , Estatísticas não Paramétricas , Inquéritos e Questionários
7.
BMC Geriatr ; 19(1): 126, 2019 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046693

RESUMO

BACKGROUND: New approaches are needed to address the challenges of demographic change, staff shortages, and societal change in the care of the elderly. While volunteering has barely been established as a pillar of the welfare state in several countries, legislators and nonprofit or community-based organizations in some countries favor the increased integration of volunteers, as they can rely on many dedicated people. When caring for the multimorbid elderly, the transition from hospital to domesticity involves certain risks. Currently, no systematic knowledge exists on whether and how elderly benefit from volunteer support after a hospital stay. Objectives of this systematic review were to (1) identify evaluated approaches with trained volunteers supporting chronically ill, multimorbid elderly one-on-one at the interface between hospital and domesticity; (2) investigate the patient-related effectiveness of the approaches; (3) present the characteristics of the supporting volunteers; and (4) present the underlying teaching and training concepts for the volunteers. METHODS: A systematic search of the following online databases was conducted in April 2017: the Cochrane Library, Medline (PubMed), CINAHL, and PsycINFO (Ebscohost). We included (cluster/quasi-) randomized controlled trials, controlled clinical trials and single-group pre-post design. An institutional search was conducted on eight national institutions from research and practice in Germany. Screening was conducted by one researcher, risk of bias was assessed. Study authors were contacted for study and training details. RESULTS: We identified a total of twelve studies, eight of which evaluated treatment following hospital stay: psychosocial-coordinative support (n = 2), physical-cognitive activation (n = 4), and assistance with medication intake (n = 2). We saw short-term effects with small and medium effect sizes. Most volunteers were women aged between 45 and 61 years. Their training lasted 12-26 h and took place prior to first patient contact. During the intervention, volunteers could rely on permanent supporting structures. CONCLUSIONS: Few studies exist that have evaluated one-on-one-volunteer support following hospitalization, and the effects are inconsistent. As such, further, well-designed studies are needed. The suitability and transferability of the interventions in country-specific settings should be examined in feasibility studies. Furthermore, an international discussion on the appropriate theoretical backgrounds of volunteer training is needed.


Assuntos
Doença Crônica/psicologia , Doença Crônica/terapia , Serviços de Assistência Domiciliar/tendências , Hospitalização/tendências , Transferência de Pacientes/tendências , Voluntários/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Multimorbidade , Transferência de Pacientes/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Resultado do Tratamento , Voluntários/educação
8.
Rev Gaucha Enferm ; 40(spe): e20180398, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31038610

RESUMO

OBJECTIVE: Describe the implementation of care transfer flow chart in postoperative, based on a risk classification model. METHOD: Experience report on the implementation of a pilot project between the post-anesthetic recovery room and the surgical hospitalization unit, developed between December/2016 and March/2017, aimed at transferring s the care of patients with low risk of postoperative mortality, in a university hospital in the South of Brazil. RESULTS: The project made it possible to expedite the discharge of the patient from the Post-Anesthetic Recovery Room to the surgical hospitalization unit, to qualify the records regarding nursing care and to optimize the time of nurses in both units for care activities. CONCLUSION: The implementation of a care transfer flow chart from the risk classification for postoperative patients contributed to a more effective communication, culminating in improvements in patient safety.


Assuntos
Transferência de Pacientes , Cuidados Pós-Operatórios , Brasil , Registros Hospitalares , Unidades Hospitalares , Hospitais Universitários/organização & administração , Humanos , Registros de Enfermagem , Transferência de Pacientes/métodos , Projetos Piloto , Cuidados Pós-Operatórios/mortalidade , Cuidados Pós-Operatórios/enfermagem , Sala de Recuperação , Risco , Desenho de Programas de Computador
10.
BMC Urol ; 19(1): 39, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101044

RESUMO

BACKGROUND: Testicular torsion (TT) is a urologic emergency that requires prompt surgical intervention. In rural Appalachia, patients are often transferred from surrounding communities due to lack of urologic care. We hypothesized that those transferred would have delayed intervention and higher rates of orchiectomy when compared to those who presented directly to our hospital. METHODS: We performed a retrospective review of patient charts with an ICD-9 diagnosis of TT from 2008 to 2016. Patients met inclusion criteria if diagnosis was confirmed by operative exploration. We compared rate of testicular loss and time until surgical intervention between groups. RESULTS: Twenty-three patients met inclusion criteria (12 transferred, 11 direct). Patient demographics did not significantly differ between groups. Transferred patients had a higher orchiectomy rate (33% v 22%,p = 0.41) although this was not statistically significant. Time to surgery from symptom onset was significantly longer in those transferred (12.9 h) compared to those not transferred (6.9 h, p = 0.02). Distance of transfer was not correlated with time of delay (r2 = 0.063). CONCLUSIONS: Transferred patients with TT have numerically higher rates of orchiectomy which may reach significance in an appropriately powered study, and relative delays in surgical intervention. This study highlights the need for improved access to urologic care in rural areas.


Assuntos
Hospitais Rurais/tendências , Transferência de Pacientes/tendências , Torção do Cordão Espermático/diagnóstico , Torção do Cordão Espermático/cirurgia , Centros de Atenção Terciária/tendências , Tempo para o Tratamento/tendências , Adolescente , Criança , Humanos , Masculino , Orquiectomia/tendências , Transferência de Pacientes/métodos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
11.
West J Emerg Med ; 20(3): 433-437, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31123542

RESUMO

Introduction: We sought to determine the association of abnormal vital signs with emergency department (ED) process outcomes in both discharged and admitted patients. Methods: We performed a retrospective review of five years of operational data at a single site. We identified all visits for patients 18 and older who were discharged home without ancillary services, and separately identified all visits for patients admitted to a floor (ward) bed. We assessed two process outcomes for discharged visits (returns to the ED within 72 hours and returns to the ED within 72 hours resulting in admission) and two process outcomes for admitted patients (transfer to a higher level of care [intermediate care or intensive care] within either six hours or 24 hours of arrival to floor). Last-recorded ED vital signs were obtained for all patients. We report rates of abnormal vital signs in each group, as well as the relative risk of meeting a process outcome for each individual vital sign abnormality. Results: Patients with tachycardia, tachypnea, or fever more commonly experienced all measured process outcomes compared to patients without these abnormal vitals; admitted hypotensive patients more frequently required transfer to a higher level of care within 24 hours. Conclusion: In a single facility, patients with abnormal last-recorded ED vital signs experienced more undesirable process outcomes than patients with normal vitals. Vital sign abnormalities may serve as a useful signal in outcome forecasting.


Assuntos
Serviços Médicos de Emergência/métodos , Serviço Hospitalar de Emergência , Admissão do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Sinais Vitais , Adulto , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Triagem/métodos
12.
J Med Syst ; 43(7): 207, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31144129

RESUMO

This paper presents comprehensive insights into mobile patient monitoring systems (MPMSs) from evaluation and benchmarking aspects on the basis of two critical directions. The current evaluation criteria of MPMSs based on the architectural components of MPMSs and possible solutions are discussed. This review highlights four serious issues, namely, multiple evaluation criteria, criterion importance, unmeasurable criteria and data variation, in MPMS benchmarking. Multicriteria decision-making (MCDM) analysis techniques are proposed as effective solutions to solve these issues from a methodological aspect. This methodological aspect involves a framework for benchmarking MPMSs on the basis of MCDM to rank available MPMSs and select a suitable one. The benchmarking framework is discussed in four steps. Firstly, pre-processing and identification procedures are presented. Secondly, the procedure of weight calculation based on the best-worst method (BWM) is described. Thirdly, the development of a benchmark framework by using the VIKOR method is introduced. Lastly, the proposed framework is validated.


Assuntos
Monitorização Ambulatorial/métodos , Telemedicina/métodos , Dispositivos Eletrônicos Vestíveis , Técnicas de Apoio para a Decisão , Demência/epidemiologia , Retroalimentação , Humanos , Monitorização Ambulatorial/instrumentação , Transferência de Pacientes/métodos , Reprodutibilidade dos Testes , Telemedicina/instrumentação , Triagem/métodos
14.
BMC Psychiatry ; 19(1): 98, 2019 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-30917798

RESUMO

BACKGROUND: International studies show a consistent finding of women in prisons as having a high prevalence of mental disorder. Most will be treated within the prison however the most severely ill require transfer to a hospital facility. The primary aim of our study was to survey the total provincial female prison population in Ontario, Canada, to determine the proportion that require treatment in a psychiatric hospital, and the security level required. The secondary aim was to investigate the validity and psychometric properties of DUNDRUM-1 and DUNDRUM-2 in making these assessments. METHODS: We carried out a cross-sectional study of all remand and sentenced female inmates detained in all 16 provincial jails that hold women in Ontario. The severity of mental health need was categorised by mental health staff on a five-point scale. Two forensic psychiatrists then examined all medical files of prisoners that had been categorised in the highest two categories and a random sample of nearly a quarter of those in the third category. An overall opinion was then made as to whether admission was required, and whether a high intensity bed was needed, and files were rated using DUNDRUM-1 and DUNDRUM-2. RESULTS: There were 643 female inmates in provincial prisons in Ontario. We estimated that approximately 43 (6.7%) required admission to a hospital facility, of which 21.6 [prorated] (3.4%) required a high intensity bed such as a psychiatric intensive care bed within a secure hospital. The DUNDRUM-1 and -2 tools showed good internal validity. Total scores on both DUNDRUM-1 and DUNDRUM-2 were significantly different between those assessed as needing admission and those who did not, and distinguished the level of security required. CONCLUSION: This is the first study to determine level of need for prison to hospital transfers in Canada and can be used to inform service capacity planning. We also found that the DUNDRUM toolkit is useful in determining the threshold and priorities for hospital transfer of female prisoners.


Assuntos
Hospitalização/tendências , Pacientes Internados/psicologia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Transferência de Pacientes/tendências , Prisioneiros/psicologia , Adulto , Estudos Transversais , Feminino , Hospitais Psiquiátricos/tendências , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Ontário/epidemiologia , Transferência de Pacientes/métodos , Prisões/tendências , Adulto Jovem
15.
J Emerg Med ; 56(5): 544-550, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30890375

RESUMO

BACKGROUND: The three U.S. Antarctic research stations' medical facilities exist in an isolated, harsh environment, typical of many such facilities throughout the world. Emergency physicians frequently staff these medical facilities; however, most who are considering this have many misconceptions about the stations and about the scope of medical practice that exists there. OBJECTIVE: This article illuminates how Antarctic medical practice is comparable with and dissimilar to other emergency medicine experiences and highlights information that any emergency physician-applicant to an isolated medical position should learn prior to accepting the position. DISCUSSION: Antarctic medical care both parallels and differs from typical emergency medical practice in many ways, including the patient population, facilities, supplies, equipment, clinical duties (e.g., providing out- and inpatient medical and dental care, performing laboratory tests and imaging), and nonclinical duties (e.g., disaster planning, teaching, food service inspection, and public health officer). Climate-related limitations on medical evacuation epitomize the stations' isolation. Medical practice may be complicated by ethical issues common in other small isolated settings, such as a lack of privacy and confidentiality. Clinicians considering an isolated practice opportunity should ask basic questions to learn as much detailed information as possible prior to taking the positions. CONCLUSION: Medical practice at U.S. Antarctic stations, as at many remote health care facilities throughout the world, has similarities to standard emergency medical practice. Even so, significant differences result in a steep learning curve. Any clinicians considering practicing in these locations should carefully evaluate the practice and the environment in advance of any deployment.


Assuntos
Medicina de Emergência/métodos , Regiões Antárticas , Planejamento em Desastres/métodos , Humanos , Transferência de Pacientes/métodos , Transferência de Pacientes/tendências
16.
BMC Geriatr ; 19(1): 95, 2019 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-30925899

RESUMO

BACKGROUND: As older patients' health care needs become more complex, they often experience challenges with managing medications across transitions of care. Families play a major role in older patients' lives. To date, there has been no review of the role of families in older people's medication management at transitions of care. This systematic review aimed to examine family involvement in managing older patients' medications across transitions of care. METHODS: Five databases were searched for quantitative, qualitative and mixed methods empirical studies involving families of patients aged 65 years and older: Cumulative Index to Nursing and Allied Health Literature Complete, Medline, the Cochrane Central Register of Controlled Trials, PsycINFO, and EMBASE. All authors participated independently in conducting data selection, extraction and quality assessment using the Mixed Methods Appraisal Tool. A descriptive synthesis and thematic analysis were undertaken of included papers. RESULTS: Twenty-three papers were included, comprising 17 qualitative studies, 5 quantitative studies and one mixed methods study. Families participated in information giving and receiving, decision making, managing medication complexity, and supportive interventions in regard to managing medications for older patients across transitions of care. However, health professionals tended not to acknowledge the medication activities performed by families. While families actively engaged with older patients in strategies to ensure safe medication management, communication about medication plans of care across transitions tended to be haphazard and disorganised, and there was a lack of shared decision making between families and health professionals. In managing medication complexity across transitions of care, family members perceived a lack of tailoring of medication plans for patients' needs, and believed they had to display perseverance to have their views heard by health professionals. CONCLUSIONS: Greater efforts are needed by health professionals in strengthening involvement of families in medication management at transitions of care, through designated family meetings, clinical bedside handovers, ward rounds, and admission and discharge consultations. Future work is needed on evaluating targeted strategies relating to family members' contribution to managing medications at transitions of care, with outcomes directed on family understanding of medication changes and their input in preventing and identifying medication-related problems.


Assuntos
Tomada de Decisões , Família/psicologia , Reconciliação de Medicamentos/métodos , Transferência de Pacientes/métodos , Relações Profissional-Família , Idoso , Idoso de 80 Anos ou mais , Pessoal de Saúde/tendências , Hospitalização/tendências , Humanos , Reconciliação de Medicamentos/tendências , Alta do Paciente/tendências , Transferência de Pacientes/tendências , Pesquisa Qualitativa
17.
J Am Assoc Nurse Pract ; 31(6): 354-363, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-30829973

RESUMO

BACKGROUND AND PURPOSE: Patient handoffs have long been identified as a potentially challenging time for patients because poor communication produces numerous complications. This is especially true with regards to patient care handoffs between areas such as the emergency department (ED) and inpatient setting. The purpose of this systematic review is to analyze existing literature pertaining to standardized handoffs between the ED and inpatient setting and its effect on perceived patient safety to guide future research, clinical practice, and patient safety. METHODS: A review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were selected using predetermined inclusion/exclusion criteria: primary research and patient handoff from the ED to the inpatient setting. Quality assessment of the studies was completed using The Joanna Briggs Institute critical appraisal tool. CONCLUSION: Existing studies demonstrate the potential for increased perception of patient safety as well as provider satisfaction when appropriate staff education and standardized handoff tools are implemented. There is a lack of data on the standardization of handoff tools between the ED and inpatient setting and their impact on perceived patient safety. IMPLICATIONS FOR PRACTICE: The combination of provider education and implementation of standardized handoff tools in the ED positively affects perceptions of patient safety and provider satisfaction. Hospital administrations should strongly consider incorporating standardized handoff tools into practice.


Assuntos
Transferência da Responsabilidade pelo Paciente , Segurança do Paciente/normas , Transferência de Pacientes/métodos , Padrões de Referência , Serviço Hospitalar de Emergência/organização & administração , Humanos , Transferência de Pacientes/normas , Percepção
18.
J Clin Nurs ; 28(11-12): 2319-2328, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30786095

RESUMO

AIMS AND OBJECTIVES: To examine the effects of the Patient-Oriented Safe Transition programme on 30-day unplanned readmissions and emergency department visits, medical costs, caregiver burden and patient health-related quality of life. BACKGROUND: With the success of hospitals' quality improvement efforts, the number of discharged patients has been increasing. Successful management of discharged patients is needed in order to reduce unplanned readmissions and to improve patient health outcomes. DESIGN: A nonequivalent control group pretest-posttest design. METHODS: This study was conducted by following TREND guideline. Eighty-three patients were assigned to either the intervention (n = 40) or control (n = 43) group. The intervention group received individual discharge planning by case managers and home visits by homecare nurses followed by telephone calls throughout the month following discharge. The outcome variables measured were 30-day unplanned readmissions and emergency department visits, medical costs, caregiver burden and patient health-related quality of life. Data were analysed by paired t test, multivariate analysis of variance and repeated-measure analysis of variance. RESULTS: The baseline characteristics of the two groups were homogeneous with respect to gender, age, length of hospital stay and medical conditions. In the intervention group, the caregiver burden decreased 30 days after discharge, whereas the control group increased (F = 12.888, p = 0.001). The patient physical (p = 0.005) and mental (p < 0.001) quality of life of the intervention group were improved more than the control group. CONCLUSIONS: This study suggests that nurses can play a significant role during discharge transitions in improving patient outcomes. The Patient-Oriented Safe Transition programme could be a beneficial service for discharged patients expected to experience high unmet needs. RELEVANCE TO CLINICAL PRACTICE: The findings of this study provide the evidences on the needs of transition programmes for discharged patients with high unmet needs.


Assuntos
Alta do Paciente/normas , Readmissão do Paciente/estatística & dados numéricos , Transferência de Pacientes/métodos , Adaptação Psicológica , Idoso , Cuidadores/estatística & dados numéricos , Estudos de Casos e Controles , Feminino , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/economia , Qualidade de Vida
19.
Am J Cardiol ; 123(8): 1214-1219, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30777319

RESUMO

The outcomes for patients transferred with cardiogenic shock and later treated with revascularization and Impella support have not previously been studied. To evaluate these outcomes, patients in cardiogenic shock were recruited from the catheter-based ventricular assist device registry, a prospective registry enrolling patients who underwent percutaneous coronary intervention with hemodynamic support using Impella 2.5 or CP. Analysis was performed on subgroups of patients who were characterized as those directly admitted to a tertiary care hospital (direct), or those transferred from an outside hospital (transfer). Patients who were transferred with acute myocardial infarction with cardiogenic shock (AMICS) more often presented in shock were in shock longer than 24 hours, and were more likely to be on intra-aortic balloon pump but were less likely to sustain cardiac arrest. The number of pressors, EF, diseased, and treated vessels were similar between the 2 groups. Despite baseline differences, the mortality was similar in the transfer versus direct patients (47.0% vs 53.5% p = 0.19). In a multivariate model, the factors independently associated with 30-day mortality in AMICS treated with revascularization and Impella support were cardiopulmonary resuscitation (CPR) (p <0.01), age (p <0.01), and ST-segment elevation myocardial infarction (STEMI) (p = 0.02). Whether the patient was transferred or directly admittedly with AMICS was not an independent predictor of death. In conclusion, these findings suggest that considerations should be given to transfer patients with AMICS to allow them to be treated in a contemporary manner.


Assuntos
Coração Auxiliar , Revascularização Miocárdica/métodos , Transferência de Pacientes/métodos , Sistema de Registros , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Choque Cardiogênico/terapia , Idoso , Canadá/epidemiologia , Angiografia Coronária , Feminino , Humanos , Balão Intra-Aórtico , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Choque Cardiogênico/etiologia , Choque Cardiogênico/mortalidade , Taxa de Sobrevida/tendências , Resultado do Tratamento , Estados Unidos/epidemiologia
20.
Support Care Cancer ; 27(4): 1287-1298, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30613907

RESUMO

PURPOSE: To establish oncology practitioners' perceptions of responsibility, confidence levels, and frequency of survivorship care practice in relation to the post-treatment phase of survivorship care in Mainland China; to identify factors associated with oncology practitioners' perceptions of responsibility, confidence levels, and frequency of survivorship care practice; and to examine factors that impede the provision of quality survivorship care. METHODS: A cross-sectional survey of Chinese oncology practitioners was conducted using a test battery consisting of a self-developed information sheet, a 29-item survivorship care scale (29-SCS), and a 16-item impeding factors scale. RESULTS: There were 331 participants. Mean values of the four subscales (8.87, 61.82, 18.62, and 40.49) on perceptions of responsibility were relatively higher than those of the mean values of confidence levels and frequency of survivorship care practice. Participant characteristics, including professional discipline, highest educational qualification achieved, work status, work role, and work setting, were identified as factors associated with oncology practitioners' responsibility perceptions, confidence levels, and survivorship care practice frequency. The top three barriers to quality survivorship care perceived by participants were lack of time, an appropriate physical location, and evidence-based practice guidelines to inform survivorship care. CONCLUSIONS: Findings of relatively high levels of perception of responsibility and low levels of confidence in survivorship care suggest that survivorship care is needed, with the aim of implementing oncology practitioners' responsibility and improving their confidence in providing survivorship care in cancer practice. Future multiple levels of cooperation for overcoming barriers and implementing quality survivorship care are highly recommended.


Assuntos
Sobreviventes de Câncer , Oncologia/métodos , Neoplasias/reabilitação , Padrões de Prática Médica/estatística & dados numéricos , Sobrevivência , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático/psicologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Sobreviventes de Câncer/psicologia , Sobreviventes de Câncer/estatística & dados numéricos , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Oncologia/normas , Pessoa de Meia-Idade , Neoplasias/terapia , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos , Percepção , Indução de Remissão , Adulto Jovem
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