Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 10.692
Filtrar
1.
J Nurs Adm ; 50(1): 34-39, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31804410

RESUMO

OBJECTIVE: An Automated Data Entry Process Technology tool was developed to free nurses from data entry tasks, thus creating time for patient care and other activities associated with improvements in performance and job satisfaction. BACKGROUND: Manually transferring data from patient measurement devices to electronic health records (EHRs) is an intensive, error-prone task that diverts nurses from patient care while adversely affecting job performance and employee satisfaction. METHODS: Performance improvement analytics were used to compare matched sets of manual and automated EHR data entries for 1933 consecutive vital signs records created by 49 RNs and certified nursing assistants in a 23-bed medical-surgical unit at a large tertiary hospital. Performance and quality effects were evaluated via nurses' responses to a postintervention survey. RESULTS: Data errors decreased from approximately 20% to 0; data transfer times were reduced by 5 minutes to 2 hours per measurement event; nurses had more time for direct patient care; and job satisfaction improved. CONCLUSION: Data entry automation eliminates data errors, substantially reduces delays in getting data into EHRs, and improves job satisfaction by giving nurses more time for direct patient care. Findings are associated with improvements in quality, work performance, and job satisfaction, key goals of nursing leaders.


Assuntos
Benchmarking , Registros Eletrônicos de Saúde , Satisfação no Emprego , Processo de Enfermagem/normas , Recursos Humanos de Enfermagem no Hospital , California , Unidades Hospitalares , Humanos , Processo de Enfermagem/economia
2.
BMC Health Serv Res ; 19(1): 792, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684952

RESUMO

BACKGROUND: There is little published data on brain imaging and intracranial haemorrhage after hospital inpatient falls. Imaging protocols for inpatient falls have been adopted from head injury guidelines developed from data in patients presenting to the Emergency Department. We sought to describe the use of brain computed tomography (CT) following inpatient falls, and determine the incidence and potential risk factors for intracranial haemorrhage. METHODS: We identified inpatient falls in acute medical wards at Monash Health, a large hospital network in the southeast region of Melbourne in Australia, from the incident reporting system during a 32 month period. We examined the post-fall medical assessment form, neurological observation chart and the diagnostic imaging system for details of the fall and brain CT findings. We used survival analysis to evaluate the timeliness of brain imaging and determined potential risk factors for intracranial haemorrhage by logistic regression. RESULTS: From 934 falls in 789 medical inpatients, 191 brain CT scans were performed. The median age of patients was 77 years. Only 55% of falls were from standing height and 24% experienced a head strike. Less than 10% of patients received an urgent scan within one hour, and timeliness of imaging was influenced by anticoagulation status rather than guideline determination of urgency. The overall incidence of intracranial haemorrhage was 0.9%. The factors associated with intracranial haemorrhage were head strike, anticoagulation, loss of consciousness or amnesia, drop in Glasgow Coma Scale and advanced chronic kidney disease. CONCLUSIONS: The incidence of intracranial haemorrhage was low as most inpatient falls were at low risk for head injury. Research is needed to determine if guidelines specific for hospital inpatients may reduce unnecessary scans without compromising case detection, and improve timeliness of urgent scans.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Unidades Hospitalares/estatística & dados numéricos , Hospitalização , Hemorragias Intracranianas/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Feminino , Humanos , Incidência , Hemorragias Intracranianas/epidemiologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X
4.
Pflege ; 32(5): 259-266, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-31538876

RESUMO

Safety Walk Rounds - Clinical unit visits with a focus on patient safety Abstract. Background: Safety Walk Rounds are a promising strategy to promote the safety culture and optimising patient safety. The purpose of this study was to explore patient safety attributes in various clinical areas including recommendations for improvement and leadership support. Methods: Safety Walk Rounds were conducted by the chief patient safety officer based on a structured questions format to open patient safety dialogues with clinicians at the ward level. Field notes were utilized for thematic analyses and topic categorization. Results: A total of 187 clinicians (64 % nursing staff, 19 % physicians, 17 % other health care professionals) participated on the Safety Walk Rounds. The discussion findings are presented in five categories: Events & circumstances (potentially) harmful for patients; safety culture; need for local action, as well as the need for leadership support to provide safe care. Conclusion and outlook: Safety Walk Rounds across the hospitals' clinical areas delivered insight into patient safety issues and safety culture with its caregiver's engagement to provide safe care as well as action points for future improvement including leadership support.


Assuntos
Unidades Hospitalares/organização & administração , Segurança do Paciente , Gestão da Segurança/organização & administração , Humanos , Liderança
5.
Psychiatr Danub ; 31(Suppl 3): 626-631, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488804

RESUMO

BACKGROUND: Springbank Ward, Fulbourn Hospital, Cambridgeshire and Peterborough NHS Foundation Trust, is a Borderline Personality Disorder (BPD) unit employing positive risk-taking, allowing for relevant psychological therapies to be carried out. The aim of this survey was to identify staff and patient attitudes to Springbank Ward. Previous research has not addressed the question of patient and staff perception of these therapeutic approaches. SUBJECTS AND METHODS: We used a qualitative open-ended semi-structured survey of staff and patients (n=2+4, respectively). We gathered information on the perception of the unit, staff, safety and the positive and negative aspects of the ward. Interview transcripts and participation notes were coded and categorised for emerging themes. RESULTS: The four main themes were: views on the unit: 'safe space', 'opportunity', 'community'; views on the programme: 'successful', 'skills-based', involving patients in their own recovery; views on staff: important part of the therapeutic process by delivering elements of dialectical behaviour therapy (DBT); views on safety: patients and staff feel safe in the context of positive risk-taking. CONCLUSIONS: The long-term therapeutic programme offered at Springbank is perceived positively by both patients and staff. Involving patients actively in their recovery remains a powerful tool. The delivery of DBT by nursing staff contributes significantly to the positive perception of the unit. Positive risk-taking is perceived to be a good and safe strategy.


Assuntos
Atitude do Pessoal de Saúde , Transtorno da Personalidade Borderline/psicologia , Transtorno da Personalidade Borderline/terapia , Unidades Hospitalares , Satisfação do Paciente , Pesquisa Qualitativa , Inquéritos e Questionários , Terapia do Comportamento Dialético , Unidades Hospitalares/normas , Humanos
6.
Med Lav ; 110(4): 278-284, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31475689

RESUMO

BACKGROUND: Under-reporting and recognition of occupational diseases is a problem in countries with workers' compensation schemes. OBJECTIVE: To describe the role of a public hospital Occupational Disease Unit (ODU) in Barcelona that resulted in improved reporting and official recognition of occupational diseases from 2010 to 2017. METHODS: Hospital physicians referred possible cases of work-related disease to the ODU, where in-depth medical evaluations were then performed, and a detailed report addressing causation was generated. Patients with confirmed cases of occupational disease were counselled and followed while pursuing official recognition and benefits claims by the Spanish Social Security System. RESULTS: Between 2010 and 2017, 149 cases were referred to the ODU for evaluation. Of these, 80 (53.7%) were confirmed to have an occupational disease, 54 (67.5%) patients pursued official recognition, and to date 26 (48.1%) have been recognized by the Social Security System. The recognition rate varied by diagnosis group (p=0.003), and was highest for skin diseases (71.4%) and cancer (66.7%), and lowest for hearing loss (29.4%) and musculoskeletal disorders (16.7%). CONCLUSIONS: A hospital ODU can improve reporting and official recognition of occupational diseases that otherwise might not have been recognized. Expanding this experience to other Spanish and European hospitals could improve the efficiency of workers' compensation schemes and better support preventive policies.


Assuntos
Doenças Musculoesqueléticas , Doenças Profissionais , Unidades Hospitalares , Humanos , Doenças Musculoesqueléticas/diagnóstico , Doenças Profissionais/diagnóstico , Indenização aos Trabalhadores
7.
Rev Infirm ; 68(253): 19-20, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31472776

RESUMO

In an approach of global collaboration, the lead nurse in a paediatric haemostasis unit uses her technical and educational role to participate in the management of the child's specific disorder. As a resource person, she coordinates the care and ensures the continuity of the child's care.


Assuntos
Hemostasia , Unidades Hospitalares/organização & administração , Enfermagem Pediátrica/organização & administração , Criança , Humanos , Papel do Profissional de Enfermagem
8.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(7): 425-433, ago.-sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182862

RESUMO

Objetivos: Elaborar un registro de situación de los Servicios y Unidades de Endocrinología y Nutrición (S°EyN) del Sistema Nacional de Salud (SNS) y valorar sus recursos asistenciales para desarrollar, a partir de los resultados obtenidos, propuestas de políticas de mejora en los S°EyN. Material y métodos: Estudio descriptivo transversal de los pacientes atendidos en los S°EyN en hospitales generales de agudos del SNS en 2016. Se utilizaron datos obtenidos mediante RECALSEEN 2017, una encuesta «ad hoc» diseñada específicamente para este fin y de las altas dadas por los S°EyN registradas en el CMBD del SNS (2015). Resultados: De un total de 125 hospitales generales de agudos de más de 200 camas instaladas del SNS español, se han obtenido 88 respuestas de los S°EyN, que representan el 70%. El 47% de los S°EyN que respondieron eran servicios y el 31% secciones. El promedio de endocrinólogos por S°EyN era de 7,4±4,4, siendo la tasa media de endocrinólogos por cada 100.000 habitantes de 2,3±1. Las actividades asistenciales más relevantes eran la consulta (promedio de 12,3 primeras consultas por mil habitantes y año), hospital de día (mediana de 2.000 sesiones/año) e interconsulta hospitalaria (mediana de 900 interconsultas/año). El 83% de los S°EyN incorporaban una Unidad de Nutrición Clínica. La dotación de dietistas, técnicos en nutrición y bromatólogos en las Unidades de Nutrición Clínica era baja. En relación con la gestión de la calidad se detectó un amplio margen de mejora; solamente un 35% de los S°EyN tenían responsable de calidad y el 38% había implantado una gestión por procesos para aquellos más frecuentemente atendidos por la unidad. Existen notables diferencias en estructura, recursos y actividad de los S°EyN entre Comunidades Autónomas. Conclusiones: La encuesta RECALSEEN 2017 es útil para el análisis de los S°EyN. La notable variabilidad hallada en los indicadores de estructura, actividad y gestión probablemente indica relevantes diferencias y, por tanto, un amplio margen de mejora


Objectives: To elaborate a diagnosis of the situation regarding the assistance in the Services and Units of Endocrinology and Nutrition (S°EyN) of the National Health System of Spain (SNHS) and to develop, based on the results obtained, proposals for improvement policies in the S°EyN. Material and methods: Cross-sectional descriptive study of the patients treated in the S°EyN departments of acute general hospitals of the SNHS in 2016. Data were obtained through RECALSEEN 2017, an "ad hoc" survey designed specifically for this purpose, and the Minimum Basic Data Set of discharges given by the S°EN of the SNHS (2015). Results: 88 responses of S°EyN have been obtained forma total of 125 acute general hospitals of more than 200 beds installed in the SNHS (70% answers). 47% of the S°EyN respondents were services and 31% sections. The average of endocrinologists by S°EyN was 7.4±4.4, and the average rate of endocrinologists per 100,000 inhabitants was 2.3±1. The most relevant care activities were the consultation (average of 12.3 first consultations per thousand inhabitants and year), day hospital (median of 2,000 sessions/year) and in-hospital consultations (median of 900 in-hospital consultations/year). 83% of S°EyNhad a Clinical Nutrition Unit. The number of dietitians, nutrition technicians and nutritionists in the Clinical Nutrition Unit was low. In relation to quality management, a large margin for improvement was detected; only 35% of S°EyN had a responsible of quality and 38% had implemented process management for those most frequent processes in the unit. There were notable differences in structure, resources and activity of S°EyN between Autonomous Communities. Conclusions: RECALSEEN 2017 survey is a useful tool for the analysis of S°EyN. The remarkable variability found in the structure, activity and management indicators probably indicates significant differences and, therefore, a wide margin for improvement


Assuntos
Humanos , Unidades Hospitalares , Assistência ao Paciente/estatística & dados numéricos , Sistemas Nacionais de Saúde/organização & administração , Sistema de Registros/normas , Endocrinologistas/estatística & dados numéricos , Política de Saúde , Estudos Transversais , Gestão da Qualidade , Análise Estatística , Serviço Hospitalar de Nutrição/organização & administração , Serviço Hospitalar de Nutrição/normas , Endocrinologistas/organização & administração , Endocrinologistas/provisão & distribução
9.
Sleep Health ; 5(6): 666-669, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31416798

RESUMO

OBJECTIVES: Poor and fragmented sleep is a common problem amongst patients hospitalized on medical wards, and is associated with a number of poor outcomes. The present study aimed to objectively measure night-time sleep duration and efficiency in an acute medical ward, and to identify barriers to sleep in this setting. METHODS: Fifty-four consecutive patients on an acute medical ward were observed with wearable actigraphy devices for one night, then administered the Richards-Campbell Sleep Questionnaire and a semi-qualitative questionnaire to determine the major barriers to sleep. RESULTS: Patients had a wide variety of reasons for admission. Mean overnight sleep duration was 4.6 hours, with mean sleep efficiency 63%. The Richards-Campbell Sleep Questionnaire mean was 52/100, indicating poor quality sleep. Major barriers to sleep identified were the need to urinate, pain, noise, and light. CONCLUSIONS: A mixture of environmental and illness-related factors contribute to poor sleep in the hospital setting. Further research looking at ameliorating these factors may improve sleep and recovery in this population.


Assuntos
Unidades Hospitalares , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Sono , Actigrafia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ruído/efeitos adversos , Pesquisa Qualitativa , Fatores de Risco , Inquéritos e Questionários , Fatores de Tempo
10.
Rech Soins Infirm ; 137(2): 6-17, 2019 06.
Artigo em Francês | MEDLINE | ID: mdl-31453673

RESUMO

Introduction : The concept of palliative sedation is not defined in a uniform way at the international level. In Switzerland, it is outlined by the recommendations issued in 2005.Background : The conceptualization of palliative sedation by nurses is likely to be heterogeneous, due to the diversity of local protocols but also to personal experiences. This poses both epistemological and practical difficulties. Although this point is crucial to take into account in order to define the object of future studies in Switzerland, it has not yet been explored in the French-speaking part of Switzerland.Objectives : To discover and describe the conceptualization of palliative sedation by nurses in a palliative care unit in French-speaking Switzerland.Methods : Exploratory qualitative research with comprehensive individual interviews.Results : Palliative sedation is considered as a treatment of last resort for one or more refractory symptoms. The search for the lowest effective dose and the temporary (at least initially) character of sedation are the main elements put forward by nurses.Discussion and conclusion : The conceptualization of palliative sedation is consistent withSwiss recommendations. These results form a basis for developing a national study on the subject.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Hipnóticos e Sedativos/uso terapêutico , Recursos Humanos de Enfermagem no Hospital/psicologia , Unidades Hospitalares , Humanos , Linguagem , Pesquisa Qualitativa , Suíça
11.
Presse Med ; 48(7-8 Pt 1): e209-e215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31421945

RESUMO

AIM: Identified Palliative Care Beds (Lits Identifiés Soins Palliatifs - LISPs) is a French specificity. Primarily created to integrate palliative care culture into conventional hospital units, the relevance of this measure became a controversial issue. Nowadays, hospital teams continue to frequently encounter complex situations regarding medical care for palliative patients. To the best of our knowledge, there is only one study, a quantitative one, bridging the gap about that subject. It showed failure in practicing palliative care work around LISP. Our study is based on a qualitative method that complements the quantitative study. It aimed to describe difficulties that limit palliative care practices in managing adult patients in LISP. METHOD: This qualitative exploratory survey was conducted with a sample of health service professionals (n=20), from senior physicians to caregivers. Each semi-structured interview included open questions regarding their experiences, feelings and difficulties with palliative care practices on LISP. It also included closed questions concerning interviewee's demographics and career course. The data for this research were submitted to a two-stage analysis: first, a global review of each interview was performed to identify trends. Then, a detailed breakdown, question by question, was implemented. RESULTS: From a quantitative perspective, the interviews revealed 305 difficulties, indicating the gaps and barriers limiting the implementation of a palliative approach in these services. From a qualitative perspective, five topics raised our attention by their recurrence in discourses: (1) partial knowledge about palliative care definition and legislation mostly due to a lack of training; (2) need for time; (3) need for human resources; (4) need for communication; (5) hard time in transitioning from curative to palliative care. PERSPECTIVE: This survey gives the opportunity to understand health service professionals' difficulties in practicing palliative care in conventional medical services. It raises the central issue of the pricing reform on the health institutes activity. It also provides angles of inquiry to improve LISP effectiveness. This qualitative and descriptive study was designed to explore difficulties in practicing palliative care around LISP. Nevertheless, according to the size of the sample, results will need to be confirmed by a more extensive qualitative survey.


Assuntos
Continuidade da Assistência ao Paciente , Unidades Hospitalares/organização & administração , Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Padrões de Prática Médica , Qualidade da Assistência à Saúde/organização & administração , Adulto , Atitude do Pessoal de Saúde , Cuidadores/organização & administração , Cuidadores/normas , Barreiras de Comunicação , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Arquitetura de Instituições de Saúde/normas , França , Conhecimentos, Atitudes e Prática em Saúde , Número de Leitos em Hospital , Unidades Hospitalares/normas , Humanos , Entrevistas como Assunto , Satisfação no Emprego , Cuidados Paliativos/psicologia , Cuidados Paliativos/normas , Equipe de Assistência ao Paciente/normas , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/normas , Estudos Retrospectivos , Inquéritos e Questionários
12.
Nurs Manag (Harrow) ; 26(1): 22-25, 2019 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31468751

RESUMO

Intentional rounding was introduced in the UK in 2012 to improve direct nursing care. Liverpool Women's NHS Foundation Trust (LWFT) introduced intentional nursing rounds, called comfort rounds, in 2013. These are carried out and documented by nursing staff who check the patients in their care every two hours, particularly in relation to pain management, nutritional needs, hygiene and toilet needs, and overall comfort. In September 2015, LWFT introduced daily matron ward rounds (MWRs) following a directive from the trust's chief executive to provide assurance that comfort rounds were completed and that patient feedback was acted on in a timely manner. This article presents findings from an evaluation of the initiative and describes how daily MWRs improve patient experience and staff morale but are resource intensive. Further qualitative research of their effect on staff morale and well-being, as well as patient experience, is recommended.


Assuntos
Unidades Hospitalares/organização & administração , Moral , Recursos Humanos de Enfermagem no Hospital/psicologia , Satisfação do Paciente/estatística & dados numéricos , Visitas com Preceptor , Humanos , Pesquisa em Avaliação de Enfermagem , Medicina Estatal , Reino Unido
13.
Nurs Manag (Harrow) ; 26(2): 22-29, 2019 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-31468760

RESUMO

The number of older people with multiple co-morbidities and cognitive impairment being admitted to hospital is increasing, and behavioural disturbances, such as confusion, agitation and delirium, are becoming commonplace. The need for nursing teams to manage the patients with such disturbances has led to the proliferation of one-to-one nursing or close observation, anecdotally known as 'specialing'. This article describes the implementation and outcomes of a new framework for providing enhanced supervision of patients in clinical wards run by the Cardiff and Vale University Health Board, one of the largest acute providers of care in Wales.


Assuntos
Unidades Hospitalares/organização & administração , Relações Enfermeiro-Paciente , Cuidados de Enfermagem/organização & administração , Segurança do Paciente , Idoso , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/enfermagem , Humanos , Multimorbidade , Pesquisa em Avaliação de Enfermagem , Organização e Administração , Medicina Estatal , País de Gales/epidemiologia
14.
BMC Res Notes ; 12(1): 491, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391105

RESUMO

OBJECTIVES: The purpose of this study to determine the clinical pattern and prevalence of heart disease in pregnancy at the first established cardio-maternal unit in Iraq over the last 4 years; since January 2015 till May 2019. Data are presented as number and percentage. RESULTS: A total of 252 pregnant women presented to cardio-maternal unit included in this study. According to the collected data, among the main diagnosis of heart disease during pregnancy was valvular heart disease 34.1%, followed by congenital heart disease 30.5%, cardiomyopathy 29.8%, pulmonary hypertension 4%, and ischemic heart disease 1.6%. Among subtypes of the main heart diseases in pregnant women, the most clinical pattern was: the prosthetic heart valve (26.7%) in valvular heart disease, both atrial septal defect and ventricular septal defect (35%) in congenital heart disease, and peripartum cardiomyopathy (76%) among cardiomyopathies.


Assuntos
Cardiomiopatias/epidemiologia , Comunicação Interatrial/epidemiologia , Comunicação Interventricular/epidemiologia , Doenças das Valvas Cardíacas/epidemiologia , Hipertensão Pulmonar/epidemiologia , Isquemia Miocárdica/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Adulto , Cardiomiopatias/diagnóstico , Feminino , Comunicação Interatrial/diagnóstico , Comunicação Interatrial/cirurgia , Comunicação Interventricular/diagnóstico , Comunicação Interventricular/cirurgia , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas/estatística & dados numéricos , Unidades Hospitalares , Humanos , Hipertensão Pulmonar/diagnóstico , Iraque/epidemiologia , Isquemia Miocárdica/diagnóstico , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/cirurgia , Prevalência
15.
S Afr J Surg ; 57(3): 50-53, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392865

RESUMO

BACKGROUND: Colorectal surgery has developed into an established surgical subspecialty in South Africa, however there is a paucity of data regarding the epidemiology and surgical outcomes of patients with colorectal disease in this country. The objective is to present the findings of a one-year audit of the Wits Donald Gordon Medical Centre (WDGMC) Colorectal Unit with specific reference to indications, surgical procedures and patient outcomes. METHOD: Patient files from December 2016 to November 2017 were included in a retrospective analysis. The Mann-Whitney U test was used to analyse continuous variables and the Chi-squared test was used to compare categorical variables. RESULTS: During the audit period, 1264 patients were admitted to the Colorectal Unit and a further 564 outpatient endoscopic procedures were performed. There were 306 emergency admissions. 139 elective colorectal resections took place, with a 16% major complication rate, a 12% anastomotic leak rate and no deaths. Rectal resections constituted 66% of the operations and 34% were colonic resections. The median length of stay for all patients undergoing resection was 9 days and there was no statistically significant difference in length of stay between open and laparoscopic cases. CONCLUSION: The WDGMC Colorectal Unit manages a high volume of patients presenting with the full spectrum of colorectal disease.


Assuntos
Colectomia/estatística & dados numéricos , Doenças do Colo/cirurgia , Complicações Pós-Operatórias/etiologia , Protectomia/estatística & dados numéricos , Doenças Retais/cirurgia , Centros Médicos Acadêmicos/estatística & dados numéricos , Fístula Anastomótica/etiologia , Colectomia/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/estatística & dados numéricos , Unidades Hospitalares/estatística & dados numéricos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/estatística & dados numéricos , Tempo de Internação , Auditoria Médica , Readmissão do Paciente/estatística & dados numéricos , Protectomia/efeitos adversos , Estudos Retrospectivos
17.
Reumatol. clín. (Barc.) ; 15(4): 211-217, jul.-ago. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184413

RESUMO

Objective: Considering the increased fracture risk in early breast cancer patients treated with aromatase inhibitors (AI), we assessed the impact of a preventive intervention conducted by a specialized osteoporosis unit on bone health at AI treatment start. Material and methods: Retrospective cohort of postmenopausal women who started treatment with AI after breast cancer surgical/chemotherapy treatment and were referred to the osteoporosis unit for a comprehensive assessment of bone health. Bone densitometry and fracture screening by plain X-ray were performed at the baseline visit and once a year for 5 years. Results: The final record included 130 patients. At AI treatment start, 49% had at least one high-risk factor for fractures, 55% had osteopenia, and 39% osteoporosis. Based on the baseline assessment, 79% of patients initiated treatment with bisphosphonates, 88% with calcium, and 79% with vitamin D. After a median of 65 (50-77) months, 4% developed osteopenia or osteoporosis, and 14% improved their densitometric diagnosis. Fifteen fractures were recorded in 11 (8.5%) patients, all of them receiving preventive treatment (10 with bisphosphonates). During the follow-up period, patients with one or more high-risk factors for fracture showed a greater frequency of fractures (15% vs. 3%) and experienced the first fracture earlier than those without high-risk factors (mean of 99 and 102 months, respectively; P=0.023). Conclusions: The preventive intervention of a specialized unit at the start of AI treatment in breast cancer survivors allows the identification of patients with high fracture risk and may contribute to preventing bone events in these patients


Objetivo: Evaluar el impacto de la intervención preventiva de una unidad de osteoporosis en supervivientes de cáncer de mama que inician un tratamiento con inhibidores de la aromatasa (IA). Material y métodos: Estudio retrospectivo en mujeres posmenopáusicas con cáncer de mama precoz que iniciaron un tratamiento con IA tras la cirugía y/o quimioterapia, derivadas a la unidad de osteoporosis para una evaluación de la salud ósea, incluyendo densitometrías óseas y búsqueda sistemática de fracturas mediante Rx al inicio del tratamiento y anualmente durante 5 años. Resultados: Se incluyeron 130 pacientes. Al inicio del tratamiento con IA el 49% tenía al menos un factor de riesgo alto para fracturas, el 55% osteopenia y el 39% osteoporosis. Tras la evaluación inicial, el 79% de las pacientes inició un tratamiento con bifosfonatos, el 88% con calcio y el 79% con vitamina D. Tras una mediana de 65 (50-77) meses, el 4% desarrolló osteopenia u osteoporosis y el 14% mejoró el diagnóstico densitométrico. Se registraron 15 fracturas en 11 (8,5%) pacientes, todas ellas en tratamiento preventivo. Durante el seguimiento, las pacientes con ≥1 factores de riesgo altos registraron una mayor frecuencia de fracturas (15 vs. 3%) y un menor tiempo hasta la primera fractura (media de 99 vs. 102 meses; p=0,023). Conclusiones: La intervención preventiva de una unidad de osteoporosis al inicio del tratamiento con IA en supervivientes de cáncer de mama permite identificar pacientes con un elevado riesgo de fracturas y puede contribuir a la prevención de eventos óseos en estas pacientes


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Osteoporose/epidemiologia , Unidades Hospitalares/organização & administração , Neoplasias da Mama/epidemiologia , Inibidores da Aromatase/uso terapêutico , Osteoporose/prevenção & controle , Sobreviventes de Câncer/estatística & dados numéricos , Inibidores da Aromatase/efeitos adversos , Fatores de Risco , Osteoporose Pós-Menopausa/prevenção & controle , Avaliação de Resultado de Ações Preventivas , Estudos Retrospectivos
18.
Reumatol. clín. (Barc.) ; 15(4): 237-241, jul.-ago. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-184417

RESUMO

Objective: To describe patient's characteristics, the activity and patient's satisfaction with a multidisciplinary care unit in patients with psoriasis and psoriatic arthritis (PsA). Methods: A retrospective medical records review of patients with psoriasis or PsA attended in a multidisciplinary care unit was performed. Included patients were contacted to fulfill a satisfaction questionnaire. A specific electronic database was set up. Data regarding to patients and their baseline characteristics and the activity of the unit were collected. Descriptive analysis were performed. Results: A total of 112 patients with 154 visits were included in almost 3 years, 54% women, with a mean age of 51 years, 43.7% presented hyperlipidemia and 30.4% arterial hypertension. Half of patients were referred due to diagnostic doubts and the other half for therapeutic problems. After the evaluation of the patients, 66 patients (58.9%) met diagnostic criteria for PsA, and 13 (11.6%) of an inflammatory disease other than PsA, and 95% came back to their usual physician. The most ordered test were laboratory tests (75.6% of patients), followed by X-rays in 57 patients (51.3%). In general the number of patients with different treatments increased, and 55.4% and 42% of patients changed their topic and systemic treatments respectively. The level of satisfaction was very high and all of patients considered that their disease was better controlled in this multidisciplinary care unit. Conclusions: This multidisciplinary care unit has improved the care and satisfaction of patients with psoriasis or PsA, and increased collaboration between rheumatology and dermatology departments


Objetivo: Describir las características de los pacientes, la actividad registrada, así como la satisfacción percibida, de una consulta de atención multidisciplinar para pacientes con psoriasis o artritis psoriásica (APs). Métodos: Estudio observacional retrospectivo con revisión de historias clínicas de todos los pacientes atendidos en la consulta de atención multidisciplinar. Se contactó con todos ellos para que contestasen una encuesta de satisfacción. Varios investigadores recogieron datos sociodemográficos y clínicos, así como administrativos incluyendo el número de visitas en una base de datos especialmente generada para este proyecto. Se realizó un análisis descriptivo. Resultados: Se incluyó a 112 pacientes con 154 visitas en casi 3 años, 54% mujeres, y una edad media de 51 años; el 43,7% presentó hiperlipidemia y el 30,4% hipertensión arterial. La mitad fueron referidos por dudas diagnósticas y la otra por problemas terapéuticos. Tras su evaluación, 66 pacientes (58,9%) cumplieron los criterios diagnósticos de APs y 13 (11,6%) de una enfermedad inflamatoria distinta. El 95% regresó a su médico habitual. La pruebas complementarias más solicitadas fueron analíticas (75,6%) y radiografías simples (51,3%). En general, el número de pacientes con nuevos tratamientos aumentó y el 55,4 y el 42% de los pacientes cambiaron sus tratamientos tópico y sistémico, respectivamente. El nivel de satisfacción fue muy alto y todos los pacientes consideraron que su enfermedad estaba mejor controlada en esta unidad. Conclusiones: Esta consulta de atención multidisciplinar ha mejorado el manejo y satisfacción de pacientes con psoriasis o APs y ha incrementado la colaboración entre los servicios de Reumatología y Dermatología


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Psoríase/terapia , Artrite Psoriásica/terapia , Unidades Hospitalares/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Satisfação do Paciente/estatística & dados numéricos , Estudos Retrospectivos
19.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(6): 460-468, jul.-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185273

RESUMO

Antecedentes y objetivo: El carcinoma de células de Merkel es un tipo de cáncer de piel infrecuente y agresivo. Hay una gran variación en su manejo y las diferentes guías extranjeras que existen cubren parcialmente los problemas identificados como principales. El objetivo de la presente guía es servir de referencia a los dermatólogos españoles para mejorar aspectos controvertidos del diagnóstico, estadificación y tratamiento del carcinoma de células de Merkel. Materiales y métodos: Se empleó el método ADAPTE: se escogió a miembros del Grupo Español de Dermato-Oncología y Cirugía (GEDOC) con experiencia en el tratamiento de estos tumores y con interés en participar en la elaboración de la guía. Tras resumir el proceso de atención y elaborar las preguntas clínicas relevantes, se hizo una búsqueda de guías, que se seleccionaron según su puntuación mediante el instrumento Appraisal of Guidelines for Research and Evaluation (AGREE II). Tras la búsqueda de las respuestas en dichas guías, se elaboraron posteriormente las recomendaciones. Por último, se sometió la guía a revisión externa. Resultados: Las guías con mejor puntuación fueron las de National Comprehensive Cancer Network, la European consensus-based interdisciplinary guideline, Alberta Healthservices Clinical practice guideline, American Cancer Society y Cutaneous Oncology Group of the French Society of Dermatology. Se obtuvieron en total 9 preguntas clínicas, contestadas a partir de estas guías. Conclusiones: Esta guía responde a preguntas habituales en la práctica clínica diaria y sirve a los dermatólogos como referencia en la toma de decisiones, siempre teniendo presentes los recursos y preferencias del paciente


Background and objective: Merkel cell carcinoma is a rare, aggressive skin cancer that is managed in a great variety of ways. However, international clinical practice guidelines give only partial coverage to issues considered major problems.The recommendations presented here aim to provide Spanish dermatologists with a guide to improving disputed aspects of diagnosis, staging, and treatment of localized Merkel cell carcinomas. Material and methods: The ADAPTE process was used. Members of the Spanish Group of Oncologic Dermatology and Surgery (GEDOC) with experience in treating Merkel cell carcinoma and interest in drafting these guidelines were selected. The group described the care process and listed the most important clinical questions. They then searched for guidelines and assessed them with the AGREE II (Appraisal of Guidelines for Research and Evaluation) tool. After consulting the guidelines for answers to their clinical questions, the group drafted the present statementand sent it for external review. Results: The guidelines that scored highest in the AGREE II assessment step were the consensus-based interdisciplinary guideline of the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer, and those of the Comprehensive Cancer Network, the Alberta Health Services in Canada, the American Cancer Society, and the Cutaneous Oncology Group of the French Society of Dermatology. A total of 9 clinical questions were answered based on these guidelines. Conclusions: The guidelines presented here answer clinical questions that arise in routine practice. They can provide dermatologists with a starting point for decision-making, although available resources and patient preferences must always be borne in mind


Assuntos
Humanos , Carcinoma de Célula de Merkel/diagnóstico , Carcinoma de Célula de Merkel/terapia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , Carcinoma de Célula de Merkel/patologia , Dermatologia/organização & administração , Medicina Baseada em Evidências , Departamentos Hospitalares , Unidades Hospitalares , Neoplasias Cutâneas/patologia , Espanha , Estadiamento de Neoplasias
20.
Hu Li Za Zhi ; 66(4): 60-69, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31342502

RESUMO

BACKGROUND & PROBLEMS: The pediatric ward in our hospital has an average occupancy rate of ten patients per day. An investigation found that nurses had a low (51.9%) rate of completing the required introduction to the hospital environment for pediatric ward patients. The main reasons for this low rate were found to be: 1) the large number of items to be introduced, 2) interruptions of staffs during the introduction process, 3) the lack of sufficient introduction tools, and 4) patient family members and new caregivers not being given the introduction. PURPOSE: To increase the rate of completeness of nursing staffs introducing the hospital environment from 51.9% to over 91.0%. RESOLUTION: The project team proposed the following solutions. First, make a video introducing the general hospital environment and make it accessible via QR (quick response) code; second, provide multiple introduction video tools; third, make the environment more friendly using ward-mascot-themed décor; fourth, install fixtures in the rooms that complement the ward-mascot theme; fifth, revise the contents of the environment introduction; and sixth, make an environment introduction checklist. RESULTS: The completeness rate of environment introduction increased from 51.9% to 97.6%. CONCLUSIONS: The pediatric ward not only increased the environment introduction completion rate but also created a more friendly environment. Using the video and QR code and providing multiple video players and a checklist has efficiently increased the environment introduction completion rate and, in creating a more friendly environment, has successfully maintained nursing quality.


Assuntos
Unidades Hospitalares , Recursos Humanos de Enfermagem no Hospital , Pediatria , Melhoria de Qualidade , Criança , Humanos , Pesquisa em Avaliação de Enfermagem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA