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1.
World J Emerg Surg ; 15(1): 33, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32414390

RESUMO

BACKGROUND: A novel coronavirus pneumonia outbreak began in Wuhan, Hubei Province, in December 2019; the outbreak was caused by a novel coronavirus previously never observed in humans. China has imposed the strictest quarantine and closed management measures in history to control the spread of the disease. However, a high level of evidence to support the surgical management of potential trauma patients during the novel coronavirus outbreak is still lacking. To regulate the emergency treatment of trauma patients during the outbreak, we drafted this paper from a trauma surgeon perspective according to practical experience in Wuhan. MAIN BODY: The article illustrates the general principles for the triage and evaluation of trauma patients during the outbreak of COVID-19, indications for emergency surgery, and infection prevention and control for medical personnel, providing a practical algorithm for trauma care providers during the outbreak period. CONCLUSIONS: The measures of emergency trauma care that we have provided can protect the medical personnel involved in emergency care and ensure the timeliness of effective interventions during the outbreak of COVID-19.


Assuntos
Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Infecções/normas , Pandemias , Pneumonia Viral , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia , Algoritmos , Anestesia/normas , China , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Emergências , Unidades Hospitalares/normas , Humanos , Pandemias/prevenção & controle , Assistência Perioperatória/normas , Equipamento de Proteção Individual/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Procedimentos Cirúrgicos Operatórios/normas , Tomografia Computadorizada por Raios X/normas , Triagem/normas
2.
J Dig Dis ; 21(4): 199-204, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32267098

RESUMO

An epidemic of an acute respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, now known as coronavirus disease 2019 (COVID-19), beginning in December 2019, has attracted an intense amount of attention worldwide. As the natural history and variety of clinical presentations of this disease unfolds, extrapulmonary symptoms of COVID-19 have emerged, especially in the digestive system. While the respiratory mode of transmission is well known and is probably the principal mode of transmission of this disease, a possibility of the fecal-oral route of transmission has also emerged in various case series and clinical scenarios. In this review article, we summarize four different aspects in published studies to date: (a) gastrointestinal manifestations of COVID-19; (b) microbiological and virological investigations; (c) the role of fecal-oral transmission; and (d) prevention and control of SARS-CoV-2 infection in the digestive endoscopy room. A timely understanding of the relationship between the disease and the digestive system and implementing effective preventive measures are of great importance for a favorable outcome of the disease and can help climnicians to mitigate further transmission by taking appropriate measures.


Assuntos
Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Doenças do Sistema Digestório , Endoscopia do Sistema Digestório/normas , Gastroenterologia/normas , Controle de Infecções/normas , Pneumonia Viral/transmissão , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/virologia , Doenças do Sistema Digestório/diagnóstico , Doenças do Sistema Digestório/etiologia , Doenças do Sistema Digestório/microbiologia , Doenças do Sistema Digestório/virologia , Unidades Hospitalares/normas , Humanos , Pandemias , Equipamento de Proteção Individual/normas , Pneumonia Viral/complicações , Pneumonia Viral/virologia
3.
J Gastroenterol Hepatol ; 35(5): 749-759, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32233034

RESUMO

From its beginning in December 2019, the coronavirus disease 2019 outbreak has spread globally from Wuhan and is now declared a pandemic by the World Health Organization. The sheer scale and severity of this pandemic is unprecedented in the modern era. Although primarily a respiratory tract infection transmitted by direct contact and droplets, during aerosol-generating procedures, there is a possibility of airborne transmission. In addition, emerging evidence suggests possible fecal-oral spread of the virus. Clinical departments that perform endoscopy are faced with daunting challenges during this pandemic. To date, multiple position statements and guidelines have been issued by various professional organizations to recommend practices in endoscopic procedures. This article aims to summarize and discuss available evidence for these practices, to provide guidance for endoscopy to enhance patient safety, avoid nosocomial outbreaks, protect healthcare personnel, and ensure rational use of personal protective equipment. Responses adapted to national recommendations and local infection control guidelines and tailored to the availability of medical resources are imminently needed to fight the coronavirus disease 2019 pandemic.


Assuntos
Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Endoscopia Gastrointestinal/normas , Unidades Hospitalares/normas , Controle de Infecções/normas , Pandemias , Pneumonia Viral/transmissão , Aerossóis/efeitos adversos , Infecções por Coronavirus/prevenção & controle , Endoscopia/normas , Unidades Hospitalares/organização & administração , Humanos , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto
6.
Med Sci (Paris) ; 35(8-9): 674-681, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31532380

RESUMO

A placebo drug is defined as a treatment without any specific pharmacological efficacy, that works when the patient thinks to receive an active treatment, through a psychological and physiological mechanism. This study aimed to evaluate the use of placebo in French hospitals, in Polyvalent Medicine units. A questionnaire comprising 15 items was sent to 372 units. The analysis of 153 responses was conducted from dynamic crosstabs in Excel and using the R software available online. The survey confirmed that the use of placebos in hospital is frequent, with nearly 2/3 of professionals answering the questionnaire declared to use it. The oral capsule is the most commonly used form. Placebo is mainly administered at night, in case of pain, insomnia or anxiety, to so-called "difficult" patients. Placebo is not always given after medical prescription. In most cases, patients are not informed that they receive a placebo. The majority of professionals believed in the placebo effect but considered to be insufficiently informed and trained in the use of placebo in current practice. Although the placebo effect is now demonstrated, ethical and legal considerations recommend placebo treatment only on medical prescription, with the prior information of the patient. The placebo could be used as complementary therapy to conventional treatment in the cases of this therapeutic effectiveness has been demonstrated. Professionals should be trained in the use of placebo in order to avoid nocebo effect and potentiate beneficial effects of placebo.


Assuntos
Hospitais , Placebos/uso terapêutico , Adulto , Revelação/ética , Revelação/estatística & dados numéricos , Feminino , França/epidemiologia , Medicina Geral/ética , Medicina Geral/métodos , Medicina Geral/estatística & dados numéricos , Unidades Hospitalares/ética , Unidades Hospitalares/normas , Unidades Hospitalares/estatística & dados numéricos , Hospitais/ética , Hospitais/estatística & dados numéricos , Humanos , Masculino , Princípios Morais , Relações Médico-Paciente , Efeito Placebo
7.
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
8.
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
9.
Ann Pharm Fr ; 77(5): 363-373, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31257018

RESUMO

OBJECTIVES: The sterilization unit of Pitié-Salpêtrière-Charles Foix hospital group is ISO 9001 certified on one of its sites. The purpose of this work is to describe how the unit prepared for the transition from the 2008 version to the 2015 version of the standard, as well as the conduct of the audit. METHODS: The pharmaceutical team has received prior training from French national organization for standardization (Afnor) to understand the new requirements and how to apply them to the sterilization unit. SWOT and PESTEL methods were used. A 3-month retro planning has been established. Deadlines were the annual management review and the certification audit. Audits carried out by the Quality and Risk Management Department helped to identify the priorities. RESULTS: The compliance of the quality management system (QMS) has led to the identification of internal and external challenges, relevant stakeholders and risks and opportunities. Management leadership and communication has been strengthened and control over external providers has improved. The auditor did not identify any non-compliance, but said that the system had to mature regarding the recent application of the new requirements. CONCLUSIONS: The QMS is more effective, new strengths and weaknesses have been identified and requirements of the unit and stakeholders have been better defined. The pharmaceutical investment necessary for this approach has been important. Involvement in the quality approach of all the staff of the unit lies to the success of the project.


Assuntos
Certificação , Unidades Hospitalares/normas , Esterilização/normas , Comunicação , França , Fidelidade a Diretrizes , Unidades Hospitalares/organização & administração , Humanos , Liderança , Auditoria Médica , Medição de Risco , Gestão da Qualidade Total
10.
Ann Biol Clin (Paris) ; 77(3): 339-349, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31219424

RESUMO

The quality of the screening of vanA and/or vanB Vancomycin-resistant enterococcal (VRE) carriage by patients transferred from foreign countries plays a role in the management of risks linked to extensively drug resistant organisms (XDRO). Accreditation of the screening according to the NF EN ISO 15189 and NF EN ISO/IEC 17025 standards contributes to satisfy the level of quality. Our laboratory was already accredited according to the NF EN ISO/IEC 17025 standard. We used its quality management system and the type B widened flexible scope to identify the required criteria based on microbiology and infection control standards and those of Afnor and Cofrac, and to validate the screening procedure. Accreditation was obtained for use of the Type B scope, for culture-based detection and identification (codes BA1 and BA5), for determination of the minimal inhibitory concentrations of glycopeptides (code BA6), and for the detection of resistance genes to glycopeptides by polymerase chain reaction (code BA8). The maturity of our quality management system contributed to validate the screening procedures following the required criteria of the NF EN ISO/IEC 17025 standard.


Assuntos
Técnicas de Laboratório Clínico/normas , Infecções por Bactérias Gram-Positivas/diagnóstico , Programas de Rastreamento/normas , Técnicas Microbiológicas/normas , Reto/microbiologia , Enterococos Resistentes à Vancomicina/isolamento & purificação , Acreditação , Adulto , Criança , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , DNA Bacteriano/análise , DNA Bacteriano/isolamento & purificação , Enterococcus faecium/isolamento & purificação , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/transmissão , Unidades Hospitalares/normas , Humanos , Recém-Nascido , Unidades de Terapia Intensiva/normas , Laboratórios/normas , Programas de Rastreamento/métodos , Técnicas Microbiológicas/métodos , Projetos Piloto , Padrões de Referência
11.
J Stroke Cerebrovasc Dis ; 28(5): 1302-1310, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30824298

RESUMO

BACKGROUND: The quality of care and outcomes for people who experience stroke whilst in hospital for another condition has not been previously studied in Australia. AIMS: To explore differences in long-term outcomes among patients with in-hospital events treated in stroke units (SUs) compared to those managed in other hospital wards. METHODS: Forty-five hospitals participating in the Australian Stroke Clinical Registry between January 2010 and December 2014 contributed data. Survival of all patients with in-hospital stroke to 180 days after stroke and health-related quality of life, using EQ-5D-3L among 73% eligible, were compared using multilevel, multivariable regression models. Models were adjusted for age, sex, index of relative socioeconomic disadvantage, ability to walk, stroke type, transfer from another hospital, and history of stroke. RESULTS: Among 20,786 stroke events, 1182 (5.1%) occurred in-hospital (median age 77 years, 49% male). Patients with in-hospital stroke treated in SUs died less often within 30 days (Hazard Ratio 0.56; 95% CI 0.39-0.81) than those not admitted to SUs. Survivors reported similar health-related quality of life between 90 and 180 days compared to those treated in other wards (coefficient = 0.01, 95% CI -0.06-0.09, P = .78). Patients managed in SUs more often received recommended management (e.g. swallowing screening). CONCLUSION: The benefits of SU care may extend to patients experiencing in-hospital stroke. Validation, including accounting for potential residual confounding factors, is required.


Assuntos
Disparidades em Assistência à Saúde/normas , Unidades Hospitalares/normas , Hospitalização , Pacientes Internados , Indicadores de Qualidade em Assistência à Saúde/normas , Reabilitação do Acidente Vascular Cerebral/normas , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Masculino , Qualidade de Vida , Recuperação de Função Fisiológica , Sistema de Registros , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
12.
Sanid. mil ; 75(1): 27-39, ene.-mar. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183702

RESUMO

El Buque de Proyección Estratégica L-61 Juan Carlos I (L-61 JC I) es el buque de mayores dimensiones que ha tenido la Armada española en toda su historia. Puede desarrollar cuatro perfiles de misión: anfibio, portaviones, transporte estratégico y ayuda humanitaria. En todos ellos su capacidad sanitaria Role 2 juega un papel determinante gracias a las importantes prestaciones médicas con las que cuenta el buque. Las maniobras FLOTEX-17 realizadas en el Mar Mediterráneo en junio de 2017 en las que participaron 29 buques y más de 3500 efectivos fue la primera vez que embarcó un Role 2 en el L-61 JC I. El objetivo de este artículo es describir las características técnicas y sanitarias del buque, las lecciones identificadas obtenidas tras las maniobras navales y analizar las semejanzas y diferencias de buques similares de marinas de guerra aliadas


Strategic Projection Ship L-61 Juan Carlos I (L-61 JC I) is the largest ship that the Spanish Navy has had in its history. This warship can develop four mission profiles: amphibian, aircraft carrier, strategic transport and humanitarian aid. In all of them, Role 2 medical capacity and capability plays a decisive role thanks to the important medical benefits available in the ship. FLOTEX-17 maneuvers carried out in the Mediterranean Sea in June 2017 with the participation of 29 warships and more than 3,500 navy members was the first time that a Role 2 was shipped in the L-61 JC I. The purpose of this article is to describe warship technical and medical characteristics, lessons identified after the naval maneuvers and analyze the similarities and differences of similar warships of allied navies


Assuntos
Humanos , Medicina Naval/organização & administração , Medicina Naval/normas , Navios/normas , Hospitais Militares/normas , Saneamento de Navios , Unidades Hospitalares/organização & administração , Unidades Hospitalares/normas , Hospitais Militares/organização & administração , Número de Leitos em Hospital/normas , Espanha , Reino Unido , França , Alemanha , Itália , Estados Unidos
13.
J Am Acad Orthop Surg ; 27(19): e887-e892, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30720568

RESUMO

INTRODUCTION: Charges, procedural efficiency, return to activity, and complications after closed treatment of fractures performed in an operating room (OR) versus closed reduction in a dedicated fracture reduction room (FRR) were compared. METHODS: Patients with closed fractures of the forearm who underwent closed reduction in the year before (OR), and after implementation of the FRR, were retrospectively reviewed. Charges, American Society of Anesthesiologists class, sex, age, length of follow-up, prior reduction, fracture location/displacement, time from injury to procedure, procedural time, time to return to activity, and complications were recorded. RESULTS: Eighteen patients met the inclusion criteria in the FRR group (13 men, 5 women), and 22 in the OR group (18 men, 4 women). No notable differences in age, sex, follow-up, American Society of Anesthesiologists class, fracture location/displacement, incidence of prior reduction, or time to return to activity were observed. Two (9.5%) complications occurred in the FRR group versus 7 (32%) in the OR group, P > 0.05. No anesthesia complications were present. Patients treated in the FRR incurred charges of $5,299 ± $1,289 versus $10,455 ± $2,290 in the OR, P < 0.001. Total time of visit in the FRR was ∼30% less than the OR, P < 0.001. No notable delay in treatment was observed. DISCUSSION: In the era of finite resources and value-based care, implementation of a FRR resulted in safe, cost-effective, and increased procedural efficiency.


Assuntos
Redução Fechada/economia , Traumatismos do Antebraço/cirurgia , Unidades Hospitalares/economia , Fraturas do Rádio/cirurgia , Fraturas da Ulna/cirurgia , Adolescente , Criança , Pré-Escolar , Redução Fechada/efeitos adversos , Redução Fechada/métodos , Análise Custo-Benefício , Eficiência Organizacional , Feminino , Traumatismos do Antebraço/economia , Unidades Hospitalares/normas , Humanos , Masculino , Salas Cirúrgicas/economia , Salas Cirúrgicas/normas , Fraturas do Rádio/economia , Volta ao Esporte , Fatores de Tempo , Fraturas da Ulna/economia
14.
Encephale ; 45(2): 139-146, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-30126611

RESUMO

OBJECTIVES: The UHSA (UHSA) are French psychiatric units for inmates which admit detainees suffering from a psychiatric disorder requiring full-time hospital care. Non-psychiatric pathologies are overrepresented in patients with psychiatric disorders but also in detainees. As a result, patients hospitalized in UHSA are largely exposed to non-psychiatric conditions, and exploring the organization of general medical care for these patients appears very relevant. The aim of this study is to review the general medical care in all French UHSA. METHODS: A descriptive study was carried out through a survey of the nine facilities. RESULTS: All UHSA benefit from the intervention of a general practitioner. The physical clinical examination, the biological assessment and the electrocardiogram are systematically performed at the patient's admission in 7, 5 and 9 establishments, respectively. However, the offer of general medical care in UHSA seems disparate and sometimes insufficient. Specialized consultations are regularly requested during hospitalizations, but no establishment benefits from a telemedicine system or specialized consultations on site. The extraction of the patient to the general hospital is therefore systematic when such a consultation is needed. But the number of penitentiary escorts per day is limited. In 6 UHSA, medical extractions are thus regularly canceled by the penitentiary administration, sometimes without a medical opinion. Finally, the patient's regular physician is only contacted in 3 UHSA during hospitalizations. CONCLUSION: Based on these results, ways of improving the organization of general medical care in UHSA are proposed through four main axes: the structure and general organization; the general medical care; the link with the healthcare partners and the articulation with the penitentiary administration.


Assuntos
Medicina Geral , Hospitais Especializados , Transtornos Mentais/terapia , Prisioneiros , Unidade Hospitalar de Psiquiatria , Internação Compulsória de Doente Mental/legislação & jurisprudência , Internação Compulsória de Doente Mental/normas , Internação Compulsória de Doente Mental/estatística & dados numéricos , Psiquiatria Legal/métodos , Psiquiatria Legal/organização & administração , Psiquiatria Legal/normas , Psiquiatria Legal/estatística & dados numéricos , França/epidemiologia , Medicina Geral/organização & administração , Medicina Geral/normas , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Unidades Hospitalares/organização & administração , Unidades Hospitalares/normas , Unidades Hospitalares/estatística & dados numéricos , Hospitais Especializados/métodos , Hospitais Especializados/organização & administração , Hospitais Especializados/normas , Hospitais Especializados/estatística & dados numéricos , Humanos , Medicina Interna/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Prisioneiros/psicologia , Prisioneiros/estatística & dados numéricos , Prisões/organização & administração , Prisões/normas , Prisões/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/organização & administração , Unidade Hospitalar de Psiquiatria/normas , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Psiquiatria/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários
15.
Nervenarzt ; 90(4): 335-342, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-30374745

RESUMO

This article describes the revised criteria for certified stroke units (SU) in Germany that will apply from 1 October 2018. Due to the high level of quality only minor adjustments and specifications were necessary in many places and the majority of criteria remained unchanged. For the first time a uniform personnel quota of ≥1.75 full-time staff per monitor bed is defined, which is a better reflection of the treatment reality. The evidence-based process of acute vascular imaging using computed tomography angiography (CTA) and alternatively magnetic resonance angiography (MRA) is now defined as a minimum rate of≥20 % of all brain infarcts. In this way the timely identification of suitable candidates for endovascular thrombectomy (ET) should be accomplished. Ultrasound diagnostics of arteries supplying the brain remain an integral part of additional diagnostics after cerebral ischemia because this generates supplementary information. The extended detection of atrial fibrillation is newly included as a diagnostic minimum standard and necessitates measures that go beyond a single long-term electrocardiograph (ECG). In order to facilitate the certification of telemedically supplied SU (Tele-SU), the minimum standard of stroke patients was reduced to ≥200 per year. A Tele-SU in the immediate catchment area of a certified SU (<20 km) must provide proof of a regional treatment need in order for certification to be approved. Quality criteria in the audit reports have now a greater importance. They require a concrete plan of action, which must be tracked within the framework of the interim report and must be presented for the recertification. Furthermore, the SU are called upon not to limit the endeavors for quality only to the minimum requirements.


Assuntos
Isquemia Encefálica , Certificação , Unidades Hospitalares , Acidente Vascular Cerebral , Alemanha , Unidades Hospitalares/normas , Humanos , Trombectomia
16.
Bull Cancer ; 106(1S): S1-S9, 2019 Jan.
Artigo em Francês | MEDLINE | ID: mdl-30580913

RESUMO

Allogeneic hematopoietic cell transplantation (HCT) is part of the standard of care for many hematological diseases. Over the last decades, significant advances in patient and donor selection, conditioning regimens as well as supportive care of patients undergoing allogeneic HCT leading to improved overall survival have been made. In view of many new treatment options in cellular and molecular targeted therapies, the place of allogeneic transplantation in therapy concepts must be reviewed. Most aspects of HCT are well standardized by national guidelines or laws as well as by certification labels such as FACT-JACIE. However, the requirements for human resources, construction and layout of a unit treating patients during the transplantation procedure and for different complications are not well defined. Here, we describe the process of planning a transplant unit in order to open a discussion that could lead to more precise guidelines in the field of personnel and infrastructural requirements for hospitals caring for people with severe immunosuppression.


Assuntos
Transplante de Medula Óssea/normas , Ambiente de Instituições de Saúde/normas , Doenças Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/normas , Ar/normas , Terapia Baseada em Transplante de Células e Tecidos/normas , Seleção do Doador/normas , França , Pessoal de Saúde/normas , Unidades Hospitalares/normas , Humanos , Higiene , Imunossupressão/normas , Monitorização Fisiológica/métodos , Roupa de Proteção/normas , Sociedades Médicas , Esterilização/normas , Transplante Homólogo/normas , Visitas a Pacientes
17.
J Matern Fetal Neonatal Med ; 32(19): 3244-3250, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29618234

RESUMO

Background: Patients treated in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology are especially vulnerable. Large multidisciplinary teams of physicians, multiple invasive and noninvasive diagnostic and therapeutic procedures, and the use of advanced technologies increase the probability of adverse events. The evaluation of knowledge about patient safety culture among nurses and midwives working in such units and the identification of critical areas at a health care institution would reduce the number of adverse events and improve patient safety. The aim of the study was to evaluate the opinion of nurses and midwives working in clinical departments that provide services in the fields of obstetrics, gynecology, and neonatology about patient safety culture and to explore potential predictors for the overall perception of safety. Methods: We used the Hospital Survey on Patient Safety Culture (HSOPSC) to evaluate nurses' and midwives' opinion about patient safety issues. The overall response rate in the survey was 100% (n = 233). Results: The analysis of the dimensions of safety on the unit level showed that the respondents' most positive evaluations were in the Organizational Learning - Continuous Improvement (73.2%) and Feedback and Communication about Error (66.8%) dimensions, and the most negative evaluations in the Non-punitive Response to Error (33.5%) and Staffing (44.6%) dimensions. On the hospital level, the evaluation of the safety dimensions ranged between 41.4 and 56.8%. The percentage of positive responses in the outcome dimensions Frequency of Events Reported was 82.4%. We found a significant association between the outcome dimension Frequency of Events Reported and the Hospital Management Support for Patient Safety and Feedback and Communication about Error Dimensions. Conclusions: On the hospital level, the critical domains in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology were Teamwork Across Hospital Units, and on the unit level - Communication Openness, Teamwork Within Units, Non-punitive Response to Error, and Staffing. The remaining domains were seen as having a potential for improvement.


Assuntos
Atitude do Pessoal de Saúde , Ginecologia/normas , Neonatologia/normas , Obstetrícia/normas , Segurança do Paciente/normas , Gestão da Segurança , Adulto , Estudos Transversais , Feminino , Ginecologia/organização & administração , Pesquisas sobre Serviços de Saúde , Unidades Hospitalares/organização & administração , Unidades Hospitalares/normas , Humanos , Recém-Nascido , Lituânia , Masculino , Pessoa de Meia-Idade , Tocologia , Neonatologia/organização & administração , Enfermeiras e Enfermeiros/psicologia , Obstetrícia/organização & administração , Cultura Organizacional , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Percepção , Gravidez , Gestão da Segurança/organização & administração , Gestão da Segurança/normas
18.
HERD ; 12(1): 108-123, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29986621

RESUMO

OBJECTIVES:: To create opportunities to increase nursing staff's satisfaction and operational efficiency and eventually improve nurses' experiences through better design in unit layout. BACKGROUND:: The majority of research performed on nursing units in China only focused on the spatial design itself, and few studies examined the nursing unit empirically based on nurses' experience. Nursing units need to be designed with understanding nurses' behavior and experience in China. METHOD:: A mixed-method approach was conducted in four double-corridor nursing units in China. Observation and interview data were collected to explore how physical environments for managing administrative duties, medications, and caring patient were used in nursing units. RESULTS:: The most frequent activities were communication, medication, and patient-care activities. The places in which nurses spent the most of theirs working times were the nurse station (NS), patient room, workstation on wheels (WoW), and medication room. The important clinical work spaces were the patient room, NS, WoW, medication room, doctor's office, disposal room, examining room, and back corridor. The important traffic linkages were between NS and medication room, patient room and WoW, and medication room and patient room. CONCLUSIONS:: This article revealed the frequency of nurse activities; how they spent their time; how they use the clinical spaces; identified important clinical spaces, linkages, and driver of inefficiency in nursing work and nursing unit design; and finally generated recommendations for double-corridor nursing unit design in China which can be used by medical planner, hospital administrator.


Assuntos
Unidades Hospitalares/organização & administração , Recursos Humanos de Enfermagem no Hospital , China , Comunicação , Arquitetura Hospitalar/normas , Unidades Hospitalares/normas , Humanos , Postos de Enfermagem/normas , Assistência ao Paciente , Quartos de Pacientes , Local de Trabalho/organização & administração
19.
Medicine (Baltimore) ; 97(48): e13467, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30508973

RESUMO

There are lack of indicators of quality of care in resuscitation units of emergency departments. With the aim of proposing a series of indicators to evaluate the quality of care delivered in hospital resuscitation areas, we conducted a descriptive study of 7579 admissions to the resuscitation unit of an emergency department at a Spanish hospital between 2012 and 2016. The proposed indicators were the percentage of patients attending to the emergency department admitted to the resuscitation area by level of triage, the length of stay, the percentage of patients moved to intensive care and surgery at disposition, the mortality in the area or in the emergency department within 24 hours of disposition, and the data completeness. A majority of the patients (62.6%) were men and the median age was 68 years. Over 99% of the required data were recorded. Median length of stay in the resuscitation unit was 0.87 hours (interquartile range, 0.5-1.5). Approximately 80% of patients categorized as an emergency on admission to the emergency department were admitted to the resuscitation unit, although the proportion of urgency patients was higher. The main disposition destination was a trauma cubicle (82.3% of cases). Mortality was 0.41%.Specific indicators are needed to assess the quality of care delivery in resuscitation units. We believe that our findings will provide new insights into the work done to date in this field.


Assuntos
Serviço Hospitalar de Emergência/normas , Unidades Hospitalares/normas , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Ressuscitação/normas , Idoso , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Unidades Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Ressuscitação/estatística & dados numéricos , Espanha , Fatores de Tempo , Triagem
20.
Tunis Med ; 96(7): 401-404, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30430482

RESUMO

BACKGROUND: The lack of continuous evaluation of training tools in medicine, especially in developing countries, represents a brake to the development of the latter. AIM: To establish an inventory of the training facilities available to residents in urology in Tunisia, to assess their satisfaction and their expectations, and to propose solutions to improve residents training. METHODS: An anonymous questionnaire was sent by E-mail in 2015 to all residents in urology in Tunisia. The questionnaire addressed demographic characteristics, educational resources used and desired, the current medical and university curriculum and evaluation of the training. RESULTS: Among 33 residents, 66.6% responded to the survey. Medical staff, courses organized by the national college of urology, reading french-language articles and daily activity in operating room were the most used pedagogic resources. Training was judged unsatisfactory by 59.1% of respondents because of a lack of theoretical training in 18.1% of cases, a lack of practical training in 13.6% of cases and both of them in 27.2% of cases. Training on animals and simulator, creation of an educational booklet, use of online course materials, and the institution of a mentoring process during residency were rated favorable by the majority of respondents. CONCLUSION: The majority of residents in urology in Tunisia believe their training is unsatisfactory. The E-learning, improved access to surgical training in animals and simulator, better information on existing resources and strengthening of companionship through tutoring should enhance satisfaction.


Assuntos
Centros Médicos Acadêmicos/provisão & distribução , Centros Médicos Acadêmicos/estatística & dados numéricos , Internato e Residência , Salas Cirúrgicas/provisão & distribução , Urologistas/educação , Urologistas/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Currículo/normas , Currículo/estatística & dados numéricos , Unidades Hospitalares/normas , Unidades Hospitalares/estatística & dados numéricos , Unidades Hospitalares/provisão & distribução , Humanos , Internato e Residência/métodos , Internato e Residência/organização & administração , Internato e Residência/normas , Internato e Residência/estatística & dados numéricos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Salas Cirúrgicas/estatística & dados numéricos , Satisfação Pessoal , Treinamento por Simulação/organização & administração , Treinamento por Simulação/normas , Treinamento por Simulação/estatística & dados numéricos , Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários , Tunísia/epidemiologia , Urologistas/provisão & distribução , Urologia/educação , Urologia/organização & administração , Urologia/normas , Urologia/estatística & dados numéricos
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