Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 307
Filtrar
1.
Medicine (Baltimore) ; 100(1): e23676, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429734

RESUMO

INTRODUCTION: Ischemic stroke caused by arterial occlusion is the cause of most strokes. The focus of treatment is rapid reperfusion through intravenous thrombolysis and intravascular thrombectomy. Two acute stroke management including prehospital thrombolysis and in hospital have been widely used clinically to treat ischemic stroke with satisfied efficacy. However, there is no systematic review comparing the effectiveness of these 2 therapies. The aim of this study is to compare the effect of prehospital thrombolysis versus in hospital for patients with ischemic stroke. METHODS AND ANALYSIS: The following electronic databases will be searched: Web of Science, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Wanfang Database, and Chinese Scientific Journal Database.The randomized controlled trials of prehospital thrombolysis versus in hospital for ischemic stroke will be searched in the databases from their inception to December 2020 by 2 researchers independently. Onset to therapy (OTT) duration and National Institute Health Stroke Scale (NIHSS) scores will be assessed as the primary outcomes; safety assessment including intracerebral hemorrhage (ICH) and mortality will be assessed as the secondary outcomes. The Review Manager 5.3 will be used for meta-analysis and the evidence level will be assessed by using the method for Grading of Recommendations Assessment, Development and evaluation Continuous outcomes will be presented as the weighted mean difference or standardized mean difference with 95% confidence interval (CI), whereas dichotomous data will be expressed as relative risk with 95% CI. If heterogeneity existed (P < .05), the random effect model was used. Otherwise, we will use the fixed effect model for calculation. ETHICS AND DISSEMINATION: Ethical approval is not required because no primary data are collected. This review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020200708.


Assuntos
Protocolos Clínicos , Hospitais/normas , Unidades Móveis de Saúde/normas , Terapia Trombolítica/normas , Hospitais/estatística & dados numéricos , Humanos , Metanálise como Assunto , Unidades Móveis de Saúde/organização & administração , Unidades Móveis de Saúde/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Terapia Trombolítica/métodos , Terapia Trombolítica/estatística & dados numéricos
2.
Malawi Med J ; 32(1): 31-36, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32733657

RESUMO

Background: While health providers consistently use malaria rapid diagnostic tests to rule out malaria, they often lack tools to guide treatment for those febrile patients who test negative. Without the tools to provide an alternative diagnosis, providers may prescribe unnecessary antibiotics or miss a more serious condition, potentially contributing to antibiotic resistance and/or poor patient outcomes. Methods: This study ascertained which diagnoses and treatments might be associated with poor outcomes in adults who test negative for malaria. Adult patients for rapid diagnostic test of malaria seen in mobile health clinics in Mulanje and Phalombe districts were followed for 14 days. Participants were interviewed on sociodemographic characteristics, health-seeking behaviour, diagnosis, treatment and access to care. Mobile clinic medical charts were reviewed. Two weeks (±2 days) following clinic visit, follow-up interviews were conducted to assess whether symptoms had resolved. Results: Initially, 115 adult patients were enrolled and 1 (0.88%) was lost to follow-up. Of the 114 adult patients remaining in the study, 55 (48%) were seen during the dry season and 59 (52%) during the wet season. Symptoms resolved in 90 (80%) patients at the 14-day follow-up visit (n=90) with the rest (n=24) reporting no change in symptoms. None of the patients in the study died or were referred for further care. Almost all patients received some type of medication during their clinic visit (98.2%). Antibiotics were given to 38.6% of patients, and virtually all patients received pain or fever relief (96.5%). However, no anti-malarials were prescribed. Conclusions: Mobile clinics provide important health care where access to care is limited. Although rapid tests have guided appropriate treatment, challenges remain when a patient's presenting complaint is less well defined. In rural areas of southern Malawi, simple diagnostics are needed to guide treatment decisions.


Assuntos
Febre de Causa Desconhecida/epidemiologia , Febre/epidemiologia , Unidades Móveis de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Adulto , Assistência à Saúde , Feminino , Febre/etiologia , Seguimentos , Acesso aos Serviços de Saúde , Humanos , Malaui/epidemiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde
4.
Anaesth Crit Care Pain Med ; 39(3): 361-362, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32360981

Assuntos
Betacoronavirus , Infecções por Coronavirus , Cuidados Críticos/organização & administração , Hospitais Militares/organização & administração , Unidades de Terapia Intensiva/organização & administração , Unidades Móveis de Saúde/organização & administração , Pandemias , Pneumonia Viral , /terapia , Idoso , Anestesia Geral/estatística & dados numéricos , Conversão de Leitos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Cuidados Críticos/estatística & dados numéricos , Despacho de Emergência Médica/organização & administração , Feminino , França/epidemiologia , Hospitais com menos de 100 Leitos , Serviços Hospitalares Compartilhados/organização & administração , Hospitais Gerais/organização & administração , Hospitais Militares/estatística & dados numéricos , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Unidades de Terapia Intensiva/estatística & dados numéricos , Unidades de Terapia Intensiva/provisão & distribução , Intubação Intratraqueal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Unidades Móveis de Saúde/estatística & dados numéricos , Doenças Profissionais/prevenção & controle , Pandemias/prevenção & controle , Admissão do Paciente/estatística & dados numéricos , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Utilização de Procedimentos e Técnicas , Respiração Artificial/estatística & dados numéricos , /etiologia
5.
Lancet ; 395(10232): 1305-1314, 2020 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-32247320

RESUMO

Fangcang shelter hospitals are a novel public health concept. They were implemented for the first time in China in February, 2020, to tackle the coronavirus disease 2019 (COVID-19) outbreak. The Fangcang shelter hospitals in China were large-scale, temporary hospitals, rapidly built by converting existing public venues, such as stadiums and exhibition centres, into health-care facilities. They served to isolate patients with mild to moderate COVID-19 from their families and communities, while providing medical care, disease monitoring, food, shelter, and social activities. We document the development of Fangcang shelter hospitals during the COVID-19 outbreak in China and explain their three key characteristics (rapid construction, massive scale, and low cost) and five essential functions (isolation, triage, basic medical care, frequent monitoring and rapid referral, and essential living and social engagement). Fangcang shelter hospitals could be powerful components of national responses to the COVID-19 pandemic, as well as future epidemics and public health emergencies.


Assuntos
Infecções por Coronavirus , Emergências , Arquitetura de Instituições de Saúde , Hospitais Especializados , Unidades Móveis de Saúde , Pandemias , Pneumonia Viral , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Controle de Custos , Surtos de Doenças , Hospitais Especializados/organização & administração , Hospitais Especializados/estatística & dados numéricos , Humanos , Controle de Infecções , Unidades Móveis de Saúde/organização & administração , Unidades Móveis de Saúde/estatística & dados numéricos , Isolamento de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia
6.
Int J Equity Health ; 19(1): 40, 2020 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-32197637

RESUMO

BACKGROUND: Mobile health clinics serve an important role in the health care system, providing care to some of the most vulnerable populations. Mobile Health Map is the only comprehensive database of mobile clinics in the United States. Members of this collaborative research network and learning community supply information about their location, services, target populations, and costs. They also have access to tools to measure, improve, and communicate their impact. METHODS: We analyzed data from 811 clinics that participated in Mobile Health Map between 2007 and 2017 to describe the demographics of the clients these clinics serve, the services they provide, and mobile clinics' affiliated institutions and funding sources. RESULTS: Mobile clinics provide a median number of 3491 visits annually. More than half of their clients are women (55%) and racial/ethnic minorities (59%). Of the 146 clinics that reported insurance data, 41% of clients were uninsured while 44% had some form of public insurance. The most common service models were primary care (41%) and prevention (47%). With regards to organizational affiliations, they vary from independent (33%) to university affiliated (24%), while some (29%) are part of a hospital or health care system. Most mobile clinics receive some financial support from philanthropy (52%), while slightly less than half (45%) receive federal funds. CONCLUSION: Mobile health care delivery is an innovative model of health services delivery that provides a wide variety of services to vulnerable populations. The clinics vary in service mix, patient demographics, and relationships with the fixed health system. Although access to care has increased in recent years through the Affordable Care Act, barriers continue to persist, particularly among populations living in resource-limited areas. Mobile clinics can improve access by serving as a vital link between the community and clinical facilities. Additional work is needed to advance availability of this important resource.


Assuntos
Unidades Móveis de Saúde/organização & administração , Unidades Móveis de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Grupos de Populações Continentais , Grupos Étnicos , Feminino , Organização do Financiamento/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoas sem Cobertura de Seguro de Saúde , Pessoa de Meia-Idade , Grupos Minoritários , Unidades Móveis de Saúde/economia , Atenção Primária à Saúde/economia , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
7.
BMC Res Notes ; 13(1): 72, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32051023

RESUMO

OBJECTIVE: Musculoskeletal disorders are one of the most important causes of disability. The aim of this study was to evaluate the prevalence of musculoskeletal disorders among the above 50-year-old population who referred to the health bus in Kermanshah. A questionnaire was used to collect data regarding musculoskeletal disorders of 589 people who voluntarily referred to the health bus. Means (SD) and range were used in descriptive statistics. RESULTS: The most prevalence of musculoskeletal complaints was related to the knee (338, 57.4%). After that, the low back pain had the most frequency (319, 54.3%). The lowest prevalence of musculoskeletal complaints was related to the thighs with a frequency of 95 (16.1%). The highest rate of musculoskeletal complaints over the past week in both genders with a frequency of 251 (59.3%) among women and 68 (41%) among men was related to the low back region The highest rate of musculoskeletal complaints over the past year was also related to the low back region, with a frequency of 220 (41%) among women and 61 (36.7%) among men. Concerning the physical health of the elderly, special attention is required for the knee joint and the low back region.


Assuntos
Dor Musculoesquelética/epidemiologia , Idoso , Estudos Transversais , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Unidades Móveis de Saúde/estatística & dados numéricos , Prevalência
8.
Can Assoc Radiol J ; 71(1): 110-116, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32063000

RESUMO

AIM: To decrease the number of mobile chest radiograph requests for inpatients in British Columbia who are medically able to tolerate transport to the main department by introducing and implementing request criteria. METHOD: Concerns regarding inappropriate mobile exam requests in patients receiving chest radiography were surveyed at 28 medical imaging sites. In response, a multidisciplinary team composed a set of mobile radiography request guidelines incorporating feedback from all sites. These were successfully implemented along with in-person education to 21 sites. The number of adult annual mobile chest radiographs was tracked from 2014 to 2018, and informal feedback was obtained from participating sites. RESULTS: The percentage of mobile chest radiographs of all chest radiographs performed between 2014 and 2018 decreased by 3.2%, while the total number of all chest radiographs performed during this time, including both departmental and mobile, increased by 1.9%. Sites reported positive engagement with the initiative and expressed need for ongoing education to optimize its effect. CONCLUSION: Implementation of request guidelines with in-person education helped to reduce inappropriate mobile exams in patients receiving chest radiographs in British Columbia between 2014 and 2018. These guidelines promote patient safety through reduced radiation exposure, empower radiographers to mitigate inappropriate requests, and help to optimize use of limited hospital resources by reducing inappropriate mobile exams where routine departmental exams are more suitable.


Assuntos
Unidades Móveis de Saúde/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Radiografia Torácica/estatística & dados numéricos , Adulto , Colúmbia Britânica , Humanos , Procedimentos Desnecessários
9.
Arch Dis Child ; 105(1): 18-25, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31270097

RESUMO

OBJECTIVE: To assess whether sustained, scheduled mobile health team (MHT) services increase antenatal care (ANC), postnatal care (PNC) and childhood immunisation in conflict-affected and remote regions of Afghanistan. DESIGN: Cross-sectional, population-based study from 2013 to 2017. Proportions were compared using multivariable linear regression adjusted for clustering and socio-demographic variables. SETTING: 54 intervention and 56 control districts in eight Afghanistan provinces. PARTICIPANTS: 338 796 pregnant women and 1 693 872 children aged under 5 years. INTERVENTIONS: 'Intervention districts' that received MHT services for 3 years compared with 'control districts' in the same province without any MHT services over the same period. MAIN OUTCOME MEASURES: District-level and clinic-level ANC, PNC, childhood immunisation (pentavalent 3, measles 1), integrated management of childhood immunisation services. RESULTS: Proportion of pregnant women receiving at least one ANC visit was higher in intervention districts (83.6%, 161 750/193 482) than control districts (61.3%, 89 077/145 314) (adjusted mean difference (AMD) 14.8%;95% CI: 1.6% to 28.0%). Proportion of children under 1 year receiving their first dose of measles vaccine was higher in intervention (73.8%, 142 738/193 412) than control districts (57.3%, 83 253/145 293) (AMD 12.8;95% CI: 2.1% to 23.5%). There was no association with PNC (AMD 2.8%;95% CI: -5.1% to 10.7%). MHTs did not increase clinic-level service provision for ANC (AMD 41.32;95% CI: -52.46 to 135.11) or any other outcomes. CONCLUSIONS: Sustained, scheduled MHT services to conflict-affected and remote regions were associated with improved coverage of important maternal and child health interventions. Outreach is an essential service and not just an 'optional extra' for the most deprived mothers and children.


Assuntos
Campanha Afegã de 2001- , Serviços de Saúde da Criança , Serviços de Saúde Materna , Unidades Móveis de Saúde , Afeganistão/epidemiologia , Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Programas de Imunização/métodos , Programas de Imunização/estatística & dados numéricos , Lactente , Recém-Nascido , Serviços de Saúde Materna/organização & administração , Serviços de Saúde Materna/estatística & dados numéricos , Vacina contra Sarampo/uso terapêutico , Unidades Móveis de Saúde/organização & administração , Unidades Móveis de Saúde/estatística & dados numéricos , Gravidez , Cobertura Vacinal/métodos , Cobertura Vacinal/estatística & dados numéricos
10.
Disaster Med Public Health Prep ; 14(1): 34-38, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31679549

RESUMO

INTRODUCTION AND OBJECTIVES: Typhoon Haiyan partially destroyed the Ormoc District Hospital in the Philippines. A field hospital was established to replace its outpatient department for 5 weeks. We investigated the reasons for medical consultation in the field hospital. METHODS: We described the consultations by sex, age, week, and diagnosis according to the Surveillance in Post-Extreme Emergencies and Disasters system. We compared the number and proportion of upper respiratory tract infections (URTIs) with a control season in 2014. RESULTS: We included 6785 consultations, 55.9% from women. The majority of consultations were communicable diseases (88.2%) followed by noncommunicable (7.1%) and injuries (5.6%). Males suffered more often from injuries than women (66.0% vs 34.0%). Consultations due to injuries decreased from 10.0% in the first to 2.9% in the last week. The most frequent diagnosis over the study period was acute respiratory infections (ARIs) (73.1%), of which 83.0% were children. The number of daily URTIs was higher than in a similar 2014 period. CONCLUSIONS: ARI was the most prevalent diagnosis. We recommend ARI treatments being fully accessible after such a disaster. During the first week, injury prevention should focus on adult men. Studies after natural disasters should include control periods to better understand disease distribution, ultimately improving the prioritization in disasters.


Assuntos
Tempestades Ciclônicas/estatística & dados numéricos , Unidades Móveis de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/tendências , Adolescente , Adulto , Criança , Pré-Escolar , Defesa Civil/métodos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Unidades Móveis de Saúde/organização & administração , Filipinas/epidemiologia , Vigilância da População/métodos , Encaminhamento e Consulta/estatística & dados numéricos
11.
BMC Health Serv Res ; 19(1): 933, 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31801526

RESUMO

BACKGROUND: Mobile (MHCs), Community (CHCs), and School-based health clinics (SBHCs) are understudied alternative sources of health care delivery used to provide more accessible primary care to disenfranchised populations. However, providing access does not guarantee utilization. This study explored the utilization of these alternative sources of health care and assessed factors associated with residential segregation that may influence their utilization. METHODS: A cross-sectional study design assessed the associations between travel distance, perceived quality of care, satisfaction-adjusted distance (SAD) and patient utilization of alternative health care clinics. Adults (n = 165), child caregivers (n = 124), and adult caregivers (n = 7) residing in New Orleans, Louisiana between 2014 and 2015 were conveniently sampled. Data were obtained via face-to face interviews using standardized questionnaires and geospatial data geocoded using GIS mapping tools. Multivariate regression models were used to predict alternative care utilization. RESULTS: Overall 49.4% of respondents reported ever using a MCH, CHC, or SBHC. Travel distance was not significantly associated with using either MCH, CHC, or SBHC (OR = 0.91, 0.74-1.11 p > .05). Controlling for covariates, higher perceived quality of care (OR = 1.02, 1.01-1.04 p < .01) and lower SAD (OR = 0.81, 0.73-0.91 p < .01) were significantly associated with utilization. CONCLUSIONS: Provision of primary care via alternative health clinics may overcome some barriers to care but have yet to be fully integrated as regular sources of care. Perceived quality and mixed-methods measures are useful indicators of access to care. Future health delivery research is needed to understand the multiple mechanisms by which residential segregation influences health-seeking behavior.


Assuntos
Acesso aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Idoso , Cuidadores , Criança , Centros Comunitários de Saúde/estatística & dados numéricos , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Louisiana , Masculino , Pessoa de Meia-Idade , Unidades Móveis de Saúde/estatística & dados numéricos , Satisfação do Paciente , Qualidade da Assistência à Saúde , Análise de Regressão , Serviços de Saúde Escolar/estatística & dados numéricos , Inquéritos e Questionários , Viagem
12.
Rev Saude Publica ; 53: 99, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31800916

RESUMO

OBJECTIVE: To evaluate the performance of the Mobile Emergency Medical Services (SAMU) in the ABC Region, using myocardial infarction as tracer condition. METHODS: The analysis of interrupted time series was the approach chosen to test immediate and gradual effects of the intervention on the study population. The research comprised adjusted monthly time series of the hospital mortality rate by myocardial infarction in the period between 2000 and 2011. Data were extracted from the Mortality Information System (SIM), using segmented regression analysis to evaluate the level and trend of the intervention before and after its implementation. To strengthen the internal validity of the study, a control region was included. RESULTS: The analysis of interrupted time series showed a reduction of 0.04 deaths per 100,000 inhabitants in the mortality rate compared to the underlying trend since the implementation of the Emergency Medical Services (p = 0.0040; 95%CI: -0.0816 - -0.0162) and a reduction in the level of 2.89 deaths per 100,000 inhabitants (p = 0.0001; 95%CI: -4.3293 - -1.4623), both with statistical significance. Regarding the control region, Baixada Santista, the difference in the result trend between intervention outcome and post-intervention control of -0.0639 deaths per 100,000 inhabitants was statistically significant (p = 0.0031; 95%CI: -0.1060 - -0.0219). We cannot exclude confounders, but we limited their presence in the study by including control region series. CONCLUSIONS: Although the analysis of interrupted time series has limitations, this modeling can be useful for analyzing the performance of policies and programs. Even though the intervention studied is not a condition that in itself implies effectiveness, the latter would not be present without the former, which, integrated with other conditions, generates a positive result. SAMU is a strategy that must be expanded when formulating and consolidating policies focusing on emergency care.


Assuntos
Ambulâncias/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Unidades Móveis de Saúde/estatística & dados numéricos , Infarto do Miocárdio/mortalidade , Adulto , Ambulâncias/normas , Brasil , Serviços Médicos de Emergência , Estudos de Viabilidade , Feminino , Humanos , Análise de Séries Temporais Interrompida , Masculino , Unidades Móveis de Saúde/normas , Qualidade da Assistência à Saúde , Valores de Referência , Análise de Regressão , Estações do Ano , Fatores Socioeconômicos , Fatores de Tempo
13.
Rev Gaucha Enferm ; 40: e20180431, 2019 Jul 29.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31365737

RESUMO

OBJECTIVE: To know the profile of service and satisfaction of users served by the Mobile Emergency Care Service (SAMU). METHODS: A cross-sectional study of the 854 services performed by the Advanced Life Support (SAV) teams from SAMU of Porto Alegre/RS, in the first quarter of 2016. A total of 164 users or respondents answered by phone to the questions regarding the service performed. Analysis performed using the Spearman and Chi-square tests. Study approved in Ethics and Research Committee of the Institutions involved. RESULTS: A higher percentage of clinical visits (48.2%) followed by trauma care (32.8%). Regarding telephone calls, 71.4% of respondents rated the service as 'very good' while the service was classified by 76.8% of the respondents. From them, 81.1% stated that the service was resolving. CONCLUSIONS: The clinical type stands out among the assistances and the users reveal satisfaction with the service provided, considering that it serves the population resolutely.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Unidades Móveis de Saúde/estatística & dados numéricos , Satisfação do Paciente , Cuidados de Suporte Avançado de Vida no Trauma/organização & administração , Estudos Transversais , Serviços Médicos de Emergência/métodos , Humanos , Telefone/estatística & dados numéricos , Fatores de Tempo
14.
J Physician Assist Educ ; 30(3): 149-154, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31385911

RESUMO

PURPOSE: Community medicine curriculum prepares physician assistant (PA) students to provide services to vulnerable and underserved populations. This article describes a service-learning model that uses a mobile health clinic (MHC) experience as part of the community medicine rotation. It provides an overview of the clinic's operation, patient documentation and characteristics, and student learning experiences. METHODS: Students collected demographic information on patients who visited the MHC during January through December 2017. The students summarized patient demographics and reflected on their experiences in a report. RESULTS: Two main outcomes are discussed: characteristics of the MHC patients and student observations about their experiences. In 2017, 113 students rotated through the MHC and recorded 813 patient encounters. The largest proportions of patients reported living on the street or in a shelter (71%) and were older than 56 years (40%), males (74%), Caucasian (43%), single (65%), nonveterans (77%), and high school graduates (41%). The top 5 reasons for visits were preventive care, cognitive/functional impairment, cardiometabolic disorders, skin issues, and respiratory illness. The MHC experience and process of recording and analyzing demographic data contributed to students' data management and analytical skills. The students identified problems of recordkeeping and their implications for patient care, gained a greater understanding of medical needs and complexities of treating the homeless, and provided suggestions for improving quality and efficiency of care. CONCLUSIONS: The MHC service-learning model provides diverse, meaningful experiences for students. Our findings benefit PA programs aiming to expand and strengthen their community medicine curriculum.


Assuntos
Unidades Móveis de Saúde/organização & administração , Assistentes Médicos/educação , Estudantes de Ciências da Saúde , Adolescente , Adulto , Eficiência Organizacional , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Unidades Móveis de Saúde/estatística & dados numéricos , Modelos Educacionais , Nevada , Assistentes Médicos/organização & administração , Melhoria de Qualidade , Adulto Jovem
15.
BMC Health Serv Res ; 19(1): 584, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426788

RESUMO

BACKGROUND: The Human Immunodeficiency Virus (HIV) epidemic is growing rapidly among South African adolescents and young adults (AYA). Although HIV counselling and testing, HIV prevention and treatment options are widely available, many AYA delay health-seeking until illness occurs, demonstrating a need for youth responsive, integrated sexual and reproductive health services (SRHS). While feasibility and cost-effectiveness have been evaluated, acceptability of mobile clinics among AYA has yet to be established. The objective of this study was to investigate patient acceptability of mobile AYA SRHS and compare mobile clinic usage and HIV outcomes with nearby conventional clinics. METHODS: Patients presenting to a mobile clinic in Cape Town were invited to participate in an acceptability study of a mobile clinic after using the service. A trained researcher administered an acceptability questionnaire. Mobile clinic medical records during the study period were compared with the records of AYA attending four clinics in the same community. RESULTS: Three hundred three enrolled participants (16-24 years, 246 (81.2%) female) rated mobile AYA SRHS acceptability highly (median = 4,6 out of 5), with 90% rating their experience as better or much better than conventional clinics. The mobile clinic, compared to conventional clinics, attracted more men (26% v 13%, p < 0,000), younger patients (18 v 19 years, p < 0,000), and yielded more HIV diagnoses (4% v 2%, p < 0,000). CONCLUSIONS: Given the high ratings of acceptability, and the preference for mobile clinics over conventional primary health clinics, the scalability of mobile clinics should be investigated as part of a multipronged approach to improve the uptake of SRHS diagnostic, prevention and treatment options for AYA.


Assuntos
Serviços de Saúde do Adolescente/estatística & dados numéricos , Unidades Móveis de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Saúde Sexual/estatística & dados numéricos , Adolescente , Análise Custo-Benefício , Aconselhamento , Serviços de Diagnóstico , Utilização de Instalações e Serviços , Feminino , Infecções por HIV/prevenção & controle , Humanos , Masculino , Satisfação do Paciente , Comportamento Sexual , África do Sul/epidemiologia , Inquéritos e Questionários , Telemedicina/estatística & dados numéricos , Adulto Jovem
16.
Stroke ; 50(7): 1911-1914, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31104620

RESUMO

Background and Purpose- Mobile Stroke Units (MSUs) provide innovative prehospital stroke care but their 24/7 operation has not been studied. Our study investigates 24/7 MSU diurnal variations related to transport frequency, patient characteristics, and stroke treatments. Methods- We compared transportation frequency, demographics, thrombolytic and mechanical thrombectomy administration, and treatment metrics across 8-hour shifts (morning, evening, and nocturnal) from our 24/7 MSU in Northwest Ohio prospective database. Results- One hundred ninety-five patients were transported by the MSU. Most transports occurred during the morning shift (52.3%) followed by evening shift (35.8%) and nocturnal shift (11.9%; Ptrend<0.001). Twenty-three patients (11.9%) received intravenous thrombolytic in the MSU, most frequently in the morning shift (56.5%). No cases of mechanical thrombectomy were performed on MSU patients in the nocturnal shift. Conclusions- Morning and evening shifts account for the majority of our MSU transports (88.1%) and therapeutic interventions. Understanding temporal variations in a resource-intensive MSU is critical to its worldwide implementation.


Assuntos
Unidades Móveis de Saúde/estatística & dados numéricos , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/tratamento farmacológico , Bases de Dados Factuais , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ohio/epidemiologia , Fatores Socioeconômicos , Acidente Vascular Cerebral/epidemiologia , Trombectomia , Terapia Trombolítica , Fatores de Tempo , Ativador de Plasminogênio Tecidual/uso terapêutico , Transporte de Pacientes
17.
Midwifery ; 72: 14-22, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30771606

RESUMO

BACKGROUND: The developing world has a significantly high risk of women and babies dying during childbirth. Interprofessional simulation training has improved birth practices and outcomes by impacting clinical and non-technical skills like communication, teamwork, leadership and effective use of resources. While these programs have become a training requirement in many high-income countries, they have not been widely introduced in the low-income, low-resource settings. QUESTION: To explore the use of a structured obstetric and neonatal emergency simulation training program in India. AIM: The aim was to identify the challenges faced by birthing staff in their clinical practice and the key messages learnt from the simulation programs that are applicable to their clinical practices. METHODS: Mobile interprofessional obstetric and neonatal workshops were piloted in three locations (metropolitan, primary rural and secondary hospitals) of India for medical and midwifery staff, and students. Using a pre-post workshop survey design, participants were asked to describe their role and challenges in their birth practice and the key learning acquired by the program. FINDINGS: Eight workshops were conducted across three sites involving a total of 150 participants. Participants at all sites described maintaining safety of women and babies as their key role. Their main challenge was lack of availability of medical back up, resources, structured training and poor compliance from women. The key learning was gaining knowledge and procedural skills, non-technical skills, a systematic approach to obstetric and neonatal emergencies and learning in teams through simulation. IMPLICATIONS FOR PRACTICE: Mobile obstetric and neonatal simulation training workshops were useful for medical and midwifery staff, and students in different health settings in India and may have a role as a routine training tool for health professionals involved in childbirth.


Assuntos
Unidades Móveis de Saúde/estatística & dados numéricos , Enfermagem Obstétrica/educação , Treinamento por Simulação/métodos , Competência Clínica/normas , Feminino , Humanos , Índia , Unidades Móveis de Saúde/organização & administração , Simulação de Paciente , Projetos Piloto , Gravidez , Avaliação de Programas e Projetos de Saúde/métodos , Pesquisa Qualitativa , Treinamento por Simulação/organização & administração
18.
J Behav Med ; 42(5): 883-897, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30635862

RESUMO

Linkage to care from mobile clinics is often poor and inadequately understood. This multimethod study assessed linkage to care and antiretroviral therapy (ART) uptake following ART-referral by a mobile clinic in Cape Town (2015/2016). Clinic record data (N = 86) indicated that 67% linked to care (i.e., attended a clinic) and 42% initiated ART within 3 months. Linkage to care was positively associated with HIV-status disclosure intentions (aOR: 2.99, 95% CI 1.13-7.91), and treatment readiness (aOR: 2.97, 95% CI 1.05-8.34); and negatively with good health (aOR: 0.35, 95% CI 0.13-0.99), weekly alcohol consumption (aOR: 0.35, 95% CI 0.12-0.98), and internalised stigma (aOR: 0.32, 95% CI 0.11-0.91). Following linkage, perceived stigma negatively affected ART-initiation. In-depth interviews (N = 41) elucidated fears about ART side-effects, HIV-status denial, and food insecurity as barriers to ART initiation; while awareness of positive ART-effects, follow-up telephone counselling, familial responsibilities, and maintaining health to avoid involuntary disclosure were motivating factors. Results indicate that an array of interventions are required to encourage rapid ART-initiation following mobile clinic HIV-testing services.


Assuntos
Uso de Medicamentos/estatística & dados numéricos , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Unidades Móveis de Saúde/estatística & dados numéricos , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Motivação , Encaminhamento e Consulta , África do Sul , Adulto Jovem
19.
Community Ment Health J ; 55(3): 394-400, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29948626

RESUMO

Mobile mental health crisis programs are a widely used and valuable community resource. Literature analyzing the service, however, is sparse and descriptive in nature. This study uses multinomial logistic regression to analyze clinical data from a mobile crisis program in Pennsylvania over 12 months. 793 individuals recommended to various levels of care were analyzed. Clinical and demographic presentations were used as predictor variables and level of care recommendation as outcome variable. Several clinical presentations were found to increase the likelihood of various levels of care recommendations. These findings are discussed in light of current suicide intervention and data-driven practice.


Assuntos
Serviços Comunitários de Saúde Mental/normas , Intervenção na Crise , Unidades Móveis de Saúde/normas , Assistência ao Paciente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Unidades Móveis de Saúde/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Pennsylvania/epidemiologia , Guias de Prática Clínica como Assunto , Adulto Jovem
20.
Mil Med ; 184(5-6): e168-e171, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30534976

RESUMO

INTRODUCTION: The 2010-2011 withdrawal from Iraq included the closure of all fixed-facility military medical resources. Operation INHERENT RESOLVE, the United States-led counter-terrorism mission in Iraq and Syria, subsequently commenced in 2014. With increasing combat operations, the 28th Combat Support Hospital deployed to Iraq to support that mission as a limited footprint unit prototyped after the new modular Army Field Hospital. We describe the non-battle utilization of the emergency medical treatment section. METHODS: We prospectively collected data for this project as part of a performance improvement initiative to track healthcare utilization to guide emergency medical treatment section staffing. The project took place at a combat support hospital near Baghdad, Iraq from July 2016 through January 2017. RESULTS: During this time, the emergency department (ED) averaged 3.5 visits per day totaling 675 non-battle encounters. Most (84.6%) were U.S. military personnel with a median age of 32 (IQR 26-38). The most common procedure performed was point-of-care ultrasound (n = 33). Most patients (96.9%) underwent discharge from the ED. Of the 21 subjects admitted, 6 were for surgical intervention and the remaining for medical or observational indications. The most common chief complaints were musculoskeletal (31.1%, n = 210), respiratory (15.3%, n = 103), and dermatologic (12.0%, n = 81). CONCLUSIONS: Non-battle injuries and illnesses were the predominant reason for ED utilization. Most subjects were discharged back to duty with relatively low-resource utilization. Few visits required procedural interventions.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Militares/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Campanha Afegã de 2001- , Serviço Hospitalar de Emergência/classificação , Serviço Hospitalar de Emergência/organização & administração , Feminino , Hospitais Militares/classificação , Hospitais Militares/organização & administração , Humanos , Guerra do Iraque 2003-2011 , Masculino , Unidades Móveis de Saúde/organização & administração , Unidades Móveis de Saúde/estatística & dados numéricos , Estados Unidos , Guerra/estatística & dados numéricos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA