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1.
Thorac Surg Clin ; 32(1): 33-42, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34801193

RESUMO

Social disparities in lung cancer diagnosis, treatment, and survival have been studied using national databases, statewide registries, and institution-level data. Some disparities emerge consistently, such as lower adherence to treatment guidelines and worse survival by race and socioeconomic status, whereas other disparities are less well studied. A critical appraisal of current data is essential to increasing equity in lung cancer care.


Assuntos
Disparidades em Assistência à Saúde , Neoplasias Pulmonares , Fidelidade a Diretrizes , Humanos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/terapia , Sistema de Registros , Classe Social
2.
Sci Rep ; 11(1): 21844, 2021 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-34737319

RESUMO

This study assesses attitudes towards COVID-19 vaccination and the predictive value of COVID-VAC, a novel scale, among adults in the four largest US metropolitan areas and nationally. A 36-item survey of 6037 Americans was conducted in mid-April 2021. The study reports factors for COVID-19 vaccine acceptance among: (1) already vaccinated; (2) unvaccinated but willing to accept a vaccine; and (3) unvaccinated and unwilling to vaccinate. More than 20% were unwilling to vaccinate, expressing concerns about vaccine efficacy and safety and questioning the disease's severity. Poverty, working outside of the home and conservative political views are predictors of unwillingness. Conversely, those who either personally tested positive for COVID-19, or had a family member who did so, were more likely to accept vaccination. Majorities of all respondents supported vaccination mandates for employees and university students. Respondents preferred to receive vaccines in their doctor´s office. Lower income and conservative ideology, but not race, were strongly associated with vaccine unwillingness. The predictive value of COVID-VAC was demonstrated. While vaccination mandates are likely to be accepted, additional effective, targeted interventions to increase vaccine uptake are needed urgently.


Assuntos
COVID-19/psicologia , Recusa de Vacinação/psicologia , Recusa de Vacinação/tendências , Adulto , Atitude , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/provisão & distribuição , Feminino , Fidelidade a Diretrizes/tendências , Política de Saúde/tendências , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/patogenicidade , Inquéritos e Questionários , Estados Unidos , Vacinação/psicologia , Vacinação/tendências , Vacinas/farmacologia
3.
Sci Rep ; 11(1): 21700, 2021 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-34737373

RESUMO

With recurring waves of the Covid-19 pandemic, a dilemma facing public health leadership is whether to provide public advice that is medically optimal (e.g., most protective against infection if followed), but unlikely to be adhered to, or advice that is less protective but is more likely to be followed. To provide insight about this dilemma, we examined and quantified public perceptions about the tradeoff between (a) the stand-alone value of health behavior advice, and (b) the advice's adherence likelihood. In a series of studies about preference for public health leadership advice, we asked 1061 participants to choose between (5) strict advice that is medically optimal if adhered to but which is less likely to be broadly followed, and (2) relaxed advice, which is less medically effective but more likely to gain adherence-given varying infection expectancies. Participants' preference was consistent with risk aversion. Offering an informed choice alternative that shifts volition to advice recipients only strengthened risk aversion, but also demonstrated that informed choice was preferred as much or more than the risk-averse strict advice.


Assuntos
COVID-19/psicologia , Fidelidade a Diretrizes/tendências , Disseminação de Informação/métodos , Adolescente , Adulto , Idoso , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Saúde Pública/tendências , Política Pública/tendências , Comportamento de Redução do Risco , SARS-CoV-2/patogenicidade
4.
Sci Rep ; 11(1): 21675, 2021 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-34737389

RESUMO

The recent outbreak of the COVID-19 led to death of millions of people worldwide. To stave off the spread of the virus, the authorities in the US employed different strategies, including the mask mandate order issued by the states' governors. In the current work, we defined a parameter called average death ratio as the monthly average of the number of daily deaths to the monthly average number of daily cases. We utilized survey data to quantify people's abidance by the mask mandate order. Additionally, we implicitly addressed the extent to which people abide by the mask mandate order, which may depend on some parameters such as population, income, and education level. Using different machine learning classification algorithms, we investigated how the decrease or increase in death ratio for the counties in the US West Coast correlates with the input parameters. The results showed that for the majority of counties, the mask mandate order decreased the death ratio, reflecting the effectiveness of such a preventive measure on the West Coast. Additionally, the changes in the death ratio demonstrated a noticeable correlation with the socio-economic condition of each county. Moreover, the results showed a promising classification accuracy score as high as 90%.


Assuntos
COVID-19/mortalidade , COVID-19/prevenção & controle , Máscaras/tendências , California , Fidelidade a Diretrizes/tendências , Política de Saúde , Humanos , Aprendizado de Máquina , Máscaras/estatística & dados numéricos , Oregon , SARS-CoV-2/patogenicidade , Washington
5.
Artigo em Inglês | MEDLINE | ID: mdl-34769642

RESUMO

(1) Background: Numerous educational interventions have been conducted to improve hand hygiene (HH) compliance and effectiveness among nursing students, with mixed results. The aim is to evaluate the effectiveness of posters as a teaching tool and factors associated with HH quality. (2) Methods: A pre-post experimental intervention study was conducted with a total of 293 nursing students randomly assigned to two groups (experimental and control) who, before and after HH, took cell culture samples from their non-dominant hands. Only the experimental group was exposed to the poster. (3) Results: In the experimental group, significant differences were observed among students older than 22 years (p = 0.017; V = 0.188), with a higher percentage of failures (15.7% vs. 3.6%). Poster displaying was associated with passing, other variables being equal, although without statistical significance (ORa = 2.07; 95% CI = 0.81-5.26). Pre-practice hand contamination was weakly associated with lower HH quality (ORa = 0.99, 95% CI = 0.99-0.99). (4) Conclusions: The use of posters as a teaching method shows indications of efficacy. Prior hand contamination slightly affects the quality of HH. Further evaluation of teaching methods is needed to ensure good technical performance of HH to prevent the spread of infectious diseases during the COVID-19 pandemic.


Assuntos
COVID-19 , Infecção Hospitalar , Higiene das Mãos , Estudos de Casos e Controles , Fidelidade a Diretrizes , Desinfecção das Mãos , Humanos , Pandemias , SARS-CoV-2 , Estudantes
6.
Infect Dis Clin North Am ; 35(4): 1055-1075, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34752220

RESUMO

Health care-acquired viral respiratory infections are common and cause increased patient morbidity and mortality. Although the threat of viral respiratory infection has been underscored by the coronavirus disease 2019 (COVID-19) pandemic, respiratory viruses have a significant impact in health care settings even under normal circumstances. Studies report decreased nosocomial transmission when aggressive infection control measures are implemented, with more success noted when using a multicomponent approach. Influenza vaccination of health care personnel furthers decrease rates of transmission; thus, mandatory vaccination is becoming more common. This article discusses the epidemiology, transmission, and control of health care-associated respiratory viral infections.


Assuntos
Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/virologia , Infecções Respiratórias/prevenção & controle , Infecções Respiratórias/virologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Fidelidade a Diretrizes , Pessoal de Saúde/normas , Humanos , Controle de Infecções/normas , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/transmissão , SARS-CoV-2/patogenicidade , Vacinação , Vírus/classificação , Vírus/patogenicidade
7.
Rev Esp Salud Publica ; 952021 Nov 19.
Artigo em Espanhol | MEDLINE | ID: mdl-34795201

RESUMO

OBJECTIVE: Hand Hygiene (HH) is the most important measure to prevent healthcare-associated infections. The aim of this study was to determine the impact of the COVID-19 pandemic on the degree of compliance (DC) of HH in an Emergency Department (ED). METHODS: Cross-sectional study. DC of HH in the ED was calculated from 2005 to 2021. We studied the association between DC of HH and different variables (age, sex, status, ED area, time of WHO, etc.) by calculating the Odds Ratio (OR) and its 95% confidence interval (95%CI). To study the impact of the pandemic, we compared the C of HH before and after the onset of the COVID-19 pandemic, calculated the OR and its 95%CI. RESULTS: DC of HH increased to 75.9% (95%CI: 68.6%-83.2%) in the period after pandemic onset from the previous baseline period of 48.9% (95%CI: 43.4%-54.5%) (p<0.001). Factors significantly and independently associated with DC of HH were time period (before or after pandemic), attending training sessions, having alcohol solution in pocket format and WHO moments 3,4 and 5. CONCLUSIONS: DC of HH in the ED has reached the highest value in 17 years of monitoring following the COVID-19 pandemic. This increase reflects a very positive change in the behavior of healthcare personnel with respect to HH.


Assuntos
COVID-19 , Infecção Hospitalar , Higiene das Mãos , Estudos Transversais , Atenção à Saúde , Serviço Hospitalar de Emergência , Fidelidade a Diretrizes , Pessoal de Saúde , Humanos , Pandemias/prevenção & controle , SARS-CoV-2 , Espanha/epidemiologia
8.
Pan Afr Med J ; 40: 56, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34795835

RESUMO

Introduction: medication error has become a global problem. Medication administration that is error free is important in achieving positive outcomes in patient's care. This study assessed adherence to medication administration guidelines among nurses in a health facility in South-West Nigeria. Methods: a cross-sectional descriptive study was carried out on 75 nurses involved in oral medication administration. Data was collected using direct observation method with an observational checklist developed from literature. Data analysis was done using frequency, percentage, Mean and Standard Deviation. Test of relationship was carried out using Kruskal-Wallis Test and Mann Whitney Test at 0.05 (p<0.05) level of significance. Results: almost an average (49.3%) of participants did not provide information about the medication. More than 1/3rd (38.7%) did not perform right assessment where necessary. The majority (76.0%) did not serve correct medication. Overall level of non-adherence was 48%. Adherence to medication administration guidelines was significantly related to age (χ2 = 9.673, p<0.05), marital status (χ2 = 9.426, p<0.05), years of experience (U=404.000 Z=2.7622, p<0.05), type of shift (χ2 = 6.314, p<0.05), nurses-patient ratio (χ2 = 11.598, p<0.05). Conclusion: some nurses did not adhere strictly to the guidelines of medication administration. Adherence to medication administration guidelines was related to age, marital status, years of experience, type of shift and nurse-patient ratio. Poor adherence to medication administration guidelines may jeopardize patient safety. There is need for development of a universal medication procedure/protocol and continuous education of nurses on medication administration practices.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Erros de Medicação/prevenção & controle , Enfermeiras e Enfermeiros/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Administração Oral , Adulto , Fatores Etários , Lista de Checagem , Estudos Transversais , Feminino , Humanos , Masculino , Estado Civil , Pessoa de Meia-Idade , Nigéria , Enfermeiras e Enfermeiros/normas , Preparações Farmacêuticas/administração & dosagem
9.
Pan Afr Med J ; 40: 63, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34804331

RESUMO

The objectives of this study were to explore the content of web-based communication on COVID-19 by religious authorities (RAs) in Uganda and to assess the level of integration of the Uganda Ministry of Health (MoH) and World Health Organisation (WHO) COVID-19 risk communication guidelines into the statements released by these RAs. A grey literature review was conducted by searching the websites of intra- and inter-religious bodies for the terms "COVID-19" and "coronavirus". Thematic analysis was used to assess the content of RA statements which were also mapped to the items of the MoH and WHO statements. Results indicate that RA communications were centred on COVID-19 description and management; the need to adhere to established guidelines; and the adoption of health-protective behaviours, notably, social distancing and avoidance of misinformation. RAs also discussed the effects of COVID-19 and its control measures on the population and spoke against pandemic-aggravated injustices (gender-based violence and embezzlement). The RA messages incorporated the WHO statement to a greater extent than the MoH statement. In conclusion, RAs played a critical role in delivering public health messages in Uganda during the COVID-19 pandemic, a position we believe should be maximized by public health authorities for effective communication during emergencies.


Assuntos
COVID-19/prevenção & controle , Comunicação , Saúde Pública , Fidelidade a Diretrizes , Guias como Assunto , Humanos , Internet , Religião , Uganda
10.
Pan Afr Med J ; 39: 287, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34754364

RESUMO

In Tunisia, Hospital sterilization guidelines recommend the establishment of a quality assurance system. The purpose of this study is to give an overview of the situation in a sterilization unit in order to assess the adherence to good practice criteria and to identify opportunities for improvement. We conducted a prospective study in the sterilization unit of the Hospital Tahar Sfar, Mahdia in 2019. Two internal audits were conducted under the same conditions and were carried out one year apart. The first audit identified failures and malfunctions and the outlining of an action plan. The impact of the measures undertaken was tested using a second audit. Data collection was carried out by direct observation of the existing resources and practices. Compliance rate was calculated taking into account compliant criteria and applicable criteria. The results of the first audit revealed a compliance rate of around 28.1%. The analysis used to observe deviations made it possible to identify 5 axes of improvement, in particular the implementation of a system of documentation and a quality management system. In total, we prepared 14 documents related to the managerial processes, 26 to the operational processes and 41 to the support processes. The actions put in place enabled to achieve a compliance rate of 60.4%. The approach taken to upgrade sterilization processes made it possible to standardize them while ensuring traceability.


Assuntos
Hospitais/normas , Garantia da Qualidade dos Cuidados de Saúde , Esterilização/normas , Fidelidade a Diretrizes , Guias como Assunto , Humanos , Auditoria Administrativa , Estudos Prospectivos , Melhoria de Qualidade , Tunísia
12.
BMC Surg ; 21(1): 404, 2021 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-34814898

RESUMO

BACKGROUND: Open reduction internal fixation (ORIF) of closed fractures is a required indication for surgical antimicrobial prophylaxis (SAP). Guidelines contain recommendations on how best to prescribe SAP, however, adherence to SAP guidelines remains suboptimal. The Australian Therapeutic Guidelines: Antibiotic v16 (updated April 2019) advocates for single dose prophylaxis for ORIF procedures. There is a paucity of information on how SAP is prescribed for ORIF of closed fractures in Australian hospitals. The aim of this study was to identify prescribing practice and to evaluate guideline adherence pre- and post-guideline update. METHODS: A retrospective audit was conducted for patients undergoing an ORIF of closed fractures at a metropolitan teaching hospital in a 6-month period during 2018 (pre-guideline update) and 2019 (post-guideline update). Data were collected on prescribing practice (perioperative antibiotics prescribed, dose, time and route of administration and duration of prophylaxis) and compared to SAP recommendations in Therapeutic Guidelines: Antibiotic v15 (2018) and v16 (2019). Descriptive statistics and Chi square tests were used to report categorical variables. Binary logistic regression was used to identify factors associated with guideline adherence. A p-value < 0.05 was deemed statistically significant. RESULTS: Data were collected for a total of 390 patients (n = 185, 2018; n = 205, 2019). Cefazolin was the most commonly prescribed antibiotic as per guideline recommendations, with variable, yet appropriate doses observed across the two audit periods. While 78.3% of patients received SAP for the correct duration in 2018, only 20.4% of patients received single dose prophylaxis in 2019. Overall adherence to guidelines was 63.2% in the 2018, and 18.0% in the 2019 audit periods respectively. Patient age was significantly associated with an increase in overall guideline adherence, while lower limb fractures, an American Society of Anesthesiologists (ASA) score of 3 and emergency admissions were associated with decreased overall adherence to SAP guidelines. CONCLUSION: Adherence to guidelines was greater with v15 (2018) compared with v16 (2019). Patient factors, including limb fracture site and ASA score, had little impact on guideline adherence. Further research is required to understand what influences guideline adherence in the orthopaedic setting.


Assuntos
Anti-Infecciosos , Antibioticoprofilaxia , Antibacterianos/uso terapêutico , Austrália , Fidelidade a Diretrizes , Hospitais Urbanos , Humanos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle
14.
Int J Public Health ; 66: 614602, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34744578

RESUMO

Objective: To evaluate the effectiveness of a university tobacco-free policy by examining differences in students' attitudes, perceptions of compliance and policy benefits, after one year of the policy's implementation. Methods: Cross-sectional studies were undertaken to collect data pre- and 1 year post-policy implementation. The two samples were selected using stratified random sampling. Results: The prevalence of smoking decreased from 26% pre-policy implementation to 21% 1 year after (p = 0.035). The proportion of smokers who thought the policy had contributed to a reduction in smoking frequency increased from 10% to 70% (p < 0.001). Smokers' support for the policy rose from 42 to 58% (p = 0.007). Conclusion: Against the background of a strongly pro-tobacco environment in Lebanon, it is possible to create a positive change in the mindset of smokers at the levels of the education and smoking cessation and more efforts should be expended to bring it about.


Assuntos
Política Antifumo , Estudantes , Atitude Frente a Saúde , Estudos Transversais , Fidelidade a Diretrizes , Humanos , Líbano/epidemiologia , Percepção , Fumar/epidemiologia , Estudantes/psicologia , Inquéritos e Questionários , Universidades
15.
Pan Afr Med J ; 39: 227, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34630839

RESUMO

Introduction: as the COVID-19 pandemic rages on, sub-Saharan Africa remains at high risk given the poor adherence to pandemic control protocols. Misconceptions about the contagion may have given rise to adverse risk behaviours across population groups. This study evaluates risk perception among 2,244 residents of seven countries in sub-Saharan Africa (Botswana, Kenya, Malawi, Nigeria, Tanzania, Zambia and Zimbabwe) in relation to socio-demographic determinants. Methods: an online survey was conducted via social media platforms to a random sample of participants. Risk perception was evaluated across six domains: loss of income, food scarcity, having a relative infected, civil disorder, criminal attacks, or losing a friend or relative to COVID-19. A multivariable ordinal logistic regression was conducted to assess socio-demographic factors associated with the perceived risk of being affected by COVID-19. Results: 595 (27%) respondents did not consider themselves to be at risk, while 33% perceived themselves to be at high risk of being affected by the pandemic with respect to the six domains evaluated. Hospital-based workers had the highest proportional odds (3.5; 95%CI: 2.3-5.6) high perceived risk. Teenage respondents had the highest predictive probability (54.6%; 95% CI: 36.6-72.7%) of perceiving themselves not to be at risk of being affected by COVID-19, while Zambia residents had the highest predictive probability (40.7%; 95% CI: 34.3-47.0%) for high-risk perception. Conclusion: this study reveals the need to increase awareness of risks among socio-demographic groups such as younger people and the unemployed. Targeted risk communication strategies will create better risk consciousness, as well as adherence to safety measures.


Assuntos
COVID-19/epidemiologia , Fidelidade a Diretrizes , Assunção de Riscos , Adulto , África ao Sul do Saara , Fatores Etários , COVID-19/psicologia , Comunicação , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Recursos Humanos em Hospital/estatística & dados numéricos , Probabilidade , Fatores de Risco , Inquéritos e Questionários , Desemprego , Adulto Jovem
16.
BMC Infect Dis ; 21(1): 1080, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34666686

RESUMO

BACKGROUND: HIV-infected persons are at increased risk of developing tuberculosis and Isoniazid preventive therapy has been shown to reduce the occurrence of tuberculosis among this group of persons. M-health technology has been reported to increase both knowledge and implementation of various health services including Isoniazid preventive therapy implementation. This study aimed to determine the effect of m-health on health worker knowledge and adherence to isoniazid preventive therapy (IPT) guidelines and on patient knowledge and adherence to isoniazid treatment. METHODS: This was a quasi-experimental study that was carried out in six health facilities in Ebonyi State, southeast Nigeria. Three health facilities were assigned to each arm (intervention and control arms) and all eligible health workers (total population of 45 and 41 in intervention and control arms respectively) were recruited. Data were also collected from 200 patients (100 per arm). The intervention consisted of mobile phone messages and reminders for health workers on the IPT guideline. Chi-square test was carried out at p < 0.05 and 95% confidence interval. RESULTS: At baseline, 54.5% and 63.4% of health workers in intervention and control arms respectively had good knowledge which improved significantly to 90.2% in the intervention arm after the intervention (χ2 = 14.22, p < 0.0001). At baseline, 61.4% and 90.2% of health workers had good adherence to the guideline in intervention and control arms respectively which also improved in the intervention arm by 28.8% after intervention although not significant(χ2 = 0.37, p = 0.54). More than 50% of the patients in both study arms had poor knowledge, with the intervention arm having a significantly higher proportion of respondents (68.0%) with poor knowledge at baseline (χ2 = 4.71, p = 0.03). The proportion of patients with good knowledge however increased significantly (88.8%) in the intervention arm after intervention (χ2 = 25.65, p < 0.001). Patients had good adherence to IPT in intervention and control arms before (100% and 84.2% respectively) and after (96.6% and 100% respectively) the study. There was no significant difference in adherence among patients in both arms. CONCLUSIONS: Health worker knowledge and practice of guidelines as well as patient knowledge improved in the intervention arm in this study. These findings suggest the consideration for the inclusion of mobile phone reminders in the guideline for tuberculosis prevention among HIV patients.


Assuntos
Telefone Celular , Infecções por HIV , Tuberculose , Antituberculosos/uso terapêutico , Fidelidade a Diretrizes , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Humanos , Isoniazida/uso terapêutico , Nigéria , Tuberculose/prevenção & controle
17.
Gac Med Mex ; 157(3): 313-317, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34667322

RESUMO

INTRODUCTION: During the COVID-19 pandemic, adherence to hygiene measures is an objective aimed at reducing morbidity and mortality. OBJECTIVE: To evaluate adherence to hand hygiene and protection measures during the COVID-19 pandemic in a tertiary care hospital. METHODS: Cross-sectional study on health personnel handwashing at the five moments recommended by the World Health Organization, as well as on the use of specific personal protective equipment. RESULTS: One hundred and seventeen hand hygiene opportunities were observed in health personnel. Hand washing was observed in 40 (34 %) and omission in 76 (65 %). Adherence to the use of face shield was observed in five (4 %), and lack of adherence in 112 (96%). Adherence to the use of face mask was observed in 65 nursing professionals (87 %), with appropriate use of the mask in 56 of them (60 %) and use of face shield in one (1 %). CONCLUSION: Health personnel showed low proportions of adherence to hand hygiene and use of equipment for specific protection during the COVID-19 pandemic.


Assuntos
COVID-19/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Higiene das Mãos/estatística & dados numéricos , Equipamento de Proteção Individual/estatística & dados numéricos , Recursos Humanos em Hospital/estatística & dados numéricos , Estudos Transversais , Feminino , Higiene das Mãos/normas , Humanos , Masculino , Recursos Humanos em Hospital/normas , Estudos Prospectivos , Centros de Atenção Terciária , Fatores de Tempo
18.
JAMA ; 326(15): 1516-1523, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34665198

RESUMO

Importance: Clinicians may rely on recommendations from clinical practice guidelines for management of patients. Observations: A clinical practice guideline is a published statement that includes recommendations that are intended to optimize patient care. In the guideline development process, a panel of experts formulates recommendation questions that guide the retrieval of evidence that is used to inform the recommendations. Typically, methods of guideline development, a summary of the supporting evidence, and a justification of the panel's decisions accompany the recommendations. To use such guidelines optimally, clinicians must understand the implications of the recommendations, assess the trustworthiness of the development process, and evaluate the extent to which the recommendations are applicable to patients in their practice settings. Helpful recommendations are clear and actionable, and explicitly specify whether they are strong or weak, are appropriate for all patients, or depend on individual patients' circumstances and values. Rigorous guidelines and recommendations are informed by appropriately conducted, up-to-date systematic reviews that consider outcomes important to patients. Because judgments are involved in the interpretation of the evidence and the process of moving from evidence to recommendations, useful guidelines consider all relevant factors that have a bearing in a clinical decision and are not influenced by conflicts of interest. Conclusions and Relevance: In considering a guideline's recommendations, clinicians must decide whether there are important differences between the factors the guideline panel has considered in making recommendations and their own practice setting.


Assuntos
Fidelidade a Diretrizes , Guias de Prática Clínica como Assunto , Medicina Baseada em Evidências , Humanos , Padrões de Prática Médica , Revisões Sistemáticas como Assunto/normas , Resultado do Tratamento
19.
Rev Esc Enferm USP ; 55: e20210104, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34605536

RESUMO

OBJECTIVE: to identify whether nursing professionals carry out hand hygiene, how they do it, and what resources are available for this practice during home visits. METHOD: cross-sectional study conducted in a public Home Care service. The World Health Organization instrument was used to observe the hand hygiene technique, the time of performance, and the product used. RESULTS: a total of 940 hand hygiene opportunities taking place in 231 home visits were observed. Overall adherence was 14.4%, with the practice of hand hygiene being higher after contact with the patient (53.7%). Before aseptic procedures, after risk/exposure to body fluids, after contact with the patient's environment, and before contact with the patient, adherence was 0.4%. Regarding the quality of the technique, in none of the 135 practices the recommended steps were followed. As for the structure available in the households, 35 (15.2%) had accessible sinks and none had liquid soap and alcohol-based formulation. CONCLUSION: adherence to hand hygiene by nursing professionals in home care was low, the technique was not performed, and households did not have resources for the practice.


Assuntos
Infecção Hospitalar , Higiene das Mãos , Serviços de Assistência Domiciliar , Estudos Transversais , Fidelidade a Diretrizes , Desinfecção das Mãos , Humanos
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