Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.601
Filtrar
1.
BMC Prim Care ; 23(1): 329, 2022 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-36526976

RESUMO

BACKGROUND: Incident depression is associated with coronary heart disease (CHD) and increased morbidity and mortality. Treatment of depression with antidepressants and psychotherapy can be beneficial for these patients to reduce the risk of further CHD events. Ongoing management of CHD and depression mainly occurs in the community, but little is known about the identification and care of patients with comorbid CHD and depression in general practice. This study explores the prescription of antidepressants for these patients by sociodemographic variables. METHODS: This is an open cohort study with de-identified data based on electronic medical records of 880,900 regular patients aged 40 + years from a national general practice database in Australia (MedicineInsight). Data from 2011-2018 was used to classify patients as newly recorded CHD (CHD recorded in 2018 but not in previous years), previously recorded CHD (CHD recorded between 2011-2017) or no recorded history of CHD. Antidepressant prescribing in 2018 considered active ingredients and commercial brand names. The association between sociodemographic variables and antidepressant prescribing was tabulated according to the CHD status. RESULTS: The proportion of current depression among patients with newly recorded CHD was 11.4% (95%CI 10.3-12.6), 10.5% among those with previously recorded CHD (95%CI 10.0-11.1) and 9.6% among those with no recorded history of CHD (95%CI 9.2-10.1). Antidepressant prescribing was slightly higher among those with newly recorded CHD (76.4%; 95%CI 72.1-80.6) than among those with previously recorded CHD (71.6%; 95%CI 69.9-73.2) or no history of CHD (69.5%; 95%CI 68.6-70.4). Among males with newly recorded CHD and depression, antidepressant prescribing was more frequent in major cities or inner regional areas (~ 81%) than in outer/remote Australia (66.6%; 95% CI 52.8-80.4%). CONCLUSIONS: Although antidepressant prescribing was slightly greater in those with newly recorded CHD compared to those with depression alone, its clinical significance is uncertain. Much larger differences in prescribing were seen by geographic location and could be addressed by innovations in clinical practice.


Assuntos
Doença das Coronárias , Medicina Geral , Gerenciamento da Prática Profissional , Masculino , Humanos , Depressão/tratamento farmacológico , Estudos de Coortes , Antidepressivos/uso terapêutico , Austrália/epidemiologia , Doença das Coronárias/epidemiologia
2.
BMC Health Serv Res ; 22(1): 1203, 2022 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-36163048

RESUMO

BACKGROUND: Midwifery group practice (MGP) has consistently demonstrated optimal health and wellbeing outcomes for childbearing women and their babies. In this model, women can form a relationship with a known midwife, improving both maternal and midwife satisfaction. Yet the model is not widely implemented and sustained, resulting in limited opportunities for women to access it. Little attention has been paid to how MGP is managed and led and how this impacts the sustainability of the model. This study clarifies what constitutes optimal management and leadership and how this influences sustainability. METHODS: This qualitative study forms part of a larger mixed methods study investigating the management of MGP in Australia. The interview findings presented in this study are part of phase one, where the findings informed a national survey. Nine interviews and one focus group were conducted with 23 MGP managers, clinical midwife consultants, and operational/strategic managers who led MGPs. Transcripts of the audio-recordings were analysed using inductive, reflexive, thematic analysis. RESULTS: Three themes were constructed, namely: The manager, the person, describing the ideal personal attributes of the MGP manager; midwifing the midwives, illustrating how the MGP manager supports, manages, and leads the group practice midwives; and gaining acceptance, explaining how the MGP manager can gain acceptance beyond group practice midwives. Participants described the need for MGP managers to display midwife-centred management. This requires the manager to have qualities that mirror what is generally accepted as requirements for good midwifery care namely: core beliefs in feminist values and woman-centred care; trust; inclusiveness; being an advocate; an ability to slow down or take time; an ability to form relationships; and exceptional communication skills. Since emotional labour is a large part of the role, it is also necessary for them to encourage and practice self-care. CONCLUSIONS: Managers need to practice in a way that is midwife-centred and mimics good midwifery care. To offset the emotional burden and improve sustainability, encouraging and promoting self-care practices might be of value.


Assuntos
Prática de Grupo , Tocologia , Gerenciamento da Prática Profissional , Austrália , Continuidade da Assistência ao Paciente , Feminino , Humanos , Liderança , Gravidez , Pesquisa Qualitativa
3.
Injury ; 53(11): 3569-3574, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36038390

RESUMO

BACKGROUND: Angioembolization is an important adjunct in the non-operative management of adult trauma patients with splenic injury. Multiple studies have shown that angioembolization may increase the non-operative splenic salvage rate for patients with high-grade splenic injuries. We performed a systematic review and developed evidence-based recommendations regarding the need for post-splenectomy vaccinations after splenic embolization in trauma patients. METHODS: A systematic review and meta-analysis of currently available evidence were performed utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. RESULTS: Nine studies were identified and analyzed. A total of 240 embolization patients were compared to 443 control patients who neither underwent splenectomy nor were embolized. There was no statistical difference between the splenic immune function of embolized and control patients. In addition, a total of 3974 splenectomy patients was compared with 686 embolization patients. Embolization patients had fewer infectious complications and a greater degree of preserved splenic immune function. CONCLUSION: In adult trauma patients who have undergone splenic angioembolization, we conditionally recommend against routine post-splenectomy vaccinations. STUDY TYPE: systematic review/meta-analysis Level of evidence: level III.


Assuntos
Traumatismos Abdominais , Embolização Terapêutica , Gerenciamento da Prática Profissional , Ferimentos não Penetrantes , Humanos , Adulto , Baço/lesões , Ferimentos não Penetrantes/terapia , Traumatismos Abdominais/terapia , Esplenectomia , Embolização Terapêutica/métodos , Vacinação , Estudos Retrospectivos
4.
5.
Am J Surg ; 224(5): 1238-1246, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35821175

RESUMO

BACKGROUND: While motorcycle helmets reduce mortality and morbidity, no guidelines specify which is safest. We sought to determine if full-face helmets reduce injury and death. METHODS: We searched for studies without exclusion based on: age, language, date, or randomization. Case reports, professional riders, and studies without original data were excluded. Pooled results were reported as OR (95% CI). Risk of bias and certainty was assessed. (PROSPERO #CRD42021226929). RESULTS: Of 4431 studies identified, 3074 were duplicates, leaving 1357 that were screened. Eighty-one full texts were assessed for eligibility, with 37 studies (n = 37,233) eventually included. Full-face helmets reduced traumatic brain injury (OR 0.40 [0.23-0.70]); injury severity for the head and neck (Abbreviated Injury Scale [AIS] mean difference -0.64 [-1.10 to -0.18]) and face (AIS mean difference -0.49 [-0.71 to -0.27]); and facial fracture (OR 0.26 [0.15-0.46]). CONCLUSION: Full-face motorcycle helmets are conditionally recommended to reduce traumatic brain injury, facial fractures, and injury severity.


Assuntos
Lesões Encefálicas Traumáticas , Traumatismos Craniocerebrais , Gerenciamento da Prática Profissional , Fraturas Cranianas , Humanos , Acidentes de Trânsito , Lesões Encefálicas Traumáticas/prevenção & controle , Traumatismos Craniocerebrais/prevenção & controle , Dispositivos de Proteção da Cabeça , Motocicletas , Fraturas Cranianas/prevenção & controle , Guias de Prática Clínica como Assunto
6.
J Surg Educ ; 79(6): e151-e160, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35842404

RESUMO

PURPOSE: Shifts in American healthcare delivery mechanisms pose significant hurdles to new physicians. Surgeons are particularly susceptible to these changes, but surgical residency educational efforts primarily focus on technical and clinical training to the exclusion of business and management practices. This study conducted a needs assessment of perceived gaps in practice management skills among early career surgeons to guide future training curricula. METHODS: This study was an exploratory qualitative study following the Consolidated Criteria for Reporting Qualitative Research. Purposive sampling was used to identify early career (<5 years following fellowship completion) surgeons across the United States. A semi-structured interview guide was created from interviews with surgical administrators and physician administrative curricula. Transcripts were de-identified and analyzed using a constructivist grounded theory approach. RESULTS: Ten surgeons from 6 specialties and 6 institutions were interviewed along with 3 surgeon administrators. Three major domains of need were identified: (1) fundamentals of procedural coding, clinical billing, & compliance, (2) finding/building a practice, and (3) navigating organizational challenges. First, surgeons thought trainees would benefit from a better understanding of reimbursement schema and the basics of health policy. They also thought that more exposure to malpractice litigation, especially for handling case review or expert witness requests, would be helpful for discerning how to handle such issues early in their career. In addition, early career surgeons expressed a desire to have dedicated mentorship time, a primer on evaluating job offers with simulated contract negotiation, and guidance regarding administrative roles. Finally, surgeons requested training in change management techniques, care pathway construction, and the basics of staffing decisions. CONCLUSIONS: There are significant practice management gaps in surgical training which may be amenable to targeted educational efforts during a residency or fellowship program. Future research will test the generalizability of these findings as well as build curricula that adequately meet these needs.


Assuntos
Internato e Residência , Gerenciamento da Prática Profissional , Cirurgiões , Estados Unidos , Humanos , Determinação de Necessidades de Cuidados de Saúde , Currículo
7.
J Clin Orthod ; 56(5): 263, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35767853
8.
Injury ; 53(8): 2717-2724, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35768327

RESUMO

INTRODUCTION: Traumatic brain injury (TBI) is one of the leading causes of fatal trauma, and patients often require prolonged ventilation and tracheostomy. There are currently no standardized guidelines regarding the optimal timing of tracheostomy placement for mechanically ventilated patients with severe TBI. This review aims to investigate the impact of tracheostomy timing on the clinical outcomes in patients with severe TBI. METHODS: A literature search was conducted according to PRISMA 2020 guidelines. PubMed, Google Scholar, EMBASE, MedLine, Web of Science, Cochrane, and CINAHL were searched for studies evaluating the impact of early versus late tracheostomy on TBI patient outcomes. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Newcastle-Ottawa Scale (NOS) were used for quality of evidence and risk of bias assessment, respectively. RESULTS: A total of nine studies met eligibility criteria. All nine studies investigated tracheostomy timing in severe TBI patients and demonstrated that early tracheostomy is associated with decreased ICU length-of-stay (LOS) and increased ventilator free-days compared to late tracheostomy. CONCLUSION: Current evidence suggests that patients with severe TBI following traumatic injury may benefit from an early tracheostomy due to improved clinical outcomes, including decreased MV duration and ICU-LOS, compared to late tracheostomy. Further multi-institutional studies are needed to develop evidence-based guidelines.


Assuntos
Lesões Encefálicas Traumáticas , Gerenciamento da Prática Profissional , Lesões Encefálicas Traumáticas/cirurgia , Humanos , Tempo de Internação , Respiração Artificial , Traqueostomia/efeitos adversos
9.
J Trauma Acute Care Surg ; 93(3): e110-e118, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35546420

RESUMO

BACKGROUND: Multiple techniques describe the management of the open abdomen (OA) and restoration of abdominal wall integrity after damage-control laparotomy (DCL). It is unclear which operative technique provides the best method of achieving primary myofascial closure at the index hospitalization. METHODS: A writing group from the Eastern Association for the Surgery of Trauma performed a systematic review and meta-analysis of the current literature regarding OA management strategies in the adult population after DCL. The group sought to understand if fascial traction techniques or techniques to reduce visceral edema improved the outcomes in these patients. The Grading of Recommendations Assessment, Development and Evaluation methodology was utilized, meta-analyses were performed, and an evidence profile was generated. RESULTS: Nineteen studies met inclusion criteria. Overall, the use of fascial traction techniques was associated with improved primary myofascial closure during the index admission (relative risk, 0.32) and fewer hernias (relative risk, 0.11.) The use of fascial traction techniques did not increase the risk of enterocutaneous fistula formation nor mortality. Techniques to reduce visceral edema may improve the rate of closure; however, these studies were very limited and suffered significant heterogeneity. CONCLUSION: We conditionally recommend the use of a fascial traction system over routine care when treating a patient with an OA after DCL. This recommendation is based on the benefit of improved primary myofascial closure without worsening mortality or enterocutaneous fistula formation. We are unable to make any recommendations regarding techniques to reduce visceral edema. LEVEL OF EVIDENCE: Systematic Review and Meta-Analysis; Level IV.


Assuntos
Traumatismos Abdominais , Parede Abdominal , Técnicas de Fechamento de Ferimentos Abdominais , Fístula Intestinal , Gerenciamento da Prática Profissional , Abdome/cirurgia , Traumatismos Abdominais/etiologia , Traumatismos Abdominais/cirurgia , Parede Abdominal/cirurgia , Adulto , Fasciotomia , Humanos , Fístula Intestinal/cirurgia , Laparotomia/métodos
10.
AJR Am J Roentgenol ; 219(4): 666-670, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35549445

RESUMO

An unanticipated but severe shortage in iodinated contrast media (ICM) is currently affecting imaging practices across the globe and is expected to persist through at least the end of June 2022. This supply shock may lead health care systems to experience an acute imaging crisis, given that many affected facilities have contrast agent supplies that are anticipated to last only a week or two under normal operating conditions. To maximize the opportunity to continue to provide optimal care for patients with emergent or life-threatening imaging indications and thereby minimize the overall impact on patient care, practice leaders will need to quickly assess their contrast material inventories, prioritize examination indications, and reduce their expected short-term usage of ICM. This Clinical Perspective reviews ICM conservation techniques that the Yale School of Medicine has deployed or is considering deploying, depending on the severity and length of the supply shortage.


Assuntos
Compostos de Iodo , Gerenciamento da Prática Profissional , Meios de Contraste/efeitos adversos , Atenção à Saúde , Diagnóstico por Imagem , Humanos
12.
CMAJ Open ; 10(2): E338-E347, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35414596

RESUMO

BACKGROUND: One of the more frequent complications following treatment for breast cancer, lymphedema is a substantial swelling of the arm, breast and chest wall that occurs on the side where lymph nodes were removed. The aim of this work is to update recommendations on the prevention, diagnosis and management of lymphedema related to breast cancer. METHODS: We present the protocol for an update of the 2001 clinical practice guideline on lymphedema from the Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. We will use a patient-oriented research approach with a focus on self-management and the positive health model to inform the updated guideline development. The methods proposed will be undertaken with consideration of the standards outlined in the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. The literature will be appraised by evaluating existing guidelines from other countries, the evidence from systematic reviews and meta-analyses and direct evidence from clinical studies. We will manage competing interests according to Guidelines International Network principles. Recommendations will be presented using an actionable statement format and will be linked to the level of evidence along with any relevant considerations used in formulation. A draft of the guideline will be produced by the steering committee then sent out to international experts and stakeholder groups for feedback. INTERPRETATION: The primary benefit of this clinical guideline will be to improve the quality of care of women with breast cancer-related lymphedema. Findings will be disseminated at national and international conferences and through webinars and educational videos hosted on the websites of the supporting organizations.


Assuntos
Neoplasias da Mama , Linfedema , Gerenciamento da Prática Profissional , Neoplasias da Mama/complicações , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Canadá/epidemiologia , Feminino , Humanos , Linfedema/diagnóstico , Linfedema/etiologia , Linfedema/terapia , Guias de Prática Clínica como Assunto
14.
Curitiba; s.n; 20220224. 277 p. ilus, tab.
Tese em Português | LILACS, BDENF - Enfermagem | ID: biblio-1370518

RESUMO

Resumo: Introdução: A Sistematização da Assistência de Enfermagem corresponde à organização do trabalho quanto ao método, pessoal e instrumentos, vislumbrando operacionalizar o processo de enfermagem. Porém, há limitação da compreensão semântica do seu significado, conhecimento, operacionalização dos seus componentes e da contribuição para prática profissional e Ciência da Enfermagem. Objetivo: analisar, sob a ótica da Teoria da Complexidade, a construção de um modelo ontológico sobre Sistematização da Assistência de Enfermagem como tecnologia de apoio à organização da prática profissional do enfermeiro. Método: estudo qualitativo e exploratório, em três etapas. Primeiramente, construiu-se um mapa conceitual baseado nas sete etapas apresentadas por Cañas, Novak, Reiska (2015), almejando identificar conceitos, estrutura, processos e operação da Sistematização da Assistência de Enfermagem, à luz da Teoria da Complexidade. Organizou-se e representou-se o conhecimento com apoio do software CMap Tools. A segunda etapa compôs-se de entrevistas semiestruturadas, entre maio e dezembro de 2020, com 17 enfermeiros, dos quais nove eram do Grupo de Trabalho da Sistematização da Prática de Enfermagem da Comissão Mista da Associação Brasileira de Enfermagem e Conselho Regional de Enfermagem-PR e oito da Comissão Permanente de Sistematização da Prática de Enfermagem, nomeada pela Associação Brasileira de Enfermagem. Empregou-se a Análise de Conteúdo Temática, apoiada no software MAXQDA. Na terceira etapa, modelou-se a representação de uma ontologia sobre a Sistematização da Assistência de Enfermagem, baseada no guia interativo Ontology Development 101 apoiada pelo software Protégé (versão 5.5.0), a partir do mapa conceitual e das entrevistas. Resultados: identificou-se inconsistência semântica e de correlações, retratando a complexidade dos componentes da Sistematização da Assistência de Enfermagem, com fragmentos mecanicistas. No mapa conceitual, elaboraram-se três camadas conceituais. Organizaram-se os conceitos de acordo com a proposta conceitual da Sistematização da Assistência de Enfermagem prevista em sua principal legislação e posteriormente foram ampliados. Desta análise, procedeu-se ao agrupamento por temáticas: Sistematização da Assistência de Enfermagem; Ações de Enfermagem; Ações da Gestão do Cuidado; Ações de Gestão do Serviço de Enfermagem; Ações para Aplicação dos Cuidados; Ações para Aplicação no Serviço de Enfermagem; Fundamentos; Competências; Instrumentos; Normativas e Pessoal. Das entrevistas, emergiram 863 unidades de registro e seis categorias: Significado de Sistematização da Assistência de Enfermagem, com três subcategorias primárias; Construção Histórica do Conceito de Sistematização da Assistência de Enfermagem, com quatro subcategorias primárias; Ensino e Aprendizagem; Pesquisa da Enfermagem; Implicações Prática e Concretização da Sistematização da Assistência de Enfermagem. Identificaram-se 156 conceitos relevantes para modelagem da ontologia, utilizando-se da "metodologia 101", objetivando representar o conhecimento do domínio Sistematização da Assistência de Enfermagem. Considerações finais: a ontologia sobre Sistematização da Assistência de Enfermagem ancorada na Teoria da Complexidade permitiu um novo olhar sobre os fenômenos, os quais devem ser desenvolvidos, revistos e ressignificados. Acredita-se que esta ontologia facilite a representação formal do conhecimento sobre Sistematização da Assistência de Enfermagem, afirmando-a enquanto área de conhecimento representativo, fortalecendo sua identidade, significado unívoco, organização, compartilhamento de saberes e de informação. Ademais, pode favorecer difusão de vocabulário comum, contribuindo com a prática profissional de enfermeiros.


Abstract: Introduction: the Systematization of Nursing Care is the work organization according to the method, personnel and instruments, which glimpses to operationalize the nursing process. However, there is a limitation in the semantic understanding of its meaning, knowledge, and operationalization of its components and the contribution to the practice and science of nursing. Objective: to analyze, from the perspective of Complexity Theory, the process of building an ontological model on Systematization of Nursing Care as a technology to support the organization of professional nursing practice. Method: qualitative and exploratory study, in three stages. Firstly, a conceptual map was built based on the seven stages presented by Cañas, Novak, Reiska (2015), aiming to identify concepts, structure, processes and operation of the Systematization of Nursing Care, in light of the complexity, anchored in the related literature. Knowledge was organized and represented with the support of CMap Tools software. The second stage consisted of semi-structured interviews, between May and December 2020, done with 17 professionals, of whom nine from the Working Group on the Systematization of Nursing Practice of the Mixed Commission of the Brazilian Nursing Association and Regional Nursing Council-PR and eight from the Permanent Commission for the Systematization of Nursing Practice, appointed by the Association. Thematic Content Analysis was used, supported by the MAXQDA software. In the third stage, the representation of ontology on the Systematization of Nursing Care was modeled, based on the interactive guide Ontology Development 101 supported by the software Protégé (version 5.5.0), from the conceptual map and the interviews. Results: semantic inconsistency and correlations were identified, portraying the complexity of the components of the Systematization of Nursing Care, with mechanistic fragments. In the conceptual map, three conceptual layers were elaborated. The concepts were organized according to the conceptual proposal of the Systematization of Nursing Care provided for in its main legislation and were later expanded. From this analysis, we proceeded to group by themes: Systematization of Nursing Care; Nursing Actions; Management Care Actions; Nursing Service Management Actions, Care Management Actions; Nursing Service Management Actions; Actions for Application of Care, and Actions for Application in the Nursing Service; Fundamentals, Competencies; Instruments; Regulations and Personnel. From the interviews, 863 record units and six categories emerged: Meaning of Systematization of Nursing Care, with three primary subcategories; Historical Construction of the Concept of Systematization of Nursing Care, with four primary subcategories; Teaching and Learning; Nursing Research; Practical Implications and Implementation of the Systematization of Nursing Care. 156 relevant concepts for ontology modeling were identified using the "101 methodology", aiming to represent the knowledge of the Systematization of Nursing Care domain. Final considerations: the ontology on Systematization of Nursing Care anchored in Complexity Theory allowed a new look at the phenomena, which must be developed, reviewed and re-signified. It is believed that this ontology facilitates the formal representation of knowledge about Systematization of Nursing Care, affirming it as a representative area of knowledge, strengthening its identity, univocal meaning, organization, sharing of knowledge and information. Furthermore, it can favor the diffusion of common vocabulary, contributing to the professional practice of nurses.


Resumen: Introducción: la sistematización de la asistencia de Enfermeríaes la organización del trabajo en cuanto a método, personal e instrumentos, con el objetivo de operacionalizar el proceso de enfermería. Sin embargo, existe una limitación en la comprensión semántica de su significado, conocimiento, operacionalización de sus componentes y el aporte a la práctica y ciencia de enfermería. Objetivo: analizar, en la perspectiva de la Teoría de la Complejidad, el proceso de construcción de un modelo ontológico sobre la sistematización de la asistencia de Enfermería como tecnología de apoyo a la organización de la práctica profesional de enfermería. Método: estudio cualitativo y exploratorio, en tres etapas. En primer lugar, se construyó un mapa conceptual a partir de las siete etapas proclamadas presentadas por Cañas, Novak, Reiska (2015), con el objetivo de identificar conceptos, estructura, procesos y funcionamiento de la sistematización de la asistencia de Enfermería, a la luz de la complejidad, anclada en la literatura relacionada. El conocimiento fue organizado y representado con el apoyo del software CMap Tools. La segunda etapa consistió en entrevistas semiestructuradas, entre mayo y diciembre de 2020, con 17 profesionales, de los cuales nueve del Grupo de Trabajo sobre Sistematización de la Práctica de Enfermería de la Comisión Mixta de la Asociación Brasileña de Enfermería y Consejo Regional de Enfermería-PR y ocho del Comisión Permanente para la Sistematización de la Práctica de Enfermería, designada por el Colegio. Se utilizó el Análisis de Contenido Temático, apoyado en el software MAXQDA. En la tercera etapa, se modeló la representación de una ontología sobre la sistematización de la asistencia de Enfermería, a partir de la guía interactiva Ontology Development 101 con el apoyo del software Protégé (versión 5.5.0), del mapa conceptual y de las entrevistas. Resultados: fueron identificadas inconsistencias semánticas y correlaciones, retratando la complejidad de los componentes de lasistematización de la asistencia de Enfermería, con fragmentos mecanicistas. En el mapa conceptual se elaboraron tres capas conceptuales. Los conceptos fueron organizados de acuerdo con la propuesta conceptual de la sistematización de la asistencia de Enfermeríaprevista en su legislación principal y posteriormente fueron ampliados. A partir de ese análisis, se procedió a agrupar por temas: Sistematización de la Asistencia de Enfermería; Acciones de Enfermería; Acciones de Gestión del Cuidado; Acciones de Gestión del Servicio de Enfermería; Acciones de Gestión del Cuidado; Acciones de Gestión del Servicio de Enfermería; Acciones de Aplicación de Cuidados; Acciones de Aplicación en el Servicio de Enfermería; Fundamentos; Competencias; Instrumentos; Reglamentos y Personal. De las entrevistas surgieron 863 unidades de registro y seis categorías: Significado de sistematización de la asistencia de Enfermería, con tres subcategorías primarias; Construcción Histórica del Concepto de Sistematización de la Atención de Enfermería, con cuatro subcategorías primarias; Enseñanza y Aprendizaje; Investigación en Enfermería; Implicaciones Prácticas e Implementación de la sistematización de la asistencia de Enfermería. Fueron identificados 156 conceptos relevantes para el modelado ontológico utilizando la "metodología 101", con el objetivo de representar el conocimiento del dominio sistematización de la asistencia de Enfermería. Consideraciones finales: la ontología sobre sistematización de la asistencia de Enfermería anclado en la Teoría de la Complejidad permitió una nueva mirada sobre los fenómenos, que deben ser desarrollados, revisados y redefinidos. Se cree que esta ontología facilita la representación formal del conocimiento sobre sistematización de la asistencia de Enfermería, afirmándola como área representativa del saber, fortaleciendo su identidad, sentido unívoco, organización, intercambio de saberes e informaciones. Además, puede favorecer la difusión del vocabulario común, contribuyendo a la práctica profesional de los enfermeros.


Assuntos
Humanos , Masculino , Feminino , Administração dos Cuidados ao Paciente , Inteligência Artificial , Vocabulário Controlado , Gerenciamento da Prática Profissional , Cuidados de Enfermagem
15.
J Arthroplasty ; 37(8): 1426-1430.e3, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35026367

RESUMO

BACKGROUND: A survey was conducted at the 2021 Annual Meeting of the American Association of Hip and Knee Surgeons (AAHKS) to evaluate current practice management strategies among AAHKS members. METHODS: An application was used by AAHKS members to answer both multiple-choice and yes or no questions. Specific questions were asked regarding the impact of COVID-19 pandemic on practice patterns. RESULTS: There was a dramatic acceleration in same day total joint arthroplasty with 85% of AAHKS members performing same day total joint arthroplasty. More AAHKS members remain in private practice (46%) than other practice types, whereas fee for service (34%) and relative value units (26%) are the major form of compensation. At the present time, 93% of practices are experiencing staffing shortages, and these shortages are having an impact on surgical volume. CONCLUSION: This survey elucidates the current practice patterns of AAHKS members. The pandemic has had a significant impact on some aspects of practice activity. Future surveys need to monitor changes in practice patterns over time.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Artroplastia de Quadril , Artroplastia do Joelho , COVID-19 , Mão de Obra em Saúde , Ortopedia , Gerenciamento da Prática Profissional , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Artroplastia de Quadril/economia , Artroplastia de Quadril/métodos , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/economia , Artroplastia do Joelho/métodos , Artroplastia do Joelho/estatística & dados numéricos , COVID-19/epidemiologia , Atenção à Saúde/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Ortopedia/economia , Ortopedia/organização & administração , Ortopedia/estatística & dados numéricos , Pandemias , Gerenciamento da Prática Profissional/economia , Gerenciamento da Prática Profissional/organização & administração , Gerenciamento da Prática Profissional/estatística & dados numéricos , Padrões de Prática Médica/economia , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/estatística & dados numéricos , Prática Profissional/economia , Prática Profissional/organização & administração , Prática Profissional/estatística & dados numéricos , Estados Unidos/epidemiologia
18.
Eur J Trauma Emerg Surg ; 48(6): 4461-4472, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34564733

RESUMO

PURPOSE: Early detection and management of acute trauma hemorrhage and coagulopathy have been associated with improved outcomes, but local infrastructure, logistics and clinical strategies may differ. METHODS: To assess local differences in infrastructure, logistics and clinical management of acute trauma hemorrhage and coagulopathy we have conducted a web-based survey amongst clinicians working in DGU®-certified supraregional, regional and local trauma centers. RESULTS: 137/1875 respondents completed the questionnaire yielding a response rate of 7.3%. The majority specified to work as head of department or senior consultant (95%) in trauma/orthopedic surgery (80%) of supraregional (38%), regional (34%) or local (27%) trauma centers. Conventional coagulation assays are most frequently used to monitor bleeding trauma patients. Only half of the respondents (53%) rely on extended coagulation tests, e.g. viscoelastic hemostatic assays. Tests to assess preinjury use of direct oral anticoagulants and platelet inhibitors are still not widely available and vary according to level of care. Conventional blood products are widely available but there remain differences between trauma centers of different level of care to access other hemostatic therapies, e.g. coagulation factor concentrates. Trauma centers of higher level of care are more likely to implement treatment protocols. CONCLUSION: This survey confirms still existing differences in infrastructure, logistics and clinical practice management for the detection of acute trauma hemorrhage and coagulopathy amongst DGU®-certified supraregional, regional and local trauma centers. Further work is recommended to locally implement diagnostics, therapies and treatment algorithms compliant to current guidelines to ensure the best possible outcomes in bleeding trauma patients.


Assuntos
Transtornos da Coagulação Sanguínea , Hemostáticos , Gerenciamento da Prática Profissional , Ferimentos e Lesões , Humanos , Centros de Traumatologia , Transfusão de Sangue/métodos , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/terapia , Hemorragia/diagnóstico , Hemorragia/etiologia , Hemorragia/terapia , Hemostáticos/uso terapêutico , Inquéritos e Questionários , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia
19.
Am J Surg ; 224(1 Pt A): 196-204, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-34836603

RESUMO

BACKGROUND: The treatment of rhabdomyolysis remains controversial. Although there is no question that any associated compartment syndrome needs to be identified and released, debate persists regarding the benefit of further therapy including aggressive intravenous fluid resuscitation (IVFR), urine alkalization with bicarbonate, and the use of mannitol. The goal of this practice management guideline was to evaluate the effects of bicarbonate, mannitol, and aggressive intravenous fluids on patients with rhabdomyolysis. METHODS: A systematic review and meta-analysis comparing treatments in patients with rhabdomyolysis was performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to assess the quality of evidence and to create evidence-based recommendations regarding the use of bicarbonate, mannitol, and aggressive IVFR in patients with rhabdomyolysis. RESULTS: A total of 12 studies were identified for analysis. On quantitative analysis, IVFR decreased the incidence of acute renal failure (ARF) and need for dialysis in patients with rhabdomyolysis. Neither bicarbonate nor mannitol administration improved the incidence of acute renal failure and need for dialysis in patients with rhabdomyolysis. Quality of evidence was deemed to be very low, with the vast majority of the literature being retrospective studies. CONCLUSION: In patients with rhabdomyolysis, we conditionally recommend for aggressive IVFR to improve outcomes of ARF and lessen the need for dialysis. We conditionally recommend against treatment with bicarbonate or mannitol in patients with rhabdomyolysis.


Assuntos
Injúria Renal Aguda , Gerenciamento da Prática Profissional , Rabdomiólise , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Bicarbonatos , Humanos , Manitol/uso terapêutico , Metanálise como Assunto , Estudos Retrospectivos , Rabdomiólise/complicações , Rabdomiólise/terapia , Revisões Sistemáticas como Assunto
20.
J Acad Nutr Diet ; 121(6): 1157-1174.e29, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34874011

RESUMO

Management of food and nutrition systems (MFNS) encompasses the varied roles of registered dietitian nutritionists (RDNs) with administrative responsibilities for food and nutrition services within an organization. RDNs in MFNS are frequently employed in acute care, but also expand into a multitude of other settings in which management of nutrition and foodservice is required, for example, foodservice departments in assisted living and post-acute and long-term care; colleges and universities, kindergarten through grade 12 and pre-kindergarten schools and childcare; retail foodservice operations; correctional facilities; and companies that produce, distribute, and sell food products. RDNs in MFNS aim to create work environments that support high-quality customer-centered care and services, attract and retain talented staff, and foster an atmosphere of collaboration and innovation. The Management in Food and Nutrition Systems Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has revised the Standards of Professional Performance (SOPP) for RDNs in MFNS for 3 levels of practice: competent, proficient, and expert. The SOPP describes 6 domains that focus on professional performance: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Indicators outlined in the SOPP depict how these standards apply to practice. The standards and indicators for RDNs in MFNS are written with the leader in mind-to support an individual in a leadership role or who has leadership aspirations. The SOPP is intended to be used by RDNs for self-evaluation to assure competent professional practice.


Assuntos
Dietética/normas , Nutricionistas/normas , Guias de Prática Clínica como Assunto , Gerenciamento da Prática Profissional/normas , Competência Profissional/normas , Âmbito da Prática , Academias e Institutos , Serviços de Dietética/organização & administração , Serviços de Dietética/normas , Serviços de Alimentação/organização & administração , Serviços de Alimentação/normas , Humanos , Qualidade da Assistência à Saúde , Sociedades
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...