Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.354
Filtrar
1.
J Cardiovasc Surg (Torino) ; 63(4): 406-414, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35343661

RESUMO

BACKGROUND: The frozen elephant trunk (FET) technique for total arch replacement (TAR) is widely used for repair of aortic arch dissections and aneurysms. Despite its widespread adoption, there are no international or regional guidelines for the sizing of FET prostheses in TAR. We seek to highlight the heterogeneity thereof and pave the way for evidence-based guidelines to advise FET prosthesis sizing in TAR. METHODS: An online questionnaire was sent to 22 specialist aortic surgeons from 13 different countries across North America, Europe, Asia, and Australia, inquiring about each surgeon's approach to FET prosthesis sizing. The results were then pooled for frequency analysis. RESULTS: All 22 surgeons responded to the questionnaire. Zone 2 is preferred implantation zone for AAD, CAD, and TAA (selected by 72.7%, 72.7%, and 68.2% respectively). The maximal diameter of the true lumen in the DTA is the most common index measurement for AAD and CAD (40.9% and 59.1%, respectively). Stent-graft diameters equal to the index measurement is the most common approach for AAD and CAD (77.3% and 45.5%, respectively) while 59.1% of surgeons oversize the index diameter by 10% for TAA; 100 mm is the preferred length for 50.0%, 27.3%, and 40.9% of surgeons in AAD, CAD, and TAA respectively. CONCLUSIONS: There is considerable heterogeneity in sizing practices for FET prostheses internationally, with variable evidence for its impact on clinical outcomes. This issue would be aided by the development of evidence-based guidelines to inform clinical decision making.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Implante de Prótese Vascular/métodos , Humanos , Prática Institucional , Estudos Retrospectivos
2.
Braz J Cardiovasc Surg ; 37(5): 769-775, 2022 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-35244378

RESUMO

Aortic valve repair combined with root stabilization procedures have been reported to have reliable mid to long-term outcomes, and this is one of the reasons that various surgical units are accepting these techniques as an option in selected cases. Aortic valve replacement is a standard procedure with established results, but to master its techniques there is a major uphill learning curve. A brief communication is presented on the aortic valve repair focusing on the lesser discussed aspects like global variability of the pathology and outcomes, variable referral patterns, and effect of ethnicity.


Assuntos
Insuficiência da Valva Aórtica , Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca , Humanos , Valva Aórtica/cirurgia , Valva Aórtica/patologia , Insuficiência da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Prática Institucional , Procedimentos Cirúrgicos Cardíacos/métodos , Resultado do Tratamento
3.
Gac. sanit. (Barc., Ed. impr.) ; 36(1): 60-63, ene. - feb. 2022. ilus
Artigo em Espanhol | IBECS | ID: ibc-209171

RESUMO

Las estrategias, los programas y las acciones en salud han sido históricamente el resultado de prácticas institucionales con un componente participativo limitado. La acción institucional ha venido determinada sobre todo por el criterio de actores políticos y, en el mejor de los casos, por el criterio de profesionales de la salud. Nuevas formas de gobernanza para la equidad en salud abogan por la inclusión de la comunidad en el diseño de estrategias, programas y actividades en salud. Por ello, una preocupación creciente en el campo de la participación en salud es la medición de la calidad participativa de los nuevos diseños de prácticas institucionales. Este artículo tiene como objetivo desarrollar una propuesta operativa para diseñar, medir o describir el alcance en términos participativos de los procesos de planificación en salud. La propuesta elabora seis dimensiones para la medición y la evaluación del proceso participativo: inclusividad, flujo de información, calidad deliberativa, toma de decisiones, compromiso institucional y empoderamiento comunitario. (AU)


Health strategies, programs and activities have historically been the result of institutional practices with a limited participatory component. Traditionally, institutional action is mainly determined by the criteria of the political actors and, in the best of cases, by the criteria of healthcare professionals. New forms of governance for health equity advocate for the inclusion of the community in the design of strategies, programmes and activities in health. For this reason, a growing concern in the field of participation in health is the measurement of the participatory quality of new designs of institutional practices. This article aims to develop an operational proposal to design, measure or describe the scope in participatory terms of the health planning processes. The proposal elaborates six dimensions for the measurement and assessment of participatory process: inclusivity, information flow, deliberative quality, decision making, institutional commitment and community empowerment. (AU)


Assuntos
Humanos , Prática Institucional , Planejamento em Saúde , Participação Social , Saúde Pública , Tomada de Decisões , Publicações
4.
Pediatr Emerg Care ; 38(1): e151-e156, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32658118

RESUMO

OBJECTIVES: High-flow nasal cannula (HFNC) is an oxygen delivery device that provides heated humidified air with higher flow rates. The purpose of this survey is to look at institutional practice patterns of HFNC initiation, weaning, and disposition for pediatric patients across the United States. METHODS: Survey was sent via electronic listservs to pediatric physicians in emergency medicine, hospital medicine, critical care, and urgent care. The questionnaire was divided into demographics and HFNC practices (initiation, management, and weaning). One response per institution was included in the analysis. RESULTS: Two hundred twenty-four responses were included in the analysis, composed of 40% pediatric emergency medicine physicians, 46% pediatric hospitalists, 13% pediatric intensive care unit (PICU) physicians, and 1% pediatric urgent care physicians. Ninety-eight percent of the participants have HFNC at their institution. Thirty-seven percent of the respondents had a formal guideline for HFNC initiation. Nearly all guideline and nonguideline institutions report HFNC use in bronchiolitis. Guideline cohort is more likely to have exclusion criteria for HFNC (42% in the guideline cohort vs 17% in the nonguideline cohort; P < 0.001) and less frequently mandates PICU admissions once on HFNC (11% in the guideline cohort vs 56% in the nonguideline cohort; P < 0.001). Forty-six percent of guideline cohort had an objective scoring system to help determine the need for HFNC, and 73% had a weaning guideline. CONCLUSIONS: Although there is general agreement to use HFNC in bronchiolitis, great practice variation remains in the initiation, management, and weaning of HFNC across the United States. There is also a discordance on PICU use when a patient is using HFNC.


Assuntos
Bronquiolite , Cânula , Bronquiolite/terapia , Criança , Humanos , Prática Institucional , Unidades de Terapia Intensiva Pediátrica , Inquéritos e Questionários , Estados Unidos
5.
Rev Rene (Online) ; 23: e71660, 2022.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1357650

RESUMO

Objetivo: analisar o cotidiano do trabalho de um Centro de Atenção Psicossocial e sua articulação com a Rede de Aten-ção Psicossocial no contexto da pandemia da COVID-19. Métodos: trata-se de um estudo qualitativo, produzido por meio do diário do pesquisador e entrevistas semiestruturadas com nove profissionais de saúde, submetidas à análise de conteúdo temático-categorial. Resultados: a pandemia revelou falhas na gestão dos serviços, falta de investimentos públicos e o despreparo dos profissionais, intensificando a fragmentação do trabalho, a desarticulação da rede, a desassistência e as práticas manicomiais pré-existentes. Conclusão: a realidade do cotidiano de trabalho dos serviços de atenção psicossocial mostra que são necessárias ações multifacetadas que considerem o processo social complexo da reforma psiquiátrica, especialmente, na pandemia, buscando a efetiva institucionalização do modelo de atenção psicossocial e a formação de núcleos de resistência ao modelo manicomial instituído. (AU)


Assuntos
Humanos , COVID-19 , Prática Institucional , Serviços de Saúde Mental , Pesquisa Qualitativa
6.
Rev. Esc. Enferm. USP ; 56: e20210473, 2022.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1376254

RESUMO

ABSTRACT Objective: to analyze the resistance to interprofessional collaboration in the professional practices of residents in primary health care. Method: Social and clinical qualitative research with 32 residents of a Multiprofessional Residency, carried out from 2017 to 2018. Data production included Institutional Analysis of Professional Practices, document analysis; investigator's diary; and observation. Data were analyzed based on Institutional Analysis concepts. Results: There were contradictions between the reproduction of uniprofessional education with a focus on the specialty and interprofessional collaborative practices. The resistance analysis pointed to two axes: not-knowing as an analyzer of resistance to collaboration; interprofessional interference and knowledge-power relations. Residents' practices were characterized as resistant to interprofessional collaboration. Conclusion: The resistance analysis in the Multiprofessional Residency showed integrative movements of assimilation and disputes with physician-centered power, with damage to the sharing of care and interprofessional communication. The collective analysis questioned health professionals education, revisiting the perspective of comprehensive care guided by the users' needs.


RESUMEN Objetivo: Hacer un análisis por medio de las resistencias a la colaboración interprofesional en las prácticas profesionales de residentes médicos en la atención primaria a la salud. Método: Investigación cualitativa socio clínica con 32 residentes de una Residencia Multiprofesional, realizada entre 2017 y 2018. La producción de datos incluyó Análisis Institucional de las Prácticas Profesionales, análisis documental; apuntes diarios del investigador; y observación. Los datos fueron analizados a partir de conceptos del Análisis Institucional. Resultados: Se revelaron contradicciones entre la reproducción de la educación uniprofesional con énfasis en la especialidad y prácticas colaborativas interprofesionales. El análisis de la resistencia destacó dos ejes: el no saber cómo método de análisis de resistencias a la colaboración; interferencias interprofesionales y relaciones de saber y de poder. Las prácticas de los residentes fueron caracterizadas por la resistencia a la colaboración interprofesional. Conclusión: El análisis de resistencia en la Residencia Multiprofesional evidenció movimientos integrativos de asimilación y disputas con el poder médico centrado, con daños a la división del cuidado y a la comunicación interprofesional. El análisis colectivo cuestionó la formación de profesionales de salud, revisitando la perspectiva del cuidado integral orientado por las necesidades de los pacientes.


RESUMO Objetivo: fazer uma análise pelas resistências à colaboração interprofissional nas práticas profissionais de residentes na atenção primária à saúde. Método: Pesquisa qualitativa Sócio-clínica com 32 residentes de uma Residência Multiprofissional, realizada de 2017 a 2018. A produção de dados incluiu Análise Institucional das Práticas Profissionais, análise documental; diário do pesquisador; e observação. Os dados foram analisados a partir de conceitos da Análise Institucional. Resultados: Revelaram-se contradições entre a reprodução da educação uniprofissional com foco na especialidade e práticas colaborativas interprofissionais. A análise resistencial apontou dois eixos: não-saber como analisador de resistências à colaboração; interferências interprofissionais e relações de saber-poder. As práticas dos residentes foram caracterizadas pela resistência à colaboração interprofissional. Conclusão: A análise resistencial na Residência Multiprofissional evidenciou movimentos integrativos de assimilação e disputas com o poder médico-centrado, com prejuízos ao compartilhamento do cuidado e à comunicação interprofissional. A análise coletiva questionou a formação de profissionais de saúde, revisitando a perspectiva do cuidado integral orientado pelas necessidades dos usuários.


Assuntos
Atenção Primária à Saúde , Educação Interprofissional , Pesquisa Qualitativa , Educação Profissional em Saúde Pública , Prática Institucional , Internato não Médico
7.
Urology ; 156: 110-116, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34333039

RESUMO

OBJECTIVE: To examine differences between telephone and video-televisits and identify whether visit modality is associated with satisfaction in an urban, academic general urology practice. METHODS: A cross sectional analysis of patients who completed a televisit at our urology practice (summer 2020) was performed. A Likert-based satisfaction telephone survey was offered to patients within 7 days of their televisit. Patient demographics, televisit modality (telephone vs video), and outcomes of the visit (eg follow-up visit scheduled, orders placed) were retrospectively abstracted from each chart and compared between the telephone and video cohorts. Multivariate regression analysis was used to evaluate variables associated with satisfaction while controlling for potential confounders. RESULTS: A total of 269 patients were analyzed. 73% (196/269) completed a telephone televisit. Compared to the video cohort, the telephone cohort was slightly older (mean 58.8 years vs. 54.2 years, P = .03). There were no significant differences in the frequency of orders placed for medication changes, labs, imaging, or for in-person follow-up visits within 30 days between cohorts. Survey results showed overall 84.7% patients were satisfied, and there was no significant difference between the telephone and video cohorts. Visit type was not associated with satisfaction on multivariable analyses, while use of an interpreter [OR:8.13 (1.00-65.94); P = .05], labs ordered [OR:2.74 (1.12-6.70); P = .03] and female patient gender [OR:2.28 (1.03-5.03); P = .04] were significantly associated with satisfaction. CONCLUSION: Overall, most patients were satisfied with their televisit. Additionally, telephone- and video-televisits were similar regarding patient opinions, patient characteristics, and visit outcome. Efforts to increase access and coverage of telehealth, particularly telephone-televisits, should continue past the COVID-19 pandemic.


Assuntos
COVID-19/prevenção & controle , Satisfação do Paciente/estatística & dados numéricos , Telemedicina/métodos , Telefone , Urologia/estatística & dados numéricos , Comunicação por Videoconferência , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Americanos Asiáticos/estatística & dados numéricos , Técnicas de Laboratório Clínico , Barreiras de Comunicação , Estudos Transversais , Feminino , Humanos , Prática Institucional/estatística & dados numéricos , Idioma , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/etnologia , Estudos Retrospectivos , SARS-CoV-2 , Fatores Sexuais , Fumar , Inquéritos e Questionários , Meios de Transporte , População Urbana/estatística & dados numéricos , Adulto Jovem
8.
Urology ; 156: 129-133, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34252388

RESUMO

OBJECTIVE: To determine characteristics of providers marketing vasectomy reversal (VR) online, degree of information available online, the ease with which patients can compare providers, and the differences in VR practice patterns between academic and private practices. MATERIALS AND METHODS: We identified VR practices operating within the top 50 most populous metropolitan areas in the US. Practice websites were reviewed to obtain information such as provider educational background, level of magnification, ability to perform vasoepididymostomy, surgical volume, and cost. Based on information available, providers were assigned a novel REVERSAL score created by the authors. Descriptive statistics were used to compare results. RESULTS: Of the 107 providers identified (29 academic, 78 private), the majority were male urologists with a Doctor of Medicine degree. Academic providers were more likely to have fellowship training than private practice providers, 96.6 vs 43.6%, respectively (P = 0.00001). Compared to non-urologists, urologists were less likely to purchase online ads or disclose cost. Non-urologists charged significantly less than urologists, $3,584 ± 1,554 and $6,591 ± 1,518, respectively (P = 0.00001). Only one provider provided complete information as defined by REVERSAL score of 12, with the majority (61.7%) of providers achieving score ≤6. CONCLUSION: There is significant lack of transparency in publicly available information from VR practices. Practices should implement measures to improve dissemination of information to the public, so that patients can more easily compare providers and make informed decisions regarding VR.


Assuntos
Marketing de Serviços de Saúde/estatística & dados numéricos , Urologistas/estatística & dados numéricos , Urologistas/normas , Vasovasostomia , Adulto , Cidades , Honorários e Preços , Bolsas de Estudo/estatística & dados numéricos , Feminino , Humanos , Prática Institucional/estatística & dados numéricos , Internet , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Prática Privada/estatística & dados numéricos , Estados Unidos , Urologistas/economia , Urologistas/educação , Vasovasostomia/economia
9.
Urology ; 156: 117-123, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34331999

RESUMO

OBJECTIVE: To describe factors associated with Quality improvement and patient safety (QIPS) participation using 2018 American Urological Association Census data. QIPS have become increasingly important in medicine. However, studies about QIPS in urology suggest low levels of participation, with little known about factors predicting non-participation. METHODS: Results from 2339 census respondents were weighted to estimate 12,660 practicing urologists in the United States. Our primary outcome was participation in QIPS. Predictor variables included demographics, practice setting, rurality, fellowship training, QIPS domains in practice, years in practice, and non-clinical/clinical workload. RESULTS: QIPS participants and non-participants significantly differed in distributions of age (P = .0299), gender (P = .0013), practice setting (P <.0001), employment (employee vs partner vs owner vs combination; P <.0001), and fellowship training (P <.0001). QIPS participants reported fewer years in practice (21.3 vs 25.9, P = .018) and higher clinical (45.2 vs 39.2, P = .022) and non-clinical (8.76 vs 5.28, P = .002) work hours per week. Non-participation was associated with male gender (OR = 2.68, 95% CI 1.03-6.95) and Asian race (OR = 2.59, 95% CI 1.27-5.29) for quality programs and private practice settings (ORs = 8.72-27.8) for patient safety initiatives. CONCLUSION: QIPS was associated with academic settings. Interventions to increase rates of quality and safety participation should target individual and system-level factors, respectively. Future work should discern barriers to QIPS engagement and its clinical benefits.


Assuntos
Segurança do Paciente/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Urologistas/estatística & dados numéricos , Urologia/estatística & dados numéricos , Adulto , Idoso , Educação Médica Continuada/estatística & dados numéricos , Feminino , Humanos , Prática Institucional/organização & administração , Prática Institucional/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prática Privada/organização & administração , Prática Privada/estatística & dados numéricos , Fatores Raciais , Fatores Sexuais , Inquéritos e Questionários , Estados Unidos , Urologistas/educação , Urologia/educação
10.
J Surg Res ; 267: 159-166, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34147862

RESUMO

BACKGROUND: The first-line treatment for intussusception is radiologic reduction with either air-contrast enema (AE) or liquid-contrast enema (LE). The purpose of this study was to explore relationships between self-reported institutional AE or LE intussusception reduction preferences and rates of operative intervention and bowel resection. METHODS: Pediatric Health Information System (PHIS) hospitals were contacted to assess institutional enema practices for intussusception. A retrospective study using 2009-2018 PHIS data was conducted for patients aged 0-5 y to evaluate outcomes. Chi-squared tests were used to test for differences in the distribution of surgical patients by hospital management approach. RESULTS: Of the 45 hospitals, 20 (44%) exclusively used AE, 4 (9%) exclusively used LE, and 21 (46%) used a mixed practice. Of 24,688 patients identified from PHIS, 13,231 (54%) were at exclusive AE/LE hospitals and 11,457 (46%) were at mixed practice hospitals. Patients at AE/LE hospitals underwent operative procedures at lower rates than at mixed practice hospitals (14.8% versus 16.5%, P< 0.001) and were more likely to undergo bowel resection (31.1% versus 27.1%, P= 0.02). CONCLUSIONS: Practice variation exists in hospital-level approaches to radiologic reduction of intussusception and mixed practices may impact outcomes.


Assuntos
Intussuscepção , Criança , Pré-Escolar , Enema/métodos , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Prática Institucional , Intussuscepção/diagnóstico por imagem , Intussuscepção/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
11.
Av. enferm ; 39(2): 198-206, 01 may 2021.
Artigo em Espanhol | LILACS, BDENF - Enfermagem, COLNAL | ID: biblio-1290987

RESUMO

Introducción: la formación del talento humano en enfermería requiere de la articulación, de manera imprescindible, con las Instituciones Prestadoras de Servicios de Salud (IPS). Objetivo: analizar la relación docencia-servicio para la formación de talento humano en enfermería en Colombia. Materiales y métodos: estudio de tipo descriptivo. Se envió una encuesta electrónica con preguntas estructuradas y semiestructuradas a 53 Instituciones de Educación Superior (IES). Se incluyeron instituciones con programas de enfermería y con convenios docencia-servicio para prácticas formativas. Resultados: participaron 48 programas de enfermería de IES privadas (60,4 %) y públicas (39,6 %). El 62,5 % no contaban con una IPS propia para el desarrollo de prácticas formativas en salud, situación que deriva en estructuración de convenios docencia-servicio y pagos en dinero o servicios por las IES. Las principales modalidades de contraprestación fueron capacitación del recurso humano, educación continuada y dotación tecnológica. Conclusiones: la integración docencia-servicio de universidades públicas y privadas con diferentes instituciones es necesaria en la formación integral de profesionales de enfermería. Las IES se ven abocadas a ofrecer actividades de compensación y contraprestación según su capacidad y valoración de las necesidades conjuntas. Un bajo porcentaje cuenta con IPS propias, cuya mayoría es de carácter privado. La relación docencia-servicio mejora la atención, educación, orientación a los pacientes y familiares y la credibilidad por la presencia de la academia en las unidades asistenciales.


Introdução: para a formação do talento humano em enfermagem, é essencial articular-se com as instituições prestadoras de serviços de saúde (IPS). Objetivo: analisar a relação ensinoserviço para a formação do talento humano em enfermagem na Colômbia. Materiais e métodos: estudo descritivo, o qual utilizou enquete eletrônica com perguntas estruturadas e semiestruturadas enviadas a 53 Instituições de Ensino Superior (IES). Foram incluídas instituições com programas de enfermagem e convênios docentes para as práticas de formação. Resultados: participaram 48 programas de enfermagem de IES privadas (60,4 %) e públicas (39,6 %). 62,5 % não contavam com IPS própria para o desenvolvimento de estágios em saúde; essa situação leva à estruturação de convênios de prestação de serviços docentes e pagamentos em dinheiro ou serviços pelas IES. As principais formas de contraprestação foram treinamento do recurso humano, educação continuada e dotação tecnológica. Conclusões: a integração ensinoserviço de universidades públicas e privadas com diferentes instituições é necessária na formação integral dos profissionais de enfermagem. As IES são forçadas a oferecer atividades de compensação e remuneração de acordo com sua capacidade e avaliação de necessidades conjuntas. Uma porcentagem baixa tem suas IPS, e a maioria é privada. A relação ensinoserviço melhora o atendimento, a educação, a orientação e a credibilidade do paciente e da família, devido à presença da academia nas unidades de atendimento.


Introduction: The training of human talent in nursing requires the articulation with the health services institutions (IPS, in Spanish) as an essential feature. Objective: To analyze the teachingservice relationship for the training of human talent in nursing in Colombia. Materials and methods: Descriptive study using an electronic survey with structured and semi-structured questions sent to 53 higher education institutions (IES, in spanish). Institutions with nursing programs and teaching service agreements for training practices were included. Results: 48 nursing programs from private (60.4 %) and public (39.6 %) IES participated in this study. 62.5 % of these did not have an IPS in charge of providing their own health services for the development of training practices. This situation leads to the structuring of teaching service agreements and payments in money or services by IES. The main forms of compensation were human resource training, continuing education, and technological endowment. Conclusions: The teachingservice integration of public and private universities with different institutions is necessary for the comprehensive training of nursing professionals. IES are forced to offer compensation activities according to their capacity and assessment of joint needs. A low percentage have their own IPS, whose majority are private institutions. The teaching-service relationship improves care, education, patient and family orientation and credibility due to the presence of the academy in health care units.


Assuntos
Humanos , Serviços de Integração Docente-Assistencial , Universidades , Educação em Enfermagem , Instalações de Saúde , Prática Institucional
12.
J Plast Reconstr Aesthet Surg ; 74(10): 2737-2743, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33896742

RESUMO

BACKGROUND: Rising health care costs and the high number of uninsured Americans has led to the increasing popularity of a single payer alternative. While opinions of physicians at large have been studied, we present the first data examining the views of United States (U.S.) board-certified plastic surgeons on a single payer health care system and its implications for patients and practice. METHODS: A total of 3,431 US plastic and reconstructive surgeons were sent a 25-item Qualtrics survey and responses collected from September 1 to November 1, 2019. Independent variables included surgeon sociodemographic characteristics. The association between these and a preference for a single payer was evaluated using the logistic regression. RESULTS: There was a 11% response rate (n = 383). The majority of respondents were in private practice (64.5%). Forty-four percent believed that it is the government's responsibility to ensure care is provided for all; 34% were willing to give up income in exchange for reduced paperwork and administrative burden. Sixty-three percent would not work the same number of hours under single payer. Private practice plastic surgeons were significantly less likely to favor single payer (95% CI: 0.19 and 0.76). Among academic plastic surgeons, 24% would consider leaving if single payer were enacted and 60% would decrease the reconstructive portion of their practice. CONCLUSIONS: Most U.S. plastic and reconstructive surgeons do not support a single payer health care system. Its enactment could have sweeping implications for plastic surgeons nationwide, among the most significant being a shift from academic to private practice with a potential reduction in patient access to complex reconstructive procedures.


Assuntos
Atitude do Pessoal de Saúde , Médicos , Procedimentos Cirúrgicos Reconstrutivos/economia , Sistema de Fonte Pagadora Única , Cirurgia Plástica/economia , Adulto , Idoso , Feminino , Acesso aos Serviços de Saúde/economia , Humanos , Prática Institucional/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prática Privada/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos
17.
Rev Esc Enferm USP ; 54: e03587, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32844965

RESUMO

OBJECTIVE: To analyze the use of the Institutional Analysis theoretical-methodological framework and of the central concept of institution in its three moments - instituted, instituting and institutionalizing in health studies. METHOD: Integrative review conducted in databases of PubMed/Medline, LILACS, Scopus, and CINAHL including original research articles published between 2012 and 2017. RESULTS: Analysis of 26 publications. A plurality of study objects was found, and the most common were related to collective health, namely: mental health, violence, family-team relationship, family health, primary care, health of women, children and adolescents, oral health, continuing education, micropolitics of health work, health surveillance, HIV, law, pedagogical practices, school education and Autism. Nursing and psychology were the areas that most opted for Institutional Analysis. The polysemy of the institution concept was confirmed in the findings, indicating the richness of modes and uses of the concepts. CONCLUSION: Institutional Analysis presents tool-concepts to perform analyzes of health practices consistent with the Unified Health System.


Assuntos
Prática Institucional , Programas Nacionais de Saúde/organização & administração , Humanos
18.
Rev. enferm. Inst. Mex. Seguro Soc ; 28(3): 255-261, Jul-sept 2020. tab, graf
Artigo em Espanhol | LILACS, BDENF - Enfermagem | ID: biblio-1343181

RESUMO

Introducción: el incremento de la esperanza de vida, la mayor supervivencia de las personas con discapacidad y el crecimiento de las enfermedades crónicas elevan las cifras de personas en situación de dependencia. Esta transformación ha incrementado las necesidades de apoyo que van más allá de los servicios o programas formales y que requieren la incorporación de nuevas herramientas que permitan identificarlas. Desarrollo: se trata de la valoración de una persona en situación de dependencia a causa de una enfermedad vascular cerebral (EVC) con uso de la Escala de Intensidad de Apoyos (SIS). Los resultados muestran la pertinencia de incorporar al enfoque del cuidado de la enfermería un marco de evaluación que facilite la determinación de la frecuencia, tiempo y tipo de apoyo necesarios para el desarrollo de las actividades cotidianas, de tal modo que sea posible planificar de manera individualizada los apoyos requeridos para mejorar, mantener o recuperar la salud. Conclusiones: el modelo de intensidad de apoyos resultó de gran ayuda para evaluar la diferencia entre las capacidades/habilidades de la persona y los requerimientos/demandas que necesita para funcionar en su entorno; asimismo, permitió planificar el entorno y las adecuaciones ambientales, la cantidad de personas necesarias para el cuidado y el grado de capacitación para suministrar el cuidado previsto.


Introduction: The increase in life expectancy, the greater survival rate of people with disabilities and the growth of chronic diseases raise the numbers of people in situations of dependency. This transformation has increased support needs that go beyond formal services or programs and that require the incorporation of new tools to identify them. Development: This is the assessment of a person in a situation of dependency due to a cerebrovascular disease (EVC) using the Support Intensity Scale (SIS).The results show the pertinence of incorporating into the Nursing Care approach, an evaluation framework that facilitates the estimation of the frequency, time and type of support required for the development of daily activities, thus allowing the intensity to be individually planned of the supports required to improve, maintain or regain health. Conclusions: The support intensity model was of great help to evaluate the difference between the capacities / abilities of the person and the requirements / demands that he needs to function in his environment, as well as allowed to plan the environment and the environmental adaptations, the quantity of people required for care and the level of training needed to provide the intended care.


Assuntos
Humanos , Transtornos Cerebrovasculares , Pessoas com Deficiência , Cuidados de Enfermagem , Atividades Cotidianas , Doença Crônica , Taxa de Sobrevida , Expectativa de Vida , Necessidades e Demandas de Serviços de Saúde , Prática Institucional
19.
Int J Gynecol Cancer ; 30(8): 1129-1135, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32499392

RESUMO

OBJECTIVES: To determine surveillance patterns of stage I cervical cancer after cervical conization. METHODS: A 25-question electronic survey was sent to members of the Society of Gynecologic Oncology. Provider demographics, surveillance during year 1, years 1-3, and >3 years after cervical conization, use of pelvic examination, cytology, Human papillomavirus testing, colposcopy, and endocervical curettage were queried. Data were analyzed. RESULTS: 239/1175 (20.1%) responses were collected over a 5-week study period. All providers identified as gynecologic oncologists. During year 1, 66.7% of providers perform pelvic examination and 37.1% perform cytology every 3 months. During years 1-3, 61.6% perform pelvic examination and 46% perform cytology every 6 months. At >3 years, 54.4% perform pelvic examination every 6 months and 43% perform annual pelvic examination. 66.7% of respondents perform cytology annually, and 51.9% perform annual Human papilloma virus testing. 85% of providers do not offer routine colposcopy and 60% do not offer endocervical curettage at any point during 5-year follow-up. 76.3% of respondents screen patients for Human papilloma virus vaccination. CONCLUSIONS: To date, there are no specific surveillance guidelines for patients with stage I cervical cancer treated with cervical conization. The most common surveillance practice reported is pelvic examination with or without cytology every 3 months in year 1 and every 6 months thereafter. However, wide variation exists in visit frequency, cytology, and Human papillomavirus testing, and there is a clear trend away from using colposcopy and endocervical curettage. These disparate surveillance practices indicate a need for well-defined, uniform surveillance guidelines.


Assuntos
Recidiva Local de Neoplasia/diagnóstico , Vigilância da População/métodos , Padrões de Prática Médica/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/patologia , Adulto , Fatores Etários , Colo do Útero/cirurgia , Colposcopia/estatística & dados numéricos , Conização , Citodiagnóstico/estatística & dados numéricos , Feminino , Preservação da Fertilidade , Exame Ginecológico/estatística & dados numéricos , Humanos , Histerectomia/estatística & dados numéricos , Prática Institucional/estatística & dados numéricos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/prevenção & controle , Prática Privada/estatística & dados numéricos , Inquéritos e Questionários , Fatores de Tempo , Neoplasias do Colo do Útero/cirurgia , Vacinação
20.
J Pastoral Care Counsel ; 74(2): 124-132, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32496955

RESUMO

Due to the high number of Muslim applicants in the Swiss asylum system, in recent years there have been calls for an introduction of a Muslim chaplaincy service into Switzerland's asylum centers. Acknowledging this need, the Swiss federal government ran a Muslim chaplaincy pilot service in Zurich's Juch Asylum Center between July 2016 and June 2017, with a view to its possible roll-out across Switzerland's federal asylum centers. This paper links methodological reflection with a presentation of key results in the evaluation of this project. Applying a mixed-method design based on the fourth-generation evaluation research, the study investigates the perspectives of the main stakeholder groups on the pilot project. The interaction with Muslim chaplains mostly led to a high degree of satisfaction among asylum seekers. The study shows there were difficulties and obstacles integrating Muslim chaplaincy into the center's inter-professional setting, although the interfaith cooperation with Christian chaplains nonetheless developed intensively. The study's methodological limitations, primarily caused by the setting of the study, are also discussed, as well as the impact the evaluation itself had on the asylum center setting.


Assuntos
Clero , Prática Institucional/organização & administração , Islamismo , Refugiados , Feminino , Humanos , Masculino , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Suíça/etnologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...