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1.
Epidemiol Prev ; 48(3): 254-259, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38995140

RESUMO

The current humanitarian crises in Ukraine and Gaza, along with the chronic crises, and the climate-related disasters, have exposed the limitations of the humanitarian system. Within these contexts, humanitarian organisations frequently struggle with collecting, analysing, interpreting, and utilising health data, due to the challenging environments in which they operate and funding constraints. It is precisely in these contexts that field epidemiology plays a crucial, but often overlooked role.Field epidemiologists face unique challenges, including rapidly changing conditions, poor-quality data, and biases. Despite these difficulties, accurate epidemiological data are essential for needs assessment, guidance on interventions, and advocacy. Conventional methods often need adaptation for crisis settings, and there are still gaps in measurement.This article discusses the role of epidemiology in such contexts, noting a shortage of trained 'humanitarian epidemiologists' and specialised training as major issues.To address these needs, the Italian Association of Epidemiology organised a course in early 2024 to enhance the epidemiological skills of staff working in humanitarian crises and introduce traditional epidemiologists to crisis-specific challenges. The course covered key concepts and methods of field epidemiology, emphasising the use of secondary health data. Its positive reception underscored the demand for such specialised training.Improving public health information collection and use in humanitarian crises is an ethical and practical necessity. Indeed, investing in field epidemiology and recognising its importance can enhance humanitarian interventions and better serve vulnerable populations.


Assuntos
Altruísmo , Epidemiologia , Itália/epidemiologia , Humanos , Epidemiologia/educação , Ucrânia/epidemiologia , Epidemiologistas , Socorro em Desastres/organização & administração , Desastres , Oriente Médio/epidemiologia , Sociedades Médicas , Recursos Humanos
2.
Int J Qual Stud Health Well-being ; 19(1): 2380360, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39010745

RESUMO

PURPOSE: This study examines how local user associations of mental health service-user organizations were affected by the pandemic, in order to provide guidance to user organizations and surrounding actors on future advancements. The pandemic is used as a case to explore organizational resilience and digitalization during crisis. METHODS: Data from focus group interviews and individual interviews with representatives of ten local associations were analysed using qualitative content analysis. A theoretical framework combining governance theory and organizational theory was applied. RESULTS: Typically, associations swiftly restructured activities to support members to meet the urgent needs that arose, not least in relation to the digital transition. Simultaneously, face-to-face interactions was valued and some members became isolated. Public sector actors often did not prioritize collaboration, and the associations had limited agency and influence in advocacy activities. CONCLUSIONS: User organizations can play an important role in times of crisis. Surrounding social systems should provide resources to counteract resource dependencies and allow organizations to develop operating reserves. They should value collaboration and establish collaborative practices to ensure a readiness to utilize the organizations' capacities when needed. User organizations should have control over future developments, both to harness the potential of digital connectivity and to prevent a digital divide.


Assuntos
COVID-19 , Grupos Focais , Serviços de Saúde Mental , Pesquisa Qualitativa , Humanos , Serviços de Saúde Mental/organização & administração , SARS-CoV-2 , Pandemias , Comportamento Cooperativo
3.
Glob Health Action ; 17(1): 2364498, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-39011874

RESUMO

Diabetes remains a major, global clinical and public health threat with consistent rises in prevalence around the world over the past four decades. Two-thirds of the projected increases in global diabetes prevalence to 2045 are expected to come from low- and middle-income countries, including those in sub-Saharan Africa. Ghana is typical of this trend. However, there are gaps in evidence regarding the appropriate development of interventions and well-targeted policies for diabetes prevention and treatment that pay due attention to relevant local conditions and influences. Due consideration to community perspectives of environmental influences on the causes of diabetes, access to appropriate health services and care seeking for diabetes prevention and management is warranted, especially in urban settings. The 'Contextual Awareness, Response and Evaluation (CARE): Diabetes in Ghana' project is a mixed methods study in Ga Mashie, Accra. An epidemiological survey is described elsewhere. Six qualitative studies utilising a range of methodologies are proposed in this protocol to generate a contextual understanding of type 2 diabetes mellitus in an urban poor population. They focus on community, care provider, and policy stakeholder perspectives with a focus on food markets and environmental influences, the demand and supply of health services, and the history of the Ga Mashie community and its inhabitants. The results will be shared with the community in Ga Mashie and with health policy stakeholders in Ghana and other settings where the findings may be usefully transferable for the development of community-based interventions for diabetes prevention and control.


Main findings: Diabetes is a major, global health threat with rises in incidence projected in low- and middle-income countries, including Ghana, yet evidence gaps remain related to the development of contextually appropriate interventions and policies for diabetes prevention and treatment.Added knowledge: Sitting within a larger, mixed methods study entitled 'Contextual Awareness, Response and Evaluation (CARE): Diabetes in Ghana', this study design paper introduces six complementary qualitative studies designed to address this gap in Ga Mashie, Accra.Global health impact for policy and action: Robust methods to describe diabetes burdens and dissemination of evidence are crucial for health policy and impact.


Assuntos
Diabetes Mellitus Tipo 2 , Pesquisa Qualitativa , População Urbana , Humanos , Gana/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Mellitus Tipo 2/epidemiologia , Acessibilidade aos Serviços de Saúde/organização & administração , Pobreza , Conhecimentos, Atitudes e Prática em Saúde
5.
Soins ; 69(887): 58-61, 2024.
Artigo em Francês | MEDLINE | ID: mdl-39019520

RESUMO

While the Ministry of Health has been communicating for several months about the launch of the reform of the nursing profession, work finally began in mid-2023 in the field of practice, to  efine the new perimeters to be covered for the profession of tomorrow. At the same time, the move towards university-based initial nursing training, which began in 2009, is continuing, with discussions starting at the end of 2023 on educational engineering, selection procedures, placements, student rights, the fundamentals of research teaching, etc. Between increasing skills and the associated responsibilities, and establishing a disciplinary field, the development of the profession is part of a gradual historical construction.


Assuntos
Educação em Enfermagem , Humanos , França , Educação em Enfermagem/organização & administração
6.
Br J Nurs ; 33(14): 677, 2024 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-39023025

RESUMO

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, looks at the work being carried out in the UK and internationally to ensure that we can build and sustain the nursing workforce.


Assuntos
Medicina Estatal , Reino Unido , Humanos , Medicina Estatal/organização & administração , Previsões , Aprendizagem
7.
Geriatr Psychol Neuropsychiatr Vieil ; 22(2): 177-190, 2024 Jun 01.
Artigo em Francês | MEDLINE | ID: mdl-39023153

RESUMO

While it is necessary to provide « homelike ¼ in nursing homes, the risk is to reduce it to decoration. As the aim is to reconcile care and home, we propose co-design, an approach involving users in the design of living spaces, as a solution. We propose tools and a protocol, then provide feedback from a workshop on co-designing a collective space with three residents in a nursing home in Île-de-France. We thoroughly analyse the contributions of the residents during the workshop, and then compare their proposals with the opinions of the nurses. We found that the workshop enabled participants to express concret needs that tended towards « homelike ¼ proposals. The convergence of day-to-day expertise, through co-design, encourages design solutions that are suitable for everyone, while its role in mediation supports organisational change in the nursing home.


Assuntos
Instituição de Longa Permanência para Idosos , Casas de Saúde , Casas de Saúde/organização & administração , Humanos , Idoso , Instituição de Longa Permanência para Idosos/organização & administração , Idoso de 80 Anos ou mais , França , Educação , Feminino , Masculino
8.
Implement Sci ; 19(1): 49, 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39010100

RESUMO

BACKGROUND: Implementation of new practices in team-based settings requires teams to work together to respond to new demands and changing expectations. However, team constructs and team-based implementation approaches have received little attention in the implementation science literature. This systematic review summarizes empirical research examining associations between teamwork and implementation outcomes when evidence-based practices and other innovations are implemented in healthcare and human service settings. METHODS: We searched MEDLINE, CINAHL, APA PsycINFO and ERIC for peer-reviewed empirical articles published from January 2000 to March 2022. Additional articles were identified by searches of reference lists and a cited reference search for included articles (completed in February 2023). We selected studies using quantitative, qualitative, or mixed methods to examine associations between team constructs and implementation outcomes in healthcare and human service settings. We used the Mixed Methods Appraisal Tool to assess methodological quality/risk of bias and conducted a narrative synthesis of included studies. GRADE and GRADE-CERQual were used to assess the strength of the body of evidence. RESULTS: Searches identified 10,489 results. After review, 58 articles representing 55 studies were included. Relevant studies increased over time; 71% of articles were published after 2016. We were unable to generate estimates of effects for any quantitative associations because of very limited overlap in the reported associations between team variables and implementation outcomes. Qualitative findings with high confidence were: 1) Staffing shortages and turnover hinder implementation; 2) Adaptive team functioning (i.e., positive affective states, effective behavior processes, shared cognitive states) facilitates implementation and is associated with better implementation outcomes; Problems in team functioning (i.e., negative affective states, problematic behavioral processes, lack of shared cognitive states) act as barriers to implementation and are associated with poor implementation outcomes; and 3) Open, ongoing, and effective communication within teams facilitates implementation of new practices; poor communication is a barrier. CONCLUSIONS: Teamwork matters for implementation. However, both team constructs and implementation outcomes were often poorly specified, and there was little overlap of team constructs and implementation outcomes studied in quantitative studies. Greater specificity and rigor are needed to understand how teamwork influences implementation processes and outcomes. We provide recommendations for improving the conceptualization, description, assessment, analysis, and interpretation of research on teams implementing innovations. TRIAL REGISTRATION: This systematic review was registered in PROSPERO, the international prospective register of systematic reviews. REGISTRATION NUMBER: CRD42020220168.


Assuntos
Ciência da Implementação , Equipe de Assistência ao Paciente , Humanos , Equipe de Assistência ao Paciente/organização & administração , Comportamento Cooperativo , Atenção à Saúde/organização & administração , Prática Clínica Baseada em Evidências/organização & administração
9.
Health Res Policy Syst ; 22(1): 85, 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39010106

RESUMO

BACKGROUND: Mental health conditions affect one in seven young people and research suggests that current mental health services are not meeting the needs of most children and youth. Learning health systems are an approach to enhancing services through rapid, routinized cycles of continuous learning and improvement. Patient-reported outcome measures provide a key data source for learning health systems. They have also been shown to improve outcomes for patients when integrated into routine clinical care. However, implementing these measures into health systems is a challenging process. This paper describes a protocol for a formative evaluation of the implementation of patient-reported measures in a newly operational child and adolescent mental health centre in Calgary, Canada. The purpose is to optimize the collection and use of patient-reported outcome measures. Our specific objectives are to assess the implementation progress, identify barriers and facilitators to implementation, and explore patient, caregivers and clinician experiences of using these measures in routine clinical care. METHODS: This study is a mixed-methods, formative evaluation using the Consolidated Framework for Implementation Research. Participants include patients and caregivers who have used the centre's services, as well as leadership, clinical and support staff at the centre. Focus groups and semi-structured interviews will be conducted to assess barriers and facilitators to the implementation and sustainability of the use of patient-reported outcome measures, as well as individuals' experiences with using these measures within clinical care. The data generated by the patient-reported measures over the first five months of the centre's operation will be analyzed to understand implementation progress, as well as validity of the chosen measures for the centres' population. DISCUSSION: The findings of this evaluation will help to identify and address the factors that are affecting the successful implementation of patient-reported measures at the centre. They will inform the co-design of strategies to improve implementation with key stakeholders, which include patients, clinical staff, and leadership at the centre. To our knowledge, this is the first study of the implementation of patient-reported outcome measures in child and adolescent mental health services and our findings can be used to enhance future implementation efforts in similar settings.


Assuntos
Serviços de Saúde da Criança , Sistema de Aprendizagem em Saúde , Serviços de Saúde Mental , Medidas de Resultados Relatados pelo Paciente , Humanos , Adolescente , Criança , Serviços de Saúde da Criança/organização & administração , Serviços de Saúde do Adolescente , Canadá , Grupos Focais , Transtornos Mentais/terapia , Avaliação de Programas e Projetos de Saúde , Cuidadores , Projetos de Pesquisa
10.
Crit Care ; 28(1): 240, 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39010113

RESUMO

BACKGROUND: The immune response of critically ill patients, such as those with sepsis, severe trauma, or major surgery, is heterogeneous and dynamic, but its characterization and impact on outcomes are poorly understood. Until now, the primary challenge in advancing our understanding of the disease has been to concurrently address both multiparametric and temporal aspects. METHODS: We used a clustering method to identify distinct groups of patients, based on various immune marker trajectories during the first week after admission to ICU. In 339 severely injured patients, we initially longitudinally clustered common biomarkers (both soluble and cellular parameters), whose variations are well-established during the immunosuppressive phase of sepsis. We then applied this multi-trajectory clustering using markers composed of whole blood immune-related mRNA. RESULTS: We found that both sets of markers revealed two immunotypes, one of which was associated with worse outcomes, such as increased risk of hospital-acquired infection and mortality, and prolonged hospital stays. This immunotype showed signs of both hyperinflammation and immunosuppression, which persisted over time. CONCLUSION: Our study suggest that the immune system of critically ill patients can be characterized by two distinct longitudinal immunotypes, one of which included patients with a persistently dysregulated and impaired immune response. This work confirms the relevance of such methodology to stratify patients and pave the way for further studies using markers indicative of potential immunomodulatory drug targets.


Assuntos
Biomarcadores , Ferimentos e Lesões , Humanos , Masculino , Feminino , Biomarcadores/sangue , Biomarcadores/análise , Pessoa de Meia-Idade , Adulto , Ferimentos e Lesões/imunologia , Ferimentos e Lesões/sangue , Análise por Conglomerados , Estado Terminal , Unidades de Terapia Intensiva/estatística & dados numéricos , Unidades de Terapia Intensiva/organização & administração , Idoso , Sepse/sangue , Sepse/imunologia , Estudos Longitudinais
11.
Health Res Policy Syst ; 22(1): 83, 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39010121

RESUMO

BACKGROUND: Adverse childhood experiences can impact physical and mental health throughout the lifespan. To support families experiencing adversity and improve child health and developmental equity, an integrated, multi-sector response is required. Child and Family Hubs (Hubs) are a feasible and acceptable approach to providing such a response. In the Australian context, a number of federal and New South Wales (NSW) state policies support an integrated, multi-sector response using Hubs to support families experiencing adversity. This study examined NSW policy stakeholder and health service manager perspectives on the barriers and enablers to translating policy into practice in the implementation of Child and Family Hubs. METHODS: Semi-structured interviews were conducted with 11 NSW government policy stakeholders and 13 community health service managers working in child and family policy and planning or child and family community-based services. Interviews were of 30-60 min duration and explored stakeholder knowledge, perspectives and experiences around childhood adversity, and barriers and enablers to operationalizing policies supporting Hubs. Analysis of barriers and facilitators to implementation of Hub models of care was undertaken using the Consolidated Framework for Implementation Research (CFIR). RESULTS: Key barriers that emerged included short-term and inconsistent funding, lack of resourcing for a Hub co-ordinator, limited support for evaluation and insufficient time to plan for Hub implementation. Key enablers included flexibility and adaptability of Hub models to meet local needs, formal change management processes, strong governance structures and engagement among Hub practitioners. Key insights included the importance of targeted strategies to support sustained individual practice change and the need for organization-wide commitment to enable the successful adoption and maintenance of the Hub model of care. CONCLUSIONS: This study provides valuable insights and contributes evidence around what is needed to strengthen and support the operationalization and scalability of the Hub model of care. Key recommendations for Hub practitioners include the importance of formal change management processes and establishment of strong governance structures, while key recommendations for policymakers include the need for sustainable Hub funding and a standardized, evidence-based framework to support Hub implementation and evaluation.


Assuntos
Política de Saúde , Humanos , New South Wales , Criança , Participação dos Interessados , Serviços de Saúde da Criança/organização & administração , Família , Pesquisa Qualitativa , Serviços de Saúde Comunitária/organização & administração , Saúde da Criança , Pessoal Administrativo , Formulação de Políticas , Entrevistas como Assunto
12.
Crit Care ; 28(1): 242, 2024 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-39010134

RESUMO

BACKGROUND: Half of pediatric in-hospital cardiopulmonary resuscitation (CPR) events have an initial rhythm of non-pulseless bradycardia with poor perfusion. Our study objectives were to leverage granular data from the ICU-RESUScitation (ICU-RESUS) trial to: (1) determine the association of early epinephrine administration with survival outcomes in children receiving CPR for bradycardia with poor perfusion; and (2) describe the incidence and time course of the development of pulselessness. METHODS: Prespecified secondary analysis of ICU-RESUS, a multicenter cluster randomized trial of children (< 19 years) receiving CPR in 18 intensive care units in the United States. Index events (October 2016-March 2021) lasting ≥ 2 min with a documented initial rhythm of bradycardia with poor perfusion were included. Associations between early epinephrine (first 2 min of CPR) and outcomes were evaluated with Poisson multivariable regression controlling for a priori pre-arrest characteristics. Among patients with arterial lines, intra-arrest blood pressure waveforms were reviewed to determine presence of a pulse during CPR interruptions. The temporal nature of progression to pulselessness was described and outcomes were compared between patients according to subsequent pulselessness status. RESULTS: Of 452 eligible subjects, 322 (71%) received early epinephrine. The early epinephrine group had higher pre-arrest severity of illness and vasoactive-inotrope scores. Early epinephrine was not associated with survival to discharge (aRR 0.97, 95%CI 0.82, 1.14) or survival with favorable neurologic outcome (aRR 0.99, 95%CI 0.82, 1.18). Among 186 patients with invasive blood pressure waveforms, 118 (63%) had at least 1 period of pulselessness during the first 10 min of CPR; 86 (46%) by 2 min and 100 (54%) by 3 min. Sustained return of spontaneous circulation was highest after bradycardia with poor perfusion (84%) compared to bradycardia with poor perfusion progressing to pulselessness (43%) and bradycardia with poor perfusion progressing to pulselessness followed by return to bradycardia with poor perfusion (62%) (p < 0.001). CONCLUSIONS: In this cohort of pediatric CPR events with an initial rhythm of bradycardia with poor perfusion, we failed to identify an association between early bolus epinephrine and outcomes when controlling for illness severity. Most children receiving CPR for bradycardia with poor perfusion developed subsequent pulselessness, 46% within 2 min of CPR onset.


Assuntos
Bradicardia , Reanimação Cardiopulmonar , Epinefrina , Humanos , Epinefrina/administração & dosagem , Epinefrina/uso terapêutico , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/estatística & dados numéricos , Masculino , Feminino , Bradicardia/tratamento farmacológico , Bradicardia/terapia , Pré-Escolar , Criança , Lactente , Adolescente , Unidades de Terapia Intensiva/estatística & dados numéricos , Unidades de Terapia Intensiva/organização & administração
13.
Implement Sci ; 19(1): 50, 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39010153

RESUMO

BACKGROUND: There are no criteria specifically for evaluating the quality of implementation research and recommending implementation strategies likely to have impact to practitioners. We describe the development and application of the Best Practices Tool, a set of criteria to evaluate the evidence supporting HIV-specific implementation strategies. METHODS: We developed the Best Practices Tool from 2022-2023 in three phases. (1) We developed a draft tool and criteria based on a literature review and key informant interviews. We purposively selected and recruited by email interview participants representing a mix of expertise in HIV service delivery, quality improvement, and implementation science. (2) The tool was then informed and revised through two e-Delphi rounds using a survey delivered online through Qualtrics. The first and second round Delphi surveys consisted of 71 and 52 open and close-ended questions, respectively, asking participants to evaluate, confirm, and make suggestions on different aspects of the rubric. After each survey round, data were analyzed and synthesized as appropriate; and the tool and criteria were revised. (3) We then applied the tool to a set of research studies assessing implementation strategies designed to promote the adoption and uptake of evidence-based HIV interventions to assess reliable application of the tool and criteria. RESULTS: Our initial literature review yielded existing tools for evaluating intervention-level evidence. For a strategy-level tool, additions emerged from interviews, for example, a need to consider the context and specification of strategies. Revisions were made after both Delphi rounds resulting in the confirmation of five evaluation domains - research design, implementation outcomes, limitations and rigor, strategy specification, and equity - and four evidence levels - best, promising, more evidence needed, and harmful. For most domains, criteria were specified at each evidence level. After an initial pilot round to develop an application process and provide training, we achieved 98% reliability when applying the criteria to 18 implementation strategies. CONCLUSIONS: We developed a tool to evaluate the evidence supporting implementation strategies for HIV services. Although specific to HIV in the US, this tool is adaptable for evaluating strategies in other health areas.


Assuntos
Técnica Delphi , Infecções por HIV , Ciência da Implementação , Humanos , Infecções por HIV/terapia , Estados Unidos , Melhoria de Qualidade/organização & administração
14.
S D Med ; 77(5): 220-229, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-39012775

RESUMO

This article makes a case to encourage pediatric/adolescent care providers and healthcare systems to implement measurement-based standardized assessments of patient's baseline and longitudinal health outcomes for mental disorders to help institute evidence-based treatments. The article discusses the current underutilization, challenges, barriers, and concerns from stakeholders with measurement-based care in clinical settings while also highlighting the advantages and importance of the aforementioned care model.


Assuntos
Transtornos Mentais , Humanos , Adolescente , Transtornos Mentais/terapia , Transtornos Mentais/diagnóstico , Criança , Serviços de Saúde Mental/organização & administração
15.
JMIR Res Protoc ; 13: e54365, 2024 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-39024011

RESUMO

BACKGROUND: Primary care physicians are at the forefront of the clinical process that can lead to diagnosis, referral, and treatment. With electronic medical records (EMRs) being introduced and, over time, gaining acceptance by primary care users, they have now become a standard part of care. EMRs have the potential to be further optimized with the introduction of artificial intelligence (AI). There has yet to be a widespread exploration of the use of AI in primary health care and how clinicians envision AI use to encourage further uptake. OBJECTIVE: The primary objective of this research is to understand if the user-centered design approach, rooted in contextual design, can lead to an increased likelihood of adoption of an AI-enabled encounter module embedded in a primary care EMR. In this study, we use human factor models and the technology acceptance model to understand the results. METHODS: To accomplish this, a partnership has been established with an industry partner, TELUS Health, to use their EMR, the collaborative health record. The overall intention is to understand how to improve the user experience by using user-centered design to inform how AI should be embedded in an EMR encounter. Given this intention, a user-centered approach will be used to accomplish it. The approach of user-centered design requires qualitative interviewing to gain a clear understanding of users' approaches, intentions, and other key insights to inform the design process. A total of 5 phases have been designed for this study. RESULTS: As of March 2024, a total of 14 primary care clinician participants have been recruited and interviewed. First-cycle coding of all qualitative data results is being conducted to inform redesign considerations. CONCLUSIONS: Some limitations need to be acknowledged related to the approach of this study. There is a lack of market maturity of AI-enabled EMR encounters in primary care, requiring research to take place through scenario-based interviews. However, this participant group will still help inform design considerations for this tool. This study is targeted for completion in the late fall of 2024. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54365.


Assuntos
Inteligência Artificial , Registros Eletrônicos de Saúde , Atenção Primária à Saúde , Design Centrado no Usuário , Humanos , Atenção Primária à Saúde/organização & administração , Canadá
16.
Wiad Lek ; 77(5): 971-979, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39008585

RESUMO

OBJECTIVE: Aim: Development of an algorithm of management actions for the formation of a resilient system of quality of medical care in health care institutions of obstetric and gynecological profile and formalization of its closed structural and logical scheme. PATIENTS AND METHODS: Materials and Methods: A set of theoretical approaches of social medicine and methods of business process reengineering is used, taking into account the dominant ones: systemic and integrated approach and alarm and process approaches; the concept of resilience; quality of medical care; reproductive health care using business ecosystem methods. RESULTS: Results: The algorithm of management actions for the formation of a resilient system of quality of medical care in obstetric and gynecological health care institutions, which is formalized in nine stages: analysis of needs and identification of problems; substantiation of performance requirements; development of a health care quality strategy; involvement of stakeholders; formation of a system of relative indicators; development of an action plan; implementation of a set of measures; monitoring and evaluation; improving the quality of health care. CONCLUSION: Conclusions: The results made it possible: construction of a closed structural and logical scheme of management actions, taking into account the combination of factors of influence, harmonized with the main functions of the resilient system, which determine the peculiarities of its functioning; justification of the boundaries of managerial and social responsibility of management entities according to the binary components of the medical and social justification of the process of improving the quality of medical care.


Assuntos
Algoritmos , Qualidade da Assistência à Saúde , Humanos , Atenção à Saúde/normas , Atenção à Saúde/organização & administração , Ginecologia/organização & administração , Ginecologia/normas , Obstetrícia/normas , Obstetrícia/organização & administração , Feminino
18.
JMIR Mhealth Uhealth ; 12: e55094, 2024 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-39018100

RESUMO

BACKGROUND: Personal sensing, leveraging data passively and near-continuously collected with wearables from patients in their ecological environment, is a promising paradigm to monitor mood disorders (MDs), a major determinant of the worldwide disease burden. However, collecting and annotating wearable data is resource intensive. Studies of this kind can thus typically afford to recruit only a few dozen patients. This constitutes one of the major obstacles to applying modern supervised machine learning techniques to MD detection. OBJECTIVE: In this paper, we overcame this data bottleneck and advanced the detection of acute MD episodes from wearables' data on the back of recent advances in self-supervised learning (SSL). This approach leverages unlabeled data to learn representations during pretraining, subsequently exploited for a supervised task. METHODS: We collected open access data sets recording with the Empatica E4 wristband spanning different, unrelated to MD monitoring, personal sensing tasks-from emotion recognition in Super Mario players to stress detection in undergraduates-and devised a preprocessing pipeline performing on-/off-body detection, sleep/wake detection, segmentation, and (optionally) feature extraction. With 161 E4-recorded subjects, we introduced E4SelfLearning, the largest-to-date open access collection, and its preprocessing pipeline. We developed a novel E4-tailored transformer (E4mer) architecture, serving as the blueprint for both SSL and fully supervised learning; we assessed whether and under which conditions self-supervised pretraining led to an improvement over fully supervised baselines (ie, the fully supervised E4mer and pre-deep learning algorithms) in detecting acute MD episodes from recording segments taken in 64 (n=32, 50%, acute, n=32, 50%, stable) patients. RESULTS: SSL significantly outperformed fully supervised pipelines using either our novel E4mer or extreme gradient boosting (XGBoost): n=3353 (81.23%) against n=3110 (75.35%; E4mer) and n=2973 (72.02%; XGBoost) correctly classified recording segments from a total of 4128 segments. SSL performance was strongly associated with the specific surrogate task used for pretraining, as well as with unlabeled data availability. CONCLUSIONS: We showed that SSL, a paradigm where a model is pretrained on unlabeled data with no need for human annotations before deployment on the supervised target task of interest, helps overcome the annotation bottleneck; the choice of the pretraining surrogate task and the size of unlabeled data for pretraining are key determinants of SSL success. We introduced E4mer, which can be used for SSL, and shared the E4SelfLearning collection, along with its preprocessing pipeline, which can foster and expedite future research into SSL for personal sensing.


Assuntos
Transtornos do Humor , Aprendizado de Máquina Supervisionado , Dispositivos Eletrônicos Vestíveis , Humanos , Estudos Prospectivos , Dispositivos Eletrônicos Vestíveis/estatística & dados numéricos , Dispositivos Eletrônicos Vestíveis/normas , Masculino , Feminino , Transtornos do Humor/diagnóstico , Transtornos do Humor/psicologia , Adulto , Exercício Físico/psicologia , Exercício Físico/fisiologia , Universidades/estatística & dados numéricos , Universidades/organização & administração
19.
J Emerg Manag ; 22(3): 235-248, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39017597

RESUMO

The US National Weather Service (NWS) and emergency managers (EMs) around the country are tasked with communicating severe weather information to the public. Frequent interaction between professionals and residents is essential to building effective partnerships. This paper investigates these interactions and also explores the perspectives of NWS forecasters, EMs, and rural residents related to the efficacy of warning communication, message understanding, preferred platforms, and engagement in protective actions. Data for this study were collected through three original survey instruments that were directed to NWS forecasters and EMs across the country, and residents in four rural communities. Findings reveal that residents generally understand warning messages and generally feel tornado risk communication is effective in their communities. However, residents do not appear to have a plan of action formulated prior to a warning and are, therefore, making, rather than implementing, a plan when warning is issued. This study gives rural residents a voice in the warning communication process and a chance for forecasters and EMs to gain valuable information as they better plan to serve these communities.


Assuntos
Comunicação , População Rural , Humanos , Estados Unidos , Planejamento em Desastres/organização & administração , Feminino , Masculino , Tempo (Meteorologia) , Adulto , Tornados , Pessoa de Meia-Idade , Inquéritos e Questionários
20.
J Emerg Manag ; 22(3): 275-290, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39017600

RESUMO

Hierarchical command-style structures are commonplace in the management of disasters, though researchers have begun to recommend the exploration of networked approaches to incident management. Furthermore, few studies are explicitly looking at the rural context of disaster management. This study seeks to contribute to both topics by examining the motivations for emergent collaboration in the direction of the response and initial recovery to the coronavirus disease 2019 pandemic in a rural West Virginia community. Between March 2020 and March 2022, the primary investigator moderated regular briefings of a community task force convened to coordinate the pandemic response and recovery. As regular operations concluded, members completed a survey, and 10 randomly selected members participated in semistructured interviews regarding their experiences in the task force. Survey responses suggest that common motivations for collaboration in nondisaster contexts (as they appear in the scholarly literature) and potential benefits of networked approaches highlighted in the incident management literature could also serve as motivators within the disaster context. Qualitative interview data extend that discussion and identify the need to gain clear information regarding the concerned authorities and specific local information to better inform the expenditure of limited resources as two additional motivators for collaboration.


Assuntos
COVID-19 , Comportamento Cooperativo , Planejamento em Desastres , Humanos , COVID-19/epidemiologia , COVID-19/psicologia , West Virginia , Planejamento em Desastres/organização & administração , População Rural , SARS-CoV-2 , Pandemias , Inquéritos e Questionários , Motivação
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