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1.
J Nurs Adm ; 52(1): 1-3, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34910702

RESUMO

The sobering facts are clear: hospitals and health systems are facing a severe nursing shortage, with safe inpatient staffing approaching near-crisis levels. Safely staffing inpatient care is challenging. Stopping the exodus of nurses from acute care must be prioritized by the entire C-suite, with the chief nurse executive at the center of all decisions. Beyond aggressive retention strategies, different in-kind solutions to address the practice environment are nonnegotiable and help address nursing concerns about continued hospital employment.


Assuntos
Emprego/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital , Admissão e Escalonamento de Pessoal , Recursos Humanos/tendências , Humanos , Enfermeiras Administradoras , Recursos Humanos de Enfermagem no Hospital/provisão & distribuição , Recursos Humanos de Enfermagem no Hospital/tendências , Segurança do Paciente , Lealdade ao Trabalho
2.
J Nurs Adm ; 52(1): 35-41, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34910707

RESUMO

OBJECTIVE: The aim of this study was to review the literature regarding the use of an in-home opioid disposal product on unused opioids after surgery. BACKGROUND: The opioid epidemic in the United States is a major cause of concern for healthcare facilities. The misuse and diversion of retained opioids after a surgical procedure continues to contribute to this problem. METHODS: A comprehensive search of the Cumulative Index of Nursing and Allied Health Literature, OVID, and PubMed databases with keywords including opioid, analgesics, narcotics, medical waste disposal, medical disposal, refuse disposal, and opioid disposal resulted in 286 articles. Articles were screened based on strict inclusion and exclusion criteria. RESULTS: Eight studies determined that an in-home opioid disposal product provided by a healthcare facility produced rates of opioid disposal between 19% and 71%. CONCLUSIONS: The provision of an in-home opioid disposal product by a healthcare facility is likely to increase the disposal of unused opioid medications in the postoperative surgical patient population.


Assuntos
Analgésicos Opioides/uso terapêutico , Substâncias Controladas/normas , Prescrições de Medicamentos , Pacientes Ambulatoriais , Cooperação do Paciente , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Analgésicos Opioides/provisão & distribuição , Humanos , Estados Unidos
5.
Nutrients ; 13(12)2021 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-34959750

RESUMO

Biofortification of food crops with iodine is a novel approach to preventing iodine deficiency in humans. The present study analyses the consumer target groups and the market potential of iodine-biofortified fruit and vegetables in Germany. For this purpose, an online survey of 1016 German fruit and vegetable consumers was conducted to investigate the acceptance of different product categories as well as relevant criteria for the market launch. The results show that iodine-biofortified fruit and vegetables are particularly attractive to consumers who purchase at farmers' markets, organic food shops, and farm stores. Out of this group, 39% of consumers rate such iodine-rich foods as very appealing. They attach importance to food that naturally contains iodine and prefer produce from integrated domestic cultivation. With their focus on sustainability and naturalness, this group of consumers clearly differs from typical users of dietary supplements, who are primarily concerned with health benefits. However, overall about 85% of respondents would prefer biofortified fruits and vegetables to supplements to improve their iodine supply. The greatest market potential for iodine-biofortified fruit and vegetables is to be expected in supermarkets, as this is the preferred food shopping location for most consumers. A total of 28% of those who buy here rate the biofortified foods presented as very appealing. Nevertheless, a successful market launch requires that the benefits of the new products are communicated according to the potential consumer group needs.


Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Dieta Saudável/psicologia , Preferências Alimentares/psicologia , Frutas/química , Iodo/administração & dosagem , Verduras/química , Adolescente , Adulto , Biofortificação , Feminino , Alimentos Orgânicos/análise , Alimentos Orgânicos/provisão & distribuição , Frutas/provisão & distribuição , Alimento Funcional/análise , Alimento Funcional/provisão & distribuição , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Verduras/provisão & distribuição , Adulto Jovem
6.
Nutrients ; 13(12)2021 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-34959777

RESUMO

Plant-based meat (PBM) has been gaining popularity due to increasing concerns over health, animal welfare, and environmental issues linked to animal foods. This study aimed to compare the nutrient profile of PBM with equivalent meat products. We conducted a cross-sectional survey of 207 PBM and 226 meat products available from 14 retailers in the UK. We extracted data on energy density, total and saturated fat, protein, fiber, and salt per 100 g from product packaging and calculated the nutrient profile of each product. Compared to meat, PBM had significantly lower energy density, total fat, saturated fat, protein, and significantly higher fiber. Salt content was significantly higher in five out of six PBM categories. Based on the UK's Nutrient Profiling Model, 14% of PBM and 40% of meat products were classified as "less healthy" (p < 0.001). When considering the UK's front-of-pack labelling criteria 20% of the PBM and 46% of meat products were considered high in either total fat, saturated fat, or salt (p < 0.001). Nearly three quarters of PBM products did not meet the current UK salt targets. PBM products have a better nutrient profile compared to meat equivalents. However, more progress is needed to reduce salt in these products.


Assuntos
Dieta Vegetariana/estatística & dados numéricos , Análise de Alimentos/estatística & dados numéricos , Produtos da Carne/análise , Carne/análise , Nutrientes/análise , Estudos Transversais , Rotulagem de Alimentos/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Humanos , Carne/provisão & distribuição , Produtos da Carne/provisão & distribuição , Valor Nutritivo , Reino Unido
7.
JAMA Netw Open ; 4(12): e2136726, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34913980

RESUMO

Importance: World Health Organization (WHO) guidelines do not recommend routine antibiotic use for children with acute watery diarrhea. However, recent studies suggest that a significant proportion of such episodes have a bacterial cause and are associated with mortality and growth impairment, especially among children at high risk of diarrhea-associated mortality. Expanding antibiotic use among dehydrated or undernourished children may reduce diarrhea-associated mortality and improve growth. Objective: To determine whether the addition of azithromycin to standard case management of acute nonbloody watery diarrhea for children aged 2 to 23 months who are dehydrated or undernourished could reduce mortality and improve linear growth. Design, Setting, and Participants: The Antibiotics for Children with Diarrhea (ABCD) trial was a multicountry, randomized, double-blind, clinical trial among 8266 high-risk children aged 2 to 23 months presenting with acute nonbloody diarrhea. Participants were recruited between July 1, 2017, and July 10, 2019, from 36 outpatient hospital departments or community health centers in a mixture of urban and rural settings in Bangladesh, India, Kenya, Malawi, Mali, Pakistan, and Tanzania. Each participant was followed up for 180 days. Primary analysis included all randomized participants by intention to treat. Interventions: Enrolled children were randomly assigned to receive either oral azithromycin, 10 mg/kg, or placebo once daily for 3 days in addition to standard WHO case management protocols for the management of acute watery diarrhea. Main Outcomes and Measures: Primary outcomes included all-cause mortality up to 180 days after enrollment and linear growth faltering 90 days after enrollment. Results: A total of 8266 children (4463 boys [54.0%]; mean [SD] age, 11.6 [5.3] months) were randomized. A total of 20 of 4133 children in the azithromycin group (0.5%) and 28 of 4135 children in the placebo group (0.7%) died (relative risk, 0.72; 95% CI, 0.40-1.27). The mean (SD) change in length-for-age z scores 90 days after enrollment was -0.16 (0.59) in the azithromycin group and -0.19 (0.60) in the placebo group (risk difference, 0.03; 95% CI, 0.01-0.06). Overall mortality was much lower than anticipated, and the trial was stopped for futility at the prespecified interim analysis. Conclusions and Relevance: The study did not detect a survival benefit for children from the addition of azithromycin to standard WHO case management of acute watery diarrhea in low-resource settings. There was a small reduction in linear growth faltering in the azithromycin group, although the magnitude of this effect was not likely to be clinically significant. In low-resource settings, expansion of antibiotic use is not warranted. Adherence to current WHO case management protocols for watery diarrhea remains appropriate and should be encouraged. Trial Registration: ClinicalTrials.gov Identifier: NCT03130114.


Assuntos
Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Desenvolvimento Infantil/efeitos dos fármacos , Diarreia/tratamento farmacológico , Doença Aguda , Administração Oral , Assistência Ambulatorial/estatística & dados numéricos , Desidratação/complicações , Desidratação/mortalidade , Diarreia/etiologia , Diarreia/mortalidade , Método Duplo-Cego , Esquema de Medicação , Feminino , Recursos em Saúde/provisão & distribuição , Humanos , Lactente , Masculino , Desnutrição/complicações , Desnutrição/mortalidade , Resultado do Tratamento
10.
PLoS Comput Biol ; 17(12): e1009697, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34898617

RESUMO

For the control of COVID-19, vaccination programmes provide a long-term solution. The amount of available vaccines is often limited, and thus it is crucial to determine the allocation strategy. While mathematical modelling approaches have been used to find an optimal distribution of vaccines, there is an excessively large number of possible allocation schemes to be simulated. Here, we propose an algorithm to find a near-optimal allocation scheme given an intervention objective such as minimization of new infections, hospitalizations, or deaths, where multiple vaccines are available. The proposed principle for allocating vaccines is to target subgroups with the largest reduction in the outcome of interest. We use an approximation method to reconstruct the age-specific transmission intensity (the next generation matrix), and express the expected impact of vaccinating each subgroup in terms of the observed incidence of infection and force of infection. The proposed approach is firstly evaluated with a simulated epidemic and then applied to the epidemiological data on COVID-19 in the Netherlands. Our results reveal how the optimal allocation depends on the objective of infection control. In the case of COVID-19, if we wish to minimize deaths, the optimal allocation strategy is not efficient for minimizing other outcomes, such as infections. In simulated epidemics, an allocation strategy optimized for an outcome outperforms other strategies such as the allocation from young to old, from old to young, and at random. Our simulations clarify that the current policy in the Netherlands (i.e., allocation from old to young) was concordant with the allocation scheme that minimizes deaths. The proposed method provides an optimal allocation scheme, given routine surveillance data that reflect ongoing transmissions. This approach to allocation is useful for providing plausible simulation scenarios for complex models, which give a more robust basis to determine intervention strategies.


Assuntos
Algoritmos , Vacinas contra COVID-19/uso terapêutico , COVID-19/prevenção & controle , SARS-CoV-2 , Vacinação/métodos , Fatores Etários , COVID-19/epidemiologia , COVID-19/imunologia , Vacinas contra COVID-19/provisão & distribuição , Biologia Computacional , Simulação por Computador , Alocação de Recursos para a Atenção à Saúde/métodos , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Humanos , Vacinação em Massa/métodos , Vacinação em Massa/estatística & dados numéricos , Países Baixos/epidemiologia , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , SARS-CoV-2/imunologia , Vacinação/estatística & dados numéricos
11.
Int J Public Health ; 66: 1604092, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34744597

RESUMO

Objectives: China was believed to be the country with the world's highest acceptance rate of the COVID-19 vaccine following several investigations. This study aims to explore the Chinese acceptance of a COVID-19 vaccine before it is made available, including its determinants. Methods: A cross-national online survey was conducted covering all 31 provinces of mainland China. The survey consists of the demographic variables, acceptance of a self-paid COVID-19 vaccine as the dependent variable, and the 3Cs factors (i.e., confidence, convenience, and complacency) as the independent variables. Results: Among the 1,532 participants, 57.9% accepted to get a self-paid COVID-19 vaccine. COVID-19 vaccine acceptors were more likely to be concerned about the effectiveness of the vaccines, believe that they were at risk of COVID-19 infection, have a high perceived susceptibility of COVID-19, and trust in the health care system. Conclusion: Findings indicate that the critical task in the early stage of the COVID-19 vaccine development in China is to increase the tolerance to some intuitive concerns about the vaccines, put more emphasis on the communication of the saliency of the disease threats, and effectively translate people's trust in the government into vaccine acceptance.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/provisão & distribuição , China/epidemiologia , Humanos , Pandemias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
14.
Sci Rep ; 11(1): 21844, 2021 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-34737319

RESUMO

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


Assuntos
COVID-19/psicologia , Recusa de Vacinação/psicologia , Recusa de Vacinação/tendências , Adulto , Atitude , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/provisão & distribuição , Feminino , Fidelidade a Diretrizes/tendências , Política de Saúde/tendências , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/patogenicidade , Inquéritos e Questionários , Estados Unidos , Vacinação/psicologia , Vacinação/tendências , Vacinas/farmacologia
15.
Br J Surg ; 108(10): 1162-1180, 2021 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-34624081

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues' experiences and published evidence. METHODS: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. RESULTS: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. CONCLUSION: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era.


Assuntos
COVID-19/prevenção & controle , Assistência Perioperatória/tendências , Padrões de Prática Médica/tendências , Procedimentos Cirúrgicos Operatórios/tendências , Adulto , Pesquisa Biomédica/organização & administração , COVID-19/diagnóstico , COVID-19/economia , COVID-19/epidemiologia , Educação de Pós-Graduação em Medicina/métodos , Educação de Pós-Graduação em Medicina/tendências , Feminino , Saúde Global , Recursos em Saúde/provisão & distribuição , Acesso aos Serviços de Saúde/tendências , Humanos , Controle de Infecções/economia , Controle de Infecções/métodos , Controle de Infecções/normas , Cooperação Internacional , Masculino , Pessoa de Meia-Idade , Pandemias , Assistência Perioperatória/educação , Assistência Perioperatória/métodos , Assistência Perioperatória/normas , Padrões de Prática Médica/normas , Cirurgiões/educação , Cirurgiões/psicologia , Cirurgiões/tendências , Procedimentos Cirúrgicos Operatórios/educação , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/normas
16.
BMC Health Serv Res ; 21(1): 1118, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34663315

RESUMO

BACKGROUND: Shortages of antimicrobials lead to treatment failures, increase medical costs, and accelerate the development of antimicrobial resistance. We evaluated the effects of the serious cefazolin shortage in 2019 in Japan on the sales, costs, and appropriate use of other antimicrobials. METHODS: We evaluated monthly defined daily doses/1000 inhabitants/day (DID) values of antimicrobial sales from January 2016 to December 2019 using wholesaler's sales databases. Using 2016-2018 sales data, we generated a prediction model of DID in 2019 under the assumption that the cefazolin shortage did not occur. We then compared the predicted DID and actual DID. Cefazolin, government-recommended alternatives, and government-not-recommended broad-spectrum alternatives were assessed. Antimicrobial groups according to the AWaRe classification were also assessed to evaluate the effect on appropriate antimicrobial use. In addition, we evaluated changes in costs between 9 months before and after the cefazolin shortage. RESULTS: DID values of total antimicrobials increased sharply 1 month before the decrease in cefazolin. Actual DIDs were higher than predicted DIDs for ceftriaxone, flomoxef, clindamycin, cefotiam, piperacillin/tazobactam, and meropenem. Actual DID values were higher than the predicted DID values in the Watch group. The costs of antimicrobials between pre- and post- cefazolin shortage were unchanged. CONCLUSION: The cefazolin shortage brought confusion to the antimicrobial market and led to a setback in the appropriate use of antimicrobials. Early recognition and structures for prompt reactions to antimicrobial shortages are needed. Moreover, development of a system to secure the supply of essential antimicrobials is required.


Assuntos
Anti-Infecciosos , Cefazolina , Uso de Medicamentos , Antibacterianos/economia , Antibacterianos/uso terapêutico , Anti-Infecciosos/economia , Anti-Infecciosos/uso terapêutico , Cefazolina/provisão & distribuição , Humanos
19.
Epidemiol Infect ; 149: e178, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34635196

RESUMO

In October 2019, public health surveillance systems in Scotland identified an increase in the number of reported infections of Shiga toxin-producing Escherichia coli (STEC) O26:H11 involving bloody diarrhoea. Ultimately, across the United Kingdom (UK) 32 cases of STEC O26:H11 stx1a were identified, with the median age of 27 years and 64% were male; six cases were hospitalised. Among food exposures there was an association with consuming pre-packed sandwiches purchased at outlets belonging to a national food chain franchise (food outlet A) [odds ratio (OR) = 183.89, P < 0.001]. The common ingredient identified as a component of the majority of the sandwiches sold at food outlet A was a mixed salad of Apollo and Iceberg lettuce and spinach leaves. Microbiological testing of food and environmental samples were negative for STEC O26:H11, although STEC O36:H19 was isolated from a mixed salad sample taken from premises owned by food outlet A. Contamination of fresh produce is often due to a transient event and detection of the aetiological agent in food that has a short-shelf life is challenging. Robust, statistically significant epidemiological analysis should be sufficient evidence to direct timely and targeted on-farm investigations. A shift in focus from testing the microbiological quality of the produce to investigating the processes and practices through the supply chain and sampling the farm environment is recommended.


Assuntos
Surtos de Doenças , Infecções por Escherichia coli/epidemiologia , Fast Foods/microbiologia , Doenças Transmitidas por Alimentos/epidemiologia , Escherichia coli Shiga Toxigênica/isolamento & purificação , Adulto , Diarreia/epidemiologia , Diarreia/microbiologia , Monitoramento Epidemiológico , Infecções por Escherichia coli/microbiologia , Fast Foods/envenenamento , Fast Foods/provisão & distribuição , Feminino , Doenças Transmitidas por Alimentos/microbiologia , Genoma Bacteriano/genética , Humanos , Masculino , Saladas/microbiologia , Saladas/envenenamento , Saladas/provisão & distribuição , Sorogrupo , Toxina Shiga/genética , Escherichia coli Shiga Toxigênica/genética , Reino Unido/epidemiologia
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