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1.
Pan Afr Med J ; 47: 124, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38854860

RESUMEN

Introduction: health sector planning and budgeting are concerned with identifying priorities that guide budgetary allocation to improve health outcomes. Engaging the community in this process empowers them to manage their own health. Despite the benefits and the availability of legislation and structures to mainstream community participation, their involvement is minimal and marred with challenges. This study, therefore, aimed to examine the level and perspectives of health managers on community health committees´ (CHC) participation in health sector planning and budgeting. Methods: the study utilized a cross-sectional research design, incorporating both quantitative and qualitative research methods. Study participants were involved in planning and budgeting. Quantitative data were collected from 100% (n=170) of health managers, while qualitative data were gathered from 100% (n=3) of county department of health executives and 94% (n=83) of community health committee members. Descriptive statistics were utilized to analyze quantitative data, while qualitative data were analyzed thematically. Results: although 87% of the health managers agreed that community health committee participation is beneficial, only 11% of them were satisfied with their participation, and 54% rated CHC participation as low; furthermore, over 50% of health managers disagreed that Community Health Unit (CHUs) have the necessary skills to effectively participate in the process, that adequate budget and time are allocated for CHC participation, and that feedback about the process is provided to them. Conclusion: the county health department of health should allocate more funds and design sustained capacity-building programs to enhance CHC participation in health sector planning and budgeting.


Asunto(s)
Presupuestos , Participación de la Comunidad , Estudios Transversales , Humanos , Kenia , Masculino , Planificación en Salud , Femenino , Adulto , Persona de Mediana Edad
2.
Isr J Health Policy Res ; 13(1): 29, 2024 Jun 06.
Artículo en Inglés | MEDLINE | ID: mdl-38845038

RESUMEN

BACKGROUND: This study explores vision care priorities and coping mechanisms for Israeli evacuees and following the October 7th, 2023, attack by Hamas, which displaced 150,000 individuals, with about 15,000 being evacuated to the Dead Sea area. Faced with minimal health care infrastructure in the Dead Sea area and often lacking personal belongings, including eyeglasses and ocular medicine, these evacuees confronted significant vision care challenges. This context sets the stage for investigating the emergency vision care needs and solutions for populations affected by conflict and displacement. METHODS: In response to this crisis, a consortium led by Hadassah Academic College's Department of Optometry and the Dept. of Ophthalmology at Hadassah Medical Center established ophthalmic clinics in the Dead Sea region. These clinics offered comprehensive vision care services, including refractive and vision examinations, ophthalmological assessments, ocular imaging, and provision of free glasses. The setup included multiple stations for different vision tests, staffed by an interdisciplinary team of professionals. The study analyzes the effectiveness of these clinics, patient flow challenges, and the psychological impact of vision care in a crisis setting. RESULTS: Approximately 800 evacuees received examinations, with around 700 pairs of glasses distributed. Notable cases included emergency referrals for serious conditions and instances where glasses served as psychological support. The operation highlighted the necessity of vision care during crises and its potential psychological and social implications. The clinics successfully provided immediate vision care, but challenges in patient flow and insufficient electronic medical record integration were noted. The experience underscores the importance of prepared eye care interventions in crises. Recommendations for health policy decision-makers include establishing a national emergency vision care network, developing standardized treatment protocols, training local health workers, and raising public awareness about eye health in emergencies. CONCLUSIONS: The consortium's effort in providing urgent vision care to evacuees from the Hamas attack on Israel demonstrates the critical role of rapid, organized eye care in crisis situations. Vision care, along with hearing and mobility, is often overlooked during evacuations but is vital for the well-being and survival of evacuees, especially under trying circumstances. This project serves as a model for future humanitarian interventions, emphasizing the importance of addressing overlooked healthcare issues once the immediate crisis has passed, and the need for strategic planning in health care policy for similar emergency scenarios.


Asunto(s)
Trastornos de la Visión , Humanos , Israel , Masculino , Femenino , Adulto , Persona de Mediana Edad , Trastornos de la Visión/terapia , Anciano , Anteojos
3.
Heliyon ; 10(11): e31842, 2024 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-38867971

RESUMEN

Objective: This pilot study evaluated the impact of using a 3D printed model of the patient's bronchovascular lung anatomy on the mental workload and fatigue of surgeons during full thoracoscopic segmentectomy. Design: We performed a feasibility pilot study of a prospective randomized controlled trial with 2 parallel arms. All included patients underwent digital 3D visual reconstruction of their bronchovascular anatomy and were randomized into the following two groups: Digital arm (only a virtual 3D model was available) and Digital + Object arm (both virtual and printed 3D models were available). The primary end-point was the surgeons' mental workload measured using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) score. Setting: Between October 28, 2020 and October 05, 2021, we successively investigated all anatomic segmentectomies performed via thoracoscopy in the Thoracic Department of the Montsouris Mutualiste Institute, except for S6 segmentectomies and S4+5 left bi-segmentectomies. Participants: We assessed 102 patients for anatomical segmentectomy. Among the, 40 were randomly assigned, and 34 were deemed analysable, with 17 patients included in each arm. Results: Comparison of the two groups, each comprising 17 patients, revealed no statistically significant difference in primary or secondary end-points. The consultation of the visual digital model was significantly less frequent when a 3D printed model was available (6 versus 54 consultations, p = 0.001). Notably, both arms exhibited high NASA-TLX scores, particularly in terms of mental demand, temporal demand, and effort scores. Conclusion: In our pilot study, 3D printed models and digital 3D reconstructions for pre-operative planning had an equivalent effect on thoracoscopic anatomic segmentectomy for experienced surgeons. The originality of this study lies in its focus on the impact of 3D printing of bronchovascular anatomy on surgeons, rather than solely on the surgical procedure.

4.
J Public Health Manag Pract ; 30: S32-S38, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38870358

RESUMEN

CONTEXT: Stroke remains a major public health concern in the state of Georgia with high mortality, disproportionately affecting rural and socioeconomically disadvantaged communities. Georgia's age-standardized stroke death rate is 10.8% higher than the national average, and related comorbidities remain elevated in adult Georgians, contributing to higher stroke prevalence. PROGRAM: The Georgia Department of Public Health piloted a Community Paramedicine (CP) program in 2 rural counties to improve stroke management, readmissions, and mortality. Various supportive interventions to address barriers to chronic disease management were provided by a local emergency medical service agency for 90 days. This study aims to evaluate the effectiveness of the CP care delivery model in improving stroke outcomes among high-risk individuals. IMPLEMENTATION: CP leverages emergency medical service infrastructure to provide community health services such as home visits, telemedicine, care coordination, education, and access to social support services. The Georgia Hospital Discharge data and Georgia death records were used to measure stroke rehospitalization and deaths at 30, 60, and 90 days post-discharge for stroke. We compared the health outcomes of high-risk individuals who participated in the CP program to those who did not. EVALUATION: Multivariable analysis suggested a reduction in stroke mortality rates among the intervention groups in both counties. DISCUSSION: The CP program demonstrated effectiveness in assisting patients with managing risk factors through medication adherence for conditions such as hypertension, hypercholesterolemia, and diabetes.


Asunto(s)
Población Rural , Accidente Cerebrovascular , Humanos , Georgia/epidemiología , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/terapia , Femenino , Masculino , Población Rural/estadística & datos numéricos , Persona de Mediana Edad , Anciano , Adulto , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/estadística & datos numéricos , Servicios Médicos de Urgencia/normas , Servicios de Salud Comunitaria/métodos , Evaluación de Programas y Proyectos de Salud/métodos , Anciano de 80 o más Años , Paramedicina
5.
J Korean Med Sci ; 39(23): e187, 2024 Jun 17.
Artículo en Inglés | MEDLINE | ID: mdl-38887201

RESUMEN

BACKGROUND: We performed a nationwide analysis to evaluate the impact of the early coronavirus disease 2019 (COVID-19) pandemic on emergency department (ED) visits by adult cancer patients having COVID-like symptoms. METHODS: We analyzed the National Emergency Department Information System (NEDIS) data on ED visits by adult cancer patients who presented with chief complaints of fever or respiratory symptoms (FRS) indicative of COVID-19, from 2016 to 2020. An interrupted time series analysis with a quasi-Poisson regression model was performed, adjusting for seasonality and time, to evaluate whether underlying trends for monthly ED visits and the in-hospital mortality rate (%) per month changed with the pandemic among these patients. We also estimated the adjusted odds ratio (aOR) of in-hospital deaths among cancer patients using multivariable logistic regression analysis. RESULTS: ED visits by cancer patients with FRS decreased during the COVID-19 pandemic (relative risk [RR] with 95% confidence interval [CI]: slope change, 0.99 [0.98-1.00] and step change, 0.84 [0.76-0.92]). However, the in-hospital mortality rate (%) for these patients was increased (slope change, 1.14 [1.04-1.25] and step change, 0.99 [0.98-1.01]). Factors such as urgent triage status, ambulance use, and treatment in hospitals with fewer than 300 staffed beds significantly contributed to increased aOR of in-hospital deaths during the COVID-19 pandemic compared to the pre-pandemic period. CONCLUSION: Further studies are needed to highlight the importance of ED service preparation in planning and managing resources for cancer patients during future pandemics.


Asunto(s)
COVID-19 , Servicio de Urgencia en Hospital , Fiebre , Mortalidad Hospitalaria , Neoplasias , SARS-CoV-2 , Humanos , COVID-19/epidemiología , COVID-19/mortalidad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Neoplasias/complicaciones , Neoplasias/mortalidad , Neoplasias/epidemiología , República de Corea/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , Oportunidad Relativa , Pandemias , Visitas a la Sala de Emergencias
6.
Psychol Serv ; 2024 Jun 20.
Artículo en Inglés | MEDLINE | ID: mdl-38900568

RESUMEN

The Safety Planning Intervention (SPI) is an evidence-based therapeutic intervention designed to mitigate suicide risk by providing a suicidal individual with a written, personalized safety plan. The Department of Veterans Affairs (VA) has implemented safety planning, but research found variability in the quality of safety plans. To improve quality, the VA developed an Advanced Training in the Safety Planning Intervention (ASPI) that went beyond previous didactic training efforts by emphasizing experiential learning. The aim of this article is to describe the procedures and initial results of VA's competency-based ASPI Training Program. Before training, providers participating in this program uploaded a written, deidentified safety plan completed with a Veteran. Providers then completed four training components, including evaluation of fidelity of written safety plans and competency in SPI during live, standardized roleplays at the conclusion of training, and at a 3-month follow-up evaluation. Of the 409 providers who initiated training, 367 (90%) completed training, 26 (6%) dropped out of training, and 16 (4%) did not meet the competency requirements for training completion. Relative to pretraining, there was a medium to large increase in the effect size of the quality of written Safety Plans at the end of training that was maintained at the 3-month follow-up. Using a standardized, observational measure of SPI competency, 383 of 391 (98%) providers met competency criteria following the training, and 367 of 375 (98%) providers met competency at 3-month follow-up. Findings suggest that ASPI training is effective in helping providers achieve and maintain fidelity in safety planning. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

7.
Stomatologiia (Mosk) ; 103(3): 50-55, 2024.
Artículo en Ruso | MEDLINE | ID: mdl-38904560

RESUMEN

The aim the study. Analyze errors in planning orthopedic treatment using dental implants using the example of clinical cases. MATERIALS AND METHODS: Two patients are presented who applied for a consultation at the orthopedic and surgical department of the Federal State Budgetary Institution National Medical Research Center Central Research Institute of Chronic and Peripheral Surgery of the Russian Ministry of Health regarding a fracture of a previously installed orthopedic structure on an implant. For diagnostic purposes, computed tomography was performed to determine the condition of the implants and teeth of the upper and lower jaws. RESULTS: The patients were found to have: a fracture of an implant 4.0*10 with a single orthopedic structure in the area of tooth 4.6 (the patient did not undergo restoration of the missing tooth 4.7 in the presence of an antagonist), a fracture of small diameter implants (3.5*9) in the area of 3.6, 3.7, prosthetic combined orthopedic crowns. CONCLUSIONS: During surgical and orthopedic treatment of patients, it is necessary to strictly follow the instructions developed by the manufacturer of dental implants and the STaR recommendations.


Asunto(s)
Implantes Dentales , Humanos , Implantes Dentales/efectos adversos , Masculino , Persona de Mediana Edad , Femenino , Fracaso de la Restauración Dental , Tomografía Computarizada por Rayos X , Implantación Dental/efectos adversos , Adulto , Coronas/efectos adversos
8.
BMJ Open ; 14(5): e085171, 2024 May 23.
Artículo en Inglés | MEDLINE | ID: mdl-38803263

RESUMEN

OBJECTIVE: Type 2 diabetes is a leading contributor to the burden of disease in South Africa. Primary care is struggling to support self-management and lifestyle change. Group empowerment and training (GREAT) for diabetes is a feasible and cost-effective intervention in our setting. This study aimed to evaluate the implementation of GREAT for diabetes. DESIGN: A convergent mixed-methods study evaluated a range of implementation outcomes: acceptability, appropriateness, adoption, feasibility, fidelity, reach and cost. SETTING: Ten primary care facilities from a district in all nine provinces of South Africa. PARTICIPANTS: Descriptive exploratory individual semistructured interviews were conducted with 34 key stakeholders from national policy-makers to primary care providers. Three focus group interviews were held with 35 patients. RESULTS: The National Department of Health saw GREAT as an acceptable and appropriate intervention, but only five of the nine provinces adopted GREAT. District-level and facility-level managers also saw GREAT as an acceptable and appropriate intervention. Factors related to feasibility included physical space, sufficient staff numbers, availability of resource materials, the health information system, adaptation to the model of care (selection of facilities, patients, adjustment of patient flow and appointment systems, leadership from local managers and the whole clinical team) and inclusion in systems for quality improvement. No major changes were made to the design of GREAT and fidelity to the session content ranged from 66% to 94%. Incremental costs were US$494 per facility. Due to disruption from the COVID-19 pandemic, only 14 facilities implemented and reached 588 patients at the time of evaluation. CONCLUSION: Key lessons were learnt on how to implement GREAT for diabetes in a middle-income country setting. The findings informed the design of a programme theory using a health system framework. The programme theory will guide further scale-up in each province and scale-out to provinces that have not yet implemented. QUESTION: This study focused on evaluating how to implement GREAT for type 2 diabetes in primary care and to take it to scale in South Africa. FINDING: The findings led to a programme theory on how to successfully implement GREAT for diabetes in the South African context. MEANING: The study demonstrates relevant contextual factors that need to be considered in the implementation of group diabetes education programme in a middle-income country.


Asunto(s)
Diabetes Mellitus Tipo 2 , Empoderamiento , Grupos Focales , Atención Primaria de Salud , Humanos , Sudáfrica , Diabetes Mellitus Tipo 2/terapia , Atención Primaria de Salud/organización & administración , Masculino , Femenino , Persona de Mediana Edad , Adulto , Educación del Paciente como Asunto/métodos , Evaluación de Programas y Proyectos de Salud
9.
J Laryngol Otol ; 138(S2): S47-S50, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38779896

RESUMEN

BACKGROUND: Balance dysfunction and vestibular conditions are major problems requiring significant resources. There is significant national and international variation in management pathways for such patients. METHODS: This paper outlines a collaborative project run by the ENT department and two vestibular rehabilitation trained physiotherapists to establish a clinic to manage patients referred to ENT with vestibular and/or balance complaints. As part of a six-month pilot, two physiotherapy-led balance clinics were provided per week. RESULTS: A total of 159 new patients were seen, with only 15 needing ENT consultant input. This led to the successful creation of substantive posts; the clinic has seen 698 patients in its first two years. CONCLUSION: Patient outcomes and experience have been positive, and accompanied by reduced waiting and in-service times. The authors discuss some of the pitfalls, challenges and opportunities of developing this type of clinic.


Asunto(s)
Modalidades de Fisioterapia , Equilibrio Postural , Enfermedades Vestibulares , Humanos , Equilibrio Postural/fisiología , Enfermedades Vestibulares/rehabilitación , Enfermedades Vestibulares/terapia , Proyectos Piloto , Instituciones de Atención Ambulatoria/organización & administración , Masculino , Derivación y Consulta , Femenino , Adulto , Persona de Mediana Edad
10.
Adv Radiat Oncol ; 9(6): 101491, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38757146

RESUMEN

Purpose: During winter 2022, western New York faced 2 major storms with blizzard conditions and record-breaking snowfall. The severe weather resulted in power outages and travel bans. This study investigates the impact of these conditions on patient adherence to radiation therapy. Combining data from a large academic center and its satellite clinic, this single-center study sheds light on the challenges faced by cancer care facilities during severe weather and proposes suggestions to prevent and mitigate harm done by severe weather. Methods and Materials: In this study, data were collected using the MOSAIQ Record and Verify system (v. 2.81) to generate deidentified reports of scheduled and treated patients. The treatment adherence rate was calculated by dividing the number of patients treated by the total number of patients scheduled. Data were specifically collected for patients undergoing treatment on linear accelerators at a primary academic center and a satellite facility. The study focused on working days from November 1, 2022, to March 31, 2023, excluding weekends and holidays (as treatments are not routinely scheduled). Severe weather days were identified using advisories from the National Weather Service and the local institution, including specific periods in November, December, and January. Results: In the study, 15,010 scheduled treatment visits were recorded across the academic center and the satellite clinic. The mean daily treatment adherence rate was 91.7%. Severe weather conditions led to a significant reduction in adherence, with rates dropping to 77.8%. Adherence rates during nonsevere weather days were notably higher at 93.9%. Statistical analysis confirmed the substantial influence of severe weather on adherence (P < .001). Severe weather had a more pronounced impact on the satellite clinic during periods of severe weather, with absolute reduction in adherence rates of 21.9% versus 15% in the primary hospital. Moreover, adherence at the satellite clinic was lower than at the primary hospital site even under standard operating conditions (92.2% vs 94.0%, P < .001). Conclusion: As a part of operational planning, it is important to be aware how severe weather can impact treatment adherence. Study findings underscore the importance of proactive measures to ensure patient access to health care services during adverse weather events and highlight the broader significance of incorporating consideration of social determinants of health into contingency planning for maintaining treatment continuity.

11.
BMJ Open ; 14(5): e083372, 2024 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-38697766

RESUMEN

INTRODUCTION: The increasing elderly population has led to a growing demand for healthcare services. A hospital at home treatment model offers an alternative to standard hospital admission, with the potential to reduce readmission and healthcare consumption while improving patients' quality of life. However, there is little evidence regarding hospital at home treatment in a Danish setting. This article describes the protocol for a randomised controlled trial (RCT) comparing standard hospital admission to hospital at home treatment. The main aim of the intervention is to reduce 30-day acute readmission after discharge and improve the quality of life of elderly acute patients. METHODS AND ANALYSIS: A total of 849 elderly acute patients will be randomised in a 1:2 ratio to either the control or intervention group in the trial. The control group will receive standard hospital treatment in a hospital emergency department while the intervention group will receive treatment at home. The primary outcomes of the trial are the rate of 30-day acute readmission and quality of life, assessed using the European Quality of Life-5 Dimensions-5-Level instrument. Primary analyses are based on the intention-to-treat principle. Secondary outcomes are basic functional mobility, resource use in healthcare, primary and secondary healthcare cost, incremental cost-effectiveness ratio, and the mortality rate 3 months after discharge. ETHICS AND DISSEMINATION: The RCT was approved by the Ethical Committee, Central Denmark Region (no. 1-10-72-67-20). Results will be presented at relevant national and international meetings and conferences and will be published in international peer-reviewed journals. Furthermore, we plan to communicate the results to relevant stakeholders in the Danish healthcare system. TRIAL REGISTRATION NUMBER: NCT05360914.


Asunto(s)
Readmisión del Paciente , Calidad de Vida , Humanos , Readmisión del Paciente/estadística & datos numéricos , Anciano , Dinamarca , Ensayos Clínicos Controlados Aleatorios como Asunto , Alta del Paciente , Servicio de Urgencia en Hospital , Análisis Costo-Beneficio , Hospitalización , Servicios de Atención de Salud a Domicilio , Femenino , Masculino , Servicios de Atención a Domicilio Provisto por Hospital/economía , Anciano de 80 o más Años
12.
Eval Health Prof ; 47(2): 219-229, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38790110

RESUMEN

Despite the millions of dollars awarded annually by the United States Department of Education to build implementation capacity through technical assistance (TA), data on TA effectiveness are severely lacking. Foundational to the operationalization and consistent research on TA effectiveness is the development and use of standardized TA core competencies, practices, and structures. Despite advances toward a consistent definition of TA, a gap still exists in understanding how these competencies are used within an operationalized set of TA practices to produce targeted outcomes at both individual and organizational levels to facilitate implementation of evidence-based practices. The current article describes key insights derived from the evaluation of an operationalized set of TA practices used by a nationally funded TA center, the State Implementation & Scaling Up of Evidence Based Practices (SISEP) Center. The TA provided by the Center supports the uptake of evidence-based practices in K-12 education for students with disabilities. Lessons learned include: (1) the need to understand the complexities and dependencies of operationalizing TA both longitudinally and at multiple levels of the system (state, regional, local); (2) the relative importance of building general and innovation-specific capacity for implementation success; (3) the value of using a co-design and participatory approach for effective TA delivery; (4) the need to develop TA providers' educational and implementation fluency across areas and levels of the system receiving TA; and (5) the need to ensure coordination and alignment of TA providers from different centers. Gaining an understanding into optimal TA practices will not only provide clarity of definition fundamental to TA research, but it will also inform the conceptual framing and practice of TA.


Asunto(s)
Práctica Clínica Basada en la Evidencia , Humanos , Estados Unidos , Práctica Clínica Basada en la Evidencia/organización & administración , Asistencia Técnica a la Planificación en Salud/organización & administración , Creación de Capacidad/organización & administración , Personas con Discapacidad , Evaluación de Programas y Proyectos de Salud/métodos
13.
Stomatologiia (Mosk) ; 103(2): 50-55, 2024.
Artículo en Ruso | MEDLINE | ID: mdl-38741535

RESUMEN

BACKGROUND: Restoring the integrity of the dentition with orthopedic structures should be carried out strictly according to indications, taking into account the condition of the supporting teeth and/or teeth limiting the defect. OBJECTIVE: To conduct a retrospective analysis of the results of orthopedic treatment of patients with shortened dentition according to clinical and radiological methods. MATERIALS AND METHODS: The material for the study was data from cone beam computed tomography (CBCT) of 126 patients with shortened dentition (most patients with the absence of a second molar, as well as the absence of the first and second molars), who sought a consultation about missing teeth in the orthopedic and surgical department of the Federal State Budgetary Institution National Medical Research Center TsNIISiCHLKh Ministry of Health of Russia. RESULTS: At the stages of treatment for patients in the study group, insufficient attention is paid to the restoration of terminal defects of the dentition in the upper and lower jaws, especially the restoration of second molars. This may be due to improper planning of dental treatment and insufficient motivation of the patient to carry out comprehensive dental rehabilitation. According to CT studies, the number of complications of orthopedic treatment in the area of supporting teeth and/or teeth limiting the included defect or terminal defect of the dentition in the masticatory region increases depending on the period of use of the orthopedic structure. CONCLUSIONS: The use of cantilever structures leads to functional overload of the supporting teeth. Neglecting the restoration of a full dentition and prosthetics of end defects of the dentition leads to dentoalveolar advancement of antagonists of missing teeth and the appearance of complications such as functional overload of supporting teeth and resorption of alveolar bone.


Asunto(s)
Tomografía Computarizada de Haz Cónico , Arco Dental , Humanos , Estudios Retrospectivos , Femenino , Masculino , Adulto , Arco Dental/diagnóstico por imagen , Arco Dental/anomalías , Resultado del Tratamiento , Persona de Mediana Edad , Adolescente , Adulto Joven , Restauración Dental Permanente/métodos , Federación de Rusia
14.
Clin Radiol ; 79(7): e941-e948, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38710602

RESUMEN

OBJECTIVES: The popularity of trans-radial access (TRA) for cerebral angiography is growing. Potential benefits of TRA over traditional trans-femoral access (TFA) are multitude. This study aimed to evaluate discharge outcomes and patient opinion of TRA compared to TFA in patients undergoing cerebral angiography prior to stereotactic radiosurgery (SRS) treatment for cerebral arteriovenous malformations. METHODS: Consecutive patients treated at the National Centre for Stereotactic Radiosurgery (Sheffield, United Kingdom) over a 22-month period were included. All patients underwent cerebral angiography with either TRA or TFA as part of treatment planning prior to SRS. TRA patients who had previously undergone TFA in other centres were surveyed for their experience of cerebral angiography using a questionnaire. SRS staff at our centre was approached for their opinion. RESULTS: 492 patients were included (median age = 43 years, 57.5% male, median lesions treated = 1). More patients underwent angiography with TFA (75.2%) than TRA (24.8%). No difference was found in accumulated dose for angiography between the groups (p>0.05). There was 17.6% reduction in overnight stay between TRA and TRF, the proportion of patients requiring overnight admission was higher for the TFA (35.2%) than TRA (17.6%, p<0.05). 101 patients were surveyed, with a response rate of 47%. Most respondents (79%) indicated preference for TRA over TFA. CONCLUSIONS: Use of TRA in pre-SRS cerebral angiography is feasible and improves both patient and staff experience. The adoption of TRA could have important implications for department resources and costs by reducing the proportion of overnight admissions.


Asunto(s)
Angiografía Cerebral , Malformaciones Arteriovenosas Intracraneales , Radiocirugia , Humanos , Radiocirugia/métodos , Masculino , Femenino , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/cirugía , Adulto , Angiografía Cerebral/métodos , Arteria Radial/diagnóstico por imagen , Persona de Mediana Edad , Resultado del Tratamiento , Encuestas y Cuestionarios , Anciano , Adolescente , Arteria Femoral/diagnóstico por imagen , Estudios Retrospectivos
15.
BMC Geriatr ; 24(1): 389, 2024 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-38693502

RESUMEN

BACKGROUND: To evaluate the effectiveness of delivering feedback reports to increase completion of LST notes among VA Home Based Primary Care (HBPC) teams. The Life Sustaining Treatment Decisions Initiative (LSTDI) was implemented throughout the Veterans Health Administration (VHA) in the United States in 2017 to ensure that seriously ill Veterans have care goals and LST decisions elicited and documented. METHODS: We distributed monthly feedback reports summarizing LST template completion rates to 13 HBPC intervention sites between October 2018 and February 2020 as the sole implementation strategy. We used principal component analyses to match intervention to 26 comparison sites and used interrupted time series/segmented regression analyses to evaluate the differences in LST template completion rates between intervention and comparison sites. Data were extracted from national databases for VA HBPC in addition to interviews and surveys in a mixed methods process evaluation. RESULTS: LST template completion rose from 6.3 to 41.9% across both intervention and comparison HBPC teams between March 1, 2018, and February 26, 2020. There were no statistically significant differences for intervention sites that received feedback reports. CONCLUSIONS: Feedback reports did not increase documentation of LST preferences for Veterans at intervention compared with comparison sites. Observed increases in completion rates across intervention and comparison sites can likely be attributed to implementation strategies used nationally as part of the national roll-out of the LSTDI. Our results suggest that feedback reports alone were not an effective implementation strategy to augment national implementation strategies in HBPC teams.


Asunto(s)
Servicios de Atención de Salud a Domicilio , Atención Primaria de Salud , United States Department of Veterans Affairs , Veteranos , Humanos , Atención Primaria de Salud/métodos , Atención Primaria de Salud/normas , Estados Unidos , Veteranos/psicología , Servicios de Atención de Salud a Domicilio/normas , Masculino , Femenino , Anciano , Retroalimentación , Documentación/métodos , Documentación/normas , Prioridad del Paciente
16.
Br J Hosp Med (Lond) ; 85(5): 1-4, 2024 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-38815964

RESUMEN

Many providers aspire to scale up proactive care that prevents escalation of health and care needs, delays onset of disability, and reduces demand for emergency department attendance or admission to hospital or care home. NHS England offers guidance on personalised and coordinated multi-professional support and interventions for people with moderate or severe frailty. This article reflects on the growing international evidence for an integrated proactive approach for older people with frailty and why investing in high-quality, joined-up care for older people across the whole system improves outcomes for people, reduces demand for services, increases system resilience, and delivers economic and societal benefits. Facing up to frailty requires creative whole system workforce planning and development that will be challenging to deliver in the current financial and recruitment context yet all the more worthwhile as scaling up proactive care has the potential to be a game changer.


Asunto(s)
Anciano Frágil , Fragilidad , Humanos , Anciano , Fragilidad/terapia , Medicina Estatal , Inglaterra , Servicios de Salud para Ancianos/organización & administración , Evaluación Geriátrica/métodos
17.
Am J Prev Med ; 2024 May 17.
Artículo en Inglés | MEDLINE | ID: mdl-38762206

RESUMEN

INTRODUCTION: Long COVID encompasses a wide range of health problems that emerge, persist, or recur following acute coronavirus disease 2019 (COVID-19) illness. Given that the prevalence of self-reported Long COVID is highest among U.S. adults in their prime working years, it is important to identify unmet needs and gaps in healthcare access and coverage among working-age adults. METHODS: Prevalences (95% confidence intervals [CI]) of health insurance coverage and access to care by Long COVID status were estimated among adults 18-64 years (n=18,117), accounting for survey design and weighted to the U.S. non-institutionalized population in the 2022 National Health Interview Survey. Analyses were conducted in 2023. RESULTS: Overall, 3.7% (95% CI 3.4, 4.0) of respondents were experiencing Long COVID. Adults experiencing Long COVID were less likely to report being uninsured relative to adults not experiencing Long COVID (p=0.004); however, 49.0% (95% CI 43.2, 54.7) had high deductible health plans. Adjusting for sociodemographic characteristics, adults experiencing Long COVID were more likely to access healthcare compared to adults not experiencing Long COVID (p<0.01 for seeing a doctor, telemedicine appointments, ≥2 urgent care visits, ≥2 emergency department visits, and hospitalized overnight). Despite more frequent healthcare use, adults experiencing Long COVID were also more likely to abstain from and delay medical care, therapy, and prescriptions due to cost compared to adults not experiencing Long COVID (p<0.0001 for all comparisons). CONCLUSIONS: These findings may be used to inform healthcare planning for adults experiencing Long COVID and highlight the ongoing need to improve access and affordability of quality and comprehensive care.

18.
Rev Saude Publica ; 58: 17, 2024.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-38716929

RESUMEN

OBJECTIVE: This study aims to integrate the concepts of planetary health and big data into the Donabedian model to evaluate the Brazilian dengue control program in the state of São Paulo. METHODS: Data science methods were used to integrate and analyze dengue-related data, adding context to the structure and outcome components of the Donabedian model. This data, considering the period from 2010 to 2019, was collected from sources such as Department of Informatics of the Unified Health System (DATASUS), the Brazilian Institute of Geography and Statistics (IBGE), WorldClim, and MapBiomas. These data were integrated into a Data Warehouse. K-means algorithm was used to identify groups with similar contexts. Then, statistical analyses and spatial visualizations of the groups were performed, considering socioeconomic and demographic variables, soil, health structure, and dengue cases. OUTCOMES: Using climate variables, the K-means algorithm identified four groups of municipalities with similar characteristics. The comparison of their indicators revealed certain patterns in the municipalities with the worst performance in terms of dengue case outcomes. Although presenting better economic conditions, these municipalities held a lower average number of community healthcare agents and basic health units per inhabitant. Thus, economic conditions did not reflect better health structure among the three studied indicators. Another characteristic of these municipalities is urbanization. The worst performing municipalities presented a higher rate of urban population and human activity related to urbanization. CONCLUSIONS: This methodology identified important deficiencies in the implementation of the dengue control program in the state of São Paulo. The integration of several databases and the use of Data Science methods allowed the evaluation of the program on a large scale, considering the context in which activities are conducted. These data can be used by the public administration to plan actions and invest according to the deficiencies of each location.


Asunto(s)
Macrodatos , Dengue , Humanos , Dengue/prevención & control , Dengue/epidemiología , Brasil/epidemiología , Evaluación de Programas y Proyectos de Salud , Factores Socioeconómicos , Programas Nacionales de Salud , Algoritmos
19.
JACC Heart Fail ; 12(6): 1059-1070, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38573268

RESUMEN

BACKGROUND: The use of recommended heart failure (HF) medications has improved over time, but opportunities for improvement persist among women and at rural hospitals. OBJECTIVES: This study aims to characterize national trends in performance in the use of guideline-recommended pharmacologic treatment for HF at U.S. Department of Veterans Affairs (VA) hospitals, at which medication copayments are modest. METHODS: Among patients discharged from VA hospitals with HF between January 1, 2013, and December 31, 2019, receipt of all guideline-recommended HF pharmacotherapy among eligible patients was assessed, consisting of evidence-based beta-blockers; angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor neprilysin inhibitors; mineralocorticoid receptor antagonists; and oral anticoagulation. RESULTS: Of 55,560 patients at 122 hospitals, 32,304 (58.1%) received all guideline-recommended HF medications for which they were eligible. The proportion of patients receiving all recommended medications was higher in 2019 relative to 2013 (OR: 1.54; 95% CI: 1.44-1.65). The median of hospital performance was 59.1% (Q1-Q3: 53.2%-66.2%), improving with substantial variation across sites from 2013 (median 56.4%; Q1-Q3: 50.0%-62.0%) to 2019 (median 65.7%; Q1-Q3: 56.3%-73.5%). Women were less likely to receive recommended therapies than men (adjusted OR [aOR]: 0.84; 95% CI: 0.74-0.96). Compared with non-Hispanic White patients, non-Hispanic Black patients were less likely to receive recommended therapies (aOR: 0.83; 95% CI: 0.79-0.87). Urban hospital location was associated with lower likelihood of medication receipt (aOR: 0.73; 95% CI: 0.59-0.92). CONCLUSIONS: Forty-two percent of patients did not receive all recommended HF medications at discharge, particularly women, minority patients, and those receiving care at urban hospitals. Rates of use increased over time, with variation in performance across hospitals.


Asunto(s)
Antagonistas Adrenérgicos beta , Antagonistas de Receptores de Angiotensina , Adhesión a Directriz , Insuficiencia Cardíaca , Alta del Paciente , Humanos , Insuficiencia Cardíaca/tratamiento farmacológico , Femenino , Masculino , Estados Unidos , Anciano , Alta del Paciente/tendencias , Antagonistas de Receptores de Angiotensina/uso terapéutico , Antagonistas Adrenérgicos beta/uso terapéutico , Guías de Práctica Clínica como Asunto , Antagonistas de Receptores de Mineralocorticoides/uso terapéutico , Persona de Mediana Edad , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Hospitales de Veteranos , Anticoagulantes/uso terapéutico , Anciano de 80 o más Años
20.
EClinicalMedicine ; 70: 102522, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38685928

RESUMEN

Background: The 2022-2024 global mpox outbreak, occurring primarily in the sexual networks of gay, bisexual and other men who have sex with men (GBMSM), has not been accompanied by a focus on patient perspectives of illness. We explore the experiences of GBMSM diagnosed with mpox in England to understand needs for social and clinical support. Methods: In-depth interviews (March/July 2023) were conducted with 22 GBMSM diagnosed with mpox in 2022, randomly selected from a national mpox surveillance database, and 4 stakeholders from clinical/community-based organisations. Interviews covered experiences of illness, testing, diagnosis, treatment and contact tracing, and were recorded, transcribed and analysed with a thematic framework. Findings: Media coverage drawing on homophobic stereotypes around sex between men contributed to feelings of stigma and shame. GBMSM living with HIV appeared to cope better with mpox stigma, drawing on their experiences of being diagnosed with HIV for resilience. Younger GBMSM with less experience of stigmatising illness found mpox diagnosis more traumatic and sometimes required support beyond what was provided. Accessing testing could be complicated when healthcare professionals did not recognise mpox symptoms. Men felt information on course of illness, isolation and vaccination after recovery was often inconsistent and contradictory. GBMSM described that care from sexual health and infectious disease units usually better met their emotional and medical needs. This was frequently linked by men to these services having skills in working with the GBMSM community and managing infection risk sensitively. General hospital services and centralised contact tracing could increase feelings and experiences of stigma as some staff were perceived to lack skills in supporting GBMSM and, sometimes, clinical knowledge. Long-term impacts described by men included mental health challenges, urethral/rectal symptoms and life-changing disability. Interpretation: In this study stigma was a central feature of mpox illness among GBMSM and could be exacerbated or lessened depending on the clinical and social support provided. Involving communities affected by outbreaks in co-producing, planning and delivering care (including contact-tracing) may help improve support provided. Funding: TCW, AJR, AS and FMB received support from the National Institute for Health and Care Research (NIHR) under its Programme Grants for Applied Research Programme (Ref: NIHR202038). CS and JS receive support from the National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with UKHSA; RV receives support from the NIHR HPRU in Emerging and Zoonotic Infections and NIHR HPRU in Gastrointestinal Infections. The views expressed are those of the author(s) and not necessarily those of the NIHR, UK Health Security Agency, World Health Organization or the Department of Health and Social Care.

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