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[PMID]:28457798
[Au] Autor:Tabit CE; Coplan MJ; Spencer KT; Alcain CF; Spiegel T; Vohra AS; Adelman D; Liao JK; Sanghani RM
[Ad] Endereço:Section of Cardiology, Department of Medicine, The University of Chicago Medical Center, Ill.
[Ti] Título:Cardiology Consultation in the Emergency Department Reduces Re-hospitalizations for Low-Socioeconomic Patients with Acute Decompensated Heart Failure.
[So] Source:Am J Med;130(9):1112.e17-1112.e31, 2017 Sep.
[Is] ISSN:1555-7162
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Re-hospitalization after discharge for acute decompensated heart failure is a common problem. Low-socioeconomic urban patients suffer high rates of re-hospitalization and often over-utilize the emergency department (ED) for their care. We hypothesized that early consultation with a cardiologist in the ED can reduce re-hospitalization and health care costs for low-socioeconomic urban patients with acute decompensated heart failure. METHODS: There were 392 patients treated at our center for acute decompensated heart failure who received standardized education and follow-up. Patients who returned to the ED received early consultation with a cardiologist; 392 patients who received usual care served as controls. Thirty- and 90-day re-hospitalization, ED re-visits, heart failure symptoms, mortality, and health care costs were recorded. RESULTS: Despite guideline-based education and follow-up, the rate of ED re-visits was not different between the groups. However, the rate of re-hospitalization was significantly lower in patients receiving the intervention compared with controls (odds ratio 0.592), driven by a reduction in the risk of readmission from the ED (0.56 vs 0.79, respectively). Patients receiving the intervention accumulated 14% fewer re-hospitalized days than controls and 57% lower 30-day total health care cost. Despite the reduction in health care resource consumption, mortality was unchanged. After accounting for the total cost of intervention delivery, the health care cost savings was substantially greater than the cost of intervention delivery. CONCLUSION: Early consultation with a cardiologist in the ED as an adjunct to guideline-based follow-up is associated with reduced re-hospitalization and health care cost for low-socioeconomic urban patients with acute decompensated heart failure.
[Mh] Termos MeSH primário: Cardiologia/normas
Serviço Hospitalar de Emergência/utilização
Insuficiência Cardíaca/terapia
Educação de Pacientes como Assunto/organização & administração
Readmissão do Paciente/estatística & dados numéricos
[Mh] Termos MeSH secundário: Doença Aguda
Idoso
Cardiologia/economia
Cardiologia/métodos
Estudos de Casos e Controles
Chicago
Controle de Custos/métodos
Controle de Custos/normas
Serviço Hospitalar de Emergência/economia
Serviço Hospitalar de Emergência/organização & administração
Feminino
Insuficiência Cardíaca/economia
Seres Humanos
Masculino
Meia-Idade
Estudos de Casos Organizacionais
Alta do Paciente/economia
Alta do Paciente/normas
Alta do Paciente/estatística & dados numéricos
Educação de Pacientes como Assunto/economia
Educação de Pacientes como Assunto/métodos
Readmissão do Paciente/economia
Guias de Prática Clínica como Assunto
Pontuação de Propensão
Encaminhamento e Consulta/economia
Encaminhamento e Consulta/normas
Estudos Retrospectivos
Fatores Socioeconômicos
Centros de Atenção Terciária/economia
Centros de Atenção Terciária/organização & administração
Saúde da População Urbana/economia
Saúde da População Urbana/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


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[PMID]:28453819
[Au] Autor:Cheen MHH; Goon CP; Ong WC; Lim PS; Wan CN; Leong MY; Khee GY
[Ad] Endereço:Department of Pharmacy, Singapore General Hospital, Singapore.
[Ti] Título:Evaluation of a care transition program with pharmacist-provided home-based medication review for elderly Singaporeans at high risk of readmissions.
[So] Source:Int J Qual Health Care;29(2):200-205, 2017 Apr 01.
[Is] ISSN:1464-3677
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective: This study aimed to determine whether pharmacist-provided home-based medication review (HBMR) can reduce readmissions in the elderly. Design: Retrospective cohort study. Setting: Patient's home. Participants: Records of patients referred to a care transition program from March 2011 through March 2015 were reviewed. Patients aged 60 years and older taking more than 5 medications and had at least 2 unplanned admissions within 3 months preceding the first home visit were included. Intervention: Pharmacist-provided HBMR. Main outcome measures: Primary outcome was readmission rate over 6 months after the first home visit. Secondary outcomes included emergency department (ED) visits, outpatient visits and mortality. Drug-related problems (DRPs) were reported for the HBMR group. Multivariate incidence rate ratios (IRR) and hazard ratio (HR) were calculated with adjustments for covariates. Results: The study included 499 patients (97 HBMR, 402 no HBMR). Pharmacist-provided HBMR reduced readmissions by 26% (IRR = 0.74, 95% CI: 0.59-0.92, P = 0.007), reduced ED visits by 20% (IRR = 0.80, 95% CI: 0.66-0.98, P = 0.030) and increased outpatient visits by 16% (IRR = 1.16, 95% CI: 0.95-1.41, P = 0.150). There were 8 and 44 deaths in the HBMR and no HBMR groups respectively (HR = 0.73, 95% CI: 0.29-1.81, P = 0.492). Pharmacists identified 464 DRPs, with 169 (36.4%) resolved within 1 month after the home visit. Conclusions: The study suggests that pharmacist-provided HBMR is effective in reducing readmissions and ED visits in the elderly. More studies in the Asian population are needed to determine its long term benefits and patient's acceptability.
[Mh] Termos MeSH primário: Reconciliação de Medicamentos/métodos
Alta do Paciente
Readmissão do Paciente/estatística & dados numéricos
Farmacêuticos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Estudos de Coortes
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle
Serviço Hospitalar de Emergência/utilização
Feminino
Seres Humanos
Masculino
Meia-Idade
Mortalidade
Serviço de Farmácia Hospitalar/métodos
Estudos Retrospectivos
Singapura
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/intqhc/mzw150


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Monte, Júlio Cesar Martins
Batista, Marcelo Costa
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[PMID]:28464841
[Au] Autor:de Souza Oliveira MA; Dos Santos TOC; Monte JCM; Batista MC; Pereira VG; Dos Santos BFC; Santos OFP; de Souza Durão M
[Ad] Endereço:Nephrology Division of Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, 05652-900, Brazil.
[Ti] Título:The impact of continuous renal replacement therapy on renal outcomes in dialysis-requiring acute kidney injury may be related to the baseline kidney function.
[So] Source:BMC Nephrol;18(1):150, 2017 May 03.
[Is] ISSN:1471-2369
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Many controversies exist regarding the management of dialysis-requiring acute kidney injury (D-AKI). No clear evidence has shown that the choice of dialysis modality can change the survival rate or kidney function recovery of critically ill patients with D-AKI. METHODS: We conducted a retrospective study investigating patients (≥16 years old) admitted to an intensive care unit with D-AKI from 1999 to 2012. We analyzed D-AKI incidence, and outcomes, as well as the most commonly used dialysis modality over time. Outcomes were based on hospital mortality, renal function recovery (estimated glomerular filtration rate-eGFR), and the need for dialysis treatment at hospital discharge. RESULTS: In 1,493 patients with D-AKI, sepsis was the main cause of kidney injury (56.2%). The comparison between the three study periods, (1999-2003, 2004-2008, and 2009-2012) showed an increased in incidence of D-AKI (from 2.56 to 5.17%; p = 0.001), in the APACHE II score (from 20 to 26; p < 0.001), and in the use of continuous renal replacement therapy (CRRT) as initial dialysis modality choice (from 64.2 to 72.2%; p < 0.001). The mortality rate (53.9%) and dialysis dependence at hospital discharge (12.3%) remained unchanged over time. Individuals who recovered renal function (33.8%) showed that those who had initially undergone CRRT had a higher eGFR than those in the intermittent hemodialysis group (54.0 × 46.0 ml/min/1.73 m2, respectively; p = 0.014). In multivariate analysis, type of patient, sepsis-associated AKI and APACHE II score were associated to death. For each additional unit of the APACHE II score, the odds of death increased by 52%. The odds ratio of death for medical patients with sepsis-associated AKI was estimated to be 2.93 (1.81-4.75; p < 0.001). CONCLUSION: Our study showed that the incidence of D-AKI increased with illness severity, and the use of CRRT also increased over time. The improvement in renal outcomes observed in the CRRT group may be related to the better baseline kidney function, especially in the dialysis dependence patients at hospital discharge.
[Mh] Termos MeSH primário: Lesão Renal Aguda/mortalidade
Lesão Renal Aguda/terapia
Taxa de Filtração Glomerular
Mortalidade Hospitalar
Diálise Peritoneal Ambulatorial Contínua/mortalidade
Diálise Peritoneal Ambulatorial Contínua/utilização
[Mh] Termos MeSH secundário: Lesão Renal Aguda/diagnóstico
Brasil/epidemiologia
Cuidados Críticos/métodos
Cuidados Críticos/utilização
Feminino
Seres Humanos
Masculino
Meia-Idade
Alta do Paciente
Diálise Peritoneal Ambulatorial Contínua/métodos
Prevalência
Estudos Retrospectivos
Fatores de Risco
Taxa de Sobrevida
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1186/s12882-017-0564-z


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[PMID]:29428043
[Au] Autor:Golob JF; Como JJ; Claridge JA
[Ti] Título:Trauma Surgeons Save Lives-Scribes Save Trauma Surgeons!
[So] Source:Am Surg;84(1):144-148, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:With the advent of the electronic medical record, the documentation burden of the trauma surgeon has become overwhelming. To help, our trauma division added scribes to the rounding team. We hypothesized that scribe utilization would improve our documentation efficiency and offer a financial benefit to the institution. A review of trauma surgeon documentation and billing was performed at a Level I trauma center over two time periods: January to May 2014 (no scribes) and January to May 2015 (scribes). The number of notes written by trauma surgeons was obtained, as were documentation charges. Documentation efficiency was determined by noting both the hour of the day in which inpatient progress notes were written and the number of notes written after patient discharge. In the 2014 period, a total of 9726 notes were written by trauma attendings. In the 2015 period, 10,933 were written. Despite having 407 fewer trauma patient-days in the 2015 period, the group wrote 343 notes/week versus 298 notes/week (P = 0.008). More inpatient progress notes were written earlier in the working day and fewer were written in the evening. Fewer notes were written after patient discharge (12.7 vs 8.4%). A total of 1,664 hours of scribe time were used over the 5-month period, generating an expense of $32,787. The additional notes generated by scribes resulted in $191,394 in charges. Conservatively, assuming a 20 per cent charge reimbursement, the cost of the scribes was covered. The addition of scribes to the daily trauma rounding team improved note efficiency and increased charge capture at our center.
[Mh] Termos MeSH primário: Custos e Análise de Custo/economia
Documentação/economia
Registros Eletrônicos de Saúde
Preços Hospitalares
Administradores de Registros Médicos/economia
Centros de Traumatologia/economia
Centros de Traumatologia/recursos humanos
[Mh] Termos MeSH secundário: Registros Eletrônicos de Saúde/economia
Registros Eletrônicos de Saúde/normas
Seres Humanos
Pacientes Internados
Alta do Paciente
Cirurgiões/economia
Estados Unidos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE


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[PMID]:29428038
[Au] Autor:Shubinets V; Fox JP; Lanni MA; Tecce MG; Pauli EM; Hope WW; Kovach SJ; Fischer JP
[Ti] Título:Incisional Hernia in the United States: Trends in Hospital Encounters and Corresponding Healthcare Charges.
[So] Source:Am Surg;84(1):118-125, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Incisional hernia (IH) is a challenging, potentially morbid condition. This study evaluates recent trends in hospital encounters associated with IH care in the United States. Using Nationwide Inpatient Sample databases from 2007 to 2011, annual estimates of IH-related hospital discharges, charges, and serious adverse events were identified. Significance in observed trends was tested using regression modeling. From 2007 to 2011, there were 583,054 hospital discharges associated with a diagnosis of IH. 81.1 per cent had a concurrent procedure for IH repair. The average discharge included a female patient (63.2%), 59.8 years of age, with either Medicare (45.3%) or Private insurance (38.3%) as the anticipated primary payer. Comparing 2007 to 2011, significant increases in IH discharges (12%; 2007 = 109,702 vs 2011 = 123,034, P = 0.009) and IH repairs (10%; 2007 = 90,588 vs 2011 = 99,622, P < 0.001) were observed. This was accompanied by a 37 per cent increase in hospital charges (2007 = $44,587 vs 2011 = $60,968, P < 0.001), resulting in a total healthcare bill of $7.3 billion in 2011. Significant trends toward greater patient age (2007 = 59.7 years vs 2011 = 60.2 years, P < 0.001), higher comorbidity index (2007 = 3.0 vs 2011 = 3.5, P < 0.001), and increased frequency of serious adverse events (2007 = 13.5% vs 2011 = 17.7%, P < 0.001) were noted. Further work is needed to identify interventions to mitigate the risk of IH development.
[Mh] Termos MeSH primário: Herniorrafia/economia
Preços Hospitalares
Hérnia Incisional/economia
Pacientes Internados
Laparoscopia/economia
Tempo de Internação/economia
Telas Cirúrgicas/economia
[Mh] Termos MeSH secundário: Custos e Análise de Custo
Feminino
Preços Hospitalares/tendências
Hospitais
Seres Humanos
Hérnia Incisional/diagnóstico
Hérnia Incisional/etiologia
Hérnia Incisional/cirurgia
Masculino
Medicare
Meia-Idade
Alta do Paciente/economia
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE


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[PMID]:29428014
[Au] Autor:Fry DE; Pine M; Nedza SM; Reband AM; Huang CJ; Pine G
[Ti] Título:Comparison of Risk-Adjusted Outcomes in Medicare Open Laparoscopic Cholecystectomy.
[So] Source:Am Surg;84(1):12-19, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:More than 90 per cent of cholecystectomies are performed laparoscopically and this has resulted in concern that surgeons will not have sufficient experience to perform open procedures when clinical circumstances require it. We reviewed the open cholecystectomies (OCs) of Medicare patients from 2010 to 2012 in hospitals with 20 or more cases, created risk-adjusted models for adverse outcomes which were evaluated for 90-days after discharge, and compared the hospital-level outcomes with laparoscopic cholecystectomy performed in the same hospitals for the same period of time. Results demonstrated that inpatient deaths, inpatient prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day readmissions were statistically the same with an overall adverse outcome rate of 21.6 per cent in OC versus 20.9 per cent in laparoscopic cholecystectomy. Conversion of laparoscopic to open procedures was not associated with increased adverse outcomes. Laparoscopic cholecystectomy provides patients with many advantages, but when clinical circumstances are necessary, OC continues to be performed with the same overall adverse outcome rates, and the conversion process is not associated with poorer results in this high-risk population of patients.
[Mh] Termos MeSH primário: Colecistectomia
Mortalidade Hospitalar
Tempo de Internação
Medicaid
Medicare
Alta do Paciente
Readmissão do Paciente
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Colecistectomia/efeitos adversos
Colecistectomia Laparoscópica/efeitos adversos
Conversão para Cirurgia Aberta
Seres Humanos
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Resultado do Tratamento
Estados Unidos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE


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[PMID]:28460770
[Au] Autor:Graziano FD; Banga S; Busman DK; Muthusamy P; Wohns DH
[Ad] Endereço:Spectrum Health, Grand Rapids, MI, USA.
[Ti] Título:Barriers to Early Discharge after Elective Percutaneous Coronary Intervention (BED PCI): A Single-Center Study.
[So] Source:Indian Heart J;69(2):217-222, 2017 Mar - Apr.
[Is] ISSN:0019-4832
[Cp] País de publicação:India
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To identify patient characteristics and procedural factors that may play a role in hindering same-day discharge (SDD) practices. BACKGROUND: Multiple studies have shown the safety and cost effectiveness of SDD following elective percutaneous coronary intervention (PCI), but factors that hinder SDD practices have not been thoroughly studied. MATERIAL AND METHODS: A retrospective comparative analysis of elective PCI patients who had an overnight stay (OS) (n=345) vs. SDD patients (n=222) was conducted to identify significant differences between the two groups in baseline patient characteristics, procedural, and postprocedural factors. RESULTS: Comparing OS to SDD patients, OS patients had a lower prevalence of radial access (20.29% vs. 39.64%, P<0.0001); a higher incidence of suboptimal angiographic results (14.49% vs. 1.80%, P=0.0027); CRCL values lower than 60mL/min (26.38% vs. 15.32%, P=0.0019); and greater femoral vascular site hemostasis with manual compression (69.09% vs. 36.57%, P=0.0027). OS patients received larger sheath sizes (P=0.0209), more bivalirudin (45.80% vs. 36.70%) and glycoprotein IIb/IIIa inhibitors (5.51% vs. 2.25%), but less heparin (51.30% vs. 53.21%). Chest pain (8.12% vs. 0.92%, P=0.0042) and vascular access site concerns (20.58% vs. 0%, P=0.0027) were more common among OS patients. CONCLUSIONS: Pre-, peri-, and post-procedural factors play a role in SDD eligibility. Understanding factors that limit as well as those that facilitate SDD may enable institutions to establish or enhance a SDD program.
[Mh] Termos MeSH primário: Doença da Artéria Coronariana/cirurgia
Procedimentos Cirúrgicos Eletivos/métodos
Alta do Paciente/tendências
Intervenção Coronária Percutânea/métodos
Medição de Risco
[Mh] Termos MeSH secundário: Idoso
Doença da Artéria Coronariana/epidemiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Período Pós-Operatório
Estudos Retrospectivos
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:28458488
[Au] Autor:Ekechukwu N; Olaleye O; Hamzat T
[Ad] Endereço:Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Enugu, Nigeria.
[Ti] Título:Clinical and Psychosocial Predictors of Community Reintegration of Stroke Survivors Three Months Post In-Hospital Discharge.
[So] Source:Ethiop J Health Sci;27(1):27-34, 2017 Jan.
[Is] ISSN:2413-7170
[Cp] País de publicação:Ethiopia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: There appears to be a dearth of published literature on the biopsychosocial predictors of community reintegration (CR) among stroke survivors. This study aims to investigate the clinical and psychosocial predictors of CR among stroke survivors three months post in-hospital discharge. METHODS: Fifty-two stroke survivors took part in this prospective exploratory study. The participants' clinical attributes of motor function (MF), balance (Bal) and psychosocial characteristics of Fall Self-Efficacy (FSE), Balance Self-Efficacy (BSE), Self-Esteem (SEst) and Social Support (SS) were assessed pre-discharge and at three months post-discharge. CR was also assessed at three months post-discharge. Data were analyzed using paired t-test, Pearson's Moment correlation and multiple regressions. Level of significance was set at p = 0.05. RESULTS: The mean age of the participants was 61.21±11.25 years with mean hospital length of stay of 5.31±3.71weeks. There were significant differences in the mean MF, Bal, FSE, BSE, SEst and SS scores of the participants pre- and post-discharge (p < 0.05). Also, there was a significant correlation between CR and each of MF, Bal, FSE, BSE, SEst and SS. Pre-discharge Age (ß = -0.226, p = 0.001) and FSE (ß = 1.387, p = 0.040) significantly predicted CR. Post-discharge age (ß = -0.164, p = 0.005) and Bal (ß = 0.142, p = 0.048). FSE (ß = 1.243, p = 0.034) also significantly predicted CR. CONCLUSION: Age, Bal and FSE are important predictors of CR among stroke survivors. Therefore, rehabilitation programmes should focus on improving Bal and FSE in order to enhance community reintegration among stroke survivors.
[Mh] Termos MeSH primário: Nível de Saúde
Reabilitação do Acidente Vascular Cerebral/métodos
Reabilitação do Acidente Vascular Cerebral/psicologia
Acidente Vascular Cerebral/fisiopatologia
Acidente Vascular Cerebral/psicologia
Sobreviventes/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Nigéria
Alta do Paciente
Equilíbrio Postural
Estudos Prospectivos
Autoeficácia
Apoio Social
Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos
Sobreviventes/psicologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


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[PMID]:28449612
[Au] Autor:Schattner A
[Ad] Endereço:a The Faculty of Medicine , Hadassah Medical School, Hebrew University , Jerusalem , Israel.
[Ti] Título:Residents' responsibilities: Adopting a wider view.
[So] Source:Med Teach;39(12):1286-1289, 2017 Dec.
[Is] ISSN:1466-187X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Current ACGME regulations have limited residents' weekly hours and continuous working hours, a marked change, despite its uncertain effects on physician well-being and quality of care. Although residency programs in internal medicine and family medicine have adapted schedules to conform to these regulations, increasing evidence is accumulating to suggest that these training experiences are not adequately preparing the next generation of practicing primary care and hospital-based physicians. Data from an array of sources continue to demonstrate significant deficiencies in six areas of residents' responsibilities towards their patients: diminished patient "face time" and direct patient care; focus on patients' "reason for hospitalization" or "reason for visit" at the expense of possible neglect of patients' "secondary" medical problems; limited attention to patients' emotional or contextual problems and limited empathy; deficient implementation of the essential constituents of patient-centered care; neglect of habitual "reflective practice"; and excessive distinction between inpatient and outpatient responsibilities, leading to missed opportunities for inpatient residents to be aware of and attend to patients' post-discharge course although new information and readmissions related to the index hospitalization are prevalent. Thus, redesigning residency programs to widen residents' outlook and cover these inseparable components of high-quality care, may infuse the often fatigued and burnt-out residents with purpose and fulfillment, finally incorporating the missing elements of patient-centered care as integral parts of patients' admissions and therefore, of physicians' future careers.
[Mh] Termos MeSH primário: Competência Clínica
Empatia
Internato e Residência/organização & administração
Assistência Centrada no Paciente/organização & administração
Estudantes de Medicina/psicologia
[Mh] Termos MeSH secundário: Emoções
Seres Humanos
Internato e Residência/normas
Alta do Paciente
Assistência Centrada no Paciente/normas
Admissão e Escalonamento de Pessoal
Qualidade da Assistência à Saúde/organização & administração
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1080/0142159X.2017.1319916


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[PMID]:29370162
[Au] Autor:Dudley L; Mukinda F; Dyers R; Marais F; Sissolak D
[Ad] Endereço:Division of Health Systems and Public Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
[Ti] Título:Mind the gap! Risk factors for poor continuity of care of TB patients discharged from a hospital in the Western Cape, South Africa.
[So] Source:PLoS One;13(1):e0190258, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: TB patients discharged from hospitals in South Africa experience poor continuity of care, failing to continue TB treatment at other levels of care. Factors contributing to poor continuity of TB care are insufficiently described to inform interventions. OBJECTIVE: To describe continuity of care and risk factors in TB patients discharged from a referral hospital in the Western Cape, South Africa. DESIGN: This retrospective observational study used routine information to describe continuity of care and risk factors in TB patients discharged from hospital. RESULTS: 788 hospitalized TB patients were identified in 6 months. Their median age was 32 years, 400 (51%) were male, and 653 (83%) were urban. A bacteriological TB test was performed for 74%, 25% were tested for HIV in hospital, and 32% of all TB patients had documented evidence of HIV co-infection. Few (13%) were notified for TB; 375 (48%) received TB medication; 284 (36%) continued TB treatment after discharge; 91 (24%) had a successful TB treatment outcome, and 166 (21%) died. Better continuity of care was associated with adults, urban residence, bacteriological TB tests in hospital and TB medication on discharge. Fragmented hospital TB data systems did not provide continuity with primary health care information systems. CONCLUSIONS: Discharged TB patients experienced poor continuity of care, with children, rural patients, those not tested for TB in hospital or discharged without TB medication at greatest risk. Suboptimal quality of hospital TB care and a fragmented hospital information system without linkages to other levels underpinned poor continuity of care.
[Mh] Termos MeSH primário: Continuidade da Assistência ao Paciente
Alta do Paciente
Tuberculose/terapia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Seres Humanos
Masculino
Fatores de Risco
África do Sul/epidemiologia
Tuberculose/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190258



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