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[PMID]:29191155
[Au] Autor:Ohene SA; Bonsu F; Hanson-Nortey NN; Toonstra A; Sackey A; Lonnroth K; Uplekar M; Danso S; Mensah G; Afutu F; Klatser P; Bakker M
[Ad] Endereço:World Health Organization Country Office, 29 Volta Street Airport, Airport Residential Area, P.O. Box MB 142, Accra, Ghana. salohene@yahoo.com.
[Ti] Título:Provider initiated tuberculosis case finding in outpatient departments of health care facilities in Ghana: yield by screening strategy and target group.
[So] Source:BMC Infect Dis;17(1):739, 2017 Dec 01.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Meticulous identification and investigation of patients presenting with tuberculosis (TB) suggestive symptoms rarely happen in crowded outpatient departments (OPDs). Making health providers in OPDs diligently follow screening procedures may help increase TB case detection. From July 2010 to December 2013, two symptom based TB screening approaches of varying cough duration were used to screen and test for TB among general outpatients, PLHIV, diabetics and contacts in Accra, Ghana. METHODS: This study was a retrospective analysis comparing the yield of TB cases using two different screening approaches, allocated to selected public health facilities. In the first approach, the conventional 2 weeks cough duration with or without other TB suggestive symptoms was the criterion to test for TB in attendants of 7 general OPDs. In the second approach the screening criteria cough of >24 hours, as well as a history of at least one of the following symptoms: fever, weight loss and drenching night sweats were used to screen and test for TB among attendants of 3 general OPDs, 7 HIV clinics and 2 diabetes clinics. Contact investigation was initiated for index TB patients. The facilities documented the number of patients verbally screened, with presumptive TB, tested using smear microscopy and those diagnosed with TB in order to calculate the yield and number needed to screen (NNS) to find one TB case. Case notification trends in Accra were compared to those of a control area. RESULTS: In the approach using >24-hour cough, significantly more presumptive TB cases were identified among outpatients (0.82% versus 0.63%), more were tested (90.1% versus 86.7%), but less smear positive patients were identified among those tested (8.0% versus 9.4%). Overall, all forms of TB cases identified per 100,000 screened were significantly higher in the >24-hour cough approach at OPD (92.7 for cough >24 hour versus 82.7 for cough >2 weeks ), and even higher in diabetics (364), among contacts (693) and PLHIV (995). NNS (95% Confidence Interval) varied from 100 (93-109) for PLHIV, 144 (112-202) for contacts, 275 (197-451) for diabetics and 1144 (1101-1190) for OPD attendants. About 80% of the TB cases were detected in general OPDs. Despite the intervention, notifications trends were similar in the intervention and control areas. CONCLUSION: The >24-hour cough approach yielded more TB cases though required TB testing for a larger number of patients. The yield of TB cases per 100,000 population screened was highest among PLHIV, contacts, and diabetics, but the majority of cases were detected in general OPDs. The intervention had no discernible impact on general case notification.
[Mh] Termos MeSH primário: Programas de Rastreamento/métodos
Tuberculose/diagnóstico
[Mh] Termos MeSH secundário: Algoritmos
Tosse/etiologia
Gana
Instalações de Saúde
Seres Humanos
Pacientes Ambulatoriais
Estudos Retrospectivos
Fatores de Tempo
Tuberculose/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2843-5


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[PMID]:29179828
[Au] Autor:Hjorth P; Juel A; Hansen MV; Madsen NJ; Viuff AG; Munk-Jørgensen P
[Ad] Endereço:Mental Health Center, Psychiatric Hospital, Randers, Denmark. Electronic address: Peter.Hjorth@rsyd.dk.
[Ti] Título:Reducing the Risk of Cardiovascular Diseases in Non-selected Outpatients With Schizophrenia: A 30-Month Program Conducted in a Real-life Setting.
[So] Source:Arch Psychiatr Nurs;31(6):602-609, 2017 12.
[Is] ISSN:1532-8228
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The most common cause of premature death in people with schizophrenia is cardiovascular disease, partially explained by an unhealthy lifestyle, smoking, poor diet and sedentary behavior. We aimed to reduce cardiovascular risk factors. METHOD: Naturalistic follow-up study with 54 long-term-treated non-selected outpatients with schizophrenia. The 30-month program consisted of individual guidance, group sessions and normal treatment and care offered in our clinic. RESULTS: On average, the participating women reduced their waist circumference by 11.4cm (P=0.037), whereas the participating men increased their waist circumference by 3.3cm (P=0.590). Patients' consumption of fast food was reduced from 1.2 to 0.8 times/week (P=0.016), just as their consumption of soft drinks was reduced from 0.7 to 0.1l/day (P=0.006). Their consumption of coffee increased from 1.6 to 2.5 cups/day (P=0.086). The time women spent on light physical activity increased from 134 to 469min/week (P=0.055). The number of daily cigarettes smoked was reduced by 25.7% for all smokers. CONCLUSIONS: Our program showed that it is possible for women but not for men to reduce their risk factors for developing cardiovascular disease. The program is manageable in most outpatient clinics and can be performed by nursing staff interested in physical health with support from and in cooperation with medical doctors, psychiatrist and leaders/managers.
[Mh] Termos MeSH primário: Doenças Cardiovasculares/prevenção & controle
Promoção da Saúde
Pacientes Ambulatoriais/psicologia
Esquizofrenia/terapia
[Mh] Termos MeSH secundário: Adulto
Doenças Cardiovasculares/mortalidade
Doenças Cardiovasculares/terapia
Exercício/fisiologia
Feminino
Seguimentos
Seres Humanos
Estilo de Vida
Masculino
Fatores de Risco
Esquizofrenia/complicações
Fumar/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE


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[PMID]:29210554
[Au] Autor:Davis J; Bittner-Fagan H; Savoy M
[Ad] Endereço:Sidney Kimmel Medical College - Thomas Jefferson University, 1025 Walnut St, Philadelphia, PA 19107.
[Ti] Título:Improving Patient Safety: Common Outpatient Medical Errors.
[So] Source:FP Essent;463:11-15, 2017 Dec.
[Is] ISSN:2159-3000
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Medical errors are common and can lead to patient harm and death. Most research on errors has focused on inpatient care, yet errors are at least as common in the outpatient setting and likely are underreported. Common types of errors in the outpatient setting are diagnostic, drug, and testing errors. The most effective specific interventions for reducing errors in the outpatient setting remain unknown. Considering the current lack of data, the authors recommend a quality improvement approach to understanding local factors in patient safety. Appropriate education and training of all staff members in their roles in patient safety is an important aspect of any program to reduce errors, though these measures rarely are sufficient on their own. Creation of a culture of safety, use of adequate systems and policies for reporting and identifying errors, and use of technologies to prevent errors also are important.
[Mh] Termos MeSH primário: Medicina de Família e Comunidade
Erros Médicos/prevenção & controle
Pacientes Ambulatoriais
Segurança do Paciente
Administração da Prática Médica
Melhoria de Qualidade
[Mh] Termos MeSH secundário: Seres Humanos
Cultura Organizacional
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE


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[PMID]:29293632
[Au] Autor:Geter A; Sutton MY; Armon C; Durham MD; Palella FJ; Tedaldi E; Hart R; Buchacz K; HIV Outpatient Study Investigators
[Ad] Endereço:Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
[Ti] Título:Trends of racial and ethnic disparities in virologic suppression among women in the HIV Outpatient Study, USA, 2010-2015.
[So] Source:PLoS One;13(1):e0189973, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In the United States, women accounted for 19% of new HIV diagnoses in 2015 and were less likely to reach virologic suppression when compared to men. We assessed trends and disparities in virologic suppression among HIV-positive women to inform HIV treatment strategies. Data were from a prospective cohort of the HIV Outpatient Study and collected at nine United States HIV clinics. We included women aged ≥18 years, with ≥1 visit, who were prescribed antiretroviral therapy, and had ≥1 viral load test performed between 2010 and 2015. We defined virologic suppression as viral load <50 copies/mL and calculated adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) for virologic suppression by race/ethnicity and year of measure. Generalized estimating equations were used for multivariable analyses to assess factors associated with virologic suppression. Among 809 women (median age = 44 years), 482 (60%) were black, 177 (22%) white, 150 (19%) Hispanic/Latina. Virologic suppression was less prevalent among black women (73%) compared with Hispanic/Latina women (83%) and white women (91%). In multivariable analyses, not achieving virologic suppression was more likely among black women (aPR = 2.13; CI = 1.50-3.02) or Hispanic/Latina women (aPR = 1.66; CI = 1.08-2.56) compared with white women, and among women who attended public clinics (aPR = 1.42; CI = 1.07-1.87) compared with those who attended a private clinic. Between 2010 and 2015, virologic suppression among HIV-positive women increased from 68% to 83%, but racial/ethnic disparities persisted. Black and Hispanic/Latina women had significantly lower rates of virologic suppression than white women. Interventions targeting virologic suppression improvement among HIV-positive women of color, especially those who attend public clinics, are warranted.
[Mh] Termos MeSH primário: Grupos Étnicos
Infecções por HIV/etnologia
Infecções por HIV/virologia
Pacientes Ambulatoriais
Grupos Populacionais
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Meia-Idade
Estudos Prospectivos
Estados Unidos
Carga Viral
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180103
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189973


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[PMID]:29237605
[Au] Autor:Jena AB; Olenski AR; Molitor D; Miller N
[Ad] Endereço:Department of Health Care Policy, Harvard Medical School Boston, MA 02115, USA; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; National Bureau of Economic Research, Cambridge, MA, USA jena@hcp.med.harvard.edu.
[Ti] Título:Association between rainfall and diagnoses of joint or back pain: retrospective claims analysis.
[So] Source:BMJ;359:j5326, 2017 12 13.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To study the relation between rainfall and outpatient visits for joint or back pain in a large patient population. DESIGN: Observational study. SETTING: US Medicare insurance claims data linked to rainfall data from US weather stations. PARTICIPANTS: 1 552 842 adults aged ≥65 years attending a total of 11 673 392 outpatient visits with a general internist during 2008-12. MAIN OUTCOME MEASURES: The proportion of outpatient visits for joint or back pain related conditions (rheumatoid arthritis, osteoarthritis, spondylosis, intervertebral disc disorders, and other non-traumatic joint disorders) was compared between rainy days and non-rainy days, adjusting for patient characteristics, chronic conditions, and geographic fixed effects (thereby comparing rates of joint or back pain related outpatient visits on rainy days versus non-rainy days within the same area). RESULTS: Of the 11 673 392 outpatient visits by Medicare beneficiaries, 2 095 761 (18.0%) occurred on rainy days. In unadjusted and adjusted analyses, the difference in the proportion of patients with joint or back pain between rainy days and non-rainy days was significant (unadjusted, 6.23% 6.42% of visits, P<0.001; adjusted, 6.35% 6.39%, P=0.05), but the difference was in the opposite anticipated direction and was so small that it is unlikely to be clinically meaningful. No statistically significant relation was found between the proportion of claims for joint or back pain and the number of rainy days in the week of the outpatient visit. No relation was found among a subgroup of patients with rheumatoid arthritis. CONCLUSION: In a large analysis of older Americans insured by Medicare, no relation was found between rainfall and outpatient visits for joint or back pain. A relation may still exist, and therefore larger, more detailed data on disease severity and pain would be useful to support the validity of this commonly held belief.
[Mh] Termos MeSH primário: Artralgia/epidemiologia
Dor nas Costas/epidemiologia
Chuvas
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Artralgia/etiologia
Dor nas Costas/etiologia
Bases de Dados Factuais
Feminino
Seres Humanos
Masculino
Medicare
Pacientes Ambulatoriais/estatística & dados numéricos
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5326


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[PMID]:29325305
[Au] Autor:Wang WQ; Lin JT; Zhou X; Wang CZ; Huang M; Cai SX; Chen P; Lin QC; Zhou JY; Gu YH; Yuan YD; Sun DJ; Yang XH; Yang L; Huo JM; Chen ZC; Jiang P; Zhang J; Ye XW; Liu HG; Tang HP; Liu RY; Liu CT; Zhang W; Hu CP; Chen YQ; Liu XJ; Dai LM; Zhou W; Huang YJ; Xu JY
[Ad] Endereço:Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China.
[Ti] Título:[Evaluation of asthma management from the surveys in 30 provinces of China in 2015-2016].
[So] Source:Zhonghua Nei Ke Za Zhi;57(1):15-20, 2018 Jan 01.
[Is] ISSN:0578-1426
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To evaluate the general level of asthma management in urban areas of China and further promote the national asthma management plan. A multi-center, cross-sectional survey was carried out in 30 provinces of China (except for Tibet) during Oct 2015 to May 2016. It's a questionnaire-based face-to-face survey which included asthma management using peak flow meter (PFM) and pulmonary function test, medication choice of maintenance therapy and asthma education. A total of 3 875 asthmatic outpatients were recruited including 2 347(60.6%) females and 1 528(39.4%) males. The mean age was (50.7±16.7) years ranging from 14 to 99. Only 10.1%(388/3 837) patients used PFM as monitoring, whereas 62.1%(2 405/3 874) patients underwent pulmonary function test during the past year. There were 57.4%(2 226/3 875) patients treated with inhaled cortical steroid plus long-acting ß(2)-agonist combinations (ICS+LABA) as daily medication. 43.3%(1 661/3 836) patients were followed up by physicians. Among this population, 1 362 asthmatic outpatients were recruited, who also took part in the asthma control survey in 2007-2008 in 10 cities. In this subgroup, 17.9%(244/1 360) were tested by PFM and 66.6%(907/1 362) by pulmonary function test during last year. As to the medication, 63.1%(860/1 362) selected ICS+LABA for daily control. There were 50.4%(685/1 359) patients in the follow-up cohort by physicians. Compared to the similar survey conducted in 2007-2008, the proportion of patients with ICS+LABA regimen and follow-up by physicians were markedly higher, while the rate of PFM use did not have significant improvement. Although the present level of asthma management in China is still far from ideal, asthma management has improved compared to 8 years ago. Yet the use of PFM does not significantly improve. Asthma action plan and application of PFM should be further promoted to improve the level of asthma management.
[Mh] Termos MeSH primário: Corticosteroides/administração & dosagem
Antiasmáticos/uso terapêutico
Asma/tratamento farmacológico
Pacientes Ambulatoriais/estatística & dados numéricos
[Mh] Termos MeSH secundário: Administração por Inalação
Adulto
Idoso
Asma/diagnóstico
Asma/epidemiologia
China/epidemiologia
Cidades
Estudos Transversais
Feminino
Seres Humanos
Masculino
Meia-Idade
Médicos
Inquéritos e Questionários
População Urbana
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Anti-Asthmatic Agents)
[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:180112
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0578-1426.2018.01.003


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[PMID]:28470892
[Au] Autor:Berk L; Hallam KT; Venugopal K; Lewis AJ; Austin DW; Kulkarni J; Dodd S; de Castella A; Fitzgerald PB; Berk M
[Ad] Endereço:Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Vic., Australia.
[Ti] Título:Impact of irritability: a 2-year observational study of outpatients with bipolar I or schizoaffective disorder.
[So] Source:Bipolar Disord;19(3):184-197, 2017 May.
[Is] ISSN:1399-5618
[Cp] País de publicação:Denmark
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Many people experience irritability when manic, hypomanic, or depressed, yet its impact on illness severity and quality of life in bipolar and schizoaffective disorders is poorly understood. This study aimed to examine the relationship between irritability and symptom burden, functioning, quality of life, social support, suicidality, and overall illness severity in a naturalistic cohort of people with bipolar I or schizoaffective disorder. METHODS: We used data from 239 adult outpatients with bipolar I or schizoaffective disorder in the Bipolar Comprehensive Outcomes Study (BCOS) - a non-interventional observational study with a 2-year follow-up period. Baseline demographic and clinical characteristics of participants with and without irritability were compared. A mixed-model repeated measures analysis was conducted to examine the longitudinal effect of irritability on clinical and quality-of-life variables over follow-up using significant baseline variables. RESULTS: At baseline, 54% of participants were irritable. Baseline irritability was associated with illness severity, mania, depression, psychotic symptoms, suicidality, poor functioning, and quality of life, but not diagnosis (schizoaffective/bipolar disorder). Participants with irritability were less likely to have a partner and perceived less adequate social support. On average, over follow-up, those with irritability reported more symptoms, functional impairment, and suicidality. Furthermore, the effects of irritability could not be fully explained by illness severity. CONCLUSIONS: Irritability was associated with more negative symptomatic, functional, and quality-of-life outcomes and suicidality. The identification, monitoring, and targeted treatment of irritability may be worth considering, to enhance health and wellbeing outcomes for adults with bipolar and schizoaffective disorders.
[Mh] Termos MeSH primário: Transtorno Bipolar
Humor Irritável
Transtornos Psicóticos
Qualidade de Vida
[Mh] Termos MeSH secundário: Atividades Cotidianas/psicologia
Adulto
Austrália/epidemiologia
Transtorno Bipolar/diagnóstico
Transtorno Bipolar/epidemiologia
Transtorno Bipolar/psicologia
Estudos de Coortes
Efeitos Psicossociais da Doença
Manual Diagnóstico e Estatístico de Transtornos Mentais
Feminino
Seres Humanos
Masculino
Meia-Idade
Avaliação de Resultados (Cuidados de Saúde)
Pacientes Ambulatoriais/psicologia
Transtornos Psicóticos/diagnóstico
Transtornos Psicóticos/epidemiologia
Transtornos Psicóticos/psicologia
Índice de Gravidade de Doença
Apoio Social
Ideação Suicida
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[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:170505
[St] Status:MEDLINE
[do] DOI:10.1111/bdi.12486


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[PMID]:28456704
[Au] Autor:Schroeder CP; Van Anglen LJ; Dretler RH; Adams JS; Prokesch RC; Luu Q; Krinsky AH
[Ad] Endereço:Healix Infusion Therapy, Inc., 14140 Southwest Freeway, Suite 400, Sugar Land, TX 77478, USA.
[Ti] Título:Outpatient treatment of osteomyelitis with telavancin.
[So] Source:Int J Antimicrob Agents;50(1):93-96, 2017 Jul.
[Is] ISSN:1872-7913
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Telavancin is a lipoglycopeptide antibiotic with bactericidal activity against Gram-positive pathogens including Staphylococcus aureus, the most frequent cause of osteomyelitis. Treatment is often challenging due to needs for surgical intervention along with prolonged administration of intravenous antimicrobials, frequently in an outpatient setting. This was a retrospective analysis of the efficacy and safety of telavancin for treatment of osteomyelitis provided as outpatient parenteral antimicrobial therapy (OPAT) in physician office infusion centres. Medical records of 60 patients receiving telavancin for osteomyelitis in 22 physician office infusion centres from 2010 to 2011 and 2013 to 2015 were reviewed. Of these, 60% were treated without hospitalisation, 37% had orthopaedic hardware and 56% had concurrent infections. Staphylococcus aureus was the most common pathogen (78%), primarily methicillin-resistant. The median duration of telavancin treatment in the outpatient setting was 21 days (range 3-105 days). Telavancin was used as first-line therapy in 32% of cases, following prior antibiotic failure in 47% and due to intolerance to previous agents in 22%, predominantly daptomycin or vancomycin. The telavancin dose was 10 mg/kg/day, adjusted for renal function in 25% of patients. The majority of patients self-administered telavancin at home via an elastomeric infusion pump. Overall clinical success was 73%. No significant differences in outcomes were observed with the presence of hardware, concurrent infection, concomitant therapies or type of osteomyelitis. Telavancin-associated adverse events occurred in 57%, with discontinuation in three patients (5%). These data demonstrate the effective and safe OPAT use of telavancin, providing an alternative for successful treatment of patients with osteomyelitis.
[Mh] Termos MeSH primário: Assistência Ambulatorial/métodos
Aminoglicosídeos/administração & dosagem
Antibacterianos/administração & dosagem
Infecções Bacterianas/tratamento farmacológico
Osteomielite/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Aminoglicosídeos/efeitos adversos
Antibacterianos/efeitos adversos
Bactérias/classificação
Bactérias/isolamento & purificação
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Pacientes Ambulatoriais
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Aminoglycosides); 0 (Anti-Bacterial Agents); XK134822Z0 (telavancin)
[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:170501
[St] Status:MEDLINE


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[PMID]:29283294
[Au] Autor:Kataruka A; Renner E; Barnes GD
[Ad] Endereço:a Department of Internal Medicine , Michigan Medicine , Ann Arbor , MI , USA.
[Ti] Título:Evaluating the role of clinical pharmacists in pre-procedural anticoagulation management.
[So] Source:Hosp Pract (1995);46(1):16-21, 2018 Feb.
[Is] ISSN:2154-8331
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: While physicians are typically responsible for managing perioperative warfarin, clinic pharmacists may improve pre-procedural decision-making. We assessed the impact of pharmacist-driven care for chronic warfarin-treated patients undergoing outpatient right heart catheterization (RHC). METHODS: 200 warfarin patients who underwent RHC between January 2012 and September 2015 were analyzed. Pharmacist-care (n = 79) was compared to the usual care model (n = 121). The primary outcome was a composite of (1) documentation of anticoagulation plan, (2) holding warfarin at least 5 days prior to procedure, (3) guideline-congruent low molecular weight heparin (LMWH) bridging, and (4) correct LMWH dosing if bridging deemed necessary. Chi-squared test performed to assess the role of pharmacist. A multivariable logistic regression analysis was performed to the composite endpoint, adjusted for the month of procedure. RESULTS: Compared to the usual care model, pharmacist-driven care (OR 4.69, 95% CI 1.73-12.71, p = 0.002) and date of the procedure (OR 1.06/month, 95% CI 1.01-1.10, p = 0.011) were independently associated with the primary composite outcome. Of the individual outcome components, pharmacist-driven care was only associated with documentation (96.2% vs. 67.8%, OR 9.19, 95% CI 2.19-38.62, p = 0.002). Remaining components including hold warfarin for at least 5 days, appropriate bridging and correct LMWH dosing were not significantly associated with pharmacist-care. CONCLUSIONS: Pharmacist-care is associated with better guideline-based anticoagulation management, but this was primarily driven by improved documentation. The impact of pharmacist managed peri-procedural anticoagulation on clinical outcomes remains unknown.
[Mh] Termos MeSH primário: Anticoagulantes/administração & dosagem
Cateterismo Cardíaco/métodos
Farmacêuticos/organização & administração
Varfarina/administração & dosagem
[Mh] Termos MeSH secundário: Idoso
Anticoagulantes/uso terapêutico
Documentação
Relação Dose-Resposta a Droga
Monitoramento de Medicamentos
Feminino
Heparina de Baixo Peso Molecular/administração & dosagem
Seres Humanos
Coeficiente Internacional Normatizado
Modelos Logísticos
Masculino
Meia-Idade
Pacientes Ambulatoriais
Guias de Prática Clínica como Assunto
Estudos Retrospectivos
Varfarina/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Heparin, Low-Molecular-Weight); 5Q7ZVV76EI (Warfarin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171229
[St] Status:MEDLINE
[do] DOI:10.1080/21548331.2018.1420346


  10 / 11674 MEDLINE  
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Fotocópia
[PMID]:29280606
[Au] Autor:Hiebert JC; Rhodes RM; Anderson MP; Vasan NR
[Ti] Título:Patient Opinion on the Affordable Care Act in an Otolaryngology Practice: the Ideological Divide.
[So] Source:J Okla State Med Assoc;109(9):441-5, 2016 09.
[Is] ISSN:0030-1876
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To assess patient opinion on the Patient Protection and Affordable Care Act (PPACA) in an Otolaryngology practice and the factors that influence those opinions. STUDY DESIGN: Observational study. METHODS: An anonymous survey assessing patient opinion on the PPACA, demographic information, political affiliation, medical diagnosis, and insurance status was distributed to patients in three separate Otolaryngology clinics (General, cancer, and Low-income/Indigent) from April to June 2014. A total of 300 surveys were distributed and 207 were used for final analysis. The primary study outcome measures were patient opinion of the PPACA and statistically significant variables affecting that opinion. The association of Support for the PPACA and variables were tested using the Chi-square test. RESULTS: The only variables that showed a significant association with support for the PPACA were Political Party (p<0.0001) and Ethnicity (p=0.0050). Specifically, a higher proportion of Democrats support the PPACA than Republicans and a higher proportion of African Americans and Hispanic/Latinos support the PPACA than Whites and Native Americans. CONCLUSION: Our survey of current Otolaryngology patients mirrors national findings of the division between Republicans and Democrats in their attitudes towards the Affordable Care Act. Political party appears to be the most significant factor in shaping patient opinion on this controversial subject regardless of insurance status or cancer diagnosis and a higher proportion of African Americans and Hispanic/Latinos support the PPACA than Whites and Native Americans. LEVEL OF EVIDENCE: IV.
[Mh] Termos MeSH primário: Atitude Frente à Saúde
Grupos Étnicos
Otolaringologia
Pacientes Ambulatoriais
Patient Protection and Affordable Care Act
Política
Opinião Pública
[Mh] Termos MeSH secundário: Afroamericanos
Grupo com Ancestrais do Continente Europeu
Feminino
Hispano-Americanos
Seres Humanos
Índios Norte-Americanos
Cobertura do Seguro
Seguro Saúde
Masculino
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171228
[St] Status:MEDLINE



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