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[PMID]:29190768
[Au] Autor:Kim SJ; Kim SJ; Han KT; Park EC
[Ad] Endereço:Department of Nursing, College of Nursing, Eulji University, Seongnam, Republic of Korea.
[Ti] Título:Medical costs, Cesarean delivery rates, and length of stay in specialty hospitals vs. non-specialty hospitals in South Korea.
[So] Source:PLoS One;12(11):e0188612, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Since 2011, specialty hospitals in South Korea have been known for providing high- quality care in specific clinical areas. Much research related to specialty hospitals and their performance in many such areas has been performed, but investigations about their performance in obstetrics and gynecology are lacking. Thus, we aimed to compare specialty vs. non-specialty hospitals with respect to mode of obstetric delivery, especially the costs and length of stay related to Cesarean section (CS) procedures, and to provide evidence to policy-makers for evaluating the success of hospitals that specialize in obstetric and gynecological (OBGYN) care. METHODS: We obtained National Health Insurance claim data from 2012 to 2014, which included information from 418,141 OBGYN cases at 214 hospitals. We used a generalized estimating equation model to identify a potential association between the likelihood of CS at specialty hospitals compared with other hospitals. We also evaluated medical costs and length of stay in specialty hospitals according to type of delivery. RESULTS: We found that 150,256 (35.9%) total deliveries were performed by CS. The odds ratio of CS was significantly lower in specialty hospitals (OR: 0.95, 95% CI: 0.93-0.96compared to other hospitals Medical costs (0.74%) and length of stay (1%) in CS cases increased in specialty hospitals, although length of stay following vaginal delivery was lower (0.57%) in specialty hospitals compared with other hospitals. CONCLUSIONS: We determined that specialty hospitals are significantly associated with a lower likelihood of CS delivery and shorter length of stay after vaginal delivery. Although they are also associated with higher costs for delivery, the increased cost could be due to the high level of intensive care provided, which leads to improve quality of care. Policy-makers should consider incentive programs to maintain performance of specialty hospitals and promote efficiency that could reduce medical costs accrued by patients.
[Mh] Termos MeSH primário: Cesárea/utilização
Custos de Cuidados de Saúde
Hospitais Especializados/estatística & dados numéricos
Tempo de Internação
[Mh] Termos MeSH secundário: Adulto
Cesárea/economia
Feminino
Hospitais Especializados/economia
Seres Humanos
Gravidez
República da Coreia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171229
[Lr] Data última revisão:
171229
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188612


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[PMID]:28683031
[Au] Autor:Auditore A; Karsten K; Rolston EJ; McMillan-Coddington D
[Ad] Endereço:Anthony Auditore, MNSt, RN, NE-BC, is Professional Development Specialist, Mount Sinai Queens, Long Island City, New York. Kathleen Karsten, PhD, RN, is Professional Development Specialist, Mount Sinai Queens, Long Island City, New York. Elizabeth J. Rolston, MEd, RN, is Director of Nursing Education, Research and Improvements, Mount Sinai Queens, Long Island City, New York. Deborah McMillan-Coddington, MS, RN, is Professional Development Specialist, Mount Sinai Queens, Long Island City, New York.
[Ti] Título:Using the Magnet® Model to Develop a State of Nursing Report.
[So] Source:J Nurses Prof Dev;33(4):185-188, 2017 Jul/Aug.
[Is] ISSN:2169-981X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Magnet® designation is a prestigious recognition given to a hospital for two reasons: excellence in nursing care and outstanding patient outcomes. Professional development specialists are in a primary position to mentor direct care nursing staff to take ownership, accountability, and responsibility for their practice through the cultivation of a report demonstrating Magnet® engagement and readiness. A State of Nursing report was developed, employing the Magnet® components to fortify the commitment to nursing excellence.
[Mh] Termos MeSH primário: Competência Clínica/normas
Hospitais Especializados/normas
Modelos de Enfermagem
Cuidados de Enfermagem/normas
Qualidade da Assistência à Saúde
[Mh] Termos MeSH secundário: Eficiência Organizacional/normas
Seres Humanos
Liderança
Profissionais de Enfermagem/normas
Cultura Organizacional
Desenvolvimento de Pessoal/métodos
Desenvolvimento de Pessoal/normas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE
[do] DOI:10.1097/NND.0000000000000356


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[PMID]:28679016
[Au] Autor:Ciliberti-Vargas MA; Gardener H; Wang K; Dong C; Yi L; Romano JG; Robichaux M; Waddy SP; Nobo U; Diaz-Acosta S; Rundek T; Waters MF; Sacco RL
[Ad] Endereço:From the University of Miami Miller School of Medicine, Miami, Florida, University of Miami School of Architecture, Coral Gables, Florida, the National Institute for Neurological Diseases and Stroke, Bethesda, Maryland, Hospital HIMA San Pablo, Caguas, Puerto Rico, American Heart Association Greater
[Ti] Título:Stroke Hospital Characteristics in the Florida-Puerto Rico Collaboration to Reduce Stroke Disparities Study.
[So] Source:South Med J;110(7):466-474, 2017 Jul.
[Is] ISSN:1541-8243
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Although disparities in stroke care and outcomes have been well documented nationally, state-based registries to monitor acute stroke care in Florida (FL) and Puerto Rico (PR) have not been established. The FL-PR Collaboration to Reduce Stroke Disparities (CReSD) was developed to evaluate race-ethnicity and regional disparities in stroke care performance. The objective of this study was to assess and compare hospital characteristics within a large quality improvement registry to identify characteristics associated with better outcomes for acute ischemic stroke care. METHODS: Trained personnel from 78 FL-PR CReSD hospitals (69 FL, 9 PR) completed a 50-item survey assessing institutional characteristics across seven domains: acute stroke care resource availability, emergency medical services integration, stroke center certification, data collection and use, quality improvement processes, FL-PR CReSD recruitment incentives, and hospital infrastructure. RESULTS: The rate of survey completion was 100%. Differences were observed both within FL and between FL and PR. Years participating in Get With The Guidelines-Stroke (8.9 ± 2.6 years FL vs 4.8 ± 2.4 years PR, < 0.0001) and proportion of hospitals with any stroke center certification (94.2% FL vs 11.1% PR, < 0.0001) showed the largest variations. Smaller hospital size, fewer years in Get With The Guidelines-Stroke, and lack of stroke center designation and acute stroke care practice implementation may contribute to poorer outcomes. CONCLUSIONS: Results from our survey indicated variability in hospital- and system-level characteristics in stroke care across hospitals in Florida and Puerto Rico. Identification of these variations, which may explain potential disparities, can help clinicians understand gaps in stroke care and outcomes and targeted interventions to reduce identified disparities can be implemented.
[Mh] Termos MeSH primário: Disparidades em Assistência à Saúde/etnologia
Disparidades em Assistência à Saúde/estatística & dados numéricos
Hospitais Especializados/organização & administração
Colaboração Intersetorial
Acidente Vascular Cerebral/etnologia
Acidente Vascular Cerebral/terapia
[Mh] Termos MeSH secundário: Florida
Fidelidade a Diretrizes
Pesquisas sobre Serviços de Saúde
Disparidades em Assistência à Saúde/tendências
Hospitais Especializados/tendências
Seres Humanos
Avaliação de Resultados (Cuidados de Saúde)/estatística & dados numéricos
Porto Rico
Melhoria de Qualidade/organização & administração
Melhoria de Qualidade/tendências
Sistema de Registros
Acidente Vascular Cerebral/epidemiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171018
[Lr] Data última revisão:
171018
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170706
[St] Status:MEDLINE
[do] DOI:10.14423/SMJ.0000000000000667


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[PMID]:28662153
[Au] Autor:Kronborg L; Bandholm T; Palm H; Kehlet H; Kristensen MT
[Ad] Endereço:Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physio- & Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark.
[Ti] Título:Effectiveness of acute in-hospital physiotherapy with knee-extension strength training in reducing strength deficits in patients with a hip fracture: A randomised controlled trial.
[So] Source:PLoS One;12(6):e0179867, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:QUESTION: Is acute in-hospital physiotherapy with additional progressive knee-extension strength training (ST) of the fractured limb more effective in reducing knee-extension strength deficit at follow-up compared to physiotherapy without strength training in patients with a hip fracture? DESIGN: Assessor blinded, randomised controlled trial with intention-to-treat analysis. PARTICIPANTS: 90 patients with a hip fracture admitted to an acute orthopaedic Hip Fracture Unit at a university hospital between October 2013 and May 2015. INTERVENTION: Daily physiotherapy with or without progressive knee-extension strength training (10RM), 3 x 10 repetitions, of the fractured limb using ankle weight cuffs conducted by ward physical therapists during hospital stay. OUTCOME MEASURES: Primary outcome was the change in maximal isometric knee-extension strength in the fractured limb in percentage of the non-fractured limb from inclusion to postoperative day 10 or discharge (follow-up). Secondary outcome was Timed Up and Go test measured early after surgery and at follow-up. RESULTS: In the intention-to-treat analysis of between-group differences, the primary outcome improved 8.1% (95% CI -2.3; 18.4) by additional strength training from baseline to follow-up. In the per-protocol analysis of non-missing data, significant between-group improvements by 10.5% (95% CI 0.3; 20.7) were found in favour of additional ST. No significant between-group differences were found in any secondary outcome. CONCLUSION: Physiotherapy with addition of 5 sessions of ST yielded no additional improvements compared to physiotherapy without strength training in reducing the knee-extension strength deficit at follow-up in patients with a hip fracture. It is debatable whether larger improvements than the observed 8-10% can be expected given that only five exercise sessions, on average, were completed. In fragile patients with a hip fracture in the acute phase, where the ability to participate in functional exercise is compromised, we still consider early strength training a possibility to improve outcomes of clinical importance, given the results of the per-protocol analysis. The present data provides an important basis and call for future investigations including longer term interventions. TRIAL REGISTRATION: Clinicaltrials.gov NCT00848913.
[Mh] Termos MeSH primário: Fraturas do Quadril/reabilitação
Articulação do Joelho/fisiopatologia
Modalidades de Fisioterapia
Treinamento de Resistência/métodos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Hospitais Especializados
Seres Humanos
Masculino
Ortopedia
Amplitude de Movimento Articular
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170928
[Lr] Data última revisão:
170928
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170630
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0179867


  5 / 9821 MEDLINE  
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[PMID]:28545856
[Au] Autor:Coirier V; Lescoat A; Fournet M; Cazalets C; Coiffier G; Jouneau S; Chabanne C; Jégo P
[Ad] Endereço:Service de médecine interne, hôpital Sud, CHU de Rennes, BP 90347, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France. Electronic address: valentin.coirier@gmail.com.
[Ti] Título:[Screening for pulmonary arterial hypertension in patients with systemic sclerosis: Comparison of DETECT algorithm to decisions of a multidisciplinary team, in a competence centre].
[Ti] Título:Dépistage de l'hypertension artérielle pulmonaire au cours de la sclérodermie systémique : comparaison de l'algorithme DETECT à une discussion pluridisciplinaire en centre de compétence..
[So] Source:Rev Med Interne;38(8):502-507, 2017 Aug.
[Is] ISSN:1768-3122
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:INTRODUCTION: Pulmonary arterial hypertension (PAH) is a severe complication of systemic sclerosis and detecting PAH efficiently remains challenging. The DETECT study has offered in 2013 a composite screening tool for PAH. The objective of our study was to compare the indication of right heart catheterisation (RHC) as suggested by the DETECT algorithm with the decisions of a multidisciplinary team. METHODS: This prospective monocentric non-interventional study consecutively included systemic sclerosis patients when data required to apply DETECT algorithm were available. We evaluate the number of RHC as requested by this algorithm and confronted it with the indications of RHC suggested by a multidisciplinary group blinded for the result of DETECT algorithm. RESULTS: In total, 117 systemic sclerosis patients were included. When DETECT algorithm was applied to all patients, RHC was suggested by this algorithm for 70 patients, whereas only 15 indications were required by the multidisciplinary group; among those patients only 7 had PAH. When DETECT algorithm was applied only to the 42 patients with DLCO<60% and disease duration of more than 3 years, RHC was suggested for 31 patients whereas only 13 were indicated by the multidisciplinary group; among those patients only 7 had PAH. CONCLUSION: The DETECT algorithm is able to efficiently detect all PAH patients finally diagnosed by our multidisciplinary team. However, it increases by 3 the number of RHC that should be performed.
[Mh] Termos MeSH primário: Algoritmos
Hipertensão Pulmonar/complicações
Hipertensão Pulmonar/diagnóstico
Programas de Rastreamento/métodos
Escleroderma Sistêmico/complicações
Escleroderma Sistêmico/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Tomada de Decisões
Feminino
Hospitais Especializados
Seres Humanos
Masculino
Meia-Idade
Equipe de Assistência ao Paciente/normas
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170527
[St] Status:MEDLINE


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[PMID]:28512170
[Au] Autor:Ng FC; Low E; Andrew E; Smith K; Campbell BCV; Hand PJ; Crompton DE; Wijeratne T; Dewey HM; Choi PM
[Ad] Endereço:From the Department of Neurology, Northern Health, Epping, Victoria, Australia (F.C.N., D.E.C.); Department of Neurology, Western Health, St Albans, Victoria, Australia (E.L., T.W.); Research and Evaluation Department, Ambulance Victoria, Melbourne, Australia (E.A., K.S.); Department of Epidemiology
[Ti] Título:Deconstruction of Interhospital Transfer Workflow in Large Vessel Occlusion: Real-World Data in the Thrombectomy Era.
[So] Source:Stroke;48(7):1976-1979, 2017 Jul.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Interhospital transfer is a critical component in the treatment of acute anterior circulation large vessel occlusive stroke transferred for mechanical thrombectomy. Real-world data for benchmarking and theoretical modeling are limited. We sought to characterize transfer workflow from primary stroke center (PSC) to comprehensive stroke center after the publication of positive thrombectomy trials. METHODS: Consecutive patients transferred from 3 high-volume PSCs to a single comprehensive stroke center between January 2015 and August 2016 were included in a retrospective study. Factors associated with key time metrics were analyzed with emphasis on PSC intrahospital workflow. RESULTS: Sixty-seven patients were identified. Median age was 74 years (interquartile range [IQR], 63.5-78) and National Institutes of Health Stroke Scale 17 (IQR, 12-21). Median transfer time measured by PSC-door-to-comprehensive stroke center-door was 128 minutes (IQR, 107-164), of which 82.8% was spent at PSCs (door-in-door-out [DIDO]; 106 minutes; IQR, 86-143). The lengthiest component of DIDO was computed-tomography-to-retrieval-request (median 59.5 minutes; IQR, 44-83). The 37.3% had DIDO exceeding 120 minutes. DIDO times differed significantly between PSCs ( =0.01). In multivariate analyses, rerecruiting the initial ambulance crew for transfer ( <0.01) and presentation during working hours ( =0.04) were associated with shorter DIDO times. CONCLUSIONS: In a metropolitan hub-and-spoke network, PSC-door-to-comprehensive stroke center-door and DIDO times are long even in high-volume PSCs. Improving PSC workflow represents a major opportunity to expedite mechanical thrombectomy and improve patient outcomes.
[Mh] Termos MeSH primário: Hospitais Especializados/estatística & dados numéricos
Trombólise Mecânica/estatística & dados numéricos
Avaliação de Processos e Resultados (Cuidados de Saúde)/estatística & dados numéricos
Transferência de Pacientes/estatística & dados numéricos
Acidente Vascular Cerebral/terapia
Trombectomia/estatística & dados numéricos
Fluxo de Trabalho
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Acidente Vascular Cerebral/diagnóstico por imagem
Acidente Vascular Cerebral/tratamento farmacológico
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170518
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.017235


  7 / 9821 MEDLINE  
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[PMID]:28510670
[Au] Autor:DeLancey JO; Softcheck J; Chung JW; Barnard C; Dahlke AR; Bilimoria KY
[Ad] Endereço:Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
[Ti] Título:Associations Between Hospital Characteristics, Measure Reporting, and the Centers for Medicare & Medicaid Services Overall Hospital Quality Star Ratings.
[So] Source:JAMA;317(19):2015-2017, 2017 05 16.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Centers for Medicare and Medicaid Services (U.S.)/normas
Hospitais/classificação
Hospitais/normas
Avaliação de Processos e Resultados (Cuidados de Saúde)
Qualidade da Assistência à Saúde/normas
[Mh] Termos MeSH secundário: Cuidados Críticos
Diagnóstico por Imagem/normas
Mortalidade Hospitalar
Hospitais Comunitários/classificação
Hospitais Comunitários/normas
Hospitais Especializados/classificação
Hospitais Especializados/normas
Hospitais de Ensino/classificação
Hospitais de Ensino/normas
Seres Humanos
Readmissão do Paciente
Segurança do Paciente
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170807
[Lr] Data última revisão:
170807
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170517
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.3148


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[PMID]:28492918
[Au] Autor:McTaggart RA; Yaghi S; Cutting SM; Hemendinger M; Baird GL; Haas RA; Furie KL; Jayaraman MV
[Ad] Endereço:Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island2Department of Neurology, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island3Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Provide
[Ti] Título:Association of a Primary Stroke Center Protocol for Suspected Stroke by Large-Vessel Occlusion With Efficiency of Care and Patient Outcomes.
[So] Source:JAMA Neurol;74(7):793-800, 2017 Jul 01.
[Is] ISSN:2168-6157
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: While prehospital triage to the closest comprehensive stroke center (CSC) may improve the delivery of care for patients with suspected emergent large-vessel occlusion (ELVO), efficient systems of care must also exist for patients with ELVO who first present to a primary stroke center (PSC). Objective: To describe the association of a PSC protocol focused on 3 key steps (early CSC notification based on clinical severity, vessel imaging at the PSC, and cloud-based image sharing) with the efficiency of care and the outcomes of patients with suspected ELVO who first present to a PSC. Design, Setting, and Participants: In this retrospective cohort study, 14 regional PSCs unfamiliar with the management of patients with ELVO were instructed on the use of the following protocol for patients presenting with a Los Angeles Motor Scale score 4 or higher: (1) notify the CSC on arrival, (2) perform computed tomographic angiography concurrently with noncontract computed tomography of the brain and within 30 minutes of arrival, and (3) share imaging data with the CSC using a cloud-based platform. A total of 101 patients were transferred from regional PSCs to the CSC between July 1, 2015, and May 31, 2016, and received mechanical thrombectomy for acute ischemic stroke. The CSC serves approximately 1.7 million people and partners with 14 PSCs located between 6.4 and 73.6 km away. All consecutive patients with internal carotid artery or middle cerebral artery occlusions transferred over an 11-month period were reviewed, and they were divided into 2 groups based on whether the PSC protocol was partially or fully executed. Main Outcomes and Measures: The primary outcomes were efficiency measures including time from PSC door in to PSC door out, time from PSC door to CSC groin puncture, and 90-day modified Rankin Scale score (range, 0-6; scores of 0-2 indicate a good outcome). Results: Although 101 patients were transferred, only 70 patients met the inclusion criteria during the study period. The protocol was partially executed for 48 patients (68.6%) (mean age, 77 years [interquartile range, 65-84 years]; 22 of the 48 patients [45.0%] were women) and fully executed for 22 patients (31.4%) (mean age, 76 years [interquartile range, 59-86 years]; 13 of the 22 patients [59.1%] were women). When fully executed, the protocol was associated with a reduction in the median time for PSC arrival to CSC groin puncture (from 151 minutes [95% CI, 141-166 minutes] to 111 minutes [95% CI, 88-130 minutes]; P < .001). This was primarily related to an improvement in the time from PSC door in to door out that reduced from a median time of 104 minutes (95% CI, 82-112 minutes) to a median time of 64 minutes (95% CI, 51-71.0 minutes) (P < .001). When the protocol was fully executed, patients were twice as likely to have a favorable outcome (50% vs 25%, P < .04). Conclusions and Relevance: When fully implemented, a standardized protocol at PSCs for patients with suspected ELVO consisting of early CSC notification, computed tomographic angiography on arrival to the PSC, and cloud-based image sharing is associated with a reduction in time to groin puncture and improved outcomes.
[Mh] Termos MeSH primário: Arteriopatias Oclusivas/terapia
Doenças Arteriais Cerebrais/terapia
Protocolos Clínicos/normas
Serviço Hospitalar de Emergência/estatística & dados numéricos
Hospitalização/estatística & dados numéricos
Hospitais Especializados/estatística & dados numéricos
Trombólise Mecânica/estatística & dados numéricos
Avaliação de Processos e Resultados (Cuidados de Saúde)/estatística & dados numéricos
Acidente Vascular Cerebral/terapia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Arteriopatias Oclusivas/diagnóstico por imagem
Doenças Arteriais Cerebrais/diagnóstico por imagem
Serviço Hospitalar de Emergência/normas
Feminino
Hospitais Especializados/normas
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Índice de Gravidade de Doença
Acidente Vascular Cerebral/diagnóstico por imagem
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170512
[St] Status:MEDLINE
[do] DOI:10.1001/jamaneurol.2017.0477


  9 / 9821 MEDLINE  
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[PMID]:28372574
[Au] Autor:Wind A; van Harten WH
[Ad] Endereço:Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
[Ti] Título:Benchmarking specialty hospitals, a scoping review on theory and practice.
[So] Source:BMC Health Serv Res;17(1):245, 2017 Apr 04.
[Is] ISSN:1472-6963
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Although benchmarking may improve hospital processes, research on this subject is limited. The aim of this study was to provide an overview of publications on benchmarking in specialty hospitals and a description of study characteristics. METHODS: We searched PubMed and EMBASE for articles published in English in the last 10 years. Eligible articles described a project stating benchmarking as its objective and involving a specialty hospital or specific patient category; or those dealing with the methodology or evaluation of benchmarking. RESULTS: Of 1,817 articles identified in total, 24 were included in the study. Articles were categorized into: pathway benchmarking, institutional benchmarking, articles on benchmark methodology or -evaluation and benchmarking using a patient registry. There was a large degree of variability:(1) study designs were mostly descriptive and retrospective; (2) not all studies generated and showed data in sufficient detail; and (3) there was variety in whether a benchmarking model was just described or if quality improvement as a consequence of the benchmark was reported upon. Most of the studies that described a benchmark model described the use of benchmarking partners from the same industry category, sometimes from all over the world. CONCLUSIONS: Benchmarking seems to be more developed in eye hospitals, emergency departments and oncology specialty hospitals. Some studies showed promising improvement effects. However, the majority of the articles lacked a structured design, and did not report on benchmark outcomes. In order to evaluate the effectiveness of benchmarking to improve quality in specialty hospitals, robust and structured designs are needed including a follow up to check whether the benchmark study has led to improvements.
[Mh] Termos MeSH primário: Benchmarking/métodos
Hospitais Especializados/normas
Modelos Teóricos
[Mh] Termos MeSH secundário: Serviço Hospitalar de Emergência/normas
Seres Humanos
Melhoria de Qualidade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170822
[Lr] Data última revisão:
170822
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170405
[St] Status:MEDLINE
[do] DOI:10.1186/s12913-017-2154-y


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[PMID]:28302125
[Au] Autor:Seyoum A; Ndlovu P; Temesgen Z
[Ad] Endereço:Department of Statistics, Bahir Dar University, Bahir Dar, Ethiopia. bisrategebrail@yahoo.com.
[Ti] Título:Joint longitudinal data analysis in detecting determinants of CD4 cell count change and adherence to highly active antiretroviral therapy at Felege Hiwot Teaching and Specialized Hospital, North-west Ethiopia (Amhara Region).
[So] Source:AIDS Res Ther;14(1):14, 2017 Mar 16.
[Is] ISSN:1742-6405
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Adherence and CD4 cell count change measure the progression of the disease in HIV patients after the commencement of HAART. Lack of information about associated factors on adherence to HAART and CD4 cell count reduction is a challenge for the improvement of cells in HIV positive adults. The main objective of adopting joint modeling was to compare separate and joint models of longitudinal repeated measures in identifying long-term predictors of the two longitudinal outcomes: CD4 cell count and adherence to HAART. METHODS: A longitudinal retrospective cohort study was conducted to examine the joint predictors of CD4 cell count change and adherence to HAART among HIV adult patients enrolled in the first 10 months of the year 2008 and followed-up to June 2012. Joint model was employed to determine joint predictors of two longitudinal response variables over time. Furthermore, the generalized linear mixed effect model had been used for specification of the marginal distribution, conditional to correlated random effect. RESULTS: A total of 792 adult HIV patients were studied to analyze the longitudinal joint model study. The result from this investigation revealed that age, weight, baseline CD4 cell count, ownership of cell phone, visiting times, marital status, residence area and level of disclosure of the disease to family members had significantly affected both outcomes. From the two-way interactions, time * owner of cell phone, time * sex, age * sex, age * level of education as well as time * level of education were significant for CD4 cell count change in the longitudinal data analysis. The multivariate joint model with linear predictor indicates that CD4 cell count change was positively correlated (p ≤ 0.0001) with adherence to HAART. Hence, as adherence to HAART increased, CD4 cell count also increased; and those patients who had significant CD4 cell count change at each visiting time had been encouraged to be good adherents. CONCLUSION: Joint model analysis was more parsimonious as compared to separate analysis, as it reduces type I error and subject-specific analysis improved its model fit. The joint model operates multivariate analysis simultaneously; and it has great power in parameter estimation. Developing joint model helps validate the observed correlation between the outcomes that have emerged from the association of intercepts. There should be a special attention and intervention for HIV positive adults, especially for those who had poor adherence and with low CD4 cell count change. The intervention may be important for pre-treatment counseling and awareness creation. The study also identified a group of patients who were with maximum risk of CD4 cell count change. It is suggested that this group of patients needs high intervention for counseling.
[Mh] Termos MeSH primário: Terapia Antirretroviral de Alta Atividade
Contagem de Linfócito CD4/métodos
Infecções por HIV/diagnóstico
Infecções por HIV/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Fármacos Anti-HIV/uso terapêutico
Peso Corporal
Contagem de Linfócito CD4/estatística & dados numéricos
Telefone Celular
Aconselhamento
Progressão da Doença
Etiópia
Feminino
Infecções por HIV/imunologia
Infecções por HIV/virologia
HIV-1/efeitos dos fármacos
Hospitais Especializados
Seres Humanos
Estudos Longitudinais
Masculino
Meia-Idade
Análise Multivariada
Estudos Retrospectivos
Fatores Sexuais
Estatística como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-HIV Agents)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:170318
[St] Status:MEDLINE
[do] DOI:10.1186/s12981-017-0141-3



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